Microbiology, Ch 23, Nester's 9th

Your patient had abdominal surgery three days ago. She seemed to be doing well after the surgery, but today the skin around the surgical incision is red and swollen. In addition, your patient has a high fever and is complaining of muscle aches. She also has a rash and has diarrhea. You realize that her wound has become infected, despite your best efforts as a nurse, and you are concerned that she has developed toxic shock syndrome. You explain the details of this type of infection to the patient's family.Wound infections are commonly caused by Staphylococcus species, common inhabitants of the nostrils and the skin. These organisms are: - Acid-fast, pyrogenic, obligate aerobes. - Gram-positive, pyogenic, obligate aerobes. - Gram-positive, pyrogenic, facultative anaerobes. - Gram-positive, pyogenic, facultative anaerobes. - Gram-negative, pyogenic, facultative anaerobes.

Gram-positive, pyogenic, facultative anaerobes. Staphylococcus - surgical wounds - pus... - not acid fast - not pyrogenic = cause fever - Gram positive - stains purple - is a facultative anaerobe (many, many wounds anaerobic) Correct

Factor(s) not found in abscesses is/are: A. pus. B. dead leukocytes. C. tissue remnants. D. blood vessels.

- blood vessels Localized collection of pus surrounded by inflamed tissue. • Pus: thick, yellowish fluid composed of living and dead leukocytes, tissue debris, and proteins

The organism that grows anaerobically in dead or damaged tissue and produces dense colonies that are the color and size of sulfur particles is: - Escherichia coli. - Staphylococcus aureus. - Actinomyces israelii. - Pseudomonas aeruginosa.

- Actinomyces israelii. Actinomycosis (Lumpy Jaw) - slide 38 Grows as dense yellowish colonies called "sulfur granules," since color and size of particles of sulfur.

The infectious agent(s) that may arise in a wound from a human bite is/are: A. Escherichia coli. B. Bacteroides. C. Actinomyces israelii. D. Staphylococcus aureus. E. Bacteroides AND Staphylococcus aureus.

- Bacteroides AND Staphylococcus aureus Human Bites slide 40, p.615 Causative Agents • Aerobic and anaerobic members of normal microbiota including streptococci, fusiforms, spirochetes, Bacteroides species, often in association with Staphylococcus aureus (on my chapter quiz - correct)

Cat scratch fever is caused by: - Bartonella (Rochalimaea) henselae. - Pasteurella multocida. - Teddis nugentaea. - Staphylococcus aureus. - Bartonella (Rochalimaea) henselae AND Staphylococcus aureus.

- Bartonella (Rochalimaea) henselae. slide 45 zoonosis of cats Causative Agent is: • Bartonella henselae: curved, Gram-negative rod

Which of the following has not been associated with human bites? - syphilis - tuberculosis - hepatitis B - Haverhill fever

- Haverhill fever slide 40 Human Bites • Common; can result in serious infections from normal mouth microbiota; occasionally syphilis, tuberculosis, hepatitis B, hepatitis C transmitted

The foodborne form of rat bite fever is called: - rat bite fever. - Haverhill fever. - cat scratch fever. - Lyme fever.

- Haverhill fever.

You are looking after your sister's cat Singa. While playing one evening, Singa accidentally bites you instead of the toy mouse you are holding. The bite wound is very small but is in the fleshy part of your hand. You wash the wound, which is not bleeding much, and put a band aid on it. The next day, your whole hand is red, swollen, and painful, and some lymph nodes in your arm are enlarged and tender. You call your sister, who is an RN. She urges you to go to the doctor, telling you that animal bites can sometimes be infected, and that if that is the case, you will need treatment before the infection gets any worse.The PA goes on to explain that cat bite infections and bartonellosis (cat scratch disease) differ in that: A) the virulence factors of P. multicoda are as yet unknown while B. henselae has an antiphagocytic capsule. B) P. multicoda is transmitted by cat bites, while B. henselae may be transmitted by bites or scratches. C) P. multicoda may be transmitted form person-to-person while B. henselae can only be transmitted by cat bites. D) P. multicoda is a Gram-positive organism while B. henselae is a Gram-negative organism. E) cat bite infections can be prevented with prophylactic antibiotics while bartonellosis may be prevented with an attenuated vaccine.

- P. multicoda is transmitted by cat bites, while B. henselae may be transmitted by bites or scratches. Not A or D, (This was on my chapter quiz) I chose B = Correct

Formation of biofilms attached to fibronectin and fibrinogen coating plastic devices like catheters and heart valves is a virulence mechanism of: - Staphylococcus - Streptococcus - Clostridium - Pseudomonas

- Staphylococcus slide 15 - Staphylococcus epidermiditis - Adheres to and colonizes medical devices by binding to fibronectin, which quickly coats surgical implants. Biofilms also problematic

The most frequent genus causing wound infections in healthy people is: - Pseudomonas. - Staphylococcus. - Pasteurella. - Rochalimea.

- Staphylococcus. Correct

Rat bite fever, characterized by fever, rash, and muscle aches, is caused by: - Afipia felis. - Bartonella (Rochalimaea) henselae. - Pasteurella multocida. - Streptobacillus moniliformis.

- Streptobacillus moniliformis. 2nd is cat scratch disease 3rd is in bite wounds Streptobacillary Rat Bite Fever slide 48 Streptobacillus moniliformis: facultatively anaerobic, Gramnegative pleomorphic rod; spontaneously develops L-forms lacking cell wall Correct

A localized collection of pus in a wound is termed a(n): leukocyte. dead tissue. granulation mound. abscess.

- abscess Localized collection of pus surrounded by inflamed tissue. • Pus: thick, yellowish fluid composed of living and dead leukocytes, tissue debris, and proteins • Abscesses form as result of body's defenses • Help localize infection, although cells may escape • Difficult to treat: no blood vessels; adjacent blood vessels often blocked by clots

Tetanus antitoxin is: - antibody against the bacteria. - inactivated toxin. - inactivated bacteria. - antibody against the toxin.

- antibody against the toxin A TOXOID is a vaccine; it is used to prevent disease. An ANTITOXIN is a treatment; it is used when a problem is immediately at hand. And that is why this is the answer it is. Correct

Gas gangrene is so named due to the formation of: A. carbon dioxide. B. oxygen. C. hydrogen. D. carbon monoxide. E. carbon dioxide AND hydrogen.

- carbon dioxide AND hydrogen. • Severe pain, swelling, and thin bloody or brownish fluid leaks from wound; may look frothy (gas bubbles) slide 35 - Organisms multiply using tissue breakdown products, release HYDROGEN AND CARBON DIOXIDE, which accumulate

Which of the following are involved in coating Staphylococcus with host proteins? A. clumping factor B. coagulase C. protein A D. leukocidin E. clumping factor, coagulase AND protein A

- clumping factor, coagulase AND protein A Clumping factor - attaches the bacterium to fibrin, fibrinogen and plastic devices. Coagulase - produces clots in the surrounding capillaries protein A - binds to Fc portion of antibody, prevents opsoniziation Correct

Wound infections may result in: A. delayed healing. B. abscess formation. C. extension of bacteria or their products into surrounding tissues or bloodstream. D. aerobic conditions. E. delayed healing, abscess formation AND extension of bacteria or their products into surrounding tissues or bloodstream.

- delayed healing, abscess formation AND extension of bacteria or their products into surrounding tissues or bloodstream.

Wound healing can be slowed by: A. normal flora. B. antiseptic ointments. C. foreign matter D. sweat.

- foreign matter Dirt, dead tissue, foreign matter...

A striking feature of Clostridium tetani that differentiates it from other pathogenic species of Clostridium is its ability to: - produce a greenish pigment. - form spores. - form terminally located, spherical spores. - grow aerobically.

- form terminally located, spherical spores. slide 28 Clostridium tetani: anaerobic, Gram-positive, rod-shaped; forms spherical endospore at one end of cell; has swarming growth that quickly spreads over media surface Correct

The nodular, red, translucent surface material of a healing wound is called: - soluble skin. - irritated scab. - granulation tissue. - abscess.

- granulation tissue Wound healing • Begins with outgrowth of connective tissue (fibroblasts) and capillaries from surface to yield GRANULATION TISSUE • Fills space created by wound • Shrinks, is converted to collagen (scar tissue) • Covered by skin or mucous membrane Correct

Both Staphylococcus aureus and Streptococcus pyogenes: - are rod shaped - cause necrotizing fasciitis -- have fibronectin binding proteins - have exotoxin A

- have fibronectin binding proteins Correct

Tetanus vaccine contains: - inactivated bacteria. - inactivated spores. - live bacteria. - inactivated tetanospasmin.

- inactivated tetanospasmin. Tetanus and diphtheria - toxoid (inactivated) vaccine.

A wound created by the drag of a knife across skin can be classified as: A. puncture. B. incised. C. lacerated. D. contused.

- incised • Incisions: produced by knife or other sharp object

Tetanus prevents the release of neurotransmitters from: - muscle cells. - excitatory neurons. - inhibitory neurons. - tetano cells.

- inhibitory neurons. slide 29 Prevents release of neurotransmitter from INHIBITORY NEURONS, so muscles contract without control Correct

Which of the following is true about protein A? - it binds to the Fc region of antibody - it hides bacteria from phagocytes - it enhances the binding of phagocytes - it digests antibodies - it binds to the Fc region of antibody AND it hides bacteria from phagocytes

- it binds to the Fc region of antibody AND it hides bacteria from phagocytes

The popular name for tetanus is: - hydrophobia. - lockjaw. - whooping cough. - consumption.

- lockjaw slide 27

The disease most feared to develop after an animal bite is: - tetanus. - rabies. - gas gangrene. - actinomycosis

- rabies (on my chapter quiz - correct)

An important feature of many wounds that may lead to more serious problems is that they are: - well aerated. - relatively anaerobic - well fed. - sterile.

- relatively anaerobic. Reasons for this include: - crush injury - presence of dirt/foreign matter in wound - aerobes using up available oxygen Many wounds RELATIVELY ANAEROBIC, allow growth of obligate anaerobes such as Clostridium tetani • Wounds with extensive tissue damage, contaminated with dirt, or small but deep punctures • Multiple species may also produce anaerobic conditions as facultative anaerobes use up available oxygen Correct

The normal habitat of Clostridium tetani is: A. humans. B. animals. C. plants. D. soil and dust.

- soil and dust. "Spores of Clostridium tetani found in SOIL AND DUST"

Streptobacillus moniliformis is unusual in that it: - forms spores. - spontaneously forms L-forms. - is anaerobic. - has a cell wall.

- spontaneously forms L-forms. Streptobacillary Rat Bite Fever slide 48 Streptobacillus moniliformis: facultatively anaerobic, Gramnegative pleomorphic rod; spontaneously develops L-forms lacking cell wall Correct

The fungal disease that may be associated with sphagnum moss is: - candidiasis. - actinomycosis. - cat scratch fever. - sporotrichosis.

- sporotrichosis. First is yeast that causes thrush and yeast infections. Second is Lumpy jaw (bacterial), third is a zoonosis of cats - bartonellosis. Last is fungal, associated with vegetation so yes.

S. pyogenes associated with invasive disease characteristically have: A. leukocidins. B. coagulase. C. streptococcal pyrogenic exotoxin A. D. streptococcal pyrogenic exotoxin B. E. streptococcal pyrogenic exotoxins A AND B.

- streptococcal pyrogenic exotoxins A AND B.: slide 18 Group A Streptococcal "Flesh-Eating Disease" Virulent strains of Streptococcus pyogenes produce damaging streptococcal pyrogenic exotoxins (SPEs) and enzymes - Exotoxin A: superantigen that causes toxic shock - Exotoxin B: protease that destroys tissue

Effective treatment of gas gangrene primarily involves: - use of an antitoxin. - use of immune globulins. - vaccination with inactivated toxin. - surgical removal of dead and infected tissues.

- surgical removal of dead and infected tissues. Clostridial Myonecrosis (Gas Gangrene) slide 35 Treatment and Prevention • Prompt surgical removal of all dead and infected tissue • Antibiotics, hyperbaric oxygen treatment • No available vaccine

The exotoxin produced by C. tetani is: - tetanoxin. - exotetanus. - tetanospasmin. - endospasmin.

- tetanospasmin slide 28/29 Exotoxin tetanospasmin released from cells - A-B toxin - Plasmid-encoded Exotoxin tetanospasmin is an A-B toxin - B portion attaches to receptors on motor neurons - A portion taken up by endocytosis, is carried to neuron cell body in spinal cord - Prevents release of neurotransmitter from inhibitory neurons, so muscles contract without control Correct

Microorganisms in abscesses often are not killed by antimicrobial agents because: - the microorganisms stop dividing. - of the chemical nature of the pus. - of the lack of blood vessels. - of the high level of oxygenation. - the microorganisms stop dividing, of the chemical nature of the pus AND of the lack of blood vessels.

- the microorganisms stop dividing, of the chemical nature of the pus AND of the lack of blood vessels.

What is true of leukocidins? - they bind to Fc regions of antibodies - they kill neutrophils - they are superantigens - they make holes in host cell membranes

- they kill neutrophils - First is protein A and protein G - last one is alpha-toxin

Frequently sporotrichosis is caused when the infectious agent is introduced into the body by: - lotions. - scissors. - thorns. - animal bites.

- thorns Fungal wound infection - sporotrichosis (Rose Gardener's Disease). Think plants. Correct

The toxin implicated in C. perfringens toxicity is: - tetanospasmin. - exoenzyme S. - alpha-toxin. - endoenzyme T.

-alpha-toxin slide 34 Releases α-toxin, an enzyme that destroys lecithin in host cell membranes, resulting in cell lysis

What percent of Staphylococcus aureus infections are due to the patient's own flora? 10-20% 30-100% 40-50% 0%

30-100%

You are looking after you sister's cat Singa. While playing one evening, Singa accidentally bites you instead of the toy mouse that you are holding. The bite wound is very small but is in the fleshy part...

5 of these...

Your patient had abdominal surgery three days ago. She seemed to be doing well after the surgery, but today the skin around the surgical incision is red and swollen. In addition, your patient has a h...

5 of these...

Which characteristic(s) is/are not common to c. tetani and c. perfringens...

?

Which signs and symptoms are not quickly resolved in a person with tetanus when they are given antibiotics?

?

how may lung damage or pneumonia occur in a person with tetanus?

?

Which of the following does not usually result from a wound infection?

? Infected wounds can have serious consequences • Delayed healing • Formation of abscesses • Spread of bacteria or toxins elsewhere in body

Why is it difficult to treat P. aeruginosa wound infections?

? Only a few antimicrobial medications effective • Established infections difficult to treat

Antibiotics are given to a person with gas gangrene to:

? Clostridial myonecrosis = Gas Gangrene Treatment. If gas gangrene is suspected, treatment must begin immediately. High doses of antibiotics, typically penicillin and clindamycin, are given, and all dead and infected tissue is removed surgically. - the antibiotic is to kill the bacteria itself - Clostridium perfringins - Gram-positive, rod-shaped, anaerobic, spore-forming pathogenic bacterium of the genus Clostridium.

Treatment of gas gangrene may involve _________. A. wound debridement B. antitoxins C. hyperbaric chambers D. All of the choices are correct.

All of the choices are correct. Clostridium perfringens -> Clostridial Myonecrosis Treatment and Prevention • Prompt surgical removal of all dead and infected tissue = DEBRIDEMENT • Antibiotics, HYPERBARIC oxygen treatment • No available vaccine Makes ALPHA TOXIN so ANTITOXIN, too

Which of the following is important in the treatment of potential infections by Clostridium tetani? A. Proper care of wounds contaminated with soil B. Prophylactic use of antitoxin C. Administration of penicillin D. All of the choices are important in the treatment of potential infections by Clostridium tetani.

All of the choices are important in the treatment of potential infections by Clostridium tetani. Clostridium tetani: anaerobic, GRAM POSITIVE, rod-shaped; forms spherical endospore at one end of cell; swarming growth quickly spreads over media surface Treatment and Prevention • Human tetanus immune globulin (TIG) injection - Antibodies bind to free toxin molecules, provide passive immunity, but do not neutralize attached tetanospasmin or repair nerve damage - Muscle relaxants, supportive care necessary • CLEANING WOUND, antibiotics, vaccine • VACCINATION with tetanus toxoid (inactivated tetanospasmin) PREVENTS - Table 23.3 says TETANUS ANTITOXIN

Why are signs and symptoms not quickly resolved in a person with tetanus when they are given antibiotics? Antibiotics will prevent the production of additional tetanospasmin but will not repair nerves already damaged by the toxin. Clostridium tetani is an acid-fast organism; it thus has a slow generation time, so it takes several weeks for an antibiotic to be effective in killing the cells. Clostridium tetani is an acid-fast organism; it thus has a waxy cell wall that prevents antibiotics from entering the cell. The antibiotics are given prophylactically, to prevent secondary infections. Nerves damaged by tetanospasmin need time to repair. Clostridium tetani is resistant to most antibiotics; treatment thus involves several weeks of combined antibiotic therapy.

Antibiotics will prevent the production of additional tetanospasmin but will not repair nerves already damaged by the toxin. Correct

You are looking after your sister's cat Singa. While playing one evening, Singa accidentally bites you instead of the toy mouse you are holding. The bite wound is very small but is in the fleshy part of your hand. You wash the wound, which is not bleeding much, and put a band aid on it. The next day, your whole hand is red, swollen, and painful, and some lymph nodes in your arm are enlarged and tender. You call your sister, who is an RN. She urges you to go to the doctor, telling you that animal bites can sometimes be infected, and that if that is the case, you will need treatment before the infection gets any worse.The PA tells you that a disease called cat scratch disease can also be contracted through a cat bite. The organism that causes this disease is ________, and that the disease is characterized by ________. Streptobacillus moniliformis; vomiting, diarrhea and rash Pasteurella multocida; rash and joint pain Bartonella henselae; local lymph node enlargement Pasteurella multocida; local lymph node enlargement Bartonella henselae; peliosis hepatis

Bartonella henselae; local lymph node enlargement

Select the TRUE statement regarding staphylococci and staphylococcal wound infections. Staphylococcus epidermidis produces several virulence factors, including exotoxins. Some S. epidermisis strains produce superantigens that activate many helper T cells, causing a cytokine storm. Staphylococcus aureus forms biofilms but lacks virulence factors and is not very pathogenic. S. aureus and S. epidermidis are both coagulase-positive, encapsulated organisms. Both HA-MRSA and CA-MRSA are resistant to multiple antibiotics, including sulfa drugs and tetracyclines.

Both HA-MRSA and CA-MRSA are resistant to multiple antibiotics, including sulfa drugs and tetracyclines.

You are looking after your sister's cat Singa. While playing one evening, Singa accidentally bites you instead of the toy mouse you are holding. The bite wound is very small but is in the fleshy part of your hand. You wash the wound, which is not bleeding much, and put a band aid on it. The next day, your whole hand is red, swollen, and painful, and some lymph nodes in your arm are enlarged and tender. You call your sister, who is an RN. She urges you to go to the doctor, telling you that animal bites can sometimes be infected, and that if that is the case, you will need treatment before the infection gets any worse.You are given a prescription for both a penicillin derivative AND a β-lactamase inhibitor. Why are you given these medications? Both P. multicoda and B. henselae produce β-lactamases. They are thus treated with β-lactamase-inhibiting medications. In addition, skin microbiota such as S. epidermidis respond to penicillins. Both P. multicoda and B. henselae respond to penicillin derivatives. In addition, some bite wounds are infected with strains of β-lactamase-producing Streptobacillus moniliformis. The causative organisms of cat bite infections and bartonellosis are not well characterized. For this reason, penicillin derivatives and inhibitors of these medications are given synergistically. Both P. multicoda and B. henselae respond to penicillin derivatives. In addition, some bite wounds are infected with strains of β-lactamase-producing Staphylococcus aureus. Both P. multicoda and B. henselae are encapsulated, so respond well to penicillin derivatives. In addition, some bite wounds are infected with strains of β-lactamase-producing Staphylococcus epidermidis.

Both P. multicoda and B. henselae respond to penicillin derivatives. In addition, some bite wounds are infected with strains of β-lactamase-producing Staphylococcus aureus. p.616 Correct

Your patient had abdominal surgery three days ago. She seemed to be doing well after the surgery, but today the skin around the surgical incision is red and swollen. In addition, your patient has a high fever and is complaining of muscle aches. She also has a rash and has diarrhea. You realize that her wound has become infected, despite your best efforts as a nurse, and you are concerned that she has developed toxic shock syndrome. You explain the details of this type of infection to the patient's family.You explain general mechanisms of antibiotic resistance to your patient's family. Which of the following mechanisms is not one used by S. aureus? A) Some bacteria are able to make minor structural changes in the cellular target of a drug. This can prevent the medication from binding to that target, thereby protecting the organism from its effects. B) Some bacteria produce enzymes that chemically modify a specific medication, interfering with its function. An example is the β-lactamases that inactivate different β-lactam antibiotics. C) Some bacteria use efflux pumps to transport antimicrobials and other damaging compounds out of the cell. Sometimes the pumps are structurally altered, conferring resistance to several different antimicrobials simultaneously. D) Some bacteria can make changes in porin proteins of the outer membrane and can therefore prevent certain antimicrobials from entering the cell's cytoplasm. By stopping entry of an antimicrobial, an organism avoids its effects. E) Resistance in S. aureus may involve any of these mechanisms.

D) Some bacteria can make changes in porin proteins of the outer membrane and can therefore prevent certain antimicrobials from entering the cell's cytoplasm. By stopping entry of an antimicrobial, an organism avoids its effects. Used by G-. S. aureus is G+.

What virulence factory of P. aeruginosa inhibits host cell protein synthesis?

Exotoxin A - stops host cell protein synthesis

Coagulase is an enzyme. T/F

False But online resources say it is a protein enzyme. Maybe here it is counting it as a virulence factor instead?

Individuals entering the room of a patient with Legionnaires' disease should wear a mask to prevent acquiring the disease from exposure to the patient. T/F

False Ch 21 After Legionella pneumophila grows and multiplies in a building water system, water containing Legionella then has to spread in droplets small enough for people to breathe in. People can get Legionnaires' disease or Pontiac fever when they breathe in small droplets of water in the air that contain the bacteria. The bacteria don't spread from person to person. Most people exposed to the bacteria don't get sick.

Clostridium tetani is a highly invasive pathogen that causes tetanus, characterized by spastic paralysis. T/F

False Is localized, not invasive.

All Staphylococci are coagulase positive. T/F

False Most, including Staphylococcus epidermiditis are coag-negative. Correct

Actinomycosis is a fungal disease. T/F

False Originally thought to be a fungal disease. Causative Agent • Most commonly Actinomyces israelii: Gram-positive, filamentous, branching, slow-growing anaerobe

"Flesh-eating" Streptococcus pyogenes is considered a newly emerging disease. T/F

False slide 20 Cases in U.S. generally sporadic - Less than 2% of deaths from S. pyogenes infections are due to necrotizing fasciitis

Please choose the reason why gas gangrene infections can be treated with oxygen therapy successfully. A) oxygen reacts with water within the cell producing hydrogen peroxide, which kills the bacterial cells.The oxygen, delivered in low concentration, creates an anaerobic environment in which the Clostridium does poorly. B) Oxygen poisons the clostridial cells. C) The oxygen delivery produces a radioisotope of oxygen within the tissue, destroying the necrotic tissue.High pressure oxygen is delivered to the infected tissue, creating an unfavorable habitat for anaerobic Clostridium. D) High pressure oxygen is delivered to the infected tissue, creating an unfavorable habitat for anaerobic Clostridium.

High pressure oxygen is delivered to the infected tissue, creating an unfavorable habitat for anaerobic Clostridium. (on my chapter quiz - correct)

Select the TRUE statement regarding clostridial myonecrosis. Prevention of clostridial myonecrosis can be achieved with the DCTaP vaccine. Hyperbaric chambers may be used to treat patients with gangrene—high levels of O2 reduce anaerobic conditions in the tissues. Clostridium perfringens infects healthy tissue and grows easily in well oxygenated tissues. The causative agent produces α-toxin, an A-B toxin that destroys lecithin in host cell membranes, leading to cell lysis. C. perfringens is an endospore-forming organism, and produces large number of spores in wounds or cultures.

Hyperbaric chambers may be used to treat patients with gangrene—high levels of O2 reduce anaerobic conditions in the tissues.

Select the TRUE statement regarding clostridial myonecrosis. Prevention of clostridial myonecrosis can be achieved with the DCTaP vaccine. C. perfringens is an endospore-forming organism, and produces large number of spores in wounds or cultures. Hyperbaric chambers may be used to treat patients with gangrene—high levels of O2 reduce anaerobic conditions in the tissues. Clostridium perfringens infects healthy tissue and grows easily in well oxygenated tissues. The causative agent produces α-toxin, an A-B toxin that destroys lecithin in host cell membranes, leading to cell lysis.

Hyperbaric chambers may be used to treat patients with gangrene—high levels of O2 reduce anaerobic conditions in the tissues. Correct

You are looking after your sister's cat Singa. While playing one evening, Singa accidentally bites you instead of the toy mouse you are holding. The bite wound is very small but is in the fleshy part of your hand. You wash the wound, which is not bleeding much, and put a band aid on it. The next day, your whole hand is red, swollen, and painful, and some lymph nodes in your arm are enlarged and tender. You call your sister, who is an RN. She urges you to go to the doctor, telling you that animal bites can sometimes be infected, and that if that is the case, you will need treatment before the infection gets any worse. The PA goes on to explain that cat bite infections and bartonellosis (cat scratch disease) differ in that

I put the whole thing further up

Why is Staphylococcus epidermidis able to colonize plastic materials used in medical procedures? It can bind to fibronectin, a blood protein that coats plastic implants. It has fimbriae that allow it to attach to plastic surfaces. It produces coagulase that allows it to colonize inert surfaces such as titanium. It can produce a glycocalyx that allows it to form biofilms. These are all factors that allow S. epidermidis to colonize implants.

It can bind to fibronectin, a blood protein that coats plastic implants. Correct

Rowley Pharmaceutical company produces a drug that promotes new blood vessel growth. Is there any application for this drug in wound treatment? A. It could be very beneficial-one of the biggest problems with wound infections is their largely anaerobic nature. The blood supply to the area is usually compromised, helping to create the anaerobic environment. Certain pathogenic microbes then thrive in this environment, creating very serious wound infections. B. It could be disastrous! Part of the reason abscesses lack blood flow is to keep toxins and bacteria from spreading to other areas of the body. Increasing blood flow to the area will provide a highway for these bacteria to seed other organ systems! C. It could be dangerous-wounds need to cut off blood supply to prevent the patient from bleeding to death. Increasing blood vessel development in the wound site might cause the patient to bleed out. D. There would be no beneficial effect-the immune response is already in place in the wound site, so increasing blood cell delivery to the area wouldn't increase or decrease the rate of wound healing.

It could be very beneficial-one of the biggest problems with wound infections is their largely anaerobic nature. The blood supply to the area is usually compromised, helping to create the anaerobic environment. Certain pathogenic microbes then thrive in this environment, creating very serious wound infections.

Choose the one FALSE statement about Pseudomonas aeruginosa. It is a Gram-positive, spore-forming encapsulated rod. Some strains can grow in nutrient-poor environments, including distilled water. It secretes pigments that together produce a green color. Under certain circumstances, it can grow anaerobically. It is widespread in nature, commonly found in plants.

It is a Gram-positive, spore-forming encapsulated rod.

Choose the one FALSE statement about Pseudomonas aeruginosa. It secretes pigments that together produce a green color. Under certain circumstances, it can grow anaerobically. Some strains can grow in nutrient-poor environments, including distilled water. It is widespread in nature, commonly found in plants. It is a Gram-positive, spore-forming encapsulated rod.

It is a Gram-positive, spore-forming encapsulated rod. p.607/608 - Pseudomonas aeruginosa is a motile, G- rod with a single polar flagellum. Found in a variety of environments such as soil and water, where it grows easily and fast. Is an aerobe but it also respires anaerobically i the absence of O2 if nitrate is present (important for it to form biofilms. Widespread in nature. Can grow in most places there is moisture: contact lens soln, hot tubs, even distilled water. Can be introduced into hospitals on flowers, potted plants and fruit baskets so these aren't allowed in ICU.

The researcher who did much of the early work on Clostridium tetani was: A. von Behring. B. Koch. C. Kitasato. D. Pasteur.

Kitasato • Studied tetanus (lockjaw) in Robert Koch's laboratory • Spores of Clostridium tetani found in soil and dust • Kitasato determined that C. tetani is obligate anaerobe, devised method of cultivating • Discovered animals injected with C. tetani developed tetanus, but no cells found elsewhere in body • Showed bacterial toxin responsible for disease Correct

What is the target of anthrax protective antigen (PA), edema factor, and lethal factor? A. Endothelial cells lining the capillaries B. Cells lining the alveoli in the lungs C. Neurons D. Macrophages

Macrophages

Which of the following produces a greenish pigment that may appear in infected wounds? E. coli S. aureus S. pyogenes P. aeruginosa

P. aeruginosa slide 21 Water-soluble pigments (fluorescent yellow pyoverdin and blue pyocyanin) yield characteristic green color

The Gram-negative opportunistic rod that can grow in a wide variety of environments, including disinfectants and soaps, is: E. coli. S. aureus. S. pyogenes. P. aeruginosa.

P. aeruginosa slide 24 Pseudomonas aeruginosa widespread in nature, grows in most places that have moisture - Soaps, ointments, eyedrops, contact lens solutions, cosmetics, disinfectants, swimming pools, hot tubs, even distilled water - Introduced into hospitals on ornamental plants, flowers, produce; also found on hospital equipment, inner soles of shoes, illegal injectable drugs

A patient presents with a wound that contains green pus. This suggests to you that the wound is infected with P. aeruginosa, which multiplies in photosynthetic biofilms that are green. S. epidermidis, which produces the water-soluble pigments pyoverdin and pyocyanin. S. pyogenes, which produces a water-soluble blue-green capsule. P. aeruginosa, which produces the water-soluble pigments pyoverdin and pyocyanin. either S. epidermidis or S. aureus, both of which produce pigment soluble coagulase

P. aeruginosa, which produces the water-soluble pigments pyoverdin and pyocyanin. yellow and blue make green pyocyanin - sidiophore to steal host cell iron Correct

The most common infectious agent acquired from the bite wounds of a number of kinds of animals is: - Escherichia coli. - Pasteurella multocida. - Actinomyces israelii. - Pseudomonas aeruginosa.

Pasteurella multocida slide 44 Humans and many animals carry P. multocida as normal oral and upper respiratory microbiota, serve as reservoirs • Cats more likely to carry than dogs Correct

You are looking after your sister's cat Singa. While playing one evening, Singa accidentally bites you instead of the toy mouse you are holding. The bite wound is very small but is in the fleshy part of your hand. You wash the wound, which is not bleeding much, and put a band aid on it. The next day, your whole hand is red, swollen, and painful, and some lymph nodes in your arm are enlarged and tender. You call your sister, who is an RN. She urges you to go to the doctor, telling you that animal bites can sometimes be infected, and that if that is the case, you will need treatment before the infection gets any worse.You go to the urgent care in your neighborhood. There, a physician's assistant (PA) tells you that wounds caused by animal bites (especially cats) can be infected with: Pasteurella multocida AND Streptobacillus moniliformis. Bartonella henselae OR Streptobacillus moniliformis. Streptococcus epidermidis AND Streptobacillus moniliformis. Staphylococcus aureus AND Streptobacillus moniliformis. Pasteurella multocida OR Bartonella henselae.

Pasteurella multocida OR Bartonella henselae. First one - worry for all animal bites Second one - more cat bite specific Correct

How is Staphylococcus aureus distinguished from Staphylococcus epidermidis? It is spherical in shape. It is Gram-positive. S. aureus produces coagulase. It is an opportunistic pathogen. It does not produce coagulase.

S. aureus produces coagulase. Staphylococcus aureus is coag-positive Staphylococcus apedermidis is coag-negative just as all other Staphylococcus species other than S. aureus are. Correct

Which of the following has been associated with the flesh-eating organism? H. lechter Pseudomonas aeruginosa Staphylococcus aureus Streptococcus pyogenes

Streptococcus pyogenes Slide 17/18 Group A Streptococcal "Flesh-Eating Disease" Nectrotizing Fasciitis • Streptococcus pyogenes commonly infects wounds • Generally easy to treat: susceptible to penicillin

Early work with Clostridium tetani and Corynebacterium diphtheriae demonstrated: - the importance of thoroughly cooking food. - the usefulness of vaccines. - the potential threat from spore-forming bacteria. - that disease can be caused by poisonous substances produced by bacteria.

TAKE WITH GRAIN OF SALT - the usefulness of vaccines I think this: - that disease can be caused by poisonous substances produced by bacteria. Kitasato determined that C. tetani is obligate anaerobe, devised method of cultivating • Discovered animals injected with C. tetani developed tetanus, but no cells found elsewhere in body • SHOWED BACTERIAL TOXIN RESPONSIBLE FOR DISEASE• Emil von Behring similarly demonstrated diphtheria caused by toxin from Corynebacterium diphtheriae

Which statement regarding the treatment of tetanus is FALSE? TIG neutralizes tetanospasmin that is already attached to nerve tissue, preventing damage to that nerve. The person is given tetanus vaccine that results in the production of anti-tetanospasmin antibodies. TIG antibodies bind to circulating toxin molecules, neutralizing their effects and providing passive immunity. The patient is given muscle relaxants and supportive care, including being placed on a ventilator if needed. An antibacterial medication such as metronidazole is given to kill any actively multiplying bacterial cells.

TIG neutralizes tetanospasmin that is already attached to nerve tissue, preventing damage to that nerve. Hint - it doesn't. Correct

Rickettsia rickettsii are readily phagocytized by macrophages. Why doesn't this control the infection and prevent the development of Rocky Mountain spotted fever? A. The bacteria interfere with the development of antibodies. B. The bacteria are toxic for T cells and prevent the development of cell-mediated immunity. C. The bacteria escape from the phagosome and reproduce in the cytoplasm of the phagocyte. D. The bacteria are unable to inactivate complement.

The bacteria escape from the phagosome and reproduce in the cytoplasm of the phagocyte. Ch 22

What is NOT a reason why an abscessed wound might not respond to antibiotic treatment? A. The bacteria within the abscess have ceased replicating, and many antibiotics require actively replicating cells in order to be effective. B. The blood vessels that would bring the drug to the area have been destroyed or clogged with clots, preventing the drug from getting to the microbes in the abscess. C. The bacteria in an abscess have all acquired multi-drug antibiotic resistance, so any drugs that are used will have no effect. D. The chemical composition of the pus in the abscess often inactivates antibiotic drugs, making them ineffective.

The bacteria in an abscess have all acquired multi-drug antibiotic resistance, so any drugs that are used will have no effect. Factors why microorganisms in abscesses often are not killed by antimicrobial agents is because - the microorganisms stop dividing, of the chemical nature of the pus AND of the lack of blood vessels. Correct

Which statement regarding the pathogenesis of necrotizing fasciitis is INCORRECT? The causative agent produces SPE A, a superantigen that causes helper T cells to release large amounts of cytokines, leading to toxic shock. SPE B is a protease produced by S. pyogenes that causes tissue death and breakdown, leading to fluid accumulation in the area and intense swelling. M protein-fibrinogen complexes causes neutrophils to release inflammatory molecules that increase vascular permeability and lead to a blood pressure drop. The causative agent sheds antibodies that attach to fibrinogen and recruit natural killer cells that destroy muscle fascia through ADCC. A hyaluronic acid capsule and M protein allow the causative agent to evade the immune responses.

The causative agent sheds antibodies that attach to fibrinogen and recruit natural killer cells that destroy muscle fascia through ADCC. Correct

An abscess is a collection of pus. T/F

True

How may lung damage or pneumonia occur in a person with tetanus? A) The person may inhale regurgitated (vomited) stomach contents. B) Tetanospasmin causes the release of degradative enzymes in the lungs. C) Tetanospasmin is an A-B toxin that binds to lung epithelial cells, killing them. D) C. tetani releases alpha-toxin that causes the alveoli of the lungs to collapse. E) Spasms of major chest muscles may be so severe that the lungs are damaged.

The person may inhale regurgitated (vomited) stomach contents. Found in textbook.

Clumping factor, coagulase and protein A serve to coat Staphylococcus with host proteins. T/F

True

Coagulase-positive S. aureus is often involved in disease. T/F

True

Your patient had abdominal surgery three days ago. She seemed to be doing well after the surgery, but today the skin around the surgical incision is red and swollen. In addition, your patient has a high fever and is complaining of muscle aches. She also has a rash and has diarrhea. You realize that her wound has become infected, despite your best efforts as a nurse, and you are concerned that she has developed toxic shock syndrome. You explain the details of this type of infection to the patient's family.You are extremely concerned, because the laboratory reports that the organism cultured from your patient's wound is capable of digesting collagen and fibronectin. Why are you worried about this? This would indicate that the bacterium is a lysogen, containing viral DNA conferring new characteristics on the organism. Bacteriophages pose an additional health risk to your patient. These are structural components of tissue. Their digestion means that not only could the organisms spread easily, but also important structures such as tendons could be destroyed. This would indicate that the organism is capable of forming biofilms and it is very difficult to eliminate biofilms once they have developed, because of resistance. These are structural components specifically of the heart. Their digestion means that the patient is at risk of heart failure, which will prove fatal. This would indicate that the pathogen has the ability to break down activated complement proteins, thereby avoiding the innate immune defenses and allowing it to persist.

These are structural components of tissue. Their digestion means that not only could the organisms spread easily, but also important structures such as tendons could be destroyed. Correct

Which characteristic(s) is/are NOT common to C. tetani and C. perfringens? They are obligate anaerobes. They are rod-shaped. They produce A-B toxins. They are Gram-positive bacteria. They are spore-formers.

They produce A-B toxins They are both the rest - they are G+ rod shaped, obligate anaerobes. Clostridium is a spore-former. Correct

Why is it not surprising that Staphylococci are the leading cause of wound infections? Staphylococci acquire antibiotic resistance very readily, making them hard to eliminate by pre-surgical antibacterial soaps. As such, they commonly infect surgical wound sites. This genus is readily present as a part of the normal microbiota on most people's skin, so it could easily enter wounds. Staphylococci form endospores, so even with appropriate control measures, there is a high risk that spores will enter a wound and cause infection. Members of this genus are all particularly virulent and highly capable of causing numerous infections. Staphylococci cannot be eradicated from the skin due to multidrug resistance in most members of the genus. Drugs simply don't kill them.

This genus is readily present as a part of the normal microbiota on most people's skin, so it could easily enter wounds.

Why is it not surprising that Staphylococci are the leading cause of wound infections? A) Staphylococci are capable of a higher degree of spontaneous mutation than most microbes. This makes them able to acquire antibiotic resistance very readily, making them hard to eliminate by pre-surgical antibacterial scrubs. As such, they commonly infect surgical wound sites. B) Members of this genus are all particularly virulent and highly capable of causing numerous infections. C) Staphylococci cannot be eradicated from the skin due to multidrug resistance in most members of the genus. Drugs simply don't kill them. D) This genus is readily present as a part of the normal microbiota on most people's skin, so it could easily enter wounds.

This genus is readily present as a part of the normal microbiota on most people's skin, so it could easily enter wounds. Correct

Why might Candida albicans become pathogenic in a person receiving antibacterial medications? This is a usual member of the normal microbiota. However, when the bacterial members of the normal microbiota are killed by a broad-spectrum antibacterial drug, this fungal cell type has little to no competition for resources and it quickly overgrows, causing disease. This is a protozoan species and part of the normal microbiota. When the bacterial members of the normal microbiota are wiped out by a broad-spectrum antibacterial drug, this protozoan cell type has little to no competition for resources and can overgrow, causing disease. This fungal organism can actually use the destroyed bacterial cells as a nutrient source and begin to multiply out of control. This can cause a pathogenic state. This is an opportunistic pathogen not normally found in normal microbiota. As such, when the bacterial normal microbiota is eliminated by broad-spectrum antibacterial drugs, this opportunist can adhere to and colonize the area left behind. The person's immune system is severely suppressed when they are on antibiotics. This means that the Candida is able to colonize areas normally protected by phagocytes, and can thrive there, causing disease.

This is a usual member of the normal microbiota. However, when the bacterial members of the normal microbiota are killed by a broad-spectrum antibacterial drug, this fungal cell type has little to no competition for resources and it quickly overgrows, causing disease.

Individuals who have recovered from tetanus are not immune to the disease and must be immunized. T/F

True

Staphylococci are the leading cause of wound infections. T/F

True

Streptobacillus moniliformis is unusual in that it spontaneously forms L-forms. T/F

True

Tetanus antitoxin can cross the placenta. T/F

True

Non-toxin-producing strains of Corynebacterium diphtheriae could infect the body but would not cause the typical symptoms of diphtheria. T/F

True Ch 21 - it's the ones that are virus infected lysogens that make the toxin that is causes diphtheria.

Both Staphylococcus aureus and Streptococcus pyonese have fibronectin binding proteins. T/F

True It is the protein F in Streptococcus pyogenes.

Bites by little children typically cause few problems. T/F

True They don't tend to break the skin. :)

Which of the following does not usually result from a wound infection? Bacterial spread. Aerobic conditions. Delayed healing. Abscess formation. These all result from delayed wound healing.

aerobic conditions

Would babies need to be immunizedagainst lockjaw (tetanus) if their mother had been immunized against the disease? Why or why not? No-because the mother's IgG antibodies would be passed along through the placenta before birth, protecting the baby from the infection. Yes-because even though maternal IgG antibodies might be passed along through the placenta, they will not last forever. The baby will need to create its own antibody response to be protected against future tetanus. No-because maternal IgG antibodies would be passed along in the breast milk, protecting the baby from infection. Yes-because the maternal response to the tetanus vaccine is to produce IgE antibodies, and IgD antibodies are the predominant type in breast milk. And what if the baby isn't breast-fed? Therefore, even if the baby is breast-fed, it won't receive the mother's protective antibodies.

Yes-because even though maternal IgG antibodies might be passed along through the placenta, they will not last forever. The baby will need to create its own antibody response to be protected against future tetanus. Correct

The most common cause of chronic lymph node enlargement at a localized body site in young children is: A. rat bite fever. B. dead bat fever. C. cat scratch fever. D. mouse itch fever.

cat scratch fever. Bartonellosis (Cat Scratch Disease) slide 46 -In the US, cat scratch disease is the most common cause of chronic, localized lymph node enlargement in young children

Which of the following virulence factors has been associated with Pseudomonas aeruginosa? endotoxin A exoenzyme S pyogenic exotoxin endoenzyme T

exoenzyme S slide 23 Exoenzyme S is a phospholipase, works synergistically with protease lecithinase to hydrolyze lecithin, results in membrane disruption and cell death

Streptobacillus moniliformis is unusual in that it has a cell wall. forms spores. is unicellular. forms L-forms. is anaerobic.

forms L-forms

A wound created by the drag of a knife across skin can be classified as a(n) abrasion. laceration. incision. puncture. contusion.

incision Correct

Which characteristic(s) is/are NOT common to C. tetani and C. perfringens?

got this right! further up i put it

Which of the following is NOT true? Microorganisms in abscesses often are not killed by antimicrobial agents because of the high level of oxygenation. the microorganisms stop dividing. of the chemical nature of the pus. of innate resistance in the microbes. of the lack of blood vessels.

of the high level of oxygenation. There is no oxygen reaching an abscess. Correct

Which of the following has been involved in causing small epidemics in the U.S.? tineasis candidiasis trichomoniasis sporotrichosis

sporotrichosis Fungal wound infection - more serious than skin mycoses. slide 49 Sporotrichosis (Rose Gardener's Disease)

Bite wounds are often serious as they may lead to an infection in which two or more species of pathogen act together to produce an effect that is greater than the sum of effects if each pathogen were acting alone...

synergistic infection Alone, usually harmless; together, produce large numbers of toxins and enzymes including leukocidin, collagenase, hyaluronidase, ribonuclease, various proteinases, neuraminidase, and enzymes that destroy complement system proteins and antibodies; yield synergistic infection

The disease that involves the muscles and often manifests itself first with spasms of the jaw muscles is: - polio. - rabies. - tetanus. - gastritis.

tetanus