Step 1 First Aid - Microbiology

Terms	Definitions
Bacterial Structures: Peptidoglycan	Gives rigid support, protects against osmotic pressure; Sugar backbone w/ cross-linked peptide side chains. (function; chemical composition)
Bacterial Structures: Cell wall / cell membrane (G+'s)	Major surface Ag; Peptidoglycan for support. Teichoic acid induces TNF and IL-1. (function; chemical composition)
Bacterial Structures: Outer membrane (G-)	Site of endotoxin (LPS), major surface Ag; Lipid A induces TNF and IL-1 Polysaccharide is the Ag (function; chemical composition)
Bacterial Structures: Plasma membrane	Site of oxidative and transport enzymes; Lipoprotein bilayer (function; chemical composition)
Bacterial Structures: Ribosome	Protein synthesis; 50S and 30S subunits (function; chemical composition)
Bacterial Structures: Periplasm	Space btw the cytoplasmic membrane and the outer membrane in G- bacteria; Contains may hydrolytic enzymes, including beta-lactamases (function; chemical composition)
Bacterial Structures: Capsule Function? Structure? (... and exception?)	Protects against phagocytosis; Polysaccharide (except in Bacillus anthracis , which contains D-glutamate) (function; chemical composition)
Bacterial Structures: Pilus/fimbria	Mediate adherence of bacteria to cell surface, sex pilus forms attachment btw 2 bacteria during conjugation; Glycoprotein (function; chemical composition)
Bacterial Structures: Flagellum	Motility; Protein (function; chemical composition)
Bacterial Structures: Spore	Provides resistance to dehydration, heat, and chemicals; Keratin-like coat, dipiclonic acid (function; chemical composition)
Bacterial Structures: Plasmid	Contains a variety of genes for ABX resistance, enzymes, toxins; DNA (function; chemical composition)
Bacterial Structures: Glycocalyx	Mediates adherence to surfaces, especially foreign surfaces (e.g. indwelling catheters); Polysaccharide (function; chemical composition)
Structures unique to gram (+) organisms	Teichoic acid Cell wall <img src="138b - cell wall.JPG" />
Structures common to Gram +/- organisms	Flagellum, pilus, capsule, PDG, cytoplasmic membrane <img src="138a - cell walls.JPG" />
Features unique to G(-) organisms	Endotoxin/LPS (outer membrane) Periplasmic space (location of many beta-lactamases) <img src="138c - cell wall gram neg.JPG" />
Bacteria w/ unusual cell membranes/walls	Mycoplasma: contain sterols and have no cell wall Mycobacteria: Contain mycolic acid. High lipid content.
G(+) cocci	Staphylococcus Streptococcus
G(-) cocci	Neisseria
G(+) Rods	My cobacterium (acid-fast) List eria B acillus C lostridium C orynebacterium What happened when you were sending that email to Gram + Rod ? My List B ecame CC 'd
My cobacterium (acid-fast) List eria B acillus C lostridium C orynebacterium What happened when you were sending that email to Gram + Rod ? My List B ecame CC 'd	G(+) Rods
G(-) Rods	H ave Y ou E ver L istened to GNR (Guns n' Roses = Gram (-) Rods)? I like B oy B ands. B esides, Fran kly, I P refer Garden s to jungles. Haemophilus Yersinia Enterics (separate card) Legionella (silver stain) Bordatella Brucella Bartonella Francisella Pasteurella Gardnerella (gram variable)
H ave Y ou E ver L istened to GNR (Guns n' Roses = Gram (-) Rods)? I like B oy B ands. B esides, Fran kly, I P refer Garden s to jungles. Haemophilus Yersinia Enterics (separate card) Legionella (silver stain) Bordatella Brucella Bartonella Francisella Pasteurella Gardnerella (gram variable)	G(-) Rods
Branching Filamentous bacteria (G+)	Actinomyces Nocardia (weakly acid-fast)
Actinomyces Nocardia (weakly acid-fast)	Branching Filamentous bacteria (G+)
Pleomorphic (G-) bacteria	Rickettsiae Chlamydiae (Giemsa stain)
Rickettsiae Chlamydiae (Giemsa stain)	Pleomorphic (G-) bacteria
Spirochetes (G-)	Leptospira Borrelia (Giemsa stain) Treponema
Leptospira Borrelia (Giemsa stain) Treponema	Spirochetes (G-)
Neither G+ nor G- (b/c no cell wall)	Mycoplasma
Bugs that won't Gram stain	These Rascals May Microscopically Lack Color Treponema (too thin to be visualized) Rickettsia (intracellular parasite) Mycobacteria (high-lipid-content cell wall requires acid-fast stain) Mycoplasma (no cell wall) Legionella pneumophilia (primarily intracellular) Chlamydia (intracellular parasite; lacks muramic acid cell wall)
Visualizing Treponemes	Darkfield microscopy and fluorescent Ab staining
Visualizing Mycobacteria	Acid-fast stain
Visualizing Legionella	Silver stain
Giemsa's stain is used to visualize...?	use for: Borrelia Plasmodium Trypanosomes Chlamydia
PAS (periodic acid-Schiff) stain	stains glycogen, mucopolysaccharides; Used to diagnose Whipple's dz (PASs the sugar)
Ziehl-Neelsen stain	Use to stain Acid-fast bacteria
India ink	used to visualize Cryptococcus neoformans
Silver stain	used to visualize: fungi, Legionella
Media/Special culture requirements for: H. influenzae	Chocolate agar w/ factors V (NAD) and X (hematin) (Media used for isolation)
Chocolate agar w/ factors V (NAD) and X (hematin)	H. influenzae
Media/Special culture requirements for: N. gonorrheae	Thayer-Martin media (Chocolate agar based, w/ various ABX) (Media used for isolation)
Thayer-Martin media (Chocolate agar based, w/ various ABX)	N. gonorrheae
Media/Special culture requirements for: B. pertussis	Bordet-Gengou (potato) agar (Media used for isolation)
Bordet-Gengou (potato) agar	B. pertussis
Media/Special culture requirements for: C. diphtheriae	Tellurite plate, Loffler's media (Media used for isolation)
Tellurite plate, Loffler's media	C. diphtheriae
Media/Special culture requirements for: M. tuberculosis	Lowenstein-Jensen agar (Media used for isolation)
Lowenstein-Jensen agar	M. tuberculosis
Media/Special culture requirements for: M. pneumoniae	Eaton's agar (Media used for isolation)
Eaton's agar	M. pneumoniae
Media/Special culture requirements for: E. coli	Eosin-methylene Blue (EMB) agar (blue-black colonies w/ metallic sheen) (Media used for isolation)
Eosin-methylene Blue (EMB) agar (blue-black colonies w/ metallic sheen)	E. coli
Media/Special culture requirements for: Lactose-fermenting enterics	Pink colonies on MacConkey's agar (Media used for isolation)
Pink colonies on MacConkey's agar	Lactose-fermenting enterics
Media/Special culture requirements for: Legionella	Charcoal yeast extract agar buffered w/ increased iron and cysteine (Media used for isolation)
Charcoal yeast extract agar buffered w/ increased iron and cysteine	Legionella
Media/Special culture requirements for: Fungi	Sabouraud's agar (Media used for isolation)
Sabouraud's agar	Fungi
G(-) Enterics (rod-shaped)	E. coli Shigella Salmonella Yersinia Klebsiella Proteus Enterobacter Serratia Vibrio Campylobacter Helicobacter Pseudomonas Bacteroides
Obligate aerobes	Use an O2-dependent system to generate ATP Examples: (Nagging Pests Must Breathe) Nocardia Pseudomonas Mycobacterium tuberculosis (w/ prediliction for apices of lungs, where PO2 is highest) Bacillus Also: to help remember Pseudomonas aeruginosa - AERuginosa is an AERobe
Pseudomonas aeruginosa O2 tolerance? Where does it show up?	P. AERuginosa is an AERobe seen in burn wounds, nosocomial pneumonia, and pneumonias in cystic fibrosis pts.
Obligate Anaerobes	Lack catalase and/or superoxide dismutase, and thus are susceptible to oxidative damage. Generally foul-smelling (short-chain FA's), are difficult to culture, and produce gas in tissue (CO2 and H2). Normal flora in GI tract, pathogenic elsewhere. Examples: (anaerobes Can't Breathe Air) Clostridium Bacteroides Actinomyces
Aminoglycosides and anaerobes	AminO2 glycosides are ineffective against anaerobes b/c these ABX require O2 to enter into the bacterial cell.
Obligate intracellular bugs	Rickettsia, Chlamydia (Stay inside [cells] when it's R eally C old) *Can't make their own ATP
Facultatively intracellular bugs	Some Nasty Bugs May Live FacultativeLY Salmonella Neisseria Brucella Mycobacterium Listeria Francisella Legionella Yersinia
Quellung Reaction	Postive quellung: If encapsulated bug is present, the capsule swells when specific anti-capsular antisera are added (Quellung = capsular swellung)
Capsule and vaccines	Capsule is Ag for vaccines (e.g. Pneumovax, H. influenzae B, meningococcal vaccines) Conjugation w/ protein increases immunogenicity and T-cell dependent response
Quellung (+) Bacteria	Encapsulated (Some Nasties Have Kapsules) Streptococcus pneumoniae Neisseria meningitidis Haemophilus influenzae (esp. type B) Klebsiella pneumoniae Polysaccharide capsule is an antiphagocytic virulence factor for above bacteria.
Urease (+) bugs	Particular Kinds Have Urease Proteus Klebsiella H. pylori Ureaplasma
Pigment-producing bacteria	S. aureus --> yellow pigment (Auerus is Latin for gold) Pseudomonas aeruginosa --> blue-green pigment (AERUGula is green) Serratia marcescens --> red pigment (Think of red maraschino cherries)
Virulence factors	Promote evasion of host immune response
Important virulence factors in S. aureus	protein A: Binds Fc region of Ig, disrupts opsonization and phagocytosis. IgA protease: Enzyme that cleaves IgA. Polysaccharide capsules also inhibit phagocytosis. [*also TSST-1, but I don't think it's technically a virulence factor]
protein A: Binds Fc region of Ig, disrupts opsonization and phagocytosis. IgA protease: Enzyme that cleaves IgA.	Polysaccharide capsules also inhibit phagocytosis. [*also TSST-1, but I don't think it's technically a virulence factor] Important virulence factors in S. aureus
IgA protease Who secretes it?	Secreted by S. pneumoniae, H. influenzae, and Neisseria to prevent phagocytosis
Secreted by S. pneumoniae, H. influenzae, and Neisseria to prevent phagocytosis	IgA protease Who secretes it?
Group A streptococcus virulence factors	M protein: Helps prevent phagocytosis
M protein: Helps prevent phagocytosis	Group A streptococcus virulence factors
Exotoxin vs. Endotoxin: Source	Certain species of some G(+) and G(-) organisms; Outer cell membrane of most G(-) bacteria and Listeria (Exo ; Endo)
Exotoxin vs. Endotoxin: Secreted from cell?	Yes; No (Exo ; Endo)
Exotoxin vs. Endotoxin: Chemistry	Polypeptide; Lipopolysaccharide (structural part of the bacteria. Released when lysed) (Exo ; Endo)
Exotoxin vs. Endotoxin: Location of genes	Plasmid or bacteriophage; bacterial chromosome (Exo ; Endo)
Exotoxin vs. Endotoxin: Toxicity	High (fatal dose on the order of 1 microgram); Low (fatal dose on the order of hundreds of micrograms) (Exo ; Endo)
Exotoxin vs. Endotoxin: Clinical effects	Various; Fever, shock (Exo ; Endo)
Exotoxin vs. Endotoxin: Mode of action	Various; Includes TNF and IL-1 (Exo ; Endo)
Exotoxin vs. Endotoxin: Antigenicity	Induces high-titer Abs called antitoxins ; Poorly antigenic (Exo ; Endo)
Exotoxin vs. Endotoxin: Vaccines	Toxoids useful as vaccines; No toxoids formed and no vaccine available (Exo ; Endo)
Exotoxin vs. Endotoxin: Heat stability	Destroyed rapidly at 60C (except staphylococcal enterotoxin); Stable at 100C for 1 hour (Exo ; Endo)
Exotoxin vs. Endotoxin: Typical diseases	Tetanus, botulism, diphtheria; Meningococcemia, sepsis by G(-) rods (Exo ; Endo)
Superantigens	Bind directly to MHCII and T-cell receptor simultaneously, activating large numbers of T-cells to stimulate release of IFN-gamma and IL-2
Toxins: TSST-1	Organism, toxin function: S. aureus SuperAg that causes toxic shock syndrome (fever, rash, shock).
S. aureus SuperAg that causes toxic shock syndrome (fever, rash, shock).	TSST-1
Toxins: Exfoliatin	Organism, toxin function: S. aureus Causes staphylococcal scalded skin syndrome
S. aureus Causes staphylococcal scalded skin syndrome	Exfoliatin
Toxins: Enterotoxins	Organism, toxin function: S. aureus (and others) Cause food poisoning
S. aureus (and others) Cause food poisoning	Enterotoxins
Toxins: Scarlet fever-erythrogenic toxin	Organism, toxin function: S. pyogenes SuperAg that causes toxic shock-like syndrome
S. pyogenes SuperAg that causes toxic shock-like syndrome	Scarlet fever-erythrogenic toxin
ADP ribosylating exotoxins	Interfere w/ host cell function. B (binding) component binds to a receptor on the surface of the host cell, enabling endocytosis. A (active) component then attaches an ADP-ribosyl to a host cell protein (ADP ribosylation), altering protein function.
Toxins: Diphtheria exotoxin	Organism, toxin function: Corynebacterium diphtheriae ADP-ribosylating A-B exotoxin that inactivates EF-2 (similar to Psudomonas exotoxin A) Causes pharyngitis and pseudomembrane in throat.
Corynebacterium diphtheriae ADP-ribosylating A-B exotoxin that inactivates EF-2 (similar to Psudomonas exotoxin A) Causes pharyngitis and pseudomembrane in throat.	Diphtheria exotoxin
Toxins: Cholera toxin	Organism, toxin function: Vibrio Cholerae ADP ribosylation of G-protein stimulates adenylyl cyclase Increased pumping of Cl- into gut and decreased Na+ absorption Water moves into gut lumen Causes voluminous rice-water diarrhea
Vibrio Cholerae ADP ribosylation of G-protein stimulates adenylyl cyclase Increased pumping of Cl- into gut and decreased Na+ absorption Water moves into gut lumen Causes voluminous rice-water diarrhea	Cholera toxin
Toxins: Heat-labile toxin, Heat-stabile toxin	Organism, toxin function: E. coli ADP-ribosylating A-B toxins Heat-labile: stimulates Adenylyl cyclase Heat-stabile: stimulates Guanylate cyclase Both: cause watery diarrhea Labile like the A ir, Stable like the G round
Toxins: Pertussis toxin (PT)	Organism, toxin function: Bordetella pertussis ADP-ribosylating A-B toxin that increases cAMP by inhibiting G-alpha1 Causes whooping cough Inhibits chemokine receptor --> causes lymphocytosis
Toxins: alpha toxin	Organism, toxin function: Clostridium perfringens Causes gas gangrene Get double zone of hemolysis on blood agar
Clostridium perfringens Causes gas gangrene Get double zone of hemolysis on blood agar	alpha toxin
Toxins: Tetanus toxin (tetanospasmin)	Organism, toxin function: C. tetani Blocks the release of inhibitory neurotransmitters GABA and glycine Causes lockjaw
C. tetani Blocks the release of inhibitory neurotransmitters GABA and glycine Causes lockjaw	Tetanus toxin (tetanospasmin)
Toxins: Botulinum toxin (aka Botox)	Organism, toxin function: C. botulinum Blocks release of ACh Causes anticholinergic symptoms, CNS paralysis (especially cranial nerves) Spores found in canned food, honey (causes floppy baby)
C. botulinum Blocks release of ACh Causes anticholinergic symptoms, CNS paralysis (especially cranial nerves) Spores found in canned food, honey (causes floppy baby)	Botulinum toxin (aka Botox)
Toxins: Anthrax toxin	Organism, toxin function: Bacillus anthracis Edema factor, part of the toxin complex, is an adenylate cyclase
Toxins: Shiga toxin	Organism, toxin function: Shigella, and E. coli O157:H7 Cleaves host cell rRNA (inactivates 60S ribosome) Enhances cytokine release, causing HUS
Shigella, and E. coli O157:H7 Cleaves host cell rRNA (inactivates 60S ribosome) Enhances cytokine release, causing HUS	Shiga toxin
Toxins: Streptolysin O	Organism, toxin function: S. pyogenes a hemolysin. Ag for ASO Ab, which is used in Dx of rheumatic fever
S. pyogenes a hemolysin. Ag for ASO Ab, which is used in Dx of rheumatic fever	Streptolysin O
cAMP inducers (list)	Vibrio cholerae B. pertussis E. coli Bacillus anthracis Cholera, pertussis, and E. coli toxins act via ADP ribosylation to permanently activate endogenous adenylate cyclase (increasing cAMP), While anthrax edema factor is itself an adenylate cyclase
Vibrio Cholerae toxin and cAMP	Toxin permanently activates Gs, Causing rice-water diarrhea (Cholera turns the on on)
B. pertussis and cAMP	Pertussis toxin permanently disables Gi, causing whooping cough (Pertussis toxin turns the off off) *Pertussis toxin also promotes lymphocytosis by inhibiting chemokine receptors.
E. coli and cAMP	Heat-labile toxin stimulates adenylyl cyclase
Bacillus anthracis and cAMP	Anthrax toxin includes edema factor, a bacterial adenylate cyclase (increases cAMP)
Endotoxin	A Lipopolysaccharide found in the cell wall of G(-) bacteria N-dotoxin is an integral part of the gram-Negative cell wall *Endotoxin is heat stable
Endotoxin and Macrophages	Activates Macs: IL-1 causes fever TNF causes fever, hemorrhagic tissue necrosis NO causes hypotension (shock) <img src="144a - endotoxins.JPG" />
Endotoxin and complement	Activates the complement (alternative pathway): C3a causes hypotension, edema C5a causes PMN chemotaxis <img src="144a - endotoxins.JPG" />
Endotoxin and Hageman factor (factor XII)	Activates Hageman factor This activates coagulation cascade, causing DIC <img src="144a - endotoxins.JPG" />
Bacterial growth curve	Lag phase: metabolic activity w/o division Log phase: rapid cell division Stationary phase: nutrient depletion slows growth. Spore formation in some bacteria. Death phase: prolonged nutrient depletion and buildup of waste products leads to death. <img src="144b - bacterial growth curve.JPG" />
Transformation	DNA taken up directly from environment by competent prokaryotic and eukaryotic cells. Any DNA can be used
F+ x F- Conjugation	F+ plasmid contains genes for conjugation process. Bacteria w/o this are termed F-. Plasmid is replicated and transferred through pilus from the F+ cell. Plasmid DNA only, no transfer of chromosomal genes.
Hfr x F- Conjugation	F+ plasmid can become incorporated into bacterial chromosomal DNA, now termed Hfr cell. Replication of incoporated plasmid DNA may include some flanking chromosomal DNA. Transfer of plasmid and chromosomal genes.
Generalized transduction	Lytic phage infects bacterium, leading to cleavage of bacterial DNA and synthesis of viral proteins. Parts of bacterial chromosomal DNA may become packaged in viral capsid. Phage infects another bacterium, transferring these genes.
Specialized transduction	Lysogenic phage infects bacterium; viral DNA incorporated into bacterial chromosome. When phage DNA is excised, flanking bacterial gnees may be excised w/ it. DNA is packaged into phage viral capsid and can infect another bacterium.
Transposition (transposons)	Segment of DNA can jump (excision and reincorporation) from one location to another, can transfer genes from plasmid to choromosome and vice versa. When excision occurs, may include some flanking chromosomal DNA, which can be incorporated into a plasmid and transferred to another bacterium.
5 bacterial toxins encoded in a lysogenic phage	ABCDE ShigA -like toxin B otulinum toxin (certain strains) C holera toxin D iphtheria toxin E rythrogenic toxin of Streptococcus pyogenes
Gram (+) \| Rods \| ?	Clostridium (anaerobe) Corynebacterium Listeria Bacillus
Gram (+) \| Cocci \| Catalase (+), in clusters (Staphylococcus) \| Coagulase (+) \| ?	Staphylococcus aureus
Gram (+) \| Cocci \| Catalase (+), in clusters (Staphylococcus) \| Coagulase (-) \| ?	Novobiocin sensitive: Staphylococcus epidermidis Nobobiocin resistant: Staphylococcus saprophyticus
Gram (+) \| Cocci \| Catalase (-), in chains (Streptococcus) \| partial hemolysis (green - alpha hemolysis) \| ?	(+) Quellung (has capsule), Optochin sensitive, Bile soluble: Streptococcus pneumoniae (-) Quellung (no capsule), Optochin resistant, not bile soluble: Streptococcus viridans
Gram (+) \| Cocci \| Catalase (-), in chains (Streptococcus) \| Complete hemolysis (clear, beta-hemolysis) \| ?	Bacitracin sensitive: Group A Strep (GAS) aka Streptoccus pyogenes Bacitracin resistant: Group B strep aka Streptococcus agalactiae
Gram (+) \| Cocci \| Catalase (-), in chains (Streptococcus) \| No hemolysis (gamma hemolysis) \| ?	Enterococcus (E. faecalis) Peptostreptococcus (anaerobe)
Identifying Staphylococci w/ Novobiocin (once you know it's a G(+)/catalase(+) coccus in clusters)	NO vobiocin - S aprophyticus is R esistant; E pidermidis is S ensitive On the office's staph retreat, there was NO S tRES
Identifying Streptococci (once you know it's a G(+)/catalase(-) coccus in chains)	O ptochin: V iridans is R esistant P neumoniae is S ensitive (OVRPS = overpass) B acitracin: group B strep are R esistant group A strep are S ensitive (B-BRAS )
alpha-hemolytic bacteria	Form a green ring around colonies on blood agar. Include: 1.) Streptococcus pneumoniae (catalase (-) and optochin sensitive) <img src="Strep pneumo.JPG" /> 2.) viridans streptococci (catalase (-), optochin resistant)
Beta-hemolytic bacteria	Form a clear area of hemolysis on blood agar. Include: 1.) Staphylococcus aureus (catalase and coagulase positive) 2.) Streptococcus pyogenes - GAS (catalase negative and bacitracin sensitive) 3.) Streptococcus agalactiae - GBS (catalase negative and bacitracin resistant) 4.) Listeria monocytogenes (tumbling motility, meningitis in newborns, unpasteurized milk)
Catalase	Catalase degrades H2O2, an antimicrobial product of PMNs. H2O2 is a substrate for myeloperoxidase.
Catalase/Coagulase in G(+) cocci	Staphylococci make catalase, whereas Streptococci do not S. aureus makes coagulase, whereas S. epidermidis and S. saprophyticus do not. (Staph make catalase b/c they have more staff. Bad staph (aureus, b/c epidermidis is skin flora) make coagulase and toxins.)
Protein A (virulence factor)	Virulence factor of Staphylococcus aureus Binds Fc-IgG, inhibiting complement fixation and phagocytosis
TSST (@ molecular level)	In Staph aureus A superAg that binds MHCII and the TCR, resulting in polyclonal T-cell activation
Dzs caused by Staphylococcus aureus	<img src="147a - S aureus.JPG" /><img src="Staph aureus (1).JPG" /> 1.) Inflammatory Dz - skin infxns, organ abcesses, pneumonia 2.) Toxin-mediated dz - Toxic shock syndrome (TSST-1), scalded skin syndrome (exfoliative toxin), rapid-onset food poisoning (pre-formed enterotoxins) 3.) MRSA (methicillin-resistant S. aureus) infxn: important cause of serious nosocomial and community-acquired infxns. Resistant to beta-lactams due to altered penicillin-binding proteins. 4.) Misc. - acute bacterial endocarditis, osteomyelitis
Staphylococcus epidermidis	Infects prosthetic devices and catheters. Component of normal skin flora. Contaminates blood cultures.
Streptococcus pneumoniae (the pneumococcus)	Encapsulated. Has IgA protease. Most common cause of: Meningitis Otitis media (in children) Pneumonia Sinusitis (S. pneumoniae MOPS are M ost OP tochin S ensitive) Associated w/ rusty sputum, sepsis in sickle cell anemia and splenectomy.
Viridans group Streptococci	Alpha-hemolytic. Normal flora of the oropharynx. Cause dental caries (S. mutans) and subacute bacterial endocarditis (S. sanguis). Resistant to optochin, differentiating them from S. pneumoniae, which is alpha-hemolytic but optochin sensitive. (Viridans group strep live in the mouth b/c they are not afraid of-the-chin <--op-to-chin resistant)
Diseases caused by Streptococcus pyogenes (GAS)	1.) Pyogenic - pharyngitis, cellulitis, impetigo 2.) Toxigenic - Scarlet fever, toxic shock syndrome 3.) Immunologic - rheumatic fever, acute glomerulonephritis PH aryngitis gives you rheumatic PH ever and glomerulonePH ritis No rheum for SPECCulation: Subcutaneous nodules, Polyarthritis Erythema marginatum Chorea Carditis
Ab's and Streptococcus pyogenes (GAS)	Ab's to M protein enhance host defenses againt GAS but can give rise to rheumatic fever. ASO titer detects recent GAS infxn.
Streptococcus agalactiae (GBS)	Bacitracin resistant Beta-hemolytic Causes: Pneumonia meningitis Sepsis (mainly in babies) B is for Babies!
Enterococci	include Enterococus faecalis and E. faecium) Penicillin G resistant. Cause UTI and subacute endocarditis. Enterococci are hardier than nonenterococcal group D, thus can grow in 6.5% NaCl. Variable hemolysis.
Lancefield group D	Includes enterococci and nonenterococcal group D streptococci. Lancefield grouping is based on differences in the C carbohydrate on the bacterial cell wall.
VRE	Vancomycin-resistant Enterococci: an important cause of nosocomial infxn.
Streptococcus bovis	Highly associated w/ colon cancer. One of the group D streptococci.
Diphtheria	Caused by Corynebacterium diphtheriae via an exotoxin encoded by beta-prophage. Potent exotoxin inhibits protein synthesis via ADP ribosylation of EF-2. Sx include: pseudomembranous pharyngitis (grayish-white membrane) w/ lymphadenopathy. Lab Dx based on G(+) rods w/ metachromatic granules. Corynebacterium diphtheriae grows on tellurite agar. ABCDEFG ADP ribosylation Beta-prophage Corynebacterium Diphtheriae Elongation Factor 2 Granules
Bacterial spores	Certain G(+) rods form spores when nutrients are limited (@ the end of stationary phase) Spores are highly resistant to destruction by heat and chemicals. Have dipiclonic acid in their core. Have no metabolic activity. Must autoclave to kill spores.
Important spore-forming bacteria	G (+) spores found in soil: Bacillus anthracis Clostridium perfringens C. tetani Other spore formers: B. cerus C. botulinum
Clostridia (generally)	G(+) Spore-forming Obligate anaerobic Bacilli
Clostridium tetani	produces the exotoxin that causes tetanus TETanus is TETanic paralysis (blocks glycine release [an inhibitory NT]) from Renshaw cells in spinal cord
Clostridium botulinum	produces preformed, heat-labile toxin that inhibits ACh release at the NMJ, causing botulism (flaccid paralysis). In adults, dz is caused by ingestion of preformed toxin. In babies, ingestion of bacterial spores in honey causes dz (floppy baby syndrome). BOTulinum is from bad BOTtles of food and honey.
Clostridium perfringens	Produces alpha-toxin (lecithinase) that can cause myonecrosis (gas gangrene) and hemolysis PERFringens PERForates a gangrenous leg
Clostridium dificile	Produces a cytotoxin, an exotoxin that kills enterocytes, causing pseudomembranous colitis. Often 2' to ABX use, especially clindamycin or ampicillin. DI fficile causes DI arrhea Tx: metronidazole
Anthrax	Caused by Bacillus anthracis: Gram (+), spore-forming rod that produces anthrax toxin. Only bacterium w/ a protein capsule (contains D-glutamate)
Anthrax infxn via contact	Malignant pustules (painless ulcer) Can progress to bacteremia and death Black skin lesions - vesicular papules covered by black eschar *[I think these only occur via contact route of infxn]
Anthrax via inhalation of spores	Flulike Sx that rapidly progress to fever, pulmonary hemorrhage, mediastinitis, and shock
Woolsorter's dz	Anthrax caused by inhalation of spores from contaminated wool
Listeria monocytogenes route of transmission	Acquired by ingestion of unpasteurized milk/cheese and deli meats, or by vaginal transmission during birth.
Listeria monocytogenes motility	Form actin rockets by which they move from cell to cell. Characteristic tumbling motility.
Listeria monocytogenes Diseases	Can cause: amnionitis septicemia spontaneous abortion granulomatosis infantiseptica neonatal meningitis meningitis in the immunocompromised mild gastroenteritis (healthy individuals) Note: is the only G(+) organism w/ endotoxin
Actinomyces and Nocardia	Both are G(+) rods forming long branching filaments, resembling fungi SNAP: S ulfa for N ocardia, A ctinomyces use P CN
Actinomyces israelii	G(+) anaerobe Causes oral/facial abscesses that may drain thru sinus tracts in skin. Forms yellow sulfur granules in sinus tracts. Normal oral flora.
Nocardia asteroides	G(+) and also weakly acid-fast aerobe found in soil. Causes pulmonary infxn in immunocompromised pts.
Primary TB	Mycobacterium infects nonimmune host (usu. child). 1' TB causes hilar nodes and Ghon focus (usu. in lower lobes) -> together = Ghon Complex Several outcomes: Heals by fibrosis Progressive lung dz Severe bacteremia Preallergic lymphatic or hematogenous dissemination <img src="150b - TB primary infxn.JPG" />
Primary TB (Heals by fibrosis)	Immunity and hypersensitivity \| Tuberculin (+)
Primary TB \| Progressive Lung dz	(Seen in HIV, malnutrition) \| Death (rare)
Primary TB (severe bacteremia)	\| Miliary TB \| Death
Primary TB Preallergic lymphatic or hematogenous dissemination	\| Dormant tubercle bacilli in several organs \| Reactivation in adult life \| Extrapulmonary TB or Reactivation of TB in lungs
Extrapulmonary TB	CNS (parenchymal tuberculoma or meningitis) Vertebral body (Pott's dz) Lymphadenitis Renal GI
Secondary TB	Due to re-infxn of partially immune hypersensitized host (usu. adult) or reactivation of dormant TB in the lungs Causes Fibrocaseous cavitary lesion (usu. in upper lobes) <img src="150c - TB secondary infxn.JPG" />
PPD test and TB	PPD (+) w/ current infxn, past exposure, or BCG vaccinated PPD (-) if no infxn or anergic (steroids, malnutrition, immunocompromise, sarcoidosis)
Ghon complex	TB granulomas (Ghon focus) w/ lobar and perihilar lymph node involvement. Reflects primary infxn or exposure.
Mycobacterium tuberculosis	Causes TB (Sx: fever, night sweats, weight loss, and hemoptysis) Often resistant to multiple drugs <img src="TB1.JPG" /><img src="TB2.JPG" /><img src="TB3.JPG" />
Mycobacterium kansasii	pulmonary TB-like Sx
Mycobacterium avium-intracellulare	Often resistant to multiple drugs Causes disseminated dz in AIDS
Leprosy (Hansen's dz)	Caused by Mycobacterium leprae, an acid-fast bacillus that likes cool temperatures (thus infects skin and superficial nerves), and cannot be grown in vitro. See common Sx below: <img src="151a - Leprosy.JPG" />
Reservoir for leprosy in the USA	armadillos
Tx for Leprosy	long-term oral dapsone Toxicity is hemolysis and methemoglobinemia Alternative Tx's: Rifampin Combination of clofazimine and dapsone
2 Forms of Hansen's dz	Lepromatous: <img src="Lepromatous Leprosy.JPG" /> and Tuberculoid Lepromatous is worse (failed cell-mediated immunity); tuberculoid is self-limited LEpromatous is LEthal
Classifying G(-) Cocci	Maltose fermenter: Neisseria meningitidis Maltose non-fermenter: Neisseria gonorrhoeae
G(-) Coccoid rods	Haemophilus influenzae Pasteurella - (animal bites) Brucella - (brucellosis) Bordetella pertusis
G(-) Rods \| Lactose fermenters \| ?	Fast fermenters: Klebsiella E. coli Enterobacter Slow fermenters : Citrobacter Serratia (others)
G(-) Rods \| Lactose non-fermenters \| ?	Oxidase (-): Shigella Salmonella Proteus Oxidase (+): Pseudomonas
Lactose-fermenting enteric bacteria	Grow pink colonies on MacConkey's agar. Examples: C itrobacter, K lebsiella, E . coli, E nterobacter, S erratia (Lactose is KEE, so test w/ MacC onKEE'S agar
PCN and Gram(-) bugs	G(-) bugs are resistant to benzylpenicillin G but may be susceptible to PCN derivatives such as ampicillin. The G(-) outer membrane inhibits entry of PCN-G and Vancomycin
Neisseria (generally)	Both are: Gram(-) cocci Ferment glucose and produce IgA proteases. <img src="Neisseria gonorrhoeae.JPG" />
Neisseria gonorrheae (Gonococci)	No polysaccharide capsule No maltose fermentation (Gonococci ferment Glucose) No vaccine Sexually transmitted Causes gonorrhea, septic arthritis, neonatal conjunctivitis, PID
Neisseria meningitidis (Meningococci)	Polysaccharide capsule Maltose fermentation (MeninGococci ferments Maltose and Glucose) Vaccine available Transmitted by respiratory and oral secretions Causes meningococcemia and meningitis, Waterhouse-Friderichsen syndrome
Haemophilus influenzae Causes...? Produces what? Mode of transmission?	HaEMOP hilus causes: Epiglottitis, Meningitis, Otitis media, and Pneumonia. (Most invasive dz caused by capsular type B) Does NOT cause flu (influenza virus does) Produces IgA Protease Aerosol transmission
Tx for Haemophilus influenzae	Ceftriaxone. Rifampin prophylaxis in close contacts.
Culturing H. influenzae	Chocalate agar w/ factors V (NAD) and X (hematin) When a child has 'flu', mom goes to the five (V ) and dime (X ) store to buy some chocolate [remember that H. influenzae does not cause flu]
Haemophilus influenzae vaccine	Contains type B capsular polysaccharide conjugated to diphtheria toxoid or other protein to improve immune system recognition of polysaccharide and promote class switching. Given btw 2 and 18 months of age.
Legionella pneumophila	Gram (-) rod Gram stains poorly --> silver stain Grow on charcoal yeast extract culture w/ iron and cysteine. Think of a French legionnaire (soldier) with his silver helmet, sitting around a campfire (charcoal ) w/ his iron dagger -- he is no sissy (cysteine )
Transmission of Legionella pneumophilia	Aerosol transmission from environmental water souce habitat. no person-to-person transmission.
Dz's caused by Legionella pneumophila Tx?	Legionnaires' dz (severe pneumonia) Pontiac fever (mild influenza) Tx: erythromycin
Pseudomonas aeruginosa Diseases?	Associated w/ wound and burn infxn PSEDUO Pneumonia (esp. in CF) Sepsis (black lesions on skin) Exteral otitis (swimmer's ear) UTI Drug use Diabetic Osteomyelitis (+ hot tub folliculitis) *Think Pseudomonas in burn victims
Pseudomonas aeruginosa classification and idenification	AERobic (AERuginosa) G(-) rod Non-lactose fermenting Oxidase (+) Produces pyocyanin (blue-green pigment) Has a grapelike odor Comes from water source
Pseudomonas aeruginosa products	Endotoxin (fever, shock) Exotoxin A (inactivates EF-2)
Pseudomonas aeruginosa Tx?	Aminoglycoside + extended-spectrum PCN (e.g., piperacillin, ticarcillin)
Members of Enterobacteriacea	Diverse family including: E. coli Salmonella Shigella Klebsiella Enterobacter Serratia Proteus
Commonalities among Enterobacteriaceae	All species have somatic (O) Ag (which is the polysaccharide of endotoxin). The capsular (K) Ag is related to the virulence of the bug. The flagellar (H) Ag is found in motile species. All ferment glucose and are oxidase (-) COFFEe Capsular (K) O Ag Flagellar Ag (H) Ferment glucose Enterobacteriaceae
Klebsiella causes...	Pneumonia in alcoholics and diabetics (red currant jelly sputum) Also a cause of nosocomial UTIs relates to the 4 A's: Aspiration pneumonia Abscess in lungs Alcoholics di-A-betics
Salmonella typhi	Causes typhoid fever: diarrhea, HA, rose spots on abdomen. Can remain in gallbladder chronically.
Salmonella vs. Shigella	Both: Lactose non-fermenters Invade the intestinal mucosa and can cause bloody diarrhea Only Salmonella: Has flagella, and can spread hematogenously (like how Salmon swim), Produces H2S. Shigella: Do not have flagella, but can propel themselves while inside cells by actin polymerization Spread by 4 F's: Food, Fingers, Feces, and Flies Is more virulent (10 organisms infective vs. Salmonella: 100,000)
Salmonellosis	Sx may be prolonged w/ ABX treatments There is typically a monocytic response
Yersinia enterocolitica	Usually transmitted from pet feses (e.g., puppies), contaminated milk, or pork. Outbreaks are common in day-care centers. Sx can mimic Crohn's or appendicitis.
Helicobacter pylori Causes...? Is a risk factor for...?	Causes: Gastritis and up to 90% of duodenal ulcers Risk factor for: peptic ulcer, gastric adenocarcinoma, and lymphoma
Helicobacter pylori Classification/identification	G(-) Rod. Urease (+) --> creates alkaline environment. <img src="154a - H pylori.JPG" />
Helicobacter pylori Tx?	Triple-therapy (two regimens): 1.) Bismuth (Pepto-bismol), metronidazole, and either TCN or amoxicillin 2.) Metronidale, omeprazole, and clarithromycin (*more costly option)
Spirochetes	Spiral-shaped w/ axial filaments. <img src="154b - Spirochetes.JPG" /> Include: Borellia (big size) Leptospira Treponema (BLT. B is Big) Only Borrelia can be vizualized w/ aniline dyes (Wright's or Giemsa). Treponema is vizualized w/ dark-field microscopy.
Leptospira interrogans	Question mark-shaped bacteria found in water contaminated w/ animal urine. <img src="154c - Leptospira.JPG" /> Causes: Leptospirosis - (flu-like Sx, fever, HA, abdominal pain, jaundice. Most prevalent in tropics) Weil's dz (ictohemorrhagic leptospirosis) - severe form w/ jaundice and azotemia from liver and kidney dysfxn; fever, hemorrhage, and anemia
Treponemal diseases	Treponemes are spirochetes. Treponema pallidum: Causes syphilis Treponema pertenue: Causes yaws; Infxn of skin, bone, and joints --> healing w/ keloids --> severe limb deformities Dz of the tropics. Not an STD, but VDRL positive.
Syphilis Cause? Tx?	Caused by Treponema pallidum Tx w/ PCN G
Primary syphilis	Presents w/ painless chancre (localized dz) Many treponemes present in chancre. <img src="Primary syphilis.JPG" />
Secondary syphilis	Disseminated dz w/ constitutional Sx's, macupapular rash (palms and soles), condylomata lata. Many terponemes are present in condylomata lata. S econdary Sy philis = Sy stemic
Tertiary syphilis	gummas (chronic granulomas), arotitis (vasa vasorum destruction), neurosyphilis (tabes dorsalis), Argyll Robertson pupil (small pupils that accomodate but do not constrict/react [according to wikipedia, known as prostitutes pupils b/c they accomodate, but don't react - not sure what that means) Signs: Broad-based axilla Positive Romberg Charcot joints Stroke w/o HTN
Congenital syphilis	CN VIII deafness Saber shins (outward curve like a saber) <img src="Saber shin.JPG" /><img src="Saber.jpg" /> Saddle nose <img src="pasteowvzle.jpg" /> Hutchinson's teeth (smaller and more widely spaced) <img src="Hutchinsons teeth.JPG" />
Argyll Robertson Pupil	Constricts w/ accomodation but is not reactive to light. Associated w/ tertiary syphilus. Prostitute's Pupil - accomodates but does not react (???)
VDRL vs. FTA-ABS	FTA-ABS is specfifc for treponemes, turns (+) earlies in dz, and remains (+) longest. VDRL and FTA-ABS: (+) result means active infxn (+) VDRL: Probably a false positive (+) FTA: Successfully treated FTA-ABS = Find The Ab ABSolutely: 1.) Most specific 2.) Earliest (+) 3.) Remains (+) longest
VDRL False Positives	VDRL detects nonspecifc Ab that reacts w/ beef cardiolipin. Used for Dx of syphilis, but many biologic false positivies. Sources of false positives --> VDRL V iruses (mono, hepatitis) D rugs R heumatic fever L upus and L eprosy
List of zoonotic bacteria	Big Bad Bugs From Your Pet named Ella B artonella henselae B orrelia burgdorferi B rucella spp. F rancisella tularensis Y ersinia pestis P asteurella multocida
Bartonella henselae Disease? Transmission?	Causes: cat scratch fever Transmission: cat scratch
Borrelia burgdorferi Disease? Transmission?	Causes: Lyme disease transmission: Tick bite; Ixodes ticks that live on deer and mice
Brucella spp. Disease? Transmission?	Causes: Brucellosis / undulant fever Transmission: Dairy products, contact w/ animals Un pasteurized dairy gives you Un dulant fever.
Francisella tularensis Disease? Transmission?	Causes: Tularemia Transmission: Tick bite; rabbits, deer
Yersinina pestis Causes? Transmission?	Causes: Plague Transmission: Flea bite; rodents (esp. prairie dogs)
Pasteurella multocida Disease? Transmission?	Causes: Cellulitis Transmission: Animal bit; cats, dogs
Gardnerella vaginalis Microscopic appearance? Causes ....? Tx?	Pleomorphic, gram-variable rod. Causes vaginosis (off-white/gray vaginal discharge w/ fishy smell; nonpainful) Mobiluncus (an anaerobe) is also involved. Vaginosis is associated w/ sexual activity, but is not an STD. Bacterial vaginosis is characterized by overgrowth of certain bacteria in vagina. Clue cells seen. Tx for vaginosis: metronidazole
Clue cells	Seen in bacterial vaginosis Vaginal epithelial cells covered w/ bacteria <img src="Bacterial vaginosis Clue cell.JPG" />
Rickettsiae Metabolism? Disease? Tx?	Obligate intracellular organisms Need CoA and NAD All except Coxiella are transmitted by an arthropod vector and cause HA, fever, and rash. Coxiella is an atypical rickettsia b/c it is transmitted by aerosol and causes pneumonia. Tx for most rickettsial infxns: TCN
Classic triad for rickettsial infxns	HA, fever, rash (vasculitis)
Rickettsia rickettsii Disease? Transmission? Tx?	Causes Rocky Mountain spotted fever Transmission via tick Tx: TCN
Ricketsia typhus dz? transmission? Tx?	Causes endemic typhus Transmission via fleas Tx: TCN
Rickettsia prowazekii Dz? Transmission? Tx?	Causes epidemic typhus Transmission via human body louse Tx: TCN
Ehrlichia Dz? Transmission? Tx?	Causes Ehrlichiosis Transmission via tick Tx: TCN
Coxiella burnetti Dz? Transmission? Tx?	Causes Q fever Q fever is Queer b/c it has no rash, no vector, and has negative Weil-felix, its causative roganism can survive outside for a long time, and does not have Rickettsia as its genus name. Transmission via inhaled aerosols Tx: TCN
Rickettsial rash vs. Typhus rash	Rickettsial rash starts on hands and feet; Typhus rash starts centrally and spreads out: R ickettisa on the wR ists, T yphus on the T runk.
Rocky Mountain Spotted Fever	Caused by Rickettsia rickettsii Sx: rash on palms and soles (migrating to wrists, ankles, then trunk), HA, fever. Endemic to East Coast (in spite of its name).
Palm and sole rash	Seen in: C oxsackievirus A infxn (hand, foot, and mouth dz) R ocky Mountain spotted fever S yphilis (You drive CARS using your palms and soles)
Weil-Felix Reaction	Assays for anti-rickettsial Abs, which cross-react w/ Proteus Ag. Weil-Felix is usually positive for typhus and Rocky Mountain spotted fever, but negative for Q fever.
Chlamydiae	Cannot make their own ATP --> obligate intracellular organisms Cause mucosal infxns Chlamydial cell wall is unusual in that it lacks muramic acid Cell cycle w/ 2 forms: elementary body and initial/reticulate body
Lab Dx, Tx for Chlamydiae infxns	Dx: cytoplasmic inclusions seen on Giemsa or fluorescent Ab-stained smear Tx: erythromycin or TCN
Chlamydiae: Elementary body	Small, dense. E lementery E nters cells via endocytosis. <img src="157a - Chlamydia life cycle.JPG" />
Chlamydiae: Initial or Reticulate body	R eticulate body R eplicates in cell by fission <img src="157a - Chlamydia life cycle.JPG" />
Chlamydia trachomatis Causes...? Tx?	Causes: reactive arthritis conjunctivitisd nongonococcal urethritis pelic inflammatory dz (PID) As with all Clamydiae, Tx w/ erythromycin or TCN
Chlamydia pneumoniae Disease? Transmission?	Causes atypical pneumonia Transmitted by aerosol As w/ all Chlamydiae, Tx w/ erythromycin or TCN
Chlamydia psittaci Disease? Transmission?	Causes atypical pneumonia Transmission by aerosol *notable for avian reservoir As w/ all Chlamydiae, Tx w/ erythromycin or TCN
Chlamydia trachomatis serotypes A, B, and C	Chronic infxn, cause blindness in Africa (ABC = Africa / Blindness / Chronic Infxn)
Chlamydia trachomatis types D-K	Urethritis/PID Ectopic pregnancy Neonatal pneumonia Neonatal conjunctivitis* Neonatal dz can be acquired during passage thru infected birth canal Tx: oral erythromycin
Chlamydia trachomatis serotypes L1, L2, and L3	Lymphogranuloma venerum (Acute lymphadenitis - positive Frei test) L 1-3 = L ymphogranuloma venerum
Mycoplasma pneumoniae Causes...? Epidemiology of dz?	Classic cause of atypical walking pneumonia (insidious onset, HA, nonproductive cough, diffuse interstitial infiltrate) Mycoplasmal pneumonia is more common in pts < 30 years of age. Frequent outbreaks in military recruits and prisons.
Mycoplasma pneumoniae Info on bacterium?	<img src="157b - Mycoplasma pneumoniae.JPG" /> No cell wall. Not seen on gram stain. Only bacterial membrane containing cholesterol. Grown on Eaton's agar.
Mycoplasmal pneumonia Dx and labs? Tx?	X-ray looks worse than pt (walking pneumonia w/ diffuse interstitial infiltrate) High titer cold agglutinins (IgM) Tx: TCN or erythromycin (bugs are naturally PCN-resistant b/c they have no cell wall)
Fungal spores	Most fungal spores are asexual. Both coccidioidomycosis and histoplasmosis are transmitted by inhalation of asexual spores. Conidia = asexual fungal spores (e.g., blastoconidia, athroconidia)
Histoplasmosis	Dimorphic fungi that can cause systemic mycosis, endemic to Mississippi and Ohio river valleys. Causes pneumonia. In bird or bat droppings. Intracellular (tiny yeast inside macrophages [below]): <img src="158a - Histoplasmosis.JPG" />
Blastomycosis	Dimorphic fungi that can cause systemic mycosis, endemic to states east of Mississippi River and Central America Causes inflammatory lung dz and can disseminate to skin and bone. Forms granulomatous nodules. Big, Broad-Based Budding: <img src="158b - Blastomycosis.JPG" /> Culture on Sabouraud's agar.
Coccidioidomycosis	Dimorphic fungi that can cause systemic mycosis, endemic to Southwestern USA, California. Causes pneumonia and meninngitis; can disseminate to bone and skin. Found in San Juaquin Vally or desert (desert bumps) vally fever <img src="158c - Coccidioidomycosis.JPG" /><img src="Coccidioidomycosis.JPG" />
Paracoccidioidomycosis	Dimorphic fungi that can cause systemic mycosis, endemic to rural Latin America Captain's wheel appearance (budding yeast below): <img src="158d - Paracoccidioidomycosis.JPG" />
Dimorphic fungi	(Histoplasmosis, Blastomycosis, Coccidioidomycosis, and Paracoccidioidomycosis) Mold in soil (@ lower temps) and yeast in tissue (@higher/body temp: 37C), except coccidioidomycosis, which is a spherule in tissue. Cold = Mold, Heat = Yeast All can cause pneumonia and can disseminate. Tx: fluconazole or ketoconazole for local infxn, amphotericin B for systemic infxn. Systemic mycoses can mimic TB (granuloma formation)
Geography of systemic mycoses/dimorphic fungi	<img src="158e - Fungi geography.JPG" />
Tinea versicolor <img src="159a - Tinea versicolor.JPG" />	Caused by Malassezia furfur. Occurs in hot, humid weather. Tx: topical miconazole, selenium sulfide (Selsun). Spaghetti and meatballs appearance on KOH prep.
Tinea pedis, cruris, corporis, capitis	Pruritic lesions w/ central celaring resembling a ring, caused by dermatophytes (Microsporum, Trichophyton, and Epidermophyton). See mold hyphae on KOH prep, not dimorphic. Pets are a reservoir for Microsporum and can be treated w/ topical azoles.
Candida albicans ( alba = white)	Systemic or superficial fungal infxn. Yeast w/ pseudohyphae in culture at 20C; germ tube formation at 37C (diagnostic). <img src="159b - Candida.JPG" /><img src="Candida albicans.JPG" />
Candida albicans Causes what?	Causes: Oral and esophageal thrush in immunocompromised (neonates, steroids, diabetes, AIDS) Vulvovaginitis (high pH, diabetes, use of ABX) Diaper rash Endocarditis in IV drug users Disseminated candidiasis (to any organ) Chronic mucocutaneous candidiasis
Candida albicans Tx?	Nystatin for superficial infxn Amphotericin B for serious systemic infxn
Aspergillus fumigatus Causes what?	Causes: Allergic bronchopulmonary aspergillosis Lung cavity aspergilloma (fungus ball) Invasive aspergillosis, especially in immunocompromised indvls and those w/ chronic granulomatous dz
Aspergillus fumigatus	Mold w/ septate hyphae that branch at a V-shaped (45 degree) angle Not dimorphic. <img src="159c - Aspergillus.JPG" />
Cryptococcus neoformans Causes what?	Causes: Crytococcal meningitis Cytococcosis
Cryptococcus neoformans	Heavily encapsulated yeast . Not dimorphic. Found in soil, pigeon droppings. <img src="159d - Cryptococcus.JPG" />
Cryptococcus neoformans Culture? Identification?	Culture w/ Sabouraud's agar. Stains w/ India ink. Latex agglutination test detects pollysaccharide capsular Ag. Soap bubble lesions in brain. <img src="Cryptococcus neoformans.JPG" />
Mucor and Rhizopus species	Cause mucormycosis. Mold w/ irregular nonseptate hyphae branching at wide angles (> 90 degrees). <img src="159e - Mucor.JPG" />
Mucormycosis epidemiology/pathogenesis	(caused by Muro and Rhizopus spp.) Dz most likely in ketoacidotic diabetic and leukemic pts. Fungi also proliferate in the walls of blood vessels and cause infarction and necrosis of distal tissue. Rhinocerebral, frontal lobe abscesses.
Pneumocystis jiroveci (formerly carinii) Causes what? Mode of transmission? In whom?	Causes diffuse interstitial pneumonia. Most infxns asymptomatic. Inhaled. Immunosuppression predisposes to dz.
Pneumocystis jiroveci (formerly carinii) (organism)	Yeast (originally classified as protozoan). Identified by methenamine silver stain of lung tissue. <img src="160a - Pneumocystis jiroveci.JPG" /><img src="Pneumocystis jiroveci.JPG" />
Pneumocystis jiroveci (formerly carinii) Dx?	Diffuse, bilateral CXR appearance. Dx by lung biopsy or lavage: identified by methenamine silver stain of lung tissue.
Pneumocystis jiroveci (formerly carinii) Tx?	TMP-SMX, pentamidine, dapsone. Start prophylaxis when CD4 drops < 200 cells/mL in HIV pts.
Sporothrix schenkii Causes what?	Sporotrichosis. When traumatically introduced into the skin, typically by a thorn (rose gardener's dz), causes local pustule or ulcer w/ nodules along draining lymphatics (ascending lymphangitis). Little systemic illness.
Sporothrix schenkii Organism?	Dimorphic fungus that lives on vegetation. Cigar-shaped budding yeast visible in pus. <img src="160b - Sporothrix schenki.JPG" />
Sporothrix schenkii Tx?	Itraconazole or potassium iodide
Protozoa: Giardia lamblia Dz? Transmission? Dx? Tx?	Giardiasis: bloating, flatulence, foul-smelling diarrhea (often seen in campers/hikers) Transmitted via cysts in water Dx: trophozoites or cysts in stool Tx: Metronidazole <img src="161a - Giardia lamblia.JPG" /><img src="Giardia lamblia.JPG" />
Protozoa: Trachomonas vaginalis Dz? Transmission? Dx? Tx?	Causes vaginitis: foul-smelling, greenish discharge; itching and burning Transmission: sexual Dx: Trophozoites (motile) on wet mount Tx: Metronidazole <img src="162e - Trichomonas vaginalis.JPG" /><img src="Trachomonas vaginalis.JPG" />
Protozoa: Trypanosoma cruzi Dz? Transmission? Dx? Tx?	Causes Chagas' dz (dilated cardiomyopathy, megacolon, megaesophagus); predominantly in South America Transmitted by Reduviid bug (kissing bug) Dx by blood smear Tx w/ Nifurtimox <img src="162a - Trypanosoma cruzi.JPG" />
Protozoa: Trypanosoma: T. gambiense T. rhodesiense Dz? Transmission? Dx? Tx?	Cause African sleeping sickness: enlarged LNs, recurring fever (due to antigenic variation), somnolence, coma Transmitted by Tsetse fly Dx via blood smear Tx w/ SUR amin for blood-borne dz, or MELA rsoprol for CNS penetration (it SUR e is nice to sleep; MELA tonin helps w/ sleep)
Protozoa: Leishmania donovani Dz? Transmission? Dx? Tx?	Causes visceral leishmaniasis (kala-azar): spiking fevers, hepatosplenomegaly, pancytopenia Transmitted by sandfly Dx via macrophages containing amastigotes Tx w/ sodium stibogluconate <img src="162b - Leishmania donovani.JPG" />
Protozoa: Plasmodium: P. vivax P. ovale P. malariae P. falciparum Dz? Transmission? Dx? Tx?	Cause malaria: cyclic fever, HA, anemia, splenomegaly. Severe (cerebral) malaria w/ P. falciparum. P. vivax and P. ovale have dormant forms in liver (hypnozoites) --> relapsing malaria Transmitted by mosquito (Anopheles) Dx via blood smear Tx w/ Chloroquine (primaquine to prevent relapse caused by P. vivax, P. ovale), sulfadoxine + pyrimethamine, mefloquine, quinine
Protozoa: Babesia Dz? Transmission? Dx? Tx?	Cause babesiosis: fever and hemolytic anemia; predominantly in northeastern USA. Transmitted by Ixodes tick. Dx: blood smear, no RBC pigment, appears as a Maltese cross Tx: Quinine, clindamycin <img src="162d - Babesia.JPG" />
Protozoa: Crytosporidium Dz? Transmission? Dx? Tx?	Causes severe diarrhea in AIDS Mild dz (watery diarrhea) in non-immunocompromised Transmitted by cysts in water Dx: cysts on acid-fast stain Tx: None :-( <img src="161c - Cryptosporidium.JPG" />
Protozoa: Toxoplasma gondii Dz? Transmission? Dx? Tx?	Causes brain abscess in HIV, birth defects (ring-enhancing brain lesions) Transmitted by cysts in meat or cat feces; crosses placenta (pregnant women should avoid cats!) Dx: serology, biopsy Tx: Sulfadiazine + primethamine <img src="161d - Toxoplasma gondii.JPG" />
Protozoa: Entamoeba histolytica Dz? Transmission? Dx? Tx?	Causes amebiasis: bloody diarrhea, (dysentery), liver abscess, RUQ pain Transmission: cysts in water Dx: Serology and/or trophozoites or cysts in stool; RBCs in cytoplasm of entaoema Tx: Metronidazole and iodoquinol <img src="161b - Entamoeba histolytica.JPG" />
Protozoa: Naegleria fowleri Dz? Transmission? Dx? Tx?	Causes rapidly fatal meningoencephalitis Transmission: swimming in freshwater lakes (enter via cribiform plate) Dx: amoebas in spinal fluid Tx: none :-( <img src="161e - Naegleria fowleri.JPG" />
Nematodes (roundworms): Enterobius vermicularis (pinworm) Transmission/dz? Tx?	Transmission via food contaminated w/ eggs; intestinal infection; causes anal pruritis (the Scotch tape test) Tx: Mebendazole/pyrantel pamoate
Transmission via food contaminated w/ eggs; intestinal infection; causes anal pruritis (the Scotch tape test) Tx: Mebendazole/pyrantel pamoate	Enterobius vermicularis (pinworm)
Nematodes (roundworms): Ascaris lumbricoides (giant round worm) Transmission/dz? Tx?	Eggs are visible in feces; intestinal infxn. Tx: Mebendazole/pyrantel pamoate.
Eggs are visible in feces; intestinal infxn. Tx: Mebendazole/pyrantel pamoate.	Ascaris lumbricoides (giant round worm)
Nematodes (roundworms): Trichinella spiralis Transmission/dz? Tx?	In undercooked meat, usually pork; Inflammation of muscle (larvae encyst in muscle); periorbital edema. Tx: Thiabendazole.
In undercooked meat, usually pork; Inflammation of muscle (larvae encyst in muscle); periorbital edema. Tx: Thiabendazole.	Trichinella spiralis
Helminths	Multicellular organisms. Life cycle involves stages in other organisms.
Nematodes (roundworms): Strongyloides stercoralis Transmission/dz? Tx?	Larvae in soil penetrate the skin; intestinal infxn; causes vomiting, diarrhea, and anemia. Tx: Ivermectin/thiabendazole.
Larvae in soil penetrate the skin; intestinal infxn; causes vomiting, diarrhea, and anemia. Tx: Ivermectin/thiabendazole.	Strongyloides stercoralis
Nematodes (roundworms): Ancylostoma duodenale, Necator americanus (hookworms) Transmission/dz? Tx?	Larvae penetrate skin of feet; intestinal infxn can cause anemia (sucks blood from intestinal walls) Tx: Mebendazole/pyrantel pamoate (worms are BEND y; treat w/ meBEND azole)
Larvae penetrate skin of feet; intestinal infxn can cause anemia (sucks blood from intestinal walls) Tx: Mebendazole/pyrantel pamoate (worms are BEND y; treat w/ meBEND azole)	Ancylostoma duodenale, Necator americanus (hookworms)
Nematodes (roundworms): Dracunculus medinensis Transmission/dz? Tx?	In dirnking water; skin inflammation and ulceration Tx: Niridazole
In dirnking water; skin inflammation and ulceration Tx: Niridazole	Dracunculus medinensis
Nematodes (roundworms): Onchocerca volvulus Transmission/dz? Tx?	Transmitted by female blackflies; causes river blindness, w/ skin nodules and lizard skin. Can have allergic reaction to microfilaria. Tx: Ivermectin (IVER mectin for rIVER blindness
Transmitted by female blackflies; causes river blindness, w/ skin nodules and lizard skin. Can have allergic reaction to microfilaria. Tx: Ivermectin (IVER mectin for rIVER blindness	Onchocerca volvulus
Nematodes (roundworms): Loa loa Transmission/dz? Tx?	Transmitted by deer fly, horse fly, and mango fly; causes swelling in skin (can see worm crawling in conjunctiva) Tx: Diethylcarbamazine
Transmitted by deer fly, horse fly, and mango fly; causes swelling in skin (can see worm crawling in conjunctiva) Tx: Diethylcarbamazine	Loa loa
Nematodes (roundworms): Wucheria bancrofti Transmission/dz? Tx?	Female mosquito; Causes blockage of lymphatic vessels (elephantiasis) Takes 9 mos to 1 yr after bite to get elephantiasis syndrome Tx: Diethylcarbamazine
Female mosquito; Causes blockage of lymphatic vessels (elephantiasis) Takes 9 mos to 1 yr after bite to get elephantiasis syndrome Tx: Diethylcarbamazine	Wucheria bancrofti
Nematodes (roundworms): Toxocara canis Transmission/dz? Tx?	Food contaminated w/ eggs; Causes granulomas (if in retina --> blindness!) and visceral larva migrans Tx: diethylcarbamazine
Food contaminated w/ eggs; Causes granulomas (if in retina --> blindness!) and visceral larva migrans Tx: diethylcarbamazine	Toxocara canis
Cestodes (tapeworms): Taenia solium Transmission/dz? Tx?	Ingestion of larvae envysted in undercooked pork leads to intestinal tapeworms. Ingestion of eggs causes cysticercosis and neurocysticercosis, mass lesions in brain (swiss cheese appearance) Tx: Praziquantel for intestinal worms and cysticercosis; albendazole for neurocysticercosis
Ingestion of larvae envysted in undercooked pork leads to intestinal tapeworms. Ingestion of eggs causes cysticercosis and neurocysticercosis, mass lesions in brain (swiss cheese appearance) Tx: Praziquantel for intestinal worms and cysticercosis; albendazole for neurocysticercosis	Taenia solium
Cestodes (tapeworms): Diphyllobothyrium latum Transmission/dz? Tx?	Ingestion of larvae in raw freshwater fish. Causes vitamin B12 deficiency, resulting in anemia. Tx: Praziquantel.
Ingestion of larvae in raw freshwater fish. Causes vitamin B12 deficiency, resulting in anemia. Tx: Praziquantel.	Diphyllobothyrium latum
Cestodes (tapeworms): Echinococcus granuloosus Transmission/dz? Tx?	Eggs in dog feces when ingested can cause cysts in liver; Causes anaphylaxis if organism's Ags are released from cyst. Tx: Albendazole
Eggs in dog feces when ingested can cause cysts in liver; Causes anaphylaxis if organism's Ags are released from cyst. Tx: Albendazole	Echinococcus granuloosus
Trematodes (flukes): Schistosoma Transmission/dz? Tx?	Snails are host; Cercariae penetrate skin of humans, causes granulomas, fibrosis, and inflammation of the spleen and liver. Chronic infxn w/ S. haematobium can lead to squamous cell carcinoma of the bladder. Tx: Praziquantel.
Snails are host; Cercariae penetrate skin of humans, causes granulomas, fibrosis, and inflammation of the spleen and liver. Chronic infxn w/ S. haematobium can lead to squamous cell carcinoma of the bladder. Tx: Praziquantel.	Schistosoma
Trematodes (flukes): Clonorchis sinensis Transmission/dz? Tx?	Undercooked fish; Causes inflammation of the biliary tract --> pigmented gallstones. Also associated w/ cholangiocarcinoma. Tx: Praziquantel.
Undercooked fish; Causes inflammation of the biliary tract --> pigmented gallstones. Also associated w/ cholangiocarcinoma. Tx: Praziquantel.	Clonorchis sinensis
Trematodes (flukes): Paragonimus wetermani Transmission/dz? Tx?	Undercooked crab meat; causes inflammation and secondary bacterial infxn of the lung. Tx: Praziquantel.
Undercooked crab meat; causes inflammation and secondary bacterial infxn of the lung. Tx: Praziquantel.	Paragonimus wetermani
Nematode routes of infxn --> Ingestion	E nterobius A scaris T richinella (You'll get sick if you EAT these!)
Nematode routes of infxn --> Cutaneous	S tongyloides A ncyclostoma N ecator (These get into your feet from SAN d)
Brain cysts, seizures	Taneia solium (cysticercosis)
Parasite hints - Finding: Taneia solium (cysticercosis)	Parasite hints - organism: Brain cysts, seizures
Liver cysts	Echinococcus granulosus
Parasite hints - Finding: Echinococcus granulosus	Parasite hints - organism: Liver cysts
B12 deficiency	Diphyllobothrium latum
Parasite hints - Finding: Diphyllobothrium latum	Parasite hints - organism: B12 deficiency
Biliary tract dz	Clonorchis sinensis
Parasite hints - Finding: Clonorchis sinensis	Parasite hints - organism: Biliary tract dz
Hemoptysis	Paragonimus westermani
Parasite hints - Finding: Paragonimus westermani	Parasite hints - organism: Hemoptysis
Portal HTN	Shistosoma mansoni
Parasite hints - Finding: Shistosoma mansoni	Parasite hints - organism: Portal HTN
Hematuria, bladder cancer	Schistosoma haematobium
Parasite hints - Finding: Schistosoma haematobium	Parasite hints - organism: Hematuria, bladder cancer
Microcytic anemia	Ancyclostoma, Necator
Parasite hints - Finding: Ancyclostoma, Necator	Parasite hints - organism: Microcytic anemia
Perianal pruritis	Enterobius
Parasite hints - Finding: Enterobius	Parasite hints - organism: Perianal pruritis
Tricky T's: Typhoid fever	caused by bacterium Salmonella typhi.
Tricky T's: Typhus	caused by bacteria Rickettsia prowazekii (epidemic), Rickettsia typhi (endemic), and Rickettsia tsutsugamushi (scrub typhus)
Tricky T's: Chlamydia trachomatis	Bacteria, STD
Tricky T's: Treponema	Spirochete; causes syphilis (T. pallidum) or yaws (T. pertenue)
Tricky T's: Trichomonas vaginalis	Protozoan, STD.
Tricky T's: Typanosoma	Protozoan, causes Chagas' dz (T. cruzi) or African sleeping sickness.
Tricky T's: Toxoplasma	protozoan, a TORCH infxn.
Tricky T's: Trichinella spiralis	Nematode in undercooked meat.
Naked Icosahedral virus	<img src="165a - Naked icosahedral virus.JPG" />
Enveloped Icosahedral virus	<img src="165b - Enveloped icosahedral virus.JPG" />
Enveloped helical virus	<img src="165c - Enveloped helical virus.JPG" />
Recombination	Exchange of genese btw 2 Chromosomes by crossing over w/in regions of significant base sequence homolgy.
Reassortment	When viruses w/ segmented genomes (e.g., influenza virus) exchange segments. High-frequency recombination. Cause of worldwide influenza pandemics.
Complementation	When 1 of 2 viruses that infect the cell has a mutation that results in a nonfunctional protein. The nonmutated virus complements the mutated one by making functional protein that serves both viruses.
Phenotypic mixing	Occurs w/ simultaneous infxn of a cell w/ 2 viruses. Genome of virus A can be partially or completely coated (forming pseudovirion) w/ surface protein of virus B. Type B protein coat determines the infectivity of the phenotypically mixed virus. However, the progeny from this infxn have a type A coat that is encoded by its type A genetic material.
Viral vaccines	Live attenuated vaccines induce humoral and cell-mediated immunity, but have reverted to virulence on rare occasions. Killed vaccines induce only humoral immunity, but are stable. No boosters are needed for live-attenuated vaccines. It's dangerous to give live vaccines to immunocompromised pts or their close contacts.
Important live attenuated vaccines	Measles, mumps, rubella, Sabin polio, VZV, yellow fever, smallpox MMR = Measles, mumps, rubella
Important killed vaccines	R abies, I nfluenza, Salk P olio, and HA V vaccines killed = RIP A lways
Important recombinant viral vaccines	HBV (Ag = recombinant HBsAg) HPV (types 6, 11, 16, and 18)
DNA viral genomes	All DNA viruses except the parvoviridae are dsDNA. All are linear except papilloma, polyoma, and hepadnaviruses (circular). All are dsDNA (like our cells), except part-of-a-virus (parvovirus)
RNA viral genomes	All RNA viruses except Reoviridae are ssRNA All are ssRNA (like our mRNA) except re peato virus (reo virus) is dsRNA
Naked viral genome infectivity	Purified nucleic acids of most sdDNA (except poxviruses and HBV) and (+)strand RNA (~mRNA) viruses are infectious. Naked nucleic acids of (-)strand ssRNA and dsRNA viruses are not infectious. They require enzymes contained in the complete viriion.
Virus ploidy	All viruses are haploid (w/ 1 copy of DNA or RNA) except retroviruses, which have 2 identical ssRNA molecules (~diploid)
Viral replication	DNA viruses all replicate in the nucleus (except poxvirus) All RNA viruses replicate in the cytoplasm (except influenza virus and retroviruses)
Non-enveloped viruses (list)	Naked (nonenveloped) viruses include: Calcivirus Picornavirus Reovirus Parvovirus Adenovirus Papilloma Polyoma Naked CPR and PAPP smear
Enveloped viruses	Generally, enveloped viruses acquire their envelopes from plasma membrane when they exit from the cell. Exceptions are herpesviruses, which acquire envelopes from the nuclear membrane.
DNA enveloped viruses (list)	Herpesviruses (HSV types 1 and 2, VZV, CMV, EBV), HBV, smallpox virus
DNA nucleocapsid viruses (list)	Adenovirus, papillomaviruses, parvovirus
RNA enveloped viruses (list)	Influenza virus, parainfluenza virus, RSV, measles virus, mumps virus, rubella virus, rabies virus, HTLV, HIV
RNA nucleocapsid viruses (list)	Enteroviruses (poliovirus, coxsackievirus, echovirus, HAV), rhinovirus, reovirus (rotavirus)
DNA viruses (list)	HHAPPPPy viruses! Hepadna Herpes Adeno Pox Parvo Papilloma Polyoma
All DNA viruses:	1.) Are double stranded (EXCEPT parvo: ssDNA) 2.) All are linear (EXCEPT papilloma and polyoma - circular, supercoiled and hepadna - circular, incomplete) 3.) Are icosahedral (EXCEPT pox: complex) 4.) Replicate in the nucleus (EXCEPT pox - carries own DNA-dep RNA pol)
Viral families: Herpesvirus Envelope? DNA strxr? Medical importance?	Enveloped. dsDNA, linear. HSV-1: oral (and some genital) lesions, keratoconjunctivitis HSV-2: genital (and some oral) lesions VZV: chickenpox, zoster, shingles EBV: mononucleosis, Burkitt's lymphoma CMV: infxn in immunosuppressed pts, especially transplant recipients; congenital defects HHV-6: roseola (exanthem subitum) HHV-8: Kaposi's sarcoma-associated virus (KSHV)
Viral families: Hepadnavirus Envelope? DNA strxr? Medical importance?	Enveloped. Partial circular dsDNA. HBV: Acute or chronic hepatitis. Vaccine available: use has increased tremendously. Not a retrovirus, but has reverse transcriptase.
Viral families: Adenovirus Envelope? DNA strxr? Medical importance?	Nonenveloped. Linear dsDNA Febrile pharyngitis - sore throat Pneumonia Conjunctivitis (pink eye)
Viral families: Parvovirus Envelope? DNA strxr? Medical importance?	Nonenveloped. Linear (-)ssDNA (smallest DNA virus). B19 virus: aplastic crises in sickle cell dz, slapped cheeks rash - erythema infectiosum (fifth dz), hydrops fetalis.
Viral families: Papillomavirus Envelope? DNA strxr? Medical importance?	Nonenveloped. Circular dsDNA HPV: warts, CIN, cervical cancer.
Viral families: Polyomavirus Envelope? DNA strxr? Medical importance?	Nonenveloped. Circular, dsDNA. JC: progressive multifocal leukoencephalopathy (PML) in HIV
Viral families: Poxvirus Envelope? DNA strxr? Medical importance?	Enveloped. Linear dsDNA (largest DNA virus). Smallpox, although eradicated, could be used in germ warfare. Vaccinia: cowpox (milkmaid's blisters) Molluscum contagiosum.
Herpesviruses: HSV-1 Dz? Route of Transmission?	Dz: Gingivostomatitis keratoconjunctivitis temporal lobe encephalitis (most common cause of sporadic encephalitis in the USA) Herpes labialis Transmission: Respiratory secretions Saliva
Dz: Gingivostomatitis keratoconjunctivitis temporal lobe encephalitis (most common cause of sporadic encephalitis in the USA) Herpes labialis Transmission: Respiratory secretions Saliva	HSV-1
Herpesviruses: HSV-2 Dz? Route of Transmission?	Dz: Herpes genitalis [below] Neonatal herpes Transmission: Sexual contact Perinatal <img src="546a - herpes.JPG" />
Dz: Herpes genitalis [below] Neonatal herpes Transmission: Sexual contact Perinatal <img src="546a - herpes.JPG" />	HSV-2
Herpesviruses: VZV (Varicella-Zoster Virus) Dz? Route of Transmission?	Dz: Shingles (below) Encephalitis Pneumonia Transmission: Respiratory secretions *VZV remains dormant in the trigeminal and dorsal root ganglia. <img src="546a - VZV.JPG" />
Dz: Shingles (below) Encephalitis Pneumonia Transmission: Respiratory secretions *VZV remains dormant in the trigeminal and dorsal root ganglia. <img src="546a - VZV.JPG" />	VZV (Varicella-Zoster Virus)
Herpesviruses: EBV Dz? Route of Transmission?	Dz: Infectious mononucleosis Burkitt's lymphoma Nasopharyngeal carcinoma Transmission: Respiratory secretions, saliva
Dz: Infectious mononucleosis Burkitt's lymphoma Nasopharyngeal carcinoma Transmission: Respiratory secretions, saliva	EBV
Herpesviruses: CMV Dz? Route of Transmission?	Dz: Congenital infxn Mononucleosis (negative Monospot) Pneumonia. Infected cells have characteristic owl's eye appearance (below) Transmission: Congenital Transfusion Sexual contact Saliva Urine Transplant <img src="545a - CMV Owls eye.JPG" />
Dz: Congenital infxn Mononucleosis (negative Monospot) Pneumonia. Infected cells have characteristic owl's eye appearance (below) Transmission: Congenital Transfusion Sexual contact Saliva Urine Transplant <img src="545a - CMV Owls eye.JPG" />	CMV
Herpesviruses: HHV-8 Dz? Route of Transmission?	Dz: Kaposi's sarcoma (in HIV pts) Transmission: Sexual contact
Dz: Kaposi's sarcoma (in HIV pts) Transmission: Sexual contact	HHV-8
EBV	A herpesvirus. Can cause mononucleosis. Infects B cells. Also associated w/ development of Hodgkin's and endemic Burkitt's lymphomas, as well as nasopharyngeal carcinoma.
Mononucleosis due to EBV Sx/findings?	Fever, hepatosplenomegaly, pharyngitis, and lymphadenopathy (especially posterior cervical LNs). Abnormal circulating cytotoxic T-cells (atypical lymphocytes). Positive Monospot test.
When does EBV peak?	Peak incidence 15-20 yrs. Most common during peak kissing years (kissing dz)
Positive Monospot test	Heterophil Abs detected by agglutination of sheep RBCs (positive in EBV infxn)
Herpesviruses (list)	Get herpes in a CHEV rolet C MV H SV E BV V ZV
Tzanck test	A smear of an opened skin vesicle to detect multinucleated giant cells. Used to assay for HSV-1, HSV-2, and VZV. Tzanck heavens I don't have herpes!
Cowdry A inclusions	Intranuclear inclusions shown in cells infected w/ HSV (would show up on Tzanck smear)
Viral family: Reoviruses Envelope? RNA structure? Capsid symmetry? Medical importance?	No Envelope. dsRNA , linear, 10-12 segments Icosahedral (double) capsid Reovirus: Colorado tick fever Rotavirus: #1 cause of fatal diarrhea in children
No Envelope. dsRNA , linear, 10-12 segments Icosahedral (double) capsid Reovirus: Colorado tick fever Rotavirus: #1 cause of fatal diarrhea in children	Reoviruses
Viral family: Picornaviruses Envelope? RNA structure? Capsid symmetry? Medical importance?	No envelope ss(+)RNA, linear Icosahedral capsid. Poliovirus: polio-Salk/Sabin vaccines -- IPV/OPV Echovirus: aseptic meningitis Rhinovirus: common cold Coxsackievirus: aseptic meningitis, herpangina --febrile pharyngitis, hand, foot, and mouth dz, myocarditis HAV: acute viral hepatitis
No envelope ss(+)RNA, linear Icosahedral capsid. Poliovirus: polio-Salk/Sabin vaccines -- IPV/OPV Echovirus: aseptic meningitis Rhinovirus: common cold Coxsackievirus: aseptic meningitis, herpangina --febrile pharyngitis, hand, foot, and mouth dz, myocarditis HAV: acute viral hepatitis	Picornaviruses
Viral family: Hepevirus Envelope? RNA structure? Capsid symmetry? Medical importance?	No envelope. ss(+)RNA, linear Icosahedral capsid. HEV
No envelope. ss(+)RNA, linear Icosahedral capsid. HEV	Hepevirus
Viral family: Calciviruses Envelope? RNA structure? Capsid symmetry? Medical importance?	No envelope. ss(+)RNA, linear. Icosahedral capsid. Norwalk virus -- viral gastroenteritis.
No envelope. ss(+)RNA, linear. Icosahedral capsid. Norwalk virus -- viral gastroenteritis.	Calciviruses
Viral family: Flaviviruses Envelope? RNA structure? Capsid symmetry? Medical importance?	Enveloped. ss(+)RNA, linear. Icosahedral capsid. HCV Yellow fever Dengue St. Louis encephalitis West Nile Virus (*=arbovirus)
Enveloped. ss(+)RNA, linear. Icosahedral capsid. HCV Yellow fever Dengue St. Louis encephalitis West Nile Virus (*=arbovirus)	Flaviviruses
Viral family: Togaviruses Envelope? RNA structure? Capsid symmetry? Medical importance?	Enveloped. ss(+)RNA, linear. Icosahedral capsid. Rubella (German measles) Eastern equine encephalitis Western equine encephalitis (*=arbovirus)
Enveloped. ss(+)RNA, linear. Icosahedral capsid. Rubella (German measles) Eastern equine encephalitis Western equine encephalitis (*=arbovirus)	Togaviruses
Viral family: Retroviruses Envelope? RNA structure? Capsid symmetry? Medical importance?	Enveloped. ss(+)RNA, linear. Icosahedral capsid. Have reverse transcriptase HIV/AIDS HTLV - T-cell leukemia
Enveloped. ss(+)RNA, linear. Icosahedral capsid. Have reverse transcriptase HIV/AIDS HTLV - T-cell leukemia	Retroviruses
Viral family: Coronaviruses Envelope? RNA structure? Capsid symmetry? Medical importance?	Enveloped. ss(+)RNA, linear. Helical capsid. Coronavirus -- common cold and SARS
Enveloped. ss(+)RNA, linear. Helical capsid. Coronavirus -- common cold and SARS	Coronaviruses
Viral family: Orthomyxoviruses Envelope? RNA structure? Capsid symmetry? Medical importance?	Enveloped. ss(-)RNA, linear. 8 segments. Helical capsid. Inflenza virus.
Enveloped. ss(-)RNA, linear. 8 segments. Helical capsid. Inflenza virus.	Orthomyxoviruses
Viral family: Paramyxoviruses Envelope? RNA structure? Capsid symmetry? Medical importance?	Enveloped. ss(-)RNA, linear, nonsegmented. Helical capsid. P aR aM yxovirus: P arainfluenza -- croup R SV -- bronchiolitis in babies; Rx -- ribavirin Rubeola (M easles) M umps
Enveloped. ss(-)RNA, linear, nonsegmented. Helical capsid. P aR aM yxovirus: P arainfluenza -- croup R SV -- bronchiolitis in babies; Rx -- ribavirin Rubeola (M easles) M umps	Paramyxoviruses
Viral family: Rhabdoviruses Envelope? RNA structure? Capsid symmetry? Medical importance?	Enveloped. ss(-)RNA, linear. Helical capsid. Rabies.
Enveloped. ss(-)RNA, linear.	Helical capsid. Rabies. Rhabdoviruses
Viral family: Filoviruses Envelope? RNA structure? Capsid symmetry? Medical importance?	Enveloped. ss(-)RNA, linear. Helical capsid. Ebola/Marburg hemorrhagic fever -- often fatal!
Enveloped. ss(-)RNA, linear. Helical capsid. Ebola/Marburg hemorrhagic fever -- often fatal!	Filoviruses
Viral family: Arenaviruses Envelope? RNA structure? Capsid symmetry? Medical importance?	Enveloped. ss(-)circular RNA, 2 segments. Helical capsid. LCMV -- lymphocyticc choriomeningitis virus. Lassa fever encephalitis -- spread by mice.
Enveloped. ss(-)circular RNA, 2 segments. Helical capsid. LCMV -- lymphocyticc choriomeningitis virus. Lassa fever encephalitis -- spread by mice.	Arenaviruses
Viral family: Bunyaviruses Envelope? RNA structure? Capsid symmetry? Medical importance?	Enveloped. ss(-)circular RNA, 3 segments. Helical capsid. California encephalitis Sandflly/Rift Valley fevers Crimean-Congo hemorrhagic fever Hantavirus -- hemorrhagic fever, pneumonia (*=arbovirus)
Enveloped. ss(-)circular RNA, 3 segments. Helical capsid. California encephalitis Sandflly/Rift Valley fevers Crimean-Congo hemorrhagic fever Hantavirus -- hemorrhagic fever, pneumonia (*=arbovirus)	Bunyaviruses
Viral family: Deltavirus Envelope? RNA structure? Capsid symmetry? Medical importance?	Enveloped. ss(-)circular RNA. Helical capsid. HDV.
Enveloped. ss(-)circular RNA. Helical capsid. HDV.	Deltavirus
Negative-stranded Viruses	Must transcribe (-) strand to (+) Virion brings its own RNA-dependent RNA polymerase. Include: A renaviruses B unyaviruses P aramyxoviruses O rthomyxoviruses F iloviruses R habdoviruses Always Bring Polymerase Or Fail Replication
Segmented Viruses	All are RNA viruses. Include: B unyaviruses O rthomyxoviruses (influenza viruses) A renaviruses R eoviruses (BOAR ) Influenza virus has 8 segments of (-)RNA These segments undergo reassortment, causing antigenic shifts that lead to worldwide pandemics of the flu.
Picornaviruses	Include: P oliovirus E chovirus R hinovirus C oxsackievirus H AV (PERCH on a 'peak ' [pico]) RNA is translated into 1 large polypeptide that is cleaved by proteases into functional viral proteins. Can cause aseptic (viral) meningitis (except rhinovirus and HAV). (PicoRNA virus = small RNA virus)
Rhinovirus	A picornavirus. Nonenveloped RNA virus. Cause of common cold. (Rhino has a runny nose) >100 serologic types.
Yellow fever virus	A flavivirus (also an arbovirus) transmitted by Aedes mosquitos. Virus has monkey or human reservoir. Sx: high fever, black vomitus, and jaundice. Councilman bodies (acidophilic inclusions) may be seen in liver. ( Flavi = yellow)
Rubella virus	A togavirus. Causes German (3-day) measles: Fever, lymphadenopathy, arthralgias, fine truncal rash. Causes mild dz in children but serious congenital dz (a TORCH infxn)
Rotavirus	The most important global cause of infantile gastroenteritis. Segmented dsRNA virus (a reovirus). <img src="170a - Rotavirus.JPG" /> Major cause of acute diarrhea in the USA during winter, especially in daycare centers, kindergartens. Villous destruction w/ atrophy leads to decreased absorption of Na+ and water. ROTA = R ight O ut T he A nus
Influenza virus	Orthomyxoviruses. Enveloped, ssRNA, w/ segmented genome. Contain hemagglutinin (promotes viral entry) and neuraminidase (promotes progeny virion release) Ags. Responsible for worldwide influenza epidemics; pt at risk for fatal bacterial superinfeciton. Rapid genetic changes.
A major mode of protection from influenza virus?	Killed viral vaccine. A reformulated vaccine is offered each fall to elderly, healthcare workers, etc.
Influenza virus and genetic shift	(pandemic) Reassortment of viral genome (such as when human flu A virus recombines w/ swine flu A virus) S udden S hift is more deadly that graD ual D rift
Influenza virus and gentic drift	(Epidemic) Minor (antigenic drift) changes based on random mutation. S udden S hift is more deadly that graD ual D rift
Paramyxoviruses	Paramyxoviruses cause dz in children. They include those that cause: parainfluenza (croup: seal-like barking cough), mumps , measles , and RSV (which causes repiratory tract infection [bronchiolitis, pneumonia] in infants)
Rubeola (measles) virus	A paramyxovirus that causes measles. Koplik spots (red spots w/ blude-white center on buccal mucosa [below]) are diagnostic. <img src="547a - Koplik spots.JPG" /> SSPE (yrs later), encephalitis (1:2000), and giant cell pneumonia (rarely, in immunosuppressed) are possible sequelae. Rash spreads from head to toe [below] <img src="547b - Measles rash.JPG" />
3C's of Measles	C ough C oryza (head cold) C onjunctivitis *Also look for K oplik spots (not actually a C, but close enough)
Mumps virus	A paramyxovirus. Sx: P arotitis O rchitis (inflammation of the testes) [aseptic] M eningitis Mumps makes your parotid glands and testes as big as POM -poms Can cause sterility (especially after puberty)
Rabies virus	Negri bodies are characteristic cytoplasmic inclusions in neurons affected by rabies viru: <img src="171b - Negri Bodies.JPG" /> Bullet shaped capsid: <img src="171a - Rabies virus.JPG" /> Rabies has a long incubation period (wks-months), which allows for immunization after exposure. Causes fatal encephalitis w/ seizures, hydrophobia, hypersalivation, and pharyngeal spasm. Travels to CNS by migrating in a retrograde fashion up nerve axons.
How is rabies virus more commonly contracted in the USA?	Bat, raccoon, and skunk bites > dog bites (in USA)
Arbovirus	Transmitted by arthropods (mosquitoes, ticks). Classic examples: dengue fever (aka break-bone fever) and yellow fever . A variant of dengue fever in SE Asia is hemorrhagic shock syndrome . ARBO virus = AR thropod-BO rne virus Includes some members of F lavivirus, T ogavirus, and B unyavirus: F ever T ransmitted by B ites
"Lots of spots": Rubella	Togavirus; German 3-day measles.
"Lots of spots": Rubeola	Paramyxovirus; measles.
"Lots of spots": Varicella	Herpesvirus; chickenpox and zoster.
"Lots of spots": Variola	Poxvirus; smallpox (no longer present outside of labs).
How many families of Hepatitis viruses are there?	5: HAV HBV HCV HDV HEV
HAV	RNA picornavirus. Transmitted primarily by fecal-oral route. Short incubation (3 weeks). No carriers. HepA is A symptomatic (usually) A cute, A lone (no carriers)
HBV	DNA hepadnavirus. Transmitted primarily by parenteral, sexual, and maternal-fetal routes. HepB = B lood-B orne Long incubation (3 months). Carriers. Cellular RNA polymerase transcribes RNA from DNA template. Reverse transcriptase transcribes DNA genome from RNA intermediate. However, the virion enzyme is a DNA-dependent DNA polymerase .
HCV	RNA flavivirus. Transmitted primarily via blood and resembles HBV in its course and severity. Carriers. Common cuase of post-transfusion hepatitis and of hepatitis among IV drug users in the USA. HepC = C hronic, C irrhosis, C arcinoma, C arriers.
HDV	Delta agent. A defective virus that requires HBsAg as its envelope. HDV can coinfect w/ HBV or superinfect; the latter has a worse prognosis. Carriers. HepD = D efective, D ependent on HBV.
HEV	RNA hepevirus. Transmitted enterically and causes water-borne epidemics. Resembles HAV in course, severity, incubation. High mortality rate in pregnant women. HepE = E nteric, E xpectant mothers, E pidemics
Both HBV and HCV...	... predispose pt to chronic active hepatitis, cirrhosis, and hepatocellular carcinoma.
HepA and HepE are transmitted...	... via the fecal-oral route. The vowels hit your bowels .
IgG HAVAb	Indicates prior infection; protective against reinfection.
IgM HAVAb	IgM Ab to HAV; best test to detect active hepatitis A.
HBsAg	Ag found on surface of HBV; continued presence indicates carrier state. <img src="173a - Hepatitis.JPG" /><img src="173b - hepatitis Abs (1).JPG" />
HBsAb	Ab to HBsAg; provides immunity to hepatitis B. <img src="173b - hepatitis Abs (1).JPG" />
HBcAg	Ag associated w/ core of HBV <img src="173b - hepatitis Abs (1).JPG" />
HBcAb	Ab to HBcAg; positive during window period [see below]. IgM HBcAb is an indicator of recent dz. IgG HBcAb signifies chronic dz. <img src="173b - hepatitis Abs (1).JPG" />
HBe Ag	A second, different antigenic determinant in the HBV core. Important indicator of active viral replication and therefore transmissibility. Be ware! <img src="173b - hepatitis Abs (1).JPG" />
HBeAb	Ab to e antigen ; indicaters low transmissibility. <img src="173b - hepatitis Abs (1).JPG" />
Viral vs. alcoholic hepatitis (liver enzymes)	Viral hepatitis: ALT > AST Alcoholic hepatitis: AST > ALT
When do you see HBsAg?	acute disease [not in window phase] [not in complete recovery] chronic carrier state [not in immunized]
When do you see HBsAb?	[Not in acute dz] [In window phase, basically no. (Pt has surface Ab, but available Ab is bound to HBsAg, so not detected by assay)] Complete Recovery [not in chronic carrier state] Immunized
When do you see HBcAb?	Acute Disease (IgM in acute stage; IgG in chronic or recovered stage) Window Phase Complete Recovery Chronic Carrier State [not in immunized]
What HBV Ag/Ab's would show up in acute disease?	HBsAg and HBcAb [not: HBsAb]
What HBV Ag/Ab's would show up in the window phase?	HBcAb only.
What HBV Ag/Ab's would show up in complete recovery?	HBsAb and HBcAb. [not: HBsAg]
What HBV Ag/Ab's would show up in chronic carrier state?	HBsAg and HBcAb. [not: HBsAb]
What HBV Ag/Ab's would show up in immunized individuals?	HBsAb only.
HIV structure and proteins	<img src="174a - HIV structure.JPG" />
HIV's genome	Diploid (2 molecules of RNA, but not dsRNA).
HIV: p24	Capsid protein
HIV: gp41 and gp120	Envelope proteins.
Function of reverse transcriptase in HIV	Synthesizes dsDNA from RNA. dsDNA integrates into host genome.
HIV virus binding	Virus binds CXCR4 and CD4 on T-cells; binds CCR5 and CD4 on macrophages. Homozygous CCR5 mutation = immunity. Heterozygous CCR5 mutation = slower course.
ELISA and HIV dx	Used for presumptive diagnosis (sensitive, high false-positive rate and low threshold, RULE OUT test); postitive results are then confirmed w/ Western blot assay (specific, high false-negative rate and high threshold, RULE IN test). ELISA/Western blot tests look for Abs to viral proteins; these tests are often falsely negative in the first 1-2 months of HIV infxn and falsely positive initially in babies born to infected mothers (angti-gp120 crosses placenta).
PCR/viral load and HIV	Tests are increasing in poluarity: allow the physician to monitor the effect of drug therapy on viral load.
AIDS diagnosis	< or = 200 CD4+, HIV positive w/ AIDS indicator condition (e.g., PCP) or CD4/CD8 ratio <1.5
4 stages of HIV infxn	1.) F lu-like (acute) 2.) F eeling fine (latent) 3.) F alling count 4.) F inal crisis During latent phase, virus replicates in LN's <img src="175a - Timecourse of HIV.JPG" />
Levels as HIV infxn progresses: CD4+ lymphocytes? Anti-p24 Abs? Anti-gp120 Abs? Virus, p24 Ag?	CD4+ T-cells have an early dip, stabilize, and fall during stages 3-4 (years after infxn) Anti-p24 and Anti-gp120 Abs rise starting ~1 mo. post-infxn, stabilize @ 3 mos (at end of acute infxn). Virus, p24 Ag: spike early (w/ start of acute Sx's), drop to low level until stages 3-4 (years later), when they take off <img src="175a - Timecourse of HIV.JPG" />
Organ system affected in AIDS: Brain (what is the infxn/dz associated?)	Infxn/dz associated w/ AIDS: Crytococcal meningitis Toxoplasmosis CMV encephalopathy AIDS dementia PML (JC virus)
Organ system affected in AIDS: Eyes (what is the infxn/dz associated?)	Infxn/dz associated w/ AIDS: CMV retinitis
Organ system affected in AIDS: Mouth and throat (what is the infxn/dz associated?)	Infxn/dz associated w/ AIDS: Thrush (Candida albicans) HSV CMV Oral hairy leukoplakia (EBV)
Organ system affected in AIDS: Lungs (what is the infxn/dz associated?)	Infxn/dz associated w/ AIDS: Pneumocystis jiroveci pneumonia (PJP) TB histoplasmosis
Organ system affected in AIDS: GI (what is the infxn/dz associated?)	Infxn/dz associated w/ AIDS: Cryptosporidiosis Mycobacterium avium-intracellulare complex CMV colitis Non-Hodgkin's lymphoma (EBV) Isopora belli
Organ system affected in AIDS: Skin (what is the infxn/dz associated?)	Infxn/dz associated w/ AIDS: Shingles (VZV) Kaposi's sarcoma (HHV-8)
Organ system affected in AIDS: Genitals (what is the infxn/dz associated?)	Infxn/dz associated w/ AIDS: Genital herpes warts cervical cancer (HPV)
HIV-assicated infxns that increase in risk at CD4+ count: < 400	Infxn: Oral thrush Tinea pedis (athlete's foot) Reactivation VZV Reactivation tuberculosis Other bacterial infxns (e.g., H. influenzae, S. pneumoniae, Salmonella)
HIV-assicated infxns that increase in risk at CD4+ count: < 200	Infxn: Reactivation HSV cryptosporidosis Isopora Disseminated coccidioidomycosis Pneumocystis pneumonia
HIV-assicated infxns that increase in risk at CD4+ count: < 100	Infxn: Candidal esophagitis Toxoplamosis histoplasmosis
HIV-assicated infxns that increase in risk at CD4+ count: < 50	Infxn: CMV retinitis and esophagitis Disseminated M. avium-intracellulare Cryptococcal meningitis
Neoplasms associated w/ HIV	Kaposi's sarcoma (HHV-8) Invasive cervical carcinoma (HPV) Primary CNS lymphoma non-Hodgkin's lymphoma
HIV encephalitis	Occurs late in the course of HIV infxn. Virus gains CNS access via infected Macrophages. Microglial nodules w/ multinucleated giant cells.
Prions What are they? What dz's do they cause? Normal vs. pathologic prions?	Infectious agents that do not contain RNA or DNA (consist only of proteins); encoded by cellular genes. Dz's: Creutzfeldt-Jakob dz (CJD -- rapidly progressive dementia), kuru, srapie (sheep), mad cow dz Associated w/ spongiform encephalopathy . Normal prions have alpha-helix conformation; pathologic prions (like CJD) are beta-pleated sheets. Pathologic conformation accumulates b/c it is resistant to proteinase digestion.
Dominant normal flora of the: Skin	Staphylococcus epidermis
Dominant normal flora of the: Nose	S. epidermis; colonized by S. aureus
Dominant normal flora of the: Oropharynx	Viridans group streptococci
Dominant normal flora of the: Dental plaque	Streptococcus mutans
Dominant normal flora of the: Colon	Bacteroides fragilis > E. coli
Dominant normal flora of the: Vagina	Lactobacillus, colonized by E. coli and GBS
Neonates and normal flora	Neonates delivered by cesarean section havve no flora, but are rapidly colonized after birth.
Food poisoning from: Vibrio parahemolyticus and V. vulnificus	Food: Contaminated seafood (V. vulnificus can also cause wound infxn from contact w/ contaminated water or shellfish)
Food poisoning from: Bacillus cereus	Food: reheated rice. (Food poisoning from reheated rice? Be Serious! [B. cereus])
Food poisoning from: S. aureus	Food: Meats, mayonnaise, custard (pre-formed toxin)
Food poisoning from: Clostridium perfringens	Food: reheated meat dishes
Food poisoning from: Clostridium botulinum	Food: improperly canned foods (bulging cans)
Food poisoning from: E. coli O157:H7	Food: Undercooked meat
Food poisoning from: Salmonella	Food: poultry, meat, and eggs.
What are two bacteria that cause a food poisoning that starts quickly and ends quickly?	S. aureus and B. cereus
Bugs that cause diarrhea: Campylobacter Type of diarrhea? Findings?	Bloody diarrhea. Comma- or S-shaped organisms; growth at 42C; Oxidase (+) [bugs that cause diarrhea: type of diarrhea and findings]
Bloody diarrhea. Comma- or S-shaped organisms; growth at 42C; Oxidase (+) [bugs that cause diarrhea: type of diarrhea and findings]	Bugs that cause diarrhea: Campylobacter
Bugs that cause diarrhea: Salmonella Type of diarrhea? Findings?	bloody diarrhea. Lactose (-); Flagellar motility [bugs that cause diarrhea: type of diarrhea and findings]
bloody diarrhea. Lactose (-); Flagellar motility [bugs that cause diarrhea: type of diarrhea and findings]	Bugs that cause diarrhea: Salmonella
Bugs that cause diarrhea: Shigella Type of diarrhea? Findings?	Bloody diarrhea Lactose (-) Very low ID50 Produces Shiga toxin [bugs that cause diarrhea: type of diarrhea and findings]
Bloody diarrhea Lactose (-) Very low ID50 Produces Shiga toxin [bugs that cause diarrhea: type of diarrhea and findings]	Bugs that cause diarrhea: Shigella
Bugs that cause diarrhea: Enterohemorrhagic E. coli (EHEC) Type of diarrhea? Findings?	Bloody diarrhea O157:H7 Can cause HUS Makes Shiga-like toxin [bugs that cause diarrhea: type of diarrhea and findings]
Bloody diarrhea O157:H7 Can cause HUS Makes Shiga-like toxin [bugs that cause diarrhea: type of diarrhea and findings]	Bugs that cause diarrhea: Enterohemorrhagic E. coli (EHEC)
Bugs that cause diarrhea: Enteroinvasive E. coli (EIEC) Type of diarrhea? Findings?	Bloody diarrhea. Invades colonic mucosa. [bugs that cause diarrhea: type of diarrhea and findings]
Bloody diarrhea. Invades colonic mucosa. [bugs that cause diarrhea: type of diarrhea and findings]	Bugs that cause diarrhea: Enteroinvasive E. coli (EIEC)
Bugs that cause diarrhea: Yersinia enterocolitica Type of diarrhea? Findings?	Bloody diarrhea Day-care outbreaks Pseudoappendicitis [bugs that cause diarrhea: type of diarrhea and findings]
Bloody diarrhea Day-care outbreaks Pseudoappendicitis [bugs that cause diarrhea: type of diarrhea and findings]	Bugs that cause diarrhea: Yersinia enterocolitica
Bugs that cause diarrhea: C. difficile Type of diarrhea? Findings?	Can cause both watery and bloody diarrhea. Pseudomembranous colitis. [bugs that cause diarrhea: type of diarrhea and findings]
Can cause both watery and bloody diarrhea. Pseudomembranous colitis. [bugs that cause diarrhea: type of diarrhea and findings]	Bugs that cause diarrhea: C. difficile
Bugs that cause diarrhea: Entamoeba histolytica Type of diarrhea? Findings?	Bloody diarrhea. Protozoan. [bugs that cause diarrhea: type of diarrhea and findings]
Bloody diarrhea. Protozoan. [bugs that cause diarrhea: type of diarrhea and findings]	Bugs that cause diarrhea: Entamoeba histolytica
Bugs that cause diarrhea: Enterotoxigenic E. coli (ETEC) Type of diarrhea? Findings?	Watery diarrhea. Traveler's diarrhea Produces ST and LT toxins [bugs that cause diarrhea: type of diarrhea and findings]
Watery diarrhea. Traveler's diarrhea Produces ST and LT toxins [bugs that cause diarrhea: type of diarrhea and findings]	Bugs that cause diarrhea: Enterotoxigenic E. coli (ETEC)
Bugs that cause diarrhea: Vibrio cholerae Type of diarrhea? Findings?	Watery diarrhea. Comma-shaped organisms Rice-water diarrhea. [bugs that cause diarrhea: type of diarrhea and findings]
Watery diarrhea. Comma-shaped organisms Rice-water diarrhea. [bugs that cause diarrhea: type of diarrhea and findings]	Bugs that cause diarrhea: Vibrio cholerae
Bugs that cause diarrhea: C. perfringens Type of diarrhea? Findings?	Watery diarrhea. Also causes gas gangrene. [bugs that cause diarrhea: type of diarrhea and findings]
Watery diarrhea. Also causes gas gangrene. [bugs that cause diarrhea: type of diarrhea and findings]	Bugs that cause diarrhea: C. perfringens
Bugs that cause diarrhea: Protozoa Type of diarrhea? Findings?	Watery diarrhea Giardia, Cryptosporidium (in immunocompromised) [bugs that cause diarrhea: type of diarrhea and findings]
Watery diarrhea Giardia, Cryptosporidium (in immunocompromised) [bugs that cause diarrhea: type of diarrhea and findings]	Bugs that cause diarrhea: Protozoa
Bugs that cause diarrhea: Viruses Type of diarrhea? Findings?	Watery diarrhea. Rotavirus, adenovirus, Norwalk virus (norovirus). [bugs that cause diarrhea: type of diarrhea and findings]
Common causes of pneumonia in neonates (< 4wks)	Group B streptococci E. coli
Common causes of pneumonia in children (4wks - 18yrs)	Viruses (R SV) M ycoplasma C hlamydia pneumoniae S treptococcus pneumoniae (R unts M ay C ough S putum)
Common causes of pneumonia in adults (18-40yrs)	Mycoplasma Chlamydia pneumoniae Streptococcus pneumoniae
Common causes of pneumonia in Adults (40-65yrs)	Streptococcus pneumoniae H. influenzae Anaerobes Viruses Mycoplasma
Common causes of pneumonia in the elderly (>65)	Streptococcus pneumoniae Viruses Anaerobes H. influenzae Gram (-) rods
Common causes of nosocomial (hospital-acquired) pneumonia	Staphylococcus Enteric Gram (-) rods
Common causes of pneumonia in the immunocompromised	Staphylococcus Enteric Gram (-) rods Fungi Viruses Pneumocystis jiroveci (w/ HIV)
Common cause of pneumonia w/ aspiration	Anaerobes
Common cause of pneumonia in alcoholics/IV drug users	Streptococcus pneumoniae Klebsiella Staphylococcus
Common causes of pneumonia in CF	Pseudomonas
Common causes of post-viral pneumonia	Staphylococcus H. influenzae
Common causes of atypical pneumonia	Mycoplasma Legionella Chlamydia
Common causes of meningitis in newborn (0-6 months	Group B streptococci E. coli Listeria
Common causes of meningitis in children (6mos - 6yrs)	Streptococcus pneumoniae Neisseria meningitidis Haemophilus influenzae type B Enteroviruses
Common causes of meningitis (6-60yrs)	N. miningitidis Enteroviruses S. pneumoniae HSV
Common causes of meningitis in 60+ year-olds	Streptococcus pneumoniae Gram (-) rods Listeria
Viral causes of meningitis	Enteroviruses (esp. coxsackievirus) HSV HIV West Nile virus VZV
Common causes of meningitis in HIV	Cryptococcus CMV Toxoplasmosis (brain abscess) JC virus (PML)
Incidence of H. influenzae meningitis?	Has decreased greatly w/ introduction of H. influenzae vaccine in last 10-15 years.
CSF findings in meningitis: Bacterial [Pressure? Cell type? Protein? Sugars?]	Increased pressure Increased PMNs Increased protein Decreased sugar
Increased pressure Increased PMNs Increased protein Decreased sugar [CSF findings in meningitis -- what is the bug?]	Bacterial
CSF findings in meningitis: Fungal/TB [Pressure? Cell type? Protein? Sugars?]	Increased pressure Increased lymphocytes Increased proein Decreased sugar
Increased pressure Increased lymphocytes Increased proein Decreased sugar [CSF findings in meningitis -- what is the bug?]	Fungal/TB
CSF findings in meningitis: Viral [Pressure? Cell type? Protein? Sugars?]	Normal/increased pressure Increased lymphocytes Normal/increased protein Normal sugar
Normal/increased pressure Increased lymphocytes Normal/increased protein Normal sugar [CSF findings in meningitis -- what is the bug?]	Viral
Osteomyelitis in most ppl is due to...? Who gets most osteomyelitis?	Staph aureus in most ppl. Most osteomyelitis occurs in children.
Elevated CRP and ESR in osteomyelitis?	Classic findings, but nonspecific
Osteomyelitis in sexually active pt	Neisseria gonorrhoeae (rare) Septic arthritis more common
Osteomyelitis in diabetics and drug addicts	Pseudomonas aeruginosa
Osteomyelitis in Sickle cell	Salmonella
Osteomyelitis in prosthetic replacement	S. aureus and S. epidermis
Osteomyelitis in vertebra	Mycobacterium tuberculosis (Pott's dz)
Osteomyelitis with cat and dog bites/scratches	Pasteurella multocida
3 Most common causes of ambulatory UTI	1.) E. coli (50-80%) 2.) Staphylococcus saprophyticus (10-30%): 2nd most common cause of UTI in young, sexually active, ambulatory women 3.) Klebsiella (8-10%)
Common causes of UTI in a hospital setting	E. coli Proteus Klebsiella Serratia Pseudomonas
Gender and epidemiology of UTIs	10:1 women to men (b/c of short urethra colonized by fecal flora)
Predisposing factors to UTIs	Flow obstruction Kidney surgery Catheterization Gynecologic abnormalities Diabetes Pregnancy
Mechanisms of UTI infxn	Mostly caused by ascending infxns. In males: babies w/ congenital defects, elderly w/ enlarged prostates
Sx of UTI	Dysuria Frequency Urgency Suprapubic pain
Sx of Pyelonephritis	Fever Chills Flank pain CVA tenderness (costovertebral angle -- tender above kidneys on back)
UTI bugs: Serratia maracescens Features?	Some strains produce a red pigment; often nosocomial and drug-resistant.
Features: Some strains produce a red pigment; often nosocomial and drug-resistant. Which UTI bug is this?	Serratia maracescens
UTI bugs: Staphylococcus saprophyticus Features?	2nd leading cause of community-acquired UTI in sexually active women.
Features: 2nd leading cause of community-acquired UTI in sexually active women. Which UTI bug is this?	Staphylococcus saprophyticus
UTI bugs: Escherichia coli Features?	Leading cause of UTI. Colonies show metallic sheen on EMB agar.
Features: Leading cause of UTI. Colonies show metallic sheen on EMB agar. Which UTI bug is this?	Escherichia coli
UTI bugs: Enterobacter cloacae Features?	Often nosocomial and drug resistant.
Features: Often nosocomial and drug resistant. Which UTI bug is this?	Enterobacter cloacae
UTI bugs: Klebsiella pneumoniae Features?	Large mucoid capsule and viscous colonies
Features: Large mucoid capsule and viscous colonies Which UTI bug is this?	Klebsiella pneumoniae
UTI bugs: Proteus mirabilis Features?	Motility cuases swarming on agar. Produces urease; associated w/ struvite stones.
Features: Motility cuases swarming on agar. Produces urease; associated w/ struvite stones. Which UTI bug is this?	Proteus mirabilis
UTI bugs: Pseudomonas aeruginosa Features?	Blue-green pigment and fuity odor. Usually nosocomial and drug-resistant.
Features: Blue-green pigment and fuity odor. Usually nosocomial and drug-resistant. Which UTI bug is this?	Pseudomonas aeruginosa
List of UTI bugs	SSEEK PP S erratia marcescens S taphylococcus saprophyticus E scherichia coli E nterobacter cloacae K lebsiella pneumoniae P roteus mirabilis P seudomonas aeruginosa
Diagnostic markers of UTI	Leukocyte esterase: (+) = bacterial Nitrite test: (+) = Gram(-) organism
ToRCHeS infxns What are they? List?	These important infxns are transmitted in utero or during vaginal birth: T oxoplasma gondii o R ubella C MV H IV H SV-2 e S yphilis
Other important congenital infxns that do not fit into ToRCHeS	Listeria E. coli Group B streptococci All can be acquired placentally or from birth canal.
ToRCHeS infxns, organism: Toxoplasma gondii Major clinical manifestations?	Classic triad of chorionitis, intracranial calcifications, and hydrocephalus. May be asymptomatic at birth.
Major clinical manifestations: Classic triad of chorionitis, intracranial calcifications, and hydrocephalus. May be asymptomatic at birth. Which ToRCHeS organism is this?	Toxoplasma gondii
ToRCHeS infxns, organism: Rubella Major clinical manifestations?	Deafness Cataracts Heart defects (PDA, pulmonary artery stenosis) Microcephaly Mental retardation Blueberry muffin baby due to rash
Major clinical manifestations: Deafness Cataracts Heart defects (PDA, pulmonary artery stenosis) Microcephaly Mental retardation Blueberry muffin baby due to rash Which ToRCHeS organism is this?	Rubella
ToRCHeS infxns, organism: CMV Major clinical manifestations?	Petechial rash Intracranial calcifications Mental retardation Hepatosplenomegaly Microcephaly Jaundice 90% are asymptomatic at birth.
Major clinical manifestations: Petechial rash Intracranial calcifications Mental retardation Hepatosplenomegaly Microcephaly Jaundice 90% are asymptomatic at birth. Which ToRCHeS organism is this?	CMV
ToRCHeS infxns, organism: HIV Major clinical manifestations?	Hepatosplenomegaly Neurologic abnormalities Frequent infxns
Major clinical manifestations: Hepatosplenomegaly Neurologic abnormalities Frequent infxns Which ToRCHeS organism is this?	HIV
ToRCHeS infxns, organism: HSV-2 Major clinical manifestations?	Encephalitis Conjuntivitis Vesicular skin lesions Often asymptomatic at birth Most infxns are transmitted during birth thru an infected maternal genital tract.
Major clinical manifestations: Encephalitis Conjuntivitis Vesicular skin lesions Often asymptomatic at birth Most infxns are transmitted during birth thru an infected maternal genital tract. Which ToRCHeS organism is this?	HSV-2
ToRCHeS infxns, organism: Syphilis Major clinical manifestations?	Cutaneous lesions Hepatosplenomegaly Jaundice Saddle nose Saber shins Hutchinson teeth CN VIII deafness Rhinitis (snuffles)
Major clinical manifestations: Cutaneous lesions Hepatosplenomegaly Jaundice Saddle nose Saber shins Hutchinson teeth CN VIII deafness Rhinitis (snuffles) Which ToRCHeS organism is this?	Syphilis
Red rashes of childhood	Measles Rubella HHV-6 (roseola) Scarlet fever (group A streptococcus) Parvovirus B19 (slapped cheek rash)
STD's: Gonorrhea Organism? Clinical features?	Neisseria gonorrhoeae Urethritis, cervicitis, PID, prostatitis, epididymitis, arthritis, creamy purulent discharge
Neisseria gonorrhoeae Urethritis, cervicitis, PID, prostatitis, epididymitis, arthritis, creamy purulent discharge Disease?	Gonorrhea
STD's: Primary syphilis Organism? Clinical features?	Treponema pallidum Painless chancre
Treponema pallidum Painless chancre Disease?	Primary syphilis
STD's: Secondary syphilis Organism? Clinical features?	Treponema pallidum Fever, lymphadenopathy, skin rashes, condylomata lata
Treponema pallidum Fever, lymphadenopathy, skin rashes, condylomata lata Disease?	Secondary syphilis
STD's: Tertiary syphilis Organism? Clinical features?	Treponema pallidum Gummas (a non-cancerous growth, a form of granuloma) Tabes dorsalis General paresis Aortitis Argyll Robertson pupil
Treponema pallidum Gummas (a non-cancerous growth, a form of granuloma) Tabes dorsalis General paresis Aortitis Argyll Robertson pupil Disease?	Tertiary syphilis
STD's: Genital herpes Organism? Clinical features?	HSV-2 Painful penile, vulvar, or cervical ulcers; can cause systemic Sx such as: fever, HA, myalgia
HSV-2 Painful penile, vulvar, or cervical ulcers; can cause systemic Sx such as: fever, HA, myalgia Disease?	Genital herpes
STD's: Chlamydia Organism? Clinical features?	Chlamydia trachomatis (D-K) Urethritis, cervicitis, conjunctivitis, Reiter's syndrome, PID
Chlamydia trachomatis (D-K) Urethritis, cervicitis, conjunctivitis, Reiter's syndrome, PID Disease?	Chlamydia
STD's: Lymphogranuloma venereum Organism? Clinical features?	Chlamydia trachomatis (L1-L3) Ulcers, lymphadenopathy, rectal strictures.
Chlamydia trachomatis (L1-L3) Ulcers, lymphadenopathy, rectal strictures. Disease?	Lymphogranuloma venereum
STD's: Trichomoniasis Organism? Clinical features?	Trichomonas vaginalis Vaginitis Strawberry-colored mucosa
Trichomonas vaginalis Vaginitis Strawberry-colored mucosa Disease?	Trichomoniasis
STD's: AIDS Organism? Clinical features?	HIV Opportunistic infxns, Kaposi's sarcoma, lymphoma
HIV Opportunistic infxns, Kaposi's sarcoma, lymphoma Disease?	AIDS
STD's: Condylomata accumulata Organism? Clinical features?	HPV 6 and 11 Genital warts, koilocytes
HPV 6 and 11 Genital warts, koilocytes Disease?	Condylomata accumulata
STD's: Hepatitis B Organism? Clinical features?	HBV Jaundice
HBV Jaundice Disease?	Hepatitis B
STD's: Chancroid Organism? Clinical features?	Haemophilus ducreyi (it's so painful, you do cry ) Painful genital ulcer, inguinal adenopathy.
Haemophilus ducreyi (it's so painful, you do cry ) Painful genital ulcer, inguinal adenopathy. Disease?	Chancroid
STD's: Bacterial vaginosis Organism? Clinical features?	Garnderella vaginalis Noninflammatory, malodorous discharge (fishy smell) Positive whiff test Clue cells
Garnderella vaginalis Noninflammatory, malodorous discharge (fishy smell) Positive whiff test Clue cells Disease?	Bacterial vaginosis
Top bugs that cause Pelvic inflammatory dz	Chlamydia trachomatis (subacute, often undiagnosed) Neisseria gonorrhoeae (acute, high fever) Chlamydia trachomatis (the most common STD in the USA: 3-4milliion cases/year)
Signs and Sx's of Pelvic inflammatory dz	Cervical motion tenderness (chandelier sign) Purulent cervical discharge. May include: Salpingitis, endometritis, hydrosalpinx, and tubo-ovarian abscess.
Pelvic inflammatory dz can lead to... ?	Fitz-Hugh-Curtis Syndrome: infxn of the liver capsule and violin string adhesions of parietal peritoneum to liver.
What is salpingitis a risk factor for?	Ectopic pregnancy Infertility Chronic pelvic pain Adhesions
Other STD's that cause PID	Garnderella (clue cells) Trichomonas (corkscrew motility on wet prep)
Nosocomial pathogen: CMV, RSV Risk factor?	Newborn nursery
Risk factor for a nosocomial pathogen: Newborn nursery	What is the pathogen? CMV, RSV
Nosocomial pathogen: E. coli, Proteus mirabilis Risk factor?	Urinary catheterization
Risk factor for a nosocomial pathogen: Urinary catheterization What is the pathogen?	E. coli, Proteus mirabilis
Nosocomial pathogen: Pseudomonas aeurginosa Risk factor?	Respiratory therapy equipment
Risk factor for a nosocomial pathogen: Respiratory therapy equipment What is the pathogen?	Pseudomonas aeurginosa
Nosocomial pathogen: HBV Risk factor?	Work in renal dialysis unit
Risk factor for a nosocomial pathogen: Work in renal dialysis unit What is the pathogen?	HBV
Nosocomial pathogen: Candida albicans Risk factor?	Hyperalimentation
Risk factor for a nosocomial pathogen: Hyperalimentation What is the pathogen?	Candida albicans
Nosocomial pathogen: Legionella Risk factor?	Water aerosols
Risk factor for a nosocomial pathogen: Water aerosols What is the pathogen?	Legionella
The 2 most common causes of nosocomial infxns?	E. coli (UTI) S. aureus (wound infxn)
Presume Pseudomonas aeruginosa as the cause of a nosocomial infxn when...?	Presume Pseudomonas AIR uginosa when AIR or burns are involved.
When do you suspect Legionella as a cause of nosocomial infxn?	Suspect Legionella when a water source is involved.
Bug hints (if all else fails):Pus, empyema (collection of pus in pre-existing anatomical cavity), abscess What is the bug?	S. aureus
Bug hints (if all else fails):Pediatric infxn What is the bug?	haemophilus influenzae (including epiglottitis)
Bug hints (if all else fails):Pneumonia in CF, burn infxn What is the bug?	Pseudomonas aeruginosa
Bug hints (if all else fails):Branching rods in oral infxn What is the bug?	Actinomyces israellii
Bug hints (if all else fails):Traumatic open wound What is the bug?	Clostridium perfringens
Bug hints (if all else fails):Surgical wound What is the bug?	S. aureus
Bug hints (if all else fails):Dog or cat bite What is the bug?	Pasteurella multocida
Bug hints (if all else fails):Currant jelly sputum What is the bug?	Klebsiella
Bug hints (if all else fails):Sepsis/meningitis in newborn What is the bug?	group B strep
Antimicrobials by mechanism of action: Block cell wall synthesis by inhibition of peptidoglycan cross-linking	<img src="184b - sites of antimicrobials without labels.JPG" /> Drugs? Penicillin, ampicillin, ticarcillin, piperacillin, imipenem, aztreonam, cephalosporins [#1 below] <img src="184a - Sites of antimicrobials with labels.JPG" />
Antimicrobials by mechanism of action: Block peptidoglycan synthesis <img src="184b - sites of antimicrobials without labels.JPG" /> Drugs?	Bacitracin, Vancomycin [#2 below] <img src="184a - Sites of antimicrobials with labels.JPG" />
Antimicrobials by mechanism of action: Disrupt bacterial cell wall membranes <img src="184b - sites of antimicrobials without labels.JPG" /> Drugs?	Polymyxins [#3 below] <img src="184a - Sites of antimicrobials with labels.JPG" />
Antimicrobials by mechanism of action: Block nucleotide synthesis <img src="184b - sites of antimicrobials without labels.JPG" /> Drugs?	Sulfonamides, Trimethoprim [#4 below] <img src="184a - Sites of antimicrobials with labels.JPG" />
Antimicrobials by mechanism of action: Block DNA topoisomerases <img src="184b - sites of antimicrobials without labels.JPG" /> Drugs?	Quinolones [#5 below] <img src="184a - Sites of antimicrobials with labels.JPG" />
Antimicrobials by mechanism of action: Block mRNA synthesis Drugs?	Rifampin [#6 below] <img src="184a - Sites of antimicrobials with labels.JPG" />
Antimicrobials by mechanism of action: Block protein synthesis at 50S ribosomal subunit <img src="184b - sites of antimicrobials without labels.JPG" /> Drugs?	Chloramphenicol, macrolides, clindamycin, streptogramins (quinipristin, dalfopristin), linezolid [#7] <img src="184a - Sites of antimicrobials with labels.JPG" />
Antimicrobials by mechanism of action: Block protein synthesis at the 30S ribosomal subunit <img src="184b - sites of antimicrobials without labels.JPG" /> Drugs?	Aminoglycosides, tetracyclines [#8 below] <img src="184a - Sites of antimicrobials with labels.JPG" />
Bacterostatic antibiotics	E rythromycin C lindamycin S ulfamethoxazole T rimethoprim T etracylcines C hloramphenicol (We're ECST aT iC about bacteriostatics )
Bacteriocidal antibiotics	V ancomycin F luoroquinolones P enicillin A minoglycosides C ephalosporins M etronidazole V ery F inely P roficient A t C ell M urder
Forms of Penicillin	Penicillin G (IV form), Penicillin V (oral form). Prototype Beta-lactam antibiotics.
Mechanism of penicillin	1.) Bind penicillin-binding proteins 2.) Block transpeptidase cross-linking of cell wall 3.) Activate autolytic enzymes
Mechanism of penicillinase-resistant penicillins: Methicillin, nafcillin, dicoxacillin	Same as penicillin. Narrow speectrum; penicillinase resistant b/c of bulkier R group. mechanism of PCN: 1.) Bind penicillin-binding proteins 2.) Block transpeptidase cross-linking of cell wall 3.) Activate autolytic enzymes
Mechanism of aminopenicillins: Ampicillin, amoxicillin	Same as penicillin. Wider spectrum; Penicillinase sensitive. Also combine w/ clavulanic acid (a penicillinase inhibitor) to enhance spectrum. AmO xicillin has greater O ral bioavailability than ampicillin. Mechanism of PCN: 1.) Bind penicillin-binding proteins 2.) Block transpeptidase cross-linking of cell wall 3.) Activate autolytic enzymes
Mechanism of antipseudomonals: Ticarcillin, carbenicillin, piperacillin	Same as penicillin. Extended spectrum. Mechanism of penicillin: 1.) Bind penicillin-binding proteins 2.) Block transpeptidase cross-linking of cell wall 3.) Activate autolytic enzymes
Clinical use of penicillin	Bactericidal for Gram(+) cocci, Gram(+) rods, Gram(-) cocci, and spirochetes. Not penicillinase resistant.
Toxicity of penicillin	Hypersensitivity rxtns. Methicillin: interstitial nephritis.
Clinical use of aminopenicillins (ampicillin, amoxicillin)	Extended spectrum penicillin: certain gram(+) bacteria and gram(-) rods: H aemophilus influenzae, E . coli, L isteria monocytogenes, P roteus mirabilis, S almonella, enterococci (Ampicillin/amoxicillin HELPS kill enterococci) Think of amp icillin/amoxicillin as AMP ed up penicillin
Toxicity of aminopenicillins (ampicillin, amoxicillin)	Hypersensitivity rxtns; Ampicillin rash; Pseudomembranous colitis.
Clinical use of: Ticarcillin, carbenicillin, piperacillin	(antipseudomonals -- TCP : T ake C are of P seudomonas) Used for Pseudomonas spp. and gram(-) rods; susceptible to penicillinase; Use w/ clavulinic acid (Beta-lactamase inhibitor).
Toxicity of antipseudomonals (Ticarcillin, carbenicillin, piperacillin)	Hypersensitivity rxtns.
Mechanism of cephalosporins	Beta-lactam drugs that inhibit cell wall synthesis, but are less susceptible to penicillinases. Bactericidal.
Clinical use of 1st generation cephalosporins (Cefazolin, cephalexin)	Gram(+) cocci, P roteus mirabilis, E . c oli, K lebsiella pneumoniae (1st gen = PEcK )
Clinical use of 2nd generation cephalosporins (cefoxitin, cefaclor, cefuroxime)	Gram(+) cocci, H aemophilus influenzae, E nterobacter aerogenes, N eisseria spp. P roteus mirabilis, E. c oli, K lebsiella pneumoniae, S erratia marcescens (2nd Gen = HEN PEcKS )
Clinical use of 3rd generation cephalosporins (ceftriaxone, cefotaxime, ceftazidime)	Serious gram(-) infxns resistant to other beta-lactams; meningitis (most penetrate the BBB). Examples: Ceftazidime for Pseudomonas Ceftriaxone for gonorrhea
Clinical use of 4th generation cephalosporins (Cefepime)	Increased activity against Pseudomonas and gram(+) organisms.
Toxicity of cephalosporins	Hypersensitivity rxtn. Cross-hypersensitivvity w/ penicillins occurs in 5-10% of pts. Increased nephrotoxicity of aminoglycosides; disulfiram-like rxtn w/ ethanol (in cephalosporins w/ methylthitetrazole group, e.g., cefamandole)
Mechanism of aztreonam	A monobactam resistant to beta-lactamases. Inhibits cell wall synthesis (binds to PBP3). Synergistic w/ aminoglycosides. No cross-allergenicity w/ penicillins.
Clinical use of aztreonam	Gram(-) rods - Klebsiella spp., Pseudomonas spp., Serratia spp. No activity against gram(+)'s or anaerobes. For penicillin-allergic pts and those w/ renal insufficiency who cannot tolerate aminoglycosides.
Toxcity of Aztreonam	Usually nontoxic; occasional GI upset. No cross-sensitivity w/ penicillins or cephalosporins.
Mechanism of Imipenem/cilastatin, meropenem	Imipenem is a broad-spectrum, beta-lactamase-resistant carbapenem. Always administer w/ cilastatin (inhibitor of renal dihydropeptidase I) to decrease inactivation in renal tubules. (With imipenem, the kill is LASTIN' with ciLASTATIN )
Clinical use of imipenem/cilastatin, meropenem	Gram(+) cocci, gram(-) rods, and anaerobes. DOC for Enterobacter. The significant side effects limit use to life-threatening infxns, or after other drugs have failed. Meropenem, howevver, has a reduced risk of seizures and is stable to dihydropeptidase I.
Toxicity of Imipenem/cilastatin, meropenem	GI distress, skin rash, and CNS toxicity (seizures) @ high plasma levels
Mechanism of vancomycin	Inhibits cell wall mucopeptide formation by binding D-ala D-ala portion of cell wall precursors. Bactericidal. Resistance occurs w/ AA change of D-ala D-ala to D-ala D-lac
Clinical use of vancomycin	Used for serious, gram(+) multidrug-resistant organisms, including S. aureus and Clostridium difficile (pseudomembranous colitis)
Toxicity of vancomycin	N ephrotoxicity, O totoxicity, T hromophlebitis, diffuse flushing - red man syndrome (can largely prevent by pretreatment w/ antihistamines and slow infusion rate) Well toleraterd in general -- does NOT have many problems.
Protein synthesis inhibitors: 30S inhibitors	A = A minoglycosides (streptomycin, gentamycin, tobramycin, amikacin) [bacteriostatic] T = T etracyclines [bacteriostatic] (But AT 30 , CCELL (sell) at 50) [*note different specific sites of action of Aminoglycosides and TCNs below] <img src="187a - Protein synthesis inhibitors.JPG" />
Protein Synthesis Inhibitors: 50S inhibitors	C = C hloramphenicol, C lindamycin [bacteriostatic] E = E rythromycin [bacteriostatic] L = L incomycin [bacteriostatic] L = L inezolid [variable] (But AT 30, CCELL (sell) at 50 ) [note different specific sites of action below] <img src="187a - Protein synthesis inhibitors.JPG" />
Aminoglycosides (list)	G entamycin N eomycin A mikacin T obramycin S treptomycin (Mean GNATS [mean = amin oglycosides)
Mechanism of aminoglycosides (gentamycin, neomycin, amikacin, tobramycin, streptomycin)	Bactericidal; inhibit formation of initiation complex and cause misreading of mRNA. Require O2 for uptake; therefore ineffective against anaerobes. (Mean GNATS canNOT kill anaerobes)
Clinical use of aminogyclosides (gentamycin, neomycin, amikacin, tobramycin, streptomycin)	Severe gram (-) rod infxns. Synergistic w/ beta-lactam ABX. Neomycin for bowel surgery.
Toxicity of aminoglycosides (gentamycin, neomycin, amikacin, tobramycin, streptomycin)	N ephrotoxicity (especially when used w/ cephalosporins) O totoxicity (especially when used w/ loop diuretics) T eratogen. (Mean GNATS canNOT kill anaerobes)
Tetracyclines (list)	Tetracylcine Doxycycline Demeclocycline Minocycline
Mechanism of tetracyclines (tetracycline, doxycycline, demeclocyclline, minocycline)	Bacteriostatic; bind to 30S and prevent attachment of aminoacyl-tRNA. Limited CNS penetration. Doxycyline is fecally eliminated and can be used in pts w/ renal failure. Must NOT take w/ milk, antacids, or iron-containing preparations b/c divalent cations inhibit absorption in gut. D emeclocycline is an ADH antagonist (acts as a D iuretic in SIADH)
Clinical use of tetracyclines (tetracycline, doxycycline, demeclocyclline, minocycline)	V ibrio cholerae A cne C hlamydia U reaplasma U realyticum M ycoplasma pneumoniae T ularemia H . pylori B orrelia burgdorferi (Lyme dz) R ickettsia (VACUUM TH e B edR oom)
Toxicity of tetracyclines (tetracycline, doxycycline, demeclocyclline, minocycline)	GI distress Discoloration of teeth and inhibition of bone growth in children Photosensitivity Contraindicated in pregnancy.
Macrolides (list)	Erythromycin, azithromycin, clarithromycin
Mechanism of macrolides (Erythromycin, azithromycin, clarithromycin)	Inhibit protein synthesis by blocking translocation; bind to the 23S rRNA of the 50S ribosomal subunit. Bacteriostatic.
Clinical use of macrolides (Erythromycin, azithromycin, clarithromycin)	URIs, pneumonias STDs -- gram(+) cocci (streptococcal infxns in pts allergic to penicillin) Mycoplasma Legionella Chlamydia Neisseria
Toxicity of macrolides (Erythromycin, azithromycin, clarithromycin)	GI discomfort (most common cause of noncompliance) Acute cholestatic hepatitis Eosinophilia Skin rashes Increases serum concentration of theophyllines, oral anticoagulants.
Mechanism of chloramphenicol	Inhibits 50S peptidyltransferase activity. Bacteriostatic.
Clinical use of chloramphenicol	Meningitis (Haemophilus influenzae, Neisseria meningitidis, Streptococcus pneumoniae) Conservative use, owing to toxicities.
Toxicity of chloramphenicol	Anemia (dose dependent) Aplastic anemia (dose independent) Gray baby syndrome (in premature infants b/c they lack liver UDP-glucuronyl transferase)
Mechanism of clindamycin	Blocks peptide bond formation at 50S ribosomal subunit. Bacteriostatic.
Clinical use of clindamycin	Tx anaerobic infxns (e.g., Bacteroides fragilis, Clostridium perfringens) (Treats anaerobes above the diaphragm)
Toxicity of clindamycin	Pseudomembranous colitis (C. difficile overgrowth) Fever Diarrhea
Sulfonamides (list)	Sulfamethoxazole (SMX) Sulfisoxazole Sulfadiazine
Mechanism of sulfonamides (sulfamethoxazole (SMX), sulfisoxazole, sulfadiazine)	PABA antimetabolites inhibit dihydropteroate synthetase [see below]. Bacteriostatic. <img src="189a - Sulfonamides.JPG" />
Clinical use of of sulfonamides (sulfamethoxazole (SMX), sulfisoxazole, sulfadiazine)	Gram(+), gram(-), Nocardia, Chlamydia. Triple sulfas or SMX for simple UTI.
Toxicity of sulfonamides (sulfamethoxazole (SMX), sulfisoxazole, sulfadiazine)	Hypersensitivity rxtns Hemolysis if G6PD deficient Nephrotoxicity (tubulointerstitial nephritis) Photosensitivity Kernicterus in infants Displace other drugs from albumin (e.g., warfarin)
Mechanism of trimethoprim (TMP)	Inhibits bacterial dihydrofolate reductase. Bacteriostatic.
Clinical use of trimethoprim (TMP)	Used in combination w/ sulfonamides (trimethoprim-sulfamethoxazole [TMP-SMX]), causing sequential block of folate synthesis. Combination used for recurrent UTIs, Shigella, Salmonella, Pneumocystis jiroveci pneumonia.
Toxicity of trimethoprim (TMP)	Megaloblastic anemia Leukopenia Granulocytopenia (may alleviate w/ supplemental folinic acid) (Trimethoprim = TMP : T reats M arrow P oorly)
Sulfa drug allergies -- what do you need to avoid?	Pts who do not tolerate sulfa drugs should not be given sulfonamides or other sulf drugs such as: Sulfasalazine Sulfonylureas Thiazide diuretics Acetazolamide Furosemide
Fluoroquinolones (list)	Ciprofloxacin Norfloxacin Ofloxacin Sparfloxacin Moxifloxacin Gatifloxacin Enoxacin [above are fluoroquinolones] Nalidixic acid [a quinolone]
Mechanism of fluoroquinolones	Inhibit DNA gyrase (topoisomerase II). Bactericidal. Must not be taken w/ antacids.
Clinical use of fluoroquinolones	Gram(-) rods of urinary and GI tracts (including Pseudomonas), Neisseria, some gram(+) organisms
Toxicity of fluoroquinolones	GI upset, superinfections, skin rashes, HA, dizziness. Contraindicated in pregnant women and in children b/c animal studies show damage to cartilage. Tendonitis and tendon rupture in adults; leg cramps and myalgias in kids. (FlouroquinoLONES hur the attachments to your BONES )
Mechanism of metronidazole	Forms toxic metabolites in the bacterial cell that damage DNA. Bactericidal, antiprotozoal.
Clinical use of metronidazole	Treats: G iardia E ntamoeba T richomonas G ardnerella vaginalis A naerobes (Bacteroides, Clostridium) Used w/ bismuth and amoxicillin (or TCN) for triple therapy against H. P ylori (GET GAP on the METRO !) Treats anaerobic infxns below the diaphragm.
Toxicity of metronidazole	Disulfiram-like rxtn w/ alcohol Headache Metallic taste
Polymyxins (list)	Polymyxin B Polymyxin E
Mechanism of polymyxins	Bind to cell membranes of baccteria and disrupt their osmotic properties. Polymyxins are cationic, basic proteins that act like detergents. (MYXins MIX up membranes)
Clinical use of polymyxins	resistant gram(-) infxns
Toxicity of polymyxins	Neurotoxicity, acute renal tubular necrosis
Antimycobacterial drugs: for M. tuberculosis	Prophylaxis: Isoniazid Tx: R ifampin I soniazid P yrazinamide E thambutol (RIPE for treatment)
Antimycobacterial drugs: for M. avium-intracellulare	Prophylaxis: Azithromycin Tx: Azithromycin Rifampin Ethambutol Streptomycin
Antimycobacterial drugs for M. leprae	Tx: Dapsone Rifampin Clofazimine
Anti-TB drugs	S treptomycin, P yrazinamide, I soniazid (INH ), R ifampin, E thambutol (INH-SPIRE [inspire]) Cycloserine (2nd-line therapy)
Side effects of anti-TB drugs	Important SE of ethambutol: optic neuropathy (red-green color blindness) For other drugs: hepatotoxicity.
Mechanism of isoniazid (INH)	Decreases synthesis of mycolic acids. *note that there are different INH half-lives in fast vs. slow acetylators.
Clinical use of isoniazid (INH)	Mycobacterium tuberculosis. The only agent used as solo prophylaxis against TB.
Toxicity of isoniazid (INH)	Neurotoxicity, hepatotoxicity. Pyridoxine (Vitamin B6) can prevent neurotoxicity. (INH I njures N eurons and H epatocytes)
Mechanism of rifampin	Inhibits DNA-dependent RNA polymerase
Clinical use of rifampin	Mycobacterium tuberculosis. Delays resistance to dapsone when used for leprosy. Used for meningococcal prophylaxis and chemoprophylaxis in contacts of children w/ Haemophilus influenzae type B.
Toxicity of rifampin	Minor hepatotoxicity and drug interactions (induces P-450) Orange body fluids (nonhazardous side effect)
Rifampin's 4 R's	R NA polymerase inhibitor R evs up microsomal P-450 R ed/orange body fluids R apid resistance if used alone
Most common resistance mechanism for: Penicillins/cephalosporins	Beta-lactamase cleavage of beta-lactam ring, or altered PBP in cases of MRSA or penicillin-resistant S. pneumoniae.
The following is the most common mechanism of resistance for what drug? Beta-lactamase cleavage of beta-lactam ring, or altered PBP in cases of MRSA or penicillin-resistant S. pneumoniae.	Penicillins/cephalosporins
Most common resistance mechanism for: Aminoglycosides	Modification via acetylation, adenylation, or phosphorylation.
The following is the most common mechanism of resistance for what drug? Modification via acetylation, adenylation, or phosphorylation.	Aminoglycosides
Most common resistance mechanism for: Vancomycin	Terminal D-ala of cell wall component replaced with D-lac, decreased affinity.
The following is the most common mechanism of resistance for what drug? Terminal D-ala of cell wall component replaced with D-lac, decreased affinity.	Vancomycin
Most common resistance mechanism for: Chloramphenicol	Modification via acetylation
The following is the most common mechanism of resistance for what drug? Modification via acetylation	Chloramphenicol
Most common resistance mechanism for: Macrolides	methylation of rRNA near erythromycin's ribosome-binding site
The following is the most common mechanism of resistance for what drug? methylation of rRNA near erythromycin's ribosome-binding site	Macrolides
Most common resistance mechanism for: Tetracycline	Decreased uptake or increased transport out of cell.
The following is the most common mechanism of resistance for what drug? Decreased uptake or increased transport out of cell.	Tetracycline
Most common resistance mechanism for: Sulfonamides	Altered enzyme (bacterial dihydropteroate synthetase), decreased uptake, or increased PABA synthesis.
The following is the most common mechanism of resistance for what drug? Altered enzyme (bacterial dihydropteroate synthetase), decreased uptake, or increased PABA synthesis.	Sulfonamides
Most common resistance mechanism for: Quinolones	Altered gyrase or reduced uptake.
The following is the most common mechanism of resistance for what drug? Altered gyrase or reduced uptake.	Quinolones
Nonsurgical antimicrobial prophylaxis of: meningococcal infxn	Rifampin (DOC), minocycline
Nonsurgical antimicrobial prophylaxis of: gonorrhea	Ceftriaxone
Nonsurgical antimicrobial prophylaxis of: syphilis	Benzathine penicillin G
Nonsurgical antimicrobial prophylaxis of: Hx of recurrent UTIs	TMP-SMX
Nonsurgical antimicrobial prophylaxis of: Pneumocystis jiroveci pneumonia	TMP-SMX (DOC), aerosolized pentamidine.
Nonsurgical antimicrobial prophylaxis of: endocarditis w/ surgical or dental procedures	Penicillins.
Tx of highly resistant bacteria	MRSA: vancomycin VRE: linezolid and streptogramins (quinupristin/dalfopristin)
Mechanism of Amphotericin B	Binds ergosterol (unique to fungi); Forms membrane pores that allow leakage of electrolytes. (Amphotear acin 'tears' holes in fungal membranes by forming pores) [on left, below] <img src="192a - Antifungal therapy.JPG" />
Clinical use of Amphotericin B	Use for wide spectrum of systemic mycoses. Cryptococcus, Blastomyces, Coccidioides, Aspergillus, Histoplasma, Candida, Mucor (systemic mycoses). Intrathecally for fungal meningitis; does not cross BBB.
Toxicity of Amphotericin B	Fever/chills (shake and bake), hypotension, nephrotoxicity, arrhythmias, anemia, IV phlebitis (amphotericin = amphoterrible). Hydration reduces nephrotoxicity. Liposomal amphotericin reduces toxicity.
Mechanism of Nystatin	Binds to ergosterol, disrupting fungal membranes. Too toxic for systemic use. [on left w/ amphotericin, below] <img src="192a - Antifungal therapy.JPG" />
Clinical use of nystatin	Swish and swallow for oral candidiasis (thrush); topical for diaper rash or vaginal candidiasis.
Azoles (list)	Fluconazole Ketoconazole Clotrimazole Miconazole Itraconazole Voriconazole
Mechanism of azoles	Inhibit fungal sterol (ergosterol) synthesis [below, top/middle] <img src="192a - Antifungal therapy.JPG" />
Clinical use of azoles	Systemic mycoses. Fluconazole for cyptococcal meningitis in AIDS pts (b/c it can cross the BBB) and candidal infxns of all types (i.e., yeast infxns). Ketoconazole for Balstomyces, Coccidioides, Histoplasma, Candida albicans, hypercortisolism. Clotrimazole and miconazole for topical fungal infxns.
Toxicity of azoles	Hormone synthesis inhibition (gynecomastia), liver dysfunction (inhibits cytochrome P-450), fever, chills
Flucytosine mechanism	Inhibits DNA synthesis by conversion to 5-fluorouracil [below, middle] <img src="192a - Antifungal therapy.JPG" />
Clinical use of flucytosine	Used in systemic fungal infxns (e.g., Candida, Cryptococcus) in combination w/ amphotericin B
Toxicity of flucytosine	Nausea, vomiting, diarrhea, bone marrow suppression
Mechanism of Caspofungin	Inhibits cell wall synthesis by inhibiting synthesis of beta-glucan. [not included in image of anti-fungal mechanisms]
Clinical use of caspofungin	Invasive aspergillosis
Toxicity of caspofungin	GI upset, flushing.
Mechanism of terbinafine	Inhibits the fungal enzyme squalene epoxidase. [below, top/right] <img src="192a - Antifungal therapy.JPG" />
Clinical use of terbinafine	Used to Tx dermatophytoses (especially onychomycosis)
Mechanism of griseofulvin	Interferes w/ microtubule fxn; disrupts mitosis. Deposits keratin-containing tissues (e.g., nails). [below, bottom/right] <img src="192a - Antifungal therapy.JPG" />
Clinical use of griseofulvin	Oral Tx of superficial infxns; inhibits growth of dermatophytes (tinea, ringworm)
Toxicity of griseofulvin	Teratogenic, ccarcinogenic, confusion, HA, induces P-450 (increasing warfarin metabolism).
Mechanism of amantadine	Blocks viral penetration/uncoating (M2 protein); may buffer pH of endosome. (A man to dine [amantadine] takes of his coat .) Also causes the release of dopamine from intact nerve terminals. [below, top/right] <img src="193a - Antiviral sites of action.JPG" />
Clinical use of amantadine	Prophylaxis and Tx for influenza A; Parkinson's Dz. (A mantadine blocks influenza A and rubellA , and causes problems w/ the cerebellA )
Toxicity of amantadine	Ataxia, dizziness, slurred speech. (A mantadine blocks influenza A and rubellA , and causes problems w/ the cerebellA ) Rimantidine is a derivative w/ fewer CNS side effects (does not cross BBB)
Mechanism of resistance to amantadine	Mutated M2 protein. 90% of all influenza A strains are resistant to amantadine, so not used.
Mechanism of: Zanamivir, oseltamivir	Inhibit influenza neuraminidase, decreasing the release of progeny virus. [below, bottom/left: Neuraminidase inhibitors] <img src="193a - Antiviral sites of action.JPG" />
Clinical use of Zanamivir, oseltamivir	Both influenza A and B
Mechanism of ribavirin	Inhibits synthesis of guanine nucleotides by competitively inhibiting IMP dehydrogenase. [not included in figure, but acts at point of NA synthesis, bottom/right] <img src="193a - Antiviral sites of action.JPG" />
Clinical use of ribavirin	RSV Chronic hepatitis C
Toxicity of ribavirin	Hemolytic anemia. Severe teratogen.
Mechanism of acyclovir	Monophosphorylated by HSV/VZV thymidine kinase. Guanosine analog. Triphosphate formed by cellular enzymes. Preferentially inhibits viral DNA polymerase by chain termination. [fits w/ NA analogs below, bottom/right] <img src="193a - Antiviral sites of action.JPG" />
Clnicial use of acyclovir	HSV, VZV, EBV. Used for HSV-induced mucocutaneous and genital lesions as well as for encephalitis. Prophylaxis in immunocompromised pts. For herpes zoster, use a related agent (famciclovir). No effect on latent forms of HSV and VZV.
Toxicity of acyclovir	Generally well-tolerated.
Mechanism of resistance to acyclovir	Lack of thymidine kinase
Mechanism of ganciclovir	5'-monophosphate formed by a CMV viral kinase or HSV/VZV thymidine kinase. Guanosine analog. Triphosphate formed by cellular kinases. Preferentially inhibits viral DNA polymerase. [fits in w/ NA analogs below, bottom/right] <img src="193a - Antiviral sites of action.JPG" />
Clinical use of ganciclovir	CMV, especially in immunocompromised pts
Toxicity of ganciclovir	Leukopenia, neutropenia, thrombocytopenia, renal toxicity. More toxic to host enzymes than acyclovir.
Mechanism of resistance to ganciclovir	Mutated CMV DNA polymerase or lack of viral kinse.
Mechanism of foscarnet	Viral DNA polymerase inhibitor that binds to the pyrophosphate-binding site of the enzyme. Does not require activation by viral kinase. (FOS carnet = pyroFOS phate analog) [would fit into DNA synthesis on bottom/right] <img src="193a - Antiviral sites of action.JPG" />
Clinical use of foscarnet	CMV retinitis in immunocompromised pts when ganciclovir fails; acyclovir-resistant HSV.
Toxicity of foscarnet	Nephrotoxicity.
Mechanism of resistance to foscarnet	Mutated DNA polymerase.
HIV therapy: Protease inhibitors (list)	Saquinavir Ritonavir Indinavir Nelfinavir Amprenavir [all protease inhibitors end in -avir ] (NAVIR (never) TEASE a proTEASE )
HIV therapy: Mechanism of protease inhibitors	Inhibit maturation of new virus by blocking protease in progeny of virus.
HIV therapy: Toxicity of protease inhibitors	GI intolerance (nausea, diarrhea) Hyperglycemia Lipodystrophy Thrombocytopenia (indinavir)
HIV therapy: Reverse transcriptase inhibitors --> nucleosides (list)	Zidovudine (ZDV, formerly AZT) Didanosine (ddI) Zalcitabine (ddC) Stavudine (d4T) Lamivudine (3TC) Abacavir (Have you dined (vudine ) with my nuclear (nucleosides ) family?)
HIV therapy: Reverse transcriptase inhibitors --> non-nucleosides (list)	N evirapine, E favirenz, D elaviridine (N ever E ver D eliver nucleosides.)
HIV therapy: Mechanism of reverse transcriptase inhibitors	Preferentially inhibit reverse transcriptase of HIV; prevent incorporation of DNA copy of viral genome into host DNA. [below, bottom/right] <img src="193a - Antiviral sites of action.JPG" />
HIV therapy: Toxicity of reverse transcriptase inhibitors	Bone marrow suppression (neutropenia, anemia) Peripheral neuropathy Lactic acidosis (nucleosides) Rash (non-nucleosides) Megaloblastic anemia (ZDV) GM-CSF and erythropoietin can be used to reduce BM suppression.
HIV therapy: Clinical use of reverse transcriptase inhibitors	Highly active antiretroviral therapy (HAART) generally entails combination Tx w/ protease inhibitors and reverse transcriptase inhibitors. Initiated when pts have low CD4 counts (<500 cells/mm^3) or high viral load. ZDV is used for general prophylaxis and during pregnancy to reduce risk of fetal transmission.
HIV therapy: Fusion inhibitor (there's one -- what is it?)	Enfuvirtide
HIV therapy: Mechanism of fusion inhibitors (enfuvirtide)	Bind viral gp41 subunit; inhibit conformational change required for fusion w/ CD4 cells. Therefore block entry and susequent replication.
HIV therapy: Toxicity of fusion inhibitors (enfuvirtide)	Hypersensitivity rxtns Rxtns at subcutaneous injection site Increased risk of bacterial pneumonia
HIV therapy: Clinical use of fusion inhibitors (enfuvirtide)	In pts w/ persistent viral replication in spite of antiretroviral Tx. Used in combination w/ other drugs.
Mechanism of interferons (as antimicrobials)	Glycoproteins from human leukocytes that block various stages of viral RNA and DNA synthesis. Induce ribonuclease that degrades viral mRNA.
Clinical use of interferons	IFN-alpha: chronic hepatitis B and C, Kaposi's sarcoma IFN-beta: MS IFN-gamma: NADPH oxidase deficiency
Toxicity of interferons	Neutropenia
Antibiotics to avoid in pregnancy (list -- what are they, and why for each one?)	S ulfonamides -- kernicterus A minoglycosides -- ototoxicity F luoroquinolones -- cartilage damage E rythromycin -- acute cholestatic hepatitis in mom (and clarythromycin -- embryotoxic) M etronidazole -- mutagenesis T etracyclines -- discolored teeth, inhibition of bone growth R ibavirin (antiviral) -- teratogenic G riseofulvin (antifungal) -- teratogenic C hloramphenicol -- gray baby (SAFE M oms T ake R eally G ood C are.)

First Time Here?

Welcome to Quizlet, a fun, free place to study. Try these flashcards, find others to study, or make your own.

Set Champions

Scatter Champion

31.6 secs by svutility

Step 1 First Aid - Microbiology

Share this set

About this set

Created by:

Subjects:

Description:

Classes:

Discuss

Step 1 First Aid - Microbiology

Study:

Games:

Tools:

848 terms

Terms

Definitions

First Time Here?

Set Champions

Scatter Champion