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Microbiology

Terms in this set (177)

what is the difference in structure of a gram positive versus gram negative organism
gram +
lipoteichoic acid induces IL-1 and TNF alpha
thicker PG layer
no outer membrane

gram -
periplasmic space: site of beta lactamase
thinner PG layer
outer membrane: contains endotoxin (LPS) which induces IL-1 and TNF alpha
What is glycalyx?
gelatinous PS coating
aid in attachment to foreign material (catheters)
either organized and firmly adherent =capsule OR loosely adherent and less organized= biofilm/slime
how do you determine capsulation
quellung reaction: anti capsular serum added to bacterium, capsule appears swollen
what are the encapsulated bacteria
SHiNE SKiS:
Strep (Pneumo and pyogènes)
H. influenzae
Neisseria meningitis
E Coli

Salmonella
Klebsiella
"Seudomonas"
what should vaccinate for in aseptic patient
SHiN

strep pneumo
H influ
Neisseria
describe transformation
take up free DNA from lysed cells (must have competence) and incorporate into chromosome DNA
add deoxyribonuclease will degrade naked DNA

"SHiN" bacteria do this
describe transposition
small DNA segments self exise and relocation
+/- to or from plasmid

can include flanking DNA -> plasmid -> other bacteria
(vanA from vanc-R enterococcus to s. aureus)
describe transduction
use phage to inject DNA

generalized (packaging) lytic:
used bacteria to replicate (messy and gains bacterial DNA)
injects new DNA to next bacterium

specialized (excision):
lysogenic phage injects toxins
may excise bacterial DNA with it

ABCDE:
shigA
botulinum
cholera
diphtheria
erythrogenic toxin of GAS
what is the difference between mycoplasma and mycobacterium
mycoplasma:
sterols for membrane
no cell wall

mycobacterium:
cell walls with mycelia acid
rich in lipids (somewhat resistant to gram stain)
which organisms do not gram stain well
These organisms May Lack Real Color

treponema: too thin
mycoplasma: no cell wall
mycobacterium: high lipids, mycelia acid in wall (carbofuchsin= AF stain)
legionella: BCFA in cell wall, also intracellular, silver stain
rickettsia: intracellular
chlamydia: intracell, no PG because of decreased muramic acid
which organisms use giemsa stain
Certain Bugs Really Try My Patience

chlamydia
borrelia
ricketssia
trypanosomes
plasmodium
histo
what is acid fast stain
ziehl neelson
carbo fuchsin
auramine rhodamine

MTB
nocardia
protozoa (cryptosporidium)
what is used to visualize cryptococcus
india ink
mucocarmine (stains red)
what bugs are seen with silver stain
legionella
PCP
H pylori
fungus
what is endotoxin and what does it cause
LPS of gram negative
when disrupted and released= lipid A

macrophages:
IL-1= fever
TNF a =fever, hypotension
NO=hypotension

complement:
c3a=edema and histamine, hypotension
c5b= PMN chemotaxis

TF= coag cascade -> DIC
describe exotoxin
usually by gram positive with plasmids or bacteriophagins

antigenic (used for vaccination)
describe superantigens
able to bind MHC 2 and TCR simultaneously
what are the exotoxins made by s aureus
alpha: hemolysis
beta: sphingomyelinase
ABC of gamma: AB=hemolysin, BC=leukocidin
delta: hemolysin and hemolysis

panton-valentin leukocidin: destroys leukocytes, community associated MRSA

enterotoxins A-E: food poisoning
TSST-1: toxic shock
epidermolytic/exfoliative: scalded skin syndrome
what are the exotoxins made by strep pyogenes
O: hemolysis (Oxygen labile and can check ASO)
S: hemolysis (oxygen Stable)
erythrogenic/pyrogenic: strep TSS, skin rash and scarlet fever rash
how does diphtheria toxin work
inactivates EF-2
inhibits protein synthesis
what is the exotoxin associated with pseudomonas
exotoxin A: also targets EF-2
what is the mechanism of shiga toxin
cleaves host rRNA at adenosine in 60S ribosome
describe the mechanism of ETEC
heat labile: increases cAMP, Activates Gs

heat stable: increases cGMP
describe yersina enterocolitica exotoxin
increases cGMP
pseduoappendicitis
describe antrax toxin
edema factor: adenylyl cyclase to increase cAMP
lethal factor
protective antigen
describe the mechanism of cholera toxin
stimulates adenylyl cyclase to increase cAMP and activate Gs

rice water stools
describe the mechanism of pertussis toxin
binds to and inactivates inhibitory G proteins to increase cAMP

"inhibits the inhibitor"
describe the bacterial growth curve
initially during division there is exponential log (most vulnerable state)

stationary phase growth plateaus for spore formation and there is nutrient depletion

the decline during death phase
what are the gram positive rods to know
clostridium (anaerobic)
corynebacterium
listeria
bacillus
describe the difference in the staph species
all staph = catalase +

aureus= coagulase +

epidermidis= Novobicin resistant
saprophyticus= Novobicin sensitive

staff meeting had NO StReSS
describe hemolysis of the strep species
alpha (partial and green)= pneumo, viridians
beta (complete)= pyogenes (GAS), agalactae (GBS)
gamma (none)= enterococcus, bovis
describe the distinguishing features of the strep species
OVRPS (overpass)
optichin resistant viridians pneumo sensitive

B-BRAS (brass)
bacitracin group B (agalactae) resistent group A (pyogenes) sensitive

bovis: grows in bile, no salt
enterococcus: grows in bile and saline
what is the virulence factor of staph aureus
protein A binds Fc-IgG inhibits C' activation and phagocytosis
where does s pneumonitis get its virulence
IgA protease
capsule
who gets s. pneumonia vaccine
PCV 13- infants
PPSV 23 - older than 65, 2-64 with chronic disease, I/C, smoker or asthma
what is GAS positive for
pyrrolidonyl arylamidase
what does GBS positive for and that is the test
CAMP factor (blocks cAMP) to increase area of hemolysis
hippurate test positive
describe c diphtheria
ABCDEFG

blocks protein synth via ADP ribosylation of EF-2
exotoxin produced by Beta-prophage
Coryne Bacterium, Cysteine Tellurite agar (loffler medium)
EF-2 affected, Elek test positive
metachromic blue and red granules

club shaped, gram positive rod
which bacteria form spores
Bacillus (anthracis, botulinum)
Clostridium (perfringens, tetani, botulinum)
Coxiella
describe C. tetani MOA and treatment
tetanospasmin
(protease that cleaves SNARE for NTs)
block inhibitory GABA and glycine release from Renshaw cells in spinal cord

diazepam for spasm
describe botulinum toxin and treatment
heat labile
blocks ACh at NMJ
flaccid paralyis

anti-toxin Ig
describe perfringens toxin
alpha toxin (lecithinase) causes gangrene and myonecrosis

enterotoxin causes food poisoning
describe difficile toxin
toxin A at brush border of gut
toxin B cytotoxin causes skeletal disruption via actin depolymerization causing colitis
describe cutaneous and pulmonary anthracis
cutaneous:
from goat hair
spore under skin
small papule to large PAINLESS ulcers with eschar and central necrosis

pulmonary:
wool sorters
flue like sx to pulm hemorrhage and mediastinitis (widening)
what are the obligate anaerobes
actinomyces, bactericides, clostridium
what is the only gram positive to create endotoxin (LPS)
listeria
describe listeria transmission and characteristics
only gram positive to have LPS
tumbling motility
rocket tails
enter thru GI to mucosa to monocytes (facultative intracellular)

milk, cheese, deli meats
crosses placenta (demise or sepsis in newborn)
how do you treat the branching fiilament gram positive bugs
SNAP

SMX-TMP- norcardia
actinomyces- PCN
describe actinomyces
gram positive branching
NOT acid fast
oropharynx and GI- oral and facial abscesses
anaerobic
sulfur granules
Tx: PCN
describe nocardia
branching filaments
(gram positive)- weakly ACID FAST
aerobic
found in soil
pulmonary infections in I/S or cutaneous after trauma in I/C
Tx: SMX-TMP
what are the gram negative cocci and distinguishing characteristics
Neisseria
Moraxella

all are oxidase positive
N. meningitidis= maltose fermenter
N. gonorrhea= not a maltose fermenter
what are the gram negative coccobacilli
H influ
B pertussis
Brucella
Pasteurella
describe the comma or curved bacteria gram negatives
oxidase positive

42 degrees C- campylobacter jejune (helical and z shaped)
urease- h pylori
alkali medium- vibrio cholerae
how do you distinguish the gram negative rods
1st: non fermenters

white on Maconkey agar
(pseudomonas, shigella, salmonella, yersinia, proteus)

pseudomonas only oxidase positive non fermenter

then on TSI agar shigella is the only oxidase negative nonfermenter to not produce H2S
(salmonella, yersinia, proteus produce H2S)


2nd: fermenters
pink on mac agar

citrobacter and serratia are slow fermenters
kleb, e coli, enterobacter are fast

E coli is green sheen on EMB agar
where does neisseria get its virulence
IgA protease
why can you not vaccinate against gonorrhea
variation in pilus
how does haemophilus get its virulence, what agar and why, describe the vaccine, what is the treatment of H influ
IgA protease

chocolate agar with V (NAD) and X (hematin)
vaccine with type B PS (polyribosylribitol phosphate) conj to diphthoid toxin

mucosal (sniffing dog position in epiglottis): augmentin

meningitis: rocephin
describe legionella and treatment
legionarie with silver helmet around charcoal fire with iron dagger and not a cyssy

gram negative rod
silver stain
charcoal yeast extract with iron and cysteine

macrolide (azithromycin) or FQ
describe pseudomonas, and toxins
gram negative rod motile
aerobe
non lactose fermenter
oxidase positive
grape like odor

endotoxin: fever and shock
exotoxin A: blocks EF-2
describe h pylori and treatment
gram negative rod
oxidase positive
urease postiive
catalase positive

triple: APC (or metronidazole if PCN allergy)

quad: bismuth, PPI, metronidazole, tetracycline
what is the difference with EHEC versus all other E coli
does not ferment sorbitol
describe the scenario of the E coli diarrheas
watery diarrhea, MCC of travelers, does not infect wall so no fever or blood, heat stable (cGMP) and labile (cAMP): ETEC

hamburger meat, shiga like toxin, does not ferment sorbitol: EHEC

watery, no toxin (vs ETEC), flattens villi to decrease water absorption, pediatrics: EPEC

invades mucosa, fever, necrosis, requires treatment with azithromicin, bacterium, or FQs: EIEC
describe shigella
gram negative rod
non fermenter
no H2S production
no flagella

only 10 bacteria to cause infection

watery for 2-3 days then bloody 1-2 weeks

FQ is 1st line treatment
what causes reiters syndrome classically
chlamydia or shigella flexneri
describe salmonella enterica typhi, toxin, signs, scenario
gram negative rod
non fermenter
motile (hematogenous spread)
H2S producer

only in humans
exotoxin: Vi capsule
large innocuous versus shigella
rose spots on abdomen
carrier in gallbladder

picnic with eggs or chicken 1-3 days then bloody diarrhea, fever
(s aureus is potato salad then vomiting)

treat: rocephin, FQ
describe campylobacter
gram negative rod
Z shaped or helical
oxidase positive
grows at 42 degrees C ("campfire")
bloody diarrhea
1-2 weeks

GBS common complication
animals also (not just humans like salmonella)
describe vibrio cholera, pathology, signs
gram negative comma
oxidase positive
alkaline media
flagellated


heat labile permanently increases cAMP activates Gs

"rice water stools"
profound dehydration -> aggressive oral rehydration
Describe Yersinia enterocolitica, signs
gram negative rod
non fermenter, oxidase negative, produces H2S

pet feces, day care centers

bloody diarrhea, mesenteric adenitis, severe pain (psuedoappendicitis) versus other diarrheas
Describe Klebsiella, presentation, at risk patients
gram negative rod
lactose fermenter fast

normal gut flora (no diarrhea) -> lobar pneumonia
weakened immune system

"red currant jelly sputum"

4 A's: Alcoholics, diAbetes, Aspiration pna, Abscesses in lungs and liver
what is the MCC of UTI
E coli (80%)
#2 S sapro in sexually active
#3 Kleb (large mucoid capsule and viscous)
describe proteus
gram negative rod
non fermenter, oxidase negative, produces H2S
swarming motility
urease positive (accumulated ammonium-Mg-PO4)
struvite stone (stag horn)
describe serratia
gram negative rod
slow lactose fermenter
red pigment

often nosocomial and resistant
describe enterococcus
gram negative rod
fast lactose fermenter
often nosocomial and resistant
what are the spirochetes
BLT
Borrelia, Leptospira, Treponema
Describe Leptospira interrogans, spread, dx, sx
animal urine in water enters breaks in skin or mucosa (watering hole)

1st: fever, chills, HA, myalgia (in calves)
then aSx
then: meningitis, liver damage, renal failure

Worst: Weil disease= icterohemorrhagic leptospirosis
describe the transmission, bug, stages of lyme disease
reservoir in mouse then ixodes deer tick in NE US is vector (like ana plasma and babesia)

initial:
fever, HA, fatigue, depression
erythema chronicum migrans (bulls eye lesion)
CN 7 palsy

2nd stage:
weeks to months later
Bells palsy BL with forehead
AV nodal block

late:
months to years later
knee/large joint arthritis, migratory
subacute encephalopathy
what are the rashes that involve the hands and feet
you drive kawasakis and CARS with your hands and feet

kawasaki disease
CoxA
RMSF
Syphilis
presentation, dx, and treatment of syphilis
primary:
painless single chancre
fluid from chancre to see dark field
VDRL + 80% screen

secondary:
Systemic sx
maculopapular rash w/ palms and soles
condyloma lata (smooth moist painless wort-like)
latent follows
alopecia areata
VDRL/RPR (nonspecific) confirm with FTA-ABS

tertiary:
Gummas (chronic granuloma), tree barking aortitis on ascending (vasa vasorum destruction)
tabes dorsalis
arygl robertson pupil (constricts to accommodation but not to light)
describe tabes dorsalis
board based gait
postive rhomberg
charcot joint (damage)
stroke without HTN
describe congenital syphilis
rhagrades (scars at corners of mouth)
mulberry molars
hitchinson teeth
saddle nose
CN 8 deafness
short maxilla
saber shins
snuffles (blood tinged rhinitis)
what causes a false positive VDRL
VDRL (false positive reaction with beef cardiolipin)

viruses (mono, hepatitis)
drugs
rheumatic fever
lupus/leprosy
describe Jarisch-Herxheimer reaction
flu like sx after antibiotics
due to killed bacteria releasing endotoxin (usually spirochetes)
regional LAD, bacillary angiomatosis (looks like kaposi) after cat scratch
bartonella henslae
relapsing fever, louse
borrelia recurrentis
undulating fever, unpasteurized dairy
brucellosis
pet/livestock fecal oral, bloody diarrhea
campylobacter
HA, myalgia, blunting of immune system, lone star tick
erlichia chaffensis
rabbits, ticks, bio warfare
francisella tularensis
animal urine through cut on skin
leptospirosis
what is the difference in the rickettsia species
prowazekii- epidemic typhus, louse
rickettsia- RMSF, rash on hands and soles, dermacentor tick (dog tick)
typhus- endemic typhus, fleas
fleas from rats or prairie dogs, plague
yersinia pestis
what agar is used for mycobacteria
lowenstein Jensen agar
describe primary TB
aSx, CP, cough, fever
usually normal CXR but hilar LAD +
Ghon focus (lower to mid, granulomatous inflammation) = Ghon complex

most heal by fibrosis -> immunity and hypersensitivity -> positive PPD

progressive lung disease (HIV and malnutrition patients) -> death

severe bacteremia -> biliary TB -> death

pre allergic lymphatic or hematogenous dissemination -> dormant TB (latent tubercle bacilli in several organs) -> reactivation in adulthood
describe secondary TB
Due to reactivation of primary (most TB); due to immune dysfunction (old age; HIV; steroids); granulomas with central cavitary caeseous necrosis in upper lobe; converted to fibrocalcific scars

more sx, WL, fever, night sweats, hemoptysis
how do dx MTB
gram positive acid fast on lowenstein jensen agar
slow to grow 2-3 weeks
so qAM acid fast stain of sputum for 3 days (if all 3 negative then negative, if even 1 is positive then diagnosis)
what is the treatment of tuberculosis
latent TB:
6-9 months of INH
aSx, normal CXR, just positive PPD

primary or secondary:
lungs, Sx, positive acid fast, positive CXR

RIPE for 2 months then IR for 4 months
describe MAC
disseminate non TB in AIDS patients
<50 CD4
ppx with azithromycin
describe M. scrofulaceum
cervical lymphadenitis
contaminated water
in pediatrics
describe M. leprae
Hansen:
peripheral n. and mucosa (glove and stocking)
cool temps
not in vitro
armadillos

Lepromatous:
leonine facies
communicable
decreased cell mediated humoral Th2 response
Tx: dapsone and rifampin, clofazimine for 2 years

tuberculoid:
hairless skin plaques
Th1 immune response high cell mediated
Tx: dapsone and rifampin for 1 year
describe gardnerella vaginalis
I have no clue why i smell fish in the vagina garden

BV
(mobiluncus, bacteroides, mycoplasma)
gray vag d/c fishy smelling (amine whiff test)
non painful

Clue cells of squamous cell covered in bacteria
describe rickettsia
obligate intracell (no stain)
+ weil Felix test (anti rickettsial antibodies cross react and agglutinate)

triad of fever, HA, rash

"R"MSF= "r"ickettsia "r"ickettsiae: "r"ash on palms and soles, periphery inward (w"R"ists inward), east coast, tick

endemic "t"yphus: rat feces
epidemic "t"yphus: prowazekii, human louse
both are "T"runks first
describe erlichiosis
sudden virus after tick
uveitis, pancarditis, ards, AKI
NO RASH
monocytes with morulae (berry like inclusions)
What is the mcc of culture negative endocarditis?
-coxiella, remember to treat with ceftriaxone.
NO RASH
inhaled aerosols of spores from tick feces or cattle placenta
NEGATIVE WEIL FELIX
describe the unique characteristics of chlamydiae
not at classic cell wall because low muramizc acid, beta lactase are not effective

"E"lementary body: (small and dense)
"E"nfectious, "E"enter cells via "E"ndocytosis to form reticulate body

"R"eticulate body:
"R"eplicates by fission, "R"eorganizes to elementary body
describe chlamydia trachomatis forms
ABC=
trachoma of eye, blindness in africa, chronic

D-K=
urethritis, PID, PNA in neonates, eosinophilia
neonatal conjunctivitis -> azithromycin, erythromycin drops
ectopic pregnancy
subclinical in females

L1-3=
lymphogranuloma venrerum
small painless ulcers on genitals
2-6 weeks later inguinal LNs that ulcerate (buboes)
rectal ulcers that get confused with IBD
treatment of chlamydia
doxycycline is 1st line
(azithromycin if empiric)
Describe Mycoplasma pneumoniae and treatment
no cell wall, no stain (only bacteria to have cholesterol in membrane)
atypical PNA
high titer of IgM (cold agglutinins)
Eaton agar
military and prisons, dorms
< 30 sos

macrolides, doxy, FQs
what are the sulfa drugs
Sulfa Pills Frequently Cause Terrible Acute Symptoms

Sulfasalazine
Probenicid
Furosemide
Celecoxib
Thiazide/TMP-SMX
Acetazolamide
Sulfonylureas
what are the tox SEs of PCN
hypersensitivity
hemolytic anemia
thrombocytopenia
what drugs cause Stevens-Johnson syndrome?
seizure drugs
sulfas
PCNs
allopurinol
What is the MOA of nitrofurantoin?
after activation by bacterial flavoproteins:
- inhibits aerobic energy metabolism
- inhibits protein synthesis
- inhibits DNA synthesis
- inhibits RNA synthesis
- inhibits cell wall synthesis
What is the MOA of flouroquinolones? caution with, toxicity, resistance
inhibit bacterial DNA topoisomerase II (gyrase) and IV
do not take with antacids

no peds or preggers (can use with CF peds) or elderly
cartilage and tendon rupture

resistance from mutation of gyrase
what is the MOA, use, and side effects of INH
blocks mycelia acid, bacterial catalase-peroxidase (encoded by KatG-source of resistance) needed to convert to active

only Rx approved for pix of MTB

"INH= Injures Nerves and Hepatocytes"
take with B6 to prevent neurotoxic effects
drug induced lupus
what is the MOA, use, and side effects of rifampin
"R"s

blocks DNA-d RNA pol, Ramps up cyt P450, Red fluids, Rapid-R when used alone

use: MTB, delay resistance to dapsone in leprosy, meningococcal ppx and for contacts

use rifabutin in HIV infection due to less stimulation of P450
(riAMPin RAMPs up, BUT rifaBUTin doesn't)
describe the MOA and side effect of pyrazinamide
prodrug
blocks pyradizamidase

increases uric acid, hepatotoxicity
describe the MOA and side effects of ethambutol
decrease carb polymerization of cell wall by blocking arabinosyl transferase

optic neuropathy (red green color blindness) which is reversible= "eye"thambutol
what is metronidazole used for
GET GAP on Metro

Giardia
Entamoeba
Trich

Gardnerella
Anaerobes
H pylori
What is the MOA of penicillins?
Blocks transpeptidase cross-linking of bacterial cell wall; activates autolytic enzymes
what is the MOA of methicillin, natcillin, oxacillin, dicloxacillin
block beta lactamase

some gram - bacteria hydrolyze B lactic ring with beta lactamase in periplasm to cause resistance to B lactams

staph and strep can alter B lactic targets (PBPs) to cause resistance
what is the use and tox SE of methicilin
just to determine the resistance of staph

tox: AIN
what are the aminoPCNs
ampicillin and amoxicillin

AMPed up PCN
amOX has greater Oral
which bugs do aminoPCNs work on
gram +

and

HHELPSS like enterococci

H influ, H pylori, E Coli, Listeria, Proteus, Salmonella, Shigella, Enterococci
what is the important SE of aminoPCNs
generalized rash with mono infection (EBV)
What is the MOA of sulfonamides and TMP? toxicity, resistance
Sulfa:
Inhibit dihydropteroate synthetaste in DHF and DNA synthesis (PABA and pteridine may increase as reactants)

TMP, pyrethamine:
inhibits DHF reductase (so does methotrexate)

hemolysis with G6PD def
TIN
kernicterus in infants in utero
displace from albumin (warfarin)
SJS
photosensitivity

resistance: altered enzyme, decreased reuptake, increased PABA synthesis
what is the MOA of clav acid, sulbactam, tazobactam
beta lactamase inhibitor

augmentin: recurrent OM
unasyn: surgical ppx
what are the carboxy PCNs, MOA, use
pipercillin, ticarcillin, carbenicillin

sensitiv to beta lactamase so need to give with beta lactamase blocker

pseudomonas
what is the MOA of cephalosporins
β-lactam drugs that inhibit cell wall synthesis but are less susceptible to penicillinases

bacterocidal
what are the first generation cephalosporins, what bugs do they treat
cefazolin, cephalexin

gram + and PECK

proteus
e coli
kleb
what are the second generation cephalosporins, what bigs do they treat
cefoxitin, ceflacor, cefuroxine, cefprozil

1st gen + HENS + PECK

H influ
enterobacter
neisseria (not gonorrhea)
serratia
what are the third generation cephalosporins, what bug do they work on
ceftriaxone, cefdinir, ceftazidime, cefotaxime

less gram + (only S pneumoniae)
more gram - (citrobacter, neisseria including gonorrhea, H influ)

cefdinir- recurrent OM
what are the SEs and tox of 4th generation cephalosporins
nephrotoxic with ahminoglycosides (gentamicin, erythromycin)
AHA
disulfiram
vit K def
what bugs are resistant to cephalosporins
LAME against ceph

Listeria
Atypicals (mycoplasma, chlamydia)
MRSA
Enterococci
what is the MOA of aztreonam and use
Inhibits cell wall synthesis ( binds to PBP3). A monobactam

synergistic with aminoglycosides

only GNRs
PCN allergies and renal insufficiency who can't tolerate aminoglycosides
what is the caveat of imipenem
always use to cilastin (inh renal dehydropeptase I) which decreases renal deactivation
what is the MOA of vancomycin
Inhibits cell wall synthesis by high affinity binding to the D-ALANYL-D-ALANINE terminus of cell wall precursors
what are the SEs of vancomycin
red man syndrome (not an allergy)

"NOT"
nephro, oto, thrombophlebitis
what antibiotics inhibit ribosomes
buy AT 30, CCELL at 50

aminoglycosides
tetracyclines

chlorampheticol
clindamycin
ertythromycin (macrolides)
lincomycin
linezolid
what is the MOA of linezolid, toxicity
binds 23S of 50S to block initiation complex

tox: marrow suppression, serotonin syndrome
what is the MOA of tetracyclines, use and toxicity
binds 30S to block amino-acyl tRNA

minocycline- blue pigmentation
doxycycline- can use in renal filature because fecally eliminated
discoloration of teeth in children
photosensitivity

DO NOT TAKE WITH 2+ CATION (block absorption in gut)

VACCUUM THe BedRoom

vibrio
acne
chlamydia
ureaplasma
mycoplasma
tularemia
H pylori
borrelia
rickettsia
what drugs cause photosensitivity
SAT for a photo:
Sulfonamides
Amiodarone
Tetracyclines
what are the aminoglycosides, tox
"Mean" GNATS caNNOT kill anaerobes. Gentamycin, Neomycin, Amikacin, Tobramycin, Streptomycin. (CAREFUL: NOT ACTINOMYCIN)

"NNOT"
nephro
NM blockage
ototox especially with loop diuretics
teratogen
what is the MOA of macrolides, what are they, what is their tox
"th"e MACROs"

aziTHro, eryTHro, clariTHro

binds 23S of 50S (resistance is due to methylation of 23S)

use: rids of "PUS"
PNA, URI, STD

MACRO:
motility issues
arrhythmia (prolonges QT)
cholestatic hepatitis
rash
eOsinophilia

increases concentration of theophylline and oral anticoagulants

SAFE FOR PREGNANCY
what is the MOA, use, tox of chlorampheticol
blocks 50S peptidyltransferase

use: rarely for meningitis

tox: anemia dose dependent, aplastic anemia, dose independent, Gray baby syndrome
what is gray baby syndrome, tx
vomiting, flaccidity, hypothermia, gray color, shock, collapse
-tox from chloramphenicol

tx: stop rx, transfuse, phenobarbitol
what is the MOA and use of clindamycin
blocks peptide bond formation at 50S

protozoal
topical acne
MRSA skin infection
anaerobes
what are polymyxins
catoionic detergents , disrupt cell membranes

last restort grame negatives

nephron and neuro toxic

now used in OTC neosporin
what is the prophylactic treatment for neisseria meningitis
cipro
rifampin
rocephin
what is the prophylactic treatment for h influ meningitis
rifampin
what is the prophylactic treatment for GBS positive in labor
ampicillin
what is the prophylactic treatment for PCP
bactrim if CD4 <200
if allergy: aerosolized pentamidine or dapsone
what is the prophylactic treatment for endocarditis for dental procedure
PCN
aminoPCN
keflex
what is the MOA and use of sulfamethoxazole, what is the SE of tox
blocks DHP synthase
gram positive UTI
gram negative GI
PCP

kernicterus
what is the MOA and SE of trimethoprim
blocks DHF reductase
What is the MOA of fluoroquinolones?
Inhibit DNA gyrase (topoisomerase II) and topoisomerase IV
what is the MOA of metronidazole and its use
forms free radical toxic metabolites in bacterial cell that damage DNA

GET GAP
giardiasis
trich
gardnerella
anaerobes
pylori
MCC of PNA in neonates
GBS, E Coli

give amp and gent
MCC of PNA in 4 weeks to 18 yo
viral (RSV)
mycoplasma

azithromycin and rocephin
MCC of PNA 18-40
mycoplasma
MCC of PNA 40 and older
S pneumo
MCC of PNA in alcoholics and IVDA
S pneumo
common COPD bacterial PNA
H influ
MCC of meningitis in 0-6 months
GBS
E coli
listeria
MCC Of meningitis 6 months to 6 years
Enterovirus
S pneumo
Neisseria
H influ
MCC of meningitis 6 years to 60 years
S pneumo
Neisseria
enterovirus
HSV
mCC of meningitis > 60
S pneumo
gram negative rods
listeria
MCC of meningitis in HIV
cryptococcus
how do you treat meningitis
steroids
rocephin and vancomycin
what are the stages of syphilis
primary: painless chancre
secondary: condyloma lata, systemic sx, moth eaten hairloss
tertiary: gummas, tabes dorsalis, aortitis, argyl robinson pupil (constricts with accommodation, not with direct)
what are the symptoms of LGV (1-3)
ulcers
rectal strictures (mistake for IBD)
what are the signs of congenital syphilis
early: (1st 3-5 weeks) organomegaly, LFTs, hemolytic anemia, jaundice, rash (desquamated of hands and feet), snuffles (blood tinged nasal), metaphysical dystrophy and periostitis

lates: hutchinson teeth, saddle nose, frontal bossing anterior shins
what is seen on histo of condyloma lata
HPV
kilobytes (squamous cells with peri nuclear cytoplasm clearing, similar to fried egg)
high vaginal pH, clue cells
BV
high vaginal pH, strawberry cervix
trichy
what are the common symptoms of TORCHeS
organomegaly
jaundice
decreased platelets
growth retardation
what are the signs of toxoplasma torch
cat feces

triad:
chorioretinitis
hydrocephalus
intracranial calcifications
what are the signs of rubella torch
transmitted with resp drops

triad:
PDA (or pulm artery hypoplasia)
cataracts
HL
what are the signs of CMV torch
MC torch

UL HL
seizures
periventricular calcifications
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