Hell (2)sdsdddddddsfsdfsdfsdsdfdsfsdfsd

7/30/2019 Hell (2)sdsdddddddsfsdfsdfsdsdfdsfsdfsd

1/30

Microbe Gram Species Location

Chlamydia Neg -tiny Chlamydia trachomatis eyes, genitals, lungs

Chamydophila pneumonia lungs

Chamydophila psittacci lungs

Mycoplasma smallest bac Mycoplasma pneumoniae lung

no cell wall Mycoplasma genitalium genitals

Mycoplasma hominis genitals

Ureaplasma urealyticum genitals (tiny colony)

Gram Positives

Staphylococci Pos Staph aureus

clusters Staph epidermidis skin

Staph saprophyticus bladder

Streptococci chains

B-hemo Strep pyogenes (A)- Large B zone

strep agalactiae (B) - small B zone GI, upper resp infants

A-hemo Strep pneumoniae- lancet

Viridans Strep mouth and gut

Clostridium Positive

Bascilli C. Tetani GI tract from rust/splinter

Anaerobe C. Botulinum Soil, canned food, honey

C. Perfringens GI sporesC. Diff Nosocomial Spread

Enterococcus Pos pairs or short chains gut

anaerobe (like strep) E.faecalis

E.faecium

Gram Negatives

Peptostreptococci mouth, GI, vagina

Non-spore Bacteroides Fragilis GI tract, Vagina

Neisseria Negative N. Meningitidis Brain

diplococci N. Gonnorhea In your Vajay/Schlong

Aerobes


2/30

Enterobacteriaceae Neg All rods All GI

anaerobes E.coli- (indole producing)

Pathovars EPEC- Enteropathogenic small bowel

EHEC- Enterohemorrhagic Large bowel

ETEC - Enterotoxiicgenic small bowel

EIEC- Enteroinvasive Large bowel

EAEC- Enteroaggregative Large Bowel

DAEC- Diffusely Adherent Small bowel

UPEC- Uropathogenic blood stream, bladder, kid

NMEC- Neonatal Meningitis bloodstream

Shigella identical to E.coli

S.dysenteriae

S.flexneri

S.boydii

S.sonnei

Klebsiella capsule, Inhabits gut

K.pneumoniae

K.oxytoca

K. granulatis

M-SPICE S Serratia marcescens not normal flora

E Enterobacter capsule

C Citerobacter citrate as sole source

I Proteus

Indole pos+ P.mirabilis

P.vulgaris

P Pseudomonus aergunosa

M Morganella

M.morganii

Salmonella

S.typhi


3/30

S.paratyphi

nontyphoidal

Non-Enterobacterace Urease -ve Campylobacter Jejuni Animals --> our gut

Urease +ve Heliobacter pylori Stomach

Oxidase +ve Vibrio Cholerae Intestinal Tract

Haemophilus Negative H. Influenzae Commensal in Pharynx

Coccobascilis H. Ducreyi Genitals

Aerobe

Legionella Pneumophilia Lungs, aerosolized water

Bordotella Pertussis Pharynx; one of few airborns

Pseudomonas Neg rod curved

aerobic P.aeruginosa colon

Plasmodium parasite

P.falciparum

P.vivax

P.malariaeP.ovale

P.knowlesi

Non-Bacteria

Protozoa parasite Giardia intestinalis cysts- infected form

trophozoites- active form

Fungi

opportunistic yeast, Pos Candida mouth, eso, vagina, skin

Mucosal &Cutaneous

Deep-seeded

Candidemia

mold Aspergillus usually inhaled as spores

A.fumigatus


4/30

A.flavus

A. niger

yeast-encap. Cryptococcus no pseudohyphae!

C.neoformans

var neoformans (birds) effects immunocomp.

var gattii effects all


5/30

Diseases

A,B,C- trachoma (blindness), D-K- conjunctivitis, infant pneu, cerviciti, PID, urethritis, L- LGV

walking pneumonia

birds

walking pneumonia (with target rash or stevens-johnson syndrome)

Skin and soft tissue infections, osteo, endocard, and septic arthritis

Mainly found coating heart valves and prosthetics, biofilm

UTI's

Pharyngitis (cobblestone), Scarlet fever, glomerulonephritis, rheumatic fever, necrotizing fasc.

UTI, endometritis, bacteremia, skin and soft tissue infections, early/late onset disease in infants

pulmonary infections and a million others

Endocarditis

tetanus blocks Gaba and causes rigid paralysis

Floppy paralysis, Ach blockage caused by endospores

Food poisoning, soft tissue infection (necro fasci, uterine infection)Diarrhea caused by antibiotics

#1 disease is UTI. Also causes bacteremia, endocarditis, meningitis, skin and soft tissue

endocarditis most common

sinusitis, stomach lung and brain abscesses, post partum endometriosis

Surgery, trauma, chronic disease leads to this commensal causing pneumonia and pleural abscesses

Pili for adhesion, LPS for epithelial cell damage, and MENINGITIS DUH.

Urethritis, Cervicits. Ophthalmic problems in neonates


6/30

UTI, blood, peritoneum, resp tract infections all common

diarrheal outbreaks in neonates

hemorrhagic colitis and HUS- Shiga toxin- bloody diarrhea

travelers diarrhea

illness similar to shigella

travelers diarrhea

diarrhea in developing nations

UTI

UTI, abscesses, pneumonia

alcoholics more suseptable

Associated with IVDUs, UTI and endocarditis

UTI sometimes resp infections

severe UTI with possible stone formation - swarming motility

UTI and wound infection

typhoid fever


7/30

typhoid fever

gastroenteritis - foodborne outbreaks

gastroenteritis leading to guilamme barre due to enterotoxins

urease allows it to survive in stomach acid. Causes stomach and duodenal ulcers

Enterotoxin A and B causes secretion of fluid to gut. Firehose Diarrhea = 20L. 1-3L/day

Capsule and IgA protease. Meningitis, pneumonia in COPD and alcoholics

Chancroid ulcer

Legionaires disease and Pontiac fever.

Whooping cough (cough of 100 days) Low grade fever progresses to vomitting and cyanosis

Hot tub Folliculitis, smells like grapes

Bacteremia, acute pneumonia, chronic resp infections (in CF), bone and joint, swimmers ear, eye, UTI

Malaria

most severe form

beaver fever

Thrush and Esophagitis (nystatin not effective here), Vaginitis (no statin) &Diaper rash, intertrigo (skin folds)

CNS, endocarditis, osteomyelitis, septic arthritis,

blood stream -> can disemminate to organs

Allergic bronchopulmonary aspergillosis (asthma/CF produce lung infiltrates


8/30

Invasive pulmonary and sinus infection - in immunosupp.

Pulmonary aspergilloma (fungus ball)- TB cavity required

pneumonia and meningitis


9/30

Treatments

tracoma-azithromycin, conju-erythromycin, pneu-macrolides, the rest are doxycycline

macrolides, quin

azithromycin or doxycycline

cefazolin (ceph), cloxacillin (penicillin), Erythromycin (macrolide), Clindmycin, sulfa,

and vanco (for MRSA)

Penicillin, Erythromycin

Penicillin, Vancomycin

Penicillin, Erythromycin - pneumococcal conjugate vaccine

Penicillin-gentamycin

Clean wound, Tetanus Ig, benzo's, tetanus vaccine series on discharge

Penicillin for wound infection, Horse made anti-toxin

Pen G + ClindamycinRemove antibiotic, metranidazole, fluids. Avoid anti-motility agents!

All have intrinsic and extrinsic resistance - to B-lactams and Aminoglycosides

Use ampicillin + gentamicin for synergy, vanco + genta if allergic

Linezolid for VRE

penicillin or clindamycin

Metronidazole, drain abscess

Penicillin, 3rd Gen Ceph. Quinolone given prophylactically to close contacts

Erythromycin eye drops to EVERY baby. Doxycycline or azithromycin


10/30

ALL can use peniciilin, most cephalosporin, ALL quin, ALL sulfa

B-lactams use depends on: 1) AB in contact with target

2) affinity of AB for target

3) production of B-lactamases

Resistance:

1) porin channel mutations

2) Efflux system mutations (more AB pumped out)

3) PBP mutations

4) B-lactamase production (MOST COMMON)

ALL ampicillin/amoxicillin resistant - non-MDR use 1st gen cephalosporins

ONLY 4th gen cephalosporins and Carbapenems can used used on M-SPICE

have AmpC cephalosporinases therefore can't use 1,2,or 3 gen

Chromosomally-inducible beta-lactamases (AmpC)


11/30

Treat between 2-50, immunocompromised and very severe cases

macrolides or quinolones, replenish fluids

OAC = Omeprazole, Amoxicillin, Clarithromycin. Check for cure with urease breath test

Replenish fluids like a mofo, Doxycycline, Quinolone

Vaccinate, Macrolide, 2/3 gen ceph, Rifampin to close contacts

Quinolone, 3rd gen ceph, macrolide

Macrolides or quinolone. Pip/tazo would probs also be a good choice IMO

Erythromycin or macrolides for patient and contacts.

Pip/Tazo, Serious infection = B-lactam + quinolone

Chloroquine (but has resistance), Doxycycline (not in kids), Primaquine (no G6PD)

Mefloquine (good drug)

metronidazole

topical nystatin (fungicidal-attacks cell mem) or oral fluconazole (fungistatic)

CNS treated with IV AF

fluconazole or newer gen voriconazole

AF, bronchodilators/inhaled corticosteroids


12/30

CT shows "halo sign" or "air-cresent" infiltrates - use Amphotericin B or voriconazole

surgery to remove fungus ball

Amphotericin B and Fluctosine, Fluconazole


13/30

Extra

Cannot be cultured, no pep wall - no beta lactams

Cannot be cultured, no pep wall - no beta lactams

All Catalase +

Coagulase +

Coag -

Coag -

All Catalase -

All have capsule

All have C protein (antigenic component)

Catalase -, Alpha hemolytic


14/30

All ferment glucose, all reduce nitrate to nitrite

All catalase +, All oxidase - (except pseudo)

Do not prescribe AB, will cause HUS


15/30

Oxidase +

grows at 42 degrees, water associated


16/30


17/30

Extra Extras

Staph Aureus #1 cause of endocarditis in IVDU

1) Disable IS- coagulase, leukocidins, penicillinase, PBP 2 (meth)

2) Tissue destroying enzymes- protease, lipase,

3) Exotoxins- exfoliation (scalded skin syndrome), Heat stable (food poisoning), TSST-1

Has M protein (rheumatic and superantigen TSS)

Has M and F antigen, produces A hemolytic colonies

virulent factors: extracellular protein and aggregation substances


18/30

Microbe Species Where to Find Them

Chlamydia Chlamydia trachomatis eyes, genitals, lungs

Chamydophila pneumonia lungs

Chamydophila psittacci lungs

Mycoplasma Mycoplasma pneumoniae lung

Mycoplasma genitalium genitals

Mycoplasma hominis genitals

Ureaplasma urealyticum genitals (tiny colony)

Gram Positives

Staphylococci Staph aureus skin/joints/diabetic foot

Staph epidermidis skin

Staph saprophyticus bladder

Streptococci

Strep pyogenes (A)- Large B zone Throat

strep agalactiae (B) - small B zone GI, upper resp infants, Genitals

Strep pneumoniae- lancet Brain, Lungs

Viridans Strep mouth, gut, heart

Clostridium

C. Tetani GI tract from rust/splinter

C. Botulinum Soil, canned food, honey

C. Perfringens GI sporesC. Diff Nosocomial Spread

Enterococcus pairs or short chains

anaerobe (like strep) E.faecalis Gut

E.faecium Gut

Gram Negatives

Peptostreptococci mouth, GI, vagina

Bacteroides Fragilis GI tract, Vagina

Neisseria N. Meningitidis Brain

N. Gonnorhea Urinary tract


19/30

Enterobacteriaceae All rods All GI


EPEC- Enteropathogenic small bowel

EHEC- Enterohemorrhagic Large bowel

ETEC - Enterotoxiicgenic small bowel

EIEC- Enteroinvasive Large bowel

EAEC- Enteroaggregative Large Bowel

DAEC- Diffusely Adherent Small bowel

UPEC- Uropathogenic blood stream, bladder, kid

NMEC- Neonatal Meningitis bloodstream

Shigella GI

S.dysenteriae GI

S.flexneri GI

S.boydii GI

S.sonnei GI

Klebsiella GI

K.pneumoniae GI

K.oxytoca GI

K. granulatis GI

GI

M-SPICE Serratia marcescens GI

GI

Enterobacter GIGI

Citerobacter GI

GI

Proteus GI

P.mirabilis GI

P.vulgaris GI

GI

Pseudomonus aergunosa GI

GI

GIGI

Morganella GI

M.morganii GI

GI

Salmonella GI

S.typhi GI


20/30

S.paratyphi GI

nontyphoidal GI

Non-Enterobacterace Campylobacter Jejuni Animals --> our gut

Heliobacter pylori Stomach

Vibrio Cholerae Intestinal Tract

Haemophilus H. Influenzae Commensal in Pharynx

H. Ducreyi Genitals

Legionella Pneumophilia Lungs, aerosolized water

Bordotella Pertussis Pharynx; one of few airborns

Pseudomonas rod curved

aerobic P.aeruginosa Resp, Urinary, Gi

Plasmodium

P.falciparum

P.vivax

P.malariaeP.ovale

P.knowlesi

Non-Bacteria

Protozoa Giardia intestinalis cysts- infected form

trophozoites- active form

Fungi

opportunistic Candida mouth, eso, vagina, skin

Mucosal &Cutaneous

Deep-seeded

Candidemia

Aspergillus usually inhaled as spores

A.fumigatus


21/30

A.flavus

A. niger

Cryptococcus Respiratory tract

C.neoformans

var neoformans (birds) effects immunocomp.

var gattii effects all


22/30

Microbe Species

Chlamydia Chlamydia trachomatis

Chamydophila pneumonia

Chamydophila psittacci

Mycoplasma Mycoplasma pneumoniae

Mycoplasma genitalium

Mycoplasma hominis

Ureaplasma urealyticum

Gram Positives

Staphylococci Staph aureus

Staph epidermidis

Staph saprophyticus

Streptococci

Strep pyogenes (A)- Large B zone

strep agalactiae (B) - small B zone

Strep pneumoniae- lancet

Viridans Strep

Clostridium

C. Tetani

C. Botulinum

C. PerfringensC. Diff

Enterococcus pairs or short chains

anaerobe (like strep) E.faecalis

E.faecium

Gram Negatives

Peptostreptococci

Bacteroides Fragilis

Neisseria N. Meningitidis

N. Gonnorhea


23/30

Enterobacteriaceae All rods


EPEC- Enteropathogenic

EHEC- Enterohemorrhagic

ETEC - Enterotoxiicgenic

EIEC- Enteroinvasive

EAEC- Enteroaggregative

DAEC- Diffusely Adherent

UPEC- Uropathogenic

NMEC- Neonatal Meningitis

Shigella

S.dysenteriae

S.flexneri

S.boydii

S.sonnei

Klebsiella

K.pneumoniae

K.oxytoca

K. granulatis

M-SPICE Serratia marcescens

Enterobacter

Citerobacter

Proteus

P.mirabilis

P.vulgaris

Pseudomonus aergunosa

Morganella

M.morganii

Salmonella

S.typhi


24/30

S.paratyphi

nontyphoidal

Non-Enterobacterace Campylobacter Jejuni

Heliobacter pylori

Vibrio Cholerae

Haemophilus H. Influenzae

H. Ducreyi

Legionella Pneumophilia

Bordotella Pertussis

Pseudomonas rod curved

aerobic P.aeruginosa

Plasmodium

P.falciparum

P.vivax

P.malariaeP.ovale

P.knowlesi

Non-Bacteria

Protozoa Giardia intestinalis

Fungi

opportunistic Candida

Aspergillus

A.fumigatus


25/30

A.flavus

A. niger

Cryptococcus

C.neoformans

var neoformans (birds)

var gattii


26/30

Treatments

Azithromycin. Erythromycin given to babies

Doxycycline

Doxycycline

Macrolides or Quinolones

azithromycin or doxycycline. Maybe Quinolone in resistance



Cloxacillin

Vancomycin (MRSA vanco as well)

Penicillin

Penicillin, Erythromycin

Penicillin, Vancomycin

Penicillin, Erythromycin - pneumococcal conjugate vaccine

Penicillin-gentamycin

Clean wound, Tetanus Ig, benzo's, tetanus vaccine series on discharge

Penicillin for wound infection, Horse made anti-toxin

Pen G + ClindamycinRemove antibiotic, metranidazole, fluids. Avoid anti-motility agents!

All have intrinsic and extrinsic resistance - to B-lactams and Aminoglycosides

Use ampicillin + gentamicin for synergy, vanco + genta if allergic

Linezolid for VRE

penicillin or clindamycin

Metronidazole, drain abscess

Penicillin, 3rd Gen Ceph. Quinolone given prophylactically to close contacts

Erythromycin eye drops to EVERY baby. Doxycycline or azithromycin


27/30

ALL can use peniciilin, most cephalosporin, ALL quin, ALL sulfa

B-lactams use depends on: 1) AB in contact with target

2) affinity of AB for target

3) production of B-lactamases

ALL ampicillin/amoxicillin resistant - non-MDR use 1st gen cephalosporins

ONLY 4th gen cephalosporins and Carbapenems can used used on M-SPICE

have AmpC cephalosporinases therefore can't use 1,2,or 3 gen

Chromosomally-inducible beta-lactamases (AmpC)

3rd generation Cephalosporin


28/30

Treat between 2-50, immunocompromised and very severe cases

macrolides or quinolones, replenish fluids

OAC = Omeprazole, Amoxicillin, Clarithromycin. Check for cure with urease breath test

Replenish fluids like a mofo, Doxycycline, Quinolone

Vaccinate, Macrolide, 2/3 gen ceph, Rifampin to close contacts

Quinolone, 3rd gen ceph, macrolide

Macrolides or quinolone. Pip/tazo would probs also be a good choice IMO

Erythromycin or macrolides for patient and contacts.

Pip/Tazo, Serious infection = B-lactam + quinolone

Chloroquine (but has resistance), Doxycycline (not in kids), Primaquine (no G6PD)

Mefloquine (good drug)

Metranidazole

topical nystatin (fungicidal-attacks cell mem) or oral fluconazole (fungistatic)

CNS treated with IV AF

fluconazole or newer gen voriconazole

AF, bronchodilators/inhaled corticosteroids


29/30

CT shows "halo sign" or "air-cresent" infiltrates - use Amphotericin B or voriconazole

surgery to remove fungus ball

Amphotericin B and Fluctosine, Fluconazole


30/30

Resistance:

1) porin channel mutations

2) Efflux system mutations (more AB pumped out)

3) PBP mutations

4) B-lactamase production (MOST COMMON)

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Hell (2)sdsdddddddsfsdfsdfsdsdfdsfsdfsd