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Flashcards in Gram Positive Bugs Deck (113):
1

Staph is grouped how?

clusters/clumps like grapes

2

Catylase associated with what kind of bacteria?

staph aureas

3

Strep grouped how?

Bunches in lines or in pairs

4

Buzz word for Diphtheria?

grey pseudomembrane

5

Where do we see anthrax?

soil, sheep, goats, cattle
bioterrism

6

Classifications of Bacteria

Reaction to certain types of stains

Physiologic structure

7

What are the different types of shapes in bacterial infetions?
5

Bacillus are Rod shaped
Coccus is sphere shaped
Spirillum are spiral shaped
Streptococci are cocci in chains
Staphylococci are cocci in clusters

8

Name the gram positive bacteria we covered?
6

1. Staphylococcus sp.
2. Streptococcus sp.
3. Clostridium Botulinum (anerobe)
4. Corynebacterium Diptheriae (Diphtheria)- grey pseudomembrane
5. Clostridium Tetanus (Tetanus)
6. Bacillus antracis (Anthrax)-soil, sheep, goats, cattle

9

Stpah aureus is the only staph that produces what?

only one that produced coagulase)-produces exotoxins

10

Name three things the exotoxins in staph aureus cause?

1. food poisening(GI)
2. scalded skin syndrome(causes skin to slough off
3. toxic shock syndrome- pinpoint rash on ab

11

What instances should we worry about Staph aureus infection?
4

foley/catheter
iv line infections
prothetic valves
knee replacement
etc

12

What is s. saprophyticus associated with?

UTIs

13

Strep Pyogenes is what kind of strep?

Lancefield antigen?
Hemolytic?

Group A beta-hemolytic strep

Positive
Yes, partially

14

Streptococcus agalactiae is what kind of Strep?

What is it mainly known to cause?
Lancefield anitgen?
Hemolytic?

Group B


neonatal meningitis in babies
Positive
Yes

15

Streptococcus pneumoniae (Pneumococcus) is what kind of strep?

What is it mainly known to cause?3
Lancefield anitgen?
Hemolytic?

GP diplococci



In adults:
CAP!! sudden onset shaking chills, rust colored sputum,
In chidlren: OM, sinusistis


NO
NO

16

Streptococcus viridans is what kind of strep?

What is it mainly known to cause?
3

Where is strep viridans normal flora in your body?

Lancefield anitgen?
Hemolytic?

Alpha hemolytic

Dental infections
Endocarditis (prothetic valve)
Abcesses

GI

NO
Yes, partially (green)

17

Enterococcus is what kind of strep?

Where does it like to hang out (normal flora)?

What is it resistance to?

Lancefield?
Hemolytic?

(Group D strep)

Bilius areas, gall bladder/liver etc

vanco and amp.


Yes
Yes

18

Common Bacterial Infections
caused by gram pos bacteria?
3

Skin-first think staph aureus
Soft tissue
Bone

19

What do localized infections not do that differentiates them from systemic infecitons?

Organism does not spread through the lymphatic system or reach the bloodstream
-infection subsides due to host defenses

20

Which pathways do bacteria take to become a generalized or systemic infection?
3

via tissues, lymphatic system, bloodstream

21

Examples of localized infections? 2

Cellulitis
Erysipelas- strep

22

Potentially lethal infections that were noted?

3

Necrotizing fasciitis (flesh eating disease)
Myonecrosis (gas gangrene or Clostridial myonecrosis)
Pyomyositis (abscess from bacterial infection of skeletal muscles)

23

What do we need to make sure we do with cellulitis infections?

mark it with a sharpy, treat cellulitis aggressively

24

Most staphylococcus are harmless and reside where?

skin and mucous membranes

25

What is Methicillin-resistant Staphylococcus Aureus resistant to?

What does MRSA look like right awa?

beta lactams


Spider bite but it develops and spreads fast to become very dangerous

26

How do we further divide Staphylococcus bacteria?
2

Further divided into ability to produce coagulase
1. Coagulase positive species (virulence)
Staphylococcus aureus (common nasal flora)
2. Coag Negative species
Staphylococcus epidermidis (universal skin flora)

27

Pathogenicity of S. aureus

Cutaneous infections?4

Deep infections? 5

Toxin mediated infections? 3

1. Cutaneous infections –
Folliculitis (boils)
furuncle
burns
wounds

2. Deep infections –
Osteomyelitis,
abscesses,
pneumonia,
endocarditis,
septicemia

3. Toxin mediated infections –
Staphylococcal scalded skin syndrome (SSSS),
Toxic Shock Syndrome (TSS),
Food poisoning (in 1-8hr, vomiting ,diarrhea, nausea, self limited )

28

People with massive burns often die of what?

Staph infections

29

Skin and soft tissue infections most common in what kind of pts?

immunocompetent host

30

What is the most common cutaneous staph aureus infection?

Abcesses

31

Other staph aureus skin infections?
4

1. Folliculitis
2. Mastitis (infection of the breast when nursing)- nights sweats ad high fevers
3. Wound Infections
4. Infected IV catheter sites

32

How would we treat mastitis?

treat with antibiotics and excessive nursing have to drain it. wont cause problems with babies

33

How would we diagnose septic arthritis?

injury to the area/staph. red swollen joint you need to tap and see what you have.

34

What major systemic infections does Staph aureus cause?
3

Bacteremia/septicemia/endocarditis
Pneumonia
Musculoskeletal: septic arthritis

35

What type of MRSA is associated with invasive procedures or devices?

What kind of MRSA can begin as a painful skin boil. Spread by skin to skin contact. At risk populations include high school wrestlers, child care workers and people who live in crowded conditions?

HA-MRSA Health care associated



CA-MRSA: Community Associated among healthy people

36

How do we treat MRSA?
3 drug choices
2 (timeline)

1. bactrim/sulfas, then 2. clinda or doxy. then 3. vanco
aggressive and early

37

How should we treat MRSA of the nares?

Bactroban (Mupirocin) ointment in the nose qd

38

Full body wash (Rules of 3) is called what?

(how often do we use it?)

(Hibiclens)
3 times a day for 3 days then 3 times a week for 3 weeks

39

Features of Cellulitis?
6

Red
swollen
warm to touch
no areas of pus!
painful
tender

40

What is the most common bug that causes cellulitis?

How does it manifest?

Group A strep

Follws an nnocuous or unrecognized injury. Inflammation is diffuse spreading along the tissue

41

When does staph aureus usually cause cellulitis?
2

Usually with a wound or penetrating trauma

Localized ABCESS becomes surrounded by cellulitis

42

What is the current antibiotic choice for cellulitis?
3

Clindamycin, Doxycycline, or Trimethoprim-Sulfa (“Bactrim, Septra”)

43

If you have severe cellulitisand its spreading quickly and systemic symptoms- fever what should we go with?

go with IV antibiotics go right to vanco. hospitalize them

44

Hospital admission criteria for cellulitis?
5

1. animal bite on pts face or hand
2. area of skin involvement is more than 50% of limb or torso or more than 10% of total body surface
3. Coexisitng morbidities
4. Compirmised host
5. If they need IV ABX

45

When the tissue in the area of cellulitis turns to pus under the surface of the skin, the collection of pus is termed what?

an abcess

46

What does an abcess consist of?
2

What is the most common bacteria in the abcess?

The pus in the abscess consists of dead, liquified tissue, billions of white blood cells

“staph”, or Staphylococcus aureus
Many other bacteria that can cause abscesses

47

Whats the difference between a empyema and an abcess?

Must be distinguished from empyemas which are accumulations of pus in a preexisting rather than a newly formed anatomical cavity.

48

Clinical features of abcesses?
3

1. superficial like on skin, subcutaneous tissues, on the hand
2. Infections of the head and neck
3. Deep seated infections

49

Example of abcesses of the head and neck?

suppurative parotitis (acute infection of the parotid)

50

Example of deep seated infections that cause abcesses?
4

hepatic abscess
splenic abscess
sub-phrenic abscess
rectal abscess

51

How will the center of the abcess feel?

soft center. feels like fluid underneath

52

Treatment of Abscesses?
2

1. I and D
? ABX- but probably do it anyway.
If the abscess has a lot of cellulitis around it, an antibiotic is probably needed.
Abscesses have to be drained.
2. Antibiotics cannot penetrate w/o drainage. They do not get into the site without it being drained first

53

When the bacteria in a cellulitis or abscess start spreading quickly between the fat layer and the muscle underneath it is termed what?

necrotizing fasciitis


Fasciitis means the infection is spreading along the space between the fat and the muscle underneath

54

How does necrotizing fasciitis kill tissue?

The infection cuts off the blood supply to the tissue above it and the tissue dies
The bacteria may also enter the bloodstream

55

Treatment of Necrotizing Fasciitis?

3

What are the main bugs associated with it?
4

1. Have to cut it out and keep cutting it out until the bacteria stops spreading
2. Antibiotics help, but they will NOT cure the infection
--Antibiotics for a minimum of 3 wks



Empiric antibiotics to cover anaerobes,
gram negative bacilli, streptococci, and
Staph aureus


56

What is myonecrosis?

What bug causes it?

Whats its incubation period?

Clinical presentation? 4

How should we treat it?
4
(2 drug choices)

gas gangrene

Pure Clostridium perfringens infection

Incubation period of hours to days

Local edema and pain accompanied by fever and tachycardia

1. Pen G (3-4 million U q4h) or
2. chloramphenicol
3. Surgical removal of infected muscle
4. Hyperbaric chamber

57

What is Pyomyositis?

What bug most often causes it?

Treatment? 2

A purulent bacterial infection of the skeletal muscles which results in a pus-filled abscess

Staph aureus

Must be drained surgically and antibiotics are given for a minimum of 3 weeks

58

Staphylococcal toxin disorders?
4

1. Gastroenteritis (Food Poisoning)
2. Toxic Shock Syndrome
3. (TEN) Toxic Epidermal Necrolysis
4. (SSSS) Staph Scalded Skin Syndrome

59

Describe the progression to (TEN) Toxic Epidermal Necrolysis?
4



What should we treat with if we even suspect this?

1. first- multiform erythematous minor. little bullseye region.

2. Its major when you get mucosal membrane involvement. treat different. (oral lesions)

3. next step is stevens johnsons/blistering

4. TEN is massive loss of dermis


Prednisone

60

What is a disease caused by epidermolytic toxins produced by certain strains of Staphylococci. This toxin is distributed systemically and results in dissolution of keratinocyte attachments in only the upper layer of the epidermis (stratum granulosum).?

What population does this mostly affect?

Staphylococcal scalded skin syndrome



SSSS usually affects newborns and children. Adults are less commonly affected because improved renal function allows for clearance of the toxins from the body, although adults with renal failure are more susceptible

61

What bug are we most worried about for Nosocomial infections: device/ implant associated infections - shunts, catheters, artificial heart valves / joints, pacemaker?

Staphylococcus epidermidis

62

How are Streptococcal Infections subdivided and what are the divisions?
3

Subdivided by ability to lyse RBC’s
1. beta hemolysis-complete lysis
2. alpha hemolysis-partial lysis
3. gamma hemolysis-no hemolysis

63

What three complications can arise from strep throat?
3

1. post streptococcal glomerulonephritis
2. Rheumatic heart disease
3. Scarlet fever

64

How will strep manifest in kids under 4 compared to older kids?

a lot of kids carry it in their sinuses and ears. so if little brother 3-4 gets sick from sister who has strep throat age 6. They will present different

65

What is Erysipelas?


What causes it?

Acute streptococcus infection of the upper dermis and superficial lymphatics

Streptococcus pyogenes (Beta hemolytic group A Strep)

66

How do we differentiate Cellulitis and Erysipelas?
2 differences

Cellulitis has an ill-defined border that merge smoothly with adjacent skin; usually pinkish to reddish

Erysipelas has an elevated and sharply demarcated border with a fiery-red appearance

67

Management of Cellulitis & Erysipelas:
Local Care?3

Long term care?
2 meds for how long

1. Immobilization
2. Elevation to reduce swelling
3. Draw lines (with the patients permission)

Two weeks of antibiotic therapy
Penicillin and Dicloxacillin for most patients

68

Superficial lesions that break and form highly contagious crust; often occurs in epidemics in school children; also associated with insect bites, poor hygiene, and crowded living conditions

Impetigo (pyoderma)

Honey crust

69

What is a pathogen enters through a break in the skin and eventually spreads to the dermis and subcutaneous tissues; can remain superficial or become systemic. Mostly in the face?

Erysipelas

Sharper and red

70

What are the two kinds of Impetigo?

Non-bullous and Bullous

71

Whats the cause of Non-bollous impetigo?

What age does it primarily present in?

How does it look?

What is its duration like?

1. Strep Group A or Staph aureus

2. Preschool and school aged kids

3. Very thin walled vescile on an erythematous base. Yellowish thick custs

4. transient

72

What is the cause of bullous impetigo?

What age does it primarily present in?

How does it look?

What is its duration like?

1. Staph aureus

2. All ages

3. Bullae of 1-2 cm. Thin flat brownish crusts

4. persist for 2-3 days

73

Predisposing factors for impetigo?
3

Malnutrition
Diabetes
Immuno-compromised status

74

Complications that can occur from impetigo?
4

1. Streptococcal infection (pink eye, meningitis, endocarditis)
2. Scarlet Fever (Scarlatina. Caused by Strep pyogenes (Group A Strep)
Can get “Strawberry tongue)
2. Urticaria (Hives. Allergic reaction)
4. Erythema Multiforme (unknown etiology. Skin condition in the superficial microvasculature of the skin and oral mucous membranes usually follows an infection or drug exposure)

1. Streptococcal infection
2. Scarlet Fever
3. Urticaria
4. Erythema Multiforme

75

Treatment of Impetigo?

2 treatments
4 drug choices

1. First soak the affected area in warm water or use wet compresses to help remove overlying scabs
2. Antibiotic Creams or ointments
-Bactroban (Mupirocin) AAA tid x 5 days
-Fusidic Acid Cream AAA x 7-12 days
-Retapamulon ointment bid x 5 days
-Consider Septra/Bactrim if has history of MRSA

76

Streptococcus pyogenes (group A beta hemolytic strep) Common infections?
6

Cutaneous infections
Pharyngitis (sore throat)
Otitis media
Sinusitis
Pneumonia
Streptococcal Toxic Shock Syndrome

77

Complications of GABHS infections
2

1. Rheumatic fever (RF)-

delayed antibody mediated disease (immune disease)

2. Glomerulonephritis

78

4 signs for pharyngitis and tonsilitis?

strep throat-
1. white exudate(in virus and bacteria)
2. petechia
3. strawberrry tongue,
4. red beefy tonsils

Mono- looks the same

79

Pathogenicity
of Beta Hemolytic group B strep?
2

Neonatal meningitis and sepsis
Pneumonia

80

Most common menigitis bugs for adults?

H. flu, nessieria meng

81

Streptococcus pneumoniae (pneumococcus)
Gram positive cocci in pairs. What are some common diseases they cause?
4

What is a core measure associated with this infection?

Does Strep Pneumo have the lansfield antigen?

Pneumonia
Otitis media
Sinusitis
Meningitis


Prevention: Vaccination (capsular antigens)
IMMUNIZATION (core measure)
Pneumovax

NO

82

What makes strep pneumo so effective against our immune system?

How would we diagnose pneumonia causes by strep pneumo?
4 symtpoms

What would we hear during auscultation?

Polysaccarhide capsule
-we think its one of our own

SHAKING CHILL
HIGH FEVER
RUST COLOR sputum, pleuridic chest pain

dullness/dead spot with consolidation

83

Why do kids have so many ear iinfections?

esuatachian tube disfuntion. angle is really poor for good drainage so you get them in chidlren

84

OTITIS MEDIA defintiion?

How is acute otitis media different from otitis media with effusion?



What would otitis with effusion respond best to?


If a child is not talking by two what do we need to ask about in the history?

Most common bug for ear infections?

Presence of a middle ear infection

Acute Otitis Media
Bulging TM thats taught with pressure, Erythmatous, might see Pus

Otitis Media with Effusion: Presence of nonpurulent fluid within the middle ear cavity

drainage (may want to treat with an antibiotic but dont need to)

Are they have lots of ear infections? Might be permanent damage to the ear

Strep pneumo

85

Major risk factors for acute otitis media are what?

7

Young age
Bottle feeding
Drinking a bottle in bed
Parental history
Sibling history
Second hand smoke
Daycare

86

Organisms responsible for otitis media are?
7

1. Streptococcus pneumoniae
2. Haemophilus influenzae
3. Moraxella catarrhalis
4. Group A Streptococcus
5. Staph aureus
6. Pseudomonas aeruginosa
7. RSV assoc. with Acute Otitis Media

87

Physical Exam findings for otitis media?

The classic description for Otitis Media is an erythematic, opaque, bulging tympanic membrane with loss of anatomic landmarks including a dull/absent light reflex

88

Treatment options for OM?

Infants younger than 6 months?

Children 6 mo to 2 years? 2

Children 2 years and older?

1. Infants younger than 6 months should receive antibiotics

2. Children 6 months to 2 years should receive antibiotics if the diagnosis is certain (acute onset, MEE, and middle ear inflammation)
---Diagnosis uncertain: Observation period 48 to 72 hours with analgesics and follow up

3. Children 2 years and older should receive antibiotics if diagnosis is certain or illness severe (severe otolagia and temp > 102)
Observation period an option

89

First line treatment for OM?
3


Allergic or second line?

Amoxicillin: 20-40 mg/kg/day TID for 10-14 days or
Augmentin: 45 mg/kg/day BID for 10-14 days
Auralgan: analgesic/adjunct for ear pain 2-4 drops TID


Cefzil, Pediazole, Bactrim

90

Streptococci viridans (alpha or gamma hemolytic)
is common where?

What are the infections that it causes?
3

Common oral/pharyngeal flora


Infections
-Endocarditis
-Bacteremia & Septic Shock
-Dental

91

Group D streptococci (enterococcus)
most common infections that it causes?
5

1. UTI
2. Endocarditis
3. Intraabdominal infections (abscesses)
4. Biliary tract Infections!!
5. Wound infections

92

Diagnosis of Streptococcal Infections?
4

Culture
ASO titers/Streptozyme
Rapid Group A Strep tests
Gram Stains

93

Antistreptolysin O (ASO) titer is a blood test to measure what?

antibodies against streptolysin O, a substance produced by group A Streptococcus bacteria

94

S. pyogenes: DOC?

PCN (low incidence of resistant organisms)

95

S. pneumoniae DOC?


Entercoccus DOC?

increased PCN resistance

Erythromycin for both in PCN allergic patient

Ampicillin for enterococcus

96

What is a Gram positive, nonmotile, spore forming bacterium Bacillus anthracis.

Natural transmission to humans by contact with what?

What makes it so good against our defenses?
2

Anthrax


infected animals or contaminated animal products


1. has special capsule that makes it really good at avoiding phagocytosis
2. spore is ideal for inhalation

97

How can anthrax be transmitted?
3

Contact, ingestion, or inhalation of infective spores

98

Incubation period of anthrax?

Clinical syndromes? 4

Main threat for anthrax?

How does it manifest?

1-7 days (1-60 days)

Cutaneous ulcer,
respiratory,
gastrointestinal, oropharyngeal

Inhalation

Bronchopneumonia not a component (hemorrhagic lymphadenitis and mediastinitis) - so you dont see it coming until symptoms are really bad

99

What are the two biggest causes of death for anthrax?
Most comomn?

1. lyphatic or hematogenous spread leading to menigitis (most common)
2. Pulmonary lymphatic bloackage leading to pulmonary edema

100

Epidemiology of inhalation anthrax?

Sudden appearance of multiple cases of severe flu illness with fulminant course and high mortality

101

Clinical symtpoms of inhalation anthrax?3



Serious symptoms?
4

1. Non-specific prodrome of flu-like symptoms
2. Possible brief interim improvement
3. Abrupt onset of

-respiratory failure and
-hemodynamic collapse 2-4

days after initial symptoms, possibly accompanied by

-thoracic edema and a
-widened mediastinum on CxR

102

INHALATION ANTHRAX: DIAGNOstic studies?
2

1. Chest radiograph with widened mediastinum
2. Peripheral blood smear with gram (+) bacilli on unspun smear

103

Microbiology for anthrax diagnosis?

Blood culture growth of large gram (+) bacilli with preliminary identification of Bacillus spp.

104

Pathology of diagnosis for anthrax?
4

1. Hemorrhagic mediastinitis, 2. hemorrhagic thoracic
3. lymphadenitis,
4. hemorrhagic meningitis

105

Prophylaxis treatment for anthrax?

Preexposure?
Postexposure?2

Pre-exposure: Vaccine
{not currently available}

Post-exposure: Ciprofloxacin (or other quinolone) or doxycycline (vaccine if available)

106

Treatment for cutaneous anthrax?

Ciprofloxacin or doxycycline x 60 days

107

Treatment of anthrax for inhalation?
3 things to remember

Ciprofloxacin or doxycline PLUS
1 or 2 other drugs (e.g., vancomycin, imipenem)
Initial Rx should be IV then switch to PO for total 60 days

108

Diphtheria infects what part of the body?

What are its most common complications?
2

mucous membrane


Most common complications are myocarditis and neuritis

109

Symtpoms of Diptheria?
4

sore throat,
malaise,
cervical lymphadenopathy
low grade fever.

110

Whats the earliest pharyngeal finding in diptheria?

pharyngeal finding is mild erythema, which can progress to isolated spots of gray and white exudate.

111

Treatmen of diptheria? 2

For severe cases?


How should we monitor?
3



How do we grow out and culture diptheria?

Antibiotics- erythromycin or penicillin G

diphtheria antitoxin for severe cases.

1. Careful airway management
2. serial electrocardiograms and cardiac enzymes
3. Neurologic status should also be monitored carefully

potassium tellurite

112

skin infections and abcesses. go to bacteria?

How do we treat staph?

Which streps have the lancefiled anitgen?

If pregnant mom has group B strep what should we treat with?

Staph auerus

sulfa then doxy then vance

Group ABD


36 weeks treat with IV antibiotics. (amoxicillin and pen G)

113

Strep pneumo treat with what?
3

amox, aug, pen g