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Upper respiratory tract normal flora
staphylococcus, corynebacterium diptheria, streptococcus pneumoniae, steptococcus mutans (mouth), Haemophilus and Neisseria
Streptococcal phayrngitis caused by ? characteristics and treatment
-caused by streptococcus pyogenes
-group A, beta-hemolytic strep
-gram + cocci
-encapsulated (inhib phagocytosis and t cell response)
-transmitted by respiratory secretions and unpasteurized milk
-treated with penicillin (augmentin)
-80 serologic types prevent total immunity
Strep pyogene can cause
-streptococcal pharyngitis
-conjuntivitis
-preseptal cellulitis
-endopthalmitis
Strep pyogenes produces
-streptokinase-breaks through fibrin
-streptolysins-toxic to host cells
-pyrogenic toxin-group of exotoxins act as superantigen and lyse red blood cells (scarlet fever)
-fibronectin binding protein/ protein F-adhesion to epithelial cells and colonization of respiratory
-M-protein-bind host cells, puncture membrane of macrophages
-c5a peptidase-degrades complement
Complications of streptococcal pharyngitis
-rhuematic fever-mainly in children, occurs 2-4 weeks later, IgG attacks heart and valves, occurs if left untreated or antibiotics stopped early
-glomerulonephritis-happen at any age, severe throat or skin infection leaves many IgG, settle into kindeys, moderate to severe inflammation, treat with NSAIDS
Diptheria treatment and characteristics
-caused by corynebacterium diptheriae
-gram +, rod, airborne and resistant to drying
-non-invasive but potent toxin that affects breathing and can lead to cardiac shock
-toxin polypeptide B binds to host cell and transports entire toxin into cell
-polypeptide A inhibit protein synthesis and kills cell
-can also for pseudomembrane that blocks the membrane (dead host cells, dead bacteria and fibrin)
-vaccine is inactivated toxin DPT
-has mutated to less virulent form and is part of normal flora
Lower respiratory tract infection: strep pneumoniae characteristics and treatment
-gram +, diplococcus, alpha-hemolytic, lancet-shaped
-90% cause of bacterial pneumonia
-some non virulent are part of normal flora in oropharynx
-large capsule resists phaygocytosis and complement
-pneumolysin-disrupts cholesterol in pulmonary cell and causes it to lyse, inhibit cilia function, suppresses oxidative burst, inhibit complement
-peroxide can damage host cell and peroxidase to protect itself from peroxide
-IgA protease, streptolysin
-90 serotypes
Symptoms: high fever, difficulting breathing and chest pain
-can spread to ear infection, sinusitis, endocarditis, and meningitis
-diabetes, alcoholism and immunodeficiency are all predisposing factors
-concurrent viral respiratory infection
-eye: dacyrocystitis, conjunctivitis and ulcer secondary to trauma
-treatment: penicillin resistance now occuring, now treat with cephlosporins and PCN’s
vaccine of 23 sertypes available
Haemophilus influenzae characteristics
-gram – , coccobaccilus
-thought to be cause of influenza
-non capsulated are part of normal flora in upper res tract
-pathogenic form is Hib
-capsule is anti-phaygocytic
-LPS can serve as endotoxin and inhibit cilia
-fimbriae to colonize respiratory tract
-IgA proteases
-children, elderly, alcholism, cancer, poor nutrition and diabetes can increase risk
-can cause pneumonia, sinusitis and meningitis
-untreated 100% fatal
-most common of acute and ear sinus infection
-hib is common cause of pre septal cellulitis in kids
-grows well on chocolate agar
-cephlosporins are DOC, vaccine against polysacch
Mycobacterium tuberculosis characteristics
-falcultative intracellular
-stained with acid fast
-spread through aerosol
-phagocytized in lungs
-disrupts the fusion of phagosome to lysosome
-thick wall protect it from enzymes in MO and NU
-releases lipoproteins that inhibit IFN-gamma
-TH1 CELLS RESPOND AND ACTIVATED MO CAN KILL SMALL AMOUNTS
-large amounts= large tissue damage
-infection can travel
-host can form granuloma
-most damage from infection comes from host
-historical cause of pylectenules
-PPD used tp test for exposure, type 4 hypersensitivity
-x-rays to look for granulomas
-isoniazid and rifampin are used for 6-12 months
-streptomyocin sometimes used
-pyrazinamide and ethambutol also
-sirturo approved for multi-drug resistant strains
-drug resistance increasing
Bordetella purtusis
-gram -, coccobacillus, does not grow well in culture
-whooping cough
-maybe has capsule
has fimbriae
-pertusis toxin/ AB exotoxin- disrupts chemotaxtic produciton
-begins as mild respiratory infection
-destroys lung tissue diminishing function
-whoop sound heard when exhaling
-maybe last weeks to months
-usually self limiting with few complications
-vaccine given with tetanus and diptheria- generates IgG against exotoxin and fimbriae
-Azythromyocin and other microlibe antibiotics do not speed resolution but limit contagousness
Normal flora of urogenital tract
staphlycoccus, pseudomonas, klebsiella and proteus
Syphilus characteristics and first stage
-treponema pallidum
-gram -, spirochete
-incubation takes two weeks to several months
-initial response muted because of high lipid content
-initial sigh is painless chancre, fluid in is highly contagous
-lesion disappears in a few weeks
-bacteria then dispersed through blood and lymph
-ocular regions rare, but possible
Syphilus secondary stage
-several weeks later
-skin and mucous membrane rash (contagious), malaise and fever
-uveitis, optic neuritis, retinitis, conjunctivitis, keratitis, 3,4,6 nerve palsies
-signs and symptoms are multi system
-most don’t go beyond this stage
Tertiary stage syphilus
-less than 50% get to this stage
-extensive tissue and organ damage
-gummas present under skin and on organs
-Argyll-Robertson pupil-small, irregular pupil react normally to accommodation but not to light
-some cases of neurosyphilus but decreased with mercury and arsenic discontinued as treatment, linked to heavy drug use
Congenital syphilus
-more dangerous
-transmitted from mother to fetus
-hutchinsons teeth
-prominent forehead with sunken nose bridge
-chorioretinitis (salt and pepper fundus)
Syphilis lab tests
-VDRL and RPR similar to indirect latex aggulations
test for reagin type antibodies
vary with immune response, good to monitor infection
false positives can occur if pt has another infection or active autoimmune
-FTA-ABS-test for antibodies, once had the disease this will always be positive
very sensitive
Syphilis treatment
penicillin (benzathine penicillin)
doxycycline
Neisseria gonorrhea characteristics
-extracellular, gram -, diplococcus, fimbriae
-attach to mucous cells in genital region as well as oral and ocular
-invades locally and dessiminates
-IgA protease
-most damage comes from host
-males are more symptomatic with purulent discharge
-untreated in males leads to arthritis, sterility, adn uerthral blockage
-females may be asymptomatic, can lead to sterility, pelvic inflammatory disease and arthritis
-bacteria can travel endocarditis and meningitis
-ocular or hyperpurulent discharge, direct contact
can lead to blindness in infants
Neisseria treatment
-cultured on chocolate agar
-used silver nitrate
-now use erythromycin for opthalmia neonatoreum (also covers chlamydia)
-resistant to peniciliin and flouroquinolones
-cepftriaxone DOC some resistance
-doxycycline and azithromycin may be used concurrently to cover possible chlamydia
Chlamydia tachomitis characteristics and treatments
-obligate intracellular, gram – , coccoid
-takes form as elementary body, attaches to epithelial by glycoproteins and enters cell by pinocytosis, inhabits cytoplasm and undergoes protein modification, after 8 hours reticulate body, divide/multiply and go back to elementary, leave cell and infect surrounding
-Giemsa stain
-causes urethritis and conjunctivitis
-trochoma from direct ocular contact can cause scarring and blindness also see Arlt’s line and Herbert’s pits
-recurrent conjunctivity/ urethritis
-usually asymptomatic
-can lead to sterility
-treatment: giemsa and ELISA used for testing
azythromycin or doxycline orally
topical treatment alone will not cure inclusion conjuntivitis
Chlamydial opthalmia neonatoreum characteristics
-called neonatal inclusion conjunctivitis
-most common conjunctivitis in newborns, treated with erythromycin
-bacteria can desiminate to lungs and cause intersitial pneumonia
-not fatal but leads to reduced pulmonary function as a adult
Chlamydia psttaci characteristics
-infection called psittacosis or parrot fever
-zoonotic spread by airborne droplets from bird poop
-causes acute respiratory infection, lead to intersitial pneumonia
-seen with poultry workers and tropical bird owners
-dessiminate and cause myocarditis, hepititis and encephalitis
-treatment same for STD
Rickettsia characteristics
-obligate intracellular, gram -, rod
-inhabits and reproduces in cytoplasm and uses ATP
-has affinity for vascular endothelial cells
-Phospholipase A induces endothelial cells to engulf bacteria
-can also thrive in MO
Rickettsia prowazekii
-causes typhus
-carried by human body louse
-mainly in unsanitary conditions
-high fever, headaches, swollen glands, rash from damage
-high mortality if not treated, doxycycline to treat
R rickettsia
-rocky mountain spotted fever
-spread by ticks
-high fever, rash
-spreads to lung, kidney and CNS
-treat with doxycylcine and flouroquinolones
Borrelia burgdorferi
-cause of Lyme disease (also mayonii)
-spirochete spread by tick
-slow growing organism, can take months, can inhibit NU
-bullseye rash
-fever, headache, fatigue, multi organ inflammation, arthritis
-may cause HLA expression causing arthritis
-penicillin, cephlosporin and doxycycline
Bartonella henselae
-gram -, coccobacillus
-cat scratch fever (bite or scratch)-evades immune system with toll like receptor non-recognition, phagolysosome prevention and up regulating IL-10
-granulomatous conjunctivitis with ipsilateral swollen pre auricular node (Parinaud’s Ocular-grandular conjunctivitis)
-rare neuroretinitis with star-shaped exudates at macula, mainly in immunocompromised pts
-usually self limiting within several weeks
-treat with azithromycin
Legionella Pneumophillia
-gram -, rod, microaerophile
-grows in protozoa in fresh water, difficult to culture
-causes Legionnaire’s disease
-spread aerosolizd water from AC and fountains
-only threat to immunocompromized
-responds to most antibiotics
Toxoplasma gondii
-causes toxoplasmosis
-protozoan lives in cats, no harm to them
-block IFN-gamma receptor in MO, can’t get activated
-reproduces i feline intestinal tract and emliminated in feces
-inhaled into human respiratory tract
-also consumed through undercooked meat
-AFFINITY FOR LUNGS AND RETINA
-no problem for immunocompetent, problem for pregnant moms because it can go to fetus
-chorioretinal scar
-protozoan can be dormant in granuloma or scar, reactivates when immunocompromised, active will have vitritis and optic neuritis
-no great treatment, pyrimethamine/ sulfadiazine, bactrim used currently
-lab test IgG and IgM titer
Histoplasma capsulatum
-fungus, lives and multiplies in MO
-causes histoplasmosis
-very common in chicken country
-carried in bird droppings and nitrogen in feces is nutrient
-initially asymptomatic and like mild flu
-fine if immunocompetent
-small, punched out lesions seen ocularly
-triad: chorioditis, neovascularizaion by macula, optic nerve atrophy
-can be transmitted across placenta
-treatment: laser photocoagulation in eye, systemic amphotericin B
Fusarium
-plant and soil fungus
-produces mycotoxins, resistant to some medications
-2006 100 cl cases with cornea fusarium infection
-most using bausch and lomb moisture loc
-most required corneal transplants
-due to biofilm created by contact lens solution that shielded fungus
Acanthamoeba
-Rhizopoda, class of protozoans move by psuedopods
-intracellular pathogen
-grows in fresh water including tap
-common in cl wears making own saline, swimming in lakes, poorly chlorinated pools or hot tubs
-outbreak in 2007 due to abusive contact lens wearers using complete
-needs abrasion to invade
-pathopneumonic appearance: raidal keratoneuritis
-symptoms: pain, decreased vision, photophobia
-ocular symptoms: eventual sub-epithelial infiltrates and ring shaped stromal infiltrate of immune cells
-slow immune response
-treatment: no true, Brolene (if available), polyhexamethylbiguanide (200x strength), opthalmic betadine, may need corneal transplant
Toxocara
-causes toxocariasis
-infection by nematode (canis or cati)
-usually between age 3-10
-history of puppy contact or eating dirt
-ocular infection with white, elevated granuloma
-ancillary test: serum ELISA, eosinophils from paracentesis of AC
-treatment:diethylcarbamazine or thiabendazole, steroids, vitrectomy
Demodex folliculorum or brevis
-parasitic mites
-folliculorum inhabits eyelash follicle
-brevis inhibits meibomian gland
-many asymptomatic cases
-common in elderly
-can cause blepharitis that is resistant to normal bleph treat
-similar to staphlococcus blepharitis but more itching
-treatment: tea tree oil, can by caustic so done in office, reinfection can occur
Actinomycetes
-in soil
-notable for streptomyces: give many antibiotics
-can cause farmer’s lung
Mycoplasma
-no cell wall
-pleomorphic
-resemble fungi really bacteria
-walking pneumonia
-sensetive to tetracyclines and microlides
Bacterial CNS infections: Abcess
-small area from trauma and invasion, can spread
-anaerobic-bacteriods, peptostreptococcus
-aerobic-streptococcus, staphylococcus
Bacterial CNS infections: Meningitis
-direct invasion or secondary infection
-kids: strep pneumo, Hib or niesseria
-adult: niesseria, strep, staph
-high fever, stiff neck, headache, altered mental status
Normal gut flora
bacteroides, avirulent clostridium, faecalibacterium, eubacterium, ruminococcus, peptococcus, peptostreptococcus, bifidobacterium, escherichia coli and listeria
Vancomycin resistant enterococcus
-gram +, cocci, falcultative anaerobe, plasmid containing
-mostly nosocomial
-treatment: probiotics and fecal transplants
Clostridium difficile
-gram +, spore forming, rod, anaerobic
-opportunistic invader after antibiotic or chemo use
-common nosocomial and CA with antibiotic resistance
Escherichia coli
-gram – , rod, fimbriae, falcultative anaerobe
-benign is part of normal gut for nutrient absorbtion and vit K production
-primary culprit shiga toxin or 0157:H7 strain
-STEC can cause intense inflammation and spread to kidney
Listeria
-gram +, rod, no spores, falcultative anaerobe
-main monocytogenes
-common in food exposed to fecal matter
Salmonella
-gram -, rod, fimbriae, facultative anaeobe
-cause of typhoid fever
-may activate HLA-B27-autoimmune state:uveitis and arthritis
-some association with Reiter’s syndrome (reactive arthritis)
Heliobacter pylori
-gram -, spiral shaped rod, microaerophilic
-common invader of stomach
-gastric ulcers and gastritis
-some association with primary open angle glaucoma

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