MICROBIOLOGY Day 1

BACTERIA

Function/Composition of peptidoglycan?

BACTERIA

Function/Composition of peptidoglycan?

Gives rigid support Protects against osmotic pressure Sugar backbone, cross-linked peptide side chains

BACTERIA
Function/Composition of cell wall/cell membrane?

BACTERIA
Function/Composition of cell wall/cell membrane? Gram positive: major surface antigen Teichoic acid induces TNF and IL-1

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Function/Composition of Outer Membrane?

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Function/Composition of Outer Membrane?

Gram negative: site of endotoxin (LPS) Major surface antigen Lipid A: induces TNF alpha and IL-1

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Function/Composition of Plasma Membrane?

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Function/Composition of Plasma Membrane?

Site of oxidative and transport enzymes Lipoprotein bilayer

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Function/Composition of Ribosomes?

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Function/Composition of Ribosomes?

Protein Synthesis

50S and 30S

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Function/Composition of Periplasm?

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Function/Composition of Periplasm?

Space between the cytoplasmic membrane and the outer membrane in GRAM NEGATIVE RODS Contains many hydrolytic enzymes (B-lactamases)

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Function/Composition of Capsule?

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Function/Composition of Capsule?

Protects against phagocytosis

Polysaccharides (except B. anthracis composed of?)

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Function/Composition of Capsule?

Protects against phagocytosis

Polysaccharides (except B. anthracis: D-glutamate)

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Function/Composition of Pilus/Fimbria?

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Function/Composition of Pilus/Fimbria?

Mediates adherence of bacteria to cell surface Sex pilus forms between 2 bacteria (conjugation)

Glycoprotein

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Function/Composition of Flagellum?

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Function/Composition of Flagellum?

Motility

Protein

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Function/Composition of Spore?

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Function/Composition of Spore?

Provides resistance to dehydration, heat and chemicals Keratin-like coat; dipicolinic acid

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Function/Composition of Plasmid?

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Function/Composition of Plasmid?

Contains genes for antibiotic resistance, enzymes and toxins DNA

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Function/Composition of Glycocalyx?

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Function/Composition of Glycocalyx?

Mediates adherence to surfaces (e.g. indwelling catheters) Polysaccharides

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Activity in Lag Phase?

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Activity in Lag Phase?

Metabolic activity without division

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Activity in Log Phase?

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Activity in Log Phase?

Rapid cell division

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Activity in Stationary Phase?

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Activity in Stationary Phase?

Nutrient depletion slows growth

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Activity in Death Phase?

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Activity in Death Phase?

Prolonged nutrient depletion and build up of waste product cell death

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Bacterial Growth Curve :

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PROPERTY SOURCE SECRETED FROM CELL CHEMISTRY LOCATION OF GENES TOXICITY EXOTOXIN ENDOTOXIN

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PROPERTY SOURCE SECRETED FROM CELL CHEMISTRY LOCATION OF GENES TOXICITY EXOTOXIN Gram +/ENDOTOXIN

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PROPERTY SOURCE SECRETED FROM CELL CHEMISTRY LOCATION OF GENES TOXICITY EXOTOXIN Gram +/ENDOTOXIN Most Gram -

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PROPERTY SOURCE SECRETED FROM CELL CHEMISTRY LOCATION OF GENES TOXICITY EXOTOXIN Gram +/YES ENDOTOXIN Most Gram -

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PROPERTY SOURCE SECRETED FROM CELL CHEMISTRY LOCATION OF GENES TOXICITY EXOTOXIN Gram +/YES ENDOTOXIN Most Gram NO

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PROPERTY SOURCE SECRETED FROM CELL CHEMISTRY LOCATION OF GENES TOXICITY EXOTOXIN Gram +/YES Polypeptide ENDOTOXIN Most Gram NO

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PROPERTY SOURCE SECRETED FROM CELL CHEMISTRY LOCATION OF GENES TOXICITY EXOTOXIN Gram +/YES Polypeptide ENDOTOXIN Most Gram NO LPS

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PROPERTY SOURCE SECRETED FROM CELL CHEMISTRY LOCATION OF GENES TOXICITY EXOTOXIN Gram +/YES Polypeptide Plasmid/ Bacteriophage ENDOTOXIN Most Gram NO LPS

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PROPERTY SOURCE SECRETED FROM CELL CHEMISTRY LOCATION OF GENES TOXICITY EXOTOXIN Gram +/YES Polypeptide Plasmid/ Bacteriophage ENDOTOXIN Most Gram NO LPS Bacterial chromosome

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PROPERTY SOURCE SECRETED FROM CELL CHEMISTRY LOCATION OF GENES TOXICITY EXOTOXIN Gram +/YES Polypeptide Plasmid/ Bacteriophage High (1 ug) ENDOTOXIN Most Gram NO LPS Bacterial chromosome

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PROPERTY SOURCE SECRETED FROM CELL CHEMISTRY LOCATION OF GENES TOXICITY EXOTOXIN Gram +/YES Polypeptide Plasmid/ Bacteriophage High (1 ug) ENDOTOXIN Most Gram NO LPS Bacterial chromosome Low (100s)

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PROPERTY Antigenicity Vaccines Heat Stability EXOTOXIN ENDOTOXIN

Typical Diseases

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PROPERTY Antigenicity Vaccines Heat Stability Typical Diseases EXOTOXIN High (antitoxins) ENDOTOXIN

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PROPERTY Antigenicity Vaccines Heat Stability Typical Diseases EXOTOXIN ENDOTOXIN High (antitoxins) Poorly antigenic

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PROPERTY Antigenicity Vaccines Heat Stability Typical Diseases EXOTOXIN ENDOTOXIN High (antitoxins) Poorly antigenic Toxoids

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PROPERTY Antigenicity Vaccines Heat Stability Typical Diseases EXOTOXIN ENDOTOXIN High (antitoxins) Poorly antigenic Toxoids None

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PROPERTY Antigenicity Vaccines Heat Stability EXOTOXIN ENDOTOXIN High (antitoxins) Poorly antigenic Toxoids Destroyed at 60C(except staph enterotoxin) None

Typical Diseases

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PROPERTY EXOTOXIN ENDOTOXIN

Antigenicity
Vaccines Heat Stability

High (antitoxins) Poorly antigenic

Toxoids Destroyed at 60C(except staph enterotoxin) None Stable at 100C for 1 hour

Typical Diseases

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PROPERTY EXOTOXIN ENDOTOXIN

Antigenicity
Vaccines Heat Stability

High (antitoxins) Poorly antigenic

Toxoids Destroyed at 60C(except staph enterotoxin) Tetanus, botulism, diphtheria None Stable at 100C for 1 hour

Typical Diseases

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PROPERTY EXOTOXIN ENDOTOXIN

Antigenicity
Vaccines Heat Stability

High (antitoxins) Poorly antigenic

Toxoids Destroyed at 60C(except staph enterotoxin) Tetanus, botulism, diphtheria None Stable at 100C for 1 hour

Typical Diseases

Meningococcemia, sepsis by gram - rods

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Gram positive bacteria with exotoxin?

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-

Gram positive bacteria with exotoxin? Corynebacterium diphtheriae Clostridium tetani C. botulinum C. perfringens Staphylococcus aureus Streptococcus pyogenes

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Gram negative bacteria with exotoxin?

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Gram negative bacteria with exotoxin? E. coli B. pertussis V. cholerae

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Bacteria with superantigen?

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Bacteria with superantigen?

S. aureus

S. pyogenes

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Bacteria with superantigen?

S. aureus : TSST-1 binds to MHCII and T cell receptor IL-1 & IL-2 Toxic Shock (other toxins: enterotoxin, exfoliatin) S. pyogenes:

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Bacteria with superantigen?

S. aureus : TSST-1 binds to MHCII and T cell receptor IL-1 & IL-2 Toxic Shock (other toxins: enterotoxin, exfoliatin)
S. pyogenes: Erythrogenic toxinScarlet Fever Streptolysin O (hemolysin) : antigen for ASO titers for Rheumatic Fever

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Bacteria with ADP ribosylating toxins

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Bacteria with ADP ribosylating toxins

C. diphtheriae - E. coli - B. pertussis - V. cholerae

-

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Bacteria with ADP ribosylating toxins

C. diphtheriae: inactivates EF2 - E. coli - B. pertussis - V. cholerae

-

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Bacteria with ADP ribosylating toxins

C. diphtheriae: inactivates EF2 E. coli: heat labile toxin- stimulates adenylate cyclase heat stable toxin- stimulates guanylate cyclase B. pertussis V. cholerae

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Bacteria with ADP ribosylating toxins

C. diphtheriae: inactivates EF2 E. coli: heat labile toxin- stimulates adenylate cyclase heat stable toxin- stimulates guanylate cyclase B. pertussis: stimulates adenylate cyclase (Gi) V. cholerae

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Bacteria with ADP ribosylating toxins

C. diphtheriae: inactivates EF2 E. coli: heat labile toxin- stimulates adenylate cyclase heat stable toxin- stimulates guanylate cyclase B. pertussis: stimulates adenylate cyclase (Gi) V. cholerae: stimulates adenylate cyclase(Gs)

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Actions of Endotoxin (especially lipid A)?

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Actions of Endotoxin (especially lipid A)?

Activates Macrophages Activates Complement (alt pathway) Activates Hageman Factor

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Actions of Endotoxin (especially lipid A)?

Activates Macrophages:
IL-1 Fever TNF Fever, tissue necrosis Nitric Oxide Hypotension

Activates Complement (alt pathway): Activates Hageman Factor:

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Actions of Endotoxin (especially lipid A)?

Activates Macrophages:
IL-1 Fever TNF Fever, tissue necrosis Nitric Oxide Hypotension

Activates Complement (alt pathway):

C3a hypotension, edema C5a neutrophil chemotaxis

Activates Hageman Factor:

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Actions of Endotoxin (especially lipid A)?

Activates Macrophages:
IL-1 Fever TNF Fever, tissue necrosis Nitric Oxide Hypotension

Activates Complement (alt pathway):

C3a hypotension, edema C5a neutrophil chemotaxis

Activates Hageman Factor:

Coagulation cascade DIC

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Bacteria that dont Gram stain well?

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Bacteria that dont Gram stain well?

Treponema Rickettsia Mycobacteria Mycoplasm Legionella pneumophila Chlamydia

These Rascals May Microscopically Lack Color

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Bacteria that dont Gram stain well?

Treponema too thin (Darkfield & FTABS) Rickettsia Mycobacteria Mycoplasm Legionella pneumophila Chlamydia

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Bacteria that dont Gram stain well?

Treponema too thin (Darkfield & FTABS) Rickettsia intracellular parasite Mycobacteria Mycoplasm Legionella pneumophila Chlamydia

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Bacteria that dont Gram stain well?

Treponema too thin (Darkfield & FTABS) Rickettsia intracellular parasite Mycobacteria high lipid content (Acid Fast) Mycoplasm Legionella pneumophila Chlamydia

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Bacteria that dont Gram stain well?

Treponema too thin (Darkfield & FTABS) - Rickettsia intracellular parasite - Mycobacteria high lipid content (Acid Fast) - Mycoplasm no cell wall - Legionella pneumophila - Chlamydia
-

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Bacteria that dont Gram stain well?

Treponema too thin (Darkfield & FTABS) - Rickettsia intracellular parasite - Mycobacteria high lipid content (Acid Fast) - Mycoplasm no cell wall - Legionella pneumophila intracellular (Silver Stain) - Chlamydia
-

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Bacteria that dont Gram stain well?

Treponema too thin (Darkfield & FTABS) Rickettsia intracellular parasite Mycobacteria high lipid content (Acid Fast) Mycoplasm no cell wall Legionella pneumophila intracellular (Silver Stain) Chlamydia intracellular parasite

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Fermentation pattern of Neisseria species?

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Fermentation pattern of Neisseria species?

N . Meningococci Maltose & Glucose N. Gonococci Glucose

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Pigment Producing Bacteria?

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Pigment Producing Bacteria? S. aureus P. aeruginosa S. marcescens

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Pigment Producing Bacteria? S. aureus yellow P. aeruginosa S. marcescens

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Pigment Producing Bacteria? S. aureus yellow P. aeruginosa blue/green S. marcescens

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Pigment Producing Bacteria? S. aureus yellow P. aeruginosa blue/green S. marcescens red

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IgA Protease producing bacteria?

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IgA Protease producing bacteria?

S. pneumoniae N. meningitidis N. gonorrhoeae H. influenzae

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Gram Positive Cocci?

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Gram Positive Cocci?

Staphylococcus Streptococcus

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How to differentiate Staph from Strep?

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How to differentiate Staph from Strep?

Staphylococcus = Catalase positive Streptococcus = Catalase negative

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How to differentiate staphylococcus?

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How to differentiate staphylococcus?

Coagulase positive S. aureus Coagulase negative S. saprophyticus S. epidermidis

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How to differentiate staphylococcus?

Coagulase positive S. aureus Coagulase negative S. saprophyticus Novobiocin S. epidermidis Novobiocin +

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How to differentiate Streptococcus?

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How to differentiate Streptococcus?

Alpha hemolytic

Beta hemolytic
Gamma hemolytic

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How to differentiate Streptococcus?

Alpha hemolytic S. pneumoniae S. viridans Beta hemolytic Gamma hemolytic

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How to differentiate Streptococcus?

Alpha hemolytic S. pneumoniae S. viridans Beta hemolytic S. pyogenes S. agalactiae Gamma hemolytic

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How to differentiate Streptococcus?

Alpha hemolytic S. pneumoniae S. viridans Beta hemolytic S. pyogenes S. agalactiae Gamma hemolytic Enterococcus Peptostreptococcus

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How to differentiate between alpha hemolytic streptococci?

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How to differentiate between alpha hemolytic streptococci?

S. Pneumoniae Optochin sensitive Bile soluble Viridans streptococci Optochin resistant Not bile soluble

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How to differentiate beta hemolytic streptococci?

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How to differentiate beta hemolytic streptococci?

S. Pyogenes (Group A) Bacitracin sensitive S. Agalactiae (Group B) Bacitracin resistant

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Gram positive rods?

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Gram positive rods? Clostridium (anaerobe) Corynebacterium Listeria Bacillus

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Gram negative Coccoid rods?

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Gram negative Coccoid rods? H. influenzae Pasteurella Brucella B. pertussis

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Fast Lactose fermenters?

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Fast Lactose fermenters? Klebsiella E. coli Enterobacter

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Slow Lactose Fermenters?

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Slow Lactose Fermenters? Citrobacter Serratia

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Lactose Nonfermenters?

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Lactose Nonfermenters?

Oxidase Positive: Pseudomonas

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Lactose Nonfermenters? Oxidase Negative: Shigella Salmonella Proteus

Oxidase Positive: Pseudomonas

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Special Culture Requirements?

H. Influenza N. Gonorrhoea B. Pertussis C. Diphtheriae M. Tuberculosis Lactose Fermenting Enterics Legionella Fungi

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Special Culture Requirements?

H. Influenza Chocolate Agar Factor V (NAD) & X (Hematin) N. Gonorrhoea B. Pertussis C. Diphtheriae M. Tuberculosis Lactose Fermenting Enterics Legionella Fungi

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Special Culture Requirements?

H. Influenza Chocolate Agar Factor V (NAD) & X (Hematin) N. Gonorrhoea Thayer-Martin (VCN) B. Pertussis C. Diphtheriae M. Tuberculosis Lactose Fermenting Enterics Legionella Fungi

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Special Culture Requirements?

H. Influenza Chocolate Agar Factor V (NAD) & X (Hematin) N. Gonorrhoea Thayer-Martin (VCN) B. Pertussis Bordet- Gengou (potato) agar C. Diphtheriae M. Tuberculosis Lactose Fermenting Enterics Legionella Fungi

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Special Culture Requirements?

H. Influenza Chocolate Agar Factor V (NAD) & X (Hematin) N. Gonorrhoea Thayer-Martin (VCN) B. Pertussis Bordet- Gengou (potato) agar C. Diphtheriae Tellurite plate, Lofflers medium, blood agar M. Tuberculosis Lactose Fermenting Enterics Legionella Fungi

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Special Culture Requirements?

H. Influenza Chocolate Agar Factor V (NAD) & X (Hematin) N. Gonorrhoea Thayer-Martin (VCN) B. Pertussis Bordet- Gengou (potato) agar C. Diphtheriae Tellurite plate, Lofflers medium, blood agar M. Tuberculosis Lowenstein-Jensen agar Lactose Fermenting Enterics Legionella Fungi

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Special Culture Requirements?

H. Influenza Chocolate Agar Factor V (NAD) & X (Hematin) N. Gonorrhoea Thayer-Martin (VCN) B. Pertussis Bordet- Gengou (potato) agar C. Diphtheriae Tellurite plate, Lofflers medium, blood agar M. Tuberculosis Lowenstein-Jensen agar Lactose Fermenting Enterics Pink colonies on MacConkeys agar Legionella Fungi

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Special Culture Requirements?

H. Influenza Chocolate Agar Factor V (NAD) & X (Hematin) N. Gonorrhoea Thayer-Martin (VCN) B. Pertussis Bordet- Gengou (potato) agar C. Diphtheriae Tellurite plate, Lofflers medium, blood agar M. Tuberculosis Lowenstein-Jensen agar Lactose Fermenting Enterics Pink colonies on MacConkeys agar Legionella Charcoal yeast extract agar buffered with increased iron & cysteine Fungi

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Special Culture Requirements?

H. Influenza Chocolate Agar Factor V (NAD) & X (Hematin) N. Gonorrhoea Thayer-Martin (VCN) B. Pertussis Bordet- Gengou (potato) agar C. Diphtheriae Tellurite plate, Lofflers medium, blood agar M. Tuberculosis Lowenstein-Jensen agar Lactose Fermenting Enterics Pink colonies on MacConkeys agar Legionella Charcoal yeast extract agar buffered with increased iron & cysteine Fungi Sabourauds agar

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Stains

Congo Red Giemsas PAS Ziehl- Neelsen India ink Silver stain

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Stains

Congo Red Amyloid; apple-green birefringence in polarized light Giemsas PAS Ziehl- Neelsen India ink Silver stain

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Stains

Congo Red Amyloid; apple-green birefringence in polarized light Giemsas Borrelia, Plasmodium, trypanosomes, Chlamydia PAS Ziehl- Neelsen India ink Silver stain

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Stains

Congo Red Amyloid; apple-green birefringence in polarized light Giemsas Borrelia, Plasmodium, trypanosomes, Chlamydia PAS stains glycogen, mucopolysaccharides used to dx Whipples disease Ziehl- Neelsen India ink Silver stain

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Stains

Congo Red Amyloid; apple-green birefringence in polarized light Giemsas Borrelia, Plasmodium, trypanosomes, Chlamydia PAS stains glycogen, mucopolysaccharides used to dx Whipples disease Ziehl- Neelsen Acid-fast bacteria India ink Silver stain

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Stains

Congo Red Amyloid; apple-green birefringence in polarized light Giemsas Borrelia, Plasmodium, trypanosomes, Chlamydia PAS stains glycogen, mucopolysaccharides used to dx Whipples disease Ziehl- Neelsen Acid-fast bacteria India ink Cryptococcus neoformans (also red on mucicarmine stain) Silver stain

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Stains

Congo Red Amyloid; apple-green birefringence in polarized light Giemsas Borrelia, Plasmodium, trypanosomes, Chlamydia PAS stains glycogen, mucopolysaccharides used to dx Whipples disease Ziehl- Neelsen Acid-fast bacteria India ink Cryptococcus neoformans Silver stain Bartonella, P. jiroveci, H. pylori, Legionella

Congo Red
Amyloid

Giemsa
Plasmodium ovale

Periodic acid Schiff (PAS) stain

Tropheryma whippelii

Ziehl-Neelson Stain
M. tuberculosis

India Ink
Cryptococcus

Silver stain
Pneumocystis jiroveci pneumonia

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Conjugation Transduction Transformation

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Conjugation: DNA (chromosomal or plasmid) transferred from one bacterium to another Transduction Transformation

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Conjugation: DNA (chromosomal or plasmid) transferred from one bacterium to another Transduction: DNA transferred by a virus from 1 bacterium to another Transformation

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Conjugation: DNA (chromosomal or plasmid) transferred from one bacterium to another Transduction: DNA transferred by a virus from 1 bacterium to another Transformation: Purified DNA taken up by a cell (pro/eukaryotic)

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Obligate Aerobes?

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Obligate Aerobes?

Nocardia Pseudomonas M. tuberculosis Bacillus

(Nagging Pests Must Breathe)

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Obligate Anaerobes?

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Obligate Anaerobes?

Actinomyces Bacteroides Clostridium

(Lack catalase and/or superoxide dismutase)

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Obligate Intracellular Bacteria?

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Obligate Intracellular Bacteria?

Rickettsia Chlamydia

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Facultative intracellular bacteria?

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Facultative intracellular bacteria?

Salmonella Brucella Mycobacterium Listeria Francisella Legionella Yersinia

(some bugs may live facultatively) (First Aid-Salmonella, Neisseria, Brucella, Mycobacterium, Listeria, Francisella, Legionella = SoMe NEISe BRUtes MaY LIve FacultativeLI.)

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Encapsulated bacteria?

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Encapsulated bacteria?

Salmonella S. pneumoniae K. pneumoniae H. influenzae P. aeruginosa N. meningitidis Citrobacter

(some strange killers have pretty nice capsules)

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Spore forming bacteria?

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Spore forming bacteria?

B. anthracis C. perfringens C. Tetani Coxiella burnettii (

WHAT IS CONTAINED WITHIN THEIR CORE?

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Spore forming bacteria?

B. anthracis C. perfringens C. tetani

(diplicolinic acid in core)

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Beta hemolytic bacteria?

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Beta hemolytic bacteria?

S. Aureus S. Pyogenes S. Agalactiae L. Monocytogenes

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S. Aureus

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S. Aureus Virulence?

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S. Aureus Virulence?

Protein A (virulence factor) TSST-1 Exfoliative toxin Enterotoxin (preformed)

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S. Aureus Virulence?

Protein A (virulence factor) binds FcIgG, inhibiting complement and phagocytosis TSST-1 Exfoliative toxin Enterotoxin (preformed)

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S. Aureus Virulence?

Protein A (virulence factor) binds FcIgG, inhibiting complement and phagocytosis TSST-1 superantigen Exfoliative toxin Enterotoxin (preformed)

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S. Aureus Virulence?

Protein A (virulence factor) binds FcIgG, inhibiting complement and phagocytosis TSST-1 superantigen Exfoliative toxin scalded skin Enterotoxin (preformed)

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S. Aureus Virulence?

Protein A (virulence factor) binds FcIgG, inhibiting complement and phagocytosis TSST-1 superantigen Exfoliative toxin scalded skin Enterotoxin (preformed) food poisoning

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S. Pyogenes (Group A beta hemolytic)

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S. Pyogenes (Group A beta hemolytic) Virulence?

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S. Pyogenes (Group A beta hemolytic) Virulence?

Pyogenic toxin Toxigenic toxin Immunologic toxin

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S. Pyogenes (Group A beta hemolytic) Virulence?

Pyogenic toxin cellulitis, pharyngitis, impetigo Toxigenic toxin Immunologic toxin

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S. Pyogenes (Group A beta hemolytic) Virulence?

Pyogenic toxin cellulitis, pharyngitis, impetigo Toxigenic toxin Scarlet fever, TSS Immunologic toxin

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S. Pyogenes (Group A beta hemolytic) Virulence?

Pyogenic toxin cellulitis, pharyngitis, impetigo Toxigenic toxin Scarlet fever, TSS Immunologic toxin RF, Acute GN
(Antibody to M protein enhances host defenses)

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Rheumatic Fever?

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Rheumatic Fever?

P E C C S

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Rheumatic Fever?

Polyarthritis E C C S

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Rheumatic Fever?

Polyarthritis Erthema marginatum C C S

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Rheumatic Fever?

Polyarthritis Erthema marginatum Chorea C S

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Rheumatic Fever?

Polyarthritis Erthema marginatum Chorea Carditis S

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Rheumatic Fever?

Polyarthritis Erthema marginatum Chorea Carditis Subcutaneous nodules

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Modified Jones Criteria for Rheumatic Heard Disease?

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Modified Jones Criteria for Rheumatic Heard Disease? Polyarthritis Erthema marginatum Chorea Carditis Subcutaneous nodules

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Major: Polyarthritis Erthema marginatum Chorea Carditis Subcutaneous nodules Minor: Fever Arthralgias Increased ESR Increased CRP Increased PR Recent Strep infection 2 major or 1 major an 2 minor = DX

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Grows on 6.5% NaCl?

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Grows on 6.5% NaCl?

Enterococcus (Lancefield Group D) UTI , SBE

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S. Viridans types?

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S. Viridans types?

S. mutans dental caries S. sanguis SBE

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Clostridia Exotoxins?

C. tetani C. botulism C. perfrigens C. difficile

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Clostridia Exotoxins?

C. tetani exotoxin tetanus C. botulism C. perfrigens C. difficile

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Clostridia Exotoxins?

C. tetani exotoxin tetanus C. botulism heat-labile botulism C. perfrigens C. difficile

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Clostridia Exotoxins?

C. tetani exotoxin tetanus C. botulism heat-labile botulism C. perfrigens alpha toxin (lecithinase) gas gangrene, hemolysis C. difficile

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Clostridia Exotoxins?

C. tetani exotoxin tetanus C. botulism heat-labile botulism C. perfrigens alpha toxin (lecithinase) gas gangrene, hemolysis C. difficile cytotoxin, exotoxin pseudomembranous colitis

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C. Diphtheriae

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C. Diphtheriae Virulence?

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C. Diphtheriae Virulence?

Exotoxin: encoded by B-prophage ,inhibits protein synthesis via ADP ribosylation of EF-2 pseudomembranous pharyngitis

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5 times skin infection is S. pyogenes and not staph?

L I N E S

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5 times skin infection is S. pyogenes and not staph?

Lymphangitis: Red streaks

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5 times skin infection is S. pyogenes and not staph?

Lymphangitis: Red streaks Impetigo: Honey crusted lesions

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5 times skin infection is S. pyogenes and not staph?

Lymphangitis: Red streaks Impetigo: Honey crusted lesions Necrotizing fascitis

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5 times skin infection is S. pyogenes and not staph?

Lymphangitis: Red streaks Impetigo: Honey crusted lesions Necrotizing fascitis Eryseplis: Infection of SQ fat; no blanching, raised borders

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5 times skin infection is S. pyogenes and not staph?

Lymphangitis: Red streaks Impetigo: Honey crusted lesions Necrotizing fascitis Eryseplis: Infection of SQ fat; no blanching, raised borders Scarlet Fever: Sand paper like rash; palms & soles
(LINES)

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END OF DAY 1

Questions:

A pharyngeal exudates sample from a 20-year old female is placed on an enriched medium containing vancomycin, colistin and trimethoprim. The media would favor growth of which of the following bacteria?

a.) E. coli b.) S. pyogenes

c.) S. pneumoniae
d.) K. pneumoniae e.) N. gonorrhoeae f.) C. diphtheriae

Questions:

A pharyngeal exudates sample from a 20-year old female is placed on an enriched medium containing vancomycin, colistin and trimethoprim. The media would favor growth of which of the following bacteria?

a.) E. coli b.) S. pyogenes c.) S. pneumoniae d.) K. pneumoniae e.) N. gonorrhoeae f.) C. diphtheriae Thayer-Martin agar: Vancomycin inhibits gram + , colistin and TMP inhibits gram - , Nystatin inhibits fungi

Questions:

Gram stain of a CSF sample from a 21 year old Caucasian male army recruit with fever and headache demonstrates bean-shaped gram negative cocci in pairs. Which of the following is the most likely route of meningeal contamination in this patient?

A.) pharynx lymphatics meninges B.) middle ear contigous tissues meninges

C.) traumatic wound leaking CSF meninges

D.) pharynx blood choroid plexus meninges E.) primary lung focus blood meninges

Questions:

Gram stain of a CSF sample from a 21 year old Caucasian male army recruit with fever and headache demonstrates bean-shaped gram negative cocci in pairs. Which of the following is the most likely route of meningeal contamination in this patient?

A.) pharynx lymphatics meninges B.) middle ear contigous tissues meninges

C.) traumatic wound leaking CSF meninges

D.) pharynx blood choroid plexus meninges E.) primary lung focus blood meninges

Questions:

Gram stain of a CSF sample from a 21 year old Caucasian male army recruit with fever and headache demonstrates bean-shaped gram negative cocci in pairs. Which of the following is the most likely route of meningeal contamination in this patient?

A.) pharynx lymphatics meninges (H. influenza) B.) middle ear contigous tissues meninges ( S. pneumoniae)

C.) traumatic wound leaking CSF meninges ( S. aures)

D.) pharynx blood choroid plexus meninges (N. meningitidis) E.) primary lung focus blood meninges ( M.tuberculosis)

Questions:

A toxic substance produced by C. perfringens induces massive hemolysis and tissue necrosis when injected into mice. The lethal effect observed in the experiment correlates with substances ability to split:

A. Collagen B. Hyaluronic acid

C. Phospholipids
D. Carbohydrates E. Plasminogen

Questions:

A toxic substance produced by C. perfringens induces massive hemolysis and tissue necrosis when injected into mice. The lethal effect observed in the experiment correlates with substances ability to split:

A. Collagen B. Hyaluronic acid

C. Phospholipids (Lecithinase/alpha toxin)

D. Carbohydrates E. Plasminogen

Questions:

An outbreak of water-born gastroenteritis reported in Latin America is caused by oxidase-positive, gram -, comma shaped rods that can survive on alkaline media. Stool microscopy in these patients is expected to demonstrate:

A. Mucus and some epithelial cells B. Many leukocytes, neutrophils predominant

C. Many leukocytes, eosinophils predominant

D. Many leukocytes , lymphocytes predominant E. Many erythrocytes and some leukocytes

Questions:

An outbreak of water-born gastroenteritis reported in Latin America is caused by oxidase-positive, gram -, comma shaped rods that can survive on alkaline media. Stool microscopy in these patients is expected to demonstrate:

A. Mucus and some epithelial cells V. cholerae B. Many leukocytes, neutrophils predominant

C. Many leukocytes, eosinophils predominant

D. Many leukocytes , lymphocytes predominant E. Many erythrocytes and some leukocytes

Questions:

An outbreak of water-born gastroenteritis reported in Latin America is caused by oxidase-positive, gram -, comma shaped rods that can survive on alkaline media. Stool microscopy in these patients is expected to demonstrate:

A. Mucus and some epithelial cells V. cholerae B. Many leukocytes, neutrophils predominant - Salmonella C. Many leukocytes, eosinophils predominant intestinal parasites D. Many leukocytes , lymphocytes predominant E. Many erythrocytes and some leukocytes EIEC, Shigella * This morphology may be confused by C. jejuni, one of the most common causes of diarrhea worldwide, which is a curved motile gram -, oxidase + rod, but this organism is unable to survive alkaline enrichment

Questions:

A 7-year old Caucasian boy is brought to your office with blisters on his face. Some of the blisters have broken and are covered with golden yellow crusts. Exudate microscopy reveals gram + cocci in chains. Which of the following would be a component of the clinical syndrome that may follow such a infection?

A. Joint pain and eye redness

B. Fatigue and heart murmurs

C. Face puffiness and dark urine D. Bilateral facial nerve palsy E. Abdominal pain and jaundice

Questions:

A 7-year old Caucasian boy is brought to your office with blisters on his face. Some of the blisters have broken and are covered with golden yellow crusts. Exudate microscopy reveals gram + cocci in chains. Which of the following would be a component of the clinical syndrome that may follow such a infection?

A. Joint pain and eye redness

B. Fatigue and heart murmurs

C. Face puffiness and dark urine Impetigo (S. pyogenes, S.aureus) D. Bilateral facial nerve palsy E. Abdominal pain and jaundice

Questions:

A 7-year old Caucasian boy is brought to your office with blisters on his face. Some of the blisters have broken and are covered with golden yellow crusts. Exudate microscopy reveals gram + cocci in chains. Which of the following would be a component of the clinical syndrome that may follow such a infection?

A. Joint pain and eye redness Sjorens, lupus, Reiters Syndrome

B. Fatigue and heart murmurs RF does not occur in relation to Streptococcal skin infections
C. Face puffiness and dark urine Impetigo (S. pyogenes, S.aureus) D. Bilateral facial nerve palsy Lymes disease (B. burgdorferi)

E. Abdominal pain and jaundice Hep A

Questions:

A 46 year old male who just returned from a mission trip to Latin America presents to your office complaining of fever, myalgias, dull abdominal pain, and a week-long history of watery diarrhea that has recently become bloody. Physical examination reveals a fever of 102F, hepatosplenomegaly, and rose-colored spots at the periumbilical area. Which of the following is the most likely cause of this patients symptoms?

A. E . coli B. S. typhi C. S. flexneri

D. V. cholerae
C. C. jejuni

Questions:

A 46 year old male who just returned from a mission trip to Latin America presents to your office complaining of fever, myalgias, dull abdominal pain, and a week-long history of watery diarrhea that has recently become bloody. Physical examination reveals a fever of 102F, hepatosplenomegaly, and rose-colored spots at the periumbilical area. Which of the following is the most likely cause of this patients symptoms?

A. E . coli B. S. typhi (Typhoid fever) C. S. flexneri

D. V. cholerae
C. C. jejuni

Questions:

A 4 year old immigrant boy is brought to the pediatric ER with a swollen right knee, accompained by fever and malaise. He is hypotensive and tachycardic. His past medical history is nothing significant except for one episode of otitis media. Some of his vaccinations are not up-to-date. Synovial fluid and blood cultures grew pleomorphic gram rods on hematin containing medium. The pathogenesis of the organism responsible for his condition is most likely related to which of the following?

A. Endotoxin B. Fimbriae C. Capsule D. Cytotoxic exotoxin E. Hemolysins F Hyaluronidase

Questions:

A 4 year old immigrant boy is brought to the pediatric ER with a swollen right knee, accompained by fever and malaise. He is hypotensive and tachycardic. His past medical history is nothing significant except for one episode of otitis media. Some of his vaccinations are not up-to-date. Synovial fluid and blood cultures grew pleomorphic gram rods on hematin containing medium. The pathogenesis of the organism responsible for his condition is most likely related to which of the following?

A. Endotoxin B. Fimbriae C. Capsule H. influenzae (polysaccharide capsule) D. Cytotoxic exotoxin E. Hemolysins F Hyaluronidase

Questions:

Group A Streptococci demonstrate significant resistance to phagocytic killing when placed in fresh human blood. This resistance can be most effectively overcome by adding antibodies to which of the following?

A. Hyaluronate B. Streptolysin O

C. Dnase
D. Protein M E. Teichoic Acid F. Streptokinase

Questions:

Group A Streptococci demonstrate significant resistance to phagocytic killing when placed in fresh human blood. This resistance can be most effectively overcome by adding antibodies to which of the following?

A. Hyaluronate B. Streptolysin O C. Dnase

D. Protein M S. pyogenes
E. Teichoic Acid F. Streptokinase

Protein M inhibits phagocytosis and complement activation, mediates bacterial adherence, and is the target of type-specific humoral immunity to S. Pyogenes.

Questions:

E. coli strains isolated from a 4 year old Caucasian female with bloody diarrhea produce a substance that inhibits protein synthesis in human cells. The substance shares many properties with the toxin produced by:

A. S. dysenteriae B. V. cholerae

C. C. difficile
D. P. mirabilis E. S. typhi F. P. aeruginosa

Questions:

E. coli strains isolated from a 4 year old Caucasian female with bloody diarrhea produce a substance that inhibits protein synthesis in human cells. The substance shares many properties with the toxin produced by:

A. S. dysenteriae Vero cytotoxins B. V. cholerae C. C. difficile

D. P. mirabilis
E. S. typhi F. P. aeruginosa

Shiga-like toxins are produced by EHEC. These toxins function to inhibit the 60s ribosomal subunit in human cells thereby blocking protein synthesis.

Questions:

An 18 year old college freshman is brought to the ER with a high fever, confusion, and headaches. Physical examination reveals nuchal rigidity and a purpuric rash on his lower extremities. This infection could have been prevented by a vaccine containing:

A. Heat-killed bacteria B. Bacterial outer membane protein

C. Capsular polysaccharide
D. Inactivated toxin E. Live attenuated bacteria

Questions:

An 18 year old college freshman is brought to the ER with a high fever, confusion, and headaches. Physical examination reveals nuchal rigidity and a purpuric rash on his lower extremities. This infection could have been prevented by a vaccine containing:

A. Heat-killed bacteria B. Bacterial outer membane protein

C. Capsular polysaccharide N.meningitidis

D. Inactivated toxin E. Live attenuated bacteria

Questions:

A 5 year old boy is found to have high serum level of antibodies against polyribitol ribose phosphate (PRP). The antibodies would most likely carry protection against: Pyelonephritis Miliary tuberculosis Rheumatic fever Osteomyelitis Epiglottitis Malignant pustule

A. B. C. D. E. F.

Questions:

A 5 year old boy is found to have high serum level of antibodies against polyribitol ribose phosphate (PRP). The antibodies would most likely carry protection against: Pyelonephritis Miliary tuberculosis Rheumatic fever Osteomyelitis Epiglottitis H. influenzae (type b) Malignant pustule

A. B. C. D. E. F.

Vaccine is composed of polyribosyl-ribitol-phosphate (PRP), a componet of Hib capsule, conjuaged with diphtheria or tetanus toxoid.

Questions:

A 6 year old male is brought to the pediatric ER with fever and sore throat. The parents tell you that the child has not received any immunizations. Physical exam reveals a grey pharyngeal exudate and Gram stain shows scant Gram positive organisms. Which of the following culture types would facilitate the growth of this organism?

A. MacConkey Agar B. Thayer-Martin VCN medium C. Blood agar containing bile and hyerptonic saline D. Cysteine-tellurite agar

E. Bordet-Gengou medium

Questions:

A 6 year old male is brought to the pediatric ER with fever and sore throat. The parents tell you that the child has not received any immunizations. Physical exam reveals a grey pharyngeal exudate and Gram stain shows scant Gram positive organisms. Which of the following culture types would facilitate the growth of this organism?

A. MacConkey Agar B. Thayer-Martin VCN medium C. Blood agar containing bile and hyerptonic saline D. Cysteine-tellurite agar C. diphtheriae (black colonies)

E. Bordet-Gengou medium

Questions:

A 6 year old male is brought to the pediatric ER with fever and sore throat. The parents tell you that the child has not received any immunizations. Physical exam reveals a grey pharyngeal exudate and Gram stain shows scant Gram positive organisms. Which of the following culture types would facilitate the growth of this organism?

A. MacConkey Agar Gram + enterics B. Thayer-Martin VCN medium Niesseria species C. Blood agar containing bile and hyerptonic saline Enterococci D. Cysteine-tellurite agar C. diphtheriae (black colonies)

E. Bordet-Gengou medium B. pertussis

Questions:

A 38-year old male intravenous drug user hospitalized for highgrade fever, fatigue and dyspnea dies in the ICU. His lung autopsy findings are shown on the slide below. This patient most likely suffered from:

A. Mycotic aortic aneurysm B. Tricupsid valve endocarditis

C. Severe small airway obstruction

D. Miliary TB E. Venous thromboembolism

Questions:

A 38-year old male intravenous drug user hospitalized for high-grade fever, fatigue and dyspnea dies in the ICU. His lung autopsy findings are shown on the slide below. This patient most likely suffered from:

A. Mycotic aortic aneurysm B. Tricupsid valve endocarditis S. aureus C. Severe small airway obstruction

D. Miliary TB
E. Venous thromboembolism MCC of tricuspid endocarditis in IVDA is S. aureus. These patients can develop multiple septic emboli in lungs. Pulmonary infarcts are almost always hemorrhagic due to the dual blood supply to the lungs.

Questions:

There is a specific bacterial product that , when injected locally into the muscles of patients with relentless focal dystonias such as torticollis, produces a dramatic but temporary relief of symptoms. This substance is produced by bacteria that demonstrate:

A. Antiphagocytic capsule B. Hypervariable pili

C. IgG-binding outer membrane protein

D. Intracellular polyphosphate granules E. Subterminal spore formation

Questions:

There is a specific bacterial product that , when injected locally into the muscles of patients with relentless focal dystonias such as torticollis, produces a dramatic but temporary relief of symptoms. This substance is produced by bacteria that demonstrate:

A. Antiphagocytic capsule B. Hypervariable pili

C. IgG-binding outer membrane protein

D. Intracellular polyphosphate granules E. Subterminal spore formation C.botulism

Questions:

A community hospital is experiencing an increased incidence of nosocomial pneumonias. Most cases occur in patients with long hospitalizations. The microorganism isolated in several cases is visualized with silver stains and demonstrates slow growth on complex media such a charcoal-yeast extract supplemented with cysteine. Which of the following is most likely implicated in the increased incidence of nosocomial pneumonias in the hospital?

A. Infection carriers among the hospital staff B. Poor isolation of the infected patients C. Failed sterilization of mechanical ventilators D. Colonization of the hospital water system E. Widespread use of antimicrobial agents F. Widespread us of intravascular devices

Questions:

A community hospital is experiencing an increased incidence of nosocomial pneumonias. Most cases occur in patients with long hospitalizations. The microorganism isolated in several cases is visualized with silver stains and demonstrates slow growth on complex media such a charcoal-yeast extract supplemented with cysteine. Which of the following is most likely implicated in the increased incidence of nosocomial pneumonias in the hospital?

A. Infection carriers among the hospital staff B. Poor isolation of the infected patients C. Failed sterilization of mechanical ventilators D. Colonization of the hospital water system - L. pneumophilia E. Widespread use of antimicrobial agents F. Widespread us of intravascular devices

Questions:

A 74 year-old previously healthy Caucasian male comes to this physicians office complaining of abrupt onset fever, headache, mayalgias, malaise, cough and throat pain . His two granddaughters missed several days of school because of similar symptoms. Examination demonstrates mild hyperemia of the throat without any exudate, and the patient is sent home on conservative management. Five days later, he is admitted to the hospital with progressive dyspnea, chest pain and productive cough. Which of the following pathogens is most likely to be isolated from this patients sputum?

A. Listeria moncytogenes B. Klebsiella pneumoniae C. Staphylococcus aureus D. Nontuberculous mycobacteria E. Cytomegalovirus

Questions:

A 74 year-old previously healthy Caucasian male comes to this physicians office complaining of abrupt onset fever, headache, mayalgias, malaise, cough and throat pain . His two granddaughters missed several days of school because of similar symptoms. Examination demonstrates mild hyperemia of the throat without any exudate, and the patient is sent home on conservative management. Five days later, he is admitted to the hospital with progressive dyspnea, chest pain and productive cough. Which of the following pathogens is most likely to be isolated from this patients sputum?

A. Listeria moncytogenes B. Klebsiella pneumoniae C. Staphylococcus aureus D. Nontuberculous mycobacteria E. Cytomegalovirus

In order, the pathogens most often responsible for secondary (Influenza Virus) bacterial pneumonia are S. pneumoniae, S. aureus, and H. influenzae.

Questions:

A 62 year old Caucasian male who recently underwent a mitral valve replacement is having low-grade fevers. He also complains of dyspnea and malaise. Repeated blood cultures grow Gram + cocci in clusters that are catalase + and coagulase - Which of the following is the best initial treatment for this patient?

A. Pencillin G

B. Naficillin
C. Vancomycin D. Ciprofloxacin E. Erythromycin F. Cefriaxone

Questions:

A 62 year old Caucasian male who recently underwent a mitral valve replacement is having low-grade fevers. He also complains of dyspnea and malaise. Repeated blood cultures grow Gram + cocci in clusters that are catalase + and coagulase - Which of the following is the best initial treatment for this patient?

A. Pencillin G

B. Naficillin
C. Vancomycin S. epidermidis (nosocomial) D. Ciprofloxacin E. Erythromycin F. Cefriaxone

Questions:

A 24-year old female presents to your office with burning during urination, urine clouding and urinary frequency. She denies fever, chills and flank pain. She had similar episodes before that was treated with antibiotics. She has no other medical problems and does not use tobacco, alcohol or drugs. Her vital signs are stable. Physical examination shows suprapubic tenderness. Which of the following bacteria is most likely to be isolated from this patients urine?

A. Klebsiella pneumoniae
B. Salmonella typhi C. Salmonella enteritidis D. Campylobacter jejuni

G. Yersinia enterocolitica
H. Haemophilus influenzae I. Vibrio cholerae J. Streptococcus pyogenes

E. Shigella dysenteriae
F. Proteus mirablis

K. Esherichia coli
L. Streptococcus pneumoniae

Questions:

A 24-year old female presents to your office with burning during urination, urine clouding and urinary frequency. She denies fever, chills and flank pain. She had similar episodes before that was treated with antibiotics. She has no other medical problems and does not use tobacco, alcohol or drugs. Her vital signs are stable. Physical examination shows suprapubic tenderness. Which of the following bacteria is most likely to be isolated from this patients urine?

A. Klebsiella pneumoniae
B. Salmonella typhi C. Salmonella enteritidis D. Campylobacter jejuni

G. Yersinia enterocolitica
H. Haemophilus influenzae I. Vibrio cholerae J. Streptococcus pyogenes

E. Shigella dysenteriae
F. Proteus mirablis

K. Esherichia coli - UTI

L. Streptococcus pneumoniae

Questions:

A 23 year old Caucasian female presents to clinic with lower abdominal pain and scant bloody vaginal discharge. She has been sexually active multiple partners and uses condoms on occasion. She has been treated for genital infections in the past but denies any history of pregnancy. Her blood pressure is 112/70 mm Hg while supine and 96/60 mm Hg while standing. A pregnancy test is positive. Which of the following microorganisms is most likely responsible for this patients current condition?

A. Gardnerella vaginalis B. Neisseria gonorrhoeae C. Trichomonas vaginalis D. Treponema pallidum E. Staphylococcus saphrophyticus F. Esherichia coli

Questions:

A 23 year old Caucasian female presents to clinic with lower abdominal pain and scant bloody vaginal discharge. She has been sexually active multiple partners and uses condoms on occasion. She has been treated for genital infections in the past but denies any history of pregnancy. Her blood pressure is 112/70 mm Hg while supine and 96/60 mm Hg while standing. A pregnancy test is positive. Which of the following microorganisms is most likely responsible for this patients current condition?

A. Gardnerella vaginalis B. Neisseria gonorrhoeae -PID C. Trichomonas vaginalis D. Treponema pallidum E. Staphylococcus saphrophyticus F. Esherichia coli PID: commonly caused by N. gonorrhoeae or C. trachomatis and is strongly assoicated wih an increased incidence of ectopic pregnancy.

Questions:

A 23 year old Caucasian female is brought to the ER with fever, vomiting, diarrhea and muscle pain. Her blood pressure is 90/50 mm Hg and pulse is 120/min. Physical examination reveals erythroderma, and pelvic exam reveals a tampon in the vagina. The activation of which of the following cells is primarily responsible for this patients condition?

a. Mast cells and eosinophils b. Basophils and macrophages c. Neutrophils and B lymphocytes d. Macrophages and T lymphocytes

e. Platelets and mast cells

Questions:

A 23 year old Caucasian female is brought to the ER with fever, vomiting, diarrhea and muscle pain. Her blood pressure is 90/50 mm Hg and pulse is 120/min. Physical examination reveals erythroderma, and pelvic exam reveals a tampon in the vagina. The activation of which of the following cells is primarily responsible for this patients condition?

a. Mast cells and eosinophils b. Basophils and macrophages c. Neutrophils and B lymphocytes d. Macrophages and T lymphocytes (TSST-1) e. Platelets and mast cells Enterotoxins, exfoliative toxins and TSST-1 are the toxins with super antigen activity.

Questions:

A sample of contaminated moist soil is heated to 100C for 15 minutes. Which of the following bacteria is most likely to be recovered from the soil sample following heat exposure?

A. Streptococcus pyogenes B. Listeria monocytogenes C. Escherichia coli D. Bacillus anthracis E. Brucella melitensis

Questions:

A sample of contaminated moist soil is heated to 100C for 15 minutes. Which of the following bacteria is most likely to be recovered from the soil sample following heat exposure?

A. Streptococcus pyogenes B. Listeria monocytogenes C. Escherichia coli D. Bacillus anthracis spore forming bacteria E. Brucella melitensis

Questions:

Microscopic examination of a sputum sample from a 34 year old male with fever and cough reveals gram + lancet-shaped cocci in pairs. These bacteria are likely to be:

A. Catalase positive B. Optochin positive C. Bile soluble D. Capable of complete hemolysis E. Bacitracin sensitive F. Able to grow in 6.5% NaCl

Questions:

Microscopic examination of a sputum sample from a 34 year old male with fever and cough reveals gram + lancet-shaped cocci in pairs. These bacteria are likely to be:

A. Catalase positive B. Optochin positive C. Bile soluble S. pneumoniae D. Capable of complete hemolysis E. Bacitracin sensitive F. Able to grow in 6.5% NaCl

End of Questions DAY 1