Flash Cards : Medically Important Bacteria

from: Kaplan Medical & First Aid

Staphylococcus

S. epidermidis

Coagulase (-), gram (+) cocci Novobiocin sensitive Infections of catheters/shunts Coagulase (-), gram (+) cocci Novobiocin resistant Honeymoon cystitis E. coli, S. saprophyticus, K. pneumoniae, P. vulgaris.
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S. saprophyticus

Urinary Tract Infections

Staphylococcus

S. aureus
Coagulase (+), gram (+), catalase (+), -hemolytic of blood agar, cocci in grape clusters. Gastroenteritis: 2-6 h onset, salty foods, custards. Endocarditis: acute Toxic Shock Syndrome: desquamating rash, fever, hypotension Impetigo: bullous + honey crusted lesions Pneumonia: nosocomial, typical, acute Osteomyelitis: #1 cause unless HbS mentioned

Treatment:
Gastroenteritis is self-limiting Nafcillin/oxacillin are DOC For MRSA: vancomycin For VRSA: quinupristin/dalfopristin (Synercid)
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Streptococcus

Group A Streptococcus (GAS); S. pyogenes

Catalase (-), hemolytic, bacitracin sensitive, gram (+) cocci Pharyngitis: abrupt onset, tonsillar anscesses Scarlet fever: blanching, sandpaper rash, strawberry tongue Impetigo: honey-crusted lesions Rheumatic fever: after streptococcal pharyngitis, ASO titer Acute glomerulonephritis (AGN): after streptococcal skin or throat infection, hypertension, edema, smoky urine.

Treatment:
lactam drugs (macrolides used in penicillin allergy)
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Streptococcus

Group B streptococcus (GBS); S. agalactiae

Group B, - hemolytic, Bacitracin resistant, Hydrolyzes hippurate Gram (+), catalase (-), CAMP test (+) Neonatal meningitis and septicemia: #1 cause, especially in prolonged labors.

Treatment:
Ampicillin or penicillin (DOC) Clindamycin or erythromycin for penicillin allergies
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Streptococcus

Streptococcus pneumoniae
Gram (+), catalase (-), hemolytic, soluble in bile, Optochin sensitive, + Quellungs reaction Pneumonia: typical, most common cause, rusty sputum (productive cough) & lobar pneumonia Meningitis: many PMNs, glucose, protein in CSF, most common adult cause. Otitis media and sinusitis: most common cause.

Typical pneumonia:
Bacterial pneumonia such as S. pneumoniae elicits neutrophils; arachidonic acid metabolites (acute inflammatory mediators) cause pain & fever. Pneumococcus produces lobar pneumonia with productive cough, grows on blood agar, and usually responds well to penicillin treatment.

Treatment:
Bacterial pneumonia macrolides
Adult meningitis ceftriaxone or cefotaxime

Otitis media and sinusitis amoxicillin, erythromycin (for allergic)

Streptococcus

Viridans streptococci (S. sanguis, S. mutans)

Gram (+), catalase (-), hemolytic, Optochin resistant, bile insoluble Plaque and dental caries (S. mutans) Subacute bacterial endocarditis: preexisting damage to heart valves; follows dental work (S. sanguis)

Tretment:
Penicillin G with aminoglycosides for endocarditis

Enterococcus

Enterococcus faecalis/faecium

Gram (+), catalase (-), variable hemolysis, hydrolyzes esculin Urinary/biliary tract infections elderly males after prostate treatment Subacute bacterial endocarditis elderly males, follows GI/GU surgery, preexisting heart valve damage

Treatment:

Some vancomycin-resistant strains have no reliable effective treatment. VanA strains have UDP-N-acetylmuramyl pentapeptide with the terminal D-alanyl-D-alanine replaced with Dalanyl-D-lactate (functions in cell wall synthesis but does NOT bind to vancomycin)
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Bacillus

Bacillus anthracis
Gram (+), spore forming aerobic rods Contact with animal hides or postal worker; eschar or life-threatening pneumonia (wool sorters disease) Treatment : ciprofloxacin or doxycycline

Bacillus cereus
Rapid onset gastroenteritis Fried rice, Chinese restaurants Treatment : self-limiting
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Clostridium

Clostridium tetani
Dirty puncture wound Rigid paralysis Treatment : TIG + metronidazole/penicillin; spasmolytic (diazepam)
TETanus is TETanic paralysis BOTulinum is from bad BOTtles of food and honey PERFringens PERForates a gangrenous leg
DIfficile causes DIiarrhea (Treat with metronidazole)

Clostridium botulinum
Home-canned alkaline vegetables Floppy baby syndrome Reversible flaccid paralysis

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Clostridium

Clostridium perfringens

Contaminated wound Pain, edema, gas, fever, tachycardia Food poisoning : reheated meats, noninflammatory diarrhea Treatment :
Gangrene clindamycin, penicillin Food poisoning self-limiting

Clostridium difficile

Hospitalized patient on antibiotics (antibiotics over-use) Develops colitis, diarrhea Treatment : metronidazole (vancomycin)

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Listeria

Listeria monocytogenes
Gram (+) rods, -hemolytic Facultative intracellular Foodborne (deli foods) unpasteurized milk Transplacental granulomatosis infantiseptica Neonatal septicemia and meningitis (3rd most common cause) Meningitis in renal transplant or cancer patients (most common cause)

Treatment : ampicillin (+ gentamycin for IC patients)

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Corynebacterium

Corynebacterium diphtheriae
Gram (+), aerobic, non-spore forming rods
BULL NECK, myocarditis, nerve palsies

Gray pseudomembrane airway obstruction

Toxin produced by lysogeny (-corynephage) Toxin ribosylates EF-2; heart, nerve damage

V-L shapes tellurite

Metachromatic granules Loefflers

Treatment :
Erythromycin and antitoxin

ABCDEFG: ADP-ribosylation; -corynephage; Corynebacterium Diphtheria; Elongation Factor-2; metachromatic Granules

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Actinomyces

Actinomyces israelii
Patient with mycetoma on jaw line or spread from IUD Causes oral/facial abscesses with sulfur granules that may drain through sinus tracts in skin (can cause 1 brain abscess) Sulfur granules in pus grow anaerobic, gram (+), non-acid fast branching rods (resembling fungi)

Treatment :
Ampicillin or penicillin G and surgical drainage
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Nocardia

Nocardia asteoids and Nocardia brasiliensis

Gram (+) filamentous bacilli, aerobic, PARTIALLY acid fast Norcardiosis: Cavitary bronchopulmonary disease, mycetomas (can cause multiple foci brain abscesses)

Treatment :
Sulfanomides or TMP-SMZ

SNAP: Sulfa for Nocardia; Actinomyces use Penicillin

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Mycobacterium

Mycobacterium Tuberculosis
High risk patient (Low SES, HIV+, IV drug user) Chronic cough, weight loss Auramine rhodamine staining, acid fast bacilli in sputum Produce niacin, heat sensitive catalase Positive DTH test (PPD) Facultative intracellular Ghon complex:
TB granulomas (Ghon focus) + lobar & perihilar lymph node involvement Reflects 1 infection/exposure

Treatment :

1st 2 mo INH + Rifampin + Pyrazinamide Next 4 mo INH + Rifampin

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Mycobacterium

Mycobacterium leprae (leprosy)

Acid fast bacilli in punch biopsy Immigrant patient with sensory loss in extremities + lepromin skin test in Tuberculoid type (TL) BUT NOT Lepromatous leprosy (LL) NO CULTURES

Treatment:
Dapsone & rifampin (with Clofazimine for LL)
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Neisseria

Neisseria meningitidis
Young adults with meningitis Abrupt onset with signs of endotoxin toxicity

Oxidase (cytochrome C oxidase) test:

flood colony with phenylenediamine; in presence of oxidase, phenylenediamine turns black. Rapid test. Major oxidase-negative gram group is Enterobacteriaceae

Treatment :
Neonates & infants: Ampicillin and cefotaxime Children & adults: cefotaxime or ceftriaxone
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Neisseria

Neisseria gonorrhoeae
Sexually active patient Urethral/vaginal discharge (leukorrhea) Arthritis possible Neonatal ophthalmia Gram diploccocus in neutrophils

Treatment :
ceftriaxone

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Pseudomonas aeruginosa
Oxidase (+), aerobic rod Blue-green pigments, fruity odor Burn infections blue-green pus, fruity odor Typical pneumonia CGD or CF UTI catheterized patients

Treatment :

Penicillin + aminoglycoside Intrinsic resistance (missing high affinity porin some drugs enter through); Plasmid mediated -lactamases and acetylating enzymes.
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Drug resistance (very common):

Legionella pneumophila
Elderly smoker, heavy drinker, or IC Exposure to aerosols of water (air conditioning) Atypical pneumonia (legionnaires disease), Pontiac fiver Associated with hyponatremia

Treatment :
Fluoroquinolone or azithromycin or erythromycin with rifampin for IC patients
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Francisella tularensis
Patient with ulceroglandular disease, atypical pneumonia, or gastrointestinal disease Arcansas/Missouri Exposure to rabbits/ticks

Treatment :
streptomycin

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Bordetella pertussis

Unvaccinated child (immigrant family or religious objections) Cough with inspiratory whoop (3 stages):
(1-2 wks) catarrhal : CONTAGIOUS (2-4 wks) paroxysmal : organism begin disappearing (>3 wks) convalescence : secondary complications
DTaP lasts 5 10 years (IgA) Immunity to actual pertussis is life long

Immunity:

Treatment :

Supportive care & Erythromycin (14 days)

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Brucella species
Patient with acute septicemia Exposure to animals or unpasteurized dairy California/Texas or travel to Mexico

Treatment :
Adults : rifampin & doxycycline (6 wks) Children : rifampin & cotrimoxazole

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Campylobacter jejuni
Patient with inflammatory diarrhea Microaerophillic, oxidase +, grows at 42C Ten or more stools/day, maybe frankly bloody Complications GBS & reactive arthritis

Treatment :
Mostly fluid and electrolyte replacement. Erythromycin, fluoroquinolones, penicillin resistant.
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Helicobacter pylori
Patient with gastritis, ulcers, stomach cancer Microaerophillic, oxidase +, urease + Reservoir HUMANS

Treatment :
Omeprazole + amoxicillin + clarothromycin Treat for 10 14 days

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Escherichia coli
Isolation of E. coli from stool is not significant.

Sorbitol MacConkey screen

Most E. coli ferment sorbitol (Most EHEC do not colorless) Toxins cAMP

EPEC = P (pediatric) ETEC = T (traveller)

EIEC = I (inflammatory) EHEC = H (hamburger; Hemolytic colitis and Hemolytic Uremic Syndrome)
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Shigella species
patient with acute bloody diarrhea + fever Non-motile, non-H2S producer and non-lactose fermenters Shigella sonnei (most common in U.S)
Shigella dysenteriae (most severe disease) SHIGA TOXIN (neuro, cyto, entero)

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Klebsiella pneumonia
Elderly patient with typical pneumonia: currant jelly sputum

UTI (catheterized associated)

Septicemia

IC or nosocomial
Oxidase (-), encapsulated, lactose fermenters Treatment : 3rd generation cephalosporin

Klebsiella Granulomatis
Patient from Caribbean or New Guinea with subcutaneous genital nodules Encapsulated, inside mononuclear cells
Treatment :TMP-SMX; tetracyclines and erythromycin
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Salmonella typhi
Patient with fever, abdominal pain, rose spots
Travel to endemic area Encapsulated, nonlactose fermenter, produces H2S and is motile.

Widal test +

Treatment:
Fluoroquinolones or 3rd gen cephalosporins
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S. enteritidis, S. typhimurium
Enterocolitis inflammatory, follows ingestion of poultry
products or handling pet reptiles. Septicemia very young or elderly

Osteomyelitis sickle cell disease

Treatment:
For gastroenteritis : self-limiting For invasive disease : Ampicillin, TMP-SMX, Fluoroquinolones or 3rd gen cephalosporins.
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Yersinia pestis THE PLAGUE!

High fever, buboes (swelling of regional lymph nodes), conjunctivitis and

pneumonia
Exposure to small rodents, desert Southwest Bipolar staining (safety pin)

Treatment : aminoglycosides

Yersinia enterolitica
Patient with inflammatory diarrhea or pseudoappendicitis

Cold climates; Unpasteurized milk, pork

Non-lactose fermenters, non-H2S producers Treatment: For IC fluoroquinoloness or 3rd generation cephalosporins.
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Proteus mirabilis/Proteus vulgaris

Patient with UTI or septicemia
Swarming motility on blood agar plate Staghorn renal calculi (struvite stones) Non-lactose fermenting, urease (+)

Treatment : fluoroquinolones,TMP-SMX, or 3rd generation cephalosporins for uncomplicated cases. NOTE: Weil Felix test: Antigens of OX strains of Proteus vulgaris crossreact with rickettsial organisms.

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Gardnerella vaginalis:
Female patient with increased thin gray vaginal discharge and a fishy amine odor.
Post antibiotic or menses Clue cells Whiff test + Treatment :
Metronidazole or clindamycin
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 Patient with non-inflammatory diarrhea

; Dehydration
Travel to endemic area Curved rods, polar flagella, oxidase (+)

Treatment :
fluid and electrolyte replacement Doxycycline or ciprofloxacin shorten disease and reduce carriage.

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 Patient with animal (cat) bite

Cellulitis / lymphadenitis : amoxicilin/clavulanate for cat bites

Eikenella corrodens

corrodes agar, bleach like odor From human bites of fist fight injuries causes cellulitis

Capnocytphaga filamentous rods From dog bite wounds causes cellulitis. Splenectomy canimorsus causes ovewhelming sepsis. Bartonella henselae

cats and dogs/bites, scratches, fleas Cat scratch fever causes bacillary angiomatosis (AIDS)

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 3 mo 2 y unvaccinated child meningitis, pneumonia, epiglottitis

Smokers with COPD bronchitis, pneumonia Requires factors X and V; + satellite test (grows near S. aureus) Treatment :
Cefotaxime or ceftriaxone

Soft and painful genital ulcers (chancroid)

you will cry with ducreyi

Slow to heal without treatment Treatment :
Azithromycin, ceftriaxone, or ciprofloxacin
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Bacteroides fragilis
Patient with abdominal trauma, emergency abdominal surgery

Septicemia, peritonitis, abscess Anaerobic Treatment :

Metronidazole, clindamycin, or cefoxitin
Abscesses surgically drained.

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Treponema pallidum
Sexually active patient or neonate of IV drug-using female Primary-nontender, indurated genital chancre

Secondary-maculopapular rash, copper colored rash, condyloma

lata Tertiary-gummas in CNS and cardiovascular system

Spirillar, visualized by dark field or fluorescent antibody

Specific and non-specific serologic tests. Treatment :
Benzathine penicillin (long acting for primary and secondary form)
Penicillin G for congenital and late syphilis
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Borrelia burgdorferi
Pateint with influenza like symptoms and erythema migrans Spring/summer seasons

Northeast (Connecticut), Midwest (Wisconsin), West Coast

(California) Later-neurologic, cardiac, arthritis/arthralgias

LYME disease (#1 tick borne disease in the U.S)

Treatment :
Doxycycline, amoxycillin, or azithromycin/clarithromycin

Ceftriaxone for secondary

Doxycycline or ceftriaxone for arthritis
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Leptospira interrogans
Patients with influenza-like symptoms GI symptoms (Weil disease)

Occupational (sewer worker) or recreational (jet skiers) exposure to water aerosols

Hawaii Spirochetes with terminal hooks Treatment :
Penicillin G or Doxycycline
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Rickettsia rickettsii
Patient with influenza-like symptoms and petechial rash that

begins on ankles and wrists and moves to trunk

Rocky mountain spotted fever (RMSF) East coast mountainous areas (North Carolina)

Spring/Summer seasons Outdoor exposure

Weil-Felix (+)

Treatment :
doxycycline
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Coxiella burnetii
Patient with fever, pneumonia, granulomatous hepatitis Q-fever and chronic Q-fever Exposure to domestic animal breeding operation

Diagnosed serologically

Treatment :
Doxycycline & erythromycin
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Ehrlichia chaffeensis/Ehrlichia phagocytophila

Patient with influenza-like symptoms, no rash, leukopenia,

thrombocytopenia
Norteast (Connecticut), Midwest (Wisconsin) and West Coast (California) same as LYME disease (Borrelia)

Spring/summer seasons
Exposure to outdoor Morulae inside monocytes or granulocytes.

Treatment :
Doxycycline (begin before laboratory confirmation)
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Chlamydia trachomatis
Sexually active patient or neonate

Adult : urethritis, cervicitis, PID, inclusion conjunctivitis

Neonate : inclusion conjunctivitis/pneumonia Immigrant from Africa/Asia, swollen genital lymphadenopathy Cytoplasmic inclusion bodies in scrappings

Active reticulate bodies & inactive elementary bodies

Treatment :
Doxycycline & azithromycin

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C. pneumonia
Atypical walking pneumonia
Sputum with intracytoplasmic inclusions Prominent dry cough and hoarseness Treatment : Macrolides and tetracycline

C. psittaci (psittacosis / ornithosis)

Atypical pneumonia with hepatitis

Cough may be absent and when present non-productive at first then

scant mucopurulent Treatment : Doxycycline
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Mycoplasma pneumoniae
Young adult with atypical pneumonia

Mulberry-shaped colonies on media containing sterols

Positive cold agglutinin test Treatment : erythromycin, azithromycin, & clarithromycin (NO CEPHALOSPORINS or PENICILLINS)

Ureaplasma urealyticum
Adult with urethritis, prostatitis, renal calculi Alkaline urine; urease (+) Treatment : erythromycin or tetracycline
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