pearls 5

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=90 BGCOLOR="#006699" TEXT="#080000" bgproperties="fixed" background="02c285a1erlcgo.png"> <div> <FONT SIZE="5" COLOR="#FFCC66" FACE="Arial" ><B>usmle med 6</B></FONT><B>     |     </B><A HREF="index.htm" TARGET="_top" TITLE="usmle med 6"><U><B>home</B></U></A></div> <div> <A HREF="id23.htm" TARGET="_top" TITLE="pearls 1"><U>pearls 1</U></A>   |   <A HREF="id20.htm" TARGET="_top" TITLE="pearls 2"><U>pearls 2</U></A>   |   <A HREF="id21.htm" TARGET="_top" TITLE="pearls 3"><U>pearls 3</U></A>   |   <A HREF="id22.htm" TARGET="_top" TITLE="pearls 4"><U>pearls 4</U></A>   |   <B>pearls 5</B>   |   <A HREF="id18.htm" TARGET="_top" TITLE="qcm"><U>qcm</U></A>   |   <A HREF="id19.htm" TARGET="_top" TITLE="answers"><U>answers</U></A>   |   <A HREF="id17.htm" TARGET="_top" TITLE="Contact Me"><U>Contact Me</U></A></div> <div> </div> </td> </tr><tr> <td valign="top" width=210 BGCOLOR="#FFCC66" TEXT="#080000" background="02ad2c00dkelyh.png"> <div> <A HREF="id23.htm" TARGET="_top" TITLE="pearls 1"><U>pearls 1</U></A></div> <div> <A HREF="id20.htm" TARGET="_top" TITLE="pearls 2"><U>pearls 2</U></A></div> <div> <A HREF="id21.htm" TARGET="_top" TITLE="pearls 3"><U>pearls 3</U></A></div> <div> <A HREF="id22.htm" TARGET="_top" TITLE="pearls 4"><U>pearls 4</U></A></div> <div> pearls 5</div> <div> <A HREF="id18.htm" TARGET="_top" TITLE="qcm"><U>qcm</U></A></div> <div> <A HREF="id19.htm" TARGET="_top" TITLE="answers"><U>answers</U></A></div> <div> <A HREF="id17.htm" TARGET="_top" TITLE="Contact Me"><U>Contact Me</U></A></div> </td> <td valign="top" height=390 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <I>pearls 5</I></div> <DIV ALIGN="LEFT"></DIV> <div> <B>Gram-negative bacilli</B></div> <bR> <div> <B>ENTEROBACTERIACEAE</B> ("coliforms")</div> <bR> <div> - mostly ifferentiated by biochemical and serological tests</div> <div> - intestinal parasites of man and animals</div> <div> - antibiotic sensitivity very variable (plasmids)</div> <bR> <div> <B>1. </B><FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><I><B><U>Escherichia coli</U></B></I></FONT></div> <bR> <div> - "Lactose - fermenting coliform" (pink colonies on DCA, DCLS media)</div> <div> Infections:</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">urinary tract </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">diarrhoea: "toxigenic strains": ETEC, travellers diarrhoea; VTEC (eg, O157, H7) colitis to haemolytic uraemic syndrome </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">infantile gastroenteritis: "enteropathogenic strains" (EPEC) </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">bloody diarrhoea: "enteroinvasive strains" (EIEC), like shigellae </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">biliary tract infection </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">peritonitis </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">septicaemia </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">neonatal meningitis </div> <div> Treatment:</div> <bR> <div> ANTIBIOTICS GUIDED BY SUSCEPTIBILITY TESTS; E.G. AMOXYCILLIN, TRIMETHOPRIM, GENTAMICIN, CEFUROXIME, CIPROFLOXACIN.</div> <bR> <div> <FONT SIZE="3" COLOR="#000000" FACE="Arial" ><B>2. </B></FONT><I><B><U>Shigella</U></B></I><I><U> spp.</U></I></div> <bR> <div> - "NON-LACTOSE FERMENTING COLIFORM"</div> <div> - SPECIES: <I>S. sonnei</I> - commonest in UK; <I>S. boydii</I>; <I>S. flexerni</I>;</div> <div> <I>S. dysenteriae</I> - most severe disease</div> <div> - FOUND IN GIT OF MAN AND PRIMATES ONLY</div> <div> - MAN-MAN TRANSMISSION (FAECAL-ORAL); LOW INFECTIVE DOSE (50-100 organisms)</div> <div> - DISEASE: DYSENTERY (BACILLARY):- BLOODY DIARRHOEA; SELF-LIMITING</div> <bR> <div> <B>3. </B><FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><B><U>Salmonellae - "Food poisoning strains"</U></B></FONT> - "NON-LACTOSE FERMENTING COLIFORM"</div> <div> -~ 1500 "SPECIES" (SEROTYPES): EPIDEMIOLOGY OF OUTBREAKS</div> <div> e.g.: <I>S. typhimurium, S. virchow</I></div> <bR> <div> Diseases: </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">gastroenteritis: chicken meat and eggs, milk; incubation 12- 36h </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">septicaemia: in AIDS (all types), uncommon in incompetent (but <I>S. dublin</I> or <I>S cholerae-suis</I>) </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">osteomylitis, septic arthritis: rare, but association with sickle cell disease </div> <div> ANTIBIOTICS FOR INVASIVE DISEASE, e.g.. CIPROFLOXACIN</div> <div> DIFFERENT FROM <I>Salmonella typhi</I> and <I>Salmonella paratyphi</I></div> <bR> <div> <B>4. </B><FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><B><U>ENTERIC FEVER SALMONELLAS</U></B></FONT></div> <bR> <div> Species:</div> <div> <I>S. typhi </I>- typhoid</div> <div> <I>S. paratyphi</I> - types A and C - from tropics; type B - in UK: paratyphoid</div> <bR> <div> Typhoid or Paratyphoid = Enteric Fever (Septicaemic; macrophage parasitism)</div> <div> Man is only host (CF food-poisoning salmonellas)</div> <div> Treatment: ciprofloxacin, chloramphenicol (susceptibility tests)</div> <bR> <div> <B>5. </B><I><B>Citrobacter, Enterobacter, Acinetobacter, Serratia, Providencia</B></I><B> species</B></div> <bR> <div> - commensals of human and animal GIT</div> <div> - hospital acquired pathogens: UTI, ventilator associated pneumonia, septicaemia</div> <div> - antibiotic susceptibility unpredictable since often multiply antibiotic resistant; need susceptibility test guidance of treatment</div> <bR> <div> <I><B><U>Campylobacter jejuni</U></B></I></div> <bR> <div> HABITAT: G.I.T. OF POULTRY, CATTLE, SHEEP, PIGS, DOGS</div> <div> EPIDEMIOLOGY: ACQUIRED FROM CONTAMINATED CHICKEN, OTHER MEAT, MILK</div> <bR> <div> DISEASE: FEBRILE GASTROENTERITIS</div> <div> Incubation 24h - 7 days</div> <div> Usually self-limiting, (erythromycin, ciprofloxacin)</div> <bR> <div> <I><B><U>Haemophilus influenzae</U></B></I></div> <bR> <div> HABITAT: UPPER RESP TRACT - MOST STRAINS NON CAPSULATED</div> <bR> <div> DISEASES:</div> <div> Non capsulated strains</div> <div> ? SINUSITIS ? OTITIS MEDIA ? EXACERBATIONS OF CHRONIC ? BRONCHITIS</div> <div> Capsulate strains- invasive disease</div> <div> AGE previously 2/12 - 3 YRS - but HiB vaccine has almost eradicated ? MENINGITIS ? <FONT SIZE="3" COLOR="#800000" FACE="Arial" >ACUTE</FONT> <FONT SIZE="3" COLOR="#800000" FACE="Arial" >EPIGLOTITIS</FONT> ? SEPTIC ARTHRITIS </div> <div> ANTIBIOTICS: AMPICILLIN (BUT MANY ?-LACTAMASE), ERYTHROMYCIN, TRIMETHOPRIM, CEFOTAXIME, CHLORAMPHENICOL</div> <bR> <div> PREVENTION: of type b disease by Hib vaccine</div> <bR> <div> <B>VIBROS - CURVED GRAM NEGATIVE RODS, SALT TOLERANT (HALOPHILES)</B></div> <bR> <div> <I><U>V.cholerae</U></I><FONT SIZE="3" COLOR="#000000" FACE="Arial" >: SEROTYPES 01 & 0139 (NB non-toxin producing strains also found)</FONT></div> <div> Disease: EPIDEMIC CHOLERA (incubation 6h to 5 days</div> <bR> <div> EXOTOXIN</div> <div> |</div> <div> |</div> <div> ACTIVATES ADENYLATE CYCLASE</div> <div> |</div> <div> |</div> <div> EXCESSIVE SECRETION OF ISOTONIC FLUID BY GIT MUCOSA</div> <div> |</div> <div> |</div> <div> PATIENT DEHYDRATION</div> <bR> <div> TRANSMISSION : FAECAL - ORAL USUALLY VIA WATER</div> <div> TREATMENT:<B> REHYDRATION</B>; TETRACYCLINE OR CIPROFLOXACIN </div> <div> PREVENTION: HYGIENE, SAFE WATER</div> <div> VACCINE - SHORT TERM, POOR PROTECTION</div> <bR> <div> <I><B><U>Bordella pertussis</U></B></I></div> <bR> <div> - WHOOPING COUGH (<5yrs OLD)</div> <div> - TREATMENT: ERYTHROMYCIN</div> <div> - PREVENTION - VACCINE: (ERYTHROMYCIN TO SUSCEPTIBLE CONTACTS)</div> <bR> <div> <I><B>Pseudomonas aeruginosa</B></I></div> <bR> <div> Habitat: GIT of humans and animals, environment inc. water; survives in hospitals (inc. in antiseptics)</div> <bR> <div> OBLIGATE AEROBE</div> <bR> <div> Infections:</div> <bR> <div> hospital acquired infections: UTI with urinary catheter, pneumonia (cystic fibrosis, ventilator associated), burns infection, septicaemia in immuno compromised (transplantation, oncology, ITU)</div> <div> chronic otitis media and externa</div> <div> eye infection secondary to trauma</div> <bR> <div> Antibiotics:</div> <bR> <div> anti-pseudomonal penicillins/cephalosporins: piperacillin, ceftazidime</div> <div> quinolones: ciprofloxacin</div> <div> aminoglycosides: gentamicin</div> <div> polymyxin (topical, inhaled)</div> <bR> <div> intrinsic resistance to many antibiotics; variable susceptibility; need to be guided by susceptibility tests</div> <bR> <div> <B><U>SPIROCHAETES</U></B><FONT SIZE="3" COLOR="#000000" FACE="Arial" ><B> - SPIRAL BACTERIA</B></FONT></div> <bR> <div> <I>Treponema pallidum</I> - SYPHILIS</div> <div> <I>Borrelia vincentii</I> - GINGIVOSTOMATITIS, VINCENTíS ANGINA</div> <div> <I>Borrelia burgdoferi</I> - "LYME DISEASE"</div> <div> <I>Leptospira interrogeans</I> (many serovars)- "WEILS DISEASE", MENINGITIS</div> <bR> <div> <B>GRAM-NEGATIVE ANAEROBES</B></div> <bR> <div> <I>Bacteroides sp.</I></div> <div> <I>Prevotella sp.</I></div> <div> <I>Fusobacterium sp.</I></div> <bR> <div> HABITAT: </div> <bR> <div> COLON : MOSTLY <I>Bacteroides fragilis</I></div> <div> FEMALE GU TRACT: MOSTLY <I>Prevotella melaninogenicus</I></div> <div> MOUTH : MOSTLY <I>Prevotella oralis</I> or <I>Prevotella melaninogenicus</I>, some <I>Fusobacterium</I></div> <bR> <div> INFECTIONS : </div> <bR> <div> INTRA-ABDOMINAL SEPSIS</div> <div> GYNAECOLOGICAL SEPSIS </div> <div> PUEPERAL SEPSIS</div> <div> - ANAEROBES + COLIFORMS ("SYNERGY")</div> <div> ORAL SEPSIS -FUSOBACTERIA + <I>Borreli</I>a or <I>P. melaninogenicus</I></div> <bR> <div> ANTIBIOTICS:</div> <bR> <div> METRONIDAZOLE - INVARIABLY SUSCEPTIBLE</div> <div> PENICILLIN </div> <div> - <I>B. fragilis</I> USUALLY RESISTANT</div> <div> -<I> P.melaninogenicus</I> USUALLY SENSITIVE</div> <div> MEROPENEM</div> <div> (TETRACYCLINE)</div> <div> (CLINDAMYCIN) </div> <bR> <bR> </td> </tr></table></body>