Final Exam - 79 Qs Total 53 MC Anaerobe Bacteria that do not require oxygen they prefer environments without oxygen Obligate

te anaerobe Strictly without oxygen Anaerobes on skin (All Except) Propionobacterium, Peptostreptococcus, S. epidermidis, S. aureus Anaerobes in GI Clostridium species, Peptostreptococci, Bacteroides fragilis, Bilophila, Campylobacter, Fusobacterium, Porphyromonas, Prevotella, Psudorella, Veilonella, Bifidobacterium Gram stain for Clostridium Boxcar, gram (-) anaerobic bacteria Causative agent of pseudomembranous colitis Clostridium difficile Non-spore forming gram-negative rods (All Except) Facultative anaerobes: Enterbacteriaceae, Bacteroides, Prevotella, and Fusobacterium Draining sinus, pus, hard nuggets (sulfur granules) - What is the disease? Actinomycosis Major gram-negative anaerobic rods (All Except) Fusobacterium, Bacteroides, Porphyromonas, Prevotella Anaerobe bacteria causes tooth abscess Treponema denticola, Fusospirochetes, Veilonella, Porphyromonas, Lactobacillus. Viridans group Streptococci 2 factors for transporting specimens Aspirate tissue and blood. No swabs. Rapidly process these specimens. Best to inject specimen into pre-reduced media, broths. Ideal anaerobic incubation system Anaerobic chamber, box, jars, bags How long are cultures routinely held in lab (4-5 days) Suspected colonies of anaerobes processedaerotolerance test SBA/CHOC = Facultative anaerobe. CHOC = Aerobe. AnaSBA = Anaerobe. ID organisms Disk IDs for peptostrep anaerobius SPS Disk (Susceptible) Double-zone hemolysis, box car Clostridium perfringens Biofilm definition Organisms attaching to a surface in a slimy layer. Biofilm associated with CF or serious lung patients - Biofilm formation equipment, ex. Oxygen tubes, vents, etc. B. cepacia, Group A Strep Sessile biofilm define Permanently adhering to the surface. Planktonic Free-floaters. What environmental factors affect biofilms (All Except)? Liquid, Nutrient levels, Attachment efficiency, Cyclic stage, Anti-effective hostile forces, Genotypic Factors, Physiochemical Environment, Substratum, Mechanical Factors and Sheer Forces Biofilms allow bacteria to do Adhere to take advantage of available nutrients Dental biofilm Plaque Layers exposed to highest nutrients and oxygen Outer layer = Most metabolically active, exposed to the highest amount of oxygen. Intermediate layer = Genetic reservoir for genes involving nutrient utilization. Persister cells are in the inner layer, high nutrient concentration. Presence of alpha hemolytic on throat culture indicates what? Group Strep Viridans and Streptococcus pneumoniae. Factors help to differentiate between colonization and infection Normal flora = Colonization without infection. Infection = Colonization that is pathogenic. Bacteria causes 50% of pneumonia in summer Walking Pneumonia, Mycoplasma pneumoniae Info helpful for initiating empiric antimicrobial therapy Giving therapy before the diagnosis is determined. Broad spectrum antibiotics can be used before diagnosis. Elements of respiratory tract that help prevent infection (All Except) Ciliary escalator, Mucous, Nasal hair, Mucociliary cells, Coughing, Normal Flora (Prevents colonization), Phagocytic Inflammatory Cells (Engulf) Virulence factors that allow organisms to produce disease (All Except): Endotoxins, Exotoxins, Capsules, Hemolysins, Hyaluronidase (Breakdown of Connective Tissue)

Why treat group A strep in throat Streptococcus pyogenes beginning as strep throat may lead to glomerulonephritis and rheumatic fever. Condition that predisposes sinusitis (predisposing factors): Elderly, Young, Immunocompromised Organisms isolated from ear infections (Otitis media): S. pneumoniae (Most Common), S. pyogenes, H. influenza, S. aureus, M. catarrhalis Why treat ear infection emperically instead of obtaining cultures before treatment -Normally, the same group of bacteria causes ear infections and it can be assumed that its on e in that group What is empyema Starts out as a lung infection, spreads and pus buildup in pleural cavity. Caused by S. pyogenes (Main), S. pneumoniae, S. aureus Which opportunistic organism commonly infects HIV/AIDS patients - Pneumocystis Most common on skin Propionobacterium, Peptostreptococcus, Staph, Strep, Yeasts, Diphtheroids Most responsible for impetigo S. aureus, S. pyogenes Swim team breaks out in rash after pool Schistosomes, causing swimmers itch or schistosome cercarial dermatitis What happens late stages of TSS result of exotoxin F S. aureus, S. pyogenes Why travel history important for diarrhea Contaminated water from traveling, Enterotoxigenic E. coli or other enterobacteriaceae. EPEC (Enteropathogenic E. coli) Patient history to narrow search for pathogen (All Except): Have you travelled, What have you eaten lately, Any recreational activities, Shellfish Diarrhea usually contracted by Enterobacteriaceae, Contaminated Food/Water

54-57) Matching Clostridium Organism with disease Same from table below + gangrene
C. difficile Motility - Positive Spore Position Subterminal Lechithinase Reaction ? Lipase Reaction ? Colony Morphology Gram (+) C. perfringens Negative Rarely Observed Positive C. septicum Positive Subterminal Spores Negative C. tetani Negative Terminal Spores Positive C. botulinum Negative Subterminal Spores Negative

Positive Gram (+), Boxcarshaped rods Double zone

Negative Swarming, Medusa-head

Positive Drumstick/Tennis Racket cells, Swarming Colonies

Disease Produced Pseudomembranous

Myconecrosis (gas gangrene), Bacteremia,

Myconecrosis, Bacteremia

Tetanus (lockjaw)

Positive Irregular margin, B-hemolytic, Opaque, Raised Center Foodborne, Infant, and Wound

colitis

Food poisoning

Botulism

C. difficile: Causes pseudomembranous colitis, Gram (+), Subterminal spore location, Produces Toxin A and Toxin B, Motility (+)

58-66) Stages of Biofilm Stage 1 5 phase with description Stage 0: Planktonic stage Stage 1: Developmental Stage, Reversible binding to surface, increased attachment via fimbrae and pili. Stage 2: Developmental Stage, Irreversible binding, aggregate formation. Decreased motility. Exopolysaccharide trap nutrients and planktonic bacteria. Stage 3: Maturation 1, colony thickness > 10 micrometers. Stage 4: Maturation 2, Colony thickness > 100 micrometers thick. Some bacteria detach and some are trapped in the film. Stage 5: Breaking off of bacteria that leads to start of new biofilm

Condition with description Sycosis vulgaris: Barbers itch, chronic infection of the chin or beard, deep infection of hair follicles (folliculitis) Carbuncle: Multiple abscesses Cellulitis: Erytherma, Red, Tenderness, Fever Erysipelas: Skin problem, Distinct raised borders, fever common 67-77) Specimen Types Acceptable/unacceptable for routine anaerobic culture and why Voided urine Not acceptable, anaerobic culture requires suprapubic aspirate. Voided urine could become contaminated in the aerobic environment. Blood Acceptable due to sterile and closed system. CSF Acceptable due to sterile and closed system. Feces Unacceptable, not a closed system Catheter urine Unacceptable, biofilms can accumulate on catheter Synovial fluid Acceptable, sterile and closed system Swab oral abscess material Unacceptable, open system and could become contaminated Swab skin lesion pus - Unacceptable Bone marrow Acceptable, closed and sterile system Tissue biopsy Acceptable, closed and sterile system Abdominal fluid Acceptable, closed and sterile system Dental Acceptable, abscesses 78) Four indications of anaerobes in culture Foul odor, Characteristic colony morphology on anaerobic agar and not on aerobic plates, Unique morphology on gram stain, Brick red fluorescence on KBLB agar, Double zone of hemolysis on blood agar, Good growth on Bacteroides Bile Esculin agar. 79) Three Clostridium botulinum/tetanum/difficile table for toxin, endogenous/exogenous C. botulinum: Neurotoxins A-G. A,B,E = Human Infections. Neuromuscular junction. A = medically treated. Toxin absorbed through small intestine into bloodstream into nervous system.

Exotoxin C. tetani: Neurotoxin C (Fragment). Exotoxin C difficile: Toxin A (Enterotoxin) and B (Cytotoxin). Endotoxin