Microbiology Quiz: Infections and Ulcers
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Questions and Answers

What is the primary cause of decubitus ulcers?

  • Fungi in the air
  • Viruses
  • Parasites in the skin
  • Bacteria near the rectum (correct)

    • Which organism is NOT associated with diabetic foot ulcers?

  • S.aureus
  • Pseudomonas aeruginosa
  • Streptococci
  • Borrelia burgdorferi (correct)

    • What is a recommended specimen type for culture in suspected anaerobic infections?

  • Sputum samples
  • Urine samples
  • Tissue aspirates (correct)
  • Swab samples

    • Which of the following is a key feature of microscopic examination using Gram stain?

    <p>Can determine specimen quality (B)</p> Signup and view all the answers

    Which culture method is NOT typically used for anaerobic infections?

    <p>Swab culture in transport medium (D)</p> Signup and view all the answers

    Which organism is primarily associated with Staphylococcal scalded-skin syndrome?

    <p>Staphylococcus aureus (B)</p> Signup and view all the answers

    What type of transport media is recommended for specimens collected for anaerobic culture?

    <p>Anaerobic transport media (C)</p> Signup and view all the answers

    What condition is characterized by inflammation with pus and often includes the Group A streptococci?

    <p>Impetigo (D)</p> Signup and view all the answers

    Which of the following conditions is linked with erythema migrans?

    <p>Lyme disease (A)</p> Signup and view all the answers

    Which of the following organisms is commonly associated with human bite wound infections?

    <p>S.aureus (C)</p> Signup and view all the answers

    What type of infection is characterized by a diffuse infection in deep epidermis and subcutaneous tissue?

    <p>Cellulitis (C)</p> Signup and view all the answers

    Which organism is specifically associated with gas gangrene?

    <p>C.perfringens (B)</p> Signup and view all the answers

    An infection that results from the obstruction of oil or sweat glands is likely to be classified as which of the following?

    <p>Folliculitis (C)</p> Signup and view all the answers

    What is the primary causative organism of erysipelas, a painful superficial skin infection?

    <p>Group A streptococci (C)</p> Signup and view all the answers

    Which organism is linked to infections from contaminated hot tubs?

    <p>P.aeruginosa (C)</p> Signup and view all the answers

    Which of the following types of bacteria are part of the normal skin flora?

    <p>Corynebacterium (C)</p> Signup and view all the answers

    What is the typical incubation period for Tularemia?

    <p>1 - 21 days (C)</p> Signup and view all the answers

    Which of the following descriptions pertains to the appearance of colonies on SBA for the bacteria responsible for Tularemia?

    <p>Fried egg colonies (D)</p> Signup and view all the answers

    What is the mortality rate for untreated Tularemia?

    <p>30% (C)</p> Signup and view all the answers

    What primary animal is associated with the transmission of Francisella tularensis?

    <p>Rabbits (D)</p> Signup and view all the answers

    Which of the following conditions is NOT related to Tularemia?

    <p>Bubonic plague (B)</p> Signup and view all the answers

    Which feature characterizes Brucellosis as described?

    <p>Profuse sweating and malaise (C)</p> Signup and view all the answers

    What is the infective dose for Tularemia?

    <p>10 - 50 organisms (B)</p> Signup and view all the answers

    How long can the Tularemia organism persist in moist soil?

    <p>Months (A)</p> Signup and view all the answers

    What is the most common organism associated with osteomyelitis?

    <p>Staphylococcus aureus (D)</p> Signup and view all the answers

    Which specimen collection method is used to diagnose conjunctivitis?

    <p>Swab of the conjunctiva (A)</p> Signup and view all the answers

    What type of culture is primarily recommended for malignant otitis externa?

    <p>All of the above (D)</p> Signup and view all the answers

    Which condition is characterized by inflammation of the cornea?

    <p>Keratitis (A)</p> Signup and view all the answers

    What distinguishes an overt bioterrorism event from a covert one?

    <p>It has immediate impact and early recognition. (B)</p> Signup and view all the answers

    Which organism is commonly involved in malignant otitis externa?

    <p>Pseudomonas aeruginosa (B)</p> Signup and view all the answers

    In which situation is bone marrow culture primarily indicated?

    <p>For identifying Brucella or Mycobacteria (D)</p> Signup and view all the answers

    What is the main characteristic of endophthalmitis?

    <p>Inflammation of the eyeball's interior (B)</p> Signup and view all the answers

    What is one of the first signs of a biological attack?

    <p>Human illness (D)</p> Signup and view all the answers

    Which of the following is a characteristic of bioterror agents?

    <p>Odorless and tasteless (A)</p> Signup and view all the answers

    What is the cost of anthrax compared to conventional weapons for achieving 50% casualties over a 1 sq/km area?

    <p>$1 (C)</p> Signup and view all the answers

    What method can biological agents be delivered via?

    <p>Food or water contamination (B)</p> Signup and view all the answers

    Which organization established the Laboratory Response Network (LRN)?

    <p>CDC (D)</p> Signup and view all the answers

    In which laboratory level does confirmatory testing take place within the LRN?

    <p>Reference Labs (C)</p> Signup and view all the answers

    What is a significant factor that affects the dissemination of biological agents?

    <p>Weather conditions (B)</p> Signup and view all the answers

    Which category does Yersinia pestis fall under in the CDC classification of biological agents?

    <p>Category A (B)</p> Signup and view all the answers

    Which example represents a characteristic of Category B biological agents?

    <p>E. coli (C)</p> Signup and view all the answers

    What is a potential impact of a bioterror attack classified as Category A?

    <p>High public panic and social disruption (C)</p> Signup and view all the answers

    What is the most common form of anthrax exposure?

    <p>Cutaneous anthrax (B)</p> Signup and view all the answers

    What is the mortality rate associated with gastrointestinal anthrax?

    <p>50% (B)</p> Signup and view all the answers

    What type of specimen is collected for diagnosing inhalation anthrax?

    <p>Sputum (B)</p> Signup and view all the answers

    Which symptoms are NOT associated with inhalation anthrax?

    <p>Nausea and vomiting (B)</p> Signup and view all the answers

    What form of plague is characterized by infected lymph nodes?

    <p>Bubonic plague (D)</p> Signup and view all the answers

    Which of the following anthrax types requires ingestion of spores for infection?

    <p>Gastrointestinal anthrax (A)</p> Signup and view all the answers

    Which type of plague is considered the deadliest due to its transmissibility?

    <p>Pneumonic plague (C)</p> Signup and view all the answers

    What is NOT a common symptom of pneumonic plague?

    <p>Rash (C)</p> Signup and view all the answers

    What type of bacterium is responsible for anthrax?

    <p>Bacillus anthracis (A)</p> Signup and view all the answers

    What is a laboratory method used to identify Bacillus anthracis?

    <p>Gram staining (C)</p> Signup and view all the answers

    Flashcards

    What bacteria cause bed sores?

    Bacteria commonly found near the rectum that cause bed sores or pressure sores.

    What makes diabetic foot ulcers difficult to heal?

    Injuries heal slowly in diabetic patients due to compromised blood flow and immune function.

    What is Nodular Lymphangitis?

    A fungal infection that causes nodules along lymphatic vessels, typically affecting the skin.

    What causes Lyme disease?

    An infection caused by the bacterium Borrelia burgdorferi, characterized by a distinctive expanding rash known as erythema migrans.

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    What is Staphylococcal Scalded-Skin Syndrome?

    Bacterial skin infections caused by Staphylococcus aureus and Streptococcus pyogenes, characterized by peeling skin, fever, and systemic toxicity.

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    What is Toxic Shock Syndrome?

    A severe multi-organ infection caused by toxins produced by bacteria like Staph aureus and Strep pyogenes.

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    What is Scarlet Fever?

    A common skin infection caused by Streptococcus pyogenes, characterized by a bright red rash and fever.

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    What is the key consideration when collecting a specimen for culture?

    The best way to collect a specimen for a culture is to avoid contamination with surface bacteria by cleaning the area before sampling.

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    Pyroderma

    Infection of the skin that causes pus formation. Examples include impetigo, erysipelas, and anthrax.

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    Dermatitis

    Inflammation of the skin characterized by redness, itching, and scaling.

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    Impetigo

    A superficial skin infection caused by Group A streptococci and S. aureus, causing blister-like lesions.

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    Erysipelas

    A superficial but painful skin infection caused by Group A streptococci, often spreading rapidly.

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    Myonecrosis (Gas Gangrene)

    A severe infection of muscle tissue, often caused by Clostridium perfringens, leading to tissue death and gas production.

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    Necrotizing Fasciitis

    A deep infection of the fascia, characterized by rapid spread and tissue damage. Often caused by Group A streptococci.

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    Cellulitis

    An infection of the subcutaneous tissue, characterized by swelling, redness, and pain. Commonly caused by S. aureus.

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    Abscess

    A deep, localized pocket of pus within the skin or subcutaneous tissue.

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    Osteomyelitis

    Infection of the bone or bone marrow, most commonly caused by Staphylococcus aureus

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    Conjunctivitis

    Inflammation of the conjunctiva, the transparent membrane that lines the inside of the eyelid and covers the white part of the eye.

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    Endophthalmitis

    Inflammation of the eyeball's interior, a rare condition.

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    Malignant Otitis Externa

    A severe invasive infection of the external ear canal, often associated with underlying conditions like diabetes.

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    Bioterrorism

    The unlawful use of microorganisms or toxins to cause death or disease in humans, animals, or plants, with the intent to create fear or intimidate.

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    Overt Bioterrorism

    A type of bioterrorism that has an immediate impact and is recognized early on.

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    Covert Bioterrorism

    A type of bioterrorism that has a delayed response and is recognized clinically.

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    Anthrax

    A bioterror agent that can be easily produced and spread, potentially causing panic and social disruption.

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    Ease of Dissemination

    The ability of a bioterror agent to be easily disseminated, e.g., spread through the air or water.

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    Public Health Impact

    The potential impact of a bioterror agent on public health, e.g., number of people affected and severity of illness.

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    Public Panic and Social Disruption

    The potential of a bioterror agent to cause widespread panic and social disruption.

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    Laboratory Response Network (LRN)

    A network of laboratories established by the CDC to respond to biological and chemical threats.

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    Sentinel Labs

    Clinical laboratories that identify potential biothreats, rule out other diseases, and refer cases to specialized labs.

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    Reference Labs

    Public health and typing laboratories that perform confirmatory testing for biothreats.

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    Category A Bioterrorism Agent

    A bioterrorism agent with high potential for causing widespread harm and public panic.

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    Category B Bioterrorism Agent

    A bioterrorism agent with moderate potential for causing harm and social disruption.

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    Tularemia

    A bacterial infection caused by Francisella tularensis, a zoonotic disease spread through contact with infected animals, ticks, or contaminated environments.

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    Tularemia transmission

    Tularemia primarily affects rodents (especially in California) and can also be transmitted through tick bites in areas like Utah, Idaho, and Montana.

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    Tularemia person-to-person transmission

    Tularemia does not spread from person to person.

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    Tularemia clinical presentations

    Tularemia usually causes flu-like symptoms and can lead to a variety of presentations, including pneumonia, glandular involvement, and ulcers.

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    Brucellosis

    A bacterial infection caused by different species of Brucella, usually transmitted through contact with infected animals or their products.

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    Brucellosis symptoms

    Brucellosis typically causes fever, profuse sweating, malaise, headache, and muscle or back pain.

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    Brucellosis person-to-person transmission

    Brucellosis is not spread from person to person.

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    Brucellosis mortality

    The mortality rate for Brucellosis is low, but it should still be treated promptly.

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    What is Anthrax?

    Anthrax is a serious bacterial infection caused by Bacillus anthracis, which can be fatal if left untreated. It can manifest in three forms: Cutaneous, GI, and Inhalation.

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    How is Anthrax transmitted?

    Anthrax is most commonly transmitted through contact with infected animals or their products.

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    What are the symptoms of Cutaneous Anthrax?

    Cutaneous Anthrax is the most common form, appearing as a painless skin lesion that develops from a papule to a black eschar over 6 days.

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    What is Gastrointestinal Anthrax?

    GI Anthrax occurs by ingesting contaminated food or water. Symptoms include nausea, vomiting, bloody diarrhea, and sepsis. Mortality is high.

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    What is Inhalation Anthrax?

    Inhalation Anthrax is the most dangerous form. Infection starts in the lungs, leading to flu-like symptoms, respiratory failure, and potential meningitis.

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    What is Plague?

    Plague is a serious bacterial infection caused by Yersinia pestis, known historically as the Black Death.

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    How is Plague transmitted?

    Plague is transmitted through the bite of infected fleas, direct contact with infected animals, or inhalation of infectious droplets.

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    What are the different forms of Plague?

    Bubonic Plague is characterized by swollen, painful lymph nodes called buboes. Septicemic Plague involves the bloodstream, leading to necrosis and organ damage. Pneumonic Plague is the deadliest, spreading through respiratory droplets.

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    Which form of Plague is the most dangerous?

    Pneumonic Plague is the most fatal due to its rapid spread through respiratory droplets and its ability to cause respiratory failure.

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    Why is specimen selection important?

    Selecting the right specimen for culture is crucial for accurate diagnosis.

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    Study Notes

    Skin and Soft Tissue

    • Skin is the outermost layer, comprising epidermis (outermost layer), dermis (hair follicles, sebaceous glands, sweat glands), subcutaneous layer (fat), fascia (fibrous tissue), and muscles.
    • Wound infections can result from trauma, blockage of glands, hair follicle inflammation.
    • Infecting organisms can be endogenous (normal flora) or exogenous (outside the body).
    • Single or multiple organisms can cause infections.
    • Identifying and isolating colony types is crucial for mixed cultures.
    • Normal skin flora includes staphylococci (S. epidermidis & S. aureus), diphtheroids (Corynebacterium), micrococci, streptococci (non-hemolytic), Propionibacterium acnes, anaerobes, and yeast.
    • Dermatitis is skin inflammation, caused by Candida spp., S. aureus, coliforms, Corynebacterium spp., and molds (Dermatophytes).
    • Pyoderma is inflammation with pus, including Impetigo (blister-like infection, Group A streptococci, S. aureus), Erysipelas (superficial, painful, Group A streptococci, S. aureus), Anthrax (rarely).
    • Erysipeloid is superficial soft-tissue infection, associated with animal products, caused by Erysipelothrix rhusiopathiae.
    • Cellulitis is deep epidermis and subcutaneous tissue infection, caused by Group A streptococci, S. aureus.
    • Folliculitis is infected hair follicles (sometimes P. aeruginosa).
    • Furuncles (boils) are deep hair follicle infections.
    • Carbuncles involve multiple hair follicles.
    • Abscesses are pus collections in skin and subcutaneous tissue.
    • Soft tissue (wound) infections involve injured tissue (surgery, burns, bites) caused by various organisms, including S. aureus, streptococci, and anaerobes. Also, burn wounds are caused by S. aureus, and P. aeruginosa
    • Animal bites can cause infection due to Pasteurella multocida, Capnocytophaga canimorsus, S. aureus, anaerobes, and rabies.
    • Human bites can cause infection due to S. aureus, alpha.
    • Myonecrosis is severe muscle infection (gas gangrene) caused by C. perfringens.
    • Necrotizing fasciitis is very severe fascia infection caused by Group A strep, and S. aureus.
    • Decubitus ulcers are bedsores caused by bacteria near the rectum (Enterobacteriaceae, Pseudomonas, Enterococci).
    • Diabetic foot ulcers take a long time to heal, caused by S. aureus, streptococci, enterococci, Enterobacteriaceae, Pseudomonas aeruginosa, and anaerobes.
    • Nodular lymphangitis has causative agents Sporothrix schenckii, Nocardia spp., Actinomyces spp., and Mycobacteria.
    • Dermatological manifestations of systemic infections include rashes from Borrelia burgdorferi (erythema migrans), T. pallidum, Rickettsiae, Leptospira, and Mycobacterium leprae.
    • Viral causes include measles (Rubeola and Rubella), chickenpox/shingles (Varicella-Zoster Virus), Herpes Simplex Virus, and Warts (HPV)
    • Toxin-mediated skin diseases, include Staphylococcal scalded-skin syndrome, Toxin shock syndrome, S. aureus and S. pyogenes, and Scarlet fever (S. pyogenes).
    • Specimen collection and transport methods include avoiding surface contamination, decontaminating skin or mucous membranes, using tissue/pus aspirates instead of swabs, and keeping samples moist for transport. Swabs are typically less desirable, and anaerobic infections require specific transport media.
    • Microscopic examination includes Gram stains for detection of clinically significant organisms, quality control of specimens (reject if many epithelial cells), and wet mounts with KOH and calcofluor white, and acid-fast stains.
    • Routine cultures use BAP, CHOC, MAC, and PEA media, and CO2 incubation at 35°C.
    • Anaerobic cultures are recommended for closed wounds and abscesses.
    • Other cultures may include Lowenstein-Jensen, Middlebrook (for mycobacteria, viral culture, and shell vials and Sabouraud's agar). Additional cultures may include Eye, Bone, BM, and External ear samples.
    • Eye cultures often involve NF of the mucous membrane, Corynebacterium, Viridans strep., Moraxella catarrhalis, staphylococci (S. aureus and CONS), Haemophlius influenzae, anaerobes, and GNR.
    • Conjunctivitis, keratitis, and endophthalmitis are eye diseases. Eye specimen collection includes conjunctival swabs and corneal scrapings with special spatulas. Eye chamber fluid can be used for endophthalmitis. Processing may involve gram staining, and MAC, CHOC, BAP culture, and anaBAP.
    • Osteomyelitis is a bone infection often caused by S. aureus. Bone cultures are commonly performed in enriched broth and on agar media (CHO). Bone marrow cultures are conducted for detecting Brucella or Mycobacteria.
    • External Ear infections and cultures, often from Moisture-related otitis externa ("swimmer's ear") and malignant otitis externa (severe, sometimes with underlying conditions like diabetes). Specimens may involve debris from the ear canal, collected with swabs, followed by gram stain and BAP, CHOC, and MAC culture growth.
    • Agents of Bioterrorism are harmful microorganisms or toxins used in unlawful attacks.

    Bioterrorism

    • Bioterrorism is the intentional use or threat of living organisms or toxins to harm humans, animals, or plants.
    • The goal is to instigate fear and intimidate governments or societies.
    • Bioterrorism can have immediate, overt impacts or delayed, covert responses.
    • The past has seen incidents involving rye ergot, Bacillus anthracis, Pseudomonas mallei, salmonella, and Bacillus anthracis in recent history.
    • Bioterrorist agents are frequently inexpensive and easy to produce, causing widespread fear.
    • Traits of bioterrorist agents include being odorless, colorless, or tasteless and affecting humans first through illness.
    • Common delivery methods include food/water contamination, aerosol dispersal, using vehicle sprayers, hand sprayers, aircraft sprayers, and mail systems.

    Laboratory Response Network (LRN)

    • The LRN was developed by the CDC in 1999.
    • The LRN is a network of labs designed to respond to biological or chemical threats, following predetermined protocols and providing timely, accurate test results.
    • LRN laboratories are organized as sentinel laboratories (clinical) and reference laboratories.
    • Sentinel labs receive specimens, recognize potential issues, rule out certain things, and then refer to reference labs of the LRN. Reference labs provide confirmatory testing, while more specialized national labs (CDC, Military, Bioforensics) conduct definitive characterization.

    Category A, B, and C Biological Agents

    • Category A agents have high mortality, ease of spread, and potential for mass panic; they include anthrax, smallpox, botulism, and plague.
    • Category B agents are moderately easy to spread with moderate illness but with lower mortality; they include E. coli O157:H7, staphylococcus enterotoxins, ricin.
    • Category C agents are emerging threats that have the potential to quickly spread and become serious health threats; they include Nipah virus, hantavirus, and others

    Anthrax (Bacillus anthracis)

    • Anthrax is a gram-positive, spore-forming bacillus, occurring in different forms (cutaneous, gastrointestinal, inhalational).
    • Cutaneous anthrax presents as a skin lesion evolving over 2-6 days, initially as a papule, progressing to a vesicle and a black eschar.
    • Gastrointestinal anthrax involves spores with an incubation period of 2–5 days, marked by nausea, vomiting, bloody diarrhea, and death. Mortality is about 50%
    • Inhalation anthrax involves spores, a brief prodrome resembling a viral respiratory illness, and radiographic evidence of mediastinal widening; flu-like symptoms, respiratory failure, and meningitis can develop. The mortality rate is high (50–80% untreated).

    Plague (Yersinia pestis)

    • Plague is an acute bacterial infection spread mainly by fleas.
    • It can manifest in different forms (bubonic, septicemic, or pneumonic).
    • Bubonic plague is characterized by swollen lymph nodes (buboes) with flu-like symptoms.
    • Septicemic plague has symptoms similar to bubonic, with no lymph node swelling, and is marked by bloodborne organisms.
    • Pneumonic plague, marked by rapid transmission, fever, hemoptysis (coughing up blood), lymphadenopathy, and cough, has the highest mortality rate.
    • Specimens for plague include sputum, bronchial washings/aspirates, environmental samples, and fleas.
    • Gram-negative bacteria (GNR) identification includes safety pin appearance, slow growth, non-motile colonies on MacConkey agar (MAC) and slow growth in general.

    Tularemia (Francisella tularensis)

    • Tularemia is a zoonotic infection spread to humans from animals (rabbits, ticks).
    • Its manifestations include localized swelling, ulcers, or a flu-like illness that spreads systemically
    • A person can contract tularemia through various ways including ticks, water-rats, or deer-flies
    • Specimens for tularemia analysis include serum, tissue, lesion aspirates, sputum, and environmental samples.
    • Identifying tularemia involves using pleomorphic, small gram-negative rods, slow growth, non-motile colonies on special media like SBA, CHOC, and MTM, and lack of oxidase, urea, or indole activity.

    Brucellosis (Brucella species)

    • Brucellosis (Malta fever or undulant fever) is an infection that involves unpasteurized dairy products, or direct skin contact, often in occupations like farming or veterinary practices.
    • It exhibits a long incubation period (5 days - 6 months).
    • The characteristic symptoms can include fever, profuse sweating, malaise, and muscle/back pain and No person-to-person transmission, and mortality rate is less than 5 percent.
    • Specimens for analysis span blood, bone marrow, tissue, spleen, liver, and environmental or evidentiary material.
    • Identifying Brucella involves using slow-growing, aerobic bacteria that can be cultured on BAP and CHOC media exhibiting catalase, oxidase, and urea positivity.

    Burkholderia Species (B. mallei and B. pseudomallei)

    • Burkholderia Species include B. mallei (glanders) and B. pseudomallei (meliodosis), transmitted through direct contact or occupational hazards; animal contact, and direct exposure.
    • These species have incubation times ranging from 1 to 2 weeks, presenting in different manners with cutaneous, systemic, or pneumonia-type symptoms.
    • Specimens include blood, bone marrow, sputum, bronchial alveolar lavage, abscess material, urine, and serum samples.

    Q Fever (Coxiella burnetii)

    • Q fever is an infection caused by inhaling infected animals or their excretions.
    • Symptoms include a flu-like illness, pneumonia, and hepatitis.
    • The mortality rate is approximately 2%.
    • Specimens include blood, serum, body fluids, visceral tissue, biopsy, and autopsy samples.

    Smallpox (Variola major)

    • Smallpox is an orthopoxvirus-borne disease involving a DNA virus.
    • It's now eradicated around the world, with only a couple labs holding reference specimens.
    • The virus has a brick-like structure, a relatively short incubation period (8 - 16 days), and is spread via droplets.
    • Clinical forms include ordinary smallpox (high mortality), modified smallpox, flat smallpox, and hemorrhagic smallpox.
    • Smallpox starts with flu-like symptoms and then develops a rash, spreading through the body, turning into raised lesions, and eventually scabs. Specimens, usually with the onset of the rash, would include materials collected from the lesions.

    Botulism (Clostridium botulinum)

    • Botulism is a neuroparalytic illness from a toxin; characterized by different types of botulinum toxin.
    • Botulism can occur from food poisoning, wound infections, or infections from injected substances (like heroin).

    Ricin

    • Ricin is a toxin derived from castor bean waste, occurring in various forms (mist, powder, pellets).
    • It is a remarkably stable substance, easily inhaled, or ingested, leading to significant morbidity.

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