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3 Question Warm-up1. What diseases might be found immediately above the pectinate line vs. immediately below

the pectinate line? (FA11 p313, FA12 p342) (coA p416)

2. How many ATP are generated during aerobic metabolism? During anaerobic metabolism? (FA11 p97, FA12 p103) (Phys 860-861)

3. What enzyme is inhibited by the drug fomepizole? (FA11p94) (FA12 p100) (GG p86, Fig. 4-11)

EntErobactEriacEaE, Uti, and antibioticsH: Chapter 133,137R: Chapter 8

Enterobacteriaceae (FA11 p137-138 150) (FA12 p147-148, 163)E. coli (FA11 p151) (FA12 p163)ProteusKlebsiella (FA11 p151) (FA12 p163)Urinary tract infections (FA11 P177) (FA12 p197) (H p2388)UTI bugs (FA11 p178) (FA12 p199)Sulfonamides and trimethoprim (FA11 p189) (FA12 p210)Sulfa drug allergies (FA11 p189) (FA12 p246)Trimethoprim (FA11 p189) (FA12 p211)NitrofurantoinFluoroquinolones (FA11 p190) (FA12 p211)

4. Enterobacteriaceae (E. coli, Salmonella, Shigella, Klebsiella, Enterobacter, Serratia, Proteus)Gram (-) rodsAll species have somatic (o) antigencapsular (K) antigen- related to the virulence of the bug Flagellar (H) antigen- motile speciesAll ferment glucose and are oxidase negative

5. E. coli diarrhea, UTi, neonatal meningitis/pneumonia/sepsisEntero-toxigenic (ETEc) Most common form of travelers diarrhea (Montezumas revenge)

Rx:TMP-SMX,fluoroquinolones Similartocholera(water,shellfish) No intestinal wall invasion no fever

Entero-hemorrhagic (EHEc)* (example) E. coli o157:H7 HUS from hamburger meat (HUS: hemolysis (anemia), renal failure (uremia), thrombocytopenia)

Entero-pathogenic (EPEc) occurs in childrenEntero-invasive (EiEc) intestinal wall invasion fever and bloody diarrhea

(* EHEc and has a sHiga like toxin (verotoxin) inhibits 60s ribosome)

above- internal hemorrhoids,adenocarcinoma,below- external hemorrhoids, squamous cell carcinoma

aerobic - 32 atpanaerobic- 2

alcohol dehydrogenase

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6. What is the most common cause of gram negative sepsis?

7. Proteus spp. (P. mirabilis, P. vulgaris)Very motile no distinct colonies can be grown (common cause of UTi)carries urease: urea NH3 + co2 ammonium-magnesium-phosphate stones staghorn calculi

8. What organisms most commonly cause UTis? (FA11 p178, FA12 p198)

Antibiotics9. What is the mechanism of action of sulfonamides? (FA11 p189, FA12 p210) What is the

mechanism of action of trimethoprim? (FA11 p189, FA12 p211)

10. What drugs have photosensitivity reactions?

11. What other drugs should be avoided in patients with an allergy to sulfa? (FA11 p189,246) (FA12 p273)

12. What drugs can cause Stevens-Johnson syndrome (SJS)? (FA11 p245) (FA12 p272)

13. What are the clinical uses for TMP-SMX? (FA11 p189) (FA12 p211)

14. NitrofurantoinMechanism: Bacteriocidal. reduced by bacterial proteins to a reactive intermediate that inactivates

bacterial ribosomes indication: UTi cystitis (not pyelonephritis) by E. coli or Staph. saprophyticus (not Proteus) SE:rarelynausea,HA,flatulence Safe in pregnancy

15.Whatisthemechanismofactionofquinolones?Whataretheclinicalusesforfluoroquinolones?(FA11p190)(FA12p211)

16.Whatarethesideeffectsoffluoroquinolones?(FA11p190)(FA12p211)

/ e.coli

e.coli 80% , staph saprofiticus , klebsiella pneumoniae , proteus

PABA Antimetaboliteinhibits dihydropetoreate synthetaseinhibits folic acid synthesis

bacterioestatic

SulfonamidesAmiodaroneTetracyclines

loop diuretics , thiazide diuretics , AC diuretics , sulfonilureas , sulfonamides . sulfalazina

penicilinssulfa drugsseizure drugs

allopurinol

UTI's , shigella,salmonella,MRSA, AIDS

inhibit DNA gyrasegram + ( 3 y 4 generacion levofloxacion y moxifloxacin)gram - ( 1 y 2 generacion cipro

pseudomonas

GI UpsetNot in pregnancy or children (affects cartilage)tendinitistendon rupture

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Quick Quiz17. Which form of E. coli causes hemolytic-uremic syndrome (HUS)? (FA11 p151) (FA12 p163)

18. What infections is Klebsiella pneumoniae known for causing? (FA11 p151) (FA12 p163)

19. What organisms are the most common causes of UTi? (FA11 p177) (FA12 p198)

20. What is the function of the enzyme urease?

diarrhEa and Food PoisoningR: Chapter 17

Salmonella vs. Shigella (FA11 p152) (FA12 p164)Campylobacter jejuni (FA11 p152) (FA12 p164) (R p799)Vibrio cholera (FA11 p152) (FA12 p164) (R p797)Yersinia enterocolitica (FA11 p152) (FA12 p164) (R p802)C. difficile (FA11 p147) (FA12 p158)Brief review of protozoa that cause diarrhea (R p805)Bugs causing food poisoning (FA11 p175) (FA12 p195) (R p800-801)Bugs causing diarrhea (FA11 p176) (FA12 p196) (R p798, Fig. 17-7)

21. Salmonella (FA11 p152, FA12 p164) common cause of osteomyelitis in sickle cell patients S. enterica and S. enteritidis: the most common cause of food associated diarrhea in developed countries

(poultry, eggs, reptiles)Antibiotics should be avoided because they may prolong the carrier state in Salmonella Gi tract

infections. S. typhi: causes typhoid fever

22. Shigella (FA11 p152, FA12 p164) Bacterial dysentery can be caused by Shigellaflexneri,Shigellasonnei,or Shigella dysenteriae Shigellaflexneri: associated with causing reiter syndrome

E.coli 0157 h7

Aspiration pneumoniaAbscess in the lungs

E. coli

UTI's

Proteus mirabilis , staph saprophyticus

Breaks down urea in NH3 and CO2

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end of session Quiz23. What medications are commonly used to treat C. diff colitis? (FA11 p147) (FA12 p158)

24. What infectious agent most likely corresponds to the following statement? (FA11 p175) (FA12 p195) Food poisoning as a result of mayonnaise sitting out too longDiarrhea caused by Gram (-) nonmotile organism that does not ferment lactoserice-water stoolsDiarrhea caused by a c- or S-shaped organism

Diarrhea transmitted from pet feces Food poisoning resulting from reheated rice (chinese food)Diarrhea caused by Gram (-) motile organism that doesnt ferment lactoseMost common cause of travelers diarrhea

Diarrhea after a course of antibioticsDiarrhea caused by Gram (-) lactose fermenting bacteria, no feverDiarrhea caused by Gram (-) comma-shaped organism, no feverDiarrhea + recent ingestion of water from a stream Food poisoning from undercooked hamburger meat

Oral vancomicinmetronidazol

staph aureus shigella

v. cholera ETEC

campylobacter

yersinia enterocoliticab.cereus

salmonella

ETEC

C.difficilee.colivibrio cholera

giardia y entomoeba hystolitica

E.coli 0157 H7