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Gram(+) bacteria ´ëÀå°æ Á¤¸®

Pneumococcal infections

1. bacterial meningitisÀÇ ÈçÇÑ ¿øÀαÕ(¼ºÀÎ)

S. pneumoniae > N. meningitidis > Listeria monocytogenes, Staphylococci, GNB

2. head trauma, neurosurgery, CSF shunt½Ã Àß »ý±â´Â bacterial meningitis¿øÀαÕ

Staphylococci, S. pneumoniae, GNB

3. S. pneumoniaeÀÌ penicillin¿¡ ´ëÇÑ ³»¼ºÈ¹µæ±âÀü: PBP alterationÀ» ÅëÇÑ target

insensitivity

4. S. pneumoniae¿¡ ÀÇÇÑ miningitisÀÇ Ä¡·á±â°£? 2ÁÖ

cf. H. influenza, N. miningitidis¿¡ ÀÇÇÑ meningitis´Â 1ÁÖ

Staphyloccal infections

5. staphylococcal toxic shock syndromeÀÇ ¿øÀι°Áú: TSST-1(mc), enterotoxin B

6. TSSÀÇ Ä¡·á: nafcillin/oxacillin or clindamycin 14ÀÏ, IV immunoglobulin °í·Á

7. MRSA°¡ ¥â-lactamase¿¡ ³»¼ºÀÌ »ý±â´Â ±âÀü: PBP alteration

cf. PBP alteration: MRSA, PRSP

8. S. aureus¿¡ ÀÇÇÑ pneumonia´Â ´ëºÎºÐ ÇϺΠȣÈí±â ¹ÙÀÌ·¯½º¼º °¨¿° ÀÌÈÄ¿¡ »ý±ä´Ù.

cf. post-influenza pneumoniaÀÇ ÈçÇÑ ¿øÀαÕ

: S. pneumoniae, S. aureus, H. influenza

9. SSSSÀº toxin(ET=exfoliative toxin)¿¡ ÀÇÇÑ´Ù.

10. acute bacterial endocarditisÀÇ °¡Àå ÈçÇÑ ¿øÀαÕ? S. aureus

°æÇèÀû Ä¡·á: nafcillin + gentamicin: GMÀº Ãʱâ 3-5Àϸ¸ »ç¿ë

11. Staphylococcal endocarditis¿¡¼­ Åë¿øÄ¡·á¸¦ °í·ÁÇÒ ¶§ °æ±¸¿ë Ç×»ýÁ¦´Â?

ciprofloxacin + rifampin 4ÁÖ

Streptococcal infections

12. Group A ¥â-hemolytic streptococcus(S. pyogenes)¸¸ acute rheumatic fever, acute GN

À» ÀÏÀ¸Å²´Ù.

pharyngitisÈÄ¿¡ »ý±â´Â acute rheumatic fever´Â ¿¹¹æ°¡´ÉÇϳª acute GNÀº ¿¹¹æÀÌ

¾î·Æ´Ù.

13. streptococcal pharyngitisÀÇ Áß¿äÇÑ ºñÈ­³ó¼º ÇÕº´Áõ 2°¡Áö

: acute PSGN, acute rheumatic fever

14. Scarlet fever: Group A ¥â-hemolytic streptococcus¿¡ ÀÇÇÑ pharyngitis & rash

rash: 1, 2Àϰ ¸öÅë¿¡¼­ ½ÃÀÛÇÏ¿© »çÁö·Î ÆÛÁø´Ù. ¼Õ, ¹ßÀº spare

strawberry tonge

pyrogenic exotoxin A, B, C¿¡ ÀÇÇÑ hypersensitivity reaction

15. Streptococcus °¨¿°Áõ Ä¡·á½Ã penicillinº¸´Ù clindamycinÀÌ ÁÁÀº ÀÌÀ¯?

i) M protein°ú toxinÀÇ ÇÕ¼ºÀ» ¾ïÁ¦Çϱ⠶§¹®¿¡ Ä¡·á°¡ 16½Ã°£ ´Ê¾îÁö´õ¶óµµ penicillinº¸´Ù

È¿°ú°¡ Å©´Ù.

ii) longer postantibiotic effect

iii) inoculum effect(-)

iv) TNFÇÕ¼º ¾ïÁ¦¿Í °°Àº immune system¿¡ ¿µÇâÀ» ÁØ´Ù.

Enterococcal infections

16. Enterococcal infectionÀº ³ëÀÎ, ¼â¾à, Á¡¸·ÆÄ±«µÇ¾ú°Å³ª, Àå±â°£ Ç×»ýÁ¦ »ç¿ëÀ¸·Î

normal flora balance°¡ ±úÁø »ç¶÷¿¡°Ô ÈçÇÏ´Ù.

ÁßȯÀڽǿ¡ Àå±âÀÔ¿ø½Ã °¨¿°°¡´É¼ºÀÌ Áõ°¡ÇÑ´Ù.

17. enterococci´Â º¹°­³» °¨¿°°ú °°Àº mixed infectionÀÇ °æ¿ì enterococci¿¡ °¨¼ö¼º ¾ø´Â

¾àÁ¦¸¦ ½áµµ Àß Ä¡·áµÈ´Ù. ÇÏÁö¸¸ Ç÷¾×¿¡¼­ ºÐ¸®µÇ¾ú´Ù¸é enterococci¿¡ °¨¼ö¼ºÀÖ´Â ¾àÁ¦

¸¦ »ç¿ëÇØ¾ß ÇÑ´Ù.

18. Enterococcus: Group D streptoccus¿¡ ¼ÓÇÔ

ÀÓ»óÀûÀ¸·Î ¹®Á¦°¡ µÇ´Â ±Õ 2°¡Áö

E. faecalis, E. faecium

19. enterococcusÀÇ penicillin³»¼º±âÀü

E. faecalis: ¥â-lactamase»ý¼º

E. faecium: PBP alteration

20. VREÀÇ Ç¥ÇöÇü 3°¡Áö : van A, vanB, van CÇü

van A´Â vancomycin, teicoplanin¿¡ µÑ´Ù ³»¼º -> È¿°úÀûÀÎ ¾à ¾øÀ½

van B´Â vancomycin¿¡´Â ³»¼º, teicoplanin¿¡´Â °¨¼ö¼º -> teicoplaninÄ¡·á

van C´Â vancomycin¿¡´Â Àúµµ³»¼º, teicoplanin¿¡´Â °¨¼ö¼º -> Ä¡·áÇÒ ÇÊ¿ä ¾øÀ½.

* van A, van B À¯ÀüÀÚ´Â transferÇÒ¼ö ÀÖÀ¸³ª van C´Â transfer ÇÒ¼ö ¾ø´Ù.

Anthrax

21. Anthrax: Bacillus anthracis

´ëºÎºÐ °¨¿°µÈ µ¿¹°ÀÇ ¿À¿°µÈ ¹è¼³¹°°ú Á÷Á¢ Á¢ÃËÇÔÀ¸·Î½á »ý±ä´Ù.

»ç¶÷¿¡°Ô »ý±â´Â °¡Àå ÈçÇÑ ÇüÅ = cutaneous anthrax(ÇǺÎźÀúº´) 95%

Tx) DOC = penicillin G

Listeria monocytogenes : G(+) rod

22. Listeria monocytogenes

Åä¾ç, ½Ä¹°, µ¿¹°¿¡¼­ ºÐ¸®µÇ¸ç À½½ÄÀ» ÅëÇÑ ÀüÆÄ

cell-mediated immunity°¡ °á¿©µÈ ȯÀÚ¿¡¼­ »ý±â´Â °æ¿ì°¡ ¸¹´Ù.

cf. T cell deficiency¶§ Àß »ý±â´Â °¨¿°±Õ

i) thymic aplasia, Hodgkin's disease, sarcoidosis: Listeria, mycobacterium, candida,

HSV, VSV

ii) AIDS : P. carini, CMV

23. pregnancy-associated listeriosis

Àڱó» °¨¿°À¸·Î chorioamnionitis, premature labor°¡ »ý±æ¼ö ÀÖ´Ù.

24. listeria°¨¿°ÀÇ ÇüÅÂ

sepsis(mc), CNS infection(2nd) -meningitis

25. Listeria¿¡ ÀÇÇÑ meningitisÀÇ Æ¯Â¡

CSF pleocytosis, protein¡è, glucose normal

nuchal rigidity´Â µå¹°´Ù.

26. ListeriaÀÇ Ä¡·á: IV penicillin or ampicillin ¡¾ aminoglycoside

penicillin allergy½Ã bactrim

Tetanus(ÆÄ»ódz)

27. Clostridium tetani: G(+) anaerobic rod

spore°¡ »óó¿¡ ¿À¿°µÇ¾î tetanospasminºÐºñ

28. tetanusÀÇ Áø´Ü: ÀÓ»óÀûÀ¸·Î ÇÑ´Ù.

CSF´Â Á¤»ó¼Ò°ßÀ̹ǷΠÀǹ̾ø´Ù.

29. tetanusÀÌ Ä¡·á

¨ç antibiotics: penicillin 10ÀÏ, ±× ¿Ü clindamycin, EMµî »ç¿ë°¡´É

¨è TIG

¨é muscle spasm control

¨ê respiratory care

30. tetanus ¿¹ÈÄ: »ç¸Á·ü 10%¡é, °æ°ú 4-6ÁÖ

* poor prognosis

i) neonate or elderly

ii) short incubation period, short period of onset

: Áõ»ó¹ßÇö½ÃºÎÅÍ ÀÔ¿ø½Ã±îÁö ±â°£ÀÌ ÂªÀº °æ¿ì, Áõ»ó¹ßÇö½ÃºÎÅÍ 1st spasm±îÁö ªÀº °æ¿ì

Gas gangrene: C. perfringens

31. C. perfringens: G(+) rod

tx : penicillin