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