Gram negative cocci

yeah hi - so I'm back here to give some mindmap yesterday we were discussing about mind maps for almost all the type of bacterial virus and the fungus right so now I'm just going to give the mind map of few bacteria like how you need to identify the bacteria how you need to identify the infection caused by the bacteria and followed by how you need to treat the diagnosis or the infection okay so this is basically a combination of few subjects like whatever we are doing the anatomy of the bacteria will be in your microbiology and whereas your clinical features and everything comes under your general medicine followed by investigations everything again you will come back to your microbiology and few areas of your general path and followed by the treatment plan is again your pharmacology and general medicine so we are going to deal few important things so straightaway now I'm going to discuss about the gram-negative cocaine so in which the main one is the nei Syria okay so the common points for this is this is gram-negative non-sporting non motile oxidase positive and mostly it appears as diplococcus you can see in the diagram say psst block okay and the most two important bacteria which are included in this is one is meningitis and second one is Canadian so the next important thing that you have to make a note is the difference between these two like how to identify these two organisms it's very simple you know meningitis meningococcus so you know meninges which are surrounding the brain so you can simply remember it has capsulated means it has a capsule around it protection capsule similarly like your brain has managers around it so the meningococcus will have capsule second one it is the lens-shaped okay it is lens-shaped few people call it as Halfmoon shape so easy to remember it is something like Halfmoon shape you can M you can remember it as m4 m m4 Halfmoon shaped and the third one it vitamins both the glucose as well as the maltose M again here an M it further means both the glucose as well as the Monroes and it is present both inside the cell and out sensor most commonly it is inside the cell intracellular and occasionally you can found it extracellular also whereas coming to the comparison of coral cocaine it is non capsulated G G looks like kidney right it looks like a kidney so it is a kidney shaped it further meant only Lucas whereas this both both the Lucas as well as the maltose and it is mostly 99.99% of the cases it is intracellular and most commonly associated with the neutrals means I hope you remember the structure of this WBC granulocytes agranulocytes if you see the neutrophil like this okay and these cock-eyed diplococcus will be present inside the inside the cell inside the neutrophils okay so this is mostly intracellular mostly most of the times when compared to the meningococcal which is both intra as well as extra cylinder it is mostly it is an intracellular thing so I am repeating again it is capsulated lens shaped or Halfmoon shaped pediments both the glucose as well as maltose present both the X intracellular as well as extras in unit so we'll go and detailee discuss both of them these two are the most important things right now okay so first we go with go knock okay so coming to the gonococcus apart from the things which I hope we have already discussed one is it is not non capsulated it means kid it is non capsulated right and it is kidney shaped G is kidney shaped it is only it vitamins only the glucose it is mostly the intracellular present in the neutral present in the WBC that is neutrophils okay so apart from this what we have to know so there is one scientist who has classified these gone up okay basing upon their Tilden okay so basing upon the fillet they have classified it into four types that is type 1 type 2 type 3 and type 4 out of which type 1 and type 2 they have this feeling and they are virulent means fillet is one other thing which calls very lansing whereas type 3 and type 4 they don't have this period and they are non virulent clear - type 2 they happily and they're very learnt type 3 and type 4 they have no peel and they are not we are not so apart from this you have protein one protein 2 and protein 3 so what are their main functions or concerns so protein 1 and protein 3 the protein 1 and protein 3 are called as forums where as the protein to the protein 2 which is present in this gonna cocaine is an Associated molecule which is called as opacity associated protein so these are the three proteins and just make a note about them so apart from this the most important thing in both meningococcus as well as Konak okay is the presence of iga proteus so I see a Proteus is present we have already discussed about IgA immunoglobin so I see a Proteus is the is the one which is going to protect these organisms these bacteria from the mucosal surfaces because your mucosal surface is mainly concerned with the production of IgA immunoglobulins which is going to kill these bacteria but because of the presence of isay a Proteus IC immunoglobin will get licensed so this is how both the meaning of coca as well as the corner okay the product the bacteria from iga immunoglobulins by presence of Isaiah proteins so this is all about the internal structure and their main functions I was just concerning about the main functions okay I hope you're very very clear about this okay so apart from this you have Lippo oligosaccharide right here you have a lip o oligosaccharide which acts as a neurotoxin so the lipo oligosaccharide which access the endotoxin so apart from this we have already discussed two days back when i'm talking about the complement system so the complement system the complement proteins are divided into three types one is early proteins second one is mid proteins and third one is late proteins or terminating complementary proteins the terminating complementary proteins are c phi 2 c 9 whenever there is deficiency of terminating or late complementary proteins that is c phi 2 c 9 there is a high chance of occurrence of this particular gram-negative diplo confections i have already discussed when i was talking about the complement system so i did note the host factor that is going to control is the deficiency of terminating complementary proteins that is c phi 2 c 9 can lead to high chances of infections of Gornick okay as well as the meaning of cocaine okay I hope you're very clear until now so I'm moving to the next level so I'm going to talk about the diseases before talking about the diseases I'm just going to give you important statements one is two to eight days is the incubation period of this and most of the asymptomatic carriers okay the asymptomatic carriers you can see most of the asymptomatic carriers for this disease are the main reservoirs for the occurrence of the disease means most of the times the disease occurs from the asymptomatic carriers okay the acts as a reservoir they store the disease and they spread the disease so these are the two important points that you have to add so coming to the diseases that are caused by this is so in the main in the mail the most common disease is your threads okay it is the most common in the mail means apart from this you can see the prostate infection and many other infections but most common is this because most of your questions will move around most common and this is a most common with the female and most of the females they acts as asymptomatic carriers for this particular disease and coming to the lining of your the vaginal lining okay so in most of the in normal condition your vaginal lining is lined by non-keratinized stratified epithelium okay so stratified epithelia will be there so whenever whenever I mean the manner of the person is a than the state of PPO Bertil pre-pubertal or post menopause so this this lining is this lining will become very thin and it dumps to the basilar layer and these epithelium which is of which is of very thin is more more exposed or more chances of getting this type of gonococcal infection okay so these are the things to be make a knot so one is the most common in males most common in females okay so apart from that you need to make a note about the lining and how the lining varies and how the lining is related to occurrence of a particular infection then the entire reproductive system most of the reported system in the female are affected by these bacteria so the occurrence of this infection can also be seen in neonates basically the neonates get the infection from the mother during the period of delivery so during the delivery okay so these the the BA the baby moves around these organs where the infection is there and the baby gets the infection and most common infection in the baby is ophthalmic neonatal of Ptolemy's an item is the most common disease that is most commonly seen in the neonates and it is transmitted from the mother and the treatment okay I'm just going to give a rough treatment the rough treatment for this is the application of one percentage of silver nitrate eyedrops or you can use eye drops either with the presence of antibodies like antibiotics like Petra my sin and tetracycline so they can give some positive results in this particular condition of ophthalmic ophthalmic neonatal okay so we're done with this so we'll go to the next level so how you will do the infection how you will do the investigations and the most common a specimen that is obtained is from urethral discharge okay so the reproductive discharges you are going to take and you're going to go for the microscopic examination and I'm going to give you transport medium as well as few culture medium which are very very important in examination point of view and both this transport medium and culture medium are almost common for both this gerak okay as well as meningococcus so it is common the most of the transport medium are common for this both gone okay okay as well as many if it is less than if it is less than six hours the transport medium if it's less than six hours then you have to go for Stewart medium or Ames medium if it is more than six servers if it is more than six servers then you need to think about je m b ec medium or gone o park system so this is about the transport medium so when I'm talking back about the culture mediums the culture mediums will be different for acute cases and will be different for chronic cases so in the acute cases you can go with a simple chocolate auger whereas in the chronic cases you need to go for a selective medium that is higher mountain medium and make a note a modified tire mark your medium is used for your meningococcus for your gonna focus you can go for a simple thing that is TM medium whereas for your meningococcus you have to go for a modified TM medium and coming to the chronic cases okay so coming to the chronic cases most of your chronic cases or asymptomatic carriers are very difficult to identify or it is very difficult to isolate the bacteria from the culture either in the chronic cases or you can add a mode in the metastatic cases means this meaning go this gonna coca apart from present presenting in the most common areas of infection sometimes it may disseminate okay means it may spread to avoid areas a wide areas are other areas but in that particular cases of the metastatic cases or in the case of chronic cases it is very difficult to isolate the organism by using the culture mediums so in that case you can go for Cyril logical test and basically the easy way identifying this particular organism with the Syria logical test is just by targeting so because they are the most virulence and they are very important apart from lipopolysaccharides you can identify with most of the seer logical test will base will targeting this villain okay so I hope you're very clear until now about the investigations and coming to the treatment plan in the drug of choice most treatment plan mostly moves around the around the drug of choice that is going to be a pharmacology part so I'm not going to touch anything related to the formal quality part okay so just just try to focus up to this level of investigation so treatment is very simple for every bacteria there will be one drug of choice that is the most commonly asked question followed by you can keep a second drug as at the second second option okay so most of your questions will move in the form of ecology related to this basing upon the drug of choice because they are going to give a description a female or a male of this is recently has sexual intercourse with a with a woman so they're going to give some description about their about the symptoms or anything and upon upon the examination of this the vaginal secretions from the particular woman okay we got this particular slide and they're going to give you some deep lock okay on this or they can give you an interim intracellular Diplo cocaine means your diplococcus and inside the inside the WBC so and they can ask you what is the diagnosis for this case and what is the treatment plan of the drug of choice for this case as an application based question okay I hope you're clear so I'm going to the second one that is meaning goq okay so first of all I mean the most common points were already discussed that it that this is the capsulated one this is a line shaped one this is a Halfmoon shaped one this is present both in the intracellular as well as extracellular this can freedom in both the glucose as well as maltose so apart from this we need to focus main on the structural aspects so what are the structure lies but the most important structural aspects on which it is it is divided into zero types is the capsular polysaccharide so capsular polysaccharide is the most important thing and most virulence effective so basing upon different types of capsular polysaccharides these are divided into 13-0 types ok 13-0 types out of which we have to be very very specific about a because a zero type is most common in India and make a not a point about B zero type there is no vaccine for various B 0 time they are divided into in two different types of zero types the most important 0 types are K type which is most common India and that the leftover is the B 0 type you have C 0 type you have y 0 type you have w124 this is similarly you have 13 0 types the most important questions are a sea row type is most common serotype in India and B 0 x there is no vaccination for it okay so this is about the capsular polysaccharide capsular polysaccharide is present outside so so outside this is the outermost one right so apart from this we need to learn about the outer membrane proteins means there are so many proteins which are present outside the membrane they are one is you need to learn about DNA which is not that important and apart from that I have already discussed a point to you that is IG a Proteus I see as Proteus is both present in both Cornucopia as well as meningococcal and it helps in protection from the mucosal IgA immunoglobulins similar to that of that other of the corner cocaine it has Lippo oligosaccharide which is and endotoxin so this is these are the few important things that you have to make a note about the structural things and similarly allah in the lane in the in the previous bacteria i was talking about the host response post factors so what host factors have talking about stalking about the term terminal complimentary system disorders or deficiencies or the end complimentary protein deficiencies that is C Phi 2 C 9 deficiencies whenever you have more C Phi 2 c 9 deficiencies there are high chances of occurrence of this type of bacterial infection okay so apart from this they they they can cause an occurrence of deficiency of alternative pathway where there is a deficiency of either C 3 or factor D okay so whenever you have a deficiency of these C 3 as well as the factor D there are chances that this particular infection can occur c phi 2 c 9 has terminal complimentary system deficiencies or deficiencies of view of the alternative pathway proteins also okay so that is about the factor side that is about the host factor side how it is causing the occurrence of this particular infection so coming to the next one is about the clinical futures okay we have to make a note about the the clinical futures so before talking about this particular clinical feature the most common area of reservoir for this case for this case is NASA pharynx because most of this things will go from the nasal secretions or will go from the respiratory secretions because the mode of transmission of this particular meaning of Hawkeye is from the respiratory rooms and it is most commonly seen in the case of children that two A's of three months to five years and the most common route is respiratory the root okay so the most common clinical futures as most of us know the first important clinical feature is meningococcal meningitis okay very well-known term meningococcal meningitis apart from this most of your questions will move around this particular syndrome that is waterhouse frederickson's syndrome okay which is also called as hemorrhagic edenal itis you can see hemorrhagic enterovirus so how you can identify this particular syndrome is the first important feature for this syndrome is septic shock the first important future is septic shock for example if they are giving a diagram based question this is the most common diagram based question that you can see humor Isak skin lesions okay these are called as humanizing skin lesions and you can see disseminated intravascular coagulation in these patients so this is most commonly associated with meningococcal meaning work on a Syria meningococcal and meningitis and it leads to septic shock it leads to due to the bleeding in the adrenal glands its need to ship septic shock okay so the important future is you can see this type of hemorrhagic skin lesions so this is very very important term when we are talking about meningococcal meningitis so the next important aspect is the lab laboratory investigations okay so laboratory investigations has already said your NASA fairings is the most common area for the reservoir so one important thing is the nasa pharyngeal swaps so the mass of our angle swabs are most commonly used in the carriers and the second one is when you see an active case so for an active cases you have to isolate these factory after cerebrospinal fluid and the best way to remove the spirit pro spinal fluid is by the lumbar puncture so for the cases you need to go for the CSF that is by lumbar puncture and further carriers you need to go for the nests of arranger slap and when I'm talking about the meningococcal okay when I'm talking so these are the two important things that you have to make it so apart from this when I'm talking about the previous one this particular syndrome the best way of isolating the factory is from the blood because it is shock related okay it is shock related and you just mainly due to the bleeding so you have to isolate from the blood so three important points one is for carriers you need to isolate from the nasa pharyngeal swab and for the normal cases you need to identify from the cerebrospinal fluid by the lumbar puncture and the third one is you need to identify you need to remove it from the blood okay so these are the investigations point of view and they can ask you the most sensitive investigation method is pc r-- okay so pcr is the most sensitive investigation and the most common is all this the most common is isolation isolation is the isolation of the bacteria from the culture is the most common whereas the most sensitive is is the pcr okay i hope you are clear with the investigations - so next i was just talking about the drug of choice drug of choice will learn in the pharmacology part and is already discussed about vaccinations this particular organism that is meningococcal has a vaccination okay so it has different vaccinations it's already discussed there is no vaccine for the B type okay so points to be added about the vaccination is there is no accent so there is no vaccine for B type B 0 type 0.1 the second important point vaccine is not effective in children less than two years and vaccine is most commonly given at the age of eleven to twelve years so in the idea Rezendes the vaccines are regularly given so drug of choice and everything will learn there so this is a slide of meningococcal you can see the tip local you can see the capsule okay you can see they can identify the capsule also very clearly so that is how you can differentiate the both one is the non capsulated one is the capsulated okay so Dan for now I'm just going to have a quick recap if you want this is how you need to prepare the map okay the map is going to give you the diagnosis and everything it's makes it's going to make your subject very very simple so this is gram-negative or non sporulating non motile oxidase positive LOC okay these are the two coming to the differences capsulated length shaped or Halfmoon shape both both non capsulated kidney shaped only glucose only intracellular so I'm going to talk about I'm going to talk more about the PNA which are divided into type 1 type 2 type 3 and type 4 and 1 2 3 proteins and lip was occupied as my only concern with a neurotoxin so different types most common in male most common in female coming to the investigations I have discussed about the culture mediums make a note the next one is I'm more concerned about your 0 types divided into 13 out of which a is most common in India and I have discussed about this ok the peculiar feature is septic shock hemorrhagic lesions and disseminated intravascular coagulation NASA pharynx is the most common area for the carriers nasa pharyngeal swath normal cases you have to take a lumbar puncture most communists this year and isolation is the most commonly used and most sensitive is the pcr so this is one no vaccination for your be type not effective in the children less than 12 years learnt always so is most is most commonly given in the of eleven to twelve years so thank you all done for now signing off doctors taken from team MDS concur stay positive this is how you need to prepare the road maps for the cases because need to zero to zero is an updated paper is a modified path