ALL BACTERIA BACTERIA
Moraxella Catarrhalis
CHARACTERISTICS
gram (-) aerobic diplococcus. Oxidase (+)
DISEASE
otitis media, sinusitis in children
RESERVOIR / TRANSMISSION
normal flora
RESPIRATORY
gram (+) coccus in Strep throat → Streptococcal rheumatic fever, normal flora, chains or pairs. pyogenes (group infected acute postcatalase (-), lactose A antigen) persons streptococcal (+) glomerulonephritis
Corynebacterium diphtheriae
gram (+) clubshaped rods, aerobe
Bordetella pertussis
gram (-) coccobacillus, strict aerobe, mucosal surface pathogen
Mycobacterium tuberculosis
ACID-FAST, rod shaped, obligate aerobe, very slow growth, facultative intracellular
tuberculosis
gram (-) pleomorphic rod, small, facultative anaerobe. requires growth factor X (hemin) and V (NAD, NADP)
otitis media, sinusitis, bronchitis epiglottitis, pneumonia, meningitis, septic arthritis, cellulitis
Haemophilus influenzae (nonencapsulated) Haemophilus influenzae (Hib)
diphtheria
normal flora, humans only
whooping cough humans only pertussis
reservoir infected humans
Chlamydophila species
Chlamydophila psittaci
smallest free-living bacteria, NO CELL "walking WALL, pneumonia", pleomorphic, no tracheobronchitis gram stain small obligate INTRACELLULAR pathogen, gram (-), not seen on gram stain, cell wall lacks peptidoglycan layer, unable ot make ATP energy parasites
pneumonia or bronchitis parrot fever, psittacosis, ornithosis, pneumonia
β-lactamase
CLINICAL
DIAGNOSIS
respiratory droplets
acute inflammation of pharynx and tonsils, LTA, surface proteins F and M, β-hemolysis on blood sore throat, fever, exudative tonsillitis, anterior hyaluronic acid capsule, streptolysin, agar, bacitracin cervical lymphadenopathy, scarlatiniform rash exo-enzymes, pyrogenic exotoxins sensitive or fever
respiratory droplets
Heat-labile A-B exotoxin, ADP ribosyl transferase (blocks protein syn), diphtheria toxin is invasive
respiratory droplets
attachment, immobilization, destruction (murein) of cilia, Fha, Ptx (AB toxin - ↑ cAMP), pertactin, pili
Catarrhal stage: 1-2 wk, highly communicable, paroxysmal stage: 2-4 wk, paroxysmal cough, whoop. Convalescent stage: wks to mn
Inhalation of infectious aerosols
Mycolic acid, sulfolipids, cord factor, tuberculin + mycolic acid DAMAGE DONE BY HOST IMMUNE SYSTEM
primary TB: Ghon complex, progressive primary (active) TB, latent dormant TB, secondary (reactivation) TB: apex. Productive cough - bloody sputum, fever, weight low, night sweats
exotoxin → cell death, necrosis
lipopolysaccharides, IgA protease, polysaccharide capsule asymptomatic carriers
infants: passive maternal protection, poor response first 2 years, > 5 - disease uncommon
respiratory droplets
rusty sputum, typical lobar pneumonia
human respiratory tract
aerosol droplets
p1 adhesin, toxic metabolic products: hydrogen peroxide and superoxide radicals
hacking cough, dry → productive, slow resolution
infected humans
respiratory droplets
inhalation of zoonotic dried pathogen, secretions from mainly birds birds
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treat to prevent acute rheumatic fever: penicillin
Loeffler medium, pseudomembrane → obstruction and antitoxin serum selective tellurite suffocation, sore throat and pharyngitis, low therapy + antibiotics medium (- extra flora) grade fever, regional lymph nodes swollen (penicillin or --> black colonies bull neck. Toxin: myocarditis & cardiac macrolides: with dark halo. Toxin dysfunction, laryngeal nerve palsy, lower limb erythromycin) DTaP detection: Eleck polyneuritis vaccine immunodiffusion test
polysaccharide capsule, autolysin, pneumolysin O, peptidoglycan/ teichoic acids, adhesins, GOOD AT PICKING UP DNA
2 stages: elementary body (EB): infectious, survive outside, non reproductive. Reticulate body (RB): noninfectious, intracytoplasmic, reproductive form
TREATMENT
penicillin + β lactamase inhibitor (amoxicillinbronchitis or pneumonia in pts with underlying mostly skipped, blood clavulanic acid), 2nd, chronic lung disease or chocolate agar 3rd gen cephalosporin, TMPSMX, macrolide
normal flora
lancet-shaped, gram (+) communityStreptococcus diplococcus or in acquired normal flora, pneumoniae chains, pneumonia, OM, humans only (pneumococcus) fermentation adult meningitis metabolism Mycoplasma pneumoniae
respiratory droplets
VIRULENCE / PATHOGENESIS
asymptomatic to pneumonia or bronchitis, complications: atherosclerotic vascular diseases
charcoal-blood agar (Bordet-gengou potato agar) , pearl-like erythromycin DTaP colonies, direct vaccine fluorescence antibody test CXR, PPD: >5mm = isoniazid, rifampin (+) in HIV, >10mm = (4m), pyrazinamide (+) in high-risk. (2m), ethambutol >15mm = (+) in lowBCG Vaccine, risk, ziehl-Neelson isoniazid stain, Lowensteinprophylaxis Jensen medium amoxicillin + chocolate agar (X and clavulanic acid V factors), satellite phenomenon, latex 3rd gen agglutination test cephalosporin Hib PRP conjugate vaccine OM: amoxicillin + α-hemolytic on blood clavulanic acid. agar, not typeable Pneumonia/meningiti (A/B), Optochins: 3rd gen sensitive, bile soluble, cephalosporin + surface capsule vancomycin PPV, PCV7 vaccine Eaton's media (sterols), serological tests
tetracycline or macrolide
serological tests, isolation is difficult
macrolides (azithromycin) or tetracyclines (doxycycline)
serodiagnosis by complement fixation test
tetracycline or erythromycin
URINARY TRACT INFECTIONS
URINARY TRACT INFECTIONS
Enterobacteriaceae gram (-) rods, facultative anaerobes, catalase (+), oxidase (-), nitrite (+)
RESPIRATORY
ALL BACTERIA BACTERIA
CHARACTERISTICS
Legionella pneumophila
weakly gram (-) rods, water organisms (45C), complex nutritional requirements, aerobic, motile
Klebsiella pneumoniae
enterobacteriaceae family, gram(-) rod, lactose (+)
Pseudomonas aeruginosa
gram(-) rod, aerobic, motile, minimal nutritional requirements
Burkholderia pseudomallei Burkholderia cepacia
gram (-), aerobic rod
Acinetobacter spp
gram (-) coccobacilli
Bacillus anthracis
aerobic gram (+), spore forming, nonmotile
Escherichia coli
Klebsiella pneumoniae
DISEASE
opportunistic pathogen
Serratia (marcescens)
lactose (+)
Staphylococcus Saprophyticus
gram (+) cocci, clusters, catalase (+), coagulase (-)
Enterococcus faecalis (80%)
respiratory ubiquitous in secretions, environment direct contact, fomites
melioidosis, acute pneumonia soil, ponds, opportunistic pathogen - same rice paddies, zoonotic as P. aeruginosa, causes serious infections
inhalation, inoculation
anthrax
DIAGNOSIS
TREATMENT
fever, chills, non-productive cough, chest pain, HA, mental confusion, diarrhea
BYCE (buffered charcoal yeast extract), requires Lcys, Fe, pH 6-9, slow growth 2-5 days, SILVER STAIN
macrolides (erythromycin), Pontiac fever - selflimiting
hacking cough, dry → productive, slow resolution. DM at high risk
mucoid colonies
3rd gen cephalosporins
unknown
resembles TB - abscesses and granulomas
β-lactams or tetracyclines, high mortality if untreated
pneumonia, wound infections, UTI, sepsis
case-by-case fluoroquinolones box car chains, large (ciprofloxacin) cellnonhemolytic colonies free vaccine - used in high-risk
ubiquitous, zoonotic
polypeptide capsule, spore, exotoxin: EF, LF, PA (adenyl cyclase)
normal flora
FimH (cystitis) - FIMBRIAL ANTIGEN, P-pilus (nephritis), capsule, hemolysin, aerobactin, LPS
MacConkey agar: lactose (+) - pink, EMB agar - LACTOSE (+): blue-black colonies
catheters
capsule, pili, endotoxin
MacConkey agar, mucoid
normal flora
peritrichous flagella - swarming, adhesins, endotoxin
MacConkey agar: clear
common cause normal flora and environment of nosocomial infections nosocomial normal flora and environment infections UTIs sexually active young endogenous women
nosocomial gram (+) infections, UTI, diplococci or short endocarditis (pt chains, catalase with damaged (-), Lancefield's heart valves), group D antigen wound infections, bacteremia
CLINICAL
blue-green colonies, pili, capsule, endotoxin: fever, productive cough, weight loss, breathing pyocyanin, antipseudomonal lipopolysaccharide, tissue damage: difficulties and cyanosis, complications: polyverdin, or PNC (carbenicillin) + exotoxin A (AB - ↓ protein syn), malignant otitis externa (DM), colonization fluorescein (green), aminoglycoside exoenzyme S, elastase, alkaline of cystic fibrosis patients fruity aroma, mucoid, (tobramycin) protease, cytotoxin, hemolysin UV light
nosocomial soil, water, sewage, animals, infections in normal skin, GI tract of pts or immunodeficient pt health care workers
community/hospita highly motile, l UTIs, pneumonia, Proteus mirabilis lactose (-), urease septicemia, wound (+) infections lactose (+), motile
VIRULENCE / PATHOGENESIS
inhalation of pneumonia, contaminated biofilms in low virulence, biofilms, prevents Legionnaire's aerosols, no water phagosome-lysosome fusion, lung disease and person-tosources damage and inflammatory response Pontiac fever person transmissions capsule, endotoxin - necrotic pneumonia, UTI, human colon and URT, from destruction of alveolar spaces, septicemia own flora abscesses, resistance plasmids
UTI, diarrheas/ dysentery, motile, lactose (+) Neonatal meningitis, septicemia UTIs, Lower non-motile, lactose respiratory tract (+) infection (lobar pneumonia)
Enterobacter
RESERVOIR / TRANSMISSION
adhesins, capsule, endotoxin adhesins, capsule, endotoxin adhesin, inflammation response
normal flora adhesins, toxins, enzymes
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dermal, respiratory, GI anthrax, possible sepsis
TMP/SMX - UTIs in hospital and acute uncomplicated UTI, acute community, uncomplicated pyelonephritis, complicated Fluoroquinolone brick-red colonies UTIs, asymptomatic bacteriuria, renal abscess complicated UTI, Cephalosporin γ-hemolysis, pregnancy novobiocin resistant
γ or α hemolytic, resistant to 40% bile salts, 6.5% to NaCl, bacitracin and Optochin.
Enterococcus faecium (20%)
Pseudomonas aeruginosa
aerobic gram (-) rod, motile, oxidase (+), lactose (-)
opportunistic infections
ALL BACTERIA RESERVOIR / TRANSMISSION
VIRULENCE / PATHOGENESIS
adhesins, toxins, enzymes
CLINICAL
normal flora
ubiquitous in environment
polysaccharide capsule, endotoxin, adhesin, exotoxins
infective endocarditis, etc…
normal flora
Protein A - (-) phagocytosis. Fibrinogen-binding protein clumping factor. Coagulase - fibrin clot. Cytotoxic toxins - pore-forming toxins. Enterotoxins A-E: gastroenteritis, TSST-1, Exfoliations skin infections
OTHER GRAM (-) ORGANISMS: HACEK
DIOVASCULAR INFECTIONS
CARDIOVASCULAR INFECTIONS
Staphylococcus epidermidis
gram (+) cocci, clusters, catalase (+), coagulase (-)
catheter and prosthetic device infections, IE in IV drug users and prosthetic valve IE
normal flora
biofilm
normal flora, dental caries
low virulence, dextran-mediated adherence - biofilm → damaged heart valve surfaces, FimA surface adhesin, lack capsule
most common gram (+) cocci, cause of Viridans chains, catalase subacute IE in Streptococci (-), lack capsule and pts with (many, do not lancefield antigens, abnormal or need to identify) no serologic group damaged heart valves Enterococcus faecalis (was classified as streptococcus)
gram (+) cocci, single cells, diplococci or short chains, catalase (-), lancefield antigen: group D
nosocomial infections, UTIs, wound infections, bacteremia, endocarditis in pts with damaged heart valves
normal intestinal flora
Streptococcus Bovis
gram (+) cocci, chain, catalase (-), lancefield antigen: group D, also named non enterococcal group D organisms
subacute infective endocarditis
normal intestinal flora
Pseudomonas aeruginosa
IE in IV drug users aerobic gram (-) and patients with motile rod, oxidase prosthetic heart (+) valves.
Haemophilus aphrophilus Actinobacillus actinomycetemco fastidious organisms; requires 5-10% mitans carbon dioxide for growth + 3 wks Cardiobacterium incubation hominis
complications: embolization from infective endocarditis to parietal lobe, to lung
Subacute IE: w/n 2 weeks of dental or other procedure, low grade fever and chills, fatigue, anorexia weight loss, new or changing heart murmurs, skin lesions. Acute IE: acute onset of high-grade fever and chills, rapid onset of CHF, murmurs can be absent
associated with colon cancer
ubiquitous in environment
subacute IE (5%), complications may include massive arterial emboli and congestive heart failure
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TREATMENT
blue-green colonies, pyocyanin, polyverdin, or fluorescein (green), fruity aroma, mucoid, UV light
CARDIOVASCUL AR INFECTIONS gram (+) cocci, clusters, catalase Staphylococcus (+), coagulase (+), aureus salt tolerant, mannitol (+)
γ or α hemolytic, resistant to 40% bile DIAGNOSIS salts, 6.5% to NaCl, bacitracin and Optochin.
mannitol-salt agar: yellow colonies, βhemolysis
no hemolysis, NOVOBIOCIN sensitive
α-hemolytic, Optochin resistant, not bile soluble
not bile soluble, growth in 6.5% NaCl, α or γhemolysis
not bile soluble, no growth in 6.5% NaCl, α or γ-hemolysis
no fermentation, produces pigments BLUE-GREEN
methicillin resistant, some vancomycin emerging Native valve IE: PNC + gentamycin. IV drug use: nafcillin + gentamicin. Prosthetic valve IE: vancomycin + gentamicin
BACTERIA
nosocomial gram (+) infections, UTI, diplococci or short endocarditis CHARACTERISTICS DISEASE (pt chains, catalase with damaged (-), Lancefield's heart valves), group D antigen wound infections, bacteremia
Multiple (+) blood cultures (3-5 sets taken), if (+) for same organism - sensitivity testing. Culture (-): recent antibiotic use, fastidious organisms, fungi. Echocardiography - vegetations
URINARY TRACT INFECTIONS
pregnancy
vancomycin
major resistant problems for antibiotic problems
sensitive to penicillin
Eikenella corrodens Kingella kingae Bartonella species Polymicrobial IE Fungal endocarditis SKIN INFECTIONS
CHARACTERISTICS
DISEASE
B. quintana most commonly involved
BACTERIAmay include massive arterial emboli and congestive heart failure subacute IE (5%),ALL complications RESERVOIR / TRANSMISSION
VIRULENCE / PATHOGENESIS
CLINICAL
DIAGNOSIS
Native valve IE: PN
OTHER GRAM (-) ORGANISMS: HAC
CARDIOVASCULAR INFECTION
BACTERIA
fastidious organisms; requires 5-10% carbon dioxide for growth + 3 wks incubation
TREATMENT
homeless males with poor hygiene, must be considered in cases of culture-negative endocarditis among individuals whoa re homeless
most common combo: Pseudomonas observed in cases of IV drug users IE, the cardiac surgery mortality rate is twice that associated with single-agent IE. + enterococci Generally found in IV drug users and intensive care unit patients who receive broad spectrum antibiotics, blood cultures often negative, causes subacute IE. Most common organisms of both fungal valve IE and fungal prosthetic valve IE are: Candida spp, and Aspergillus spp.
fibronectin-binding proteins, collagen binding proteins, clumping factors (A, MSSA: nafcillin, B), teichoic acids, capsule, protein A Furuncles, carbuncles - neck, face, axillae, MRSA: person-to- binds Fc, prevents complement, buttocks. NTSS associated with tampons, β-hemolysis, mannitol vancomycin, VRSA: person enzymes, exotoxins, inflammatory scalded skin syndrome in neonates, bullous salt agar, 7.5% NaCl linezolid, Synercid, response, superantigen: TSST-1, impetigo is localized form. daptomycin enterotoxins, ETA, ETB, exfolatins produce bullae impetigo, M-protein, F-protein and lipoteichoic HONEY CRUSTED LESIONS - involves erysipelas, acid, hyaluronic acid capsule, gram (+), chain normal flora, dermal lymphatics, pain and systemic Streptococcus respiratory cellulitis, streptococcal pyrogenic exotoxins, forming cocci and infected manifestation, necrotizing fascitis "fleshβ-hemolysis penicillin, macrolide pyogenes necrotoxic fasciitis droplets superantigens, streptolysin S + O, diplococci persons eating bacteria", scarlet fever: strawberry - gangrene, scarlet exoenzymes, peptidoglycan + teichoic tongue, diffuse erythematous rash, TSS fever acids blue-green colonies, antipseudomonal pyocyanin, aerobic gram (-) "Hot tub: capsule, biofilm, lipopolysaccharide blue-green pus, grape-like odor, inflamed penicillin Pseudomonas polyverdin, or motile rod, oxidase folliculitis, burn ubiquitous and lipid A, A-B toxin, exoenzymes, follicles from neck down, shallow puncture (carbenicillin) + aeruginosa fluorescein (green), (+) wounds pili wound through tennis shoe sole aminoglycoside fruity aroma, mucoid, (tobramycin) UV light paucibacillary/tuberc uloid: Dapsone + Paucibacillary (tuberculoid) leprosy: central obligate intracellular parasite of rifampin ~6 months. Mycobacterium healing, low infectivity, few rods, DTH to no growth on medium acid fast bacillus Leprosy reservoir: humans macrophages and Schwann cells. Multibacillary/leprom Leprae lepromin. Multibacillary (lepromatous) or tissue culture DAMAGE FROM HOST RESPONSE atous: Dapsone + leprosy: infectious, many rods, (-) lepromin rifampin + clofazimine ~2 years "box car chains" culture: large ubiquitous, zoonotic, lives in vegetative form, dormant spore, cutaneous anthrax: erythematous papule, colonies; NONfluoroquinolones Bacillus anthracis gram (+) rod, spore anthrax soil, causes anthrax in polypeptide capsule, PA, EF, LF black eschar surrounded by edema HEMOLYTIC, (ciprofloxacin) animals and humans M'Fadyean methylene blue stain or DFA WOUND INFECTIONS culture under anaerobic conditions, necrotizing and hemolytic toxins: large gram (+) Iron Milk Medium @ myonecrosis "GAS LECITHINASE ~ PHOSPHOLIPASE marked gas formation, "crepitance in tissue", surgery, amputation, Clostridium rods, spore, strict 45ºC → stormy GANGRENE", ubiquitous in soil, flora C ~ ALPHA TOXIN - splits systemic signs: fever, hemolysis, hypotension, penicillin, hyperbaric perfringens anaerobes, lactose fermentation, blood cellulitis phospholipid molecles., renal failure, shock, death O2 chamber (+) only agar - characteristic enterotoxins, DNase, hyaluronidase double zone of hemolysis
ANAEROBIC GRAM (+)
WOUND INFECTIONS
SKIN INFECTIONS
folliculitis, gram (+) cocci, furuncles, clusters, catalase carbuncles, Staphylococcus human skin (+), coagulase (+), impetigo, scalded aureus and mucosa salt tolerant, skin syndrome, mannitol (+) toxi shock syndrome
Actinomyces (israelii)
gram (+) rods, facultative or strict anaerobes
actinomycosis
part of oral, intestinal and vaginal human flora
low
Page 4 of 15
anaerobic conditions, sulfur granules. long granulomatous lesions, suppurative, branching filaments, abscesses, sulfur granules: YELLOW PUS, slow growth ~2 weeks, dental extraction or trauma white colonies: molar tooth appearance
surgical drainage, penicillin or amoxicillin
ANAEROBIC
BACTERIA
Peptostreptococcus
ANAEROBIC GRAM (-)
WOUND INFECTIONS
ALL BACTERIA CHARACTERISTICS
gram (+) cocci, anaerobic
Bacteroides fragilis, pleomorphic Fusobacterium anaerobic gram (-) nucleatum, rods Prevotella melaninogenica Pasteurella multocida
Bartonella henselae
DISEASE
CLINICAL
Rickettsial Diseases/Rickettsiosis SYSTEMIC INFECTIONS
Rickettsia akari (Spotted fever group)
Rickettsia prowazekii (Typhus group)
small gram(-) rods; take gram staining weakly; obligate INTRACELLULAR pathogens; zoonotic Rickettsia typhi pathogens (Typhus group) Orientia tsutsugamushi (Scrub typhus group)
TREATMENT
mixed, skin and soft-tissue infections
normal human flora
endogenous
flora of animals
animal bites
systemic infection in immunocompromised pts
reservoir: animals
cat scratches, bites, contact with fleas
cutaneous papules or pustules at inoculation site → painful regional lymphadenopathy, Bacillary angiomatosis in IC - pts
rods in lymph nodes, culture usually negative, definitive dx by serologic tests
antibiotics not indicated
wound infections after exposure to contaminated seawater - necrotic cellulitis, gastroenteritis and septicemia after consumption of raw oysters
culture: requires salt for growth media: Thiosulfate citrate bile salts sucrose agar (TCBS), ID biochemical tests
tetracycline (doxycycline)
5-10 days incubation. EARLY: Flu-like symptoms; LATER: petechial-hemorrhagic rash (first on extremities → spread to entire body); various organs failures (2nd & 3rd febrile day). Fever + Rash + Previous tick bite
Clinical presentation + Serologic tests (indirect immunofluorescence assay) (high Ig titers by the 7th day of illness); PCR (most rapid and specific); Immunostaining (70%)
Tetracycline (doxycycline)
cat-scratch disease
found in salt water, oysters
capsule, fimbriae, succinic acid, extracellular enzymes
polar flagella, polysaccharide capsule
illness when native host defenses and anatomical barriers are altered, progress to myonecrosis
SYSTEMIC INFECTIONS
Rickettsia rickettsii (Spotted fever group)
DIAGNOSIS
anaerobic conditions, gram (+) in pairs or brain abscesses, sinusitis, endocarditis, chains, rich media for osteomyelitis, intraabdominal infections, pelvic culture, long infections, skin and soft tissue infections incubation time 5-7 days
part of normal human flora; oral, GI, GU, skin
gram (-) rods, curved, facultative Vibrio vulnificus necrotic cellulitis anaerobe, oxidase (+)
WOUND
VIRULENCE / PATHOGENESIS
infection at normally sterile sites
gram (-) coccobacilli, localized cellulitis small, facultative and lymphadenitis anaerobes gram (-) rods, short, aerobes
RESERVOIR / TRANSMISSION
Tick (Dermacentor), Infect vascular Wild rodents, Mortality: 5-7% Rocky mountain American dog endothelial cells → domestic delayed therapy to (1) induced spotted fever tick (eastern animals 2nd week, ~25% if (April → Sept) US), Rocky Mt endocytosis (2) (dogs), ticks untreated. lysis of wood tick phagosome (western US) membrane phospholipase A (3) replication in host cell Wild rodents, Mouse mite cytoplasm (4) lysis benign, self-limited Rickettsialpox of host cell → rodent mites (transovarian) disease, not fatal vascular damage (hemorrhage, edema), LPS weak endotoxin Epidemic typhus, activity, vasculitis exit: cell lysis Brill-Zinsser Humans; Human body and thrombosis disease flying (around all the Mortality: 10-60% louse (Recrudescent squirrels body). if untreated typhus) IMMUNITY: both humoral and cell mortality rate mediated Endemic typhus Rats Rat flea rare even with important - after (Murine typhus) untreated recovery - solid and lasting Mite larva immunity Rodents, mortality ~30% in Scrub typhus (chigger) rodent mites untreated (transovarian)
Page 5 of 15
Phase1: (~1 wk) local proliferation → eschar at bite site; Phase2: (~3-7d) dissemination → flu-like symptoms + fever + generalized rash (randomly distributed, papulovesicular → eschar, exanthem ~ chicken pox)
anaerobic culture, foul odor
penicillin + broad spectrum
metronidazole, surgery
amoxicillin + βlactam inhibitor
Tetracycline (doxycycline) + chloramphenicol can speed recovery (benign)
(~8d) Flu-like symptoms; maculopapular Clinical presentation + rash (first on trunk → spread to extremities); Tetracycline Serologic tests, complications: myocarditis, CNS (doxycycline) or typhus (indirect dysfunction; Recrudescent typhus = (10-40 fluorescent antibody chloramphenicol, yrs later) endogenous secondary infection by vaccine for high-risk test, latex R. prowazekii persisting in pop agglutination tests). reticuloendothelial cells NO STAIN Tetracycline (1-2 wk) Same as Epidemic typhus but milder; INTRACELLULAR (doxycycline) and rash not always present chloramphenicol (1-3 wks) Necrotizing eschar at bite site; flulike symptoms; maculopapular rash (first on trunk → spread to extremities) + generalized lymphadenopathy
Tetracycline (doxycycline) or chloramphenicol
SYSTEMIC INFECTI
ALL BACTERIA BACTERIA
CHARACTERISTICS
Human Monocytic Ehrlichiosis
Ehrlichia chaffeensis
Ehrlichiosis
DISEASE
Anaplasma phagocytophila
Human Granulocytic Ehrlichiosis
Ehrlichia ewingii
RESERVOIR / TRANSMISSION
Deer, dogs Sheep, cattle, rodents, bisons, deer… Dogs, ticks
VIRULENCE / PATHOGENESIS
CLINICAL
mononuclear leukocytes (monocytes, macrophages)
Infect leukocytes → (1) phagocytosis (2) Similar to RMSF but generally without rash, Inhibition of granulocytes 5-10 days, leukopenia, thrombocytopenia, phagosome(neutrophils > elevated liver enzymes. Severe: prolonged Black legged lysosome fusion + eosinophils) fever, renal failure, disseminated intravascular tick (Ixodes) multiplication in (higher morality ~ coagulopathy, meningoencephalitis, adult cytoplasmic 10%) respiratory distress syndrome, seizures, coma. vacuoles - Morula Mortality ~2-3% same - pts with (3) Host cell + underlying Lone star tick phagosome lyses immunosuppression Lone star tick
Enterobacteriaceae
Infect macrophages=> (1) phagocytosis Sheep, Small gram(-) (2) phagosomegoats, cattle resistant to heat pleomorphic rod; lysosome fusion; (excreted in and drying, intracellular Q. fever; Chronic Inhalation of but bacteria Flu-like symptoms, rarely rash; pneumonia; milk, urine, Proliferation in Coxiella burnetii pathogen with Q fever dust containing survive and hepatitis; endocarditis (Chronic form - 1-20 feces, respiratory tract extracellular (Endocarditis) pathogen multiply inside y, high mortality ~65%) amniotic then dissemination "spore-like" form; acidic fluids and to other organs zoonotic pathogen phagolysosome placenta (3) Host cell + phagolysosome lyses
Yersinia pestis
EMIC INFECTIONS
Francisella tularensis
Gram(-) rod, lactose (-), oxidase (-), catalase (+), coagulase (+), nonmotile, bipolar staining; facultative intracellular pathogen; zoonotic pathogen
DIAGNOSIS
TREATMENT
Clinical presentation + Microscopy: Giemsa stain. (Morulae) + Serologic tests: IFA (high IgM or IgG titers by the 2nd wk of illness), PCR
Tetracycline (doxycycline)
Acute: tetracycline Serologic tests (doxycycline); antigenic variation => Chronic: acute disease: high (doxycycline + titer of phase II quinolones for 4 yrs antigen; chronic or doxycycline + disease: high titers of hydroxyphase I and II chloroquine 1.5 to 3 antigens; PCR yrs), vaccine for high risk pop
Virulence plasmids; Changes in genes expression in response to environmental changes (1) Changes in flea behavior: yersinia murine Bubonic plague: flu-like symptoms; toxin (survival), low T - fibrinolysin & Multiplication of bacteria in regional lymph Serologic tests: direct phospholipase (agglutination); (2) node => suppurative lymphadenitis = "Bubo" immunofluorescence Wild Flea bite; Survival in human body: Capsule (F1 (~70% M untreated); Pneumonic plague: flutest (rapid, presence of Streptomycin, Plague: Bubonic, rodents direct contact; protein), plasminogen activator: like symptoms + cough, bloody sputum, F1); microscopy: gram tetracycline, and Pneumonic & (Sylvanic respiratory prevents opsonization, important for dyspnea and cyanosis (2-3rd day death due to stain or Giemsa chloramphenicol, Septicemic cycle); Urban droplets (only dissemination (3) Damage: Type III septic shock); Septicemic plague: bacteremia bipolar staining, isolation for 72 hours rats (Urban pneumonic secretion system (Yop proteins: without buboes => flu-like symptoms+ culture: highly cycle) plague) Lcr, Ysc) suppress cytokine bleeding into skin and other organs => dark infectious production, cytotoxic effect; discoloration (40% M in treated, 100% in endotoxin (septic shock); untreated) yersiniabactin (obtain iron from host); intracellular grow in reticuloendothelial cells
Small gram(-) rod, aerobe, require cysteine, facultative intracellular Wild animals, Tularemia (rabbit pathogen; zoonotic ticks, deer or deer fly fever) pathogen, oxidase fly (-), urease (-), nonmotile, thin lipid capsule
Infects reticuloendothelial organs: Serologic tests; PCR, Tick or fly bite, Ulceroglandular form: 75% painful ulcerating multiplication in macrophages, gram stain direct contact, lesion at site of infection; Oculoglandular hepatocytes and endothelial cells => unsuccessful, requires inhalation, form: 1% purulent conjunctivitis + necrosis and granuloma production in cysteine-glucose ingestion of lymphadenopathy; also Pneumonic, areas of multiplication; Survival: blood agar - tiny contaminated Gastrointestinal & Septicemic forms (10inhibition of phagosome-lysosome transparent colonies, food or water 15%, more severe). Untreated ~5-30% M fusion; antiphagocytic lipid capsule culture is hazardous
Page 6 of 15
Streptomycin
ALL BACTERIA CHARACTERISTICS
SYSTEMIC INFECTIONS
Small gram(-) rods, strict aerobes, Brucella spp. facultative (abortus, intracellular melitensis, suis) pathogens, zoonotic pathogens, no capsule, no spore
Bartonella quintana
Spirochetes infections
Borrelia burgdorferi
Borrelia recurrentis
other Borrelia spp.
ease - No invasion, no inflammation
Leptospira interrogans
Small gram(-) rod; aerobe, zoonotic pathogen
DISEASE
Brucellosis
Trench fever, bacillary angiomatosis, subacute endocarditis
RESERVOIR / TRANSMISSION
Domestic livestock
Humans, lice
VIRULENCE / PATHOGENESIS
CLINICAL
DIAGNOSIS
TREATMENT
Serologic tests, microscopy: Multiply in Inhibit insensitive, culture: Direct contact, Flu-like symptoms; night sweats (undulant macrophages in phagosomedifficult and hazardous. inhalation, fever); Chronic illness: body aches, headache, reticuloendothelial lysosome fusion; B abortus - needs ingestion of anorexia, depression… few physical findings system => impair cytokine CO2, antigen A, (-) by unpasteurized unless enlargement of reticuloendothelial granulomas => production; dye thionine, B. dairy products organs. (M is low <25) septicemia endotoxin Melitensis - antigen M, B. Suis - (-) by fuchsine
Doxycycline + rifampin (for 6 weeks)
Serologic tests; PCR, fastidious growth requirements, difficult culture, blood of chocolate agar, 5% CO2 with high humidity for 4 weeks
Erythromycin
Contaminated louse feces (scratching)
Prolonged bacteremia, WWI, now amongst homeless, little is known, biopsy of skin does not reveal organisms
4 fever patterns: (1) asymptomatic with 1 episode; (2) 3-5 days single febrile episode; (3) multiple recurrent febrile episodes "5-day fever"; (4) persistent fever for 2-6 weeks.
OspA (in tick), OspC (in Stage1 (localized infect.): erythema migrans mammals); toxic CDC:ELISA or IFA Tetracycline (bull's eye appearance) + flu-like symptoms; LPS; then Western blot, (doxycycline), Spiral morphology, Antigenic Black Stage2 (disseminated infect.): cardiac and Lyme disease Tick bite serologic - later stages, amoxicillin, or large; motile; slow variation - escape downregulation of legged tick neurologic (nerve palsies) abnormalities; immune functions; culture - not rec, OCT - cefuroxime, Vaccine growth; gram(-), immune (Ixodes) Stage3 (persistent infection): fluctuating possible not standardized no longer available zoonotic pathogens, clearance, arthritis. autoimmune hard to isolate in modulation of host response culture, complex immune system nutritional needs, inhibition of flexible mononuclear and Endotoxin (febrile Crushing peptidoglycan cell natural kill cell illness); Recurrent Epidemic Human body Microscopy (during infected louse wall around which Relapsing Fever function, antilouse episodes of fever febrile period) + scratching several axial OspA has + septicemia High fever, headache, muscle pain, weakness. Giemsa or Wright Tetracycline endoflagella are autoimmune separated by 2-4 days between relapses; 2-3 relapse staining; Serologic (doxycycline) or wound activities afebrile periods; cycles; possible myocarditis. tests unhelpful erythromycin new set of (because of antigenic Endemic Tick Tick bite surface antigens variation) Relapsing Fever at each relapse
Spiral morphology; motile; slow growth; gram(-) but not seen on gram stain; zoonotic pathogen, tight terminal hooks
ETEC EnteroToxigenic E. coli
Leptospirosis
Traveler's Diarrhea
Enterobacteriacea e; Motile; lactose(+)
Direct contact with urine, blood or Shed in urine tissues of Multiply in blood and tissues; damage of infected infected endothelium of small blood vessels; animals animals; no virulent factors known Contact with contaminated water
Human's intestine
Fecal-oral
Cfa (colonization factor antigen) adherence; ST (heat stable toxin) guanylate cyclase activation → ↑ [cGMP]; LT (heat labile toxin, AB toxin) - ADP ribosylates G protein → activation of adenylate cyclase → [↑cAMP]; High cGMP or cAMP → hypersecretion of H2O and Cl; ↓ in Na reabsorption
Page 7 of 15
both febrile: Septicemic phase: flu-like symptoms; Immune phase: anicteric form (possible meningitis), icteric form or Weil's disease (jaundice, renal + pulmonary dysfunctions, subconjunctival hemorrhage)
Culture: from blood, CSF during septicemic phase; from urine during immune phase; slow growth, special media, PCR - not widely available. Serologic tests: agglutination test
Watery diarrhea, abdominal cramps
Immunoassays
Penicillin or Doxycycline
Fluoroquinolon es (ciprofloxacin), TMP/SMX
te replacement
BACTERIA
DISEASE
RESERVOIR / TRANSMISSION
Watery diarrhea
Human's intestine
Chronic diarrhea
Human's intestine
Yersinia Enterobacteriacea enterocolitica (Y. e; Bipolar staining; Watery diarrhea, pseudotuberculosi lactose (-), gastroenteritis s - uncommon) zoonotic
Animal's intestine
EAEC EnteroAggregativ e E. coli
Vibrio Cholerae (serogroups O1 and O139)
Curved gram(-) rods; facultative anaerobes, oxidase(+), motile (polar flagella)
Cholera and gastroenteritis
Watery diarrhea
Dysentery
Enterobacteriaceae; Shigella spp. (S. Non-motile; sonnei) lactose(-)
Dysentery, shigellosis (gastroenteritis)
Bfp (Bundle-forming pilus) Fecal-oral, adherence; Type III secretion system LOW in infants → cytoskeleton proteins modification (person-toin host cell; Attaching and effacing person); high in lesions → changes in microvilli → adults malabsorption
CLINICAL
DIAGNOSIS
Watery diarrhea, abdominal cramps (INFANTS)
Immunoassays
Fecal-oral
Bfp (Bundle-forming pili) → autoagglutination "stacked-brick" arrangement + biofilm → malabsorption
Chronic watery diarrhea (in AIDS patients), abdominal cramps, dehydration in infants and children ~ growth retardation
Immunoassays
Fecal-oral
Invade M cells: Yops and Type III secretion system; gene expression under Ca and T control, virulence genes, spread Æ microabscesses in lymph nodes
Watery diarrhea, abdominal cramps, fever; mesenteric lymphadenitis (mimics acute appendicitis) other: arthritis, intra-abdominal abscess, septicemia, osteomyelitis
Stool culture at 25°C
Warm costal Ingestion of water contaminated (marine life) seafood
Human's intestine
Human's intestine
Fecal-oral, LOW → person-toperson transmission
Fecal-oral
Enterotoxin - chloride secretion
Watery diarrhea, abdominal cramps, nausea
Bloody diarrhea with pus, fever, abdominal cramps, nausea
Immunoassays, sorbitol (-), glucuronidase (-)
Bloody diarrhea with pus, fever, abdominal cramps, nausea (first watery then blood mucoid stools)
Hektoen enteric agar: lac(-), H2S(-) → green colonies
Ruffles, invasion, inflammation
Bloody diarrhea with pus, fever, abdominal cramps, nausea
Hektoen enteric agar: lac(-), H2S(+) → blue colonies with dark center
Invasion of intestinal mucosa; virulence factors poorly defined
Bloody diarrhea with pus, fever, abdominal pain; Complications: Guillain-Barre syndrome, Reactive arthritis
Culture (microaerophilic conditions - ↑ T - 42°C, blood or charcoal media)
Invasion of colonic mucosa through M Fecal-oral, cells; Invade basal surface of LOW → enterocytes → cell death + person-toinflammation, focal ulcer; shiga-toxin, person cleaves rRNA - HUS (see above), transmission acid resistant, endotoxin
ingestion of Intestinal Dysentery-like contaminated Enterobacteriaceae; tracts of food (eggs, diarrhea; possible Motile; lactose(-) animals and poultry) or water; bacteremia humans direct contact
Fluoroquinolon es (ciprofloxacin), TMP/SMX Fluoroquinolon es or doxycycline + gentamycin
Self-limiting
Attaching & Effacing lesions (no invasion); Shiga toxin (AB toxin) Culture on MacConkey cleaves rRNA → blocks protein Bloody diarrhea (no leucocytes), abdominal agar (sorbitol(-)); synthesis → cell death; circulating cramps, vomiting; oliguria+renal failure (HUS) Immunoassays shiga toxin can bind to renal tissue → renal failure (HUS) Invasion and destruction of colonic epithelium, virulent plnv genes, INACTIVATE RIBOSOMAL SUBUNITS
Fluoroquinolon es (ciprofloxacin), TMP/SMX
Ciprofloxacin or doxycycline
TCBS - blue-green colonies; Halophilic
Fecal-oral;
Salmonella enterica (enteritidis & typhimurium)
TREATMENT
Tcp (toxin coregulated pilus) adherence; Ctx (cholera toxin, ABWarm costal Ingestion of TCBS (Thiosulfate toxin, on lysogenic CTXФ phage) water, contaminated Profuse watery diarrhea; "rice-water" stools; citrate bile salts ADP ribosylates G protein → constant asymptomati water or severe dehydration → hypovolemic shock sucrose agar) - yellow activation of adenylate cyclase → c carriers shellfish colonies ↑cAMP → hypersecretion of H2O and Cl; decrease in Na reabsorption
EHEC Enterobacteriaceae; Hemorrhagic EnteroHemorrhag Motile; lactose(+), Colitis; Hemolytic Intestine of ic E. coli sorbitol(-) Uremic Syndrome cattle (O157:H7) "spinach outbreak" (HUS) EIEC Enterobacteriaceae; EnteroInvasive E. Motile; lactose(+) coli
VIRULENCE / PATHOGENESIS
Fluid+electrolyte replacement
EPEC EnteroPathogenic E. coli
CHARACTERISTICS
Enterobacteriacea e; Motile; lactose(+)
Antibiotic therapy not recommended; dialysis in HUS cases
Fluid + electrolyte replacement
Watery Diarrhea - Small intestine disease - No invasion, no inflammatio
BACTERIA
Vibrio parahaemolyticus
Watery to Bloody Diarrhea - Large Intestine
GI INFECTIONS
ALL BACTERIA
Fluoroquinolon es (ciprofloxacin), TMP/SMX Fluoroquinolon es (ciprofloxacin), TMP/SMX
Fluoroquinolon es (ciprofloxacin), TMP/SMX
with reptiles
Campylobacter jejuni
Thin gram(-) rods; spiral shape; microaerophile; oxydase(+),
Dysentery-like diarrhea
Animal's intestine
Fecal-oral; ingestion of contaminated food (poultry), milk or water; direct contact with pets, LOW
Page 8 of 15
Fluoroquinolon es (ciprofloxacin) or erythromycin
ALL BACTERIA BACTERIA
Salmonella typhi
Helicobacter pylori
Enterobacteriaceae;
Non-motile; lactose(-)
DISEASE
Typhoid fever
Gram(+) rods, motile; spore forming
Emetic gastroenteritis
Ubiquitous
VIRULENCE / PATHOGENESIS
CLINICAL
DIAGNOSIS
Invasion of M cells; Multiply in Fecal-oral; macrophages; bacteremia and Sustained fever and headache; possible rash Culture from blood or Mod-low invasion of RES (mesenteric lymph and/or diarrhea; persistent bacteremia → feces, Hektoen enteric (possible node, liver, spleen); infection of myocarditis, encephalopathy…constipation agar: → blue colonies person-togallbladder (carrier state); Capsule (Vi more common, diarrhea = late in disease with dark center person trans) polysaccharide); endotoxin
Fecal-oral; oral-oral
Mucous layer invasion (Mucinase, phospholipase, flagella) + Alteration of gastric acid production (urease -> ammonium production) → Inflammation of gastric mucosa → Tissue destruction
Ingestion of preformed toxin (rice)
Heat-stable enterotoxin (if spore Onset <6h after ingestion - Vomiting, nausea, survive cooking → germination + toxin abdominal cramps production in non-refrigerated food)
Biopsy=> microscopy, culture, urease test; Stool antigen test; Urea breath test; PCR
TREATMENT
Fluoroquinolones (ciprofloxacin), TMP/SMX
Proton pump inhibitor + clarithromycin + amoxicillin or metronidazole
Isolation of organism Self-limiting; Fluid + from implicated food, electrolyte β-hemolysis on blood replacement agar
Ingestion of Heat-labile enterotoxin (germination food Incubation time >6h - Watery diarrhea, of spore + toxin production in contaminated nausea, abdominal cramps intestinal tract) with spore Ingestion of Gram(+) cocci in preformed Heat stable enterotoxin → acute Isolation of toxin Self-limiting; Fluid + Staphylococcus Staphylococcal Normal Onset <6h after ingestion - Vomiting, nausea, cluster, catalase(+); toxin (potato inflammation of gastric mucosa, small producing bacteria electrolyte aureus food poisoning human flora abdominal cramps and watery diarrhea coagulase(+) salad, intestine (mannitol salt agar) replacement custard…) Exposure to antibiotics → AntibioticVegetative overgrowth of C. difficile associated Watery diarrhea form: human (endogenous); Toxin A Immunoassays (toxins diarrhea carrier; Discontinue Endogenous Enterotoxin: disrupts tight junctions detection); difficile Spore in implicated antibiotic; infection between enterocytes + induces colonoscopy Antibioticenvironment vancomycin inflammation → watery diarrhea; (pseudomembrane) associated (hospital Profuse diarrhea, abdominal cramps, fever Toxin B - cytotoxin: modification of pseudomembrano rooms) enterocyte cytoskeleton → cell death us colitis Large gram(+) Enterotoxin: alteration of membrane Watery diarrhea Watery diarrhea + abdominal cramps Self-limiting Ingestion of rods; Spore permeability in enterocytes Clostridium Soil and Culture; Immunoassay spore or forming; Strict perfringens human colon Necrotizing Bloody diarrhea; abdominal pain; vomiting, (enterotoxin detection) β-toxin (lethal toxin): necrotizing bacteria anaerobes Penicillin enteritis peritonitis destruction of jejunum Diarrheal gastroenteritis
Ubiquitous
Botulism, neuromuscular paralysis
Spores in soil and dust
lancet-shaped, gram (+) cocci, chain or diplo, catalase (-)
pneumococcal meningitis in adults
Weakness, dizziness, then neurological Botulinum toxin=AB neurotoxin → features: blurred vision, drooping eyelids… blocks release of acetylcholine from Clinical respiratory paralysis. THREE Ds: DIPLOPIA, peripheral nerves → flaccid paralysis trivalent botulinum DYSPHAGIA, DYSPHONIA Antitoxin Ingestion of Germination of spores in colon → Spores in soil Clinical + C. botulinum spore (honey), multiplication of vegetative form → "floppy baby" and dust found in feces LOW neurotoxin production
throat & nasopharynx
Ingestion of preformed toxin, LOW
person-toperson via respiratory droplets
nasopharynx → infection of lung or eustachian tube → inflammation or OM → bacteremia, meningitis. Polysaccharide capsule: antiphagotic, pneumolysin: transmembrane pore-forming toxin, IgA protease, others: teichoic acid, peptidoglycan fragment, hydrogen peroxide
Page 9 of 15
acute onset, complications: mental retardation, learning disabilities, deafness WBCs, ↑proteins, ↓glucose
Clostridium botulinum
Streptococcus pneumoniae
Bacterial Meningitis
Humans only
Gram(-) rods; bacillary or spiral Gastritis, peptic Stomach of shape; ulcer, gastric humans and microaerophile; adenocarcinoma, animals oxydase(+); urease lymphomas (+)
Infant botulism
CNS INFECTIONS
RESERVOIR / TRANSMISSION
Infants: slow-appearing, irritable, vomiting, or poor feeding
Clostridium spp & GI infections
GI INFECTIONS
Bacillus cereus
CHARACTERISTICS
gram stain: WBCs + gram(+) cocci, Culture: mucoid, α-hemolytic, Optochin sensitive, bacitracin resistant, bile solubility (+), capsule (+) quellung
vancomycin + 3rd gen cephalosporin (ceftriaxone or cefotaxime), Prompt txt of OM and respiratory infections. VACCINES: 7valent conjugated vaccine, 23-valent polysaccharide vaccine.
aerobic gram (-) diplococci, polysaccharide capsule (A, B, C, Y, W135), flattened adjacent sides
gram (+) cocci in short chains, βhemolytic or Streptococcus nonhemolytic, agalactiae (Group group B lancefield B hemolytic capsular antigen, streptococcus) bile resistant, polysaccharide capsule E. coli
RESERVOIR / TRANSMISSION
Listeria monocytogenes
gram (+) rods, catalase (+), βhemolysis
Mycobacterium tuberculosis
obligate aerobe, rod shaped, facultative intracellular pathogen, acid-fast bacteria
initial infection of upper resp tract → attachment to non-ciliated cells of nasopharynx: pili, IgA protease (colonization), capsule → invasion into bloodstream → brain. Diffuse vascular damage: endotoxins (LPS, LOS)
nasopharynx
Haemophilus meningitis and sepsis
direct contact nasopharynx → invasion → with respiratory bacteremia → CNS. Pili, IgA human droplets. Risk: protease, polysaccharide capsule: nasopharynx infants - young type-b: poly-ribitol-phosphate, children endotoxin (LPS) - inflammation
meningitis in neonates
GI tract, vagina
respiratory droplets
VIRULENCE / PATHOGENESIS
meningococcal meningitis
capsule rich in sialic acid, peptidase infection - inactivates C5a, hydrolytic enzymes during delivery, nosocomial transmission
gram (-) rod, K1 polysaccharide capsule
Other
CNS INFECTIONS
Bacterial Meningitis in Neonates
gram (-) Haemophilus pleomorphic influenzae type b coccobacillus, capsule serovar b
DISEASE
CLINICAL
hemorrhagic skin rash (petechiae). Waterhouse-Friderichsen syndrome (ADRENALS), complications: 11-19% permanent hearing loss, mental retardation, etc
nonspecific: fever, feeding difficulty, vomiting, diarrhea, respiratory distress, irritability alternating with lethargy
Bacteremia: occult, proliferate in placenta. ingestion of pathogenic serotypes have unique Neonatal: early onset sepsis host-dependent: contaminated teichoic acid, facultative intracellular "granulomatosis infantisepticum", late-onset intestine of listerosis, sepsis, food, pathogen: growth in cells, internalins: meningitis: via vaginal transmission. CNS: animals and meningitis, fetal transplacental attachment and entry, listeriolysin O: meningitis, encephalitis, brain abscess in humans loss , during pore-forming exotoxin, ActA: actin 10%. Febrile gastroenteritis (IC+), (IC- and delivery polymerization: motile comet tails old: sepsis and meningitis, pregnant: flu-like illness, fetal loss.
tuberculous meningitis
Inhalation of infectious aerosols
Mycolic acid, sulfolipids, cord factor, tuberculin + mycolic acid
Page 10 of 15
gradual onset (weeks), malaise, apathy, anorexia → brain abscesses, spinal TB
DIAGNOSIS
TREATMENT
cefotaxime or ceftriaxone (10-15% gram stain of CSF, fatal, 100% if culture: Thayeruntreated), Martin agar (mod antimicrobial chocolate agar) + chemoprophylaxis: 5% CO2. rifampin or MALTOSE & ciprofloxacin, GLUCOSE (+) VACCINES: MPSV4, MCV4 culture: chocolate agar, X and V cefotaxime or factors, gram (-) ceftriaxone, Hib coccobacilli or conjugate vaccine. rods. Antigen Rifampin prophylaxis detection, latex test
initially: runny nose, low grade fever, HA, complications: 20% - hearing loss, delayed language development or mental retardation
capsule (sialic acid, ~ meningococcus), pili
reservoir infected humans.
CSF: WBCs, ↑proteins, ↓glucose
Neisseria meningitidis
CHARACTERISTICS
CAMP test
BACTERIA
high fever, HA, stiff neck. Infants: slow-appearing, irritabl poor feeding
Bacterial Meningitis
CNS INFECTIONS
ALL BACTERIA
PCR, latex particle agglutination test of urine: rapid, antiviral (acyclovir) CSF and blood + antibacterial cultures, CSF: (ampicillin + difficult in cefotaxime) neonates. Bacterial culture from mother.
broad T range, motile at 25˚C "TUMBLING", nonmotile at 37˚C, microscopy - wet mount, culture: blood agar, β-hemolytic, CSF: pleocytosis, ↑ protein, ↓ glucose
ampicillin + gentamicin
CXR, PPD skin test, ACTIVE: combo: Ziehl-Neelsen stain = isoniazid, rifampin acid fast stain. Culture (4m), pyrazinamide confirms dx. (2m), ethambutol. Lowenstein-Jensen LATENT: isoniazid. medium = lipid rich
CNS I
ALL BACTERIA
Clostridium Spp
BACTERIA
gram (+) rods, strict anaerobes, no capsule, motile, Clostridium tetani spore-forming drumstick appearance
Clostridium botulinum
Bacterial Conjunctivitis: purulent discharge, conjunctival hyperemia
Streptococcus pneumoniae
EYE INFECTIONS
CHARACTERISTICS
gram (+) rods, fastidious, spore forming, strict anaerobes
DISEASE
tetanus: generalized, localized, cephalic, neonatal
botulism: foodborne, infant, wound, neuroparalytic illness
RESERVOIR / TRANSMISSION
spores survive spore, botulinum toxin: heat labile sterilizing AB-neurotoxins, blocks release of Ach soil, process and from peripheral nerves → flaccid contaminate improper paralysis, type A most significant in d foods canning US, highly toxic. Path: ingestion of procedures preformed toxin
gram (+) diplococci or chains, catalase (-)
Hemophilus influenzae
gram (-) pleomorphic rod
Staphylococcus aureus
gram (+) cocci, clusters, catalase (+), coagulase (+)
VIRULENCE / PATHOGENESIS
polysaccharide capsule, autolysin, pneumolysin O Acute Bacterial Conjunctivitis
CLINICAL
spore: survival in environment, tetanolysin (not sig), enter body via tetanospasmin: heat labile AB wound, neurotoxin, blocks release of developing inhibitory NTs (GLYCINE)→ severe painful spasms and rigidity of voluntary countries: nonspores: constant contraction (spasms), muscles, early = lockjaw, exg reflexes, sterile ubiquitous highly toxic. Anaerobic conditions muscle rigidity → apnea, fractures, techniques, → germination of spores, local dislocations, death from respiratory failure umbilical stump bacterial multiplication, toxin → neonatal production → enters nervous tetanus system peripherally → carried to CNS
Direct contact
pili, lipopolysaccharides, IgAspecific protease, polysaccharide capsule protein A (inhibits phagocytosis), fibrinogen-binding protein (clumping factor), coagulase, cytotoxic toxins
weakness, dizziness, dryness of mouth (N and V), neuro: B/L flaccid paralysis and motor and autonomic nerves, blurred/double vision, drooping eyelids, difficulty swallowing, speech, descending weakness, respiratory paralysis
DIAGNOSIS
TREATMENT
clinical
neutralization of unbound toxins (toxin binding is irreversible), supportive, metronidazole to eliminate bacteria in wound, Vaccine
mainly clinical, mouse bioassay
trivalent botulinum antitoxin (A, B, E), respiratory support, elimination of bacteria: gastric lavage, metronidazole or PNC
α-hemolytic on blood agar - large mucoid colonies, Optochin sensitive, bacitracin resistant, bile soluble
Empiric txt w/ burning, irritation, tearing, mucopurulent topical antibiotics, chocolate agar (X & V discharge Gati/levo/ factors) moxifloxacin β-hemolysis, mannitolsalt agar, yellow colones
Trachoma: leading cause of blindness in world, mostly children, ~ poor hygiene. Chronic, inflam granulomatous dz of eye surface → corneal ulceration, scarring, pannus formation → blindness Direct contact/newborn via birth canal from conjunctival fluid → tropism for epithelial cells of or surface scrapings; conjunctiva; intracellular pathogen gram stain/culture; (evades host defense, killing host immunocell); LPS (inflammation) → severe fluorescence, inflam response → necrosis, cytologic exam (I) Adult: acute infections --> mucopurulent d/c, fibrosis, scarring infiltrates, corneal scarring in chronic form; ocular-genital contact, sexually active - preceded by genital infection. acquired from infected mom Newborn: swelling of eyelids, copious purulent d/c
trachoma, Direct contact; hand to eye, urogenital contaminated clothing, infections (Sero Aflies C)
Chlamydia trachomatis
small obligate INTRACELLULAR, no PG layer; elementary & reticulate bodies
inclusion conjunctivitis (sero D-K)
lymphogranuloma venereum (sero L1 - L3)
Page 11 of 15
azithromycin or doxycycline, erythromycin (newborn).
BACTERIA
Other Eye Infections
Neisseria gonorrhoeae
CHARACTERISTICS
Aerobic gram (-) diplococci, beanshaped, no capsule, facultative intracellular
Pseudomonas aeruginosa (gram (-) rod) Contact lens-related Acanthamoeba spp.
DISEASE
RESERVOIR / TRANSMISSION
Gonococcal ophthalmia neonatorum
DIAGNOSIS
TREATMENT
ceftriaxone; Neonatorum prophylaxis: silver nitrate or erythromycin or tetracycline
keratitis
immunocompromised Ocular toxocariasis - retinal detachment River blindness, sclerosing keratitis, chorioretinitis African eye worm
Gonorrhea
Aerobic gram (-) diplococci, beanshaped, no capsule, facultative intracellular
PID Rectal & Pharyngeal ophthalmia neonatorum
Transmissio n
F: Cervix, ~50% asymptomatic, Untreated → PID, ectopic pregnancy, salpingitis. M: Urethra, ~25% asymptomatic, purulent strict human pathogen, urethral discharge and dysuria, Untreated pili: adhesion, sexual or intimate contact → epididymitis, prostatitis, periurethral inhibit gram smear from abscesses. Both untreated → infertility, phagocytosis. genital site in disseminated infection, anorectal infection, OMPs (outer Attachment and cytoplasm of membrane invasion of non pharyngitis, conjunctivitis and dissemination neutrophils, sensitivity third generation proteins): ciliated epithelial spread of organisms along fever, lower abdominal pain, and specificity: 95% in cephalosporins fallopian tubes (salpingitis), serotyping, Opa cells → survival complications: infertility or ectopic M, 50% in W, nucleic (ceftriaxone), proteins in submucosa → pelvic cavity (peritonitis, pregnancy due to scarring of fallopian acid amplification resistance to first adherence, spread and abscesses) tubes tests, culture: line drugs (also antigenic variation, dissemination Thayer-Martin agar treat chlamydia) both usually asymptomatic, tenesmus, PorB prevent (inflammation and linked to sexual practice (chocolate, antibiotics discharge, rectal bleeding, sore throat phagolysosome local damage) to normal flora, 35°C + fusion, IgA CO2) acute purulent conjunctivitis, lid edema, protease, LPS acquired at birth erythema, parked purulent discharge and LOS
disseminated gonococcal infections
Chlamydia trachomatis (all biovars but L)
CLINICAL
bacterial keratitis, scleral abscess, endophthalmitis
Toxocara canis Onchocerca volvulus Loaloa
Neisseria gonorrhoeae
VIRULENCE / PATHOGENESIS
at birth from infected mom → attach & invade epithelial cells; Pili + from conjunctival fluid PorB/Opa (adhesion/protection); IgA or surface scrapings; protease (colonization); Antigenic acute purulent conjunctivitis acquired at birth: gram stain/culture; variations → escape immune lid edema, erythema, marked purulent d/c Thayer-Martin agar, surveillance; LPS & LOS GLUCOSE (+) (inflammation); no capsule → severe inflammatory response
Fungal infections
Urethritis and Cervicitis, PID
EY
Bacterial Conj
ALL BACTERIA
D-K: urogenital infections (noninvasive), AC: trachoma. Other: inclusion conjunctivitis, small obligate INTRACELLULAR, infant pneumonia no PG layer; elementary & reticulate bodies
generally in women, leading cause of purulent arthritis, large necrotic gray skin lesions
close personal contact
EB: infectious, outside, nonreproductive, RB: noninfectious, intracytoplasmic, reproductive form. Intracellular replication, no phagolysosome fusion, LPS
spread by direct contact → tropism for epithelial cells 3.3 F (15-19) > M. F: 70% asymptomatic, (F: endocervix, cervicitis ± urethritis: mucopurulent upper genital tract discharge ± dysuria. Complications: PID in; both: urethra, (40% untreated), permanent damage → rectum, chronic pelvic pain, infertility, and ectopic conjunctiva) → pregnancy. M: 25% asymptomatic, infection, severe urethritis: dysuria + thin urethral discharge, inflammatory complications: rare, spread to epididymis → response → pain, fever, and sterility necrosis, fibrosis, scarring
Page 12 of 15
collection of epithelial cells, direct azithromycin or immunofluorescence: doxycycline. Ebs are bright yellow Pregnant and young green dots under UV, children: NAAT (urine), enzyme erythromycin. immunoassay, Follow-up: repeat culture: iodine staining testing (NAAT) 3 of glycogen inclusion months bodies - dark brown
BACTERIA
small obligate INTRACELLULAR, no PG layer; elementary & reticulate bodies CHARACTERISTICS
Chlamydia trachomatis (L biovar)
DISEASE
L: Lymphogranuloma venereum
small, pleomorphic, gram (-) rods
Chancroid
Syphilis Treponema pallidum
thin, tightly coiled spirochetes, not intracellular
STDs
Genital Ulcers
Haemophilus ducreyi
ALL BACTERIA
Congenital Syphilis
Klebsiella granulomatis
Vaginal Discharge
Trichomas vaginalis
intracellular encapsulated gram (-) bacillus
protozoa flagellate
round/oval budding yeasts, polymorphic: y, Candida albicans hyphae, and pseudohyphae
Granuloma inguinale or Donovanosis
RESERVOIR / TRANSMISSION
sexual
VIRULENCE / PATHOGENESIS
CLINICAL
L-serovar are invasive → travels via lymphatics, multiply w/n mononuclear phagocytes in regional lymph nodes, characteristic granuloma formation → necrotic lesions, inflammation spread to surrounding tissues
small painless ulcer at site of infection, spontaneously heals. Second stage: inguinal adenopathy, painful buboes → draining fistulas.
tender papule with erythematous base → painful ulceration with associated inguinal lymphadenopathy. F: often asymptomatic, often diagnosed in men
sexual contact
Primary: 1+ chancres at infection site, lots of spirochetes → painless ulcer, heals local primary spontaneously w/n 2 months, pt highly infection: skin or infections. Secondary: dissemination: fluouter membrane mucosal → slow only host = humans, like syndrome, lymphadenopathy, proteins: multiplication, susceptible to heat, drying generalized mucocutaneous adherence, endarteritis & and disinfectants, requires hyaluronidase: maculopapular rash, 1/3 → condylomata granulomas. close contact lata, highly infectious, resolve perivascular Dissemination spontaneously → latent stage (clinically infiltration, (lymph nodes and inactive). Tertiary: diffuse, chronic antigenically blood), quiescent unreactive. for months to inflammation → neurosyphilis, CV syphilis, gummas Tissue damage = years, late patient's immune syphilis: injury response due to prolonged intrauterine death, congenital hypersensitivity abnormalities, silent infections, most: born transplacental responses with rhinitis followed by rash
granulomatous ulcers that bleed on contact, inguinal lesions (10-15%)
sexual contact
F: frequently symptomatic → vaginitis, replicates by axostyle: purulent discharge, copious, foamy, foulbinary fission, attachment, smelling yellowish, vulvar and cervical only trophozoite sexual contact, humans only contact-dependent lesions, dysuria, itching. Pregnant: premature Trichomoniasis form, no cyst, host damage to rupture of membranes, preterm delivery, does not survive epithelium, not low birthweight. M: rarely symptomatic, in external invasive mild urethritis, mild discharge, slight burning environment after urination or ejaculation, ~ prostatitis
Vulvovaginal Candidiasis
normal oropharyngeal, GI, genital flora, endogenous or direct contact
mannoproteins: adherence, resistance F: pruritus and erythema of vulvar area, thick to phagocytosis, hyphae secrete cheesy vaginal discharge, itching of vulva. proteinases and phospholipases (kill M: 10% - balanitis: inflammation of glans epithelial cells, tissue penetration) penis, itchy rash on penis, rare: urethritis
Page 13 of 15
immunofluorescence: doxycycline. Ebs are bright yellow Pregnant and young green dots under UV, children: NAAT (urine), enzyme erythromycin. immunoassay, Follow-up: repeat DIAGNOSIS TREATMENT culture: iodine staining testing (NAAT) 3 of glycogen inclusion months bodies - dark brown
clinical, microscopy, DNA probe, culture: relatively insensitive, require x factor for growth
azithromycin, ceftriaxone, ciprofloxacin, or erythromycin
culture: no growth on artificial media, microscopy: darkfield microscopy (live motile bacteria), direct fluorescence antibody test, silver staining. Serology: nonspecific penicillin (cardiolipin, VDRL, RPR, measure IgG and IgM from damaged cells), specific (confirmation, FTAABS test, MHA-TP), enzyme immunoassays Wright or Giemsa stained: clusters or encapsulated coccobacilli in Doxycycline cytoplasm of mononuclear cells "Donovan bodies" vaginal, urethral, prostatic secretions: microscopy: wet mounts (motile), metronidazole or Giemsa stained, direct tinidazole (txt immunofluorescence partners, do not use antibody staining, during 1st trimester) Culture: most sensitive, diamond's medium, anaerobic, pH 5.5-6 (3-7 days) from discharge, microscopy: KOH: budding years and oral fluconazole, pseudohyphae, topical azole or culture: Sabouraud or nystatin, not blood agar, large recommended to smooth white colonies: treat sex partners rapid growth, "germtubes" formation after 2 hr
Vagi
ALL BACTERIA BACTERIA
Gardnerella vaginalis
CHARACTERISTICS
gram-variable rods, facultative anaerobes
DISEASE
RESERVOIR / TRANSMISSION
Bacterial vaginosis
VIRULENCE / PATHOGENESIS
CLINICAL
DIAGNOSIS
TREATMENT
shift in vaginal flora, lactobacillus spp replaced, increase risk: anything that can upset normal balance of bacteria
"non-specific vaginitis" ,white or gray vaginal discharge with unpleasant odor, dysuria, itching, or asymptomatic. Complications: PID, preterm delivery, low birthweight, increased susceptibility to HIV, STDs
white discharge, microscopy: clue cells, absence of lactobacilli, vaginal pH > 4.5, "whiff" test after adding KOH
metronidazole
Mycoplasma hominis
sexual contact
postabortal or postpartum fever, PID ~ fallopian tubes infection, self-limiting
Ureaplasma ureolyticum
sexual contact
F: chorioamnionitis and postpartum fever, M: non-gonococcal, non-chlamydial urethritis
urease production (distinguish from mycoplasma)
erythromycin or tetracyclines
intense itching and redness, bumps, blisters, and crusting
rash, burrows, isolation of mites, ova or feces in skin scrapings
topical permethrin (5%), wash everything, treat everyone
Sarcoptes scabiei
Phthirus pubis
human itch mite arthropod
genital scabies
insect
pediculosis pubis, lice or "crabs"
close - sexual contact
sexual
adult mites risk of 2nd create burrow in bacterial infection, upper layer of Norwegian epidermis, female scabies - more lay eggs in skin severe form burrow
Nit - egg, hard to see, attached to feeds on human hair, nymph itching in genital area, visible nits or crawling blood and baby louse, adult lice multiplies rapidly females lay nits, larger than males
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special media - large tetracycline (resistant fried-egg colonies to erythromycin)
lice-killing shampoo (pediculicide) 1% permethrin or pyrethrin
ALL BACTERIA BACTERIEAL RESPIRATORY INFECTIONS BACTERIA Sinusitis & Otitis Pharyngitis Epiglottis Media Streptococcus Streptococcus Haemonphilus pyogenes (strep Pneumoniae influenzae throat) Corynebacterium Haemonphilus diphtheriae influenzae (diphtheria) Moraxella catarrhalis
Pertussis Bordetella pertussis
Bronchitis
Tuberculosis
Streptococcus Pneumoniae Haemonphilus influenzae Mycoplasma pneumoniae
Mycobacterium tuberculosis
Pneumonia Streptococcus Pneumoniae Haemonphilus influenzae Staphylococcus aureus Klebsiella pneumoniae Chlamydophil pneumoniae & psittaci Mycoplasma pneumoniae Legionella pneumonia Pseudomonas aeruginosa Pulmonary Anthrax Bacillus anthracis
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