Microbiology Step 1 weird exceptions and forgotten detail Introduction Prokaryotes: have a nucleoid instead of a nucleus Mycoplasma has cholesterol in membrane and no peptidoglycan Cant gram stain it and beta-lactams beta- lactams don’t work (so use macrolides) o o Cholesterol needed to grow it Fungi have ergosterol except PCP ( therefore need to use TMP/SMX trimethoprim/ sulfamethoxazole ) PCP visualized by SILVER STAIN o Polycistronic DNA only bacteria and viruses o One mRNA carry many proteins (have multiple SHINE DELGARNO sequences) Sterile organs (detection any organism= pathological) o Blood o CSF Stomach o Candida is normally present in the mouth, when decreased immune it over grows and causes oral thrush Breast fed only= bifidobacterium ( BB= breastfed baby) Pathogenicity Antigenic Variation o N.gonorrhea pili o Trypanosome brucie (African sleeping sickness) Enterobacteriaceae: capsular and flagellar antigen o o HIV : antigenic drift of gp120 IgA protease : SHiN Strep pyogenes M protein = degrade C3b Survive intracellular o TB : sulfatides prevent sulfatides prevent fusion phago and lysosome o Listeria: listerolysin O escape phagosome Physical damage o Entamoeba histolytica: ulceration intestine and liver abscess o Cysticerosis causes brain lesions seizure Endotoxins LPS = Gram negative (LIPID ( LIPID A toxic A toxic potion) T cell independent antigen o o Causes release of cytokines IL-1 IL-6 TNF-alpha o Leads to SEPSIS (septic shock)
o
* works the same mechanism as superantigen from Straph aureus and strep pyogenes = high cytokines they activate many CD4 T cells = polyclonal activation T cells sunburn rash and involves palms and soles
Exotoxins Protein synthesis o EF2 ADP ribosylation(stops translation): C.dipthernia, Pseudomonas aueriginosa o 28S of the 60S ribosome : Shigella, EHEC Neurotoxin: by inhibit release NT o C.tetani: prevent release glycine and GABA o C.botulinum: prevent release Ach Superantigen: staph aureus and strep pyogenes CAΣP : cholera, anthrax, Ecoli ETEC, Pertusis o CAΣ: work via Gs o P works via Gi Cytolysins: ALPHA TOXIN o Clostridium perfringens: lecithinase = GAS gangrene Straph aureus: cell membrane leaky o
Bacteria Structure Cell wall protect from osmotic damage (peptidoglycan) o Therefore penicillin will break this down Capsule protects (only removed by OPSINIZATION) o Bacillus anthracis made from polyglutamate can activate T cell Spores: bacillus and clostridium o Diplicolinic acid, calcium dipicolinate , keratin o Spores are made in the stationary phase when birth=death Growth on medias Thioglycolate : anerobes “ cant breath air” : clostridium, bacterioides, actinomyces Chocolate agar o Neisseria ( Thayer-Martin, VNP : vancomycin, colistin, nystatin) Haemophilus influenza. * also grows SATELLITE colony with Staph o aureus Need vactors X and V ( protoporphyrin and NAD) Atypical pneumonia ( all don’t stain with gram) o Mycoplasma pneumonia = grows MALBURY colony on sterol agar o Legionella: grows on cysteine and iron o Chlamydia : intracellular Oxygen special Anerobes: “cant breath air” = clostridium. Bacteroides, actinomycin
Obligate aerobes: mycobacterium, Nocardia, and pseudomonas aeruginosa, bacillus Microaerophil: campylobacter and Helicobacter o They will say “SPECIAL INCUBATOR”
Stains
Acid fast : cryptosporidium Gomori’s methamine silver stain = PCP Auramine rhodamine fluorescent dye: TB Don’t stain with GRAM 1. Mycobacteria due to waxy cell wall 2. Spirochetes thin 3. Chlamydia and rickettsia intracell 4. Legionella (use silver) Top nosocomial infections 1. Staph aureus : IV, skin, 2. Pseudomonas * ventilator DTP : all TOXOID VACCINE (toxin inactivated by formaldehyde) SHiN: strep pneumonia, Haemophilus influenza, Neisseria meningitides All have capsule, and VACCINE that is conjugated to protein (diphtheria toxoid) IgA proteinase Transformation takes up material from outside Latex agglutination Latex agglutination Strep pneumonia Neisseria meningitides Hemophilus infuelnzae Cryptococcus Granulomas Listeria ( also only Gram + with LPS)
Gram Positive cocci
Strep agalactiae : CAMP test + HIppucrate Staph aureus o Coagulase forms abscess bc fibrinogen fibrin Yersinia other who has coagulase o Scalded skin syndrome : epidermis peal (exfoliative toxin) Nikolski + o Draining sinus from osteomyelitis predispose to squamous cell cancer o ACUTE ENDOCARDITIS (HIGH fever, fatigue, murmer) Subacute: splinter hemorrhage, osler nodes, roth spots, weighloss, night sweats
Treatment 1. Nafcillin and oxacillin 2. MRSA: vancomycin 3. VISA and VRSA: quinupristin, linezolin, streptogramin, daptomycin Strep pneumonia o Serotype via capsule Strep Pneumonia : #1 MOPS ( meningitis, otitis media, Pneumonia, o sinusitis) RUSTY sputum, with consolidation whole lobe, or whole lung o Strep pyogenes o Serotype via M protein M12 = glomerulonephritis o PYR + (pyrrolidonyl arylamidase) o ASO + ( streptolysin O) o DNAse B Streptokinase ( break down clots) o Enterococcus Subacute endocarditis after GI or GU procedure (Transurethral o resection, colonoscopy) o
Gram Positive rods Bacillus anthracis “ boxcar large gram Wool sorter disease ( animals) + postal worker (bioterrorism) Skin: MALIGNANT pustules= central eschar(black) and red border Pneumonia: mediastial widening, dyspnea and FACIAL EDEMA Clostridium tetani and botulinum Both PREVENT THE RELEASE of NT (damage the SNARE protein) Tetanus Spores germinate in tissues Treatment if symptomatic or no vaccine= Ig + metronidazole(anaerobe) + diazepam for spasm Tetanus prone If didn’t get primary vaccination or unknown: vaccine + Ig o If had vaccine : give vaccine if booster was 5 years ago o Perfringens Stormy fermentation for milk + double zone hemolysis Crepitus ALPHA toxin/ phospholipase C = lecithinase Identify on EGG YOLK agar Hyperbaric chamber after debridement and clindamycin bc its anerobic therefore die from high O2 Difficile
Autoclave things to kill spores If rxn need 1. Stop antibiotic 2. Give metronidazole 3. Give vancomycin 4. Remove infected tissue Listeria PREGNANT AND HIV DON’T EAT SOFT CHEESE OR DELI Causes spontaneous abortion Granulomatosis infantisepticum Tumbling motility + facultative intracellular + cold grow Corynebacterium diphtheria Club shaped, chinese letter Phage carried toxin ( EF2 ADP ribosylation= stop elongation translation) Myocarditis , ECG change, hoarsness of voice (recurrent laryngeal) Tinsdale/ tellurite agar Elek test= toxin Loeffler serum Nocardia 1. Asteroides: causes pulomary like TB mimicks it 2. Brasiliensis = cutaneous only Mycobacteria TB Produces B3= niacin Pathogenesis o Sulfatides: prevent fusion phago and lysosome o Cord factor= serpentile growth , inhibit WBC migration Correlates with virulence Tuberculin :surface protein + mycolic cause PPD o Zone of induration = MEANS EXPOSED (not diseased) 5mm : HIV or recent exposure o o 15 mm : normal people Mycobacteria leprae: Tuberculoid = Lepromin + test, granuloma, Th1, little acid fast Leptromatous: test -, Th2, many acid fast
Gram Negative Facultative intracell Legionella Francisella - granulomatous Brucella- granulomatous Rifampin prophylactic exposure N.meningitisis Hemophilus Oxidase positive (all enterobacteriacea negative for oxidase)
Neisseria Pseudomonas Helicobacter Campylobacter Urease + “PUNCH” -proteus -urea plasma - nocardia -cryptococcus -h.pylori Spontaneous peritonitis : CHEMOTHERAPY PATIENTS ( the epithelium damaged) enter in cause peritonitis ( also nephrotic) -Bacteriodes fragillis -E.coli Bacteria Neisseria meningitides Usually associated with DIC bc only gram negative to RELEASE LPS since it over produces it Vaccine only (YWCA) NOT B which is 50% of meningitis in US bc capsule nonimunogenic Gonorrhea Gram negative diplococci INTRACELLULAR SEPTIC arthritis in sexually active young KNEE Causes ophthalmia like chlamydia o Chlamydia also has PNEUMONIA Pseudomonas aeruginosa In respirators, in flowers and water, and raw vegetables therefore not allowed in burn units LIVER PRIMARY TARGET ( Diptheria was <3 and nerves with same toxin) Capsule Colonize eschar in burn victim Neutropenia, burn patient, and CGD Legionella Pool boy, air conditioner, fountains Pathy infiltrate = atypical pneumonia Diagnose: DFA ( direct fluorescent antibody) Silver stain, and CYE/BCYE ( buffer charcoal yeast extract= cysteine and iron)) Francisella tularensis Tick bite or traumatic= ulceroglandular = ulcer and regional lymph Pneumonia if inhaled Serology diagnose ( NEVER CULTURE, ALSO BRUCELLA AND YERSINIA) Brucella Unpasteurized dairy (GOATS MILK ) SWEATING AND HEPATOMEGALLY ( leptospira other hepatomegaly)
Chronic: DEPRESSION + sweating Bordetella pertussis Unvaccinated (immigrant, Jehovahs, religious) Have filamentous hemagglutinin Camp by inhibit Gi Also tracheal cytotoxin: interfere with cilia ( therefore need to cough hard to get it up) Whooping cough= paroxysmal cough ending with gasp(whoop) o o Repetitive cough with GASP at end, and may vomit Causes hypoglycemia Campylobacter jejuni Curved, microaerophile, oxidase + (like Helicobacter) Grows at 42 degrees Polar flagella (gulls wings) Guillain barre( O:19 serotype) and Reiter Vibrio cholera = a lot of fluid loss Ringers lactate give them = replenish the K+ and HCO3 Vibrio vulnificus : from swimming salty water ( oysters etc) Get cellulitis and gastroenteritis(if ingested) o Enterbobacteriaceae 1. All ferment glucose 2. Nitrates nitrites 3. Catalase + 4. OXIDASE – -H= flagella -K= capsule -K1: E.coli -Vi: Salmonella typhi Lactose: CEEK Motile and H2S: Salmonella, Proteus Nonmotile and no H2S: Shigella and Yersinia E.coli
UTI: Pili is virulence factor Neonatal meningitis: capsule Sepsis: LPS Gastroenteritis: toxin EHEC: DON’T FERMENT SORBITOL (other do) Only NONINVASIVE(no pus or fever) bloody diahrea o DON’T GIVE ANTIBIOTICS (increase HUS) o Klebsiella Mucoid colony, red gelatinous sputum ( wont say red current jelly), large polysaccharide capsule Alcoholic, homeless, elderly
* even alcoholic #1 pneumonia still strep pneumonia form abscess Yersinia 1. Pestis Bipolar staining ( look like safety clip) = stain at both ends Flea bite from rodent Bubonic plague: high fever and BUBOES sepsis and death Pneumonic plague: HIGHLY CONTAGIOUS TREAT: aminoglycosides 2. Enterocolitica: unpasteurized milk and pork Multiplies in cold Pseudoappenidx: appendix normal, but MESENTERIC LN enlarged Proteus mirabilis or vulgaris: Swarming (due to peritrichous flagella: all over) WEIL-FELIX TEST for ricketssia Same treatment as E.coli: fluoroquinolones and TMP-SMX Salmonella = Vi capsule 1. Typhi = TYPHOID FEVER * never cause of gastroenteritis or osteomyelitis only btw humans Lives in macrophages bc prevent fusion phago and lysosome like TB Concentrated in gall bladder where bile concentrated ( therefore resistant to bile) Week 1 in blood, rose coloured spots Week 3 in stool CONSTIPATION more common than diahrea 2. Others: typhimurium, enteritidis Widal test: antibodies to antigen O,H, Vi Chickens and reptile pets Osteomyelitis in sickle cell ( kid played with turtle) Haemophilus influenza Type b capsule ( polyribitol phosphate ) 3 month- 2 years not vaccinated meningitis o o epiglottitis (thumb print on lateral Xray) o pneumonia * still cause otitis media + sinusitis by nontypable (but strep penumo #1) o
HACEK endocarditis subacute - Haemophilus aphrophilus - Actinobacillus actinomycetemcomitans - Cardiobacterium homonis - Eikenella corrodens : HUMAN BITES - Kingella kingae: HUMAN BITES
Treponema Pallidum Primary Painless chancre (open sore) Secondary
Rash macuopapular diffuse include soles and palms -condyloma lata : flat
Tertiary
Gummas(granulomas) Aortitis CNS Tabes dorsalis Argyll Roberston pupil “ accommodate but don’t react” Still birth Deaf, notched teeth, rash, saber shin( new bone on periosteum)
Congenital
Dark field Fluorescent microscopy 1) Serology : VDRL sensitive (Ab to cardiolipin) 2)Specific: FTA-ABS Only FTA-ABS
Jarisch-Herxheimer rxn: increase temp, decrease BP, rigors, leukopenia
Lyme disease (“lyme on FACE= facial palsy, arthralgia, cardiac, erythemia migrans) Stage 1 Target rash ( hyperemic concentric rash) 2 Muscle and joint pain, headache, fatigue, fever and chills (flu like) 3 Bell palsey (bilateral), arrhythmia, arthritis immune complex, meningitis Chlamydia Obligate intracellular No ATP Modified peptidoglycan (lacks muramic)
Rickettsia Obligate No ATP Normal
Mycoplasma No Normal ATP No peptidoglycan has cholesterol instead
Chlamydia penumoniae: ATHEROSCLEROSIS Atypical pneumonia #2 ( after mycoplasma) Intracytoplasmic inclusions Diseases Chlamydia trachomatis o Causes conjunctivitis and atypical pneumonia in neonate Staccato cough : inspiration btw each cough o o Need erythromycin drops after birth into eye (N.gonorrhea also causes conjunctivitis but NO PNEUMONIA Listeria can cause SPONTANEOUS abortions, or infant granulomas all over
Lymphogranuloma venereum : chlamydia L1-L3 o PAINLESS, lymph nodes large painful buboes o Genital elephantiasis o Enlarged abscess lymph node = Buboes Chancroid: painful nonindurated Syphilis primary :PAINLESS chancre heals spontaneously No buboes o Granuloma inguinale: klebsiella granulomatis PAINLESS ulcer that develop into granulomatous ulcer that bleeds easy STELLATE GRANULOMA: bartonella henselae
Virus
Paramyxoviridae: Measles, mumps, parainfluenza, rsv ( all kid diseases) CMV congenital: blueberry muffin. Thrombocytopenic purpura, jaundice, hepatosplenomegally, and intracerebral calficication If they have mononucleosis and u give them ampicillin they get maculopapular rash
