Name COCCI Staphylococc us aureus
Morphology
epidermidis
Gray to white, Coagulase -, M-,N s, Y-, H-
saprophyticus saprophyticus
Weapons
Disease
Lab
Tx
Misc
Cutaneous (acne etc),SSSS(bullous exf oliative oliative dermatitis) TSS tampon Gastroenteritis(f ood ood poisoning) Endocarditis Bones, Joints Pneumonia,empyema Most common isolate in infections with artificial cardiac valves, prosthetic joints (THR) and CNS shunts Causes UTI in sexually active young f emales emales
Smear Culture BAP Biochem
Penicillin Cloxacillin Naf cillin cillin Vancomycin
Handwash and proper hygiene Can prevent disease
Aminoglycosi des etc.
Normal f lora lora of skin, oppurtunistic
Pen-G
Prevented by pneumovacc.
Pen-G with aminoglycosi des f or or IE
Penicillin
Gram + grape facultative fa cultative anaerobe, Catalase + Gray or golden yellow colonies Coagulase +, +, mannitol +, Novobiocin s, Yellow pigment + Beta Hemolysis +
Some +Capsule/slime Superweapon/antigen 1. Exf oliative oliative 2. TSST1
Only one which is novobiocin resistant, resistant, Coagulase Streptococcus Gram +, in chains or pairs, catalase Alpha Hemolytic, Hemolytic , pneumonia IgA protease colonization Optochin (S),bile (S) ,bile Teichoic acid attachment soluble, lancet Polysaccharide Polysaccharide capsule shaped diplococcic major, inhib phago f ound ound in URT Pneumolysin O damage respi epithelium (rusty sputum) Alpha Hemolytic, Hemolytic , viridians Dextran (biof ilm) ilm) Optochin (r), (r) , bile Growth in vegetation resistant (S. sanguis, (protects f rom rom immune) S. mutans, S. salivarius), normal
Bacterial pneumonia (most common on >65y/o) Adult meningitis (most common cause) Otitis media and sinusitis (most common in children) Septicemia Dental caries S. mutans Inf ective ective endocarditis
Pyogenes (group A)
Agalactiae (group B)
Enterococcus f aecalis aecalis
bovis
f lora lora of human oropharynx Beta Hemolytic, Hemolytic , Bacitracin (s), (s) , PYR +
Beta Hemolytic, Bacitracin Bacitracin (r), Hippuric acid, CAMP +, reservoir in human vagina, transmitted in child birth, PROM increases risk Gamma Hemolytic, 6.5%NaCl(+), 6.5%NaCl(+), group D Gamma Hemolytic,
Hyaluronic acid Capsule (antiphago) M CHON deadly virulence fx, used to type GABS M12 strain AGN Streptolysin O immunogenic Streptolysin S nonimmunogenic Streptokinase f ibrin ibrin clot breakdown Stretococcal Stretococcal DNAse liq. Pus and extension of lesion Hyaluronidase Hyaluronidase spread in cellulitis Exotoxin A-C pyrogenic or erythrogenic, assoc to scarlet f ever, ever, activate Th cells and MHC class 2 Capsule Beta hemolysin CAMP fx
able to live in bowel, colon, urethra and gallbladder due to bile/salt tolerance
Acute/suppurative 1. Pharyngitis 2. Scarlet f ever ever sandpaper rash, strawberry tongue, circumoral pallor, palms and soles spared 3. Pyoderma/Impetigo honey crusted lesions 4. Cellulitis/Necrotizing f asciitis asciitis f lesh lesh eating bacteria Non-suppurative sequalae 1. RF seq of Pharyngitis 2. AGN(m12 serotype) seq of cutaneous cutaneous and pharyngitis
Rapid antigen test Throat swab ASO titer f or or RF (>200)
Pen-g DOC nd Erythro 2
Penicillin
Ampicillin Cef ota otaxime with genta
Treat mother prior to delivery
Vancomycin Vancomycin
Penicillin and gentamycin
Misc: puerperal f ever, ever,
pneumonia, TSS like syndrome Neonatal Septicemia Meningitis
UTI and Biliary tract inf ections ections SBE through hematogenous route
Neisserriae gonorrhea
Meningitides
Moraxella
catarrhalis
6.5%NaCl( -), group D Medium of Choice: BAP, Selective Media: Grows on Thayer Martin (Vancomycin, Colistin and Nystatin), Martin Lewis, New York, very sensitive to adverse envt and cold, gram , catalase +, oxidase + Gram , acquired Pili attach, antiphago, Genital Gonorrhea Gram stain Cef triaxone + through sexual POR-antiphago, Opa symptomatic in males, of urethral Doxycycline f or contact and birth attach to eukaryotes, Rmp- cervicitis with purulent smear, canal against antibody, -Ferrin, discharge and intermenstrual Proceed to Chlamydia LOS endotoxin,mimicry, bleeding in f emales culture f or Resistant to f emales, IgA1 protease, B-lactamase Rectal, Pharyngeal, penicillin Meningitis, Ophthalmia molecular (PPNG) neonatorum, PID, probe Disseminated gonococcal inf ection Meningitis Colonizes Capsule, LOS, IgA1 Gram stain: Pen-G Vaccine: nd nasophary x, 2 protease Septicemia Culture: Alter: A,B,C,Y and most common CA Waterhouse Friedrichsen acid prdxn Chloram w135 most rd meningitis in adults syndrome (hemorrhage of with 3 gen Ceph: important to people with adrenals) glu,mal Cef humans, complement (MAC) Pneumonia, arthritis, Capsular groups a and def iciencies, respi urethritis polysacch: c cause droplet serogroup epidemics, Bprev by nonimuuno Rif ampin and genic minoclycline Nomal f lora, does Bronchitis, pneumonia, not utilize sinusitis, otitis media and carbohydrate(asacc conjunctivitis harolytic) B-lactamase (+)
RODS Gram + bacilli, spore formers Clostridium Obligate anaerobe, terminal spores Motile, botulinum Botulinum tox in heat
Botulism f loppy baby
Clinical
Polyvalent
Proper
soil/dust/animal f eces, non-acidic and anaerobic (tae)
labile, f laccid paralysis, blocks release of Acth
syndrome, f laccid paralysis, eye sx like blurring, NV, diarrhea, dizziness, weakness
Toxin in stool/seru m
No GI symptoms f or wounds Perf ringens
tetani
diff icile
Bacillus anthracis
Invasive, soil and human colon, encapsulated, non motile, double hemolysis
Spores germinate in tissue Alpha toxin licithinase tissue destruction, hepatic toxicity Enterotoxin
Gas gangrene (myonecrosis) crepitus, tense tissue, contaminated f rom soil or f eces, systemic symptoms
Culture double hemolysis on BAP Chopped meat gas
Motile, localized, soil, f eces of horses and other animals
Tetanospasmin blocks Glycine and GABA (inhib NTA)
Tetanus trismus, risus sardonicus, opisthotonus
Clinical
Reservoir is human colon, antibiotic associated (clindamycin, cepha-, amox, ampi), invasive
Toxin A enterotoxin damaging mucosa Toxin B cytotoxic
Pseudomembranous colitis
Endoscopy,
Zoonotic, encapsulated, nonmotile, from wool
Capsule polypeptide Anthrax toxin PA - entry, LF(lethal) EF(edema)
Anthrax eschar, papule & pustules, of ten with regional lymphadenopathy
Antitoxin (ABE) Amoxicillin Respiratory Support debridement Penicillin and clindamycin Debridement , Hyperbaric chamber Penicillin or + Immune globulin f or toxin, zepam Metro
Toxins in stool
Culture and Serology
canning and no honey f or inf ants
Self -limiting inf ection f or f ood poisoning so give supportive care DPT, Penicillin, TIG, Proper wound cleaning f or prevention, f or linear less than 6h old wounds vaccine only, otherwise add TIG
Metro-,
DC antibiotics
Cipro, Doxy
Autoclave, Vaccine
and animal hair
cereus
Motile, morile, non-encapsulated, B-hemolytic
Emetic toxin -
Diarrheal toxin meats, sauces
Lab contaminant Ground glass colonies Gram + Bacilli, non-spore formers Listeria Facultative intracellular, tumbling motility monocytogen Cold growth: sof t Listeriolysin O B es cheeses, deli meats, hemolysin, helps organism cabbages, f ound in escape or jump when non-pasteurized lysosome tries to dump milk, across contents into phagosome, placenta, during lethal to decreased delivery immune
(cutaneous) Wool sorters disease(pulmonary) GI(rare) Emetic diarrhea and vomiting (1-6 hours) diarrheal - watery diarrhea (e.coli like, 18 hours)
subtilis
meningitis
Actinomyces israelii
Renal transplants and Ca meningitis most commonly due to Listera meningitis Anaerobic, branching rods, gingival and f emale GT, endogenous transmission, invasive
Listeriosis peaks in summer, symptomatic in pregnant women
Ampi and genta
Neonates granulomatosis inf antiseptica, in utero early onset, meningitis with septicemia in late onset due to f ecal exposure
Actinomycosis abscesses with sulfur granules, very invasive but not painf ul, in tissues with low oxygenation Lumpy jaw dental trauma, poor hygiene CNS, thoracic, Abdominal, Pelvic
Microscopy
or culture of sulf ur granules
Ampi or PenG and drainage
Food precaution
Nocardia asteroides
Partially acid fast, found in soil or dust, airborne or trauma
Erysipelothrix rhusopathiae
Catalase, oxidase and indole (-); +H2S(black), land/sea animals, direct inoculation Club shaped rods in V or L shapes in tellurite medium, Palisades or Chinese characters, lysogenic C. diphtheria. 4 biotypes: belf anti, intermedius, gravis, mitis. Reservoir:RT, wounds, skin
Corynebacteri um diphtheriae
Nocardiosis bronchopulmonary but may spread to brain hematogenously Cutaneous f rom trauma, subcutaneous abscesses with granules(mycetoma) Erysipelod/sea f inger/whale f inger- raised lesion violaceous color (+)pain and swelling K antigens heat labile, type specif ic, major
Diphtheriae toxin pseudomembrane(dead cells, f ibrin, pigments), lymphadeno, a.way obstruction Membrane f ormation on inf ected wound that f ails to heal
Sulf onamid es or TMSZ
PenG
Gram stain Antitoxin + or PenG or Erythro Methylene O antigen cross reactive Blue to nocardia and mycobac Culture (Loeff ler Diptheria toxin inhib Slant, Chon synth by inactivating Tellurite EF-2, f ragment A, f ragment plate) Elek plate B f or transpo test precipitin lines at zone of equivalence SCHICK test Acid f ast, sensitive to UV, unique mycolic acid cell wall resistant to dessication and to many chemicals
DPT <7y/o TD >7y/o
Mycobacteriu m avium & Potentially pathogenic, f ormer non-chromogen(-dark/-light) and latter photochromogen(-dark/+light), f ound in surf ace waters, kasasii soil, animals scrof ulaceum Scotochromogen(+dark/+light), f ound in surf ace waters, soil, animals f ortuitum and chelonae Rapid growers
gordonae, f lavescens, f allax, gastri tuberculosis
Auraminerhodamine staining(sensitive than Kinyoun or Nielsen), produces NIACIN, heat sensitive catalase, malachite green f or selective growth, albumin to detoxif y media, doubling time is 18 hours
Leprae
Cold lover, obligate intracellular, cannot be grown in-vitro, f ound in human skin or in armadillos, transmitted via nasal discharge f rom lepromatous leprosy pts
Saprophytic, rarely cause disease Sulf atides inhibits phagosome-lysosome f usion Cord f actor serpentine growth inhibiting leukocyte migration, disrupts mitochondria Tuberculin + mycolic acid cell mediated immunity, damage done by immune system
Tuberculoid damage f rom immune response killing cells, granuloma and loss of sensation Lepromatous nerve damage f rom bacterial overgrowth
Tuberculosis
Tuberculoid Strong cell mediated immunity, beningn course and low # of organisms, f ew macular lesions, paresthesia Lepromatous weak cell mediated immunity, progressive course and high # of organisms, numerous nodular lesions, leonine f acies
Microscopy
sputum, organ aff ected NaOH decontam Naceylcysteine liquef action Culture Chest X-ray PPD skin test 10mm+ Punch Biopsy, Nasal scrapings, Gram stain Lepromin test (+)tuberculoi d ()lepromatou s
RIPE 2 months intensive phase RI f or 4 months maintenan ce phase -mycin injectables
BCG to prevent
Dapsone and Rif ampin, add clof azamin e f or lepromato us f orm
Dapsone
No cultures Gram negative bacilli Enterobactericeae all oxidase (-), all ferment glucose, facultative anaerobes, most ar e motile except Shigella, Klebsiella and Yersinia(SKY), serologic tests useful to Salmonella, Escherichia and Shigella (SES), EKE lactose fermenters KlebsiellaKlebsiella K. pneumoniae & oxytoca Enterobacter- pneumoniae(f riedla lobar pneumonia with
Serratia
nders bacillus) IMVC --++, urease (+) with capsule Enterobacter IMVC -++, urease (-) no capsule Serratia marcescens with prodigiosin (red)
Proteeae
Proteus vulgaris, mirabilis Morganella morgani, Providencia rettgeri, stuarti, alkalif aciens Urease positive
Citrobacter Escherichia coli
EPEC (pathogenic)
Most
abundant aerobic f lora of colon, index f or f ecal pollution of water, high inf ective dose, most virulent
currant jelly sputum, alcoholics and comp. pulmo f unction K. ozaenae chronic atopic rhinitis K. rhinoscleromatis granulomatous disease of the nose K. granulomatis donovanosis(granuloma inguinale) Enterobacter UTI UTI alkalinazation of urine causing precipitation of Ca and Mg salts causing caliculi f ormation -damage to renal epithelium, most common is P. mirabilis
Adhesins, Exotox ins, heatstable toxins (STa and STb), heat labile (LT-I and LT-II), hemolysin, P f imbriae, K antigen
Disruption of normal microvilli
UTI and neonatal inf ections Neonatal meningitis K antigen UTI most common, uncomplicated cystitis hemolysin Complicated pyelonephritis p. f imbrae, non uropathogenic strains
Inf ant diarrhea in underdeveloped countries, malabsorption and non
Specimen as indicated by the localization of the disease process
Antibacteri als e.g. sulf onamid es, ampicillinm cephalospo rins, f luoroquin olones and aminoglyco sides
ETEC (toxigenic)
Production of enterotoxin (heat stab and labile) leading to hyper secretion of f luids and electrolytes Production of shiga toxin (Stx 1 and Stx 2) leading to destruction of microvillus structure
EHEC (hemorrhagic )
EIEC (invasive)
EAEC (aggregative)
Shigella dysenteriaegrpA f lexneri-grpB boydii-grpC sonnei-grpD Salmonella
Does not infect animals, inf ection usually localized to GIT, transmitted by 4f s, very low inf ective dose, least virulent, TSI: K/A Fecal oral, most
bloody diarrhea Travelers diarrhea in developed countries, watery diarrhea Grossly bloody diarrhea (hemorrhagic colitis) may lead to hemolytic uremic syndrome (HUS) with the use of antibiotics. No f ever since no invasion.
Invasion and destruction of Scanty, bloody diarrhea epithelial cells lining the (dysentery) colon Disease in underdeveloped countries, presents with f ever Adherence of rods (stacked Inf ant diarrhea, travelers bricks) leading to diarrhea, dehydration, low decreased f luid absorption grade f ever and shortening of microvilli Invasive ulcerates Painf ul passage of bloody terminal ileum and colon, mucoid stools with cramping rarely penetrates (dysentery), f ever, Shiga toxin enterotoxic, convulsions cytotoxic, neurotoxic
Enterocolitis
typhimurum,
0157:h7 is the most common, sorbitol (-) on McConkey agar, assay f or shiga toxin, no leukocytosis in stool but (+) f or RBC
Rectal swab best Non-lactose f ermenter Conf irmed by serotyping Culture f rom
Do not use antibiotics, rehydrate only, may develop HUS
Thoroughly cooking ground beef
Cef triaxone
Vaccine f or
enterica
Yersinia pestis
serotypes animal, typhi and paratyphi human, TSI: K/A no gas, with H2S
gut only Septicemia occurs in chronic disease or pt with enterocolitis, positive f or seeding Enteric f ever typhoid and paratyphoid, (intestineblood-intestine) Chronic carrier state: gallbladder Bubonic plague f lea bites, f ever, regional buboes, conjunctivitis, septicemia, DIC and death Pneumonic plague inhalation, contagious
Saf ety pin Coagulase Endotox in appearance Facultative Two antigens (v and w) Envelope antigen (f -1) intracellular, coagulase (+), f ound inhibits phagocytosis in rodents, PAI (pathogenecity island) transmitted by iron rodent f lea bite(sylvatic plague), respi droplets enterocolitica Zoonotic, majority Yersioniosis, bloody diarrhea come f rom northern mimics appendicitis Europe (cold), person to person or f eces of animals Gram () eubacteria with cell walls, oxidase (+) Vibrio, Capylobacter, Helicobacter Vibrio cholera Alkaliphilic, most Flagellar H antigen Attach to microvilli -> cholera common bacteria in O1 antigen no capsule enterotoxin, mucinase, surf ace waters, O139 antigen - similar to endotoxin, not invasive -> polar f lagellum. 01 el tor , with ogawa, prolonged hypersecretion of Convex, smooth inaba and hikojima f or water and electrolytes -> round colonies, does f urther typing diarrhea 20-30L/day, rice not f erment watery stool -> hypovolemic
blood/bone marrow is the best st nd 1 -2 week blood nd Af ter 2 stool/urine Widal Typhi Dot IgG and IgM Serologic
or Cipro
prevention IM polysacc capsule Oral live attenuated
Strep with tetra Quarantine f or 72 hours
Animal control Killed vaccine
Fluid and electrolyte replaceme nt Doxy or Tetra Furazol
Increased susceptibility when decreased stomach acidity
Culture requires cold enrichment
1. Gram (-) comma shaped curved bacilli, darkf ield or phase
arabinose, some are halophilic
El
tor -(+) hemolysin,(+)VP and polymyxin(r)
shock -> death
No enterotoxin
Watery bloody diarrhea
transmitted personperson, oral ingestion, f lies
parahaemolyt icus
Halophilic, seaf ood (raw f ish or shellf ish)
vulnificus
Free-living, oysters
Campylobact er jejuni & coli
Most common widespread causes of inf ection
Gull wing shaped, motile with single f lagellum, oxidase (+), catalase (+), microaerophilic and thermophilic
Can cause severe wound inf ections, gastroenteritis and bacterimia then death
Lipopolysaccharides with endotoxic activity Some have extracellular and enterotox ins
Multiply
in SI->invades>inf lammation-> blood in the stool Enteritis tissue invasion
Resembles shigella Bacteremia -> enteric f ever(typhoid)
contrast 2.Culture 3. Slide agglutination using anti-O group 4. serology oxidase (+) 1.Culture green colonies 2.Oxidase (+) on BAP 1.Culture blue green, sucrose ()colonies
f or
Endemic in
pregnant TMSZ children
India and SEA Pandemic in Af rica
1.Culture Skirrows, Butzlers, Campy gray/colorles s with vancomycin, polymixin B and trimethopri m 2. Microscopy darting motility
Erythromyc
Tetra DOC
in DOC Fluids and electrolyte s
3. urease(+), H2S(+) fetus
Helicobacter pylori
Aeromonas hydrophilia, caviae, veronii biovar sobria Plesiomonas shigelloides
Spiral shaped, multiple f lagella at one pole, urease (+), oxidase (+), catalase (+)
Fresh and brackish water, f acultative anaerobic, stool specimen, large zone of hemolysis, non-halophilic Gram (-) rod with polar f lagellum, tropical or subtropical areas, f rom f reshwater f ish and anials, oxidase(+) DNase (+) <-aeromonas (-)
S-Chon f orms a capsule like structure on organism structure preventing phagocytosis Protease modif ies gastric mucus Urease buff ers acids Toxins and LPS damages cells
Diarrhea, organism enters through GI , can cause bacteremia and systemic inf ections in IC patients PUD crampy abdominal pain, N/V, f ever, colonization may persist f or years or lif etime
Hemolysin, some with enterotoxin
Gastroenteritis and wound inf ection (with or without bacteremia)
Similar antigen with shigella sonnei
diarrhea
1.Biopsy 2.Skirrow&C AP colorless 3.Microscopy Giemsia or silver 4. Serum Ab 5.antigen test(stool specimen) 6.Urea breath test 7. Serology
Metro
+ Bismuth + Amox or tetra or clary + omeprazol e (MBAO)
Cipro, Gentamyci n, Amikacin, TMSZ
Deep in mucous layer Overlies gastric type Associated with PUD,Gastric Ulcer, AdenoCA of stomach, MALT B-cell lymphomas
Gram (-) bacilli non-fermentative, oxidase (+) Pseudomonas Obligate aerobe, Capsule, pili, LPS aeruginosa sweet/taco odor, (endotoxic), Pyocyanin mucoid colonies impair ciliary f unction, alginate capsule, inf lamm, oxygen radicals Exotoxin A Chon motile with single polar f lagella synthesis, tissue damage, immunosuppressive Exotoxin S Chon synthesis, tissue damage Cytotoxin(leukocidin) Burkholderia Bipolar saf ety-pin pseudomallei staining on meth blue or wright stain, wrinkled colony, lopotrichous mallei
Small, non-motile, non-pigmented, disease of horses, mules and donkeys cepacia Grows in environment, most media, colistin + media, CF patients vulnerable Stenotropho Oxidase negative, monas motile lopotrichous maltophilia Lavender green or gray O-F (glucose, maltose) Uncommon Gram (-) bacteria Eiknella Non-f ermentative,
Breach of barriers, compromised def ense mechanisms Nosocomial, burns, wound (ecthyma gangrenosum), swimmers ear, contact lens, cystic f ibrosis
Combinatio n of Antibiotics Aminoglyc oside + B lactam
Meliodosis pulmonary
Tetra, TMSZ, Chloram at least 8 weeks, 6mo-1yr Tetra + aminoglyco side
inf ection similar to TB MOT
inhalation, ingestion, contam skin inf ection Pneumonia when inhaled
Use of indwelling plastic IV catheters
Human bites
Ampicillin
corrodens
oxidase+, small f astidious capnophilic, gram()rods, normal f lora of the gingival crevices and bowels in 40-70% of humans Acinetobacter Oxidase(-), catalase(+), nonmotile, mistaken as Neisseria, iwoff i (non-oxidizer) anitratus (oxidizer) Alkaligenes Oxidase(+) catalase faecalis (+) peritrichous f lagella, asacchorylitic, apple or f ruity odor Moraxella Oxidase(+) catalase (+) Non-motile, non f ermentative, assacharolytic, MacConkey (-) mistaken as Neisseria Chryseobac. Yellow colonies Meningosepti cum Kingela Hemolytic, pits agar, normal oral flora Parvobacteria - Small gram(-) bacteria
and sulbactam
UTI, wound, diarrhea
UTI, wound, diarrhea
Blepharoconjunctivitis
Neonatal meningitis
SBE (HACEK group)
Haemophilus influenza
aegypticus
ducreyi
Bordetella pertussis
parapertussis bronchiseptic
Capsulated: group 1 (a,b,c,d,e,f ) Unencapsulated: group 2 (NTHI) satellite phenomenon with S. aureus Requires X&V on CAP Koch-weeks bacillus, biotype III, f ailure to produce indole and f erment xylose Growth: X(+), V(-) on CAP
Polysaccharide capsule type b capsule is polyribitol phosphate, a,c,d,f teichoic acid ; epolysaccharide; most important virulence fx IgA protease mucosal colonizing fx
Meningitis
HIB Otitis media NTHI Bronchitis Pneumonia inf ants, smokers Epiglottitis- major causative agents in unvaccinated toddlers
Antigen screen on CSF latex particle agglutination
Purulent conjunctivitis Brazilian purpuric f ever
STD, chancroid, slow to heal without treatment, open lesions increase transmission of HIV Small, gram(-), encapsulated, non-motile, strict aerobes, human pathogen only Mucosal surf ace pathogen Fastidious growth, Pertussis (whooping cough) f source o culture Filamentous hemagglutinin Incubation - 7-10 days saline nasal wash, Adenylate cyclase toxin Catarrhal 1-2 weeks f lu-like, direct cough plate, edema and impaired highest f or culture medium Regan leukocytosis Paroxysmal 2-4 weeks lowe Tracheal cytotoxin whoop, vomiting, impairs cilia leukocytosis Pertussis toxin ADP Convalescence diminished ribosylation of G, cough, secondary lymphocytosis, complications hypoglycemia(insulin), increases histamine Silent copy of pertussis similar toxin RT of dogs Chronic RTI
Ceph + Rif ampin if still colonized
Sulf onamid es
DNA probe/cultur e
Cef t, Co-tri, Erythro
Blood count: lymphocytosi s Direct immunof luor escence naso swab PCR
Supportive Erythro
Actively prevented by conjugate capsular polysacch Chon vaccine Passive by Ig
a Pasteurella multocida
Francisella tularensis
Brucella
SPIROCHETES Treponema pallidum pallidum
Small, encapsulated, gram(-), facultative anaerobe, bipolar staining, f ound in dog and cat mouths, transmitted via bites Gram(-), f acultative intracellular, wild animals, skinning rabbits ulceroglandular disease, aerosols pneumonia, ingestion of meat typhoidal Gram(-), f acultative intracellular, zoonotic, aerobic, oxidase(+), catalase(+), domestic, dairy products, bioterrorism
Endotox in,
capsule
Cellulitis with lymhadenitis
Rarely cultured
Facultative intracellular in RES, granulomatous response
Syndromes of Tularemia Ulceroglandular, pneumonic, oculogladndular, glandular, oropharyngeal, typhoidal
serological
Endotox in, Facultative
Brucellosis(undulant f ever, malta f ever) Acute septicemia f ever, f lulike, sweating, hepatomegaly Undulant milder, incomplete tx Chronic depression and sweating, ocular complications
serological
Teta, genta, ampicillin, streptomyc in, rif ampin
Syphilis
Darkf ield, Direct f luorescence Nontreponemal tests: VDRL, RPR
PenG, tetracyclin e, erythro, chloram
intracellular in RES, granulomatous response
PenG Amox/clav u f or most bites as prophylaxis and tx Strep or Genta Tetra B-lactam resistant
Thin, helical, gram(-) Humans only host, sexually transmitted, birth canal, contaminated blood
OMP adherence Hyaluronidase perivascular inf iltration Fibronectin coatphagocytosis Immune response tissue destruction
Avoidance and immunization
Vaccinate animals, pasteurize milk
pallidum endemicum
Use of contaminated eating utensils
pallidum pertenue
Bejel (endemic syphilis) oral lesions, papules and mucosal patches late: gumma Yaws granulomatous disease, destructive lesions on skin, LN and bones
carateum
Direct contact with inf ected lesion
Yaws/Pinta small pruritic papules on the skin surf ace that enlarge and present f or months or years
Borrelia
Gram(-) with periplasmic cylinder and outer envelope, twisting motility, microaerophilic Bite f rom arthropods
Borreliosis: Relapsing f ever (epidemic/louse born) human reservoir, body louse vector Relapsing f ever (endemic/tick born) Rodent,tick reservoir, sof t shelled tick vector Lyme disease rodent, hard shelled tick, domestic pet reservoir, hard shelled tick vector
Treponemal Tests: FTAABS, MHA-TP + VDRL, +treponemal tests + VDRL, +treponemal tests Darkf ield microscopy Serologic test late inf ection + VDRL, +treponemal tests RF giemsa/wrig ht stain during f ebrile period Lyme disease Immunof luor /ELISA, western blot to conf irm ELISA +treponemal tests
PenG, tetracyclin e, erythro, chloram PenG, tetracyclin e, erythro, chloram PenG, tetracyclin e, erythro, chloram
RF: Tetra, Doxy jarischherxheimer rxn Lyme Doxy, Amox, Erythro
-VDRL
Leptospira interrogans and biflexia
Thin coiled with hook at one or both ends, entry through break in the skin in urine-contam water
Anicteric Leptospirosis leptospires present in blood, csf , urine -3-7 days septicemic with body pains, conjunctival suff usion, f ever -0-1 month immune stage with meningitis, uveitis, rash, f ever Weils disease(icteric) no leptospires in CSF -3-7 days similar 10-30 days immune stage with jaundice, hemorrhage, renal f ailure, myocarditis
Culture through Fletchers st Blood- 1 week nd CSF 2 week Urine af ter st 1 week Serology only af ter 2 weeks but sensitive and specif ic peaks af ter 5-6 weeks
Tetra, Doxy
Doxy to prevent
Chlamydiaceae and Mycoplasmataceae Smallest and simplest f orms Chlamydia Obligate intracellular energy parasites gram(-), peptidoglycan layer no muramic acid, with an e lementary body(inf ectious f orm) and reticulate body(reproductive f orm); divide by binary f ission trachomatis Iodine staining, Two human biovars: Chlamydia trachomatis Cytology Tetra, Eythro, Susceptible to Trachoma A,B,Ba,C A,B,Ba,C,;chronic f ollicular Iodine stain sulf onamides inf ects conjunctiva, D-K conjunctivitis, blindness due Culture Sulf isoxazo UG tract to chronic corneal abrasion most le LGV L1,L2,L2a,L3 A-C and D-K; adult or acute specif ic, f ollicular conjunctivitis, McCoy inguinal lymph nodes (lymphogranuloma preceded by genital inf ection medium venereum) with mucopurulent Ag detection Intracellular replication discharge, keratitis, corneal direct IF, ELISA, Probe, prevents phago-lyso f usion inf iltrates Neonatal conjunctivitis (dPCR K), f rom birth canal, purulent discharge, may lead to
pneumonia with distinct staccato sound, a f ebrile UG inf ection, f emales asymptomatic, males most common case of non gonococcal infection, dual inf ection with gonorrhea, associated with Reiters syndrome
Chlamydophil a psittaci
LGV primary lesion papule or ulcer of ten overlooked, heals rapidly. Secondary stage Inguinal LN most of ten involved, painf ul Buboes Systemic body pains, menigismus, f ever, chills, anorexia Untreated elephantiasis Psittacosis(parrot f ever), Ornithosis Atypical pneumonia, CNS involvement is common, GIT Bronchitis, atypical pneumonia, sinusitis, most common in adults; may lead to atherosclerosis
Inhalation of dried Serology: CF, Tetra and Erythro MIF bird excrement, urine or respi secretions pneumonia TWAR agent (TWCF, MIF Tetra and 183 and AR-39) erythro lethal species of psittaci or Taiwan acute respiratory agent; human pathogen, bronchitis Mycoplasmataceae Smallest and simplest of self replicating prokaryotes, polymorphic (lack cell wall) requires cholesterol f or growth, only invades mucous
membrane; f ried egg appearance of colonies Mulberry shaped pneumoniae P1 adhesion Chon colonies, children 5- attaches to respi 15y/o worldwide, epithelium f inhalation o respi droplets
genitalum and U.urealyticu m hominis
Mild
URTI Severe LRTI tracheobronchitis and atypical pneumonia(walking pneumonia)
CF, ELISA, cold agglutinins but non specif ic (+) in other diseases EBV, CMV
Tetra and erythro
NGU
Urealyticum resistant to tetra
Pyelonephritis, PID, postpartum f ever
Resistant to erythromycin
