Family Gram+cocci

Organism

Physiology/Metabolism/Dx

VirulenceFactorsStructural

VirulenceFactorsToxins

Disease

Transmission/reservoir

Notes

Staphylococcus:gram+cocci,grapelikeclusters,catalase+,faculatativelyanaerobic,S.aureus coagulase+,

Streptococcus:gram+cocci,chainsorpairs,allcatalase,mostarefacultativeanaerobes

coagulase+

S.Aureus

Staphylococcus Catalase+

Staphylococcalscaledskinsyndrome(SSSSRitter ds)/bullousimpetigo:exfoliativetoxin(ETAheatstable andchromosomal,ETBheatlabileandplasmid),serine Cytotoxins: proteasessplitsdesomosomesthatholdstratum :disruptssmoothmuscleinblood granulosumepidermis(toxinmediatesonostaphorPMNs vesselsandistoxictoRBCs,WBCs, ProteinA:bindstoFcreceptorof attissuelevel),noscarformation,children,onsetwith hepatocytes,plts;importantcauseof goldpigment(atroomtemp) IgG1/2/4thereforeblockingantibody perioralerythema. sx. mediatedimmuneresponse coagulase+, Foodpoisoning:enterotoxinA(mcfoodpoisoning),B :(sphingomyelinaseC)hasspecificitiy mannitolsaltagar(halophiles), Coagulase:allowsfibrinformation (staphpseudomembranouscolitis),C/D(milkproducts) forsphingomyelinand aroundorganism(clumpsorganism) hemolytic(2*totoxin), resistanttogastricacidandjejunalenzymes,stableto lysophosphotidylcholine,killsRBCs, nutritionallyenrichedsheep Catalase:removalofH2O2 heating100Cx30mins,actsassuperantigen,severe fibroblasts,WBCs,macrophages;lyses N/V/nonbloodydiarrhea/abdpain;processed(salted bloodagar, Pencillinase: hydrolyzespcn cellmembranes. meats),custard,potatosalad,icecream,rapidonset<4hr, Staphylokinase:dissolvesfibrinclots :hasSlow&Fastelutingproteins,lyse rapidcourse<24h neutrophilsandmacrophages;caues Toxicshocksyndrome:TSST1(formensturatingFand poreformationthereforelyses enterotoxinBfornonmesturatingFandM),superatigen, death2*hypovolemicshockandmultiorganfailure,diffuse maculareryrash,fever,hypotensive

Disease2*directorganinvasion (infectious): commoninnasopharynx,doesnot capsule:PNA,empyema requireanimalcontact coagulase:impetigo,folliculitis, Neonates:colonizationofthe furncules,carbuncles umbilicalstump,skin,andperineal adhesion:endocarditis areaisalsocommon other:meninigits,bacteremia,osteomyelitis Sheddingofbacteriacauses (Brodieabscess),septicarthritis infectiontospread MecA:codesforNPBP2'willnotbindto NOTE:staphylococciare PCNbutstillfunctional;locatedon susceptibletohightemp., staphylococcalcassettechromosomemec disinfectants,andantiseptics,but (SCCMEC)responsibleforhospital cansurviveondrysurfacesforlong acquiredMRSA periodsoftime canacquireSSSfromcutting umbilicus Note:bloodculturesnegativeintoxin mediatedillnesses! Abxnotcurative,willkillbacteriabutnot exotoxins

Novobiocinsensitive S.Epidermidis

Coagulase, NovobiocinSensitive Coagulase, NovobiocinResitive, nonhemolytic

prostethicdevicesproducesapolysaccharideslime (biofilm);greaterthan50%ofcathetersandshunt infections;endocarditis;woundinfections UTIsinsexuallyactiveF,2ndtoe.coli,communityacquired

Novobiocinresistant S.Saprohyticus

Family Gram+cocci

Organism

Physiology/Metabolism/Dx

VirulenceFactorsStructural

VirulenceFactorsToxins

Disease

Transmission/reservoir

Notes

Staphylococcus:gram+cocci,grapelikeclusters,catalase+,faculatativelyanaerobic,S.aureus coagulase+,

Streptococcus:gram+cocci,chainsorpairs,allcatalase,mostarefacultativeanaerobes

S.Pyogens

hemolytic BBRAS

PyrogenicexotoxinStreptocococcal pyrogenicexotoxin(Spes):causes Suppurative: Scarletfeverrash,necrotizingfascitis, pharyngitis, Mprotein:responsiblefor streptococcalTSS;producedby 1)adhesion, scarletfever;("sandpaperrash,strawberrytongue,"desaq lysogenicstrains,actsassuperantigen. ofhandsandfeet) 2)mediatinginternalizationbyhost GroupA;bacitracinsensitive; cell;bindstheserumglobulinfactor Streptokinase:A/Bcleavesfibrinand pyoderma, fibrinogen=lysisofclotsandfibrin microaerophilic; erysipelas, H,whichisregulatoryproteinfor deposits;resultsinrapidspreadof PYRpositive; cellulitis, alternativecomplementpathway inhibitedbyelevatedglucose degradesC3bandinhibitsphagocytosis S.pyogens necrotizingfascitis, DNase:reduceviscosityofabscess antiDnases streptococcaltoxicshock (needtomakeantibodiesagainstM materialandfaciliatesspreadof protein),fibrinogenalsobindstoM orgaism NonSuppurative(antibodymediated): protein C5apepitdase:inactivatesC5awhich RFs/ppharyngitis pili mediatesinflammation acuteglomerulonephritiss/pskin/pharyngitis StreptolysinO/S:destroyRBCandWBC, Oisantigenic

ASOtesttestsantibodiesagainst streptolysinO(oxygenlabilehemolysin), documentsrecentgroupAstrepinfection, normallylivesonskin,soskin samplesneedPMNstobepositive forRFandAG,willbenegativeinptswith skininfections pharyngitisP2Pviaresp Anteriortotonsils,normalflorainhibitS. skintraumainoculatesbacteriain pyogens sodon'tcontaminateswab skin AntiDNasesmarkersforskininfections(b/c ASOnegative); AntiDNABfor?glomerulonephiritis

S.agalactiae

StreptococcusCatalase

GroupB;bacitracinresistant, CSFsamples,rapidgrowing colonieswithnarrowzoneof hemolysis;PCRrectal/vag polysaccharidecapsule swabs;catalase,+CAMPtest, hydrolyisisofhipporate Immunogeniccapsule polysaccharide

Earlyonsetneonatalds(acquiredinuteroorbirthcanal): onset<7dold,bactermia,pna,meningitis(CSFtesting) Lateonsetneonatalds (acquiredfrommomorotherbaby): colonizelowerGIand onset1wk3m,bacteremiawithmeningitis genitourinarytract;transient PregnantF:postpartumendometritis,woundinfection, vaginalcarriagein1030%ofF UTIss/ppreg MenandnonpregF(withunderlyingconditions): bactermia,pna,bone/jtinfections,skin/STinfections

S.pneumonae hemolytic/Bile sensitive OVRPS

encapsulated(Quelleng+); diplococci;bilesensitive; optochinsensitive;+ fermenter,lacticacid producing;pneuomococcalC polysacinurine

polysaccharidecapsule

S.viridans

bilesensitive;optochin resistant; microaerophilic

secretoryIgAproteaseblocks usuallyhaveantecedentviralillnessorotherconditionthat secretoryIgAwhichnormallybindsto interfereswithbacterialclearance; bacteriaandtomucinatFcregion MCC: trappingbacteriainmucus, normallylivesinoropharynx adults:pna(aspiration),bacterialmeningitis; Pneumolysinbindstocholesterolin respiratorydroplets children:otitismedia hostcellmembraneandcreatespores asplenicpatientsathigherrisk,alsocausesbacterial thatdestroyciliatedepithelialcellsand sinusitis phagocyticcells,stopsphagocyticcell oxidativeburst S.mutans:dentalcariesandbacteremia S.viridans:subacutebacterialendocarditis colonizeoropharynx,GItract,GU tract,rarelyonskin(fattyacidsare S.angionosus:deepabscessformation S.bovis:GImalignancies(invadesbloodstreamthroughGI toxictothem) lesions)

Teichonicacid(ofpolysaccharidecapsule) 1)Cpolysaccharideprecipitatesserum gobilinfraction,CRP(Creactiveprotein),in presenceofcalcium 2)Fantigen aerobicgrowthappearhemolytic anerobicgrowthappear

ManyPCNresistantstrains

GroupD//non/ rarely

enterococcus facealis

bileresistant;optochin resistant;microaerophilic;PYR positive;chocolateagar; catalasehalophile

importantnosocomialinfection;UTIinpatientswithfoley onbroadspectrumcephalosporins;alsoinfectionsof normalflora urinarytract,peritonitis,endocarditis

veryresistant,VRE,difficulttotreat Abriotrophia:opportunisitcinfection,will growinbloodculturebrothsbutwillnot growwhensubcultured;requiresvitaminB6 (pyridixal);Ds:bactermia,endocarditis, nosocomiabrainabscesses,meningitis,eye infxn

Family Gram+rods

Organism

Physiology/Metabolism/Dx

VirulenceFactorsStructural

VirulenceFactorsToxins

Disease

Transmission/reservoir

Notes

B.anthracis

Nonmotile,encapsulated

Bacillus catalase+

Cutaneous:inoculationfrominfectedanimals,20%death, pXO1 painlesspurpleulcersurroundedbyvesiclesnecrotic EdemaFactor(EF);activeAsubunit; eschar calmodulindependentadenylate Gastrointestinal: pXO2 cyclase,cAMP Upper:ulcersinmouth/esophaguswithregional Capulse:inhibitsphagocytosisof LethalFactor(LF):zincmetalloprotease, lymphadenopathy,edema,sepsis; replicatingcells**onlybacteriawith inactivatesproteinkinase,stimulates Lower:N/V/malaiseprogressestosystemicsx,upto100% capsulemadeofprotein(polyD macrophagetoreleaseTNFandIN1 death glutamicacid) =death Inhalation:prolongedlatentperiod(>2months),initial: Protectiveantigen(PA):activeB nonspecificfever,myalgias,drycough,malaisefollowedby subunit,mostimmunogenic,bothEF rapidonsetofsepsis;alveolarmacrophagesingestinhaled andLFrequirePA,bindstocellandhas sporesandtraveltomediastinallymphnodes(widened threecompetitivebindingsites mediastinum)

Epidemiology:anthraxisdsof herbivores,formsresilientspores, contaminatedsoilsoranimal productscanbeinfectiousfor years;nopersontopersoncontact (becausereplicationisin mediastinallymphnodesandno bronchopulmonarytree) 1.Skin:95%ofhumancases inoculationofsporesthrough exposedskinfromcontaminated soilorinfectedanimalproducts 2.GIingestion(MCroutefor herbivores) 3.inhalation:uncommon,unless bioterrorism

Weaponized:infectiousdoseislow, weaponizedversionminimizeclumpingso sporescanreachlowerrespiratorytract (wherealveolarmacrophagesphagocytize sporestoinitiatebacterialreplication);

B.cereus

Motile,lackscapsule

Enterotoxin: heatstable,proteloysisresistant:MOA unclear,B.cereusmultipliesinleftout riceandformsheatstabletoxinthatis resistanttoreheating heatlabile:stimulatesadenylate cyclase,cAMP,profusewatery diarrhea(similartoe.coliandvibrio) Oculartoxins: necrotictoxin(heatlabile) cereolysin(hemolysin) phospholipaseC(lecithinase)

Foodpoisoning: Emeticform:heatstableenterotoxin,reheatedrice,onset <6h Diarrhealform:heatlabiletoxin,haslongerincubation becauseactuallyinfectedwithB.cereus(>6hrs) Ocularinfection:s/ppenetratingeyeinjurywithsoil contaminatedFB,rapiddestructionofeye Other: IVcatheterrelatedsepsis Severepna(rareanthraxlike)

C.perfringens SporeForming

Nonmotile

softtissueinfection:cellulitis,suppurative,myositis, myonecrosisgasgangrene foodpoisoning enteritis septicemia botulinum:toxinresultsinflaccidparalysis(blocksAch releaseatNMJ) A/Btoxin:A:zincendopepitdasewhich adult(foodborne):ingestionofpreformedneurotoxin; inactivatesproteinsthatregulateAch diplopia,drymouth,constipation,abdpain,dizziness,b/l release;similartotetanusbutstaysat weaknessandflaccidparalysis NMJ,irreversible,protectedbynontoxic infant"floppybaby":ingestionofsporesinhoney wound:similartoonestasfoodbornebutlessGIsxand proteinsduringGIpassage longerincubation inhalation:rapidonsetandhighmortalitiy

C.botulinum

Motile

C.Septicum ;gasgangrene,septicemia

Clostridum strictanaerobe inabilitytoreduce sulfatetosulfite

C.tetani

Motile

Tetanolysin:oxygenlabilehemolysin (inhibitedbyoxygenandserum cholesterol) Tetanospasmin:plasmidencoded,heat labileA/Bneurotoxin;nonconjugative (nontoxicstrainscannotbeconverted totoxigenic);neurotoxinproduced duringstationaryphaseofgrowthand releasedduringcelllysis

tetanus:tetanospasmin:bindstosialicacidreceptoron motorneuron,travelstocellsomaandcreatespore allowingAsubunittoentercytosol;Aiszincendopeptidase whichcleavescoreproteinsinvolvedwithneurotransmitter insoil release;inactivatesreleaseofinhibitoryNTs(GABA, glycine),resultsinirreversibleunregulatedexcitatory synapticactivity=spasticparalysis

C.difficle

Motile

Enterotoxin(toxinA):chemotacticfor neutrophilsstimulatinginfiltrationof PMNsintoileumwithreleaseof cytokines;cytopathiceffect:resultingin antibitoicassociateddiarrhea:510days/pabxtx Surfacelayerproteins(SLPs):binding disruptionoftightcellcelljxn, pseudomembranouscolitis:profusediarrheaabd permeabilityofintes nalwall ofC.difftoepithelium cramping,fever,whitishplaquesoverintactcolonictissue resultingindiarrhea Cytotoxin(toxinB):causesactinto depolymerizeresultingindestructionof cellularcytoskeleton

partofnormalflora;patienton abxallowsc.diff toovergrow

Family Gram+rods

Organism

Physiology/Metabolism/Dx

VirulenceFactorsStructural

VirulenceFactorsToxins

Disease

Transmission/reservoir

Notes

faculativeintracellular organism;coccibacilli, Listeria (monocytogenes) motile, coldenrichment,hemolytic, +CAMP,endoverend movement

Primarysource:soilanddecaying vegetablematter;contaminated Earlyonsetdisease(granulomatosisinfantiseptica): milk,softcheese(goatcheese), acquiredtransplacentallyinutero,disseminatedabscesses undercookedmeat(turkeyfranks, andgranulomasinmultipleorgans;highmortalityrateif coldcuts,microwavedbeef), nottreated unwashedrawveggies,cabbage; Lateonsetdisease:acquiredatorshortlyafterbirth(23 cangrowinwidepHrangeand weeks);presentsasmeningitisormeningoencephalitiswith coldtemps(cangrowduring septicemia prolongedrefrigation);15%of peoplearefecalcarriers

L.monocytogenes :worsewithdefective cellularimmunity(transplants,lymphomas, AIDS);thisisintracellularwithin macrophagesandthereforeavoidantibody mediatedclearance;alsooccursin neonates,elderly,andpregnantwomen

Erysipelothrix rhospathrae

Catalase+aerobic

faculativeanaerobe

Erysipelod:painful,puriticinflammatoryskinlesion,with raisedviolaceousedgeandcentralclearing;adiffuse cutaneousinfectioncandeveloprarelywithsystemicsx; lesionsMConfingersorhandsandslowspreads Septicemic:bacteriainbloodendocarditis(acuteor chronic);rarely:abscesses,meningitis,osteoomyelititis

Occupational:mostlyonwildand domesticanimals:butchers,meat processors,farmers,poultry workers,fishhandlers,vets; Cutaneousinfectionsdevelopafter organismisinoculated subcutaenouslythroughand abrasionorpuncturewound duringhandlingofcontaminated animalproductsorsoil

Nonsporeforming pleomorphicrod, cysteinetelluritebloodagar Cornyebacterium (characteristicgraytoblack diptheriae color), Tinsdale colistinnalidixicagar(CNA), PCR(testsfortoxgene)

diphtheriatoxin:(exotoxin)produced atsiteofinfectionandspreads;tox Respiratorydiphtheria:24dayincubationperiod, geneintroducedvialysogenic organismsmultiplylocallyinpharynxandcauselocalized bacteriophage damage2*toexotoxin;suddenonsetofmalaise,sore A/Bsubunits:B:bindstoheparin bindingepidermalgrowthfactor(MCon throat,exudativepharyngitis,lowgradefever pseudomembrane:composedofbacteria,lymphocytes, heartandnervecells);A:catalytic regionterminatesproteinsynthesisby plasmacells,fibrin,deadcells,*bleedswhenremoved inactivatingelongationfactor2(EF2) recoveryinoneweek Diptheriatoxinrepressor(DTxR):binds sequelea:myocarditis,neurotoxicity toandpreventstoxinproductionin presenceofhighiron

humansonlyreservoir(in oropharnyxoronskin) transmittedP2Pviarespiratory droplet

Nocardia

Filamentous(beaded filaments),strictaerobe, poorlystaining,weaklyacid fast,aerialhypahe;catalase+, oxidase+,slowgrowingon bufferedcharcoalyeast extract[BCYE],whiteto orangecolor

pulmonarynocardia

generallyfoundinimmunocompromised patients: Tcelldeficiences:leukemia,AIDs immunosuppressivetherapy: corticosteroids,renal,cardiac,marrow transplants

Actinomyces Anerobic,filamentous

Filamentous(beaded filaments),strictanerobe, slowgrowing,formssulfur granules,whitecolonieswith domedsurface,"molar" appearance

cervicofacial:MC,slow,painless,tissueswellingwith fibrosisandscarring,drainingsinustractsalongangleofjaw thoracic:abscessesinlung pelvis:vaginitis,tubovarianabscessesorurethral obstruction CNS:solitarybrainabscess(meningitis,subduralempyema, epiduralabscess)

commonlycausestransient,insignificant bacteremiafromoropharynxorGItract

Family

Organism Gramdiplococci

Physiology/Metabolism/Dx

VirulenceFactorsStructural

VirulenceFactorsToxins

Disease

Transmission/reservoir

Notes

Hasoutermembrane,LPS:LipidAisendotoxincomponentthatcausesfeverandshock,polysaccharide,Oantigenisimportantsurfaceantigen;periplasmicspacesiteoflactamases

Maltoseandglucose oxidizer

N.meningitis

capsule:antiphagocytic(calssifiedinto serogroupsbasedondifferent capsules) LOS:causeshemorrhage,sepsis,and encapsulated, petechiae,andTNF(lacksOantigen) maltoseandglucoseoxidizer, releasesmembraneblebs nonmotile IgA1protease:cleavesIgAinhalf intracellulardiplococci, Pili:allowsattachmenttohuman oxidase+, nasopharyngealcells,undergoes catalase+, antigenicvariationtoavoidimmune chocolateagarorThayer system;pilinsmediateattachmentto MartinVCN, nonciliatedepithelialcells,interfers keepmoistandwarm withneutrophilkilling;lackof immunitytoreinfection2*toantigenic variation. PorAandPorB:antigenicvariation; porinproteinsthatallowsfornutrients inandwastesout nasopharyngealcells,undergoes antigenicvariationtoavoidimmune system;pilinsmediateattachmentto nonciliatedepithelialcells,interfers withneutrophilkilling;lackof immunitytoreinfection2*toantigenic variation. IgA1protease:cleavesIgAinhalf LOS:causeshemorrhage,sepsis,and petechiae,andTNF(lacksOantigen) releasesmembraneblebs PorB:promotesinvasioninto epithelialcells;interfereswith degranulationofneutrophils;resistant tocomplementmediatedserumkilling Opaprotein:(opaticyproteins) membraneproteinsthatmediatefirm bindingtoepithelialandphagocytic cells;integraltocelltocellsignaling, appearopaquewheninculture (opaqueinlocalizeddiseases& transparentinPIDordisseminatedds) Rmpproteins(reductionmodifable proteins):stimulateantibodiesthat blockserumbactericidalactivity receptorsfortransferrin/lactoferrin/ hemoglobin

Capsule:diseaseoccursintheabsenceofspecific antibodiesagainstthecapsuleandotherantigens:children <2yrshavegreatestincidenceofdieaseduetolackof antibodies;alsorequirescomplementactivity;capsuleis indestructiblebyphagocyticvacuolesandallowsfor migrationtosubepithelialspaces DIC:occurswithmeningococcemia(septicemia)

transmissionviarespiratory droplet humansonlynaturalcarriers; nasopharynx closequarters:collegestudentsin dormsandmilitarybarracks

Antigenicvariation: Pili:Lackofimmunitytoreinfection PorA/PorB:unabletomakevaccine canbetreatedwithPCN

Neisseria facultativeintracellular organim, oxidase+, catalase+

N.gonorrhoea Glucoseonlyoxidizer

glucoseonlyoxidizer, nonmotile intracellulardiplococci, oxidase+, catalase+, chocolateagarorThayer MartinVCN, keepmoistandwarm needsCO2

gonorrhealurethritis(note:onlyinfectsendocervical Asxcarriageismorecommonin columnarepithelialcellsandnotsquamousepithelialcells womanthanmen inpostpubescentwomen) primarilysexualcontact purulentarthrtisinsexuallyactivepatients

PCNnolongerdrugofchoicbecauseonly somestrainsaresusceptible,butthe amountrequiredhasincreased Frankresistancehasbecomecommondue to:1)lactamaseproduction,2) chromosomallymediatedchangestoPBPs andcellwallpermeability

Family Grambacilli

Organism

Physiology/Metabolism/Dx ENTERICS

VirulenceFactorsStructural

VirulenceFactorsToxins

Disease

Transmission/reservoir

Notes

enteritis,mostcommoncauseofUTIinsexuallyactiveF(P pili), Capsule:pna,neonatalmeningitissepticshock,HUS hospitalacquiredgramnegative rod

Escherichiacoli Indole+

Lactosefermenter

LipidA(LPS) Capsule(Kantigen):protectsfrom facultativeanaerobic, phagocytosis glucoseandlactose TypeIIIsecretionsystems:facilitates fermenting, secretionofbacterialvirulencefactors hemolytic siderophores:ironchelating oxidasenegative, compounds catalasepositive, Oantigen:extpartofLPS indole+, Hantigen:flagella motile P.Pili:adhesinsthatallowsE.coli to greenmetallicsheenonEMB, remaininurinary/GItract;Ppili=P lightpurpleonMacConkey) bloodgroupantigens Other:frimbriae,bundleformingpili, Serology:OandHantigens intimin,Ipaprotein,Drfrimbriae

ETEC(enterotoxigenicE.coli) Colonizationfactorantigens

Traveler'sDiarrhea:smallintestine,watery(secretory) diarrhea("ricewater"), N/V/cramps,lowgradetonofever; hypersecretionoffliudsandelectrolytes fecaloral,infantdiarrheaindev Heatlabiletoxin(LT):plasmidmediated;similartocholera countries toxinincreasewaterandNaClsecretion);(cAMP) Heatstabiletoxin(ST):similartoY.enterocoliticatoxin( cGMP),decreasesNaClabsorption

VibriocholeraandETEC Nocellinvasion:diarrheacausedby exotoxinwhichcauseselectolytesandfluid lossfromintestinalcells:waterydiarrhea withoutsystemicsymptoms(afebrile)

EHEC(enterohemorrhagicE.coli) bundleformingpili,intimin

Hemorrhagiccolitis:adheretocolonicepitheliumbutdo notinvade;Largeintestine;littleornofever;initially wateryandprogressestogrosslybloodydiahrreaand cramps; Shigaliketoxin(SLT/verotoxin):vialysogenic bacteriophage,inhibits60Sribosome,destroysglomeruli endothelialcells HUS:anemia,thrombocytopenia,renalfailure(0157:H7)

persontoperson <100bacteriacancausedisease hamburgermeat

EIEC(enteroinvasiveE.coli) invasiveplasmidantigen

adheretocolonicepitheliuminvademucosallayerand secretes: diseaseindevelopingcountries hemolysinA(HlyA) SLT1andSLT2whichleadstoinflammation,fever,watery diarrheadystenterywithleukocytesinstool Notoxin,waterydiarrheaandvomiting;plasmidmediated persontoperson,PEDS A/Ehistopathologywithdisruptionofnmlmicrovillus majorcauseofinfantdiarrheain impoverishedcountries structuremalabsorptionanddiarrhea lobarpneumonia:andcommunityandnosocomial"currant jelly"sputum,verycommoninalcoholicsanddiabetics hospitalacquiredgramnegative nosocomialUTI(hospitaladministeredabx,urinarytractis rod blockedbystoneorcatheter);sepsis2ndtoe.coli

EIEC,shigella,salmonellaenteritidis Invasionofintestinalepithelialcells:cell penetrationresultsinsystemicimmune responsewithbloodydiarrhea+leuks+ fever

EPEC(enteropathogenicE.coli) bundleformingpili,intimin nonmotile, largecapsulegivesmucoid appearance urease+ lightpurpleonMacConkey

Indole

Klebsiella pneumoniae

Capsule

K.granulomatis: granulomainguinale: causespainlessgranulomatousdiseaseof genitaliaandinguinalregion(donovanosis) K.rhinoscleronitis :granulomatouslesionof nose K.ozaerae ;chornicatropicrhinitis

Salmonellatyphi

motile, producesH2S, urease, HandViantigens, facultativeintracellular parasite

Salmonella enteritidis Oxidase

motile, producesH2S, urease, HandViantigens, facultativeintracellular parasite

PathogenicitiyislandI:invasion proteinsandtypeIIIsecretionsystems PathogenicitiyislandII:evadeshost immunesystemandtypeIIIsecretion system PathogenicitiyislandII:evadeshost immunesystemandtypeIIIsecretion system Pathogenesis:ingestion,attachedto mucosaandinvadeM(microfold)cells inPeyer'spatchesandenterocytes; remaininendocyticvacuoleand replicate;transportedandreleased intobloodorlymp

Septicemia:bacteremia,increasedriskinpeds,elderly,
andimmunosuppressed; Entericfever(Typhoidfever):leavesintestineinside macrophagestoliver,spleen,andmarrow,1014 incubation;nonspecificsx(GI:constipation;fever,malaise, myalgias,anorexia);persistx1week redmacules(rosespots) Carrierstate:canliveingallbladderforyears! survivesonlyinhumans commoninothercountries(Asia) fecaloral higherriskinasplenicpatients

Salmonellatyphi,Yersiniaenterocolitica, Campylobacterjejuni Invastionoflymphnodesandblood stream:abdpain,bloodydiarrheawith leuks,systemicsx:fever,HA,elevatedWBC (lymphadenopathy,bacteremia,sepsis)

Zoonotic:infectsbothanimalsand EIEC,shigella,salmonellaenteritidis Gastroenteritis:MCform;sxonset648hours;intialsx: humans Invasionofintestinalepithelialcells:cell N/V/nonbloodydiarrhrea,F,cramps,myalgias,HA;sx acquiredfromreptiles(turtles, penetrationresultsinsystemicimmune persist2daysto1weekwithspontaneousresolution;no snakes),poultry,eggs,anddairy; responsewithbloodydiarrhea+leuks+ abx(prolongscarrierstate);moresusceptiblewithimpaired consumptionofcontaminated fever gastricacidsecretion foodandwater;fecaloral

Family

Organism

Physiology/Metabolism/Dx

VirulenceFactorsStructural

VirulenceFactorsToxins

Disease

Transmission/reservoir

Notes

Shigllea dysenteriae

nonmotile(vs.motile Salmonella) doesnotproduceH2S,(vs. Salmonella) doesnotfermentlactose(vs. E.coli ) urease

TypeIIIsecretionsystem

Shigatoxin:A/Btoxin;Asubunit inactivates28SrRNAof60Sribosomal subunitwhichinactivatesprotein synthesis similartoEIECandEHEC

HumansonlyreservoirforShigella; epidemicsoccurinAfricaand CentralAmerica; Shigellosis:(pedsandMSM);initialwaterydiarrheathat EIEC,shigella,salmonellaenteritidis Endemicdiseaseiscommonin progressestoabdominalcrampsandtenesmusandbloody Invasionofintestinalepithelialcells:cell adultmalehomosexualsandin diarrhea(2*toinflamedcolonandunabletoreabsorb penetrationresultsinsystemicimmune householdcontactsofinfected fluids);fever,abdominalpain, responsewithbloodydiarrhea+leuks+ children Bacterialdysentery fever Persontopersonviafecaloral Neverconsideredpartofnormalflora route requireslessthan200bacteriato causedisease UTIandrenalcalculiStruvitestones(urease+),causes alkalineurine P.Vulgaris

Proteusmirabilis

urease+, swarminggrowth

fimbriae

Vibriocholerae

Commashapedwithsingle polarflagella flatyellowcoloniesonTCBS Opolysaccharide0140,only01and agar 0139havecholeratoxin,01isMCC survivespoorlyinacidicordry environments,alkaline peptonebroth

Choleragen:A/Btoxin;BbindstoGM1 gangliosideintestinalepithelialcells;A activatesGprotein,adenyalycyclases andcAMP,secretesNaandCland inhibitsreabsorption>osmoticfluid loss (similartoLTofe.coli,exceptthisis chromosomal)

epidemiology:growsinesturaine andmarineenvironment; Cholerae:60%mortaliltyunreated,and<1%iftreated; flourishesinwaterswithshellfish contaminatedfood/water;abruptonsetofwaterydiarrhea (oysters,clams,mussels);canbe andvomiting23daysafteringestion;"ricewaterstool:" carriedonasxpts stoolbecomescolorless/odorless,freeofprotein,speckled spreadbycontaminatedwater withmucusandfecesstreaked;severefluidandlytesloss andfood,nopersontoperson leadingtodehydration spread;poorsanitation; highinoculationrequired

VibriocholeraandETEC Nocellinvasion:diarrheacausedby exotoxinwhichcauseselectolytesandfluid lossfromintestinalcells:waterydiarrhea withoutsystemicsymptoms(afebrile)

bluegreencentersonTCBS Vibrio (thiosulfatecitratebilesalts parahaemolyticus sucroseagar)

MCCofgastroenteritisinJapan,SoutheastAsia:self limiteddiarrheatomildcholeralikeillness;572hour incubationwithexplosivewaterydiarrhea;HA,abd cramps,N/V,lowgradeF,maypersistfor72hoursormore Woundinfections

Gastroenteritis:impromperly cookedseafood Woundinfections:expsoureto contaminatedseawater

Vibriovulnificus Oxidase+

Severewoundinfections:2030%mortality;initialswelling, Woundinfections:contaminated erythema,painvesicles/bullaeandtissuenecrosis seawater Primarysepticemia:50%mortalitiy;suddenonsetfever, Septicemia:consumptionof chills,vomiting,diarrhea,abdpain,secondaryskinlesions improperlycookedseafood withnecrosis

Pseudomonas aeruginosa

Lactosenonfermenter

gramrodsarrangedsingly andinpairs,withbluegreen coloniesandfruity(sweet grapelike)odor,requires aerobicincubation, oxidase+, growsrapidlywithflat coloniesandspreading border, hemolytic

1)flagellaand2)piliactasadhesion andhelpwithmotility 3)LPSendotoxin 4)capsuleformedbyalginate mutationofporinproteinsmajor mechansimofresistance ExotoxinA;(mostimportant):disrupts lacmtamses proteinsynthesisbydisablingEF2 TypeIIISecretorysystem (dermatonecorsis,cornealdamage, Pyocyanin:bluepigmentthatcatalyzes pulmtissuedamage) productionofsuperoxideandH2O2and ExoenzymesS/T:causesactin rearrangementthatleadstoepithelial attractsneutrophils Pyoverdin:yellowgreenpigmentthat celldamagethatfacilitatesbacteral spread,tissueinvasion,andnecrosis regulatessecretionofotherfactors PhospholipaseC:heatlabilehemolysin thatbreaksdownlipidsandlecithin tissuedescruction LasA(serineprotease)andLasB(zinc metalloprotease):degradeselastin Alkalineprotease:

Nature:soil,decayingorganic matter,vegetation,water Hospital:moistreservoirsfood, cutflowers,sinks,toilets,mops, respiratorytherapy,dialysis equipement rareasnormalflora(onlyin hospitalizedor immunocompromisedpatients)

Burkholderiacepacia :respiratorytract infectionscommoninpatientswithcystic fibrosisorchronicgranulomatousdisease Stenotrophomonasmaltophilia: occursin debilatedpatientswithimpairedhost defenses;resistanttolactamand aminoglycosideantibitoics;patientsonlong termabxtherapyatrisk;commonlyfoundin hopsitaldisinfectantsolutions,respiratory machines,monitoringequipment,ice machines Acinetobacter :growsonmoistanddry surfaces,partofnormalfloraof oropharyngealregion;atrisk:onbroad spectrumabx,recoveringfromsurgeryor onrespiratoryventilation

motileat25C,notat 37C

Yersinia enterocolitica

nonmotile,cansurvive refrigeration

VandW

Enterotoxin:activatesguanylatecyclase cGMPcotransportofNaCl Acuteenterocolitis:F,diarrhea,abdominalpainx12 intocellswaterremainsinlumen weeks;canbecomechronic;mimicsacuteappy waterydiarrhea similartoheatstabletoxinofE.coli;

Zoonotic:pigs contaminatedfoodandwater unpasteruizedmilk

Salmonellatyphi,Yersiniaenterocolitica, Campylobacterjejuni Invastionoflymphnodesandblood stream:abdpain,bloodydiarrheawith leuks,systemicsx:fever,HA,elevatedWBC (lymphadenopathy,bacteremia,sepsis)

Family

Organism

Physiology/Metabolism/Dx

VirulenceFactorsStructural

VirulenceFactorsToxins

Disease

Transmission/reservoir

Notes

Yersiniapestis Bipolarstaining

VandWantigens

Reservoir:rats Urbanplague:rats Vector:fleas/rats Reservoir:squirrels,rabbits,field Sylvaticplague:mammals rats,domesticcats Vector:fleas flea Bubonicplague:incubationperiodupto7days;highfever contaminatedanimalsandanimal NewMexicoandArizona andlargebubo(lymphadenopathyingroinoraxilla) tissue Pneumonicplague:(90%mortality)incubation23days;F, malaise,andpulmonarysxwithinoneday;highlyinfectious fleas

persontopersonvia
respiratorydroplet Pathogenesis:initialcolonizationfaciliated byblockageofacidproducingbybacterial acidinhibitoryprotein;neutralizationof gastricacidbyammoniaproducedby ureaseactivity(enhancedbyheadshock protein);highlymotilehelicobacterscan thenpassthroughthegastricmucusand adheretoepithelialcells Localizedtissuedamagemediatedbyurease byproducts,mucinase,phospholipase, vacuolatingcytotoxin protectedfromphagocytosisand intracellularkillingbyproductionof superoxidedismuatseandcatalase

curved,smallgrowthon Urease Campyagar,urease+,urea Heatshockprotein breathtest,WarthinStarry Acidinhibitoryprotein silverstainmostsensitive, Flagella gastricbx,antigendetection Adhesins Helicobacterpylori viastoolsample,Serologycan mucinaseandphospholipase demonstrateexposure,culturesuperoxidedismutase organismisadherentanddoes catalase notappearinstoolorblood; vaculotatingcytotoxin microaerophilic,catalase+, highlymotile

Acutegastritis:feelingoffullness,nausea,vomiting, hypochlorhydria; leadstohistologicalevidenceofgastritis(infiltrationof neurophilsandmononuclearcellsintogastricmucosa) Chronicgastritis:canbeconfinedtoantrumorpangastric Gastriculcers:causes85% Duodenalulcers:causes95% IncreasesriskforgastricCAandmucosaassociated lymphoidtissueBcelllymphomas

humansprimaryreservoir,fecal oral

Curved Microaerophilic AcuteenteritiswithD,malaise,fever,abdominalpain; mayhave>10BMperday,maybebloody MCCofgastroenteritisinUS producteshistologicdamagetomucosalsurfaeofjejunum, poultry,cattle,sheep ileum,colon;appearsulcerated,edematous,bloody,with cryptabscessesinepithelialglands AssociatedwithGBS 25%ofgastroenteritisinUSbutisMCCofgastroenteritis indevelopingcountries pigs,poultry,sheep,birds AssociatedwithGBS gastroenteritis,extraintestinalinfections dogs,cats systemicsxincludingsepticemia,septicthrombophlebitis, arthritis,septicabortion,meningitis;morecommonin cattle,sheep debiliatedandimmunocompromised

C.jejuni thin,curved(commashaped), gramrod, oxidize+ unabletoferment carbohydrates. Microaerophilicgrowth, motileviapolarflagellum acquiredfromingestionof contaminatedfood/water, unpasteurizedmilk persontopersonuncommon infectiousdoseishighunless decreasedgastricacid worldwidedistribution

Campylobacter

Salmonellatyphi,Yersiniaenterocolitica, Campylobacterjejuni Invastionoflymphnodesandblood stream:abdpain,bloodydiarrheawith leuks,systemicsx:fever,HA,elevatedWBC (lymphadenopathy,bacteremia,sepsis)

C.coli C.upsaliensis C.fetus

Capsuleantiphagocytic polysacchariderichcapsule producesblackpigmenton fimbriaeadherence Bacteroidesfragilis bileesculinagar,growsrapidly shortchainfattyacidproduced (<2days); duringmetabolsimandinhibits largecapsulegivesthatgives phagocytosisandintracellularkilling mucoidappearance;catalase+ catalaseandsuperoxidedismutase Onlygramwithoutendotoxin(NO LipidA)

Strictanaerobe

varietyofcytotoxicenzymescause tissuedestruction,inactivate immunoglobulins,andresistoxygen toxiciity B.fragilistoxin(BFT)somestrains majorityofintrabdominalinfections createheatlabilezincmetalloprotease diarrhealdiseasesomestrains toxincausesdiarrhealdisease (changesofintestinalepitheliumand stimulationofClsecretionandfluid loss;IL8inducedinflammation

normalGIflora,mouth,vagina, skin,softtissue

Family

Organism Gramcoccobacilli,pleomorphic

Physiology/Metabolism/Dx

VirulenceFactorsStructural

VirulenceFactorsToxins

Disease

Transmission/reservoir

Notes

Hasoutermembrane,LPS:LipidAisendotoxincomponentthatcausesfeverandshock,polysaccharide,Oantigenisimportantsurfaceantigen;periplasmicspacesiteoflactamases small,gramrod,facultative anaerobe,hemophilus, requireshemin(X)andNAD(V) LPSendotoxin factors,chocolateorlevinthal polysaccharidecapsulesixantigen agar,satellitephenomenon serotypeswithBmostcommon (cangrowarounds.aureuson unheatedagar),growsbetter anaerobically Vaccine:firstpolysaccharidevaccinenot epidemiology:colonizedin protectiveforchildrenyoungerthan18 Morelabstuff: mucosalmembranesofrespiratory months;Purifiedpolyribosephosphate H.aegyptius :chocolateagarwith1%isoVitaleXandCO2 tract (PRP)antigenconjugatedwithprotein incubationx24d nonencapsulatedstraincommonly carrierselicitsresponseininfants2months H.ducreyi :bestongonococcalagarwith12%hemoglobin, foundinupperresptract,earand andolder 5%fetalbovineserum,IsoVitaleX,andvancomycin, sinusinfectionscommoninpeds, infectionsnowoccurinnonimmunechildren incubatedat33degreesCin510%CO2for7days andelderlyadults;innonvaccinated pulmdiseasecommoninelderly countriesstillverycommon

X&Vfactorsrequired

Haemophilus influenzae

charcoalyeastwith ironandcysteine Respiratorydroplet

Legionella pneumophila

shortcoccobacilli,dieterle silverstain,facultative intracellularparasites,culture onbufferedcharcoalyeast extract(BCYE),canuseantigen tests,ornucleicacid amplicationtests

Pontaiacfever:HA,muscleache,andfatiguefollowedby F/C;suddenonsetandresolvesinoneweek Legionnaires'disease:highfevers,severepna,HA, confusion,myalgia,cough,hyponatremia,diarrhea,abd pain;verycommoncauseofCAP

Pathogenesis;bindtoC3bon mononuclearphagocytes Foundinmoistenvironmentsandcan endocytosis;phagolysosomefusion surviveinhightempsandchlorine;canlive isinhibited;chemokinesand inbiofilm cytokinesstimulatesevere capableofsporadic,epidemic,and inflammatoryresponserequires nosocomialinfections cellmediatedimmunityand inferferongamma

BordetGengou

Filamentoushemagglutinin(FHA): verysmall,strictaerobe, Pertusistoxin:A/Bsubunit;inactivates bindstosulfatedglycoproteinson oxidizeAA,nonmotile,does Giproteinsuninhibitedadenylate membranesofciliatedrespiratorycells notferment,collectonCalcium cyclasecAMPlymphocytosis, intraches;initiatesphagocytosis phagocytosis Bordetellapertusis alginateordacronswabs, withoutinitiatinganoxidativeburst; Reganlowemedium,room Trachealcytotoxin:lowlevelsresultsin protectsagainsthumoralantibodies; c temp,prolongedincubation, ciliostasisandhighlevelsdestroy AntiFHAantibodiesaregeneratedby PCRmostsensitive(negative: ciliatedcellsdecreasesmucus vaccine clearanceandresultsinwhooping urease,growthonsheepblood Extraadenylatecyclase:cAMPand cough orMacConkey) decreasesphagocytosis

Whoopingcough: 1)Catarrhalstage;mostcontagious,mostbacteria,similar toURI,lasts12weeks 2)Paroxysmalstage:repetitivecoughsfollowedby inspiratorywhoop;lasts24weekslciliatedepithelialcells areextrudedfromresptractandmucusclearanceis impaired,havemarkedlymphocytosis 3)Convalescentstage:paroxysmdiminish,secondary complicationoccurincludingpna,sz,encephaolopathy,no longercontagious

Humanreservoirhost,worldwide distribution;children<1yearat greatestrisk;diseaseMCin adolescentsandadults; transmissionviarespiratory droplets;710dayincubation period

Vaccine: 1)wholecell,inactivatedvaccine:high levelsofcomplicationsandnolongerused inUS 2)Acellularvaccines:administeredin combinationwithvaccinesfortetanusand diphtheria=DTaP(children),Tdap(adult)

Family

Organism Gramcoccobacilli,pleomorphic

Physiology/Metabolism/Dx

VirulenceFactorsStructural

VirulenceFactorsToxins

Disease

Transmission/reservoir

Notes

Hasoutermembrane,LPS:LipidAisendotoxincomponentthatcausesfeverandshock,polysaccharide,Oantigenisimportantsurfaceantigen;periplasmicspacesiteoflactamases

Brucella Aerobic

B.melitenis: goatsandsheep; severediseasewithsevere Undulantfever:temperaturerisesduringthedayandfalls complications atnight;fever,malaise,chills,sweats,fatigue,weakness, B.abortus: cattleandamerican myalgias,anorexia,arthralgias,drycough,backache,HA, bison;milddisease(rarepus) B.suis: swine,reindeer,caribou; lympahadenopathy formationofdestructivelesions; Zoonotic:meatpackers,vets,farmers,travelers, prolongedcourse unpasteurizeddairyproducts(importedgoatcheese) B.Canis: dogs,foxes,coyotes;mild disease(rarepus)

requirescysteine

Francisella tularensis

Zoonotic

verysmall,faintlystaining, pleomorphine,nonmotile, facultativelyintracellular, strictlyaerobic,culture requirescysteine,chocolate agar,bufferedcharcoalyeast extract(BCYE);highly infectioussonotdone;>1 week

Capsuleantiphagocytic polysacchariderichcapsule

Tularemia(glandular,rabbit,tick,deerflyfever) Ulceroglandular:cutaneousulcerandlymphadenopathy Oculoglandular:eyeinvolvement,swollencervicallymph nodes Pneumonic:pulm Typhoidal:systemicsignsofsepsis OropharyngealandGi:s/pingestion

Epidemiology:rabbits,cats,hardticks, Pathogenesis; bitingflies Handlinginfectedrabbitsandcats reservoir:wildmammals,domesticanimals, andfrombitesofticksordeerflies; birds,fish,bloodsuckingarthropods intracellularpathogencansurvive subsptularensis restrictedtoNorthAmerica forprolongedperiodsin TypeAEast:Oklahoma,Missouri,Arkansas macrophagesof TypeAWest:aridregionfromRockyto reticuloendothelialsystembecause SierraNevadamountains itinhibitsphagosomelysosome subspholarctica inNorthernHemisphere fusion (rodentsandcats)

oxidase+,catalase+

Pasteurella multocida

small,facultativeanaerobic, fermentative,oxidaseand catalase+,growsaslarge, butterycolonieswithamusty odoronbloodagar,+indole production

cellulitiss/pcatbite

Acquiredfromanimalcontact: bites,scracthes,sharingfoodwith animals,aspirationofanimaloral secretions commonlyfoundinoropharynxof healthyanimals bitefromsandfliesAndes mountains

B.bacilliformis:

Bartoenlla silverstains

B.quintana:

Carriondisease:acutefebrileillnesswithsevereanemia (Oroyafever)followedbychronic,cutaneous,bloodfilled nodules(verrugaperuana) Trenchfever:severeHA,F,weakness,paininlongbones; feverrecursq5days Bacillaryangiomatossis:vascularproliferativediseasein immunocompromisedpatients;bodyaches,malaise, fatigue,weightloss,HA,fevers Subactueendocarditis:mildbutprogressive Catscratchdisease:chronicregionallymphadenopathy Bacillaryangiomatosis Subacuteendocarditis

fecesofhumanbodylouse

spreadfromcolonizedanimalsviadirect contactofinsectvectors

B.hensalae

catsandtheirfleas;carriedin felineoropharynx

Family

Organism Gramrandoms Cardiobacteriumhominis

Physiology/Metabolism/Dx

VirulenceFactorsStructural

VirulenceFactorsToxins

Disease

Transmission/reservoir

Notes

Hasoutermembrane,LPS:LipidAisendotoxincomponentthatcausesfeverandshock,polysaccharide,Oantigenisimportantsurfaceantigen;periplasmicspacesiteoflactamases presentin~70%ofhealthypeople; sxdevelopifpatienthas Subacuteendocarditis:mildprogressiveinfectionof preexistingheartdiseaseororal endocardium;fatigue,malaise,lowgradefever diease Dysgonicfermenter(DF1): colonizehumanoropharynx Dysgonicfermenter(DF2): colonizeoralcavitiesofdogsand cats;associatedwithbitewounds

Capnocytophaga MiscellaneousGram Bacilli

Streptobacillusmonoliformis

Opportunisiticinfections:peridonitis,septicemia, bacteremia,endocarditis

Porphyromonas

Ratbitefever:irregularfever,HA,chills,myalgia,arthralgia associatedwithrodentbite;maculopapularrashextending tohandsandfeet foundinnasopharynxofrats,small Haverhillfever:pharyngitisandvomitingassociatedwithh rodents,andinanimalsthatfeed bacteriainfoodandwater ontheserodents proteases:degradeimmunoglobulins pigmented,asaccharolyticrods fimbriae:adhesin capsule proteases:degradeimmunoglobulins Brainabscess:typicallyfromchronicsinusitisorOM,if bacteremicspreadfrompulmthenmultipleabsceses;ALL THREE Intraabdominalinfections;MCCB.fragilis; B. thetaiotaomicron,Prevotellamelaninogenica Bacteremia:B.fragilis 13%ofinfxns periodontaldisease,aspirationpna,abdominalandpelvic abscess,andOM oralcavity,GItract,respiratory tract,colon difficultyinlabdxofanaerobes: stainfaintlyandirregularly mustbecollectedinoxygenfreesystem keepmoist lysedbloodenrichedmediastimulate pigmentproductioninPorphyromonas and Prevotella

Prevotella AnaerobicGramBacilli

Fusobacterium

verysmall

respiratorytract;femalegenitalia

elongatedrods

respiratorytract