ALL BACTERIA

BACTERIA CHARACTERISTICS DISEASE RESERVOIR / TRANSMISSION VIRULENCE / PATHOGENESIS CLINICAL DIAGNOSIS TREATMENT

penicillin + β
lactamase inhibitor
gram (-) aerobic
Moraxella otitis media, respiratory bronchitis or pneumonia in pts with underlying mostly skipped, blood or (amoxicillin-clavulanic
diplococcus. Oxidase normal flora β-lactamase
Catarrhalis sinusitis in children droplets chronic lung disease chocolate agar acid), 2nd, 3rd gen
(+)
cephalosporin, TMP-
SMX, macrolide

Strep throat →
Streptococcal gram (+) coccus in rheumatic fever, normal flora, LTA, surface proteins F and M, hyaluronic acute inflammation of pharynx and tonsils, sore treat to prevent acute
respiratory β-hemolysis on blood
pyogenes (group A chains or pairs. acute post- infected acid capsule, streptolysin, exo-enzymes, throat, fever, exudative tonsillitis, anterior cervical rheumatic fever:
droplets agar, bacitracin sensitive
antigen) catalase (-), lactose (+) streptococcal persons pyrogenic exotoxins lymphadenopathy, scarlatiniform rash or fever penicillin
glomerulonephritis

Loeffler medium,
Heat-labile A-B antitoxin serum
pseudomembrane → obstruction and suffocation, selective tellurite
exotoxin, ADP therapy + antibiotics
sore throat and pharyngitis, low grade fever, regional medium (- extra flora) -->
Corynebacterium gram (+) club-shaped normal flora, respiratory ribosyl transferase exotoxin → cell (penicillin or macrolides:
diphtheria lymph nodes swollen - bull neck. Toxin: myocarditis & black colonies with dark
diphtheriae rods, aerobe humans only droplets (blocks protein syn), death, necrosis erythromycin)
cardiac dysfunction, laryngeal nerve palsy, lower limb halo. Toxin detection:
diphtheria toxin is DTaP
polyneuritis Eleck immunodiffusion
invasive vaccine
test

charcoal-blood agar
gram (-) cocco-
attachment, immobilization, destruction Catarrhal stage: 1-2 wk, highly communicable, (Bordet-gengou potato erythromycin
bacillus, strict aerobe, whooping cough - respiratory
Bordetella pertussis humans only (murein) of cilia, Fha, Ptx (AB toxin - ↑ paroxysmal stage: 2-4 wk, paroxysmal cough, agar) , pearl-like colonies, DTaP
mucosal surface pertussis droplets
cAMP), pertactin, pili whoop. Convalescent stage: wks to mn direct fluorescence vaccine
pathogen
antibody test

CXR, PPD: >5mm = (+) in isoniazid, rifampin

ACID-FAST, rod
primary TB: Ghon complex, progressive primary HIV, >10mm = (+) in high- (4m), pyrazinamide
shaped, obligate reservoir - Inhalation of Mycolic acid, sulfolipids, cord factor,
Mycobacterium (active) TB, latent dormant TB, secondary risk. >15mm = (+) in low- (2m), ethambutol
aerobe, very slow tuberculosis infected infectious tuberculin + mycolic acid - DAMAGE
tuberculosis (reactivation) TB: apex. Productive cough - bloody risk, ziehl-Neelson stain,
growth, facultative humans aerosols DONE BY HOST IMMUNE SYSTEM
RESPIRATORY

sputum, fever, weight low, night sweats Lowenstein-Jensen BCG Vaccine,

intracellular
medium isoniazid prophylaxis
Haemophilus
otitis media, amoxicillin +
influenzae (non- gram (-) pleomorphic sinusitis, bronchitis normal flora
chocolate agar (X and V clavulanic acid
encapsulated) rod, small, facultative
lipopolysaccharides, IgA protease, infants: passive maternal protection, poor response factors), satellite
anaerobe. requires epiglottitis, 3rd gen cephalosporin
Haemophilus polysaccharide capsule first 2 years, > 5 - disease uncommon phenomenon, latex
growth factor X (hemin) pneumonia,
influenzae (Hib) asymptomatic carriers agglutination test - PRP
and V (NAD, NADP) meningitis, septic Hib conjugate
arthritis, cellulitis vaccine
OM: amoxicillin +
clavulanic acid.
lancet-shaped, gram community- polysaccharide capsule, autolysin, α-hemolytic on blood
Streptococcus Pneumonia/meningitis:
(+) diplococcus or in acquired normal flora, respiratory pneumolysin O, peptidoglycan/ teichoic agar, not typeable (A/B),
pneumoniae rusty sputum, typical lobar pneumonia 3rd gen cephalosporin +
chains, fermentation pneumonia, OM, humans only droplets acids, adhesins, GOOD AT PICKING UP Optochin-sensitive, bile
(pneumococcus) vancomycin
metabolism adult meningitis DNA soluble, surface capsule
PPV,
PCV7 vaccine
smallest free-living
"walking human
Mycoplasma bacteria, NO CELL p1 adhesin, toxic metabolic products: Eaton's media (sterols),
pneumonia", respiratory aerosol droplets hacking cough, dry → productive, slow resolution tetracycline or macrolide
pneumoniae WALL, pleomorphic, hydrogen peroxide and superoxide radicals serological tests
tracheobronchitis tract
no gram stain

macrolides
Chlamydophila small obligate pneumonia or respiratory serological tests, isolation (azithromycin) or
infected humans 2 stages: elementary body (EB):
species INTRACELLULAR bronchitis droplets is difficult tetracyclines
pathogen, gram (-), not infectious, survive outside, non (doxycycline)
asymptomatic to pneumonia or bronchitis,
seen on gram stain, cell reproductive. Reticulate body (RB):
wall lacks peptidoglycan parrot fever, complications: atherosclerotic vascular diseases
zoonotic inhalation of dried noninfectious, intracytoplasmic,
Chlamydophila layer, unable ot make psittacosis, reproductive form serodiagnosis by tetracycline or
pathogen, secretions from
psittaci ATP - energy parasites ornithosis, complement fixation test erythromycin
mainly birds birds
pneumonia

weakly gram (-) rods, inhalation of BYCE (buffered charcoal

pneumonia,
water organisms (45C), contaminated low virulence, biofilms, prevents yeast extract), requires L- macrolides
Legionella Legionnaire's biofilms in fever, chills, non-productive cough, chest pain, HA,
complex nutritional aerosols, no phagosome-lysosome fusion, lung cys, Fe, pH 6-9, slow (erythromycin), Pontiac
pneumophila disease and Pontiac water sources mental confusion, diarrhea
requirements, aerobic, person-to-person damage and inflammatory response growth 2-5 days, SILVER fever - self-limiting
fever
motile transmissions STAIN

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BACTERIA CHARACTERISTICS DISEASE RESERVOIR / TRANSMISSION VIRULENCE / PATHOGENESIS CLINICAL DIAGNOSIS TREATMENT
enterobacteriaceae capsule, endotoxin - necrotic destruction
Klebsiella pneumonia, UTI, human colon and URT, from own hacking cough, dry → productive, slow 3rd gen
family, gram(-) rod, of alveolar spaces, abscesses, resistance mucoid colonies
pneumoniae lactose (+) septicemia flora resolution. DM at high risk cephalosporins
plasmids

blue-green colonies,
pili, capsule, endotoxin: lipopolysaccharide, fever, productive cough, weight loss, breathing antipseudomonal PNC
gram(-) rod, aerobic, respiratory pyocyanin, polyverdin,
Pseudomonas opportunistic ubiquitous in tissue damage: exotoxin A (AB - ↓ protein difficulties and cyanosis, complications: malignant (carbenicillin) +
motile, minimal secretions, direct or fluorescein (green),
aeruginosa pathogen environment syn), exoenzyme S, elastase, alkaline otitis externa (DM), colonization of cystic fibrosis aminoglycoside
nutritional requirements contact, fomites fruity aroma, mucoid, UV
protease, cytotoxin, hemolysin patients (tobramycin)
light
RESPIRATORY

Burkholderia melioidosis, acute

pseudomallei pneumonia
opportunistic soil, ponds, β-lactams or
inhalation,
gram (-), aerobic rod pathogen - same as rice paddies, unknown resembles TB - abscesses and granulomas tetracyclines, high
Burkholderia inoculation
P. aeruginosa, zoonotic mortality if untreated
cepacia
causes serious
infections
soil, water, sewage, animals,
nosocomial infections
Acinetobacter spp gram (-) coccobacilli normal skin, GI tract of pts or pneumonia, wound infections, UTI, sepsis case-by-case
in immunodeficient pt
health care workers
fluoroquinolones
aerobic gram (+), (ciprofloxacin)
polypeptide capsule, spore, exotoxin: box car chains, large
Bacillus anthracis spore forming, anthrax ubiquitous, zoonotic dermal, respiratory, GI anthrax, possible sepsis cell-free
EF, LF, PA (adenyl cyclase) nonhemolytic colonies
nonmotile vaccine - used in high-
risk

UTI, diarrheas/ MacConkey agar: lactose

Enterobacteriaceae gram (-) rods, facultative anaerobes,

FimH (cystitis) - FIMBRIAL ANTIGEN, P-

dysentery, Neonatal (+) - pink, EMB agar -
Escherichia coli motile, lactose (+) normal flora pilus (nephritis), capsule, hemolysin,
meningitis, LACTOSE (+): blue-black
aerobactin, LPS
URINARY TRACT INFECTIONS

septicemia colonies
catalase (+), oxidase (-), nitrite (+)

UTIs, Lower
Klebsiella respiratory tract
non-motile, lactose (+) catheters capsule, pili, endotoxin MacConkey agar, mucoid
pneumoniae infection (lobar
pneumonia)
community/hospital
highly motile, lactose UTIs, pneumonia, peritrichous flagella - swarming, adhesins,
Proteus mirabilis normal flora MacConkey agar: clear
(-), urease (+) septicemia, wound endotoxin
infections
common cause of
Enterobacter lactose (+), motile nosocomial normal flora and environment adhesins, capsule, endotoxin TMP/SMX - UTIs in
infections hospital and community,
acute uncomplicated UTI, acute uncomplicated
Serratia nosocomial Fluoroquinolone -
lactose (+) normal flora and environment adhesins, capsule, endotoxin pyelonephritis, complicated UTIs, asymptomatic brick-red colonies
(marcescens) infections complicated UTI,
bacteriuria, renal abscess
Cephalosporin -
gram (+) cocci,
Staphylococcus UTIs sexually active γ-hemolysis, novobiocin pregnancy
clusters, catalase (+), endogenous adhesin, inflammation response
Saprophyticus young women resistant
coagulase (-)
URINARY TRACT INFECTIONS

Enterococcus nosocomial
infections, UTI, normal flora
faecalis (80%) gram (+) diplococci or γ or α hemolytic, resistant
endocarditis (pt with
short chains, catalase to 40% bile salts, 6.5% to
damaged heart adhesins, toxins, enzymes
(-), Lancefield's group NaCl, bacitracin and
valves), wound
Enterococcus D antigen Optochin.
infections, normal flora
faecium (20%) bacteremia

blue-green colonies,
aerobic gram (-) rod, pyocyanin, polyverdin,
Pseudomonas opportunistic polysaccharide capsule, endotoxin,
motile, oxidase (+), ubiquitous in environment or fluorescein (green),
aeruginosa infections adhesin, exotoxins
lactose (-) fruity aroma, mucoid, UV
light
CARDIOVASCULAR
INFECTIONS

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BACTERIA CHARACTERISTICS DISEASE RESERVOIR / TRANSMISSION VIRULENCE / PATHOGENESIS CLINICAL DIAGNOSIS TREATMENT

Multiple (+) blood cultures (3-5 sets taken), if (+) for same organism - sensitivity testing. Culture (-): recent
Protein A - (-) phagocytosis. Fibrinogen-
gram (+) cocci, binding protein - clumping factor. methicillin
mannitol-salt agar:
Staphylococcus clusters, catalase (+), infective Coagulase - fibrin clot. Cytotoxic toxins - complications: embolization from infective resistant, some
normal flora yellow colonies, β-
aureus coagulase (+), salt endocarditis, etc… pore-forming toxins. Enterotoxins A-E: endocarditis to parietal lobe, to lung vancomycin

Native valve IE: PNC + gentamycin. IV drug use: nafcillin + gentamicin. Prosthetic valve IE: vancomycin + gentamicin
hemolysis
tolerant, mannitol (+) gastroenteritis, TSST-1, Exfoliations - skin emerging

antibiotic use, fastidious organisms, fungi. Echocardiography - vegetations

infections

catheter and
gram (+) cocci, prosthetic device no hemolysis,
Staphylococcus
clusters, catalase (+), infections, IE in IV normal flora biofilm NOVOBIOCIN vancomycin
epidermidis
coagulase (-) drug users and sensitive
prosthetic valve IE
CARDIOVASCULAR INFECTIONS

most common
gram (+) cocci,
Viridans cause of subacute low virulence, dextran-mediated
chains, catalase (-), α-hemolytic,
Streptococci (many, IE in pts with adherence - biofilm → damaged heart
lack capsule and normal flora, dental caries Optochin resistant,
do not need to abnormal or valve surfaces, FimA surface adhesin, lack
lancefield antigens, no not bile soluble
identify) damaged heart capsule
serologic group
valves

nosocomial
Subacute IE: w/n 2 weeks of dental or other
gram (+) cocci, single infections, UTIs,
Enterococcus procedure, low grade fever and chills, fatigue, not bile soluble, major resistant
cells, diplococci or wound infections,
faecalis (was anorexia weight loss, new or changing heart growth in 6.5% problems for
short chains, catalase bacteremia, normal intestinal flora
classified as murmurs, skin lesions. NaCl, α or γ- antibiotic
(-), lancefield antigen: endocarditis in pts
streptococcus) Acute IE: acute onset of high-grade fever and hemolysis problems
group D with damaged heart
chills, rapid onset of CHF, murmurs can be absent
valves

gram (+) cocci, chain,

catalase (-), lancefield not bile soluble, no
Streptococcus antigen: group D, also subacute infective growth in 6.5% sensitive to
normal intestinal flora associated with colon cancer
Bovis named non endocarditis NaCl, α or γ- penicillin
enterococcal group D hemolysis
organisms

IE in IV drug users
aerobic gram (-) no fermentation,
Pseudomonas and patients with
motile rod, oxidase ubiquitous in environment produces pigments
aeruginosa prosthetic heart
(+) - BLUE-GREEN
valves.
Haemophilus
CARDIOVASCULAR INFECTIONS

ORGANISMS: HACEK

aphrophilus
OTHER GRAM (-)

Actinobacillus
actinomycetemcomi
tans fastidious organisms; requires 5-10% carbon
subacute IE (5%), complications may include massive arterial emboli and congestive heart failure
dioxide for growth + 3 wks incubation
Cardiobacterium
hominis
Eikenella corrodens
Kingella kingae
Bartonella species B. quintana most commonly involved homeless males with poor hygiene, must be considered in cases of culture-negative endocarditis among individuals whoa re homeless
most common combo: Pseudomonas +
Polymicrobial IE 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
Fungal endocarditis
valve IE and fungal prosthetic valve IE are: Candida spp, and Aspergillus spp.
SKIN INFECTIONS

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 ALL BACTERIA

BACTERIA CHARACTERISTICS DISEASE RESERVOIR / TRANSMISSION VIRULENCE / PATHOGENESIS CLINICAL DIAGNOSIS TREATMENT

fibronectin-binding proteins, collagen

folliculitis, furuncles, binding proteins, clumping factors (A, B),
gram (+) cocci, Furuncles, carbuncles - neck, face, axillae, MSSA: nafcillin,
carbuncles, teichoic acids, capsule, protein A - binds
Staphylococcus clusters, catalase (+), human skin buttocks. NTSS associated with tampons, scalded β-hemolysis, mannitol MRSA: vancomycin,
impetigo, scalded person-to-person Fc, prevents complement, enzymes,
aureus coagulase (+), salt and mucosa skin syndrome in neonates, bullous impetigo is salt agar, 7.5% NaCl VRSA: linezolid,
skin syndrome, toxi exotoxins, inflammatory response,
tolerant, mannitol (+) localized form. Synercid, daptomycin
shock syndrome superantigen: TSST-1, enterotoxins,
ETA, ETB, exfolatins produce bullae

M-protein, F-protein and lipoteichoic acid, HONEY CRUSTED LESIONS - involves dermal
impetigo, erysipelas,
gram (+), chain normal flora, hyaluronic acid capsule, streptococcal lymphatics, pain and systemic manifestation,
Streptococcus cellulitis, necrotoxic respiratory
forming cocci and infected pyrogenic exotoxins, superantigens, necrotizing fascitis "flesh-eating bacteria", scarlet β-hemolysis penicillin, macrolide
pyogenes fasciitis - gangrene, droplets
diplococci persons streptolysin S + O, exoenzymes, fever: strawberry tongue, diffuse erythematous rash,
scarlet fever
peptidoglycan + teichoic acids TSS
SKIN INFECTIONS

blue-green colonies,
antipseudomonal
aerobic gram (-) blue-green pus, grape-like odor, inflamed follicles pyocyanin, polyverdin,
Pseudomonas "Hot tub: folliculitis, capsule, biofilm, lipopolysaccharide and penicillin (carbenicillin) +
motile rod, oxidase ubiquitous from neck down, shallow puncture wound or fluorescein (green),
aeruginosa burn wounds lipid A, A-B toxin, exoenzymes, pili aminoglycoside
(+) through tennis shoe sole fruity aroma, mucoid, UV
(tobramycin)
light

paucibacillary/tuberculoi
Paucibacillary (tuberculoid) leprosy: central d: Dapsone + rifampin
obligate intracellular parasite of
Mycobacterium healing, low infectivity, few rods, DTH to lepromin. no growth on medium or ~6 months.
acid fast bacillus Leprosy reservoir: humans macrophages and Schwann cells.
Leprae Multibacillary (lepromatous) leprosy: infectious, tissue culture Multibacillary/lepromato
DAMAGE FROM HOST RESPONSE
many rods, (-) lepromin us: Dapsone + rifampin
+ clofazimine ~2 years

"box car chains" culture:

ubiquitous, zoonotic, lives in soil, large colonies; NON-
vegetative form, dormant spore, cutaneous anthrax: erythematous papule, black fluoroquinolones
Bacillus anthracis gram (+) rod, spore anthrax causes anthrax in animals and HEMOLYTIC, M'Fadyean
polypeptide capsule, PA, EF, LF eschar surrounded by edema (ciprofloxacin)
humans methylene blue stain or
DFA
WOUND
INFECTIONS
culture under anaerobic
necrotizing and hemolytic toxins: conditions, Iron Milk
large gram (+) rods,
myonecrosis "GAS LECITHINASE ~ PHOSPHOLIPASE C ~ marked gas formation, "crepitance in tissue", Medium @ 45ºC → surgery, amputation,
Clostridium spore, strict
GANGRENE", ubiquitous in soil, flora ALPHA TOXIN - splits phospholipid systemic signs: fever, hemolysis, hypotension, renal stormy fermentation, penicillin, hyperbaric O2
perfringens anaerobes, lactose
cellulitis molecles., enterotoxins, DNase, failure, shock, death blood agar - characteristic chamber
(+) only
hyaluronidase double zone of
ANAEROBIC GRAM (+)

hemolysis

anaerobic conditions,
sulfur granules. long
gram (+) rods, granulomatous lesions, suppurative, abscesses,
Actinomyces part of oral, intestinal and vaginal branching filaments, slow surgical drainage,
facultative or strict actinomycosis low sulfur granules: YELLOW PUS, dental extraction
(israelii) human flora growth ~2 weeks, white penicillin or amoxicillin
anaerobes or trauma
colonies: molar tooth
appearance
WOUND INFECTIONS

anaerobic conditions,
brain abscesses, sinusitis, endocarditis, gram (+) in pairs or
Pepto- gram (+) cocci, infection at normally part of normal human flora; oral, penicillin + broad
osteomyelitis, intraabdominal infections, pelvic chains, rich media for
streptococcus anaerobic sterile sites GI, GU, skin spectrum
infections, skin and soft tissue infections culture, long incubation
time 5-7 days
ANAEROBIC

Bacteroides fragilis,
GRAM (-)

Fusobacterium pleomorphic
mixed, skin and soft- normal human capsule, fimbriae, succinic acid, illness when native host defenses and anatomical anaerobic culture, foul
nucleatum, anaerobic gram (-) endogenous metronidazole, surgery
tissue infections flora extracellular enzymes barriers are altered, progress to myonecrosis odor
Prevotella rods
melaninogenica

gram (-) coccobacilli,

Pasteurella localized cellulitis and flora of amoxicillin + β-lactam
small, facultative animal bites systemic infection in immunocompromised pts
multocida lymphadenitis animals inhibitor
anaerobes

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BACTERIA CHARACTERISTICS DISEASE RESERVOIR / TRANSMISSION VIRULENCE / PATHOGENESIS CLINICAL DIAGNOSIS TREATMENT
rods in lymph nodes,
cat scratches, cutaneous papules or pustules at inoculation site →
gram (-) rods, short, reservoir: culture usually negative,
Bartonella henselae cat-scratch disease bites, contact painful regional lymphadenopathy, Bacillary antibiotics not indicated
aerobes animals definitive dx by serologic
with fleas angiomatosis in IC - pts
tests

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BACTERIA CHARACTERISTICS DISEASE RESERVOIR / TRANSMISSION VIRULENCE / PATHOGENESIS CLINICAL DIAGNOSIS TREATMENT

culture: requires salt for

growth media:
WOUND

gram (-) rods, curved, wound infections after exposure to contaminated

Thiosulfate citrate bile tetracycline
Vibrio vulnificus facultative anaerobe, necrotic cellulitis found in salt water, oysters polar flagella, polysaccharide capsule seawater - necrotic cellulitis, gastroenteritis and
salts sucrose agar (doxycycline)
oxidase (+) septicemia after consumption of raw oysters
(TCBS), ID - biochemical
tests
SYSTEMIC
INFECTIONS

Clinical presentation +
Tick
5-10 days incubation. EARLY: Flu-like symptoms; Serologic tests (indirect
Wild rodents, (Dermacentor), Mortality: 5-7%
Rocky mountain LATER: petechial-hemorrhagic rash (first on immuno-fluorescence
Rickettsia rickettsii domestic American dog Infect vascular delayed therapy to Tetracycline
spotted fever (April extremities → spread to entire body); various organs assay) (high Ig titers by
(Spotted fever group) animals (dogs), tick (eastern US), endothelial cells → 2nd week, ~25% if (doxycycline)
→ Sept) failures (2nd & 3rd febrile day). Fever + Rash + the 7th day of illness); PCR
ticks Rocky Mt wood (1) induced untreated.
Previous tick bite (most rapid and specific);
tick (western US) endocytosis (2) lysis
Rickettsial Diseases/Rickettsiosis

Immuno-staining (70%)
of phagosome
membrane -
phospholipase A (3)
replication in host cell Phase1: (~1 wk) local proliferation → eschar at bite
Tetracycline
cytoplasm (4) lysis of site; Phase2: (~3-7d) dissemination → flu-like
Rickettsia akari Wild rodents, Mouse mite benign, self-limited (doxycycline) +
Rickettsialpox symptoms + fever + generalized rash (randomly
(Spotted fever group) rodent mites (transovarian) host cell → vascular disease, not fatal chloramphenicol can
damage distributed, papulovesicular → eschar, exanthem ~
speed recovery (benign)
(hemorrhage, chicken pox)
edema), LPS - weak
endotoxin activity, (~8d) Flu-like symptoms; maculopapular rash (first Clinical presentation +
Epidemic typhus, vasculitis and Serologic tests, typhus Tetracycline
on trunk → spread to extremities); complications:
Rickettsia Brill-Zinsser exit: cell lysis (indirect fluorescent (doxycycline) or
small gram(-) rods; Humans; flying Human body thrombosis (around myocarditis, CNS dysfunction; Recrudescent
prowazekii disease all the body). Mortality: antibody test, latex chloramphenicol,
take gram staining squirrels louse typhus = (10-40 yrs later) endogenous secondary
(Typhus group) (Recrudescent IMMUNITY: both 10-60% if untreated agglutination tests). NO vaccine for high-risk
weakly; obligate infection by R. prowazekii persisting in
typhus) humoral and cell STAIN - pop
INTRACELLULAR reticuloendothelial cells
mediated important - INTRACELLULAR Tetracycline
Rickettsia typhi pathogens; zoonotic Endemic typhus mortality rate - rare (1-2 wk) Same as Epidemic typhus but milder; rash
after recovery - solid
SYSTEMIC INFECTIONS

pathogens Rats Rat flea (doxycycline) and

(Typhus group) (Murine typhus) and lasting immunity even with untreated not always present
chloramphenicol
(1-3 wks) Necrotizing eschar at bite site; flu-like
Orientia Mite larva Tetracycline
Rodents, mortality ~30% in symptoms; maculopapular rash (first on trunk →
tsutsugamushi Scrub typhus (chigger) (doxycycline) or
rodent mites untreated spread to extremities) + generalized
(Scrub typhus group) (transovarian) chloramphenicol
lymphadenopathy
mononuclear
Ehrlichia Human Monocytic leukocytes
Deer, dogs Lone star tick
chaffeensis Ehrlichiosis (monocytes,
Infect leukocytes → macrophages)
(1) phagocytosis (2)
Similar to RMSF but generally without rash, 5-10 Clinical presentation +
Ehrlichiosis

Inhibition of
granulocytes days, leukopenia, thrombocytopenia, elevated liver Microscopy: Giemsa
Sheep, cattle, phagosome-
Anaplasma Black legged tick (neutrophils > enzymes. Severe: prolonged fever, renal failure, stain. (Morulae) + Tetracycline
rodents, lysosome fusion +
phagocytophila (Ixodes) eosinophils) (higher disseminated intravascular coagulopathy, Serologic tests: IFA (high (doxycycline)
Human bisons, deer… multiplication in
morality ~ 10%) meningoencephalitis, adult respiratory distress IgM or IgG titers by the 2nd
Granulocytic cytoplasmic vacuoles
syndrome, seizures, coma. Mortality ~2-3% wk of illness), PCR
Ehrlichiosis - Morula (3) Host cell
+ phagosome lyses same - pts with
Ehrlichia ewingii Dogs, ticks Lone star tick underlying immuno-
suppression

Infect
macrophages=> (1) Acute: tetracycline
Serologic tests - antigenic
Small gram(-) Sheep, goats, phagocytosis (2) resistant to heat (doxycycline); Chronic:
variation => acute
pleomorphic rod; cattle (excreted phagosome- and drying, (doxycycline +
Inhalation of dust Flu-like symptoms, rarely rash; pneumonia; disease: high titer of
intracellular pathogen Q. fever; Chronic Q in milk, urine, lysosome fusion; but Proliferation in quinolones for 4 yrs or
Coxiella burnetii containing hepatitis; endocarditis (Chronic form - 1-20 y, high phase II antigen; chronic
with extracellular fever (Endocarditis) feces, amniotic bacteria survive and respiratory tract then doxycycline +
pathogen mortality ~65%) disease: high titers of
"spore-like" form; fluids and multiply inside acidic dissemination to hydroxy-chloroquine
phase I and II antigens;
zoonotic pathogen placenta phagolysosome (3) other organs 1.5 to 3 yrs), vaccine for
PCR
Host cell + high risk pop
phagolysosome lyses

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BACTERIA CHARACTERISTICS DISEASE RESERVOIR / TRANSMISSION VIRULENCE / PATHOGENESIS CLINICAL DIAGNOSIS TREATMENT

Virulence plasmids; Changes in genes

expression in response to environmental
changes (1) Changes in flea behavior:
Bubonic plague: flu-like symptoms; Multiplication of
Enterobacteriaceae

Gram(-) rod, lactose yersinia murine toxin (survival), low T -

bacteria in regional lymph node => suppurative Serologic tests: direct
(-), oxidase (-), fibrinolysin & phospholipase
Wild Flea bite; direct lymphadenitis = "Bubo" (~70% M untreated); immunofluorescence test
catalase (+), (agglutination); (2) Survival in human body: Streptomycin,
Plague: Bubonic, rodents contact; Pneumonic plague: flu-like symptoms + cough, (rapid, presence of F1);
coagulase (+), Capsule (F1 protein), plasminogen tetracycline, and
Yersinia pestis Pneumonic & (Sylvanic respiratory bloody sputum, dyspnea and cyanosis (2-3rd day microscopy: gram stain or
nonmotile, bipolar activator: prevents opsonization, important chloramphenicol, isolation
Septicemic cycle); Urban droplets (only death due to septic shock); Septicemic plague: Giemsa - bipolar
staining; facultative for dissemination (3) Damage: Type III for 72 hours
rats (Urban pneumonic bacteremia without buboes => flu-like symptoms+ staining, culture: highly
intracellular pathogen; secretion system (Yop proteins: Lcr,
cycle) plague) bleeding into skin and other organs => dark infectious
zoonotic pathogen Ysc) suppress cytokine production,
discoloration (40% M in treated, 100% in untreated)
cytotoxic effect; endotoxin (septic shock);
yersiniabactin (obtain iron from host);
intracellular grow in reticuloendothelial cells

Small gram(-) rod,

Infects reticuloendothelial organs:
aerobe, require Tick or fly bite, Serologic tests; PCR,
multiplication in macrophages, hepatocytes Ulceroglandular form: 75% painful ulcerating lesion
cysteine, facultative direct contact, gram stain unsuccessful,
and endothelial cells => necrosis and at site of infection; Oculoglandular form: 1%
Francisella intracellular pathogen; Tularemia (rabbit or Wild animals, inhalation, requires cysteine-
granuloma production in areas of purulent conjunctivitis + lymphadenopathy; also Streptomycin
tularensis zoonotic pathogen, deer fly fever) ticks, deer fly ingestion of glucose blood agar - tiny
multiplication; Survival: inhibition of Pneumonic, Gastrointestinal & Septicemic forms
oxidase (-), urease (-), contaminated transparent colonies,
phagosome-lysosome fusion; (10-15%, more severe). Untreated ~5-30% M
nonmotile, thin lipid food or water culture is hazardous
antiphagocytic lipid capsule
capsule
Serologic tests,
Small gram(-) rods, Multiply in microscopy: insensitive,
Direct contact, Inhibit phagosome- Flu-like symptoms; night sweats (undulant fever);
strict aerobes, macrophages in culture: difficult and
Brucella spp. inhalation, lysosome fusion; Chronic illness: body aches, headache, anorexia,
facultative intracellular Domestic reticuloendothelial hazardous. B abortus - Doxycycline +
(abortus, melitensis, Brucellosis ingestion of impair cytokine depression… few physical findings unless
SYSTEMIC INFECTIONS

pathogens, zoonotic livestock system => needs CO2, antigen A, (-) rifampin (for 6 weeks)
suis) unpasteurized production; enlargement of reticuloendothelial organs. (M is low
pathogens, no capsule, granulomas => by dye thionine, B.
dairy products endotoxin <25)
no spore septicemia Melitensis - antigen M, B.
Suis - (-) by fuchsine
Serologic tests; PCR,
Trench fever,
4 fever patterns: (1) asymptomatic with 1 episode; (2) fastidious growth
Small gram(-) rod; bacillary Contaminated Prolonged bacteremia, WWI, now amongst
3-5 days single febrile episode; (3) multiple recurrent requirements, difficult
Bartonella quintana aerobe, zoonotic angiomatosis, Humans, lice louse feces homeless, little is known, biopsy of skin Erythromycin
febrile episodes "5-day fever"; (4) persistent fever for culture, blood of chocolate
pathogen subacute (scratching) does not reveal organisms
2-6 weeks. agar, 5% CO2 with high
endocarditis
humidity for 4 weeks

OspA (in tick), OspC

Stage1 (localized infect.): erythema migrans (bull's CDC:ELISA or IFA then Tetracycline
(in mammals); toxic
eye appearance) + flu-like symptoms; Stage2 Western blot, serologic - (doxycycline),
LPS; downregulation
Lyme disease Black legged Tick bite (disseminated infect.): cardiac and neurologic (nerve later stages, culture - not amoxicillin, or
Borrelia burgdorferi Spiral morphology, Antigenic variation - of immune functions;
large; motile; slow tick (Ixodes) escape immune palsies) abnormalities; Stage3 (persistent infection): rec, OCT - not cefuroxime, Vaccine no
possible autoimmune
growth; gram(-), clearance, fluctuating arthritis. standardized longer available
response
zoonotic pathogens, modulation of host
hard to isolate in immune system -
Spirochetes infections

culture, complex inhibition of

nutritional needs, Crushing infected mononuclear and
flexible peptidoglycan Epidemic Relapsing Human body natural kill cell Endotoxin (febrile
Borrelia recurrentis louse + illness); Recurrent
cell wall around which Fever louse function, anti-OspA Microscopy (during
scratching episodes of fever +
several axial has autoimmune High fever, headache, muscle pain, weakness. 2-4 febrile period) Giemsa or Tetracycline
endoflagella are wound activities septicemia separated
days between relapses; 2-3 relapse cycles; possible Wright staining; Serologic (doxycycline) or
by afebrile periods;
myocarditis. tests unhelpful (because erythromycin
new set of surface
Endemic Relapsing of antigenic variation)
other Borrelia spp. Tick Tick bite antigens at each
Fever relapse

Culture: from blood, CSF

Direct contact
Spiral morphology; both during septicemic phase;
with urine, blood
motile; slow growth; febrile: Septicemic phase: flu-like symptoms; from urine during immune
Shed in urine or tissues of Multiply in blood and tissues; damage
Leptospira gram(-) but not seen Immune phase: anicteric form (possible meningitis), phase; slow growth, Penicillin or
Leptospirosis of infected infected animals; endothelium of small blood vessels; no
interrogans on gram stain; zoonotic icteric form or Weil's disease (jaundice, renal + special media, PCR - not Doxycycline
animals Contact with virulent factors known
pathogen, tight pulmonary dysfunctions, subconjunctival widely available.
contaminated
terminal hooks hemorrhage) Serologic tests:
water
agglutination test

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BACTERIA CHARACTERISTICS DISEASE RESERVOIR / TRANSMISSION VIRULENCE / PATHOGENESIS CLINICAL DIAGNOSIS TREATMENT

Cfa (colonization factor antigen) -

adherence; ST (heat stable toxin) -
guanylate cyclase activation → ↑ [cGMP];
ETEC Fluoroquinolones
Watery Diarrhea - Small intestine disease - No invasion, no inflammation

Human's LT (heat labile toxin, AB toxin) - ADP

EnteroToxigenic E. Traveler's Diarrhea Fecal-oral Watery diarrhea, abdominal cramps Immunoassays (ciprofloxacin),
intestine ribosylates G protein → activation of
coli TMP/SMX
adenylate cyclase → [↑cAMP]; High cGMP
or cAMP → hypersecretion of H2O and Cl;
↓ in Na reabsorption

Enterobacteriaceae;
Motile; lactose(+) Fecal-oral, LOW Bfp (Bundle-forming pilus) - adherence;
EPEC in infants Type III secretion system → cytoskeleton Fluoroquinolones
Human's
EnteroPathogenic E. Watery diarrhea (person-to- proteins modification in host cell; Attaching Watery diarrhea, abdominal cramps (INFANTS) Immunoassays (ciprofloxacin),

Fluid+electrolyte replacement
intestine
coli person); high in and effacing lesions → changes in TMP/SMX
adults microvilli → malabsorption

EAEC Bfp (Bundle-forming pili) → Chronic watery diarrhea (in AIDS patients), Fluoroquinolones
Human's
EnteroAggregative Chronic diarrhea Fecal-oral autoagglutination "stacked-brick" abdominal cramps, dehydration in infants and Immunoassays (ciprofloxacin),
intestine
E. coli arrangement + biofilm → malabsorption children ~ growth retardation TMP/SMX

Yersinia Invade M cells: Yops and Type III Watery diarrhea, abdominal cramps, fever;
Enterobacteriaceae; Fluoroquinolones
enterocolitica (Y. Watery diarrhea, Animal's secretion system; gene expression under mesenteric lymphadenitis (mimics acute appendicitis)
Bipolar staining; Fecal-oral Stool culture at 25°C or doxycycline +
pseudotuberculosis - gastroenteritis intestine Ca and T control, virulence genes, spread other: arthritis, intra-abdominal abscess, septicemia,
lactose (-), zoonotic gentamycin
uncommon) Æ microabscesses in lymph nodes osteomyelitis

Tcp (toxin coregulated pilus) - adherence;

Warm costal Ctx (cholera toxin, AB-toxin, on lysogenic
Vibrio Cholerae Ingestion of TCBS (Thiosulfate citrate
Cholera and water, CTXФ phage) - ADP ribosylates G protein Profuse watery diarrhea; "rice-water" stools; severe Ciprofloxacin or
(serogroups O1 and Curved gram(-) rods; contaminated bile salts sucrose agar) -
facultative gastroenteritis asymptomatic → constant activation of adenylate cyclase dehydration → hypovolemic shock doxycycline
O139) water or shellfish yellow colonies
carriers → ↑cAMP → hypersecretion of H2O and Cl;
GI INFECTIONS

anaerobes,
oxidase(+), motile decrease in Na reabsorption
(polar flagella)
Warm costal Ingestion of
Vibrio TCBS - blue-green
Watery diarrhea water (marine contaminated Enterotoxin - chloride secretion Watery diarrhea, abdominal cramps, nausea Self-limiting
parahaemolyticus colonies; Halophilic
life) seafood

Attaching & Effacing lesions (no Antibiotic therapy

Enterobacteriaceae; Fecal-oral, LOW
EHEC Hemorrhagic Colitis; invasion); Shiga toxin (AB toxin) - cleaves Culture on MacConkey not
Motile; lactose(+), Intestine of → person-to- Bloody diarrhea (no leucocytes), abdominal cramps,
EnteroHemorrhagic Hemolytic Uremic rRNA → blocks protein synthesis → cell agar (sorbitol(-)); recommended;
sorbitol(-) - "spinach cattle person vomiting; oliguria+renal failure (HUS)
E. coli (O157:H7) Syndrome (HUS) death; circulating shiga toxin can bind to Immunoassays dialysis in HUS
outbreak" transmission
renal tissue → renal failure (HUS) cases
Watery to Bloody Diarrhea - Large Intestine

Invasion and destruction of colonic Fluoroquinolones

EIEC EnteroInvasive Enterobacteriaceae; Human's Bloody diarrhea with pus, fever, abdominal cramps, Immunoassays, sorbitol
Dysentery Fecal-oral epithelium, virulent plnv genes, (ciprofloxacin),
E. coli Motile; lactose(+) intestine nausea (-), glucuronidase (-)
INACTIVATE RIBOSOMAL SUBUNITS TMP/SMX

Fluid + electrolyte replacement

Invasion of colonic mucosa through M cells;
Fecal-oral, LOW
Enterobacteriaceae; Invade basal surface of enterocytes → cell Hektoen enteric agar: Fluoroquinolones
Shigella spp. (S. Dysentery, shigellosis Human's → person-to- Bloody diarrhea with pus, fever, abdominal cramps,
Non-motile; death + inflammation, focal ulcer; shiga- lac(-), H2S(-) → green (ciprofloxacin),
sonnei) (gastroenteritis) intestine person nausea (first watery then blood mucoid stools)
lactose(-) toxin, cleaves rRNA - HUS (see above), colonies TMP/SMX
transmission
acid resistant, endotoxin

Fecal-oral;
Salmonella enterica Dysentery-like Intestinal tracts ingestion of Hektoen enteric agar: Fluoroquinolones
Enterobacteriaceae; contaminated food Bloody diarrhea with pus, fever, abdominal cramps,
(enteritidis & diarrhea; possible of animals and (eggs, poultry) or Ruffles, invasion, inflammation lac(-), H2S(+) → blue (ciprofloxacin),
Motile; lactose(-) nausea
typhimurium) bacteremia humans water; direct colonies with dark center TMP/SMX
contact with reptiles

Fecal-oral;
Thin gram(-) rods; ingestion of
contaminated food Bloody diarrhea with pus, fever, abdominal pain; Culture (microaerophilic Fluoroquinolones
Campylobacter spiral shape; Dysentery-like Animal's Invasion of intestinal mucosa; virulence
(poultry), milk or Complications: Guillain-Barre syndrome, Reactive conditions - ↑ T - 42°C, (ciprofloxacin) or
jejuni microaerophile; diarrhea intestine water; direct factors poorly defined
arthritis blood or charcoal media) erythromycin
oxydase(+), contact with pets,
LOW

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BACTERIA CHARACTERISTICS DISEASE RESERVOIR / TRANSMISSION VIRULENCE / PATHOGENESIS CLINICAL DIAGNOSIS TREATMENT

Invasion of M cells; Multiply in

Fecal-oral; Mod- Sustained fever and headache; possible rash and/or Culture from blood or
Enterobacteriaceae; Non- macrophages; bacteremia and invasion of Fluoroquinolones
low (possible diarrhea; persistent bacteremia → myocarditis, feces, Hektoen enteric
Salmonella typhi motile; Typhoid fever Humans only RES (mesenteric lymph node, liver, spleen); (ciprofloxacin),
person-to-person encephalopathy…constipation more common, agar: → blue colonies
lactose(-) infection of gallbladder (carrier state); TMP/SMX
trans) diarrhea = late in disease with dark center
Capsule (Vi polysaccharide); endotoxin

Mucous layer invasion (Mucinase,

Gram(-) rods; bacillary Gastritis, peptic ulcer, Biopsy=> microscopy, Proton pump inhibitor +
Stomach of phospholipase, flagella) + Alteration of
or spiral shape; gastric Fecal-oral; oral- culture, urease test; Stool clarithromycin +
Helicobacter pylori humans and gastric acid production (urease ->
microaerophile; adenocarcinoma, oral antigen test; Urea breath amoxicillin or
animals ammonium production) → Inflammation of
oxydase(+); urease (+) lymphomas test; PCR metronidazole
gastric mucosa → Tissue destruction

Ingestion of Heat-stable enterotoxin (if spore survive

Onset <6h after ingestion - Vomiting, nausea,
Emetic gastroenteritis Ubiquitous preformed toxin cooking → germination + toxin production in
abdominal cramps Isolation of organism from
Gram(+) rods, motile; (rice) non-refrigerated food) Self-limiting; Fluid +
Bacillus cereus implicated food, β-
spore forming Ingestion of food electrolyte replacement
Diarrheal Heat-labile enterotoxin (germination of Incubation time >6h - Watery diarrhea, nausea, hemolysis on blood agar
Ubiquitous contaminated
gastroenteritis spore + toxin production in intestinal tract) abdominal cramps
with spore
GI INFECTIONS

Ingestion of
Gram(+) cocci in Heat stable enterotoxin → acute Isolation of toxin
Staphylococcus Staphylococcal food Normal human preformed toxin Onset <6h after ingestion - Vomiting, nausea, Self-limiting; Fluid +
cluster, catalase(+); inflammation of gastric mucosa, small producing bacteria
aureus poisoning flora (potato salad, abdominal cramps and watery diarrhea electrolyte replacement
coagulase(+) intestine (mannitol salt agar)
custard…)

Antibiotic-associated Exposure to antibiotics → overgrowth of

Vegetative Watery diarrhea
diarrhea C. difficile (endogenous); Toxin A -
form: human
Enterotoxin: disrupts tight junctions Immunoassays (toxins
carrier; Spore Endogenous Discontinue implicated
Clostridium spp & GI infections

difficile between enterocytes + induces detection); colonoscopy

in environment infection antibiotic; vancomycin
Antibiotic-associated inflammation → watery diarrhea; Toxin B - (pseudomembrane)
(hospital
pseudomembranous cytotoxin: modification of enterocyte Profuse diarrhea, abdominal cramps, fever
rooms)
colitis cytoskeleton → cell death

Large gram(+) rods; Enterotoxin: alteration of membrane

Spore forming; Strict Watery diarrhea Watery diarrhea + abdominal cramps Self-limiting
Clostridium Soil and Ingestion of permeability in enterocytes Culture; Immunoassay
perfringens anaerobes human colon spore or bacteria (enterotoxin detection)
b-toxin (lethal toxin): necrotizing
Necrotizing enteritis Bloody diarrhea; abdominal pain; vomiting, peritonitis Penicillin
destruction of jejunum
Weakness, dizziness, then neurological features:
Botulism, Ingestion of Botulinum toxin=AB neurotoxin → blocks
Spores in soil blurred vision, drooping eyelids… respiratory
neuromuscular preformed toxin, release of acetylcholine from peripheral Clinical
and dust paralysis. THREE Ds: DIPLOPIA, DYSPHAGIA,
Clostridium paralysis LOW nerves → flaccid paralysis trivalent botulinum
DYSPHONIA
botulinum Ingestion of Germination of spores in colon → Antitoxin
Spores in soil Clinical + C. botulinum
Infant botulism spore (honey), multiplication of vegetative form → "floppy baby"
and dust found in feces
LOW neurotoxin production

high fever, HA, stiff neck. Infants: slow-appearing, irritable, vomiting, or

lancet-shaped, gram
Streptococcus
(+) cocci, chain or
pneumoniae meningitis in adults
diplo, catalase (-)
vancomycin + 3rd gen
gram stain: WBCs + cephalosporin
nasopharynx → infection of lung or
gram(+) cocci, (ceftriaxone or
eustachian tube → inflammation or OM →
Culture: mucoid, α- cefotaxime), Prompt txt
person-to-person bacteremia, meningitis. Polysaccharide
pneumococcal throat & acute onset, complications: mental hemolytic, Optochin of OM and respiratory
via respiratory capsule: antiphagotic, pneumolysin:
nasopharynx retardation, learning disabilities, deafness sensitive, bacitracin infections. VACCINES:
droplets transmembrane pore-forming toxin, IgA
resistant, bile 7-valent conjugated
protease, others: teichoic acid,
solubility (+), capsule vaccine, 23-valent
peptidoglycan fragment, hydrogen peroxide

CSF: WBCs, ↑proteins, ↓glucose

(+) quellung polysaccharide
vaccine.
Bacterial Meningitis
CNS INFECTIONS

poor feeding
cefotaxime or
aerobic gram (-) initial infection of upper resp tract → gram stain of CSF, ceftriaxone (10-15%
hemorrhagic skin rash (petechiae).
diplococci, attachment to non-ciliated cells of culture: Thayer- fatal, 100% if
Waterhouse-Friderichsen syndrome
Neisseria polysaccharide capsule meningococcal respiratory nasopharynx: pili, IgA protease Martin agar (mod untreated), antimicrobial
nasopharynx (ADRENALS), complications: 11-19%
meningitidis (A, B, C, Y, W135), meningitis droplets (colonization), capsule → invasion into chocolate agar) + 5% chemoprophylaxis:
permanent hearing loss, mental retardation,
flattened adjacent bloodstream → brain. Diffuse vascular CO2. MALTOSE & rifampin or ciprofloxacin,
etc
sides damage: endotoxins (LPS, LOS) GLUCOSE (+) VACCINES: MPSV4,
MCV4

Page 9 of 14
 high fever, HA, stiff neck. Infants:
poo

CSF: WBCs, ↑
Bacteri
CNS I ALL BACTERIA

BACTERIA CHARACTERISTICS DISEASE RESERVOIR / TRANSMISSION VIRULENCE / PATHOGENESIS CLINICAL DIAGNOSIS TREATMENT

culture: chocolate
direct contact
nasopharynx → invasion → bacteremia → agar, X and V cefotaxime or
gram (-) pleomorphic with respiratory initially: runny nose, low grade fever, HA,
Haemophilus Haemophilus human CNS. Pili, IgA protease, polysaccharide factors, gram (-) ceftriaxone, Hib
coccobacillus, droplets. Risk: complications: 20% - hearing loss, delayed
influenzae type b meningitis and sepsis nasopharynx capsule: type-b: poly-ribitol-phosphate, coccobacilli or conjugate vaccine.
capsule serovar b infants - young language development or mental retardation
endotoxin (LPS) - inflammation rods. Antigen Rifampin prophylaxis
children
detection, latex test

gram (+) cocci in

short chains, β-
Bacterial Meningitis in

hemolytic or PCR, latex particle

Streptococcus
nonhemolytic, group agglutination test of
agalactiae (Group B capsule rich in sialic acid, peptidase -

CAMP test
B lancefield capsular
Neonates

hemolytic infection during inactivates C5a, hydrolytic enzymes urine: rapid, CSF antiviral (acyclovir) +
antigen, bile nonspecific: fever, feeding difficulty, vomiting,
streptococcus) meningitis in delivery, and blood cultures, antibacterial
resistant, GI tract, vagina diarrhea, respiratory distress, irritability
neonates nosocomial CSF: difficult in (ampicillin +
polysaccharide alternating with lethargy
transmission neonates. Bacterial cefotaxime)
capsule culture from
mother.
gram (-) rod, K1
capsule (sialic acid, ~ meningococcus),
E. coli polysaccharide
pili
capsule

broad T range, motile at

Bacteremia: occult, proliferate in placenta. Neonatal:
pathogenic serotypes have unique teichoic 25˚C - "TUMBLING",
ingestion of early onset sepsis - "granulomatosis
host-dependent: acid, facultative intracellular pathogen: non-motile at 37˚C,
gram (+) rods, intestine of contaminated infantisepticum", late-onset meningitis: via vaginal
Listeria listerosis, sepsis, growth in cells, internalins: attachment and microscopy - wet mount, ampicillin +
catalase (+), β- animals and food, transmission. CNS: meningitis, encephalitis, brain
monocytogenes meningitis, fetal entry, listeriolysin O: pore-forming exotoxin, culture: blood agar, β- gentamicin
hemolysis humans transplacental, abscess in 10%. Febrile gastroenteritis (IC+), (IC-
loss ActA: actin polymerization: motile comet hemolytic, CSF:
during delivery and old: sepsis and meningitis, pregnant: flu-like
tails pleocytosis, ↑ protein, ↓
Other

illness, fetal loss.

CNS INFECTIONS

glucose

CXR, PPD skin test, Ziehl- ACTIVE: combo:

obligate aerobe, rod
reservoir - Inhalation of Neelsen stain = acid fast isoniazid, rifampin (4m),
Mycobacterium shaped, facultative tuberculous Mycolic acid, sulfolipids, cord factor, gradual onset (weeks), malaise, apathy, anorexia →
infected infectious stain. Culture confirms dx. pyrazinamide (2m),
tuberculosis intracellular pathogen, meningitis tuberculin + mycolic acid brain abscesses, spinal TB
humans. aerosols Lowenstein-Jensen ethambutol. LATENT:
acid-fast bacteria
medium = lipid rich isoniazid.

enter body via spore: survival in environment,

wound, tetanolysin (not sig), tetanospasmin: neutralization of
gram (+) rods, strict developing heat labile AB neurotoxin, blocks release unbound toxins (toxin
tetanus: severe painful spasms and rigidity of voluntary
anaerobes, no countries: non- of inhibitory NTs (GLYCINE)→ constant binding is irreversible),
generalized, spores: muscles, early = lockjaw, exg reflexes, muscle
Clostridium tetani capsule, motile, spore- sterile contraction (spasms), highly toxic. clinical supportive,
localized, cephalic, ubiquitous rigidity → apnea, fractures, dislocations, death from
forming - drumstick techniques, Anaerobic conditions → germination of metronidazole to
neonatal respiratory failure
Clostridium Spp

appearance umbilical stump spores, local bacterial multiplication, eliminate bacteria in

→ neonatal toxin production → enters nervous wound, Vaccine
tetanus system peripherally → carried to CNS

trivalent botulinum
botulism: spores survive spore, botulinum toxin: heat labile AB- weakness, dizziness, dryness of mouth (N and V),
antitoxin (A, B, E),
gram (+) rods, foodborne, infant, soil, sterilizing process neurotoxins, blocks release of Ach from neuro: B/L flaccid paralysis and motor and
mainly clinical, mouse respiratory support,
Clostridium fastidious, spore wound, contaminated and improper peripheral nerves → flaccid paralysis, type autonomic nerves, blurred/double vision, drooping
bioassay elimination of
botulinum forming, strict neuroparalytic foods canning A most significant in US, highly toxic. Path: eyelids, difficulty swallowing, speech, descending
bacteria: gastric lavage,
anaerobes illness procedures ingestion of preformed toxin weakness, respiratory paralysis
metronidazole or PNC

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BACTERIA CHARACTERISTICS DISEASE RESERVOIR / TRANSMISSION VIRULENCE / PATHOGENESIS CLINICAL DIAGNOSIS TREATMENT

α-hemolytic on blood agar

gram (+) diplococci or - large mucoid colonies,
Streptococcus polysaccharide capsule, autolysin,
chains, Optochin sensitive,
pneumoniae pneumolysin O
catalase (-) bacitracin resistant, bile
soluble
Empiric txt w/ topical
Acute Bacterial burning, irritation, tearing, mucopurulent
Hemophilus gram (-) pleomorphic Direct contact pili, lipopolysaccharides, IgA-specific chocolate agar (X & V antibiotics, Gati/levo/
Conjunctivitis discharge
influenzae rod protease, polysaccharide capsule factors) moxifloxacin
Bacterial Conjunctivitis: purulent discharge, conjunctival hyperemia

gram (+) cocci, protein A (inhibits phagocytosis),

Staphylococcus β-hemolysis, mannitol-salt
clusters, catalase (+), fibrinogen-binding protein (clumping
aureus agar, yellow colones
coagulase (+) factor), coagulase, cytotoxic toxins

Trachoma: leading cause of blindness in world,

trachoma, urogenital
Direct contact; hand to eye, mostly children, ~ poor hygiene. Chronic, inflam
infections
contaminated clothing, flies granulomatous dz of eye surface → corneal
(Sero A-C)
ulceration, scarring, pannus formation → blindness
Direct contact/newborn via birth canal →
from conjunctival fluid or
tropism for epithelial cells of conjunctiva; azithromycin or
surface scrapings; gram
small obligate intracellular pathogen (evades host doxycycline,
stain/culture; immuno-
Chlamydia INTRACELLULAR, no defense, killing host cell); LPS erythromycin
EYE INFECTIONS

fluorescence, cytologic
trachomatis PG layer; elementary (inflammation) → severe inflam response → (newborn).
exam (I)
& reticulate bodies necrosis, fibrosis, scarring
Adult: acute infections --> mucopurulent d/c,
inclusion
ocular-genital contact, acquired infiltrates, corneal scarring in chronic form; sexually
conjunctivitis
from infected mom active - preceded by genital infection. Newborn:
(sero D-K)
swelling of eyelids, copious purulent d/c

lymphogranuloma venereum
(sero L1 - L3)
at birth from infected mom → attach &
invade epithelial cells; Pili + PorB/Opa from conjunctival fluid or ceftriaxone;
Aerobic gram (-)
Gonococcal (adhesion/protection); IgA protease surface scrapings; gram Neonatorum
Neisseria diplococci, bean- acute purulent conjunctivitis acquired at birth: lid
ophthalmia (colonization); Antigenic variations → stain/culture; Thayer- prophylaxis: silver
gonorrhoeae shaped, no capsule, edema, erythema, marked purulent d/c
neonatorum escape immune surveillance; LPS & LOS Martin agar, GLUCOSE nitrate or erythromycin
facultative intracellular
(inflammation); no capsule → severe (+) or tetracycline
inflammatory response

Pseudomonas
bacterial keratitis, scleral abscess,
aeruginosa
Other Eye Infections

endophthalmitis
(gram (-) rod) Contact lens-related
Acanthamoeba spp. keratitis
Fungal infections immunocompromised
Toxocara canis Ocular toxocariasis - retinal detachment
Onchocerca
River blindness, sclerosing keratitis, chorioretinitis
volvulus
Loaloa African eye worm
Transmission

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F: Cervix, ~50% asymptomatic, Untreated → PID,

Gonorrhea
Aerobic gram (-)
Neisseria diplococci, bean-
gonorrhoeae shaped, no capsule,
facultative intracellular
Urethritis and Cervicitis, PID
ectopic pregnancy, salpingitis. M: Urethra, ~25%
asymptomatic, purulent urethral discharge and
strict human pathogen, sexual or
dysuria, Untreated → epididymitis, prostatitis,
intimate contact
periurethral abscesses. Both untreated → infertility,
pili: adhesion, inhibit disseminated infection, anorectal infection, gram smear from genital
phagocytosis. OMPs Attachment and pharyngitis, conjunctivitis and dissemination site in cytoplasm of
(outer membrane invasion of non
neutrophils, sensitivity third generation
proteins): serotyping, ciliated epithelial
spread of organisms along fever, lower abdominal pain, complications: and specificity: 95% in M, cephalosporins
Opa proteins - cells → survival in
PID fallopian tubes (salpingitis), pelvic adherence, antigenic infertility or ectopic pregnancy due to scarring of 50% in W, nucleic acid (ceftriaxone),
submucosa →
cavity (peritonitis, abscesses) fallopian tubes amplification tests, resistance to first line
variation, PorB - spread and
culture: Thayer-Martin drugs (also treat

prevent dissemination
both usually asymptomatic, tenesmus, discharge, agar (chocolate, chlamydia)
Rectal & Pharyngeal linked to sexual practice phagolysosome (inflammation and
rectal bleeding, sore throat antibiotics to normal flora,
fusion, IgA protease, local damage)
35°C + CO2)
LPS and LOS
ophthalmia acute purulent conjunctivitis, lid edema, erythema,
acquired at birth
neonatorum parked purulent discharge
disseminated
generally in women, leading cause of purulent
gonococcal
arthritis, large necrotic gray skin lesions
infections

spread by direct
EB: infectious, contact → tropism
outside, non- for epithelial cells (F: 3.3 F (15-19) > M. F: 70% asymptomatic, cervicitis ±
D-K: urogenital
reproductive, RB: endocervix, upper urethritis: mucopurulent discharge ± dysuria.
infections
Chlamydia noninfectious, genital tract in; both: Complications: PID (40% untreated), permanent
(noninvasive), A-C:
trachomatis intracytoplasmic, urethra, rectum, damage → chronic pelvic pain, infertility, and collection of epithelial
trachoma. Other: close personal contact
(all biovars but reproductive form. conjunctiva) → ectopic pregnancy. M: 25% asymptomatic, cells, direct
inclusion
L) Intracellular infection, severe urethritis: dysuria + thin urethral discharge, immunofluorescence: azithromycin or
conjunctivitis,
small obligate replication, no inflammatory complications: rare, spread to epididymis → pain, Ebs are bright yellow doxycycline. Pregnant
infant pneumonia
INTRACELLULAR, no phagolysosome response → fever, and sterility green dots under UV, and young children:
PG layer; elementary fusion, LPS necrosis, fibrosis, NAAT (urine), enzyme erythromycin. Follow-
& reticulate bodies scarring immunoassay, culture: up: repeat testing
iodine staining of glycogen (NAAT) 3 months
inclusion bodies - dark
L-serovar are invasive → travels via brown
lymphatics, multiply w/n mononuclear
Chlamydia L: Lympho- small painless ulcer at site of infection,
phagocytes in regional lymph nodes,
trachomatis granuloma sexual spontaneously heals. Second stage: inguinal
characteristic granuloma formation →
(L biovar) venereum adenopathy, painful buboes → draining fistulas.
necrotic lesions, inflammation spread to
surrounding tissues

tender papule with erythematous base → painful clinical, microscopy, DNA azithromycin,
Haemophilus small, pleomorphic, ulceration with associated inguinal probe, culture: relatively ceftriaxone,
Chancroid sexual contact
ducreyi gram (-) rods lymphadenopathy. F: often asymptomatic, often insensitive, require x factor ciprofloxacin, or
diagnosed in men for growth erythromycin

Primary: 1+ chancres at infection site, lots of

local primary spirochetes → painless ulcer, heals culture: no growth on
Genital Ulcers

infection: skin or spontaneously w/n 2 months, pt highly infections. artificial media,

only host = humans, mucosal → slow Secondary: dissemination: flu-like syndrome, microscopy: darkfield
outer membrane
susceptible to heat, drying and proteins: adherence, multiplication, lymphadenopathy, generalized mucocutaneous microscopy (live motile
Syphilis endarteritis & bacteria), direct
disinfectants, requires close hyaluronidase: maculopapular rash, 1/3 → condylomata lata,
thin, contact granulomas. highly infectious, resolve spontaneously → latent fluorescence antibody
perivascular
tightly coiled Dissemination stage (clinically inactive). Tertiary: diffuse, chronic test, silver staining.
Treponema pallidum infiltration, penicillin
spirochetes, not (lymph nodes and inflammation → neurosyphilis, CV syphilis, Serology: nonspecific
antigenically
intracellular blood), quiescent for gummas (cardiolipin, VDRL, RPR,
unreactive. Tissue
months to years, measure IgG and IgM
STDs

Congenital Syphilis
damage = patient's
late syphilis: injury from damaged cells),
immune response
due to prolonged specific (confirmation,
hypersensitivity intrauterine death, congenital abnormalities, FTA-ABS test, MHA-TP),
transplacental responses silent infections, most: born with rhinitis followed enzyme immunoassays
by rash

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STDs ALL BACTERIA

BACTERIA CHARACTERISTICS DISEASE RESERVOIR / TRANSMISSION VIRULENCE / PATHOGENESIS CLINICAL DIAGNOSIS TREATMENT

Wright or Giemsa stained:

intracellular Granuloma clusters or encapsulated
Klebsiella granulomatous ulcers that bleed on contact,
encapsulated gram (-) inguinale or sexual contact coccobacilli in cytoplasm Doxycycline
granulomatis inguinal lesions (10-15%)
bacillus Donovanosis of mononuclear cells
"Donovan bodies"

vaginal, urethral, prostatic

F: frequently symptomatic → vaginitis, purulent secretions: microscopy:
replicates by binary discharge, copious, foamy, foul-smelling wet mounts (motile),
axostyle: attachment,
fission, only yellowish, vulvar and cervical lesions, dysuria, Giemsa stained, direct metronidazole or
contact-dependent
trophozoite form, itching. Pregnant: premature rupture of immunofluorescence tinidazole (txt partners,
Trichomoniasis sexual contact, humans only host damage to
Trichomas vaginalis protozoa - flagellate no cyst, does not membranes, preterm delivery, low birthweight. M: antibody staining, do not use during 1st
epithelium, not
survive in external rarely symptomatic, mild urethritis, mild discharge, Culture: most sensitive, trimester)
invasive
environment slight burning after urination or ejaculation, ~ diamond's medium,
prostatitis anaerobic, pH 5.5-6 (3-7
days)
Vaginal Discharge

from discharge,
microscopy: KOH:
budding years and oral fluconazole,
round/oval budding mannoproteins: adherence, resistance to F: pruritus and erythema of vulvar area, thick cheesy
normal oropharyngeal, GI, genital pseudohyphae, culture: topical azole or
yeasts, polymorphic: Vulvovaginal phagocytosis, hyphae secrete proteinases vaginal discharge, itching of vulva. M: 10% -
flora, endogenous or direct Sabouraud or blood agar, nystatin, not
Candida albicans y, hyphae, and Candidiasis and phospholipases (kill epithelial cells, balanitis: inflammation of glans penis, itchy rash on
contact large smooth white recommended to treat
pseudohyphae tissue penetration) penis, rare: urethritis
colonies: rapid growth, sex partners
"germ-tubes" formation
after 2 hr

white discharge,
"non-specific vaginitis" ,white or gray vaginal
shift in vaginal flora, lactobacillus spp microscopy: clue cells,
Gardnerella gram-variable rods, discharge with unpleasant odor, dysuria, itching, or
Bacterial vaginosis replaced, increase risk: anything that absence of lactobacilli, metronidazole
vaginalis facultative anaerobes asymptomatic. Complications: PID, preterm delivery,
can upset normal balance of bacteria vaginal pH > 4.5, "whiff"
low birthweight, increased susceptibility to HIV, STDs
test after adding KOH

Mycoplasma postabortal or postpartum fever, PID ~ fallopian tubes special media - large tetracycline (resistant to
sexual contact
hominis infection, self-limiting fried-egg colonies erythromycin)
urease production
Ureaplasma F: chorioamnionitis and postpartum fever, M: non- erythromycin or
sexual contact (distinguish from
ureolyticum gonococcal, non-chlamydial urethritis tetracyclines
mycoplasma)

adult mites create

risk of 2nd bacterial
burrow in upper rash, burrows, isolation of topical permethrin
human itch mite - infection, Norwegian intense itching and redness, bumps, blisters, and
Sarcoptes scabiei genital scabies close - sexual contact layer of epidermis, mites, ova or feces in skin (5%), wash everything,
arthropod scabies - more crusting
female lay eggs in scrapings treat everyone
severe form
skin burrow

Nit - egg, hard to

see, attached to hair, lice-killing shampoo
feeds on human
pediculosis pubis, nymph - baby louse, (pediculicide) 1%
Phthirus pubis insect sexual blood and multiplies itching in genital area, visible nits or crawling lice
lice or "crabs" adult - females lay permethrin or
rapidly
nits, larger than pyrethrin
males

Page 13 of 14
BACTERIEAL RESPIRATORY INFECTIONS
BACTERIA
Sinusitis & Otitis
Pharyngitis Epiglottis Pneumonia
Media
Streptococcus
Streptococcus Haemonphilus Streptococcus
pyogenes (strep
Pneumoniae influenzae Pneumoniae
throat)
Corynebacterium
Haemonphilus Haemonphilus
diphtheriae
influenzae influenzae
(diphtheria)
Staphylococcus
Moraxella catarrhalis
aureus
Klebsiella pneumoniae

Chlamydophil
pneumoniae & psittaci

Mycoplasma
pneumoniae
Legionella pneumonia
Pseudomonas
aeruginosa

Pertussis Bronchitis Tuberculosis Pulmonary Anthrax

Streptococcus Mycobacterium
Bordetella pertussis Bacillus anthracis
Pneumoniae tuberculosis
Haemonphilus
influenzae
Mycoplasma
pneumoniae