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Bacteria Corynebacteria diphtheriae

O2 req Aerobic

Gram Stain Shape Positive bacilli

Bacteriology "Chinese letter" palisade

Listeria monocytogenes

facultative Positive

bacilli

motile, tumbling Coccobacillary to long chained filaments, nonmotile large, non-motile

Bacillus anthracis

Aerobic

Positive

bacilli

Clostridium perfringens

Anerobic

Positive

bacilli

Clostridium tetani

Anerobic

Positive

bacilli

large, non-motile

Clostridium botulinum

Anerobic

Positive

bacilli

motile flagella

Clostridium difficile

Anerobic

Positive

bacilli has capsule without Lipid A

Bacteroides fragilis

Anerobic

Negative

bacilli

Neisseria meningitidis

Aerobic

Negative

diplococci

12 serogroups (A, B, C, W-135, Y)

Neisseria gonorrhoeae

Aerobic

Negative

diplococci

sticky clusters

Vibrio cholerae

Aerobic/ Anerobic

Negative

bacilli

curved, single flagella

Camphylobacter jejuni

microaero Negative philic

bacilli

curved, single flagella

Helicobacter pylori

microaero Negative philic

Escherichia coli - uropathic (UPEC)

Aerobic/ Anerobic

Negative

bacilli

Escherichia coli enterotoxigenic (ETEC)

Aerobic/ Anerobic

Negative

bacilli

ferments lactose

Escherichia coli enteropathogenic (EPEC)

Aerobic/ Anerobic

Negative

bacilli

ferments lactose

Escherichia coli enterohemorrhagic (EHEC) Escherichia coli enteroinvasive (EIEC) Shigella dysenteriae, flexneri, boydii, sonnei

Aerobic/ Anerobic Aerobic/ Anerobic

Negative

bacilli

O157:H7, ferments lactose

Negative

bacilli

ferments lactose

bacilli

non-motile

Salmonella enterica

Negative

motile

Salmonella typhi

Negative

motile

Haemophilus influenzae type b (Hib)

Negative

cocco-bacilli small size,

Bordetella pertussis

Negative

cocco-bacilli

Mycoplasma pneumonia

none

single triplelayered sterolcontaining membrane, poor staining motile, colorful water-soluble pogments, oxidase positive, highly antibiotic resistant thin, pleomorphic, requires L-cys, ferric ions, pH~6.9,

Pseudomonas Aeruginosa

aerobic

Negative

Legionella pneumophila

Negative

Treponema pallidum

Anerobic

Negative

spirochetes

endoflagella, motile with flexion and rotation

Borrelia recurrentitis

Negative

spirochetes

Borrelia burgdorferi

Negative

spirochetes

microaerophilic

Leptospira interrogans

aerobic

Negative

spirochetes

slim shirochete

Mycobacterium tuberculosis

strict aerobe

Positive

bacilli

slim, hydrophiobic cell surface, acid fast

Mycobacterium leprae

bacilli

acid fast

Actinomyces Israel

Anerobic

Positive

bacilli

microaerophilic, branch at acute angles, irregular staining

Nocardia asteroides, Norcardia brasiliensis

strict aerobe

Positive

bacilli

weakly acid fast, branching

Chlamydia trachomatis

multiple serovars, intracellular pathogens

Chlamydia pneumoniae, Chlamydia psittaci

intracellular pathogens intracellular pathogens

Rickettsia rickettsii

negative

cocco-bacilli

Rickettsia prowazekii

negative

bacilli

intracellular pathogens

Yersinia Pestis

facultative Negative

bacilli

bipolar staining facultative intracellular parasites requires sulfhydryl compounds

Brucella abortis

aerobic

Francisella tularensis

facultative Negative

cocco-bacilli

Pasteurella multocida

facultative Negative

cocco-bacilli small size,

Transmission droplet

Virulence DT: A/B, targets EF-2 to inhibit ADPribosylation and shuts off protein synthesis, on phage

grows in refrigerated temperatures. animals (fowl), cole slaw, soft cheese,packaged Listeriolysin O: escape phagolysosomes of meat, transplacentally, beta macrophages animals (herbivors), skin contact, inhaled, beta polypeptide capsule: antiphagocytic, exotoxin complex, increases cAMP, decreases ACh -> edema in lungs alpha toxin: hemolysin, enterotoxin,

soil, foreign material

soil, foreign material

tetanus toxin, tetanospasmin: heat labile, antigenic, destroyed at 65 C

soil, pond and lake sedements - uncooked foods, honey

neurotoxin: destroyed at 100C, resistant to GI enzymes, and inhibits release of Ach. Toxin A: enterotoxin causing fluid secretion, hemorrhagic necrosis, diarrhea, Toxin B: cytotoxin, decreasing protein synthesis leading to cell death polysaccharide capsule antiphagocytic, SOD production,

normal intestinal flora

normal intestinal flora

droplet

Polysaccharide capsule antiphagocytic, OMP, LOX, lipid A, pili, LSP/LOS mimics self brain, bind to factor H to downregulate complement using host sialic acid

OMP (Protein I A&B), invasion; OPA adherence protein (Protein II), LPS/LOS sexual contact via mucosal mimics self, bind to Factor H to surfaces, asymptomatic downregulate complement using host sialic carriers (resivoir) acid, fast antigenic change/ variation , peptidoglycan fragments, pili

LPS, O Antigenic structure, CT: A/B toxincatallyzes ADP ribosylation of G protein contaminated saltwater, crustaceans and plankton, yielding constant activation of adenylate pH 8.0-9.5, fecal-oral, sea cyclase and cAMP accumulation, Toxinfood coregulated pilus (TCP), polysaccharide capsule in O139 serotype animals (sheep, cattle, uncooked chickens , wild low infecting dose birds, dogs), contaminated water, unpasteurized milk Urease: survive low pH via ammonia roduction, Vacuolating cytotoxin (VacA): induce eukaryotic apoptosis, pathogenicity island (PAI), Cag protein, flagella: adherence, P-pilli: adherence to uroepithelial cells Labile toxin (LT): catalyzes A/B toxin which activates adenylate cyclase system causing Cl and water secretion into lumen, Stable toxin (ST): binds glycoprotein receptor, increses cGMP, CFA pili: adherence to enterocytes Bundle Forming Pili (BFP): forms microcolonies on enterocytes, attachment and effacing (A/E), pathogenicity island (PAI), intimin: attachment, Esps: disrupts cytoskeleton Shiga toxin: A/B toxin, prevents tRNA binding to 60s, blocking protein synthesis, low infecting dose (100-200), A/E lesions,

human (fecal-oral)

normal intestinal flora

contaminated food (and water)

human (fecal-oral)

Animals (cattle), hamburgers, unpasturized milk, fruits and vegitables Human

human (fecal-oral), contaminated food/water Animals (poultry, exotic pets- turtles), Humans (food handlers), animal feces

low infecting dose (<200 organisms), acid resistance, Invasin protein antigens (IpaA, IpaB, IpaC, etc.): attachment, cytoskeleton reorganization, actin polymerization, apoptosis; Stx: food incubation at room temperatures

human (fecal-oral)

Vi antigen: lowers infecting dose, LPS endotoxin: seeding causes fever

normal nasopharyngeal flora

polyribitol phosphate (PRP); antiphagocytic

PT: A/B toxin, ADP-ribosylation inactivates adenylyl cyclase;adenylate cyclase: converstion of host ATP to cAMP, hemolytic, droplet, previously Tracheal cytotoxin: death of ciliated immunized adults (resivoir) tracheal cells; filamentous hemagglutinin (Fha): adherence; surface pili, pertactin, highly contageous,

droplet

low infecting dose (100),

water, soil, vegitation

LPS, porin proteins, slime layer of alginate, extotoxin A: catalyzes EF-2 by ADP ribosylation and shuts down protein synthesis leading to cell death, Exoenzyme S: ADP-ribosylates cytoskeleton vimentin, Elastase: acts on elastin, IgA, IgG, complement, collagen presist in adequate chlorine, extract iron outer membrane protein (OMP), macrophage invasion potentiator (Mip): mediates cell entry, prevent lysosome fusion, lytic destruction of inflammatory cells

water (aerosoled)

spread via lymphatics, avoid immune sexual contact via mucosal recognition via molecular mimicry, bind to surfaces, asymptomatic host proteins, Igs, and complement, no carriers (resivoir) toxins,

lice, humans (resivoir)

OMP constantly changing causing recurrent evasion of immune system OpsA:major outerprotein when in ticks OpsC: outer protein to facilitate transmission to human , stimulate protective Ab;changes in antigenic makeup

ixodes ticks, whitefooted mouse, deer

water with animal urine (rodents, cattle, dogs), skin spread via blood, breaks, conjunctiva or ingestion

resistant to disinfectants, acids, and alkalisis, tuberculin, spread via lymphatics, mycolic droplet, unpasteurized milk acids, lipoarabinomannan(LAM), sulfopilids: disrupt phagosome/lysosome interaction

footpads of mice and via minor skin lesions, obligate intracellular armadillo, infected humans parasite (resivoir),

normal intestinal flora

soil, inhalation or prick

none known

humans, sexual mucosal contact, asymptomatic humans (resivoir)

Elementary Body (EB): infectious form, compact. Hardy; Reticulate Body (RB): replicative form, protein synthesis

animals, tick

LPS, large proteins, peptidoglycan,

animals (louse), person-toperson virulence plasmids, Yersinia outer membrane proteins (Yops), F1: intracellular, plasminogen-activating protease, spread via blood multiply in macrophages in RES, suppression of myeloperoxidase system, inhibit phagosome lysosome fusion

fleas on rodents, droplets

animals, unpasteurized diary products,

wild mammal, bloodfeeding low infecting dose (<100), arthropod, skinning animals animal respiratory flora, bite/scatch of dog or cat

Diseases Pharyngitis (2-4d), Tonsillitis: malaise, sore throat, fever, pseudomembrane appearance Diphtheric myocarditis, neuro Fetal stillbirth, neonatal sepsis, internalin, listeiolysin O, epithelial spread, multiplies in macrophages, meningitis, encephalitis,

Dx Tinsdale medium, K+ Tellurite agar, gram stain culture with cold enrichment

Cutaenous anthrax: 2-5d, malignant pustule, Pulmonary anthrax: 1Ordinary media 5d respiratory distress, cyanosis Gas Gangrene, alpha toxin leading to shock, crepitus, Food poisoning: (8-24h) nausea, abdominal pain, diarrhea (no fever or vomiting)from enterotoxin in stews, soups or gravy Tetanus:(4 days to several weeks) tetanospasmin ascends motor nerves and acts on anterior horn cells by blocking pstsynaptic inhibiton. Tresmus/lockjaw, convulsions, opisthotonos (back m. contraction) Botulism (18-96h) cranial nerve palsies with descending symmetrical motor paralysis, no fever. Infant botulism: constipation, poor muscle anerobic culture tone, lethargy, feeding problems, paralyses, "floppy baby" Pseudomembranous colitis (PMC): diarrhea, intense inflammation, Antimicrobic-associated diarrhea (AAD): watery, bloody diarrhea, abdominal craming, leukocytosis and fever. deep pain and tendernes below the diaphram, intra-abdominal abscess (polysaccharide capsule), fever Acute, purulent meningitis: fever, nuchal rigidity, headache, seizures, mental signs, increased intracranial pressure, rash, purpura, arthralgia, bulging anterior fontanelle (infants), thrombocytopenia, chocolate agar, progresses to Disseminated intravascular coagulation (DIC) Oxidase positive syndrome: scattered skin petechiae (endotoxin caused vascular necrosis), shock, bilateral hemorrhage of adrenal glands, slow-grade fever, arthritis, bacteremia, endotoxemia: PID: fever, lower abdominal pain, adnexal tenderness, leukocytosis, infertility, ectopic pregnancy Gonorrhea (2-7d) MEN( purulent urethral discharge, dysuria), WOMEN(increased vaginal discharge, urinary frequency, dysuria, abdominal pain, menstrual abnormalities, chocolate agar, dyspareunia), can lead to Disseminated gonococcal infection (DGI): Oxidase positive fever, migratory polyarthralgia, petechial, maculopapular/pustular rash, Opthalmia: conjunctivitis in neonates, Rectal gonorrhea, pharyngeal gonorrhea, cervicitis, urethritis, salpingitis, urethritis (acute), epididmytis

toxin A and B in stool

Cholera (2-5d) water and electrolyte shift from inside cell to intestinal thiosulfate-citrate-bile lumen, isotonic dehydration, hypokalemia, metabolic acidosis from bicarbonate loss. Rapid onset, abdominal fullness, gurgling, rushes of salt-sucrose agar peristalsis, loose stools, rice-water stools .

Diarrhea (1-7d): lower abdominal pain, fever, watery or blood/pus, selfoxidase positive limiting 3-5d, Guillain-Barre syndrome: cross reaction of LPS core with myelin,

Gastritis, gastric ulcer, duodenal ulcer: burning upper abdominal pain, nausea, vomiting, flank bleeding/rupture, anoexia, belching adenocarcinoma, Bastric B-cell lymphoma (MALT) UTI: pyelonephritis, pyelonephritis fever, cystitis: self-limiting, polyuria, dysuria

gastric mucosal biopsy, culture, IgG/IgA

blood agar

Traveler's diarrhea (2-4d): watery, dehydration, rice-water (~cholera)

Diarrhea: (2-4d) watery

Diarrhea, bloody after 1-2d, intense abdominal pain, Hemolytic Uremic Syndrome (HUS): hemolytic anemia, acute renal failure (Stx no sorbitol binding to renal tissue causing glomerular swelling), thrombocytopenia fermentation, MacConkey agar (Stx depositio of fibrin and platelets), in 10% ppl, oliguria, edema, pallor Shigella-like dysentary (stool with blood and WBC) Shigallosis: dysentery, adherence to M cells via Ipa, cell-cell invastion via projections; focal ulcers; stools with WBC, RBCs, and bacteria; stool culture Febrile dysentery syndrome: cramps, tenesmus (painful, straining defecation), frequent, small-volume, bloody mucoid discharge Food poisoning/ Salmonellosis: (24-48h)abdominal pain, nausea, vomiting, diarrhea for 3-4d, bacteria invade enterocytes, induce inflammatory response, membrane ruffling induce internalization of bacteria, infection of bone

blood or stool culture

Typhoid fever: extended fever, sustained bacteremia, subtle rash, enlarged spleen, headache, abdominal pain. Bacteria ingested by macrophages (inhibit oxidative metabolic burst), proliferate, enter lymphatics to reticular endothelial system (mesenteric lymph nodes, liver, spleen). Then re-enters the gut via bile. Invasive Diseases: Meningitis: preceded by URI like pharyngitis, sinusitis or otitis media, vabue malaise, lethargy, irritability and fever pneumonia, acute epiglottitis: fever, sore throat, stridor, hoarseness, muffled cough, laryngospasm to death; bacteremia spreads to CNS, bones, joints, Cellulitis: tender, reddish-blue swelling in cheek or periorbital areas, fever, moderately toxic state; Arthritis: fever, irritability, local inflammation (single joint) Localized Disease: Otitis media: acute, painful; chronic bronchitis: exacerbations, conjunctivitis, otitis media, acute and chronic sinusitis, Whooping cough: (7-10d) ciliated cells are progressively destroyed producing cough, paralysis and cell death of neutrophils, macrophages and lymphocytes, lymphocytosis, histamine sensitization and insulin secretion. (1) Catrrhal stage (1-2w): mucoid rhinorrhea, malaise fever, sneezing, anorexia, communicable, (2) paroxysma coughing stage (24w): inspiratory whoop then cough, vomiting, mucoid secretions, apnea in infants (3) convalescent stage (3-4w): decreased symptoms Primary Atypical Pneumonia (PAP)/ Walking Pneumonia: nonproductive cough, fever, malaise, headache, scattered areas of pneumonia, attaches to cilia and microvilli, binds sialic acid, desquamation of mucousa leading to inflammation attachment via pili, flagenna and slime; local destruction that is rapid and destructive; alveolar necrosis, vascular invasion, infarcts, bacteremia, black, necrotic ulcers. Otitis externa: swimmer's ear, Pneumonia in CF patients, Osteomyelitis in Diabetics, burn wound infections, sepsis, UTI and pyelonephritis in catheterized patients, Right endocarditis in IV drug users, corneal infections in contact wearers

blood or stool culture

exogenous hematin and/or nicotinamide adenine dinnucleotide (NAD) of chocolate agar

nicotinamide supplement culture, nasopharyngeal swab, direct immunofluorescent antibody (DFA), charcoal needed mycoplasma agar, Xray showing pneumonia in lower lobe

oxidase positive, pyocyanin production (greenish-blue wound)

direct fluroescent Necrotizing Multifocal Pneumonia:headache, fever, chills, dry cough antibody (DFA), bufferend charcoal may turn purulent, chest pain, myalgia, chills, pleuritic chest pain, yeast extraction vomiting, diarrhea, confsion, delirium, shock respiratory failure, (BCYE), charcoal

Primary Syphilis: entrer via genital ulcer (indurated, painless, firm base, rasied margins) chancre, Secondary Syphilis: (28w)maculopapular rash, enlarged lymph nodes, fever malaise, condylomata lata, highly infectious, followed by latency,Tertiary Syphilis (5yrs), neurosyphilis: chronic meningitis, fever, headache, focal neuro findings, tabes dorsalis, cardiovascular syphilis medial necrosis of asa vasorum, ruptured aortic aneurysm, enarteritis, gumma; Congenital Syphilis: rhinitis, maculopapular rash, saddler nose, saber shins, anemia, thrombocytopenia, liver failure

dark field microscopy, immunoflorescence, Nontreponemal test: reagin Ab against cardiolipin, rapid plasma reagin (RPR), Veneral Disease Research Lab tests (VDRL), Treponemal tests: fluorescent treponemal ab (FTA), microhemagglutinatio n (MHA-TP) Giemsa, Wright staining blood smears exposure and typical clinical findings (long incubation in special media)

Relapsing fever: high fever, headache, myalgia, weakness, rigors, 1 week fevers and relapse after 2-4d. Lyme disease: fever, "bulls eye" skin rash spreading from bite erythema migrans , myalgia, joint pain, meningeal irritation, fatigue, headache, long term meningoencephalitis,myocarditis and relapsing arthritis (large joints: knees). After weeks: nervous, cardiovascular involvement

Leptosirosis: systemic flu-lilke illness, fever , chills, nausea, vomiting, headache, abdominal pain, severe myalgia, intestinal nephritis when dark field, serologic spread to kidneys, hepititis, meningitis Primary TB: initial infection in unsensitized individuals, affects middle/lower lobes, multiply in macrophages, microscopic granuloma, multinucleated giant cells; fever, malaise, enlarged hilar lymph nodes, Ghon complex; Reactivation TB: apex of lungs, caseous necrosis, dry cough progresses to hemoptysis, stress induced, fever, malaise, fatigue, sweating, weight loss, loss of lung tissue, kidneys, vertebrae; Chronic pneumonia: fever, cough, bloody sputum, chronic wasting to death; acid fast bacilli (AFB), LowensteinJensen (LJ) medeium after 3-6w with radiometric detection, purified protein derivative (PPD) of tuberculin skin test,

Leprosy (2-7d) via minor skin lesions, invasion of macrophages and Schwann cells; Tuberculoid leprosy: granulomas, giant cells, large, flattened plaque on face, trunk, limbs, with raised, erythematous edges acid-fast stained and dry, pale, hairless centeres, non-contageous; Lepromatous scrapings, skin Leprosy: deficint CMI, extensive, symmetric, diffuse skin lesions on biopsy face, with thickening of lips, forehead, and ears - leonine apperance , loss of nasal bones, septum, digits, testicular atrophy, RES involvement Actinomycosis: cervicofacial area, firm, fibrous mass, localized chronic endometritis clinical presentation, biopsy

Nocardiosis/ confluent bronchopneumonia: dyspnea, fever, cough, sputum production, acute inflammation, suppuration, parachyma destruction, lymphadenitis, Skin infection: after minor trauma, superficial pustule Genital infection (B, D-K) sexual transmission, causing cervicitis, urethritis, salpingitis, urethritis, epididymitis, PID, tropism for endocervix, infiltration of inflammatory cells result in fibrosis and scarring long term; conjunctivitis/ trachoma (A-C) blindness, contact cervical secretion during birth, corneal scarring, conjunctival deformities, chronic inflammation, acute mucopurulent eue discharge 5-25d after birth; Lymphogranuloma venerum (LGV) (L1-L3) genital lesions, multiocular suppurative inguinal lymph nodes, inguinal adenopathy, matted and suppurative bubos respiratory pathogen, Atypical pneumonia Rocky Mountain Spotted Fever: (2-6d) fever, myalgia, myositis, small erythematous macules becomes petechial, rash on palms and soles migrates centripetally, toxicity, mental confusion,

blood agar

cell sample at infection, direct fluorescent antibody (DFA), PCR

serologic tests (culture difficult), clinical signs, symptoms, epidemiology

Typhus: (1-2w) fever, headache, maculopapular rash on trunk then Giemsa stain spreads to extremities, malaise, myalgia, myocarditis, CNS dysfunction Bubonic plague: (2-7d) not contageous, fevergram-negative septic shock; Pneumonic plague: highly contageous via droplets, mucoid then blood sputum, cyanosis; hemorrhagic suppurative lymphadenitis bubo Brucellosis, (7-21d) small granulomas in RES, bacteremic episodes, malaise, chills, drenching/night sweats for weeks-years, headache, anorexia, weight loss, undulant fever Tularemia (2-5d): infects reticuloendothelial organs, granulomas, chronic relapsing course, fevers, chills, ulceroglandular: local papule that is necrotic, ulcerative, swollen/painful lymph nodes, oculoglandular: painful, purulent conjunctivitis, typhoidal: prolonged fever, penumonic: follows inhalation Diffuse cellulitis (<24h), well-definited erythematous border streptomycin, (doxycycline, ciprofloxacin, chloramphenicol) blood culture with CO2 supplementation cystine-glucose blood agar, aerobic blood agar, oxidase positive

Tx Diphtheria antitoxin, erythromycin Penicillin G, ampicillin, TMP/SMX, Ampicillin + Gentamicin (fulminant) Penicillin, Chemophylaxis: Doxycycline, ciprofloxacin GG: excision, penicillin, hyperbaric oxygen chamber, tetanus immune globulin (TIG) - anti-toxin

Prevention Diphtheria toxoid/ DTaP

Immunity

Target population children pregnant women, fetus, neonate, elderly, immunocompromised

no vaccine

CD4+, CD8+

vaccine

DTaP vaccine (toxoid) autoclaving, cooking food >100C for 10min

Trivalent (A, B, C,) horse antitoxin

Vancomycin (oral), metronidazole Clindamycin, metronodazole group-specific close living rifampin, antipolysaccharide populations ciprofloxacin, MCV4 antibody, capsular (army/dorms), vaccine (A, C Y, polysaccharides T- children from 6moW135 serotypes) independent IgG2 2yrs (window period)

Penicillin, 3rd generation cephalosporin,

3rd generation cephalosporin, opthalmia: erythromycin eye drops.

no vaccine, use barrier methods during intercourse

none, prone to multiple infections

tetracyclines, pregnant/children: TMP/SMX, erythromycin

good sanitation, cooking of crustaceans

Erythromycin, (Fluoroquinolonesresistance)

children

Bismuth salts (PeptoBismol) + 2 of: Metronidazole, tetracycline, clarithromycin, amoxicillin sexually active women TMP/SMX, ciprofloxacin, washing fruit, hot drinks

self-limiting

rehydration, TMP/SMX

travelers, <2yrs in developing countries

self-limiting

rehydration, TMP/SMX

bottle-fed infants in developing countries

rehydration, hemodialysis or hemapheresis in HUS rehydration, TMP/SMX sewage disposal, water chlorination

cooking hamburgers

industrialized countries children <5 in developing countries

self-limiting

young children

fluid and electrolyte replacement

humoral and cell mediated

industrialized societies

ampicillin, TMP/SMX, ceftriaxone, ciprofloxacin , norfloxacin, (chloramphenicol)

humoral and cell mediated

ampicillin, amoxicillin, 3rd generation cephalosporins, tetracycline, Rifampin aminoglycosides, sulonamides.

anitcapsular (PRP) antibodies, Tindependent antigen, vaccine 99% effective

6-18months Meningitis, 2-5yrs, epiglottitis and pneumonia

erythromycin, clarithromycin,

IgG against PT, pili and pertactin, <1yrs DTaP

erythromycin, tetracycline, azythromycin, clarithromycin, quinolones newer aminoglycoside, gentamicin, tobramycin, amikacin, carbenicillin, ticarcillin, 3rd generation cephalosporins, monobactams

5-15yrs

in persons with underlying diseases: leukemia, cystic fibrosis , burns.

erythromycin, macrolides (azithromycin, clarithromycin)

cell mediated response

immunecompromised patients

Penicillin, tetracyclines, erythromycin, cephalosporins

humoral and cell mediated

tetracycline, erythromycin

crowded living populations humans in wooded area, new england states

Doxycycline and amoxicillin prevent exposure for 30-60d

vaccine for OspA, efficacy 75%

penicillin, ampicillin, erythromycin

isoniazid, ethambutol, rifampin, pyrazinamide, streptomycin

heat, and UV, isoniazid, BCG (bacirallus, Calmette, and Guerin) vaccine

delayed-typer hypersensitivity (DTH) - NK cells, cell-mediated immunity (CMI), CD4+/8+

sulfones (dapsone) blocks para-aminobenzoic acid metabolism. + Ripampin for 6m cures TL. + clofazimine for 2y for LL.

CMI mediated

Penicillin G 4-6w

sulfonamides, TMP/SMX

T-mediated

immunecompromised patients

tetracyclines, macrolides, some fluoroquinolones, LGV - coxycycline, trachoma - single dose of azithromycin

Doxycycline effective in 1st deticking week

mid-Atlantic states

crowded living populations

doxycycline, diprofloxacin occupational exposure, pasteurization abattoir employees, meat inspectors, vetinarians

doxycycline + aminoglycoside streptomycin, gentamicin, coxycycline, chloramphenicol penicillin

hunter

Organism

Trichophyton tonsurans

Trichophyton rubrum Trichophyton rubrum, Trichophyton mentagrophytes

Malassezia furfur

normal skin flora

Candida albicans, Candida glabrata, Candida parapsilosis, Candida tropicalis, Candida lusitanaie, Candida dubliniensis

normal intestinal and vaginal flora

Aspergillus flavus, Aspergillus terreus, Aspergillus niger

Fusarium Scedosporium apiospermum, Scedosporium prolificans, Pseudallescheria boydii

ubiquitous in environment (grains), contact lenses

Zygomycosis mucorales, absidia, rhizopus

Pneumocystosis jirovecii

airborne transmission

Cryptococcosis neoformans (var neoformans, var grubii, var gatii)

soil, decaying matter, bird excrement

Histoplasmosis

Ohio, mississippi River valley, pigeon/bat droppings south and north-central US, wooded areas with lakes and streams US, Japan - plants, trees, soil, moss Brazil

Blastomycosis

Sporotrichichosis schenckii Paracoccidioidomycosis brasiliensis

Penicilliosis

Vietnam, bamboo rat, SE Asia San Joaquin Valley California, south-central AZ, Rio Grande Valley TX

Coccidioidomycosis immitis, Coccidiodimycosis posdasii

Diseases Tinea captitis: affects scalp of children 3-7y via sharing combs. Starts at stratum coreum, invades hair follicles. Ectothrix: spores surround hair shaft. Endothrix: spores invade hair shaft. Favus: hyphe invade hair shaft. "gray patch" "black dot" "inflammatory" Tinea barbae: beard Tinea faciei: face of non-bearded people Tinea corporus: on the trunk, in warm, humid climates with scaly plaques Tinea cruris: inguinal region, "jock itch" Tinea pedis: "athletes foot" maccasin, interdigital and inflammatory Tinea manuum: "moccasin" on the hands Tinea unguium: nails, onychomycosis, increases with age, toenails > fingernails, accumulation of debri under nail and opaque, chalky or yellow nails. Spreads distal to proximal/lateral Pityriasis versicolor: patchy areas of hypopigmented and hyperpigmented macules on trunk. Seborrheic keratitis parynchium or intertrigo (DM and obese ppl), scrotum involvement, angular cheilitis, erythematous candidiasis, pseudomembranous candidiasis - thrush , vaginal candidiasis (DM women, antibiotic use, pregancy, HIV+), Esophgeal candida: dysphagia, odynophagia, volvovaginal candidiasis: erythema on vaginal muosa, adherent white discharge; candida funguria: indwelling urethral catheter, antibiotic therapy and DM; chronic mucocutaneous candidiasis: first decade of life, worsening superficial candidiasis and endocrinopathies; invasive candiasis: fungemia, fever, tachycardia, hypotension, hematogenous spread Allergic bronchopulmonary aspergillosis (ABPA): noninvasive, peripheral blood eosinophilia, elevatd IgE, Chronic necrotizing aspergillosis (CAN): invades pulmonary tissue but not vasculature

Dx

Tx

Grisofulvin, triazoles, terbinafine fluconazole, itraconazole, terbinafine yellow-green under topical selenium Wool's lamp (UV sulfide light)

visualization, culture,

clotrimazole, nystatin, oral fluconazole for severe cases, amphotericin B, triazole, echinocandins

corticosteroids amphotericin B, newer triazoles, echinocandins emphotericin B, trazoles intraconazole, posaconazole voriconazole, echinocandins amphotericin B, voriconazole amphotericin B, voriconazole

Invasive pulmonary aspergillosis (IPA): angioinvasive, elevated glactomannan

isolation from secretions

produce mycotoxins: inoculation into host, fungemia, multiprgan involvement direction inoculation, multiorgan dissemination

infection of maxillary sinuses, extending back to orbit and brain, rhino-facial-cranial form. Lung, skin, GI infection, associated with vascular invasion and tissue infarction with necrosis protozoan, pneumocustosis, dyspnea, fever, dry cough, diffuse bilateral interstitial infiltrates, hypoxia with hyppocarbia, trophozoites or cysts in respiratory fluid meningitis: subacute headache, decreased mental status, no biopsy, India ink nuchal rigidity, mild lymphocytic pleocytosis in CSF (<100 cells), pulmonary nodules, skin lesions, osteomyelitis Acute pneumonic syndrome: dry cough, fatigue, erythema nodosum, patchy alveolar infiltrate; chronic pulmonary histoplasmosis, pericarditis, fibrosing mediastinitis: weight loss, hepatosplenomegaly, pancytopenia Blastomyces dermatiditis: fluffy, white mold at 30C, broadbased budding yeast at 37C; pneumonia, skin, bone disease, pustules, ulcers, lymphangitic spread self-limiting, growing fungus, antigen test body fluids

amhotericin B, triazole

TMP/SMX

Amphotericin B, fluconazole

amphotericin B, itraconazole

histological section, amphotericin B, culture (weeks) itraconazole histological section, itraconazole, culture (1w) terbinafine histological section itraconazole steering wheel histological section central septation, amphotericin B, red diffusable itraconazole pigment coccidioidal skin fluconazole, test, sputum itraconzole, culture, high antiamphotericin B coccidioidal IgG

"steering wheel" appearance

fever, weight loss, papular skin lesions, hepatosplenomegaly, lymphadenopathy acute pulmonary coccidioidomycosis: periheral blood eosinophilia, hilar or mediastinal adeopathy, night sweats, fatigue, weight loss, dissemination to skin, bone, joints, meninges; meningitis, hydrocephalus,

Target population

children, elderly, antibiotic use, immunodeficiencies

immunocompetent host immunocompetent host

immunocompetent host

immunocompetent host immunocompetent host

immunocompetent host immunocompetent host immunocompetent host

rose-grower middle-age to older men with alohol and tobacco use immunocompetent host

Virus

Classification

Types

Genome

Viron structure

Influenza

Orthomyxovirus

A (~95%), 8x (-)ssRNA linear helical, segments enveloped B, C

Parainfluenza

Paramyxovirus

4 (-) ssRNA linear serotypes

helical, enveloped

Pneumovirus/ Resiratory Paramyxovirus Synchtial Virus (RSV)

A, B

(-) ssRNA linear

helical, enveloped cubic, naked, icosahedral cubic, naked, icosahedral helical, enveloped cubic, naked, icosahedral

Adenovirus Rhinovirus Coronavirus Reoviruses

Adenoviridae Picornaviridae Coronaviridae Reoviridae

47 dsDNA linear serotypes 115 (+) ssRNA linear serotypes (+) ssRNA linear 4 10x dsRNA linear serotypes

Paromyxovirus (Mumps) Paramyxovirus

1 strain

(-) ssRNA linear

helical, enveloped

Morbillivirus (Measles)

Paramyxovirus

1 strain

(-) ssRNA linear

helical, enveloped

Rubivirus (Rubella)

Togaviridae

(+) ssRNA linear

cubic, enveloped, icosahedral

Erythema infectiosum

Parvoviridae

B19

ssDNA

HIV (Lentivirus)

Retroviridae

I, II

(+) ssRNA linear, diploid

cubic, enveloped

HTLV-I (Oncovirus)

Retroviridae

(+) ssRNA linear, diploid

cubic, enveloped

HTLV-II (Oncovirus)

Retroviridae

(+) ssRNA linear, diploid

cubic, enveloped

Poliovirus

Picornaviridae

(+) ssRNA linear

cubic, naked, icosahedral cubic, naked, icosahedral cubic, naked, icosahedral cubic, naked, icosahedral cubic, naked, icosahedral cubic, naked

Coxsackie A Coxsackie B Echovirus Enterovirus

Picornaviridae Picornaviridae Picornaviridae Picornaviridae

(+) ssRNA linear (+) ssRNA linear (+) ssRNA linear (+) ssRNA linear

Hepatitis A

Picornaviridae

(+) ssRNA linear

Hepatitis B

Hepadnaviridae

dsDNA circular adw, ayw, with one strand adr, ayr gap

cubic, enveloped

Hepatitis C

Flaviviridae

6 major (+) ssRNA linear genotypes

cubic, enveloped

Hepatitis D

Hepatitis D

(-) ss circular

cubic, enveloped cubic, naked

Hepatitis E Hepatitis G

Hepatitis E

(+) ss linear

Epstein-Barr virus (EBV) Herpesviridae

dsDNA linear

cubic, enveloped

Cytomegalovirus (CMV) Herpesviridae

dsDNA linear

cubic, enveloped

Varicella-zoster virus

Herpesviridae

dsDNA linear

cubic, enveloped

Flavivirus

Flaviviridae

(+) ssRNA linear

cubic, enveloped

West Nile Fever Virus

Flaviviridae

(+) ssRNA linear

cubic, enveloped cubic, enveloped

Powassan Virus

Flaviviridae

(+) ssRNA linear

Herpes Simplex Virus Type 1

Herpesviridae

dsDNA linear

cubic, enveloped

Herpes Simplex Virus Type 2

Herpesviridae

dsDNA linear

cubic, enveloped

Herpes Simplex Virus Type 6 Herpes Simplex Virus Type 7 Herpes Simplex Virus Type 8

Papillomavirus

Papovaviridae

70 dsDNA circular genotypes

cubic, naked

Polyomavirus/ JC virus

Papovaviridae

dsDNA circular

cubic, naked

Polyomavirus/ BK virus Papovaviridae Variola major and minor Poxviridae Cowpox Poxviridae

dsDNA circular dsDNA linear dsDNA linear

cubic, naked helical, enveloped helical, enveloped

Vaccinia Monkeypox Parapoxvirus

Poxviridae Poxviridae Poxviridae

dsDNA linear dsDNA linear dsDNA linear

helical, enveloped helical, enveloped helical, enveloped

Smallpox

Poxviridae

dsDNA linear

helical, enveloped

Alphavirus Bunyavirus (California virus) Hantavirus Colorado Tick Fever virus (Oribivirus, Reovirus) Arenavirus

Togaviridae Bunyaviridae Bunyaviridae

(+) ssRNA linear 3x (+/-) ssRNA linear 3x (+/-) ssRNA linear 10x dsRNA linear segments 2x (+/-) ssRNA ambisense (-) ssRNA linear

cubic, enveloped helical, enveloped helical, enveloped cubic, naked helical, enveloped helical, enveloped

Reoviridae

Arenaviridae

Ebola virus

Filoviridae

Rabies virus

Rhabdoviridae

(-) ssRNA linear

helical, enveloped

Rotavirus

Reoviridae

4 10x dsRNA linear serotypes segments 4 (+) ssRNA linear serotypes

cubic, naked

Norwalk-like virus

Calciviridae

cubic, naked

Herpes 6, adenovirus, coxsackievirus, echovirus

Astrovirus

ssRNA

naked

Piron

Piron

Piron Piron

Virology

Transmission

Incubation period

Replication

Pathogenesis multiplies is respiratory epithelium leads to ciliary abnormalities (cell death and cytokines), recruit leukocytes

H: absorption, N: aerosol fusion, glycoprotein spikes

1-2 d

RNA replication in nucleus, needs priming;

H, N: attach; F: fusion

in cytoplasm, bud through cytoplasm membranes contact with infective secretions fecal-oral aerosol contact with infective secretions short in cytoplasm in cytoplasm uses viral RNA dependent RNA polymerase, in cytoplasm, bud through cytoplasm uses viral RNA dependent RNA polymerase, in cytoplasm, bud through cytoplasm bud though ER/ Golgi induce INFalpha, beta in cytoplasm, bud through cytoplasm membranes upper respiratory, causes ciliary abnormalities, plugging of smaller airways

G: attach, F: fusion

H, N: attach; F: fusion

aerosol

replicates in respiratory epithelium and lymph nodes

H: attach; F: fusion aerosol

enters via respiratory tract, spreads lymphatically

aerosol

14-21d

enters via respiratory assembly in golgi tract, spreads or PM lymphatically

in nucleus

LTR: promotor, gag: codes structural proteins, pol: codes RT, integrase, protease, env: codes spikes gp120 (V3 mutation), gp41 for fusion Tat: acts on LTR to increase transcription. Rev: increase transport to cytoplasm

intimate contact, cellassociated OR cell-free fluids

reverse transcriptase converts RNA to cDNA, moves to nucleus and integrates into host chromosome at transcriptional hotspots via viral protein integrase

infect and kills T-cells (CXCR4 - X4 virus), monocyte, macrophages (CCR5 R5 virus), dendritic cells, langerhan cells

gag, pol, env, Tax: transcriptional cell-associated activator, Rex: fluids, vertical transports proteins from nucleus to cytoplasm gag, pol, env, Tax: transcriptional cell-associated activator, Rex: fluids, vertical transports proteins from nucleus to cytoplasm

replication of protooncogenes because of Tax

infect and transform Tcells

replication of protooncogenes because of Tax

infect and transform Tcells

fecal-oral

4-35d

in cytoplasm

fecal-oral fecal-oral fecal-oral fecal-oral

in cytoplasm in cytoplasm in cytoplasm in cytoplasm

fecal-oral

14-40d

in cytoplasm

HbcAg: core antigen, HBeAg: encoded by core gene, HBsAg: surface antigen

sexual

160d

incomplete dsDNA filled in nucleus and integrate into host chromosome. Makes mRNA and pre-genomic +RNA. In cytoplasm HBcAg packages RNA, dNTP pool, RT. RT turns RNA to cDNA, +DNA made, RNA degrades hepatocytes killed by immune-mediated CD4+, activates cytokines and INF, TNF, NK cells release perforins

E1/E2

parenterally, blood transfusions, sexually

6-12w

(-) RNA intermediate

HBsAg surrounds RNA complex fecal-oral

replicates in nucleus, cRNA reads like dsDNA

contact with infected secretions

replicates in B cells

Heterophile-positive antibodies

giant cells, Heterophilenegative antibodies in Mono

close contact, sexually

14-18d

mosquito

sylvatic

Bird, mosquito

2-5d

sylvatic

tick alpha genes: immediate, LAT1 for latency, beta genes: early direct contact, genes for DNAbp, saliva DNA polymerase, thymidine kinase, gamma genes: structural proteins tegument proteins: required for replication after infection, DNA replication in nucleus using viral polymerase, bud through nuclear membranes Latency not affected by tx, reactivation by stresses. Ganglionic Theory: virus travels down peripheral nerves to skin respiratory replicates in lyphoid tissue in T cells activated CD4+ sexual replicates in B cells transcription, early proteins E1E7, DNA replication, late proteins, viral assembly and release

sexual

E7: interacts with pRB to cause transformation. E6: degrades p53. E5: in benign papollomas. Genomic integration in malignancy

2 lateral bodies 2 lateral bodies

same as smallpox same as smallpox

2 lateral bodies 2 lateral bodies 2 lateral bodies monkey bite, secretion or person-person

same as smallpox same as smallpox same as smallpox cytoplasm, 1st uncoating removes outer membrane, second uncoating removes core membrane, DNA dependent RNA polymerase, DNA replication, assemply sylvatic

2 lateral bodies, for replication in aerosol cytoplasm from DNA.

replicates in respiratory tract, spreads lymphatically, targets SKIN ,

mosquito mosquito inhaled, direct contact, wild rodents tick contains host ribosomes aerosol, close contact, rodents African green monkeys 10d - 1y, depends on amount of virus introduced 1-3d 3-6d

most pathogenic virus Urban form: unimmunized dogs and cats. Sylvatic form: bats, skunks in cytoplasm virus through epidermis, enters PNS then CNS, replicates in gray matter, passes to salivary glands localizes in duodenum and destroyes villi

bullet shaped

dog bite,

double capsid

fecal-oral

1-2d

star-shaped

fecal-oral

1-2d

intestine

cannibalism

60-360m

2-8y

Disease

Immunity

Dx

Tx

fever, myalgia, headache, muscle ache, chills, cough, fatigue; may lead to Reye's syndrome, and Guillainculture, Barre. Avian Flu (H5N1): primary viral pneumonia, CMI. Anti-H Ab Anti-H high fever, respiratory and neurologic symptoms, > Anti-N Ab serology lymphopenia, diarrhea, binds sialic acid alpha2,3 gal (upper resp) vs. human flu binds sialic acid alpha2,6 gal (lower resp), significant antigenic drift Parainfluenza 1: acute croup/laryngotracheitis in infants and young children. Parainfluenza 2: croup in children Parainfluenza 3: bronchitis/ pneumonia in <1y kids Parainfluenza 4: rare, mild URI Bronchiolitis/ Pneumonia: in infants (<1yr), cough, wheezing , respiratory diestress for 1-3w febrile, respiratory disease and gastroenteritis, pretussislike cough in children, linked to obesity Common Cold syndrome: SARS: mostly asymptomatic, no fever, sneezing, congestion, nasal secretions, duration 2-4d Parotitis: painful swelling of one or both parotid glands lifelong for 12-29d. Viremia may lead to Meningitis, Encephalitis, Orchitis clinical , isolate virus, serology immunofluores cence of nasal secretions isolate virus clinical, serology, virus isolation

supportive, Amantadine-HCl, Rimantadine, Zanamivir, Oseltamivir

n/a

supportive, aerosol ribavirin

supportive n/a

BIRR-4

supportive

Lasts 7-18d; Koplik spots on mouth - small bluishyellow, rash appears on head then trunk and clinical , extremities, high fever, delirium, cough, photophobia, macrophages, isolate conjunctivitis, cough, cold-like. Viremia may lead to CD4+, virus, encephalitis, otitis media, mastoiditis, pneumonia, cytokines serology situsitis, DEATH, Subacute sclerosing Panencephalitis: insidious onset of personality change German/ 3-day measles: symtoms presist for 1-3 days, mild rash, on head/neck/trunk, viremia, vertical transmission, Congenital Rubella: cardiac defects, caracracts, hearing loss, hepatosplenomegaly, lifelong thrombocytopenia, low birth weight, mental retardation, mortality <1yr, subtle to severe symptoms. Progressive Postrubella Panencephalitis: degenerative neuologic disorder Erythema infectiosum/ Fifth disease: mild fever, headache, rash "slapped face", presist 1-2w

supportive

isolate virus, hemagglut supportive inationinhibition

clinical

supportive

AIDS: mostly caused by HIV-1, R5 is transmitted type, no viral latency only clinical, macrophages first cells. CD4>500: no symptoms. 200<CD4<500: shingles, TB, coccidiodomycosis, histoplasmosis. CD4<200: PCP dyspnea, fever, bilateral diffuse infiltrates, oral candidiasis - colonize GI mucosa, oral discomfort, white patches on tongue, easily removed. CD4<50: CMV, toxoplasmosis, mycobacterium avium - fever, weight loss, diarrhea, retroperitoneal lymphadenopathy. AIDS Dementia: 20-25% of patients

loss of CD4+, gp120 and gp41 are targeted by humoral response

Adult T-cell Leukemia: high malignancy, HTLV associated myelopathy: lymphocytic pleocytosis, elevated proteins; hematologic malignancies, B-cell chronic lymphocytic leukemia, immunosuppression

ELISA, PCR

Deoxycoformycin, Interferon

Hairy Cell Leukemia: T-cell origin

ELISA, PCR

Deoxycoformycin, Interferon

Polio: tropic for CNS/ motor neurons, Abortive poliomyelitis: nonspecific fever for 2-3d; Aseptic meningitis: nonparalytic, stiff neck, back and pain, fast recovery, Paralytic poliomyelitis: 2-3d symtoms with free intervening days Aseptic Meningitis, Exanthems, Herpangia, Conjuctivitis, GI in immunocompromised Aseptic Meningitis, Myocarditis, pericarditis, mylagia, fever, intense upper abdominal or throacic pain, IDDM

Acute hepatitis: viremia, fever, poor appetitie, nausea, complete headache, malaise, vomiting, abdominal pain, jaundice, immunity dark urine, clay-colored stool, hepatomegaly

clinical, immune serum globulin

Acute Hepatitis: slow onset, vertical transmission, 10% ELISA, anti-HBsAg HBcAg chronic. Chronic Hepatitis: resivoir in liver, HBsAg, protective, CMI antibody HBeAg, Anti-Hbc, cirrhosis, 200x risk of HCC

interferon

Acute: mild, asymptomatic, Chronic: in 85% of patients, cirrhosis, HCC

elevated ALT, ELISA, RIBA II, PCR Antibody delta, PCR IG assay, PCR

interferon + ribavirin

accelerates pace of HepB, superinfection, HDV alone is asymptomatic abortion of fetus non-cirrhotic hepatitis, prolongs survivial of HIV+ individuals Burkitt's lymphoma, nasopharyngeal carcinoma (China and SE Asia), Mononuceosis: low fever, headache, sore throat, fatigue, night chills/ sweats, enlarged lymph nodes, splenomegaly, elevated lymphocytes and monocytes. Complications: splenic rupture, Neonatal: asymptomatic, Congenital: hearing loss, mental retardation, hepatosplenomegaly, jaundice, anemia, low weight, microcephaly, rash, thrombocytopenia; Immunocompromised: pneumonia, Chicken Pox: viremia, rash on heads, neck and trunk, vesicles with clear fluid and itchy, mild fever, malaise, headache; shingles: reactivation of DNA in ganglia, over age 50, pain before vesicles, unilateral St. Louis Encephalitis: adults >40, Yellow Fever: abrupt fever, chills, headache, hemorrhage, vomiting, bradycardia, jaundice, shock, Dengue: same and Yellow Fever but with RASH, Japanese B. Encephalitis: mostly subclinical

VCA detection, supportive, monospot acyclovir test, Ab to EA culture, hyperimmune lesion IFA, globulin, PCR gancyclovir

clinical

supportive, acyclovir

West Nile Fever: fever, headache, backache, myalgia, rash, general lymphadenopathy, pharyngitis, GI problems. West Nile Disease: stupor, disorientation, convulsions, tremors, coma, meningitis, meningoencephalitis, CSF pleocytosis encephalitis

PCR

above the belly button. Gingivostomatitis: fever, oral blisters, ulcerate, in children, enter latency; cold sores/ Labialis: reactivation, painful ulceration; keratitis: corneal ulceration; herpes encephalitis: temporal lobe; eczema, herpes witlow at finger tips

culture, lesion IFA, PCR

below the belly button: Vulvovaginitis/genital herpes: ulcerated, painful lesions, fever; neonatal herpes: 610% babies, intrapartum ; aseptic meningitis: self limiting.

culture, Acyclovir (stops lesion IFA, DNA polymerase) PCR

roseola infantum: rash unknown Karposi's Sarcoma (KS): in AIDS patients

serology serology PCR

Acyclovir (stops DNA polymerase)

INFalpha cytotoxins, podyphyllins, podophyllotoxin, 5-flurouracil, trichloroacetic acid

common warts: type 1,2. Benign genital warts: type 6,11. Carcinoma of cervix: type 16, 18, 31, 45.

koilocytosis on papsmear, in situ hybridization

Progressive Multifocal Leukoencephalopathy: latent and reactivated in immuno-compromised patients, rare, subacute, degernative, focal demyelination, impaired memory, confusion, disorientation, death in 3-6mo hemorrhagic cysts in bone marrow, nephrpathy, vasculopathy in renal transplant patients. UTI, cystitis: in immunocompromised patients Major: Smallpox with 3-40% death; minor: alastrim, 1% death mild lesion on hands

CSF normal, need none EM/PCR, cells in urine cells in urine

used for vaccination major Public Health concern Orf, Pseudocowpox, Molluscum contagiosum

vesicles appear on face, arms and lower extremities, bigger than chickenpox and SIMULTANEOUS pox. Complications: keratitis, encephalitis, pneumonia, bacterial superinfections.

clinical picture, serology

Methisazone

Western Equine Encephalitis: severe illness in children, nonspecific fever, aseptic meningitis, 5% death; Eastern Equine Encephalitis: encephalitis, seizure fulminant respiratory disease, 67% death Colorado Tick Fever: headache, muscle pain, fever, encephalitis, leukopenia Hemorrhagic fever: fever, shock, prolonged viremia no Ab (no time to make before death) Rabies: illness of CNS, encephalitis: most fatal, acute, fulminant. Prodrum: (2-7d) non-specific symptoms, fever, headache, nausea, sore throat, insomnia. Acute neurological phase: (2-7d) Furious hyperactiity, hydrophobia, excitement or Dumb paralytic, lethargy. Leads to coma and death. abrupt onset, vomiting, followed by diarrhea (5-8d), lifethreatening malnourishment in immunocompromised IgA, IgG (life) child abrupt onset, vomiting, diarrhea (1-2d) Rosela infantum (rose colored rash): abrupt onset fever, brief confulsions, rash after 3-5d of fever. Echo19 roset on face/body, Coxsackie A rash on finger, hands and mouth isolate animal and observe virus in stool Antibody test (IgM = recent) Ribavirin

supportive

hyperimmune globulin

fluids and electrolytes

Kuru: subacute, progressive neuologic disease due to cannibalism (lasts 3-13m) Creutzfeld-Jacob Disease (CJD): changes in cerebral function, psychiatric problem, forgetfulness, changes in gait, seizures, increased tone in limbs (lasts 1-55m) Gerstmann-Straussler-Scheinker Disease: cerebral ataxia, dementia, paralysis Mad Cow Disease/ Bovine Spongiform Encephalopathy (BSE): psychiatric problems, neurologic changes, dementia, death in 14m

Season

Vaccine

Target population

Jan/Feb

Flu shot (killed), Nasal spray (attenuated)

adults

in children development

late fall early spring

in very young development infants young children

live vaccine none

elderly none

live, attenuated vaccine

5-15yrs

live, winter and attenuated spring vaccine

>6mo

live, winter and attenuated spring vaccine

IV drug users, Japan, Caribbean, Hawaii

late summer

Salk- killed, IgG; Sabin attenuated, IgA infants infants

Inactivated Havrix

lower SES

HBsAg

in development

people with Hep B pregnant women

none

early childhood and early adulthood

VARIVAX

<10yrs

yellow fever vaccine

children <2

vaccine

vaccinia virus

infants 5-18yrs

cooler months cruise virus

in 1-24m development older children, adults 6mo-4yrs

infants, children, elderly

Fore culture

50s and 60s

30s and 40s young adults

Organism

Classification

Transmission

Definitive Host

Vector

Intermedia te host 1

Toxoplasma gondii

Ingestion of Apicocomplexan sporulated oocyst from cat feces

Cat

Humans and multiple other mammals

Cryptosporidium spp.

Giardia lamblia

Ingestion of oocyst (fecal-oral, Apicocomplexan contaminated water/ food) Ingestion of cyst (fecal-oral, Flagellate contaminated water) Ingestion of cyst (fecal-oral, Human contaminated food/water, sexual)

Entamoeba histolytica

Ameba

Naegleria fowleri

Ameba

Organisms in fresh water Sexual, (vertical transmission)

Trichomonas vaginalis

Flagellate

Plasmodium falciparum, vivax, ovale, and malariae

Bite of infected Anopheles Apicocomplexan mosquito (nightime)

Anopheline mosquito

Anopheline mosquito

Leishmania spp.

Kinetoplast

Bite of infected fly

Sandfly

Trypanosoma brucei gambiense

Kinetoplast

Bite of Tsetse fly

Tsetse fly

Trypanosoma brucei rhodesiense

Kinetoplast

Bite of Tsetse fly

Tsetse fly

Trypanosoma cruzi

Kinetoplast

Bite of Reduviid bug

Reduviid/ kissing bug

Enterobius vermicularis (pinworm) Trichuris trichiura (whipworm) Ascaris lumbricoides (roundworm) Necator americanus or Ancylostoma duodenale (hookworm) Ancylostoma duodenale (hookworm)

Nematode Nematode

Ingestion of ova (fecal-oral) Ingestion of ova (fecal-oral) Ingestion of ova (fecal-oral)

Human Human

Nematode

Human

Nematode Nematode

Skin penetration by Human filariform larvae Skin penetration by Human filariform larvae Skin penetration by Human filariform larvae Skin penetration by filariform larvae Same as Ascaris Dog

Strongyloides stercoralis

Nematode

Dog or cat hookworm

Nematode

Toxocara canis

Nematode

Trichinella spiralis

Nematode

Ingestion of viable larvae in meat (usually pork)

Pig, others (rats, bears)

Wuchereria bancrofti

Nematode

Bite of infected mosquito

Human

Mosquito, multiple types Mosquito, multiple types

Brugia malayi

Nematode

Bite of infected mosquito

Human

Loa loa (African Eye Worm) Onchocerca volvulus Clonorchis sinensis (Chinese Liver Fluke)

Nematode Nematode

Bite of infected fly

Human

Bite of Simulium fly Human Ingest uncooked fish Humans and other carnivores

Tavanid flies Simulium fly 1. Snail 2. Freshwater Fish

Trematode

Schistosoma mansoni, japonicum, or mekongi (Blood fluke)

Trematode

Cercariae penetrate skin

Human

Snail

Schistosoma haematobium

Trematode

Cercariae penetrate skin Ingest uncooked crabs

Human Humans and other carnivores

Snail 1. Snail 2. Freshwater Crabs Cow Pig Human 1. Crustacean "water flea" 2. Freshwater fish Sheep or human

Paragonimus westermani Taenia saginata Taenia solium Taenia solium

Trematode Cestode Cestode Cestode

Ingest larvae Human (cysticerci) in beef (1) Ingest larvae in Human pork (2) Ingest ova Human

Diphyllobothrium latum

Cestode

Ingest uncooked fish

Humans and other carnivores

Echinococcus granulosus

Cestode

Ingestion of dog feces

Dog

Non-human reservoirs

Pathogenesis

Multiple

Sexual cycle completed in cat, oocyst passed in feces which sporulates in environment and is then infective; obligate intracelluar parasite of most nucleated cells

cattle for C. parvum, none for C. hominus Several mammals (beaver)

Diarrhea which can persist in immunocompromised hosts, localilzed in small intestine/ gall bladder

Asymptomatic to protracted diarrhea

None

Primary invasion of colon (excyst as trphozoite); invasion through mucosa causes necrosis; kill neutrophils, ingest RBCs; secondary abscess in liver or rarely other organs, encyst to pass in feces

Environmental

Travel up olfactory nerve to invade via nasal mucosa brain, cause acute meningitis Infects vaginal epithelial cells and causes vaginitis Hepatic Phase: mosquito bites and injects sporozites which travel to liver. (1-2w) rupture and release merozoites. RBC Phase: invasion (1-2d), rupture simultaneously Sequesteration: S. falciparum; infected cell develops male and female and infects mosquito. P. vivax invages reticulocytes 1. sand fly takes up amastigotes 2. infects animal, 3. transforms to promastigotes in stomach 4. invages mid-gut 5. taken up by monocyte 6. fusion of lysosome causes change to amastigotes 7. burst monocyte chancre at site of painful bite, 1. Hemolymphatic phase: relapsing fever and lymphadenopathy; 2. Meningoencephalitis: CNS infection (sleeping sickness)

None

None

L. donovani and L. tropica are human, others have multiple reservoirs

None

Multiple/ wild game

chancre at site of painful bite, 1. Hemolymphatic phase: relapsing fever and lymphadenopathy; 2. Meningoencephalitis: CNS infection (sleeping sickness)

Multiple/ wild game

puritic wound, feces of vector introduced when scratched. Initial infection may cause systemic, cardiac or CNS disease, followed by indeterminate infection, then mega-disease

None None

Adults in rectum and colon; (pinworm) Most common parasite of children; anal pruritis; restlessness Adults in colon and rectum; burrow into epithelium with posterior protruding into lumen. requires development in soil before infective; adults in small intestine, hematogenous spread to liver, heart and lungs, larvae coughed up and swallowed, mature in small intestine Adults in small intestines;(hookworm) duodenale penetrate skin, eggs pass out of feces and hatch in stool Adults in small intestines;(hookworm) duodenale penetrate skin,

None

None None

free living and parasitic generation. Penetrate skin Uncommonly and burrow into villi and lay eggs. Eggs are passed other mammals out of feces or migrate to liver, lung and trachea (auto infection) . Hookworm penetrates thru intact skin and migrates thru skin Ingested ova hatch into larvae, which invade various organs hematogenously; eosinophilia; IgE; hepatosplenomegaly occasionally retinal granuloma due to larval migration encyst in muscle by penetrating intestinal wall. Become adults in 30h. Intestinal phase 2-3w and expelled Larva develop into adults in hosts; immune response to these causes scarring which may develop to elephantiasis Inflammatory response and scarring in lymphatics, much directed againstWolbachia, the obligate endosymbiont

None

Multiple mammals

Monkeys None Multiple mammals None for S. mansoni, multiple for japonicum and mekongi None Multiple mammals None None

Calabar swellings Larvae develop into adult worms in subcutaneous tissue; cause formation of tumor-like nodules. Adults live in intrahepatic biliary tree and may cause gb or liver disease

Granulomatous reactions to eggs deposited. in intestinal venules or those trapped in liver or other organs

Granulomatous reactions in bladder

Lung lesions from migration thru lungs eggs disseminated by proglottids break up (1) Vague GI disturbances (2) CNS symptoms due to larvae

Multiple mammals

Vitamin B12 deficiency may develop

Eggs mature to larvae which migrate to multiple organs, causing cysts

Disease

Diagnosis

Toxoplasmosis: invastion of nucleated cells (ex: liver), ingestion by macrophages, local and hematogenous spread, trophozoites (block phagosome-lysosome fusion) become bradyzoites, bradyzoites wall off to become pseudocyst, becomes latent infection. Congenital/ Neonatal Serology infection: chorioretinitis, microcephaly, intracranial calcifications, neurological abnormalities, deafness, ocular infection Acute infection: mono-like illness, fever, immunocompromised host, lymphadenopathy, hepatosplenomegaly, meningoencephalitis, myocarditis Reactivation: AIDS patients, seizures, headache, focal findings, chorioretinitis

Cryptosporidiosis (2-14d) watery, presist for months - lifetime, usually lasts 2-7d

Stool for modified acid fast stain or FA of stool

Stool for cysts or trophs , Giardiasis: diarrhea, foul-smelling stools, abdominal cramps, bloating, stool IFA or ELISA, weight loss, some have malabsorption duodenal aspirate Stool for trophozoites or cysts; Trophozoites seen amebiasis/ amebic dysentery: abdominal pain, bloody diarrhea, liver only in warm fresh stool; serology for invasive abcesses , RUQ pain, fever, elevated liver enzymes, flask-shaped disease, indirect ulcers in colon hemagglutination, no fecal leukocytes Visualize organisms in CSF; they look similar to monocytes Trichomoniasis: usually femals, dysuria; males usually asymptomatic Visualize motile organisms from vaginal specimen

Malaria: periodic high ever (40-41C), chills, musculoskeletal pains, severe headache, diarrhea; P. falciparum capillary occlusions especially dangerous. Cerebral Malaria: children with seizures and coma. Severe anemia: Hgb < 5, RBC lysis, removal by spleen, dyserythropoiesis, Visceral leishmaniasis: caused by L. donovani. Seen in spleen and lier with hypergammaglobulinemia, hypersplenism and death. Mucocutaneous Leishmaniasis: caused by L. braziliensis, primary nodule, destruction of nasal and mucosal tissue. Cutaneous leishmaniasis: caused by L. mexicana, ulcerative lesions West African trypanosomiasis: (w-m) for stage 2, daytime somnolence and nighttime insomnia, progression to coma

Blood smear , thick & thin, obtained several times in 24 hr

Microscopic visualization or culture of organism from lesion

Blood or CSF smear, biopsy specimen

East African trypanosomiasis: (m-y) for stage 2, daytime somnolence and nighttime insomnia, progression to coma, more fatal Chagas disease; American trypanosomiasis: nerve destruction, muscle inflammation/hypertrophy, Romona's sign: when parasite enters via mucosal surfaces. Acute Chagas: chagoma, local inflammation, parasitemia , lymphocytosis, lymphadenopathy, fever. Inderterminant phase: mild parasitemia. Chronic Phase: cardiac arrheythmias, cardiomyopathy, CHF. GI: dysphagia, odynophagia, regurgitation, constipation, ab pain, perforation

Blood or CSF smear, biopsy specimen

Serology, blood smear

Emperor of pruritis ani: (4w) females migrate out of the anus at night Cellulose tape for ova; Collect first thing in morning and expel eggs. Eggs hatch in small intestine, larvae hatch in colon (90d) light infections asymptomatic; heavy infections may cause diarrhea, tenesmus and rectal prolapse; anemia, malnourishment light infections asymptomatic; occasional intestinal obstruction or migrations of adult in heavy infection. Migratory phase: release antigen in alveolar capillaries causing eosinophilia, elevated IgG and asthma condition. Intestinal phase: adults entagle and block lumen, may perforate or block bile duct Intestinal phase: light Infections asymptomatic; heavy infection plus malnutrition cause anemia and hypoproteinemia. Migratory phase: itching, dermatitis with larvae is skin. light Infections asymptomatic; heavy infection plus malnutrition cause anemia and hypoproteinemia Strongyloidiasis: Adults in small intestinal mucosa symptoms vary, i.e. asymptomatic mucoid diarrhea with malabsorption of fats (steatorrhea), potentially fatal in immunologically compromised host due to autoinfection Cutaneous larval migrans: long tortuous red tracks, lasts 10d Viscera larval migrans: depends on location n encyst. Liver: fever, hepatomegaly. Retina: blindness. Eosinophilia granuloma similar to retinoblastoma Trichinosis: Adults cause GI disturbances (intestinal phase) larvae cause muscle pains,ocular edema , eosinophilia , splinter hemorrhages, fever, vasculitis, CNS involvement, death (parenteral phase) Acute Filariasis: fever, chills, headache, leukocytosis, marked eosinophilia, local swelling; elephantiasis/ obstructive filariasis: poor lymphatic drainage, especially of legs and genatalia. Asymptomatic: good Ab and CMI. Topical pulmonary eosinophilia: pulomary infiltrates Acute Filariasis: fever, chills, headache, leukocytosis, marked eosinophilia, local swelling; elephantiasis/ obstructive filariasis: poor lymphatic drainage, especially of legs and genatalia. Asymptomatic: good Ab and CMI Stool for ova "barrelshaped"

Stool for ova

Stool for ova Stool for ova Stool or duodenal aspirates for larvae; Baerman concentration (hydrophilic), Eosinophilia (>50%) Clinical Diagnosis difficult; white cell count and differential for eosinophilia ; IgE level; precipitin test, liver biopsy Skin test; serologic tests; muscle biopsy

blood for microfilaria; may be day or night depending on local pattern, high IgE blood for microfilaria; may be day or night depending on local pattern, high IgE

painful eye onchocerciasis; river blindness: Microfilarial forms migrate through eye and may cause blindness majority asymptomatic

daytime blood for microfilaria Skin snip for microfilaria

Stool for ova

Swimmer's itch (2h) self limiting 2-3d; Swimmer's Fever/ Katayama (for acute disease): 3w after, splenomegaly, fever, diarrhea, Stool & rectal biopsy for constipation; Swimmer's Fibrosis/ Bilharzia for chronic: portal HTN, ova; Eggs may be scarce esophageal varasies, ascides, hepatosplenomegaly, rectal varicose veins Urine for ova; biopsy of hematuria, hydronephrosis with renal failure, calcification and edema bladder; Eggs may be around ureter-bladder junction, increase bladder cancer scarce brown sputum (eggs are brown) Vague GI disturbances, usually asymptomatic Ova in stool or sputum Stool for proglottids or ova Stool for proglottids or ova Cysticercosis: epilepsy, death, seizures , hydrocephalus, focal neurological abnormalities, tumor-like Radiologic evidence of cysticerci in affected organ; serology

percicious megaloblastic anemia

Stool for proglottids or ova

Hydatid disease: rapid growth of cysts causing pressure atrophy of adjacent organs.rupture can lead to anaphylactic shock.

Skin test; serologic tests

Target population

pregnant women, neonates

immunocompromised hosts

IgA deficiency

lower SES, tropica regions

People with Duffy receptor, and people with Ss trait, alpha thalassemia, hemoglobin C

Central and South America

Most common puritis; parasite of children; restlessne anal ss children, eat dirt, poor hygene,

children

children children

children

<3mo old Meningitis 6m-2y elderly

Listeria monocytogens Escherichia coli Group B Strep Neisseria meningitides Haemophilus influenzae Listeria monocytogens Pneumococcus

Pneumonia

Community Hospital Atypical

Legionella pneumophilia Escherichia coli Klebsiella pneumoniae Chlamydia pneumoniae Mycoplasma pneumoniae Kebsiella pneumoniae

Facultative Intracellular Organisms Listeria Monocytogens Salmonella typhi Yersinia Francisella trularensis Brucella Legionella pneumophilia Mycobacterium