You are on page 1of 15








Moraxella Catarrhalis

gram (-) aerobic diplococcus. Oxidase (+)

otitis media, sinusitis in children

normal flora

respiratory droplets


penicillin + lactamase inhibitor (amoxicillinbronchitis or pneumonia in pts with underlying mostly skipped, blood clavulanic acid), 2nd, chronic lung disease or chocolate agar 3rd gen cephalosporin, TMPSMX, macrolide treat to prevent acute rheumatic fever: penicillin

gram (+) coccus in Strep throat Streptococcal rheumatic fever, normal flora, chains or pairs. pyogenes (group infected acute postcatalase (-), lactose A antigen) persons streptococcal (+) glomerulonephritis

respiratory droplets

acute inflammation of pharynx and tonsils, LTA, surface proteins F and M, -hemolysis on blood sore throat, fever, exudative tonsillitis, anterior hyaluronic acid capsule, streptolysin, agar, bacitracin cervical lymphadenopathy, scarlatiniform rash exo-enzymes, pyrogenic exotoxins sensitive or fever Heat-labile A-B exotoxin, ADP ribosyl transferase (blocks protein syn), diphtheria toxin is invasive

Corynebacterium diphtheriae

gram (+) clubshaped rods, aerobe


normal flora, humans only

respiratory droplets

exotoxin cell death, necrosis

Loeffler medium, pseudomembrane obstruction and antitoxin serum selective tellurite suffocation, sore throat and pharyngitis, low therapy + antibiotics medium (- extra flora) grade fever, regional lymph nodes swollen (penicillin or --> black colonies bull neck. Toxin: myocarditis & cardiac macrolides: with dark halo. Toxin dysfunction, laryngeal nerve palsy, lower limb erythromycin) DTaP detection: Eleck polyneuritis vaccine immunodiffusion test Catarrhal stage: 1-2 wk, highly communicable, paroxysmal stage: 2-4 wk, paroxysmal cough, whoop. Convalescent stage: wks to mn charcoal-blood agar (Bordet-gengou potato agar) , pearl-like erythromycin DTaP colonies, direct vaccine fluorescence antibody test CXR, PPD: >5mm = isoniazid, rifampin (+) in HIV, >10mm = (4m), pyrazinamide (+) in high-risk. (2m), ethambutol >15mm = (+) in lowBCG Vaccine, risk, ziehl-Neelson isoniazid stain, Lowensteinprophylaxis Jensen medium amoxicillin + chocolate agar (X and clavulanic acid V factors), satellite phenomenon, latex 3rd gen agglutination test cephalosporin Hib PRP conjugate vaccine OM: amoxicillin + -hemolytic on blood clavulanic acid. agar, not typeable Pneumonia/meningiti (A/B), Optochins: 3rd gen sensitive, bile soluble, cephalosporin + surface capsule vancomycin PPV, PCV7 vaccine Eaton's media (sterols), serological tests tetracycline or macrolide macrolides (azithromycin) or tetracyclines (doxycycline) tetracycline or erythromycin

Bordetella pertussis

gram (-) coccobacillus, strict aerobe, mucosal surface pathogen

whooping cough humans only pertussis

respiratory droplets

attachment, immobilization, destruction (murein) of cilia, Fha, Ptx (AB toxin - cAMP), pertactin, pili


Mycobacterium tuberculosis

ACID-FAST, rod shaped, obligate aerobe, very slow growth, facultative intracellular gram (-) pleomorphic rod, small, facultative anaerobe. requires growth factor X (hemin) and V (NAD, NADP)


reservoir infected humans

Inhalation of infectious aerosols

Mycolic acid, sulfolipids, cord factor, tuberculin + mycolic acid DAMAGE DONE BY HOST IMMUNE SYSTEM

primary TB: Ghon complex, progressive primary (active) TB, latent dormant TB, secondary (reactivation) TB: apex. Productive cough - bloody sputum, fever, weight low, night sweats

Haemophilus influenzae (nonencapsulated) Haemophilus influenzae (Hib)

otitis media, sinusitis, bronchitis epiglottitis, pneumonia, meningitis, septic arthritis, cellulitis

normal flora lipopolysaccharides, IgA protease, polysaccharide capsule asymptomatic carriers infants: passive maternal protection, poor response first 2 years, > 5 - disease uncommon

lancet-shaped, gram (+) communityStreptococcus diplococcus or in acquired normal flora, pneumoniae chains, pneumonia, OM, humans only (pneumococcus) fermentation adult meningitis metabolism Mycoplasma pneumoniae smallest free-living bacteria, NO CELL "walking WALL, pneumonia", pleomorphic, no tracheobronchitis gram stain
small obligate INTRACELLULAR pathogen, gram (-), not seen on gram stain, cell wall lacks peptidoglycan layer, unable ot make ATP energy parasites

respiratory droplets

polysaccharide capsule, autolysin, pneumolysin O, peptidoglycan/ teichoic acids, adhesins, GOOD AT PICKING UP DNA

rusty sputum, typical lobar pneumonia

human respiratory tract

aerosol droplets

p1 adhesin, toxic metabolic products: hydrogen peroxide and superoxide radicals

hacking cough, dry productive, slow resolution

Chlamydophila species

pneumonia or bronchitis parrot fever, psittacosis, ornithosis, pneumonia

infected humans

respiratory droplets

Chlamydophila psittaci

inhalation of zoonotic dried pathogen, secretions from mainly birds birds

2 stages: elementary body (EB): infectious, survive outside, non reproductive. Reticulate body (RB): noninfectious, intracytoplasmic, reproductive form

asymptomatic to pneumonia or bronchitis, complications: atherosclerotic vascular diseases

serological tests, isolation is difficult serodiagnosis by complement fixation test

Page 1 of 15






Legionella pneumophila

weakly gram (-) rods, water organisms (45C), complex nutritional requirements, aerobic, motile
enterobacteriaceae family, gram(-) rod, lactose (+)

Klebsiella pneumoniae

inhalation of pneumonia, contaminated biofilms in low virulence, biofilms, prevents Legionnaire's aerosols, no water phagosome-lysosome fusion, lung disease and person-tosources damage and inflammatory response Pontiac fever person transmissions capsule, endotoxin - necrotic pneumonia, UTI, human colon and URT, from destruction of alveolar spaces, septicemia own flora abscesses, resistance plasmids respiratory ubiquitous in secretions, environment direct contact, fomites

fever, chills, non-productive cough, chest pain, HA, mental confusion, diarrhea

BYCE (buffered charcoal yeast extract), requires Lcys, Fe, pH 6-9, slow growth 2-5 days, SILVER STAIN mucoid colonies

macrolides (erythromycin), Pontiac fever - selflimiting 3rd gen cephalosporins

hacking cough, dry productive, slow resolution. DM at high risk

Pseudomonas aeruginosa

gram(-) rod, aerobic, motile, minimal nutritional requirements

opportunistic pathogen

blue-green colonies, pili, capsule, endotoxin: fever, productive cough, weight loss, breathing pyocyanin, antipseudomonal lipopolysaccharide, tissue damage: difficulties and cyanosis, complications: polyverdin, or PNC (carbenicillin) + exotoxin A (AB - protein syn), malignant otitis externa (DM), colonization fluorescein (green), aminoglycoside exoenzyme S, elastase, alkaline of cystic fibrosis patients fruity aroma, mucoid, (tobramycin) protease, cytotoxin, hemolysin UV light


Burkholderia pseudomallei Burkholderia cepacia gram (-), aerobic rod

melioidosis, acute pneumonia soil, ponds, opportunistic pathogen - same rice paddies, zoonotic as P. aeruginosa, causes serious infections

inhalation, inoculation


resembles TB - abscesses and granulomas

-lactams or tetracyclines, high mortality if untreated

Acinetobacter spp

gram (-) coccobacilli

nosocomial soil, water, sewage, animals, infections in normal skin, GI tract of pts or immunodeficient pt health care workers polypeptide capsule, spore, exotoxin: EF, LF, PA (adenyl cyclase) FimH (cystitis) - FIMBRIAL ANTIGEN, P-pilus (nephritis), capsule, hemolysin, aerobactin, LPS

pneumonia, wound infections, UTI, sepsis

case-by-case fluoroquinolones box car chains, large (ciprofloxacin) cellnonhemolytic colonies free vaccine - used in high-risk MacConkey agar: lactose (+) - pink, EMB agar - LACTOSE (+): blue-black colonies MacConkey agar, mucoid

Bacillus anthracis

aerobic gram (+), spore forming, nonmotile


ubiquitous, zoonotic

dermal, respiratory, GI anthrax, possible sepsis

Enterobacteriaceae gram (-) rods, facultative anaerobes, catalase (+), oxidase (-), nitrite (+)

Escherichia coli


Klebsiella pneumoniae

UTI, diarrheas/ dysentery, motile, lactose (+) Neonatal meningitis, septicemia UTIs, Lower non-motile, lactose respiratory tract (+) infection (lobar pneumonia)

normal flora


capsule, pili, endotoxin

community/hospita highly motile, l UTIs, pneumonia, Proteus mirabilis lactose (-), urease septicemia, wound (+) infections Enterobacter Serratia (marcescens) Staphylococcus Saprophyticus Enterococcus faecalis (80%) lactose (+), motile lactose (+) gram (+) cocci, clusters, catalase (+), coagulase (-)

normal flora

peritrichous flagella - swarming, adhesins, endotoxin

MacConkey agar: clear


common cause normal flora and environment of nosocomial infections nosocomial normal flora and environment infections UTIs sexually active young endogenous women normal flora

adhesins, capsule, endotoxin adhesins, capsule, endotoxin adhesin, inflammation response

TMP/SMX - UTIs in hospital and acute uncomplicated UTI, acute community, uncomplicated pyelonephritis, complicated Fluoroquinolone brick-red colonies UTIs, asymptomatic bacteriuria, renal abscess complicated UTI, Cephalosporin -hemolysis, pregnancy novobiocin resistant

nosocomial gram (+) infections, UTI, diplococci or short endocarditis (pt chains, catalase with damaged (-), Lancefield's heart valves), group D antigen wound infections, bacteremia

adhesins, toxins, enzymes

or hemolytic, resistant to 40% bile salts, 6.5% to NaCl, bacitracin and Optochin.

Page 2 of 15

pregnancy URINARY TRACT INFECTIONS nosocomial gram (+) infections, UTI, diplococci or short endocarditis CHARACTERISTICS DISEASE (pt chains, catalase with damaged (-), Lancefield's heart valves), group D antigen wound infections, bacteremia aerobic gram (-) rod, motile, oxidase (+), lactose (-)




adhesins, toxins, enzymes


Enterococcus faecium (20%)

normal flora

or hemolytic, resistant to 40% bile DIAGNOSIS salts, 6.5% to NaCl, bacitracin and Optochin. blue-green colonies, pyocyanin, polyverdin, or fluorescein (green), fruity aroma, mucoid, UV light Multiple (+) blood cultures (3-5 sets taken), if (+) for same organism - sensitivity testing. Culture (-): recent antibiotic use, fastidious organisms, fungi. Echocardiography - vegetations



opportunistic infections

ubiquitous in environment

polysaccharide capsule, endotoxin, adhesin, exotoxins

gram (+) cocci, clusters, catalase Staphylococcus (+), coagulase (+), aureus salt tolerant, mannitol (+)

infective endocarditis, etc

normal flora

Staphylococcus epidermidis CARDIOVASCULAR INFECTIONS

gram (+) cocci, clusters, catalase (+), coagulase (-)

catheter and prosthetic device infections, IE in IV drug users and prosthetic valve IE

normal flora


no hemolysis, NOVOBIOCIN sensitive

Native valve IE: PNC + gentamycin. IV drug use: nafcillin + gentamicin. Prosthetic valve IE: vancomycin + gentamicin

Protein A - (-) phagocytosis. Fibrinogen-binding protein clumping factor. Coagulase - fibrin clot. Cytotoxic toxins - pore-forming toxins. Enterotoxins A-E: gastroenteritis, TSST-1, Exfoliations skin infections

complications: embolization from infective endocarditis to parietal lobe, to lung

mannitol-salt agar: yellow colonies, hemolysis

methicillin resistant, some vancomycin emerging


most common gram (+) cocci, cause of Viridans chains, catalase subacute IE in Streptococci (-), lack capsule and pts with (many, do not lancefield antigens, abnormal or need to identify) no serologic group damaged heart valves Enterococcus faecalis (was classified as streptococcus) gram (+) cocci, single cells, diplococci or short chains, catalase (-), lancefield antigen: group D gram (+) cocci, chain, catalase (-), lancefield antigen: group D, also named non enterococcal group D organisms nosocomial infections, UTIs, wound infections, bacteremia, endocarditis in pts with damaged heart valves

normal flora, dental caries

low virulence, dextran-mediated adherence - biofilm damaged heart valve surfaces, FimA surface adhesin, lack capsule Subacute IE: w/n 2 weeks of dental or other procedure, low grade fever and chills, fatigue, anorexia weight loss, new or changing heart murmurs, skin lesions. Acute IE: acute onset of high-grade fever and chills, rapid onset of CHF, murmurs can be absent

-hemolytic, Optochin resistant, not bile soluble

normal intestinal flora

not bile soluble, growth in 6.5% NaCl, or hemolysis

major resistant problems for antibiotic problems

Streptococcus Bovis

subacute infective endocarditis

normal intestinal flora

associated with colon cancer

not bile soluble, no growth in 6.5% NaCl, or -hemolysis

sensitive to penicillin

Pseudomonas aeruginosa

IE in IV drug users aerobic gram (-) and patients with motile rod, oxidase prosthetic heart (+) valves.

ubiquitous in environment

no fermentation, produces pigments BLUE-GREEN



Haemophilus aphrophilus Actinobacillus actinomycetemco fastidious organisms; requires 5-10% mitans carbon dioxide for growth + 3 wks Cardiobacterium incubation hominis

subacute IE (5%), complications may include massive arterial emboli and congestive heart failure

Page 3 of 15





fastidious organisms; requires 5-10% carbon dioxide for growth + 3 wks incubation

ALL BACTERIAmay include massive arterial emboli and congestive heart failure subacute IE (5%), complications




Native valve IE: PN


Eikenella corrodens Kingella kingae Bartonella species Polymicrobial IE Fungal endocarditis SKIN INFECTIONS

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 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 valve IE and fungal prosthetic valve IE are: Candida spp, and Aspergillus spp.


fibronectin-binding proteins, collagen binding proteins, clumping factors (A, MSSA: nafcillin, B), teichoic acids, capsule, protein A Furuncles, carbuncles - neck, face, axillae, MRSA: person-to- binds Fc, prevents complement, buttocks. NTSS associated with tampons, -hemolysis, mannitol vancomycin, VRSA: person enzymes, exotoxins, inflammatory scalded skin syndrome in neonates, bullous salt agar, 7.5% NaCl linezolid, Synercid, response, superantigen: TSST-1, impetigo is localized form. daptomycin enterotoxins, ETA, ETB, exfolatins produce bullae impetigo, M-protein, F-protein and lipoteichoic HONEY CRUSTED LESIONS - involves erysipelas, acid, hyaluronic acid capsule, gram (+), chain normal flora, dermal lymphatics, pain and systemic Streptococcus respiratory cellulitis, streptococcal pyrogenic exotoxins, forming cocci and infected manifestation, necrotizing fascitis "flesh-hemolysis penicillin, macrolide pyogenes necrotoxic fasciitis droplets superantigens, streptolysin S + O, diplococci persons eating bacteria", scarlet fever: strawberry - gangrene, scarlet exoenzymes, peptidoglycan + teichoic tongue, diffuse erythematous rash, TSS fever acids blue-green colonies, antipseudomonal pyocyanin, aerobic gram (-) "Hot tub: capsule, biofilm, lipopolysaccharide blue-green pus, grape-like odor, inflamed penicillin Pseudomonas polyverdin, or motile rod, oxidase folliculitis, burn ubiquitous and lipid A, A-B toxin, exoenzymes, follicles from neck down, shallow puncture (carbenicillin) + aeruginosa fluorescein (green), (+) wounds pili wound through tennis shoe sole aminoglycoside fruity aroma, mucoid, (tobramycin) UV light paucibacillary/tuberc uloid: Dapsone + Paucibacillary (tuberculoid) leprosy: central obligate intracellular parasite of rifampin ~6 months. Mycobacterium healing, low infectivity, few rods, DTH to no growth on medium acid fast bacillus Leprosy reservoir: humans macrophages and Schwann cells. Multibacillary/leprom Leprae lepromin. Multibacillary (lepromatous) or tissue culture DAMAGE FROM HOST RESPONSE atous: Dapsone + leprosy: infectious, many rods, (-) lepromin rifampin + clofazimine ~2 years "box car chains" culture: large ubiquitous, zoonotic, lives in vegetative form, dormant spore, cutaneous anthrax: erythematous papule, colonies; NONfluoroquinolones Bacillus anthracis gram (+) rod, spore anthrax soil, causes anthrax in polypeptide capsule, PA, EF, LF black eschar surrounded by edema HEMOLYTIC, (ciprofloxacin) animals and humans M'Fadyean methylene blue stain or DFA WOUND INFECTIONS culture under anaerobic conditions, necrotizing and hemolytic toxins: large gram (+) Iron Milk Medium @ myonecrosis "GAS LECITHINASE ~ PHOSPHOLIPASE marked gas formation, "crepitance in tissue", surgery, amputation, Clostridium rods, spore, strict 45C stormy GANGRENE", ubiquitous in soil, flora C ~ ALPHA TOXIN - splits systemic signs: fever, hemolysis, hypotension, penicillin, hyperbaric perfringens anaerobes, lactose fermentation, blood cellulitis phospholipid molecles., renal failure, shock, death O2 chamber (+) only agar - characteristic enterotoxins, DNase, hyaluronidase double zone of hemolysis folliculitis, gram (+) cocci, furuncles, clusters, catalase carbuncles, Staphylococcus human skin (+), coagulase (+), impetigo, scalded aureus and mucosa salt tolerant, skin syndrome, mannitol (+) toxi shock syndrome anaerobic conditions, sulfur granules. long granulomatous lesions, suppurative, branching filaments, abscesses, sulfur granules: YELLOW PUS, slow growth ~2 weeks, dental extraction or trauma white colonies: molar tooth appearance


Actinomyces (israelii)

gram (+) rods, facultative or strict anaerobes


part of oral, intestinal and vaginal human flora


surgical drainage, penicillin or amoxicillin


Page 4 of 15









gram (+) cocci, anaerobic

infection at normally sterile sites

part of normal human flora; oral, GI, GU, skin

anaerobic conditions, gram (+) in pairs or brain abscesses, sinusitis, endocarditis, chains, rich media for osteomyelitis, intraabdominal infections, pelvic culture, long infections, skin and soft tissue infections incubation time 5-7 days

penicillin + broad spectrum

Bacteroides fragilis, pleomorphic Fusobacterium anaerobic gram (-) nucleatum, rods Prevotella melaninogenica Pasteurella multocida


mixed, skin and soft-tissue infections

normal human flora


capsule, fimbriae, succinic acid, extracellular enzymes

illness when native host defenses and anatomical barriers are altered, progress to myonecrosis

anaerobic culture, foul odor

metronidazole, surgery

gram (-) coccobacilli, localized cellulitis small, facultative and lymphadenitis anaerobes gram (-) rods, short, aerobes cat-scratch disease

flora of animals

animal bites

systemic infection in immunocompromised pts rods in lymph nodes, culture usually negative, definitive dx by serologic tests culture: requires salt for growth media: Thiosulfate citrate bile salts sucrose agar (TCBS), ID biochemical tests Clinical presentation + Serologic tests (indirect immunofluorescence assay) (high Ig titers by the 7th day of illness); PCR (most rapid and specific); Immunostaining (70%)

amoxicillin + lactam inhibitor

Bartonella henselae

reservoir: animals

cat scratches, bites, contact with fleas

cutaneous papules or pustules at inoculation site painful regional lymphadenopathy, Bacillary angiomatosis in IC - pts wound infections after exposure to contaminated seawater - necrotic cellulitis, gastroenteritis and septicemia after consumption of raw oysters

antibiotics not indicated

gram (-) rods, curved, facultative Vibrio vulnificus necrotic cellulitis anaerobe, oxidase (+) SYSTEMIC INFECTIONS


found in salt water, oysters

polar flagella, polysaccharide capsule

tetracycline (doxycycline)

Rickettsia rickettsii (Spotted fever group)

Rickettsia akari (Spotted fever group)


small gram(-) rods; take gram staining weakly; obligate INTRACELLULAR pathogens; zoonotic Rickettsia typhi pathogens (Typhus group) Orientia tsutsugamushi (Scrub typhus group)

Rickettsia prowazekii (Typhus group)

Tick (Dermacentor), Infect vascular Wild rodents, Mortality: 5-7% Rocky mountain American dog endothelial cells domestic delayed therapy to (1) induced spotted fever tick (eastern animals 2nd week, ~25% if (April Sept) US), Rocky Mt endocytosis (2) (dogs), ticks untreated. lysis of wood tick phagosome (western US) membrane phospholipase A (3) replication in host cell Wild rodents, Mouse mite cytoplasm (4) lysis benign, self-limited Rickettsialpox of host cell rodent mites (transovarian) disease, not fatal vascular damage (hemorrhage, edema), LPS weak endotoxin Epidemic typhus, activity, vasculitis exit: cell lysis Brill-Zinsser Humans; Human body and thrombosis disease flying (around all the Mortality: 10-60% louse (Recrudescent squirrels body). if untreated typhus) IMMUNITY: both humoral and cell mortality rate mediated Endemic typhus Rats Rat flea rare even with important - after (Murine typhus) untreated recovery - solid and lasting Mite larva immunity Rodents, mortality ~30% in Scrub typhus (chigger) rodent mites untreated (transovarian)

Rickettsial Diseases/Rickettsiosis

5-10 days incubation. EARLY: Flu-like symptoms; LATER: petechial-hemorrhagic rash (first on extremities spread to entire body); various organs failures (2nd & 3rd febrile day). Fever + Rash + Previous tick bite

Tetracycline (doxycycline)

Phase1: (~1 wk) local proliferation eschar at bite site; Phase2: (~3-7d) dissemination flu-like symptoms + fever + generalized rash (randomly distributed, papulovesicular eschar, exanthem ~ chicken pox)

Tetracycline (doxycycline) + chloramphenicol can speed recovery (benign)

(~8d) Flu-like symptoms; maculopapular Clinical presentation + rash (first on trunk spread to extremities); Tetracycline Serologic tests, complications: myocarditis, CNS (doxycycline) or typhus (indirect dysfunction; Recrudescent typhus = (10-40 fluorescent antibody chloramphenicol, yrs later) endogenous secondary infection by vaccine for high-risk test, latex R. prowazekii persisting in pop agglutination tests). reticuloendothelial cells NO STAIN Tetracycline (1-2 wk) Same as Epidemic typhus but milder; INTRACELLULAR (doxycycline) and rash not always present chloramphenicol (1-3 wks) Necrotizing eschar at bite site; flulike symptoms; maculopapular rash (first on trunk spread to extremities) + generalized lymphadenopathy Tetracycline (doxycycline) or chloramphenicol

Page 5 of 15







Ehrlichia chaffeensis

Human Monocytic Ehrlichiosis

Deer, dogs Sheep, cattle, rodents, bisons, deer Dogs, ticks

Anaplasma phagocytophila

Human Granulocytic Ehrlichiosis

Ehrlichia ewingii

Infect leukocytes (1) phagocytosis (2) Similar to RMSF but generally without rash, Inhibition of granulocytes 5-10 days, leukopenia, thrombocytopenia, phagosome(neutrophils > elevated liver enzymes. Severe: prolonged Black legged lysosome fusion + eosinophils) fever, renal failure, disseminated intravascular tick (Ixodes) multiplication in (higher morality ~ coagulopathy, meningoencephalitis, adult cytoplasmic 10%) respiratory distress syndrome, seizures, coma. vacuoles - Morula Mortality ~2-3% same - pts with (3) Host cell + underlying Lone star tick phagosome lyses immunosuppression Lone star tick

mononuclear leukocytes (monocytes, macrophages)

Clinical presentation + Microscopy: Giemsa stain. (Morulae) + Serologic tests: IFA (high IgM or IgG titers by the 2nd wk of illness), PCR


Tetracycline (doxycycline)

Infect macrophages=> (1) phagocytosis Sheep, Small gram(-) (2) phagosomegoats, cattle resistant to heat pleomorphic rod; lysosome fusion; (excreted in and drying, intracellular Q. fever; Chronic Inhalation of but bacteria Flu-like symptoms, rarely rash; pneumonia; milk, urine, Proliferation in Coxiella burnetii pathogen with Q fever dust containing survive and hepatitis; endocarditis (Chronic form - 1-20 feces, respiratory tract extracellular (Endocarditis) pathogen multiply inside y, high mortality ~65%) amniotic then dissemination "spore-like" form; acidic fluids and to other organs zoonotic pathogen phagolysosome placenta (3) Host cell + phagolysosome lyses

Acute: tetracycline Serologic tests (doxycycline); antigenic variation => Chronic: acute disease: high (doxycycline + titer of phase II quinolones for 4 yrs antigen; chronic or doxycycline + disease: high titers of hydroxyphase I and II chloroquine 1.5 to 3 antigens; PCR yrs), vaccine for high risk pop

Yersinia pestis

Gram(-) rod, lactose (-), oxidase (-), catalase (+), coagulase (+), nonmotile, bipolar staining; facultative intracellular pathogen; zoonotic pathogen

Virulence plasmids; Changes in genes expression in response to environmental changes (1) Changes in flea behavior: yersinia murine Bubonic plague: flu-like symptoms; toxin (survival), low T - fibrinolysin & Multiplication of bacteria in regional lymph Serologic tests: direct phospholipase (agglutination); (2) node => suppurative lymphadenitis = "Bubo" immunofluorescence Wild Flea bite; Survival in human body: Capsule (F1 (~70% M untreated); Pneumonic plague: flutest (rapid, presence of Streptomycin, Plague: Bubonic, rodents direct contact; protein), plasminogen activator: like symptoms + cough, bloody sputum, F1); microscopy: gram tetracycline, and Pneumonic & (Sylvanic respiratory prevents opsonization, important for dyspnea and cyanosis (2-3rd day death due to stain or Giemsa chloramphenicol, Septicemic cycle); Urban droplets (only dissemination (3) Damage: Type III septic shock); Septicemic plague: bacteremia bipolar staining, isolation for 72 hours rats (Urban pneumonic secretion system (Yop proteins: without buboes => flu-like symptoms+ culture: highly cycle) plague) Lcr, Ysc) suppress cytokine bleeding into skin and other organs => dark infectious production, cytotoxic effect; discoloration (40% M in treated, 100% in endotoxin (septic shock); untreated) yersiniabactin (obtain iron from host); intracellular grow in reticuloendothelial cells Infects reticuloendothelial organs: Serologic tests; PCR, Tick or fly bite, Ulceroglandular form: 75% painful ulcerating multiplication in macrophages, gram stain direct contact, lesion at site of infection; Oculoglandular hepatocytes and endothelial cells => unsuccessful, requires inhalation, form: 1% purulent conjunctivitis + necrosis and granuloma production in cysteine-glucose ingestion of lymphadenopathy; also Pneumonic, areas of multiplication; Survival: blood agar - tiny contaminated Gastrointestinal & Septicemic forms (10inhibition of phagosome-lysosome transparent colonies, food or water 15%, more severe). Untreated ~5-30% M fusion; antiphagocytic lipid capsule culture is hazardous


Francisella tularensis

Small gram(-) rod, aerobe, require cysteine, facultative intracellular Wild animals, Tularemia (rabbit pathogen; zoonotic ticks, deer or deer fly fever) pathogen, oxidase fly (-), urease (-), nonmotile, thin lipid capsule



Page 6 of 15







Small gram(-) rods, strict aerobes, Brucella spp. facultative (abortus, intracellular melitensis, suis) pathogens, zoonotic pathogens, no capsule, no spore


Domestic livestock

Serologic tests, microscopy: Multiply in Inhibit insensitive, culture: Direct contact, Flu-like symptoms; night sweats (undulant macrophages in phagosomedifficult and hazardous. inhalation, fever); Chronic illness: body aches, headache, reticuloendothelial lysosome fusion; B abortus - needs ingestion of anorexia, depression few physical findings system => impair cytokine CO2, antigen A, (-) by unpasteurized unless enlargement of reticuloendothelial granulomas => production; dye thionine, B. dairy products organs. (M is low <25) septicemia endotoxin Melitensis - antigen M, B. Suis - (-) by fuchsine Prolonged bacteremia, WWI, now amongst homeless, little is known, biopsy of skin does not reveal organisms 4 fever patterns: (1) asymptomatic with 1 episode; (2) 3-5 days single febrile episode; (3) multiple recurrent febrile episodes "5-day fever"; (4) persistent fever for 2-6 weeks. Serologic tests; PCR, fastidious growth requirements, difficult culture, blood of chocolate agar, 5% CO2 with high humidity for 4 weeks

Doxycycline + rifampin (for 6 weeks)

Bartonella quintana

Small gram(-) rod; aerobe, zoonotic pathogen

Trench fever, bacillary angiomatosis, subacute endocarditis

Humans, lice

Contaminated louse feces (scratching)


Borrelia burgdorferi

Spirochetes infections

Borrelia recurrentis

other Borrelia spp.

OspA (in tick), OspC (in Stage1 (localized infect.): erythema migrans mammals); toxic CDC:ELISA or IFA Tetracycline (bull's eye appearance) + flu-like symptoms; LPS ; then Western blot, (doxycycline), Spiral morphology, Antigenic Black Stage2 (disseminated infect.): cardiac and Lyme disease Tick bite serologic - later stages, amoxicillin, or large; motile; slow variation - escape downregulation of legged tick neurologic (nerve palsies) abnormalities; immune functions; culture - not rec, OCT - cefuroxime, Vaccine growth; gram(-), immune (Ixodes) Stage3 (persistent infection): fluctuating possible not standardized no longer available zoonotic pathogens, clearance, arthritis. autoimmune hard to isolate in modulation of host response culture, complex immune system nutritional needs, inhibition of flexible mononuclear and Endotoxin (febrile Crushing peptidoglycan cell natural kill cell illness); Recurrent Epidemic Human body Microscopy (during infected louse wall around which Relapsing Fever function, antilouse episodes of fever febrile period) + scratching several axial OspA has + septicemia High fever, headache, muscle pain, weakness. Giemsa or Wright Tetracycline endoflagella are autoimmune separated by 2-4 days between relapses; 2-3 relapse staining; Serologic (doxycycline) or wound activities afebrile periods; cycles; possible myocarditis. tests unhelpful erythromycin new set of (because of antigenic Endemic Tick Tick bite surface antigens variation) Relapsing Fever at each relapse Direct contact with urine, blood or Shed in urine tissues of Multiply in blood and tissues; damage of infected infected endothelium of small blood vessels; animals animals; no virulent factors known Contact with contaminated water Cfa (colonization factor antigen) adherence; ST (heat stable toxin) guanylate cyclase activation [cGMP]; LT (heat labile toxin, AB toxin) - ADP ribosylates G protein activation of adenylate cyclase [cAMP]; High cGMP or cAMP hypersecretion of H2O and Cl; in Na reabsorption Culture: from blood, CSF during septicemic phase; from urine during immune phase; slow growth, special media, PCR - not widely available. Serologic tests: agglutination test

Leptospira interrogans

Spiral morphology; motile; slow growth; gram(-) but not seen on gram stain; zoonotic pathogen, tight terminal hooks


both febrile: Septicemic phase: flu-like symptoms; Immune phase: anicteric form (possible meningitis), icteric form or Weil's disease (jaundice, renal + pulmonary dysfunctions, subconjunctival hemorrhage)

Penicillin or Doxycycline

ease - No invasion, no inflammation

ETEC EnteroToxigenic E. coli

Traveler's Diarrhea

Human's intestine


Watery diarrhea, abdominal cramps


Fluoroquinolon es (ciprofloxacin), TMP/SMX

Enterobacteriacea e; Motile; lactose(+)

Page 7 of 15

te replacement

Watery Diarrhea - Small intestine disease - No invasion, no inflammatio


Watery diarrhea


EAEC EnteroAggregativ e E. coli

Chronic diarrhea

Human's intestine


Bfp (Bundle-forming pili) autoagglutination "stacked-brick" arrangement + biofilm malabsorption Invade M cells: Yops and Type III secretion system; gene expression under Ca and T control, virulence genes, spread microabscesses in lymph nodes

Fluid+electrolyte replacement Fluid + electrolyte replacement

EPEC EnteroPathogenic E. coli

Enterobacteriacea e; Motile; lactose(+)








Human's intestine

Bfp (Bundle-forming pilus) Fecal-oral, adherence; Type III secretion system LOW in infants cytoskeleton proteins modification (person-toin host cell; Attaching and effacing person); high in lesions changes in microvilli adults malabsorption

Watery diarrhea, abdominal cramps (INFANTS)

Fluoroquinolon es (ciprofloxacin), TMP/SMX Fluoroquinolon es (ciprofloxacin), TMP/SMX Fluoroquinolon es or doxycycline + gentamycin

Chronic watery diarrhea (in AIDS patients), abdominal cramps, dehydration in infants and children ~ growth retardation Watery diarrhea, abdominal cramps, fever; mesenteric lymphadenitis (mimics acute appendicitis) other: arthritis, intra-abdominal abscess, septicemia, osteomyelitis


Yersinia Enterobacteriacea enterocolitica (Y. e; Bipolar staining; Watery diarrhea, pseudotuberculosi lactose (-), gastroenteritis s - uncommon) zoonotic

Animal's intestine


Stool culture at 25C


Vibrio Cholerae (serogroups O1 and O139)

Curved gram(-) rods; facultative anaerobes, oxidase(+), motile (polar flagella)

Cholera and gastroenteritis

Tcp (toxin coregulated pilus) adherence; Ctx (cholera toxin, ABWarm costal Ingestion of TCBS (Thiosulfate toxin, on lysogenic CTX phage) water, contaminated Profuse watery diarrhea; "rice-water" stools; citrate bile salts ADP ribosylates G protein constant asymptomati water or severe dehydration hypovolemic shock sucrose agar) - yellow activation of adenylate cyclase c carriers shellfish colonies cAMP hypersecretion of H2O and Cl; decrease in Na reabsorption Warm costal Ingestion of water contaminated (marine life) seafood Fecal-oral, LOW person-toperson transmission Enterotoxin - chloride secretion Watery diarrhea, abdominal cramps, nausea TCBS - blue-green colonies; Halophilic

Ciprofloxacin or doxycycline

Vibrio parahaemolyticus

Watery diarrhea

Self-limiting Antibiotic therapy not recommended; dialysis in HUS cases Fluoroquinolon es (ciprofloxacin), TMP/SMX Fluoroquinolon es (ciprofloxacin), TMP/SMX

EHEC Enterobacteriaceae; Hemorrhagic EnteroHemorrhag Motile; lactose(+), Colitis; Hemolytic Intestine of ic E. coli sorbitol(-) Uremic Syndrome cattle (O157:H7) "spinach outbreak" (HUS) Watery to Bloody Diarrhea - Large Intestine EIEC Enterobacteriaceae; EnteroInvasive E. Motile; lactose(+) coli

Attaching & Effacing lesions (no invasion); Shiga toxin (AB toxin) Culture on MacConkey cleaves rRNA blocks protein Bloody diarrhea (no leucocytes), abdominal agar (sorbitol(-)); synthesis cell death; circulating cramps, vomiting; oliguria+renal failure (HUS) Immunoassays shiga toxin can bind to renal tissue renal failure (HUS) Invasion and destruction of colonic epithelium, virulent plnv genes, INACTIVATE RIBOSOMAL SUBUNITS Bloody diarrhea with pus, fever, abdominal cramps, nausea Immunoassays, sorbitol (-), glucuronidase (-)


Human's intestine


Enterobacteriaceae; Shigella spp. (S. Non-motile; sonnei) lactose(-)

Dysentery, shigellosis (gastroenteritis)

Human's intestine

Invasion of colonic mucosa through M Fecal-oral, cells; Invade basal surface of LOW enterocytes cell death + person-toinflammation, focal ulcer; shiga-toxin, person cleaves rRNA - HUS (see above), transmission acid resistant, endotoxin

Bloody diarrhea with pus, fever, abdominal cramps, nausea (first watery then blood mucoid stools)

Hektoen enteric agar: lac(-), H2S(-) green colonies

Salmonella enterica (enteritidis & typhimurium)

ingestion of Intestinal Dysentery-like contaminated Enterobacteriaceae; tracts of food (eggs, diarrhea; possible Motile; lactose(-) animals and poultry) or water; bacteremia humans direct contact with reptiles Fecal-oral; ingestion of contaminated food (poultry), milk or water; direct contact with pets, LOW

Ruffles, invasion, inflammation

Bloody diarrhea with pus, fever, abdominal cramps, nausea

Hektoen enteric agar: lac(-), H2S(+) blue colonies with dark center

Fluoroquinolon es (ciprofloxacin), TMP/SMX

Campylobacter jejuni

Thin gram(-) rods; spiral shape; microaerophile; oxydase(+),

Dysentery-like diarrhea

Animal's intestine

Invasion of intestinal mucosa; virulence factors poorly defined

Bloody diarrhea with pus, fever, abdominal pain; Complications: Guillain-Barre syndrome, Reactive arthritis

Culture (microaerophilic conditions - T - 42C, blood or charcoal media)

Fluoroquinolon es (ciprofloxacin) or erythromycin

Page 8 of 15






Salmonella typhi


Non-motile; lactose(-)

Typhoid fever

Humans only

Invasion of M cells; Multiply in Fecal-oral; macrophages; bacteremia and Sustained fever and headache; possible rash Culture from blood or Mod-low invasion of RES (mesenteric lymph and/or diarrhea; persistent bacteremia feces, Hektoen enteric (possible node, liver, spleen); infection of myocarditis, encephalopathyconstipation agar: blue colonies person-togallbladder (carrier state); Capsule (Vi more common, diarrhea = late in disease with dark center person trans) polysaccharide); endotoxin Mucous layer invasion (Mucinase, phospholipase, flagella) + Alteration of gastric acid production (urease -> ammonium production) Inflammation of gastric mucosa Tissue destruction Heat-stable enterotoxin (if spore Onset <6h after ingestion - Vomiting, nausea, survive cooking germination + toxin abdominal cramps production in non-refrigerated food) Biopsy=> microscopy, culture, urease test; Stool antigen test; Urea breath test; PCR

Fluoroquinolones (ciprofloxacin), TMP/SMX

Helicobacter pylori

Gram(-) rods; bacillary or spiral Gastritis, peptic Stomach of shape; ulcer, gastric humans and microaerophile; adenocarcinoma, animals oxydase(+); urease lymphomas (+) Emetic gastroenteritis Diarrheal gastroenteritis Ubiquitous

Fecal-oral; oral-oral

Proton pump inhibitor + clarithromycin + amoxicillin or metronidazole

Clostridium spp & GI infections

Ingestion of Heat-labile enterotoxin (germination food Incubation time >6h - Watery diarrhea, of spore + toxin production in contaminated nausea, abdominal cramps intestinal tract) with spore Ingestion of Gram(+) cocci in preformed Heat stable enterotoxin acute Isolation of toxin Self-limiting; Fluid + Staphylococcus Staphylococcal Normal Onset <6h after ingestion - Vomiting, nausea, cluster, catalase(+); toxin (potato inflammation of gastric mucosa, small producing bacteria electrolyte aureus food poisoning human flora abdominal cramps and watery diarrhea coagulase(+) salad, intestine (mannitol salt agar) replacement custard) Exposure to antibiotics AntibioticVegetative overgrowth of C. difficile associated Watery diarrhea form: human (endogenous); Toxin A Immunoassays (toxins diarrhea carrier; Discontinue Endogenous Enterotoxin: disrupts tight junctions detection); difficile Spore in implicated antibiotic; infection between enterocytes + induces colonoscopy Antibioticenvironment vancomycin inflammation watery diarrhea; (pseudomembrane) associated (hospital Profuse diarrhea, abdominal cramps, fever Toxin B - cytotoxin: modification of pseudomembrano rooms) enterocyte cytoskeleton cell death us colitis Large gram(+) Enterotoxin: alteration of membrane Watery diarrhea Watery diarrhea + abdominal cramps Self-limiting Ingestion of rods; Spore permeability in enterocytes Clostridium Soil and Culture; Immunoassay spore or forming; Strict perfringens human colon Necrotizing Bloody diarrhea; abdominal pain; vomiting, (enterotoxin detection) -toxin (lethal toxin): necrotizing bacteria anaerobes Penicillin enteritis peritonitis destruction of jejunum Ubiquitous Botulism, neuromuscular paralysis Infant botulism Weakness, dizziness, then neurological Botulinum toxin=AB neurotoxin features: blurred vision, drooping eyelids blocks release of acetylcholine from Clinical respiratory paralysis. THREE Ds: DIPLOPIA, peripheral nerves flaccid paralysis trivalent botulinum DYSPHAGIA, DYSPHONIA Antitoxin Ingestion of Germination of spores in colon Spores in soil Clinical + C. botulinum spore (honey), multiplication of vegetative form "floppy baby" and dust found in feces LOW neurotoxin production Spores in soil and dust Ingestion of preformed toxin, LOW Infants: slow-appearing, irritable, vomiting, or poor feeding nasopharynx infection of lung or eustachian tube inflammation or OM bacteremia, meningitis. Polysaccharide capsule: antiphagotic, pneumolysin: transmembrane pore-forming toxin, IgA protease, others: teichoic acid, peptidoglycan fragment, hydrogen peroxide gram stain: WBCs + gram(+) cocci, Culture: mucoid, -hemolytic, Optochin sensitive, bacitracin resistant, bile solubility (+), capsule (+) quellung vancomycin + 3rd gen cephalosporin (ceftriaxone or cefotaxime), Prompt txt of OM and respiratory infections. VACCINES: 7valent conjugated vaccine, 23-valent polysaccharide vaccine.

Bacillus cereus

Gram(+) rods, motile; spore forming

Ingestion of preformed toxin (rice)

Isolation of organism Self-limiting; Fluid + from implicated food, electrolyte -hemolysis on blood replacement agar


Clostridium botulinum

Streptococcus pneumoniae

lancet-shaped, gram (+) cocci, chain or diplo, catalase (-)

pneumococcal meningitis in adults

throat & nasopharynx

person-toperson via respiratory droplets

acute onset, complications: mental retardation, learning disabilities, deafness WBCs, proteins, glucose

Bacterial Meningitis


Page 9 of 15

high fever, HA, stiff neck. Infants: slow-appearing, irritabl poor feeding





CSF: WBCs, proteins, glucose



Neisseria meningitidis

aerobic gram (-) diplococci, polysaccharide capsule (A, B, C, Y, W135), flattened adjacent sides

meningococcal meningitis


respiratory droplets

initial infection of upper resp tract attachment to non-ciliated cells of nasopharynx: pili, IgA protease (colonization), capsule invasion into bloodstream brain. Diffuse vascular damage: endotoxins (LPS, LOS)

hemorrhagic skin rash (petechiae). Waterhouse-Friderichsen syndrome (ADRENALS), complications: 11-19% permanent hearing loss, mental retardation, etc

cefotaxime or ceftriaxone (10-15% gram stain of CSF, fatal, 100% if culture: Thayeruntreated), Martin agar (mod antimicrobial chocolate agar) + chemoprophylaxis: 5% CO2. rifampin or MALTOSE & ciprofloxacin, GLUCOSE (+) VACCINES: MPSV4, MCV4 culture: chocolate agar, X and V cefotaxime or factors, gram (-) ceftriaxone, Hib coccobacilli or conjugate vaccine. rods. Antigen Rifampin prophylaxis detection, latex test PCR, latex particle agglutination test of urine: rapid, antiviral (acyclovir) CSF and blood + antibacterial cultures, CSF: (ampicillin + difficult in cefotaxime) neonates. Bacterial culture from mother.

gram (-) Haemophilus pleomorphic influenzae type b coccobacillus, capsule serovar b

Haemophilus meningitis and sepsis

direct contact nasopharynx invasion with respiratory bacteremia CNS. Pili, IgA human droplets. Risk: protease, polysaccharide capsule: nasopharynx infants - young type-b: poly-ribitol-phosphate, children endotoxin (LPS) - inflammation

initially: runny nose, low grade fever, HA, complications: 20% - hearing loss, delayed language development or mental retardation

Bacterial Meningitis in Neonates

gram (+) cocci in short chains, hemolytic or Streptococcus nonhemolytic, agalactiae (Group group B lancefield B hemolytic capsular antigen, streptococcus) bile resistant, polysaccharide capsule E. coli gram (-) rod, K1 polysaccharide capsule

meningitis in neonates

GI tract, vagina

capsule rich in sialic acid, peptidase infection - inactivates C5a, hydrolytic enzymes during delivery, nosocomial transmission capsule (sialic acid, ~ meningococcus), pili

nonspecific: fever, feeding difficulty, vomiting, diarrhea, respiratory distress, irritability alternating with lethargy

Listeria monocytogenes Other

gram (+) rods, catalase (+), hemolysis


Bacteremia: occult, proliferate in placenta. ingestion of pathogenic serotypes have unique Neonatal: early onset sepsis host-dependent: contaminated teichoic acid, facultative intracellular "granulomatosis infantisepticum", late-onset intestine of listerosis, sepsis, food, pathogen: growth in cells, internalins: meningitis: via vaginal transmission. CNS: animals and meningitis, fetal transplacental attachment and entry, listeriolysin O: meningitis, encephalitis, brain abscess in humans loss , during pore-forming exotoxin, ActA: actin 10%. Febrile gastroenteritis (IC+), (IC- and delivery polymerization: motile comet tails old: sepsis and meningitis, pregnant: flu-like illness, fetal loss.

broad T range, motile at 25C "TUMBLING", nonmotile at 37C, microscopy - wet mount, culture: blood agar, -hemolytic, CSF: pleocytosis, protein, glucose

CAMP test

ampicillin + gentamicin

Mycobacterium tuberculosis

obligate aerobe, rod shaped, facultative intracellular pathogen, acid-fast bacteria

tuberculous meningitis

reservoir infected humans.

Inhalation of infectious aerosols

Mycolic acid, sulfolipids, cord factor, tuberculin + mycolic acid

gradual onset (weeks), malaise, apathy, anorexia brain abscesses, spinal TB

CXR, PPD skin test, ACTIVE: combo: Ziehl-Neelsen stain = isoniazid, rifampin acid fast stain. Culture (4m), pyrazinamide confirms dx. (2m), ethambutol. Lowenstein-Jensen LATENT: isoniazid. medium = lipid rich

Page 10 of 15







Clostridium Spp

gram (+) rods, strict anaerobes, no capsule, motile, Clostridium tetani spore-forming drumstick appearance

tetanus: generalized, localized, cephalic, neonatal

spore: survival in environment, tetanolysin (not sig), enter body via tetanospasmin: heat labile AB wound, neurotoxin, blocks release of developing inhibitory NTs (GLYCINE) severe painful spasms and rigidity of voluntary countries: nonspores: constant contraction (spasms), muscles, early = lockjaw, exg reflexes, sterile ubiquitous highly toxic. Anaerobic conditions muscle rigidity apnea, fractures, techniques, germination of spores, local dislocations, death from respiratory failure umbilical stump bacterial multiplication, toxin neonatal production enters nervous tetanus system peripherally carried to CNS spores survive spore, botulinum toxin: heat labile sterilizing AB-neurotoxins, blocks release of Ach soil, process and from peripheral nerves flaccid contaminate improper paralysis, type A most significant in d foods canning US, highly toxic. Path: ingestion of procedures preformed toxin


neutralization of unbound toxins (toxin binding is irreversible), supportive, metronidazole to eliminate bacteria in wound, Vaccine

Clostridium botulinum

gram (+) rods, fastidious, spore forming, strict anaerobes

botulism: foodborne, infant, wound, neuroparalytic illness

weakness, dizziness, dryness of mouth (N and V), neuro: B/L flaccid paralysis and motor and autonomic nerves, blurred/double vision, drooping eyelids, difficulty swallowing, speech, descending weakness, respiratory paralysis

mainly clinical, mouse bioassay

trivalent botulinum antitoxin (A, B, E), respiratory support, elimination of bacteria: gastric lavage, metronidazole or PNC

Streptococcus pneumoniae

gram (+) diplococci or chains, catalase (-) gram (-) pleomorphic rod gram (+) cocci, clusters, catalase (+), coagulase (+) Acute Bacterial Conjunctivitis Direct contact

polysaccharide capsule, autolysin, pneumolysin O pili, lipopolysaccharides, IgAspecific protease, polysaccharide capsule protein A (inhibits phagocytosis), fibrinogen-binding protein (clumping factor), coagulase, cytotoxic toxins

Bacterial Conjunctivitis: purulent discharge, conjunctival hyperemia

Hemophilus influenzae Staphylococcus aureus

Empiric txt w/ burning, irritation, tearing, mucopurulent topical antibiotics, chocolate agar (X & V discharge Gati/levo/ factors) moxifloxacin -hemolysis, mannitolsalt agar, yellow colones

-hemolytic on blood agar - large mucoid colonies, Optochin sensitive, bacitracin resistant, bile soluble

trachoma, Direct contact; hand to eye, urogenital contaminated clothing, infections (Sero Aflies C) small obligate INTRACELLULAR, no PG layer; elementary & reticulate bodies


Chlamydia trachomatis

inclusion conjunctivitis (sero D-K)

Trachoma: leading cause of blindness in world, mostly children, ~ poor hygiene. Chronic, inflam granulomatous dz of eye surface corneal ulceration, scarring, pannus formation blindness Direct contact/newborn via birth canal from conjunctival fluid tropism for epithelial cells of or surface scrapings; conjunctiva; intracellular pathogen gram stain/culture; (evades host defense, killing host immunocell); LPS (inflammation) severe fluorescence, inflam response necrosis, cytologic exam (I) Adult: acute infections --> mucopurulent d/c, fibrosis, scarring infiltrates, corneal scarring in chronic form; ocular-genital contact, sexually active - preceded by genital infection. acquired from infected mom Newborn: swelling of eyelids, copious purulent d/c

azithromycin or doxycycline, erythromycin (newborn).

lymphogranuloma venereum (sero L1 - L3)

Page 11 of 15

Bacterial Conj







Neisseria gonorrhoeae

Aerobic gram (-) diplococci, beanshaped, no capsule, facultative intracellular

Gonococcal ophthalmia neonatorum

at birth from infected mom attach & invade epithelial cells; Pili + from conjunctival fluid PorB/Opa (adhesion/protection); IgA or surface scrapings; protease (colonization); Antigenic acute purulent conjunctivitis acquired at birth: gram stain/culture; variations escape immune lid edema, erythema, marked purulent d/c Thayer-Martin agar, surveillance; LPS & LOS GLUCOSE (+) (inflammation); no capsule severe inflammatory response

ceftriaxone; Neonatorum prophylaxis: silver nitrate or erythromycin or tetracycline

Other Eye Infections

Pseudomonas aeruginosa (gram (-) rod) Contact lens-related Acanthamoeba spp. Fungal infections Toxocara canis Onchocerca volvulus Loaloa

bacterial keratitis, scleral abscess, endophthalmitis keratitis

immunocompromised Ocular toxocariasis - retinal detachment River blindness, sclerosing keratitis, chorioretinitis African eye worm Transmissio n


Neisseria gonorrhoeae Urethritis and Cervicitis, PID

Aerobic gram (-) diplococci, beanshaped, no capsule, facultative intracellular

PID Rectal & Pharyngeal ophthalmia neonatorum disseminated gonococcal infections

F: Cervix, ~50% asymptomatic, Untreated PID, ectopic pregnancy, salpingitis. M: Urethra, ~25% asymptomatic, purulent strict human pathogen, urethral discharge and dysuria, Untreated pili: adhesion, sexual or intimate contact epididymitis, prostatitis, periurethral inhibit gram smear from abscesses. Both untreated infertility, phagocytosis. genital site in disseminated infection, anorectal infection, OMPs (outer Attachment and cytoplasm of membrane invasion of non pharyngitis, conjunctivitis and dissemination neutrophils, sensitivity third generation proteins): ciliated epithelial spread of organisms along fever, lower abdominal pain, and specificity: 95% in cephalosporins fallopian tubes (salpingitis), serotyping, Opa cells survival complications: infertility or ectopic M, 50% in W, nucleic (ceftriaxone), proteins in submucosa pelvic cavity (peritonitis, pregnancy due to scarring of fallopian acid amplification resistance to first adherence, spread and abscesses) tubes tests, culture: line drugs (also antigenic variation, dissemination Thayer-Martin agar treat chlamydia) both usually asymptomatic, tenesmus, PorB prevent (inflammation and linked to sexual practice (chocolate, antibiotics discharge, rectal bleeding, sore throat phagolysosome local damage) to normal flora, 35C + fusion, IgA CO2) acute purulent conjunctivitis, lid edema, protease, LPS acquired at birth erythema, parked purulent discharge and LOS generally in women, leading cause of purulent arthritis, large necrotic gray skin lesions spread by direct contact tropism for epithelial cells 3.3 F (15-19) > M. F: 70% asymptomatic, (F: endocervix, cervicitis urethritis: mucopurulent upper genital tract discharge dysuria. Complications: PID in; both: urethra, (40% untreated), permanent damage rectum, chronic pelvic pain, infertility, and ectopic conjunctiva) pregnancy. M: 25% asymptomatic, infection, severe urethritis: dysuria + thin urethral discharge, inflammatory complications: rare, spread to epididymis response pain, fever, and sterility necrosis, fibrosis, scarring

Chlamydia trachomatis (all biovars but L)

D-K: urogenital infections (noninvasive), AC: trachoma. Other: inclusion conjunctivitis, small obligate INTRACELLULAR, infant pneumonia no PG layer; elementary & reticulate bodies

close personal contact

EB: infectious, outside, nonreproductive, RB: noninfectious, intracytoplasmic, reproductive form. Intracellular replication, no phagolysosome fusion, LPS

collection of epithelial cells, direct azithromycin or immunofluorescence: doxycycline. Ebs are bright yellow Pregnant and young green dots under UV, children: NAAT (urine), enzyme erythromycin. immunoassay, Follow-up: repeat culture: iodine staining testing (NAAT) 3 of glycogen inclusion months bodies - dark brown

Page 12 of 15


small obligate INTRACELLULAR, no PG layer; elementary & reticulate bodies CHARACTERISTICS




Chlamydia trachomatis (L biovar)

L: Lymphogranuloma venereum


L-serovar are invasive travels via lymphatics, multiply w/n mononuclear phagocytes in regional lymph nodes, characteristic granuloma formation necrotic lesions, inflammation spread to surrounding tissues

immunofluorescence: doxycycline. Ebs are bright yellow Pregnant and young green dots under UV, children: NAAT (urine), enzyme erythromycin. immunoassay, Follow-up: repeat DIAGNOSIS TREATMENT culture : iodine staining testing (NAAT) 3 of glycogen inclusion months bodies - dark brown

small painless ulcer at site of infection, spontaneously heals. Second stage: inguinal adenopathy, painful buboes draining fistulas.

Haemophilus ducreyi

small, pleomorphic, gram (-) rods


sexual contact

tender papule with erythematous base painful ulceration with associated inguinal lymphadenopathy. F: often asymptomatic, often diagnosed in men

clinical, microscopy, DNA probe, culture: relatively insensitive, require x factor for growth

azithromycin, ceftriaxone, ciprofloxacin, or erythromycin

Syphilis Treponema pallidum thin, tightly coiled spirochetes, not intracellular

Congenital Syphilis

Primary: 1+ chancres at infection site, lots of spirochetes painless ulcer, heals local primary spontaneously w/n 2 months, pt highly infection: skin or infections. Secondary: dissemination: fluouter membrane mucosal slow only host = humans, like syndrome, lymphadenopathy, proteins: multiplication, susceptible to heat, drying generalized mucocutaneous adherence, endarteritis & and disinfectants, requires hyaluronidase: maculopapular rash, 1/3 condylomata granulomas. close contact lata, highly infectious, resolve perivascular Dissemination spontaneously latent stage (clinically infiltration, (lymph nodes and inactive). Tertiary: diffuse, chronic antigenically blood), quiescent unreactive. for months to inflammation neurosyphilis, CV syphilis, gummas Tissue damage = years, late patient's immune syphilis: injury response due to prolonged intrauterine death, congenital hypersensitivity abnormalities, silent infections, most: born transplacental responses with rhinitis followed by rash

Klebsiella granulomatis

intracellular encapsulated gram (-) bacillus

Granuloma inguinale or Donovanosis

sexual contact

granulomatous ulcers that bleed on contact, inguinal lesions (10-15%)

Trichomas vaginalis

protozoa flagellate

F: frequently symptomatic vaginitis, replicates by axostyle: purulent discharge, copious, foamy, foulbinary fission, attachment, smelling yellowish, vulvar and cervical only trophozoite sexual contact, humans only contact-dependent lesions, dysuria, itching. Pregnant: premature Trichomoniasis form, no cyst, host damage to rupture of membranes, preterm delivery, does not survive epithelium, not low birthweight. M: rarely symptomatic, in external invasive mild urethritis, mild discharge, slight burning environment after urination or ejaculation, ~ prostatitis

round/oval budding yeasts, polymorphic: y, Candida albicans hyphae, and pseudohyphae

Vulvovaginal Candidiasis

normal oropharyngeal, GI, genital flora, endogenous or direct contact

mannoproteins: adherence, resistance F: pruritus and erythema of vulvar area, thick to phagocytosis, hyphae secrete cheesy vaginal discharge, itching of vulva. proteinases and phospholipases (kill M: 10% - balanitis: inflammation of glans epithelial cells, tissue penetration) penis, itchy rash on penis, rare: urethritis

culture: no growth on artificial media, microscopy: darkfield microscopy (live motile bacteria), direct fluorescence antibody test, silver staining. Serology: nonspecific penicillin (cardiolipin, VDRL, RPR, measure IgG and IgM from damaged cells), specific (confirmation, FTAABS test, MHA-TP), enzyme immunoassays Wright or Giemsa stained: clusters or encapsulated coccobacilli in Doxycycline cytoplasm of mononuclear cells "Donovan bodies" vaginal, urethral, prostatic secretions: microscopy: wet mounts (motile), metronidazole or Giemsa stained, direct tinidazole (txt immunofluorescence partners, do not use antibody staining, during 1st trimester) Culture: most sensitive, diamond's medium, anaerobic, pH 5.5-6 (3-7 days) from discharge, microscopy: KOH: budding years and oral fluconazole, pseudohyphae, topical azole or culture: Sabouraud or nystatin, not blood agar, large recommended to smooth white colonies: treat sex partners rapid growth, "germtubes" formation after 2 hr

STDs Vaginal Discharge

Genital Ulcers

Page 13 of 15







Gardnerella vaginalis

gram-variable rods, facultative anaerobes

Bacterial vaginosis

shift in vaginal flora, lactobacillus spp replaced, increase risk: anything that can upset normal balance of bacteria

"non-specific vaginitis" ,white or gray vaginal discharge with unpleasant odor, dysuria, itching, or asymptomatic. Complications: PID, preterm delivery, low birthweight, increased susceptibility to HIV, STDs postabortal or postpartum fever, PID ~ fallopian tubes infection, self-limiting F: chorioamnionitis and postpartum fever, M: non-gonococcal, non-chlamydial urethritis

white discharge, microscopy: clue cells, absence of lactobacilli, vaginal pH > 4.5, "whiff" test after adding KOH


Mycoplasma hominis Ureaplasma ureolyticum

sexual contact sexual contact adult mites risk of 2nd create burrow in bacterial infection, upper layer of Norwegian epidermis, female scabies - more lay eggs in skin severe form burrow

special media - large tetracycline (resistant fried-egg colonies to erythromycin) urease production (distinguish from mycoplasma) rash, burrows, isolation of mites, ova or feces in skin scrapings erythromycin or tetracyclines topical permethrin (5%), wash everything, treat everyone

Sarcoptes scabiei

human itch mite arthropod

genital scabies

close - sexual contact

intense itching and redness, bumps, blisters, and crusting

Phthirus pubis


pediculosis pubis, lice or "crabs"


Nit - egg, hard to see, attached to feeds on human hair, nymph itching in genital area, visible nits or crawling blood and baby louse, adult lice multiplies rapidly females lay nits, larger than males

lice-killing shampoo (pediculicide) 1% permethrin or pyrethrin

Page 14 of 15

ALL BACTERIA BACTERIEAL RESPIRATORY INFECTIONS BACTERIA Sinusitis & Otitis Pharyngitis Epiglottis Media Streptococcus Streptococcus Haemonphilus pyogenes (strep Pneumoniae influenzae throat) Corynebacterium Haemonphilus diphtheriae influenzae (diphtheria) Moraxella catarrhalis

Pneumonia Streptococcus Pneumoniae Haemonphilus influenzae Staphylococcus aureus Klebsiella pneumoniae Chlamydophil pneumoniae & psittaci Mycoplasma pneumoniae Legionella pneumonia Pseudomonas aeruginosa Pulmonary Anthrax Bacillus anthracis

Pertussis Bordetella pertussis

Bronchitis Streptococcus Pneumoniae Haemonphilus influenzae Mycoplasma pneumoniae

Tuberculosis Mycobacterium tuberculosis

Page 15 of 15