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Candida sp.

Clinical Presentation Diagnosis Treatment Notes cutaneous: a) oral thrush: whitish lesion, topical antifungals: b) vaginal, c) dermatitis, d) ketoconazole, miconazole, onychomycosis: invasion of nail plates, e) chrome agar differentiates nystatin diaper rash Candida, no sputum samples budding yeast, pseudohyphae, true hypha most common, normal flora (opportunistic), C. glabrata systemic(catheters, IV drug use): (normal flora); direct exam: (serum), chlamydospores (nutritionally deficient (only yeast form, resistant to azoles, no transient (immunocompetent), gram +, 10% KOH; culture (look amphotericin B w/ fluconazole media), protease, phospholipase, Hsp's, biofilms, pseudohyphae); C. dubliniensis (develops resistance infections anywhere for hyphae, pseudohyphae, and Alibicans and dubliniensis form germ tube faster) (immunocompromised) germ tubes); serology: LAT, chronic mucocutaneous: skin and ELISA mucous membranes, rare, childhood, lifelong azole immunodeficiencies bird seed agar (contains pulmonary: asymptomatic / flu-like; diphenol oxidase); india ink disseminated: yeast prefers CSF (capsule); serology: detection (meningitis), skin lesions, cryptococcoma of capsule antigen in CSF via LAT Allergic aspergillosis (asthma) Aspergilloma / extrapulmonary: aspergilloma (lungs), otomycosis, onychomycosis, eye infection amphotericin B w/ flucytosine; lifelong fluconazole in AIDS patients immunocompetent (C. gatti), immunocompromised (C. neoformans); soil & bird droppings -> meningoencephalitis; non communicable

Characteristics / Virulence


Cryptococcus sp.

budding, encapsulated cells, diphenol oxidase (forms melanin), grow @37C (only one that can)



Aspergillus sp.

serum IgE, Direct exam: septate hyphae, conidia, powdery mold (aerosolize); true hyphae (hyaline, intravascular hyphae, SDA septate); microconidia; phospholipase Invasive aspergillosis (fatal): pulmonary culture, ELISA: galaktomannan and disseminated antigen Mycotoxicosis: aflatoxin production (A. flavus most severe)

amphotericine B + surgery

posaconazole + surgery

A. fumigatus most common; A. flavus: most severe toxins; immunocompetent are asymptomatic; Risk factors: immunosuppression, allergy, hepatocellular colon carcinoma; rhizopus and mucor are non septate, assocated with diabetes

Pneumocystis pneumoniae

Pneumocystis jiroveci

extracellular pathogen: a) thin-walled trophozites, b) cysts (infectious)

Sx: fever, SOB, wt. los, night sweats, non productive cough; interstital fibrosis of lung w/ thickened alveoli -> hypoxia

CXR: infiltrates; can NOT be cultured; toluene blue stain (cysts), PCR no definitive

TMP-SMZ w/ steroids; wont respond to true antifungals

causes disease in immunocompromised only; classified as a yeast

primary/pulmonary: self-limited flu-like symptoms, diffuse pneumonia dimorphic (in pt: sporangiospore; in culture: arthroconidia); spherule w/endospores; soil, powdery; "empty cells" are the distinguishing feature, hyphae fragment easily; arthrospore is inhaled; aerobic (dust storms) extrapulmonary: cutaneous, bones, meninges disseminated: immunodeficient or pregnant (estradiol, progesterone), chorioretinitis, racial succeptability as well erythema nodosum: allergic response (type IV), good prognosis (CMI) Histoplasma capsulatum Blastomyces dermatitidis yeast: blastoconidia; mold: dimorphic a)tuberculate macroconidia, b) microcondia; histoplasmin antigen (broth); urease (raise pH neutralize lysosome) thermally dimorphic; broad based multinucleate budding; chlamydospores possible inhaled microconidia -> convert to yeast Location, intracellular yeast, > flu-like symptoms -> RES (intracellular LAT mycosis) -> granulomatous foci (miliary) inhaled microconidia soil --> flu-like -> non-caseating granulomas (can be extrapulmonary/cutaneous) wet mount KOH: broadly attached buds on thick walled cells DOC: itraconazole or amphotericin B DOC: itraconazole or amphotericin B slow growing; Ohio & Miss River valleys; bird/bat droppings, cottony colony; can be disseminated; non communicable slow growing; Ohio & Miss River valleys & SE USA; microconidium = infective, can disseminate culture: Sabouraud's agar (arthroconidia); sputum: KOH; bx: PAS stain; blood: IgG/IgM to coccidioidin or spherulin

Valley Fever

Coccidioides immitis

DOC: fluconazole or amphotericin B (IV if disseminated) long-term

endemic to SW USA; C. posadasii (outside CA), airborne but not communicable; in the soil and lab it is arthroconidia



Disease Paracoccidioidomycosis

Agent Paracoccidioides brasiliensis Streptococcus mutans Lactobacillus sp.

Characteristics / Virulence yeast: multiple buds lactic acid fermentation (decreases pH), glucosyltransferase (sucrose -> glucan) lactic acid fermentation, grows @ low pH catalase+ anaerobic, converts lactic acid to weaker acids (^ pH)

Clinical Presentation pneumo, self-limited granulomatous disease (can disseminate) initiator of dental caries progression of caries implicated in root surface caries possible anticariogenic role

Diagnosis KOH prep (multiple buds); skin test

Treatment DOC: itraconazole

Notes central/south America; soil-dwelling normal flora

Dental Caries

Actinomyces viscosus Veillonella sp.

remove lesion and fill; remineralization agents to reverse damage, decrease carb intake, control cariogenic bacteria, sealants, fluoride

normal flora (small amount) primary colonizer of dental plaque normal flora

Chronic Gingivitis

55% gram+ facultative organisms; actinomyces (+), capnocytophaga (-)

inflammatory response limited to gingiva - no bone or periodontal pockets

red & swollen gingivae, bleeding gums, halitosis

w/ tx usually reversible

occasional spirochetes and motile rods; uncommon to have pain or unpleasant taste

Periodontitis Porphyromonas gingivalis (NF) Chronic periodontitis Prevotella intermedia & Tanerella forsynthia Capnocytophaga (NF) Actinobacillus / Aggregatabacter

increase in anaerobic organisms; prphyromonas gingivalis and prevotella intermedia (both -) gram - coccobacilli, obligate anaerobe, fimbrae, HG, hemolysins, proteases, capsule gram - short bacilli, obligate anaerobes; 95% of peridontal disease; saccharolytic gram - bacillus (fusiform); capnophilic

progression of gingivitis that involves connective tissue & bone black on blood agar (hemin required) gingival lesion + gingival recession & bleeding pockets, NO PAIN; G+ near tooth, G- near gingival crest tx: mechanical therapy, oral hygiene, antibiotics prevelance/severity increase with age, 75% gram -, motile rods and spirochetes present; not found in children

brown-black on blood agar

Aggressive periodontitis Acute Necrotizing Ulcerative Gingivitis (ANUG) "Trench Mouth" Noma (Gangrenous Stomatitis, Cancrum Oris) Dentoalveolar Abscess Lugwig's Angina Periodontal Abscess Cervicofacial actinomycosis Oral Thrush Candidaassociated Denture Stomatitis

gram -, capnophilic, tetracyline sensative

begins on incisors / 1st molars (local or generalized); bone loss c no bleeding, inflammation, or plaque

tx: antibiotics

rare (young females); associated w/ immuno deficiencies (genetic); asians and west africans

Fusobacterium nucleatum Treponema sp.

gram - cigar shaped bacillus; obligate anaerobe; NF, adhesins, endotoxin oral spirochete, motile, gram-; obligate anaerobe

red inflamed shiny bleeding painful gums, covered by pseudomembrane, metallic taste; painful

3 components: fusobacteria, spirochetes, leukocytes

local debridement & metronidazole

predisposition: malnutrition, smoking, stress

same as ANUG Prevotella, spread to soft tissue or bone or to lymphatics and Porphyromonas, bloodstream Fusobacterium Polymicrobial polymicrobial Actinomyces israelii post extraction infection localized infection; tooth loss w/o treatment gram + anaerobe; infection from endogenous flora, yeast cells c pseudohyphae (invasive) Candida albicans; opportunistic

severe ANUG; young children in developing countries

tissue loss & disfigurement

reconstructive surgery, Ab and nutrition drain pus, remove source of infection

malnutrition, recent viral or TB infection

extension of a carioius lesion

normal flora spreads bilaterally extends from an infected periodontal pocket

non-invasive; plaque biofilms

swelling at the front of the neck (airway keep airway open, antibiotics obstruction), fever red, swollen, & tender gingivae overlying extraction, anitbiotics abscess; painful submandibular region swelling (lumpy "sulfur granules" (pus); "molar abscess drainage; long-term jaw); fibrosis; gritty/sand-like pus c tooth" appearance (culture) antibiotics yellow granules pseudomembrane; "cottage cheese curds" clinical presentation; germ tube oral nystatin; gentian violet (anti erythema & edema of mucosa in contact test fungals!) w/ surface of upper denture

pts: very young, very old, very sick

pts who wear dentures full-time, diabetes a risk


Agent HSV-1 (oral and genital)

Characteristics / Virulence linear dsDNA, enveloped, path: primary infection (mucoepithelial cells) -> syncitia & intranuclear inclusions bodies -> neuron (retrograde to trigeminal ganglion)

Clinical Presentation fever blisters / cold sores; persistent infections in neurons; lytic infections in epithelium & fibroblasts; gingivostomatitis seen in children; pharyngotonsillitis, herpetic whitlow




Herpes Simplex HSV-2 (oral and genital) Herpangina Hand-footmouth disease Aspetic meningitis

both can cause oral & genital lesions; clinical lesions, tzanck smear children/adolescents; spread via contact; humans are multinucleated giant cells, acyclovir, adenosine arabinoside only reservoir; trigeminal path; VSV may show sharp Cowdry type A inclusions lines of demarcation at midline

fever, sore throat c pain, ulcerations on soft palate ssRNA+, non-enveloped; path: lymphoid tissues / vesicular lesions on hands, feet, mouth, Coxsackie A Virus mucosa -> primary viremia -> skin/mucous tounge, low grade fever membranes (symptoms); enterovirus

clinical presentation; culture

no anti-viral treatment; symptom management

summer; children; fecal-oral; humans are only reservoir


dsRNA segmented genome; non-enveloped; NSP4 (enterotoxin: mobilizes Ca from ER, Clsecretion enhanced -> loss of water from cells, reversible) non-invasive acute watery diarrhea; dehydration

Viral Gastroenteritis: Enteric Adenovirus Calicivirus Norovirus Astrovirus Coronavirus Coxsackie A Virus

ELISA: stool; LAT; Vaccines: Rotashield (removed from market - critisized) Rotarix (monovalent LAV for GI), RotaTeq (live oral reassortment) immunoassay no good tests EM oral rehydration (electrolytes + sugar); solid food ASAP

infants (<2yo); 10-20 episodes/day; winter, 5-7 dyas of fever, vomitting and diarrhea

dsDNA; acid-resistant capsule sapporo-like virus; ssRNA non-enveloped "Norwalk"; ssRNA non-enveloped ssRNA star-shaped capsid

infants (<2yo); 5-12 days of diarrhea (extended) fecally contaminated food (shellfish); older children & adults; person-to-person; mild, self limiting no seasonal link; young children, peds ward, daycare, nursing homes immunocompromised

Vibrio cholerae


gram- vibrio, facultative anaerobe, motile, oxidase+, O antigens (O-1 [El Tor], O-139); virulence: a) cholera toxin (AB) increases cAMP (causes hypersecretion of water and electrolytes), b) toxin coregulated pilus (VP1) for attachment; CTX binding to VPI cel causes release of toxin (2 lysogenic conversions needed

acute massive (1L/hr) watery diarrhea ("rice water" stool); "washwoman hands", weak pulse -> hypovolemic shock, metabolic acidosis -> death

direct exam; culture: yellow on frequent during natural disasters; contaminated TCBS agar - alkaline, ^salt; self-limiting; oral rehydration drinking water; more infectious after passing through oxidase+; serology; Strains of O- (ORS); pt c bacteremia (non-O1) GI tract; human carriers in endemic locations; worse in 1 can sause diarrheal disease or "true" cholera give type O pts; O-139 can cause disease in people that but not cholera (lack cholera antibiotics; no antacids have had O-1 toxin)

Vibrio parahaemolyticus

mild cholera-like illness; 2-3 days watery diarrhea; can get in via wounds a) wound infections; b) sepsis (underlying liver disease -> ^Fe) -> bullous skin lesions

oxidase+; green on TCBS, no sucrose fermentation

endemic in Japan; summer; raw shellfish (improper refrigeration), seasonal, Gulf coast

Vibrio vulnificus

emerging pathogen

green on TCBS


associated c raw oysters; more common when warm


Shigella sp.

Reiter's syndrome: non-specific acute inflammatory arthritis gram - facultative intracellular bacilli; lactose nonSuspect with fever and diarrhea fermenter; virulence: enterotoxins, O antigen (blood mucus acute), fecal late summer; highly infectious (low dose); serotypes: Hemolytic uremic syndrome (HUS): type exam: PMNs & RBCs present; fluid replacement; antibiotics (c A) S. dysenteriae, B) S. flexneri (gay males), C) S. boydii, (lyses phagosome and escapes to cytoplasm), susceptibility testing); proper 1 infection, acute renal failure, poor actin binding protein (steals host actin), shiga culture: fast (w flecks of bloodD) S. sonnei (children); human only; can be seen in handwashing; self limiting prognosis, provoked by Ab therapy toxin - disrupts protein synthesis, not confined to tinged mucous) on SS agar modern areas; carrier state GI (white); sigmoidoscopic exam Autoimmune disease: pasmid encoded antigen reacts c host myosin

S. enterica (species) includes: Salmonellosis

gram - rod, facultative anaerobe, lactose nonfermenter; virulence: enterotoxin, mucosal invasion genes (A-H), LPS, acid resistance, phoPQcontrolled genes (phagocyte survival) **Unlike shigella it can enter M and epithelial cells

a) gastroenteritis, b) bacteremia / septicemia, c) enteric fever, d) carrier state

fecal exam: macrophages > birds/animal gut normal flora; high inoculum; usually PMNs; culture: SS agar (white) - fluid maintence; antibiotics (if contaminated food/water; worst in infants (<5yo); food, water, feces, blood; systemic or immunosupressed) summer/fall; animal reservoir, high dose microbe, serology rare person to person

Disease Salmonellosis

gram - rod, facultative anaerobe, lactose nonAgent Characteristics / Virulence fermenter; virulence: enterotoxin, mucosal S. typhi (typhoid invasion genes (A-H), LPS, acid resistance, phoPQfever) controlled genes (phagocyte survival) **Unlike S. typhimurium shigella it can enter M and epithelial cells (food poisoning) S. enteritidis (food poisoning)

Clinical Presentation a) gastroenteritis, b) bacteremia / septicemia, c) enteric fever, d) carrier state

Diagnosis Treatment Notes fecal exam: macrophages > birds/animal gut normal flora; high inoculum; usually PMNs; culture: SS agar (white) - fluid maintence; antibiotics (if contaminated food/water; worst in infants (<5yo); food, water, feces, blood; systemic or immunosupressed) summer/fall; animal reservoir, high dose microbe, serology rare person to person