Hemophilus influenzae

Bacteriology
Gm ve bacilli,
Grows poorly on blood agar, better on chocolate agar
Requires both X and V factors for growth
Virulence factors
Encapsulated and non encapsulated
6 capsule types !"#$
Epidemiology
%ransmission& respiratory droplets
'arriage& often carried in throat
!t ris(& young children, infection in older patients is due to the non"encapsulated strains
Clinical presentations
)ost cases occur in young children
'ellulitis
!cute epiglottitis" epiglottitis swollen and inflamed, child has difficulty breathing, avoid ta(ing throat swabs
)eningitis
*neumonia
+eptic arthritis
+epticaemia
,ra-ilian *urpuric fever" con.unctivitis leading to overwhelming septicaemia
/n adults, it will cause otitis media, sinusitis and e0acerbation of '1*23
" caused by uncapsulated strains
Lab Diagnosis
'linical diagnosis or blood cultures
21 not ta(e throat swabs3
Management
%reatment" cefo0atime, ceftria0one many strains resistant due to , lactamase$
Vaccination" con.ugate vaccine for 4i,, chemoprophyla0is with rifampicin contacts with child with 4i,$
Clostridium perferingens
Bacteriology
Gram positive rods, spore forming, obligate anaerobic
Grows on blood agar
Virulence factors
*roduces alpha e0oto0in that can be detected using 5agler plate3
*roduces enteroto0in that is a superantigen causing diarrhea3
Epidemiology
%ransmission" via wound infection or ingestion of spores
+ource& found in the environment, normal flora of the colon and vagina of humans and animals3 #requently found in
feces of humans and animals3
'arriage& normal flora of the colon in humans
!t Ris(& Gas gangrene is assoc with war wounds, traumatic in.ury, septic abortions, surgery of bowel and biliary
tract, adrenaline in.ections to the buttoc(s, people with vascular d- and amputation of limbs3 6eu(emia, neutropenia
and 2) and underlying disease of the bowel3 3
Clinical presentation
Gas Gangrene&
" )yonecrosis
" Gas produced causing crepitus
" *atient febrile and hypothermic, shoc( develops
" +evere pain at site of infection
" +welling and discolouration of s(in with fluid filled blebs
" %hin smelly discharge
#ood poisoning
" abdominal cramps and watery diarrhea occurs 78"79 hours after consumption of contaminated meat stew
" little vomiting
" resolves in 89 hours
Complications
" outbrea(s of diarrhea in elderly
" pigbel necroti-ing enteritis associated with por( feast by natives of new guinea3
"
Lab diagnosis
+ample of pus or infected tissue preferred3
,lood cultures in anaerobic conditions gas .ars and cabinets$
Gm stain of discharge
+erology not useful
X"Ray gas shadows growing along muscle fibers
Management
%reatment
" ben-ylpenicillin
" usually in combination : ,en-ylpenicillin ; metronida-ole ; Gentamicin
" 'lindamycin sometimes given as ptn synthesis inhibitors prevent pdn of to0ins3
" 4yperbaric 18
" +urgical debridement
" 5o treatment necessary for food poisoning self limiting$
*revention
" prophylactic ,en-ylpenicillin for < days for those at ris(
" metronida-ole for *en allergic pts
" good food handling practices, do not allow cooling meat dishes to remain warm for long periods3
" %horough reheating of precoo(ed food3
Clostridium tetani
Bacteriology
Gm ; rod, 1bligate anaerobe, spore forming
Grows in well in blood agar in anaerobic conditions
6ong" thin rod shaped bacteria with large terminal spores3 2R=)+%/'>$
Virulence factors&
" %etanoplasmin" potent neuroto0in,
o +ite of action is the 6)5
o Reaches brainstem and spinal cord via upta(e along motor nerves or bld stream
o ,loc(s the inhibitory stimuli causing nerve cells to fire continuously causing spastic paralysis
" +pores forming that are highly resistant
Epidemiology
%ransmission& spores inoculated into tissues via wounds3
'arriage& #ound in feces of large farm animals, sometimes in the human gut and soil3
!t ris(& frequent contact of wounds with soil, neonates born in villages with custom of putting cowdung on the
umbilical stump3
Clinical Presentation
" *ain and stiffness at site of infection3not always present cryptogenic tetanus$
" 6oc(.awstiffness of .aw$
" +ardonic Grin due to spasm of facial muscles3
" 1pisthotonus contraction of all the bac( muscles$
Management
%reatment
" 2ebridement of wound, 4%/g given to neutrali-e free to0in in the blood$, ben-ylpenicillin3
" symptomatic treatment for pts with respiratory difficulties due to severe spasm
o sedation and ventilation
*revention
" %etanus to0oid vaccine part of the 2*% vaccination3
" /n +g, given ?,9,<, 7@ months 2*%$, and boosters at 6;, 77; yo 2% boosters$
o Vaccine lasts for 7A yrs or more3
Clostridium botulinum
Bacteriology
Gm ; rods, obligate anaerobe, spore forming
Virulence factors
*roduces botulinum to0in which prevents transmission at the 5)B, causing flaccid paralysis
#ormation of highly resistant spores
Epidemiology
%ransmission
" wound site inoculation, /V2 use
" !erosol " bioterrorism
" ingestion of food contaminated with preformed to0in honey$
o coloni-ation of infantCs G/%
+ources& found in soil, badly canned food, contaminated heroin
!t ris(& 'hildren, /V2!
Clinical features
" early symptoms& diplopia, ptosis early$
" later symptoms& dysarthria, dysphagia, dysphonia, development of descending, progressive paralysis and
respiratory failure due to paralysis of respiratory muscles
" patients usually alert and febrile, sometimes initially there is nausea and vomiting
Diagnosis
,lood and stool culture
%o0in is detected by mouse inoculation
2etect by giving antiserum
Management
%reatment&
+upportive care" ventilation
!ntiserum to be given
2ebride any wound or purge any to0in from gut
*revention&
2econtamination of surfaces contaminated with to0in with A3<D hypochlorite solution3
,oiling foods for 7A min to destroy to0ins3
Clostridium difficile
Bacteriology
Gm ;ve rods, 1bligate anaerobe, +pore forming
Grown in ,ld agar in anaerobic conditions
Virulence factors
" Enteroto0in ! cause fluid secretion and mucosal inflammation leading to diarrhea3
" 'ytoto0in , cytoto0ic to colonic epithelial cells
" Resistant spores formed3
Epidemiology
%ransmission& #ecal 1ral, fomites
'arriage& in colon of minority of general population, higher in hospital patients3
!t Ris(& !ntibiotic use clindamycin, penicillins$, hospital patients, cancer, leu(emia
Clinical presentations
" *)'
o 5on"bloody watery diarrhea
o #ever, abdominal cramps3
o Ehite inflamed colonic mucosa with *seudomembrane formation
Complications
" to0ic megacolon
Diagnosis
+igmoidoscopy
#ecal culture
2irect to0in detection
" E6/+!
" 'ytoto0icity test
Management
%reatment
)etronida-ole and oral vancomycin
2ecoloni-ation of the gut with normal flora
'olon resection last resort for to0ic megacolon$
*revention
/solating the patient to prevent cross"infection and outbrea(3
Mycobacteria tuberculosis
Bacteriology
!#,, wea(ly Gm ;ve, characteristically slow growing, obligate aerobes, intracellular pathogen
Virulence factors&
!void host defences
!ble mulitiply intracellularly resisting macrophage microcidal activity form granulomas
!dherence&
5il
2amage to host&
5o endoto0in, e0oto0in
Epidemiology
%ransmission& respiratory droplets
!t ris(& being in endemic areas eg +E!$, immunocompromised3
/n +g, %, more prevalent in males and )alay population3 )ore prevalent in elderly3
'arraige& can lie latent in macrophages and may reactivate when immunocompromised3
Reactivation accounts for ma.ority of adult %, cases in +ingapore3
79AA new %, cases per year3
Pathogenesis
" ,acteria enter lungs and are ingested by alveolar macrophages3
" 'ontinues to multiply intracellularly by resisting or inhibiting host macrophages microbicidal mechanisms3
" /nfected macrophages are eventually destroyed, releasing bacteria that are ingested by other macrophages3
" )acrophages activate % helper cells which in turn release /#5"gamma which activates more macrophages3
" 'hronically activated macrophages differentiate into epitheloid cells with differentiate into multinucleated
giant cells surrounding the focus of infection
" %his results in formation of granuloma
" 'aseous necrosis may occur resulting in cavity formation and erosion of blood vessels causing bleeding3
" /nfected macrophages carry bacteria into the regional lymph nodes which become enlarged3
" Ghon 'omple0 formed comprises of mediastinal and hilar nodes with the pulmonary focus
" ,acteria can remain latent in the macrophages and reactivate many years later3
Clinical features
#ever, night sweats, loss of apetite and weight3 #atigue3
*ulmonary %,
" symptoms include prolonged productive cough F?w(s$, chest pain, hemoptysis
" common cause of adult community acquired pneumonia
E0trapulmonary %, spread via lymph, blood and contiguous $
" 6ymphadenitis most commonly in the cervical region$
" 1steomyelitis %, spine potts d-$
" )eningitis
o ,ase of brain common
o 6ow glucose in '+#
o 'ranial nerve palsy
o 4yponatremia
o 4ydrocephalus
" G/%
" +(in lupus vulgaris$
)iliary %,
" progressive hematogenously disseminated %,
" granuloma affecting multiple organs
o pneumonitis, pleuritis, meningitis, peritonitis
o high mortality
Lab Diagnosis
4ematology
" normocytic, normochromic anemia
" hyponatremia in %, meningitis
" E,' often normal occasionally monocytosis$
+pecimen
" E0pectorated or induced sputum ? early morning sputum samples$
" ,lood cultures
" +terile body fluids '+#, *ericardial, *eritoneal$
" Early morning urine for ? separate days3
" %issue biopsy eg lymph nodes, s(in$
)icroscopy&
" !#, staining Giehl"5eelsen, >inyoun$
'ulture
" e0amined for 6"@w(s before negative culture report
" 6owenstein Bensen or )iddlebroo( media
" !utomated broth culture medium which detects utili-ation of substrates by bacteria
)olecular
" nucleic acid probes
" *'R
4istology
" 'aseating granulomas
Management
'hemotherapy
#irst line&
Rifampicin
Ethambutol
+treptomycin
*yra-inamide
/sonia-id
'orticosteriods indicated in %, meningitis
2irect observed therapy 21%$ recommended for %, pts due to problems in compliance3

*revention
,'G vaccination at birth
" helps to reduce the incidence of )iliary %, and %, meningitis
'ontrol
Early detection and treatment
/solation of smear ;ve patients for at least 8 w(s after initiation of treatment3
'ontact tracing 6mth isonia-id prophyla0is for close contacts
Chlamydia trachomatis
Bacteriology
+mall bacteria with small genome, obligate intracellular as are not able to produce energy to grow independently3
+mall amt of peptidoglycan in cell wall hence ,"lactams not useful
'ell wall resembles Gm ve bact but lac( muramic acid
Pathogenesis
Elementary body, E, enters host cell and reproduces inside membrane bound vesicles as 8
nd
morphological form
reticulate body R,$3 %he daughter reticulate body changes bac( to elementary body before being released to infect
other cells3
Epidemiology
%ransmission& /nfects only humans, transmitted se0ually or via finger to eye or fomite to eye
'an be passed to the neonate via infected birth canal
!t ris(& developing countries with poor hygiene due to flies and inadequate hygiene practices, se0ually
promiscuous
%he most common +%2 in developing countries3
'arriage& may be carried aymptomatically and these people are important reservoirs of infection
'linical features
? serovars& F7< immunotypes
%rachoma '3trachomatis !,'$
" transmitted by flies fingers fomites
" eye infection
" cornea becomes clouded pannus formation$
" chronic inflammation of eyelids and cornea eventually leads to blindness3
6GV lymphogranuloma venereum$ '3trachomatis 67,68,6?
" +%2
" *rimary lesion small papule or vesicle on genitalia
" /nfection spreads to regional lymph nodes which enlarge suppurate or discharge through sinuses
" )ales & inguinal glands
" #emales & perirectal glands leading to proctitis and bloody anal discharge
o 'hronic inflammation leads to rectal stricture or elephantiasis
'3trachomatis 2">
)ales
" important cause of 5G= in *G=3
" 2ischarge in dysuria
" !scend to affect epididymis
" *rocitis in homose0uals
#emale
" site of infection is the endocervical canal
" usually asymptomatic
" may have discharge, dysuria, urethritis and proctitis
" ascending infection may cause acute salpingitis or */23 instrumentation or menstruation$
" may lead to #it-"4ugh"'urtis +yndrome peri"hepatitis$
" *eri"appendicitis
)ale and #emale
" may autoinfect eyes leading to paratrachoma adult inclusion con.unctivitis$
5eonate
" important cause of ophthalmia neonatorum
" must not only be treated with topical antibiotic or pneumonitis, recurrent con.uncitivitis would develop
eventually3
Management
%reatment
%etracyclines, Erythromycin, !-ithromycin
Prevention of STD
Education targeted approach$
" patients with +%2
" +e0 Eor(ers
" Houth
" )ilitary *ersonnel
" General *ublic
'ontact tracing
!ntenatal screening
Regular screening of se0 wor(ers
5o chemoprophyla0is should be given3 let doctors (now not to$
Neisseria gonorrhea
Bacteriology
Gm ve cocci in pairs
Grows poorly in blood agar but grows in chocolate agar3 Grows on selective %hayer )artin )edium3
#acultatively intracellular bacteria usually found in *)5s3
2elicate bacteria
10idase ;ve
#erments Glucose
Virulence factors
!void host defences
" antigenic variation of fimbriae and 1)*, fimbriae able to turned on and off
" pili are anti phagocytic
" /g! protease, hydrolyses secretatory /g!3
!dhesion
" *ili mediate attachment to mucosal surfaces and are anti"phagocytic
2amage to 4ost
" 61+ 6ipooligosaccharride$
" 'ontribute to host inflammatory response and serum resistance3
Epidemiology
%ransmission& +e0ual transmission
'arriage& may be carried asymptomatically in the genitals and throat3
!t ris(& +e0 wor(ers and se0ually promiscuous
/mmunity does not develop after infection therefore multiple infections possible3
Clinical presentations
)ales
" urethritis and discharge and dysuria
" proctitis in homose0uals
#emales&
" asysmptomatic carriers usually
" may cause discharge and dysuria
" primary site of infection is endocervical canal3
" may ascend to upwards to cause acute salpingitis and */2 after instrumentation or menstruation
" may further spread to the perihepatic areas to cause #it-"4ugh"'urtis syndrome3
" prepubertal girls may develop vulvovaginitis, due to poor hygiene
,oth se0es
" autoinfection of eyes
" can rarely cause disseminated infection with small pustular s(in lesions, fever and .t pain3
5eonates
" cause 1pthalmia 5eonatorum
Lab Diagnosis
)icroscopy
Gm stain of discharge Gm ve diplococci inside *)5
8
nd
%est to confirm microscopy
1)* !ggluttination3
'ulture
+elective and non selective growth media
+pecimen collection
#emale&
=rethral, endocervical, rectum and throat direct stain from female genital tract less sensitive$
)ale&
=rethral, throat and rectum if homose0ual$
Management
%reatment
'eftria0one /)
*revention
+ilver nitrate eye drops for opthalmia neonatorum
'ondom use
Refer to +%2 prevention above3
E!Coli
Bacteriology
Gm ve bacilli, facultative anaerobe, )otile
Grows on )ac'on(ey !gar as lactose fermenting *in( colonies
E), agar with a green sheen
4ave 1 and 4 antigens that can be detected3
Virulence factors
!void host defences
" anti"phagocytic capsule
" #lagella aids its ability to ascend up urethra to the bladder, up the ureter to the (idney3
!dherence
" *ili * *ili used to attach to =rinary %ract epithelium
2amage to host
" endoto0in
" e0oto0ins
o 4eat +table %o0in +%$ E%E'$ ,oth cause cholera"li(e effects leading to diarrhea
o 4eat 6abile %o0in 6%$ E%E'$ "
o Veroto0in E4E'$
Epidemiology
%ransmission& #ecal oral, autoinfection, birth canal
Reservoir& humans and animals3 'attle main reservoir for E4E'
'arriage& normal flora of colon
+ources& spinach, raw meat contaminated with feces3
Clinical presentations
=%/
" 6eading cause of community acquired =%/
" #ound mostly in women due to & short urethra, pro0imity of urethra to anus, coloni-ation of the vagina by
members of the fecal flora
" *resentation& cystitis and pyelonephritis
" 'ystitis dysuria, decrease freq of urination
" *yelonephritis fever chills and flan( pain
5eonatal infections meningitis and sepsis$
" usually have >7 !g
" 8
nd
most common cause of neonatal meningitis
" due to coloni-ation of the vagina of I8<D of pregnant women
+epsis
" associated with the gut and also post operatively
2iarrheal disease
9 main types of diarrhea causing E3'oli
" E*E' causes infantile gastroenteritis
" E%E' causes travelerCs diarrhea, watery, non"bloody diarrhea3
" E/E' causes dysentery li(e diarrhea with fever
" E4E' produces +higa"li(e to0in that causes hemorrhagic colitis with bloody diarrhea3 %his may be
complicated by 4=+ acute renal failure, microangiopathic hemolytic anaemia, thrombocytopenia$
"
Lab Diagnosis
'ulture )c'on(ey or E), !gar
,iochemical tests 2etect for bacterial antigen
+erology not useful
Management
%reatment
2iarrhea usually self limiting antibiotics not indicated$
" antibiotic treatment contraindicated in 4=+
=%/ %)*"+)G, 5itrofurantoin, !mpicillin
+epticemia, meningitis 'ephalosporins& 'efo0atime ; gentamicin sepsis$, ampicillin ; cefta-idime meningitis$
*revention
=%/
" removal of catheters
" cranberry .uice
" prolonged prophyla0is for recurrent =%/
" =rinary after se0
2iarrhea
"*rophylactic 'iproflo0acin, %)*"+)G
"almonella
Bacteriology
Gram negative rods, grows on )ac'on(ey agar produces pale colourless colonies$, 2'! medium, does not
ferment lactose 56#$
Virulence factors
!voidance of host defences" capsule Vi antigen$, motility
!dherence"
2amage to host" invades colonic mucosa
Epidemiology
%ransmission& fecal 1ral 4umans feces only source for typhoid fever, but animals feces cause non typhoid causing
salmonella$
'arriage& !symptomatic carrirs are important source of carriers for the typhoid causing salmonella
!t ris(& /f you are living in +E !sia
Clinical features
+almonella typhi, paratyphi
" typhoid fever
o /*&7"?wee(s
o ,acteria penetrates ileal mucosa
o )ultiply in mesenteric 65
o Enter bloodstream
o )ultiply within macroaphages of many organs
o 8
nd
invasion of bloodstream
fever, anore0ia, epita0is, cough, abdominal pain and tenderness
acute psychosis
headache
%emperature rises gradually over a wee(, remains elevated for 7A"79 days, then falls
gradually
,radycardia
4epatospenomegaly palpable$
'onstipation or rarely diarrhea
Rose +pots on abdomen
o Gallbladder gets infected and e0cretes infected bile
o +econd invasion of the intestinal wall occurs
o %yphoid ulcers due to inflammation
o 'ause severe hemorrhage and interstinal perforation impt cause of death$
o 'omplications& to0ic myocarditis, encephalitis, hemolytic anemia and abscesses in liver spleen and
bone
+almonella enteritidis, +almonella typhimurium
!cute gastroenteritis
" symptoms& diarrhea, abdominal pain, vomiting, fever
" usually self"limiting
" severe cases confined to the young and elderly or those delibitated by other diseases
" other complications include& bacteraemia, infection of atheromatous plaques, implanted prosthesis,
osteomyelitis esp in sic(le cell anaemia, meningitis in neonates3
" #or 4/V patients, non"typhoid"causing salmonella might cause typhoid li(e invasive disseminated
infections3
Lab diagnosis
%yphoid fever
" early& blood cultures
" late" stool or urine cultures
" culture on 2'! agar which suppresses 6# bacteria E coli$
" serological diagnosis not reliable without tests
+almonella gastroenteritis
" culture from stools
Management
%reatment for typhoid
" 'iproflo0acin chec( for !, sensitivity$
%reatment for Gastroenteritis
" self limiting
" !, only used if immunocompromised, neonates or have chronic d- who are at ris( of septicaemia or
multiple abscesses
*revention&
" Vaccination confer limited protection <A"@AD$
o Vi capsular polysaccharide
o 6ive attenuated oral vaccine
o #or travelers or residents of high ris( areas or whose occupation requires so
" proper sewage treatment
" chlorinated water supply
" personal hygiene
" pasteuri-ation
" proper coo(ing of food
Malaria
Plasmodium "pp
Microbiology
!picomple0a
/ntracellular parasites
9 different plasmodia
Epidemiology
%ransmission&
Vector borne
#emale anopheles mosquito !3sundaicus coastal, bra(ish water$, !3maculatus clear water, streams, hilly$
#eeds silently after dus(3
%ransfusion
'ongenital %ransmission
5eedle +haring
Reservoir 4umans are the only important reservoir primates as .ungle hosts not important$
!t ris(&
Endemic in +E! particularly rural areas3
+pecial Ris(s& 4/V, child, airports, pregnancy, children, splenectomy
/nfectious period& until parasites are cleared from blood
+ingapore&
7AA"?AAcasesJyr I6<D viva0, I??Dfalciparum, almost all imported3
6ife 'ycle of *lasmodium
" 2uring a blood meal, female anopheles mosquito inoculates sporo-oites into the human host3
" +poro-oites infect liver cells and mature into schi-onts, which rupture to release mero-oites3
" )ero-oites goes into the bloodstream to infect R,'s3
" #orms ring stage tropho-oites that mature into schi-onts, which rupture releasing more mero-oites3
" +ome tropho-oites differentiate into gametocytes which are ingested by a mosquito during blood meal3
" /n the mosquito, the gametocytes fuse to from -ygotes that develop into oocysts, which rupture releasing
sporo-oites3
" %he sporo-oites ma(e their way to the mosquito salivary glands to be inoculated into a new host upon the
ne0t blood meal3
Clinical features
" /*& K"79 days
" *rolonged by immunity, chemoprophyla0is or partial chemotherapy
" +ymptoms&
o #ever and chills
o )yalgia
o 2i--iness, anore0ia, malaise
o G/% abnormalities
" +igns
o #ever
o !nemia *allor$
o %ender +penomegaly
o *ostural 4ypotension
" +evere disease usually appear after ?"Ldays of non specific symptoms
Complications
+evere )alaria
'linical features
" 'erebral malaria
o Repeated convulsions
o Retinal hemorrhage
o FK<D full recovery no sequelae
" 4emoglobinuria
" *ulmonary Edema
o 8ndary bact pneumonia
o most common cause of death
" #ever F9A'
" +hoc( MLAmm4g
" ,leeding from nose gum and G/
" *rostration unable to sit or stand$
6ab #eatures
" 4igh 'reatinine
" !nemia
" 4yperparasitemia
" 4yperbilirubinemia
" !cidosis
" 4ypoglycemia
" 2/'
Lab Diagnosis
)icroscopy
" thic( and thin smear
o giemsa stain
!ntigen 'apture
o detect 4R*"8 *3falciparum$
o p624 panspecific$
o 51E test, *arasight
5ucleic !cid +tain
" acridine orange
)olecular mtds
" R%"*'R
)alaria pigment detection
" hema-oin pigment detection depolari-es light
Management
%reatment&
#alciparumJ )alariae& 'hloroquine
5on"falciparum malaria *3vova0, ovale$" chloroquine followed by primaquine
'hloroquine resistant #alciparum malaria mild$" 1ral quinine and do0ycycline 1R clindamycin
+evere complicated malaria& /V quinine and do0ycycline or artemisinine
'hemoprophyla0is& mefloquine, do0ycycline, !tovaquone
'hloroquineJproguanil not optimal alt
*revention&
*rotect yourself from e0posure during the period that the female !nopheles mosquito bites
Eear long sleeves light coloured clothing when traveling at night
/mpregnated bednets
=se mosquito coils and mosquito repellent
Candida
Microbiology
Heast
5on"encapsulated yeast
'3albicans forms germ tubes upon incubation at ?L'
Epidemiology
%ransmission& 1pportunistic infection, se0ual rare$
'arraige& normal commensal of humans in s(in, female genital tract and human G/ tract
*resent in soil hospital and inanimate ob.ects
!t Ris(&
#oreign body &
'atheterisation
/V cannulae
/V2!
)a.or +urg
%rauma
E0tremes of !ge&
/mmunocompromised&
'ancer chemo
!/2s
5eutropenia
!ntibiotic usage
2iabetes )ellitus
6ocal factors
/ntertrigo
Eet hands
*oor 4ygiene
4ormones
*regnancy
1ral 'ontraceptives
Pathogenesis
1vergrowth of yeast at mucosal surfaces due to wea(ened local and systemic defences3
Clinical features
+uperficial candidiasis
" )ucocutaneous
o %hrush
1ropharyngeal
Vaginal
o discrete white patches
o !ngular cheilitis soreness of the corners of mouth$
o Vaginal discharge and pruritus
o ,alanitis inflammation of glans penis$
" +(in and 5ails
o /ntertrigo
o 5appy rash
o +atellite lesions
o *aronychia
" 'hronic )ucocutaneous 'andida
o Rare
o /n pple with in born % cell abnormalities
+ystemic candidiasis
" 'ardiovascular
o 'andidemia
o *urulent pericarditis
o )yocarditis
o Endocarditis
" 4epatosplenic for leu(emic and granulocytopenic$
" =%
o !ntibiotic use
o /ndwelling catheters
" Respiratory
o +pread via endobronchial or hematogenous route
o 5on specific 'XR range from mild to necrotising
,one n .oint
Eye " endophthalmitis
'5+ meninges
Gallbladder
*eritonitis
2isseminated inf0n
Lab Diagnosis
)icroscopy
" Gm stain
'ulture
" resembling staph colonies
o soft cream colonies with yeasty odour3
o *seudohyphae apparent
o '3albicans produces germ tubes
,lood culture for systemic inf0ns3
Management
%reatment&
+J# inf0n
" %opical 5ystatin
+ystemic
" +top antibiotics
" Remove infected /V lines
" /V amphotericin , w or wo flucytosine
)ucocutaneous
" (etocona-ole
Cryptococcus
Microbiology
'apsulated yeast polysaccharide capsule$
=rease producing
Epidemiology
*resent in ,ird #eces '3neoformans var neoformans$ and Eucalyptus trees '3neoformans var gatti$
!lso found in fruit mil( and soil3
'3neoformans var neoformans infects immunocompromised
'3neoformans var gatti infects immunocompetent
%ransmission& inhaled spores causing lung infection then dissemination, s(in and open wounds
Clinical features
'5+
" meningitis progressing to coma
" cryptococcoma resemble brain tumour$
*rostate
6ung
" pneumonia and pleural effusion
+(in
65
,one
Lab Diagnosis
)icroscopy
" /ndia in(
" Reveals capsule clear halo$ of yeast with blac( dots on red bac(ground
" +ingle bud with narrow base
!g 2etection most sensitive and reliable$
" 'ryptococcal !g %est blood or '+#$
'ulture
" Ehitish mucoid colonies in 8"? days
Management
%reatment
" #lucona-ole
" !mphotericin ; " flucytosine
" %reat for several wee(s
Pneumocystis carinii
Microbiology
Heast
1pportunistic inf0n in people with % cell defects
Clinical presentations
*neumonia
" 'XR non specific
2isseminated infection in !/2+
Lab Diagnosis
Grocott +ilver +tain
" appears as blac( granules
/# of ,!6
Management
%reatment& 5o response to !mphotericin ,
4igh dose of %)*"+)G commonly used
*entamidine as alt
)ore severe cases req corticosteroids