Micro Master

PRI O N VI RUS BACTERI A

SIZE =
SIZE = .3-2 u
Prokaryote
DN A & RN A
O rganelles not membrane bound
Binary Fission Replication
O XYG EN REQ UIREM EN TS
1: O bl i gat e aerobes need oxygen because t hey cannot f erment or respi re
anaerobi cal l y. They gat her at t he t op of t he t ube w here t he oxygen
concent rat i on i s hi ghest .
Tubercul osi s M ycobact eri um
Pseudomonas
2: O bl i gat e anaerobes (ABCs) are poi soned by oxygen, so t hey gat her at
t he bot t om of t he t ube w here t he oxygen concent rat i on i s l ow est .
A nt i nomyces
B act eroi des
C l ost ri di um

3: Facul
can t at i ve
met abol i seanaerobes can cal
energy aerobi grow w i tanaerobi
l y or h or w ical
t hout
l y. oxygen
They gatbecause t hey
her most l y at
t he t op because aerobi c respi rat i on generat es more ATP t han ei t her
f erment at i on or anaerobi c respi rat i on.
Ent erobact eri aceae
4: M i croaerophi l es need oxygen because t hey cannot f erment or respi re
anaerobi cal l y. H ow ever, t hey are poi soned by hi gh concent rat i ons of
oxygen. They gat her i n t he upper part of t he t est t ube but not t he very
t op.
H el i cobact er
Campyl obact er
5: Aerot ol erant organi sms do not requi re oxygen as t hey met abol i se
energy anaerobi cal l y. Unl i ke obl i gat e anaerobes how ever, t hey are not
poi soned by oxygen. They can be f ound evenl y spread t hroughout t he
t est t ube.

Anaerobi c bact eri a can be i dent i f i ed by grow i ng t hem i n t est t ubes of

t hi ogl ycol l at e brot h:

TERM IN O LO G Y

O XID ASE +
CATALASE +

N ormal Flora

Subt opi c 1

BLO O D NONE

SKIN St aph Epi dermi di s

N O SE St aph Epi dermi di s, but col oni zed by St aph Aureus
O RO PH ARYN X Vi ri dans St ept ococci

D EN TAL PLAQ US
Et rep M ut ans
CO LO N Inf ant s: Bi f i dobact eri um
Adul t s: Bact eroi des Fragi l i s > E. Col i
VAG IN A Lact obaci l l us, but col oni zed by E. Col i & B G roup St rep

Staining/Culturing/Media

Staining/Culturing/Media
Cul t uri ng M edi a
G ram Stai ni ng
M acConkey = G ram N egat i ve
Bl ood Agar = a, b, g H emol ysi s = St rep
CRYSTAL VIO LET
BCYE = Legi onel l a
-Pri mary st ai n
-St ai ns G ram ( + ) & ( - ) EM B = E. Col i
G RAM S IO D IN E Chocol at e Agar = N i sseri a, H omophael us
-M ordant TCBS
Chol est erol , Puri ne & Pyri mi di ne = M ycopl asm
-Forms Cryst al vi ol et i odi ne compl exes
D ECO LO RIZER Cyst ei ne = Franci sel l a, Brucel l a, Legi onel l a, Past eurel l a
-Acet one + M et hanol X(heme) & V(N AD ) = H aemophi l us
-Removes Cryst al vi ol et i odi ne compl ex f rom t hi n pept i dogl ycan l ayers
-D i ssol ves out er l ayer of G ram negat i ve org
G RAM SAFRAN IN E
-Count er st ai n
-Red col ored
-St ai ns t hi n w al l ed G RAM N EG
-Pus cel l s cyt opl asm & l obes of nucl i e al so st ai n red

A pat i ent Treat ment w i t h ant i mi crobi al agent s may cause gram-posi t i ve
bact eri a t o appear gram-negat i ve.

Weakl y G ram St ai ni ng
spi rochet es,
ri cket t si as,
chl amydi ae,
mycopl asmas,
mycobact
Coxi eri a
el l a and
Legi onel l a.
M ost are t oo t hi n i n di amet er f or t he l i ght mi croscope

GRAM STAI N I N G
Col

reagent GRAM ( - ) GRAM ( + )

CRYSTAL VI O LET PU R PLE PU R PLE

GRAMS I O DI N E PU R PLE PU R PLE

DECO LO RI ZER CO LO R LESS PU R PLE

*PI N K *PURPLE
SAFRAN I N E

GRAM PO SI TI VE VS GRAM N EGATI VE

GRAM PO SI TI VE VS GRAM N EGATI VE

G RAM PO SITIVE
G RAM N EG ATIVE EXO TO XIN VS EN D O TO XIN CELL WALL
*Li popol ysacchari de (endot oxi n / LPS) – LIPIDEXO A TO XIN S are t oxi c prot ei ns produced by bact eri a and rel eased out si de.
M ost are mot i l e by peri t ri chous f l agel l a --H antGi ram
gens. (+ / - )
Capsul e – K ant i gen ( Vi f or Sal monel l a). B component Bi nds N -acet yl gl ucosami ne and N -acet yl murami c aci d are |
Cel l envel ope (w al l ) A component i s Act i ve (t oxi c) pol ymeri zed t o f orm t he pept i dogl ycan backbone of t he cel l w al l .
vari ous out er membrane prot ei ns. Ent erot oxi ns
Pi l i - vari ous ant i gen t ypes, some encoded by pl asmi N eurot
ds oxi ns G RAM PO SITIVE
TH ICK Pept i dogl ycan cel l w al l
Cyt ot oxi ns
Tei choi c Aci d
Cyt ol ysi ns

EN D O TO XIN S are bact eri al t oxi ns consi st i ng of l i pi ds t hat are part

G RAMof Nt he
EG ATIVE
cel l w al l ; rel eased w hen Bact eri a i s l ysed; TH IN Pept i dogl ycan Cel l Wal l
G ram ( - ) = LIPID A of Li popol ysacchari de Li popol ysacchari de Toxi n
+ Li st eri a M onocyt ogenes (gram (+ ) ) -Li pi d A
--> Fever -O Ant i gen
--> Sept i c Shock -Core
Peri pl asmi c Space - B-Lact amase
Pori n

GRAM (+)
Staphylococcus
GRAM ( + )
CATALASE ( + ) ( H 2O 2)
FACULTATI VE AN AERO BE

Staphylococcus
GRAM ( + )
CATALASE ( + )
FACULTATI VE AN AERO BE
-G rapel i ke Cl ust ers Staph G enus
-N on-M ot i l e
-O xi dase (-)
-Ferment at i on (+ /-)
-Sl i me Capsul e Coagul ase (+ ) Coagul ase (-)
-0. 5-1. 5µm i n di amet er
-N on spore-f ormi ng
Fami l y: St aphyl ococcaceae Staph Aureus Staph Epidermis Staph Saprophyticus
G enus: M i crococcus and St aphyl ococcus
-Smal l YELLO W col oni es i n medi a - N ovobi oci n Sensi t i ve - N ovobi oci n Resi st ant
IM PO RTAN T: -B H emol yt i c l i ke St rept ococcus
*S. Aureus -Ferment at i on (+ ) CLI N CAL M AN I FESTATI O N
S. Epi dermi s - Col oni zes mucosa (25% of adul t s are carri ers). - Part of ski n Fl ora CLIN ICAL M AN IFESTATIO N
S. pseudoi
Saprophyt i cus us IN FLA MMA TO R Y D ISEA SE
S. nt ermedi
-- Transmi
Food Poi tsoni
t edng
bycommon
di rect cont
f or act
Custand
ard,f omi
pot tates
o sal ad, past ri es, canned meat s Produces a pol ysacchari de sl i me CLI N CAL M AN I FESTATI O N
M . Lut eus and mast i t i s
- Cont ai ns Superant i gen (aureus & pyogenes) SKIN IN FECTIO N S-Abscesses
-Surgi cal Wound Inf ect i ons (al so know n as gl ycocal yx or - 2nd most common cause of UTI
ext racel l ul ar mat ri x) made by UTI
- i n new l y sexual l y act i ve f emal es
PRED ISPO SIN G FACTO RS IN FECTIVE Inf ect i ve endocardi t i s (acut e) St aph. epi dermi di s w hi ch serves
*Surgi cal Wounds EN D O CARD ITIS --> Fever, mal ai se, Leukocyt osi s, H eart M urmur as adi‘ fglf iue,
cul’ t’ tcreat
i ng w
bi ioft hout
i l ms t hat Saprophyti cus gi ves ya
are o cl ear
Forei gn Bodi es (t ampons) ' honeymoon cysti ti s'
removal of t he devi ce.
-Acut e i ve
-Product
VIRU
y LEN
heat CE
FACTO
st antRS
PN EUM O N IA
-Rel at i vel resi -Empyema TREATM EN T
-Resi st ant t o hi gh concent rat i ons of sal t -N osocomi al Pneumoni a Vancomyci n
-Can survi ve l ong peri ods on dry i nani mat e obj ect s
O STEO M YELITIS -M -M ost
et aphysi s most
common common
overal l cause area of St
of ost aph i nvasi
eomyel i t i s on due t o haiCLIN
r-pi n l oop;
*PRO TEIN A - Prevent s compl ement f i xat i on of IgG --> Inhi bi t s Phagocyt osi s CAL M AN IFESTATIO N
SLIM E LAYER - Prevent s i mmedi at e i mmune response;
TO X IC D ISEA SE
LIPO TEICH O IC ACID S - When cel l i s l ysed pl ay a rol e i n Sept i c Shock
CATALASE
M RSA cont( ai+ns) ALTERED
- preventPEN
s phagocyt
ICILLINi cBIN
ki l D
l i IN
ng G
by PRO
neut TEIN
ral i ziSng peroxi ng
des;i nt eract i on w i t h bi ndi ng Food poi soni ng WO UN D opport uni st requi ri ng ent ry
- changi
*(Caused by PRE-FO RM ED EN TERO TO XIN S A-E i n f ood) IN FECTIO N S (surgery, medi cal devi ces)
prot ei ns; RAPID O N SET ACUTE - 2-6 H ours
SUBACUTE BACTERIAL i n art i f i ci al val ve 2 mont hs af t er surgery
FO O D PO ISO N IN G Survi ves i n-->
sal t Area
y f oods;
TO XIN S *Vomi t i ng Post rema EN D O CARD ITIS
EN TERO TO XIN S A-E - pre-f ormed i n f ood w hi ch causes Food Poi soni ng; D i ahrrea --> Loss of brush border cel l s
surgi cal oppurtuni st
H eat and sal t st abl e
medi cal devi ces
-Rare but-Sharp
l i f e-tdrop
hreati n
eniblng;
ood pressure t hat can l ead t o organ hypoxi a;
EXFO LIATIVE TO XIN n
--> Cadheri SDA esmogl
& B (ETA, ETB)
ei n = StSSSS
1 in rat um G ranul osum -M al ai se, conf usi on, D i ahrrea, Fever, Sei zures,
-Wi despread sunburn l i ke rash part i cul ary on t he pal ms and sol es;
TSST-1 ' SUPERAN TIG EN ' = Toxi c Shock Syndrome -mc
M E ioccur
n w omen caused by St aph Auresu i nf ect ed TAM PO N S
TO XIC SH O CK SYN D RO -Can
- Prevent s det t achment of T-Cel l TCR t o M H CII Compl ex i n men and w omen due t o open w ound exposure t o St aph;
--> i ncrease cyt oki ne rel ease -M ost l y < 19yrs age;
-Can happen post chi l dbi rt h;
Cyt ol yt i c Toxi ns Ent erot oxi n Type B or TSST-1
Al
Betpha
a == sphi
β hemol ysi s
ngomyel i nase
D el t a = at t acks RBCs, macrophages, l ympphocyt es, neut rophi l s, pl at el et s -St aphyl ococcal Scal ded Ski n Syndrome (i n new borns & i nf ant s) -
G amma = hemol yt i c Spect rum of Superf i ci al Epi dermal bl i st erst eri ng due t o Exf ol i at i ve Toxi ns
Leukoci di n = RBC hemol ysi s (exf ol atMi ns ETA & ETB);
Leukot oxi n = WBC dest ruct i on Spares ucus membranes
STAPH YLO CO CCAL *N ot t o be conf used w i t h Toxi c Epi dermal N ecrosi s (TEN ) w hi ch does N O T
SCALD
Coagul ase = Convert s Fi bri nogen t o Fi bri n --> creat es a Fi bri n cl ot f or SYN ED SKIN
reproduct spare mucous membrane, i s more deadl y, Idi osyncrat i c, al l ages;
D RO Mi E
ve
envi
yalronment
-->
= H
eart Ting
ssue;
H uroni dase “spreadi f act or” of S. aureus -Fol l i cul i t i s - i nf l amed puss f i l l l ed hai r f ol l i cl es
N ucl ease = cl eaves D N A and RN A i n S. aureus -Boi l s (f uruncl es)
St aphyl oki nase - f i bri nol ysi n -Carbuncl es - sever abscess
D N ase -Impet i go - sores around mout h --> coagul ase
FAM E (f at t y aci d modi f yi ng enzyme)
Toxi c Epi dermal N ecrosi s (TEN ):
-Idi osyncrat i c (mc cuase i s SA of drugs)
-D ore
oes deadl
N O Ty,spare mucous membrane,
TEATM EN T -M
S. Aureus
-Al l ages;
M et hi ci l l i n (B-Lact am) - > 30% of body af f ect ed
M RSA - i mpt i n nosocomi al
Vancomyci n (expensi ve & t oxi c) SJS (St even-Johnson Syndrome)
VRSA
-same as above except < 10% af f ect ed
D al f opri st i ne and qui nupri st i n- Bl ock 50S ri bosomes
-Rash --> Bul l ae
Li nezol i d - Bl ocks Ini t i at i on of prot ei n synt hesi s -Product i ve
Cef met
t obi hopri
prol em/sul
(5t h fGamet
en Cephal ospori a; Cough w / Purul ent Sput um;
e - n) - Cel l w al l i nhi bi t or (B-Lact am)
-Art hral gi
Tri hoxazol
-t arget appearance
Bl ocks de novo f ol at e synt hesi s --> Inhi bi t s D N A synt hesi s;
ID : M anni t ol agar
-Fever
-M al ai se
O TH ER -Excessi ve Cryi ng
-Poor Suckl i ng
-Sept i c Shock upt on bact eri al dest ruct i on (Sept i c / Endot oxi c Shock)

Streptococcus
GRAM ( + )
CATALASE ( -)
FACULTATI VE AN AERO BE

Streptococcus
GRAM ( + )
CATALASE ( -)
FACULTATI VE AN AERO BE

-CH A IN S (someti mes pai rs) ID EN TIFICA TIO N

-O xi dase (-) H emol yti c Pattern + 1 A ddi ti onal ID
H abi tat pri mari l y i n the R espi ratory Tract and secondari l y
the G I and U rogeni tal tracts;
H EMO LYTIC PA TTER N Lancefi el d G roups
TR EA TMEN T
' Sheep B l ood A gar' -Cel l Wal l Carbohydrate A nti gen
Peni ci l l i n G roup
-B -Lactam ' P. V . A . P. E'
-Cel l Wal l i nhi bi tor
G roupabl e N on-G roupabl e
a-H EMO LYTIC B -H EMO LYTIC y-H EMO LYTIC
- Parti al H emol ysi s -Compl ete H emol ysi s -N O H emol ysi s A B D -S. Pneumoni ae
-V i ri dans Streptococci
- G reen Col or Tx = Tri methopri m Sul famethazol e (SX T) S. Pyogenes S. A gal acti ae
Enterococci (S. Mutans)
S. B ovi s - gut, col on cancer
Enterococcis B ovi s i n the B l ood, Cancer i n the Col on
Strep Pneumoniae Viridans S. Agalacitae S. Pyogenes
- grow s i n 6. 5% Sal i ne &
Bi l e
- N O T B i l e sol ubl e - B aci traci n R esi stant -B aci traci n Sensi ti ve
- B i l e Sol ubl e (test)
- O ptochi n R esi stant
- O ptochi n Sensi ti ve - N O Capsul e - N ormal col oni c Fl ora
- Col oni zes Vagi na - Col oni zes ski n and upper respi rat ory t ract mucosa.
- PEN ICILLIN G RESISTAN T*
- mc common - Facul at at i ve anerobe - Survi ves on hard surf aces;
t op 3 most common cause of Bact eri al M eni ngi t i s - D ental procedures cause V i ri dans to enter the bl ood - M ai nl y af f ect s babi es (part um t ransmi ssi on) - spread by f omi t es, respi rat ory dropl et s, and di rect cont act . - Vancomyci n Resi st ant Ent erococci --> nosocomi al
-- O
N pport
o vi rul
unience
st w i t hout capsul e. --> adhere to fi bri n-pl atel et aggregates; i n t he absence of speci f i c ant i body, - Requi res col oni zat i on & ski n t rauma - Col on mal s
' Bovi i gnanci
i n t heesBli ood,
ncrease RISKi n
Cancer ost he
St rept ococcus
Col on ' Bovi s
- “rust y” sput um
- Riopsoni
zators:
i on, recrui t ment , & phagocyt osi s do not -proceed;
Cont ai ns Superant i gen (aureus & pyogenes)
sk Fact
- O ropharyngeal mucosal col oni st /opport uni st . *acqui red by Cyst oscopy
Premat uri t y VIRULEN CE FACTO RS
- Transmi ssi on by respi rat ory dropl et s
- Lancet -Shaped D i pl ococci Strep Mutans Strep Sanguins M embrane rupt ure STRUCTURAL
M PRO TEIN - Ant i phagocyt i c adhesi n; Responsi bl e f or Post St rep Acut e ID : N egat i ve
N i t ri t e uri ne t est on di pst i ck
M at ernal S. Agal aci t ae carri age
- sepsi s i n si ckl e cel l di sease and spl enect omy. (compared t o G ram - Ent erobact er speci es produci ng posi t i ve)
F PRO TEIN - adherence
N ormal O ropharynx f l ora i nvol ved
i ni damaged
n: heart val ves, can cause: ID : H YALURO N IC ACID - i nhi bi t s phagocyt i c upt ake;
**M ost M common
EN IN Gcause
of n
: adul t s) D EN TAL CARIES SUBACUTE BACTERIAL EN D O CARD ITIS TREATM EN T
ITIS (i - screen pregnant w omen at 35-37 w eeks LIPO TEICH O IC ACID - Cyt ot oxi c Vancomyci n
PN EUM O N IA (i n adul t s) i f cul t ure i s + , t reat w i t h: FIM BRAE: at t achment and adherence
O TITIS M ED IA (i n chi l dren) IN TRAPARTUM AM PICILLIN / PEN ICILLIN
CLIN ICAL M AN IFESTATIO N bl San gui inn
i sth
=e h
bleart”
ood. (en
Thi nk, “there
ti s).i sSl. ots
sanof
PATH O G EN IC
SIN USITIS ood docardi gui ni s CLIN ICAL M AN IFESTATIO N
makes dextrans, whi ch bi nd to fi bri n-pl atel et *STREPTO LYSIN O - H emol yt i c & Cyt ol yt i c, bet a-hemol ysi n.
VIRULEN CE FACTO RS aggregates on damaged heart val ves. CLIN ICAL M AN IFESTATIO N S STREPTO LYSIN S - bet a-hemol ysi n
*PO LYSACH ARID E CAPSULE - reduces ef f ect i veness of compl ement & ant i bodiBACTEREM TRAN
es; SIENIA
T V i ri dans group strep l i ve i n the mouth because *PYRO G EN IC ERYTH RO G EN IC TO XIN S A & B - UTI
-promot es pro-i nf l ammat ory cyt oki nes IL-1, IL-2, IFN -γ, and TN F-α
-->TEASE decreases phagocyt
IgA, i c
al upt
l owake
they are resi stant of-the-chi n (op-to-chi n
IgA PRO - degrade i ng mucosal col oni zat i on; --> SH O CK
resi stant). PN EUM O N iIA n babi es BILIARY TRACT
D N ASESKIN
STREPTO & HASE
YALU
ARO N ID
and B - ASE - 'clspreadi
l yse ot s ng f act or' of N ecrot i zi ng Fasci cul i t i s IN FECTIO N S
M EN IN G ITISi n babi es
pl asmi nogen --> pl asmi n
ID : Capsul es are t yped by t he quel l ung react i on (apparent capsul ar sw el l i ng w hen SUBACUTE
mi xed w i t h t he speci f i c mat chi ng ant i body). G BS SEPSISi n babi es EN D O CARD ITIS
| SEQ UELAE
G R O U P b FO R bA B IES
G l omerul ar N ephri t i s & Rheumat i c H eart D i sease ' 40% B ILE '
TREATM EN T:
Peni ci l l i n i s Cl ass I M prot ei ns ext end t hrough t he cel l w al l ;
n fori rst
l i ne n i n peni ci l l i n al l ergy or resi st ance
Eryt hromyci Vancomyci --> Rheumat i c heart di sease
Cl ass-->II glM omerul
prot ei onephri
ns are tnot
i s. exposed on t he surf ace.
PREVEN TIO N
A. 7-val ent pol ysacchari de-prot ei n conj ugat e vacci ne (T-cel l dependent ) f or i nf ant s. ID Pharyngi t i s: rapi d ant i gen det ect i on RAD T t est w i t h cul t ure;
B. A 23-val ent pol ysacchari de vacci ne f or pat i ent s 65 years or ol der, aspl eni cs,
Al l ot her i nf ect i ons: cul t ure.
di abet i cs, H uman i mmunodef i ci ency vi rus (H IV) posi t i ve, CO PD , and so f ort h.
*ASO (Ant i body t o St rept ol ysi n O ) i s a marker of recent mucosal i nf ect i ons and
or rheumat i c heart di sease w hi ch i s cul t ure negat i ve.
Encapsul ated V i rul ent O rgani sms
CLIN ICAL M AN IFESTATIO N
Peni ci l l TREATM
i n f or EN T
Pharyngi ti s
*Some - Strep Pneumoni ae
K ave
i l l ers
-- K H lomoph
ebsi eli ll a
l uP
sneu
Inmon
i ae
most common cause of : H fl uen zae
Pretty - Pseudomonas O ri gi nosa CLIN ICAL M AN IFESTATIO N
i n i mmunocompromiNsed
i ce - N i sseri a Meni ngi ti s
M EN IN G ITIS & Capsul es - Cryptococcus N eoformi ns
adul t s
i n i mmunocompromi sed PYO G EN IC
PN EUM O N IA ' quel l i ng test '
' rust y sput um ' Soret hroat , H eadache, M al ai se;
PH ARYN G ITIS Purul ent
O TITIS i n chi l dren *mc cause of bact eri al pharyngi t i s
M ED IA (i n chi l dren)
IM PETIG O & Subcut aneous N odul es
SIN USITIS CELLULITIS - hi ghl y communi cabl e i n i nf ant s
TO X IG EN IC
Fever
Rash
SH O CK Shock
N ecrot i zi ng Fasci l i t i s = Ski n & subcut aneous t i ssue deat h
> 50% mort al i t y
FLESH EATIN G
N ecrot i zi ng Fasci l i t i s = Ski n & subcut aneous t i ssue deat h
PRO TERIES
Compl i cat i on of w hen st rai n i s Lysogeni zed
SCARLET FEVER
--> rash on chest w hi ch spreads t o ext remet i es;
IMMU N O LO G IC SEQ U ELA E
Eryt hrogeni c Toxi ns;
art hri t i s, cardi t i s, chorea, redness
Type II H ypersensi t i vt y react i on
RH EUM ATIC H EART D ISEASE --> our ant i bodi es at t ack heart val ves due t o
st ruct ural homol ogy of ant i geni c det ermi nant s
and t he H eart Ti ssue;
*causes H eart M urmur
St rept ol ysi ns S & O
PO STSTREPTO CO CCAL
G LO M ERULO N EPH RITIS Type III H ypersensi t i vi t y
(M -Prot ei n IgM compl ex i s causi ng t he damage);
*Syndenham Chorea
O TH ER *Joi nt Pai n
SEPTICEM IA
' l i cks the joi nts and bi tes the heart'

Bacilli / Rods
GRAM ( + )

Bacilli / Rods
GRAM ( + )
ID EN TIFICATIO N

EN DO SPO RE FO RMERS N O N -EN DO SPO RE FO RMI N G I RREGULAR SH APES

BACI LLUS CLO STRI DI UM Listeria Monocytogenes Erysipelothrix Cornyebacterium Mycobacterium fillamentous BRAN CH I N G RO DS
Aerobe Anaerobe Diphteria - acid fast
- N o Capsul e - Aerobi c
- **TUM BLIN G M O TILITY - Ani mal s and rot t i ng organi c mat eri al ; aerobe *V* - obligate aerobe N ocardia AntiN O myces
-Facul tati ve A naerobe -A naerobi c -20% deat h rat e - Traumat i c i mpl ant at i on.
-Catal ase (-) -Catal ase (-) - Ani mal Feces, Rot t i ng Veget at i on, and occasi onal l y i n
-Moti l e R ods -Chai n Formi ng Sof t Cheeses, del i meat s, and cabbage CUTAN EO US ERYSIPELO ID pri mari l y i n f i shmongers, but chers, and
-ACI D FAST -N O ACI D FAST
-- Chi l dren N
- O
N oCAPSU
LEl a
-Mostl y saprobi c (Scavenger whi ch feeds on dead ti ssue) --> Transmi t t ed by cont ami nat ed f ood vet eri nari ans. Cl ub-shaped, Chi nese charact er-l i ke cl ust ers. f l agel
-Source of anti bi oti cs O voi d subtermi nal spores (O ST) used for ??? - O ppurt uni st , requi ri ng compromi sed i mmune syst em - N on-M ot i l e - G row Sl ow l y
-aerobic -anaerobic
-SO IL - A s soon as Cl ostri di um i nfecti on i s suspected, A nti toxi ns must be El derl y & N ew borns --> D i pht heroi ds - Poor G ram-st ai ni ng
-Can survi ve for decades i n dry envi ronment; admi ni stered; -FACU
i nLTATIVE
INzat
TRACELLU
i on, wLAR
patpropel
hogen;s tt he
heybact
move f romdi rect
cel l l y
t oi nt
celol an
by - Respi rat ory D ropl et spread - Ubi qui t ous - Branchi ng, N onM ot i l e
act pol ymeri hi ch eri um
- Part of normal G I Fl ora VIRULEN CE FACTO RS - SO IL & WATER - N ormal O ral Fl ora
adj oi ni ng cel l w i t hout exposure t o ext racel l ul ar mi l i eu. WAXY CELL SURFACE - prevent s dest ruct i on by l ysosomes and - Tropi cal and subt ropi cal regi ons - most mi sdi agnosed di sease si nce i t l ooks so cl ose t o f ungus;
-Avoi ds humoral i mmune syst em
Bacillus Anthracis Bacillus Cereus Lactobacillus Clostridium Perfringens Clostridium Dificil Clostridium Tetani****** Clostridium Botulinum VIRULEN CE FACTO RS macrophages M exi co, Cent ral and Sout h Ameri ca, Af ri ca and Indi
- Found
a f ol l ow i ng t rauma and i nvade necrot i c t i ssue?
D IPH TH ERO TO XIN - EXO TO XIN (1) Pori n prot ei ns al l ow aqueous t ransport ; -O ppurt uni st requi ri ng i mmunocompromi sed
VIRULEN CE FACTO RS 2 part t oxi n – (2) Resi st s dryi ng 3 cl i ni cal present at i ons
VIRULEN CE FACTO RS – FO O D PO ISO N IN G 1-6 H O URS AFTER IN G ESTIO N ormaN Vagi nal bact eri a w hi ch -Spores i nt roduced by severe t rauma; - M aj or cause of nosocomi al D i arrhea TETAN US vi a Tet anospasm -SO IL & D UST -*O nl y G ram (+ ) Bact eri a t hat produces EN D O TO XIN * part B bi nds and i nduces endocyt osi s; (3) Al l ow s t he survi val of nont ubercul ous mycobact eri a i n soi l . N O CARD IA ASTERO ID ES 1. chroni ci t y, progress across t i ssue boundari es, mass l i ke
-*Resi st ant t o col d, heat , sal t , pH ext remes and bi l e; part A i nact i vat es El ongat i on f act or E2 ' Tubercul osi s-Li ke' but not cont agi ous 2. devel op si nus t ract , resol ve and recur
Survi ves w el l i n H eat --> N AUSEA & VO M ITTIN G produce Aci d and neut ral i ze 1-7 D ay i ncubat i on - 3-5 cays af t er cl i ndamyci n t reat ment ; -H eat resi st ant
-Abi l i t y t o repl i cat e i n t he cyt opl asm of cel l s af t er i nduci ng phagocyt osi s; --> *ARRESTS PRO TEIN SYN TH ESIS; D ue t o t hei r Aerobi c needs, G ranul oma i s f ormed t rappi ng t he bact eri a and 3. ref ract ory/rel apsi ng af t er a short course t herapy
PO LY-D G LUTAM IC ACID CAPSULE - prot ect s f rom phagocyt osi s by host or Fungi ; -O nl y af f ect s damaged/t raumat i zed t i ssue; -N ormal G I Fl ora
neut *O
rophi l sBact eri a w i t h D -G LUTAM ATE capsul e; --> WATERY D IAH RREA --> Sporul at i on ID : el i mi nat i ng oxygen suppl y; N O CARD IA BRASILIEN SIS
TO XIN VIRU
LEN CEoxiFACTO
n, biRS
- t. ranmi ssi on t hroughn ski nosomes VIRULEN
H eatCELabi
FACTO
nl y A, ent erot nds t o t he brush border of t he gut Tet anus Toxi n act s on Synapt Pre-Formed l e RS
Bot ul i num Toxi n (absorbed f rom G I) ID : Rapi d di agnost i c t est s usi ng ELISA avai l abl e Lof f l er' s M edi um Subcut aneous Ski n l esi ons ID : Fl uorescent M i croscopy
-Found i n nat ure, not abl y i n ri ce. VIRULEN CE FACTO RS TO XIN B, cyt ot oxi n, causes cyt oskel et al di srupt i on vi a act -->i n Bl ocks rel ease of i nhi bi t ory neurot ransmi t t ers, G ABA & gl yci ne f rom --> i nhi bi t s Acet yl chol i ne rel ease at N M J; Pseudomembrane and sw el l i ng of Pharynx ID : Zi ehl N eel sen St ai n
AN TH RAX TO XIN It germi nat es and produces Pre-Formed t oxi n i n LECITH IN ASE / ALFA TO XIN depol ymeri zat i on Renshaw cel l s i n spi nal cord. Condi ogi
t i ons, hi st ory ID : TB M edi a
TREATM EN T Serol cal assay
3 prot ei n component s: poorl y ref ri gerat ed cooked ri ce (especi al l y f ri ed). -- > breaks dow n Phosphol i pi ds --> pseudomembranous col i t i s Spores (babi es)
Prot ect i ve ant i gen (PA), --> M yonecrosi s --> di arrhea. Causes
Ampi ci l l i n and t ri met hopri msul f amet hoxazol e TREATM EN T A. I sraelii
*Edema f act or (EF) Increases cAM P Spast i c Paral ysi s TREATM EN T Prevent i on – past euri zat i on and cooki ng TREATM EN T Mycobacterium Tuberculosis Mycobacterium Leprae Mycobacterium Kansasii Sul f onami des
' that ri ce gave me some CER EU S D IA H R R EA Ant i t oxi n
Let hal f act or (LF) cl eaves M AP Ki nase ID i n bl ood or egg-yol k agar - O f t en 2° t o ant i bi ot i c use, especi al l y cl i ndamyci n or Triampi smus
ci l l (l
i n.ockj aw ), Tri val ent equi ne AN TITO XIN - D oes not respect borders, , grow s cont i guousl y i n t i ssue;
PA pl us LF produces l et hal t oxi n -> Ti ssue D eat h Ri sus sardoni cus (rai sed eyebrow s and open gri n) Peni ci l l i n or eryt hromyci n - Est i mat ed 1/3rd of w orl d popul at i on i s carryi ng; - Transmi ssi on by cont ami nat ed w at er; These opport uni st s cause respi rat ory di seases i n PELVIC D ISEASE assd w i t h IUCD (copper T)
PA pl us EF produces edema t oxi n -> Edema TREATM EN T TREATM EN T CLIN CAL M AN IFESTATIO N S Prevent ed by t oxoi d vacci ne seri es and boost ers - O nl y 5% i nf ect ed peopl e devel op cl i ni cal di sease; H ansen’ s baci l l us/H ansen’ s D i sease pat i ent s w i t h l ow CD 4+ count s such as acqui red i mmunodef i ci ency
Removal of dead t i ssue (*Pri ori t y) met roni dazol e or oral vancomyci n. - t et anus vacci ne. CLIN ICAL M AN IFESTATIO N S - Unt reat ed, t he di sease progresses sl ow l y; St ri ct pat hogen – has not been grow n on art i f i ci al medi a syndrome or t i ssue (AID
cul t ure
S) pat i ent s or pat i ent s on chemot herapy. They are LUM PY JAW =
Peni ci l l i n For recurrent cases, consi der repeat i ng pri ornregi men, f i daxomi ci n, or
- M aj ori t y of TB cases cont ai ned i n LUN G APEX *Sl ow est grow i ng of al l speci es not cont agi ous f rom person t o person and are acqui red f rom show ers or - Very sl ow -grow i ng drai ni ng abscess cont ai ni ng Puss
-Large, Bl ock-shaped rods;CLIN ICAL M AN IFESTATIO N S f ecal mi crobi ot a t ranspl ant . Treat ment
M EN IN G ITIS -InCSF
chi l dren, neonat es, & i mmune compromi sed
- Sl ow grow
reati ed,
ng, 60%
gradual l y al
sympt oms
e get w orse
M ul t i pl i es w i t hi n host cel l s i n l arge packet s cal l ed gl obidust .
-- Absent
mc Anglofe of Jaw
ant i t oxi n + /− vacci ne boost er, Bot ul i ni sm f rom ' H oney' Pl eocyt osi s - Unt mort i t y rat Causes l eprosy, a chroni c dii nt
sease t hat begi ns i n t he ski n and mucous puss --> N eopl asm
- ID by one or bot h t oxi ns i n st ool by PCR. D i azepam (f or muscl e spasms) - t ransmi t t ed by ai rborne respi rat ory dropl et s; membranes and progresses o nerves
FLO PPY BABY SYN D RO M E --> i ngest ed SPO RES germi nat e i n t he G I & produceGBot ASTRO
ul i num
EN TERITIS
-Ext remel y rare PN EUM O N IA-LIKE SYM PTO M S
Inhal
-->at Fl
i on
u-lofi ke
spores
sympt oms (6mo-2yr) --> ToxiPrognosi
G ood c i nf ectsi on SEPTECEM IA IN VIRULEN CE FACTO RS CLIN ICAL M AN IFESTATIO N S
Rapi d progressi on t o CLIN ICAL M AN IFESTATIO N S PREG N AN T WO M EN CO RD FACTO R - M ycol i c aci ds i n t he cel l w al l , CAUSE O F D ISEASE TREATM EN T
PULM O N ARY Fever, Ingest i on of Pre-Formed Tpxi ns t hi ck, ropel i ke ' serpent i ne' grow t h of Tubercul osi s
AN TH RAX Pul monary H emorrhage ' D ai ry Products' RESIRATO RY
iFO
O DULTS
PO ISO N IN G Respi al
rat nerve
ory paral
Pal ysi
'senti re fami l y gets deathy i l l ' M ycobact eri um w i t hout cord f act or w i l l N O T cause di sease CLIN ICAL M AN IFESTAITO N
D ISEASE Subt opi c 1
' Sul f ur G ranul es' buzzw ord
n AD Crani si es ' R ocket Tai l s'
H emorrhagi c Lymphadeni t i s
PSEUD O M EM BRAN ONUormal
G I Fl ora act i vat ed by Ant i bi ot i c
--> RD & Cyanosi s S --> Secret es an ent erot oxi n & Cyt ot oxi n D eat h ' Tumbl i ng' SULFATID ES - Inhi bi t s Phagol ysosome f usi on; ' Chroni c Pul monary D i sease oppurtuni st'
Wi deni ng of medi ast i num CO LITIS --> M aj or cause of nosocomi al D i arrhea PERIPH ERAL A unti e Lump-Jaw was sul ffuri ng wi th her IU D
N EURITIS
CUTAN EO USPai nl ess papul e surrounded by vesi cl es G ASTRO EN TERITIS CLIN ICAL M AN IFESTATIO N S Cl i ni cal t ubercul osi s di vi ded i nt o:
' Sul fur granul es '
AN TH RAX w i t h bl ack eschar;
*more common i n ani mal s, i n Pri mary TB = LUN G
2 st ages of di sease: - M i n Inf ect i ous dose i s 10 cel l s;
questi ons l ook for exposure to farm
1. Local Inf ect i on – - Phagocyt osed by al veol ar macrophages and mul t i pl y i nt racel l ul arl y;
ani mal s CLIN ICAL M AN IFESTATIO N S - Upper respi rat ory t ract Inf ect i on - Af t er 3-4 w eeks i mmune syst em at t acks, f ormi ng t ubercl es cont ai ni ng Caseat i ng G ranul oma;
- sore t hroat ,
Secondary TB = REACTIVATIO N
- nausea, vomi t i ng,
CELLULITIS - sw ol l en l ymph nodes; - If pat i ent doesn’ t recover f rom pri mary t ubercul osi s, react i vat i on of baci l l i can occur.
FASCIITIS bet a t oxi n-produci ng C. Perf ri ngens Type C D IPH TH ERIA - Pseudomembrane Format i on (can cause asphyxi at i on)
M YO N ECRO SIS
-f erment at i on of muscl e gl ycogen --> G AS D essi mat ed TB = Ubi qut uous
G AS G AN G REN E 2. D i pt herot oxi n product i on and t oxemi a t arget organs, pri mari
- Dl yuri
heart
ng secondary
and TB, baci l l i di ssemi nat e t o regi onal l ymph nodes, ki dneys, l ong bones, geni t al t ract ,
nerves; brai n, compl
These and meni
i cat nges.
i ons are grave.
al f a t oxi n-produci ng C. Perf ri ngens Type A
Tox+ C. di pht heri ae;
FO O D PO ISO N IN G -- D
Acut e Pai n
M ost cases occur i n non-i mmuni zed chi l dren l i vi ng i n Inadequat e nut ri t i on, D ebi l i t at i on of t he Immune Syst em, Poor access t o medi cal care, Lung D amage,
i arrhea crow ded, unsani t ary condi t i ons. and G enet i cs are al l predi sposi ng f act ors;
- qui ck recovery
Baci l l us very resi st ant ;
Corynebact eri um j ej enum causes i nf ect i ons vi a
crepi t us = crackl i ng noi ses of ski n IN FECTIO N cat
S het ers and f orei gn bodi es i n i mmunocompromi sed host s.
ID :
st ormy f erment at i on
' chi l dren, pharyngi ti s, gray pseudomembrane ' 3 Consecut
Low ensti ei
venoral sampl esumof sput um
Jensen M edi
' arrests protei n synthesi s EF2 ' X rays
D i rect i dent i f i cat i on of aci d-f ast baci l l i i n speci men
Cul t ural i sol at i on and bi ochemi cal t est i ng

TREATM EN T
6-24 mont hs of at l east 2 drugs f rom a l i st of 11
O ne pi
nel lbased
regi men
on at cal
l eded
Ri fbaci
at erl l (*i soni azi-G
d, ueri
*ri fnampi
Vacci t enuat i Cal met st rain,n pyrazi
of M . nami
bovi de)
s used i n ot her count ri es
Si de ef f ect of Isoni azi d i s neuropat hy;
In M ul t i D rug Resi st ant TB, must be resi st ance t o at l ease i sonazi de or Ri f ampi n;

CLIN ICAL M AN IFESTATIO N S

- Vi ol ent coughi ng
- G reeni sh or bl oody sput um,
- Fever,
- N i ght Sw eat s
TUBERCLES
- Anorexi a
G RAN ULO M A
--> CASEO US N ECRO- SIS
Fat i gue
granul omas consi st i ng of a cent ral core cont ai ni ng baci l l i surrounded by
WBCs;
--> Form Caseous l esi on heal ed by cal ci f i cat i on;

GRAM (-)
G RAM N EG ATIVE
- M ost are mot i l e by peri t ri chous f l agel l a --H ant i gens;
- Capsul e – K ant i gen (Vi f or Sal monel l a).
- Thi n pept i dogl ycan l ayer
- Pi l i - vari ous ant i gen t ypes, some encoded by pl asmi ds

EN D O TO XIN (LIPID A O F LPS) – O ant i gen;

- LPS i s composed of l i pi d A, core pol ysacchari de, and O -speci f i c pol ysacchari de.
- Li pi d -->
A = Act
Responsi bl of
e f compl
or Endot oxi ns
i vat i on ement , cyt oki ne rel ease, f ever, i mpai red organ perf usi on
& aci dosi s, hypot ensi on, SH O CK, deat h;
Ref erence l aborat ory ant i gens
O (l i pO pO l ysachari de)
H (FLAG ELLAH )
K (KAPSULE)

Comma Shaped
oxidase ( + )

Comma Shaped
oxidase ( + )
-Enterics-

Camylobacter J ejuni H elicobacter Pylori Vibrio Cholerae

42* C urease ( + ) A l kal i ne

Medi um
*most common cause of IN FLAM M ATO RY D IARRH EA i n devel oped count ri es; - M i croaerophi l i c
*most common cause of Food Borne Il l ness i n t he Uni t ed St at es; - Curved / Spi ral
- Facul t at i ve Anaerobe
- M i croaerophi l i c & *Thermophi l i c - Pol ar Fl agel l a
- Pol ar Fl agel l a
- H el i cal ' Seagul l -Wi nged' (grow s i n 42* C)
rapi
l ydt ransmi
corkscrew
- O ral t t edmovement - Asi an count rt i es
- M ot i l e w / Fl agel l a - 30% of popul at i on af f ect ed
-- H
Transmi ssi al
oni ti y
s f ecal -oral
i gh M ort
' rapi d dart i ng' uncommon i n chi l dren
- The i mmune syst em appears not t o rout i nel y el i mi nat e H . pyl ori . -- Found
i n w at er
- Ingest i on of cont ami nat ed *Poul t ry, Unpast euri ed M i l k, unsani t ary w at er;
H i ghl y sensi t i ve t o aci d --> (*hi gh i nf ect i ous dose necessary)
- < 1 yrs ol d & 15-24yrs --> Prot on pump i nhi bi t ors w i l l i ncrease chances of acqui ri ng pat hogen;
- 2-21 day durat i on Col oni zes gast ri c mucosa i n duodenum or esophagus;
- H . Pyl ori ' s M ucus l ayer coat causes Chroni c Inf l ammat i on; VIRULEN CE FACTO RS
VIRU
ALLEN
CE FACTO
D INRS si -eases
on;N onU–
i nvasi
w ve
butproduces
recrui t s and actai vat es i nf l ammat ory cel l s* CH O LERA
CYTO LETH D ISTEN G TO XIN (CD T) = nucl ease damages D N A & arrest s di viRel rease hi ch ammoni TO XIN - B Frag. Bi nds t o epi t hel i al cel l s of smal l i nt est i ne brush border mi crovi l l i ;
AD H ESIN S --> N eut ral i zes st omach aci di t y, f avori ng bact eri al mul t i pl i cat i on. A Fragment : Increases cAM Psby t urni
rolng
on&Stf li ui
mul at ory G Prot ei n;
G BS --> Ammoni a may al so cause i nj ury and pot ent i at es t he ef f ect s of a cyt ot oxi n --> di srupt el ect yt e d bal ance
--> H ypersecret i on of Bi carbonat e & Chl ori de;
produced by H . pyl ori .
CAM YLO BACTER JEJUN I - 80% --> Acut e Inf ect i on VIBRIO CH O LERAE
CAM YLO BACTER CO LI
Expl osi ve di arrhea
CAM YLO BACTER FETUS VIRULEN CE FACTO RS
--> 15-20 L/ day f l ui d l oss
UREASE
M UCIN ASEproduct i onect
- prot - s neut
H .ralPyl
i zes
ori Hi n
CLM ucosal cel l s --> M et abol i c Aci dosi s & H ypovol emi c shock
TREATM EN T VACUO LATIN G CYTO TO XIN - Epi t hel i al Cel l D amage
> 95% of i nf ect i ons cl ear up on t hei r ow n. CATALASE ( + ) - prevent s phagocyt i c ki l l i ng by neut ral i zi ng peroxi des VIBRIO PARAH AEM O LYTICUS
Fl ui ds Shart s (mi l d di arrhea)
Ant i di arrheal medi cat i ons; ID : (ELISA)
ID : TCBS (Thi osul f at e Ci t rat e Bi l e Sal t s Sucrose. . . Al kal i ne medi um)
If severe, - det eci t on of ant i gen i n st ool
M acrol i des (Eryt hromyci n & Azi t hromyci n) Urease t est , H i st ol ogy, Urea breat h t est (radi oact i ve carbon-l abel ed urea sw al TREATM l ow ed EN& T
Urease act i vi t y det ect ed)
3. Lab ID : D i agnosed by t he f i ndi ng of numerous dart i ng mi croorgani sms i n t he st- ool D etalect
ongi onw of
i t hHbl Pyl
oodori ant i gen i n st ool Prompt repl acement of f l ui ds and el ect rol yt es;
and excess neut rophi l s (i ndi cat i ng i nvasi on w i t h i nf l ammat i on). Proper t herapy reduces t he f at al i t y rat e f rom 60% t o 1%.
Tet racycl i ne shoul d be gi ven t o prevent t he pat i ent f rom i nf ect i ng ot hers;
i f ant i bi ot i cs not gi ven, pat i ent w i l l recover but w i l l shed organi sms f or as l ong as 1 year.
TREATM EN T
CLIN ICAL M AN IFESTATIO N Combi nat i on of a prot on pump i nhi bi t or (omeprazol e) +
Amoxi ci l l i n or Cl ari t hromyci n;
CLIN ICAL M AN IFESTATIO N
**most common cause i n D evel oped Count ri es
- Wat ery D i arrhea t hat can cont ai n Pus and Bl ood CLIN ICAL M AN IFESTATIO N
- Fever Abrubt onset of :
Int ense vomi t t i ng
- Abdomi nal pai n
IN FLAM M ATO RY CH O LERA Vol umi nous ' ri ce w at er' D i arrhea
- M yal gi a 70% of gast ri c ul cers are col oni zed by H . Pyl ori
D IARRH EA D eat h i n 2-3 days (i f no t reat ment )
Vi bri o Chol erae
-Ul cerat i on &on
Infofl ammat
M -Cel lory
l esi ons
patt ches)
o t he Jej enum, Il D
G
eum
ASTRITIS,
& EN
Col AL
on & Anorexi
Epi gast ari c pai n (somet i mes w i t h nausea & vomi t i ng)
- i nvasi (Peyers UOD
' Travel er' s D i arrhea' PEPTIC ULCERS Bel chi ng G ASTRO EN TERITIS
Vi bri o Parahaemol yt i cus
Pept i c ul cers are charact eri zed by burni ng epi gast ri c pai n l essened by
Asympt omat i c carri ers pri mari l y peopl e w ho are exposed t o Camyl obact er eat i ng; ' ri ce water di arrhea'
ASYM PTO M ATIC chroni cal l y;
M ost gast ri c adenocarci nomas and l ymphomas are concurrent ' sushi '
G ASTRIC
post vi ral sequel ae AD EN O CARCIN OwMi tAh or preceded by an i nf ect i on w i t h H . pyl ori
' Acut e, rapi d Symet t ri cal ascendi ng f l aci d paral ysi s (demyel i nat i ng)'
G UILLAIN -BARRE -Post vi ral i nf ect i on M ALT LYM PH O M A
SYN D RO M E (30%)
--> ICU! * (event ual respi rat ory muscl e paral ysi s)
l ow i nci dence
- due t o Immune response t o O AN TIG EN cross-react i ng w i t h peri pheral
pot ent i al sequel a nerve G angl i osi des;
SEPTICEM IA
' contact wi th farm ani mal s '
' CA MPyl obacter --> H O T CA MPFIR E '

GRAM ( -)
RO DS

RO DS
- Enterics-

Lactose Fermenters N O N Lactose Fermenters

'Pink on MacConkey' 'Clear on MacConkey'

O xi dase ( - ) O xi dase ( + )
FAST SLO W

Shigella Salmonella Yersinia Proteus PSEUDO MAN AS AERUGEN O SA

Klebsiella
- O xi dase ( + )
- Facul t at i ve Anaerobes
- Immot i l e; f ound i n t he col on and i n w at er
- M aj ori t y of N ormal G I Fl ora
- O pport uni st s; cause vent i l at or-associ at ed pneumoni as. - Fecal -O ral Transmi ssi on
Ri sk f act ors f or pneumoni a:
al cohol i sm;
compromi sed pul monary f unct i on.
VIRULEN CE FACTO RS
*CAPSULE - causes t he ' j el l y' sput um
Produce copi ous amount s of t hei r pol ysacchari de capsul e.
K. pneumoni ae and
K. oxyt oca
ID : ' currant j el l y sput um'
Chest X-Ray (si mi l ar t o TB)
TREATM EN T
3rd gen Cephal ospori n
CLIN ICAL M AN IFESTATO N
N O SO CO M IAL i n di abet i cs and al cohol i cs w hen aspi rat ed;
LO BAR PN EUM O N- IAD ark red “currant j el l y” sput um (bl ood/mucus).
N O SO CM IAL UTI
' Pneumoni a i n A l cohol i cs '
' Currant jel l y sputum'
4 A ’ s of K l ebsi el l A :
A spi rati on pneumoni a
A bscess i n l ungs and l i ver
A l-A
coh ol i cs
di
Escheria Coli Enterobacter Citrobacter Serratia
EN TERO BACTERICIAE Fami l y EN TERO BACTERICIAE Fami l y EN TERO BACTERICIAE Fami l y EN TERO BACTERICIAE Fami l y EN TERO BACTERICIAE Fami l y
oxidase ( - ) - AERobi c
EN TERO BACTERICIAE Fami- l Oy xi dase ( + ) EN TERO BACTERICIAE Fami l y EN TERO BACTERICIAE Fami l y EN TERO BACTERICIAE Fami l y - N O T normal Fl ora --> CO N TAM IN ATIO N - N O T normal Fl ora --> CO N TAM IN ATIO N - N O T normal Fl ora --> CO N TAM IN ATIO
- Facul
N t at i ve Anaerobes - N on-M ot i l e
- M ot i l e EN TERO BACTERICIAE Fami l y - Facul t at i ve Anaerobes - Facul t at i ve Anaerobes - Food, Fi nger, Feces t ransmi ssi on - Food, Fi nger, Feces t ransmi ssi on - Food, Fi nger, Feces t ransmi ssi on - G rape-l i ke odor
- M aj ori t y of N ormal G I Fl ora Prot eus - G reen bl ue sput um
- O ppurt uni st pat hogen - Facul t at i ve Anaerobes - Facul t at i ve Anaerobes - Facul t at i ve Anaerobes - Facul t at i ve Anaerobes M ost common i sol at es: P. mi rabi l i s. - Frequent l y i n f ound i n w at er (hot t ubs)
CLIN ICAL M AN IFESTATIO N
-- N
on-Mnot
ot i lproduce
e (no f lGagel
AS ll a)
i ke-->
N o Hl aant i gen
-- M
Survi
ot i lve
e i n M acrophages
- Transmi ssi on by pet f eces, cont ami nat ed mi l k or pork Cause uriurease,
nary t ract
makii nf
ngect
i ons
uri and
ne ofbact
eremi
pat i a.
- O ppurt
Cyst uni
st brosi s
- Facul t at i ve anaerobes BRS D oes sal monel Produce t he t he ent s of UT i nf ect i on w i t h i c Fi
- H umans are t he onl y reservoi r - TRAN SM ISSIO N : VIRULEN CE FACTO RS Prot eus al kal i ne, promot i ng st one f ormat i on by preci pi t at i ng M g and Ca. D i abet i cs
- Fecal -O ral rout e (ATM ) Fecal -O ral rout e (ATM ) i n Typhi Burn Vi ct i ms
-PILLI VIRULEN CE FACTO RS
a. G eneral charact eri st i cs
--> ' f eces f ood, f i ngers, f l i es ' Chi cken, meat , eggs, Exot i c ani mal pet i n Ent eri t i di t i s
(1) G ram-negat i ve rods t hat f erment gl ucose.
-IRO N CAPTURIN G ABILITY (ent erochel i n) - 3-5 w eek durat i on - Very di f f i cul t t o t reat
. - Invade M cel l s of t he l arge i nt est i ne / i l l eum and t hen move cel l t o cel l - 30% t o 50% M ort al i t y rat e, depends on preexi si t ng debi l i t at i on;
CLIN ICAL M AN IFESTATIO N
**EN TERO TO XIG EN IC E. CO LI --> Prof use D i arrhea(3) H ave ant i gens t hat may be used i n i dent i f i cat i on: O ant i gen (cel l vi a host cel l act i n; creat es ' shal l ow ul cerat i on' usual l y w i t hout CLIN ICAL M AN IFESTATIO N VIRULEN CE FACTO RS
- ' Travel er' s di arrhea' envel ope), H ant i gen bl oodstCel
ream i nvasi
Cel lon;
VIRU
atLEN
ed CE
- FACTO
avoi dsRS
EXO TO XIN A - Inact i vat es EF-2
l --> Encapsul Phagocyt osi s --> Inhi bi t s Prot ei n Synt hesi s
H EAT LABILE (LT-1) EN TERO TO XIN S (f l agel l a), K ant i gen (capsul e), Vi ant i gen (Sal monel l a t yphi capsul e), and
Adhesi ons – bot h f i mbri al and non-f i mbri al CAPSULE PO LYSACH ARID E SLIM E
i ncreases cAM P P ant i gen ACUTE D IARRH EA
VIRULEN CE FACTO RS Ent erot oxi n - may be i nvol ved i n gast roent eri t i s
Hcausi
ng i nt ense
(STa)prol
ENonged
hyper
EAT STABLE TERO TO XINsecret i on of chl ori de i ons. (pi l i ). - Type III secret i on Syst em aka ' i nj ect i some' --> di rect del i very of O ut er membrane prot ei ns - i nvol ved i n t he abi l i t y of Sal monel l a t o survi ve Ri ght l ow er abdomi nal pai n due t o mesent eri c adeni t i s and/or t ermi nal
PSEUD O APPEN D ICITIS TREATM EN T
Increases cG M P; TREATM EN T t oxi ns t o eukaryot i c host cel l . i nsi de macrophages i l ei t i s; Q ui nol ones
short onset ; st i mul at es f l ui d secret i on; poorl y i mmunogeniCephal c; ospori n - H i ghl y Aci d resi st ant --> onl y need f ew organi sms t o cause di sease; Fl agel l a – hel p bact eri a t o move t hrough i nt est i nal mucous Ami nogl ycosi des
i nhi bi t s t he reabsorpt i on of sodi um and chl ori de SH IG A TO XIN - Inact i vat es 60S Ri bosomes (Shi gel l os D ysent ry onl y) *af t er recovery, 3% remai n carri ers (G al l bl adder)
CO LO N IZATIO N FACTO RS (CFAs) f aci l i t at e t he at t achment of E. col i --> Cel l D eat h --> Bl oody D i arrhea
SALM O N ELLA EN TERITID IS
st rai ns t o i nt est i nal epi t hel i um. Usual l y are pi l i i n nat ure. CLIN ICAL M AN IFESTATIO N
M ILD i nf ect i on - di arrhea
Cl assi f i ed i nt o f our O ant i geni c groups: SEVERE i nf ect i on - bl oody darrhea
- most **EN
TEROstHrai
EMnOproduci
RRH AGng ICdiE.sease
CO LIi n -->
devel D
ysent ry &
common oped count ri H
es;US - Poul t ry, eggs, pet s, and t urt l es are common sources
- di st i ngui sh f rom t he rest by ' does not f erment sorbi t ol ' SH IG ELLA SO N N EI causes mi l d di sease; t he most common cause of - O nl y t reat i f sympt oms are sever CO RN EAL IN FECTTIOcont
N act l enses
SH IG A ' LIKE' TO XIN - Bi nd & di srupt 28S ri bosomes shi gel l osi s i n t he Uni t ed St at es. Chroni c Pneumoni a i n Cyst i c Fi brosi s pat i ent s
PN EUM O N IA
SALM O N ELLA TYPH IRIUM *V D i abet es
EN TERO PATH O G EN IC E. CO LI --> D i arrhea, Pedi at ri cs SHatIG
es.ELLA FLEXN ERI causes more severe di sease; common i n t he Uni t ed
V1 Causes
AN TIG EN = dVif rul
St t yphoi everence Ant i gen O TITIS EXTERN A i n sw i mmers
- pi l i are i nvol ved i n at t achment t o t he i nt est i nal mucosa. - bact eri a l eave t he i nt est i ne, mul t i pl y w i t hi n cel l s of t he ret i cul o-
- D est ruct i on of surf ace mi crovi l l i SH IG ELLA BO YD II causes more severe di sease; rarel y f ound i n t he Uni t ed endot hel i al syst em t hen re-ent er t he i nt est i ne, causi ng G I sympt oms. ; UTI
-St i mul at i on of i nt racel l ul ar cal ci um
St at es. - 10-14 day i ncubat i on
i n IV drug users
EN TERO IN VASIVE E. CO LI --> D ysent ry - may l ast f or several w eeks. O STEO M YELITIS
D i abet i cs
- i nvades i nt est i nal mucosa vi a PILI; SH IG ELLA D YSEN TRIAE causes t he most severe di sease; rarel y f ound i n - Cont ami nat ed Wat er
- O ut er membrane prot ei ns are i nvol ved i n di rect penet rat i on, i nvasi on of t he Uni t ed St at es, unl ess i mport ed Rapi dl y progressi ng necrot i c t i ssue l esi on caused by Pseudomonas
t he i nt est i nal cel l s, and dest ruct i on of t he i nt est i nal mucosa. *Shi ga Toxi n (H ECYTH YM A
Anteat
i bi-Labi
ot i cl e Prot ei n)--> D ysent ry
TREATM EN T are sel f -l i mi t i ng 2-5 days bact eremi a;
Tx = *most G AN G EN O SUM
- There i s l at eral movement of t he organi sm f rom one cel l t o adj acent (i n i mmunocompromi sed pat i ent s)
cel l s. Cef t ri axone
-beti cs Fl uoroqui nol one SEPSIS BURN WO UN D IN FECTIO N
EN TERO AG G REG ATIVE E. CO LI TREATM EN T
Encapsul ated V i rul ent O rgani sms
- mucosal damage adherence - Fl ui d & El ect rol yt e ID : i sol at ed i n M acConkey t hen di f f erent i at ed on H ext oan --> BLACK;
EAST (Ent eroaggregat i ve H eat St abl e Toxi n) - Fl oroqui nol ones, Chl orampheni col , Tet racycl i ne
secret i on of l arge amount s of mucus, and di arrhea. *Some - Strep Pneumoni ae
K i l l ers - K l ebsi el l a Pneumoni ae
ID : i sol at ed i n M acConkey t hen di f f erent i at ed on H ext oan --> CLIN
BLACK;ICAL M AN IFESTATIO N H ave - H omophi l l us Infl uenzae
ID : D i pt si ck N i t ri t e t est
Rapi d di agnosi s can be made usi ng PCR and D N A probes. PSEU D D OPneumoni aPretty - Pseudomonas O ri gi nosa
Napsu
i cel es - Cryptococcu
- N i sserisaNMen i ngi tins
-Fl ui TREATM
EN T f or i nt est i nal ' SA LMO N ELLESIS' Sepsi s C eoformi s
d repl acemnt
oti ti s Externa
- Cephal ospori n, Fl oroqui nol one f or Ext rai nt est i nal CLIN ICAL M AN IFESTATIO N Loose D i arrhea U TI ' grape l i ke order'
N ausea
D i abetes ' swi mmers ear'
Vomi t t i ng O steomyel' i green
ti s -bl ue' sputum'
CLIN ICAL M AN IFESTATIO N S ' SH IG ELLO S' 2-5 days
most Shi gel l a Peri t oni t i s - O ppurtuni st
*G ASTRO EN TERITIS Cysti c Fi brosi s
*D EH YD RATIO N D i arrhea - maj(eg.ori t y
si of
mplcases
e w atneed
noarrhea)
t herapy D i abeti cs
EN TER IC & Fever ery di B urn V i cti ms
WATERY D IARRH EA ELECTRO LYTE IM BALAND HCE
eadache some cases produce D YSEN TRY
i f f i cul t y Concent rat i ng Sal monel l a Ent eri di t i s
- nausea,
Sal monel l a Typhi muri um
- abdomi nal cramps l ess common & caused
- l ow -grade f ever f or 1-5 days by Shi gel l a D ysent rae: Rose Spot s on Abdomen
D IARRH EA
- more *Ent
mi l d t han
oxi chol
geni era
Const i pat i on f ol l ow ed by D i arrhea
erot c E. Col i H US 1.
= H emol yt i c Anemi a EN TERIC ' TYPH O ID ' Abdomi nal Pai n
Ent eroaggregat i ve E. Col i HREM
EM O
U ICLYTIC FEVER G radual Fever t hat progresses as t he day goes on
Ent eropat hogeni c E. Col i SYN D RO M E (H US) 2. Acut e Ki dney Fai l ure (Uremi a) *Bradycardi a
3. Low Pl at el et count (Thrombocyt openi a)
Sal monel l a Typhi muri um
BLO O D Ent
Y, eroi
M UCUSY, PU
veSSY
D IARRH EA
D YSEN TRY nvasi E. Col i
Sudden onset of abdomi nal pai n & cramps - H i gh remi t t ent Fever
Ent erohemorrhagi c E. Col i D i arrhea & f ever B Bl ood 1st w eek
D YSEN TRY - Li t t l e t o N o G I i nvol vement A
af t er 1 t o 4 days: Aggl ut i nat i on 2nd w eek
St ool s cont ai n mucus, pus, and occasi SEPTICEM
onal l y bl IA
- 5-10% of Sal monel l esi s
H EM O LYTIC H US 1.
= H emol yt i c Anemi a ood Sal monel l a Chol S St ool 3rd w eek
l a eraesui sU U
mc
any Sal monel ri ne 4t h w eek
UREM IC 2. Acut e Ki dney Fai l ure (Uremi a) ' SH IG ELLA SH R IV ELS you up'
SYN D RO M E (H US) 3. Low Pl at el et count (Thrombocyt openi a)
' food, fi ngers, fl i es, feces' ASM PTO M ATIC
Ent erohemorrhagi c E. Col i
O STEO M YELTIS
EX TR A -EN TER IC onl y i n Si ckl e Cel l D i sease*
rest i s St aph Aureus*
* most common cause of UTI
*UTI - f i mbrae
- Uri nary f requency, D ysuri a, H emat uri a, Pyuri a;
N EO N ATAL M EN IN G ITIS
capsul e
N O SO CM IAL IN FECTIOcapsul
NS e
SEPTICEM IA Li pi d A
EN TER O TO X IG EN IC E. CO LI
LA B ILE i n the A i r (l abi l e toxi n i nhi bi ts cA MP)
STA B LE on the G round (stabl e toxi n i nhi bi ts cG MP)

GRAM ( -)
Coccoid Rods

Coccoid Rods
-Respiratory-
Coccoi d =

H aemophilus *V* Bordetella Pertussis *V* Legionella Pneumophila

t op 3 most common cause of Bact eri al M eni ngi t i s - O bl i gat e Aerobe - Facul t at i ve Int racel l ul ar
- Young chi l dren (6mo - 6yr) mc af f ect ed - Respi rat ory dropl et t ransmi ssi on; H i ghl y Inf ect i ous - *Poorl y G ram st ai ni ng
- Facul t at i ve Anaerobe - St ri ct l y human pat hogen, pri mari l y i nf ant s & chi l dren - Respi rat ory D ropl et t ransmi ssi on onl y, grow s best i n WARM & WET;
- N on-M ot i l e, Pl eomorhi c, Short Rods - 7-10 day i ncubabat i on *Ai r-Condi t i oners
-- ASPLEN
TransmiIC t t ed vi a Respi
TS & rat
ory D ropl et s & sed
di retmost
cont at
act riwsk
/ secret i ons
-- N
M ai nl y af f ect
ve, sonl
chiyl dren & i nf ant s Whi rl Pool
PATIEN i mmune compromi on-Invasi Inf l ammat ory Sauna / M i Spas
st er
- Encapsul at ed - O pport uni st requi ri ng underl yi ng i l l ness / w eak i mmune syst em;
:) N O N CAPSULATED = H . PARAi nf l uenzae (N ormal Respi rat ory Fl ora) :) N osocomi al Inf ect i ons
:( CAPSULATED = H . Inf l uenzae (95%) Cause probl ems :( VIRULEN CE FACTO RS El derl y
FILAM EN TO US H AEM AG LUTIN (FH A) - Adherence t o respi rat ory mucosa Smokers & CO PD
VIRULEN CE FACTO RS Progressi ve dest ruct i on of Ci l i at ed cel l s - 15-75% M ort al i t y f or Legi onnai re' s D i sease
*PO LYSACCH ARID E CAPSULE (SERO TYPE B) - Ant i phagocyt i c *PERTUSSIS TO XIN - Exot oxi n causes l ocal t i ssue damage; - 2-10 day i ncubat i on
*IgA PRO TEASE nder)
- neut -ralShock
i zes mucosal IgA & at t achament *Increases cAMi mpares
P by di sabl i ng Gosi
i s;
(AD P-ri bosyl at es G i Prot ei n)
LIPID A (remi --> phagocyt VIRUEN CE FACTO RS
FIM BRAE - at t achment SECRETIO N SYSTEM
PSEUD O PO D - Phagocyt osi s IN TO M acrophage f or i nt racel l ul ar repl i cat i on;
H AEM O PH ILUS IN FLUEN ZIAE TYPE B ID : Sympt oms, t hen
- CAPSULE* *Bordet -G engou agar of N aso-Pharyngeal sw abs ID : Buf f ered Charcoal Yeast Agar BCYE
H AEM O PH ILUS D UCREYI - Cyst ei ne & Iron f or grow t h
- sexual l y t ransmi t t ed TREATM EN T Si l ver St ai n
TREATM EN T M acrol i de (50s) Ant i bi ot i cs: Azi t hromyci n * L. Pneumophi l i a Ant i gen
(t he onli y
n Pneumoni
Uri ne* c bact eri a w i t h uri ne ant i gen t est )
Cef t ri axone (f or meni ngi t i s) VACCIN E
amoxi ci l l i n-cl avul anat e D TP Vacci ne - ki l l ed bact eri al cel l suspensi on (conj ugat ed); TREATM EN T
Ri f ampi n (f or cl ose cont act s) 2-15 mont h M acrol i des (Eryt hromyci n)
Fl oroqui nol ones
VACCIN E D TaP (di pht heri a, t et anus, and acel l ul ar pert ussi s) has t hree pert ussi s
Capsul ar pol ysacchari de-prot ei n Conj ugat ed Vacci ne component s:
*onl y prot ect s agai nst H . Inf l uenzae Type B 2, 4, ers
andare
6 mont hsevery
and t hen agai n bet w een 4 and
CLIN 6 ICAL
years.M AN IFESTATIO N
Boost gi ven 10 years.
ID : Chocol at e AgaR (Fact or V & X)
At ypi cal Pneumoni a w / N on-Product i ve Cough
CLIN ICAL M AN IFESTATIO N LEG IO N AIRES D ISEASEM aj or Conf usi on
CLIN ICAL M AN IFESTATIO N S
(Severe Present at i on)D i arrhea
nosocomi al
Acutbegi
e t ns
racheobroncht i sdevel ops i nt o sever coughi ng over 1-4 w eeks;
ATYPICAL PN EUM O 15-75%
N IA4, 000 M deat
ort alhs
i ty
- Rapi dl y progressi ve mi l d, t hen per year i n US
- Permanent CN S def i ci t s (hydrocephal us, ment al ret ardat i on, and speech
BACTERIAL and heari ng probl ems) i n a t hi rd of t he cases. WH O O PIN G Cat arrhal St age - M i l d, Upper respi rat ory, l ow f ever PO N TIAC FEVER
M EN IN G ITIS CO UG H (M i l d Present at i on)Fever. . . . WITH O UT pneumoni a
Paroxysmal St age - Severe, Low er respi rat ory, H acki ng, (5-20/20sec)
i n unvacci nat ed*prevent ed by vacci nat i on Conval escent St age - Less severe, may persi st f or montWATERY hs
D IARRH EA
Capsul at ed Form
H . Inf l uenzae Type B ' cough on expi rat i on, w hoop on i nspi rat i on' H YPO N ATREM IA
EPIG LO TTITIS *prevent ed by vacci ne “100-day cough” Legi on:
i n unvacci nat ed H . Inf l uenzae Type B ASYM TO M ATIC mai
/ nl y i n young adul t s & adul t s Stumbl i ng D runks
M ILD Contami nated Water & A i r
PN EUM O N IA H . Inf l uenzae Type B D i arrhea i n the toi l ets;
SIN USITIS H . Inf l uenzae Type B
Lung Lovi ng Legi onel l a
Pai n
O TITIS M ED IA Redness
*N O T prevent ed by vacci ne
H . Inf l uenzae Type B
H . Parai nf l uenzae
PIN K EYE / Subt opi c 3
CO N JUCTIVITIS

G eni t al Ul cer f ormed by H . D ucreyi ;

CH AN CRO ID onl y B l ack Mi cro cul ture
PAIN FUL (unl i ke Syphyl i s) you cry wi th D ucreyi , but not wi th syphyl i s
STD
H aemophi l us D ucreyi
Infl uenze i s the i nvader
Some K i l l ers H ave Pretty

GRAM ( -)
Diplocci

N eisseria
- Aerobi c, Capnophi l i c
- N on-M ot i l e ' Ki dney Shaped' D i pl occi
- Col oni zes Upper Respi rat ory t ract & G eni t ouri nary t ract ;

VIRUEN CE FACTO RS
IgA PRO TEASE
CELL M EM BRAN E PRO TEIN S
ID : Thayer-M art i n M edi um (Chocol at e Agar + Vancomyci n (i nhi bi t s G ram
+ , Col i st i n (i nhi bi t s G ram -), N yst at i n (i nhi bi t s Fungi ) & Tri met hopri m;

G LU CO SE MA LTO SE & G LU CO SE

FER MEN TER FER MEN TER

N eisseria MeninGococci
t op 3 most common cause of Bact eri al M eni ngi t i s (al l ages)
- Col oni zes N asopharynx
- Respi rat ory dropl et & O ral t ransmi ssi on
- About 10% of heal t hy peopl e are carri ers w ho have suf f i ci ent i mmuni t y t o
-bl O
ock di sease
uni st but
st i l l have mucosal col oni zat i on.
pport Pat hogen
young chi l dren & t rauma vi ct i ms
- 25% M ort al i t y

PATH O G EN ESIS
N M bi nds t o nonci l i at ed mucosal cel l s w i t h pi l i and t hen passes t hrough t he
mucosa i nt o t he submucosa and event ual l y i nt o t he bl oodst ream;
--> D i ssemi natsed,
i on organi sms di ssemi nat e t o most t i ssues (especi al l y t he
In i mmunocompromi
ski n, meni nges, j oi nt s, eyes, and l ungs)
--> Causes permanent CN S def i ci t s, ski n necrosi s, sei zures, deaf ness;
N eisseria Gonococci
VIRULEN CE FACTO RS
PO LYSACCH ARID E CAPSULE - Ant i phagocyt i c (al l ow s survi val i n t he bl ood)
- Sexual l y or Peri nat al l y Transmi t t ed
PILI
- O xi dase ( + )
CELL M EM BRAN E PRO TEIN S - Inf l ammat i on
- D i pl ococcus w i t h a ‘ ‘ pai red ki dney bean’ ’ morphol ogy
- Somet i mes Int racel l ul ar af t er phagocyt osi s ID :
Kerni g si gn
VIRULEN CE FACTO RS Burzi nski Si gn
PILI - cause adherence t o mucus membranes:
Cervi x (cervi ci t ti is)s) oror vagi
penina
s ii n
n tt he
he mal
f emal
e e
PREVEN TIO N
Uret hra (uret hri
Vacci ne
*Pi l i al so show ant i geni c vari at i on, causi ng recurri ng epi sodes
TREATM EN T
AN TIBIO TIC RESISITAN CE: Cet ri axone
1. Pl asmi d-encoded bet a-l act amase product i on H i gh-D ose IV peni ci l l i n (passes t hrough t he i nf l amed bl ood–brai n barri er)
2. Chromosomal l y-medi at ed changes i n cel l ul ar permeabi l i t y i nhi bi t ent ry of +
peni ci l l i ns, t et racycl i ne, eryt hromyci n, ami nogl ycosi des; Ri f ampi n t o eradi cat e oropharyngeal col oni zat i on & use i n i mmunocompromi sed
TREATM EN T cl ose cont act s;
- Immedi at e syst emi c cef t ri axone and l avage i s needed t o prevent l oss of
eyesi ght .
- Prophyl axi s w i t h eryt hromyci n or si l ver ni t rat e prevent s neonat al t ransmi CLIN
ssi on;ICAL M AN IFESTATIO N S
- Azi t hromyci n i f new born i s coi nf ect ed w i t h Chl amydi a
- Sl appi ng t he peni s (' t he cl ap' ). . . . N o l onger t he t reat ment ;
begi ns as mi l d pharyngi t i s + occasi onal f ever
WATERH O USE-FRIED RICH SEN SYN D H Adrenal
M E IN
ROemorrhage= suf f i ci ency
CLIN ICAL M AN IFESTATIO N S M enni ngococcemi a = di ssemi nat ed Ci
di rcul
sease
at ory Shock
Purul ent M eni ngi t i s
Uret hri t i s
Fever
Cervi ci t i s MEN IN G ITIS Pneumoni a
Sal pi ngi t i s
Pel vi ict iInf St i f f N eck
Proct s l ammat ory D i sease *FATAL IN 1-5 D AYS
Creamy Purul ent D i scharge

* Chroni c exposure can cause st eri l i t y i n bot h sexes

* O FTEN ASYM PTO M ATIC IN WO M EN
G O N O R R H O EA E / H EMMO R H A G IC PU R PU R IC
U R O G EN ITA L
CU TA N EO U S SK IN R A SHdue t o overproduct i on of capsul e (cont ai ni ng LPS)
IN FLA MMA TO R Y D ISEA SE

Meni ngi ti s + Ski n R ash K i dney shaped di pl ococci

V IR U LEN T EN CA PSU LA TED B A CTER IA
Some - Strep Pneumoni ae
K i l l ers - K l ebsi el l a Pneumoni ae
Acqui red duri ng bi rt h
- Sympt oms st art 2 t o 5 days af t er bi rt h H ave
Pretty -- H omoph
Pseu i l las
domon usOIn
riflgiuenzae
nosa
- Eyes are purul ent (hyperpurul ent ) w i t h pus reaccumul at i ng w i t hi n *N i ce - N i sseri a Meni ngi ti s
mi nut es of l avage. Capsul es - Cryptococcus N eoformi ns
- Eyesi ght i s rapi dl y dest royed f rom apparent pressure necrosi s of t he
corneal surf aces due t o t he rapi d accumul at i on of pus under t he eyel i d.
*N eonat es may be coi nf ect ed w i t h Chl amydi a, w hi ch i s more common.

N EO N A TA L
CO N JU CTIV IS

R EA CTIV E / R EITER S D i ssemi nat ed di sease

A R TH R ITIS
+
N ECR O TIC SK IN LESIO NType
S III H ypersensi t i vi t y React i on
FITZ-H UG H -CURTIS SYN D iRO
nf ect
M Ei on of t he l i ver capsul e and “vi ol i n st ri ng” adhesi ons of peri t oneum t o l i ver
K i dney shaped di pl ococci

GRAM ( -)
ZO O N O TI C

ZO O N O TI C

B artonel l a B rucel l a Franci sel l a Pasteurel l a

Subt opi c 1 Subt opi c 1 Subt opi c 1 Subt opi c 1

CLIN ICAL M AN IFESTATIO NCLIN ICAL M AN IFESTATIOCLIN

N ICAL M AN IFESTATIO CLIN
N ICAL M AN IFESTATIO N

CAT SCRATCH
D ISEASE

GRAM ( -)
ATYPI CAL
BACTERI A
doxycycline

ATYPI CAL
BACTERI A

RI CKETTSI ACEAE FAMI LY

- O BLIG ATE Int racel l ul ar repl i cat i on
- Zoonot i c Inf ect i on
- Thi n Cel l w al l STAIN LY WEAKLY and
has onl y smal l amount s of LPS
*N O TO XIN S O R IM M UN O PATH O LO G Y;
Abrupt f ever, chi l l s & unremi t t i ng headache
ID : G i emsa St ai n
*w i l l not show up on G ram St ai n
TREATM EN T
D oxycycl i ne

RI CKETTSI A
( common)
D i e qui ckl y out si de of host
- Transmi ssi on by Vect or (f l eas, t i cks, mi t es, l i ce)
- Requi res ATP and act i ve process t o ent er host cel l

CLIN ICAL M AN IFESTATIO N

H eadache
Fever
Fl u-Li ke Sympt oms
Rash t hatand
st spreads
art s at tworit runk,
st s and
palanl
kes
ms and sol es;
*RO CKY M O UN TAIN
SPO TTED FEVER < 19, t ransmi t t ed by Ti ck Bi t e
Ri cket t si a Ri cket si i
Ri cket si i

Rash st art s cent ral l y and spreads out ,

except f ace, pal ms, sol es;
Sever
TYPH US
Typhi