TOXINS

CHAPTER 1  Proteins released by gram pos and neg bacteria

Blue: Gram positive (has techoic acid-antigen determinant)  Divided into endo and exotoxins
Red: Gram negative  Vibrio cholerae: Diarrhea-> Dehydration (for around a
Outer: Peptidogylcan week)-> Hypovolemic shock
Inner: Transpeptidase  SHort urethra in females may lead to UTI brought
about by escherichia coli
Serologic exam: You have to give blood  Respiratory anthrax (Iraq, Ilocos Norte) very
contagious
Lipopolysaccharide  Botulism: Food poisoning (by the botulinum toxin)
1. Outer carb chain  Tetanus (search for the bacteria of origin)
2. Center: Water soluble core poly  Neurotoxins: Result to paralysis 
3. Interior: Lipid A (disaccharide)- toxic to humans (also
known as the gram negative toxin) Structure and Classification of Bacteria

MORPHO DIFFERENCES a. Does not have a membrane-bound nucleus, the DNA is

a. Circular: (+) -coccus; (-) eria in the cytoplasm (nucleoid)
b. Rod b. Has a flexible cell wall that protects it from physical
c. Spiral: (+) None; (-) Borrelia, Leptospira, etc.  damage
c. Has a flagellum that helps it move
Aerobic versus anaerobic d. Has two types of DNA:
i. Chromosomal: Contains most of its genetic
Facultative Intracellular Organisms information
Legionella: from aircon  ii. Plasmid: Contains information to fight
Mycobacterium: TB antibiotics, protection to toxins and tolerance to
toxic environments
Bacteria:  b. Has the ribosome for protein synthesis
Existed for 3.5 billion years c. Has pili to aid in the adhesion to organs
Responsible for diseases such as cholera, tuberculosis, and d. Slime: secreted by some bacteria to protect it from
the plague immune attack
Unicellular prokaryotes that are smaller than plant and animal e. Spores: For long term survival (i.e. non sporing
cells bacteria, sporing bacteria-can regrow)
Can be found anywhere on earth (even in inhospitable places)
therefore they come in all shapes and sizes Mycobacterial cell wall found in ____ and ____ (TB).
Good bacteria comprise 
Classification of Bacteria
 *acythromicine- sore throat
By cell shape *S. Pneumonia- pneumonia in adults versus S agalactieae-
1. Capsulated versus non capsulated pneumonia in babies
2. Lypopolysaccharide *what bacteria causes gas gangrene
*request for THREE stool exams to check for salmonella,
Pili e.g. E coli (UTI) shigella, escherichia, proteus
Gonoccocus-> Neisseria gonorrhoeae Community acquired versus hospital acquired
*Legionella phenophilia (through aircon systems) let the janitor
Bacteriophages: Viruses that live in bacteria open the aircon lol; pool water-> diarrhea

Classified according to: Bactericidal- kills the growth

a. Gram reaction Bacteriostatic- inhibits the growth
*Acid fast staining for TB bacteria X gram staining
b. Cell shape
b. Endospore CHAPTER 2
b. Fastidiousness Innate Immunity and Normal Flora
b. Serologic reactions  Lysozyme in tears which kills gram positive bacteria
b. Key enzymes (sayang luha mo ghorl)
b. DNA sequence  Cilia in the nose to prevent organisms from passing
*16S ribosomal RNA- through blood exam through
 Fatty acids
Groups of Bacteria  Flushing action of urinary flow
1. Gram + cocci  Low vaginal pH (ave: 4.5-5.5) will  result to vaginitis
2. Gram - cocci
3. Gram - coccobacilli EXAM: What comprise the innate immune system
4. Gram + bacilli  Toll-like receptors- triggers the phagocytic cells put
5. Spiral bacteria them in the spleen (graveyard of the body)
 Narrow spectrum antibiotic (?)
*Colonizes-> multiply
*Helicobacter pylori causes gastric cancer (goodness) Physical and Chemical Barriers
*Leptospira enters intact skin (OMG) a. Skin: Secreted sebum and fatty acids to inhibit
*Mycoplasma pneumoniae and something else causes bacterial growth
pneumonia (request for sputum exam) i. Through bit of a vector i.e. dengue mosquito
*Chlamydia-> what antibiotic ii. Through invasion of intact skin i.e. leptospirosis
*Rickettsia ___, ricketssia ___, and rickettsia iii. Upper respiratory tract i.e. Streptococcal
*Clostridium difficile- pseudomembranous colitis pneumoniae
 iv. Through intravenous cannulation (IV) hepa B or
HIV can be transmitted CHAPTER 3
v. Through disease or burns in the skin i.e.
Streptococcus pyogenes (pyo- nana) a. Pathogenic versus non pathogenic (will not cause a
b. Mucociliary clearance mechanisms disease)
i. Air is humidified and warmed by passing the b. Commensal: part of the normal flora
turbinate bones (dont cut your f-ing nose hair) c. Pathogenicity is the ability to cause a disease
ii. Sticky mucus (>nanometer): tract is sterile d. Virulence is the ability to cause severe disease
below the carina e. Obligate pathogens: Always associated with disease
iii. <5 nanometer  f. Opportunistic pathogen: Causes infection when the
b. Secreted antibacterial compounds host defenses are compromised i.e. Pneumocytis
i. Sticky mucus jirovecci in people with HIV
ii. Covid moms can breastfeed babies because
lactoferrin and lactoperoxidase can interfere *No antibiotic will eradicate the antigen/antibody
with the transfer of the virus
b. Gastric acid
Mechanism of Pathogenicity
i. Acids suppress the risk of intestinal infection
a. Access to a vulnerable host-transmission
b. Urinary Flushing
i. Most respiratory pathogens are transmitted
i. Deliks and bukana ny urethra (always sterilize)
through droplets
ii. Obstruction will result in the pee to go back and
ii. Fecal-oral route: Vomiting and diarrhea
will result to urinary infection
associated organisms
b. Phagocytosis
b. Attachment to the host
c. Complement and other plasma proteins
i. Neisseria gonorrhoeae using fimbriae
i. Chemotaxis (at the site of the infection);
ii. Bacterial biofilms (yuck)
(Opsonization) stimulates the phagocytosis of
b. Invasion
the bacteria
ii. Mannose binding protein by E. coli and C.
______
CHAPTER 4 
*Two tests for Covid: Rapid test- positive antibody IgG and
IgM; PCR (?) more accurate but more expensive Motility
*There are four species of plasmodium (very impt to ident the  Non motile mutants are less virulent
correct organism that causes the infection to know the right  V. cholerae is motile d/t its flagellum 
antibiotic)

CHAPTER 5 Immune Evasion

 SIDE EFFECTS
Damaging the Host Toxins a. GIT
 One tablespoon of sputum b. Cutaneous
 Use special stains (giemsa stain) be sure patient is at c. Hematopoietic system
the height of fever for a malarial smear d. Renal system: X aminoglycoside and tetracylcine
 Tatlong stool exam for cholera (V. cholerae) e. Macrolides: X to pregnant women; Azythromycin
 Contact tracing for people with meningococcal f. Streptogramins
meningitis g. Oxazolidinones
h. Metronidazole: active against all anaerobic organisms,
Susceptibility testing also some species of protozoa
 Resistant: antibiotic will fail; moderately resistant will i.
respond to a larger dose 
 Thrice a day for seven days; then ask for a lab *Cefotaxime- a type of Cephalosporin
*Moxyfloxacin
Serology
 For organisms that are difficult to grow e.g. HIV or CHAPTER 6 The Laboratory Investigation of Infection
Hepatitis
A. Transformation
Molecular Techniques B. Conjugation
a. Nucleic acid amplification tests (NAAT): can detect a. Transfer of DNA matierials in the plasmid of
slow growing microorganisms one bacteria to another
B. Transposons/Integrons
Antibacterial therapy C. Multiple resistance
*Therapeutic index a. Integrons- only in gram neg
 Aminoglycoside: dangerous, can cause problems in the b.
kidney and hearing CHAPTER 7
Resiststance to antibacterial agents
Severity 
History of allergy: May limit the choice of antibiotic *Viral: symptoms for 24hrs; Bacterial: more than 24 hours
Likelihood of unwanted effects *Azythromycin (for upper respiratory tract infection; Covid
patients however do not have phlegm)
ROUTES OF ADMINISTRATION

MONITORING THERAPY
 Pharmacokinetics: know the action and side effects CHAPTER 8
 A. Endogenous Surveillance system
a. From the host’s flora  Notifications and systems allow an outbreak to be
b. Peritonitis detected (by the hopsital epidemiologist)
c. S. aureus if inoculated in a surgical wound
d. Surgery and skin cannulation can allow skin Typing
organisms to invade (therefore gloves are very
important, limited traffic of people in the OR)
B. Exogenous Chapter 10
a. From an outside source Food
b. Through direct contact: Droplets (most common -          Bacterimia versus septicimia
means of transmission), food, person-person -          Bacterimia-blood only; septicimia- all systems
transmission -          Food is centrally prepared in hospitals
c. Survival transmission  
1. Airborne: Infection may occur when a Air Supply
person inhales the infected droplets -          Supplied through a theatre air supply
2. Fecal-oral e.g. Salmonella -          Badly maintained air conditioning system may be a
D. Parental/Transcutaneous e.g. schistosoma source of legionella
(what bacteria can be found in   
those snails?); through injections/IV cannulae Fomites
(48hrs at the most) -          Trashcan- important to put plastic and use gloves
E. Vector borne e.g. dengue mosquito -          Trashcan beside the doctor
F. Sexual intercourse  
Water supply
-          Legionella
CHAPTER 9  
Ischemia
Principles of Infection Control -          Turning Is important every two hours
 Identifying an outbreak: should be recognized by  
clinical awareness (identification of signs and Chapter 11
symptoms) and effective lab diagnosis to confirm Medical activities
 Screening and diagnostic: necessary to make a lab  
diagnosis to prevent its transmission A.      IV access
 Sample should be sent to a reference lab a.       48 hrs for IV; if more than 48 hrs,
 Identification of the organism to recognize key mamamaga ang pinaginsertan i.e. Staph
pathogens aureus
 b.      Signs of inflammation: redness, swelling,
etc.
c.       No dead space when inserting an IV
d.      Canula site should be regularly inspected
e.      NGT lines every 48 hrs; central and tunnel
line should be changed when there are signs of
inflammation; wag hintayin lagnatin ang patient
B.      Urinary catheters
a.       Infection should be minimized by due
aseptic techniques
C.      Respiratory
a.       Do deep breathing exercises/
diaphragmatic breathing to prevent hypostatic
pneumonia
b.      Turning the patient side to side every 2 hrs
c.       Diet from oral fluids to soft diet to tolerable
fluid
d.      Incline patient to reduce chances i=of
aspiration pneumonia
D.      Surgery
a.       X gauze para madaling matuyo andg gasa
b.      Post-operative ischemia
c.       Major surgery- more high risk to infection
d.      Pre-op perio should be short; elective
surgery must be postponed if infection is
present
e.      Sa labas magobserve through the TV cam
f.        Staff movement should be limited
g.       Surgical suit prior to the surgery
h.      Pre op care- antibiotic prior to surgery:
should be bactericidal enough
 
Chapter 12
Type 1, Type 2 coronavirus-> covid (systemic disease)
1.       New pathogen i.e. covid 19
2.       Established pathogens invading new territories
3.       Re-emergence of a previously controlled organism
 
a.       Pandemic- worldwide disease
b.      Endemic- disease that is constantly present in the
community (all seasons)
c.       Epidemic- large number of individuals for a short period of
time e.g. dengue
d.      Sporadic- disease that occurs occasionally e.g. bird flu
Bioterrorism
Smallpox (Edward Jenner- discovered the smallpox
vaccine)
a.       Tularemia
b.      Plague caused by ____ (classified as pneumonic i.e. In
India)
c.       Viral hemorrhagic fever by the Aedes mosquito
*Syria? Yemen? Chemical and biological warfare
 
CHAPTER 13
Staphylococcus
-          Part of the normal flora of the skin
-          Has an enzyme catalase
-          Few species are pathogenic
-          Staphylococcus aureus is the most invasive species
 
A.      Staph. Aureus
a.       Also found in the vagina
b.      Causes impetigo (galis aso-wag tuklapin
magccause ng scar), secondary skin infection,
pneumonia (rare)
c.       Endocarditis- rapid and destructive if IV
has been passed fromone person to another
d.      Treatment: Penicillin, Flucloxacillin
e.      Patients should be isolated with diseases
like boils e.g. prisoners, treatment: topical med
f.        Coagulase-positive
B.      Staph. Epidermidis
 a.       Part of the normal flora a.       E. faecalis and E. faecium
b.      Coagulase-negative b.      Causes UTI, wound infection
c.       Can cause nosocomial infections c.       Treatment: Ampicillin, amoxicillin (primary)
d.      Signs: Discharge from a wound d.      Occasionally treated with Daptomycin
e.      Treatment: Antibiotics such as Vancomycin *Memorize them
and Teicoplanin
C.      Staph. Saprophyticus
a.       Most common cause of UTI in young Chapter 15
women A.      Strep. Pneumoniae
b.      Coagulase-negative a.       Lancet-shaped
c.       Treatment: Penicillin b.      Has a polysaccharide capsule
d.      Resistant to Novobiocin c.       Has damaging enzymes: Neuraminidase,
D.      Streptococcal infections hyaluronidase
a.       Gram positive but in chain or pair parang d.      May be present in smokers
rosary e.      Can cause otitis media, and community-
b.      Requires rich blood acquired pneumonia
c.       Staph. pyogenes f.        Penicillin; if allergic to penicillin,
                                                               i.      In the erythromycin
pharynx B.      Alpha-haemolytic streptococci
                                                             ii.      Causes a.       Part of the normal GIT flora
sore throat, pharyngitis, skin infection- b.      Gingivitis, dental infection, brain or liver
erysipelas, impetigo, folliculitis), scarlet abscess
fever, toxic shock syndrome, rheumatic c.       Treatment: Penicillin only
fever, and glomerulonephritis (can C.      Other
cause renal failure) a.       Alloiococcus otitidis
                                                            iii.      Spread b.      Leuconostoc and pediococcus
through aerosol and direct contact; can c.       Streptococcus pseudoneumoniae: Causes
be contagious emphysema or COPD
                                                           iv.      Treatment:
Amoxicillin
Chapter 16
E.       Streptococcus agalactiae A.      Listeria
a.       Causes neonatal diseases: meningitis, a.       Gram positive
sepsis, pneumonia b.      Facultative anaerobe
b.      Treatment: Penicillin, aminoglycoside, c.       Found in animals feces
perinatal penicillin (IV) d.      Causes infection when contaminated food
F.       Enterococcus species e.      Lysteria monocytogenes (meningitis in
children)
 f.        Treatment: Ampicillin
g.       Effective: Psycrophyllic bacteria can live in
the refrigerator
B.      Corynebacterium
a.       Diphtheria: With pus
b.      Will give treatment to everyone in contact
c.       Given deep IM (given at the lateral aspect
of the thigh in children)- vaccine DPT
C.      Mycobacterium
a.       Rod-shape
b.      Acid-fast organism
c.       M. tuberculosis: remember the three
treatment drugs
d.      M. leprae: Undifferenciated: Rifampin,
Dapsone
e.      Hospital for leprosy patients
D.      Environmental mycobacteria
E.       Bacillus
a.       Two pathogenic species: B. anthracis by
anthrax (Ph Post Office- case of pulmonary
anthrax); B. cereus: sa kakanin sa Bohol,
produces heat-stable toxin, causes NVD
(nausea, vomiting, diarrhea)