Professional Documents
Culture Documents
Concise Notes in Micro-Para
Concise Notes in Micro-Para
PARASITOLOGY
GRAM-POSITIVE COCCI
GRAM-STAIN OTHER FEATURES ORGANISM
Catalase-positive ENCAPSULATED BACTERIA
Staphyloccus aureus - capsules serve as an antiphagocytic virulence factor
Coagulase-positive
Catalase-positive - are opsonized, and then cleared by spleen
Gram Positive Cocci Coagulase-negative Staphyloccus epidermidis - Asplenics have Ü opsonizing ability and thus Û risk for severe infections
- Give S. pneumoniae, H. influenzae, N. meningitidis vaccines
in Clusters Novobiocin-sensitive
Catalase-positive
Some Killers Have Pretty Nice, Elegant, Shiny Bodies
Coagulase-negative Staphyloccus saprophyticus
Novobiocin-resistant Streptococcus pneumoniae
Klebsiella pneumoniae
Haemophilus Influenzae type B
GRAM-STAIN OTHER FEATURES ORGANISM
Catalase-negative Pseudomonas aeruginosa
Alpha-hemolytic Streptococcus pneumoniae Neisseria meningitidis
Bile-optochin-sensitive Escherichia coli
Catalase-negative Salmonella typhi
Alpha-hemolytic Viridans streptococci
Group B Strep
Bile-optochin-resistant
Gram Positive Cocci Catalase-negative Streptococcus pyogenes
in Chains Beta-hemolytic (Group A Beta Hemolytic Streptococcus
Bacitracin-sensitive / GABHS)
CATALASE-POSITIVE ORGANISMS
Catalase-negative - Catalase degrades H2O2 into H2O and bubbles of O2 before it can be
Streptococcus agalactiae converted to microbicidal products by the enzyme myeloperoxidase
Beta-hemolytic
(Group B Streptococcus / GBS)
Bacitracin-resistant - People with chronic granulomatous disease (NADPH oxidase deficiency)
Catalase-negative have recurrent infections with certain catalase-positive organisms
Group D Streptoccocci
Gamma-hemolytic
PLACES NBSH
Pseudomonas
GRAM-POSITIVE BACILLI Listeria
GRAM-STAIN O2 UTILIZATION OTHER FEATURES ORGANISM
Aspergillus
Non-motile
Candida
Box-car-shaped Bacillus anthracis
Aerobic Medusa head E. coli
Motile Staphylococci
Bacillus cereus Nocardia
Reheated Fried Rice
Spore-forming Drumstick-, tennis B. cepacia
gram-positive racket-, or lollipop- Clostridium tetani Serratia
rods like H. pylori
Bulging cans Clostridium botulinum
Anaerobic
Lecithinase
Double hemolysis Clostridium perfringens PIGMENT-PRODUCING BACTERIA
Gas-forming
Actinomyces israelii Yellow “sulfur” granules
Pseudomembranes Clostridium difficile
Staphylococcus aureus Yellow pigment
Non-motile
Non-Spore- Corynebacterium Pseudomonas aeruginosa Blue-green pigment
Curved
diphtheria (pyocyanin and pyoverdin)
forming gram- Aerobic Chinese characters
Curved Serratia marcescens Red pigment
positive rods Listeria monocytogenes
Tumbling Motility
TREATMENT AND
MICROORGANISM RESERVOIR TRANSMISSION METABOLISM VIRULENCE FACTORS TOXINS CLINICAL SYNDROMES DIAGNOSIS NOTES
PREVENTION
Staphylococcus Human nose Direct contact (Hands) Catalase-positive IMMUNOMODULATORS: Exofoliatin: causes PYOGENIC: Methicillin-sensitive GRAM-STAIN: 95% resistance to
aureus (anterior nares) To test, rub a wire Protein A: prevents epidermal separation SKIN and SOFT TISSUE INFECTIONS SA (MSSA) reveals gram-positive penicillins
and skin Fomites loop across a colony complement activation; in Scalded Skin î bullous impetigo, folliculitis, furuncles, î Penicillinase- cocci in grape-like
of gram-positive binds IgG, preventing Syndrome carbuncles, cellulitis, hidradenitis resistant cluster 60% MRSA in the
Contaminated food cocci and mix on a opsonization and suppurativa, mastitis, surgical site penicillins Philippines
slide with H202. If phagocytosis infections
Enterotoxins (heat- (nafcillin, oxacillin, CULTURE:
bubbles appear,
- Beta-hemolytic Community acquired
stable): superantigens ACUTE ENDOCARDITIS and dicloxacillin)
this indicates that
Coagulase: Allows insoluble causing food - Produces a golden methicillin resistant
H202 is being broken î most common cause of acute
fibrin formation around poisoning Methicillin-resistant yellow colonies on Staphylococcus
down into oxygen endocarditis
organism, protecting it SA (MRSA) blood agar aureus (CA-MRSA)
bubbles and water; î native valve (tricuspid valve) in IV
catalase-positive from phagocytosis Toxic shock î contain altered - “Gold color” is due produces a particular
drug abusers
staphylococci are syndrome toxin penicillin-binding to pigment leukocidin called
present. Hemolysins (cytotoxins): PNEUMONIA protein (PRB) STAPHYLOXANTHIN Panton-Valentine
(TSST-1): superantigen
toxic to hematopoietic cells î nosocomial pneumonia, VAP, î due to resistance Leukocidin
leading to toxic shock
Coagulase-positive necrotizing pneumonia gene mecA Polymerase chain (PVL), which is
syndrome
Leukocidin: specific for î complicated by empyema, abscess or î DOC is reaction (PCR): mecA associated with a
Salt-tolerant on WBCs pneumatocele vancomycin gene for MRSA propensity to form
Alpha toxin: causes
Mannitol salt agar î post-viral pneumonia abscesses
marked necrosis of the
(halotorelant) Catalase: detoxifies
skin and hemolysis OSTEOMYELITIS and SEPTIC ARTHRITIS Vancomycin-
hydrogen peroxide resistant SA (VRSA)
î from hematogenous spread or local
Facultative anaerobe introduction at wound site î DOC is linezolid
Penicillinase: secreted form
î Brodie Abscess: sequestered focus of Causes of
of beta-lactamase; disrupts
osteomyelitis arising in the Necrotizing
the beta-lactam portion of
metaphyseal area of a long bone Pneumonia
the penicillin molecule,
thereby inactivating the TOXIGENIC: î S. aureus
antibiotic GASTROENTERITIS î Pseudomonas
î acute onset (4 hrs) of vomiting and î Aspergillus
TISSUE PENETRANCE: diarrhea due to ingestion of preformed î Viral Pneumonia
Hyaluronidase: "Spreading heat-stable enterotoxin
Factor"; breaks down î source: salad made with mayonnaise
proteoglycans in connective (potato or tuna salad)
tissue (hyaluronic acid)
saphrophyticus Coagulase-negative
common cause of UTI in sexually TMP-SMX clusters
Facultative anaerobe
active women
[
Nitrite-negative CULTURE:
(unlike E. coli) Whitish, non-
Viridans Oral flora Enters bloodstream Catalase-negative Glycocalyx enhances DENTAL CARIES: S. mutans Penicillin G +/- Gram-positive cocci in OVeRPaSs
Streptococci during dental
adhesion to damaged aminoglycoside chains
Bile and optochin- SUBACUTE BACTERIAL ENDOCARDITIS OPTOCHIN
procedures heart valves (Gentamicin)
resistant
(SBE): S. sanguis à most common cause Alpha-hemolytic Viridans
OVRPS (overpass) Vancomycin for
Protected from host of subacute and native valve Resistant
Viridans strep live in the endocarditis penicillin-resistance
mouth because they are defenses within
Pneumoniae
vegetations Linezolid for
not afraid of the chin
(op-to-chin resistant) BRAIN ABSCESSES: S. intermedius Sensitive
vancomycin-
resistant strains
TREATMENT AND
MICROORGANISM RESERVOIR TRANSMISSION METABOLISM VIRULENCE FACTORS TOXINS CLINICAL SYNDROMES DIAGNOSIS NOTES
PREVENTION
Bacillus anthracis Herbivores Contact with infected Aerobic (but since it Protein capsule: polymer of Exotoxin (encoded on CUTANEOUS ANTHRAX: Cutaneous Anthrax: Aerobic, gram-positive Bacillus anthracis is
(zoonotic): animals or inhalation can grow without gamma-D-glutamic acid; plasmin pXO1) - Most common route of entry (95%) DOC is ciprofloxacin box-car shaped rods; the only bacterium
- Sheep of spores from animal oxygen. It is classified antiphagocytic; encoded contains 3 separate - Direct epidermal contact with spores spore-forming; NON- with a capsule
- Goats hair or wool as a facultative on a plasmid called pXO2 proteins, which by causes localized tissue necrosis, Inhalational / MOTILE composed of protein
- Cattle (woolsorter’s disease) anaerobe) themselves are evidenced by a painless round black Gastrointestinal (poly-D-glutamic
nontoxic but lesion with a rim of edema Anthrax: Medusa head acid).
Habitat is soil Human-to-human Virulence depends on together produce the (malignant pustule) Ciprofloxacin or morphology on
transmission has never acquiring 2 plasmids. One systemic effects of - 20% mortality rate Doxycycline with 1 culture: dry “ground Infections result to
been reported. carries the gene for the INHALATIONAL/PULMONARY ANTHRAX: or 2 additional glass” surface and permanent immunity
anthrax:
protein capsule (pXO2); the - Edema factor (EF): antibiotics irregular with (if the patient
- inhaled spores from animals
other carries the gene for its the active A subunit (Woolsorter’s disease) or from (Rifampin, projections along lines survives)
exotoxin (pXO1) of the exotoxin;
weaponized preparations Vancomycin, of inoculation
calmodulin-
(bioterrorism) Penicillin, RAXIBACUMAB:
dependent
- prolonged latent period (2mos) Imipenem, Serology monoclonal antibody
adenylate cyclase
before rapid deterioration Clindamycin, for use in inhalational
- Protective antigen
- massively enlarged mediastinal Clarithromycin) PCR of nasal swab anthrax
(PA): promotes
entry of EF into lymph nodes; pulmonary
hemorrhage (MCC of death); Vaccine: for high-
Cutaneous Anthrax phagocytic cells
meningeal symptoms risk individuals;
- Lethal factor (LF):
- 100% mortality rate without composed of the
zinc metallo- MCC of death is
immediate treatment protective antigen
protease that pulmonary
(PA); Animal
inactivates protein GASTROINTESTINAL ANTHRAX: hemorrhage in:
vaccine is
kinase; stimulates - ingestion of live spores leads to UGI - Anthrax
composed of a live
the macrophage to ulceration, edema, and sepsis - Leptospirosis
strain, attenuated
release TNF-a and - vomiting abdominal pain, bloody (Weil’s syndrome)
by loss of its
IL-1B à death diarrhea protein capsule
- Congenital syphilis
PA + EF = Edema Toxin - rapidly progressive course
PA + LF = Lethal Toxin - mortality approaches 100%
Bacillus cereus Endospores No capsule ENTEROTOXINS EMETIC FORM DIARRHEAL FORM Food Poisoning: Aerobic, gram-positive
Heat-labile: similar to Rice Meat, vegetables Symptomatic spore-forming rod;
Spores on grains such the enterotoxin of Short IP: <6 hrs Long IP: >6 hrs treatment only; MOTILE
as rice survive cholera and the LT (mean, 2h) (mean, 9h) food poisoning
steaming and rapid from E. coli; causes Vomiting, nausea, Diarrhea, nausea, is caused by the Culture specimen from
frying ADP-ribosylation, abdominal cramps abdominal cramps pre-formed suspected food source
increasing cAMP enterotoxin
Shorter duration: Longer duration:
Spores germinate
8-10h (mean, 9) 20-36h (mean, 24)
when rice is kept Heat-stable: Ophthalmitis:
Heat-stable Heat-labile
warm for many hours staphylococcal-like Vancomycin
enterotoxin enterotoxin
(e.g., reheated fried enterotoxin functions Clindamycin
Similar to Resembles
rice) à Chinese fried as superantigen Ciprofloxacin
staphylococcal clostridial
rice syndrome Gentamicin
food poisoning gastroenteritis
Resistant to beta-
OPHTHALMITIS: occur after penetrating
lactam antibiotics
eye injuries of the eye with soil-
contaminated object; complete loss of
light perception within 48 h of injury
TREATMENT AND
MICROORGANISM RESERVOIR TRANSMISSION METABOLISM VIRULENCE FACTORS TOXINS CLINICAL SYNDROMES DIAGNOSIS NOTES
PREVENTION
Clostridium tetani Habitat is soil Endospores: Spores germinate Motile: Flagella (so H- Tetanus Toxin TETANUS Debridement of Anaerobic, gram- Obligate Anaerobes
introduced through under anaerobic antigen-positive) (Tetanospasmin) - “the acute onset of hypertonia or … primary wound positive, spore-forming Can’t Breathe Fresh Air
wound or traumatic conditions in the painful muscular contractions (usually
rods, often with an Clostridium
break in the skin wound Tetany occurs after the of the muscles of the jaw and neck) Metronidazole endospore at one end
tetanus toxin is taken up and generalized muscle spasms or Penicillin (see Bacteroides
- Skin popping in IV (terminal spore), giving
drug use at the neuromuscular without other apparent medical notes)
them the appearance Fusobacterium
junction (end plate) and cause” --CDC Actinomyces
- Stepping on a nail is transported to the
of a drumstick, tennis
- strong muscle spasm Tetanus toxoid:
central nervous system racket, or lollipop
- lockjaw (trismus) vaccination with
(retrograde transport).
- risus sardonicus formalin-
There the toxin acts on the
TETANUS PROPHYLAXIS inhibitory Renshaw cell - opisthotonos inactivated toxin
interneurons, preventing - respiratory muscle paralysis (toxoid), part of the
VACCINATION HISTORY Metronidazole (400
the release of GABA and DPT vaccine; given
Uncertain or <3 doses >3 doses mg rectally or 500 mg
WOUND glycine, which are in childhood and IV every 6 h for 7 days)
Toxoid Toxoid inhibitory NEONATAL TETANUS is defined by the q10yrs thereafter
TIG (ATS) TIG (ATS) is the preferred
(TeANA) (TeANA) neurotransmitters. This World Health Organization (WHO) as “an
NO (Yes, only inhibition of inhibitory antibiotic. An
illness occurring in a child who has the Antitoxin (ATS): alternative is penicillin
Clean, minor YES NO if last dose NO interneurons allows motor
normal ability to suck and cry in the first 2 human tetanus Requires anaerobic (100,000–200,000
neurons to send a high
given >10y) days of life but who loses this ability immune globulin IU/kg per day),
frequency of impulses to conditions
NO (Yes, only between days 3 and 28 of life and becomes (TIG) at the wound
muscle cells, which results although this drug
Contaminated YES YES if last dose NO in a sustained tetanic rigid and has spasms.” site à Passive theoretically may
given >5y) contraction. exacerbate spasms.
Supportive therapy: (Harrisons)
may require
ventilator
assistance
Clostridium Habitat is soil Endospores (heat Anaerobic Motile: Flagella (so H- Botulinum toxin: FOOD-BORNE BOTULISM: eye symptoms Trivalent Botulinum Anaerobic, gram- TRIAD OF BOTULISM:
botulinum resistant) antigen-positive) - heat-labile (BOV, diplopia, ptosis, mydriasis), bulbar Antitoxin (for food- positive, spore-forming - Symmetric
Alkaline neurotoxin signs (diplopia, dysphonia, dysarthria, borne and wound rods descending flaccid
vegetables such as - inhibits release of dysphagia) anticholinergic effects (dry botulism) paralysis (with
green beans, acetylcholine from mouth, constipation, abdominal pain), Culture: requires prominent bulbar
peppers and peripheral nerves à bilateral descending flaccid paralysis, Human botulism: anaerobic condition involvement)
mushroom: flaccid paralysis respiratory paralysis immunoglobulin (thioglycollate- - Absence of fever
Home-canned (descending (for infant botulism) enriched agar) - Intact sensorium
Zip-lock pattern) INFANT BOTULISM: when baby ingests Elimination of the
storage bags - Eight immunologic spores found in household dust or organism from GIT Patient’s serum BOTOX is a
types of toxins honey; due to absence of competitive injected into mice commercial
Corynebacterium Throat Respiratory droplets Facultative anaerobe Pseudo-membrane forms in Exotoxin (encoded by DIPHTHERIA Antitoxins Aerobic, non-spore- Schick test: injection
diphtheriae from carrier the pharynx, which serves ß-prophage); obtained - Mild sore throat with fever initially forming, non-motile of diphtheria
Catalase-positive as a base from where it from a temperate - Pseudomembrane forms on pharynx Penicillin or gram-positive rods; exotoxin into the
secretes its toxin bacteriophage by (results from death of mucosal erythromycin Club or comma-shaped skin, to determine
lysogenic conversion epithelial cells) rods arranged in V or L
whether a person is
- Myocarditis Vaccine DPT configuration; looks susceptible to
Subunit A: has ADP- î A-V conduction block - DIPHTHERIA: like Chinese characters
infection by
ribosylating activity; î dysrhythmia formalin- diphtheriae
blocks protein - Neural involvement: inactivated Culture:
synthesis by î peripheral nerve palsies exotoxin, as Potassium tellurite:
inactivating EF2 (which î GBS antibodies to the dark black colonies
is involved in translation î palatal paralysis B-subunit are
ADP-ribosylation
of eukaryotic mRNA into î neuropathies Loeffler’s medium:
protective ß-prophage
proteins) after 12 hours of
- pertussis growth, stain with Corynebacterium
- tetanus methylene blue. Diphtheriae
Subunit B: provides
entry into cardiac and
Elongation factor 2
Reddish
neural tissue metachromatic (Babes- Granules
Ernst / Volutin)
Exotoxin is like a granules can be seen
“human antibiotic”
OTHER CLOSTRIDIA
to form ammonia à á pH à Culture: Swarming against certain strains
Indole-negative Lipopolysaccharide alkaline urine à struvite stone pattern colonies on BAP of Proteus to diagnose
formation (staghorn calculi; rickettsial disease
Non-lactose Urease production
composed of magnesium- (as certain rickettsiae
fermenter
ammonium-phosphate) share similar antigens)
Gram-negative rod with
peritrichous flagella
SEPSIS
Pseudomonas Habitat is Transmission is via Non-lactose Motile (polar flagella) Endotoxin SKIN AND SOFT TISSUE INFECTIONS Combination of active Gram-negative rods, It is the most common
aeruginosa environmental water aerosols, fermenter î Burn wound infections antibiotics required obligate aerobe pathogen isolated
water sources aspiration, and fecal Elastase: causes vascular Exotoxin A î Hot tub folliculitis: spa pools, whirl pools, because of resistance from patients who
e.g., in hospital contamination Oxidase-positive necrosis and local tissue î similar to or inadequately chlorinated swimming to multiple antibiotics Culture: have been
respirators and destruction diphtheria toxin pools and hot tubs î Antipseudomonal î Grown on Cetrimide hospitalized longer
humidifiers Medical devices î inhibits protein î Skin graft loss due to infection penicillins agar than 1 week, and it is
Hands of healthcare Proteases: destroy synthesis by î Green nail syndrome (ticarcillin, î greenish, metallic a frequent cause of
Inhabits the skin, workers antibody and blocking EF2 BONE AND CARTILAGE INFECTIONS piperacillin) colonies on blood nosocomial infections.
upper respiratory complement î causes tissue î Puncture wound osteomyelitis î Penicillin + Beta- agar
tract, and colon of (major pathogen for necrosis î Pubic osteomyelitis in IV drug users lactamase inhibitor î with sweet, fruity Nosocomial
about 10% of nosocomial infections Pyocyanin: damages the î Type III secretion ticarcillin- grape-like odor organisms similar
Ecthyma gangrenosum people because of its cilia and mucosal cells; system facilitates EAR INFECTIONS clavulanate, î produces pigments: to Pseudomonas:
ubiquitous presence generates reactive exotoxin transfer î Most common cause of: piperacillin- - Pyocyanin (blue) î Acinetobacter
Soil, Water, Plants, in the hospital oxygen species - Otitis externa tazobactam - Pyoverdin (green, baumannii
Animals, Intestinal environment) - Malignant otitis externa in diabetics rd
î 3 gen fluorescent î Elizabethkingia
Flora, Skin Verdoglobin: from - Chronic suppurative otitis media cephalosporins:
meningo-septicum
hemoglobin breakdown PNEUMONIA ceftazidime î Burkholderia
th
î Ventilator-associated pneumonia î 4 gen cepacia
Hemolysins: lyses RBC î Necrotizing pneumonia (fleur-de-lis cephalosporins:
pattern) cefepime
PSEUDOMONAS
Collagenase î High-risk CAP: î Monobactam:
aztreonam
Pneumonia, pyocyanin
- Immunocompromised
Fibrinolysin î Carbapenems: Sepsis
- Broad-spectrum antibiotics
- Steroid therapy imipenem, Ecthyma gangrenosum
Phopholipase C: - Structural lung lesions meropenem, UTIs
degrades cell membranes • Bronchiectasis doripenem, Diabetes, drug use
Green nail syndrome ertapenem
• Cystic fibrosis Osteomyelitis (eg,
DNAse î Fluoroquinolones: puncture wounds)
GASTROINTESTINAL INFECTIONS ciprofloxacin
î Typhlitis (necrotizing enterocolitis) Mucoid
Antiphagocytic polysaccharide
î Shanghai fever (mild form of typhoid) Examples of suitable
mucopolysaccharide capsule
î Peritonitis in peritoneal dialysis patients combinations:
capsule: may contribute Otitis externa
to chronic pneumonia in URINARY TRACT INFECTONS î Ceftazidime +
(swimmer’s ear)
cystic fibrosis patients rd
î 3 MCC of nosocomial UTIs Amikacin
î Piperacillin +
Nosocomial infections
due to biofilm formation
(catheters,
SEPSIS Amikacin
î Ecthyma gangrenosum (hemorrhagic î Azlocillin + equipment)
lesions) Ciprofloxacin Exotoxin A
î Febrile neutropenia Skin infections (hot
- Leukemia or lymphoma post chemo- Rifampicin is added for tub folliculitis)
or radiation therapy refractory cases
- Severe burns
TREATMENT AND
MICROORGANISM RESERVOIR TRANSMISSION METABOLISM VIRULENCE FACTORS TOXINS CLINICAL SYNDROMES DIAGNOSIS NOTES
PREVENTION
Bacteroides fragilis Predominant Spreads to blood or Capsular polysaccharide: Lipid A does not elicit Infections commonly due to Metronidazole – DOC Anaerobic, gram- Obligate Anaerobes
anaerobe of the peritoneum during antiphagocytic and a strong host combinations of bacteria in for anaerobic infections negative rods Can’t Breathe Fresh Air
human colon bowel trauma, anticomplement inflammatory synergistic pathogenicity Clindamycin Clostridium
perforation, or response (attenuated) Chloramphenicol
Carbapenems
Bacteroides
surgery Succinate: inhibits PMN à LPS with low ABDOMINAL ABSCESS
phagocytosis endotoxic activity
nd
2 gen FQ Fusobacterium
PERITONITIS Actinomyces
Attachment factors: pili Enterotoxins: causes Surgical drainage of
diarrhea PERICARDITIS abscess Most Common
Bacteria in Colon
ENDOCARDITIS Chloramphenicol is
static, but cidal to the Bacteroides fragilis
following: E. coli
CEREBRAL ABSCESS
î Chloramphenicol is ideal because it No Bf Since Highschool Enterococcus
is lipophilic N. meningitidis
B. fragilis
S. pneumoniae
H. influenzae
Yersinia Zoonotic: can be Ingestion of Non-lactose Virulence factors are Enterotoxin: MESENTERIC LYMPHADENITIS Antibiotics do not Stool or blood cultures Survives refrigeration
enterocolitica found in pigs contaminated food or fermenter temperature sensitive; î similar to the heat- î in children alter the course of the may be positive
o
water expressed at 37 C stable toxin (ST) of î pseudo-appendicitis diarrhea. However, Closely related to
E. coli patients with positive Examination of the Yersinia pestis
Unpasteurized milk V and W antigens î á cGMP levels ACUTE ENTEROCOLITIS blood culture should terminal ileum with
î with fever, diarrhea (MC be treated with colonoscopy will reveal
Motile manifestation) and abdominal pain antibiotics mucosal ulceration
TREATMENT AND
MICROORGANISM RESERVOIR TRANSMISSION METABOLISM VIRULENCE FACTORS TOXINS CLINICAL SYNDROMES DIAGNOSIS NOTES
PREVENTION
Brucella spp. Direct contact with Obligate aerobe Non-motile BRUCELLOSIS: Pasteurization of milk Aerobic gram-negative Facultative intracellular
contaminated livestock or î Undulating fever (fever peaks in the coccobacilli parasite
Brucellae are that Treat with combination of
Brucella meltitensis Goats aborted placentas Tropism for erythritol, a evening, and returns to normal by
possess a unique ability sugar found in animal morning) doxyxycline Culture blood, bone
(highest pathogenicity)
Ingestion of infected/ to invade both
placentas î Weakness and one other drug: marrow (best yield), liver,
contaminated/ phagocytic and î Loss of appetite - gentamicin
Brucella abortus Cattle or lymph nodes
unpasteurized dairy nonphagocytic cells and - streptomycin
to survive in the
products Includes ABORTIONS in animals - rifampin Serologic tests
Brucella suis Pigs intracellular
environment by finding
Aerozolization in All cattle are immunized Skin test: Indicates
Brucella canis Dogs ways to avoid the
laboratory or possibly due immune system. with a living attenuated exposure only
to bioterrorism strain of Brucella abortus
Francisella Rabbits and Bite of tick (e.g. Obligate aerobe Capsule antiphagocytic TULAREMIA Streptomycin (DOC) Culture (but very Facultative intracellular
tularensis squirrels Dermacentor), deerfly Ulceroglandular: at the site of tick bite Gentamicin dangerous due to its high parasite
or infected animals Requires cysteine Non-motile or direct contact with contaminated rabbit, infectivity, requires
Ticks can serve as a an ulcer develops, with swelling of focal Doxycycline addition of cysteine to
reservoir Direct contact with The ability of F tularensis to lymph nodes blood agar media
infected animal tissue impair phagocyte function and Attenuated vaccine: only
(usually rabbit) survive in infected cells is central Pneumonia: inhalation, or through the for high-risk individuals Skin test
to its virulence. This intracellular
blood
life cycle has been shown to be Measure rise in IgG
Inhaled aerosolized
related to the tightly regulated antibody titer (IgM is not
organisms Oculoglandular: direct inoculation into
expression of a series of genes. very good)
eyes
Ingestion of contaminated
meat or water Typhoidal: ingestion results in
gastrointestinal symptoms (abdominal
Easily transmitted to lab pain) and fever
personnel
Yersinia pestis Wild rodents Flea bite Facultative anaerobe Fraction 1 (F1): this capsular Pesticin: kills other BUBONIC PLAGUE Streptomycin or Gram-negative rods MOST VIRULENT
antigen is antiphagocytic bacteria (including E. coli) î Regional lymph nodes (usually groin) Gentamicin with bipolar staining:
Virulence factors are
BACTERIA!!!
City rats Contact with infected swell, and become red, hot and tender the ends of these rod-
animal tissue temperature sensitive: V and W proteins Intracellular murine (called a bubo) shaped bacteria take up
o Doxycycline Facultative intracellular
Squirrels and prairie only expressed at 37 C toxin: lethal to mice î high fever stain more than the center
parasite
dogs in the US Inhaled aerosolized (temperature inside î conjunctivitis (closed safety pin
Non-motile Killed vaccine is
organisms: human to macrophages)
effective only for a few appearance) Yersinia can accept
human transmission o
Requires calcium at 37 C. SEPTICEMIC PLAGUE months (attenuated plasmids in E. coli, and
Virulence is plasmid-
occurs during epidemics î bacteria survive in macrophages, and vaccine is more effective Blood culture shares many antigens
mediated If insufficient calcium, Y. pestis
spread to blood and organs but also has more side with enteric bacteria
alters its metabolism and protein
î death occurs in 75% in untreated effects) Culture bubo aspirate
production. This trait assists with
Subcutaneous
its intracellular state
PNEUMONIC PLAGUE Serology hemorrhage result in a
The bacteria elaborate a î during epidemics, pneumonia occurs, as blackish skin
lipopolysaccharide bacteria are spread from person to Rapid diagnostic test: discoloration, giving the
person by aerosolized respiratory antibody against F1 name “Black Death”
endotoxin, coagulase, and a secretion (capsular antigen)
fibrinolysin, which are the î 100% fatal if untreated
principal factors in the
pathogenesis of plague.
Pasteurella Part of the normal Bite from dog or cat Facultative anaerobe Capsule WOUND INFECTIONS (following dog Penicillin G Short encapsulated NOT a facultative
flora of domestic and or cat bites): may progress to infection of Doxycycline gram-negative rod that intracellular organism
multocida wild animals Non-motile nearby bones and joints Third generation exhibits bipolar staining
cephalosporin Human bite infection:
Buttery colonies with Eikenella corrodens
musty odor due to
indole production
TREATMENT AND
MICROORGANISM RESERVOIR TRANSMISSION METABOLISM VIRULENCE FACTORS TOXINS CLINICAL SYNDROMES DIAGNOSIS NOTES
PREVENTION
Mycobacterium Habitat is human Transmission is via Produces catalase Mycolic Acid: large fatty acid No exotoxin nor TYPES OF LESIONS: (see next page) Aerobic, acid-fast, thin, Purified Protein
lungs inhalation of and niacin endotoxin EXUDATIVE LESIONS non-motile rods Derivative (PPD) Test
tuberculosis DIAGNOSTICS
respiratory droplet Mycoside: a mycolic acid î pus from acute inflammatory - Ziehl-Neelsen (or 1. Measure zone of
bound to a carbohydrate RAPID CULTURE: induration:
nuclei produced by response Kinyoun)
Facultative coughing forming a glycolipid Bactec radiometric
Positive reaction:
High lipid content: 40% intracellular growth: GRANULOMATOUS LESIONS culture: a liquid broth in a
Slow-growing on > 5mm (immune-
of total cell dry weight is M. tuberculosis can Cord factor î central area of Langhan’s type bottle, with radioactive
Lowenstein-Jensen compromised host)
lipid survive and multiply palmitate as a carbon
î a mycoside formed by union giant cells surrounded by a zone of source. Mycobacteria medium > 10 mm (have
in macrophages of 2 mycolic acids with a epithelioid ells grow and use the carbon, chronic disease or risk
disaccharide (trehalose) î tubercle is a granuloma surrounded allowing early detection factors for exposure to
Mycolic acids are also
î only found in virulent strain TB)
by fibrous tissue that has (in 1-2 weeks) even found in Nocardia (which
î most important virulence before colonies can be also is acid fast) >15mm (all others)
undergone central caseation
factor seen.
î inhibits neutrophil PPD skin test 2. A positive reaction
PHASES OF INFECTION
migration and damages Chest X-ray (“seroconversion”)
PRIMARY COMPLEX indicates:
mitochondria PCR and DNA probes
î usually in middle or lower lobes - current infection /
î may be responsible for
release of tumor necrosis î subpleural granuloma (Ghon’s Mycobacterium Tb Direct active disease
factor à cachexia focus) + associated lymph node = Test (MTDT): amplifies - past exposure but
Ghon’s complex ribosomal RNA in does not mean active
Sulfatides respiratory secretions, disease
î radiologically detectable - BCG vaccination
î mycoside that resemble cord allowing rapid
calcification (Ranke’s complex) identification of M.
factor with sulfates attached
MYCOBACTERIUM TUBERCULOSIS
Diagnostic Algorithm
Screening of Pediatric Drug-Susceptible Household Contacts of TB
APPROPRIATE SPECIMENS
Pulmonary TB Sputum AFB x 2
TB lymphadenitis Excisional Biopsy
TB Effusion Pleural fluid studies (AFB, Q/Q)
Genitourinary TB Urine AFB
Spinal TB (Pott’s) Tissue Biopsy
Abdominal TB Barium studies for intestinal disease
Abdominal CT for extraintestinal
Peritoneal fluid studies (AFB, Q/Q)
TB Meningitis CSF studies (AFB, Q/Q)
TB Pericarditis Pericardial fluid studies (AFB, Q/Q)
TB DISEASE REGISTRATION GROUPS
MECHANISM OF ACTION OF ANTI-TB DRUGS
Drug Mechanism of Action Mechanisms of Resistance
Rifampicin (RIF) Inhibit DNA-dependent RNA polymerase Mutations in DNA-dependent RNA polymerase
Isoniazid (INH) Inhibit mycolic acid synthesis Mutations of catalase-peroxidase reduce intracellular
transformation to active form
Pyrazinamide (PZA) Interferes with NAD and affects the ETS
Ethambutol (EMB) Inhibit arabinosyl transferase which blocks arabinogalactan synthesis
Streptomycin Interferes with the 30s subunit of ribosomes Mutations of genes encoding the 30s subunit
RECOMMENDED TREATMENT REGIMEN FOR ADULTS AND CHILDREN
MYCOBACTERIUM AVIUM INTRACELLULARE COMPEX (MAI, MAC)
Cause pulmonary disease in immunocompromised hosts (AIDS patients with CD4 <50)
DOC: Azithromycin
VIRULENCE FACTORS / SPECTRUM OF DISEASE / TREATMENT AND
MICROORGANISM RESERVOIR TRANSMISSION METABOLISM DIAGNOSIS NOTES
TOXINS / PATHOGENESIS CLINICAL SYNDROMES PREVENTION
Mycobacterium Humans Prolonged exposure to Catalase-positive Non-motile LEPROSY / HANSEN DISEASE Tuberculoid Leprosy: Aerobic, acid-fast rods
nasal secretions of î most common cause of crippling of the hand Rifampin
Mycoplasma Habitat is human Respiratory droplets Aerobic Protein P1 adhesin ATYPICAL PNEUMONIA (WALKING Macrolides NOT SEEN ON GRAM STAIN Mycoplasma has
pneumoniae respiratory tract î Toll-like receptor 2 protein PNEUMONIA) (erythromycin, î No cell wall limited biosynthetic
Requires STEROL for î adheres to epithelial cells of î Mycoplasma pneumoniae is the most azithromycin, î Only bacteria with cholesterol capabilities.
tiniest free-living membrane formation the respiratory tract common cause of atypical pneumonia clarithromycin) in cell membrane
organisms capable of î causes inhibition of ciliary î insidious onset, headache, dry, They can be grown in
self-replication motion (ciliostasis) and nonproductive hacking cough, patchy or Tetracyclines High titer of cold agglutinins cell-free media.
necrosis diffuse interstitial infiltrate (doxycycline) (IgM), which can agglutinate or lyse
î Chest X-ray will show patchy infiltrates that RBCs
Hydrogen Peroxide look worse than clinical findings
Quinolones
î contributes to the damage CULTURE:
(ciprofloxacin,
to the respiratory tract cells TRACHEOBRONCHITIS levofloxacin) î Eaton’s agent
î takes 2-3 weeks
Motile (glides) EXTRAPULMONARY MANIFESTATIONS î Requires cholesterol and nucleic
î Stevens-Johnson Syndrome (most common PENICILLIN AND acids
Community-acquired infectious cause is M. pneumoniae) CEPHALOSPORINS î Add penicillin to inhibit growth
respiratory disease toxin î Erythema multiforme î do NOT work as of contaminating bacteria
(CARDS) î Hemolysis mycoplasma does not î Dome-shaped colonies with
î An exotoxin î Raynaud’s have a cell wall “fried egg” appearance or
î Major role in damage to the î Guillain-Barre syndrome “mulberry” appearance (in the
respiratory epithelium case of Mycoplasma pneumoniae)
î ADP-ribosylating and Children with sickle cell disease and functional
Complement fixation test
vacuolating cytotoxin asplenia may be at greater risk for severe
similar to pertussis toxin. respiratory tract disease PCR/Nucleic acid probes
VIRULENCE FACTORS / SPECTRUM OF DISEASE / TREATMENT AND
MICROORGANISM RESERVOIR TRANSMISSION METABOLISM DIAGNOSIS NOTES
TOXINS / PATHOGENESIS CLINICAL SYNDROMES PREVENTION
Treponema Habitat is the Sexual Microaerophilic Motile PRIMARY SYPHILIS Benzathine Penicillin G Coiled spirochete / thick rigid FALSE-POSITIVE VDRL
pallidum pallidum human genital î Within hours, enters lymphatics and spirals RESULTS
tract Transplacental Highly sensitive to multiplies Erythromycin Viruses (EBV,
elevated î Local non-tender / painless chancre Not seen on Gram stain Hepatitis)
temperatures - Versus painful chancroid of H. ducreyi î Too thin Drugs (Marijuana)
Doxycycline
SECONDARY SYPHILIS Rheumatic fever,
î maculopapular rash on palms and soles Jarisch-Herxheimer Cannot be cultured in vitro: Rheumatoid arthritis
î Condylomata lata: painless, wart-like lesion î lacks tricarboxylic acid (Kreb’s)
reaction: acute Lupus, Leprosy
which occurs in warm, moist places (vulva or cycle
worsening of symptoms
scrotum) after Penicillin is started;
î Occurs after 1-3 months DARKFIELD MICROSCOPY: most
due to lysis of
Pathogenic treponemes î Fever, headache, malaise, anorexia, important (definitive) diagnostic
treponemes
are associated with the lymphadenopathy test for primary syphilis The antigens in non-
following diseases:
treponemal tests
LATENT SYPHILIS
NON-TREPONEMAL TESTS: contain measured
T. pallidum pallidum: î 25% may relapse back to the secondary amounts of
VDRL, RPR
Venereal syphilis stage cardiolipin,
î Screening test for syphilis
T. pallidum pertenue: TERTIARY SYPHILIS î Correlates with disease activity cholesterol, and
Yaws î many years after inoculation î Used to monitor treatment purified lecithin in
T. pallidum endemicum: î granulomas (gummas) of skin and bone quantities sufficient to
Endemic syphilis (bejel) î Cardiovascular syphilis (aortitis) TREPONEMAL TESTS: yield a standardized
- Obliterative invasion of small blood FTA-ABS, TPHA amount of reactivity.
T. carateum: Pinta vessels and vasa vasorum, causing Historically, the
î Confirmatory test
endarteritis î DO NOT repeat even after cardiolipin was
î Neurosyphilis treatment extracted from beef
- Tabes dorsalis î Remain positive throughout life heart or liver with
o Argyll-Robertson pupil (prostitute despite treatment added lecithin and
pupil; can accommodate but do not cholesterol to enhance
react) VDRL: Venereal Disease Research
reaction with syphilitic
- Dementia paralytica Laboratory; RPR: Rapid Plasma Reagin; “reagin” antibodies.
Fluorescent Treponemal Antibody Reagin is a mixture of
CONGENITAL SYPHILIS ABSorption (FTA-ABS); Treponema Pallidum IgM and IgG antibodies
î Snuffles/saddle nose Haemagglutination Assay (TPHA) reactive with the
î Mulberry molar cardiolipin–cholesterol–
î Hutchinson triad (Hutchinson teeth, lecithin complex.
sensorineural hearing loss, interstitial Take Note!!!
keratitis)
î Saber shins FTA-ABS
- Most specific
î Rhagades
- Earliest positive
î Higoumenakis sign (unilateral enlargement
of the sternoclavicular portion of the clavicle - Remains positive longest
à detachment)
î Clutton’s joints (synovitis)
î Pulmonary hemorrhage (MCC of death)
BORRELIA RECURRENTIS
Relapsing Fever
î rapid antigenic changes due to programmed rearrangements of bacteria DNA encoding surface proteins
î transmitted by human body louse (Pediculus humanus)
î Diagnosed by microscopy
î DOC: Tetracycline or Erythromycin
VIRULENCE FACTORS / SPECTRUM OF DISEASE / TREATMENT AND
MICROORGANISM RESERVOIR TRANSMISSION METABOLISM DIAGNOSIS NOTES
TOXINS / PATHOGENESIS CLINICAL SYNDROMES PREVENTION
Borrelia Animal Bite from deer ticks Microaerophilic LYME DISEASE Early Localized or Weakly staining, gram-negative Thiomargarita
Reservoirs: (Ixodes ticks) Disseminated Lyme spirochetes namibiensis is the
î ELISA
Stage 3: Late stage
î Western immunoblotting
î Autoimmune migratory polyarthritis (onion PREVENTION:
î Insectides
skin lesion)
î Insect repellents
î Acrodermatitis chronica atrophicans
î Protective clothing
î Encephalopathy
Leptospira Zoonotic (dogs, Direct contact with Obligate aerobe Leptospires penetrate intact Incubation Period: 2-20 days Mild Leptospirosis: Thin-coiled spirochetes The traditional system
interrogans cats, livestock, and infected urine or (the other spirochetes mucous membranes or skin î Doxycycline divided the genus into
wild animals) animal tissue: are microaerophiles) through small cuts or ACUTE LEPTOSPIREMIC PHASE: Spiral shaped, with hooks on both 2 species: the
î Ampicillin
Organism penetrate abrasions î organisms in blood and CSF ends (“ice tongs”) à Shepherd’s pathogenic Leptospira
î Amoxicillin
broken skin (i.e. on â î causes high spiking temperature, chills, crook appearance interrogans and the
feet) and mucous Multiply rapidly and damage intense headache nonpathogenic
endothelium of small blood Severe Leptospirosis:
(The resting site membranes î rapid multiplication of leptospires in Darkfield Microscopy: insensitive; Leptospira biflexa.
for leptospires in (swallowing urine- vessels (VASCULITIS) muscles with high oxygen tension à severe î Penicillin G not recommended
the natural host is contaminated water) muscle aches (calf tenderness) î Ampicillin
the lumen of the Organisms found in: î damaged and leaky conjunctival vessels à î Ceftriaxone Microscopic agglutination Test:
Two axial flagella wrap nephron tubules.) History of wading in blood and CSF (early in the conjunctival suffusion (painful and itchy î Cefotaxime î LeptoMAT
rd
around and run along flood water (in 3 disease) and in the but with minimal tearing) î the gold standard / criterion
the length of the world setting) urine (later stages) Jarisch-Herxheimer standard for serologic
organism under the IMMUNE LEPTOSPIRURIC PHASE: reaction may develop identification of leptospires
outer membrane History of exposure to Immune complex-mediated î correlates with emergence of IgM within hours after starting
(periplasmic flagella) animals (butcher) meningitis and î involves recurrence of the above symptoms therapy CULTURE:
glomerulonephritis î aseptic meningitis î Grown on Ellinghausen-
- CSF pleocytosis with or without McCullough-Johnson-Harris
meningeal symptoms PREVENTION: (EMJH) medium or Fletcher’s
- Coincides with appearance of antibody î Doxycycline for medium
titer postexposure î only becomes positive after 2
î Pulmonary involvement chemoprophylaxis weeks of incubation
- Snowflake lesions on CXR î Rat control î First week: culture blood or CSF
î Hepatic necrosis î Vaccination of domestic (on lab media, or by inoculation
î Glomerulonephritis (due to immune livestock and pets into animals
complex deposition î Second week to months: culture
urine
WEIL’S SYNDROME:
î most severe form of leptospirosis Antibody based ELISA to detect
î triad: Bleeding, Jaundice, Uremia Leptospira antigens in the urine
î orange cast skin (severe jaundice)
î MCC of death: respiratory failure due to Polymerase Chain Reaction (PCR)
massive pulmonary hemorrhage to detect bacterial DNA in serum,
CSF and urine
VIRULENCE FACTORS / SPECTRUM OF DISEASE / TREATMENT AND
MICROORGANISM RESERVOIR TRANSMISSION METABOLISM DIAGNOSIS NOTES
TOXINS / PATHOGENESIS CLINICAL SYNDROMES PREVENTION
Chlamydia Habitat is the Sexual Energy parasites Obligate intracellular TRACHOMA GENITAL AND EYE Gram-negative TRACHOMA
trachomatis human genital that use host ATP bacteria î C. trachomatis types A-C INFECTIONS: lacks classic peptidoglycan layer TYPES A, B, C
tract and eyes During passage î leading infectious cause of blindness Doxycycline (use only due to reduced muramic acid Africa
A-C: trachoma through birth canal Resistant to lysozyme (since î Chronic keratoconjunctivitis for adults) (rendering Beta-lactam antibiotics Blindness
D-K: genital, neonatal (C. trachomatis is their cell wall lacks muramic î scarring of the inside of the eyelid, resulting ineffective)
Chronic infection
L1-L3: LGV strictly human Hand-to eye contact acid) in redirection of the eyelashes onto the Erythromycin (especially
pathogen) corneal surface à corneal scarring and for infants and pregnant Cytoplasmic inclusions in
Prevents phago–lysosome blindness woman) Giemsa: (Halberstaedter-
FORMS: fusion î Scraping from the surface of the conjunctiva Prowazek inclusions)
ELEMENTARY BODY RETICULATE (INITIAL) BODY
will show round to oval intracytoplasmic Azithromycin
Non-motile inclusion bodies within conjunctival
Can classically be grown in chick
Inactive Metabolically active
Extracellular Intracellular No pili epithelial cells (Halberstaedter-Prowazek For STD, add yolk sacs: More commonly
Enters the cells by endocytosis Seen microscopically inclusions) CEFTRIAXONE for chlamydia is cultured in certain cell
No exotoxins possible concomitant lines (McCoy cells for example)
Infectious Replicates the binary fission
GENITAL TRACT INFECTIONS gonorrhea - To enhance the sensitivity of
Elementary body: Enfectious, Enters the cell via Endocytosis
PATHOGENESIS: î C. trachomatis types D-K
McCoy cells to C. trachomatis
Reticulate body: Replicates in cell by fission, Reorganizes into
î balance that is often î Most common cause of STDs Note: Systemic treatment growth, cycloheximide was
elementary bodies. reached between host and î Men: Nongonococcal urethritis, epididymitis is required for any added to culture medium for
parasite, resulting in and prostatitis chlamydial eye infection. cultivating infected cells.
prolonged persistence of î Women: Urethritis, cervicitis and pelvic This is especially true for
infection inflammatory disease (PID) infants, who can develop PCR
î Infection persists in the î Associated with Reiter’s syndrome: triad chlamydial pneumonia
presence of high antibody of conjunctivitis, urethritis, and arthritis following chlamydial Nucleic acid amplification test
titer î Birth complications: neonatal pneumonia, conjunctivitis. (NAAT)
neonatal conjunctivitis
NEONATAL PNEUMONA
î C. trachomatis types D-K
î Late-onset (2-4 weeks)
î Striking tachypnea, characteristic
paroxysmal cough (staccato cough),
absence of fever, and eosinophilia
LYMPHOGRANULOMA VENEREUM
î C. trachomatis types L1-L3
î Papule or vesicular which ulcerates leads to
Elementary body (EB): dense spherule that infects cells
Initial (reticulate) body: After EB enters cell, it transforms into an initial
suppurative inguinal lymphadenitis
body; larger, osmotically fragile; can produce via binary fission; (buboes)
requires ATP from the host. The initial body transform back into EB, î (+) Frei test: intradermal injection of antigen
which leaves the cell to infect the other cells.
Chlamydophila Humans (spread Respiratory route Life cycle similar to ATYPICAL PNEUMONIA Doxycycline Examine blood for elevated titers TWAR: Taiwan Acute
pneumoniae from human to Chlamydia î Viral-like atypical pneumonia (similar to a of antibodies with complement Respiratory agent
(strain TWAR) human) trachomatis Mycoplasma pneumonia) in young adults Erythromycin fixation and immunofluorescence
tests
Associated with atherosclerosis, meningo- Intracytoplasmic inclusion bodies
encephalitis, arthritis, myocarditis, Guillain- that DO NOT STAIN with iodine
Barre syndrome
Chlamydophila Parrots, parakeets, Humans are infected PSITTACOSIS (BIRD FANCIER’S DISEASE) Azithromycin
psittaci macaws, cockatiels by inhaling Chlamydia- î Sudden onset pneumonia with malaises,
laden dust from fever, anorexia, sore throat, photophobia,
feathers or dried-out and severe headache
feces.
RICKETTSIAE
î Classical detection using Weil-Felix Reaction (cross-reaction with antigens of OX strains of Proteus mirabilis)
î Drug of choice for all rickettsial infections is DOXYCYCLINE.
DISEASE CAUSE VECTOR INCUBATION ONSET RASH ESCHAR MORTALITY
Rocky mountain Macular with centripetal
Rickettsia rickettsii Tick 7 Abrupt NO 10-25%
spotted fever spread
Mites
Rickettsial pox Rickettsia akari
(chiggers)
9 - 14 Abrupt Generalized papulovesicular YES Low
immune responsiveness) they may invade tissue or vasculature and DRUGS MECHANISM OF ACTION
cause disease. Polyenes Binds to ergosterol in fungal cell membranes,
• PATHOGENS infect the healthy but cause more severe disease in - Amphotericin B forming leaky pores
the compromised hosts. The damage to living cells provides Azoles Inhibit fungal P450-dependent enzymes (lanosterol
nutrition. Most of these are also environmental saprobes. - Ketoconazole 14-a-demethylase) blocking ergosterol synthesis;
- Fluconazole resistance can occur with long-term use
COMPARISON: FUNGI VERSUS BACTERIA - Itraconazole
Feature Fungi Bacteria - Posaconazole
Nucleus Eukaryotic Prokaryotic - Voriconazole
Mitochondria and ER Present Absent Terbinafine Inhibits epoxidation of squalene
Cell membrane sterols Absent Echinocandins Inhibit β-glucan synthase decreasing fungal cell
Present - Caspofungin wall synthesis
(except in Mycoplasma)
Cell wall content Chitin Peptidoglycan - Micafungin
Spores Reproduction Survival - Anidulafungin
Dimorphism Yes No Flucytosine Blocks nucleic acid synthesis by Inhibiting DNA and
Metabolism Aerobic Aerobic or anaeroic RNA polymerases
Griseofulvin interferes with microtubule function in
dermatophytes and may also inhibit the synthesis
and polymerization of nucleic acids
NAME RESERVOIR / TRANSMISSION MORPHOLOGY PATHOGENESIS / CLINICAL SYNDROME DIAGNOSIS TREATMENT NOTES ANATOMIC LOCATION
DERMATOPHYTES Depending on the particular - Chronic infections often located in the warm, 10% KOH: branched /septate hyphae Topical imidazole Secretes the enzyme CUTANEOUS
Trichophyton species humid areas of the body keratinase, which digests
- Infection of skin, hair, and - Inflamed circular border containing Wood’s lamp: certain species of Oral griseofuivin is used for keratin (infect only
nails Soil (geophilic) papules and vesicles surround a clear Microsporum will fluoresce under tinea unguium and tinea superficial keratinized
Animals (zoophilic) area of normal skin ultraviolet light (green fluorescence) capitis structure)
Microsporum Human (anthropophilic)
- Hypersensitivity causes dermatophytid
- Infection of skin and hair A fungal culture using Sabouraud’s Oral terbinafine For atypical presentations
- Not the cause of tinea Infections due to zoophilic or
reactions (inflammatory reaction to of tinea corporis, further
dermatophytosis to a cutaneous site DISTANT from
agar: hyphae and conidia
unguium geophilic dermatophytes may Keep skin dry evaluation for HIV
the primary infection)
produce a more intense PCR infection and/or an
Epidermophyton inflammatory response than immunocompromised
DERMATOPHYTOSES
- Infection of skin and nails those caused by Fungal DNA identification state should be
Tinea corporis (body): “ringworm”
- Not the cause of tinea anthropophilic microbes considered.
Tinea cruris (groin): “jock itch”
capitis
Tinea pedis (feet): “athlete’s foot”
Transmission: direct contact, Tinea capitis (scalp)
dogs, and cats Tinea unguium (nail): Onychomycosis
Tinea manum
Tinea barbae (facial hair)
Malassezia furfur Naturally found on the skin A basidiomycete TINEA/PITYRIASIS VERSICOLOR KOH prep: reveals short, curved, Dandruff shampoo SUPERFICIAL (SKIN)
surfaces of many animals, î usually characterized by hypopigmented or unbranched hyphae with spherical (containing selenium sulfide)
including humans. Lipophilic, skin hyperpigmented macules and patches on yeast cells (look like “spaghetti and
Isolated in 18% of infants and inhabitant the chest and the back meatballs”) Topical imidazole
90-100% of adults. î In patients with a predisposition, tinea
Predominantly produce versicolor may chronically recur Fluorescence under Wood’s lamp
May be spread from person to yeast-like conidia î fungal infection is localized to the stratum
person, fomites corneum Malassezia is extremely difficult to
Infectious particles: î High temperature, humidity favour propagate in laboratory culture and is
short hyphae, yeast-like occurrence culturable only in media enriched
cells (conidia) î Degradation of lipids leads to production of with C12- to C14-sized fatty acids.
acids and eventual destruction of
melanocytes
Sporothrix schenkii Found on rose thorns Dimorphic SPOROTRICHOSIS KOH exam of aspirates, pus, biopsy Cutaneous form: SpROSEthrix SUBCUTANEOUS
î Gardener’s / Rose-hander’s disease materials (typically unrewarding) Potassium iodide ROSE-hander’s disease
An ascomycete î causes local pustule or ulcer with nodules Oral itraconazole ROSEtte/daisy-like
(Ophiostoma stenoceras) along draining lymphatics (ascending Tissue smears (often negative, cluster of conidia
lymphangitis) sensitivity enhanced by GMS, PAS, Systemic form:
Soil, plant saprophyte î Occur as: FAB) Amphotericin B
- Cutaneous (lymphocutaneous) - Round-oval, cigar-shaped yeast
- Disseminated/systemic (bones, joints) cells
Infectious particles: î Follows a puncture wound (thorn prick, - Asteroid bodies (H&E)
hyphae, conidia splinter)
î frequently an occupational disease Others: direct IF, serology
Culture:
- On SDA (at room temperature):
fine, septate hyphae and
rosette/daisy-like clusters of
conidia on thin conidiophores
- On BHIA (at 37ºC): round to oval
yeast cells
NAME RESERVOIR / TRANSMISSION MORPHOLOGY PATHOGENESIS / CLINICAL SYNDROME DIAGNOSIS TREATMENT NOTES ANATOMIC LOCATION
Coccidioides immitis Desert areas of the Dimorphic: - Arthospores form spherules filled with Biopsy of affected tissue: lung Drugs-of-Choice: Common oppurtunisitc SYSTEMIC
southwestern United States - Mycelial (mold) forms biopsy, skin biopsy, etc. Amphotericin B infection in AIDS patients
endospores of coccidiodes
and northern Mexico
o
with spores at 25 C Itraconazole from the southwest The most common
- Granulomata in bones and CNS
(soil) Silver stain or KOH prep United States mode of infection of
- Dissemination in those who have defective
Transmission: Respiratory - Spherule (not yeast) If meningitis occurs, systemic fungi is thru
CMI
via inhalation of
o
forms at 37 C (tissues) Culture on Sabouraud’s agar Fluconazole inhalation.
arthrospores VALLEY FEVER
Serology
î Very common in Filipinos living in Latin Systemic mycoses are
caused by dimorphic
America and Southwestern USA
Skin test fungi: cold (20°C) =
î Asymptomatic (in most persons)
mold; heat (37°C) =
î Influenza-like illness
yeast. Only exception is
î Lung infiltrates, adenopathy, or effusions
î Erythema nodosum (desert bumps) Coccidioides, which is
Fluconazole - systemic
Transmission: Respiratory Yeast form only (Not
chemotherapy
dimorphic) Fungal culture
via inhalation of airborne - AIDS
yeast cells
NAME RESERVOIR / TRANSMISSION MORPHOLOGY PATHOGENESIS / CLINICAL SYNDROME DIAGNOSIS TREATMENT NOTES ANATOMIC LOCATION
Aspergillius fumigatus Ubiquitous: widely distributed Exists only as molds Aspergillus may cause a broad spectrum of disease in Allergic brochopulmonary Allergic bronchopulmonary Rarely found in OPPORTUNISTIC
in nature (not dimorphic) the human host, ranging from hypersensitivity aspergillosis: aspergillosis: treat with individuals who are
Aspergillius flavus reactions to direct angioinvasion
Aspergillius niger - High level of IgE (IgE level > 1000 corticosteroids immunocompetent
Transmission: Respiratory Septate hyphae that ALLERGIC BRONCHOPULMONARY IU/dL)
ASPERGILLOSIS
via inhalation of airborne form V-shaped - Sputum culture Aspergilloma: removal via The FDA has approved an
î IgE-mediated
conidia (dichotomous) - Wheezing patient and chest X-ray thoracic surgery intravenous formulation
î Asthma-type reaction with shortness of with fleeting infiltrates of the triazole antifungal
branches (acute
O breath, high fever, and expectoration of - Increased level of eosinophils Invasive aspergillosis: treat posaconazole (Noxafil),
angles, 45 ) brownish bronchial plugs - Skin test: immediate with voriconazole, possibly which is indicated for the
hypersensitivity reaction
Aspergillus: Acute Angles
ASPERGILLOMA caspofungin (very high prophylaxis of invasive
î Fungus ball Aspergillus and Candida
mortality)
î associated with hemoptysis Aspergilloma: diagnose with chest X- infections in severely
î Monod sign: air around aspergilloma ray or CT scan immunocompromised
adults who are at high
INVASIVE ASPERGILLOSIS
Invasive aspergillosis: sputum risk of developing these
î necrotizing pneumonia
examination and culture infections.
î may disseminate to other organs in
immune-compromised patients
Aflatoxins contaminate
î (+) air crescent sign on radiography
peanuts, grains, and rice
AFLATOXIN CONSUMPTION
î produced by Aspergillus flavus
î can cause liver damage and liver cancer
INFECTIONS: wounds, burns, cornea, external
ear, sinuses
Rhizopus Saprophytic molds Broad, non-septated, MUCORMYCOSIS Biopsy Amphotericin B The disease is rapidly OPPORTUNISTIC
Rhizomucor branching hyphae (right î Causes disease mostly in ketoacidotic Black nasal discharge fatal
o
Mucor angles, 90 ) diabetic and/or neutropenic patients (eg, Surgery
leukemia)
î fungi proliferate in blood vessel walls,
penetrate cribriform plate, and enter
brain
î Rhino-orbito-cerebral infection, frontal
lobe abscess; cavernous sinus thrombosis
î Headache, facial pain, black necrotic
eschar on face; may have cranial nerve
involvement
Pneumocystis jirovecii Unicellular fungi found in the Indeterminate organism PNEUMOCYSTIS JIROVECII PNEUMONIA Diagnosis by staining BAL washings Treatment/prophylaxis: The taxonomic classification of the Pneumocystis
respiratory tracts of many
î Occurs when CD4 <200 î Toluidine blue TMP-SMX (DOC) genus was debated for some time. It was initially
mammals and humans Disc-shaped yeast mistaken for a trypanosome and then later for a
Pneumocystis carinii î Most common AIDS-defining illness î Methenanime silver stain
(former name) Major surface î Cysts in the alveoli induce an inflammatory For sulfa allergy: protozoan. In the 1980s, biochemical analysis of the
Transmission: Respiratory glycoprotein undergoes response consisting plasma cells à frothy Elevated LDH >220 U/L in patients Pentamidine nucleic acid composition of Pneumocystis rRNA and
via inhalation of cysts Dapsone (prophylaxis only) mitochondrial DNA identified the organism as a
programmed exudate that blocks oxygen exchange with PCP
rearrangements î Diffuse interstitial pneumonia with Atovaquone unicellular fungus rather than a protozoan.
Quantitative PCR for pneumocystis Subsequent genomic sequence analysis of multiple
bilateral ground glass infiltrates
î 100% mortality if untreated may become useful in distinguishing Start prophylaxis when CD4+ genes including elongation factor 3, a component
Morphologic stages:
between colonization and active count drops to < 200 of fungi protein synthesis not found in protozoa,
Trophozoite (trophic 3
form): often exists in infection. cells/mm in HIV patients. further supported this notion.
clusters
Sporozoite (precystic
form)
Cyst: contains several
intracystic bodies (spores)
DNA VIRUSES RNA VIRUSES
HHAPPPPy DNA Viruses: Hepadna, Herpes, Adeno, Pox, Parvo, Papilloma, Polyoma
All DNA viruses have double stranded DNA EXCEPT: PARVOVIRUS (single-stranded) All RNA viruses have single stranded RNA EXCEPT: REOVIRUS (ROTAVIRUS) (dsRNA)
All DNA viruses have linear DNA EXCEPT: PAPILLOMAVIRUS (circular, supercoiled) All RNA viruses have replicate in the cytoplasm EXCEPT: INFLUENZA VIRUS
POLYOMAVIRUS (circular, supercoiled) RETROVIRUSES
HEPADNAVIRUS (circular, incomplete)
All DNA viruses are icosahedral EXCEPT: POXVIRUS (complex)
All DNA viruses replicate in the nucleus EXCEPT: POXVIRUS (cytoplasm; carries own DNA-dependent RNA
polymerase)
VIRUS MORPHOLOGY TRANSMISSION PATHOGENESIS / SPECTRUM OF DISEASE DIAGNOSIS TREATMENT / PREVENTION NOTES
NAKED DNA VIRUSES
PARVOVIRIDAE: The smallest DNA virus; the only DNA virus that is single-stranded.
Parvovirus B-19 Naked icosahedral Respiratory Droplets ERYTHEMA INFECTIOSUM (FIFTH DISEASE) Illness is self-limited RBC destruction in fetus
î affects children between the ages of 4 to 12 leads to hydrops fetalis and
Single-stranded linear DNA Transplacental î bright red cheek rash (“Slapped cheek”) with fever, coryza, and sore I.V. immunoglobulin can be used death, in adults leads to
virus (negative stranded) throat with aplastic crisis pure RBC aplasia and
rheumatoid arthritis–like
APLASTIC CRISIS:
One serotype symptoms
î Transient but severe aplastic anemia in children with sickle cell anemia,
thalassemia, or spherocytosis
î occurs when the Parvovirus stops the production of red blood cells in the
bone marrow
FETAL INFECTIONS
î First trimester: Fetal death
î Second trimester: Hydrops Fetalis
ARTHRITIS
î Immune-complex arthritis of small joints
ADENOVIRIDAE
Adenovirus Naked icosahedral Aerosol droplet URT: Pharyngitis, conjunctivitis, coryza Histopathology: Illness is self-limited
Double-stranded linear DNA LRT: bronchitis, atypical pneumonia Cowdry type B intranuclear
41 serotypes Fecal-oral GIT: acute gastroenteritis basophilic inclusion bodies
Only virus with fiber GUT: acute hemorrhagic cystitis
Direct contact
PAPOVAVIRIDAE: The second smallest DNA virus
Human Naked icosahedral Direct contact - Infect squamous cells and induce formation of cytoplasmic vacuole Genital warts: Podophyllin Koilocytes: small, round,
Double-stranded circular (koilocytes) deeply basophilic nuclei
Papillomavirus
DNA Sexually - Genes E6 and E7: encode proteins that inactivate tumor suppressor Skin warts: Liquid nitrogen surrounded by a clear
At least 100 types genes. E6 inhibits p53; E7 inhibits Rb halo and pale-staining
- Genes E1 and E2: promote viral DNA replication Plantar warts: Salicylic acid cytoplasm
HPV 1, 2, 4, 7 Skin and plantar warts, verruca vulgaris PREVENTION:
HPV 6 and 11 Genital warts (condyloma acuminata) Vaccine for HPV 6, 11, 16, and
Respiratory tract papillomas 18 for females 9-26 years old
Most common viral STD
HPV 16, 18, 31, 33 Carcinoma of the cervix, vulva, penis, anus
JC Polyoma Virus Naked icosahedral - Only causes disease in immunocompromised hosts JC: Junky Cerebrum
(John Cunningham virus) Double-stranded circular - Causes progressive multifocal leukoencephalopathy in patients
DNA with AIDS
î Demyelinating disease that affects the oligodendrocytes
characterized by deficits in speech, coordination, and memory
BK Polyoma Virus Naked icosahedral - causes disease in immunocompromised hosts BKV blood test or a urine test BK: Bladder, Kidney
Double-stranded circular - causes hemorrhagic cystitis and nephropathy in patients with solid for decoy cells
DNA organ (kidney) and bone marrow transplants Biopsy of the kidneys
PCR techniques
VIRUS MORPHOLOGY TRANSMISSION PATHOGENESIS / SPECTRUM OF DISEASE DIAGNOSIS TREATMENT / PREVENTION NOTES
ENVELOPED DNA VIRUSES
HERPESVIRIDAE
Herpes Simplex Enveloped icosahedral HSV 1: saliva or - Vesicle filled with virus particles and cell debris Tzanck smear: Drug-of-choice: HSV-1 is the most
Double-stranded linear DNA direct HSV-1 (HHV-1) HSV-2 (HHV-2) multinucleated giant cells Acyclovir common cause of sporadic,
Viruses (HSV)
Gingivostomatitis Genital herpes - Shortens duration of the fatal encephalitis in the
HSV 2: sexual or Herpes labialis (lips) Neonatal herpes (TORCH) Large, pink to purple Cowdry lesions USA
transvaginal Keratoconjunctivitis Aseptic meningitis Type A eosinophilic - Reduces the extent of
MALIGNANCIES
î Burkitt’s lymphoma (in African people) Use of amoxicillin in
î B-cell lymphomas mononucleosis can cause
î Nasopharyngeal carcinoma (in Chinese people) characteristic
î Hairy leukoplakia (in AIDS patients) maculopapular rash.
Human Herpesvirus 6 Enveloped icosahedral saliva ROSEOLA / EXANTHEM SUBITUM / SIXTH DISEASE
Double-stranded linear DNA - rose-colored macules appear on body after several days of high fever;
(HHV-6)
can present with febrile seizures; usually affects infants
- Nagayama spots: erythematous papules on soft palate and base of the uvula
POXVIRIDAE: Largest DNA virus; the only DNA virus that is complex (not icosahedral); the only DNA virus that replicates in the cytoplasm (not in the nucleus)
Variola virus Enveloped complex Aerosol SMALLPOX HP: Guarnieri bodies:
î Only disease that has been eradicated from the face of the earth intracytoplasmic
Brick-shaped poxvirus Contact î Incubation Period: 7 – 14 days
containing linear double- eosinophilic inclusions
î Prodrome of fever and malaise followed by centrifugal rash
stranded DNA î Classic smallpox lesions: deep-seated, firm/hard, round well-circumscribed
Replicates in the cytoplasm vesicles or pustules; as they evolve, lesions may become umbilicated or
confluent Guarnieri bodies
î Lesions with same stage of development
Molluscum Direct contact MOLLUSCUM CONTAGIOSUM HP: Henderson-Patterson Cifodovir
Contagiosum virus î flesh-colored dome-shaped papules with central umbilication bodies: intracytoplasmic
eosinophilic inclusions
VIRUS MORPHOLOGY TRANSMISSION PATHOGENESIS / SPECTRUM OF DISEASE DIAGNOSIS TREATMENT / PREVENTION NOTES
HEPADNAVIRIDAE
Hepatitis B Virus Enveloped virus with Blood transfusion - the only DNA virus that produces DNA by reverse transcription with Acute diagnosis: Entecavir The virus is one of the
incomplete circular double- mRNA as the template; not a retrovirus but has reverse transcriptase HBsAg, IgM anti-HBc smallest enveloped animal
Tenofovir
stranded DNA Needlestick injury - hepatocellular injury due to immune attack by cytotoxic T cells viruses, and the 42 nm
Interferon-alpha virions, which are capable of
Ø HBV has no cytopathic effect Chronic diagnosis:
Sexual Lamivudine infecting hepatocytes, are
HBsAg, IgG anti-HBc
VIRULENCE FACTORS: referred to as "Dane
Across the placenta î Surface antigen (HBsAg) Markers of replication: PREVENTION: particles" à the complete
î Core antigen (HBcAg) HBeAg, HBV DNA HEPATITIS B VACCINE infectious form of Hepatitis
Perinatally î e antigen (HBeAg): used as marker of potential infectivity - First vaccine to prevent a B virus
Liver Biopsy: Granular human cancer
HEPATITIS B INFECTION eosinophilic “ground - 1st dose should be given first
î Incubation Period: 10-12 weeks 12 hours of life and counted Age at the time of
î Fever, anorexia, and jaundice glass” appearance
as part of 3-dose primary infection is the best
î Dark urine, pale feces, and elevate transaminase levels
series predictor of chronicity.
î Can lead to cirrhosis and hepatocellular carcinoma - Subsequent doses are given at
î Extrahepatic manifestations: Councilman body: least 4 weeks apart
The younger the age at the
eosinophilic globule of cells time of HBV infection, the
o Aplastic Anemia - 3rd dose preferably given >24
that represents a dying higher the probability of
o Membranous à Membranoproliferative glomerulonephritis weeks of age chronicity.
hepatocyte often surrounded
o Polyarteritis nodosa (autoimmune vasculitis) by normal parenchyma
SEROLOGIC EVOLUTION INTERPRETATION OF SEROLOGY Complications:
Time Period HBsAg Anti-HBs Anti-HBc HBeAg HEPATORENAL SYNDROME: functional renal failure without renal
Incubation Period (+) (-) (-) (+) pathology
Acute Infection (+) (-) (+) IgM (+)
Window Period (-) (-) (+) IgM (-) HEPATOPULMONARY SYNDROME: vascular dilatations cause
Complete Recovery (-) (+) (+) IgG (-) overperfusion relative to ventilation, leading to V/Q mismatch and
Chronic Carrier (+) (-) (+) IgG (-) hypoxemia
Chronic Active (+) (-) (+) IgG (+)
Vaccinated (-) (+) (-) (-) PORTAL HYPERTENSION
HEPATIC ENCEPHALOPATHY
The only positive during window period: Anti-HBc IgM
The only positive among vaccinated patients: Anti-HBs
What can differentiate chronic active infection from chronic carrier: HBeAg
Chronic infection is characterized by the persistence of HBsAg for at least 6
months.
Persistence of HBsAg is the principal marker of risk for developing chronic
liver disease and liver cancer (hepatocellular carcinoma) later in life.
VIRUS MORPHOLOGY TRANSMISSION PATHOGENESIS / SPECTRUM OF DISEASE DIAGNOSIS TREATMENT / PREVENTION NOTES
NAKED RNA VIRUSES
PICORNAVIRIDAE
Poliovirus Naked (+) ssRNA Oral-fecal - replicates in motor neurons in anterior horn of spinal cord, causing HP: Cowdry type B PREVENTION: ENTEROVIRUSES
Naked icosahedral symmetry paralysis intranuclear inclusions Vaccination
- Poliovirus
- host range is limited to primates SALK SABIN
Three serologic (antigenic) - Limitation is due to the binding of the viral capsid to a receptor found - Echovirus
IPV OPV
types based on different only on primate cell membrane Killed Live, attenuated - Coxsackie virus
antigenic determinants on the
outer capsid proteins POLIOMYELITIS AND MENINGITIS RNA viruses with
î Inapparent, asymptomatic infection icosahedral symmetry
The oral vaccine or Sabin vaccine
î Abortive poliomyelitis which is a live attenuated vaccine § Flaviviruses
- Most common clinical form is preferred over the Salk vaccine § Caliciviruses
- Mild febrile illness with headache, sore throat, nausea, and vomiting or killed vaccine because it § Reoviruses
î Non-paralytic poliomyelitis interrupts fecal-oral transmission § Picornavirus
- Aseptic meningitis by inducing secretory IgA in the
î Paralytic poliomyelitis § Togaviruses
GIT; killed vaccine does not.
- Flaccid paralysis, permanent nerve damage § Hepevirus
Coxsackie virus Naked (+) ssRNA Oral-fecal Coxsackie A viruses Coxsackie B viruses NOTE:
î Herpangina (vesicular pharyngitis) î Pleurodynia (Bornholm disease, Pleurodynia is pain due to
Classification is based on î Acute hemorrhagic conjunctivitis “devil’s grip”) an infection of the
pathology in mice î Hand-foot-and-mouth disease î Severe generalized disease of intercostal muscles
(vesicular rash on hands and feet infants (myositis), not of the pleura.
and ulcerations in the mouth) î Myocarditis, pericarditis (Most
î Aseptic meningitis commonly identified causative
agent of heart disease in humans)
î Aseptic meningitis
ECHO virus Naked (+) ssRNA Oral-fecal ASSOCIATED DISEASES: Orphan virus means a
î Aseptic meningitis virus that is not associated
(Enteric Cytopathic
î Upper respiratory tract infection with any known disease.
Human Orphan) î Febrile illness with and without rash Even though Echoviruses have
î Infantile diarrhea since been identified with
various diseases, the original
î Hemorrhagic conjunctivitis name is still used.
Rhinovirus Naked (+) ssRNA Aerosol droplets - replicate better at 33°C than at 37°C à affect primarily the nose and Common cold: most
conjunctiva rather than the lower respiratory tract common human infection
More than 100 serotypes Hand-to-nose - acid-labile à they are killed by gastric acid when swallowed à do not
contact infect the GIT (unlike the enteroviruses)
- Host range is limited to humans and chimpanzees
Hepatitis A virus Naked (+) ssRNA Oral-fecal - The virus replicates in the GI tract and then spreads to the liver during a Anti-HAV IgM: most useful PREVENTION: There is no antigenic
brief viremic period. test to diagnose acute Vaccine contains killed virus. relationship between
(aka Enterovirus 72)
Virus has a single serotype - The virus is not cytopathic for the hepatocyte. infection Hepatitis A and other
- Hepatocellular injury is caused by immune attack by cytotoxic T cells. Administration of immune hepatitis viruses.
globulin during the incubation
HEPATITIS A INFECTION period can mitigate the disease
î Children most frequently infected
î Self-limited hepatitis
î Short incubation hepatitis
î Anicteric hepatitis: asymptomatic or only mildly ill, absence of jaundice,
with positive serologic evidence of infection
VIRUS MORPHOLOGY TRANSMISSION PATHOGENESIS / SPECTRUM OF DISEASE DIAGNOSIS TREATMENT / PREVENTION NOTES
HEPEVIRIDAE
Hepatitis E virus Naked icosahedral (+) ssRNA Oral-fecal î Causes outbreaks of hepatitis (epidemics), primarily in developing Liver Biopsy: Hepatitis E
countries Patchy necrosis - Expectant (pregnant)
î no chronic carrier state, no cirrhosis, and no hepatocellular mother
carcinoma - Enteric
î Infection is frequently subclinical
- Epidemic
î Fulminant hepatitis in pregnant women
CALICIVIRIDAE
Norwalk virus Naked icosahedral (+) ssRNA Oral-fecal VIRAL GASTROENTERITIS RNA viruses with
î Most important cause of epidemic viral (nonbacterial) gastroenteritis icosahedral symmetry
(Norovirus)
in adults § Flaviviruses
î Sudden onset of vomiting, diarrhea, accompanied by fever and abdominal § Caliciviruses
cramping § Reoviruses
§ Picornavirus
§ Togaviruses
§ Hepevirus
REOVIRIDAE: only RNA virus with a double-stranded RNA (dsRNA) genome
Rotavirus Naked double-layered capsid - Rotavirus is resistant to stomach acid and hence can reach the small ROTAVIRUS VACCINE SEGMENTED GENOME
with segmented double- intestine î 1st dose: 6 weeks of age Bunyaviruses
stranded RNA (10 or 11 - Villous destruction with atrophy à â absorption of Na+ and loss of K+ î Last dose: not later than 32
weeks of age Orthomyxoviruses
segments) VIRAL GASTROENTERITIS
î Monovalent (RV1)/Rotarix: 2- (influenza)
î Most common cause of childhood diarrhea
dose series Arenaviruses
î Severe cases: stools are clear (“white stool diarrhea”) î Pentavalent (RV5)/RotaTeq: 3-
Reoviruses
dose series
î Min interval: 4 weeks
To God be the Greatest Glory!
VIRUS MORPHOLOGY TRANSMISSION PATHOGENESIS / SPECTRUM OF DISEASE DIAGNOSIS TREATMENT / PREVENTION NOTES
ENVELOPED RNA VIRUSES (NEGATIVE SENSE)
ORTHOMYXOVIRIDAE
Influenza Virus Enveloped virus with a helical Respiratory droplets Influenza A worldwide epidemics (pandemics) Oseltamivir (DOC) Antigenic Shift vs
nucleocapsid and segmented, each year, influenza is the MCC of respiratory and Zanamivir Antigenic Drift
ss-negative RNA infections Sudden Shift is more deadly
î used for both the treatment
has 16 antigenically distinct types of hemagglutinin and prevention of influenza than GraDual Drift
and 9 antigenically distinct types of neuraminidase; Shifts cause PANDEMICS
î neuraminidase inhibitors,
some of these types cause disease in humans but most of Drifts cause EPIDEMICS
which act by inhibiting the
the types typically cause disease in other animal species
- Many species of animals (e.g., aquatic birds, release of virus from infected
such as birds, horses, and pigs
chickens, swine, and horses) have their own cells
Influenza B Major outbreaks of influenza A for Amantadine
influenza A viruses. î effective against both influenza
Does NOT lead to pandemic effective only against
- These animal viruses are the source of the RNA A and B viruses
segments that encode the antigenic shift variants Influenza C Mild respiratory tract infection Influenza A
Does NOT cause outbreaks of influenza
that cause epidemics among humans.
The envelope is covered with two different types of spikes (which are also
Amantadine and Rimantadine
§ E.g., if an avian and a human influenza A virus
considered as the virus’ major antigens): î effective only against influenza
infect the same cell (e.g., in a farmer’s A NEGATIVE-STRAND
respiratory tract) àreassortment ànew variant o HEMAGGLUTININ
• bind to the cell surface receptor (neuraminic acid, sialic acid) to
î no longer used due to RNA VIRUSES
of the human A virus, bearing the avian virus widespread resistance Always Bring Polymerase
hemagglutinin, may appear initiate infection of the cell
Or Fail Replication
- There is evidence that aquatic birds (waterfowl) are • the target of neutralizing antibody
Arenaviruses
a common source of these new genes and that the • most important antigen
PREVENTION:
reassortment event leading to new human strains o NEURAMINIDASE
î The main mode of prevention
Bunyaviruses
occurs in pigs. • cleaves neuraminic acid (sialic acid) to release progeny virus from the Paramyxoviruses
infected cell is the vaccine, which contains
- Pigs may serve as the “mixing bowl” within which
• degrades the protective layer of mucus in the respiratory tract à both influenza A and B viruses Orthomyxoviruses
the human, avian, and swine viruses reassort.
enhances the ability of the virus to gain access to the respiratory (annual vaccination) Filoviruses
§ Waterfowl: H1 to H16, N1 to N9
§ Humans: H1 to H3, N1 and N2 epithelial cells. Rhabdoviruses
C
î Incubation Period: 10-14 days - Age: 9 months of Measles
î Period of communicability: 4 days before and 4 days after the onset of the rash - may be given as early as 6 ough
î Pathognomonic enanthem: Koplik’s spots (bright red lesions with a white central dot on months of age in cases of oryza
the buccal mucosa) outbreaks onjunctivitis
î Timing of appearance of rash: Height of the fever oplik spots
î Cephalocaudal appearance of maculopapular rash (face – trunk – extremities – MMR Vaccine
palms/soles) - Given subcutaneously
ENVELOPE SPIKES OF PARAMYXOVIRUSES
î Rash fades in the same sequence in which it appears à branny desquamation and - Given at 15 months
Virus Hemagglutinin Neuraminidase Fusion Protein disappears within 7-10 days - 2 doses recommended PaRaMyxoviruses
Measles (+) (-) (+) î Complications: Parainfluenza virus
Mumps (+) (+) (+) o Otitis Media POSTEXPOSURE PROPHYLAXIS
RSV (-) (-) (+) o Giant cell Pneumonia, Secondary Bacterial Pneumonia î Measles Ig for prevention & RSV
Parainfluenza (+) (+) (+) o Higher rate of activation of PTB attenuation within 6 days of Measles
Hemagglutinin: binds sialic acid and promotes viral entry o Subacute Sclerosing Panencephalitis (SSPE) / Dawson disease exposure
Neuraminidase: promotes progeny virion release - neurodegenerative disease caused by persistent infection of the brain by an altered î Measles Active Vaccine can
Mumps
form of the measles virus; manifests 5-7 years after initial infection be given to susceptible children
î Final common pathway to a fatal outcome is the development of bronchiolitis obliterans >1yo within 72 hours
Mumps virus Enveloped, helical, non- Respiratory droplet - The virus infects the URT à spreads through the blood à infects the: PREVENTION Three MCC of viral
segmented (-)ssRNA o parotid glands à Parotitis (increase in pain when drinking citrus juices) MMR Vaccine (aseptic) meningitis
o testes à Orchitis - live attenuated vaccine
- Given subcutaneously î Mumps virus
o ovaries
o meninges à aseptic Meningitis - Given at 15 months î Coxsackie virus
o pancreas à Pancreatitis - 2 doses recommended î Echovirus
Respiratory Enveloped, helical, non- Respiratory droplet - Surface spikes are fusion proteins, not hemagglutinins or neuraminidase Ribavirin
segmented (-)ssRNA - Fusion protein causes cells to fuse, forming multinucleated giant cells (syncytia)
Syncytial Virus
Palivizumab (monoclonal
(RSV) Humans are the
VIRAL PNEUMONIA
î RSV is the most important cause of pneumonia and bronchiolitis in infants antibody against F protein)
natural hosts of prevents pneumonia caused by
î Severe disease in infants due to immunologic cross-reaction with maternal antibodies
RSV. RSV infection in premature
RSV is also an important cause of otitis media in children and of pneumonia in the elderly
infants.
and in patients with chronic cardiopulmonary diseases.
Parainfluenza Enveloped, helical, non- Respiratory droplet LARYNGOTRACHEOBRONCHITIS / CROUP Racemic epinephrine
segmented (-)ssRNA î results in a “seal-like” barking cough and inspiratory stridor
virus 1 and 2
î Narrowing of upper trachea and subglottis à steeple sign on x-ray
î Severe croup can result in pulsus paradoxus secondary to upper airway obstruction.
In addition to croup, these viruses cause a variety of respiratory diseases such as the
common cold, pharyngitis, laryngitis, otitis media, bronchitis, and pneumonia.
VIRUS MORPHOLOGY TRANSMISSION PATHOGENESIS / SPECTRUM OF DISEASE DIAGNOSIS TREATMENT / PREVENTION NOTES
RHABDOVIRIDAE
Rabies virus Bullet-shaped Animal Reservoirs: - When a human is bitten, the virus replicates locally at the wound site for a few days, then HP: Negri bodies Pre-exposure:
enveloped, helical, non- Dogs, cats, skunks, migrates (15-100 mm/day) up to nerve axons to the CNS (retrograde transport) (cytoplasmic, round to Vaccine
segmented, (-)ssRNA raccoons, and bats oval, eosinophilic inclusions (PVRV or PDEV or PCEV – D0, D7,
SPECTRUM OF DISEASE and D21/28)
that can be found in
Transmission by Incubation 2 weeks to 6 years (depending on the site of the bite)
pyramidal neurons of the
animal bite Period The only time when vaccination is effective hippocampus and Purkinje Post-exposure:
Prodrome Nonspecific symptoms of fever, headache, sore throat, fatigue, nausea cells of the cerebellum, Vaccine +/- Immunoglobulin Negri bodies
1st rabies symptom: pain / itchiness / paresthesia sites usually devoid of
Acute ENCEPHALITIC / FURIOUS RABIES WHO GUIDELINES FOR POST-EXPOSURE PROPHYLAXIS
inflammation
neurologic - Phobic spasms: hydrophobia, aerophobia Category I Touching or feeding animals, No Treatment
period - Fluctuating consciousness licks on intact skin
Immunofluorescent Category II Minor scratches or abrasions Vaccine
- Autonomic instability
antibody test without bleeding or licks on
PARALYTIC / DUMB RABIES (IFAT): gold standard in broken skin and nibbling of
- Percussion myoedema: mounding of the muscles at the percussion site the detection of rabies uncovered skin
which disappears after a few seconds specific antigen Category III Single or multiple transdermal Vaccine +
Coma Follows the acute neurologic period, regardless of the presentation bites or scratches; Immunoglobulin
Death occurs secondary to respiratory center dysfunction contamination of mucous
Rabies has the highest case fatality ratio of any infectious disease membranes with saliva from
licks; exposure to bat
bites/scratches
All Category II exposures on
head and neck areas
FILOVIRIDAE: longest viruses
Ebola virus Enveloped, helical, non- Natural Host: fruit - targets endothelial cells, phagocytes, hepatocytes ELISA Supportive care, no definitive Ebola virus is named for the
segmented, (-)ssRNA bats of the - Incubation period: 2- 21 days treatment. river in Zaire that was the site
Pteropodidae family - abrupt onset of flu-like symptoms, diarrhea/vomiting, high fever, myalgia Antigen tests of an outbreak of
thread-like viruses - can progress to DIC, diffuse hemorrhage, shock Strict isolation of infected hemorrhagic fever in 1976.
Transmission: - high mortality rate (100%) RT-PCR individuals and barrier practices
direct contact with for health care workers are key
bodily fluids, to preventing transmission
fomites (including
dead bodies),
infected bats or
primates (apes/
monkeys)
VIRUS MORPHOLOGY TRANSMISSION PATHOGENESIS / SPECTRUM OF DISEASE DIAGNOSIS TREATMENT / PREVENTION NOTES
ENVELOPED RNA VIRUSES (POSITIVE SENSE)
CORONAVIRIDAE
Coronavirus Enveloped, helical, non- Reservoir: SPECTRUM OF DISEASE
segmented, (+)ssRNA Horseshoe bat COMMON COLDS
with prominent club- î Second to rhinovirus as the most common cause of common colds
shaped spikes form a Immediate host: SEVERE ACUTE RESPIRATORY SYNDROME
“corona” (halo) Civet cat î Incubation Period: 2-10 days (mean, 5 days)
î Receptor for SARS-CoV on surface of cells is angiotensin-converting enzyme-2 (ACE-2)
Two serotypes: Transmission:
î Binding of the virus to ACE-2 on the surface of respiratory tract epithelium à dysregulation
229E and OC43 Respiratory Droplet
of fluid balance à alveolar edema
î Severe atypical pneumonia rapidly progressing to ARDS
î Leukopenia and thrombocytopenia are seen
î CXR: interstitial “ground-glass” infiltrates that do not cavitate
Confirmed dengue:
• Viral culture isolation
• PCR
VIRUS MORPHOLOGY TRANSMISSION PATHOGENESIS / SPECTRUM OF DISEASE DIAGNOSIS TREATMENT / PREVENTION NOTES
FLAVIVIRIDAE (continued)
Hepatitis C virus Enveloped, icosahedral, Humans are the PATHOGENESIS: Anti-HCV antibodies: ACUTE HEPATITIS C: A chronic infection is
non-segmented, reservoir for HCV. - Replication of HCV in the liver is enhanced by a liver-specific micro-RNA called miR-122. screening Peginterferon alfa characterized by elevated
(+)ssRNA
This micro-RNA acts by increasing the synthesis of HCV mRNA. - significantly decreases the transaminase levels, a
HCV is the most
- Death of the hepatocytes is probably caused by immune attack by cytotoxic T cells Recombinant immunoblot number of patients who positive RIBA, and
prevalent blood-
Has at least six - Alcoholism greatly enhances the rate of hepatocellular carcinoma in HCV-infected assay (RIBA): confirmatory become chronic carriers detectable viral RNA for at
borne pathogen in
genotypes and multiple individuals. test
least 6 months
the United States. CHRONIC HEPATITIS C:
subgenotypes based on - Rate of chronic carriage of HCV is much higher than that of HBV
differences in the genes
• PCR–based test that combination of
Major mode of î Peginterferon alfa-2a
that encode one of its SPECTRUM OF DISEASE: detects the presence of
transmission:
two envelope - Incubation period: 8 weeks HCV-RNA (viral load) in î Ribavirin
blood-borne
glycoproteins. - Acute infection: milder than infection with HBV the serum should be If genotype 1, add:
Setting: IV drug
This genetic variation - Hepatitis C resembles hepatitis B as far as the ensuing chronic liver disease, cirrhosis, and performed to determine î Protease inhibitor
users
results in a the predisposition to hepatocellular carcinoma are concerned whether active disease - Boceprevir, Simeprevir,
“hypervariable” region
- HCV infection also leads to significant autoimmune reactions and extrahepatic exists. Telaprevir
Minor modes:
in the envelope manifestations, including:
Needle-stick
glycoprotein. o Thyroiditis o DM Cirrhosis resulting from chronic
injuries, during
birth, sexual o Autoimmune hemolytic anemia o leukocytoclastic vasculitis HCV infection is the most
Genotype 1: most
common in US o ITP o á risk of B-cell NHL common indication for liver
o MPGN o lichen planus transplantation
o porphyria cutanea tarda
- HCV is the main cause of essential mixed cryoglobulinemia
Zika virus Enveloped, icosahedral, Aedes mosquito - Causes conjunctivitis, low-grade pyrexia, muscle and joint pain, malaise, headache, and Supportive care, no definitive Zika virus was first identified
non-segmented, bites itchy rash in 20% cases treatment. in Uganda in 1947.
(+)ssRNA - These symptoms are usually mild and last for 2-7 days.
Sexual and vertical
transmission Complications:
possible î Microcephaly
î Guillain-Barre Syndrome
Yellow Fever virus Enveloped, icosahedral, Reservoir: - characterized by jaundice and fever May see Councilman PREVENTION: Arbovirus is an acronym for
non-segmented, monkey or human - severe, life-threatening disease that begins with the sudden onset of fever, headache, bodies (eosinophilic î mosquito control arthropod-borne virus and
(+)ssRNA myalgias, and photophobia apoptotic globules) on liver î vaccine containing live, highlights the fact that these
- After this prodrome, the symptoms progress to involve the liver, kidneys, and heart biopsy attenuated yellow fever virus viruses are transmitted by
- Prostration and shock occur, accompanied by upper gastrointestinal tract hemorrhage arthropods, primarily
with hematemesis (“black vomit”) mosquitoes and ticks. Most
arboviruses are classified in
West Nile virus Enveloped, icosahedral, Bite of Culex - bird-mosquito-man cycle
three families, namely,
non-segmented, mosquito - Virus transmitted via blood from bite site to brain.
togaviruses, flaviviruses,
(+)ssRNA
Reservoir: Wild - Initial self-limited febrile illness with progression to neuroinvasive disease
and bunyaviruses
birds - The most important clinical picture is encephalitis with or without signs of
meningitis, typically in a person over 60 years of age.
Humans are
dead-end hosts - Asymptomatic in 80%; fever and headache in 20%; encephalitis in 1%
Japanese B Enveloped, icosahedral, Bite of Culex - most common cause of epidemic encephalitis PREVENTION:
non-segmented, mosquitoes - most prevalent in Southeast Asia JE vaccine
Encephalitis virus
(+)ssRNA - Thalamic infarcts on CT scan - live attenuated recombinant
Principal vector: monovalent viral vaccine
Culex - given 0.5ml subcutaneous for
tritaeniorhynchus children 12 months and above
summarosus - primary series: single dose
- booster dose: 12-24 months
after the 1st dose
VIRUS MORPHOLOGY TRANSMISSION PATHOGENESIS / SPECTRUM OF DISEASE DIAGNOSIS TREATMENT / PREVENTION NOTES
TOGAVIRIDAE
Rubella virus Enveloped, icosahedral, Respiratory RUBELLA / GERMAN MEASLES / 3-DAY MEASLES PREVENTION: 5Bs of Congenital Rubella
non-segmented, droplets î Incubation period: 14-21 days MMR Vaccine Syndrome
(+)ssRNA î Period of communicability: 1 week before up to 1 week after the appearance of rash - live attenuated vaccine Bulag (cataracts)
Transplacentally î Prodrome: malaise, fever and anorexia for several days; may be accompanied by mild - Given subcutaneously
Only one known coryza and conjunctivitis (children may not have a prodrome) - Given at 15 months
Bingi (SN deafness)
serotype î Cephalocaudal appearance of maculopapular rash - 2 doses recommended Bobo (mental retardation)
î Postauricular lymphadenopathy: most characteristic clinical feature - should not be given to Butas puso (PDA)
î Enanthem: Forchheimer’s spots (petechiae on soft palate; not pathognomonic) immunocompromised patients Blueberry muffin rash
î polyarthritis caused by immune complexes (especially in adult women) or to pregnant women
î Natural infection leads to lifelong immunity.
CONGENITAL RUBELLA SYNDROME
î Risk is greatest early in fetal development when cell differentiation is at a peak (first
trimester)
î Rubivirus infected human embryo cells demonstrate chromosomal breakage and inhibition
of mitosis.
î Body areas affected in congenital rubella include:
o Heart: patent ductus, interventricular septal defects, pulmonary artery stenosis, etc.
o Eye: cataracts, chorioretinitis, etc.
o CNS: mental retardation, sensorineural deafness, microcephaly
î “blueberry muffin” appearance due to dermal extramedullary hematopoiesis
To God be the Greatest Glory!
RETROVIRIDAE p24
î Distinguished from all other RNA viruses by the presence of an î Group-specific antigen
unusual enzyme, reverse transcriptase à which converts a î Located in the core
single stranded RNA viral genome into a double-stranded viral î Not known to vary
DNA (ssRNA à dsDNA) î Antibodies against p24 do not neutralize HIV infectivity but
serve as important serologic markers of infection
HUMAN IMMUNODEFICIENCY VIRUS (HIV)
gp120
CHARACTERISTICS: î Interacts with the CD4 receptor
î Enveloped virus with two copies (diploid) of a single-stranded î Gene mutates rapidly à many antigenic variants
positive polarity RNA genome î V3 loop: most immunologic region of gp120
î Most complex of the known retroviruses î Antibody neutralized HIV infectivity, but the rapid appearance
î Many serotypes of variants à difficult to prepare vaccine
î High mutation rate may be due to lack of an editing function in
STRUCTURE: the reverse transcriptase
gp41
î Mediates the fusion of the viral envelope with the cell
membrane at the time of infection
GENOME:
Gene Proteins Function
Structural genes found in all retroviruses
p24, p7 Nucleocapsid
gag
p17 Matrix
Reverse Transcribes RNA genome into DNA
transcriptase
pol Protease Cleaves precursor polypeptide
Integrase Integrates viral DNA into host cell DNA
Attachment to CD4 protein
gp120
env Antigenicity changes rapidly
gp41 Fusion with host cell à Inhibited by INFUVIRTIDE
î Transmembrane protein, TM (fusion protein, also called gp41), Regulatory genes found in HIV that are required for replication
which is linked to a surface protein, and SU (attachment Activation of transcription of viral genes
tat Tat
protein, gp120)
Transport of late mRNAs from nucleus to
î Cone-shaped, icosahedral core containing the major capsid rev Rev
cytoplasm
protein (CA also called p24)
Regulatory genes found in HIV that are not required for replication
î MA (outer matrix protein, p17) – directs entry of the double-
Decreases CD4 proteins and class I MHC
stranded DNA provirus into the nucleus, and is later essential
for the process of virus assembly. There are two identical
nef Nef proteins on surface of infected cells; induces
death of uninfected cytotoxic T cells
copies of the positive sense, single-stranded RNA genome in
Enhances infectivity by inhibiting the action
the capsid (that is, unlike other viruses, retroviruses are diploid)
î The RNA is tightly complexed with a basic protein, NC vif Vif of APOBEC3G (an enzyme that causes
hypermutation in retroviral DNA)
(nucleoprotein, p7), in a nucleocapsid structure that differs in
morphology among the different retrovirus genera. Transports viral core from cytoplasm into
vpr Vpr
nucleus in non-dividing cells
vpu Vpu Enhances virion release from cells
Transmission: Pathogenesis:
î Original source: chimpanzees î Virus binds CD4 as well as a coreceptor, either CCR5 on
î Transfer of body fluids macrophages (early infection) or CXCR4 on T cells (late infection)
î Transplacental o The drug MARAVIROC is a CCR5 receptor antagonist.
î Perinatal î Preferentially infects and kills helper (CD4+) T lymphocytes
î Needlestick o Loss of cell-mediated immunity
o High probability of opportunistic infections
î also targets a subset of CD4+ cells called Th17 cells, which are
important mediator of mucosal immunity
o Th17 cells produce IL-17, which attracts neutrophils to the site
of bacterial infection.
o loss of Th17 cells à bloodstream infections by bacteria in the
normal flora of the colon (eg., E.coli)
î Main immune response consists of cytotoxic (CD8+) lymphocytes
STAGES OF INFECTION
Phase 0 Infection HIV acquired through sexual DIAGNOSIS
intercourse, blood, or perinatally î Presumptive diagnosis: detection of antibodies in the
Phase 1 Window Rapid viral replication but HIV test is patient’s serum to the p24 protein of HIV using ELISA.
Period negative o There are some false-positive results with this test
î Definitive diagnosis: Western blot (aka Immunoblot) analysis
Phase 2 Seroconversion Peak of viral load o Viral proteins are displayed by acrylamide gel electrophoresis,
Positive HIV test transferred to nitrocellulose paper (the blot), and reacted with
Mild flu-like illness lasting 1-2 weeks the patient’s serum.
Phase 3 Latent Period Asymptomatic o If antibodies are present in the patient’s serum, they will bind to
the viral proteins (predominantly to the gp41 or p24 protein).
CD4 goes down
o Enzymatically labeled antibody to human IgG is then added.
Lasts 1-15 years o A color reaction reveals the presence of the HIV antibody in the
Phase 4 Early CD4 500 to 200 infected patient’s serum.
Symptomatic Lasts 5 years ELISA WESTERN BLOT
Mild mucocutaneous, dermatologic, Presumptive diagnosis Definitive diagnosis
and hematologic illnesses sensitive specific
high false positive rate low false positive rate
Phase 5 AIDS CD4 <200 low threshold high threshold
Lasts 2 years rule out test rule in test
AIDS-defining illnesses develop
î HIV can be grown in culture from clinical specimens, but this
AIDS-DEFINING ILLNESSES procedure is available only at a few medical centers.
CD4 ETIOLOGY CLINICAL SYNDROME
î The PCR is a very sensitive and specific technique
M. tuberculosis Disseminated tuberculosis o can be used to detect HIV DNA within infected cells
HSV HSV esophagitis o Some individuals who do not have detectable antibodies
<500
C. albicans Esophageal candidiasis have been shown by this test to be infected.
HHV-8 Kaposi sarcoma o The amount of viral RNA in the plasma (i.e., the viral
P. jiroveci PCP pneumonia load) can also be determined using PCR-based assays.
T. gondii Cerebral toxoplasmosis
<200 C. neoformans Meningoencephalitis TREATMENT
C. immitis Coccidioidomycosis î Highly active antiretroviral therapy
C. parvum Chronic diarrhea
M. avium Invasive pulmonary disease
<50 H. capsulatum Histoplasmosis
CMV CMV retinitis
AIDS-DEFINING ILLNESS: Prevalence
P. carinii pneumonia (PCP) 42.6%
Esophageal candidiasis 15.0%
Wasting 10.7%
Kaposi sarcoma 10.7%
Disseminated MAC 4.8%
COMMON OPPORTUNISTIC INFECTIONS
Site of Infection Disease or Symptom Causative Organism
Lung 1. Pneumonia Pneumocystis jiroveci, CMV
2. Tuberculosis Mycobacterium tuberculosis
Mouth 1. Thrush Candida albicans
2. Hairy leukoplakia Epstein-Barr virus
3. Ulcerations HSV-1, Histoplasma capsulatum
Esophagus 1. Thrush Candida albicans
2. Esophagitis CMV, HSV-1
î Immune reconstitution inflammatory syndrome (IRIS)
Intestinal tract Diarrhea Salmonella sp., Shigella sp,
CMV, Cryptosporidium parvum, describes a collection of inflammatory disorders associated
Giardia lamblia with paradoxical worsening of preexisting infectious processes
Central nervous 1. Meningitis Cryptococcus neoformans (HBV, HCV, MAC, MAI, etc) following the initiation HAART in
system 2. Brain abscess Toxoplasma gondii
HIV-infected individuals
3. Progressive multifocal JC virus
leukoencephalopathy
Eye Retinitis CMV PREVENTION
Skin 1. Kaposi's sarcoma HHV-8 General Prevention:
2. Zoster Varicella-zoster virus î Condoms, not sharing needles, proper blood disposal,
3. Subcutaneous nodules Cryptococcus neoformans
Reticulo- Lymphadenopathy or Mycobacterium avium complex,
postexposure prophylaxis
endothelial system splenomegaly Epstein-Barr virus
Perinatal Prevention:
The two most characteristic manifestations of AIDS are Pneumocystis î Perinatal Prophylaxis, cesarean delivery, breastfeeding
pneumonia and Kaposi’s sarcoma. cessation
HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART):
î Often initiated at the time of HIV diagnosis.
3
î Strongest indication for patients presenting with AIDS-defining illness, low CD4+ cell counts (< 500 cells/mm ), or high viral
load
î Regimen consists of 3 drugs to prevent resistance: 2 NRTIs (zidovudine and lamivudine) and protease inhibitor (indinavir)
HEPATITIS VIRUSES
Plasmodium
Babesia
Protozoa Apicomplexa Sporozoa
Cytoisospora
(no organelle of locomotion) (no locomotory organ)
Cryptosporidium
Toxoplasma
Ciliophora
Balantidium
(move by cilia)
Microspora
Enterocytozoa
(spore-forming)
Metazoa
ASCHELMINTHES PLATYHELMINTHES
(Round worms) (Flat worms)
Appear round in cross-section Dorsoventrally flattened
With body cavities No body cavity
With straight alimentary canal and an And if present, the alimentary canal is
anus blind-ending
NEMATODES CESTODES TREMATODES
Elongated cylindrical worms - Adult tapeworms are found in - Non-segmented, usually leaf-
Sexes are separated, unsegmented the intestine of their host shaped, with two suckers but no
Reproduce by oviparous and - Have a head (scolex) with sucking distinct head
viviparous organs, a segmented body but no - They have an alimentary canal
alimentary canal and are usually hermaphrodite
- Each body segment is - Schistosomes are the exception.
Ascaris (roundworm)
e hermaphrodite (They are threadlike, not leaf-
Trichuris (whipworm)
shaped, and have separate sexes)
Enterobius (pinworm/threadworm)
Ancylostoma (hookworm)
Necator (hookworm)
Diphyllobothrium Paragonimus
Strongyloides
Taenia (Tapeworm) Schistosoma
Capillaria
Echinococcus Fasciolopsis
Dipylidium Echinostoma
Hymenolepis Fasciola
Clonorchis
Opisthorchis
PROTOZOA PARASITE BIOLOGY TRANSMISSION INFECTIVE STAGE DIAGNOSTIC STAGE PATHOGENESIS/VIRULENCE FACTORS SPECTRUM OF DISEASE TREATMENT NOTES
INTESTINAL PROTOZOA
Entamoeba î Pseudopod-forming Fecal-oral Mature Cysts Trophozoite î Lectin: mediates adherence ASYMPTOMATIC CYST CARRIER STATE ASYMPTOMATIC CYST
nonflagellated protozoa CARRIER STATE
Giardia lamblia î Flagellate that lives in the Fecal-oral Cysts Trophozoite î Adhesive disc and lectin facilitate ACUTE INFECTION î Metronidazole
duodenum, jejunum, and - found only in diarrheal attachment to avoid peristalsis î abdominal pain
upper ileum stools î Villous flattening, crypt î watery, foul-smelling diarrhea
- pear-shaped with two hypertrophy and disruption of î excessive flatus, smelling like rotten
î Falling leaf motility nuclei, four pairs of flagella, cytoskeleton eggs
î Simple asexual life cycle and a suction disk with î Ultimately leads to enterocyte î No fever and non-bloody (does not
which it attaches to the apoptosis invade the mucosa and does not enter the
î Covered with variant bloodstream)
UROGENITAL PROTOZOA
Trichomonas î Exists only as Sexual intercourse Trophozoites Trophozoite TRICHOMONIASIS î Metronidazole 2g
trophozoite (“ping-pong” (seen in wet mount of î Watery, foul-smelling, greenish single dose
vaginalis
î Pear-shaped flagellated transmission) vaginal fluid) discharge accompanied by itching and - Treat both the
trophozoite with jerky burning patient and the
î Strawberry cervix partner
motion
î cannot exist outside human
because it cannot form cysts
Motile Trophozoites
THE COMMENSAL AMOEBA
- non-invasive and do not cause disease
- reproduce by binary fission
- cysts pass through the acidic stomach unscathed, protected by their cyst wall
- excystation occur in the small intestine
Entamoeba dispar morphologically similar to E. histolytica but their DNA and ribosomal RNA are
different
Entamoeba hartmanni similar to E. histolytica but is much smaller and does not ingest RBC, sluggish
Entamoeba coli cosmopolitan in distribution, harmless inhabitant of colon, has a larger cyst and
greater number of nuclei than E. histolytica
Entamoeba polecki parasite of pigs and monkey, cyst is uninucleated
Entamoeba gingivalis has no cyst stage and does not inhabit the intestines, found in the mouth,
moves quickly and has numerous blunt pseudopodia, transmission is via kissing
or droplet spray
Endolimax nana small size, sluggish movement
Iodamoeba butschlii no peripheral chromatin granules on the nuclear membrane
PROTOZOA PARASITE BIOLOGY TRANSMISSION INFECTIVE STAGE DIAGNOSTIC STAGE PATHOGENESIS/VIRULENCE FACTORS SPECTRUM OF DISEASE TREATMENT NOTES
BLOOD AND TISSUE PROTOZOA
Plasmodium î Most important parasitic Bite of infected Sporozoites Trophozoite (ring forms) î Most of the pathologic findings of î Paroxysmal fever with malaise and bone PREVENTION BUZZ WORDS
disease in man female mosquito malaria result from the destruction pains î Chemoprophylaxis
species Infected RBC with 1-2
(Anopheles of RBCs. î Hemolytic anemia, jaundice, î Insecticide-treated nets
splenomegaly î Insect repellants with small chromatin dots
î ASEXUAL life cycle consists minimus DIAGNOSTIC TESTS FOR MALARIA - enlarged spleen characteristic
à P. falciparum
of schizogony and flavirostris) î Thick and thin smears with Giemsa stain of malaria is due to congestion of î Parasitic pneumonitis DEET
î Cerebral malaria î Biological modification
gametogony - Thick smear: to screen for the presence of sinusoids with erythrocytes,
coupled with hyperplasia of - Malarial or Durck granulomas à cultivation of snails infected RBC
transmission organism
lymphocytes and macrophages î Acute Renal Failure (Blackwater fever) that eat up mosquito with presence of ring
î SEXUAL life cycle involves across the - Thin smear: for species identification
placenta, in blood î Septic shock (algid malaria) larvae form stage only à P.
sporogony - HIGHEST YIELD WHEN BLOOD SAMPLES
falciparum
transfusions, and TAKEN DURING FEVER OR 2-3 HOURS AFTER î People with RBC defects ( G6PD
by intravenous PEAK deficiency, sickle cell) are SPECIAL CLINCAL OUTCOMES
Areas of High Areas of Chloroquine infected RBC
Endemicity Resistance
drug use also protected against the severe effects î RECRUDESCENCE
occurs of falciparum malaria - Recurrence of symptoms after a with presence of
î Palawan î Palawan
temporary abatement (2-4 weeks) band form stages à
î Kalinga- Apayao î Davao del Norte - Seen in P. falciparum and P. P. malariae
î Partial immunity based on humoral
î Ifugao î Campostela Valley malariae
antibodies that block merozoites
î Agusan del Sur from invading the red cells occurs in
infected individuals (premunition) î RELAPSE
- Return of disease after its apparent
Leishmania î Flagellate protozoa Bite of the female Promastigotes Amastigote LEISHMANIASIS Conventional Therapy:
sandfly of the CUTANEOUS MUCOCUTANEOUS VISCERAL Sodium
species
genus Causative L. tropica stibogluconate
L. braziliensis L. donovani
Phlebotomus or Agent L. mexicana (Pentavalent antimonial)
Lutzomyia LABORATORY DIAGNOSIS
Local Name Oriental Sore Espundia Kala-azar
Examination of Giemsa- Second-line agents:
Presentation ulcerating single or parasite attacks infects macrophages
stained tissue and fluid Amphotericin B
multiple skin sores tissue at the à migrate to the
samples for the Pentamidine
mucosal-dermal spleen, liver, and
nonflagellated form junctions of the bone marrow à
(amastigote), which is the nose and mouth à parasite rapidly
Macrophages containing only form that occurs in multiple lesions multiplies à
L. donovani amastigotes humans and other mammals. hepatosplenomegaly
Babesia microti î Sporozoan Bite Ixodes tick Giemsa-stained blood smears î Babesia infects RBCs, causing them BABESIOSIS Mild to moderate
(same as Borrelia reveal intraerythrocytic to lyse, but unlike plasmodia, it has î Influenza-like symptoms begin gradually disease:
burgdorferi of ring-shaped trophozoites no exoerythrocytic phase. and may last for several weeks Atovaquone +
Lyme disease) are often in tetrads in the î Hepatosplenomegaly and anemia occur Azithromycin
î Asplenic patients are affected
form of a Maltese cross
more severely. Severe disease:
Quinidine +
or muscle biopsy î neuronal damage leads to cardiac (Romaña’s sign) There is no effective
specimen (which may arrhythmias and loss of tone in the - resolves in about 2 months drug against the
reveal amastigotes) colon (megacolon) and esophagus
chronic form.
î CHRONIC FORM:
î culture of the organism on (megaesophagus)
- myocarditis, dilated cardiomyopathy
Trypomastigote in special medium
with apical atrophy
blood smear î Xenodiagnosis: allowing - megacolon, megaesophagus
an uninfected, laboratory- (secondary achalasia)
raised reduviid bug to feed - Death is usually due to cardiac
on the patient and, after arrhythmias or congestive heart
several weeks, examining failure
the intestinal contents of
- leading cause of CHF in Latin
the bug for the organism
America
Trypanosoma î Blood and tissue protozoan Tsetse fly Metacyclic Trypomastigote in blood î Trypomastigotes spread from the skin à blood à lymph nodes à brain Suramin for
î Only two forms: (Glossina), a trypomastigote î The typical somnolence (sleeping sickness) progresses to coma as a result of a bloodborne disease
brucei
- Epimastigote painful bite demyelinating encephalitis (ARAS, brainstem)
Melarsoprol for
- Trypomastigote î In the acute form, a cyclical fever spike (approx. every 2 weeks) occurs that is
î exhibit remarkable related to antigenic variation. CNS penetration
antigenic variation of
Morula cells of Mott
their surface glycoproteins AFRICAN TRYPANOSOMIASIS / AFRICAN SLEEPING SICKNESS
î initial lesion: indurated skin ulcer (“trypanosomal chancre”) at the site of the
Trypanosoma brucei gambiense Trypanosoma brucei rhodesiense fly bite
î causes the disease along water courses î found in the arid regions of east Africa î intermittent weekly fever and lymphadenopathy
in west Africa î enlargement of the posterior cervical lymph nodes (Winterbottom’s sign) MELlow music will
Trypomastigote in î deep hyperaesthesia (Kerandel's sign) SURely put you to
î runs a low-grade chronic course î causes a more acute, rapidly SLEEP.
blood smear î Encephalitis à excessive somnolence
over a few years progressive disease that, if untreated, is
• Morula cells of Mott: plasma cells with cytoplasmic immunoglobulin
usually fatal within several months MELarsoprol and
globules
î Transmitted by Glossina î Transmitted by Glossina SURamin for African
î Untreated disease is usually fatal as a result of pneumonia.
palpalis (or riverine tsetse) morsitans (or savannah tsetse) SLEEPing sickness
î Treatment: î Treatment:
Stage 1 Stage 2 • Suramin (to clear parasitemia)
Pentamidine Eflornithine followed by Melarsoprol
Suramin Melarsoprol
Acanthamoeba î free-living amebas carried into the Trophozoites Occur primarily in î KERATITIS: most common disease Pentamidine, î MC parasite that
î Most common protist in soil skin or eyes immunocompromised individuals associated with Acanthamoeba infection ketoconazole, or contaminates
castellani
during trauma î GRANULOMATOUS AMEBIC flucytosine contact lenses
ENCEPHALITIS
Naegleria fowleri î free-living amebas Swimming in Trophozoites occur in otherwise healthy persons î PRIMARY AMEBIC Amphotericin-B
freshwater Trophozoites can penetrate the nasal MENINGOENCEPHALITIS
lakes mucosa and cribriform plate
PROTOZOA PARASITE BIOLOGY TRANSMISSION INFECTIVE STAGE DIAGNOSTIC STAGE PATHOGENESIS/VIRULENCE FACTORS SPECTRUM OF DISEASE TREATMENT NOTES
DINOFLAGELLATES
Dinoflagellates î Flagellated marine protists Eating bivalve î Filter feeders accumulate toxins produced by dinoflagellates î Gastric lavage with
î Algal blooms cause red mollusks
activated charcoal
SHELLFISH POISONING SYNDROMES
tide (mussels, clams, î Supportive fluid
Syndrome Toxin Incubation Clinical presentation
î Most common in the oysters, and resuscitation
Philippines is Pyrodinium scallops) and fish Facial paresthesia, total
Paralytic Saxitoxin
PLATYHELMINTHES
Species Transmission Intermediate Host Site Affected Treatment
CESTODES / TAPEWORMS
Eggs/larvae in undercooked
Taenia solium Pigs Intestine Praziquantel
pork
Taenia saginata larvae in undercooked beef Cattle Intestine Praziquantel
Diphyllobothrium latum larvae in undercooked fish Fish Intestine Praziquantel
Eggs in food contaminated
Echinococcus granulosus Swine Liver Albendazole
with dog feces
TREMATODES / FLUKES
Schistosoma japonicum Penetrate skin Snail Blood Praziquantel
Pargonimus westermani Ingested with raw crab Snail and crab Lung Praziquantel
Clonorchis sinensis Ingested with raw fish Snail and fish Liver Praziquantel
ASCHELMINTHES / NEMATODES
Location Species Disease Transmission Treatment
Ascaris lumbricoides Ascariasis Ingestion of eggs Albendazole
Ancylostoma duodenale
Hookworm Larval penetration of skin Albendazole
Necator americanus
Intestines Trichuris trichiura Whipworm Ingestion of eggs Mebendazole
Enterobius vermicularis Pinworm Ingestion of eggs Pyrantel pamoate
Strongyloides stercoralis Strongyloidiasis Larval penetration of skin Ivermectin
Capillaria phiippinensis Capillariasis Eggs in undercooked fish Albendazole
Wuchereria bancrofti Diethylcarbamazine
Filariasis Mosquito bite
Tissue Brugia malayi (DEC)
Trichinella spiralis Trichinosis Eggs in undercooked meat Thiabendazole
CESTODES / FLATWORMS Taenia solium Taenia saginata Diphyllobothrium latum Echinococcus granulosus
Parasite Biology / Scolex: has four suckers and circle of hooks arranged around a rostellum Scolex: has four suckers but, longest of the tapeworms composed of a scolex and only three
Characteristics Gravid proglottids: have 5 -10 primary uterine branches no hooklets (no rostellum) Scolex: has two elongated sucking proglottids à one of the smallest
Gravid proglottids: have 15-25 grooves for attachment; no hooks tapeworms
T. solium T. saginata
Suckers 4 4 primary uterine branches Proglottids: wider than they are long; Scolex: circle of hooks and four
Rostellum (+) (-) gravid uterus is in the form of a rosette suckers (similar to T. solium)
Uterine Branches 5-10 15-25 Have oval and operculated eggs
Intermediate Host Pigs Cattle Copepods (first IH) and fish (second IH) Sheep / Humans (accidental IH)
Infective stage Larvae (cysticerci) Eggs Larvae (cysticerci) Plerocercoid / sparganum larvae Eggs
Mode of Transmission Ingestion of larvae (cysticerci) in Ingest eggs in food or water Ingestion of larvae (cysticerci) in Ingestion of plerocercoid larvae in Ingestion eggs in food contaminated with
undercooked pork contaminated with human feces undercooked beef undercooked fish dog feces (Dog is the definitive host)
Stage in Humans Adult tapeworm in intestine, Cysticercus, especially in brain; Adult tapeworm in intestine, Adult tapeworm in intestine can cause Larva causes unilocular hydatid cyst
Associated with Disease causing taeniasis causing cysticercosis causing taeniasis diphyllobothriasis disease, especially in liver and lung
Sites Affected Intestine Brain and eyes Intestine Intestine Liver, lungs, and brain (hydatid cysts)
Signs and symptoms Mild intestinal symptoms Brain (neurocysticercosis): Abdominal pain Abdominal pain Liver cysts à hepatic dysfunction
headache, vomiting, seizure Weight loss Diarrhea Pulmonary cysts à erode into a bronchus
Pruritus ani Vitamin B12 deficiency caused by à bloody sputum
Eyes: uveitis or retinitis, larvae in Intestinal obstruction preferential uptake of the vitamin by Cerebral cysts à headache and focal
viterous the worm à megaloblastic anemia neurologic signs.
Rupture of cyst à anaphylactic shock
Diagnosis/Diagnostic Stage Gravid Proglottids in stool Biopsy, CT scan Gravid Proglottids in stool Unembryonated operculated eggs in Biopsy, CT Scan, serology
stool
Treatment Praziquantel Praziquantel, Albendazole, or Praziquantel Praziquantel Albendazole, or surgical removal of cyst
surgical removal of cysticerci PAIR procedure: Puncture, Aspiration,
Injection, Reaspiration
Pathogenesis Ingested larvae (cysticerci) in small Ingestion of eggs in food or water Taeniasis similar with T. solium See diagram on the next page Worms in the dog’s intestine liberate
intestine attach to gut wall contaminated with human feces thousands of eggs
Ü Ü
Ü
eggs hatch in the small intestine T. saginata does NOT cause Eggs ingested by sheep (or humans)
Grow into adult worms à taeniasis
Ü Ü cysticercosis in humans. Ü
Gravid proglottid containing eggs detach oncospheres burrow through the wall into Oncosphere embryos emerge in the small
intestine
daily a blood vessel
Ü Ü
Ü
Eggs are passed in the feces disseminate to many organs, especially the migrate primarily to the liver but also to
Ü
eyes and brain the lungs, bones, and brain
Eggs eaten by pigs (intermediate host) Ü Ü
Ü
Six-hooked embryo (oncosphere) encyst to form cysticerci Embryos develop into large fluid-filled hydatid
Ü
emerges from each egg in pig’s intestine cysts, the inner germinal layer of which
Ü
cysticercosis generates many protoscoleces within “brood
Embryos burrow into blood vessel and
capsules.”
carried to skeletal muscle Living cysticerci do not cause
Ü
inflammation Cyst acts as a space-occupying lesion
Develop into cysticerci in muscle
Ü
Eaten by human (definitive host) Cysticerci can become space- Cyst fluid contains parasite antigens,
occupying lesions in the brain which can sensitize the host.
CESTODES OF MINOR IMPORTANCE
Echinococcus multilocularis Hymenolepsis nana Hymenolepsis diminuta Dipylidium caninum
• Definitive hosts: FOXES • Dwarf tapeworm • Rat tapeworm • most common tapeworm of dogs and cats
• Intermediate host: RODENTS • most frequently found tapeworm in developed • Transmission: ingestion of RAT FLEA cysticercoid • Transmission: ingestion of DOG OR CAT FLEAS
• Transmission: accidental ingestion of food countries larvae carrying cysticerci
contaminated with fox feces • Ingestion of cysticercoid larvae from infected • Accidental parasite • Diagnosis: “barrel-shaped” proglottids in stools
• larvae form multiloculated cysts (honeycomb RICE or FLOUR BEATLE • Drug-of-choice: NICLOSAMIDE
vesicles) • eggs are directly infectious for humans
• Treatment: ALBENDAZOLE; surgical cyst removal • eggs either pass in the stool or can reinfect the
small intestine (autoinfection)
• Eggs: 8-10 polar filaments and six-hooked larva
• Treatment: PRAZIQUANTEL
TREMATODES ARTHROPRODS OF MEDICAL IMPORTANCE
▫ Phylum: Platyhelminthes Organism Scientific Name Disease Features
▫ Flattened, leaf-shaped or cylindrical worms (Schistosoma) Lice Pediculus humanus Pruritus of the scalp or trunk
▫ Unsegmented Nits seen of hair shaft
▫ Hermaphroditic / Monoecious except SCHISTOSOMA Treatment: topical ivermectin lotion, lindane, and malathion
▫ All flukes are transmitted by ingestion of METACERCARIA except SCHISTOSOMA which is Phthirus pubis Pruritus in pubic area
transmitted by skin penetration of CERCARIA. Nits seen on hair shaft
▫ All fluke eggs are operculated except SCHISTOSOMA. Flies Dermatobia hominis Pruritic, painful, and erythematous nodule
Larva may be seen emerging from nodule
SPECIES: Pruritic, erythematous wheal
Bedbugs Cimex lectularius
▫ Paragonimus (lung fluke)
Mites Sarcoptes scabei Pruritic, erythematous papules and linear tracks
▫ Schistosoma (blood fluke) Treatment: permethrin cream, washing/drying
▫ Fasciolopsis all clothing/bedding, treat close contacts
▫ Echinostoma Ticks Dermacentor Ascending paralysis
Small intestinal flukes
▫ Metagonimus
▫ Heterophyes
Mechanisms of Action of Anti-mite/Anti-Louse Therapy
▫ Fasciola î Permethrin: neuronal membrane depolarization via Na+ channels
▫ Clonorchis Liver flukes
î Malathion: acetylcholinesterase inhibitor
▫ Opistorchis
î Lindane: blocks GABA channels à neurotoxicity
▫ Eurytrema pancreaticum (pancreatic fluke)
▫ Gastrodiscoides (large intestinal fluke)
CLASSIFICATION OF TREMATODE EGGS
LARGE UNEMBRYONATED MEDIUM, UNEMBRYONATED SMALL / MINUTE, EMBRYONATED
▫ Echinostoma ▫ Paragonimus ▫ Clonorchis
▫ Fasciolopsis ▫ Heterophyes
▫ Fasciola ▫ Opisthorchis
▫ Metagonimus
CLASSIFICATION OF FLUKES ACCORDING TO SECOND INTERMEDIATE HOST
WATER PLANT-
ANT-BORNE
SNAIL-BORNE
FISH-BORNE
BORNE (MOLLUSKS)
▫ Faciolopsis buski ▫ Eurythrema ▫ Echinostoma ▫ Clonorchis sinensis
▫ Fasciola hepatica pancreaticum ilocanum ▫ Heterophyes heterophyes
▫ Opisthorchis spp.
▫ Metagonimus yokogawai
TREMATODES / FLUKES Schistosoma japonicum S. mansoni S. haematobium Paragonimus westermani Clonorchis sinensis
Parasite Biology / î Oriental fluke; Blood flukes î Japanese lung fluke î Chinese liver fluke / Oriental liver fluke
Characteristics î Reside in the mesenteric and portal veins î Hermaprodite î Hermaprodite
î Adult schistosomes exist as separate sexes (other trematodes are hermaphrodite)
î Evade host defenses by coating themselves with host antigens
î Can cause schistosomiasis (aka bilharzias, bilharziasis, or snail fever)
Intermediate Host Snail: Snail: Snail: Snail: Antemelania asperata Snail: Parafossarulus
Oncomelania hupensis quadrasi Biomphalaria glabrata Bulinus truncatus Mountain crab: Sundathelphusa philippina Fish: Cyprinidae
Infective stage CERCARIAE LARVAE (metacercariae) LARVAE (metacercariae)
Mode of Transmission SKIN PENETRATION BY CERCARIAE INGESTION of raw crabmeat/crayfish INGESTION of undercooked fish
Stage in Humans
Associated with Disease
Adult flukes living in mesenteric or bladder veins lay eggs that cause granulomas Adult flukes live in the lungs Adult flukes live in the liver
Sites Affected Veins of small intestine, liver Veins of colon Veins of urinary bladder Lung Liver, especially the common bile duct
Spectrum of Disease Intestinal Schistosomiasis Urinary Schistosomiasis Paragonimiasis Clonorchiasis
ACUTE SCHISTOSOMIASIS: î Within the lung, the worms exist in a fibrous î Inflammatory response can cause
î Cercarial dermatitis (swimmer’s itch) capsule that communicates with a bronchiole à hyperplasia and fibrosis of the biliary
î Katayama fever: systemic hypersensitivity; serum sickness-like syndrome provokes a granulomatous reaction tract
CHRONIC SCHISTOSOMIASIS î Secondary bacterial infection frequently occurs
î Main symptom: chronic cough with bloody ACUTE DISEASE:
î Pseudopolyps in the colon î Painless hematuria and î Fever, eosinophilia, lymphadenopathy,
î Liver granulomas (due to delayed hypersensitivity) lead to sputum
fibrosis of the bladder tender hepatomegaly
presinusoidal obstruction, hepatomegaly, and portal î CXR: ring shadow opacity
î Hydronephrosis
î Closely resembles tuberculosis CHRONIC DISEASE:
hypertension î Associated with squamous
î Hepatobiliary disease
î gastrointestinal hemorrhage, massive splenomegaly cell carcinoma of the î Pancreatitis
î Liver UTZ: clay pipestem fibrosis with lacelike pattern bladder î Cholangiocarcinoma (Klatskin tumor)
î MCC of death: exsanguination from ruptured esophageal
î Neurocirculatory dystonia
varices
Diagnostic Test Fecalysis (Kato-Katz technique): demonstration of parasite eggs 3% NaOH preparation Direct fecal smear
Circumoval precipitin test (COPT): detects circulating schistosome antigen Potassium permanganate stain
Rectal imprint: biopsy of rectal tissue with the aid of proctoscopy - showing melon-like ridges with
abopercular protuberance
Diagnostic Features of Eggs Large, prominent Operculated / unembryonated egg in Operculated / embryonated egg in
Small lateral spine (‘knob’) Large terminal spine
lateral spine sputum or feces feces
Treatment PRAZIQUANTEL PRAZIQUANTEL PRAZIQUANTEL
Others AREAS OF ENDEMICITY: Sorsogon, Samar, Leyte, Oriental Mindoro, Bohol, ASIAN LIVER FLUKES:
all of Mindanao EXCEPT Misamis Oriental • Clonorchis sinensis
• Opistorchis viverrini (Southeast Asian liver fluke)
The single most important epidemiological factor in schistosomiasis is human waste in water
containing the intermediate host.
TREMATODES/FLUKES OF MINOR IMPORTANCE
Fasciola hepatica Fasciolopsis buski Heterophyes heterophyes
î sheep liver fluke î giant intestinal fluke î intestinal parasite of people living in Africa, the Middle East, and Asia
î Humans are infected by eating watercress (or other aquatic plants) î intestinal parasite of humans and pigs that is endemic to Asia and India. who are infected by eating raw fish containing cysts
î Symptoms are due primarily to the presence of the adult worm in the î Humans are infected by eating aquatic vegetation that carries the î Pathologic findings are due to inflammation of the intestinal
biliary tract. cysts. epithelium as a result of the presence of the adult flukes.
î In early infection, right-upper-quadrant pain, fever, and hepatomegaly î Pathologic findings are due to damage of the intestinal mucosa by î Mimics peptic ulcer disease
can occur, but most infections are asymptomatic. the adult fluke. î Praziquantel is the treatment of choice.
î Months or years later, obstructive jaundice can occur. î Most infections are asymptomatic, but ulceration, abscess
î Halzoun is a painful pharyngitis caused by the presence of adult flukes formation, and hemorrhage can occur.
on the posterior pharyngeal wall. î Gland abscesses
î The drug of choice is triclabendazole. î Worm intoxication: anasarca and coma resulting from
accumulation of toxins
î Praziquantel is the treatment of choice.
Necator americanus Strongyloides
NEMATODES Ascaris lumbricoides Trichuris trichiura Enterobius vermicularis Capillaria philippinensis
Ancylostoma duodenale stercoralis
Common Name or Giant Roundworm / Ascariasis Hookworm Whipworm Pinworm / Seatworm / Strongyloidiasis Pudoc Worm / Capillariasis
Disease Miners’ anemia, “tunnel disease”, Wakana disease, Mystery Disease / Wasting Disease
Enterobiasis / Oxyuriasis
“brickmaker’s anemia” “Egyptian chlorosis”
Parasite Biology / î Most common and largest nematode î Soil-transmitted helminth (STH) î Soil-transmitted helminth î Soil-transmitted helminth î Soil-transmitted helminth î intestinal nematode
Characteristics î Soil-transmitted helminth (STH) î Blood-sucking nematodes î Life cycle is confined to humans î Facultative parasites î only nematode whose life cycle
î Differentiated based on character of buccal î MC STH in developed countries î only helminth that causes involves a migratory bird
spears of filariform larvae à a cosmopolitan worm greater pathology in AIDS
patients
Habitat Small intestine Small intestine Large intestine Large intestine Small intestine Small intestine
Transmission Ingestion of embryonated eggs Skin penetration by filariform larva (L3) Ingestion of embryonated eggs Ingestion of embryonated eggs Skin penetration by filariform ingestion of infected fish with
Inhalation of eggs larva (L3) L3 larvae
Infective Stage Embryonated egg L3 / Filariform larva Embryonated egg Embryonated egg L3 / Filariform larva L3 larvae
Diagnostic Stage Fertilized egg Eggs in feces Unembryonated egg Eggs on perianal folds Rhabtidiform (L1) Unembryonated egg
Diagnostic Test Direct fecal smear Direct fecal smear Direct fecal smear Graham’s scotch/cellulose Harada-Mori culture Direct fecal smear
Kato-katz technique Kato-katz technique Kato-katz technique tape test Kato-katz technique
Harada-Mori culture - lemon-shaped or barrel- (distinguished by their - Peanut-shaped eggs with
- D-shaped ovum with thin
shaped eggs with bipolar prominent genital primordium flattened bipolar plugs
colorless cell wall
plugs / football-shaped eggs and a pointed tail)
Pathogenesis î Major damage occurs during larval î The major damage is due to the loss of î Burrow their hairlike anterior î Female releases thousands of î Larvae penetrate intestinal î Embryonated eggs can cause
migration blood at the site of attachment in the ends into the intestinal mucosa fertilized eggs on perianal skin wall directly without leaving autoinfection and
î Principal site of tissue reaction is the small intestine (0.1-0.3 mL/worm/day) î Does NOT cause significant - Eggs develop into larvae, host and migrate to the lungs hyperinfection
lungs, where inflammation with an î Blood is consumed by the worm and oozes anemia causing anal pruritus (autoinfection) î ulcerative and compressive
eosinophilic exudate occurs from the site in response to an î Autoinfection can occur degeneration of enterocytes à
î Heavy worm burden à malnutrition anticoagulant made by the worm. severe malnutrition
Spectrum of LUNG PHASE: CUTANEOUS PHASE: î Diarrhea î Pruritus ani CUTANEOUS PHASE: ACUTE DISEASE:
Disease î L3àL5 î Penetration of L3 to the skin î Rectal prolapse (from î Eosinophilic enterocolitis î Penetration of L3 to the skin î Borborygmi
î Hypersensitivity pneumonitis î Ground itch increased peristalsis to expel the î Vulvovaginitis î Acute: Ground itch î Fever, abdominal pain,
(Loeffler’s Syndrome) î Cutaneous larva migrans (creeping worms) î Salpingitis î Chronic: serpiginous track eosinophilia
INTESTINAL PHASE: eruption) î Appendicitis (oxyuriasis) (larva currens)
î L5 à adult worms LUNG PHASE: LUNG PHASE: CHRONIC DISEASE:
î Acute intestinal obstruction î Lung migration of L3 (no development) î Lung migration of L3 î Chronic watery diarrhea
î Malabsorption syndrome î Simple lung eosinophilia (Loeffler’s î Acute: Loeffler’s syndrome î Edema, wasting
î Nutrient deficiencies syndrome) î Chronic: Paradoxical asthma î Protein-losing enteropathy
WANDERING WORMS: INTESTINAL PHASE: INTESTINAL PHASE: î hypogammaglobulinemia
î Due to erratic behavior of adult worms î L3 à L5 î Mild watery diarrhea
î Hepatobiliary ascariasis î Up to 200mL of blood may be lost per day î burrowing into the mucosa and
î Pancreatitis, appendicitis î Iron-deficiency (microcytic submucosa à ulceration and
hypochromic) anemia à weakness and sloughing à duodenitis
pallor DISSEMINATED
î Protein malnutrition (hypoalbuminemia) STRONGYLOIDIASIS:
î Hyperinfection syndrome
(in immunocompromised)
Treatment Albendazole (has greater larvicidal Albendazole Mebendazole Pyrantel Pamoate Ivermectin Albendazole
activity than mebendazole)
Wuchereria bancrofti
NEMATODES Trichinella spiralis
Brugia malayi
Disease Filariasis Trichinosis
Parasite Biology / î blood and tissue nematode î Tissue nematode
Characteristics î most debilitating nematode infection î Intermediate host: pigs
î Usual scenario: farmer from abaca plantation
SEVERE DISEASE:
CHRONIC DISEASE: î Myocarditis
î Hydrocele î Encephalitis
î Elephantiasis î Pneumonia
î Milky urine (chyluria) î Respiratory myositis
Treatment Diethylcarbamazine Thiabendazole
Others LOCAL EPIDEMIOLOGY
BANCROFTIAN FILARIASIS MALAYAN FILARIASIS
Sorsogon Albay Eastern Samar
Samar Mindoro Agusan del Sur
Leyte Marinduque Palawan
Palawan Rombon Sulu
Camarines All of Mindanao
NEMATODES OF MINOR IMPORTANCE
Ancylostoma caninum, Angiostronglyus
Onchocerca volvulus Loa loa Dracunculus medinensis Toxocara canis Anisakis simplex
A. braziliense cantonensis
î Transmitted by female î African eye worm î Guinea fire worm î Dog ascaris î Dog and cat hookworm î Transmitted in î Zoonotic roundworms
blackfly (Simulium) î Transmitted when copepods î Visceral larva migrans
î Transmitted by deer fly or î Creeping eruptions undercooked seafoods î Transmitted in raw
î Clinical findings: mango fly (Chryops) are swallowed in water î Ocular toxocariasis (cutaneous larva î Eosinophilic meningitis seafoods
- Dermal nodules î Clinical findings:
î Loaiasis characterized by - Ocular larva migrans migrans) î Most common cause of î Causes eosinophilic
- Hanging groin deformity - Pruritic painful papule parasitic meningitis
- Subcutaneous edema - Uveitis gastroenteritis
- Lizard skin (calabar swellings) - Live worm in skin ulcer - Endophthalmitis
- River blindness - Worm crawling across
î DOC: Ivermectin the conjunctiva
- Lysis of worms à î DOC: Diethylcarbamazine
Mazzotti hypersensitivity
reaction
PARASITE HINTS ANTIMICROBIALS TO AVOID DURING PREGNANCY
REFERENCES: No copyright infringement intended.
î TOPNOTCH Medical Board Prep Microbiology Handout by Pacifico Eric E. Calderon, MD
î TOPNOTCH Medical Board Prep Microbiology Supplemental Handout by Pacifico Eric E. Calderon, MD
î FIRST AID for the USMLE Step 1 2017
î LANGE Review of Medical Microbiology and Immunology 13th edition
î Clinical Microbiology Made Ridiculously Simple 6th edition
î Board Review Series Microbiology and Immunology 5th edition
î Lippincott’s Illustrated Reviews: Microbiology 3rd edition
î DLSHSI College of Medicine Department of Microbiology and Parasitology Lectures (AY 2013-2014)
î Various internet sources
DISCLAIMER:
Care has been taken to confirm the accuracy of the information presented. Nevertheless, it is difficult to ensure that all the information presented is entirely accurate for all circumstances, and the author cannot accept any responsibility for any error or omission. The author makes no warranty,
expressed or implied, with respect to this work, and disclaims any liability, loss, or damage as a consequence, directly or indirectly, of the use and application of any of the contents of this work. READ AT YOUR OWN RISK!