Flagellum Pilus/fimbria Capsule nai) Slime (S) layer ‘Outer membrane Periplasm Cell wall Cytoplasmic membrane (Sayeescome) eR eg apse rat Heaton, aera Youle, te lM “at tans ope ‘GhEWICAL COMPOSITION minke Proteins Glycoprotein Fazer Sai Keratin-like coat dipicolinic peptidoglyear Discrete layer usually made of polysak (and rarely proteins)-te. Ry 2 gtande Loose network of polysaccharides Outer leaflet: contains endotoxin (LLPS/LOS) Embedded prot membrane proteins (OMPs) Inner leaflet: phospholipids (a'exertosrl Ps) porins and other outer Space between cytoplasmic membrane and outer membrane in gram © bacterial (peptidoglycan in middle) Peplidoglycan is a Sugar backbone with peptide side chains cross-linked by transpeptidase Phospholipid bilayer sac with embedded proteins (eg, penicillin-binding proteins [PBPs)) and other enzymes Lipoteichoie acids (gram posi from membrane to exterior ) only extend Vota, Gacy he tl peste FUNCTION Motility Mediate adherence of bacteria to cell surface, ng conjugation ns du heat, chemicals Protects against phagocytosis Mediates adherence to surfaces, especially foreign surfaces (eg, indwelling catheters fg Gram © only Endotoxin: lipid A induces TNF and IL-l antigenic O polysaccharide component Most OMPs are antigenic Porins; transport across outer membrane Aceumulates components exiting gram O cells, including hydrolytic enzymes (eg, Balactamiises) Netlike structute gives rigid support, protects against osmotic pressure damage Site of oxidative and transport enzymes; PBPS involved in cell wall synthesis Yi ea pea For Ta REEstains ram stain Giemsa stain Periodic acid-Schiff stain Ziehl-Neelsen stain (carbol fuchsin) India ink stain Silver stain Fluorescent antibody stain Oo wo “ AY Frstine lab test in bacterial identification, Bacteria with thick peptidglyean layer Miolet dve (gram @); bacteria with thin peptidoglycan layer turn red or pink | contntersta These bugs do not Gram stain well (These Little Microbes May Unfortunately Lack But Ate Everywhere Treponema, Leptospira Too thin to be visualized Mycobacteria Cell wall has high lipid content Mycoplasma, Ureaplasma No cell wall Legionella, Rickettsia, Chlamydia, Bartonella, Primarily intracellular, also, Ghlamydia lack Anaplasma, Ehrlichia classic peptidoglycan because of Rickettsia, Chlamydia, ‘Trypanosomes EX, Plasmodium, Borelia, Helicobacter pylori Bored Hot “Geisha” Stains glycogen, mucopolysaccharides; used PSs the sugar to diagnose Whipple disease (Tropheryma 3 whipplei Acid-fast bacteria (eg, Mycobacteria (3, Auramine-thodamine stain is more often used Nocardia; stains mycolic acid in cell wall); for screening (inexpensive, more sensitive) protozoa (eg, Cryptosporidium oocysts) Cryptococeus neoformans; rmucicarmine can also be used to stain thick polysaccharide capsule red " Fungi (eg, Coccidioides Preumocysts jirovecii), Legionella, Helicobacter pylori Used to identify many bacteria, viruses, Example is PTA-ABS for syphilis Pneumocystis jiroveeit, Giardia, and CryptosporidiumProperties of growth media A Selective media ; Indicator (differential) Yic media agar contains Special culture requirements Sars EDAD FOROUATON Hinfluenzae Chocolate a gonorrhoeae, Bhayer-Martin agar (SHEA Be meningitidis Bpertussis Bordet-Gengou agar (Bordet for Bordetella) Regan-Lowe medium diphtheriae Teller, Laffer medium M tuberculosis Lowenstein-Jensen medium, Middlebrook medium, rapid automated broth cultures Mpneumoniae Eaton agar Lactose-fermenting MacConkey agar enterics coll Eosin-methylene blue (EMB) agar Brucello, Francisella, Charcoal yeast extract agar buffered with g pe th wth of Neisseria iting {certain organisms. Example: MacConkey actose to acidic = ron nT se Factors V (NAD*) and X (hematin} Selectively favors growth of Neisseria by inhibiting growth of gram © organisms with Vancomycin, gram © organisms except Neisseria with Trimethoprim and Colistin, and fungi with Nystatin Very Typically Cultures Neisseria Potato extract Charcoal, blood, and antibiotic Requires cholesterol Fermentation produces acid, causing colonies tum pink artes Me le 0 rememeneay Colonies with green metallic sheen la siblings, Bruce, Franeis, a 4 pasteur (pastor) built the iron, “Sab’sa fun guy!” Legionella, Pasteurella —_cysteine and iron Fungi Sabouraud agar Aerobes Use an O-dependent system to generate ATP. Examples include Nocardia, Pseudomonas aeruginosa, Mycobacterium tuberculosis, and Bordetella Reactivation of M tuberculosis (eg, after immunocompromise or TNF-or inhibitor use) has a predilection for the apices of the hing Bain Hache, at ES TRIER ESTER eG PL BY CRE EMEC BETH aw Se ‘ie oe Lounin 6 aleve 0 Atrptocens intros and 5: Lat ge iaph apes isons Psa awe femmes mantel hari pant rol te yeasOe eashn BD) Reapimhims ETE mrkan ath Bit Ys Sploneus Pequites Ox» (i tm Maran Bad) See ace dal, a a a a ‘anaerobes Examples inchade Clostridium, Bacteroides, Facultative anaerobes intracellular bacteria : obligate intracellular Facultative intracellular Encapsulated bacteria Encapsulated bacteria vaccines Urease-positive organisms einai Salmonella Neier, nt My Fusobacterium, and Actinomyces israelit. Th and are thus Generally foul smelling (short-chain fatty acids), are difficult to culture, in tissue (COs and Hy, May use O; as a terminal el generate ATP, but can and other O-indeper fata ee een lection acceptor to also use fermentation 1 pathways Fathi ally Rickettsia, Rely on host Ses nest yeobacteri ‘Reowte Examples are Pseudomonas aeruginosa, Streptococcus pneumoniae EX. Haemophilus influenzae type b, Neisseria meningitidis, Escherichia coli, Salmonella, Klebsiella pneumoniae, and group B Strep. Their capsules serve as an antiphagocytic virulence Factorvte complement machin. apsular polysaccharide + protein conjugate serves as an antigen in vaccines, Sualing Ris Barecl otal in sri emi Some vaccines containing polysaccharide capsule antigens are conjugated to a carrier protein, enhancing immunogenicity by promoting ‘T-cell activation and subsequent class switching, A polysaccharide antigen 1¢ cannot be presented to'T cells Proteus, Cryptococeus, H pylori, Ureaplasma, Nocardia, Klebsiella, § epidermidis, saprophyticus. Urease hydrolyzes trea to release ammonia and CO» ~ t pH. Predisposes to struvite (ammonium magnesium phosphate) stones, particularly Proteus. and produce gas they Tahibll femmentahion ottacked by NK cots j Later by 604¢Teele hey Anaerobes are n 0 Streptococci, bacteria. im, Please SHINE my Ski. ‘Are opsonized, and then cleared vote Asplenics (No Spleen Here) h: ability and thus 1 risk for severe infections; need vaccines to protect against: = N meningitidis preuinoniae * H influenzae Ailon'S epee 9 Sisal wnder lowe Pneumococcal vaccit conjugate vaccine), polysaccharide vac protein) H influenzae type b (conjugate vaccine). Meningococcal vaccine (conjugate vaccine). 298 ines: (pneumococeal (pneumococcal ith’ no conjugatedCatalase-positive Catalase degrades HO; into HO and bubbles of O, EY befor wverted to mictobieida organisms products by the enzyme myc oxidase. People with chronic granulomatous disease NADI oxidase deficiency) have recurrent infections with certain catala organisms Examples: Nocardia, Staphylococci, Serratia, Candida, Listeria, E coli, Burkholderia cepacia, Pseudomonas, Aspergillus, Helicobacter pylori, Bordetella pertussis. eat ee ee Pigment-producing Actinomyces israelii—yellow “sulfur” granules, Israel has yellow sand bacteria which are composed of filaments of bacter S aureus—yellow pigment Aureus (Latin) = gold P aeruginosa—blue-green pigment (pyocyanin Aerugula is green and pyoverdin) Serratia marcescens—red pigment ‘Think red Sriracha hot sauce In vivo biofilm- S epidermidis Catheter and prosthetic device infections producing bacteria Viridans streptococci ($ mutans, S sanguinis) Dental plaques, infective endocarditis P aeruginosa Respiratory tree colonization in patients with cystic fibrosis, ventilator-associated pneumont Contact lens-associated keratitis Nontypeable (unencapsulated) H influenzae Otitis media Shap Pcie can me LE He ore FERS BOG pO TE ADCOe-forming Some gram @ bacteria can form spores EVwhen Examples: B a nutrients are limited. Spores lack metabolic isoni activity and are highly resistant to heat and chemicals. Core contains dipicolinie acid. Must autoclave to kill spores (as is done to surgical equipment) by steaming. 1 121°C for 5 2s, Armature te ahovtcs te ee ‘These promote evasion of host immune response. ina Binds Fc region of IgG. Prevents opsoni otease Enzyme that cleaves IgA, allowing bacteria to adhere to and colonize s iae, 1 inj type b, and Neisseria (SHiN). by S pneumoniae, . are ype b, and suit a nas tein Helps prevent phagocytosis, Fxpressed by group A streptococci. Shares similar epitopes to | cellular proteins (molecular mimicry); possibly underlies the autoimmune response seen in rheumatic fever. +e JastcHans Geen lar Vantonts) , Gerelifo Reciananhis (Re tapsing FOOD, Ah gonarhaa (piney te. Varad ae aaa a 5 Fanaaites ~ TrypancsomesTransformation finat wphahe of fercatuiay 8A Hitamact Aams!e Ma chante ‘Competent bacteria can bind and apart short Degraded pieces of environmental yaked bacterial a = chiwomosomal DNA (from bacterial cell ~0 x “3 lysis). The transfer and expression of newly Naked DNA Recipient cell ‘Transformed ct transferred genes is called t A feature of many bacteria, especially S pneumoniae, H influenzae type b, and Neisseria (SHiN), Adding deoxyribonuclease degrades naked DNA, preventing transformation. Conjugation ~ Pius medistd £214 transfer. eg. Transntation of gene, for Anitbiohc Restrance og EBL wvch fa tated fr Plaar eur plasmid contains genes required fe ih racers’ fans quired for sex pilus mes were and conjugation, Bacteria without this plasmid Pp a = 4 termed F. Sex pilus on lerium fe Oo iO O71" contacts F bacterium, A single strand “Yo of plasmid DNA is transferred across the Pett feet Peal Feet Bt conjugal bridge ing bridge”). No transfer . n become incorporated into eee pera bacterial chromosomal DNA, termed high- Be, BC). Ale, .04 frequency recombination (Ife) cell. Tra =o 7 of leading part of plasmid and a few flanking Fol Tot teat Fe Wek et ct chromosomal genes. High-frequency yy integrate some of those bacterial genes. Recipient cell remains !* but have new bacterial genes. now m Transduction - Pag. vine pidu ue QnA trarater te archer boleve eding fo Gone er vrulense onl Atte Resale i Generalized (Le eyete) Specialized (Crago Ge) A packaging “error” Lytie phage infeets a bacterium, leading to cleavage of bacterial sae s DNA. Parts of bacterial chromosomal DNA ( 2 Ae may become packaged in phage capsid. Phage Ob infeets another bacterium, transferring these EN ee Ss) ./ © Release of new phage lfectsother Genes transfed trom ised cel bacteria To new bates ‘An “excision” event. Lysogenic phage infects bacterium; viral DNA incorporates into bacterial chromosome. When phage DNA excised with it. DNA is packaged into phage capsid and can infect another bacterium. Genes for the following 5 bacterial tox encoded in a lysogenic phage ((ABCD’S): Group Botulinum toxin,acterial genetics (continued) ee the) A “jumping” process involving a transposon (pe and excise itself olecule or an unt plasmid or chromosome). plasi ines (eg, Til546 with vanA from Enterococcus to $ aureus). Main features of exotoxins and endotoxins sounct sgceveD FROM CELL coeusreY can OF GENES vest ECTS caweauertcrs ne ACTION annceway wots sastasuTY TAL SEASES Exotoxins C Yes Polypeptide gO" 2 geek an tems Plasmid or bacteriophage High (Fatal dose on the order of 1 1g) Various effects (see following pages) Various modes (sce following pages) bodies called ar Induces high-titer 3 loxins ‘Toxoids used as vaceines Destroyed rapidly at 60°C (except staphylococcal enterotoxin and E.coli heat- stable toxin) ‘Tetanus, botulism, diphtheria, cholera alized segment of DNA), which ean copy nd ther insert into the same Endotoxins in species of gram ® and gram © bacteria Outer cell membrane of m No Lipid A component of LPS bacteria; released when lysed) -" Bacterial chromosome Low (fatal dose on the order of micrograms) Fever, shock (hypotension), DIC Induces TNE, IL-1, and IL-6 Poorly antigenic " No toxoids formed and no vaceine available ‘Stable at 100°C for Lhe be Meningococcemia; sepsis by gram © rods Endotoun TN It, Le Host cell, Sd? oe >ew ee gay coe ef Bahanyote: Rtn (Cater ft cmpemnrt) Duinis rehim syatsns byrdos AANA ACTER TON MECHANISW Corynebacterium Diphtheria toxin’ diphtheriae Inactivate clongation factor (EIF-2) ty sdéng Rot case Pseudomonas Exotoxin A" yugtin pectoc’ ae A» Palle aeruginosa ot Shigella spp Shiga toxin (ST)* Inactivate 60S ribosome by removing adenine from Enterohemorrhagic §—Shigalike toxin. RNA Ecol (sury Pharyngitis with pseudomembranes in throat and severe lymphadenopathy (bull neck; Host cell death Gl mucosal damage — dysentery; ST also ‘enhances cytokine release, causing hemolytic remic syndrome (HUS) SLT enhances cytokine release, causing HUS (prototypically 3 serotype O157:H7 Unlike Shigella, EHEC does not invade host cells Enterotoxigenic Heatlabile Overactivates adenylate Ecoli toxin (LT)" cyclase (t cAMP) = 1 Clr secretion in gut and HzO efflux Heat-stable Overactivates guanylate toxin (ST) cyclase (teGMP) = | resorption of NaCl and H0 in gut Bacillus anthracis Anthraxtoxin’ _ Mimics adenylate eyclase (t cAMP) Overactivates adenylate cyclase (cAMP) by Cholera toxin® permanently activating G, = 1CF secretion in gut and H,0 efflux as Bordetella pertussis Pertussis toxin’ —_Inactvates inhibitory G Mingle fries subunit (@) = activation of adenylate ey = t cAMP Clostridium tetani —‘Tetanospasmin’ Both are proteases that Aegean Bret aye SNARE (soluble NSF attachment protein receptor), a set Clostridium Botulinum toxin’ of proteins requited for botulinum neurotransmitter release i via vesicular fusion *An AB toxin (aka, two-component toxin [or three for anthrax}) with B of the active A component. The A components are usually ADP ribosylt in chart. Watery diarrhea: “labile in the Air (Ad cyclase), stable on the Ground (Gx cyclase)” Likely responsible for characteristic ed borders of black eschar in cutaneous anthrax Voluminous “rice-water” diarthea Whooping cough child coughs on expiration and “whoops” on inspiration (tox not actually be a cause of cough; can cause “100-day cough” in adults) may ‘Toxin prevents release of inhibitory (GABA and glycine) neurotransmitters from Rensh® cells in spinal cord -> spastic paralysis, risus sardonicus, trismus (lockjaw) ‘Toxin prevents release of sti signals at neuromuscular paralysis (floppy baby) nulatory (ACh) inction ~ flaccid bling binding and triggering uptake (erdocytos® nsferases; others have enzymatic activities as lst— vith exotoxins (continued) TOXIN e: MECHANISH that degrades tissue and ‘Toxic shock R= ak ee ee Sen Phospholipasé (Iecithinase) MANIFESTATION Degradation of phospholipids ~ myonecrosi (‘gas gangrene”) and hemolysis (“double zo cell membranes [2'%ebyemet)] of hemolysis on blood agar) Protein that degrades cell membrane Lyses RBCs; contributes to B-hemolysis; host antibodies against toxin (ASO) used to diagnose rheumatic fever (do not confuse with immune complexes of poststreptococcal glomerulonephritis) ‘Toxic shock syndrome: feygt, rash, shock; other parame tain : ms taking. cause scalded skin gyndsonte Te (TSST-1) on APCs outside of the toxin) and food poisoning (heat-stable * antigen binding site enterotoxin) Eiltiagenic = overwhelming release oxic shoe-ke syndrome: eer, rsh, shock; of IL-1, IL-2, IPN-y, an a TNE-a — shock LBS found in outer membrane of gram © ENDOTOXINS bacteria (both cocci and rods). Composed of Edema O antigen + core polysaccharide + lipid A (the Nitric oxide toxic component). DIC/Death Released upon cell lysis or by living cells by Outer membrane TNFa blebs detaching from outer surface membrane (ss exotoxin, which i actively secreted ‘Three main effects: (DaRAiGIDA4 ee pelagent activation, ei tissue factor activation. O-antigen + core polysaccharide + lipid A eXtremely heat stable IL-1 and IL-6 Neutrophil chemotaxis ShockGam@ purple/due! Branching ood! flaments Coagulase oc ® aa e: sei (No hemolysis eno . seen deat a _— Saureus siti Bacitracn sensitivity Growth in 65% NaCl sensitivity natescubiny and PYRStatus a oon Feta let ee ete savant ‘porta teat ae bald Impo'a’ pathogen ain bold talc. Note Enterococcus iether oy hemos a Gram-positive cocci antibiotic tests Staphylococci Novobiocin—Saprophyticus is Resistant; On the office’ “staph” retreat, there was Epidermidis is Sensitive no stress Streptococci Optochi Sensitive Viridans is Resistant; Pneumoniae is OVRPS (overpass) Bacitracin—group B strep are Resistant; group B-BRAS. A strep are Sensitiveqhemolyticbacteria Gram ® cocci. Partial oxidation of hemoglobin causes greenish or brownish color without clearit arou growth on blood agar GJ. Inchide the following organisms: Streptococcus pneumoniae (catalase © and optochin sensitive * Viridans streptococci (catalase clude the follow ing organisms * Staphylococcus aureus catalase Staphylococcus aureus Gram ®, Bshemolytic, catalase ©, coagulase b © cocci im clusters £3, Protein A (virulence factor) binds Fe-IgG, inhibiting complement activation and phagocytosis, Commonly ; , colonizes the nares, ears, axilla, and groin % Causes ' * Inflammatory disease—skin infections, abscesses, pneumonia (often after ons influenza virus infection), endocarditis, seplic arthritis, and osteomyelitis * Toxin-mediated disease—tovic shock syndrome (TSS1:1), sealded skin syndrome {exfoliative toxin), rapid-onset food poisoning (enterotoxin). MRSA (methicilin-resistant 5 aureus). important cause of serious nosocomial and community-acquited infections; resistance due to altered penicillin-binding protein. ‘mec gene from staphylococeal chromosomal cassette wolved in penicillin gesistance taphylococcus pidermidis Normal flora of ski and optochin resistant im ® cocci. Complete lysis of RBCs = pale/elear area surrounding colony on blood agar £3 nd coagulase ® ® Streptococcus pyogenes—group A strep (catalase © and bacitrac Streptococcus agalactiae—group B strep (catalase Mast dangerens Vindante faclor—lpulecidin , rovarsiteat by Gackalophoge Fay Aale tr Nacratinng Me™ TSST-1 isa superantigen that binds to MHC I and F-cell receptor, resulting in polyclonal Cytokine release Peell activation Staphylococcal toxic shock syndrome (TSS) —~ fever, vomiting, rash, desquamation, shock,4enee end-organ failure. TSS results in LAST. LAL: Liliubin. Associated with prolonged use of \aginal tampons or nasal packing Compare with Streptococcus pyogenes TSS (a toxic shock-like syndrome associated with painful skin infection)» Nerang Fate $ aureus food poisoning due to ingestion of preformed toxin - short incubation period (2-6 hr) followed by nonbloody diarrhea and emesis. Enterotoxin is heat stable + not destroyed by cooking S aureus makes coagulase and toxins. Forms fibrin clot around itself + abscess c, Ti a Une US = Assurant @ Suspect metmaabe Inte” (Aer cin sensitive. Does not Infects prosthetic devices (eg, hip implant, heart valve) and IV catheters by producing adherent biofilms, PR Hie me hs Td ISR AYE eR Ka aT qSecond most common cause of uncompli Gram ®, o-hemolytic, lancet-shaped rae causes * Meningitis * Otitis media (in children) * Pneumonia Gram ®, catalase @, coagulase ©, urease ® cocet in clusters. Nev Normal flora of female genital tract and perineum ted UTI in young w Sette ove Pneumococeus is associated with “rusty + Gan sputum, sepsis in patients with sickle cell disease, and asplenic patients No virulence without capsule Viridans group Gram ®, a-hemolytic cocci. Optochin resistant Viridans group strep live in the mouth, because streptococci and bile insoluble. Normal flora of the they are not afraid of-the-chin (op-to-chin oropharynx. resist Streptococcus mutans.and.S.mitis cause dentak — Sanguinis ~ blood. Think, “there is lots of caries. blood in the heart” (endocarditis ins makes dextrans that bind to fbrin- on damaged heart valves, causing subacute bacterial endocarditis Streptococcus Gram © cocci in chains EY Group A strep Ph’yogenes pharyngitis can result in pyogenes (group A cause: sheumatic “phever” and glomerulonephritis streptococci) * Byogenic— pharyngitis, cellulitis, impetigo Strains causing impetigo can induce (“honey-crusted” lesions), erysipelas scarlet fever, toxie shock-like “syndrome, necrotizing fasciitis * Lmmunologie —rheumatic fever, glomerulonephrit Bacitracin sensitive, B-hemolytic, pyrrolidonyl arylamidase . Hyaluronic acid capsitle and M protein inhibit phagocytosis. Antibodies to M protein enhance host defenses against S pyogenes but can give rise to rheumatic fever. Inicatiene prtirese, ASO titer or anti-DNase B antibodies indicate recent S pyogenes infection o. glomerulonephritis Scarlet fever—blanching, sandpaper-like body rash, strawberry tongue, and cireumoral pallor in the setting of group A streptococcal pharyngitis (erthrogenie toxin @)¢ any Fearn 1 gm pipe toned te abt le Ys esa (am oa) ok apna pin Dfagpasls Threat uo RAST [Raptd Aniiyen Keech Testy) Tnamuresniay POTD Chrplouaccan Nedales, conser diate Sebo ‘Cauises pulmonaty infections in Canses oralffacial abscesses that drain through immunocompromised (can mimic TB but sinus tracts; often associated with dental caries! with © PPD); eutancous infections after extraction and other maxillofacial traum: trauma in immunocompetent; can spread to. forms yellow “sulfur granules", can also cause PID with TUDs 5 Ralmanany Attmngents das n Ako ENS, posers (rtiolnted) Treat with sulfonamides (TMP-SMX) Tieatwith penicillin ov Smyeyene (fate) Treatment is a SNAP: Sulfonamides—Nocardia, Aetinomyces—Penicillin hs P Geen Inui OZ Untena Whasamnalad Abs cos and Gromalamas Tn Lren, Spleen Lange Kitiays,! Cammain iatare rane LR ee eae Ga | Se a Natinctive, Tofionmabin (Cherfaanatenttic Via Abscass form)resistant to multiple drugs) causes disseminates non-PB disease in AIDS; often resistant to multiple drugs). Prophylaxis wit azithromycin when CD44 count < 50 cells/ { tube 1 ont ivede! ese (amis) fren Cog Float chat ran BN SE Sons and ee downdey Thm Engh hte, ge, "Night bua, Cutan emma 5 3 tones {io of eatiion Hts, dane, Lag mas Bas Aenean FERGIE TERI REN Fal WK Re RE EID Gplecind icles casing mulsle ay. Cain ing trample (arbre) aLeprosy Also called Hansen disease. Caused by Myeobucte rium leprae, an acid-fast bacillus that likes coo} a temperatures (infects skin and stiperfical herves—“glove and stocking” loss of sensation E) and cannot be grown in vitro. Diagnosed via skin biopsy or tissue POR. Reservoir in United States: armadillos, Leprsy hos Fedte te VER Leproyy has 2 forms (many ases fall temporarily between two extr Lepromatous—presents diffusely over the skin, with Leonine (Liow-like) facies E3, and is communicable (high bacterial load), characterized by low cell-mediated immunity with a largely Th2 response. Lepromatous form can be Lethal * Tuberculoid—limited lo a few hypoesthetic, hairless skin plaques; characterized by high cell- nediated immunity with a largely ‘Thl-type response and low bacterial load. Treatment: dapsone and rifampin for tuberculoid form; clofazimine is added for lepromatous form. Gram-negative lab algorithm Gam© (pink) Diplococe! Coceobaci Cane hee Onidase ‘Maltose acid detection Grows in 42°C ©» Grows in alkaline media Produces urease saci Lactose fermentation © é fut_| Sow e Sproducton aa) mn ‘on TS ager ot» = =a. . limponant tests are in bold. Importan pathogens aren bold tales ‘Pleomorphic rod/coccobacilusen Seen Onenen TeREONAe = Ua = Caprunsone « Antnarmychr (Nol Sonyeylc) Gram and produce IgA proteases. Contain lipooligosaccharides (LOS) with strong, endotoxin activity. N gonorrhoeae is often intracellular (within neutrophils) EX Gonococci No pol diplococei. Metabolize glucose accharide capsule No maltose acid detection Nov nic variation of pik prot Sexually or perinatally transmitted Causes gonorthea - neonatal conjunctivitis (2-5 days after birth), pelvic inflammatory disease (PID), and Fitz-Hugh Curtis syndrome Diagnosed with NAT (re) Condoms 4 sexual transmission, erythromycin eye ointment prevents neonatal blindness ‘Treatment: ceftriaxone (+ azithromy’ or doxycycline, for possible chlamydial Small gram © (coccobacillary) rod. Aerosol influenzae transmission. Nontypeable (unencapyulated) strains are the most common cause of mucosal infeetions (otitis medi nctivitis, bronchitis) as well as invasive infections since the vaccine for capsular type b was introduced. Produces IgA protease Culture on chocolate agar, which contains factors V (NAD*) and X (hematin) for growth can also be grown with S aureus, which provides factor V via RBC hemolysis. HaEMOPhilus causes Kpiglottitis endoscopic appearance in EY, can be “cherry red” in children; *thumb sign” on lateral neck }), Meningitis, Otitis media, and integer monia, [sds Fecrt con associated with resistant hospital associated pneumonia and septicemia in Acid production: MeninGococst Malte Glucose; Gonococei—Ghucose Meningococci Polysaecharide capsule Maltowe acid detection Vaceine (type B vaccine available for at-risk individuals ae ssmitted Mi spretony and oral secretions. with petechial 2auses meningococce hemorrhages and gangrene of toes El meningitis, Waterhouse-Friderichsen syndrome (adrenal insufficiency, fever, DIC shock} Diagnosed via culture-based tests or PCR or ceft prophylaxis in close contacts Treatment: ceftriaxone or penicillin G Vaccine contains type b capsular polysaccharide (polyribosyiribitel phosphate) conjugated to diphtheria toxoid or other protein. Given between 2 and 18 months of age Does not canse the flu (influenza virus does Treatment: amoxicillin +/+ elavulanate for mucosal infections; ceftriavone for meningitis, sifampineprophylaxis for close contacts tnpsbts component earl pagel © coccobacillus. Commensal opportunist but increasingly quired infections, especially in ICU, Can cause ventilator mmunocompromised patientsBordetellapertussis. © Grain ©, aerobic coccobacillus. Viruler s inchide pertussis toxin (disables Gy, adenylate eyelase toxin (t cAMP), and tracheal cytotoxin, Three clini * Catarrhal—low-grade fevers, Coryza, —* Sarvs erttetern Paroxysmal—paroxysms of intense cough followed by inspiratory “whooP” whoop postiussive vomiting Se ae Tele hone Convalescent—gradual recovery of ehronie cough Prevented by Tdap, DTaP vaccines. May be mistaken as viral infection due to lymphocytic infiltrate resulting from immune response. Gees reqsired exnry toyre Treatment: tiaciolides. allergic use ‘TMP-SMX Brucella Gram ©, aerobic coccobacillus. ‘Transmitted via ingestion of contaminated animal products (eg, Meat m= unpasteurized milk), Survives in macrophages jn the seticuloendothelial system. Can form non- caseating granulomas. Typically presents with indnfant fever, night sweats, and arthralgia Treatment: doxycycline + rifampin or streptomycin Legionella pneumophila Gram stain. Grow on eh medium with i oal yeast extract [pyeey . Detected by presence of antigen in urine, Labs may show hyponatremia Aegon transmission fron ronmental FRR Stee Rada CEP air conditioning n and eystei transmission. 1 ment: macrolide or quinolone Aeruginosa— aerobic; motile, catalase @. gram © rod. Non-lactose fermenting Oxidase ®. Frequently found in water. Has a grape-like odor PSEUDOMONAS is associated with: Pneumonia, Sepsis, Hethyma gangrenosum, UTIs, Diabetes, Osteomyelitis, Mucoid polysaccharide capsule, Otitis externa {swimmer’s ear), Nosocomial infections (eg, catheters, equipment), Addicts (drug abusers), Skin infections (eg, hot tub folliculitis, wound infectio Mucoid polysaccharide capsule may contribute to chronic pneumonia in cystic fibrosis patients due to biofilm formation. Produces PEEP: Phospholipase C (degrades cell membranes); Endotoxin (fever, shock); Exotoxin A (inactivates EF-2); Pigments: and pyocyanin (blue-green. algo generates reactive oxygen Pseudomonas a eater piginent species) systems, hot water tanks), No person-to-person frend au cing tod. Gram stains poorly —use silver J vis a French legionnaire (soldier) with his silver helmet, sitting around a campfire charcoal) with his iron d Legionnaires’ disease—severe pneumonia yee (often unilateral and lobar BY), tevr, Fand Raine CNS Sitptonns, Common a in chronic hing disease Pontiac fever. anid futike syndrome, ne Kea p camplal itis in contact lens wearers’ Comeal uleers/ke minor eye trauma cthyma gangrenosum—rapidly progressive, nue necrotic cutaneous lesion EJ caused by Pseudomonas bacteremia. Typically seen in ‘unnaiinGCotpromised patients (Ave- TA-4 Gardnerella vaginalis A pleomorphic, gram-variable rod involved in bacterial vaginosis. Presents as a gray vaginal discharge with a fishy smell; nonpainful (vs vaginitis). Associated with sexual activity, but not sexually transmitted. Bacterial vaginosis is also characterized by overgrowth of certain anaerobic bacteria in vagina (due to Lactobacilli). Clue cells (vaginal epithelial cells covered with Gardnerella) have stippled appearance along outer margin (arrow in EY) Chlamydiae cannot make their own ATP.'Phey are obligate intracellulay organisms that cause mucosal infections. 2 forms * lilementary body (small, dense) is “Enfectious” and Enters cell via Endocytosis; transforms into reticulate body * Relioulate body Replicates in cell by fission; Reorganizes into elementary bodies. Chlamydia trachomatis causes neonatal inctiviti nongonococeal urethritis, PID, arthritis, Chlamydophila pneumoniae and Chlamydophila psittaci cause atypical pneumonia; transmitted by aerosol. id reactive Tdon't have a clue why I smell fish in the v. garden! Amine whiff test—mixing discharge with I KOH enhances fishy odor ‘Treatment: metronidazole or clindamycin Chlamydial cell wall lacks classic peptidog! (due to reduced muramic acid), rendering Brlactam antibiotics ineffective Chlamys = cloak (intracellular as an avian reservoir (parrots) al pneumonia mosis: PGR, nuc ytoplasmic inchs ic acid amplifiea ons (reticulate be seen on Giemsa or fluorescent antibody stained smear ‘Treatment: azithromycin (favored because one-time treatment) or doxycycline, Add ceftriaxone for possible concomitant gonortheaEtkenciia Corvedans Clanched fist fight Inpoy. Chlamydia trachomatis serotypes Types A,B, and C Chronic infection, cause blindness due to ABC Africa, Blindness, Chronie infection. follicular conjunctivitis in Africa types D-K Urethritis/PID, ectopic pregnancy, neonatal DK = everything else. "<<" 8" *egerenge Pneumonia (staceato-cough) with eosinophilia, Neonatal disease can be acquired neonatal conjunctivitis (2D Weeks after birth). passage through infected birth canal. TypesLt,2,and 3 Lymphogranuloma venereum—sinall, painless uuleers on genital swollen, painful inguinal io nodes that uleerate (buboes). Treat with doxycycline Zoonotic bacteria Zoonosis— infectious disease transmitted between animals and humans. At are Ret Senyeyehe ces co a ‘Anaplasma spp Anaplasmosis Ihodes ticks (live on deer and mice) Bartonella spp Cat serach disease, bacillay angioma callicut seater, cines eae Borrelia burgdorferi Lyme disease Ixodes ticks (live on deer and mice) Borrelia recurrentis Relapsing fever (ste taditieaisidnata antigens) Brucella spp (fy. 143) Brucellosis/undulant fever Unpasteurized dairy Compylobacter Bloody diarrhea Feces from infected pets/animals; contaminated rmeats/foods/handls Chlamydophila psittaci Psittacosis Parrots, other birds Coxiella burnetii Qfever Aerosols of cattledsheep amniotic fhiid Ehrlichia chaffeensis _{‘hrlichiosis Amblyomma (Lone Stat tick) Francisella tularensis, —‘Tularemia Aerracenter Vicks, rabbits, deer Mies Leptospiraspp Leptospirosis Animal urine in water; recreational water use Mycobacterium leprae Leprosy Humans with lepromatous leprosy; armadillo rare) Pasteurella multocida Cellulitis, osteomyelitis Animal bite, cals, dogs Rickettsia prowazekii _ipidemic typhus Human to human via human body louse Rickettsia rickettsii Rocky Mountain spotted fever Dermacentor (dog tick) Rickettsia typhi “Endemic typhus Fleas Salmonella spp Diarrhea (which may be bloody), vom Reptiles and poultry (except 5 typhi) fever, abdominal cramps Yeinla pestis Plague Ree Arneghuesides: Fleas (rats and prairie dogs are reservoirs) PE Lapiespiva (ipireclate) Coif Pain, Fa Whe. Sis , Phofophobia Frapalicla, Toarnats Sour Reason feral Maxie Vea Ranch mterkes deals E cadties , Frewroria+ (owielia busrt earaciantien I: revs te ett Fer ae FEE tt uoeanw sated) fe antige vedas Immune response hen a5 es Reservior | Rabbit , Sermacenter le Rei: rane fersnia, feake - Sater ala Cot Sepoteh te» Qaualy tn i ca tse onos nanny Aer i Sr ge tin ee Tes : re ise A inca SER ee ea pana nO) meen eee ee er oe Seater ies teertnn ae aye te rr a pcac, aces seas CO Rae A de fan ted Boer ‘May lead 4 tadwreans dire ted Ree Denice.ettsiarickeltst, vector is ick. Despite its name, disease occurs primayly jy the Sguth Atlantic states, especially North Rash typically starts al wrists BY and ankles and then spreads to trunk, palms, and soles a 2 OS eSE cat kt Sarolina,Tesem« Glasie tind headache, fever, ash (wascuh Palms and soles rash is seen in Covsackievi A infection (hand, foot, and mouth dhs Rocky Mountain ppottedeyer. and 2 Sypll (you drive CARS using your paln Rickettsii on the wRists, Typhus on the Trunk body louse)—R prowazehii.s Louse ina aushs bled. Lae dafsnte trie hfe fein, Fe TT amaiaaate Typhus: nic (fleas) —R typhi. p Fis He Mheas + Rash “Epon ty Rash starts centrally and spreads out, sparing palms and soles. RASH RARE z "MEGA berry — Ehrlichiosis Anaplasmosi Monocyte c morulae [2 in cytoplasm, females wheel all the way to formation (much La larger than RBC) Ala lehey Nou fs Hstoplismoss, = Bastomycoss 15 Cocessoidomycoss STahkale spans Wh Envvrerment (Anadis) is Soe eT ae aed G coun ooSECTION I GIO RUS ett eck Micsos ponoms als bin Epidasme plage «shin, nell “Trichophyton » Hein; +hin, rel ay mycoses , ophytes inclu Clinical name for dermatophyte (cutaneous fungal) infections. Dermatop z ; state hyphae visible »phytes) Microsporum, Trichophyton, and Epidermophyton. Branching septate byph coe r (hair (ooks Gree ets preparation with blue fungal stain £J. Associated with pruritus pitis (%'3 Occurs on head, scalp. Associated with lymphadenopathy, alopecta gre rporis Oceurs on body (usually torso). Characterized by enlarging erythemalous, s¢ aly ring 5 eae h infected pets or farm a 482) with central clearing {@. Can be acquired from contact with infected pe ‘uris Occurs in inguinal area fH}. Often does not show the central clearing seen in linea cc edis Three varieties: * Interdigital &; most common * Moccasin distribution G = Vesicular type nguium Onychomycosis; occurs on nails. Re Trmumarole tyriasis) Caused by Malassezig spp. (Pityrosporum spp.), a yeast like fungus (not a dermatophy or being called tinea). Degradation of lipids produces acids that inhibil tyrosinase (inv at tre set jrewe melanin synthesis) ~ hypopigmentation ; hyperpigmentation and/or pink patche occur due to inflammatory response. Less pruritic than dermatophytes. ner Can oceur any time of year, but more common in summer (hol, humid weather). “S] niffifialls” appearance on microscopy [- Treatment: selenium sulfide, topical and/or eal antifungal medications [ord satire cra)> guieal tas ae matey eeattete cae MANS Ty Warm, monet akin areas (4y-axilla, grey) — Wy caused by candlie following fawohe tne ae Opportunistic fungal infections Candida albicans Iba = wh ite phe: fos pseudoypha sd budkling yeasts at 20° BV germ tubes at tie oF superficial fungal infection. Causes oral {@ and esophageal thrush in immunocompromised (neonates, steroids, diabe tes, AIDS), vulvovaginitis (diabetes, use of antibiotics), diaper rash, endocarditis (IV drug users), disseminat kan seine tts aod clustered ied candidiasis (especially in Nendo Takin destons Rewopente patients) chronie mucocutaneous candidiasis (#248 dyin and Myepewnue deter) 3 mith Srimabarard fHid Treatment: oral fluconazole/topical azales for vaginal: nystatin, a r Iy, echinocandins for * re nae a ginal; nystatin, azoles, or, rarely, echinocandins fo [anys port Arpendactorty oral; fliconazole, echinocandins, or amphotericin B for esophageal or systemic disease Aspergillus Seplateypige that branch at 45° Acute Angle [VE Conde n atvor ein atthe ard of Cenllphoe, Cal fumigatus c ses invasive aspergill losis in immunocompromised patients, neutrophil dysfunction (eg, chron granulomatous disease). Anqiomanve Asprglt « rg enbrang hates n CX Cin cause aspergillomas Ed in pre-existing ling cavities, especially after'TR infection, emangea-> peti Some species of peri Produce Aflatoxins (asso Treatment: voriconiazole or echinocandins (2nd-li Allergic bronchopulmonary aspergillosis (ABPA). growing in lung mucus, Associated with asthma and eystic fibrosis; may cause bronchiectasis and eosinophilia. CF: cough, Foie, Malane, Bren mute peg, Kemaplle, iated with hepatocellular carcinoma) hypersensitivity response to Aspergillus Gr Sheila, Cryptococcus 5-10 um with narrow budding, Heavily GRRMSSiMteD yeast. Not dimorphic neoformans Found in soil, pigeon droppings. Acquired through inhalation with hem: logenous dissemination italy severemats or tag et, 0 meninges, Highlighted with India ink (clear halo &) and nkitScSfmine (red inner eapsule EE) B- Minegr Het Pe sieeWLalex agglutination test detects polysaccharide capsular antigen and is mote sensitive and specif sae redies & Hite UX Cauises cryplococcosis, eryplococeal meningitis, ery cal encephahiis (“soap bubble” lesions LE ee mati coe in brain), primarily in immunocompromised (fst rmplan A204, ume) > S18" Soy wenenng Senda Tesla in nbeal ene (rg toms Wiad casa. Treatment: amphotericin B + flucytosine followed by iaZale for cryplococeal meningitis, Mucorand Rhizopus Irregular, broad, nonseptate hyphae branching at wide angles [Lara forms Spereng it spp Causes mucormycosis, mostly in ketoacidotic diabetic and/or neutropenic patients (eg, leukemia) Inhalation of spores = fungi proliferate in blood Weel walle penetrate cxibriforn Bate and enter brain. Rhinacerebral, frontal lobe abscess; cavernous sinus thrombosis. Headache, facial pain, ot ay have ranial nerve mvolvement Treatment: surgical debridement, amphotericin B or isavuconazole.SECTION II | MICROBIOLOGY > MiCROBIOLOGY—MYCOLOGY, Bp — imocystisjirowed) §— Causes Pneumocystis pneumonia (PCP), «diffuse mbes! eum (originally cl fied as protozoan). Most infection" an AIDS) predisposes to disease. Diffuse, bilateral oceles FJ. Diagnosed by bronchoalveolar lavage oF 11" Rr re iverstain of ung tissue i or with foreseen a> ; la prophylaxis as single Treatment/prophylaxis: TMP-SMX, penauaisine. dapsone (Prep Y reece ery eer Arcalmentinreombination with TMP), atovaquone. Start prophylanis wher cps <200 cells/mm! in HIV patients. pneums Sporothrixschenckii Causes sporotrichosis. Dimorphie fungus. Exists asa cigar-shaped.yeashat37 °C in the human oI body and as hyphae with spores in soil (conidia). Lives on vegetation. When spores traumatically introduced into the skin, typically by a thomn (“rose gardeners disease” Tocal pustule or ulcer with nodules along draining lymphatics (agcending lymphangitis EX) aa Disseminated disease possible in immunocompromised host “git eons ‘Treatment: itraconazole or potassium iodide (only for cutaneous/!ymphocutancous ‘Think of a rose gardener who smokes a cigar and pot. eae sete Nendjsjsvanicdetes 4c, Haris, Sserminiad by oe cas & Ree ort Caxkel clger shoved badd| epee. Cyots Feeding -torm. Mere. Viinenaila TO Enuvrermantal Condihins. Mare unable form Often prsent In feces > Vater —w now infect )BIOLOGY—PARASITOLOGY ba oridium foe pere. es) gastrointestinal infections _ _DISEASE Giardiasis— bloating, flatulence foul-smelling, fatty diarthe: (often seen in campers/hikers) think fat-rich Ghirardelli chocolates for fatty stools of Giardia . No eesmephiia Amebiasis —bloody diarthea (dysentery), liver abscess (“anchovy paste” exudate), RUO pain; histology of colon biopsy shows flask-shaped ulcers Severe diarthea in AIDS Mild disease (watery diarrhea) in immunocompetent hosts 1 Znteatiral epthelaen nea by, Cut Histo 2 Taflirotes in lamina G 8 a > é¢ » 2 i ae iP se o . Beit v Shrove Wwleamtlent lashes In AESS TRANSMISSION Cysts in water rulence: Vis6C DIAGNOS! (ce Settee sate trophozoites EY or rolelns) ~ doves from fre Adhesive dtc ittaen Biopsy » Variable degree ae jet hy perpias| en cysts EY in stool, qantigen detections “ils Aron eh Sie Seed Cysts in water Male te Mala fa indMtduals Tavelnea tn Ormanal dex. Oocysts in water * Chicrination dosn't destrey Cogs i Sammy ane ite Casters presen Serology, antigen testing, and/or foamy oites (with soca oneysts with up to 4 nuclei in stool B; Entamoeba Eats Erythrocytes Oocysts on acid-fast stain , antigen detection nt Craprt anc vous Sturn TREATMENT Metronidaz< ‘oe sprain passers Prevention ( filtering city water supph wutazonanid immunoco!Protozoa—CN infections ORGANISM Toxoplasma gondii DISEASE Immunocompetent tmononuiclcslibe symptoms, © heterophile autibedy test Reactivation in MIDS bein abscesses usually seen as multiple ring-enhancing lesions on MRUEY 515-7 hendsene, Congenital toxoplasmosis: classic of chorioretinitis, hydrocephalus, and intracranial calcifications Rapidly fatal meningoencephalitis Taste: ond Sra Abnawmalives African sleeping sickness— : iso "fever (due to antigenic variation), somnolence, coma (ep) or ~s, « +, , Cysly in meat (most Fr common); oocysts in eat feces; crosses placenta (pregnant women should avoid cats) Amoebas in CSF C56 Washer Is 066 SG eninge Swimming in warm ‘Tsetse Ay, a painful bite gives Friraaee ‘Lxxpomastigote in blood smear B} > ; Suet ” ‘ sa wr + Sulfadiazi Amphoteric been effec few survivi Fiewmideadie Suramin fo borne dise melarsop GNS peni “I sure at mellow w sleeping” 0, =,