Professional Documents
Culture Documents
PARASITOLOGY
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
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
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
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
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
Diagnostic Algorithm
Screening of Pediatric Drug-Susceptible Household Contacts of TB
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
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
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
î ELISA
Stage 3: Late stage
PREVENTION: î Western immunoblotting
î Autoimmune migratory polyarthritis (onion
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
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.
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
Fluconazole - systemic
Transmission: Respiratory Yeast form only (Not
chemotherapy
dimorphic) Fungal culture
via inhalation of airborne - AIDS
yeast cells
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)
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)
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
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
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
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!
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.
Confirmed dengue:
• Viral culture isolation
• PCR
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:
Encephalitis virus non-segmented, mosquitoes - most prevalent in Southeast Asia JE vaccine
(+)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
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.
oloss 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
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)
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
Life cycle of Entamoeba histolytica, showing the sites of action of amebicidal drugs
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
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
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
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
Clonorchis
Ascaris
Necator &
Ancylostoma
lemon-shaped or
barrel-shaped eggs
with bipolar plugs /
football-shaped eggs
Trichuris
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)
D-shaped ovum
Strongyloides
Enterobius
Wuchereria
Capillaria
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