Huny_00@yahoo.

com

MICRO Renal failure Bugs with Exotoxin

Steps in Gram Staining
1. Crystal Violet
2. Iodine
3. Alcohol
4. Safrin
Crystal Violet stain?
Petidoglycan – Gm (+) stains blue
What does Iodine do?
Seals in the Crystal Violet
What is the function of Etoh?
Washes excess Crystal Violet
What is stained by Saffrin?
Gram (-) are stained pink
How is staining of acid fast organisms
different from Gm
The opposite of gram staining occurs,
pathogens with mycolic acid are stained
PINK and others are stained BLUE
Acid Fast Organisms
1. Mycobacterium
2. Nocardia (G+; partial; likes DM Tx
TMP-SMX)
3. Cryptosporidium (protozoa; likes
AIDs)
Watery diarrhea in AIDs patient
Cryptosporidium
Gm (+) with Endotoxin
Listeria
Features of Gram positive
Thick peptidoglycan layer (>40)
Teichonic acid
Some have superantigen (exaggerated
response bc amplified..staph and strep)
Features of Gram Negative
1 Peptidoglycan layer thin
Outer membrane
Endotoxin (LPS-lipopolysaccaride)
Lipid A (the same for all)
O Ag (variable)
Core Ag
Some have capsule
Periplasmic space
Cytoplasmic membrane
HUS (FATDR)
Fever
Anemia (hemolytic)
Thrombocytopenia
Diarrhea (uncooked beef)
Where is O-Antigen located?
In the Periplasmic Space
Therefore, when give Abx  initial
increase in endotoxin  swelling
** must give steroid for anti-
inflammatory action
What steroid is given for meningitis
before Abx and how long before?
Dexamethasone; 15 minutes
Endotoxins virulence
Caused by Lipid-A (low variability)
Most variable part of LPS
Core Ag-responsible for symptoms
(inflammatory)
Phases of bacteria
Lag – bacteria getting use to new
surrounding (# bacteria stays the same)
Log- replicating
Plateu- replicating cells = cells dying
Decline- more dying (total # decreases);
where most endotoxin released (when
membrane is being destroyed)
Bacteriostatic
If use bacteriostatic drug  puts bacteria
into platue phase (stops growth) and let
neutrophils and/or macrophages eat up
Leaves log phase
Bacteriocidal
If bacteriocidal drug  Kill too early 
decline phase
One bacteria that releases endotoxin
during log phase?
Neisseria (presents with
toxicity..multiple organs!!!)
Vasculitis or purpura in someone
who’s sick?
Neisseria
Heat stable/unlabile
Can travel through blood stream 
sepsis
Heat unstable/labile
Can’t travel through blood stream
Sick and toxic =?
Gram negative
Sick and non toxic =?
Gram positive
1. E. Coli
2. Pseudomonas
3. Vibrio
4. Bordetella Pertussis
Pseudomonas auregenosa
 Whirlpool folliculitis
 Tennis shoe folliculitis
 Malignant otits externa (ICU, CT to
see if infection is eroding through
bone, consult surgery)
 Mcc of death in second week after a
burn
 Recurrent pulmonary infection in
CF
 Ecthyma gangrenosum (rash, tense
black bullea, eruption, advise pt not
to pop bc can  spread)
ADP ribosylation of EF-2
Cornybacterium Diptheria
Pseudomonas exotoxin A
ADP ribosylation of Gi
Pertussis
ADP ribosylation of Gs? Also cause
secretory diarrhea
Vibrio
E. Coli (ETEC-enterotoxogenic E. coli)
Tumor that causes secretory diarrhea
Vipoma
NPO with secretory diarrhea?
*secretory does not change with fluid
restriction
Osmotic diarrhea improves with
dehydration (bc inflammatory)
Anytime inflammation of bowel 
malabsorption of ?Test?
Sugar in stool first
Clinitest
BACTERIAL KILLING
1. O2  O2 radical (NADPH oxidase)
2. O2 radical  H2O2 (Superoxide
dismutase)
3. H2O2  HOCl (bleach) radical
(MPO)
Neutrophils contain the aforementioned
MO only have MPO
Some bacteria have catalase which
breaks down peroxide to water (H2O2
 H2O)
1 of 13
 Huny_00@yahoo.com

Free Radicals - High energy bonds, kill 3 features of Scarlet Fever?
anything in site, destroy membranes Sandpaper Rash
Neutrophils show up on day 3 and then Strawberry Tongue
it’s determined if T cells and MO will be Rash on Palms and Soles
needed (i.e. for anything other then
bacter and subsequently IL-10 inhibits Bullous Impetigo–vs- Impetigo
cell mediated while IL-12 stimulates it) Impetigo – Strep
Bullous Impetigo – Staph (elastase)
Catalase (+) Bacteria
1. Staph Aureus Clue for Impetigo
2. Pseudomonas Honey crusted lesion
3. Neisseria
Define the Following MCC skin infxns
Most Infxn become anaerobic at day ? by Staph:
Most infections become anaerobic at day Carbuncle - Boil (firm), small nodular
7 due to oxygen burst indurated area with infection
Day 1-3 Staph Aureus Carbunculosis – several carbuncles
Day 3-7 Strep pyogens Furuncle – C + hair follicle
>day 7 = anaerobes Furunculosis – several furuncles
Periorbital cellulitis- red around eye, non
Calculate Absolute Neutrophil Count painful eye movements
(ANC) Orbital cellulitis - painful
(% PMN + % BANDS) * WBC Cellulitis - Area of redness + blanching
Folliculitis - Infxn at hair follicle (pus)
Normal ANC Panniculitis – cellulitis as a ring around
< 2500 Neutropenic abdomen
< 1500 Moderate Neutropenia Oomphalitis – cellulitis around
< 1000 Severe Neutropenia umbilicus of newborn (hospitalize and
Tx)
Patients Susceptible to Staph and Mastitis – Breast (from breast feeding)
Pseudomonas Fascitis – Compartment syndrome (5 Ps)
1. Neutropenia without flesh eating bacteria
2. Burn Ballintitis – infxn of head of penis
3. Diabetics Blepheritis– eye lid
4. CF
Compartment syndrome
Pathogens on the skin 5 Ps, > 30 ccHg
Staph. Aureus 1. Pain
Staph. Epidermidis 2. Pallor
Strep. Pyogenes 3. Parasthesia
Propionobacterium Acne 4. Poiklyothermia (cold)
5. Pulselessness
MCC of All skin Infections Tx- fasciotomy  amputation
Staph Aureus NO ICE compression (vasoconstriction)
Group A Strep Infections? Reflex sympathetic dystrophy
L- Lymphangitis During compartment syndrome 
I- Impetigo sympathetic localized  sweat
N- Necrotizing fascitis Rx- α1 blocker (phentolamine)
E- Erysipelas
S- Scarlet Fever Bacteria picks up new enzyme
Transduction
What causes LINES?
Strep. Pyogenes Infxn caused by Staph Epi?
Group A β-hemolytic Shunt infection
Bacitracin Sensitive Central Line infection
Tx-Blood Cx, remove linve, Cx tip and
Cellulitis –vs- Erysipelas Abx
Cellulitis- flat and blanch (turn white)
Erysipelas- Raised/not blanched MCC Acne?
Proprionobacterium Acne
G+ anaerobe (hinds under skin)
Women & adolescents have more acne
because ?
Proprionic acid is stimulated by
progesterone, which is high in women 2
weeks b/4 menses (day 14-28 = Luteal
phase) and adolescents around puberty
Rx for Proprionobacterium
Expose to air
OXY5/OXY10 Pads
Antibiotic
Retin A - Isotretinoin
Pathogens in Mouth/Throat/Esoph
1. S. Pyogens
2. S. Pneumonia
3. H. Influenza
4. Neisseria catarrhalis (catar=
mucus)
a. Meningiococcus
b. Gonorrhea
** at risk when cilia destroyed or
aspiration**
3 bugs with IgA protease
1. S. Pneumonia
2. H. Influenza
3. Neisseria Meningiococcus
MCC of sinusitis
Obligate Aerobic organisms:
Must Breathe, Clean, Fresh air
Must - Mycobacterium
Breathe - Bacillis
Clean – C. diphtheria
Fresh - Francisella
Oral Infxns start after a viral infection
because?
Organisms live in the mouth and are
normally innocuous because the cilia
beat the organism up and they are
swallowed. Viral infections paralyze the
cilia and lead to infections by these
organisms.
Does skin or throat Strep cause
PSGN?
Either can cause PSGN
Does skin or throat Strep cause
Rheumatic Fever? Tx?
Throat Strep (petechiea)
Tx-PCN
Jones Criteria (Strep Pyogens)
2 major criteria and strep throat
OR chorea alone (brain involved)
S- Subcutaneous Nodules
2 of 13

P- Polyarthritis
E- Erythema Marginatum
C- Carditis (MS  MS + AS  AS 
TS)
C- Chorea
Pathogens found under gum: (G+
facultative anaerobe- prefer no O2)
1. Streptococcus
2. Peptostreptococcus (anaerobe)
3. Actinomyces (sulfur granules,
fistulas in the face, PID if have
IUD)
4. Fusobacterium (fused/tapered at
both ends)
5. Strep Viridans (MCC of SBE)
 Strep Mutans (dental caries)
 Strep Sanguis (SBE, saliva)
 Strep Salivarius (Cold agglutin
test - Cryoglobulinemia)
Bug with "Sulfur Granules"?
Actinomyces Israelii (yellow exudates)
Anerobic
Fistulas in the face
PID s/p IUD
Tx- PCN 6-12 months
2 Fusobacterium diseases?
1. Vincent's Angina - Painful ulcer in
the back of the throat + malodor
2. Trench Mouth – pus oozing from
gums
MCC SBE
Strep Viridans (previously diseased
valve) mitral stenosis
Aureus – ACUTE (MR)
What bacteria causes dental carries?
Strep Mutans (ferments sugars)
Septic Emboli from SBE
Brain - Mycotic Aneurysm
Retina - Roth Spots
Fingertips – Osler’s Spots
Toes - Janeway Lesions
Under nail beds - Splinter Hemorrhages
Urease (+) pathogens
1. Pseudomonas
2. Proteus
3. Ureaplasma
4. Nocardia
5. Cryptococcus
6. H. Pylori
7. Staph saphrophyticus
8. Brucellosis
Huny_00@yahoo.com
Most abundant organism in the colon?
MC bacteria found in Stomach Bacteroides Fragilis
H. Pylori
Name the Pathogen:
2 ulcers H. Pylori Causes Red Pigment – Serratia
Gastric - 70% Multiple cerebral abscesses -
Duodenal - 90% (hypertrophy of Citrobacter
brunner’s glands) Colonizes everyone after a 48hr stay in
the hospital - Pseudomonas
Most Abundant in small Intestine? Seen in alcoholics/ homeless - Klebsiella
E.Coli
Cholecytitis Normal Rectum Flora
Ascending cholangitis anGEL
Appendicitis Group B Strep
Spontaneous bacterial E. Coli (spinach)
Peritonitis Listeria
Abdominal abscess All cause sepsis in newborn
From fecal material (meningitis)
4 vitamins E. Coli makes
Biotin
Folic Acid
Panthothenic Acid Staphlococcus
Vit K (broad spectrum Abx  bleeding) G+ cocci in clusters
Aurues- catalse
Vitamin E. Coli helps absorb Epidermitis- NO catalase, white pigment
B12 Saphrophyticus (Tx- PCN)
Most abundant gas in the colon? Staph Aureus Enzymes
Carbon dioxide Catalase (breaks down H2O2  H2O)
ß-Lactamase (-lactam Abx)
Gases responsible for the smell in Coagulase (busts clots & valves/MCC of
flatulence (abdominal distension)? acute Endocarditis)
Methane and sulfur Staphylokinase – MC death 1 wk s/p
burn
Acenetobacter Lipase (eats through lipids 
Burn patients panniculitis, folliculitis, mastitis)
Hyaluronidase (destroys tissues 
Pathogens found in the terminal spreads)
ileum/colon? Collagenase (bone & skin/ MCC of
Primarily G- osteomyolitis)
Clostridia Difficile (pseudomembranous Lecithinase (skin infxn)
colitis) Elastase – (bullous emphysema, eating
Clostridia Malanogocepticus (Colon Ca) through valves  acute endocarditis)
Clostridia Perfringens (gastroenteritis
a/w holiday ham, Gas Gangrene a/w Fever + arthritis (joint pain)
DM) S. aureus until proven otherwise
Strep Bovis (Colon Ca) TAP
Bacteroides Fragilis (MCC of abscess)
E.Coli (MCC of UTI) Osteomyelitis
Proteus (2nd MCC of UTI) Sickle cell- klebsiella
Serratia Marscescens (red pigment, IC All else- S. Aureus
pt’s)
Actinobacter Supratoxin
Citrobacter (Cerebral abscess 1-2 mo) huge
Pseudomonas
Klebsiella (currant jelly sputum) Staph Aureus toxins
TSST - Fever, Shock, Red, Rash on
Pathogens causing colon cancer? Palms and Soles (a/w lengthy tampon)
Strep Bovis Exfolatoxin - SSSS  (+) Nykolsky (red
Clostridia Melanogocepticus rash all over + palms and soles sloughs
off)
3 of 13
 Huny_00@yahoo.com

Enterotoxin – food poisoning from dairy Strep Pneumo Cornybacterium Diptheria

products (custard pie) with preformed Kidney bean Shaped Secure airway if compromised
toxin w/in 8 hours Toxin killing patient
Erythrodermotoxin (bright red rash MCC of PSGN Tx- antitoxin 1st, Abx
scarlet fever) Strain 12  Group A Strep (Pyogenes)
Staph infxns usually arrive after flu-like 5 bugs causing heart block
symptoms Differentiate Strep strains by 1. Chaga's Disease
Their M-Protein 2. Legionella
5 bugs and their colors 3. Lymes
Strep. Viridans - Green Give the strep class 4. Diptheria
Staph. Aureus - Gold Group A  Pyogenes (70 strains) 5. Salmonella Typhi
Pseudomonas - Blue/Green Group B  Agalactiaceae (rectal)
Serratia Mecansus - Red Group C  nameless  pharyngitis 4 features of spores:
Staph. Epidermidis - White Group D  Enterococcus & Viridans Formed in harsh environment
Not replicating -release toxin
Infxn by Saprophyticus? Do not like heat
UTI in women 5-10 & 18-24 Alpha hemolysis – blood turned into D-dipicolinic acid membrane
Honey moon cystitis green zone (partial) Resistant to heat, dehydration,
Beta – complete hemolytic = clear zone chemicals
Antibiotic to Rx Epidermidis Gama – none = red (blood still there)
Vancomycin (best cell wall inhibitor) How to destroy spores
Main s/e = nephro-, oto- toxic and Rheumatic fever 121 degrees centrigrade vaporized heat
redman syndrome (slow down, Tx- Only from throat strep  LA  mitral
antihistamine) valve Membrane of Bacillus has?
**If allergic  isolate, Lenezolid Poly D-glutamic acid (seen as foreign)
Pregnant woman’s rectum culture **we have poly-L acids**
Catheter related sepsis associated with returns (+) for Group B Strep. Tx
which bug? with? 3 factors in Bacillus Anthracis
Staph epidermidis 1. PCN 1. Protective factor
2. Ampicillin 2. Lethal Factor (kills)
Rash of Palms and Soles 3. Cefazolin 3. Edema factor (swells)
1. SSSS- Staph Aureus 4. Clindamycin & erythromycin (Cx +)
2. TSST – Staph Aureus 5. Vancomycin Infection caused by B. Anthracis
3. Scarlet Fever - Strep Pyogens Cutaneous - malignant pustule (black)
4. RMSF – Riketssia Ricketsi Infection caused by Group C Strep Pulmonary - Wool sorter's disease
(parasites transmitted by Pharyngitis (farmers)
arthropods)
5. Syphillis - Treponema Pallidum Infection caused by Group D Strep Bacillus Cereus causes?
6. Kawasaki – Mucocutaneous Lymph SBE Gastroenteritis associated with reheated
7. Coxsakie A– Hand/Foot/Mouth Chinese fried rice  rice water stools
Enterococcus
Who gets Pneumovax? Faecalis C. Difficile
Greater than 65 yo Faecium Pseudomembranous colitis (grey)
Sickle Cell > 2yo associated with antibiotic use (primarily
Sickle Cell with end organ damage Pneumococcus Clindamycin)
G+ DIplococci Tx- Metronidazole, Vancomycin (most
Give the DOC for: M protein (polysaccharide capsule) effective)
Staph Epidermidis  Vancomycin Quellung + = has capsule
Strep Pyogenes  Ampicillin 80 strains Anaerobic coverage
Strep Agalactiaceae  Ampicillin 23 strains make up pneumovax Clindamycin
Metronidazole
Nitrate Negative UTI? Pneumovax Cefoxitin
Enterococcus  > 65
 Splenectomy C. Botulinum Causes
MCC of Meningitis by age  Sickle cell > 2 yo heat-labile toxin that inhibits presynaptic
0-2mos  GEL  End organ damage release of Ach  M. Paralysis 
2mos-10yr  Strep, Neisseria Botulism
10yr -60yr  Neisseria Spore formers respiratory failure (restrictive)
>60yrs  Strep Pneumo Clostridium (anaerobe) Children – honey (spore) & molasses
Bacillus (aerobe) “floppy baby” (paralysis)
Only Gm(+)diplococci
4 of 13

Adults - Canned foods (preformed
toxin)
C. Tetani causes
Exotoxin inhibits the release of Glycine
from Renshaw cells in spinal cord and
inhibits release of GABA in anterior
horn  inhibit inhibitory NT  muscle
spasm Tx= metronidazole
Lockjaw(Trismus) in association with
dirty wounds
Soil and feces
Tetanus q 10 yr booster
Note** PCN is a GABA antagonist
C. Perfringens causes
Gas gangrene a/w DM & wounds
(necrosis)Tx- immediate amputation
Gastroenteritis a/w holiday ham
Best Rx for C. Difficile colitis
Vancomycin
Current Rx for C. Difficile colitis
Metronidazole
Botulinum toxin works by
Inhibiting presynaptic release of Ach
C. Tetanus work by?
INH release of Gly from S.C.
What works like C. Tetanus?
Strychnine
1st step to treat dirty wound
Tetanus Anti-toxin
Treatment for Gas gangrene
Immediate Amputation
Air emboli hurt by
Causing Ventricular Outlet Obstruction
Treatment for VOO
L. Lateral Decubitus
Chest PT on Right
Associated with Holiday Ham &
Turkey?
Clostridium
Clostridium associated with colon
cancer?
Melanogosepticus
What bacteria Looks like Chinese
letters?
Corynebacterium
Huny_00@yahoo.com
Most bacteria acquire their toxins
through? 3 bugs Cause illness in 8hrs
Transduction (phage) Clostridium p.
Bacillus c.
ADP ribosylation of EF-2 Staph aureus
Diptheria
Pseudomonas exotoxin A Reason for illness in 8 hrs
Preformed toxins
ADP ribosylation of Gi
Pertussis
Rule of 6 for Treponema Pallidum?
ADP ribosylation of Gs A Painless Chancre will appear 
Vibrio Disappear 6 wks later
E. Coli 6 wks later  Rash on palms and soles
6 years later  Neurological symptoms
Only acid fast G (+) (Neurosphyillis = Tabes Dorsalis =
NOCARDIA Dorsal Columns)
Clues for Nocardia What part of the brain does
Attacks Diabetic’s Sinuses & Lungs Treponema Pallidum effect?
Behaves like a fungus The Edinger-Westpal Nucleus  can’t
Branching filamentous constrict to light = prostitutes pupil
IC pt’s
What part of the spinal column does it
Only Gm(+) with endotoxin particularly attack?
Listeria Dorsal Columns  Tabes Dorsalis 
loss of position sensation and vibration
Rx to cover meningitis
Vancomycin, cephatatime, ampicillin (to Result of attack on EW nucleus?
cover listeria) Argyle Robertson Pupil (can
accommodate but not react, i.e.
Illness caused by listeria constrict to light)
Gastroenteritis in adults
Meningitis in infants < 2 months What is the clue for treponemal pain?
Shooting, Lacinating (piercing),
Clues for Listeria Stabbing
Raw Cabbage
Spoiled Milk Neonate Syphilitic infection
Migrant workers Saddle nose  Snuffles - Destroys
sinuses
5 – causes of monocytosis (> 15%) Hutchinson’s Teeth  sharp
Salmonella typhi (typhoid fever) Sabre Shin – anterior bowing
TB Rhagades - Split from corner of mouth
EBV PseudoParalysis - Bones hurt
Listeria monocytogenes movement
Syphilis
Most specific test for Syphilis
Mononucleosis #1 Dark-field Microscopy - Most
1. Strep Specific
2. EBV FTA-ABS (specific blood test)
3. CMV TPI
Strep-acute, petechiea on palate
EBV-drag, atypical lymphocytes Which Syphilitic tests are most
Heterophile Ab positive, sensitive?
cryoglobulinemia, enlarged spleen RPR and VDRL
CMV-heterophile Ab negative, enlarged
spleen Which test is used to test pregnant
women for Syphilis?
Worst complication of Mono? RPR - Blood test
Enlarged spleen
No contact sports until it shrinks down
5 of 13

Which test is used for screening for
Syphilis by testing the CSF?
VDRL
How long does RPR stay positive?
One Year
Why are RPR and VDRL not specific
for Syphilis?
Because it will also be positive with
Viruses, Drugs, Rheumatoid Arthritis,
SLE
Rx for Syphilis:
IM PCN G
Primary - 1.2x10 6 in one Buttock
Secondary - 2.4x10 6 2 in each Buttock
Tertiary - 2.4x10 6 x 3 wks 2 each
Buttock Neonate - 50,000 Kg/day for x
7-10 days
Jarisch-Herxheimer reaction?
> 50 % of those treated with PCN
1-2 hours after Tx
Fever, HA, myalgias (immune rx sx)
Tx-supportive and NSAIDs for
symptomatic relief
Treatment for ALL SPIROCHETES?
PENICILLIN (Borellia, Leptospira,
Treponema)
TORCHS organisms
Toxoplasma (ring lesions in parietal
lobe, a/w cats)
Rubella (cataracts, deaf, autism)
CMV (MCC of congenital blindness)
Herpes (Temporal lobe encephalitis)
Syphilis
Clues for Toxoplasma
Associated with Cat urine
Multiple ring enhancing lesions in
parietal lobe
Clues for Rubella
Hearing loss
Cataracts (opacification of lens)
PDA
Autism
Clues for Herpes
Temporal lobe encephalitis
Clues for CMV
Central calcifications (nonfunctional
legs, but arms work), and eye problems
MCC congenital blindness?
CMV
If a pregnant woman has a herpetic
outbreak w/in two weeks of delivery?
Deliver by C-Section
Vector for LYME’S Disease?
The IXODES Tick
What organism causes LYME'S
Disease?
Borrelia Burgdorferi (BAKE)
Tx- PCN > Doxycycline
Ceftriaxone IV x 7 days (pregnancy)
3 diseases carried by IXODES tick?
1. Lymes Disease
2. Babesiosis
3. Erlichiosis
Clues for primary stage of LYME'S?
Erythema Chronicum Migrans
(Red rash migrating outward bull’s
eye)
Flu like Symptoms
Only 60% Symptomatic
Clue for secondary LYME'S Disease?
PolyArthritis and Carditis (HEART
BLOCK)
Eosinophilia
Clue for tertiary stage of LYME'S?
Neuropathies (Bell’s palsy)
How is LYME'S Disease Diagnosed?
History
Lyme Titers (IgM < 2 months and IgG >
2 months to Borrelia)
Rx for LYME'S disease?
Penicillin – First Line
Tetracyclins
Fever Patterns
Brucellosis – Undulating Fever (spikes
7/day)
Malaria – Cyclic
Clues for BORRELIA
RECURRENTIS?
Fever
Head Ache
Nonspecific SSX qwk x 5-6wks
BORRELIA RECURRENTIS likes to
hide in? It escapes detection by?
Lymph nodes
Escapes by going through variation
What disease is caused by
LEPTOSPIRA ENTEROGANS?
How is it transmitted? What organs
are particularly affected?
1. Causes Fort Bragg Fever
2. Is transmitted by Rat Urine
Huny_00@yahoo.com
3. Likes the Liver and Kidney (Weil’s
disease) => Hepatitis and Kidney disease
List the ATYPICALS?
1. Chlamydia Pneumonia (0-6 mo)
2. Mycoplasma (10-30 yo)
3. Legionella (>40 yo)
4. Ureoplasma
Cell Mediated
MCC atypical pneumonia 0-6 months?
Chlamydia Pneumonia
Infiltrate seen in atypical Infections?
Cell mediated  T cells and
Macrophages
In addition to T-Cells and M0, what
else is seen with chlamydia Infx?
Why?
Eosinophils
This is because Chlamydia is an obligate
intracellular organism
What are the two bodies that appear
in CHLAMYDIAL infections? What
does each indicate?
1. Reticulate Body - Resting Stage
2. Elementary Body - Infective Stage
Chlamydia associated with what 2 dz?
Nerofibrillary tangles of Alzheimer's
Atherosclerotic Plaques of Angina
MCC of neonatal (< 1 mo) blindness?
Chlamydia Trichomatis (> 7 days)
Trachoma = destruction of cornea from
scarring
MCC congenital blindness?
CMV (central calcifications)
What are the deep corneal ulcerations
caused by CHLAMYDIA called?
Trochomas
Neonatal Conjunctivitis
1st 24hrs – Chemical from silver nitrate
2-7days – Opthalmia Neonatorum - GC
More than 7 days – Chlamydia
MCC of STI, PID, CERVICITIS, &
SALPINGITIS?
Chlamydia Trichomatis (ELIZA)
% of asymptomatic Chlamydia Infxn
Ninety percent (90%)
MCC of infertility in women?
Chlamydia Trichomatis
Chlamydia Psittaci is transmitted by?
Parrots and Parakeets
6 of 13
 Huny_00@yahoo.com

MCC of symptomatic STD? Pontiac Fever - Fever with Erythema nodosum

N. Gonorrhea nonspecific Sx Shigella

MCC of STD? 5 causes f cryoglobulinemia (Cold Shigella

Chlamydia Agglutinins)? Gastroenteritis
Use the mnemonic : I AM HE
I - Influenza Salmonella
% symptomatic Chlamydia infections A - Adenovirus Sickle cell  osteomyelitis
Ten percent (10%) M - Mycoplasma Gastroenteritits a/w raw chicken and
Alzheimers and CAD H - Hepatitis B and C eggs (Do NOT treat)
a/w Chlamydia pneumonia E - EBV
Typhoid fever
What is a Chlamydiazyme? (+) Antibody to Strep Salivarius? Salmonella
ELIZA Test for Chlamydia done at every Means you have cold agglutinins Triad-Fever, rose spots, intestinal fire
PAP Smear for sexually active teens Causes heart block
3 criteria for cold agglutinins? a/w contaminated water
Patients get arthritis/vasculitis with IgM only Tx- Ciprofloxacin
the flu because? Nonbacterial
This is due to cold agglutinins Acute Inflammation only Bordatella pertussis
Whooping cough “staccato”
Mycoplasma HOMMINUS Causes? How is Mycoplasma different from Exotoxin that ADP ribosylates Gi
STD other pathogens? High mucous in lungs
NO cell wall High lymphocytosis
MCC of STD It has Mycolic acid just like Dx- ELIZA (Ab test)
Chlamydia Mycobacterium Tx – erythromycin; also treat close
Gonorrhea contacts
Ureoplasma Urolytica MCC of atypical pneumonia 10-30yo
Mycoplasma Homminus Mycoplasma Pneumonia (Walking Brucella
Pneumonia) Undulating fever (5-7 fever spikes per
Infections associated with Reiter's day
(HLA-B27)? Presentation for mycoplasma Primarily in vetinarians and farmers who
1. Chlamydia pneumonia deliver animals
2. Shigella (most immunogenic Interstitial Pattern of pneumonia Attaches to placenta
bacteria) Cold agglutinins
3. Yersinia Enterocolitica Symptoms out of proportion to PE Bartonella henselae
4. Inflammatory Bowel Disease Walking Pneumonia Silver stains
Cat scratch disease
Infections caused by Ureoplasma How is interstitial pneumonia Kittens
Urolytica? described?
PID and Urethritis in men Interstitial Pattern Vibrio
Ground Glass Appearance Curved
Silver Stain in the lung? Reticulo-Nodular appearance
Legionella Secretory diarrhea
Pneumocystis Carinii Vibrio
Fungi Etec
Crytosparidium (AIDS)
Legionella grows on? Vipoma tumor
Charcoal Yeast Extract Agar (CYEA)
+ Cys and Fe Osmotic diarrhea (inflammatory)
Reducing agent + = sugars in stool =
MCC of atypical pneumonia > 40 yo malabsorption
Legionella NPO  diarrhea stops
D-xylose test (sugar not used by
Legionella Pneumophilia causes? humans)  detected in urine = secretory
Standing water on heating and air
conditioning systems Campylobacter jejunii
“hotel/motel syndrome” Curved
Legionaries Dz - Full illness + Attacks jejunum  bloody diarrhea
pneumonia a/w raw chicken and eggs
Tx- erythromycin

7 of 13
 Huny_00@yahoo.com

Yersinia
Likes southewest
Pestis
Bubonic plague
Pneumonic plague
Enterocolitica
Attacks ileum  ileitis
Causes Reiter’s syndrome

Aytpicals
No cell wall
Granulomatous inflammation
Covered by quinalones, macrolides,
tetracyclines

8 of 13

FUNGI
Superficial fungi
Like to feed off karitin on hair shaft
Immune response seen with fungi
Cell Mediated – T cells & Macrophages
What Environment do fungi like?
Warm, Dry, Sugary, Moist
Which country are these found?
Given the following location clues, give
the fungal infection:
Southwest – Coccidioidomycosis,
Hantavirus, Yersenia
Midwest - Histoplasmosis
South America/Puerto Rico -
Paracoccidio
North East - Blastomycosis
Moldy Hay/Basement – Aspergillus
First 4 are systemic mycoses &
Dimorphic (mold in soil where the
temperature is lower, yeast in tissue)
Can mimic TB (granulomas)
Organisms from the Southwest
Coccidiomycosis
Hanta Virus
Histoplasmosis
Clues for coccidiomycosis
Southwest
Thin walled cavities in the lung
Spherules + endospores
Clues to Histoplasmosis
Midwest
Bat droppings
Pigeons
Yeast w/in Macrophages
Clues for Paracoccidio
South America
Looks like ships wheel
Blastomycosis
Broad based budding yeast
Pigeons
Clues for Actinomycosis
Pigeons
Broad based hyphae
Cavitates
Opportunistic Infections?
1. Candida
2. Aspergillus
3. Cryptococcus
4. Mucor and Rhizopus
Candida clues?
Oval Budding yeast + pseudohyphae
Most likely to get Candidal infections?
Immunocompromised individuals (T cell
Mediation)  thrush (neonates)
White patches
Clues for Aspergillus?
Cavities with fungal ball
mold + branching septate hyphae @ 45
degree (fruiting bodies)
Sudden severe Asthmatic symptoms with
increased eosinophils and increased IgE
Gomori methenamine silver stain
Tx- Voriconazole
Clues for Cryptococcus?
Encapsulated yeast (polysaccharide)
Pigeons
India Ink
Aids pt w/ headache
Urease +
Clues for Rhizopus/Mucor Mycosis?
Irregular broad nonseptate hyphae
> 90 degrees
Mold
Growing out the nose of diabetics
Leukemic
Dx- Bx
Tx- surgery
PCP clues?
Yeast
Interstitial pneumonia
IC pt’s (diagnostic of AIDS in HIV +
patients)
CD4< 200
Methenamine silver stain
Tx: TMP-SMX, pentamidine, dapsone
What CD4 count causes concern for
this organism?
< 200
RX for PCP
Trimethaprim/Sulfamethoxazole
Rx For Patients Allergic to
TMP/SULFA
Pentamidine
Clues to Sporothrix
Rosebush stick
Dimorphic
Cigar shaped budding yeast
Tx: Itraconazole or KI
Huny_00@yahoo.com
MCC pulmonary infiltrate with
Eosinophilia (PIE)?
Allergic Broncho pulmonary
Aspergillosis
Loeffler - Infiltrate in Lung from
Parasite
Churg Strauss - Idiopathic
MCC vaginitis in women?
BV
What are the deep fungal infections?
Tinea Unguum (nails) and Candidiasis
MCC causes of vaginitis
1. Gardnerella
2. Candidiasis
3. Trichomonas
Name the Organism
White curdy discharge - candida
Fishy odor with clue cells - gardnerella
Frothy green discharge - trichomonas
Superficial fungal infections?
Piedra
Clue for Piedra
Little black balls on the hair shaft
Treatment for Piedra
Cut the hair
Beigelii
White balls
Transmission – hats by children
Tx- hair cut
Name of the cutaneous fungi
General
Dermatophyton
Trichophyton
Epidermaphyton
Micropsorum-Grows red with
woods lamp (+)
Tinea (skin)
Tinea Versicolor - Back Infxn, V-shaped
tree, eats melanin  hypopigmented
skin lesions (Malassezia furfur) Tx-
imidazoles, PO ketoconazole,
itraconazole
Tinea Nigra - pigmentation in hand
lines (Cladosporium Werneckii)
Tinea Pedis - Athletes foot
Reddened white scaly, macerated
infection between toes
Tinea Corporis - Ring worm (body)
Tinea Capitis - Flaky crust on scalp
Tinea Barbae - infection on chin
9 of 13

Tinea Intertrigo - Infection in the skin
folds
Tinea manis – between fingers
Tinea cruris – jock itch
Tinea unguum – under nail bed (tx.
Terbinafine)
Mold hyphae in KOH prep
Dermatophytes (Tx: Terbinafine
Griseofulvin (less efficacy) ,
itraconazole)
Pruritic lesions w/ central clearing
(ring)
2 fungal infections Rx by
Griseofulvin?
Tinea Capitis and Tinea Versicolor
What is a Karion?
Skin infection superimposed on a tinea
capitis infection
How is it treated?
Tinea Capitis - Griseofulvin
The Infection (Staph Aureus) -
Antibiotics
The Inflammatory infection – Steroids
Tx- antifungal, Abx, steroid
Why should you not scrape a tinea
corporis infected site?
The site has live organisms. Scraping
will cause further infections.
Fungal infection is seen in the nail
bed? Multiple nail beds?
Tinea Unguum
Onychomycosis
How are fungi different from bacteria
and human cells?
They have a unique cholesterol
(Ergosterol)
Goal of treatment with antifungal?
Target Ergosterol
Topical (creams) antifungal work by?
They bind to Ergosterol and destroy it
(Poke holes in the membrane)
Why can you not use topical and
IV/Oral antifungal in combination?
IV/Oral antifungal inhibit the synthesis
of ergosterol
So if there is no Ergosterol, the creams
cannot work
Human molecule damaged by
Antifungals?
Cholesterol
Huny_00@yahoo.com
What topical antifungal is parenteral?
Amphotericin B
Hyperkalemia + Amphotericin mean?
Systemic Toxicity due to destruction of
cholesterol in the cell membrane leading
to leaking of K+ into cytoplasm
Hypokalemia + Amphotericin mean?
Nephrotoxicity due to destruction of the
cholesterol in the kidney cells and K+
leaks out in urine
Side Effects of Amphotericin?
Hypokalemia
Hyperkalemia
Renal Failure
How do the IV/Oral antifungals work?
By inhibiting the synthesis of Ergosterol
P-450 dependant drugs
Warfarin
Estrogen
Phenytoin
Theophylline
Digitalis
One dose treatment for candidiasis?
Fluconazole (systemic mycoses)
Imidazole that crosses (BBB)?
Fluconazole
Imidazole inhibits P450?
Ketoconazole
How does Griseofulvin work?
It inhibits microtubules leading to
inhibition of fungal replication (induces
P450)
Oral treatment for Superficial
(Dermatophytes)
How is Griseofulvin delivered to the
infected site?
Through the sweat
Sporonox treats? Toxic side effects?
Nail fungus, Liver toxicity
10 of 13

HELMINTHS
Immune response with parasites?
Cell mediated response with T cells and
Macrophages
What part of the body do parasites
like?
They like the GI tract and they cause
Gastroenteritis
List all the liver flukes
1. Schistosomiasis Mansoni
(hepatocellular carcinoma)
2. Schistosomiasis Hematobium
(squamous cell carcinoma)
3. Clinorchis/Opthorchis Sinensis
(biliary tract)
4. Echinococcus (hydatid cyst)
5. Toxacara (cutaneous larva migrans)
Given the following, name the
organism:
1. Walking barefoot in the swamp
2. Raw lamb (dog food)
3. Cat or Dog larvae
4. Biliary tract infection
1. Schistosomiasis
2. Echinococcus
3. Toxacara
4. Clonorchis Sinensis (Opthorcus)
Rx for liver flukes?
Prazaquintel (damages mitochondria)
Kill adult worms  defecate
Infection due to Toxacara penetrates
the skin?
Cutaneous Larvae Migrans
Infection is due to Toxacara invading
organs?
Visceral Larvae Migrans
Rx for parasitic infections?
Prazaquintel
Name the hookworms
Hook bowel wall
Use the mnemonic: NEATAS (so much
diarrhea  can’t have a neat ass)
N - Nectar Americanus (MC in US)
E - Enterobius Vermicularis (MC in
peds, lives in cecum)
A - Ancylostoma Duodenale
T - Trichurius Trichura
A - Ascaris Lumbricoides
S – Strongyloides
Tx- Mobendazole, albendazole,
thiobendazole, pyrantel pamoate
Huny_00@yahoo.com
Treatment for Hookworms Name the flatworm
Mabendazole B12 deficiency – D. Latum
Thiabendazole Raw Beef – Taenia Saginata
Raw Pork – Taenia Solium
Hookworms cause disease by? Bear Meet + M. pain – Trichinella
Hooking into the GI tract and cause Spiralis
decreased absorption leading to diarrhea Infantile form, Raw Pork - Cystocercosis
Masses in the brain, floater across visual
What syndrome is associated with field -Cystercircosis
Pulmonary Infiltrate with
Eosinophilia? What is the treatment for flatworms?
Loeffler’s Syndrome (endocarditis + Hyclosamine & Niclosamine
pneumonitis)
How do these agents work?
The PIE organisms (Pulmonary They paralyze the worm's nervous
infiltrate + severe Eosinophilia) system
Use the mnemonic NASSA = life cycles
in lung and heart
N - Nectar
A - Anklystoma
S - Strongyloides
S - Schistosomiasis
A – Ascaris
Enzyme which indicates biliary tract
involvement?
Alkaline Phosphatase
Most common hookworm in US
Nectar Americanus
Hookwork causing tenesmus  rectal
prolapse
Trichurius Trichura
Worm causing duodenal obstruction
Ankylostoma Duodenale (Fe deficiency
anemia)
What drug is used to treat
Strongyloides?
Thiebendazole
Which worm lives in the Cecum?
Enterobius Vermicularis (Pinworm)
What does the pinworm cause? Test?
Pruritis Ani (eggs  Itching)
Scotch tape (see worms on tape)
Worm that travels from the cecum to
the anus to lay eggs
Enterobius Vermicularis
List all the flatworms:
1. D. Latum
2. Taenia Sanginata
3. Taenia Solium
4. Trichinella Spiralis
11 of 13
 Huny_00@yahoo.com

PROTOZOA Clues for Toxoplasma 1. Mefloroquine

Protozoa causing skin infections?
Leishmania (macrophages w/
amastigotes)
Cause of Gulf War syndrome?
Leishmania
Protozoa causing skin & nose
infections?
Leishmaniais Donovani (facial
ulcerations)
How is Leishmania transmitted?
Sandflies
The organ infection caused by
Leishmania is called?
Kala-Azar
What causes Kala-Azaar?
Leishmaniais Rodiensis
RX for Leishmania
Stibogluconate
Protozoa associated with the GI
System?
1. Giardia lamblia (tx- metronidazole)
2. Entamoeba Histolytica (tx- metro)
3. Cryptosporidia
4. Isospora belli
Name the organism:
 Fresh water/Well water,
malabsorption - Giardia
 Multiple liver Abscesses –
Entamoeba Histolytica
 Severe Watery diarrhea in AIDS -
Cryptosporidia (Tx- cipro)
 MC in AIDS patients -
Microsporidia
Only acid fast protozoa?
Cryptosporidia
Disease caused by Trypanosoma Cruzi
Reduvid bug
Likes ganglia
Chagas's disease (DCM,
Megaesophagus, Megacolon)
Achalasia in an adult
Trypanosoma Cruzi causes disease by
It likes to eat ganglia
Associated with Cat urine
Multiple ring enhancing lesions in
parietal lobe
Brain abscesses in HIV (must tx)
What is the treatment for Toxoplasma
Pyramethamine/Sulfamethoxazole
Spuromycin (in pregnancy first
trimester)
Naegleria Fowlerii invades the body
by?
Entering through the cribiform plate
What is the treatment for Babesia?
Treat it like malaria
What is the most common cause of
death worldwide?
Plasmodium Malaria
What is the most common cause of
hemolytic anemia world wide?
Plasmodium Malaria
Malaria like illness in US?
Babesiosis (Ixodes tick) usually east
coast
Fever Patterns?
Fever every 3 days: Plasmodium
Malaria (traveler)
Fever Every 2 days:
1. Plasmodium Falciparumn (fatal)
2. Plasmodium Vivax
3. Plasmodium Ovale
Form of Plasmodium that is
Most fatal  Falciparum  black water
fever
MC worldwide  Malaria
Likes Mature RBC's  Ovale
Likes Reticulocytes  Vivax
Effects all stages  Falciparum
Chronic disease  Vivax & Ovale (go to
liver)
Malaria protocol for travelers?
Mefloquin 1 pill once a week two weeks
before trip
Once a week for each week away
Once a week for four weeks after return
Therefore add 6 to # of weeks gone
What drugs are used to treat Malaria?
Free radicals  oxidize RBC membrane
 release organisms
Methhemoglobinmeia
Hemolytic anemia
2. Quinine (S/E- colorful dreams)
3. Primaquine (best liver penetration)
4. Tetracyclines (daily)
Malaria Rx work by
Causing Oxidative stress to RBC's &
causing them to lyse  hemolytic
anemia
Which Malaria Rxs have the best liver
penetration?
Primaquine & Mefloroquine
Anti anaerobe Rx
Clindamycin – above diaphragm
Metronidazole – below
Cefoxitin/cefotetan
PCN + sulbactam
Imipemen (pancreatitis)
Erlichiosis
Xodes tick
Attacks cornea
Tx- cornea transplant (immuneprivileged
 good outcome)
Wuchereria bancrofti
Vector - mosquito
Elephantitis
No tx
Pneumocystis Jiroveci
Fungal infection of lung
TMP-SMX
If hypoxic  add steroid
Kid with chronic malabsorption
(carbs 1st)
Giardia
Name the organism
Cat Urine  Toxoplasma
Swimming in a swamp - Naegleria
Naeiglaria fowlerii (dive into swamp 
rapidly  nostril  cribiform plate 
meningoencephalitis)
Tse Tse fly  Trypanosoma
Rhodesiense (African Sleeping Sickness.
Sleep and die (GABA))
Contact lenses  Acanthomeoba
Dog saliva  Erlichiosis
Like malaria  Babesia (maltese cross,
Ixodes tick) Acanthomeoba
Fever + Anemia
Protozoa with RBCs inside = entamoeba
histolytica
No surgery on
Entamoeba histolytica
12 of 13
 Huny_00@yahoo.com

Mycobacterium
Not a true bacterium
Has mycolic acid
Bacaterium = has peptidoglycan wall
Cell mediated inflammation
If destroy mycolic acid  destroy
mycobacterium
INH works by inhibiting mycolic acid
synthesis (supplement B6)
Ghon focus – naked tubercle on
respiratory epithelium
Chord factor – virulence factor
(lysosomes can’t wrap around  can
never kill)
Ghon complex- tubercle ingested by
macrophages and taken to the lymph
nodes
Granuloma- macrophages surrounded by
T cells

Primary TB
RLL
Once granuloma formed
INF aka cachekin (revs up
BMR  catabolic  break
things down  weight loss)
TNF
1 hydroxylase

Secondary TB
Fever, night sweats, weight loss,
hemoptysis
Dx- XR cavitary lesion upper lobes
Isolate
Sputum sample

Block TNF receptors

Etanercept
Ebatacept

Block TNF
Infliximab
Adalimumab
Golimumab

Any granulomatous disease can lead

to which vitamin excess
Excess vitamin D from 1-hydroxylase

13 of 13