INFECTIONS OF THE NERVOUS SYSTEM
➔ Exchange is faster
TOPIC
SUBTOPIC
TERM & DEFINITION
The nervous system has two subsystems:
1. Central Nervous System
2. Peripheral Nervous System
Central Nervous System
➔ Consists of the brain and spinal cord
➔ Plays a vital role in the control of most bodily functions
such as movement, sensations, awareness, speech,
memory
➔ Some reflex movement can occur via spinal cord
pathways without the participation of the brain
structure
Peripheral Nervous System
➔ Division of the central nervous system containing of
the nerves that lie outside the central nervous system
➔ Primary role is to connect the central nervous system
to the organs, limbs, and skin
THE BLOOD BRAIN BARRIER
Blood Brain Barrier
➔ Serves as to exclude most of the microbes so as the
solute in the blood
➔ These parts of the body (brain, spinal cord, spinal
column) are sterile
◆ You can’t find red blood cells inside because
of the blood brain barrier
◆ Microbes should not be found in this area
◆ It is being cushioned by the CSF that
maintains everything inside the nervous
system
➔ Its main purpose is to prevent the microbes (bacteria,
fungi, viruses) out of the CNS. Otherwise, if the
microbes will be able to enter in the area, there will be
infection
◆ Infection may be a cause of trauma, injury,
hemorrhage, scalp fracture
◆ If there is an infection, it can be life
threatening
➔ Most common cause of infection is injury
➔ Blood brain barrier will serve as a “checkpoint”
NORMAL BLOOD VESSELS VS BRAIN BLOOD CELLS
Normal Blood Vessels
➔ Have so called “pore passages”
◆ There is a gap for the red blood cells and
other solute to go freely in and out
Brain Blood Cells
➔ Has a tight junction because it serves as the blood
brain barrier
➔ The solute and the red cells, among others, will pass
through the blood vessels only
➔ If there is a need for oxygen exchange and transport of
protein, it will pass through the blood vessels
★ Endothelial cells are tightly connected (tight junction)
○ Proteins should have a transporter. Hindi dire-
diretso pumapasok sa normal blood vessel
○ All of these is being guarded by the
astrocytes
★ Astrocytes are cells that are found in the brain
○ Ang mga astrocytes ay di basta basta
nakakalusot sa mga solute that are being
protected by the blood brain barrier
IMMUNOSUPPRESSED VS IMMUNOCOMPROMISED
Immunosuppressed
➔ Such as people undertaking medication for cancer, the
immune system is being suppressed
◆ Immune system cells are being suppressed,
so as to prevent the proliferation of the
cancers cells including the healthy cells after
taking medications
Immunocompromised
➔ Such as people with HIV, those persons who are
infected with a disease
VIRAL INFECTION VS BACTERIAL INFECTION
★ If there is a bacterial infection, it is more alarming as
compared to viral infection
★ Viral infection is self-limiting as long as you can
monitor and supplement the needs of the patient for
the immune system, most likely they will recover
★ Ex: for BACTERIAL MENINGITIS you will have to
address medication; mas malala ang bacterial kesa sa
viral meningitis
★ Infections should be diagnosed immediately or
promptly and should be treated accordingly
Most common causes of CNS infections: bacteria, fungi, and
viruses
DEFINITION OF TERMS
Meningitis
➔ Infection of the meninges
Bacterial Meningitis
➔ Meningitis with evidence of pathogenic bacteria in
cerebral
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INFECTIONS OF THE NERVOUS SYSTEM

➔ Any mammal can have rabies

➔ After being bitten by the animal, the doctor says to
TOPIC
check within 1 week kung kamusta yung dog if nag-iba
SUBTOPIC ba ugali niya, takot ba siya sa water, or may intense
salivation ba siya
TERM & DEFINITION
Taenia solium
➔ Pork tapeworm
Neisseria Meningitidis
◆ Causes the condition taeniasis
➔ Gram-negative diplococci
◆ Taeniasis is a parasitic infection of the
➔ Colonize the oro- and
tapeworm caused by taenia solium
naso- pharyngeal mucosa
◆ Has 4 na parang mata which are cup-like
of a human person
suckers and has an arm called rostellum with
➔ Commonly known as
spines na nasa ibabaw (hooklets)
meningococci
➔ Leading cause of fatal
bacterial meningitis
◆ A person with
this type of
infection has a ➔ Cysticercosis
characteristic ◆ Disease associated with the development of
high fever, the larval form (cysticercus)
hemorrhagic rash, and Waterhouse- ◆ Intermediate host: Swine
Friderichsen Syndrome ◆ Definitive host: Humans
➔ Waterhouse-Friderichsen Syndrome ◆ Only acquired from the fecal-oral route
◆ The hands has (ingestion of eggs), not via the ingestion of the
gangrene due to cysticerci in undercooked pork
meningococcemia ◆ The infection of both humans and pigs with
caused by this the larval stage of the Taenia solium
organism ➔ Paran tapeworm, pahaba nang pahaba
➔ To view the organism, we ◆ Has the head or the scolex, the neck which is
don’t just use the light the which is the area for elongation, and the
microscope but we can body
use other techniques na ◆ Gravid proglottids have eggs
mas advanced such as ➔ Considered as a hermaphrodite (both female and male
electron microscopy genitalia are present) so it keeps on producing eggs
◆ Electron until too much have been produced
microscopy ➔ Meron ding beef tapeworm called taenia saginata
zooms your ◆ The person will get it if the person eats raw or
microorganism undercooked beef
fully with much higher magnification ◆ White, cyst-like appearance on beef
compared to the Brightfield microscope ◆ Hookless and has no spines

Rabies Virus
➔ Bullet-shaped virus
➔ Family rhabdoviridae
(rabies)
➔ This infection is primarily a ➔ Once we give anti-parasitic drugs to the patient will
disease of lower animals get a sample and check it under the microscope
and is spread to humans ◆ Kapag cineck mo siya, we are looking for the
thru bites of rabid animals scolex kasi ayun yung nag-aattach sa cell wall
➔ Rabies is an acute, ng body (ng patient), so unless nakita mo
fulminant, and fatal under the microscope yung head or the
encephalitis (affects the scolex, that is the only time that we can say
brain) with a usual that the patient is already negative from
incubation period of 1-2 infection
months but may be as ◆ Pag kinuha mo yung sample ng stool tapos
short as 1 week or as long as up to 6 years or more ang laman lang niya ay puro proglottid it is
➔ Major cause of death is respiratory paralysis considered positive for infection
➔ Diagnosis is mainly based on history and manifestation
➔ Histologic examination of the brain (man and animals) Life Cycle of Taenia solium
will show presence of Negri bodies that contain the
virus antigen
➔ Once bitten by a rabid dog or cat, we are asked to be
injected immediately with anti-viral sa doctor; hindi na
iniintay yung patient na maging severe pa and umabot
sa brain
◆ Once it reaches the brain, it is irreversible;
fatal na
◆ A person with rabies is scared of water and
light, hindi nila alam ano ginagawa nila, and
will eventually lead to death

1 | VISTAN & DOMINGO

What if we ingested the proglottid with gravis?
➔ Gravis = pregnant
➔ The eggs will hatch in the intestine and then it will
seep into the bloodstream and it will migrate to the
different tissues of the body
➔ Pag nagmigrate yung larva (cysticercus) sa brain,
which is called neurocysticercosis
Cryptococcus neoformans
➔ Gram-positive yeast-like fungus
➔ Fungi that infects the lungs or the CNS
◆ If it is in the environment and na-inhale ng
person, it will go to the lungs
◆ Coughing, chest pains, fever, shortness of
breath
➔ Reproduces by budding and with a surrounding large
polysaccharide capsule
➔ Causes meningitis (inflammation of the meninges)
➔ Diagnosis
◆ Cerebrospinal fluid stained with India ink
(stains the capsule)
◆ The organism may also be grown in artificial
culture media

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INFECTIONS OF THE CIRCULATORY SYSTEM

Composition ➔ Although uncommon, death can result

★ Circulatory system ➔ Spotted fever rickettsiosis occurs in all parts of the
★ Cardiovascular system United States, especially the Atlantic seaboard
○ Heart
○ Arteries Patient care
○ Veins ➔ Use standard precautions for hospitalized patients
○ Blood
Pathogen
➔ The etiologic agent of spotted fever rickettsiosis is
Cardio = heart
Rickettsia rickettsii, a Gram-negative bacteria
Vascular = various blood vessels
➔ Like all rickettsias, R. rickettsii is an obligate
intracellular pathogen (need vells to live)
★ Cardiovascular system ➔ It invades endothelial cells (cells that line blood
○ Endocarditis: endocardium vessels)
- inflammation within the endocardium.
○ Myocarditis: myocardium
- inflammation within the myocardium. Reservoirs and Mode of Transmission
○ Pericarditis: pericardium ➔ Include infected ticks on dogs, rodents, and other
- inflammation within the pericardium. animals
○ Bacteremia: +bacteria (presence) ➔ Transmission occurs via the bite of an infected tick
○ Septicemia: overwhelmed body defenses ➔ Person to person transmission rarely occurs – through
- happens during immunocompromised state blood transfusion
which overwhelms the body's defenses due to
the bacteria thriving in the blood (caused by Laboratory Diagnosis
lack of WBCs in blood). ➔ Immunodiagnostic procedures are used to diagnose
★ Lymphatic system this disease
○ Lymph nodes ➔ Culture: It needs cells.
○ Tonsils
○ Thymus
ENDEMIC TYPHOID FEVER
○ Spleen
★ Lymphatic system
○ Lymphadenitis: lymph nodes (kulani) Endemic Typhus Fever
- inflammation of lymph nodes ➔ Also known as Murine
○ Lymphadenopathy: diseased lymph nodes Typhus Fever and Flea-
- progressed Lymphadenitis Borne Typhus is an acute
○ Lymphangitis: lymphatic vessels febrile disease that is
- inflammation of lymphatic vessels similar to, but midler
★ Etymology than, epidemic typhus
○ Endo - Within ➔ Symptoms include
○ Myo - Muscle shaking chills, headache,
○ Peri - Around fever, and a faint, pink
○ Itis - Inflammation rash
○ Adenopathy - Swelling of glands ➔ Endemic typhus has a
○ Osis - Process, condition, or state, usually worldwide occurrence,
abnormal or diseased but is rare in the United
○ Megaly - Irregular enlargement States.
➔ In the PH, usually
farmers get this disease.
RICKETTSIAL AND EHRLICHIAL BACTERIAL INFECTIONS
Patient Care
➔ Use standard precautions for hospitalized patients
SPOTTED FEVER RICKETTSIOSIS

Pathogen
Spotted Fever Rickettsiosis (Archaic ➔ The etiologic agent of endemic typhus is Rickettsia
Term - Rocky Mountain Spotted typhi, a Gram-negative bacterium and obligate
Fever) intracellular pathogen
➔ A tick-borne rickettsial
disease characterized by Reservoirs and Mode of Transmission
sudden onset of moderate to ➔ Reservoirs include rats, mice, possibly other mammals,
high fever, extreme and infected rat fleas
exhaustion (prostration), ➔ Transmission occurs from rat -> flea -> human
muscle pain, severe headache, ➔ Infected fleas defecate while feeding, and the
chills, conjunctival infections, rickettsiae in the feces are rubbed into the bite wound
and maculopapular rash on or other superficial abrasions
extremities on about the third ➔ Person to person transmission does not occur
day, which spreads to the
palms, soles, and much fo the Laboratory Diagnosis
body ➔ Immunodiagnostic procedures are used to diagnose
➔ In about 4 days, small endemic typhus
purplish areas (petechiae)
develop as a result of ◆ Try to find antigens and antibodies to confirm
bleeding in the skin the presence of the disease.

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 ➔ Would be needing cells in order to culture. ➔ There are two types of ehrlichiosis
◆ Human monocytic ehrlichiosis (HME)
Other Notes: ◆ Human granulocytic anaplasmosis (HGA)
➔ Filipino farmers are at high risk of this because of ◆ Cases of HGA are more common than HME
working in rice fields, where rats could be found. cases
◆ Most HME cases have occurred in the
southeast and mid-Atlantic states, whereas
EPIDEMIC TYPHUS FEVER
most HGA cases have occurred in states with
the highest rate of Lyme Disease (particularly
Epidemic Typhus Fever Connecticut, Minnesota, New York, and
➔ Epidemic typhus or Wisconsin). In these states, the tick that
louse-borne typhus transmits the HGA agent is the same tick that
is an acute rickettsial transmits Borrelia burgdorferi, the etiologic
disease, often with agent of Lyme disease and Babesia, a
sudden onset of parasitic infection
headache, chills,
prostration (extreme Patient Care
exhaustion or ➔ Use standard precautions for hospitalized patients
fatigue), fever and
general pains Pathogens
➔ A rash appears on the ➔ The etiologic agents of ehrlichiosis are Gram-negative
fifth or sixth day, coccobacilli that are closely related to rickettsias
initially on the upper ➔ They are obligate intraleukocytic pathogens
trunk, followed by ➔ Ehrlichia chaffeensis invades human monocytes,
spread to the entire causing HME
body, but usually not ➔ Anaplasma phagocytophilum invades human
to the face, palms, or granulocytes, causing HGA
soles ➔ A canine species, Ehrlichia ewingii, has caused a small
➔ Epidemic typhus fever may be fatal if untreated number of human cases
➔ It occurs in cold climates in areas where people live ◆ Zoonotic diseases
under unhygienic infections and are louse-infested.
➔ In World War I, the body lice that transmitted epidemic Reservoirs and Mode of Transmission
typhus were referred to as “cooties” by soldiers ➔ Reservoirs are unknown
➔ Transmission occurs via tick bite
Patient Care ➔ The to different types of ehrlichiosis seem to be
➔ Use standard precautions for hospitalized patients transmitted by different species of ticks

Pathogen Laboratory Diagnosis

➔ The etiologic agent of epidemic typhus is Rickettsia ➔ Ehrlichiosis is diagnosed using immunodiagnostic
Prowazekii, a Gram-negative bacterium and obligate procedures and nucleic acid assays
intracellular pathogen

OTHER BACTERIAL INFECTIONS

Reservoirs and Mode of Transmission
➔ Reservoirs include infected humans and body lice
BRUCELLOSIS
(Pediculus humanus)
➔ Transmission occurs from human -> louse -> human
➔ Infected lice defecate while feeding, and the rickettsiae Brucellosis
in the feces are rubbed into the bite wound or other ➔ Brucellosis is a disease of
superficial abrasions the reticuloendothelial
system
Laboratory Diagnosis ➔ The infection can have a
➔ Immunodiagnostic procedures are used to diagnose prolonged incubation
epidemic typhus period
➔ Disease onset is insidious
and nonspecific with
EHRLICHIOSIS
complaints such as fever,
seats, arthralgias,
Ehrlichiosis myalgia, fatigue, loss of
➔ An acute, febrile illness appetite, weight loss,
ranging from hepatomegaly, and
asymptomatic to mild to splenomegaly
severe and life
threatening Pathogen
➔ Patients usually present ➔ Three species of Brucella are most commonly involved
with acute influenza-like in human infections: Brucella melitensis, Brucella
illness with fever, abortus and Brucella suis
headache, and generalized ➔ Brucella spp. are gram-negative coccobacilli
body malaise
➔ Ehrlichiosis is reminiscent Reservoirs and Mode of Transmission
of spotted fever ➔ Brucellosis is a zoonotic disease tyxpically transmitted
rickettsiosis, without the by consumption of contaminated food (typically
rash unpasteurized goat milk cheese) or by direct contact
➔ The estimated fatality rate with infected animals (goats, cattle, sheep)
is about 5%
➔ Target cells: Monocytes or Granulocytes Laboratory Diagnosis

4 | VISTAN & DOMINGO

 ➔ Brucella are most often recovered in blood or bone Plague
marrow cultures making them both specimens ➔ Plague is an acute, often
➔ Because Brucella spp. are considered potential agents severe zoonosis
of bioterrorism, full identification should be performed ➔ Initial signs and symptoms
at public health laboratories using molecular-based may include fever chills
methods malaise, myalgia, nausea,
➔ Serologic methods can also aid in the diagnosis prostration sore throat, and
headache
LYME DISEASE
Bubonic Plague
➔ Named for the swollen,
Lyme Disease inflamed, and tender lymph
➔ Lyme disease or Lyme nodes (buboes) that
borreliosis is a tick- develop.
borne disease ➔ Usually the lymph nodes
characterized by three affected are those receiving drainage from the site of
stages: the bite of an infected flea
◆ (1st stage) ➔ In about 90% of the cases the inguinal (groin area)
An early lymph nodes are involved.
distinctive,
target-like, Pneumonic Plague
red skin ➔ Highly communicable and involves the lungs
lesion, ➔ Happens when the causative agent is inhaled
usually at the ➔ It can result in localized outbreaks or devastating
site of the epidemics
tick bite
expanding to Septicemic Plague
a diameter of ➔ May lead to septic shock, meningitis, and death
15 cm, often
with a central Patient Care
clearing ➔ Use standard precautions for hospitalized patients with
◆ (2nd stage) Early systemic manifestation that bubonic and septicemic plague
may include fatigue, chills, fever, headache, ➔ Add droplet precautions for pneumonic plague
stiff neck, muscle pain, joint aches, with or patients, until 48 hours after initiation of effective
without lymphadenopathy therapy
◆ (3rd stage) Neurologic abnormalities (e..
Aseptic meningitis, facial paralysis, myelitis, Pathogen
and encephalitis) and cardiac abnormalities ➔ The etiologic agent of plague is Yersinia pestis a
(e.g. Arrhythmias and pericarditis) several nonmotile bipolar-staining Gram-negative
weeks or months after the initial symptoms coccobacillus, sometimes referred to as the plague
appear bacillus
➔ The disease gets its name from the fact that the first
U.S. cases occurred in Lyme, Connecticut Reservoirs and Mode of Transmission
➔ Although Lyme disease is the most common ➔ Reservoirs include wild rodents (especially ground
arthropod-borne disease in the United States, it does squirrels in the United States) and their fleas and,
not occur nationwide rarely rabbits, wild carnivores and domestic cats
➔ In 2017 96% of cases are reported from 13 states, ➔ Transmission may also occur as a result of handling
primarily in the northeast and upper midwest tissues of infected rodents rabbits, and other animals
as well as droplet transmission from person to person
Patient Care (in pneumonic plague)
➔ Use standard precautions for hospitalized patients
Laboratory Diagnosis
Pathogen ➔ Plague is diagnosed by observation of the typical
➔ The etiologic agent of Lyme disease if Borrelia appearance of Y. pestis (bipolar-staining bacilli that
burgdorferi, a loosely coiled Gram-negative spirochete resemble safety pins) in Gram-stained or Wright-
Giemsa-stained sputum, cerebrospinal fluid, or
Reservoirs and Mode of Transmission material aspirated from a bubo (inflamed lymph node)
➔ Ticks, rodents (especially deer mice) and mammals ➔ Diagnosis can also be made by culture, but because Y.
(especially deer) serve as reservoirs pestis is consideed a potential agent of bio-terrorism
➔ Transmission occurs via tick bite full identification should be perfomed by public health
➔ Person to person transmission does not occur laboatories using molecular-based methods.

Laboratory Diagnosis
TULAREMIA
➔ Lyme disease is usually diagnosed by observation of
the target-like skin lesion, plus immunodiagnostic and
molecular diagnostic procedures Tularemia
➔ B. burgdorferi can be grown in the laboratory on a ➔ Tularemia, also
special medium (Barbour-Stoenner-Kelley [BSK] known as rabbit
medium at 33°C) although yield from patient fever, is an acute
specimens is not high. Growth is not always zoonosis with a
guaranteed, though it does not cross out its absence. variety of clinical
manifestations
depending on the
PLAGUE
portal of entry of

5 | VISTAN & DOMINGO

 the pathogen into the body
◆ Ingestion of the pathogen results in
pharyngitis abdominal pain diarrhea and
vomiting
◆ Inhalation of the pathogen results in
pneumonia and septicemia with a 30%-60%
fatality rate
➔ Tularemia most often presents as a skin ulcer and
regional lymphadenitis
Patient Care
➔ Use standard precautions for hospitalized patients
Pathogen
➔ The etiologic agent of tularemia is Fancisella
tularensis a small pleomorphic Gram-negative
coccobacillus
➔ Some strains are more virulent than others
Reservoirs and Mode of Transmission
➔ Reservoirs include wild animals (especially rabbits
muskrats and beavers) some domestic animals and
hard ticks
➔ Transmission occurs via tick bite
➔ Ingestion of contaminated meat or drinking after entry
of organisms into a wound while skinning infected
animals, inhalation of dust, or animal bites
➔ Person to person transmission does not occur
Laboratory Diagnosis
➔ Diagnosis of tularemia is by culture but because F.
tularensis is considered a potential agent of
bioterrorism full identification should be performed by
public health laboratories using molecular-based
methods
VIRAL INFECTIONS
HIV INFECTION AND AIDS
HIV Infection and AIDS
➔ The signs and symptoms of acute HIV infection (i.e.
infection with the “AIDS Virus”) usually occur within
several weeks to several months after infection with
HIV
➔ Initial symptoms include an acute self-limited
mononucleosis-like illness lasting or 2 weeks
➔ Unfortunately acute HIV infection is often undiagnosed
or misdiagnosed because anti-HIV antibodies are
usually not present in a high enough concentration to
be detected during this early phase of infection
➔ Other signs and symptoms of acute HIV infection
include fever, rash, headache, lymphadenopathy,
pharyngitis, myalgia (muscle pain), arthralgia (joint
pain), aseptic meningitis, retro-orbital pain, weight
loss, depression, GI distress, night sweats and oral or
genital ulcers
➔ Without appropriate anti-HIV treatment,
approximately 90% of HIV-infected individuals
ultimately develop AIDS
◆ AIDS is a severe life-threatening syndrome
that represents the late clinical stage of
infection with HIV
◆ Invasion and destruction of the Helper T-Cells
leads to suppression of the patient’s immune
system (immunosuppression)
➔ Secondary infections caused by viruses (e.g.
cytomegalovirus and herpes simplex), protozoa (e.g.
cryptosporidium and toxoplasma), bacteria (e.g.
mycobacteria) and/o fungi (e.g. candida, cryptococcus,
and pneumocystis) become systemic and cause death
➔ Tuberculosis (TB) is the most common opportunistic
infection in HIV-positive people worldwide, often
leading to death.
➔ Persons with AIDS die as a result of overwhelming
infections caused by a variety of pathogens, often
opportunistic pathogens. People with AIDS don’t die
from AIDS.
➔ Kaposi sarcoma, a previously rare type of cancer, is a
frequent complication of AIDS, thought to be chased
by a type of herpes virus called human herpesvirus 8
➔ Previously considered to be a universally fatal disease
certain combinations of drugs, referred to as cocktails,
are extending the life of some HIV-positive patients
➔ In the absence of effective anti-HIV treatment, the
AIDS case-fatality rate is very high, approaching 100%
➔ People who are HIV-positive could live a long and
healthy life as long as they’re taking medication.
Patient Care
➔ Used standard precautions for hospitalized patients
and appropriate Transmission-Based precautions for
specific infections that occur in AIDS patients
➔ HIV Treatment just slows the replication, and does not
eliminate the virus.
Pathogens
➔ AIDS is caused by HIV
➔ HIV is the causative agent, while AIDS is a stage
➔ Two types have been identified:
◆ Type 1 HIV which is the most common type
◆ Type 2 HIV viruses are single stranded RNA
viruses in the family Retroviridae
(retroviruses)
Reservoirs and Mode of Transmission
➔ Infected humans serve as reservoirs
➔ Transmission occurs via:
◆ Direct sexual contact (homosexual o
heterosexual)
◆ Sharing of contaminated needles and syringes
by intravenous drug abusers
◆ Transfusion of contaminated blood and blood
products
◆ Transplacental/Vertical Transmission transfer
from mother to child
◆ Breastfeeding by HIV-infected mothers
◆ Transplantation of HIV-infected tissues or
organs
◆ Needlestick (accidentally punctured), scalpel,
or broken glass injuries
➔ There is no evidence of HIV transmission via biting
insects
➔ Most likely, HIV-1 first invades dendritic cells in the
genital and oral mucosa
◆ These cells then fuse with CD4+ lymphocytes
(helper T cells) and spread to deeper tissues
Laboratory Diagnosis
➔ Immunodiagnostic procedures are available for
detection of antigen and antibodies
➔ Most HIV infected patients develop detectable
antibodies within 1-3 months after infection
◆ However, there may be a more prolonged
interval of up to 6 months, or even longer in
some cases
➔ The most commonly used screening test is an enzyme-
linked immunosorbent assay (ELISA)
◆ If the screening test is positive, a confirmatory
test such as the Western Blot Analysis is
performed
◆ Antigen detection procedures detect an HIV
antigen known as p24
➔ Molecular diagnostic procedures are also available
➔ Quantitative assessment of viral RNA (viral load) is
used to monitor the effectiveness of antiviral therapy
Other Notes
6 | VISTAN & DOMINGO
 ➔ The first case of HIV infection in the Philippines was meningitis, encephalitis, deafness, pancreatitis,,
reported in January 1984. arthritis, mastitis, nephritis, thyroiditis, and pericarditis
➔ There is no absolute treatment/cure for HIV/AIDS ➔ Non-Life Threatening

Patient Care
INFECTIOUS MONONUCLEOSIS
➔ Use droplet precautions for hospitalized patients until
9 days after the onset of swelling
Infectious Mononucleosis
➔ Infectious Pathogen
mononucleosis ➔ Mmps is caused by mumps virus, an RNA virus in the
(also called genus Rubulavirus, family Paramyxoviridae
“mono or the
“kissing disease) Reservoirs and Mode of Transmission
is an acute viral ➔ Infected humans serve as reservoirs
disease that may ➔ Transmission occurs via droplet spread and direct
be asymptomatic contact with the saliva of an infected person
or may be
characterized by Laboratory Diagnosis
fever, sore throat, ➔ Diagnosis of mumps is made using immunodiagnostic
lymphadenopathy procedures, molecular diagnostic procedures, or cell
(especially culture
posterior cervical
lymph nodes),
VIRAL HEMORRHAGIC DISEASE
splenomegaly
(enlarged spleen) and fatigue
➔ Infectious mononucleosis is usually a self-limited Viral Hemorrhagic Diseases
disease of to several weeks duration ➔ Are extremely
➔ It is rarely fatal, except for those who are serious, acute
immunocompromised viral illnesses
➔ Initial symptoms
Patient Care include sudden
➔ Use standard precautions for hospitalized patients onset of fever,
malaise (a feeling
Pathogen of general
➔ The etiologic agent of infectious mononucleosis is discomfort and
Epstein-Barr virus (EBV) which is also known as feeling “out of
human herpesvirus 4. It is a DNA virus in the family sorts), myalgia,
Herpesviridae and headache, followed by pharyngitis, vomiting,
◆ EBV infects and transforms B cells, although diarrhea, rash, and internal hemorrhaging
it also infects other types of cells ➔ Case-fatality rates for Marburg virus infection and
◆ EBV is known to be oncogenic (cancer- Ebola virus infection have been 25% and 50%-90%,
causing), causing or being associated with respectively
lymphomas (e.g. Hodgkin disease and Burkitt ➔ All known cases of both diseases occurred in or could
lymphoma), carcinomas (e.g. nasopharyngeal be traced back to Africa
carcinoma and gastric carcinoma), sarcomas,
among other cancers

Reservoirs and Mode of Transmission Patient Care

➔ Infected humans serve as reservoirs ➔ Exercise standard, droplet, and contact precautions for
➔ Transmission occurs from person to person by direct hospitalized patients for the duration of the illness
contact with saliva, such as MOMOL ➔ Emphasize:
➔ Kissing facilitates spread among adolescents ◆ The use of sharps safety devices and safe
➔ EBV can be transmitted via blood transfusion work practices
◆ Hand hygiene
Laboratory Diagnosis ◆ Barrier protection against blood and body
➔ Patients with infectious mononucleosis usually present fluids
with a lymphocytosis (abnormally high peripheral ◆ Appropriate waste handling
lymphocyte count), including 10% or more abnormal ➔ Use N95 or higher respirators when performing
lymphocyte forms, and abnormalities in liver function aerosol-generating procedures
tests (LFT)
➔ Specific diagnosis is usually made by detection of Pathogens
antibodies ➔ Viral hemorrhagic fevers are caused by many different
➔ Molecular diagnostic procedures are also available viruses, including dengue virus, yellow fever virus,
➔ EBV can be cultured from the buffy coat–the layer of Crimean-Congo hemorrhagic fever virus, Lassa virus,
white blood cells that appears in centrifuged blood Ebola virus, and Marburg virus
◆ Ebola virus and Marburg virus are filamentous
viruses in the family Filoviridae. Both are
MUMPS
extremely large viruses
◆ Ebola virus is about 80 nm in width and up to
Mumps (Infectious parotitis) 1 mm or longer in length
➔ An acute viral infection characterized by fever and ◆ Marbu
swelling and tenderness of the salivary glands rg
➔ Complications can include oophoritis (inflammation of virus is
the ovaries), orchitis (inflammation of the testes), about

7 | VISTAN & DOMINGO

 80 nm in width and 790 nm in length

Reservoirs and Mode of Transmission

➔ Infected humans serve as reservoirs
➔ Infected African green monkeys also serve as
reservoirs of Marburg virus
➔ Transmission is from person to person via direct
contact with infected blood, secretions, internal organs,
or semen, or by needlestick
➔ The risk is the highest when the patient is vomiting,
having diarrhea, or hemorrhaging
➔ Crimean-Congo hemorrhagic fever is a tick borne
disease
➔ Dengue fever and yellow fever are mosquito-borne
diseases, transmitted primarily by mosquitoes in the
genus Aedes

Laboratory Diagnosis
➔ Viral hemorrhagic diseases are diagnosed using
immunodiagnostic and molecular procedures, cell
culture but will take time, or electron microscopy
➔ Laboratory studies of viral hemorrhagic fevers
represent an extreme biohazard and should be
conducted only in BSL-4 containment facilities

INFECTIONS OF THE SKIN & EYES

SKIN
Skin
➔ The largest organ in the body
➔ Serves as first line of defense against microbial
infection
➔ Layers:
◆ Epidermis

8 | VISTAN & DOMINGO

 ◆ Dermis ◆ Toxins
◆ Subcutaneous ● Cytolytic toxins (alpha, beta,delta,
➔ Serves as physical barrier gamma hemolysin, and leukocidin) -
➔ Normal flora of the Skin Can damage WBC
◆ Staphylococcus epidermidis ● Enterotoxins - Can cause food
● Non-pathogenic in the skin. poisoning
However, it can become pathogenic ◆ Extracellular Enzymes
if you have an open wound like ● Coagulase, catalase, hyaluronidase,
surgery and the bacteria when into fibrinolysin, lipases, nucleases and
the bloodstream = will result to penicillinase.
bacteremia. ➔ Staphylococcus aureus is the #1 causative agent of :
◆ Propionibacterium acnes 1. Cutaneous Infections
◆ Corynebacterium xerosis ➔ Skin
➔ The largest organ in the body and burn
infection, pustules (small cutaneous
Skin Rashes and Lesion
abscesses), furuncles or boils (Large
Macule cutaneous abscesses), carbuncles (cluster of
➔ Red, flat lesion furuncles) styles, impetigo and pemphigus
neonatorum.
2. Deep Infections
➔ Osteomyelitis, tonsillitis, pharyngitis,
sinusitis,bronchopneumonia, empyema,
septicemia, meningitis, endocarditis, breast
abscess, renal abscess and abscesses in other
organs.
3. Toxin-Mediated Diseases
➔ Food Poisoning
Papule ➔ Toxic Shock Syndrome (TSS)
➔ Lesion is firm and raised ➔ Exfoliative Diseases
◆ Staphylococcal Scalded Skin
Syndrome (SSSS) - Strains of
Staphylococcus aureus that produce
toxins that lyse the epidermis layer
of the skin that results to SSSS.
● R
i
t
Vesicle t
➔ A small fluid-filled lesion e
➔ If size is >1 cm, It is called a Bulla r
’
s

Disease (Newborn)
- Severe form of SSSS in
newborns.
● Toxic Epidermal Necrolysis
(Adult)
● Impetigo or Pemphigus
Pustule Neonatorum - Mild version
➔ A pus-filled lesion of SSSS

Acne
Acne
➔ Most common skin disease in humans (teenagers)
➔ Classification:
◆ Mild Acne
● Characterized by plugging of
sebaceous gland.
● Hormonal changes (such as
Androgen) - Influences Sebum
Formation

◆ Inflammatory / moderate Acne

● Involves a larger number of
inflammatory papules/pustules and
Bacterial Infections
small cystic nodules
Staphylococcal Infections ● Caused by Propionibacterium Acnes
● This bacteria is normally found in the
Staphylococcus aureus
skin. It metabolizes the sebum
➔ Pathogenicity and Virulence
because it needs the glycerol in the
➔ Most pathogenic staphylococcus
sebum for growth and nutrition. In
➔ Able to produce toxins that can damage or lyse
result, Free fatty acids are released
different cells

9 | VISTAN & DOMINGO

 which triggers the inflammatory
response that also prevents the
formation of sebum.
● If the natural process is not effective,
the doctor can prescribe antibiotics.
◆ Nodular cystic / severe Acne
● Scarring or “Peklat” occurs.
● Marked by large numbers of non-
inflammatory and inflammatory
lesions and cystic nodules.
➔ Results to Cellulitis
➔ If cellulitis spreads, it becomes Fasciitis or Suppurative
Myositis
➔ If there is muscle mycrotis or systemic symptoms
Clostridial Myonecrosis or Gas Gangrene. Doctor can
amputate the part .
2. Other Infections:
➔ Septicemia, Food Poisoning, Enteritis necroticans, C.
Perfringens Colitis, Clostridial Endometritis

Tetanus
From Left to Right: Mild, Moderate, Severe Acne
Leprosy
Leprosy
➔ Oldest disease known to mankind because as early as
600 BC there is data about leprosy.
➔ During 1874, Hansen discovered that Mycobacterium
leprae is the bacteria that caused leprosy.
➔ Chronic granulomatous diseases of humans primarily
involving the skin, peripheral nerves and nasal mucosa
but capable of affecting any tissue or organ.
➔ Samples are skin scrapings or biopsy.
➔ Types:
◆ Tuberculoid
● Seen in patients with strong cell-
mediated immune system. Their
body is able to fight Leprosy. The
body has good prognosis (meaning
high chance of healing)
● Few erythematous or
hypopigmented plaques with flat
centers and raised, demarcated
borders; peripheral nerve damage
with complete sensory loss; visible
enlargement of nerves.
◆ Lepromatous
● Many nodules; extensive tissue
destruction (e.g. Nasal cartilage,
bones, ears); diffuse nerve
involvement with patchy sensory
loss; lack of nerve enlargement;
leonine face.
➔ Transmitted via Nasal secretions and shedding from
lesion
Tetanus
➔ Caused by Clostridium tetani
➔ Pathogenicity
◆ Toxins
● Tetanospamin
➔ It happens when the spores of Clostridium tetani enter
a punctured wound.
➔ The infection remains strictly localized in the area of
devitalized tissue (wound, burn, skin puncture, injury,
umbilical stump, surgical suture) into which the spores
have been introduced.
➔ The toxin released from vegetative cells reaches the
central nervous system and rapidly becomes fixed to
receptors in the spinal cord and brainstem.
➔ Characterized with severe muscle spasm, usually
involving jaw muscles leading to trismus or lockjaw.
➔ Progression to the upper- and lower extremities to
opisthotonos (arching back of the body).
➔ There are anti tetanus vaccines available for
prevention.
Trachoma & Inclusion Conjunctivitis
1. Ocular Infections
➔ Trachoma or Chlamydia Keratoconjunctivitis
◆ Caused by Chlamydia trachomatis - serotypes
A to C
◆ Transmitted eye-to eye by droplet, hands,
contaminated clothing, and eye-seeking flies.
The pathogen may also be transmitted by
respiratory droplet or through fecal
contamination.
➔ Inclusion Conjunctivitis or Paratrachoma
◆ Caused by Chlamydia trachomatis - serotypes
D to K
◆ Transmission occurs via contact with genital
discharges of infected people, contaminated
fingers to eye, infection in newborns via an
infected birth canal, or non chlorinated
swimming pools (swimming pool
conjunctivitis)
2. Other infections:
➔ Infant Pneumonia, Non-gonococcal Urethritis (NGU),
Salpingitis, Cervicitis, genital Infections
(Lymphogranuloma venerum).

Gas Gangrene

Gas Gangrene
➔ Caused by Clostridium perfringens
Fungal Infections
➔ Pathogenicity and Virulence
◆ Toxins - can cause damage to the cells and Mycoses
tissues.
Mycoses
● Alpha,beta,epsilon and iota toxins
➔ Mycosis - Fungal Infection
● Enterotoxins
1. Soft Tissue Infections
1. Superficial
➔ Caused by spores Clostridium perfringens from the soil
enters the skin via open wound.

10 | VISTAN & DOMINGO

 ➔ Only the outermost layer of the skin (epidermis) is ◆ Tinea capitis - Scalp and hair (Causes
affected. Non-invasive infection. dandruff)
➔ Stratum corneum and epidermis layer. Does not ◆ Tinea favosa - Chronic Hair (Cup Shaped
penetrate skin, crust)
◆ Tinea barbae - Beard (Face and Neck)
2. Cutaneous ◆ Tinea ungium - Nails
➔ Infections of the skin, hair, and nails. There is ◆ Tinea pedis - Foot (Athlete’s foot)
penetration of the epidermal layer to the Dermis layer. ◆ Tinea imbricata - Skin (concentric rings of
scales)
3. Subcutaneous ◆ Tinea manuum - Hands
➔ Infection reaches the Subcutaneous layer.
Subcutaneous Fungi
4. Systemic
➔ If a microorganism reaches the bloodstream, it can ➔ Sporothrix schenckii
result in systemic infection. ◆ Sporotrichosis (Rose Gardener’s Disease))
◆ Cord- like multiple subcutaneous nodules.
5. Opportunistic ➔ Madura Foot (Maduramycosis/Mycetoma) Agents
➔ Targets immunocompromised individuals. ◆ Lesion: Granulomatous lesions on foot w/
multiple draining sinus tract
◆ A. Fungal (Eumycotic Mycetoma)
● Pseudallescheria boydii, Madurella,
Superficial Fungi
Leptosphaeria
➔ Malassezia furfur ◆ B. Bacterial (Actinomycotic Mycetoma)
◆ Lipophilic ● Actinomyces (Nocardia;
◆ Tinea versicolor or Pityriasis versicolor Streptomyces)
◆ Chronic, Mild infection of Stratum Corneum ➔ Chromoblastomycosis Agents - subcutaneous flower-
◆ Hypopigmentation or Hyperpigmentation of like lesion.
the skin ◆ Lesion: Cauliflower like lesion
➔ Hortae werneckii ◆ A. Phialopora verrucosa
◆ Tinea nigra ◆ B. Fonsacae pedrosoi
◆ Brown to Black (Dark pigmentation), Painless, ◆ C. Cladosporium carionii
Non-scaly Macules. ➔ Rhinosporidium seeberi
◆ Treatment: Topical antifungal solution ◆ Rhinosporidiosis (Nasal Polyps)
➔ Piedra Agents ◆ Lesion: Polypoid masses in the nose and
◆ A. Piedra Hortae pharynx
● Black Piedra ➔ Loboa loboi
● Black nodules are gritty, hard, ◆ Lobomycosis
brown to black encrustations that ◆ Lesion: Keloid like subcutaneous nodule
vary in size. involving the extremities.
◆ B. Trichosporon beigelii
● White Piedra
● Softer granule; Beard Axilla, Groin
Opportunistic Fungi
● Associated with lax bodily hygiene
. ➔ Candida albicans
◆ Normal flora of Gastrointestinal Tract
Cutaneous Fungi
◆ DM, Malnutrition, Pregnancy Prolong
➔ Ecological Groups of Fungi antibiotic use
◆ Geophilic ◆ Diseases:
◆ Zoophilic ● Candidiasis/Moniliasis
◆ Anthropophilic - Cutaneous lesion of skin folds and
➔ Dermatophytes: intertriginous areas, as well as
◆ Trichophyton onychomycosis (nail infection)
● Skin, Hair, and Nail - Oral through - occurring on the
◆ Epidermophyton tongue, lips, palate or gum, which
● Skin and Nail only appear as patchy to conflent, whitish
◆ Microsporum pseudomembranous lesion.
● Skin and Hair only - Vulvovaginitis
➔ Dermatophytosis - infection caused by Dermatophytes. - Systemic infections
◆ Tinea or Ringworm Infection
◆ Tinea Corporis - Body (Non-hairy)
◆ Tinea cruris - Groin (Jock’s itch)

11 | VISTAN & DOMINGO

INFECTIONS OF THE GASTROINTESTINAL

○ Short incubation period = E.coli ( 5 to 15 days)

○ Long incubation period = Giardia lamblia or
Gastrointestinal Tract
Giardia intestinalis or entamoeba histolitica (
weeks ) produces steatorrhea or fecal fat.
Gastrointestinal Tract ★ Medications
➔ The GI tract consists of a long tube with many ○ Can cause GI upset
expanded areas designed for digestion of food ○ Iatrogenic- associated with treatment or
absorption of nutrients and elimination of undigested medications.
materials ○ Antibiotic associated diarrhea - causative
➔ Transient and resident microbes continuously agent is clostridium difficile.
ingested iht food are destroyed in the stomach and ★ Underlying medical conditions
duodenum by the low pH and are inhibited from ○ Predispositions and other complications
growing in the lower intestines by the resident ○ Surgery or immunocompromised individual
microbiota (microbial antagonism) ★ Physical examination
◆ Gastric contents have a pH of 1.5 ○ State of hydration
(Hydrochloric acid) ■ Sunken eyes
◆ Transient flora are micororganisms that are ■ Dry oral membranes
just passersby and later on will be expelled in ■ Skin Testing
the form of feces or stool ■ Orthostatic changes in BP - change
◆ Resident microorganisms reside long-term in in position may change BP (sitting,
the GI tract standing)
➔ They are then flushed from the colon during defecation ★ Examination of abdomen
along with a large number of indigenous microbes ○ Pain
○ Use stethoscope
Microbial Flora Found in the Large Intestine ★ Laboratory studies
○ Leukocytes
○ Anemia
○ Thrombocytopenia -decrease in platelets
○ Electrolyte abnormalities - blood chemistry
abnormalities. Electrolytes - serum sodium
potassium chloride
★ Fecal examination
○ Red blood cells - presence of inflammation
○ Fecal leukocytes - indicates infection
Common Pathogens Involved in Diarrhea

➔ Predominantly the adult large bowel or colon consists

of anaerobes such as:
◆ Bacteroides fragilis, Bacteroides spp., and
Fusobacterium spp.
➔ 80% of your the dry weight of feces consists of the
following:
◆ Strict anaerobes, Gram - positive, Facultative ➔ Campylobacter jejuni - associated with abortion in
anaerobes Gram positive cocci, Gram- animals (sheep and cattle). Causes stillbirth.
negative (enterobacteriaceae) ➔ Salmonella - causes typhoid fever
➔ E.Coli is known as the colon bacillus ➔ Shigella - causes dysentery
➔ Enterohemorrhagic Escherichia coli (Ehec), Clostridium
difficile, Yersinia enterocolitica groups of bacteria
➔ Cryptosporidium spp. Cyclospora, Giardia lamblia - are
Diarrhea
parasites that do not induce bloody stool because
Diarrhea Trophozoite form of histolitica contains ingested red
➔ An alteration in a normal bowel movement blood cells, Cyst form is the infective stage.
➔ Characterized by an increase in the water content,
volume or frequency of stools Common Food Vehicles for Specific Pathogens or Toxins
➔ More than 3 bowel movements per day

A Practical Approach to Diagnosis of a Patient with Diarrhea

★ History
○ Food ingestion, travel, recreational activities
(hiking)
★ Traveler’s Diarrhea
○ EPEC - Enteropathogenic E. Coli
■ Giardia lamblia and Escherichia coli
are associated with Traveler’s
diarrhea ➔ Fried rice bacillus is Bacillus cereus
★ Parasitic Infections ➔ Colon bacillus is E. coli
○ Giardiasis ➔ Vibrio cholerae can be found in saltwater (shellfish)
○ Amebiasis caused by Entamoeba historitica ➔ Undercooked chicken - Salmonella can be associated
Entamoeba histolitica with poultry like eggs and unpasteurized milk
★ Duration of illness ◆ We need to pasteurize milk

12 | VISTAN & DOMINGO

 ➔ Water-born parasites
◆ Giardia lamblia (water-born) - causes
steatorrhea (fecal fat/fat/lipids in stool)
◆ Noroviruses, Campylobacter
Cryptosporidium spp., Cyclospora Bacillus
cereus.
➔ Tuns, mackerel, mahi-mahi produces Scombroid
poisoning = fish poisoning
➔ Grouper, amberjack, snapper produces Ciguatera
➔ Sushi and sashimi is associated with anisakis, which
causes anisakiasis
◆ Anisakiasis = referred to as herring worm
disease
➔ Taenia Saginata= beef tape worm
➔ Taenia Solium = pork tape worm
Enterotoxin-Mediated Diarrhea
➔ Causative agents:
◆ E.coli, Vibrio cholerae, Staphylococcus aureus,
Clostridium perfringens, and Bacillus cereus.
➔ Symptoms:
◆ Rapid onset of diarrhea - Less than 12 hours.
◆ Lack fever
◆ Absence of blood or pus - point to
enterotoxin mediated illness
◆ Large number of water stools - Sometimes
more than 20 per day. Causes patient to be
dehydrated.
Diarrhea Mediated by Invasion of the Bowel Mucosal
Surface
➔ Invasion of the bowel mucosal surface
➔ Symptoms
◆ Fecal leukocytes
◆ RBCs
◆ Sometimes fever
➔ Organisms
◆ Salmonella spp.
◆ Campylobacter spp.
◆ Shigella spp.
◆ E. coli
◆ E. histolitica
Common Viral, Bacterial, & Parasitic Pathogens associated
with Gastrointestinal Tract Infection
Parasitic Pathogens
Giardia Intesstinalis (lamblia)
➔ Associated with steatorrhea
➔ Cysts (infective stage):18 to 14 um, oval, one to four
nuclei, four axonemes, four median bodies.
➔ Trophozoites (feeding stage): 9 to 21 um, tear-drop
shape, two nuclei, two axonemes, eight flagella,
sucking disk “falling leaf-like, kite-like, gliding” motility.
➔ Patient can be asymptomatic or GI symptoms to
malabsorption syndrome can be severe, light -colored
stools.
➔ Retracted Cytoplasm
➔ Looks like : Old man with pair of eyeglasses, Old man
with whiskers, Monkey’s face
Entamoeba histolytica
➔ Asymptomatic to chronic-acute colitis; extraintestinal
disease may occur )Primary site: right upper lobe of the
liver)
➔ Can cause dysentery and abscess in the liver, spleen,
lung and brain.
➔ Cyst and trophozoite in stool are diagnostic, or use
amebic abscess fluid or sigmoidoscopy specimen
➔ Cyst (dormant stage): 10 to 20 um, round, one to four
nuclei, central karyosome, fine and even peripheral
chromatin, rounded chromatid bar.
spp., ➔ Trophozoite (Motile stage): 12 to 60 um, rapid and
directional motion, one nucleus with central
karyosome, ingested RBC (diagnostic), uses
pseudopods
➔ Bull’s eye kardosome
Cryptosporidium parvum
➔ Oocysts (Infectious stage/state): 4 to 6um, round, no
sporocysts
➔ Self-limiting infection with diarrhea and abdominal
pain
➔ Oocyst in stool are diagnostic, immunologic methods,
modified acid-fast stains.
➔ Stain it with the ziehl-neelsen method or kinyoun’s
method. Give you a red color.
Cyclospora cayetanensis
➔ Honored to Cayetano university in Peru
➔ Self-limiting infection with diarrhea; produce biliary
disease with immunocompromised host.
➔ Oocyst in stool are diagnostic, immunologic methods,
modified acid-fast stain
➔ Oocysts: 7 to 10 um, round, two sporocysts, with
greenish central morula or mulberry-like mass
containing 6-9 refractile globules.
➔ Oocyst is the infective stage.
Cyclospora belli
➔ Self-limiting infection with mild diarrhea or no
symptoms, may lead to severe diarrhea and possible
death.
➔ Produces gastrointestinal diseases with dysentery and
malabsorption. Just like Giardia.
➔ Produces foul smelling stool and fecal fat.
➔ Oocyst: 30 x 12 um, ovoid, one or two sporocysts, thin
shell
➔ Oocyst in stool are diagnostic, immunologic methods,
modified acid-fast stains.
Microsporidia: Enterocytozoon bieneusi and Encephalitozoon
intestinalis
➔ Ingestion and inhalation of spores
➔ Causes GI symptoms (enteritis) also corneal infection,
diarrhea with malabsorption of fats and vit. B 12
➔ Sexual contact in AIDS patients
➔ Spores (infectious stage) in stool are diagnostic,
immunologic methods, modified acid-fast stain
➔ Spores: 1 to 5 um, round, two sporocysts.
➔ Specimen diagnosis: Check spores and polar tubules in
tissue biopsy.
Viral Pathogens
Rotavirus
➔ Member of Reoviridae - isolated from respiratory tract
and enteric samples.
➔ Characteristics: Segmented dsRNA, icosahedral capsid
with no envelope.
➔ Most common cause of diarrhea in children
➔ Detection: EIA, latex agglutination test
➔ Epidemiology: Winter-spring seasonality in temperate
climates; nosocomial transmission can occur easily
➔ Treatment: Supportive, especially fluid replacement
➔ Prevention: Avoid contact with virus; vaccine in
underdeveloped countries.
Adenovirus
➔ First isolated under adenoid tissues.
➔ Characteristics: dsDNA genome; icosahedral capsid;
no envelope
13 | VISTAN & DOMINGO
 ➔ Adenovirus serotypes 40 and 41 cause gastroenteritis
S. paratyphi C (S. cholera Septicemia
in infants and young children
suis)
➔ Other serotypes cause conjunctivitis (eye infection)
and keratitis. Specifically Pink Eye Keratoconjunctivitis.
S. enteritidis Gastroenteritis
➔ Mode of transportation: Ingestion (fecal or oral) ,
Respiratory and direct contact transmission. Other Salmonella species Food poisoning
➔ Diagnosis: Cell culture; EIA
➔ Treatment: Supportive
➔ Prevention: Vaccine for military recruits Shigella spp.
➔ Clinical disease: Two-basic clinical presentations:
Calicivirus Watery diarrhea with vomiting and mild-to moderate
➔ Characteristics: Nonenveloped, Icosahedral capsid dehydration. Dysentery characterized by a small
surround ssRNA genome. volume of bloody, mucoid stools and abdominal pain.
➔ Diagnosis: Electron Microscopy (EM), Reverse ➔ Shiga toxin (cytotoxin) causes inflammation and
Transcriptase- polymerase reaction (RT-PCR), Enzyme ulcerative lesions
Immuno Acid (EIA) ➔ Laboratory diagnosis: Gram negative bacilli, lactose
➔ Treatment: Supportive negative, urease negative. Confirm with sero-typing.
➔ Prevention: Avoid contact with the virus
➔ Types: Serotyping
◆ Norovirus “Winter vomiting bug” “stomach
bug”
● Leafy greens (such as lettuce), fresh A Shigella dysenteriae
fruits, and shellfish (such as oysters).
B Shigella flexneri
● Nausea, explosive vomiting, watery
diarrhea and abdominal pain.
C Shigella boydii
● Mode of transmission: is through
aerosolization of vomit.
D Shigella sonnei
◆ Sapovirus
● Shellfish and environmental water
samples. Escherichia coli
● Self-limited, acute foodborne ➔ Clinical disease: May cause several types of diarrheal
gastroenteritis. illnesses
➔ Laboratory diagnosis: Gram negative bacilli, ferment
glucose, lactose and xylose.

PATHOGENIC GROUPS OF Notes

E. coli

ETEC Traveler’s Diarrhea

EIEC Dysentery

EPEC Infantile diarrhea

Bacterial Pathogens EHEC Hamburger poisoning

Campylobacter jejuni Ingestion of raw milk
➔ Clinical disease: Food-borne gastroenteritis, Hemorrhagic colitis
diarrhea,cramps,abdominal pain, fever. Bloody stool
with high WBC count, can be fatal O157:H7 Shigalike toxin
➔ Associated with stillbirth in animals: Sheep and
Cattles. Vibrio spp.
➔ Guillain barre syndrome ➔ Clinical disease: Cholera (Massive fluid loss: Death
➔ Laboratory diagnosis: Curved or S-shaped gram within 24 hours).”Rice-water stools” WBC and RBC
negative, non-spore forming rod, motile (single polar are absent.
flagellum), microaerophile. ➔ Laboratory diagnosis: Comma-shaped gram-negative
➔ Culture Media: Campy blood agar, Butzler and bacilli, facultative anaerobic, non-spore forming. Motile
Skirrow’s medium. (single, polar flagellum) Darting or shooting star
motility.
Salmonella spp. ➔ Culture: Thiosulfate Citrate Bile Salt
➔ Clinical disease: Gastroenteritis
➔ Laboratory diagnosis: Gram negative bacilli with
peritrichous flagella Species Clinical Infections
➔ Antigenic antigens: H Ag, O Ag, K Ag and Vi Ag
V. cholerae 01 (El Cholera aka Asiatic
(Salmonella Typhi has this antigen).
torr/Classic) cholera or epidemic
cholera

V. cholerae non- 01 Gastroenteritics

Species Disease septicemia, ear infections

S. typhi Typhoid or enteric fever V. cholerae 0139 Cholera aka Eight

pandemic cholera
S. paratyphi A & B Paratyphi fever
V. parahemolyticus Causes Summer diarrhea

14 | VISTAN & DOMINGO

 Prions
Kanagawa phenomenon
➔ Infectious agents composed of protein are unique in
Wagatsuma agar
that they are associated with specific forms of
neurodegenerative disease.
Yersinia enterocolitica ➔ Causes: Abnormal folding of the brain
➔ Clinical disease: Gastroenteritis (May resemble ➔ Scrapie - a fatal, degenerative disease affecting the
appendicitis) central nervous system of sheep and goats.
➔ Laboratory diagnosis: Gram negative bacilli, lactose- ➔ Bovine spongiform encephalopathy (BSE, or “mad
negative. cow disease”) in cattle.
➔ Culture Media: Cefsulodin-irgasan-novobiocin (CIN) ➔ Variant Creutzfeldt-Jakob Disease (vCJD) in humans,
agar (pink colonies with red center) Most common form.
➔ Consuming bovine products containing specified risk
Clostridium difficile material, e.g. brain tissue, is the most likely route of
➔ Clinical disease: Use of broad-spectrum antibiotics transmission of the prion agent to humans.
lowers relative amount of other normal gut flora and
allows C difficile to proliferate and infect large
intestine.
Virus Prion
➔ Laboratory diagnosis: Gram positive anaerobic bacilli,
motile. Colonoscopy shows pseudomembranous
Filterable infectious agents Yes Yes
colitis.
➔ Pseudomembranous colitis develops as a consequence Presence of nucleic acid Yes NO
of the release of cytotoxins by non-invasive c. difficile
in the colon. Define morphology (EM) Yes NO

Listeria monocytogenes Presence of protein Yes Yes

➔ Clinical disease: Listeriosis (foodborne illness),
Meningitis and sepsis Disinfected by Formaldehyde Yes NO
➔ Laboratory diagnosis: Gram positive short rods/ Proteases Heat (80 deg C) Some NO
coccobacilli, aerobic, non-spore forming, not acid fast. Ionizing and UV radiation Most NO
Psychrophile (Loves cold temp). Motility characteristic: Yes NO
Umbrella-shaped pattern. Cold temp - motile ; Body
temp- non-motile. Disease
➔ Can be isolated in a wide range of temperature: 4 1. Cytopathic effect Yes NO
degrees celsius. Ice cream, Dairy products, coleslaw, 2. Incubation period Depends on the LONG
etc. 3. Immune response virus NO
4. Interferon Production Yes NO
Helicobacter pylori 5. Inflammatory Yes NO
➔ Clinical disease: Gastroenteritis, Peptic ulcers, response
Associated with Gastric cancer
➔ Urease-producer
Prion disease (Slow infections)
◆ Converts urea to ammonia and bicarbonate
◆ Ammonia neutralizes stomach acid
◆ Ammonia is toxic to the epithelial cells Host species Disease
➔ Laboratory diagnosis: Curved gram-negative bacilli,
microaerophile Sheep, goats Scrapie
➔ Carcinogenic & produces enzyme urease
Cows Bovine Spongiform
Encephalopathy (BSE) “Mad
cow disease)
Gastrointestinal Infections and Food poisoning
Human (Cannibals) Kuru
Miscellaneous Organisms Associated with Diarrhea
Tropheryma whipplei Human Creutzfeldt-Jakob disease
➔ First identified in Duodenum Biopsy in 1991
➔ Laboratory diagnosis: Gram positive actinomycete, Variant CJD
facultative intracellular pathogen. PAS (Periodic Acid-
Schiff) positive. PCR test. Scrapie
➔ Clinical disease: Whipple’s disease, diarrhea, weight ➔ A fatal, degenerative disease affecting the central
loss, malabsorption, arthralgia and abdominal pain. nervous system of sheep and goats. It is among a
➔ Whipple’s disease: unable to metabolize fat which number of diseases classified as transmissible
leads to malabsorption spongiform encephalopathies (TSE).
➔ Specimen: Stool, saliva, gastric secretion ➔ The oldest known TSE, and under natural conditions
only sheep an goats are known to be affected by
Blastocystis hominis scrapie.
➔ Cyst: 8 to 30um, round, central vacuole surrounded by ➔ There is damage to the nervous system that shows
several peripheral nuclei. nervousness or aggression, intense rubbing, and
➔ Acquired through ingestion of contaminated water. locomotor incoordination that progresses to
➔ Clinical Disease: Mild GI symptoms (Diarrhea colitis recumbency and death.
and irritable bowel movement)
➔ Vacuolated form produces a ring around the BSE
cytoplasm. ➔ A progressive neurological disorder of cattle.
➔ Forms: Amoeboid, Granular, Vascular & cyst ➔ Characterized by spongy degeneration of the brain
➔ Isolated among the developing countries with severe and fatal neurological signs and
➔ Can survive chlorine/ Chlorine-resistant symptoms.

15 | VISTAN & DOMINGO

 ➔ 1970- the 1st probable infection of BSE in cows. ➔ Serological Test
◆ Widal test - S. typhi
CJD
➔ First reported from the United Kingdom in 1996 (CDC) Recommended specimen for typhoid fever:
➔ Spongiform refers to the characteristic appearance of
Weeks of infection Specimen
infected brains, which become filled with holes until
they resemble sponges when examined under a
1-2 Blood
microscope.
➔ Other human TSEs include kuru, fatal familial insomnia 2-3 Stool
(FFI), and Gerstmann-Straussler-Scheinker disease
(GSS) 3-4 Urine

Kuru
➔ Was identified in people of an isolated tribe who E.coli O157:H7 on Mac (Positive) and SMAC (negative
practice ritual cannibalism in Papua, New Guinea and
has now almost disappeared.

Laboratory Diagnosis of Gastrointestinal Pathogens

➔ Specimen collection and handling
◆ Fresh specimens are best for bacterial culture
◆ Fresh or preserved for ova and parasite
detection
➔ Direct microscope examination
◆ Fecal leukocytes
◆ Red blood cells
◆ Seagull-wing appearance
Thiosulfate-Citrate-Bile Salts (TBCS) - are yellow colonies
● Campylobacter or Vibrio
that ferment sucrose.

Parasitic Pathogen
➔ Giardia intestinalis ( Giardia lamblia)
➔ Entamoeba histolytica
➔ Cryptosporidium parvum (Oocyst)
➔ Cyclospora cayetanensis (Oocyst)
➔ Cystoisospora belli (Oocyst)
➔ Microsporidia (Spores)

Treatment for Gastrointestinal disease caused by Parasite

➔ Giardia intestinalis
◆ Nitazoxanide (approved by FDA)
➔ Entamoeba histolytica
◆ Paromomycin, diloxanide furoate (furamide) or
metronidazole
Viral Pathogen ◆ Metronidazole or tinidazole (recommended for
➔ Rotavirus (EIA, latex agglutination test) RNA extraintestinal amebiasis)
➔ Adenovirus (EM, Cell culture; EIA) only DNA VIRUS ➔ Cryptosporidium parvum
➔ Calicivirus 9EM, RT-PCR, EIA) RNA ◆ Nitazoxanide (approved by FDA)
➔ Astrovirus (EM) RNA and non-culturable ➔ Cyclospora cayetanensis
◆ Combination of TMP=-SMX (Bactrim)
Terms and extra notes: ➔ Cystoisospora belli
EIA - Elisa test (a test that detects and measures antibodies in ◆ Combination of TMP - SMX ( Bactrim)
your blood) ➔ Microsporidia
EM - Electron Microscope ◆ Albendazole; oral fumagillin (alternative
Serological test: Only applicable within 3-4 weeks after treatment)
infection so that enough antibodies are present.
RT-PCR- Molecular test
Antibiotics for Gastrointestinal Infection
Bacterial Pathogen
➔ Gram positive - C. difficile, Listeria monocytogenes ➔ C. difficile
◆ Vancomycin - against gram-positive inhibits
➔ Gram negative - C. jejuni, Salmonella spp., Shigella
the cell wall synthesis
spp., E.coli, Vibrio spp., Y. enterocolitica (bipolar
staining - safety pin appearance) ., H. pylori (causes ➔ C. jejuni
◆ Macrolide - inhibits protein synthesis
cancer or duodenal ulcerations)
➔ Vibrio spp. (Cholera)
◆ Doxycycline
➔ Special Media
◆ You need rehydration
◆ C. jejuni - CBAP, Butzler and Skirrows
➔ H. pylori
medium
◆ Bismuth quadruple therapy (H2 blocker +
◆ V. cholerae -TCBS
◆ Y. enterocolitica - CIN bismuth metronidazole + tetracycline)

16 | VISTAN & DOMINGO

 ◆ Proton Pump Inhibitor (PPI) - standard
treatment for Helicobacter

Treatment and Prevention of Diarrhea (Cont’d)

➔ Prevention
◆ Avoid high-risk foods and ice
◆ Foods prepared by another person and served
undercooked or raw
◆ Dips or other foods left at room temperature
◆ Properly cook foods such as poultry
◆ Thoroughly was al fruits and vegetables

17 | VISTAN & DOMINGO

18 | VISTAN & DOMINGO
 Quiz 9 LEC Infectious Agents of the Neisseria meningitidis - Transmitted via
Nervous System respiratori droplets

Neisseria meningitidis - Causative agent of Quiz 10 LEC

Waterhouse-Friderichsen syndrome

True - Endemic Typhus Fever is also known

Neisseria meningitidis - Causes as Murine Typhus Fever.

meningococcemia

False - Lymph node is a component of the

Man - De nitive host of Taenia solium:
cardiovascular system

Gravid proglottid - Harbors the eggs of True - Brucellosis is commonly transmitted

Taenia:
to man via consumption of unpasteurized
goat milk cheese

Respiratory paralysis - Major cause of

death of a rabid animal:
False - Borrelia burgdorferri is a gram
negative coccobacilli

Neck - Region of growth of Taenia:

True - HIV invades and destruct Helper T

Bullet - Shape associated with rabies virus:
cells

India ink - Stain used to identify the capsule False - Pediculus humans is the major cause
of the organism
of the spread of Endemic Typhus Fever in
man.

Scolex - Target of anti parasitic drugs for

pork tapeworm
False - Francisella tularensis is a Gram
negative spirochete

Quiz 9 LAB Infectious Agents of the

Nervous System True - Yersinia pestis exhibits bipolar
staining

Cysticercosis - Larva infection pf Taenia

solium
False - Rocky Mountain Spotted fever is
caused by Rickettsia prowazekii

Taenia Saginata - Beef Tapeworm

True - Anaplasma phagocytophilum invades

All of the above - Cause/s of cysticercosis
granulocytes

All of the above - Transmission of rabies:

Quiz 10 LAB

All of the above - Can cause meningitis

Cats - De nitive Host of Toxoplasma gondii

All of the above - Manifestation/s of Rabies

Staphylococcus epidermis - Normal ora of
the skin

TRUE - Negri bodies are found in the

cytoplasm of rabies infected nerve cells
Transplacental Route - Transmission of
Toxoplasma gondii

Saliva of infected animal - Rabies virus is

present in the:
Anopheles Mosquito - Sexual Reproduction
of Plasmodium takes place in;

Pig - Intermediate host of Taenia solium

Bite of a mosquito carrying L3 larva -

Transmission of Filariasis

fi
fi
fl
All of the above - Disease/s caused by
Leptospira spp.

All of the above - Intracelleular Parasites:

Most prevalent specie in the Philippines -

TRUE about Plasmodium falciparum

Microgametocyte - Małe sex cells of

Plasmodium

Man serves as an intermediate host -

FALSE about Schistosomiasis