Vaginal itching, Pain, discharge odor Adherent yellowish discharge, PH 25, fishy amine odor in KOH, clue cells; gram- negative cells dominate (Bacterial vaginosis) overgrowth of Gardnerella vaginalis and anaerobes Vulvovaginitis, pruritis, erythema, discharge: consistency of cottage cheese Candida spp. Foamy, purulent discharge, many PMNs and motile trophozoites microscopically (corkscrew motility) | Trichomonas vaginalis Pelvic Disease (PID) Adnexal tendemess, bleeding, deep dyspareunia, vaginal discharge, fever; inflammatory tenderness from cervical movement, possibly palpable inflammatory mass on bimanual exam, onset often follows menses Neisseria gonorrhoeae or Chlamydia trachomatis or both or a variety of other organisms Genital elephantitis Initial papule heals; lymph nodes enlarge and develop fistulas; genital elephantiasis may develop Tropics, microfilariae in bloodstream Chlamydia trachomatis L1i-L3 Wuchereria or Brugia (filarial nematodes)Vaginal itching, Pain, discharge odor Adherent yellowish discharge, PH 25, fishy amine odor in KOH, clue cells; gram- negative cells dominate (Bacterial vaginosis) overgrowth of Gardnerella vaginalis and anaerobes Vulvovaginitis, pruritis, erythema, discharge: consistency of cottage cheese Candida spp. Foamy, purulent discharge, many PMNs and motile trophozoites microscopically (corkscrew motility) | Trichomonas vaginalis Pelvic Disease (PID) Adnexal tendemess, bleeding, deep dyspareunia, vaginal discharge, fever; inflammatory tenderness from cervical movement, possibly palpable inflammatory mass on bimanual exam, onset often follows menses Neisseria gonorrhoeae or Chlamydia trachomatis or both or a variety of other organisms Genital elephantitis Initial papule heals; lymph nodes enlarge and develop fistulas; genital elephantiasis may develop Tropics, microfilariae in bloodstream Chlamydia trachomatis L1i-L3 Wuchereria or Brugia (filarial nematodes)Human herpesviruses 6 and ROUTE OF TRANSMISSION: Saliva CLINICAL SIGNIFICANCE: Roseola infantum (exanthem subitum) fevers for several days that can cause followed by diffuse macular rash (1) NOTES: Roseola: fever first, Rosie (cheeks) later. HHV-7—less com cause of roseola. — Human herpes virus 8 ROUTE OF TRANSMISSION: Sexual contact CLINICAL SIGNIFICANCE: Kaposi sarcoma (neoplasm of endothelial c Seen in HIV/AIDS and transplant patients. Dark/ violaceous plaques or nodules (J) representing vascular proliferations. NOTES: Can also affect GI tract and lungs. HSV Identification Viral culture for skin/genitalia. CSF PCR for herpes encephalitis. Tzanck test—a smear of an opened skin vesicle to detect multinucleated glant cells commonly seen In HSV-1, HSV-2, and VZV infection. PCR of skin lesions is currently test of choice. intranuclear eosinophilic Cowdry A inclusions also seen with HSV-1, HSV-2, VZV. Tzanck heavens | do not have herpes.© CD4+ cell count < 100/mm* _ Aspergillus fumigatus |Haemoptysis, — pleuritic Cavitation or infiltrates on pain chest imaging Candida albicans Esophagitis White plaques on endoscopy; yeast and _ pseudohyphae on biopsy Linear ulcers on Retinitis, esophagitis, &"40S¢opy, cotton wool i spots on fundoscopy. itis, itis, . ‘ CMV colts, epedments Biopsy reveals cells with encephalitis intranuclear (owl eye) inclusion bodies Cryptococcus Encapsulated yeast on inciti India ink stain or capsul: neoformans Meningitis antigen © in Or capeear | Cryptosporidium spp. Chronic, Acid-fast oocysts in stool watery diarrhoea a "| B-cell lymphoma (eg, CNS lymphoma—ring— non-Hodgkin lymphoma, enhancing, may be EBV CNS lymphoma) solitary (vs Toxoplasma) Mycobacterium Nonspecific systemic ” . symptoms (fever, night avium intracellulare, sweats, weight loss) or Mycobacterium focal lymphadenitis | avium complex Toxoplasma gondii “Multiple ring-enhancing lesions on MRI Brain abscessesRash Rare: Ehrlichiosis 2 Ehrlichia, vector is tick. Monocytes with morulae (mulberry-like inclusions) in cytoplasm. Rash Rare: Anaplasmosis 2 Anaplasma, vectoris tick. Granulocytes with morulae in cytoplasm. Histoplasmosis 2 Macrophage filled with Histoplasma. (smaller than RBC)Leishmania donovani DISEASE: Visceral leishmaniasis (kala-azar) spiking fevers. hepatosplenomegaly, TRANSMISSION: Sand-fly © DIAGNOSIS: Macrophages Containing amastigotes nas _vaginali: 2 DISEASE: Vaginitis—foul-smelling, greenish discharge; itching and ‘burning; do not confuse with Gardnerella vaginalis, a gram-variable bacterium associated with bacterial vaginosis. 2 TRANSMISSION: Sexual (cannot exist outside human because it cannot form cysts) 2 DIAGNOSIS: Trophozoltes (motile) on wet mount; “strawberry cervix” oe a, Enterobius vermicularis (pinworm 2 DISEASE: Causes anal pruritus . {Diagnosed by seeing egg via the tape test). 2 TRANSMISSION: Fecal-oralCharacteristics of Common Vaginal Infections Normal None ‘white, cleat - 38-42 NA BV (Odor, increased after | Thin, gray or + >45 | Cluecells, bacteria intercourse and/or | white, clumps (saline wet prep) menses adherent, often Increased vs Bacterial Thin, watery Purulent——y aS ‘Many WECS (Streptococcal, | discharge, pruritus staphylococcal, escherichla col Candidiasis [itching burning, White, curdy = <45_—— [Hyphae and buds discharge cottage cheese” (20-percent KOH Trichomoniasis discharge Frothy discharge, odor, dysuria, pruritus, spotting discharge (AlIMS May 2027) solution wet prep) Motile trichomonads ers wet prep) ON 0 e eee @Entamoeba histolytica © DISEASE: Amebiasis © TRANSMISSION: Cysts in water © DIAGNOSIS: Serology and/or trophozoites (with engulfed RBCs in the cytoplasm) or cysts with up to 4 nuclel in stool Giardia lamblia © DISEASE: Giardiasis © TRANSMISSION: Cysts in water © DIAGNOSIS: Multinucleated trophozoites or cysts in stool, antigen detection + 6. Toxoplasma gondii 2 DISEASE: Congenital toxoplasmosis = classic triad of chorioretinitis: hydrocephalus, and intracranial calcifications; reactivation in AIDS > brain abscesses usually seen as multiple ring-enhancing lesions on MRI 2 TRANSMISSION: Cysts in meat (most common); oocysts in cat feces; crosses placenta (pregnant women should avoid cats) 2 DIAGNOSIS: Serology, biopsy (tachyzoite)FASCIOLA BUSKI Q Operculated eggs in stool Fasciolopsis buski e909 ok 5 Paragonimus Westermanii (Lung Fiuke) Q Operculated eggs in early morning, deeply co! sputum Morphology of Adult Paragonimus westermant operculum Clonorchis Sinensis (Oriental tiver fluk Q Flask shaped operculated egg in stool.Hepatitis Serologic Markers Anti-HAV (IgM): IgM antibody to HAV; best test to detect Acute hepatitis A. Anti-HAV (IgG): IgG antibody indicates prior HAV infection And/or prior vaccination; protects against Re-infection. « HBsAg: Antigen found on surface of HBV; indicates hepatitis B infection. « Anti-HBs: Antibody to HBsAg; indicates immunity to hepatitis B Due to vaccination or recovery from infection. * HBcAg: Antigen associated with core of HBV. « Anti-HBc: Antibody to HBcAg; IgM = acute/recent infection; IgG = prior exposure or chronic infection. IgM anti-HBc may be the sole ® marker of Infection during window period. « HBeAg: Secreted by infected hepatocyte into circulation. Not Part of mature HBV virion. Indicates active viral Replication and therefore high transmissibility and Poorer prognosis. Anti-HBe: Antibody to HBeAg; indicates low transmissibility. Surface antigen HBsAg DNA aN polymerase DNA . . Envelope antigen Core antigen HBcAgSCHISTOSOMA MANSONI Q Egg has lateral spine (feces), eggs of S. mansoni are acid fast. SCHISTOSOMA JAPONICUM Q Egg with nubby spine FASCIOLA HEPATICA Q Operculated eggs in stool encanta sreapiny sen gaan patna pe or © ° | 11.98 Fac pc ty ge oom K-Fed: BTon tage ‘Coy co ge, Oat mcsAscaris lumbricoides (giant roundworm) ' 1 DISEASE: May cause obstruction at ileocecal valve, biliary obstruction, intestinal perforation, migrates from nose/mouth 4 TRANSMISSION: Fecal-oral; knobby-coated, oval eggs seenin feces under microscopeHerpesviruses Herpes simplex virus-1 ROUTE OF TRANSMISSION: Respiratory secretions, saliva CLINICAL SIGNIFICANCE: Gingivostomatitis, keratoconjunctivitis (A), her herpetic whitlow on finger, temporal lobe ence; esophagitis, erythema multiforme. NOTES: Most common cause of sporadic encephalitis, can present as altered status, seizures, and/or aphasia, Herpes simplex virus ROUTE OF TRANSMISSION: Sexual contact, perinatal CLINICAL SIGNIFICANCE: Herpes genitalis (C) , neonatal herpes. NOTES: Latent in sacral ganglia. Viral meningitis more common with HSV-2 than with HSV-1 Varicella-Zoster virus (HHV-3) ROUTE OF TRANSMISSION: Respiratory secretions CLINICAL SIGNIFICANCE: Varicella-zoster (chickenpox (D), shingles\ encephalitis, pneumonia. Most common c of shinglesis post-herpetic neuralgia. NOTES: Latent in dorsal root or trigeminal ganglia; CN V1 branch involv cause herpes zoster ophthalmicus. oeIRO 'Y iL Live attenuated vaccines > MMR, > Yellow fever, > Rotavirus, » Influenza (intranasal), > Chickenpox (VZV), > Smallpox, » Sabin polio virus. * Mnemonics: - “Music and LYRICSS are best enjoyed Live.” « MMR =measles, mumps, rubella; live attenuated vaccine that can be given to HIV @ patients who do not show signs of immunodeficiency. * Killed vaccines > Rabies, > Influenza (injected), > Salk Polio, and > HAV vaccines. Killed/inactivated vaccines induce only humoral immunity but are stable. « Salk =Killed. « Mnemonics: - RIP Always. = Subunit * HBV (antigen = HBsAg), HPV (types 6, 11, 16, and 18). RNA viral genomes « All RNA viruses except Reoviridae are ssRNA. * @ stranded RNA viruses: * [went to a retro (retrovirus) toga (togavirus) party, where | drank flavored (flavivirus) Corona (coronavirus) and ate hippie (hepevirus) California (calicivirus) pickles (picornavirus). Viral envelopes * Naked (non-enveloped) viruses include > Papillomavirus, » Adenovirus, > Parvovirus, DNA = PAPP; RNA = CPR and hepevirus » Polyomavirus, > Calicivirus, » Picornavirus, > Reovirus, and » HepevirusH.NANA Vs H.DIMINUTA DIPYLIDIUM CANINUM Q Eggs in packets, Proglotted has two common pore, Barrel shaped Proglottid. SCHISTOSOMA HEMATOBIUM Q Schistosoma haematobium egg with terminal spi \CD 4+ Count Associated with Disease in HIV + Patients © CD4+ cell count < 500/mm* Candida albicans Oral thrush Scrapable white plaque, pseudohyphae on microscopy EBV Oral hairy leukoplakia Unscrapable white plaque on lateral tongue Bartonella henselae Bacillary angiomatosis Biopsy with neutrophilic inflammation HHV-8 Kaposi sarcoma Biopsy with lymphocytic inflammation HPV Squamous cell carcinoma, commonly of anus (men who have sex with men) or cervix (women) a ° CD4+ <2 Histoplasma Fever, weight loss, Oval yeast cells within fatigue, cough, dyspnea, | macrophages capsulatum nausea, vomiting, diarrhoea HIV Dementia JC virus (reactivation) | Progressive multifocal Non enhancing areas leukoencephalopathy of demyelination on MRI Pneumocystis jirovecii Pneumocystis pneumoni: ia “Ground-glass” opacities on CXRv v IgG v Important Incubation _—_Prodrome, Convalescence diagnostic period acute disease Early late tests | HBsAg DNA Anti-HBc palate polymerase concentration - of reactants HBV particles fo ‘HBsAg \ ‘\ Window period Anti-HBs ———_Anti-HBe levelof | ff detection Months after 0 1 2 3 4 5 6 7 8 exposure symptoms SGPT (ALT)Gonococci Vs Meningococci Neisseria:- + Gram © diplococci. Metabolize glucose and produce IgA proteases. * Contain lipooligosaccharides (LOS) with strong endotoxin activity. +N gonorrhoeae is often intracellular (within neutrophils). > Gonococci | Meningococci ~~ No polysaccharide capsule — [ ~ Polysaccharide capsule No maltose metabolized | Maltose fermentation No vaccine due to antigenic variation of | Vaccine (lype B vaccine not widely availabe) pilus proteins ‘Sexually or perinatally transmitted | Transmitted via respiratory and oral ‘secretions ‘Causes gonorrhoea, septic arthritis, |Causes meningococcemia with petechial neonatal conjunctivitis (2-5 days after haemorrhages and gangrene of toes birth), pelvic inflammatory disease meningitis, Waterhouse-Friderichsen (PID), and Fitz-Hugh-Curtis syndrome. syndrome (adrenal insufficiency, fever, DIC shock) Condoms decrease sexual transmission, | Rifampin, ciprofloxacin, or ceftriaxone erythromycin eye ointment prevents | prophylaxis in close contacts neonatal blindness Treatment: ceftriaxone + (azithromycin | Treatment: cefiriaxone or penicillin G ‘or doxycycline) for possible chiamydial coinfectionMODE OF TRANSMISSION: HIV ®@ Decreasing order of Most Common mode of transmission of HIV in Heterosexual > Homosexual > Parent to child > Injection drug abuse > Blood transfusion > Needle stick exposure. @ Most common mode of transmission of HIV in India:- Heterosexual > Parent to child > Injection drug abuse > Homosexual >Blood transfusion and Needle stick exposure ® Decreasing order of Most common Risk of transmission of HIV:- Blood transfusion > Parent to child > Injection drug abuse > Needle stick exposure > Sexual (Anal) > Vaginal intercourse Reference Book:- WY teareuteas ace Immunology Hg ait)Hepatitis Serologic Markers Anti-HAV (IgM): IgM antibody to HAV; best test to detect Acute hepatitis A. Anti-HAV (IgG): IgG antibody indicates prior HAV infection And/or prior vaccination; protects against Re-infection. « HBsAg: Antigen found on surface of HBV; indicates hepatitis B infection. « Anti-HBs: Antibody to HBsAg; indicates immunity to hepatitis B Due to vaccination or recovery from infection. * HBcAg: Antigen associated with core of HBV. « Anti-HBc: Antibody to HBcAg; IgM = acute/recent infection; IgG = prior exposure or chronic infection. IgM anti-HBc may be the sole ® marker of Infection during window period. « HBeAg: Secreted by infected hepatocyte into circulation. Not Part of mature HBV virion. Indicates active viral Replication and therefore high transmissibility and Poorer prognosis. Anti-HBe: Antibody to HBeAg; indicates low transmissibility. Surface antigen HBsAg DNA aN polymerase DNA . . Envelope antigen Core antigen HBcAgrane Tract Infections Urethritis Cystitis Gram-negative diplococci in PMNs in urethral exudate Culture negative, inclusion bodi Urease positive, no cell wall Flagellated protozoan with corkscrew motility Frequent and painful urination, hematuria, and fever ye Young, newly sexually | active individual; gram- Neisseria gonorrhoeae ies Chlamydia trachomatis Ureaplasma urealyticum Trichomonas vaginalis E.coli, other gram-negative enterics, Pseudomonas, Proteus Staphylococcus saprophyticus Pyelonephritis As above, with flank pain and E. coli, Staphylococcus prominent fever Cervicitis Friable, inflamed cervix with mucopurulent discharge; probes or culture to distinguish Neisseria gonorrhoeae (gram-negative diplococci) Chlamydia trachomatis (non-staining obligate intracellular parasite) Herpes simplex (virus)Herpesviruses Herpes simplex virus-1 ROUTE OF TRANSMISSION: Respiratory secretions, saliva CLINICAL SIGNIFICANCE: Gingivostomatitis, keratoconjunctivitis (A), her herpetic whitlow on finger, temporal lobe ence; esophagitis, erythema multiforme. NOTES: Most common cause of sporadic encephalitis, can present as altered status, seizures, and/or aphasia, Herpes simplex virus ROUTE OF TRANSMISSION: Sexual contact, perinatal CLINICAL SIGNIFICANCE: Herpes genitalis (C) , neonatal herpes. NOTES: Latent in sacral ganglia. Viral meningitis more common with HSV-2 than with HSV-1 Varicella-Zoster virus (HHV-3) ROUTE OF TRANSMISSION: Respiratory secretions CLINICAL SIGNIFICANCE: Varicella-zoster (chickenpox (D), shingles\ encephalitis, pneumonia. Most common c of shinglesis post-herpetic neuralgia. NOTES: Latent in dorsal root or trigeminal ganglia; CN V1 branch involv cause herpes zoster ophthalmicus. oeAscaris lumbricoides (giant roundworm) ' 1 DISEASE: May cause obstruction at ileocecal valve, biliary obstruction, intestinal perforation, migrates from nose/mouth 4 TRANSMISSION: Fecal-oral; knobby-coated, oval eggs seenin feces under microscopeRNA Viruses Zz © aretlar ee No DS linear Teasahedral | Colivius-—Colorado ick faver 10-12segments | (double) Rotavitis—cause of fatal diarthes in children Ficornaviruses | No SS inear | leosahedrar | Potowinis—poko Sok Satin vaccines— yORV Ectovinss—asentie meningitis, Rhinowrus—common cold” Corsackievitus—aseptic meningtts, herpangina (mouth Disters, fever); and, foot. and mouth disease, myocarditis, pericarditis HAV—acute viral hepatitis PERCH |Hepeviras No. SSG linear Teosahedral_——[ HEV Caliciviruses No SS @ linear Tcosahedral_—_| Norovitus—vira: gastroententis, Flaviviruses Yes SS @ linear Teosahedrat | HCY Yellow fever St Louis encephalits ‘West Nile virus (meningoencephatis) ka vinus Togaviruses Yes | SS @ linear Teosohedral | Rubella Retroviruses Yes] SS@ near Toosahedral | Have reverse ranserplase 2ecopies (HTLV)complex | HTLY—T-cell leukemia ‘and conical (HIV) | HiV—AIDS Coronavituses | Yes, SS 6 linear 7 “Common cold, SARS, MERS Orikomyxoviruses| Vos | SSOinear | Helical Tivivena vine 8 sogments Paramyxoviruses | Yes | SS @unear | Helicar PaRaniyronnis ‘Non-segmenied Paranfuenza—croup SV—broncholits 1 babies; Rx— ribavirin Measles, Mumps vos ‘SS Oinear | Helical Rabies Yes SS Omer | Hatcal Epa cry hegre eration fata Arenaviruses Yes SS@ and@ | Helical LCMV—lymphocytic choriomeningitis circular virus 2 segments Lassa fever encephalts—spread by rostents Bunyavirases | Yes S86 crear | Hoical California encephaiis 3 segments Sandtly Rit Valley fevers Crimean-Congo hemorrhagic fever Hantavinus—hemormagic fever, pneumonia Delta virus Yes HDV's a “defective” virus that requires the presence of HBV to replicateGenitourinary Tract Infections Gram-negative diplococci in Neisseria gonorrhoeae PMNs in urethral exudate Culture negative, inclusion bodies Chlamydia trachomatis Urethritis Urease positive, no cell wall Ureaplasma urealyticum gellated protozoan with —=«‘Trichomonas vaginalis corkscrew motility Frequent and painful E. coli, other gram-negative urination, hematuria, and __enterics, Pseudomonas, fever Proteus Cystitis | Young, newly sexually active individual; gram- | positive cocci Staphylococcus saprophyticus Pyelonephritis As above, with flank pain and | E. coli, Staphylococcus prominent fever Neisseria gonorrhoeae (gram-negative diplococci) Chlamydia trachomatis (non-staining obligate intracellular parasite) Herpes simplex (virus) Friable, inflamed cervix with mucopurulent discharge; Cervicitis probes or culture to distinguishCryptosporidium |G DISEASE: Severe Diarrhea in AIDS Mild disease (watery Diarrh in immunocompetent hosts 4 TRANSMISSION: Oocysts in water DIAGNOSIS: Oocysts on acid-fast stain, antigen detection Blastomycosis . Broad-based budding of Blastomyces. (same size as RBC) Coccidioidomycosis a Spherule (much larger than RBC) filled with endospores of CoccidioidesNaegleria fowleri 2 DISEASE: Rapidly fatal meningoencephalitis 2 TRANSMISSION: Swimming in freshwater lakes (think Nalgene bottle filled with fresh water Containing Neegieria); enters: cribriform plate 2 DIAGNOSIS: Amoebas in spinal fuid Trypanosoma brucei 2 DISEASE: African sleeping sickné ‘enlarged lymph node recurring fever (due to antigenic variation), somnolence, coma Two subspecies: Trypanosoma bruce/ rhodesiense, Trypanosoma brucei gambiense 2 TRANSMISSION: Tsetse fly, a painful bite 2 DIAGNOSIS: Trypomastigote in blood smear Trypanosoma cruzi N DISEASE: Chagas dise: 4 TRANSMISSION: Reduviid bug (“kissing bug”) feces, deposi In a painless bite (much like a kiss) 4 DIAGNOSIS: Trypomastigote in blood smear ~CLINICAL BACTERIOLOGY C perfringens : © Produces a toxin (lecithinase, a phospholipase) that can Y cause myonecrosis (gas gangrene) and hemolysis . C difficile q Q Produces 2 toxins. Toxin A, an enterotoxin, binds to brush border of gut and alters fluld secretion. Toxin B, a cytotoxin, disrupts cytoskeleton via actin depolymerisation. Both toxins lead to Diarrhea > pseudomembranous colitis. uy Corynebacterium diphtheriae " = Symptoms include pseudomembranous pharyngitis — (greyish-white membrane)with lymphadenopathy, myocarditis, and arrhythmias.EGG’s of CESTODES & TREMATODES Diphyllobothrium Lactum Q Operculated eggs in stool | rs (eo HYMENOLEPIS NANA UEgg smaller, bile non stained and has polar fil: 5 ae = an a» HYMENOLEPIS DIMINUTA seTreatments include “CAMPFIRE” drugs: > Carbapenems > Aminoglycosides » Monobactams > Polymyxins (eg, polymyxin B, colistin) > Fluoroquinolones (eg, ciprofloxacin, levofloxacin) > ThiRd- and fourth-generation cephalosporins (eg, ceftazidime, cefepime) > Extended-spectrum penicillins (eg, piperacillin, ticarcillin) Aeruginosa—aerobic. Mucoid polysaccharide capsule may contribute to chronic pneumonia in cystic fibrosis patients due to biofilm formation. Can cause wound infection in burn victims. Corneal ulcers/keratitis in contact lens wearers/ minor eye trauma. Frequently found in water > hot tub folliculitis. Ecthyma gangrenosum—tapidly progressive, necrotic cutaneous lesion caused by Pseudomonas bacteremia. Typically seen in immunocompromised patients. Escherichia coli e Gram © rod. E coli virulence factors: fimbriae—cystitis and pyelonephritis (P-pili); K capsule—pneumonia, neonatal meningitis; LPS endotoxin—septic shock Invasive; dysentery. Clinical manifestations similar to Shigella Travelers’ diarrhea (watery). Diarrhea, usually in children (Pediatrics). Dysentery (toxin alone causes necrosis and inflammation). Does not ferment sorbitol (vs other E coll). Hemorrhagic, Hamburgers, Hemolytic- uremic syndromeGonococci Vs Meningococci Neisseria:- + Gram © diplococci. Metabolize glucose and produce IgA proteases. * Contain lipooligosaccharides (LOS) with strong endotoxin activity. +N gonorrhoeae is often intracellular (within neutrophils). > Gonococci | Meningococci ~~ No polysaccharide capsule — [ ~ Polysaccharide capsule No maltose metabolized | Maltose fermentation No vaccine due to antigenic variation of | Vaccine (lype B vaccine not widely availabe) pilus proteins ‘Sexually or perinatally transmitted | Transmitted via respiratory and oral ‘secretions ‘Causes gonorrhoea, septic arthritis, |Causes meningococcemia with petechial neonatal conjunctivitis (2-5 days after haemorrhages and gangrene of toes birth), pelvic inflammatory disease meningitis, Waterhouse-Friderichsen (PID), and Fitz-Hugh-Curtis syndrome. syndrome (adrenal insufficiency, fever, DIC shock) Condoms decrease sexual transmission, | Rifampin, ciprofloxacin, or ceftriaxone erythromycin eye ointment prevents | prophylaxis in close contacts neonatal blindness Treatment: ceftriaxone + (azithromycin | Treatment: cefiriaxone or penicillin G ‘or doxycycline) for possible chiamydial coinfectionLeishmania donovani DISEASE: Visceral leishmaniasis (kala-azar) spiking fevers. hepatosplenomegaly, TRANSMISSION: Sand-fly © DIAGNOSIS: Macrophages Containing amastigotes nas _vaginali: 2 DISEASE: Vaginitis—foul-smelling, greenish discharge; itching and ‘burning; do not confuse with Gardnerella vaginalis, a gram-variable bacterium associated with bacterial vaginosis. 2 TRANSMISSION: Sexual (cannot exist outside human because it cannot form cysts) 2 DIAGNOSIS: Trophozoltes (motile) on wet mount; “strawberry cervix” oe a, Enterobius vermicularis (pinworm 2 DISEASE: Causes anal pruritus . {Diagnosed by seeing egg via the tape test). 2 TRANSMISSION: Fecal-oralGenital Non-tender, indurated ulcer Treponema pallidum lesions ‘yeaks (most common U.S. STD), Genital warts Treponema pallidum, - - molluscum contagiosum Multiple painful vesicular, Herpes simplex virus coalescing, recurring healing spontaneously 2-10 Non-indurated, painful papule, | Haemophilus ducreyi Suppurative with adenopathy, slow to heal Soft, painless ulcer, patient from | Klebsiella granulomatis Caribbean or New Guinea, (granuloma inguinale) gram negative intracellular bacilli Pseudomonas aeruginosa * Aerobic, motile, gram © rod. Non-lactose fermenting, oxidase @. Produces pyocyanin (blue-green pigment A); has a grape-like odor. * Produces endotoxin (fever, shock), exotoxin A (inactivates EF-2), phospholipase C (degrades cell membranes), and pyocyanin (generates reactive oxygen species). * PSEUDOMONAS is associated with: > Pneumonia, pyocyanin > Sepsis > Ecthyma gangrenosum > UTIs & Diabetes, drug use > Osteomyelitis (eg, puncture wounds) > Mucoid polysaccharide capsule > Otitis externa (swimmer's ear) > Nosocomial infections (catheters,equipment) > Exotoxin A > Skin infections (hot tub folliculitis)Epstein-Barr virus (HHV-4 ROUTE OF TRANSMISSION: Respiratory secretions, saliva; aka “kissing disease,” (common in teens, young adults) CLINICAL SIGNIFICANCE: Mononucleosis—fever, hepatosplenomegaly, pharyngitis, lymphadenopathy (especialy posterior cervical nodes (F). Avoid contact sports unti reso risk of splenic rupture. Associated with lymphomas (eg, endemic Burkitt lymphoma), nasoy carcinoma (especially Asian adults), lymphoproiiferative disease in transplant patients. NOTES: Infects B cells through CD21 Atypical lymphocytes on peripheral blood smear(6| B cells but reactive cytotoxic T cells. @ Monospot test—heterophile antibodies detected by. agglutination of sheep or horse RECs. Use of amoxicillin in mononucleosis can cause charac! maculopapular rash. aRe Cytomegalovirus(HHV-5) ROUTE OF TRANSMISSION: Congenital transfusion, sexual contact, saliva, Uni CLINICAL SIGNIFICANCE: Mononucleosis (@ Monospot) in immunocompetent inimmunocompromised, especially pneumonia in tra esophagitis; AIDS retinitis (‘sightomegalovirus"): he cotton-wool exudates, vision loss. Congenital CMV NOTES: Infectedcells have characteristic “owl eye” inclusions (H).Latent in mononuclearCharacteristics of Common Vaginal Infections Normal None White, dear 2 Be ry BV Odor, increased after | Thin, grayor >45 Clue cells, bacteria intercourse and/or | white, clumps (saline wet prep) menses adherent often increased | Bacterial Thin, watery Purulent - 245 Many WBC: {Streptococcal, | discharge, pruritus staphylococcal, Escherichia cal.) Candidiasis | Itching. burning. White, curdy - <45 Hyphae and buds scharge “cotiage cheese” {tO-percent KOH dscharge solution wet pep) Trichomoniasis | Frothy discharge, Motile tichomonads odor, dysuria, ae wet prep) pruritus, spotting OMe Aas Or Re ae Noid! (AWIM'S May 2017)© CD4+ cell count < 100/mm? Aspergillus fumigatus Candida albicans |Haemoptysis, —_pleuritic Cavitation or infiltrates on pain chest imaging Esophagitis White plaques on endoscopy; yeast and } pseudohyphae on biopsy Retinitis, esophagitis, colitis, pneumonitis, Linear ulcers on endoscopy, cotton wool ‘spots on fundoscopy. CMV a Biopsy reveals cells with encephalitis intranuclear (owl eye) inclusion bodies Cryptococcus Encapsulated yeast on eoforindis Meningitis pra in a or capsular Cryptosporidium spp. Chronic, Acid-fast oocysts in stool watery diarrhoea | B-cell lymphoma (eg, CNS lymphoma—ring non-Hodgkin lymphoma, enhancing, may be EBV CNS lymphoma) solitary (vs Toxoplasma) Mycobacterium Nonspecific systemic i symptoms (fever, night avium intracellulare, | swe, ats, weight loss) or Mycobacterium focal lymphadenitis avium complex Toxoplasma gondii | Brain abscesses Multiple ring-enhancing lesions on MRIRNA Viruses Zz © aretlar ee No DS linear Teasahedral | Colivius-—Colorado ick faver 10-12segments | (double) Rotavitis—cause of fatal diarthes in children Ficornaviruses | No SS inear | leosahedrar | Potowinis—poko Sok Satin vaccines— yORV Ectovinss—asentie meningitis, Rhinowrus—common cold” Corsackievitus—aseptic meningtts, herpangina (mouth Disters, fever); and, foot. and mouth disease, myocarditis, pericarditis HAV—acute viral hepatitis PERCH |Hepeviras No. SSG linear Teosahedral_——[ HEV Caliciviruses No SS @ linear Tcosahedral_—_| Norovitus—vira: gastroententis, Flaviviruses Yes SS @ linear Teosahedrat | HCY Yellow fever St Louis encephalits ‘West Nile virus (meningoencephatis) ka vinus Togaviruses Yes | SS @ linear Teosohedral | Rubella Retroviruses Yes] SS@ near Toosahedral | Have reverse ranserplase 2ecopies (HTLV)complex | HTLY—T-cell leukemia ‘and conical (HIV) | HiV—AIDS Coronavituses | Yes, SS 6 linear 7 “Common cold, SARS, MERS Orikomyxoviruses| Vos | SSOinear | Helical Tivivena vine 8 sogments Paramyxoviruses | Yes | SS @unear | Helicar PaRaniyronnis ‘Non-segmenied Paranfuenza—croup SV—broncholits 1 babies; Rx— ribavirin Measles, Mumps vos ‘SS Oinear | Helical Rabies Yes SS Omer | Hatcal Epa cry hegre eration fata Arenaviruses Yes SS@ and@ | Helical LCMV—lymphocytic choriomeningitis circular virus 2 segments Lassa fever encephalts—spread by rostents Bunyavirases | Yes S86 crear | Hoical California encephaiis 3 segments Sandtly Rit Valley fevers Crimean-Congo hemorrhagic fever Hantavinus—hemormagic fever, pneumonia Delta virus Yes HDV's a “defective” virus that requires the presence of HBV to replicateCD 4+ Count Associated with Disease in HIV + Patients © CD4+ cell count < 500/mm* Candida albicans Oral thrush Scrapable white plaque, pseudohyphae on microscopy EBV Oral hairy leukoplakia Unscrapable white plaque on lateral tongue Bartonella henselae Bacillary angiomatosis Biopsy with neutrophilic inflammation HHV-8 Kaposi sarcoma Biopsy with lymphocytic inflammation HPV Squamous cell carcinoma, commonly of anus (men who have sex with men) or cervix (women) a ° CD4+ <2 Histoplasma Fever, weight loss, Oval yeast cells within fatigue, cough, dyspnea, | macrophages capsulatum nausea, vomiting, diarrhoea HIV Dementia JC virus (reactivation) | Progressive multifocal Non enhancing areas leukoencephalopathy of demyelination on MRI Pneumocystis jirovecii Pneumocystis pneumoni: ia “Ground-glass” opacities on CXRSCHISTOSOMA MANSONI Q Egg has lateral spine (feces), eggs of S. mansoni are acid fast. SCHISTOSOMA JAPONICUM Q Egg with nubby spine FASCIOLA HEPATICA Q Operculated eggs in stool encanta sreapiny sen gaan patna pe or © ° | 11.98 Fac pc ty ge oom K-Fed: BTon tage ‘Coy co ge, Oat mcsEGG’s of CESTODES & TREMATODES Diphyllobothrium Lactum Q Operculated eggs in stool | rs (eo HYMENOLEPIS NANA UEgg smaller, bile non stained and has polar fil: 5 ae = an a» HYMENOLEPIS DIMINUTA seGenital Non-tender, indurated ulcer Treponema pallidum lesions ‘yeaks (most common U.S. STD), Genital warts Treponema pallidum, - - molluscum contagiosum Multiple painful vesicular, Herpes simplex virus coalescing, recurring healing spontaneously 2-10 Non-indurated, painful papule, | Haemophilus ducreyi Suppurative with adenopathy, slow to heal Soft, painless ulcer, patient from | Klebsiella granulomatis Caribbean or New Guinea, (granuloma inguinale) gram negative intracellular bacilli Pseudomonas aeruginosa * Aerobic, motile, gram © rod. Non-lactose fermenting, oxidase @. Produces pyocyanin (blue-green pigment A); has a grape-like odor. * Produces endotoxin (fever, shock), exotoxin A (inactivates EF-2), phospholipase C (degrades cell membranes), and pyocyanin (generates reactive oxygen species). * PSEUDOMONAS is associated with: > Pneumonia, pyocyanin > Sepsis > Ecthyma gangrenosum > UTIs & Diabetes, drug use > Osteomyelitis (eg, puncture wounds) > Mucoid polysaccharide capsule > Otitis externa (swimmer's ear) > Nosocomial infections (catheters,equipment) > Exotoxin A > Skin infections (hot tub folliculitis)Human herpesviruses 6 and ROUTE OF TRANSMISSION: Saliva CLINICAL SIGNIFICANCE: Roseola infantum (exanthem subitum) fevers for several days that can cause followed by diffuse macular rash (1) NOTES: Roseola: fever first, Rosie (cheeks) later. HHV-7—less com cause of roseola. — Human herpes virus 8 ROUTE OF TRANSMISSION: Sexual contact CLINICAL SIGNIFICANCE: Kaposi sarcoma (neoplasm of endothelial c Seen in HIV/AIDS and transplant patients. Dark/ violaceous plaques or nodules (J) representing vascular proliferations. NOTES: Can also affect GI tract and lungs. HSV Identification Viral culture for skin/genitalia. CSF PCR for herpes encephalitis. Tzanck test—a smear of an opened skin vesicle to detect multinucleated glant cells commonly seen In HSV-1, HSV-2, and VZV infection. PCR of skin lesions is currently test of choice. intranuclear eosinophilic Cowdry A inclusions also seen with HSV-1, HSV-2, VZV. Tzanck heavens | do not have herpes.Cryptosporidium |G DISEASE: Severe Diarrhea in AIDS Mild disease (watery Diarrh in immunocompetent hosts 4 TRANSMISSION: Oocysts in water DIAGNOSIS: Oocysts on acid-fast stain, antigen detection Blastomycosis . Broad-based budding of Blastomyces. (same size as RBC) Coccidioidomycosis a Spherule (much larger than RBC) filled with endospores of CoccidioidesCLINICAL BACTERIOLOGY C perfringens : © Produces a toxin (lecithinase, a phospholipase) that can Y cause myonecrosis (gas gangrene) and hemolysis . C difficile q Q Produces 2 toxins. Toxin A, an enterotoxin, binds to brush border of gut and alters fluld secretion. Toxin B, a cytotoxin, disrupts cytoskeleton via actin depolymerisation. Both toxins lead to Diarrhea > pseudomembranous colitis. uy Corynebacterium diphtheriae " = Symptoms include pseudomembranous pharyngitis — (greyish-white membrane)with lymphadenopathy, myocarditis, and arrhythmias.. Treatments include “CAMPFIRE” drugs: > Carbapenems > Aminoglycosides >» Monobactams > Polymyxins (eg, polymyxin B, colistin) Fluoroquinolones (eg, ciprofloxacin, levofloxacin) > ThiRd- and fourth-generation cephalosporins (eg, ceftazidime, cefepime) > Extended-spectrum penicillins (eg, piperacillin, ticarcillin) Aeruginosa—aerobic. Mucoid polysaccharide capsule may contribute to chronic pneumonia in cystic fibrosis patients due to biofilm formation. Can cause wound infection in burn victims. © Corneal ulcers/keratitis in contact lens wearers/ minor eye trauma. Frequently found in water > hot tub folliculitis. Ecthyma gangrenosum—rapidly progressive, necrotic cutaneous lesion caused by Pseudomonas bacteremia. Typically seen in immunocompromised patients. Escherichia coli « Gram © rod. E coli virulence factors: fimbriae—cystitis and pyelonephritis (P-pili); K capsule—pneumonia, neonatal meningitis; LPS endotoxin—septic shock Invasive; dysentery. Clinical _ manifestations similar to Shigella ETEC Travelers’ diarrhea (watery) EPEC Diarrhea, usually in children (Pediatrics). Dysentery (toxin alone causes necrosis and inflammation). Does not ferment sorbitol (vs other E col). Hemorrhagic, Hamburgers, Hemolytic- uremic syndromev v IgG v Important Incubation _—_Prodrome, Convalescence diagnostic period acute disease Early late tests | HBsAg DNA Anti-HBc palate polymerase concentration - of reactants HBV particles fo ‘HBsAg \ ‘\ Window period Anti-HBs ———_Anti-HBe levelof | ff detection Months after 0 1 2 3 4 5 6 7 8 exposure symptoms SGPT (ALT)Nocardia vs Actinomyces « Both are gram © and form long, branching filaments resembling fungi. Nocardia Actinomyces > Aerobe Anaerobe » Acid fast (weak) Not acid fast > Found in soil Normal oral, reproductive, and GI flora > Causes pulmonary infections in Causes oral/facial abscesses that |mmunocompromised drain through sinus tracts; often (Can mimic TB but with © PPD); associated with dental caries/ Cutaneous infections after trauma —_ extraction; forms yellow In immunocompetent; can spread to “sulfur granules”; can also CNS. Cause PID with IUDs. » Treat with sulfonamides (TMP-SMX) Treat with penicillin Treatment is a Sulfonamides—Nocardia; Actinomyces—Pernicillin Mnemonics: - “SNAP”Epstein-Barr virus (HHV-4 ROUTE OF TRANSMISSION: Respiratory secretions, saliva’ aka “kissing disease. (commen in teens, young aduits) CLINICAL SIGNIFICANCE: Mononucleosis—fever, hepatosplenomegaly, pharyngitis, lymphadenopathy (especially posterior cervical nodes (F). Avoid contact sports until resol risk of spleni¢ rupture. Associated with lymphomas (eg, endemic Burkit lymphoma), naso carcinoma (especially Asian adults), lymphoproliferative disease in transplant patients. NOTES: infects B cells through CD21 Atypical lymphocytes on peripheral blood smear(G)—1 6 cells but reactive cytotoxic T cells. @ Monospot test—heteroprile antibodies detected by agglutination of sheep or horse RECs. Use of amoxicilin in mononucleosis can cause charact maculopapular rash. Cytomegalovirus(HHV-5) ROUTE OF TRANSMISSION: Congenital transfusion, sexual contact, saliva, Uri CLINICAL SIGNIFICANCE: Mononucleosis (© Monospot) in immunocompetent inimmunccompromised, especially pneumonia in tran esophagitis; AIDS retinitis (“sightomegalovirus): h cotton-wool exudates, vision loss. Congenital CMV NOTES: Infected cells have characteristic “owleye” inclusions (H).Latent in mononuclearNaegleria fowleri 2 DISEASE: Rapidly fatal meningoencephalitis 2 TRANSMISSION: Swimming in freshwater lakes (think Nalgene bottle filled with fresh water Containing Neegieria); enters: cribriform plate 2 DIAGNOSIS: Amoebas in spinal fuid Trypanosoma brucei 2 DISEASE: African sleeping sickné ‘enlarged lymph node recurring fever (due to antigenic variation), somnolence, coma Two subspecies: Trypanosoma bruce/ rhodesiense, Trypanosoma brucei gambiense 2 TRANSMISSION: Tsetse fly, a painful bite 2 DIAGNOSIS: Trypomastigote in blood smear Trypanosoma cruzi N DISEASE: Chagas dise: 4 TRANSMISSION: Reduviid bug (“kissing bug”) feces, deposi In a painless bite (much like a kiss) 4 DIAGNOSIS: Trypomastigote in blood smear ~Nocardia vs Actinomyces * Both are gram © and form long, branching filaments resembling fungi. Nocardia Actinomyces > Aerobe Anaerobe > Acid fast (weak) Not acid fast » Found in soil Normal oral, reproductive, and GI flora > Causes pulmonary infections in Causes oral/facial abscesses that Immunocompromised drain through sinus tracts; often (Can mimic TB but with © PPD); —_ associated with dental caries/ Cutaneous infections after trauma —_ extraction; forms yellow In immunocompetent; can spread to “sulfur granules”; can also CNS. Cause PID with IUDs. > Treat with sulfonamides (TMP-SMX) Treat with penicillin Treatment is a Sulfonamides—WNocardia, Actinomyces—Penicillin Mnemonics: - “SNAP”Entamoeba histolytica © DISEASE: Amebiasis © TRANSMISSION: Cysts in water © DIAGNOSIS: Serology and/or trophozoites (with engulfed RBCs in the cytoplasm) or cysts with up to 4 nuclel in stool Giardia lamblia © DISEASE: Giardiasis © TRANSMISSION: Cysts in water © DIAGNOSIS: Multinucleated trophozoites or cysts in stool, antigen detection + 6. Toxoplasma gondii 2 DISEASE: Congenital toxoplasmosis = classic triad of chorioretinitis: hydrocephalus, and intracranial calcifications; reactivation in AIDS > brain abscesses usually seen as multiple ring-enhancing lesions on MRI 2 TRANSMISSION: Cysts in meat (most common); oocysts in cat feces; crosses placenta (pregnant women should avoid cats) 2 DIAGNOSIS: Serology, biopsy (tachyzoite)H.NANA Vs H.DIMINUTA DIPYLIDIUM CANINUM Q Eggs in packets, Proglotted has two common pore, Barrel shaped Proglottid. SCHISTOSOMA HEMATOBIUM Q Schistosoma haematobium egg with terminal spi \IRO 'Y iL Live attenuated vaccines > MMR, > Yellow fever, > Rotavirus, » Influenza (intranasal), > Chickenpox (VZV), > Smallpox, » Sabin polio virus. * Mnemonics: - “Music and LYRICSS are best enjoyed Live.” « MMR =measles, mumps, rubella; live attenuated vaccine that can be given to HIV @ patients who do not show signs of immunodeficiency. * Killed vaccines > Rabies, > Influenza (injected), > Salk Polio, and > HAV vaccines. Killed/inactivated vaccines induce only humoral immunity but are stable. « Salk =Killed. « Mnemonics: - RIP Always. = Subunit * HBV (antigen = HBsAg), HPV (types 6, 11, 16, and 18). RNA viral genomes « All RNA viruses except Reoviridae are ssRNA. * @ stranded RNA viruses: * [went to a retro (retrovirus) toga (togavirus) party, where | drank flavored (flavivirus) Corona (coronavirus) and ate hippie (hepevirus) California (calicivirus) pickles (picornavirus). Viral envelopes * Naked (non-enveloped) viruses include > Papillomavirus, » Adenovirus, > Parvovirus, DNA = PAPP; RNA = CPR and hepevirus » Polyomavirus, > Calicivirus, » Picornavirus, > Reovirus, and » HepevirusFASCIOLA BUSKI Q Operculated eggs in stool Fasciolopsis buski e909 ok 5 Paragonimus Westermanii (Lung Fiuke) Q Operculated eggs in early morning, deeply co! sputum Morphology of Adult Paragonimus westermant operculum Clonorchis Sinensis (Oriental tiver fluk Q Flask shaped operculated egg in stool.MODE OF TRANSMISSION: HIV ®@ Decreasing order of Most Common mode of transmission of HIV in Heterosexual > Homosexual > Parent to child > Injection drug abuse > Blood transfusion > Needle stick exposure. @ Most common mode of transmission of HIV in India:- Heterosexual > Parent to child > Injection drug abuse > Homosexual >Blood transfusion and Needle stick exposure ® Decreasing order of Most common Risk of transmission of HIV:- Blood transfusion > Parent to child > Injection drug abuse > Needle stick exposure > Sexual (Anal) > Vaginal intercourse Reference Book:- WY teareuteas ace Immunology Hg ait)