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com)

Gram + cocci
Organism
Staph aureus

Gram
G+ cocci

ChCh
Catalase +, coagulase +, B heam. ferment manitol, yellow clusters flora in ant. Nares. Catalse +, coagulase -, no heam., novobiocin sens. Catalse +, coagulase -, no heam., novobiocin resis. Catalase -, B heam., pyr +, chains Bacitracin sens.
Subtyped acc. To ptn M cause hyalurunic caps. Is not immunogen.

Virulance
TSST, Exfoliatins(SSS), Cytolysins(pores) , ptn A(antiphag bind to
IgG Fc portion at C Binding site to dec C activation ), enterotoxin, coagulase

Disease
Pdf: IV drug abuse, CGD

TTT
Methicillin MRSA Vancom., fusidic a.
Usually Methicillin resis.

Staph epidermidis Staph saprophyticus Strept Pyogens GAS

G+ cocci G+ cocci G+ cocci

IE, osteomyelitis (mcc except in sickle) , abcess, impetigo,SSS IE (in iv drug abusers usually in
Rt side of i heart)

UTI Hyalurunic a. Capsule, ptn M (antiphag), streptolysin O: heamolysis, immungenic streptolysin S: heamolysis,not imungen Exotoxin A-C: superAg, dec. Liver clearance
of normal flora, fever&rash of scarlet fever Pharyngitis,impetigo,Scarlet fever

RF: (pharyngitis- type II) AGN: (pharyn. Or impetigo by

m12- type III) ASOT > 200 = significant Pdf:present in vaginainfect newborn esp in PROM

B lactams or Erythromycine

Strept Agalaciae GBS Strept Viridans (mutans+sanguis) Not gropable Strept Pneumonia Not gropable

G+ cocci

Catalase -, B heam., camp +, Bacitracin resis. Catalse -, heam., bile resis., optochin resist Biofilm to adher to tooth or damaged Ht valve by making insol. Dextrans from glucose adher to fibrin pltlt aggreg. valve veget. IgA protease teichoic a. pneumolysin O Polysach. Capsule swelling e antisera (Quelling t.) , can be acq. by chrom.l uptake from media e virulent strain

Ampicillin + gentamycine
Intrapartum pen

G+ cocci

Neonatal Meningitis (MCC), IE (after dental work) , Dental caries

Penicillin G + gentamycine
AB befre dental work

G+ cocci

Catalse -, heam., bile sens., optochin sens. D shaped dipplococci

Pneumonia MCC of bact

pneumonia

Meningitis MCC in adults O.M MCC in children

Pdf:asplenia,alcohol,CHF, COPD

Enterococcus fecalis GDS Strept bovis GDS

G+ cocci

Catalse -, var heam., pyr + Grow in 6.5% NaCl (also staph &
vibrio paraheam. Grow in 6.5 NaCl)

IE (after genitourinary procedure) UTI IE (in patient e coloncancer)

Resist vancomycine by
using Dalanyl Dlactate instead of D alanyl D alanin

G+ cocci

Catalse -, var heam. No growth in 6.5% NaCl

Heamolysis:Gamma(none) (partial green heamolysis) (complete) Strept is classified by Lancfield acc to cell wall carbohydrates

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Gram + Rods
Organism
Bacillus Anthracis Bacillus Cereus Listeria

Gram ChCh
G + rods

Virulance
Polypeptide cap immunogenic, antiphago. Anthrax toxin: LF(kill cells)-EF(adenyl
cyclase)- protecting Ag

Disease
Cut. Anthrax Pulm. Anthrax Food poisoning Listeriosis: healtyasymp.
Pregcross placentafetal dis. in utero granulomatosis infantsepticum After birth meningitis In IC meningitis (MCC in IC)

TTT
Ciprofloxacin Doxycycline

Aerobic - Sporing exotoxin - not motile (most other bacilli r motile)

G + rods G + rods

Emetic toxin(rice) Diarrheal toxin(meat) Aerobic - non sporing motile no toxins Intracellular prblm in IC
Cold growth in soft cheese avoid in pregnancy

Listeriolysin O escape pf phagosomes Jet(tumbling) motility move to cytosol of other cells

Ampicillin + gentamycine

Cornybacterium
Diphteria

G + rods

Aerobic non sporing non motile exotoxins -V&L shapeschinese letters Polar metachrom. gran. stain e anilin Loffler serum(S) Tollerete agar(D) Aerobic - Partialy acid fast

Diphteria toxin dec. Ptn synthesis(EF2) Diphteria: psaudomemb. (coded by phage can be transmitted) myocarditis RLN palsy Elik test: to document toxin prod: strip of org.
On paper e antitoxin precipitate line

Erythromycine + antitoxin

Nocardia asteroids Actinomyces israeli Clostridium tetani Clostridium botulinum Clostridium perfringens

G + rods

G + rods G + rods

Anerobic Anerobic sporing exotoxins motile Anerobic sporing exotoxins motile Anerobic sporing exotoxins Not motile(the only clostridia that not motile) Double heamolysis Lecithinas producer: detected by

No virulance By implantation or dust inhalation In IC & cancer patients Invasive growth in tissues e poor O2 supp. Tetanus toxin: tetanospasmin Carried intra axonal to CNSblock GABA releasems spasm Botulinum toxin: heat labile neurotoxin coded
by prophage-absorbed from gut to priph. ns block A.Ch release at NM junc flacid paral.

Nocardiosis: cut abcess Pulm goto brain abcess Actinomycosis: invasive dis.-->
abcesses e sulpher granules.

Cotrimoxazole

Penicillin + drainage
IG + Vaccine Depriment Penicillin or flagyl Diazepam

Tetanus: opisthotonus, risus sardonicus Implant. From soil in wound Botulism: Flaccid paral. e diplopia, dysphagia, resp. Paral. Gas gangrene:wound e soil or feacespain, edema,exudat Food poisoning AB ass. psaudomemb. Colitis
&

G + rods

G + rods

Alph toxin: lecithinase(dmg phospholipids)heamolysis, cytolysis Negler reaction: egg yolk plate e side e antitox.
& side e out toxin activity on side e no antitoxin

Clostridium deficile

G + rods

Enterotoxin watery diarrhea, cramps Anerobicsporingexotoxins-motile Toxin A: enterotoxin dmg mucosa norm colon flora prod dis. only when Toxin B: cytotoxindmg other flora(biomass) lost by AB use. cytoskel. by actin depolymerization.

Depriment & Delayed closure Clindam. + penicilline Hyperbaric ch.

Metronidazole

Diarrhea (penicillin-Cephalosporinclindamycine)

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Wound managment of tetanus:

Not tetanus prone
Linear no dead tissue no contamination e in 6 hours

Tetanus prone
Blunt dead tissue contamination any wound > 6 hs

Not completed 1ry vaccination completed

Vaccine Vaccine if booster < 10 years

Vaccine + TIG Vaccine if < 5 years

Forms of Botulism:
Food borne Aquisition Symptoms Toxin present in Prevention TTT
Preformed toxin ingestion in smoked flish & canned vegetables Weakness, flaccid paral (reversible), NVD

Wound
Traumatic implantation of spores Same e no NVD

Infant
Spores ingested in honey & dust Toxin produced in gut Constipation, flacid paral (reversible), diplopia, dysphagia, resp. Arrest Serum & Stool No honey in 1st year Hyper immune human IG No AB worsen the dis. Resp. Support

Serum & Food Heating all canned food Polyvalent antitoxin No AB because toxin is already performed Resp. support

Serum

Polyvalent antitoxin Amoxicillin Resp. Support

+ Mycobacterium

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Gram Aerobes
Organism
N. meningitidis N. gonorrhea Moraxella cataralis Pseudomonas aerogenosa

Gram ChCh
G - cocci Oxidase + , ferment maltose, kidney diplococci Choclate agar Nasopharynxdroplet infbloodmeninges Oxidase + ,not ferm. maltose, kidney diplococci thyer martin (vancomycin,nystatin,polymixin) Genital tract STD, at birth Diplococci Oxidase + , not ferment on maconkey ,catalase + Pyocyanin blue green pig. blue green pus, grap like odor In water aerosols & raw vegetables

Virulance
Capsule pili Ig A protease endotoxins(lipo-oligosacharide) No capsule pili Ig A protease invade mucosa inflam. B lactamase B lactamase Capsule endotoxin Exotoxin: dec ptn synthesis (EF2) mainly affect liver
(target shaped necrotic lesions e black center)

Disease
Meningitis Water house fridrichson synd:DIC + shock + meningitis Gonorrhea: urithritis, cervicitis, PID OM , bronchopneumonia Healthy: no symp folliculitis Burn ptn: mig. frm gut to burn CGD & asthma: pneumonia Catheter: UTI CF: rec. Pneumonia IC: Ecthyma gangonosum Legionairs dis: Atypical pneum. mental confusion diarrhea Pontiac fever: pneumonitis Wooping cough lifelong immunity 20% of adults e cough e out fever > 2 weeks have pertussis Tick ulceroglandular dis Traumatic imp.: ulcerogland dis Aerosol(skinning rabbits): pneumonia Ingestion: typhoid tuleremia Brucellosis(undulant fever) B. abortus: cattle B. suis: pigs B. meltinesis: goats Diarhea e pus & blood (MCC in US) Self limited to 3:5 days Complic.: GBS guilan bare
Gastritis DU cancer stomach

TTT
Penicillin G - Ceftriaxone

G - cocci

Prev:Vaccine to risk rifampicine to contacts Ceftriaxone + tetracycline (for clamydia)

Prev:Silver nitrate 4 newborn

G - cocci G - rods

Legionelle
pneumophilia

G - rods

Boordetelle pertussis Francesella tuleransis Brucella

G - rods

Req iron & cysteine , CYE media , fac. Intracellular In air conditioning no human to human transmission Strict aerobe , regan lwe or bordet gengu media In human throat

G - rods

Intracellular facult. In wild andimals esp. Rabbits & rodents

Endotoxin intracellular Diag by legionella Ag in urine (diffic. To find bacteria in sputum by gram stain) Adenyl cyclase toxin edema Pertussis toxin: ADP ribosyl. Of Gi lymphocytosis, block immune cells, hypoglycemia Granulomatous response, intracellular

Antipseudomonal pen. 3rd gen cephalosporins Prevention: Disinfic. Of water equip. No flowers or veget. In burn units Fluroquinolon ICerythromycine + rifampicine
Prev:decont. Air conditioning

Erythromycine Prevention: Dtap vaccine7 ys Streptomycine Gloves while butchering rabbits Vaccine 4 high risk Prevention: Vaccine cattle Pasteurize milk Erythromycine Fluroquinolones Omeprazole + amoxicilline+ clarithromycine

G - rods

Intracellular facult. zonotic In domestic animals (by contact or dairy products) Motile curvedflagellaCampy or skirrow media In intestine of humans & poultry feco-oral Can be transmited from domestic animals Motile spiral flagellacampy or skirrow media In humans feco-oral

Endotoxin, intracellular, granulomatous response

Campylobac ter jejuni Helicobacter pylori

G Helical rods G Helical rods

Invade mucosa, law infec. Dose

Urease + amonia neutralize acids Mucinase invade mucus Invade mucousa

Breath test: C131 ureaCO2131 - serology

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Gram Enterobacteriacea
Gram ve rods , facult. Anearobes , catalase +ve , oxidase ve(all other G ve are Oxidase +) , ferment glucose, differ in lactose (determind on macConkey) CEEK ferment (Citrobacter, Ecoli, Enterobacter, Klebsiella colored colony) , SHYPS not ferment (Shigella, Yersenia, Proteus, Salmonella colorless)

Organism
Klebsiella pneumonia Echerichia coli

Lactose Ferm. +ve

ChCh
Large capsule

Reservoir
Human colon, resp. tract

Virulance
Capsule endotoxins

Disease
Pneumonia e abcess & thick

TTT
AB sens. T.

+ve Green colony

All ferment sorbitol except EHEC Reduce nitrate to nitrite Motile capsulated (K1 Ag) B heamolytic EMB "eosin methylin blue agar" blue black colonies metallic sheen

Human colon EHEC: bovine feaces (undercooked beef)

bloody sputum current jelly esp in DM&alcoholic - UTI ETEC: LT:heat labile, stim. Adenyl cyc. Cholera like toxin ST:heat stable, stim. Guanyl cyc Travellers diarrhea EPEC: Infantile diarrhea (2nd MCC after rotaavirus) adher. F. Adher to mucosa blunting of brush border EIEC: invade mucosa Watery diarrhea, fever, WBCs in stool EHEC: VTEC Verotoxin prod. Ecoli No fever, HUS e AB use Verotoxin: shiga like toxin dec. Ptn synth.Not invasive no fever EaggEC: fimbria brick like stocking on epithPersis. Diarrhea, UTI

Rehyd.&cotrimoxazole

Fluroquinolones no AB

-Neonatal meningitis (2nd MCC after GBS) UTI - Cystitis

Shigella Yersenia pestis Yersenia enterocolitica Proteus

-ve

-ve

Not motile , not H2S prod. Resist acid & bile very law infective dose as low as 10 Not motile , not H2S prod. Bipolar stain coagulase +

Human colon only

Invade mucosa (most imp. Pathogen. Fact.) shallow ulcers Shiga toxin: dec ptn synth(inh. 60 S)

Rodent flea bite Resp droplet

-ve -ve Motile e flagella , H2S prod., urease prod. Proteus Ag cross react e ricketsia in weil fleix T. Motile , H2S prod.

Milk&pork (zonotic) Human colon Soil & water Urease alk. Urine staghorn stone

Shigellosis enterocolitis High fever, bloody diarrhea, shallow ulcers Bubonic plague: by Rodent flea bite Pneumonic plague Inh. From inf. Person or emboli from bub. Enterocolitis & pseudo appendicitis UTI e stone formation

cotrimoxazole Rehyd. + AB Tetracyclin + streptomycine + 3 days quarantine Prev.: killed vaccine AB sens. T.

Salmonella typhi

-ve

Human colon only Feco oral from GB carrier

Salmonella typhimurium, enteritidis

-ve

Motile, H2S prod.

Human & domestic animals Raw chicken products

Infec. Begin in ileocecal region reach basal border of M cells st mesentric LN Blood (+ in 1 week) rd GB stoolstool (+ by 3 week) Survive intracel. & when released escape complement by Vi capsule Ag Invade mucosa inflam. diarrhea

Typhoid fever enteric fever D: Widal test.

Ciprofloxacin, Ceftriaxone

Vaccine:3 types Oral attenuated, Parent. Killed,Parent. Polysach. Caps.

Gastroenteritis ( 2 MCC after campylobacter) Osteomyelitis (MCC in sickle dis.

not trait) d.t. defec. monocyte func.

nd

If severe AB sens. T.

Korieshs Extract of Microbiological Arts (Drkoriesh@yahoo.com) Curved Motile, inactivated Human colon Vibrio cholera G-ve
rods by antisera Grow on TCBS and alkaline media (Very sens to gastric acidity infec. dose e omeprazole )

Cholera enterotoxin inc. Adenyl
cyclase inc. CAMP efflux of Cl , H2O
-

Cholera: rice water stool

Contaminate shellfish

Rehyd. + doxycycline Prev: vaccine + doxycyc.

Pasterulla multocida Bacteroides fragilis Heamophilus influenza

G-ve rods G-ve rods G-ve rods Anearobic

Mouth of cats & dogs Predominant colonic bact. Modified LPS endotoxin e reduced activity Polysach. Capsule , Ig A protease Vaccine only against Hib so vaccinated can still get O.M, bronchitis by non capsulated or other strain then B

Cat bite cellulitis Peritonitis , septicemia Meningitis: in unvaccin. Children 3m:2ys (MCC) Epiglottitis (MCC) OM - pneumonia

Emox/Clav. Metronidazole, clindamycine

Ceftriaxone &check throat before discharge if still + rifampicin Prev: Capsul. Vaccine+ rifampicin to contacts

Req factor Nasopharynx X(hemin),V(NAD) not present on blood agar but present on choclate. Grow on blood agar seede e staph aureus w release heamin Ag: O= cell envelop H=flagellum K=capsule Vi=salmonella capsule

Vibrio paraheamolyticus: in undercooked sea foods food poisoning Vibrio vulnificus: in brakish water wound cellulitis ingested GE Bacteroides melaningicus: melanin prod. (black) normal gingival flora Heamophilus ducrei: STD chancroid soft painful chancre do cry of pain Ureaplasma urealyticum : genital flora urethritis req special media rich in urea & cholesterol ttt as Chlamydia by doxyclin or azithromycin

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Spirochetes (spiral e axial endoflagellum poor Gram stain but G-ve)

Organism
Treponema pallidum

ChCh
Not cultured

Reservoir
Human genital t.--> STD Or Cross placenta

Disease
Syphilis: 1ry chancre 2ry macculopap. Rash including palm&sole Condyloma accuminata perianal wart like 3ry Gumma Cong.--> notched tooth, 8th n. Palsy, keratitis

Lab
Dark field or immunoflorscence Non treponemal Ag T.: using cardiolipin of cows Ht Very sens. But not specific, confirm by FTA-ABS VDRL-RPR-ART Treponem Ag T.: specific FTA-ABS: florsc. trepon. Ab abs. t.
TORCH no longer cont. syphilis, you must order separatly

TTT
Benzathine penicillin Jerish Heximer reaction: inc temp, dec BP in 1st day of ttt

Borrelia burgdorferi

Leptospira interrogans

White footed mouseby Lyme dis. : nymph erythema migrans: annular skin White tailed deerby tick lesions Fever, headache, malaise Lamphadenopathy Later meningitis, Bells palsy, myocarditis, pericarditis ,arthritis Terminal In urine&feces of animals Leptospirosis: influenza like dis hook jet skinners-sewe workers hepatitis, RF

Ampilifiacation probe Serodiag. Kelly media

1st Doxycyclin 2nd-> Ceftriaxone Avoid tick bite Vaccine to risky

Dark field microscopy, Serodiag. Fletcher media

Doxycyline&Vaccine of animals & pets

Ricketsia : obligate intracellular, cant make enough ATP, not seen e Gram (too small) but have G-ve wall
Disease
Rocky mountain spotted fever Q Fever Ehrilichosis

Bacterium
Ricketsia ricketsii

Vector Reservoir
Ticks Dogs, rodents, tichs

C.P.
Fever,malaise,ankle&wrist swilling Rash maculopapular then petichal start on wrist&ankle then to trunk Fever e no rash Pneumonia, hepatitis Like rocky mountain e out rash Infect monocytes or granulocytes Cause also Bacillary angiomatosis in IC (red popular skin lesions)

Diag
Symp foll. Tick bite

TTT
Doxycyclin

Weil flix T. Doxycyclin

Vaccine to high risk

Coxiella burnetti Ehrilica

none Ixodes ticks None louse Flea mites

Cattle, sheep, goats

By inhal. Of urine&stool aerosol

Ticks Cats Humans Rodents rodents

Cat scratch disease Bartonella hansele

Epidemic Typhus Endemic Typhus Scrub Typhus

R. prowazekii R. Typhi R. tsutsu gamoshi

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Organism
Dermatophytes Sporotrix schenkii Histoplasma capsulatum no capsule Coccidoids immitis Blastomyces dermatidis Aspergillius fumigatus

ChCh
clusters & short curved hyphea Hyphea e arthroconidia Microsporum woods lamp Env form hyphea e rosttes&sleeves of conidia Tissue form Cigar shaped yeast Env form hyphea e tubercle macroconidi&microconidia Tissie form small intracel. Yeast e no capsule, fac. IC in RES cells (misssesebi & ohaio river valley) Env hyphea e arthrocon. Tissuespherules&endospores (arisona,California,new mixico) After earth quakes Env hyphea e non descript conidia Tissue budding yeast e dbl refractile wall (central America ) Filamentous branching e acute angles

Reservoir Disease
Skin flora Humans & animals On plant material rose thorns Soil e bird or bat feces in cave explorers&chi cken cleaners Desert sand Pityriasis versicolor Fungemia in prematures Tinea capitis, cruris, corporis, barba(beard), pedis, favus Sporotrichosis: rose gardener dis. subcut. Lesion Pulmonary sporotrichosis:alcoholic rose gardener sleeper dis in homeless alcoholics Fungus flavus: self resolving pneumonia e flue like symp + HSM In summer, in kids & new comers Dissim. Mucocut. Lesions & meningitis in AIDS Calcify after healing Valley fever: self resolving pneumonia, dissim. In 3rd trimester of preg. Dissim. Mucocut. Lesions & meningitis in AIDS Calcify after healing Blastomycosis: non self resolving pulm. dis. So ttt even acute cases e ketoconazole Can infect immunocompetent host. Allergic bronchopulm. Aspergillosison mucus Fungus ball(in preformed cavity) surg. Removal to dec. cough & hge Invasive aspergillosis in CGD, CF, burns cellulitis,pneumonia,meningitis Oral thruch esophagitis gastritis septicemia endocarditis vaginitis (pdp f: G+ve bactobacilli in vagina PH dmg normal flora) Meningitis in AIDS, hodgkin Pulm. infec in pigeon breeders Rhinocerebral infec para nasal swelling, hgic exudate from nose& eye Very invasive esp in DKA & Leukemia Pneumonia (in AIDS, premature) Serum leak in alveoli exudate Foamy honey comb appearance cysts in the exudate cause spaces
Trichophytonskin, hair, nail Microsporum skin, hair Epidermophytonskin, nail

TTT
Topical selenium sulphide Topical&systemic imidazoles,Grisof ulvin, Keep dry Itrakonazole

Malassezia furfur Spagetti&meat balls : yeast

KI in milk
Amphotricin B

Amphotricin B

Rotting wood

Ketoconazole

Moldy marijuana Pits

AMB or itrakonazole

Candida albicans Cryptococcus neoformans Mucur

Rhizopus, absidia

Env yeast Tissue hyphea&pseudohyphea Serum budding yeast Encapsulated yeast: Detect capsule Ag by latex India inkbudding yeast e caps halo Broad non septate hypha e 90 branches Silver stained cysts in tissue Oblig. Extracellular

Topical imidazole,

Soil e pigeon
dripings

nystatin DesimAMB AMB + 5FU till afebrile then fluconazole Debride necrotic tissue AMB Cotrimoxazole

Soil

Pneumocystitis carinii