Microbiology Concept Maps

Grace Huang (MS3)

Dr. Cannella did an amazing job of synthesizing what we covered in the microbiology lectures into
systematic charts, emphasizing the high-yield facts. Sadly, he left UCSD after my year, but, with the
help of the wonderful Dr. Sharon Reed, Dr. Sanjay Mehta, and Dr. David Pride, I have complied
microbiology charts based on Dr. Cannella’s charts and the information covered in lecture. The
maps are designed with MindMaple software and are fully editable with the free software
download. The lectures cover a great deal of information, so I hope these charts will help you better
sort each microbe in a systematic way.
ISP Chair: Dr. Sharon Reed
ISP Committee Members: Dr. Sanjay Mehta & Dr. David Pride

1. Download + install MindMaple Lite (free

software):
http://www.mindmaple.com/Downloads/Windows/

2. Open Micro Concept Maps file.

3. Toggle between the different maps using the tabs at the bottom of the
screen.
4. Two categories of maps:
a. Frame: outline of complete map
b. Comprehensive maps: usually focused on a subset of a particular group

5. Branches can be hidden by clicking on (-) or revealed with (+).

 Gram Positive

Bacilli
Cocci

Catalase + Catalase -
division 90 division 180
Clusters Chains Aerobe Obligate Anaerobe

Staphylococcus Streptococcus
Spores No spores

Coagulase + Coagulase - Clostridium Actinomyces

Corynebacterim Spores Nocardia israeli
Listeria
Obligate Diphtheriae Asteroides
monocytogenes
Anaerobes Non-motile Motile
Staph aureus Staph epidermidis Bacillus

Peptostreptococcus
Non-motile Motile C. perfringes C. difficile C. botulinum C. tetanus
Peptococcus
methicillin methicillin
resistant sensitive
hemolysis hemolysis Non hemolytic Bacillus
Bacillus
anthracis cereus

MRSA MSSA Strep Strep Enterococcus Strep Bovis

inhibited by growth on pyogenes agalactiae faecalis
Optichin optichin

Enterococcus
faecium
Strep Viridans
pneumoniae streptococci
 Gram Positive

Bacilli
Cocci

Catalase + Catalase -
division 90 division 180
Clusters Chains

Staphylococcus Streptococcus

Coagulase + Coagulase -

Staph aureus Staph epidermidis

hemolysis hemolysis Non-hemolytic Obligate

Anaerobes
General: General:
commonly colonizes the nose normal skin flora
causes a broad range of diseases: can migrate in through foley Strep Strep Enterococcus Strep Bovis
-exotoxin mediated disease catheters or IV lines pyogenes agalactiae faecalis & Peptostreptococcus
-direct organ invasion: skin infections, Novobiocin sensitive faecium Peptococcus
inhibited by growth on
pneumonia, endocarditis, septic arthritis,
Optochin Optochin General:
osteomyelitis
General: General: normal gut flora
Pathophysiology: Group A Strep Group B strep General: grow well in bile General:
polysaccaride capsule allows pus-producing 25% of women carry S.agalactiae normal gut flora can cause subacute endocarditis part of normal flora in mouth, vagina,
Pathophysiology: adherence to many surfaces vaginally, so babies can acquire grow well in bile and 6.5% NaCl associated with colon cancer and intestine
produces biofilms > able to bind to during delivery common nosocomial infection mixed with other anaerobes in
Many virulence factors: prosthetic devices + protect from common cause of meningitis in lots of drug resistance (vancomycin) abscesses
Strep Viridans Pathophysiology:
Penicillinase: breaks down penicillin > attack infants <3 months seen in aspiration pneumonia
pneumoniae streptococci
penicillin-resistance
Many virulence factors:
Protein A - binds to Fc portion of IgG, preventing
M protein - inhibits complement activation and prevents Pathophysiology:
opsonization and phagocytosis Presentation: phagocytosis, but antibodies form against M protein which Pathophysiology:
Coagulase - activates prothrombin > fibrin clot General: General: In hospitalized patients, commonly cause
bacteremia can then cause rheumatic fever babies infected during delivery
around bacteria protects it from phagocytosis lancet-shaped diplococci part of normal GI tract flora UTI, biliary tract infections, subacute
sepsis Streptolysin O - destroys RBC and WBC, ASO antibodies > meningitis
Hyaluronidase & proteases: enables it to tunnel encapsulated often live in nasopharynx and endocarditis (post surgery)
develop against antigen
through tissue IgA protease gingival crevices
Pyrogenic exotoxin - found in a few strains of group A strep,
Vancomycin Resistant Enterococcus (VRE):
Diagnosis: cause scarlet fever and strep toxic shock syndrome Chromosomal transposon vanA that changes
Exotoxins: major cause of bacterial Presentation:
Exfoliatin Toxin A & B: diffusible toxin that cleaves Gram stain: gram (+) cocci in clusters pneumonia, meningitis, otitis Non-specific signs in neonates peptidoglycan cell wall from D-ala-D-ala to
Pathophysiology: Delayed antibody-mediated response:
the middle epidermis > scalded skin syndrome coagulase (-) media, and sinusitis in adults fever, vomiting, poor feeding, irritability D-ala-D-lactate
Bind to teeth leading to dental infections antibodies that form against M protein during pharyngitis
Toxic Shock Syndrome Toxin (TSST-1): > low affinity for vancomycin
infection cross react with antigens on the heart > damage the > very difficult to treat
superantigen that binds to MHC II and T cell Subacute Bacterial Endocarditis heart, especially the mitral valve
receptors > TNF and IL-1 stimulation > massive Treatment: Pathophysiology: > dental manipulation sends showers of antibodies formed against pharynx or skin infection > strep Diagnosis:
immune response Vancomycin (if significant infection) Polysaccharide capsule protects organism into bloodstream antigen planted on glomerular basement membrane > Lumbar puncture
Enterotoxins: preformed, heat-stable toxin in against phagocytosis > implant on previously damaged heart antibodies bind to GBM > activation of complement > acute Presentation:
contaminated food that stimulates peristalsis of Asplenic patients particularly valve (rheumatic fever) post-streptococcal glomerulonephritis Depends on type of infection
intestine > gastroenteritis susceptible to sepsis > produce a dextran that allows them to
Tx/Prevention:
cling to valve
Screen pregnant women at 35-37
>subacute bacterial endocarditis
Presentation: weeks and treat GBS+ women with Diagnosis:
Presentation: Presentation: Diseases caused by local invasion/exotoxin penicillin Culture
Gastroenteritis Meningitis - nuchal rigidity, fevers, nausea Streptococcal pharyngitis (Strep throat):
-2-6 hour incubation time before symptoms Presentation: red swollen tonsils and pharynx
-non-bloody diarrhea and vomiting Pneumococcal pneumonia - sudden onset of Subacute bacterial endocarditis: fever, swollen lymph nodes Tx/Prevention:
shaking chills, high fevers, chest pain, SOB. low grade fevers, heart murmurs,
Scalded skin syndrome: Ampicillin or Vancomycin if sensitive
Consolidation made of WBCs, bacteria, and anemia, fatigue Streptococcal skin infection
-fine sheets of skin peeling off revealing moist Daptomycin/linezolid for VRE
exudate. Cough up yellow-green phlegm erysipelas - infection of upper dermis
red skin underneath
cellulitus - infection of dermis and subQ fat
-often seen in neonates or older children w/ Otitis media - middle ear infection in children impetigo - vesicular, blistered eruption around mouth
skin infections
Necrotizing fasciitis - spreads between subcutaneous
tissue and muscle > bullae, skin death, and myositis
Toxic Shock Syndrome:
-fever, rash, vomiting, desquamation, shock Diagnosis:
Optochin (P disc) sensitivity helps Scarlet fever
-end organ damage (ARDS or acute renal
differentiate S. pneumo from pyrogenic toxin produces fever and scarlet-red rash
failure)
Viridans strep rash starts axially and spreads to extremities, sparing
-associated with prolonged tampon use
the face

Streptococcal toxic shock syndrome

Diagnosis: Tx/Prevention:
similar to toxic shock caused by Staph aureus
produce golden pigment on sheep blood agar Pneumococcal vaccine
gram stain: gram (+) cocci in clusters Penicillins (depends on resistance
Delayed antibody mediated diseases
pattern and type of infection
Rheumatic fever
To distinguish from Strep: Occurs after untreated streptococcal pharyngitis
Wire loop test: check for catalase Fever, myocarditis, migratory arthritis, Sydenham's
chorea, subcutaneous nodules, erythema marginatum
To distinguish from other Staph species: can lead to long-term damage to heart valves +
Coagulase (+) murmurs

Acute post-streptococcal glomerulonephritis

Tx: coca-cola urine (hematuria)
periorbital edema (fluid retention)
high blood pressure
methicillin methicillin
resistant sensitive
Diagnosis:
Throat swab for Rapid Strep and/or culture
Serum ASO titers for chronic infection
MRSA MSSA

Tx/Prevention:
Resistant to methicillin and nafcillin Cephazolin or Oxacillin Penicillin G
acquired by mecA DNA segment
which encodes penicillin binding
protein, confering resistance against
penicillinase-resistant penicillins and
cephalosporins
treat with Vancomycin
 Gram Positive

Bacilli
Cocci

Aerobe Obligate Anaerobe

No spores
Spores

Listeria Corynebacterim Spores Nocardia

monocytogenes Diphtheriae Asteroides

General: General: Actinomyces

General: Bacillus long, branching bacteria Clostridium israeli
flagellated, tumbling motility Causes diphtheria
facultative intracellular (hides inside Acid fast (weak)
colonizes the pharynx then inhaled and grows in the lungs
cells to evade immune system) produces exotoxins
from unpasteurized dairy products > pulmonary infection
causes lung + brain abscesses General:
and cold deli meats filamentous, branching bacteria
pregnant women should avoid dairy and cavitations
Non-motile Motile normal oral flora
products/deli meats because listeria Pathophysiology:
not acid fast
can infect the baby > neonatal forms grayish pseudomembrane in pharynx Non-motile Motile causes oral/facial abscesses
meningitis Tx: produce yellow colonies called
Diphtheria toxin: TMP-SMX sulfur granules
-B subunit: binds to heart and neural tissue
-A subunit: ADP ribosylates elongation factor Bacillus Bacillus
Tx: (EF2), inhibiting tranlsation of human mRNA anthracis cereus
Ampicillin into proteins Tx:
Penicillin G

General:
Presentation: C. perfingens C. difficile C. botulinum C. tetanus
General: commonly seen in reheated fried rice
myocarditis causes anthrax (cutaneous preformed exo-toxin causes food
pseudomembranous and respiratory form) poisoning
pharyngitis (gray-white only bacterium with watery, nonbloody diarrhea General: General: General:
General:
membrane) polypeptide capsule no antibiotic treatment (since just often seen in soldiers wounded in battle produces heat-labile neurotoxin > blocks classically from rusty nail puncture wound
infection follows the use of broad
neural symptoms pre-formed toxin) spores are found in soil the release of ACh from presynaptic
spectrum antibiotics
produces gas as it matures nerve terminals > flaccid muscle paralysis Tetanospasmin:
produces many types of exotoxins -exotoxin that is transported to the CNS
Tx:
Diagnosis: Infant botulism: infants ingest food -inhibits release of inhibitory
Ciprofloxacin Pathophysiology:
forms black colonies on tellurite agar (typically honey) with C. botulinum spores neurotransmitters (GABA, glycine)
antibiotics wipe out normal intestinal flora,
Pathophysiology: > floppy baby syndrome -allows upper motor neurons to send high
allowing C.diff superinfection
enters body through wounds Adult botulism: ingest preformed toxin frequency impulses to muscle cells
Prevention: from improperly canned foods > -causes tetany (sustained contraction),
Exotoxins:
toxoid vaccine (DPT) toxin: lecithinase descending paralysis lockjaw, risus sardonicus
-Exotoxin A: binds to brush border of cut > diarrhea
-most lethal exotoxin -Exotoxin B: cytotoxin that kills colonic cells
-phospholipase that hydrozlyes Tetanus vaccine (part of DPT)
-together they cause pseudomembranous colitis
lecithin in cell membranes
-causes cell death > gas gangrene
Presentation:
patient that develops diarrhea within a month of
Presentation: being on antibiotics
Gas gangrene
pockets of gas within muscle and Pseudomembranous colitis:
subcutaneous tissue - severe diarrhea, abdominal cramping, fever
thick blackish fluid exudes from skin - blood and mucous can be present in stools
- red inflamed mucosa and areas of white exudate
on large intestine (colonoscopy)
Diagnosis:
Gram stain (many bacilli with few PMNS)
Culture on blood agar with double zone of Diagnosis:
hemolysis PCR testing for toxin A and B genes

Tx/Prevention: Tx/Prevention:
Surgical debridement and discontinuing antibiotic
High dose penicillin Metronidazole
oral Vancomycin
 Gram negative

Bipolar rod Coccobacilli Cocci Pseudomonad Comma-shaped

Neisseria Pseudomonas Vibrio cholera Campylobacter

Enterobactericea

Respiratory Anaerobic
Lactose Non-lactose
no capsule encapsulated
fermenter fermenter
Small coccobacilli Fusiform
Legionella Haemophilus Moraxella Bordatella
Motile Non-motile Non-motile Motile
influenzae pertussis N. gonorrhea N. meningitidis
Fastidious Fusobacterium
Bacteroides

Citrobacter E. Coli Enterobacter Klebsiella Shigella Yersinia Proteus Salmonella

pneumoniae dysenteriae Pestis Mirabalis Facultative Obligatory
intracellular intracellular

Salmonella typhi Salmonella

Enteritica
Brucella Bartonella Chlamydia Rickettsiae
trachomatis

B. henselae B. quitana R. rickettsiae R. typhi Coxiella

burnettil
 Gram negative

Bipolar rod Coccobacilli Cocci Pseudomonad Comma-shaped

Enterobactericea

Lactose Non-lactose
fermenter fermenter

Motile Non-motile Non-motile Motile

Citrobacter E. Coli Enterobacter Klebsiella Shigella Yersinia Proteus Salmonella

pneumoniae dysenteriae Pestis Mirabalis

General:
Salmonella typhi Salmonella
Normal intestinal flora General: General: Cause of bubonic plague
General: Enteritica
Flagellated Encapsulated Not part of normal intestinal flora only non-motile Yersinia
Highly motile, Urease +
Most common cause of UTI Normal intestinal flora No flagella
Common cause of UTI
Severity of disease determined Urease + Transmission: fecal-oral, eating
and nosocomial infections General:
by which virulence factors E.coli Disease commonly seen in raw food General:
has acquired from plasmids alcoholics and diabetics Not part of normal intestinal flora Not part of normal intestnal flora
Transmission: fecal-oral Encapsulated Non-lactose fermenter
Pathophysiology: Small amt H2S production Encapsulated
Pathophysiology:
Urease +: able to break down Only carried by humans H2S production
Pathophysiology: urea into NH3 and CO2 Transmission: fecal-oral
Pathophysiology: Bacteria gets into respiratory (similar to EIEC) Lives in the GI tracts of animals
> can live in urinary tract Transmission: eating chicken and
tract from vomiting invade intestinal epithelial cells
ETEC: Severe pneumonia that destroys release Shiga toxin uncooked eggs, pet turtles (animals
pili - helps bind to intestinal epithelium lung tissue > intestinal cell destruction Pathophysiology: with cloacas b/c eggs are covered
Enterotoxins LT and ST - inhibit the Characterized by bloody sputum > inflammatory response Presentation: Invades intestinal epithelial cells with fecal bacteria)
reabsorption of Na+ and Cl- and stimulate > diarrhea results because inflamed Alkaline urine >travels to regional lymph nodes
secretion of Cl- and HCO3- into intestinal lumen colon unable to reabsorb fluids UTI symptoms >seeds in multiple organs by living
> water follows osmotic pull > severe watery intracellularly once phagocytosed by m
Pathophysiology:
diarrhea Presentation:
Chronic carriers harbor S.typhi in their endotoxin similar to cholera toxin
red current jelly sputum Diagnosis:
Presentation: gallbladder causes watery or bloody diarrhea
EHEC: Strain O157:H7 Swarming on agar and inflammation
fever, abdominal pain
pili - helps bind to intestinal epithelium can disseminate throughout body
dysentery with pus (WBCs) Sickle cell anemia patients with
Shiga-like toxin - inhibit 60S ribosome > no Diagnosis: colonoscopy shows shallow ulcers autosplenectomy are particularly prone to
protein synthesis > intestinal epithelial cell death Culture where cells have sloughed off Tx/Prevention: Salmonella osteomyelitis
> hemorrhagic diarrhea
> vascular damage caused by shiga-like toxin P. mirabilis (not vulgaris) Presentation:
associated with Hemolytic uremic syndrome sensitive to Ampicillin Gastroenteritis: nausea, abdominal
(HUS) Tx/Prevention: pain, fever, bloody/watery diarrhea
Diagnosis: Presentation:
3rd generation cephalosporins
Stool culture eating at restaurants where cooks do not
EIEC: wash hands after going to the bathroom
virulence factor > invasion of epithelial cells Typhoid fever: fever, abdominal pain (can be Diagnosis:
Shiga-like toxin released over terminal ileum mimicking appendicitis), Stool, blood, or urine culture
Tx/Prevention:
generates inflammatory reaction in host and diarrhea, and rose spots on abdomen
Avoid raw fruits and vegetables
necrosis > bloody diarrhea with WBCs
in developing countries
Tx/Prevention:
Diagnosis: Only fluid and electrolytes
Presentation: Stool, blood, or urine culture *antibiotics cause prolonged
bacterial shedding in the stool
ETEC:
people traveling in underdeveloped
Tx/Prevention:
countries drinking contaminated water
Vaccine (live-attenuated)
traveler's diarrhea = severe watery
prior to travel
diarrhea, rice water stool

EHEC:
eating infected hamburger meat
dysentery (bloody diarrhea), severe
abdominal cramps
HUS: anemia, thrombocytopenia,
renal failure

EIEC:
fever
dysentery with pus (WBCs)

Diagnosis:
EMB agar - green sheen
MacConkey agar - pink/purple

Tx/Prevention:
Only treat invasive disease with
Cipro or Cephalosporins
Prevention: avoid raw food

Legionella
General
aerobic
facultative intracellular bacteria
lives in moist environments - water
parks, air conditioning, mist machines in
supermarkets
Famous for causing pneumonia
outbreak at American Legion convention
Transmission: inhaling water droplets
Pathophysiology:
Once inhaled, settles in lower
respiratory tract
> alveolar m phagocytose
> survives inside m by inhibiting
phagocyte-lysosome fusion
> produce toxins that cause
respiratory disease
Presentation:
Pontiac fever - flu-like illness with
headache, muscle aches, fatigue,
fever chills
Legionnaires' disease - severe
pneumonia, high fevers,
diarrhea/abdominal pain
Diagnosis:
Culture on charcoal yeast
extract medium
urinary antigen
Does not gram stain well
Tx/Prevention:
antibiotic must be
concentrated inside m
atypical coverage -
azithromycin, levofloxacin
Gram negative
Bipolar rod Coccobacilli Cocci Pseudomonad Comma-shaped
Respiratory Fastidious Anaerobic
Facultative Obligatory Fusiform
Small coccobacilli
intracellular intracellular
Haemophilus Moraxella Bordatella
influenzae pertussis
Bartonella Bacteroides Fusobacterium
Brucella Chlamydia Rickettsiae
trachomatis
General: General: General:
Transmission: respiratory route part of normal Many virulence factors General:
General: B. henselae B. quitana R. rickettsiae R. typhi Coxiella General:
respiratory flora and exotoxins Anaerobic
commonly seen in meat-packing burnettil obligate anaerobe
Most virulent strains are encapsulated Cause pneumonia in Transmission: General: Found in oral cavity
industry, farmer, or traveler makes up majority of flora in
-Typed (a, b, c, d, e, f) by capsule patients with lung disease aerosolized form need host ATP to grow
consuming dairy products not in the US intestinal tract
-Type b most invasive General: General: unable to culture on nonliving media General: General:
undulant fever: peaks at night and also lives in mouth and vagina
HIV patients are susceptible Trench fever no peptidoglycan layer small, intracellular organism cause Endemic Typhus General:
Requires blood medium to grow normal in the morning Pathophysiology:
Pathophysiology: -first seen in WWI -lactams cannot target) require ATP to grow -fever, headache Does not live in arthropod vector
-uses NAD+ (V factor) in blood for Causes peridontal
Pertussis toxin inhibits Gi protein Transmission: -five day intervals between very small, ~size of large viruses require arthropod vector -maculopapular rash that forms endospore that allows it to survive
metabolic activity Diagnosis: Pathophysiology: disease and aspiration
cAMP > impaired phagocytosis Cat bite or scratch febrile episodes primarily infects eyes and genitals dogs are reservoir starts centrally and spreads outside host
-uses hematin (X factor) for cytochrome small Gram neg coccobacillus, culture causes abscesses in pneumonia
found into southeastern US, Appalachian out, sparing palms and soles does not have arthropod transmission
system (in BSL3) Transmission: Louse -Tennessee, North/South Carolina, Oklahoma peritoneal cavity if there is a
Transmission: Grows in large, domesticated mammals Dental abscess in
Transmission: Tick bite rodents are reservoir penetrating wound of the GI tract
Presentation: Pathophysiology: sexual contact Spores aerosolized > cause human disease diabetic, alcoholic, or
Transmission: Tranmission: Flea bite can lead to septic shock
W hooping cough - bursts of non Infects regional lymph node but usually vaginal delivery Q-fever - abrupt onset of fever, soaking immunocompromised
Unpasteurized dairy
Pathophysiology: productive cough followed by inspiratory resolves within a few days Tx: transfer of eye secretions sweats with pneumonia patient
Direct contact with infected animal
gasps through narrowed epiglottis. meat Doxycycline Pathophysiology:
Meningitis (children) HIV patients - causes bacteremia, Tick bite transmits R. Rickettsiae Tx: Presentation:
Patients can become hypoxemic during very infectious in laboratory
inhaled > invades local lymph nodes > endocarditis, bacillary angiomatosis > proliferate in the endothelial lining of Doxycycline patient with bowel rupture
attacks and vomiting often follows Tx: Presentation:
blood stream > infects meninges Cough can last for a few months. (proliferation of small blood vessels in the Pathophysiology: capillaries Doxycycline Bad breath
> if treated with antibiotics, bacterial lysis skin and other organs) > hemorrhages and thrombi > Rocky
leads to release of LPS lipid A (endotoxin) > Life cycle: Mountain Spotted Fever Tx/Prevention:
violent immune responses that destroys 1. Elementary body - inert, infectious particle that Metronidazole
neurons Diagnosis: can enter into cell Tx:
PCR most sensitive Presentation:
2. Reticulate body - inside host cell Clindamycin
Culture on Bordet-Gengou medium Cat-scratch disease: Presentation:
Epiglottitis (children) -inhibits phagosome-lysosome fusion
(potato, blood, and glycerol) Enlarged lymph node Rocky Mountain Spotted Fever:
cause rapid swelling of the epiglottis > -host cell releases elementary bodies to infect
Low-grade fever, malaise fever, severe headache, rash,
obstruction of the airways more cells
conjunctival redness
Pneumonia Rash typically starts at wrist, ankles,
Tx/Prevention: Pelvic Inflammatory Disease:
Patients with viral influenza infection or Diagnosis: soles, and palms and then spreads to
Pertussis vaccine (DTaP): travels upward from urethra > cervix
preexisting lung disease susceptible to Serology/PCR trunk
acellular vaccine if spreads to uterus, fallopian tubes, and ovaries
getting H. flu pneumonia Tx: macrolides > pelvic inflammatory disease (PID) + fallopian
tube scarring
Upper Respiratory Infection Tx/Prevention: can spread to liver capsule > Fitz-Hugh-Curtis Diagnosis:
Nonencapsulated (nontypeable) strains Doxycycline Syndrome Serology, PCR
colonize ears and upper respiratory tract >
otitis media, bronchitis Lymphogranuloma Venereum:
ulcers on the genitals followed by migration to Tx/Prevention:
lymph nodes Early removal of tick
Presentation: Doxycycline
Epiglottis: stridor, excessive saliva, Conjunctivitis:
cherry red epiglottis, + thumb sign infection of the eyes
on xray
Reiter's Syndrome:
Meningitis: fever, vomiting, altered infection of large joints
mental status
Otitis media: ear pain, bulging Presentation:
tympanic membrane Nongonococcal urethritis - asymptomatic,
dysuria, mucoid discharge from urethra
Cervicitis - inflamed, red cervix with yellow
Diagnosis: mucopurulent discharge, dyspareunia
Culture on chocolate agar PID - uterine bleeding, lower abdominal pain,
-Factor V (NAD+) cervical motion tenderness
-Factor X (hematin) -infertility, risk for ectopic pregancy
Fitz-Hugh-Curtis Syndrome - right upper
quadrant pain
Lymphogranuloma Venereum - painless
Tx/Prevention:
papule on genitals that heals spontaneously,
Hib capsule vaccine
enlarging region lymph nodes that are tender and
-conjugated to diphtheria toxoid
can break open
Conjunctivitis - discharge, blindness
Reiter's Syndrom e - arthritis of large joints,
commonly seen in young men
Diagnosis:
gram stain - reveals neutrophils
but does not take up gram
PCR endocervical swab or urine
Tx/Prevention:
doxycycline
azithromycin
 Gram negative

Bipolar rod Coccobacilli Cocci Pseudomonad Comma-shaped

Neisseria Pseudomonas Vibrio cholera Campylobacter

General: General: General:

no capsule encapsulated highly resistant to antimicrobials Single, polar flagellum Single polar flagellum
extremely important nosocomial pathogen
obligate aerobe Transmission: Transmission:
motile Fecal-oral: fecally Fecal-oral
non-lactose fermenting contaminated water Consuming unpasteurized
N. gonorrhea N. meningitidis likes aqueous environments milk, poultry, meat
Reservoir in wild and
Pathophysiology: domestic animal
General: General: Pathophysiology: (similar to ETEC)
diplococci diplococci Can infect many different areas of the body: Cholera enterotoxin enters
non-encapsulated usually lives asymptomatically in ear, lung, bones, urinary tract, skin wounds, intestinal epithelial cells Pathophysiology:
grows best on GC agar nasopharynx heart valves > activates Gs protein Invades lining of small intestine
Risk factors: High risk groups - college Exotoxin A - stops protein synthesis cAMP production and spreads systemically
-unprotected sex freshmen, army recruits, infants Forms biofilms - prevents phagocytosis, > active secretion of Na+ and Cl-
-IUD only typable strains cause antibodies, and complement > fluid, HCO3-, K+ lost with
invasive disease: A, B, C, W X, Y osmotic pull of NaCl Presentation:
Transmission: Transmission: respiratory
Fever and bloody diarrhea.
sexual contact secretions
Presentation: May precede Guillain-Barre
delivery
Sweet, grape-like scent Presentation: syndrome or reactive arthritis
rice water diarrhea
Pathophysiology: Depending on where patient is infected: volume depleted from
Pathophysiology: Endotoxin (LPS) - cause hemorrhage of Pneumonia severe dehydration: Diagnosis:
varies genes coding for pili to evade blood vessels, especially on the skin Sepsis diminished pulses, sunken Stool culture
antibodies and vaccines > classic petechial rash + damage to Otitis Externa eyes, poor skin turgor
adrenal glands Endocarditis
Urethritis: > sepsis (meningococcemia) can lead to UTI + pyelonephritis
In men - penetrates mucous membranes of systemic symptoms Osteomyelitis Tx/Prevention:
Diagnosis: Macrolides
urethra Infected burn-wound Culture of stool
IgA1 protease - cleaves IgA (so need
Pelvic Inflammatory Disease: complement MAC to kill)
In women - urethritis usually asymptomatic
with little discharge Diagnosis: Tx/Prevention:
infects cervix and can lead to pelvic Gram stain and culture Fluids and electrolytes
Presentation:
inflamm atory disease (PID) Meningitis - fever, vomiting, irritability,
-PID = infection of uterus, fallopian tubes, lethargy, nuchal rigidity
and/or ovaries Tx/Prevention:
menstruation allows infection to spread from Ciprofloxacin, Ceftazidime, Cefipime
Meningococcemia - abrupt onset of
cervix to upper genital tract fevers, chills, arthralgias, muscle pains,
can infect the capsule that surrounds the petechial rash
liver (Fitz-Hugh-Curtis Syndrome)
W aterhouse-Friderichsen syndrome
Conjunctivitis: -septic shock due to meningococcemia,
In infants - eye infection when transmitted -bleeding into adrenal glands > adrenal
during delivery insufficiency
-hypotension + tachycardia

Presentation:
In men - dysuria, purulent urethral discharge, or Diagnosis:
asymptomatic Gram stain
Culture on chocolate agar
In women - usually asymptomatic CSF analysis
-Cervicitis - lower abdominal discomfort, dyspareunia,
purulent vaginal discharge
-PID - fever, abnormal menstrual bleeding, cervical Tx/Prevention:
motion tenderness, infertility, risk of ectopic pregnancy Vaccination
-Fitz-Hugh-Curtis syndrome - right upper quadrant pain Ceftiaxone or penicillin G

In infants - purulent discharge, conjunctivitis/blindness

Diagnosis:
Gram stain discharge (men)
culture on GC agar
PCR urine, throat, rectum

Tx/Prevention:
Ceftriaxone + azithromycin (for
possible chlamydial coinfection)
For infants - erythromycin eye drops
 Mycobacterium
Acid Fast

Cording Non-cording

Mycobacterium Tuberculosis (MTB) Non-TB Mycobacterium (NTB)

Subtypes Rapid growing Soil Water Avium species Armadillos

M. bovis M. africanis M. hominis M. fortuitum M. kansasii M. marinum MAC M. leprae

M. chelonae
M. abscessus
 Mycobacterium
Acid Fast

Cording Non-cording

Mycobacterium Tuberculosis (MTB) Non-TB Mycobacterium (NTB)

General: M. bovis M. africanis M. hominis

high lipid content in cell wall > acid fast, Rapid growing Soil Water Avium species Armadillos
difficult for antibiotics to penetrate
mycolic acid in cell wall
Ingestion of unpasterurized from Africa Ubiquitous, but cases are rare
obligate aerobe
milk causing infection of GI tract worse resistance patterns worse resistance patterns
facultative intracellular M. fortuitum M. kansasii M. marinum MAC M. leprae
need T cell immunity to fight pathogen Infects wild animals: bison, elk, M. chelonae
Transmission: inhalation moose M. abscessus
pyrazinamide resistant
Similar presentation to MTB, Exposure to General: General:
often are confused with one contaminated sea water common opportunistic Causes leprosy
Pathophysiology: Outbreak from another -aquarium owner infection in AIDS patient
Mycoside virulence factors: pedicures, tattoos -angler (CD4 < 100)
Cord factor - inhibits m maturation
sulfatides - inhibit phagosme-lysosome fusion
Presentation:
Acute phase: fever, weight loss, diarrhea,
1. Inhaled into lungs and causes local inflammation, malaise, ALP
usually in lower lobes
2. Phagocytosed and multiply in m
3. Can either cause systemic disease (Primary TB)
Diagnosis:
or gets walled off in caseous granuloma and
Blood culture
remain dormant in m
4. Primary TB can spread to lungs, kidney, bones,
CNS, liver, etc.
Tx/Prevention:
Chronic phase (secondary TB): Azithromycin for prophylaxis
1. If MTB dormant, can reactivate later in host
2. Lungs - infection reccurs in upper lobes (highest
O2) > caseation and cavitation

Presentation:
Fever, night sweats, weight loss,
hemoptysis, swollen cervical lymph nodes

Pott's disease - destruction of

intervertebral discs + vertebral bodies
CNS involvement - meningitis,
granulomas in brain
Miliary TB - tiny millet-seed granulomas
disseminated all over the body

Diagnoses:
PPD skin test or
gamma-interferon release assay
(blood test) - indicates exposure
Chest x-ray
Sputum acid fast stain
Culture - faster growth (7 days) than
solid media; PCR most sensitive

Tx/Prevention:
BCG vaccine (not used in US)
-only prevents TB meningitis

For active infection (RIPE):

Rifampin
Isoniazid
Pyrazinamide
Ethambutol
 Miscellaneous bacterium

Mycoplasma pneumoniae Spirochetes

Trepenema pallidum Leptospira Borrelia burgdorferi

 Miscellaneous bacterium

Mycoplasma pneumoniae Spirochetes

gram negative
corkscrew movements
axial flagella
General:
tiniest free living organism
lack peptidoglycan wall (cannot use -lactams)
cell membrane contains cholesterol Trepenema pallidum Leptospira Borrelia burgdorferi
Transmission: inhalation

General: General: General:

Pathophysiology:
After inhalation > attaches to
respiratory epithelial cells
> 2-3 week incubation period > walking
pneumonia
patients can develop cold agglutinins
(monoclonal IgM that bind to RBC
causing them to agglutinate at 4 C)
Presentation:
Walking pneumonia: fever, sore
throat, malaise, persistent dry
hacking cough
Diagnosis:
Cold agglutinin test - cool
sample of patient's blood and
check for agglutination
Tx/Prevention:
Doxycycline
causes syphilis
cannot be grown in laboratory
Transmission: skin contact
Pathophysiology:
Penetrates intact mucous membranes
by burrowing through tissue
> kills nerves so painless lesion
> can then move systemically
>infection occurs in 3 phases
syphilis: initial infection
syphilis: systemic spread
syphilis: slow inflammatory damage
to multiple organs
-damage vasa vasorum (arteries
supplying the heart)
-damage posterior columns and dorsal
roots of spinal cord
-damage nerve cells of the brain >
psychiatric symptoms
-rapid progression to 3 syphilis in 6
months with HIV
found in the urine of animals
Transmission: fresh water contamined
with animal urine coming in contact with
any mucosal membrane
Weil's Disease: severe illness involving
renal failure, hepatitis,
meningoencephalitis, septic shock
Tx:
Doxycycline
causes lyme disease
seen in Northeast
Reservoir: deer, small rodents
Arthropod vector: Ixodes tick
Pathophysiology:
Infection occurs in stages
Early localized stage: lesion at site of bite
Early disseminated stage: travels to heart,
skin, nervous system, and joints
Late stage: chronic arthritis
Presentation:
Early localized stage:
Erythema chronicum migrans - red,
target-like lesion at site of tick bite
Early disseminated stage:
CNS: facial palsy (bilateral),
polyneuropathies
Cardiac: AV heart block
Migratory arthritis

Late stage:
Chronic arthritis of large joints
Presentation:

syphilis:
painless chancre at site of contact, highly infective Diagnosis:
Heals after 4-6 weeks Culture difficult
Rely on clinical signs
syphilis: and serology
Generalized lymphadenopathy, fever, weight loss
maculopapular rash - widespread involving palms
and soles Tx/Prevention:
condyloma latum - painless, wartlike lesion on Doxycycline
genitals Ceftriaxone for
disseminated
syphilis: infection
Gummas- granulomas in skin and bones
Aortic aneurysm - due to damage of vasa vasorum
Tabes dorsalis: loss of all sensation
(proprioception, vibratory, temp, pain) and reflexes
General paresis: mental deteriortaion and
psychiatric symptoms
Argyll-Robertson pupil: midbrain lesion > pupils do
not constrict to light but constricts for
accommodation

Diagnosis:
RPR/VDRL test:
-testing for antibodies against lipids that are
released into the serum due to cellular damage
-non-specific tests that can be falsely positive
-titer useful to follow response to therapy

EIA, TPPA (treponema pallidum particle

agglutionation) test:
-tests for antibodies against Treponema
-more specific test

Tx/Prevention:
Penicillin G
 Fungi

Yeast Mold

Septated Non-septated
hyphae hyphae

Candida Aspergillus Mucor/Rhizopus

fumigatus
Cryptococcus Pneumocystis
jiroveci Dimorphic
C. albicans Non-albicans
candida
C. neoformans C. gattii

Coccioides Sporothrix
immitis Schenkii
Histoplasma Blastomyces
capsulatum dermatitidis
 Fungi

Yeast Dimorphic Mold

Septated Non-septated
hyphae hyphae
Candida Cryptococcus

Pneumocystis Coccioides Histoplasma Blastomyces Sporothrix Aspergillus Mucor/Rhizopus

C. albicans Non-albicans C. neoformans C. gatti jiroveci immitis capsulatum dermatitidis Schenkii fumigatus
candida
General:
General: General: General: General: General: General: high risk of infection in patients
General: General:
can cause invasive disease General: large polysaccharide capsule which Found on eucalyptus trees AIDS defining illness (CD4+ count < 200) General: Found on rose thorns Septate hyphae w/ with diabetic ketoacidosis
AIDS defining infection endemic to areas east of Mississippi River
in HIV patients no germ tube present appears mucoid on culture can infect only fungus with cholesterol in membrane endemic to areas draining into the causes ulcers with nodules on the skin 45 branching mold likes pH
likelihood of disseminated disease in and Central America
has germ tube and able to found in pigeon droppings nonimmunocompromised instead of ergosterol Mississippi River Transmission: pricking finger on thorns Transmission: feed off iron in blood by
African Americans, Latinos, and SE Asians broad-based budding
reproduce sexually infections occur in patients Pathogen acquired at birth but T cells likes moist environments inhalation of spores growing in blood vessels
(especially Filipinos) chronic, disseminated disease with weight
immunocompromised patients keep it in check present in bat and bird droppings - Transmission: environmental
endemic to southwestern US (California, loss, night sweats, inflammatory lung
Transmission: inhalation Transmission: inhaled outbreaks when spelunking or cleaning contact
Arizona, New Mexico) disease, and skin ulcers
Pathophysiology: likes dry environments chicken coops Transmission: inhaled in spore form Pathophysiology:
1. T cell deficiency (diabetes, BM Transmission: inhaled in spore form Transmission: inhaled in spore form Cause 3 major types of disease:
transplant, HIV): leads to disseminated Pathophysiology: Pathophysiology:
disease Inhaled yeast travels in the blood Pathophysiology: 1. Allergic Bronchopulmonary Aspergillosis Aggressively invades sinuses,
2. Long-term antimicrobial usage: kills stream to the brain In immunocompromised, multiplies in lungs -develop asthma type reaction to spores cranial bones, and blood vessels
skin and GI tract bacteria, allowing > make melanin to inhibit phagocytosis > cause pneumocystic pneumonia (PCP) Pathophysiology: -IgE mediated allergic reaction with >travels to brain quickly
Pathophysiology:
yeast to overgrow > make mannitol which causes water >immune response causes significant Microconidia are inhaled and lodge bronchospasm and eosinophilia
Arthroconidia produce arthrospores which drop
3. Total parenteral nutrition: yeast like to move into meninges inflammation in terminal bronchioles and alveoli
out of every other cell in hyphae
to grow in nutrition rich environments > meningoencephalitis and death >m die, lungs fill with fluid > phagocytosed and grow in m 2. Aspergillomas:
> aerosolized during large wind storms Presentation:
>lungs unable to undergo gas exchange -Fungus ball can form if patient has lung
> inhaled spores form spherules in the lungs Black necrotic eschar on face
> pneumonia If immunocompetent: cavitations from previous TB infection
Presentation: Presentation: >can cause disseminated disease in HIV asymptomatic
patients or susceptible patients 3. Invasive aspergillosis:
Oral thrush/Esophagitis: creamy white Meningitis Presentation:
> spread to bone and skin If immunocomprom ised: -in immunocompromised hosts Diagnosis:
exudate covering mucous membranes of Soap bubble lesions in the brain Fever, SOB, nonproductive cough
> disseminated disease -invade blood vessels, causing disseminated Non-septate hyphae on
mouth or esophagus
> cause pneumonia disease pathology or growth in culture
Vulvovaginitis: vaginal itching and cottage
> can form granulomas like TB -cause pneumonia, low grade fevers
cheese patches on speculum examination Diagnosis: Diagnosis: Presentation:
Diaper rash: red area under skin folds Stain with India Ink Microscopy of bronchoalveolar lavage Asymptomatic or mild respiratory illness Treatment:
Cryptococcal antigen test shows sporozoites Pneumonia
Presentation: Presentation: Surgical debridement
Lung biopsy with silver stain reveal cysts Granulomas with calcifications Amphotericin B
Diagnosis: Asymptomatic
Erythema nodosum 1. ABPA: eosinophilia, bronchiectasis
KOH preparation of skin scrapings Tx: Arthralgias
Pneumonia 2. Aspergilloma: fungus balls can be
Gram stain and culture Meningitis: Cavitary lesions in the lungs
Tx: Erythema nodosum as large as golf balls
Amphotericin B + 5FC (flucytosine) Steroids may be necessary to first 3. Invasive aspergillosis: hemoptysis,
Arthralgias
Prophylaxis in HIV patients: bring down inflammation and facilitate pulmonary symptoms
Cavitations in upper lobes
Tx/Prevention: Fluconazole gas exchange Diagnosis: Liver and splenic calcifications
Azoles or amphotericin B High-dose bactrim Sputum culture
Serology: complement fixation titers Diagnosis:
Prophylaxis: Biopsy & culture
TMP-SMX (bactrim) once CD4+ Diagnosis:
Antigen detection in urine serum or bronch Galactomannan
counts < 200
Tx/Prevention:
Fluconazole
Tx/Prevention: Treatment
Itraconazle Voriconazole, amphotericin
Amphotericin B
 Protozoa

Blood Genitourinary GI Tract Systemic

Plasmodium Trypansomas
Trichomonas Entamoeba Giardia lamblia Cryptosporidium Toxoplasma Leishmania
vaginalis histolytica parvum gondii donovani
Babesia microfi
T. cruzii T. bruceii
P. falciparum P. vivax

P. ovale P. malarie T. gambiense T. Rhodesiense

 Protozoa

Blood Genitourinary GI Tract Systemic

P. falciparum
General:
╸most deadly form
╸can infect any stage of RBCs, so
high parasitemia
╸does not have exo-erythrocytic
cycle (liver does not get reinfected)
╸Chloroquine-resistance seen in
most of Africa, Central America,
South America, India, and SE Asia
Pathophysiology:
╸RBCs burst > anemia
╸Infected RBCs express lipoproteins
> RBCs become sticky
>RBCs plug up capillaries
> hemorrhage and underperfusion of
kidney, lungs, and brain
╸Liver and spleen reticuloendothelial
system clean up large amounts of debris
Presentation:
╸cyclic fevers, chills, sweats
╸Renal failure, lung edema, coma
╸Cerebral malaria - seizures and
imparied consciousness
╸hepatomegaly, splenomegaly, splenic
rupture
Diagnosis:
╸Microscopic examination of blood
smears reveal trophozoites and
schizonts in RBCs; diagnostic
banana-shaped gametocyte
Plasmodium
╸Malaria: cyclic fevers, chills,
soaking sweats
╸each episode lasts about 6 hours
╸transmitted by anopheles mosquito
╸disease found in areas near the
equator
╸Falciparum and vivax cause >95%
of malaria worldwide
P. vivax
Pathophysiology:
╸Burst red cells every 48 hours
╸Form dormant hypnozoite in the liver
╸Require reticulocyte membrane
antigens Duffy a and b to enter RBC
╸many Africans and African Americans
are resistant to P. vivax because Duffy a
and b are absent
╸only infects reticulocytes
Presentation:
╸Cyclic fevers, chills, drenching
sweats every 48 hours
╸Hypnozoites can cause
relapsing malaria
Diagnosis:
╸Blood smears reveal
trophozoites and schizonts in RBCs
╸Infected reticulocytes (larger rings
with pigment)
Tx/Prevention:
╸ patients are not allowed to donate blood
due to possible presence of hypnozoites
╸patients that have absent Duffy a and b
RBC antigens are resistant
╸take prophylaxis before entering
endemic areas
╸Chloroquine = mainstay treatment
╸Primaquine required to kill hypnozoites
in the liver
P. ovale
Pathophysiology:
╸Burst red cells every 48 hours
╸Form dormant hypnozoite in the liver
╸only infects reticulocytes
Presentation:
╸Cyclic fevers, chills, drenching
sweats every 48 hours
╸Hypnozoite can cause
relapsing malaria
╸Blood smears reveal trophozoites
Diagnosis:
╸Blood smears reveal trophozoites
and schizonts in RBCs
╸Infected reticulocytes
Tx/Prevention:
╸patients are not allowed to donate blood
due to possible presence of hypnozoites
╸take prophylaxis before entering
endemic areas
╸Chloroquine = mainstay treatment
╸Primaquine required to kill hypnozoites
in the liver
P. malarie
Pathophysiology:
╸Burst red cells every 72 hours
╸T. cruzii from bug feces enter skin when scratched
╸Found in southern US and Central & South America
Presentation:
╸Fever, chills, and sweats
every 72 hours
> dilated cardiomyopathy: leads to arrhythmias
> megacolon, megaesophagus
Diagnosis:
and schizonts in RBCs
Tx/Prevention:
╸take prophylaxis before
entering endemic areas
╸Chloroquine = mainstay
treatment
Entamoeba
Babesia microfi Trichomonas E. histolytica E. dispar Giardia lamblia Cryptosporidium Toxoplasma Leishmania
vaginalis parvum gondii donovani
General: General: General: General:
Trypansomas General:
╸transmitted by Ixodes tick (same as Lyme disease) General: ╸cyst: has 4 nuclei ╸Non pathogenic form ╸cyst and trophozoite form General:
╸common illness seen in AIDS patients General:
╸found in Northeastern coastal US ╸most common STD in the world ╸trophozoite: have pseudopodia ╸microscopically identical to E. histolytica ╸flagellated ╸cysts found in cat feces
╸Acid fast + organism (magenta color) ╸Sandfly bite
╸sporozoites invade during tick bite and enter RBCs ╸flagellated ╸homosexual men are commonly ╸need antigen assays to differentiate ╸Transmission: campers drinking ╸up to 80% of cats in the US
╸Transmission: drinking water from ╸cause painless skin ulcer at site
╸asexually bud into 4 merozoites that stick together ╸highly motile asymptomatic carriers because would not treat from mountain streams are infected
wells on a farm ╸Found in South and Central America,
T. cruzii T. bruceii forming Maltese cross ╸Transmission: sexual contact ╸Brain infection commonly
Africa, and Middle East
╸cause African sleeping sickness ╸cause mild hemolytic anemia Transmission: seen in AIDS patients ╸different regions of the world have
╸transmitted by Tsetse fly, painful bite! ╸need spleen to clear disease > asplenic patients ╸Fecal-oral route Pathophysiology: ╸Transmission: ingestion different predominant presentations
╸leaves eschar-like lesion due to necrosis have more severe presentation Pathophysiology: ╸Sexual transmission Cyst form is ingested Pathophysiology: ╸has ergosterolin membrane so can
╸cause Chagas disease
╸spreads via bloodstream to cause fevers and Lives in the vagina or urethra (men) > converts into trophozoite and Cysts form is ingested
╸transmitted by Reduviid bug (kissing bug) use some anti-fungal drugs that target
lymph node swelling on-and-off for months > men often asymptomatic adheres to small intestine > only causes severe illness in
╸Bug bites and defecates white it eats Pathophysiology: ergosterol synthesis
╸intermittent fevers occur because trypanosomes > women often symptomatic > does not invade intestinal wall, so patients with low T cell counts
Pathophysiology: ╸ Latent infection
are able to alter their surface glycoproteins which ╸cyst ingested and converts to trophozoite no blood in stool > trophozoite forms then invades M
> Cyst forms bradyzoite (slow growing)
causes an inflammatory response > Cause of diarrhea is not well cells and enterocytes
╸Invade local skin and spreads through the blood > trophozoite eats RBCs, intestinal cells, > T cells keep infection in check
╸CNS symptoms then develop with drowsiness in understood > limited immune response as in Pathophysiology:
╸Infects large visceral organs > enlargement Presentation: other microbes in the gut
the daytime, behavioral changes, and then > can invade intesinal mucosa > bloody vacuole within enterocyte ╸Enter through sandfly bite
In women ╸Reactivation of latent infection
coma/death > produce 3-17 liters of stool/day > invades mΦ and spreads throughout
╸fishy odor, itching diarrhea (without fever) > In immunocompromised adults
> penetrates into portal blood circulation the reticuloendothelial system
╸burning urination Presentation: > bradyzoite then form tachyzoite
forming liver abscess > can cause diffferent level of invasion
╸copious, thin, watery discharge ╸foul, greasy, frothy diarrhea > travel to the brain > form cysts
> can spread to lung > pulmonary abscess based on host immune system
T. gambiense T. rhodesiense ╸strawberry cervix ╸abdominal gassy distention Presentation:
and cramps Severe diarrhea in AIDS patients ╸Congenital toxoplasmosis
> organism can cross the blood-placenta
barrier if pregnant woman has never been Presentation:
General: General: Diagnosis: Presentation:
previously exposed and has not already *variable depending on
╸West African sleeping sickness ╸East African sleeping sickness ╸Microscopic examination/PCR Asymptomatic Diagnosis: Diagnosis:
developed a protective immune response degree of invasion*
with slower clinical course with rapid course if untreated of vaginal discharge Dysentery without fever ╸Examine stool for Acid fast stain
Liver abscess, RUQ pain cysts or trophozoites
Lung abscess Hepatosplenomegaly
Presentation: Pancytopenia
Tx/Prevention:
Treatment: ╸Immunocompromised adults:
Metronidazole Tx/Prevention: ╸Filter water supply
> Toxoplasma encephalitis
Diagnosis: ╸Metronidazole
> Brain infection - headache,
╸stool examination for cysts or ╸Filter water
focal neurologic signs, seizures,
trophozoites gait disturbances
╸trophozoites with RBCs in > Ring-enhancing brain lesion on
cytoplasm suggest active disease CT/MRI
╸Antigen detection assays of
stool or serum ╸Infants:
> Chorioretinitis
> Hydrocephalus
Treatment: > Intracranial calcifications
╸Metronidazole
Diagnosis:
╸CT/MRI: ring-enhancing brain lesion
╸Serology useful:
> IgM in primary disease
> IgG in reactivation disease

Tx/Prevention:
Tx/Prevention: ╸TMP-SMX
╸Chloroquine in chloroquine sensitive areas ╸Sulfadiazine
(Central America north of Panama Canal) ╸Pregnant women must
╸Artemisin drugs, Quinidine, atavaquone-proguanil, stay away from cats!
or mefloquine in chloroquine resistant areas; use 2
drugs so + Doxycycline
╸Sickle cell anemia trait appears to protect RBCs
from infection
╸take prophylaxis before entering endemic areas
 Helminths

Nematodes Cestodes
(Roundworms) (Tapeworms)

Enterobius Ascaris Hookworm Strongyloides Taenia Echinococcus

vermicularis lumbricoides granulosus

Necator Ancylostoma Trematodes T. solium T. saginata

americanus duodenale (Flatworms/Flukes)

Schistosoma Clonorchis
sinensis

S. haematobium S. japonicum S. mansoni


Enterobius
verm icularis
General:
also known as pinworm
Transmission: fecal-oral
Pathophysiology:
Eggs are ingested
> mature in the large intestine
> at night, females migrates to
perianal area to lay eggs
> hatch a few hours later >
intense itching
scratching allows for host to
reinfect themself or others
Presentation:
perianal itching,
especially at night
no eosinophilia because
no tissue invasion
Diagnosis:
scotch tape test: tape placed
in perianal region at night
Treatment:
Mebendazole
Helminths
Nematodes Trematodes Cestodes
(Roundworms) (Flatworms/Flukes) (Tapeworms)
Schistosom a Taenia
Hookworm Life cycle:
1. Eggs hatch in freshwater and infect freshwater snail
2.. Released to infect humans swimming in freshwater
through exposed skin Clonorchis
Ascaris Necator Ancylostoma Strongyloides 3. Travel to intrahepatic portion of portal system Echinococcus
sinensis T. solium T. saginata
lumbricoides americanus duodenale 4. Schistosomes mature and mate granulosus
5. Pairs will migrate either to veins around intestine or
General: bladder (depending on species)
General: General: 6. Lay eggs which are excreted through feces or urine General: General: General:
General: similar to Necator
potentially lethal disease in
pork tapeworm beef tapeworm General:
Transmission: contact with soil from ingesting undercooked fish
affects over 1 billion people americanus but with
immunocompromised
eating undercooked pork infected only causes disease when ingestion of eggs from dog feces
Clinical Manifestations seen in SE Asia
can grow up to 1 meter long seen in any tropical area
with larvae or eggs or from food larvae form is ingested
more blood loss Many of the eggs that the schistosomes pairs lay do
Transmission: contaminated food workers that don't wash hands
Can cause invasive disease b/c of Pathophysiology: not reach the feces or urine
> flow in bloodstream to deposit in liver, lung, or brain causes different pathologies
developmental cycle Larvae lives in soil Pathophysiology: Pathophysiology:
Pathophysiology: > cause inflammatory response + fibrosis/granuloma depending on whether larvae or egg
> transforms and able to penetrate Fluke travels to the biliary tract Pathophysiology: Eggs are ingested and larvae hatch in intestine:
larvae grows in soil formation forms are ingested
human skin > cause large abscess in liver or biliary tree same lifecycle as T.solium > penetrate intestinal wall and disseminate
> penetrate human skin > can get stuck in blood vessels > fibrosis > occlusion can grow to 2-8 meters
> travels to alveoli and grow > relapsing cholangitis > choloangiocarcinoma no development of cysticerci so throughout body
Pathophysiology: > travels to the lungs > cirrhosis of the liver/hepatocellular carcinoma hermaphroditic
> coughed up and swallowed > produce eggs that are passed in stool infection considered benign > most go to liver; some to lungs, kidney, brain
Eggs are ingested > coughed up and swallowed
> move to small intestine > larve form fluid-filled hydatid cyst that undergo
> larvae emerge in the small intestine > travels to the small intestine + lays eggs Diagnosis:
> attach to wall with pincers and asexual budding
> burrow through intestinal wall and > hatched larvae can penetrate intestine >Identfy eggs in the stool or urine
suck blood Presentation: Pathophysiology: Presentation: > humans highly allergic to fluid within cysts,
travel in the blood stream to the lungs and travel to the lungs to continue cycle >Differentiate between species based on spine
> sexually reproduce - release Pigmented gallstones malnutrition and weight loss allergic rxn to cyst bursts may be fatal
> grow in alveoli until coughed up and location on egg
fertilized eggs in feces Cholangiocarcinoma Larvae encysted in undercooked
swallowed Immunosuppressive agents can cause
disseminated disease in infected Tx: pork is ingested:
> reach small intestine and grow by
individuals > larvae attaches to mucosa of Diagnosis:
consuming food in the GI tract Praziquantel Presentation:
Presentation: Diagnosis: intestine via hooklets Identify eggs in feces
> adults lay eggs which are then Anaphylaxis from cyst burst
diarrhea, abdominal pain, weight loss When penetrating gut wall, can bring gut Identify eggs in stool > releases eggs in feces
excreted in the feces Compression of organ based
Iron deficiency anemia bacteria along with it > minimal symptoms
High worm load, can lead to swelling on location of cyst
Eosinophilia > see gram (-) infections in the CNS S. haematobium S. japonicum S. mansoni
+ twisting of intestine Tx/Prevention:
Cysticercosis:
Tx/Prevention: > ingest eggs instead of hatched larvae Praziquantel
Praziquantel > eggs hatch in small intestine
Diagnosis: Diagnosis:
General: General: General:
Presentation: Identify eggs in fecal sample Presentation: > larvae travel throughout the body CT scan for cysts
Found in Africa found in Eastern Asia Found in South America and Africa
Asymptomatic Vomitng, abdominal bloating, > penetrate tissues and encyst Tissue biopsy
egg has terminal spine egg does not have spine egg has lateral spine
> Pulmonary infiltrates diarrhea, anemia > particularly likes to encyst in brain
resides in veins around bladder resides in veins around intestine resides in veins around intestine and SKM
> High eosinophil count Pruritic rash, lung symptoms deposits eggs in urine deposits eggs in feces deposits eggs in feces
Tx/Prevention:
Eosinophilia can lead to squamous cell Tx:
High worm load: Bendazoles
carcinoma of the bladder with Albendazole
Wear shoes at the beach in
> Malnutition painless hematuria +Surgical removal
developing countries! Presentation:
> Intussusception or volvulus pulmonary hypertension
of intestine Diagnosis: Asymptomatic
> Necrosis of bowel Identify larvae in feces Cysticercosis: calcified cysticerci
Eosinophilia Neurocysticercosis: cysts in the brain >
seizures, obstructive hydrocephalus, focal
deficits
Diagnosis:
Identify eggs in feces Treatment:
Ivermectin
Diagnosis:
Eggs in fecal sample
Tx/Prevention: CT scan or biopsy of infected tissue
Treat acute infection with
mebendazole or limit worm burden
in endemic areas with yearly
therapy Tx/Prevention:
Albendazole + steroids for
cysticercosis
Praziquantel for intestinal
 Viruses

Herpes Virus Hepatitis HIV Respiratory Viruses GI/Neuro Viruses Neuro Viruses
all DNA viruses viruses are not in one family
Has particular cell it lays dormant in grouped because they all cause hepatitis

General: Orthomyxovirus Orthomyxovirus: Influenza Fecal oral viruses: West Nile Virus
RNA virus, enveloped Paramyxovirus RNA virus, protein coat Enterovirus (Coxsackie) Rabies
HHV 1 = HSV 1 HSV 1: Herpes simplex 1 Hepatitis B: Glycoprotein 120 and 41 on the surface Respiratory Syncytial Virus (RSV) enveloped Poliovirus
Hep A: fecal oral, vaccine
HHV 2 = HSV 2 acquired through sexual contact or kissing only one that is a DNA virus Infects CD4 T cells Metapneumovirus originally in water fowl, their domestication > infection Norvovirus
Hep B: body fluid, vaccine, the only DNA virus
HHV 3 = VZV usually infects mucosal-integument border enveloped virus of farm animals and humans Rotavirus
Hep C: body fluid W est Nile Virus:
----------------------- associated with oral mucosa very infective (much more infective surface proteins H (hemagglutinin) and N
Hep D: body fluid, needs coinfection w/ Hep B Arbovirus, spead by mosquitos
HHV 4 = EBV than HIV or Hep C) (neuraminidase) are assigned #'s based on their
Hep E: fecal oral, lethal in pregnant women Pathophysiology: through birds
HHV 5 = CMV Pathophysiology: composition (ex. H1N1)
Antigens Influenza Type A and Influenza Type B Coxsackie Virus: fever, chills
HHV 6 = Roseola Dormant cell: cell body of neuron 1. Fusion: pericarditis encephalitic symptoms > coma
HHV 7 = Roseola reactivation at original site of infection during clearing virus depends on whether
or not immune system can Glycoprotein 120 and 4 binds to CCR5 on the CD4 T cell usually affects elderly patients in
HHV 8 time of stress Cell membranes fuse together, allowing entry the summertime
local tissue destruction > painful ulcers recognize the antigens
Pathophysiology:
S protein: surface Poliovirus:
2. Reverse transcription virus can mutate within each organism it infects
Can cause herpes encephalitis: C protein: core infects the cell bodies of the lower motor
reverse transcriptase: transcribes RNA into looped DNA Drift: virus changes its own genetic material
travels from CN V to specific brain regions > E protein: enzymes neurons within the spinal cord Rabies:
looped DNA can then become dsDNA Shift: two viruses exchange genetic material
hemorrhagic necrosis paralysis occurs neurovirus that lives in salivary glands of animals
Targeted by: NNRTI Influenza typically causes death because of secondary
-temporal lobes (auditory) Pathophysiology: dystrophy of muscles Bat is most commonly infected animal
bacterial infection of the lungs
-amygdala (memory loss) Acute phase if infects C3-C5, used to cause respiratory
Window phase 3. Integration: Pathophysiology:
-hippocampus Integrase: integrates dsDNA into host genome paralysis
-fever, RBCs in CSF Chronic phase Bite > virus enters and finds closest neuron
Targeted by: Integrase inhibitor causes local destruction at the cell body
Tx: Non-endemic areas:
Dx: culture, PCR, serology Dx: serology, PCR; Amantadine - only works on type A killed vaccine begins to moves toward the head
4. Transcribed RNA proteins further the bite, the better the prognosis
Oseltamivir - works on A and B
Tx: Antivirals Protease: cleaves peptide chain to form active protein
Tx: acyclovir, valacyclovir Targeted by: protease inhibitor Endemic areas:
need live vaccine because need to Presentation:
develop stronger immune response, but will hydrophobia
shed live vaccine dry mouth with copious saliva dripping out
HSV 2: Herpes simplex 2 Hepatitis C: Negri bodies: found in nerve cells containing virus
chronic process > destruction of Common infections based on CD4 counts:
acquire through sexual contact
hepatocytes 200: TB, Candida, viral
usually infects mucosal-integument border Tx: do everything possible
can either progress to hepatocellular < 200: AIDS dx, pneumocystis, cryptococcus
associated with genital mucosa Norvovirus: vaccinate patient
carcinoma or cirrhosis < 150: toxoplasma, histoplasma, HHV8 Kaposi sarcoma
< 100: cryptosporidium, MAC cause fever, watery diarrhea 24-48 try to find the animal responsible for the bite
Pathophysiology: IL-28R: allele of receptor determines hours after infection
how well patient will clear infection < 50: CMV
Dormant cell: cell body of neuron associated with cruise ships, barracks,
reactivation at original site of infection during time given treatment (C allele better chance trains, or travel to another country
of stress than T allele)
local tissue destruction > painful ulcers Diagnosis:
Dx: serology, viral loads
RNA PCR: Rotovirus:
Dx: culture, PCR, serology -measures viral load
Tx: cure rate >90% with proteinase cause watery diarrhea 24-28
inhibitors and polymerase inhibitors -can detect within days hours after infection
Tx: acyclovir, valacyclovir -main method of diagnosis affects children, seen in day
care centers
Antibody response:
VZV: Varicella zoster -test if body has produced antibody against HIV
inhaled pathogen
present with lesions at different stages of CD4 counts used to follow patients longterml
development (as opposed to small pox)
can occur on the eye, inside the ear

Pathophysiology:
Dormant cell: all the cell bodies within a ganglion
Reactivation within a particular dermatome

Vaccine:
Zoster vaccine: for younger patients
Shingle vaccine for older patients

Tx: acyclovir, valacyclovir

EBV: Epstein Barr Virus

direct contact - kissing, sharing drinks

Pathophysiology:
enters oral pharynx > lymphoid tissue (tonsils)
infects B cells and causes massive proliferation
Causes Mono: lymphadenopathy, malaise, low grade fever
T cells fight off infection, but virus remains dormant in B cells

Lymphoma:
In the future, if infected B cell multiplies > lots of replication errors
mutated B cells can develop into lymphoma

Tx: no good antivirals

CMV: Cytomegalovirus
direct contact - kissing, sharing drinks

Pathophysiology:
Dormant cell: monocytes and endothelium
can cause especially large giant cells

In immuno-compromised patients
only causes disease when T cells
CMV starts to pour out of monocytes an endothelial cells
innate immune system starts to destroy endothelial cells
vasculitis > end organ damage
HIV patients: see end organ damage commonly in colon
and retina (vision loss)

Dx: culture, viral loads

Tx: ganciclovir, foscarnet

HHV8:
direct contact

Pathphysiology:
Dormant cell: monocytes and endothelium
Enter into the genome causing mutations and
uncontrolled growth
disease typically seen in immunocompromised patients
Causes angiosarcoma (cancer of blood vessel)

Kaposi Sarcoma
purple, shiny lesions on the skin
can cause bleeding into compartments of the body

Tx: antiretrovirals, local therapy tx, chemotherapy if

significant lesions