Gram Negative

Produces profuse rice-water diar-

rhea via toxin that permanently
activates G5, ++ cAMP.

Comma shaped, oxidase positive,

grows in alkaline media. Endemic
to developing countries. Prompt
oral rehydration is necessary
Vibrio Cholera
A) Bacteriology
-Comma-Shaped
-Gram - Major cause of bloody diarrhea, Causes gastritis and up to 90% of
-Transmitted By Fecal Contaminated Drinking Water
especially in children. Fecal-oral duodenal ulcers.
B) Pathogenesis
-Non Invasive and Remain within the Intestinal Lumen
transmission through foods such
-Flagellar Proteins(Adhesion) Necessary For Colonization as poultry, meat, unpasteurized Risk factor for peptic ulcer, gastric
-Hemagluttinin is important for Deatacment + Shedding In Feces
milk. Comma or S-shapecl, oxi- adenocarcinoma, and lymphoma.
a. Cholera Toxin(Found In Chromosome)
= a Preformed Phage Enterotoxin dase positive, grows at 42°C
-Five identical B-Subunits + a Single A-Subunit
("Campylobacter likes the hot Gram-negative rod. Urease positive
*B-subunit Binds @ Surface of Intestinal Epithelial Cells
>> Carried Via Retrograde Transport To ER(Endocytosis) campfire."). Common ante- (e.g., urease breath test). Creates
*A-subunit Is Reduced By *Disulfide Isomerase*
>> A Unfolded & Released cedentto Guillain-Barre syn- alkaline environment.
*A Is Transported to Cytosol For Degradation
Escherichia Coli (Refolds To Avoid Proteosome) drome.
-Gram (-) Bacilli *A Interacts W/ Cytosolic ADP-Ribosylation Factors(RFs)>> Campylobacter Jejuni
>> Activation of Stimulatory G Protein>> -curved, gram - rods(appear comma or s shapped)
Most common initial treatment is
-Ferments Lactose
-Colonize Healthy Gi Tract (NF) >> Stimulates AC >>Increased cAMP >> -motile triple therapy: l. proton pump
-Usually Non Pathogenic >> CFTR Opens >> Cl- Into Lumen -grow well at 5% 02 and 42 C
>>>Secretion Of Bicarb, Sodium And Water -most common bacterial enteric pathogen in developed nations inhibitor; 2. clarithromycin; 3.
>> Diarrhea
Pathogenesis
-Pili Attach To Jejunum And Ileum Transmission: via amoxicillin or metronidazole.
C) Clinical Features -improperly cooked chicken
Subgroups -Most Are Asymptomatic or Develop Mild Diarrhea -unpasturized milk
-Others -contam H2O
-Abrupt onset Of Watery Diarrhea/Vomiting -fecal-oral
Entero-Invasive E. Coli (EIEC) -After 1 To 5 Days Incub
a. Similar To Shigella -Rice Water Stool(Fishy Odor?) A) Pathogenesis
b. Transmission -Dehydration, Hypotension, Muscular Cramping, Anuria, -Virulence Factors
-Via Food, Water Disease: Chancroid
-Person To Person
Shock, Coma
-Acidosis And Hypokalemia
-Motility-Flagella
-Adherence-Flagella
Transmision: Bordetella Pertussis Rickettsia Rickettsii
c. Pathogenesis -only through sexual contact = a Small, Encapsulated, Gram Negative Coccobacilli -Small, Gram - Rod, Stain Poorly w/ Gram stain
-Toxin -found mainly in developing and third world countries.
-No Toxins -Causes: Whooping Cough -Vector-Borne Obligate Intracellular Bacteria
D) Rx 1. Cytotoxins Epidemiology
-Non Motile A) Transmission -Cause Spotted Fevers
-Oral Rehydration (Cyto-Lethal Distending Toxin)>> Swelling of Epithelial Cells -most cases brought over sease
-Does Not Decarboxylate Lysine -Only Human Pathogen Xmited by Airborne -Rocky Mountain Spotted Fever
-Tetracycline -US Cases since it peaked at over 5000 in 1987. (@ 2009 28 cases)
-Do Not Ferment Lactose Droplets During Cough Episode
2. Cholera-like entertoxin (released by some) -Uncircumcised men are at much higher risk than circumcised men
-Invade Large Intestin Epithelial Cells > Tx
>> Acute Self Limited Colitis Usually transniitted from pet
-invasion >> dysentery(only a few strains)
-penetrates and proliferates in ileum and colon
for getting chancroid from an infected partner
B) Pathogenesis -By Dog Ticks Ehrlichia Chaffeensis
d. Symptoms Symptoms a. Attachment -Endemic to: SE + S. Central USA -Tick Transmitted Disease By Rickettsiales
Enterotoxigenic E. Coli (ETEC)
a. Principle Cause of Traveler’s Diarrhea
-Bloody Diarrhea w/ Mucus + Inflammatory Cells In Stool feces (e.g., puppies), contami- B) Causes
-1-2 days post >> bump @ genitals >>> Ulcer (1/8 inch-2inches in diameter)
-ulcer which resembles that of a "primary syphilis chancre" except that it is painful.
@ Ciliated Epithelium of UR Tract
-Doe Not Invade Pathogenesis
-Infects Primarily Macrophages
-Characteristic Cytoplasmic Inclusion (Morulae)
-Usually Children In Underdeveloped nations
(Induces Cl- & H20 Secretion)
(Inhibits Fluid Absorption)
nated milk, or pork. 1. Enteric fever
-When Campo Proliferate @ Lamina Propria & Mesenteric Lymph Nodes
50% of infected individuals will develop enlarged inguinal lymph nodes (buboes)
50% Buboes >>> break through the skin, forming draining abscesses.
-Mediated By Pili Protein -Infect Primarily Vascular Endothelial Cells = Shaped Like Mulberries
(= Filamentous Hemagglutinin) (Esp Lung And Brain) >> Vasculitis -Composed Of Masses of Bacteria In Leukocytes
b. Transmission: Via Food Or Water 2. Other Manifestations Men: 50% have only one ulcer. -Decreases Ciliary Activity 1. Enter Cells Via Endocytosis -Abrupt Onset of Fever, Headache, and Malaise
c. Pathogenesis -Reactive Arthritis(HLA-B27) Women usually have 4 or more ulcers located @
-Followed by Death of Ciliated Epithelial Cells 2. Escape into Cytoplasm before Phagolysosome -Progesses to Respiratory Insuff, Renal Failure, Shock
1. Heat Labile Toxin(LT) Outbreaks of diarrhea are -Erythema Nodosum -labia majora/minora, the perianal area, and the inner thighs.
-most common symptoms in women are pain with urination and intercourse. c. Pertussis Toxin(A-B Exotoxin) 3. Proliferate @ Cytoplasm and Either... -Rash Occurs In 40% Of People
-LT = Similar To Cholera Toxin **Guillain Barre Syndrome
-Activates AC >> efflux of H2O, K, Cl- common in clay care centers. -Autoimmune Destruction of Peripheral Nerves
Dx: visual
1. Mechanism
-ADP-Ribosylation of Inhibitory Subunit of G-Prot Complex(Gi)
a. Lyse (Typhus)
Or Lab Findings
2. Heat Stable Toxin(ST) -Possibly Due to Molecular Mimicry
-looking at the ulcers >>Adenylate Cyclase Stimulation>> Increases [cAMP] b. Spread From Cell To Cell Via Actin Mobilized Motion -Lymphopenia
-ST: Binds GC >>Increase cGMP ---x Ion Uptake @ Lumen GI -checking for lymphadenopathy/buboes. -Toxin Inhibits Signal Transduction By Chemokine Receptors EX: (Spotted Fever) -Thrombocytopenia
3. Do Not Cause Inflam or Invade Mucosa
d. Symptoms
Causes mesenteric adenitis that C) Manifestations
1. Acute Self Limited Colitis
-H. ducreyi is difficult to culture
-there are no other tests.
>> Failure of Lymphocytosis -Severe Manifestations Due To Vascular Leakage -Elevated Liver Enzyme Values (LFTs)
(Lymphocytes To Enter Lymphoid Tissue) (Due To Endothelial Damage)
= Secretory, Noninflammatory Diarrhea can mimic Crohn's or appendici- -Starts As Watery, Foul Smelling Diarrhea
-Followed By Bloody Stools W/ Fever & Severe Abd Pain Rx:
-Hypoglycemia -Hypovolemic Shock w/ Peripheral Edema
-Dehydration, possibly septic Shock -Increased IgE Synthesis -Pulmonary Infection
tis. 2. Mucosal and Intraepithelial Neutrophil Infiltrates are Prominent -Antibiotics: Azithromycin, ceftrioxone, ciprofloxacin, and erythromycin
(Esp @ Superficial Mucosa) -Large lymph nodes need to be drained, either with a needle or local surgery Haemophilus Influenza -Increased Histamine + Endotoxin Sensitivity
d. Exportation of Adenylate Cyclase
-Renal Failure
CNS Manifestation(Possibly Coma)
>> Degeneration >> Shortening of Villi -Pleomorphic, Gram (-) -Can Inhibit our Phagocytes Bactericidal Activity
Enteropathogenic (EPEC) >> Exudate Production In Lumen Neisseria gonorrhoea -Ubiquitous Colonizer of Pharynx e. Tracheal Cytotoxin (TC) from PGN + LPS >> Immune Response
-Fever, Vomit, Nausea, Non-Bloody Diarrhea 3. Cryptitis = Neutrophil @ Crypts 1) Disease? -5% Encapsulated, 95% Unencapsulated forms > Ciliated Epithelial Cell death -Is Mounted By Nk Cells
-Infants, Mexico And N. America Traveler’s 4. Crypt Abscesses-Crypts W/ Accum Of Neutro (PMN) 2) Symptoms a. Encapsulated f. Dermonecrotic Toxin (Heat-Labile) -Produce INF-y >> Reduces Bacterial Proliferation
3) Epidemiology -Can Kill Unencapsulated By Secreting "Haemocin" -Strong Vaso-Constrictor -CTL Responses are Critical For Elimination of Infection
Pathogenesis(Inflam Response) D) Clinical 4) Pregnancy Complications b. Nonencapsulated(Nontypeable Forms)
5) Pathogenesis -Causes Ischemia and Extravasation of Leuko -INF-y & TNF from activated NK & T-Cell = Bactericidal NO Production
-Destruction of Microvilli w/o Invasion -ingestion of as few as 500 can cause disease -Spread >> Otitis Media, Sinusitis and Bronchopneumonia
6) Diagnostics -CTLs Lyse Infected Cells
-Need EPEC "Adherence Factor" Pili -incub period of up to 8 days -Fastidious
7) Treatments C) Clinical Findings
a. Mannose Sensitive EPEC >>> Bind Mannose -watery diarrhea (Culture on Heated Blood Agar HBA) -Acute Tracheobronchitis w/ Mild URI Dx
b. Mannose Resistant EPEC >>> Bind Cerebrosides -dysentery in 15% of patients A) Causes
1) Gonhorrea -Followed By Severe Cough (Lasts 1-4 Wk) -Clinical Enough To Start Treatment
-Intimin -antibiotics usually not required 2) Symptoms a. Many cases of Pediatric LRI's -Copious Amounts of Mucus Produced -AB Test, PCR + Serology To Confirm
= Outer Membrane Protein which Mediates Late Adherence a. Men: b. Many cases of Pediatric Meningitis -WHOOP AS AIR GOES PAST NARROWED GLOTTIS
-DO NOT PRODUCE LT OR ST TOXINS E) Rx -Often asymptomatic c. Nonencapsulated (Nontypeable Forms) -NOTE* whoop can be Absent Rx: Tetracyclines & Chloramphenicol
-Fluid Replacement -1-14dayspost-infection: burning urination + discharge -Otitis Media
-Ciprofloxacin (many are resistant) -Occasionally–painfulorswollentesticles -Sinusitis
Enteroaggregative E. Coli D) Dx Morphology Rickettsia Rickettsii
-Erythromycin -Bronchopneumonia
“Stacked Bricks” = a Unique Pattern of Adherence to Epithelial Cells b. Women: (PID) -Nasophary Swab>>Bordet Gengou Medium -Starts w/ Fever, Severe Headache, Myalgias and Prostration
-Attaches To Entercytes Via Adherence Fimbriae -More Symptomatic (Fastidious W/ Penicillin G) -2-6 Days Later...
B) Virulence H.i. -Cultured 4-7 Days in Moist Environment -Hemorrhagic Rash Begins @ Wrist + Ankles
-Enterohemorrhagic E. Coli (EHEC) -Aided By Dispersin -Symptoms may mimic Bladder/vaginal Infection
-buring while urinating -Type B are More Invasive -Strict Aerobe -Rash extends Over Entire Body
(often O157:H7 Strain) = a Surface Protein that Neutralizes (-) Surface Charge Of LPS 1. Pili @ Surface for Adherence @ Resp Epithelium
-vaginal discharge E) Rx (Including Palms And Soles)
a. Transmission Symptoms 2. Secrtes a Factor that Disorganizes Ciliary Beating
-vaginal bleeding a. ABX: Erythromycin -Rash moves To Trunk
-Undercooked Ground Beef -Nonbloody Diarrhea c. Rectal: discharge, anal itching, soreness, bleeding, or painful bowel movements in both men and women. 3. Produces a Protease That Degrades IgA (IgA Protease)
(MAJOR SOURCE IS FROM CATTLE) -Does Not Invade b. Vaccine: -Widespread Aches and Pains
d. Throat: sore throat, but are usually asymptomatic. 4. Capsule (Polyribosylribitol Phosphate) = Killed Whole Bact Vaccine In DPT Vaccination -Diarrhea And Delirium
-Sometimes Fast Food -Has Heat Labile Plasmid Encoded Toxin e. Pregnancy Complication: Conjuctivitis in adults and neonates born to infected women. >>Prevents Opsonization By Complement
-Contam Milk & Veggies -Produces Hemolysin -Vascular Lesion Under Rash >> Acute Necrosis
>>Prevents = Survival in Blood (bactermia) (Fibrin Extravasation & Occasional Thrombosis of Small BVs)
3) Pathogenesis
*NOTE: Antibodies Are Produced To Capsule a. Begin As Macules
b. Pathogenesis Salmonella Enteritidis -Infects mucus-secreting epithelial cells via the pili on it’s surface
5. LPS >>> Inflammation b. Proceed To Petechiae
1. Produce Shiga Like Toxins (SLT) A) Bateriology -Pili prevent phagocytosis by neutrophils
-Pili contain an IgA protease which digests the mucosal IgA -In Severe Cases
-Phage Encoded -Gram (-) Bacilli C) Clinical Hi
-N. gonorrhea is able to alter the amino acid sequence of the pili to evade the immune response. -Foci Of Necrotic Skin Appear On Fingers Toes Elbows Ears And Scrotum
-Production Enhanced By Iron Deficiency -Produces H2S, 1. (LRI) Symptoms
-Organism may induce an acute inflammatory reaction, resulting in a purulent exudate. -Perivascular Response Seen In Brain, Skeletal, Kidneys, Testes And Heart
2. Hemolysins(Plasmid encoded) -Does Not Ferment Lactose -Start As Runny Nose + Fever + Headache For 3 Days
B) Epidemiology -Non Cardiogenic Pulmonary Edema>
4) Prgenancy Complicaitons -Symptoms become more Serious as HI Disseminates
c. Symptoms -Over 1 Million Cases/Year @ USA –In neonates, transmission occurs during delivery
>ARDS = Major Cause Of Death
-Pneumonia May Follow A Viral Respiratory Infection
-Similar To S. Dysenteriae -Most Common In Young Children & Elderly -infection of the conjunctiva appears 1-4 days after birth *Pediatric Emergency w/ High Mortality Rate
-Bloody And Copious Diarrhea w/o Leukocytes -Case Frequency Peaks @ Summer + Fall severe discharge with marked swelling and redness.
-Descending Laryngo-Tracheo-Bronchitis = AIRWAY OBSTRUCTION!
-Do Not Cause Inflammation C) Transmission -This infection can lead to corneal perforation and blindness.
-Smaller Bronchi Are Plugged By Dense, Fibrin Rich Exudate Of Pmns
-Can Dissemeninate Into Bloodstream >> Hemolytic Uremic Syndrome (HUS) -Through Contam Food *Pulmonary Consolidation is Usually Lobular And Patchy
5) DX
* (HUS) = Hemolytic Uremic Syndrome -Raw Meat, Poultry, Eggs, Milk -May Involve Entire Lung Lobe
-Gram stain of exudate or sample of infected tissue
-Hemolytic Anemia D) Causes -culture on Thayer-Martin medium in 5-10% CO2.
-Thrombocytopenia -Typhoid Fever -Nucleic Acid Amplification Test (NAAT) 2. NOTE: Vaccine Has Decreased Incidence of H.i. Meningitis
-Kidney Failure -Patients have Sustained High Fever (103-104F!) 3. Children
-Due To Salmonella Typhii = (3Rd World Problem) 6) Rx - Acute, Purulent Conjunctivitis(Pink Eye)
@ lower genital tract, gonococcal infections are more responsive to antibiotic therapy. -Suppurative Arthritis
E) Pathogenesis Surgery may be necessary if the infection ascends and becomes well established (PID).
4. Adults: @ risk can develop H.i.
a. Usually At Least 100K are Needed establish an Infection ABX-resistance is an increasing problem
Individuals w. gonorrhea should be tested for chlamydia, syphilis, and HIV.
-Septicemia
(Less w/ Atrophic Gastritis or Acid Suppressive Therapy) -Endocarditis
(many patients infected with N. gonorrhea are co-infected with Chlamydia trachomatis)
b. Invades Intestinal Epithelium -Pyelonephritis
>> Get Into Blood >> -Cholecystitis
>> Disseminate Via Macrophages >> -Suppurative Arthritis
= "Temporary Septicemia" 5. NOTE: Most Common Cause of Acute Exacerbation of COPD
-Salmonella Lodges @ Gall Bladder -Common In Children And Young Adults
-Sheds Into Gi -Sporadic transmission in Close Quarters(School Etc)
c. Virulence Genes
1. Encode Type III Secretion System D) Prevention
-Transfers Bacterial Proteins into M Cells + Enterocytes -Vaccine: Haemophilus-B PRP-Conjugate
>> Activates Rho GTPases >> -PRP = Capsule (Polyribosylribitol Phosphate)
>> Triggers Actin Rearrangement >>
& Bacterial Uptake In Phagosomes

2. Flaggelin
>> Activates TLR5 >> Increased Inflammatory Response

Atypical Pneumonia Pneumonia

3. LPS >>Activates TLR4
(Some Strains Can Prevent TLR4 activation)

4. Secrete Molecule that Induces Release of Hepoxilin A3

*Hepoxilin A3 = Chemotaxic for PMN >>> Mucosal Damage = (Viral and Mycoplasma) = Any Infection Of The Lung Parenchyma
-Acute Febrile Resp Disease -Contributing Factors
*NOTE: Th17 Response Is Important To Limiting Colon Infection
-w/ Patchy Inflammatory Changes I@ Lungs a. Loss Of Cough Reflex
F) Morphology -Confined to Alveolar Septa & Pulmonary Interstitium b. Injury To Mucociliary Apparatus
-Similar To Campy & Shigella -Moderate amount of Sputum c. Accumulation Of Secretions(Cf )
-Invade Epithelial + Subepithelial Tissue of SI and LI
-Penetrate Through and Around Mucosal Cells>> -No Consolidation d. Interference W/ Phagocytic Or Bacterial Action Of Alveolar Macros
>> Lamina Propria >> Inflam + Diarrhea -Moderate Elevation of Leukocyte Count e. Pulmonary Congestion And Edema
G) Clinical Features
-Lack Of Alveolar Exudate *NOTE: One Type Of Pneumonia Predisposes To Another Type
-Clinically Indistinguishable from other Enterics
-Symptoms Range From... A) Pathogenesis Atypical Pneumo Bacterial Pneumonia
-loose Stools
-to Cholera-Like Profuse Diarrhea -Incubation: 1-4 Weeks Types
-to Dysentery -Attach to Sialic Acid on URI-Epithelium >> Necrosis + Inflammatory Response 1. Lobar Bronchopneumonia
-Fever Resolves w/In 2 Days
-Diarrhea Can Persist For up to a Week
-Damage to Resp Epith ---x Mucociliary Clearance = ++ Bact Infection -Patchy Consolidation of Lung
-If Extends to Alveoli >> Interstitial Inflammation (due To Acute Suppurative Inflammation)
H) Rx -May Have Outpouring of Fluid into Alveolar Spaces Define: Suppurative
-Antibiotics Not Recommended
-Can Prolong Or Cause Relapse -CRX looks Like Bacterial Infection -The formation or discharge of pus.
-Usually Self Limiting -Produce ROS = Damage to Host Cells And Tissues -Also called pyesis, pyopoiesis, pyosis.
-Species Is a Superantigen >> Activates Macro + Lympho -PMN Rich Exudate That Fills Bronchi, Bronchioles
(inflammatory response = symptoms) + Adjacent Alveolar Spaces
-Often Multilobar
B) Morphology -Frequently Bilateral And Basal
-Affected Areas are Red-Blue and Congested -Lesion Are...
-Can Be Patchy or Whole Lung -Slightly Elevated
-Pleura Is Smooth -Dry, Granular
(Pleuritis/Pleural Effusions are Rare) -Gray-Red To Yellow
-Inflammation Is Interstitial & Localized @ Walls of Alveoli -Poorly Delimited @ Their Fargins
-Alveolar Septa are Widened & Edematous
-Have Mononuclear Infiltrate of Lympo +Macro + Some Plasma 2. Lobar Pneumonia
-If Complicated by ARDS >> Pink Hyaline Lining of Alveolar Walls -Fibrino-suppurative Consolidation of Large Portion or Entire Lobe
-4 Stages Of Inflammatory Response
Clinical 1. Congestion
-Many Present as Severe URI or Chest Cold -Heavy, Boggy and Red Lung
-Cough May Be Absent -Vascular Engorgement
-Fever, Headache, Muscle Aches + Pain In Legs -Intra-Alveolar Fluid w/ Bact + Few PMN
-Edema and Exudation Located To Cause V-Q Mismatch 2. Red Hepatization
*NOTE: Symptoms are out of Proportion w/ Physical Findings!!! *(Looks Like Liver)
-Massive Confluent Exudation of PMN, RBC + Fibrin Filling
-Alveolar Spaces = Red, Firm & Airless
3. Gray Hepatization
-Progressive Disintegration of RBC
-Persistence of Fibrinosuppurative Exudate
-Grayish Brown, Dry Surface
4. Resolution
-Consolidated Exudate @ Alveolar Spaces Undergoes...
>> Enzymatic Digestion >> Granular + Semi Fluid Debris >>
>> Resorbed By Macro & "Expectorated"
aka Organized By Fibroblasts Growing Into It
-Pleural Fibrinous RXN To Inflammation >> Pleuritis(Early Stages)

Complication of Pneumonia
-Tissue Destruction & Necrosis >> Abscesses
-Spread of Infection To Pleural Cavity >> Emphysema (#Fibrinosuppurative Rxn)
-Bacteremic Dissemination @
-Heart Valves >>>> Endocarditis
-Pericardium
-Brain >>>> Meningitis
-Kidney,
-Spleen
-Joints >>> Arthritis
(+ Metastatic Abscesses)

Clinical Pneumonia
-Abrupt Onset of High Fever
-Shaking Chills & Cough w/ Mucopurulent (productive) Sputum
-Occasional Hemoptysis
-Pleuritic Pain And Pleural Friction Rub if Fibrino-suppartive Pleuritis
-Radiography
a. Lobar = Radio-Opaque
b. Broncho = Focal Opacities

Treponema pallidum

Chlamydia trachomatis
1) Disease?
2) Symptoms
3) Epidemiology
4) Pregnancy Complications
5) Pathogenesis
6) Diagnostics
7) Treatments

Microbiology/Pathogenesis
1. Chlamydiae are obligate intracellular bacteria
2. Gram- negative cell wall.
3. Generally attach to and infect columnar epithelial cells @ genital tract.
4. Infection often chronic – months to >1year.

Symptoms
– Urogenital infections in both sexes
– Distinct strains of C. trachomatis cause eye disease (trachoma) leading to blindness.
– Rectal infection can lead to severe proctitis or protocolitis.
– C. trachomatis strains rare in the US can cause Lymphogranuloma venereum (LGV)
– Sexual abuse is a major concern when chlamydia is detected in pre-adolescent males and females.

A) Men:
-asymptomatic (most)
-NGU) nongonococcal urethritis.
-Complications are uncommon:
-Epididymitis
-fever, unilateral scrotal pain, swelling, tenderness,
-evidence of urethritis on Gram stain, testicular tenderness or mass on exam
-Reiter’s syndrome
=post-inflammatory autoimmune disease that can result from chlamydial infection.
Symptoms include:
conjunctivitis, and skin lesions, which occur 3-6 weeks after genital chlamydial infection.

B) Women:
-asymptomatic (most)
-cervicitis is asymptomatic in most cases, although spotting may occur.
-Speculum examination may include an endocervical discharge, and/or bleeding.
-Urethritis may be asymptomatic or mimic acute cystitis
-Complications
(PID~40%)
20% will become infertile,
18% will experience debilitating chronic pelvic pain
9% will have an ectopic pregnancy.
-Perihepatitis= (Fitz-Hugh-Curtis Syndrome)

Epidemiology
-most common reportable STD in the US with ~3 million cases per year.
-rates higher @ adolescents and young adults.
-Infection rates have been reported at >50%.

Pregnancy Complications
-neonatal conjunctivitis 30-50% of exposed babies and pneumonia in 3-16%.
– Perinatal transmission results in neonatal conjunctivitis in 30-50% of exposed babies and pneumonia in 3-16%.

DX
a. Culture
b. Non-culture
1. Nucleic Acid AmplificationTests(NAATs)
2. Non-amplificationtests
-Enzyme-immuno assays (EIA)
-Direct fluorescent antibody tests (DFA)
-Nucleic acid hybridization tests
3. Serology
Rx
– Azithromycin or Doxycycline for uncomplicated cases
Mycoplasma Pneumoniae
-Smallest Free Living Organisms
– Azithromycin or Amoxicillin for treatment of pregnant women
-No Cells Wall, Strict Aerobe(Pneumoniae Species Only)
– Azithromycin or erythromycin for treatment of neonates
-Pleomorphic
-Membrane Contains Cholesterol

A) Pathogenesis
-Transmitted by Respiratory Droplets
-a stricktly Human Pathogen
-Attaches to Resp. Epith but Does Not Invade
-Causes Necrosis of Ciliated Epith
-Auto-Antibodies to RBC, Brain, Lung & Liver Are Produced
= "Cold Agglutinins"
-Agglutinate Erythrocytes @ 4 C
-Seen In Winter In Young Adults

B) Clinical Findings
-Mycoplamsa = Most common cause or Atypical pneumo
-75% Develop Tracheo-Bronchitis (common)
-33% Develop Pneumonia
-Gradual onset @ Beginning w/...
-Nonproductive Cough
-Sore Throat Or Earache
-Small Amount of White-ish, nonbloody Sputum
-Fever, Headache, Malaise, And Myalgias

Dx-Serologic Testing
Rx: Macrolide or Tetracycline