MICROBIO&PARA

Recall Vignettes and Buzzwords

Jon Major C. Wee, MD MPH
 PURPOSE

• Supplement and Review

 GOAL
• To recall and have a better understanding of the subject
• To get a highest grade possible for each of you
MICROBIO TIDBITS
 Question:
Lysozymes are enzymes that kil bacteria
by cleaving?
a. Pentaglycine Wall
b. Multiple Layers of Peptidoglycan
“net”
c. B1 – 4 glycosidic bond between NAG
and NAM
d. Tetrapeptide Sidechains

Component Gram (+) Gram (-)

Peptidoglycan Thicker Thinner
Teichoic Acid + -
LPS - +
Periplasmic Space - +
 BACTERIA NOT SEEN IN GRAM
STAIN
Name Reason Alternate Approach
Mycobacteria Too much lipid in cell wall, dye Acid-Fast Stain
cannot penetrate
Spirochetes Too thin Darkfield Microscopy
Mycoplasma No cell wall, very small None (Serologies)
Legionella Poor uptake of red counterstain Silver Stain
Chlamydiae Intracellular, very small Giemsa Stain = Inclusion Bodies
Rickettsiae Intracellular, very small Giemsa/Tissue Stain

Mnemonic: These Rascals May Microscopically Lack Color: Treponema, Rickettsiae, Mycobacteria,
Mycoplasma, Legionella, Chlamydia
 • Responsible for nonspecific endotoxin in
TRIVI Gram (-)? – LPS
A
• Oldest Acid Fast Stain? – Ziehl-Neelsen

• Component of Gram (-) cell wall which reduces its

susceptibility to lysozymes? –
Outer membrane
 COMPONENTS OF A BACTERIA
All bacterial capsule Essential Non-Essential
are made of Cell Wall Capsule
polysaccharide,
except? – Cytoplasmic Membrane Pilus/Fimbrae
Ribosome Glycocalyx
B. Anthracis (Poly D- Nucleoid Flagellum
Glutamate)
Mesosome Spore
Periplams Plasmid
Granule
B lactams act during
what phase?

Phase 2
Statics

Cidals
 MICROBIAL PATHOGENICITY

1. Route of Transmission
2. Infective Dose
3. Evasion of local defense
4. Adhesion
5. Invasion
Enzymes in Bacterial
Invasion
Collagenase and Spreading Factor, spreads through subcutaneous tissue
Hyaluronidase
Coagulase Accelerates formation of a fibrin clot coating the organisms with a layer of fibrin

Immunoglobulin A Allows adherence to mucous membrane

Protease
Leukocidin Destroys both neutrophilic leukocytes and macrophages
 MEDIA FOR BACTERIAL GROWTH
Bacteria Agar
Clostridium Perfringens Egg Yolk
Corynebacterium Diphteriae Tellurite
Group D Streptococci Bile Esculin
Staphylococci Mannitol Salt
N. Meningitidis, N. Gonorrhea from Sterile Chocolate
N. Gonorrhea from Non-Sterile Thayer-Martin (Vancomycin, Colistin, Nystatin)
H. Influenzae Chocolate + Factor X and V
 Agar Bacteria
Lowenstein – Jensen Mycobacterium Tuberculosis
Thiosulfate Citrate Bile Salts (TCBS) Vibrio Cholerae
Bordet-Gengou Bordetella Pertusis
Charcoal-Yeast Extract Legionella
Skirrows Campylobacter; Helicobacter
Barbour-Stoenner-Kelly (BSK) Borrelia Burgdoferi
Eaton Mycoplasma Pneumonia
Cetrimide Pseudomonas Aeroginosa
Xylose-Lysine-Deoxycholate (XLD) Salmonella, Shigella
Ellinghausen-McCulloagh-Johnson-Harris (EMJH) Leptospira Interrogans
MICROBIO VIGNETTES
ANTIOBIOTICS CLAIM TO FAME
 Bactericidal Abx Bacteriostatic Abx

Vancomycin Erythromycin
Fluorquinolones Clindamycin
Penicillins Sulfamethoxazole
Aminoglycosides Trimethroprim
Tetracycline
Metronidazole Chloramphenicol
Mnemonic: We’re ECSTaTiC about
Mnemonic: Very Finely Proficient At bacteriostatics!
Murder!
Penicillins
Drug Characteristic Side Effects
Pen G, Pen V Narrow Spectrum Penicillin Hypersensitivity, GI Upset
Methicillin, Nafcillin Penicillinase Resistant Penicillin Interstitial Nephritis, Neutropenia
Ampicillin Extended Spectrum Pseudomembranous Colitis
Piperacillin Antipseudomal Penicillin Hypertension, Hypervolemia,
Bleeding
• Anti Pseudomonal Penicillins? • Amoxicillin Coverage?

Ticarcillin H. Influenzae
Carbenicillin E. Coli
L. Monocytogenes
Piperacillin Proteus Mirabilis
Salmonella Spp.
Enterococci
Mnemonics: Takes Care of
Pseudomonas Mnemonics: Amox HELPS kill Enterococci
 Cephalosphorins
Drug Desrciption Side Effects
Cefazolin 1st Gen. High Bone Penetrance Hypersensitivity
Surgical Prophylaxis, Greatest G (+)
Coverage
Cefamandole 2nd Gen. Added Gram Negative Disulferam Like Reaction
Coverage
Cefoperazone 3rd Gen. Pseudomonas Coverage Disulferam Like Reaction
Ceftazidime Most efficacious for Pseudomonas
Cefepime 4th gen. with Gram (+) and Gram (-)
Ceftriaxone Has the best penetration in BBB
 Other Cell Wall Synthesis Inhibitors
Drug Description Side Effects
Aztreonam DOC for Gram (-), No Gram (+)
Activitiy, With Antipseudomonal
Coverage
Bactams (Tazobactam, Sulbactam), Beta-Lactamase Inhibitor Cholstatic Jaundice
Clavulanic
Vancomycin Tx for MRSA Red Man Syndrome
Imipenem, Cilastatin Drug of Last Resort, Broad CNS Toxicity
Spectrum Activity
 Protein Synthesis Inhibitors
Drug Characteristic Side Effects
Chloramphenicol Binds to 50s subunit Aplastic Anemia, Gray Baby
Tetracyclines Binds to 30s subunit Tooth Enamel Discoloration,
Photosensitivity
Erythromycin Binds to 50s, DOC for Pen-Allergic Diarrhea, Cholestatic Jaundice
Patients
Azithromycin Binds to 50s, Highest Vd in single
dose Administration
Clindamycin Binds to 50s, Anaerobic Coverage Pseudomembranous Colitis
Linezolid Binds to 50s subunit, next in line for
Vanco resistance
 Aminoglycosides
Drugs Characteristics Side Effects
Gentamicin Bactericidal, Binds to 30s Subunit. Nephrotoxic, ototoxic
Tx for endocarditis
Tobramycin Tx for ocular infection
Streptomycin Tx for TB
Spectinomycin Tx for Drug-Resistant Gonorrhea
Amikacin Widest Spectrum of Activitiy
Pseudomonas Coverage
Narrow Therapuetic Window
Neomycin Treatment for Hepatic
Encephalopathy
 Sulfonamides
Drugs Characteristics Side Effects
Sulfamethoxazole Blocks dihydropteroate Synthase
Trimetroprim Blocks dihydrofolate synthase
TMP-SMX Sequential blockade in folate Hypersensitivity (SJS, TEN,
synthesis, Tx for UTI Kernicterus, Hemolysis
Sulfadiazine Tx for Burn
 Other antimicrobials
Drugs Characteristic Side Effects
Metronidazole Anaerobic and Antiprotozoal Disulferam Reaction, Metallic Tase,
Coverage, Tx for Neurotoxicity
Pseudomembranous Colitis
Nitrofurantoin Tx for UTI Pulmonary Fibrosis
Anti-TB
Drugs Characteristics Side Effects
Isoniazid Cidal, Inhibits Mycolic Synthesis Neurotoxic, Hepatotoxic,
Sideroblastic Anemia, Drug Induced
Lupus, CYP450 Inhibitor
Rifampicin Cidal, Inhibits DNA-dependent RNA Red Orange Urine, Hepatotoxic,
Polymerase CYP450 Inducer
Ethambutol Static, Inhibits arabinoglactan Visual Dysfunction, retrobulbar
synthesis neuritis, color blindness
Pyrazinamide Static but Cidal on actively dividing Hyperuricemia, Most Hepatotoxic
MTB
Streptomycin Cidal, Binds to 30s Nephrotoxic, Ototoxic
 Anti Malarials
Drugs Characteristics Side Effects
Chloroquine Primary Drug for Malaria, Retinal Damage, hearing loss
Prevents heme polymerization into
Hemozoin
Quinine Chloro-resitant, Severe Malaria. Hypoglycemia, Cinchonism
DOC for Pregnant
Primaquine Eradication of Hypnozoits for Vivax
and Ovale
Malarone, Meflorquine Chemoprophylaxis for Chloro-
resistant Areas
Doxycycline Chemoprophylaxis for Multi Drug
Resistant Areas
Artemeter/Lumefrantine DOC for Malaria in Ph
 Antiprotozoal
Drugs Remarks
Diloxanide Furoate Asymptomatic Cyst Carriers of E. Histolytica
Metronidazole Amebic Dysentery, Trichomonas, Bacterial Vaginosis
Nitazoxanide Cryptosporidium
TMP-SMX Pneumocystis Jiroveci
Pyrimethamine-Sulfamethoxazole Toxoplasmosis
Suramin + Melarsoprol African Sleeping Sickness
Nifurtimox Chagas
Na Stibogluconate Leishmaniasis
 Antihelminthic Drugs
Drugs Remarks
Mebendazole Inhibits helminthic microtubules, ovicidal alone
Albendazole Inhibits helminthic microtubules, ovicidal and larvicidal,
DOC for hydatid dse
DEC DOC For Filaria and Loa, Loa
Ivermectin Doc for Strongyloides and Onchocerca
Pyrantel Pamoate DOC for Enterobius
Thiabendazole DOC For Trichinosis
Praziquantel DOC for trematodes and cestodes, except
echinococcosis
Niclosamide Back up drug for Praziquantel