51121813 All Bacteria

ALL BACTERIA BACTERIA

Moraxella Catarrhalis

CHARACTERISTICS

gram (-) aerobic diplococcus. Oxidase (+)

DISEASE

otitis media, sinusitis in children

RESERVOIR / TRANSMISSION

normal flora

RESPIRATORY

gram (+) coccus in Strep throat → Streptococcal rheumatic fever, normal flora, chains or pairs. pyogenes (group infected acute postcatalase (-), lactose A antigen) persons streptococcal (+) glomerulonephritis

Corynebacterium diphtheriae

gram (+) clubshaped rods, aerobe

Bordetella pertussis

gram (-) coccobacillus, strict aerobe, mucosal surface pathogen

Mycobacterium tuberculosis

ACID-FAST, rod shaped, obligate aerobe, very slow growth, facultative intracellular

tuberculosis

gram (-) pleomorphic rod, small, facultative anaerobe. requires growth factor X (hemin) and V (NAD, NADP)

otitis media, sinusitis, bronchitis epiglottitis, pneumonia, meningitis, septic arthritis, cellulitis

Haemophilus influenzae (nonencapsulated) Haemophilus influenzae (Hib)

diphtheria

normal flora, humans only

whooping cough humans only pertussis

reservoir infected humans

Chlamydophila species

Chlamydophila psittaci

smallest free-living bacteria, NO CELL "walking WALL, pneumonia", pleomorphic, no tracheobronchitis gram stain small obligate INTRACELLULAR pathogen, gram (-), not seen on gram stain, cell wall lacks peptidoglycan layer, unable ot make ATP energy parasites

pneumonia or bronchitis parrot fever, psittacosis, ornithosis, pneumonia

β-lactamase

CLINICAL

DIAGNOSIS

respiratory droplets

acute inflammation of pharynx and tonsils, LTA, surface proteins F and M, β-hemolysis on blood sore throat, fever, exudative tonsillitis, anterior hyaluronic acid capsule, streptolysin, agar, bacitracin cervical lymphadenopathy, scarlatiniform rash exo-enzymes, pyrogenic exotoxins sensitive or fever

respiratory droplets

Heat-labile A-B exotoxin, ADP ribosyl transferase (blocks protein syn), diphtheria toxin is invasive

respiratory droplets

attachment, immobilization, destruction (murein) of cilia, Fha, Ptx (AB toxin - ↑ cAMP), pertactin, pili

Catarrhal stage: 1-2 wk, highly communicable, paroxysmal stage: 2-4 wk, paroxysmal cough, whoop. Convalescent stage: wks to mn

Inhalation of infectious aerosols

Mycolic acid, sulfolipids, cord factor, tuberculin + mycolic acid DAMAGE DONE BY HOST IMMUNE SYSTEM

primary TB: Ghon complex, progressive primary (active) TB, latent dormant TB, secondary (reactivation) TB: apex. Productive cough - bloody sputum, fever, weight low, night sweats

exotoxin → cell death, necrosis

lipopolysaccharides, IgA protease, polysaccharide capsule asymptomatic carriers

infants: passive maternal protection, poor response first 2 years, > 5 - disease uncommon

respiratory droplets

rusty sputum, typical lobar pneumonia

human respiratory tract

aerosol droplets

p1 adhesin, toxic metabolic products: hydrogen peroxide and superoxide radicals

hacking cough, dry → productive, slow resolution

infected humans

respiratory droplets

inhalation of zoonotic dried pathogen, secretions from mainly birds birds

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treat to prevent acute rheumatic fever: penicillin

Loeffler medium, pseudomembrane → obstruction and antitoxin serum selective tellurite suffocation, sore throat and pharyngitis, low therapy + antibiotics medium (- extra flora) grade fever, regional lymph nodes swollen (penicillin or --> black colonies bull neck. Toxin: myocarditis & cardiac macrolides: with dark halo. Toxin dysfunction, laryngeal nerve palsy, lower limb erythromycin) DTaP detection: Eleck polyneuritis vaccine immunodiffusion test

polysaccharide capsule, autolysin, pneumolysin O, peptidoglycan/ teichoic acids, adhesins, GOOD AT PICKING UP DNA

2 stages: elementary body (EB): infectious, survive outside, non reproductive. Reticulate body (RB): noninfectious, intracytoplasmic, reproductive form

TREATMENT

penicillin + β lactamase inhibitor (amoxicillinbronchitis or pneumonia in pts with underlying mostly skipped, blood clavulanic acid), 2nd, chronic lung disease or chocolate agar 3rd gen cephalosporin, TMPSMX, macrolide

normal flora

lancet-shaped, gram (+) communityStreptococcus diplococcus or in acquired normal flora, pneumoniae chains, pneumonia, OM, humans only (pneumococcus) fermentation adult meningitis metabolism Mycoplasma pneumoniae

respiratory droplets

VIRULENCE / PATHOGENESIS

asymptomatic to pneumonia or bronchitis, complications: atherosclerotic vascular diseases

charcoal-blood agar (Bordet-gengou potato agar) , pearl-like erythromycin DTaP colonies, direct vaccine fluorescence antibody test CXR, PPD: >5mm = isoniazid, rifampin (+) in HIV, >10mm = (4m), pyrazinamide (+) in high-risk. (2m), ethambutol >15mm = (+) in lowBCG Vaccine, risk, ziehl-Neelson isoniazid stain, Lowensteinprophylaxis Jensen medium amoxicillin + chocolate agar (X and clavulanic acid V factors), satellite phenomenon, latex 3rd gen agglutination test cephalosporin Hib PRP conjugate vaccine OM: amoxicillin + α-hemolytic on blood clavulanic acid. agar, not typeable Pneumonia/meningiti (A/B), Optochins: 3rd gen sensitive, bile soluble, cephalosporin + surface capsule vancomycin PPV, PCV7 vaccine Eaton's media (sterols), serological tests

tetracycline or macrolide

serological tests, isolation is difficult

macrolides (azithromycin) or tetracyclines (doxycycline)

serodiagnosis by complement fixation test

tetracycline or erythromycin

URINARY TRACT INFECTIONS

URINARY TRACT INFECTIONS

Enterobacteriaceae gram (-) rods, facultative anaerobes, catalase (+), oxidase (-), nitrite (+)

RESPIRATORY

ALL BACTERIA BACTERIA

CHARACTERISTICS

Legionella pneumophila

weakly gram (-) rods, water organisms (45C), complex nutritional requirements, aerobic, motile

Klebsiella pneumoniae

enterobacteriaceae family, gram(-) rod, lactose (+)

Pseudomonas aeruginosa

gram(-) rod, aerobic, motile, minimal nutritional requirements

Burkholderia pseudomallei Burkholderia cepacia

gram (-), aerobic rod

Acinetobacter spp

gram (-) coccobacilli

Bacillus anthracis

aerobic gram (+), spore forming, nonmotile

Escherichia coli

Klebsiella pneumoniae

DISEASE

opportunistic pathogen

Serratia (marcescens)

lactose (+)

Staphylococcus Saprophyticus

gram (+) cocci, clusters, catalase (+), coagulase (-)

Enterococcus faecalis (80%)

respiratory ubiquitous in secretions, environment direct contact, fomites

melioidosis, acute pneumonia soil, ponds, opportunistic pathogen - same rice paddies, zoonotic as P. aeruginosa, causes serious infections

inhalation, inoculation

anthrax

DIAGNOSIS

TREATMENT

fever, chills, non-productive cough, chest pain, HA, mental confusion, diarrhea

BYCE (buffered charcoal yeast extract), requires Lcys, Fe, pH 6-9, slow growth 2-5 days, SILVER STAIN

macrolides (erythromycin), Pontiac fever - selflimiting

hacking cough, dry → productive, slow resolution. DM at high risk

mucoid colonies

3rd gen cephalosporins

unknown

resembles TB - abscesses and granulomas

β-lactams or tetracyclines, high mortality if untreated

pneumonia, wound infections, UTI, sepsis

case-by-case fluoroquinolones box car chains, large (ciprofloxacin) cellnonhemolytic colonies free vaccine - used in high-risk

ubiquitous, zoonotic

polypeptide capsule, spore, exotoxin: EF, LF, PA (adenyl cyclase)

normal flora

FimH (cystitis) - FIMBRIAL ANTIGEN, P-pilus (nephritis), capsule, hemolysin, aerobactin, LPS

MacConkey agar: lactose (+) - pink, EMB agar - LACTOSE (+): blue-black colonies

catheters

capsule, pili, endotoxin

MacConkey agar, mucoid

normal flora

peritrichous flagella - swarming, adhesins, endotoxin

MacConkey agar: clear

common cause normal flora and environment of nosocomial infections nosocomial normal flora and environment infections UTIs sexually active young endogenous women

nosocomial gram (+) infections, UTI, diplococci or short endocarditis (pt chains, catalase with damaged (-), Lancefield's heart valves), group D antigen wound infections, bacteremia

CLINICAL

blue-green colonies, pili, capsule, endotoxin: fever, productive cough, weight loss, breathing pyocyanin, antipseudomonal lipopolysaccharide, tissue damage: difficulties and cyanosis, complications: polyverdin, or PNC (carbenicillin) + exotoxin A (AB - ↓ protein syn), malignant otitis externa (DM), colonization fluorescein (green), aminoglycoside exoenzyme S, elastase, alkaline of cystic fibrosis patients fruity aroma, mucoid, (tobramycin) protease, cytotoxin, hemolysin UV light

nosocomial soil, water, sewage, animals, infections in normal skin, GI tract of pts or immunodeficient pt health care workers

community/hospita highly motile, l UTIs, pneumonia, Proteus mirabilis lactose (-), urease septicemia, wound (+) infections lactose (+), motile

VIRULENCE / PATHOGENESIS

inhalation of pneumonia, contaminated biofilms in low virulence, biofilms, prevents Legionnaire's aerosols, no water phagosome-lysosome fusion, lung disease and person-tosources damage and inflammatory response Pontiac fever person transmissions capsule, endotoxin - necrotic pneumonia, UTI, human colon and URT, from destruction of alveolar spaces, septicemia own flora abscesses, resistance plasmids

UTI, diarrheas/ dysentery, motile, lactose (+) Neonatal meningitis, septicemia UTIs, Lower non-motile, lactose respiratory tract (+) infection (lobar pneumonia)

Enterobacter

RESERVOIR / TRANSMISSION

adhesins, capsule, endotoxin adhesins, capsule, endotoxin adhesin, inflammation response

normal flora adhesins, toxins, enzymes

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dermal, respiratory, GI anthrax, possible sepsis

TMP/SMX - UTIs in hospital and acute uncomplicated UTI, acute community, uncomplicated pyelonephritis, complicated Fluoroquinolone brick-red colonies UTIs, asymptomatic bacteriuria, renal abscess complicated UTI, Cephalosporin γ-hemolysis, pregnancy novobiocin resistant

γ or α hemolytic, resistant to 40% bile salts, 6.5% to NaCl, bacitracin and Optochin.

Enterococcus faecium (20%)

Pseudomonas aeruginosa

aerobic gram (-) rod, motile, oxidase (+), lactose (-)

opportunistic infections

ALL BACTERIA RESERVOIR / TRANSMISSION

VIRULENCE / PATHOGENESIS

adhesins, toxins, enzymes

CLINICAL

normal flora

ubiquitous in environment

polysaccharide capsule, endotoxin, adhesin, exotoxins

infective endocarditis, etc…

normal flora

Protein A - (-) phagocytosis. Fibrinogen-binding protein clumping factor. Coagulase - fibrin clot. Cytotoxic toxins - pore-forming toxins. Enterotoxins A-E: gastroenteritis, TSST-1, Exfoliations skin infections

OTHER GRAM (-) ORGANISMS: HACEK

DIOVASCULAR INFECTIONS

CARDIOVASCULAR INFECTIONS

Staphylococcus epidermidis

gram (+) cocci, clusters, catalase (+), coagulase (-)

catheter and prosthetic device infections, IE in IV drug users and prosthetic valve IE

normal flora

biofilm

normal flora, dental caries

low virulence, dextran-mediated adherence - biofilm → damaged heart valve surfaces, FimA surface adhesin, lack capsule

most common gram (+) cocci, cause of Viridans chains, catalase subacute IE in Streptococci (-), lack capsule and pts with (many, do not lancefield antigens, abnormal or need to identify) no serologic group damaged heart valves Enterococcus faecalis (was classified as streptococcus)

gram (+) cocci, single cells, diplococci or short chains, catalase (-), lancefield antigen: group D

nosocomial infections, UTIs, wound infections, bacteremia, endocarditis in pts with damaged heart valves

normal intestinal flora

Streptococcus Bovis

gram (+) cocci, chain, catalase (-), lancefield antigen: group D, also named non enterococcal group D organisms

subacute infective endocarditis

normal intestinal flora

Pseudomonas aeruginosa

IE in IV drug users aerobic gram (-) and patients with motile rod, oxidase prosthetic heart (+) valves.

Haemophilus aphrophilus Actinobacillus actinomycetemco fastidious organisms; requires 5-10% mitans carbon dioxide for growth + 3 wks Cardiobacterium incubation hominis

complications: embolization from infective endocarditis to parietal lobe, to lung

Subacute IE: w/n 2 weeks of dental or other procedure, low grade fever and chills, fatigue, anorexia weight loss, new or changing heart murmurs, skin lesions. Acute IE: acute onset of high-grade fever and chills, rapid onset of CHF, murmurs can be absent

associated with colon cancer

ubiquitous in environment

subacute IE (5%), complications may include massive arterial emboli and congestive heart failure

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TREATMENT

blue-green colonies, pyocyanin, polyverdin, or fluorescein (green), fruity aroma, mucoid, UV light

CARDIOVASCUL AR INFECTIONS gram (+) cocci, clusters, catalase Staphylococcus (+), coagulase (+), aureus salt tolerant, mannitol (+)

γ or α hemolytic, resistant to 40% bile DIAGNOSIS salts, 6.5% to NaCl, bacitracin and Optochin.

mannitol-salt agar: yellow colonies, βhemolysis

no hemolysis, NOVOBIOCIN sensitive

α-hemolytic, Optochin resistant, not bile soluble

not bile soluble, growth in 6.5% NaCl, α or γhemolysis

not bile soluble, no growth in 6.5% NaCl, α or γ-hemolysis

no fermentation, produces pigments BLUE-GREEN

methicillin resistant, some vancomycin emerging Native valve IE: PNC + gentamycin. IV drug use: nafcillin + gentamicin. Prosthetic valve IE: vancomycin + gentamicin

BACTERIA

nosocomial gram (+) infections, UTI, diplococci or short endocarditis CHARACTERISTICS DISEASE (pt chains, catalase with damaged (-), Lancefield's heart valves), group D antigen wound infections, bacteremia

Multiple (+) blood cultures (3-5 sets taken), if (+) for same organism - sensitivity testing. Culture (-): recent antibiotic use, fastidious organisms, fungi. Echocardiography - vegetations

URINARY TRACT INFECTIONS

pregnancy

vancomycin

major resistant problems for antibiotic problems

sensitive to penicillin

Eikenella corrodens Kingella kingae Bartonella species Polymicrobial IE Fungal endocarditis SKIN INFECTIONS

CHARACTERISTICS

DISEASE

B. quintana most commonly involved

BACTERIAmay include massive arterial emboli and congestive heart failure subacute IE (5%),ALL complications RESERVOIR / TRANSMISSION

VIRULENCE / PATHOGENESIS

CLINICAL

DIAGNOSIS

Native valve IE: PN

OTHER GRAM (-) ORGANISMS: HAC

CARDIOVASCULAR INFECTION

BACTERIA

fastidious organisms; requires 5-10% carbon dioxide for growth + 3 wks incubation

TREATMENT

homeless males with poor hygiene, must be considered in cases of culture-negative endocarditis among individuals whoa re homeless

most common combo: Pseudomonas observed in cases of IV drug users IE, the cardiac surgery mortality rate is twice that associated with single-agent IE. + enterococci Generally found in IV drug users and intensive care unit patients who receive broad spectrum antibiotics, blood cultures often negative, causes subacute IE. Most common organisms of both fungal valve IE and fungal prosthetic valve IE are: Candida spp, and Aspergillus spp.

fibronectin-binding proteins, collagen binding proteins, clumping factors (A, MSSA: nafcillin, B), teichoic acids, capsule, protein A Furuncles, carbuncles - neck, face, axillae, MRSA: person-to- binds Fc, prevents complement, buttocks. NTSS associated with tampons, β-hemolysis, mannitol vancomycin, VRSA: person enzymes, exotoxins, inflammatory scalded skin syndrome in neonates, bullous salt agar, 7.5% NaCl linezolid, Synercid, response, superantigen: TSST-1, impetigo is localized form. daptomycin enterotoxins, ETA, ETB, exfolatins produce bullae impetigo, M-protein, F-protein and lipoteichoic HONEY CRUSTED LESIONS - involves erysipelas, acid, hyaluronic acid capsule, gram (+), chain normal flora, dermal lymphatics, pain and systemic Streptococcus respiratory cellulitis, streptococcal pyrogenic exotoxins, forming cocci and infected manifestation, necrotizing fascitis "fleshβ-hemolysis penicillin, macrolide pyogenes necrotoxic fasciitis droplets superantigens, streptolysin S + O, diplococci persons eating bacteria", scarlet fever: strawberry - gangrene, scarlet exoenzymes, peptidoglycan + teichoic tongue, diffuse erythematous rash, TSS fever acids blue-green colonies, antipseudomonal pyocyanin, aerobic gram (-) "Hot tub: capsule, biofilm, lipopolysaccharide blue-green pus, grape-like odor, inflamed penicillin Pseudomonas polyverdin, or motile rod, oxidase folliculitis, burn ubiquitous and lipid A, A-B toxin, exoenzymes, follicles from neck down, shallow puncture (carbenicillin) + aeruginosa fluorescein (green), (+) wounds pili wound through tennis shoe sole aminoglycoside fruity aroma, mucoid, (tobramycin) UV light paucibacillary/tuberc uloid: Dapsone + Paucibacillary (tuberculoid) leprosy: central obligate intracellular parasite of rifampin ~6 months. Mycobacterium healing, low infectivity, few rods, DTH to no growth on medium acid fast bacillus Leprosy reservoir: humans macrophages and Schwann cells. Multibacillary/leprom Leprae lepromin. Multibacillary (lepromatous) or tissue culture DAMAGE FROM HOST RESPONSE atous: Dapsone + leprosy: infectious, many rods, (-) lepromin rifampin + clofazimine ~2 years "box car chains" culture: large ubiquitous, zoonotic, lives in vegetative form, dormant spore, cutaneous anthrax: erythematous papule, colonies; NONfluoroquinolones Bacillus anthracis gram (+) rod, spore anthrax soil, causes anthrax in polypeptide capsule, PA, EF, LF black eschar surrounded by edema HEMOLYTIC, (ciprofloxacin) animals and humans M'Fadyean methylene blue stain or DFA WOUND INFECTIONS culture under anaerobic conditions, necrotizing and hemolytic toxins: large gram (+) Iron Milk Medium @ myonecrosis "GAS LECITHINASE ~ PHOSPHOLIPASE marked gas formation, "crepitance in tissue", surgery, amputation, Clostridium rods, spore, strict 45ºC → stormy GANGRENE", ubiquitous in soil, flora C ~ ALPHA TOXIN - splits systemic signs: fever, hemolysis, hypotension, penicillin, hyperbaric perfringens anaerobes, lactose fermentation, blood cellulitis phospholipid molecles., renal failure, shock, death O2 chamber (+) only agar - characteristic enterotoxins, DNase, hyaluronidase double zone of hemolysis

ANAEROBIC GRAM (+)

WOUND INFECTIONS

SKIN INFECTIONS

folliculitis, gram (+) cocci, furuncles, clusters, catalase carbuncles, Staphylococcus human skin (+), coagulase (+), impetigo, scalded aureus and mucosa salt tolerant, skin syndrome, mannitol (+) toxi shock syndrome

Actinomyces (israelii)

gram (+) rods, facultative or strict anaerobes

actinomycosis

part of oral, intestinal and vaginal human flora

low

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anaerobic conditions, sulfur granules. long granulomatous lesions, suppurative, branching filaments, abscesses, sulfur granules: YELLOW PUS, slow growth ~2 weeks, dental extraction or trauma white colonies: molar tooth appearance

surgical drainage, penicillin or amoxicillin

ANAEROBIC

BACTERIA

Peptostreptococcus

ANAEROBIC GRAM (-)

WOUND INFECTIONS

ALL BACTERIA CHARACTERISTICS

gram (+) cocci, anaerobic

Bacteroides fragilis, pleomorphic Fusobacterium anaerobic gram (-) nucleatum, rods Prevotella melaninogenica Pasteurella multocida

Bartonella henselae

DISEASE

CLINICAL

Rickettsial Diseases/Rickettsiosis SYSTEMIC INFECTIONS

Rickettsia akari (Spotted fever group)

Rickettsia prowazekii (Typhus group)

small gram(-) rods; take gram staining weakly; obligate INTRACELLULAR pathogens; zoonotic Rickettsia typhi pathogens (Typhus group) Orientia tsutsugamushi (Scrub typhus group)

TREATMENT

mixed, skin and soft-tissue infections

normal human flora

endogenous

flora of animals

animal bites

systemic infection in immunocompromised pts

reservoir: animals

cat scratches, bites, contact with fleas

cutaneous papules or pustules at inoculation site → painful regional lymphadenopathy, Bacillary angiomatosis in IC - pts

rods in lymph nodes, culture usually negative, definitive dx by serologic tests

antibiotics not indicated

wound infections after exposure to contaminated seawater - necrotic cellulitis, gastroenteritis and septicemia after consumption of raw oysters

culture: requires salt for growth media: Thiosulfate citrate bile salts sucrose agar (TCBS), ID biochemical tests

tetracycline (doxycycline)

5-10 days incubation. EARLY: Flu-like symptoms; LATER: petechial-hemorrhagic rash (first on extremities → spread to entire body); various organs failures (2nd & 3rd febrile day). Fever + Rash + Previous tick bite

Clinical presentation + Serologic tests (indirect immunofluorescence assay) (high Ig titers by the 7th day of illness); PCR (most rapid and specific); Immunostaining (70%)

Tetracycline (doxycycline)

cat-scratch disease

found in salt water, oysters

capsule, fimbriae, succinic acid, extracellular enzymes

polar flagella, polysaccharide capsule

illness when native host defenses and anatomical barriers are altered, progress to myonecrosis

SYSTEMIC INFECTIONS

Rickettsia rickettsii (Spotted fever group)

DIAGNOSIS

anaerobic conditions, gram (+) in pairs or brain abscesses, sinusitis, endocarditis, chains, rich media for osteomyelitis, intraabdominal infections, pelvic culture, long infections, skin and soft tissue infections incubation time 5-7 days

part of normal human flora; oral, GI, GU, skin

gram (-) rods, curved, facultative Vibrio vulnificus necrotic cellulitis anaerobe, oxidase (+)

WOUND

VIRULENCE / PATHOGENESIS

infection at normally sterile sites

gram (-) coccobacilli, localized cellulitis small, facultative and lymphadenitis anaerobes gram (-) rods, short, aerobes

RESERVOIR / TRANSMISSION

Tick (Dermacentor), Infect vascular Wild rodents, Mortality: 5-7% Rocky mountain American dog endothelial cells → domestic delayed therapy to (1) induced spotted fever tick (eastern animals 2nd week, ~25% if (April → Sept) US), Rocky Mt endocytosis (2) (dogs), ticks untreated. lysis of wood tick phagosome (western US) membrane phospholipase A (3) replication in host cell Wild rodents, Mouse mite cytoplasm (4) lysis benign, self-limited Rickettsialpox of host cell → rodent mites (transovarian) disease, not fatal vascular damage (hemorrhage, edema), LPS weak endotoxin Epidemic typhus, activity, vasculitis exit: cell lysis Brill-Zinsser Humans; Human body and thrombosis disease flying (around all the Mortality: 10-60% louse (Recrudescent squirrels body). if untreated typhus) IMMUNITY: both humoral and cell mortality rate mediated Endemic typhus Rats Rat flea rare even with important - after (Murine typhus) untreated recovery - solid and lasting Mite larva immunity Rodents, mortality ~30% in Scrub typhus (chigger) rodent mites untreated (transovarian)

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Phase1: (~1 wk) local proliferation → eschar at bite site; Phase2: (~3-7d) dissemination → flu-like symptoms + fever + generalized rash (randomly distributed, papulovesicular → eschar, exanthem ~ chicken pox)

anaerobic culture, foul odor

penicillin + broad spectrum

metronidazole, surgery

amoxicillin + βlactam inhibitor

Tetracycline (doxycycline) + chloramphenicol can speed recovery (benign)

(~8d) Flu-like symptoms; maculopapular Clinical presentation + rash (first on trunk → spread to extremities); Tetracycline Serologic tests, complications: myocarditis, CNS (doxycycline) or typhus (indirect dysfunction; Recrudescent typhus = (10-40 fluorescent antibody chloramphenicol, yrs later) endogenous secondary infection by vaccine for high-risk test, latex R. prowazekii persisting in pop agglutination tests). reticuloendothelial cells NO STAIN Tetracycline (1-2 wk) Same as Epidemic typhus but milder; INTRACELLULAR (doxycycline) and rash not always present chloramphenicol (1-3 wks) Necrotizing eschar at bite site; flulike symptoms; maculopapular rash (first on trunk → spread to extremities) + generalized lymphadenopathy

Tetracycline (doxycycline) or chloramphenicol

SYSTEMIC INFECTI

ALL BACTERIA BACTERIA

CHARACTERISTICS

Human Monocytic Ehrlichiosis

Ehrlichia chaffeensis

Ehrlichiosis

DISEASE

Anaplasma phagocytophila

Human Granulocytic Ehrlichiosis

Ehrlichia ewingii

RESERVOIR / TRANSMISSION

Deer, dogs Sheep, cattle, rodents, bisons, deer… Dogs, ticks

VIRULENCE / PATHOGENESIS

CLINICAL

mononuclear leukocytes (monocytes, macrophages)

Infect leukocytes → (1) phagocytosis (2) Similar to RMSF but generally without rash, Inhibition of granulocytes 5-10 days, leukopenia, thrombocytopenia, phagosome(neutrophils > elevated liver enzymes. Severe: prolonged Black legged lysosome fusion + eosinophils) fever, renal failure, disseminated intravascular tick (Ixodes) multiplication in (higher morality ~ coagulopathy, meningoencephalitis, adult cytoplasmic 10%) respiratory distress syndrome, seizures, coma. vacuoles - Morula Mortality ~2-3% same - pts with (3) Host cell + underlying Lone star tick phagosome lyses immunosuppression Lone star tick

Enterobacteriaceae

Infect macrophages=> (1) phagocytosis Sheep, Small gram(-) (2) phagosomegoats, cattle resistant to heat pleomorphic rod; lysosome fusion; (excreted in and drying, intracellular Q. fever; Chronic Inhalation of but bacteria Flu-like symptoms, rarely rash; pneumonia; milk, urine, Proliferation in Coxiella burnetii pathogen with Q fever dust containing survive and hepatitis; endocarditis (Chronic form - 1-20 feces, respiratory tract extracellular (Endocarditis) pathogen multiply inside y, high mortality ~65%) amniotic then dissemination "spore-like" form; acidic fluids and to other organs zoonotic pathogen phagolysosome placenta (3) Host cell + phagolysosome lyses

Yersinia pestis

EMIC INFECTIONS

Francisella tularensis

Gram(-) rod, lactose (-), oxidase (-), catalase (+), coagulase (+), nonmotile, bipolar staining; facultative intracellular pathogen; zoonotic pathogen

DIAGNOSIS

TREATMENT

Clinical presentation + Microscopy: Giemsa stain. (Morulae) + Serologic tests: IFA (high IgM or IgG titers by the 2nd wk of illness), PCR

Tetracycline (doxycycline)

Acute: tetracycline Serologic tests (doxycycline); antigenic variation => Chronic: acute disease: high (doxycycline + titer of phase II quinolones for 4 yrs antigen; chronic or doxycycline + disease: high titers of hydroxyphase I and II chloroquine 1.5 to 3 antigens; PCR yrs), vaccine for high risk pop

Virulence plasmids; Changes in genes expression in response to environmental changes (1) Changes in flea behavior: yersinia murine Bubonic plague: flu-like symptoms; toxin (survival), low T - fibrinolysin & Multiplication of bacteria in regional lymph Serologic tests: direct phospholipase (agglutination); (2) node => suppurative lymphadenitis = "Bubo" immunofluorescence Wild Flea bite; Survival in human body: Capsule (F1 (~70% M untreated); Pneumonic plague: flutest (rapid, presence of Streptomycin, Plague: Bubonic, rodents direct contact; protein), plasminogen activator: like symptoms + cough, bloody sputum, F1); microscopy: gram tetracycline, and Pneumonic & (Sylvanic respiratory prevents opsonization, important for dyspnea and cyanosis (2-3rd day death due to stain or Giemsa chloramphenicol, Septicemic cycle); Urban droplets (only dissemination (3) Damage: Type III septic shock); Septicemic plague: bacteremia bipolar staining, isolation for 72 hours rats (Urban pneumonic secretion system (Yop proteins: without buboes => flu-like symptoms+ culture: highly cycle) plague) Lcr, Ysc) suppress cytokine bleeding into skin and other organs => dark infectious production, cytotoxic effect; discoloration (40% M in treated, 100% in endotoxin (septic shock); untreated) yersiniabactin (obtain iron from host); intracellular grow in reticuloendothelial cells

Small gram(-) rod, aerobe, require cysteine, facultative intracellular Wild animals, Tularemia (rabbit pathogen; zoonotic ticks, deer or deer fly fever) pathogen, oxidase fly (-), urease (-), nonmotile, thin lipid capsule

Infects reticuloendothelial organs: Serologic tests; PCR, Tick or fly bite, Ulceroglandular form: 75% painful ulcerating multiplication in macrophages, gram stain direct contact, lesion at site of infection; Oculoglandular hepatocytes and endothelial cells => unsuccessful, requires inhalation, form: 1% purulent conjunctivitis + necrosis and granuloma production in cysteine-glucose ingestion of lymphadenopathy; also Pneumonic, areas of multiplication; Survival: blood agar - tiny contaminated Gastrointestinal & Septicemic forms (10inhibition of phagosome-lysosome transparent colonies, food or water 15%, more severe). Untreated ~5-30% M fusion; antiphagocytic lipid capsule culture is hazardous

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Streptomycin

ALL BACTERIA CHARACTERISTICS

SYSTEMIC INFECTIONS

Small gram(-) rods, strict aerobes, Brucella spp. facultative (abortus, intracellular melitensis, suis) pathogens, zoonotic pathogens, no capsule, no spore

Bartonella quintana

Spirochetes infections

Borrelia burgdorferi

Borrelia recurrentis

other Borrelia spp.

ease - No invasion, no inflammation

Leptospira interrogans

Small gram(-) rod; aerobe, zoonotic pathogen

DISEASE

Brucellosis

Trench fever, bacillary angiomatosis, subacute endocarditis

RESERVOIR / TRANSMISSION

Domestic livestock

Humans, lice

VIRULENCE / PATHOGENESIS

CLINICAL

DIAGNOSIS

TREATMENT

Serologic tests, microscopy: Multiply in Inhibit insensitive, culture: Direct contact, Flu-like symptoms; night sweats (undulant macrophages in phagosomedifficult and hazardous. inhalation, fever); Chronic illness: body aches, headache, reticuloendothelial lysosome fusion; B abortus - needs ingestion of anorexia, depression… few physical findings system => impair cytokine CO2, antigen A, (-) by unpasteurized unless enlargement of reticuloendothelial granulomas => production; dye thionine, B. dairy products organs. (M is low ammonium production) → Inflammation of gastric mucosa → Tissue destruction

Ingestion of preformed toxin (rice)

Heat-stable enterotoxin (if spore Onset microscopy, culture, urease test; Stool antigen test; Urea breath test; PCR

TREATMENT

Fluoroquinolones (ciprofloxacin), TMP/SMX

Proton pump inhibitor + clarithromycin + amoxicillin or metronidazole

Isolation of organism Self-limiting; Fluid + from implicated food, electrolyte β-hemolysis on blood replacement agar

Ingestion of Heat-labile enterotoxin (germination food Incubation time >6h - Watery diarrhea, of spore + toxin production in contaminated nausea, abdominal cramps intestinal tract) with spore Ingestion of Gram(+) cocci in preformed Heat stable enterotoxin → acute Isolation of toxin Self-limiting; Fluid + Staphylococcus Staphylococcal Normal Onset mucopurulent d/c, fibrosis, scarring infiltrates, corneal scarring in chronic form; ocular-genital contact, sexually active - preceded by genital infection. acquired from infected mom Newborn: swelling of eyelids, copious purulent d/c

trachoma, Direct contact; hand to eye, urogenital contaminated clothing, infections (Sero Aflies C)

Chlamydia trachomatis

small obligate INTRACELLULAR, no PG layer; elementary & reticulate bodies

inclusion conjunctivitis (sero D-K)

lymphogranuloma venereum (sero L1 - L3)

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azithromycin or doxycycline, erythromycin (newborn).

BACTERIA

Other Eye Infections

Neisseria gonorrhoeae

CHARACTERISTICS

Aerobic gram (-) diplococci, beanshaped, no capsule, facultative intracellular

Pseudomonas aeruginosa (gram (-) rod) Contact lens-related Acanthamoeba spp.

DISEASE

RESERVOIR / TRANSMISSION

Gonococcal ophthalmia neonatorum

DIAGNOSIS

TREATMENT

ceftriaxone; Neonatorum prophylaxis: silver nitrate or erythromycin or tetracycline

keratitis

immunocompromised Ocular toxocariasis - retinal detachment River blindness, sclerosing keratitis, chorioretinitis African eye worm

Gonorrhea

Aerobic gram (-) diplococci, beanshaped, no capsule, facultative intracellular

PID Rectal & Pharyngeal ophthalmia neonatorum

Transmissio n

F: Cervix, ~50% asymptomatic, Untreated → PID, ectopic pregnancy, salpingitis. M: Urethra, ~25% asymptomatic, purulent strict human pathogen, urethral discharge and dysuria, Untreated pili: adhesion, sexual or intimate contact → epididymitis, prostatitis, periurethral inhibit gram smear from abscesses. Both untreated → infertility, phagocytosis. genital site in disseminated infection, anorectal infection, OMPs (outer Attachment and cytoplasm of membrane invasion of non pharyngitis, conjunctivitis and dissemination neutrophils, sensitivity third generation proteins): ciliated epithelial spread of organisms along fever, lower abdominal pain, and specificity: 95% in cephalosporins fallopian tubes (salpingitis), serotyping, Opa cells → survival complications: infertility or ectopic M, 50% in W, nucleic (ceftriaxone), proteins in submucosa → pelvic cavity (peritonitis, pregnancy due to scarring of fallopian acid amplification resistance to first adherence, spread and abscesses) tubes tests, culture: line drugs (also antigenic variation, dissemination Thayer-Martin agar treat chlamydia) both usually asymptomatic, tenesmus, PorB prevent (inflammation and linked to sexual practice (chocolate, antibiotics discharge, rectal bleeding, sore throat phagolysosome local damage) to normal flora, 35°C + fusion, IgA CO2) acute purulent conjunctivitis, lid edema, protease, LPS acquired at birth erythema, parked purulent discharge and LOS

disseminated gonococcal infections

Chlamydia trachomatis (all biovars but L)

CLINICAL

bacterial keratitis, scleral abscess, endophthalmitis

Toxocara canis Onchocerca volvulus Loaloa

Neisseria gonorrhoeae

VIRULENCE / PATHOGENESIS

at birth from infected mom → attach & invade epithelial cells; Pili + from conjunctival fluid PorB/Opa (adhesion/protection); IgA or surface scrapings; protease (colonization); Antigenic acute purulent conjunctivitis acquired at birth: gram stain/culture; variations → escape immune lid edema, erythema, marked purulent d/c Thayer-Martin agar, surveillance; LPS & LOS GLUCOSE (+) (inflammation); no capsule → severe inflammatory response

Fungal infections

Urethritis and Cervicitis, PID

EY

Bacterial Conj

ALL BACTERIA

D-K: urogenital infections (noninvasive), AC: trachoma. Other: inclusion conjunctivitis, small obligate INTRACELLULAR, infant pneumonia no PG layer; elementary & reticulate bodies

generally in women, leading cause of purulent arthritis, large necrotic gray skin lesions

close personal contact

EB: infectious, outside, nonreproductive, RB: noninfectious, intracytoplasmic, reproductive form. Intracellular replication, no phagolysosome fusion, LPS

spread by direct contact → tropism for epithelial cells 3.3 F (15-19) > M. F: 70% asymptomatic, (F: endocervix, cervicitis ± urethritis: mucopurulent upper genital tract discharge ± dysuria. Complications: PID in; both: urethra, (40% untreated), permanent damage → rectum, chronic pelvic pain, infertility, and ectopic conjunctiva) → pregnancy. M: 25% asymptomatic, infection, severe urethritis: dysuria + thin urethral discharge, inflammatory complications: rare, spread to epididymis → response → pain, fever, and sterility necrosis, fibrosis, scarring

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collection of epithelial cells, direct azithromycin or immunofluorescence: doxycycline. Ebs are bright yellow Pregnant and young green dots under UV, children: NAAT (urine), enzyme erythromycin. immunoassay, Follow-up: repeat culture: iodine staining testing (NAAT) 3 of glycogen inclusion months bodies - dark brown

BACTERIA

small obligate INTRACELLULAR, no PG layer; elementary & reticulate bodies CHARACTERISTICS

Chlamydia trachomatis (L biovar)

DISEASE

L: Lymphogranuloma venereum

small, pleomorphic, gram (-) rods

Chancroid

Syphilis Treponema pallidum

thin, tightly coiled spirochetes, not intracellular

STDs

Genital Ulcers

Haemophilus ducreyi

ALL BACTERIA

Congenital Syphilis

Klebsiella granulomatis

Vaginal Discharge

Trichomas vaginalis

intracellular encapsulated gram (-) bacillus

protozoa flagellate

round/oval budding yeasts, polymorphic: y, Candida albicans hyphae, and pseudohyphae

Granuloma inguinale or Donovanosis

RESERVOIR / TRANSMISSION

sexual

VIRULENCE / PATHOGENESIS

CLINICAL

L-serovar are invasive → travels via lymphatics, multiply w/n mononuclear phagocytes in regional lymph nodes, characteristic granuloma formation → necrotic lesions, inflammation spread to surrounding tissues

small painless ulcer at site of infection, spontaneously heals. Second stage: inguinal adenopathy, painful buboes → draining fistulas.

tender papule with erythematous base → painful ulceration with associated inguinal lymphadenopathy. F: often asymptomatic, often diagnosed in men

sexual contact

Primary: 1+ chancres at infection site, lots of spirochetes → painless ulcer, heals local primary spontaneously w/n 2 months, pt highly infection: skin or infections. Secondary: dissemination: fluouter membrane mucosal → slow only host = humans, like syndrome, lymphadenopathy, proteins: multiplication, susceptible to heat, drying generalized mucocutaneous adherence, endarteritis & and disinfectants, requires hyaluronidase: maculopapular rash, 1/3 → condylomata granulomas. close contact lata, highly infectious, resolve perivascular Dissemination spontaneously → latent stage (clinically infiltration, (lymph nodes and inactive). Tertiary: diffuse, chronic antigenically blood), quiescent unreactive. for months to inflammation → neurosyphilis, CV syphilis, gummas Tissue damage = years, late patient's immune syphilis: injury response due to prolonged intrauterine death, congenital hypersensitivity abnormalities, silent infections, most: born transplacental responses with rhinitis followed by rash

granulomatous ulcers that bleed on contact, inguinal lesions (10-15%)

sexual contact

F: frequently symptomatic → vaginitis, replicates by axostyle: purulent discharge, copious, foamy, foulbinary fission, attachment, smelling yellowish, vulvar and cervical only trophozoite sexual contact, humans only contact-dependent lesions, dysuria, itching. Pregnant: premature Trichomoniasis form, no cyst, host damage to rupture of membranes, preterm delivery, does not survive epithelium, not low birthweight. M: rarely symptomatic, in external invasive mild urethritis, mild discharge, slight burning environment after urination or ejaculation, ~ prostatitis

Vulvovaginal Candidiasis

normal oropharyngeal, GI, genital flora, endogenous or direct contact

mannoproteins: adherence, resistance F: pruritus and erythema of vulvar area, thick to phagocytosis, hyphae secrete cheesy vaginal discharge, itching of vulva. proteinases and phospholipases (kill M: 10% - balanitis: inflammation of glans epithelial cells, tissue penetration) penis, itchy rash on penis, rare: urethritis

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immunofluorescence: doxycycline. Ebs are bright yellow Pregnant and young green dots under UV, children: NAAT (urine), enzyme erythromycin. immunoassay, Follow-up: repeat DIAGNOSIS TREATMENT culture: iodine staining testing (NAAT) 3 of glycogen inclusion months bodies - dark brown

clinical, microscopy, DNA probe, culture: relatively insensitive, require x factor for growth

azithromycin, ceftriaxone, ciprofloxacin, or erythromycin

culture: no growth on artificial media, microscopy: darkfield microscopy (live motile bacteria), direct fluorescence antibody test, silver staining. Serology: nonspecific penicillin (cardiolipin, VDRL, RPR, measure IgG and IgM from damaged cells), specific (confirmation, FTAABS test, MHA-TP), enzyme immunoassays Wright or Giemsa stained: clusters or encapsulated coccobacilli in Doxycycline cytoplasm of mononuclear cells "Donovan bodies" vaginal, urethral, prostatic secretions: microscopy: wet mounts (motile), metronidazole or Giemsa stained, direct tinidazole (txt immunofluorescence partners, do not use antibody staining, during 1st trimester) Culture: most sensitive, diamond's medium, anaerobic, pH 5.5-6 (3-7 days) from discharge, microscopy: KOH: budding years and oral fluconazole, pseudohyphae, topical azole or culture: Sabouraud or nystatin, not blood agar, large recommended to smooth white colonies: treat sex partners rapid growth, "germtubes" formation after 2 hr

Vagi

ALL BACTERIA BACTERIA

Gardnerella vaginalis

CHARACTERISTICS

gram-variable rods, facultative anaerobes

DISEASE

RESERVOIR / TRANSMISSION

Bacterial vaginosis

VIRULENCE / PATHOGENESIS

CLINICAL

DIAGNOSIS

TREATMENT

shift in vaginal flora, lactobacillus spp replaced, increase risk: anything that can upset normal balance of bacteria

"non-specific vaginitis" ,white or gray vaginal discharge with unpleasant odor, dysuria, itching, or asymptomatic. Complications: PID, preterm delivery, low birthweight, increased susceptibility to HIV, STDs

white discharge, microscopy: clue cells, absence of lactobacilli, vaginal pH > 4.5, "whiff" test after adding KOH

metronidazole

Mycoplasma hominis

sexual contact

postabortal or postpartum fever, PID ~ fallopian tubes infection, self-limiting

Ureaplasma ureolyticum

sexual contact

F: chorioamnionitis and postpartum fever, M: non-gonococcal, non-chlamydial urethritis

urease production (distinguish from mycoplasma)

erythromycin or tetracyclines

intense itching and redness, bumps, blisters, and crusting

rash, burrows, isolation of mites, ova or feces in skin scrapings

topical permethrin (5%), wash everything, treat everyone

Sarcoptes scabiei

Phthirus pubis

human itch mite arthropod

genital scabies

insect

pediculosis pubis, lice or "crabs"

close - sexual contact

sexual

adult mites risk of 2nd create burrow in bacterial infection, upper layer of Norwegian epidermis, female scabies - more lay eggs in skin severe form burrow

Nit - egg, hard to see, attached to feeds on human hair, nymph itching in genital area, visible nits or crawling blood and baby louse, adult lice multiplies rapidly females lay nits, larger than males

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special media - large tetracycline (resistant fried-egg colonies to erythromycin)

lice-killing shampoo (pediculicide) 1% permethrin or pyrethrin

ALL BACTERIA BACTERIEAL RESPIRATORY INFECTIONS BACTERIA Sinusitis & Otitis Pharyngitis Epiglottis Media Streptococcus Streptococcus Haemonphilus pyogenes (strep Pneumoniae influenzae throat) Corynebacterium Haemonphilus diphtheriae influenzae (diphtheria) Moraxella catarrhalis

Pertussis Bordetella pertussis

Bronchitis

Tuberculosis

Streptococcus Pneumoniae Haemonphilus influenzae Mycoplasma pneumoniae

Mycobacterium tuberculosis

Pneumonia Streptococcus Pneumoniae Haemonphilus influenzae Staphylococcus aureus Klebsiella pneumoniae Chlamydophil pneumoniae & psittaci Mycoplasma pneumoniae Legionella pneumonia Pseudomonas aeruginosa Pulmonary Anthrax Bacillus anthracis

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