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MICROBIOLOGY REVIEW NOTES

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MICROBIOLOGY REVIEW NOTES

CULTURE AND STERILISATION

CONTENTS CULTURE AND STERILISATION ...................................................................................................................................... 9 CULTURE ................................................................................................................................................................... 9 STERILISATION........................................................................................................................................................... 9 DISINFECTION ......................................................................................................................................................... 10 BACTERIAL GENETICS .................................................................................................................................................. 11 GENERAL FEATURES OF BACTERIA.......................................................................................................................... 11 GRAM POSITIVE AND GRAM NEGATIVE ORGANISMS............................................................................................. 12 LIGAND AND HOST RECEPTORS FOR MICROORGANISMS ...................................................................................... 12 MULTIPLICATION OF BACTERIA .............................................................................................................................. 13 BACTERIAL RESISTANCE .......................................................................................................................................... 13 BIOTERRORISM AND VESICANTS ............................................................................................................................ 14 BACTERIOLOGY ........................................................................................................................................................... 15 GENERAL FEATURES OF BACTERIA.......................................................................................................................... 15 FEATURES OF STAPHYLOCOCCUS ........................................................................................................................... 17 SPECIES OF STAPHYLOCOCCUS ............................................................................................................................... 18 DISEASES CAUSED BY STAPHYLOCOCCUS ............................................................................................................... 19 TOXINS OF STAPHYLOCOCCUS ................................................................................................................................ 19 STAPHYLOCOCCAL FOOD POISONING .................................................................................................................... 20 FEATURES OF STREPTOCOCCUS.............................................................................................................................. 20 SPECIES OF STREPTOCOCCUS.................................................................................................................................. 21 DISEASES CAUSED BY STREPTOCOCCUS ................................................................................................................. 22 TOXINS OF STREPTOCOCCUS .................................................................................................................................. 22 CROSS SENSITIVITY OF STREPTOCOCCAL ANTIGEN ................................................................................................ 23 ENTEROCOCCUS...................................................................................................................................................... 23 PNEUMOCOCCUS.................................................................................................................................................... 23 GENERAL FEATURES OF NEISSERIA ......................................................................................................................... 24 NEISSERIA GONORRHOEA ....................................................................................................................................... 24 NEISSERIA MENINGITIDIS........................................................................................................................................ 25 GENERAL FEATURES OF CLOSTRIDIA....................................................................................................................... 26 CLOSTRIDIUM PERFRINGENS .................................................................................................................................. 26 GAS GANGRENE ...................................................................................................................................................... 27 CLOSTRIDIUM TETANI ............................................................................................................................................. 27

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MICROBIOLOGY REVIEW NOTES

CULTURE AND STERILISATION

GENERAL FEATURES OF TETANUS........................................................................................................................... 27 MANAGEMENT OF TETANUS .................................................................................................................................. 28 PREVENTION OF TETANUS ...................................................................................................................................... 28 CLOSTRIDIUM BOTULINUM .................................................................................................................................... 29 BOTULISM ............................................................................................................................................................... 29 CLOSTRIDIUM DIFFICLE AND PSEUDOMEMBRANOUS COLITIS .............................................................................. 30 GENERAL FEATURES OF CORYNEBACTERIUM......................................................................................................... 30 CORYNEBACTERIUM DIPHTHERIA........................................................................................................................... 31 FEATURES OF DIPHTHERIA...................................................................................................................................... 31 MANAGEMENT OF DIPHTHERIA ............................................................................................................................. 32 HEMOPHILUS .......................................................................................................................................................... 33 BORDETELLA PERTUSSIS ......................................................................................................................................... 33 BRUCELLA................................................................................................................................................................ 34 BARTONELLA ........................................................................................................................................................... 35 ACTINOMYCES......................................................................................................................................................... 35 NOCARDIA............................................................................................................................................................... 36 LISTERIA .................................................................................................................................................................. 36 BACILLUS ANTHRACIS ............................................................................................................................................. 37 BACILLUS CEREUS.................................................................................................................................................... 38 LEGIONELLA ............................................................................................................................................................ 38 CAMPYLOBACTER.................................................................................................................................................... 39 HELICOBACTER ........................................................................................................................................................ 39 PASTEURELLA .......................................................................................................................................................... 39 FRANSCIELLA ........................................................................................................................................................... 40 YERSINIA.................................................................................................................................................................. 40 PSEUDOMONAS ...................................................................................................................................................... 41 BURKHOLDERIA....................................................................................................................................................... 42 GENERAL FEATURES OF ENTEROBACTERIACEAE .................................................................................................... 42 E.COLI ...................................................................................................................................................................... 42 PROTEUS ................................................................................................................................................................. 43 SALMONELLA .......................................................................................................................................................... 43 TYPHOID.................................................................................................................................................................. 44 SHIGELLA ................................................................................................................................................................. 45 FEATURES OF VIBRIO .............................................................................................................................................. 46

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MICROBIOLOGY REVIEW NOTES

CULTURE AND STERILISATION

CHOLERA ................................................................................................................................................................. 47 HALOPHILIC VIBRIO ................................................................................................................................................. 47 ATYPICAL MYCOBACTERIA ...................................................................................................................................... 48 GENERAL FEATURES OF RICKETTSIA ....................................................................................................................... 49 ENDEMIC TYPHUS ................................................................................................................................................... 49 EPIDEMIC TYPHUS................................................................................................................................................... 49 SCRUB TYPHUS........................................................................................................................................................ 50 RICKETTSIAL POX..................................................................................................................................................... 50 ROCKY MOUNTAIN SPOTTED FEVER ....................................................................................................................... 50 Q FEVER................................................................................................................................................................... 51 EHRILICHIA .............................................................................................................................................................. 51 CHLAMYDIA............................................................................................................................................................. 51 MYCOPLASMA......................................................................................................................................................... 52 NON VENERAL TREPONEMES.................................................................................................................................. 53 Yaw and Pinta ............................................................................................................................................................. 53 LEPTOSPIRA............................................................................................................................................................. 54 BORRELIA ................................................................................................................................................................ 54 VIROLOGY ................................................................................................................................................................... 55 GENERAL FEATURES OF VIRUS ................................................................................................................................ 55 HERPES VIRUS ......................................................................................................................................................... 57 PARVOVIRUS ........................................................................................................................................................... 58 EBSTEIN BARR VIRUS............................................................................................................................................... 58 CYTOMEGALOVIRUS ............................................................................................................................................... 59 ROSEOLA INFANTUM .............................................................................................................................................. 59 VARICELLA ZOSTER VIRUS ....................................................................................................................................... 59 ADENOVIRUS........................................................................................................................................................... 60 ROTAVIRUS ............................................................................................................................................................. 61 SMALL POX.............................................................................................................................................................. 61 PAPOVA VIRUS ........................................................................................................................................................ 61 POLIO VIRUS............................................................................................................................................................ 62 ENTEROVIRUS ......................................................................................................................................................... 63 COXSACKIE VIRUS.................................................................................................................................................... 63 INFLUENZA VIRUS ................................................................................................................................................... 63 MEASLES ................................................................................................................................................................. 64

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MICROBIOLOGY REVIEW NOTES

CULTURE AND STERILISATION

MUMPS ................................................................................................................................................................... 65 RABIES ..................................................................................................................................................................... 66 GENERAL FEATURES OF ARBOVIRUS....................................................................................................................... 67 DENGUE .................................................................................................................................................................. 67 CHIKUNGUNYA........................................................................................................................................................ 68 YELLOW FEVER ........................................................................................................................................................ 68 JAPANESE ENCEPHALITIS ........................................................................................................................................ 68 WEST NILE FEVER .................................................................................................................................................... 69 KYASANUR FOREST DISEASE ................................................................................................................................... 69 HANTA VIRUS .......................................................................................................................................................... 69 RESPIRATORY SYNCITIAL VIRUS .............................................................................................................................. 70 REOVIRUS................................................................................................................................................................ 70 RUBELLA .................................................................................................................................................................. 70 FEATURES OF HIV .................................................................................................................................................... 71 TRANSMISSION OF HIV ........................................................................................................................................... 72 EPIDEMIOLOGY OF HIV ........................................................................................................................................... 73 MANIFESTATIONS OF AIDS ..................................................................................................................................... 73 KAPOSI’S SARCOMA ................................................................................................................................................ 74 DIAGNOSIS OF AIDS ................................................................................................................................................ 75 TREATMENT OF AIDS .............................................................................................................................................. 75 PREVENTION OF HIV ............................................................................................................................................... 77 PRIONS AND SLOW VIRUS....................................................................................................................................... 78 MYCOLOGY ................................................................................................................................................................. 79 GENERAL FEATURES OF FUNGI ............................................................................................................................... 79 DIMORPHIC FUNGI.................................................................................................................................................. 80 DERMATOPHYTES ................................................................................................................................................... 80 CRYPTOCOCCUS ...................................................................................................................................................... 80 CANDIDA ................................................................................................................................................................. 81 PNEUMOCYSTIS JEROVECI ...................................................................................................................................... 82 BLASTOMYCOSIS ..................................................................................................................................................... 82 HISTOPLASMOSIS .................................................................................................................................................... 82 ASPERGILLUS........................................................................................................................................................... 83 MUCOR ................................................................................................................................................................... 83 MADURELLA ............................................................................................................................................................ 84

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MICROBIOLOGY REVIEW NOTES

CULTURE AND STERILISATION

SPOROTRICHOSIS .................................................................................................................................................... 84 CHROMOBLASTOMYCOSIS...................................................................................................................................... 84 PROTOZOA .................................................................................................................................................................. 84 GENERAL FEATURES OF PROTOZOA ....................................................................................................................... 84 ENTAMOEBA HISTOLYTICA ..................................................................................................................................... 85 AMOEBIC MENINGOENCEPHALITIS ........................................................................................................................ 86 GIARDIA................................................................................................................................................................... 86 LEISHMANIA............................................................................................................................................................ 86 TRYPANOSOMA....................................................................................................................................................... 88 TOXOPLASMA.......................................................................................................................................................... 89 BABESIOSIS.............................................................................................................................................................. 90 CRYPTOSPORIDIOSIS ............................................................................................................................................... 90 ISOSPORA ................................................................................................................................................................ 90 CYCLOSPORA ........................................................................................................................................................... 90 BALANTIDIUM COLI................................................................................................................................................. 90 FEATURES OF PLASMODIUM .................................................................................................................................. 91 FEATURES OF MALARIA .......................................................................................................................................... 92 EPIDEMIOLOGY OF MALARIA .................................................................................................................................. 93 DIAGNOSIS OF MALARIA ......................................................................................................................................... 93 TREATMENT OF MALARIA ....................................................................................................................................... 93 HELMINTHS ................................................................................................................................................................. 95 GENERAL FEATURES OF HELMINTH ........................................................................................................................ 95 CLONORCHIS ........................................................................................................................................................... 96 DIPHYLLOBOTHRIUM LATUM ................................................................................................................................. 96 FASCIOLA HEPATICA................................................................................................................................................ 96 FASCIOLOPSIS BUSKI ............................................................................................................................................... 96 ASCARIS................................................................................................................................................................... 97 TAENIA SOLIUM ...................................................................................................................................................... 97 NEUROCYSTICERCOSIS ............................................................................................................................................ 97 TAENIA SAGINATA................................................................................................................................................... 98 ECHINOCOCCUS ...................................................................................................................................................... 98 FEATURES OF FILARIASIS......................................................................................................................................... 99 MANAGEMENT OF FILARIASIS .............................................................................................................................. 100 ENTEROBIUS.......................................................................................................................................................... 100

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MICROBIOLOGY REVIEW NOTES

CULTURE AND STERILISATION

TRICHINELLA ......................................................................................................................................................... 100 GUINEA WORM ..................................................................................................................................................... 101 STRONGYLOIDES ................................................................................................................................................... 101 SCHISTOSOMA ...................................................................................................................................................... 101 TRICHURIS ............................................................................................................................................................. 102 HOOKWORM......................................................................................................................................................... 102

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MICROBIOLOGY REVIEW NOTES

CULTURE AND STERILISATION

KEY TO THIS DOCUMENT Text in normal font – Must read point. Asked in any previous medical entrance examinations Text in bold font – Point from Harrison’s text book of internal medicine 18th edition Text in italic font – Can be read if you are thorough with above two

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CULTURE AND STERILISATION

MICROBIOLOGY REVIEW NOTES

CULTURE AND STERILISATION CULTURE Father of medical microbiology Exceptions to Koch’s postulates NOT true about Koch’s postulates Resolution provided by light microscope Magnification of electron microscope up to Ultraviolet source is used in Nutrient broth is Fastidious organisms are grown by McConkey’s agar medium is NOT a selective media A substance when added to culture causes inhibition of multiplication but on removal causes enhanced growth In patient with UTI CLED cysteine lactose electrolyte deficient media is preferred over McConkey media because pH of Sabroud’s dextrose agar adjusted to Intracellular Organisms can NOT be cultured in cell free medium Does NOT grow in cell free media Viable non cultivable is used for NOT a method of cultivation of viruses Organism cannot be cultured

Robert Koch M.leprae, T.pallidum, N.gonorrhea, E.coli (cannot be grown in cell free media also) Antibiotics cure the disease 200 nm 1,00,000 Fluorescence microscope Basal media Enrichment media Differential media Blood Agar Bacteriostatic Promotes growth of staphylococcus aureus and candida 4-6 Virus, Chlamydia, Rickettsia Treponema pallidum, Pneumoystis jiroveci, Rhinosporidium seeberi M. leprae, Rickettisa, T. pallidum M.leprae, Treponema pallidum Chemically defined media Pneumocystis jiroveci, Rhinosporidium seeberi

STERILISATION Asepsis means Process of destroying all microbes including spores NOT a complete sterilization Most resistant to antiseptics Decreasing order of resistance to sterilization Sterilization of prion Reliably used for hand washing Savlon contains Algae growth in water controlled by NOT true about Phenol Sporicidal agents Sporicidal

Absence of pathogenic microbes Sterilization Sodium hypochlorite Prion Prions, bacterial spores, bacteria Heating at 134*C for 5 hours, 2N concentration NaOH Chlorhexidine, Isopropylalcohol, Cresol Cetrimide + chlorheximide Bleaching powder Phenol require organic matter to act Glutaraldehyde, Formaldehyde, Ethylene oxide, Halogens Glutaraldehyde, Formaldehyde, Chlorine dioxide

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CULTURE AND STERILISATION

MICROBIOLOGY REVIEW NOTES Spores of bacteria are destroyed by Glutaraldehyde is Hypochlorites are Principle of autoclave Autoclaving is done at Operating temperature in a ethylene oxide sterilization during warm cycle Used as control during plasma gas sterilization Radiation can be used to sterilize Rays used for Cold sterilization Endoscope disinfected by Proctoscope is sterilized by Heat labile instruments such as plastic syringes sterilized by Plastic syringes are sterilized by Glassware and syringes sterilized by Lippe’s loop is sterilized by Infant feeding bottle is sterilized by Egg containing culture media are sterilized by Best method for sterilizing liquid paraffin Oil and grease are sterilized by Culture media sterilized by Vaccines are sterilized by Sterilization method for catgut suture Surgical instruments are sterilized by Heat labile instruments for use in surgical procedures can be best sterilized by Heart Lung machine is sterilized by Operation theatre is sterilized by In operation theatre, by using filter of 5 mm pore size with 20 air changes and adequate ventilation, bacterial count can be reduced to NOT a best way to sterilize sputum Hospital waste are disposed by Best method to sterilize by dry heat Gamma radiation are used for sterilizing Irradiation NOT used to sterilize

Autoclaving at 120*C for 15 mins Sporicidal Virucidal Denaturation and Protein coagulation 120 degree Celsius for 30 minutes 49-63 degree Celsius Bacillus stearothermophilus Bone graft, artificial tissue graft, suture UV rays 2% glutaraldehyde for 20 minutes Glutaraldehyde Ethylene oxide Ionising radiation Hot air oven 1/2500 solution of iodine Sodium hypochlorite Tyndallisation Dry heat Hot air oven Autoclaving Seitz filter Radiation Radiation Ethylene oxide gas Ethylene Oxide gas Formaldehyde gas 200 CFU/m3

Chlorhexidine Incineration Hot air oven Syringes Bronchoscope

DISINFECTION Disinfectants

Disinfectant destroys NOT true about disinfectants Rideal and walker coefficient is employed for

Hypochlorites are bactericidal and inactivated by organic matter, glutaraldehyde is sporicidal and NOT inactivated by organic matter, formaldehyde is bactericidal, sporicidal and virucidal All harmful microbes but not spores Phenol usually requires organic matter to act Germicidal power of disinfectant

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BACTERIAL GENETICS

MICROBIOLOGY REVIEW NOTES assessment of Standard against which disinfectants are measured Disinfection of water by routine chlorination can be classified as Precurrent disinfection Chlorine exerts disinfectant action in Required amount of bleaching powder necessary to disinfect choleric stools Disinfection of sputum by Disinfectant used for blood spills Most powerful chemical disinfectant Ethylene oxide is an Disinfectant acting by causing plasma membrane damage Castellani’s paint for disinfecting skin contains Frequency of microwaves for disinfection Sputum can NOT be disinfected by NOT true about spaulding’s criteria NOT an disinfectant NOT a test to test the efficiency of disinfectant Most likely cause of infection after disinfection procedure that killed vegetative cells but does not kill spores

Phenol Precurrent disinfection Hand washing, pasteurization of milk, chlorination of water Bleaching powder, Halozone tablets, Sodium hypochlorite 50 gm/lit Boiling, autoclaving, burning, cresol Sodium hypochlorite Lysol Intermediate disinfectant Ammonium compounds Phenol, resorcinol, basic fuschin, boric acid, acetone 2450 MHz Chorhexidine Semi critical items need low level disinfection 100% alcohol Hugh Leifson test (to differentiate micrococci from staphlococci) Clostridia

BACTERIAL GENETICS GENERAL FEATURES OF BACTERIA Smallest size that can be seen by naked eye Smallest size that can be seen by light microscope Smallest size that can be seen by electron microscope Dye used in fluorescent microscopy Total number of microbes Rearing of animals under sterile conditions Prokaryotic organism have Prokaryotes refers to organism with Prokaryotes are characterized by Prokaryotes have Prokaryotic counterpart of mitochondria

200 micron 0.3 micron 10^(-4) micron Auramine 10^30 Gnotobiotics DNA without Nucleus Chromosome Absence of nuclear membrane DNA Mesosomes

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BACTERIAL GENETICS

MICROBIOLOGY REVIEW NOTES Prokaryotic DNA differ from eukaryotic organism by Muramic acid is present in Steroids are present in Doth DNA and RNA found in Absent in bacteria Bacteria lacks in Bacterial flagella confers Lophotrichous Dark ground microscopy used to see Peritrichous flagella Peritrichous flagella is NOT seen in Bacteria growing between 25 – 40 * C Bacterial genome completely recognized for Lyophilisation means Bacteriocins are Dipicolinic acid is found in Few gram negative organisms inject toxin directly to host target cells by means of complex set of proteins Should NOT be refrigerated before primary inoculation Gold standard for bacterial strain analysis

No complex with proteins Prokarytoes Eukaryotes Bacteria Mitochondria Sterol Specific antigenecity Tuft of flagella at one pole Flagella E.coli, salmonella, proteus, listeria, bacillus, clostridium Vibrio cholera Mesophilic H.pylori Preserving microorganisms Antibiotic like substance produced by Coliform bacteria Spores Type III secretion (Salmonella, Yersinia, Pseudomonas) CSF Pulsed field gel electrophoresis

GRAM POSITIVE AND GRAM NEGATIVE ORGANISMS GRAM POSITIVE 2 layers (inner cytoplasmic membrane, outer thick peptidoglycan) Low lipid No endotoxin except listeria monocytogenes Teichoic acid

Associated with protein F

GRAM NEGATIVE 3 layers (inner cytoplasmic membrane, thin peptidoglycan, LPS) High lipid Endotoxin Aromatic aminoacids, indole ring (eg. Cholera), periplasmic space, porin channel, resistant to penicillin and lysozyme attack Associated with Pili, Fimbriae

LIGAND AND HOST RECEPTORS FOR MICROORGANISMS P. falciparum P. vivax E. histolytica Influenza Mealses HSV

ORGANISM

LIGAND Erythrocyte binding protein – 175 Merozoite Surface lectin Hemagglutin Hemagglutin Glycoprotein C

HOST RECEPTOR Glycophorin A Duffy antigen N – acetyl glucosamine Sialic acid (N – acetylneuramic acid) CD 46/mosein Heparin sulphate

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BACTERIAL GENETICS

MICROBIOLOGY REVIEW NOTES

MULTIPLICATION OF BACTERIA Phase of bacterial growth during which growth rate of bacteria is constant Sporulation occurs in Sporulation does NOT occur in A bacterium can divide every 20 minutes. how many bacteria will be there if there is exponential growth for 3 hours Substance when added to a culture causes inhibiton of multiplication but on removal enhanced growth Area of Lysis produced by Bacterial Lawn Culture True about bacteriophage Lambda phage

Lytic phase of bacteriophage is an example for NOT true about lambda phage Bacteriophage is Bacteriophage replication occurs through

Stationary phase Stationary phase Live organisms 512 Bactericidal Plaque It imparts toxigenicity to bacteria In lysogenic phase it fuses with host chromosome and remain dormant, in lytic phase it fuses with host chromosome and replicates, in lytic phase it cause cell lysis and releases virus particles Type C response Lytic and lysogenic phase occur together Virus that invade bacteria Transduction

BACTERIAL RESISTANCE Bacteria may acquire characteristics by Antibiotic resistance

Bacterial drug resistance in tuberculosis is via MDR acts by Tranferable resistance F factor integrates with bacterial chromosome to form Ability to form or grow in multicellular masses Phenomenon responsible for antibiotic resistance in bacteria due to slime production Bacteria can NOT acquire characteristics by NOT true about antibiotic resistance Not used to introduce genome into the bacteria NOT true about Bacteriophage Does NOT transfer drug resistance Organ of attachment of bacteria

Taking up soluble DNA fragments across their cell wall, through bacteriophage, through conjugation MC mechanism is production of neutralizing enzymes by bacteria, Complete elimination of target is the mechanisms by which enterococci develop resistance to vancomycin, Alteration of target lesions lead to development of resistance in pneumococci, Drug resistance commonly acquired horizontally Mutation Cause efflux of drug High degree of resistance, Involves resistance to multiple drug, Plasmids play a role Hfr Biofilm Biofilm formation Incorporating part of host DNA Plasmid mediated antibiotic resistance is always transmitted vertically FISH It transfers only by chromosomal gene Hfr Fimbriae

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BACTERIAL GENETICS

MICROBIOLOGY REVIEW NOTES Surface appendage of bacteria function as organ of adhesion Organ of bacterial adherence Phage typing is used as an epidemiological tool for Phage typing is NOT useful in Phage typing NOT used as an epidemiological tool in Segment of DNA between chromosomal and extrachromosomal DNA molecules within the cell Jumping gene Horizontal transfer of R factor occurs from one bacteria to other Multidrug resistance is transmitted through Transmitted through pili Conjugation does NOT involve Free DNA across cell membrane transferred by Transformation is seen in Virus mediated transfer of host DNA from one cell to another is known as In transduction, DNA transmitted by vector belongs to Plasmid Plasmid

Drug resistance most commonly transmitted by Plasmid is responsible for NOT true regarding plasmid Process of host gene transfer through F factor E strip method is used for

Fimbriae Pili Staphylococcus aureus, Vibrio cholera, Shigella dysenteriae Salmonella Streptococci Transposons Transposons Conjugation Conjugation Conjugation Bacteriophage Transformation Bacillus, hemophilus, pneumococcus Transduction Bacteria Transferred by conjugation, mediate drug resistance, determine pili production Involved in conjugation and multidrug resistance transfer, Imparts capsule and pili formation, Eliminated by heating with radiation, Transmission of different species, Can cause lysogenic conversion R.Plasmid Drug resistance Extrachromosomal Sexduction Minimum inhibitory concentration

BIOTERRORISM AND VESICANTS Category A bioterrorism agents Category B bioterrorism agents

Category C bioterrorism agents Strain used in anthrax bioterrorism Vesicants Vesicants Treatment of mechlorethamine induced vesicles

Anthrax, Botulism, plague, small pox, tularemia, viral hemorrhagic fever Brucellosis, Epsilon of clostridium perfringens, Glanders (Burkholderia mallei), Melidiosis, Psittacosis, Q fever, Ricinus communis, Straphylococcal enterotoxin B, Typhus fever, viral encephalitis, food safety threat, water safety threat Nipah, Hanta, SARS and emerging infections Ames strain Mustard, lewisite, phosgene Mechlorethamine, vincristine, doxorubicin, BAL, phosgene oxime Thiosulphate

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BACTERIOLOGY

MICROBIOLOGY REVIEW NOTES Treatment of vincristine induced vesicles

Hyaluronidase

BACTERIOLOGY GENERAL FEATURES OF BACTERIA Bacteria Bacteria does NOT divide by binary fission Bacterial cell wall is composed of Zwitter ionic pattern of capsular polysaccharide is responsible for Responsible for inherent virulence of organism Bacteria survive intracellularly by inhibiting Shape of Cocci Normal microbial flora Normal bacterial flora Pharyngoscleroma is a Difference between gram positive and gram negative organisms is that gram negative organisms contain Steps in gram staining Gram’s stain is NOT useful in diagnosing Which is NOT present in gram negative bacteria NOT gram negative Acid fast organisms Acid fast organisms Bipolar staining

Craige’s tube differentiates Non motile organism Darting motility Stain not taken by capsule if it contains Capsulated organism Polysaccharide capsule related antigen antibody responses present in Pigment produced by serratia Safety pin appearance Organism arranged in cubical pocket of eight cocci Bacteremia is associated with

Mitochondria always absent, Divide by binary fission Chlamydia, Spirochete (Transverse fission, Complex fission) Muramic acid, glucosamine, mucopeptide Abscess formation Adhesion, capsule, lipids Formation of phagolysosome Spherical Can NOT be eradicated by antimicrobial agents Established only after neonatal period Bacterial Disease Aromatic amino acids Crystal violet, iodine, decolorisation, safranin Streptococcal pharyngitis Teichoic acid Acinetobacter Mycobacteria, Nocardia, Spores, Isospora, Cryptosporidium, Cyclospora Legionella, eggs of tenia saginata, head of sperm, rhodococcus Hemophilus ducreyi, Yersinia pestis, pseudomonas mallei, pseudomonas pseudomallei, campylobacter granulomatis Motile and non motile Klebsiella V.cholera, Campylobacter jejuni Polysaccharide, protein Klebsiella, Cryptococci Pneumococcus, Meningococcus, Hemophilus influenza Prodigiosin Chlamydia, hemophilus ducreyi Sarcina Pneumococci, staphylococci, E.coli

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BACTERIOLOGY

MICROBIOLOGY REVIEW NOTES Toxins inhibiting protein synthesis Toxins mediated by cAMP Heat stable E. coli toxin is mediated by Heat labile toxin is mediated by Obligate aerobe Obligate anaerobe Facultative anerobe Facultative aerobe Ratio of anaerobe to aerobe in stool Anaerobes grow in Obligatory anerobes Bacteroides fragilis

Bacteroides fragilis Bacteroides may cause Bacteroides cause Bacteroides melaninogenica is associated with Bacteremia due to bacteroides fragilis do NOT cause NOT useful in anaerobic infection Drug of choice for bacteroides infection Meleney gangrene PAPA Exotoxins are Exotoxin NOT true about exotoxins Endotoxin from gram negative organism Gram negative bacteria without endotoxin Act by increasing c-AMP level Heat labile toxin is associated with Heat stable toxin is associated with Preformed toxin is important in food poisoning due to Preformed toxin Heat stable enterotoxin

Diarrhea type of Bacillus cereus Heat stable enterotoxin causing food poisoning produced by Food poisoning with shortest incubation period

Verotoxin of E.coli, Shigella toxin, Exotoxin A of pseudomonas Vibrio cholera O1, Vibrio cholera O137, Heat labile E. coli toxin cGMP cAMP Superoxide dismutase (SOD), peroxidase (POD) and catalase present SOD, POD, catalse negative Two enzymes present, one absent One enzyme present, two absent 1000:1 CDC anerobic blood agar Clostridium botulinum, Bacteroides Frequent anaerobe isolated from clinical samples, NOT uniformly sensitive to metronidazole, LPS formed by bacteroides fragilis is structurally and functionally different from conventional endotoxin Gram negative anaerobic non sporing bacillus Peritonitis Carbuncle, peritonitis, necrotizing fasciitis Red fluorescence when exposed to UV light Shock and DIC Penicillin Metronidazole Anaerobic bacterial synergistic gangrene Pyoderma gangrenosum, acne, septic pyogenic arthritis Highly antigenic Heat labile, by both gram positive and gram negative organisms Heat stable Lipopolysaccharide Cholera Proteus, E.Coli, Vibrio cholera cAMP cGMP (exception S.aureus – vagal action) S.aureus, Clostridium botulism, emetic type of B.cereus Longer incubation period Staphylococcus enterotoxin, enterotoxin of klebsiella pneumonia, emetic type of bacillus cereus, ST of ETEC, Yersinia enterocolitic toxin, Clostridium botulinum toxin Heat labile Bacillus cereus, Yersinis enterocolitica, Staphylococcus Staphylococcus aureus

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BACTERIOLOGY

MICROBIOLOGY REVIEW NOTES Stool examination is required for diagnosis of infection with Pus cell in diarrhea seen in Microorganisms invading GIT causing gasteroenteritis Biosafety precaution grade III is followed in Organism known to survive intracellularly Intracellular organisms Obligatory intracellular Obligate intracellular parasites Rhabdomyolysis is associated with F fever Sodoku Rat bite fever is caused by Rat bite fever is caused by Haverhill fever is caused by Strongly urease positive Urease positive bacteria Ureaplama urealyticum Acinetobacter baumannii

Superinfection is common with Treatment for aeromonas infection Treatment for chrysobacterium infection

Staphylococcal food poisoning, Clostridia, Shigella, Campylobacter, Enterobius vermicularis Shigella, campylobacter Shigella, Vibrio parahemolyticus, Campylobacter, Salmonella Human influenza virus, Coxiella burnetti, Mycobacterium tuberculosis N.meningitits, Salmonella typhi, legionella pneumophilia Virus, Chlamydia, rickettsia Chlamydia Prions, virus, rickettsia, chlamydia Clostridium perfringens, Streptococcus, Clostridium tetani Spirillium minus, Leptospira canicola, streptobacillus moniliformis Spirillum infection Spirillum minus Streptobacillus moniliformis Streptobaciilus moniliformis H.pylori > Proteus Proteus, klebsiella, staphylococci Non gonococcal urethritis, epididymitis, bacterial vaginosis Combat related infection in Iraq and Afghanistan, resistant, treated with sulbactam, carbopenem resistant Acinetobacter baumannii is treated with colistin and polymyxin Immunocompromised host Ciprofloxacin Fluoroquinolones

FEATURES OF STAPHYLOCOCCUS Staphylococcus aureus Staphylococci

Staphylococcus

Important virulent factor in staphylococcus aureus Abnormal neutrophil function is

30% of population is healthy nasal carriers, epidermolysin and TSS toxin are superantigens, methicillin resistance is chromosomally mediated Majority of infection caused by coagulase negative staphylococci are due to staphylococcus epidermidis. beta lactamase production in staphylococci is under plasmid control, methicillin resistance in staphylococcus aureus in independent of beta lactamase production Gram positive, blood agar, clear zone of hemolysis, coagulase positive, pathogenicity is indicated by coagulase positivity Coagulase Staphylococcus aureus

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BACTERIOLOGY

MICROBIOLOGY REVIEW NOTES associated with recurrent infections caused by Antibody marker in serum for staphylococcal endocarditis Staphylococcus remains in skin for longer period because of MC human staphylococcus aureus infection is due to capsular subtype MC mechanism of drug resistance in Staphylococcus Staphylococcus aureus differs from staphylococci epidermidis by Differentiation of staphylococcus aureus from other staphylococci Protein A is the component of cell wall of NOT true about Staphylococcus aureus NOT true about staphylococcus Methicillin resistance Methicillin resistant bacteria are Resistance in MRSA is produced by Methicillin resistance by Staphylococci is expressed when incubated at MRSA resistance

MRSA resistance primarily mediated by Infections caused by community acquired MRSA Streptococcal gangrene is same as Drug of choice for MRSA Drug of choice for MRSA Drug of choice for MRSA Useful for MRSA MRSA infection in ward. Best way to control infection Drug of choice for MRSA MRSA NOT expected to respond to NOT used for MRSA

Antiteichoic acid Hyaluronidase 5,8 Transduction S.aureus is coagulase positive Coagulase test Staphylococci Most common source of infection is by cross infection from infected patients Catalase negative Chromosomally mediated Staphylococcus Alteration in penicillin binding protein (MeCA gene) 30 degree Celsius Resistance may be produced because of hyperproduction of beta lactamase, expression of resistance is enhanced by incubating at 37*C during susceptibility testing Chromosomal MecA gene Necrotizing fasciitis, necrotizing pneumonia, sepsis with Waterhouse Friedrichson syndrome, Purpura fulminans Necrotizing fasciitis Vancomycin, Teichoplanin, Linezolid Quinupristin/dalfopristin, Linezolid, Teicoplanin Teicoplanin Cotrimoxazole, Ciproflaxacin, Vancomycin Vancomycin given empirically to all patients Glycopeptides Carbapenem Cefaclor

SPECIES OF STAPHYLOCOCCUS Staphylococcus aureus differ from staphylococcus epidermidis by ICU on CVP line, gram positive cocci, catalase positive and coagulase negative MC gram positive cause of UTI among sexually active women Gram positive cocci

Coagulase positive Staphylococcus epidermidis Staphylococcus saprophyticus Staphylococcus saphrophyticus cause UTI in female. micrococci are oxidase positive, pneumococci are capsulated

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MICROBIOLOGY REVIEW NOTES Novobiocin susceptible staphylococci

Staphylococcus hemolyticus, Staphylococcus epidermidis

DISEASES CAUSED BY STAPHYLOCOCCUS Oppurtunistic infection most commonly seen in children with neutropenia MC cause of surgical wound infections MC caue of pyopneumothorax and pyopericarditis in infants Botryomycosis is caused by Pedal botyromycosis is caused by Staphylococci can cause Pyomyositis is caused by Postoperative parotitis is caused by Lymphangitis is caused by Common cause of acute borne infections Ritter’s disease is caused by A boil in staphylococcal infection of Carbuncle caused by Carbuncle are common in Carbuncle is treated by MC cause of epidural abscess MC cause of sepsis in India within 2 months Right sided endocarditis in IV drug abusers MC cause of primary bacterial infection MC cause of endocarditis in prosthetic valve replacement within one year MC catheter induced blood infection due to Non coagulase staphylococci Toxic shock syndrome is due to Toxic shock syndrome is caused by Toxic shock syndrome caused by Toxic shock syndrome is associated with Toxic shock syndrome is mainly caused by

Staphylococcus Staphylococcus aureus Staphylococcus Staphylococcus aureus Staphylococcus aureus Furuncle, sycosis barbae Staphylococcus aureus Staphylococcus aureus Staphylococcus Staphylococcus aureus Staphylococcus aureus Hair follicle Staphylococcus Lower neck Incision and drainage Staphylococcus aureus Coagulase positive staphylococci aureus Staphylococcus aureus Coagulase negative staphylococci Coagulase negative staphylococci (Staphylococcus epidermidis) Coagulase negative staphylococci Infect indwelling prosthesis Forgotten tampon Clostridium sordelli (endometrium) Infected measles vaccine Large amount IL-2 Staphylococci

TOXINS OF STAPHYLOCOCCUS Superantigens Staphylococcus infection spreads by Synergohymenotrophic toxin of staphylococci consists of Panton valentine leucocidin toxin is associated with Panton valentine (leucocidin) toxin is associated with Hot cold phenomenon in staphylococcus is due to Staphlococcal toxic shock syndrome is due to Ritter’s syndrome is caused by

Epidermolysin, TSS toxin Hyaluronidase Gamma toxin, Panton valentine toxin Necrotizing fascitis Furunculosis Beta hemolysin Enterotoxin B and Enterotoxin C (heat stable) Exfoliative toxin

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MICROBIOLOGY REVIEW NOTES Toxin responsible for SSSS NOT a toxin of staphylococcus

Exfoliative toxin Erythrogenic toxin

STAPHYLOCOCCAL FOOD POISONING Staphylococcal food poisoning Incubation period of Staphylococcal food Poisoning Staphylococcus in stool occurs in Food poisoning within 6 hours of intake of milk is caused by Vomiting and diarrhea within few hours after taking food MC cause of food poisoning Gastroenteritis 4 to 6 hours after consumption of food Mechanism of vomiting in Staphylococcal food poisoning NOT true about staphylococcal food poisoning NOT true about staphylococcal food poisoning

Optimal temperature for formation of toxin 37* C, intradietetic toxins are responsible for intestinal symptoms, incubation period 1-6 hours 1-6 hours Staphylococcal food poisoning Staphylococcus aureus Staphylococcus Staphylococcus aureus Staphylococcus aureus Vagal stimulation Fever common Toxins can be destroyed by boiling for 30 minutes

FEATURES OF STREPTOCOCCUS Differentiation of streptococci from staphylococci Streptococci Streptococci Lancefield group of streptococci is done using Lancefield group A contains PYR positive Lancefield classification based on Streptococcus pyogenes is classified on the basis of Mainly responsible for virulence in streptococci Nephritogenic strain of Streptococci identified by Classification of pathogenic streptococci into group A,B,C,D,G is based on Streptococcus pyogenes with type 12 M protein cause Micrococci are A child had a skin infection, a catalase negative organism was isolated which showed haemolysis andwas sensitive to bacitracin. Another doctor isolated a similar organism from the throat of the child. The correct statement is Boy with skin ulcer on leg reveals beta hemolysis. Sore throat culture also revealed beta hemolysis. Similarity is Infective skin lesions of leg in infants, gram positive

Catalase test M protein responsible for virulence, mucoid colonies are virulent, no resistance to penicillin has been reported Streptodornase cleaves DNA, Streptolysin O is active in reduced state (oxygen labile) Group C carbohydrate antigen Streptococcus pyogenes alone Enterococcus, streptococcus pyogenes Carbohydrate antigen M protein M protein M typing Antigenicity of cell wall carbohydrate Soft tissue infection resembling TSS of Staphylococcus Oxidase positive Skin infection by group D

C carbohydrate antigen is same Bacitracin sensitivity

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MICROBIOLOGY REVIEW NOTES chain cocci, hemolytic colonies. Test identifying organism Differentiation of group A streptococci from other beta hemolytic streptococci Component of streptococci pyogenes having cross reactivity with synovium of human Mucoid colonies Function of adherence factor for colonization of mucous membrane Mucoid colonies are due to production of Antistreptolysin titre Streptokinase is produced from NOT true about streptococcus Transport medium for streptococci

Bacitracin test Capsular hyaluronic acid Virulent but M protein is NOT responsible for production of mucoid colonies Lipoteichoic acid of streptococcus pyogenes Capsule of hyaluronic acid Low in acute glomerulonephritis Serotype A,C,K Pyrogenic toxin A is plasmid mediated Pike’s media

SPECIES OF STREPTOCOCCUS Streptococci with no lancefield antigen classification A patient with RHD developed infective endocarditis after dental extraction. Most likely organism Causative organism of late prosthetic valve endocarditis Features of streptococcus viridans

Streptococcus causing dental caries Bacteria causing neonatal meningitis, shows beta hemolysis, bacitracin resistance, CAMP positive. Meningitis acquired through birth canal is due to Child presents with sepsis. Beta hemolysis on blood agar, resistance to bacitracin and positive CAMP test. Streptococcus pneumonia is MC cause of meningitis in 1 year old child Group B streptococcus produce Group B streptococcus Pathogenesis of group B streptococcal disease in neonate Does not affect fetus by transplacental spread To show identified organ group A streptococci Bacitracin sensitivity Enterococci and non enterococci belong to Streptococcus bovis grows in Longest streptococcal chain

Viridans group, pneumococci Streptococcus viridians Streptococcus viridans Negative quellung test, negative inulin fermentation, negative bile solubility, intraperitoneal inoculation in mice is non pathogenic Streptococcus mutans Streptococcus agalactiae Streptococcus agalactiae S.agalactiae Alpha hemolytic Group B streptococcus CAMP factor Cause neonatal meningitis, hydrolyse hippurate In the absence of a specific antibody, opsonization, phagocyte recognition and killing do not proceed normally Group B streptococcus Bacitracin sensitivity Specific for S. pyogenes Group D streptococci 40% bile Streptococcus salivarius

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MICROBIOLOGY REVIEW NOTES NOT a medically important streptococci

S. salivarius

DISEASES CAUSED BY STREPTOCOCCUS Causative agent of subacute bacterial endocarditis is cultured in MC cause of Subacute bacterial endocarditis MC organism causing cellulitis Streptococcus pyogenes Impetigo contagiosa is caused by Necrotizing fasciitis Erysipelas is caused by Erysipelas Primary pyomyositis is caused by Erythema marginatum can be caused by Millian sign NOT true about erysipelas Group A Streptococcus does NOT cause Group B cause Group D cause MC agent responsible for human bite infections Infection caused by anaerobic gram positive cocci Chronic burrowing ulcer Drug of choice for sore throat caused by group A beta hemolytic streptococci Used in prophylaxis of streptococcal sore throat Treatment of streptococcal necrotizing fasciitis

Blood agar Streptococci Streptococcus pyogenes Bacitracin sensitive Group A beta hemolytic streptococci Infection of fascia and subcutaneous tissue, MC group A beta hemolytic streptococci, surgical debridement is mandatory Beta hemolytic Streptococci Peu de orange texture Streptococcus pyogenes Streptococcus pyogenes Erysipelas Contagious and infectious, Common in tropics Epidermolysis bullosa Neonatal meningitis UTI Anerobic streptococci Puerperal infection Microaerophilic streptococci Penicillin Injection benzathine penicillin Debridement, penicillin, clindamycin

TOXINS OF STREPTOCOCCUS Toxin produced by S.pyogenes Toxin of streptococcus causing hemolysis Toxin involved in streptococcal toxic shock syndrome Streptococcal toxic shock syndrome is due to Antigenically similar to Streptolysin O Streptolysin O is inactivated by Post streptococcal infection is best diagnosed by Serological marker for retrospective diagnosis of infection due to streptococcus pyogenes Streptococcal glomerulonephritis is best diagnosed by Enterotoxin is NOT produced by

Streptolysin O, Erythrogenic toxin, Hyaluronidase Streptolysin S Pyrogenic exotoxin M protein Clostridium perfringens toxin, Tetanolysin Oxygen Streptozyme test Anti DNAase antibody Anti-DNAase, Anti-hyaluronidase Streptococcus pyogenes

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MICROBIOLOGY REVIEW NOTES

CROSS SENSITIVITY OF STREPTOCOCCAL ANTIGEN Capsular hyaluronic acid Group A carbohydrate antigen Cytoplasmic membrane antigen Cell wall protein Peptidoglycan

Synovial fluid Cardiac valves Vascular intima Myocardium Skin antigen

ENTEROCOCCUS Enterococcus Beta hemolytic bacteria resistant to vancomycin, growth in 6.5% NaCl, Non bile sensitive ICU, central venous line 1 week, ceftazidime and amikacin. Spike of fever, blood culture positive for gram positive cocci in chains catalase negative. Vancomycin started culture remained positive even after 10 days of therapy Organism when isolated in blood require synergistic activity of penicillin plus an aminoglycoside for appropriate therapy Intrabdominal abscess. Vancomycin, gentamycin, ampicilin resistant. Grows well in presence of 6.5% NaCl and arginine. Bile ascenlin hydrolysis is positive Treatment of enterococcus infection Drugs approved for vancomycin resistant enterococci Enterococcus resistance

Common species are enterococcus fecalis and enterococcus faecium, cause for peritonitis, cause for intrabdominal abscess Enterococcus Enterococcus fecalis

Enterococcus fecalis Enterococcus fecalis Ampicillin Linezolid, Quinopristin/Dalfopristin Chromosomally mediated

PNEUMOCOCCUS Discovery of gene transformation come from study of Most virulent type of pneumococci Pneumococcus Pneumococci

Streptococci pneumonia Streptococcus pneumonia Enolase binds to

Streptococcus pneumonia Type 3 Capsule aids in virulence, commonest cause of otitis media, respiratory tract carriers are most common source of infection Pneumolysin is a thiol activated toxin, exerts a variety of events on ciliary and PMN’s action, Autolysin can contribute to pathogenesis of pneumococcal disease by lysing bacteria, Anticapsular antibodies are serotype specific Bile insoluble and optochin sensitive Alpha hemolytic, greenish color on blood agar due to reduction of iron in hemoglobin Fibronectin

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MICROBIOLOGY REVIEW NOTES Griffith demonstrated biotransformation with Property demonstrated by Griffith with experiments on mice using Pneumococcus Virulence in pneumococci due to Thiol activated toxin Orbital cellulitis, greenish colonies and Optochin sensitivity 8 year old child, pain and discharge from ear, fever neck rigidity and positive Kernig’s sign. gram positive cocci Austrian syndrome

Differentiation of pneumococci from other alpha hemolytic streptococci High grade fever respiratory distress at the time of presentation. Alpha hemolytic colonies. gram positive cocci, susceptible to 65 year male, chest pain, fever, cough with sputum. Gram positive cocci. Blood agar positive result. differentiate this from other gram positive cocci Sputum of 70 years old male cultured on 5% sheep blood agar. alpha hemolytic colonies next day Draughtsman colonies Quellung phenomenon is due to MC infection after splenectomy MC cause of pyogenic meningitis in 6 months to 2 years of age NOT true about pneumococci NOT true about pneumococci Prevention of pneumococcal infection in HIV

Pneumococcus Transformation Capsular polysachharide Pneumolysin Pneumococcus Pneumococcus Triad of meningitis, pneumonia and endocarditis. Caused by Streptococcus pneumonia Optochin test Optochin Bile solubility Gram positive cocci in pairs, catalase negative bile soluble Pneumococci Capsular swelling (Pneumococcus) Pneumococcal Streptococcus pneumonia Virulence of pneumococci depend only on production of capsular polysachharides Catalase positive Pneumococcal vaccine

GENERAL FEATURES OF NEISSERIA Neisseria is a Most abundant gonococcal surface protein Type IV pili is associated with Differentiation between Neisseria gonorrhea and Neisseria meningitides by Complement deficiency associated with Neisseria Thayer Martin Media for Gas liquid chromatography NOT true about neisseria

Gram negative cocci Porin Neisseria Maltose fermentation C5-C9 (late complement) Neisseria Neisseria All strains are highly sensitive to penicillin

NEISSERIA GONORRHOEA Features of Neisseria gonorrhea

Kidney shaped, non capsulated, ferment glucose only

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MICROBIOLOGY REVIEW NOTES Neisseria gonorrhea

Kidney shaped organism Virulence factor of Neisseria gonorrhea include IgA1 protease is associated with Opacity associated protein is associated with Most abundant gonococcal surface protein Neisseria gonorrhea ferments Incubation period of Gonorrhoea Watercan perineum caused by NOT a virulence factor for Neisseria gonorrhea NOT true about Neisseria gonorrhea NOT a metastatic complication of gonococci Diagnosis of gonorrhea established by Gonorrhea can be diagnosed by Treatment of penicillinase producing neisseria gonorrhea Gonorrhea shows QRNG means

Exclusive human pathogen, Some strains may cause disseminated disease, Acute urethritis is the most common manifestation in males, Most patients present with symptoms of dysuria Gonococci Outer membrane protein, Pili, IgA1 protease Pneumococci, neisseria Neisseria gonorrhoea Porin Glucose only 2-8 days Neisseria gonorrhea M protein Highly sensitive to penicillin Nephritis Complement fixation tests Pili agglutination test Ciprofloxacin, Cefotaxime Marked resistance to multidrug therapy Quinolone resistant Neisseria gonococci

NEISSERIA MENINGITIDIS Features of Neisseria meningitides Intracellular gram negative diplococci Only reservoir meningococci Protein expressed in choroid plexus of meningeal epithelium for binding of meningococcal endotoxin Skin reaction in meningococcal meningitis is due to Subcutaneous injection of gram negative organism evokes hemorrhagic reaction after 24 hours. On intravenous injection of same give rise to Neisseria meningitides is associated with NOT found in meningococci Female with fever, red spot on applying BP cuff Source of infection in menigococcus is mainly MC cause of meningitides in children NOT a cause of neonatal meningitis Death from meningococcal disease is due to Prophylaxis of meningococcal infection Meningococcal meningitis

Treatment of meningococcal infection

Lens shaped, capsulated, ferments both glucose and maltose Neisseria meningitides Nasopharynx CD46

Endotoxin Schwartzmann reaction IgA1 protease Plasmid Neisseria meningitis Carriers Neisseria meningitides Neisseria meningitides Hypovolemic shock Penicillin, sulfonamide, rifampicin Disease is more common in dry and cold months, Chemoprophylaxis of close contacts of cases is recommended, Vaccine is not effective in children below 2 years Cephalosporin

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MICROBIOLOGY REVIEW NOTES Chemoprophylaxis of meningococcal meningitis carrier Vaccine against Neisseria meningitides contain Meningococcal vaccines are available for Vaccine NOT available for

Rifampicin Capsular polysaccharide A, C, Y, W135 Group B meningococci

GENERAL FEATURES OF CLOSTRIDIA Sacchrolytic clostridium Sub terminal spores Clostridium novyi Drum stick appearance Oval bulging terminal spore Tennis racket spores Gas in tissue should be differentiated with Post abortal sepsis causing renal failure is likely due to Toxins of Clostridium septicum Citron bodies Septicemic orchitis is caused by Management of clostridium tertium

Cl. Welchi, Cl. Septicum Cl.botulinium, Cl.sporogenes, Cl.sordelli Subterminal spores cl.tetani, cl.tetanomorphum, cl.sphenoids Cl.tertium Clostridium difficle, clostridium tertium, clostridium cochleum Clostridium novyi Clostridium Alpha – lethal, hemolytic, necrotizing. Beta – DNAase. Gamma – hyaluronidase. Delta - septicoysin Clostridium septicum Clostridium tertium Vancomycin, metronidazole

CLOSTRIDIUM PERFRINGENS Non motile clostridia Clostridium perfringens

Clostridium perfringens Clostridium welchii Clostridium perfringens Alpha toxin of clostridium perfringens Food poisoning in Clostridium perfringens NOT true about clostridium perfringens NOT true about clostridium perfringens and gas gangrene NOT motile Opacity around colonies of clostridium perfringes Nagler reaction is shown by Nagler’s reaction is due to

Clostridium perfringens Commonest cause of gas gangrene, Normally present in human feces, Principal toxin is alpha toxin, Gas gangrene producing spores are NOT heat resistant, Food poisoning producing spores are heat resistant, Gas is invariably present in muscle compartment Found in intestinal tract of some healthy patients Capsulated, non motile, type A causes gastroenteritis A – food poisoning, necrotizing enterocolitis, B and D – epsilon toxin, C – enteritis necroticans, theta toxin perfringolysin Liberation of phosphoryl choline from lecithin and hemolysis Stimulating calcium dependent alteration in permeability Gas gangrene producing strains of C.perfringens produce heat resistant spores Most important toxin is hyaluronidase Clostridium perfringens Lecithinase Clostridium perfringens Lecithinase

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MICROBIOLOGY REVIEW NOTES Gastrointestinal enteritis necroticans caused by Pigbel is Vomiting and diarrhea 6-10 hours after party NOT true about necrotizing fasciitis Administration of immunoglobulins is life saving in

Cl.perfringens Necrotizing enteritis Clostridium perfringes MC site is perineum Clostridium welchi

GAS GANGRENE Gas gangrene is caused by Toxins responsible for gas gangrene Clostridium perfringes causes Not a cause of Gas gangrene Gas gangrene is NOT caused by Incubation period of clostridium septicum gas gangrene Incubation period of clostridium novyi gas gangrene Foaming liver Hyperbaric oxygen is used in Best way to prevent gas gangrene Hypotension in case of gas gangrene is treated by Treatment of gas gangrene after contaminated road traffic accident Treatment of gas gangrene

Cl.perfringes, Cl.septicum, Cl.novyi, Cl.histolyticum, cl.fallax Alpha toxin, theta toxin Gas gangrene Clostridium difficle Clostridium sporogenes 1-3 days 4-6 days Gas gangrene Gas gangrene Proper wound debridement Ringer lactate IV administration of anti gas gangrene serum, Penicillin, Surgical debridement Clindamycin

CLOSTRIDIUM TETANI Clostridium tetani Clostridium tetani Clostridium tetani Spherical and terminal bulging spore are seen in Swarming growth of gram positive bacilli Non flagellated Clostridium tetani NOT true regarding clostridium tetani

Gram positive, Produce heat resistant spores, NO man to man transmission Aerobic, Gram positive, Motile Swarming growth Clostridium tetani Clostridium tetani Type 6 Seen commonly in winter and dry season

GENERAL FEATURES OF TETANUS Cause of Localised tetanus Tetanus is noticed usually in Tetanus is due to Tetanus Period of tetanus refers to time between If incubation period of tetanus is more than 30 days Communicable period in tetanus

Incomplete immunity Wounds contaminated with fecal matter Exotoxin bound to motor end plate Spread through nerve, Variable incubation period First symptom to spasm Delayed None

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MICROBIOLOGY REVIEW NOTES Main site of action of tetanus toxin Premonitary symptoms of tetanus Sardonic grin Risus sardonicus 8 day old extensor posture 3 day old excessive cry, suckling difficulty, umbilical sepsis, generalized stiffness NOT true regarding tetanus NOT true about tetanus Diagnosis of tetanus is made Indicators of elimination of neonatal tetanus includes

Presynaptic terminal of spinal cord Sleeplessness, Anxious expression, Headache Tetanus Tetanus Neonatal tetanus Neonatal tetanus Man to man transmission Neonatal tetanus develops after passage through contaminated birth canal Clinically Incidence rate < 0.1/1000 live births, TT2 injection coverage in pregnant mothers > 90%

MANAGEMENT OF TETANUS Drug used for tetanus

Metronidazole

PREVENTION OF TETANUS Vaccine preventable neonatal disease Vaccine routinely indicated in pregnancy Maternal antibody does NOT protect neonate from Tetanus Immunization 10 years age, presents with clean wound without laceration A 37 weeks pregnant woman attends an antenatal clinic at a primary health centre. She has not any antenatal care till now. Best approach regarding tetanus immunization in this case would be Previously unimmunized against tetanus, clean non penetrating wound sustained 2 hours before Pregnant women, full course of tetanus immunization, again to deliver within 11 months, she will require No of tetanus toxoid injection to vaccinate all pregnant woman in one year in a village with population of 1000 with birth rate of 30/1000 in one year A full course of immunization against tetanus with 3 doses of toxoid confers immunity for Booster dose of tetanus should be given every Neonatal tetanus best prevented by Most effective way of PREVENTING tetanus NOT done to prevent tetanus NOT a strategy for prevention of neonatal tetanus Dose of human tetanus Immunoglobulin for post exposure prophylaxis Best preventive measure against Tetanus Neonatorum

Tetanus Tetanus Tetanus TT and Ig both may be given in suspected cases Single dose of tetanus toxoid Give a dose of tetanus toxoid and explain to her that it will not protect the newborn and she should take second dose after 4 weeks even if she delivers in the meantime Tetanus toxoid complete course 0 doses of TT 60 10 years 5 years Toxoid to mother Tetanus toxoid Injection penicillin to all neonates Giving penicillin to newborn 250 units Active immunization of mother

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MICROBIOLOGY REVIEW NOTES Complete immunization against tetanus 10 years ago, clean wound without any laceration injury sustained 2.5 hours ago Active immunity offered by tetanus toxoid is effective nearly Administration of Tetanus antitoxin serum Neonatal tetanus is said to be eliminated when the rate is

Human tetanus globulin and single dose of toxoid 100% of patients Neutralizes toxin < 0.1 per 1000

CLOSTRIDIUM BOTULINUM Cl.botulinium causing human disease Botulinium causing human disease Non neurotoxic type of clostridium botulinium Contaminant in home canned vegetables and smoked fish Food poisoning associated with constipation instead of diarrhea Food poisoning in canned food is due to Paralytic food poisoning is caused by Botulinum toxin acts by Most potent biological toxin Botulinum toxin is Botulinum toxin produce skeletal muscle paralysis by

A (severe), B, E A, B, C, F Type G (enterotoxic) Clostridium botulism Clostridium botulinium Clostridia Clostridia Closure of ca++ channels at presynaptic membrane Botulinium toxin Phage mediated Inhibiting release of acetylcholine

BOTULISM Botulism Botulism Botulinum affects Feature of botulism Feature of Botulism Infant botulism is caused by Type of paralysis in botulism Botulinium toxin Most Powerful exotoxin Botulinium toxin acts by Mechanism of action of botulism toxin Non Neurotic toxin of Botulism Gene for botulism toxin is coded by

Caused by Exotoxin, Honey ingestion can cause infant botulism, Constipation is seen, Detection of antitoxin in serum can aid in diagnosis Symmetric descending flaccid paralysis Neuromuscular junction, preganglionic junction, postganglionic nerves Afebrile, Clear sensorium, Cranial nerve palsy Diplopia, constipation, No fever, Exaggerated tendon reflexes Ingestion of spores Descending paralysis Effective for 3-4 months, Used in treatment of Blepharospasm, static and dynamic wrinkles, Invariably decreased Ach in Neuromuscular junction Botulinium toxin Inhibiting release of acetylcholine Complete failure of all cholinergic neurotransmission D Bacteriophage

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MICROBIOLOGY REVIEW NOTES 18 year old male, acute onset of descending paralysis 3 days duration. blurring of vision, quadriparesis, areflexia, both pupils NON reactive In a 6 months old baby, floppy infant syndrome is seen commonly due to infection with Disease not associated with antitoxin antibodies in serum of recovering patients MC cause of death in Untreated Botulism Best sample for clostridium botulinium food poisoning NOT a feature of botulism NOT true about botulism NOT a differential diagnosis of Botulism NOT true about botulism

Botulism Clostridium botulinum Botulism Respiratory Failure Stool Diarrhea Ascending paralysis Clostridial myonecrosis Infant botulism is caused by ingestion of preformed toxin

CLOSTRIDIUM DIFFICLE AND PSEUDOMEMBRANOUS COLITIS Clostridium difficle infection is associated with Commonly associated with clostridium difficle colitis Antibiotic induced colitis Pseudomembranous colitis associated with Pseudomembranous colitis is caused by Clostridium difficle Toxins involved in Pseudomembranous colitis Pseudomembranous colitis Pseudomembrane Punctuate yellow exudates in colon on endoscopic examination Pathological appearance in pseudomembranous colitis Mushroom cloud appearance of intestinal mucosa Most sensitive test for Clostridium difficle infection Most specific investigation for Clostridium difficle infection Treatment of Pseudomembranous colitis (severe) Treatment of clostridium difficle associated diarrhea (mild) Duration of antibiotic therapy for antibiotic induced diarrhea

Prolonged antibiotic therapy, pantoprazole, rectal thermometer, increase in proportion of hospital stay Clindamycin Clindamycin Ampicillin Clostridium difficle Normal commensal of gut Toxin A (Enterotoxin), Toxin B (Cytotoxin) Organism is normal commensal of gut, treated by vancomycin Gram positive bacillus Antibiotic colitis Small ulceration with slough Pseudomembranous colitis Stool culture Cell culture, cytotoxic test, PCR for C.difficle toxin B gene Vancomycin Metronidazole 10 days

GENERAL FEATURES OF CORYNEBACTERIUM Ehrlich phenomenon is seen in Multidrug resistant Corynebacterium responding only to Vancomycin Erythrasma is caused by

Corynebacterium Corynebacterium jeikeium Corynebacterium miniutissimum

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MICROBIOLOGY REVIEW NOTES Alkaline encrusted cystitis is caused by Daisy head colonies are produced by MDR resistant corynebacterium sensitive to vancomycin

Corynebacterium urealyticum C.diphtheria gravis C.striatum

CORYNEBACTERIUM DIPHTHERIA Diphtheria Corynebacterium diphtheria Corynebacterium diphtheria Corynebacterium diphtheria

Clostridium diphtheria Kleb Loeffler’s bacteria (KLB) Elek’s gel precipitation test Non motile Albert staining, Ponder’s staining Volutin granules Metachromatic granules made of Metachromatic granules are stained with Tellurite plates should be incubated for Corynebacterium diphtheria are cultured on NOT true about corynebacterium diphtheria Does NOT produce spore Diphtheroids Preisz Nocard bacillus Non hemolytic frog’s egg colony on cysteine tellurite blood agar

Club shaped bacillary appearance, palisades, Chinese characters Gram positive, lysogenic phase cause disease Deep invasion is NOT seen, Elek gel PRECIPITATION test is done for toxigenecity, Metachromatic granules are seen Iron is required for toxin production, Local reaction is due to membrane, Systemic effects are due to toxin, Non sporing, Non motile, Non capsulated, Toxin production is by Lysogenic conversion Organism may be identified by tests of toxigenicity, toxin act by inhibiting protein synthesis, toxin may affect heart and nerves Corynebacterium diphtheria Corynebacterium diphtheria Diphtheria Corynebacterium diphtheria Metachromatic granules, seen in mycobacteria, gardenella, diphtheria Polymetaphosphate Toluidine blue Atleast 2 days before considering negative Loeffler’s serum slope, tellurite blood agar Toxin mediated by chromosomal gene Corynebacterium diphtheria Rhodococcus equi, Corynebacterium pseudotuberculosis Corynebacterium pseudotuberculosis Corynebacterium intermedius

FEATURES OF DIPHTHERIA Diphtheria Diphtheria Diphtheria Diphtheria is Diphtheria

Laryngeal diphtheria mandates tracheostomy, Child is infectious with faucial diphtheria, Myocarditis may be a complication Endemic in india Lysogenic conversion by β phage Toxemia Incubation period 2-6 days, schick test detects susceptibility, portal of entry is through an infective agent

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MICROBIOLOGY REVIEW NOTES Diphtheria susceptibility Diphtheria Bull neck adenitis Bull neck in Diphtheria is due to The term Leather is used for Type of diphtheria with highest mortality Colour of diphtheric membrane is Common source of diphtheria Incubation period of diphtheria Short incubation period Babes Ernst Granules associated with Commonest cause of death in diphtheria MC ocular complication of diphtheria Single infection in diphtheria does NOT give Diphtheria NOT associated with Diphtheria is NOT characterized by NOT a complication of Diphtheria Diphtheria toxin is a powerful Diphtheria toxin inhibitis Diphtheria toxin is

Diphtheria toxin Skin test based on Neutralisation reaction Shick test does NOT indicate Positive Schick test indicate that person is A negative schick test indicate Immunization against diphtheria Percentage of herd immunity required to prevent endemic spread of diphtheria

2-5 years Punched out ulcer Diphtheria Lymphadenopathy Diphtheria Laryngeal Gray Carriers 2-6 days Diphtheria Diphtheria Myocarditis Paralysis of accommodation Lifelong immunity Rash Endotoxemia Hepatic failure Exotoxin Protein synthesis (blocks elongation of protein) Exotoxin, Toxin production depends on optimal concentration of iron, Inhibiting protein synthesis, Schick test demonstrates circulating antitoxin Phage mediated Schick test Carrier of diphtheria Susceptible to diphtheria Immunity to diphtheria Will prevent toxemia but NOT a carrier state 70%

MANAGEMENT OF DIPHTHERIA Loeffler/Tinsdale selective medium Child present with white patch over tonsils, diagnosis made by culture in Diphtheroids grow on Selective media for isolation of diphtheria from carriers Corynebacterium diphtheria can be grown within 6-8 hours on Investigation of choice for diphtheria carrier Investigation of choice for diphtheria carrier Investigation NOT done for a child with fever and pharyngitis Prophylaxis of household contacts of diphtheria Prophylaxis of diphtheria Drug of choice for Diphtheria carrier Drug for unimmunized contacts in Diphtheria One unit of diphtheria antitoxin is defined as the

Diphtheria Loeffler medium Potassium tellurite medium Potassium tellurite medium Loeffler’s serum slope Throat swab culture Culture in tellurite blood agar Widal test Erythromycin Erythromycin Erythromycin Erythromycin + Antitoxin + Toxoid 100 MLD of toxin

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MICROBIOLOGY REVIEW NOTES smallest amount of antitoxin required to neutralize

HEMOPHILUS Hemophilus influenza Hemophilus influenza produces Hemophilus influenza

Gram negative coccobacilli, culture only on chocolate agar not on blood agar Types of hemophilus Pfeifers bacillus Features of hemophilus Important role in pathogenesis Satellitism is seen in culture of Pleomorphism is most commonly seen in Bacterial vitamins X and Y are required for NOT true about influenza Diseases caused by H.influenza Brazilian purpuric fever is caused by Prophylaxis of H.influenza Beta lactamase producing hemophilus influenza, resistant to chloramphenicol Hemophilus ducreyi

Gram negative, grow on chocolate agar Immunogenic antiphagocytic capsule Serotyping is based on capsular polysaccharide, Can be a part of normal flora in some persons, Requires hemin and NAD for growth in culture medium, Type b is responsible for invasive disease Hemophilus influenza Type b (capsulated) is associated with meningitis and epiglottis. Non typable (non capsulated) is associated with otitis media, LRI, sinusitis Hemophilus Satellitism on Flide medium, iridescence on Levinthal medium Capsular polysaccharide Hemophilus Hemophilus influenza H.influenza Capsular polypeptide protein is responsible for virulence Chancroid, Acute epiglottitis, Brazilian purpuric fever, Meningitis Hemophilus influenza biogroup aegypticus Rifampicin Third generation cephalosporins Chocolate agar with isovitale X

BORDETELLA PERTUSSIS Bordetella pertussis Bordetella pertussis is Bordetella pertussis is associated with Organism in which capsule does not have virulence factor Piracy of adhesins is associated with Aluminum paint appearance Whooping cough Pertussis

Strict human pathogen, Can be cultured from patient during catarrhal stage, Leads to invasion of respiratory mucosa, Infection is NOT prevented by acellular vaccine Aerobic Filamental hemagglutinin, fimbria, pertactin Bordetella pertussis Bordetella (promotes coating of H. influenza, Pneumococci) Bordetella Affect children of 1 year of age, contagious in catarrhal stage, secondary attack rate is high Erythromycin prevent spread of disease between children

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MICROBIOLOGY REVIEW NOTES Pertussis Pertussis Mechanism of pertussis toxin Incubation period of pertussis Pertussis affect 100 day cough A child with pertussis should be isolated for Secondary attack rate of pertussis NOT a feature of pertussis Congenital passive immunity is NOT observed in Newborns does NOT have transplacental immunity against Post exposure prophylaxis NOT useful in Recurrent bouts of severe cough, audible whooph, best specimen to isolate organism and confirm diagnosis Child cough, inspiratory whoop. NOT immunized. sample for investigation Cough plate is used for Regan Lowe characoal medium for Treatment of pertussis contacts children Drug of choice in pertussis Treatment of bordetella infection

Associated with inspiratory wheeze, Droplet infection, Pneumonia is most common complication, Parapertussis is less severe than pertussis Erythromycin should be given to contacts ADP ribosylation of protein associated with receptors, increase cyclic AMP, acts through G alpha subunit 7-14 days Less than 5 years Cough due to Bordetella pertussis 3-4 weeks 90% Cerebellar ataxia Pertussis Pertussis Pertussis Nasopharyngeal swab Nasopharyngeal swab Bordetella pertussis Bordetella Prophylactic antibiotic for 10 days Erythromycin Macrolide

BRUCELLA Brucella Brucella melitensis is common in Brucella Capnophilic brucella Brucellosis Pyrexia of unknown origin in veterinary doctor, gram negative short bacilli, oxidase positive Malta fever is caused by Undulant fever Disease occurring both in man and animals Brucella commonly affect Brucella infection NOT a method of transmission of brucella Brucella is NOT transmitted by Medium for Brucella Milk ring test for Coomb’s test may be useful in

Brucella abortis is capnophilic, Transmitted by aerosol can occur occasionally, Pasteurization can occur occasionally Camel, sheep, goat Melitensis in goat, abortis in cow, suis in pig Brucella abortus Transmitted by ingestion of milk, cause spinal spondylitis, causes GE Brucella Brucella melitensis Brucella melitensis Brucella abortis Lumbar spine Anterosuperior epiphysitis (Pedro Pon sign) Person to person transmission Person to person Serum dextrose agar, Trypticose soy agar Brucellosis Brucellosis

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MICROBIOLOGY REVIEW NOTES Investigation for Brucellosis Serological tests for brucellosis 2 mercaptoethanol is used to detect NOT a serological test for diagnosis of Brucellosis Treatment of brucellosis Drugs used for Brucellosis NOT a treatment of Brucellosis

Standard agglutination test 2 mercaptoethanol test, Complement fixation test, Coomb’s test IgG Standard agglutination test Streptomycin Rifampicin,Streptomycin,Doxycyline Penicillin

BARTONELLA Bartonella henslae Bacillary peliosis primarily involve Bartonella Quintana Trench fever Intermediate host for trench fever Bartonella bacilliformis Stages of carrion disease Carrion disease is transmitted by Cat flea Bacillary angiomatosis is caused by Cat scratch disease is caused by Macular scar Mollaret debra test for Cats are NOT associated with Incubation period of Bartonellosis Bacillary angiomatosis Verruca peruana is caused by

Cat scratch disease, bacillary angiomatosis, bacillary peliosis Liver Trench fever 5 day fever, Quintan fever Louse Carrion disease (Bartonellosis) Oroya fever, Verruga peruana Lutzomyia Ctenocephalides felis Bartonella Henslae, Bartonella quinatana Bartonella henslae Cat scratch disease Cat scratch fever Bartonella quintana 14 – 21 days Multiple hemangioma like lesion on AIDS patient, Biopsy with Warthin starry stain shows bacilli Bartonella bacilliformis

ACTINOMYCES True of Actinomyces Mycetoma Granules discharged in mycetoma contains Actinomyces is Most common actinomyces Actinomycetoma is caused by Actinomycotic mycetoma is caused by Actinomycosis is caused by Commonest form of actinomycosis Actinomycosis Actinomycosis Rivalta disease

Causes endogenous infection Can affect upper and lower extremities, Caused by actinomycetes and filamentous fungi, Diagnosis is by examination of pus Fungal colonies (erodes bone) Gram positive bacteria Actinomyces israeli Bacteria Actinomyces, Nocardiosis, Streptomyces Gram positive organism Cervicofacial Usually respond to antibiotics Demonstration of filaments, actinomycosis Israeli, suphur granules in pus, can be cultured Actinomycosis

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MICROBIOLOGY REVIEW NOTES Spidery colonies on solid media and fluffy ball in thioglycollate liquid media Sunray appearance Actinomycosis is associated with Maxillary osteomyelitis is associated with Frozen pelvis Most predominant constituent of sulphur granules of Actinomycosis Sulphur granules Colour of granules of actinomyces Sulphur granules is a feature of Bread crumb colony appearance is of Lumpy jaw is seen in Discharging sinus A patient with fistula and chronic pain discharge from lower face and mandible is most commonly suffering from In actinomycosis of spine, abscess usually erode Actinomycetoma Madurella Actinomycosis is sensitive to Drug of choice for thoracic actinomycosis

Actinomyces israeli Actinomycosis Wooden fibrotic masses Actinomyces viscosus Pelvic actinomycosis Organism Misnomer, inflammatory cells with filaments of bacteria Yellow Actinomyces Actinomyces Israeli Actinomycosis Actinomycosis Acinomycosis Towards the skin Responds to antibiotics Does NOT respond to antibiotics Penicillin Penicillin

NOCARDIA Nocardia resemble actinomyces but morphologically NOT true about nocardia Causative organism of mycetoma MC cause of mycetoma in India MC cause of mycetoma in India Persistent fever and cough. Features suggestive of pneumonia. Aerobic branching gram negative filaments that are partially acid fast MC form of Nocardia Characteristic infection of Nocardia asteroids Stains for Nocardia Nocardia is stained by Best method for selective isolation of Nocardia Nocardia is susceptible to

Aerobic Penicillin is the drug of choice Nocardia Nocardia brasiliensis Actinomadura madurae Nocardia asteroids Pneumonia Brain abscess Acid fast, alcian blue, mucin stain Acid fast (Ziehl Nielson stain) Paraffin bait technique Amikacin

LISTERIA Listeria is a Temperature for listeria LLO means Listeria

Gram positive bacilli 1 – 45*C Listeriolysin Gram positive but produces exotoxin and endotoxin

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MICROBIOLOGY REVIEW NOTES Listeria monocytogenes Tumbling motility (end over end motility) is seen in Not true about listeria Listeria transmitted by Main step in pathogenesis of listeriosis Zipper type of phagocytosis in Listeriosis in pregnancy Culture media for Listeria After 5 days of birth, baby developed poor feeding, convulsions, fever with low protein, low sugar, high chloride in CSF Gram positive small to medium coccobacilli that are pleomorphic occurring in short chains. direct wet mount from culture show tumbling motility

d-xylose negative, d-methyl d-mannoside positive Listeria Gram negative bacteria Refridgerated food Survival and multiplication of L.monocytogenes within mononuclear phagocytes and host epithelial cells Listeria Granulomatus infantiseptica Blood agar Listeria monocytogenes Listeria monocytogenes

BACILLUS ANTHRACIS Anthrax bacilli is differentiated from anthracoid bacilli by Features of anthrax Anthracoid bacilli Only bacterium with capsule having protein Anthrax bacilli Factors in bacillus anthracis

Largest pathogenic bacilli Anthrax Anthrax bacilli differs from anthracoid bacilli by being Virulence of bacillus anthracis is associated with McFadyean reaction Methylene blue discolours the capsule of bacillus anthracis, this reaction is called String of pearl colonies on nutrient agar Medusa head colonies Frosted glass appearance Inverted fir tree appearance of culture Ascoli thermoprecipitation test Gram positive bacilli in long chains, McFaydean reaction Anthrax bacillus toxin

Non motile Capsulated, non motile, response to penicillin Non capsulated, motile, no response to penicillin Bacillus anthracis (poly D glutamic acid) Non motile, no flagella Factor I – edema factor, factor II – protective antigen, factor III – lethal factor Bacillus anthracis Plasmid is responsible for toxin production, Cutaneous anthrax generally resolve spontaneously, Capsular polysaccharide aids virulence by inhibiting phagocytosis Non motile Polypeptide capsule Bacillus anthracis McFadyean reaction Bacillus Bacillus anthrax Bacillus anthracis Bacillus anthracis Anthrax Bacillus anthracis cAMP liberate edema factor, capsular polysaccharide aids virulence by inhibiting phagocytosis, plasmid

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Commonest form of anthrax Anthrax Gasteroenteritis with high fatality is caused by Malignant pustule (Hide Porter disease) Cutaneous anthrax Person working in Abattoir presented with papule on hand which turned in to an ulcer

responsible for toxin production Cutaneous McFadyean reaction shows capsule, Humans are usually resistant to infection, Sputum microscopy helps in diagnosis Anthrax Anthrax of skin Painless, Whole area is congested and edematous, Central crustation with black eschar, Satellite nodule around inguinal region Trichrome methylene blue helps in diagnosis

BACILLUS CEREUS A patient present with vomiting he had eaten rice 6 hours before. Most probable cause Non invasive diarrhea is caused by Characteristic of Bacillus cereus food poisoning Selective medium for Bacillus cereus

Bacillus cereus Bacillus cereus Abdominal pain Mannitol egg yolk phenol red polymyxin agar (MYPA)

LEGIONELLA Legionella is Legionella Transmission of Legionella MC serotype isolated from humans Toxicity of legionella through Contaminated water source is associated with infection of Legionella by 28 year female, diarrhea, confusion, high grade fever, bilateral pneumonitis Pontiac fever is caused by Causative agent of Pneumonia associated with Aerosols spread Epidemics are associated with Legionella pneumophilia is associated with Legionnaire’s disease cause Good media for Legionnaire’s disease Growth on charcoal yeast medium Test for legionella in community Treatment of choice for legionairre’s disease Treatment for Legionella infection

Gram negative, Uncapsulated, Oxidase positive Can be grown on complex media, legionella pneumophila is NOT effectively killed by polymorphonuclear leukocyte No man to man transmission L.pneumophilia serogroup 1 Toxin Legionella Inhalation of aerosol in the air conditioned room Legionella Legionella Legionella Legionella Hyponatremia, temperature > 40% Acute respiratory infection BCYE agar Legionella Urinary antigen testing Erythromycin Macrolides, respiratory quinolones

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CAMPYLOBACTER Microaerophilic bacteria Microaerophilic bacteria Campylobacter jejuni Alpha chain disease Campylobacter associated with seagull NOT true about Campylobacter Fecal leucocytes are present in One of the leading causes of traveller’s diarrhea Method of choice for culture of stool for campylobacter jejuni Culture media for campylobacter DOC fo Campylobacter Jejuni associated Diarrhoea

10 % CO2 Campylobacter Microaerophilic, tumbling motility, Invasive Immunoproliferative small intestine disease associated with campylobacter jejuni Campylobacter luri Human is the only reservoir, Spore forming Campylobacter Campylobacter Culture on Skirrow’s medium incubated at 42*C under microaerophilic condition CVA medium, Skirrow medium, Campylobacter blood agar, Regan Lowe media Erythromycin

HELICOBACTER Helicobacter pylori

H.pylori

H. pylori H.pylori found in NOT true about H.pylori Helicobacter pylori NOT associated with Most sensitive test for H.pylori

Even with chronic infection, urease breath test remains positive. H.pylori remains life long if untreated, Endoscopy is diagnostic. Toxigenic strains usually cause ulcer, 75% of ulcers associated with H.pylori, Medical therapy is the treatment of choice Gram negative bacilli, curved rod, flagellated. Causes chronic gastritis in adults due to reinfection, Treatment prevents gastric lymphoma, C14 urease breath test is used in diagnosis, Transmitted from man to man, fecoorally and by orogastric route. Common in adults of developing countries, Controlled urease breath is negative with massive infection, Anti urease antibody are produced only by invasive strains, Urease activity provide protective environment to the bacilli Vacuolated cytotoxin Mucosa It should be eradicated in all cases whenever detected Gastric leiomyoma Rapid urease test

PASTEURELLA Mode of infection of Pasturella multocida Common organism isolated from cat bite Gram negative bacilli sensitive to penicillin Features of pasteurella multocida

Animal bite or scratches Pasteurella multocida Pasteurella multocida Gram negative bacilli, non motile, acid from sucrose, indole positive, oxidase positive, urease negative

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FRANSCIELLA Ulcerated inguinal lymphadenopathy Fransciella tularensis is related to Tularemia Parinaud complex is associated with Treatment of tularemia

Fransciella Rabbit Ulcer with black base, chancriform lesion, buboes Preauricular lymphnode enlargement Gentamycin

YERSINIA Yersinia pestis Stalactite growth in ghee broth agar Fermentation of glycerol is the basis of classification of Bioterrorism agent Plague is Plague Girl from shimla, fever, hypotension, malaise, axillary and inguinal lymphadenopathy, culture in glucose broth show stalactite growth Most efficient vector for plague Plague in Surat in 1995 has occurred after a silence period of Most dangerous type of Plague Highly infectious clinical form of plague Isolation is strictly recommended for Incubation period of pneumonic plague MC type of plague Main reservoir of plague in India Lifelong immunity NOT seen with Maximum explosiveness of plague is determined by Cheopsis index Most effective method to break transmission chain in plague in Flea bite in wheat godown. Axillary lymphadenopathy Plague patient is kept isolated till Longest and shortest incubation period of plague are 7 days and 2 days respectively. time required to declare an area free from plague is Plague epidemic is controlled by NOT done to control epidemic in plague Treatment of plague Drug of choice in chemoprophylaxis in contacts of a patient of pneumonic plague MC presentation of Yersinia enterocolitica

Gram negative non motile cocco bacilli, Repeated cultures is diagnostic Yersinia Yersinia Plague Metazoonotic Both sexes of rat flea bite to transmit disease, IP for bubonic plague is 2-6 days, Infants under 6 months are not given killed vaccine Yersinia pestis Xenopsylla cheopis 28 years Pneumonic plague Pneumonic plague Pneumonic plague 1 – 3 days Bubonic plague Tatera indica Plague Cheopsis index Average no of cheopsis per rat Control of rat flea Wayson staining 48 hours of treatment 14 days Isolation of patients Vaccination of susceptible Streptomycin Tetracycline Self limiting diarrhea

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PSEUDOMONAS Pseudomonas aeroginosa Pseudomonas Strictly anaerobic Organism having considerable resistance to antiseptics, disinfectants, antibiotics Bacteria act by inhibiting protein synthesis NOT true about pseudomonas NOT a coccobacilli Blue pus Green coloured colonies Gunmetal colonies Fruity odour Species of pseudomonas commonly associated with intravenous catheter related infection Puncture wound through sneakers in children is associated with Other Pseudomonas Pseudomonas septicemia cause Ecthyma gangrenosum is caused by Shock associated with bullous skin lesion Hot tub folliculitis is associated with Green nail is due to Does NOT cause food borne infection Cetrimide agar for Pseudomonas is eradicated by local application of Effective against pseudomonas Pseudomonas producing extended spectrum beta lactamase enzyme Antibiotic potent against Pseudomonas Drug of choice for Pseudomonas septicemia Penicillin effective against proteus and pseudomonas Cephalosporin active against Pseudomonas Antipseudomonal penicillin Antipseudmonal action Carbenicillin In treatment of pseudomonas infection, cabenicillin is frequently combined with NOT used in pseudomonas infection NOT used for pseudomonas NOT having good activity against pseudomonas aerugenosa NOT used against pseudomonas NOT antipseudomonal NOT an antipseudomonal

Oxidase positive, Polar flagellate, Obligate aerobe Pili, flagella, LPS, Type III secretion system, proteases, phospholipases, exotoxin Pseudomonas Pseudomonas Pseudomonas Ferments glucose forming acid and gas Pseudomonas Pseudomonas Pseudomonas Pseudomonas Pseudomonas Pseudomonas aeruginosa Pseudomonas osteomyelitis Burkholderia, Stenotrophomonas (soil organism) Ecthyma gangrenosum Pseudomonas Pseudomonas Pseudomonas Pyocyanin Pseudomonas Pseudomonas Acetic acid Colistin, Piperacillin, Ciprofloxacin, Cefoperazone, Ceftazidime Imipenem and amikacin Colistin Tobramycin + Ticarcillin Carbenicillin Ceftazidime Cloxacillin Cefoperazone Effective in pseudomonas infection Gentamicin Vancomycin Azithromycin Cephadroxil Oxacillin Vancomycin Cephalexin

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BURKHOLDERIA Melidiosis is caused by Chronic alcoholic agricultural worker, chills rigor, bilateral crepitation with scattered rhochi, multiple subcutaneous nodules on extensor surface. Gram negative bacilli with bipolar staining, distinct rough corrugated grey white colonies on blood agar. motile oxidase positive Melidiosis Syndrome of respiratory distress and septicemia in cystic fibrosis (Cepacia syndrome)

Burkholderia psedomallei Melidiosis

Common form pulmonary infection, bipolar staining of etiological agent is with methylene blue stain, gram negative aerobic bacteria Burkholderia cepacia

GENERAL FEATURES OF ENTEROBACTERIACEAE Enterobacteriaceae Flagellar pattern in enterobacteriaceae Enterobacteriaceae Non lactose fermenters Fever, leucopenia, DIC and hypotension caused by members of enterobacteriaceae family are strongly associated with ELISA for virulence marker antigen(VMA) is done to detect virulence in

Glucose is NOT fermented by all members of the family, All are oxidase negative Peritrichous Glucose in NOT fermented by all members of the family Shigella, salmonella Lipid A

Enteroinvasive E.coli, shigella

E.COLI Many E.coli isolated from UTI E.coli E.coli E.coli E.coli attached to surface with the help of Lactose fermenting colonies on EMB agar Serotype of E.coli causing hemorrhagic colitis Enterohemorrhagic E.coli EHEC Enteroaggregative E.coli Stacked brick pattern of adherence Enterotoxigenic E.coli

Attach to uroplakin by mannose binding type I pili Labile toxin in ETEC act via CAMP, UTI causing E.coli attaches through pili, EIEC invasiveness under plasmid control Aerobe and facultative anaerobe, E.coli is motile by peritrichate flagella Non capsulated Fucose E. coli O157:H7 Hemolytic uremic syndrome Ferments sorbitol, Causes HUS, Elaborates shiga like exotoxin Persistent diarrhea Enteroaggregative E. coli Traveller’s diarrhea

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MICROBIOLOGY REVIEW NOTES ETEC ETEC ETEC spread by Enteroinvasiveness of E. coli is under control of Enteroinvasive E.coli Sereny test is positive in EPEC is associated with Enteropathogenic E.coli A microbiologist wants to develop a vaccine for prevention of attachment of diarrheagenic E.coli to specific receptors in GIT. Fimbrial adhesion NOT a appropriate candidate Eiken test for E.coli Verocytotoxin of E.coli act by E.coli heat labile toxin resembles action of Incubation period 6-7 hours for Preformed toxin is NOT important in food poisoning due to MC cause of liver abscess E.coli gives pink colour with Culture media used for EHEC O157:H7 ELISA for Virulence Marker Antigen is done to detect virulence

Common cause of acute watery diarrhea in children in developing countries Heat labile enterotoxin Contaminated water Plasmid Produce disease similar to Shigellosis EIEC Epidemic Cause acute gastroenteritis in infants P1 pili

Precipitin test Decreasing protein synthesis Vibrio cholera E.coli food poisoning ETEC E.coli McConkey medium Sorbitol McConkey media Enteroinvasive E.Coli

PROTEUS Proteus Phenylalanine deaminase positivity is shown by Proteus Diene’s phenomenon Maximum urease production Seminal smell on culture Swarming growth To prevent swarming, the percentage of Nutrient agar is increased to

Forms struvite stone, Proteus cause deamination of phenylalanine to phenylpyruvic acid Proteus Urease positive Proteus mirabilis, Proteus vulgaris Proteus Proteus Proteus mirabilis 4%

SALMONELLA Organism requiring tryptophan for growth Microorganism that can enter freshly laid eggs Feature common to all species of Salmonella Antigen blocking agglutination of salmonella by O antiserum

S.typhi Salmonella Indole negative Vi

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MICROBIOLOGY REVIEW NOTES Salmonella is associated with Ebeth Gaffky Bacillus Only salmonella not producing H2S Only non motile salmonella Fever for 3 weeks, splenomegaly, hypoechoic shadow in spleen near hilum. Gram negative bacilli isolated on culture Salmonella infection Food poisoning after 16 hours Enrichment media of choice for Salmonella DT104 strain belong to Prolonged salmonella septicemia is caused by Non typhoid salmonella

NOT true about non typhoid salmonella

Type III secretion Salmonella typhi Salmonella typhi S. gallinarum pyllorum Salmonella Blood culture is positive in 3-7 days Salmonella Selenite F broth Salmonella typhimurum Salmonella cholera suis Transmission is most commonly associated with eggs, poultry and undercooked meat, common in immunocompromised individuals, resistance to fluoroquinolones are emerged Blood culture is more sensitive than stool culture in gastroenteritis in adults

TYPHOID Both lactose positive and lactose negative colonies on EMB agar NON gas producing salmonella Agglutination with O antigen of S.typhi is inhibited by Infective dose of Salmonella typhi Food poisoning after 24 hours Salmonella gastroenteritis Salmonellosis Typhoid Typhoid Incubation period of typhoid Reserve and source of infection are same for 10 year old child 10 days continuous fever, enlarged spleen Rose spot Erythema marginatum Coma vigil is seen in Typhoid in children Salmonella typhi infection in intestine Pea soup stool Muttering delirium is associated with

Salmonella typhi Salmonella typhi Vi antigen 10^2 to 10^5 bacilli Salmonella gastroenteritis Caused by animal products, Symptoms appear between 4 to 48 hours Increased incidence in developed countries, Antacid and prolonged antibiotic administration promote infection, Food borne to man and animal Urinary carriers are more dangerous, Vi ab is used for detecting carrier, Urine carrier is associated with anomalies Male carriers though less are more dangerous 3 – 21 days Enteric fever Enteric fever Enteric fever Enteric fever Enteric fever Mild splenomegaly is usual Affects Peyer patches Typhoid Typhoid

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MICROBIOLOGY REVIEW NOTES Perforation of gut associated with Massive splenomegaly is NOT seen in NOT a feature of typhoid NOT common in typhoid Highest incidence of typhoid fever Incubation period of typhoid Isolation in salmonellosis done till Maximum isolation period of enteric fever Enrichment media for Salmonella typhi Which gives strong evidence of typhoid fever carrier status Chronic carrier state in typhoid is diagnosed by Widal test

Antibody to H antigen Widal test is an rd Diagnosis of typhoid in 3 week st Typhoid is diagnosed on 1 week by NOT true about widal test NOT true about Widal test Typhoid carriers are NOT detected by Drug of choice for carriers of typhoid Most successful method for treatment of typhoid carriers Drug of choice for treatment of typhoid fever in pregnancy Treatment of salmonella typhi Treatment of Chloramphenicol resistant typhoid infection NOT commonly used against enteric fever Chemoprophylaxis is NOT done for Ty21a is a Typhoid oral vaccine is given Immunization of choice for typhoid in India

Typhoid Typhoid Non involvement of ileum Constipation 5-19 years 10-14 days Stool culture negative for three times Till three consecutive negative urine/stool culture samples are obtained from the patient Selenite F broth Isolation of Vi antigen Vi agglutination test Tube agglutination test, Previous infection affects Widal test, H antigen titre remains positive for several months and reaction to it is rapid Appears first and persists for long period Agglutination test Widal test Blood culture O antibodies are least useful First test is confirmatory Widal test Ampicillin Cholecystectomy with ampicillin Ceftriaxone Ciprofloxacin Ciprofloxacin Amikacin Typhoid Oral vaccine 1,3,5 days Monovalent vaccine

SHIGELLA Role of plasmid in conjugation first described by Lederberg and tatum in Shigella can be differentiated from E.coli by Shigella MC species of shigella in India Most virulent shigella Exotoxin is produced by Shigella are subdivided based on their ability to ferment

Shigella dysenteriae Shigella does not produce gas from glucose, Shigella does not ferment lactose, Shigella is non motile SMALL dose can cause infection, Associated with HUS, causes bloody diarrhea, Gut pathology is due to toxin Shigella flexneri Shigella dysenteriae Shigella dystenteriae Mannitol

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MICROBIOLOGY REVIEW NOTES Shigella does not have Lactose fermenter Acrogenic shigella Enterotoxin produced by Toxin acts by inhibiting protein synthesis Shigella is associated with Gold standard test for Shigella dysentery Shigellosis is best diagnosis by Medium for shigella Selective media for shigella Differential media for shigella

H antigen Shigella sonnei Shigella dysenteriae, shigella sonnei, shigella boydii Shigella dysenteriae Shiga toxin Toxic megacolon Isolation from feces Stool culture Deoxycholate citrate agar Hektoen enteric agar Triple sugar iron agar

FEATURES OF VIBRIO Robert Koch discovered Vibrio cholera in Vibrio cholera first isolated by Cholera caused by O139 vibrio is derived from Vibrio cholera O139 Stain of vibrio cholera in Bengal Pathogenecity of O139 vibrio is due to Recent infection of cholera in india is caused by Types of O1 vibrio Eltor vibrio differentiated from classical cholera by El tor cholera El tor vibrio El tor vibrio Seventh pandemic of cholera caused by Vibrio cholera Vibrio cholera

Napiform liquefaction in gelatin swab Optimal growth of Vibrio cholera Growth of Vibrio cholera is inhibited by Virulence is controlled by Quorum sensing Endotoxin of the following gram negative bacteria does not play any part in pathogenesis of natural disease Vibrio cholera toxin is similar to Bacteria acts by increasing cAMP V.cholera able to stay in GIT because of Diarrhea due to vibrio cholera

Africa Koch Vibrio cholera 0.01 El tor Clinical manifestations are similar to O1 el tor strain, epidemiologically undistinguished from O1 El tor strain O:139 O antigen O139 vibrio ogawa Classical, El tor Chick erythrocyte agglutination Infection is mild and asymptomatic, resistant to polymyxin unit disc, chronic carriers are common Humans are only reservoir, can survive in cold water for 2-4 weeks, killed by boiling for 30 seconds More subclinical cases, less mortality, able to survive longer, harder E1 tor Transported in alkaline medium, gram negative aerobic, ferments glucose, grows on simple media, non halophilic, man is only natural host Has marked tolerance of alkaline pH, El tor is milder than classical, Produces indole and reduces nitrate, Synthesize neuraminidase Vibrio cholera 0.5 – 1% 7% NaCl Quorum sensing Incessant chatting of microbes Vibrio cholera ETEC (but more potent) Vibrio cholera Motility, Binds to specific receptors Neutophilia, Occurrence of many cases in the same

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Cholera red reaction is tested by adding Selective media and best suitable media for vibrio Transport medium for Cholera Selective medium for vibrio cholera

locality Sulphuric acid TCBS VR Medium TCBS-Thiosulphate, Citrate, Bile salt, Sucrose

CHOLERA Incubation period less than 1 week Prevalence of cholera measured by Cholera transmission by Mode of spread of cholera Cholera A convalescent case of cholera remain infective for Cholera toxin acts by Cholera toxin in small intestine acts by Cholera toxin

Function of B subunit of cholera toxin Modification occurring in Gs subunit leading to watery diarrhea in cholera Cholera toxin Vibrio cholera diarrhea is associated with Washerwoman skin is associated with Cholera gravis Death in cholera is due to Drug of choice for treating cholera in pregnant woman Drug of choice for treating cholera in children Antibiotic of choice for treating cholera in an adult is a single dose of Mechanism by which cholera might be maintained during intervals between peak cholera session is Best approach to prevent cholera epidemic in a community Tetracycline used in prophylaxis of Drug of choice for chemoprophylaxis of cholera NOT a measure recommended for controlling outbreak of cholera Best disinfectant for cholera stools

Cholera Vibriocidal antibody Food and healthy carriers John snow Culture medium TCBS agar, produces indole and reduce nitrate, synthesize neuraminidase 14-21 days Stimulation of adenylate cyclase ADP Ribosylation of G regulatory protein Oligomeric protein composed of one A subunit and five B subunits (AB5). A subunit detaches and becomes activated by proteolytic cleavage, allowing it to catalyze the ADP ribosylation of the Gαs subunit of the heterotrimeric G protein resulting in constitutive cAMP production. To bind GM1 ganglioside receptor ADP ribosylation Causes continued activation of adenylate cyclase Neutrophilia Cholera Life threatening diarrhea Hypovolemic shock Furazolidone Cotrimoxazole Doxycycline Continuous transmission in man Safe water and sanitation Cholera Tetracycline Mass chemoprophylaxis Cresol

HALOPHILIC VIBRIO Halophilic vibrio

Vibrio parahemolyticus, V.alginolyticus, V.flovalis

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MICROBIOLOGY REVIEW NOTES Vibrio parahemolyticus associated with Vibrio parahemolyticus Toxin is NOT a pathogenic mechanism in Recently visited sea coast presented with ulcer over left leg Cellulitis is associated with Vulfincus means

Shell fish Food borne enteritis, Kanagawa phenomenon – hemolysis on Wagatsuma agar Vibrio parahemolyticus Vibrio vulnificus Vibrio vulvifuncus Wound maker

ATYPICAL MYCOBACTERIA Mycobacterial species differentiated by Mycobacterium other than tuberculosis Tubercle bacilli showing yellow orange pigment MC cause of non tubercular mycobacteria pulmonary disease Mycobacterium avium NOT photochromogen Lady windermere syndrome is caused by Prevention of MAC in HIV Second most common cause of non tubercular mycobacteria pulmonary disease Can cause disease indistinguishable from tuberculosis Exposure to the organism having antagonistic effect on BCG Rapidly growing atypical organism NOT involved in lung infection Scotochromogens Photochromogens Mycobacterium siniae is Rapid growers Rapid grower and pathogenic to humans Cutaneous lesions produced by Mycobacterium can be grown in 1-2 weeks Pedicure bath and leg shaving is associated with Swimming pool granuloma (fish tank) Mycobacterium that grows best at 45*C Battey bacillus Mycobacterium ulcerans

Non pathogenic Mycobacterium vaccae Most useful in treatment of mycobacterium avium complex Active against atypical mycobacteria Drug of choice for treatment of skin infection with

Catalase test, Niacin, Amidase Causes decreased efficacy of BCG due to cross immunity Atypical Mycobacterium avium complex Do NOT form pigment Mycobacterium avium Mycobacterium avium complex Azithromycin M.kansasii M.kansasii M.kansasi M.kansasi M.szulgai, M.scrofulaceum, M.gordonae/acquae M.kansasii, M.marinum, M.asiaticum, M.siniae Photochromogen M.fortuim, M.chelonei, M.smegmatis M.chelonei M.tuberculosis, M.leprae, M.ulcerans, M.marinum, M.hemophilum M.fortuitum M. fortuitum M.marinum M.smegmatis Mycobacterium intracellulare Tropic zone geographic distribution, cause chronic progressive ulcer, no pigment production in light, rarely cause ulcer in mouse foot pad M.smegmatis, M.paratuberculosis, M.phlei Immunomodulator Clarithromycin Clarithromycin, Rifabutin, Ciprofloxacin Cotrimoxazole

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MICROBIOLOGY REVIEW NOTES M.marinum NOT a treatment of MAC (avium)

Pyrazimanide

GENERAL FEATURES OF RICKETTSIA Rickettsia Primary site of multiplication of Rickettsial organisms Transovarial transmission occurs in Only rickettsiae able to grow in cell free media Oriental Spotted fever is caused by Rash starting peripherally is a feature of Murine typhus Mediterranean spotted fever is caused by Vector for R.conori African tick bite fever Maculatum disease Tick borne lymphadenopathy is caused by Flea borne spotted fever Tunica reaction Antigen used for Weil felix reaction obtained from Typhus fever is diagnosed by Weil felix reaction is POSITIVE in Weil felix reaction is Weil Felix reaction is NEGATIVE in Neil Mooser reaction given by Neil Mooser reaction is positive in OK-19 is positive in

Gram negative, non motile Endothelial cells of small vessels Rickettsiae R.quintana Rickettsia japonica Indian tick typhus R. typhi (transmitted by Xenopsylla) R.conori Mite R.africae R.parkeri R.slovaca R.felis R. mooseri Proteus Weil Felix reaction Epidemic typhus Agglutination reaction Q fever, R.pox and trench fever Rickettsial infection R.typhi Epidemic typhus, endemic typhus, Brill Zinser disease

ENDEMIC TYPHUS Endemic typhus Vector for endemic typhus Mooser bodies

Caused by R.typhi, Transmitted by bite of fleas (rat flea) Flea Endemic typhus

EPIDEMIC TYPHUS Epidemic typhus is also known as Only rickettsial disease showing recrudescence Man presents with fever, chills 2 weeks after a louse bite, maculopapular rash on trunk, which spreads peripherally Chills and fever following louse bite 2 weeks before, rashes all over body, delirious at the time of presentation. vasculitis due to Rickettsial infection

Sutama (Crouching) Epidemic typhus Epidemic typhus R.prowazekii

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MICROBIOLOGY REVIEW NOTES Vasculitis due to rickettsia by Jail fever is associated with Rickettsiae prowazeki is transmitted by Epidemic typhus is transmitted by Brill Zinser disease

Rickettsia prowazekii Rickettsia prowazeki Louse Louse Recrudescence

SCRUB TYPHUS Scrub typhus

Rash starting peripherally Disease caused by mite Which transmit both rickettsial disease(R pox) and oriental disease (scrub typhus) Leptotrombidium deliensis Transovarian transmission is associated with NOT true about scrub typhus Weil felix reaction is Weil felix reaction with OXK

Adult mite feeds only on plants, R.tsutusgamushi Vector is trombiculid mite, Tetracycline is the drug of choice, Eschar indicates the location of mite bite, Spread by infected chigger Scrub typhus Scrub typhus Trombiculid mite Trombiculid mite Scrub typhus Transmitted by adult mites when feed on hosts OX-K R.tsutsugamushi

RICKETTSIAL POX Rickettsial pox is caused by Rickettsial pox transmitted by Vector for Rickettisal pox Herald spot

R.akari Mite Gamasid mite Rickettsial pox

ROCKY MOUNTAIN SPOTTED FEVER Most severe form of Rickettsial infection is caused by Rocky mountain spotted fever is caused by RMSF transmitted by RMSF is transmitted by Rocky mountain spotted fever RMSF resembles OX-2 and OX-19 positive in Rumpel Leede test for NOT a viral hemorrhagic fever MC serological test for RMSF

Rickettsia rickettsii R.rickettsii Tick Dog tick (Dermacentor) Pinpoint, petechial lesions of palm and volar aspect of wrist Bacterial meningitis Rocky mountain spotted fever Rocky mountain spotted fever Rocky mountain spotted fever Indirect immunofluorescence

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MICROBIOLOGY REVIEW NOTES

Q FEVER Q fever is caused by Q fever Q fever Coxiella burnetti Rash is absent in Mode of transmission of Q fever Lice is NOT a vector for Organism NOT needing vector for transmission

Coxiella burnetti Zoonotic disease, Human disease is characterized by an interstitial pneumonia, No rash is seen Highly infectious zoonotic disease, mode of transmission is by inhalation, no rash or local lesion Transmitted by inhalation of aerosol of unpasteurized milk Q fever Inhalation of aerosol Q fever Coxiella burnetti

EHRILICHIA Ehrilichiosis Human granulocytic ehrilichiosis is caused by Human monocytic ehrlichiosis is caused by Cytoplasmic mulberries (morula) are seen in blood granulocyte in which of the following

Tick borne bacterial infection Anaplasma phagocytophilum Ehrlichia chaffeensis Ehrlichiosis

CHLAMYDIA Chlamydia Chlamydia is also known as Chlamydia Obligate parasite Infectious part of chlamydia Chlamydia escape killing by Chlamydia grow in Hep2 cells are example of Ornithosis is caused by NOT true about Chlamydia Young male with UTI, pus cells but no organisms 45 year female, lower abdominal pain and vaginal discharge, cervicitis along with mucopurulent cervical discharge. best approach to isolate possible causative organism Fitz Hugh Kurtis syndrome Chlamydia is associated with Chlamydia does NOT cause Chlamydia does NOT cause

Gram negative but do not have peptidoglycan, do not have muramic acid Basophilic viruses Their cell wall lacks a peptidoglycan layer, Can NOT grow in cell free media, Obligate intracellular bacteria Chlamydia Elementary body Molecular mimicry HeLa,HeP2,McCoy Continuous cell lines Chlamydia Can grow in cell free culture media McCoy culture Culture on McCoy cells

Perihepatitis in female caused by Chlamydia trachomatis Coronary artery disease Parotitis Community acquired pneumonia

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MICROBIOLOGY REVIEW NOTES Isolation of Chlamydia from tissue specimen is done by Method of isolation of Chlamydia from clinical specimen NOT a method of isolation of Chlamydia from clinical specimens NOT useful for Chlamydia Chlamydia Chlamydia can NOT grow in Drug of choice of Chlamydia infection in Pregnancy NOT useful in Chlamydia treatment Chlamydia trachomatis is a Chlamydia trachomatis

In reticulate body of Chlamydia Halber Steadter Prowazeki bodies Chlamydia trachomatis serovars D-K cause Burning micturition in sexually active male, ulcer in genitals, 50 WBC, leucocyte esterase positive. gonococcal culture negative Chlamydia trachomatis is NOT associated with Chlamydia trachomatis NOT associated with Chlamydia is isolated by Most sensitive test for detecting cervical Chlamydia trachomatis infection Serology of choice for Chlamydia Drug of choice for Chlamydia trachomatis infection in pregnancy Chlamydia pneumonia Chlamydia showing only one serotype Chlamydia psittaci Levinthal colle lille bodies NOT true about Chlamydia psittaci

Yolk sac inoculation Yolk sac inoculation, Tissue culture using irradiated McCoy cells and BHK cells Enzyme immunoassay Blood culture Nucleic acid amplification Ordinary media Azithromycin Cefotaxime Bacteria Elementary body is NOT metabolically active, biphasic, reticulate body divides by binary fission, evades phagocytosis inside the cell, genital chlamydial infections are often asymptomatic, can be cultured, inclusion conjunctivitis caused by C.trachomatis serotype D and K RNA > DNA Chlamydia trachomatis Urethritis Chlamydia trachomatis Group specific antigen is responsible for production of complement fixing antibodies Community acquired pneumonia Yolk sac inoculation Polymerase chain reaction(Nucleic acid amplification) Microimmunofluorescence Azithromycin Group specific antigen is responsible for the production of complement fixing antibodies Chlamydia Pneumoniae Acquired from bird droppings, pneumonia. tetracycline Psittacosis Cause non gonococcal urethritis

MYCOPLASMA Mycoplasma

Mycoplasma Mycoplasma differ from Rickettsia by

NOT obligate intracellular organism, Smallest prokaryotic organisms that can grow in cell free media, Lack cell wall, Resistant to beta lactams, Affinity for mammalian cell membrane, Can pass through filters of 450 mm pore size, Multiply by binary fission, Requires sterols for their growth, Raised ESR, Diagnosed by serum cold antibody May be commensal in growth, L form is commonest No cell wall

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MICROBIOLOGY REVIEW NOTES Positive cold agglutination test is seen in infections with Gliding motility Mycoplasma is stained by Dappe’s stain Diene’s method Cell wall deficient organisms Eaton agent Fried egg colonies L forms are found in Pleomorphic organism Pleuropneumonia like organisms Multiply by binary fission, can grow in cell free media, require sterol for growth NOT true about mycoplasma NOT true about mycoplasma Mycoplasma and Penicillin G Mycoplasma pneumonia is differentiated from other forms of mycoplasma and other L forms of bacteria by Metabolizes arginine

Mycoplasma Mycoplasma Dienes method Mycoplasma in cell culture Mycoplasma Mycoplasma Mycoplasma Mycoplasma Mycoplasma Mycoplasma Mycoplasma Mycoplasma Obligate intracellular parasites Inhibited by penicillin Resistant The ability of its colonies to adsorb sheep blood cells Mycoplasma hominis

NON VENERAL TREPONEMES Does NOT develop resistance to penicillin Non veneral treponemal infection Non veneral treponemas Yaws caused by Yaws Yaws Yaw Yaw NOT true about Yaw NOT true about Yaws Yaw and Pinta Pinta caused by Pinta Pinta is associated with Bejel is caused by

Treponema Yaws, Pinta, Endemic syphilis T.pertenue, T.carateum Treponema pertenua NOT sexually transmitted, Caused by T.perteune, Secondary yaw can involve bone Treponema pertunae, non venerally, secondary yaws can involve bone T. pertenue, skin to skin transmission, occurs in early childhood, ulcerative papilloma in extremities, destructive gumma Also known as pian, framboesia, bouba, raspberry like, crab like gait, gangosa Later stages involve heart and bone Spread by sexual transmission CANNOT be differentiated by serological tests T.carateum T. carateum, skin to skin transmission, late childhood, non ulcerative papule, non destructive, dyschromic or achromic macule Purpura Treponema endemicum

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MICROBIOLOGY REVIEW NOTES

LEPTOSPIRA Most widespread zoonotic disease in world Rat, rain, rice fields True about leptospirosis Reservoir of Leptospirosis Transmitted by Rat urine Characteristic feature of Leptospira Leptospira Disease seen in Sewer worker Leptospirosis Accidental and dead end host in leptospirosis Leptospirosis Leptospirosis High grade fever, altered sensorium, comatosed and conjunctival hemorrhage, elevated serum bilirubin and serum urea, negative peripheral blood for malarial parasite Weil’s disease caused by Features of Weil’s disease NOT true about Leptospirosis NOT used in leptospirosis NOT true about leptospirosis EMJH medium Korthof culture media for Culture medium for Leptospirosis 14 year boy, icterus, conjunctival effusion, hematuria. serological test Diagnosis of Leptospirosis Treatment of leptospirosis Drug having no effect of leptospira

Leptospirosis Leptospirosis Rats are prime reservoirs Rat Leptospira Hooked ends Viable as long as 10 days at room temperature in blood Leptospirosis Zoonosis, Man acts as accidental host and dead end, Rats are the reservoir, person to person transmission is rare Man Urine may show microscopic hematuria, Incubation period in leptospirosis ranges from 2 – 20 days Infection acquired by direct contact with infected urine. mortality is 5-15% in severe cases, penicillin, antibodies NOT usually detectable in first week Weil’s disease

Leptospira icterohemorrhagica Hepatorenal damage, jaundice, renal failure, albuminuria, bleeding diathesis, purpuric hemorrhages, pyrexia Quinolones are drug of choice Weil felix reaction Lice act as vector Leptospirosis Leptospirosis Korthof Microscopic agglutination test Microscopic agglutination test Penicillin G Erythromycin

BORRELIA Lyme’s disease Lyme disease

Bull’s eye lesion Lyme disease

Borrerlia burgdorferi, Transmitted by Ixodes tick (deer tick), Rodents act as natural host, Erythema chronicum migrans may be a clinical feature Borrelia burgdorferi replicates locally and invades locally, Infection progresses inspite of good humoral immunity, Intrathecal IgA confirms meningitis Lyme’s disease CSF pleocytosis

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MICROBIOLOGY REVIEW NOTES Bannwarth syndrome(meningopolyneuritis) is Erythema migrans is a feature of Skin feature of lyme disease NOT true about lyme’s disease NOT true about Lyme disease Relapsing fever MC symptom of tick borne relapsing fever Treatment of relapsing fever Organism using antigenic variation as a major means of invading host defences Louse borne relapsing fever caused by NOT associated with tick borne relapsing fever Tick borne relapsing fever caused by Noguchi medium Barber Stonner Kelly medium Kelly’s medium Borrelia infection is confirmed by Misdiagnosis of Lyme disease Treatment of Lyme disease

Lyme’s diseae Lyme disease Acrodermatitis chronic atrophica Intrathecal specific IgA antibodies is diagnostic Polymorphonuclear lymphocytes in CSF suggest meningitis Tick borne relapsing fever (Ornithodoros tick), Louse borne relapsing fever also known as epidemic relapsing fever caused by Borrelia recurrentis Headache Chloramphenicol, doxycycline, erythromycin, penicillin Borrelia recurrentis Borrelia recurrentis Borrelia recurrentis Borrelia duttoni, Borrelia hermsii, Borrelia parkeri Borrelia Borrelia Borrelia Stain for inculsion bodies within the cells involved in rash Chronic fatigue syndrome Doxycycline (oral), Ceftriaxone (IV)

VIROLOGY GENERAL FEATURES OF VIRUS National institute of virology is located in Viroids Viroids Virion Virus contains Virus DNA covering material of virus is called Virus grows well on Von magnus phenomen nd

One virus particle prevents multiplication of 2 virus. this phenomena is called Virulent strain has ability to Electron microscope is used to study the morphology of Plaque formation in virus is done for Plaque assay is done for Viral plaque made for

Pune Resistant to heat Infectious nucleic acid Extracellular infectious virus particle Either DNA or RNA Form extracellular infectious particle, heat labile, NOT affected by antibiotics Capsid Cell culture Virus yields high hemagglutinin titre but low in infectivity Viral interference Invade and multiply Viruses Quantitative assay of infectivity of virus Measuring the number of infectious virus particles Quantitative assay of infectivity of virus

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MICROBIOLOGY REVIEW NOTES Pocks on chick embryo is formed by Hemadsorption is exhibited by Property of elution (reversal of hemagglutin due to presence of neuraminidase that destroys receptor) NOT a cytopathic effect of virus NOT a test for lab diagnosis of viral respiratory track infection Single stranded viruses Double stranded viruses Negative stranded viral RNA Negative stranded RNA viruses

RNA viruses undergoing replication in nucleus Segmented double stranded RNA virus Non enveloped DNA virus Simian virus 40 is Cytoplasmic vacuolation is associated with MC cause of URI Ideal temperature for Rhinovirus Virus causing gasteroenteritis Viruses showing renal involvement Virus associated with malignancy Virus is definitely associated with New infectious agents Latent infection is associated with Reverse transcriptase PCR is used in diagnosis of Reverse transcriptase polymerase chain reaction can NOT aid in diagnosis of NOT a method for detection of viral respiratory tract infection Continuous cell lines for virus are Non cultivable virus SARS is caused by Super spreaders are associated with Incubation period of SARS SARS is identified on Crimean congo fever is caused by Crimean Congo Hemorrhagic fever NOT common in India Virus etiology is NOT implicated in Vector for vaccine preparation Used for vaccine preparation Orf Arena virus

Variola, vaccinia, cowpox Rabies virus, measles vaccine Myxovirus

Budding Detection of viral hemagglutinin inhibiting antibodies in single serum specimen Papova virus Pox virus, reovirus Requires a special polymerase in virion Rhabdoviridae, Filoviridae, Paramyxoviridae, Orthomyxoviridae, Bunyaviridae, Arenaviridae, Reoviridae Retrovirus, orthomyxovirus Reovirus Adenovirus, Parvo virus, Papova virus DNA virus SV40 Rhinovirus 33*C Rotavirus, Adenovirus, Norwalk virus, Enterovirus CMV,HIV,HBV Herpes virus, Retrovirus, Papova virus Burkitt’s Lymphoma, Hairy cell leukemia Nipah virus, Corona virus, SARS HSV 2, HIV, EBV, CMV Astrovirus, Picorna virus, Rota virus Adenovirus Direction of viral hemagglutinin inhibiting HAI antibodies in single serum specimen Vero, Hela, Hep2 Rota virus, Norwalk virus, Molluscum contagiosum Corona virus Corona virus 2 – 7 days 2003 Nairo virus Zoonosis, Develop petechial patches, Recently reported in Gujarat, Has high fatality Lassa fever Condyloma lata Vaccinia Adenovirus Parapox virus Old world virus eg. Lassa virus, Lymphocytic

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MICROBIOLOGY REVIEW NOTES

Transovarian transmission is seen in Bunyaviridiae cause Ganjam virus belongs to Mayor fever is transmitted by Ebola virus Bowl of sphagetti appearance Ebola virus is diagnosed by

choriomeningitis Bunyaviridae eg. Nairo virus, Hanta virus Orapouche, Punta toro infection, Sandfly fever, Toscana fever Bunyaviridae Heamagogus virus Flavivirus Ebola virus Bromide green dye for PCR

HERPES VIRUS Herpes group virus Lipid envelope is found in HSV is a Varicella, EBV belong to Focal degeneration (pocks in chorioallantoic membrane) Cold sore is caused by Encephalitis is caused by Scrum pox is common in HSV II

Neonatal herpes is caused by Virus B6-7 is causative agent in Roseola infantum or Exanthem subictum is caused by HHV 6B cause Nagayama spot Rash usually appears after fever has subsided Kaposi sarcoma caused by Castleman disease is caused by Herpetic whitlow in NOT a treatment of herpetic whitlow Herpetic gladiatorum Herpes virus may remain dormant in Genital herpes simplex can be diagnosed by Biopsy of herpes simplex viral lesion Cowdry A intranuclear acidophilic inclusion bodies Drug of choice for Herpes simplex Acyclovir

Ether sensitive, may cause malignancy, HSV II involve below diaphragm Herpes virus Double stranded DNA virus Herpes virus Herpes HSV-1 HSV 1 Rugby players Primary infection is usually widespread, Recurrent attacks are due to reactivation of latent infection, Encephalitis can be caused by HSV II, Newborn can acquire infection via birth canal at the time of labour, Treatment is with acyclovir HSV II Focal encephalitis HHV 6 Focal encephalitis Exanthema subictum Exanthema subictum and erythema infectiosum HHV8 HHV- 8 Finger Surgery Wrestler Sacral ganglia Tzank smear Multinucleated keratinocytes Herpes simplex, varicella zoster Acyclovir Inhibits DNA synthesis and viral replication, low toxicity for host cells, renal impairment necessitates dose reduction

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MICROBIOLOGY REVIEW NOTES Mechanism of action of acyclovir Famcicyclovir Valacyclovir

Inhibits HSV polymerase Prodrug of peniclovir Prodrug of acyclovir

PARVOVIRUS Parvovirus Parvovirus B19 Parvovirus B19 Virus with smallest genome Smallest DNA virus Target for parvovirus Parvovirus cause th 5 disease is caused by Predominant route of parvovirus Common manifestation of Parvovirus infection in adult Erythema infectiosum Lazy reticular rash is associated with Slapped cheek appearance Glove and stock syndrome is a variant of

Non enveloped, SINGLE stranded DNA virus, linear DNA, icosahedral symmetry DNA virus, severe anemia, aplastic crisis, crosses placenta frequently Spread by respiratory route, Has affinity for erythrocyte progenitor cells, Causes transient aplastic crisis, Transplacental transfer occur in 30% of cases Parvovirus Parvovirus Immature cells in erythroid lineage Erythema infectiosum, Aplastic anemia, Arthropathy Parvovirus B19 Repiratory route Arthropathy Parvo virus, Slapped cheek appearance Erythema infectiosum (Parvovirus) Erythema infectiosum Erythema infectiosum

EBSTEIN BARR VIRUS EBV EBV belongs to EBV EBV Virus spreading through both hematogenous and neural route Infectious mononucleosis is caused by Diseases associated with EBV Infectious mononucleosis is caused by Oral hairy leukoplakia is associated with Patient with sore throat having positive paul bunnel test Lymphoid interstitial pneumonitis in HIV infected individual is commonly caused by Epitrochlear lymphadenopathy is associated with African Burkitt’s lymphoma is caused by EBV cause autoimmunity by Sore throat and positive paul bunnel test

HHV 4 Herpes group Double stranded DNA virus Gp350 binds to CD21 EBV Epstein barr virus Infectious mononucleosis, Nasopharyngeal carcinoma, Oral hairy leukoplakia, Hodgkin’s and Non Hodgkin’s lymphoma, Ca tonsil, Burkitt’s lymphoma EBV EBV Epstein Barr virus EBV EBV EB virus Polyclonal B cell activation EBV

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MICROBIOLOGY REVIEW NOTES EBV is associated with

NOT caused by EBV Ebstein Barr Virus does NOT cause EBV is NOT associated with Inclusion bodies are NOT seen in Paul bunnel test is done for Most sensitive test for diagnosis of infectious mononucleosis Ampicillin NOT given in EBV infection because of

Post transplant lymphoreticular disease, Non Hodgkin’s lymphoma, Bell’s palsy, carcinoma tonsil Kaposi’s sarcoma Adult T cell Leukemia Thrombocytopenia Infectious Mononucleosis Infectious mononucleosis Monospot test Skin rash

CYTOMEGALOVIRUS Cytomegalovirus is Post kidney transplantation caused by Mononucleosis like syndrome is caused by MC presentation of congenital CMV Maternal viremia most commonly spreading to fetus in utero CMV rarely cause In CMV infection of brain, viruses are present in Owl eye appearance on picture Congenital CMV infection Great concern for CMV infection Congenital CMV infection in infant established by Does NOT establish diagnosis of congenital CMV in neonate Drug used in CMV infection Famciclovir is a prodrug of

HHV 5 CMV CMV Hepatosplenomegaly CMV CNS infection WBC CMV Hepatosplenomegaly 2nd month after transplantation Urine culture of CMV, Intranuclear inclusion bodies in hepatocytes, CMV viral DNA in blood by polymerase chain reaction IgG CMV antibodies in blood Gancyclovir Penciclovir

ROSEOLA INFANTUM A patient had fever and coryza for last 3 days developed maculopapular erythematous rash which lasted for 48 hours and disappeared without leaving behind pigmentation is commonly due to Roseola infantum Fever stops and rash begins is diagnostic of

Roseola infantum

HHV 6 and 7, Rash appear in trunk, During deferverescence rash appears Roseola infantum

VARICELLA ZOSTER VIRUS Varicella zoster virus Varicella are classified under

HHV 3 Herpes virus

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VIROLOGY

MICROBIOLOGY REVIEW NOTES Virus causing chicken pox belongs to NOT a pox virus Herpes zoster is caused by Varicella

Chicken pox Chicken pox Rash of chickenpox Rash pattern in chickenpox Dew drop on petal appearance Pleomorphic rash Incubation period of Varicella Zoster Infectivity of chickenpox lasts for Varicella zoster remains latent in MC extraskin manifestation of Varicella Intrauterine infection associated with limb reduction defects and scarring of skin Hypoplasia of limb and scarring caused by MC complication of chickenpox in children Known complication of chicken pox NOT a complication of chicken pox NOT true about chicken pox NOT true about chickenpox NOT true about varicella infection Multiple calcification in chest X ray Sensitive test for VZV Prevention of VZV in HIV

Herpes virus (HHV3) Chicken pox virus Varicella No recurrence(single infection gives lifelong immunity), All stages of rash are seen at same time, Rash commonly seen in flexor area, Secondary attack rate is 90% Centripetal rash, Pleomorphic rash, Rapid progression from macule to vesicle, Lesion appear in crops Rash appears on first day, Rash can occur in axilla Quick prodromal period, quick evolution, rash begins on trunk Centripetal Varicella Chicken pox 1 – 2 weeks 6 days after onset of rash Trigeminal ganglion CNS Varicella Varicella Secondary bacterial infection Pancreatitis Enteritis Scabs are infective Crusts contain live virus Only single stage infection found at a time Following chickenpox FAMA (Fluorescent antibody to membrane antigen), ELISA VZ immunoglobin

ADENOVIRUS Adenovirus Grape clump appearance is associated with Virus with space vehicle appearance Basophilic inclusion body Disease caused by Adenovirus Shipyard eye is caused by Virus causing hemorrhagic cystitis, diarrhea, conjunctivitis Pharyngoconjunctival fever is caused by Serotype 1,2 Serotype 3,7 Serotype 4, 7 Serotype 40, 41 Serotype 11,12

Double stranded DNA virus Adenovirus Adenovirus Adenovirus Pneumonia, Pharyngitis, conjunctivitis Adenovirus Adenovirus Adenovirus Respiratory disease Pharyngoconjunctival fever (swimming pool conjunctivitis) Military recruits respiratory distress Diarrheal illness in children Hemorrhagic cystitis in children

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MICROBIOLOGY REVIEW NOTES Serotype 8, 19, 37 Cowdry B intranuclear basophilic bodies

Epidemic keratoconjunctivitis Adenovirus

ROTAVIRUS Rota virus Segmented gene Rota virus Reassortment is typically seen in Virus enterotoxin detected as a possible mechanism of action Rota virus commonly affects Rota virus infection in children below MC cause of gastroenteritis in children Rota virus Diarrhea in Rotavirus infection due to Rota virus are responsible for Rota virus detected by Rota virus is diagnosed by Best vaccine for Rota virus

Culture can NOT be done, Rota B can grow in cell culture, Rota C can cause diarrhea in children Rota virus VP6, virus shed in stool Rotavirus Rota virus Children 5 years Rotavirus Terminal ileum villi destroyed Decreased absorption by villi Infantile diarrhea Antigen in stool Presence of antigen in stools by ELISA Genetic reassortment

SMALL POX Largest DNA virus DNA virus with complex capsid symmetery Pox virus Inclusion bodies in cytoplasm is seen with Pox virus Guarneri bodies are seen in Most sensitive method for diagnosis of small pox Protection against small pox by previous infection with cowpox represents Successful eradication of small pox because of Small pox eradication was NOT due to India become small pox free in Bollinger bodies

Pox virus Poxviridae Double standed DNA virus encoding DNA dependent RNA polymerase Pox virus Complex shape, relicate and assemble in cytoplasm (unique feature) Small pox Smear test Antigenic cross reactivity Subclinical cases did not transmit the disease, A highly effective vaccine was available, Infection provided lifelong immunity Cross immunity with animal pox virus April Fowl pox

PAPOVA VIRUS Papova virus

DNA virus, non enveloped icosahedral virus, warts and

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MICROBIOLOGY REVIEW NOTES

papilloma, SV 40 is oncogenic Viral warts resolve spontaneously, Plantar warts should not be excised, Callosity are formed occupationally

Warts

POLIO VIRUS Picorna viruses Polio virus

Type I polio virus

Type II polio virus Type III polio virus Main portal of polio virus Wide polio outbreak in 2nd half of 2007 Polio Polio Disease transmitted by water Virus that spread by both hematogenous and Neural route Isolation NOT needed for Bilateral phrenic nerve palsy Neuronophagia is seen in Biot’s respiration Acute stage of poliomyelitis lasts for NOT seen in non paralytic polio NOT a feature of poliomyelitis NOT true about polio patient who had paralysis Acute flaccid paralysis in children aged Under AFP surveillance, follow up examination is done after Epidemiological trend of Polio Prevalence of all clinical cases of polio can be estimated by multiplying the no of residual paralytic cases For every case of poliomyelitis, the subclinical cases of poliomyelitis to be estimated Sample used to isolate polio virus earliest Cowdry B intranuclear acidophilic inclusion bodies Kenny packs were used in treatment of Best way to stop epidemic poliomyelitis spread Pulse polio immunization

Polio virus, foot and mouth virus, encephalomyocarditis Transmitted by fecooral route, Asymptomatic infections are common in children, Live attenuated vaccine produces herd immunity, Increased muscular activity leads to increased paralysis Responsible for most epidemics, very difficult to eliminate, responsible for vaccine induced paralytic polio Highly antigenic Vaccine induced paralysis due to mutation GIT Type 3 IM injection and increased muscular activity increases the risk of paralytic polio Paralytic polio is most common Polio Polio virus Polio Polio Poliomyelitis Bulbar poliomyelitis 1-5 days Extensor plantar Progressive course Can transmit it by nasal discharge 0-15 years 60 days of onset of paralysis Sporadic to epidemic, increasing in tropics, Affects higher age groups 1.33 1000 children and 75 adults Stool Polio Poliomyelitis OPV drops to all children All children between 0-5 years of age on a single day, irrespective of their previous immunization status

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MICROBIOLOGY REVIEW NOTES Target age group under pulse polio programme OPV OPV strain Concentration of type 3 virus in OPV Salk vaccine

Under 5 years Poliomyelitis in recipients, Poliomyelitis in contacts of recipient Poor growth in stable cell line of monkey kidney 3,00,000 TCID 50 Prevent paralysis, Oral polio can be given as booster, Easily transported

ENTEROVIRUS Total sheet degeneration is associated with MC cause of Rubelliform(discrete) rash Epidemic hemorrhagic conjunctivitis caused by Enterovirus associated with Enterovirus 71 is associated with Bornholm disease Hallmark of pleurodynia Summer grippe Virus shed in stool in Enterovirus does NOT cause

Enterovirus Echovirus 9 Picorna virus (enterovirus which is a subtype of Picorna virus) Myocarditis, Pleurodynia, Herpangina Hand foot mouth disease, herpangina Pleurodynia Servere muscle pain Non specific febrile illness seen in enterovirus infection Herpangina Hemorrhagic fever

COXSACKIE VIRUS Coxsackie virus causes Cox sackie group A commonly causes Cox sackie A 16 is associated with Herpangina is caused by Cox sackie virus does NOT cause Coxsackie virus does NOT cause Suckling mice is used for culture of

Herpangina, Hand foot mouth disease, Infantile myocarditis Aseptic meningitis Vesicles on hand Cox sackie A virus Bornholm disease Erythema subictum Coxsackie virus

INFLUENZA VIRUS Segmented RNA virus M protein in orthomyxovirus maturation

Influenza A All pandemic of influenza by Pandemic of influenza is caused by Influenza Influenza

Influenza virus Serves as a recognition site for nucleocapsid at the inner face of plasma membrane Hemagglutinin and neuraminidase is strain specific Influenza A only Antigenic shift Primary infectious pneumonia is less common than secondary bacterial pneumonia Major epidemics are due to antigenic SHIFT, Antigenic drift is gradual antigenic change over a period of time, Antigenic shift is due to genetic recombination of virus,

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MICROBIOLOGY REVIEW NOTES

Segmented RNA H5N1 H1N1 swine flu was found on Gradual and sequential change in antigenic structure at regular intervals Influenza causes new epidemic by Antigenic shift Shift occurs only with Reye syndrome is associated with Antigenic variation NOT seen in Influenza Influenza is associated with Most serious complication of Influenza B Immunofluorescence Amantidine and rimantidine are active against Amantidine is most effective for Which is a Neuraminidase Inhibitor Avian influenza treated by Oseltamivir is used to treat Oseltamivir inhibit Mechanism of action of oseltamivir

Dose of oseltamivir in adults Newer influenza vaccine

Influenza A is subjected to frequent antigenic variations Influenza Bird flu virus 2009 Antigenic drift Antigenic drift Gradual Influenza A Influenza B Influenza C Affects all sexes and ages, Incubation period 18 – 72 hours Myositis and rhabdomyolysis Reye syndrome Detection of influenza Influenza A only Influenza A Oseltamivir Oseltamivir Influenza A & B Neuraminidase Inhibition of a viral enzyme that aids the spread of virus through respiratory mucus and is required for release of progeny virus 75 mg BD Split virus vaccine, Neuraminidase, Recombinant vaccine

MEASLES Moribilli Measles Measles virus Syncitium formation is associated with NOT a teratogenic virus Measles

Measles Measles Measles Epidemiology of measles

Measles Single stranded negative sense RNA virus Paramyxovirus Measles Measles Higher secondary attack rate, Only one strain cause infection, Infectious in prodromal period, Infections confer lifelong immunity, Meningoencephalitis can precede parotitis, Flaring up of TB Fever occurs 7-10 days after occurrence of infection, immunity develops after 7 days of vaccination, single dose of vaccine gives 95% protection Immunosuppression Koplik spots appear in prodromal stage, Fever stops after onset of rash Secondary attack rate of measles is less than that of rubella

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MICROBIOLOGY REVIEW NOTES Epidemiological determinants of measles Reservoir for measles Incubation period of measles Measles is infectious Koplik spot appear Clinical manifestation of measles appearing last Rash in measles occur first in Fever with centrally distributed maculopapular eruption Macular rash with red margins Remission in Nephrosis Comphy’s sign (white patches due to degenerated squamous epithelium occurring on buccal mucosa and gums) A line of conjunctival inflammation in lower eyelid margin is diagnostic of Warthin finkedly cells (giant cells) Bolognini symptom (a feeling of crepitation occurring from gradual increasing pressure on the abdomen) Hetch giant cell pneumonia MC complication of measles in children Infection having most neurological complications Least common complication of measles MC cause of post measles death Cause of death in measles Bronchopneumonia in measles due to Ice berg phenomenon NOT seen in Chronic carrier NOT seen in NOT true about measles NOT a complication of Measles Chemoprophylaxis not done in Measles vaccination strategy in 9 months to 4 years Catch up, keep up, follow up for

Epidemiological determinants of measles Man 10 days 4 days before rash and 5 days after rash 1 day before rash Rash Post auricular region Measles Measles Measles Measles Measles Measles Measles Measles ASOM Measles SSPE Diarrhea Pneumonia Immunomodulation Measles Measles Not infectious In prodromal stage Pancreatitis Measles Catch up Measles

MUMPS Mumps virus belongs to Virus easily cultured from CSF Virus NOT causing pneumonia NOT transmitted transplacentally Presternal edema is seen in Mumps Mumps cause Commonest complication of mumps MC complication of mumps in children MC ocular manifestation of mumps NOT a complication of mumps

Paramyxovirus Mumps Mumps Mumps Mumps Menigoencephalitis can precede parotitis Aseptic meningitis in children Orchitis and oophoritis Aseptic meningitis Dacroadenitis Parotid abscess

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RABIES Vesicular stomatitis virus Rabies virus RNA Rabies Shape of rabies virus Rabies Rabies Rabies virus inactivated by Paralytic rabies is caused by bite of an infected Incubation period of rabies depends on Characteristic manifestation of rabies MC type of pathological change in Rabies Rabies is transmitted by Rabies NOT transmitted by Mode by which Rabies virus NOT transmitted Foaming at mouth is associated with Rabies free area FALSE about Rabies Bite of which of the following animals do not result in human rabies Rabies free country Rabies is NOT found in Most suitable clinical sample that can confirm the antemortem diagnosis of Rabies Rabies best diagnosed by Intracytoplasmic inclusion bodies Negri body seen in Negri bodies commonly seen in Negri body Babes nodule in rabies Negri bodies are NOT found in NOT used for confirming rabies encephalitis In case of dog bite, biting animal observed for NOT done for dog bite Class II exposure in animal bite Which should be injected in and around wound in class II rabies bite NOT a treatment of class III bite Antiseptic/disinfectant is best for local wound application in case of dog bite Rabies vaccine first developed by Commercially available rabies vaccine NOT a commercially available rabies vaccine

Rhabdoviridae Negative polarity Multiple strains are seen Bullet shape Intracytoplasmic basophilic inclusion bodies are seen in brain cells Vaccine virus has fixed incubation period, IP depends on site of bite, All bites on fingers with laceration are class III injuries Phenol, UV radiation, BPL Vampire bat Site of bite Meningitis Brainstem encephalitis Dogs, Vampire bat, Jakal Ingestion Sexual Rabies No indigenously acquired case for 2 years Limited to brain Mouse Australia, Britain Lakshwadeep, Andaman Nicoar islands Corneal impression smear for immunofluorescence stain Immunofluorence study Rabies Rabies Cerebellum > Hippocampus Eosinophilic cytoplasm Microglia White matter PCR 10 days Immediate wound closure Licks on a fresh wound Antirabies serum Immediately stitch wound under antibiotic coverage Alcohol Louis Pasteur Killed sheep brain vaccine, Human diploid cell vaccine, Vero continuous cell vaccine Recombinant glycoprotein vaccine

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MICROBIOLOGY REVIEW NOTES Vaccine prepared by embryonated hen’s egg Number of HDCV for pre exposure prophylaxis of rabies Pre exposure prophylaxis of rabies Post exposure prophylaxis for rabies

Rabies 3 0,7,28 and booster dose after 2 years HDCV 0,3,7,14,30 booster dose 90 days

GENERAL FEATURES OF ARBOVIRUS Arboviral disease Arboviruses are Suckling mice used for cultivation of Arboviral diseases Only group A arbovirus causing epidemic disease in India

KFD, West Nile fever, Ganjam virus, Puumala virus Heat labile Arbovirus Yellow fever, Japanese encephalitis, Dengue Dengue, Chikungunya fever

DENGUE Break bone fever caused by Dengue virus is a In India, dengue viruses associated with human infections Dengue virus appears to have direct man to man cycle in India. mechanism of dengue virus survival in the inter epidemic period Dengue Infective fever of aedes mosquito for classical dengue fever Infective period of Aedes mosquito in Dengue Dengue fever Dengue Classical dengue fever Saddle back temperature Classical dengue fever is transmitted by Dengue hemorrhagic fever is caused by 5 year petechial rash, Lymphadenopathy, Reduced air entry into Right lung Dengue hemorrhagic fever is due to NOT true about dengue hemorrhagic fever NOT a feature of dengue shock syndrome Minimum platelet count for diagnosis of Dengue Most sensitive diagnostic test for dengue Most specific dengue diagnosis

Arbovirus Flavi virus All 4 types Transovarian transmission of virus Endemic in india Life long Till death Most common arboviral infection, Can be both epidemic as wall as endemic, Can survive in ambient temperature, Vector is Aedes aegypti Increased hematocrit, Decreased platelet, Positive tourniquet test, Vector aedes aegypti usually bite during day time, Pleural effusion present Case fatality is low, break bone fever, self limiting disease Dengue fever Aedes mosquito Reinfection with different serotype of dengue virus Dengue hemorrhagic fever Infection by another strain of dengue virus Shock Decreased hemoglobin 100000 Neutralization test IgM ELISA

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CHIKUNGUNYA Chikungunya Epidemic caused by Type A arbovirus in India Vectors for Chikungunya Vector for Chikungunya fever

Alpha virus Chikungunya Aedes, culex, mansonia Aedes

YELLOW FEVER Arboviral disease NOT reported in India Yellow fever

Yellow fever

Yellow fever is NOT present in India because Incubation period of yellow fever Quarantine period for Yellow fever Torres bodies Yellow fever reference centre No risk of yellow fever if aedes aegypti index remains below Vector control for yellow fever around an airport is done upto a distance of Validity of yellow fever vaccination certification

Yellow fever Subclinical cases present, One attack gives lifelong immunity, Hepatic and renal involvement in severe cases, Caused by flavi virus, Case fatality rate upto 80%, Transmitted by aedes, Incidence is increased by humidity, Vaccine is 17D Incubation period is 3-6 days, Validity of international certificate lasts up to 10 years, Urban form is controlled by 17D vaccine, Aedes aegypti index should be less than 1% Virus is NOT present 3-6 days 6 days Yellow fever Central institute kasauli 1% 400 m 10 years starting 10 days after vaccination

JAPANESE ENCEPHALITIS Old name for Japanese encephalitis Mosquito borne encephalitis caused by JE does NOT cross react with Japanese encephalitis Japanese encephalitis Japanese encephalitis Japanese encephalitis Subclinical infection is common with Japanese encephalitis commonly seen in

Von economo encephala Group B Arbovirus (Flavivirus) Dengue virus Man is incidental dead end host, Culicine and anopheles vectors involved, 85% of cases occur in children 100:1 Zoonoses Japanese encephalitis Pigs

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MICROBIOLOGY REVIEW NOTES Amplifier host of Japanese encephalitis Only domestic animal showing signs of encephalitis due to JE virus Man in Japanese encephalitis Japanese encephalitis in India is associated with Most important vector of Japanese encephalitis in south India Japanese encephalitis is associated with Aedes does NOT transmit Vector for Japanese encephalitis Epidemic in Japanese encephalitis is declared if Abnormal signals in bilateral thalami on MRI brain NOT true about Japanese encephalitis NOT true about Japanese encephalitis virus NOT true about Japanese encephalitis NOT a feature of Japanese encephalitis Major deterrant in elimination of Japanese encephalitis

Pig Horses Dead end host Culex vishnui Culex tritaeniorhynchus Culex tritaenorrhyunchus Japanese encephalitis Culex 2-3 cases in a village Japanese encephalitis Man to man transmission Four doses of vaccine 90-100% mortality rate Infected pigs manifest symptom of encephalitis Large inapparent infections

WEST NILE FEVER Found in India Culex transmit Polio like encephalopathy

West Nile fever West nile fever West Nile fever

KYASANUR FOREST DISEASE Flavivirus closely related to Russian spring summer encephalitis causing virus KFD Viral encephalitis Viral infection transmitted by tick KFD transmitted by NOT useful in prevention of KFD

KFD Zoonosis, affects monkeys, caused by virus KFD Kyasanur forest disease Hard tick – Hemophysalis Deforestation

HANTA VIRUS Sin Nombe virus Hanta virus Hanta virus pulmonary syndrome is caused by

Hanta virus RNA virus, Caused by rodents, Causes recurrent respiratory infection, Hemorrhagic fever with renal failure Inhalation of rodent urine and feces

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RESPIRATORY SYNCITIAL VIRUS Virus lacking hemagglutinin and neuraminidase but have membrane fusion protein RSV does NOT cause

RSV Bronchitis

REOVIRUS Virus composed of two distinct capsules enclosing double stranded RNA Segmented double stranded RNA is found in

Reovirus Reovirus

RUBELLA rd

3 day disease 8 years following URTI developed maculopapular rash rd on jaw spreading on to trunk which cleared on 3 day without desquamation and tender postauricular and suboccipial lymphadenopathy Maculopapular rash on jaw cleared on 3rd day without desquamation and tender postauricular and suboccipital lymphadenopathy Exanthema spreads from hairline to downwards and clears as it spreads Rubella causes Multiple sites of narrowing of peripheral pulmonary arteries Forscheimer spots are seen in Incubation period of rubella Complications of Rubella Uncommon clinical feature of Rubella Most severely affected in Rubella infection MC age group affected by rubella Average incubation period of Rubella is equal to that of Features of Congenital rubella Congenital rubella syndrome is associated with Multiple sites of narrowing of peripheral pulmonary artery NOT true about congenital rubella Risk of fetal damage in rubella is maximum if mother gets infected in Chance of transmission of rubella In 9 – 10 weeks pregnancy Rubella infected a mother at 10-14 weeks of Gestation, Chances of congenital malformation NOT true about rubella

Rubella Rubella

Rubella Rubella Microphthalmia, Congenital cataract, Salt pepper fundus Rubella Rubella, infectious mononucleosis, scarlet fever 2-3 weeks Arthritis, Arthralgia, Encephalitis Encephalitis Unborn child Women of child bearing age Sleeping sickness PDA, Deafness, Cataract VSD, PDA Rubella embryopathy Infection after 16 weeks of gestation results in major congenital defects 6-12 weeks of pregnancy 40% 5-10% Incubation period more than 10 days

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MICROBIOLOGY REVIEW NOTES FALSE about rubella infection Recommended vaccination strategy of rubella is to vaccine first

Rose spots on soft palate Women of 15-49 years

FEATURES OF HIV Retrovirus DNA form of retroviral genome Retrovirus contain HIV 1 and HIV 2 HTLV 1 HIV discovered in AIDS HIV belongs to Retrovirus Main HIV in India MC subtype of HIV in India HIV belongs to HIV HIV virus has HIV is HIV Accessory proteins associated with HIV Relation between HIV and CCR5 with homozygous mutation in an individual is Primary receptor for HIV Receptors for HIV Co receptor for HIV T cell trophic HIV needs the following co receptor for entry and fusion Gp120 in HIV helps in P17 Gp160 Genes present in HIV genome Viral gene NOT associated with HIV Gag encodes for Reverse transcriptase endoded by Tat encodes HIV is inhibited by Reverse transcriptase sequence in HIV Reverse transcriptase Unusual mode of replication is seen in CCR 5 mutation in HIV is related to NOT true about HIV Isolation NOT needed for HIV is common in HIV commonly affects NOT a target for initiation and maintenance of HIV

RNA dependent DNA polymerase Provirus Large terminal repeats Lentivirus (Retrovirus) Delta virus (Retrovirus) 1983 HTLV III E AII Retrovirus Thermolabile HIV 1 C Lentivirus ssRNA Single stranded RNA Enveloped RNA P24 early diagnosis, lysis of infected CD4, macrophage is the reservoir for virus Vpu, Vpx Protective against HIV infection CD4 CCR 5, CXCR 4 CCR 5 CXCR4 Virus attachment Matrix protein Envelop protein Gag, pol and env Tat Core antigen Pol Transactivator protein 0.3% H2O2 RNA – DNA - RNA RNA dependent DNA polymerase Retrovirus High resistance to infection Increased release of acid labile interferon AIDS Males than females Helper cells Neutrophil

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MICROBIOLOGY REVIEW NOTES infection Seroconversion in HIV Window period Window period of AIDS Window period in HIV HIV antibodies show CNS infection in HIV is caused by MC site of lymphoma in AIDS patient Most characteristic CNS lesion of HIV MC CNS Neoplasm in HIV Common late CNS complication of HIV Most common in childhood AIDS NOT a feature of CNS involvement in AIDS NOT a cause of seizure in HIV patient NOT found in CNS in case of AIDS Most common vascular tumour in AIDS patient In AIDS, lymphadenopathy is most often due to Cardiovascular complication of HIV NOT a cardiovascular complication of HIV Malignancy associated with AIDS Cancer NOT seen in AIDS CMV retinitis in HIV when CD4 below Cryptococcus neoformans infection in HIV when CD4 below Cotrimoxazole prophylaxis in AIDS in indicated NOT a feature of AIDS NOT an opportunistic infection of AIDS NOT common in HIV infection NOT seen in childhood AIDS Body fluid having maximum HIV load Diagnosis of AIDS according to WHO

4 weeks Antibody is absent 3-12 weeks Period between onset of infection and clinically detectable level of antibodies Antibody enhancement, bystander killing Cryptococcus,Toxoplasma CNS Microglial nodule Primary CNS Lymphoma Dementia Recurrent chest infection with typical organisms Vasculitis PML Inclusion bodies Kaposi sarcoma Non specific enlargement of lymphnode Pericardial effusion, cardiac tamponade, cardiomyopathy Aortic aneurysm Kaposi sarcoma, CNS lymphoma, Non hodgkin’s lymphoma Carcinoma Colon 50 200 Cryptosporidiosis Toxocara uveitis Rhizopus Aspergillus Kaposi sarcoma Breastmilk 2 major signs and 1 minor sign

TRANSMISSION OF HIV HIV MC mode of HIV infection worldwide Commonest transmission of HIV from mother to baby Chance of acquiring HIV infection following needle prick Percentage of risk of HIV transmission by needle stick injuries Transmission of AIDS in India in descending order MC mode of HIV transmission from mother to child Perinatal transmission of HIV

Male to female transmission is more common than female to male transmission Heterosexual During delivery through vagina 0.3% 0.5 to 1% Heterosexual, transplacental, homosexual Perinatal Cannot be diagnose by routine confirmatory test, Infant rate transmission 5%) World AIDS day Age group of highest number of AIDS cases in India First case of AIDS reported in India If prevalence of HIV is constantly >1% in pregnant woman Without any specific intervention of HIV positive mother, from conception, term, preterm, after delivery, lactation and non lactation, risk of transmission to child NOT a OSHA guideline for needle stick injury 3 by 5 implementation by WHO in 2003 Achieve zero level transmission of HIV by

Seminal secretion are highly infectious than vaginal secretion, Infectious in window period, Southern Africa have 72% of total global burden, Children are rarely affected Thailand Tamil nadu Nagaland December 1 30-44 years 1981 Generalised epidemic 15-30 % Pre exposure prophylaxis Providing treatment to 3 million sufferers by 2005 2010

MANIFESTATIONS OF AIDS Cells infected by HIV virus HIV commonly infects HIV infection

HIV infection

HIV infection associated with HIV in neonate

CD4+ T lymphocytes CD4 cells Following needle stick injury,infectivity is reduced by administration of nucleoside analogues, P24 is used for early diagnosis, Lysis of infected CD4 cells, Macrophage is a reservoir for the virus Caused by enveloped RNA virus, Rate of killing is directly proportional to T4 molecules on cell surface, Decreased delayed hypersensitivity activity reaction, Gamma interferon is acid STABLE Glandular fever like illness, Generalized lymphadenopathy, Gonococcal septicemia, Presenile dementia Cannot be diagnosed accurately by current methods,

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Characteristic finding in HIV in children AIDS defining criteria Major signs for AIDS case definition according to WHO A patient with AIDS related complex is most likely suffering from Lesion associated with HIV Oral ulcer in HIV patients commonly due to MC genital lesion in HIV patient Cutaneous manifestation of AIDS MC psychological feature of AIDS Painful articular syndrome is associated with MC hematological manifestation of HIV Diffuse infiltrative lymphocytosis syndrome (DILS) in Fungal infection associated with AIDS patient Meningitis due to cryptococcal meningitis occurs when Oral candidiasis Stage IV NOT an AIDS defining illness WHO stage IV does NOT include NOT associated with HIV infection CMV retinitis in HIV occurs when CD4 counts fall below In HIV patient, complains of visual disturbance, fundal examination shows bilateral renal exudates and perivascular hemorrhages MC causative agent of diarrhea in HIV patient A patient with HIV has diarrhea with AFB positive organism in stool Diarrhea syndrome in AIDS children can be due to NOT associated with persistent diarrhea in AIDS patient Commonest helminthic infection in AIDS NOT a common infection in HIV Prophylactic therapy in P.carni infection in HIV if

Failure to thrive may be presentation, Transmission vertically from mother Recurrent chest infection Generalized lymphadenopathy, Fever, weight loss and fatigue, Pneumocystis carnii pneumonia, Mycobacterium avium infection, Persistent diarrhea Generalized lymphadenopathy, Prolonged fever more than 1month, Chronic diarrhea > 1 month, Weight loss > 10% Opportunistic infection Hairy leukoplakia Candida Herpes Seborrhoic dermatitis Depression HIV Anemia HIV Pneumocystis carnii, Penicilliuea marneffi, Candida, Cryptococcus CD4+ < 100/microliter Stage III Esophageal candidiasis, pneumocystis carni pneumonia, wasting syndrome Oropharyngeal candidiasis Oral thrush Hypogammaglobulinemia 50 Cytomegalovirus Cryptosporidium Mycobacterium avium intracellulare Rotavirus, Cryptospora Giardia, Cryptococcosis Strongyloides Aspergillosis CD4