- •Contents
- •1. Overview of the Immune System
- •2. Cells of the Immune System
- •4. Lymphocyte Recirculation and Homing
- •5. The First Response to Antigen
- •12. Acquired Immunodeficiency Syndrome
- •14. Transplantation Immunology
- •1. General Microbiology
- •2. Medically Important Bacteria
- •4. Medically Important Viruses
- •5. Medically Important Fungi
- •8. Comparative Microbiology
- •Index
Comparative Microbiology |
8 |
MORPHOLOGY/TAXONOMY
Spore-Forming Bacteria (Have Calcium Dipicolinate)
Bacillus
Clostridium
Non-motile Gram-Positive Rods
Corynebacterium diphtheriae
Nocardia
Clostridium perfringens (rest of the pathogenic Clostridia are motile)
Bacillus anthracis (most other Bacillus species are motile)
Acid Fast Organisms
Mycobacterium
Nocardia (partially acid fast)
Cryptosporidium oocysts
Isospora oocysts
Bacteria and Fungi That Characteristically Have Capsules
The "biggies" can be remembered by the mnemonic: Some Killers Have £retty Nice
.Capsules!
Streptococcuspneumoniae
Klebsiellapneumoniae Haemophilus influenzae
Pseudomonas aeruginosa-slime producer especially in cystic fibrosis patients' lungs
Neisseria meningitidis
Cryptococcus neoformans (only encapsulated fungal pathogen)
Bordetella pertussis
Other Important Capsule Producers
E. coli meningeal strains have capsule, mostly K1
Bacillus anthracis---poly D-glutamate capsule
Salmonella enterica subsp. typhi-(virulence; Vi) capsular antigen
Streptococcus pyogenes when first isolated; non-immunogenic (but anti-phagocytic) hyaluronic acid capsule
MEDICAL 483
Section II • Microbiology
Biofilm Producers
Staphylococcus epidermidis (catheter-related infections)
Streptococcus mutans (dental plaque)
Pigment Production
Pseudomonas aeruginosa (blue-green}-pyocyanin, fluorescein
Serratia-red pigment
Staphylococcus aureus-yellow pigment
Photochromogenic and scotochromogenic Mycobacteria-Carotenoid pigments (yellow and orange)
Corynebacterium diphtheriae-black to gray
Unique Morphology/Staining
Metachromatic staining-Corynebacterium
Lancet-shaped diplococci-Pneumococcus
Kidney bean-shaped diplococci-Neisseriae
Bipolar staining-Yersiniapestis
Gulls wings-Campylobacter
Table 11-8-1. Viral Cytopathogenesis
Inclusion Bodies |
Virus |
lntracytoplasmic (Negri bodies) |
Rabies |
lntracytoplasmic acidophilic (Guarnieri) |
Poxviruses |
lntranuclear (Owl eye) |
Cytomegalovirus |
lntranudear (Cowdry) |
Herpes simplex virus |
|
Subacute scterosing panencephalitis |
|
(measles) virus |
Syncytia formation |
Virus |
|
Herpes viruses |
|
Varicella-zoster |
|
Paramyxoviruses (measles, mumps, |
|
rubella and respiratory syncytial virus) |
|
HIV |
484 MEDICAL
Section II • Microbiology
Catalase positive organisms are major problems in chronic granulomatous disease (CGD):
•Allstaphylococci
•Pseudomonas aeruginosa
•Candida
•Aspergillus
•Enterobacteriaceae
Coagulase positive
•Staph. aureus
•Yersiniapestis
DETERMINANTS OF PATHOGENICITY
Genetics
Genes encoding pathogenicfactors reside on:
•The bacterial chromosome Endotoxin
•A plasmid
Most toxins and multiple drug resistances
•A bacteriophage genome stably integrated into the host DNA as a pro phage. Virulence modified by the stable presence of phage DNA in bacterial cell = lysogenic conversion.
Examples:
C = cholera toxin
0 = Salmonella 0 antigen
B = Botulinum toxin (phage CE13 and DEl3)
E = Erythrogenic toxin of Streptococcus pyogenes
D = Diphtheria toxin (Corynephage 13) S = Shiga toxin
Mnemonic: COBEDS (when 2 people share a bed somebody gets a little pregnant [with phage] )
Antigenic variation
Neisseria gonorrhoeae (pili)
Borrelia recurrentis
Trypanosoma brucei
HIV
486 MEDICAL
Chapter 8 • Comparative Microbiology
Toxins
Table ll-8-3. Disease Due to Toxin Production
Bacterium |
Disease |
Activity ofToxin |
Corynebacterium diphtheriae |
Diphtheria |
ADP ribosylation of eEF-2 re |
|
|
sults in inhibition of protein |
|
|
synthesis |
Clostridium tetani |
Tetanus |
Binds to ganglioside in |
|
|
synaptic membrane, blocks |
|
|
release of glycine and GABA |
Clostridium botulinum |
Botulism |
Prevents release of acetyl |
|
|
choline |
Vibrio cholerae |
Cholera |
Choleragen stimulates |
|
|
adenylate cyclase |
E. coli (ETEC) |
Travelers' diarrhea |
LT stimulates adenylate |
|
cyclase |
|
Clostridium difficile |
Diarrhea |
Toxin A and B inhibit protein |
|
|
synthesis and cause loss of |
|
|
intracellular K+ |
Bordetella pertussis |
Whooping cough |
Hypoglycemia due to activa |
|
|
tion of islets |
|
|
Edema due to inhibition Gi |
|
|
Lymphocytosis due to |
|
|
inhibition of chemokine |
|
|
receptors |
|
|
Sensitivity to histamine |
eEF-2 = eukaryotic elongation factor-2
Heatstable toxins
60°C
• Staphylococcus aureus enterotoxin
• ST toxin of E. coli
• Yersinia enterocolitica toxin
100°c
• Endotoxin
MEDICAL 487
Section II • Microbiology
Facultative intracellularparasites ofhumans
• Bacteria
Francisella tularensis Listeria monocytogenes Mycobacterium tuberculosis Brucella species
Non-tuberculous mycobacteria Salmonella enterica subsp. typhi Legionella pneumophila Yersinia pestis
Nocardia species
• Fungi
Histoplasma capsulatum
Obligate Parasites ThatAre NotIntracellular
(e.g., cannot be cultured on inert media but are found extracellularly in the body)
•
•
Treponema pallidum Pneumocystis jirovecii
EPIDEMIOLOGY/TRANSMISSION
Bacteria That Have Humans as the Only Known Reservoir
Mycobacterium tuberculosis M. leprae (armadillos in Texas)
Shigella species
Salmonella enterica subspecies typhi Rickettsiaprowazekii (epidemic typhus)
Group A -hemolytic streptococcus
Neisseria meningitidis and N. gonorrhoeae Corynebacterium diphtheriae Streptococcus pneumoniae
Treponema pallidum Chlamydia trachomatis
Zoonotic Organisms
(Diseases ofanimals transmissible to humans)
Bacillus anthracis
Salmonella enterica all subspecies except typhi Leptospira
Borrelia
Listeria monocytogenes Brucella species Francisella tularensis
Pasteurella multocida (cat bites)
490 MEDICAL
Chapter 8 • Comparative Microbiology
Vibrio parahaemolyticus (from fish)
Capnocytophaga canimorsus (dog bites)
Bartonella henselae (cat scratches)
Streptobacillus moniliformis (rat bite fever)
Mycobacterium marinum (fish tank granuloma)
Vibrio vulnificus (oysters)
Yersinia pestis, Y enterocolitica, Y pseudotuberculosis
Campylobacterfetus, C. jejuni
Most Rickettsia
Chlamydophila psittaci (birds)
Rabies virus
Arthropod Vectors in Human Disease: Insects
• Lice
Epidemic or louse-borne typhus (Pediculus h. humanus) Epidemic relapsing fever
Trench fever
• True bugs
Chagas' disease (American trypanosomiasis)-kissing bugs (Reduviidae)
• Mosquitoes
Malaria (Anopheles mosquito) Dengue (Aedes)
Mosquito-borne encephalitides: WEE, EEE, VEE, SLE, WNV Yellow Fever (Aedes)
Filariasis
•Sandflies Leishmaniasis
Bartonellosis
•Midges Filariasis
•Blackilies Onchocerciasis
•Deerflies (Chrysops) and horse flies
Loaloasis
Tularemia
• Tsetse flies
African trypanosomiasis
• Fleas Plague
Endemic typhus
MEDICAL 491
Section II • Microbiology
Arthropod Vectors That Are Not Insects
• Ticks
Rocky Mountain spotted fever (Dermacentor) Colorado tick fever (Dermacentor)
Lyme disease (Ixodes)
Ehrlichia (Ixodes, Amblyomma)
Babesiosis (Ixodes)
Tularemia (Dermacentor)
Recurrent fever or tick-borne relapsing fever (Ornithodoros,a soft tick)
• Mites
Scrub typhus (Leptotrombium) (transovarial transmission in vector) Rickettsialpox
Parasitic Infections Transmitted by Ova
Enterobius vermicularis (pinworm)
Ascaris Lumbricoides (roundworm)
Toxocara canis (visceral larva migrans)
Trichuris trichiura (whipworm)
Echinococcus granulosus!multilocularis
Taenia solium (cysticercosis)
Allothers are transmitted in larval stage.
Bacterial and Fungal Infections That Are Not Considered Contagious
(i.e., no human-to-hwnan transmission)
Nontuberculous mycobacterial infections, e.g., Mycobacterium avium-intracellulare Non-spore forming anaerobes
Legionella pneumophila
All fungal infections except the dermatophytes
Infections That Cross the Placenta
(Mnemonic: TORCH)
Toxoplasma
Other (Syphilis)
Rubella
CMV
Herpes and HIV
<5% perinatal hepatitis B could possibly have been acquired by crossing placenta.
• Viruses
Cytomegalovirus
Rubella
HSV 2 (in primary infection)
Coxsackie B
Polio
492 MEDICAL
Chapter 8 • Comparative Microbiology
HIV
Bl9
•Parasites
Toxoplasma gondii
•·Bacteria
Treponeniapallidum
Listeria monocytogenes
Spread by Respiratory Droplet
Streptococcus pyogenes (Group A)
Streptococcus pneumoniae |
Influenza |
Neisseria meningitidis |
Rubella |
Mycobacterium tuberculosis |
Measles |
Bordetella pertussis |
Chickenpox |
Haemophilus infiuenzae |
Pneumocystisjirovecii |
Corynebacterium diphtheriae |
|
Mycoplasma pneumoniae |
|
Spread by Inhalation of Organisms from the Environment
Histoplasma
Coccidioides
Blastomyces
Nontuberculous mycobacteria, e.g.,M. avium-intracellulare (MAC)
Legionella
Chlamydophila psittaci
Pseudomonas (also spread by ingestion and contact)
Spread by Oral/Fecal Route
(Infections may be spreadbyoral sex.)
Salmonella
Shigella
Campylobacter
Vibrio
Yersinia enterocolitica
Yersinia pseudotuberculosis
Bacillus cereus
Clostridium
Staphylococcus (also other routes commonly)
Enteroviruses, including poliovirus
Rotavirus
Norwalk agent
Hepatitis A
MEDICAL 493
Section II • Microbiology
Toxoplasma-cat feces
Entamoeba
Giardia
All nematodes except filaria and Trichinella
Allcestodes
Contact: (Person-to-Person) Nonsexual
Impetigo (Strep and Staph)
Staphylococcus
Herpes I
Epstein-Barr (kissing)
Hepatitis B (all body fluids)
Molluscum contagiosum (wrestling teams)
Contact: Sexual
Chlamydia |
HPV |
HBV |
Neisseria |
HIV |
HCV |
Treponema |
HSV 2 |
|
Trichomonas |
CMV |
|
PATHOLOGY
Organisms that Produce Granulomas
(most are intracellular, others have persistent antigen)
Fran Likes My Pal Bruce And His Blasted Cockerspaniel (in) Salt Lake City. (Mnemonic by M. Free.)
(ic) = intracellular organism
Francisella (ic) Listeria (ic) Mycobacterium (ic) Treponema pallidum Brucella (ic) Actinomyces Histoplasma (ic) Blastomyces Coccidioides Schistosoma species
Lymphogranuloma venereum (ic) Cat scratch fever
494 MEDICAL
Chapter 8 • Comparative Microbiology
Infections Causing lntracerebral Calcifications
Toxoplasma
CMV
Cysticercosis
Cryptococcus neoformans
Tuberculous meningitis
LABORATORY DIAGNOSIS
Special Stains
• Silver stains Dieterle-Legionella
Gomori methenamine-Pneumocystis, fungi
• Acid fast (Ziehl-Neelsen or Kinyoun)
Mycobacterium, Nocardia (partially AF), Cryptosporidium, Tsospora,
Cyclospora, and Microsporidia (oocysts in feces)
•India ink-Cryptococcus (if negative not a reliable diagnostic method)
•Calcofluor white-fungi
•Giemsa
Blood protozoa (Plasmodium, Babesia, Trypanosoma, Leishmania)
Histoplasma capsulatum in RES cells
Name Tests
Tests |
Disease |
PPD or Tuberculin (Mantoux) |
TB |
Lepromin |
Leprosy |
Fungal skin tests |
Clinicallyvaluable only to demonstrate |
|
exposure or anergy |
CAMP test |
Strept agalactiae carriers |
Elek test |
Toxin producing C. diphtheriae strains |
Weil-Felix |
Rickettsia (with Proteus strain OX antigens) |
Unusual Growth Requirements
Haemophilus (most species require one or both)
•X factor == protoporphyrin IX, the precursor ofhemin
•V factor == 
AD (nicotinamide dinucleotide) or NADP
Mycoplasma
•Cholesterol
Salt (halophilic organisms)
•Staph aureus will grow on high salt media.
•Group D enterococci will grow on 6.5% NaCl.
•Vibrio species requires NaCl to grow and grows at 6.5%.
MEDICAL 495
Section II • Microbiology
Cysteine requirement for growth
•Four Sisters Ella of the Cysteine Chapel (mnemonic by M. Free)
Francisella, Legionella, Brucella, and Pasteurella
Cultures that must be observed for a long time
•Mycobacterium tuberculosis and all non-tuberculous mycobacteria except rapid growers
•Mycoplasma pneumoniae
•Systemic fungal pathogens (Blastomyces, Histoplasma, and Coccidioides in U.S.)
TREATMENT/PREVENTION
Treat Prophylactically
•Neisseria meningitidis (household and day care contacts-vaccination also used in outbreaks)
•Mycobacterium tuberculosis with a recent skin test conversion
or known household (i.e., significant) exposure; or persons under 35 with a positive skin test who have never been treated
•Haemophilus influenzae B (unvaccinated household contacts <6 years old) -also vaccinate
•Neisseria gonorrhoeae (sexual contacts)
•Treponema pallidum (sexual contacts)
•Yersinia pestis
•Neonatal eyes (Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pal lidum)
Vaccines Available in the U.S.
Inactivated vaccines (RIP-A; ll_est ln feaceAlways)
•Rabies
•Influenza virus
•Salk polio (killed)-all primary vaccinations in U.S., including IC patients
•Hepatitis A
•Japanese encephalitis and several other encephalitis vaccines
•Vibrio cholerae
Live, attenuated vaccines
•Francisella tularensis
•Measles (rubeola)
•Rubella
•Mumps (killed vaccine available for IC patients)
•Sabin polio (oral)
•Smallpox
•Yellow fever
•Varicella-Zoster
•Rotavirus
496 MEDICAL
Chapter 8 • Comparative Microbiology
Live, Pathogenic Virus (in enteric-coated capsules)
• Adenovirus
Toxoid: ChemicallyModified Toxin-Vaccines
•Tetanus
•Diphtheria
•Pertussis toxoid (in DTaP)
Subunit Vaccines
•Haemophilus-purified capsular polysaccharide conjugated to protein
•Neisseria meningitidis-capsular polysaccharides, pediatric version is
conjugated to protein
•Pneumococcal-capsular polysaccharide (7 and 23 serotypes) (pediatric version is conjugated to protein)
Recombinant Vaccines
•Hepatitis B-HBsAg (produced in yeast)
•Human papilloma virus vaccine, 4 capsid proteins
MEDICAL 497
Flow Charts/Clue Sheets |
9 |
MEDICAL 499
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device infections |
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•#1 for pneumonia>60yr
•#1 for adult
meningitis
• #1 Otitis media in kids
• DOC: Macrolides, ceftriaxone, amoxicillln
• -20% Pen resist.
• Vaccine for elderly (23 serotypes)
• Vaccine pediatric
(7 serotypes conjugated to protein)
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S. sanguis
S. mutans
•Dextrans: Adherence dental caries
·Normal in oropharynx
•Subacute endocarditis (Post-dental work
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•DOC: penicillin + aminoglycosides
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•Erythrogenic toxin (SPE-A)
•Rheumatic fever
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•Cellulitis
·Impetigo
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• CAMP Test (+) (Incomplete hemolysin)
• C carbohydrate
• Hydrolyzes hippurate
• Salt-tolerant
• Colonizes vagina in 15-20%
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• #1 for neonatal meningitis (.J.ing)
• DOC: Ampiclllin + aminoglycoside
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• Non-enterococcal |
• C carbohydrate |
• C carbohydrate |
• Hydrolyzes bile |
• Hydrolyzes bile |
esculin with |
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•Salt-tolerant
•Normal in colon, gut
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•Bilary tract infections
•Post-op endocarditis
•Opportunistic infxns
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• Partially acid-fast |
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Heart, Nerves, epithelium |
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• Multiple brain abscesses |
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Loeffler's medium |
• Mycetoma (granules) |
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• Gray pseudomembrane |
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Renal transplant |
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• Myocarditis |
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Neonatal |
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• Recrnt larngl nerve palsy |
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Cancer |
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• DOC: Antitoxin PLUS |
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• DOC: Ampicillin and |
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Erythromycin |
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Gentamicin for IC |
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• Toxoid vaccine |
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A.israelii
•Rods with branching
•Non-motile
•Not restricted by anatomical boundaries
•Sulfur "granules" in exudates from sinus tract
•Normal in mouth and female genitourinary tract
•Cervicofacial (lumpy jaw)
•IUD-associated infections
•Solitary brain abscess
•Mycetoma
•Rx: Penicillin plus drainage
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-- Aerobic -- |
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Anaerobic |
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Motile |
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Non-Motile |
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Motile |
Non-Motile |
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B. cereus |
B. anthracis |
C. tetani |
|
C. botulinumI |
C. difficile |
C. perfringrens |
|||||||||||||
· Heat-stable exotoxin: |
• Poly-D-glutamate |
· Terminal spores |
• Neurotoxin |
• Nosocomial |
• Subterminal spore |
||||||||||||||
vomiting |
capsule |
• Exotoxin |
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heat-labile |
• Diarrhea to |
• Alpha lecithinase= |
|||||||||||
increase cAMP |
· Spores |
Tetanospasmin |
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BlocksACh release |
pseudomembranous |
|
Phospholipase C |
||||||||||
• Heat-labile toxin: |
· In R-E cells |
Inhibits GABA |
• Flaccid paralysis |
colitis |
• Enterotoxin |
|
|||||||||||||
diarrhea |
· Toxin: |
Glycine |
• Canned-food poisoning |
• Antibiotic {Clindamycin) |
• Stormy fermentation |
||||||||||||||
· Fried rice |
Protective Ag |
· Tetanus |
• Trivalent antitoxin |
usage |
• Double-zone hemolysis |
||||||||||||||
· Food poisoning (2-18 h) |
Lethal factor |
Spastic paralysis |
· DOC: antitoxin |
• Yellow plaques |
• Egg yolk agar |
|
|||||||||||||
• Symptomatic Rx |
Edema factor (an |
• DOC: hyperimmune |
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PLUS Penicillin |
· Colon |
• Normal in colon |
|
||||||||||
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|
adenylate cyclase) |
globulin, Penicillin |
• Infant botulism |
· Toxins A + B |
• Food poisoning |
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• Painless skin ulcer 95% |
PLUS spasmolytic |
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human hyperimmune |
· DOC: Change or |
• Gas gangrene |
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• Black eschar |
• Toxoid vaccine |
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serum, no drugs |
stop antibiotic |
• Myonecrosis |
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• Striking local edema |
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• High mortality |
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• Woolsorter's disease |
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• DOC: Penicillin G |
Clindamycin |
|||
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Pneumonia |
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PLUS |
debridement |
|||
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± |
||||
· DOC: Ciprofloxacin or doxycycline
"'
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GRAM (-) RODS
& SPIROCHETES
Facultative Anaerobes
I
AEROBES
B.pertussis
•Adhesion to cell via hemagglutinin and pertussis toxin
•Adenylate cyclase txn (local edema)
•Tracheal toxin
•Dermanecrosistoxin
•Endotoxin - Lipid X, A ADP-R of GNBP
•Bordet-Gengou agar
•Regan-Lowe agar
•Whooping cough
·DOC: Erythromycin
•Vaccine toxoid and filamentous hemagglutinin
Bruce/la sp |
F. tularensis |
|
· In R-E cells |
· In R-E cells |
|
• Endotoxin |
• Requires CVS |
|
• Requires CVS, C02 |
• Dermacentortick bite |
|
• Unpasteurized milk |
Transovarian trans. |
|
• Undulant Fever |
· Aerosol |
|
Bang's disease |
• Rabbits, rodents |
|
Malta fever |
• Granulomatous rxn |
|
• B. abortus |
· Tularemia - AR, MO, TX |
|
• Live, attntd vaccine |
||
cattle, mild |
||
• B. suis |
• DOC: Streptomycin |
pigs
suppurative, chronic
•B. melitensis goats severe, acute
•DOC: rifampin and
doxycycline
L.pneumophila
•Water-loving
air conditioning
•Requires CVS & Fe
•Buffered Charcoal Yeastagar
•Dieterle silver stain
•Stains poorly Gram (-)
•Atypical pneumonia
•Mental confusion
· Diarrhea
•DOC: Erythromycin
•Not contagious
|
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I |
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||
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|
SPIROCHETES |
||
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• Thin-Walled |
|||
|
ANAEROBES |
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|
• |
Spiral-Shaped |
||||
|
Bacteroides sp |
|
Treponema sp |
• Axial Filaments |
|||||
|
• |
• |
Jarisch-Herxheimer Rxn |
||||||
• B. fragilis obligate |
pallidum - Syphilis |
|
|
I |
|||||
• Modified LPS,- |
capsules |
• |
T.Obligate parasite |
|
|
Borrelia sp |
|||
• Predominant colonic flora |
1·- PAINLESS chancre, infectious |
• |
Microaerophillic |
||||||
• Normal in oropharynx, vagina |
• 2·- Rash infectious |
||||||||
• |
Giemsa stain |
||||||||
• Predisposing factors: |
• |
3°- Gummas, CVS, CNS |
• |
B. |
burgdorferi |
||||
|
surgery, trauma |
· Congenital: stillbirths, malformed |
|
|
|||||
|
|
|
|
• VDRL & RPR - Screening tests |
|
Lyme disease |
|||
|
chronic disease (cancer) |
|
|
(/. scapularis), I. pacificus |
|||||
• Septicemia, peritonitis |
• |
Reagin ab - xrxn with Cardiolipin |
|
Reservoirs: mice, deer |
|||||
|
aspiration pneumonia |
• FTA-ABS (immunofluorescence) |
|
||||||
|
|
CT, WI, CA |
|||||||
• Prevotella melaninogenica |
|
specific test |
|
||||||
• |
|
Erythema Migrans |
|||||||
|
Human oropharynx |
Dark-field microscopy |
|
||||||
|
|
|
Target lesions |
||||||
• Fusobacterium (combined w/ |
• |
DOC: Benzathine Penicillin |
|
|
|||||
• |
B. recurrentis |
||||||||
|
Treponema microdentium) |
|
|
||||||
|
Vincent's angina |
|
|
|
Relapsing fever |
||||
|
|
|
|
Vector: body louse |
|||||
|
Trench mouth |
|
|
|
|||||
|
|
|
|
Antigenic variation |
|||||
• DOC: Metronidazole OR |
|
|
• |
||||||
|
|
DOC: Penicillin or azithromycin |
|||||||
|
Clindamycin OR Cefoxitin |
|
|
||||||
|
|
|
|
|
|
||||
P.aeruginosa
•Slime-layer
•Grape-like odor
•Exotoxin A:
ADP-R of eEF-2
Liver
• Oxidase (+)
· Pigments
pyocyanin, pyoverdin
• Transient colonization In 10% of normal pop
• Osteomyelitis in drug abusers
• Pneumonia in cystic fibrosis
•Nosocomial infections Burn patients Neutropenic patients
•Ecthyma gangrenosum
•DOC: Penicillin
PLUS Aminoglycoside
Leptospira sp
•Dark-field microscopy
•Contaminated water Animal urine
•Fever, jaundice, uremia
•Non-icteric Leptospirosis Meningitis - No PMN in CSF uveitis, rash
•lcteric Leptospirosis
Weil's disease
Renal failure, myocarditis
· DOC: Penicillin G or doxycycline
n ::r Ill
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FACULTATIVE ANAEROBES
P. multocida |
H. influenzae |
|
• Requires CYS |
• Polyribito\ capsule |
|
· Animal bites (cats & dogs) |
• Quellung (+) |
|
• Cellulitis with Lymphadenitis |
• lgA protease |
|
• DOC: Amoxicillin/Clav |
• Requires X (Hemin), V (NAO) |
|
(prophylaxis) |
• Normal in nasopharynx and |
|
|
conjunctiva |
|
|
• Pathogenic in kids: type B |
|
|
· Meningitis in 1-2 yr |
|
|
• Otitis media, pneumonia |
|
|
• Acute epiglottitis |
|
|
· DOC: Cefotaxime/Celtriaxone |
|
|
• Prev: HIB vaccine, Rifampin |
|
|
|
|
ENTEROBACTERIACEAE
- Ferment Glucose
- Oxidase (-), Catalase (+) - Reduce Nitrates to Nitrites
Lactose-Fermenting
Vibrio sp
•Polar flagella, comma-shaped
•Enterotoxin (Choleragen) ADP-R, increase cAMP
•Catalase (+), Oxidase (+)
·Alkaline culture (TCBS)
•Classic cholera 01
•Biotypes: El Tor, Cholerae
•Rice-water stools
•Most severe dehydration
•Rx: fluid & electrolytes tetracycline for contacts
•\I. parahaemolyticus
Catalase (-), salt-tolerant Raw seafood
•\I. vulnificus
Brackish water • Oysters Cellulitis, Septicemia DOC: tetracycline
Campylobacter sp
Helicobacter sp
•Microaerophilic
•Polar flagella
•Comma or S-shaped
•Oxidase (+), Catalase (+)
•Skirrow's agar C02
· Invasive
• H. pylori
37'C, urease(+) gastritis, ulcers carcinoma
•DOC: omeprazole + amoxicillin + c\arithromycin
•C.jejuni
42'C enterocolitis
111 bacterial diarrhea U.S.A. · "Gull-Wings"
•C. fetus escapes GIT
•DOC: Erythromycin, fluoroquinolones
Non-Lactose-Fermenting ---
Also:
• Gardnerella
·Capnocytophaga
•Actinobacil/us
·Cardiobacterium
E.coli
•Normal in colon · #1 for UT\
P-pili, X-Adhesins
•Nosocomia\ infections
•Neonatal meningitis (K1)
•ETEC • Traveler's Drha Toxins: LT, ST
•EIEC • Invasive
•EHEC • VTEC 0157:H7
Hemorrhagic colitis Hemolytic uremic S Does not ferment Sorbitol
· EPEC Plasmid-coded EAF
· EAEC Fimbriae/biofilm
•DAEC Infants
Bacteria in microvi\li
•DOC: Ampicillin or Sulfonamides Cephalosporins
K. pneumoniae
· Capsule
• Quellung (+)
· Pneumonia
Currant jelly septum
Chronic lung disease
Alcoholism
Aspiration
·UT\ Nosocomial Catheterization
·DOC: Cepha\osporin +/- aminog\ycoside
Motile and |
|
I |
NonNon-H2S-Motile-Producingand |
l |
|
I H2S-Producing l |
|
|
|||
Proteus sp. |
Salmonella |
Shigella sp |
Y. pestis |
||
• Swarming motility |
enterica subsp. |
• No H Antigens |
• Coagulase (+) |
||
• lndole (+), Urease (+) |
• Antigens: Vi, 0, H |
• Invasive |
|
• V&W antigens |
|
• UT\, Septicemia |
• EMB/MacConkey |
• Shigatoxin |
|
• Safety-pin appearance |
|
• Staghorn calculi |
• Predisposing factors |
Nicks 60S SU |
(bipolar staining |
||
• DOC: Fluoroquinolones |
High gastric pH |
Neurotoxin |
|
Wayson's stain) |
|
|
Cytotoxin |
|
• Wild rodents |
||
|
Gastrectomy |
|
|||
|
• Wida! test (0, H ag) |
Enterotoxin |
|
· Flea bite |
|
|
• Osteomyelitis in Sickle |
• Enterocolitis |
|
• Southwest U.S. (Sylvatic) |
|
|
Cell disease |
• Bloody diarrhea |
• Bubonic plague |
||
|
• S. entericasubsp. |
FQ, Azithro |
conjunctivitis |
||
|
typhi |
• DOC: fluid and electrolytes |
fever, buboes, |
||
|
|
|
• Pneumonic plague |
||
|
No animal res. |
|
|
• DOC: Aminoglycosides |
|
|
No H2S produced |
|
|
||
|
Invasive (R-E) cells |
|
|
PLUS Quarantine (72 h) |
|
|
Rose spots |
|
|
• Y. enterocolitica |
|
|
• DOC: fluoroquinolones |
|
|
Cold growth |
|
|
or cephalosporins |
|
|
• Heat-stable toxins |
|
• S. entericasubsp. enteritidis
Poultry, reptiles Rx: Symptomatic
• DOC for invasive: ampicillin, cephalosporins
"' ID
"
....
c;·
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------------ |
Poorly Gram-<Staining Organisms* > |
---------- |
|
ACID FAST |
SOME ATP |
NO ATP, mod. peptidoglycan |
NO CELL WALL |
MycobacteriaI |
I |
ChlamydiaceaeI |
I |
Rickettsias |
Mycoplasmas |
||
I |
I |
I |
I |
M. tuberculosis |
R. rickettsii |
Chlamydia trachomatis |
M. pneumoniae |
•Gram (+) wall but doesn't stain due to waxy CW
•Acid fast, obligate aerobe
•Respiratory transmission
•Pathogen, contagious
•Cord factor-trehalose
mycolate-inhib. WBC migration mitoch. resp./ oxid. phosphor
•Sulfatides-inhib. phagosome- lysosome fusion
•Niacin (+), catalase (+) at 37'C, (-) at 68'C
•Slow growing
•Drug resistance
•Lowenstein-Jensen medium
•DOC: isoniazid + rifampin +
pyrazinimide (2 mo) then isoniazid + rifampin (4 mo)
M.avium-intrace/lulare
•Gram (+) wall but doesn't stain due to waxy CW
•Acid fast
•Obligate aerobe
•Soil organism
•Opportunist, non-contagious
•Pulmonary -) diss infections CA pis, late AIDS pis
M.leprae
•Obligate intracellular bacterium
•Tuberculoid (CMI damage)
•Lepromatous leprosy (poor CMI)
•DOC: dapsone + rifampin + clofazimine
M.marinum
•Obligate intracellular bacteria
•Gram-negative envelope but stain poorly
•Rocky MT Spt'd Fever-rash on wrists/ankles -) trunk, palms, soles
•Vector: Dermacentortick
•Reservoirs: ticks, wild rodents
•Dx: serol: 4x incr indir Fl. Ab + Weil-Felix DOC: Doxycycline
R.prowazekii
•Obligate intracellular bacteria
•Epidemic typhus
•Vector: Pediculus louse
•Reservoir: humans, squirrel fleas,
flying squirrels
Bartone/la henselae
•Cat scratch fever
•Bacillary angiomatosis in AIDS
Ehrlichia
•Ehrlichiosis
•Morulae in WBC
•DOC: doxycycline
•E. chafeensis-monocytes + macrophages
•E. phagocytophila - PMNs
•Jxodes tick
•Obligate intracellular bacteria
•Gram-negative envelope but stain poorly; lack muramic acid
•Elementary body-transmitted
•Reticulate body-intracellular
•Dx: serology or tissue culture
growth confirmed by inclusion
bodies (Fl Ab, Giemsa, iodine)
Serotypes D-K
•U.S.-Most common bacterial STD (HPV and HSV2 more common)
•Neonatal/adult inclus. conjunct, neonatal. pneumo; urethritis
cervicitis, PID, infertility
Serotypes L1, 2, 3
•Lymphogranuloma venereum
•STD in Africa, Asia, S. America
Serotypes A, B, Ba, C
•Trachoma-follic conjunctivitis -) conj. scarring, entropion -) corneal scarring
•Leading infectious cause blindness
•DOC: Doxycycline or azithromycin
Chlamydophila pneumoniae
•TWAR agent
•Respiratory infections
•Probably very common
•Potential association with atherosclerosis
•DOC: macrolides and tetracycline
Chlamydophila psittaci
•Atypical pneumonia
•Birds (parrots)
•DOC: tetracycline
•Lack cell wall peptidoglycan -) non-Gram-staining
•Cholesterol (req'd) in membr.
•Atypical pneumonia in youth and young adults
•Free living (culturable, extracell.)
•Slow growth, special media: Myco plasma, Eaton's or Hayflick's media-sterols+pur/pyrimidines: mulberry colonies
•Cold aggulutinins in 65% cases
•No Penicillins nor Cephalosporins
•DOC: erythromycin, azithromycin
Ureaplasma urealyticum
•Urethritis, prostatitis
•Urease positive
•No cell wall
•DOC: erythromycin or tetracycline
•Cutaneous lesions (fish tank granuloma)
•DOC: isoniazid, rifampin, ethambutol
*Also note that Legionelta and the spirochetes (Treponema, Leptospira, and Borre/ia)-all Gram-negative-do not show up reliably with Gram stain.
n ::r DI "l::J
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r- - |
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GRAM STRAIN |
|
r- |
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||||||
|
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® |
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||||||
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<f- |
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I_ |
|
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CATALASE |
|
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fermentationMALTOSE |
1l |
||||||
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||||||||||||||
|
-,--- |
|
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|||
|
COAGULASE |
|
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|
® |
|
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|
||||
|
|
|
®rNOVOBIOCIN |
l |
|
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||||||
|
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I- |
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I |
|
||
ALPHA-HEMOLYTIC |
|
|
|
|
BETA-HEMOLYTIC |
|
|
|
|
|
GAMMA-HEMOLYTIC |
||||||||||
Partial (green) Hemolysis |
|
|
Complete (clear) Hemolysis |
|
|
|
Group D |
|
|||||||||||||
|
|
|
Usually NOIHemolysis |
||||||||||||||||||
|
- OPTOCHIN --i® |
|
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|||||||||
@ |
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BACITRACIN - |
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r--Growth in ----i |
||||||||||
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t |
|||||
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|
S. aureus |
S. epidermidis |
|
S. pneumoniae |
Viridans group |
|
s. sanguis |
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S. mutans |
|
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Neisseria sp
S. saprophyticus
N. meningitidis |
N. gonorrhoeae |
Streptococcus sp
Group A |
Group B |
S. pyogenes |
S. agalactiae |
I |
Group D |
Group D |
|
s. faecalis |
s. bovis |
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|||
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Aerobic ---- |
I |
|
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Non-Motile |
Anaerobic |
||
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r--- |
|
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Aerobic--------- |
1 SPORE-FORMING t------- |
|
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Anaerobic |
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Motile |
Non-Motile |
||||
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ID t'I
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0 |
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IFACULTATIVE ANAEROBES |
|
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(') |
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;i:. |
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r |
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I
ENTEROBACTERIACEAE
I
Lactose-Fermenting |
---Non-Lactose-Fermenting -- |
|
|
IH2SMotile-Producingand I |
INonNon-H2S-Motile-Producingand l |
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RNA VIRUSES
DOUBLE-STRANDED |
|
SINGLE-STRANDED |
|
-i |
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POSITIVE SENSE |
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NEGATIVE SENSE---AMBISENSE |
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I |
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NAKED |
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I |
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AND NIEGATIVE |
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NAKED |
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ENVELOPED |
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|
ENVELOPED |
ENVELOPED |
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I |
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I |
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I |
ICOSAHEDRAL ICOSAHEDRAL |
HELICAL |
|
ICOSAHEDRAL |
HELICAL |
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HELICAL |
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REOVIRUS |
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FLAVIVIRUS |
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CORONAVIRUS |
CALICIVIRUS |
PARAMYXOVIRUS |
ARENAVIRUS |
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Reovirus |
Yellow Fever Virus |
Coronavirus |
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Norwalk Agent |
Mumps Virus |
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(Segmented) |
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Rotavirus |
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Dengue Virus |
SARS-CoV |
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Noro-like |
Measles Virus |
Lassa Fever Virus |
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Colorado tick |
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St. Louis EV |
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RSV |
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Lymphocytic |
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fever virus |
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WNV |
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HEPEVIRUS |
Parainfluenza |
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Choriomeningitis |
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Hepatitis C |
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Hepatitis E |
Human metapneumovirus |
BUNYAVIRUS |
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TOGAVIRUS |
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PICORNA |
RHABDOVIRUS |
(Segmented) |
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Rubella Virus |
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California EV |
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Polio Virus |
Rabies Virus |
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Western Equine EV |
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La Crosse Virus |
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Enteroviruses |
Vesicular Stomatitis |
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Eastern Equine EV |
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Hantavirus |
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Echovirus |
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Venezuelan EV |
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FILOVIRUS |
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Coxsackie A & B |
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RETROVIRUS |
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Marburg |
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Rhinoviruses |
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HIV |
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Hepatitis A Virus |
Ebola |
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HTLV |
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ORTHOMYXOVIRUS |
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(Segmented) |
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Influenza A & B |
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DNA VIRUSES |
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DOUBLE-STRANDED |
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SINGLE-STRANDED |
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----- |
-, |
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|
I |
||
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|
I- |
|
ENVELOPED |
I |
|
NAKED |
|
|
NAKED |
|||
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|
|
|
|
|
|
|
I |
|
|
I |
|||
|
|
ICOSAHEDRAL |
COMPLEX |
|
ICOSAHEDRAL |
|
ICOSAHEDRAL |
|||||||
|
|
|
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|
R |
J_ |
|
|
|
-- |
i |
J_ |
|
|
CIRCULAR |
|
|
|
|
CIRCULARI |
I |
-------LINEAR |
|
|||||
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|
POXVIRUS |
PAPILLOMAV/RUS |
ADENOVIRUS |
|
PARVOVIRUS |
||||||
HEPADNAVIRUS |
HERPESVIRUS |
|
||||||||||||
Hepatitis B Virus |
Herpes Simplex Virus |
Variola |
Papilloma Viruses |
Adenoviruses |
|
819 |
||||||||
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|
|
Varicella-Zoster Virus |
Vaccinia |
POLYOMAVIRUS |
|
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|
||||
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Epstein-Barr Virus |
Molluscum |
Polyoma Viruses |
|
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Cytomegalovirus |
Contagiosum |
|
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|||||
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||||
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|
Herpes virus 6 |
|
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||
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Herpes virus 8 |
|
|
|
|
|
|
|
||
"'
t'I
..
s·
:I
-
-
•
:I:: ;:;· a
1:1"
;·6"
s:
m
0
f"'l
)>
r
V'I
....
IN
|
|
|
|
RNA VIRUSES |
|
|
|
DOUBLE-STRANDED |
|
|
SINGLE-STRANDED |
|
|||
|
|
|
1 - |
I |
I |
I |
|
|
|
|
|||||
|
|
|
|
POSITIVE SENSE |
NEGATIVE SENSE |
AMBISENSE |
|
|
|
|
|
|
|
I |
I |
|
|
|
|
|
|
|
AND NEGATIVE |
NAKED |
ENVELOPED |
NAKED |
ENVELOPED |
ENVELOPED |
|||
|
I |
|
|
I |
I |
I |
|
ICOSAHEDRAL ICOSAHEDRAL HELICAL |
ICOSAHEDRAL |
HELICAL |
HELICAL |
||||
|
|
|
|
|
|
|
|
DNA VIRUSES
|
|
|
|
DOUBLE-STRANDED |
|
SINGLE-STRANDED |
|||
|
|
|
I |
I |
|
|
I |
|
I |
|
|
|
ENVELOPED |
- I |
|
NAKED |
|
NAKED |
|
|
|
|
- |
|
|
I |
|
I |
|
|
ICOSAHEDRAL |
COMPLEX |
|
ICOSAHEDRAL |
----, |
ICOSAHEDRAL |
|||
|
I |
I |
J_ |
|
|
I |
J_ |
||
CIRCULAR |
LINEAR |
CIRCULAR |
LINEAR |
||||||
|
|
|
|
|
|
|
|
|
|
n
:::r
Ill "a
;
..
'°
•
f
n ::r Ill
;:::.
Ill
-
n
S'
ID "' ::r ID ID
Ii:'
