Genus and species I. STAPHYLOCOCCUS a. S.

aureus

morphology

virulence factors

Dse, prominent S/S gastroenteritis, TSS, SSSS, food poisoning, impetigo, cutaneous infections, pneumonia, bone and joint infections artificial heart valves, prosthetic joints (THR), CNS shunts infections UTI in sexually active females

MOT

lab methods

DOC

prevention/control

remarks

g(+), grapelike

fecal-oral, skin, nasopharynx reservoir

coagulase(+), mannitol (+), penicillin, cloxacillin, nafcillin, novobiocin S, hemolytic (BAP), vancomycin grows in 6.5-10% NaCl novobiocin S novobiocin R antibiotics: aminoglycosides, etc novobiocin

yellow pigment

b. S. epidermidis c. S. saprophyticus II. STREPTOCOCCUS

g (+) g (+)

normal flora of skin

a. S.pyogenes

g(+), chains or pairs

M Protein, hyaluronic acid acute glomerulonephritis (M12 strain), capsule, Streptolysin C and S; Scarlet fever (exotoxins A-C), pharyngitis, hemolysin, cytolysin, pyoderma/impetigo, necrotizing spreading factors fascites/cellulitis, TS-like syndrome, (streptokinase, DNAse, pneumonia, Rheumatic fever hyaluronidase) capsule, cAMP factor, hemolysin neonatal septicemia, meningitis

respiratory droplets or direct contact

throat swab, ASO titer (>200); Bacitracin S, PYR (+), -hemolytic

Penicillin G, also erythromycin (a), other Blactam antibiotics

penicillin injection

Group A streptococcus

b. S. agalactiae

same

during birth (vaginareservoir)

-hemolytic, Bacitracin R, hippurate hydrolysis, CAMP (+)

Ampicillin, cefotaxime w/ gentamycin

treat mother prior to delivery

Group B streptococcus Predisposing factors: influenza or measles, COPD, CHF, alcoholism, asplenia; " rusty sputum" normal flora of oropharynx group D streptococci

c. S. pneumoniae

g(+) lancet shaped, diplococci

IgA protease, teichoic acid, polysaccharide capsule, pneumolysin

bacterial pneumonia, adult meningitis, otitis media, sinusitis, septicemia (splenectomized)

respiratory droplets (URTreservoir)

-hemolytic, Optochin S,

Penicillin G

pneumovaccine

d. Viridans streptococci

dental caries, infective endocarditis dextran (biofilm), growth in (prosthetic valves, dental work, poor oral vegetation hygiene) SBE (elderly), urinary and biliary tract infections colon, urethra, female genital tract-reservoir

-hemolytic, bile and Optochin R bile esculin hydrolysis in 40 % bile, 6.5% NaCl, PYR (+)

penicillin G with aminoglycosides (IE) vancomycin

prophylactic penicillin penicillin and gentamicin

e. Enterococcus III. NEISSERIACEAE Pili, POR, OPA, RMP, Transferrin-binding protein, g (-) diplococci, non motile, lactoferrin-binding protein, no spores Hgb-binding protin, Lipooligosaccharide, IgA protease, -lactamase

a. N. gonorrhea

genital gonorrhea, rectal infection, pharyngeal infection, meningitis and conjunctivitis, opthalmia neonatorum, PID, disseminated gonococcal infection

catalase (+), oxidase (+), fastidious close personal contact: (enriched medium with 5-10% CEFTRIAXONE; add sexual contact, newborns CO2), poor in BAP, MOC: Doxycycline for concomitant from birth canal of chocolate agar, selective media: Chlamydia infection infected mother Thayer Martin+CAP +Vancomycin, Colistin, Nystatin gram stain smear (blood, CSF, petecial skin lesion, nasopharyngeal swab-carrier); culture: BAP∩ oxidase (+), CHO utilization using CTA (g,m); capsular polysaccharide detection assacharolytic

very sensitive to adverse environment, do not refrigerate

b. N. meningitides

g (-) diplococci, nonmotile, encapsulated (A, B, C, Y and W-135)

capsule, LOS (endotoxin, Lipid A), IgA protease

meningitis, septicemia (meningococcemia), WaterhouseFriederichsen syndrome, DIC, milder, chronic septicemia, pneumonia, arthritis, urethritis bronchitis, pneumonia, sinusitis, otits media, conjunctivitis

respiratory droplets

PENICILLIN G; if allergic: Chloramphenicol, 3rd generation cephalosporins:cefotaxime, ceftriaxone

Chemoprophylaxis: rifampin, minocycline Vaccine: serogroups A, C, Y amd W-135

grp A and C associated with epidemic disease

c. Moraxella cattarhalis

g (-)

most strains produce lactamase

normal flora

Genus and species IV. ENTEROBACTERIACEAE

morphology G(-) BACILLI

virulence factors ENDOTOXIN, CAPSULE (K1, Ag, Vi Ag), EXOTOXIN, INVASIVENESS

Dse, prominent S/S

MOT

lab methods OXIDASE (-) PRIMARY ISOLATION: EMB, MAC, DCA; SELECTIVE MEDIA: HEKTOEN ENTERIC AGAR, XLD, SSA

DOC

prevention/control

remarks FACULTATIVE ANAEROBES

A. Opportunistic group 1. Klebsiella a. K. pneumoniae b. K. oxytoca c. K. ozaenae d. K. rhinoscleromatis encapsulated, non motile (Friedlander's bacillus) capsule

can infect any part of the body

alteration in defenses of host, community acquired or nosocomial

commensals of large intestine

lobar pneumonia, extensive necrotizing consolidation of the lungs, "currant jelly" sputum same as K. Pneumoniae chronic atrophic rhinitis granulumatous disease of the nose does not grow in artificial culture media, Giemsa or Wright stain (125 bacteria per mononuclear cell) previously Calymmatobacterium granulomatis formerly Aerobacter S. Marcescens prodigiosin (red pigment) Proteus, Morganella, Providencia most common species formerly BethesdaBallerup group most abundant aerobic flora of colon; index for fecal pollution of water small intestine

e. K. granulomatis

granuloma inguinale (donovanosis)

2. Enterobacter 3. Serratia 4. PROTEEAE a. P. mirabilis 5. CITROBACTER B. True pathogens 1. ESCHIRICHIA COLI

no capsule, motile, no urease Dnase, lipase, gelatinase

infects any tissue, commonly UTI major entities in nosocomial infections UTI UTI char. By alkalinization of urine causing urinary calculi, damage to renal epithelial cells urinary tract, neonatal infections UTI, uncomplicated cystitis, pyelonephritis, neonatal meningitis, nosocomial infections, most common cause of g (-) sepsis infant diarrhea, voomiting, nonbloody stools urease (+)

hemolysin, P fimbriae, capsular, adhesins plasmid-mediated A/E histopathology w/ disruption of normal microvillus plasmid-mediated, heat stable and/or heat labile enterotoxins that stimulate hypersecretion of fluids and electrolytes cytotoxic Shiga toxins (Stx-1, Stx-2), which disrupts protein synthesis

a. EPEC

b. ETEC

traveler's diarrhea; low-grade fever

small intestine

c. EHEC

initial watery diarrhea, followed by grossly bloody diarrhea; HUS

large intestine

Genus and species d. EIEC e. EAEC

morphology

virulence factors plasmid-mediated invasion and destruction of epithelial cells lining colon "stacked bricks"

Dse, prominent S/S watery diarrhea may progress to dysentery with scant, bloody stools infant diarrhea, traveler's diarrhea

MOT large intestine

lab methods

DOC

prevention/control

remarks

2. SHIGELLA

invasiveness; Shiga toxin

dysentery; fever, convulsions

fingers, flies, food and feces

blood and mucus in stool; spx: rectal swab; NLF; TSI: K/A, (-)gas () H2S; confirmed by serotyping by slide agglutination

usually no bacteremia; very low infective dose: 100 bacilli most severe disease S. Sonnei- most common in industrial world S. Flexneri - most common in

a. S. dysenteriae

Shiga toxin (type 1 strain)

b. Other Shigella

Shiga like toxins

3. Salmonella enterica

enterocolitis (typhimurium 105 ), septicemia, enteric fever (typhoid & paratyphoid)

fecal-oral

blood/bone marrow culture (1st &2nd wk); stool or urine (after 2nd wk); S. Typhi - NLF; TSI: K/A; no gas; with H2s (small); Widal test; Typhidot cold enrichment culture

CEFTRIAXONE or CIPROFLOXACIN

vaccine (50-80% typhi and paratyphi: protection): IM (Vi human source only; polysaccharide capsule), chronic carrier state: oral (live attenuated) gallbladder

4. Yersinia enterocolitica V. VIBRIOS

Yersiniosis; bloody diarrhea, mimics AP

zoonotic (feces), also person to person

1. V. cholera

g(-), comma-shaped, curved bacilli; motile

cholera toxin; toxin coDOXYCYCLINE/TETRACYCLINE regulated pilus; accesory direct contact; ingestion oxidase (+); 0/129 S; Alkaline cholera (01 and 0139); classical and el tor; : adults; Fuazolidine: cholera enterotoxin; zonnula of contaminated food or peptone broth (ph9), TCBS-yellow rice-water stool pregnant; Trimethoprimoccludens toxin; Colonization water; flies colonies sulfamethoxazole: children factor; neuraminidase ingestion of contaminated TCBS : green colonies; Oxidase (+) seafood on BAP TCBS: blue-green; sucrose (-) TETRACYCLINE, ciprofloxacin

fluid and electrolyte therapy; oral vaccine

long term carriage do not occur

2. V. parahaemolyyticus

gastroenteritis severe wound infections, bacteremia, gastroenteritis; bloody diarrhea

water and electrolyte replacement

dos not produce enterotoxin

3. V. vulnificus VI. CAMPYLOBACTER

1. C. jejuni & C. coli

thin, comma/curved, g (-) rods, gull-wing (S-shaped); motile (single)

acute enteritis with diarrhea, malaise, fever, abdominal pain; septicemia

zoonotic; ingestion of contaminated food and water, unpasteurized milk

unable to oxidize or ferment carbohydrates; Skirrow's, Butzler's media, Campy-BAP- colorless or gray; incubated with reduced oxygen, increased CO2; oxidase (+), catalase (+)

ERYTHROMYCIN gastroenteritis and septicemia; tetracycline, fluoroquinolones

management by fluid and electrolytes

high dose required for infection; microaerophilic, thermophilic; humans are primary reservoir

2. C. fetus

S protein

septicemia disseminated to multiple organs

GI tract

opportunistic

Genus and species

morphology

virulence factors

Dse, prominent S/S

MOT

lab methods

DOC

prevention/control

remarks

VII. Helicobacter pylori

g(-) spiral shaped bacilli; peritrichous

urease; HSpB; Acid-inhibory protein, flagella, adhesins, mucinase, phospholipase, gastritis; peptic ulcers; gastric CA; MALT; Bsuperoxide dismutase, cell lymphomas catalase, vacuolating cytotoxin

fecal-oral

Oxidase (+); urease (+); catalase (+) biopsy;urea breath test; serology;Skirrow's &CAP grows optimally at ph 6-7

combined therapy for 2 wks: tetracycline, metronidazole, bismuth, omeprazole

microaerophilic

VIII. AEROMONAS

g (-) facultative anaerobic rod g (-) rod with polar flagellum g(+), smallest, cell wall free; pleomorphic (sterol) share similar antigen with S. Sonnei glycolipids, P1 adhesin protein; H202

gastroenteritis; wound infection;

contaminated food or water(ubiquitous in fresh and brackish water) contaminated freshwater fish and animals oxidase (+), DNAse (+)

ciprofloxacin, gentamicin. Amikacin, trimethoprimsulfamethoxazole

fluid and electrolyte replacement

IX. Plesiomonas shigelloides X. MYCOPLASMA 1. M. pneumoniae 2. M. hominis 3. M. genitalium 4. Ureaplasma urealyticum XI. CHLAMYDIAE

diarrhea

PPLO-"fried egg appearance" pneumonia, joint infection; salpingitis and tubo-ovarian abscess; post partum fever acute and chronic non-gonoccocal urethritis non-gonococcal urethritis in men; lung dse in low birth weight infants; probably infertility blood-streaked sputum with consolidation on CXR TETRACYCLINE &ERYTHROMYCIN

free-living, selfreplicating; microaerophilic

female genital tract inhalation of aerosols or direct contact

requires 10% urea for growth obligate intracellular parasites or "energy parasites" culture with HeLa229. McCoy, BHK21, Buffalo GM kidney cells; cytology (iodine, IF); Ag detection tetracycline, macrolides, sulfisoxazole

g(-) coccobacilli intracellular replication; prevents lysosomephagosome fusion ocular trachoma, urogenital disease, infant pneumonia, LGV; adult inclusion conjunctivitis; urogenital infections psittacosis (parrot fever)/ornithosis; atypical pneumonia, CNS, GI tract symptoms bronchitis, atypical pneumonia, sinusitis

1. C. trachomatis

2. C. psittaci

serology

tetracyclines and macrolides

3. C. pneumoniae XII. PARVOBACTERIA 1. Haemophilus Polysaccharide capsule (Bpolyribitol phosphate; A, C, D, F - techoic acid; Epolysaccharide), IgA protease

respiratory droplets

growth in Hep-2 cell line

tetracycline and macrolides

TWAR agent

a. H. influenzae

g(-), capsule;

meningitis (type B), otitis media, bronchitis, pneumonia, epiglotittis

respiratory droplets, shared toys

chocolate agar (X &V), "satellite" phenomenon on BA w/ S. Aureus

cefotaxime or ceftriaxone

vaccine: active(polyribitol capsule conjugated to protein); passive: Ig; Rifampin to reduce oropharynx colonization

fastidious

b. H. aegypticus c. H. ducreyi

purulent conjunctivitis chancroid(soft, painful chancre) sexually transmitted

indole fermentation (-), xylose fermenter DNA probe/ culture; X (+), V(-)

topical sulfonamides ceftriaxone IM, Co-tri PO, Erythromycin

Koch-Weeks Bacillus

Genus and species 2. Bordetella

morphology small, g (-) encapsulated coccobacilli

virulence factors

Dse, prominent S/S

MOT

lab methods

DOC

prevention/control

remarks strict aerobes

a. B. pertussis

Filamentous hemagglutinin, Pertussis toxin, Toxins, Adenylate cyclase toxin, tracheal cytotoxin silent copy of pertussis toxin gene small, g(-) bacilli small g(-) rods small g(-), encapsulated rods g (-) small pleomorpic rods endotoxin, capsule

whooping cough (pertussis)

respiratory droplets

Regan-Lowe, Bordet-Gengou (spx saline nasal wash, direct cough plates, nasopharyngeal cultures); blood count, DFA, PCR and serological test

supportive care, erythromycin

Vaccine: DTaP; erythromycinx5

fastidious

b. B. parapertussis c. B. bronchisepta 3. Pasteurella a. P. multocida 4. Francisella

similar to whooping cough Chronic Respiratory Tract Infection reservoir: RT of canines bipolar staining wound infection leading to cellulitis with lymphadenitis animal bites; particularly from cat bites rarely cultured penicillin G; amoxicillin/clavulanate for cat bites amoxicillin/ clavulanate for prophylaxis facultative intracellular ulceroglandular disease, pneumonia, typhoidal tularemia tick bites, traumatic implantation while serodiagnosis (culture is skinning rabbits, aerosols, hazardous) ingestion unpasteurized dairy catalase (+), oxidase (+), serology, products, direct contact culture is hazardous with infected animal wild rodents flea bite (sylvatic pague), respiratory droplets oxidase (-), coagulase (+), culture is hazardous, serodiagnosis or immune fluorescence streptomycin; gentamicin/tetracycline tetracyclin+gentamicin , ampicillin streptomycin + tetracycline(quarantine for 72 hrs) live, attenuated vaccines for high-risk; gloves vaccinate animals, pasteurize milk, esp. Goat milk animal control, killed vaccine localizes in reticuloendothelial cells zoonotic, facultative intracellular, aerobic facultative intracellular ; safety pin appearance facultative anaerobic

a. F. tularensis

5. Brucella

g (-) rods

endotoxin, coagulase, endotoxin, V & W antigens, envelope antigen (F1) inhibits phagocytosis

brucellosis, acute septicemia

6. Yersinia pestis

g(-) rod with bipolar staining

bubonic plague, pneumonic plague

XIII. GRAM (+) BACILLI SPOREFORMERS 1. Clostridium respiratory support polyvalent antitoxin(ABE)(adult), proper canning, heating, hyperimmune human serum, no honey during 1st yr (infant), amoxicillin+antitoxin, debridement(wound) debridement, clindamycin extensive debridement and penicillin, hyperbaric of wound plus + chamber, supportive for food penicillin poisoning hyperimmune human globulin (TIG) + metronidazole or penicillin; spasmolytic drugs (diazepam)

a. C. botulinum

g (+) bacilli w/ subterminal spores, Botulinum toxin (A-B spores, motile, neurotoxin)

adult/food-borne botulism, infant botulism, wound botulism

preformed toxin in canned goods, honey, contaminated soil

clinical, toxin in serum/stool

obligate anaerobes

b. C. perfringens

spores, alpha toxin, enterotoxin

gas gangrene/myonecrosis, food poisoning

contamination with soil or feces

gram staining, culture (wounds, pus, tissue), clinical

c. C. tetani

terminal spores

tetanospasmin

tetanus (trismus, sardonicus, opisthotonus)

contamination with soil/ feces of horses and other animals through puncture wounds/trauma

clinical

DTP, DTaP, Td; TIG; penicillin

require low oxygenation

Genus and species

morphology

virulence factors

Dse, prominent S/S antibiotic-associated diarrhea, pseudomembranous colitis

MOT excessive antibiotic administration

lab methods

DOC

prevention/control

remarks antibiotics: clindamycin, cephalosporins, amoxicillin, ampicillin

d. C. difficile

toxin A, toxin B

metronidazole, vancomycin toxins (stools), endoscopic exam (use only when no other drug is available), D/C antibiotics

2. Bacillus a. B. anthracis capsule, anthrax toxin (PA, LF, EF) spores, emetic toxin, diarrheal toxin virulence factors cutaneous anthrax, pulmonary (Woolsorter's) anthrax food poisoning Dse, prominent S/S MOT lab methods DOC prevention/control remarks contact with infected animals/inhalation of spores from animal hair and wool ciprofloxacin, doxycycline vaccine

b. B. cereus Genus and species morphology XIV. GRAM(+) NONSPOREFORMERS 1. Listeria monocytogenes g(+), nonspore-forming rods, tumbling motility

listeriolysin O, immunologic immaturity

listeriosis, neonatal disease, septicemia foodborne, transplacental, -hemolytic on BA, cold growth and mengitis contact during delivery actinomycosis (lumpy jaw, pelvic, thoracic, abdominal disease, solitary brain abscess)

ampicillin, + gentamicin (for immunocompromised) ampicillin or penicillin G and surgical drainage sulfonamide or trimethoprim/sulfemethoxaz ole Penicillin G

precaution with food

facultative intracellular,

2. Actinomyces israelii

g(+) branching anaerobic

endogenous airborne or traumatic implantation direct inoculationat site of catalase (-), oxidase (-), indole (-), cut /abrasion H2S on TSI

3. Nocardia asteroides 4. Erysipelothrix rhusiopathe XV. RICKETTSIAE 1. R. ricketsii 2. R. akari 3. R. prowazekii 4. R. Typhi 5. R. tsutsugamushi 6. Coxiella burnetii 7. Erlichia chafeensis XVI. PSEUDOMONADS

g(+) filaments breaking up no toxins or virulence factors Nocardiosis (cavitary bronchopulmonary, into rods, partially acid known cutaneous/subcutaneous) fast g(+) bacilli Erysipeloid/Sea Finger/Whale finger

aerobic

obligate intracellular bacteria OX-2 & OX-19 OX-19 OX-19 (V) OX-K Rocky Mountain Spotted Fevers rickettsialpox endemic typhus endemic typhus scrub typhus Q fever Erlichiosis ticks from dogs and rodents mites from mice lice from human fleas from rodents mites from rodents cattle, sheep, goats ticks (Ixodes/lonestar) from ticks/deer cell culture, Weil-Felix test, doxycycline/tetracycline

Weil-Felix (-)

doxycycline, erythromycin

1. P. aeruginosa

g (-) rod

endotoxin, exotoxin A ADP, hot tub follliculitis, eye ulcer, cellulitis, capsule/slime layer, septicemia, pneumonia, ecthyma microcolonies gangrenosum, UTI, recurrent pneumonias

water aerosols, raw vegetables, flowers, hospital repirator and humidifiers

oxidase (+), nonfermenter, catalase (+), grape-like odor, green pigment

antipseudomonal penicillin, 3rd gen. Cephaloporins

pasteurization or disinfection of water related equipment, drug resistance is very hand washing, prompt common removal of catheters; no flowers or vegetable sin burn unit

2. Burkholderia pseudomallei

small, motile, g (-) bacilllus

melioidosis, pulmonary infection

contamination of skin abrasions, ingestion or inhalation

mucoid and smooth to rough and wrinkled colonies, pigments: cream to orange, oxidizes glucose, lactose and other CHO

tetracycline, TMP-SMZ, Chloramphenicol

none

grows at 42C

Genus and species 3. Burkholderia mallei 4. B. Cepacia 5. Stenotrophomonas maltophilia

morphology small, nonmotile, nonpigmented, g(-) bacillus slow growing g(-) free living g(-) rod

virulence factors

Dse, prominent S/S glanders disease, pneumonia,

MOT contamination of skin abrasion, inhalation of organism

lab methods requires glycerol requires colistin

DOC tetracycline +aminoglycosides

prevention/control slaughter of infected horses and mules, clean laboratory areas

remarks

hospital-acquired infections

oxidase (-), lysine decarboxylase (+); lavender-green or gray on BAP

TMP-SMZ

6. Acinetobacter sp

g(-) coccobacilli or cocci

commensal/nosocomial infection, pneumonia, bacteremia

oxidase (-)

usually resistant, aminoglycosides and newer penicillins and cephalosporins

resembles Neisseria on smear isolated from respirators, nebulizers ans renal dialysis

7. Alcaligenes sp.

g (-) rods with peritrichous flagella, motile small, fastidious capnophilic, g (-)

nosocomial infections

oxidase (+) catalase (+) indole (-), urease (-), sweet odor resembling green apples on culture media human bites oxidase (+) oxidase (+) ampicillin, +sulbactam penicillin, ampicillins and erythromycin

8. Eikenella corrodens 9. Kingella XVII. CORYNEBACTERIUM

infection of bones, joints and tendon

K. Kingae

1. C. diptheriae

g (+) rods, aerobic, nonspore forming, non motile, K antigens (heat labile), O "club-shaped appearance", antigens (heat stable), diptheria (whooping cough), wound/skin metachromatic granules, diptheria toxin (Fragment A, diptheria palisades or chinese Fragment B) characters(pleomorphic), V or L shapes in tellurite

droplets or contact with susceptible individuals

culture: BAP, Loeffler slant, Tellurite plate, Elek plate test, Schick test

Penicillin G, Erythromycin; antitoxin

toxoid vaccine (DPT, Td)

biotypes: gravis, mitis, intermidius, belfanti

XVIII. MYCOBACTERIA first line drugs: Rifampin (R), Isoniazid, (H), Pyrazinamide catalase (-) at 68C, catalase (+) at (Z), Ethambutol (E), cannot be decolorized body temp, media: Middlebrook respiratory droplets and Streptomycin (S); second line Bacille-Calmette-Guerin by alcohol -weakly g 7H10 & 7H11, Lowenstein-Jensen, droplet nuclei drugs: Kanamycin, (BCG) (+);NaLc - digestant, Middlebrook 7H9 and 7H12, Ethionamide, Capreomycin, NaOH-decontaminate BACTEC, PPD skin test, PCR Cycloserine, Ofloxacin, Ciprofloxacin

1. M. tuberculosis

sulfatides/sulfolipids, cord aerobic, slow growing, acid factor (serpentine formation fast (+) in vitro), proteins and polysaccharides

Tuberculosis (Exudative and Productive type)

2. M. aviumintracellulare/ M. avium complex (MAI/MAC)

non-chromogen, grow optimally at 41 C, small, nonpigmented colonies, slow-grower

Disseminated, pulmonary; very common in AIDS patients; occurs in other immunosuppressed patients, bacteremia, organ dysfunction pulmonary and systemic disease indistinguishable from tuberculosis, in patients with impaired immune responses

opportunistic

resistant to first line antitubercular drugs

azithromycin or clarithromycin prophylaxis

ubiquitous; also found in other animals

3. M. kansasii

photochromogen

requires complex media for growth at 37 C

rifampin or w/ ethambutol+ isoniazid

Genus and species

morphology

virulence factors

Dse, prominent S/S

MOT

lab methods

DOC

prevention/control

remarks

4. M. scrofulaceum

schotochromogen

occasionally found in chronic cervical lymphadenitis in children, water and as a saprophyte other granulomatous disease (rare) in adults with chronic lung disease superficial skin lesions ( "swimming pool granulomas") superficial and systemic disease occur in water

Surgical excision of resistance to antituberculosis involved cervical lymph drugs nodes tetracyclines, rifampin, and ethambutol amikacin, doxycycline, cefoxitin, erythromycin, or rifampin. punch biopsy or nasal scrapings, acid fast stains, lepromin test, NO CULTURES Dapsone and Rifampin + clofazamine (lepromatous) Surgical excision

5. M. marinum 6. M. fortuitumchelonae Complex

grow best at low temperature (31 C) grow rapidly (36 days) in culture, no pigment acid fast, obligate intracellular, grows best below body temp

7. M. leprae

Hansen's disease (lepromatous and tuberculoid leprosy),

nasal discharge from untreated lepromatous leprosy patients

dapsone

XIX. SPIROCHETES 1. Treponema thin, helical g (-) bacteria, actively motile (endoflagella), visible on silver impregnation method outer membrane protein, hyaluronidase, fibronectin coating, sexual, infected birth canal, transfusion with contaminated blood

cannot be cultured in vitro microscopy: darkfield, direct fluorescent, antibody staining, Serology: Non treponemal (VDRL, RPR), Trponemal test ( FTA-ABS, MHA-TP) Penicillin, Tetracycline, erythromycin, Chloramphenicol

a. T. pallidum spp. pallidum

primary, secondary, late, congenital syphilis

b. T. pallidum spp. endemicum

highly infectious skin lesions (BEJEL), oral person to person by use of lesions (rarely observed); late lesions: contaminated eating gummas of skin, bone and nasopharynx utensils ulcerating papule, usually on the arms or by person-to-person legs (YAWS), Scar formation of skin contact in children under lesions and bone destruction are common age 15, (PINTA) primary lesion: nonulcerating papule on exposed areas. later, flat, hyperpigmented lesions appear on the skin; depigmentation and hyperkeratosis take place years afterward

Penicillin

c. T. pallidum spp.pertenue

d. T. pallidum spp. carateum

darkfield microscopy of spirochetes in skin lesions, (+) serologic test for syphilis late in the course of infection

Penicillin, tetracycline, chloramphenicol

2. Borellia burgdoferi

g (-) rods with periplasmic cylinder in outer envelope responsible for twisting motility, microaerophilic

Borreliosis: relapsing fever, lyme disease

bite from infected arthropods (ticks, lice)

Giemsa/ Wright stain of blood, culture, serology, ELISA, Western Blot darkfield microscopy, Direct Fluorescent Ab, Culture: Fletcher's. EMJH, Tween-80 albumin

Doxycycline, Amoxicilin, Erythromycin

3. Leptospira interrogans

thin, coiled bacilli with hook at ne or both ends

Leptospirosis, Weil's disease

through break in skin after exposure to urinecontaminated water

Penicillin, Tetracycline, doxycycline

Doxycycline, vaccination of livestocks and pets, control of rodents