ALL - BACTERIA

OVERVIEW
Bacteria
Overview
Gram(+)
Gram(-)
Random notes

BACTERIA
Overview

Gram(+)

Lipotechoic acid

Gram(-)

Porin
Outermembrane = Endotoxin/LPS
Periplasmic space (B-lactamase location)

Both

Penicillin binding protein (PBP) — located in cell wall

Cell wall = Peptidoglycan

Flagellum = proteins
Pilus/fimbria = glycoprotein
Spore = keratin-like coat; dipicolinic acid; peptidoglycan, DNA (gram+ only)
Cell envelope

Capsule
Glycocalyx = aderes to surfaces
(Indwelling catheters)
Outer membrane (gram- only)
Periplasm (gram- only)
Cell wall
Cytoplasmic membrane

Biofilm — Polysaccaride matrix

Adheres — not removed by gentle rinsing

Stains
Gram

gram(+) = purple/blue ; gram(-) = pink/red

These Microbes May Lack Real Color
Treponema, Mycobacteria, Mycoplasma, Legionella, Rickettsia, Chlamydia

Giemsa

Certain Bugs Really Try my Patience

Chlamydia, Borrelia, Rickettsia, Trypanosomes, Plasmodium

Periodic acid-Schiff = stains glycogen

PaSs the sugar

Whipple disease (Tropheryma whipplei)

Ziehl-Neelsen (carbol fuchsin)

Acid fast — Mycobacteria, Nocardia (weakly), Protozoa (Cryptospordium oocysts)

India ink

Capsules (Crypto)

Silver — Legionella, H pylori, fungi

Fluorescent antibody

FTA-ABS = syphilis

Aerobes — Nagging Pests Must breathe

Nocardia, Pseudomonas aeruginosa, Mycobacterium tuberculosis

O2-dependent ATP generation

Anaerobes — Can’t Breathe Fresh Air

Clostridium, Bacteroides, Fusobacterium, Actinomyces

Lack Catalase / SOD
Normal GI flora, pathogenic elsewhere (usually)
AminO2glycosides are ineffective (require O2 to enter bacterial cell)

Intracellular

Obligate — Stay inside (cells) when Really CHilly and COld

Rickettsia, CHlamydia, COxiella
rely on host ATP
Facultative — Some Nasty Bugs May Live FacultativeLY
Salmonella, Neisseria, Brucella, Mycobacterium, Listeria, Francisella, Legionella,
Yersinia pestis
like to live inside cell, but don’t have to

Encapsulated — Please SHINE my SKiS

Pseudomonas aeruginosa, S pneumoniae, H Influenza type B, N meningitidis, E coli,

Salmonella, Klebsiella pneumoniae, Strep (group B)
Opsonized, cleared by spleen
(spleen needed for clearing encapsulated bacteria)
Asplenic = vaccinate with
S pneumoniae, H influenza, N meningitidis
Pneumococcal
PCV = conjugate
PPSV = no conjugate
H influenzae (type B) = conjugate
Meningococcal = conjugate

Urease-positive — Pee CHUNKSS

Proteus, Cryptococcus, H pylori, Ureaplasma, Nocardia, Klebsiella, S epidermidis,

S saprophyticus
Ammonium magnesium phosphate stones
Urease - Urea — CO2+ammonia = +pH

Catalase-positive — Cats Need PLACESS to Belch their Hairballs

Nocardia, Pseudomonas, Listeria, Aspergillus, Candida, E coli, Staphylococci, Serratia,

B cepacia, H pylori
H2O2 to H2O + O2
Chronic Granulomatous disease (NADPH oxidase deficiency)
increased risk

Pigment-producing

Actnomyces israelii — yellow “sulfur” granules

Israel has yellow sand
S auerus — yellow
P aeruginosa — blue-green
Serratia marcescens — red — “red maraschino cherries"

In-vivo biofilm

S epidermidis = Catheter, Prosthetic

Viridans streptococci (S mutans, S sanguinis) = Dental plaques, Infective endocarditis
P aeruginosa = Respiratory tree (CF patients), Contact-lens-associated keratitis
H influenza (Nontypeable unencapsulated) = Otitis media

Bacterial virulence factors = promote evasion of host immune response

Protein A = binds Fc of IgG (prevents opsonization)

IgA protease = cleaves IgA
S pneumoniae, H influenza type B, Neisseria (SHiN)
colonize respiratory mucosa
M protein = MiMicry
group A streptococci

Endospores = Bacillis, Clostridium

induced by depletion of nutrients

Asymmetric division forms endospore
Multiple protein coats for membranes
Germination initiation
Trauma, Water, Aging (damage to spore)

Endotoxins

Main effects
Macrophage activation (TLR4)
Complement activation
Neutorphil chemotaxis, Histamine (hypotension, edema)
Tissue factor activation
DIC
O antigen + core polysaccharide + lipid A (toxic)
ENDOTOXINS
Edema
NO = Hypotension
DIC/Death
Outer membrane
TNF-a = Fever, Hypotension
O antigen
eXtremely heat stable
IL-1, IL-6 = Fever
Neutrophil chemotaxis
Shock

Type III secretion = “injectisome"

direct delivery of toxins from gram(-) to eukaryotic

Bacterial genetics

Transformation — take up naked DNA

S pneumoniae, H influenza type B, Neisseria (SHiN)
Conjugation
F+ = sex pilus for conjugation
Plasmid
Hfr = contains plasmid incorporated in chromosome
Plasmid + Chromosomal
Transposition — excision, reintigration
Transduction
Generalized
Phage packages, injects in someone else
Specialized
Viral phage DNA incorporated into bacterial chromosome
genes encoded from lysogenic phages (ABCD’S)
Group A strep (erythrogenic), C botulinum, V cholera, C diptheria, shiga

Plasmids

Autonomous, self-replicating, extrachromosomal

(usually selective advantage, and not essential survival genes)
Episomal — plasmid integrated into host chromosome, passed to progeny
Non-integrative — plasmids outside bacterial chromosome

Gene transfer

Vertical — “mother to daughter"

Horizontal — between cells of same generation through recombinationo

Replication = Binary fission (asexual)

Bacterial growth

Lag phase — acclimatization

Log phase — exponential growth
Doubling time = time required for pop to double
(most sensitive to antibiotics targeting metabolic pathways)
Stationary phase — no net increase
Death phase — exponential death

O2 requirements

Aerobe — requires O2
Anaerobe — killed by O2 (ferments)
Facultative anaerobe — ferment + can use O2
Microaerophile — Low O2 = optimal (but can do without)

Pathogenesis

Inoculum = # of bacteria
Infectious dose = Infection ID50
Lethal dose = Death ID50

GRAM (+)
Overview
Gram(+) cocci

Staph Aureus = “The golden Staff of Moses"

Staph Epidermidis/Saphrictius = “Beauty and th Plumber"
S pyogenes (A) = “The Pie-genies’ bakery"
S agalactiae (B) = “a-galactic baby"
S pneumoniae/viridans = “The alpha knight tournament"
Enterococcus = “Protest at the Caucus"

Gram(+) bacilli

C tetani = “Rhesus research revolution"

C botulinum = “Robotulism"
C difficle = “Field trip to the chocolate factory"
C perfringens = “Private Ringen’s motorcycle accident"
B anthracis, B cereus = “King Anthra’s-axe"
Corynebacterium diphtheriae = “Corazon de la corrida"
Listeria monocytonegenes = “Santa’s List"

Gram(+) filamentous rods

Actinomyces israelii = “Israeli soldier"

Nocardia = “No card game for old men”

Staph
Overview

Cat(+), Cocci (cluster)

NOvobiocin — Saprophyticus = Resistant ; Epidermidis = Sensitive
“NO StRESs on staph retreat”

S aureus

Coagulase(+) (fibrinogen-fibrin), B-hemolytic (gold in blood augur), Mannitol(+) (turn

augur yellow)
Pneumonia, Septic arthritis, Abcesses, Impetigo
(usually post-viral superinfection)
Bacterial endocarditis (tricuspid) / osteomyelitis
IV-drug abuse
Virulence
Protein A= binds Fc-IgG — (prevents activation of compliment /opsonization)
Nares colonization
TSST-1 = superantigen
Toxic Shock Syndrome — (vaginal tampons, nasal packing)
MHC-II~TCR — IL-1,2, IFN-y, TFN-a — fever, vomiting, rash, shock
Enterotoxin
Food poisoning (1-6hr incubation) — mayonnaise
Exfoliative toxin
Scalded skin syndrome (umbilicle cord cut with unsterile scissors)
Protease — Break down epidermis
Panton-Valentine Leukocidin — creates pores in infected cells
Community-aquired pneumonia = common
Non-MRSA = Nafcillin, Oxacillin
“Naf for Staph"
MRSA = Vancomycin
Altered penacillin binding protein = methacillin resistance

S epidermidis

Novobiocin sensative
Coagulase(-)
Urease(+)
Normal skin flora
commonly contaminates blood cultures
Biofilm — massive polysaccharide
Prosthetic devices
joint implants
artificial heart valve — (endocarditis),
IV catheters
(usually have to replace valve)
Treatment = Vancomycin - “need big guns for biofilm"

S saprophyticus

Coagulase(-)
Urease(+)
Female genital tract, Perineum (normal flora)
UTI (uncomplicated cystitis) in young women — (#2 cause)
“honeymoon cystitis” = sexually active

Strep
Overview

B-hemolytic
Bacitracin — “B-BRAS"
a-hemolytic
Optochin — “OVRPS"
y-hemolytic
6.5% NaCl growth = Enterococcus(+)

S pyogenes (group A)

Capsule (Hyaluronic acid), B-hemolytic, Bacitracin (S)

(Hyaluronic acid — cannot be immunogenic because we already have it
everywhere in our body)
Pyogenic = Pharyngitis (strep throat), Impetigo (honey-crusted skin infection)),
Erysipelas/Cellulitis
"PIEogeniC"
Toxigenic = Scarlet fever, Toxic-Shock-like-syndrome, Necrotizing fasciitis
SPE = streptococcal pyogenic exotoxin
A,C = superantigens (TSLS, scarlet fever) ; B = protease (Nec. fasc.)
Scarlet fever = Pharyngitis, Sandpaper-like body rash, Strawberry tongue
Immunologic = Rheumatic fever, Glomerulonephritis
RF diagnosis = "J<3NES"
Joints (polyarthritis), Endocarditis, Nodules (subq), Erythema
marginatum, Sydenham chorea (rapid involintary movements)
Anti-M causes RF
M protein = prevents phagocytosis, mimicry
Type II HSR
“RF is precipitated by Pharyngitis"
PSGN = 2 weeks after infect
Cola-colored-urine, Facial swelling
"Post-Strep GN after Pharyngitis or Skin (cellulitis)"
Type III HSR
Pharyngitis (Strep-throat) precipitates RF and PSGN
Impetigo (skin infect) precipitaes only PSGN
Treatment = Penecillin
prevents RF but not GN (early detection is crucial)
Virulence factors
1. M protein = MiMics (cardiac myosin) = anti-phagocytic + anitgenic = Mitral-valve
stenosis
2. Streptylysin O = B hemolytic
ASO titer = recent infect = diagnosing RF or PSGN
3. Streptokinase = plasminogen—plasmin = lyse clots
4. DNase B

S agalactiae (group B)

Vagina colonization
Pregnant = prophylactic Penicillin (swab at 35wk)
Pneumonia, Meningitis, Sepsis - (mainly in Babies)
“Bitchy when PMS when pregnant"
Properties
CAMP factor
enlarges S aureus homolysis area
(+)Hippurate test
(hydrolyzes sodium hippurate)
Capsule — polysaccharide

S pneumoniae = lancet-shaped diplococci, bile soluble

Meningitis, Otitis media (children), Pneumonia (“rusty sputum”, lobar, #1 community-

acquired), Sinusitis - (#1 cause)
“MOPS"
(#1 cause meningitis in kids/elderly)
Virulence
Encapsulated = polysaccharide
Sepsis in sickle cell or splenectomy
IgA protease = cleaves
Pneumolysin
Treatment = Ceftriaxone, Macrolides - Erythromycin (uncomplicated)
Pneumnoccocal vaccines
Children = conjugate (IgG response)
longer lasting, 7 valent
Adults = polysaccharide (IgM response)
23 valent

S viridans — (S mutans, S mitis, S sanguinis), bile insoluble

No capsule
S mutans, S mitis
Oropharynx (normal) — Dental caries
S sanguinis — "sangrias = red like blood"
Subacute bacterial endocarditis — heart valve damage (if have pre-existing)
(Dextrin adheres to fibrin platelet aggregates — why only if pre-existing)
“not afraid Of-the-chin aka Op-to-chin (live in mouth)"

S bovis — (S gallolyticus)

Gut colonization
S gallolyticus (biotype 1)
Bacteremia, Subacute endocarditis
“Bovis in the blood = Cancer in the Colon"

Enterococcus (Group D) — (E faecium, E faecalis) - “faec = feces", Bile resistant

Colonic flora (normal)

6.5% NaCl = still can grow
Bile resistant
Symptoms
UTI
Biliary tree infection,
(soluble in bile)
Subacute endocarditis (following GI/GU procedures)
Peritonitis
“Do U <3 trees?"
Treatment = Linezolid, Tigecycline
VRE (vancomyacin resistant enterococci) = increasing problem
Peniclin G resistant
faecalis = more prevelent, less pathogenic
faecium = less prevelent, more pathogenic

Bacilli
Clostridia = spore forming, obligate anaerobe
C tetani

Tetanospasmin (exotoxin)
Motor axons — Retrograde travel
protease, cleaves SNARE for NT’s, prevents exocytosis of NT
blocks GABA, glycine (inhibitory) from
Renshaw cells in spinal cord
Inhibit overactivity of cells
“wrench-saw” = usually inactivate overactive cells
Symptoms
Spastic paralysis
Trismus (lockjaw)
Risus sardonicus (facial spasm = raised eyebrows, open grin “evil smile”)
Opisthotonus — (exaggerated arching of back)
DTaP vaccine
tetanus-part is toxoid
(toxin conjugated to protein)
Treatment: Metronidazole

C botulinum

Obligate anaerobe
flourish inside anaerobic environment — canned food/honey
Botulinum toxin
protease, cleaves SNARE, prevents exocytosis
blocks ACh release (motor neurons)
“from bad canned of food, juice, honey"
PNS only
cannot cross BBB
Injestion of spores
Floppy Baby syndrome
(babbies lack enough flora to outcompete spores)
Injestion of preformed toxin = adult disease
Descending flaccid paralysis
Diplopia
Ptosis
Multiple people experiencing same symptoms
(opposite of Guianne Barre)
(adults normal flora kill spores)
(preformed in anaerobic “canned” environment)
(preformed toxin — absorbed in gut — blood stream — PNS)
Local injections = botox

C difficile — “Difficile = Diarrhea” — "ABCD"

Exotoxin A (enterotoxin)
Binds brush border (gut)
Watery diarrhea
accumulation of neutrophils
inflammation, loss of water
cell death
Exotoxin B (cytotoxin)
Cytoskeletal disruption (Actin depolymerization)
Pseudomembranous colitis - membrane covers colon
2º to antibiotic use - (normally in gut, but restricted by normal flora)
especially Clindamycin or Ampicillin
(Ampicillin actually more common, it was just first discovered with
Clindamycin)
“Clean-damycin, if don’t clean your hands properly, you spread"
Spores = transport around hospital
Treatment
Metronidazole, Vancomycin (oral)
(Metronidazole can ironically cause pseudomembranous colitis, but
Vancomycin causes antibiotic resistant species)
(recurrent = Fidaxomicin, fecal microbiota transplant) “Fix-dat"
Lab = stool toxin analysis
(most people have C diff, just not a toxin producing strain)

C perfringens — “Perfringens perforates a gasgrenous leg"

Obligate anaerobe
Spore forming
Soil = Reservoir
Double zone hemolysis + Anaorobic environment = C perfriengens
Gas-gangreen
a-toxin
Lecthinase (Phospholipase)
degrades tissue cell membranes
Symptoms
Myonecrosis (“gas gangrene")
Crepidis
(due to gas from bacterial carbohydrate metabolism)
Hemolysis
“double zone” on blood agar
(due to a-toxin degrading cell membrane)
Deep penetrating wounds, Major Trauma
Motorcycle accidents
Military combat
(large amount flesh exposed to dirt/dust)
Food poisoning
Spores — survive in undercooked food
Enterotoxin (heat-labile) = food poisoning
Slow onset diarrhea
Injest large amount of spores
Spores germinate, create toxin while in body
(unlike others that create toxin before ingested)
(slow-onset due to time it takes to germinate in gut)
Treatment
Self-limited (usually)
Treatment = Penicillin G (IV)

Bacillus = gram(+), “rods-in-chains”, obligate aerobe, spore forming

Bacillus anthracis

Spore forming, Polypeptide capsule (poly-D-glutamic acid)

Edema factor (EF)
Adenylase cyclase - cAMP elevation - fluid in EC space
Lethal factor (LF) — (Exotoxin)
Protease - cleaves MAP-Kinase - tissue necrosis
Cutaneous anthrax
Painless papule surrounded by vesicles
Ulcer w/ Black eschar (painless, necrotic) due to LF
Bacteremia, death (uncommon)
Pulmonary anthrax — “Woolsorter’s"
Inhalation of spores
Flu-like ; Fever, Shock, Mediastinitis (widened mediastinum on X-ray)
Pulmonary infection ; Pulmonary hemorrhage
Treatment = Flouroquinolone, Tetracycline

Bacillus cereus

Spore forming
“Reheated rice syndrome”
(also Tacos or Pasta)
Cereulide - (preformed enterotoxin)
Nausea, Vomiting (1-5hr)
Enterotoxin
Diarrhea (8-18hr)

Corynebacterium diphtheriae — “dumb ABCDEFG, likes LAMP — anchor man"

Diptheria toxin
Subunit A
EF-2 (protein synthesis) inhibition via ADP-ribosylation
(EF-2 = translocation of ribosome)
Subunit B = binding
encoded by B-prophage
Lymphadenopathy (“bull’s neck”), Arrhythmias, Myocarditis, Pseudomembranous
pharyngitis (grayish-white)
“LAMP"
Nerve demyelination (oropharynx)
Lab tests
Metachromatic (blue and red) Granules
+ Elek test = toxic or non-toxic form
Tellurite agar, Loeffler’s medium = diagnosis - “Love on the Tele"
Treatment = Anti-toxin + Penicillin
DTaP vaccine = toxoid vaccine
"ABCDEFG = ADP-ribosylation, B-prophage, Corynebacterium Diptheriae, EF-2,
Granules"

Listeria monocytogenes

Facultative intracellular (anaerobic), B-hemolytic, Catalase(+)

Movement
Flagella = room temp (30ºC and below) - “tumbling motility"
Actin rockets (from host, inside cell)
Transmission
Unpasteurized dairy products, Cold deli meats (mom’s shouldn’t eat!)
Transplacental, Vaginal (during birth)
Amnionitis, Septicemia, Spontaneous abortion — (early exposure)
Granulomatosis infantiseptica, Neonatal meningitis (#3— behind E coli
(#2), Strep B (#1))
Meningitis = immunocompromised / elderly (cell-mediated immunity impairment)
Gastroenteritis (mild, self-limited) = healthy adults
Treatment = Ampicillin

Branching - gram(+), filimentous rod

Actinomyces israelii = Anaerobe, not acid fast

Oral, reproductive, GI (normal flora)

Jaw trauma (can cause), takes advantage of injury
Oral/Facial abcesses
drain through sinus tract in skin (differentiate from neoplasm)
Yellow “sulfur granules"
can cause PID with IUD's
Treatment = Penicillin G
“Treatment is a SNAP: Sulfonamides = Nocardia — Actinomyces = Penicllin"

Nocardia = Aerobe, Acid fast (weak), Catalase(+), Urease(+)

Soil
Immunocompromised
Pulmonary infections (immunocompromised), Brain abcesses (rare)
mimics TB, but (-)PPD
Cutaneous infections after trauma
Treatment = Sulfonamides (TMP-SMX)

GRAM(-)

Overview
Gram(-) cocci

Neisseria = “Noir series"

Neisseria meningitidis = “A shocking death on campus"
Nisseria gonorrheae = “The violinist’s last Clap"

Gram(-) bacilli (enteric)

Klebsiella, Enterobacter, Serratia = “Enterodactyl, Triserratiatops, Kleb-tailed

dinosaur"
Salmonella = “The salmon dinner"
Shigella = “She-Gorilla’s Circus"
E coli = “E cola’s soda fountain"
Yersinia enterocolitica = “Yersin’s Pets"
Campylobacter = “The Camping guy and the Bears"
Vibrio = “Colonel Cholera’s base cAMP"
Helicobacter = “The Helicopter pilot"
Pseudomonas = “The Suitors of Pseudo Mona"
Proteus mirabilis = “The god of the Public restroom"

Gram(-) bacilli respiratory

Bordatella pertussis = “Board and care"

Haemophilus influenzae = “Phyllis’s chocolate covered cherries"
Legionella = “The S.S. Cysteine joins the Legion"

Gram(-) zoonotics

Bartonella henselae = “Bart the leopard"

Brucella = “Bruce farms"
Francisella tularensis = “Francis the rabbit"
Pasteurella multocida = “Louis Pasteur’s lab"

Mycobacteria

Mycobacterium tuberculosis = “Shootout at the TB Corral"

Mycobacterium leprae = “The good, the bad, and the Lion faced"

Spirochetes

Borrelia = “The Bows and arrows of Borrelia"

Leptospirosis = “The surfer’s oasis"
Treponema pallidum = “Pallidum observatory"

Gram-indeterminate

Chlamydia = “The piratees of Chlam island"

Coxiella burnetii = “Curly Q the ram"
Gardnerella vaginalis = “The fish Garden"
Mycoplasma pneumoniae = “Walking on thin ice"
Rickettsia = “Rickettsia tennis"
Rickettsia prowazekii = “Pro boot camp"
Rickettsia rickettsii = “Rickett’s Rock climbing competition"

gram(-) bacilli

E coli, Kleb/Entero/Serr = Lactose(+)

E coli = Lactose(+), Catalase(+)
Kleb = Lactose(+), Urease(+)
None
Salmonella = H2S(+), acid-labile, capsule, motile
Shigella
Yersenia = Bipolar, capsule
Curved bacilli = Oxidase(+)
H Pylori, Pseudomonas = Oxidase(+), Catalase(+), Urease(+)
Proteus = Urease(+)

COCCI

Neisseria

Diplococci, Glucose(+), Oxidase(+)

IgA protease
Survival on mucosal surfaces
Pili / Fimbriae
antigenic variation
attachment to mucosal surfaces
C5-9 deficiency (MAC) = Neisseria infections!
“MeninGococci ferment Maltose and Glucose” + Capsular
“Gonococci ferment Glucose"
Thayer-Martin media = VPN agar
(Vancomyacin - inhibits gram(+) ; Polymixin - inhibits gram(-), Nystatin inhibits
fungi)
Chocolate agar — heated blood ager (unable to grow in normal blood agar)

N meningitidis

Capsule = polysaccharide
inhibits phagocytosis
Maltose(+)
Sickle cell/Apslenic = more suseptible
LOS — (Lipo-Oligo-Saccharides)
Neisserias LPS
Very high production = Blebbing off
Meningitis (acute) — Nausea, Headache, Fever, Chills, Photophobia
Meningococcemia (disseminated) = multi-organ disease (Severe!)
1. Inflammatory response (massive)
LOS proteins = blebbing (when outgrow themselves)
Capillary leakage — Hypovolemic shock
2. Petechial rash = thrombocytopenia
Little red dots on skin
Small vessel thrombrosis
NEVER a good sign, disease likely progressing to DIC
3. DIC - (Disseminated-Intravascular-Coagulation)
Bleeding + Clotting — “in all the wrong locations"
4. Waterhouse-Friderichsen syndrome
Hemorrhagic adrenal glands
DIC + Hypovolemic shock (vasoconstriction)
(bilateral - due to DIC) = cortasol(-) — fucks up electrolytes! = MEDICAL
EMERGENCY!
Hypovolemic (from inflammatory response), leads to Peripheral
Vasoconstriction, Adrenal insufficiency = worse shock!
Septic shock
Respiratory, Oral transmission
Nasopharynx colonized — Hematogenous spread
Military recruits, College dorm rooms
Treatment = Ceftriaxone, Penicillin G
Prophylactic = Rifampin, Ciprofloxacin, Ceftriaxone (for close contact)
(mortality ~15%)
Vaccine = conjugated/capsular saccarides
Type A, C, D (not B) — Covers 4/5 common serotypes
College/Military/adolescents 10-12y/o
CSF = WBC(++), Glucose(--), Protein(+)

N gonorrheae = Gonorrhea

Facultative intracellular - (PMNs)

does NOT gram stain (intracellular infection)
(not encapsulated)
Symptoms
Male
Urethritis
White purulent discharge
Prostatitis
Orchitis
(can be asymptomatic)
Women
Urethritis
White purulent discharge
Thick — (thicker than clamydia)
Cervicitis
PID - (Pelvic Inflammatory Disease)
Ascending infection
Uterus
Fallopian tubes
Ectopic pregnancy risk
Ovaries
Sterility risk
"Cervical motion tenderness” = PID
Septic arthritis — (#1 cause of septic arthritis 15-40y)
Asymmetric
 Mono- / Poly-articular — Knee = most common
(vs. s auerus = monoarticular)
“Sexually active man + New-onset arthritis in knee — likely due to
gonorrhea, even if shows no genitial sympoms"
(men can many times be assymptomatic except for arthritis
in a knee)
Fitz-Hugh-Curtis syndrome
Direct spread of PID (N gonorrhea or Chlamydia) from Fallopian tubes to:
Liver capsule
“Violin string adhesions”
Peritoneum
Perinatally = Transmission to baby during birthing
Conjuctivitis neonatal
Within 5 days — (vs Chlamydia 7+ days)
Erythromycin ointment — prevents neonatal transmission
Sexual = Transmission
Treatment
Ceftriaxone
Azithromycin or Doxycycline for possible chlamydial coinfection
(always treat for both)

Bacilli — enteric
Klebsiella, Enterobacter, Serratia

Lactose(+)
MacConkey = pink(+)
Nosocomial = (Hospital aquired)
Multi-drug resistant
Treatment = Carbapenam
Pneumonia, UTI's
“Enteric bacilli, MacConkey agar = E coli or these"

Klebsiella

Capsule (polysaccharide), Immotile, Intestinal flora

Urease(+)
Aspiration pneumonia (Alcoholics), Abscess in lungs,liver
Cavitary lesions "chest X-ray”
(can look like TB)
“red currant jelly sputum” = Klebsiella
UTI’s
Alcoholics, di-A-betics

Enterobacter

Motile

Serratia

Motile, (slow lactose fermenter)

Red pigment - "pink ring around shower - from Serratia"

Salmonella

Facultative intracellular (MPh), Motile - “salmon swim", Acid labile (degraded in

stomach)
Capsule
Hektoen agar = black - H2S(+)
Hematogenously disseminated
(Taken up by MPh in intestine, carried into blood)
Virulence factor
Type III secretion (helps infectivity)
Transmission = Contaminated chicken, eggs, dairy
Reservoir = animals (especially chicken)
Typhi
Typhoid fever
Rose spots (abdomen), Fever
Constipation, followed by Diarrhea (“Pea soup”)
Intestinal perforation — death
(Pseudo-appendicitis)
Osteomyelitis (#1 cause in Sickle cell)
Week 1
Peyer patch invasion
Sepsis
Week 2
Diarrhea
Classic triad
Bradycardia
Neutropenia
Splenomegaly
Gall bladder = carrier state
Treatment = Usually do NOT treat — can prolong disease
If do treat — Fluoroquinolones (Cipro), Ceftriaxone
Vaccine (live, attenuated)
Enteritidis
Transmission = Contaminated chicken, eggs, dairy
Reservoir = chicken
Virulence factor
Type III secretion (helps infectivity)
Diarrhea (Bloody, Inflammatory), Gastroenteritis
Food poisoning

Shigella - (Shigella dysenteriae, Shigella sonnei = most common is US)

Facultative intracellular (M cells), Immotile, Acid stable (need less than salmonella to
cause infection)
Hektoen agar = green (vs salmonella = black)
Invade M cells (in pyrus patches) — present antigens
M cells phagocytise, but Shigella escapes degredation
Actin filaments (hijacks hosts - uses as tail)
Type III secretion = inflamatory cytokines
Cell-to-cell spread
Shiga-toxin
60S ribosomal inhibition (protein synthesis inhibition)
Endothelial damage
Diarrhea (bloody, inflammatory)

Shigella dysenteriae
Hemolytic-uremic syndrome (HUS) — (young children)
Anemia, Thrombocytopenia, Renal failure (acute, glomerular damage)
(kid who has bloody diarrhea, and just as about to get better has renal
failure)

Transmission = humans only (fecal-oral)

NO animal reservoir (as opposed to salmonella)
Treatment (dysenteriae only) = Cipro, TMP-MTX
(sonnei=none)

E coli

MacConkey = pink(+)
Lactose(+), Catalase(+)
EMB agar = green
Virulence factors
Fimbriae (pilli) = UTI (#1), Cystitis, Pyelonephritis
Kapsule = Pneumonia, Neonatal meningitis (only if K-antigen)
LPS endotoxin = Sepsis (#1 gram(-))
EHEC = STEC - (Shiga toxin-producing E coli)
Sorbitol(-) = distingueshes from other E coli
Diarrhea (bloody)
Dysentery (infection of intestines, severe diarrhea w/ blood and mucus)
(Toxin alone causes Necrosis, Inflammation)
Shiga-like toxin
60S ribosome inhibition — protein-synthesis(-)
Hemolytic-uremic syndrome (HUS)
Anemia, Thrombocytopenia, Renal failure (acute)
Endothelium swelling, Blood vessel narrowing
Microthrombi on damaged endothelium
(mechanical hemolysis, platelet consumption, decreased renal
blood flow)
O157:H7 = most common serotype in US
Transmission = undercooked meat
ETEC
Travelers’ diarrhea (watery) = EnTeroToxins
Heat-labile = cAMP(+)
similar to cholera toxin
Heat-stable = +cGMP
similar to yersinia toxin
“Stable on the Ground, Labile in the Air"
(no inflammation or invasion)
Transmission = water
EPEC
Diarrhea (Pediatrics)
Intestinal adhesion, Villi flattens, Inflammation
(no toxic = almost always ; Shiga-like = very rarely)
EIEC
Intestinal mucosa (Invasive)
Necrosis, Inflammation (similar to Shigella)
Dysentery
(no toxin)

Yersinia

Bipolar staining "safety pin appearance"

Encapsulated
Treatment = Tetracyclines + Streptomycin

Yersinia enterocolitica

Diarrhea (bloody)
Disseminated = Fever, Leukosystosis, Abcesses (intestine)
Pseudo-appendicitis
(RL-abdominal pain: Mesenteric adenitis/Terminal ileitis)
Autoimmune reactive arthritis (Righter syndrome) — Adults
Conjunctivitis, Urethritis, Arthitis
“can’t See, can’t Pee, can’t Climb a tree"
Transmission = Puppy feces, Milk / Pork (contaminated)
Toddlers most effected
Cold resistant

Yersinia pestis = Black/Bubonic plague

Buboes = Swollen lymph nodes (nasty, tender)

Organ abcess, Cutaneous hemorrhage (DIC), Tissue necrosis
Prarie dogs, Rodents = Resivoir
Fleas spread
Virulence
Exotoxins
YOPS secretion (Type III secretion)
Phagocytosis inhibition of MPh, Neutrophils
Vaccine (killed)

Bacteroides fragilis

Gram(-) rod, Anaerobic (but aerotolerant), Capsule

Normal flora
Trauma causes spread to sterile sites (eg Appendix rupture)
Absesses (enzymes cause tissue destruction outside gut), Bacteremia
Exotoxin
Watery diarrhea (children)

Comma-shaped
Campylobacter jejuni

Comma- S-shaped, Oxidase(+)

42ºC growth - “Campylobacter likes hot campfire"
Bloody diarrhea - (Children major cause), Bacteremia (invasive)
Autoimmune antecedent
Guillain-Barre, Reactive arthritis (writer syndrome)
Fecal-Oral transmission
Undercooked chicken
Intestinal tract of animals (poultry) = resivoir
(person-to-person ; poultry, meat, unpasturized milk ; infected animal contact -
dogs, cats, pigs)
“dog pooping in your kids sandbox” — campylobacter, yersinia
enterocolitica

Vibrio cholerae

Comma-shaped, Oxidase(+)
Acid-labile — Alkaline media growth
(lower acidity of stomach - increased chance of infection — eg. PPI's)
Diarrhea - "profuse rice-water"
Fimbrae attachment
Enterotoxin (A-B)
Gs activation — cAMP(+)
(ADP-ribosylation of Gs-a subunit)
Transmission = Fecal-Oral
Developing countries (endemic)
Treatment = Oral rehydration

Vibrio parahaemolyticus, Vibrio vulnificus

Raw seafood, especially oysters

Chronic liver disease = increased likely
Paraheaemolyticus
Diarrhea
Vlunificus
Skin infections (Cellulitis, Fascitis, Necrosis)
Septic shock/Hemorrhagic bullae

Helicobacter pylori — (Helico = “curved” - Pylori = "near pylorus")

Curved Rod, Motile

Catalase(+), Oxidase(+), Urease(+)
Urease(+) breath test
Serum antibodies/Stool antigen = used now
Peptic ulcers (esp duodenal), Gastritis (inflamation of stomach)
Gastric-adenocarcinoma, MALT-lymphoma
Treatment (3) = PPI + Clarithromycin (Macrolide) + Amoxicillin (or Metronidazole if
penicillin allergy)
(~80% in developed countries have been infected)

Pseudomonas aerginosa

Obligate Aerobic, Motile, Oxidase(+), Urease(+), Catalase(+)

Capsule = mucoid polysaccharide (biofilm)
Pyocyanin / Pyoverdin = blue-green pigment
Grape-like odor - (sweet, fruity)
Water-loving
PSEUdOmonaS(kin)
Pneumonia (ventilator), Sepsis (burn victims), Otitis Externa (swimmer’s ear), UTI
(nosocomial)
Osteomyelitis (diabetics, IV drug)
Ecthyma gangrenosum (immunocompromised, burn)
Black Necrotic cutaneous lesion (rapidly progressive)
Hot tub folliculitis (thrives in water)
Virulence
1. Exotoxin A = EF-2 inactivation (protein synthesis - same as diptheria)
2. Endotoxin = Fever, Shock
3. Elastase, Alkaline protease = allows spread
Susceptible
CF, Burn victims
Treatment = Piperacillin (Extended Spectrum Penicllin) + Aminoglycopside,
Fluoroquinolones

Proteus mirabilis

Facultative anaerobe, Urease(+), Motility (“swarming” when plated)

Fishy odor
UTI
Staghorn calculi in renal pelvis
Struvite stone
(alkaline environment — from urease)
(Ammonia, Mg, PO4)
Coffin-lid shaped
Nidus for recurrant infections
Treatment = Sulfonamides

Bacilli — respiratory
HaEMOPhilus influenzae

Coccobacillary rod (small)

IgA protease
Mucosal or Invasive infections
Epiglottitis (cherry red in children, “thumbprint X-ray”), Meningitis, Otitis media,
Pneumonia
Bronchitis, Conjunctivitis
Meningitis — (only Type B capsular type)
“immigrant kid leaning forward, having trouble swollowing own saliva, inspiratory
stridor (due to narrowing airway)"
Aerosol transmission
Sickle cell, Asplenic
Treatment
Mucosal = Amoxicillin (+/- Clavulanate)
Meningitis = Ceftriaxone
Prophylaxis = Rifampin (just like N Meningitidis)
Vaccine — Type B - (meningitis causing)
2-18 month-age
capsular polysaccharide (conjugated to diptheria toxoid/other protein)
(N meningitidis is Type A,C,D)
Culture
Chocolate agar — factor V (NAD+), factor X (hemaTEN)
w/ S aureus (provides factor V through hemolysis of RBCs)
(does not cause the flu - influenza virus does)

Bordetella pertussis

Phases

1. Cataral — Non-specific conjunctivitis, lacrimation

2. Paroxysmal — Whooping cough — "Expiration = cough - Inspiration = whoop"
3. Convalescence — Reduction of symptoms

Pertussis toxin
inhibits Gi — cAMP(+)
[Insulin(+) — Sugar(-) — PMN response(-) — Phagocytosis(-)]
Lymphocytosis = stimulates release from lymph nodes
prevents extravation out of blood vessels
Adenylate cyclase toxin
(+)cAMP, (same as EF from anthracis)
Edema
Tracheal toxin
Ciliary inhibition (trachea)
(part of peptidoglycan wall)
Resperatory droplet transmission
Filimentous Hemagglutinin (Pili) = attachment
Treatment = Macrolides
DTaP vaccine = acellular Pertussusis antigens
Ca alginate swab — Potato agar or Regan-Lowe agar

Legionella pneumophila

Silver stain (gram stains poorly), Oxidase(+)

Legionnaires’ disease
Pneumonia (unilateral, severe, highly variable X-
ray), Diarhhea, Hyponatremia (<130)
Unilateral lobar — “Patchy infiltrate, consolidation of lobe — X-ray”
Micro-abscesses from neutrophils
Fever (high), Cough (non-productive), Headache, Confusion
CNS = Death
Pontiac fever — (mild form of disease)
Flu-like (mild)
Treatment = Macrolide (Azithro), Fluoroquinolone
Aerosol transmission from environmental water source
Air-conditioning, Hot water tanks - (No person to person)
Smokers
“Legionnaire convention = where discoverd"
Culture
Charcoal yeast, Fe, Cysteine
“French legionnaire (soldier) w/ Silver helmet, sitting by campfire (Charcoal)
with Fe dagger - he is no Sissy (cysteine)"
Urine antigen test = rapid diagnosis
Pathogenesis
Inhabits water reservoires, Aerosolizes from misting machines
Pili = adheres to respiratory epithelium
MPh = Phagocytose
1. Proliferates inside nutrient rich MPh
2. Prevents Phago-Lysosome fusion
3. Infected MPh’s secrete cytokines
+PMN's

Bacilli — Zoonotics

Zoonotic = Transmitted between Animals and Humans

Bartonella henselae = Cat scratch

Warthin-Starry stain (Silver stain type)

Cat scratch fever = Immuno-competent
Fever
Painful lymphadenopathy
Regional, near sight
Treatment = (usually self-limited)
Macrolides - (if lymphadenopathy is too painful)
Bacillary angiomatosis = Immuno-compromised
“angiomatosis”
Raised, red vascular lesions
Tumor-like
(similar to Kaposi sarcoma)
Fever, chill, headaches
Treatment = Doxycycline or Macrolides

Brucella

Facultative intracellular — (intra or extra cellularly)

MPh (prevent phago-lysosome fusion)
Caseating granulomas
Spread to reticular organs (spleen, liver, lymph nodes)
Primary symptoms
Fever, Chills, Anorexic
Undulant fever (rises and falls)
Systemic/chronic
HepatoSplenomegaly
Lymphadenopathy
Osteomyelitis — #1 complication
Transmission
Pig/Cow/Sheep/Goat (direct)
Unpasturized dairy (indirect, eg. Goat cheese)
Veteranarians, Slaughterhouse workers, Farmers
Treatment = Doxycycline + Rifampin

Francisella tularensis = Rabbits (main reservoir), Ticks (dermacantor), Deer fly

Facultative intracellular, Coccobacilli

Touleremia
Painful Ulcer — site of infection
Granulomas w/ Caseating necrosis in reticuloendothelial organs
Lymph nodes
Lymphadenopathy (regional)
Pathogenesis
Carrier = Rabbits
Transmission = Dermacantor ticks, Lice, Mites, Deer fly — (introduce bacteria to
skin)
Bacteria multiply
Form papule
Ulcer with black base develops
Phagocytosis of bacteria
Localize to Reticuloendothelial system (Lymph nodes)
Caseating granulomas form
Regional lymphadenopathy
Treatment = Aminoglycopsides — (Streptomycin)
Transmission = Aerosol
CDC manditory report due to possible bioterorrism
Arkansas, Oklahoma, Missouri — most common locations in US

Pasteurella multocida = Animal bite - (cats, dogs respiratory tract)

Capsule, Catalase(+), Oxidase(+)

5% sheep agar
Bipolar staining (safety pin)
Symptoms
Cellulitis — within 24hrs
Osteomyelitis
Immuno-compromised
Lymphadenopathy
Nec. fasc.
Transmission = Animal bite - (cats, dogs)
Treatment = Penicillin, (+/-)B-lactim inhibitor

Mycobacterium

Acid fast, bacilli

Carbol-Fuchin stain (acid fast) = Mycolic acids (pink rods)

Mycobacterium tuberculosis

Obligate aerobe = MPh latency

Lowenstein-Jenses agar
Cord factor — (serpantine "snake-like" pattern)
MPh, neutrophils inhibition
protects from being destroyed
TNF-a = inflammatory
MPh activation = walls off
Sulfatides = inhibit phago-lysosomal fusion (surface glycolipids)
survival inside MPh
Fever, Night sweats, Weight loss, Cough, Hemoptysis
Caseating granulomas = Central necrosis, Multinucleated Langhans giant cells
Pulmonary
Primary = middle/lower lobes
Calcification/Fibrosis (Hilar lymph node)
Ghon complex
Hilar lymphadenopathy + Peripheral granulomatous lesion
Latent/healed infection
Fibrosis
Miliary (systemic) (entry into blood)
Bacteremia (severe) — Death
Multi-organ failure
Multiple-fine granulomas (liver)
can invade Peyer patches
Strictures - possible
Reactivated = upper lung
TNF-a down regulation - allows reactivation
TNF-a allows infection to be contained
Extra-pulmonary
CNS = Parenchymal tuberculoma (cavitary lesion), Meningitis
Bones = Pott’s disease
(Lymphadenitis, Renal, GI, Adrenals)
Diagnosis
PPD — BCG vaccine = false(+)
Type IV HSR
IGRA = Interferon-y release assay - less false(+)
Transmission = respiratory — (human-human)
Treatment = Rifampin, Isoniazide, Pyrazinamide, Ethambutol + B6
"RIPE"
Prophylaxis (Rifampin, Isoniazid) — (sources vary on this)

Mycobacterium leprae

Carbol-fuschin stain (acid fast), MPh latency

Cool temps
Peripheral skin, Superficial nerves
Hansen disease
Tuberculoid = Th1
Skin plaques
øPigmentation
Hairless
Well-demarcated
High-cell-mediated immunity with Th1 response
bacteria maintained in MPh
(patients have strong-intact cell-mediated immunity)
Lepromin skin test(+)
immune system has under control
Lepromatous = Th2 (more severe, immunocompromised)
Nodular growth, Skin thickening - (Diffuse)
Leonine facies (lion-like)
Peripheral neuropathy
“symmetric glove and stocking loss of sensation”
Extremities — most vulnerable
Low-cell-mediated immunity with humoral Th2 response
unable to contain bacteria in MPh
Human-human transmission (communicable)
Armadillos = main US reservoir
Treatment
Dapsone + Rifampin
(add Clofazimine for Lepromatous form) — 2-5yrs
Treatment complications
(Anti-leprosy drugs should NOT be discontinued even if there is a rxn)
Type 1 — DTH response
+TB-like symptoms
Prednisone = treatment
Type 2 — Immune complex deposition
Erythema Nodosum Leprosum
Thalidomide = treatment

Mycobacterium avium-intracellulare (MAI)

AIDS = CD4 < 50

Acid fast rods
Foamy MPh’s in lamina propria — stimulate Whipple disease
Symptoms
GI
Diarrhea
Malabsorption
Pulmonary
Pnemonia
Treatment = Azithromiacin
(treat CD4<50 propylactically)

Spirochetes

“BLT = Borrelia, Leptospira, Treponema"

Dark-field microscopy
“Borrelia is Big"
Analine dyes/Giemsa stain
Spiral-shaped, Axial filaments

Borrelia = Lyme disease = Ixodes ticks

Wright stain, Giemsa stain

Initial
Erythema chronicum migrans (bulls-eye)
Flu-like
(+/-)Bilateral Facial nerve palsy
Later
Bilateral Facial (Bell’s) palsy
Arthritis (migratory)
Cardiac (AV-block)
Neurologic (Meningitis, Polyneuropathy)
"FACE = Facial nerve palsy (usually bilateral), Arthritis, Cardiac block, Erythema
chronicum migrans"
Treatment = Doxycycline, Ceftriaxone (when more severe)
Pregnant/Child = Amoxycillin
(white-footed-mouse = larvae feast on ; white-tailed-deer = adult live on)
Mouse = main reservoire
Deer = obligatory host
Tick = vector

Leptospira interrogans

Gram(-) spirochetes
Crook at end — resembles “shepherd’s staff”
Reservoir = rats, dogs
Excreted in Urine — (Water with Animal urine)
Surfers in tropics (Hawaii)
Water sports associated — (not the R. Kelly type)
Septicemic phase
Early
Flu-like
Myalgias (calves)
Conjuctival suffusion
Erythema w/o exudate
(or the surfer might just be high)
Photophobia
Severe = Weil diseaes (biphasic
Hemorrhagic diathesis
Renal failure (interstitial nephritis)
Azotemia
Liver failure
Jaundice
Meningitis
Antibody appearance — ends phase
(organism clears, symptoms resolve)
Immune phase
Leptospira in urine
Treatment = Penicllin G
(Prophylaxis = Doxycycline)

Treponema pallidum = Syphilis

Treatment = Penecillin G
Jarisch Herxheimer rxn possible
brisk treponema lysis — release LPS
Fever, Chills
1º — 6wks after exposure
Painless chancre (genital)
local small vessel invasion
ischemic necrosis
takes out nerves, hence painless
Chancre resolves in 3-6wks
2º = Systemic — 6wks after chancre heals
Maculopapular rash (palms, soles)
Condylomata lata (smooth, moist, painless, wart-like white lesions on genitals)
(Meningitis, Hepatitis, Arthritis)
3º — “causes a NAGing infection” — Years later
Neurosyphilis (tabes dorsalis, “general paresis”), Aortitis (vasa
vasorum), Gummas (chronic granulomas) — granulomas of soft tissue/bone
Argyll Robertson pupil - “prostitutes pupil”
(constricts with accomodation, non-reactive to light)
(Broad-based ataxia, Romberg(+), Charcot joint, Stroke w/o hypertension)
Congenital
Congenital syphilis
Saddle nose, Saber shins, Teeth (Hutchingson’s, Mulberry
molars), Rhagades, Snuffles
Deafness (CN VIII)
“saddle teeth, knoched nose, saber shins”
Stillbirth, Other anomalies
Transplacental transmission
Prevention = treat mother early in pregnancy
VDRL — (Vernereal Disease Research Lab)
Quantitative, Sensitive (non-specific)
False positives
Viral infection (mono, hepetitis), Drugs (IV), Rheumatic factor, Lupus,
Leprosy
detect antibodies react w/ beef Cardiolipin
FTA-ABS = Specific/sensitive
(detects anti-treponema antibodies)

Indeterminate
Chlamydia - “Chlamys = cloak (intracellular)"

Obligate intracellular
Muramic acid lacking (peptidoglycan) in cell wall
B-lactam antibiotics NOT effective
Inclusion bodies - cytoplasmic
Giemsa
NAAT test
(nucleic acid amplification test = PCR)
C. trachomatis
Reactive arthritis
Auto-immune disorder
(Reiter's syndrome = Uveitis(eye),Urethritis,Arthritis)
Sacroiliac, Knee, Other
HLA-B27 associated
“can’t See, can’t Pee, can’t climb a tree"
Serotypes
A,B,C — “Africa, Blindness, Chronic infection"
Blindness — (#1 worldiwide)
“A,B,C with your eyes"
Chronic infection — (chronic conjunctivitis)
(inflammation — corneal vascularization/scarring)
Africa
Transmission = Hand-Eye, Fomites
D-K — STI
Watery discharge
Urethritis
(can be asymptomatic)
PID
Fallopian tube damage — EKtopic pregnancy
Complications
Liver capsule infect — Fitz-Hugh-Curtis syndrome
L1-3 — LGV
LymphoGranuloma Venereum
Painless genital ulcers (small, shallow, heal rapidly)
Buboes — Inguinal lymph nodes (ulcerate, swollen, painful)
Also an STD
Congenital (D-K)
Pneumonia
Staccato cough
Conjunctivitis
7+ days
(vs. Gonorrhea, which is <5 days — “gonoREA REActs quicker in
baby eyes”)
C. pneumoniae
Aerosol transmission
Atypical (walking) pneumonia
Elderly
C. psittaci
Avian reservoir
Bird poop = Transmission
Pneumonia
Pet shop workers, Veternarians
Treatment = Azithromycin (Macrolides), Doxycycline
+ Ceftriaxone for N. gonorrhea
(Macrolides/Tetracyclines used because Chlamydia is intracellular — need an
antibiotic that can enter cells)
Replication — 2 forms
Elementary body (small, dense) — exist outside cells
Enfectious, Enters cell via Endocytosis
Transforms to Reticular body
Reticulate body (active form) — use host ATP
Replicates in cell by fission
Reorganizes into elementary bodies

Coxiella burnetii — (used to be categorized with Rickettsia)

Obligate intracellular
Spore forming
Q-fever (no rash)
Headache, Fever, Pneumonia
Hepetitis, Endocarditis (sometimes)
closely related to Rickettsia genus, however:
“Q fever is Queer — no rash, no vector, causitive organism can survive
outside in endospore form”
Farm animals = reservoir
Aerosol transmission (to humans)
Farmers, Veterinarians
Contaminated spore-like-structures in animal feces
(unlike other rickettsia sp., it does not require an arthropod vector
because it can survive as a spore)
Treatment = Supportive or Tetracycline
Culture(-) endocarditis (rarely)
CDC manditory report

Gardnerella vaginalis

Gray discharge, Fishy smell, Non-painful (vs. vaginitis)

"I don’t have a clue why I smell fish in the vagina garden!"
Clue cells
epithelial cells w/ adhering bacteria on outer margin
(“stippled”)
Amine whiff test
KOH (10%) enhances odor of discharge
Gram variable
gram(+) or gram(-) staining
pH > 4.5
due to bacterial overgrowth disrupts normal flora
(Lactobacilli - normal bacterial flora, normally keeps pH < 4.5 by producing lactic
acid)
Treatment = Metronidazole
Associated w/ sexual activity (not an STD)
(do not have to treat partner)

Mycoplasma pneumoniae = atypical “walking” pneumonia

No cell wall, Pleomorphic

Sterols (cholesterol) in membrane - for stability — (only bacteria)
Eaton’s agar — (2-3wks to culture)
Cold agglutinins (IgM) - lyse RBC's
"Walking” Pneumonia (atypical)
Headache, Cough (nonproductive)
Interstitial infiltrate (patchy, diffuse)
X-ray looks worse than patient
Gradual onset
Military recruits, Prisons
< 30 y/o = most common
Treatment = Macrolides (or Doxycycline, Fluoroquinolone)
(Penicillin = ineffective - Mycoplasma have no cell wall)

Rickettsia

Obligate intracellular, Coccobacillary

Unable to produce NAD+, CoA
Weil-Felix agglutinin test
Giemsa stain
Treatment = Doxycycline
“Rickettsii on the wRists, Typhus on the Trunk"
Rash = Rickettsia-rickettsii -typhus
Vasculitis causes rash
No rash = Ehrlichia, Anaplasma, Coxiella burnetii

R prowazekii = Louse ; R typhi = fleas

Myalgia, Arthralgia, Pneumonia, Encephalitis — Coma

Rash
Central - (spreads out, spares palms/soles)
Military recruits, Prisoners of war
Louse (lice) spread
(scratching where louse deficates spreads to blood)

R rickettsii = Rocky Mountain spotted fever = tick (dermacentor)

Headache, Fever, Myalgia

Rash
Palms, Soles - (from ankles, wrists)
“drive CARS with palms and soles"
(Palms and soles rash seen in Coxsackie A, Rocky Mountain Fever, Syphilis 2º)
— (Erythema multiforme)

RANDOM NOTES

Ehrlichia = Ehrlichiosis — tick

Monocytes with morulae (mulberry-like inclusions) in cytoplasm

Anaplasma = Anaplasmosis — tick

Granulocytes w/ morulae in cytoplasm

Bloody diarrhea

Y enterocolitica (daycare, pseudoappendicitis)

Salmonella
Shigella
EHEC (shiga-like-toxin)
EIHC (invades intestinal mucosa)
Campylobacter
E hystolytica (protozoa)

Watery diarrhea

Noro, Rota, Adeno

 C difficile (pseudmembranous colitis, antibiotics cause, occasionally bloody)
C perfringens (slow onset)
ETEC (travelers, labile=LT=cAMP, stable=ST=cGMP)
V cholerae (rice water)
Giardia, Cryptosporidium

Rash causing

HSV-1,2 = dew drops on roses

VZV = different stage
HHV-6/Roseola = spares face
Parvo = face down
Smallpox = same stage
Molluscum contageosum = central umbilication
Measles, Mumps = face to body, koplic spots

Bloody pee / hemorrhagic cystitis

Polyoma (BK)
Adeno

Rubella = Post-auricular lymphadenopathy

Anaerobes

Clostridium
Actinomyces
Bacteroides
Fusobacterium

Aerobes

Nocardia, Pseudomonas, M tuberculosis

HUS

Shigella
EHEC

Pseudo-appendicitis

Yersinia enterocolitica

Autoimmine Reactive Arthritis (Rriter syndrome)

“can’t see, can’t pee, can’t climb tree"

Camylobacter jejuni
Chlamidia
Yersinia enterocolitica (adult)

Food poisoning

S aureus = mayonnaise (enterotoxin)

B cereus = reheated rice — (cereulide = nausea,vomiting ; enterotoxin = diarrhea)
C botulinum = honey, home bottled (spores = floppy baby ; preformed = adult)
C perfringens = undercooked food (spores)

Food related

Listeria monocytogenes = unpasturized dairy, deli meat

Campylobacter jejuni = undercooked chicken, unpasturized milk

TORCHeS (some)
HSV-2
VZV

Congenital Varicella Syndrome

Limb hypoplasia ; Cutaneous dermatomal scarring ; Blindness

CMV

80-90% asymptomatic
Hydrops fetalis; Blueberry muffin rash; Hepatomegaly/Jaundice
Sensorineural hearing loss; Ventriculomegaly / Periventricular calcifications (brain);
Seizures

Rubella

Deafness, Blindness (cataracts), Heart (PDA), Brain (microcephaly), Jaundice

“Blueberry muffin” - dermal extramedullary hematopoiesis

Histology:
Rabies = Negri bodies
EBV = Downey/Atypical lymphocytes (atypical CD8 cells)
CMV = Owl eyes
HSV = Cowdry
HPV = Kiliocytes (atypical cells on PAP)
Pox = Inclusion bodies (Guarnieri)

Bartonella = Starry sky

Hemaglutinin antigens = Flu
Chlamidia = inclusion bodies (NAAT, Giemsa)

Accessory organs
Spontaneous peritonitis

Adults — E coli
Children — Streptoccous pneumoniae
Symptoms
Ascites
Treatment = Cefotaxime

Ascending cholangitis

E coli
Duct obstruction — bacterial infection
Life threatening
Fever
Jaundice
RUQ pain
Multiple liver abscesses = #1 cause
Treatment = Piperacillin-tazobactam + drainage

Liver abscess

Causes
E coli
Entamoeba histoytica
#1 cause liver abscess Worldwide — (NOT in US)
Bacteroides fragilis
Enterococcus faecalis
R lobe = most common

M hominis, M genitalium, U urealyticum

No cell wall (gram-resistant)

resistant to B-actams
UTI's

Heath care-associated infections (HAIs)

Epidemiology
1/25 hospitalized patients has an HAI
722,000 HAIs in US acute care hospitals (2011)
75,000 pts w/ HAIs died during hospitaliztion
Causes
Surgical site infections ~50%

Genital ulcers

HSV
Painful lesions
Treponema pallidum
Non-painful ulcer
Haemophilus ducreyi — Chancroid
Gram(-) rod — “School of fish” pattern
Erythematous papule — Pustule — Painful ulcer
“You do cry with ducreyi!"
Chlamydia trachomatis L1-2
Klebsiella granulomatis — granuloma inguinale
Africa tropics
Painless
Beefy red bump + Granulation tissue — bleeds easily

Ixodes tick

Lyme disease (Borrelia burgdorferi)

Babesia microti
Hemolytic anemia
Anaplasma phagocytophilia
Febrile, Leukopenia, Thrombocytopenia

Mycobacterium marinum

Tropical fish enthusiasts — “Fish-tank granuloma”

Ulcerating granuloma on hands

Mycobacterium scrofulaceum

Children exposed to contaminated water

Solitary cervical lymphadenopathy
Scotochromogen — produces carotenoid pigments in the dark

Moraxella catarrhalis

Gram(-) diplococcus

Bordetella pertussis

+cAMP (due to toxins)

Activates islets of Langerhans — Hypoglycemia
+Histamine sensitivity
+Lymphocytosis
Blocks immune effector cells
Edema
Postussive emesis — Vomit after a cough fit

Food poisoning

E. coli — Watery diarrhea, Minimal vomiting

S. aureus — Vomiting within a few hours, Watery diarrhea

Organisms cauasing arthritis

Granulomas / Gummas

MPh — #1 numerous type of cell

Th1 — #2

Ventilator associated pneumonia (VAP)

30-45º bed angle to prevent

AIDS diarrhea

Cryptosporidium — CD4<50
Acid fast + Larger, extracellular
MAI — CD4<50
Acid fast + Intracellular
Microsporidia, Isospora
Adenovirus, Astrovirus
Campylobacter, Listeria, Salmonella, Shigella

Viral neonatal encephalits

HSV-1, HSV-2
Temporal lobes — preferentially involved
CMV

C difficile

Exotoxin A — Attracts granulocytes

Exotoxin B — Cytopathic

Intracytoplasmic inclusions — Chlamydia

Intranuclear inclusions — Herpes

Osteomyelitis mechanisms

1. Hematogenous seeding due to bacteremia

2. Spread from a contiguous focus of infection, as occurs in an infected diabetic foot
wound
3. Direct inoculation of bone, such as with a compound fracture