Microbe Background Epidemiology Diagnostic Features Virulence Conditions Condition Info

Gram-positive cocci (6%)

Staphylococcus
STOIC

Pustular Imepetigo Macule --> Papule --> Honey Crusted Lesion

Folliculitis Superficial, raised, red, pus-filled bump

Furuncle Unresolved folliculitis. Painful raised nodule with underlying necrotic tissue.
Carbuncle Unresolved furuncle. Deep into cutaneous tissue. Also have chills and fevers (could lead to sepsis)
Ubiquitous - part of normal
skin and nasopharynx flora SSSS (Staph scaled skin syndrome) Secreted Toxin. Perioral erythema & whole body rashes. No scarring Nikolsky sign + (easy to separate stratum corneum)
Bullous Impetigo No secreted toxin. Perioral erythema. Rash primarily on fase. Scarring. Nikolsky sign -
Painful localized erythema. Large flaccid blisters. Epidermis peels off in sheets. Fever, chills, myalgia, malaise, n/v, H/A. Potentially fatal (fluid
TEN (Toxic Epidermal Necrosis) Sequelae to certain drugs. DDX from SSSS: age, history, biopsy
imbalance and organ failure)
Cause of most infections, Fever, diffuse mascular erythematous rash that can deqaquamate. Potentially fatal: hypotension, septic shock, multiple organ system failure
S. aureus TSS (Toxic Shock Syndrome) Risk factor: hyper absorbency tampons and intravaginal contraceptive devices
coagulase +, golden colonies (MOSF)
Gram +, grapelike clusters. Cytolytic and exfoliative
Faculatative anaerobe. exotoxins. Staphylococcal Food Poisoning Intoxication. Very rapid onset of illness. Severe n.v, ab pain/cramps. No fever & watery, non-bloody diarrhea. Lasts 24 hours or less From contaminated food: processed meats (e.g. ham), turkey, potato salad
Very similar to disease caused by Clostridium Difficile. DDX by lab dx: Stool culture + and Stool leukocyte
Staph. Pseudomembranous Colitis Watery diarrhea, abdominal cramps. Fever. White, ulcerated plaques on colonic mucosa.
+
Bacteremia Often disseminates to HT (endocarditis) Most common source is iatrogenic
Triad: fever, murmur, anemia. Chest pain, dyspnea, clubbing fingers. Chills, rigor, night sweats. Weight loss. Arthritis. Characteristic skin
50% mortality. Initially looks like fly but can progress rapidly if not treated ASAP. Suspect if: congenital HT
Endocarditis lesions: 1) Janeway - flat, painless lesions on palms and soles during acute episodes. 2) Osler's Notes - painful red bumps on pads of fingers
dx, IV drug use, chronic localized abcess or infection
and toes. 3) Septic embolization - localized infarction in extremeties 4) Splinter hemorrhages - linear bleeding under nails
transferred by physical 2 types: 1) Apiration - in young/elderly. People with COPD , post-influenza. 2) Hematogenous. LAB: CXR -
S. aureus pneumonia Central cyanosis, dyspnea, chest pain. Sudden fever with prolonged chills. Productive cough with mucupurulent sputum.
contact, fomites, aspiration patchy infiltrates with consolidation and abscesses. Culture + sputum with neutrophils
Bacterial related inflammation of joints. In children, adults with prosthetic or diseased joints, and intra-articular injection therapy. Painful,
Staph. Mediated Septic Arthritis Number one cause of this: Neiserrio Gonorrhea
erythematous joints with purulent aspiration of fluid.
Staph. Associated Osteomyelitis Infection of osseous tissue. Children: sudden pain in metaphyseal area. Adults: intense back pain with fever. Lab dx: blood culture +, Brodies abcess on Xray (necrosis)
S. epidermidis surgery/ skin wounds Coagulase negative staph disease Infections associated with: catheters, surgery, CVS shunts and artificial joints. Primary cause of endocarditis in artificial HT valves
S. saprophyticus UTI's Coagulase negative staph disease Cause UTI's in sexually active women. Dysuria, pyuria, culture + urine
Streptococcus
SEARS
Erythematous posterior pharynx. Culture + creamy yellow exudate. Localized lymphadenopathy. Halitosis (bad breath) Spreads via person to
Strep Throat Rapid Strep Test (+) (Direct Elisa) High Anti-ASO Ab titer
person contact. Resolution or abcess or Rhematic Fever (sequele)
Seasonal variation in Complication of Strep Throat. Fever, H/A, malaise, anorexia, pharyngitis. Diffuse erythematous rash that blances with pressure.
Scarlet Fever Lab test - DICK test.
disease: Winter: pharyngitis, Strawberry tongue. 1st appeard on upper chest and then spreads to extremities. Circumoral pallor. Spares palms and soles.
RF, PSGN. Summer: Septicemia following childbirth that occurs because of poor hygiene on the part of the delivering physician. Infxn from endometrium --> others
pyoderma, PSGN Puerperal fever "Childbed fever"
and baby.
Cause by different strain of S. pyogenes than one causing pharyngitis. Localized pain and inflammation. Systemic signs
DDX Staph TSS: Strep is most commonly after deep tissue infection vs tampon usage. No single virulence
Streptococcal Toxic Shock Syndrome (feverl/chills/n/v/diarrhea). Can progress to shock and organ failure. Sudden fever. Hypotension, Rash (diffuse, blanching). Involvement of 3 or
Might colonize oropharynx factor (vs. TSST-1) No exfoliative rash.
more organ systems.
of healthy: host develops
Group A Strep - S. Ab to M-protein. Diseases
Gram + pairs/chains
pyogenes occur before Ab or if Acute superficial skin infection after URI. Localized erythema, bullae and pain. Clear distinction between infected and non-infected skin - well
commensal bacteria Streptococcal Erysipelas "St. Anthony's Fire"
defined borders. Localized lymphadenopahy and possible systemic signs. More superfician than cellulitis.
insufficient

transferred by respiratory Deeper infection of the skin and subcutaneous tissue. Most commonly face and trunk. Erythema, warmth, tenderness. No clear distinction
Streptococcal Cellulitis
droplets or break in skin after between infected and non-infected tissue. Systemic signs and symptoms are more common than with erysipelas. Peau d'orange.
contact with vector Caused by mutant form of S. pyogenes in susceptible people. Possibly fatal. Unexplained localized redness, swelling and pain. May have flu
Necrotizing Fasciitis
symptoms. Rapid spread, descruction of tissue. TSS develops if not aggresively treated.
Complication of Srep A associated URI. Damage to HT valve predisposes patient to bacterial endocarditis. CHANCE: Chorea, migratory Jones Criteria 1) Supporting evidence for preceding Group A strep infection (+ throat swab, rising ASO
Rheumatic Fever
polyArthritis, subcutaneous Nodules, Carditis, Erythema marginatum titers) 2) at least 1 major and 2 minor manifestations (see notes)
Acute Glomerulonephritis Complication of Strep A disease. Cause of renal failure. Generalized edem, oligouria, dark urine, fatigue, ab pain Document group A strep infection. Blood: Anti DNAse B+, Urine: frank hematuria, proteinuria, RBC casts
Early Onset Neonatal Disease Endogenous infection acquired in utero or in 1st 7 days of lige. Pneumonia, meningitis, bacteremia with neurological squelae. Risk factors: heavily colonized birth canal. Maternal disseminated group B Strep infection
CAMP test: used to Late Onset Neonatal disease Exogenous disease within 1 week - 3 months after birth. Meningitis. Risk factor: contact with heavily colonized persons. Breastfeeding is important!!
Group B Strep - S. In the normal flora of the
Penicillin-resistant differentiate group B from A condition of the mother. Rise in temperature to greater than 38 on any 2 consecutive days after the 1st 24 hours post-partum. Fever, chills,
agalactiae femail genital tract Postpartum (peurpural) feverl Risk factors: Unsterile obstetric techniques!! Hand washing!
group A strep. malaise…foul smelling, yellow green/blood tinged lochia (discharge)
UTI
Group D Strep - S. Resistant to bile salts. ABC
Normal gut flora. Normal gut flora. URTI in immunocompromised. Needle stick.
Enterococcus resistant.
Physical exam: increased fremitus (vibration), dullness on percussion, Adventitious sounds (crackles) on
Very rapid onset. Single severe shaking chill with persistently high fever. Productive cough: hemoptysis, copious purulent "rust" colored
Lobar Pneumonia auscultation. CXR: dense uni-lobar consolidation with typical air bronchograms. Rapid onset of visible
sputum. May have URI before and immunocompromized have minimal symptoms. MC R middle lobe.
signs. Lab: Gram +, lancet shaped, encapsulated
Sinusitis Facial pain, tightness, H/A. Decreased valsalva (defection) and dependency (gravity). Tenderness. Low fever and mucopurulent discharge Many causes: Strep pneumonia, H. influenza, Moraxella catarrhalis.
85 antigenically distinct sub- Lancet-shaped in diplococci Otaglia (pain in ear), otorrhea, tinnitus, vertigo, nystagmus. Reduced acuity. Bulging, erythematous TM with reduced visible landmarks, gluid
S. pneumoniae Otitis Media Increased risk with dietary sensitivites, ABC,s…
types or short chains. line and displaced COL
Sudden onset of fever, nuchal rigidity (stiff neck), blinding H/A, n/v. Irritability, malaise, restlessness, delerium. Petechial rash. Seizures. S. Common causes: N. meingitides, H. influenza, S. pneumonia. CSF culture +, decreased CSF glucose,
Meningitis pneumonia is 4-20x more likesly to cause neruological complications than other bacterial meningitis. Sequele : defness, blindness, mental predominate cells are PMNs. Viral mengitis is less severe/quick and is culture -, increased CSF protein
retardation, memory loss, SIADH (syndrome of inappropriate ADH secretion) and lymphocytes in CSF
Bacteremia endocarditis, arthritis, or peritonitis
Poor flossing/brushing --> S. mutans sticks to enamel --> acidic environment --> plaque. Carie develops if demineralization is greater than
S. mutans and dental carries Risk: inadequate salivary flow (And all the usual stuff like hygiene and high sucrose)
S. viridans minteralization
Bacteremia, abcess Wound or traumatic injuries

Page 1 of 12

Ubiquitous - soil, sedaments
of lakes and ponds, and
decaying vegetation. Home-
C. botulinum
canned foods are the MC
source. Honey is the MC
source of infant botulism.
Can be normal gut flora.
Found in soil, air and water.
C. perfringens need
devitalized tissue to grow
best
C. perfringens
Disease MC after trauma that
causes ischemia: lowered
pO2 and pH favors C.
perfringens growth
Spores are widespread in the
C. tetani soil. Enter the body through
penetrating injury.
long, thin bacillus with "tennis inhibits the release of
raquet" morphology
difficult to grow: sensitivy to
O2 - obligate anaerobe.
Relatively inactive
metabolically (unlike C.
perfringens)
Can be a normal part of GI
Gram (+) rods
flora without causing disease
C. difficile
MC after broat spectrum
obligate anaerobes, spore- Difficult to culture, very
ABCs and Proton pump
forming
inhibitors (PPI's)
Primary reservoirs: domestic
herbivores (sheep, goats,
cattle, horses)
Three routes of
transmission: Inoculation
of skin, inhalation of
spores, ingestion of
B. anthracis "Wool sorters disease" contaminated food.
Developing countries:
endemic, can't affort to
vaccinate livestock
Developed countries:
occupational disease and
biological warfare
Ubiqutous distribution
B. cereus Farmers get this
Low mortality compared to B.
anthracis
Ubiquitous worldwide
distribution on plants and
All species are opportunistic animals
C. diphtheriae
pathogens Disease is transmitted most
commonly by areosolized
nasopharyngeal secretion
Other Cornebacterium - Normal commensals of the
Diptheroids skin and URT
Gram (+) bacillus,
"sausage shaped"
Gram (+) "plump,
rectangular" rod
Gram strain variable: (-) in
old cultures of fresh wounds,
(+) in fresh culture
2 toxins: Toxin A is like
cholera enterotoxin and
causes diarrhea and
mucosal damge. Type B:
diphtheria-like cytotoxin.
slow growing.
Gram (+) bacillus. Single or
paired "joined bamboo rod"
culture - "medusa head -
long, serpentine chains"
Gram (+) bacillus
Gram + club shaped bacillus
Black colonies with tellurite Non-pathogenic or
medium. Dark grey colonies. opportunistic infxns.
Inhibits acetylcholine
release at presynaptic
terminals and therefore,
flaccid paralysis
(opposite
tetanospasmin)
Infant botulism "infection-intoxication"
Botulinum toxin: one of the
most potent neurotoxins.
Two parts: B - protects
from ST acid. A part -
neurotoxin specific to
irreversible binding to
cholinergic neurotoxins
Replicated in 10 min!
Alpha toxin lecithinase
C. perfringens myonecrosis "Gas gangrene"
Tetanospasmin: heat
labile neurotoxin (one of
the most potent toxins).
Causes spasdic paralysis.
2 part toxin: B chain binds
R in neuronal membrane.
A chain moves to post-
synaptic terminals in
CNS and irriversibly
GABA and glycine
Capsule - anti-capsular
Abs are NOT protective
Toxin: 3 parts that work
together: Protective Ag
(binding, anti-phagocytic),
lethal factor, edema factor
(stim adenylyl cyclase)
Heat stable enterotoxin -
causes emesis. Found in
contaminated, improperly
refrigerated rice dishes
Heat labile enterotoxin -
similar to enterotoxin of
ETEC and Vibro cholera
Profuse watery diarrhea.
Contaminated meat and
veggies.
Cornyebacterium diphtheriae respiratory diseases
Exotoxin: Classic A-B
type
Cornyebacterium diphtheriae cutaneous diseases papule that can progress to chronic persistent ulcer with greyish membrane. Can progress to systemic signs and symptoms if not treated
May contribute to acne
Gram-positive endospore-forming rods (4%)
Food borne botulism "Intoxication"
Wound botulism
Unclassified botulism
Simple wound infection
Anaerobic cellulitis
C. perfringens food poisoning
Tetanus "lockjaw"
Pseydomembranous colitis
ABC-associated diarrhea
Cutaneous anthrax
Inhalation anthrax (pulmonary)
Ingestion anthrax
Emetic disease
Diarrheal disease
Bacillus cereus panopthalmitis
Gram positive non-spore forming rods (2%)
Clostridium
Inadequate sterilization of food: home canned foods, preserved fish. 2h-72 hour incubation. No GI distress - unlike other food poisonings,
Dilated, fixed pupils; dry/ "furry" tongue. Bilateral descending weakness - of neck, face, throat. Respiratory paralysis (mortality 32-40%.) No
permanent immunity - can get repeated occurances. MC complete recovery in months to years.
Consumption of honey contaminated with spores. MC form of Botulism in the USA. MC in 1-6 months because infant GIT doesn't have as
many competitive bowel microbes. Can resemble SIDS iff rapid onset. Non-specific signs: constipation, weak cry, failure to to thrive, weak
sucking. Floppy baby: acude flaccid paralysis (head, fact, throat), descent to extremities/trunk. Death reom respiratory paralysis (low 1-2%
mortality)
Very rare, little evidence of clinical infection. Limited paralysis. Same sx's of food borne botulism but long incubation (1-4 days) and no
abdominal pain or constipation
People over 1 year who have had symptoms of botulism but no documented vehicle of transmission. DDX is important.
People over 1 year who have had symptoms of botulism but no documented vehicle of transmission. DDX is important.
Trauma and favourable conditions. Organism spread through subQ tissue - spares fascia and deep muscles. Pain, redness, inflammation,
superficial skin discoloration and skin necrosis. Gas forms develop suppurative myostitis - foul smelling discharge. No muscle necrosis, no
systemic signs and symptoms.
Rapid worsening of cellulitis. Trauma and 1 week incubation. Rapid onset of intense pain, extensive muscle necrosis (blue black, edematous,
Fast growth of culture on sheep's blood agar. Nagler's reaction on egg yolk agar. Gram (+) rods in tissue
does not bleed or contract on stimulation), toxic delerium. Progress to shock, renal failur, death within 48hrs if untreated. Much damage due to
specimens with no leukocytes.
alpha toxin and gas bubbles. MC in areas of poor blood supply. Need to perform debridement and examine inderlying tissue.
Ingest meat (refrigerating and re-heating destroys enterotoxins) Large infective dose. Short incubation: 8-24 hrs. Abdominal cramps. Self
limiting > 24 hrs. Watery diarrhea, no fever or vomiting.
MC form of tetanus. Bacterium introduced by trauma to skin: rusty nail, animal bites. 3 Early signs: 3 day-2 week incubation. Muscle stiffness/
ridigity, exaggerated DTRs (deep tendon reflexes). Trismus (lockjaw), risus sardonius (rye smile), drooling, dysphagia, diaphoresis, irritabiliey. Patient history. Clinical S's and Sx's. Gram stain culture not that important diagnostically - only 30% of
Later signs: opisthotonus (backward arching), flexion of arms, extension of lower extremitis. Complications: HTN/hypotension, tachycardia, people with tetanus are culture (+). Treatment: tetanospasmin binds irreversible and therefore, can only
pneumonia, dehydration, bone fractures, meningitis, Rh incompatibility. Other forms: 1) localized (to point of infection, less common than treat symptoms until nerve terminals regenerate. Either penicillin high doses or tetracycline, or passive
generalized), 2) Cephalic (rare but poor prognosis, from improperly cleaned umbilical stump), 3) Neonatal - first sign, difficulty sucking 8-10 immunization - bind free tetanospasmin and decrease progression of disease.
days after birth.
Pseudomem colitis confirmed by biopsy - multiple, raised white/yellow exudative plaques adhering to
Range from mild diarrhea to colitis to potentially life-threatining pseudomembranous colitis. Prolonged diarrhea --> dehydration. colonic mucosa. In vitro cytotoxicity assay in culture cells. Immunoassay for C. difficile toxins A and B.
Sigmoidoscopy. Fecal leukocytes.
Bacillus species
Painless papule. Ulcer surrounded by vesicles - necrotic eschar - gelatinous edema. MC arms, hands, face, neck. Potentially fatal - 20% Direct contact with spore contaminated animals/producers. Look at px history: wool worker? Gm (+)
mortality (could spread to blood/lymph) . Internal hemorrhage, myalgia, fever, H/A, n/v. bacillus in lesions, no neutrophils.
Carried by alveolar macrophages to mediastinal LN - prolonged latency. Initial disease: fever/chills, dyspnea, cough, H/A, vomiting, chest/ab
pain. Second stage: rapidly worsening fever, pulmonary edema, massive enlargement of mediastinal LNs, shick/death within 3 days. No person to person disease transmission. 87% mortality.
Hemorrhagic meningitis Sx's MC than pulmonary Sx's.
IFF upper GI: ulcers, edema, sepsis, regional lymphadenopathy - dysphagia. IFF lower GI: n/v, malaise, systemic s's and sx's, bloody diarrhea Extremely rare. 100% mortality.
Contaminated rice, not refrigerated. 15 min-4hr incubation. Self limiting >24 hrs. Nausea, no fever or vomiting.
Contaminated meat, veggies, sauces. 8-12 hr incubation in GIT. Self limiting <24 hrs. Nausea and bloody diarrhea. No fever.
Post-traumatic, penetrating eye injury or hematogenous spread. Pain, H/A, drowziness, swelling. Muddy grey iris, turbid aqueos humor,
precipitate on posterior surface of cornea. Rapid <48 progressive loss of light perception. Fever.
Cornebacterium
Form grey pseudomembrane that bleeds if forcibly removed. Malaise, sore throat, low grade fever, chills, pharyngitis. Can cause sequelae
Schick test - like the razor.
of myocarditis, CHF, focal neurological signs
Clinical signs and symptoms are most important. Culture +, PCR for tox gene, Elek test for toxin produced.
Treat with diphtheriae anti-toxin or ABC's. Screening test: Schick (like TB test)
Page 2 of 12

Zoonotic: disease of animals
that is transmissible to
small, Gram + cocobacilli
humans. Animal vectors:
birds, ticks, spiders…
rarely affects humans but high
L. monocytogenes
mortality
Ubiquitous: direct person to
person, ingest contaminated
meat and dairy
Vertically transmitted (esp. motility.
transplacentally) is the most
fatal type of transmission
Humans are sole natural
carriers
2nd most common STD in the
N. gonorrhoeae
US (chlamydia is #1)
Need intimate sexual contact.
MC in 15-24 year olds.
Can be normal flora of URT
MC cause of baterial
meningitis in infants
N. meningitidis
through adolescence and in
young adults transferred via close contact
with respiratory droplets (e.g.
daycares, military barracks).
Classmates in school not
close enough.
Part of the normal flora of the
GIT: opportunistic pathogen
Increased risk of disease
with: hospitalization, poor
E. coli
personal hygiene, travel to
countries with poorly
developed sanitary practices,
sub-optimal immune
defences
K. pneumoniae Opportunistic pathogen
Normal flora of the LI in
E. aerogenes
humans and animals
"chinese character clumping"
- V or L shapes. Tumbling
Gram (-) diplococci, "coffee
bean" appearance
Facultative anaerobe
Gram (-) diplococci, "coffee
bean" appearance
Can ferment glucose and
maltose (onlke N.
gonorrhoeae which only
ferments glucose).
Catalase and oxidase +
Gram (-) bacillus with outer
envelope
Mucoid colonies
Fast-growing, shiny colonies
Facultative anaerobes
Pili - enhance ability to
attach to mucosal surfaces
and inhibit phagocytosis
IgA Protease - neutralizes
secretory IgA
LOS endotoxin
LPS
Capsule - resists
phagocytosis
IgA Protease - neutralizes
secretory IgA
1) Adhesins: colonize GTU
or GIT despite voiding or
peistalsis
2) Exotoxins
3) H and K antigens -
relative importance/
presence of these factors
depends on genetics of the
strain + site of infection + Enteroinvasive (EIEC) - "taveler's diarrhea"
condition of host
Large capsule - prevents Lobar Pneumonia
phagocytosis
UTI's
UTI's, nosocomial
Listeriosis
Gonorrhoeae in males
Gonorrhoeae in females
Disseminated gonorrhoeae
Opthalmia neonatorum
Meningiococcemia - mild disease
Meningiococcemia - marked disease
Meningococcal meningitis
Neonatal Meningitis
Septicemia
UTI's
Gastroenteritis - Enterotoxigenic (ETEC/ VTEC)
Enteropathogenic (EPEC)
Enteroaggregative (EAggEC)
Enterohemorrhagic (EHEC)
Diffuseaffregative (DAEC)
Listeria
Dark red rash over trunk and legs. Endocarditis, fever malaise, septic shock, circulatory collapse and hepatosplenomegaly. Occur in 4
populations: 1) Pregnant female: causes abortion and most common in 3rd trimester with mild brief disease of chills, fever, malaise. 2) Fetus:
CSF culture -, motility test +, cold enrichment
aborted or early onset disease (granulomatosis infantiseptica) - multi organ disseminated abscesses of granulomas and high mortailty; 3)
Neonate: signs of meningitis; 4) Adults: low grade fever with personality changes. Also may get meningitis/gastroenteritis
Gram-negative diplococci (4%)
Neisseria
95% of men get acute symptoms. MC'ly gonococcal urethritis. Infection usually restricted to mucous of penis. 2-7 day incubation - purulent Clinical signs similar to Chlamydia. Gram stain: sensitive and specific iff men with purulent urethritis.
urethral discharge, red/ edematous urethral meatus, itching, burning, dysuria, urgency. Can progress to peri-urethral abcesses, prostatitis, Oxidase (+), Gram (-) diplococci on chocolate blood agar - (Thayer-Martin agar) Genetic probes: PCR,
epididymitis. Urethritis. Yellow-green discharge. ELISA.
>50% of women are asymptomatic or mild symtoms. Infection site MC'ly cervix (cervicitis). 2-7 day incubation. Vaginal discharge or abnormal
vaginal bleeding, dysuria, urgency, swollen painful abdomen (RUQ). If untreated an ascending infection can develop. Major cause of infertility
iff chronic. Secondary: Fitz Hughe Curtis syndrome: periphepatitis (affects liver - symptomatic gonorrhea). Can lead to PID.
Rare but MC in women (1-3%). Systemic symptoms or complex syndrome with fever, migratory arthralgias, tender papillary lesions/ rash on
extremities. Arthritis: MC'ly mono-articular - knee in females. N. gonorrhoeae is the #1 cause of purulent arthritis in young adults
MC'ly caused by N. gonorrhoeae or C. trachomatis. 2-5 days after vaginal birth. Purulent conjunctivitis in newborns infected during vaginal
delivery. Sticky discharge, edema/ inflammation. Can lead to scarring and blindness. Reason why newborns get eye drops of 1% sulver nitrate.
Persistent (few days to weeks). Arthritis. Petechial skin rashes. Pharyngitis. Low grade fever.
URI infection then 1-3 day incubation. Small, petechial rash on trunk and lower extremities that can coalesce to form larger bullae (due to
thrombosis of small blood vessels). Iff untreated can progress to DIC or hammorhage into adrenal glands (Waterhous-Friderichsen syndrome).
Sequelae: none or large areas of necrosis. Deafness. Mortality 100% if untreated, 25% if treated. Occurs with or without meningitis. Rapid
onset fever.
N. mengintidis is 2nd MC cause of adult bacterial meningitis. Triad: fever, nuchal rigidity, blinding HA. Neurological sequelae (hearing
Clinical signs and symptoms and CSF analysis. High number of Gram (-) diplococci in PMNs.
deficits, arthritis, memory loss) low compared to H. influenzae or S. pneumonia
Gram negative rods (14%)
Escherichia
Most commonly caused by E. coli and group B strep. Most isolated strains from babies have K1 capsular
Colonization of infants with E. coli is common but rarely leads to disease
Ags (maternal anti-K1 Abs are protective).
Usually results from spread from GIT or GTU. Increased mortality if immunocompromised or due to complication of intestinal perforation. E. coli is most common cause of enterobacterial septicemia (45%), then K. pnemonia
Cystitis: dysuria, urgency, increased frequency, incomplete voiding. Pyelonephritis: same as cystitis but more severe and with fever, loin pain Very common infection. (decrease attachment with D-mannose, blueberry & cranberry juice). Lab dx:
and (+) KI punch. pyuria, hematuria, bacteriuria.
Gastroenteritis (6 types) - most common E coli infection in normally healthy persons. Exotoxins: St a/ST b:
Most important cause of traveler's diarrhea and infant diarrhea (in developing countries). Symptoms take 3-4 days to resolve. Symptoms similar
heat stable, stimulate guanylyl cyclase. LT1/ LT 11: heat labile, stimulate adenylyl cyclase. Induce fluid
to cholera but much milder. Cramps, nausea, vomiting (Rare), low grade fever, watery diarrhea.
and electrolyte loss: watery diarrhea
Variable onset (1-4 days). Intense abdominal cramps. Can progress to colonic ulceration and more severe sequelae. Similar disease to
Bacteria invade and destroy tissue.
Shigella. Fever. Initial watery diarrhea progressing to scant, bloody stool that is leukocyte +.
Bacteria adhere to plasma membrane of mucosal epithelial cells and destroy adjacent microvilli. Common
Nausea. Fever. Non-bloody stool. Bottle fed infants
cause of infant diarrhea.
Cause persistant diarrhea in developing countries. Subset of EPEC that can form aggregates on surfaces
Nausea. Low grade fever. Persistant, watery diarrhea (dehydration on risk).
that they colonize.
3-4 day incubation. Severe abdominal pain. Most commonly self-limiting in 4-10 days but can progress to HUS (hemolytic uremic syndrome).
Most common strain causing disease in developed nations. Cause of "Hamburger disease" and HUS
Spread via: undercooked beef or other meat, feces contaminated water, unpasteurized milk, fruit juices, raw veggies/fruit. Nausea. No fever or
(Walkerton). Virulence factor: hemolysin. Very low inoculation is needed (100 bacilli)
just low grade. Initial non-bloody diarrhea progressing to bloody diarrhea. - E coli O157:H7
Watery diarrhea (infants 1-5) Bacteria are embedded in cell membrane of elongated microvilli.
Klebsiella
Thick jelly-like sputum that may have blood.
Enterobacter
Page 3 of 12
 Citrobacter
Similar to salmonella, whithout
C. freundii Occurs in normal flora UTI's
causing salmonellosis

S. Typhi
Humans most commonly get
Salmonellosis from:
undercooked poultry,
S. enteritidis
contaminated cutting boards,
egg salad, undercooked/ raw
eggs
Humans are the only known
animal host. GB infxn =
carrier state.
Disease in NA primarily
associated with foreign travel.
Spread by food or water
contaminated by infected
food handlers
Animals are the primary
reservoirs for S. enteritides:
livestock, fish, poultry/ birds, Gram (-) bacillus
rodents, humans, reptiles
(turtles)
Humans are the only carriers
Gram (-) bacillus
Facultative anaerobe
Requires a high infective
dose - killed by gastric
acid. Antacids inc risk of
infxn.
Very low inoculum (only
10-100 baccili)
Salmonella induced septicemia
Enteric fever
S. enteritidis gastroenteritis
Salmonella
Most commonly due to S. typhi and S. paratyphi but also seen with S. enteritidis. Increased risk with AIDS,
Symptomology similar to other Gram (-) septicemia: 10% of patients develop arthritis, osteomyelitis, and endocarditis
geriatrics and pediatrics.
MC spread is by food handlers infected with S. typhi (typhoid fever) or S. paratyphi (paratyphoid fever).
Non-specific systemic symptoms (H/A, malaise, myalgias, and anorexia). Rose coloured spots on abdomen (erythematous, maculopapular,
Bacteria pass directly through intestinal walls. Enter thoracic duct and then blood stream to replicated in
blances with pressure, only 50% of patients). Complications: GI lesions, Toxemia, meningitis, osteomyelitis, endocarditis. 1-3% become chronic
Sp, LV, bone marrow and GB. Back into the intestine to cause increased inflammation. This is NOT
carries. Increasing, remittant fever.
typhus.
Occurs 6-48 hours after ingestion of contaminated food or water. Abdominal cramps, h/a, myalgia. Most commonly self limiting (2 days to 1
Most common type of Salmonellosis
week). Low mortality but increased risk with elderly and children. Nausea, fever and non-bloody diarrhea.
Shigella

Attach and invade M cells GI symptoms are caused by Shiga toxin. Enterotoxic, neurotoxic and cytotoxic. 1-3 day incumation. Fever and diarrhea proceeds to tenesmus,
S. dysenteriae Gram (-) rod Shigellosis - bacillary dysentery Bacteremia rare. Infection self-limited. 5% can asymptomatically carry.
in PP abdundant blood and pus in stool. Profuse watery diarrhea.
Transmission due to fecal-
oral route Shiga toxin (only S.
dysenteria) disrupts protein
synthesis
S. sonnei Bloody diarrhea Usually produces a mild watery diarrhea in children. In more virulent strains it can progress to abdominal cramping and bloody mucoid stools.

Proteus
Can be normal flora of the
Highly motile colonies,
P. mirabilis colon. Opportunistic - enter
outgrow other organisms
via catheterization UTI Once there is an infection, urease can lead to stone formation.
Urease + (Urea --> ammonia
P. vulgaris Main microbe.
and CO2)
Yersinia

Invades through lymphatics
causing them to swell
Y. pestis (buboes). Can also cause
hemorrhaging --> DIC or
septic shock.
Ubiquitous
Zoonotic: most common
vectors are rodents: rats,
ground squirrels, rabbits,
mice, prairie dogs, cats, ect.
Get bitten by infected flea, 2-6 days later get high fever, chills. Not large but painful buboes in groin, axilla, neck. Prostration with rapid, Black plague 2 types: Urban: affects humans and can cause 3 types of plague. Rats are the main
Gram (-) rod or coccobacillus Bubonic plague thready pulse, delerium. Bubonic purperea: vasculitis of superficial blood vessels cause bleeding into skin - black death. Can spread to blood reservoir, rat flea (Xeopsylla cheopsis) is main vector. 2) Sylvatic (Woodland): disease of wild rodents
then to lungs. Fatal within days (75% mortality) found everywhere but Australia
Org clots in flea's stomach
by enzyme coagulase then
is regurgitated into the
Bipolar staining: "safety pin" human at next meal. Hematogenous spread from infected buboes or aerosols from infected person. Only 2-3 day incubation. Fever, malaise, hemoptysis, dyspnea.
Pneumonic plauge
appearance Highly virulent, rapidly fatal form of bronchopneumonia (90% mortality)

Can be transmitted by:

Facultative anaerobe Septicemic plague Direct deposit of bacteria into open wound or orifice. Most common in children. Rapidly fatal meningitis before buboes form.
fleas or inhalation

Assoc with polyarthritis with
Y. enterocolitica
diarrhea
Blue-green pus: 2 pigments:
pyocyanin (blue) and
pyoverdin (green)
P. aeruginosa
Goes to the lungs in CF
patients --> pneumonia
Discovered in 1976
L. pneumophila
legionnaire's conference
H. pylori
Gram - rod that is oval in Need a large infective dose, ingest contaminated food product. 4-6 day incubation. Right sided abdominal pain. Lasts for 1-2 weeks. Can
Enterotoxin similar to E.
shape and larger than Y. Yersinia entrolytica gastroenteritis/ Yersinosis progress to perforation of ilum and skin rash (erythema nodosum). Can get mesenteric adenitis in children (mimics acute signs of appendicitis).
coli ST toxin.
pestis. Fever. Watery or bloody diarrhea. - mimics appendicitis
Pseudomonas
Most common cause of bacterial keratitis and neonatal opthalmia. Increased risk iff immunocompromised,
Unilateral, acutely painful, photophobic, intensely injected eye. Decreased visual acuity. Profuse tearing, thick ropey mucopurulent discharge. contaminated eye drops (contacts), hypoxic damage from prolonged contact wearing, corneal trauma, eye
Gram (-) baccilus Bacterial Keratitis
Edematous cornea and eyelid operations. Can lead to blindness. Most common bacteria is S. aureus unless contact wearer, then P.
aeruginosa.
Sweet, grape-like fruity
Ubiquitous - soil, water, UTI's 3rd leading cause of nosocomial UTIs. Prolonged indwelling catheters.
odor
plants, hospital sinks and
respiratory equipment, GIT infections Any part of the tract. Eg. Perirectal, pediatric diarrhea, gasteroenteritis, necrotizing enteritis
swimming pools, raw
vegetables. Can be a part of Minimal nutritional
normal flora. Initial pruritis and fullness in ear. Increased pain/tenderness on palpation. Otorrhea (?), Possible hearing loss (mild erythema and edema of Can get chronic supporitive OM, malignant otitis externa or Swimmer's ear (acute diffuse otitis externa).
requirements - can grow in Swimmer's Ear
external auditory canal. Dull injected TM with displaced COL). No systemic signs. Weber test: laterlize to affected side. Rinne test: AC>BC.
distilled water. Strickly
aerobic. Bactermia Primarily nosocomial. Increased risk if immunocompromised. Similar clinical presentation as other bacteremias but with higher mortality.
Hot tub folliculitis After breakdown in skin integrity (burns, trauma, cuts, dermatitis). High moisture conditions or immunocompromised.
Pathognomic Pseudomonas skin infection. Erythematous vessels become hemorrhagic, necrotic and ulcerated with a fruity odor. Can have
Ecthyma gangernosum
rapid necrosis to adjacent tissue (potentially fatal)
Legionella
Contaminated central water Thin, flagellated, non-
systems, especially AC sporulating gram - Incubation is 2-10 days. Spread through contaminated central water systems (especially AC). NOT person to person spread. Flu-like symptoms
Legionellosis, legionella pneumonia Culture, serological tests for rising serum IgM
Not person to person - just with rising fever, cough, pneumonia, diarrhea, and delerium.
Aerobic
inhalation
Gram-negative curved rods (4%)
Helicobacter
Found in stomach of humans,
Epigastric pain, abdominal tenderness, bloating, nausea, anorxia, dyspepsia. Epigastric tenderness on percussion, foul smelling breath, 30-50% of people with gastritis have H. pylori but most commonly asymptomatic. Lab Dx: 13C urea breath
primates, pigs, cheetas, Microaerophillis, urease + Type B (infective) gastritis
hematemesis (coffee grounds) (Type A gastritis is autoimmune AKA pernicious anemia) test, anti-H. pylori Abs (IgG), gastroscopy with biopsy, CLO test (+(
dogs, cats, ferrets, mice, rats
Only found in gastric antrum Closely resembles Expecially dodenal ulcers. Burning, gnawing upper GI pain 1-3 hours after meals. < night, > eating or > antacids. Anemia, epigastric
Peptic ulcer disease (PUD) Endoscopy, urea breath test, serology (anti-H. pylori Abs)
and body campylobacter tenderness.
Gram (-) bacillus: gram stain
is variable. Sprial shape in Sequelae of untreated chronic gastritis. Classifies as a class I carcinogen. Fatigue, weight loss, low grade fever, night pain.
Developing countries high Gastric adneocarcinoma
fresh culture, coccoid in older Epigastric/abdominal mass. Hemoccult (+) stools, anemia.
colonization, developed culture
countries low colonization
Flagellated, highly motile Gastric mucosa-associated lymphoid type (MALT) Chronic H. pylori infection assoc with B-cell lymphoma. No evidence that eradicating H. pylori prevents the
Dysphagia, dyspepsia, weight loss, GI bleeding - hematemesis.
"corkskrew motion" B cell lymphomas progression of gastritis to carcinomas

Page 4 of 12

Transmission is recal-oral
Not recognized as a pathogen
C. jejuni route of animal-contaminated
until 1973
food or water
Fecal-oral via contaminated
Can have human carriers.
food or water
V. cholerae
Epidemics in SE Asia, Europe Large animal reservoir in
and Africa marine shellfish
Lives in salt water in costal
V. parahemolyticus
areas globally
Can be normal flora of the
H. influenzae
URT
H. ducreyi Common in tropical countries Non-encapsulated.
Indicater of dysbiosis in
H. vaginalis (Gardnerella) vaginal flora. Appearance of
clue cells.
Can only cause disease in
humans - reportable
disease
B. pertussis and Spread by infectious
parapertussis
droplets.
No long term imminity - can
Encapsulated
get disease more than once
"protection" in developed
countries due to DPT vaccine
Causes more deaths
worldwide than any other
bacteria. Infects 1/3 of the
population.
M. tubercylosis
Humans are natural
reservoir. Spread via
aerosolized droplets.
Armadillos are naturally
Similar to M. tuberculosis but:
infected and provide reservoir
Campylobacter
Some strains can produce
2-11 day incubation. Foul smelling, watery diarrhea progressing to profuse bloody diarrhea. Resolution in 3 days - 3 weeks. Residual
Microaerophilic an enterotoxin similar to Gastroenteritis
histological damage to mucosa of jejuni, ileum and colon.
cholera.
Low infectious dose.
Idiopathic, peripheral polyneuritis 1-3 weeks after mild above conidition. Progressive, symmetric pain and weakness in extremities - might Many causes. Also immunizations, pregnancy, URI, EBV, CMV, Hodgkin's lymphoma. Autoimmune link:
Comma or S-shaped Resistant to penicillins and Guillian Barre syndrome
ascend to trunk, face, thorax. Self limiting (few weeks to months) with complete recovery. cross reactivity with glycosphingolipids on surface of neural tissue
cephalosporins.
Vibrio
O1 antigen causes
epidemics, non-O1 antigen
Comma shaped
are non pathogenic or
cause mild diarrhea
2-3 day incubation. Abrupt onset of watery diarrhea and vomiting. Rice water stools. Severe fluid and electrolyte loss.Hypovolemic shock leads Cam resemble ETEC induced gastroenteritis. Lab Dx: rarely seen in Fram stained stool or wound
O1 --> entrotoxin Cholera
oxidase positve to cardiac arrhythmia, renal failure, muscle cramps. 60% mortality iff untreated, self limiting within a week. No abdominal cramps or fever. specimens. Dark field/ phase contrast microscopy: characteristing darting motility.
production
Need large infective dose.
Facultative anaerobic Simulates G protein -->
cAMP --> water in intestine
Manifests after 24-48 hr incubation. Occurs after eating contaminated seafood. Sx include painful abdominal cramps and watery diarrhea as
Food poisoning
well as, sometimes, flu-like syndrome. Self limiting. ABC not helpful.
Gram-negative coccobacilli (4%)
Haemophilus
Coccobacillus with a Pili - damage respiratory Same signs and symptoms as other bacterial meningitis - but more insidious onset and increased risk of neurological sequelae. Used to be
Menigitis Gram stain of CSF. Chocolate agar culture. Agglutination reaction to PRP capsule in CSF and urine.
polysaccharide capsule ciliated epithelium MC pediatric meningitis, before Hib vaccine
Epiglottitis Medical emergency, MC'ly in boys 2-4 yo. Dysphagia, drooling, muffled voice, minimal cough. Severe dyspnea. HIGH fever. "Thumb sign" on lateral X-ray of neck
Cellulitis Reddish/ blue patch on cheek or peri-orbital. Fever. Gram stain of blood
Requires factor X (heme) and LPS - responsible for
Arthritis Monoarticular. Large joint. Gram stain of blood
factor V (NAD) found on mengitis. Protease digests
chocolate agar for growth secretory IgA. Otitis media / Sinusitis Three MC causes: H. influenzae, S. pneumonia, Moraxella catarrhalis. Unexplained fever in children. Gram stain of blood
Pneumonia Might be secondary to influenzae virus damage to respiratory epithelium. Secondary bacterial infection is more life-threatening than primary. Gram stain of blood
STD, most common to developing world. Unlike primary syphilis which causes hard chancre. Soft, purulent, painful ulcer (genitalia). MC
Chancroid males, uncircumcised, tropical & sub-tropical (female MC asymptomatic). 5-7 day incubation. Progress to painful buboes, phimosis, urethral
stricture.
Gram-variable rod. Bacterial vaginosis Positive whiff test (pungent, fishy odor with the application of 10% KOH). Trichomoniasis can also cause a positive whiff test.
Bordetella
Pertussis toxin - increase
Adenylate cyclase. cAMP
respiratory secretions/
Strictly aerobic mucous. Binds ciliated
epithelium and kills NK
cells, monocytes,
macrophages, neutrophils
Tracheal cytotoxin - part
of the PG layer. Cause Incubation: 7-10 days, sub-clinical. Catarral phase: 2 weeks, looks like common cold: rhinorrhea, sneezing, low grade fever, anorexia, malaise Bacteria are best isolated using nasopharyngeal aspirates during catarrhal stage. Culture: difficult
ciliostasis and then
Coccobacillary Whooping cough (most infectious stage). Paroxymal stage: 1-2 weeks, dry non-productive repetitive "whooping" cough. Cough ends in vomiting and exhaustion. humitidy, 35 C, 7 days, specialized agar (Bordet-Gengou medium) (only 50% of infected people are
damage to ciliated Convalescent stage: 2-4 weeks. Cough resolves, secondary complications: aspiration pneumonia, seizures, encephalopathy. culture (+). Throat swabs not as good - need synthetic fiber swabs. PCR. Lymphocytosis (not specific)
epithelial cells - cough -
IL-1 = fever
Filamentous
haemagglutin and other
adhesins: attachment to
ciliated epithelial cells and
PMNs. Intracellular survival
protects against clearance
by humoral immunity
Acid-fast rods (4%)
Mycobacterium
No toxin produced, it is
phaocytosed and secretes
Obligate, aerobic, acid-fast an exported protein that
rod prevents fusion of the "TB is the master impersonator." Primary infection (only 5% get active TB within 2 years): insidious onset: malaise/ listlessness, night sweats, CXR: cavitations in one or more upper lobes of lung. Sputum sample: acid fast bacillus. Fastidious
lysosome with the low grade fever, unexplained weight loss and progressive fatigue. Productive purulent cough progressing to hemoptysis, dyspnea. Apical rales, growth requirements, PCR.. Skin test (Mantoux test/PPD) - intradermal injection, wait 48 hours and
TB
phagosome cyanosis. Secondary TB (reactivation): haematogenous spread anywhere: miliaty TB (no pulmonary signs). Destroys tissues - liver, measure induration/ erythema (type IV hypersensitivity). Doesn't tell whether TB is active or not. False
adrenals... positives due to BCG vaccine.
Produces caseous
One of the slowest growers granulomas. Ghon
complex on x-ray.
3-6 year incubation. Strong cellular response, weat humoral. Not infectious. <5 cutaneous macular lesions with hypopigmented centers. Some
Tuberculoid (paudibacillary) Will react to skin test - lepromin
nerve enlargement and damage.

Can not be articicially Found intracellularly in

M. leprae
Spread via respiratory route
or contact with break in skin
MC'ly disease in HIV/ AIDS
M. avium-intracellulare
patients but can cause Ubiquitous in water and soil
complex
disease in birds and pigs
Intimate contact. Vertical and Thin-walled, flexible, motile,
horizontal transmission.
Contagious only during
T. pallidum primary stage and rash of
secondary stage - not highly
contagious (only 30% chance
after single sexual contact)
cultured (need live mice or
armadillos)
Grow in globi bundles
(encapsulated globs of rods
in tissues)
Similar to M. tuberculosis but
only case opportunistic
infections
Also can cause
lymphadenitis in children
spiral rods
histiocytes, endothelial
cells, Schwann cells 3-10 year infection. Weak cellular response, strong humoral. Relatively highly infectious. Most destructive - disfiguring skin/bone, cartilage
Lepromatous (Multibacillary) Not reactive to skin test
lesions ("leonine face") Diffuse nerve involvement. Erythema nodosum present and >5 kin lesions
Opportunistic infection. Begins as mild pulmonary disease: spreads to local lymph nodes and then quickly to every organ. AIDS px: fever,
MAC diseases sweats, weight loss, fatigue, diarrhea, SOB. Pulmonary disease is similar to TB: usually GIT involvement, usually fatal within months. No Sputum cultures: acid fast bacilli. CBC with diff: AIDS diagnosis, anemia, neutropenia.
person to person spread via aerosolized droplets.
Spirochetes (4%)
Treponema
Antibodies react with
cardiolipin Primary: small papule - painless, hard chancre. Painless, regional lymphadenopathy (buboes). Very infectious. Heals spontaneously within 2
months without scarring. Secondary: flu-like syndrome. Painless, localized lumphadenopathy. Diffuse, non-pruritic maculpapular rash, Microscopy: no Gram stain, use silver stain and fluorescent stains. Non-specific tests: VDRL (veneral
includes soles, palms. Very infecious (kissing). Tertiary (Lues/Leutic): after 3-40 years of latent syphilis. Gummas (flat rubbery tumors disease research lab) and RPR (rapid plasma reagin) (+4-6 weeks after infection - indicates current active
Syphilis
Hyaluronidase - spreads anywhere in body - ulcerate and heal by scarring). Affect many organ systems: neurosyphilis, cardiosyphilis. Painless or deep burrowing pain. disease but false positive). Specific tests: FTA-Abs (fluroscent treponema Ab) and MHA-TP (micro
Congenital: infected mother infects fetus. 1) Intra-uterine death; 2) Congenital abnormalities 3) Born appearing well then several weeks or up haemoglotunin for Treponema) - indicate past infection
through tissue
to 2 years later: snuffles, widespread desquamating maculopapular rash. (Risk if mother is in primary or secondary syphilis)

Page 5 of 12

vector: deer tick (Ioxdes
B. burgdorferi scapularis/ Ioxdes
pacificus)
Zoonotic - rodent (rat) and
domestic animal (dog)
reservoirs
Humans are accidental hosts:
L. interrogans
MC'ly acquire disease via
contact with infected urine alkaline environment for
Swimming or drinking
contaminated water
Human pathogen only.
M. pneumonia Smallest free-living organism
Respiratory droplets
U. urealyticum
Need arthropod vectors -
MC in children and in summer
R. rickettsii hard ticks (dog tick or wood
months
tick) - Dermacentor
Intimate contact. Vertical and
horizontal transmission.
Spread by droplets, hands,
contaminated clothing, eye
make-up, flies
C. trachmatis MC STD in the US
Can get from toilet seat - EB
is resistant to the
environment!
Infects only humans. Spread
C. pneumoniae Form of walking pneumonia.
by respiratory droplets.
Infects birds and other
animals. Spread by inhaling
dry bird feces (parrots,
C. psittaci parakeets, love birds and
also poultry, pigeons, and
canaries. Can also be
respiratory droplets.
Malassezia furfur Tinea, or ringworm, prefers
(pityriasis ovale) heat and moisture
Dermatophyte, it infects nails,
Phaeoannuellomycoses skin and hair (never deeper
wernickii (Exophilia structures). Presents as:
wernickii) ringworm, dermatitis Spread by direct contact with
infected individuals
Piedraia hortae
Trichosporon beigelii
agricultural belt - N2 soil
Dimporphic: means it lives as
MC found in "histo belt".
H. capsulatum a mold in soil and as a yeast
(Ohio/ Mississippi River
in tissues.
valley to S. Ont/Que.)
Also areas of a lot of bird
(starling/ chichen) and bat
excrement.
Larger than other spirochetes
and more complex nutrition Dormant in glial cells
required
Microaerophilic
Internal flagella
Contain cholesterol in cell
wall (unlike other bacteria) membranes
obligate aerobe
Survive moist, slightly
many days (up to 6 weeks in
urine soaked soil).
Instead of a cell wall, have a
3 layer membrane (which
contains cholesterol)
"Fried egg" appearance
Very similar to mycoplasma
but urease + (breaks urea
into ammonia and CO2)
Virus-like properties -
filterable and obligate
intracelular parasites
Bacteria-like properties -
inner/ outer membranes,
bacterial ribosomes, contain
DNA, RNA and LPS
Unlike other bacteria there
is no PG layer, therefore no No long term immunity
Gram stain
Unique growth cell cycle
within host cell - EBs
(elementary body) and RBs
(reticylite body)
Spirochetes release
neurotoxins that affect pre
and post-synaptic
Leptospirosis (Weil's disease) --> jaundice and
Cause ciliostasis
"Walking pneumonia", "Eaton's agent"
Incomplete immunitiy
Trachoma inclusion conjunctivitis
Reactive arthritis (Reiter's syndrome)
Chlamydophila psittace - parrot fever or
Adapted to live on
outermost, non-living layer
of skin
No immune reaction
Just cosmetic
Inhale hyphal fragments
Convert to yeast form and
replicate in macrophages --
> travel to lymphatics
Borrelia
Unlike othr Borrelia diseases - non relapsing. Tick bite - must stay attached for >48 hrs. 7-30 day incubation. Stage 1: erythema migrans rash
"bull's eye lesion". Annular rash with central clearing (40-60% don't get this!) Painless, non-infectious, H/A, myalgia, lymphadenopathy.
Clinical signs and symptoms and patient history. Culture and IFA stain of biopsy of initial rash (30% don't
Lyme disease Resolves 1-2 months. Stage 2: iff untreated develop into neurologic signs (meningitis, Bell's palsy, etc.), conjunctivitis or cardiac dysfunction.
get rash and cross-reactivity with Treponema). Indirect ELISA. PCR. IgM or IgG Ab to spirochete.
Stage 3: 2 months to 2 years after stage 1: migratory arthralgias/arthritis (knees, large joint, TMJ), encephalitis. Resolves in months, years or
never. )Can manifest as popliteal cyst. ) If neurologic symptoms: neruoborelliosis.
Leptospira
Range from mild, febrile disease to LV/KI failure (Weil's disease iff icteric) No skin lesion at site of entry. Septic phase: aprupt onset fever,
HA, myalgia, nausea, lasts 1 week. Immune phase - two days asymptomatic, then aseptic meningitis with severe HA, NV, myalgia. Weil's Too small for light microscope and Gram stain. Microscopic agglutination.
aseptic meningitis
disease (icteric) - jaundice, scleral and conjunctival hemmorhages and KI failure (MC cause of death)
Wall-less bacteria (2%)
Mycoplasma
MILD URI/pharyngitis Symptoms similar to RSV, group A strep Most difficult pathogenic organisms to grow (fastidious growth). "Fried egg colonies". Cold agglytination
Acute tracheobronchitis Persistant dry cough that might become paroxysmal
Prolonged, mild form of pneumonia. Initial symptoms "non specific". Increases in severity over a few days. C XRAY before symptoms felt
pneumona
Erythema multiforme Hypersensitivity syndrome (vasculitis). Bulls-eye lesions, associated with HSV.
Stevens-Johnson Syndrome Severe, sometimes fatal, bullous form of erythema multiforme
OM Common
Hemolytic anemia auto-immune destruction of RBCs
Meningitis, pericarditis
Ureaplasma
KI stones Produce urease
Urethritis no progression to PID (non gonococcal). Might be asymptomatic
Obligate intracellular bacteria (4%)
Rickettsia
Painless tick bite leaves no mark (very low inoculum - <10 organisms) 1 week incubation - rapid fever, severe HA, nausea. 5 days later: rash -
DDX with Typhoid. (Typhus is Rickettsia). DFA stain of skin biopsy. IFA stain for LPS. Complement fixation
Rocky Mountain Spotted Fever diffuse, maculopapular rash, MC spread from trunk to extremities (inclusing palms and soles). Respiratory symptoms. Iff untreated spread to
tests, (+) iff <4x increase in Ab titer.
CNS (confusion), SP, GIT, LV. Encephalitis, DIC, shock, death (up to 20% mortality)
Chlamydia
Must have spscific attachment to conjuctiva - resist flushing from tears. Begins as conjunctivits. Entropian - eyelashes chronically irritate
Trachoma disease One of the leading causes of blindness in the world.
cornea causing ulceration
Adult. Most common 18-30. Genital infection 1st then unilateral mucopurulent discharge in eye. Neonatal: infected mother and vaginal birth.
Bilateral, intense papillary conjunctivitis with lid swelling, chemosis, and mucopurulent discharge
Women: termed Chlamydia (the drip?) Most commonly asymptomatic (80%) but risk of intertility, miscarriage, ectopic pregnancy. Can cause
urethritis, conjunctivits, perihepatitis (pain in RUQ). Pain/ cramping in lower abdomen, dyspaerunia, bleeding between menses. Men: NGU
Chlamydia urogenital infections Currently MC bacterial STD in USA.
(non gonoccocal urethritis). MC symptomatic (75%) - yellow clear discharge, pain/ tenderness of genitals. Ractive arthritis (Reiter's syndrome) -
can't see, can't pee, can't dance with me! Can cause cervicitis and PID.
Seronegative (Rh-) spondyloarthropathy. MC in young men (20-40 years) that are HLA-B27 positiv. C. trachomatis is MC bacterial pathogen.
Unexplained diarrhea, low grade fever. 2-4 weeks later conjunctivits, superficial lesions on palms/ sole/ oral mucosa, asymptomatic Clear yellow discharge (gonorrhea is yellow/purulent)
polyarthritis, urethritis
Also termed LGC. MC in Africa, Asia, South America (male homosexuals). Need adequeate sample of
Reportable STD. Initial lesion: small painless papule on penis, urethra, glans, scrodtum, vaginal wall. 2nd stage: buboes --> painful, can infected cells (specimen of pus/ discharge is inapproptirate since they are in the cells). Culture: most
Lymphogranuloma vererum
rupture and drain spontaneously. Systemic. Mimics IBS. Can get proctitis in men and women. specific method, only infects certain cell lines; formation of inclusion bodies. DFA (direct fluorescent)
staining. PCR.
TWAR isovar. Human pathogen that can cause atypical pneumonia (mild, persistent cough/ malaise that might progress to lobar pneumonia).
Chlamydiophilia pneumonia Difficult: PCR, Microimmunoflorescence
Potential link to atherosclerosis, CAD, MS, asthma, Alzheimer's disease? MC in adults. Spread via respiratory droplets. Many cases subclinical.
Cause psittacosis. Biggest risk from psittacine birds (parrots, mascaws, parakeets, cockatiels) Transmitted via inhaled dried bird excrement,
Rare person to person spread (non-productive cough). DX: serology: 4x increase in Ab titre. Prevention:
urine and respiratory secretions. Non-productive cough., rales, mucous plug can block bronchi. Commonly progesses to CNS(encephalitis,
Psittacosis control and quarantine domestic and imported birds.
convulsions, coma, death)
FUNGI (8%)
Superficial Funal Infections
Tinea Infections
"spaghetti and meatballs" organisms after KOH prep. Wood's lamp (+). DDX with vitiligo. Wood's lamp +
Tinea (pityriasis) versicolor Lipophilic, yeast-like organism. Non-itchy hypopigmented telsions on upper torso, arms, abdomen. Dry chalky and scale easily.
(false negative 25% of the time)
Tinea nigra MC asymptomatic. Well demarcated, macular lesions on palms/soles. Characteristically dark pitmented yeast cells and hyphal fragments on KOH prep
Black piedra Hairs of scalp, mustache, beard, groin. Direct or sexual contact. Dar, hard nodules along infected hair shaft
White piedra Hairs of scalp. Direct contact only. Soft, pasty white growth on hair shaft.
Systemic Fungal Infections
Histoplasma capsulatum
Only 5% of people get it. 10 day incubation. Acute, self limiting influenzae like illness (fever, malaise, dry cough, lymphatenopathy. Resolve
Microscopy: 10% KOH prep with silver or Giemsa stain. Serological: skin test: too many false (+). Cultures:
completely with some residual calcified lesions (coin lesions). Not contagious.Complications: overly aggressive immune response. Mediastinal
Primary histoplasmosis slow growing (1-2 weeks) and spores are infectious. DNA probes. Direct ELISA. Characteristic millet
fibrosis. Progressive: Disseminate via lumphatics. Increased risk if impaired CMI. TB-like iff chronic: fever, night sweats, weigh loss with
seed pattern in lungs.
destructive (caseating necrosis) lung lesions.
Serious retinal condition. Leading cause of blindness in 20-40 year olds. Often misdiagnosed. "Histo spots" bilaterally. MC'ly no visual loss but
Ocular histoplasmosis syndrome.
can be activated to cause visual changes (4 kinds)
Page 6 of 12

Dimorphic - 37C, tissue,
multinucleated sperule
"sporangia"
C. immitis
New World Disease
-azole drugs treat fungal
infections
unknown reservoir - unlike H.
Endemic areas overlap those
capsulatum it is rarely
of Histoplasmosis
cultured from soil
B. dermatiditis
Dust clouds at construction
sites or crop dust during
farming
C. albicans Seen in AIDS patients.
strict pathogen (unlike
Aspergillus
Candida)
C. neoformans
Included with fungi only
because of molecular traits
P. carinii also found in rodents (not
Has features like protozoans
reservoir for human disease)
Most people exposed by age Transmission is via
4. Seen in AIDS. respiratory droplets
Stachybotris
Mucor spp
Penicillium spp
Rhizopus spp
Common indoor and outdoor
Alternaria spp
mold
Pullalaria spp
(Aureobasidium)
Numerous species, possibly
Cladosporium spp the most common source of
spores in indoor/outdoor air
HSV-1 infects above the
Herpes simplex waist, hsv-2 infects below the
waist
Endemic in soils of hot, dry,
semi-arid areas. Extensively
spread via dust storms.
In San Jaouquin Valley in
Cali (SW US)
MC in males: 25-55
Can cause diseases in
animals
Normal flora of URT, GI,
female genital tracts. Not
spread person to person.
Extremely common. V-
shaped branching and
septate hyphae.
Ubiquitous: soil, pigeon
droppings (dessicated
alkaline rich, N2 rich,
hypertonic), poultry farms,
eucalyptus trees
Infection via inhalation
Opportunistic infection -
common in environment
Associated with wed, old
buildings
4M's: Mixing & Matching of
Mucous Membranes (vesicle
fluid, saliva, vaginal
secretions)
HSV-1: early on in life.
Horizontal: oral contact, auto-
inoculation to eye or mouth Herpes virus DNA. Humans
HSV-2: later on in life.
Horizonal: sexual practices.
Vertical: ascenting in utero
infection or during vaginal
birth
oval yeast that stains gram-
positive
Can grow in germ tube
serum
no yeast-like form - only a
mold form (form spore
bearing hyphae)
NO dimorphism in
pathogenesis (unlike other
systemic mytotic agents)
Encapsulated yeast
Unusual black, slimy molds
that grow on wet paper or
wood
Form large, fluffy white
colonies that turn gray/brown
with age
Grow as variably colored
colonies, depending on
species
Colonies are like white cotton
candy and brown with age
Colonies are velvety, ranging
from dark green to brown.
Colonies appear white-pink
and blacken with age
Colonies tend to be black,
brown or dark green and can
be powdery.
are reservoirs
Coccidiodomycosis (San Joaquin valley fever)
Inhale conidia
phargocytosed by
macrophages - convert to
yeast - replicate in
macrophages
Carried by lymphatics
Aspergillosus flavus (on
peanuts, corn and other
grains) produces
aflatoxin - very potent
carcinogen:
hepatocellular carcinoma
Cryptococcosis (also Busse-Buschke disease or
Capsule (anti-phagocytic)
Produces urease
Attaches to alveolar cells -
inducing an inflammatory
response
Damages BM --> frothy
exudate
Toxin produces pulmonary
hemorrhage
Contain mycotoxins
Allergic reaction and hypersensitivity pneumonitis
Allergic reactions (rhinitis --> asthma). Opportunistic
Infect and replicate in
mucoepithelial cells
Lytic infections at site,
persistent infections in
macrophages and
lymphocytes, and latent
infections in nerve
ganglia and salivary
glands
Coccidioides immitis
Skin test antigens. Skin test 2-4 weeks after symptoms. Coccidiodin. Spherulin - hypersensitivity testing.
1) MC'ly asymptomatic. 2) 40% of infected people get mild, febrile to moderately severe respiratory disease. Not contagious. 3) <5% - (for both phases)Complement fixation. CXR - "egg shell" lesions. Tissue Biopsy- staining and microscopy
progressive pulmonary disease. 4) <<1% - disseminated disease. Erythema nodosum with arthralgia. for spherules. Culture - CAUTION - infectious - leading cause of lab infections! Coin like lesions on x-
ray.
Blastomyces dermatiditis
45 day incubation. Bronchopneumonia. Drenching sweats, No residual calcified lesions (unlike Histo). Not contagious. Skin lesions are slowly
Skin test and serology - too many false (+). Microscopty - biopsy/ histology of KOH prepped tissue.
Acute Blastomycosis expanding ulcerative or cerrucous lesions with a granulous base on face and mucocutanoues borders of nose and mouth.Ulverative
Culture. No tuberculat macroconidia in saprobic phase (unlike H. capsulatum). CXR.
granulomas of skin and bone are most recognizable signs of a disseminated infection.
Chronic Blastomycosis TB or cancer like
Opportunistic Fungal Infections
Candida albicans
White patches on an erythematous base that can be scraped off. Perleche is the name given to candidal infections at the corners of the mouth
Thrush (oral candidiasis)
(related to dentures not fitting or persistant, excessive lip moisture)
Manifests as vaginal erythema, white discharge, pruritis, and burning. Skin lesions are clearly defined, erythematous patches with satellite
Candidal vaginitis
pustules on red bases.
Chronic mucocutaneous candidiasis Multiple erythematous, pustular, or thick lesions appear, particularly on the face.
Apergillus
Mycotoxicoses hypersensitivity pneumonitis Skin sensitivity testing (wheal and flare reactions). IgE antibodies. Monitor with spirometry to detect
Allergic broncophulmonary asperfillosis associated with asthma (10-20%)
(allergic bronchopulmonary aspergillosis) development of progressive fibrosis
Aspergillus Secondary colonization Aspergillus colonizes pre-existing cavity. Minimal distress, hemoptysis. Fungus ball on CXR - moves with dependency
Paranasal granuloma Chronic sinusitus due to Aspergillus colonization of paranasal sinuses.
Otitis externa/sinusitis
Sepsis Indistinguishable from bacterial sepsis.
Cryptococcus neoformans
MC self-limiting mild pulmonary infection. Can lead to pulmonary nodule which mimics carcinoma or pnemonia with diffuse pulmonary infiltrates Microscopy: examine CSF after treating with 10% KOH and India ink. Serology: look for capsular Ags
torulis) (mc in males) (unlike other systemic mycoses that look for Abs)
MC cause of fungal meningitis. Insidious onset of HA, low grade pyrexia, focal neurological changes. Immunocompromised also get skin
Cryptococcosis meningitis
lesions or osteolytic bone lesions (e.g. lymphoma)
Pneumocystis carinii (P. jirovecci)
Pneumonia Non-specific. Plasma cell infiltrates with "ground glass appearance" Microscopy: typical octonucleate cysts.CXR: diffuse infiltrates with ground glass appearance
Extrapulmonary In AIDS - eye, ear, liver, bone marrow
Environmental Molds
Stachybotris
Infection may be prefaced by nose bleeds, cough or chest congestion and worsened by concomitant cigarette exposure. Small areas may be
Systemic poisoning
cleaned with bleach; larger infestations require professional removal.
Mucor spp
Associated with allergy to its spores (including hypersensitivity pneumonitis) and opportunistic infections of the sinuses, skin, and lungs in
Allergic reactions
immunosuppressed patients
Penicillium spp
Allergic reactions To toxins.
Aspergillus - see above
Rhizopus spp
Allergic reactions
Alternaria spp
Pullalaria spp (Aureobasidium)
Cladosporium spp
infxns.
Viruses and Prions (14%)
Herpes
Skin break - localized primary infection in mucosa. Vascular lesions (damage due to viral immonopathology and apparent healing). Then Tzanck smear: look for Syncytia (fused membrane, not specific, also for: HSV, VZV, HIV,
Herpes simplex infection retrograde transport to neuron nucleus - latent infection. Stress (emotional, fever, direct sunlight, menstruation / hormones, paramyxovirus.Cowdry Type A inclusion bodies (HSV or VZV). Characteristic CPE (cyto pathological
immunosuppresion). Lesions: "dew drop on rose petal". Secondary infection is more localized and shorter duration than primary infection. effect)
Herpetic keratitis (ocular herpes) Unilateral, recurrent. Can lead to dendritic corneal ulcers --> permanent damage
Herpetic Whitlow Herpes infection of finger
Meningitis. HSV-2 - often a complication of genital herpes. Sudden onset of nuchal rigidity, blinding H/A, nausea, photophobia.
Encephalitis Seizures, signs of SOL (space occupying lesion), cause destruction to temporal lobe. MC cause of sporadic encephalitis.
Caused by HSV-1 (10& orogenital sexual practices) and HSV-2 (90%). STD 3-7 days after contact. Regional lymphadenopathy, painful shallow
Genital herpes ulcers. Recurrent (2-3 weeks or rarely) prodrome of burning/tingling. Female: pruritis, vaginal or cervial mucoid discharge. Increased risk of
cervical CA in adulthood and HIV. Male: dysuria and/or duspaerunia.
Neonatal Herpes simplex infection Acquired in utero or during vaginal birth or post-natal (family members or hospital personnel). Devastating, often fatal. Affects CNS, lungs, liver.
Page 7 of 12

Peak occurrence of chicken
pox: spring time and 5-10
years old
Peak occurrence of shingles: respiratory route, no
Varicella Zoster adult pop esp >65 (10-20%). detectable lesions at site of DNA enveloped herpes virus thoracic fever.
Active herpes zoster can
cause chicken pox in
susceptible child or adult but symptoms until all the lesions
will NOT cause shingles.
Ebstein-Barr virus
Cytomegalovirus
Human herpes virus-6
Adenovirus 41 antigenic types
Human papilloma virus
Measles can depress CMI for
a short time, allowing bacterial Transmission by respiratory
Measles virus (rubeola) -
superinfections. It can also
morbillovirus
allow reactivation of latent
diseases: shingles or TB.
Mumps virus -
paramyxovirus
Like Herpes simplex: causes
blister-like lesions (but
different sizes and stages,
deeper, more painful and can
cause scarring), establish
latent infections in nerves,
CMI
Unlike HSV: spread via
entry
Very contagious - contagious
from 48 hrs, before
are completely dry
Very common virus
A DNA enveloped herpes
Transmitted MC'ly by saliva
virus. A gamma herpesvirus
or from contaminated
glassware - "kissing disease"
To cause neoplasms - need
other cofactors
Immunity to EBV is lifelong
Opportunistic pathogen -
rarely causes disease in
immuno-competent hosts
Transmitted as STD,
transfusion/
transplantation, oral,
congenital
Can be latent in T cells,
macrophages, other cells
Ubiquitous. Cause life long
infections
Respiratory droplets, fecal
oral, direct fomite inoculation virus
Can get through birth canal
Through breaks in skin and
mucosa
transferred by fomites - direct
contact into small breaks in
skin/ mucosa
Also infected birth canal
(STD transmission)
droplets: prodromal and first
few days of rash
Only infects humans
Transmission is by
respiratory droplets.
Primary infection: 2-4 days
after: to lympatics
Secondary viremia:
VZV becomes latent in
dorsal root or cranial root
ganglia
Reactivated in older adults
and immunocompromised -
migrates back along
dermatome --> shingles
Ultimate B lymphocyte
pathogen. Mitogenic and
immortalizing. Viral capsid
Ag helps ID it in tissues.
Infection first in
oropharynx, shed in saliva
- saliva remains infectious
for months after clinical
recovery
Iiff overactive immune
system --"infectious mono"
iff lack of immune
response --"lymphoma"
e.g. burkitt's
URT - lymphotropic -
infected cells (leukocytes,
lymphocytes) spread CMV
throughout the body
DNA Enveloped herpes virus. Similar to Herpesviridae: 1)
contains both mRNA and
syncytia, 2) latent state, 3)
DNA --> unlike other viruses reactivation in
immunosuppressed state
Lymphotropic
latent infection in t cells
DNA non-enveloped (naked) Hemagglutinin fiber - aids
in attachment
Used as a vector for gene
Icosahedral nucleocapsid therapy - help stimulate
bone growth
cause lytic, chronic, latent
or transforming infections
transformation occurs bc
Naked capsid virus
proteins bound by
HPV16&18 bind tumor
suppressor molecules
Very contagious - 85%
infection rate, 95% chance
of disease development
Hemagglutinin helps the
RNA enveloped
virus penetrate cells and
paramyxovirus
uncoat. Cell fusing and
hemolytic properties.
Infects epithelium of URT
then blood and RE cells.
Very infectious (but less
than measles or chicken
pox)
infect upper respiratory
tract epithelial cells. Infect
RNA enveloped parotid gland via viremia or
Stenson's duct --> Parotitis
paramyxovirus. Similar to
measles.
Life-long resistance to
infection (like measles)
Incubates for 14-21 days. One of the 5 childhood exanthems: rubella, roseola, 5th disease, measles/rubeola. Inhalation: maculopapular rash
("dew drop on rose petal"), intense pruritus, rapid development and spread from back/chest to scalp. Within 12 hours: successive crops of Tzanck smear: giant, multinucleate cells - syncytia. Cowdry Type A inclusion bodies: "drop like masses of
Chicken pox
lesions. Prolonged low grade fever. extremem irriability/malaise. Much more harmful to adults - scarring. More severe on trunk than acidophilic material surrounded by a clear halo within the nucleus"
extremeties, also on mouth, conjunctiva, vagina. complications: 1) secondary bacterial infections.2) Reye's syndrome, CNS symptoms.
Can occur after chicken pox, enterocirus, EBV, influenzae B, aflatoxin (peanuts), pesticide. ASA associated - do NOT give aspirin to a child
Reye's syndrome
with chickenpox.
Recurrence of latent VZV infection. Prodrome: severe pain in localized nerve area. 3-5 days later: gradual development of small red macules,
Shingles closely spaced, MC'ly in thoracic area or trigeminal nerve area, unilateral. Post herpetic neuralgia: long term (months to years) severe recurring
burning or itching pain, hyperesthesia. Unlike herpex simplex: lesions are various sizes.
Herpes zoster opthalmicus CN V (facial) and CN III (ocular changes - cornal ulcers - blindness)
painful lesions along CN VIII (severe otalgia, hearing loss, vertigo, vesicular lesions along external ear canal) and lesions along CN V (Bell's
Ramsey Hunt syndrome (Herpes zoster oticus)
palsy)
Triad of: fever, pharyngitis and lymphadenopathy for 1-4 weeks. Downey cells. Monospot test (+)
kissing disease - heterophile (+) mono. Symtoms: high fever, malaise, pharyngitis, tonsils with whitish exudate, lymphadenopathy,
Heterophile Abs - polyclonal activation of B cells produces wide reportoire of abs that recognize
Mononucleosis hepatosplenomegaly, fatige. Spleen rupture - avoid contact sports, hepatitis. Cyclic recurrent disease. (if lasts over 6 months) EbV induced
"paul Bunnel" Ags on horse, sheep, cow, RBCs but not guinea pig. High IgM = acute. High IgG = past
lymphoproliferative dease(looks like leukemia)
infection
African Burkitt's Lymphoma Tumor cells are from lymphocytes and contain EBV DNA. Malaria is a co-carcinogen. Large lesions - osteolytic - on jaw
Chronic Fatigue Syndrome Proposed to be one of the causitive factors of chronic fatigue
Nasopharyngeal carcinoma Epithelial cell tumor. Co-factor: ingested nitrosamines.
Hairy oral leukoplakia Opportunistic infection in HIV AIDS patients. Vertically ribbed keratinized plaques on lateral borders of the tongue
MC viral agent of congenital disease in US. Clinical disease in 10%: microencephaly, hearing loss(SNL) rash, hepatosplenomegaly. Fetus is
congenital - cytomegalic inclusion disease infected either: placenta or recurrent mother infection - ascending infection from cervix. Appearance of multinucleated giant cells with Confirm by isolating CMV from child's urine in 1st week of life.
intranuclear inclusions.
Infectection of fetus or newborn by any of the TORCH agents. Toxoplasmosis, other, rubella virus, cytomegalovirus, histoplasmosis. Outcome
TORCH syndrome
is abortion, stillbirth, or premature delivery. Fever, lethargy, poor feeding…..
CMV mono, CMV hepatitis
Through vaginal birth with infected cervix or colostrum or milk. 2 outcomes: asumptomatic or symptomatic if immunocompromised. Very
Heterophile (-) mono. Clinical signs and symptoms too vague to be that useful. Biopsy: owl's eye
Peri-natal common cause of failure of KI transplants. IFF immunocompromised: Retinitis: "pizza pie retina" --> scotoma, "blind spot". Esophagitis: mimic
nuclease. Cell culture: characteristic CPE in diploid fibroblastic cells
CRC esophagitis
Roseola infantum Rapid onset of high fever. Fever subsides and then get maculopapular rash. Also termed exanthum subitum. "Slapped cheeck appearance"
Mononucleosis type illness progression time of HIV to aids. Assoc with neurological disorders: might be linked to MS, cronic fatigue. Heterophile (-) mono.
Adenovirus
Pharyngitis (acute respiratory disease) mild URI with fever, rhinorrhea and cough. #4 on viral respiratory diseases. #1: RSV, #2: parainfluenza #3: Rhinovirus Similar to owl's eye inclusion body (in CMV). Increased CRP (unique to viruses --> similar to bacteria)
Atypical pneumonia pertussis-like illness
conjunctivitis Associated with swimming pools, dust/ debris.
2nd only to rotaviruses as cause of acute gastroenteritis in children. Serotypes 40 and 41 are thought to cause up to 15% of
Gastroenteritis
gastroenteritis in children.
Hemorrhagic cystitis Usually occurs in epidemics
Papillomaviruses
Common flat wart (verruca plana or verucca
MC on hands and feet. Surface is studded with black dots. Plantar is painful because it grows on pressure points
vulgaris)
Oral papillomas
Laryngeal papillomas MC epithelial tumor in the larynx. Infected birth cana. Hoarseness or abnormal cry. HPV 6 & 11.
Condyloma acuminata (anogenital warts) HPV 6 and 11. STD, vaginal birth, or ?. Rarely regresses spontaneously. Plaque-like flesh colored lesions. Can be pre-neoplastic. Lesions turn white with acetic acid
Cervical dysplasia and cervical CA 2nd MC canver in women in USA. HPV 16 & 18 & 31. Need cofactors to progress to CA PAP smear - presence of Koilocytes. Topical 5% acetic acid.
Paramyxoviruses
Prodrome: Cough, coryza, conjunctivitis, photophobia. 2 days later: Koplik's spots "grains of salt surrounded by a red halo". 1-2 days MC clinical only - pathognomic. Microscopy: syncytia. Serology: 4x increase in measles specific IgMs
Measles
later - rash, maculopapular descending rash. MC self limiting with no complications suggest recent infection
Pneumonia Rarely occurs but is MC cause of mortality from measles
Giant cell pneumonia IFF T cell deficient children
Post infectious encephalis immunopathological - demyelinate neurons
Sub-acute sclerosing panencepahalitis charaterized by changes in personality, behaviour, memory, movement
Atypical measles Response to vaccine - abrupt onset of more severe symptoms. Get increased imunopathologic response.
Mumps Incubation 14-21 days. Fever, malaise, anorexia. MC'ly asymptomatic (unlike measles). Bilateral parotitis. Test samples from saliva, urine or CSF. Elevated amylase (bc pancreatitis). Hemadsorption.
Orchitis Testicular swelling. MC unilateral, can lead to sterility if bilateral.
Oophoritis Unexplained abdominal pain.
Pancreatitis might be a link to juvenile onset DM
Meningitis. H/A, stiff neck, drowsiness, unsteadiness when walking. #1 cause of aseptic meningitis in non immunized (non bacteria). Typically self-limiting
Arthritis Rare cause of polyarthritis in young men
Page 8 of 12

Common cold causes: 1)
rhinorhea virus. 2)
coronavirus 3) RSV
Respiratory Syncytial
Virus #1 cause of severe lower
respiratory tract infection in
young children (Day cares,
nurseries)
Parainfluenza Virus
Differences from HBV:
HAV can not initiate a chronic Pathology due to immune
infection
HAV not associated with
hepatic CA
Hepatitis A (HAV)
rarely get immune complex
related rash and polyarthritis
rarely fatal (fulminant hepatitis)
Hep A vaccine can prevent
1 month incubation --> abrupt
infection
onset of icteric symptoms
fecal-oral spread
differences from HAV:
hepDNA vuris
transmitted by over 1/3 of the world is
blood/needles/STD/perinatal infected
longer incubation (3 months)
Hepatitis B (HBV)
and then insidious onset of
symptoms
can get chronic hepatitis
carriers
can cause primary
hepatocellular carcinoma
(PHC)
not as resistant
Hepatitis C (HCV)
Hepatitis D (HDV)
over 100 serotypes - can get MC common cause (>50%)
common cold more than once! of the common cold
Rhinovirus
only transient immunity
1) Influenzae A: epidemics,
pandemics, bird reservoirs
(ducks, chickens)
2) Influenzae B: stomach flu
Orthomyxovirus
3) Influenzae C - mild URTI
Picornaviridae - One of the
largest families: Includes
enteroviruses (HAV,
Coxsackie virus, polio virus,
echo virus) and rhinovirus
Poliovirus
IPV (salk) - inactivated polio
vaccine. OPV (sabin) - live,
attenuated oral polio vaccine
(both stim humoral immunity)
Ubiquitous - virtually
everyone in NA is infected by
age 4 (very contagious)
Epidemics in every winter in
cold, temperate climate
Transmitted via hands,
fomites and respiratory
secretions
Ubiquitous
Transmission is person to
person and respiratory
droplets
MC in infants and children <5
Ingested (contaminated
shellfish, clams, oysters)
extremely stable capsid
mediated hepatocyte damage
Person-to-person, fecal-oral
and sewage contaminated
food/water (often traceable
source, can live in water for
many months)
Children most common.
Usually from restaurants.
MC'ly in blood or blood
products (serum hepatitis)
Chronic carrier - test + for
HbsAg 2 occasions
unusally stable for an
enveloped virus
IV drug users - transmitted
through blood
Chronic carrier state
Spread via aerosolized nasal
droplets, fomites, hands (#1)
Can't grow in acid of stomach
(unlike enteroviruses) and
also grows best at 33 C
(cooler in nasal mucosa) -
acid and temp sensitive
Enveloped virus - wash your
hands! Destroyed with soaps
Epidemic --> antigenic drift.
Small mutations. Will re-infect
every 2-3 years
Pandemic --> antigenic shift. segments: facilitates
Only in influenzae A, major
recombinations. Every 10
years.
Also zoonoses - a new strain
is formed that can be spread
to humans
Transmission is fecal-oral
No hemagglutininor
neuraminidase. F
URI with marked rhinorrhea In older children/adults 4x increase in anti-RSV indicates disease
glycoprotein in envelope
causes cells to fuse
Form syncytia Bronchiolitis OM also is common. These 2 in infants. Respiratory secretions or detection of syncytium. Rising Ab titers.
Enveloped RNA virus
Infection localized to upper
or lower respiratory tracts.
No systemic spread/ Severe pharyngitis In older children and adults, croup, severe pharyngitis or URI symptoms occur
viremia
No long term immunity
4 serotypes: Types 1-3:
2nd most common cause
of severe respiratory
Enveloped RNA virus Laryngitis
distress in infants and
young children, can cause
croup
Initial site of infection is the
upper respiratory tract -
epithelial cells. Usually
Parainfluenzae range from mild cold-like URI to bronchitis and pneumonia. Milder disease in older children and adults
contained here and rarely
4 serotypes. No antigen drift. becomes systemic (unlike
measles/ mumps)
Only partial immunity Laryngeotracheobronchitis - "sound worse than they look". Seal bark - harsh brassy cough. MC self limiting - 48 hours. Xray: steeple sign. Lab DDX epiglottitis (caused by H. influenzae). "Look worse than they sound" Medical emergency, drooling.
Croup
(unlike measles) Dx: Serology >>false -. Presence of syncytia. Hamadsorb guinea pig RBCs. Xray: thumb sign.
Hepatitis viruses
Naked icosahedral ssRNA
genome
slow replication, transient Children: often asymptomatic (only 1-2% get jaundice). Adults: abrupt onset of fever/chills. Symptoms decrease in 4-6 days. Jaundice in 67%. Patient history - source of infection. Acute or recent: anti HAV igM by ELISA or RIA. IgM rises early in
Hepatitis A
viremia 99% full recovery. 1-3/1000 progress to fulminant hepatitis. disease, IgG persist for life. Serum LIV enzymes usually elevated
Not stable to chlorine
HBsAg (surface antigen): rises in acute infection. Assoc with infectivity. HBeAg (e antigen): occurs
during active infection; associated with infectivity and risk of progression to chronic liver disease. Anti-
Partially double-stranded Infects hepatocytes --> immune response. CD8+ T cells recognize viral particles and start attacking virus-filled hepatocytes. Ag-Ab complexes
HBsAb (Anti-sruface antibody): appears weeks after recovery. Suggests past infection. Anti-HBcAb
DNA enveloped Hepatitis B form, which probably explain arthralgias and arthritis, immune-complex glomerulonephritis, and vasculitis. Incubation is 10-12 weeks --> fever,
(anti-core antibody): appears at onset of clinical symptoms. Suggests current or previous infection. Anti-
hepadnavirus fatigue, nausea, jaundice with hepatosplenomegaly.
HBeAb (anti-e antibody): suggests low risk of infectivity and good chance of avoiding chronic liver
disease.
Similar to hep B. Tends to not have jaundice symptoms. Chronic state usually involves low-grade, intermittent symptoms of fatigue and
RNA enveloped flavivirus CMI response Hepatitis C arthralgies. Increased rate of AI disease in carriers. Low risk of developing cirrhosis and hepatocellular carcinoma. Hepatitis, cirrhosis, liver
cancer, carrier state.
Incomplete viral particle Coinfection with Hepatitis B needed (HBsAg required) --> acute hepatitis and also fulminant hepatitis. Increased likelihood of
Hepatitis D
(Delta particle) cirrhosis.
Rhinovirus
Gradual antigenic drift (like
influenza A)
Infection by as little as 1
infectious particle
ssRNA Common cold - coryza rhinorrhead (clear, waterty -> purulent/ mucoid iff secondard bacterial infection) Lab not necessary. Characteristic CPE in himan diploid fibroblast cells at 33C and acid labile
bing ICAM-1
Influenza Viruses
Haemagglutinin Influenzae A Abrupt onset of fever (38-41C for 1-5 days). Non-productive cough, severe myalgia, rhinorrhea, anorexia Usually symptomology and community history of outbreak is enough for diagnosis
Neuramidase - allows
spread through mucous Influenzae B Milder, more GI symptoms
ssRNA genome in 8 membranes
first strain known to cross
rearrangement species barrier from Secondary Bacterial pneumonia In young children
chicken to human - H5N1
Encephalopathy
Limited viremia - very
rarely spread beyond lung Reye Syndrome Linked to ASA
Enteroviruses
Damage is direct to viral
Naked capsid virus pytopathology NOT Asymptomatic Most common (90%). Limited to oropharynx and GIT.
immunopathology
Replicates in anterior horn
of spinal cord --> death of
Abortive non-specific febrile illness.
motor neurons and
paralysis
Enterovirus - stable at pH3-9.
Non-paralytic poliomyelitis Symptoms of abortive poliomyelitis as well as aseptic meningitis
Affects lower motor neuron Spinal paralytic: asymmetric flaccid paralysis in one or more limbs, no sensory loss. Bulbar: affect cranial nerves or medullary respiratory center
Paralytic
(75% mortality)
Post polio syndrome (PPS) Deterioration of affected muscles (or previously non-affected muscles) later in life (10-40 years later) without presence of virus.
Page 9 of 12
 Coxsackie A --> usually
vesicular lesions
Coxsackie B --> myocarditis,
pleurodynia
Coxsackie virus
60% of infections are
subclinical
Other enteroviruses
one of the most deadly viral
Rabies virus
diseases - 100% mortality
Live attenuated vaccine has
provided immunity for up to 10
years
Rubivirus (Rubella)
Exterminated from the US in
2005
Alphaviruses -> arboviruses
(arthropod borne), similar
antigenicity
Flavivirus -> Hep B, Hep C
Alpha and Flavi Viruses similar pathogenesis and
(Arthropod-borne viruses) epidemiology
cause lytic infections in
vertebrate hosts
HIV-1: 70% men. 42%
homosecual men. Geveloping
countries: relative increase
among heterosexuals.
HIV Virus
HIV-2: mostly west africa
Eradicated except in lab
Smallpox virus samples since 1979. Vaccine No asymptomatic carriers
no longer given due to risks.
Unlike other viruses - pox
Molluscipoxvirues. Can
viruses contain all the
survive environment for
necessary information for their zoonoses - STD, fomites,
years.
own DNA and RNA synthesis wrestling, rugby
Rotavirus - #1 cause of infant
Rotavirus
diarrhea worldwide
Parvovirus B19
Prions very resistant
Cysts --> trophozoite in the
ileum. Reside in cecum and Found in tropical areas with
Entamoeba histolytica colon --> necrosis. Can enter poor sanitation. Fecal-oral
portal circulation --> liver --> spread
liver abscess
Fecal oral spread
zoonoses. MC bite of rabid
dog (also cats, foxes,
raccoons, coyotes, skinks,
bats). Body fluids
Does not penetrate intact
mucosal membranes
Respiratory droplets or
across placenta
Enveloped, linear ssRNA
Mosquito control helps
controlling the virus
Yellow fever has a live
attenuated vaccine
Sexual intercourse
(anal/vaginal) - HIV enters
and infects Langerhands
DC's in epithelium or GIT?
Peri-natal - from birth
Blood: IV drug users, needle
stick injuries, blood
transfusions
Problem: long, prodromal
asymptomatic period.
Infectious before identifiable
symptoms.
Molluscum contagiosum and
other pox viruses are
Large enveloped DNA virus
Fecal-oral transmission
MC spread from respiratory
droplets or close contact to
blood products
Eating infected tissue, organ
transplants, or iatrogenically Non-viral glycoproteins, 5nm
filterable (size of viruses) but in diameter
no DNA or RNA
RNA virus
Enveloped RNA virus
RNA enveloped virus with
hemagglutinin to aid
attachment
Delicate outer envelope -
hard to get!
gp120 (Ag and receptor
specificity leads to high
amount of antigenic drift).
Changes all the time!
RNA virus
Very large enveloped DNA
virus
Antigenic shift like Influenza A
dsDNA
Non-enveloped but
Enveloped virus-like
properties
Smallest of Dna viruses (only
22nm)
naked capsid virus
very resistant to drying,
acid/base, high salt etc
Can cause permanent
nerve damage
Infects sensory nerve cells
vectors -> mosquitoes
Reservoirs ->
"immunologically naïve"
birds
Humans - dead end hosts
puddles, ditches, artificial
ponds, toys, trash cans
Affinity for CD4+ T cells -->
loss of CMI
Infects monocytes/
macrophages (Especially
brain)
HIV gp41 and gp120 help
virus enter the cell
(envelope glycoproteins)
binds P antigen on rbc's,
erythrocyte progenitor
cells, vascular endothelium
and fetal myocytes
Herpangina
Hand-foot-mouth disease
Acute hemorrhagic conjunctivitis
Pleurodynia (Bornholm's disease)
Myocarditis/ Pericarditis
IDDM
Aseptic meningitis
Paralytic disease, Encephalitis, URTI
Gastroenteritis
Rabies
Rubella
Polyarthritis
Rubella congenital TORCH agent
Flu-like syndromes
Meningitis/ encephalitis
Hepatitis, hemorrhagic fever, shock, viral arthritis
Yellow Fever
Dengue (break bone) Fever
Dengue hemorrhagic shock syndrome
HIV
Smallpox
Ecthyma contagiousum (Orf)
Molluscum contagiousum
Gastroenteritis
Erythema infectiousum - 5th disease
Parvovirus B19 fetal infection
Aplastic crisis
Arthritis
Sporatic Creutzfeld Jakob disease
Creutzfeld-Jacob disease - variant form
Amebiasis/ Amebic dysentery
Coxsackie A and echovirus (not Hsv). No external skin lesions --> unlike hand-foot-mouth disease. Self limiting. White lesions inside mouth Enterovirus lab dx: CPEs on monkey KI tissue culture. RT-PCR in CSF/ other fluids.
Caused by Cosdackie A16. Mild febrile disease with vesicular lesions on hands, foot, tongue
Extremely contagious
"devil's grip" --> severe pleuritis chest pain --> unilateral intercostal myalgia --> "stich-like pain"
MC in adult males. Mistaken for MI. Children - sudden unexplained heart failure
possible link if Cosxsackie B infects pancreas
# 1 cause is echo virus
MC cause of nonbaverial CNS infection in the US. Causes self-limiting meninigitis lasting 5-14 days or progressing to encephalitis
with potentially permanent nerve damage and paralysis. Can mimic paralytic polio
Rhabdoviruses
Long incubation phase: asymptomatic. Delay is important for treatment. Prodrome: retrograde axoplasmic flow and dorstal root ganglia. No
Once there is evidence of infection (symptoms or Abs) it is too late for effective intervention. Post mortem
detectable Abs. ..................Neurologic phase: travel to infect brain/encephalitis. Hydrophobia, aerophobia, hyperactivity, aggressiveness,
Negri bodies.
"furius rabies" (death in 1 week). "Dumb rabies" - progress to death by cardiac ......Then back down to salivary glands (where is its spread)
Togaviridae
Incubation 14-21 days. Prodrome of malaise and lymphadenopathy for 1-5 days. "3 day measles" regional lymphadenopathy (esp sub-occipital
glands). Spread to skin: rash - small erythematous nodules that spread from face to trunk/limbs, gone in 3 days. Rubella disease has
similar severity even if immunosuppressed. More severe in adults than children due to more vigorous immunopathology.
MC in adult females. Symmetrical polyarthritis of fingers, ankles, wrists and knees
Increased risk (70% babies infected) if mother infected in 1st trimester (if 4th month just sensorineural deafness). Iff no maternal Abs
Difficult to diagnose clinically. Highly specific anti-rubella IgMs. NO CULTURE - no characteristic CPE.
teratogenic effects. Classic triad: eyes, ears, heart. Also microencephaly, IDDM. Highly infectious for 1st few months of life.
Serology: problem: false +, RT-PCR
West nile
Dengue fever/yellow fever
Jungle fever, Aedes aegypti mosquito. Not contagious - no person to person spread. 3-6 days incubation, then organ pathology. Jaundice,
haemorrhage, encephalitis is rare.- africa and S. america
Aedes aegypti mosquito. Primary infection --> bone pain. Enlarged lymph nodes, maculopapular rash, leukopenia. Seen in Middle East,
Arfrica, Caribeean
Hypersensitivity reactions --> weaken, rupture vasculature. No bone pain.
Retroviruses
Acute retroviral syndrome: viremia. Mono-like syndrome (heterophile -), mucocutaneous sores. Illness subsides spontaneously. 60%+ become
asymptomatic. Mouth ulcers, oral candidiasis, EBV-like.
Mid stage - ACR (AIDS related complex). Insiduous onset - weight loss. Night sweats, fatigue,opportunistic infections
Initial screen: indirect ELISA for gp120 or gp41 (2x to confirm). New- Ora Quick Rapid HIV-1 Ab test.
Western blot: for gp120 or p24 or p31 proteins (confirmatory). Active viral replication (Recent infection or
AIDS: 1) presence of anti-HIV gp120 abs, 2) decreased CD4+ t cells, 3) wasting syndrome 4) presence of opportunistic infections. Primary late stage) - direct ELIZA for p24, viral load in Rt or in blood via PCR. Culture - difficult, looking for syncitia
defence against opportunistic pathodens is progressively diminised. Diseases: hairy oral leukoplakia, oral thrush, kaposi's sarcoma,
pneumocystis pneumonia, CMV retinitis
AIDS related dementia: sub-acute encephalopathy. Slow, progressive deterioration of mental abilities. Can minic alzheimer's disease
Poxviruses
variola is inhaled (4-19 days asymptomatic and not contagious). Prodrome (2-4 days). Skin rash (most contagious) Think opaque fluid filled
center with "belly button-like depression in center". Infectious until all scabs fall off. Unlike chicken pox, in smallpox all the lesions are at MC clinical only.
the same stage at the same time. 35% mortailty.
Direct contact with sheep/goats, soil? Contagious pustular dermatitis.
In immunocompromised. Fleshy, pearl-like umbilicated nodules with central caseous plug. Characteristic skin lesions. Molluscum bodies on biopsy.
Reovirus
48 hr incubation --> sudden onset of severe vomiting (progectile), watery diarrhea, fever, dehydration. Selt limiting. Not distinguishable from
Diagnosis via stool samples - looks like a wheel!
other types of gastroenteritis (Norwalk virus, bacterial) by signs and symptoms. Death by dehydration.
Parvovirus
Nonspesific URI (looks like influenza). 2-7 days later develop a "slapped cheek rash" which fades after 4 days but spreads to trunk and limbs
(lacey/ reticulate appearance). Biphasic: 1) Infectious stage. 2) Immune mediated stage: recurrent rash (immune mediated) that is <sunlight, RIA or ELIsa for B19 specific Abs. IgG comes later but persists for life
<exercise, <hot water, <stress.
Iff seronegative mother is infected in 2nd or 3rd trimester. Hydrops fetals (dropsy) - massive edema in the fetus.
Especially if SCA or thalassemia - chronic hemolytic anemia. Not developing RBC's for 5-7 days. Fever, malaise, myalgia, chills, pruritus.
Symmetrical, transient polyarthritis - presents just like rubella arthritis. Increased risk in female adults. Unlike RA - no RF.
Prions
Long incubation (up to 30 years) but rapidly fatal once symptomatic (MC only 1 year). Rapidly progressing dementia. Most common after age
Not cultivated in lab, no Abs producted, normal CT scan, normal MRI, abnormal EEG
70. Some genetic susceptibility.
Young onset --> mean is 27 years of age. Psychiatric/ sensory symptoms. Dementia at final stage only - unlike sporatic CJD. Detect PrPSc in
Strong lab and epidemiological evidence of link to BSE
follicular dendritic cells (lymphoid tissue)
Parasites (6%)
Amoebae
Colitis with diarrhea and/ or many bloody stools. LV abscesses. (RUQ pain, weight loss, fever, hepatomegaly) Can have asymptomatic
Stool examinations - multiple stool samples (3-5). DDX UC, shigella
carriers. Failure to thrive in kids.
Page 10 of 12

Worldwide sylvatic
(wilderness): Beavers and
muskrats are local reservoirs
Forms cyst in dueodenim.
contaminated water: resist
Trophozoites attach anywhere
Giardia lamblia chlorination (unlike
along the gut wall. Interferes
Entamoeba but like
with nutrient absorption
Cryptosporidia)
person to person spread via
fecal-oral or oral- anal
practices
Worldwide STD - can get with
Trichomonas vaginalis Monomorphic- no cyst stage
infected towels as well.
Trypanosomes (T. brucei) Transmitted by tsetse flies
transmitted by triatomine
(reduvid, kissing, or
assassin) bugs
"Tom Cruise likes to Shag Reservoirs: dogs, cats,
T. cruzi
and Kiss" opossums, rats, other
mammals
Can be transmitted by
transfusion or
transplacentally
Vector: phlebotomine
L. tropica, L. mexicana, L.
sandflies. Reservoir: wild
braziliensis, L donovani
mammals
female Anopheles
P. falciparum, P. vivax, P. Sickle cell trait confers mosquito feeds on a person
ovale, P. malariae resistance with malaria and then feeds
on an uninfected person
•microbe present in
cat feces
fecal-oral spread
1) improperly cooked
Tosoplasma gondii contaminated meat/ meat
juices
2) contaminated soil
3) contaminated cat feces
Worldwide zoonotic
Cryptosporidium parvum Waterborne- resistant to usual Fecal- oral, person to person
water purification (MC) - Oral-anal: MSM (Flagship in
highly resistant to chlorine AIDS)
Transmitted by ticks
Babesia microti Malaria-like protozoa
MC in New England islands
Can grow up to 25cm or
longer
Ascaris lumbricoides
Eggs transmitted through
(giant intestinal
inhalation or ingestion
roundworm) Thousands of eggs produced
daily --> pass out in stool and
infect soil
Enterobius vermicularis
(pinworm)
Necator americanus,
"Naked american hookers
Ancylostoma duodenale Burrow through skin and feet
working barefoot at night"
(hookworm)
Trichinella spiralis Pigs are the major source.
(trichinosis) Undercooked pork.
Reservoir is humans. Vector microfilariea daily for 15
Ochocerca volvus
- black fly
Vector: mosquito
Wucheria bancrofti
(anopheline or Culex)
Transmitted by Mansonia
Brugia malayi
mosquitoes
ST acid induces changes
to trophozoites
Very rarely spread beyond
the GIT
no tissue necrosis
MC protozoal disease in
developed nations.
Urogenital protozoan
Hematoflagellated,
Invade macrophages. Ab
unicellular, obligate,
not protective - result in
intracellular, zoonotic
glomeruloN
parasite
Scizogony - invasion and
rupture of RBC - cause
symptoms
Lives in RBC
Ingested infected egg -
develops into larval worm
that penetrates duodenal
wall
Larvae in alveoli are
coughed up and
reswallowed -->
malnutrition/blockage
Female lives in cecum but
migrates out of anus at
Female is 1 cm long, pin
night to lay 20,000 eggs on
shaped, off-white worm.
bedding and peri-anally
every 2 weeks.
Larvae migrate to lungs.
Coughed up and
swallowed. Slice intestinal
wall and feed on blood of
intestinal capillaries.
Larvae migrate to striated
muscle but also cardiac
and nervous tissue
2-5cm long. 2000
bite from infected
mosquitoe: migrate to River blindness
years - burrow in the eye for
lymphatics
2 years.
chronic symptoms are due
to: physical blockage of Elephantiasis
lymphatic vessels
Like wucheria but half has
large
Flagellated protozoa
Giardia lamblia
1) Asymptomatic carriers- 50%
"beaver fever" - Gastroenteritis 2) Symptomatic: range from mild diarrhea to severe mal-absorption syndromes. 1-4 week incubation and then sudden onset of: DDX: Isospora belli in HIV/ AIDS. Cysts in stool. ELiSA.
foul smelling, watery diarrhea, abdominal cramps, flatulence and steatorrhea
Trichomonas vaginalis
Vaginitis 1) Females: M/C’ly asymptomatic or profuse frothy vaginal discharge 2) Males: M/C’ly asymptomatic Microscopic examination of urine. Culture is also possible.
Trypanosomes
1 week after being bitten, trypomastigotes spread to the bloodstream and lymph. Cycle of replication and lysis. Found in the myocardium and
African sleeping sickness (african
CNS. Can cause death within 9 months - 2 years. Within 3-14 days, painful, indurated red nodule (trypanosoma chancre) develops and Wet mount on ir in Giemsa stained smears. Anemia, monocytosis and elevated IgM.
trypanosomiases)
remits. Fever, HA, rigors, edema. Chronic dz can progress to meningoencephalitis.
Kissing bug deposits feces on skin while biting and enters through mucous membranes. Parasites invade macrophages, where they transform
into amastigotes, multiply and are released as trypomastigotes into blood and tissue. Infect nervous system, RE cells, myocardium, and muscle
Chagas disease (american trypanosomiases) Culture of blood or lymph node. PCR.
cells. Initially asymptomatic. 1-2 weeks later: fever, hepatomegaly, lymphadenopathy. Chronic: cardiomyopathy, atipcal aneuryisms, heart
failure, Stokes-Adams attacks, thromboembolism, mesaesophagus, or megacolon.
Leishmania
Caused by L. tropica (Asia, Africa) or L. mexicana (Latin America). Papules that itch eventually, over months, ulcerate painlessly then
Oriental sore, chiclero ulcer Intracellular amastigotes and Lieshman-Donovan bodies
ultimately heal (again, over months), leaving pitted scars. Lymphadenopathy accompaines initial manifestation.
Semi-epidemic disease. Caused by L. donovani. Incubation is 3-12 months. Fever, hepatosplenomegaly, lymphadenopathy, diarrhea,
Visceral leishmaniasis (kala azar)
malabsorption, gray skin discoloration "black disease", anemia, thrombocytopenia, agranulocytosis. Mortality 90% without treatment.
Sporozoa
Plasmodium species
Periodic episodes of high fever, shaking chills followed by profuse sweating. Other sx: anemia, hepatomegaly, splenomegaly (Brain/LU/KI
Malaria damage with P falciparum). Tertian: sx every 48 hours (P. vivax and P. ovale). Quartan: sx every 72 hours (P. malariae). P. Falciparum is MC Giemsa stain. IgM and then IgG antibodies.
and most deadly. Black water fever - dark red or black urine.
Toxoplasma gondii
heterophile negative mononucleosis like syndrome
chorioretinitis
iff 2nd or 3rd trimester: microencephaly, chorioretinitis +/- blindness, anemia, jaundice, neurological signs (retardation, seizures,
microencephaly, hearing loss). Can be asymptomatic at birth and develop disease months to years later. One of the major cause of
congenital disease Microscopy of biopsy sample.
encephalitis in AIDS. One of the TORCH agents. Can be asymptomatic.
Cryptosporidium parvum
three consecutive stool samples:
Cryptosporidosis Iff immunocompromised (HIV/AIDS) --> Severe diarrhea
Un-concentrated (HIV/ AIDS) or concentrated (centrifuge, etc.). Diagnosis made by O&Px3
Babesia microti
Fatigue Prolonged fever and hemolytic anemia
Arthritis
Roundworms
Ascaris lumbricoides (giant intestinal roundworm)
Concentrated stool - knobby coated, bile stained, oval egg
Bowel obstruction/appendicitis Adult worm in feces (20- 35 cm long)
Pneumonitis Asthma-like attack. Eosinophilia and micratory pulmonary inflitrates seen on plain films help differentiate it from asthma or bronchitis. Worms in stool/ larvae and eosinophils in sputum
Enterobius vermicularis (pinworm)
Perianal itching Periodic nocturnal anal itch (When eggs are laid). No intestinal damage or immune reaction. Spreads easily and rapidly Observation of eggs
Necator americanus, Ancylostoma duodenale (hookworm)
skin reaction/ rash at site of entry. If progress to LU --> pneumonitis. Iff large amount of adult worms: microcytic hypochromic anemia, Characteristic eggs in stool
Hookworm clinical disease
fatigue, nutritional deficiencies.
Trichinella spiralis (trichinosis)
if many migrating --> splinter hemorrhages, persistent fever, GI distress, periorbital edema. Iff >1000 to 5000 larvae/ gm tissue - Can be lethal.
T. spirales clinical syndrome encysted larvae in implicated meat
Acute inflammation and myositis.
Filariasis
Swelling of legs and genitals due to lymph blockage
Page 11 of 12
 Flukes
Schistosoma spp.
develop in intrahepatic
portal system or in vesical,
prostatic, rectal and uterine
Snail as intermediate host plexuses and veins
skin penetrating cercariae Immediate and delayed hypersensitivity reactions. Katayama syndrome. Chronic stage: hepatosplenomegaly with portal HT and
Schistosoma spp. --> burrows through skin to Shitstomiasis Characteristic eggs in stool and urine
liberated from snails hematemesis. retained eggs cause extensive inflammation and scarring. Urinary bladder, bowel, and liver dysfunction.
enter bloodstream
Host response to eggs:
intense, inflammatory
reaction

Tapeworms
Taenia
Form cystericeri are SOL's
Ingestion of undercooked
Taenia: T. saginata, T. (imp in BRAIN) . No
beef (saginatum) or pork Malnutrition, cysticerciasis
solium intestinal damage except
(solium)
absorption problems.
Diphyllobothrium latum
Fish tapeworm
Diphyllobothrium latum From raw, freshwater fish Clinical disease low serum levels of Vitamin B12 --> megaloblastic anemia bile stained, operculated egg with knob-like projection on posterior
one of the longest
tapeworms - 45cm

Page 12 of 12