MYCOLOGY

NAME RESERVOIR MORPHOLOGY CLINICAL SYNDROME TREATMENT DIAGNOSIS NOTES ANATOMIC LOCATION

Malassezia furfur Naturally found on the skin “Spaghetti and meat balls” Tinea/Pityriasis versicolor - a common, Dandruff shampoo (containing Potassium hydroxide (KOH) prep: SUPERFICIAL (SKIN)
AN-AN surfaces of many animals, Dimorphic, lipophilic fungi benign, superficial cutaneous fungal selenium sulfide) reveals short, curved, unbranched
AP-AP including humans. infection usually characterized by hyphae with spherical yeast cells (
hypopigmented or hyperpigmented look like “spaghetti and meatballs”)
macules and patches on the chest and the
back. In patients with a predisposition,
tinea versicolor may chronically recur. The
Isolated in 18% of infants and 90- Topical imidazole Malassezia is extremely difficult to
fungal infection is localized to the stratum
100% of adults. propagate in laboratory culture and
corneum.
is culturable only in media enriched
with C12- to C14-sized fatty acids.
DERMATOPHYTES Depending on the particular Dermatophytosis Topical imidazole KOH: branched hyphae Secretes the enzyme CUTANEOUS
species Tinea corporis (body): “ringworm” Oral griseofuivin is used for Wood’s lamp: ceratin species of keratinase, which digests
Tinea cruRis (groin): “jock itch” tinea unguium and tinea Microsporum will fluoresce under keratin
Tinea pedis (feet): “athlete’s foot” capitis ultraviolet light
Microsporum Soil (geophilic) Tinea capitis (scalp) Oral terbinafine A fungal culture, which is often used For atypical presentations of
Trichopyton Animals (zoophilic) Tinea unguium (nail): Onychomycosis as an adjunct to KOH for diagnosis, is tinea corporis, further
Epidermophyton floccosum Human (anthropophilic) more specific than KOH for detecting evaluation for HIV infection
a dermatophyte infection. Therefore, and/or an
if the clinical suspicion is high yet the immunocompromised state
KOH result is negative, a fungal should be considered.
culture should be obtained.
Infections due to zoophilic or If the above clinical evaluations are
geophilic dermatophytes may inconclusive, a polymerase chain
produce a more intense reaction (PCR) assay for fungal
inflammatory response than deoxyribonucleic acid (DNA)
those caused by anthropophilic identification can be used.
microbes
Sporothrix schenkii Found on rose thorns Suppurating subcutaneous nodules that Itraconazole Dimorphic Primary pulmonary infection SUBCUTANEOUS
progress proximally along lymphatic Fluconazole Culture at 25ºC will grow branching (pulmonary sporotrichosis) is
channels (lymphocutaneous Oral potassium iodide hyphae rare, as is direct inoculation
sporotrichosis) Culture at 37ºC will grow yeast cells into tendons, bursae, or joints.

Definitive diagnosis of sporotrichosis Osteoarticular sporotrichosis is

at any site requires the isolation of S caused by direct inoculation or
schenckii in a specimen culture from hematogenous seeding.
a normally sterile body site.

The organism can be recovered with In rare cases, disseminated S

fungal culture from sputum, pus, schenckii infection
subcutaneous tissue biopsy, synovial (disseminated sporotrichosis)
fluid, synovial biopsy, bone drainage occurs, characterized by
or biopsy, and cerebrospinal fluid disseminated cutaneous
(CSF). lesions and involvement of
multiple visceral organs; this
occurs most commonly in
persons with AIDS.
Coccidioides immitis Desert areas of the southwestern Dimorphic: Coccidiodomycosis Amphotericin B Biopsy of affected tissue: lung Common oppurtunisitc SYSTEMIC
United States and northern Mycelial forms with spores Asymtomatic (in most persons) Itraconazole biopsy, skin biopsy, etc. infection in AIDS patients from
Mexico at 25ºC Pneumonia Fluconazole Silver stain or KOH prep the southwest United States
Respiratory transmission Yeast forms at 37ºC Disseminated: can affect the lungs, skin , Culture on Sabouraud’s agar SPHERULES WITH
bones and meninges Serology ENDOSPORES
Skin test

Histoplasma capsulatum Mississippi valley Dimorphic: Histoplasmosis Itraconazole Lung biopsy Can survive intracellularly SYSTEMIC
Present in bird and bat droppings Mycelial forms with spores Asymptomatic (in most persons) Amphotericin B (in Silver stain specimen within macrophages
Respiratory transmission at 25oC Pneumonia: lessions calcify, which can be immunocompromised patients Culture on Sabouraud’s agar will
Yeast forms at 37oC seen on chest X-ray (may look similar to reveal hyphae at 25oC and yeast at YEASTS WITHIN
PTB) 37oC MACROPHAGES
Disseminated: can occur in almost any Serology
organ, especially in lung, spleen, or liver Skin test (test for exposure only)
Urine antigen test

Blastomyces dermatitidis Dimorphic: Blastomycosis Itraconazole Biopsy of affected tissue: lung BROAD-BASED BUD SYSTEMIC
Mycelial forms with spores Asymptomatic (uncommon) Ketoconazole biopsy, skin biopsy, etc.
at 25oC Pneumonia: lesion rarely calcifies Amphotericin B Silver stain specimen
Yeast forms at 37oC Dessiminated (most common): present Culture on Sabouraud’s agar
with weight loss, night sweats, lung Serology
involvement and skin ulcers Skin test (test for exposure only)
Cutaneuos: skin ulcer Sputum specimens processed with
Blastomycosis is usually localized to the 10% potassium hydroxide, cytology
lungs and may present with: smears, or a fungal stain
A self-limited flulike illness with fever, Enzyme immunoassay (EIA)
chills, myalgia, headache, and a techniques on sputum, tissue, or
nonproductive cough bronchoscopic specimens
An acute illness resembling bacterial
pneumonia, with high fever, chills, a
productive cough, and pleuritic chest pain;
mucopurulent or purulent sputum
Chronic illness, with low-grade fever, a
productive cough, fatigue, night sweats,
and weight loss
Rapidly progressive, and severe disease,
eg, multilobar pneumonia or ARDS, with
fever, shortness of breath, tachypnea,
hypoxemia, and finally hemodynamic
collapse
Cryptococcus neoformans Pigeon droppings Polysaccharide capsule Cryptococcus Amphotericin B and flucytosine India-ink stain of cerebrospinal fluid Most cases occur in SYSTEMIC
Yeast form only (Not Subacute or chronic meningitis (is superior to amphotericin B (CSF): observe encapsulated yeast immunocompromised person
dimorphic) Pneumonia: usually self-limited and alone) Cryptococcal antigen test of CSF:
asymptomatic detects polysaccharide antigens MCC of meningoencephalitis in
Skin lesions: look like acne Fungal culture HIV

YEAST WITH A HALO

Candida albicans Normal flora of the skin, mouth Pseudohyphae and yeast Candidiasis in a normal host The choice of antifungal agent KOH stain of specimen YEAST WITH PSEUDOHYPHAE CUTANEOUS or SYSTEMIC
and gastrointrointestinal tract Oral thrush depends on the area involved Silver stain of specimen (normal host, or
Vulvovaginal candidiasis and its severity. Blood culture: growth must be opportunistic)
Cutaneous respected
Diaper rash Blood assay for beta-D-glucan
Rash in the skin folds of obese individuals
Candidiasis in an immunocompromised
host
Thrush, vaginitis and/or cutaneous, plus:
Esophageal
Disseminated candidiasis: acquired by very
sick hospitalized patients, resulting in
multi-organ system failure
Chronic mucocutaneous candidiasis
Aspergillius fumigatus Ubiquitous Branching septated Aspergillosis Allergic bronchopulmonary Allergic brochopulmonary Rarely found in individuals who OPPORTUNISTIC
Aspergillius flavus hyphae (acute angles, 45O) Allergic bronchopulmonary aspergillosis aspergillosis -> treat with aspergillosis: are immunocompetent
Aspergillius niger Aspergillus may cause a broad (IgE mediated): asthma type asthma type corticosteroids High level of IgE (IgE level > 1000
spectrum of disease in the human reaction with shortness of breath and high Aspergilloma: removal via IU/dL) The FDA has approved an
host, ranging from fever thoracic surgery Sputum culture intravenous formulation of the
hypersensitivity reactions to Asperigilloma (Fungus ball): associated Invasive aspergillosis: treat Wheezing patient and chest X-ray triazole antifungal
direct angioinvasion. Aspergillus with hemoptysis (blood cough) with voriconazole, possibly with fleeting infiltrates posaconazole (Noxafil), which
primarily affects the lungs, Invasive aspergillosis: necrotizing caspofungin. (very high Increased level of eosinophils is indicated for the prophylaxis
causing the following four main pneumonia. May disseminate to other mortality) Skin test: immediate hypersensitivity of invasive Aspergillus and
syndromes: organs in immunocompromised patients reaction Candida infections in severely
• Allergic bronchopulmonary Aflatoxin consumption (produced by Aspergilloma: diagnose with chest X- immunocompromised adults
aspergillosis (ABPA) Aspergillus flavus ) can cause liver damage ray or CT scan who are at high risk of
• Chronic necrotizing Aspergillus and live cancer Invasive aspergillosis: sputum developing these infections.
pneumonia (or chronic examination and culture Aflatoxins contaminate
necrotizing pulmonary peanuts, grains, and rice
aspergillosis [CNPA])
• Aspergilloma
• Invasive aspergillosis

Rhizopus Saprophytic molds Broad, non-septated, Mucormycosis Amphotericin B and surgery Biopsy The disease is rapidly fatal OPPORTUNISTIC
Rhizomucor branching hyphae (right Rhinocerebral (associated with diabetes): Black nasal discharge
Mucor angles, 90o) starts on nasal mucosa and invades the
sinus and orbit
Pulmonary mucormycosis
Pneumocystis jirovecii Unicellular fungi found in the The organism is found in 3 PJP – Pneumocystis jirovecii pneumonia TMP-SMX A lactic dehydrogenase (LDH) study is The taxonomic classification of
respiratory tracts of many distinct morphologic occurs when both cellular immunity and performed as part of the initial the Pneumocystis genus was
mammals and humans stages, as follows: humoral immunity are defective. workup.[24] LDH levels are usually debated for some time. It was
The trophozoite (trophic elevated (>220 U/L) in patients with initially mistaken for a
form), in which it often Once inhaled, the trophic form of P jiroveci pneumonia (PJP). They are trypanosome and then later
exists in clusters Pneumocystis organisms attach to the elevated in 90% of patients with PJP for a protozoan. In the 1980s,
The sporozoite (precystic alveoli. Multiple host immune defects who are infected with HIV. The study biochemical analysis of the
form) allow for uncontrolled replication of has a high sensitivity (78%-100%); its nucleic acid composition of
The cyst, which contains Pneumocystis organisms and development specificity is much lower because Pneumocystis rRNA and
several intracystic bodies of illness. Activated alveolar macrophages other disease processes can result in mitochondrial DNA identified
(spores) without CD4+ cells are unable to eradicate an elevated LDH level. [Clin Invest the organism as a unicellular
Pneumocystis organisms. Increased Med. 1992 Aug. 15(4):309-17. fungus rather than a
alveolar-capillary permeability is visible on Quantitative PCR for pneumocystis protozoan. Subsequent
electron microscopy. may become useful in distinguishing genomic sequence analysis of
between colonization and active multiple genes including
infection, but these assays are not elongation factor 3, a
yet available for routine clinical use. component of fungi protein
synthesis not found in
protozoa, further supported
this notion.
 DNA VIRUSES

VIRUS MORPHOLOGY VIRULENCE FACTORS CLINICAL SYNDROMES TREATMENT & PREVENTION DIAGNOSIS

HSV 1 and 2 Double-stranded DNA Direct contact of mucous membranes Gingivostomatitis Acyclovir Tzanck smear reveals multinucleated giant
Enveloped Valacyclovir cells with intranuclear inclusions
Icosahedral symmetry Viral shedding usually occurs in the Reactivation of Gingivostomatitis occurs Famciclovir Viral culture
presence of obvious herpetic lesions, immunocompromised individuals Trifluridine eye drops: for corneal infection Polymerase chain reaction
but viral shedding can also occur Serology
when there no visible lesions Herpetic keratitis Direct Fluorescent Antibodies (DFA) Ulcer
base scrapings can be tested with antibodies
Sexually transmitted TEMPORAL lobe encephalitis: infection (most cases are will latch onto HSV if present, & will fluoresce
reactivation of latent HSV-1) of the brain results in cell
HSV travels up sensory nerve fibers to death and brain tissue swelling , manifested as fever,
the sensory nerve ganglia, where it headache and neurologic abnormalities
replicates then returns along the
sensory nerve fibers to produce skin Genital herpes: painful group local vesicles on the cervix,
lesions (NEUROTROPISM, LATENCY) or on the external genitalia of men and women. Often
associated with fever and viral symptoms. These vesicles
usually do not scar.

Reactivation of genital herpes similar eruption of

vesicles, but less painful and vesicles last for few more
days

Neonatal herpes: acquired during the passage of a fetus

through an infected birth canal. The risk of transmission
HERPESVIRIDAE

is highest when a primary genital infection is present

during delivery (One of the TORCHES Organism)

Herpetic whitlow
Disseminated herpes infection of organs
Varicella-Zoster Virus Aerosolized respiratory secretions Varicella (chicken pox) Acyclovir Vesicles are described as few drops on the top
2 week incubation period Valacyclovir of a rose petal: a red base with fluid filled
Contact with ruptured vesicles Fever and headache Famciclovir vesicle on top
Rashes: vesicles first erupts on the trunk and face, and Varicella vaccine Lesions appear in all stages of development
Zoster: reactivation of VZV from spread to involve the entire body (including mucous Zoster immune globulin (erupting papules, active vesicles, crusting
dorsal root ganglion membranes). Vesicles erupt in crops, so one crop forms lesions) at a single time -> differentiates
as another crop scabs over. Patients are infectious until varicella from other pediatric rashes
Risk factors for severe varicella in all their lesions scab over. Tzanck smear reveals multinucleated giant
neonates are as follows: Pneumonia or encephalitis can occur in cells
The first month of life: A neonate’s immunocompromised patients
first month of life is a susceptible
period for severe varicella, especially Zoster (shingles): painful eruption of vesicles isolated to
if the mother is seronegative. a single dermatome distribution. The vesicles dry up and
Early delivery: Delivery before 28 form crusts, which disappear in about 3 weeks. Pain in
weeks’ gestation also renders a baby the dermatomal distribution can last for months in the
susceptible because transplacental elderly.
transfer of immunoglobulin G (IgG)
antibodies occurs after this time Herpes zoster ophthalmicus: vesicles on one side of the
forehead and on tip of the nose (the dermatomal
distribution of the first division of cranial nerve V) may
be associated with severe corneal involvement that
(similar to HSV) can lead to blindness
Although most varicella infection confers life-long
immunity, varicella clinical reinfections among healthy
children have been described [Pediatrics. 2002 Jun.
109(6):1068-73.]

Cytomegalovirus (CMV) Double-stranded linear DNA Virus present in milk, saliva, urine & Asymptomatic infection (latent phase) Ganciclovir CMV shell viral culture: Blood buffy coat
Enveloped tears Foscarnet (WBC) is cultured overnight. The cells are then
Icoshedral symmetry Congenital disease (TORCHES) Cidofovir centrifuged. This breaks up the white blood
CMV mononucleosis (heterophil-negative) Formivirsen cells, releasing CMV antigens, which are
detected with monoclonal antibodies

Transmission occurs with prolonged Reactivation in immunocompromised patients Healthy people who are infected with CMV MV has been detected via culture (human
exposure, such as between children A. Pneumonia but who have no symptoms usually do not fibroblast), serologies, antigen assays,
in households or day care center B. Retinitis (MCC of blindness in HIV) require medical treatment. polymerase chain reaction (PCR), and
C. Esophagitis cytopathology. In the transplant population,
D. Disseminated DIsease Antiviral treatment is used for antigen assays or PCR is used (sometimes in
immunocompromised individuals who have conjunction with cytopathology) for diagnosis
eye infections or life-threatening illnesses due and treatment determinations.
to CMV.

Sexual transmission DOC for prevention of CMV disease in solid- Histology: reveals enlarged (Cytomegalic) cells
organ transplant patients is valganciclovir with intranuclear and cytoplasmic inclusion
[Lancet. 2005 Jun 18-24. 365(9477):2105-15] bodies. The pathologic hallmark of CMV
infection is an enlarged cell with viral
inclusion bodies.
Currently, no vaccine available CMV early antigens can be detected in WBC’s.
These antigens are an early marker for
infection in bone marrow transplant patients
PCR testing for CMV DNA
Epstein-Barr virus (EBV) Double-stranded linear DNA Intimate contact from asymptomatic Infectious mononucleosis: fever, sore throat, severe Supportive Elevated heterophileantibodies
shedders of EBV lethargy, enlarged lymph nodes and spleen (generalized)

Enveloped Infects human B-cells -> transforms Infectious mononucleosis was first described by Sprunt Differential white blood cells count will show
them (Receptor: CD 21) and Evans in the Bulletin of the Johns Hopkins Hospital in elevated “atypical lymphocytes” -> Downey
1920. cells
Icoshedral symmetry Immune response to EBV infection is Associated with Burkitt’s B-cell lymphoma (MCC Serology: IgM against the viral capsids
fever -> occurs because of cytokine lymphoma in children) antigens (VCA)
release consequent to B-lymphocyte
invasion by EBV. Lymphocytosis
observed in the RES is caused by a
proliferation of EBV-infected B
lymphocytes.
Pharyngitis observed in EBV
infectious mononucleosis is caused by
the proliferation of EBV-infected B
lymphocytes in the lymphatic tissue
of the oropharynx.
Human Herpesvirus 6 (HHV-6) Double-stranded linear DNA Transmitted by saliva Roseola (exanthum subitum): Supportive Clinical diagnosis

Enveloped

Icoshedral High fever lasting 3-5 days, which resolves, and is

followed by a …

Rash: located mostly on trunk, which lasts just a day or

two
HHV-8 Double-stranded linear DNA Sexual transmission, especially with Appears to be the cause of Kaposi’s sarcoma HAART is an integral part of successful Kaposi CD4 lymphocyte counts and plasma HIV viral-
MSM practice sarcoma therapy. HAART may be tried as the load studies should be performed for patients
sole modality in nonvisceral disease. For with HIV infection.
visceral disease, chemotherapy may be
added.
Enveloped Kaposi’s sarcoma - a spindle-cell tumor thought to be The following local therapies can be used for
derived from endothelial cell lineage; carries a variable palliation of locally advanced symptomatic
clinical course ranging from minimal mucocutaneous disease or in individuals who have
disease to extensive organ involvement. cosmetically unacceptable lesions:

Icoshedral Categorized into 4 types: • Radiation therapy

• Epidemic of AIDS-related • Cryotherapy

• Immunocompromised • Laser therapy

• Classic, or sporadic • Surgical excision

• Endemic (African) • Intralesional vinca alkaloid therapy

AIDS-related Kaposi sarcoma, unlike other forms of the • Topical retinoids

disease, tends to have an aggressive clinical course. It is
the most common presentation of Kaposi sarcoma.
 Immunomodulation with interferon-alfa has
clinical activity in Kaposi sarcoma that may be
mediated by its antiangiogenic, antiviral, and
immunomodulatory properties.

Poxviridae Complex coat: large, brick- Smallpox is a high-priority (category Smallpox: causes skin lesions and death. This disease has Vaccine: an avirulent pox vaccine was No animal reservoirs: Virologists have
shaped virus (making it A) agent for bioterrorism, defined as been eradicated from the earth. Histopathology: developed that included immunity to virulent speculated that it evolved from an African
cytoplasmic in location) follows by the CDC: Guarnieri bodies pox virus rodent poxvirus 10 millennia ago. Because of
Double-stranded linear DNA • Easily disseminated or transmitted the absence of an animal vector, communities
The only DNA virus to replicate from person to person Molluscum contagiosum: small white bumps with a had to reach a critical population (estimated
in cytoplasm • High mortality rate and potential central dimple (like a wart). Often found in the genital at 200,000 around 3000 B.C.) before endemic
for significant public health effect region. Histopathology: Henderson-Peterson bodies smallpox could be established.
• Probable instigator of panic and
social disruption

Special actions required for public Codes for DNA and RNA polymerase
health preparedness
Papovaviridae Naked icosahedral Human papilloma virus (HPV) causes warts (over 50 viral Methods of wart removal Second smallest DNA virus
Double-stranded circular DNA strains) Liquid nitrogen (freeze them off) - best
Replicates in nucleus A. Common warts (types 1, 2, 4 & 7) method HPV is oncogenic because of E6 and E7 genes
koilocytes B. Genital warts (types 6, 11, 16, 18 and others) – Surgical that code for suppressors of human tumor
condylomata acuminata Electrosurgery (laser ablation) suppressor genes.
C. Laryngeal warts (6, 11) Podophyllin: for genital warts
D. Penile, vulvar, cervical, anal cancer (type 16, 18, 31, Many warts resolves spontaneously in 1-2 Condylomata lata – syphilis
33) years Condylomata acuminate – genital warts,
About 50% of men who are homosexual and have anal okay?
squamous cell carcinoma (SCC) have a history of Relapses are common after treatment, In genital intraepithelial neoplasia, it is
anorectal warts because HPV DNA is found in normal essential to determine the extent of disease
appearing tissue around the wart through careful inspection and colposcopy.
BK Polyomavirus: causes kidney disease in renal Laboratory studies that may be considered
transplant patients, hemorrhagic cystitis in bone include the following:
marrow transplant patients, and mild respiratory illness Cervical cytologic testing with the
in children Papanicolaou (Pap) test to screen for cervical
JC polyomavirus: Progressive multifocal neoplasia (guidelines for cervical cancer
leukoencephalopathy, characterized by degenerative screening now include a delay in the initiation
central nervous system white matter disease of screening and longer intervals between
subsequent screens
HPV DNA testing (eg, with Hybrid Capture II
or polymerase chain reaction [PCR] assay) for
detection of HPV and posttreatment follow-up
of cervical intraepithelial neoplasia
The acetic acid test: This test can be used in
conjunction with colposcopy to examine
cervical lesions; however, it is reserved for
suspicious lesions and should not be used for
routine screening

Adenoviridae Naked icosahedral Childhood upper respiratory tract infections Illness is self-limited Pharyngo-conjunctival fevel
Double-stranded circular DNA A. Rhinitis
Replicates in nucleus B. Sore throat
C. Fever
D. Conjunctivitis
2. Epidemic keratoconjunctivitis (pink eye)
3. Epidemic diarrheal illness in infants and children
 Parvoviridae Naked icosahedral Erythema infectiosum (fifth disease): affects children Illness is self-limited Smallest DNA virus
Parvovirus B-19 Double-stranded linear DNA between the ages of 4 to 12
virus (negative stranded) Fever + “Slapped cheek” rash I.V. immunoglobulin can be used with aplastic
Replicates in nucleus Transient aplastic anemia crisis: occurs when the crisis
Parvovirus stops the production of red blood cells in the
boone marrow

RNA VIRUSES

VIRUS MORPHOLOGY VIRULENCE FACTORS CLINICAL SYNDROMES TREATMENT & PREVENTION DIAGNOSIS

Influenza A: human and Negative (-) single-stranded RNA Hemagglutinin (HA) glycoprotein: binds Influenza Vaccine contraindicated in egg allergies Antigenic drift, small mutations, resulting
animal strain Segmented (7-8) genome to red blood cells. Also binds to cells of • Fever (vaccine grown in eggs) in minor changes in the antigenicity of HA
Influenza B: human only Lipid containing envelope the upper respiratory tract. The HA is • Sore throat or NA. This results in epidemics of the
strain Helical symmetry then cleaved into pieces (HA1 & HA2) by • Myalgias common flu
Influenza C: human only host cell proteases, which allows HA to • Frontal or retro-orbital headache
strain activate fusion. The viral RNA in then • Nasal discharge
dumped into these cells • Weakness and severe fatigue
Replicates in the nucleus (Retroviruses are the Neuraminidase (NA) glycoprotein: • Cough and other respiratory symptoms Prevention of influenza is the most effective Antigenic shift (occurs with Influenza A):
only other type of RNA viruses that replicate in breaks down neuraminic acid, an • Tachycardia management strategy. Influenza A and B genomic reassortment. Major changes of
the nucleus) important component of mucin • Watery eyes vaccine is administered each year before flu the HA or NA (including acquisition of
season. The CDC analyzes the vaccine animal HA or NA). This results in
subtypes each year and makes any necessary devastating influenza pandemics
changes on the basis of worldwide trends.
The hemagglutinin and neuraminidase Traditionally, the vaccine is trivalent (ie, New avian influenza H5N1 has infected
variants are used to identify influenza A designed to provide protection against 3 viral hundreds of people and represents a
virus subtypes. For example, influenza A subtypes, generally an A-H1, an A-H3, and a great risk of starting a human pandemic.
subtype H3N2 expresses hemagglutinin 3 B). The first quadrivalent vaccines, which also
and neuraminidase 2. The most common provide coverage against a second influenza Mortality is highest in infants and the
subtypes of human influenza virus B subtype, were approved in 2012 and were elderly. The 2012-2013 season was
identified to date contain only made available for the 2013-2014 flu season. notable for widespread disease and a
hemagglutinins 1, 2, and 3 and higher death rate than was reported in
neuraminidases 1 and 2. H3N2 and H1N1 Amantadine and Rimantidine (used in previous years. In addition, the
are the most common prevailing parkinsonism) prevent viral uncoating of predominant influenza virus subtype was
influenza A subtypes that infect humans. influenza A an H3N2, in contrast to dominance by
Each year, the trivalent vaccine used H1N1 subtypes in recent past years.
worldwide contains influenza A strains
from H1N1 and H3N2, along with an
influenza B strain.
ORTHOMYXOVIRIDAE

Because the viral RNA polymerase lacks Complications Zanamivir (inhaled) & Oseltamivir (oral) are Year 1918 - the Spanish flu (though cases
error-checking mechanisms, the year-to- Secondary bacterial pneumonias in the elderly neuraminidase inhibitors. Can shorten course appeared earlier in the United States and
year antigenic drift is sufficient to ensure Reye’s syndrome in children who use aspirin, get of influenza A and B elsewhere in Europe), this pandemic
that there is a significant susceptible liver and brain disease killed an estimated 20-50 million persons
host population each year. However, the Increased mortality in the elderly and in those [Emerg Infect Dis. 2006 Jan. 12(1):9-14.]
segmented genome also has the underlying pulmonary and cardiac disease
potential to allow reassortment of
genome segments from different strains
of influenza in a coinfected host.
 Negative (-) single stranded RNA HA, but no NA Measles - one of the most contagious infectious Treatment of measles is essentially Although the diagnosis of measles is
Measles (Rubeola) Unsegmented diseases, with at least a 90% secondary infection supportive care, as follows: usually determined from the classic
Lipid containing envelope F-protein (fusion protein) – leads to rate in susceptible domestic contacts. Despite • Maintenance of good hydration and clinical picture, laboratory identification
Helical symmetry formations of multinucleated giant cells being considered primarily a childhood illness, replacement of fluids lost through diarrhea and confirmation of the diagnosis are
measles can affect people of all ages. or emesis necessary for public health and outbreak
• IV rehydration may be necessary if control. Laboratory confirmation is
dehydration is severe achieved by means of the following:
• Vitamin A supplementation should be • Serologic testing for measles-specific
considered IgM or IgG titers
• Isolation of the virus
Replicates in cytoplasm Prodrome: high fever, hacking cough and Postexposure prophylaxis should be Reverse-transcriptase polymerase chain
conjunctivitis considered in unvaccinated contacts; timely reaction (RT-PCR) evaluation
Koplik’s spots: small red-based blue-white tracing of contacts should be a priority. Biopsy of rash or Koplik’s spots reveals
centered lesions in the mouth Patients should receive regular follow-up multinucleated giant cells
Rash: from head, then to neck and torso, then to care with a primary care physician for Warthin-Finkeldey bodies
feet. As the rash spreads, it coaleces surveillance of complications arising from the (multinucleated giant cells in measles)
infection.

Complications:Pneumonia, eye damage, WHO recommends vitamin A

myocarditis and encephalitis20% risk of fetal supplementation for all children diagnosed
death if acquired by a pregnant women early in with measles, regardless of their country of
her pregnancySubacute Sclerosing residence, based on their age, as follows:•
Panencephalitis: slow form of encephalitis that Infants younger than 6 months: 50,000
occurs many years after a measles infection IU/day PO for 2 doses • Age 6-11 months:
(Damson disease) 100,000 IU/day PO for 2 doses • Older than 1
year: 200,000 IU/day PO for 2 doses
Children with clinical signs of vitamin A
deficiency : The first 2 doses as appropriate
for age, then a third age-specific dose given
2-4 weeks later

Prevention: MMR vaccine:

1. Measles (live attenuated)
2. Mumps
3. Rubella
Parainfluenza 1 and 2 Negative (-) single stranded RNA Glycoproteins with combined HA and NA Upper respiratory tract infection in adults: Supportive: racemic epinephrine Isolation and identification of the virus in
Unsegmented activity bronchitis, pharyngitis, rhinitis cell culture or direct detection of the
PARAMYXOVIRIDAE

Lipid containing envelope F-protein (Fusion protein): results in Viral pneumonia in children elderly and Antiviral agents are of uncertain benefit; virus in respiratory secretions by means
Helical symmetry multinucleated giant cells (called immunocompromised antibiotics are used only if bacterial of immunofluorescent assay, enzyme-
Replicates in cytoplasm syncytial cells) complications (eg, otitis and sinusitis) linked immunosorbent assay (ELISA), or
develop. polymerase chain reaction (PCR) assay

Human PIVs are common community- Croup. Children develop a barking cough due to Demonstration of a significant rise in
acquired respiratory pathogens without infection and swelling (narrowing) of the larynx -> specific immunoglobulin G (IgG)
ethnic, socioeconomic, gender, age, or steeple sign antibodies between appropriately
 geographic boundaries. Many factors Human PIV-1 is most commonly associated with collected paired serum specimens or in
have been found that predispose croup. specific immunoglobulin M (IgM)
individuals to these infections, including Human PIV-2 is also associated with croup. antibodies in a single serum specimen
the following: Human PIV-3 is second only to RSV as a cause of
• Malnutrition pneumonia and bronchiolitis in infants and young
• Overcrowding children.
• Vitamin A deficiency Human PIV-4 is detected in patients less often,
• Lack of breastfeeding perhaps because HPIV-4 causes less severe
• Environmental smoke or toxins disease.
Bronchiolitis in children

Respiratory syncytial virus Negative (-) single stranded RNA F-protein Most common cause of pneumonia in infants less Palivizumab: a monoclonal antibody against Specific diagnostic tests for confirming
(RSV) Unsegmented NO HA nor NA glycoproteins 6 months of age RSV that is produced a recombinant DNA. It RSV infection include the following:
Lipid containing envelope Acute otitis media occurs in up to 33% of children is given intramuscularly. • Culture
The leading cause of lower Helical symmetry with RSV illness The American Academy of Pediatrics has • Antigen-revealing techniques
respiratory tract infections Replicates in cytoplasm released updated guidelines addressing • Polymerase chain reaction (PCR)
(LRTIs) in infants and young palivizumab prophylaxis for respiratory assay
children. syncytial virus (RSV). • Molecular probes

According to the updated recommendations,

palivizumab prophylaxis for RSV should be
limited to infants born before 29 weeks'
gestation and to infants with chronic illness
such as congenital heart disease or chronic
lung disease. Other recommendations
include the following:• Give infants who
qualify for prophylaxis in the first year of life
no more than five monthly doses of
palivizumab (15 mg/kg per dose) during the
RSV season • In the second year of life,
palivizumab prophylaxis is recommended
only for children who needed supplemental
oxygen for 28 days or more after birth and
who continue to need medical intervention
(supplemental oxygen, chronic
corticosteroid, or diuretic therapy). •
Clinicians may consider prophylaxis for
children younger than 24 months if they will
be profoundly immunocompromised during
the RSV season.

Ribavirin - primarily reserved for patients

with significant underlying risk factors and
severe acute RSV disease (eg, transplant
recipients)
 Mumps (Rubulavirus) Negative (-) single stranded RNA Glycoproteins with combined HA and NA Mumps - acute, self-limited, systemic viral illness Conservative, supportive medical care is Mumps is a clinical diagnosis.
Unsegmented activity characterized by the swelling of one or more of indicated for patients with mumps. No
Lipid containing envelope F-protein the salivary glands, typically the parotid glands. antiviral agent is indicated for viral illness, as Only one antigenic type. Therefore, the
Helical symmetry The illness is caused by the RNA virus, Rubulavirus mumps is a self-limited disease. vaccine is protective.
Replicates in cytoplasm
Parotid gland swelling (painful) Current evidence suggests that patients
diagnosed with mumps should be isolated
Testicular inflammation (very painful) for 5 days from the onset of symptoms.

MeningitisEncephalitis Prevention: MMR vaccine:

1. Measles (live attenuated)
2. Mumps
3. Rubella

Rubella Enveloped virus with an icosahedral nucleocapsid The virus attaches to and invades the Rubella: ( Geman mesles/3 day measles) Prevention: MMR vaccine: A clinical diagnosis of rubella may be
and one ss-positive-RNA respiratory epithelium. It then spreads Fever, lymphadenopathy and mild flu-like 1. Measles (live attenuated) difficult to make because many
Derived from a Latin term hematogenously (primary viremia) to symptoms 2. Mumps exanthematic diseases may mimic rubella
meaning "little red." regional and distant lymphatics and Rash: from forehead to face to torso to 3. Rubella infection. In addition, as many as 50% of
replicates in the reticuloendothelial extremities (lasts 3 days) rubella infections may be subclinical;
system. This is followed by a secondary therefore, laboratory studies are
viremia that occurs 6-20 days after important to confirm the diagnosis of
infection. acute rubella infection.
The major complication of rubella is its The laboratory diagnosis of rubella can be
teratogenic effects when pregnant women made either though serologic testing or
contract the disease, especially in the early weeks by viral culture. The serologic diagnosis
of gestation.Congenital defects: occurs when a consists of demonstrating the presence of
women in her first trimester of pregnancy gets rubella-specific immunoglobulin M (IgM)
exposed. The fetus may develop defects of the antibody in a single serum sample or
heart, eyes, or central nervous system observation of a significant (>4-fold) rise
in rubella-specific immunoglobulin G
(IgG) antibody titer between the acute
and convalescent serum specimens
drawn 2-3 weeks apart.

False-positive rubella IgM test results

TOGAVIRIDAE

have been reported in persons with other

viral infections (eg, acute EBV, CMV,
parvovirus B19 infection) and in the
presence of rheumatoid factor (RF).
The “R” in TORCHES
 Yellow fever virus Positive (+) single-stranded RNA Yellow fever: hepatitis with(jaundice), Fever, Prevention: mosquito control Viral culture
Dengue virus Nonsegmented RNA Backache Vaccination required when travelling to and Serology
St. Louis encephalitis Icosahedral symmetry from endemic countries With repeat infections, individuals are at
Japanese B encephalitis Replicates the cytoplasm Dengue fever: “Break bone fever” higher risk of developing the
Hepatitis C virus Enveloped “Painful fever”: High fever along with hemorrhagic form of dengue fever
West Nile Virus Vector = mosquito 1. Headaches West Nile: Serology is much more
Aedes: yellow fever and dengue fever 2. Muscle aches sensitive that PCR, although because of
3. Joint aches cross-reactions with other flaviviruses, it
Culex: St. Louis, Japanese, and West Nile 4. backache is less specific
encephalitis
Dengue hemorrhagic fever: hemorrhage,
thrombocytopenia and septic shock

St. Louis, Japanese, West Nile encephalitis:

encephalitis and fever

Hepatitis C virus – see Hepatitides

West Nile: fever and encephalitis or myelitis that

produces flaccid paralysis
FLAVIVIRIDAE

Poliovirus Positive (+) single-stranded RNA Inapparent, asymptomatic infection Vaccine: Transmission: Fecal-oral
Naked icosahedral symmetry Abortive poliomyelitis – most common clinical The chance of developing paralytic
Salk vaccine formalinkilied polio virus that is
form; mild, febrile illness with headache, sore poliomyelitis increase as one gets older.
injected subcutaneously
throat, nausea, and vomiting.
Oral polio vaccine (developed by Sabin):
Attenuated (non-virulent) polio virus is
Replication occurs in the cytoplasm Nonparalytic poliomyelitis – aseptic meningitis Since the World Health Assembly in May
ingested
1988 resolved to eradicate poliomyelitis,
PICORNAVIRIDAE

Paralytic poliomyelitis – virus destroys the the estimated global incidence of polio
anterior horn cells in the spinal cord -> flaccid has decreased by more than 99%, and 3
paralysis; permanent motor nerve damage World Health Organization (WHO)
regions (the Americas, the Western
Pacific, and Europe) have been certified
as polio-free.
Coxsackie A “Cold” rashes, viral meningitis
 Coxsackie B Herpangina: Fever, sore throat and small red-
based vesicle over the back of the patient’s throat

Hand Foot and Mouth Disease: Occurs in children

less than 5, Vesicles erupt on hands, foot and
mouth, which are highly contagious

Viral meningitis

Myocarditis/pericarditis: arrhythmia,
cardiomyopathy, heart failure

Pleurodynia: fever and sharp pleuritic chest pain

ECHOviruses (Enteric, “Cold”, rashes, viral meningitis

Cytopathic, Human Orphan) Pericarditis

Rhinovirus Common colds

113 serotypes
Replicates better at 33°C than at 37°C -> they
affect primarily the nose and conjunctiva rather
than the lower respiratory tract.

Acid-labile -> killed by gastric acid when

swallowed -> they do not infect the
gastrointestinal tract, unlike the enteroviruses.

Host range is limited to humans and chimpanzees

Norwalk virus ; Positive (+) single stranded RNA Noroviruses are highly contagious, with Viral gastroenteritis: (explosive, but self-limited): Supportive Immune electron microscopy: Immune
New name: NOROVIRUS Naked icosahedral symmetry infection requiring fever than 10 virions Fever, Abdominal pain, Vomiting, Diarrhea serum is used to aggregate virus in stool
The most common cause of Replication occurs in the cytoplasm (ID50 = 10 virions), leading to disease in samples to aid detection
epidemic nonbacterial Fecal-oral transmission 50% of inoculated individuals.
gastroenteritis in the world
The virus is extremely stable in the Antigen detection immunoassay: Has high
environment and resists freezing sensitivity but low specificity because of
temperatures, heat (up to 60°C), reactivity with antigenic variants and
disinfection with chlorine, acidic homologous viruses
conditions, vinegar, alcohol, antiseptic
hand solutions, and high sugar
concentrations.
The incubation period is approximately 1- Nucleic acid amplification: Highly
REOVIR CALICIVIRIDAE

2 days, and symptoms typically last 1-3 sensitive and specific

days (or longer in immunocompromised Serum antibody titers can be detected
individuals). Viral shedding occurs for up within 2 weeks of illness. During
to 3 weeks following infection. norovirus infection, immunoglobulin M
(IgM) to norovirus has been found to be
more specific than IgG.
Rotavirus Double-stranded RNA Viral gastroenteritis: causes profound Intravenous fluids Rotavirus may be identifies by the
Segmented (11 segments) genome dehydaration New oral rotavirus vaccine appears safe and following means:
IDAE

Naked icosahedral symmetry Hyperactive bowel sounds: Most common finding effective in infants • enxyme immuno assay (most common)
 Fecal-oral tranmission Especially in infants. Fever, abdominal pain, There are currently 2 FDA-approved rotavirus • latex agglutination
vomiting and diarrhea vaccines to protect against rotavirus • electron microscopy
gastroenteritis (ie, RotaTeq and Rotarix). • culture
No blood, No pus in diarrhea These vaccines are indicated in infants aged
6-32 weeks (RotaTeq) and those aged 6-24
A major cause of infant death in underdeveloped weeks (Rotarix)
countries and the most common cause of diarrhea
in infants less than 3 years of age

Coronavirus Positive (+) single-stranded RNA Upper respiratory tract infection (“common cold”) Supportive
Nonsegmented After establishment of infection, SARS- Severe acute respiratory syndrome (SARS) is a According to guidelines from the Centers
Helical symmetry CoV causes tissue damage by (1) direct serious, potentially life-threatening viral infection for Disease Control and Prevention (CDC),
Enveloped lytic effects on host cells and (2) indirect caused by a previously unrecognized virus from the laboratory diagnosis of SARS-CoV
Replication in the cytoplasm consequences resulting from the host the Coronaviridae family, the SARS-associated infection is established on the basis of
immune response. Autopsies coronavirus (SARS-CoV) detection of any of the following with a
demonstrated changes that were validated test, with confirmation in a
confined mostly to pulmonary tissue, reference laboratory:
where diffuse alveolar damage was the • Serum antibodies to SARS-CoV in a
most prominent feature. single serum specimen
• A 4-fold or greater increase in SARS-CoV
The other mechanism was thought to be The clinical course of SARS generally follows a antibody titer between acute- and
the induction of apoptosis. The SARS- typical pattern. convalescent-phase serum specimens
CoV–3a and –7a proteins have been Stage 1 is a flulike prodrome that begins 2-7 days tested in parallel
demonstrated to be inducers of apoptosis after incubation, lasts 3-7 days, and is • Negative SARS-CoV antibody test result
in various cell lines characterized by the following: on acute-phase serum and positive SARS-
• Fever (>100.4°F [38°C]) CoV antibody test result on convalescent-
• Fatigue phase serum tested in parallel
• Headaches • Isolation in cell culture of SARS-CoV
• Chills from a clinical specimen, with
• Myalgias confirmation using a test validated by the
• Malaise CDC
• Anorexia • Detection of SARS-CoV RNA via reverse
transcriptase polymerase chain reaction
(RT-PCR) assay validated by the CDC, with
confirmation in a reference laboratory,
from (1) two clinical specimens from
different sources or (2) two clinical
specimens collected from the same
source on 2 different days
Middle East respiratory syndrome (MERS) is a No vaccine currently exists for MERS, and no The recommended algorithm for
respiratory disease caused by a newly recognized specific treatment has been recommended. detection of MERS-CoV includes testing
coronavirus (MERS-CoV). It was first reported in Management is currently supportive. using rRT-PCR.
2012 in Saudi Arabia and is thus far linked to
countries in or near the Arabian Peninsula (United Serologic testing is available for the
CORONAVIRIDAE

Arab Emirates [UAE], Qatar, Oman, Jordan, evaluation of MERS-CoV infection or

Kuwait, Yemen, and Lebanon). As of May 2014, exposure
two cases had been reported in the United States,
both in men who had recently returned from
Saudi Arabia. [MMWR Morb Mortal Wkly Rep.
2015 Jan 30. 64 (3):61-2]
 Rabies virus Bullet shapedNegative (-) single-stranded Rabies is a highly neurotropic virus that Incubation period: asymptomaticProdromal NO TREATMENTVaccination of animalsIf Diagnosis: Microscopic examination of
RNANonsegmentedHelical nucleocapsid is coiled evades immune surveillance by its period: The virus enters the CNS. The duration of bitten by possible rabid animal, there are the central nervous system reveals Negri
into a bullet shape Replication in the sequestration in the nervous system. this period is 2-10 days. Nonspecific symptoms three possibilities:Capture animal: observe bodies. These are collections of virions in
cytoplasmZoonotic (all warm blooded animals): Upon inoculation, it enters the peripheral and signs develop. Paresthesia, pain, or intense for 10 daysDestroy animal: examine for Negri the cytoplasm where replication occurs
dogs, cats, skunks, coyotes, foxes, raccoons, and nerves. A prolonged incubation follows, itching at the inoculation site is pathognomonic bodies
bats are reservoirs in the U.S.Transmitted via an the length of which depends on the size for rabies and occurs in 50% of cases during this
animal bite of the inoculum and its proximity to the phase; this may be the individual’s only
CNS. Amplification occurs until bare presenting sign.Acute neurologic period:
nucleocapsids spill into the myoneural associated with objective signs of developing CNS
junction and enter motor and sensory disease.
axons. At this point, prophylactic therapy
becomes futile, and rabies can be
expected to follow its fatal course, with a
mortality rate of 100%.
The rabies virus travels along these axons Furious rabies may develop during this period: Treat immediately (if you can not capture the Viral cultures and PCR
at a rate of 12-24 mm/d to enter the patients develop agitation, hyperactivity, animal, or the animal is found to have a • Saliva - Results of saliva culture for
spinal ganglion. Its multiplication in the restlessness, thrashing, biting, confusion, or rabies): rabies virus are positive in low yield
ganglion is heralded by the onset of pain hallucinations. 1. Clean wound within 2 weeks of illness onset
or paresthesia at the site of the inoculum, 2. Passive immunization with rabies immune • Cerebrospinal fluid - After the first week
which is the first clinical symptom and a Paralytic rabies (dumb rabies or apathetic rabies) globulin of illness, 80% monocytosis is observed;
hallmark finding. From here, the rabies -> patient is relatively quiet compared with a 3. Active immunization with killed rabies protein and glucose test results are
virus spreads quickly, at a rate of 200-400 person with the furious form virus baccine normal
mm/d, into the CNS, and spread is • Brain tissue - Often postmortem;
RHABDOVIRIDAE

marked by rapidly progressive staining with immunohistochemical or

encephalitis. Thereafter, the virus florescent antibody staining is definitive.
spreads to the periphery and salivary Negri bodies are pathognomonic
glands. (cytoplasmic inclusion bodies reflective of
accumulated virions within rabies-
infected neurons). They are found in the
horn of Ammon of the hippocampus and
cerebral cortex
HIV Enveloped virus with two copies (diploid) of a Transmembrane protein, TM (fusion PHASE 0 – INFECTION: HIV acquired through highly active antiretroviral therapy (HAART): Presumptive diagnosis -> detection of
single-stranded, positive-polarity RNA genome protein, also called gp41), which is linked sexual intercourse, blood, or perinatally two nucleoside inhibitors (zidovudine and antibodies by ELISA. There are some
Most complex of the known retroviruses to a surface protein, and SU (attachment PHASE 1 - WINDOW PERIOD: rapid viral lamivudine) and protease inhibitor (indinavir) false-positive results with this test
Many serotypes protein, gp120) replication but HIV test is negative Definitive diagnosis -> Western blot
PHASE 2 – SEROCONVERSION: peak of viral load, analysis
positive HIV test, mild flu-like illness, lasting 1-2 Grown in culture from clinical specimens
Cone-shaped, icosahedral core containing weeks
the major capsid protein (CA also called PHASE 3 - LATENT PERIOD: asymptomatic, CD4
p24) goes down, lasts 1-15 years
MA (p17)-- directs entry of the double- PHASE 4 - EARLY SYMPTOMATIC: CD4 500 to 200, Polymerase chain reaction (PCR) -> very
stranded DNA provirus into the nucleus, lasts 5 years, mild mucocutaneous, dermatologic sensitive and specific: To detect HIV DNA
and is later essential for the process of and hematologic illnesses within infected cells. Some individuals
virus assembly. There are two identical PHASE 5 – AIDS: CD4 <200, lasts 2 years, AIDS- who do not have detectable antibodies
copies of the positive sense, single- defining illnesses develop have been shown by this test to be
stranded RNA genome in the capsid (that infected. Amount of viral RNA in the
RETROVIRIDAE

is, unlike other viruses, retroviruses are plasma (i.e., the viral load) can also be
diploid). determined using PCR-based assays.
The RNA is tightly complexed with a basic
protein, NC (p7), in a nucleocapsid
structure that differs in morphology
among the different retrovirus genera.
 HEPATITIDES

VIRUS TAXONOMY/MORPHOLOGY TRANSMISION CLINICAL TREATMENT SEROLOGY

Hepatitis A Picornaviridae Fecal-oral Acute viral hepatitis fever, jaundice Pooled immune serum globulin Anti-HAV IgM - Active disease
and a painful enlarged liver Supportive care Anti-HAV IgG – old: No active disease against repeated infection
Positive (+) single-stranded RNA HAV vaccine
No envelope (naked)
Icosahedal capsid
Hepatitis B Hepadnaviridae Blood transfusion Acute viral hepatitis Prevention: Hepatitis B recombinant HBsAg – Disease (acute or chronic)
Double-stranded circular DNA Needlestick injury Fulminant haepatitis: severe acute vaccine Anti-HbsAg – immunity provides protection against repeated infection
Enveloped Sexual hepatitis and rapid destruction of liver Screen blood to remove HBV IgM anti-HBcAg – New infection
Icosahedal capsid Across the placenta Chronic hepatitis (10%) contaminated blood to the donor pool HBeAg – high infectivity
Dane particle (intact virus) includes: envelope, Perinatally A. Asymptomatic carrier Treatment options: interferons (alfa Anti- HBeAg – Low infectivity
capsid- associated proteins, capsid, core B. Chonic persistent hepatitis and pegylated-interfron alfa) or
(DNA+protein enzymes), hepatis B surface antigen C. Chronic active hepatitis nucleoside analogs (Iamivudine,
(HBsAg), envelope, capsid-associated proteins, Coinfection or superinfection with adefovir, entecavir and telbivudine
heptitis B core antigen (HBcAg) hepatitis Delta virus (HDV) Lamivudine – antiretroviral drug; also
Double-stranded DNA Complications: primary hepatocellular used in HIV; a reverse transcriptase
DNA polymerase enzyme carcinoma, cirrhosis inhibitor because HBV also expresses
Capsid reverse transcriptase

Hepatitis B antigen (HBeAg): soluble component of the core, which is

marker for active disease

Hepatitis C Flavivirus Blood transfusion Acute viral hepatitis Treatment: combination therapy with Screening anti-HCV antibodies
Single-stranded RNA Needlestick injury Up to 85% develop chronic hepatitis interferon and ribavirin
Enveloped icosachedral capsid Sexually 20% will develop cirrhosis
Across the placenta Increased risk of developing primary
hepatocellular carcinoma (especially
with alcoholism)
Hepatitis D Incomplete RNA virus-only infective with the help of Blood transfusion Coinfection: HBV and HDV are acquired Control of HBV infection is currently Serology is not very helpful, since detectable titers of IgM and IgG anti-HDV are
Complementation with HBV hepatitis B virus Needlestick injury at the same time, and caused an acute the only way to protect against HDV present only fleetingly
Helical nucleocapsid that requires the hepatitis B Sexual hepatitis.
envelope (HBsAg) to be infectious Across the placenta Anti-HBV antibodies help cure
infections
Superinfection: HDV infects a patient
with chronic hepatitis B who can not
manufacture Anti-HBsAg antibodies
Complications:
A. Fulminany hepatitis
B. Cirrhosis

Hepatitis E Hepeviridae Fecal-oral Hepatitis (like hepatitis A)

Single-stranded RNA
No envelope (naked) High mortality in pregnant women

GRAM POSITIVE COCCI

GRAM POSITIVE BACILLI

 GRAM POSITIVE COCCI
MICROORGANISM RESERVOIR TRANSMISSION METABOLISM VIRULENCE FACTORS TOXINS CLINICAL SYNDROMES TREATMENT AND DIAGNOSIS NOTES
PREVENTION
Staphylococcus aureus Humans (nasal) Direct contact, fomites, Catalase-positive Protein A: binds IgG, Exofoliatin: Scaled skin SKIN and SOFT TISSUE INFECTIONS methicillin-sensitive SA Gram-stain: 95% resistance to
contaminated food Coagulase-positive preventing opsonization syndrome; epidermal - bullous impetigo, folliculitis, furuncles, (MSSA) - Penicillinase- reveals gram- penicillins
Facultative anaerobe and phagocytosis separation carbuncles, cellulitis, hidradenitis resistant penicillins positive cocci in 60% MRSA in the
Coagulase: Allows fibrin Enterotoxin: superantigen suppurativa, mastitis, surgical site (nafcillin, oxacillin, and cluster Philippines
formation around causing food poisoning infections dicloxacillin) Culture: Mode of resistance:
organism Toxic shock syndrome ACUTE ENDOCARDITIS methicillin-resistant SA Beta-hemolytic mecA gene
Hemolysins: toxc to toxin (TSST-1) - most common cause of acute (MRSA)- contain altered Produces a golden DDX strawberry
hematopoietic cells Alpha toxin: marked endocarditis PBP; DOC is vancomycin yellow pigment. tongue: TSS,
Penicillase : inactivate necrosis of skin and - native/non-prosthetic/natural/normal vancomycin-resistant SA Polymerase chain Kawasaki, Scarlet
penicillin derivatives hemolysis eg Gangrene valve (tricuspid valve) in IV drug abusers (VRSA)- DOC is linezolid reaction (PCR): fever
Hyaluronidase: breaks PNEUMONIA mecA gene for Vancomycin: rapid
down connective tissue - nosocomial, necrotizing, complicated MRSA infusion casues
Staphylokinase: lyses by empyema, abscess or pneumatocele histamine release -->
formed - post-viral Red man/neck
PV Leukocidin: white OSTEOMYELITIS and SEPTIC ARTHRITIS syndrome
blood cell secific GASTROENTERITIS Linezolid: inhibits
Lipase : spread in fat - acute onset (4 hrs) of vomiting and initiation of
containing areas of the diarrhea due to ingestion of preformed translation
body eg cellulitis heat-stable enterotoxin
- source: salad made with mayonnaise
(potato or tuna salad)
SCALDED SKIN SYNDROME (Ritter
Disease)
- exfoliatin cleaves desmoglein in
desmosomes; separation at Stratum
granulosum

TOXIC SHOCK SYNDROME

- fever, hypotension, strawberry
tongue, desquamating rash and multi-
organ involvement (>3)
- usually no site of pyogenic
inflammation; blood CS negative;
TOXEMIA
-tampon-using menstruating women or
in patients with nasal packing for
epistaxis
Staphylococcus epidermidis Humans Nosocomial Catalase-positive Polysaccharide capsule Prosthetic device infections (valves, Removal of prosthetic Gram stain: gram-
Coagulase-negative (glycocalyx): adheres to joints, plates) device Vancomycin (50% positive cocci in
Facultative anaerobe a variety of prosthetic methicillin resistance) clusters
NOVOBIOCIN devices. Forms a Culture: white
SENSITIVE biofilm. colonies on blood
Highly resistant to agar, non-
antibiotics hemolytic
Metabolism:
Catalase-positive
Coagulase-positive
Staphylococcus Humans Catalase-positive 2nd most common cause of UTI in Fluoroquinolones Gram stain: gram- 2nd most common
saphrophyticus Coagulase-negative sexually active women TMP-SMX positive cocci in cause of UTI in
Facultative anaerobe clusters sexually active
NOVOBIOCIN Culture: gamma- women
RESISTANT hemolytic
Metabolism:
NO STRES Catalase-positive
Coagulase-positive

Streptococcus pyogenes Humans Respiratory droplets Catalase-negative Erythrogenic toxin: Hyaluronidase: degrades Impetigo contagiosa: accummulation of DOC is Penicillin G Gram-positive Disease of poverty
GABHS produces scarlet fever hyaluronic acid (spreading neutrophils beneath stratum corneum Patients with a history of cocci in chains ASO titers:
Streptolysin O (oxygen- factor) Erysipelas: infection that extends into rheumatic fever require Catalase-negative antecedent
labile): highly antigenic, Streptokinase dermal lymphatics long-term antibiotic Beta-hemolytic pharyngitis
causes AB formation (fibrinolysin) Cellulitis prophylaxis to prevent Bacitracin- Anti-DNAase B:
Streptolysin S (oxygen- DNase (streptodornase): Necrotizing recurrence of the disease sensitive antecedent skin
stable) degrades DNA in exudates PHARYNGITIS: most common bacterial Lancefield group A infection
Pyogenic exotoxin A: or necrotic tissue cause of sore throat positive PYR test: Anti-streptokinase
superantigen similar to C5a peptidase: inactivates SCARLET FEVER: "Second disease"; due non-specific; antibodies: decrease
TSST complement C5a to erythrogenic toxin; Dick Test for cannot efficacy of
Exotoxin B: protease susceptibility differentiate streptokinase in
that rapidly destroys STREPTOCOCCAL TOXIC SHOCK pygenes from managing MI
tissue → necrotizing SYNDROME: clinically similar but milder other streptococci M protein: major
fasciitis than S. aureus TSS, due to pyogenic virulence foof Group
exotoxin A, recognizable site of A streptococcus;
pyogenic inflammation, blood cultures inhibits the activation
are often positive of complement and
ACUTE RHEUMATIC FEVER protects the organism
APSGN from phagocytosis; it
is the weakest point
in the organism's
defense

Streptococcus agalactiae/ Vagina Transvaginally Bacitracin-resistant UTI in pregnant women DOC: Penicillin G Gram-positive Most common cause
Group B streptococcus Transplacentally Neonatal sepsis (meningitis, Penicillin G + cocci in chains of neonatal sepsis in
Hydrolyzes hippurtae pneumonia) Aminoglycoside for serious Beta-hemolytic the world (the
Endometritis → most commonly infections CAMP test universe, rather)
grows using LIM polymicrobial; foul-smelling lochia positive: CAMP
broth All pregnant women should factor enlarges the
be screened for GBS area of hemolysis
Catalase negative colonization at 35-37wks formed by S.
AOG; if (+), aureus
chemoprophylaxis with IV
penicillin or ampicillin 4 hrs
prior to delivery
Group D streptococci Human colon May enter bloodstream Catalase-negative UTIs due to indwelling urinary catheters Penicillin plus gentamicin Gram-positive There is aremarkable
Urethra and during GIT or GUT and urinary tract instrumentation Vancomycin for penicillin- cocci in chains association between
female genital surgery Bile and optochin Biliary tract infections resistance Catalase-negative S. bovis and colon CA
tract can be resistant Endocarditis in patients who underwent Linezolid for vancomycin- Gamma hemolytic
colonized GIT surgery due to E. faecalis resistant strains colonies
Hydrolyzes essculin
in Bile esculin agar Marantic endocarditis in patients with
abdominal malignancy due to S. bovis
E. faecalis can grow
in 6.5% NaCl while S.
bovis cannot

Viridans streptococci Oral flora Enters blood stream Cata;ase-negative Glycocalyx enhances Dental caries: S. mutans Penicillin G +/- Gram positive OVeRPaSs
during dental adhesion to damaged aminoglycoside cocci in chains
procedures Bile and optochin heart valves Subacute bacterial endocarditis: S (Gentamicin) Optochin
resistant sanguis--> most common cause of Alpha-hemolytic Viridans
protected from host subacute and native valve endocarditis Vancomycin for penicilli Resistant
defenses within resistance Pneumoniae
vegetations Brain Abscess: S. intermedius Sensitive
Linezolid for vancomycin
resistant strains

GRAM POSITIVE BACILLI

MICROORGANISM RESERVOIR TRANSMISSION METABOLISM VIRULENCE FACTORS TOXINS CLINICAL TREATMENT AND PREVENTION DIAGNOSIS NOTES
SYNDROMES
Bacillus anthracis Herbivores Endopores Aerobic (but Protein capsule (polymer of Exotoxin: 3 proteins Anthrax Cutaneous: Ciprofloxacin (DOC) Gram stain: box-car shaped bacteria Protein capsule
(zoonotic): since it can gamma-D-glutamatic acid):
Sheep Goats grow without antiphagocytic
Cattle oxygen. It is Non-motile Protective antigen (PA) Cutaneous (95%) Inhalational/GI anthrax: Culture: Medusa head morphology Permamnent
classified as a painless black Ciprifloxacin or Doxycycline with 1 - ground glass surface and irregular with immunity of the
facultative vesicles; can be fatal or 2 additional antibiotics projectios along lines of inoculation patient survives
anaerobe if untreated (Rifampin, vancomycin, penicillin,
imipinem, clindamycin, or
clarithromycin)

Edema factor (EF) Pulmonary Vaccine: for high-risk individuals Serology MCC of death in
(woolsorter’s woolsorter’s
disease) disease is
-prolonged latent pulmonary
period before rapid hemorrhage
deterioration
- massively enlarged
mediastinal lymph
nodes; pulmonary
hemorrhage
- 100% mortality
withput immediate
treatment
 Lethal factor (LF) GI: abdominal pain, Vaccine is composed of the PCR of nasal swab MCC of death is
vomiting and bloody protective antigen (PA) pulmonary
diarrhea hemorrhage in:
- rapidly progressive Anthrax,
course Leptospirosis
- mortality (Weil’s syndrome),
approaches 100% Congenital syphilis

Infections result to Animal vaccine is composed of a

permanent live strain, attenuated by loss of its
immunity protein capsule

Bacillus cereus Endospores Aerobic No capsule Enterotoxins ENTERAL Form: Food poisoning: Symptomatic Culture specimen from suspected food Chinese fried rice
Vomiting, nausea treatment only; food poisoning is source syndrome
and abdominal caused by the pre-formed
cramps enterotoxin
-duration: 8-10hrs
Motile heat labile: similar to interotoxin Ophthalmitis:
-heat-stable
of cholera and E. coli (diarrheal -Vancomycin
enterotoxin
form) -Clindamycin
similar to
-Ciprofloxacin
staphylococcal food
-Gentamicin
poisoning
heat stable: produces syndrome Resistant to beta-lactam antibiotics
similar to that of Staphylococcus DIARRHEAL Form:
aureus food poisoning, but with Diarrhea, nausea,
limited diarrhea (emetic form) abdominal cramps
-duration: 20-36hrs
-heat-labile
enterotoxin
-resembles
clostridial
gastroenteritis

OPHTHALMITIS:
occur after
penetrating eye
injuries with soil
contaminated
object; complete
loss of light
perception within
48hrs of injury

Clostridium Soil Endospores Anaerobic Motile: flagella (so H-antigen Neurotoxins inhibits release of Food-Borne Antitoxin (for food-borne and Gram stain TRIAD of
botulinum (heat resistant) positive) acetylcholine from peripheral botulism: cranial wound botulism) BOTULISM:
nerves nerve palsies, - Symmetric
muscle weakness, descending flaccid
respiratory paralysis paralysis (with
prominent bulbar
involvement)
- Absence of fever
- Intact sensorium
 Stored vegetables: Anaerobes: Toxin is not secreted, rather it is Infant botulism: Human botulism: immunoglobulin Culture: requires anaerobic condition Floppy baby
home-canned ABC released upon the death of the constipation, flaccid (for infant botulism) (thioglycollate-enriched agar) syndrome
zip-lock storage Actinomyces bacterium paralysis (floppy
bags Bacteroides baby syndrome)
Clostridium

Smoked fish Wound botulism: Penicillin Patient’s serum injected into mice Botox neurotoxin
similar to food- results in death
borne except
absence of GI
prodromal
symptoms
Wild, raw honey: Supportive therapy: including
associated with incubation and ventilator assistance
infant botulism
Clostridium tetani Soil Endospores: Anaerobic Motile flagella (so H-antigen- Tetanospasmin: inhibits release Tetanus Tetanus toxoid: vaccination with Gram stain: gram-positive rods, often Spastic paralysis
introduced positive) of GABA and glycine (both - muscle spasm formalin- inactivated toxin (toxoid), with an endospore at one end, giving Drumstick, tennis
through wound inhibitory neurotransmitters) - lockjaw (trismus) part of the DPT vaccine them the appearance of a drumstick racquet, lollipop
from nerve cells, resulting in - risus sardonicus Antitoxin: human tetanus immnue Requires anaerobic conditions appearance
sustained muscle contraction - respiratory muscle globulin (pre-formed anti-tetanus
paralysis antibodies)
Clean the wound
Penicillin (DOC)
Supportive therapy: may require
ventilator assistance
vaccine
DPT:diphtheriapertussistetanus

Clostridium Ubiquitous: Endospores Anaerobic NON-motile Alpha toxin: lecithinase (splits Cellulitis/wound Radical surgery (may require Gram stain: spore-forming rods Double hemolysis
perfringens lecithin into phosphocoline and infection amputation) on blood agar
diglyceride)

Soil 11 other tissue destructive Clostridial Penicillin Culture: requires anaerobic conditions Looks motile, but
enzymes myonecrosis: fatal if not motile on blood
untreated Growth on egg yolk agar: non-motile but agar -> due to
with rapidly spreading growth on culture avidity for lecithin
media in the blood
membranes
G tract of humans Watery diarrhea: Hyperbaric oxygen
and mammals associated with
food-borne ingestion
Clostridium Intestinal tract Fecal-oral: Anaerobic Motile flagella (so H-antigen- Toxin A: diarrhea Pseudomembranous Metronidazole Immunoassay for C. difficile toxin PO vancomycin
difficile ingestion of positive) enterocolitis: because it has poor
Endospores found endospores Toxin B: cytotoxic to colonic -antibiotic- Oral vancomycin Examine colon with colonoscopy intestinal
in hospitals and epithelial cells associated diarrhea absorption, hence,
nursing homes -Clindamycin, 2nd “coats” the lesions
and 3rd generation with antibiotic
 cephalosporins, Terminate use of the responsilbe
ampicillin antibiotic
-non-bloody
diarrhea associated
with
pseudomembranes
(yellow-white
plaques) on the
colonic mucosa
Corynebacterium Throat Respiratory Facultative Pseudomembrane forms in the Exotoxin (coded by a Diphtheria Antitoxins Gram stain: gram-positive pleomorphic Obtains exotoxin
diphtheriae droplets from anaerobe pharynx, which serves as a base bacteriophage) - mild sore throat Penicillin or Erythromycin rods (sometimes describe as looking like from a temperate
carrier Catalase- from where it secretes its toxin Subunit A: blocks protein with fever initially Chinese letters) bacteriophage by
positve synthesis by inactivating EF2 - pseudomembrane vaccine DPT: lysogenic
Subunit B: provides entry into forms on pharynx diphtheria: formalin inactivated Culture: conversion
cardiac and neural tissue - myocarditis causing exotoxin, as antibodies to the B- Potassium tellurite: dark black colonies
A-V condution block subunit are protective Schick test:
Exotoxin is like a human and dysrhythmia pertussis Loeffler’s medium: after 12 hours of injection of
antibiotic, as it inhibits - neural tetanus growth, stain with methylene blue. diphtheria exotoxin
eukaryotic protein synthesis, involvement: Reddish (Babes-Ernst) granules can be into the skin, to
just as tetracycline inhibits perpheral nerve seen determine whether
protein synthesis in bacteria palsies, GBS, palatal a person is
paralysis, and susceptible to
neuropathies infection by
diphtheriae

Modified Elek test:

for detection of
toxigenicity

Listeria Ubiquitous Ingestion of Facultative Motile (via flagella): so has H- The Only gram positive bacteria EARLYONSET Ampicillin +/p GentamicinTMP- Gram stain:gram-positive rodsNarrow Facultative
monocytogenes contaminated anaerobe antigen -> tumbling motility that produces LPS NEONATAL SMX: if allergic to penicillin zone of beta-hemlysis intracellular
raw milk or LISTERIOSIS parasite
cheese from (Granulomatosis
infected cows Infantiseptica)-
transplacental
transmission-
characterized by late
miscarriage; birth
complicated by
sepsis, multiorgan
abscess, and
disseminated
granulomasLATE-
ONSET NEONATAL
LISTERIOSIS-
transmission during
childbirth-manfests
as meningitis or
meningoencephalitis
Plants Vaginally Catalase- Hemolysin: (like streptolysin O) Meningitis in Culture: can grow at temperature as low Cell-mediated
(vegetables) (during birth) positive immune-suppressed as 0 C so use cold enrichment technique immunity is
Listeriolysin O: allows escape from patients and the to isolate from mixed flora protective
the phagolysosomes of elderly (>50)
macrophages; major virulence
factor Septicemia in
pregnant women
Internalin: Interacts with E-
cadherin on the surface of cells

Actin rockets: propel the bacteria

through the membrane of one
human cell to another

Tranplacental Beta- NOT CEPHALOSPORINS:

infection of hemolytic on NONE OF THE CEPHALOSPORINS
fetus from blood agar ARE ACTIVE AGAINST MRSA,
bacteremic LISTERIA, AND ENTEROCOCCI
mother

GRAM NEGATIVE COCCI

GRAM NEGATIVE BACILLI

 GRAM NEGATIVE COCCI

MICROORGANISM RESERVOIR TRANSMISSION METABOLISM VIRULENCE FACTORS TOXINS CLINICAL SYNDROMES TREATMENT AND PREVENTION DIAGNOSIS NOTES

Neisseria meningitidis Respiratory Respiratory droplets Ferments both Antiphagocytic No exotoxins MENINGITIS: most common Penicillin Culture on chocolate agar Complement
tract maltose and polysaccharide cause among aged 2-18 yrs Ceftriaxone (or cefotaxime) - The drug of choice for deficiencies in the
glucose capsule the treatment of meningococcal meningitis and late-acting
septicemia complement
components (C5–
C9) predispose to
illness
Oxidase-positive Endotoxin (LOS): MENINGOCOCCEMIA: Vaccine contains capsular polysaccharide of strains Gram-negative, aerobic, Most patients with
colonies on An LOS can be shed in dissemination of A, C, Y, and W-135 coupled to a carrier protein encapsulated diplococcus meningococcal
chocolate agar large amounts by a meningococci into the (diphtheria toxoid) to enhance immunogenicity that grows best on enriched meningitis, caused
process called bloodstream; mmultiorgan media, such as Mueller- by the gram-
blebbing, causing disease, consumptive Currently, vaccinations against meningococcus A, C, Hinton or chocolate agar, at negative
fever, shock, and coagulopathy, petechial or W, and Y are available. The first meningococcal 37°C and in an atmosphere diplococcus
other purpuric rash (purpura vaccine for serogroup B was approved in October of 5-10% carbon dioxide Neisseria
pathophysiology. This fulminans) 2014. meningitidis,
is considered the recover completely
principal factor that Meningococcemia is defined Rifampin chemoprophylaxis to close contacts if appropriate
produces the high as dissemination of antibiotic therapy
endotoxin levels in meningococci (Neisseria is instituted
meningococcal meningitidis) into the promptly.
sepsis. bloodstream (see the image Nonetheless, the
below). Patients with acute disease still is
Meningococcal LOS meningococcemia may associated with a
interacts with human present with (1) meningitis high mortality rate
cells, producing (2) meningitis with and persistent
proinflammatory meningococcemia, or (3) neurologic defects,
cytokines and meningococcemia without particularly among
chemokines, including clinically apparent infants and young
interleukin 1 (IL-1), IL- meningitis. children.
6, and tumor necrosis
factor (TNF). LOS is WATERHOUSE-
one of the important FRIDERICHSEN SYNDROME:
structures that most severe form of
mediate meningococcemia; high
meningococcal fever, shock, widespread
attachment to and purpura, disseminated
invasion into intravascular coagulation,
epithelial cells. thrombocytopenia, and
adrenal insufficiency ->
LOS triggers the bilateral hemorrhagic
innate immune destruction of the adrenal
system by activating glands
the Toll-like receptor
4MD2 cell surface
receptor complex and
myeloid in non-
myeloid human
sounds. The degree of
activation of
complement then
 coagulation system is
directly related to the
bacterial load.
IgA protease
At least 13
serogroups have been
described: A, B, C, D,
E, H, I, K, L, W-135, X,
Y, and Z. Serogroups
B and C have caused
most cases of
meningococcal
meningitis in the
United States since
the end of World War
II; before that, group
A was more
prevalent. More than
99% of
meningococcal
infections are caused
by serogroups A, B, C,
29E, or W-135.
Neisseria gonorhoeae Humans only Sexually Facultative- Pili: Endotoxin: Asymptomatic (but still Antibiotic of choice: third generation cephalosporin Gram-stain of urethral plus Kidney bean
(no immunity Birth anaerobe Adherence to lipooligosaccharide infectious) such as ceftriaxone (Add doxycycline to cover reveals the tiny gram- shaped with
to repeated epithelial cells (LOS) incubating Chlamydia trachomatis and syphilis) negative doughnut-shaped concave sides
infections) Antigenic variation diplococci within white facing each other
Antiphagocytic, binds blood cells forming the
bacteria tightly to appearance of
host cell protecting it doughnut
from phagocytosis
Grows best in IgA protease No exotoxins Men: urethritis The Centers for Disease Control (CDC) Culture: Specimen on Gram-negative
high CO2 Women: cervical gonorrhea, recommends that all patients with gonorrheal chocolate agar diplococci
environment which can progress to pelvic infection also be treated for presumed co-
inflammatory disease (PID) infection with Chlamydia trachomatis (2015)
complications of PID

Lower abdominal pain: Most

consistent symptom of PID
Ferments only Outer membrane Both men and women: Second line, but not effective against Selective media: prevents Reinfection
glucose (not proteins: Protein I: Gonococcal syphilis:FlouroquinolonesSpectinomycin growth of other bacteria because there is
maltose)- easy to porin protein II bacteremiaSeptic arthritis: no immunity to
remember, since (opacity protein): gonococcal arthritis is the previous infections
there is only a “g” presence associated most common cause of
(no “m”) in with dark, opaque septic arthritis in sexually
gonorrhoeae colonies active individuals
 For adherence: Neonates: Ophthalmia For opthalmia neonatorum: Thayer Martin with VCN Fitz-Hugh-Curtis
Has unique protein neonatorum conjunctivitis in Erythromycin eye drops should be given Cell wall contains syndrome
that can extract iron newborns -> N. immediately following birth, for prophylaxis against cytochrome oxidase which Septic arthritis in
from transferrrin, gonorrhoeae is acquired both N. gonorrhoeae and Chlamydia trachomatis oxidizes dye sexually active
lactoferrin and during passage through an conjunctivitis tetramethylphenylene patients
hemoglobin infected birth canal; Infants with ophthalmia neonatorum require diamine from colorless to Well-characterized
conjunctivitis usually erupts systemic treatment with ceftriaxone. deep pink. Used to ID plasmids
within the first 5 days Erythromycin syrup should also be provided to colonies commonly carry
cover for possible concurrent chlamydial disease PCR in bacterial DNA in antibiotic-
(this is important, as failure to treat neonatal clinical specimens resistance genes,
Chlamydia conjunctivitis can lead to chlamydial most notably
pneumonia) penicillinase.
Plasmid and
nonplasmid genes
are transmitted
freely between
different subtypes.
The ensuing
exchange of
surface protein
genes results in
high host
susceptibility to
reinfection. The
exchange of
antibiotic
resistance genes
has led to
extremely high
levels of resistance
to beta-lactam
antibiotics.
Moraxella (Branhamella Part of the Otitis media in children Azithromycin or clarithromycin Resistant to
catarrhalis) normal flora penicilins
Can cause other respiratory Amoxicillin with clavulanate
tract infections, such as
sinusitis, bronchitis and
pneumonia
COPD exacerbation Oral second or third generation cephalosporin

TMP-SMX

GRAM NEGATIVE BACILLI

MICROORGANISM RESERVOIR TRANSMISSION METABOLISM VIRULENCE FACTORS TOXINS CLINICAL TREATMENT AND DIAGNOSIS NOTES
SYNDROMES PREVENTION
Haemophilus influenzae Man only Transmitted via respiratory Haemophilus Some strains of H. influenzae possess Hib meningitis: Most Second or third generation Gram stain NTHi strains form
(obligate human route influenzae requires a polysaccharide capsule, and these serious manifestation cephalosporins (since H. biofilm in vitro and
parasite) two factors for strains are serotyped into 6 different of Hib infection; influenzae can acquire ex vivo and have
growth (both found types (a-f) based on their antecedent upper ampicillin resistance by been implicated in
The NTHi strains in blood): biochemically different capsules. respiratory tract plasmids) chronic infection
colonize the The most virulent strain is H. infections are such as otitis media,
nasopharynx in up X factor: Hematin influenzae type b (Hib). common; Hib sinusitis, and
V factor: NAD+ meningitis bronchitis. NTHi
 to 80% of Satellite growth Some H. influenzae strains have no manifestations biofilm formation
individuals around capsule and are termed indistinguishable from was found in
Staphylococcus nonencapsulated H influenzae or other bacterial patients with CF on
aureus nontypeable H influenzae (NTHi). meningitis causes the apical surface of
airway epithelia with
decreased antibiotic
susceptibility.

Cellulitis: Most Hib vaccine: H. influenzae Culture specimen on blood Approximately 6% of

commonly involves polysaccharide capsule of agar that has been heated to individuals with Hib
the buccal and type b strain (Hib) is 80oC for 15 minutes (now meningitis
periorbital regions; conjugated to diphtheria called chocolate agar). This experience
usually associated toxoid high temperature lyses the red permanent
with fever Passive Immunization: blood cells releasing both sensorineural
mother is immunized hematin (called X factor) and hearing loss.
Epiglottitis: Fever, during 8th month of NAD+ (called V factor). Like
sore throat, pregnancy to increase the Neisseria, H. influenzae
dysphagia, drooling, passive antibody transfer grows best when the
and difficulty in breast milk chocolate agar is placed in a
breathing high CO2 environment at 37oC
Hib pneumonia: The Centers for Disease Fluorescently labeled
Clinically Control and Prevention antibodies (ELISA and latex
indistinguishable from (CDC) Advisory Committee particle agglunation)
other bacterial on Immunization has
pneumonias—except released updated 2014 Positive Quellung test: due to
for its insidious onset vaccination its capsule, similar to
and a history of fever, recommendations for Streptococcus pneumoniae
cough, and purulent adults aged 19 years and
sputum production older. Key changes in the
recommendations include
the following:
Hib pericarditis: Fever, Hib vaccine: Vaccination is
respiratory distress, recommended for (1)
and tachycardia certain adults at increased
Septic arthritis: Joint risk for Hib who have not
pain, swelling, and previously received the
decreased mobility vaccine—except for
Occult bacteremia: individuals with human
Fever, anorexia, and immunodeficiency (HIV)
lethargy infection, who have a low
NTHi infections: risk for Hib infection; and
Commonly causes (2) adults who have
various mucosal undergone a successful
infections, including hematopoietic stem cell
otitis media and transplant (HSCT).
conjunctivitis (Administer a 3-dose series
of Hib vaccine 6-12 mo
posttransplantation,
regardless of Hib
vaccination status.)
Haemophilis ducreyi Sexually Small, gram- Chancroid: painful Azithromycin or Gram stain and culture of A sexually
transmitted negative, facultative genital ulcer, often erythromycin ulcer exudate and pus transmitted disease
disease anaerobic bacillus associated with Ceftriaxone(IM) released from swollen lymph Requires X factor
unilateral swollen node (hematin) only.
 that is highly lymph nodes that can Ciprofloxacin Chancroid is most
infective rupture, releasing pus commonly observed
in nonwhite men
who are
uncircumcised.
Women represent
only 10% of known
cases because they
are more likely to be
asymptomatic
carriers.
Gardnerella vaginalis Normal flora Shift in vaginal flora Bacterial vaginosis: Metronidazole Clue cells: vaginal epithelial Does not require X
foul smelling vaginal cells factor or V factor for
discharge (with fishy that contain tiny pleomorphic growth
odor), vaginal gram-negative bacilli
pruritus, and often within the cytoplasm
dysuria
Gray, thin, and Therapy with Demonstration of
homogeneous vaginal metronidazole or clue cells on a saline
discharge, which clindamycin may alter the smear (the most
adheres to the vaginal vaginal flora and specific diagnostic
mucosa (milk- predispose the patient to criterion)
splattered) development of vaginal
candidiasis
Bordetella pertussis Man: highly Transmitted via respiratory Capsule Pertussis toxins: Whooping Cough Erythromycin (most Bordet-Gengou agar: The diagnosis of
contagious route Beta-lactamase activates G proteins 1. Catarrhal phase: effective when given in potatoes, blood and glycerol pertussis is made by
that increases cAMP patient is highly catarrhal stage) agar, with penicillin added isolation of B
resulting in: contagious (1-2 Vaccine: DaPT pertussis in culture.
Increased sensitivity weeks) Pertussis vaccination A polymerase chain
to histamine 2. Paroxysmal phase during pregnancy is safe reaction (PCR) test
Increased insulin (2-10 weeks) Treat household contacts can also be
release Whoop (burst of non- with erythromycin. performed.
Increased number of productive coughs) The culture
lymphocytes in blood Increased number of specimen should be
lymphocytes in blood obtained during the
smear first 2 weeks of
Antibiotics ineffective cough by using deep
during this stage nasopharyngeal
3. Convalescent stage aspiration
For PCR testing,
nasopharyngeal
specimens should be
taken at 0-3 weeks
following cough
onset
Filamentrous hemagglutinin (FHA): A 2. Extracytoplasmic Rapid serologic tests: The CDC
pili rod that extends from the surface adenylate cyclase: (ELISA)Collect specimen from recommends a
of B. pertussis, enabling the bacteria ”weakens” posterior pharynx on a calcium combination of
to bind to ciliated epithelial cells of neutrophils alginate swab since B. culture and PCR
the bronchi lymphocytes and pertussis will not grow on assay if a patient has
monocytes3. cottonDirect fluorescein- a cough lasting
Filamentous labeled antibodies applied to longer than 3
hemagglutinin: allows nasopharyngeal specimens for weeksEarly serial
binding to ciliated rapid diagnosisPCR detection monitoring of white
 epithelial cells4. of bacterial DNA in respiratory blood cell (WBC)
Tracheal cytotoxin: seceretions counts is warranted
kills ciliated epithelial
cells

Legionella pneumophila Ubiquitous in man No person-to-person Aerobic, motile, and Facultative intracellular parasite: Cytotoxins: kill Pontiac fever: Azithromycin Culture on buffered charcoal Facultative
and natural water transmission nutritionally inhibits macrophage hamster ovary cells headache, fever, yeasts extract agar (L-cysteine intracellular parasite:
environments (air fastidious phagosome/endo/lysosome fusion muscle aches and is a critical ingredient) inside alveolar
conditioning Predisposing factors: pleomorphic gram- fatigue, self-timing: macrophages
systems; cooling - old age negative rods. recovery in a week is
towers) - smoking common
Freshwater high alcohol intake Growth depends on Cu-Zn superoxide dismutase and Legionnaires’ Levofloxacin Serology (IFA and ELISA) Persons with
amoebae appear - immunosuppression the presence of L- catalase-peroxidase protects bacteria Disease: pneumonia: compromised
to be the natural cysteine and iron in from macrophage superoxide and fever and non- immune systems are
reservoir for the special media. hydroperoxide oxidative burst productive cough especially
organisms. susceptible
The organism has 3. Pili and flagella promote Doxycycline Urinary antigen can be Atypical pneumonia
been isolated in attachment and invasion detected by + diarrhea +
natural aquatic radioimmunoassay with high hyponatremia
habitats (freshwater sensitivity and specify and will
streams and lakes, remain positive for months
water reservoirs) after infection. Urine antigen
and artificial test only detects L.
sources (cooling pneumophilia serogroup 1, but
towers, potable this accounts for 90% of cases.
water distribution
systems).
Optimal growth 4. Secretion of protein toxins like Legionnaires disease
temperature is 28- RNAase, phospholipase A and (LD) was recognized
40°C; organisms are phospholipase C in 1976 after an
dormant below outbreak of
20°C and are killed pneumonia at an
at temperatures American Legion
above 60°C. convention in
Philadelphia.

GRAM NEGATIVE BACILLI 9GI AND GU0

MICROORGANISM RESERVOIR TRANSMISSION METABOLISM VIRULENCE FACTORS TOXINS CLINICAL SYNDROMES TREATMENT AND DIAGNOSIS NOTES
PREVENTION
Escherichia coli Humans: Fecal-oral Indole-positive Fimbriae (pili): attachment/ Enterotoxins Neonatal meningitis Penicillins Gram-negative
GI and urinary Ascending Beta-hemolytic colonization factor 1. LT (heat- UTI Aminoglycosides Culture
tract infection to the Ferments lactose Siderophore: obtains iron fro labile): increases Nosocomial sepsis 2nd and 3rd gen (specimen may
urethra human transferrin or cAMP (same as Nosocomial pneumonia cephalosporins be urine,
Colonization of lactoferrin cholera toxin) Diarrhea Fluoroquinolones sputum, CSF or
catheters in Adhesins 2. ST (heat- ETEC: releases LT and ST toxins, traveler’s diarrhea blood); can
hospitalized Capsule (K-antigen): causes stable) Increases EHEC/STEC (Shiga-like toxic producing E. coli): no grow at 45.5 C
patients pneumonia cGMP fever, no pus in stool; secretes shiga-like toxin Pathogenic
Aspiration strains may be
 Flagella (H-antigen): 3. Shiga-like (verotoxin): causes hemorrhagic colitis and isolated from
attachment/colonization toxin hemolytic uremic syndrome (E. coli strain O157:H7) stool
factor; causes cystitis and (verotoxin): EIEC: with pus in the stool and fever E. coli
pyelonephritis inhibits protein ferments
synthesis by lactose, so
inactivating the colonies
60S ribosomal appear purple
subunit of to black on
eukaryotic cells EMB agar and
(E. coli O157:H7, pink to purple
STEC, EHEC) on MacConkey
Endotoxins: agar
- Lipid A [porion
of LPS
-causes septic
shock

Proteus mirabilis Urease: Swarming motility No toxins UTI: high urine pH due to urease production -> Ampicilin Culture: Weil-Felix reaction: a test that uses
hydrolyzes ureas struvite calculi formation; staghorn calculi (tx with TMP-SMX Colonies antibodies against certain strains of
into NH3 and CO2 surgery) swarm over Proteus to diagnose rickettsial
Indole-negative Sepsis entire culture disease (as certain rickettsiae share
Does not ferment plate similar antigens)
lactose Alkaline urine See also: Rickettsia species
(high pH)

Shigella dysenteriae Humans Fecal-oral No H2S Invades submucosa of Shiga toxin Bloody diarrhea with mucus and pus (similar to Floruoquinolones Stool culture: IgA is best for immunity
production intestinal trac, but not the MOA: enteroinvasive E. coli) Azithromycin because Shigella is more toxic and invasive
Does not ferment lamina propria -> ulcers -> inactivates the TMP-SMX Shigella is than Salmonella
lactose bleeding 60S ribosome, never a part of
NON-motile: No H-antigen inhibiting the normal
(since they have no flagella) protein intestinal flora
synthesis and
killing intestinal
epithelial cells
Shiga toxin,
therefore, is a
protein
synthesis
inhibitor of
EUKARYOTES

Salmonella typhi S. typhi is found S. typhi is Produces H2S Motile (H-antigen) Enteric fever Ciprofloxacin Culture: blood A. Facultative intracellular parasite:
Non-typhoidal groups only in humans transmitted via Does not ferment Capsule (called the Vi Typhoid fever Ceftriaxone stool or urine 1. Lives within macrophages in
of Salmonella fecal-oral route lactose antigen): protects from Parathypoid - fever (similar to typhoid fever, but TMP-SMX may contain S. lymph nodes
Zoonotic: intracellular killing caused by non-typhoidal Salmonella) Azithromycin typhi 2. Can live in gall bladder for years
1. Pet turtles Siderophores Chronic carrier state in the gall bladder *Salmonella (carriers secrete S. typhi in stool)
2. Chickens Gastroentritis gastroenteritis: there is Never part of B. Persons who are asplenic or have
3. Uncooked Sepsis little benefit from the intestinal non-functioning spleens (sickle cell
eggs Osteomyelitis: Especially in sickle cell patients antibiotic treatment; it flora anemia) are at increased risk of
(Salmonella choleraesuis) may prolong carrier state infection by this organism
In the Philippines, first Gastric acid is protetive against
line drug for typhoid: salmonellosis, hence,
Amoxicillin, TMP-SMX, gastrectomy/antacids increase the
Chloramphenicol risk
Yersinia enterocolitica Zoonotic: can Ingestion of Non-lactose V and W antigens Enterotoxin Pseudoappendicitis (RLQ pain) -> mesenteric Antibiotics do not alter Stool or blood Survives refrigeration
be found in pigs contaminated fermenter Motile similar to the lymphadenitis the course of the cultures mat Closely related to Yersinia pestis
food or water Virulence factors heat stable toxin Acute enterocolitis, with fever, diarrhea and diarrhea. However, be positive Mesenteric lymphadenitis in children
Unpasteurized are temperature of E. coli abdominal pain patients with positive Examination of -> pseudoappendicitis
milk sensitive increases cGMP Diarrhea - The most common clinical manifestation blood culture should be the terminal
expressed at 37oC levels of this infection; diarrhea may be bloody in severe treated with antibiotics ilium with
cases colonoscopy
Low-grade fever will reveal
Abdominal pain - May localize to the right lower mucosal
quadrant ulceration
Vomiting - Present in approximately 15-40% of
cases

Vibrio cholerae Humans only Fecal-oral Oxidase-positive Motile (H-antigen) -> Choleragen Cholera: severe diarrhea with rice water stools. No Fluid and electrolyte Dark field Death by dehydration: children
transmiision Ferments sugar Shooting star motility (enterotoxin): pus in stools replacement microscopy of affected in endemic areas 1991:
Morphology: (except lactose) Digest mucous layer so V. like LT of E. coli, -Washer woman's hands sign: wrinkled skin due to Doxycycline stool reveals Latin America epidemic
Short, comma cholera can attach to cells increases levels loss of skin turgor due to dehydration Flouroquinolones motile 1993: Epidemic in Bangladesh and
shaped, with a 3. Fimbrae: helps with of cAMP, -Complications: cardiac and renal failure, organism that India
single polar attachment to cells causing hypokalemia are
flagellum 4. Non-invasive secretion of immobilized
electrolytes with antiserum
from the Grows as flat
intestinal yellow
epithelium. This colonies on
results in selective
secretion of media:
fluid into the thiosulfate-
intestinal tract. - citrate-bile-
> secretory salts-sucrose
diarrhea (TCBS) agar

Vibrio Fish, seafood Consumption of Halophilic (likes Motile (H-antigen) Hemolytic Cause of 25% of food poisoning in Japan (diarrhea Doxycycline TCBS Diarrhea after ingestion of raw
parahaemolyticus raw fish salt) Capsule cytotoxins for 3 days) -> because Japanese love seafood J Fluoroquinolone seafood; also consider Norwalk virus;
Morphology: Unclear if antibiotics important to distinguish viral from
short, comma change clinical course of bacterial
shaped, with a the disease
single polar
flagellum
Campylobacter jejuni Zoonotic: wild Uncooked meat Microaerophilic Motile (H-antigen) Enterotoxin: Gastroentritis Fluoroquinolone Microscopic One of the three most common
and domestic (especially poultry) Oxidase Positive Invasive similar to -most common cause of bacterial gastroenteritis Erythromycin : for exam of stool causes of diarrhea in the world:
animal and Unpasteurized Optimum cholera toxin ingestion of undercooked chicken severe disease reveals motile, -Campylobacter jejuni
poultry; milk temperature is and the LT of E. -watery, foul-smelling diarrhea followed by bloody curved gram- -ETEC
undercooked Fecal-oral 42oC – to inhibit coli stools accompanied by fever and severe abdominal negative rods -Rotavirus
chicken Morphology: the growth of Cytotoxins: pain Selective
curved gram- other fecal species destroy mucosal -may mimic ulcerative colitis media with
negative rods with cells Associated with Guillain-Barre syndrome-antigenic antibiotic at
a single polar cross-reactivity between oligosaccharides in 42oC
flagellum bacterial capsule and glycosphingolipids on surface Skirrow’s agar
of neural tissue Campy’s agar
Reactive Arthritis (Reiter's Syndrome)
-Urethritis
-Uveitis
-Arthritis

Helicobacter pylori Habitat is the Transmission by Microaerophilic Urease: produces ammonia; No toxin Peptic ulcer disease Bismuth, ampicillin, Morphology: Peptic ulcer disease
human ingestion Oxidase postive makes the environment -most common cause of duodenal ulcers and metronidazole and curved gram- Gastric carcinoma
stomach Cayalase-positive alkaline--> helpas H. pylori chronic gastritis tetracycline negative rods MALT lymphoma
Urease positive survive in acidic mucosa -second leading cause of gastric ulcer Clarithromycin and with a tuft of
Disease associations: omeprazole polar flagella
-Gastric carcinoma Both regimens reduce
-MALT Lymphoma duodenal ulcer relapse EGD with
biopsy
showing H.
pylori

Urease breath
test, h.pylori
stool antigen:
document cure
Bacteriodes fragilis Colon Part of the normal Anaerobic (O2 Capsular polysaccharide: Does not contain Abscesses in the gastrointestinal tract, pelvis and Metronidazole – DOC for Gram-stain Infection occurs when the organism
flora of the inhibits its growth) antiphagocytic and lipid A lungs anaerobic infections Anaerobic enters the peritoneal cavity
intestine Gram-negative anticomplement Brain abscesses (chloramphenicol is ideal because it Clindamycin culture Hence, if the anatomy of the GI tract
Most common rod is lipophilic) Chloramphenicol is altered (surgery, trauma,
colonic flora Non-spore former Succinate: inhibits PMN Chloramphenicol is perforation)
phagocytosis static, but cidal to the
Spreads to blood following:
or peritoneum Attachment factors: pili Neisseria meningitidis
during bowel Bacteroides fragilis
trauma, Streptococcus
perforation or pneumonia
surgery Haemophilus influenza
NBSH – No Boyfriend
Since Highschool
Pseudomonas Soil, Water, Medical devices 1. Obligate aerobe Motile (polar flagella) Exotoxin A Burn infections MDR, XDR strains Culture: Common etiology for infection in
aeruginosa Plants, Animals, Hands of (does not Hemolysins (similar to Endocarditis in IV drug users SEE ANTIPSEUDOMONAL greenish, neutropenic patients.
Intestinal Flora, healthcare ferment) Collagenase diphtheria Necrotizing pneumonia – fleur de lys morphology on LIST GIVEN BY DR. metallic Produces pigments when cultured:
Skin workers 2.Non-lactose Elastase toxin): inhibits histopath CALDERON colonies on a. pyocyanin (blue pigment)
fermenter Fibrinolysin protein Sepsis (in the immunocompromised); ecthyma Antimicrobials are the blood agar, b. pyoverdin (green pigment)
3. Oxidase- Phopholipase C synthesis by gangrenosum mainstay of therapy. with fruity Norocomial organisms similar to
positive DNAse blocking EF2 Malignant otitis externa Meningitis: Ceftazidime odor (grape- Pseudomonas:Acinetobacter
Antiphagocytic capsule UTI (catheter-related) is the antibiotic of like odor) baumanniiElizabethkingia
Diabetic osteomyelitis choice Cetrimide meningosepticumBurkholderia
Typhlitis, Shanghai fever Eye infections: Treat medium cepacia
It is the most common pathogen isolated from small superficial ulcers
patients who have been hospitalized longer than 1 with topical therapy (eg,
week, and it is a frequent cause of nosocomial ophthalmic
infections. aminoglycoside solution
rather than an ointment)
every 30-60 minutes;
when perforation is
imminent,
subconjunctival (or
subtenon)
administration is
preferred; management
of endophthalmitis
requires aggressive
antibiotic therapy
(parenteral, topical,
subconjunctival [or
subtenon], and, often,
intraocular)

GRAM NEGATIVE BACILLI (ZOONOTOC)

MICROORGANISM RESERVOIR TRANSMISSION METABOLISM VIRULENCE FACTORS TOXINS CLINICAL SYNDROMES TREATMENT AND DIAGNOSIS NOTES
PREVENTION
Yersinia pestis Wild rodents Vector: Flea bite Facultative anaerobe Fraction 1 (F1): this capsular Pesticins: kills other Bubonic plague: rRegional Streptomycin or Gram strain will Facultative intracellular
antigen is antiphagocytic bacteria (including lymph nodes ( usually gentamicin reveal gram- parasite
E. coli) groin) swell, and become negative rods with
red, hot and tender (called bipolar staining: the
a bubo); high fever; ends of these rod
conjunctivitis shaped bacteria take
up stain more than
the center (closed
safety pin
appearance)
City rats Contact with infected Virulence factors are V and W proteins Intracellular murine Septicemic plague: Doxycycline Blood culture Yersinia can accept
animal tissue temperature sensitive: toxin: lethal to mice bacteria survive in plasmids in E. coli, and
only expressed at 37oC macrophages, and spread shares many antigens with
(temperature inside to blood and organs. Death enteric bacteria
macrophages) occurs in 75% in untreated
Squirrels and Inhaled aerosolized Virulence is plasmid- Non-motile Pneumonic plague: during Killed vaccine is Culture bubo Subcutaneuos hemorrhage
prairie dogs in the organisms: human to mediated epidemics, pneumonia effective only for a few aspirate result in a blackish skin
U.S human transmission occurs, as bacteria are months (attenuated discoloration, giving the
occurs during epidemics spread from person to vaccine is more name “Black Death”
person by aerosolized effective but also has
respiratory secretion: 100% more side effects)
in untreated
Requires calcium at 37oC. If Serology Yersinia is named in honor
insufficient calcium, Y. pestis of Alexander Yersin, who
alters its metabolism and successfully isolated the
protein production. This trait bacteria in 1894 during the
assists with its intracellular pandemic that began in
state China in the 1860s.
The virulence of this bacterium Rapid diagnositic Plague was first described
results from the 32 Y pestis test: antibody in the Old Testament and
chromosomal genes and two Y against F1 (capsular has persisted into the
pestis –specific plasmids, antigen) modern era. Plague has
constituting the only new caused large-scale
genetic material acquired since epidemics, thereby
its evolution from its changing the course of
predecessor. These acquired history in many nations.
genetic changes have allowed The first pandemic was
the pathogen to colonize fleas believed to have started in
and to use them as vectors for Africa and killed 100
transmission. million people over a span
of 60 years. In the Middle
The bacteria elaborate a Ages, plague killed
lipopolysaccharide endotoxin, approximately one fourth
coagulase, and a fibrinolysin, of Europe's population.
which are the principal factors The pandemic that began
in the pathogenesis of plague. in China in the 1860s
spread to Hong Kong in the
1890s and was
subsequently spread by
rats transported on ships
to Africa, Asia, California,
and port cities of South
America. In the early
twentieth century, plague
epidemics accounted for
about 10 million deaths in
India. As reported in
National Geographic, mass
graves of plague victims
were recently discovered
in an area of Venice called
"Quarantine Island."
Francisella tularensis Rabbits and Bite of tick, deerfly or Obligate aerobe Capsule antiphagocytic Tularemia Gentamicin or Culture (but very The diagnosis of tularemia
squirrels infected animals Requires cysteine Non-motile Ulceroglandular: at the site streptomycin (DOC) dangerous due to its is usually based on
Ticks can serve as a Direct contact with The ability of F tularensis to of tick bite or direct contact Doxycycline high infectivity, serology results. Tests vary
reservoir infected animal tissue impair phagocyte function and with contaminated rabbit, Attenuated vaccine: requires addition of from antibody detection
(usually rabbit) survive in infected cells is an ulcer devcelops, with onlfor high-risk cysteineto blood (using latex agglutination
Inhaled aerosolized central to its virulence. This swelling of focal lymph individuals agar media or enzyme-linked
organisms intracellular life cycle has been nodes Skin test immunosorbent assay
Ingestion of contaminated shown to be related to the Pneumonic: inhalation, or Measure rise in IgG [ELISA] testing) to the
meat or water tightly regulated expression of through the blood antibody titer (IgM is examination of a range of
Easily transmitted to lab a series of genes. Oculoglandular: direct not very good) polymerase chain reaction
personnel inoculation into eyes (PCR) assay products.
Typhoidal: ingestion results An agglutination titer
in gastrointestinal greater than 1:160 is
symptoms (abdominal considered presumptively
pain) and fever positive, and treatment
may be started if this result
is obtained. A second titer,
demonstrating a 4-fold
increase after 2 weeks,
confirms the diagnosis.

Brucella Direct contact with Obligate aerobe Capsule Brucellosis: Pasteurization of milk Culture blood, bone Brucella ovis –
contaminated livestock or marrow (best yield), nonpathogenic to man
aborted placentas liver, or lymph nodes
Brucella meltitensis (highest Goats (meeee!) Ingestion of infected milk Brucellae are aerobic Non-motile Undulating fever (fever 2Treat with Serologic tests Although Brucella infection
pathogenicity) products gram-negative peaks in the evening, and combination of is primarily controlled
coccobacilli that possess returns to normal by doxyxycline and one through cell-mediated
a unique ability to morning) other drug (gentamicin, immunity rather than
invade both phagocytic streptomycin, or antibody activity, some
and nonphagocytic cells rifampin). immunity to reinfection is
and to survive in the provided by serum
intracellular immunoglobulin (Ig).
environment by finding Initially, IgM levels rise,
ways to avoid the followed by IgG titers. IgM
immune system. may remain in the serum
in low levels for several
months, whereas IgG
eventually declines.
Persistently elevated IgG
titers or second rises in IgG
usually indicate chronic or
relapsed infection. IgA
antibodies are elaborated
late and also may persist
for very long intervals.
Brucella abortus Cattle Aerozolization in Tropism for erythritol, a sugar Weakness All cattle are Skin test: Indicates
laboratory or possibly due found in animal placentas immunized with a living exposure only
to bioterrorism attenuated strain of
Brucella abortus
Brucella suis Pigs Erythritol is a four-carbon Loss of appetite
sugar preferentially utilized by
Brucella spp. The presence of
erythritol in the placentas of
goats, cows, and pigs has been
used to explain the localization
of Brucella to these sites and
the subsequent accumulation
of large amounts of bacteria,
eventually leading to abortion.
[Microbes Infect. 2013
Jun;15(6-7):440-9]
Brucella canis: Dogs Includes abortions in
animals
Pasteurella multocida Part of the normal Bite from dog or cat Facultative anaerobe Capsule Wound infections Penicillin G Culture specimen on Not a faculatative
flora of domestic Non-motile (following dog or cat bites): Doxycycline standard laboratory intracellular organism
and wild animals may progress to infection Third generation media Human bite infection-
of nearby bones and joints cephalosporin Eikenella corrodens
 MISCELLANEOUS

MICROORGANISM RESERVOIR TRANSMISSION METABOLISM VIRULENCE FACTORS CLINICAL SYNDROMES TREATMENT DIAGNOSIS NOTES

Chlamydia trachomatis Humans Direct contact LIFE CYCLE Resistant to lysozyme Serotypes A, B, & C Trachoma: causes Genital and eye infections: Can NOT be grown artificial Gram-negative, but lacks
A-C: trachoma Primarily affects the Elementary body (EB): (since their cell wall scarring of the inside of the eyelid, Doxycycline (use only for adults media. Can classically be peptidoglycan layer and muramic
D-K: genital, neonatal eyes, genitals, lungs dense spherule that lacks muramic acid) resulting in redirection of the eyelashes Erythromycin (especially for grown in chick yolk sacs: More acid
L1-3: LGV Poor hygiene for infects cells Prevents phagosome – onto the corneal surface -> corneal infants and pregnant women) commonly chlamydia is Trachoma is seen in
trachoma Initial (reticulate) body: lysosome fusion scarring and blindness Azithromycin cultured in certain cell lines underdeveloped countries, and
After EB enters cell, it Non-motile Serotypes D through K Inclusion (McCoy cells for example) transmission occurs due to poor
transforms into an No pili conjunctivitis (opthalmia neonatorum) For inclusion conjunctivitis hygiene
initial body; larger, No exotoxins Infant pneumonia (ophthalmia neonatorum): Presence of chlamydial inclusions
osmotically fragile; can Urethritis, cervicitis and pelvic Scraping from the surface of or elementary bodies on Giemsa-
produce via binary inflammatory disease (PID) in women the conjunctiva will show stained smears of the conjunctivae
fission; requires ATP Nongonococcal urethritis, epididymitis intracytoplasmic inclusion or nasopharynx confirms the
from the host and prostatitis in men bodies within conjunctival diagnosis
The initial body Complications of chlamydial genital epithelial cells Interesting risk factors:
transform back into EB, tract infection: (Halberstaedter-Prowazek Certain cytokine polymorphisms –
which leaves the cell to Sterility, ectopic pregnancy and chronic inclusions). The inclusion These have been associated with
infect the other cells pain may occur after pelvic bodies contain glycogen and severe disease and risk of tubal
inflammatory disease thus, stain of iodine or Giemsa factor infertility
Reiter’s syndrome: triad of Gram-stain of genital Certain variants in Toll-like receptor
conjunctivitis, urethritis, and arthritis secretions will not show gram- 1 and 4 genes – These predispose
Fitz-Hugh-Curtis Syndrome: negative organisms to infection
perihepatitis Urethritis: most commonly Having been a foster child (males
Serotypes L1, L2 & L3 diagnosed by polymerase only)
Lymphogranuloma venereum (LGV) chain reaction of urethral
swab or urine sample
Immunofluorescent slide test
place infected genital or ocular
secretions on a slide and stain
with fluorescein-conjugated
anti-chlamydial antibody
Serologic: Examine blood for
elevated titers of
antichlamydial antibodies with
compliment fixation and
immunofluorescence tests.
Lymphogranuloma venereum:
Serologic test
Frei test, which is rarely used,
is similar to the PPD skin test
for tuberculosis
Chlamydophila psittaci Birds, poultry Bird feces dry out, Life cycle is similar to Psittacosis: a viral-like atypical Doxycycline Serologic: Examine blood for History of occupational exposure to
fecal particles are Chlamydia trachomatis pneumonia, with fever and dry, non- Erythromycin elevated titers of antibodies birds
inhaled, infecting the productive cough (similar to compliment fixation and This bacterium can infect parrots,
lungs Mycoplasma pneumonia) immunofluorescence tests parakeets, canaries, and other avian
An occupational According to case definitions species (eg, turkeys, pigeons,
disease of zoo and from the CDC (2000), a ducks). Another term for this
pet-shop employees, confirmed case involves one of infection is ornithosis, which
poultry farmers, and the following criteria: describes the infection caused by
ranchers. Human-to- Isolation of the organism by nonpsittacine birds.
human transmission is culture Psittacosis is found worldwide. The
rare. Compatible clinical illness with incidence seems to be increasing in
a 4-fold rise (to a reciprocal developed countries, which is
titer of 32 or greater by paired correlated to the import of exotic
sera collected at least 2 weeks birds.
apart) in CF or MIF antibodies
against C psittaci
Detection of an IgM titer of 16
or greater against C psittaci by
MIF

Chlamydophila Humans (spread Respiratory route Life cycle is similar to Atypical pneumonia: viral like atypical Macrolides are the first-line Serologic: Examine blood for Accelerated atherosclerosis
pneumoniae from human to Chlamydia trachomatis pneumonia ( similar to Mycoplasma) in antibiotics for the treatment of elevated titers of antibodies
human) young adults C pneumoniae pneumonia with compliment fixation and
immunofluorescence test.
Criteria for infection include a
single IgM titer ≥1:16 or a 4-
fold increase in IgG titer.

Doxycycline Intracytoplasmic inclusion Culture for C. pneumoniae is

bodies do not stain with iodine technically complex and time
consuming. When compared to
serology and PCR, it also has low
sensitivity and is mainly used in
research labs
Erthromycin The Infectious Diseases Society The FilmArray Respiratory Panel is a
of America and American multiplex PCR which detects
Society of Microbiology common respiratory pathogens in
currently recommend nasopharyngeal specimens. In
serologic testing or 2012, the US Food and Drug
polymerase chain reaction Administration (FDA) approved the
(PCR) for the diagnosis of C addition of 2 corona viruses and 3
pneumoniae. Despite evident bacteria to the Panel, including C
drawbacks, serology is still pneumoniae, Bordetella pertussis,
considered the gold standard and Mycoplasma pneumonia. The
FilmArray Panel can now detect 17
viruses and 3 bacteria from a single
sample. Reported sensitivity and
specificity were both 100% for C
pneumoniae but the sample size
was small and fewer than 10
samples were positive in the study.
 Real-time PCR assays of
pharyngeal swab,
bronchoalveolar lavage,
sputum or tissue can be used
to detect C pneumoniae-
specific DNA. Because of the
complexity of these tests,
widespread implementation
had been limited until recent
years.
Rickettsia rickettsii Dogs, rabbits & wild Wood tick: In western Rocky mountain spotted fever: Doxycycline Clinical exam
rodents U.S Dermacentor 1. Fever Chloramphenicol Direct immunofluorescent
andersoni 2. Conjunctival injection (redness) exam of skin biopsy from rash
Dog tick: In Eastern 3. Severe headache site
U.S Dermacentor 4. Rash on wrists, ankles, soles and Serology
variabilis palms initially, become generalized Well-Felix reaction
later Positive OX-19
Positive OX-2

Rickettsia akari House mice Mites (which live on Rickettsial Pox: Vesicular rash similar to Doxycycline Well-Felix reaction negative
the house mice) chicken pox. It resolves over 2 weeks Chloramphenicol

Rickettsia prowazekii Humans Human body louse 1, Epidemic Louse-borne typhus Doxycycline Well-Felix reaction: positive Epidemic typhus is caused by
Flying squirrels (Pediculus humanus A. Abrupt onset of fever and headache Chloramphenicol OX-19 Rickettsia prowazekii and
var. corporis) B. Rash, which spares the palms, soles, Eradicate human lice Serology transmitted by human body lice.
and face For centuries, it has been
C. Delirium/stupor associated with overcrowding, cold
D. Gangrene of hands or feet weather, and poor hygiene.
2. Brill-Zinsser Disease: Brill-Zinsser disease is a recurrent
A. Reactivation of Rickettsia prowazekii form of epidemic typhus that is
B. Mild symptoms unrelated to louse infestation and
C. NO rash develops sporadically years after
the primary illness. Clinical features
are similar to, but milder than,
those of epidemic typhus

Rickettsia Rats Rat flea (Xenosylla Endemic (or murine) typhus: fever, Doxycycline Well-Felix reaction: positive
typhi Small Rodents cheopsis) headache and rash Chloramphenicol OX-19
Orientia tsutsugamushi Rats Mite larvae (chiggers) Scrub typhus: Doxycycline Well-Felix reaction: positive
Shrew Fever and headache Chloramphenicol OX-K
Mongooses Eschar (scab) at bite site
Birds Followed by a rash

Bartonella quintana Humans Body louse Not an obligate 1. Trench Fever: fever, headache and Doxycycline Serology
intracellular parasite back pain. It last for 5days recurs at 5 Chloramphericol PCR
day interval Azithromycin
2. Bacteremia, endocarditis, and
baciliary angiomatosis

Bartonella henselae Cats Cat bite or scratch Not an obligate Cat-scratch disease Azithromycin Serology Bacillary angiomatosis is a
intracellular parasite Baciliary angiomatosis Doxycycline PCR differential diagnosis for Kaposi’s
Bacteremia sarcoma
Endocarditis, “culture negative”

Coxiella burnetii Cattle,sheep, goats No anthropod vector Can grow at pH 4.5 Q fever. Fever, headache & viral-like Doxycycline Complement fixation test This is the only rickettsial disease
required. Direct within phagolysosomes pneumonia. No rash! Erythromycin demonstrating a rise in without a skin rash.
airborne transmission Has an endospore form Complications: Pasteurize milk at 60oC antibody
of endospore from 1. Hepatitis PCR
cow hide or dried 2. Endocarditis
placenta, or via
consumption of
endospore-
contaminated
unpasteurized
cowmilk
Ehrlichia chaffeensis Deer, dogs, coyotes Ticks Clusters of Ehrlichia Human ehrlichiosis: similar to rocky Doxycycline Rise in acute and convalescent Ehrlichiosis is an infection of white
Anaplasma multiply in host mountain spotted fever, but rash is rare Rifampin antibody liters blood cells that affects various
phogocytophilum monocyte vacuoles Resistant to chloramphericol Characteristic ehrlichial mammals, including mice, cattle,
Ehrlichia ewingii Deer, white-footed (phagosomes) to form inclusion bodies are dogs, deer, horses, sheep, goats,
mouse large, mulberry-shaped sometimes seen in leukocytes and humans
aggregates called on blood smears The primary target cell for human
morulae PCR monocytic erlochiosis (HME) is the
macrophage, and the primary
target for human granulocytic
anaplasmosis (HGA) is the
granulocyte.
Intracellular infection is established
within phagosomes, most often
found in macrophages in the liver,
spleen, lymph nodes, bone marrow,
lung, kidney, and CNS.

Treponema pallidum Humans only Sexual Microaerophilic Motile Syphilis Penicillin G Cultaneuos lesions examined Jarisch-Herxheimer reaction: acute
pallidum Morphology: thick rigid A. Primary: painless chancre Erythromycin by dark field microscopy, worsening of symptoms after
spirals Doxycycline immunofluorescence. ELISA, or Penicillin is started
silverstain
Between 1905 and 1910, Highly sensitive to B. Second stage: Rash on palms and Non-specific treponemal tests:
Schaudinn and Hoffman elevated temperatures soles VDRL; RPR
identified T pallidum as Condylomata lata: painless, wart-like Specific treponemal test : FTA-
the cause of syphilis, and lesion which occurs in warm, moist ABS, MHA-TP
Wasserman described a places (vulva or scrotum) VDRL and FTA-ABS are positive
diagnostic test for the CNS, eyes, bones, kidneys and/or joints
long-recognized infection. can be involved
Pathogenic treponemes
are associated with the
following 4 diseases:
C. Latent: 25% may relapse back to the
Venereal syphilis, caused secondary stage
by T pallidum pallidum
Yaws, caused by T D. Tertiary (33%):
pallidum pertenue Gummas of skin and bone
Endemic syphilis (bejel), Cardiovascular syphilis (aortitis)
caused by T pallidum Neurosyphilis: Agryll-Robertson pupil
endemicum Pinta, caused
by T carateum

E. Congenital syphilis: contacted

transplacentally (MCC of death is
pulmonary hemorrhage) -> According
to a Centers for Disease Control and
Prevention report, untreated syphilis,
especially early syphilis, during
pregnancy can lead to deafness,
neurologic impairment, bone
deformities, stillbirth, and neonatal
death

Borrelia burgdorferi White-footed Vector = Ixodes ticks Microaerophilic LYME DISEASE Doxycycline (DOC) Elevated levels of antibodies Largest medically important
mouse Ixodes scapularis: A. Early localized stage (stage 1): Amoxicilin against Borellia burgdorferi bacterium (size)
White-tailed deer East & Midwest Erythema chronicum migrans (ECM) Ceftriaxone for neurologic ban be detected by ELISA
Ixodes pacificus: West disease Western immunoblotting
coast
Together with Babesia B. Early disseminated stage (stage 2):
microti Multiple smaller ECM
Neurologic: aseptic meningitis, cranial
nerve palsies (Bell’s palsy), and
peripheral neuropathy
Cardiac: transient heart block or
myocarditis
Brief attacks of arthritis of large joints
(knee)

C. Late stage (stage 3):

Chronic arthritis
Acrodermatitis chronica atrophicans
Encephalopathy
Leptospira interorgans Zoonotic (dogs, cats, Direct contact with AEROBIC – the other Leptospiremic phase: organisms in Penicillin G First week: culture blood or The traditional system divided the
livestock, and wild infected urine or spirochetes are blood and CSF causes high spiking Doxycycline for cerebral spinal fluid (on lab genus into 2 species: the
animals) animal tissue: microaerophiles temperature, headache and severe chemoprophylaxis media, or by inoculation into pathogenic Leptospira interrogans
Organism penetrate muscle aches (thighs and lower back) animals and the nonpathogenic Leptospira
broken skin (i.e. on biflexa. These species were divided
23 serogroups, 250 History of wading in feet) and mucous Spiral shaped, with Immune phase: correlates with Second week to months: further into serogroups, serovars,
serovars flood water (in 3rd membranes hooks on both ends emergence of IgM and involves culture urine and strains based on shared
world setting) (swallowing urine- (“ice tongs”) -> recurrence of the above symptoms, antigens. L interrogans included
contaminated water) Shepherd’s crook often with meningismus (neck pain) more than 250 serovars.
appearance
History of exposure Two axial flagella wrap WEIL’S DISEASE: most severe case of Rarely, dark field microscopy is
to animals (butcher) around and run along leptospirosis with renal failure, successful (not recommended)
the length of the hepatitis (and jaundice), mental status
organism under the changes, and hemorrhage in many Antibody based ELISA to
outer membrane organs. ECG abnormalities are common detect Leptospira antigens in
(oeriplasmic flagella) during the leptospiremic phase of Weil the urine
syndrome. In severe cases, congestive
Polymerase Chain Reaction
heart failure and cardiogenic shock may
(PCR) to detect bacterial DNA
occur.
in serum, CSF and urine
Microscopic agglutination
testing (MAT; the criterion
standard for serologic
identification of leptospires,
available only at reference
laboratories)
Mycobactrium 40% of total cell dry Aerobic Mycosides No exotoxin nor Tuberculosis First line drugs: Acid-fast stain of specimen Mycolic acids are also found in
tuberculosis weight is lipid Catalase-positive Cord factor: only found endotoxin A. Primary tuberculosis: Isoniazid (INH) (carbolfuchsin primary stain; Nocardia (which also is acid fast)
Composed of Slow growth rate in virulent strain (May Asymptomatic Rifampin methylene blue secondary
mycolic acids be responsible for Overt disease, involving the lungs or Pyrazinamide stain) Purified Protein Derivative (PPD)
Thin rods release of tumor other organs Ethambutol RAPID CULTURE: Test
Non-motile necrosis factor Streptomycin Bactec radiometric culture: a 1. Measure zone of unduration:
Facultative Sulfatides: inhibit B. Reactivation or secondary liquid broth in a bottle, with Positive reaction:
intracellular growth: phagosome-lysosome tuberculosis: radioactive palmitate as a > 5mm (immune-compromised
M. tuberculosis can fusion 1. Pulmonary carbon source. Mycobacteria host)
survive and multiply Wax D: acts as an 2. Pleural or pericardial grow and use the carbon, > 10 mm (have chronic disease or
in macrophages adjuvant 3. Lymph node infection allowing early detection (in 1-2 risk factors for exposure to TB)
Iron siderophore 4. Kidney weeks) even before colonies >15mm (all others)
(mycobactin) 5. Sketetal can be seen. 2. A positive reaction does not
6. Joints PPD skin test mean active disease.
7. Central Nervous System Chest X-ray 3. Can get false negative in patients
8. Miliary Tuberculosis PCR and DNA probes with AIDS or malnourished
Mycobacterium Tb Direct Test individuals
(MTDT): amplifies ribosomal
RNA in respiratory secretions,
allowing rapid identification of
M. tuberculosis
QuantiFERON-TB - blood test
that measures interferon
gamma levels produced in
whole blood in response to
addition of specific
tuberculosis antigens has been
approved by the FDA. An
advantage of this test is the
relative specificity for
Mycobacterium tuberculosis; it
is not positive in patient in
previous BCG vaccination,
(MMWR, Recommendation
and Reports, 2005)
Luciferase Reporter
Mycobacteriophage (LRP)
Assays - can detect
Mycobacterium tuberculosis
and characterize
mycobacterial drug
susceptibility patterns within
24 to 48 h in positive cultures
(luciferase is an enzyme
obtained from fireflies)

Mycobacterium leprae Humans Catalase-positive Non-motile Leprosy - the most common cause of Rifampin Can NOT be grown on artificial Lepromin skin test - Although not
Armadillos Grows best at low Facultative intracellular crippling of the hand Dapsone lab media: can only be useful for diagnosis, it allows
temperature growth A. Lepromatous leprosy (LL): Clofazimine cultured in certain animals, positioning of patients on the
Phenolase-positve: 1. Low cell-mediated immunity such as mice foot pads, immunologic spectrum
converts DOPA into a 2. Organisms found everywhere (organs armadillos or monkeys Also known as Hansen disease,
pigmented product and blood) Skin or nerve biopsy will named after G.A. Hansen, who is
(used for diagnosis) 3. Skin, nerves, eyes and testes involved reveal acid-fast bacilli credited with the 1873 discovery of
bilaterally: multiple skin lumps and M leprae.
 bumps, leonine facies, saddle nose, (lepromatous) or granulomas Classification of leprosy: Leprosy
peripheral neuropathy, digit absorption, (tubercoloid) has 2 classification schemas: the 5-
blindness and infertility in men (from category Ridley-Jopling system and
testicular damage) the simpler and more commonly
used WHO standard.
B. Tubercoloid leprosy (TL): Ridley-Jopling: Depending on the
1. Intact-cell mediated immunity host response to the organism,
2. Difficult to isolate M. leprae from leprosy can manifest clinically along
skin or blood a spectrum bounded by the
3. Skin and nerves involved: 1 or 2 tuberculoid and lepromatous forms
superficial unilateral lesions of the disease. Most patients fall
Damage in the following nerves is into the intermediate
associated with characteristic classifications, which include
impairments in leprosy: borderline tuberculoid leprosy,
• Ulnar and median - clawed hand midborderline leprosy, and
• Posterior tibial - Plantar insensitivity borderline lepromatous leprosy.
and clawed toes The classification of the disease
• Common peroneal - Foot drop typically changes as it evolves
• Radial cutaneous, facial, and greater during its progression or
auricular nerves (may also be involved) management. The Ridley-Jopling
system is used globally and forms
the basis of clinical studies of
leprosy. It may also be more useful
in guiding treatment regimens and
assessing risk of acute
complications. Physical findings in
each subtype are presented in the
Clinical section.
WHO system: The WHO
recommends classifying leprosy
according to the number of lesions
and the presence of bacilli on a skin
smear. This method is useful in
countries where biopsy analysis in
unavailable.
Paucibacillary leprosy is
characterized by 5 or fewer lesions
with absence of organisms on
smear. Paucibacillary leprosy
generally includes the tuberculoid
and borderline lepromatous
categories from the Ridley-Jopling
system.
Multibacillary leprosy is marked by
6 or more lesions with possible
visualization of bacilli on smear.
Lepromatous leprosy, borderline
lepromatous leprosy, and
midborderline leprosy on the
Ridley-Jopling scale are included in
the multibacillary leprosy category.
Mycoplasma pneumoniae No cell wall Requires STEROL for Protein P1 adhsesin: Recently, M Tracheobronchitis Macrolides (azithromycin, Cold agglutinins Chest X-ray will show patchy
The smallest free-living membrane formation adheres to epithelial pneumoniae has been clarithromycin) infiltrates that look worse than
organisms. -> bacteria do not cells of the respiratory shown to produce an physical examples and clinical
tract; mediates exotoxin that is also symptoms suggest
Although scientists have normally contain attachment, followed believed to play a major
isolated at least 17 species sterols by induction of role in the damage to
of Mycoplasma from ciliostasis, local the respiratory
humans, 4 types of Pleomorphic: can Aerobic (the other inflammation that epithelium that occurs Walking pneumonia (also called atypical Tetracyclines (doxycycline) Complement fixation test Disease usually occurs in children,
organisms are responsible appear round to mycoplasmas are consists primarily of during acute infection. pneumonia): fever with a dry, non- adolescents and young adults
for most clinically oblong shaped facultative anaerobes) perivascular and This toxin, named the productive hacking cough
significant infections that peribronchial community-acquired
Smallest bacteria Quinolones (ciprofloxacin, Culture: takes 2-3 weeks CHILD 5-15 YEARS OLD WITH
may come to the attention infiltration of respiratory disease
capable of growth & levofloxacin) (Eaton’s agent) Requires PNEUMONIA? THINK
of practicing physicians. mononuclear toxin (CARDS) is an
reproduction cholesterol and nucleic MYCOPLASMA!Children with sickle
These species are leukocytes, and tissue ADP-ribosylating and
outside a living cell acidsAdd penicillin to inhibit cell disease and functional asplenia
Mycoplasma pneumoniae, destruction that may vacuolating cytotoxin
(smaller that some growth of contaminating may be at greater risk for severe
Mycoplasma hominis, be mediated by similar to pertussis
viruses: 1-2 microns) bacteria respiratory tract disease
Mycoplasma genitalium, liberation of hydrogen toxin. [Infect Immun.
and Ureaplasma species. Motile (glides) peroxide 2005 May. 73(5):2828- Penicillin and cephalosporins Dome-shape colonies with
34.; Am J Respir Crit do NOT work as mycoplasma “fried egg” appearance or
Care Med. 2010 Sep 15. does not have a cell wall “mulberry” appearance (in the
182(6):797-804.] case of Mycoplasma
pneumoniae)
Evidence from animal Rapid identification Test:
models of M Sputum can be tested with
pneumoniae infection DNA probes (nucleic acid
have proven that hybridization). PCR sputum
recombinant CARDS samples.
toxin results in
significant pulmonary
inflammation, release
of proinflammatory
cytokines, and airway
dysfunction. [PLoS One.
2009. 4(10):e7562]
Actinomyces israelii Normal flora of the Gram-positive rod; Actinomycosis is a subacute, chronic, Penicillin G Examine tissue or pus from Yellow “sulfur granules”:
mouth and GI tract filamentous bacterium cellulitic invasion of the soft tissues that infection site, and look for microcolonies of Actinomyces and
causes the formation of external sinus “sulfur granules” cellular debris
tracts that discharge sulfur granules.
This process spreads unimpeded by All species of Actinomyces are
traditional anatomic barriers after the normal commensal inhabitants of
endogenous oral commensal organisms the oral and buccal cavities in
invade the tissues of the face and neck. humans and certain other
Actinomycosis may also spread to the mammals. They cannot be classified
pulmonary and GI systems. as symbiotic organisms because
they do not have a mutually
beneficial relationship with their
host. They are not true parasites
Anaerobic bacteria Surgery Anaerobic culture because they usually do not cause
(ABC!) harm to the host; however, they
Grow as branching Eroding abscesses of the mouth, lung or definitely assume a parasitic role
chains or beaded gastrointestinal tract, classified as: when they result in an infection
filaments with an inflammatory tissue
response.
1. Cervicofacial actinomycosis

2. Thoracic actinomycosis Does not appear to be an

opportunistic infection because
3. Abdominal actinomycosis actinomycosis is not common in
patients who are
 immunosuppressed or in patients
with AIDS

Nocardia asteroides Never part of the Gram-positive rods Pneumonia Thrimethoprim/sulfamethozole Gram-stain Nocardia infection usually occurs in
normal flora immunocompromised patients
Respiratory Partially acid-fast: due Formation of abscesses in the lung, Modified acid-fast stain:
transmission to mycolic acids in the kidney, and central nervous system Decolorized with 1%sulfuric
cell wall acid instead of acid alcohol.
Nocardia are typically weakly
acid-fast after traditional
staining and positive on
modified acid-fast staining, but
this is not invariable.
Members of the Aerobic SNAP= Aerobic culture
genus Nocardia are
aerobic
actinomycetes that
are ubiquitous
saprophytes in soil,
decaying organic
matter, and fresh
and salt water. Grow as branching Sulfa -> Nocardia
chains or beaded
filaments Actinomyces ß Penicillin