Pearls of

microbiology for viva

MICROBIOLOGY PEARLS and MCQS point of

view
 Microbiology pearls
GRAM POSITIVE COCCI

STAPHYLOCOCUS STROTOCOCUS
❖ Grape like arrangement ❖ Chain like arrangement
❖ Catalase +ve ❖ Catalase -ve
 SPECIES:

1. S.AUREUS
2. S.EPIDERMIDIS
3. S.SAPROPHYTICUS

1) STAPHYLOCOCUS AUREUS DISEASE :

• ABCESSES
• PYOGENIC INFECTION (ENDOCARDITIS ,SEPTICT ARTHRITIS)
• SKIN AND SOFT TISSUE INFECTION (CELLULITIS, IMPETIGO,

EN9TEROTOXIN TOXIC EXOFOLIATIN EXOTOXIN ENZYMES

SHOCK
SYNDROME ALPHA TOXIN
TOXIN CAUSE
Acts as super NECROSIS OF
SCALDED COAGU
SKIN AND
antigen in git ACT AS SKIN LASAE,
and cause HEMOLYSIS
SUPER SYNDROME HYALUR
P-V LEUCOCIDIN
foodpoisoning( ANTIGEN ONIDASE,
PORE
vomiting, non TOXIC BULOUS FORMING PROTEASES
bloody SHOCK IMPETIGO TOXIN, ,NUCLEASES
diarrhea) necrotizing FIBRIN
pneumonia OLYSIN
AND KILL
WBCs
 FOLLICULITIS
• HOSPITAL ACQUIRED PNEUMONUA
• SEPTICIMIA
• BACTERIAL CONJUCTIVITIS
• Pathogenesis

LAB DIAGNOSIS

• COAGULASE POSITIVE
• GRAM -STAINED SMEAR +VE COCCI IN GRAPES LIKE
• CATALASE TEST NEGATIVE
• FERMENT MANNITOL
• ON BLOOD AGAR SHOW GOLDEN COLOR COLONIES
• HEMOLYSIS IS BETA
SPECIES PATHOGENESIS LAB DIAGNOSIS DISEASE
S.EPIDERMIDIS PYOGENIC COAGULASE S.EPIDERMIDIS
INFECTION -VE
NO CULTURE Pyogenic
EXOTOXIN, SHOWA infection on
TOXIN WHITE prosthetic heart
SHOCK COLONIES valves
SYNDROME SO NO BETA
TOXIN HEMOLYTIC
PRODUCE Sensitive to
GLYCOCALYX novobiocin
FOR
ADHERE
SAME as Resistant to UTI
S.SAPROPHYTICUS above novobiocin

Streptococcus pyogenes

❖ Disease+clinical finding :
Pharyngitis
cellulitis otitis media
sinusitis, sepsis
Scarlet fever caused by Erythrogenic toxin produce by S.
Pyogenes
 SCARLET FEVER ( STRAWBERRY TONGUE, CELLULITIS,
DIFFUSE RASHES, PHARYNGITIS)
SKIN AND SOFT TISSUE INFECTION:impetigo, flesh eating
Toxigenic:: toxic shock syndrome toxin (super antigens)
immune mediated
1) Rheumatic fever :: joint migratory, endocarditis
nodules, chorea ) occur after pharyngitis. And show type
2 hypersensitivity reaction.
2) Acute glomerulonephritis:: M protein 49 involved,

smoke colored urine hypertension, edema of face .

❖ PATHOGENESIS
ENZYMES RELATED : Hyaluronidase, streptokinase,
Dnase , IG degrading enzymes Toxin :

1. Erythrogenic toxin : super antigen and cause

scarlet fever ,
2. pyrogenic Toxin A : Toxic shock syndrome toxin
Exotoxin B : flesh eating
3. Hemolysin: hemolysin O( oxygen labile ,
antigen) Hemolysin S ( stable , non antigenic )
❖ Lab diagnosis:: Beta hemolysis, inhibited by bacitracin
Group B streptococcus
❖ Disease and clinical:
Neonatal sepsis, meningitis (in adult )can use
endocarditis, osteomyelitis, arthritis
❖ PATHOGENESIS: Polysaccharide capsule
❖ Lab diagnosis: Bacitracin resist,hypurate hydrolyzed ,cAMP
test positive .
Viridian's Groups
❖ DISEASES:
( s.anguis , intermedius, milleri) Cause Brain abscess with
mixed anaerobic and aerobic bacteria infection after
dental surgery)
S. Mitis, mutans, salivarius cause infective endocarditis
because of dextran.

❖ PATHOGENESIS:: because of glyco calyx or dextran

❖ LAB DIAGNOSIS:: not bile soluble, not inhibited by
optochin
❖ Non enterococcus s.bovis : ( endocarditis especially in
colonic cancer patients.)
❖ Enterococcus ( Feacalis, faecium) :disease+ clinical: biliary
infection by faecium , UTI , endocarditis , pelvic infection.
❖ Pathogensis : Bacterimia
❖ Lab diagnosis: s. Bovis : not grown in 6.5 percent NaCl.
While S. Faecalis: can grow in 6.5 percent NaCl.
S. Pneumonia

❖ Diseae+ clinical finding:

Upper respiratory infection ( otitis media ,
mastoiditis)
bronchitis, pericarditis,bacterial meningitis
conjunctivitis abcess in spleen if aspleen
Suptum is rusty colored

❖ Pathogensis:
1) capsular polysaccharide
2) lipotechoic acid
3) ig A protease
❖ Diagnosis:
1. lancet shape diplococcic

2. alpha hemolysis
3. urinary antigen positive if pneumonia occur
4. inhibited by optochin
5. Latex agglutination test for bacteria meningitis

Gram Negative cocci ( Neisseria)

1) N. Meningitidis
2) N. Gnorrhea
❖ common Feature :: Gram negative diplococci with bean
shaped,Oxidase test positive and endotoxin has lipo -oligo
saccharides
N. Meningitidis
❖ Clinical finding+ Disease :
• Meningitis ( stiffness of neck and fever)
• Meningococcemia: septic shock
• DIC
• petechial hemorrhage
• Waterhouse Friedrichsen syndrome related to necrosis
of adrenal gland and septic shock
Pathogensis:
1) Polysaccharide capsule
2) Endotoxin
3) Ig A protease
4) Factor H binding protein
❖ diagnosis:
1) latex agglutination test
2) chocolate agar
3) PCR
❖ treatment: ceftriaxone or penicillin G

N. GONORRHEA

❖ TRANSMISSION: SEXUALLY ACTIVE INTERCOURSE

PATHOGENSIS:
1) PILI
2) OUTER MEMBRANE PROTEIN
3) LIPOOLIGOSACCARIDES
4) IgA protease.
❖ Clinical finding::
in men : urethritis, epididymitis and purulent discharge
in women: localized infection: urethritis, cervicitis and
vaginal white discharge
• Disseminated Gonococcal infection: septic arthritis,
tenosynovitis, skin pustules, polyarthritis
• Assending infection: Salpingitis, PID
• Neonatal conjunctivitis (ophthalmia neonatorum)
❖ Lab diagnosis:
1) chocolate agar
2) gram staining
3) NAAT.
❖ treatment: ceftriane and azithromycin

Bacillus Anthracis
❖ Important points :

▪ Gram positive rods having square ends

▪ its antiphagocytic capsule has D - Glutamate
▪ Non motile and produce spores .
▪ Transmitted by spores in soil enter the wound in case of
cutaneous anthrax
▪ inhalation anthrax is not communicable from person to
person
 ▪ cause mediastinal lymph nodes hemorrhagic mediastinitis

❖ pathogensis :

o Exotoxins which consist of two protein sub unit A(

enzymatic activity) while B ( binding site )
o Edema Factor ➡ Inc the cAMP lead to edema
o while Lethal Factor ➡is a protease cause necrosis ( Black
eschar)

❖ clinical findings :
o Cutaneous Anthrax produce painless ulcer with black

eschar, striking local edema this skin lesions is called ➡

Malignant pustules
o Pulmonary anthrax leads to wool sorters disease with dry

cough it can lead to hemorrhagic mediastinitis, septic shock

so on X ray ➡ mediastinal widening is seen
o Git Anthrax ➡ Bloody diarrhea ❖ LAB DIAGNOSIS:
o Comets tail appearance on blood agar colonies ❖ Bacillus
cereus : Gastroenteritis due to eating of Reheated rice.
 Clostridium tetani
❖ Disease and clinical finding :
• Tetanus
• spastic paralysis
• lockjaw
• trismus
• risus sardonicus opisthotonic , respiratory paralysis
❖ PATHOGENESIS: tetanus Toxin that is grow on vegetative
cells at wound site. it
will travel in retrograde Manner to CNS and
block the inhibitory neurotransmitter
Glycine and GABA
❖ Laboratory diagnosis: Terminal spore having tennis racket
appearance.
Clostridium botulinum
❖ Disease and clinical finding
botulism, descending weakness while in Gullein Barre
ascending weakness
diplopia, mydriasis, dysphagia
infant botulism in case of honey ingestion (floppy baby
syndrome)
wound botulism in drug user skip Popping
 Pathogensis:
• canned food or taking preformed toxin ( eating of
canned vegetables)
• the toxin will will inhibit the acetylcholine in PNS .
• Botox used to reduce wrinkles, torticollis etc.
❖ Laboratory diagnosis: PCR, ELISA

Clostridium perfringens
Disease:
hemolysis
smelly bloody vaginal discharge in case of
endometriosis
❖ Pathogensis:
Alpha toxin will produce lecithinase that
will hemolysis RBC's membrane.
Transmission by war wounds , motorcycle accident,
endometritis
❖ Laboratory diagnosis:
blood agar : double zone of hemolysis
egg yolk agar : precipitation of colonies
 C. Perfringens:
cause food posioning with watery diarrhea onset is delay and
due to enterotoxin production that is acting as super antigen.

Clostridium difficil

❖ Disease: toxic megacolon

❖ Pathogensis:
antibiotics (Clindamycin, ampicillin, PPI, chemotherapy drug)
suppress this normal flora

• production of Exotoxin A, B will act to depolymerization of

actin and destabilize the cytoskeleton integrity and leads
to apoptosis of entrocytes.
laboratory diagnosis: ELISA, PCR, NAAT
corynebacterium diphtheria
❖ Disease:
Diphtheria
bulls neck
pseudomembrane over tonsils with grey
exudates
myocarditis
cutaneous Diphtheria .
❖ Properties: club,v and L shaped arrange,
metachromatic granules
❖ Pathogensis: Diphtheria toxin inhibits the ADP
ribosylation of EF- 2.
❖ Laboratory diagnosis:

Tellurite and Loeffler medium

❖ Treatment: toxoid vaccine Listeria monocytogenes

❖ Disease and clinical finding:

meningitis and sepsis in newborn, pregnant woman,
immunocompromised and Gastroenteritis
❖ PATHOGENSIS:
attach to E cadherin of host cell by internalin
produce by this bacteria
 listeriolysin prevent it from phagocytosis with in
phagosome.
❖ Laboratory diagnosis: on blood agar Beta hemolysis,
motile
Gardnerella vaginosis
❖ Disease
vaginosis with fishy odor
❖ lab diagnosis: shows clue cells and whiff test positive
E. COLI
❖ Disease and clinical finding:
UTI
travelor diarrhea
EHEC strains cause bloody diarrhea and HUS.
O157:H7 strain cause bloody diarrhea
neonatal meningitis caused by K1 Capsular
polysaccharide
sepsis caused by Endotoxin.
❖ important properties:

gram( -) , facultative anaerobe and ferment the lactose

Three antigen
1) O antigen
2) H antigen
3) K antigen
O55 and O 111 strain cause neonatal diarrhea.
❖ Pathogensis:
1) PILI
2) capsule
3) three Exotoxin
4) Endotoxin
5) Enterotoxigenic strains of E. Coli produce
two Exotoxin one is
1) Heat labile toxin work like cholera toxin
(ADP ribosylation) to increase cAMP
2) Hear stable toxin will Inc cGMP .

6) EHEC produce shiga toxin which will cause

bloody diarrhea.
7) By eating of Ham Burger will cause Bloody
diarrhea beacuse of O157:H7 strain.
8) if shiga toxin enter blood then it will cause
HUS ( hemolytic anemia, thrombocytopenia,
acute renal failure)
9) UTI : O serotype of E. Coli having PILI with
Gal-Gal dimers cause UTI and cranberry
juice have flavonoids prevent from UTI.
10) Systemic infection cause by Capsule
(neonatal meningitis) and Endotoxin( sepsis)
 ❖ Laboratory diagnosis: EMB agar show green sheen
colonies and ferment lactose
Salmonella
❖ Disease and clinical Finding
enterocolitis, enteric fever
typhoid fever and osteomyelitis (metastatic
infection)
Salmonella typhimurium cause enterocolitis.

Typhoid fever cause by s. Typhi and

paratyphi.
Typhoid fever characterized by constipation
and diarrhea,high fever, abdominal pain and
rose spots. Leukopenia and enlarged spleen.
❖ important properties:
don't ferment lactose
produce SH2 , three antigen
O - cell wall antigen
flagellar antigen H and capsular Vi antigen
(antiphagocytic)
❖ Pathogensis
Enterocolitis: invasion of epithelial cells of
entrocytes, results in inflammation and
diarrhea
typhoid fever : organisms infect small
intestine with Git
symptoms and then multiply in mononuclear
phagocytes of payer patches and then
spread to phagocytes of liver, spleen,
gallbladder and results in Bacterimia with
onset of fever.
Septicemia occur in those patient with sickle
cell disease and cause osteomyelitis in these
children.
❖ Lab diagnosis:
salmonella don't ferment lactose so form color less
colonies on EMB agar.
TSI agar its colonies form gas and SH2 .
Shigella species
❖ Disease and clinical finding: enterocolitis , shigellosis
 ❖ Properties:: don't produce SH 2. And don't ferment
lactose, non motile
❖ Pathogensis: shiga toxin
❖ Laboratory diagnosis:
o Form color less colonies on EMB agar
o on TSI agar , shows no SH2 and gas production.
Vibrio cholera
❖Disease&clinical finding:
• Cholera, watery diarrhea
• rice water stool and dehydration
• hypokalemia, electrolytes imbalance
❖ Pathogensis: Cholera toxin

❖ Lab diagnosis:
oxidase test positive
EMB agar color less colonies
on TSI agar shows no gas and SH2 production.
VIBRIO PARA HAEMOLYTICUS
CAUSE GASTROENTERITIS
DIARRHEA BY EATING RAW SHELLFISH, OYSTERS
 Vibrio vulnificus
cause cellulitis, gastroenteritis, septicemia in
fisher man hand

Campylobacter jejuni
❖ disease and clinical finding:
• Enterocolitis in children
• watery foul smelling diarrhea followed by bloody
diarrhea,
• Git infection is associated with Gullein Barre
syndrome, reiter's syndrome, reactive arthritis.
Helicobacter pylori
❖ Disease and clinical finding:
gastritis, peptic ulcers, MALT-Lymphoma.
❖ Pathogensis: urease helps its survival in stomach.

❖ Laboratory test : urea breath test. klebsiella

Enterobacter Serratia Group
❖ Disease and clinical finding

k. Pneumonia cause pneumonia

these organisms cause nosocomial infection and
UTI.
Currents jelly sputum in case of K. Pneumonia Proteus
-Providencia Morganella
o swarming effect, no lactose fermentation
o struvite formation
o Proteus species cause pneumonia, wound
infection, septicemia. Pseudomonas Diseae (
P.aerugonsia cause septicemia,
pneumonia,UTI )
ventilator associated pneumonia
otitis externa
ecthyma gangrenous.
❖ Pathogensis: endotoxin, Exotoxin, enzymes

❖ important properties: Oxidases positive,non ferment of

glucose,form pyocyanin,pyoverdin in pus.
BACTERIODES AND PREVOTELLA
❖ Disease and clinical finding sepsis, peritonitis, abscess
(Lung abscess)
P. Melaninogenica form black pigment colony
b.fragilis cause intra abdominal infection, pelvic abscess,
necrotizing fasciitis
p. Intermediate cause gingivitis,dental abscess
❖ important properties: anaerobic, non spore forming

FUSOBACTERIUM NUCLEATUM
❖ CAUSE VINCENT ANGINA
FUSOBACTERIUM NECROPHORUM
❖ CAUSE LEMIERRE S DISEASE.

Haemophilus influenza
o meningitis, otitis media , sinusitis, pneumonia and
epiglottis encapsulated,heme ,NAD are required for
energy production
o ig A protease , antiphagocytic capsule, Endotoxin
are acting as virulence factors.
o Cherry red epiglottis
o can grow on chocolate agar
o latex agglutination test to detect
Capsular polysaccharide in case of
meningitis
Bordetella pertussis :
cause whooping cough
❖ pathogenesis :
Filamentous hemagglutinin ( attachment)
Pertussis toxin adenylate cyclase toxin
trachea cytotoxin
clinical finding:
Hacking cough with copious mucus
lymphocytosis
has catarhaeal stage with rhinorea,low grade
fever , paroxysmal stage with inspired
whopping sound , convalescent stage (100 day
cough )

Legionella pneumonia
pneumonia
legionnaires disease ( mental
confusion,non bloody diarrhea,
hyponatremia)
pontiac fever
lipopolysaccharide is virulence factor.
 ACTINOBACTER BAUMANNI
❖ CAUSE VENTILATOR ASSOCIATED PNEUMONIA
Brucella
species cause
Brucellosis
Francisella tularensis cause Tularemia

yersinia pestis
cause plague or black
death bubonic plague,
septicemia plagues
pneumonia plague
yops acts as virulence factors
F1 antigen, endotoxin, Exotoxin are virulence
factors.
❖ pasteurella multocida cause cellulitis
❖ Bartonella henselae causes: cat scratch disease
Mycobacterium tuberculosis:
pulmonary tuberculosis
scrofula
erythema nodosum
 TB meningitis
GIT TB
oropharyngeal TB
Renal TB ( sterlie urea )
pots diseae
two lesions(exudative lesion, granulomatous
lesion)
PPD skin test (15mm No risk factor )10mm Risk factor
(5mm AIDS)
BCG vaccine given
stages of TB
Heal by fibrosis
progressive lung disease
Bacterimia
hematogenous disseminated ( encephalopathy,
knee joint arthritis)
cell wall has mycolic acid and protein
acid fast stain is done
form cavity in latent lesion in upper lobar and
primary TB occur in lower Lobar
 Mycobacterium Leprae
Species
Tuberculoid leprosy (have few lesion, thicken
superficial nerve )
lepromatous leprosy ( many lesion with
marked tissue
destruction, leonine face , ENL)

Actinomyces Israeli
cause Actinomycosis
sulphur granules in pus
Anaerobic
Nocardia asteroid
cause Nocardiosis with cavity formation in
lungs
lung abscess aerobic
Weakly acid fast stain
Mycoplasma Pneumonia
Atypical pneumonia
 no cell wall
cold agglutinin
grow at cold temperature
pneumonia present with whitish non bl1oody
sputum, fever ,
headache, malaise, myalgia
HAEMOLYTIC anemia
Raynaud's phenomenon

Treponema pallidum
syphilis cork screw motility
primary syphilis (chancre, Bacterimia)
Secondary syphilis (condylomata Lata ,
maculopapular rash
tertiary syphilis ( Gummas formation)
Neonatal syphilis ( skin and bones lesion, eight
nerve deafness
Borrelia Burgdorferi
Lyme disease
ixodex mostly cause lyme disease
erythema chronicum migrans
 Bulls eye
flu like symptoms
stage 2 is disseminated and cause Bells
palsy , myocarditis
late stage cause Lyme encephalopathy,
polyneuropathy
Borrelia Recurrentis
causeRelapse fever
Borrelia Miyamoti:cause relapsing like fever
syndrome

Leptospira interogans
Leptospirosis
grow even in swimming pool
conjunctiva suffusion
myalgia
flu like symptoms
 Chlamydia Trachomatis
urethritis, pneumonia, conjunctivitis, trachoma
A to C immunotypes cause Trachoma
D to K cause Genital tract infection
L to L3 cause : lympho granuloma venereum
patients with genital tract infection cause
reactive arthritis,
reiter's syndrome
Chlamydia pneumonia

cause Atypical
pneumonia
bronchitis
Chlamydia psittaci
cause psittacosis (pneumonia)
Rickettsia rickettsi cause
Rocky mountain spotted fever ( flu like
symptoms, delirium, petechial
haemorrhage,DIC , circulatory collapse
 Rickettsia prowwazeki
epidemic fever or typhus has
influenza like symptoms
coxiella Burnetti
Q fever , endocarditis, fever , headache,
atypical pneumonia

VIRIOLOGY
CHAPTER 37:
HERPES VIRUS
Herpes Virus 1 cause the lesion above the waist
HSV -2 cause lesion below the waist

❖ HSV 1 cause :
Gingivostomatitis
recurring herpes labials
keratitis, keratoconjunctivitis
herpetic whitlow
herpetic gladiatorum occurs in wrestler
Encephalitis
HSV 1 become latent in Trigeminal Neurolagia
Tzanck smear ( multinucleated giant cells )
❖ HSV-2 :
cause the lesion below the waist
neonatal encephalitis, aseptic meningitis
neonatal herpes
Both HSV 1 and 2 form rash of erythema (bull's eye
lesion)
Mycoplasma Pneumonia is common cause of Stevens
Johnson syndrome.
Tzanck smear shows multiple nucleated giant cells.
Becomes latent in lumber and sacral region ganglia.
Cytomegalovirus (CMV)
cause congenital abnormalities
cause of pneumonia and heterophile
mononucleosis in immunocompromised
patient
Largest virus
CMV cause cytomegalic inclusion disease in fetus
CMV enters in latent state in Monocytes.
Histological stain of inclusions bodies shows owl's eye
shape
Epstein Barr virus: cause infectious mononucleosis
Burkitt's lymphoma
nasopharyngeal carcinoma
Transmission by kissing, blood transfusion, College
student
EBV remain latent with in B lymphocytes
hairy leukoplakia
X linked Lymphoproliferative syndrome
PTLD ( post transplacental trauma
EBV -specific antibody test (igM VCA antibody response
to detect acute infection,
Ig G VCA antibody response to detect prior infection)
Human Herpes virus 6 (exanthem subitum)
Roseola infantum, common in young children
in immunocompromised patient cause pneumonia,
encephalitis, hepatitis
Human Herpes virus 8
associated with Kaposi sarcoma common in
AIDS patient
small pox virus
largest and common virus
variola virus second name
transmission by respiratory aerosol
infect upper respiratory tract and lymph nodes and then
enters in blood stream ( primary viremia) ,internal organ
infected, then virus reenters in blood and spread to skin
and form rash due to replication in skin.
fever , malaise, rash on face , extremities and than on
trunk
detect the viral antigen in vesicular fluid (lab test )
Molluscum contagiosum virus:
flesh colored papules on skin or mucous membrane
that is pain less and non pruritic, common in childreN
Human papilloma virus
Causes papilloma which is benign tumor of squamous
cells ( warts on skin)
HPV types 16 and 18 cause the carcinoma of cervix,
penis, anus .
Skin warts ➡ HPV 1 and HPV 4
Genital warts :➡ HPV 6 and 11
 papilloma virus infect the saqumous epithelial cells and
induce the perinuclear cytoplasmic vacuoles (
koilocytes)
condylomata acuminata on penis caused by ➡HPV 6
and HPV 11 especially in Young children
skin and planter warts caused by ➡ HPV 1 and HPV 4.

Presence of koilocytes in the lesion indicate HPV

infection
chap 38‼
❖ Human influenza Virus :
❖types
Influenza virus A pandemic
Influenza virus B out breaks
influenza Virus C mild respiratory infection
influenza virus is envelope by two different
spikes hemagglutinin
and neuraminidase ( influenza A virus )
Hemagglutinin helps to bind to receptors
 neuraminidase helps degrades protective
layer of mucous in
respiratory tract.
Antigenic shift :major changes based on
reassortment of segment of genome of RNA
Antigenic drift : minor change based on
mutation in the genome of RNA.
Transmission by aerosol droplets
fever , myalgia, headache, sorr Throat, cough
pneumonia
Reye syndrome characterized by
encephalopathy and liver degeneration.
Necrosis of upper respiratory epithelium
H 5 N1 influenza virus pneumonia and ARDS.
H1N1 strain cause swine influenza virus
infection.

Parainfluenza virus
cause: croup ( harsh , barking cough , hoarseness) (
acute laryngotracheobronchitis) , laryngitis,
bronchitis, pneumonia in children.
 Respiratory syncytial virus
cause : pneumonia and bronchitis,
otitis media in children and pneumonia in
elderly
form multinucleated giant cells
in infant , RSV cause bronchiolitis and
pneumonia
Human metapneumovirus: cause
bronchiolitis, pneumonia in young children

Coronavirus
pneumonia caused by SARS coronavirus
characterized by diffuse edema resulting in
hypoxia
bind to ACE -2 receptors and cause
dysregulation of fluid balance
that cause edema in alveolar space.
MERS -Cov binds to CD 26 on the respiratory
mucosa
 coryza (rhinorea, running nose ) , scratchy nose
throat, low grade fever
bronchitis
SARS cause Atypical pneumonia, non
productive cough , dyspnea, hypoxia, rigor
mortis, malaise, headache
chest X ray shows ground glass infiltration that
doesn't form cavity inside lungs

Rhino virus
cause common
common cold.
acid labile sneezing, nasal discharge, sore
throat, cough , headach
others virus like influence C , Coxsackie
Virus, adenovirus and
coronavirus cause common cold
Adenovirus
cause pharyngitis, pink eyes (conjunctivitis), common
cold , pneumonia, kerato conjunctivitis, hemorrhagic
cystitis, gastroenteritis
 serotype 3,4,7,21 ➡ Respiratory disease
Serotype 8,9 ➡ epidemic keratoconjunctivitis
serotype 11,21 ➡ hemorrhagic cystitis
infect the mucousal epithelium of upper and
lower respiratory tract, Git tract and
conjunctivas.
pharyngitis, pharyngoconjunctival fever and
common cold.
Bronchitis, pneumonia (Lower respiratory
disease)

Measles Virus
causes : maculopapular rash, occurs
primarily in children
transmission by respiratory droplets
Koplike spot's of measles location on buccal
mucosa
after infecting the cells lining of upper
respiratory tract, virus
 enter 4 and infect reticuloendothelial cells and
replicate there and via blood spread to skin and
rash occurs due to cytotoxic T cells
multinucleated giant cells form
photophobia, fever, running nose , cough
sever complications are encephalitis,
permanent sequelae ( deafness and mental
retardation)
primary measals pneumonia and bronchitis
otitismedia common.
Measles in pregnant woman cause stillbirth
Atypical meals occur in those who were given.
Killed vaccine.
Mumps virus
cause salivary glands swelling
Mumps occur at once
tender swelling of salivary gland either unilateral
orbilateral prodromal stage of fever , malaise and
anorexia doesn't occur
orchitis in postpubertal male , if bilaterally results
in sterility except in unilaterally orchitis where sterility
doesn't occur
cause aspectic meningitis (Coxsackie, echovirus,
mupms)
 Rubella Virus:
cause congenital rubella syndrome (congenital
malformation)
transmission by respiratory droplets and
transplancental
virus replicate in the nasopharynx and local
Lymph node , where
it spread via blood to internal organs and skin
origin of rash is unclear
prodromal stage of fever , malaise,
maculopapular rash
teratogens and infect during first trimester
in fetus cause patents ductus arteriosus,
cataract, deafness and mental retardation

parvovirus B 19
: erythema Infectiosum ( slapped cheeks
syndrome, fifth disease), aplastic anemia and
fetal infection including hydros fetalis
transmission by transplacental and blood
transfusion
 it will infect RBC's and precursor (erythroblast)
in bone marrow
so results in aplastic anemia and infect
endothelial cells in Blood vessels results in rash
(erythema Infectiosum)

fetal infection
arthritis
chronic B19 infection (leukopenia,
thrombocytopenia, chronic anemia)
Measles , rubella, scarlet, Roseola cause
maculopapular rash disease in children

Human Heroes virus 6

cause Roseola infantum (exanthem
subitum) , maculopapular rash on face , trunk
in children (6th month to 3 years )

Norovirus :
causes gastroenteritis (watery diarrhea
without RBC's and WBC's )
 headache, photophobia, obtundation
Rotavirus
cause : Gastroenteritis (watery diarrhea
especially in children)
watery diarrhea due to stimulation of
enteric nervous systems
detection of Rotavirus antigen in stool (Lab
test )

POLIO VIRUS
cause poliomyelitis
transmission by fecal oral route and
replicate in oropharynx and intestinal tract
after replication in oropharynx and small
intestine especially in lymph node , virus
spread through blood stream to CNS , in the
CNS it replicate in motor neurons and death of
these motor neurons will lead to paralysis of
muscles supplied these Neuronal cells, virus
affect the brain stem leading to bulbar
poliomyelitis
 inapparent poliomyelitis ➡ asymptomatic
abortive poliomyelitis ➡ mild febrile illness
characterized by
nausea and vomiting
non paralytic poliomyelitis ➡ aspectic
meningitis
paralytic poliomyelitis ➡ painful muscle spasm
, flaccid paralysis Coxsackie virus cause:
Type A ➡hand ,foot and mouth disease,
herpangina ( fever , sore throat, tender
vesicles)
Type B ➡ pleurodynia (epidemic myalgia,
devil's grip ) , Myocarditis, pericarditis,
myositis
Both type A and B ➡ aseptic meningitis,
common cold , pharyngitis, febrile rash and
acute flaccid paralysis
❖ Echovirus ➡ aseptic meningitis, Upper respiratory
infection, febrile illness, hemorrhagic conjunctivitis
❖ parechovirus ➡cause respiratory,GIT ,CNS disease in
children
 ❖ Enterovirus 68 :➡ common cold , pneumonia and acute
flaccid myelitis.
❖ Enterovirus 70:➡ acute hemorrhagic conjunctivitis

Hepatitis A :
• Non enveloped
RNA virus No
DNA polymerase
typical enterovirus
transmission by
fecal oral route
• children are more affected , rarely
transmission by blood replicate in GIT
tract and spread to liver via blood and then
• damage the hepatocytes
🛑 fever , anorexia, nausea, vomiting, jaundice, Dark urine ,
pale face
immune response is mediated by ig M and Ig G.

Hepatitis B
partially double stranded DNA virus
 surface antigen a diagnostic
point
transmission by Blood , sexual
act , transplacental
high incident of Hepatocellular
carcinoma
immune is mediated by
cytotoxic T cells.
Auto immune complex lead to arthralgia,
arthritis and urticaria
viral antigen damage the hepatocytes ⭕in
chronic carrier HB sAg will be positive ⭕HCC
occur in chronic carrier
antigen is indicator of transmissibility ⭕in
acute infection serum sickness like symptoms
occur (fever , rash, arthralgia)
chronic HBV (neuropathies, glomerulonephritis,
polyarthritis nodosa) 🛑 window phase:when
HBsAg is disappear but HBsAB is detectable
HbeAg is present in incubation, acute and
chronic state.
Detection of Viral DNA in the serum ➡viral
load.

Hepatitis C
Enveloped RNA virus
No virion polymerase
Chronic HCV leads to HCC
HCV is most prevalent blood borne pathogens
Alcoholic patient predisposed to HCC in HCV
fever , jaundice,cirhosis of liver ,
peripheral neuropathy in chronic HCV
malaise
nausea, right upper quadrant pain , Dark urine,
pale feces , transaminases level Inc
Hepatitis D :
defective virus
replicate only in cells with infected with HBV
because HDV uses the
surface antigen of HBV(HBsAg )
internal core protein Delta protein
 patient who is chronic HBV has high incidence
of HDV ( confection or super infection state)
Hepatitis E :
transmission by fecal oral route
non envelope RNA virus
disease resemble to HAV except in high mortality rate in
pregnant
woman.
Chronic infection results in chronic hepatitis and
cirrhosis

❖ yellow fever
caused by (Aedes mosquito,haemagogus
mosquito) characterized by
Jaundice and fever , headache, myalgia,
photophobia
sever condition leads to involved kidney,
liver , heart , git .
Prostration and shock occur with black vomit
Dengue Fever :
caused by Aedes mosquito
 break bone fever having influenza like symptoms
(fever , malaise,retro orbital pain , headache,
arthralgia, myalgia). enlarged lymph node , facial
flushing, maculopapular, leukopenia
Dengue hemorrhagic fever occur due to cross
reacting antibody at second time of dengue
infection results in shock and hemorrhage
(black
vomit)
zika virus
cause Zika fever (fever , arthralgia, myalgia,
pruritic maculopapular rash and non prulent
conjunctivitis
Guillain Barre syndrome
vertical transmission can occur and lead to
fetal abnormalities like microcephaly
❖ chicken Gunya virus : sudden onset of fever,
joint pain especially wrist and ankle joint pain
(bilaterally Joint affect), maculopapular rash
occurs and encephalitis occur
 Rabies virus:
cause rabies virus characterized by Encephalitis
single stranded RNA virus
bullet shaped capsids
Broad host range
RNA polymerase
Rabies is caused by Wild animal like shunks , raccoon,
bats , dogs , cats bite , rabies virus is present in their
saliva ⭕rodents and rabbit don't cause rabies
transmission
Virus multiply at the bite site, infect the sensor
nerves and move by retrograde axonal to CNS ,
during transport is unaffected by immune and
multiply in CNS and then travels downs to

peripheral nerve to salivary gland and others

organ , from salivary gland it enters to saliva to
be transmitted by bite.
with in CNS , cause encephalitis, infected neurons
contain eosinophilic cytoplasmic inclusion called
a Negri body
 Furious stage : encephalitis , hydrophobic,
difficult to swallow, agitation, delirium
dumb stage : paralytic (Ascending paralysis)
Ebola Virus
: cause Ebola hemorrhagic fever bleeding in to
skin , Git and brain Headache) DIC and
thrombocytopenia
❖ DNA tumor virus:
Human papilloma virus ➡ Papilloma
Ebstein Bar virus ➡ Burkitt's lymphoma
Human Herpes virus 8 ➡ Kaposi sarcoma
❖ RNA tumor virus,:Human
T -cell lymphotropic Virus ➡ Adult T -cell lymphoma
Hepatitis C ➡HCC

Human immune deficiency virus

AIDS
tat gene encodes a protein that activate viral
transcription
cytotoxic T cell reduce, MHC 1 protein synthesis reduce
predisposed to AIDS
 Early Stages ➡flu like illness, fever, chills, night sweats,
sore throat, swollen lymph node
Middle stage ➡Latent
Late stage:➡AIDS , weight loss , memory loss , diarrhea,
depression, extremely tiredness
Varicella zoster virus
Varicella cause chicken pox in children
Zoster (shingles) in adult
transmission by respiratory aerosol in varicella
and reactivate in zoster
VZV cause skin rashes, pneumonia, malaise,
Reye syndrome
Zoster Virus cause pain vesicles along course of
sensory nerve on head or trunk

MYCOLOGY
Cutaneous Mycoses
❖ Dermatophytoses are caused by fungi ➡ Dermatophytes.
❖ Dermatophytes three genera are
1) trichophyton
2) Epidermophyton
3) microsporum
▪ Ring worm form on warm , humid areas of
body e. g (athletes foot.
▪ Ring worm location on different parts of body

▪ Tinea
barbae➡beare
d
▪ tinea

capitis➡head
▪ tinea

pedis➡feet
▪ tinea cruris ➡

groin
▪ tinea corporis

➡ body
▪ tinea unguium ➡ fingers (in dish washer and

sprinkler)
▪ Trichophyton tonsurans, rubrum ➡Tinea

capitis
 ▪ tinea schoenleini ➡ favus ( kerion or crust on
scalp )
▪ wood lamp used to ➡ diagnosis the tinea

capitis
▪ culture on saburauds agar

❖ Tinea versicolor ➡ superficial skin infection

with hypopigmention of skin cause by
Malassezia which has hyphae and yeast .
❖ Sporotrichosis ➡ pustules or ulcer on hands
often with nodules on arms.
❖ Tinea Nigra ➡ infection of keratinized layer of
skin (brownish spot )
❖ Chromomycosis ➡has hyphae dark colored and
form wart like lesion mainly affecting
Lymphatic system.
❖ Mycetoma ➡ form abscess having compact
color granules.
 systemic mycosis
COCCIDIODES
❖ coccidioides immitis and posadasii cause➡
coccidioidomycosis
❖ have spherules with endospores ⚪forms
hyphae with alternative Arthrospore
Arthrospore infect lungs and form spherules which
will ruptured and endospores release which will
affect others organ .
❖ Forms granulomatous lesion in bone and
CNS (meningitis)
❖ forms erythema nodules
❖ influenza like symptoms
❖ valley fever (second name )
❖ Dissemination will result in to meningitis,
osteomyelitis, nodules. HISTOPLASMA
❖ Histoplasma capsulatum ➡ histoplasmosis
❖ dimorphic fungus

tuberculate macroconidia and microconidia are

smooth walled spores.
 ❖ grows in the soil having bird dropping
(starling)
❖ forms oval bud yeast inside macrophages
and prevented by macrophages from
phagocytosis by producing Alkaline substances.
❖ Early symptoms are fever , headache,
chills , cough and chest pain pneumonia and
❖ cavitation lung lesions (common in
chicken house worker )
❖ Disseminated in AIDS patient ➡
pancytopenia and ulcerative lesion on tongue
and Erythema nodosum formation.
❖ microscopic ➡oval yeast with in
macrophages are seen.
BLASTOMYCES
❖ Blastomyces dermatitis cause : blastomycosis
❖ dimorphic fungus having broad based bud
❖ Dissemination results ➡ ulcerative
granuloma of skin , bone
❖ Paracoccidioides brasiliensis cause
➡paracoccidioidomycosis
❖ dimorphic fungus
❖ oral mucous membrane lesion and lymph
node enlarged occur
mainly in lungs. ⚪ Captain ship wheel ➡yeast
with multiple buds.
CANDIDA

❖ Candida Albicans cause : thrush in

mouth, vaginal thrush , vaginitis,
esophagitis, diaper rash , chronic
mucocutaneous rash
❖ Dissemination results in endocarditis,
candidemia, endophthalmitis (common in
indwelling intravenous and urine catheters)
❖ oval yeast with single bud and
pseudohyphae and form germ tube.
predisposing factors towards disease are
alter mucous membrane and skin , low
Immunity (th 1 cell production is low ) ,
antibiotics
 ❖ thickening and loss of nails ( in
dishwasher and
immunocompromised patient)
1. in culture form typical yeast colonies
❖ cryptococcus
❖ cryptococcus neoformans cause ➡
cryptococcal meningitis
❖ oval budding yeast with wide polysaccharide

capsule and form narrow base bud

❖ grows in soil contain bird dropping especially

pigeon
1. sub cutaneous nodules in AIDS patient.
2. Treat the cryptococcus first then do HAART
therapy in AIDS or hepatitis patient to
prevent from IRIS
3. form highly mucoid colony l
4. atex agglutination test in case of
cryptococcus meningitis
❖ Aspergillus fumigatus

cause infection of skin , eyes , ears and forms

Fungus ball in the lungs and Allergic
bronchopulmonary aspergillosis
• have septate hyphae that
form V shaped branches
conidia will form radiating
chains grow on decaying
vegetables
• cause fungal sinusitis in
immunocompromised patient
it affects the lungs and form
• ➡ hemoptysis and in brain
causing ➡ brain abscess
• have ability to grown in
cavitation of lungs and form
fungus ball and x Ray shows
radio opaque
• mucor and Rhizopus form the
mold with non septate hyphae
• necrotic lesion form when
mold invade blood vessels
• culture grows mold with the
black spores
Intestinal protozoa
❖ Entamoeba histolytica cause :amebic dysentery
and liver abscess
❖ trophozoites having single nucleus and cyst
having four nuclei
❖ flatulence and tenesmus

❖ granulomatous lesion (ameboma) in cecal

or rectosigmoidal region
❖ Amebic abscess ➡on aspiration shows
brownish anchovy paste
❖ GIARDIA LAMBLIA : ➡ Giardiasis
❖ have pear shaped trophozoites with two nuclei
and four flagella
❖ oval shaped,thick walled and having four nuclei
❖ hominis causes ➡ cryptosporidiosis
❖ transmission by fecal oral route
❖ watery diarrhea
❖ watery ,foul smelling diarrhea 🛑nausea and
flatulence and no fever.
❖ Cryptosporidium Urogenital protozoa
❖ Trichomonas vaginalis: ➡ trichomoniasis
 ❖ trophozoites with pear shaped, central
nucleus,four anterior
flagella Mode of transmission by
❖ sexual act
❖ foul smelling watery greenish,vaginal
discharge accompanied by itching and burning
(in woman)

Blood and tissue protozo

❖ sporozoa
1) plasmodium
2) toxoplasma
❖ flagellated 1) trypanosoma 2) leishmania

plasmodium ‼
Species Plasmodium vivax , ovale,
malaria,falciparum
P.PARUM ➡ can infect all stages
of life . P. Ovale ➡can infect only
reticulocyte stage.
p.falciparum is lethal because
➡black water fever and cerebral
 malaria,
14 days after mosquito bite patient presents
with ,
continuous high grade fever
headache
myalgia
arthralgia
splenomegaly and hepatomegaly
prominent anemia
form hemozoin
❖ Toxoplasma gondii cause ➡ asymptomatic infection in
immunocompromised patient people

congenital infection ( encephalitis,

chorioretinitis, intracranial
calcification in fetus)
in immunocompromised patient ➡
Dissemination disease,
encephalitis, Rim enhancing lesion (brain
abscess
 Pneumocystis jirovci causes pneumonia in
immunocompromised patient
fever , non productive cough
dyspnea and Tachypnea, bilateral ronchi
❖ Trypanosoma cruzi : cause chagas disease
❖ acute phase ➡facial edema , fever, chagoma at bite site ,
hepatosplenomegaly
chronic phase ➡ megacolon, carditis
❖ Trypanosoma gambiense : cause low grade chronic Disease
and rhodesiense cause more acute rapidly progressive
illness
❖ Leishmania denovani ➡viceral leishmania (kala -azar ) ,
intermittent fever, fatigue, weight loss , splenomegaly,
hyperpigmentation of skin
❖ Lesihmania tropica ,mexicana ➡ cutaneous leishmania
❖ leishmania Braziliensis ➡ mucocutaneous leishmaniasis
❖ Acanthamoeba and Naeglaria ➡ meningoencephalitis
❖ Babesia ➡ hemolytic anemia
❖ cyclospora ➡ diarrhea in immunocompromised patient
Schistosoma cause
 acute stage ➡ dermatitis, itching,
fever, chills, diarrhea , lymphadenopathy
and Hepatosplenomegaly
chronic stage ➡Git hemorrhage, massive
splenomegaly, esophageal varices, hematuria
(associated with S. Hematobium)
❖ Clonorchis sinensis cause ➡ Clonorchiasis ,
asymptomatic infection, abdominal pain ,
Hepatosplenomegaly, eosinophilic
❖ Paragonimus westermani cause :
paragonimiasis, chronic cough with bloody
sputum, dyspnea, pleuritic chest pain
❖ Fasciola species cause : right
hypochondriac pain , fever ,
Hepatosplenomegaly, obstructive jaundice
🛑 Fasciolopsis buski (largest intestinal fluke)
❖ Heterophyes cause : abdominal pain and
non bloody diarrhea.
Cestodes
❖ Taenia solium ( pork worm ) cause: Taeniasis
and its larva cause :
 cystercosis
intestinal: anorexia and diarrhea
Brain : head ache, vomiting, seizure
Eye : retinitis, uveitis
cyst can be found in skeletal muscle
❖ Taenia saginata (beef tapeworm) cause
Taeniasis and its larva doesn't not cause any
disease
malaise, nausea,mild cramping, pruritic ani
❖ DIPHYLLOBOTHRIUM LATUM: ➡
DIPHYLLOBOTHRIASIS
Abdominal discomfort, diarrhea
❖ ECHINOCOCOSIS
GRANULOSUS:➡ECHINOCOCUS AND ITS
LARVA CAUSE ➡ UNILATERAL HYADIT CYST
❖ liver cyst ➡ hepatic dysfunction
❖ lung cyst ➡bloody sputum
Brain cyst ➡head ache , focal neurologic sign
rupture of cyst cause : anaphylactic shock
Nematodes
❖ Enterobius vermicularis (pin worm infection)
cause entrobiasis perianal pruritus
Trichuris Trichuria cause
trichuriasis rectal
prolapse diarrhea
❖ Ascaris lumbricoides (giant round worm )
largest intestinal nematodes
blockage of lumen
nutrients uptake by worms results in to
malnutrition
Ascaris pneumonia
❖ Ancylostoma and Necator (Hook worm )
❖ microcytic anemia
❖ in lungs cause pneumonia
cutaneous skin migrans
❖ Strongyloides stercoralis cause :
Pneumonitis
cutaneous larva migrans
ground itch
 hyper infection in immunocompromised
patient
❖ Trichnella spirals sub conjunctival
hemorrhage and diarrhea followed by fever,
muscle pain ,peri orbital
pain Tissue
nematodes
❖ wucheria bancrofti cause filariasis and
elephantiasis edema of leg hydrocoele
❖ onchcerca volvulus cause River blind ness
dermatitis
❖ Loa loa cause : loasis adult worm moving
across conjunctiva
❖ Dranculus cause burning and itching of
papules and skin ulcer
Nematodes whose larva can cause Diseae

❖ toxocara ➡ visceral larva migrans

 ❖ ancylostoma ➡cause cutaneous larva
migrans
❖ angiostronglyus ➡ cutaneous larva migrans
anisakis ➡git pain ,

Guidelines By Team MEDICOS FEVER

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