Comlex Micro Bacteria And Fungi

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G(+)
G(-)

G(+) spores

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+: teichoic acid (cell wall/membrane), PM, thick peptidoglycan

(-): outer membrane (endotoxin/lipopolysaccharide=Lipid A), PM, periplasm (β-lactamases)

Spores: DIPICOLONIC Acid; autoclave; end of stationary phase; B.anthracis,C.perfringens,C.tetani,B.cerus,C.botulinism

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STAINS
Giemsa
PAS
Ziehl-Neelson
India
Silver stain

not gram stain

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G: "Gimme & Try Plain Boring Cheescake" trypanosomes, plasmodium, Borrelia, Chlamydia
PAS: whipplie
ZN: "Ziehl=rocker on acid-fast"
In: cryptoccous neoformas
S: Fungi, Legionella, PCP

not gram stain: These Rascals May Microscopically Lack Colon: Treponema, Rickettsia, Mycobacteria, Mycoplasma, Legionella, Chlamydia

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Special Requirements
HiB
N. gonoorrhoeae
B. pertussis
C. diphtheriae
M. tuberculosis
M. pneumoniae
E. coli
Lactose-fermenting enterics
legionella
Fungi

Back 3

HiB=kid's chocolate with V/NAD and X/hematin
NG: "Dr. Martin's gonnorrhoea" thayer-martin
BP: borriella=bordet-gengou (potato) agar
Cdip= "I'll TELL if you DIP, LOFFing" Tellurite, Lofflers
TB: "LOW ghon" lowenstein-jensen agar
M.p: eaton's
E.Coli: EMB (metallic sheen)
Lac: MacConKEE
Leg: "campfire w/iron; no Sissy": charcoal w/Fe, cysteine
Fun: "FUN SAturday (sabouraud's)

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Obligate Aerobes
Obligate Anaerobes

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AIR: "Nagging Pests Must Breathe": Nocardia, Pseudomonas, M. Tuberculosis, Bacillus

"Anaerobes Can't Breathe Air": Clostridium, Bacteriodes, Actinomyces--> GASFC2: gas (CO2, H2), no aminoglycosidases, no superoxide dismutase, foul smell, no catalase, no culture

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Obligate Intracellular
Encapsulated

Urease-producing

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Really Cold: Rickettsia, Chlamydia and can not make ATP
E: Some Nasties Have Kapsules (s. pneu, n. mening, HiB, Kleb); impairs opsonization & phagocytosiss
bacillus anthracis=protein capsule

Particular Kinds Have Urease: Proteus, Kleb, H. Pylori, Ureaplasma

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Virulence Factors

PrteinA
IgA Protease
Mprotein

Exotoxin
Endotoxin and LipidA

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PrtA: binds Fc; stops opsonization, phagocytosis: staph
IgA: cleaves IgA in S. pneu, H. Influenzae, Neisseria
M: groupAstrep; no phagocytosis

Exo: G+; cell secreted; poplypeptide; plasmid/bacteriophage location; toxicity; antigenic; destroy at 60⁰ C (tetanus, botulism, diphtheria)
Endo: G(-); lipopolysaccharide; bact chr; fever/shock; TNF, IL-1; stable at 100⁰ C for 1 hr (meningoccemia, sepsis by rods)
LipidA: activates macrophages (IL1, TNF, NO); activates complement (C3a=hypoTN, edema & C5a=neutrophil); Hageman Factor=DIC

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SuperAgs

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bind MHC2, T-cell receptor to release IFN-γ, IL2

S.aureus: TSST1 or ENTEROTOXINS (food poison) or EXFOLIATIN (scalded skin); PROTEIN A;
SOFTPAINS: skin infection,sepsis,osteomyelitis,food poision,TSS,pneumonia,acute endocarditis,impetigo,infect arthritis,necrotizing fasciculation,scalding skin infection (desquamation)
MRSA: if hospital setting, base tx on hospital incidence

S.pyogenes: erythrogenic toxin like toxic shock-like syndrome; scarlet fever (starts at trunks and spreads to extremities; strawberry tongue);
PHaryngitis, PHever, glomerulonePHritis;
No RHEUM for SPECCulation: Subcutaneous nodules, Polyarthritis, Erythema marginatum, Chorea, Carditis
SMASHED: streptolysinO (hemolysisn & antigen for ASO antibody for rheumatic fever), Mprotein, Anti-C5aPeptidase, streptokinase, hyaluronidase, exotoxin, DNAses

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ADP ribosylating A-B toxins

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ADP CoVE-B
Corynebacterium diphtheriae: pseudomembrane pharyngitis w/lymphadenopathy; ABCDEFG: ADP ribosylation, β-prophage, CD, ØEF2, Granules metachromatic

Vibrio Cholerae: comma shape, polar flagella, oxidase+, rice-water diarrhea; ↑permanet Gs, ↑Cl- into gut, ↓Na+ absorption

E. Coli: G(-) rod, fast lactose fermenter, watery diarrhea"Labile like the Air (permanent Adenylate cyclase), Stable like the Ground (Guanylate cyclase)"; e.coli 0:157:H7 d/t ground beef if several kids w/bloody diarrhea

Bordetella pertussis: whooping cough; ØGαi=permanent ↑cAMP; no chemokine receptor=lymphocytosis

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other toxins

clostridium (3)
bacillus
shigella

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C. PERFfrinogens PERF a gangrenous leg: anaerobe G(+) spore-form rod; α toxin(lecithinase)=gas gangrene(myocrenosis); double zone of hemolysis

C. TETani: ØTGG=glycine (renshaw), GABA=TETanic paralysis

C.Botulinism: "baby BACH"=anticholinergic, CNS paralysis; spores in food, honey

Bacillus anthracis: G(+) encapsulated, spore-forming; EDEMA factor=↑Gs

Shigella: G(-) nonlactose fermenter, oxidase(-); shiga toxin cleaves rRNA/inactivate 60s; cytokine release=HUS

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Bacterial genetics
Transformation
Conjugation
Transduction (special, generalized)
Transposition

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Transf: any dna by environment
Conj: plasmid DNA for F+,F-; plasmid/chromosomal DNA for HFr
Transd (general): lytic, bacterial dna
Transd (special): lysogenic viral dna (ABCDE: shigA-like toxin, Botulinum, Chloera, Diphtheria, Erythrogenic of s. pyogenes)
Transp: jump flanking chr DNA

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Strep. Pneumoniae
Strep. Viridans
Strep. Agalactiae
Strep. Bovis
Enterococci

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s. pneumoniae: encapsulated, IgA protease; POMS (pneumonia, OM, meningitis, sinusitis); rusty sputum, sickle cell anemia, splenectomy
Viridans: mutans=teeth, endocarditis=sanguis
Agal: group B for Babies
Bovis: colon cancer, group D (BCD)
Enterococci: PEDUNcle; PencillinGresistant, Endocarditissubacute, lancefieldD; UTI, grow in NaCl

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C. difficile
Bacillus anthracis
Listeria monocytogenes

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DIfficile=DIarrhea: cytotoxin kills enterocytes =clindamycin/ampicillin=pseudomembranous colitis

Anthrax: spore; protein capsule; CONTACT=black skin lesions/painless ulcer/malignant pustule; death or INHALE=woolsorter's disease=contaminate; fever, pulm hemorrhage, mediastinitis, shock

Listeria: Leche (dairy, deli meats=cold, vag transmission); ACTIN ROCKETS, ENDOTOXIN, TUMBLING motility,

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TB
1⁰
2⁰
extra
PPD+/-

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1⁰: nonimmune host--> ghon complex=hilar nodes+ghon focus (LLobe)
2⁰: paritially immune--> fibrocaseous cavity (ULobe)
leads to fibrosis, progressiv elung diseaes, miliary TB, hematogenous dissemination (2⁰)
extrapulm TB: CNS, Pott's, lymphadenitis, renal GI
PPD+: current, past, BCG vaccinate
PPD-: SSIM steroids, malnutrition, immunocompromise, sarcoidosis

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Mycobacteria (TB, kansaii, maic, leprosae)

Mycoplasma

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all acid-fast; +cold agglutinins
TB: fever, night sweats, weight loss, hemoptysis; HORSESHOE NUCLEI; RED SNAPPERS
Kansaii: pulm TB-like symptoms
MAIC: disseminated by AIDS
Leprae: cool temps=skin, superficial nerves(schwann); loss of eyebrows, nasal collapse, lumpy earlobe; leonine faces; tuberculoid=self-limited; LEpromatous=LEthal

Mycoplasma: atypical walking pneumonia; Cold Agglutins(IgM); Eaton's Agar; NOcell wall but cholesterol; <30y/o; military recruits, prisons: "Young Military Eaton atypical walkIgM with no coat=cell wall, only cholesterol"; mild conjunctivitis, pharyngitis, bullous, meningitis; tx erythromycin

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Neisseria gonoccoi
Neisseria menigococi

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kidney-bean shape, IgA protease, Catalase+,

G: arthritis, conjunctivitis, PID

M: vaccine, resp, oral secretions, Waterhouse-Friderichsen Syndrome

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Haemophilus influenzae
Legionella pneumophila
Pseudomonas aeruginosa

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haEMOPhilus: Epiglottis (thumb print, lateral xray), Meningitis, OM, Pneumonia; IgA PROTEASE; chocolae agar V(NAD), X(hematin); rifampin prophylaxis; vaccine type B

"french legionnaire with his SILVER (stain) helmet, around a campfire (CHARCOAL) with his IRON dagger..he is no SISSY (cysteine); aerosol water; tx. erythromycin

PSEUDOmonas: Pneumonia (CF), Sepsis (black skin lesions), ENDOTOXIN(fever,shock), EXOTOXIN A (Ø EF-2), EO (swimmer's ear), UTI, Drugs, Diabetic Osteomyelitis, hot tub folliculitis; tx. aminoglycoside+car/tic/piper-acillin

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Enterobacteriaceae
Klebsiella
Salmonella
Shigella

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E: KEEPS3 (Klebsiella,Enterobacter,E.coli,Proteus,Salmonella,Shigella,Serratia)-->KOFFEe (Kapsular=K,O Ag,Flagellar Ag(H),Ferment glucose,Enterobacteriaceae)

Klebsiella: 4A's=Aspiration pneumonia,Abcess in lung,Alcoholics,diAbetics; RED currant jelly sputum, nosocomial

Salmonella: flagella, H2S, TYPHOID fever (abd rose spots),bacteremia, animal reservoir, bloody diarrhea; GALLBLADDER chronically; HIV pts;

Shigella: ACTIN POLYMERASE, shiga toxin; more virulent, 4F's (Feces,Flies,Fingers,Food)

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Yersinia Enterocolitica
Helicobacter pylori

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Y: mimic Crohn's or Appendicitis, day care of pet feces, contaminated milk or pork

H: 90%duodenal, urease to make alkaline environ; tx. Make Tummy All Better (metronidzole,tetracycline, amoxicillin,bismuth) or COM (clarithromycin,omeprazole, metronidazole)

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Spirochetes

Back 19

BLT is big

Borrelia: wright/giemas stain; v=Ixodes tick,r=whitefootmouse; bull's eye; B2A3K2E1 a key Lyme pie: Bell'spalsy(2),Arthritis(3),Kardiacblock(2),ErythemaMigrans(1); tx PCN or ceftriaxone

Leptospira: ? mark due to animal urine in H2O; WEIL's disease=jaundice, AZOTEMIA of liver/kidney, hemorrhage, anemia

Treponema Pertenue: dark-field microscope; tropic YAWS; VDRL+; infect skin/bone/joints-->KELOIDS-->limb deformities

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Treponema pallidum (syphillis)

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1)painLESS chancre
2)maculopalpular skin rash, condylomata lata (flat wartlike)
3)gummas, tabes dorsalis, ARP (broad-based ataxia, Charcot joints, +Romberg, stroke w/o HTN)
Congenital: saber shins, saddle nose, CN8 deafness, Hutchinson's teeth
VDRL-FTA++(active infection); +- (false+); -+(successfully treated)
Viruses(mono, hepatitis)Drugs,Rheumaticfever,Lupus,Leprosy
penicillin G

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Zoonotic

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Bartonella: bart's cat scratch; no cutaneous lesions
Borrelia: Lyme disease; tick bite
Brucella: brucellosis/UNdulant fever; "Bruce Cowen" UNpasteurized dairy, animals;
Franciscella tularensis: tick bite;rabbits, deer
Yersinia PESTIS: plague; flea bite; rodents
Pasteurella multocida: cellulitis; animal bites; cats, dogs (multiple peAts)

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Ricketssiae

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RR: arthropod vector+NAD+Coa-->aerosol+pneumonia-->HA,Fever,Rash (wrist inward)
tx. tetracycline

R. typhi=endemic=fleas, R. rash (Typhus from trunk)
+Weil Felix: rickettsial, typhus, (cross-react with PROTEUS)

R. Prowazekii=epidemic=human body louse; (pro-human)

Qfever=coxiella burnetti=no rash, no vector, outside long time

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Trichomoniasis
Gardenela
N. Gonorrhea

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T: corkscrew motile, yellow-green discharge, strawberry-colored mucosa; metronidazole
G: clue cells, fish smell, metronidazole
N: dipploccocci, creamy purulent discharge; ceftriaxone

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Chlamydia
-trachomatis
-pneumonia
-psittaci

Back 24

obligate intracellular organism: Elementary Body Enters Endocytosis; Reticuloate body Replicates by fission; NO muramic acid

c. trachomatis (ABC): Africa/Blindness/Chronic infection
c. trachomatis (D-K): inguinal lymphadenopathy
urethritis, cervicitis, conjunctivitis, Reiter's syndrome, PID,
ulcers, rectal strictures; tx: doxycycline
c. trachomatis (L1-3): Lymphogranuloma venerum; +FREI test
neonatal: birth canal by erthromycin

c. pneumoniae, c. psittaci: atypical pneumoniae by avian reservoir tx. erythromycin or tetracycline

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Systemic Mycoses

Back 25

TB-like presentation; DIIMORPHIC, mold=soil=cold vs. yeast=tissue=hot except coccido; all PNEUMONIAE
tx. fluconazole/ketoconazole=local or amphotericin B for systemic

COCCIDIOIDOMYCOSIS: spherule filled with ENDSPORES, valley fever/desert bumps=pneumonia, meningitis; disseminate to bone, skin
HISTOPLASMOSIS: filled with MACROPHAGES; pneumonia by BIRD/BAT droppings
BLASTOMYCOSIS: Big, Broad-Base Budding; Cauliflower, granulomatous nodules, inflammatory lung disease to skin & bone; verrucous lesion, bone pain; cxr nodular infiltrates
PARACOCCIDIOIDOMYCOSIS: budding CAPTAIN WHEEL form

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Cutaneous Mycoses

+2 others

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CUT
TINEA VERSICOLOR: malassezia furfur; hot, humid weather, Sphaghetti meatball on KOH prep; tx. miconazole, selenium sulfide
TINEA PEDIS/CRURIS/CORPORIS/CAPITIS: dermatophytes (microsporum, trichophyton, epidermophyton); not dimophic, MOLD HYPHAE (not dimorphic); pets; Central Clearing=ring; "Microsporum"

PNEUMOCYSTIS JIROVECI: cxr: DIFFUSE INTERSTITIAL pneumonia; problem for Immunocompromised; Tx: TMP-SMX, pentamidine, dapsone
SPOROTHRIX SCHENCKII: dimporphic on vegetation, "ROSE GARDENER w/CIGAR-SHAPED yeast pustulating or ulcer" tx. itraconazole or KI

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Opportunisitic Fungal

Back 27

CANDIDA ALBICANS: 20⁰C PSEUDOHYPHAE BUDDING vs. GERM TUBE at 37⁰C (dx); Thrush, vulvovaginitis, diaper rash, IVdrugs=endocarditis, dissemination, chronic mucocutatneous; tx: nystatin (sperficial) or amphotericin B(systemic)

ASPERGILLUS FUMIGATUS: Brain ABscesses, bronchial plugs; repeated infiltrates, wheezing extraction; not dimorphic=VSHAPE MOLD or CRESCENT shape, 45⁰angle, septate, branching

CRYPTOCCOUS NEOFORMANS: soil, pigeon droppings, CAPSULE YEAST, sabouraud's agar, indian ink, "SOAP BUBBLES in brain"/capsular halo; narrow based UNEQUAL BUD

MUCOR/RHIZOPUS: IRREGLAR/EMPTY, no septate, WIDE-ANGLE MOLD, ketoacidodic, leukemic, diabetic

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ToRCHeS

Back 28

TOXOPLASMA GONDII: eye (chorioretinitis, calcifications (intracranial), hydrocephalus
RUBELLA: that DEAF and DUMB CAT ate my BLUEBERRY MUFFIN and stepped on my PDA
CMV: RASH, HSM, jaundice, SMALL HEAD, RETINITIS
HIV: HSM, NEURO problems
HSV2: TEMPORAL ENCEPHALITIS, head, eyes, skin lesions
SYPHILLIS: saddle nose, saber shins, hutchinson teeth

Listeria, E. coli, Group B Strep

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Meningitis causing

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#1 strep pneumonia
#2 n. meningitis (rash)
#3 listeria

Front 30

Providencia stuartii
Actinomyces israelii
P. carinii (PCP or p. pneumonia or pneumocystosis)

Back 30

PS: UTI of hospitaied pt; g(-); ampicillin
AI: painless, fluctuant purplish lesion of manbile; sulfur granules; g(-); tx PCN or ampicillin
PC: fungus; SOB, no sputum; INTERSTITIAL infiltrates on cxr; can lead to cavitation; rf=opprotunistic; dx Silver Methenamine stain; tx steroids+tmp-smx or pentamidine

Front 31

Fever Unknown Origin
No prophylactic antibiotic therapy

Back 31

FUO: occult bacterial infection, lymphoma, adult still's disease, factitious fever
NO: cardiac catherization

Front 32

SKIN ISSUES
Petechiae on trunk

Back 32

P: meningococcemia, gonococcemia, rickettsial, infective endocarditis, atypical measles, DIC w/sepsis