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197 Cards in this Set
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Advantages of a Broth vs Agar Medium:
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Broth Medium: Allows detection of a much SMALLER NUMBER of Bacteria
Agar Medium: Better detection of MULTIPLE TYPES of bacteria in a SINGLE specimen |
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Enrichment Medium
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Contains Complex Growth Factors derived from Blood, Blood Products, or Extracts of Yeast
Allows growth of Fastidious Organisms Examples: Blood Agar - Includes WHOLE RBCs Chocolate Agar - Contains LYSED RBCs |
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Selective Medium
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Contains Chemical INHIBITORS of Certain Types of Microbial Growth such as Bile Salts, Dyes, and Antibiotics
Used to culture specimens contaminated with Normal Flora Examples: CNA Agar - Colistin and Nalidixic Acid, INHIBITS GRAM NEGATIVE MacConkey Agar - Contains Bile Salts and Crystal Violet, INHIBITS GRAM POSITIVE |
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Indigenous in ***WEST CENTRAL AFRICA***
Fever w/ a localized infection/rash or can be disseminated ***Extremely Enlarged Lymph Nodes*** Acquired from ***Prairie Dogs*** |
Orthopoxvirus Monkeypox
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Which strains of E. coli are found in the SMALL Intestines?
LARGE Intestines? |
E_EC
Small Intestines = ATP EAEC ETEC EPEC Large Intestines = HI EHEC EIEC |
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Differential Medium
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Detects differences in Metabolic Capabilities
Examples MacConkey Agar - Lactose fermenting colonies are Red Blood Agar - Detect production of Hemolysins: Alpha = Yellow-Green Beta = Clear (Amber) Gamma = No Change in Color |
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***PERSISTENT WATERY DIARRHEA****, Vomiting, Dehydration, Low-Grade Fever, NO Fecal Leukocytes. Associated w/ Chronic Diarrhea and Poor Growth.
AUTOAGGLUTINATE forming ***"STACKED BRICK"*** Appearance |
EAEC - EnteroAggregative E. coli
Location = Sm-Int |
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Reddish, weeping, nodular lesions (usually on fingers) with spontaneous resolution
OCCUPATIONAL DISEASE of those that handle CATTLE (farmers, butchers, vets) |
Parapoxvirus Milker's Nodule
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Why do we heat fix smears?
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Heat fixing coagulates the proteinaceous substances of bacterial cells and causes the bacteria to adhere to the slide
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TRAVELER'S DIARRHEA: Watery Diarrhea WITHOUT Blood, Mucus, or Fecal Leukocytes. Vomiting, cramps, nausea, no or low-grade fever, infection is mild to severe.
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ETEC - EnteroToxigenic E. coli
Two Toxins: Heat Stable and Heat Labile. Stimulate HYPERSECRETION of Fluids/Electrolytes Location = Sm-Int |
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Impairment of Speech, Vision, Coordination, Mentation, followed by Paralysis of Arms and Legs, then Death.
Causes Progressive Multifocal Leukoencephalopathy (PML) = lesions in brain white matter --> a fatal CNS demyelinating disease caused by viral damage to Oligodendroglial Cells Found in Urinary Tracts of Immunosuppressed Adults |
Polyomavirus JC Virus
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For what bacteria is the Gram Stain NOT a useful diagnostic tool?
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Mycobacteria - Stains can NOT penetrate cell wall due to HIGH Mycolic Acid
Mycoplasma - LACK a Cell Wall Legionella - Too thin or small to be detected Chlamydia and Rickettsia - Too small to be seen with light microscope |
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Associated with Ureteral Stenosis (Renal Transplants) and Hemorrhagic Cystitis (Bone Marrow Transplants)
Found in Urinary Tracts of Immunocompromised Patients |
Polyomavirus BK Virus
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INFANT DIARRHEA: Watery Diarrhea and Vomiting WITHOUT Fecal Lymphocytes, perhaps fever.
Common outbreak in Nurseries. |
EPEC - EnteroPathogenic E. coli
Attaches to Epithelial Cells/Effacement (shortening or thinning) of Microvillus Location = Sm-Int |
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Kirby Bauer Antimicrobial Susceptibility Test
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Most Used
Advantages: Most practical, standardized, well controlled. Multiple antimicrobials can be tested at once. Disadvantages: Qualitative. NOT applicable to slow-growing bacteria (anaerobes and Mycobacterium) |
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Watery then GROSSLY BLOODY DIARRHEA (Hemorrhagic Colitis), Vomiting, Cramps, NO FEVER usually, NO Fecal Leukocytes usually.
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EHEC - EnteroHemoragic E. coli AKA the "Hamburger" Strain AKA O157:H7
Shiga Toxin (Stx1 & Stx2) May become HEMOLYTIC UREMIC SYNDROME (HUS). Antimicrobials might PROVOKE this! Location = Lg-Int |
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Dimorphic Fungi
Mold Phase (25 C) consists of Septate Hyphae, turning ***WHITE TO BLACK*** with age, with delicate Conidiophores bearing ***PYRIFORM (pear-shaped) CONIDIA in ROSETTE CLUSTERS*** Tissue Phase (37 C) consists of Elongated, ***CIGAR-SHAPED YEASTS***. RARELY seen in histological sections of tissue. Yeast forms surrounded by ***EOSINOPHILIC HALO*** |
Sporothrix schenckii
Etiologic Agent causing a Sporotrichosis, Subcutaneous Mycoses Halo = Antigen/Antibody Complex |
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How are Pox Viruses an Exception to the characteristics governing all other Enveloped DS DNA Viruses?
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In Pox Viruses:
1) Replication takes place in CYTOPLASM (NOT in Nucleus) 2) Envelope is formed in Cytoplasm PRIOR to exiting the cell (NOT during the exit) |
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Localized, Chronic Infection of the Skin and Subcutaneous Tissues acquired by Implantation of Soil Organisms
Lesions are usually PAINLESS and ***"CAULIFLOWER-LIKE"*** Caused by a group of SLOW Growing, ***DEMATIACEOUS (BLACK)**** Fungi ***BROWN-SEGMENTED HYPHAL*** Forms seen in Infected TIssue |
Chromomycosis causing a Subcutaneous Mycoses
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Etest Antimicrobial Susceptibility Test
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Advantage: Accurate and Quantitative.
Disadvantage: Expensive. NOT applicable to slow-growing bacteria (anaerobes and Mycobacterium). |
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***FEVER***, Vomiting, Painful Cramping, Watery Diarrhea. May develop into ***DYSENTERY with SCANT, BLOODY STOOLS & FECAL LEUKOCYTES***
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EIEC - EnteroInvasive E. coli
Invades and Destroys Colonic Epithelium. Invades and Replicates in Cell Cytoplasm. Thus, it is "SHIGELLA-LIKE" in terms of INVASIVENESS. Usually does NOT GO BEYOND EPITHELIUM. Thus, does NOT GO INTO BLOOD STREAM Anti-Motility Agents CONTRAINDICATED aka DONT USE THEM! Location = Lg-Int |
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Beta-Lactamase Detection Antimicrobial Susceptibility Test
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Cefinase Disc impregnated with Nitrocefin (yellow) turns red when hydrolyzed by a beta-lactamase
Advantage: Rapid. Disadvantage: Detects only ONE mechanism of resistance against Beta-Lactams. |
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Gram-Positive Organisms are usually Susceptible to _______ and Resistant to _______.
Opposite for Gram Negative! |
Vancomycin
Colistin |
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MIC < Breakpoint =
MIC > Breakpoint = |
Susceptible
Resistant |
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If an organism is susceptible to MULTIPLE antimicrobials, which is the most appropriate to use?
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Breakpoint/MIC is the GREATEST = MBQ
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Mollicutes
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The ONLY Bacteria with NO CELL WALL
Human Pathogens are Mycoplasma and Ureaplasma |
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Lipoteichoic Acid
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High Concentrations in Gram POSITIVE Cell Wall
Anchors Cell Wall to Cytoplasmic Membrane |
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RED EYE, pain, tearing, sensitivity to light, decreased vision, rash on eyelid.
Primary infection consists of Vesicles on lids, follicular conjunctivitis, ***PREAURICULAR ADENOPATHY***. Recurrent infection involves any and/or all layer of ***CORNEA***. Ocular lesions can lead to permanent corneal scarring. Usually limited to ***ONE EYE*** Transmitted via touching site of infection, then rubbing eye or placing contact lens in eye. |
Herpetic Keratitis (Ocular Herpes) caused by HSV-1
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Common in soils of the Lower Sonoran Life Zone
Prevalent in Southwestern US (Southern Cali, Arizona, Nevada, New Mexico, West Texas), as well as parts of Mexico, Central and South America Mould Phase: White to tan fluffy colony whose hyphae will fragment into ***BARREL SHAPED ARTHROCONIDIA*** separated by Disjunctor Cells. Perturbations in Environmental Conditions (Rainfall, Wind, Earthquakes) may affect the Concentration and Spread of Arthroconidia in the Atmosphere. Tissue Phase: Formation of MULTINUCLEATED SPHERULES. Repeated internal cleavage products produces Endospores. 60% of cases may be Asymptomatic 35% have Mild Flu-like illness with Fever, Chest Pain and Arthralgia First Presenting Symptom of Infection = Allergic Manfestations (erythema nodosum, eythema multiforme) Extrapulmonary Disease is rare (<5%) but serious and may involve CNS, Skin, Pericardium Antibody Response is NOT PROTECTIVE |
Coccidioides spp. infection causing Coccidioidomycosis aka San Joaquin Valley Fever aka Desert Rheumatism
C. immitis (San Joaquin Valley CA) C. posadasii (Texas, AZ, Outside US) |
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Corynebacterium Characteristics
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Gram Positive (Gram Variable Rxn) with METACHROMATIC GRANULES
Non-Motile Club Shaped Bacillus Grow best under Aerobic Conditions Nonhemolytic on Blood Agar Catalase-Positive |
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Mycolic Acid
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High Concentration in ACID FAST CELL ENVELOPE
Waxy, long-chain fatty acids. Makes cell wall relatively impermeable Ex. Mycobacteria Survive and grow within Macrophages for months or years. |
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Endemic to Mississippi River Valley and Parts of South-Central US (including East Texas), also found in parts of Mexico and Central America
Prospers in soils laden with ***BIRD and BAT GUANO*** --> ****SPELUNKERS*** BEWARE!!! Typically a Self-Limiting Pulmonary Disease (Cough, SOB) Minority of patients will develop Progressive Pulmonary Disease and/or Disseminated HISTOPLASMOSIS (Immunosuppressed/AIDS) Disseminated infection can involve ANY organ system, typically bone marrow, spleen, skin, GI, CNS. Mould Phase: Microconidia (infectious) and ***TUBERCULATED MACROCONIDIA*** (diagnostic) Tissue Phase: Small Oval Yeast Cell Mediated Response causes GRANULOMA FORMATION (like TB) |
Histoplasma capsulatum causing Histoplasmosis (Darling's Disease)
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Sudden onset of Severe Abdominal Cramping, Large Volume of Watery Diarrhea, High Fever, Vomiting (Emesis)
Develops Into: ***ACUTE BLOODY DIARRHEA WITH MUCUS*** (***BACILLARY DYSENTERY***) Straining (Tenesmus), Abdominal Pain, Fecal Incontinence, Urgency, Possible Dehydration |
Shigella!
Invades M Cells (Peyer's Patches) and Replicates in Host Cell Cytoplasm. Does NOT PROGRESS BEYOND EPITHELIUM. Thus, does NOT GO INTO BLOOD STREAM. |
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Endemic in Mississippi and Ohio River Valleys, Middle-Eastern Seaboard, also in parts of Africa.
Chronic infection of the Skin and Bones. Lesions characterized by MICROABSCESS FORMATION, PAPULOPUSTULAR NODULES, and CRUSTY VERRUCOUS GRANULOMAS of the Hands, Face, and Mucocutaneous Areas. If systemic, can involve CNS or Urogenital System. Mould Phase: Septate hyphae, white colony, OVAL MICROCONIDIA Tissue Phase: Large, THICK-WALLED YEAST with BROAD-BASED BUD |
Blastomyces dermatitidis infection causing North American Blastomycosis (Gilchrist's Disease)
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Infection of FINGERS due to Occupational Exposure (***DENTISTS***) or ***NAIL BITERS***
Virus infects breaks in skin and forms vesicles on fingers. Vesicles rupture and crust over. |
Herpetic Whitlow caused by HSV-1 (HSV-2 seen in sexually active adults)
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Found in Soil of Subtropical Sylvatic Regions of Central and South America
Chronic Granulomatous Disease Begins as a Pulmonary Infection and disseminates to form Ulcerative Granulomata of Buccal, Nasal, and occasionally GI Mucosa Lymph Node involvement is common, with extension to cutaneous tissue. Systemic involvement of multiple organ systems is RARE. Mould Phase: Septate hyphae, white colony, Oval Microconidia. Tissue Phase: THIN-Walled Yeast with Multiple Buds arranged in a "SHIP'S WHEEL" Configuration |
Paracoccidioides brasiliensis infection causing Paracoccidioidomycosis aka South American Blastomycosis
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Pathogenicity vs Virulence
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Pathogenicity relates to Genus, Species and Disease Production
Virulence relates to a given STRAIN to produce illness |
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Found in Soil and ***BAMBOO RATS***.
Most disease in **HIV Patients** in ***THAILAND*** and ***SOUTHERN CHINA*** Prominent Mycotic Disease in HIV-Infected individuals of Southeast Asia Disseminated disease which may mimic TB, Leishmaniasis or Histoplasmosis Skin lesions reflect dissemination, may mimic Molluscum Contagiosum-like lesions of face and trunk. Mould Phase: Filamentous hyphae with Sporulating Structures. May have RED PIGMENT. Tissue Phase: Yeast-like organism that divides by fission and shows Transverse Septation. |
Penicilliosis marneffei Infection!
P. marneffei is the ONLY species of Penicillium that is a dimorphic fungus! |
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Vesicle formations that crust over due to viral infection of arms, legs torso.
Common in WRESTLERS/ATHLETES |
Herpes Gladiatorum caused by HSV-1
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Commonly infected sites include Urogenital Tract (Cystitis, Vaginitis, Urethritis), Oropharynx (Oral Thrush, Esophagitis), Skin, CV
Cutaneous infection can occur with breakdowns in skin integrity from Burns, Chronic Moisture and Maceration (Dishwashers, Bartenders, Intertriginous Areas of the Obese) Common in IV drug abusers. GERM TUBE!!! |
Opportunistic Candida albicans infection!
Endogenous Fungi of Enteric System! Associated with CMC |
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Assimilation vs Nitrogen Fixation
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Assimilation = NO3 --> NH4
Nitrogen Fixation = N2 --> NH4 |
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Binding Protein Transport
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Gram NEGATIVE ONLY!
Protein in the periplasm which carries the substrate to a cytoplasmic membrane translocation system |
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What is the Cyt C Oxidase test used as a diagnostic tool for?
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Certain Gram NEGATIVE Organisms
Modified Oxidase Test is used for Gram POSITIVE |
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Endocarditis in I.V. Drug Abusers
Species found on skin and introduced into blood stream at sites of innoculation |
Candida tropicalis and Candida parapsilosis infections
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10-14 Day Incubation Period (Fairly SLOW), followed by:
Low-grade fever increases to High-grade fever in step wise fashion. Malaise (discomfort), Frontal Headache, Dry Cough. Constipation (initially) or ***SPLIT PEA SOUP*** Diarrhea develops after approx 1 week of symptoms. Abdominal tenderness and pain. ***"ROSE SPOTS"*** may appear on ABDOMEN, BACK, or ARMS. |
Typhoid/Enteric Fever caused by S. typhi (most sever), S. paratyphi
LOW INFECTIOUS DOSE = SPREADS EASILY! |
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Major reservoir for fungus is ***PIGEONS*** (however, no disease seen in them)
Virulence Trait = ***POLYSACCHARIDE CAPSULE***, thus appearing as a ***SMOOTH, MOIST COLONIES*** Chronic, Subacute, or (rarely) Acute Pulmonary, Systemic, or Meningitic Infection Primary infection is usually SUBCLINICAL Serious, life threatening disease in patients with impaired immune response (particularly T Lymphocytes in AIDS, Lymphoma) Fungus has a predilection for the CNS Produces ***BLASTOSPORES ONLY*** |
Cryptococcus neoformans infection
Diagnostic Test = Latex Agglutination for detection of Cryptococcal Polysaccharide in CSF and Serum |
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Where does Peptidoglycan Cross-Linking occur?
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From Terminal D-Ala D-Ala of one Peptide Side Chain to NH2 Group of Another Side Chain
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Monomorphic Moulds ubiquitous to most environments.
Mycelium consist of Septate Hyaline Hyphae with ***45 ANGLE BRANCHING*** May produce a spectrum of diseases including: 1) Fungus ball in patients with preexisting cavities in lungs (TB or Sarcoidosis) 2) Allergic Bronchopulmonary Hypersensitivity Response WITHOUT Tissue Invasion 3) Parenchymal invasion with hyphal progression along vascular pathways. 4) Disseminated Disease 5) Mycotoxicoses (Ingestion of food containing toxins) Conidiophores with Terminal Vesicle and Phialides produce Chains of Conidia |
Aspergillus Infection causing Aspergillosis
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Tzanck Smear
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Detects Herpes Viruses
However, does NOT distinguish between them! |
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Differentiating between the 3 Zygomycetes (RAM)
1) Rhizopus spp. 2) Absidia spp. 3) Mucor spp. |
1) Rhizopus spp. = Rhizoids DIRECTLY OPPOSITE Sporangia
2) Absidia spp. = Rhizoids BETWEEN TWO Sporangia (Internodal) 3) Mucor spp. = NO Rhizoids |
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Penicillin Binding Proteins (PBPs)
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Transpeptidases and Carboxypeptidases
Catalyze cell-wall cross linking |
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Often found as common ***BREAD MOULDS***
White colony mould, turns dark upon sporulation. Hyaline, NON-SEPTATE HYPHAE with ***90 ANGLE BRANCHING*** Sporangia and Sporangiospores. Can be EXTREMELY ACUTE AND FULMINANT Several Clinical Presentations: 1) ***RHINOCEREBRAL INFECTION*** (most common) - Rapidly Progressive infection of ***SINUSES, ORBITS and BRAIN***, with Infarction and Necrosis. 2) Associated with KETOACIDOTIC DIABETES 3) Thoracic Infection 4) Abdominal, Gastric Infection 5) Skin Infection (Burn Patients) |
Zygomycosis aka Mucormycosis caused by Zygomycete (Rhizopus, Absidia, Mucor) Infection
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Fever and itchy maculopapular rash which develops after approx 2-3 week incubation period. ***Successive "CROPS" of Lesions***, thus vesicles present in differing stages from Vesicles to Crusted Over. Lesions are generalized, and MORE PREVALENT ON TRUNK than extremities (centrifugal spread)
Generally occurs in children before the age of 10 |
Chickenpox due to acute/primary form of Varicella-Zoster Virus (VZV) = Varicella = HHV-3
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Hallmark of Infection = ***INTERSTITIAL PNEUOMONITIS and PLASMA CELL INFILTRATION***
Subclinical infection probably common. Pulmonary infection associated with clinical conditions of debilitation, secondary to Immunosuppression and more recently AIDS |
Pneumocystis jiroveci (formerly carinii)
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Widal Test
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Serology Test for Salmonella typhi O & H Antigens!
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Usually seen as ***BLUE-GREEN*** Colony
Produces Conidiophores with ***SECONDARY BRANCHES*** called ***METULAE*** |
Penicillium spp. causing a Hyalohyphomycoses Infection
Whorled Phialides that bear Conidia in chains are known as "Penicillus" |
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Bacterial Autolysins
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Endogenous enzymes that hydrolyze various bonds in peptidoglycan.
Required for bacteria to grow and divide In the absence of synthesis of new peptidoglycan material, they will actually DEGRADE the peptidoglycan. |
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***WHITE TO PINK*** Colony, forms ***BANANA-SHAPED CONIDIA***
Causes Eye, Skin and Nail Infections Occasionally Disseminates |
Fusarium spp. causing a Hyalohyphomycoses Infection
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Acute onset of high fever, chills, flu-like symptomsm productive cough, ***THICK, STICKY, BLOOD TINGED SPUTUM (CURRENT JELLY)***
UNI-lateral chest signs, predominantly UPPER lobe Common in MIDDLE-AGED ALCOHOLICS or INDIVIDUALS w/COMPROMISED PULMONARY FUNCTION |
Community-Acquired Pneumonia caused by KLEBSIELLA PNEUMONIA
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Corneal and Nail Infections, Rare Cause of Mycetoma
White Cottony Colony Delicate Tapering Conidiophores with OBLONG Conidia Occuring in Clumps at Terminal Ends |
Acremonium spp. causing a Hyalohyphomycoses Infection
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Types of Membrane Disrupting Toxins
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1) Pore-Forming - NON-Enzymatic
2) Phospholipases - Enzymatic |
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Superantigen Example:
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Staph aureus and Strep pyogenes Toxic Shock Syndrome Toxin (TSST)
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Most common in Older Men
INCREASED Urine pH (more alkaline) UTI & ***RENAL STONES*** |
Proteus mirabilis, a member of the Enterobacteriaceae Family
Produces Urease, which forms Ammonia --> INCREASE Urine pH |
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Travelers to RUSSIA
Usually exposed via Fecal-Oral Route, generally via contaminated Water and/or Food. ***RESISTANT TO CHLORINE*** levels used in Water Treatment Plans Usually asymptomatic. Symptoms include ***MALODOROUS (STINKY)***, Watery Diarrhea, Cramping and Distention, Epigastric Pain. Sometimes accompanied by Low-Grade Fever. Severe cases can entail significant Weight Loss Limited Tissue Destruction. Reduced absorption of some nutrients due to Epithelial Turnover. |
Giardia lamblia aka Giardia duodenalis causing Giardiasis
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Bacillus anthracis Characteristics
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Gram Positive Rods
NON-Motile (unlike Bacillus cereus) Protein Capsule Spore Forming BAMBOO-LIKE CHAINS |
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Common in travelers to ST. PETERSBURG (Russia)
Usually exposed via Fecal-Oral Route, generally via contaminated Water and/or Food. ***RESISTANT TO CHLORINE*** levels used in Water Treatment Plans 80% are Symptomatic! Profuse, Watery Diarrhea, Cramping. Less common are Fever (rarely), Nausea, Anorexia. Symptoms usually abate after 1-2 weeks. Dehydration is a serious concern in Immunocomprimised patients and can be life-threatening. Mild and self limited Tissue Destruction in Immunocompetent individuals Dx via ***MODIFIED ACID-FAST STAIN*** |
Cryptosporidium (C parvum most common) causing Cryptosporidiosis
Unlike other Intestinal Protozoa, Crypto Oocysts do NOT stain well! Solution: Modified Acid-Fast Stain! |
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What appear as Gram Positive Cocci in Pairs, which are LANCET Shaped?
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Streptococcus pneumoniae
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Rare in US, some outbreaks have occurred in Institutional Settings
Reservoir = ***PIGS*** Symptoms resembles Amebiasis - Diarrhea, Abdominal Pain, Nausea, Anorexia Cyst are large and round with a ***DARK, CRESCENT-SHAPED MACRONUCLEUS*** |
Balantidium coli causing Balantidiasis
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Common cause of Kidney Transplant Rejection
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Cytomegalovirus (CMV) HHV-5 Infection in transplant that is REACTIVATED
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Bacteria Associated w/ Abscess (Indolent aka Painless Localized Infection) or Fascitis (Progressive and Lethal Infection) Formation. Can be rapid and distressing in onset, but are Slowly progressive.
Gram Negative ***Safety Pin Appearance*** Growth stimulated on ***BILE***! ***Resistant to Penicilin G!!!!*** |
Bacteroides fragilis
MOST Common and Important Anaerobic Pathogen! Habitat = COLON Has a CAPSULE! |
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Corynebacterium vs Listeria monocytogenes
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Listeria are motiLe.
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Which virus immortalizes B Cells and is associated with atypical lymphocytes called Downey Cells?
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Epstein-Barr Virus (EBV), HHV-4
Spread via Saliva - Kissing, Sharing Toothbrush, Cups/Glasses |
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Indolent (Painless) Pneumonia, Foul Breath
In Lab Dx, BLACK COLONIES due to pigment REQUIRES Vitamin K and Hemin to grow Gram Neg Coccobacillary in appearance |
Prevotella melaninogenica
Habitat = Oral Cavity (thus, common in homeless people) |
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Typically acquired while ***SWIMMING IN FRESH WATER*** contaminated with the organisms
Rare, but Extremely Serious. Mortality ~95%. Symptoms include: 1) Headaches (potentially severe) 2) Mental-Status Changes 3) ***ALTERATIONS IN TASTE/SMELL*** 4) ***SENSITIVITY TO LIGHT*** 5) Diffuse HEMORRHAGE and Necrosis of BRAIN tissue |
Naegleria flowerli OR Acanthamoeba spp causing Primary Amebic Meningoencephalitis (PAM)
Progression is SLOWER with Acanthamoeba |
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B-cell lymphoma of JAW and FACE, occurs in children in Malarial Regions of Africa
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African Burkitt's Lymphoma (Endemic Lymphoma) caused by Epstein-Barr Virus (EBV), HHV-4
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Typically acquired while ***SWIMMING IN FRESH WATER*** contaminated with the organisms
***CORNEAL ULCERS*** resulting from Trauma or ***CONTACT LENS*** Use GRANULOMATOUS SKIN LESIONS! |
Acanthamoeba spp causing Amebic Keratitis
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Bacillus cereus vs Bacillus anthracis
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Cereus are motile (Cereus are SERIOUS about Motility!)
Anthracis has a Capsule! |
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Lymphoproliferative disease common in ASIA which is associated with SALTED FISH and NITROSAMINES IN FOOD
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Nasopharyngeal Carcinoma caused by Epstein-Barr Virus (EBV), HHV-4
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Unique, Darkly Staining Organelle (the ***KINETOPLAST***)
Vector: ***TSETE FLY*** 3 Phases: 1) Acute Phase: Ulceration at the Bite Site (Chancre) 2) Systemic Phase: -Fever (Intermittent, but UNRESPONSIVE to Antimalarials), Myalgia, Arthralgia. -ENLARGEMENT OF POSTERIOR CERVICAL LYMPH NODES = WINTERBOTTOM'S SIGN or a More Generalized Lymphadenopathy 3) CNS Involvement: ***LETHARGY***, ***TREMORS***, Headaches, ***WASTING SYNDROME***, Meningoencephalitis, ***ATAXIA***, or ***PERSONALITY CHANGES*** Becomes increasingly pronounced extending to Coma and Death within a few months or a few years. |
Trypanosoma brucei causing African Trypanosomiasis aka African Sleeping Sickness
Subspecies gambiensis (West) = Winterbottom's Sign, Coma/Death in 2-5 Years Subspecies rhodensiensis (East) = Generalized Lymphadenopathy, Coma/Death in 9-12 Months |
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Most commonly causes lung abscesses, involved in pleuro-pulmonary infections.
Gram Negative ***NEEDLE SHAPED BACILLI*** |
Fusobacterium nucleatum
Habitat: Oral Cavity |
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Vector: ***REDUVIID*** aka ***"KISSING BUG"***
Transmitted when feces from infected bugs contaminate bites. Endemic to CENTRAL AND SOUTH AMERICA Inflamed Lesion (Chagoma) may occur at bite site. Three Stages: 1) Acute Phase: Fever, Lymphadenopathy, Hepato/Splenomegaly, Subcutaneous Edema and Rash. Few may develop acute myocarditis or meningoencephalitis. 2) Indeterminant/Asymptomatic Chronic Phase: Occurs in 20-40% of those infected. Little or No signs of infection. May or May Not progress to stage 3. 3) Symptomatic Chronic Phase: ***CARDIAC ENLARGEMENT*** with Heart Enlargement and ***DEFECTS IN CONDUCTION***. Arrythmias, blockages and thromboembolisms can occur. Involvement of Esophagus or Colon is also possible. Most DEATH occurs in this phase! |
Trypanosoma cruzi causing American Trypanosomiasis aka Chagas' Disease
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Lymphoproliferative disease characterized by Lesions in MOUTH of AIDS patients
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Oral Hairy Leukoplakia (productive EBV infection) caused by Epstein-Barr Virus, HHV-4
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Most common cause of Gas gangrene (endogenous infection). Seen on microscopy.
Double Zone of Hemolysis on Blood Agar Common cause of short lived food poisoning (exogenous intoxication) Associated most often with Wound Infections! Gram Stain ***"BOX CAR APPEARANCE"*** |
Clostridium perfringens!
Habitat: Soil and Intestinal Tract of Man! |
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Virus associated with pathogenesis of Kaposi's Sarcoma
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HHV-8 aka Kaposi's Sarcoma-Associated Herpesvirus (KSHV)
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Diarrhea with or without the presence of pseudomembranes and fecal leukocytes
Common in those with prolonged, high use of Antibiotics (but NOT necessary) Dx via Stool assessment of Toxin presence: Toxin A (Enterotoxin) and Toxin B (Cytotoxin) |
Clostridium difficile
Produces both Toxins A and B! Habitat: Colon NORMAL FLORA OF HUMANS, thus Toxins in STOOL are assessed for disease! ELISA test is used clinically. |
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Parotitis: Prodrome followed by enlargement of one or both PAROTID GLANDS (most begin as unilateral and progress to bilateral): edema over parotid, pain with pressure, angle of mandible obscured.
Fever (persists about 1 week), Headache, Malaise, Anorexia, Abdominal pain, ACIDIC FOOD PAINFUL, Earache or facial pain, Swelling of salivary glands, esp. parotid(s), persist 7-10 days. Intraoral examination may reveal erythema and edema of ***STENSENS DUCT*** Viruria (virus in urine) is common Peak in Late Winter and Spring, Most common in School Aged Children (5-15) Lemon Juice causes increased salivation and pain! |
Mumps Virus (Paramyxoviridae Rubulavirus)
Can lead to: 1) Meningoencephalitis 2) Orchitis and/or Epididymitis 3) Deafness 4) Facial Nerve Neuritis 5) Oophoritis (rare) 6) Pancreatitis (rare) |
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Vector: TICK
Reservoir: VOLES and Other Small Mammals Endemic to NORTHEASTERN SEABOARD Malaise, Fever, Chills, Weakness. Severe cases may develop Hepatosplenomegaly, Anemia and Renal Failure. ***SPLENECTOMY*** Significantly Raises Susceptibility and Likelihood of Severe Disease! Blood Film reveals Erythrocytic Cycle similar to Plasmodium. Difference is that here it is LARGER and DARKER and sometimes forms an X-SHAPE = MALTESE CROSS |
Babesia microti causing Babesiosis
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Hyperflexia and Muscle Spasms, Associated with "LOCK-JAW" aka Trismus
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Clostridium tetani
Habitat: Ubiquitous in Environment, Especially Soil (NOT IN THE RUST ON NAILS) Produces Extremely Potent Neurotoxic Exotoxin, TETANOSPASMIN, which spreads along mostly MOTOR nerves, blocking release of INHIBITORY NTs, preventing their Post-Synaptic Inhibition. Toxin, Tetanospasmin, is treated w/ Tetanus Immune Globulin (TIG) |
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What is the ONLY definitive Dx of TB?
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Grow it on Lowenstein-Jensen Media!
Takes a LONG time (4-8 Weeks) |
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When is a Tuberculin Skin Test (Intradermal Mantoux Test) POSITIVE under the following conditions:
A) 5 mm or Greater B) 10 mm or Greater C) 15 mm or Greater D) Induration Size Changes over Time (Conversion from Neg --> Pos) |
A) 5 mm or Greater:
1) Close contact to patients with TB 2) Person w/ HIV 3) Person w/ Fibrotic Lesions on Chest X-Ray 4) Person w/ Organ Transplants or Immunosuppressed B) 10 mm or Greater 1) Recent immigrant (5 years) from High Prevalence Countries 2) Injection Drug Users 3) High risk crowded facilities (jails, nursing homes, homeless shelters) 4) Mycobacteriology Lab Personnel 5) Persons w/ Medical Risk Factors which increase risk of TB once infected 6) Children younger than 4 or infants/children/adolescents exposed to adults at high risk C) 15 mm or Greater = ALWAYS POSITIVE D) Induration increases 10 mm or Greater within 2 Years *Positive = Infection, Could be Active OR Inactive!* |
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Worldwide carriage, in US mostly in the ***SOUTHEAST US***
Most carriers are asymptomatic with pathology more common in Children. Abdominal Pain and Secondary Bacterial Infections can occur if organism Penetrates Mucosa. High burdens can produce Diarrhea, Weight Loss, and , occasionally, APPENDICITIS. Eggs are Oval, Slightly YELLOWISH (bile-stained), with ***THICK WHITE CAPS ON BOTH ENDS*** |
Trichuris trichiura (Whipworms, Nematodes) causing Trichuriasis
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How do the envelopes of Mumps Virus (Paramyxoviridae Rubulavirus) and Measles Virus (Paramyxoviridae Morbillivirus) differ???
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Both have Hemagglutinin and Fusion Protein
Only Mumps has Neuraminidase! |
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Very common in Tropical and Subtropical Climates
Infection comes from contact with Soil contaminated with Feces. A few Zoonotic Species can infect Humans High burdens can cause ***HYPOCHROMIC ANEMIA***, with potential DEVELOPMENTAL RETARDATION in Malnourished Children. Other symptoms are generally Mild (or undetectable) and include Abdominal Pain, Diarrhea, Malnutrition, Loeffler's Syndrome, and Rash at Penetration Site |
Ancyclostoma duodenale (Old World Hookworms, Nematodes) or Necator americanus (New World Hookworms, Nematodes) causing Ancyclostomiasis
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Bacteria associated with ***DISSEMINATED DISEASE***
Major Problem in people with ***AIDS*** |
Mycobacterium avium intracellulare
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Bacteria found in tissue cooler than 37 degrees Celsius such as skin, ***PERIPHERAL NERVES***, Anterior portion of eye, respiratory passage above larynx, hands, feet.
First signs are usually hypo or hyper pigmented skin lesions that are often anesthetic or paresthetic. Then develops into more advanced forms with various cutaneous lesions. Common carrier = Armadillos. CANNOT be cultured on synthetic media. Acid-Fast Bacilli |
Mycobacterium leprae aka Hansen's Disease
Treated by those with SPECIAL EXPERTISE! |
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Worldwide in association with ***MEAT PRODUCTS***, most Particularly ***PORK***
Agent carried by many Meat-Eating Mammals. Carnivorous Animals (including humans) Eat Raw or Undercooked Meats containing Encysted Larvae Can form ***CYSTS IN STRIATED MUSCLES*** (Nurse Cells) Can be asymptomatic (depending on number ingested), Fever, Adnominal Pain, Myalgia, Marked Eosinophilia with Increasing Severity ***SPLINTER HEMORRHAGES*** sometimes seen Under the Nails Lethal Infections usually combine Myocarditis, Encephalitis, and Pneumonitis Dx: Clinical Signs + Eosinophilia = Clues Muscle Biopsies NOT Fecal Samples, they are NOT informative! |
Trichenella spiralis (Nematode) causing Trichinosis
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Forms of Leprosy:
1) Lepromatous 2) Tuberculoid 3) Borderline or Dimorphous |
PERIPHERAL NERVE INVOLVEMENT IN ALL FORMS!
1) Lepromatous - Lack of Cellular Immunity, Extensive DIFFUSE tissue involvement. DIFFUSE INFLAMATION DISSEMINATED reaction with large Macrophages filled with organisms. 2) Tuberculoid - Few Skin Lesions which are SHARPLY DEMARCATED. Pronounced neurologic involvement. Lymphocytes, epithelioid cells with some giant cells. Bacilli are FEW. 3) Borderline or Dimorphous - Mixture of the Two above! |
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STAR Complex
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Sore Throat - Arthritis - Rash, all presenting together
Can be caused by: 1) Parvovirus B19 ***** 2) Rubella ***** 3) Hep B 4) Adenovirus 5) Echovirus 6) Coxsacieviruses 7) Epstein-Barr Virus |
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Extraintestinal infections
Vectors: AEDES, ANOPHELES, CULEX MOSQUITOES (None Endemic to US) Infect the Lymphatic System causing Lymphadenopathy and RECURRENT FEVER, causing ENLARGEMENT OF TISSUES and susceptibility to other Bacterial Infections. Extreme, Chronic manifestation is ***ELEPHANTITIS*** |
Lymphatic Filariasis (Threadlike Nematodes)
Can be caused by: 1) Wuchereria bancrofti - Bancroft's Filariasis, Endemic to Tropical Areas 2) Brugia malayi, Brugia timori - Brugian or Malayan Filariasis, Endemic to SE Asia |
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Chronic destructive abscess formation often with sinus tracts, presence of ***SULFA GRANULES***
Multiple forms including: 1) Cervicofacial - ***"LUMPY JAW"*** 2) Thoracic 3) Abdominal 4) Miscellaneous - Brain Abscess, Endocarditis, Other Abscesses NOT Acid Fast! Anaerobic or Microaerophilic |
Actinomyces (Actinomyces israelii, Actinomyces bovis)
***NORMAL MOUTH & GUT FLORA!*** |
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Extraintestinal Infection
Endemic to Africa Vector: BLACKFLY Tissue Preference for ***SKIN AND EYES*** Dermatitis, Skin Nodules, Ocular Lesions. Eye involvement progresses from Conjunctivitis to Keratitis and causes ***BLINDNESS*** in 5% |
Onchocerca volvulus (Filariasis, Nematodes) causing Onchocerciasis aka River Blindness
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Year round, but Most common in ***LATE WINTER & SPRING***
4-12 day incubation period, subsequent viremia with spreading to bone marrow and elsewhere followed by biphasic disease: Phase 1: Febrile infectious stage = Initial mild illness with fever, malaise, headache, myalgia, sore throat, sometimes itching. May be accompanied by lymphadenopathy, splenomegaly. Mild decrease in WBC and RBC (leukopenia, anemia). Arthralgias/arthritis may develop (particularly SYMMETRICAL POLYARTHRITIS IN FEMALE ADULTS). Phase 2: Immune Mediated Symptomatic Stage = Manifestations of skin including ***SLAPPED CHEEK*** Syndrome (bright red, confluent, indurate rash on face) and/or ***GLOVES & SOCKS*** Syndrome (papular-purpuric erythema spreads to proximal extremities (acral distribution), fades to lacy pink-red exanthem. Palms and soles usually SPARED. May have enathem. Rash resolves in 5-7 days. IgG on rise when rash appears! |
Fifth Disease aka Parvovirus B19 aka Erythema Infectiosum (Family Parvoviridae)
Complications: 1) Fetus: Hydrops Fetalis and Death 2) Patients with Hemoglobinopathy: Anemia and Aplastic Crisis 3) Immunocompromised Patients: Persistent Infection with Persistent Anemia 4) Implicated in Etiology of KAWASAKI Disease |
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Symptoms arising in early teens, consisting of:
1) Bone and Tooth Deformities 2) WRINKLED SKIN (Rhagades) 3) Interstitial Keratitis 4) Deafness 5) Mental Impairment |
Caused by LATE CONGENITAL SYPHILIS
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Extraintestinal Infection
Endemic ONLY in ***AFRICAN RAIN FOREST*** Vector: ***CHRYSOPS FLY*** Organisms MIGRATE particularly through MUSCLE, Subcutaneous Tissue, and the EYE "CALABAR SWELLINGS" on Extremities |
Loa loa (Filariasis, Nematode) causing Loaisis
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History:
1st Disease- 2nd Disease- 3rd Disease- 4th Disease- 5th Disease- 6th Disease– |
History:
1st Disease- Rubella 2nd Disease- Measles 3rd Disease- Scarlett Fever 4th Disease- Filatov-Dukes Disease (Atypical Scarlet Fever) 5th Disease- Parvovirus B19 6th Disease– Roseola (HHV6) |
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Mostly Affects Dogs with potential Fatal Heart Infections.
Can be transmitted to Humans via a Mosquito Bite, where it causes a ***"COIN LESION" IN THE LUNG*** |
Dirofilaria immitis (Filariasis, Nematode) aka Dog Heartworm
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What is the ONLY DEFINITIVE Dx of Syphilis?
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Detection of Treponema pallidum via DARKFIELD MICROSCOPY!
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Peak incidence in ***LATE WINTER & EARLY SPRING***
More severe in adolescents and adults (complications include arthralgia, arthritis and thrombocytopenic purpura) Major concern is damage to fetus in pregnant woman/congenital infection. Symptoms include low grade fever, chills, headache, sore throat, ***EYE PAIN ON LATERAL & UPWARD MOVEMENT***, conjunctivitis, general body aches, anorexia, nausea, ***TENDER LYMPHADENOPATHY*** (especially posterior auricular and suboccipital lymph nodes)***, ***FORCHHEIMER SPOTS*** (pinpoint or larger petechiae usually occurring on Soft Palate) Exanthem: a discrete pinkish-red fine maculopapular eruption, which like measles, typically begins on the face and neck, spreading CENTRIFUGALLY to trunk and extremities in 24 hours. On second day, rash begins to fade centrifugally, beginning on the face. Resolved by end of ***DAY 3***! ***TERATOGENIC EFFECTS*** |
Rubella (Little Red) aka German Measles aka 3-Day Measles (Togaviridae Rubivirus)
Complications: 1) Arthralgia/Arthritis - more common in WOMEN 2) Meningoencephalitis (rare) 3) Congenital Rubella Syndrome |
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Schistosoma Species Blood Site Preference and Egg Shape:
1) S. mansoni: 2) S. japonicum: 3) S. hematobium: |
1) S. mansoni: Inferior Mesenteric Veins; Ovoid with Lateral Spine (Dagger)
2) S. japonicum: Superior Mesenteric Veins; Ovoid and Smaller/Rounder and LACK a Spine 3) S. hematobium: Urinary Plexus and Veins; Terminal Spine (Syringe Tip) |
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Nontreponemal vs Treponemal Tests
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Nontreponemal Tests:
-Detect Ab for Cardiolipin! -Ex: VDRL, RPR Tests -SCREENING Test Treponemal Tests: -Detect Ab against Treponema pallidum! -Ex: FTA-ABS, MHA-TP -CONFIRMATORY Test |
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Infection transplacentally during maternal viremic phase
***SENSORINEURAL HEARING LOSS*** is most common symptom Other Symptoms: Ocular Abnormalitis, Cardiac Defects, Liver and Spleen Enlargement, Growth Retardation ***BLUEBERRY MUFFIN BABY*** |
Congenital Rubella Syndrome
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Jarisch-Herxheimer Reaction (Fever and Chills)
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Can be caused by Penicillin treatment of a Fulminant Syphilis Infection (e.g. Secondary Syphilis)
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Inflammation, retraction of Gums, Exposure of Tooth Root
Severe Forms (Acute Necrotizing Gingivitis or TRENCH MOUTH) - Bone Resorbtion and Tooth Loss |
PERIDONTAL DISEASE
Caused by accumulation of Normal Flora, including Oral Spirochetes (Treponema vincentii, Treponema denticola) and Fusiform Anaerobic Bacteria in the Gingival Crevices around teeth Most people get it at some point in their life! |
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Antigenic Drift vs Antigenic Shift
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Antigenic Drift = MINOR changes in Neuraminisase and/or hemagglutinin (changes strain but NOT subtype) = Influenza A,B,C
Antigenic Shift = MAJOR changes in neuraminidase and/or hemagglutinin (changes subtype) due to reassortment of segmented genome = Influenza A ONLY |
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Nausea, Vomiting, Abdominal Cramps, Profuse and Watery Diarrhea containing ***FLAKES OF MUCUS aka "RICE-WATER STOOLS"***, but no blood or inflammatory cells, No Fever (Afebrile)
Progresses to Dehydration (Isotonic Fluid Loss), Hypokalemia, Hypovolemic Shock (Potassium Loss), Metabolic Acidosis (Bicarbonate Loss), with Cardiac Arrhythmia and Renal Failure Common in ***FRESH WATER SYSTEMS*** (low salt content) and associated with ***SHELLFISH*** Endemic to Southern Asia |
Cholera caused by Vibrio cholerae O1 and/or O139
Non-Invasive and Colonizes Small Intestines Produces Heat-Labile Enterotoxin = Choleragen (Encoded on Lysogenic Bacteriophage) |
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Common epidemics in ***MIDWINTER***
***PLEOMORPHIC SHAPE*** (tubular or spherical), segmented (8) genome Fever, chills, nonproductive cough, headache, sore throat, malaise, myalgia, nasal congestion/rhinitis, dizziness, conjunctivitis, cervical adenopathy, pulmonary findings (rales, rhonchi, wheezing) In children, they can also have high fever, GI tract symptoms (abdominal pain/vomiting), otitis media, frequent ***CROUP*** (sounds like a barking seal) Complications include: 1) Viral pneumonia (primary and secondary) 2) Bacterial pneumonia (secondary) 3) Myositis (inflammation of muscle tissue) 4) Cardiac Involvement 5) Neurologic: -***GUILLAIN-BARRE'*** Syndrome -Encephalopathy -Encephalitis -***REYE SYNDROME*** (avoid treating with Aspirin) |
Influenza Virus Infection
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Gastroenteritis, explosive watery diarrhea (similar, but less severe than Cholera) with No blood or mucus, fever, chills, headache
Associated with consumption of Raw Seafood Cause of Wound infections associated w/exposure to contaminated Water Halophilic (salt loving) |
Vibrio parahaemolyticus
Produce Thermostable Direct Hemolysin (TDH) |
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Found Worldwide
Obtained from eating Raw or Undercooked Fish (which had eaten Small Fresh Water CRUSTACEANS) Usually Asymptomatic, but typical Vague GI complains can occur. ***VITAMIN B12 DEFICIENCY*** is occasionally seen. Dx: Oval, ***BILE-STAINED OPERCULATED EGGS*** |
Diphyllobothrium latum, The Fish Tapeworm
Largest Parasite of Humans!!! Up to 10 Meters! |
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Cause of Wound Infection associated with Marine Water
***EXTERNAL OTITIS*** Normal Flora member of Marine Life! Collagenase is a Virulence Factor! |
Vibrio alginolyticus
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Acute Gastroenteritis - Acute diarrhea w/BLOOD and NEUTROPHILS. Can have 10 or more bowel movements/day. Stools may be BLOODY. Malaise, fever, and abdominal pain common. Destruction of mucosal surfaces of the jejunum, ileum and colon are common.
Associated with consumption of CONTAMINATED WATER or FOODS - especially MILK, POULTRY, MEAT PRODUCTS Thermophilic (Optimal Temp = 42 Degrees Celsius) Reservoir = Birds, Mammals Associated w/ Guillain-Barre Syndrome |
Campylobacter jejuni
FLAGELLA implicated in pathogenesis (one of few organisms to have this trait)! Most are SELF-LIMITING! |
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Spring to Early Fall in Temperate Climates ("Summer Cold")
Nonenveloped, ***ACID LABILE, GROWS AT 33 DEGREES CELCIUS*** Typical "Common Cold" Symptoms Young infants: febrile illness associated with upper respiratory symptoms Children and adults: Afebrile upper respiratory illness (coryza, cough, and nasal congestion) Complications or Sequela: 1) Exacerbation of Asthma 2) Purulent otitis media or sinusitus |
Rhinovirus
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Vesicles that Rupture and result in HONEY-COLORED Crusting
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IMPETIGO
1) Streptococcus pyogenes 2) Staphylococcus aureus |
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Guillain-Barre Syndrome
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Associated w/ Campylobacter jejuni
Immune Disorder of the PNS! |
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Well-Demarcated, Brownish-Red Macular Patches on Inner Thighs, Crural Region, Scrotum
Toe Web Lesions appear as Maceration Wood's Lamp: CORAL-RED FLUORESCENCE |
ERYTHRASMA
1) Corynebacerium minutissimum |
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Initial Gastroenteritis followed by Bacteremia w/ Dissemination to Multiple Organs (septic thrombophlebitis, arthritis, septic abortion and meningitis)
Debilitated and immunocompromised individuals most susceptible! Reservoir = Cattle and Sheep Optimal Growth = 37 Degrees Celsius Often FATAL! |
Campylobacter fetus
Capsular like S Protein = Evades Immune Response |
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Well-Demarcated Erythematous Patch with Edema, Pain, Fever
Face and Legs Most Common Sites Rapidly Spreading |
ERYSIPELAS
1) Streptococcus pyogenes |
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Regan-Lowe Media
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Hallmark Special Chocolate agar media for Bordetella pertussis
Contains charcoal, horse blood, and cephalosporin |
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Subcutaneous tissue; Redness, Warmth, Induration, Pain, Fever
Red Streaking is characteristic of Ascending Lymphangitis |
CELLULITIS
1) Staphylococcus aureus 2) Streptococcus pyogenes 3) Young Children with Facial Cellulitis: Haemophilus influenza 4) Diabetics and Debilitated Patients: S. aureus, Enterobacteriaceae, Anaerobes |
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Causes Legionnaire's Disease and Pontiac Fever, which are Lower Respiratory Tract Infections --> High fever, cough, chills, headache, myalgia, chest pain, confusion
Common in Late Summer to Early Fall Found in Natural Aquatic Bodies, Polluted Water, Moist Soil, ***HOT WATER TANKS (grow in Amoebae and Ciliated Protozoa)***, ***AIR CONDITIONING SYSTEMS***, ***CRUISE SHIPS***, ***HOT TUBS***, Water Pipes (Grows in Biofilms) |
Legionella!
Spread by Aerosolization! |
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Inflammation of Hair Follicles; Seen in areas of Friction
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FOLLICUITIS
1) S. aureus 2) Hot Tubs: Pseudomonas aeruginosa 3) HIV: Eosinophilic Pustular Folliculitis 4) Pityrosporum ovale caused by Yeast 5) Gram Negative Folliculitis caused by Klebsiella or Enterobacter species due to Antibiotic Acne Therapy |
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Thayer-Martin Medium
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Classic Medium for Neisseria gonorrhoeae!
Selective medium! |
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Tender and Painful Red Subcutaneous Nodule
Becomes Fluctuant (like a WATER-FILLED BALLOON) May drain spontaneously with Pus |
FURUNCLE
1) S. aureus |
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Salk Vaccine
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Inactivated Poliovirus Vaccine (IPV)
Requires booster, 99-100% protection after 3 doses. Used in children and high risk adults. |
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MULTILOCULATED Subcutaneous Nodules
Appear in areas of Friction or Minor Trauma May Ooze Puz or Weep |
CARBUNCLE
1) S. aureus |
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Affect Immunocomprimised Patients, except in ***SWIMMERS EAR*** and ***HOT-TUB FOLLICULITIS***
Also associated with Otitis, Eye Infections, Osteomyelitis, UTIs, Burns, Pneumonia, Bacteremia ***PIGMENTED - Blue-Green*** ***GRAPE LIKE ODOR*** Gram Neg Rod w/ Polar FLagella |
Pseudomonas aeruginosa
Presence of Cytochrome Oxidase differentiates it from Enterobacteriaceae! |
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Sabine Vaccine
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Live-Attenuated Oral Poliovirus Vaccine (OPV)
Provides local GI tract immunity and circulating antibodies NOT used for Immunocomprimised NOR in USA due to vaccine-associated paralytic poliomyelitis (VAPP) |
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Flaccid, Ill-Defined Bullae
Nikolsky Sign - Gentle Stroking of Skin causes Skin to Separate at the Epidermis ***SANDPAPER***-Like Rash ***PERIORAL CRUSTING*** Widespread Desquamation |
STAPHYLOCOCCAL SCALDED SKIN SYNDROME (SSSS)
1) Epidermolytic Toxin A and B by S. aureus Infection from Skin, Throat, Nose, Mouth, Umbilicus, or GI Tract - NOT in the Bullae |
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Chlamydia Life Cycle: EB and RB
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Elementary Body (EB):
-Small -EXTRAcellular -Metabolically INACTIVE -CANNOT Proliferate -Infectious Reticulate Body (RB): -Large -INTRAcellular -Metabolically ACTIVE -Divides by Binary Fission -NONinfectious |
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***FLACCID PARALYSIS***, GENERALIZED myositis, infect skin and mucous membranes causing:
1) ***HERPANGINA*** - Oropharyngeal lesions with fever 2) ***ACUTE HEMORRHAGIC CONJUNCTIVITIS (AHC)*** - Catarrhal inflammation, conjunctival petechiae that coalesce, subconjunctivitis hemorrhages, painful progressive conjunctivitis, swollen eyelids, resolves in approx 1 week 3) ***HAND-FOOT-AND-MOUTH-DISEASE***- sore throat and mouth, low grade fever, macular lesions on buccal mucosa, tongue, hard palate. Lesions turn into vesicles which erode and surrounded by a red erythematous ***HALO***. 75% develop skin lesions. |
Group A Coxsackieviruses Infection
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Reiter's Syndrome
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USUALLY in Men!
Caused by nonviable Chlamydia trachomatis in Joints, leading to Reactive Arthritis |
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***CAT SCRATCH DISEASE***: pustule, regional adenopathy (single node), fever; ***Parinaud's oculoglandular syndrome***
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Bartonella henselae
Reservoir = Cat or Cat Flea |
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***TRENCH FEVER*** (5-day fever): fever, sever headache, weakness, pain in long bones (esp tibia); infect erythrocytes at 5 day intervals. Immunocompromised (HIV) recurrent fever +bacterimia
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Bartonella quintana
Reservoir = Humans + Louse |
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Fever, Rash, Hypotension, Constitutional Symptoms, Multi-Organ Involvement
MUCOUS MEMBRANES: Red Eyes, Mouth, Vagina Cutaneous: ***DIFFUSE*** Erythema, ***STRAWBERRY TONGUE***, Desquamation of Palms and Soles ***FEMALES ONLY*** Severe Pain is RARE |
STAPHYLOCOCCAL TOXIC SHOCK SYNDROME (TSS)
1) S. aureus Predisposing Factors: Tampons and Nasal Packs |
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All Enterobacteriaceae are motile with peritrichous flagella EXCEPT for 3. Which are they?
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(Your Stationary Kinds)
1) Yersinia 2)Shigella 3) Klebsiella |
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Fever, Rash, Hypotension, Constitutional Symptoms, Multi-Organ Involvement
Cutaneous: ***LOCALIZED*** Erythema More Common than Generalized, ***STRAWBERRY TONGUE***, Possible Desquamation ***SEVERE PAIN*** Associated w/ Bacteriema and Mortality |
STREPTOCOCCAL TOXIC SHOCK SYNDROME (TSS)
1) Streptococcus pyogenes Predisposing Factors: Cuts and Burns |
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Typically a Winter Epidemic
***HUBBED WHEEL APPEARANCE*** on EM 1-3 day incubation period, abrupt onset on ***FEVER*** and vomiting followed by explosive watery, non-bloody diarrhea. Results in MILD DEHYDRATION, ***METABOLIC ACIDOSIS*** = ***SEVERE***, and ELECTROLYTE ABNORMALITIES Duration of illness = 3-9 days. Re-infection occurs throughout life, but most subsequent reinfections are asymptomatic |
Gastroenteritis caused by ROTAVIRUS Infection
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More common in hot, humid climates or in those who sweat heavily, so it may recur each summer.
HYPO OR HYPERPIGMENTED Macules and Patches on the CHEST AND BACK. They may be mildly itchy. Microscopy shows ***"SPAGHETTI AND MEATBALLS"*** "Cigar-Butt" Hyphae Wood's Light: ***COPPERY-ORANGE FLUORESCENCE*** |
Malassezia furfur causing Tinea versicolor
Benign, superficial cutaneous fungal infection. |
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Which Pathogenic E. coli strains should you NOT use the following with:
1) Antimicrobials 2) Antimotility Agents |
1) Antimicrobials - EHEC, may cause Hemolytic Uremic Syndrome (HUS)
2) Antimotility Agents - EIEC |
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Headache, Nuchal Rigidity, Photophobia
Increased # WBC in CSF (Pleocytosis) |
MENINGITIS
Can be Bacterial/Viral/Fungal in Origin Bacterial Causes Dependent on Age: <1 month old: Streptococcus pyogenes, Listeria monocytogenes 1-2 years old: Streptococcus pneumoniae, Neisseria meningitidis 2-18 years old: Neisseria meningitidis, Streptococcus pneumoniae 19-59 years old: Streptococcus pneumoniae, Neisseria meningitidis >60 years old: Streptococcus pneumoniae, Listeria monocytogenes Listeria seen in Extremes of Age: Very Young/Very Old - People concerned most with this because it can be spread by close human contact. |
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1-2 day incubation period, abrupt onset on ***FEVER*** and vomiting followed by explosive watery, non-bloody diarrhea. Results in mild dehydration, metabolic acidosis, and electrolyte abnormalities. Also, ***FLU-LIKE SYMPTOMS***- fever, headache, anorexia, malaise, myalgia, and abdominal cramping
Duration of illness = 3-7 days (slightly shorter than Rotavirus). Re-infection occurs throughout life, but most subsequent reinfections are asymptomatic |
Calicivirus Infection (very similar to Rotavirus, only shorter duration and additional Flu-Like Symptoms)
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Bacterial vs Viral vs Fungal CSF Profiles in Meningitis
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Bacterial/Fungal:
-Protein/Pressure Increased -Glucose Decreased -PMN Infiltrate = Bacteria -Lymphocyte Infiltrate = Fungal Viral: -Protein/Pressure/Glucose Approximately Normal -Lymphocyte Infiltrate |
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Common characteristic of Aerobes and Facultative Anaerobes?
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Typically Oxidase POSITIVE!
Exception: Enterobacteriaceae - a facultative anaerobe that is Oxidase NEGATIVE! |
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***STAR SHAPED*** w/ 5-6 Points
Gastroenteritis less severe than that caused by Rotavirus, otherwise indistinguishable! |
Astrovirus
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DS DNA Naked Virus w/ 12 Pentons (***ANTENNA-LIKE STRUCTURES***) projecting from vertices.
8-10 day incubation period, followed by symptoms indistinguishable from other enteric viruses (gastroenteritis) EXCEPT Mild ***RESPIRATORY SYMPTOMS*** - presents w/ low grade fever, vomiting and diarrhea. Diarrhea lasts 5-12 days, vomiting 2-3 days. NOT Detected by routine tissue culture techniques |
Enteric Adenovirus: Serotypes 40 and 41
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Hepatocellular Carcinoma
***"GROUND GLASS"*** Cytoplasm in Hepatocytes Most common in Asia, Pacific Islands and Middle East Non-Specific Changes: Hepatocellular Necrosis, Portal Inflammation, Lobular Inflammation, Fibrosis and Cirrhosis |
Hepatitis B Virus (HBV)
Parenteral Spread Hepatitis F (HFV) was misnamed, it is most likely HBV. |
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Caffeic Acid Agar (Birdseed) Culture
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Cryptococcus neoformans
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Acute infection is mild and Anicteric (without Jaundice)
Also present with Cryoglobulinemia, Porphiria Cutanea Tarda, Aplasic Anemia 80% are Chronic Carriers, 20% have Cirrhosis (Scarring of Liver) Portal Dense Lymphocytic Infiltrate with Follicle Formation, Lobar Inflammation, Patchy Lobar Stenosis, Kuppfer Cell Hyperplasia, Cholestasis, Fibrosis, Cirrhosis Risk Factors: ***INTRANASAL COCAINE USE***, Injected Drug Use, Received clotting factors made before 1987, received blood/organs before July 1992, ever on Chronic Hemodialysis, Evidence of Liver Disease Progression increased in Alcoholics, people over 40, HIV co-infection, Males, other coinfections. |
Hepatitis C Virus (HCV)
Parenteral Spread |
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1) HBV-HDV Coinfection (infected at SAME time)
2) HBV-HDV Superinfection (infected with one AFTER the other) |
1) HBV-HDV Coinfection (infected at SAME time):
-Severe ACUTE Disease -LOW risk of CHRONIC Infection 2) HBV-HDV Superinfection (infected with one AFTER the other): -Usually develop CHRONIC HDV Infection -High Risk of Severe CHRONIC Liver Disease |
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"Typical" Pneumonia: Cough, ***RUSTY SPUTUM***, Fever, Chest Pain
Elderly, Alcoholics, Immunocompromised (ex. Splenectomy), Children, Closed Populations Sputum Stain: GRAM POSITIVE DIPLOCOCCI --> ***LANCET SHAPED*** Often associated with Bacteremia |
Streptococcus pneumoniae
Treatment: Penicillin! |
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Retrovirus which infects ***CHICKENS***
Contains Proto-Oncogenes and causes a Rapid Onset of DIRECT Cellular Transformation (Over-Production of Growth Stimulating ONCOGENIC Product) Important Oncovirus/Oncogene Research Tool |
Rous Sarcoma Virus aka Acute Transforming Virus (Complex)
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Prominent cough and Yellow Sputum production
Associated with Otitis, Sinusitis, Epiglottitis Frequently in Alcoholics, SMOKERS, COPD, Children Sputum Stain: GRAM NEGATIVE COCCOBACILLI Associated with Pleural Effusions and Rapidly Progressive Empyema (Pus in Pleural Cavity) Chocolate Agar: GROWTH Sheep Blood Agar: NO GROWTH |
Haemophilus influenza
Treatment: Cephalosporins (Beta-Lactamase provides Penicillin resistance) If Sputum were Gram Negative Cocci and everything else was similar, it would be Moraxella catarrhalis |
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Retrovirus which causes a SLOW (up to 30 years of latency) and INDIRECT Cell Transformation.
Produces ***TAX***, a Transcriptional Regulator --> promotes outgrowth of host cell Tropism for CD4 Cells and Neurons (associated with malignancy and neurological disease) Endemic to Japan, the Caribbean, and parts of Central America |
Humane T-Cell Leukemia Viruses (HTLV) aka NON-Acute Transforming Virus (Complex)
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Natural Habitat = Water
Inhalation of Aerosolized organisms from ACs or Water Sources SMOKERS, Diabetics, Immunosuppressed, Cancer Patients, those with Chronic Illness Productive Cough, Fever, GI Symptoms, Altered Mental Status Chest X Ray: Bilateral Interstitial Infiltrates Sputum Stain: WBC's BUT NO ORGANISMS Charcoal Yeast Extract Agar: GROWTH |
Legionella pneumophilia
Treatment: Erythromycin, Rifampin, Tetracyclines |
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Symptoms manifest 2-6 weeks post infection and last 1-2 weeks, including:
Fever, NIGHT SWEATS, Myalgia/Arthralgia, Headache, Diarrhea, Pharyngitis, Lymphadenopathy, Rash |
Acute Phase/Seroconversion of an HIV Infection
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Typically in younger adult population (less than 30 years old)
Cough, Fever, Sore Throat Systemic Signs are frequent, including Lymphadenopathy, Muscle Aches, Chills and ***BULLOUS MYRINGITIS*** = Bleb on Tympanic Membrane producing EARACHE Chest X Ray: Bronchopneumonia Sputum Stain: MIXED BACTERIA |
Mycoplasma pneumoniae
Treatment: Empiric-Tetracyclines or Macrolides |
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Screening/Confirmation of HIV Infection
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Screening = ELISA (detects Ab in Blood, can give false positives as it does NOT detect recent infection)
Confirmation: Western Blot (detects Ab in Serum) |
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Definition of AIDS
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CD4 <200 OR 14%
Indicator Diseases: 1) PULMONARY TB 2) INVASIVE CERVICAL CANCER 3) RECURRENT PNEUMONIA ADDED Viral Load is NOT part of definition!!! |
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Pneumonia associated with Septic Pulmonary Emboli in INJECTION DRUG USERS
Sputum Stain: GRAM POSITIVE COCCI IN CLUSTERS Bacteremia may result in SKIN LESIONS Chest X Ray: Cavitation, Pleural Effusions, MULTIPLE NODULES (Hematogenous) |
Staphylococcus aureus
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Recurrence of Poliomyelitis symptoms after approximately 30 years of good health.
Fatigue, muscle weakness, muscle pain, respiratory problems, swallowing problems, gait disturbance, ***FLAT-BACK SYNDROME*** (unable to stand erect due to lower back and leg pain) and sleep apnea. Rarely life threatening but decreases quality of life. NOT infectious. |
Post Polio Syndrome
In initial poliomyelitis, growth of affected leg is often affected. Years (approx 30) of compensation "Wears Out" surviving Motor Neurons (which have been innervating WAY MORE muscle cells than normal) |
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Pneumonia associated with Oral Colonization in setting of Chronic Illnesses
Frequently in Alcoholics, Diabetics, Debilitated Nursing Home Patients, Cystic Fibrosis Chest X Ray: Cavitation, Pleural Effusions |
Enteric Gram Negative (Enterobacteriaceae) Pneumonias!
Alcoholics = Klebsiella Cystic Fibrosis = Pseudomonas |
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Sudden onset of mild or high fever, FRONTAL HEADACHE, back pain, myalgias, anorexia, sometimes rash.
Can be Neuroinvasive: Meningitis and/or Encephalitis - 1/150 have Focal Necrotic Neurons and Inflammatory Changes. Can cause Flaccid Paralysis, Seizures, and Optic Neuritis. Member of Japanese Encephalitis serogroup. Reservoirs: Wild Birds Vectors: Culex Mosquitoes Dead End Hosts: Humans and Horses Risk Factors: Older than 50, hypertension, immunosuppression. |
Flavivirus WEST NILE VIRUS (WNV)
Dx via Serology Detection of IgM Antibodies: AT LEAST 4-FOLD OR HIGHER! |
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Mild Systemic Disease
Fever Malaise, Muscle and Joints Pain, RETRO-ORBITAL PAIN, Nausea and Vomiting, Rash on Elbows, Knees and Chest that spreads to extremities. "Scarlatiniform Rash" Vector: Aedes Mosquito |
Flavivirus causing CLASSIC DENGUE
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Distinguishing Plasmodium Species:
1) P. falciparum 2) P. vivax 3) P. ovale 4) P. malariae |
1) P. falciparum: 24 Hr Periodicity
2) P. vivax: 48 Hr Periodicity 3) P. ovale: Not Regular Periodicity (sometimes 48 Hr) 4) P. malariae: 72 Hr Periodicity. P. falciparum is Most Severe, has Neurological Symptoms, and has CRESCENT SHAPED GAMETOCYTES P. vivax and P. ovale Infect YOUNG RBCs, RBCs are Enlarged, have Schuffner's Dots, "HYPNOZOITE LIVER STAGES" P. malariae Infects OLD RBC's |
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Fever, headache, myalgias and photophobia
Liver - jaundice (yellow skin), coagulation defects Kidney - proteinuria Hemorrhage of stomach mucosa (***BLACK VOMIT***) Mortality 50%; no sequelae in survivors Vector: Aedes Mosquito Reservoir: Monkeys Endemic in Africa and South America 2 Transmission Cycles: Urban and Jungle |
Flavivirus causing YELLOW FEVER
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***SUBACUTE CHORIOMENINGITIS*** --> CSF shows many lymphocytes
Incubation period: 10-14 days Non-specific illness with fever, headache, myalgias, vomiting, stiff neck, changes in mental status Illness may persist for 3 months Diagnosis suggested by contact history Reservoir= House Mice, Mus musculus ***SANDY*** Appearance due to Host Cell Ribosomes being seen inside the outer membrane. |
Arenaviridae causing LYMPHOCYTIC CHORIOMENINGITIS (LCM)
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HIV-1 Structural or Enzymatic Genes:
1) gag: 2) pol: 3) env: 4) tat: |
HIV-1 Structural or Enzymatic Genes:
1) gag: -Capsid Protein (p24) -Matrix Protein -Nucleic Acid Binding Protein 2) pol: -Reverse Transcriptase (RT) -Integrase -Protease 3) env: -Surface Glycoprotein (gp120) -Transmembrane Glycoprotein (gp41) 4) tat: -Transactivator of Transcription (similar to Tax in HTLV-1) |
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***BULLET SHAPED***
Raccoons (Eastern States), Bats, Skunks (Central and Western States), Foxes (Central and SW States), Coyotes (Texas and SW) CNS involvement causing furious symptoms including hyperactivity, bizarre behavior, anxiety, depression, hallucinations interspersed with periods of calm and lucidity. Can also be paralytic with hydrophobia, pharyngeal spasms, nuchal rigidity, paresis, paralysis Can lead to Coma after hypotension, hypoventilation, secondary infections, cardiac arrest. ***NEGRI BODIES*** found in Neurons |
Rabies infection caused by Rhabdovirus
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"Hypnozoite" Liver Stages
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Plasmodium vivax and ovale
Dormant Stages, UNRESPONSIVE to most drugs Solution: Give them PRIMAQUINE in combination with the primary antimalarial! |
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Infects Mammals including Horses, Sheep and Humans. Recently found in Birds/Parrots.
Primarily in Central Europe, but also in North America and Asia Human infections associated with outbreaks in HORSES In animals, subtle loss of learning and memory, fatal immune-mediated meningoencephalitis. Resembles human neuropsychiatric disorders such as: depression, bipolar disorder, schizophrenia, autism. In humans with SCHIZOPHRENIA, AUTISM, or other Neuropsychiatric Diseases: prescence of Viral Abs and/or infected PMNs |
Bornavirus Infection
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Clinical presentation similar to CJD. Difference is the age of onset:
Onset from 20s-40s (CJD onset is usually older than 60s) Duration is around 7 years (4 months for CJD) Autosomal DOMINANT Inheritance with HIGH Penetrance |
Gerstmann-Strausler-Scheinker (GSS) Syndrome
1 of 2 Inherited Prion Diseases |
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Progressive ***INSOMNIA***, ***AUTONOMIC*** dysfunction and dementia.
Neuronal degeneration limited to selected ***THALAMIC NUCLEI***. Average Duration = 13 Months Autosomal DOMINANT Inheritance with HIGH Penetrance |
Fatal Familial Insomnia (FFI)
1 of 2 Inherited Prion Diseases |
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LATEX AGGLUTINATION as a Diagnostic Test for Diarrhea Virus:
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Rotavirus!
Rapid Test |
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Which STDs have Culture and Nucleic Amplification Assays (NAATs) as Diagnostic Tests?
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Chlamydia and Gonorrhea
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Disinfectants which are TOXIC to Humans:
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1) Chlorine
2) Hexachlorophene 3) Chlorhexidine (less toxic than Hexa) 4) Glutaraldehyde |
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What does Sterilization NOT kill?
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Prions!
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Low Dose vs Intermediate Dose vs High Dose GI Infections
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Low Dose:
1) Shigella 2) EHEC 3) Giardia and Cryptosporidium parvum 4) Norwalk Virus Intermediate: 1) Salmonella 2) Campylobacter High Dose: 1) Vibrio cholerae 2) ETEC |
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Category A Agents (6)
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1)*** Bacillus anthracis (Anthrax)
2) *** Clostridium botulinum (Botulism) 3)*** Francisella tularensis (Tularemia) 4) Yersinia pestis (Plague - pneumonic) --> Droplet Spread 5) Variola Major (Smallpox) --> Airborne + Contact Spread 6) Viral Hemorrhagic Fever (Ebola, Marburg) --> Droplet + Contact Spread *** = NO Person-to-Person Spread! |
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Causes of CHRONIC Gastroenteritis (> 2 Weeks)
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Parasitic:
1) Giardia 2) Cryptosporidium 3) Cyclospora Disaccharide Deficiency EAEC Occasionally: Shigella Salmonella Campylobacter Yersinia |
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Plasmodium Life Cycle:
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Sporozoites Injected by Mosquito --> Invade Hepatocytes of Liver --> Asexual Production there produces Merozoites which are then released into Blood Stream--> Merozoites invade Erythrocytes and undergo a Trophic Period to become a Ring form Trophozoite--> Enlarges to become a Schizont --> Merozoites then bud off of the Schizont and are released following Rupture of the Erythrocyte
Some Merozoites differentiate into Gametocytes which are sexually competent. These are taken up into Mosquitos and reproduce in the foregut, resulting in a zygote. Meiosis then occurs, reforming Sporozoites. |
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Pigment Producing Bacteria:
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1) Staphylococcus aureus - YELLOW
2) Psuedomonas aeruginosa - BLUE-GREEN 3) Serratia marcescens - RED |
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Urease Positive Bugs
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Particular Kinds Have Urease
P = Proteus K = Klebsiella H = Helicobacter pylori U = Ureaplasma |
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E coli Toxins
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Heat-Labile --> Stimulates ADENYLATE Cyclase
Heat-Stable --> Stimulates GUANYLATE Cyclase |
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cAMP Inducers
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PEVB
Pertussis Toxin E. coli Vibrio cholerae Bacillus anthracis PEV = ADP Ribosylation --> Activate Adenylate Cyclase --> Increases cAMP B = Edema Factor is ITSELF an Adenylate Cyclase! |
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Toxins encoded by Lysogenic PHAGE
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ABCDE
A = shigA-like toxin B = Botulinum toxin C = Cholera toxin D = Diphtheria toxin E = Erythrogenic toxin (strep pyogenes) |
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Bacteria with Capsules
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Some Nasties Have Kapsules
S = Streptococcus pneumoniae N = Neisseria meningitidis H = Haemophilus influenza (Especially B) K = Klebsiella pneumoniae |
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Only Bacterium with a Protein Capsule (D-Glutamate)
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Bacillus anthracis
Gram Pos Spore Forming Rod! |
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Only Gram-Positive Bacteria with Endotoxin
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Listeria monocytogenes
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