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154 Cards in this Set

  • Front
  • Back
Which bacteria gram stain poorly? (What othe stains could you use?)
"These Rascals May Microscopicallly Lack Color"
1. Treponema - Dark Field Microscopy, Ab staining
2. Rickettsia (intracellular)
3.Mycobacteria (mycolic acid w high lipid content) - Acid Fast Stain
4. Mycoplasma (no cell wall)
5. Legionella (intracellular) - Silver stain
6. Chlamydia (intracellular), no muramic acid)
Bacteria with unusual cell walls?
Mycoplasma - sterols, no cell wall
Mycobacteria - mycolic acid, high lipid content
Virulence Factors to evade host immune response:
1. What bug?
2. Virulence Factor?
3. Mechanism?
S. Aureus
- protein A
- binds Fc portion of IgG

N. Meningitis, S. Pnuemo, H. Influenza
1. Capsule - inhibits phagocytoses
2. IgA protease - cleaves IgA

Group A strep (pyogenese)
- M protein (70 serotypes)
- inhibits phagocytosis
Name all bugs with Exotoxins. (11)
Staph. Aureus
Group A Strep (pyogenes)
Corynebacterium Diptheriae
Vibrio Cholera
E. Coli
Bordatella Perutssis
Clostridia Perfrinces (not dificile)
C. Tetani
C. Botulinum
Bacillus Antrhacis
Shigella
Exotoxins:
Staph Aureus
(name exotoxins, mechaninsm and disease)
TSST-1 - Superantigen: binds MHC II and T-cell receptor releasing massive quantities of TNF and IL-2. Leads to rash, fever, shock
Enterotoxin - food poisoning
Exfoliatin - Scalded skin syndrome
Exotoxins:
Group A Strep (pyogenese)
(name toxin, mech, and disease)
Scarlet fever-erythrogenic toxin (Superantigen): causes toxic syndrome like syndrome.

Steptolysin O: Hemolysin, antigen for ASO ab, marker for dx in rheumatic fever
Exotoxins:
Corynebacterium Diptheria
AB toxin: B - Binds cell, A - Active toxin, ADP-ribosylates cell protein
Inactivates EF-2 (elongation factor) in throat. Leads to pharyngitis and pseudomembrane
Exotoxins
Vibrio Cholera
AB toxin: ADP-ribosylates G protein --> inc adenylate cyclase (like heat labile toxin) --> inc Cl secretion and dec Na absorption. Water follows and leads to "rice water stool"
Exotoxins:
E. Coli
AB toxin:
Heat labile --> inc AC --> inc cAMP --> Cl secretion and diarrhea
Heat stabile --> inc GC --> cGMP --> Cl secretion and diarrhea
Exotoxins:
Bordatella Pertussis
Pertussis toxin (AB toxin): inhibits G-α --> inc cAMP --> whooping cough
inhibitis chemokine receptor --> inh macrophage and PMN phagocytosis
Exotoxins
Clostridium Perfringes
lecinithinase (α toxin) - causes gas gangrene, double zone of hemolysis on blood agar (McConkey)
Exotoxins
Clostridium Tetani
Tetanus toxin (tetanospasmin) : binds neurons and inhibits release of GABA and glycine (lock jaw)
Exotoxins
Clostridium Botulinum
Botulinum toxin: Inhibits ACh release from motor neurons at NMJ (flaccid paralyis, canned fruit spores, honey --> floppy babies)
Exotoxin
Bacillus Anthracis
Antrax Toxin - 3 parts:
1. EF - edema factor - AC --> inc cAMP --> impaired PMN function and edema
2. LF - lethal factor
3. PA - protective antigen
Exotoxin
Shigella
Shiga Toxin: cleaves host cell rRNA in ribosomes --> inh protein synth, inc cytokine release, (causes HUS in EHEC E. Coli O157:H7)

*Epithelial cells killed and shed leading to bloody diarrhea
Pigment producing bacteria on colonies?
Staph Aureus - golden yellow
Pseudomonas - blue-green
Serratia Marcescens - red pigment (think red maraschino cherries
Culture Requirements: Name which bugs (and fungus) require special cultures and what those are. (8)
H. Influenza - Chocolate Agar with factor V (NAD) and X (hematin)
N. Gonorrhea - Thayer Martin median (VCN)
B. Pertussis - Bordet-Gengou (potato) agar
C. diptheriaea - Tellurite plate, Loffler's media
M. Tuberculosis - Lowenstein-Jensen agar
Lactose-fermenting enterics - pink colonies on McConkey
Legionella - Charcoal yeast extract agar buffered with in iron and cysteine
Fungi - Sabouraud's agar
Special Stains: Name the stain and its use
Congo Red - Dx amyloid - apple green birefringence in polarized light (β-pleated sheets)
Giemsa - Borrelia, Plasmodium, trypanosomes, Chlamydia
PAS - stains glycogen, mucopolysaccharides (capsules), dx Whipples disease
Ziehl-Neelsen - acid fast bacteria
India ink - cryptococcus neoformans (stains capsule)
Silver stain - Fungi, legionella
Bacterial Genetics:
Explain Transformation
DNA (any) taken up directly from environment - prokaryotes or eukaryotes
Bacterial Genetics:
Explain Conjugation
2 types:
1) F+ x F- :F+ plasmid contains genes required for conjugation - plasmid replicated and transferred to F- cell via pilus. ONLY Plasmid DNA, NO Chromosomal DNA

Hfr x F-: Plasmid incorporates into bacterial DNA. Plasmid replication may include transfer of some Chromosomal DNA and transfer to F- cell.
Bacterial Genetics:
Explain Transduction
Phage
Lytic phage infects host cell, replicates DNA, cleaves host DNA, may incorporate host DNA into capsid and phage then goes on to infect other cells

Specialized: Lysogenic phage inserts genome into host cell. When it becomes lytic and brings some of host cell DNA with it as it is excised. Packaged in capsid and then infects other cells.
Bacterial Genetics:
Transposition
"Jumping" DNA that can move from one location to another within chromosome. When jumping may incorporate nearby genes. Therefore can transfer genes from Chr to plasmid or plasmid to chr. Plasmid can then infect another bacteria.
Lysogeny:
Which bacterial toxins are encoded by a bacteriophage (ie - presence of bacteriophage determines virulence)?
ABCDE
ShigA-like Toxin
Botulinum toxin
Cholera toxin
Diptheria toxin
Erythrogenic toxin of Strep A (pyogenes) - scarlet fever
Obligate Aerobes
"Nagging Pests Must Breathe"
1. Nocardia
2. Psuedomonas - burns, nosocomial pnuemonias (respirators) and CF
3. Mycobacterium TB - apices of lungs
4. Bacillus

*use O2 system to generate ATP
Obligate Anaerobes
Anaerobes know ABCs
1. Actinomyces
2. Bacteroides
3. Clostridium (Difficile, Tetanus, Botulinum, Perfringes)

*Lack SOD and Catalase
*Generally foul smelling (LCFAs), difficult to culture, produce gas in tissue (CO2, H2)
*Normal Flora of GI, pathogenic elsewhere
*AminO2glycosides are ineffective b/c require O2 to be activated
Intracellular Bugs:
Obligate?
"stay inside when its Really Cold"
1. Rickettsia
2. Chlamydia
*require host machinery to produce ATP
Intracellular Bugs:
Facultative
"Some Nasty Bugs May Live FacultativeLY"
1. Salmonella
2. Neisseria
3. Brucella
4. Mycobacterium
5. Listeria
6. Francisella
7. Legionella
8. Yersinia
Encapsulated Bacteria?
Quellung Rxn: Capsule swells when specific anticapsular antisera added

1. H. Influenza
2. N. Meningitis
3. Strep Pneumo
4. Klepsiella Pneumonia

*Capsule is anti-phagocytic
*Capsule is antigen in vaccines (Pneumovax, Hib, N. Meningitis vaccine)
*Vaccines conjugated with protein inc T-cell dependent response and immunogenicity
Spores - Bacterial
Gram (+) Rods
1. Clostridium - Tetani, Botulinum, Perfringes
2. Bacillus - Anthraxis, Cereus

*spores formed at end of stationary phase when nutrients are limited. No metabolic activity, resistant to heat and chemical destruction, dipocolinic acid. Must autoclave to kill (surg equipment)
*Botulism - spores in chili pepper germinate and produce toxin. Cooking kills toxin, not spores. Acid of stomach kills spores so they can't germinate. Everyone safe except grandma who tested a pepper before cooking and ingested uncooked toxin.
Urease Positive
1. H. Pylori
2. Proteus
3. Kleibsiella
4. Ureaplasma
α-Hemolytic
-What does it look like?
-What organisms?
Green ring on blood agar
1. Strep Pneumo
-Optochin S
-Bile R
-Capsule

2. Strep Viridans
-Optochin R
-Bile S
-no capsule
β-Hemolytic
-What does it look like?
-What organisms?
Clearing around colonies on blood agar
1. Staph Aureus
- catalase pos, coag pos
2. Group A Strep (pyogenes)
- catalase neg, bacitracin sensitive
3. Group B Strep (agalactiae)
- catalase neg, bacitracin res
4. Listeria
-tumbling motility, meningitis in newborns, unpasteurized milk
γ-Hemolytic
No hemolysis on blood agar.

Organisms = essentially everything, but if its a gram (+) coccus in strains then probably Enteroccocus (group D strep)
Staph Aureus
1. Main Virulence Factor?
2. Diseases (inflammatory, toxin, resistance)
Protein A - binds Fc of IgG

Dz
1. Inflammatory
-SKIN = cellulitis, impetigo, abcess/furuncles
-Organ abscesses = osteomyelitis in children (#1 cause of osteomyelitis)
-Pnuemonia (nosocomial, post virus, immunosupressed, Alcoholoic/IV drugs)
-Acute Endocarditis (subacute = viridans)
2. Toxin Mediated
-TSST-1 = Toxic shock syndrome
-Exfoliatin = scalded skin
syndrome
-Enterotoxin = food poisoning (picnics)
3. MRSA - Tx = Vancomycin

*Think of Pus, Empyema, Abcess
Strep Pyogenes (GAS)
M Protein - adherence

Dz
1. Pyogenic
-pharyngitis (strep throat), cellulitis, impetigo, (no abscesses, necrotizing fascitis
2. Toxigenic
-Scarlet Fever, toxic shock syndrome
3. Immunologic
-Glomerulonephritis
-Rhuematic fever/heart dz

Strep thoat --> heart or kidney
Skin --> kidney (not heart)

"PHaryngitis gives you PHever, and glomerulonePHritis

*ASO titers detects recent infection
Strep Pyogenes - Rheumatic Fever symptoms?
"No rheum for SPECCulation"
1. Subcutaneous nodules
2. Polyarthritis
3. Erythema
4. Chorea
5. Carditis (rheumatic heart dz)
Strep Pneumonia
1. Dz (and prevalence)?
2. Associated with what conditions?
MOPS - Most OPtochin Sensitive

1. Meningitis - (#1 6mo-6yrs & 60 yr+, #3 6yr-60yr)
2. Otitis Media
3. Pneumonia (#4 4wk-18yr, #3 18-40, #1 40-60yr and 60yr+,
4. Sinusitis

*associated w/: rusty sputum, sepsis in sickle cell, and splenectomy
Group B Strep (agalactia)
"Group B = Babies, Bacitracin R, β hemolytic"
1. Pneumonia (#1 0-wks)
2. Meningitis (#1 0-6mo)
3. Sepsis
Enterococci (Group D strep)
1. Dzs?
2. Lancefield grouping? Difference b/n enterococci and strep?
E. Faecalis & E. Faecium
*Opportunistic - nL Flora of URT, GU, GI, skin

Dz
1. Subacute Endocarditis
2. Biliary tract infections
3. UTIs

*Lancefield grouping - C-carbohydrate on cell wall
*Enterococci 6.5% NaCL resistance (not GDS)
*Pen G resistant
*VRE - nosocomial infections
Staph Epidermidis
1. Dz?
2. Virulence factor
3. vs staph sapro?
Dz
1. Infects prosthetic devices - valves, joints, catheters

2. Virulence = creates biofilm
3. Novobiocin sensitive
* skin nL flora, common contaminant of blood cultures
Strep Viridans
1. Dz?
2. Culture: hemolysis? sensitivity?
1. SUBacute endocarditis (sanguis = blood -->heart) - major cause
2. Dental Carries (mutans)

*nL Flora of mouth - "not afraid OF-THE-CHIN = Optochin Resistant
*α-hemolytic
Clostridia
1. Gram
2. Types, toxin, Dz & Tx
3. Spore formers?
gram (+) rods, ANAEROBIC

1. Tetani - spore forming
-AB exotoxin - inh GABA and gly release -->tetanus (lock jaw)
-found in soil
Tx: anti-toxin for unbound toxin, penicillin and support
Vaccine - toxoid

2. Perfringes - spore forming
-α-toxin (lecinthase) - gas gangrene (myonecrosis) and hemolysis
Tx: Surg/Amputation, Hyperbaric chamber
(no vaccine)

3. Botulinum - spore forming
AB exotoxin (heat labile) - inh ACh release --> flaccid paralysis
-canned fruit/vegetables (toxin)
-honey (spores - germinate in infants nonacidic stomach)
Tx: Anti-toxin, support, hyperbaric chamber, penicillin
(no vaccine)

4. Dificile
-exotoxin kills GI epithelial cells --> pseudomembranous colitis (2nd to Ab use)
Tx - Metronadazole
Corynebacterium Diptheriae
1. Gram & Culture
2. Dz
3. ABCDEFG
4. Tx
Gram (+) Rod w/metachromatic granules- club shaped, Lysogeny - bacteriophage encodes toxin

"TELL YOUR InTErn not to LOAF around"
-Tellurite agar
-Loeffer's coagulated blood serum
Dz
1. Pharyngitis - Pseudomembrane (darker than strep throat) - colization
2. Myocarditis - toxin
3. Neuron -toxin
-peripheral n palsy
-Guillain Barre like
-Paltal paralysis and other cranial neuropathies

ABCDEFG
ADP-Ribosylation (AB toxin)
Beta-prophage
Corynebacterium
Diptheriae
Elongation Factor-2
Granules

Tx: Antitoxin, Pen, Vaccine (toxoid)
Bacillus Antrhacis
1. Gram
2. Epidemiology
3. Dz
4. Tx
Gram (+) rod, spore forming
Protein capsule (D-glu) - antiphagocytic

Woolsorter's Dz - inhale spores from contaminated wool

Dz
1. Contact --> malignant pustule (painless ulcer), progress to bactermia and death
-Black skin lesions -vesicular papules covered by black eschar
2. Inhalation of spores --> flulike --> fever, pulm hemorrhage, mediastinitis, shock

Tx: Cirpo, doxy
Listeria Monocytogenes
1. Gram/characteristics
2. Dz
3. Tx
Gram (+) rod, intracellular
*Unpasteurized milk, cheese
*Listeriolyis O and Phospholipases allow exit from phagolysosome, enter epithelial cells, move cell-cell via "actin-rockets"
*tumbling motility

Dz
1. Neonatal Meningitis (#3)
2. Meningits in immunosuppressed
3. Septicemia in pregnant (amnionitis, abortion, granulomatosis infantiseptica)

Tx: Amp, Bactrim
Actinomyces vs Nocardia
1. Same
2. Differences
3. Tx
Both: Gram (+) rods, long branching filaments resembling fungi

Actinomyces Israeli
anaerobe, nl Flora mouth/GI, cause oral/facial abcess, pus drains through sinus tract in skin
*Sulfur granules
Tx: Pen, drain abscess

Nocardia Asteroides -aerobe
*wealy acid fast (confused for TB), soil - not nL flora, inhaled --> pneumonia, pulmonary abscess (in immunocompromised
Tx: Bactrim
Neisseria
1. Both: gram, glucose met, virulence factor, Cx
2. Compare: Capsule, maltose ferment, vaccine, transmission, Dz
3. Tx
Gram (-) cocci, glucose fermenters, IgA protease
Cx: Chocolate Agar, Thayer Martin Agar VCN (Vanc, Colistin, Nystatin)

Gonococci
-no capsule
-no maltose fermentation
-no vaccine
-sexually transmitted
Dz: Gonorrhea --> PID, septic arthritis, neonatal conjunctivitis

Meningococci
-polysaccharide capsule
-maltose fermenter
-vaccine (capsule - not B)
-resp/oral secretions
Dz: Meningitis, meningococcemia, waterhouse-Friderichsen syndrome (adrenal gland hemorrhage, hypotension, petechial rash)

Tx: 3rd gen cephalosporin
Rifampin prophylaxis for contacts
Haemophilus Influenzae
1.Gram, Cx, characteristics
2. Dz
3. Tx
Gram (-) coccobacillus,
Cx: Chocolate agar with factors V (NAD) and X (Hematin)
Aerosol Transmission, mainly type B (vaccine to capsule B - conjugated to Diptheria toxoid)

Dz - haEMOPhilus
1. Epiglottitis
2. Meningitis (#3 6mo-6yrs)
3. Otitis Media
4 Pneumonia

Tx: Ceftriaxone
Rifampin prophylaxis for meningitis contacts
Enterobacteriaceae (Family)
1. Species
2. Common Virulence Factors
Species
1. Salmonella
2. Shigella
3. Enterobacter
4. E. Coli
5. Kleibsiella
6. Proteus
7. Serratia

Virulence - think COFFEe
Capsule - K antigen
Oligosacharide - O (LOS)
Flagella - H antigen
Ferment Glucose
Enterobacteriaceae
*all oxidase negative
Klebsiella
1. Dz & epidemiology
2. Characteristic of sputum
3. 3As
Dz
Pneumonia - alcoholics and diabetics

*Red Currant Jelly Sputum

3As -
Aspiration Pneumonia
Abscess in lungs
Alcoholics
Lactose Fermenting Enteric Bacteria
Lactose is KEE, McConKEE (pink colonies)
1. Kleibsiella
2. E. Coli
3. Enterobacter
4. (Citrobacter)
Salmonella vs Shigella
1. Both
2. Salmonella
3. Shigella
4. Tx
Both non-lactose fermenting, invade epithelial cells, bloody diarrhea

SALMONella
4Fs: Feces, Food, Fingers, Flies
-flagella (can swim), disseminate hematogenously
-H2S
1. Gastroenteritis
2. Chronic Carrier (gall bladder)
3. Sepsis
4. Osteomyelitis in sickle cell
5. Typhoid Fever - fever, abdmL pain, hepatosplenomegaly, rose spots on abdomen

Tx: Cipro or ceftriaxone
-for diarrhea can prolongue course and make a chronic carrier

Shigella
1. Bloody diarrhea with mucus and pus
*no flagella but intracellular propulsion using actin polymerization
*more virulent 10 org (vs 10^5 for salmonella)
Tx: Fluoroquinolones
Yersinia Enterocolitica
1. Transmission
2. Dz & Dzs mimmicked
3. Tx
Transmission: Puppy feces, pork, milk, day-care centers

Dz
1. Acute enterocolitis w fever, diarrhea and abdmL pain (mimmick chron's or appendicitis)

Tx: no Ab other than for septicemia
Food Poisoning (Bacterial)
7 bugs and associated food?
1. S. Aureus - mayonaise, meats, custard (picnic)
2. C. Perfringes - reheated meat
3. C. Botulinum - self canning
4. Vibrio parahemolyticus & Vulnificus - shellfish (also can cause wound contamination)
5. Bacillus cereus - reheated rice
6. E. Coli 0157:H7 - undercooked meat
7. Salmonella - poultry, meat, eggs

*S Aureus and B cereus start quickly and end quickly
Bloody Diarrhea
1. Organism
2. How to recognize
3. Tx
All bacteria gram (-) rods
1. Campylobacter (most common cause of gastroenteritis)
-S-shaped (gull-winged), Campy plate (abiotics) at 42° C, oxidase pos
Tx: Fluoroquinolone (cipro)

2. Salmonella
-non-lactose fermenting, oxidase neg
-flagellar motility
Tx: none

3. Shigella - w/ mucus & pus
- lactose neg, ox neg
-no flagella
-low ID50
-shiga toxin (phage encoded)
Tx:Fluoroquinolones (cipro)

4. EHEC (Enterohemorrhagic E. Coli) - w/out fever and pus
- lactose pos,
- Shiga-like toxin --> Hemorrhagic colitis, HUS (O157:H7)
Tx: Cephalosporins (cipro)

5. EIEC (Enteroinvasive E. Coli) - w/ mucous, pus & fever
-lac pos
-ivades mucosa
Tx: Cephalosporins (cipro)

6. Yersinia Enterocolitica - w/ fever & abdmL pain
-lac neg
-day care outbreaks,
-pseudoappendicitis
Tx: none

7. C. Difficile (gram + coccobacillus), anaerobe, flagella
- can cause bloody or watery diarrhea
-pseudomembranous colitis
Tx: Metronidazole

8. Entamoeba Histolytica - Protozoan
Watery Diarrhea
1. Organism
2. How to recognize
3. Tx
1. ETEC - (Enterotoxigenic E. Coli)
-lac +
-LT -->cAMP (same as Cholera)
-ST -->cGMP
Tx: (none), cipro

2. Vibrio Cholera (rice water stools)
-Comma shaped, single flagella
-lac neg, ox?
Tx: ORS, (doxy, fluoroquinolones)

3. C. Perfringens
-gram + coccobacillus, anaerobe, non-motile, spore forming
-also causes gas gangrene
Tx: (penicillin?)

4. Protozoa - Giardia (streams), Cryptosporidium (immunocompromised)
Tx: Metronidazole
Amphotericin B/ Flucytosine

5. Viral (infants & children)
-Gastroenteritis (vomitting & diarrhea), fever, abdmL pain
-Rotavirus (most common, major cause of infant death)
-Norwalk (noro) virus -cruise ships
-Adenovirus
Tx: ORS
cAMP inducers
1. organism
2. mech of action
1. V. Cholera --> Gs --> ADP-Ribosylaton of AC --> inc cAMP--> NaCl secretion (rice water stools)
"turns the on, ON"

2. ETEC - Heat Labile toxin (same mech as cholera)
Heat Stablie = cGMP

3. D. Pertussis --l Gi --> whooping coucgh
"turns the off, OFF"
-also promotes lymphocytosis by inhibiting chemokine receptors
4. Bacillus Anthracis - EF = AC --> inc cAMP --> massive edema

*1-3 ADP ribosylate, 4 is an AC itself
Legionella Pneumophila
1. Dz
2. Stain, Cx
3. Transmission
4. Tx
Dz
1. Legionaire's Dz (severe pneumonia)
2. Pontiac Fever (mild influenza)

Silver stain (gram - rod, but stians poorly)
Cx - Charcoal yeast extract w/ iron and cysteine

Transmission: Aerosol from water source, not human-human, (ventilators, AC, etc)

Tx: Erythromycin

"think of french Legionnaire, with Silver helmet, sitting around Charcoal fire with Iron dagger = no Sissy (Cysteine)"
Pseudomonas Aeruginosa
1. Dz
2. Association
3. Characteristics
4. Tx
PSEUDOmonas
Pneumonia (exp in CF)
Sepsis (black lesions on skin)
External otitis (swimmer's ear)
UTI
Drug use and Diabetic Osteomyelitis
+ hot tub folliculitis

Associated w/ burns, hot tubs/swimming pools, and hospitals

Gram (-) rod, non-lactose ferment, ox pos, obligate aerobe, blue-green colonies (pyocyanin), grape-like scent

Endotoxin: fever, shock
Exotoxin A: --l EF2 (same mech as diptheria)

Tx: Aminoglycoside (gentamycin) + ticarciliin or piperacillin
Helicobacter Pylori
1. Dz (& risk factors)
2. Characteristics
3. Tx
Dz
1. Gastritis
2. 90% of Duodenal ulcers
3. Risk Factor: Gastric ulcer, gastric adenocarcinoma, lymphoma

Gram (-) rod (gull-wing), many flagella Urease pos --> alkaline env't (neut acid),

Tx: Triple Tx -
1. bismuth, metronidazole, tetracycline or ampicillin
3. Metronidazole, PPI (omeprezole), clarithromycin
Zoonotic Infections
1. organism
2. dz
3. transmission/reservoir
"Big Bad Bugs From Your Pet"
1. Bartonella Henselae
Catch scratch fever
Cat scratch

2. Borrelia Burgdorferi
Lyme Dz
Tick bite (ixodes) live on deer and white footed mice

3. Brucella spp.
Brucellosis
Undulent Fever
Unpasturized dairy products, animal contact

4. Francisella Tularensi
Tularemia
Rabbits, tick bite, deer

5. Yersinia Pestis
Plague
Flea bit, rodent- rats, prarie dogs

6. Pasteurella Multocida
Cellulitis
Cat or dog bite
Gardnerella Vaginalis
1. Dz
2. Characteristics
3. transmission
4. Tx
Vaginitis - white gray vaginal discharge w fishy smell, non-painful

Pleomorphic - gram variable rod, Clue cells - vaginal epithelial cells covered w/ bacteria
-associated w/ Mobiluncus (anaerobe)

Transmission: sexual

Tx: Metronidazole
Mycobacterium
1. Stain & Characteristics
2. Dz
3. S&S
4. Tx
Dx: AFS, catalase pos, facultative intracellular (mØs), non-motile, no capsule, no pili

1. Tuberculosis
S&S - fever, night sweats, weight loss and hemoptysis
Tx: Rif & INH - 6 mo, Pyrazinamide & ethambutol 2 mo
if Res: add streptomycin

2. Mycobacterium Avium Complex
S&S - pnuemonia & disseminated dz in immunocompromised
Tx: Amoxacillin, rifampin, ethambutol, streptomycin

3. Leprosy
S&S- hypopigmented region that is anesthisized
Tx: Dapsone, rifampin, clofazimine

4. M. Kansasii - pulm TB like symp
5. M. scrofulaceum - cervical lymphadenitis in kinds
Mycobacteria Leprae
1. Dz
2. S&S
3. Dx
4. Reservoir
5. Tx
Dz
1. Tuberculoid -TB like
-cell mediated immunity
1 or 2 unilateral skin lesions

2. Lepromatous - severe-lethal
- no cell mediated immunity
S&S- bilateral skin (hypopig, lumps, bumps, leonine faces, saddle nose), nerves (peripheral neuropathy), eyes (blindness), testes (infertitlity)

Dx: Clinical
-Skin or nerve biopys of AF Bacilli or Granuloma (tb-like)
-Cannot be grown on lab media

Reservoir: Armadillos

Tx: Dapsone (hemolysis and methemoglobinemia)
+ rifampin and/or clofazimine
Rickettsia (general)
1. Characteristics
2. Transmission
3. Tx
Obligate intracellular, require host CoA and NAD

Transmission: arthropod (except coxiella)

Tx: Tetracycline (Doxy!)
S&S: Triad: HA, fever, petechial rash (vasculitis)
Rickettsia (specific)
1. Match Dz w/ bug
2. w/ vector
3. w/ rash
1. Rocky Mountain spotted fever - rickettsia rickettsia
- tick
- extremities --> trunk

2. Endemic Typhi - R. Typhi
- fleas
- trunk --> extremities

3. Epidemic Typhus - R. Prowazekii
-lice
-trunk - extremities

4. Ehrlichiosis (Brill's Dz) - Erlichia
- tick
-no rash

5. Q Fever - Coxiella Burnetii
-inhaled (no vector)
-no rash

"Q is Queer b/c it has no rash, no vector, no Weil-felix, causative org can survive outside, not ricketsia"
-
1. Patient presents with rash on palms and soles what is your differential?

2. Patient also complains of fever, HA and was hiking on the east coast a few weeks ago. What is you Dx?

3. What confirmatory test would you do?
1. Rocky Mountain spotted fever, Syphilis, Coxsackie virus A (hand, foot, and mouth)

2. RMSF - Triad of fever, HA, rash that spreads from ext --> trunk. Org = R. ricketsia. Despite name it is endemic to east coast - ticks

3. Weil-Felix reaction: assay for Anti-Ricketsial Abs that cross react w/ proteus antigen
+ = RMSF & Typhus
- = Q Fever
Chlamydia
1. spp --> dz
2. Dx & characteristics
3. Tx
Dz
1. Chlamydia Trachomatis = urethritis, conjuctivitis, reactive arthitis (rider's dz) --> PID

Elementary Body (EB) = Enter via Endocytosis
Reticulate Body (RB) = Replicate by fission
- transmission: sexual

2. C. Pneumonia & C. Psittaci - atypical pneumonia from contact w birds
-transmitted via aerosol

Dx: Giemsa stain or Fluorescent Ab- cytoplasmic inclusion bodies (intracellular org)
-cell wall lacks muramic acid

Tx: erythromycin or tetracycline (Doxy! + Ceftriaxone for gonorrhea)
Chlamydial serotypes
1. match serotype with dz
ABC = African, Blindness (conjuntivitis), Chronic Infection

D-K: urethritis/PID, ectopic preg, neonatal pneumonia or conjunctivitis
Tx: neonate w/ oral erythromycin

L1-3 = Lymphogranuloma venereum (acute lymphadenitis - positive Frei test)
Spirochetes
Organisms and stain?
"BLT" "B is Big"
Borellia (big size)- Lyme Dz
-light microscopy w aniline dyes (wright or giemsa)
Leptospira
Treponema - Dark field microscopy
Leptospira Interrogans
1. Dz
2. Reservoir/Transmission
3. Dx
4. Tx
Dz
1. Leptospirosis - flu-like symp, fever, HA, abdmL pain, and jaundice
-Tropics

2. Weil's Dz (icterohemorrhagic leptospirosis) - severe form with jaundice, azotemia from liver & kidney dysfunction, fever, hemorrhage, anemia

Reservoir: water contaminated with animal urine

Dx: Culture blood or CSF (week 1), urine (wk 2-mos) on protein rich, aerobic media -Question mark spirochetes
Tx: Penicillin, Doxy
Patient presents with expanding "bulls-eye" rash and flu-like symptoms
1. Dx and organism
2. Reservoir/Transmission
3. Complications w/out Tx (stages?)
4. Tx
1. Lyme Dz - Borellia Burgdorferi
2. White footed mouse and white tailed deer transmit via ixodes tic
3. Stage 1: Erythema Chronicum Migrans, flu-like symp
Stage 2: Neurologic manifestations (CN7 - BELL's palsy, meningitis, peripheral neuopathy) Cardiac (heart block)
Stage 3: Monoarthritis (knee) or migratory polyarthritis

Tx:Doxy
Treponemal Dz
1. match spp w/ dz
1. Treponemes = syphilis
2. Pertenue = yaws (tropical infection, not STD)
-1° & 2° ulcerative skin lesions - condyloma like
-3° gummas of skin and bone
Tx: pen, plastic surgery
27 yo male presents w/ painless penile ulceration w/ a hard indurated edge
1. Dx and Bug
2. Dx and Bug had lesion been painful
3. Stages of Dz
4. Dx
5. Tx & Rxn
1. Syphilitic chancre - Treponema Pallidum

2. Chancroid lesion from H. Ducreyi

3. Stage 1: painles chancre

Stage 2: Disseminated Dz w/ constitutional symptoms, maculopapular rash (palms & soles, condyloma lata. 1° and 2° chancres are very contagious (lots of bugs)

Latent Stage:

Stage 3: Gummas, aortitis, neurosyphilis (tabes dorsalis -broad based ataxia, positive romberg, charcot joints, stroke w/out HTN), Argyll Roertson pupil (prostitute's pupil - accomodates, doesn't react)

Congenital: Saber shins, sadlle nose, CN VIII deafness, hutchinson teeth

4. Dx - Dark Field Microscopy
VDRL vs FTA
FTA-ABS -specific for treponemes, positive earliest, remains positive longest
"FTA-ABS = Find The Antibody - ABSolutely"

Tx: PenG or Doxy
Jarisch-Herxheimer rxn: acute worsening of symp
VDRL vs FTA
Dx the following
1. VDRL +, FTA +
2. VDRL +, FTA -
3. VDRL - , FTA +
4. What can cause VDRL false positives
1. Active syphilis infection
2. Probably false positive
3. Successfully treated

FTA-ABS - Find The Antibody - ABSolutely
-most specific
- + earliest
- + longest

4. VDRL = Viruses (mono, hepatitis), Drugs, Rheumatic fever, Lupus & Leprosy
- VDRL detects Abs that react w/ cardiolipin (non-specific test)
Mycoplasma Pneumonia
1. Dz
2. S&S
3. Dx
4. Epidemiology
5. Tx
1. Atypical "walking" pneumonia
2. insidious onset, HA, nonproductive cough, diffuse interstitial infiltrate - CXR looks worse than patient
3. No gram stain b/c no cell wall
-Hight tighter of cold agglutinins
-Cx - Eaton's agar

4. <30 yo, military recruits, prisons

5. Tx: tetracycline or erythromycin (no pens b/c no cell wall)
Dermatophytes
-name them
Candida, malassezia furfur, microsporum, trichophyton and epidermophyton
Candida Albicans
1. Dzs - what patients
2. Transmission
3. Dx
4. Tx
Dz: Systemic or superficial fungal infection
Thrush esophagitis (immunocomp)
Endocarditis (IV drug)
Vaginitis (post-Abiotic)
Diaper rash

Transmission: Inhalation of spores (no person-person)

Dx: budding yeast w/ pseudohyphae at 20°C, germ tube formation at 37° C

Tx: Nystastin for superficial, amphotericin B for systemic
Tinea
1. Dzs = fungus
2. Dx
3. Tx
1. Versicolor - Malassezia furfur
-hot humid weather
Dx: "spaghetti and meatball" appearance on KOH prep
Tx: topical miconazole, selenium sulfide

2. Tinea pedis, cruris, corporis, capitis - Microsporum, Trichophyton, Epermophyton
- pruritic resions in a ring w/ central clearing = ring worm

Reservoir: pets (microsporum)

Dx: Mold hyphae on KOH (not dimorphic)

Tx: Topical azoles
Systemic Mycoses
1. Fungus
2. Region
3. Dz
4. Dx
5. Tx
1. Histoplasmosis
Region: Mississipi & Ohio river valleys - bird (starling) and bat droppings
Dz: Pneumonia
Dx: yeast inside mØs ("histiocyte = MØ in skin")

2. Blastomycosis
Region: East of Miss & Central America
Dz: Inflammatory lung dz, disseminate to skin and bone, forms granulomatous nodules
Dx: Big, Broad Based Budding
Cold = mold
Heat = yeast
Cx - sabouraud's agar

3. Coccidiomycosis
Region: SW US, Cali, San Joaquin Valley or desert
Dz: "Valley fever", pneumonia, meningitis, disseminate to bone and skin
Dx: spherule filled w/ endospores

4. Paracoccidiomycoses
Region: Rural Latin Amer
Dz: Lung involvement --> disseminate
Dx: Captain's wheel (mickey mouse) budding yeastt

*all are dimorphic
cold = mold
heat = yeast (except coccidio)
*all can cause pneumonia --> disseminate
*mimmick TB

Tx: local: fluconazole or ketoconazole, systemic: amphotericn B
Opportunistic Fungal Infectons
1. Fungus
2. Dz
3. Dx
1. Candida Albicans
Dz:
Thrush in immunocompromised
Vulvovaginitis (high pH, diabetics, abiotics)
disseminated (any organ)
Chronic mucocutaneous
Dx: germ test tube - look like sperm, Cx: Pseduohyphae budding yeast

2. Aspergillus Fumigatus
Dz
Allergic bronchopulmonary aspergillosis
Lung cavity aspergilloma ("fungus ball")
- in immunocomp and CGD
Dx: Mold w/ septate hyphae that branc at 45° angle (V), fruiting bodies - conidophores

3. Cryptococcus Neoformans
Dz
Crypto meningitis
Cryptococcosis
Dx: Heavily encapsulated yeast = india ink, not dimorphic, found in soil & pigeon droppings.
Cx on sabouraud's agar. Latex agglutination test detects polysacch capusle "soap bubble" in brain
Narrow based unequal budding

4. Mucor and Rhizopus
Dz
Mucormycosis, infarction and necrosis of distal tissue (proliferate in vessels), prefers DKA patients, rhinocerebral frontal lobe abscess
Dx: Mold w. irregular nonseptate hyphae branching at wide angles (90°)
Pneumocystic Jiroveci (formerly carinii)
1. Dz
2. Transmission
3. Dx
4. Tx
Dz:
Asymp
Diffuse Interstitial Pneumonia (immunocomp)

Transmission: Inhaled yeast (thought to be protozoa - cw lacks ergosterol)

Dx: CXR - diffuse bilateral
Lung biopys or lavage - methenamine silver stain

Tx: Bactrim (lacks ergosterol in cell wall), pentamidine, dapsone
Prophylaxis - when CD4 < 200
Sporthrix Schenkii
1. Dz
2. Dx
3. Tx
Dz: Sporotrichosis - introduced via rose thorn --> local pustules or ulcer w/ nodules along draining lymphatics (ascending lymphangitis) = sporotrichoid spread
Little systemic illness

Dx: Clinical, cigar-shaped budding yeast in pus

Tx: Itraconazole, KI
DNA Viruses
1. Name them
2. dsDNA or ssDNA
3. Enveloped or naked
4. Linear or circular
5. Icosahedral or Helical
6. Replicate in nucleus or cytoplasm
HHAPPPPy
1. Herpes - envelope
2. Hepadnavirus - envelope
3. Adenovirus
4. Parvovirus - only, ssDNA
5. Papillovirus
6. Polyomavirus
7. Poxvirus - envelope

*all dsDNA except parvovirus "part of a virus"
*all naked except Herpes (acquires from nuclear membrane), Hepadnavirus, Poxvirus
*all linear except adenovirus (partial circular), polyomavirus and poxvirus
*all Icosahedral
*all replicate in nucleus except poxvirus (carries own DNA-dept RNA pol)
RNA Viruses
1. Name them
2. enveloped?
3. dsRNA or ssRNA
4. circular or linear
5. Icosahedral or Helical
6. Replicate in nucleus or cytoplasm
1. Picornavirus (enterovirus) - naked, icosahedral
2. Calicivirus - naked, icosahedral
3. Reovirus - naked, dsRNA, icosahedral
4. Flavivirus -icosahedral
5. Togovirus - icosahedral
6. Retrovirus - icosahedral
7. Coronavirus - helical
8. Orthomyxovirus - helical
9. Paramyxovirus - helical
10. Rhabdovirus - helical
11. Filovirus - helical
12. Arenavirus - circular, helical
13. Bunyavirus - circular, helical
14. Deltavirus - circular, helical

* all replicate in cytoplasm except retroviruses and influenza
RNA and DNA virus
- be able to replicate the table on p. 162-163 of first aid
-DO IT!
Viral Vaccines
1. Live attenuated
2. Killed
1. Live = humoral and cell mediated immunity
MMR - Measles, Mumps, Rubella
VZV, Polio (sabin), Yellow Fever, (small pox)

2. Killed = humoral only
Rabies, Influenza, Polio (salk), HAV
"RIP Always"
(-) strand RNA viruses
"Always Bring Polymerase Or Fail Replication Horribly"
Arenavirus
Bunyavirus
Paramyxovirus
Orthomyxovirus
Filovirus
Rhabdovirus
hepatitis Delta virus
Segmented Viruses
BOAR
Bunyavirus
Orthomyxovirus (Infuenza 8 segments - genetic shift --> worldwide pandemics)
Arenavirus
Reovirus
Herpesviruses
1. Virus
2. Dz
3. Transmission
4. Other characteristics
1. HSV1
Dz: Herpes Labialis, Gingivostomatitis, keratoconjunctivitis, temporal lobe encephalopathy
Transmission: respiratory secretions, saliva

2. HSV-2 - Herbes genitalis (genital warts), neonatal herpes
Transmission: sexual contact, perinatal

3. VZV
Dz: Chicken pox, shingles, encephalitis, pneumonia
Transmission: Respiratory secretions

4. EBV
Dz: Infectious Mononucleosis (heterophilic Abs), Burkitt's lymphoma

5. CMV
Dz: Congenital infection, mononucleosis (neg monospot - no heterophilic Abs), pneumonia
Dx: "Owl's eye" appearance of infected cells
Transmission: Congential, transfusion, sexual contact, saliva, urine, transplant

6. HHV-8
Dz: Kaposi's Sarcoma (HIV patients)
Transmission: sexual contact
HSV identification
"Tzanck heavens I do not have Herpes"
Tzanck test - a smear of an opened skin vesicle to detect multinucleated giant cells. Use to assay for HSV-1, 2, VZV.
Infected cells also have Cowdry A inclusions.
EBV
1. Dz
2. S&S
3. Epidemiology
4. Dx
5 Associated cancer
Dz: Mononucleosis - B cells
S&S: fever, hepatosplenomegaly, pharyngitis, lymphadenopathy (esp post auricular nodes)

Epidemiology: 15-20 yo (kissing dz)

Dx: (+) heterophilic Ab test (monospot test = agglutination of sheep RBCs)
Abnormal cytotoxic T cells (atypical lymphocytes)

Cancer: Hodgekin's and endemic Burkitt Lymphoma
Picornavirus
1. Name viruses
2. associated dz
"PERCH on a peak (pico)"
1. Poliovirus
2. Echovirus
3. Rhinovirus
-common cold > 100 serotypes
4. Coxsackievirus
- Aseptic Meningitis
5. HAV
Yellow Fever Virus
1. Dz
2. S&S
3. Reservoir
4. Transmission
5. Dx
Dz: Yellow Fever (flavivirus, flavie = yellow)
S&S: high fever, black vomitus, and jaundice
Reservoir: Human or Monkey
Transmission: mosquitos (arbovirus)
Dx: Councilman bodies (acidophilic inclusions) seen in liver --> jaundice
Rubella Virus
1. Viral family
2. Dz
3. Severity and transmission
Togavirus
Dz: German (3day) Measles
S&S: Fever, lymphadenopathy, arthralgias, fine truncal rash
-mild in children
-severe in neonate (mother prenatal screen)
-TORCH infection - crosses placenta
Rotavirus
1. Viral family (characteristics)
2. Dz
3. Mech
Reovirus (segmented dsRNA, naked)
DZ: Gastroenteritis - most important cause in infants in world
Mech: villous destruction --> dec absorption Na and H2O --> diarrhea and dehydration
Influenza Virus
1. Viral fam (characteristics)
2. Dz
3. Virulence factors
4. Drift vs Shift
5. Tx
6. Vaccine
1. Orthomyxovirus (segmented (-) ssRNA virus, enveloped)
2. Dz: Influenza --> fatal bacterial infection

3. Neuraminidase & Hemagluttinin
4. Drift = mutation (minor)
5. Shift = recombination (major, pandemic)
6. Tx: Amantadine and Rimantadine --l Hg, A only (high level of resistance, no longer used)

Zanamivir, Oseltamivir --l neuraminidase, useful for A and B

Killed vaccine - 2As and B
Paramyxovirus
1. Epidemiology
2. Dz
Children
1. Parainfluenza - croup
2. Mumps
3. Measles
4. RSV - bronchiolitis, pneumonia (#1 4wk-6yo)
Rubeola virus
1. Dz
2. S&S
Dz: Measels
S&S: 3Cs - Cough, Coryza, Conjunctivitis
Koplik spots (red spots w/ blue-white center on buccal mucosa) = Dx
-rash spreads head to toe

Rare - SSPE (subacute sclerosing panencephalitis - years later), Encephalitis, Giant cell pneumonia
Mumps virus
1. Viral fam
2. Dz
Paramyxovirus
S&S: Parotitis, Orchitis --> sterility, and aseptic Meningitis

"Mumps makes your parotid glands and testes as big as POM-poms"
Rabies Virus
1. Transmission, epidemiology, progression
2. Dz and S&S
3. Dx
Transmission: Bite of infected animal (bat, raccoon, skunk > dog in US) --> retrograde transport (dynein) to CNS = long incubation period

Dz/S&S: Fatal encephalitis, seizures, hydrophobia, hypersalivation (anterograde transport - kinesin), pharyngeal spasm

Dx: Negri bodies - cytoplasmic inclusions in neurons
Bullet shaped capsid
Arbovirus
"Fever Transmitted by Bites"
Flavivirus
1. Dengue (break bone fever)
2. WNV
3. Yellow fever
4. St. Louis Encephalitis

Togavirus
1/2. E & W Equine Encephalitis

Bunyavirus
1. California Encephalitis
2. Crimean-Congo hemorrhagic fever
"Lots of Spots" Viruses
Rubella - German (3day) measles
Rubeola - Paramyxovirus, measles
Varicella - Herpes virus, chicken pox, shingles
Vareola - Poxvirus, small pox
Vaccinia - Poxvirus, cow pox vaccine
Hepatitis Viruses
1. Name viral family for A-E
1. Hep A - Picornavirus
2. Hep B - Hepadnovirus (dna)
3. Hep C - Flavivirus
4. Hep D - Deltavirus
5. Hep E - Calicivirus
Hepatitis A
1. Viral fam
2. S&S, Dx
3. Transmission
4. Incubation
5. Carrier?
6. Vaccine?
A: Asymp, Acute, Alone (no carriers
1. Picornavirus
2. Asymp --> mild = flu-like, dark urine, jaundice, anti-HAV IgM
3. Fecal-oral
4. short (3 weeks)
5. no carriers
6. Vaccine --> anti-HAV IgG (vaccine or past infection)
HBV
1. Viral fam
2. S&S, Dx
3. Transmission
4. Incubation
5. Carrier?
6. Vaccine?
7. Mech
1. Adenovirus
2. S&S - mild - severe hepatitis ----> cirrhosis, hepatocellular carcinoma
Dx: HBsAG = infection
Anti-HBsAG IgG = past infection, or vaccine
3. Blood born - parenteral, sexual and maternal-fetal
4. long (3 months)
5. Chronic carriers
6. Vaccine yes - anti-HBsAg IgG
7. Mech - RNA pol transcribes RNA from DNA template. Reverse transcriptase transcribes DNA genome from RNA intermediate. However, Virion enzyme is DNA-dependent DNA pol
Make the Hep B Dx:
(-) HBsAg
(-) anti-HBc
(-) anti-HBsAg
Susceptible - no acute dz, no previous infection, no vaccine
Make the Hep B Dx:
(-) HBsAg
(+) anti-HBc
(+) anti-HBsAg
Immune due to natural infection - no current infection
Make the Hep B Dx:
(-) HBsAg
(-) anti-HBc
(+) anti-HBsAg
Immune due to vaccine
Make the Hep B Dx
(+) HBsAg
(+) anti-HBc
(+) anti-HBc IgM
(-) anti-HBsAg
Acutely infected - in window period
Make the Hep B Dx:
(+) HBsAg
(+) anti-HBc
(-) anti-HBc IgM
(-) anti-HBsAg
Chronic infection
HCV
1. Flavivirus
2. Asymp --> mild -----> cirrhosis, heptocellular carcinoma
Dx: HCV Ab = previous or ongoing infection
HCV RNA (PCR) = ongoing infection
3. Parenteral (IV drugs), some sex
4. 6-8 wks
5. Carriers
6. no vaccine

Hep C: Chronic, Common, Carriers, Carcinoma
HDV
1. Viral fam
2. Infection restraints 3.symp/prognosis, Dx
4. Carriers?
1. Deltavirus
2. Requires HBsAg as its envelope.
3. Coinfect or Superinfect w/ HBV --> worse prognosis
Dx: HDVAg or HDV RNA = ongoing infeciton
4. Carriers
HEV
1. Viral fam
2. Transmission
3. S&S, Dx
4. Epidemiology
1. Calicivirus
2. Enteric transmission (Fecal-oral)
"A &E - vowels hit your bowels"
3. Dz resembles HAV
anti-HEV IgM
PCR RNA from stool
4. High mortality rate in pregnant women
Opportunistic Infections in Aids
1. Brain
2. Eyes
3. Mouth & Throat
4. Lungs
5. GI
6. Skin
7. Genitals
1. Cryptococcal meningitis, Toxoplasmosis, CMV encephalitis, AIDS dementia, PML (JC virus)
2. CMV retinitis
3. Thrush (Candida albicans), HSV, CMV, oral leukoplakia (EBV)
4. PCP (PJP), TB, Histoplasmosis
5. Cryptosporidium, MAC (Mycobacterium avium-intracellulare complex), CMV colitis, non-Hodgekins lymphoma (EBV), Isospora belli (parasite)
6. Shingles (VZV), Kaposi's sarcoma (HHV8)
7. Genital herpes (HSV2), warts (HPV), cervical cancer (HPV)
HIV-associated infections and CD4 count
1. <400
2. <200
3. <100
4. <50
1. Oral thrush, tinea pedis, shingles, reactivation TB, bacterial infections (H. flu, S. Pneumo, Salmonella)
2. Reactivation HSV, cryptosporidiosis, Isospora, disseminated coccidiodomycosis, PCP
3. Candidal esophagitis, toxoplasmosis, histoplasmosis
4. CMV retinitis & esophagitis, disseminated MAC, cryptococcal meningoencephalitis
Neoplasm associated with HIV
Kaposi's Sarcoma (HHV8), Invasive cervical carcinoma (HPV), 1° CNS lymphoma, non-Hodgekin's lymphoma
HIV encephalitis
1. timing
2. mech
3. Dx
1. late
2. virus accesses CNS via Macrophages
3. Microglial nodules w multinuclated giant cells
Prions
1. CJD (Creutzfeldt-Jacob Dz) - rapidly progressive dementia
-spongiform encephalopathy
-nl prions α-helix --> β pleated sheet
2. Kuru (canibals)
3. Scrapie (Sheep)
4. Mad cow dz
Dominant nL Flora
1. Skin
2. Nose
3. Oropharynx
4. Dental plaque
5. Colon
6. Vagina
1. Staph epidermidis
2. Staph epidermidis, colonized by S. Aureus (int nares)
3. Strep viridans
4. Step mutans (viridans)
5. Bacteroides fragilis > E. Coli
6. Lactobacillus, colonized by E. coli and GBS
Common Cause of Pneumonia
1. Neonates (<4wk)
2. Children (4wk - 18yr)
3. Adults (18-40yo)
4. Adults (40-65yo)
5. Elderly
1. GBS
E. Coli
2. Viruses (RSV)
Mycoplasma
Chlamydia Pneumonia
Strep Pneumo
3. Mycoplasma
Chlamydia Pnuemonia
Strep Pnuemonia
4. Strep Pneumo
H. Flu
Anaerobes
Viruses
Mycoplasma
5. S. Pneumo
Viruses
Anaerobes
H. Flu
Gram (-) Rods
Pneumonia - Special Groups
1. Nosocomial
2. Immunocomp
3. Aspiration
4. Alchoholic/IV Drug
5. Postviral
6. Atypical
1. Staphylococcus, gram (-) rods
2. Staphylococcus, gram (-) rods, fungi, viruses, PCP - HIV
3. Anaerobes
4. Strep Pneumo, Klebsiella, Staphylococcus
5. Staphylococcus, H. Flu
6. Mycoplasma, Legionella, Chlamydia
Common Causes of Meningitis
1. Newborn (0-6 wk)
2. Children (6mos-6yr)
3. 6 yr - 60
4. 60 + yrs
1. GBS
E. Coli
Listeria
2. Strep Pneumo
N. Meningitis
H. Flu (B)
Enteroviruses (coxsackie)
3. N. Meningitis
Enterovirus
Strep Pneumo
HSV
4. S. Pneumo
Gram (-) rods
LIsteria

Viral: Enterovirus (coxsackie), HSV, HIV, WNV, VZV
In HIV: Cryptococcus, CMV, Toxoplasmosis (brain abscess), JC virus (PML)
CSF findings in Meningitis
(Pressure, Cell type, Protein, Sugar)
1. Bacterial
2. Viral
3. Fungal
1. Inc pressure, Inc PMNs, Inc protein, Dec glucose
2. Inc pressure, Inc Lymphocytes, Inc protein, Dec glucose
3. nL/Inc pressure, Inc Lymphocytes, nL protein, nL sugar
Osteomyelitis
1. Most Common
2. Sexually active
3. Diabetic/Drug Addict
4. Sickle Cell
5. Prosthetic replacement
6. Vertebral
7. Cat/Dog bites and scratches
1. Staph Aureus
2. N. gonorrhea (rare), septic arthritis more common
3. Pseudomonas Aeruginosa
4. Salmonella
5. S. Aureus and S. Epidermidis
6. TB (potts dz)
7. Pasteurella multocida
UTIs
1. Ambulatory
2. Hospital
3. Epidemiology
4. Predisposing factors
1. E. Coli (50-80%), Staph Saprophyticus (10-30%) - 2nd most common cause in young sexually active women, Kleibsiella (8-10%)
2. E. Coli, Proteus, Klebsiella, Serratia, Pseudomonas
3. 10:1 women
4. Flow obstruction, kidney surgery, cath, gyn abnLties, diabets, pregnancy
UTI bugs
1. Serratia Marcescens
2. Staph Saprophyticus
3. E. Coli
4. Enterobacter Cloacae
5. Klebsiella pneumonia
6. Proteus Mirabilis
7. Psuedomonas Aeruginosa
1. Some strains - red pigment, nosocomial, drug resistant
2. 2nd leading cause in sexually active women
3. Leading cause. Colinies have metallic green sheen on EMB agar
4. Often nosocomial and drug resistant
5. Large mucoid capsule and viscous colonies
6. Motility causes swarming on agar, produces urease, struvite stones
7. Blue-green pigment and fruity odor (grapes), usually nosocomial and drug resistant
ToRCHeS Infections
1. Name
2. Dz
1. Toxoplasma gondii - "classic triad" of chorioretinitis, intracranial calcifications and hydrocephalus. May be asymp at birth
2. Rubella - deafness, cataracts, heart defects (PDA, pulm art stenosis), and mental retardation
3. CMV - petechial rash, intracranial calcifications, mental retardation, hepatosplenomegaly, microcephaly, jaundice, 90% are asymp at birth
4. HIV - hepatosplenomegaly, neurologic abnormalities, frequent infection
5. HSV-2 - encephalitis, conjunctivitis, vesicular skin lesions. Often asymp at birth
6. Syphilis - cutaneous lesions, hepatosplenomegaly, jaundice, saddle nose, saber shins, hutchinson teeth, CNVIII deafness, rhinitis (snuffles)

Others: Listeria, E. Coli, GBS can be acquired placentally or from birth canal
Osteomyelitis
1. Most Common
2. Sexually active
3. Diabetic/Drug Addict
4. Sickle Cell
5. Prosthetic replacement
6. Vertebral
7. Cat/Dog bites and scratches
1. Staph Aureus
2. N. gonorrhea (rare), septic arthritis more common
3. Pseudomonas Aeruginosa
4. Salmonella
5. S. Aureus and S. Epidermidis
6. TB (potts dz)
7. Pasteurella multocida
UTIs
1. Ambulatory
2. Hospital
3. Epidemiology
4. Predisposing factors
1. E. Coli (50-80%), Staph Saprophyticus (10-30%) - 2nd most common cause in young sexually active women, Kleibsiella (8-10%)
2. E. Coli, Proteus, Klebsiella, Serratia, Pseudomonas
3. 10:1 women
4. Flow obstruction, kidney surgery, cath, gyn abnLties, diabets, pregnancy
UTI bugs
1. Serratia Marcescens
2. Staph Saprophyticus
3. E. Coli
4. Enterobacter Cloacae
5. Klebsiella pneumonia
6. Proteus Mirabilis
7. Psuedomonas Aeruginosa
1. Some strains - red pigment, nosocomial, drug resistant
2. 2nd leading cause in sexually active women
3. Leading cause. Colinies have metallic green sheen on EMB agar
4. Often nosocomial and drug resistant
5. Large mucoid capsule and viscous colonies
6. Motility causes swarming on agar, produces urease, struvite stones
7. Blue-green pigment and fruity odor (grapes), usually nosocomial and drug resistant
ToRCHeS Infections
1. Name
2. Dz
1. Toxoplasma gondii - "classic triad" of chorioretinitis, intracranial calcifications and hydrocephalus. May be asymp at birth
2. Rubella - deafness, cataracts, heart defects (PDA, pulm art stenosis), and mental retardation
3. CMV - petechial rash, intracranial calcifications, mental retardation, hepatosplenomegaly, microcephaly, jaundice, 90% are asymp at birth
4. HIV - hepatosplenomegaly, neurologic abnormalities, frequent infection
5. HSV-2 - encephalitis, conjunctivitis, vesicular skin lesions. Often asymp at birth
6. Syphilis - cutaneous lesions, hepatosplenomegaly, jaundice, saddle nose, saber shins, hutchinson teeth, CNVIII deafness, rhinitis (snuffles)

Others: Listeria, E. Coli, GBS can be acquired placentally or from birth canal
STDs
1. Urethritis, cervicitis, PID, prostatitis, epididymitis, arthritis, creamy purulent discharge
1. Gonorrhea - N. Gonorrhea
STDs
2. Painless chancre
- possible complications if not diagnosed
Syphilis - Treponema Pallidum
Secondary - Fever, lymphadenopathy, skin rashes, condylomata lata
Tertiary - Gummas, tabes dorsalis, general paresis, aortitis, Argyll Robertson pupil
STDs
5. Painful penile, vulvar, or cervical ulcers; can cause systemic symptoms such as fever, HA, myalgia
Genital Herpes - HSV-2 (1)
STDs
6. Urethritis, cervicitis, conjunctivitis, Reiter's syndrome, PID
Chlamydia - C. Trachomatis
STDs
7. Ulcers, lymphadenopathy, rectal strictures
Lymphogranuloma Venerum - C. Trachomatis (L1-L3)
STDs
8. Vaginitis, strawberry colored mucosa
Trichomoniasis - Trichomonas vaginalis (see motile trophozoites on wet mount)
STDs
9. Opportunistic infections, Kaposi's sarcoma, lymphoma
AIDS - HIV
STDs
10. Genital warts, koilocytes
Condylomata acuminata - HPV 6 & 11
STDs
11. Jaundice
Hepatitis B
STDs
12. Painful genital ulcer, inguinal adenopathy
Chancroid - H. Ducreyi
STDs
13. Noninflammatory, malodorous discharge (fishy smell), positive whiff test, clue cells
Bacterial Vaginosis - Gardnerella vaginalis
Cervical motion tenderness (chandelier's sign), purulent cervical discharge
1. Dx
2. Most likely organisms
3. Areas affected/complications
1. PID
2. C. trachomatitis - subacute, often unDx, most common STD in US
N. Gonorrhea - Acute, high fever
Others: Gardnerella - clue cells, Trichomonas - motile wet prep
3. Endometritis, Salpingitis --> ectopic, infertility, chronic pelvic pain, adhesions; hydrosalpinx, and tubo-ovarian abscess
Nosocomial infection
1. Newborn Nursery
2. Urinary Cath
3. Resp therapy equipment
4. Work in renal dialysis unit
5. Hyperalimentation
6. Water aerosols (humidifier?)
1. RSV, CMV
2. E. Coli, Proteus
3. Pseudomonas
4. HBV
5. Candida albicans
6. Legionella
If all else fails:
1. Pus, empyema, abscess
1. Staph aureus
If all else fails
2. Peds infection
2. H. Flu (including epiglotitis)
If all else fails
3. Pneumonia in cystic fibrosis, burn wounds
3. Pseudomonas
If all else fails
4. Branching rods in oral infection
4. Actinomyces israelli
If all else fails
5. Traumatic open wound
5. Clostridium perfringes
If all else fails
6. Surgical wound
6. Staph Aureus
If all else fails
7. Dog or Cat bite
7. Pasteurella multocida
If all else fails
8. Currant jelly sputum
8. Kleibsiella
9. Sepsis/Meningitis in newborn
9. Group B Strep