MICROBIOLOGY

OUTLINE
I.
A.
B.
C.

II.
A.
B.
C.

D.

III.
A.
B.

IV.
A.
B.
C.

Introduction
Discovery
of
Microorganisms/
History
Types
of
microorganisms
1.
Prokaryotic
2.
Eukaryotic
Control
of
microorganism
1.
Sterilization
a.
physical
b.
chemical
c.
chemotherapy
Immunology
Introducton
Cells
involved
Nonspecific
immunity
inflammation
phagocytosis
complement
system
Specific
Immunity
CN
OP
Complex
IV
Humoral
immunity
(antibodies)
Cellular
immunity
Mycology
Introduction
Medical
Mycology
hypersensitivity
mycotoxicosis
mycetisma
fungal
infection
1.
Superficial
mycosis
2.
Cutaneous
mycosis
3.
Subcutaneous
mycosis
4.
Endemic/
systemic
mycosis
5.
Opportunistic
mycosis
Virology
Introduction
General
properties
of
DNA/RNA
virus
DNA
viruses
(HH
APP)
Herpes
virus
Hepadria
virus
-

D.
1.

Papova

Papilloma
Polyoma
Pox
virus
(polyoma
RNA
RNA
(+)

and

Adenovirus
virus
virus
virus
papilloma)
virus
Sense

Pi

CoT

2.

RNA
-

(-)
Par

E.
V.
VI.

CaFlaRe
Picornaviridae
Coronaviridae
Togaviridae
Flaviviridae
Retroviridae
Reoviridae
Sense
FABOR
Parmyxoviridae
Filoviridae
Arenaviridae
Buryaviridae
Orthomyxoviridae
Rhabdoviridae
Antiviral
Bacteriology
Parasitology

-------------------------------------------------------------------------------------------------------------------------------

I.

INTRODUCTION

TO

MICROBIOLOGY

Microbiology - the study of MOs which can be single or clustered

- also involves the study of virus which are "acellular"

A.

History
1.

Anton
Van
Leeuwenhoek
Father
of
Microbiology
- Developed the simple microscope (using his stool as the
specimen- found
giardia lambia- first to be diagnosed with
giardiasis"The
gay
man's
diarrhea")
coined
the
term
"animalcules"
2.
based on
Taxonomy

Otto
Muller
- first person who classified organisms into genus and species
Linnaeus classification. <-- Father of

3.

Robert
Hooke
Father
of
cytology
- 1st person to describe the cell- (basic struture in biology)
[[
Unicellular
Bacteria
/
Yeast
]]
[[
Multicellular
Helminths
]]

4.

John
Needham
Living
can
arise
from
non
living
organisms
- Spontaneous generation or apious theoris - Rotten beef
AKA
abiogenisis
Theory

based

on

the

greek

philosopher

5.
-

Small

invertebrates

arise

from

non

living

Aristotle
Aristotle
matter

6.

Francesco
Redi
theory
derived
from
John
Needham
1st
opponent
of
abiogenesis
theory
Basis
of
our
sciences
- Living organisms can only arise from living things
Eperiment:
3
containers
1. Uncovered
(+) growth of maggots
2. Covered w/ paper
(-) growth " "
3. Covered w/ gauze
(-) growth " "

7.

Lazzaro
Spallanzani
- Sealed flask w/ boiling water can prevent growth of MOs.

8.
-

Louis
Pasteur
Pasteurization
60'C,
30
minutes
Swan
neck
flask
experiment
1. w/ neck(-)
growth
(clear
broth
solution)
2. w/out neck(+) growth (turbid broth solution)
Paired up with Rober Koch with other experiments -

vaccinations
9.
10.
aseptic

11.

Successive

John
Intermittent
series
of

boiling

Tyndall
sterilization
(Tydallization)

Joseph
Lister
Father
of
aseptic
technique
- Researched on why mother die during childbirth-- due to lack of
technique.
decreased
the
incidence
of
babies
with
sepsis
Discovered
Phenol
(Carbolic
acid)
Caustic
Friedrich
Henle
- Proposed a criteria that MO can cause diseases- Germ theory of

disease
12.

Also

worked

with

Robert
Robert
Bacillus

Koch

Koch's

postulate
Koch
Anthracis
Anthrax

Koch's
Postulate
1. MO must be present in all stages of the disease
2.
MO
must/can
be
isolated
in
a
pure
culture
3. Suspected MO when innoculated in a healthy host must cause

the same

disease
4. Suspected MO when isolated in a diseased host must be the
same
MO
IMMUNOLOGY
13.
Edward
Jenner
Father
of
vaccination
- small pox vaccine (eradicated 1980. 1978 was the last case)
bioterorecept
CDCCenter
for
disease
control
14.

John
Ender
- 1st person who isolated viruses and grown in culture media

(artificial)
15.
-

witholding the

Paul
Ehrlich
Father
of
chemotherapy
Arsphenamine/
Salvarsan
/
compd
606
- tx for syphilis - Treponema Pallidum (bacteria)
DOC
Pen
G
- Experiment on black africans on 19320-1972,
tx
Tuskeegee
Experiment

16.
17.

discovered
Howard

Florey
clinical

18.

and
use

TYPES
based

on

1.
-

Ernst

Boris
of

the

or

nucleus

MOS
or

nuclear

membrane

Prokaryotes
1um
)
no
membrane
Nucleoid
Bacteria
no
nuclear
membrane
NO
important
organelles
- ER , Golgi apparatus, Mitochondria
They
have
ribosomes
- cell wall - peptidoglycan or murein <--- target of

relatively
a.

Waksman
tx
for
TB
amphotericin
B

OF

absence

Chain
penicillin

Domagk
sulfanilamide

Selman
1st
aminoglycoside
Treptomycin
fungus

B.
-

Fleming
Penicillin

isolated

Gerhard
discovered

19.

Alexander
and

small

size
(
nuclear

<

penicillin
b.
-

interlink
of
polysacharides/peptides
- NAM (N- acetylmuramic acid)
- NAG
(N- acetylglucosamine)
Reproduce
by
Binary
fission
- separation of mother to daughter cells.
Archaea
cell
wall
(non
pathogenic)
extreme
environment
ex. a. Methanogens - high conc. of methane
- present in decomposing organic

no

matter
b. Extreme halophiles- high conc. of salt
sea)
c. Extreme thermophiles - high temp.
hot springs)

(dead
(volcanoes,
2.
-

true

Eukaryotes
nucleus
RNA
have
organelles
Fungi
generally
they
are
multicellular
most
are
molds
except
yeast
Yeast
Candida,
cyptococcus
have their own cell wall - made of chitin
filamentous
except
yeast
filaments
=
hyphae
interlinking
tubular
structure
nucleus
DNA

a.
-

presence
,

b.
Japnese
c.

assinglas

of

Algae
photosynthetic
plant-like
agar

Parasites
multicellular
Helminths
,
Ectoparasites
(insects)
unicellular
protozoans
3.
Virus
composed
of
nucleic
acid
and
protein
Nucleic acid (DNA or RNA) , Protein (nucelo capsid - basis
of symmetry
or
shape
and
Envelope)
-----------------------------------------------------------------------------------------------------------------PROKARYOTIC
STRUCTURE
A.
Cell
membrane
encloses
the
cytoplasm
-

- structure - phospholipid bilayer (Fluid Mosaic model)

polar
head
(phosphate
group)
hydrophobic
tail
(Lipid)
B.

Cytoplasm
the
cell
of
cell
cytoplasm
Ribosomes
Cytoplasmic
inclusions
bodies
Nucleoid
( organelles must have plasma membranes- separated from
compartmentalization)
-

cytoplasm-

intercellular
water
organelles

C.

matrix
of
component
inside
of

Gas
floating
cytoplasm

for
structure
in
bacterias/prokaryotes
ex.
Cyanobacteria
D.

Inclusion

bodies

only

(not

/
found
usually

(instead

1.
-

contains

genetic

information

Vacuole
bouyancy
in
aquatic
pathogenic)

of

organelles)
Nucleoid
(DNA
&
RNA)

2.

Ribosomes
70s - 30s and 50s - target of antibiotics (selective toxicity)
- site of protein synthesis

3.

Endospores
only
found
in
spore
formers
Bacillus
aerobic
Clostridium
anaerobic
dormant
stage
of
bacterial
growth
when
the
environment
is
depleted
(vegetative
-->
dormant)
heat
resistant
drying
resistant
staining
Malachite
green
(+)
Green
()
Red
VR:
(under
microscope)
- Bacillus
nonswollen
sporangium
- Clostridium swollen
sporangium
-Vegetation
(
spore
--->
vegetative)
- Sporolation or Sporogenesis
( vegetative ---> spore)

4.
-

"extrachromosomal
Chromosome
=
organizes

Plasmid
DNA"
the
DNA

ex.
(no

=
double
helix
plasmid
resistance
plasmid
MRSA,
MRSE,
CRSA/CRSE
- Measles - MMR - 6 mons. (if epidemic), 9 mons.
epidemic)
R-

5.

Periplasmic
space
only found in Gram (-) bacteria
the
hydrolytic
enzyme
plasmid
for
resistance
------------------------------------------------------------------------------------------------------------------

1st

structure
contains

GRAM
-

GRAM
-

(+)

7-8

layers

plasma
peptidoglycan
cytoplasmic

of

layer

membrane
cell
wall
membrane

PM
outer
membrane
1-2
layers
of
peptidoglycan
/
cell
wall
periplasmic
space
contains
hydrolytic
enzyme
(higher
antibiotics
fluoroquinolones- Fluorinereach
DNA
gyrase
cytoplasmic
membrane
cytoplasm
-----------------------------------------------------------------------------------------------------------------6.
Teichoic
acid
only
in
gram
(+)
negative
charge
of
the
cell
crystal violet - positive dye - staining for gram (+)
- antibody production (major antigen for gram +)
2
TYPES
(depend
on
location)
1. MTA = membrane teichoic acid (Present in
plasma
membrane
and
cell
wall/peptidoglycan)
2. LTA/WTA= lypoteichoic acid/ wall teichoic acid
(Present in
the plasma membrane and half of the
cell
wall)
7.
Cell
Wall
main
component
:
peptidoglycan
Murein
rigid
structure
that
protects
the
bacteria
- based for classification (Gram + , Gram -)

GRAM (+)

7-8 layers
Peptidoglycan
Teichoic acid

GRAM

1-2 layers

(-)

Complex
(adaptation)
>
Periplasmic
space
>
LPS
lypopolysaccharide

Rgt

Crystal violet
Iodine
Ethanol
(temporary)
Saffranin

stains

^component of outer membrane

Lipid
A
(pyrogen-fever
causing)
^Endotoxin
(gram
staining)

Function

Gram (+)

Gram

2' stain- counter

stain

Violet

Pink/Red

Primary stain
Violet
Violet
Mordant (Stabilize Violet
Blue violet/ violet
1'
stain)
Decolorizer
Violet
Colorless

Structure

Gram (+)

Gram

(-)

Cell wall
TA (Teichoic acid)
PS (Periplasmic space)

Thick
Thin
Present
Not Present
Not Present

Toxin

Exotoxin

Present
Exotoxin
Endotoxin
Highly Res.
Low

Resistance to Physical
Res.
stress
8.
2

Glycocalyx
cell
wall
types:
Capsule
Excludes
particles
not
all
bacteria
have
capsules
form
of
virulence
- can escape phagocytosis (cannot be
macrophages-- too big)
firmly
attached
well
organized
(like
peptidoglycan)
H.
influenza
(pneumonia)
Neisseria
meningitis

polysaccharide
a.
-

eaten by
ex.
b.

found

outside

the

Slime
does
not
exclude
loosely
not
organized
for
attachment
to
GLYCOCALYXES
fxns:
CAPSULE
VIRULENCE
SLIME LAYER ATTACHMENT
*For
*For food reservoir

layer
particles
attached
structure
surfaces

protection

9.

end- (like

Cell
appendages
- extracellular structure used by the cell for motion
a. Flagella (plural form)
Locomotion/movement
TYPES
(
L
A
M
P
)
L - ephotrychous - "TUFF" of flagellum at one
a
ponytail)
A- mphitrychous
- Single polar flagillum at both

ends
M- onotrychous
P- eritrychous
cell (like a

- Single flagella at one end

- Flagella "all around" the
sun)

b.

Pili
TYPES
a.

Ordinary
-

b.
ex.
c.

pili
(Fimbriae)
for
attachment
Sex
pili
bacterial
conjugation
transfer
of
genetic
material
N.
gonorrhia

Axial
"spirochetes"
spiral
inside

filament
spiral bacteria
locomotion
the
cell

- used by
located
of
Ex.
1.
Treponema
pallidum
CA:
Syphilis
- First manifestation: "Hard chancre" ulcer
- can be transferred to infant (Vertical)
causes
infant
to
have:
Sudden
nose
Chainsaw
teeth
Mulberry
molar
2.
Leptospira
interigans
-leptospirosis
3.
Borella
burgderferi
lime
disease
Vector:
Tick
4.
Borella
recurrentis
Relaxing
fever
Vector:
Louse
-----------------------------------------------------------------------------------------------------------------E.
Bacteria
-

Reproduction
Binary
fission
Generation time/budding time
- process in which bacterial

population

double
-

Yeast (Eukaryote)

STAGES
1.

2.
3.
4.
-

no.
Budding

MICROBIAL

GROWTH

INFECTIOUS

DISEASES

Lag
phase
Phase
of
adjustment
synthesis
of
macromolecules
/
nutrients
very
important
in
chemotherapy
- phase wherein the MO is susceptible to Abx
Log
phase
exponential
growth
phase
rapid growth in the no. at constant maximum rate
Stationary
phase
cell
reproduction
=
cell
death
phase
of
equilibrium
accumulation
of
waste/
toxic
materials
Decline
phase
AKA
death
phase
cell
death
>
cell
reproduction

STAGES
1st

OF

in

OF

Period
(Incubation
Period)
period
wherein
MO
enters
the
body
common
portal
of
entry
mouth
defining moment - No Signs and symptoms
Signs = Objective (seen by the doctor) can be

measured
ex.
BP
Symptoms = Subjective (Manifested or felt by the
patient)
ex.
2nd
diseases

Period
(Prodromal
period)
appearance
of
mild
signs
and
symptoms
- not pathognomonic - not unique for specific disease. all
manifest
these.
ex. fever, HA, Nausea and Vomitting, Diarrhea

3rd
4rth

Period
(ACME
period)
AKA
period
of
illness
appearance
of
S/S
pathognomonic
for
a
certain
disease
ex. Cholera (Vibri Cholerae) - "Rice water" stool
Period

5th

headache

(Period
S/S

of

Decline)
Subsides

Period
(Convalescence
Period)
- body is restored to its healthy stage/state
- can be a subclinical symptom - latent or full recovered

OCCURENCE

OF

DISEASE

1.

Endemic
the
disease
is
present
all
year
round
no.
of
cases
all
yr.
round
ex.
Palawan
Malaria
Mefloquine,
Doxycycline
(2
weeks)
post and pre (1 month , 2 months)
Samar - Schistosomiasis (vector: snail)

2.

Epidemic
outbreak
- sudden increase in no. of cases for a certain period of
and
place
seasonal

3.

Sporadic
cases

time

4.
influenza

scatterd/

isolated

no.

of

Pandemic
more
than
1
continent
is
affected
- highest level = level 6 -- achieved last 2009 - AH1N1 virus

TYPES

OF

according
1.
-

to

ex.
2.
-

CULTURE
koch's

MEDIA

postulate
Simple
Media
Non
fastidious
MOs
No
special
nutrition
Nutrient Agar - Japanese isinglas (solid)
Nutrient
Broth
(ilquid)

Enriched
Media
for
fastidious
MOs
contain special nutrition, vitamins, and minerals
ex. Blood Agar - MOs that require high nucleic acid

nutrition
Milk Agar - MOs that require high protein
nutrition
Chocolate Agar - MOs that require high
nutrition

hemoglobin
3.
a.
lactose

Differential
Media
classifies
MOs
into
categories
MacConkey
Agar
(MCA)
- classifies MOs into lactose formers and non
formers
Visible
Reaction:
LF
Pink
NLF
Colorless

b.

Eosin
Methylene
Blue
(EMB)
same
with
MCA
VR: LF - Metallic green/ Green ( ex. E. coli )
NLF
colorless
Classificaton
1.
Rapid
lactose
formers
(EKE)
Escherichia
coli
Enterobacter
spp.
Klebsiella
spp.
*-ella
=
non
motile
Haf

2. Slow lactose formers ("Slow" SCAPE of Edward who is a

vam/human)
S
erratia
Citrobacter
Arizonia
Providencia
Ervinia
Edwardciella
Hafnia
3.

Non
SPPS-

c.
-

lactose

almonella
Blood
both
3
1.
2.

3.
d.

former
(SSPP
higella
roteus

Mannitol

spp

or

SPPS)
spp
spp
seudomonas
(motile)

Agar
Plate
(BAP)
enriched
and
differential
rxns
in
the
BAP
Alpha
hemolytic
partial
hemolysis
green
Beta
hemolytic
complete
hemolysis
- most important - very virulent
colorless
- basis of classifying Streptococcus
Lancefilled
classification
Group A - Streptococcus pyogenes
Group B- Streptococcus agalactae
(Pneumonia,
meningitis)
until
Group
G
Unclassified - Viridans Streptococci
S.
pneumoniae
Gamma
hemolytic
no
hemolysis
Salt

Agar

(MSA)

- used in the classification of Staphylococcus

3
rxns:
1.
Staph.
aureus
- only bacteria that can ferment
Mannitol
2.

VR:
Golden
yellow
Staph.
epidermidis
skin
- opportunistic pathogen for
immunocompromised

pxs.
VR
3.

4.
growth

(more

:
Porcelain
white
rxn
Staph.
saprophyticus
- UTI for sexually active women
VR:
No
visible
rxn

Selective
Media
- allows the growth of 1 group of MOs and inhibits the
of
the
other.
ex.
a. MCA and EMB are both differential and selective
b.
CNA
colistin
nalidixic
acid
selective
for
Gram
(+)
only
c.
Sabaraud
dextrose
agar
(SDA)
- selective only for fungi <-- very acidophylic
- pH 5.6
d.
ThayerMartin
Media
(TMM)
only
for
STD
(N.
gonorrhea)
e.
Loeffler's
Media
and
Tellurite
Media
only
for
Corrynbacter
spp
- Tellurite is the identification test for diptheria
selective)
f. Campy blood agar plate and Skirrow's agar
only
for
Campilobacter
jejuvi
g.
Lowenstein
Jenssen
only
for
mycobacterium
TB
diagnosis
of
choice
(TCR)
h.
Bordel-Gengor
agar
for
Bordetella
pertussis
CA
for
whooping
cough

5.
ex.

they

Anaerobic
die
in
the

presence

Media
of
O2

a.
Candle
Jar
Method
b.
GasPak
c.
Thioglycolate
agar
-----------------------------------------------------------------------------------------------------------------EUKARYOTIC
STRUCTURE
1.
Cell
membrane

2.
ER

Golgi
ex.

rough

Organelles
(for
ribosomal
smooth

attachment)
(for
lipids)
apparatus
packaging/
post
translational
modification
insulin
- C-peptide is removed by the golgi apparatus
- Assay of C- peptide is done to know if insulin is

endogenous
or
exogenous
Ribosomes
site
of
protein
synthesis
Mitonchondria
powerhouse
- highest ATP produced (36) through oxidative
phosphorylation
------------------------------------------------------------------------------------------------------------------

C.

CONTROL

OF

MOS

1.
-

process
a.

of

removal

of

MO, virus,
Physical

abd

Sterilization
viable spores
Method

Heat
Moist
15mm
Dry

Low

heat
sterilization
(most
common)
MOA:
Protein
coagulation
ex. autoclave (121' C, 15 psi pasteuriation,
intermittent sterilization, 30 mm
full)
boiling
heat
sterilization
MOA:
Oxidation
ex.
Oven,
incinerator

temperature
Refrigeration/freezing
- most common method of preservation
Deep
freezing
use
of
liquid
Nitrogen
ex.
Croscopic
freezer
lyophilization
aka
freeze
drying
- preservation of large volume of MO

Filtration
- physical removal of MO using a FILTER/MEMBRANE
(0.2-0.3
ex.
HEPA

Filter

efficiency:

mm)
99.97%

Radiation
MOA:
mutation
ex. UV rays ionizing radiation, radioactive I2
b.

Chemical

1.

2.

AntiMO

3.

Method
Phenol
MOA:
protein
denaturation
aka
carbolic
acid
- std for disinfectants to test its properties
- phenol coefficient : Salmonella typhi - (+) control
Alcohol
MOA:
CHON
denaturation
most
common
- structure - activity relationship : high C = high
activity*but
until
C8
only
ex.
Ethanol
95%
Isopropyl
70%
Halogens
Grp.
VIIA
ex.
I2
most
potent
I2
tincture
2%
alcoholic
base
I2
soln.
same
;
H2O
Lugol's
soln
5%
thyroxitoxicosis
Povidone
I2
10%
surfactant:
PVP
Cl - pools and H20

4.

Heavy
bind
to

MOA:
ex.
Hg
5.
MOA:
Ex.

6.

7.

-SH

Metals
group

Thiomersal
mercurial
- now: Merthiolate -- benzalkonium CL
for
Minamata
disease
Aldehyde
sporicidal

Formaldehyde
embalming
agent
mucosal
irritant
Glutaraldehyde
less
irritating
Sterilizing
gases
Heat
labile
materials
MOA:
alkylation
of
CHON
ex.
Ethylene
oxide
Dyes
ex.

gentian violet - suppository for tx. of yeast

infection
basic fuschin - component of carbolfuschin
(castellani's paint)
- tx for ringworm/ tinea and
foot
methylene blue - used in cyanide poisoning
antifungal
for
fishes
*carbolfuschin
1'
stain
in
acid
fast
Methylene blue - 2' stain for acid fast

athlete's

c.

Chemotherapy
- Abx - substance produced by MO that inhibit the growth
other
MO

of

Classification
of
ABX:
Spectrum
of
Activity
1. Broad spectrum
ex, Carbapenems - widest spectrum among B-lactam
Tetracycline - g(+), g(-), IC parasites, widest among abx
2.
Narrow
spectrum
ex.
Aztreonam
monobactams
not
for
g(+)
SOURCE
1.
Bacterial
Bacitracin
Bacillus
subtilis
Polymyxin Bacillus
polymyxa
2.
Fungi
Cephalosporin Cephalospora
spp
Griseofulvin Penicillum
griseofulvum
Penicillin
P.
notatum
Amphoterin B
Streptomyces
nodosus
Nystatin
S.
noursei
Streptomycin
S.
griseus
Clindamycin S.
lincolnensis
Chloramphenicol - S.
venezuelae
Vancomycin S.
orientalis
*DOC:Pseudomembranous
colitis
Cycloserin S.
orchidaceus
Gentamicin Micromonospora
purpurea
3.
Artificial
Antimicrobial
parameters:

susceptibility
Minimum Inhibitory

Conc.,

testing
Minimum lethal

1.
a.

Kirby-

Bauer Diffusion test - disk

measure
zone
of
>
=
15mm13-14
mm
-

conc.

Diffusion
diffusion test
inhibition
susceptible
intermediate

<13
b.
c.

E-test

use

2.
a.
b.

mm
stoke's
strip of paper
Broth
tube
Agar

with

abx

resistant
test
gradient
Dilution
dilution
dilution

TERMINOLOGY
1. Autonomous / indifferent - result of 2-day testing = most effective
drug
2.
Antagonism
bactericidal
+
bacteriostatic
1
+
1
=
0
ex.
Amox
+
Doxycycline
3.
Addition
bactericidal
+
bactericidal
1
+
1
=
2
exception: penicillin + aminoglycoside = synergistic
4.
Synergism
Bacteriostatic
+
bacteriostatic
1
+
1
=
>2
ex. cotrimoxazole = trimethoprim + sulfamethoxazole
5.
Potentiation
penicillin
+
B
lactamase
inhibitor
1+
0
=
2
ex. Amox + clavulanic acid = augmentin , co-amoxiclav
ampicillin
+
sulbactam
=
unasyn
piperacillin
+
tazobactam
=
piptaz,
tazocin

CHEMICAL
A.

CLASSES

Inhibitors

of

OF

ABX

cell
wall
synthesis
1.
B-lactam
abx
MOA: bind to the penicillin-binding proteins (PBP) stabilize NAMNAG
in
cell
wall.
has
g(+)
activity
has
no
activity
against:
wallless
MO
=
mycoplasma
spp
IC
parasites
=
Legionella,
Brucella,
Chlamydia
Resistant
strains
=
MRSA/MRSE
A/E:
allergic
rxn
alternative:
Erythromycin
anaphylactic rxn - *penicillin - Herxheimer rxn
cross-sensitivity - Pens. and cephs > B lactam thiazolidine
(???)
1a.

Penicillin
Pen

Natural
Isoxazolyl
-

Pen
G
benzylpenicillin;
DOC
syphilis;
Pen
V
phenoxymethylpenicillin
;
aka

antistaphylococcal
methycillin
prototype;

IV
PO
pen
pens

withdrawn

- Cloxacillin, Dicloxacillin, Oxacillin, Nafcillin

Extended spectrum pens - expanded activity against g(-)
able
to
penetrate
g(-)
MO
- Aminopenicillin - amoxicillin, ampicillin,
bacampicillin
- high PO bioavailability- parent cmpd.
- most active B- lactam against pneumococci
(S.

pneumoniae)
Carboxypenicillin
can
kill
Shigella
spp.
Carbenicillin,
Ticarcillin
Ureidopenicillin
piperacillin,
Mezlocillin,
Azlocillin
use:
pseudomonas
Cephalosporins
Cefazolin - 1st and only PARENTALLY used ceph
Cefurozime
community-acquired
pneumonia
Ceftaroline fosamil - new; prodrug; ONLY active against
MRSA/MRSE
Cephamycins - grp. of 2nd gen; ANAEROBIC
cefotetan,
cefoxitin,
cefmetazole
Cefixime
uncomplicated
gonorrhea
Ceftriaxone
and
Cefotaxime
Meningitis
Ceftazidime and cefoperazole - Pesudomonas aeruginosa
Carbapenems
WIDEST
SPECTRUM
among
B-lactams
- Meropenem, Imipenem, Ertapenem + Cilastatin = help
inhibiting
the
dehydropeptidase
Monobactam
- Aztreonam - No activity against g(+) and anaerobes
-

1b.

1c.
in
1d.
2.
2a.

2b.
2c.
2d.
3.

Glycopeptides
Vancomycin
MOA: Binds to D-Ala-D-Ana terminus of the peptidoglycan
DOC pseudomembranous colitis (Clostridium colitis)
A/E
:
Red
man's
syndrome
(infusion-related)
form
of
PHLEBITIS
prophylaxis
:
DIPHENHYDRAMINE
Slow
IV
Infusion
Teicoplanin
same with Vancomycin in terms of MOA and spectrum
can
be
given
IM
unlike
Vancomycin
Telavancin
Semi-synthetic lipoglycopeptide derived from Vancomycin
Dalbavacin
SS
lipoglycopeptide
from
teicoplanin

Cycloserine
MOA: inhibits Alanine racemase <-- promotes synthesis of L-

analine

4.

B.
1.

to
inihibits
2nd line

for

D-alanyl-D-analine
PTB if MO is resistant

to

D-alanine
ligase
1st line.

Bacitracin
-mixture
of
cyclic
peptide
=
polypeptide
ONLY
topical
- use: g(+) infection --> impetigo - lesions by S. aureus
INHIBITORS
OF
CHON
SYNTHESIS
inhibit
30s
ribosomal
unit
(Trent
A)
1a.
Aminoglycosides
source: Streptomyces - mycin, Micromonospora - micin
MOA:
30s
-inhibition of initiation of complex (precursor of peptide

chain)
misreading
of
mRNA
- break up of polysomes into monosomes (nonfunctional)
Features:
-conc.dependent
killing
post-abx
killing
effect
synergistic
killing
A/E
Nephrotoxicity - renal tubular acidosis w/ Mg, K
wasting
Neomycin
Gentamicin
Tobramycin
Ototoxicity
Neomycin
Amikacin
Kanamycin
Vestibulotoxicity
Streptomycin
Gentamicin
2a.

Tetracycline
widest
spectrum
among
the
abx
(Spirochetes, g(+), g(-), protozoans, IC parasites)
MOA: - aminoacyl + RNA (transfer of protein)
ex. Tetracycline, Docycline, Minocycline, Demeclocycline
A/E:
hypoplasia of teeth - not for <8 yrs. old
phototoxicity- potent chelator of polyvalent cation
-

(Ca)

2.

Demecloycline
Ototoxicity
Minocycline
Inhibit
50s

ribosomal

lactone

2a.
large

unit
Macrolide
ring

- alternative for B- Lactams

MOA: Blockade of exit tunnel = dissociation of peptidyl
tRNA
A/E:
Ex.

*if

Jaundice,

Abdominal
cramps
Erythromycin
before
ILOTYCIN
- alternative for px. allergic to B-lactams
- estolate form is associated with jaundice
Clarithromycin
-methylated
erythromycin
- high activity against staph. and strptococcus
less
abdominal
cramping
Azithromycin
well
absorbed=
less
dosing
(3
days)
A/E
:
arrythmia
2b.
Chloramphenicol
MOA: inhibit peptidyl transferase (elongation of peptide
chain)
Use:
typhoid
fever
A/E: baby: gray baby syndrome, adult: aplastic anemia
^due
to
the
NITRO
(????)
2c.
Lincosamides
Lincomycin
sulfur
containing
Clindamycin
from
S.
Licolnensis
use:
soft
tissue
inf.
by
staph/strep.
Infection
is
above
the
diaphragm
infection
is
below
the
diaphragm=
Metronidazole
2d.

Oxazolidinones
Linezolid
MOA: bind to 23s of the SOS R.S.U.
use:
treatment
of

2e.
Streptogramin
Ratio:
streptogramin
Ratio:
Use: MRSA/MRSE
3.

Inhibitors
3a.
MOA:
TOPOISOMERASE

A
B

aka
-

aka

MRSA/MRSE
Streptogramins
balfopristin
70
Quinupristin
30

of
NUCLEIC
ACID
Quinolone/Fluoroquinolone
inhibition
of
TOPOISOMERASE

SYTHESIS
II

and
IV
DNA
gyrase
supercalyx
(?)
SAR: F is added to enhance g(-) spectrum and

increase
inhibition
Generation:
1st
-

of
Nalidixic

DNA
acid

gyrase

2nd
3rd
4rth

limited
for
tx.
of
uncomplicated
UTI.
limited/no
activity
for
g
(-)
ciprofloxacin,
ofloxacin,
Norfloxacin
Expanded
g
(-)
for
IC
pathogen
Levofloxacin
retained
g
(-)
activity
expanded
IC
parasite
activity
Moxifloxacin
retain
g
(-)
activity
expanded
g
(+)
and
anaerobic
activity

COMMON
Ciprofloxacin - tx. & prophylaxis for B. anthracis
Res.
Quinolone
a.
Levofloxacin
(2nd
line
for
PTB)
b.
Gemfloxacin
c.
Gattifloxacin
d.
Moxifloxacin
^TX
FOR
URTI
and
LRTI
Cipro
and
levo
tx.
UTI
3b. Rifamycin
MOA:
inhibit
RNA
polymerase
ex.
*Rifampicin
A/E:
red-orange
discoloration
of
urine
4.

ANTI-TB
4a.

4b.

5.
5a.

DRUGS
line

1st
Isoniazid
isonicotininc
hydrazine
MOA:
inhib.
MYCOLIC
acid
synthesis
A/E:
peripheral
neuritis
tx.
B6
Metabolism:
Phase
2acetylation
Resistance:
SE
asians
fast
acetylators
Rifampicin
Pyrazinamide
-short-term
therapy;
prevent
resistance
A/E:
hepatotoxicity
Ethambutol
-prevent
resistance,
stop
2
months
A/E: red-green visual disturbance, optic neuritis
Streptomycin
only
aminoglycoside
for
pTB
2nd
line
Fluoroquinolone
(nucleic
acid
sythesis
inhib.)
Cycloserin
(cell
wall
synthesis
inhib.)
Thioamides
P-aminosalicylic
acid
ANTI-METABOLITES
Sulfonamides

SAR:

PABA-like
structure
PABA- Starting material to produce folic acid and

purine.

5b.

MOA:
inhib.
of
DIHYDROPTEROATE
SYNTHETASE
A/E: jaundice, kernicterus (infant) - unconjugated bilirubin
reaches
the
brain.
Pyrimethamine
and
Trimethoprim
MOA:
inhib.
DIHYDROFOLATE
REDUCTASE
combination:
Co-trimoxazole
tx. pneumocystis jeruveci
Daraprim - Sulfadiazine + pyrimethamine -

toxoplasma
Fansidar - sulfadoxine + pyrimethamine - malaria
6.

Miscellaneous

Agents
Nitroimidazoles
ex.
Metronidazole,
Tinidazole
A/E:
Metallic
taste
disulfiram-like effect : alcohol + metronidazole
USE:
Trichomonas
vaginalis
Amoebiasis
Giardiasis
*anaerobic
inf.
below
diaphragm
6b.
Nitrofurantoin
-effective
at
an
acidic
pH
USE:
uncomplicated
UTI
6c.
Methanamine
Prodrug-formaldehyde
(active)
USE:
urinary
antiseptic
-----------------------------------------------------------------------------------------------------------------6a.

II. IMMUNOLOGY
A.

Introduction
Immunity- process where body recognizes itself from nonself
types:
1.
Nonspecific
innate
immunity
2.
Specific
acquired
immunity

B.

Cells
b1.

involved
Agranulocytes
young
-

in

immunity
(WBC)
macrophages
adult
phagocytosis
presentation
chronic
infection

Monocytes Macrophages
fxn:
antigen
present
in
Lymphocytes
B cellsmature
in
bone
marrow
fxn:
antigen
presentation
mature to PLASMA(produce antibody) and

MEMORY
(recognize
immunology)
cells
mature
in
thymus
increase
in
VIRAL
types:
Helper
T
cells
- stimulate B-cell and affected by HIV
Cytotoxic
T
cells
- attaches to viral and bacterial

surfaces
b2.

Granulocytes
Basophils
produces
Eosinophils
increases

(WBC)
histamine

during

helmintic

type 1 sensitivity
infestation.

rxn

and

Neutrophil
1st to respond during inflammatory process
increase
during
BACTERIA
infection
C.

Nonspecific
aka
c1.

immunity
innate

immunity
Inflammation

Trauma
Physiological
process:
a.
Vasodilation
occurs
inc in blood floow. transport neutrophils
during acute
inflammation.
Macrophages during chronic
inflammation)
b. Increase in Permeability in the Endothelium
-Proteins
and
H2O
and
plasma.
Immunity
a.
Active
neutrophils to
out
site of
crawl/walk to the site of
adhering
to
(accumulation of

side:
Chemotaxis
BV releases chemicals to atract
the site of inflammation.
2
processes
involved:
Margination - neutrophils doesn't get washed
because
of
vasodilation.
Diapedesis - movement of neutrophils to the
infection.
(they
infectionthe
side
of
the
BV).
*pus is formed if there is an aerobic inf.
neutrophils)
b.

Phagocytosis
(site
cell
interacts with microbes:

of

infection)
eating

attached to neutrophils (opsonization)

*Opsonin - is a protein (site of
interlocking process with
microbe).
phagosome
formation/
phagolysosome
microbe
is
already
inside
th

the
neutrophils

degraded
by
lysosome
*Lysosome releases Hydrogen
and Nitric oxide to kill the

oxide
microbe.
*these
5
1.
2.
3.
4.
5.
c2.
c3.
COMPLEX

all

occur

CARDINAL
SIGNS
Redness
Dolor
Calor
Tumor
Funti
leasa
-

simultaneously
OF
loss

INFLAMMATION
Rubor
pain
heat
edema
of
function

Phagocytosis
Complement
system
- series of protein released to produce the MEMBRANE ATTACK
(MAC) - series of cleavage of c5c6c7c8c9
MAC : fxn: lysis of microbial cell - attached to microbial

membrane.
3
1.

Antibody

pathways
for
c5
-->
c9
(to
produce
MAC)
Classical
pathway
(slower
than
the
alternative)
common
antibody
mediated
IgG,
IgM
complement
protein:
C1
3
proteins
c1
Q
:
reponsible
for
attachment
R : responsible for cleavage of proceeding protein --------> C4C2
S : no fxn
------>
c4bc2b
(c3

converted)
^bind
to
c3
*c3a, c5a - anaphylotoxin (resp. for anaphylaxis)
release
c3a
------>
c3b
------>
c4bc2b
------>c4bc2bc3b
(c5
convertes)
------>
c5
^release
c5a
------>
c5b
------>
c5bc6c7c8c9
(MAC)

2.
not
Complement:

Alternative
mediated

pathway
antibodies
c3
(cleaved via
D and

by
------>

c3

factors B,
properdin)
------>

c3bBb
------>

convertes)
release

------>
------>c3bBbc3b

(c3
c3
c3a
c3b
(c5

convertes)
------>

c5
c5a
c5b
c5bc6c7c8c9

^release
------>
------>
(MAC)
3.

Mannos-binding
Lectin
pathway
not
mediated
by
antibodies
- mediated by microbial surfaces (plasma membrane)
Complement: c4c2
------->
------->

MBL
c4c2
release

c4ac2a
------->

c4bc2b

(c3

convertes)
------->
release
------->
----->
c4bc2bc3b

c3
c3a
c3b
(c5

convertes)
------>

c5
c5a
c5b
c5bc6c7c8c9
release

------>
------>
(MAC)
*all
D.
already
2

released

protein

goes

to

the

circulation

Specific
Immunity
- it is only activated if there is an active infection (person has
recovered
from
inf.)
acquired
immunity
responsible
in
most
of
our
diseases
types:
1.
Humoral
immunity
=
B
cells
2.
Cellular
mediated
immunity

T-cell
Helper
Cytotoxic

Primary
-

lymphoid
organs
maturation
of
B
cell,
T
cell
bone
marrow
B
cell
Thymus
T
cell
^regresses upon maturation of human body

Secondary
lymphoid
organs
fxn:
activation
of
B-cell
and
T-cell
- activated only during infection-- Dormant B cell and T cell
becomes
active.
lymph
nodes,
spleen,
tonsil
-----------------------------------------------------------------------------------------------------------------Immunoglobulins <--------> antibodies ------> produced by plasma cells
(T-cells)
composed of Fab portion (where antibody binds to)
-Light
chain
- hypervariable region (where specific
antibody
bind)
variable
region
constant
region
and
Fc
portion
(complement
proteins)
heavy
chain
5

TYPES

OF

a.
secretory
Found
b.
c.

d.

e.

Ig
secretions
IgE
Allergies,
TYPE
I
HYPERSENSITIVITY
IgM
Large/
macroimmunoglobulin
1st
to
respond
during
an
allergic
rxn.
can't
cross
placental
barrier
IgG
Dominant
Ig
can
cross
the
placenta
RH antigen - if this is wrong, baby is killed
RH
(+)
Caucasians
RH
(-)
Asians
IgD
No
known
fxn
found
in
B
cell
receptors

TYPES

in

body

OF
-

IMMUNOGLOBULINS
IgA

humoral

and

HYPERSENSITIVITY
cellular
immunity

TYPE
TYPE

a.

3
--->

-->
antiboy-mediated
cellular
mediated

Type
AKA
immediate
mediated
ex.
Allergic
rxn:
Anaphylaxis,

hypersensitivity
by
due
to
memory
Bronchial

I
rxn
IgE
cells
asthma

b.

Type
II
mediated
by
IgG,
IgM
attachment
of
antibodies
to
microbial
surfaces
ex.
Blood
transfusion
rxn
erythroblastosis
fetalis
- during 1st pregnancy IgM cannot enter (if father is
mother
is
RH
(-)
)
- during 2nd pregnancy- IgG now enters and kills

c.

Type
III
hypersensitivity
complex
mediated
by
IgG
formation
of
antigen-antibody
complex
ex.
Acute
poststreptococcal
Glomerulonephritis
Adecard disease - constant sore throat that it reaches to
heart.

RH (+) and
baby

the
d.

Type

IV
cellular
mediated
delayed
type
mediated
by
helper
T-cell
ex.
Tubercullin
rxn
poison
ivy
contact
dermatitis.
------------------------------------------------------------------------------------------------------------------

III.

MYCOLOGY

*Mycology
*Mycosis
-

mostly

superficial
fungal
markers

fungal
study
of
disease/
inf.
-es:
of
HIV
(systemic

FORMS

OF

1.
2.
-

lives

in

room

infection
fungi
plural
mycoses)

FUNGI
Molds
multicellular
filamentous
temp.
(25'C)
Yeast
unicellular

ex.
**Dimorphic

fungi

MORPHOLOGY
1.
2.

lives

in
:

non
body
Cryptococcal
Yeast

"root"
group
of
filamentous
^tubular

filamentous
(37'
C)
meningitis

temp.

inside,

mold

of
hyphae

structures

outside
Hyphae
fungi
Mycellum
molds

Septae/Septum
regular
cross
walls
in
the
hyphae
Conidia
and
Spores
- mode of reproduction/structures for asexual reproduction
3
types
of
conidia:
3a.
Arthroconidia
3b.
Blastoconidia
3c.
Chlamidoconidia
-

3.

CHARACTERISTIC OF FUNGI
a.
b.
saprophytic
(eats
decomposing
organic
c.
filamentous
Candida
albicansonly
yeast
with
true
d.
Multicellular
(except
e.
Dimorphic
(some)
causes
systemic
Basis

of
3
1.

2.

3.

classification:

MODE

OF

plant-like
matter)
hyphae
hyphae
yeast)
mycoses

REPRODUCTION
Phyla
Phylum
Glomerulomycota,
order
Mucorales
formerly
known
as
Phylum
Zygomycota
sexual
rep:
Zygospores
asexual
rep:
Sporangia/
spores
Common members:
Rhizopus
nigricans
Mucor
opportunistic
infection
Cunningliamella
Phylum
Ascomycota
sac
fungi
Sexual
rep:
Ascus/
Sac
Asexual
rep:
Conidia
common
members:
(yeast)
Blastomyces
Aspergillus
Saccharomyces
Phylum
Basidiomycota
club
fungi
sexual
rep:
Basidiospores

-ex.
MYCOSES
1.
ex.
2.
ex.

Mushrooms,

cryptococcus

Hypersensitivity
respiratory
allergens
apergilliosis
Mycotoxicosis
ingestion
of
preformed
fungal
toxin
Stale
peanuts
aflatoxin.
- aspergillus, a carcinogen (hepatocellular carcinoma- liver

due

to

inhalation

of

cancer)
Wheat
ergotoxin
,
Claviceps
purpurea
3. Mycetisma
ingestion
of
poisonous
fungi
ex.
Amanita
phalloides
(mushroom)
4.
Fungal
infection
classified
based
on
the
layer
of
skin
affected
4a.
Superficial
mycoses
(moist
areasepidermis)
most
common
for
fungal
infection
IgAskin
affects
the
skin,
hair,
nails
>
Black
Piedra
tinea
nodosus
CA:
Piedra
hortae
CM:
Black
nodules
on
the
hair
shaft
>
White
Piedra
CA:
Trichosporon
beigelii
CM:
Beige
nodules
on
the
hair
shaft
>
Pityriasis
tinea
versicolor
CA:
Malassezia
furfur
CM: white patches/ hypo and hyper pigmentation
>
Tinea
nigra
CA:
Exophiala
werneckii
CM: Dark (brown-black) pigments on the palms
4b.
Cutaneous
mycoses
(Dermis)
CA: Dermatophytes - causes diff. types of ringworm
a.
Epidermophyton
skin
and
nail
b.
Mocrosporum
skin
and
hair
c.
Trichophyton
skin,
nail,
hair
CM:
Tinea
-ringworm
BODY PARTS
TINEA
DERMATOPHYTE
---------------------------------------------------------------------------------------------------------Feet
Tinea Pedis
T.
rubrum

E.
floccosum
----------------------------------------------------------------------------------------------------------T.
metagrophytes
Groin
Tinea cruris
- same with tinea pedis
"jock
itch"
-----------------------------------------------------------------------------------------------------------Hand
Tinea manuum
- same with ^
Nails
Tinea
unguium
(onychomycosis)
----------------------------------------------------------------------------------------------------------Body/ trunk
Tinea corporis
T.
rubrum
E.
floccosum
---------------------------------------------------------------------------------------------------------Beard area
Tinea barbae
- T. metagrophytes
---------------------------------------------------------------------------------------------------------Head
Tinea capitis
T.
metagrophytes
microsporum
canes
----------------------------------------------------------------------------------------------------------4c.

Subcutaneous
Mycoses
Deeper
mycoses
acquired from skin trauma (wound)/ penetration of the

fungus
4
4.c.1.

TYPES
Chromoblastomycosis
CA:

CM:

Fonsasaea pedrosoi
Fonsasaea compacta
Phialophora verrucosa
Cladophialophora carrionii
Rhinoeladiella
aquaspora
Verrucous/ wart-like lesions

along

the

lymphatics
4.c.2.

Mycetoma
common
for
barefooted
people
- commonly affects the feet and lower extremeties
Bacteria:
Actinomycetoma
CA:
Actinomycetes
more
infectous
eumyetoma
Fungal:
Eumycetoma
CA:
Pseudallescheria boydii
Madurella
mycetomatis
Exophiala
jeanselmei
Acremonium falciforme
could manifest in 3 forms:
suppuration
and
abcess
formation
- formation of granuloma
- formation of draining abcess with granules

4.c.3.

Sporotrichosis
from
rose
thorns
usual
habitat
of
the
fungi
Habitat: soil + tree bark + rose thorns
"occupational
disease
of
gardeners"
CA:
Sporothrix
schenckii
CM: Nodules/ nodular lesions along the lymphatics
DOC:
KI
(potassium
iodide
solution)
4.c.4.
Phaeohypomycosis
-caused
by
dermataceous
mold
pigment:
melanin
CA:
Phialophora richardciae
Bipolaris
spicifera
Wangiella
dermatitidis
Exophlala
jeanselmei
Alternalia
spp.
Curvularia
spp.
Exerschilum
rostratum
CM:
solid
tarry/
encapsulated
cyst
sinusitis
and
CNS
manifestation
4.d.

Systemic/
Endemic
mycoses
- generally caused by thermally dimorphic fungi
1'
site
of
infection:
LUNGS
General
Tx:
Moderate
case
=
Itraconazole
Severe case = Amphotericin

TYPES
4.d.1.

Coccidiomycosis
Coccidioides
immitis
Coccidioides
posadesii
CM:
Valley
fever/
Dessert
rhematism
* the 1st outbreak happened in San Joaquin valley,
CA:

CA
Diagnosis:
4.d.2.

presence

of

Microscopy
spherules

Histoplasmosis
- most common acquired through pulmonary route.
determining
for
pulmonary
TB
CA:
Histoplasma
capsulatum
^fungi
is
encapsulated
CM:
Similar
TB
SPELUNKER'S
DISEASE
^mode of transportation: Bat droopings/poo
Dx: small ovid cells enclosed in macrophages.

4.d.3.

South
CA:
CM:

1'

american
blastomycosis
Paracoccidioides
brasiliensis
respiratory
granulomachronic

inflammation where
the
fungus

in
-Pharyngeal
Dx:
multiple

4.d.4.
genetalia

macrophages eat
the
lungs.
mucosal
ulcer
budding
yeast

North

American
Blastomycosis
CA:
Blastomyces
dermadidis
CM: 1' - respiratory infiltrates - can spread to BONE,
and
CNS.
Dx: thick walled with broad based single lead yeast.

4.e.

Opportunistic

mycoses
Candidiasis

>
CA:

C.
Fluconazole
^

forms
a.

Albicans

resistant
krusei
C.
lusetansi
of
candidiasis
(site
of
infection)
Cutaneous/
mucosal
ex. Intertriginous intention (between fingers)
^common
in
obese
individuals
Oral thrush - white pseudomembranous
C.

patches.

b.
and
c.

White cottage cheese-like deposit.

Onycomycosis
Nails
Vulvovaginitis
Systemic
candidiasis
- required from prostethic valves (surgery
catheters)
Chronic
mucocutaneous
candidiasis
associated
with
endocrinopathics
(usually diabetes in immunocompromised

pxs)
Dx: Candida albicans - true hyphae
Treatment:
Cutaneous/Mucutaneous
- Nystatin - only for candida
(topical)

(can

or
Ketoconazole
Systemic
Fluconazole - more preferred
cross
BBB)
Flucytosine
>Cryptococcosis
- one of the markers of AIDS (clinical stge of AIDS/HIV)
targets
Helper
T
cell
CA:
Cryptococcus
neoformans
^encapsulated
fungi

Flucytosine (poor
>

CM:
cryptococcal
mengitis
<--brain
Mode
of
transmission:
Pigeon
dropping
Tx:
Fluconazole
Standard tx: Amphoteric B (helps cross BBB) +
penetration
to
BBB)
Pneumocystis
jiroveci
pneumonia
Marker
of
AIDS
P.
jiroveci
<-specific
in
humans
former: P. carinii <--- specially in rodents
CM:
Pneumonia
a
former
protozoan
DOC:
Cotrimoxazole
or
Pentamidine
(alternative)
CA:

>

Aspergillosis
CA:
Aspergillus
fumigatus
A.
flavus
MOT:
Inhalation
of
spores
of
aspergillus
Target:
Lungs
CM:
Pulmmonary
aspergillus
^ px who were primarily infections with aspergillus
*creates
cavities
in
the
lungs-causing

aspergilloma.

Tx:
>

"Fungal
Allergic
broncho
pulmonary
Invasive
aspergillosis
DOC
is

ball"
aspergillosis
(systemic)
Voriconazole

Mucormycosis
AKA
zygomycosis
Phyllum
zygomycota
CA: Members of phylum glomerulomycota = zygomycota

(former)
CM:
DOC:

Rhinocerebellar

infection
Posaconazole

----------------------------------------------------------------------------------------------------------------

ANTIFUNGAL
A.

Superficial

mycosa
1.
Griseofulvin
MOA: protection of newly formed keratin <-- protecting the skin
from fungal
infection.
Pharmacokinetics: taken with fatty meal = high abs.
- used for tx of tines or ringworm and dermatophytes.
Administered:
PO
Fungistatic
2.
-

Nystatin
polyene

(topical)
antifungal

MOA:
Use:

tx

3.

binds
of

to
cutaneous

ergosterol
candidiasis

Terbinafine
counterpart
of
griseofulvin
inhibits
squalene
epoxidase
^accumulation in squalene ergosterol = toxic to

MOA:
fungi
Fungicidal
LARGE
4.

GROUPS
MOA: inhibition
2 types:

of

fungal

cytochrome

P450

SYSTEMIC
Azoles
(CYP450)

a.

Imidazole
less
selectivity
in
inhibiting
human
CYP450
enzyme
inhibitors
ex. Ketoconazole = USA withdrawn. more on the skin
of
A/E
Topical
Azoles:
Clotrimazole
("Canestan")
Ticonazole
(Trosyd)
Miconazole
(Daktarin)

b.

Triazoles
(systemicsafer)
Fluconazole
Voriconazole
Itraconazole
Posaconazole
A/E:
Inhibition
of
CYP450
- enzyme inhibitors (more
seen in imidazole)
anti-androgenic
effects
^lead to gynecomastia (Man boobs) and galactorea
(involuntary
milking)
lowers
libido
lowers
sperm
count
(more
on
imidazole)

because

5.

FOR

Miscellaneous
Ap-ap
used
b.
Whitfield's
c.
Selenium
d.
-DOC
a.

B.

Agents
(neither
classified)
solution
-salicylic
acid
in
tinea
versicolor
ointment
-SA
+
Benzoic
acid
sufide
Selsun
blue
anti-seborrhea
(anti-dandruff)
KI
Solution
for
sporotryhosis

Less

serious

1.
-

1st

azole

to

be

introduced

for

mycoses
Ketoconazole
clinical
use

2.

higher

propensity

to

inhibit

mammalian

CYP450

Fluconazole
- exhibits higher water solubility and higher ability to penetrate

BBB
-

used
-

DOC

for
the
Mucocutaneous
for
cryptococcal

3.
-

2nd
line
alternative
for

for
less
amphotericin

ff:
candidiasis
meningitis

Itraconazole
serious
mycoses
B
(if
severe)

C.

Systemic
mycoses
Amphotericin
B
grandfather
of
all
antifungals
MOA: Binds to ergosterol and creates pores : causing leakage of
cytoplasmic
contents in the fungi.
like
nystatinit
is
a
polyene
antifungal
Use:
systemic
mycoses
Combined with flucytosine <-- not a stand alone drug
initial
tx
to
reduce
fungal
burden.
A/E:
Renal
nephrotoxicity
Infusion
related
A/E:
Parenteral
(IV)
Dosage:
Colloidl
susp.
1.

2.
3.
DOC:
used

for

fluconazole

Itraconazole
Voriconazole
aspergillosis
resistant
candida

4.

Echinocandins
newest
MOA: inhibits an important component of chitin cell wall
Beta
(1,3)
Dglucan
caspofungin,
mirafungin,
and
anidulafungin

5.

Flucytosine
- Pyrimidine analogue of antineoplastic 5-fluorouracil.
Prodrug
---->
5-fu
MOA: taken up by the cell via cytosine permease
Cytosine permease - converted to 5-FU forming two active

metabolites:

(standard

Fluorodioxyuridine
monophosphate
(FDUMP)
Fluorouridine
triphosphate
(FUTP)
5-FC --> 5FU --> FDUMP, FUTP <-- inhibits nucleic acid sythesis
USE: combined with amphotericin B for cryptococcal meningitis
tx)
it
is
only
effective
for
yeast
infections

6.
DOC
Also

for
for

effective

Posaconazole
mucormycoses
and
aspergillus

candida

------------------------------------------------------------------------------------------------------------------

IV.

VIRULOGY

Characteristics:
obligate
intracellular
parasite
acellular
- do not replicate - replicate only when the host cell replicates
non
living
- can also infect other living cells -- bacterial cell (bacteriophage)
Morphology:
1.
Nucleic
^basis

acid

--

DNA

of

2.
-

core

basis
protein
serves
as

Capsid
viral
oart
protection

of

or

RNA
classification

symmetry
(shape)
of
the
virus
of
nucleic
acid
core

3.

Envelope
also
a
protein
not
all
viruses
have
an
envelope
(naked)
- if virus is enveloped - they are susceptible to inactivation or
destruction
(protein
denaturation)
- if naked - they are not susceptible for inactivation ro
destruction
^Paradoxical
reverse

Symmetry
1.

of

Virus

Icosahedral/
cubic
composed
of
20
faces
equilateral
triangle
most
are
spherical
GENERAL RULE: All DNA viruses are icosahedral except POX

VIRUS.
All RNA (+) sense are all icosahedral except FLAVI VIRUS,
VIRUS
and
RETRO
VIRUS.

CORONA
2.

Helical
shape
form
of
a
helix
(spherical)
GENERAL RULE: All are RNA (-) sense except ARENAVIRIDAE

3.
Po

neither

helical
Fa

or
Co

Complex
icosahedral
Re

Pox
Flavi
Corona
Retro

virus
virus
virus
virus

Viral

Genome:
double
stranded
GENERAL RULE: All DNA viruses are DS except REOVIRUS (RNA) and
Parvo virus
(single
stranded).
SS = most RNA are single stranded except REOVIRUS (ds)
RNA

viruses

classification:
sense
identical
to
mRNA
of
the
host
cell.
easily
translated
into
protein
sense
complementary
to
mRNA
is not translated but can be converted to (+) to produce

Lysogenic
preparatory
avirulent
no

(+)
(-)
protein

VIRAL

LIFE

1.
AKA

2.

Lytic
AKA
presence

STEPS

1.
2.
3.
4.
5.
6.

IN

VIRAL

Expression
Synthesis
Packaging

virulent
of

of

CYCLE

stage
stage
stage
S/S
stage
stage
S/S

INFECTION

Attachment
Penetration
of
viral
genome
Replication
virions
<-young
virus
and
release
of
virions

Unconventional
Viruses
do
not
infect
human
cells
1.
Viroids
single
stranded
smallest
pathogen
that
can
infect
plants
2.
Prions
viral-like
does
not
contain
nucleic
acid
they
only
have
proteins
resistant
to
heat
Mad
cow's
disease

Diseases:
-

Scrappie
sheep
"encephalopathy"
Mad
cow's
disease
Bovine
spongioform
encephalitis
- Kuru - cannibalism in a tribe in papua new guinea. They eat the
brain of their
dead
tribemates.
Creatz
Held
Jakod
Disease
like
kuru

GENERAL

PROPERTIES

DINExceptions:
Parvo
Pox
Pox
*Naked
-

ouble

OF

DNA

VIRUSES

stranded
cosahedral
(replicate)

ucleous

virus

Virus
virus
(replicates
in

DNA virus
Adenovirus
Parvo Virus
Papilloma virus

(ss)
(complex)
cytoplasm)

the

Enveloped
DNA
Pox
Hepadna
Herpes
Polyoma

GENERAL

PROPERTIES

S-ingle
EC-ytoplasm
S-pherical/helical
Exceptions:
Reovirus
PRC
(Naked)
ROI:
Retrovirus,
Rabies
virus

OF

RNA

virus
virus
virus
virus
virus

VIRUSES

stranded
nveloped

(ds)
Picorna,
Reovirus,
Calicivirus
Orthomyxovirus,
Influenza
virus
helical
bullet
shape

Segmented
Viruses
^ viruses capable of genetic assortment, form different strains.
Bunya
Virus
(hemorrhagic
fever)
(ss)
Arena virus - from rodents (also causes hemorrhagic fever) (ss)
Reovirus
(ds)
Orthomyxovirus
*flu/influenxa virus is capable of genetic assortment. (H1N1, H5N1 <-strains)

DNA

1.

VIRUS

(generally

there

is

no

tx

for

viruses)
Adenovirus
intestine

Target:
Conjunctiva,
pharynx,
small
CM:
Pink
conjunctivitis
(sore
eyes)
self-limiting
^ do symptomatic approach- just let it pass.

Pharyngitis
Gastroenteritis
Respiratory
Hemorrhagic

2.

3.

4.

respiratory

(sore

throat)

diseases
cystitis
Parvovirus
common
in
dogs
simplest
DNA
virus
(ss)
Target: Tropism to red blood cell / affinity to red blood cells
most
virulent
strain
:
Parvovirus
B19
CM: Erythema
infectiosum
(children)
^known
as
5th
disease
S/S: Children - Slapped cheek appearance
Adult
Arthritis
Transient
aplastic
anemia
(acute
anemia)
Pure Red cell hypoplasia (dec. in no. of red cell)
- severe chronic anemia usually associated with
IC(immunocompromised)
patients.
- can cross the placenta - cause hemolysis
kills
the
baby
=
Hydrops
fetalis
Papilloma
virus
1st
virus
common
cause
of
warts
CM: inc. in proliferation of stratum basale and spinosum.
*
Before
Sex
get
latex
condom
(Stratum
basale,
spinosum,
lucida,
corneum)
Strain
number:
1
Plantar
warts
(most
common)
2
common
skin
warts
7
Butcher's
hand
warts
**6, 11 - condyloma auminata (genital/ anugenital warts)
^
laryngeal/
tracheolaryngeal
cancer
**16, 18 - cervical cancer (girls)
Prevent
papilloma:
Vaccines: Quadrivalent ( 6, 11, 16, 18) - Gardesil
Bivalent
(16,
18)
Cervarix
Polyoma
virus
2nd
to
cause
cancer
>
BK
virus
- causes nephrotoxicity to renal transportation.
causes
bone-marrow
toxicity/cancer
>
JC
virus
among
AIDS
pxs.
CM: PML - Progessive multifoccal Leucoencephalopathy
Common
among
IC
pxs.
>
Ki
and
Wu
virus
- contain in laryngeal aspirates of children who had
infection.
>
Merckel
cell
virus
- common among px with merckel cell carcinoma. (cancer

in

endocrine)
SV40
virus
- commonly found in human tumors (brain, respiratory mesothelioma,
and
lymphoma)
Pox
Virus
complex
usual
shape
is
"brick-shaped"
TYPES:
a.
Orthopox
Members:
Monkey
pox
1'
member
CM: cervical lymphadenopathy (inflm. of lymph
>

5.

nodes)
- Cow pox - ancestor of the vaccinia virus <-- 1st vaccine
CM:
Red-base
lesions
Small
poxeradicated
in
1980
CM: lesions - appears on the head (cephalogaudal) starting from the head heading down.
*Varicella
from
trunk
to
head
- lesions are all in the same stage***
Vaccinia
virus
- model of all poc virus in terms of structure and

appearing

replication.
(standard)
used
b.
c.
d.
6.

in

small
pox
Parapox
ORF
virus
CM:
Contagious
pustular
dermatitis.
Occupational
disease
of
sheep
handlers
Mollusca
pox
virus
Mollusca
contagious
virus
CM: small pink warty-like lesions on the skin
YATApox
virus
Yabapox
Tanapox
Herpes

vaccination

of

Virus

Characteristics:
1st stage: can become a laten infection - px is asymptomatic
- tends to go to the nerves and become dormant
Cytophatic
effects
(cause
deformation
of
cells)
FAMILIES
(3):
-------------------------------------------------------------------------------------------------SUBFAMILY
STRAIN #
HERPES
VIRUS
-------------------------------------------------------------------------------------------------Alpha Herpes
1
Herpes
simplex
virus
1
2
Herpes simplex virus 2
3
Varicella
virus
-------------------------------------------------------------------------------------------------Beta Herpes
5
Cytomegalo
virus

6
Human herpes virus 6
7
Human herpes virus 7
-------------------------------------------------------------------------------------------------Gamma herpes
4
Epstein- barr virus
8
Human
herpes
8
-------------------------------------------------------------------------------------------------a.
Human
herpes
simplex
virus
1
&
2
>
HSV1
Face
nonsexually
transmitted
CM:
Gingivostomatitis
(mouth)
Cold
sores
Fever
blisters
Keratitis
(eyes)
Herpes
encephalitis
>
HSV2
sexually
transmitted
CM:
Congenital
(neonatal)
herpes
Genital
herpes
Herpes
meningitis
b.
Varicella
*variety
of
lesions
CM:
Chiken
pox
S/S:
water-filled
/
vesicular
lesions
*Lesions are NOT in the same stage (all over the body)
starts
in
the
trunk
area.
CI:
Aspirin
(ASA)
- not allowed -- complication - Reye's Syndrome (?)
***
Zoster
CM: Shingles - due to activation from latent infection of Varicella.
In
Ic
pxs.
S/S: lesions are very painful. It already involves the nerves
(not
all
over
the
body)
Dermatomal origin - area of the skin innervated by a
nerve connected
to
the
spinal
cord.
c.

d.

Cytomegalo
virus
most
common
congenital
infection
most
lethal
to
cause
deformity
in
babies
can
cross
the
placental
barrier
vertical
mother
to
baby
Mother
to
baby
S/S:
asymptomatic
(90-95%)
Symptomatic
(5%-10%)
retiritis
mental
growth
restriction
jaundice
hepatospleenomegaly
- can cause sequelae (Blindness, Deafness, Mental
retardation)
Human
herpes
virus
6&
7
>
HHV6

CM:
-

e.

f.

Infantem

sibitum/
Roseola
6th
disease
>
HHV7
(rabies)
CM:
related
to
Infantem
subitum
Higher
titer/conc.
of
HHV7:
salivary
glands
Epstein-barr
virus
(EBV)
CM:
infectious
mononucleosis
(IM)
aka
kissing
disease
Cancers:
Gastic
CA
hodgkins
and
nonhodgkins
lymphoma
^B-cell
lymphoma
***Burkitt's
lymphoma
"Black
man's
disease"
Human
herpes
virus
8
(1980)
CM:
Kaposi
sarcoma
(common
among
AIDS)
- black circle that grows bigger in the neck/leg.

7.
**only
Family:

one

Hepatitis
DNA-hepa

Hepa
DNA

Virus
B
viridae

Hepa A
Hepa B
Hepa C
Hepa
D
Hepa E
-----------------------------------------------------------------------------------------------------------------Characterstics:
RNA
DNA
RNA
unclassified
RNA
(coinfection
with
hepa
B)
-----------------------------------------------------------------------------------------------------------------Family
Picorna
Hepadna
Flavi
unclassified
Itepe
viridae
viridae
viridae
viridae
-----------------------------------------------------------------------------------------------------------------Source
Fecally
Blood and
Blood and
Blood
and
Fecal
transmitted body fluids body fluids body
fluids
-----------------------------------------------------------------------------------------------------------------Mode of
Fecal-oral
Blood transfusion- needle prick, congenital
trans. Fecal
transmission
-oral
-----------------------------------------------------------------------------------------------------------------Chronic
NO
YES
YES
YES
NO
infection

-----------------------------------------------------------------------------------------------------------------Disease
infectious
serum hepa non A,
Cirrhosis +
hepa
hepa
non B hepa fulminant
on
hepa
pregant
women
----------------------------------------------------------------------------------------------------------------->

Hepa
D
requires
coinfection
of
Hepa
B
^also
known
as
Delta
agent
Hepa
B
+
Hepa
D
=
severe
hepatitis
> Hepa B & C - can cause hepatocellular carcinoma (cancer of the liver)
cirrhosis
of
the
liver
(presence
of
nodules
due
to
chemicals
(hepacort)
Diagnosis

of

Hepa

Hbs antigen
Interpretation

(common

anti Hbs

in

phils.)

antiHbc

(already in the body)

(protein present in virus)

(antibodies, long-term)
(chronic, present in vaccination)

(recent

past)

(+)

(-)

(-)

current

(+)

(+)

acute

infection/

(+)

(+)

prev.

infection/

(-)
(-)
(+)

(+)
(-)
(-)

inf. in the recent past

no
exposure
vaccination response

or

active

infection

(+)
chronic
infection

(-)

immunity

(-)
(-)
(-)

------------------------------------------------------------------------------------------------------------------

RNA
A.

VIRUSES
RNA
1.

(+)

Sense

(Pi

CoT

smallest
naked
RNA
SUBFAMILY
a.
Primary
target:
Portal
of
ex.
>
Primary target:
intestine)

Ra
RNA
(+)
Small
entry:
Peyer's

Fla
Re)
Picornaviridae
virus
sense
/GENUS
Enterovirus
intestine
Mouth
Poliovirus
patches (small

CM:

(^lymphoid tissue in the small

intestine)
Aseptic
meningitis
mild
fever
conditions
Paralytic
poliomyelitis
(paralyzed)
^ targets spinal cord (Anterior horn)
atrophy of lower leg (lack of

innervation)
*Tabe
used by

b.
c.
d.
e.
f.
2.

dorsalis:
Prevention:

targetted
by
T.
pallidum
a.
Salk
IV
(killed
viruses)
b. Sabin - PO (live attenuated viruses,
DOH"Patak
polio")
>
Rhinovirus
CM: most common cause of common colds
>
Coxsackie
viruses
*Group
A
-->
Herpangina
hand
and
foot
disease
- Acute hemorrhagic conjuctivitis
*Group
B
-->
Pleurodynia
myocarditis
pericarditis
Hepatovirus
Hepa
A
Robuvirus
Aichivirus
Parechovirus
Aphthovirus
Hand-foot-mouth
disease
Cardiovirus

Coronaviridae
largest
genome
among
viruses
Shape:
corona
-colar
shape
CM:
gastroenteritis
2nd
to
cause
common
colds
to
Rhinovirus
SARS
MERS
Strains:
229Edomestic
animals/rodents
0C43
cause
of
SARS
(2003)
*No
vaccine,
approach
is
always
SYMPTOMATIC

3.
2

Togaviridae
virus
ARBO
vector:
mosquito
genuses
a.
Alpha
virus
ARBO
virus
ex. Chikungunia virus (common in phils.)
Vector:
Aedes
aegypti
CM:
cripling
arthritis
(joints
area)
b.
Rubi
virus
not
an
ARBO
virus
"cloaked"
virus
-->

Host:
ex.
CM:
cardiac
retardation)

vertebrates
German
measles
/
Rubella
3
day
maculopapular
rash
Congenital
diseases
Child/infant: Deafness, Cataract formation,
anomaly,
mental
Adult:

4.

Severe

arthritis

Caliciviridae
Naked
RNA
aka
"Norwalk
virus"
1st outbreak happened in Norwalk, Ohio elementary school
CM: most common agent associated with viral gastroenteritis
MOT: ingestion of improperly prepared cold foods.

5.
a.

Flaviviridae
the
ARBO
virus
Dengue
virus
Vector:
Aedes
aegypti
CM:
level 1: Uncomplicated fever (most common
one

of

manifestation)
level
2:
Classic
dengue
fever
symptomatic
- signs of hemorrhage (rashes, petechae,
echimosa)

worse

weak
b.
CM:
c.
d.

Nausea
and
vomitting
Malaise
(body
ache)
Joint
pain
(break
bone
fever)
retrorbital
pain
(eye
pain)
level 3: Dengue hemorrhagic fever (2nd to the
type)
recent
fever
signs
of
hemorrhage
- low platelet count (<100, 000 per mm3)
(normal
platelet:
400,000/mm3)
signs
of
leaky
capillaries
-elevated
hematocrite
low
albumin
pleural
effusion
level
4:
Dengue
shock
syndrome
^common
among
asians
4
criteria
has
been
fulfilled**
signs of circulatory failure (hypotension,
pulse)
Yellow
fever
virus
target:
Liver
:
Jaundice
GIT
:
"black
vomitus"
West
nile
virus
St.
louis
encephalitis

e.
f.
g.

Japanese
Russian
Hepaci

virus

encephalitis
encephalitis
Hepa

virus
virus
C

6.

Retroviridae
- capable of reverse transcription (via reverse transcriptase)
human:
DNA
->
RNA
virus:
RNA
->
DNA
a.)
HIV
targets
helper
T-ells
CD4+
receptor
tropism to macrophage(CCR5) and monocytes(CXR4).
AIDS
clinical
stage
(all
infections
are
present)
b.)
HTLV
human
Tlymphocyte
virus
CM:
Leukemia

7.

Reoviridae
double
stranded,
segmented
a.) coltivirus - colorado tick fever (mountain fever)
Vector:
Dermacentor
andersoni
b.) rotavirus - most common cause of INFANTILE DIARRHEA
c.)
orbivirus
african
horse
sickness
blue
tongue
virus

B.

RNA
1.
a.
b.
-

(-)

sense
Paramyxoviridae
Respirovirus
genus
para
influenza
virus
has
several
strains
1,3 laryngotracheobronchitis (in
children)
4
mild
upper
RTI
Morbilivirus
houses
the
measles
virus/
rubeolla
prodomal
symptoms
(cough,
fever,
rhinitis,

conjunctivitis)
CM:

rashes
all
over
koplik spots (in the buccal
Complications:
Severe,
latent
panencephalitis-

c.

the prostate
d.
2.

the
body
cavity-- molars)
(subschlerosing
SSP)

^chronic
^recurring
- most common -- otitis media (ear)
Rubula
virus
--->
MUMPS
virus
CM: infectious parotitis (infection of parotid gland)
^painful
hits
facial
nerves
Complications: Male --> orchitis (inflammation of
gland)
Pneumovirus
respiratory
synsitial
virus
(RSV)
- most common cause of URTI/LRTI in children
Filoviridae

thread
like/
filamentous
>EBOLA
virus
MOT: direct contact with blood and body fluids
Strains:
(1,
2
:
most
virulent)
1 - Zaire- west african ebola epidemia (largest)
2Sudan
3Tail
forest
4Bundibugyo
**5Reston
from
Philippines,
China
from
monkey
infects pigs - respiratory disease in pigs
CM: Hemorrhagic necrosis - pathological death of cells
DIC

bleeding to
>
3.

Arenaviridae
from
rodents
Lassa
virus
house
rat:
Mastomys
ratalensis
b.
South
african
arena
virus
(Tacaribe
complex)
from
rodents
*
Junin
virus
Argentinian
hemorrhagic
fever
Rodent:
Caliomys
muscullinus
*
Machupo
virus
Bolivan
hemorrhagic
fever
Rodent:
Caliomys
caliosus
*
Guanaritu
virus
Venezuelan
hemorrhagic
fever
*
Sabia
virus
Brazilian
hemorrhagic
virus
* LCM virus (lymphocytic choriomeningitis virus)
Rodent:
House
mice
(Mus
musculus)
Bunyaviridae
-one
of
the
members
of
ARBO
virus.
a.
Phlebo
virus
vector:
Aedes
aegypti
mimicks
malaria
b.
California
encephalitis
virus
and
complex
>
La
crosse
virus
vector:
Aedes
aegypti
c.
Hantaan
and
dobrava
virus
CM:
Hemorrhagic
fever
with
renal
symptoms
d.
Sin
Nombre
virus
CM:
Hantaan
pulmonary
syndrome
e.
Puumala
virus
a.

4.

(disseminated intravascular coagulation)death

Fecal hemorrhage but minimal inflammation
Marburg
virus
acquired by lab workers from african green monkey

CM:
5.

Epidemia

(mild

version)

Orthomyxoviridae
Influenza
types:
(yearly
flu
vaccine)
a.)
Influenza
A
antigenically
unstable
Reservior:
Animals
(birds)
Can
always
result
to
an
epidemic
*has
vaccination
b.)
Influenza
B
-Influenza
B
Reservoir:
Animals
c.)
Influenza
C
-antigeniccaly
stable
no
genetic
reassortment
no
animal
reservoir/
only
in
humans
only
cause
mild
respiratory
conditions
- classified according to proteins present and antigens present.
Proteins
:
Amides
(N)
nucleocapsid
(M)
matrix
types
A,
B,
C
Antigens:
H
(hemaglutinin)
N
(neuranionidase)
typings
of
influenza
A
ex.
H1N1,
H5N1
Genetic
Strain
Progeny
2
types
>
>
-

6.

nephropathica

1
-of

&

new
genetic
Antigen
no
new
minor
types
A,
Antigenic
major
new
result
to
only
for

Rhabdoviridae

reassortment
2
strain
reassortment:
drift
strain
changes
B,
C
shift
change
strain
epidemia
type
A
(rabies)

Characteristics:
Varying
incubation
period
>
common:
1-3
months
>
can
be
1
week
or
1
year
shape:
Helical-bullet
shape
CM:
100%
fatal
encephalitis
What
to
do
when
bitten:
> observation of the dog ( standard: 10 days)
> all suspected rabid animal should be sacrifice for

autopsy
Brain:
Diagnosis:
presence
of
negri
bodies
** the more closer to the bite to the head, the lesser the
incubation
period
S/S:
Hydrophobia
Stiff
neck
Photophobia
Drooling
Exposure
category:
1.
casual
contact
wash
the
area
no
vaccine
no
rabies
immmunoglobulin
(RIG)
2.
contact
to
broken
skin/
minor
scratches
wash
the
area
give
vaccine
no
rabies
immunoglobulins
(RIG)
3.
Bite/
laceration
wash
area
give
vaccine
give
immunoglobulin
(RIG)
------------------------------------------------------------------------------------------------------------------

ANTIVIRALS
A.

Treatment

for
Respiratory
Viral
infection
Neuraminidase
inhibitor
(IV)
for
influenza
- used to release the virions (Neuraminidase enzyme)
MOA: inhibits the enzyme neuraminidase thus there woul be no
release of
virions.
ex.
Oseltamivir
(Tamiflu)
Zanamivir
(Relenza)
USE:
tx.
of
influenza
A,
B
2.
Inhibitor
of
viral
uncoating
(prevents
release
virions)
MOA: inhibits the M2 channel protein <-- uncoats virus
ex.
Amantadine
tx.
for
parkinson's
too
Rimantidine
USE:
tx.
for
type
A
ONLY
3.
Ribavirin
used together with interferon alpha for tx. of hepa C.
Tx.
of
RSV
infection
1.

B.

Treatment
I
LAET-

C.

lamivudine

Treatment

--

for
-nterferon
effective

for

for

hepa

Herpetic

Hepatitis
alpha
and
HIV
delovir
nteravir
elbivudine
Infection

Acyclovir
Baradovir
<-Penciclovir

Viral kinases
host kinases
------------------------> Monophosphate -----------------> Triphosphate
Foscarnei
Cidofovir

1.
2. Cidofovir
3.
4.
5.
6.
7.
8. Trifluvidine
D.

*all

Penciclovir

Treatment
1.
NRTI
DAZZLE ST
a.
b.
c.
d.
e.
f.
g.
h.
2. NNRTI
NEED
NE-favirenze
E-lravirine
D-

non

nucleoside

and

reverse

transcriptase

inhibitor
evirapine
elavirdine

Protease
that
sa

^enzyme
Trip
-Tripanavir
-

manufactures
SRI

inhibitor
proteins
LANFA
Saquinarin
Ritonavir
Indinavir
Lopinavir
Amprenavir
Nelfinavir
Fosamprenavir
Atazanavir

Entry
prevents
-

inserted

for
Retroviral
Infection
nucleoside
reverse
transcriptase
inhibitor
A
and
Tdoes
not
end
with
-ine
Didanosine
Abacavir
Zidovudine
Zalcitabine
Lamivudine
Emtricitabine
Stavudine
Tenofovir

3.

4.

are

Acyclovir
to the DNA
Fomivirsen
Foscarnet
Ganciclovir
Famiciclovir
Vidarabine

entry
Enfurvirtide

of
of
and

inhibitors
virus
Maraviroe

5.

Integrase
-

inhibitor
Rallegravir

------------------------------------------------------------------------------------------------------------------BACTERIOLOGY
Shapes:
1.
cocci
spherical
chains,
cluster,
single
form
2.
Bacillus/
bacilli
rod
shaped
organisms
they
do
not
exist
in
chains
and
cluster
3.
Vibrio
comma
shape
organism
single
turning
point
4.
Spirochetes
multiple
turning
points.
A.

Staphylococci
- grape-like