Agent

1. Haemophilu
s influenza

Defining
Characteristics

Growth
Requirement

Determinants of
Pathogenicity

Clinical Diseases

Chocolate Agar
Plate:
grow best in
plates
prepared by
adding RBC
to agar at
80C and
incubated at
50C for 15
mins
heating of
RBC causes
release of
factor X
(protophorph
yrin IX) or
hematin, to
release this
RBC should
be
hemolyzed,
and factor V
(NAD)
oxidized
form
Blood AGAR
do not
support
growth oh H.
influenzae

a. Capsular
Polysaccharide
serotypre B has
PRP
( phosphoribosyl
ribitol
phosphate)
considered as
prime virulence
factor
has antiphagocytic
activity
b. Membrane
Lipopolysaccharide\
similar to LPS of
E. coli
has role in:
bacterial
attachment
invassivenes
s
paralysis of
ciliated
respiratory
epithelium
c. IgA Protease
inactivates
secretory
antibodies

1. Meningitis
6 months to 2 years of
age
predisposing factors
non-immunized
pateients
otitis media
hypogammaglobuli
nemia
decreased conc.
of hemoglobin
sickle cell anemia
portal of entry
nasopharynx;
droplet infection
2. Otitis Media and
Sinusitis
3. Acute Bacterial
Epiglotitis
4. Cellulitis involving face
and neck
5. Bacteremia
caused by capsulated
organisms
presence of orgism in
the blood is
asymptomatic

coccobacillus
gram (-)
non-spore
forming
non-motile
facultative
anaerobe

6. Respiratory Diseases
a. Chronic

Laboratory
Diagnosis

Treatment

Laboratory Diagnosis
1. Gram Staining of
sputum or CSF
2. Neufeld-Quellung
Reaction
3. Culture and isolation
(Definitive Dx):
- CSF and
Levinthal and Feld's
Agar
4. Serological Tests

Treatment (Empirical
Treatment)
1. Emperical
Treatment: Ampicillin
+ Chloramphenicol
or 3rd generation
Cephalosporins
2. Ampicillin and
Amoxicillin
3. 3rd generation
Cephalosporins +
Chloramphenicol
drug of choice in
case of penicillin
resistance

since RBC is
intact and
concentratio
n of factor V
is
inadequate.
only freshly
prepared CAP
support the
growth
because
Factor V is
labile.
satellitism
H. influenzae
grow on BAP;
S. aureus is
simultaneous
ly inoculated
S. aureus
provides
additional
source of
factor
V
(NAD)
Classifications:
Six major
serotypes (AF)
classified
based on the
capsular
polysacchari
de

Bronchitis
b. Pneumonia

2. Haemophilu
s ducreyi

Chancroid
Bacillus
Ducrey's
Bacillus
Aerobic, gram
(-)
causative agent
of soft chancre
(sexuality
transmitted
disease)

3. Haemophil
us
aegyptius

Koch-weeks
bacillus
resemble noncapsulated H.
influenzae
causes purulent
conjunctivitis

Serotype B
- most
pathogenic
- Haemophilus
influenza B
vaccine
(penta
vaccine)
Quellung
Reaction
classic
approach to
serotyping
Direct
Immunofluoresc
ence
preffered for
quick
identification

1
1

Soft Chancre
transmitted through
direct sexual contact
man: symptomatic
female: carrier:
asymptomatic
lymph node (lymph
adenitis):
becomes matted &
tender (bubo)
incubation period: 3-5
days (longest: 14 days)

Microscopic
Examination
- school of
red fishes
because it is
gram (-) with
no
characteristi
c
appearance
Culture:
- specimen:
biopsy of
lymph
nodes, pus /
discharge
from bubo
- medium:
CAP with
vancomycin
vancomy
cin:
inhibit
the
growth of
gram (+)
organism
s

Oral
Erythromycin:
drug of choice
Trimethoprinsulfamethoxa
zole:
alternative
drug

4. Bordetella
pertusis

(pink eye
disease)
specimen: eye
discharge
1. Supportive
measures
2. Erythromycin:
drug of choice

gram (-), short

rod,
non-spore
forming
hemolytic
capsulated
strict aerobe
found in lungs

Adhesins:
capsular
Fimbrae /
agglutinogen
s
- filamentous
hemogglutini
n: most
important
adhesion
factor
- causes RBC
agglutination
Toxins
a. Pertussis
Toxin
- Effects:
- increase
sensitivity
to
histamine
and
serotinin:
increase
susceptibi

Whooping Cough
3 Phases:
1. Catharral Phase: low
grade fever, rhinorrhea,
and progressively
worsening cough
2. Paroxymal Phase:
paroxysms of cough:
leukocytosis
3. Convalescence: lasts 13 days
Transmission:
person to person by
inhalation of
contaminated droplets
highly communicable
contagious during
early catharral phase

1.Culture and isolation

specimen collected
using calcium
alginate
nasal swabs
moistened with
aqueous PEN
cough method
plate
doned during
catharral stage
Bordet-Gengou
Agar (selective
medium)
Culture of ReganLowe agar
2. Direct
Immunofluoresence:
for rapid diagnosis
3. Enzyme
Immunoassays (ELISA)

Prevention and
Control:
1. Immunization
DPT
2. Isolation of patient
during the catharral
phase

5. Brucellae
Species:
Brucella
mellitensis
Brucella abortus
Brucella suis

gram (-)
Non-motile
facultative
intracellullar

lity to
anaphyla
xis
- increase
insulin
synthesis
leukocyto
sis
- increase
binding to
C3
receptor
on
phagocyti
c cells
b. Adenylate
Cyclase
- Effects:
- inhibit
chemotax
is and
superoxid
e burst in
PMN's:
favors
intracellul
ar
survival
c. Tracheal
cytotoxin: cough
d. Endotoxin:
O antigen (no major
role)

Clinical Disease:
incubation period: 3-6
days

Laboratory Diagnosis:
High index of
suspicion and
based on the
occupation, ethnic

Treatment:
1 Tetracycline:
drug of choice
2 Tetracycline
and
Streptomycin
Control and
Prevention

6. Actinomye
s israelii

organisms
fastidious
grow in any
medium
require
enriched
complex media
and grow best
in 5-10% CO2
colonies may
take 2-5 days to
develop

Ability to resist
phagocytosis: due
to presence of low
molecular weight
substances that
inhibit fusion of
lyosomal granules
with the
phagosome.
1 Ability to
survive
intracellullarl
y in the
lymph node,
spleen, liver,
and bone
marrow.
(Reticuloendothelial
system)
Portal of Entry:
1

GITingestion of
contaminate
d food
(goat's and
sheep's milk)
Dermal
abrasions:
direct
contact with

Signs and Symptoms:

(non-specific Sx)
1 Influenza-like
Syndrome:
- fever (undulant,
may last for
months)
- headache
- constipation
- severe limb or
abdominal pain
2 Anemia
3 Weakness and easy
fatigability
Sequalae: due to
spread to other organs
a. arthritis
b. meningitis
c. uveitis
(eyes)
d. orchitis
(testicles)

background, and
travel history
A. Culture Isolation
Blood culture
Bone marrow
aspirate
liver biopsy
B. Serologic Tests
Agglutination
test
EIA test: detects
IgM

2
3

Vaccination
for both
animal and
host
Pasteurization
of animal milk
preparation of
milk
derivatives
with
pasteurized
milk

Epidemiology:
Reservoir: animals
Bacteria multiply in the
uterus of the gravid
animals and in the
mammary gland.
Organisms may be
excreted in milk for
years
Mortality rate: 5-10%

Treatment:

7. NOCARDIA
Species:
N.
braziliensis
N.
asteriodes

8. STREPTOM
YCES

contaminate
d animal
products,
bacteria
localized in
the RES--->
focal
abscesses
and
ceasation

Actinomycosis
presents an abscess
located near the
lower jaw (lumpy
jaw) and in the
thoracic area (upper
lobe of the lung) and
abdomen (usually
liver)
seen in patients with
history of oral surgery
and tooth extraction
which provide
opportunity for
organisms to
penetrate to deep
tissues. (esp. in
diabetic patients)

Clinical Disease:
(1) Pulmonary
Nocardiasis
- by N.asteroides
- multiple abscess
in lung, necrotic and
confluent
- spread

Laboratory Diagnosis:
Macroscopic
Examination
sulfur
granulesyellow granules
seen
macroscopicall
y in the
exudate.
Culture:
anaerobe at 37
C
colonies
usually appear
within 24-48 h
but may take
as long as 2
weeks
to grow.

Laboratory Diagnosis:
* Macroscopic
Examination
- pus with
white granules
(mycelial element)
* Microscopic
Examination
- gram staining
- acid-fast

incision and
drainage
Penicillin G: 20M
units / day (4
divided doses)

Treatment:
* incision and
drainage
* trimethoprin
sulfamethoxazole

9. L.
Monocytog
enes

hemtaogenously in the
brain
(2) Subcutaneous
Nocardiasis
- N. braziliensis
- subcutaneous
draining abscess
-exudate with
white granule
- transmission:
wound contamination or
by aspiration of
contaminated particles

-soil saprophyte
- thru wound
contamination

Characteristics:
- intracellular
organism (in
macrophages)
- small
pleuromorphic
gram (+) rod
- motile and nonspore forming
- catalase (+)
- soil, vegetables,
feces of domestic
and wild animals
- micoaerophilic

Clinical Disease
Mecytoma of Fungustumor
- subcutaneous
abscesses in lower
extremities
- invade deeper
tissues and invade the
bone

* Internalin
membrane
protein that

- weakly acid
fast
- specimen:
sputum, pus, biopsy
- filamentous
(Diagnostic finding)
* Culture
- takes 1-2
weeks

Laboratory Diagnosis
* Culture and
Isolation from
exudates and biopsy
material
- both in
bacterial and fungal
media
- chalky white
aerial mycelium with
extensive branching

Laboratory Diagnosis
- end over end
tumbling

Treatment
* DOC:
trimethophrim
sulfamethazole
(Antibacterial)
Amphotericin B
(Antifungal)
* Amputation of
involved extremities

Treatment
- PEN or betalactam
antibiotic
- immunity: long
lasting

and grow at 5-40

C avergae at 37C
- Culture BAP: Bhemolytic
- Culture NA: Blue
green color
10.
Erysi
pelothrix
rhusiopath
iae

Defining
characterist
ic:
- non-spore
forming,
non-motile,
nonencapsulate
d
- gram(+) rod
- mciroaerophilic
- alpha-hemolytic

facilitate
ingestion of
microorganis
m by
macrophage
s and
endothelial
cells
* Listeriolysin O
- major
virulence
factor
- exotixin
- hemolytic
protein
responsible
for
disruption of
phagolysoso
mal
membrane
* Phospholipases
- digesting
enzymes
that destroy
membranes
spread of
infection

Clinical Disease
* Point of Entry: GI tract
* Listeriosis
(1) Neonatal Listeriosis
- meningitis in 1st 3
weeks of life
- 54-90%
- vaginal delivery:
localized in CNS
- transplacental
transmission:
widely
disseminated
(liver, spleen,
lungs, CNS)
(2) Adult Listeriosis
- meningities,
bacteremia and
endocarditis

-motility in
Nutrient Agar
for 1-2 hours
and 22 C
- semi-solid agar
- exhibit a
motility pattern
as inverted
umbrellashaped after
overnight
incubation at
room temp
- specimen:
CSF/Blood
- Cold enrichment
procedure
- recovering of
organism in the
specimen if
placed in ref at
4C
- enhance
growth of
orgnaims

Treatment
- PEN: DOC
- Erythromycin:
Alternative
Drug

on BAP
2 colonies:
* smooth
- short,
slender
straight or
slightly
curved
- acute
infection
* rough
- long
filamentous
structure
and long
chains
- chronic
infection
primary isolation:
Heart
Diffusion
Agar with
rabbits
blood and
5% CO2
incubated
at 37C
black colonies
are formed
in Tellurite
medium
Resistant to
Neomycin:

Pathogenic
Determinant
s
* hyaluronidase
production:
virulent
strains
(Serogroup
B)
* neurominidase

Clinical Infection
- zoonotic: domestic
animals, fish,
birds, swine, cows,
horses
- human: contact with
animals and
animal products
- more prevalent in
males
- most infection skin
injury
Erysipeloid
- disease in human
- non-suppurative
purplish red lesion
at the site of
inoculation (hands
and fingers)
- (-) systemic symptoms
(-) pain
(-) lymphangitis
- disseminated and cause
infective
endocarditis and
septic arthritis

Laboratory Diagnosis
* culture:
- specimen:
aspirated/biops
ied matl from
margin of local
lesion
- blood culture:
necessary for
disease of
bacteremia or
endocarditis

used rapid
test to
differentiate
with L.
monocytog
enes