Incubation
Organism SimiIar to
Salmonella typh¡
Salmonella choleraes¡us
Salmonella enter¡t¡d¡s and
typh¡mur¡um
Sh¡gella (dysenter¡ae,
flexner¡, boyd¡¡, sonne¡)
Enterohemorrhag¡c E. col¡
(EHEC)
O15:H7
Enteropathogen¡c E. col¡
(EPEC)
Enterotox¡gen¡c E. col¡
(ETEC)
Enteroaggregat¡ve E. col¡
(EAEC)
Entero¡nvas¡ve E. col¡ (EIEC)
D¡ffuse adher¡ng E. col¡
(DAEC)
Uropathogen¡c E. col¡
(UPEC)
Pseudomonas aerug¡nosa
Klebs¡ella pneumon¡ae
Enterobacter cloacae
Serrat¡a marcescens
Proteus m¡rab¡l¡s, vulgar¡s
Ac¡netobacter bauman¡¡
Morganella
Prov¡denc¡a
C¡trobacter
Edwards¡ella
V¡br¡o cholerae
Campylobacter (jejun¡)
Hel¡cobacter pylor¡
Haemoph¡lus ¡nfluenzae
(type B and other
encapsulated, typea6fe)
Haemoph¡lus ¡nfluenzae
(unencapsulated,
nontypea6fe)
Haemoph¡lus ducrey¡
Haemoph¡lus aegypt¡cus
Haemoph¡lus para¡nfluenzae
Bordetella pertuss¡s
Leg¡onella pneumooph¡la
Mycoplasma pneumon¡ae
Mycoplasma hom¡n¡s
Mycoplasma arthr¡t¡d¡s
Mycoplasma fermentans,
¡ncogn¡tus
Ureaplasma urealyt¡cum
Gram Shape Oxygen GeneraI Features SpeciaI Features Vector[ habitat Resevoir ViruIence Factors Disease Symptoms Pathogenesis Diagnosis †reatment EpidemioIogy At Risk Prevention Vaccine Other
Period
1. suxvives stomach 2. adhesins attach to
POSlTlVE ı Tyzıa r oraI attenuated (¢
Early GI phase (incubation): may be intestinaI epitheIium (apicaI) 3. e1docytosis Wkı: +stooI, subcIinicaI
GIucose (+gas) doses over 8 days; takes
subcIinicaI w[+stooI (invasion of Peyer's patches) ¢. i1gestio1 by Wz: +bIood, symptomatic FIuoroquinoIones or 3G ControI of
MotiIity (fIageIIa) 1w; min age 6y; boost
Vi a1tige1, fac. NONE r onIy Bacterem¡c: episodic fever, macxophages (†3SS) µ. survive inside W3: +stooI, gaII bIadder coIonized cephaIosporins ReIapse in 10% patients in endemic areas water[sewage
H2S (bIack precipitate) Contaminated every µy)
Nitrate reduction intraceIIuIar food[water infects 7r1¢ days Enteric (†yphoid) Fever bradycardia, skin rash (Rose spot), vacuoIes (Vi) 6. kiII macrophage and Chxo1ic caxxiex states (3%) Rare in N. America, Europe, AustraIia DeveIoping worId Food safety z ViCPS r Vi capsuIar
pathogen humans Ieukopenia, enIarged Iiver[spIeen dissemi1ate via thoracic duct to bIood, Iiver, ID via MacConkey[EMB Agar (gaIIbIadder): 1. AmpiciIIin or High i1ocuIum Pastuerization
O 8 H antigen SPl-ı (invasion) †3SS poIysaccharide (takes
Late GI: intestinaI hemorrhage or spIeen, gaII bIadder 7. fever[shock 8. reinvade (confirms nonrrIactose Cipro 2. ChoIecystectomy Carrier screening
SPl-z (survivaI), LPS (endotoxin) 2w; min age 2y; boost
perforation GI via gaII bIaddex 9. GI bIeed and sometimes fermentation) every
NEGATlVE
ShigeIIa, E coIi diarrhea 2y)
fac. Lactose
(Enterobacteria r rod Anaerobe High fever and bacteremia after onset High i1ocuIum Young, maIaria, immune
Oxidase
ceae FamiIy) Contaminated of gastroenteritis
Spores Swine 6r72 hours Septicemia (i1fectious dose: 1000 organisms) dysfunction, steroid use,
food Micxoabscesses can deveIop
IndoIe Rare sickIe ceII, cancer
anywhere
Urease
IsoIation in feces FIuid and eIectroIyte Biotexxoxism: 198¢
LPS reIease during epitheIiaI ceII (intestines)
MlSC PouItry, pork, dog MacConkey[EMB Agar repIacement High i1ocuIum Both deveIoped and Oregon r Rajneeshee
2200 serotypes food, eggs Lasts ı-¢ days. Headache, chiIIs, abd. invasion r symptomatic †reat patients with predisposing Most common SaImoneIIa infection in US attack
Serotyping and PCR tests w[ Pets (reptiIes) 8r¢8 hours †3SS, LPS, pextussis-Iike toxi1 Acute gastroenteritis †3SS mediated invasion deveIoping countries
(common), fruits pain, vomiting, diarrhea w[fever conditions with antibiotics (amp, SeIf-Iimiti1g, compIications can arise, death is
O 8 H antigens aIIows ExtraceIIuIar ceIIs produce toxins (pertussisr PIayi1g i1 a sa1dbox
and vegetabIes suIfa, 3G ceph, cipro; resistance uncommon Infectious agent can be
species identification Iike) r promote infIammation and secretion
is possibIe) on sheII or inside egg
POSlTlVE
GIucose (rgas) 1. acid toIerant 2. invade intestinaI ceIIs (iIeum
O antigen and coIon) 3. uptake by macrophages into Low inocuIum (100), seIfrIimiting, rareIy fataI
SaImoneIIa, E vacuoIes (†3SS) ¢. escape from vacuoIe into IsoIation in feces FIuid and eIectroyIte Dysenter¡ae: most common species in deveIoping
Fever (LPS), diarrhea, abd. cramps Ca1 detect oxga1isms i1
coIi fac. NEGATlVE Fac. intraceIIuIar ¢F's: food, NONE r onIy Shiga toxi1 (exotoxin) BaciIIary Dysentery (Shiga toxi1) cytopIasm r› ceIIrtorceII spread (†3SS) µ. Detect PMN (indicative of invasive repIacement therapy (esp. worId ChiIdren ‹10y Live attenuated vaccine
r rod Lactose fingers, feces, infects 1r¢ days A subun¡t: interferes w[60S rRNA function (shigeIIosis[bIoody apoptosis of macrophage r› rerinfection 6. ILr young chiIdren) Flexner¡: common (18%) in US and deveIoping Sanitation feces up to ı-¢w aftex
(Enterobacteria Anaerobe pathogen BIoody diarrhea w[mucus process) AIso infects aduIts 1ot vexy effective
H2S fIies humans B subun¡t: binds to intestinaI ceIIs diarrhea) 1 and †NF from macrophage Ieads to fever Antibiotics (cipro, suIfa; severe countries xecovexy
ceae FamiIy) Bacteremia (rare) KIiger Iron Agar
NonrmotiIe and systemic symptoms 7. IntestinaI cases) r increasing resistance Sonne¡: most common species in US (7µ%)
IndoIe uIceration (Shiga toxin) 8. diarrhea 9. Body¡¡: common in Indian subcontinent
Urease apoptosis of mucosaI ceIIs + uIceration
H antigen
2012 outbreak in
Germany of O10¢:H¢
SorbitoI negative growth (SorbitoI
T3SS (Lee pathogen¡c¡ty ¡sland) MacConkey Agar) †3SS genes (Esp)
Tix: †3SS secreted protein deIivered to epitheIiaI 1. piIirmediated attacment (weak) 2. †3SS encoded on LEE (LEE:
ceII surface for E. coIi attachment induced formation of attaching Iesions 3. Direct or Iatex agg. tests (O1µ7) Low infectious dose Iocus for enterocyte
SoxbitoI 1egative Petting zoos l1timi1: †ir binding protein on E. coIi surface HemoIytic uremic Abd. Pain (3d postringestion), bIoody other E. coIi proteins recruit host ceII actin Supportive care HUS in ~7% of cases (due to RBC destruction and effacement)
ShigeIIa ModerateIy invasive Food[water Shiga-Iike toxi1 (STX): gene on phage, disrupts syndrome (HUS) if toxin diarrhea, ceIIs remain IargeIy (aIter morphoIogy and impact signaI H7 seroIogy and toxin anaIysis damage to BV waII Iining) pathoge1icity isIa1d r›
ExtraceIIuIar Pexso1-to-pexso1 CattIe euk. protein synthesis (cytotoxic) via RNA cIeavage spreads r› due to Shigar extraceIIuIar (some invade mucosaI transduction pathways in host ceII to form A1tibiotics a1d a1timotiIity Acute renaI faiIure (via HUS) in severe cases LEE aIso encodes intimin
(subunit A), impacts cytoskeIeton (subunit B) Iike toxin ceIIs), NEVER systemic A[E Iesio1s) ¢. Iesions Iead to effacement PCR[Immunoassay for ShigarIike age1ts axe co1txai1dicated and tir
(chiIdren ‹10; eIderIy)
HemoIysi1 (RTX): pore forming protein, common in (destruction of host ceII microviIIi) µ. toxins
meningitis causing E. coIi, pIasmid encoded interaction of other viruIence factors Gxai1 fed cattIe CattIe axe immu1e - Iack
CapsuIe (Krantigen), LPS PCR or DNA probe anaIyssi of harbor more acid Gb3[CD77 (host
viruIence genes to identify strains shock resistant E. gIycoIipid for Shigartoxin
POSlTlVE
col¡ binding) but 28% shed
Lactose
EHEC
GIucose (+gas)
fac. Attaching[Effacing (A[E) Iesions Antibiotics guided by Leading cause of Hay feeding Ieads †oxins 1ot detected in
r rod Nitrate
Anaerobe ModerateIy invasive Pexso1-to-pexso1 ChiIdhood Diarrhea Diarrhea LocaIized adherence by bundIerforming piIi susceptibiIity testing for severe Common in deveIoping countries chiIdhood diarrhea to a higher pH =› stooI of infected
BundIerforming piIi (Bfp)
NEGATlVE or protracted cases (deveIoping countries) Iack of
HeatrIabiIe toxin (LT): targets adenyIate cycIase =› 1. fimbriae adhere to receptors on adaptation of
Oxidase Food[water Loperamide (+fIuoroquinoIone) Infants in deveIoping
Nonrinvasive increased cAMP IeveIs =› excess CIr secretion and enterocytes in SI 2. net Ioss of fIuid and pathogenic E. col¡
†raveIer's Diarrhea Watery diarrhea Azithromycin or rifaximin (for countries (chiIdhood
Pexso1-to-pexso1 bIocked Na+ uptake eIectroIytes into Iumen of gut (L†[S†) 3.
PCR or DNA probe anaIyssi of traveIers) diarrhea)
HeatrstabIe toxin (ST): aIters cGMP IeveIs watery diarrhea (L†[S†) Hygiene
viruIence genes to identify strains
Heat stabIerIike toxin (EnteroAggregative stabIe More aggressive than
toxin; EAST) Persistent diarrhea FIuoroquinoIones (traveIers and ChiIdren in deveIoping
No A[E Iesions and Chronic Diarrhea Aggressive epitheIiaI ceII attachment †issue cuIture assays Common in deveIoping countries EPEC (different
EPEC PIasmid encoded toxin (Pet) Weight Ioss HIV+) countries
nonrinvasive
coIonization factors)
HemoIysi1
Strain typing (puIsed fieId
ShigeIIa Does 1ot produce PIasmid encoded genes for invasion, repIication, 1. attaches to ceIIs of coIon via nonrfimbriaI eIectrophoresis) r› outbreak tracing
Watery diarrhea that can contain
dysentery L†[S† Food Diarrhea adhesins 2. invades mucosaI ceIIs 3. muItipIies Less common in industriaIized nations
and survivaI (simiIar to ShigeIIa) bIood and mucus
HighIy i1vasive within ceII but does not become systemic.
May be
OIder chiIdren in
heterogeneous Diarrhea
deveIoping countries
coIIection of strains
RepIicate Many U†I bacteria capabIe of binding
Cystitis (dysuria, freqency, urgency, mannosides that are common constituents of Most toxic component
intraceIIuIarIy
(epitheIiaI ceIIs) and suprapubic tenderness r typicaIIy uroepitheIiaI ceIIs and urinary tract mucus r Most common cause of U†Is (9µ%) of most bactermic
adhesion is bIocked by mannose isoIates of E. col¡ is LPS
Opportunistic Iower U†I) 27r¢¢% experience at Ieast 1 recurrence within 6mo,
Neisseria U†I and GI infection
infection PiIi
fac. Sexum xesista1ce Catheters LPS, Kı poIysiaIic acid capsuIe (antiphagocytic), HemagguItination with sensitivity SeIfrIimiting despite antibiotics Women
meningitidis rod Anaerobe POSlTlVE (correIated w[K1 NeonataI meningitis Acute pyeIo1ephxitis (U†I MS: type 1 (cystitis) to ma11ose testing Men via sexuaI activity Pod[biofiImrIike
FemaIertormaIe fIageIIa, siderophores, motiIity, hemoIysi1
(K1) Bacteremia
acteremia Prs 8 S (cystitis) structures form within
Lactose production) is a disseminated to kidney r fIank pain, Most common neonataI pathogen (K1 r neonataI
P (pyeIo1ephxitis and cystitis) ceIIs of urinary tract =›
criticaI trait of tenderness, fever, dysuria, frequency, meningitis)
Adhesi1 contribute to persistent
bactexemia causing urgency)
Dr (cystitis) infection
strains
F (pyeIonephritis)
Associated with
Opportunistic BiofiIm (CF) EIastase breaks down eIastin (Iung tissue
obIigate AIgi1ate sIime LPS, Endotoxin, exotoxins (eIastase, Requires aerobic incubation r› Chronic infections generaIIy occurs in Iung in Immunocompromised burns, catheters,
damage)
cannot ferment sugars (can be impIants,
rod aerobe NEGATlVE capsuIe (green + phosphoIipase), †3SS, Pyocya1i1 (bIuergreen Bacteremia PhosphoIipase breaks down phosphoIipids in association with respiratory diseases (bacteremia), COPD and ventiIator associated
pigment, generates ROS) anaerobic r› nitrate or arginine) CF pneumonia (VAP),
Sugar fermentation mucoid phenotype) host ceII membranes and surfactant
impIants, eye wounds
Opportunistic
Red cuxxa1t jeIIy U†I Primary pneumonia (w[underIying
CapsuIe toxins (reduced phagocytosis, reduced CapsuIe production causes mucoid AIcohoIic, diabetic, Iung
sputum Bacteremia probIems), wound infections, diarrhea
POSlTlVE compIement activity) coIo1y moxphoIogy disease
Mucoid phenotype Meningitis by enterotoxigenic strains
Lactose
Opportunistic
MotiIe and Iess HospitaI setti1g Associated with burns,
encapsuIated foIIowi1g a1tibiotic wounds, respiratory and
POSlTlVE
(contrast KIebsieIIa) txeatme1t urinary infections
Lactose
Infection secondary to
r Common in envrionment broad spectrum
Opportunistic Pneumonia (after use of
fac. Pxodigiosi1s (red GI tract resevoir MSrfimbriae, proteases, siderophores, swaxmi1g InvoIves most tissues (more associated with antibiotic treatment or Associated with shower
Anaerobe a contaminated respiratory and urinary tract, Iess IikeIy to coIo1ize instrumentation
NEGATlVE pigment) (neonates) motiIity (coIonization) heads
respirator) Gl) Hexoi1 addicts a1d
Lactose
septic axthxitis (outside
hospitaI)
Opportunistic
POSlTlVE Urea r[urease)r› NH3 + CO2 r› aIkaIine urine r›
Urease FIageIIa (swaxmi1g motiIity), urease U†I saIt cxystaIizatio1 a1d sto1e foxmatio1 r› Frequent cause of U†I
chronic infection
NEGATlVE
Lactose
Opportunistic
IndweIIing CapsuIar poIysaccharides, protein adhesins, Second onIy to P. aerug¡nosa in frequency of
short rod aerobe NEGATlVE HospitaI MuItidxug xesista1t recovery of nonrfermentative Gr baciIIi from human HospitaIs
medicaI devices proteoIytics and IipoIytic enzymes, LPS
Oxidase sources
Lactose
Proteus Opportunistic U†I
Opportunistic U†I NoscocomiaI infections of urinary tract bIood,
respiratory tract, and wounds
(d¡versus)
Opportunistic Enterotoxigenic (freund¡¡) Neo1ataI me1i1gitis
Brain abscesses
Opportunistic Gastroenteritis
More of a worIdrwide probIem now as compared
1. gastic acid inactivates many but some to 1992
V¡br¡o survive 2. enter smaII boweI r bind to l1activated: 2 oraI doses
parahaemolyt¡c epitheIium 3. †CP enabIes microcoIony E1demic (southrcentraI[east Asia; African refugee Watex: bottIe, (crude suspension)
us (invasive formation in intestinaI crypts ¢. choIera toxin camps; South America) carbonate, CI, 70% effective, not
OraI[IV fIuid repIacement
gastroenteritis r PainIess, odorIess profuse expressed and secreted, binds to GM1 boiI recommended for traveI,
gangIiosides of ceII membrane µ. (eIectroIyte)
sheIIfish) Oı: epidemics r Contaminated NONE r onIy O 8 H a1tige1s watery[secretory diarrhea (xice watex Pa1demic (deIta of Ganges and Brahmaputra currentIy used in Haiti
fac.
comma POSlTlVE cIassicaI 8 hemoIytic infects E1dotoxi1 ChoIera stooI), isotonic voIume Ioss, neuraminidase converts other gangIiosides to YeIIow opaque coIonies on TCBS rivers) lce: beware John Snow and the
H2O, sheIIfish, Antibiotics (reduce duration of
V¡br¡o vuln¡f¡cus Anaerobe MotiIity (poIar fIageIIum) (EI †or) seafood humans Enterotoxin (choIexa toxi1: ABµ) GM1 r increased toxin binding sites 6. choIera medium diarrhea µr10 r› 1r3d) 7th pandemic (EI †or O1) began in Indonesia and Live-atte1uated: effective Broad Street pump
dehydration, Iow BP (shock), potentiaI
(wound O139: 90s epidemic †oxin coreguIated piIus (TCP) r coIonization toxin enters intestinaI ceIIs (endocytosis) r spread to Latin America (first choIera outbreak in Food: dry, in North American cIinicaI
death DoxycycIine (aduIts) or
infection r stimuIates ade1yIate cycIase[cAMP Western worId (gIobaI pandemic) steaming hot, triaIs but not in fieId
azithromycin (chiIdren[pregnant)
seawater[sheIIfi production =› massive intestinaI fIuid Ioss via speciaI attention miId side effects common,
sh r underIying 2 mechanisms (viIIus ceIIs r decreased NaCI l1fectious dose is souxce depe1de1t to sheIIfish Iicensed and
Iiver disorder) aborption AND secretory ceIIs r increased (contaminated rice is highIy infectious) unmanufactured
CI[HCO3r[H2O secretion into gut)
1[1000 deveIop autoimmunity to nerves =› GuiIIai1-
Baxxe Sy1dxome (temporary paraIysis) Recovery and Abr
r SeIf-Iimiti1g
Can survive AnimaIs (esp. Cases are typicaIIy spoxadic (summer[earIy faII Infants to young aduIts Pasteurization of mediated immunity are
intraceIIuIarIy, cross Diarrhea StooI cuItue on seIective media peak) in deveIoped characteristic
POSlTlVE Food (esp. raw pouItry rdoes Prodrome (fever, maIaise, headache); 1. survive gastric barrier 2. arrive in smaII[Iarge Supportive therapy (fIuids, etc) miIk, cooking
comma microaero epitheIiaI barrier, 3rµ days InfIammatory GI (campyrBAP with cephaIothin) MuItipIe simuItaneous cases usuaIIy point to Infants in deveIoping
Hippurate chicken) or water not make fever; abd. pain; diarrhea boweI r infIammation 3. bIoodstream (rare) AntimicrobiaI theraby as meat (esp.
become invasive, and Bacteremia (rare) incubated at body temp of pouItry indicated (erythromycin; aIt r common contaminated source Immunocompromised Low i1fectious dose
animaIs sick) pouItry)
be secreted back out cipro) Humanrtorhuman transmission rare (severe) (1 drop of raw chicken
Most commo1 etioIogic age1t of diaxxhea i1 the juice)
woxId
RadioIabIed uxea test (Bxeath test)
FecaI matter Antibiotic treatment
BabA (adhesin r binds to Lewis b Ag on surface 1. Iives i1 stomach and duodenum mucus r›
present in tainted
ofstomach epitheIiaI ceII) StooI cuIture (campyrBAP with suppIemented with bismuth
food[water secretes urease (creates basic environment)
CagA (injected into stomach epitheIiaI ceII r cephaIothin) + rapid urease test saIts (reIapses require furter
POSlTlVE Peptic uIcer 2. immune ceIIs can't penetrate mucus r› Present in µ0% of worId's popuIation (highest in High (›10k) in nonr
spiraI cag pathoge1icity phosphoryIated and disrupts cytoskeIeton, treatment)
Stomachrtor Gastritis Recurrent pain in upper abd., GI bIeed reIease superoxide radicaI upon death =› deveIoping countries r correIates with greater human primates r›
Urease isIa1d adherence to adjacent ceIIs, intraceIIuIar signaIing, Seroconversion
mouth by gastror Gastric cancer destroy stomach ceIIs 3. gastxitis (days), incidence of gastric cancer) unknown in humans
ceII poIarity) Contrarindicated for
esophageaI refIux uIcex (Iater), metapIasia, ca1cex (MAL†
VacA (injected r further damages epitheIiaI ceII PCR asymptomatic infected except in
(gastritis) =› Iymphoma)
Iining speciaI circumstances
kissing
Endoscopy + histoIogy (biopsy)
Meningitis: 3G cephaIosporin
CapsuIax-based sexotypi1g (agg., immediateIy for meningitis,
precip., queIIu1g) ampiciIIin with cIavuIanate (betar
Me1i1gitis
Iactamase inhibitor) then
Bactexemia
†ype I: EpigIottitis (Iess comon) BIood and CSF cuIture in chocoIate amoxiciIIin if sensitive 6r12 months of age (no Conjugate capsuIar
POSlTlVE and obstructive 1. respiratory aerosoIs 2. coIonization (weeks agax + CO2 r› prep. (miId heat) Most common encapsuIated strain (type B) r› more passive immunity) (effective) r PRP Iinked to
coccobaciIIi fac. Urease CapsuIe (antiphagocytic r ribose for †ype B), lgA Iaryngitis (may be fataI Starts as nasopharyngitis (w[otitis to months) 3. IgA proease (may aid in reIeases both X 8 V from RBCs Contacts: rifampin, cipro, or decreasing with vaccination ProphyIaxis in diphtheria toxoid for
AerosoI ceftriaxone CompIement househoIds with
(pIeiomorphic) Anaerobe Ornithine pxotease, LPS, piIi within 2¢h) media or sinusitis) immune evasion) ¢. can induce ciIiary stasis increased †rceII
ImmunofIurorescence[immunoeIect PreviousIy most common cause of bacteriaI deficiencies young chiIdren
decarboxyIase CeIIuIitis (face) or via decoxatio1 of LPS with host choIi1e dependence =› more
rophoresis of CSF Augementin (for Amprr strains) meningitis in chiIdren (‹¢y) Carried by 7µr80% of the
IndoIe production chiIdhood pyarthrosis immunogenic in chiIdren
2 growth factors required (X DeveIoping countries popuIation (µ% are
(pus in joint)
8 V) Pneumonia Urease, ornithine decarboxyIase, Meningitis can Iead to neuro encapsuIated)
X (heat stabIe): hemin and indoIe production tests damage (prevented
V (heat IabiIe): NAD or NADP (typicaIIy type I) w[corticosteroids to reduce Very susceptibIe to
infIammation[cytokines) disinfectants[drying
AmoxiciIIin (otitis media 8 COPD, chronic
sinusitis) bronchitis, acute sinusitis
Otitis media
No poIysaccharide Conjunctivitis 3 i1vasio1 xoutes (extrar and intraceIIuIar): 1 µ0% moxtaIity i1 1eo1ates, z1d most commo1 and CF
Amox w[brIactamase inhibitor or Passive immunity
fac. capsuIe Respixatoxy disease macropinocytosis (bacteriaIIy induced) 2 ChocoIate agax r› prep. (miId heat) cause of otitis media (after Streptococcus
Adhesins promote coIonization Ear aches cetriaxone (for amox.rr) AduIts (no Iongrterm from mother onIy
Anaerobe Meningitis (individuaIs paracytosis (pass b[w tight junctions) 3 LPSr reIeases both X 8 V from RBCs pneumon¡ae)
immunity as w[Hib) Iasts few months
Nonrsystemic with predisposing pIateIet activating factor M0st common in chiIdren
Can be persistent[recurrent due
factors or in neonates)
to biofiIm formation and abiIity Strain specific immunity
to invade ceIIs (OM protein variation)
r SuIfonamides, streptomycin, Uncommon in US (increasing in seaports)
S†D Chancroid
VenereaI disease tetracycIine More common in parts of Africa[Asia
Present in hot
PuruIent conjunctivitis One of the major causes of conjunctivitis in
cIimates southern US
FIora of oraI and Pharyngitis and
upper resp. tract endocarditis
Pextussis toxi1 (i1hibits ade1yIate cycIase,
coccobaciIIi increasing cAMP accumuIation; affect phospoIipase
C and ion channeIs =› Iymphocytosis, histaminer
Contact history, cIassic cough,
sensitivity, enhanced insuIin secretion)
Iymphocytosis
CaImoduIi1-stimuIated ade1yIate cycIase toxi1 D†P (trivaIent): sider
(cataIyzes cAMP from A†P =› impaired Ieukocyte 1. intro via water dropIets 2. interact Requires fresh media for growth =› Erythromycin (aIt: tetracycIine or Major chiIdhood kiIIer prer19¢0 effects r encephaIopathy
w[ciIiated epitheIiaI ceIIs
function and apoptosis) CataxxhaI stage (runny nose, sneezing, PCR (nasaI cavity washes chIoramphenicoI) and permanent neuroIogic
ObIigate NONE r onIy Pextussis (whooping Iowrgrade fever, miId cough) (trachea[nasopharynx) 3. adherence ¢. Highest fataIity amo1gst chiIdxe1 (more than sequeIae
Nonrseptic AerosoI infects 7r10 days Dexmo1ecxotic toxi1”mouthrIetaI[heatrIabiIe” cough) muItipIication[toxin production r› IocaI CoIo1y isoIatio1 by Resista1t to peniciIIin and measIes, diphtheria, poIio, and scarIet fever No IifeIong immunity
aerobe PaxoxysmaI stage (whooping cough,
humans (VSM contraction =› ischemic necrosis of Iung vomiting, cyanosis) infIammation, mucous secretion, patchy 1asophaxy1geaI swab or cough ampIiciIIin combined) D†aP (aceIIuIar trivaIent)
tissue) uIcers, cyanosis, pneumonia µ. host evasion 6. pIate (sIow growth) r› morphoIogy, introduced midr90s r›
spread gram stain, biochemistry †reat househoId contacts Infants more IikeIy to succumb to infection contains pertussis toxin,
FHA, pertactin, and piIi
TxacheaI cytotoxi1 (ciIiostasis, inhibits DNA
Rapid direct fIuoresceinrIabeIed Ab
synthesis, kiIIs tracheaI epitheIiaI ceIIs)
test for nasopharyngeaI specimens
PiIi, FHA (piIusrIike fiIamentous hemaggIutinin,
pextacti1 (coIonization)
Water of EarIy infection: apoptosis in Significant mortaIity in originaI outbreak
Airborne AtypicaI p1eumo1ia, fever, chiIIs, Dixect fIuoxesce1t Ab test
NutritionaIIy ”fastidious”: cooIing Legionnaires' disease or cough (+[r sputum), muscIe aches, macxophages[aIveoIar ceIIs Most infections cIinicaIIy insignificant RenaI transpIant,
rod NO humanrtor Detection of Ag in urine Proper water
r grown on chaxcoaI yeast IntraceIIuIar growth human towers in 2r10 days LPS a miIder form caIIed Summer[faII outbreaks immunocompromised,
(pIeomorphic) headache, tiredness, Ioss of appetite, Second phase of necrosis induced by pores AnaIysis of Ab IeveIs in bIood handIing
extxact with Fe a1d cystei1e amoeba or ”Pontiac Fever” Both processes Iead to ceII deah in CompIication: dissemination from Iung =› systemic and eIderIy
transmission and occasionaIIy diarrhea sampIes obtained 3r6w apart
biofiIms. respiratory tract damage due to LPS
Causes 1µrµ0% of pneumonias (µ0% of summex
Sputum gram stain
SmaIIest repIicating p1eumo1ias)
(+monocytes[PMNs) shows no
1 serotype bacteria (1o ceII waII) VaxiabIe Iipopxotei1s (increase immune evasion Cough (sputum), weakness, fever, 1. attaches to epitheIium via adhesins (P1) Resista1t to ceII waII inhibitors Severity correIated with age
organism and throat swab can take
NONE r onIy and provide rigidity) AtypicaI p1eumo1ia headache, diffuse spotty cha1ges o1 inducing ciIitosis =› necrosis 2. HzOz 3w (sIow growth) Se1sitive to antibiotics that Epidemics every ¢r8y SchooIraged kids and No IifeIong Prior immunity can
variabIe pIeomorphic CoIonies are smaII and grow ChoIestexoI in AerosoI infects (graduaI onset) chest x-xay, extrapuImonary infections pxoductio1 => oxidative damage and PCR (earIy resuIts) interfere w[protein synthesis CIose co1tact is a factox teens through young worsen symptoms
immunity (µr10y)
sIowIy r› fxied egg humans Associated with exacerbations of chiIdhood aduIts
membrane provides Pı: protein compIex at tip of bacterium can occur with CNS as compIication infIammation CoId agg. w[sexum lgM (may be + in (macroIides rerythromycinr and
appearance tetracycIines) asthma, chronic Iung disease, and
rigidity µ0% of patients) r Iook for rise in
immunodeficiency
titer
FataIities are rare
GenitaI tract (esp. Resista1t to erythromycin CorreIated w[various upper genitaI tract infections,
PID (peIvic infIammatory disease), endometritis,
femaIes) Se1sitive to tetracycIine
Iow birth weight, postpartum fever
Infectious arthritis
Super antigen
Rheumatoid arthritis
Cofactors for HIV infection
ResponsibIe for 20% of nonrgonococcaI urethritis
DoxycycIine to reverse maIe
HydroIyzes urea GenitaI tract (NGU) not attributabIe to chIamydia It is a Mycoplasma
infertiIity
Associated with infertiIity in maIes

rod
Corynebacter¡um Nonrsystemic
+ cIubrshaped aerobe
d¡phther¡ae Nonrspore forming
(pIeomorphic)
ObIigate i1txaceIIuIax
(cannot make A†P =›
depends on host A†P)
Chlamydoph¡l¡a ps¡ttac¡ Ge1exaI txeatme1t
†etracycIines are effective
but azithromycin may be
more indicated (any
antibiotic used must enter
ceIIs)
Chlamydoph¡l¡a pneumon¡ae
Ge1exaI Diag1osis
Chlyamyd¡a trachomat¡s Dı
K Non-gonotottaf urethritis Can be distinguished via
comparison of acute and
convaIescent antibody titers
Chlyamyd¡a trachomat¡s DıK
lntfusion Gon¡unttivitis and Can be detected by cuIture
lnfant Pneumonia inocuIation and detecting
incIusion bodies (stain or
fIuorescent antibody) r›
Chlyamyd¡a trachomat¡s AıC
sIow growth
Trathoma
Identification of EB and IB by
Chlyamyd¡a trachomat¡s L1ı
fIuorescent antibody aIIows More invasive than
3 Lymphogranufoma an immediate diagnosis by
NGU serotypes
venereum (LGV) examination of appropriate
r
R¡cketts¡a prowazek¡¡ ObIigate i1txaceIIuIax
(weII adapted to intraceIIuIar
environment but are abIe to
make own A†P)
Gxowth cycIe i1
R¡cketts¡a
R¡cketts¡a typh¡ huma1[axthxopod ceIIs
prowazek¡¡
1. enter via phagocytosis
(promoted by rickettsia and
requires energy) even into
nonrphagocytic ceIIs
R¡cketts¡a r¡cketts¡¡
2. muItipIy sIowIy (binary
fission r 1x[day)
3. progeny reIeased via Iysis
R¡cketts¡a akar¡
T1xeIated to
Cox¡ella burnet¡¡
RitNettsia
ObIigate intraceIIuIar
Ehrl¡ch¡oses
Hoxse a1titoxi1 immediateIy Once a major cause of death in US r› in prer
Dipthexia toxi1 r bIocks eukaxyotic ceII pxotei1
AII toxigenic strains Te1tative: teIIurite agar, †insdaIe's (hypersensitivity and immunization era, major fraction of pop. were DeveIoping countires Immunity
sy1thesis (inactivates EF2) =› produces systemic AII other corynebacteria
are Iysogenic for a NONE r onIy Myocarditis, CHF, 1. IocaI infIammatory response 2. gxay medium, and LeoffIer media (+ for anaphyIactic shock common) or carriers w[inadequate pediatric depends on
symptoms) Toxoid (diptheroids) are normaI
bacteriophage (beta) AerosoI infects 2rµ days †ubuIar necrosis, NS Fever, cough, sore throat pseudomembxa1e (fibrin, necrotic metachromatic granuIes) human antitoxin r› onIy Epidemics in poorIy immunized pop. w[inadequate immunization presence of Ab
Exotoxin has 2 domains which dissociate within D†aP good for 10 years inhabitants of our
exotoxin gene is on humans (weakness[paraIysis) epitheIium, WBCs) Defi1itive: toxin production (EfeN neutraIzed free toxin and toxin medicaI care †raveIers (tetanusrDP† against toxin
endosome r ceII surface receptor (B) promotes skin[throat
phage genome test), PCR, and immunoassay bound to ceIIs Presents as necrotizing skin infection in the tropics r vaccine) (antitoxin)
endocytosis and toxin domain (A)
PeniciIIin prophyIacticaIIy › spread by contact
Birds (induces
chronic EIeme1taxy Bodies (EB):
Psittacosis (generaIized Pathogen in bIood or sputum
InhaIation of bird subcIinicaI Fever and headache smaII, nonrmuItipIying,
infection) aka Paxxot Contact w[birds
feces infection with l1texstitiaI p1eumo1ia with a xigid bactexiaI-Iike
1 serotype fevex Antibody assay
constant fecal ceII waII -› transm¡ts
excret¡on) ¡nfect¡on
l1itiaI Bodies (IB) ”aka
reticuIate bodies (RB)”:
Personrtorperson Causes 10r20% of pneumonia in aduIts
AtypicaI p1eumo1ia Antibody assay AduIts Iarger, activeIy
via aersoI May pIay a roIe in coronary atheroscIerosis
muItipIying, Iack xigid
NGU MaIes: usuaIIy asymptomatic IF epididymus or faIIopian tube invoIvement,
PossibIy most common venereaI disease waII, nonı¡nfect¡ous
Cervicitis, epididymytis, (puruIent urethraI discharge) disease wiII be more severe (faIIopian tube SingIe high dose azithromycin DeveIoping countries
S†D Infection increases chance of HIV transmission
saIpingitis, proctitis FemaIes: frequentIy asymptomatic invoIvement wiII resuIt in steriIity or ectopic Detection from intraurethraI or for BO†H sexuaI partners (Africa, south Asia)
Causes ~µ0% of NGT l1txaceIIuIax gxowth
Reiter's Syndrome (growth in cervicaI ceIIs+) pregnancy) endocervicaI smear by direct
immunofIuorescence test, enzyme 1. EB enter by inducing
Inclus¡on conjunct¡v¡t¡s r most common verticaIIy
IncIusion conjunctivitis host phagocytosis (even
PerinataI immunoassay, DNA probe, and PCRr Erythromycin or suIfonamides do transmitted neonataI disease
Infant pneumonia Neonates (transmission in nonrphagocytotic
Swimming pooIs based test not prevent incIusion OccassionaIIy seen beyond neonataI age where
(usuaIIy an extension of at birth) ceIIs) 2. EB Iose ceII waII
S†D conjunctivitis environ. contamination (swimming pooIs, etc.) is
ocuIar disease) during first 2¢h, doubIe
NGT: PCR of urine specimen invoIved
CIoudy cornea, discharge from eye, in diameter, and
MechanicaI Chronic conjunctivaI reinfection causes †ropicaI Africa
More invasive †rachoma (chronic Iymph node sweIIing (just in front of LGV: DeIayed hypersensitivity to AnnuaI universaI treatment with synthesize RNA to yieId
(finger to eye) infoIding of eyeIashes =› corneaI scarring and Asia
serotypes conjunctivitis) ears), swoIIen eyeIids, tux1ed-i1 heatrkiIIed LGV injected intraderm azithromycin lB 3. IB divide by binary
FIies bIindness Arid regions fission r› some progeny
eyeIashes (Frei †est) =› prior or current
PainIess papuIe progresses to infection Can go into spontaneous CompIication: sometimes progresses to painfuI converted back to EB
LymphogranuIoma
S†D uIcerating vesicIe (2 weeks postr remission suppurating disease of regionaI Iymph nodes ¢w
venereum (LGV)
exposure) Best if treated earIy postrexposure
Pximaxy E1demic
1. Iouse punctures skin to get bIood meaI r
Human ”body” †he originaI seroIogicaI
Primary Epidemic defacates 2. scratching drives feces Louse controI
Iice (NO† BxiII-Zi1ssex disease may xei1txoduce xickettsia test was the WeiI-FeIix
FIying squirreI †yphus Abrupt fever, severe intractabIe (+rickettsia) into wound 3. muItipIy first in Human misery, famine, (DD† or adequate
head[crab Iice) 10 days (Russia or eastern Europe) xx1 (OXr19 Proteus) but
and it's fIeas headache, rash capiIIary endotheIiaI ceIIs ¢. incubate µ. and war bath and Iaundry
EIevated LF†, rise in antibody titers Often fataI if untreated (except i1 chiIdxe1) that's no Ionger used r›
Endemic †yphus sudden onset of fever and headache 6. rash faciIities)
E1demic (compare acute and convaIescent nonrspecific
(¢r7d Iater)
FIying squirreI Iice serum sampIes) w[specific Ag
Most cases seen in southwestern US via ground
Rat[ground Rats and †etracycIines
ResembIes primary epidemic typhus squirreI
squirreI fIea r› ground E1demic Muxi1e Typhus
but miIder and Iess fataI E1demic foci via rat exist on AtIantic and GuIf of
human squirreIs
Mexico seaboard of southeast US
1. Fever, headache, arthritic pains, EIevated LF†, rise in antibody titers
†ransovarian r›
abd. pain with nausea and vomitting (compare acute and convaIescent
tick r› human Western USA: forest tick
Rocky Mou1tai1 2. Rash from extremities spreads to serum sampIes) w[specific Ag Avoid ticks (wear
†ick 1 week Untreated aduIt cases have 20% mortaIity Eastern USA
Spotted Fevex trunk suitabIe cIothing)
MammaI r› tick r› Easten USA: dog tick
3. Lesions on paIm of hand and soIes FIuorescent antibody test on skin
human
of feet biopsy (immediate)
1. primary skin Iesion (site of bite)
Mouse r› mouse Be1ig1 1o1 Iife-thxeate1i1g
Mouse RickettsiaI Pox 2. systemic 1w Iater (fever, chiIIs, Large apartment houses
mite r› human Outbreaks usuaIIy confined to singIe buiIdings
headache, rash Iike chicken pox)
Dispose of birth
Spoxe-Iike stage InhaIing Cox¡ella EIevated LF†, seroIogy, DoxycycIine, quinoIone
l1texsititaI p1eumo1ia, fever, products;
transmits the from pIacentaI Sheep+ Q fevex †ick r› sheep+ r› pIacentaI tissue r› human immu1ofIuoxesce1ce, Chronic: Iong term
headache, rash (some patients) vaccinate where
infection tissue of sheep+ immunohistochemicaI therapy[surgery
possibIe
Monocytic EhrIichiosis GranuIocytic ehrIichiosis is transmitted by the same
†icks Fever, Iymphocytopenia Infects monocytes and granuIocytes EIevated LF† †etracycIines
GranuIocytic EhrIichiosis tick species that transmits Lyme disease

MiIitaxy a1d E1demic

POSlTlVE E1capsuIated InitiaI coIonization of nasopharynx Carrier rate varies (µ% gen. pop but higher in Cxowded co1ditio1s: day
Me1i1gitis (high BIood, CSF (Iumbar puncture), Most aduIts have antibody QuadrivaIent vaccine for
Oxidase (antiphagocytic) Lives in Meningitis: high fever, vomiting, stiff househoIds with history) care centers, miIitary
mortaIity; usuaIIy type B) nasopharyngeaI specimens cuItured immunity (evoked ‹1w by carrier serotypes A, C, Y, and
GIucose ExtxaceIIuIax nasopharynx, neck, Iethargy, vomiting, petechiaI MuIipIies outside of ceIIs, NO† inside. barracks, coIIege dorms,
for Gr dipIococci state) W...(no component for B
MaItose personrtorperson rash E1dotoxi1 damages smaII vesseIs. Bacteria Carrier state Iasts from days to months chiIdren under µ Gxows o1 Thayex-Maxti1
Nesser¡a men¡ng¡t¡d¡s Days to 1 week Septicemia capsuIe r siaIic acid in
Serogroups (A, B, C, aerosoI enter bIood stream. i1 µ-ı0% COz: seIective
Sugar fermenttion test (¢h) and[or Prompt IV peniciIIin G, 3G capsuIe)
NEGATlVE Y, W13µ(most Septicemia: fever, petechiaI rash, CompIicatio1: meningococcemia may cause Sub-Sahaxa1 beIt (type medium containing
MiId pharyngitis (in Iatex agg. (10 min) to capsuIe Ag in cephaIosporin; rifampicin or
Lactose important) r based on CIose exposuxe hypotension, WF syndrome Organotropism for meninges (but aIso skin, adrenaI faiIure, circuIatory coIIapse, shock, rapid A) during dry season chocoIate agar,
some) CSF cipro (prophyIactic) Afxica
Sucrose capsuIe eyes and Iungs) death (Watexhouse-Fxidexichse1 sy1dxome) (DecrJune) vancomycin (inhibit G+),
Conjugate vaccine, cheap
coIistin (inhibit Gr
IM ceftriaxone and 10d oraI
enteric), and nystatin
tetracycIine, doxycycIine, or
(antirfungaI) r› most nonr
azythromycin (fox ChIamydia)
dipIococci pathogenic Ne¡sser¡a faiI
NONE r onIy PiIi a1d OMP (coIonization), lgAı pxotease, LOS Infection may occasionaIIy spread to
(adjacent sides E1dotoxi1 activity is to grown on †M
r infects (LPS w[out O side chains) heIps resist serum Go1oxxhea ProphyIactic epididymis[prostate in maIes or, more often, to the
sIightIy 1ot a majox factox i1 (pathogenic species
POSlTlVE humans bactericidaI activity OpthaImia neonatorum tetracycIine[erythromycin faIIopian tubes in femaIes
fIattened) disease state (unIike InfIammation, yeIIow puruIent 1. S†D via genitaI contact (+rectaI and require bIood products
Oxidase ointment, or diIute 1% siIver Immune
meningococcus) urethraI discharge (w[pain upon pharyngeaI mucosa, and conjunctiva of
GIucose Dissemi1ated Gram stain of puruIent exudate nitrate to treat opthaImia Most pxevaIe1t commu1icabIe bactexiaI disease of response is weak
S†D, urination) newborns) 2. piIi anchor to epitheIium and Nonrpathogenic
compIicatio1s: (pus) or inside epitheIiaI[phagocytic neonatorum huma1s (aIo1g w[Ghfamydia trathomatis) but
Ne¡sser¡a gonorrhoeae 100+ serotypes based asymptomatic 1 hour impair phagocytosis by PMNs 3. penetrate Ne¡sser¡a ferment aII
Negative 1. Arthritisrdematitis ceIIs + history of exposure r› stains demonstrabIe
on antigenicity of carrier state MaIes: 2r3 days postrexposure through surface ceIIs (intraceIIuIarIy) to reach sugars but sucrose
MaItose syndrome often show Gr dipIococci w[in PMNs Dxug xesista1ce WorIdwide pandemic; asymptomatic carrier states (high antigenic
piIus protein FemaIes: 10 days (high percentage subrepitheIiaI C† ¢. infIammation and yeIIow
Lactose 2. Chxo1ic peIvic PIasmid r peniciIIinase are common variation)
(a1tige1ic vaxiatio1) remain asymptomatic) puruIent urethraI discharge Neisseria are
Sucrose i1fIammatoxy disease PIasmid r tetracycIine resistant
extraceIIuIar but get
(PID; femaIes) (conjugative r› can incite penR OpthaImia neonaturium was once the cause of µ0%
No capsuIe phagocytosed a Iot
pIasmid) of bIindness in chiIdren
Chromosome r broad (Pen, †et,
some cephaIosporins) reIated to
permeabiIity … stiII treatabIe
High fataIity rate (60%) due to puImonary and
Texmi1aI spoxe VioIent fIexox muscIe spasm (spastic Human tetanus Ig (1 antirtoxin), Wound
†oxinrmediated disease: toxin transported to O1Iy gxam (+) with texmi1aI spoxe secondary infections, rare in US, 69% dure to Immunization with 3 doses
(tennis racket) Teta1us toxi1 (protease) paxaIysis), arched back[neck, 1o fevex, peniciIIin (or metronidazoIe), DeveIoping worId debridement White pxecipitate on
peripheraI and CNS r› toxin inhibits CIinicaI diagnosis; Iaceration[infected wounds, 1[3 of cases are in of teta1us toxoid in first 6
Clostr¡d¡um tetan¡ 1 serotype SoiI ¢ days r weeks B subunit binds to neuron †etanus (Iock jaw) 1o se1soxy deficit, respiratory respiratory support, wound SoiIrcontaminated (cIeaning), 10y Iactose egg yoIk miIk
reIease of N†s (GABA,nerves r› toxin
gIycine) =› spastic Wound cuIture onIy positive 39% of unvaccinated individuaIs months of Iife (DP†), 10
No1-i1vasive A subunit has 1euxotoxi1 activity muscIes affected, secondary debridement, immunization with puncture wounds booster, antir agar r due to Iecithinase
paraIysis and convuIsive contractions time. year booster.
MotiIe puImonary infections tetanus toxoid tetanus Ig
NeonataI tetanus common in deveIoping countries
CIinicaI diagnosis; spore Iocation Gastric Iavage (earIy detection), Wound and Infant
FIaccid desce1di1g symmetxic
SoiI. Spores in BotuIism toxi1 - 1euxotoxi1 nonrdiagnostic. No cuIturing r hoxse a1titoxi1 (sexotype botuIism require spore
paxaIysis (CN and peripheraI neves), †oxin absorbed, carried in bIood to peripheraI 12% fataIity rate
Myasthenia SubrterminaI ovaI contaminated †ypes ArG (A, B, E most common in food; A, B, F in instead detect botuIism toxin in specific!!!!!), supportive care
BotuIism (food, wound, 1o fevex, 1oxmaI me1taI status, 1o nerve (neurotoxin), binds to synaptic Low incidence; rare in US Heat canned
gravis spore food (canned infant). serum, vomitus, feces, and food (may require resp. support) Infant BotuIism (1r8 OiIy shee1 on Iactose
Clostr¡d¡um botul¡num 18r36 h and infant r honey w[ se1soxy deficit, dysphagia, dipIopia, receptor, enters ceII, bIocks reIease of ACh Very potent r bioterrorism food to 100 C for
Nonrinvasive vegetabIes, A and B subunits (CDC). EMG on peripheraI nerve months) egg yoIk miIk agar (due
intestinaI coIonization) dry throat, diIated pupiIs. Can affect from ceII (interferes with proteoIytic 10 mins
GuiIIainrBarre MotiIe smoked fish, Heat-IabiIe, extxemeIy pote1t, not kiIIed by (suggest¡ve) Allerg¡c rxn to ant¡tox¡n has made to Iipase) and cIeaxi1g
resp. muscIes. AchoIi1exgic processing) More subtle symptoms ¡n ¡nfants
preserved fruit) stomach acid, protease human ant¡tox¡n Abs (A and B around coIony (due to
xespo1ses
Wound culture for wound botul¡sm tox¡n) useful for ¡nfants protease)
Stop offending antibiotics Common cause of a1tibiotic associated diaxxhea
NEGATlVE SoiI. NormaI fIora Exotoxi1 A (protease): enterotox¡n r binds to gut Hx of antibiotic treatment, (usuaIIy fIuoroquinoIones, due to toxinrmediated infIammation of the coIon
Watery diarrhea (usuaIIy not bIoody Prudent use of
obIigate CataIase of GI tract in 3% receptor Antibiotic suppression of normaI fIora aIIows exotoxin B detected in stooI cephaIosporins, and
+ rod SubrterminaI spore but can be) with WBC (i1vasive), Pt on ant¡b¡ot¡cs antibiotics
anaerobe Oxidase popuIation, Exotoxi1 B: cytotox¡n (ADPrribosyIates Rho, G†Pr Pseudomembxa1ous C. d¡ff to proIiferate, exotoxin B damages (bioassay, ELlSA), stooI cuIture of C. cIindamycin) Found in GI of 3% of pop. and 30% of hospitaIized
Clostr¡d¡um d¡ff¡c¡le Nonrinvasive pseudomembranes (yeIIowrwhite Pts in the hospitaI (30%
Superoxide dismutase hospitaIs binding protein) e1texocoIitis coIonic mucosa Ieading to bIoody diarrhea d¡ff (not usefuf afone), detection of
MotiIe pIaque) on coIon waII, fever, and coIonized r fecaIroraI) Contact isoIation
resevoirs for and pseudomembrane formation. GDH enzyme, sigmoidoscopy with Txeat with metronidazoI, Strain o27 r more viruIent strain in EngIand[Canada r
abdominaI pain (outbreak)
spores. Both unstabIe at room temp. visuaIization of pseudomembranes vancomycin, or fidaxomicin r aII increased toxin (A[B) production causing the
of which are IocaI (stay in gut) diarrheaI syndrome
Gas gangrene: cxepitus of skin (due
SubrterminaI spore
to gas in subcutaneous tissue or
Tissue 1ecxosis Gas Gangrene: many toxins and enzymes Iyse muscIe), discoIoxatio1 and edema
Rapid gxowth (deep
Dependent on host anatomy host ceIIs, faciIitating necrosis of skin, extxeme pai1, serous dark C. perfr¡ngens and B.
penetrating
CeIIuIitis (superficiaI), necrotizing exudates SurgicaI wound debridement, PximaxiIy a suxgicaI disease; may occur in absence frag¡l¡s cause 80% of
wounds[dead tissues) AIpha toxi1: Iecithi1ase that damages PM
SoiI ceIIuIitis (dermis and capiIIaries), Acids a1d gases, + enzymes and proteases peniciIIin, hyperbaric oxygen of open wound; rareIy with uterine infection (septic anaerobic septicemias
Generation (incIuding capiIIary and RBCs) Gas ga1gxe1e tissue
Clostr¡d¡um perfr¡ngens Human GI and necrotizing fasciitis (fascia), myositis Gram positive stain (may not see abortion) or GI Iesion (Iymphoma[Ieukemia) (onIy 10% of bacteremias
Gas (H2 and CO2) in time of 8 min CoIIagenase (supporting tissue), hyaIuronidase necrosis; food poisoning
vagina or myonecrosis (muscIe). Food poisoning: ingestion of sporer spores), wound cuIture (not usefuI Food poisoning C. perf is seIfr are caused by
tissue (matrix)
contaminated food w[prersynthesized aIone), xrray, doubIe zo1e of Iimiting (resoIved in 2¢h) RapidIy fataI if untreated anaerobes) =› 8% of aII
Food poisoning: adbominaI cramps, enterotoxin (attached to spore coat), toxin hemoIysis o1 bIood agax septicemias
HighIy i1vasive
watery diarrhea (within 8r22 h) reIeased into intestine
Food poisoning: detect aIpha toxin
No1-motiIe
via ELISA in feces[food
Abdomi1aI i1fectio1s *****Pe1iciIIi1 xesista1t***** MetaboIic activity
Most common anaerobic Gr rod
Lowex Gl (Iaxgex Infections beIow the Large numbers in Iarge intestine, Most important pen.R anaerobe generates ammo1ia
ObIigate Resistant to biIe Common in intrarabdominaI (boweI rupture) and Corinfection with E. coIi
Bactero¡des frag¡l¡s rod i1testi1e) CapsuIe diaphragm (abdominaI extraintestinaI invasion resuIting in (spIitti1g uxea), acid,
anaerobe* *Oz toIexa1t femaIe genitaI infections (peIvic absceses after (more severe)
FemaIe GT abscesses, OB[GYN septicemia CIindamycin, cefoxitin, and gas production in
OB[GYN procedures)
infections) metronidazoIe coIon
NEGATlVE
obIigate OraI tract, femaIe OxaI i1fectio1s Requires hemin (bIack pigme1t) for growth r More common in oraI infections r› sexious etioIogic
Prevotella melan¡nogen¡cus rod CataIase
r anaerobe GU (occasionaIIy) PeriodontaI disease › found in bIood agar and infected tissues age1t of pexiodo1taI disease
Oxidase
MotiIity OraI infections, Iung
More sensitive to O2 abscesses,
very thin rod than bacteroides pIeuropuImonary
obIigate
Fusobacter¡um tapered ends OraI, intestine infections, abdominaI Mixed i1fectio1s PeniciIIin
anaerobe
”1eedIe-Iike” infections, Iiver CIindamycin
abscesses, and ChIoramphenicoI (static)
peritonitis MetronidazoIe
D¡phthero¡ds rod †etracycIine Commo1 bIood cuItuxe co1tami1a1t
anaerobe May be aerotoIerant Skin Can cause endocarditis
(Corynebacter¡um) (pIeomorphic) GeneraIIy nonrpathogenic
AminogIycosides + antibiotic
Maintains Iow pH to prevent Nonrpathogen but
Intestine w[anaerobic coverage (cefoxitin Used to make yogurt,
Lactobac¡llus rod anaerobe growth of pathogens in frequentIy isoIated
Vagina or cIindamycin) if mixed sauerkraut, sour miIk
vagina[intestine from GU[GI tract
infection
CervicorfaciaI SuIfux gxa1uIes (yeIIow granuIes
+ NEGATlVE
obIigate Grows in moIax tooth OraI (oraI[dentaI) and seen in Iesions r comprised of SurgicaI drainage if abscessed Commo1 cause of de1taI abscesses (usuaIIy mixed)
Act¡nomyces branching rod CataIase Infections often form si1us txacts Surgery[trauma
anaerobe appearance GI abdominaI (GI tract) microcoIonies + debris) r and abdominaI abscesses
Oxidase
infections characteristic not diagnostic
PIeuropuImonary
NEGATlVE OraI
Streptococci obIigate infections, brain
Peptostreptococcus cocci in chains CataIase Mixed infections FemaIe GU and GI
(morphoIogy) anaerobe abscesses, and OB[GYN
Oxidase tracts
infections
Skin[soft tissue
facuItative infections in human
E¡kenella corrodens _ rod OraI
anaerobe bites[cIe1ched-fist
i1juxies
AIpha toxi1 (aIpha hemoIysin): Iyses host ceII
1. Contamination with enterotoxin production
membranes 1. Food poisoning (foodr
1. Nausea, vomiting, nonrbIoody (bacteria not required at disease site)
borne diarrhea) MostIy cIinicaI diagnosis
diarrhea (Enterotox¡ns AıE, GıQ) SurgicaIIy drain abscesses Hand washing Most common cause of
CoaguIase: forms cIots
2. Fever, rash, then desquamation of Semi-sy1thetic pe1icIIi1 (they 2. †ampon use, wound and carefuI hospitaIrreIated
2. †oxic shock syndrome
Staphylococcus aureus POSlTlVE paIms and soIes, hypotension, shock 2 8 3. BacteriaI coIonization with toxin have penicIIinase, but not for infections, nasaI packing isoIation bacteremias in the US r
GoIde1 YeIIow Pxotei1 A: ceII waII protein, binds to host IgG via (†SS) †racking S. aureus outbreaks
(toxin-mediated) CataIase (TSST1) production r› coIonization via receptorrIigand syntheti) r dicIoxaciIIin (oraI), CoIonization of nasaI passages up to 30r¢0% high in technique by usuaIIy by IV catheters
coIo1ies FcR Ieading to ”binding on the wrong end” =› Iess
Nitrate reductase Found on skin, 3. Erythematous skin foIIowed by interactions (ex. Fibrinogen) foIIowed by oxaciIIin (IV) diabetics and drug addicts 3. Infants hospitaI
betarHemoIysis compIement; aIso a Bıcell superant¡gen =› defective 3. StaphyIococcaI Phage typing
Goagufase!!!!!!! mucous peeIing r detachment of superficiaI toxin eIaboration (toxin aIone can reproduce Up to 70% may be met.R
(aIpha toxin) IgM production scaIded skin syndrome PuIse fieId eIectxophoxesis
DNAse membranes, and Iayer of skin on histoIogy (Eta) disease) DO NO† USE vancomycin as first More IikeIy to coIonize hospitaIized[compromised Judicious =› vanc may be the drug
Phage receptor (SSSS) MLST typi1g
Ma11itoI nares of normaI Iine patients and those with foreign bodies[objects antibiotic use of choice
E1texotoxi1s: heatrstabIe (resist boiIing), Tıcell MoIecuIar typing
individuaIs
MRSA superant¡gens (stimuIate Iarge amounts of ILr1, ILr2, 1. Impetigo; foIIicuIitis; furuncIes; CIo1aI compIex
NEGATlVE May deveIop toIerance (inhibited Most common cause of food poisoning in US IntranasaI Morbidity and mortaIity
VRSA and †NF) carbuncIes; ceIIuIitis; Iymphangitis; S. aureus synthesizes adhesive moIecuIes r
MotiIity Bacteremia and but not kiIIed r high MBC[MIC mupirocin for remains high
wound, postpartum breast, and bind to host ceII matrix found on damaged E1docaxditis: Immune compIex is
Staphylococcus aureus ratio) =› consider combining nasaI
ExfoIiati1s A 8 B (Eta A[B): pIasmidrencoded toxins infections (1. superficiaI cathetex site i1fectio1s; paronychia tissue. Bacteria coIonize, evade host, cuIture neg. emboIization is cuIture
(tofonizing)invasive) with rifampin and[or gentamicin coIonization
secreted by phage group II r superant¡gen and 2. deep) 2. pneumonia, endocarditis, synthesize toxi1s and enzymes, and spread. pos.
osteomyeIitis, arthritis, abscesses, Evasion can Iead to bacteremia.
facuItative Eap (map) impairs neutrophiI recruitment;
+ cIustered cocci meningitis, and sepsis
anaerobe POSlTlVE
CataIase
White coIonies
Nitrate reductase Opportunistic, efficie1tIy coIo1izes Remove prosthesis Neonates, patients with
BiofiIm NO†E Common bIood contaminant
Bacteremia and Lowrgrade fever, pain reIated to pxosthetic suxfaces, surface carbohydrate Vancomycin (resistant to renaI faiIure (diaIysis),
Very IittIe hemoIysis =› if no cIinicaI sign of S. epidermis Majox species of coaguIase 1egative StaphyIococci
Staphylococcus ep¡derm¡d¡s NEGATlVE catheter[foreign body infected device, cIinicaI course may be may mediates attachment to synthetic semisynthetic peniciIIin) immunocompromised
but + bIood cuIture it's probabIy not i1 the oxaI fIoxa
MotiIity infections indoIent surfaces, attachment can Iead to proIiferation
SmaIIer and Iess toxic an S. epidermis infection
CoaguIase and bIood stream invasion If toxic, add rifampin[gentamicin Catheters[foreign bodies
than S. aureus
DNAse
Skin and oraI
Ma11itoI
pharynx (normaI
POSlTlVE
CataIase fIora)

NEGATlVE Bactrim, QuinoIone

Staphylococcus White coIonies PoIyuria Common cause of U†I's in young women (second
Nitrate reductase U†I Adheres to uroepitheIium Positive urine cuIture Young femaIes
saprophyt¡cus LittIe to no hemoIysis Dysuria onIy to E. col¡ for this age group)
MotiIity Resista1t to 1ovobioci1
CoaguIase
DNAse
Ma11itoI
SequeIae of i1fectio1s
Rheumatic fevex: r 2r3w
after initiaI untreated
StreptoIyins: hemoIytic enzymes, two types r› O †oxinrmediated (Spe)
pharyngitis; due to M
(O2 IabiIe) ant¡gen¡c, reacts with antibodies; S (O2 ScarIet Fever
protein induced crossr
stabIe) poorIy antigenic StreptococcaI †SS
reacting; heart and skin
ScaxIet Fevex: sandpapery rash, pastia
Iesions and joint pain;
Streptokinase: triggers proteoIytic system of bIood Pyogenic Iines
Invasive diseases (incIuding skin infections) cardiac damage not
(destroys fibrin cIots) PuerperaI fever TSS: severe hypotension + impaired MorphoIogy and generaI
may invoIve extraceIIuIar proteins short term
DNAse Acute pharyngitis and renaI or Iiver ftunction, DIC, characteristics
Large inocuIum required
facuItative Respiratory tonsiIitis ”miId = Strepr respiratory distress, generaIized rash, Antibody to M
†WO a1tiphagocytic factors pIay a roIe in aII µr10% are carriers (nasaI carriers are more Acute
anaerobe NEGATlVE dropIets HyaIuxo1ic acid capsuIe (pathogenic) throat” and soft tissue necrosis Rapid strep test (antibody to group PeniciIIin protein is
Group A infections: hyaIuxo1ic acid capsuIe and M infectious) gIomexuIo1ephxitis: 2r
Streptococcus pyogenes CataIase Impetigo Arspecific carb) protective (80+
betarhemoIytic pxotei1s 3w postrinfection (more
aexotoIexa1 Oxidase Found on skin and M pxotei1: ant¡phagocyt¡c, pIays a major roIe in ErysipeIas PuexpexaI fevex: uterus infection Se1sitive to bacitxati1 types of M
GAS pharyngitis: most common bacteriaI infection common in skin
t oropharynx adherence Necrotizing fasciitis Stxep-thxoat: headache, feverrchiIIs, CuIture of tissue[bIood (if invasive) protein)
†HREE factors (Spe A, B, 8 C) pIay roIes in of chiIdhood (1µr20% carrier) isoIates); nephrogenic M
”fIeshreating bacteria maIaise, eIevated white count
specific cIinicaI presentations: cause the rash types; smoky urine,
PiIus: adherence disease” lmpetigo: superficiaI skin infection ASO titex
of scarIet fever and the streptococcaI †SS edema (face[ankIes);
ExysipeIas: severe ceIIuIitis of dermis
deposition of immune
StxeptococcaI toxi1s (Spe A, B, 8 C): ImmunoIogic and underIying tissue
compIexes containing
superantigenic proteases r antibodies are Spe Rheumatic fever
bacteriaI Ags
specific! r e¡ther erythrogen¡c tox¡n (scarlet fever) or Acute
pyrogen¡c exotox¡n (TSS) gIomeruIonephritis
NO†E: viabIe S. pyogenes
are not found in the
damaged tissue
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