Gram (+) Gram(-) ●Gram stain limitations

Circular (coccus) 1. staphylococcus 1. Neisseria ----不需 記 These Rats May Microscopically Lack Colors
2. streptococcus 2. Moraxella catarrhalis ---需 CO2 1.Treponema
Rod (Bacillus) 1. Clostridium Enterics 人畜 2. Rickettsia
2. Bacillus 1. Enterobacter 10. Yersinia 1. Yersinia 4. Mycobacteria ---Acid Fast stain
3. Corynebacterium 2.E.coli 11.Vibrio 2. Francisella 5. Mycoplasma
4. Listeria 3.Klebsiella 12. campylobacter 3. Brucella 6.Legionella pneumophila---silver stain
5. Mycobacterium (AFS) 4.Citrobacter 13. Helicobacter 4. Pasteurella 7. Chlamydia
5. Serratia 14.Bacteroides 5. Bartonella
(anaerobic) 其他
6. Shigella
7. Salmonella 1.Haemophilus ●Stain
8. Proteus 2. Bartonella Giemsa’s Borrelia, Plasmodium,
Actinobacter 3.Leigionella (Silver) trypanosomes, Chlamydia
9.Pseudomonas 4.Gardnerella (gram variable) PAS Glycogen, 診斷 Whipple;s disease
(Periodic acid mucopolysaccharides 記 PASs the sugar
Branching 1. Actinomyces
filamentrous schiff)
2. Nocardia (弱 AFS)
Ziehl- Neelsen Acid fast bacteria
Pleomorphic 1. Ricketssia
India ink Cryptococcus enoformans
2. chlamydia
Silver stain Fungi, Legionella
Spiral Spirochetes: 1. leptospira
2. Borrelia (Giemsa)
3. Treponema
沒 cell wall Mycoplasma—沒有 cell wall(只有 chitin+β-glucan); 有 cell membrane 含 sterol

Special culture requirements

Bug Media Zoonotic 疾病
H. influenzae Chocolate agar with factor V (NAD) & X(hematin) 背 1. Yersinia pestis Plaque Flea bite; rodents esp prairie dogs(鼠蚤)
N. gonorrhoeae Thayer-Martin media 記 N-M 2. Francisella tularensis tularemia Tick bite; rabbits, deer
B. pertussis Bordet-Gengou (potato) agar 記 B-B 3. Brucella Brucellosis/ undulant fever Daily products, contact with animals
C. diphtheriae Tellurite plate, Löffler’s media 記 C-T 4. Pasteurella cellulitis Animal bite; cats, dogs
M.tuberculosis Löwenstein-Jensen agar 5. Bartonella Cat scratch fever Cat scratch
M. pneumoniae Eaton’s agar 6.borrelia burgdorferi Lyme dis Tick bite; Ixodes ticks tht live on deer & mice
E. coli Eosin-methylene blue (EMB)agar 記 E-E 自 Leptospira Weil’s dis 污染的水 (被動物的尿)
(icterohemorrhagic leptospirosis)
(blue-black colonies with metallic sheen)
Lactose-fermenting enterics Pink colonies on MacConkey’s agar
Legionella Charcoal yeast extract agar buffered with ↑iron & cysteine
記 Legion coal
Fungi Sabouraud’s agar
●Obligate an-aerobes ●Intracellular bugs ●Urease (+)
記 Cant Breath Air Obligate Facultative 記 Particular Kinds Have Urease
1. Clostridium 記 Really Cold 記 Some Nasty Bugs May Live FacultativeLY 1. Proteus
2. Bacteroids 1.Rickettsia, 1. Salmonella 4. Mycobacterium 7. Legionella 2. Klebsiella
3. Actinomyces 2Chlamydia 2. Neisseria 5. Listeria 8. Yersinia 3. H. pylori
-缺 catalase (分解 02), SOD(分解 H2O2) -無法自己造 ATP 3.Brucella 6.Francisella 4. Ureaplasma
-foul smelling (short chain fatty acid) 測 Urea breath test: Urea(14C)-->NH3+14CO2;
Urea agar(測 urease 活性

●Pigment producing bacteria ●Encapsulated bacteria

Yellow pigment---S. aureus
Blue-green ~ ----Pseudomonas aeruginosa
Red ----Serratia marcescens
記 Some Nasties Have Kapsules
1. Strep. Pneumonia
2. Neisseria meningiitidis
3. Haemophillus influenza (esp B serotype)
-(+)Quellung reaction: encapsulated bug swells whn specific anticapsular antisera are added
- capsule serves as Ag in vaccine T-cell dependent response

●Bacterial virulence factor

Protein A S. aureus 與 Fc region of Ig 結合 - 破壞 opsonization, phagocytosis
Ig A protease S. pneumoniae, 1. Cleaves IgA
H. influenzae, 2. polysaccharide capsule 也防 phagocytosis
Neisseria
M Protein Group A streptococcal 防 phagocytosis
缺 superoxidase dismutase—遇 O2 則死
缺 catalase -- 遇 H2O2 則死

G (+)cocci G(+)coccus in cluster G(-)cocci—Moraxella

—staphylococcus
 NOvobiocin 記 NO StRES
Optochin 記 OVRPS(overpass)
Bacitracin 記 B-BRAS
Gram (+) Purple
Cocci Catalase Coagulase(+) S.aureus (1)(a)MRSA (b)resistant to β-lactam(altered penicilin-binding protein) ;
(+) (2)(1)inflamatory dis
(2)toxic mediated dis--(a)TSS(TSST-1 Toxin) (b)SSS(exfoliative toxin), food poisoning(enterotoxins)
Coagulase(-) Novobiocin (S) S.epidermis 皮膚normal flora; Infects prosthetic devices & catheters 或 contaminates blood culture
Novobiocin(R) S.saprophyticus
(-) Partial Optochine(S) S.pneumonia 具Ig A protease(quelling (+))
hemorrhage Bile soluble
(α) Capsule (quellung)
Optochin(R) Viridans streptococci 口腔normal flora; dental carries(Streptococcus mutans) Rheumatic fever 的 Jones criteria:
~ in-soluble Endocarditis (S. sanguis) 記 MaJor Criteria’S: 或 CANCER
~ a-capsule
(1)Erythema Marginatum
Complete(β) Bacitracin (S) Group A-S.pyogenes 1.Pyogenic: pharyngitis (2) migratory polyArthritis (Joint )
2.toxigenic(exotoxin: Spe-A, C): scarlet fever, TSS (3)Carditis
3.immunologic: rheumatic fever(by M protein,見Aschoff body), PSGN (4)Subcutaneous Nodule
診斷: ASO titier (測 streptolycin O) (4)sydenham’s Chorea
測immune for scarlet fever: Dick test
Bacitracin (R) Group B-(S.agalactiae) Entero= intestine,
Faecalis= feces;
No (γ) Gourp D strep -較硬;可 6.5%NaCl 生 Cause UTI, subacute endocarditis Enterococci E. faecalis Strepto=twisted(cains);
; VRE 長 E.faecium Coccus= berry
-Penicilin G resistance
不可 Non- ? Peptostreptococcus
Pepto-streptococcus (an-aerobic)
Rods/ 外毒 芽孢 厭氧 Clostridium C.tetani X GABA,glycine 釋出→lock jaw Spore
Bacillus (+) (+) (+) C.botulinum X Ach釋出→floppy baby 只有部分 G(+)rod 形成 spre(當食物不足)
C.perfingens 產α toxin(lecithinase)→myonecrosis(gas gangrene), hemolysis 土壤: 1. B.anthracis 2. C. perfingens 3. C. tetani
其他: 1. B.cereus 2. C. botulinum
C.difficile ∵by抗生素(ampicilin, clindamycin) 治:vancomycin或metronidazole
(+) (+) Bacillus Bacillus anthracis 2種傳染方式: (1)接觸→malignant pustule(painless ulcer)
 (2)吸入spore→又叫 Woolsorters’ disease
(+) Corynebacterium (Coryn=club C.diphtheria 機轉: exotoxin X elongation factor(EF-2)像psuedomonas; 培養: tellurite agar
shape) 記 ABCDEFG= ADP ribosylation, B-prophage(encode exotoxin), C.Diphthria,
Elongation Factor 2, Granules;
疾病: psydomembranous pharyngitis
Listeria 特徵 27°c tumbling motility,唯一G(+)具endotoxin, 病因:unpaseurized乳制品or產道感染→ 小兒腦膜炎
具 branch filament An- Actinomyces israelii 正常口腔;具sulfur granules 記 SNAP = Sulfa for Nocardia, Actinomyces use Penicilin Sulfonamide 治: 1.Nocardia,
(像 fungus) 2.Pneumocystic jirovecii
Aerobe 部分 AFS Nocardia asteroides 土壤 ; silver stain
其他 aerobe AFS Mycobacteria M. tuberculosis (A) 1°TB-Gohn complex(鈣化小點,Hilar LN, Gohn focu(下肺葉)) 中& 下肺葉
(B) 2°tuberculosis-fibrocaseous lesion(上肺葉)
©Extra-pul. Tuberculosis-CNS, 脊椎(Pott's dis), lymphadenitis, 腎, GI
治療: 無洞HERZ(2m)→HER(4m); 有洞2m-->4+3m
檢驗: PPD(5 unit tuberculin)48~72hr後判讀:
(+)>10mm=現在有,過去有,BCG疫苗, (-)=未感染, 免疫力差
M.kansasii
M.avium opportunistic inf(玩鳥)
M.leprae Leprosy(Hansen's dis). 特徵: 喜低溫(感染皮膚,表淺神經),無法培養
.2種型態:(1)痲瘋瘤型(lepromatous type):惡性, 進行性, 皮膚, AFS(+)
(2)類結核型(tuberculoid type)-良性(自癒),非~ ,lepromin test(+)
治療:dapsone(副hemolysis, methemoglobinemia)

Gram (-)
Cocci maltose glucose CO2
+ + 需要 N.meningitis Polysaccharide capsule(抗吞噬), Vaccine, 口腔器官分泌物, meningococcemia & meningitis, waterhouse-friderichsen synd
- + N.gonorrhea No~, No~, 性傳染, gonorhea, septic arthritis, neonatal conjunctitivitis, PID
不 Moraxella
“Cocc Haemophillus H.influenza small G(-)(coccobacillary)rod.
oid” 產IgA protease,
Rods 培養在chocolate agar(需 factor V(NAD) & X(hematin)來生長).
Meningitis治ceftriaxone;接觸者用rifampin 不會感冒.
H.ducreyi →軟性下疳
H.aegypticus
Pastueurella 動物咬
Brucella brucellosis 污染牛奶
 Bordetella pertusis 機轉: ↑cAMP ( byGαi)→whooping cough,
潛伏期(7~14d)catarrhal stage(高傳染)paroxymal(發作期,咳嗽激烈) 恢復期
Rods Lactose Fast Klebsilla Urease (+) 記 4A's: Aspiration pneumonia, Abcess in lung, Alcoholics, diAbetic p't.
Fermenter pneumonia-red currant jelly sputum Enterobacteriaceae
E.coli Heat labile toxin △AC-2者皆造成diarrhea 記COFFEe
Lactose fermenting enteric bacteria Heat stable toxin△GC- =Capsular(K antigen), O antigen, Flagellar antigen, Ferment
記 MacConKEE’S agar Enterobacter glucose, Enterobacteriaceae
-培養: MacConkey’s agar(粉紅菌落) -E.coli, Enterobacter, Klebsiella, Salmonella, Shigella,
slow Citrobacter
-Citrobacter, Klebsiella, E.coli, Proteus,, Serratia
Enterobacter, Serratia Serratia
Yersinia Urease(-) Yersinia bipolar →pneumonic, septicemia, notorious bubonic plagues(black
pestis staining(safety pin death)
外觀)
Yersinia pseudotuberculosis
Yersinia enterocolitica pet feces, common in day-care center
Campylobacter C.jejuni 空腸 腸炎,下痢
C.fetus 胎兒 菌血症
Helicobater urease(+) →90%的duodenal ulcer,會peptic ulcer,gastric adenoca.,lymphoma 治Triple
pylori 測Urea breath test: Urea(14C)-- therapy: (1)bismuth+metronidazole+tetracyclin或amoxilin;
>NH3+14CO2; Urea agar(測 (2)(貴)omeprazole+metronidazole+clarithromycin
urease活性
其他
Non~ Oxidase + Pseudomonas AERuginosa-AERobic, 產pyocyanin(綠藍)pigment,grapelike odor,
aeruginosa 產(1)endotoxin(fever,shock)(2)exotoxin A(inactivates EF-2)-像C.dipthteria
Oxidase - Shigella 侵入GI mucosa-->bloody 無 無 較virulent(10X1)
diarrhea
Salmonella 侵入GI mucosa-->bloody 具 產H2S 需10X5; If用 Salmonella typhi →Salmonella typhi, 慢性存於膽
diarrhea flagella(可 抗生素會延長 囊
經血擴散) 感染期
Proteus
Actinobacter motility(-)
Spiroc Borrelia B.burgdoferi aniline dyes →Lyme dis 媒介:tick, lice 記 BAKE Lyme pie —Bell’s palsy, Arthritis, Kardiac block, Erythema migrans.
hetes 型態: spiral shape+ axial (big size) (Wright's或 uspg151
filaments Giemsa stain) 1˚期:erythema chronicum migrans2˚期:aseptic menigitis, Bell's palsy, 心律阻
記 Buy LapTop Light microscope 斷,myocarditis3˚期:慢性關節炎,腦病變
治: Doxycycline
B.recurrentis →relapsing fever 媒介:tick, lice
Leptospira →Leptospirosis/ 媒介:水(動物 黃膽脾大腎炎 治:penicilin G
Weil's dis/

VDRL, FTA,
RPR TPHA
+ + Active infection
+ - 可能 False positive
- + 治療成功
 ("?"型) ictero-hemorrhagic / 尿污染)接觸人
7day fever 黏膜or傷口
Treponema T.pallidum dark field →syphilis 性 1˚ 3wk Painless chancre 局部
microscopy VLDL 2˚ 3m Maculopapular rash(手掌,腳掌), condylomata lata
3˚ 3-30y
Gummas(chronic granuloma),
動脈-vasa vasorum destruction(動脈)
神經-neurosyphilis dorsalis
眼睛-Argyll Robertson pupil=prostitute’s pupil(對光無反應,accomodation
Congenital Saber shins, saddle nose, CN8 deafness, Hutchinson’s teeth
T.pertenue →yaws not 性 VLRL(+)

Atypical pneumonia
Silvr legionella legionella 記 Legionnaire(soldier) with silver helmet, charcoal with iron dagger-he is no sissy(cystein)
G(-)
Rod

1. Mycoplasma
stain pneumophila 培養: charcoal yeast extract culture(BCYE)( wit iron & cystein). 2. Legionella
經水塔,空調etc 3.Chlamydia
legionnaires' di=severe pneumonia. Pontine fever=mild influenza 治: erythromycin

Gram Gardnerella 媒介:性(但 無痛, off-white/gray discharge with fishy smell 治:metronidazole
Rod

variable vaginalis 不是STD)

Weil-felix(皆+) (除了 Rickettsiae R.rickettsii tick →Rocky Mountain spotted fever; 症狀:Palm & Soles rash---->migrate to trunk (要與其他並
Coxiella) 媒介:節肢動物(除 DDx(pg153))
-方法:測 anti- 了coxiella) R.typhi fleas →Endemic typhus
rickettsial Ab, cross- 治療:tetracycline R.prowazekii humen →Epidemic typhus
react with Proteus Ag body louse
Ehrlichia tick →Ehrlichiosis
Coxiella burnetii (為 吸入 →Q fever
atypical rickettsiae) aerosols
R.tsutsugamushi恙蟲 mite(恙蟲) eschar @台灣常見 @媒介: larval mite(chigger) @治療: doxycycline 或 choramphenicol
R.quintana 五日熱, 戰壕熱 @唯一不胞內寄生(可用一般培養基生長)

un-usual chlamydia-特徵: 無法做 Chlamydia C.trachomatis 媒介: reactive arthritis, conjunctivitis, NGU(non-gonococcal urethritis), PID
bacteria
ATP(必須胞內寄生); C.penumoniae 媒介:空氣 atypical pneumonia
治:erythromycin或 C.psittaci 媒介:空氣 atypical pneumonia
tetracyclin
另分類 A,B,C 盲
D~K型 NGU
L1~3 LGU(lymphogranuloma venereum)