Bugs

GRAM (+) COCCI STAPH CATALASE (+) CLUSTERS COAGULASE (+) β HEMOLYTIC Staph aureus Facultative anaerobe #1 Infectious agent Nosocomial (surgery) ≠Food Mayo; Mustards

COAGULASE (-)

Staph epidermidis Facultative anaerobe Skin flora

Staph saprophyticus Facultative anaerobe

RODS STREP CATALASE (-) PAIRS & CHAINS

β HEMOLYTIC (Complete - Clear) S. pyogenes (GAS) Micro-aerophilic

S. algactiae (GBS) Micro-aerophilic Vaginal flora

α HEMOLYTIC (Partial - Green) S. pneumonia Micro-aerophilic

AEROBIC

γ HEMOLYTIC (NO Hemolysis) Peptostreptococcus Micro-aerophilic

Listeria monocytogenes Facultative anaerobe Non-spore I.C. Pathogen Farm animals Fertilizer (cow feces)

Actinomyces israelii Obligate anaerobe Mouth flora

Corynebacterium diphtheria Facultative anaerobe Non-spore Club-shaped

Clostridium Perfringens Obligate anaerobe Spore ≠Food Meats

Nocardia asteroides Obligate Aerobe Spore

Clostridium Dificile Obligate anaerobe Spore 2' to Antibiotic use Clindamycin Ampicillin Imipenem

Bacillus cereus Obligate Aerobe Spore ≠Food Reheated rice

Clostridium Botulinum Obligate anaerobe Spore ≠Food Canned foods

Bacillus anthracis Facultative Anaerobe Spore

Clostridium Tetani Obligate anaerobe Spore Soil

S. viridans Micro-aerophilic Nasopharynx flora S. mutans Micro-aerophilic Dental plaque

ANAEROBIC

Enterococcus Faecalis (GDS) Micro-aerophilic Nosocomial

E. faecium (GDS) E. bovis (GDS)

Bacillus thuringiense Insecticide

Gram (+) Characteristics

Gram (+) Characteristics

GRAM (+) COCCI STAPH CATALASE (+) CLUSTERS COAGULASE (+) β HEMOLYTIC Staph aureus Exotoxin (Super Ag toxin) A Binds MHC II A IL-1 & IL-2 synth. Enterotoxin A (mayo, cust.) TSST (Super Ag toxin) Exfoliative toxin; α-Toxin β-Lactamase Surface protein (adherent) Blood agar + Yellow pigment

COAGULASE (-)

Staph epidermidis Exopolysacharide A Biofilm (slime) ΦHemolysis

ΦHemolysis Superoxide dismutase Novobiocin sensitive Staph Saprophyticus (Novobiocin resistant)

RODS STREP CATALASE (-) PAIRS & CHAINS

β HEMOLYTIC (Complete - Clear) S. pyogenes (GAS) Exotoxin (Super Ag; ASO Ag) - Erythrotoxin (Super Ag) A Scarlet Fever - Streptolysin O (ASO Ag) A Rheumatic Fever M & F Proteins (≠Phagocytosis) Hyaluronidase; S-kinase; PAF Bacitracin sensitive S. algactiae (GBS) Polysacc Capsule A ≠Phagocytosis

Clear = galactic Bacitracin resistant

α HEMOLYTIC (Partial - Green)

AEROBIC

γ HEMOLYTIC (NO Hemolysis)

S. pneumonia Peptostreptococcus Capsule (#1 VF; Polysaccharide) Anaerobic IgA protease A ΦHemolysis Takes up DNA Pneumolysin (lyses host cells) Neuramidase Quellung serotyping Optichin sensitive Blood agar S. viridans Viridans = verde / grn Optichin resistant S. mutans Dextran (Adherence to teeth) Lactic acid (degrades enamel)

Listeria monocytogenes Motility I.C. pathogen Listeriolysin O (Hemolysin) Internailins A Bind to E-cadherins A Phagocytotic entry ActA (VF) β Hemolytic Cold environment Corynebacterium diphtheria Exotoxin (via β-prophage) A ADP Ribosylation A ≠EF-2 ADP Ribosylation β prophage C Diphtheria Toxin EF-2; Granules; K Ag Albert's stain; ELEK test Tellurite; Schick's; Loeffler's Nocardia asteroides

Optichin resistant

Superoxide dismutase

ANAEROBIC Actinomyces israelii

Yellow colonies (sulfur) Y Clostridium Perfringens Exotoxin (αβ) - α toxin (Lecithinase) A Partial lysis of RBC - β toxin A Complete lysis of RBC αβεζ Toxins

Double-hemolysis Clostridium Dificile Exotoxin A Kills enterocytes A P. colitis

Enterococcus Faecalis (GDS) Leukocyte esterase β-Lactamase(+)

Catalase A H2O2 (lysosomes) A H2O + CO2

E. faecium (GDS) β-Lactamase(-) E. bovis (GDS)

Weakly acid-fast Bacillus cereus Exotoxin

Grows in 6.5% NaCl

Clostridium Botulinum Exotoxin (Neurotoxin) ≠ACh release A Flaccid paralysis Anit-Ch Sx's Toxin used to Tx Muscular Dz's Achalasia (LES) Botox

Bacillus anthracis Exotoxin (anthrax toxin) A ADP Ribosylation A Adenylate cyclase Anti-phag capsule Protective Ag Bacillus thuringiense OK (humans) ≠Morphogenesis of larvae

Mycobacterium T.B. Lowenstein-Jensen Agar Fungi

Clostridium Tetani Exotoxin (Tetanospasmin) ≠Glycine release A Φ(-)NT; Only (+++)NT A Spastic

Toxoid used for Vaccines Tetanus & Diphtheria

Sabouraud's Agar

Gram (+) Mechanisms

GRAM (+) COCCI STAPH CATALASE (+) CLUSTERS COAGULASE (+) β HEMOLYTIC Staph aureus #1 infxs agent Inflammatory Dz Pneumonia (bronchial) IE (IVDU) Arthritis OM (prosthetics) Skin Lesions Food poison (entero-T) Scalded skin (exfoliat.-T) TSS (TSST-1); Impetigo

COAGULASE (-)

Staph epidermidis Catheter Creeper UTI's Arthritis (prosthetics) OM (prosthetics) IE (Prosthetic Valves)

Staph saprophyticus Adults #2 UTI's (young♀) Purperal fever Skin infection IE (Prosthetic Valves) Neonates Meningitis Sepsis Pneumonia

RODS STREP CATALASE (-) PAIRS & CHAINS

β HEMOLYTIC (Complete - Clear) S. pyogenes (GAS) ≈ PYRO = Red Fire!! Pharyngitis - (#1 "Strep thrt") Impetigo (pyogenic) Rheumatic Fever (inflamm.) Acute GN (inflamm.) TSS; Tissue infxns (pyogenic) Erysepelas Scarlet Fever (toxigenic) S. algactiae (GBS) Al' go to ya Vadge!! Vaginal flora = PMS Pneumonia Meningitis (neonatal) Sepsis (neonatal)

α HEMOLYTIC (Partial - Green) S. pneumonia Respiratory Infections Otitis media Sinusitis URTI (50% of POP) Bronchitis Pneumonia (95% CAP) System Spread Bacteremia Meningitis (elderly) S. viridans IE (subacute) S. sanguis (50% of IE) IE (Congenital defects) S. mutans Dental caries

AEROBIC

γ HEMOLYTIC (NO Hemolysis) Peptostreptococcus Mixed infections Cutaneous Oral Respiratory Female genital tract

Listeria monocytogenes Meningitis (infants) Granulomatosis infantiseptica A Granulomas A Death

ANAEROBIC Actinomyces israelii Lumpy jaw Sinus tracts; Sulfur granules OM (facial, cervical)

Infants and Elderly Pregnant women Murky brown amniotic fluid Corynebacterium diphtheria Dyphtheria Pharyngitis Pseudomembranes LN'opathy Huge neck Recurrent laryngeal palsy Myocarditis

Clostridium perfringens Skin & Soft Tissue Myonecrosis Gas gangrene Skin & S.T. Dz's Diarrhea (food poisoning) "Perforates the fringe" "Letch" = lecithinase

Nocardia asteroides Madura foot Pulmonary infxn (↓Immune)

Clostridium dificile Pseudo-m colitis A Diarrhea (green, foul) 2' to antibiotic use Ampicillin / Clindamycin

Bacillus cereus Diarrhea (food poisoning) Brief gastroenteritis

Clostridium botulinum Flaccid paralysis Floppy baby Bulbar paralysis Unreactive pupils Descending weakness Respiratory weakness

Bacillus anthracis Painless ulcers (95%) Black lesions (eschars) Pneumonia (serious) A Bacteremia A Death "Woolsorter's Dz"

Clostridium tetani Spastic paralysis Lockjaw

Enterococcus faecalis "Enter & Endo" UTI's IE (subacute) E. faecium (GDS) E. bovis (GDS) EI (α w/ CRC; Valve lesions)

Gram (+) Diseases

GRAM (+) COCCI STAPH CATALASE (+) CLUSTERS COAGULASE (+) β HEMOLYTIC Staph aureus PCN (P-ase-R) Nasty Messy Ox Clox Dicloxacillin Oxacillin Nafcillin Methicillin Vancomycin (For MRSA) Bacitracin

COAGULASE (-)

Staph epidermidis Vancomycin

RODS STREP CATALASE (-) PAIRS & CHAINS

β HEMOLYTIC (Complete - Clear) S. pyogenes (GAS) PCN (#1) Ab to M protein Bacitracin

α HEMOLYTIC (Partial - Green) S. pneumonia PCN (#1) Vancomycin (for PCN-R) Erythromycin (#2) Chloramphenicol (#3) Vaccine (23 IgG anti-capsule) Elderly; ↑Risk Px's Not for kids or CA's

Staph saprophyticus PCN

S. algactiae (GBS) PCN (P-ase-R)

S. viridans PCN

AEROBIC

γ HEMOLYTIC (NO Hemolysis)

Listeria Amino-PCN's SMT / TMP

ANAEROBIC Actinomyces israelii "SNAP Tx" PCN (1 mo)

Peptostreptococcus PCN Cephalosporins Clindamycin Metronidazole Corynebacteria Clostridium perfringens Antitoxin (Equine diphtheria AT) PCN + Debridement PCN; Erythromycin Anti-toxin Vaccine (DPT) Food poisoning A Self-limiting

S. mutans Nocardia asteroides "SNAP Tx" SMX / TMP (sulfur)

Clostridium dificile Vancomycin (#1) Metronidazole Bacitracin

Bacillus cereus Self-limiting ΦRx's

Clostridium botulinum Anti-toxin (human) Respiratory support

Bacillus anthracis PCN

Clostridium tetani Tetanus toxoid Anti-toxin (Ig) Respiratory support Muscle relaxants Antibiotic (PCN; Metronidazole) DPT Vaccine (Diphth-Pert-Tet)

Enterococci ΦRx effective Syncercid (experimental) Fosfomycin

Gram (+) Treatment

GRAM (-) COCCI MALTOSE (+) NEISSERIA

RODS MALTOSE (-) NEISSERIA

AEROBIC FASTIDIOUS GROWTH REQ'S

N. Meningitis Obligate aerobe

N. Gonorrhoeae Obligate aerobe

I.C. GROWTH (+)

I.C. GROWTH (-)

Brucella Obligate aerobe ≠Food Dairy products Cows

H. Influenza Micro-aerophilic Pleomorphic rods

Francisella Obligate aerobe MO; AK; OK areas (50%) ≠Vector Rabbits; Deer Tick bite

Campylobacter jejuni Micro-aerophilic Comma shaped ≠Food (#1) Poultry dishes Birds; Aviaries

Legionella Obligate aerobe Pleomorphic thin rods

Bordetella pertussis Obligate aerobe

H. ducreyi Pleomorphic rods "School of Fish" pattern STD

Helicobacter pylorus Micro-aerophilic Comma-shaped

ANAEROBIC SIMPLE GROWTH REQ'S

OXIDASE (+) P. Aeruginosa Obligate aerobe #1 Opportunistic Nosocomial Burn victims CF Ventilator Px's

Vibrio cholera Comma-shaped Ogana (AB) Inaba (AC) Hikojima (ABC) V. vulnificus V. parahemolyticus ≠Food Seafood Pasteurella multicocida Micro-aerophilic Cat bite Dog bite

Bacteroides fragilis Obligate anaerobe Colon Flora

OXIDASE (-) LACTOSE (+)

LACTOSE (-)

Klebsiella Facultative Anaerobe GI Flora Rods w/ halos

Salmonella enteritidis Facultative Anaerobe I.C. Pathogen ≠Food Poultry; Eggs; Meat Reptiles; Turtles Salmonella typhi Facultative Anaerobe Fecal-oral

Enterobacter Facultative Anaerobe GI Flora Nosocomial

Shigella sonnei Facultative Anaerobe Food; Fingers Feces; Flies

E. Coli Facultative Anaerobe Colon Flora GI Flora Vaginal Flora #1 Nosocomial (UTI mostly) ≠Food (EHEC) Undercooked meat ≠Water (ETEC)

Proteus Facultative Anaerobe GI Flora Nosocomial

Serratia marcescens Facultative Anaerobe GI Flora Nosocomial

Yersinia pestis Facultative Anaerobe I.C. Pathogen ≠Vector (SW U.S.) Flees; Animal host Bipolar rod Yersinia enterocolytica Facultative Anaerobe Pet feces Pediatric mini-epidemics

Bacteroides melaninogenicus Obligate anaerobe Trauma

Citrobacter Facultative Anaerobe GI Flora Nosocomial

Gram (-) Characteristics

Gram (-) Characteristics

GRAM (-) COCCI

RODS

MALTOSE (+) NEISSERIA

MALTOSE (-) NEISSERIA

N. Meningitis Capsule (#1 VF) = N-a acid IgA protease Maltose(+) Glucose(+) - Dextrose

N. Gonorrhoeae Capsule IgA protease β-Lactamase Glucose(+) - Dextrose Pili; Adhesins PII (binding) A Enters PMN vacuoles Ag Variation (Pili) Thayer-Martin (VCN) Chocolate agar

AEROBIC FASTIDIOUS GROWTH REQ'S

Thayer-Martin media Chocolate agar

I.C. GROWTH (+) Brucella Intra-macrophage ≠PMN degranulation Erythritol-phillic A Affinity for placenta

Francisella tulerensis

Mycobacterium T.B. Lowenstein-Jensen Agar Fungi Sabouraud's Agar

I.C. GROWTH (-) H. Influenza Capsule (#1 VF) IgA protease B most virulent Polyribitol-P capsule (B) Satellite growth (S. Aureus) Chocolate agar Factors V & X V = NAD (HL) X = Hematin (HS) Campylobacter jejuni Invades colonic epithelium A Reproduces in Mes. LN's A Enteric Fever Depends on host signaling

Cysteine

↓O2 Tension

Legionella Intra-macrophage A/C or Water source Req's Fe2+ & Cysteine Complement-R A Invades macrophage

Helicobacter pylorus Oxidase(+) Urease(+)

Fe+ + Cysteine Charcoal yeast-extract agar Bordetella pertussis Exotoxin (Pertussis toxin) A ≠Ribosylation A ↓Gi --> ↑cAMP A W. Cough Whooping Cough turns off off Pili; H-gluttinins Bordet-Gengou (potato) agar

↓O2 Tension Slow growing Chocolate agar

ANAEROBIC SIMPLE GROWTH REQ'S

OXIDASE (+) P. Aeruginosa Endotoxin (Sepsis) Exotoxin A A ADP ribosylation A ≠EF-2 Mucoid (resists Ab's+Comp) Fe2+ compounds (toxic) Trypticase agar; Fruity odor A Blue pigment (pyocyanin) Tripticase; Blood agar; EMB Vibrio cholera Exotoxin (Choleratoxin) A Binds GM1 Ganglioside A ADP ribosylation A ↑Gs --> ↑cAMP A Cl / H20 into gut Turns the faucet "on" on Flagella (motility; adherence) String Test(+) ↑pH (Citrate; Bile; Th'sulfate) Pasteurella multicocida Oxidase(+)

Fast growing

Bacteroides fragilis Capsule (polysaccharide) Endotoxin β-Lactamase

OXIDASE (-) LACTOSE (+)

LACTOSE (-)

Klebsiella Salmonella enteritidis Non-motile ↑ID50 = Non-virulent Encapsulated (thick; mucoid) Vi Polysaccharide Ag Invades GI mucosa A Motile (Salmon swim) A Hematogenous ↓O2; ↓pH (Mac lysosome) A Induction of VF Genes Viscous, creamy colonies S. typhi replicate in Macs MacConkey's or EMB agar H. sulfide(+) Enterobacter Shigella sonnei Vit K synthesis ↓ID50 = VIRULENT!! Bile salt conjugation Shiga toxin Hormone conjugation A ≠60S Ribosome Colicin / bacteriocin A ≠Protein synthesis A Prevent pathogens Adhesins; Invasins A Invades GI mucosa A Reproduce in cytosol Fast fermenter A Ulcers MacConkey's or EMB agar E. Coli Proteus ETEC Motile Exotoxin (HLT) Urease(+) A ADP Ribosylation A ↑pH A Ad. cyclase A Struvite crystals A ↑cAMP HLT - cAMP ("head lAMP") H. sulfide(+); Indole(-) SLT - cGMP ("slow GMP") Swarming on agar (motile) EHEC (O157:H7) Ag used for Weil-Felix test Verotoxin (shiga-like) A ≠Protein synthesis Yersinia pestis K1 pili bind mannose Protease A Activates plasminogen Cleaves complement MacConkey's or EMB agar Yersinia enterocolytica Serratia marcescens - Flora Pathogenicity island A Bacterial proteins A ≠Host signaling Slow fermenter Red "maraschino" pig. MacConkey's or EMB agar Citrobacter- Flora

Slow grower MacConkey's or EMB agar

Superoxide dismutase (-) A Super-O ion --> H2O2 A H2O2 --> O2 H2O All anaerobes lack this

All Enteros MacConkey's agar EMB agar A Lactose(+) A Δcolor of agar Enteros Motile (ΦShigella) Pili Polysacc Capsule Endotoxins (LPS) Ferment GLU K, H, O Antigens Oxidase (-)

Gram (-) Mechanisms

GRAM (-) COCCI MALTOSE (+) NEISSERIA

RODS (UTI's) MALTOSE (-) NEISSERIA

AEROBIC FASTIDIOUS GROWTH REQ'S

N. Meningitis Meningitis DIC Waterhouse-Fridrichsen

N. Gonorrhoeae Urogenital Dz Gonorrhea; Urethritis Orchitis; PID Salpingitis; Sterility Pharyngitis Septic arthritis (#1 in healthy) Opthalmia (neonatal)

I.C. GROWTH (+) Brucella Brucellosis Undulating fever LN-opathy Hepatosplenomegaly Abortion (spontaneous)

Francisella tulerensis Tularemia Plague-like LN-opathy Sepsis Ulcers + necrosis

I.C. GROWTH (-) H. Influenza MOPE w/ H Flu Sx's Meningitis (<6yrs) Otitis media (#2 bug) Pneumonia (2' to V. flu) Epiglotitis Conjunctivitis (#1) H. ducreyi Chancroid (STD) Campylobacter jejuni "Campfire in jejunum" Diarrhea (RBC; PMN) Enterocolitis-->Arthritis 1-2 days incubation C. fetus Bacteremia in I.C. Hosts

Legionella Legionnaires Dz Pneumonia A Death (30%)

Bordetella pertussis Whooping Cough Seal cough Convalescence

Helicobacter pylorus PUD Duodenal ulcer (90%) Gastritis

ANAEROBIC SIMPLE GROWTH REQ'S

OXIDASE (+) P. Aeruginosa "Aer" = air; PSEUdO Pneum. (CF; Nosoc) Sepsis Ecthyma gangrenosum UTI's (catheters) Burns Otitis externa (#1) Corneal kerititis (Contacts) Random cut on foot!! Vibrio cholera Diarrhea (H2O) LOTS! A Na+, Cl-. Bicarb loss V. parahaemolyticus V. vulnificus Food poison (seafood) Soft tissue Dz; Blisters

Pasteurella multicocida Cellulitis Dz < 24hrs of bite

OXIDASE (-) / GLU (+) LACTOSE (+) Klebsiella UTI's (10%) Pneumonia (lobar) Alcoholics; DM Upper lobe cavitations Foul sputum Current jelly sputum Sepsis

Enterobacter UTI

Yersinia enterolytica Enterolytic = "lyses GI" Diarrhea (RBC) Pet feces (fecal-oral) Sepsis (abdominal) E. Coli #1 UTI's (80%) Pneumonia (infants) Meningitis (infants) Diarrhea ETEC Diarrhea (H2O; 3-6d) "Traveller's diarrhea" EHEC (O157:H7) - RBC Food poison (meat) HUS Diarrhea (RBC; WBC) Sepsis (abdominal) Serratia marcescens UTI Abdominal sepsis

Citrobacter Lung Dz Abdominal sepsis

Bacteroides fragilis Abscesses (purulent) Peritonitis

LACTOSE (-) Salmonella enteritidis Enterocolitis (#1 of Salm) Diarrhea (RBC; PMN) "Salmon colored" Constipation Bacteremia OM (Sickle Cell Dz) Salmonella typhi Typhoid fever; Carrier GI; Spleen; Liver; BM; GB Shigella sonnei Diarrhea (RBC; PMN) 1-2 wks Fever 3-4 days Carrier state

Proteus UTI's Struvite stones

Sepsis (abdominal) Yersinia pestis Bubonic plague LN-opathy (Bubos = groin) Pneumonia Sepsis Yersinia enterocolytica Diarrhea (RBC; PMN) Mesenteric lymphadenitis Pediadric mini-epidemic

Bacteroides melaninogenicus Oral abscess

Gram (-) Diseases

GRAM (-) COCCI MALTOSE (+) NEISSERIA

RODS MALTOSE (-) NEISSERIA

AEROBIC FASTIDIOUS GROWTH REQ'S

N. Meningitis PCN G Prophylaxis A Rifampin

Vaccine (A, C, Y, W) Not B

N. Gonorrhoeae Ceftriaxone (#1) Tetracycline (Doxy) Prophylaxis for neonates A Macrolide Silver Nitrate

I.C. GROWTH (+) Brucella Tetracycline

≠PCN (β-Lactamase) No Vaccine

I.C. GROWTH (-) H. Influenza Cephalosporins Ceftriaxone (meningitis) +/- Ampicillin (40% resistant) Vaccine (H Flu B < 18 mo) + Tetanus toxoid + Diphtheria toxoid + N mening. prot.

Francisella tulerensis Aminoglycoside Vaccine (attenuated)

Campylobacter jejuni Macrolide (#1) Quinolone

SIMPLE GROWTH REQ'S OXIDASE (+) P. Aeruginosa 2x Rx Therapy: Aminoglycosides Ticar / Piperacillin Ciprofloxacin Aztreonam

Bordetella pertussis Macrolide (#1) Vaccine (killed; acellular)

Helicobacter pylorus 3X Metronidazole Amoxicillin Bismuth 3X Metronidazole Chlorythromycin PPI

Bacteroides fragilis Clindamycin Metronidazole

OXIDASE (-) LACTOSE (+) Klebsiella Cephalosporin (3rd) UTI = Cefazolin (1st G) Aztreonam

LACTOSE (-) Salmonella enteritidis Self-limiting (usually) ORT + Antibiotics (kids) Ampicillin; Tetracycline ≠Opiates Salmonella typhi Chloramphenicol

Vibrio cholera Cholera cot ORT Tetracycline; Ampicillin ≠Opiates V. parahaemolyticus V. vulnificus Tetracycline; Ampicillin

Legionella Macrolide (#1)

ANAEROBIC

Enterobacter

Shigella sonnei Ciproflaxacin Ampicillin TMP/SMX

Yersinia enterolytica

Pasteurella multicocida Tetracycline E. Coli Cephalosporin TMP / SMX (UTI) ETEC Tx: Ciproflaxacin (#1) TMP/SMX (kids) EHEC Tx Support

Proteus

Serratia S. marcescens Cephalosporin Aztreonam

Yersinia pestis Streptomycin (10 days)

Yersinia enterocolytica ORT

Citrobacter

Gram (-) Treatment

BUG / Dz

PROCEDURE / PERPARATION

FINDINGS

Stains Bacteria Gram Stain Mycobacteria (high lipid wall) Acid-Fast Stain

PAS

Fungi Amoeba Cryptococci

Mucicarmine Cryptococcus neoformans India Pink

Giemsa

Campylobacteria Chlamydia Leishmania Malaria TB

Ziehl-Neelsen

Silver Stain

Tripanema pallidum Legionella Pneumocystis carinii Treponemes (Trip in the dark)

Dark Field Herpes family (HSV; VZV) Tzanck Preparation

Wood's Light

Ab Probes

DNA Probes

VDRL

Microsporum = Green (ΦTrichophyton tonsurans) Erythrasma (corynebacteria) = Coral red Porphyria cutanea tarda = Pink Depigmentation (Vitiligo) = Chalk-white Hypopigmentation (tinea versicolor; post-inflamm.) = Whitish TB sclerosis = Leaf spots Viruses Rickettsiae (esp. Coxiella) Chlamydia (cytoplasmic inclusions; Ab fluorescence) Triponemes (Ab fluorescence) Viruses Mycobacteria TB Bacteria (E. coli; Gonorrhea) Protozoa Triponema Beef cardiolipin False(+) = EBV; Hep viruses; Rh. F.; RA; SLE; Leprosy; Rx's Triponema

FTA-Ab's Mycoplasma hominus Eastons Agar Mycoplasma pneumonia (Ag-Ab Glycolipid) Complement Fixation Bartonella henselae (Cat scratch) Warthin-Starry Silver

CAMP

Group B Strep distinguisher S. algalactiae C. diphthyria

ELEK

Giemsa or Wright Stain Smear of open-skin vesicle A Multinucleated Giant Cells

Multinucleate giant cells Hyperpigmented nuclei Long-wave UV light

Venereal Disease Research Laboratory Less specific React w/ beef cardiolipin Most specific for Triponemes (+) early and late

Viral (EBV; Hep) Drugs Rh. Fever; RA Lupus; Lipid; Leprosy

BUG / Dz

PROCEDURE / PERPARATION

FINDINGS

Stains Randome Tests Nikolsky's Sign

Pemphigus Toxic epidermal necrolysis

Pressure applied laterally to bulla A Extension of blister (crawls laterally)

Urticaria pigmentosa Solitary Mastocytoma

Dev't of wheal upon stroking lesion

Darier's Sign

Psoriasis α w/ papillary dermal dilatation of capillaries

Dev't of pinpoint bleeding upon picking off scale

Auspitz's Sign

Dermatofibroma Distinguishes pigmented dermatofibroma vs. other pig. lesions

Lesion dimples inward upon pinching with thumb + forefinger

Dimple Sign

Granulomatous lesions = apple-jelly color Purpura vs. vascular dilatation

Press glass slide against lesion

Diascopy

↓Ca2+; ↓PTH

Troussaeo = Tourniquet (cuff --> spasm)

↓Ca2+; ↓PTH

Chvostek's Sign = Chvostek's Cheek (tap --> twitch)

Trousseau's Sign

Chvostek's Sign 1st test for Thyroidisms TSH

T3

Measures TBG-affecting Dz's Does NOT measure thryoid function

Tests

Sx's & SIGNS

CLINICAL FINDINGS

LAB DIFFERENTIALS

ETIOLOGY

COMPLICATIONS / Tx

Bacteria PUD / Duodenal Ulcer

Vaginitis

Mycobacteria

Mycobacteria Leprae

Epigastric pain (at night) DU > PU Nausea; Vomiting; "Heartburn" Duodenal Ulcer (90%) Pain relieved by eating & antacids PUD Green vaginal discharge Fishy smell Painless M. TB M. kansasii (~TB) M. scrofulaceum (cervical LN-itis in kids)"Scarf = scrof. (ie neck LN's)" M. avium-I.C. (Dissem. Dz in AIDS Px's) M. leprae (leprosy) Leprosy; Skin nodules; Leonine facies AKA = Hansen's Dz Burns; Cuts; Self-mutilation ≠Skin; ≠Nerves ↓Sensitivity ↓Pigmentation over ≠skin A Infection of superficial skin + nerves

Scarlet Fever

Kids Pharyngitis; Fever; Chills; Polyarthritis Swollen tonsils Kids Strawberry tongue

Cat Scratch Dz

LN-opathy Cat scratch

Rheumatic Fever

↑H+; ↓HCO3-; ↓Mucus Upper GI Bleed; Urease(+) Stool Ag(+); Serum Ag(+) Vaginal epithelial cells + bug

H. pylori (70%); Z-E Syndrome NSAIDS; Alcohol; Smoking Trauma; Surgery; Physical stress Gardnerella vaginalis

Tx: H. pylori - Chlorythromycin; Azole; PPI ≠NSAIDS; H2 Blocks; Antacids Surgery (for perforation; severe) Tx = Metronidazole

Acid Fast(+)

Acid Fast(+) M. leprae Lepromin test Obligate I.C. parasite - Tuberculous (Macs; Giants) Person-to-person (aerosol) + Lepromatous (ΦT cells) Armadillo reservoir Strep pyogenes GAS - β-hemolytic

Pleomorphic rod (Afipia) Silver impregnation stain

Lepromatous = Slowly progressive Tuberculous = self-limiting Death not due to leprosy Tx = Rifampin; Clofazimine; Dapsone Tx = PCN G

Bartonella henselae AKA R. henselae

Bacterial Infections

Sx's & SIGNS

CLINICAL FINDINGS

LAB DIFFERENTIALS

ETIOLOGY

COMPLICATIONS / Tx

Bacterial Infections

Sx's & SIGNS Chlamydiae, Rickettsiae & Mycoplasmas NGU (non-gonococcal urethritis) Arthritis; Conjunctivitis Lymphogranuloma; Trachoma Chlamydia trachomatis Reiter Syn (♂) Genital infection + Conjunctiviits; Polyarthritis Fever; Headache; Cough; Anorexia Chlamydia psittaci

CLINICAL FINDINGS

LAB DIFFERENTIALS

Elementary bodies --> Enter via endocytosis; Infectious Giemsa(+) Reticulate body --> Fission replication in cell; ≠Infxs Frei test(+) = L1, L2, L3 Chandalier Sign = Cervical motion pain L. venereum Chlamydia invades columnar epithelial cells Granulomatous infl. A Urethritis; Lymphogranuloma venereum; Trachoma

ETIOLOGY

COMPLICATIONS / Tx

Chlamydia trachomatis Tx = Tetracycline; Erythromycin I.C. parasite (chlamys = cloak) Urethritis; PID; Ectopic pregnancy ΦMuramic acid in cell wall Neonatal infection A, B, C = Africa; Blindness; Chronic Conjunctivitis D-K = Neonatal pneumonia + Conjunctivitis Pneumonia L1, L2, L3 = Lymphogranuloma venereum Avian farms; Cockatiels I.C. parasite (chlamys = cloak) ΦMuramic acid in cell wall

Rickettsia

Rickettsia

R. rickettsii

Headache; Fever; Rash Weil-Felix(+) RMSF = centriPetal (inward rash) R. rickettsii = Rocky Mt. Spotted Fever (tick) - SE U.S. Anti-R Ab's Typhus = centriPHugal (outward rash) R. typhi = Endemic typhus (fleas) X-react w/ Proteus R. prowazekii = Epidemic typhus (human louse) - SE U.S. Q = Weil-Felix(-) Q = Queer (no rash); Atyp. pneumonia Coxiella burnetii = Q Fever (aerosols) R. tsutsugamushi = Scrub typhus (chigers) - WWII; West

East coast endemic Headache; Fever Rash (palms; feet; wrists; ankles) Shock; Renal Failure

Rickettsia Arthropod vector Obligate I.C. bugs; Need CoA + NAD Coxiella (aerosol) = Sheep wools; Hides Infect endothelial and vascular Smooth mm. A Vasculitis + perivascular inflammation A Mutli-organ failure (Shock; RF)

Thrombi or hemorrhage Typhus fever = gangrene on tips Fingers; Nose; Ears; Penis; Vulva Multi-organ vasculitis A Shock; Renal Failure

Tx = Tetracycline Multi-organ vasculitis A Shock; Renal Failure

Rocky Mt. Spotted Fever Rash pattern also seen in Coxsackievirus A (Hand, foot and mouth Dz) Syphilis

Tx = Tetracycline Mycoplasma

Mycoplasmas

Mycoplasma pneumoniae

M. pneumonia U. urealyticum M. hominus (postpartum fever)

Eaton agar (mycobacterium) Require sterols for growth U.U. = sterols + urea

Military; Young Px's < 30 yrs old Walking pneumonia (#1 cause) Insidious onset; Headache; Dry cough Signs worse than Sx's

Diffuse I.S. infiltrate M. pneumonia Tx = Erythromycin; Tetracycline IgM cold agglutinins (O+ RBC) Only bacterium with cholesterol membrane PCN-R b/c no cell wall Strep MG Agglutinins (S. saliv.) DNA probe 16s Ribosome Very slow growing Pregnant women are often ASx carriers Eatons agar A Neonate infected Requires urea + sterol to grow ΦCell wall (no Gram stain; No PCN)

Northeastern U.S. Lyme Dz Flu-like Sx's Bull's eye rash (Erythema migrans) Arthritis

Spiral bugs + Axial filaments Giemsa(+)

BLT to screw A Lyme Dz B. recurrentis A Relapsing fever Jarisch-Herxheimer reaction

Spiral bugs + Axial filaments

BLT to screw A

Ureaplasma urealyticum Spirochetes

Borrelia burgdorferi

Leptospirosis Leptospira

Treponema pallidum

Painless genital chancre (local Dz) Maculopapular rash (palms; soles) Condylomata lata Tabes dorsalis Neurosyphilis (paresis) Personality; Affect; Reflexia Eyes; Sensory; Intellect; Speech

Ixodes tick (live on deer - life cycle) --> Tick bite A Erythema chronicum migrans; Flu-like Sx's A Bull's eye rash (E. migrans); LN-opathy; Myalgia A ≠CNS (meningitis) ≠Heart (arrhythmias) - 70% of Px's A Chronic arthritis

1' (3 wks) = Painless, red, raised genital chancre Spiral bugs + Axial filaments BLT to screw; TORCHS A 2' (2-10 wks) = Rash on palms+soles; Fever; Headache Outer membrane; Helical protoplasm A Syphilis (T. pallidum) Arthritis; LN-opathy; White oral lesions Obliterative Endarteritis Yaws (T. pertenue) A 3' (15 yrs) = Aortitis; Heart lesions Dark field microscopy Micro-aerophilic Gummas; Tabes dorsalis; CNS lesions Non-specific: VRDL(+); RDR(+) Specific: FTA; TPHA; MHTP PCR; TPI (immobilization test)

Tx = Ceftriaxone (#1) Tetracycline; Erythromycin; PCN

Neurosyphilis Tabes dorsalis Congenital Syphilis Abortion; Stillbirth Rash (early 2' Syphilis in newborn) Teeth abnormalities (late syphilis)

Sx's & SIGNS

CLINICAL FINDINGS

LAB DIFFERENTIALS

ETIOLOGY

COMPLICATIONS / Tx

CRM & Spirochetes

Sx's & SIGNS

CLINICAL FINDINGS

LAB DIFFERENTIALS

ETIOLOGY

COMPLICATIONS / Tx

Fungal Infections Cold = Mold (soil) Heat = Yeast (body temp) Sabouraud's agar = Fungi

Fungi Tinea Tinea Capitis

Tinea Barbae

Tinea Corporis

Tinea Cruris

Tinea Pedis

Tinea Versicolor

Kids; ≠Scalp Crusting; Erythema; Scale Scalp; Hairless patches ♂ (mostly) ≠Beard

Uncommon

Children; ≠Body Common Plaques: Erythematous Scaling w/ elevated border (ringworm) Obese men; ≠Inguinal area Patches: Most; Red; Scaling borders Erythema; Scaling AKA = Athlete's Foot Interdigital spaces Common; 40% of people affected at some point in life Upper trunk Macules: Polymorphic; ↑/↓Pigmented Peripheral scaling Brown spot

Tinea Nigra

Onchomycosis

ΔNail A Discoloration; Thickening; Deformity

≠Striatum corneum KOH; Branching hyphae Athroconidia ≠Striatum corneum KOH; Branching hyphae Athroconidia ≠Striatum corneum KOH; Branching hyphae Athroconidia ≠Striatum corneum KOH; Branching hyphae Athroconidia ≠Striatum corneum KOH; Branching hyphae Athroconidia ≠Striatum corneum KOH; Branching hyphae Athroconidia ≠Striatum corneum KOH; Branching hyphae Athroconidia ≠Striatum corneum KOH; Branching hyphae Athroconidia

Dermatophytes (fungi in soil + animals)

Tx = Topical azole

Dermatophytes (fungi in soil + animals)

Tx = Topical azole

Dermatophytes (fungi in soil + animals) Tx = Topical azole Predisposing factors = Heat; Humidity; Animals Dermatophytes (fungi in soil + animals) Predisposing factors = Heat; Humidity

Tx = Topical azole

Dermatophytes (fungi in soil + animals)

Tx = Topical azole

Dermatophytes (fungi in soil + animals) Malassezia furfur

Tx = Topical azole

Cladosporidium werneckii

Tx = Topical salicylic acid

Dermatophytes (fungi in soil + animals)

Tx = Topical azole

Opportunistic Fungal Infections Px's = Neonates; AIDS; DM; Steroids Yeast (in humans) Budding yeast (white) Normal flora of mouth, skin, and GI Thrush (Neonates; Steroids) Pseudohyphae Proteinases (degrade host tissue) Endocarditis (IVDU) 37C germ tube formation Surface molecules (bind host cells) Candida albicans Vaginitis (Steroids; DM) Not dimorphic Adenosine (≠PMN O2 radical synth) Diaper rash Cryptococcal meningitis Cyclospora (AIDS stool) = oval orgs; Acid fast; FluoresceYeast; Capsular halo Soil; Pigeon droppings Soap bubble lesions in gray matter C. neoFormans = Fungus; C. Parvus = Protozoa Narrow-based budding Encapsulated (Polysacch Ag) Cryptococcus neoformans Inhalation of yeast --> Meningoencephalitis (↓Immune) India Pink(+); Latex agglutinin(+) RF = Corticosteroids Allergic bronchopulmonary infection α w/ Asthma like Sx's 45' angle hyphae; ΦDimorphic Mold Pneumonia (Brewer's lung) Necrotizing pneumonia w/ "target lesions" Lung cavity "fungus ball" Grow on surface of peanuts Aspergillus fumigatus Sinusitis (severe) Target lesions = Gray foci; Hemorrhagic borders "Target lesions" in lung Secrete aflatoxin (carcinogen) Microvascular occlusion (DM; Leukemia) Enter Nasal sinuses; Lungs; GI tract 90' angle hyphae Bread mold fungi A Ischemia of distal tissues A Invasion of vascular walls --> Proliferation of fungi Wide-angle branching Mucor; Rhizopus Mucormycosis A Tissue necrosis Absidia; Cunninghamella Pneumonia (AIDS Px's) Yeast most likely (~protozoan) - still unverified Silver stain(+); Giemsa(+) Inhaled ↓Organelles; Phyogenetic similarity to fungi Foamy edematous fluid Pneumocystis carinii Chitin-containing cell wall (like fungi) Sporotrichosis Yeast Cigar-shaped budding yeast Vegetation Ascending lymphangitis Rosettes conidia Rose thorn (rose shank) Sporothrix schenckii Dimorphic Systemic Mycoses Southwestern U.S.; San Joaguin ValleyInhalation of asexual spores Spherule in tissue Valley fever; Desert bumps Dimorphic Coccidioidomycosis "Cocksuckers in LA" Latin America Inhalation of asexual spores Captain's Wheel formation Dimorphic Paracoccidioidomycosis "Para latinos"

Histoplasmosis

Blastomycoses

Ohio River Valley "Histo = Ohio" East of Mississipi river Central America "Blast the East Coast"

Inhalation of asexual spores

Dimorphic

Broad-Based Budding Dimorphic

Bird / Bat droppings I.C. (Macs)

Disseminated infection Microabscesses (severe invasion) Tx = Nystatin (superficial) Amphotericin B (systemic)

Invasive aspergillosis Secrete aflatoxin (carcinogen) A Liver CA (Africa)

Formerly #1 Cause of death in AIDS Px's Tx = TMP/SMX; Pentamidine Start prophylaxis at CD4 < 200 Tx = Itracanazole; K+Iodide

Tx = Fluconazole; Ketoconazole Amphotericin B (systemic) Tx = Fluconazole; Ketoconazole Amphotericin B (systemic) Tx = Fluconazole; Ketoconazole Amphotericin B (systemic) Tx = Fluconazole; Ketoconazole Amphotericin B (systemic)

Sx's & SIGNS

CLINICAL FINDINGS

LAB DIFFERENTIALS

ETIOLOGY

COMPLICATIONS / Tx

Fungi

Sx's & SIGNS

CLINICAL FINDINGS

LAB DIFFERENTIALS

ETIOLOGY

COMPLICATIONS / Tx

Protozoa Amebiasis Diarrhea (RBC); Dysentery RUQ pain Giardiasis Diarrhea (WBC); Foul smelling stool Giardia lamblia Bloating; Flatulence AIDS Px's mostly Cryptosporidium parvum Severe, debilitating diarrhea (AIDS) Entamoeba histolytica

Toxoplasma gondii

Pneumocystis carinii

Immunocompromised Px's only AIDS Px's mostly ≠CNS Sx's Birth defects

E. histolytica attaches to colonic epithelium (lectin) Cysts or trophozoites in stool Cysts in water A Lyse epithelial cells (pore-forming protein) Flask-shaped colonic ulcers A Invade bowel wall #1 GI Protozoan Cysts or trophozoites in stool Cysts in water G. lamblia attach to duodenal epithelium via sucker disksClubbed villi; Shallow crypts Binucleate parasites A ≠Absorption of food --> Osmotic diarrhea Crytposporidia invade intestinal epithelium Cysts in stool Cysts in water C. neoFormans = Fungus; C. Parvus = Protozoa Inflammation of lamina propria

Liver abscess

#1 Parasitic infection in U.S. (+/- world) 60-80% of population infected --> ASx Life carriers Ingestion of oocysts in cat feces; Uncooked pork A Penetration of ANY host cell (unique to T. gondii) ie. Can penetrate placenta --> organ damage CNS lesions (most common in AIDS Px's)

Life carrier Dormant until immunosuppressed Congenital toxoplasmosis Hx of mom cleaning catboxes

AIDS Px's mostly I.S. Pneumonia (diffuse)

Biopsy (CNS abscess) Serology(+)

TORCH Cysts in meat; Cysts in cat poop I.C. protozoan

Lung lavage(+); Biopsy(+) Silver stain(+)

Inhalation of aerosol

Tx = Metronidazole

Tx = Metronidazole No Tx Sand filters in sanitation systems

Tx = Sulfadiazine + Pentamidine

Tx = TMP / SMX; Dapsone; Pentamidine Plasmodium P. vivax

P. ovale

P. malariae

P. falciparum

Malaria Cyclic fever; Headache; Anemia Splenomegaly Malaria Cyclic fever; Headache; Anemia Splenomegaly Malaria Cyclic fever; Headache; Anemia Splenomegaly Malaria Cyclic fever; Headache; Anemia Splenomegaly

Blood smear(+)

Blood smear(+)

Blood smear(+)

#1 Fatal Parasite Infects liver cells --> infects RBC's A RBC lysis; CNS infarcts

Blood smear(+)

Mosquito (anopheles) Genetic resistance HLA-B53 in liver cells; Sickle Cell Dz Mosquito (anopheles) Genetic resistance HLA-B53 in liver cells; Sickle Cell Dz Mosquito (anopheles) Genetic resistance HLA-B53 in liver cells; Sickle Cell Dz Mosquito (anopheles) Genetic resistance HLA-B53 in liver cells; Sickle Cell Dz

Cerebral malaria (severe) Tx = Chloroquine; Primaquine Cerebral malaria (severe) Tx = Chloroquine; Primaquine Cerebral malaria (severe) Tx = Chloroquine; Pyrimethamine Cerebral malaria (severe) Tx = Quinolones; Pyrimethamine Tx = Artemethol (severe falciparum)

Trypanosoma

Babesia microti

Chagas Dz #1 Cause of HF in Brazil Acute Chagase T. cruzi binds to E.C. matrix proteins via penetrin prot. Myocardial necrosis + I.S. infl. A Invades host cell Chronic Chagas (20%) Cardiomegaly; Mural thrombi RBB arrhythmias; Dilated esoph. African sleeping sickness Demyelinating panencephalitis West Africa Large rubbery chancre at bite African sleeping sickness Demyelinating panencephalitis East Africa Large rubbery chancre at bite Greenish vaginal discharge Foul, fishy smelling Itching; Burning Skin Leishmania Chronic inflammatory Dz Itchy indurated papule Skin (L. major; L. aethiopica; L. mexicana) A Shallow expanding irregular ulcer Mucous membranes (L. brasiliensis) Disfiguring keloids on skin (rare) Viscera (L. donovani; L. chagasi) Visceral Leishmania Fever; ↓Wt.; ↑Pigmentation (kala-azar / black fever) Hepatosplenomegaly; LN-opathy Pancytopenia Babesiosis B. microti invades RBC A Mild fever; Hemolytic anemia

Naegleria

Meningoencephalitis A Rapid death

T. cruzi

T. gambiense

T. rhodesiense

Trichomonas vaginalis

Leishmania

Blood smear(+) Riduviid bug Parasitized myocytes I.C. parasite Chronic inflammation; E'phils Decay accelerating factor (VF)

Tx = Nifurtimox

Blood smear(+)

Tsetse fly Variable suface gP (VF)

Tx = Suramin (blood-borne) Melarsoprol (CNS infxn)

Blood smear(+)

Tsetse fly Variable suface gP (VF)

Tx = Suramin (blood-borne) Melarsoprol (CNS infxn)

Trophozoite on wet mount

STD

Tx = Metronidazole

Macs w/ amastigotes

Sandfly Obligate I.C. parasite Resist acid and proteases of Macs T-cell immune response

Involuted healing < 6 mo's

Hemolytic anemia Blood(+); ΦRBC pigment A Maltese Tetrads (Dx) Amebas in CSF

Ixodes tick Malaria-like protozoan Swimming in fresh water lakes

Tx = Pentavalent Antimony Na-Stibogluconate Tx = Quinine; Clindamycin

No Tx

Sx's & SIGNS

CLINICAL FINDINGS

LAB DIFFERENTIALS

ETIOLOGY

COMPLICATIONS / Tx

Protozoa

Sx's & SIGNS

CLINICAL FINDINGS

LAB DIFFERENTIALS

ETIOLOGY

COMPLICATIONS / Tx

Helminths Cestodes (Tapeworms) Cysticercosis Mild abdominal pain ≠Mental; Convulsions Hydatid Dz Echinococcus granulosus Cysts in liver Taenia solium

Ingestion of undercooked pork A Attachment to stomach wall w/ scolices A Release of eggs --> Bloodborne --> CNS cysts Ingestion of tapeworm eggs A Hatch in duodenum A Invade liver, lungs or bones

CNS lesions Minor inflammation

Undercooked pork

E. granulosus (unilocular cysts; dog feces) E. multilocularis (rodents)

Rupture A Anaphylaxis

Trematodes (Flukes)

Schistosoma

Liver & Spleen cysts #1 Helminth Dz (200M infected annually) Hepatic granulomas + fibrosis Snails (fresh water) Portal HTN S. mansoni S. mansoni (side spine) --> Colon venules Eggs --> Granulomas S. mansoni (Latin America; Africa; Mid East) A Splenomegaly A Liver Granulomas + Portal fibrosis S. japonicaum (no spine) --> Small bowel venules Macs; L'cytes; PMN's; E'phils S. japonicaum (Northeast Asia) Esophageal varices S. japonicaum S. hematobium (middle spine) --> Bladder venules S. hematobium (East Asia) Ascites A Liver Granulomas + Portal fibrosis A Cercariae penetrate skin --> Loose tails S. hematobium A Schistosomulae mature in liver --> Hepatic granules A Hematuria; Chr. obstructive uropathy A Mature adults migrate to Bowel and Bladder Tx = Praziquantel Biliary tract infection Undercooked fish

Clonorchis sinensis Lung inflammation Paragonimus westermani A 2' Bacterial lung infection

Undercooked crab

Tx = Praziquantel Tx = Praziquantel

Nematodes (Roundworms) GI infection Anemia Ancylostoma duodenale

Larvae penetrate feet Anemia A Lung A GI A Worms consume 0.2 mL of blood / worm / day A Anemia

Hookworm Anticoagulants Antioxidants Anti-ACh-ase Hyalinuronidase Pinworm

Tx = Mebendazole; Pyrantel Pamoate

GI infection

Giant roundworm Eggs in human feces

Tx = Mebendazole; Pyrantel Pamoate

Myositis; Fever Periorbital edema

Undercooked pork

Tx = Thiobendazole

Larvae penetrate feet

Tx = Thiobendazole; Ivermectin

♀Blackfly

Tx = Ivermectin

≠Water

Tx = Niridazole

≠Food (eggs)

Tx = Diethylcarbamazine (Toxo; Witchy; Loa)

♀Mosquito W. bancrofti Brugia malayi Dear Fly

Tx = Diethylcarbamazine (Toxo; Witchy; Loa)

Anal pruritus

Tx = Mebendazole; Pyrantel Pamoate

Enterobius vermicularis

Ascaris lumbricoides

Trichinella spiralis

GI infection Strongyloides stercoralis

Strong penetration of feet A GI

River blindness; Pruritic dermatitis (chr)Major cause of blindness in Africa Subcutaneous nodule (onchocercomata) Oncho river / Ivermectin Leopard skin (atrophic + ↑pigement) Black fly on the river Skin infection + ulceration Drink the dracunc The unculus ulcerates Dracunculus medinensis Onchocerca volvulus

Toxocara canis

Wuchereria bancrofti

Loa loa

Granulomatous Dz Blindness (if in retina)

Toxocara ~ Toxoplasma = Granulomatous infection

≠Lymphatic drainage A Elephantitis Lymphedema in groin downward Worm crawls across conjunctiva Swelling in skin

Mosquito --> Elephant = Witchcraft

Look Look a Dear!! Look Look a worm in your eye!!

Sclerosing keratitis A Opacification of cornea

Circulating parasites Chronic lymphatic filariasis Meyers-Kouvenaar bodies

Tx = Diethylcarbamazine (Toxo; Witchy; Loa)

Sx's & SIGNS

CLINICAL FINDINGS

LAB DIFFERENTIALS

ETIOLOGY

COMPLICATIONS / Tx

Helminths

Sx's & SIGNS

CLINICAL FINDINGS

LAB DIFFERENTIALS

ETIOLOGY

COMPLICATIONS / Tx

Viruses - Characteristics

All Viruses

DNA Viruses

RNA Viruses

Infectious

Non-infectious

Slow Viruses

Segmented Viruses

Arboviruses

Hepatitis Transmission

Mostly like human DNA (infectious to us) Envelope = plasma membrane (ΦHerpes) Haploid = 1DNA or 1RNA (ΦRetro = 2ssRNA)

Like Human DNA dsDNA (ΦParvos) Parvo is "part of a" viruse (ssDNA) Linear (ΦPapovas; ΦHepadnas) -AdnA / OvA is like an oval (circular) Icosahedral (ΦPox - complex) Pox is complex Replicate in nucleus (ΦPox) Pox carries own DNA-dependent RNA Enveloped (ΦPAP) Need to be naked for a PAP smear Like Human RNA (mRNA) ssRNA (ΦRios) Rio = repeato virus (dsRNA); A river has 2 beaches (strand) Linear (ΦArena; ΦBunya; ΦDelta) Circular like an Arena a Bunion and a "D"elta Enveloped (ΦPicorna; ΦCalici; ΦReo) Porn stars of Rio and Cali are naked!! Replicate in cytoplasm (ΦInfluenza; ΦRetro) Naked nucleic acids of: dsDNA (Pox; HBV) (+)ssRNA Naked nucleic acids of: (-)ssRNA dsRNA Measles (late sequela) PML (JCV) - AIDS BOAR (all RNA viruses) Bunya Ortho = Influenze (8 segs) Arena Reo ARthropod BOrne Flavi; Toga; Bunya A = Enteric; Fecal - oral A & E = Vowels hit your bowels B = STD; Perinatal; Blood; Parenteral C = Needle (IVDU) D = HBsAg HBV coinfection E = Enteric; Water-borne Epidemics A & E = Vowels hit your bowels

A = Self-limiting B = Chronic hep; Cirrhosis; HCC C = Chronic hep; Cirrhosis; HCC D = ~B E = ~A; ♀Pregant mortality

Sx's & SIGNS

CLINICAL FINDINGS

LAB DIFFERENTIALS

ETIOLOGY

COMPLICATIONS / Tx

Viruses - Characteristics

Sx's & SIGNS

CLINICAL FINDINGS

LAB DIFFERENTIALS

ETIOLOGY

COMPLICATIONS / Tx

DNA Viruses

DNA Viruses

Like Human DNA dsDNA (ΦParvos) Linear (ΦPapovas; ΦHepadnas) Icosahedral (ΦPox - complex) Replicate in nucleus (ΦPox) Enveloped (ΦPAP)

Parvo is "part of a" viruse (ssDNA) -AdnA / OvA is like an oval (circular) Pox is complex Pox carries own DNA-dependent RNA Need to be naked for a PAP smear

Papovaviridae HPV

JC

Genital warts; Cauliflower-like CIN Cervical cancer AIDS Px's (mostly) Progressive Multifocal Leukoencephalopathy

ΦEnvelope ; Nucleocapsid dsDNA; Circular

Kidney transplant Px's

"Brand new Kidney"

ΦEnvelope ; Nucleocapsid dsDNA; Circular

Red eye - Conjunctivitis Sore throat - Pharyngitis Lung Dz - Pneumonia

aDeno = DNA aRena = RNA

ΦEnvelope; Nucleocapsid dsDNA; Linear

"Slapped cheek"; Erythema infectiosumSlap the pervert Aplastic crisis (SCD) PVB12 makes part of a RBC (SCD; Aplastic anemia)

ΦEnvelope ; Nucleocapsid ssDNA; Linear

Adeno-associated viruses

ΦEnvelope ; Nucleocapsid ssDNA; Linear

ΦEnvelope ; Nucleocapsid dsDNA; Circular

BK

Adenovirus Parvoviridae B12

AAV Herpesviridae (CHEV) HSV-1

Oral (+/-genital) lesions Herpes labialis; Corneal blindness Gingivostomatitis; Keratoconjunctivitis Genital (+/-oral) lesions Neonatal herpes encephalitis

#1 Cause of corneal blindness in U.S. Replicate in epithelium --> Vesicular lesions in skin A Latency in ganglia --> Reactivation (sun; stress)

TORCHS Pink Cowdry A (I.N.) Incl. Multinucleated syncytia (Dx) Saliva Tzanck preparation Respiratory sec. Pink Cowdry A (I.N.) Incl. TORCHS Multinucleated syncytia (Dx) STD Tzanck preparation Perinatal Dew-drop skin lesions (pox) α Group Pink Cowdry A (I.N.) Incl. Saliva; Aerosols Tzanck preparation Respiratory sec. Monospot test γ Group Heterophil Ab's: EBV+CVA Saliva Sheep RBC Agglutination Respiratory sec. Atypical T's; Reed-Sternbergs Hemolytic anemia; ↓Plt's β Group; TORCHS Owl's eye influsions (urine sed)Saliva Atypical T L'cytes STD; Perinatal Serology; IgM or IgG Ab's Transfusion

Envelope (nuc m) dsDNA; Linear

Tx = Acyclovir; Steroids (keratitis) Envelope (nuc m) dsDNA; Linear

HHV-6

Replicate in epithelium --> Vesicular lesions in skin A Latency in ganglia --> Reactivation (sun; stress) Respiratory infection --> 2 wks to pox Infects mucus membranes, skin, and neurons A Chicken pox; Centrifugal spread A Infects satellite cells around neurons in DRG Zoster; Shingles A Latency in DRG --> Recurrence (shingles) Mononucleosis (15-20 yrs old) EBV fusion w/ B-cell plasma membrane Fever; Pharyngitis A EBV enters B Cell LN-opathy (Post. Auricular nodes) A B Cell immortalization (vie EBNA2; LMP-1) Hepatosplenomegaly Nasopharyngeal CA (Asia) Neonates; Immunosuppressed Px's Infects endothelial and epithelial cells Hepatosplenomegaly; Jaundice Esophagitis; Colitis; Hepatitis; Pneumonitis; Purpura; Anemia Renal tubulitis; Meningoencephalitis; Choriotinitis Infectious Mono (if not EBV) Roseola Exanthum subitum

HHV-7

Monkey bite A Fatality

Envelope (nuc m) dsDNA; Linear

KSHV-9

AIDS Px's (mostly) Kaposi's Sarcoma

Envelope (nuc m) dsDNA; Linear

Small pox (eradicated; ~warfare) Molluscum contagiosum

Largest dsDNA

Poxvirus

HBV Hepatitis

HBsAg = Surface; Carrier state HBsAb = Immunity; Fights virus HBcAg = Core Ag (never seen b/c inside) HBcAb = Recent Dz HBeAg = Transmissability (Beware) HBeAb (low transm)

HSV-2

VZV

EBV

CMV

Hepadnavirus

Neonatal TL Encephalitis; Pneumonia; DIC

Tx = Acyclovir; Steroids (keratitis) Envelope (nuc m) dsDNA; Linear Envelope (nuc m) dsDNA; Linear

Tx = Live vaccine; Acyclovir; Famciclovir Self-limiting Dz B-Cell Lymphoma Burkitt's Lymphoma t(8;14)

Envelope (nuc m) dsDNA; Linear

Blindness in AIDS Px's Deafness

Envelope (nuc m) dsDNA; Linear

dsDNA Linear IgM (acute); IgG (chronic) Serology test HBcAb HBeAg HBeAb HBsAg W HBsAb

Envelope

dsDNA Envelope Partially Circular

Vaccine (cow pox)

Sx's & SIGNS

CLINICAL FINDINGS

LAB DIFFERENTIALS

ETIOLOGY

COMPLICATIONS / Tx

DNA Viruses

Sx's & SIGNS

CLINICAL FINDINGS

LAB DIFFERENTIALS

ETIOLOGY

COMPLICATIONS / Tx

RNA Viruses RNA Viruses

Like Human RNA (mRNA) ssRNA (ΦRios) A river has 2 beaches (Rio = 2 Strande) Linear (ΦArena; ΦBunya; ΦDelta) Circular like an Arena a Bunion and a "D"elta Enveloped (ΦPicorna; ΦCalici; ΦReo) Pico (small) Calico cat on the River cannot be enveloped

Helical Influenza virus A Influenza Orthomyxoviruses Worldwide Flu epidemics

Mucosal hyperemia Edema + Swelling Rapid reassortment of genes --> Variation Mono infiltrate Shift (major) --> Pandemic (swine + human virus combo) CT-Killers --> Clear virus Drift (slight) --> Epidemic (mutation)

BOAR (segmented) Hemagluttinin; Neuraminidase Ag's H1; H2; H3; N1; N2 Antigenic Shift + Drift

Superinfection (S. aureus; S. pyogenes) A Death Tx = Amantadine; Rimantadine (A only) Zanamivir (A & B); Killed vaccine

Paramyxoviruses (PRM) Croup

4 Serotypes

Parainfluenza

RSV

Brionhiolitis (infants) Bronchopneumonia (infants)

Measles

Measles SSPE (Subacute Sclerosing Panencephalitis) Koplik spots (blue-gray buccal mucosa) Cough; Conjunctivitis; Coryza (runny nose) Maculopapular rash (blotchy)

Mumps

Rhabdovirus

SSPE (Subacute Sclerosing Panencephalitis)

Mumps --> Bumps A Parotitis; Meningitis Orchitis (20%) Rabies Fatal encephalitis; Seizures Hydrophobia Common cold

15% of all asceptic meningitis in U.S.

Meningitis LCV - Lymphocytic Choriomeningitis

aDeno = DNA aRena = RNA

Bat; Dog; Racoon bite A wks - 3mo incubation A Migrates retrograde PNS axons --> CNS Crown of the common colds

≠Stensons ducts Oral ulcerations (Koplik spots) Necrosis; PMN's; Vasc. Follicular hyperplasia of LN's Warthin-Finkeldey cells E'philic I.N. + I.C. Inclusions Pathognomonic I.S. edema Mumps virus Histiocytes; L'cytes; Plasmas Human reservoir

SSPE Giant cell pneumonia Tx = Ribavirin T-cell immunity A Measles rash on reintroduction SSPE; Inclusion-body encephalitis ≠CNS; Mental change; ≠Visual; IgG in CSF Myoclonus; Cerebral atrophy Sterility

Negri bodies (cyt. Inclusions) Rhabdovirus Hippocampus Bullet-shaped capsule G Protein; M Protein; Nucleocapsid

Coronaviruses

Arenaviruses

BOAR (segmented)

Bunyavirus Hantavirus

California Encephalitis

Along southern Rocky Mountain states Fever; Myalgia; ≠GI (3-4 days) A Cough; Dyspnea; Tachypne A ARDS --> Death Kids < 10 yrs; Midwestern U.S. Fever; Headache; Nausea; Vomiting Photophobia

Hantavirus (deer mice) - BOAR (segmented) Hantavirus (60% death)

Arbovirus (sandfly) - BOAR (segmented)

Rift Valley Fevers

Crimea-Congo Hem. Fever

Filovirus

HDV

Ebola Marburg hemorrhagic fever Fatal!! Hepatitis HBV co-infection only

Arbovirus Incomplete RNA virus

Sx's & SIGNS

CLINICAL FINDINGS

LAB DIFFERENTIALS

ETIOLOGY

COMPLICATIONS / Tx

RNA Viruses - Helical

Sx's & SIGNS CLINICAL FINDINGS Icosahedral Picornaviruses (PERCH) Little bird: PERCHES on Rhino's Cock Pole; He Echos (screams) and they HAVe a good time Polio Polio replicates in: A Anterior horn of SC --> Muscular paralysis Poliovirus Bulbar (brain stem) neurons --> Respiratory paralysis Asceptic meningitis Echovirus

ΦEnvelope Nucleocapsid

PicoRNA (small RNA)

ΦEnvelope Nucleocapsid

PicoRNA (small RNA) > 100 serotypes

ΦEnvelope Nucleocapsid

Asceptic meningitis (herpangina) Febrile pharyngitis; Rash (Cox A) Hand, foot, and mouth Dz (Cox A) Myo-pericarditis (Cox B) Acute hepatitis Jaundice

PicoRNA (small RNA)

ΦEnvelope Nucleocapsid

PicoRNA (small RNA)

ΦEnvelope Nucleocapsid

Young; Elderly; Epidemic Gastroenteritis

Fecal-oral

ΦEnvelope

Common cold

HAV

ETIOLOGY

PicoRNA (small RNA)

Rhinovirus

Coxsackievirus

LAB DIFFERENTIALS

Rhino has a runny nose Rhinovirus bind ICAM-1 of URT A Bradykinin release --> Mucus secretion

IgA + IgG Ab's

COMPLICATIONS / Tx

Tx = Polio-Salk/Sabin vaccines (IPV/OPV)

Caliciviruses Norwalk virus

Hepatitis

ΦEnvelope

HEV Reoviruses Colorado Tick Fever

BOAR (segmented)

ΦEnvelope Nucleocapsid

Contaminated water BOAR (segmented)

ΦEnvelope

Reovirus

Rotavirus

Kids < 6 yrs old; Epidemic Diarrhea (severe; fatal)

#1 Cause of fatal diarrhea in kids Rota rooter --> Right Out of The Anus

Flaviviruses St. Louis

Yellow Fever

Dengue

HCV

Fever Black vomit Jaundice C. America; S. America; Mexico Sever aching bone pain Rash IVDU Chronic hepatitis

Councilman body in liver

AKA = Break-bone fever Variant = Hemorrhagic Shock Syndrome (Southeast Asia)

Arbovirus (Aedes mostquito) Monkey or human reservoir Arbovirus (mosquito)

Hemorrhagic dengue (prior exposure)

Hepatic cirrhosis

Togaviruses Encephalitis Eastern Equine Encephalitis Western Equine

Rubella Retroviruses

URTI; Rash; LN-opathy Hepatosplenomegaly Purpura; Pneumonia; Encephalitis (Retro = RNA) AIDS

HIV T Cell Leukemia HTLV

AKA = German measles Thrombocytopenia ≠CNS (encephalitis; cataracts; retinopathy; hearing loss) ≠Heart (Patent DA; Pulm. Arterial hypoplasia) Acute (p24-Ag; ↓CD4+; Φab) ELISA (out) / Western Blot (in) A Latent (↓p24-Ag; ↑Ab's to p24 + p120; =CD4+) A Immunodeficiency (↓CD4+ < 200; ↓Ab's; ↑p24-Ag) Ab's: p24+p120 p24 Ag p24-Ag

Rubellavirus; TORCHS Tx = ΦRx; Live vaccine

Sx's & SIGNS

CLINICAL FINDINGS

LAB DIFFERENTIALS

ETIOLOGY

COMPLICATIONS / Tx

RNA Viruses - Icosahedral

Sx's & SIGNS

CLINICAL FINDINGS

LAB DIFFERENTIALS

ETIOLOGY

COMPLICATIONS / Tx

STD's Gonorrhea

Urethritis; Cervicitis Arthritis

N. gonorrhea

Chancre; Very painful

H. ducreyi

Vaginitis

Trichomonas vaginalis

Genital warts Koilocytes

HPV 6, 11

PID; Prostatitis; Epididymitis

Chancroid

Trichomoniasis

Condylomata acuminata

Chlamydia trachomatis

Treponema pallidum

HPV

HSV-1

HSV-2

EBV

CMV

Hepadnavirus

HIV

TORCHES Bugs

PID

NGU (non-gonococcal urethritis) Arthritis; Conjunctivitis Lymphogranuloma; Trachoma Reiter Syn (♂) Genital infection + Conjunctiviits; Polyarthritis Painless genital chancre (local Dz) Maculopapular rash (palms; soles) Condylomata lata Tabes dorsalis

Elementary bodies --> Enter via endocytosis; Infectious Giemsa(+) Reticulate body --> Fission replication in cell; ≠Infxs Frei test(+) = L1, L2, L3 Chandalier Sign = Cervical motion pain L. venereum Chlamydia invades columnar epithelial cells Granulomatous infl. A Urethritis; Lymphogranuloma venereum; Trachoma

Chlamydia trachomatis Tx = Tetracycline; Erythromycin I.C. parasite (chlamys = cloak) Urethritis; PID; Ectopic pregnancy ΦMuramic acid in cell wall Neonatal infection A, B, C = Africa; Blindness; Chronic Conjunctivitis D-K = Neonatal pneumonia + Conjunctivitis Pneumonia L1, L2, L3 = Lymphogranuloma venereum 1' (3 wks) = Painless, red, raised genital chancre Spiral bugs + Axial filaments BLT to screw; TORCHS Neurosyphilis A 2' (2-10 wks) = Rash on palms+soles; Fever; Headache Outer membrane; Helical protoplasm A Syphilis (T. pallidum) Tabes dorsalis Arthritis; LN-opathy; White oral lesions Obliterative Endarteritis Yaws (T. pertenue) Congenital Syphilis A 3' (15 yrs) = Aortitis; Heart lesions Dark field microscopy Micro-aerophilic Abortion; Stillbirth Gummas; Tabes dorsalis; CNS lesions Non-specific: VRDL(+); RDR(+) ΦEnvelope ; Nucleocapsid dsDNA; Circular

Genital warts; Cauliflower-like CIN (HPV 6, 11) Cervical cancer (HPV 16, 18, odd 30's) TORCHS Oral (+/-genital) lesions #1 Cause of corneal blindness in U.S. Pink Cowdry A (I.N.) Incl. Envelope (nuc m) Herpes labialis; Corneal blindness Replicate in epithelium --> Vesicular lesions in skin Multinucleated syncytia (Dx) Saliva dsDNA; Linear Gingivostomatitis; Keratoconjunctivitis A Latency in ganglia --> Reactivation (sun; stress) Tzanck preparation Respiratory sec. Genital (+/-oral) lesions Pink Cowdry A (I.N.) Incl. TORCHS Envelope (nuc m) Neonatal herpes encephalitis Replicate in epithelium --> Vesicular lesions in skin Multinucleated syncytia (Dx) STD dsDNA; Linear A Latency in ganglia --> Reactivation (sun; stress) Tzanck preparation Perinatal Mononucleosis (15-20 yrs old) EBV fusion w/ B-cell plasma membrane Monospot test γ Group Envelope (nuc m) Fever; Pharyngitis A EBV enters B Cell Heterophil Ab's: EBV+CVA Saliva dsDNA; Linear LN-opathy (Post. Auricular nodes) A B Cell immortalization (vie EBNA2; LMP-1) Sheep RBC Agglutination Respiratory sec. Hepatosplenomegaly Atypical T's; Reed-Sternbergs β Group; TORCHS Neonates; Immunosuppressed Px's Infects endothelial and epithelial cells Hemolytic anemia Envelope (nuc m) Hepatosplenomegaly; Jaundice Esophagitis; Colitis; Hepatitis; Pneumonitis; Thrombocytopenia; Saliva dsDNA; Linear Purpura; Anemia Renal tubulitis; Meningoencephalitis; Choriotinitis Atypical T L'cytes STD; Perinatal Infectious Mono (if not EBV) Nasopharyngeal CA (Asia) Serology; IgM or IgG Ab's Transfusion HBV HBsAg = Surface; Carrier state IgM (acute); IgG (chronic) dsDNA Envelope Hepatitis HBsAb = Immunity; Fights virus Serology test Partially Circular HBcAg = Core Ag (never seen b/c inside) HBcAb = Recent Dz HBcAb HBeAg = Transmissability (Beware) HBeAg HBeAb HBeAb (low transm) HBsAg W HBsAb AIDS Acute (p24-Ag; ↓CD4+; Φab) ELISA (out) / Western Blot (in) HIV Immunodificiency A Latent (↓p24-Ag; ↑Ab's to p24 + p120; =CD4+) Opportunistic infections A Immunodeficiency (↓CD4+ < 200; ↓Ab's; ↑p24-Ag) Ab's: p24+p120 p24 Ag p24-Ag

Toxoplasma Rubella CMV HSV; HIV Syphilis Salpingitis Aendometritis Hydrosalpinx Tubo-ovarian abscess

Chlamydia trachomatis (subacute PID) N. gonorrhea (acute PID) Gardnerella (clue cells) Trichomonas (motile on wet prep)

Temporal lobe encephalitis Mono's --> Neovascularization --> Sarring Tx = Acyclovir; Steroids (keratitis)

Tx = Acyclovir; Steroids (keratitis) Self-limiting Dz B-Cell Lymphoma Burkitt's Lymphoma t(8;14) Blindness in AIDS Px's Congenital CMV Periventricular Ca2+; Encephalitis Deafness

Bacterial = TB; M. avium / I.C. Viral = HSV; VZV; CMV; JC; KSHV Fungal = Cryptococcus; Candida; Histo Protozoan = Toxo; Cryptosporidiosis Lymphoma Meningitis (Cryptococcus; CMV; JCV) CNS Abscess (Toxoplasmosis)

Ectopic pregnancies Infertility Chronic pelvic pain Adhesions

Sx's & SIGNS

CLINICAL FINDINGS

LAB DIFFERENTIALS

ETIOLOGY

COMPLICATIONS / Tx

STD's

Sx's & SIGNS Infectious Agent Descriptions Spongiform encephalopathies CJD; Mad cow; Kuru; Scrapie Prions Neurodegenerative Dz Cold; Flus Enteritides Viruses Chronic (HBV; HIV; HCV)

CLINICAL FINDINGS

LAB DIFFERENTIALS

Obligate I.C. organisms DNA or RNA Protein capsid (protein) +/- envelope (lipid) Mobile DNA or RNA Extracellular or Intracellular Rigid cell wall (phospholipid bilayers 2(+); 1(-) ΦNuclei; Φmitochondria e- transport in cytoplasmic membrane Extracellular or Intracellular Rigid cell wall (except mycoplasma) Φnuclei; No metabolic ability in chalmydia Thick, chitin-containing cell walls Yeasts in humans

Bacteria

Chlamydiae, Rickettsiae & Mycoplasmas

Protozoa

Helminths

Ectoparasites

COMPLICATIONS / Tx

Modified host protein (PrPsc) ΦRNA; ΦDNA (therefore not a virus)

Bacteriophages & Plasmids

Fungi

ETIOLOGY

Systemic infections; Necrosis Superficial infections (tinea) Hemorrhage; Vasc. Occlusion Abscesses (sporotrichosis) P. carinii = Pneumonia Granulomas (Coccidio; Histo; Blasto) Trichomonas vaginalis Plasmodia E. histolytica Leishmania Giardia lamblia Nematodes (roundworms) = GI; Tissues Cestodes (tapeworms) = GI; Tissue (cysts) Trematodes (flukes) = Schistosome Ticks Lice Bugs Fleas

Single cells Pliable plasma membrane w/ organelles Nucleus Multicellular organisms w/ complex lifecycles

Arthropods attached extracorporally

Invasion Viruses

Bacteria

Acute; Abortive Dz Latent; Chronic Dz

Bind to host cell surface proteins A Translocate into cytosol or nucleus A Replicate via virus-specific or host enzymes Adhesins and pili allow attachment Endotoxins; Exotosxins Cytosolic or Phagolysosomal reproduction

Inhibit host cell DNA, RNA, or prot. Synth. ≠Cell membrane; Lyse cells Induce host immune response

Inflammatory Responses Suppurative

Mononuclear

Cytoproliferative

Necrotizing

Chronic

↑Vascular permeability, leukotaxis A Suppurative inflammation

PMN's

L'cytes Macs Inclusion bodies (CMV) Polykaryons (measles) Blisters; Warts Necrosis ΦInfiltrates

Pyogenic bacteria Gram(+) cocci Gram(-) rods Viruses Spirochetes I.C. bacteria Helminths I.C. parasites Viruses (CMV; HSV; HPV; Measles) ΦInflammatory response Uncontrolled viral infections (HBV) Bacterial exotoxins (C. perfringens) Protazoa (E. histolytica) Acute infections (Gonococcal salpingitis) Chronic infections (Schisto)

Inflammation & Background

Sx's & SIGNS Respiratory Infections Rhinovirus (Cold)

Influenza Viruses

Haemophilus influenza

Tuberculosis

Histoplasma

Coccidioides

CLINICAL FINDINGS

LAB DIFFERENTIALS

ETIOLOGY

COMPLICATIONS / Tx

Inflammation & Background

Sx's & SIGNS

CLINICAL FINDINGS

LAB DIFFERENTIALS

ETIOLOGY

COMPLICATIONS / Tx

Respiratory Infections

Sx's & SIGNS GI Infections Viral Enteritis Rotavirus

Norwalk Virus

Enteric Adenovirus Bacterial Enteritis Shigella

E. coli

E. coli

Campylobacter jejuni

Yersinia

Salmonella

Vibrio cholera Parasitic Enteritis Entamoeba histolytica

Giardia lamblia

CLINICAL FINDINGS

LAB DIFFERENTIALS

ETIOLOGY

COMPLICATIONS / Tx

Sx's & SIGNS

CLINICAL FINDINGS

LAB DIFFERENTIALS

ETIOLOGY

COMPLICATIONS / Tx

GI Infections

Sx's & SIGNS STD's HSV - I

HSV - II

Chlamydia trachomatis

Neisseria gonorrhea

Teponema pallidum

Trichomonas vaginalis

CLINICAL FINDINGS

LAB DIFFERENTIALS

ETIOLOGY

COMPLICATIONS / Tx

Sx's & SIGNS

CLINICAL FINDINGS

LAB DIFFERENTIALS

ETIOLOGY

COMPLICATIONS / Tx

STD's

Sx's & SIGNS Childhood & Adolescent Infections Measles

Mumps

EBV

VZV

Poliovirus

Whooping Cough

Diphtheria

CLINICAL FINDINGS

LAB DIFFERENTIALS

ETIOLOGY

COMPLICATIONS / Tx

Sx's & SIGNS

CLINICAL FINDINGS

LAB DIFFERENTIALS

ETIOLOGY

COMPLICATIONS / Tx

Childhood Infections

Sx's & SIGNS Opportunistic Infections CMV

Pseudomonas auruginosa

Legionella pneumophila

Listeria monocytogenes

Candida albicans

Cryptococcus neoformans

Aspergillus fumigatus

Mucormycosis

Pneumocystis carinii

Cryptosporidium parvum

Cyclospora cayetanensis

Toxoplasma gondii

CLINICAL FINDINGS

LAB DIFFERENTIALS

ETIOLOGY

COMPLICATIONS / Tx

Sx's & SIGNS

CLINICAL FINDINGS

LAB DIFFERENTIALS

ETIOLOGY

COMPLICATIONS / Tx

Opportunistic Infections

Sx's & SIGNS

CLINICAL FINDINGS

LAB DIFFERENTIALS

ETIOLOGY

COMPLICATIONS / Tx

Tropical Infections Denguevirus

Rickettsiae

Chlamydia trachomatis

Mycobacterium leprae

Yersinia pestis

Borrelia bergdorferi

Babesi microti

Leishmania Trypanosoma T. rhodesiense

T. gambiense

T. cruzi

Trichinella spiralis

Hookworm

Teaenia solium

T. saginatum

Hydatid Dz

Wuchereria bancrofti

Onchocerca volvulus

Tropical Infections

Sx's & SIGNS Tropical Infections Schistosomas S. mansoni

S. japonicum

S. haemotobium Plasmodium Species P. falciparum

P. vivax

P. malariae

P. ovale

CLINICAL FINDINGS

LAB DIFFERENTIALS

ETIOLOGY

COMPLICATIONS / Tx

Sx's & SIGNS

CLINICAL FINDINGS

LAB DIFFERENTIALS

ETIOLOGY

COMPLICATIONS / Tx

Tropical Infections

Sx's & SIGNS Gram(+) Bacteria Cocci Staph aureus

Strep pneumoniae

Strep pyogenes

Strep agalactiae

Strep viridans

Strep mutans

Enterococcus faecalis Rods Clostridium perfringens

Clostridium tetani

Clostridium botulinum

Clostridium defficile

CLINICAL FINDINGS

LAB DIFFERENTIALS

ETIOLOGY

COMPLICATIONS / Tx

Sx's & SIGNS

CLINICAL FINDINGS

LAB DIFFERENTIALS

ETIOLOGY

COMPLICATIONS / Tx

Gram (+) Bacteria

BACTERIUM Staphylococcus epidermidis Staphylococcus aureus Streptococcus mitis Streptococcus viridans Streptococcus mutans Enterococcus faecalis Streptococcus pneumoniae Streptococcus pyogenes Neisseria species Neisseria meningitidis Veillonellae species Enterobacteriaceae* (E. coli) Proteus species Pseudomonas aeruginosa Haemophilus influenzae Bacteroides species Bifidobacterium bifidum Lactobacillus species Clostridium species Clostridium tetani Corynebacteria Mycobacteria Actinomycetes Spirochetes Mycoplasmas GRAM(-) CELL WALL

++ +

≈

++ +

Vagina

Potential pathogen ++ 100% + Common ≈ Rare

Pharynx

ETIOLOGY

Skin

GRAM(+) & GRAM(-) CELLS WALL STRUCTURES

++ + + ++ + ≈ + + ++ ++

++ + +

≈ + ≈ +

+ +

+

++

+ ≈ + + +

+

+ ≈ ≈ + +

≈

Leading cause of bacterial Dz in humans Endocarditis (subacute) Plaque formation; Caries; Dental Dz Antibiotic-resistant, nosocomial pathogen URT in 1/2 the population. 95% of all Bact. Pneum. Refers to the Group A, Beta-hemolytic streptococi Gram(-) cocci; Bacterial meningitis; Host immunity GI Infections; UTI's; Neonatal meningitis Neighbors = Klebsiella, Enterobacter and Citrobacter Nosocomials!!; Gram(-) Infections; #1 opport. p'gen 2nd invader to viral influenza; H Flu type B vaccine ~Initiate colitis and colon cancer Prevents colonization by potential pathogens Acid formation --> dental caries & vaginal ↓pH Commonly in feces; Diarrhea / P. colitis (2' to Antibiotics) 25% of population has in feces; Does not colonize GI Acne; C. diphtheria; Consistent skin flora

+

PATHOPHYSIOLOGY

Bacterium Bacterial ligand Host cell receptor Attachment site Streptococcus pyogenes Protein F Amino terminus of fibronectin Pharyngeal epithelium Streptococcus mutans Glycosyl transferaseSalivary glycoprotein Pellicle of tooth Streptococcus salivarius Lipoteichoic acid Unknown Buccal epithelium of tongue Streptococcus pneumoniae Cell-bound protein N-acetylhexosamine-galactose Mucosal disaccharide epithelium Staphylococcus aureus Cell-bound protein Amino terminus of fibronectin Mucosal epithelium Neisseria gonorrhoeae N-methylphenyl- alanine Glucosamine-galactose pili carbohydrate Urethral/cervical epithelium Enterotoxigenic E. coli Type-1 fimbriae Species-specific carbohydrate(s) Intestinal epithelium Uropathogenic E. coli Type 1 fimbriae Complex carbohydrate Urethral epithelium Uropathogenic E. coli P-pili (pap) Globobiose linked to ceramide Upper lipid urinary tract Bordetella pertussis Fimbriae Galactose on sulfated glycolipids Respiratory epithelium Vibrio cholerae N-methylphenylalanine Fucose pili and mannose carbohydrate Intestinal epithelium Treponema pallidum Peptide in outer membrane Surface protein (fibronectin) Mucosal epithelium Mycoplasma Membrane protein Sialic acid Respiratory epithelium Chlamydia Unknown Sialic acid Conjunctival or urethral epithelium

NOTES Bacteria Found in Human Feces Bacteroides > Lactobacilli > E. coli > Enterococci > C. perfringens Fimbriae ("filamentous hemagglutinin")

Normal Flora

GRAM(+) & GRAM(-) CELLS WALL STRUCTURES

ETIOLOGY

GRAM(+) & GRAM(-) CELLS WALL STRUCTURES

ETIOLOGY

GRAM(+) & GRAM(-) CELLS WALL STRUCTURES

ETIOLOGY