Tim's Micro Database
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Document Sample
Shape Genus Species Diease
Gram(+)
branching A. israelii
filamentous Actinomyces actinomycosis
Gram(-) rods Bacteroides spp. B. fragilis intra-abdominal and bloodstrem
infections, abscess, bacteremia
B. henselae cat-scratch disease (CSD),
endocarditis
Gram(-) Bartonella spp.
urban-trench fever, endocarditis,
B. quintana
lymphoadenopathy, bacillary
angiomatosis
B. cereus food-poison
Gram(+) rods Bacillus
B. anthrax
Gram(-) rods Bordetella B. pertussis
"Whooping cough"
Gram(-)*
spirochetes Borrelia B. burgdorferi
too small
Lyme disease
Gram(-) Brucella
Gram(-) rods Campylobacter C. jejuni
gastroenteritis, food-poison
chlamydia (Reiter's Syndrome, Pelvic
Gram(-)* Chlamydiae spp. C. trachomatis, C.
Inflammatory Disease, PID,
pleomorphic (Chlamydophila) pneumoniae
Lymphogranuloma venereum, LGV);
ophthalmia neonatorum; neonatal
afebrile pneumonia
Gram(-) rods Citrobacter
septicemias
C. difficile
Pseudomembranous colitis;
nosocomial diarrhea
C. botulinum
Gram(+) rods Clostridium botulism (infant, adult, or wound),
"floppy baby"
C. perfringens (and
others) gas gangrene, anaerobic cellulitis,
wound infection, uterine infection
(abortion), type A food-poison
C. tetani
tetanus (convulsive muscle
contration, lockjaw)
Gram(+) rods Corynebacterium C. diphtheriae
diphthera
Enterotoxigenic E. coli watery diarrhea, food poison (infants
(ETEC) or travelers)
Enteropathogenic E.
coli (EPEC)
diarrhea (infants in developing
countries)
Enteroaggregate E.
chronic watery diarrhea (AIDS and in
coli (EAEC)
developing countries)
Gram(-) rods Escherichia
Enteroinvasive E. coli
(EIEC) bloody diarrhea (similar to Shingella
spp.)
hemorrhagic colitus (bloody
Enterohemolytic E.
diarrhea), pediatric hemolytic uremic
coli (EHEC)
syndrome (HUS)
E. coli (meningitis)
neonatal meningitis
E. coli
(uropathogenic) UTI
Gram(-) rods Enterobacter
E. coli, Shigella spp,
Salmonella spp,
Klebsiella spp,
Enterobacteriaceae (family)
Enterobacter spp,
Serratia spp, Proteus
spp
Gram(+) cocci Enterococcus E. faecalis, E. faecium nocosomial bloodstream infection
(abd. abscess, endocarditis) and UTI
Gram(-) rods Francisella F. tularensis
Tularemia
Gram(-) Gardnerella
Gram(-) rods Haemophilus H. influenzae
pediatric meningitis, epliglottitis
(croup), penumonia/bacteremia;
chronic bronchitis, otitis media
Gram(-) rods Helicobacter H. pylori
gastric ulcer and duodenal ulcer,
adenocarcinoma
Gram(-) rods Klebsiella K. pneumoniae
bloodstream infection, nosocomial
pneumonia and UTI
Gram(+) rods Listeria L. monocytogenes
listeriosis, neonatal meningitis,
spontaenous abortion, bacteremia or
meningitis (ImmuComp pts)
Gram(-) rods Legionella spp. L. pneumophila
Legionnarie's Disease (pneumonia),
Pontiac Fever (actute febrile illness,
no pneumonia)
Gram(-)*
spirochetes Leptospira
too small
M. leprae
leprosy (Lepromatous, Tuberculoid,
or borderline)
M. Avium
(MAI) chronic pulmonary disease,
Gram(+) waxy Non-tuberculous
MAC (AIDS); (M. marinum): “fish tank
rod (acid fast: mycobacteria (MAI,
granulomas” or “swimmer’s
high lipid M. marinum, M.
Mycobacterium granulomas” (hands); (M. ulcerans)
content, ulcerans)
mycolic acid in Bruili ulcer
CM)
Gram(+) waxy
rod (acid fast:
high lipid
Mycobacterium
content,
mycolic acid in
CM)
M. tuberculosis (and
others)
Tuberculosis (TB), chronic pneumonia
no cell wall Mycoplasma spp. M. pneumoniae atypical pneumonia ("walking
pneumonia")
N. gonorrhoeae
gonorrhea
Gram(-)
Neisseria
diplococci
N. meningitidis
(Meningococcus)
pediatric meningitis
Gram(+)
branching Nocardia
filamentous
Gram(-) Pasteurella
P. bivia PID, abscess formation, possible
Gram(-) rods Prevotella
P. melaninogenica bacteremia
Gram(-) rods Proteus spp. P. mirabilis
UTI (cath), diarrhea
RTI, abscess formation, possible
Gram(-) rods Porphyromonas P. gingivalis
bacteremia
Gram(-) rods Pseudomonas P. aeruginosa
lung infection (chronic penumonia),
PTI, UTI, burn/wound infection,
bacteremia => septic shock
(opporunistic)
Gram(-)*
Rickettsia spp. R. rickettsii
pleomorphic
Rocky Mountain Spotted Fever,
typhus
S. typhi
Gram- Salmonella spp.
typhoid fever (enteric fever)
Nontyphoid
Salmonella
salmonellosis (gastroenteritis), food-
poison, septicemia
Serratia S. marcescens
UTI
S. dysenteriae, S.
Gram- Shigella spp. flexneri, S. boydii, S.
sonnei
shigellosis (gastroenteritis, bloody
diarrhea), food-poison
S. epidermidis
staph infection
Staphylococcus
Gram(+) cocci
spp.
Staphylococcus
Gram(+) cocci
spp. food-poison, toxin shock syndrome
S. aureus
(TSST-1), scalding skin infection
(impetigo, follliculitis, furuncles,
wound infection, cellulitis, fascitis),
deep infections (endocarditis,
osteomyelitis, nosocomial
pneumonia, IV-cath related
bacteremia)
S. pyogenes (GAS)
pharyngitis, pneumonia, soft tissue
infection, (2°) Scarlet fever, acute
rheumatic fever (ARF), streptococcal
toxic shock-like syndrome (TSS)
Gram(+) cocci Streptococcus spp. S. agalactiae (GBS)
neonatal meningitis and sepsis
S. pneumoniae
pneumonia, ottis media, meningitis,
(Pneumococcus)
spontaneous bacteterial peritonitis
(alcoholics), 1° bacteremia
(ImmuComp), endocarditis,
pneumonia
Gram(-)*
spirochetes Treponema T. pallidum
too small
syphilis, etc.
Tropheryma T. whipplei
Whipple's disease (GI disorder)
Ureaplasma
Gram(-) rods Vibrio V. cholerae
cholera ("rice water" diarrhea)
Viridans V. streptococci dental caries, endocarditis, and
abscesses
Y. pestis
acute febrile lymphadenitis ("Bubonic
Plague"), Pneumonia Plague
Gram(-) rods Yersinia
Y. enteroclitica, Y.
pseudotuberculosis
GI disease
Gram(+) obligate intracellular
cause pneumonia
Gram(-) facul. intracellular cause meningitis
cause diarrhea
Biology Pathogenesis [P] and Virulence Factor [V]
obligate anerobic (foul smelling, difficult
to culture, produice CO2 and H2)
obligate anaerobic (foul smelling,
difficult to culture, produice CO2 and [P] breeching of epithelim (surgery, wounds,
H2); gut flora ruptures)
[P] invade erythrocytes and endotheliam cells =>
trigger endothelial growth (nodules and liver
fastidous peliosis) => disseminates; [V] angiogenic factors,
hemin-binding proteins, invasion associated locus
(IalA, B), deformin (aid in colonization/entry), and
large adhesion proteins (Bad A)
obligate aerobe [V] enterotoxin
[P] spore germinates/multiplies => toxin spread via
spore-forming, protected by bloodstream and lymphatics => inflammation of
polyglutamyl capsule; exotoxin has LNs; [V] (exotoxin) lethal factor (kills macroage and
edema factor and protective Ag endothelium, impairs neutrophil chemotaxis),
(facilitates cellular uptake) edema factor (adenylyl cyclase ↑)
[P] inhalation => attach to epithelial cilia =>
multiply in lower respiratory tract => damage
strict aerobe, fastidious, sensitive to mucociliary elevator function; [V] filamentous HA,
envrionmental factors, grow on Bordet- Pertussin toxin (ADP ribosylating A-B exotoxin:
Gengou (potato) agar; exotoxin; bvg permenantly inhibiting Gi => ↑ cAMP => cough,
system that turns virulence factors on in inhibits chemokine receptor, lymphocytosis),
response to environmental signals adenylate cyclase, tracheal cytotoxin, heat-liable
(temp., chemicals) toxin, pili
[P] enters bite wound via salivation, requires
>48hrs to attach to glycoprotein => cause erythema
chronicum migran (ECM) at site => disseminate to
brain => joints and brain; [V] surface lipoprotein
must use silver-stain or dark-field to see, (Osps, outer surface proteins) for tissue attachment
Giemsa stain(+) and tropism/Ag
facult. intracellular,
[P] attach to UPR large intestine & LWR small
motile, curved, oxid(+), microaerophilic, intestine => infection & induce inflammation; [V]
grow best at 42°C (unlike H. pylori) adhesins, LPS, enterotoxin (?)
intracellular ENG-obligate, no muramic
acid (cell wall), no pepti-doglycan,
Giemsa stain(+); elementary body (EB) is [P] infect mucosal surface (LGV invades lymphatics)
extracellular & spore-like => reticular => prolong immune response to subclinical
body (RB) replicates (cyto. inclusion) => infection lead to tissue damage => no adaptive
nuc. condesate into EB immunity (repeated infections)
enterobacteriaceae family, oxid(-),
cat(+), glu(+), lactose(+, slow) => pink
colonies on MacConkey's agar; facult.
Anaerobes
[P] toxin A, B => leaky enterocytes & intense
inflammation (neutrophil chemo-attractant, ↑TNF)
=> colonic pseudomembrane; [V] toxin A
(enterotoxin: discrupts signal transduction and
actin skeleton); toxin B (+cytopathic effects)
[P] (classic, infant) ingestion of contam. food
(intoxication); (adult) colonize GI after Abx; wound
infection; [V] heat-labile Botulinum exotoxin (block
spore-forming, obligate anaerobe (foul ACh release => anticholinergic symptoms, CNS
smelling, difficult to culture, produice paralysis) A-G (toxin A most serious & persists in
CO2 and H2); exotoxins; prevalent in soil neuron); heat-resist. spores
[P] (cutaneous) spores enter wounds, exotoxin in
low redox condition kill cells and forms gas
gangrene; [V] α-toxin (exotoxin): gas gangrene,
discrupts PM, 2x zone of hemolysis on blood agar;
(GI) heat-labile enterotoxin
[P] implantation of spores at wound or childbirth =>
tetanus neurotoxin (exotoxin) infiltrate to CNS =>
prevent release of inhibitory NT (GABA & Gly)
facultative aerobe, fastidious (grow on [P] non-invasive colonization and toxin production
Tellurite plate or Loffler's media), => necrosis leads to pseudomembrane in throat
histological palisade formation; contain (bacteria, necrotic epithelial cells, PMNs) => toxin
polyphosphate granules; diphtheriae enters circulation => organ damage; [V] adhesins,
exotoxin (encoded by β-phage) is Diphtheria exotoxin (ADP ribosylating A-B toxin:
expressed in low-iron conditoin detected interfere with host cell protein syn. via inactivating
by bacteria EF-2)
[P] colonize using special pili (CFA); [V] STa and/or
LT => ↑ intestinal fluid secretion
enterobacteriaceae family, oxid(-),
cat(+), glu(+), indole(+) (from
tryptophan); heat-stable/labile (STa, LT)
exotoxin; facult. anaerobes, grow on
simple media (glucose as only carbon)
w/ bile salts (MacConkey agar) or on
Posin-methylene blud (EMB) agar (blue-
enterobacteriaceae family, oxid(-),
cat(+), glu(+), indole(+) (from
[P,V] adheres using bundle-forming pilus (bfp) =>
tryptophan); heat-stable/labile (STa, LT)
type III secretion sys. deliever TIR (receptor for
exotoxin; facult. anaerobes, grow on
EPEC intimin) and effectors that stimulate signal
simple media (glucose as only carbon)
transduction causing pedestal formation
w/ bile salts (MacConkey agar) or on
Posin-methylene blud (EMB) agar (blue-
[P] adhere to enterocytes en mass as aggregate =>
black colonies with metallic sheen);
↑ mucus production => trapped in biofilm
differentiated based on O (LPS), H
[P] invade enterocytes (type III secretion) => lysing
(flagellar) and K (capsular) Ags; all have
vesicles and escapes => multiply and kill cell; [V]
common (type 1) pili that attaches to
lack specific pili but have afimbrial adhesion and
mannose receptor, pathogenic ones also
common pili
have unique pili; produce siderophore
for iron acquisition
(O157:H7 Ag) [P] adhere via intimin and releases
STX => damages colon and kidney via circulation
K1 Ag (homopolyer of sialic acid) avoids
phagocytosis & complement activation
(mol. mimicry) [P] endotoxin induces inflammation in meninges
O4:H5 Ag, Pap pili (P-pili) binds to [P] P-pili binding to kidney and bladder; [V]
Forssman Ag, D-ga-D-gal common pili, P-pili, α-hemolysin, LPS
enterobacteriaceae family, oxid(-),
cat(+), glu(+), lactose(+, fast); facult.
Anaerobes
oxid(-), cat(+, except Shingella), glu(+);
non-spore forming, facult. anaerobes;
somatic O Ag (polysaccharide of
endotoxin), capsular K Ag (virulence),
flagellar H Ag (if motile)
cocci appear in pairs or short chains,
facultative anaerobes; β- or γ-hemolytic
facultative intracellular; very infectious
(10-50 organisms can cause disease); [P] spread via bloodstream and lymphatics to LN =>
Abs confer no protection (need cell- (cutaneous) ulcer and enlarged LNs or (inhaled)
mediated) lung and lymph tissue necrosis, blood clots
Gram stain variable
obligate parasite; small, fastidious [P] (noninvasive) local inflammation & infection of
metabolism (chocolate agar), polysacch. ear, eye, or bronchi; (invasive) mostly Hib, include
encapsulated (more severe, Hib) or non- meningitis, epiglottis, pneumonia, and bacteremia;
encapsulated (nontypeable), can [V] polysacch. capsule (PRP on Hib => anti-
transform macrophagocytic), LOS, and IgA protease
curved, microaerophilic and motile,
grows best at 37°C (unlike C. jejuni), [P] altered flora ↑ release of toxin and cause
urease(+); cag pathogenicity island inflammation => ammonia, VacA, CagA causes
(encodes type IV secretion sys. and ulcer; [V] urease and VacA (damage stomach
CagA, induces inflammation) epithelum); CagA
enterobacteriaceae family; facult.
Anaerobes; oxid(-), cat(+), urease(+),
glu(+), lactose(+) => pink colonies on
MacConkey's agar; polysach. capsule [V] capsule (anti-phagocytic)
catalase(+), coagulase(-), incomplete β- [P] ingested food enters and survives GI =>
hemolytic, facultative intracellular, multiplies in liver (innate response) => disseminate
facultative anaerobe, optimal growth 30- to brain or placenta (cell-mediated response); [V]
37°C; escapes phagosome to cytoplasm listeriolysin O (breaks phagosome), ActA (polarizes
(immune evasion) actin), PlcB (breaks vacuole in 2nd cell)
facultative intracellular obligate
aerobe, silver stain(+); grows on
charcoal yeast extra agar (buffered with
iron and cystein) or in water (biofilm); [P] inhibit phagolysosome fusion using type IV
blocks phago-lysosome fusion and secretion sys. (remodel phagosome => RER); [V]
modulate endocytic vacuole (immune two sets of genes (replication phase; transmission
evasion) phase)
[P] replicate in macrophage and Schwann cells
facultative intracellular acid-fast rod, (tropism for peripheral nerves); (Lepro.) high
obligate aerobe, capsule has phenolic bacterial load, few T cells, foamy macrophage,
glycopid 1 (PGL-1), much smaller cause Type 2 immune response (CD8>CD4, Abs
genome than M. tb, very slow growing, ineffective); (Tuber.) low bacterial load, many T
prefer low temp (32-34°C); cannot be cells, granulomas; cause B. type 1 immune
grown in lab, no useful animal model response (CD4>CD8)
grow faster than M. tb; opportunistic [P] (MAI) systemic disease (disseminates to blood,
pathogen; (M. marinum) aquatic liver, bone marrow), low CD4 count (<50), very high
mycobacteria, infect fish, frogs; grows at bacterial numbers; (M. ulcerans) toxin cause Bruili
lower temp (28-30°C) ulcer
[P] (lung) survives in macrophage (inhibit
phagolysosome fusion & acidification, resists
oxygen intermediates, down-regulate MHC II
cat(+), facultative intracellular obligate expression) => bacteria replicates (active TB) => DC
aerobe (prefers apical lung), grow on cells detection => priming of T cells in LN =>
Lowenstein-Jensen agar; has LAM granuloma formation (latent TB) => no disease or
(mycobacterial LPS); slowing growing (18- reactivation; [V] Kat G (catalase/peroxidase),
24hrs) mycolic acids, no toxins
very small, CM contain sterols, no cell [P] attach to bronchial epithelium and inhibit ciliary
wall, can't be gram stained, grow on function => not destructive but induces inflam.; [V]
Eaton's agar adhesions & hydrogen peroxide
[P] attach to non-ciliated epithelium => penetrate
to submucosal tissue; [V] (phase & antigenic
oxid(+), facultative intracellula ,
variation) pili (attachment; PilE has variable region,
facultative anaerobe, non-motile, can
diff. PilS inserts via recombination), Opa proteins
transform; grow on Thayer-Martin
(receptor-binding), IgA protease
media; diff species have diff virulence
factors: N. meningitidis, (polysacch.
capsule and pili, acid from maltose), N.
[P] attach and avoids mucosal defense => invade
gonorrhoeae (no capsule, but has pili
epithelium & vascular space => multiply & release
and Opa, no acid from maltose),
LOS to brain/skin; [V] capsule (branched carbs, anti-
commensal Neisseria (no capsule, no pili
phagocytic, multiple serotypes => mimic human),
=> no disease)
pili & OMP (attachment, antigenic variation), IgA-
protease, iron-stealing (transferrin), LOS
(inflammatory)
weakly acid fast, obligate aerobe
Bacteroides-like, anaerobic, pigemented,
bile-salt sens. [V] endotoxic LPS
enterobacteriaceae family, oxid(-),
urease(+)
Bacteroides-like, anaerobic, pigemented,
bile-salt sens. [V] endotoxic LPS
motile encapsulated, obligate aerobes, [P] (can't penetrate epithelium) infect burns,
oxid(+), lactose(-); exotoxin, blue-green wounds, incision, or nosocomial (cath, IV) =>
pigment; grows rapidly; quorum sense septicemic infection => shock; [V] exotoxin A (ADP
system: autoinducer (PAI-1) ribosylating A-B toxin: inhibit protein syn. via EF-2
transcription activation (+ exotoxin A inhibition => necrosis), enzymes (proteases,
prod.) => 2nd autoinducer (PAI-2) => ↑ elastase), leucocidin (kill WBCs), PLC (hemolysin),
virulence genes (VF1,2) endotoxin (shock), capsule (slime layer, biofilm), pili
[P] invade vascular endothelium (endothelitis) =>
group of very small atypical bacteria lysis lead to rupture of capillaries; [V] actin
based on clinical features, epidemiology, reorganization (filopodia) that enhanes spread and
and morphology; intracellular (obligate), immune avoidance; phospholipase, protease,
ENG-obligate membrane peroxidase; energy parasite
enterobacteriaceae family, oxid(-),
cat(+), glu(+), lactose(-), H2S(+); facult.
anaerobes; facul. intracellular [P] (ileum) penetrate M cell & enterocytes w/ TTSS
(endosome), non-polysach. capsule; transfer of Sip (membrane-ruffling &
invasion needs >30 genes; (two macropinocytosis) => basal side => (non-typhoid)
component regulatory sys.) PhoP/PhoQ engulf by macrophage or (typhoid) disseminates =>
system (senses presence in phagosome): enters blood/lymph & multiplies in liver, spleen =>
↑ pag expres. (activates PrmA/PrmB => septicemia or secrets thru bile => intestinal
modifies LPS and produce protective inflammation (hemorrhage, perforation); [V]
membrane proteins => survival in flagella, TTSS, Sip (Inv/Spa), LPS, PhoP/PhoQ, PagC
macrophage but ↓ prg expression (resist. antimicrobial), fimbrial/afrimbrial adhesins,
(extracellular survival) Vi Ag (S. typhi)
enterobacteriaceae family; facult.
anaerobes, lactose(+, slow) => pink
colonies on MacConkey's agar;
nosocomial, drug-resistant; red pigment
[P] (colon) apical penetration of M cell (or
enterobacteriaceae family, oxid(-), cat(-), enterocytes basally) TTSS transfer of Ipa; [V] LPS,
glu(+); lactose(-), H2S(-), non-motile; Ipa, Mxi-Spa proteins, IcsA & IcsB (intracellular
exotoxin; facult. anaerobes; uses Ipa in spread of Shigella), Shiga toxin (cleaves host rRNA
plasmid (instead of Sip by Salmonella); => inactivate host 60S ribosome; enhances
escapes phagosome (immune evasion) cytokine release => HUS)
[P] causes nosocomial infection only with IV lines or
cat(+), coagulase(-), facult. anaerobe implants
[P] binds to epithelium => toxins cause hemolysis &
cytokine release => inflammation, endothelial leak
=> shock & multi-organ failure; [V] hemolysins (α
toxin), exfoliative toxin (skin), exotoxin (TSST-1
super Ag: directly binds to MHC-II and TCR
cat(+), coagulase(+), β-hemolytic; simultaneously => 20% of T-cells respond =>
exotoxin (superAg); yellow pigment; release of INF-g and IL-2), enterotoxin (food
MSCRAMMs: protein A, clumping factors poisonins), exfoliatin (scalded skin), leucocidin
A&B (binds fibrinogen), collagen binding (inhibit phagocytosis); protein A (binds Fc region =>
protein, fibronectin binding proteins disrupts opsonization and phagocytosis);
A&B, plasmin-sensitive protein (binds MSCRAMMs (adhesins), polysacch. capsule,
nasal eithelial cells) peptidoglycan & lipoteichoic acid
cat(-), β-hemolytic, encapsulated
microaerobe, exotoxin, bacitracin
sensitive; protein B (Fc frag., immune [P]; [V] (scarlet f.) erythrogenic exotoxin, (TSS)
evasion); cross-talk btwn quorum pyrogenic toxin (encoded by phage); streptolysin O
sensing system and two component (hemolysin, inhibit phagocytosis), M proteins
regulatory system: autoinducer (AIP) (antigenically variable, adherence, bind host Factor
activates AgrC (sensor protein) => H); antigen for ASO Ab (used for diagnosis of
activates AgrA => toxin production rheumatic fever)
catalase(-), β-hemolytic, bacitracin
resistant
[P] nasopharngeal colonization => infect lungs =>
inflam. response (cytokines ↑, capillary leak into
alveoli, leukocyte infiltrate); [V] IgA protease, NA
(cleave SA for entry, ↑ adherence), polysac.
capsule (anti-phagocytic & completment),
catalase(-) diplococci, α-hemolytic, pneumolysin (cytotoxin: damages ciliary cells &
polysac. capsulale ("halo", 90+ serologic capillaries, stim. TNF-a & IL-1), peptidoglycan (stim.
types) TNF-a & IL-1); streptolysin O (inhibit phagocytosis)
[P] adhere to endothelial cells => (1°) vasculitis,
extracellular, microaerobe; too small for lesions with infectious treponemes => heals => (2°)
light-microscope (fluorescent Ab blood dissemination to skin, liver, joint, LN, muscle
staining, dark-field), outer sheath and brain; lymphadenopathy => (latent) reside in
contains gag similar to host (mol. LN and spleen => (3°) reactivates and penetrates
mimicry); kills by air, sunlight various tissues, brain, heart
stain by PAS
urease(+)
[P] ingestion => survive gastric acid => moves thru
intestinal mucus (flagella) => attaches to
highly motile (flagella), extracellular enterocytes (TCP and adhesins) => produce toxin;
facultative anaerobes, oxid(+) (not [V] Cholera exotoxin (ADP ribosylating A-B toxin: Gs
Enterobacteriaceae), halotolerant; protein modification permenantly stimulates AC =>
exotoxin; O-Ag for serotyping (O1 must ↑ cAMP => ↑ Cl- into and ↓ Na+ absorption of gut
important, O139 has capsule); Cholera => H20 into lumen => fluid & electrolyte loss),
toxin has A & B subunits (A: active, B: accessory eneterotoxins, colonization factors (toxin-
binding) coregulated pilus, adhesins)
β- or γ-hemolytic
[V] LPS, capsular envelope, tempature-dep.
facultative intracellular , bipolar coagulase & fibrinolysin => gangrene at
staning; very contagious extremities
oxid(-), cat(+), glu(+), H2S(+); facultative [P] ingestion => ilea/colonic epithelium penetration
intracellular , facult. anaerobes; utilize thru M cells (invasin binding to β-integrin) =>
"zipper" mode of entry by causing host transcytose to Peyer's Patches => subepithelium
cell to pull in (as Listeria) using invasin (grows extracellularly, resist phagocytosis via YOPs)
(made in room temp. before ingestion => disseminate to mesenteric LNs; [V] YOPs,
and can transform E. coli) invasin, LPS
obligate/fastidious aerobe
microaerobe
anaerobe
Reservior [R], Susceptible Pop. [SP],
Transmission [T] Symptoms [S] and Diagnosis [D]
[R] vagina, colon, and mouth
[R] (flora) colon, vagina, and mouth
[R] arthropod vectors (lice, flea, [S] (CSD) lymphadenopathy preceded by
ticks), rodent reservoir; [T] bite or erythematous papule at inoculation site; [D]
feces of cat flea contact history, inoculation lesion, serology
[S] various single/relapse febrile illness; [D]
"culture-neg." endocarditis, bacillary
[R, T] body louse, urban homeless at- angiomatosis; specific culture, serology, PCR, no
risk blood culture (too long)
[T] food-borne [S] vomiting
[S] (cutaneous, 1-12ds incub.) painless small
[R] spores on grass or cows; [T] papule => fluid-filled vesicle => black ulcer;
contact with infected animals or (inhaled, 1-6ds incub.) flu-like symptoms =>
animal products; intentional (terminal phase, 4-6ds incub.) respiratory failure,
exposure shock, meningitis, enlarged mediastinal LN on CXR
[S] (children, <1wk-3wks incub.) upper resp. symp.
=> dry non-productive cough => paroxysmal
[R] asymptomatic adults; [SP] phase: expiration bursts with inspiratory gasp
children; [T] respiratory (very ("whoop" at end of cough) => 2° pneumonia,
contagious) neurologic sequelae (life-threatening)
[S] (early, 2-30ds incub.) ECM ("Bull's Eye") =>
(early disseminated, 2wks-6ms incub.) 10% has
cranial neuropathy, meningitis,
[R] ixodes ticks (only nymph & adult radiculoneuropathy => (late, 2ms-yrs incub.,
stages transmit), different from intermittent) oligoarthritis in 60%, ECMs, neuro.
RMSF; must acquire from infected demyelination with fatigue & dementia; [D] case
rodent to become infectious; [T] history, clinical symptoms serology, culture from
tick bites ECM
[S] fever and diarrhea for 5d after few days; [D]
[R] animal (chicken); [T] food-borne culture & biochem.
[T] sexual exposure; [S] many asymptomatic (25-70%), (m) dysuria, discharge; (f)
urethrtis, cervicitis => (PID) abd. pain, discharge, bleeding, dysuria, nausea, vomiting,
infertility; (LGV) small, painless genital papule => fever, headache => enlarged,
ruptured LN => elephantiasis, proctitis; (newborns) conjunctivitis and pneumonia; (D)
PCR (urine), cell culture, serology
[R] soil, hospital environment, [S] asymptomatic, diarrhea, toxic megacolon
(flora) GI; [SP] hospitalized pts and (death), relapse; [D] ↑ fecal leukocytes;
Abx treatment; [T] fecal-oral, direct sigmoidoscopy (pseudomembranes); toxin
contact detection (cell culture cytotoxicity or ELISA)
[S] (anticholinergic symptoms) double vision,
swallowing difficulties => (CNS paralysis) flaccid
paralysis, breathing problems, other cranial n.
problems; (infant) start with constipation; [P]
[R] soil; [T] food-borne (Alasaka) prepare food carefully; vaccine for special use
[S] (cutaneous) skin lesion, (GI) diarrhea, cramps;
[R] soil; [T] (GI) food-borne [D] gas from leision, culture
[S] uncontrolled muscle spasm => respiratory
[R] soil failure
[S] (1-7ds incub.) malaise, pharyngitis, enlarged
cervical LN => (exotoxin) pseudomembrane
[R] human (perhaps healthy (become more adherent) => enlarged
immunized carriers); [T] aerosols pseudomembrane can block respiration; [D]
(inhaled => nasopharyngeal form; clinical, confirmed by lab (culture & toxin
skin => cutaneous form) detection)
[S] watery diarrhea
[S] formation of attaching & effacing (A/E) lesions
visible on biopsy
[S] watery discharge w/ subtle inflammation but
[R] (flora) GI; [T] pathogenic strains no fecal leucocytes
can be passed to other body
locations or person-to-person via
contaminated vectors (food/water) [S] watery diarrhea, may have blood and
leucocytes
[S] (hemorrhagic colitus, 2-4ds incub.) bloody
stool and no fever for 10ds => 10% has kidney
failure (hemolytic uremic syndrome)
[D] presence of neutrophils in CSF (differential
from other neonatal meningitis)
[S] cystitis (bladder infection) and pyelonephritis
(kidney infection)
[R] many are gut flora in humans
and animals; others are in water or
soil, or are parasites on animals and
plants.
[R] (flora) lower GI tract, skin; [SP]
hospitalized pts; [T] person-to-
person
[R] animals; [T] bite of insect, [S] (aerosolized) acute, severe, resp. illness w/
contact or ingestion of fevers, chills, headache, malaise, fatigue, dry
contaminated animal, aerosol (lab cough, & inflam. of bronchi, pleura, lungs; [D]
or intentional exposure); no person- sputum culture, serology confirms; CXR (inflam.,
to-person pleural effusion, enlarged hilar LN)
[R] (flora) 20-80% adults carry
nontypeable strain in nasopharynx; [D] CSF exam (gram- pleomorphic coccobacillus),
[T] direct contact with respiratory PRP detection (LPA, CIE, ELISA), serology (anti-
secretion or infectious aerosols capsular Ags)
[S] mild GI symptoms (vomiting, gastritis) =>
[R] human; [SP] colonization ↑ with gastric ulcer (1%); [D] (invasive) endoscopy =>
age and lower economic standing; gram-stain the biopsy; (noninvasive) serology and
[T] fecal-oral or oral-oral breath test (urease activity)
[R] human (flora) lower GI tract,
skin (hands); [SP] hospitalized pts;
[T] person-to-person
[S] (spon. abortion) asymptomatic mom or with
[R] soil, decaying vegetatioin, fever => stillbirth, baby with sytemic infection,
intestinal tracts of animals; [SP] meningitis, and rash; (listeriosis) CNS infection,
ImmuComp pts, fetus [T] food- meningo-encephalitis, usually ImmuComp pts; [D]
borne illness (processed food not CSF, blood, Gram stain, presence of
reheated, soft cheese, salads); monocytes/macrophage in CSF (differential from
crosses placenta other neonatal meningitis)
[R] amoeba, ciliated protozoa in
water; [SP] elderly, ImmuComp pts,
smoker; [T] (water contam.) aerosol [D] culture of sputum (often neg. gram stain);
from water sys., air condi-tioners; (pneumonia) CXR for infiltrate; urinary Ag test
no human-to-human (only 1 serogroup)
[S] (Lepro.) skin nodules, plaques, thickened
dermis, nasal mucosa, nerve impairment; (Tuber.)
few flat lesions (hypopigemented, anesthetic),
nerve impairment; (compli.) Erythema nodusum
leprosum (ENL): painful nodules & neuritis after
Abx ; [D] skin lesions, biopsy (acid fast staining),
[T] respiratory, rarely skin-to-skin histology
[SP] ImmuComp pts (AIDS)
[S] (MAI, MAC) fever, diarrhea, wasting; [D]
[R] inhabitant of environment; [SP] depends on special media culture or at lower
(MAI) AIDS pts temp.; acid fast smears
[R] human; [SP] social economic and
living condition, ImmuComp (HIV), [S] ("Consumption") persistent cough, low-grade
genetics, children; [T] respiratory fever, night sweats, difficulty breathing, weight
(air droplets); 1-10 bacilli can infect loss; [D] PPD test (can’t distinguish latent
a person; risk correlates with # of infection or active disease), CXR, ELISA (INF-γ),
contacts sputum, or culture (acid-fast stain, very slow)
[S] pneumonia (self-limiting); [D] distinguishable
when prolonged and no gram stain; culture takes
[R] human 2-4wks ("fried egg")
[S] (male, 2-5ds incub.) asymptomatic or purulent
discharge & dysuria; (female) cervicitis, urethritis,
pelvic inflammatory disease; (neonate)
[R] human only, (flora) genital tract conjunctivitis (transmitted during utero delivery)
[R] human only, (flora) resp. tract
(20% carrier but few gets disease);
[SP] carrier risk: young adults, [S] hypotension, meningitis symptoms (high
geography (Africa), social setting fever, headache, stiff neck), characterisitic rash
(dorm), disease risk: bacterial (petechiae or purpura) => could be fulminate and
capsule, recent colonization, new death in hrs.; [D] clinical; (lab) blood & CSF
strains, immune dificiency (aspenia culture (few other virulent gram(-) diplococci) =>
or complement deficiency) serotype (has acid from glucose & maltose)
[R] (flora) female genital tract
[R] (flora) mouth
[S] infections, bacteremia => septic shock; [D]
[R] ubiquitous; [SP] ImmuComp, culture (Gram-, colorless colonies on MacConkey
burns, CF, or pts with cath & IV lines plates)
[S] (2-12ds incub.) abrupt fever, malaise, sev.
frontal headache, myoalgia, vomiting => abd.
pain, diarrhea, conjunctivitis, confusion,
meningitis, resp./renal dysf. => (2-4ds incub.) rash
[R] arthropod vectors (restricts at extremities; [D] clinical signs & exposure;
distribution to Southeast U.S.); [T] difficult to culture; immuno-staining w/ Abs &
tick bites ELISA, Weil-Felix test
[S] (septicemia) fever, kidney dysfunction; (bile)
diarrhea, hemorrhage, perforation => secondary
[R] human only, (gallstone) carrier; bacterial infection; [D] (clinical) rose spots;
[T] fecal-oral MacConkey agar (white); blood culture
[R] asymp. carriers; zoonotic (food [S] fever and diarrhea => (ImmuComp)
animal, pets); [SP] ImmuComp septicemia; [D] high level of fecal leukocytes;
(AIDS); [T] ingestion of contam., stool culture & biochem. or serology tests;
sometimes water or fecal-oral) epidemiology; (septicemia) blood culture
[D] some stains produce red pigment
[S] from mild diarrhea (S. sonnei) to dysentery
[R] asymptomatic human; [T] food- (bloody diarrhea) and fever => possible death
borne, fecal-oral, person-to-person from fluid loss & electrolyte imbalance; [D] many
contact (very virulent) fecal leukocytes; culture & biochem./serology
[R] (flora) skin
[R] human, naterior nares flora
(30%); [SP] young women using [S] (food poison, 2-6hrs incub.) vomiting, diarrhea;
tampon; [T] (food-poison) (TSST-1) fever, diffuse rash, hypotension, multi-
contaminated food, heat-stable; organ system dysfunction; staphylococcal scalded
(others) contact and droplet skin syndrome (exfoliatin)
[S] (ARF) arthritis, carditis, chorea, erythma
margnatum, subcutaneous nodules; (TSS)
hypotension, renal/hepatic impairment,
erythematous rash; 2° complication: toxin
mediated (Sarlet fever, TSS), suppurative
(sinusitis, otitis media, retropharyngeal abscess),
nonsuppurative (ARF); [D] (TSS) isolation of GAS +
symptoms; (ARF) prior GAS infection + symptoms
[D] presence of neutrophils in CSF (differential
from other neonatal meningitis)
[R] human (nasalpharynx flora); [SP]
elderly or smokers (defective ciliary)
and infants or ImmuComp
(defective Ab); [T] respiratory [S] (pneumonia) fever, chills, cough (sputum),
droplet, close contact dyspnea, pleuric chest pain
[S] (1°) chancre in 3wks => (2°) rash on palm
trunk, sole for 3-6wks, lymphadenopathy =>
(latent) asymp., CSF abnor. for 3-30yrs => (3°,
irreversible) gumma of skin, bone, liver, testes;
neurosyphilis, Tabes dorsalis, cardiovascular
[R] human; [T] sexual contact, skin lesions (immune); [D] PE (chancre), serology: non-
abrasion, mucosal contact, or trep. (VDRL, RPR) or trep. (FTA, MHA-TP) tests; no
transplacenta culture
[S] wt loss, diarrhea, joint pain, and arthritis; [D]
PAS stain
[S] (hrs-ds incub.) diarrhea, poor skin turgor,
sunken eyes, vomiting; (cholera gravis) ~1L/hr
fluid loss and pale grey stool with small flecks of
mucus ("rice water stool") => cardiac problems or
[R] estuary waters (biofilm), shock; [D] clinical, confirmed by
asymptomatic human, stool; [T] biochem./serology or stool culture (non-invasive
water-borne, usually in pandemics => no leukocyte)
[R] human (flora) upper respiratory
tract, colon, and female genital tract
[S] (acute febrile lymphadenitis) sudden fevers,
chills, weakness, headahce, intense pain/swelling
of LNs => pneumonia or sepsis; (Pneumonic
Plague, 2-4ds incub.) fever, cough, difficulty
breathing, bloody sputum, pneumonia (50%
[R] rodents, flea vector; mortality)
[T] ingestion [S] (GI diease) fever, cramps, diarrhea
arbovirus
Treatment [T] and Prevention [P] Others
frequently confused with neoplasms
[T] drainage of abscess, metronidazole,
Clindamycin responsible for non-Clostridial anaerobic infection
[T] Doxycycline, Clarithromycin,
Ciprofloxacin
[T] (uncomplicated bacteremia)
Doxycylin or Arithromycin; (endocarditis)
4-6ms of treatment and Cephalosporin &
Aminoglycoside
[T] Doxycycline, Ciprofloxacin,
Raxibacumab; [P] Anthrax vaccine
[T] supportive care, Abx that penetrate
respiratory tract (Erthyromycin); [P]
(wane over time) DPT vaccine (killed:
sequelae include fever & seizures) or
DPaT (acellular: fewer side effects,
contain FHA)
[T] (early) Doxycylin, (late) Ceftriaxone;
[P] environmental modification, cover
skin, repellent, check for ticks
[T] supportive or antimicrobial; [P]
hygiene, cooking sequelae can include Guillain-Barre syndrome
[T] Macrolides or Doxycyclin (RBs only);
[P] abstinence, barrier protection, difficult to Gram stain (intracellular), high co-transmission
communication, diagnosis with gonococcal disease
[T] treat symptoms w/ Vancomycin or
Metronidazole, avoid opiates or
antimotility drugs, stop Abx; [P] contact
precautions, designated equipment,
wash hands, limit Abx most common cause of hospita-acquired diarrhea
relatively uncommon in U.S.; class A select agent
[T] botulinum antitoxin, supportive (bioterrorism);
therapy {nabc.ksu.edu/images/uploads/botulism.jpg}
[T] (cutaneous) surgical removal of
gangrene; [P] (cutaneous) keep wounds
clean
[T] (very difficult) antitoxin and muscle
relaxant; [P] DPT vaccine
[T] antitoxin and antimicrobials; [P] DPT
vaccine isolated on media containing tellurite salts
[D] grown on MacConke agar forms pink
colonies due to lactose utilization
(differentiate from Pseudomonas,
Salmonella and Shigella that form white
colonies) => biochemical tests including [V] LPS: part of OM, Hemolysin (Hly): can damage kidney;
enteric testing panels and APT strips => heat-stable enterotoxin (STa): small exotoxin that simulate
[D] grown on MacConke agar forms pink
colonies due to lactose utilization
(differentiate from Pseudomonas,
Salmonella and Shigella that form white
colonies) => biochemical tests including [V] LPS: part of OM, Hemolysin (Hly): can damage kidney;
enteric testing panels and APT strips => heat-stable enterotoxin (STa): small exotoxin that simulate
serology, clinical grounds, and guanylate cyclase => ↑ intestinal cGMP => fluid/eletrolyte
molecular testing (e.g. LT genes) for secretion; heat-labile enterotoxin (LT): large exotoxin that
differentiation btwn serotypes; [T] varies stimulates adenolyate cyclase => ↑ intestinal cAMP level
with disease condition, ranges from (homologous to Cholera) => water diarrhea; Shinga toxin
symptomatic (ETEC), Abx (neonatal (STX): large protein that cleaves host rRNA => inactivate
meningitis & UTIs), kidney dialysis & host 60S ribosome; also enhances cytokine release =>
blood transfusion but no Abx (HUS); HUS; released by EHEC (O157:H7 Ag) & S. dysenteriae
possible Abx include Cephalosporins
(3rd), Aminoglycosides (Streptomycin,
Gentamycin), Bactrim, and
Fluoroquinolones (Ciprofloxiane)
.
enterics: gut flora bacteria (e.g. Bacteroides, Escherichia)
[T] cell wall change => Vancomycin &
Ampicillin (resistent VRE: use Linezolid, this genus were classified as Group D Streptococcus until
Daptomycin, Tigecyclin) 1984; E. faecium: has more Abx resistence
[T] (preferred, IV) Streptomyin,
Gentamycin; (alt., oral) Doxycyclin,
Ciprofloxacin, Chloramphenicol; [P]
vaccine under review
[T] many produce β-lactamase but
newer Abx works (2nd, 3rd gen.
Cephalosporin); [P] exposure is
inevitable, conjugated PRP vaccine is chocolate agar has facotr V (NAD) and X (hematin); PRP
effective vaccine decreased pediatric meningitis significantly
[T] combination therapy of antimicrobial
(Clarithromycin, Amoxillin, Bismuth Salts) causes all duodenal ulcer and 70% of gastric ulcer; rest are
and acid-blocker (Omeprazole) from excess NSAIDs
[T] Ciprofloxacin, Cephasporin (3rd);
many has β-lactamase (ESBL inactivate
all except Carbapenems) non-motile, indole-negative
[T] Ampicillin or Bactrim (even w/out
postive gram stain); [P] clean food, listeriosis has 20-60% mortality; bacteremia or septicemia
(pregnant women/ImmuComp pts) avoid has 70% mortaliy; aoids immune response by using actin to
certain food move to adjacent cell without going outside
[T] Macrolides and Quinolones (bacteria
in phagocytes); [P] inspect and disinfect
water supply (chlorine ineffective) difficult to Gram stain (intracellular)
[T] depends on lepromatous or
tuberculoid; Dapsone, Rifampin for 1-
2yrs; steroid for ENL
[T] difficult to treat; (MAI, MAC)
Rifabutin, Clarthromycin, Ethambutol; [P]
(MAI, MAC) Azithromycin MAI = M. avium-intracellulare
[T] (compliance) 1st line (RIPE): (active) *Infection of M. tuberculosis does NOT necessarily lead to
2ms of Rifampin, Isoniazid (↓ mycolic disease*; infection can occur in any organ (Pulmonary,
acid syn.), Pyrazinamide, Ethambutol Extrapulmonary, Miliary, or others, e.g. meningitis); after
(cell wall biosyn.) => INH/RIF (4-10ms); contact, one could have active TB (PPD+, infectious), clear
(latent) Iso (9ms); 2nd line: suscep. 1st + infection (PPD-, not infectious), or latent (no disease or
Ethonamid, Fluoroquinolone, reactivation from immunosuppresion); cell mediated
Cycloserine, Streptomycin, PAS, immune response: INF-γ, TNF, IL-12 => macrophage
Capreomycin; (resist.) MDR; [P] BCG activation: NO production kills mycobacteria, granuloma
vaccine (live-attenuated, low efficacy) formation
[T] can't use cell-wall Abx; abx shorten
symptoms (Doxycycline, Azithromycin,
Fluoroquinolones)
[T] highly susceptible to Penicillin,
Cephalosporin, Rifampin,
Fluoroquinolones (only N. gonorrhea);
[P] vaccine or Abx to avoid 2° case (no
vaccine against serotype B because it's
similar to neural SA)
[T] drainage of abscess, metronidazole
[T] drainage of abscess, metronidazole
[T] (shock) supportive; Piperacillin,
Ticarcillin (+ β-lactamase Inhibitors);
Cefepime, Ceftazidime (no other 3G
cephalosporins); Imipenem; Aztreonam;
Gentamycin (Aminoglycosides); makes blue-green pigment, fruity odor; resistant to many
Ciprofloxacin (Quinolones); Colistin drugs
[T] prompt treatment with Tetracycline;
[P] public awareness difficult to Gram stain (intracellular)
[T] Ciprofloxacin, Azithromycin
(macrolid), Bactrim, Ceftriazone
(cephalosporin); gall-bladder removal if
shedding continues; [P] hygiene, isolate
carriers, some vaccine (Vi Ag, live-
attenuated)
[T] symptomatic therapy (fluid
replacement), no anti-motility;
(septicemia) Abx; [P] hygiene, no vaccine
[T] Ciprofloxacin, Azithromycin
(macrolid), Bactrim; replenish
fluid/eletrolytes, keep motility; [P] live IcsA manipulates actin; IcsB helps break out from vesicle;
attenuated vaccine under development; Shigella enters apical side of M cells only but can enter
hygiene enterocytes from basal side
[T] (wt) Oxacillin, Vancomycin, CA-MRSA affects pts with no history of hospitalization or
Clindamycin, or Cephalosporin; other risk factors, e.g. healthy children, military, athletic
(nosocomial S. aureus) β-lactam resistant teams, MSM, prisoners (nocosomial MRSA affects sickest
(MRSA: use Vacomycin); [P] (nosocomial pts); HA-MRSA (50% of nocosomial S. aureus) treatment
S. aureus) preventable with better hand with Vancomycin may turn floral Enterococcus into VRE;
hygiene, protecitve clothing "aureus" = yellow
[T] Penicillin, Erythromycin (macrolid);
(ARF) NSAIDs, or steroids; [P] (ARF) treat
pharyngitis w/in 10ds (PCN)
Biology for Streptococcus spp.: aerotolerant , can
transform (DNA transfer), catalase(-)
[T] Peniccilin G, Erythromycin
(macrolid), Ceftriaxone (cephalosporin);
[P] pneumococccal anti-capsule vaccine
(for <2yrs, >65yrs, or other high risk)
difficult to Gram stain (too small); Congenital Syphilis:
causes still-birth, dead babies; survivors have physical
[T] Penicillin (up until 3°); lesions with 1° deformities and neurological complications (premature,
or 2° are self-resolving; [P] abstinence, enlarged spleen, skeletal problem, pneumonia, & skin
barrier protection, communication, rashes); Late-onset disease (>2yrs) have malformations in
diagnosis bones, teeth, skin (Hutchinson's Triad); "TORCHES"
regulators of virulence factor expression: environmental
stimulus activates ToxR/TcpP/ToxS membrane protein
[T] Abx, restore fluid/electrolyte loss; [P] complex and activate transctiption of ToxT => ToxT
hygiene, vaccine approved abroad activate virulence genes => ↑ virulence factors
[T] (preferred, IV) Streptomyin,
Gentamycin; (alt., oral) Doxycyclin,
Ciprofloxacin, Chloramphenicol
Name Diease
yeast Candida C. albicans
oral thrush, rash, absecesses, blood
infection
C. neoformans, C.
yeast Cryptococcus meningitis, chronic pneumonia, yeast
gattii
infection
allergic bronchopulmonary
aspergillosis (ABPA, asthema/CF),
A. fumigatus, A.
mold Aspergillus Aspergilloma, invasive pulmonary
niger
aspergillosis (90% mortality in
transplant pts)
mucormycosis (oropharyngeal, facial
mold Zygomycete infection): rhinocerebral disease (high
mortality)
S. schenickii, S.
Fusarium,
dimorph Sporothrix
Penicilllium
marneffei Sporotrichosis
acute 1° infection, mediastinal
dimorph Histoplasma H. capsulatum granuloma and fibrosis,
histoplasmosis
dimorph Coccidoimyces C. immitis
coccididioidomysosis ("valley fever")
dimorph Blastomyces B. dermatitidis
bastomycosis (skin/lung leisions)
Microsporum canis,
mold Dermatophytes
Trichophyton rubrum "ring worm", tinea pedis ("athelet's
foot)
PCP (pneumonia) in HIV or transplant
yeast Pneumocystis P. jirovecii
pts
Biology (stain by Silver, grow on
Sabouraud's agar) Pathogenesis [P] and Virulence Factor [V]
growth controlled by flora and cellular [P] immunosuppression or mucosal injury (surgery)
imunity; has pseudohyphae (elongated => may disseminate to brain (meningitis),
budding) pneumonia (lung), cardiac
encapsulated, grows well at 37°C, [P] affects ImmuComp; enters body via respiratory
suppressed by CD4; stain by India Ink tract; has capsule (anti-phago.)
[P] inhalation of spores -> evasion of immune sys.
kill by neutrophils, could cause excess (compromised) -> local lung infection ->
inflammatory response disseminate via blood vessels
[P] entry via respiratory tract -> brain infection;
usually infects diabetics and pts on steroids
[P] cutaneous infection -> lymphatic spread
associated with peripheral eosinophilia; [P] 1° infection could be asymptomatic =>
mycelial in soil, yeast-form in human; disseminate years after infection when ImmuComp;
infectious as arthroconidia, non- inhalation of infectious arthroconidia => spherule
infectious as spherule containing endospores
[P] 1° infection in lung and disseminate
infects skin, use keratin as nutrient,
can't be grown in lab
Reservior [R], Susceptible Pop. [SP],
Transmission [T] Symptoms [S] and Diagnosis [D]
[R] (flora) mouth, GI, vagina; [SP]
ImmuComp pts (AIDS, T cell
deficiency, neonate, diabetes, stress,
iatrogenic, Abx) [S,D] oral lesion that can be scraped off
[R] pigeon dropping, trees/rotting
wood; [SP] ImmuComp pts (AIDS, [D] mixing India Ink with body fluid (CSF); serology
CD4 <200) for capsular Ag
[R] ubiquitous; [SP] ImmuComp pts [D] examinatoin of dissected tissue, growth of
(transplant or AIDS) respiratory specimen, Ag in blood
[R] envrionment
[R] soil and infected plant products
[R] (endemic in Ohio, Miss. River
valleys soil) [D] find organism, culture, Ag in urine or serum
[S] 60% asymptomatic; repiratory symptoms,
fatigue, fever, wt loss, rash (similar to TB) => self-
[R] soil (endemic in U.S. SW, limiting in 1-3wks; (complications) cavity,
Cen./Sou. Am.); [T] no person-to- dissemination to skin, meningitis, pneumonia; [D]
person travel history, Ab or Ag in blood
[R] soil (endemic in Ohio, Miss. River
valleys)
[R] zoophilic, geophilic, or [D] microscopic examination of skin scraping or nail
anthropophilic clipping
[SP] ImmuComp pts (AIDS, CD4 <200) `
Treatment [T] and Prevention [P]
[T] Fluconzole+Voriconazole
[T] Amphotericin+Flucytosine, follow
by Fluconazole
[T] Amphotericin, Voriconazole,
Posaconazole (not Fluconazole--no
activity against molds)
[T] topical therapy (imidazole), azoles
[T] Bactrim; [P] prophylaxis w/ Bactrim
if CD4<200
Other names,
Class Type Name Generations Mechanism of Action Broad (B), Narrow
Clavulanic acid ,
β-lactamase
Sulbactam,
Inhibitors
Tazobactam suicide inactivator
Penicillin G (IV), inhibit transpeptidase (mimic D-
Penicillin V (oral) Ala-D-Ala), penicillinase sensitive N
Methicillin, Nafcillin, anti-Staph. Penicillin,
Dicloxacillin penicillinase resistant N
Penicillins
Amino-Penicillin (wider
Ampicillin, Amoxicillin spectrum), penicillinase sensitive B
Carboxy-Penicillin: anti-
Carbenicillin, pesudomonal Penicillin,
Ticarcillin, Piperacillin penicillinase sensitive E
Inhibit Cell wall Synthesis
β-Lactams
(time- (1) Cefazolin,
BC
depend.) Cephalexin
Cephalosporins
(2) Cefoxitin, Cefaclor,
Cefuroxime same as Penicillin, penicillinase
(3) Ceftazidime, resistant
Ceftriaxone,
Cefotaxime
(4) Cefepime
Imipenem,
Carbapenems Meropenem,
Ertapenem B
Monobactams
Aztreonam N
inhibit Gram+ peptidoglycan
Vancomycin BC polymerization a step before
penicillin N
binds lipid carrier of
Bacitracin peptidoglycan, preventing
delievery of cell wall syn.
Membrane
cationic detergent that disrupts
Damaging
Polimixins BC
cell membrane
Agents
insertion into membrane;
Cell
Daptomycin BC
disrupts cellular synthesis
Quinolones
Inhibit Nuclear Acid Synthesis
(1)Nalidixic Acid -> BC
DNA (fluoroquinolone)
(2)Ciprofloxacin, strand breaking by inhibition of
damaging (3)Levofloxacin
Nitrofurantoin DNA gyrase & topo IV DNA-
nitro-reduction to form that B
B
formaldehyde formation B
Agent Nitrofuran
Methenamine BS-
BC
Metronidazole BC nitro-reduction to form DNA-
damaging radicals
Sulfonamides
BS
(Sulfamethoxazole) inhibit folic acid syn. B
anti-Folate Bactrim
inhibit folic acid syn. (highly
BS
Trimethoprim selective for bacterial DHFR)
anti-RNA
Rifampin BC
Poly. inhibit bacterial RNA syn.
Doxycycline, BS
30S Tetracyclines Minocycline binds and inhibits bacterial 30S B
ribosomal subunits (also binds to
BC
Tigecycline eukaryotes) B
Inhibit protein Synthesis
Erythromycin ->
Azithromycin, BS
Macrolides Clarithromycin
Chloramphenicol BS
B
binds and inhibits bacterial 50S
50S Clindamycin BS ribosomal subunits
Quinupristine &
BC
dalforpristin
Linezolid BS
B
Streptomycin
30S and Gentamycin, binds and inhibits bacterial 30S,
Aminoglycosides BC
50S Tobramycin 50S ribosomal subunits
Neomycin
Gram(+)
Gram(+/-)
Gram(-)
Antifungal
bind to ergosterol in funcal cyto.
Amphotericin
Amphotericin B membrane (↑perm.)
Imidazole, Triazole,
Fluconzole,
Azoles
Voriconazole, bind to fungal cyto. membrane
Posaconazole and ↓ ergosterol
Echinocandin inhibit fungal cell wall syn.
interferes with funcal DNA
Flucytosine
synthesis
Antibacterial spectrum Clinical Use
Clavulanate+Amoxicillin/Ticarcillin;
bacteria sensitive to β-Lactams Sulbactam+Amp; Tazobactam+Piperacillin
Gram+ cocci/rods (S. penumoniae, GAS, Listeria),
few Gram- cocci (N. meningitidis, T. pallidum);
spirochetes
pneumonia, meningitis, otitis media,
Gram+ (S. aureus) bacteremia, STDs (syphils), UTI, epiglotitis
Gram+ cocci/rods (Enterococcus, L.
monocytogenes), few Gram- rods (non-β-lactamase bronchitis, otitis media, sinusitis, broad
E coli, H. influenza, P. mirabilis, Salmonella), not P. gram(-) coverage w/ Gentamycin ("Amp-
aeruginosa or VRE gent")
Gram+, specific Gram- (Pseudomonae) w/ clavulanic
acid
Gram+ cocci (Staph, Strep, Enterococcus) and Gram-
(P. mirabilis, E. coli, K. pneumoniae) gastroenteritis, diarrhea
Gram+ cocci (Staph, Strep, Enterococcus), Gram-
rods (H. influenza, E. aerogenes, Neisseria spp., P.
mirabilis, E. coli, K. pneumonia, Serratia
marceescens)
Gram- (Psuedomonas by Ceftazidime, gonorrhea by serious Gram- infections, bacterial
Ceftriaxone) meningitis (penetrates BBB)
Gram+ and Psuedomonas (increased efficacy)
Gram+/- (very broad spectrum, including Klebsiella); restricted for serious nosocomial
kills ALL (Pseudonomas, ESBLs) infections due to serious toxicity
restricted use serious nosocomial gram-
aerobic Gram- (Pseudomonas) infections
ALL Gram+ (Staph, Strep., Enterococcus,
Clostridium) treats MRSA (Staph), C. difficile; not VRE
Gram+ cocci (S. pyogen but not S. agalatiae), some
Gram- topical use for skin/eye infection
topical use for skin/eye infection; effective
Gram-: Pseudomonas against
Gram+ only: VRE, MRSA serious skin infections
Gram+/-: (+) S. aureus, S. pneumonia; enterics: (+)
Enterococcus, (-) Shigella, Salmonella, E. coli,
Pseudonomas, Campylobacter, Klebsiella; N. UTI, RTI, TB, Anthrax; 3,4th gen. target
gonorrhea; atypical: Legionella, Brucella, Borrelia, CAP (penicillin resist. S. pneumoniae, other
Mycobacterium, Yersinia
Gram+/- (except P. aeruginosa) gram+ infections), gastroenteritis, diarrhea
UTI only
Gram+/- UTI (prophyl)
Anaerobic Gram +/- (Clostridium, Bacteroides),
some protozoa (Trichomonas vaginalis, Giardia,
Entamoeba histolytica) anaerobic infection , some protozoa
UTI, malaria, PCP (AIDS); meningitis &
Gram+/-: (+) Listeria, Strep.; (-) Hemophilis, E. coli, burns (prophy)
Salmonella, Shigella, Proteus; (others) T. gondii,
Pneumocystis UTI, RTI, prostatitis, PCP & T. gondii (AIDS)
specific Gram(-): Nessieria, M. tuberculosis
(intra/extracellular) 1st line for TB; resist. Staph
Gram+/-: (-) Chlamydia, Treponema, Borrelia &
Brucella; (zoonotics) Rickettsia, Borellia, B. anthrax, tick-borne disease, STD (chlamydia &
Yersinia; (others) Mycoplasma syphilis), walking pneumonia
bacteria resistant to Tetracyclin, β-
Gram+/-: VRE, MRSA Lactams, or Vancomycin (VRE)
Gram+/-: (+) Staph., Strep; (-) Legionnaires, upper and lower respiratory tract
Chlamydia, Shingella, Salmonella; (others) infections (pneumonia), gastroenteritis,
Mycoplasma diarrhea
Gram+/- (very broad spectrum): (-) Rickettsia, B. bacterial meningitis, topical use for serious
fragilis skin/eye infection
Gram+: Staph., Strep.; (anaerobes) Bacteroide; Penicillin-resistant anaerobic infections;
(pthers) T. gonii pts with Pencillin hypersensitivity; TSST
Gram+: VRE, MRSA
nosocomial pneumonia, complicated skin
Gram+: VRE, MRSA or soft tissue infection
Gram- aerobic enterics (E. coli; especially anti-TB
Pseudomonae); also Yersinia, Brucella, alone or with β-Lactam for serious Gram-
Mycobacterium infections, diarrhea
topical for burns, wounds, skin infections
anti-enterics diarrhea
anti-anaerobe
active against all fungi
Imidazole (topical), Triazole (IV, serious fungal), Fluconzole+Voriconazole (Candida),
Fluconzole+Voriconazole+Posaconazole (mold)
active against Candida and Aspergillus; not active against Cryptococcus and Zygomycetes
combination therapy with amphotericin against cryptococal meningitis
Major toxicities Resistance Others
some β-lactamase are not
inhibited
hypersensitivity, hemolytic β-lactamase (S. aureus), altered
anemia PBP (S. pneumoniae)
hypersensitivity, interstital no →CNS; short 1/2 life; can use
nephritis (methicillin) altered PBP (MRSA) clavulanic acid (β-lactamase
inhibitor) to increase efficacy against
hypersensitivity, resistant bacteria; all classes of
pseudomembranius colitis, rash penicillin will cause hypersensitivity
(ampicillin) β-lactamase reaction to susceptible pts
hypersensitivity β-lactamase
hypersensitivity, cross not affected by β-lactamase but
hypersensitivity with Penicillin (5- by ESBL
not against MRSA, Enterococcus, or
10%), increase nephrotoxicity of
Pseudomonas (except 3rd/4th
aminoglycosides, disulfiram-like
generation Cephalosporins);
reaction with ethanol (e.g.
anaerobic coverage (B. fragilis)
cefamandole: cephalosporin with
methylthiotetrazole group)
GI distress, skin rash, CNS toxicity not affected by β-lactamase but
(seizures) at high plasma level by ESBL not against Mycoplasma, MRSA
not affected by β-lactamase but
by ESBL "decerebrate antibiotic"
time-dependent; large size can't
hearing loss, dose-related renal D-Ala-D-Ala is changed to D-Ala- penetrate OM of gram-; synergistic
impairment D-xxx; VRE, VRSA w/ aminoglycoside
Gram+ are spared because thick cell
dose-related nephrotoxivity wall retains integrity
concentration dep.; can't reach
very little Gram(-) IM
1) alter DNA gyrase (S. aureus, E. effective against "flora"; conc.
faecium, S. pneumoniae); 2) ↑ dependent; Ca2+ chelate (no milk!);
efflux; 3) alter porins (P. not effective against anearobes or
insomnia, tendon rupture
radical species, pulmonary aeruginosa) most Gram+
crystalluria
headache, nausea, Disulfiram-like "metro" runs underground away
(no alcohol) from oxygen (anaerobic); →CNS
→CNS; crystalluria; infant
slight alter enzyme contraindicated
slight (hematopietic) BC with Sulfamethoxazole
induces p450 enzyme; TB (RIPE) w/
hepatotoxicity rapid (alter binding to RNA poly) Isoniazid; Pyrazinamide; Ethambutol
binds teeth, inhibit bone growth 2nd line because of toxicity and
(avoid kids or pregnancy), resistance; Ca2+ chelate (no milk!);
photosensitivity efflux; ↓ ribosomal binding →CNS
not affected by Tetracycline
efflux
efflux; ribosomal methylation Azithromycin (Z-pack) has long half-
Safe; some hypersensitivity, GI (GAS) life
aplastic anemia (80% fatal), "grey →CNS; rarely used because of its
baby syndrome" acetylation; ↓ ribosomal binding lethal side-effects
rashes and diarrhea
(Pseudomembranous colitis by C.
dfficile)
vein necrosis, myalgias,
nausea/vomiting each drug alone is BS
myelosuppression, peripheral
neuropathy
(not metabolized) Ototoxicity, concentration dependent (post-
nephrotoxiity, neuromuscular acetylation, phosphorylation and antibiotic effect); no →CNS; poor
blockade adenylylation of Aminoglycosides oral absorption
nephrotoxicty
(well tolerated) liver toxicity
(well tolerated)
Family Genus and Name Abbre.
Diease
Herpes Simplex
HSV
virus
herpes, encephalitis, Herpetic
stromal keratitis (HSK)
Cytomegalovirus CMV Retinitis, colitis, pneumonia,
Herpesviruses E b. hair leukoplakia (AIDS)
mononucleosis, post-
Epstein Barr virus EBV
transplant lympho-
proliferative disease (PTLD);
oral hairy leukoplakia (OHL)
Varicella Zoster
VZV
virus
Chickenpox (Varicella),
dsDNA
shingles (Zoster)
Human Herpes
HHV-8
virus 8 Kaposi sarcoma (AIDS)
Hepadnavirus E Hepatitis B virus HBV
Blood-borne hepatitis B,
hepatocelluar carcinoma
respiratory infection,
conjunctivitis, tonsilitis,
Human
Adenovirus N AAV gastroeneteritis; severe
Adenovirus
pneumonia in infants or
ImmuComp
progressive multifocal
John Cunningham
Polyomavirus N JCV leukoencephalopathy (PML)
virus
in ImmunoComp
Human Papilloma
Papillomavirus N HPV
virus
Warts (skin, genital, anal,
laryngeal), cervical
carcinoma
Poxviruses E Variolavirus
Smallpox
ssDNA Parvoviruses N erythema infectionsum
Hepatitis A virus HAV
Food-borne hepatitis A
(poliovirus) polio (pralytic
poliomeylitis)
Picornaviruses N I Enterovirus (Coxsackie virus) aseptic
(Poliovirus, meningitis, herpangina,
Coxsackie, febrile pharyngitis; hand,
echovirus) foot, and mouth disease
(echovirus) aseptic meningitis
Rhinovirus common cold
Norovirus
Caliciviruses N I (Norwalk Virus) infantile viral gastroenteritis
Hepatitis E acute hepatitis
Togaviruses E I Rubella virus German measles (Rubella),
ssRNA(+)
serious congenital
abnormalities
Blood-borne hepatitis C
(acute/chronic hepatitis, liver
Hepatitis C virus HCV
cirrhosis, hepatocellular
carcinoma)
Flaviviruses E I Yellow fever
hemorrhagic fever, hepatitis
arthralgia and rash. Dengue
Dengue
hemorrhagic fever
West Nile virus WNV
encephalitis
HIV-1,
Retroviruses* E I HIV
HIV-2
AIDS, opportunistic Infection
of AIDS (CD4 < 500: TB; CD4 <
200: PCP, Toxoplasma,
Cryptococcus, MAC, CMV)
Human
Coronaviruses E H
Coronaviruses
common cold, SARS
Rhabdovirus E H Rabies virus
Rabies
Filoviruses E H Ebola
viral hemorrhagic fever
ssRNA(-)
(Ebola, Marburg)
Mumps Virus
Mumps
Paramyxo-viruses E H
Rubeola
Measles
Respiratory
RSV
Syncytial virus Bronchitis, pneumonia
Influenza A,
Influenza B
segmented ssRNA(-)
Orthomyxo-
E H
viruses Influenza, 2° pneumonia
Avian influenza H5N1
Avian Flu
segmented ssR Hemorrhagic fever (HF, HFRS
Bunyaviruses E H Hantavirus w/ renal syndrome),
Hantavirus Pulmonary
Syndrome (HPS)
Arenaviruses E H Lassavirus
viral hemorrhagic fever
(Lassa)
seg. Reoviruses N H Rotavirus
dsRNA infantile diarrhea
not Hepatitis D virus
classified
variant Creutzfeldt
Prions Jacob Disease vCJD
("Mad Cow")
spongiform encephalopathies
treatment types (see
antivirals)
Biology Pathogenesis [P] and Virulence Factor [V]
[P] (active) attach, replication, assembly =>
HSV-1 (oral), HSV-2 (genital, egress => vesicular lesion (cytopathic & inflam.);
more severe); infects large (latent) retrograde axonal transport to PNS =>
variety of cells but prefers DNA as extra-chromosomal circular episome
neurons; has tropic envelope, (no lytic) => asymptom.; (reactivation) lytic
icosahedral capsid; replicate and cycle => anterograde spread => asymp. viral
assembles in nucleus; stimuli for shedding; [V] TK & ribonucleotide reductase
reactivation (UV, surgery, stress, (viral DNA syn.); UL41 (↓ host protein syn.),
truama, hormones, ImmuSup.); γ34.5 (prevent neural apoptosis); (immune
infection clears by cell-mediated evasion) gE/gI (binds to Fc), gC (to C3b), ICP47
response (NK cells) (to TAP)
establish latency in monocytes
[P] infect pharyngeal epithelium or tonsillar B
cells => spread via bloodstream and lymph =>
establish latency (only EBNA-1 infect B cells (life-time latency) => CD8
Ag is produced, can't be recognition or outbreak during stress;
presented by MHC 1) or (lymphoma) aggressive, extranodal, often CNS
immortalization in B cells involved
[P] (shingles) viral latent stage in ganglia =>
reactivation (stress, ImmuComp)
[P] bloodstream inoculation => S ORF binds to
hepatocyte => viral replication w/out cytopathic
circular incompletely dsDNA, has effect (80%) => CD8 response injuries liver =>
RT, 4 genes: surface (S, HBsAg), chronic hepatitis (HBsAg+) => oncogenesis (X
core (C, HBcAg), polymerase (P, ORF and viral DNA integration into host
HBpAg), transcriptional activator chromosome); [V] chronic infection, HBsAg,
(X, HBxAg) HBV X proteins
many Ags associated with
infection, receptor/ligand
determines serotype and [P] acquired via GI or lower respiratory tract
tropism infection
potentially oncogenic
encapsulated, circular DNA; 100+
genotypes (~40 genitals); [P] skin abrasion => infects basal keratinocytes
(tumor) E6 degrades p53, E7 => (latency) quiescent state as episomal (E1/2
sequesters Rb; E2 transcribes expression) or integration (E6/7 expression =>
early gene => Lp1&2 (late genes hypertrophy or cancer) => basal cells mature &
for capsid); can't grow in tissue virus encodes early genes => late genes => shed
culture (raft system) virus at top epithelium layer
replicative Guarnieri bodies in
cytoplasm (virus provides
replication & gene expression
machinery); Variola major (more
virulent) & minor strains; one [P] (rash) maculopapular (flat/raised) =>
antigenic type vesicles => pustules => crusts => scarring
[P] ingestion => replicate in gut => (w/out
sufficient neutralizing Ab) spread to liver =>
acute liver damage; [V] ??
normal life cycle [P] entry via GI => 1° rep. in mesenteric LN => 2°
(replicate/assembly in in liver/spleen and secret thru stool =>
[P] infection via upper respiratory tract
error prone polymerase
(immune evasion); hetero-
geneous quasispecies (hyper-
variation of envelope gene) [V] chronic infection
*diploid; copies of RT and INT;
acute infection syndrome (2- [P] (HIV-1) infects CD4+ cells (blood & LN),
6wks) => latency (8-10yrs, macrophage/microglia (brain & spinal cord) =>
dependeing on viremea) => massive viral production (10^10 virions/d) &
advanced (AIDS, ~18ms, CD4+ CD4+ destruction => vigorous host response
count <200 cells/uL or (Abs & cell-mediated) but only partially
opportunistic infection) => death effective => CD4+ depletion
(correlation with viral load and (immunodeficiency) => death (opportunistic
CD4 count) infections & malignancies)
(SARS) not previously endemic in [P] spread via fecal-oral or upper respiratory
people, adapted thru mutation tract infection; high infectivity
helical capsid with single viral [P] animal bite => muscle => peripheral n. =>
glycoprotein (neuronal tropism); axon to CNS => peripheral n. to organs (salivary
large, bullet-shaped virion with glands); [V] viral glycoprotein targets Ach
RdRt receptor
pathogen easily killed w/ soap,
disinfectant, detergent
one serotype
fusion (F) protein fuse infected glycoproteins (HA and F protein)
cells into multi-nucleated giant
cells
host cell derived envelope; 3 [P] infects respiratory epithelium (U&L respir.
genra: A (most important), B tracts) => HA binds to glycoprotein and cleaved
(mild), and C => all have surface => virus is endocytosed and acidified => HA2
HA (binding/fusion) & NA (viral allows genes to enter cell => viral replication =>
release) cell lysis
very virulent in birds; H5, H7, H9
strains; most are low
pathogenicity but high ones can
be dangerous [P] survives longer in environment
spherical nucleocapsid w/ 3 RNA(-
) molecules; envelope (Golgi) [P] invade via respiratory => circulatory =>
glycoproteins determines heart, gut, liver, CNS; [V] envelope
tropism glycoproteins
pathogen easily killed w/ soap,
disinfectant, detergent
isconsahedral capsid, withstand [P] ingestion => replication in intestine; [V]
acid in stomach NSP4 (non-structural, enterotoxin-like)
contain RNA and delta-Ag; can
self-cleave/ligate [P] requires HBV for infection (HBsAg)
normal prions (protein) present
in all brains without harmful [P] abnormal prion in meat transform others =>
effects accumulates and kill brain cells
Reservior [R], Susceptible Pop. [SP],
Transmission [T] Symptoms [S] and Diagnosis [D]
[S] fever, blisters, oral or genital lesion
(severity of primary infection depends on
serotype & correlates with ↑ frequency &
[R] human only; [SP] neonates duration of reactivation, viral load) => CNS
(disseminate to CNS, skin, eye, encephalitis/meningitis or corneal lesion; [D]
mouth); ImmuComp (AIDS, clinical, Tzanck smear stain (multi-nucleated
transplant pts); [T] respiratory giant cells with inclusion bodies, serology
(droplets), sex (mucosal surface) or (sensitive, type specific), PCR, direct virus
direct contact (skin abrasion) isolation from infected tissue (gold standard)
[SP] ImmuComp pts (AIDS) [S,D]
[S] (acute) asymptomatic or fever, pharyngitis,
lymphadenopathy, atypical lymphocytosis;
(OHL) oral lesion that cannot be scraped off; [D]
[T] saliva; [SP] (lymphoma) AIDS pts (acute) Monospot test, serology (anti-EBV Abs);
(CD4 < 400) (PTLD) PCR, biopsy
[S] (chicken pox, 14ds incub.) low grade fever,
malaise => rash (maculopapular => vesicular =>
[R] human only; [SP] children; scabs) => self-limiting or 2° bacterial infectoin of
ImmuComp pts (AIDS); [T] (chicken lesions; (shingles) clustered and dermatomal
pox) extremely contagious (prior to lesions (painful); [D] stain (multi-nucleated giant
rash), repiratory or contact cells)
[S] multifocal proliferation of vascular cells (skin
[SP] ImmuComp pts (AIDS) and lungs/GI)
[S] mainly self-limiting; (asymtomatic, mild,
fulminant) acute hepatitis: RUQ pain, malaise,
jaundice, high AST/ALT => chronic hepatitis (1-
10%), cirrhosis (<30%) => hepatocellular
carcinoma (5%); [D] liver enzyme (AST/ALT),
[R] human; [T] blood/semen, PCR (HBV DNA), serology (HBsAg, HBcAg,
perinatal HBeAg)
[R] human; [T] direct contact w/ resp.
secretion or infectious aerosols; fecal-
oral; pharyngeal or conjunctival [S] respiratory diseases, eye infection, GI
inoculation w/ contam. water; problems; [D] clinical symp., (sometimes)
nocosomial culture/serology
[S] infection of respiratory system, kidneys, or
brain; [D] PCR on biopsy or CSF
[S] 80% clear infection; skin warts (HPV 1, 2, 4);
anal, laryngeal genital warts (HPV 6, 11);
cervical carcinoma (HPV 16, 18); normal cervix
[R] human; [T] sexual intercourse, <=> infected cervix <=> precancerous lesion =>
direct contact, vertical transmission cancer; [D] clinical, PAP smear, FISH, PCR
[S] rash (different from chicken pox, more
prominent in face/extremities and all lesions in
[R] human; [T] respiratory (aerosols), same phase of development, doesn't itch) =>
direct contact (rash), fomites death or disfigured & blind
[S] flu-like symptoms (often asympt.); self-
limiting; sometimes acute hepatitis; [D] can't
clinically distinguish from other Hep's; HAV IgM
[R] human; [T] fecal-oral (IgG from previous exposure)
[S] (90% asympt.) meningitis/encephalitis, V&D;
[D] tissue culture from stool/CSF
[R] human; [T] fecal-oral; non-
seasonal
[S] self-limiting D&V, abd. pain, nausea; [D] PCR
& EM of stool, serum for Ab (ELISA)
[S] (12-23ds incub.) maculopapular rash (not
confluent) on face => moves down body;
(congenital) fetal death, premature delivery,
mental retardation, deafness, blindness, heart
[T] respiratory, transfetal disease
[S] chronic hepatitis (90%) => cirrhosis (>30%)
=> hepatocellular carcinoma (3% annually); [D]
[T] blood, transfusion, IV durg use, serology (anti-HCV Abs), RT-PCR for circulating
sexual(?), parental virus
[R] birds but transmit thru mosquitos [D] serology and NA analysis
[S] ~50% asympt., mimics EBV; fever, headache,
malaise, wt loss (N&V, anorexia, diarrhea),
[SP] (opportunistic infections) arthralgis, myalgias, rash; (clinical) pharyngitis,
ImmunComp pts with AIDS; [T] mucocuataneous ulcers, maculopapular rash,
(common) sexual intercourse, IV durg lymph-adenopathy, meningitis/encephalitis;
use, vertical transmission, (lab) lymphopenia, neuropneia/anemia,
(uncommon) transfusion, hepatitis; [D] exposure, lifestyle, ELISA (high
transplantation, accidental sens., low spec.) => Western blot confirms; PCR
inoculations for acute (pre-Ab) or neonate
[R] bats; (SARS) [T] respiratory and
aerosol feces
[S] confusion, lethargy, paresis, salivation &
aggression => hydrophobia, seizures, paralysis,
[R] often asymptomatic infection in coma, death (cardiac/respiratory failure); [D]
mammailians (skunk, racoon, foxes, clinical history (rabid animal contact),
bats); [T] animal bites fluorescent Ab of animal brain
[T] (animals) aerosols, fomites, saliva
or ocular exposure; (human) contact [S] high fever, severe illness, and generalized
w/ blood or body fluid vascular damage
[S] acute viral infection, parotid gland swelling &
tenderness => (complications) meningitis,
[T] respiratory orchitis (gonads)
[S] (2wks incub.) malaise, fever, runny nose,
cough and Koplik spots => contagious
erythematous, maculopapular rash (face =>
body => legs) => (complica.) pneumonia,
[T] respiratory (very contagious) encephalitis, immunosuppression
[S] (1-2ds incub.) sudden fever (100-4°F), chills,
malaise, myalgia, anorexia for 3ds => cough
(recover in 2 wks); (complic.) 1° viral
[SP] children/elderly; [T] droplet pneumonia or 2° bacterial pneumonia (S.
inhalation (infectious before pneumoniae or H. influenzae); [D] clinical signs;
symptoms) epidemiology; nasal swab
[R] birds, pigs; [SP] all!!; [T] can't
transmit among humans yet because
of different HA, but probably will
thru reassortment [S] highly lethal (60%)
[S] most asympt.; (HF) renal; (HPS) headache,
[R] reside in rodent (deer mouse) in malaise, myalgia, vomiting, diarrhea, death
urine, saliva, and feces (can survive (pulmonary edema); [D] clinical history
dehydration); [T] aerosols (exposure), PCR (viral mRNA in lung), serology
[T] (animals) aerosols, fomites, saliva
or ocular exposure; (human) contact [S] high fever, severe illness, and generalized
w/ blood or body fluid vascular damage
[S] intense diarrhea, vomiting, fever for 48hrs to
[R] human; [T] fecal-oral 1wk; possible death to dehydration; [D] serology
[S] ↑ severity of acute hepatitis, ↑
parental prevalance/severity of chronic hepatitis
[R] scrapies, bovine spongiform
encephalopathy (BSE); [T]
consumption of BSE meat
Treatment [T] and Prevention [P]
[T] VZV IgG, (Val)Acyclovir, Penciclovir
(Famciclovir), Foscarnet; (neonatal)
cesarean; [P] barrier method
[T] (Val)Ganciclovir, Foscarnet, Cidofovir
[T] (acute) none; (PTLD) ↓ immuno-
suppression, Acyclovir & Ganciclovir
(during replicative cycle), immune
therapy (CTL, IVIG, anti-CD20);
(lymphoma) ART and chemo.; [P] prevent
(+)donor to (-)recepient
[T] (Val)Acyclovir, Penciclovir
(Famciclovir); VZ-IG; [P] live-attenuated
vaccine, prophyolytic antiviral
[T] ART for immunodeficiency
[T] (acute) HBIG; (chronic) INF-a,
Lamivudine, Adefovir, Entecavir, and
Telbivudine; (cirrhosis) transplant; [P]
HBV vaccine, HBIG
[T] supportive, no antiviral, [P] vaccine in
military, pool chlorination
[T] (skin, anal/genital wart) surgery;
(cervical cancer) topical agents,
cryotherapy, surgery, IFNs (painful,
effective with surgery); [P] pap smear
screening; non-infectious L-1 capsid
vaccine w/o NA (Gardasil)
[T] supportive, no antiviral, [P] vaccine
(Dryvax); very contagious (isolation, neg.
pressure room, N95 respirator,
gowns/gloves)
[T] HAIG, no antiviral; [P] vaccine, HAIG
[T] Pleconaril; [P] Polio vaccine
[P] hand-washing, harsh cleaning
[P] attenuated MMR virus vaccine
(prevent congenital rubella)
[T] pegylated INF + Ribavirin, no
prophylaxis with Ig, liver transplant; [P]
no vaccine
[T] (NRTIs) Abacavir, Emtricitabine,
Lamivudine, Tenofovir, Zidovudine;
(NNRTIs) Efavirenz, Nevirapine;
(integrase inhibitor) Raltegravir; (PI)
Atazanavir, Indinavir, Lopinavir,
Nelfinavir, Ritonavir; (fusion inhibitor)
Enfuviride; (CCR-5 receptor blocker)
Maraviroc; [P] education, safe sex
[T] no antiviral, clinical sign = death; post-
exposure receive human rabies Ig (HRIG)
and then HDCV (human diploid cell
vaccine); [P] high risk individuals receive
HDCV
[T] no treatment; [P] outbreak controlled
with isolation & protective clothing
[P] attenuated MMR virus vaccine (one
shot) at >12ms
[P] attenuated MMR virus vaccine at
>12ms (maternal Abs); babies <1yr
susceptible
[T] Palivizumab
[T] Amantadine/Rimantadine or Tamiflu;
[P] inactivated (2A + 1B strains) or live-
attenuated vaccine ("Flumist", intranasal,
more effective in children) targets HAs;
egg allergies
[T] Oseltamivir, Zanamivir (resist. to
Amantodine/Rimantadine)
[T] IV fluid and dialysis (if renal failure),
no antiviral; [P] avoid rodent habitats,
exposure confers immunity
[T] Ribavirin; [P] outbreak controlled with
isolation & protective clothing
[T] restore fluid/electrolyte, no antiviral;
[P] Rotavirus vaccine
[T] INF-a, liver transplant; [P] HBV vaccine
Others
"TORCHES"
"TORCHES"
(AIDS) can lead to Burkitt's or Non-Hodgkin's lymphoma
HBeAg is from HBcAg; Anti-HBs indicates immunity; Anti-HBc indicates
previous or current HBV infection; Anti-HBe indicates current infection
(could be chronic)
name derived from "adenoids" = "tonsils", where it was first isolated;
outbreak during summer
used to be Papovavirus along with Papillomavirus
integration into host genome: breaks circular DNA at E1, E2 gene (no
transcription) but increases E6, E7 genes (disrupts cellular replication =>
tumorigenesis)
stopped vaccine (polymyxin B and Abx) in 1972; Ab level ↓ in 5-10 yrs;
contraindicated for ImmuComp (HIV), eczema/dermatitis, pregnancy, or
Abx allergy; AE: (mild) sore, red, swollen LNs, fever, fatgue, muscle
ache, or (severe) inoculation, allergic rxn, vaccinia; vaccine success: one
Ag type, no persistent carriers or asympt. infections, no animal
reservoir, high motivation
name derived from "parvo" = "small"
name derived from pico-RNA-virus, meaning "small RNA virus"
name derived from "calici-", meaning "chalice-like"
"TORCHES"
name derived from "Flavi-", which means "yellow"; family of arboviruses
carried by arthropods ; all are tropical diseases
1/3 of infected pts are undiagnosed; multisystem disease with different
organ dysfunctions: direct effect of HIV (AIDS dementia complex),
immune reaction (thrombocytopenia), 2° infection by opportunistic
pathogens (PCP), malignancies (non-Hodgkin’s lymphoma); other
opportunistic infections: M. tuberculosis (TB), M. avium, Candida (oral
thrush), VZV, Pneumocystis, C. neofromans, CMV, H. capsulatum, T.
gondii; "TORCHES"
name derived from "corona-", referring to "radiating" shape of viral
surface
name derived from "rhabdo-", which means "rod-shaped", referring to
the shape of the viral particles
name derived from "filo-", which means "filamentous"
name derived from "para-" and "myxo-", which means "beyond" and
"mucus"
name derived from "ortho-" and "myxo-", which means "straight" and
"mucus" (mode of transmission); Seasonal outbreak (antigenic drift:
accumulation of RNA transcription mutation and continuous selective
pressure, mainly in HA; previous exposure alleviates because of cross-
reactivity): winter months
Pandemic (antigenic shift: major changes of HA & NA to new serotype,
current Abs ineffective; reassortment btwn 2 viruses in human or diff.
host): rapid transmimssion, concurrent outbreaks, infect all age group,
high mortality
name derived from "arena-", meaning "sandy" because of grainy
particles (ribosomes acquired from their host cells)
REOviruses is derived from "respiratory enteric orphan)
Antiviral
Class Name spectrum Mechanism of Action
HSV, EBV, requires viral TK for activation ->
(Val)Acyclovir VZV competitively inhibit viral DNA pol
Penciclovir HSV, EBV,
(Famciclovir) VZV similar to Acyclovir
resistant monophosphate nucleotide analogue;
Nucleoside/tide analogues
Cidofovir HSV, CMV does not require viral phosporylation
pyrophosphate analogue and inhibits
resistant DNA polymerase; does not require viral
Foscarnet HSV, CMV phosporylation
CMV, require viral UL97 (phospho.) -> inhibits
(Val)Ganciclovir herpes viral DNA pol
chain terminator of HBV RNA in reverse
Lamivudine HBV, HIV transcription of genome
Adefovir,
Telbivudine,
Entecavir HBV chain terminator of HBV DNA
RSV, HCV, decreases nucleotide pool and inhibit
Ribavirin Lassa viral mRNA
modulant
Ion-chan. Immuno-
HCV, HBV, cytokine with strong
Interferon-a HPV immunomodulatory activity
Palivizumab RSV monoclonal Ab against RSV
inhibit viral M2 ion-chan and prevent
Analogue blocker
Amantadine, endosome acidification => can't uncoat
Rimantadine Influenza A HA or enter cytoplasm
SA analogues and block viral release by
NA
Oseltamivir, Influenza A, competitively inhibiting viral
Zanamivir B neuramnidase
Lamivudine (3TC), Abacavir NRTIs: nucleoside/tide analog that
(ABC), Tenofovir (TDF), competitively binds to growing viral DNA
Emtricitabine (FTC), chain => termination (no 3°-hydroxyl
Zidovudine (ZDV/AZT) group)
Efavirenz (EFV), Nevirapine NNRTIs: non-competitive inhibitors of RT
(NVP) (not nucleotide site)
HIV-1 Antivirals
Atazanavir (ATV), Indinavir
(IDV), Lopinavir (LPV), protease inhibitors (PIs): non-cleavable
Nelfinavir (NFV), Ritonavir substrate for protease (essential to
(RTV) cleave gag into structrual proteins)
integrase inhibitor: blocks viral DNA
Raltegravir (RAL) insertion into host genome
HIV- fusion inhibitor: prevent fusion of viral
Enfuviride (T-20) and host membrane
entry inhibitor: CCR-5 co-receptor
blocker, not active against virus that use
Maraviroc (MRV) CXCR-4 receptor
Clinical Use Major toxicities
(well tolerated) rarely cause acute renal
oral/genital herpes; serious herpes
failure
encephalitis; HSV/VZV infection in
ImmuComp pts
CMV retinitis and AIDS; some against
smallpox kidney damage
Acyclovir-resistant HSV (TK-), Ganciclovir- renal toxicity (electrolye imbalance, renal
resistant CMV (UL97-) insufficiency)
CMV disease (AIDS and transplant ptps),
CMV prophylaxis bone marrow suppression (leukopenia)
chronic Hep. B infection; HIV infection
chronic Hep. B infection
Hep C (with INF-a), RSV in high-risk infants (severe) hemolytic anemia, teratogenicity,
and ImmuComp pts, Lassa virus rashes, headaches
flu-like symptoms, bone marrow
Hep B, Hep C (with Ribavirin), intralesional suppression, depression, and aggravate
genital warts autoimmune disorders
RSV prophylaxis for ImmuComp infants
Influenza A only (prophylaxis, pre-emptive,
early treatment) but not Influenza B or Avian
Flu reversible neurotoxicity
Influenza A, B, and Avian flu (prophylaxis,
pre-emptive, early treatment); strains that
are amantadine/rimantadine resist.
HIV treatment: delay treatment until CD4+ (acute and chonric toxicities)
count is <350-500 cells/uL; use combination hyperlipidemia, insulin resistance,
of at least 3 drugs (2 NRTI + 1 NNRTI, or 2 lipodystrophy, neuropathy; (problems) pill
NRTI + 1 PI) => increases CD4+ cell count, number; daily, life-long therapy; strict
delays progression to AIDS, prolongs survival; medication compliance necessary
NRTI + 1 PI) => increases CD4+ cell count, number; daily, life-long therapy; strict
delays progression to AIDS, prolongs survival; medication compliance necessary
Resistance Others
Suppressive therapy (80% reduction
↓TK level or ↓ DNA pol of recurrencec) is much more
affinity for drug effective than episodic treatment (1
day benefit)
CMV does not have TK
90% of HBV are resist.
resistance develops
quickly (Influenza A)
"LATEZ"
major problem because of
variants (high viral
turnover & error prone RT)
"-navir"
turnover & error prone RT)
Family Genus and Name
Location Diease
Protozoa
flagellated sexual Trichomonas vaginalis
world, US vaginitis (STI)
trophozoite greasy diarrhea (no blood or
Giardia lamblia
US mucus)
intestinal
amoebae Entamoeba histolytica
US bloody diarrhea, liver abscess
Cryptosporidium parvum
US watery diarrhea
obligate
intracellular chorioretinitis (congenital
toxoplasmosis),
AIDS
Toxoplasma gondii
lymphadenopathy (acute),
Toxoplasma encephalitis and
US ocular toxoplasmosis (AIDS)
Plasmodium spp. (P.
malaria
falciparum, P. vivax, P. ovale,
malaria (P. falciparum most
P. malariae)
severe; P. vivax & ovale less
severe; P. malariae few serious
cases), microvascular disease
Babesia
US anemia
Naegleria fowleri
rapidly fatal menigoencephalitis
C.Am., Kala-azar (visceral, fever and
flagellated
Leishmania spp. (T. donovani) S.Am., ME, hepatosplenomegaly), skin ulcers
parasite
Afr. (cutaneous)
blood-borne flagellates
Chagas disease (T. cruzi)
flagellated Trypanosoma spp. (T. cruzi, T.
parasite gambiense, T. rhodesiense)
C.Am., African sleeping sickness (T.
S.Am. gambiense, T. rhodesiense)
Helminth
Ascaris lumbricoides
US Intestinal worms, anemia
Necator americanus,
Ancylostoma duodenale intestinal worms, cutaneous larva
Intestinal
(Hookworm) migrans, rash/itches
roundworms
Enterobius vermicularis
(nematodes)
(Pinworm) US Intestinal worms, perianal itch
Hyperinfection syndrome,
Strongyloides stercoralis
US pneumonia, sepsis, rash
Trichuris (Whipworm) US Intestinal worms, anemia
Onchocerca Filiriasis
Tissue
Nematodes river blindness
Wuchereria Filiriasis, Brugia elephantiasis (lymphatic
Filiriasis obstruction)
Flatworms, Schistosoma japonicum,
Flukes Schistosoma mansoni
(trematodes) not in NA, Liver cirrhosis
Schistosoma hematobium Eur, Aus Bladder cancer
Taenia solium (pork), Taenia
Tapeworms
saginata (beef) Tapeworm, cysticercosis
(cestodes)
Echinococcus granulosus Hydatid disease, liver cysts
Reservior [R], Susceptible
Pathogenesis [P] and Transmission [T] Pop. [SP]
cyst or spores (inactive) => transmit to human => germinate
into trophozoites (active) => reproduce
[SP] women with multiple
sexual partners
[P] infectious cyst (colon) via stool => trophozoites
(duodeum); [T] contaminated water or fecal-oral [R] zoonotic
[P] ingested cyst germinates in gut => trophozoite attache to
colonic mucosa => new cyst form in gut
[P] ingested oocyst (stool) => sporozoites (intestine) =>
trophozoites (virulent, reproduce) => merozoites (sexual
reproduction) => oocysts; [T] contaminated water or fecal-
oral [R] zoonotic
[P] ingestion of infectious sporozoites (cat or contaminated
meat) => penetrate intestinal wall and engulfed by
macrophage (tachyzoite: asexual multi.) => hemato.
dissemination to fetus or brain (cysts) => reactivation of [R] cat (sexual cycle); [SP]
latent cysts during ImmuComprom => multiple "ring- AIDS pts (CD4<100); pregnant
enhancing" lesions women
[P] mosquito infects human (sporozoites) => trophozoite =>
invades hepatocytes, multiplies (schizonts) => merozoites => [R] mosquitoes (vector); [SP]
invades RBC, multiplies => some become gametozytes and endemic in warm regions
undergoes sexual stage in mosquitos; (RBC infection) PfEMP (Cen./S, America, Africa, SE
causes sequestration (microvascular disease) => obstructed Asia); children, pregnant
perfusion and RBC death (anemia); [T] mosquito bites women, unexposed travelers
infects erythrocytes; part of life-cycle occurs in non-human
vertebrates (deer/mice) [R] ticks (vector)
[R] swimming in freshwater
[T] enter via cribiform plate lakes
intracellular amastigotes in macrophage in human =>
extracellular promastigotes in gut of sandflies [R] sandflies
[P] amastigote in human and sometimes in blood [R] Reduviid bug ("kissing
(trypomastigote) to avoid complement bugs")
[P, T] metacyclic (infectious form) in fly => bites human
(bloodstream form) and divide via binary fusion in body
fluids (blood, lymph, CSF), survives Abs using VSG => fly bite
and transforms to procyclic that divides in mid-gut =>
transforms into epimastigotes and divide in salivary glads =>
transforms into metacyclic [R] tsetse flies
eggs hatch into larvae in intestines => migrate to lungs =>
cough & swallow => intestines and shed eggs
[SP] impoverished rural area
eggs produced in gut => feces contaminate ground and
where children play on
germinate => penetrates bare feet
contaminated soil and
farmers use excretion as
fertilizer
life-long infection that can be reactivated with T-cell
immunosuppression
larvae of roundworms are transmitted by mosqiotoes or
other insects => pass into lymphatics and mature into adult
worms => microfilariae into blood
fecal contamination with eggs => hatch in snails => (human)
penetrates skin and migrates to lung/liver => mature to
adult worms => migrate to veins (GI, bladder) and release
eggs [R] snail (intermediate host),
slow moving water
ingest undercooked pork containing larval cysts
ingestion of eggs => hatch in GI => circulation => Liver [R] dogs
Treatment [T] and Prevention
Symptoms [S] and Diagnosis [D] [P]
[S] (W) frothy discharge, fish-like odor; (M)
often asymp.; [D] microscopic exam Metronidazole
[S] cramp, wt loss, fatigue; [D] cysts or [T] Metronidazole; [P] clean
trophozoites in stool water & hygine
[D] stool exam [T] Metronidazole
[T] (ImmuComprom only)
nitazoxanide, anti-retrovirals
[S] diarrhea for 1-4wks after 1wk; [D] oocysts for AIDS; [P] hygiene & clean
in stool (acid fast), serology water
[S] mostly asymptomatic in ImmuCompetent;
(ImmuComprom, T. encephalitis) altered
mental state, seizures, pain; [D] (T.
encephalitis) symptoms, serology, CT (ring
lesion); (congenital) ocular, CNS abnormalities [T, P] Bactrim
[S] cyclic fever every 48hrs (cold stage => hot
=> sweating/fatigue => resolution) after 7-
30ds; (microvascular disease) hypoglycmia, [P] insecticide-reated bed nets;
renal failure, multi-organ failure, metabolic prophylaxis for travelers,
acidosis => cerebral malaria (neurological repeated infection can build up
symptoms, coma); [D] travel history; blood partial immunity, vaccine being
smear for parasites ("ring form" for P. tested; [T] Chloroquine
falciparum) (depending on drug resistance)
Clindamycin+Quinine or
Atovaquone+Azithromycin
[D] amoebas in spinal fluid [T] none
[D] blood smear
[S] (stage 1) chancre at bite site => (systemic
spread) lymphadenopathy, fever, anemia,
rash => (stage 2) CNS infection &
inflammation at brain and meninges =>
daytime sleeping; [D] epidemiology and
clinical; blood smear (stage 1) or CSF exam [T] depend on clinical stage,
(stage 2) parasites, side-effects
mebendazole, albendazole or
ivermectin; Pyrantel for E.
vermicularis
[D] finding eggs in feces or urine [T] Praziquantel
symptoms could be acute, chronic, or relapse
T cells important for immune response; sprozoites can infect all
cell types; need to differentiate from Rubella, CMV, and HSV for
congenital infection; TORCHES
(immune evasion) sequestration and infection and cells w/out
MHC (RBC); (RBC modification): infected RBC are covered with
"knobs" (PfEMP, antigenic variation), which prevents clearance by
spleen ("sequesteration"); P. falciparum: tropical regions,
mosquitoes year round, no dormant liver stage (no relapse); P.
vivax: temperate regions, mosquitoes only during warmer months,
dormant liver stage (relapse), only infects reticulocytes (not all
RBCs)
no antigenic variation
survives Abs via variant surface glycoprotein (VSG) that surrounds
parasite; many diff mechanisms to induce antigenic variation of
VSG (mainly gene conversion)
Terms
Virulence Factor
Gangrene
Arboviruses
Fomite
Virulence
Reservoir
Vector
Zoonosis
Diapedesis
gummas
suppurative
maculopapular
MacConkey
HUS
ESBL
VRE
MRSA
PID
RTI
UTI
LPA
CIE
ELISA
Abx
LN
MSCRAMMs
YOPs
HA
NA
TTSS
NRTI
NNRTIs
Hib
DHFR
TK
Definition
factor produce by pathogen that causes disease
tissue necrosis involving decaying
arthropod-borne viruses
non-living ofject that trasmits infectious agents
speed with which an infection agent kills its host, or number of organisms needed to start an infection (LD vs ED)
ecological niche (vs. source which is the actual object)
source (e.g. mosquito or tick) which harbors infectious agent and transmits to individuals
infections that can spread from vertebrate animals to man (e.g. SARS, WNV)
leaving the bloodstream
large, necrotic granulomatic lesions surrounded by immune cells
pus-forming
(maculo) blurred or double impression; (papular) small, solid, usually inflammatory elevation of the skin that
does not contain pus
latose-fermenting enterics for pink colonies
hemolytic-uremic syndrome: hemolytic anemia, acute renal failure (uremia) and thrombocytopenia
extended spectrum β-lactamase
Vancomycin-resistant enterococcus
Methicillin-resistant Staphylococcus aureus
pelvic inflammatory disease
respiratory tract infection
urinary tract infection
latex particle agglutination
counter immune electrophoresis
antibiotics
lymph nodes
microbial surface component reacting with adherence matrix molecules
Yersinia Outer Proteins
hemagglutinin
neurominidase
type III secretion system
nucleoside analog reverse transcriptase inhibitors
non-nucleoside analog reverse transcriptase inhibitors
Hemophilus Influenza type B
thymidine kinase
°
↑
↓
β
α
Chemical Source Basic Function
macrophage, endothelial, fibroblasts
IL-1
IL-2 CD8+ and CD4+ cells (Th1 best at producing) leukocyte proliferation
IL-3
CD4+ (Th2), mast cells, and others
IL-4
IL-5 CD4+ (Th2) and mast cells
IL-6 macrophage
IL-8 macrophage, eosinophil
IL-9
monocytes
IL-10 Treg
macrophage, DCs
IL-12
IL-13 Th2
IL-17
macrophage, lymphocytes, endothelial,
TNF-a fibroblasts, neutrophils
TGF-b CD4+, macrophage, lymphocytes
NK, CD4+ (Th1), CD8+ activate leukocytes (increase activity)
INF-g
PAF neutrophil, basophil, platelets, and endothelial
Target Function
endothelium allow access of effector cells
induces inflammation (endogenous pyrogen) and
release of IL-6
T cells stimulates proliferation
induce monocyte production
CD4+ cells induces Helper T cells into Th2 (inhibits Th1)
B cells switch to IgE and upregulate MHC-II
Bone Marrow increase production of eosinophils
B cells cause fever, B cell growth
neutrophil, basophil, T cels chemo-attractant
chemo-attractant
down-regulates Th1 cytokines, MHC-II Ags, and
macrophage costimulatory molecules (lead to anergy)
enhances B cell survival, proliferation, and antibody
B cells (IgA) production
develop into IL-10 producing DCs, blocks CD28
DC activation of T cells
NK recruits NK cells, induces inflammation
CD4+ cells induces Th1 selection
B cells switch to IgE
induces chemokines
induces inflammation, recruits leukocytes, allows
endothelium extravasation, increase permeability
DC DC maturation
T cells inhibit T cell activation, anti-inflammatory
[activation] secrete enzyme, increase
macrophage mobility/phagocytosis
T cell activation, promote Th1 response (inhibit Th2)
B cell differentiation, increase IgG1 and IgG3 production
many induction of MHC I, II
NK increase NK activity
platelet aggregation, inflammation, anaphylaxis, and
bronchoconstriction
CD What it is
CD3 molecule associated with TCR
CD4 Co-receptor for MHC II
CD5 marker
CD8 Co-receptor for MHC I
CD11c marker
CD14 PRR that binds LPS (e.g. TLR)
CD16a receptor for IgG
CD19, CD21 signaling (ITAMs), Co-receptor for C3d/b
CD23 Low affinity Fc epsilon receptor
CD25 IL-2 receptor
CD28 binds to B7 (co-stimulator from B cell)
CD32 Fc receptor, phagocytosis, cell activation
CD34 adhesion molecule for L-selectin
CD35 (CR1) receptor for C3b, C4b ligands
CD40 binds to CD154; activates B cells and macrophage
CD52 marker
CD56 marker
CD62L (L-Selectin) homing receptor to lymph nodes
CD62E (E-Selectin) produced for leukocyte adhesion ("rolling")
CD62P (P-Selectin) rapidly released for leukocyte adhesion ("rolling")
CD121 IL-1 receptor
CD138 unknown proteoglycan
CD154 (CD40L) induces cytokine release
CD94, CD158, CD159a marker
CD162 (PSGL-1) ligand for CD62, binds to endothelium
B7 costimulator, produced when activated
TLR recognize PAMP
Who has it
all T cells
helper T cells,
B1 cells (T-independent)
cytotoxic T cells,
DC cells
macrophage, mast cells, NK
most B cells
activated B cells, monocytes, macrophages
T cells (high In regulatory T cells)
CD4+ T cells
macrophage, neutrophil, eosinophil, platelets
high endothelial venoules (HEV) in lymph nodes allows lymphocytes back into bloodstream
RBC, macrophages, monocytes, neutrophils, B cell, and DCs promotes C3b, C4b decay, induces phagocytosis
B cells, macrophages, DCs, endothelial cells
monocytes, NK, peripheral T cells
NK cells
leukocytes
endothelial cells activated by LPS or cytokines (IL-1, TNF-a)
platelets or endothelial cells activated by thrombin or histamine
broadly expressed
plasma cells
Th2 cells
NK cells
T cells, monocytes, granulocytes, and B cells
B cells
DC, macrophage, B cells
