Tim's Micro Database

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Tim's Micro Database Powered By Docstoc
					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

				
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