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GRAM-POSITIVE BACTERIA: Organism
Diagnostics
Virulence Factors
Clinical Manifestations
Treatment
Staphylococcus Staphylococcusaureus (nose, skin esp.hospital staffand pts; vagina)
- gram stain:
a.^
gram (+), clusteredcocci
- culture:
a.^
β-hemolytic b.^
golden w/ sheepblood
- Metabolic:
a.^
catalase (+) b.^
coagulase (+) c.^
facultative anaerobe
- Protective
a.^
microcapsule b.^
Protein A: binds IgG c.^
Coagulase: fibrinformation aroundorganism d.^
hemolysins e.^
leukocidins f.^
penicillinase
- Tissue-Destroying
a.^
hyaluronidase b.^
staphylokinase (lysis ofclots) c.^
lipase
- Exotoxin Dependent
a.^
enterotoxin
Æ^ gastroenteritis
(rapid
onset and recovery) b.^
TSST-
Æ^ toxic shock syndrome (fever, GI sx w/diarrhea, rash,hypotension, desquamation of palms andsoles) c.^
exfoliatin
Æ^ scalded skin syndrome (children)
- Direct Invasion of Organs
a.^
pneumonia b.^
meningitis c.^
osteomyelitis (children) d.^
acute bacterial endocarditis e.^
septic arthritis f.^
skin infection g.^
bacteremia/sepsis h.^
UTI
- penicillinase-resistantpenicillins (eg. methicillin,naficillan) 2. vancomycin 3. clindamycin * if methicillin resistant, treat w/IV vancomycin
Staphylococcusepidermidis (skin, mucousmembranes)
- gram stain:
a.^
gram (+), clusteredcocci
- Metabolic:
a.^
catalase (+) b.^
coagulase (-) c.^
facultative anaerobe
- Protective
a.^
polysaccharide capsule(adherence to prostheticdevices)
- high antibiotic resistance
- Nosocomial Infection
a.^
prosthetic joints, valves b.^
sepsis from intravenous lines c.^
UTI
- skin contamination in blood cultures
- vancomycin
Staphylococcussaprophyticus
- gram stain:
a.^
gram (+), clusteredcocci
- culture:
a.^
γ-hemolytic
- Metabolic:
a.^
catalase (+) b.^
coagulase (-) c.^
facultative anaerobe
1.^ UTIs
in sexually active women
- penicillin
Organism
Diagnostics
Virulence Factors
Clinical Manifestations
Treatment
Streptococcus Streptococcuspneumoniae (oralcolonization)
- gram stain:
a.^
gram (+), diplococci
- culture:
a.^
does not grow inpresence of optochinand bile b.^
α-hemolytic
- Metabolic:
a.^
catalase (-) b.^
facultative anaerobe
- (+) quellung test (encapsulatedbacteria)
- capsule (83 serotypes) 1.^ pneumonia 2.^ meningitis 3. sepsis 4.^ otitis media
(children)
(secretes pneumolysins that bind cholesterol of host-cell membranes, actual effect is unknown)
- penicillin G (IM) 2. erythromycin 3. ceftriaxone 4. vaccine: against the 23 mostcommon capsular Ag’s
Streptococcuspyrogenes (groupA)
- gram stain:
a.^
gram (+), chains
- culture:
a.^
inhibited by bacitracin b.^
β-hemolytic(streptolysinOÆ oxygen labile, antigenic; S
Æoxygen stable, non-antigenic)
- Metabolic:
a.^
catalase (-) a.^
microaerophilic
- M-protein (adherence factor,antiphagocytic, antigenic) 2. lipoteichoic acid (adherence factor) 3. steptokinase 4. hyaluronidase 5. DNAase 6. Anti-C5a peptidase
- Direct Invasion/toxin
a.^
pharyngitis
(purulent exudates on tonsils, fever, swollen lymph nodes) b.^
sepsis c.^
skin infections d.^
scarlet fever e.^
toxic shock syndrome
- Antibody-mediated
a.^
rheumatic fever
(fever, myocarditis,
arthritis, chorea, rash, subcutaneousnodules) b.^
acute post-streptococcal glomerulonephritis
- Penicillin G 2. Penicillin V 3. Erythromycin 4. Penicillinase-resistant penillicin(skin infections b/c might be staph) * après RF, cont. prophylaxis forrepeat infection, if heart valvecomplications, prophylaxis avantcertain procedures (eg. dental work)
Æ
endocarditis ** invasive
Æ^ clindamycin
Steptococcusagalactiae (vaginalcolonization)
- gram stain:
a.^
gram (+), chains (urineor CSF)
- culture: (urine, CSF, blood)
a.^
β-hemolytic
- Metabolic:
a.^
catalase (-) b.^
facultative anaerobe
1. neonatal meningitis 2. neonatal pneumonia 3.^ neonatal sepsis
- penicillin G
Enterococci (group D) (normal colonflora)
- gram stain:
a.^
gram (+), chains
- culture:
a.^
bile, sodium chloride b.^
α,β, γ-hemolytic
- Metabolic:
a.^
catalase (-) b.^
facultative anaerobe
- extracellular dextran helps bind toheart valves (high intrinsic resistance)
- subacute bacterial
endocarditis
- biliary tract infections 3.^ UTI
- ampicillin (combined w/aminoglycosides in endocarditis) *resistance to penicillin G andemerging resistance to vancomycin
Streptococcusviridans (normal orophrynx flora & GI)
- gram stain:
a.^
gram (+), chains
- culture:
a.^
resistant to optochin b.^
α-hemolytic (green)
- Metabolic:
a.^
catalase (-) b.^
facultative anaerobe
- subacute bacterial
endocarditis
- dental cavities 3. brain or liver abcesses
- penicillin G
Organism
Diagnostics
Virulence Factors
Clinical Manifestations
Treatment
Listeria Listeriamonocytogenes (ingestion ofcontaminatedraw milk orcheese; vaginaltransmission)
- gram stain:
a.^
gram (+), non-spore-forming rods
- culture:
a.^
low temperature(2.
°C)
- metabolism:
a.^
catalase (+) b.^
β-hemolysis c.^
facultativeintracellularanaerobic parasite
- flagella (H-Ag (+)) 2. hemolysin
a.^
heat labile b.^
antigenic
1.^ neonatal meningitis 2.^ meningitis
in immuno-suppressed pts*
3.^ septicemia * cell-mediated immunity protective ** only gram (+) w/endotoxin (LPS-Lipid A)—clinical significance is ambiguous
- ampicillin 2. trimethoprim/sulfamethoxazole
GRAM-NEGATIVE BACTERIA: Organism
Diagnostics
Virulence Factors
Clinical Manifestations
Treatment
Enterobacteriaceae Salmonella species (zoonotic: turtles,chicken, uncookedeggs)
- gram stain:
a.^
gram(-) rods
- culture: (EMB/MacConkey)
a.^
HS production^2
- metabolism:
a.^
catalase (+) b.^
oxidase (-) c.^
glucose fermenter d.^
does not fermentlactose e.^
facultative anaerobe
- flagella (H antigen) 2.^ capsule
(Vi antigen): protects from intracellular killing 3. siderophore *^ lives in M
φ^ in lymph nodes ** asplenic or non-fxn splenic
pts are
at increased risk
- paratyphoid fever (similar to typhoid fever) 2.^ gastroenteritis 3.^ sepsis 4.^ osteromyelitis
(esp SS pts)
- ciprofloxacin 2. ceftriaxone 3. trimethoprim & sulfamethoxazole 4. azithromycin 5.^ diarrhea: only fluid andelectrolyte replacement
Salmonella typhi (fecal-oraltransmission)
- gram stain:
a.^
gram(-) rods
- culture: (urine, blood, CSF;EMB/MacConkey agar)
a.^
HS production^2
- metabolism:
a.^
catalase (+) b.^
oxidase (-) c.^
glucose fermenter d.^
does not fermentlactose e.^
facultative anaerobe
- flagella (H antigen) 2.^ capsule
(Vi antigen): protects from intracellular killing 3. siderophore *^ lives in M
φ^ in lymph nodes **can live in
gall bladder
for years
*** asplenic or non-fxn splenic ptsare at increased risk
1.^ typhoid fever
a.^
fever b.^
abdominal pain c.^
hepatosplenomegaly d.^
rose spots on abdomen (light skinned pts)
2.^ chronic carrier state 1.^ ciprofloxacin 2.^ ceftriaxone 3. trimethoprim & sulfamethoxazole 4. azithromycin
Shigelladysenteriae (humans; fecal-oraltransmission)
- gram stain:
a.^
gram(-) rods
- culture: (stool;EMB/MacConkey agar)
a.^
no H
S production 2
- metabolism:
a.^
catalase (+) b.^
oxidase (-) c.^
glucose fermenter d.^
does not fermentlactose e.^
facultative anaerobe
1.^ non-motile
(no H antigen)
- invades submucosa not laminapropria *IgA best defense 1.^ Shiga toxin
: inactivates the 60S ribosome,
inhibiting protein synthesis and killing intestinal cells a.^ bloody diarrhea
with mucus and pus
- fluoroquinolones 2. trimethoprim & sulfamethoxazole
Klebsiellapneumoniae
- gram stain:
a.^
gram(-) rods
- culture: (EMB/MacConkey) 3. metabolism:
a.^
indole, oxidase (-) b.^
glucose , lactosefermenter c.^
facultative anaerobe
- capsule 2. non-motile 1.^ pneumonia
, with significant lung necrosis and
bloody sputum, commonly in alcoholics, or those withunderlying lung disease 2.^ hospital acquired UTI and sepsis
rd 1. 3 generation cephalosporins
- ciprofloxacin
Organism
Diagnostics
Virulence Factors
Clinical Manifestations
Treatment
Vibrionaceae Vibrio cholera (fecal-oraltransmission)
- gram stain:
a.^
short, commashaped, gram(-)rods
w/ single polar flagellum
- culture: (TCBS agar)
a.^
flat yellow colonies
3.^ dark field microscopy
of
stool
a.^
motile organismsimmobilized withantiserum
- metabolism:
a.^
ferments sugar(except lactose)
- flagellum (H antigen) 2. mucinase: digests mucous layerto attach to cells 3. fimbriae: helps with attachmentto cells 4.^ noninvasive 1.^ cholergen
(enterotoxin): like LT,
↑^ cAMP
Æ
secretion of electrolytes from the intestinalepithelium (secretion of fluid into intestinal tract)
a.^
cholera
: severe diarrhea with rice water stools, no pus^ (death by dehydration)
1991 Latin America 1993 Bangladesh and India
- replace fluids 2. doxycycline 3. fluoroquinolone
Campylobacterjejuni (zoonotic: wildand domesticanimals andpoultry;transmitted byuncooked meatand fecal-oral)
- gram stain:
a.^
curved
gram(-) rods w/^ singular polarflagellum
- culture: (stool;EMB/MacConkey agar)
a. optimum temp is 42
°C
- metabolism:
a.^
oxidase (+) b.^
does not fermentlactose c.^
microphilic aerobe
- flagella (H antigen) 2. invasiveness
- enterotoxin: similar to cholera toxin and LT 2. cytotoxin: destroys mucosal cells Î^ secretory or bloody diarrhea * one of the three most common causes ofdiarrhea in the world
- fluoroquinolone 2. erythromycin
Organism
Diagnostics
Virulence Factors
Clinical Manifestations
Treatment
Pseudomonadaceae Pseudomonasaeruginosa (opportunistic)
- gram stain:
a.^
gram(-) rods
- culture: (blood agar)
a.^
greenish-metallicappearance w/ fruitysmell
- metabolism:
a.^
oxidase (+) b.^
non-lactosefermenter c.^
obligate aerobe
- polar flagellum (H antigen) 2. hemolysin 3. collagenase 4. elastase 5. fibrinolysin 6. phospholipase C 7. DNAase 8. some strains possess anantiphagocytic capsule
- exotoxin A (similar to diptheria toxin):inhibits protein synthesis by blocking EF
a.^
pneumonia (cystic fibrosis andimmunosuppressed pts) b.^
osteomyelitis (diabetics, IV drug users,children) c.^
burn wound infections d.^
sepsis e.^
UTI
f.^
endocarditis (IV drug users) g.^
malignant external otitis h.^
corneal infections in contact lenswearers
- ticarcillin 2. timentin 3. carbenicillin 4. piperacillin 5. mezlocillin 6. ciprofloxacin 7. imipenem 8. tobramycin 9. aztreonam
Organism
Diagnostics
Virulence Factors
Clinical Manifestations
Treatment
Bacteroidaceae Bacteroidesfragilis (normal GI flora)
- gram stain:
a.^
gram(-) rods b.^
non-spore forming c.^
polysaccharidecapsule
- metabolism:
a.^
anaerobe
- infection when organism entersperitoneal cavity
- does not contain Lipid A
a.^
abcesses in GI tract, pelvis, lungs
- metronidazole 2. clindamycin 3. chloramphenicol 4. surgically drain abcess
Actinomyces
GRAM-NEGATIVE RODS RELATED TO RESPIRATORY TRACT INFECTIONS: Organism
Diagnostics
Virulence Factors
Clinical Manifestations
Treatment
Hemophilus Hemophilusinfluenzae (humans;respiratorytransmission)
- gram (-) rods 2. culture: (blood agar heatedto 80
°C for 15 min) a.^ high CO
2 environment
- Fluorescent Ab’s 4. (+) Quellung test
- capsule (6 types, b mostvirulent) 2. attachment pili (FHA) 3. IgA
protease 1
I. encapsulated 1.^ meningitis
(type b): infants 3 – 36 m/o
cx: retardation, seizures, deafness, and death 2. acute epiglottis 3. septic arthritis in infants 4. sepsis esp pts w/o functioning spleens 5.^ pneumonia II. nonencapsulated 1.^ otitis media 2.^ sinusitis
nd 1. 2 or 3
rd^ generation c’sporins
- Hib vaccines: DTP 3. passive immunization (
↑^ mother
transfer of immunity )
Hemophilusdureyi (STD)
- gram (-) rods 2. culture: (ulcer exudates &pus from lymph node)
- no capsule 1.^ chancroid
: painful genital ulcer, often
associated w/ unilateral swollen lymph nodes thatrupture releasing pus
- azithromycin or erythromycin 2. ceftriaxone 3. ciprofloxacin
Bordetella Bordetellapertussis (man; highlycontagious;resptransmission)
- gram (-) rod 2. culture: (Bordet-Gengoumedia) 3.^ serologic tests
(ELISA)
a. specimen from post.pharynx (does not grow oncotton) 4. direct flourescein-labeledAb’s
1.^ pertussis toxin
: activate G
proteins that
↑^ cAMP
Æ^ ↑
histamine sensitivity,
↑^ insulin
release,
↑^ lymphocytes in blood
- extracytoplasmic AC:“weakens” PMNs, lymphocytes,and monocytes 3. FHA: binding to ciliated epicells 4. tracheal cytotoxin: kills ciliatedepi cells 1.^ whooping cough
a.^
catarrhal phase
: 1-2wks; pt is high
contagious (low grade fever, runny nose,& mild cough) b.^
paroxymal phase
: 2-10wks (whoop,
lyphocytes in blood smear,
antibiotics
ineffective
c.^
convalescent phase
- erythromycin (before paroxymalstage) 2. Vaccine: DPT (may cause rash& fever, rarely systemic disease) 3. newer-acellular vaccinew/pertussis toxin, FHA, pertactin,and frimbrial Ag 4. treat household contacts w/erythromycin
Legionella Legionellapneumophilia (ubiquitous inman & naturalwater environ.;airconditioning,cooling towers)
- gram (-) rod (faint) 2. culture: (buffered charcoalyeast extract) 3.^ serologic tests (IFA,ELISA) 4.^ urinary Ag
can be detected
by radioimmunoassay;remains (+) for months afterinfection 5. facultative intracellularparasite
- capsule 2. flagella & multiple fimbriae) 3. hemolysin
- cytotoxin 2.^ Pontiac fever
: headache, fever, myalgia (self-
limiting) 3.^ Legionnaires’ Disease
: pneumonia (atypical),
fever, non-productive cough *compromised immune systems, greater risk
- erythromycin 2. rifampin
GRAM-NEGATIVE RODS RELATED TO THE ENTERIC TRACT: Organism
Diagnostics
Virulence Factors
Clinical Manifestations
Treatment
Enterobacteriaceae Salmonella species (zoonotic: turtles,chicken, uncookedeggs)
- gram stain:
a.^
gram(-) rods
- culture: (EMB/MacConkey)
a.^
HS production^2
- metabolism:
a.^
catalase (+) b.^
oxidase (-) c.^
glucose fermenter d.^
does not fermentlactose e.^
facultative anaerobe
- flagella (H antigen) 2.^ capsule
(Vi antigen): protects from intracellular killing 3. siderophore *^ lives in M
φ^ in lymph nodes ** asplenic or non-fxn splenic
pts are
at increased risk
- paratyphoid fever (similar to typhoid fever) 2.^ gastroenteritis 3.^ sepsis 4.^ osteromyelitis
(esp SS pts)
- pneumonia and meningitis
indicated for neonates or pts at riskfor septicemia or dissemination 1. ciprofloxacin (sepsis) 2. ceftriaxone (sepsis) 3. trimethoprim & sulfamethoxazole 4. azithromycin 5.^ diarrhea: only fluid andelectrolyte replacement
Salmonella typhi (fecal-oraltransmission)
- gram stain:
a.^
gram(-) rods
- culture: (urine, blood, CSF;EMB/MacConkey agar)
a.^
HS production^2
- metabolism:
a.^
catalase (+) b.^
oxidase (-) c.^
glucose fermenter d.^
does not fermentlactose e.^
facultative anaerobe
- flagella (H antigen) 2.^ capsule
(Vi antigen): protects from intracellular killing 3. siderophore *^ lives in M
φ^ in lymph nodes **can live in
gall bladder
for years
*** asplenic or non-fxn splenic ptsare at increased risk
1.^ typhoid fever
a.^
fever b.^
abdominal pain c.^
hepatosplenomegaly d.^
rose spots on abdomen (light skinned pts)
2.^ chronic carrier state 1.^ ciprofloxacin 2.^ ceftriaxone 3. trimethoprim & sulfamethoxazole 4. azithromycin 5. ampicillin (carriers)
Shigelladysenteriae (humans; fecal-oraltransmission)
- gram stain:
a.^
gram(-) rods
- culture: (stool;EMB/MacConkey agar)
a.^
no H
S production 2
- metabolism:
a.^
catalase (+) b.^
oxidase (-) c.^
glucose fermenter d.^
does not fermentlactose e.^
facultative anaerobe
1.^ non-motile
(no H antigen)
- invades submucosa not laminapropria *IgA best defense ** very low ID
50
1.^ Shiga toxin
: inactivates the 60S ribosome,
inhibiting protein synthesis and killing intestinal cells a.^ bloody diarrhea
with mucus and pus (
dysentery
)
- fluid and electrolyte replacement 2. fluoroquinolone (severe cases) 3. trimethoprim & sulfamethoxazole
Klebsiellapneumoniae (colon, soil,water)
- gram stain:
a.^
gram(-) rods
- culture: (EMB/MacConkey)
a.^
vicous colonies
- metabolism:
a.^
indole, oxidase (-) b.^
glucose , lactosefermenter c.^
facultative anaerobe
- capsule 2. non-motile 1.^ pneumonia
, with significant lung
necrosis
and
bloody sputum
, commonly in alcoholics, or those
with underlying lung disease 2.^ hospital acquired UTI and sepsis
rd 1. 3 generation cephalosporins
- ciprofloxacin
Organism
Diagnostics
Virulence Factors
Clinical Manifestations
Treatment
Vibrionaceae Vibrio cholera (fecal-oraltransmission)
- gram stain:
a.^
short, commashaped, gram(-)rods
w/ single polar flagellum
- culture: (TCBS agar)
a.^
flat yellow colonies
3.^ dark field microscopy
of
stool
a.^
motile organismsimmobilized withantiserum
- metabolism:
a.^
ferments sugar(except lactose)
- flagellum (H antigen) 2. mucinase: digests mucous layerto attach to cells 3. fimbriae: helps with attachmentto cells 4.^ noninvasive 1.^ cholergen
(enterotoxin): like LT,
↑^ cAMP
Æ
secretion of electrolytes from the intestinalepithelium (secretion of fluid into intestinal tract)
a.^
cholera
: severe diarrhea with
rice water
stools
, no pus (death by dehydration)
1991 Latin America 1993 Bangladesh and India
- replace fluids 2. doxycycline 3. fluoroquinolone
Campylobacterjejuni (zoonotic: wildand domesticanimals andpoultry;transmitted byuncooked meatand fecal-oral)
- gram stain:
a.^
curved
gram(-) rods w/^ singular polarflagellum
- culture: (stool;EMB/MacConkey agar)
a. optimum temp is 42
°C
- metabolism:
a.^
oxidase (+) b.^
does not fermentlactose c.^
microphilic aerobe
- flagella (H antigen) 2. invasiveness
- enterotoxin: similar to cholera toxin and LT 2. cytotoxin: destroys mucosal cells Î^ secretory or
bloody diarrhea
(associated with Guillain-Barre syndrome—acuteneuromuscular paralysis; autoimmune) * one of the three most common causes ofdiarrhea in the world
- fluoroquinolone 2. erythromycin 3. ciprofloxacin
Helicobacterpylori
- gram stain:
a.^
curved
gram(-) rods w/^ tuft of flagella
- metabolism:
a.^
urease (+) b.^
microaerobe
1.^ duodenal ulcers 2.^ chronic gastritis
- bismuth, ampicillin,metronidazole & tetracycline 2. clarithromycin & omeprazole * both reduce duodenal ulcerrelapse
Organism
Diagnostics
Virulence Factors
Clinical Manifestations
Treatment
Pseudomonadaceae Pseudomonasaeruginosa ( opportunistic
soil, water; usuallynosocomial)
- gram stain:
a.^
gram(-) rods
- culture: (blood agar)
a.^
greenish-metallicappearance w/ fruitysmell
- metabolism:
a.^
oxidase (+) b.^
non-lactosefermenter c.^
obligate aerobe
- polar flagellum (H antigen) 2. hemolysin 3. collagenase 4. elastase 5. fibrinolysin 6. phospholipase C 7. DNAase 8. some strains possess anantiphagocytic capsule * high antibiotic resistance
- exotoxin A (similar to diptheria toxin):inhibits protein synthesis by blocking EF
a.^
pneumonia
( cystic fibrosis
and
immunosuppressed pts) b.^
osteomyelitis (diabetics, IV drug users,children) c.^
burn wound infections d.^
sepsis e.^
UTI
f.^
endocarditis (IV drug users) g.^
malignant external otitis h.^
corneal infections in contact lenswearers
1.^ ticarcillin 2. timentin 3. carbenicillin 4.^ piperacillin 5. mezlocillin 6. ciprofloxacin 7. imipenem 8. tobramycin 9. aztreonam
Organism
Diagnostics
Virulence Factors
Clinical Manifestations
Treatment
Bacteroidaceae Bacteroidesfragilis (normal GI flora)
- gram stain:
a.^
gram(-) rods b.^
non-spore forming c.^
polysaccharidecapsule
- metabolism:
a.^
anaerobe
- infection when organism entersperitoneal cavity (resistant to penicillins, 1
st
generation cephalosporins,aminoglycosides)
- does not contain Lipid A
a.^
abcesses in GI tract, pelvis, lungs (disease below the diaphragm)
1.^ metronidazole 2. clindamycin 3. chloramphenicol 4. surgically drain abcess
Actinomyces
GRAM-NEGATIVE OBLIGATE INTRACELLULAR PARASITES: Organism
Diagnostics
Virulence Factors
Clinical Manifestations
Treatment
Chlamydia Chlamydiatrachomatis (humans, directcontact)
- gram stain:
a.^
gram (-), lackspeptidoglycan layer
- culture: (conjunctiva surface,genital secretions)
a.^
no gram(-) diplococci
3.^ immunofluorescent slidetest 4. serologies
- resistant to lysozyme 2.^ prevents phagosome-lysosomefusion 3. nonmotile 4. no pili 5. no exotoxins Cell Cycle: 1.^ elementary body
infects cells
Æ
reticulate body
that replicates (
req’
host ATP
Æelementary body that leaves cell and infects other cells 2. tropism for endothelial columnarcells
- serotypes A, B, C:
a.^
trachoma
: scarring of inside of eyelid
Æ
redirection of eyelashes onto cornealsurface (corneal scarring and blindness)
- serotypes D-K:
a.^
inclusion conjunctivitis (opthalmianeonatorum) b.^
infant pneumonia c.^
urethritis, cervicitis, PID in women d.^
nongonoccal urethritis, epididymitis,prostatitis in men cx: sterility, ectopic pregnancy, chronic pain,reiter’s syndrome, perihepatitis (Fitz-Hugh-Curtis Syndrome)
- serotypes L
:(1-3)
a.^ lymphogranuloma venereum
- doxycycline (adults) 2. erythromycin (infants andpregnant women) 3. azithromycin * systemic tx needed for any eyeinfection
Æ^ pneumonia
Chlamydiapneumoniae (humans;respiratoryroute; TWAR)
- gram stain:
a.^
gram (-), lackspeptidoglycan layer
- culture: (conjunctiva surface,genital secretions)
b.^
no gram(-) diplococci
- immunofluorescent slide test 4.^ serologies
cell cycle similar to above
1.^ atypical pneumonia
: viral-like atypical
pneumonia, with fever and dry, non-productivecough in young adults
- doxycycline 2. erythromycin
Rickettsia Rickettsiarickettsii (transmitted bydog and woodticks;southeasterntick belt)
- clinical exam 2. ELISA of skin biopsy fromrash site 3. serology 4. Weil-Felix reaction: (
x-rxn to
proteus
Ag ), OX-2,19 (+)
1.^ Rocky Mountain Spotted Fever
a.^
fever b.^
conjunctival injection c.^
severe headaches d.^
rash on wrists, ankles, soles, and plamsinitially, becomes more generalized later(centrifugal)
- doxycycline 2. chloramphenicol
Rickettsia akari (transmitted bymites on housemice)
- clinical exam 2. weil-felix reaction (-) 1.^ Rickettsial Pox: a. vesicular rash similar to chicken pox (resolvesover 2 wks)
- doxycycline 2. chloramphenicol
Ehrlichia Ehrlicihiacanis/chaffeenis (dog ticks)
- rise in acute and convalescentAb titers 2. morula bodies in leukocyteblood smears 1.^ Human Ehrlichiosis a. similar to Rocky Mountain spotted Fever, butrash is rare
- doxycycline 2. rifampin (resistant to chloramphenicol)
MISCELLANEOUS BACTERIA: Organism
Diagnostics
Virulence Factors
Clinical Manifestations
Treatment
Actinomycetes Actinomycesisraelli (normal oralflora)
- gram (+),
long branching filaments 2. hard, yellow granules( sulfur granules
) formed in
pus 3. culture of pus or tissue 4.^ anaerobe 5. immunofluorescence
1.^ Actinomycosis
a.^
abscess with draining sinuses b.^
initial lesion involves face and neck(rest
Æ^ chest and abdomen) c.^
not communicable
- prolonged penicillin G w/surgical drainage
Nocardiaasteroids (soil)
- gram (+) filaments, acid fast 2. aerobic 1.^ Nocardiosis
a.^
abscesses in brain and kidneys inimmunodeficient pts b.^
pneumonia c.^
not communicable
- trimethoprim-sulfamethoxazole 2. surgical drainage may benecessary
Mycoplasma Mycoplasmapneumoniae (humans, respdroplets
1.^ absence of cell wall 2. bacterial membranecontains cholesterol 3. grown on artificial mediareq’ lots of different lipids;characteristic “fried egg”colonies w/raised center 4. rod-shaped w/ pointed tip 5.^ serologies; cold-aglutinintiter
(IgM autoAb’s against type O blood cells)—non-specific
- produces hydrogen peroxidedamages resp tract cells 2. Ab’s against RBCs (coldagglutinins), brain, lung, and livercells produced during infection 1.^ Atypical Pneumonia
a.^
most common cause of pneumonia inyoung adults b.^
gradual onset with non-productivecough, sore throat, ear ache c.^
constitutional sx of fever, headache,malaise, and myalgias pronounced d.^
minimal chest x-ray findings e.^
resolves spontaneously in 10-14 days
- macrolide (erythromycin,azithromycin) 2. tetracycline (doxycycline) (penicillins and c’sporinsineffective b/c no cell wall)
