USMLE Step 1 Web Prep Medically Important Bacteria, Part 4

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Table II-26. Comparison of the Genera Ric ettsia! Chlam"#ia! an# $"coplasma %ith T"pical &acteria
Typical bacteria Chlamydia (S. aureus) Obli ate i!tracell"lar parasite# Make &T'# 'eptido lyca! layer i! cell e!)elope# Most !o %ormal &T' $es %o &T' $es (imited &T' %o %ormal &T' Rickettsia Mycoplasma

%ormal Modi*ied+ peptido lyca! peptido lyca!

%ormal %o peptido lyca! peptido lyca!

+Chlamydial peptido lyca! lacks m"ramic acid a!d is co!sidered by some as modi*ied, by others as abse!t-

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Table //021- /!*ectio!s Ca"sed by Rickettsias a!d Close Relati)es+ &rthropod Reser)oir 2ro"p disease 3acteri"m )ector host 4potted 5e)ers: Rocky Mo"!tai! 4potted 5e)er Rickettsialpo7 Typh"s 2ro"p: 8pidemic 8!demic 4cr"b Others: Rickettsia pro9a:ekii Rickettsia typhi Rickettsia ts"ts" am"shi ;"ma! lo"se 5leas Mites ;"ma!s Rode!ts Rode!ts Rickettsia rickettsii Rickettsia akari Ticks Mites 6o s, rode!ts, ticks++ Mice

< *e)er Tre!ch *e)er, bacillary a! iomatosis Cat 4cratch 5e)er,4epticemia i! homeless ;"ma! ra!"locytic or mo!ocytic 8hrlichiosis+

Co7iella b"r!etii 3arto!ella ="i!ta!a (Rochalimaea)

%o!e ;"ma! lo"se

Cattle, sheep, oats ;"ma!s Cats

3arto!ella he!selae %o!e (Rochalimaea) 8hrlichia

/7odes ticks # >#

+%e9 tick0bor!e rickettsial disease ca"sed by 8hrlichia ++?ertical tra!smissio! i! arthropod o)"m %OT8: Co0i!*ectio!s *rom a si! le tick i!*ected 9ith more tha! o!e a e!t may occ"r: % 8ast @4&: 3abesia a!d 3- b"r dor*eri % Ce!tral @4&: 3- b"r dor*eri a!d 8hrlichia
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Gen(s) Rickettsia (Rickettsia rickettsii)

Obli ate i!tracell"lar bacteria that di)ide by bi!ary *issio! (ca!!ot make s"**icie!t &T') %ot see! 9ell o! ram0stai!ed smear (too small)B b"t ha)e ram0!e ati)e cell e!)elope Cross reactio! o* Rickettsia a!ti e!s 9ith OC strai!s o* P. vulgaris (Deil05eli7 reactio!) Reser)oir: 4mall 9ild rode!ts a!d lar er 9ild a!d domestic a!imals (do s) Tra!smissio!: ;ard ticks 'atho e!esis: Rickettsias i!)ades e!dothelial li!i! o* capillaries, ca"si! )asc"litis Rocky Mo"!tai! 4potted 5e)er: ;eadache, *e)er, malaise, myal ias, to7icity, )omiti! , a!d co!*"sio!, rash (mac"lopap"lar petechial) starts (by day . o* ill!ess) o! a!kles a!d 9rists a!d the! spreads to the tr"!k, palms, soles, a!d *ace (ce!tripetal rash) Treatme!t: 6o7ycycli!e
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Gen(s) Rickettsia (Rickettsia rickettsii)

Obli ate i!tracell"lar bacteria that di)ide by bi!ary *issio! (ca!!ot make s"**icie!t &T') %ot see! 9ell o! ram0stai!ed smear (too small)B b"t ha)e ram0!e ati)e cell e!)elope Cross reactio! o* Rickettsia a!ti e!s 9ith OC strai!s o* P. vulgaris (Deil05eli7 reactio!) Reser)oir: 4mall 9ild rode!ts a!d lar er 9ild a!d domestic a!imals (do s) Tra!smissio!: ;ard ticks 'atho e!esis: Rickettsias i!)ades e!dothelial li!i! o* capillaries, ca"si! )asc"litis Rocky Mo"!tai! 4potted 5e)er: ;eadache, *e)er, malaise, myal ias, to7icity, )omiti! , a!d co!*"sio!, rash (mac"lopap"lar petechial) starts (by day . o* ill!ess)

o! a!kles a!d 9rists a!d the! spreads to the tr"!k, palms, soles, a!d *ace (ce!tripetal rash) Treatme!t: 6o7ycycli!e
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Gen(s) Coxiella(Coxiella burnetii)

Obli ate i!tracell"lar bacteri"m %ot see! 9ell o! ram0stai!ed smear Reser)oir: 6omestic li)estock: pre !a!t a!imals ha)e hi h titers Tra!smissio!: /!halatio! o* aerosols o* "ri!e, *eces, am!iotic *l"id, or place!tal tiss"e 4"r)i)es dryi! : ca! be i!*ecti)e miles a9ay %o si !i*ica!t arthropod )ector i! h"ma! i!*ectio! < *e)er: 5ebrile ill!ess 9ith %O R&4;, atypical p!e"mo!ia 9ith hepatitis Treatme!t: 6o7ycycli!e or erythromyci!
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Gen(s) Ehrlichia
Reser)oir: ticks a!d deer Tra!smitted by the (o!e 4tar Tick (&mblyoma) /!*ects mo!ocytes a!d macropha es ;"ma! mo!ocytic ehrlichiosis 4imilar to Rocky Mo"!tai! 4potted 5e)er
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Gen(s) Chlamydia (Chlamydia trachomatis)

Obli ate i!tracell"lar bacteri"mB ca!!ot make &T' /!*ecti)e *orm: i!acti)e, e7tracell"lar eleme!tary body 5o"!d i! cells as metabolically acti)e, replicati! retic"late bodies %ot see! o! ram stai!B peptido lyca! layer lacks m"ramic acid Reser)oir: ;"ma! e!ital tract a!d eyes Tra!smissio!: 4e7"al co!tact a!d at birth- Trachoma is tra!smitted by ha!d0to0eye co!tact Trachoma: 4erotypes &, 3, 3a, a!d C 4T6: 4erotypes 60F (This is the most commo! bacterial 4T6 i! @-4B ;erpes a!d ;'? are more commo!) %o! o!ococcal "rethritis, cer)icitis, '/6 a!d maGor portio! o* i!*ertility /!cl"sio! co!G"!cti)itis /!cl"sio! co!G"!cti)itis a!dHor p!e"mo!ia i! !eo!atesHi!*a!ts (staccato co" h) (ympho ra!"loma )e!ere"m: (4erotypes (1, 2, 3) 4T6, s9olle! lymph !odes (b"bo) leadi! to e!ital elepha!tiasis i! late sta es
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Gen(s) Chlamydia (Chlamydia trachomatis)

Obli ate i!tracell"lar bacteri"mB ca!!ot make &T' /!*ecti)e *orm: i!acti)e, e7tracell"lar eleme!tary body 5o"!d i! cells as metabolically acti)e, replicati! retic"late bodies %ot see! o! ram stai!B peptido lyca! layer lacks m"ramic acid Reser)oir: ;"ma! e!ital tract a!d eyes Tra!smissio!: 4e7"al co!tact a!d at birthTrachoma is tra!smitted by ha!d0to0eye co!tact Trachoma: 4erotypes &, 3, 3a, a!d C 4T6: 4erotypes 60F (This is the most commo! bacterial 4T6 i! @-4B ;erpes a!d ;'? are more commo!) %o! o!ococcal "rethritis, cer)icitis, '/6 a!d maGor portio! o* i!*ertility /!cl"sio! co!G"!cti)itis /!cl"sio! co!G"!cti)itis a!dHor p!e"mo!ia i! !eo!atesHi!*a!ts (staccato co" h) (ympho ra!"loma )e!ere"m: (4erotypes (1, 2, 3) 4T6, s9olle! lymph !odes (b"bo) leadi! to e!ital elepha!tiasis i! late sta es
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Gen(s) Chlamydia (Chlamydia trachomatis)

Obli ate i!tracell"lar bacteri"mB ca!!ot make &T' /!*ecti)e *orm: i!acti)e, e7tracell"lar eleme!tary body 5o"!d i! cells as metabolically acti)e, replicati! retic"late bodies %ot see! o! ram stai!B peptido lyca! layer lacks m"ramic acid Reser)oir: ;"ma! e!ital tract a!d eyes Tra!smissio!: 4e7"al co!tact a!d at birthTrachoma is tra!smitted by ha!d0to0eye co!tact Trachoma: 4erotypes &, 3, 3a, a!d C 4T6: 4erotypes 60F (This is the most commo! bacterial 4T6 i! @-4B ;erpes a!d ;'? are more commo!) %o! o!ococcal "rethritis, cer)icitis, '/6 a!d maGor portio! o* i!*ertility /!cl"sio! co!G"!cti)itis /!cl"sio! co!G"!cti)itis a!dHor p!e"mo!ia i! !eo!atesHi!*a!ts (staccato co" h) (ympho ra!"loma )e!ere"m: (4erotypes (1, 2, 3) 4T6, s9olle! lymph !odes (b"bo) leadi! to e!ital elepha!tiasis i! late sta es
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Gen(s) Chlamydia (Chlamydia trachomatis)

Obli ate i!tracell"lar bacteri"mB ca!!ot make &T' /!*ecti)e *orm: i!acti)e, e7tracell"lar eleme!tary body 5o"!d i! cells as metabolically acti)e, replicati! retic"late bodies %ot see! o! ram stai!B peptido lyca! layer lacks m"ramic acid Reser)oir: ;"ma! e!ital tract a!d eyes Tra!smissio!: 4e7"al co!tact a!d at birth- Trachoma is tra!smitted by ha!d0to0eye co!tact Trachoma: 4erotypes &, 3, 3a, a!d C 4T6: 4erotypes 60F (This is the most commo! bacterial 4T6 i! @-4B ;erpes a!d ;'? are more commo!) %o! o!ococcal "rethritis, cer)icitis, '/6 a!d maGor portio! o* i!*ertility /!cl"sio! co!G"!cti)itis /!cl"sio! co!G"!cti)itis a!dHor p!e"mo!ia i! !eo!atesHi!*a!ts (staccato co" h) (ympho ra!"loma )e!ere"m: (4erotypes (1, 2, 3) 4T6, s9olle! lymph !odes (b"bo) leadi! to e!ital elepha!tiasis i! late sta es
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Gen(s) Chlamydia (Chlamydia trachomatis)

Obli ate i!tracell"lar bacteri"mB ca!!ot make &T' /!*ecti)e *orm: i!acti)e, e7tracell"lar eleme!tary body 5o"!d i! cells as metabolically acti)e, replicati! retic"late bodies %ot see! o! ram stai!B peptido lyca! layer lacks m"ramic acid Reser)oir: ;"ma! e!ital tract a!d eyes Tra!smissio!: 4e7"al co!tact a!d at birth- Trachoma is tra!smitted by ha!d0to0eye co!tact Trachoma: 4erotypes &, 3, 3a, a!d C 4T6: 4erotypes 60F (This is the most commo! bacterial 4T6 i! @-4B ;erpes a!d ;'? are more commo!) %o! o!ococcal "rethritis, cer)icitis, '/6 a!d maGor portio! o* i!*ertility /!cl"sio! co!G"!cti)itis /!cl"sio! co!G"!cti)itis a!dHor p!e"mo!ia i! !eo!atesHi!*a!ts (staccato co" h) (ympho ra!"loma )e!ere"m: (4erotypes (1, 2, 3) 4T6, s9olle! lymph !odes (b"bo) leadi! to e!ital elepha!tiasis i! late sta es
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Gen(s) Chlamydia (Chlamydia trachomatis)

Lab Dia/nosis 6%& probes i! @4 Cytoplasmic i!cl"sio!s see! o! 2iemsa0, iodi!e0, or *l"oresce!t0a!tibody0stai!ed smear or scrapi! s 4erodia !osis: compleme!t *i7atio! or microimm"!o*l"oresce!ce test
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Gen(s) Chlamydia (Chlamydia trachomatis)

Lab Dia/nosis 6%& probes i! @4 Cytoplasmic i!cl"sio!s see! o! 2iemsa0, iodi!e0, or *l"oresce!t0a!tibody0stai!ed smear or scrapi! s 4erodia !osis: compleme!t *i7atio! or microimm"!o*l"oresce!ce test
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Gen(s) Chlamydia (Chlamydia trachomatis)

Lab Dia/nosis 6%& probes i! @4 Cytoplasmic i!cl"sio!s see! o! 2iemsa0, iodi!e0, or *l"oresce!t0a!tibody0stai!ed smear or scrapi! s 4erodia !osis: compleme!t *i7atio! or microimm"!o*l"oresce!ce test
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Gen(s) Chlamydia (Chlamydia trachomatis)

Lab Dia/nosis 6%& probes i! @4 Cytoplasmic i!cl"sio!s see! o! 2iemsa0, iodi!e0, or *l"oresce!t0a!tibody0stai!ed smear or scrapi! s 4erodia !osis: compleme!t *i7atio! or microimm"!o*l"oresce!ce test
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Gen(s) Chlamydia (Chlamydia trachomatis)

Lab Dia/nosis 6%& probes i! @4 Cytoplasmic i!cl"sio!s see! o! 2iemsa0, iodi!e0, or *l"oresce!t0a!tibody0stai!ed smear or scrapi! s 4erodia !osis: compleme!t *i7atio! or microimm"!o*l"oresce!ce test
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Chlam"#ia pne(moniae

Respiratory i!*ectio!s- &typical p!e"mo!ia (si! le lobe) is )ery commo! /!*ect smooth m"scle, e!dothelial cells o* coro!ary artery a!d macropha es 'ote!tial associatio! 9ith atherosclerosis
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Chlam"#ia psittaci

Chlamydia that is associated 9ith birds %o lyco e! i! the i!cl"sio! bodies Reser)oir: 3irds0 parrots (psittaci!e), t"rkeys, others Tra!smissio!: 6"st o* dried bird secretio!s a!d *eces 'sittacosis (&typical '!e"mo!ia) :Co" h may be abse!tB 9he! prese!t, !o!0 prod"cti)e i!itially the! sca!t m"cop"r"le!t Cytoplasmic i!cl"sio!s see! o! 2iemsa or *l"oresce!t0a!tibody0stai!ed sp"t"m or biopsy Or a!ism ca! be isolated *rom sp"t"m i! tiss"e c"lt"re, b"t this is rarely do!e 4erodia !osis by compleme!t *i7atio! test
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Gen(s) Mycoplasma (Mycoplasma pneumoniae)

4mallest *ree0li)i! (e7tracell"lar) bacteria %o cell 9all a!d !ot see! o! ram0stai!ed smear Membra!e 9ith cholesterol b"t does !ot sy!thesi:e cholesterolB re="ires cholesterol *or i! )itro c"lt"re Reser)oir: ;"ma! respiratory tract Tra!smissio!: Respiratory droplets- Close co!tact: *amilies, military recr"its, medical school classes, colle e dorms 5ried e colo!ies o! Mycoplasma or 8ato!Js media (re="ire sterols) i! 10 days 'ositi)e cold a l"ti!i!s (a"toa!tibody to red blood cells) test is !ot )ery speci*ic a!d positi)e i! o!ly .5K Compleme!t *i7atio! test *or a!tibodies to Mycoplasma p!e"mo!iae is more speci*ic Treatme!t: 8rythromyci!, a:ithromyci!, clarithromyci!- %o cephalospori!s !or pe!icilli!
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0reaplasma (real"tic(m

3elo! s to the Mycoplasma *amily

 'rod"ces a "rease @rethritis (hal* o* the !o!0%eisserial, !o!0Chlamydial), prostatitis Ca! ca"se re!al calc"li