BACTERIA

Staph Aureus-
-gram positive cocci
-grape like clusters
-golden colored when plated
-beta hemolytic (looks like glowing when plated on red agar)
-ferments mannitol turns agar bright yellow (if not it will stay pink)
-protein A is the main virulence factor for staph aureus - component of cell wall
combined FC portion of immunoglobulin prevents compliment from binding
same region preventing phagocytosis
-coagulase positive (parting the red sea in the picture) (converts fibrinogen to
fibrin)
-CATALSE POSITIVE (hydrogen peroxide to water conversion)
-colonizes the nose
-MCC of septic arthritis in adults
-pneumonia which looks like patchy infiltrates on x-ray
-post-viral bacterial pneumonia
-abscesses
-rapid onset acute bacterial endocarditic
>IV drug users endocarditis
>tricupsid most likely involved
-MCC of Osteomyelitis
-scalded skin syndrome where skin peals off (exfoliatin toxin)
-toxic shock syndrome like leaving gause on or tampon in (foreign material in
the body) which is a superantigen (TSST)
-staph food poisoning from performed toxin - more associated with vomitting;
from meats and mayonnaise
-MRSA resistance by altering PBP which constructs cell walls
-treat MRSA with VANCOMYCIN
-Nafcillin if its methacillin sensitive
Staph epidermidis and Staph saprophyticus
Staph epidermidis and Staph saprophyticus
-gram positive take up crystal violet stain
-staph grows in clusters
-CATALSE positive
-UREASE positive (urea ->ammonia conversion)
- coagulase negative

Staph epidermidis
-part of normal skin flora
-contamination of blood cultures
-effects artificial joints and prosthetic joints
-indwelling catheters is a common source of infection
-MCC of endocarditis in artificial heart valves
-produces biofilms coating valves etc.
-Novobiocin sensitive
-treat with VANCOMYCIN

Staph saprophyticus
-Novobiocin resistant
-common cause of UTI in sexually active females
Strep pyogenes (Group A Strep)
GRAM POSITIVE COCCI
-form long chains or pairs
- encapsulated
-hyaluronic acid what the capsule is made up (we produce this in our CT)
-beta hemolytic
-impetigo honey crusted! (skin rash also caused by s.aureus)
- pharnygitis
- MCC of cellulitis and erysipeias (inflammation of the skin)
STREP PYOGENIC EXOTOXIN SPE causes the following 3:
1) scarlet fever (strawberry tongue, pharyngitis, diffuse rash that spares the
face)
2) TSLS- toxic shock like syndrome by a superantigen
3) necrotizing fasciitis (surgical emergency)
SpeA- superantigen (TSLS)
SpeB- protease (Nec. fasc)
SpeC- superantigen (TSLS)

-Rheumatic fever
>type 2 hypersensitivity reaction
>M protein main virulence factor responsible for RF (antiphagocytic)
>M protein mimics myosin in our heart causing antibodies to attack our mitral
valve (damaged causing mitral stenosis in RF)
>pharyngitis precipitates RF
>jones criteria (joints (polyarthritis), o (heart problems), n (subcutaneous
nodules), erythema marginatum, sydenham's chorea)
> can occur only after pharyngitis
>>TREATMENT: penicillin WILL help

-post streptoccocal glomerularnephritis PSGN

>type 3 hypersensitivity reaction
> glomerulonephritis (cola colored urine, facial edema)
>2 weeks post infection
>can occur after pharyngitis or impetigo
>TREATMENT: penicillin will not help

VIRULENCE FACTORS:
-streptolysin O - lyse red blood cells and be beta hemolytic (we generate ASO
antibodies)
-streptokinase (lyses clots)
-DNase (depolymerize DNA)

-BACATRACIN sensitive (group b strep is resistant)

-antistreptolysin O titer tell us if we have a had a recent infection with group A
strep
Strep agalactiae (Group B Strep)
-polysaccharide capasule
-CAMP test positive - separates GROUP B strep from ALL the other streps
(WHEN its plated with s.aureus it has an increasing zone of hemolysis;
"arrowhead" zone of hemolysis)
-positive hippurate (hydrolyses Na hippurate)
-beta hemolytic (like group A strep)
-bacitracin resistant (unlike group A strep)
-CAUSES really serous infections in newborns
- #1 cause of meningitis in neonates
- common cause of sepsis in neonates
-causes pneumonia
-culture mom at 35 weeks of pregnancy to see if colonized with group B strep
-prophylaxis give mother intrapartum penicillin
Strep. pneumoniae / Strep viridans- BACTERIA
BOTH:
alpha hemolytic = partial hemolysis giving a green hue (group A and B are beta
hemolytic)

strep pneumoniae
- polysaccharide capsule (main virulence factor)
-optochin sensitive
-lancet shaped diplococci
-bile soluble (cant grow in bile)
- #1 cause of CA pneumonia (lobular)
-rust colored sputum
-"MOPS", Meningitis, Otitis media, Pneumonia, Sinusitis (MC bacterial cause
of all of these)
-IgA protease
-encapsulated
-sickle cell disease (Asplenia) particularly susceptible
- Treatment: macrolide (erythromycin), 3rd gen cephalosporin (ceftriaxone)
-prophylaxis (adult) 23 valent IgM response; (child) is 7 conjugated to protein -
IgG generates a more robust T cell response
Strep viridans
-optochin resistance
-NO CAPSULE
-bile insoluble (bile resistant)
-strep mutans causes dental caries ->subacute endocarditis in damaged heart
valves (mitral valve)
-adheres to platelets
-dextrans that makes them stick to platelets
Enterococcus
Enterococcus Faecalis (more common)

Enterococcus Faecium (more dangerous)

Both:
-inhabits the INTESTINAL tract
-gram + cocci
-can grow in 6.5% NaCl
-bile resistant
-UTI, endocarditis, biliary tree infections (hence bile resistant)
-VRE - vancomycin resistant
TREATMENT: Linezolid (antibiotic); Tigecycline
Gardnerella vaginalis
-the cause of BACTERIAL VAGINOSIS
-gram variable rod staining- can stain both
-normal vaginal flora contains majority lactobacilli; bacterial overgrowth that
disrupts the normal flora
-grayish-white discharge
-FISHY ODOR
-KOH wiff test
-infection occurs when pH >4.5
-CLUE CELLS - epithelial cells diffusely coated with bacteria - are
characteristic* on wet mount
-TREATMENT: metronidazole
(also used to treat c.diff)
Mycoplasma pneumoniae
no cell wall so cant appear on gram stain
-Cell membrane contains cholesterol - UNIQUE for a bacteria
-atypical pneumonia "walking pneumonia"
-xray shows severe pneumonia appears much worse than the patient looks;
shows reticulonodular or "patchy" infiltrate
-increase incidence in young adults like military recruits living in close quarters
-diagnosis: IgM cold agglutination test causes agglutination of red blood cells
-culture it takes a long time - Eaton agar
TX: macrolides because no cell wall
campylobacter jejuni
curved gram neg rod of the digestive tract (this is one of three curved)
-oxidase positive (as are all the other two curved)
-thermophilic - grows at 42 degrees celsius (intrinsically linked to heat)
-poultry reservoir
-bloody stool
-invasive
-reactive arthritis (Reiters syndrome)
-Guillain-Barree syndrome- ascending paralysis (remember botulism is
descending paralysis)
Bordatella pertussis –
- gram negative, aerobic, coccobacillus.
-transmission: respiratory droplets
-filamentous hemagglutinin
-(1)pertussis toxin acts by ADP ribosylation and toxin inhibits Gi
(toxin inhibits inhibitor and thus increases cAMP) and causes lymphocytosis
-(2)adenylate cyclase toxin acts like the anthracis EF toxin and increase in
cAMP
-(3) tracheal toxin damages respiratory epithelium
-catarrhal stage (nonspecific symptom stage)
-paroxysmal stage: whooping cough
-convalescent stage can last for months can have gradual reduction of symptoms

-treatment: treat early with macrolides

-prevention: killed vaccine no longer available; acellular vaccine = DTaP (aP is
for acellular pertussis antigens)
-bordet gangue agar and regan lowe medium.
Bacillus anthracis and Bacillus cereus
-black eschar
-large gram positive rods in chains
-encapsulated - made of proteins & poly-D
-obligate aerobe- only survive in the presence of oxygen

bacillus anthracis
-spore forming
-2 toxins = LF lethal factor and EF= edema factor
-EF increases cAMP and causes edema
-LF exotoxin acts as a protease and cleaves MAP kinase (signal transduction
responsible for cell growth) causes tissue necrosis seen in the black eschar
-wool sorter's disease causing pulmonary anthrax starting as a dry cough but can
progress to pulmonary hemorrhage (hemorrhagic mediastinitis) which on xray
appears as widened mediastinum
-TREATMENT: Fluroquinolones and secondary doxycycline

Bacillus cereus
-aerobic and spore forming
-food poisoning
-vomiting and/or diarrhea from reheated fried rice
Klebsiella pneumoniae, Enterobacter cloacae, Serratia marcescens
-nosocomial infections
-pneumonia and UTI
-multi-drug resistant
-ferment lactose (e.coli also does) form pink colonies on MacConkey agar
Enterobacter cloacae
-motile
Serratia marcescens
-motile
-produces red pigment when cultured

Klebsiella pneumoniae
-immotile
-Alcoholics, Abscesses and Aspiration
-polysaccharide CAPSULE
-BUZZ WORD "currant jelly sputum"
-cavitary lesion originally makes people think its TB
-UREASE POSITIVE
Salmonella general
-motile
-H2S positive black colonies on Hektoen Agar(all enteric bacteria that are
motile are H2S positive)
-encapsulated
-acid labile (means easily degraded in the stomach so need large dose to infect)
>taking omeprazole, or prenicious anemia where you lower stomach acid= more
susceptible to infection
-type 3 secretion system
-facultative intracellular (specifically in macrophages)
Salmonella enteritidis
-the reservoir is chicken; get it from undercooked chicken
-inflammatory diarrhea
Salmonella typhi
-in gallbladder of chronic carriers
-Typhoid Mary
-rose-colored macules on abdomen
-#1 cause of osteomyelitis in sickle cell patients
-constipation and sometimes pea soup diarrhea
-TREATED with FQ (Cipro)
-live attenuated vaccine
Shigella general
-gram negative enteric leading to bloody diarrhea
-green colonies on hektoin agar
-immotile
-acid stable (acid doesnt effect it)few organism to cause infection
-shigella induces M cells to take it up and escapes by use of actin filaments;
fecal blood and leukocytes
-bloody diarrhea and inflammatory diarrhea
-facultative intracellular
-binds 60s subunit of ribosomes and inhibits translation
-type 3 secretion system to release cytokines
Shigella sonnei
-most common in the US
Shigella dysenteriae
-infection can cause HUS in children (<10 years old)
-glomerular damage activates platelets ->leading to drop in platelet count ->lyse
RBCs (RBC hemolysis) ->shistocytes
Escherichia coli
(ETEC, EHEC)
Escherichia coli
-lactose fermenter
-Pink on MacConkey Agar
-encapsulated
-K antigen present on capsule
-green on EMB agar
-catalase postiive
-fimbriae necessary for UTI
-#1 cause of UTI
-leading cause of gram negative sepsis
-LPS endotoxin located in outer cell membrane (virulence factor for all gram
negatives)
-neonatal meningitis - only if it has the K antigen

Enterohemorrhagic E.coli (EHEC)

-transmitted by eating undercooked meat/hamburgers
-bloody diarrhea
-only e.coli that DOESNT ferment sorbitol
-inhibits ribosomes at 60s subunit - like SHIGA LIKE TOXIN
-hemolytic uremic syndrome in <10 y.o. patients (damages endothelial cells in
glomerulus; platelet aggregation and decrease in platelet count; hemolysis of
RBCs)
-O157:H7 associated with outbreaks

enterotoxigenic E.coli (ETEC)

-"travelers diarrhea"
-"montezuma's revenge"
-transmitted via water
-recent travel to Mexico
-heat labile toxin increases cAMP
-heat stable toxin increases cGMP (similar to cholera)
-watery diarrhea
Listeria monocytonegenes
is gram positive bacillis
-infections in pregnant women (20x more likely)
-pregnant women are discouraged from eating soft cheese may lead to early
termination or disease in newborn
-3rd MCC of meningitis in the newborns
-in adults over 60 can cause meningitis
-narrow zone of hemolysis when plated
-beta hemolytic
-facultative intracellular
-TUMBLING motile extracellularly on LM
-ACTIN ROCKETS intracellular and can jump from cell to cell
-catalase positive
-survives and multiplies in near freezing temperatures (can contaminate things
even in the refrigerator)
-contaminates UNPASTEURIZED milk and soft cheeses

TREATMENT AMPICILLIN
esp to cover elderly getting meningitis
Yersinia general
-gram negative
-resistant to cold temperates
-SAFETY PIN, bipolar staining
-encapsulated
Yersinia enterocolitica
-transmitted through puppy feces
-commonly infects toddles
-also transmitted through contaminated milk products
-bloody diarrhea- invasive
-CAN MIMIC appendicitis symptoms: RLQ pain
Yersinia pestis
-the black bubonic plaque
-characteristic buboes form on the skin
-causes blackening and death of tissues
-Yops secreted via type 3 secretion system (yersinia associated outer protein)
-prairie dogs are main reservoir in US
-transmitted by flea bites
Treatment: aminoglycosides (streptomycin) used in combination with
tetracycline.killed vaccine used to prevent infection (not typically used)
vibro cholerae
vibro parahaemolyticus
vibrio vulnificus
BUZZ WORD: "COMMA SHAPED"
gram negative

vibro cholerae
-perfuse watery diarrhea - RICE WATER stools
-fimbraie attachment then releases cholerae toxin
but does NOT invade
-grows on alkaline media - its ACID LABILE (hate acidic environment of the
stomach)
-oxidase positive
-activates Gs pathway, increases cAMP secretion of water into intestinal lumen
hence watery diarrhea
-Treatment: oral rehydration with electrolytes

vibro parahaemolyticus & vibrio vulnificus

-they can contaminate sea food particularly oysters
Helicobacter pylori
-helical shaped
-pylori near our pylorus in the antrum of our stomach
-MOTILE
-curved gram negative rods (but more helical)
-UREASE POSITIVE (helps reduce acidity of the environment)
-urea breath test
-oxidase positive (all curved are)
-95% of all DUODENAL ulcer are from H.pylori
-ULCERS (reducing somatostatin or increasing gastrin production)
-increased risk for gastric adenocarcinoma
- MALT (maltoma) mucus associated lymphoid tissues

TREATMENT: TRIPLE THERAPY - Proton pump inhibitor, amoxicillin,

macrolide (clarithromycin specifically)
Rickettsia species overview
-obligate intracellular
-unable to produce CoA, gets it from eukaryotic cells
-NAD+ also important for bacterial growth and replication
-poor gram stain
-weakly gram negative
-coccobacillary shape
-weil-felix agglutination test for Rickettsial infections
-headache and fever in early Rickettsia infections
-vasculitis -infection and rupture
-rash may be associated with vasculitis

TX: Doxycycline DOC

Rickettsia prowazekii
-obligate intracellular
-poor gram stain
-unable to produce CoA, gets it from eukaryotic cells
-NAD+ also important for bacterial growth and replication

-Rash starts at trunk, and spreads outwards towards extremities

-rash SPARES hands, feet and head
-affects military camp recruits and prisoners of war
-spread by LOUSE (scratching usually introduces poop into blood)
-illness is called epidemic typhus (wide spread rapid outbreak)
-causes myalgia and arthalgia
-causes pneumonia
-encephalitis with dizziness and confusion
-serious infections can cause coma

TX: Doxycycline
Rickettsia rickettsii
-obligate intracellular
-poor gram stain
-use Giemsa stain
-unable to produce CoA, gets it from eukaryotic cells
-NAD+ also important for bacterial growth and replication

-transmitted by direct contact with Dermacentor Tick

-rash not immediate- has incubation period between 2-14 days
-rash begins at extremities (WRIST and ANKLES)
-rash spreads centrally from extremities INCLUDING face and feet
-symptoms include, headache, fever* and myalgia

TX: Doxycycline
Nocardia species
-gram positive filamentous branching rod (similar to actinomyces)
-obligate aerobe (UNLIKE actinomyces which is obligate anaerobe)
-found in soil but does NOT form spores
-weakly stains acid fast - carbol fuchsin stain used
-mycolic acids (long chain FA with long tails)
-catalase positive, pts with chronic granulomatous disease are susceptible to
infection
-urease positive
-primarily infects immunocompromised patients and men more
-symptoms include pulmonary nocardiosis as pneumonia like symptoms with
cavitary lesions in the lungs associated; brain abscess formation; cutaneous
symptoms - indurated lesions and inflammatory reaction

TX: sulfonamides (unlike actinomyces you treat with penicillin)

Haemophilus influenzae
Gram negative bacteria
-coccobacillary shape
-chocolate agar needs factor 5 (Nicotinamide=NAD) and factor 10 (hematin)
-aerosol transmission
-main cause of epiglottitis (inflamed epiglottis, inspiratory stridor, drooling,
"cherry red epiglottitis")
-otitis media
-strains with type B capsule cause meningitis
-increased risk of infectino in sickle cell asplenic patients
-VACCINE is for type B capsule; vaccine is polysacccharide conjugated to
Diptheria toxoid; between 2-18 months should get vaccine
TX: beta-lactam antibiotic
use ceftriaxone for meningitis or systemic disease; rifampin is used for close
contact prophylaxis
Legionella -
-gram negative but doesn't take up gram stain well but needs SILVER STAIN to
be visualized
-grows on charcoal yeast extract
-oxidase positive
-growth requires presence of iron and cysteine
-Pontiac fever, fever and malaise and usually self limited
-Legonnaires' disease more common in smokers
-atypical pneumonia
-Xray shows patchy infiltrate with consolidation of one lobe
-Legonnaires' disease may present with hyponatremia (<130)
-may present with headache and confusion (neurological symptoms)
-pneumonia with diarrhea* and hyponatremia think Legonnaires' disease
-Legonnaires' disease present with high fever (>104F)
-culture respiratory sputum but can do RAPID URINE ANTIGEN test for
diagnosis

TX: macrolides and flouroquinolones

Brucella
-gram negative
-direct contact: cow, pig, and farm animals
-ingestion of unpasteurized dairy products
-facultative intracellular organism (can live in both)
-symptoms: fever, chills and anorexia
-undulant fever
-liver and spleen involvement and enlargement
-osteomyelitis in chronic brucella infection

TX: doxycycline, rifampin as adjunct therapy

Bartonella henselae
-gram negative
-warthin-starry silver stain

-cat scratch fever transmitted by cat scratches

>can also involve regional lymph nodes (painful) especially in the axilla
>axillary lymphandenitis
>occurs in immunoCOMPETENT patients
TX: Self-limiting but can use azithrymycin (macrolides) for painful lymph
nodes

-bacillary angiomatosis also transmitted by cat scratches

>fever, chills, HA
>raised red vascular lesions in bacillary angiomatosis
>affects immunocompromised patients
TX: doxycycline treatment for bacillary angiomatosis; can also use macrolides
Francisella tularensis
-rabbits are main reservoir (eating, handling - direct)
-transmitted by dermacentor tick -MC
-aerosolized
-gram negative, coccobacilli
-facultative intracellular organism
-painful ulcer at site of inflammation
-goes into macrophages and travels in the lymph system
-causes granulomas with caseating necrosis in reticuloendothelial organs (i.e.
lymph nodes)
-regional lymphadenopathy

TX: Streptomycin (aminoglycosides)

Pasteurella multocida
-catalase positive
-oxidase positive
-capsule is important virulence factor
-grows on 5% Sheep blood agar
-demonstrates bipolar staining, described as "safety pin" staining (like yersenia)
-found in the respiratory tract of small animals like cats and dogs
-transmission by dog and cats bites
-cellulitis may occur within first 24 hours of infection
-infection may spread to bone and cause ostemyelitis
TX: penicillin is empiric treatment + beta lactamase inhibitor to prevent
resistance (so can use amoxicillin + clavulanic acid)
Mycobacterium tuberculosis
-acid fast stain
-Mycolic acids
-carbol fushon stain
-TB grows on Lowenstein-Jensen medium
-obligate aerobe (like nocardia)
-transmission by respiratory droplets primarily residing and living in
macrophages
-cord factor (serpentine shape) activates immune system to activate
macrophages so it can be walled off by a granuloma - VIRULENCE FACTOR
-sulfatides prevent phagolysosome fusion
-primary infection infects the middle or lower lobes of the lungs; hilar lymph
node involvement
>GHON COMPLEX = hilar lymphadenopathy + peripheral granulomatous
lesion in middle or lower lung lobe
-necrotic macrophages

-after primary infection:

1) healed latent infection
-primary TB in children often resolves and becomes latent infection and
fibrosis
-positive PPD skin test
-BCG vaccine can cause a false positive PPD skin test
2) systemic infection (miliary TB)
-miliary means it can go to multiple organs; potentially lethal
3) reactivation TB
-TNFa inhibitors (neutralized TNFa) ->uncontained infection
>like inflixamab
-when reactivated affects the UPPER LOBES
-symptoms of reactivation: cough, night sweats and hemoptysis
-TNFa promotes wasting
-POTTS disease (vertebrae) demineralized bones
-CNS: cavitary lesion or tubulerculoma

TX:
R- RIFAMPIN
I- ISONIAZID
P- PYRAZINAMIDE
E- ETHAMBUTOL

prophylaxis for latent TB for 9 months:

R- RIFAMPIN
I- ISONIAZID
Mycobacterium leprae -
-thrives in cool temperatures explaining predilection for extremities
-acid fast bacteria
-Mycolic acids
-carbol fushon stain
-armadillo is main reservoir in US
-leprosy also known as Hansen's disease

Tuberculoid
-Tuberculin response
-TH1 response with cell mediated immunity
-can contain bacteria within macrophages
-symptom: include well demarcated hairless lesion on skin
-positive Lepromin skin test demonstrates good cell mediated response
-generally well controlled

Lepromatous
-Lepromatous response
-TH2 response humoral response
-bacteria unable to be contained by macrophages
-human to human transmission
-symptoms: symmetric glove and stocking neuropathy
-poorly demarcated raised lesions on extensor surfaces of extremities
-profound facial deformity described as "Leonine facies"

tx:
Tuberculoid needs Dapsone and Rifampin for 6 months
Lepromatous needs Dapsone and Rifampin + Clofazimine FOR 2-5 YEARS
Borrelia burgdorferi
-Northeastern US
-wooden areas
-transmitted by tick bite
-Ixodes scapularis - tick
-mouse reservoir: (host of the tick larvae)
-deer obligatory host: (host of adult tick)
-tick is the vector
-humans are incidental host
-dont gram stain
-Giemsa stain and Wright stain

LYME disease
-stage 1: erythema migrans (within 1 month of tick bite) "bull's eye rash"
>flu like symptoms
-stage 2: heart block caused by mycocarditis
>Bilateral bells palsy
-stage 3: arthritis of large joints (knee) - migratory polyarthritis
>CNS: memory difficulty, encephalopathy. TX: doxycycline in early
stages ceftriaxone for more severe or lateral diseases
Leptospirosis -
-SPIROCHETE small thin and spiral shaped
-commonly associated with water sports
-found in water contaminated with animal urine
-fever occurs in early disease
-conjunctival suffusion, redness around the eyes (without pus)
-Weils disease
-travels through the blood stream and affects multiple organs
-renal dysfunction and jaundice from liver infection
Proteus mirabilis
-gram negative
-facultative anaerobe
-when plated demonstrates swarming motility
-staghorn calculi kidney stones
-urease positive whats responsible for forming staghorn calculi and creating
alkaline environment
-alkaline environment can cause struvite stones formation
-may cause UTI
-FISHY ODOR

-TREATMENT: sulfonamides
Pseudomonas
-gram negative ROD
-encapsulated
-#1 cause of gram neg nosocomial pneumonia
-MCC of respiratory failure in CF patients
-osteomyelitis in IVDU and diabetics
-thrives in aquatic environments
-OXIDASE positive AND MOTILE (according to UWORLD)
-Catalase positive
-blue/green pigment when plated (pyocyanin and pyoverdin)
-fruity grape like odor
-obligate aerobe
-BURN patients infections
-nosocomial UTI
-undercloronated hot tubs - hot tub fasciculitis
-ECTHYMA GANGRENOSUM- black necrotic lesions on skin
-otitis externa (swimmers ear)
-exotoxin A (diptheria toxin have identical toxins) inactivates by ribosylation
target elongation factor 2

Treatment: piperacillin (With tazobactam) and aminoglycosides (in combo with

beta lactam antibiotics) and FQ (UTI)
Treponema Pallidum -
-SYPHILIS
-SPIROCHETE. May be described as spiral shaped
-STD
-DARKFIELD microscopy needed for direct visualization, taken from direct
sample from a lesion of a pt
-VDRL is screening test (checking for antibody)
-RPR rapid plasma reagent
-mono, Rheumatoid factor, SLE, leprosy , IV drug user = can cause false
positives
-FTA-Ab (ab directly against t. pallidum) is specific test to confirm positives
screening result
-early stages: (first year) primary, secondary and early latent
primary: PAINLESS genital chancre (bacteria damages small vessels and
nerves taken out with necrosis) heals within 3-6 weeks, if not treated progresses
secondary: systemic disease; maculopapulary rash occurs on palms and soles
weeks to months after infection; condyloma latum on mucous membranes;
visualize spirochetes within condyloma latum on darkfield microscopy
-late stages: tertiary and late latent
tertiary: formation of gummas- soft growths within firm necrotic center that can
occur anywhere; ascending thoracic aneurysm - tree barking appearance
(destroys vasa vasorum that supplies aorta with blood- weakening of the aortic
wall); tabes dorsalis (damage to posterior columns of spinal cord) loss of
vibration sense, proprioception and descriptive touch; Argyll Robertson pupils
reacts to accommodation but NO REACTION TO LIGHT (prostitutes pupil)
-congenital syphilis: saber shins (anterior bowing of the tibia), saddle shaped
nose, hutchinson's teeth and mulberry molars, deafness
Treatment: PENICILLIN in every stage and in everyone, desensitize and use
penicillin if they are allergic, even in pregnant pts
-JARISCH-HERXHEIMER reaction may occur hours after treatment- dying
spirochetes release LPS releasing cytokines, causing fever and chills
Chlamydia trachomatis -
Chlamydia pneumoniae
Chlamydia psittaci
-obligate intracellular bacteria
-lack of staining with gram staining
-lack of muramic acid in cell wall
-1st stage: elementary stage
-2nd stage: reticular body active form that can multiply

elementary body is the infectious form "elementary enters"

reticular body is active dividing form "reticular body replicates"

-inclusion bodies visible within cells under microscope (a bunch of reticular

bodies)
-Giemsa stain to be visualized
-NAAT nucleic acid amplification test to diagnose (PCR)

Chlamydia trachomatis
A-C: blindness
-leading cause of blindness worldwide
-transmitted by hand to eye contact or fomites
D-K: STI
-characterized by WATERY discharge
-infection if left untreated can lead to pelvic inflammatory disease (PID)
-newborns born to infected mothers can develop neonatal conjunctivitis and
pneumonia (these babies will present later 1-2 weeks later)
L1-L3: LGV
>lymphogranuloma venereum characterized by tender inguinal
lymphadenopathy

reactive arthritis or Reiters syndrome

-uveitis, urethritis, arthritis
-"cant see, cant pee, cant climb a tree"

Chlamydia pneumoniae
-causes atypical pneumonia "walking pneumonia" in elderly

Chlamydia psittaci
-also causes pneumonia transmitted by bird droppings

TX: macrolides such as azithromycin

oral macrolides effective against trachoma
tetracyclines (doxycycline) also effective
coinfection with gonorrhea (treat ceftriaxone for this coverage)
Neisseria
-gram negative diploccoci
-oxidase positive
-heat blood agar = chocolate agar allows neisseria to grow because it inhibits
enzymes that would prevent growth
-VPN agar (vancomysin, polymixin and nystatin)
-thayer martin agar another name for VPN agar
-C5-C9 deficiency (complement deficiency) are unable to form MAC complex
leading to increased infections
-pili (fimbriae) demonstrate antigenic variation
-IgA protease - cleaves IgA at hinge region

Neisseria meningitidis
-colonizes nasopharynx first and transmitted by respiratory secretions and then
spreads hematogenously
-LOS envelope proteins cause inflammatory response
-inflammation leads to leaky capillaries
-characterized by petechial rash (indicator of thrombocytopenia)
-capillary leakage can lead to hypovolemia and shock
-Waterhouse-Friderichsen syndrome, characterized by hemorrhage of adrenals
-only meningitis ferments maltose but both ferment glucose
-polysaccharide capsule inhibits phagocytosis
-vaccine contains polysaccharide capsule - except type b not included in
vaccine
-sickle cell and asplenic pts at higher risk of infection because its encapsulated
-TX: CEFTRIAXONE; close contacts prophylaxis RIFAMPIN

Neisseria gonorrheae
-STD
-facultative intracellular likes to invade PMNs
-NO capsule
-in men -> urethritis and prostatitis
-in women -> PID can cause scarring leading to infertility or ectopic
pregnancies
-PID can spread to peritoneum - Fitz Huge Curtis Syndrome; "violin string"
adhesions form to capsule of liver
-both men and women characteristic white purulent discharge (thick)
-asymmetric arthritis commonly at knee
-purulent synovial fluid that doesnt gram stain (because its intracellular)
-early purulent neonatal conjunctivitis can happen within days
TX: CEFTRIAXONE for gonorrheae (coinfection with chlamydia is with
azithromycin or doxycycline)
Clostridium perfringens -
-infection associated with motorcycle accidents and military combat wounds
-SPORE FORMING can be found in soil and dirt
-obligate ANAEROBE - need to plate it in anaerobe environment
-soft tissue infection GAS GANGRENE (gas is produces gas under tissue as it
eats carbohydrates- crepitus)
-myonecrosis involves alpha toxin or lecithinase that cleaves lecithin that is a
phospholipase and causes damaged to cell membranes by damaging
phospholipids
-lecithinase can cause RBC hemolysis
-double zone of hemolysis when plated on blood agar
-TX IS IV PENICILLIN G

food poisoning diarrhea

-large amount of spores which germinate in the gut that produce toxin so it is
slow onset -> watery diarrhea
-transient and self resolves
Clostridium tetani
-gram POSITIVE
-obligate anaerobe (cant survive in presence of oxygen)
-all SPORE formers

-spores found in rusty nails and in soil

-SPASTIC paralysis
-RISUS SARDONICUS "evil grin" or Lock Jaw symptoms
-opisthotonus-exaggerated arching of the back due to spastic exaggeration of
back muscles
-spores are embedded in the flesh where it produces and releases tetanus toxin
(which causes the symptoms) travels RETROGRADE through motor neurons
from periphery to the spinal cord
-tetanus toxin acts as protease which cleaves SNARE protein inhibiting release
of GABA and Glycine (inhibitors) so it inhibits inhibitors ->uncontrolled firing
of the neurons and spasms
-GABA and Glycine released from Renshaw cells is inhibited

vaccine is TOXOID (toxin conjugated to protein)

Clostridium botulinum -
-gram POSITIVE
-obligate anaerobe (cant survive in presence of oxygen)
-all SPORE formers

-transmitted by improper canning of food (when you hear multiple family

members developing neuro symptoms)
-DESCENDING FLACCID paralysis (absence of muscle contraction) -
(opposite of guillain barre syndrome which is ascending paralysis)
-early symptoms included ptosis and diplopia
-adults get PREFORMED toxin only effects PNS (not able to cross BBB)
-toxin targets nerves that release acetylcholine (excitatory) so inhibiting
excitatory causing flaccid paralysis
-toxin is a protease that cleaves SNARE proteins

in babies = flaccid paryalsis "floppy baby syndrome"

-SPORES germinate and produce toxin in the baby
-infantile botulism transmitted through injections of honey -so thats why you
dont give honey to infants (spores in the honey)
Clostridium difficile -
-SPORE former like all clostridium species
-obligate anaerobe and gram positive
-nosocomial diarrhea
-spores are removed with soap and water and cant compete well with normal
flora- but antibiotics kill normal flora
-antibiotics like CLINDAMYCIN can kill normal flora and poor hand washing
can cause c.diff infections
-exotoxin A and B
-exotoxin A binds to brush border enzymes causes inflammation, cell death and
WATERY diarrhea
-exotoxin B causes depolymerization of actin filaments causes
pseudomembrane formation, enterocyte death and necrosis
-assay (like PCR) to detect TOXIN in the stool, not the actual bacterial - to see
if its the cause of diarrhea
-nurses can detect this by smell alone
-TREATMENT: ORAL VANCOMYCIN and METRONIDAZOLE
Corynebacterium diphtheriae-
GRAM POSITIVE
-CLUB shaped
-metachromatic granules
-V or Y formation
-exotoxin A (active) and B (binding)
-toxin causes ADP ribosylation of elongation factor 2 (EF2) which inhibits
ribosome function and inhibit protein synthesis ->cell death
-pseudomembranes formation (throat and tonsils)
-RESPIRATORY DROPLET spread
-"bulls neck" due to lymphadenopathy
-cardiotoxic effects (myocarditis, arrhythmia, heart block)
-damages myelin of nerve fibers
-plated on tellurite agar and Loeffler's medium to culture
-Elek's test
-often immigrants get this because can be vaccinated (toxoid- inactivated
exotoxin bound to protein)
-passive immunization by administrating anti-toxoid if pt presents with
symptoms
Actinomyces israelii-
gram POSITIVE branching (filamentous) rod
-obligate anaerobe
-normal flora of the oral cavity
-infection happens with jaw trauma (like dental procedure)
-cervical facial actinomyces
-formation of sinus tracts that drain pus of yellow sulfur granules
TX: penicillin G and surgical drainage (for more complicated infections)
Coxiella burnetii -
cause of Q fever
-pneumonia, headache, cough and fever
-MAY CAUSES HEPATITIS
-gram negative
-no rash
-once classified as rickettsia species
-obligated intracellular organism
-forms a spore structure that can survive in the GI of animals
-contained in spore like structure in animal poop
-transmitted to humans in aerosol transmission
-immunocompromised can cause endocarditis
-vets can receive an acellular vaccine- may transmit by birthing a baby animal
-pasteurized milk can kill most organisms

treatment - self limiting and goes away in 2 weeks