MICROBIOLOGY - Food poisoning: 1-6 hours

Post-Midterm Topics 6. SIGNS AND SYMPTOMS:

​Food poisoning:
VI. Bacteria and their Disease Process: - Nausea
A. Cocci - Vomiting
1. GRAM POSITIVE - Diarrhea
a. S. Aureus - loss of appetite
- severe abdominal cramps
1. DESCRIPTION: - mild fever
- Non-moving ​Toxic shock syndrome
- Round and grape like clusters - high fever
- one of the five most common causes of - Nausea and vomiting
infections after injury or surgery - Rash on your palms and soles that
resembles sunburn
- discovered by the surgeon Sir Alexander
- Confusion
Ogston in Aberdeen, Scotland in 1880 - Muscle aches
- Classic opportunist - Diarrhea
POTENTIAL VIRULENCE FACTORS:: - Abdominal pain
- Has surface proteins that promote
colonization of host tissues Skin infections
- Inhibits phagocytosis - ​Inflammation​ with redness, warmth,
- Has toxins ​(hemolysin/leucocidin​)​ ​that swelling, and pain
damage host tissues and cause disease - skin sore or ulcer
symptoms - If the staph infection spreads: fever,
PATHOGENICITY: sometimes with chills and sweats
- produces rash on hands / feet methicillin-resistant staphylococcus aureus
- Skin Infection infections
- Toxic Shock Syndrome
- Warm to the touch
- Food poisoning
- Nosocomial infections - Full of pus or other drainage
2. PORTAL OF ENTRY - Accompanied by a fever
- Breakage in skin - can quickly turn into deep, painful
- Usually found on the skin, nose, and abscesses that require surgical draining
respiratory tract - can also burrow deep into the body, causing
- Can enter and spread through the potentially life-threatening infections
bloodstream
7. TREATMENT/NURSING MANAGEMENT
3. PORTAL OF EXIT
​Food poisoning:
- Direct from skin contact with infected areas
- Encourage fluid intake of 1.5 to 2.5 liters/24
- nasal secretions / buccal secretions
hour plus 200 ml for each loose stool in
4. MODE OF TRANSMISSION:
adults unless contraindicated
- direct contact with an infected person
- Encourage the client to restrict the intake of
- using a contaminated object
caffeine, milk and dairy products
- inhaling infected droplets
- Teach client about the importance of hand
5. INCUBATION PERIOD:
washing after each bowel movement and
- The incubation period is variable and
before preparing food for others
indefinite. It is most commonly 4–10 days.
- Antibiotics
*perform hand hygiene - Red and swollen tonsils, sometimes with
white patches or streaks of pus
- Tiny red spots on the area at the back of the
b. S. Pyogenes (GRP A.)
roof of the mouth (soft or hard palate)
1. DESCRIPTION: - Swollen, tender lymph nodes in your neck
- contains the Lancefield group A antigen on - Fever
their cell surface
- Headache
- grows in chains and causes numerous
infections in humans - Rash
- Usually pathogenic (opportunistic bacteria) - Nausea or vomiting, especially in younger
- Part of normal flora children
- Nonmotile
- Body aches
- aerobic
PATHOGENICITY/TOXICITY: Scarlet fever
- it can cause streptococcal sore throat - pink-red rash
- Scarlet fever - Fever
- Impetigo - a red, sore throat, sometimes with white or
- Pneumonia
yellowish patches
- necrotizing fasciitis
- a fever of 101 Fahrenheit (38.3 Celsius) or
2. PORTAL OF ENTRY
- Breakage in skin higher, frequently with chills.
- Usually found on skin and mucous - A rash appears 12 to 48 hours after these
membranes first symptoms
3. PORTAL OF EXIT - Red blotches appear on the skin. These
- Direct from skin contact with infected areas turn into a fine pink-red rash that looks like
- nasal secretions / buccal secretions sunburn. The skin feels rough when
4. MODE OF TRANSMISSION: touched, like sandpaper.
- direct contact with an infected person - Patient cheeks is flushed
- using a contaminated object
- inhaling infected droplets Type II necrotizing fasciitis
5. INCUBATION PERIOD: - pain in the affected area
- usually 1-4 days - Swelling
Period of communicability: 24–48 hours
- group A strep pharyngitis is approximately 2 to - Erythema
5 days. - Tenderness
- scarlet fever is approximately 2 through 5
days. - Heat

- Spread within subcutaneous tissue with

6. SIGNS AND SYMPTOMS:
​Strep throat: relative sparing of the overlying skin
- Throat pain that usually comes on quickly
- Absence of lymphadenitis and lymphangitis
- Painful swallowing
- Swelling progresses to brawny edema and
then to dark-red induration
 - Within 24 to 48 hours, the overlying skin
may turn dusky, indicating small vessels in
the dermal papilla have thrombosed
- Cutaneous ischemia also develops
- Bullae form and are filled with straw colored
fluid that progressively turns to hemorrhagic
fluid
- affected tissues progressively darken from
red to purple to blue to black
- As gangrene sets in, skin becomes
anesthetized due to destruction of
superficial nerves
7. TREATMENT/NURSING MANAGEMENT
- Proper hand hygiene
- Instruct people to wash their hands regularly
and to get new toothbrushes for the infected
person and anyone else who keeps her
toothbrush near his.
- Antibiotics
c. S. Pneumonia
1. DESCRIPTION:
- catalase-negative organism commonly
referred to as pneumococcus
- non motile organisms
- the leading cause of acute lower respiratory
tract infections
INVASIVE: bacteraemia (mild blood infection),
septicaemia (blood poisoning), osteomyelitis, septic
arthritis, pneumonia, meningitis
NON-INVASIVE: bronchitis, otitis media, sinusitis
2. PORTAL OF ENTRY
- if inhaled can cause pneumonia
- if enters the G.I. Tract, no disease
3. PORTAL OF EXIT
- nasal secretions / buccal secretions
4. MODE OF TRANSMISSION:
- ​person-to-person by direct contact with
respiratory secretions, like saliva or mucus
5. INCUBATION PERIOD:
- can occur within 1-3 days after exposure
6. SIGNS AND SYMPTOMS:
​Pneumonia
- Chest pain when you breathe or cough
- Confusion or changes in mental awareness
(in adults age 65 and older)
- Cough, which may produce phlegm
- Fatigue
- Fever, sweating and shaking chills
- Lower than normal body temp. (in adults
other than 65 and people with weak immune
system)
- Nausea, vomiting or diarrhea
- Shortness of breath
7. TREATMENT/NURSING MANAGEMENT
- Antibiotics
- washing your hands regularly and
disinfecting frequently touched surfaces.
- Making healthy choices, like quitting
smoking and managing ongoing medical
conditions, can also help prevent
pneumonia.
2. GRAM NEGATIVE
a. Neisseria Meningitides
Members of the genus Neisseria are:
- aerobic
-gram-negative cocci
-typically arranged in pairs (diplococci)
-adjacent sides flattened together (resembling
coffee beans).
1. DESCRIPTION:
· Gram-negative oval or spherical cocci
(0.6-0.8 μm in size)
· typically arranged in pairs
· the adjacent sides are flattened or concave
opposing edges and the long axes are parallel
· non-sporing and nonmotile
· Has a capsule that protects them from
phagocytosis as they replicate in the bloodstream
then enter the CSF
2. PATHOGENICITY:
 ● Meningococci are strict human parasites
inhabiting the nasopharynx. Infection is
usually asymptomatic.
● Symptoms are mostly caused by endotoxins
● Initial symptoms: fever, headache, stiff
neck, convulsions, coma
3. MODE OF TRANSMISSION:
● Direct Contact and airborne droplets
● Close contact with infectious person
● Family members
● Daycare centers
● Military barracks
● Prisons
● Other institutional settings
4. INCUBATION PERIOD:
● 2-10 days
5. SIGNS AND SYMPTOMS:
Infants
- Fever, possibly with cold hands and feet
- Refusing feeds or vomiting
- High pitched moaning cry or whimpering
- Dislike of being handled or fretful
- Neck Retraction with Arching of back
- Blank and sterling expression
- Child is difficult to wake, lethargic
- Pale, blotchy complexion
In other children and adults:
- High temperature, fever possibly with cold
hands and feet
- Vomiting, sometimes diarrhea
- Severe headache
- Joint or muscle pains, sometimes stomach
cramps
- Neck stiffness (unable to touch the chin to
the chest)
- Dislike of bright lights
- Drowsiness
- The patient may be confused or
disorientate. Seizures may also be seen
- A rash may develop
- Fitting
6. STAGES OF INFECTION:
I. Nasopharyngeal Infection
● The organisms appear in nasopharynx
leading to nasopharyngeal infection- may
result in a minor inflammation.
● induces the formation of protective
antibodies within a week, even though the
infection remains asymptomatic.
● Dissemination occurs only in a small
proportion.
II. Meningococcal Septicemia
● the meningococci enter the bloodstream
from the posterior nasopharynx through the
cervical lymph nodes where they rapidly
multiply (meningococcemia).
● patient develops fever, malaise and
petechial skin lesions due to foci of infection
in the capillaries.
● The organisms may also cause lesions in
the joints and lungs
● characterized by shock, disseminated
intravascular coagulation (DIC) and
multisystem failure.
● The hemorrhagic lesions occurring in both
the skin and the internal organs, particularly
the adrenals, are from the release of
endotoxin.
III. Meningitis
● the organisms can ​cross the blood-brain
barrier ​and infect the meninges, causing
the major symptoms of severe headache,
stiff neck, and vomiting accompanied by
delirium and confusion.
● The route of spread from the nasopharynx
to the meninges may be directly along the
perineural sheath of the olfactory nerve​,
through the ​cribriform plate to the
subarachnoid space​, or more probably,
through the ​bloodstream​. In certain cases,
the site of entry of the meningococcus may
be the conjunctiva.
● On reaching the central nervous system, a
suppurative lesion of the meninges is set
up, involving the surface of the spinal cord
and the base and cortex of the brain.
 ● The cocci are invariably found in the spinal o Anal itching, discomfort, bleeding, or
fluid, both free and within the leukocytes. discharge
o Abnormal vaginal discharge
7. TREATMENT/NURSING MANAGEMENT o Abnormal vaginal bleeding during or after
● Health Education sex or between period
● Laboratory Diagnoses o Genital itching
● Penicillins and cephalosporins are usually o Irregular menstrual bleeding
the first choice of antibiotics o Lower abdominal (belly) pain
● They limit the spread of an outbreak if they o Fever and general tiredness
do not affect the outcome o Swollen and painful glands at the opening of
● A patient returning home as a carrier may the vagina (Bartholin glands)
still infect others. o Painful sexual intercourse
o Sore throat (rare), Pinkeye (conjunctivitis)
(rare)
b. Neisseria Gonorrhoeae
In men:
o Abnormal discharge from the penis (clear or
1. DESCRIPTION: milky at first, and then yellow, creamy, and
❖ appears as a diplococcus with the adjacent excessive, sometimes blood-tinged)6
sides concave o Painful or frequent urination or urethritis
❖ typically kidney shaped. o Anal itching, discomfort, bleeding, or
❖ Gonococci possess pili on their surface discharge
❖ facilitate adhesion of the cocci to mucosal o Sore throat (rare)
surfaces o Pinkeye (conjunctivitis) (rare)
❖ promote virulence by inhibiting
phagocytosis. Other Symptoms:
o Rash
2. SITE OF INFECTION: o Arthritis
● Male – urethra o Inflamed Tendons
● Female – cervix
Because of the columnar epithelial cells 6. TREATMENT/NURSING MANAGEMENT:
❏ Control of gonorrhea consists of ​early
3. INCUBATION PERIOD: detection of cases, ​contact tracing,​
● The incubation period is 2-14 days. health education
❏ Increased dosage of penicillin, use of
4. MODE OF TRANSMISSION: fluorquinolone antibiotics such as
● Direct contact ciprofloxacin or ofloxacin
I. Close contact with an infected penis, ❏ Barrier methods of contraception, condoms
vagina, mouth, or penis in particular, greatly reduce the rate of
Ii. Can also spread from another to baby transmission.
during delivery ❏ Centers for Disease Control and
Prevention ​(CDC)- Doxycycline or
5. SIGNS AND SYMPTOMS: azithromycin should be added for infections
Prodromal Period complicated by dual infections with
In women: chlamydia.
o Painful or frequent urination
B. Bacilli - Headache
1. GRAM POSITIVE - Loss of Appetite
a. Bacillus Anthracis - Fever
- Severe bloody diarrhea (in late stages of
1. DESCRIPTION:
the disease)
● Gram positive
- Sore throat
● Rod-Shaped
● Responsible for ​ANTHRAX - Dysphagia
- Is a disease that takes only 10 days to kill - Swollen Neck
a person if not properly treated. c. Inhalation Anthrax
- Has 4 types: - Flu-like symptoms, such as sore throat, mild
a. Cutaneous (Skin Anthrax) fever, fatigue and muscle aches, which may
b. Inhalation (Infects the Respiratory last a few hours or days
Tract)
- Mild chest discomfort
c. Gastrointestinal
d. Injection Anthrax - Shortness of breath
2. Portal of Entry: - Nausea
a. Nasal Mucosa - Coughing up blood
- Associated with lymphoid tissue
- Painful swallowing
b. Lumen of Lungs
c. Cuts on the skin - High fever
3. Portal of Exit: - Trouble breathing
a. Direct from skin contact with infected areas - Shock
b. Drainage from open sores
- Meningitis — a potentially life-threatening
4. Mode of Transmission:
a. Air inflammation of the brain and spinal cord
b. Contaminated Food d. Injection Anthrax
c. Direct unprotected contact with infected - Redness at area of Injection
area of a person - Significant Swelling
5. Incubation Period: - Shock
● 1 to 7 days - Multiple Organ Failure
6. Signs and Symptoms: - Meningitis
● Anthrax Symptoms depend greatly on what 7. Nursing Management:
type of anthrax a person has. - Alleviation of Pain and Suffering
a. Cutaneous Anthrax: - Fever is involved, so work to lower the body
- A raised, itchy bump resembling an insect temperature (e.g. Tepid Sponge baths)
bite that quickly develops into a painless - Health Teaching
8. Medical Management:
sore with a black center
- Prescription of Antibiotics
- Swelling in the sore and nearby lymph
glands b. Bacillus Cereus
b. Gastrointestinal Anthrax:
- Nausea 1. DESCRIPTION:
● Gram Positive
- Vomiting
● Rod-Shaped
- Abdominal Pain
 ● Associated in ​FOOD POISONING a. Contaminated Wounds
- Bacillus Cereus Produces Toxin that b. Contact from Soil
causes food poisoning in humans 4. Mode of Transmission
- They are commonly found in rice & - Tetanus is generally not a communicable
leftovers (& contaminated food) ​ f humans
disease from ​direct contact o
- Two signs are discernable when although unprotected contact from wounds
differentiating the type of toxin involved: with prominent said bacteria might.
a. Diarrhea Therefore:
b. Nausea & Vomiting - Due to a. Contaminated Wounds
“emetic Toxin” b. Tissue Injury
2. Portal of Entry: 5. Signs and Symptoms:
a. Ingestion ● Jaw cramping.
3. Portal of Exit: ● Sudden, involuntary muscle tightening
a. From Soil (muscle spasms) – often in the stomach.
b. From Contaminated Food ● Painful muscle stiffness all over the body.
4. Mode of transmission: ● Trouble swallowing.
a. If ingested from contaminated food ● Jerking or staring (seizures)
b. When food is exposed to contaminated soil ● Headache.
5. Incubation Period: ● Fever and sweating.
a. 6-15 Hours for diarrhea ● Changes in blood pressure and fast heart
b. 30min - 6 Hours for nausea & vomiting rate
6. Signs & Symptoms 6. Nursing Management:
● Can either be diarrhea or Nausea & a. Alleviation of Pain & Suffering
Vomiting b. Make sure that the patient does not injure
7. Nursing Management: himself when having convulsions
a. Alleviation of Pain & Suffering c. Wound Care and aseptic procedures
b. Making sure patient is hydrated d. Health Teaching
c. Health Teaching 7. Medical Management:
8. Medical Management: a. Medications to control muscle spasms such
a. Administration of medication & antibiotics as ​chlorpromazine or diazepam
b. Administering Injection shots for antitoxins
c. Clostridium Tetani
d. C. Perfringhens
1. DESCRIPTION: e. C. Botulinum
● Gram Positive f. C. Diphtheria
● Anaerobic bacteria
● Found in the Soil
● Responsible for ​TETANUS 2. GRAM NEGATIVE ASSOC. W/ ENTERIC
- Also known as ​“Lockjaw” TRACT
- Convulsive - Spasms of skeletal muscles
- Manifested out of two exotoxins: 3. GRAM NEGATIVE ASSOC. W/ RESPIRATORY
a. Tetanolysin DISEASE
b. Tetanospamin (neurotoxin)
2. Portal of Entry: 4. GRAM NEGATIVE ASSOC. W/ NOSOCOMIAL
a. Openings of wounds INFECTION
3. Portal of Exit:

C. Acid-Fast Bacteria
D. Spirochetes
1. Treponema Pallidum
A. Treponema pallidum pallidum
1. Description
● Causes syphilis
● Pandemic, involving young people
between 20-35 years old
2. Portal of Entry
● The portal of entry must provide
access to tissues in which the
pathogen can multiply or a toxin can
act. Often, infectious agents use the
same portal to enter a new host that
they use to exit the source host.
3. Portal of Exit
● Syphilis portal of exit is via open
areas caused by disease. These
areas commonly appear on external
genitals, in the vagina and in the
rectum.
4. Mode of Transmission
● By direct contact with skin lesions,
mucous membranes, body fluids and
secretions (semen, vaginal
discharge, saliva, blood) of infected
persons during sexual contact
● rarely by kissing, blood transfusion;
congenital transmission is possible
5. Incubation Period
● From 10 days to 3 months; usually 3
weeks
6. Signs and Symptoms
● P​rimary symptoms- ​The symptoms
of primary syphilis are one or many
painless, firm, and round syphilitic
sores called chancres. These
appear ​about 3 weeks​ after
exposure. ​Chancres disappear
within 3 to 6 weeks, but, without
treatment, the disease may progress
to the next phase.
● Secondary symptoms- ​a non-itchy
rash that starts on the trunk and
spreads to the entire body, including
the palms of the hands and soles of
the feet. It may be rough, red, or
reddish-brown in color; oral, anal,
and genital wart-like sores; muscle
aches; fever; sore throat; swollen
lymph nodes; patchy hair loss​;
headaches; ​weight loss; fatigue.
These symptoms can resolve a few
weeks after they appear, or they can
return several times over a longer
period. Untreated, secondary
syphilis can progress to the latent
and late stages.
● Latent syphilis- ​The latent phase
can last several years. During this
time the body will harbor the disease
without symptoms​. After this, tertiary
syphilis may develop, or the
symptoms may never come back.
However, the ​T. pallidum​ bacteria
remain dormant in the body, and
there is always a risk of recurrence.
Treatment is still recommended,
even if symptoms are not present.
● Late or tertiary syphilis- ​Tertiary
syphilis can occur 10 to 30 years
after onset of the infection, normally
after a period of latency, where there
are no symptoms. Symptoms
include: damage to the heart, blood
vessels, liver, bones, and joints;
gummas, or soft tissue swellings that
occur anywhere on the body. Organ
damage means that tertiary syphilis
can often be fatal.
● Neurosyphilis- ​Neurosyphilis is a
condition where the bacteria has
spread to the nervous system. It is
often associated with latent and
tertiary syphilis, but it can appear at
any time after the primary stage. It
may be asymptomatic for a long
time, or it can appear gradually.
Symptoms include: dementia or
altered mental status; abnormal gait;
 numbness in the extremities;
problems with concentration;
confusion; headache or seizures;
vision problems or vision loss;
weakness.
● Congenital syphilis- ​Congenital
syphilis is severe and frequently
life-threatening. Infection can
transfer from a mother to her fetus
through the placenta, and also
during the birth process. Data
suggests that without screening and
treatment, 70 percent of women with
syphilis will have an adverse
outcome in pregnancy. Adverse
outcomes include early fetal death,
preterm or low birth weight, neonatal
deaths, and infection in infants.
Symptoms in newborns include:
saddle nose, in which the bridge of
the nose is missing; fever; difficulty
gaining weight; a rash of the
genitals, anus, and mouth; small
blisters on the hands and feet that
change to a copper-colored rash and
spread to the face, which can be
bumpy or flat; watery nasal fluid.
Older infants and young children
may experience: Hutchinson teeth,
or abnormal, peg-shaped teeth;
bone pain; vision loss; hearing loss;
joint swelling; saber shins, a bone
problem in the lower legs; scarring of
the skin around the genitals, anus,
and mouth; gray patches around the
outer vagina and anus. In 2015, the
WHO confirmed Cuba as the first
country in the world to have fully
eradicated congenital syphilis.
7. Nursing Management
● Educate people about safe sex,
especially the use of condoms
● Inform people about syphilis and
how to prevent it
● Refrain the infected person from
sexual activity until infection is gone
8. Treatment / Medical Management
● Penicillin remains the drug of choice
for treating syphilis. In
non-penicillin-allergic patients
without central nervous system
involvement, infection is usually
treated with benzathine penicillin G,
a long-acting penicillin preparation
which produces treponemicidal
levels in serum for up to ten days.
Penicillin-allergic, nonpregnant
patients with early syphilis can be
treated with tetracycline.
Penicillin-allergic, pregnant patients
and patients with neurosyphilis must
be desensitized to penicillin because
of the lack of effective alternative
therapies.
B. Treponema pallidum pertenue
1. Description
● Causes yaws
● Endemic and occurs in humid
equatorial countries
2. Portal of Entry
● Skin
3. Portal of Exit
● Skin of infected person
4. Mode of Transmission
● Yaws is transmitted mainly
through direct skin contact with
an infected person.
5. Incubation Period
● 9-90 days, average of 21 days
6. Signs and Symptoms
● In early yaws, an initial papule
develops at the site of entry of the
causative organism. This papule
is full of the organisms and may
persist for 3-6 months followed by
natural healing. Without
treatment, this is followed by
disseminated skin lesions over
 the body. Bone pain and bone stages, soft, gummy lumps
lesions may also occur. (gummas) appear on the roof of the
● Late yaws appears after five mouth and in the nasal passages.
years of the initial infection and is ● Other symptoms may include
characterized by disabling swollen glands or lymph nodes
consequences of the nose, bones (lymph-adenopathy), and/or skin
and palmar/plantar ulcerations under the arms or
hyperkeratosis. around the rectum and groin.
7. Nursing Management 7. Nursing Management
● Educate people about the ● Health education
importance of personal hygiene and ● Advice people to improve living and
cleanliness sanitation
8. Treatment / Medical Management 8. Treatment / Medical Management
● Either of 2 antibiotics – azithromycin ● Either of 2 antibiotics – azithromycin
or benzathine penicillin or benzathine penicillin
C. Treponema pallidum endemicum
1. Description 2. Leptospira Interrogans
● Causes bejel 1. Description
● Endemic syphilis ● Causes leptospirosis
● Endemic and occurs in arid ● Pandemic
countries 2. Portal of Entry
2. Portal of Entry ● break in skin, mucosa, or
● Broken skin and mouth conjunctiva
3. Portal of Exit 3. Portal of Exit
● Direct contact with broken skin or ● Animal urine
contaminated hands 4. Mode of Transmission
● Contaminated drinking vessels and ● Contact of the skin or mucous
eating utensils membranes with contaminated
4. Mode of Transmission water, soil or vegetation;
● In bejel, transmission is by direct ● direct contact with urine or tissues of
contact, with broken skin or infected animals;
● occasionally through ingestion of
contaminated hands, or indirectly by
contaminated food or by inhalation
sharing drinking vessels and eating of droplet aerosols of contaminated
utensils. fluids
5. Incubation Period 5. Incubation Period
● 21 days ● Usually 2 days to 4 weeks
6. Signs and Symptoms 6. Signs and Symptoms
● At the outset, children with bejel ● High fever
have patchy, slimy, ulcerations ● Headache
(lesions) on the mucous ● Chills
membranes, particularly in or near ● Muscle aches
the mouth. Later, blisters appear on ● Vomiting
the back, arms, and legs. Further ● Jaundice (yellow skin and eyes)
disease progression is indicated by ● Red eyes
infections of the bones, especially ● Abdominal pain
those of the legs. In these later ● Diarrhea
 ● Rash
Leptospirosis may occur in two phases:
● After the first phase (with fever,
chills, headache, muscle aches,
vomiting, or diarrhea) the patient
may recover for a time but become
ill again.
● If a second phase occurs, it is more
severe; the person may have kidney
or liver failure or meningitis.
7. Nursing Management
● Inform people to avoid swimming or
wading in water that may be
contaminated with animal urine.
● Hand hygiene teaching
8. Treatment / Medical Management
● Various antibiotics usually clear ​L.
interrogans depending on the gravity
of the infection (e.g penicillin (or
penicillin G), doxycycline, ampicillin
and amoxicillin). A few new
antibiotics are being tested (e.g
cefepime, ertapenem, norfloxacin).

E. Other minor bacteria-like pathogens