Module 6 Microbiology

Microbiology is the study of microorganisms !

which are large and diverse group of k. Robert Koch!
microscopic organisms that can occur as • 1st microorganism: G(+) aerobic
either single cell or in cluster arrangement, microorganism Bacillus anthracis (DOC:
including the viruses which are microscopic Ciprofloxacin)!
but acellular. ! !
! !! Koch’s Postulates:!
HISTORY! !
! ! 1. C a u s a t i v e A g e n t - t h e s u s p e c t e d
a. Anton van Leeuwenhoek! ! microorganism must be present in all stages
• Father of Microbiology! ! of the disease!
• developed the first simple microscope! ! 2. Pure Culture media - identifies the
• 1st Sample: feces (Giardia lamblia) ! ! suspected microorganism; the suspected
! ! microorganism must be grown in a pure
b. Robert Hooke ! ! culture media!

• Father of Cytology! ! 3. H e a l t h y H o s t - t h e s u s p e c t e d

! ! microorganism must cause the same

c. John Needham! ! disease when introduced to a healthy host!

• Spontaneous Generation Theory or ! 4. D i s e a s e H o s t - t h e s u s p e c t e d

microorganism when inoculated from the
Theory of Abiogenesis! ! disease host, must be the same
• non-living things can give rise to living ! microorganism
organisms! !
! l. Edward Jenner!
d. Aristotle! • developed the vaccine for small pox!
• small invertebrates can give rise to !
living organisms! m. John Enders!
! • first person who artificially cultured
e. Francesco Redi! viruses (lead to the mass production of
• first opponent of the Theory of vaccines)!
Abiogenesis! !
• proposed: Theory of Biogenesis where n. Paul Ehrlich!
only living things can give rise to living • Father of Chemotherapy!
organisms! • discovered Salvarsan aka asphenamine,
! compound 606 or magic bullet!
f. Lazzaro Spallanzani! !
• entry of microorganism can be o. Gerhard Domagk!
prevented by boiling! • discovered Sulfonamides!
! !
g. Louis Pasteur! p. Paul Waksman!
• “pasteurization” - heating at 60C at • discovered Streptomycin!
around 30 minutes! !
• “Swan-Neck Flask Experiment”! q. Alexander Flemming!
! • discovered Penicillin!
h. John Tyndall! • Note: Chain & Florey discovered the
• Tyndallization / moist heat sterilization / clinical use of Penicillin!
intermittent sterilization! !
! TYPES OF MICROORGANISMS!
i. Joseph Lister! !
• Father of Aseptic Technique! Eukaryotes!
• discovered carbolic acid/phenol • Characteristics:!
(phenol coefficient)! • possess true nucleus!
! • enclosed by nuclear membrane!
j. Friedrich Henle! !
• propes: Germ Theory of Disease! 1. Fungi!
! • molds, yeast!

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 • multicellular except yeast (unicellular)! • reproduction: binary fission!
• filamentous! • pathogenic / disease causing!
2. Animals! • lives at temperature 40-45 C!
• parasites! 2. Archaea (Archaebacteria)!
• Endoparasites - helminths, worms! • no cell wall !
• Ectoparasites - insects, arachnids! • non-pathogenic!
3. Plants! • lives in extreme environmental
• Photosynthetic - Algae (Japanese conditions!
Isinglass)! • ex: Thermophiles (>85 C) live in high
• Cell wall - contain chitin (Echinocandin temp environment, Barophiles (live in
- targets chitin ex. Micafungin)! high pressure environment),
4. Protozoans! Methanogens (live in high methane
• unicellular, free-living microorganisms concentration), Halophiles live in high
(endoparasites)! salt concentration.!
***viruses - small intracellular parasites !
(obligate) acellular entities ! Prokaryotic Cell Structure!
! !
Eukaryotic Cell Structure! • Cellular / Plasma Membrane - acts like a
! fluid (fluid mosaic model); phospholipid
• Plasma Membrane (phospholipid bilayer)! bilayer!
• Cytoplasm (composed of fluids and • Cytoplasm - fluid intracellular matrix!
organelles)! • Gas Vacuole* - only found in cyanobacteria;
• Organelles ! function: buoyancy effect!
! • Cytoplasmic Inclusion Bodies - different
• Golgi Apparatus - packaging center; organelles (compartmentalized); primary
post-translational modifications! storage of energy!
! !
• Mitochondria - powerhouse center; • Nucleoid - contains the genetic
oxidative phosphorylation; 1% DNA! material!
! !
• Endoplasmic Reticulum - Rough • Ribosomes - primary site of protein
(ribosomal attachment) Smooth (lipid synthesis (30s, 50s RSU)!
attachment)! !
! • Endospores !
• Ribosomes - site of protein synthesis • only found in Bacillus and
(translation); primary RSU is 80s (60 & Clostridium !
40)! • dormant stage in bacteria’s life cycle!
! • rationale: sense that the
• Nucleus ! environment is depleted with
• composed of genetic material! nutrition!
• Biochemical processes:! • heat resistant; dissociaton resistant!
• DNA Replication ! • ID test: Malachite green (+)VR is
• Transcription! Green (-) si Red!
! • Bacillus - nonswollen spore!
Prokaryotes! • Clostridium - swollen spore!
• Characteristics: ! !
• relatively small in size (>1mcm in • Plasmids - extrachromosomal genetic
diameter)! material found in the cytoplasm (ex. R
• absence of nuclear membrane or true Factor or R Plasmids indicate antibiotic
nucleus and important organelles (ER, resistance)!
mitochondria, golgi apparatus)! !
! • Teichoic Acid !
1. Bacteria (Eubacteria)! • only found in G(+) organisms!
• cell wall: Peptidoglycan (Murein / • primary surface antigen of G(+)!
Mucopeptide) as primary component!

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 • function: responsible for the negative • Axial Filament - used by spirochetes
cell surface; contribute to the for spiral motion!
antigenicity of organism where it !
could stimulate antibody production! ! Spirochetes:!
• 2 Types: Lipoteichoic Acid & !!
Membrane Teichoic Acid! ! 1. Treponema pallidum - causative agent for
! ! syphilis!
• Periplasmic Space - only found in ! 2. Leptospira interrogans - causative agent for
G(-); function is it contains hydrolytic ! leptospirosis!
enzymes (eg B-lactamase)! ! 3. Borrelia burdorferi - causative agent for Lyme
! ! disease!

• Glycocalyx - extracellular ! 4. Borrelia recurrentis - causative agent for

polysaccharide material found outside !! relapsing fever!

the cell! !
! ! ***binary fission is their primary method of

• Capsule - organized structure, firmly ! reproduction

attached to the cell, excludes !

particles; function: bacterial Transfer of DNA!
virulence, can escape 1. Conjugation!
phagocytosis! • transfer of genetic material using
! plasmids!
• Slime layer - unorganized structure, !
loosely attached to the cell, does not 2. Transduction!
exclude particles. function : • bacteriophage mediated transfer of
bacterial attachment.! genetic material!
• ex: Neissereae (DOC: 3rd gen !
Ceftriaxone)! 3. Bacterial Transformation!
! • direct transfer of genetic material from the
! General Rule:! donor cells to the receptor cell!
! a. All cocci are nonencapsulated except: !
! Streptococci! OPTICAL METHODS!
! b. All bacilli are nonencapsulated except:
A. Light Microscope!
! Klebsiella, Haemophilus, Bacillus
!
! 1. Bright field Microscope!
• Cell Appendages:! • magnification: 1000x!
! • Ocular Lens (10x)!
• Flagella - for movement or • Objectives (100x)!
locomotion. highly antigenic • difference in contrast between the
structure (H antigen). its protein unit specimen and surrounding medium!
is flagellin. LAMP:! • killed and stained specimen!
• Lophotrichous - tuft of flagella at !
one end! 2. Phase Contrast Light Microscope!
• Amphitrichous - single polar • provides magnification of living cells
flagella at both ends! which are unstained!
• Monotrichous - single polar !
flagella at one end! 3. Dark Field Light Microscope!
• Peritrichous - flagella all over the • lighting system is just able to reach the
cell! sides of the specimen!
! • ex: Spirochete (Treponema pallidum)!
• Pili - hair-like rigid structure; shorter !
than flagella; twitching movement; only 4. Fluorescent Light Microscope!
found in G(-) organisms! • used for specimen that fluoresce (able
• Ordinary Pili (FImbriae) - for to absorb short wavelengths of light
attachment! and emit long wavelengths naman)!
• Sex Pili - for bacterial conjugation! • used in clinical diagnostic microbiology!

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 • ex: Auramin O - for staining M. E. Capsule Staining!
tuberculosis! • Stains:!
! • hot solution of crystal violet then rinsing
5. Differential Interference Contrast with copper sulfate!
Microscope (DIC)! • India Ink - used for Cryptococcus
• employs a polarizer! neoformans (DOC: Fluconazole)!
• provides a 3D structure of spores, !
vacuoles, granules! F. Nucleoid Staining!
! • Stain: Feulgen stain (sensitive for DNA)!
B. Electron Microscope! !
! G. Spore Staining!
1. Transmission Electron Microscope! • Stain: Malachite green !
• uses an electron beam from an • Carbolfuschin (alt.)!
electron gun, focused by an electron !
condenser into a thin specimen! !
REPRODUCTION
! !
2. Scanning Electron Microscope! STAGES OF MICROBIAL GROWTH!
• provides a 3D structure of microscopic !
surfaces of microorganisms! !
! !
STAINING METHODS! !
! !
A. Gram Staining! !
! !
!
Reagent Function G(+) G(-)
!
Crystal primary Blue-violet Blue-violet !
Violet stain !
Stain !
!
Iodine mordant Blue-violet Blue-violet
!
!
Ethanol decolorizer Blue-violet colorless
!
Safranin counterstain Blue-violet Red/pink !
! !
B. Acid Fast Staining! 1. Lag Phase!
• aka Ziehl-Neelsen staining! • aka Phase of Adjustment!
• 2 Methods: Hot & Cold! • synthesis of important biomolecules!
• susceptible to the action of antibiotics!
• Primary Stain: Carbol Fuschin!
• Modant: heat! !
• Decolorizer: ethanol! 2. Log Phase!
• Counterstain: Methylene Blue / • aka Exponential Growth Phase!
Malachite green ! • double in number at a constant
! maximum rate!
• rapid increase in number of
C. Negative Staining!
• cell or specimen appears colorless! microorganisms!
• accumulation of toxic waste!
! • Primary Stain: Nigrosin!
!
D. Flagella Staining! 3. Stationary Phase!
• Stain: unstable colloidal suspension of • aka Equilibrium Phase!
• cell reproduction = cell death!
tannic acid!
• precipitates in the presence of flagella! !
! 4. Decline!
! ! • cell death > cell reproduction!

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! OCCURRENCE OF INFECTIOUS DISEASE!
STAGES OF INFECTIOUS DISEASE! !
! a. Endemic!
! • number of cases all year round!
! !
! b. Sporadic!
! • scattered number of cases in a certain
! time period and place!
! !
! c. Epidemic!
! • aka outbreak!
! • sudden increase in number of cases in
! a certain time period and place!
! !
! d. Pandemic!
! • sudden increase in number of cases
! from one continent to another (more
! than one continent)!
! !
! !
1. Incubation Period!
CULTURE MEDIA
!
• entry of microorganism into the SIMPLE MEDIA!
systemic circulation! • for nonfastidious microorganism; does not
• pathogenesis period; no signs and require special nutrients!
symptoms! • ex. nutrient agar, nutrient broth!
• but varies depending on the !
characteristic of the organism! ENRICHED MEDIA!
! • for fastidious microorganism; contains
2. Prodromal1 Period! special vitamins & minerals!
• appearance of mild signs and 1. Blood Agar Plate (BAP) - for
symptoms which are not pathognomic microorganisms that require high nucleic
with the disease! acid nutrition!
• eg. fever, headache! 2. Chocolate Agar - for microorganisms that
! require high hemoglobin nutrition (sheep’s
3. ACME Period! blood) ex. Thayer Martin!
• peak of the illness! 3. Milk Agar - for microorganisms that
• appearance of the major signs and require high protein nutrition!
symptoms which are pathognomic with !
the disease! DIFFERENTIAL MEDIA!
! • presence of visible color reaction;
4. Period of Decline! subdivides a large group of microorganisms
• major signs and symptoms subsides! into classifications!
! !
5. Convalescence Period! 1. Blood Agar Plate!
• body is restored to its normal healthy • classify groups of streptococci (G+ in
condition! chains) based on hemolytic reactions!
! • Alpha-Hemolytic - partial hemolysis
! VR=Green!
! • Beta-Hemolytic - complete hemolysis
! VR=Colorless!
! • further classified into Lancefield
! classification:!

1 prodrome - sign that there's an impending disease

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 • Group A: Streptococci pyrogenes S. saprophyticus (most no VR
(pharyngitis)! common cause of UTI
• Group B: Streptococcus agalactiae in sexually active
(most common cause of meningitis)! women)

! • Gamme-Hemolytic - no VR! !
SELECTIVE MEDIA!
2. MacConkey Agar (MCA) & Eosin
Methylene Blue Agar (EMB)!
• allows the growth of one group of
microorganisms and inhibits the other!
• classify enterobacteriaceae whether they
are lactose or non-lactose fermenters!
!
! 1. EMB and MCA !
• both differential and selective media!
MCA EMB !
2. Saboraud Dextrose Agar (SDA)!
Lactose Pink Colonies Metallic sheen
Fermenter green (E.coli)
• selective only for fungal growth!
• provides an acidic pH which is very
Non-lactose N/A N/A suitable for fungal growth (ph5.6)!
Fermenter • fungi are keratophilic/acidophilic!
! !
Classification of Enterobacteriaceae! 3. Colistin-Nalidixic Acid Medium (CNA)!
a. Rapid Lactose Fermenter (EKE)! • selective only for gram positive organisms
only!
• E. coli!
• Klebsiella! !
4. Thayer-Martin !
• Enterobacter spp.!
! • selective for the gram negative diplococci
Neisseriae !
b. Slow Lactose Fermenters (Slow SCAPE of
• modified chocolate agar!
Edward who is a Half Vampire)!
• Serratia! !
5. Lowenstein-Jenssen Media!
• Citrobacter!
• Arizona! • very selective only for the culture of the
acid fast M. tuberculosis!
• Providencia!
• Erwinia! • previous gold-standard for the diagnosis
of tuberculosis (3-5 months), !
• Edwardsiella!
• Hafnia! • DSSM - direct sputum direct microscopy
! is now the gold standard!
• very expensive!
c. Non-Lactose Fermenters (SPPS)!
• Salmonella! • used only if there is suspected
extrapulmonary TB!
• Proteus (most common cause of acne
vulgaris)! !
6. Thiosulfate Citrate Bile Sucrose (TCBS)!
• Pseudomonas!
• selective only for Vibrionaceae!
• Shigella!
• all -ella are non-motile except for !
Salmonella! 7. Loefler’s Serum Media & Tellurite Media!
! • selective only for Corynbacterium
diphtheriae!
3.
!
Mannitol Salt Agar (MSA)!
!
8. Skirrow’s Agar & Campy BAP!
Staph Reaction • selective only for Campylobacter jejuni!
S. aureus (gold) golden-yellow
!
9. Bordet-Gengou Agar!
S.epidermidis porcelain white • selective only for Bordetelle perussis the
causative agent for whooping cough!
!
!
!
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 ANAEROBIC MEDIA! 3. Based on the Antimicrobial Activity!
! !
1. Candle Jar Method - obsolete! • Bacteriostatic - inhibits the growth and
2. Thioglycollate Agar! reproduction of microorganisms!
3. GasPak! • general rule: all protein synthesis
! inhibitors, and antimetabolites (folic
! acid synthesis inhibitors) are
! OF MICROORGANISMS bacteriostatic EXCEPT
!
!
CONTROL
aminoglycosides !
! !
Chemotherapy:! • Bactericidal - kills the pathogen !
1. Antineoplastics! • general rule: all cell wall synthesis
2. Antimicrobials! inhibitors are bactericidal!
! !
Paul Erlich is the father of chemotherapy! 4. Based on the Mechanism of Action (MOA)!
! !
Antibiotics are compounds sourced from INHIBITORS OF CELL WALL SYNTHESIS!
microorganisms (fungi, or bacteria) that can !
inhibit the growth of other microorganisms! Beta-lactam Antibiotics!
! • inhibits cell wall synthesis by binding to
Classification! penicillin binding proteins !
1. Based on their source (eg. fungi or • at the terminal portion of your NAM
bacteria)! there is something known as your D-
! ala,D-ala terminus, yout PBP binds
• Bactracin - Bacillus subtilis ! here causing a catalytic action causing
• Polymyxin (B & E) - Bacillus polymyxa the binding of N-AM and N-AG.!
(cationic detergent)! • Clinical Use: !
• Penicillin - Penicillium notatum • effective for both gram(-) and
(accidentally by Alexander Flemming, gram(+)!
clinical use by: _____)! • ineffective for the following
• Grisefulvin - Penicillium griseofulvum! conditions:!
• Gentamicin - Micromomospora purpurea • Wall-less microorganisms
(ototoxic aminoglycoside)! (Mycoplasma)!
• Streptomycin - Streptomyces griseus! • microorganisms with atypical
• Vancomycin - peptidpoglycoside antibiotic cell wall component (waxy
Streptomyces orientalis! substance in their cell wall, eg
• Chloramphenicol - Streptomyces Mycobacterium)!
venezuelae! • intracellular parasites (eg.
• Clindamycin - anaerobe infection, Legionella, Brucella,
Streptomyces linconensis! Chlamydia, Rickettsia)!
• Nystatin - Streptomuces noursei! • Resistant microorganisms
• Amphotericin B - systemic fungal (MRSA, MRSE)!
infection, Streptomyces nodosus! • Adverse Effect:!
• Erythromycin - macrolide, Streptomyces • allergic reaction!
erythreus! • anaphylactic reaction!
!• • Cross-sensitivity reaction!
Cycloserine - Streptomyces orchidaceus!
• PENS (thiazolidine)!
2. Based on Spectrum of Activity! • Cephs (Dihydrothiazine)!
! • Jarisch-Hercheimer reaction -
• Narrow Spectrum ex. Aztreonam! idiosyncratic reaction!
• Broad Spectrum ! !
• ex. Carbapenems! !
• Tetracyclines ! !
! !
! !
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 NTK:!
!! • Azlocillin!
! Rickettsia causes Rocky Mountain Spotted • Mezlocillin (PAM)!
!! Fever! !
! 2. Cephalosporins!
! Always test PENS for allergy dapat (-) ANST!
!
! a. Range of Effectiveness!
! • 1st to 4th generation increases
1. Penicillins ! coverage for G(-)!
! • 4th to 1st increases coverage for G(+)!
a. Natural Penicillins ! b. Nomenclature!
• Pen G ! • First Generation - all starts with CEPH-
• Benzyl penicillin! except: Cefazolin & Cefadroxil!
• DOC for Syphillis, severe !
leptospirosis! • Second Generation - all starts with
• PK: poor oral BA! CEF-, nothing ends in -ONE or -IME ,
• Route: Parenteral (IM/IV)! except Cefuroxime, Lovacarbef!
• Pen V! !
• Phenoxymethyl penicillin! • Third Generation - all starts with CEF-,
• PK: good oral BA! all ends in -ONE or -IME, except:
• Route: PO! Cefdinin, Cefibuten, Cefditoren,
! Moxalactam!
b. Isoxazolyl Penicillins! !
• aka antistaphylococcal penicillins! • Fourth Generation - Cefepime,
• type of penicillin which are resistant to Cefpirone!
the action of B-lactamases! !
• Prototype (withdrawn): Methicillin • Fifth Generation - Ceftaroline fosamil !
withdrawn due to nephrotoxicity! !
• examples:! • COMMONLY USED:!
• Cloxacillin PO - dermal inf. ! • Cefazolin !
• Oxacillin! • the only 1st generation available
• Dicloxacillin! in parenteral form!
• Nafcillin! • clinical use: surgical prophylaxis!
! • Cefuroxime!
c. Extended Spectrum Penicillins! • extensively used for the treatment
• increased gram(-) coverage! of respiratory infections (CAP2)!
• increased gram(-) cell membrane • Cephamycins!
penetration! • group of 2nd generation CEPH
• Aminopenicillin! with activity for anaerobic infection!
• Amoxicillin PO - mucosal inf.! • Cefoxitin!
• Ampicillin IV - used for PROM • Cefotetan!
(premature rupture of membrane) • Cefmetazole!
loading dose to prevent neonatal • Ceftaroline fosamil!
sepsis for labor that lasts greater than • prodrug!
24h! • the only cephalosporin active for
• Bacampicillin! MRSA and MRSE!
• Carboxypenicillin! • Ceftriaxone and Cefotaxime!
• has activity for Pseudomonas infection! • used for the treatment of
• Carbenicillin (prototype)! meningitis except if the meningitis
• Ticarcillin! is caused by Listeria
• Ureidopenicillin! monocytogenes!
• also used for Pseudomonas! • Cefixime!
• Piperacillin!

2 community acquired pneumonia

8 Narco2017
 • used for the treatment of 4. Dalbavancin!
gonococcal or nongonococcal • Chem: semisynthetic lipoglycopeptide
urethritis and cervicitis (STI)! derived from Teicoplanin!
! !
! !
• Cefoperazone and Ceftazidime! Cycloserine!
• only two cephalosporins which • MOA: inhibits cell wall synthesis by
have activity for pseudomonas inhibiting the activity of:!
infection! • Alanine racemase!
! • D-ala-D-alanyl ligase!
3. Carbapenems! • Clinical use:!
• widest spectrum among the B-lactam • 2nd line agent for M. tuberculosis
antibiotics! resistant to the first line!
• used for empyrical therapy (unknown !
microorganism! Polypeptide!
• examples! • Bacitracin!
• Imipenem + Cilastatin (dihydropeptidase • chemically classified as a mixed
inhibitor)! cyclic polypeptide!
• Meropenem! • PK: Poor oral BA!
• Ertapenem! • Route: Topical ointments!
! !
Monobactam! INHIBITORS OF PROTEIN SYNTHESIS!
• narrow spectrum! !
• ex. Aztreonam! Inhibitors of 30s Ribosomal Subunit!
• only effective for aerobic and gram(-) !
organisms! a. Tetracyclines!
! • Chem: Naphthacene ring!
Glycopeptides! • MOA: inhibits protein synthesis by
! inhibition of the binding of the
1. Vancomycin! aminoacyl tRNA to the mRNA (prevents
• inhibits cell wall synthesis by binding to peptide elongation) !
the terminal peptide D-ala,D-ala terminus • examples:!
of the nascent peptide chain ! • Tetracycline!
• clinical use:! • Doxycycline - DOC mild leptospirosis!
• formerly the DOC for • Minocycline!
Pseudomembranous colitis ! • Demeclocycline!
• DOC for treatment of infection caused • widest or broadest spectrum among
by MRSA and MRSE! the antibiotics!
• Adverse effect: Red Man Syndrome a • effective for the following:!
form of allergic reaction / phlebitis.! • G(+) and G(-)!
• prophylaxis: Diphenhydramine IV! • wall-less organisms!
• administered via slow IV infusion! • intracellular parasites!
! • Spirochetes!
2. Teicoplamin! • Protozoans (eg. plasmodium)!
• same MOA with Vancomycin, same • Adverse effect:!
spectrum of activity! • chelator for divalent cations (Ca+)!
• Route: both IV and IM! • contraindicated for px <8 yrs old!
! • permanent yellow staining of teeth!
3. Telavancin! • hypoplasia of teeth!
• Chem: semisynthetic lipoglycopeptide • use of expired tetracyclines:
derived from Vancomycin! Fanconi-like syndrome renal failure!
• 2 MOA:! • Minocycline - Ototoxicity!
• 1st - same with Vancomycin! • Demeclocyclone - Phototoxicity!
• 2nd - alters membrane potential and !
membrane permeability! !
9 Narco2017
b. Aminoglycosides! • Jaundice with the use of
• generally sourced from fungi! erythromycin estolate salt!
• -MICIN Micromonospora! !
• -MYCIN Streptomyces! ! Macrolides, specifically erythromycin,
• MOA: inhibit protein synthesis via 3 ! stimulate motillin receptors in the stomach
mechanisms! ! mucosa which increases peristalsis
1. Prevention of the formation of !
the initiation complex! !
2. causes the misreading of the • Clarithromycin!
mRNA complex thus leading to • chem: methylated erythromycin!
mutations! • least associated with edverse
3. Formation of nonfunctional effects!
polysomes or peptides! • clinical use: treatment for inf.
• Pharmacodynamic properties (CPS):! caused by Staphylococci and
1. Concentration-dependent killing! Streptococci!
2. Post-antibiotic Effect! • treatment of PUD3 caused by H.
3. Synergistic effect (with another pylori!
-cidal agent)! !
• Adverse effects:! • Azithromycin!
• damage to CNVIII ! • PK:!
! • excellent distribution to body
! tissues!
!
The CNVIII has 2 components: Sensory
(Cochlear portion) and Motor (Vestibular) • longer half-life!
!
for balance • Dosing: OD for 3-5 days!
! • Adverse effect: Arrhythmia!
! !
• Ototoxicity (KAN)! b. Chloramphenicol!
• Kanamycin! • MOA: inhibition of the rate limiting
• Amikacin! enzyme in peptide elongation
• Neomycin! peptidyltransferase !
• Vestibulotoxicity (SG)! • Adverse effect: (attributed to the nitro
• Streptomycin! group)!
• Gentamicin! • aplastic anemia!
• Nephrotoxicity (NGT)! • Grey Baby Syndrome!
• Neomycin! !
• Gentamicin! !Babies lack the enzyme for glucoronidation
• Tobramycin! !which is needed for the metabolism of
! !Chloramphenicol leading to GBS an aplastic
Inhibitors of 50s Ribosomal Subunit! !!
anemia which targets the bone marrow.!
! !
a. Macrolides! !Aplastic anemia - blood is deficient of all of its
• chemistry: large lactone ring! !components (RBC, WBC, platelet, etc)!

• MOA: blocks the peptide exit tunnel !

resulting to the dissociation of the
peptidyl tRNA from the ribosome !
• examples:!
• Erythromycin (prototype) -
alternative for patients allergic to
b-lactam antibiotics. !
• AE assoc w/ Eryth:!
• GI distress!
• Toxic Dose: >50mg/kg/day!
• Clinical Use: alternative for the
treatment of typhoid fever!
!
c. Lincosamide!
• same MOA as of Macrolide!
• Members:!
• Lincomycin (Prototype)!

3 peptic ulcer disease

10 Narco2017
 • chem: sulfated or sulfur-containing • addition of fluorine offers 2 advantages:!
antibiotic! 1. increased gram(-) coverage!
• Clindamycin! 2. improved penetration on gram(-)
• clinical use: treatment of skin and membrane!
soft tissue infection caused by • Generations!
Staphylococci and Streptococci! 1. First Generation!
• DOC for anaerobic infection above • Nalidixic acid, Cinoxacin!
the diaphragm! • moderate G(-) activity!
• alternative treatment for • limited use for the tx of
Toxoplasmosis (combined with uncomplicated UTI!
another folic acid synthesis inhibitor: !
PYRIMETHAMINE)! ! Complicated UTI:!
! ! • UTI in males!
d. Oxazolidinones! ! • UTI in HIV or Immunocompromised
• MOA: inhibits the 23s subunit of the 50s ! individuals
subunit! !
• Linezolid! 2. Second Generation!
• treatment of VRSA, VRSE! • Ciprofloxacin, Ofloxacin, Norfloxacin,
! Enoxacin, Lomefloxacin!
e. Streptogramins! • improved G(-) activity!
• combined in one dosage form with a ratio • has activity for G(+) and atypical
of: 70(A):30(B)! microorganisms!
• Streptogamin A - Dalfopristin! 3. Third Generation!
• Streptogamin B - Quinupristin! • Levofloxacin, Gemifloxacin,
• Clinical Use: tx of VRSA, VRSE! Moxifloxacin, Gatifloxacin,
! Sparfloxacin!
INHIBITORS OF NUCLEIC ACID SYNTHESIS! • retained G(-) activity!
! • improved activity for G(+) and
Rifamycin! atypical microorganism!
• examples:! ! 4. Fourth Generation!
• Rifampicin, Rifabutin! • Trovafloxacin!
• MOA: inhibition of RNA polymerase (rate • retained activity for gram (-),
limiting enzyme in transcription)! G(+) and atypical
• Clinical Use: ! microorganisms!
• treatment of pulmonary and • has activity for anaerobic
extrapulmonary TB! microorganisms!
• treatment of cutaneous TB (leprosy • COMMONLY USED:!
or Hansen’s disease)! • Ciprofloxacin - used as tx and prophylaxis
• Adverse effects:! of anthrax!
• red-orange discoloration of body • Ciprofoxacin & Levofloxacin - tx for
fluids (urine, saliva, sweat)! uncomplicated UTI!
! • Respiratory Fluoroquinolones:!
Quinolones / Fluoroquinolones! • tx of URTI and LRTI!
• MOA: inhibition of two enzymes: • Levofloxacin!
topoisomerase II (DNA Gyrase) and • Gatifloxacin!
topoisomerase IV! • Gemifloxacin!
! • Moxifloxacin!
! • Adverse Effect: !
!Topoisomerase II relaxes the supercoiled
strand of the DNA! • toxic to bone or cartilage development
!! (ex. tendinitis)!
!Topoisomerase IV separates the DNA • phototoxicity (CI with geria and pedia)!
!strand into two daughter strands! !
! ANTITUBERCULAR AGENTS!
! !
! First Line Agents (HRZE)!

11 Narco2017
! ANTIMETABOLITES!
1. Isoniazid! • generally bacteriostatic agents!
• chem: Isonicotinic hydrazide! !
• MOA: inhibits mycolic acid synthesis! Sulfonamides!
• PK: acetylation is the process of • chemically: P-aminobenzoic acid (PABA-
metabolism if Isoniazid (enzyme like)!
responible: N-acetyltransferase)! • MOA: inhibits dihydropteroate synthetase!
! • known as an OXIDANT!
! !
!Southeast Asians (fast acetylators) have
! PABA is the first component in the
!rapid development of resistance. it is
! folic acid synthesis in bacteria.!
!managed by giving ethambutol to prevent
! PABA! to dihydrofolate to
!resistance to isoniazid.!
DOTS therapy is usually tailored to fit ! tetrahydrofolate and then purine
!southeast asian patients ! bases to nucleic acid synthesis !
! !
! • Adverse effect:!
• Adverse effect:! • Steven-Johnson syndrome !
• Peripheral neuritis! • CI: G6PD Deficiency, Fava beans!
• management: Vit B6 (pyridoxine! • hemolysis!
2. Rifampicin! • Jaundice!
3. Pyrazinamide! !
• only given as short term therapy for the ! G6PD produces the co-factor NADPH
treatment of TB! ! through the PPP (reducing processes in the
• not given until 6 months! ! body like reduction of glutathione with
• Adverse effect: Hepatotoxicty! ! ! Glutathione reductase) !
! !
4. Ethambutol! ! Reduced Glutathione - master antioxidant

• MOA: inhibits arabinosyl transferase, !

which in turn will decrease the synthesis !
of your arabinoglucan! Pyrimethamine & Trimethoprim!
• Adverse effect:! • MOA: inhibits dihydrofolate reductase
• red-green visual disturbance! (converts DHF to THF)!
• in toxic doses: causes optic neuritis! • Adverse effect:!
! • megaloblastic anemia!
Second Line Agents ! • management: Leukovorin!
! !
1. Aminoglycosides - Streptomycin (IM)! ! Megaloblastic anemia can also be caused
2. Fluoroquinolones - Respiratory FQ! ! ! by the deficiency in Vit B12!
• Levofloxacin or Moxifloxacin! !
3. Ethionamides! ! Pernicious anemia on the other hand is
4. Cycloserine! ! caused by the deficiency in intrinsic factor!
5. P-aminosalicylic Acid! !
! !
! COMBINATIONS!
! a. Sulfamethoxazole + Trimethoprim (Co-
! Trimoxazole)!
! • DOC for Pneumocstis jiroveci
! (pneumonia)!
! b. Sulfadiazine + Pyrimethamine (Daparine)!
! • DOC for Toxoplasmosis!
! c. Sulfadoxime + Pyrimethamine (Fansidar)!
! • used for the treatment of malaria!
! !
! !
! !
12 Narco2017
 MISCELLANOUS AGENTS! IMMUNOLOGY!
! Immunity is a physiologic process in which
Nitroimidazoles! the body or self recognizes itself from nonself
• Metronidazole - tx for anaerobic infection! (foreign)!
• Tinidazole (alt.)! !
• clinical use: ! 2 Types of Immunity!
• DOC for pseudomembranous colitis! Nonspecific Immunity (Innate)!
• DOC for tx of 3 protozoan infection • does not require antigen recognition!
(TAG)! • not antigen-specific!
1. Trichomoniasis - yellow green fishy order • response is immediate!
discharge! • does not result to antibody production!
2. Amoebiasis! • does not result to immunologic memory!
3. Girdiasis! !
• AE: Metallic aftertaste when taken with Specific Immunity (Adaptive)!
Ethanol: Disulfiram-like effect! • requires antigen recognition!
! • antigen specific!
Mupirocin! • lag time before response!
• aka pseudomonic acid! • result to antibody production!
• MOA: inhibits the staphylococcal isoleucyl • results to immunologic memory!
tRNA synthetase ! !
• Route: topical! Cells Involved in Immunity!
• Clinical Use: treatment of skin infections !
caused by staphylococcus (ex. impetigo)! GRANULOCYTES (BEN)!
! !
Polymyxin! a. Basophils!
• MOA: acts like a cationic detergent • function: histamine release!
(disruption of cell membrane)! • present during acute allergic reaction!
• ex: Polymixin B, Polymyxin E (aka • found in the peripheral circulation!
Colistin)! !
• Route: Topical! b. Eosinophils!
! • present during type I hypersensitivity
Urinary Antiseptics! reaction and helminthic infection!
• Nitrofurantoin! !
• safest medicine for UTI in pregnancy! c. Neutrophils!
• active at acidic pH! • function: phagocytosis!
• clinical use: treatment of uncomplicated • present in bacterial infection and acute
UTI! inflammation!
• Methenamine! !
• urinary acidifier! mast cells:!
• prodrug (activated to formaldehyde)! function: histamine release!
• urinary antiseptic! found near organs or tissues!
• active at acidic pH! !
• treatment of uncomplicated UTI! AGRANULOCYTES (ML)!
! !
! a. Monocytes and Macrophages!
! • Monocytes - young macrophage, no
! phagocytic effect!
! • Macrophage !
! • function: phagocytosis and antigen
! presentation!
! • present during chronic infection (>2
! weeks present anginf)!
! b. Lymphocytes!
! • mature/activated in lymphoid organcs!
! • B Lymphocytes / B cells!

13 Narco2017
 • function: antigen presentation to 3. Phagocytosis !
your T cell! 4. Complement system - 3 Pathways!
• from bone marrow! • Primary Goal: to create complements/
• matures into 2 types of cell (with the proteins that attack the membranes of
help of your T helper)! these organisms aka Membrane Attack
1. Plasma Cell - anti-body Complex (MAC) C5bC6C7C8C9!
production (Ig)! • Classical Pathway!
2. Memory Cells - immunologic • Alternative Pathway!
memory ! • Mannose-Binding Lectin pathway!
• ex: Vaccination for • all three processes happen
Measles at 9 months has 1 simultaneously and converge to make
strain which entails no the MAC!
further infection expected, !
in contrast to Dengue Specific Immunity (Adaptive)!
virus, which has 4 other !
strains which can in turn 2 Branches:!
make you still susceptible 1. Humoral Immunity - B cells!
to infection.! 2. Cellular-mediated Immunity - T cells!
! !
• T Lymphocyte / T cells ! LYMPHOID ORGANS!
• from Thymus. (Myasthenia Gravis - 1. Primary Lymphoid Organs!
patent pa rin ang thymus, source siya • site of maturation!
ng antibodies na kaya inaattack yung • ex: bone marrow and thymus!
receptors mo for Acetylcholine)! 2. Secondary Lymphoid Organs!
• Helper T Cell ! • site of activation!
• aka CD4+ Cells! • ex: tonsils, lymph nodes, spleen, peyer’s
• attacked by the HIV! patches !
• function: stimulates B cells and !
Cytotoxic T Cells! IMMUNOGLOBULINS!
• Cytotoxic T Cells! • antigen binds to the variable region
• aka CD8+ cells! (antigen binding region)!
• function: directly attacks viruses and !
tumor or cancer cells ! 1. Immunoglobulin A!
• Natural Killer Cells (NK Cells)! • aka: secretory immunoglobulin!
• function: ADCC - antibody dependent • found in body secretions or fluids (saliva,
cellular cytotoxicty! sweat, tears, colostrum)!
• indirectly attacks viruses and tumor or !
cancer cells! 2. Immunoglobulin E!
! • responsible for type 1 hypersensitivity
Non-specific Immunity (Innate Immunity)! reaction (allergy)!
! !
Types:! 3. Immunoglobulin M!
1. Inflammation ! • malaki, mauuna!
• 5 Cardinal Signs:! • largest immunoglobulin (macroglobulin)!
• Redness (Rubor)! • first to respond during an infection!
• Heat (Calor)! • highest sa titer during an acute infection!
• Swelling/Edema (Tumor)! • cannot cross the placental barrier!
• Pain (Dolor)! !
• Loss of Function ! 4. Immunoglobulin G!
2. Chemotaxis! • most dominant immunoglobulin!
• movement of the neutrophils to the site • can cross the placental barrier!
of infeection! • secondary infections gamit na gamit!
• involves 2 processes:! !
• Margination (kapit)! 5. Immunoglobulin D!
• Diapedesis (siksik)! • has no know function!

14 Narco2017
 • found in B cell receptors! MYCOLOGY!
! • morphology, classification and characteristic
Hypersensitivity Reactions! of fungi!
! !
1. Antibody mediated hypersensitivity Introduction!
reaction (Type I, Type II, Type III)! a. Molds!
! ! • generally multicellular!
Type I Hypersensitivity! • filamentous (hyphae)!
• aka: immediate hypersensitivity reaction! • can live at room temperature (20-25C)!
• ex: allergy, atopy, anaphylaxis! !
• mediated by IgE! b. Yeasts!
! • causes different opportunistic infections!
Type II Hypersensitivity! • part of our normal flora !
• aka: cytotoxic hypersensitivity reaction! • unicellular!
• mediated by IgM, IgG! • nonfilamentous!
• ex: blood transfusion (ABO • live at body temperature (37C)!
incompatibility, Rh incompatibility)! !
! Characteristics!
Type III Hypersensitivity! • generally multicellular and filamentous,
• aka: antigen-antibody complex formation! except for yeast.!
• mediated by IgG! • saprophytic!
• ex. Rheumatic Heart Disease, Acute • parasitic or pathogenic!
Glomerulonephritis, Vasculitis, serum • plant-like!
sickness, SLE! !
! Morphology!
!Type II! a. Hyphae (means filamentous)!
!Erythroblastosis fetalis (Rh Incompatibility) • microtubular structures found specifically
!wherein the mom is Rh- and the fetus is Rh+. in molds!
!First pregnancy will be okay, but the second b. Septum!
!pregnancy, the mother’s IgG will attack the 2nd • cross-wood structures found inside a
!!
baby.! single hyphae!
! !
!!
Management: RhoGAM!
c. Conidia and Spores!
! • primary method of asexual reproduction!
!Another example of Type II Hypersensitivity is
• basis of their classification!
!!
Grave’s Disease!
!
! d. Phyla!
!Type III!
Streptococcus bacteria forms an insoluble !
!complex with antibodies that can lodge either • Phylum Glomerulomycota order
!sa valve ng heart or kidneys Mucorales!
! • formerly: Phylum Zygomycota!
! • sexual reproduction via zygospores!
2. Cellular mediated Hypersensitivity! • asexual reproduction via sporangium
! (spores)!
Type IV Hypersensitivity Reaction! !
• aka: delayed hypersensitivity raction! • Phylum Ascomycota!
• ex: Tubercullin skin test / PPD, contact • largest phylum !
dermatitis! • most molds belong under here!
! • aka: “sac” fungi!
! • sexual reproduction via ascospores!
! • asexual reproduction via conidia!
! !
! • Phylum Basidiomycota!
! • where most yeasts are under!
! • aka: “club” fungi!

15 Narco2017
 • sexual reproduction: basidiospores! • Microsporon!
• asexual reproduction: conidia/spores! • affects the skin and hair!
! • Trichophyton!
Medical Mycology! • affects all areas of the skin, nails
• study of fungal diseases (mycosis) and and hair!
associated treatment! • CM: Tinea/Ringworms!
! !
Mycoses! Tinea Part of the Dermatophyte
1. Hypersensitivity reactions! Body
2. Mycotoxicosis!
• ingestion of preformed fungal toxin! Tinea pedis Feet T. rubrum!
(Athlete’s foot) E.
• Aflatoxin ! mentagrophytes!
• from stale peanuts acted upon by E. flocossum
Aspergillus!
• potent carcinogen (hepatocellular Tinea cruris! Groin area ^^^SAME
carcinoma)! (Jock itch) An-An
• Ergotoxin! Tinea uniguium Nails/Hands ^^^SAME
• wheat acted upon by Claviceps (Onychomycosis)
purpurea!
! Tinea corporis Trunk/Body
Area
T. rubrum!
E. flocossum
3. Mycetisma!
• ingestion of a poisonous fungi! Tinea barbae Beard Area E.
• Amanita phalloides - most toxic ! mentagrophytes
! Tinea capitis Scalp Area E.
4. Fungal Infections!
! mentagrophytes!
M. canis
A. Superficial Mycoses (Epidermis)!
!
• skin, hair, nails!
• Black Piedra - fungal infection of the !
hair! C. Subcutaneous Mycoses!
• aka Tinea nodosa! • introduces into the SQ/Hypodermis area
via a skin incision/trauma!
• CA: Piedraia hortae!
• CM: black nodules found on the hair !
shaft (due to poor hygiene)! • Chromoblastomycosis!
! • Causative Agents:!
• Phialophora verrucosa!
• White Piedra!
• CA: Trichospora beigelii! • Fonsacaea pedrosoi!
• CM: beige nodules found on the hair • Fonsacaea compacta!
shaft! • Rhinocladiela aquaspersa!
! • Cladophialophora carrionii!
• CM: warty-like/verrucous skin lesions
• Pituriasis!
found in the draining of lymphatics!
• aka: Tinea versicolor!
• CA: Malassezia furfur! !
• CM: hypo/hyperpigmented • Mycetoma!
serpentine skin lesion! • aka: Madura foot (Africa)!
! • associated with barefoot individuals!
• Causative Agents:!
• TInea Nigra!
• CA: Exophiala werneckii! • Pseudallescheria boydii!
• CM: brown to black lesions found on • Madurella mycetomatis!
the palms and soles ! • Madurella grisea!
! • Exophiala jeanselmei!
• Acremonium falciforme!
B. Cutaneous Mycoses (Dermis)!
• CA: Dermatophytes! • CM:!
• Epidermophyton! • suppuration !
• affects the skin and nails! • abscess formation!

16 Narco2017
 • granuloma formation! South American Blastomycosis!
! • CA: Paracoccidiodoides basillensis!
• Sporotrichosis! • CM: painful mouh / pharyngeal ulcers!
• nakukuha sa rose thorns! !
• CA: Sporothix schenckii! North American Blastomycosis!
• Mode of Transmission: rose thorns, • CA: Blastomycoses dermatitides!
tree barks, and soil (usually anaerobic • CM: !
areas)! • Presence of pulmonary or lung
• aka: occupational disease of gardeners! infiltrates!
• CM: nodules found along the draining • Lesions found on the genitalia, bones
of the lymphatics! and the central nervous sys. (brain)!
! !
• Phaeohyphomycosis! Tissue/Microscopic
• Causative Agents:! Form
• Phialophora richardsiae!
• Wangiella dermatitides! Histoplasmosis oval yeasts inside
• Bipolaris spicifera! macrophages
• Exophalia jeanselmei! Coccidiomycosis spherules containing
• Alternaria, Curvularia, Exhorilium endospores
rostratum!
• CM: solitary encapsulated cyst found N. American thick walled yeast with
on the skin! Blastomycosis broad based, single
! bud
D. Systemic / Endemic Mycoses! S. American large, multiple budding
• CA: thermally dimorphic fungi! Blastomycosis yeast
• MOT: Respiratory transmission (initial !
!
site: lungs)!
!
E. Opportunistic Mycoses!
Mode of Treatment!
• Mild to Moderate: Itraconazole!
!
Candidiasis!
• Moderate to Severe: Amphotericin B!
! • CA:!
• Candida albicans - ability to form germ
Coccidioimycosis!
tube (cellular extension of yeast)!
• CA:! • C. glabrata!
• Coccoidoides immitis! • C. tropicalis!
• Coccoidoides posadasii! • C. krusei!
• CM: Valley fever / Desert Rheumatism! • C. lusetanei!
• 1st outbreak: San Joaquin, Californa!
! • CM: !
• cutaneous or mucosal (oral thrush,
Histoplasmosis!
diaper rash, vaginosis, intertriginous
• CA: Histoplasma capsulatum (not infection, onychomycosis)!
encapsulated)!
• aka: Spelunker’s disease! • systemic - associated with prosthetic
devices!
• MOT: bat dropping! • chronic mucocutaneous - associated
• CM: Mimicks the symtoms of PTB (cough, with immunocompromised state and
hemophysis !
! diseases of the endocrine system (eg
! Histoplasmosis!
DM)!
! Paragomimiosis!
• Treatment:!
! ! Asbestosis! • Cutaneous/Mucosal!
! • Nystatin (DOC)!
! Mimickers of PTB • Ketoconazole!
! • Systemic/Chronic mucocutaneous!
! • Amphotericin B + Flucytosine!
! • Fluconazole (alt.)!

17 Narco2017
Cryptococcosis! (squalene epoxide) which is toxic to the
• CA: Cryptococcus neoformans fungal cell!
(encapsulated fungi)! !
• MOT: pigeon droppings! 3. Nystatin!
• capsule staining: India Ink! • chemically: polyene antifungal!
• CM: cryptococcal meningitis! • MOA: Inhibition of Ergosterol synthesis!
• Treatment:! • PK: poorly absorbed in systemic
• Meningitis! circulation!
• Fluconazole (DOC)! • Routes: topical!
• Systemic! • Clinical Use: Effective for skin infection
• Amphotericin + Flucytosine! caused by yeasts (eg candidiasis)!
! !
Pneumocystis jiroveci Pneumonia! 4. Azoles!
• CA: Pneumocystits jivoreci (humans) • MOA: inhibition of fungal CYP450!
*carinii is for rodents! • chemically:!
• formerly classified as a protozoan! • Imidazoles - non or less selective in
• CM: pneumonia! inhibiting human CYP450
• Treatment:! (ex Ketoconazole, topical azoles -
• Co-Trimoxazole (DOC)! clotrimazole, ticomazole, miconazole)!
! • Triazoles - more selective in inhibiting
Aspergillosis! fungal CYP450. (ex. Fluconazole,
• CA: ! Voriconazole, Itraconazole,
• Aspergillus fumigatus! Posaconazole)!
• Aspergillus flavus! • AE: !
• CM: ! • anti-androgenic effects (gynecomastia),
• bronchopulmonary aspergillosis! galactorrhea!
• systemic or invasive aspergillosis! • enzyme inhibition!
• aspergilloma (aka fungal ball) ! !
• Treatment: Voriconazole (DOC)! 5. Miscellaneous Agents / Topical !
! • Salicylic Acid - Ap-ap solution!
Mucormycosis! • Salicylic Acid + benzoic acid - Whitfield’s
• CA: Zygomucor! ointment!
• CM: Rhinocerebellar infection! • Selenium sulfide - Selsun blue Shampoo!
• Treatment: Posaconazole (DOC)! • Potassium Iodide Solution - DOC for
! Sporotrichosis!
ANTIFUNGALS! !
! Less Serious Mycoses!
Superficial Mycoses ! !
• administered PO, topical! 1. Ketoconazole!
! • first azole available for clinical use!
1. Griseofulvin ! !
• fungistatic! 2. Fluconazole!
• no known or approved MOA! • PK: !
• proposed MOA: protects the newly • excellent penetration into the blood
formed skin against dermatophytic brain barrier!
infections ! • good water solubility!
• PK: increased absorption with high lipid • least associated with adverse effect!
meal! !
• clinical use: treatment of skin infection 3. Itraconazole - 2nd line!
caused by dermatophytes ! • treatment for systemic or endemic
! myoses!
2. Terbinaphin! !
• fungicidal! !
• MOA: inhibition of squalene epoxidase !
thus accumulation of toxic metabolite !
18 Narco2017
Life Threatening Mycoses! VIROLOGY!
! !
1. Amphotericin B! Characteristics:!
• aka grandfather of antifungals! • obligate intracellular parasites!
• MOA: polyene antibiotic that binds to • acellular (only composed of nucleic acids
ergosterol in the fungal membrane and and proteins)!
creates pores holes leading to • do not replicate (replication happens inside
cytoplasmic leakage (death of the fungal the cell)!
cell)! !
• Clinical Use: initially used to decrease Morphology!
fungal burden! • Nucleic Acid core - either DNA or RNA!
! • Viral Capsid !
! The holes caused by Amphotericin • protein part!
! B are used as entry points for the • function: protection, basis for the viral
! drugs of choice symmetry!
! • Viral Envelope!
• combined with Flucytosine which provides • Enveloped viruses - more vulnerable to
a synergistic effect! the effect of surfactants!
• AE:! • Naked viruses!
• Nephrotoxic! !
• acute renal failure with wasting of K+ Viral Symmetry!
and Mg+ (electrolyte imbalace)! !
! a. Cubic/Icosahedral !
2. Flucytosine! • spherical!
• Chemically: pyrimidine analogue! !
• prodrug activated into 5-fluorouracil! !
• MOA: ! !! General Rules:!

• taken up by Cytosine Permease! ! All DNA viruses are Icosahedral except for
• converted to 5-FU! !! poxviridae!
• 5-FU is converted to:! !
a. FdUMP - Fluorodeoxyuridine ! All RNA (+)sense viruses except:!
monophosphate! ! flaviviridae!
b. FUTP - Fluorouridine triphosphate! ! coronaviridae!
• Clinical Use: treatment for systemic yeast ! retroviridae!
infection combined with Amphotericin B! !
! b. Helical!
3. Echinocandins! !
• MOA: inhibition of the B-1,3-D-glucan !
synthesis (which is an important !! General Rule:!

component of fungal cell wall or chitin)! !

• ex. Caspofungin, Anidulafungin, ! All RNA (-)sense viruses except:!

Micafungin! ! Arenaviridae!

! !
4. Voriconazole! c. Complex!
! • neither cubic nor helical!
5. Posaconazole! • PoFACoR - Poxviridae, Flaviviridae,
• broadest spectrum amongst the family of Arenaviridae, Coronaciridae, Retroviridae!
the azoles! !
• effective for (ZAC)! !
• Zygomucor! !
• Aspergillus! !
• Candida! !
! !
! !
! !
19 Narco2017
Viral Genome! • Bovine Spongiform Encepalopathy
a. Double stranded (ds)! (Mad Cow’s disease)!
• General rule: all DNA viruses except • Scrapie - prion disease in sheep!
Parvoviridae (ss)! • Kuru - associated with human
! cannibalism (tribe in Papua New
b. Single stranded (ss)! Guinea)!
• General rule: all RNA viruses except • Creutzfeld-Jakob disease - associated
Reoviridae (ds)! with the use of human growth hormone
! from corpse!
! !
!! Segmented Viruses (BARO)!
General Properties of DNA and RNA
! Viruses!
! Bunyaviridae!
!
! Arenaviridae!
! DNA VIRUSES Exceptions!
!!
! Reoviridae!
!! (DIN)!
!! Orthomyxoviridae*!
!
! *most important! !! D-double stranded! Parvoviridae!
!
! !
! !! I-cosahedral ! Poxviridae!
!
Viral Life Cycle! !
! ! N-ucleus
(replication)!
Poxviridae!

Lysogenic Stage! !
• avirulent stage - no signs and symptoms! !
• synthesis and packaging of VIRIONS4! !
! ! RNA VIRUSES Exceptions!
!!
Lytic Stage! !! (SECS)!

• presence of signs and symptoms! !

• release of the virions! !! S-ingle stranded! Reoviridae(ds)!
!
! !
Steps in Viral Infection (APERSP)! !! E-nveloped! PRC: picornaviridae,

! !! reoviridae,
caliciviridae!
1. Attachment of the virus to host cell! !! !
2. Penetration of the virus into the host cell! ! Cytoplasm! ROI: Retroviridae,
3. Expression of the viral genome! !! (replication)! Orthomyxoviridae,
4. Replication of the virus! !! Influenza (nucleus)!
!
5. Synthesis of the virions! !
6. Packaging and release of the virions! !! Spherical-helical! Rabies virus (helical-
! !! bullet shape)
! !
Uncoventional Virus! !
! Naked DNA:!
a. Viroid ! • Adenoviridae!
• single stranded! • Parvoviridae!
• smallest pathogen that can infect plants! • Papilloviridae!
! • Polyomaviridae!
b. Prions! !
• viral entities which are only composed of Enveloped DNA:!
proteins! • Hepadnaviridae!
• heat-resistant! • Poxviridae!
• dessication-resistant! • Herpesviridae!
• usually associated with diseases in !
humans and animals: (prion diseases)! !
4 mature viral particle

20 Narco2017
DNA VIRUSES (HHAPPPy)! 3. Papillomaviridae!
! • Human Papilloma virus (HPV)!
Hepadnaviridae (hepatitis B is the only dna !
virus)! HPV Strain Diseases
Herpesviridae!
Adenoviridae! 1 Plantar Warts
Poxviridae!
Parvoviridae! 2 Common skin warts
Papillomaviridae! 3 Cutaneous Warts
Polyomaviridae!
! 7 Butcher’s hand warts
1. Adenoviridae!
• sites of infection:! 6,11 Anogenital warts;
• Conjunctiva! latyngeal CA
• Pharynx! 16,18 Cervical CA
• Urinary Bladder!
• Small Intestine! !
!•
• CM:! Prevention of HPV:!
• Pink Conjunctivitis (sore eyes)!
• Pharyngitis (sore throat)! a. Papanicolau Smear (PAP Smear) !
• Gastroenteritis (at a lesser degree)! • to start PAP smear at the age of
• hemorrhagic cystitis! 21 yrs. old (regardless of sexual
! !
activity)!
2. Parvoviridae!
• simplest DNA virus because it is the only b. Vaccination!
(ss) DNA virus! • Gardasil (Quadrivalent) -
• most of the parvovirus strains affect HPV6,11,16,18!
• Cervarix (Bivalent) - HPV 16,18!
animals, only one strain affects humans!
• In Humans: Parvovirus B19! !
• Tropism: RBC! 4. Polyomaviridae!
• CM:! • BK Virus!
• commonly seen in the pediatric age • JC Virus!
group! • Ki and Wu Virus!
• Erythema infectiosum! • Merkell cell Virus!
• aka 5th disease! • SV40 Virus!
• ssx: children - slapped cheek • not usually encountered by ordinary
appearance. adults - severe joint human beings, mostly associated with
HIV/AIDS patients!
athralgia!
• Glove and Stocking syndrome! !
• rashes found on the hands and 5. Poxviridae!
• brick-shaped virus!
lower exremities (benign)!
• Transient Aplastic Anemia! !
• Pure Red Cell aplasia! a. Orthopox!
• Hydrops fetalis (if it crosses the • Monkey pox!
placenta)! ! ! - primary member!
! ! ! - CM: cervical and inguinal !
! ! ! lymphadenopathy!
! • Small pox (Variola)!
! ! ! - eradicated. last case was !
! ! ! seen in Somalia in 1978 !
! ! ! (extensive vaccination)!
! ! ! - CM: !
! • skin lesions start at the
! head/facial area!
!
21 Narco2017
 • skin lesions are of the FAMILY STRAIN COMMON
same stages! NAME
• Vaccinia!
! ! - primary component of the ! Alpha Herpes 1 Herpes
! ! small pox vaccine! Simplex Virus
1
! ! - model virus in terms of !
! ! structure and replication! 2 Herpes
• Cow pox ! Simplex Virus
! ! - ancestor of the vaccinia! 2
! ! - host: rodents!
3 Varicella-
! ! - CM:!
Zoster Virus
• hemorrhagic red-based
skin lesions! Beta Herpes 5 Cytomegalovir
! us (CMV)
b. Parapox!
6 Human herpes
• ORF Virus! virus 6
• commonly found in sheep!
• CM: benign pustular dermatitis! 7 Human herpes
• aka occupational disease of sheep virus 7
handlers!
! Gamma
Herpes
4 Epstain-barr
virus (EBV)
c. Molluska pox!
• Mollusca contagiosum virus - 8 Human herpes
common in pregnant women! virus 8
• found in poorly ventilated
portions of the body!
!
Alpha Herpes!
• CM: small pink warty-like skin
lesions found at the back,
!
1. Herpes Simplex Virus 1 & 2!
buttocks, genitalia!
! • MOT: HSV1 - not sexually transmitted,
HSV2 - sexually transmitted!
d. Yatapox! • CM:!
• Yaba pox! • HSV1 - gingivostomatitis (cold sores or
• Tana pox!
! fever blisters), herpetic encephalitis!
• HSV2 - genital herpes, neonatal
6. Herpesviridae! sepsis, herpetic meningitis!
• Characteristics:!
• very capable of undergoing latency
!
2. Varicella-Zoster Virus (VZV)!
period (dormant at the ganglions), px is • Varicella (Chicken Pox)!
rendered asymptomatic! • CM:!
• cytopathic effect on ganglions - • skin lesions begin at the periphery
formation of “giant5” cells!
! (trunk)!

! • skin lesions are of different stages,

! but most are vesicular6!

! • Zoster (Shingles)!
! • reactivation of Varicella, seen in
! geria px and immunocompromised

! px!
• CM:!

5look normal under microscope but full of virions, awaiting host to be immunocompromised in
order to become virulent
6 water-filled

22 Narco2017
 • skin lesions are dermatomal RNA (+) VIRUSES (PiCoTCaFlaRe2)!
(dermatomes)! a. Picornaviridae!
• skin lesions are more painful than • smallest RNA virus!
varicella (because they involve • Enterovirus!
spinal nerves)! • Polio virus!
! • CM: Paralytic poliomyelitis!
Beta Herpes! • prevention: Vaccination!
! • Sabin - live attenuated virus (PO)!
1. Cytomegalovirus (CMV)! • Salk - killed virus (IM)!
• most common congenital infection! !
• ToRCHeS - organisms that can cross • Rhino virus!
the placenta! • most common cause of common
• Toxoplasma gondii! colds!
• Rubella (valvular defects and !
cataract formation)! • Coxsackie Virus!
• CMV! • Coxsackie A !
• Herpes/HIV/Hepa B! • herpangina (vesicular
• Syphilis! pharyngitis)!
• CM: ! • Hand-Foor-Mouth disease!
• 90-95% - asymptomatic! • Hemorrhagic conjunctivitis!
• 5-10% - symptomatic, can lead to • Coxsackie B!
stillbirth, intrauterine growth • pleurodynia!
retardation, blindness, deafness, • pericarditis!
mental retardation! • myocarditis!
! !
2. Human herpes virus 6 & 7! • Aphtho Virus!
• CM: Roseola (aka infantem subitum, • CM: Foot and Mouth disease (swine)!
6th disease)! !
• more on the HPV6! • Kobu Virus!
! • Cardio Virus!
Gamma Herpes! • Hepato Virus!
! • Hepatitis A!
1. Epstein-barr Virus (EBV)! !
• cancer forming virus! b. Coronaviridae!
• CM:! • solar / petal shape!
• infectious mononucleosis (IM) ! • CM:!
• aka kissing disease! • SARS (galing sa birds)!
• Dx: Monospot test! • MERS (galing sa camels)!
• Burkitt’s Lymphoma! • Gastroenteritis!
• Hodgkin’s Lymphoma! • Common colds!
• Non-Hodgkin’s Lymphoma! !
• Gastric Carcinoma! c. Togaviridae!
! • arbovirus (arthropod-borne)!
2. Human herpes virus 8! • Alpha Virus - arbo virus!
• CM: Kaposi sarcoma! • Chikungunya virus!
! • CM: crippling arthritis!
7. Hepadnaviridae *see appendix! • Rubi Virus!
! • Rubella (German Measles)!
! • CM: 3-day Maculopapular rash,
! Forschneimer spots (petechae seen on
! soft palate)!
! • Congenital effects:!
! • Cataract formation!
! • deafness!
! • valvular defects!

23 Narco2017
d. Caliciviridae! • Japanese Encephalitis Virus!
• Calici virus / Norwalk Virus! • most common cause of viral
• First Outbreak: Norwalk, Ohio encephalitis in Asia!
Elementary School! • Vector: Culex Mosquito!
• CM: most common cause of viral • St. Louis Encephalitis!
gastroenteritis! • Zika Virus - re-emerging!
! • West Nile Fever Virus!
e. Flaviviridae! • Hepaci virus (Hepatitis C)!
• arbovirus! !
• Dengue Virus! f. Retroviridae!
• Vector:! • presence of reverse transcriptase (RNA to
• Aedes egypti! DNA) !
• Aedes salbopictus! • cancer-forming!
• CM: Dengue Hemorrhagic Fever! • promote the effect of oncogenes!
• 3 Clinical Phases:! • Human T-Lymphocyte Virus (HTLV)!
1. Febrile Phase! • CM: leukemia!
• occurs between day 2-7 of the • Human Immunodeficiency Virus!
illness! • Tropism: Helper T-cells (CD4+)!
2. Critical phase! • normal count: >500 CD4!
• occurs at days 5-6 of the illness! • AIDS >200 CD4!
• ssx: plasma leakage, bleeding, • 2 Strains:!
severe organ involvement! • HIV1 - Philippines!
• can last for 24-48h! • HIV2 - Africa (most likely to cause
3. Convalescence / Recovery Phase! AIDS)!
! !
WHO recommends to start antiretrovirals at
Classification! !
any CD4 level once diagnosed with HIV.
1. Probable Dengue! !
(previously at 350)
• recent travel/residency in a place with !
dengue epidemic! !
• fever plus any two of the following ssx:! g. Reoviridae!
• nausea and vomiting! • double stranded!
• rashes! • Colti Virus!
• muscle aches or joint pains! • Vector: Dermacentor andersoni (tick)!
• mucosal bleeding ! • CM: Colorado Tick fever, Mountain
• positive tourniquet test (>20 fever!
petechial/sq. in.)! • Rotavirus!
• CBCPC - leukopenia! • most common cause of diarrheal
! illness in infants!
2. Dengue with warning signs! • Orbivirus!
• abdominal pain due to liver enlargement! • common in horses!
• persistent vomiting! !
• mucosal bleeding! !
• clinical sign of plasma leakage !
(decreased BP)! !
• lethargy / restlessness! !
• liver enlargement >2cm! !
• laboratory confirmation (low platelets, !
increased hematocrit)! !
! !
3. Severe Dengue! !
• severe hemorrhage/bleeding! !
• severe plasma leakage! !
• severe organ involvement (liver, kidneys)! !
! !
• Yellow fever Virus!

24 Narco2017
RNA (-) SENSE (ParFABOR)! 1. Ebola Virus!
! • MOT: direct contact to body fluids (blood)!
Paramyxoviridae! • 5 Strains:!
(+) sense is
Filoviridae!
i m m e d i a t e l y
• Zaire & Sudan - most virulent, 2014
Arenaviridae! West Africa Outbreak!
translated into
Bunyaviridae! proteins while the (-) • Tailforest!
Orthomyxoviridae! sense is not • Bundibugyo!
Rhabdoviridae! • Reston!
! • found in Philippines and China!
Paramyxoviridae! • sourced from Philippine Macacue
! Monkey!
1. Respiro Virus! • does not cause disease in
• Parainfluenza Virus (4 strains)! humans!
• 1,2,3 - viral croup aka • causes disease in swine!
laryngeotracheobroncholitis (LTB7)! • CM; severe bleeding in all outlets of the
• ssx: barking cough! body!
• 4 - mild URTI! !
! 2. Marburg Virus!
• Rubula Virus (Mumps virus)! • came from African Green Monkey!
• host: humans! !
• MOT: respiratory droplets! Arenaviridae!
• CM: infectious parotitis! • from rodents!
• Tropism: Parotid Gland! • South American region!
• Complication: Orchitis (inflammation !
of the prostate gland) ! 1. Lassa virus!
! • sourced from house rat!
2. Morbili Virus! !
• Measles (Rubeola)! 2. Tacaribe complex!
• host: humans! • most common cause of south american
• MOT: respiratory droplets! hemorrhagic fever!
• Prodromal period (3Cs) : cough, • Junin Virus - Argentine hemorrhagic
coryza & conjunctivitis! fever!
• CM: ! • Machupo Virus - Bolivian hemorrhagic
• Morbiliform rashes all over the fever!
body! • Guanarito Virus - Venezuelan
• Koplik spots - found opposite the hemorrhagic fever!
lower molars! • Sambia Virus - Brazillian hemorrhagic
• Complication: ! fever!
• Otitis Media - most common • Lymphocytic choriomeningitis (LCM)
complication! Virus - house mouse!
• Pneumonia - most fatal! !
• Subsclerosing Panencephalitis Bunyaviridae!
(SSPE) - chronic ! • arbovirus!
• Prevention: MMR Vaccine (advised • (bunya, flavi, toga)!
to be given at 9 months)! !
! Causing Encephalitis (arbo)!
3. Pneumo Virus! • Phlebovirus!
• Respiratory Syncitial Virus (RSSV)! • La Crosse virus!
• CM: Acute Bronchiolitis (<1 yr old)! !
! Hemorrhagic Fever!
Filoviridae! • Hanta virus!
• thread-like viruses! • Dobrave virus!

7 upper airways

25 Narco2017
• Sin Nombre virus! ANTIVIRALS!
• Puumala Virus! !
! Treatment for Respiratory Viral Infections!
Orthomyxoviridae! !
! A. Neuraminidase Inhibitors!
Influenza Virus A ! • ex. Oseltamivir (PO), Zanamivir (inh)!
• most common encountered by humans! • Clinical Use: Influenza A & B!
• most antigenically unstable (genetic !
reassortment, thus producing new strains)! B. Inhibitors of Viral Uncoating!
• cause of major epidemics (eg AH1N1)! • ex. Amantadine8, Rimantadine!
• Antigens:! • Clinical Use: Influenza A!
• H Antigen - hemagglutinin! !
• N Antigen - neuraminidase! C. Ribavirin!
! • Clinical Use: !
Influenza B! • treatment of respiratory viral infection in
• more stable compared to Inf. A! children (DOC)!
• may cause epidemics! • combined with interferon alpha for the
! treatment of Hepatitis C !
Influenza C! ! Hepatitis C most common cause of liver
• exact opposite of Inf. A! ! carcinoma while Hepatitis E is the most
• most antigenically stable! ! common hepa virus in pregnant women
• does not cause epidemics! !
! !
Rhabdoviridae! Treatment for Hepatic Viral Infection!
! !
1. Rabies Virus! MOA: inserted in the viral nucleic acid!
• helical-bullet shape! !
• Incubation Period:! • Interferon Alpha!
• 1-3 Months! • Lamivudine - active for both hepatitis
• CM: Rabies encephalitis (100% fatal)! viruses (Hep B, HIV)!
! • Adefovir!
!• General Rule:! • Entecavir!
!• Observation period: 10 days! • Telbividine!
! All rabid animals should be sacrificed to !
!• confirm and to perform an autopsy: ! Treatment for Herpetic Viral Infection!
!! Negri bodies! !
! • Acyclovir (most common but expensive)!
! Levels of Exposure!
• Cidofovir!
! • 1. Casual contact!
• Ganciclovir - DOC for herpes resistant to
! • wash the area with soap and water!
Acyclovir!
! do not give vaccine & RIG!
• Foscarnet!
! • 2. Minor scratches/Abrasions!
• Fomivirsen!
! • wash the area with soap and water!
Give vaccine! • Penciclovir!
! • do not administer RIG! • Famciclovir!
! • 3. Transdermal Wound! • Trifluridine!
! • wash area with soap and water! !
!
administer both vaccine and RIG! !
! !
! !

8 have anti-parkisonism property

26 Narco2017
 BACTERIOLOGY
Treatment of Retroviral Infection! !
! GRAM (+)!
Mode of Treatmenr: 2 NRTI’s + 1 NNRTI! !
• Lamivudine + Tenofovir9 + Efavirenz ! Staphylococci !
• Lamivudine + Zidovudine10 + Efavirens! 1. Staphylococcus aureus!
! • catalase (+), coagulase (+)!
A. Nucleoside Reverse Transcriptase • most abundant in anterior nares!
Inhibitors (NRTIs) ! • CM: Abscess formation (stye furuncle,
• end in -INE! carbuncle)!
• “DAZZLE ST”! • Food poisoning!
• Didanosine! • toxin producing : enterotoxin!
• Abacavir! • ssx: projectile vomiting!
• Zidovudine! • Toxic shock syndrome!
• Zalcitabin! • toxin: TST1 (toxic shock syndrome
• Lamivudine! toxin 1)!
• Emtricitabin! • associated with childbearing age
• Stavudine! women who use tampons!
• Tenofovir! • acute infective endocarditis!
! • osteomyelitis!
B. Non-nucleoside Reverse Transcriptase !
Inhibitors (NNRTI)! 2. Staphylococcus epidermidis!
• “NEED”! • most common contaminant of
• Nevirapine! laboratory samples!
• Efavirenz! • associated with infections introduced
• Etravirine! into the body / blood by prosthetic
• Delavirtine! devices!
! • catalase (+), coagulase (-)!
C. Protease Inhibitors! !
• end in -VIR! 3. Staphylococcus saprophyticus!
• “Trip sa SRI LANFA”! • most common cause of UTI in sexually
• Tipranavir! active women!
• Saquinavir! !
• Ritonavir! Streptococci!
• Indinavir! 1. Streptococcus pneumoniae!
• Lopenavir! • lancet shaped !
• Amprenavir! • capsulated streptococci!
• Nelfinavir! • Quellang reaction (swelling)!
• Fosamprenavir! • CM: most common cause of bacterial
• Atazanavir! pneumonia in adults!
! • tx: Penicillin (Amoxicillin) Cephs
D. Entry Inhibitors! (cefuroxime)!
• Enfurvitide! !
• Maraviroc! 2. Streptococcus mutans!
! • CM: dental carries!
E. Integrase Inhibitors! !
• Raltegravir! 3. Viridans streptococci!
! • CM: subacute infective endocarditis!
! • tx: pen G (DOC)!
! !
! !
! !
9 causes allergy
10 causes anemia

27 Narco2017
4. Streptococcus agalactiae! b. Bacillus anthracis!
• Group B, Bea hemolytic! • CM: Anthrax!
• CM: neonatal sepsis & meningitis • 3 forms:!
(most common cause)! • Cutaneous - most common
• tx: Penicillins (eg Ampicillin - covers form; ssx - formation of black
both g(-) and g(+) ; especially those eschar!
who had PROM)! • Pulmonary Form - aka Wool
! Sorter’s disease; most fatal
5. Streptococcus pyrogenes! form; ssx - widening of
• Goup A, beta-hemolytic microorganism! mediastinum!
• CM: most common cause of bacterial • Gastrointestinal - rarest form!
pharyngitis (sore throat/ strep throat)! !
• Complications:! 2. Clostridium!
• Peritonsilar abscess formation! a. Clostridium botulinium!
• Otitis media! • toxin: botulinium toxin!
• Scarlet fever (2nd disease)! • MOToxicity: inhibition of the primary
• Rheumatic heart disease! excitatory NT (ACh)!
• acute glomerulonephritis! !
• tx: Penicillin (eg Amoxicillin)! b. Clostridium tetani!
! • tennis-racket shape!
! • toxin: tetanosporin!
Non-spore Forming Bacilli (Aerobic)! • MOToxicity: inhibition of GABA &
1. Corynebacterium diphtheriae! Glycine (Increase ACh)!
• Chinese-letter in apearance under • CM: Spastic paralysis!
microscopy! • ssx:!
• metachromatic granules (Babes- • trismus (lock-jaw)!
Ernst Bodies)! • sardonic smile!
• CM: Diphtherieae - formation of • dysphagia, dyspnea!
pseudomembranous / necrotic • muscle stiffness!
membrane found in the tonsillar area! • opistotonous!
• “bull-neck appearance”! • DOC: metronidazole!
• Dx: Dacron swab! • Prevention: Tetanus toxoid (TT)
• Tx: Macrolides (DOC)! effective for 10 years; anti-tetanus
• Erythromycin, Azithromycin! serum (ATS)!
• Prevention: ! !
• OPT Vaccine! c. Clostridium perfingens!
• Pentavax ! • toxin: Alpha Toxin (lecithinase)!
! • CM: Gas gangrene!
2. Listeria monocytogenes! !
• CM: Meningitis! d. Clostridium diffile!
• Granulamatosis infantiseptia! • CM: pseudomembranous colitis!
• Tx: Penicillins (eg. Ampicillin)! • tx: Metronidazole (DOC)!
! !
Spore forming Bacilli! !
1. Bacillus (aerobes)! !
! !
a. Bacillus cereus! !
• most often cause of food !
poisoning! !
• 2 Types:! !
• Emetic type - associated with !
ingestion of contaminated fried !
rice! !
• Diarrheal type - associated with !
saucy food or meaty food! !
28 Narco2017
 ACID-FAST! • Culture: Lowenstein-Jensen Media
! (used to determine extrapulmonary TB)!
Mycobacterium! • Prevention: TB DOTS (Directly
• primary component: mycolic acid (waxy observed Treatment short course)!
substance)! • 5 Pillars:!
! • Test for Diagnosis!
1. Mycobacterium leprae! • Adequate drug supply!
• CM: Leprosy / Hansen’s disease / • treatment partner!
Cutaneous disease! • LGU support!
• 2 Forms:! • Proper Recording and Monitoring!
• Tuberculosis Form! • Follow up: 2nd, 5th and 6th
• skin lesion: erythematous flat skin month of tx!
lesions! • Failure Tx: non-compliance for
• Lepromin test (+)! more than 2 months!
• small number of microorganism !
present! GRAM (-)!
• Lepromatous Form! !
• skin lesion: nodular skin lesions Spirochetes!
found in well ventilated parts of the 1. Treponema pallidum!
body (ex Nose)! • MOT: Sexual contact (horizontal),
• Lepromin Test (-)! childbirth (vertical)!
• depressed cutaneous sensation! • Incubation period: 3 weeks!
• large number of microorganism • CM: Syphilis, Congenital Syphilis!
present! !
• tx: Dapsone (DOC), Rifampicin, !3 STAGES:!
Clofazerone! ! •
1. Primary!
! ! ssx: appearance of hard chancre sores
2. Mycobacterium tuberculosis! ! • (painless genital lesions/ ulcers)!
• CM: Pulmonary and Extrapulmonary TB ! • inflammation of groin area!
(ovary, colon - most common in women)! !! resolves after 1 week!
• Dx: ! !
• Clinical:! ! •
2. Secondary!

• cough (> 2 weeks)! ! • latency period: asymptomatic!

• unexplainable weight loss! !! reactivation: rashes all over the body!

• low grade fever! !

• night sweats! ! •
3. Tertiary!

• chest pain associated in coughing / ! • multiorgan involvement (lesions)!

“Guma formation”!
back pain! !
• hemoptysis! !
• Laboratory Diagnosis:! • Congenital Syphilis:!
• Direct Sputum Smear Microscopy • transmitted during the 2nd trimester
(DSSM)! of pregnancy!
• gold standard for the dx of • CM: Stillbirth, intrauterine growth
tuberculosis (cheapest)! retardation (IUGR)!
• submit 2 samples of sputum for 2 • congenital defects:!
consecutive days, early morning! • saddle nose!
• Positive if at least one sample has • saw-like teeth/Hutcherson teeth!
AFB! • mulberry molars!
• Chest X-Ray (AP, Lat)! • scaphoid scapula!
• Purified Protein Derivatives Skin Test / • saber skin!
Tuberculin / Mantou! • Dx: Serological methods!
• PPD Skin Test is used to determine • Non-treponemal - screening!
Tuberculosis exposure! • VDRL - venereal disease research
• 0.1 mL ID and is read 48-72 hours lab method!
after (positive > 15mm)! • RPR - rapid plasma reagin!

29 Narco2017
 • Treponemal Conformation! 2. Neisseria meningitidis!
• TPHA - treponema pallidum • g(-) diplococci!
hemagluttinin assay! • coffee bean / kidney shape!
• FTA Abs - Fluorescent treponemal • CM:!
antibody absorption! • meningitis!
• Tx: Pen G (DOC)! • meningococcemia (fulmenant stage:
! purpurea fulmenan - large
2. Leptospira interrogans! ecchymoses)!
• MOT: direct contact with leptospira • tx: pen G (DOC), Ceph (ceftri,
infected urine! cefotaxime)!
• CM: leptospirosis! !
• 3 Classifications:! Bordetella pertussis!
• suspected leptospirosis! • strict aerobe!
• anicteric leptospirosis (mild)! • selective medium:!
• icteric leptospirosis (severe)! • Bordey-Gengou Media!
• aka: Weil’s disease! • colony: mercury drop colony
• Triad: Jaundice, hemorrhagic formation!
condition, proteinuria! • CM: pertussis!
• Tx: ! • ssx: whooping cough!
• Prophylaxis - Doxycycline (DOC)! • 2 stages:!
• Mild form - Doxycycline (DOC)! • Paroxysmal stage - non-infectious!
• Severe form - Pen G! • Catarrhal stage - infectious stage;
! toxin production!
3. Borrelia! • Tx: MAcrolides (ex. Azithromycin)!
a. Borrelia burgdorferi! • Prevention: DPT Vaccine!
• vector: tick! !
• CM: Lyme disease - “bull’s eye” Haemophilus!
appearance (tick bite)! 1. Haemophilus influenzae!
! • Humans: Tyoe B (HIB)!
b. Borrelia recurrentis! • CM:!
• CM: relapsing fever! • pneumonia (infants) atypical!
• 2 forms:! • meningitis!
• Epidemic! • sepsis!
• vector: body louse! • osteomyelitis!
• host: humans! • prevention: Haemophilus influenzae B
• Endemic! Conjugate Vaccine (HiB)!
• vector: ticks! • Tx: vaccination if!
• host: rodents! • complete: Pen G!
! • Incomplete: Penicillins (Ampicllin
Neisseriae g(-) diplococci! extended spectrum)!
1. Neisseria gonorrhea! !
• g(-) intracellular diplococci! 2. Haemophilus ducreyi!
• MOT: sexual contact, childbirth! • MOT: sexual contact!
• Risk of Infection:! • appears like a "school of red fish”!
• Men - 20% chance (asymptomatic)! • CM:!
• Women - 50% chance (symptomatic)! • soft chancre / chancroid!
• CM: ! • painful genital wheal / lesion!
• pelvic inflammatory disease (PID)11! • tx: Ceftriaxone, Cefixime!
• ophthalmia neonatorum! !
• STI: Urethritis, epididymitis, cervicitis! !
• Tx: 3rd gen Ceph, Azithromycin !
(prophylactic)! !
11 trichomatis is the most common causative agent

30 Narco2017
Chlamydiae! • rose spots - salmon-colored,
1. Chlamydiae! blanching, maculopapular rashes!
a. Chlamydia trachomatis! • Tx:!
• sister of neisseria gonorrhea! • Empirical therapy - Ceftriaxone,
• MOT: sexual contact (primary), Azithromycin!
childbirth! • Severe Typhoid Fever - Ciprofloxacin
• Risk of Infection:! (1st line) Chloramphenicol (alt)!
• Men - symptomatic! !
• Women - asymptomatic! 3. Escherichia coli!
• CM:! • most common cause of UTI!
• pelvic inflammatory disease (PID)! • 5 strains:!
• ophthalma neonatorum! ETEC Enterotoxigenic traveller’s diarrhea
• blindness >72h!
• Trachoma (can also cause EPEC Enteropathogenic infantile diarrhea in
blindness)! 3rd world countries!
• Lymphomagranuloma venereum but the most
(LGV) an STI! common cause of
• STI: urethritis, cervicitis, protatis, infantile diarrhea is
epididymitis! Rotavirus
• Tx: Tetracycline (eg. Doxycycline)!
! EIEC Enteroinvasive shigella-like
diarrhea
2. Chlamydophila!
a. Chlamydia psittaci! EAEC Enteroaggregative diarrhea in
immunocompromis
• CM: Psittacosis! ed individuals
b. Chlamydia pneumoniae!
! EHEC Enterohemorrhagic aka 0157:H7!
Mycoplasma and Ureaplasma! CM: Hemolytic
1. Mycoplasma pneumoniae! Uremic Syndrome!
• wall-less, pleomorphic! (bloody diarrhea
• primary component: sterols! with renal
• staining method: Diene’s staining! component)
• Colony: Fried Egg Colony! !
• CM: Walking pneumonia!
• Tx: Tetracycline (DOC)!
!
Pseudomonas aeruginosa!
! • obligate!
2. Ureoplasma urealyticum! • oxidase (+)!
• CM: nongonococcal urethritis in men! • CM:!
! • wound infection / burn wound infection!
Enterobacteriaceae! • Pigment: pyocyanin, pyoverdin!
1. Shigella (non-lactose fermenter)! • odor: grape-like / sweet taco-corn like
• Causative Agent: Shigella dysenteriae, S. odor!
flexnerii, S. sonei, S. boydii! • Sepsis - skin lesion : Ecthema
• MOT: Fecal-oral (associated with gangrenosum!
improper hand hygiene)! • atypical pneumonia!
• CM: bloody dysenter (scanty stool with • tx: penicillins (eg Carbenicillin, Ticarcillin,
blood and mucous)! Piperacillin) & Ceph (Ceftazodime,
• Tx: Ampicillin (DOC)! Cefoperazone)!
! !
2. Salmonella typhi (non-lactose !
fermenter)! !
• MOT: ingestion of contaminated poultry !
products (eg, Chicken * eggs)! !
• CM:! !
• bacterial gastroenteritis!
• typhoid/enteric fever!
!
31 Narco2017
 PARASITOLOGY

Campylobacter and Helicobacter! 2 Branches:!

1. Campylobacter jejuni! 1. Protozoology!
• “S-shape” / Gull wing shape! 2. Helminthology!
• MOT: fecal-oral! !
• CM: bloody diarrhea! PROTOZOAN!
• Tx: macrolides! • unicellular, free-living!
! • infectious form: cyst form!
2. Helicobacter pylori! • Phyla:!
• Urease (+)! a. Sarcomastigophora!
• CM:! b. Ciliophora - cilia!
• gastric carcinoma! c. Apicomplexa!
• peptic ulcer disease! d. Microspora!
• Gastric - 70% (nocturnal pain)! !
• Duodenal type - 90% (pain is Amebiasis!
relieved by food - OBESE patient)! • CA: !
• Dx:! • Entamoeba histolytica!
• endoscopy (gold standard)! • Entamoeba dispar - normal flora in GIT!
• urea breath test! • MOT: fecal-oral!
• Tx: ! • CM:!
• monotherapy! • amoebic dysentery (bloody diarrhea)!
• double therapy! • amoebic liver abscess (ALA)!
• triple therapy (PPI + 2 Antibiotics • Tx: Metronidazole (DOC), Tinidazole,
Clarithro/Amox/Metronidazole)! Iodoquinol!
• quadruple therapy (PPI + 2 Antibiotics !
+ Surface coating agent Sucralfate or Fresh Water Amoeba!
rebamipide)! a. Naegleria fowleri!
! • CM: Primary Amoebic
Vibrionaceae! Meningoencephalopathy (PAM) !
• comma-shaped microorganism! • directly enters the host to the brain!
! !
1. Vibrio cholerae (flagellated)! b. Acanthamoeba castellani!
• MOT: fecal-oral! • CM: Granulomatous Amoebic
• CM: ! Encepholpathy (GAE) !
• cholera characterized by:! • associated with defective contact lenses!
• osmotic type diarrhea! !
• ssx: rice-watery stool! Giardiasis!
• dx: selective media (TCBS: yellow colony)! • CA: Giardia lamblia!
• Tx: Fluoroquinolones - Ciprofloxacin • MOT: Fecal-oral!
(DOC)! • CM:!
! • Traveller’s diarrhea!
2. Vibrio parahemolyticus! • Gay bowel syndrome!
• MOT: ingestion of shell fish na raw! • ssx:!
• CM: causes cholera-like diarrhea! • abdominal pain!
• TCBS: green colony! • foul smelling diarrhea!
! • malabsorption of ADEK (steatorrhea)!
3. Vibrio vulnificus! • Tx: Metronidazole!
• CM: ! !
• mild URTI! Cyclosporidiasis!
• wound infection! • CA: Cyclospora cayetanensis!
• TCBS: blue-green colony formation ! • MOT: ingestion of cyst-contaminated fruits
! and vegetables!
! • CM: abdominal pain N&V, diarrhea!
! • tx: Co-trimoxazole (DOC)!
! !
! !
32 Narco2017
 Life Cycle:!
Cryptosporidiasis! ! 1. Sporozoites!
• CA: Cryptosporidium hominis! ! • introduced by anopheles into humans!
• MOT: ingestion of cyst-contaminated food ! 2. Merozoites !

and water supply! ! • happens in the liver (multiplication)!

• CM: cholera-like diarrhea in ! 3. Trophozoites !
• happens in the erythrocytes, ssx appears
immunocompromised individual (HIV/ ! (erythrocytic stage)!
AIDS)! ! 4. Gametocytes!
• tx: IV fluid management therapy! !
! !
Trichomoniasis! Tx:!
• CA: Trichomonas vaginalis (only sexually 1. Chloroquine + Fansidar (Sulfadoxime +
transmitted protozoan)! Pyrithimethamine)!
• MOT: sexual contact! 2. Artemeter + Lumefantrine!
3. Quinine + Doxycycline!
• CM:! 4. Primaquine!
• difficulty in urination! 5. Chloroquine!
• burning sensation during urination!
• severe vaginal pruritus!
!
Leishmaniasis!
• yellow-green/yellow curdy vaginal • vector: sand fly!
discharge with fishy odor! • CA: Leishmania spp.!
• tx: Metronidazole (DOC)! • Leismania tropica, & L. mexicana !
! • (cutaneous leishminiasis)!
Toxoplasmosis! • Leishmania barasillensis!
• CA: Toxoplasmosis gondii! • mucocutaneous leishmaniasis
• definitive host: cats! (espundea)!
• MOT:! • Leishmania donocani, L. chapadi!
• ingestion of cyst from cat’s feces • visceral leishmaniasis (Kala-agar)!
• tx: Stibogluconate!
(primary)!
• ingestion of raw pork!
!
Trypanosmosis!
• CM:! a. African trypanosmosis!
• cervical lymphadenopathy! • vector: Tsetse fly!
• retinits! • West African: Trypanosoma brucei gambense!
• tx: sulfadiazine + pyrimethamine (DOC) ; • E a s t A f r i c a n : Tr y p a n o s o m a b r u c e i
clindamycin (alt.)! rhodesiense!
! • Tx:!
• Non-nervous - Suramin, Pentamedene!
H. Malaria!
• Nervous - Melansoprol!
• vector: Anopheles mosquito (female)!
• CA: plasmodium spp.! !
b. American ttrypansomosis!
• P. falciparum!
• vector: Kissing bug!
• most common spp; 50% of malarial • CA: Trypanosoma cruzi!
cases!
• CM: Chaga’s disease!
• most virulent! • Tx: Nifurtimox, Benznidazole!
• malignant tertian malaria (fever every
48hrs)!
!!
• P. vivax! !!
• 40%!
• responsible for benign tertian malaria! !!
• P. malariae!
• 10%! !!
• quartan malaria (fever every 72h)!
• P. ovale! !!
• 5%!
• rarest, least common, benign tertian
!!
!
malaria! !!
!
33 Narco2017
 HELMINTHOLOGY! 8. Filariasis!

Platyhelminths (Flatworms)!
! • CA: Wuchereria bancrofti // Brugia malayi!
• MOT: mosquito bites!
1. Trematodes (flukes)! • CM: Elephantiasis, tropical eosinophilia!
2. Cestodes (tapeworms)! • Tx: Diethylcarbamazine!
!
Roundworms (nematodes)!
!
ii. Trematodes!
!
i. Nematodes!
• Schistomiasis!
• CA:!
1. Ascariasis! • Schistosoma japonicum!
• CA: Ascaris lumbricoides aka giant • S. mansoni!
intestinal round worm; spaghetti-like! • S. haematoruum!
• MOT: ingestion of egg! • ***affects the liver!
• CM: GI disturbances! • MOT: direct penetration of cercariae into
• Tx: Albendazole, Mebendazole! the skin!
! 2. Strongyloidiasis!
• CM:!
• Swimmer’s itch!
• CA: Strongyloides schoralis aka thread • Katayama fever!
worm! • Liver cirrhosis!
• MOT: direct penetration into the skin of the • Portal hypertension (ascites)!
larval form! • Tx: Praziquantel!
• massive autoinfection!
• Tx: Ivermectin!
!
iii. Cestodes!
! 3. Hookworm!
1. Taenia solium!
• aka pork tapeworm!
• CA: ! • MOT: ingestion of raw pork!
• Necator americanus (New World • Intermediate host: human!
Hookworm)! • CM: neurocystesercosis!
• Ancylostoma duodenale (Old World • Tx: Niclosamide, pyraziquantel!
hookworm)!
• MOT: direct penetration of the larvae into
! 2. Taenia saginata!
the skin! • aka beef tapeworm!
• CM: iron deficiency anemia! • MOT: ingstion of raw beef!
• Tx: Mebendazole, Albendazole! • CM: GI disturbances!
! 4. Trichinellosis! ! • Tx: Praziquantel!

• CA: Trichinella spiralis! 3. Diphyllobothrium latum!

• MOT: ingestion of the eggs encysted in raw • aka fish tapeworm!
pork! • MOT: ingestion of eggs of raw fish!
• CM: muscle aches! • CM: Vit b12 deficiency!
• Tx: Albendazole, Mebendazole! • Tx: Praziquantel!
! 5. Whipworm!
! 4. Hymenolepis nana!
• CA: Trichuris trichiura! • aka dwarf tapeworm!
• MOT: ingestion of ehhs! • MOT: ingestion of eggs!
• CM: massive infection (rectal prolapse)! • CM: GI disturbances!
• Tx: Albendazole, Mebendazole! • Tx: praziquantel!
! 6. Enterobiasis!
!!
• CA: Enterobius vernicularis aka pinwork! !
• MOT: ingestion of eggs! !
• CM: severe nocturnal perineal itching! !
• Dx: Scotch tape, Swab test! !
! • Tx: Pyrantel pamoate, Albendazole! !
!
7. Onchocercavolvulus!
!
• MOT: Black fly (vector)!
!
• CM: river blindness!
• Tx: ivermectin! !
34 Narco2017
FEATURES A B C D E

Family Picornaviridae Hepadnaviridae Flaviviridae “Delta” agent Caliciviridae

(RNA) (DNA) (RNA) (co-infection w
Hep B)

Source Feces Blood and Body Fluids! Feces

(blood-borne hepatitis)

MOT Fecal-oral Blood transfusion, sexual contact, childbrith Fecal-oral

Chronic N Y Y Y N
Infection

Prevention Hepa A Vaccine Hep B Vaccine Health Education! Hep B Vaccine maintain a
Blood donor potable water
screening supply

35 Narco2017