Mechanism of action: antibiotics

A. Bacterial cell envelope

- Polymyxins disrupt the outer membrane that is
present in gram-negative bacteria.
- Beta-lactams, glycopeptides, and epoxides
inhibit cell wall synthesis.
- Daptomycin forms ion channels on the cell
membrane that lead to membrane
depolarization and disruption.
B. Nucleic acids and related enzymes
- Nitroimidazoles disrupt DNA strands by creating
free radicals.
- Fluoroquinolones interrupt DNA replication by
inhibiting prokaryotic DNA gyrase.
- Rifamycin prevents transcription by inhibiting RNA
polymerase.
C. Bacterial ribosomes
- Macrolides, amphenicols, lincosamides,
and oxazolidinones inhibit protein synthesis
by binding to the 50s subunit of the
bacterial ribosome.
- Aminoglycosides, tetracyclines, and glycylcyclines inhibit protein synthesis by binding to the 30s subunit of the bacterial ribosome.
D. Folic acid metabolism (required for DNA synthesis)
- Sulfamethoxazole inhibits bacterial purine synthesis by inhibiting dihydropteroate synthetase, which converts para-aminobenzoate (PABA) into dihydrofolate (DHF).
- Trimethoprim, a diaminopyrimidine, inhibits bacterial purine synthesis by inhibiting dihydrofolate reductase, which converts DHF into tetrahydrofolate (THF).

Contraindications (Antibiotics)

Patient group Contraindicated antibiotics

Age Infants • Chloramphenicol

< 8 years • Tetracyclines

• Ethambutol is relatively contraindicated in children.

< 18 years • Fluoroquinolones

Patient group Contraindicated antibiotics

Pregnant women • All trimesters

o Tetracyclines
o Fluoroquinolones
o Erythromycin
o Clarithromycin
o Streptomycin
• Only in the last trimester
o Sulfonamides
o Chloramphenicol
• Limited data on safety (use with caution, i.e., when benefits outweigh risks)
o Aminoglycosides
o Vancomycin
o Azithromycin
o Clindamycin
o Trimethoprim
o Rifampin
o Pyrazinamide
• Confirmed safe: penicillins, cephalosporins, INH, ethambutol
• For more details, see pharmacotherapy during pregnancy.

Breastfeeding women • Sulfonamides

• Tetracyclines
• Metronidazole
• Fluoroquinolones
• Nitrofurantoin

Renal failure • Absolutely contraindicated: tetracyclines

• Relatively contraindicated
o Aminoglycosides
o Cephalosporins
o Fluoroquinolones
• Confirmed safe: penicillins, macrolides, vancomycin, metronidazole, INH, rifampin
Patient group Contraindicated antibiotics

Hepatic failure • No antibiotic is absolutely contraindicated.

• Relatively contraindicated
o Chloramphenicol
o Erythromycin
o Fluoroquinolones
o Metronidazole
o Rifampin
o Isoniazid
• Confirmed safe: penicillins, cephalosporins, ethambutol, aminoglycosides
Gram-positive cocci
Staphylococcus
Catalase-positive
Important Reservoir Characteristics and important virulence factors Diseases Antibiotic of choice
species

Staphylococcus • Skin • Bacterial culture: hemolysiswith • Abscess • Isoxazolyl penicillin(e.g., oxacillin)

aureus
• Detectable in the typical gold-yellowcolonies • Skin infections (e.g., cellulitis, impetigo) or clindamycin
nostrils in ∼ 30% of • Virulence factors: See resistance and virulence • Acute bacterial endocarditis • MRSA: vancomycin or linezolid
the healthy of staphylococci.
• Diseases triggered by toxins • See treatment of staphylococcal diseases.
population o Coagulase positive o TSS
o Protein A
o Food poisoning
o Leukocidins o SSSS
o Enterotoxins (heat stable)
o Exfoliative toxins • Further staphylococcal infections

o TSS toxin-1

Staphylococcus • Natural skin flora • Coagulase-negative • Foreign body infections (e.g., central-line
epidermidis
• Novobiocin-sensitive associated bloodstream infection)

• Does not ferment mannitol

• Urease-positive
• Biofilm formation

Staphylococcus • Natural • Coagulase-negative • Urinary tract infection • Cephalexin, amoxicillin-clavulanate,

saprophyticus (mucosal) skin flora • Novobiocin-resistant (in antibiotic resistance or ciprofloxacin
testing)

Treatment
Staphylococcus aureus
• Anti-staphylococcal penicillins: oxacillin, flucloxacillin
• First and second generation cephalosporins
• In case of penicillin allergy: clindamycin
• MRSA: drugs of last resort such as vancomycin and linezolid
Coagulase-negative staphylococcus (particularly S. epidermidis)
• Methicillin-sensitive: oxacillin, nafcillin, or cefazolin
• Methicillin-resistant: vancomycin or daptomycin
Streptococcus and enterococcus
• Catalase-negative
• Classified according to:
o Type of hemolysis
§ Alpha hemolysis
§ Beta hemolysis
§ Gamma hemolysis
o Lancefield groups further classify β-hemolytic streptococci according to specific bacterial cell wall polysaccharides.
Classification groups range from group A to W.
Genus Important species Reservoir Characteristics and important virulence Diseases Antibiotic of choice
factors

Streptococcus Streptococcus Nasopharynx • Facultative anaerobe • Pneumonia • Penicillin

pneumoniae (pneumococci
) • Bacterial culture: alpha • Meningitis or 1st or 2nd generation cephalosporins
hemolysis • Otitis media • Macrolides in patients
• Microscopy: lancet- • Sinusitis, pharyngitis
with penicillin allergy
shaped diplococci
• OPSI
• Important virulence factors:
o Capsular polysacch
arides
o IgA1 protease
• Optochin-sensitive
• Bile-soluble

Viridans streptococci Usually present in • Facultative anaerobe • Dental caries

the oral cavity
• Bacterial culture: alpha • Subacute bacterial endocarditis
hemolysis
• Optochin-
resistant (in antibiotic resistanc
e testing)
• Bile-insoluble
Genus Important species Reservoir Characteristics and important virulence Diseases Antibiotic of choice
factors

Streptococcus gallolyticus Isolated in stool in up • Facultative anaerobe • Bacteremia

to 10% of the
population (higher • Bacterial culture: beta • Endocarditis
rates in patients hemolysis or gamma hemolysis • Colorectal carcinoma
with colorectal • Lancefield group D
cancer) • Important virulence
factor: capsule
• Growth in bile, not 6.5% NaCl
Streptococcus Humans are the sole • Facultative anaerobe • Head and
pyogenes (Group host; nasopharynx
A Streptococcus) • Bacterial culture: beta neck: tonsillitis, peritonsillar
hemolysis abscess, otitis media

• Lancefield group A • Skin and soft tissue

infections: erysipelas, cellulitis, im
• Important virulence factors petigo, necrotizing fasciitis
o Streptolysin O • Toxin-mediated disease: scarlet
o Streptococcal enzy fever , streptococcal toxic shock
mes
syndrome (STSS)
(DNase, hyaluronid
ase, streptokinase) • Complications of primary
o M protein infection
(virulence factor): :
prevents phagocyto o Acute rheumatic
sis and inhibits fever
alternative o Post-streptococcal
complement glomerulonephritis
activation. Rheumat o Others
ic fever may occur
as a result
of cross-reactivity.
o Hyaluronic acid
capsule:
prevents phagocyto
sis, forms mucoid
colonies
o Frequently, protein
F
o Erythrogenic
exotoxin
A: superantigen tha
t causes toxic shock
syndrome
o Bacitracin sensitive
o Erythrogenic scarlet
fever exotoxins
Genus Important species Reservoir Characteristics and important virulence Diseases Antibiotic of choice
factors

Streptococcus Colonizes the human • Facultative anaerobe • Neonatal meningitis, sepsis,

agalactiae (Group gastrointestinal and
B Streptococcus) genital tracts • Bacterial culture: beta and pneumonia
hemolysis
o CAMP factor (used
to identify S.
agalactiae; enlarges
the hemolysis area
in culture formed
by S. aureus)
• Lancefield group B
• Important virulence
factors: capsule is possible
• Bacitracin-resistant

Peptostrepto Numerous peptostreptoco Part of the natural • Anaerobe • Wound infections (soft tissue,
coccus ccus species (e.g., P. flora of
anaerobius, P. magnus) mucocutaneous • Bacterial culture: gamma bone)

surfaces hemolysis • Brain abscesses

• Upper respiratory tract infections
• Dental infections
• Pelvic infections in women

Enterococcus E. faecium and E. faecalis • Part of • Facultative anaerobe • Urinary tract infection • Intrinsic resistance
the • Bacterial culture: gamma • Cholecystitis to cephalosporins
natural hemolysis, partially also alpha • Endocarditis • Ampicillin
flora of
the gastro
hemolysis • Vancomycin in patients
intestinal • Lancefield group D with penicillin allergy
tract • Growth in bile and 6.5% NaCl • Vancomycin-resistant enterococci: li
nezolid, daptomycin
Gram-negative cocci
Genus Important Reservoir Characteristics and Diseases Antibiotic of choice
species important virulence factors

Neisseri • Neisseria • Humans are • Aerobe • Meningitis • 3rd generation

a meningiti the only • Bacterial growth on culture • Waterhouse-Friderichsen cephalosporins (e.g., ceftr
dis hosts; nasoph medium is usually syndrome iaxone)
arynx challenging • Meningococcemia with petechial • Penicillin G if penicillin-
o Thayer-Martin Agar: bleeding susceptible
selective medium that
favors growth
of Neisseria spp.
• Microscopy: intracellular
and extracellular location
possible
• Important virulence factors:
o Capsular polysaccharid
es
§ Lipooligosaccharid
e (LOS)
: serum levels
correlate with
severity of
symptoms
o IgA1 protease
o Adhesins: pili and opaci
ty proteins facilitate
nasal colonization,
which is a prerequisite
for systemic infection
• Maltose fermenter
Genus Important Reservoir Characteristics and Diseases Antibiotic of choice
species important virulence factors

• Neisseria • Humans are • Aerobe • Gonorrhea • 3rd generation

gonorrho the only hosts • Bacterial growth on culture • Neonatal conjunctivitis cephalosporins (e.g., ceftr
eae medium is usually iaxone) + azithromycin
challenging.
o Thayer-Martin agar:
selective medium that
favors growth
of Neisseria
• Microscopy: intracellular
bacteria (within neutrophils)
• Important virulence factors:
o Pilus proteins
§ Antigenic variation
of
expressed pili allow
s avoidance of
neutralizing antibo
dies that would
prevent reinfection.
o IgA1 protease
o Porin protein II
• Maltose nonfermenter

Moraxe • Moraxella • Humans are • Microscopy: diplococci • Sinusitis • Amoxicillin-clavulanate

lla catarrhali the only • Otitis media • 2nd or 3rd generation
s hosts; nasoph • Bronchitis cephalosporins
arynx • Bronchopneumonia in COPD • Trimethoprim-
sulfamethoxazole (TMP/S
MX)
Gram-positive bacilli
Genus Important Reservoir Characteristics and Diseases Antibiotic of choice
species important virulence factors

Clostridia (spore-forming • Clostridiu • Natural • Anaerobe • Pseudomembra • Metronidazole or vanco

bacteria) m difficile gut flora • Facultative pathogen nous colitis mycin
of ∼ 5% of • Important virulence factor:
all adults o Toxin A (enterotoxin)
and toxin B (cytotoxin)

• Clostridiu • Part of the • Anaerobe • Gas • Piperacillin-

m natural ski • Facultative pathogen gangrene (clost tazobactam + clindamy
perfringen n and • Microscopy: club-shaped bacilli ridial cin
s gastrointe • Important virulence factor: myonecrosis) • Early
stinal flora o Exotoxins; • Food poisoning surgical debridement is
o Some strains vital.
produce enterotoxins (alph • Supportive treatment
a toxin) of food poisoning;
no antibiotics required

• Clostridiu • Found in • Anaerobe • Tetanus • Penicillin

m tetani soil, • Obligate pathogen G or metronidazole
worldwide • Microscopy: drumstick form
• Important virulence Tetanus prophylaxis may
factor: tetanospasmin be necessary depending
on the vaccination status
and wound type (severity,
contamination).
Genus Important Reservoir Characteristics and Diseases Antibiotic of choice
species important virulence factors

• Clostridiu Found in soil, • Anaerobe • Botulism • Administration of

m intestinal tracts • Obligate pathogen a botulism antitoxin is
botulinum of birds and • Microscopy: club-shaped bacilli the most important
fish, and with flagella treatment
agricultural • Important virulence measure. Antibiotics ar
products (e.g., factor: botulinum toxin e of secondary
vegetables) importance.

Listeria • Listeria • Most • Facultative anaerobe • Listeriosis • Ampicillin or penicillin

monocyto commonly • Important virulence factor: G
genes found in resistance to cold
unpasteuri
zed milk
products

Corynebacterium Corynebacter • Humans • Facultative anaerobe • Diphtheria • Erythromycin or penicill

ium are the • Microscopy: stainable using the in G
diphtheriae only hosts Neisser stain • Administration of
• Important virulence a diphtheria antitoxin is
factor: Diphteria an essential part of
toxin, an exotoxin which treatment.
inhibits protein synthesis by
inactivating elongation factor
2
Genus Important Reservoir Characteristics and Diseases Antibiotic of choice
species important virulence factors

Bacillus • Bacillus • Found in • Aerobe • Anthrax • Ciprofloxacin (or Penici

anthracis soil and • The only obligate pathogen of llin
mammals the Bacillus genus. G) plus clindamycin (or
• Microscopy: appearance is linezolid)
similar to that of a bamboo stick o Plus meropenem in
• Important virulence the case
factor: spore of meningitis
formation; exotoxins • Anthrax antitoxin

• Bacillus Proliferate • Aerobe • Food • There is no specific

cereus quickly in • Important virulence poisoning (see treatment against
contaminated factor: enterotoxin bacillus the enterotoxin availabl
food; rice that cereus infection e.
is kept warm ) • Antibiotic treatment is
and/or not indicated.
reheated is a
particularly
good
breeding
ground.
Gram-negative coccobacilli
Genus Important species Reservoir Characteristics and Diseases Antibiotic of choice
important virulence factors

Haemophil • Haemophilus influe • Colonizatio • Bacterial culture: • Otitis media • Amoxicillin or 3rd generation
us nzae n of the o Hemophilic • Meningitis cephalosporins (e.g., cefota
nasopharyn bacteria: isolation on choc • Epiglottitis xime)
x is olate agar • Sinusitis
relatively § Requires factors X
common in (hematin) and V
young (NAD), which are
children. present in lysed red
blood cells
o May
demonstrate satellitism in
culture
• Important virulence factors:
o IgA protease (for mucosal
surface infection)
o Capsular polysaccharides
→ Hib vaccine is only
effective against
capsulated strains of H.
influenzae because non-
typeable serotypes lack
a polysaccharide capsule

• Haemophilus ducre • Humans are • Bacterial culture: hemophilic • Chancroid • Azithromycin or ceftriaxone
yi the only bacteria
hosts

Brucella • Brucella melitensis • Goats and • Facultative intracellular • Brucellosis: Malta • Doxycycline + streptomycin
sheep serve fever
as hosts
Genus Important species Reservoir Characteristics and Diseases Antibiotic of choice
important virulence factors

• Brucella abortus • Cattle are • Brucellosis: Bang

the only 's disease
hosts

Bordetella • Bordetella pertussis • Humans are • Strictly aerobic • Pertussis (whoop • Supportive treatment
the only • Important virulence factors: ing cough) • Macrolides (e.g., erythromy
hosts; o Capsule cin)
particularly o Pertussis toxin
adults and
adolescents
Gram-negative bacilli
Genus Species/serotype Reservoir Characteristics and Diseases Antibiotic of choice
important virulence
factors

Yersinia • Yersinia pestis • Primarily • Obligate • Plague • Aminoglycosides (e.g., gentamici

rodents pathogen n or streptomycin)
• Important virulenc • Tetracyclines
e factor: cold
enrichment possib
le

• Yersinia enterocolitica • Contamina • Obligate • Yersiniosis • Fluoroquinolones (e.g., ciprofloxa

• Yersinia ted pork pathogen • Reactive arthritis cin) or 3rd generation
pseudotuberculosis and milk • Important virulenc cephalosporins (e.g., ceftriaxone)
products e factor: cold
enrichment possib
le

Shigella • Shigella dysenteriae • Humans • Obligate • Shigellosis • Fluoroquinolones (e.g., ciprofloxa

• Shigella sonnei are the pathogen • Reactive arthritis cin) or 3rd generation
• Shigella flexneri only host • Important virulenc • HUS cephalosporins (e.g., ceftriaxone)
e factor: shiga
toxin
• Fastidious: Stool
samples require
prompt testing.

Salmo Salmo Nontyphoid Humans and Obligate pathogen • Salmonellosis • Fluoroquinolones (e.g., ciprofloxa
nella nella salmonellae animals serve • Reactive arthritis cin) or 3rd generation
enteric Serotype as hosts cephalosporins (e.g., ceftriaxone)
a Enteritidis

Serotype
Typhimurium
Genus Species/serotype Reservoir Characteristics and Diseases Antibiotic of choice
important virulence
factors

Typhoid sal Humans are • Obligate • Typhoid • Fluoroquinolones (e.g., ciprofloxa

monellae the only hosts pathogen fever and paratyphoi cin) or 3rd generation
Serotype d fever cephalosporins (e.g., ceftriaxone)
Typhi
Serotype
Paratyphi

Klebsi Klebsiella pneumoniae Part of Important virulence • Nosocomial urinary • Fluoroquinolones,

ella the natural factor: capsular polys tract infection or 3rd generation cephalosporins
flora of accharides • Aspiration pneumon
the gastrointes ia and lung
tinal tract Lactose- abscess (currant
fermenting: cause eo jelly sputum)
sin methylene blue
agar to change in
color to purple

• Klebsiella Human genital Important virulence • Granuloma • Azithromycin

granulomatis tract factor: capsular poly inguinale • Doxycycline
(endemic in saccharides
tropical and
subtropical Bacterial growth on
developing culture medium is
countries) usually challenging
Genus Species/serotype Reservoir Characteristics and Diseases Antibiotic of choice
important virulence
factors

Escheri EPEC (enteropathogen Part of Important virulence Gastroenteritis (see Dia • Ciprofloxacin or TMP/SMX •
chia ic E. coli) the natural gut factor: adherence to rrheagenic E. coli) • Antibiotic treatment
coli (E. flora intestinal epithelium of EHEC infections is not
coli) with subsequent Independent of recommended → increased
destruction subtype: nosocomial release of the shiga toxin →
of microvilli infections, cholecystitis, increased risk of HUS
peritonitis
EPEC for Pediatric

• ETEC (enterotoxic E. • Important virulenc

coli) e factor: produce
an enterotoxin tha
t is structurally
similar to
the cholera toxin
• ETEC for Travelers

• EIEC (enteroinvasive E. • Important virulenc

coli) e factor: direct
invasion of the
intestinal epitheliu
m and formation
of enterotoxins
• EIEC for Invasive

• EAEC (enteroaggregat • Important virulenc

ive E. coli) e factor: ability to
aggregate with
one another
Genus Species/serotype Reservoir Characteristics and Diseases Antibiotic of choice
important virulence
factors

• EHEC (enterohemorrh • Important virulenc

agic E. coli) e
factor: Shiga-like t
oxin
• EHEC for HUS

• UPEC (uropathogenic • Important virulenc

E. coli) e factor:
expresses P
fimbria

• NMEC (neonatal • Important virulenc • Neonatal meningitis • Ampicillin

meningitis-causing E. e factor: K1 • Ampicillin-resistant E.
coli) capsular coli: 3rd generation
polysaccharide pr cephalosporins (e.g., cefotaxime)
otects plus gentamicin
from phagocytosis

Proteu • Proteus vulgaris • Part of • Important virulenc • Nosocomial • Fluoroquinolones (e.g., ciprofloxa
s • Proteus mirabilis the natural e factor: urease infections, cin), cephalosporins, or TMP/SMX
flora of particularly urinary
the gastroi tract infections
ntestinal • Kidney
tract stones (struvite
stones)
Further gram-negative bacilli
Genus Important Reservoir Characteristics and Diseases Antibiotic of choice
species important virulence factors

Helicobacte • Helicobact • Humans are the • S-shaped or spiral-shaped • Type B gastritis • Clarithromycin + amoxicillin + P
r er pylori predominant • Microaerophile PI (see also: Helicobacter
hosts • Produces urease pylori eradication therapy)

Legionella • Legionella • Natural aquatic • Facultative intracellular • Legionellosis • Groups III and
pneumophi habitats • Aerobic IV fluoroquinolones (e.g., levoflo
la • Waterborne bacteria; often xacin)
symbiotic with amebae

Campyloba • Campyloba • Component of • Curved • Campylobacter • Macrolides (e.g., erythromycin)

cter cter jejuni the gut flora in or spiral-shaped with enterocolitis
birds. polar flagellum • Reactive arthritis
Transmission • Microaerophile • Guillain-Barré syndr
often occurs via • Grows at 42°C ome
contaminated
poultry.
Genus Important Reservoir Characteristics and Diseases Antibiotic of choice
species important virulence factors

Pseudomon • Pseudomo • Common in the • Lophotrichous flagella • Infections caused • Piperacillin or ceftazidime
as nas environment; • Aerobic by Pseudomonas • Ciprofloxacin in severe
aeruginosa grows in water • Special macroscopic aeruginosa infections
and humid characteristics o Nosocomial • Intrinsic and acquired
conditions, o A urinary tract resistances are common; some
e.g., hot tubs, typical blue-green pus infections strains are multidrug-resistant.
contaminated may form in infection o Nosocomial
contact lens sol o Sweet odor, if grown in pneumonia
ution culture o Nosocomial bur
• Produces exotoxin A, which n wound
inhibits protein synthesis by infections
inactivating elongation o Malignant otitis
factor 2 externa in
• Produces phospholipase C, elderly
which degrades cell individuals
membranes with diabetes
• Produces pyoverdin and py o Pneumonia in
ocyanin association
with cystic
fibrosis
o Endocarditis in
intravenous dru
g abuse

Burkholderi • Burkholder • Aquatic • Aerobic • Pneumonia in • Cotrimoxazole, meropenem, cef

a ia cepacia environments association tazidime, or quinolone
with cystic fibrosis
 Genus Important Reservoir Characteristics and Diseases Antibiotic of choice
species important virulence factors

Vibrio • Vibrio • Humans and • Straight or curved, polar • Cholera • Fluoroquinolones (e.g., ciproflox
cholerae contaminated flagella acin)
water • Facultative anaerobe
• Produces cholera
toxin (enterotoxin) consistin
g of two subunits:
o The B unit binds to the
intestinal epithelium.
o The toxic A unit is
cleaved and channeled
into the cell.

• • Anaerobic • Injury to the skin or • Primary resistance

• In some cases, formation of mucous membranes against aminoglycosides
a capsule can lead to the • Metronidazole, clindamycin,
• Bile-resistant formation of or extended spectrum
foul-smelling absces penicillin with penicillinase inhib
s or itor
Bacteroides • Numerous • Account even peritonitis and
for 90% of all sepsis
fecal flora
• Responsible for
the typical odor
of stool

Bartonella • Bartonella • Cats are • Facultative intracellular • Cat scratch disease • Azithromycin or clarithromycin
henselae asymptomatic • Microaerophile • In HIV patients: bacil
carriers lary angiomatosis

• Bartonella • Humans (the • Facultative intracellular • Trench fever • Doxycycline + gentamicin

quintana louse is usually • Microaerophile
the vector)
Branching filamentous bacteria

Genus Species Reservoir Characteristics and Diseases Antibiotic of choice

important virulence
factors

Actinomyces • Actinomyces • Natural • Primarily • Actinomycosis High-dose penicillin G;

israelii bacteria of an anaerobe • Caries and alternatively tetracycline or erythromycin
the oral • Formation of sulfur periodontitis
cavity and the granules in tissue
intestine

Nocardia • N. asteroides • Ubiquitous in • Aerobe • Nocardiosis • TMP/SMX

• N. brasiliensis soil • Weakly acid- • Combination therapy (TMP/SMX and,
worldwide fast staining e.g., meropenem or linezolid) is indicated in
severe disease and CNS involvement

Atypical gram-staining bacteria

 Mycobacterium and mycoplasmataceae
Important Reservo Characteristics and Diseases Antibiotic of choice
species ir important virulence
factors

Mycobacterium Mycobact Humans • Microscopy: acid- • Tuberculosis • See tuberculosis treatment;

erium fast bacilli (AFB) combination therapy of four drugs
tuberculo • Generation (isoniazid, rifampicin, ethambutol,
sis time: 12–18 h and pyrazinamide) over a period
• Important virulenc of ∼ 6 months
e factor:
o Cord factor
o Infiltration of
nonactivated
macrophages

Mycobact Humans • Microscopy: acid- • Leprosy • Dapsone + rifampicin

erium and fast bacilli
leprae armadillo • Obligate
s intracellular
bacterium
• Generation time:
up to 13 days!

Nontuberc Ubiqui Microscopy: acid- • Nontuberculous mycobacterial • Clarithromycin or azithromycin PLU

ulous tous fast bacilli infections S rifabutin (or rifampin)
mycobacter • PCR confirms • Mainly PLUS ethambutol
ia ; • Generation time: in immunocompromised patien • Strong antibiotic resistances are
Important varies among the ts (e.g., HIV; see HIV-associated common
examples subtypes; faster conditions)
include than
M. avium- other mycobacteri
intracellular a
e
M. kansasii
M. marinum
M. ulcerans
 Important Reservo Characteristics and Diseases Antibiotic of choice
species ir important virulence
factors

Mycoplasmataceae ( Mycoplas Humans • Microaerophile • Atypical pneumonia • Macrolides (e.g., clarithromycin)

Mycoplasma) ma are the • Incomplete/absen
pneumon only t cell wall
iae hosts • Pleomorphic
• Bacterial culture is
time consuming
(2–3 weeks) and
the bacteria are
Ureaplas May be fastidious → • Urocystitis • Doxycycline or macrolides (e.g., er
ma part of Serological ythromycin)
urealyticu the diagnosis is
m normal required in most
flora cases.
• M. pneumoniae :
grows on Eaton
agar
Spirochetes
Genus Important species Reservoir Characteristics and Diseases Antibiotic of choice
important virulence factors

Treponema Treponema pallidum Humans • Bacterial growth in culture is • Syphilis • Penicillin G

not possible.
• Darkfield
microscopy and serology are
Treponema vincentii primarily used for detection. • Acute necrotizing • Penicillin G, tetracycline,
ulcerative or clindamycin
gingivitis (Vincent
angina)

Borrelia Borrelia burgdorferi Ticks or • Obligate intracellular • Lyme disease • Doxycycline or ceftriaxone
mammals • Motile: possess flagella
• Microaerophile
• Darkfield microscopy
and serology are primarily
used for detection. Giemsa
stain is also possible.

Leptospira Leptospira Animals (e.g., • Aerobic • Leptospirosis (Weil's • Penicillin G or tetracycline

interrogans, rats, cattle, • Darkfield disease)
Leptospira kirschneri sheep, and microscopy or silver-stain are
goats) are the primarily used for detection.
natural hosts;
incidental
transmission to
humans through
direct contact to
animals, or
indirectly
through contact
with
contaminated
water or soil
Obligate intracellular bacteria
Genus Species Reservoir Characteristics Diseases Antibiotic of choice
and
important virule
nce factors

Chlamydiaceae (Chlamy Chlamydia • Humans are the only • Gram-negative • Chlamydial • Doxycycline or macrolides
dia) trachomatis hosts • Culture: genitourinary
difficult; infections
requires tissue • Lymphogranuloma
medium venereum
• Various • Chlamydial
pathogenic conjunctivitis
serotypes with
different organ
associations
(see table
in chlamydia
infections)

Chlamydoph • Birds are the typical • Microscopy: • Ornithosis

ila psittaci hosts visible
as inclusion
bodies
• Culture:
difficult and
dangerous
(highly
infectious)

Chlamydoph • Humans are the only • Microscopy: • Chlamydial pneum

ila known hosts visible onia
pneumoniae as inclusion
bodies
• Culture:
difficult;
requires tissue
culture
Genus Species Reservoir Characteristics Diseases Antibiotic of choice
and
important virule
nce factors

Rickettsia • Rickettsia • Arthropods (transmis • Weakly gram- • Rocky Mountain • Doxycycline or chloramphe
rickettsii sion to humans negative bacter spotted fever nicol
via ticks or mites) ia

• Rickettsia • Spotted fever

prowazeki • Typhus
i

Coxiella • Coxiella • Cattle, sheep, and • Gram- • Q fever • Doxycycline or erythromyci

burnetii goats are the typical negative bacter n
hosts ia
• Ability to
survive in very
harsh
environments