Bacteriology 1
Bacterial G General Characteristics
Genus +/- Epidemiology
Staphylo-
coccus
+ Cocci
Catalase Positive
Facultative anaerobes
Grape like clusters
- never present in chains
- Catalase Positive:
- used to differentiate
between staphylococci
and streptococcus
- non motile
- staphylococci usually
found on anterior nares,
nasopharynx, or on skin
of the human body
- commonly shed:
- passed person to
person
- persist in environment
- disinfection and
handwashing is
essential
- S. aureus is present in
20-50% of humans
- endocarditis:
-mortality ~50%
Epidermidis
Saprophyticus
Haemolyticus
Species Species Characteristics/
Lab Diagnosis
Aureus - Coagulase Pos.
- β-hemolytic
- True pathogen
- Light gold blood agar
colonies
- Salt tolerant
- Ferments manitol
- mannitol/salt agar test:
- contains 7.5% NaCl
- mannitol is used as
carbon/energy source
- only S. aureus can
tolerate & grow on
agar
- changes manitol from
phenol red to yellow
- opportunistic pathogen
- no β-hemolysis of blood
- Coagulase Neg.
- Novobiocin
- opportunistic pathogen
- no β-hemolysis of blood
- Coagulase Neg.
- Novobiocin
- opportunistic pathogen
- no β-hemolysis of blood
- Coagulase Neg.
Clinical Diseases Virulence/Treatment/Other
Toxin Based:
- Scalded-skin syndrome:
- virulence factors:
- Structural
- inflammation around mouth and then spreads to body - Protein A – anti-Fc IgG
- blisters form  leads to Nikolsky‟s Sign (peel @ touch) - toxins:
- Bullous Impetigo - α, β, γ, δ cytotoxins:
- Food poisoning - lyse cells (i.e RBC) by acting
- bacteria in food on cell membrane
- heating kills bacteria (not toxin) - leukocidin:
- symptoms: 1-6hrs - form pores in WBC membrane
- nausea/vomiting - exfoliative toxins:
- abdominal pain & diarrhea - cause loss of superficial skin
- Toxic Shock Syndrome: layer
- tampon, wound, abrupt, multi-organ failure - enterotoxin A-E:
-high fever, vomiting, diarrhea, muscle pain - heat-stabile toxins
Bacterium Based: pyogenic infections - act as superantigens
-folliculitis- infected hair follicle - act on GI neural receptors
-furuncle- boil or abscess - cause vomiting
-carbuncle- abscess that spread through subcutaneous - TSST
tissue - act as superantigen
-impetigo- involve s. pyogenes -increase cytokine release
- red macula - hypovolemic shock
- pustule (may rupture/crust) - inhibit phagocytosis
- bacteremia & endocarditis - Protein A on cell wall of bacteria
- begin with flu like symptoms binds to Fc receptor on
- if prolongedendocarditis neutrophils
- reduced cardiac output - prevent phagocytosis
- septic emboli - attachment:
- pneumonia & empyema (pus in a cavity/space) - teichoic acids
- acquired via aspiration/blood - microcapsule or slime layer
- old, young - enzymes:
- osteomylitis & septic arthritis - coagulase, catalase, penicillinase
-metaphyseal long bone effected hyaluronidase, lipase, nuclease
- adults: Brodie’s abscess
- children: abrupt onset Treatment:
- septic  joint, back pain - Resistance via Beta-lactamase
- resistant to PBP alternates
- MRSA
- Vancomycin, Clindamycin
- Polysaccharide Capsule adheres to prosthetic devices
- associated with nosocomial infections Treatment:
- Blood Culture contamination - Vancomycin
Urinary Tract Infections:
- mainly in young females who are 1st time sexually active Other CNS Staphylococci Infections:
- dysuria, pyruia - subacute endocarditis
- artificial valves
- catheter/shunt infections
- prosthetic join infections
- glomerulonephritis

Bacterial G General Characteristics
Genus +/- Epidemiology
Strepto-
coccus
+ Cocci
Catalase Negative
Anaerobic
- Cocci in pairs or
chains
- some are hemolytic
- Capsule
- require enriched media
for good growth
S. Pyogenus:
- often colonize (found) in
oropharynx - SWAB
- usually transferred via
large droplet
transmission
- pharyngitis usually seen
in 5-15yr olds
- crowded indoor living
fascilitates spreading
- soft tissue infections are
usually preceded by
breaks in skin:
- pyoderma
- erydipelas
- cellulites
- fasciitis
- necrotizing fasciitis:
- mortality > 50%
- Strep. Shock Syndrome:
- increased in
immunodepressed
patients (i.e. AIDs,
cancer, diabetes
mellitus, heart &
pulmonary disease)
Bacteriology 2
Species Species Characteristics/ Clinical Diseases Virulence/Treatment/Other
Lab Diagnosis
Pyogenus - Lancefield Group A
- Catalase Neg.
Toxin Based – Supportive:
Pharyngitis: (similar to viral pharyngitis)
Virulence Factors:
- Capsule
- β-hemolytic - abrupt onset of symptoms: -has M-protein found on fimbriae
- (large zone) - sore throat, fever, malaise, headache - inhibits complement activation
- PYR Pos. - tonsilor erythema, hypertrophy, and exudates - antiphagocytic, adherence
- Pyrrolidonyl - possible abscesses, otitis media, sinusitis - Lipoteichoic Acid, F protein
Arylamidase - enlarged anterior cervical lymph nodes - Strep. Pyogenic exotoxins A, B, C:
- unique to pyogenus Scarlet Fever: - Heat labile, supertoxin
- M-protein (gives matte - caused via lysogenization w/ phage that contains - shock, organ failure, fever, rash
appearance) the gene for pyrogenic exotoxin - T-cell proliferation
- short of long chains - - day 1: (pharyngitis) - B-cell suppression
usually found coupled - buccal mucosa, temples, deep red cheeks - A & C: superantigens
with WBCs - pale area around nose and mouth - inhibit liver clearance of
- not usually on skin - yellow coat on tongue (shed: “strawberry tongue”) endotoxin
- small glossy or matte - day 2: (rash – spares face) - B: cause tissue invasion &
white colonies - starts at trunk and neck and spread to extremities spread of necrotizing fasciitis
- latex agglutination: Pyroderma (impetigo): - streptolysin O:
- used to detect group- - confined purulent (pussy) infection on skin - responsible for β-hemolysis
specific antigens - person-person contact, children poor hygiene - antigenic (anti-streptolysin O
back of oropharynx - purulent vescicles  rupture, & honey colored crust over antibodies will be formed
- Strict anaerobes Erysipelas: following infection)
- aero (O ) tolerant
2 - acute skin infection with systemic signs - oxygen Labile
-
but grows best in low - preceded by pharyngitis or skin infections - streptolysin S:
O2 environments - red, edematous skin with sharp demarcated borders - also responsible for β-hemolysis
- common on leg (with local inflammation) - not antigenic
- Bacitracin Sensitive - local lymph node enlargement - Oxygen stable
-
inhibits S. pyogenus Cellulitis: - streptodornase (DNase):
growth on blood agar - acute, spreading inflammation involving skin and - causes necrosis
-
only Beta-H strep Sens subcutaneous tissue - Hyalyuronidase:
- different from erysipelas (indistinct non raised margins) - spreading factor
- may be caused by non-pyogenus species - streptokinase:
Necrotizing Fasciitis: - type of fibrinolysin
- subcutaneous necrotic infection that spreads along - activates plasmin causing
fascial planes the break up of fibrin blood
- begins with cellulites & associated with severe pain clots
- extensive damage to muscle and fat (gangrene) - C5a peptidase
- gangrene and bacteremia - prevents PMN action
- systemic symptoms and signs
- treatment: antibiotics & surgical debridement
Streptococcal Shock Syndrome (TSS): Treatment:
- initial soft tissue inflammation, bacteremia - Penecillin G:
- may have shock and organ failure - given early to prevent rheumatic
Post-Streptococcal (non-supportive) Disease: fever in pharyngitis patients
- Rheumatic Fever: ASO test - erythromycin, cephalosporin
- M-protein auto-antibodies to cardiac myosin etc. - Drainage of pustules
- heart, joints, blood vessel inflammation - Debridement (in Necrotizing
- chronic progressive heart damage Fascititis)
- permenant residual damage – recurrent
- Subacute Endocarditis
- Ashchoff body- pathognomic lesion
- Acute Glomerulonephritis: (type III hypersensitivity)
- anti DNase Test

Bacterial G General Characteristics
Genus +/- Epidemiology
S. Agalactiae:
- normally found in GI tract
& genitourinary tract
-15-20% of women carry
this in vagina pregnancy
- Screen all preg women
Pneumoniae
S. Pneumoniae:
- commonly found in throat
& nasopharynx in healthy
people (5-40%)
- Disease occurs when
spread to:
- lungs, ears, paranasal
sin
(aginus, mitus,
S. Viridans:
- colonize throat, GI tract,
and genitourinary tract
uses, meninges
Entero- - enteric commensals
coccus
Species Species Characteristics/
Lab Diagnosis
Agalactiae - Lancefield Group B
- β-hemolytic
- Bacitracin Resistant
- Hippurate Hydrolysis
- CAMP pos.
- Facultative anaerobes
- CSF or urine test
- No Lancefield Group
- α-hemolytic
- Catalse Neg.
- Facultative anaerobes
- bullet diplococci
- in pairs or short chains
- round glistening colonies
- Capsule (83 ser.)
- Optochin Sensitive
- antibiotic culture test
- only strep sens, dies
- Bile Soluble/Sensitive
- no growth on media
- Quellung Pos.
- Anti-Capsular Ab`s
- swelling
Viridans - No Lancefield Group
- α/non-hemolytic
mutans) - Facultative anaerobes
- have some antibiotic
resistance
Faecalis / - Lancefield Group D
Faecium - Variable hemolysis
- Facultative anaerobes
- Hydrolyze Esculin
-in presence of bile
and salt
- Cocci, pairs, short
chains
- different genus but still
considered part of
streptococcus family
- non-hemolytic or
α-hemolytic
- can grow in 6.5% salt &
40% bile
Bacteriology 3
Clinical Diseases Virulence/Treatment/Other
- immune complex depositions in glomerulus
- edema, hematuria, proteinuria
- decreased urination, hypertention
- no long term residual damage
Neonatal Diseases Virulence Factors:
- Septicemia, Meningitis, Pneumonia : - Capsule (pyogenic)
- most important cause of this - C5a inactivating peptidase
- Neurolgic Sequelae, low mortality Treatment of Choice:
- Early Onset: in-utero or at birth - Penecillin G
- Late Onset: exogenous sorurce Meningitis - w/ aminoglycoside if serious
- stiff neck seen more in adults - Chemoprophylaxis - @ risk mothers
Pneumonia- occurs when bacteria spreads to lungs Virulence Factors:
- S. pneumonia is the most common cause of - Capsule - Antiphagocytic (pyogenic)
pneumonia, lobar pneumonia - surface protein adhesion
- predisposing factors: - pneumolysin O:
-crowded conditions, alcohol/drugs, splenectormy, COPD - pores in cell, prevents O2 burst
- alveolar edema – PMNS, RBCs, etc - alpha hemolysin, cilia
- abrupt onset: -Colonization, Tissue destruction
- chills, high fever, bloody cough, pleuritic chest pain - IgA protease, adhesins
Otitis Media- occurs when bacteria spreads to ears - Teichoic acid, peptidoglycan
Sinusitis- occurs when bacteria is spread to paranasal fragments & pneumolysin:
sinuses - activate complement system
Meningitis- occurs when bacteria is spread to meninges - inflammation
- teichoic acid: adhesin
Treatment:
- Penecillin resistant - PBP
- resistance due to alt transpeptides
- Vaccine (Conjugated, Unconjugated)
- Other: erythromycin, vancomycin,
quinolones, ceftriaxone
Dental Infections: Treatment:
- can bind to teeth and ferment sugar - Penecillin, aminoglycoside
- cause dental
cavities
Subacute Endocarditis
- usually occurs on previously damaged heart valves
- Brain abscesses
- intra-abdominal infections
Nosocomial Infections Leading Cause- - resistant to vancomyocine,
- affect urinary tract and blood - UTI sulfonamides, tetracyclines,
- via catheter use, prolonged hospitalization, or antibiotic erythromycin, cephasporins
use - New VRE antibiotics
- can effect abdomen after bowel surgery -linezolid, quinipristin, fluorquinones
Endocarditis:
- high mortality
Biliary Tract infection
 Bacteriology 4
Bacterial G General Characteristics Species Species Characteristics/ Clinical Diseases Virulence/Treatment/Other
Genus +/- Epidemiology Lab Diagnosis

Bacterial G General Characteristics Species Species Characteristics/
Genus +/- Epidemiology Lab Diagnosis
Botulinum: Botulinum - Motile (H antigen)
- found in soil and water - fastidious (complex
- rare in US nutritional
- Canned food, fish (A,B,E) requirements)
- form endospores
- 7 possible toxins
- each bacterial isolate
only has 1 toxin
- RCM
- growth on
anaerobic medium
- ferment glucose, digest
milk proteins,
- associated with cocaine use
- Inhalation Botulism: Bioterrorism
Tetani - Drum stick
Tetani: -small, rounded
- underdeveloped terminal spores
countries: - Motile (H antigen)
- 20-50% mortality - may be gram negative in
- usually caused by very young or old cultures
non-sterile care of - Strict Anaerobe
Umbilicus - very sensitive to
-Epi: soil, GI, spores oxygen toxicity
- US: toxoid - Grows as film, no
immunization colonies
sometimes (rarely) - proteolytic, no
causes disease fermentation
- anti tetanus toxin test
Difficile - Motile (H antigen)
Difficile: - Strict anaerobe
- relapses may occur in up - part of normal flora of GI
to 30% of the patients tract
- can be eliminated
using second
courses of treatment
Bacteriology 5
Clinical Diseases Virulence/Treatment/Other
- Flaccid Paralysis - Botulinum Toxin:
- Foodborne Botulism: - targets cholinergic nerves
- caused by 12-36 hour incubation of food - blocks acetylcholine release
- ingestion of contaminated food Treatment:
- nausea, dry mouth, and sometimes diarrhea - clinical diagnosis done first
- weakness / dizziness - culture and toxin activity used for
- blurred vision (fixed dilated pupils) confirmation
- constipation and abdominal pain - treatment:
- *no fever, flaccid paralysis - ventilation support
- respiratory paralysis may cause death - trivalent botulinum anti-toxin or
- Irreveribl bound toxin, months for recovery heptavalent antitoxin (used for
- Infant Botulism: military; prepared in horses)
- most common in US - elimination of organism from GI:
- often seen when feeding baby non-pasturized honey - gastric lavage
- neurotoxin colonize in GI tract - antibiotics:
- ‘floppy baby syndrome’- - metronidazole
- constipation, weak cry, poor muscle tone, failure to - NO penicillin
thrive, possible (rare) death - *antibiotics only used for
- C Botulin does not survive in adults wound botulism
- Wound Botulism: C Botulin - prevention:
- neurotoxin produced in contaminated wounds - proper food storage,
- food heating
- no honey for babies
Tetany- spastic paralysis Tetanospasmin - heat labile neurotoxin
- Generalized: - released from lysed cells
- unregulated muscle contracts - A-B toxin (Light , Heavy)
- caused by tetanospasmin - A -Chain: travels retrograde via
- trismus- inability to open mouth (locked-jaw) neurons and localizes in presynaptic
- Opisthotonus- massive contraction of back muscles nerve terminals- B-anti sialic Recptors
- risus sardonicus- facial spasms, grimace, smile - blocks the release of GABA and
- Localized glycine (inhibitory neurotransmitters)
- @ site of infection Tetanolysin- oxygen-labile hemolysin
- Neonatal Treatment:
- umbilical infection – developing world - diagnosis based on clinical signs
- debridgement, passive ab, DPT,
- Tetanus remains bound to nerves  wait for recovery vaccination with toxoid + Booster
- antibiotics: metronidazole
- Antibiotic-associated diarrhea colitis - enterotoxin (toxin A): Diarrhea
- caused by ampicillin or clindamyocin - chemotactic for neutrophils
- result in alterations of normal flora - cause cytokine release in ileum
- Leads to Pseudomembranous Colitis (PMC) - hypersecretion of fluid
- hemorrhagic necrosis
- cytotoxin (toxin B): Cell Death
- causes depolymerization of actin
- results in cell death
Treatment:
- culture isolation on selective media
- invitro cytotoxicity assay
-*immunoassay of enterotoxin in stool
- discontinuation of symptom causing
previous antibiotics
- metronidazole or vancomycin
 Bacteriology 6
Bacterial G General Characteristics Species Species Characteristics/ Clinical Diseases Virulence/Treatment/Other
Genus +/- Epidemiology Lab Diagnosis
Corny-
bacterium
+ Rod
Non Spore Forming
diptheria - Catalase Pos.
- Non - Motile
Respiratory Diptheria
- Sudden Onset: malaise, sore throat, exudative
Virulence:
- Exotoxin gene – lysogenized
Fac Anaerobic - Arabinose cell wall pharyngitis, local infection - A toxin: prevents EF 2
-Non – Acid Fast - Pseudomembrane (WBC, fibrin, cells, exudate) - B toxin: entry
- Pleiomorphic bacillius - hard to remove, causes tissue bleeding - cysteinase
- Humans only reservoirs - club shaped, terminal - breathing obstruction
- Normal Flora swelling - site of toxin release Treatment/Prevention:
- skin, URT, GI, UTI - Chinese letter - Bullneck appearance - use clinical diagnosis, toxic test
- throat swab - palisades Cutaneous Diptheria - Diptheria antitoxin immediately to,
- Worldwide, USSR - V,Y shaped - via skin contact person – person neturalize exotoxin (binds irreversibly)
outbreak -Microscopy: - Initial Papule  chronic non healing ulcer w/ gray - Penicillin or Erythromycin
- Uncommon US - Metachromatic granules Membrane - Bed rest, open airway
- Primarily Paediatric - via Alberts Stain - Immunization: DPT toxoid w/ boost
Disease - Culture Analysis
- Potassium Tellurite-
Tinsdale Agar
- gray black colonies
- cysteinase produces
brown halo’s
- Loefflers serum
- enhances m. granule
growth
- Toxicity Test
- Elek Test
- Immuno Assay
- Tox detection

Listeria
+ Rod
Non Spore Forming
monocytogen - β- hemolyitic (weak)
- Catalase Pos.
Fetal/Neonatal Disease
- Early Onset: In utero, high fetal mortality
- Intracellular Parasite
- Macrophage, epithelial cells
es
Fac Anaerobic - Motile - Late Onset: Neonatal Meningitis - Listeriolsyin O, PLC
- cold enhancement Adult: - released via phagolysosome pH
- Mild flu like, GI diarrhea, fever - heat labile, antigenic
- GI of mammals, soil, - Sepsis or Meningitis in Immunocompromised or fetus - Endotoxin
water - LPS- Lipid A
- Outbreak via food - only g Pos w/ LPS
- Unpasteruized Cheese - Internalins
(US), milk, meat - Actin: cell to cell movement
- In utero infection
- Highest mortality of all
food infections

Other Listeria - Acne (Proprionibacterium acnes)

- Dental Caries (Lactobacillus)
- Erysipelothrix rhusopathiae
- Rare skin infection via animal products

Bacterial G General Characteristics
Genus +/- Epidemiology
Neisseria-
ce
- Diplococci
Aerobic?
Catalase Pos.
Oxidase Pos.
- kidney bean shaped
- oxidative-positive
- cytochrome c, need Fe
- Aerobic
- but grows best in 5%
CO2 (high CO2)
environments
Meningitis:
- RESV: humans only host
- MOT: air droplets
- peak late winter / early
spring
- 5-15% chronic carriers
- disease more common in
C5-C9 deficient people
gonorrhoeae
Gonorrhoeae:
- RESV: humans only host
- MOT: STD
- risk of acquisition on first
exposure:
M: 20%
F: 50% (main RESV)
- aftican-americans more
prone to these infections
- penicillin no longer
antibiotic of choice
Species Species Characteristics/
Lab Diagnosis
meningitis - Acid production via
glucose and maltose
oxidative metabolism
- oxidase-positive
- catalase-positive
- susceptible to drying and
cool temperatures
- blood and CSF test
- diplococci w/in PMNs
- latex agglutination via
soluble polysaccharide
antigen
Culture:
- Thayer-martin agar or
chocolate agar
- Acid production via
glucose oxidation
- doughnut shaped
diplococci
- oxidase-positive
- catalase-positive
- Fastidious: require
complex media, humid
atmosphere,cysteine high
CO2
Culture:
- Thayer-martin agar for
gonorrhea, and on
chocolate agar for
infections
- Chlamydia: #1 STD, co-
infection w/ gonorrhea
Bacteriology 26
Clinical Diseases Virulence/Treatment/Other
Meningitis
- abrupt onset w/ headache, fever, seizures
Virulence Factors:
- True polysaccharide capsule
- may have just fever and vomiting (less specific signs) (main virulence factor) protects from
- mortality close to 100% if not treated intracellular killing
Meningoccemia (septicemia): - LPS endotoxin w/ Lipid A
- More serious, life threatening - pili attach to receptors on
- skin rash types non-ciliated cells of nasopharynx
- urticarial- hives (type 1 hypersensitivity) - Por A, Por B
- maculopapular- raised non-fluid filled - avoid phagocytic killing and
- petechial- hemorrhagic spots caused by migrate to subepithelial space
thrombosis of small blood vessels in skin - endotoxin (LPS):
- indicate development of disseminated - causes diffuse vascular damage
intravascular coagulation (DIC) - IgA protease
- malaise, weakness, headache - Transferrin - absorb iron
- hypotension, peripheral vasoconstriction, cyanotic - serogroups: A, B, C, X, Y, W135
extremities - A: more likely to cause epidemics
Waterhouse- Friderichsen Sydrome: in undeveloped countries
- severe form of meningococcemia Treatment:
- disseminated intravascular coagulation, shock (DIC) - DOC: penicillin
- bilateral destruction of adrenal glands  Fatal - prophylactic treatment to those that
may be exposed:
- antibiotics
- group specific vaccine
Gonorrhea: Virulence Factors:
- Pathogenesis: OMPs for invasion, - NO capsule - but neg charge
- Enter subepithilum  TNF- α via LOS  complement - pili for attachment
activation  Risk for Immunocompromised - lack immunity to re-infection
- Men: - LOS has lipid A and weak
- purulent urethral discharge and dysuria endotoxin activity
- 95% of men have acute symptoms - outer membrane proteins (OMPs):
- G -ve diplococci seen in gram stain of discharge - PorA: prevent lysosome-
- anorectal infection phagosome fusion
- Women: - Opa: mediate binding to
- cervix with vaginal discharge, dysuria, abdominal epithelial cell
pain, bartholin gland abscess - Rmp: stimulate antibodies to
- *often may be asymptomatic block bactericidal activity
- can spread up into fallopian tube & abdominal cavity against bacteria
- can cause pelvic inflammation disease, salpingitis - Transferrin - absorb iron
- sterility, ectopic pregnancy, abscess - IgA protease, β-lactamase
Disseminated Gonococcemia:
- systemic infection  Joints and skin  ARTHRITIS Treatment:
- Pustular Rash - Resistance:
Ophthalmia Neonatorum: - Penicillin: βL, ∆ PBP
- Mother  fetus @ delivery - Tetra, erthyro, amino, cipro
- Purulent Conjunctivitis  Lid Edema, Erythema, - DOC: cephalosporin: ceftriaxone
discharge - doxycycline or azithromycine if
*Additional Treatment: - Chlamydia is also presen
- 1% silver nitrate or 1% tetracycline or 0.5%
erythromycine ointment placed in new borns eyes to
protect baby
- sex education, aggressive detection, and follow up on
sexual contacts

Bacterial G General Characteristics
Genus +/- Epidemiology
Entero-
bacteria-
- Bacilli
Fac. Anaerobic
ceae Catalase Pos.
Oxidase Neg.
- RESV: human, animal GI
- MOT: fecal - oral
- enteric bacilli
- No spore formation
- found as normal flora in
humans and animals
- members of normal
intestinal flora
- true facultative anaerobes
- most common important
species of
enterobacteriaceae to
cause human diseases
- opportunistic
pathogens
Intestinal Diseases:
- MOT: F O via water
- diarrheal diseases
Bacteriology 12
Species Species Characteristics/ Clinical Diseases Virulence/Treatment/Other
Lab Diagnosis
Escherichia
Coli
- Motile or nonmotile
- Ferment glucose and
Extra Intestinal Disease:
Urinary Tract infection:
Virulence Factors:
- adhesions:
(E. Coli) lactose (MacConkey - uncomplicated --. Cystis = lower UTI - variable p-pili, fimbriae
Agar) - complicated  pyelonephritis = upper UTI - colonizing factor antigen (CFA)
General - Reduce Nitrate, energy - E. coli is most common cause of UTI - exotoxins:
Characteristic - Non-selective agars - comes from GI tract - vertotoxin
Of E. Coli - bovine species: - P. pili or fimbriae cause E. coli to adhere to uroepithelial - heat-stable toxin
- have hemorrhagic cells allosing the bacteria to ascend into the urethra - heat-labile toxins
strains - may decrease IgA transport into the lumen - Shiga - Toxins
Neonatal Septicemia & Meningitis: (K1 antigen) - hemolysis
- E. coli is second most common cause (1st: S. agalactiae) - antigens:
- Neonatal meningitis treatment: - O-antigen
- ampicillin + cefalotaxime - present in all E.coli strains
Septicemia - Nosocomial: - heat stable
- invasion along IV lines or escape from GI tract after - polysaccharide core of
cytotoxic drugs damage to mucosa, highly mortality in IC Lippopolysaccharide (LPS)
- endotoxin shock, pneumonia - Lipid A – released @ lysis
- treatment: - H-antigen
- parenteral antibiotics (3rd generation cephalosporin + - only present on motile strains
aminoglycosides) - removed via heat/alcohol
Meningitis: - can change between 2 forms
- OMP-A: outer membrane protein that allows the K-1 - K-antigen
capsule to cross epithelium & enter blood brain - capsule or fimbriae
barrier - sequestration of growth factors, Fe
- K-1 Capsule: increases bacterial survival in brain
Gastroenterides/Diarrhea
Entero- - Intimin Neg. T raveler‟s Diarrhea- watery stool Toxins:
Toxigenic - enterohemolysin negative - No fever - Heat Labile Toxin:
E. Coli - primarily involves small - E. colli adhere to CFA-1
(ETEC) intestine through CFA-4
- infective at high doses - activates adenylate cyclase
- increase cAMP (like cholera)
Identification: - increases outflow of Cl- & H2O
- immunoassay - Heat Stabile Toxin
- bioassay in animals - type A:
- DNA probes or PCR for - increases cGMP
toxins - water loss, diarrhea
- type B:
- activates intracellular
calcium
- secrete cyclic nucleotide
independent bicarbonate
- CFA - Colonizing Factors:
- attachment to epithelium
Treatment:
- rehydration
- trimethoprim-sulfamethoxazole
- slows peristalsis
 Bacteriology 13
Bacterial G General Characteristics Species Species Characteristics/ Clinical Diseases Virulence/Treatment/Other
Genus +/- Epidemiology Lab Diagnosis
Entero- - invasive - Begin as watery diarrhea  progress to dysentery  Plasmid:
Invasive - Intimin Neg. bloody dystentry w/ mucus + WBC in feces - invade local mucosa
E. Coli - enterohemolysin negative - mucoid, bloody, leukocytic (WBC) stool - use host actin filaments for motility
(EIEC) - involves small intestine - minimal blood: usually if it gets into circulation it will Invasive Gene Product:
and colon get destroyed - Type III secretion system
- infective at high doses - high fever & abdominal cramps - Ipa A- related to invasiveness
- same pathogenicity as - Ipa B- lyses vacuole
type 1 shigela - Not impt?

Entero- - Intimin Pos. Infant Diarrhea: Plasmid (60MDa, pMAR2, EAF, bfpa)
pathogenic - enterohemolysin negative - second most common cause after rotovirus - attach to epithelial cells via bundle-
E. Coli - primarily involves small - prefusive watery diarrhea in 0-1 year olds forming pili (BFP)
(EPEC) intestine - increased cytoplasmic Ca2+ LEE:
- infective at high doses - outbreaks seen in day care centers and peds wards - attach to and efface brush border of
watery & bloody stool epithelium by injection and
high fever phosphorylation of TIR receptor
which is then presented by host cell
and allows binding of intimin
(OMP) and entry of E. coli
AE lesions:
-results in loss of microvilli from
intestinal epithelium and the
formation of cuplike pedestals
(where EPEC) attach (adherence
and effacement lesions)
Serology:
- O26, O111, etc…
Treatment:
- for blood diarrhea with pus
and fever: flouroquinolones

EHEC: Entero- - Intimin Pos. Hemolytic Uremic Syndrome: Toxins:

- RESV: Cattle Hemolytic - Enterohemolysin Pos. - more common in children under age 5 - Shiga Toxin (Verotoxin/STX toxin)
- MOT: Food or water w/ E. Coli - Non Sorbitol Fermenter - microangiopathic hemolytic anemia - inhibits protein synthesis
human, cattle (EHEC - compare Klebsiella - thrombocytopenia - injures 60S ribosome
feces 0157:H7) Serology: - renal failure - types 1 and 2
- most common Ecoli w/ - most common: O157:H7 - hemorrhagic colitis (watery bloody stool) - kills cells with STX receptors
toxin production - others: O26, O111, etc... - no fever - absorptive villus cells
- primarily involves colon - no excessive WBCs (NOT secertory crypt cells)
- infective at low doses Diagnosis: - *antibiotic use may increase chance of HUS and kidney - renal epithelium cells
- can survive low pH - isolation of non-sorbitol damage - reach here through blood
- more common in Western fermenters on sorbitol - ascending/transverse colon
Canada and northern US MacConkey‟s agar Clinical Presentation: - often induces proinflammatory
- 10% get renal heart - DNA probes for - pallor (pale skin) cytokine expression
failure verotoxin gene - weakness Treatment:
- 3-5% mortality rate - irritability - Rehydrate
- anuria or oliguria - No antibiotics

Bacterial G General Characteristics
Genus +/- Epidemiology
Shigella:
- RESV: Humans only
- MOT: FO,PP, via
fecal contamination of h
hands
- highly infectious
- highly communicable
- primarly effects children
under 15 years old
- day care centers,
nurseries
Salmonella
RESV: Typhi  humans
Others  all animals
MOT: Food, water, FO
- most common source:
- eggs, poultry, dairy
products
- S. typhi only needs low
infectious dose
- all others require high
infectious dose
Species Species Characteristics/
Lab Diagnosis
Entero- - attach to each other via
Aggregative fimbriae to create
E. Coli „stacked-brick-like’
(EAEC) Biofilm
- aggregative adherence
to intestinal epithelium
and typical lesion:
- mucus aggregates of
bacteria seen on surface
- shorter, rounder villi
- hemorrhagic necrosis of
villus tip
- inflammation
Shigella - Ferments glucose
- MacConkey Agar
- Non Motile: No flagella
- do NOT ferment lactose
- do NOT produce
hydrogen sulfide gas
Species:
- Sonnei, flexneri,
dysenteriae (most
severe)
Diagnosis:
- Widal Test
Salmonella - Motile (flagella)
- Oxidase Neg.
- Fac. Anaerobic
- Ferment glucose
- do NOT ferment lactose
- Hydrogen Sulfide Gas
production
Species:
- enterica & bongori
Diagnosis:
- EMB, MacConkey media
- used to distinguish
lactose fermenters
from non-lactose
fermenters
- XLP selective media:
- distinguish between
salmonella and shigella
- Selenite F Broth
Bacteriology 14
Clinical Diseases Virulence/Treatment/Other
Persistant Diarrhea: Virulence:
- low grade fever Plasmid:
- vomiting - aggregative adherence to HEp-2
- no mucus or blood present in diarrhea cells
Travelers Diarrhea Enterotoxins
Neonatal Meningitis:
- treated with ampicillin + cefataxime
Shigellosis: Virulence Factors:
- short incubation period, few organisms - endotoxin
- abdominal cramping and tenesmus (rectal spasms) - adherence genes
- diarrhea - invasion genes
- fever - intracellular replication genes
- blood stool with pus (dysentery) - Shiga Toxin:
- seen in S. dysenteriae
- disrupts protein synthesis
- causes endothelial damage
- renal failure: disrupts glomerulus
- actin filament rearrangement
transfers bacteria from host to host
Treatment:
- self limited
- start w/ trimeth/sulfa
- switch based on susceptibility testing
Typhoid (enteric) Fever: Virulence Factors:
- via dissemination of S. enterica typhi (has a vaccine) - invade & survive in M cells of
- bacteria are taken up by macrophages from M cells peyer’s patches and macrophages
- transported to and multiply in liver, spleen, & bone - fimbriae
marrow - invasion proteins (Sips / Ssps)
- colonization of gall bladder, reinfection of intestines - can survive acid environment of
- fever appear 10-14 days after infection phagosomes (ATR gene)
- rose spots on chest - endotoxin
- diarrhea may be seen later in disease
- treatment: flouroquinolones, chloroamphenicol,
etc.. Asymptomatic colonization:
- treatment: flouroquinolones, chloroamphenicol, etc..
Gastroenteritis:
- via salmonella enteritidis
- nausea, vomiting, non-bloody diarrhea
- fever, abdominal cramps, myalgias, headache
- lasts 2 days – 1 week
- antibiotic treatment NOT recommended
Septicemia:
- more likely in young or immunocompromised people
- treatment: flouroquinolones, chloroamphenicol, etc..
 Bacteriology 15
Bacterial G General Characteristics Species Species Characteristics/ Clinical Diseases Virulence/Treatment/Other
Genus +/- Epidemiology Lab Diagnosis
Yersina pestis: Yersina pestis - Diagnosis; Sylvatic Plague: - Capsule
- Zoonotic - bipolar staining safety - spread by squirrels, rabbits, rats, cats - Cytokine decresse
- RESV: Rats, squirrles pin appearance Bubbonic plague - Plasminogen Activator Protease:
- Vector: Fleas Y. Pestis, - human (true) pathogen - high fever, axilla or groin lymph node inflammation - only in Y. pestis
- Xenopsylla - resistant to phagocytic Buboes - degrades C3b & C5a
cheopsis killing - bacteremia at later stage - reduces phagocytosis & clot
- MOT: Flea Vector - 75% mortality if untreated breakdown
- DOC: Tetracylcine - Yersinia Outer Proteins (YOPs):
Pneumonic Plague: - for adherence
- high fever, malaise, pulmonary signs - YopE: depolymerization of
- highly infectious actin microfilaments
- 90% mortality if untreated - YopH: dephosphorylation of host
- DOC: Tetracylcine cell proteins
- YopJ/P: initiate apoptosis of
macrophages
- YpkA: serine/threonine kinase
activity
- YopB/D & YopN: translocation and
Other Yersinia: Yersina - enterics Enterocolitis: sensory function
- RESV: pigs, rodents, Entercolitica - rarely enter blood - diarrhea, fever, abdominal pain - YopM: inhibition of
rabbits & - human (true) pathogen - may become chronic  terminal ileum ( mimic platelet
-MOT: milk, meat, water Yersina appendicitis) or may recover in 1-2 weeks aggregation
- Zoonotic Pseudo- - may cause bacteremia and endotoxic shock if Treatment:
- Zoo animals, humans are tuberculosis contaminated blood products are given - vaccine
accidental hosts - chemoprophylaxis with
tetracycline

Klebsiella - MacConkey agar Lobar Pneumonia: Virulence Factor:

pneumoniae - w/ Mucoid colonies - alcoholics and immunocompromised at risk - large capsule!!!
- Community acquired - Necrotic pneumonia destruction of alveolar spaces
- bacilli, large capsules - cavity formation
- Sorbitol Fermentation - Currant Jelly Sputum
- Only pyogenic bacterium w/ permanent damage to lungs

Proteus - colonies show swarming Urinary Tract Infection

Mirabilis growth - facilitates renal stone formation via urease production
- Urease Pos. - increase pH

Enterobacter - TSA, Blood agar, Eosin - Nosocomial: Treatment:

, Citrobacter, methylene blue (Lactose -infections of neonates and immunocompromised patients - use susceptibility testing to
Morganella, fermenter detection) -multiple antibiotic resistant determine which antibiotics are not
& - meningitis, brain abscess resistant
Serratia

Bacterial G General Characteristics
Genus +/- Epidemiology
Vibrio - Curved Bacilli
Fac. Anaerobic
- 60 species,
curved, comma
shaped
- Species:
- parahaemolyticus,
cholera, Vulnifus
- RESV: human colon
- MOT: contaminated food
or water, FO
- PP rare
- present in esturian and
marine environments
with  salinity and
temperatures between
10ºC and 30ºC from
human fecal
contamination
- associated with shellfish
- requires high dose to
cause infection because it
is killed by stomach acids
Species Species Characteristics/
Lab Diagnosis
Cholera - curved rods, w/ polar
flagellum
- Oxidase Pos.
- Fermenter
- Motile: Darting Motility
- subdivided by O antigen
- O1 & O139 cause
classical cholera
- O1 biotypes:
- El Tor
- classical
Diagnosis:
- rarely observed on gram
stain of stool or wounds
- Culture of fresh stool on
TCBS agar
- Motility Detection
- Hanging drop method
- DF Microscopy
- must be protected from
drying
- appropriate transport
medium required if lab is
delayed
- biochemical tests /
serology
Bacteriology 11
Clinical Diseases Virulence/Treatment/Other
Vibrio Cholerae:
- incubation period: 2-3 days
Virulence Factors:
- Cholera A-B Toxin
- abrupt onset of watery diarrhea - heat labile enterotoxin
- rice-water stools - feces streaked water stools that - activates adenyl. cyclase- ↑cAMP
contain mucus - causes hypersecretion of water
- severe fluid and electrolyte loss and electrolytes
- metabolic acidosis - Hap (hemagglutination) gene:
- hypokalemia (cardiac arrhythmias) - stimulates II-8 production and
- hypovolemic shock (renal failure) degredation of junctions of
- mortality: 60% if untreated; 1% if given fluid replacement intestinal mucosa
Vibrio Parahaemolyticus (shellfish): - causes mild to moderate diarrhea
- self-limited explosive diarrhea to mild-cholera like in absence of cholera toxin
symptoms, Adherence:
- wound infection in people w. contaminated sea water – - pili: (toxin coregulated pilus
- bacterimia (TCP) gene complex)
Vibrio Vulnifus: - used for attachment / adherence
- Virulent species of vibrio - accessory colonization factor (ACF)
- rapidly progressive wound infections or septicemia genes
following the consumption or handling of contaminated Treatment:
oysters, cellulitis - fluid/electrolyte replacement
- initial swelling and pain  progression to vesicles - antibiotic therapy:
- important in immunocompromised and liver disease - doxycycline or ciprofloxacine
- may reduce exotoxin production
- doxycline, minocylcine w/
fluroquinonolone or cefotaxime
used to treat v. vulnifus wound
infections
Prevention:
- killed parenteral and oral vaccines
- tetracycline prophlaxis

Aeromona
s
- Bacilli
Fac. Anerobic.
Hydrophila,
caviae,
Gastroenteritis:
-via water or food
Treatment:
- self limited
veronii biovar - acute severe illness in children - DOC: ciproflaxin, gentamicin,
sobria - chronic diarrhea in adults amikacin, Tri-Sulfa
- RESV: fresh and brackish - resembles shigellosis  Blood, WBC in stool - antibiotics for chronic diarrhea
waters Wound Infection: via water - Resistant to penicillin,
Opportunistic Infection: cephalosporin, erythromycin

Bacterial G General Characteristics Species Species Characteristics/
Genus +/- Epidemiology Lab Diagnosis
Campylo-
bacter
- Spiral Bacilli
Fac. Anaerobic
jejuni - Motile: Darting
- curved rods with two
Microaerophilic polar flagellum @
opposite ends
- low dna ( G+C) - Oxidase Pos.
- zoonotic animal - non-fermenter
reservoirs - Catalase Pos.
- food, water, milk - Hippurate Hydrolysis
- more common than
salmonella and shigella Diagnosis:
- Campy Agar
- RESV: normal GI flora of - selective media with
many wild and blood or charcoal to
domestic remove toxic oxygen
animals and antibiotics that
- MOT: Raw Poultry, F O inhibit normal flora
- Grows best @ 42 °C
- not usually gram stained
Helico-
bacter
- Spiral Bacilli
Fac. Anaerobic
pylori - spiral shaped bacterium
- Motile: high, with tuft of
microaerophilic polar flagella
- Oxidase Pos.
- Catalase Pos.
- RESV: Humans only - Produces Urease
- MOT: F  O, O O - does not ferment or
oxidize sugars
- invade neutral pH areas
of stomach and cause
inflammation
Diagnosis:
- Biopsy
- Urease activity
- Urease breath test
measure breath for
ammonia and radioactive
CO2 (after swallowing
radioactive urea)
- serology, Ab detection
Bacteriology 10
Clinical Diseases Virulence/Treatment/Other
Gastroenteritis Diarrhea:
- begins watery and foul smelling
Virulence Factors:
- low ID
50
- later becomes bloody and pusy -
adherence to and invasion of
- more than 10 stools a day intestinal mucosa
- abdominal pain, malaise, nausea,
vomiting Ulcerated Jejunum: Treatment:
- abscesses in jejunum -
fluid and electrolyte replacement
Guillain-Barre Syndrome: -
erythromycin, flouroquinolones,
- autoimmune disease involving Antibodies that cross-react macrolides,
with antigens on neurons and lead to acute chloramphenicoletc
neuromuscular paralysis
- reactive arthritis
- septicemia, meningitis
Chronic gastritis
- recurrent pains in upper abdominal
Virulence factors:
- urease
- frequent bleeding in GI tract - acid-inhibitory protein
- no bacteremia - mucinases and phospholipases:
Peptic ulcers - penetrate stomach mucous layer
- Gastric or duodenal - superoxide dismutase and catalase:
- recurrent pains in upper abdominal - inhibit phagocytic killing
- frequent bleeding in GI tract - Biotype 1: produces
- no bacteremia vacuolating cytotoxin
Stomach Cancers Treatment:
- DOC: Omeprazole (proton pump
inhibitor) + amoxicillin +
clarithromycin + bismuth (Pepto
Bismol)
- Omeprazole + tetracycline +
metronidazole + bismuth

Bacterial G General Characteristics
Genus +/- Epidemiology
Pseudo-
monas
- Curved Rod
Obligate Aerobe
Aeruginosa
- RESV:
- common environment:
- soil, water, normal flora
of moist skin and colon
- resistant to many
antibiotics and
antiseptic, disinfectants
- population at risk:
- burns
- cystic fibrosis
- immunosuppressed
- in dwelling
catheters
- opportunistic pathogens
- minimal nutritional
requirements
- tolerant to wide range
of temperature
- Most common
Nosocomial and drug
resistant infection
Bacter-
oides
- Pleomorphic Rod
Anaerobic
- RESV: Normal flora
- break in mucosa
- tissue necrosis
- poor blood supply
- predominant organism in
human colon
- found in vagina of 60%
of women
- predisposing factors:
- surgery, trauma
- chronic disease
- not communicable
- often found with
facultative
anaerobes
- MC anaerobic infection
after abdominal surgery
Species Species Characteristics/
Lab Diagnosis
- Oxidase Pos.
- Motile: polar flagella
- slightly curved or straight
rod shaped
- does NOT ferment sugars
- pigment production:
- pyocyanin (blue/green)
- flourescein (yellow)
- pyorubin (red/brown)
Diagnosis:
- Non-lactose fermenter
on EBM or MacConkey‟s
- Flat, spreading colonies
with hemolysis
- sweet, fruity odor \
(grapes)
- blue-green pigment on
TSA blood agar
- confirm ID by
biochemical
testing
- Centramide Agar
fragilis - Bile Esculin Formation
- Black Halo
- anaerobic w/ blood agar
- identification by
- pleomorphic size & shape
- non-spore former
biochemical tests
Bacteriology 16
Clinical Diseases Virulence/Treatment/Other
Urinary Tract infection:
Pneumonia:
Virulence:
- Slime layer in Polysaccharide
- especially in cystic fibrosis Capsule
patients Wound Infections: - adhesin
- especially in burn - inhibits phagocytic and antibiotic
patients Septicemia: killing
- mortality: 50% - Pili: adhesion
Ecthyma Gangrenosum: - LPS: endotoxin
- Black Necrotic Lesions on Skin: compare B.anthracis - phospholipase C & rhamnolipids:
Endocarditis: - hemolysins
- seen in IV drug users - breakdown membrane lipids
Corneal Infections: Oncylitis - inhibit ciliary function
Osteomyelitis: - pyocyanin
- diabetics, children, IV drug users - impairs ciliary function
- stimulates inflammation
Treatment: - mediates tissue damage
- sensitivity testing* - toxins:
- DOC: antipseudomonal penicillin + aminoglycoside - exotoxin A: ribosylates EF-2
- patient care: - similar to diphtheria toxin
- timely removal of catheters - exotoxin B: inhibits translation
- care of burns - exoenzyme S: ADP-ribosylation
of GTP-binding
proteins
- enzymes:
- protease, phospholipase,
elastase*
- cause pulmonary hemorrhages
- Invasins:
- elastase, alkaline protease,
hemolysins, cytotoxin,
siderphores, pyocyanin
diffusible pigment
Intra-abdominal Infections:
- peritonitis
Virulence:
- polysaccharide capsule
- local abscess - little or no endotoxin activity
Pelvic Abscesses:
Necrotizing Fasciitis: Treatment:
Bacteremia: - DOC: Mentronidazole
- low number - aminoglycosides to treat facultative
anaerobe
- presurgery antibiotic prophylaxis

Bacterial G General Characteristics
Genus +/- Epidemiology
Bordetella - Small coccoBacilli
Strict Aerobe
- affect respiratory system
- RESV: humans
- MOT: aerosols
- occurred primarily in
children in past
- more cases in older
children & adults
- endemic worldwide
although incidence
reduced by vaccine
- care in collection and
transport of tracheal
aspirate
- cannot be grown on
cotton
Species Species Characteristics/
Lab Diagnosis
Pertussis - extremely small cocco-
bacilli
- no sugar fermentation
- require enriched media
containing charcoal,
starch, blood, or albumin
to absorb toxic
substances from agar
- slow growing
-7 days make tiny colonies
- *huge increases in
lymphocytes
Diagnosis
- Culture sensitive to
drying
- use Bordet-Gengou
medium
- DFA of specimen, ELISA
- false positives and false
negatives are common
- require nicotinamide
factor V (NAD)
- PCR or agglutination ID
Bacteriology 17
Clinical Diseases Virulence/Treatment/Other
Whooping Cough:
- 7-10 day incubation
Virulence:
- O & K antigens
- 3 stages: - two LPSs:
1. catarrhal resembles common cold - lipid A & lipid X
2. paroxysmal after 1 – 2 weeks - activate alternative complement
- ciliated epithelium lost, impairs mucus clearance pathway and lead to cytokine
- classic whooping cough paroxysms on inspiration release
- often terminate with vomiting and exhaustion - filamentous hemagglutinin on pili
3. convolascent after 2- 4 weeks (FHA)
- paroxysomes diminish in number and severity - adhere to ciliated epithelium
- 2º complication can - also bind to CR3 on neutrophile
occurs Treatment: - initiate phagocytosis
- mainly supportive - erythromycin - S2 unit of toxin= binding
- antibiotics do not change course of - Adenylate cyclase synthesis
disease Toxins:
- DPT Vaccine - inactivated (whole - pertussis toxin*
cell) vaccine given with diphtheria - S1  ribosylates G protein
and tetanus toxoids (DPT Vaccine) - removes inhibition of adenylate
- newer multivalent vaccines confer cyclase, cAMP
equal protection w/ few side effects - cause lymphocytosis
- cannot enter 2° lymphoid tissue
- tracheal cytotoxin - kills ciliated
cells and stimulates IL-1 release
- acts in concert with endotoxin
 Bacteriology 18
Bacterial G General Characteristics Species Species Characteristics/ Clinical Diseases Virulence/Treatment/Other
Genus +/- Epidemiology Lab Diagnosis
- -

Francisella - Small coccoBacillus

Strict Aerobe
tularenis - very small coccobacillus
- Non-Motile
Tularemia, Glandular Fever, Rabbit Fever, Tick Fever:
- 3-5 day incubation
- intracellular parasite that survives I
in macrophages
Zoonotic - thin lipid capsule - symptoms: - prevents phagosome- lysosome
- antiphagocytic - fever, chills, malaise, fatigue fusion
- fastidious (req. cysteine) - lymphadenopathy, possible bacteremia Treatment:
- worldwide distribution - strict aerobe - Forms : - DOC: Streptomycin
- RESV: - Ulceroglandular - common with papule on skin in - also: gentamycin, tobramycin
- wild and domestic Diagnosis: area of enlarged lymph node Prevention:
- fish, birds, arthropods - culture on chocolate, papule ulcerates  necrotic - live-attenuated vaccine lessens
- in US: Main RESV: blood or BCYE agar - Oculoglandular- direct inoculation of eye severity (does not prevent disease)
- rabbits, ticks, muskrats - requires prolonged - causes conjunctivitis - avoid reservoirs & vectors
- Missouri, Arkansas incubation - Glandular- lymphadenopathy without ulcers - do not handle ill-appearing rabbits
Oklahoma Identificiation: - Typhoidal- systemic disease with - wear gloves while skinning rabit
- MOT: infectied tick - preliminary by slow multiorgan involvement - remove ticks promptly
bite, contact with growth of very small - Oropharyngeal- acquired via ingestion
infected animal, coccobacilli on - Gastrointestinal- acquired via ingestion
consumption of chocolate Agar - Pneumonic- inhalation
contaminated meat - Confirmation by - serious with high mortality unless it is diagnosed
or water - agglutination tests early and treated
- low ID through bite and - Serology by indirect
Inhalation fluorescent antibody
- tularemia infection is a tests(IFA)
danger physician (BE
CAREFUL)

Bacterial G General Characteristics
Genus +/- Epidemiology
Brucella - Small coccoBacillus
Strict Aerobic
melitenisis,
Zoonotic
- rare in US
- RESV:
- B. abortus (cattle)
- B. melitensis (goats &
sheep)
- B. suis (swine)
- B. canis (dogs, foxes,
coyotes)
- most cases in U.S. in
Hispanics of CA and TX
from comsumption
of unpasteurized milk
and other dairy products
- B. canis does NOT react
with other species
Haemo-
philus
- Small Bacilli
- affect respiratory system
- RESV: Humans only
- MOT: Respiratory droplet
- Normal Flora
- encapsulated species are
rare as normal flora
- encapsulated serotype b
- caused over 95% of
invasive diseases
before vaccines
- type c & f & nontypable
(nonencapsulated)
species now cause most
diseases
- People at risk:
- without Abs
- defective complement,
no spleen
Legionella - Pleomorphic Bacilli
Microaerophilic
Pneumophila
Catalase Pos
Species Species Characteristics/
Lab Diagnosis
Abortus,
- small coccobacillus
- Non-Motile
Undulant Fever:
suis, - no capsule
& - strictly aerobic
Canis - some require CO2 as well
- no sugar fermentation
- Growth in tissues w/
erythritol (sugar):
- in breast, uterus, - mild complication bacteria:
placenta, epididymus
Diagnosis:
- prolonged incubation
Identification:
- Oxidase Pos.
- reactive with antibodies - cause sterility, abortion, asymptomatic, carriage in animals
- culture biphasic medium
- Castenedas medium
- 4 x in serum Ab
Influenza - small, sometimes
pleomorphic bacilli
- Catalase Pos.
- capsule on many strains
Diagnosis:
- CSF culture: meningitis
- Blood culture: epiglottitis,
cellulitis, arthritis,
pneumonia
- Media w/ X-factor
(hematin) or V factor
(NAD) or both
- found on chocolate agar
- Mueller Hinton Agar
- Satellitism:
- s aureus produces
NAD, enhances
growth, RBC lysis on
blood Agar
- aspirates required for
URT
- Quellung Pos.
ducreyi - aegyptius & H. ducreyi
require special media
- Motile
- Slender, pleomorphic
baccili
Bacteriology 19
Clinical Diseases Virulence/Treatment/Other
- incubation up to 2 months
Virulence:
- intracellular parasites in
- initital symptoms: macrophages
- malaise, chills, sweats, fatigue, weakness, myalgias, - inhibit neutrophil degranulation
weight loss, arthralgias, dry cough, - carried to various organs in
- intermittent fever: seen in untreated patients macrophages
- advanced disease: - liver, spleen, lymph nodes, bone
- symptoms seen in various tissues marrow, kidneys
- form granulomas here
- B. abortus ; B. canis - cause tissue
- destructive lesions and prolonged course bacteria: destruction Treatment:
- B. suis - DOC: Doxycycline combined with
- severe lesions and high complications: gentamycine, streptomycin,
- B. melitenisis or rifampin
- reduce
relapses Prevention:
- animal examination, elimination (if
infected), vaccination (cannot be
used on humans)
- avoid unpastuerized milk
- protective clothing
Diseases previously cased by type b:
- Meningitis:
Virulence:
- obligate parasites on mucus
- starts from nasopharynx membrane
- mild upper respiratory tract infection before - polysaccharide antiphagocytic
meningitis signs appear capsule (polyribitol phosphate)
- Epiglottitis for tybe b**
- cellulites & swelling - IgA proteases
- more common in 2-4 year old boys - Pili & nonpilus for adherence
- Cellulitis: - translocated across epithelium and
- fever and cellulites with reddish- blue patches on endothelium into blood - bacteremia
cheeks or periorbital area - cell wall:
- Arthritis: - impair ciliary function*
Disease caused by non-encapsulated strains: - damage respiratory epithelium*
- Otitis Media & Sinusitis: Treatment:
- one of the most common causes of otitis media - meningitis: cefotaxime & cefriaxone
- Pneumonia: - check nasopharynx for carriage
- seen in elderly and COPD & alcoholism patients - non-type b diseases:
- Subacute endocarditis: - amoxicillin + clavulanate
- Conjunctivitis (pink eye) & Brazilian purpuric fever - 2 or 3 cephalosporin or
- vomiting & fever following conjunctivitis trimethoprom + sulfonamide
- caused by biogroup aegyptius - Hib conjugate capsular
- if untreated: polysaccharide vaccine:
- petechiae, purpura, shock, death - given at 2, 4, 6 mon, w/ boost @ 15
- vaccine for type b, 95% effective
Chancroid Treatment:
- ulcerated STD - azithromycin
- painful ulcer with erythematous base - chancroid requires swab of base or
- inguinal lymphadenopathy margin of ulcer in throat
Asymptomatic Infection:
Pontiac Fever:
Virulence:
- facultative intracellular parasites
- self-limiting febrile disease - multiply inside alveolar macrophage
 Bacteriology 20
- slow growing - headache, flu - like - prevent phagolysosome fusion
- affect respiratory system - does NOT ferment sugars - resolves in 2-5 days Treatment:
Diagnosis L egionnaire‟s Disease: (legionellosis or pneumonia) - Azithromycin or flouroquiolone or
- RESV: natural bodies of - gram stains poorly - incubation of 2-10 days Erythromycin + rifampin
water, cooling towers, - DFA staining of sputum - begins with fever, chills, headache
condensers, water - Fastidious, culture w/ - dry nonproductive coughs
systems Fe, cysteine, absorbant - spreads and becomes multiorgan:
- MOT: inhalation of remove fatty acids - GI, CNS, liver, kidneys
aerosols , from showers, - BCYE agar w/ long - primarily manifest as multilobar pneumonia with
AC systems, and cooling incubation culture inflammation and microbascesses
Towers - 15-20%
- more likely in chronic lung
disease patients or the
immunocompromised
Clos-
tridium
+ Large Rod
Spore forming
Perfringens - large, retangular bacillus
- rarely have endospores
- Skin and Soft Tissue Diseases:
- cellulites (inflammatio) w/ gas formation (gangrene)
Type A Perfringens:
- α-toxin- (lecthinase lethal toxin)
Anaerobic - Non-motile, (motile on - fasciitis (supportive myositis): - causes soft-tissue infections,
media) - progression of cellulites with pus collection along food poisioning, primary septicemia
- will not grow in - Double zone hemolysis muscle paines - increases vascular permeability
conditions of > 10% O2 - spreading growth on agar - myonecrosis (Gas Gangrene): - causes hemolysis
- founding soil, water, - gas gangrene- H and - most serious disease Type C Perfringens (Most common):
sewage CO2 from carbohydrates - intense pain onset is 1-4 days after infection - α & β toxin
- normal GI flora - Enzymes: - rapid progression with edema, hemorrhagic bullae, - β toxin- (Protected via Trypsin-I)
- produce exotoxins - collagenase muscle necrosis, shock, renal failure, and death - cause enteritis necroticans
- Infections 1) Skin, - protease - crepitance (gas in tissue) Other Toxins:
2) Food 3) Colitis - hylaronidase - Food Poisoning – Type A & C - Θ-toxin- pores, altering
- DNase - short incubation (8-24hrs) and short course capillary permeability, heart damage
- neuraminadase - abdominal cramps & watery diarrhea - enterotoxin- alters membrane
Perfringens: - Culture via RCM - *no fever, nausea or vomiting permeability
- normally found in GI - Roberstons cooked - Enteritis Necroticans (pig bell disease): Type C Treatment:
tract of humans and meat medium - necrosis of jejunum – 50% mortality - lab diagonosis: only used to confirm
animals - bloody diarrhea, shock, peritonitis (inflammation - aggressive treatment:
- feces contaminate soil of peritoneum) - surgical debridgement
- found everywhere, - Via Pork and Sweet Potatoes – Trypsin Inhibitor - high dose penicillin
prevention difficult - Septicemia - food poisoning:
- bacteria in circulating blood - no antibiotic treatment
- bacteria seen blood cultures (may be normal in people) - hyperbaric oxygen
Bacilllus + Large Rod
Spore forming
Anthracis - Protein Capsule
- Non - Motile
Cutaneous Anthrax:
- papule at site  rapidly to ulcer w/ vesicles  necrotic
Virulence Factors:
- poly-D-glutamic acid capsule
Aerobic & Fac Anaerobic - large bacillus eschar (black scab) - protein capsule via pX02
- single, paired w/ long - systemic signs: lymphadenopathy, edema - three exotoxins via plasmid pX01:
- form endospores serpentine chains GI anthrax: - PA, EF, LF
- Aerobic & facultative - Aerobic, Fac Anaerobic - upper GI tract: ulcers similar to cutaneous anthrax - protective antigen: mediates entry
anaerobes - rough colonies (uneven - lower GI tract: nausea, vomiting, malaise - more immunogenic
surfaces): - mortality ~ 100% - edema factor: a cyclase  CAMP
- medium-large size Inhalation Anthrax (Woolsorter‟s disease): - lethal factor: kills cells, TNFα, IL1
Anthracis: - gray color - in alveoli  Mediastinal Lymph Nodes via alveolar - PA + EF = EdTx, PA + LF = LeTx
- disease of herbivores - raised macrophages
- spore inhalation - „medusa ‟head - may remain latent (asymptomatic, 2 months) Diagnosis:
- exposure to animals extensions on edges - initial onset: (non-specific) - microscopic examination of papules
may infect people - Spores stain - fever, shortness of breath, cough, headache, & ulcers
- Bioterrorism Malachite Green stain vomiting, chills, chest/abdominal pain
- Postal workers - Capsule stain - stage 2: Treatment:
- Military, wool sorters - India Ink stain - increased fever, edema, lymph node enlargement - ciprofloxacin is recommended
- MacFadyean Meth - Almost all cases - vaccination & burning carcasses
Blue - 3 days after initial symptoms  shock & death - vaccine for high risk humans
- DFA test Pos. - Resistant to sulfanomide,
Cephalosporin
 Bacteriology 21

Cereus:
- catheter related
- drug users
- opportunistic infection
Cereus - No capsule Gastroenteritis Food Poisoning: Virulence Factors:
- Motile - heat-stabil toxin, proteolysis-resistant enterotoxin - heat stabile toxin
- Only Aerobic - vomiting (via spore contaminated rice) - heat labile toxin
- wax coloured - heat-labile toxin activates adenylate cyclase Treatment:
- diarrhea (via spore contaminated - usually resolves, acute
meat, vegetables, or - Vancomycin, clindamyicn, ciproflaxin
sauces)
- Ocular infections – blindness, via PLC, cereolysin, HLtx

Actino-
bacillus
- Bacilli
Zoonotic
Muris Rat Bite Fever:
- follows bite or scratch by rat or other rodents like mice
Treatment:
- DOC: penicillin
and gerbils
- oral or urine secretion contact could also cause it
- 2-10 day incubation period
- abrupt onset of chills and fever, vomiting joint or back
pain, headache, muscle pain
- red rash mostly on hands and feet develop 2-4 days
after onset of fever
- one or more large joints may become swollen and
painful
Spirullum - - same as above Minus - same as above – Rat Bite Fever - same as above

Bacterial G General Characteristics
Genus +/- Epidemiology
Myco- Bacilli
bacteria Acid Fast
Obligate aerobe
- acid-fast bacilli
- stain poorly with gram
stain
- high lipid content in cell
walls
- mycolic acid
- waxes
- beaded
Tuberculosis:
- RESV: human alveoli
- MOT: PP via droplets
- #1 infection cause of
death in the world
- S.E. Asia, Sub-Saharan
Africa, E. Europe
- US: seen in prisoners,
street people, IV
drug users, AIDs
Patients
- BCG vaccine given to
many foreign immigrants,
conflicting results with
PPD test
- elimination difficult, 1/3
population affected
Species Species Characteristics/
Lab Diagnosis
Tuberculosis - Non- motile
- resistant to acids, alkalis,
and drying
- non spore former
- mostly effects people with
depressed immune
function and poor living
conditions (crowding,
poor nutrition, poor
hygene)
- Ziel Neilson (carbol
fuschin stain)
- cannot be decolorized
- Kinyoun – AFB
- sensitivty for
respiratory specimens
- +ve AFB =  chance of
TB
- due to high glycolipid
content
Diagnosis:
- Mantoux TB test
- (+) skin test w/ purified
PPD derivative (cell
wall), type IV Reaciton
- X-ray of lungs
- w/+ve Mantoux
- look @ apical lungs for
granuloma
- AFB stain or auramine-
rhodamine-labeled
antibody stain
- prolonged incubation
(weeks) of culture on
Lowenstein-jensen or
middlebrook agar
- broth culture is faster
-Turant Flurochrome
method
- nucleic acid probes, gas
chromatography of lipids
or 16s rRNA sequencing
can be used for ID
- nucleic acid
detection: 1hr -1day
- test for rRNA or DNA
- Gen-Probe MTD test:
- tests respiratory samples
that are AF positive
- Roche-Amplicor test:
- uses PCR
Bacteriology 7
Clinical Diseases Virulence/Treatment/Other
Tuberculosis: - Cell wall made of mycolic acids
- Primary Tuberculosis/Initial Infection: - cord factor (trehalose dimycolate)
Healthy Persion - inhibit chemotaxis
- large number bacteria  form granulomas - proteins plus wax- Most impt.
- small numbers bacteria  macrophages eliminate them - elicit delayed hypersensitivity
- bacteria may remain dormant in granulomas for years - Phthiocerol dimycoserate:
- exudative lesions, no disease, only infection - lung pathology (caseous necrosis)
- Ghon complex: (opaque swirls in upper lung on Xray) - sulfolipids:
- subpleural granuloma - prevent phagosome-lysosome
- found in hilar lymph nodes fusion (prevents death by
- inflammation and limited replication in ‘lung spot’ macrophage)
- Bacteria  macrophages, inhibit Phagolysosome fusion - grows intracellularly
Immunocompromised Patient - resistant to acids, alkalis and drying
- contagious spread of infection and cavitation Granuloma Cells:
- coin lesion in lung - produced by type IV hypersensitivity
- symptoms: reaction
- acute inflammation with PMNs (neutrophils) - epitheloid macrophages and
- fever; non-productive cough; pleuritic pain langerhan cells in center
- abdominal pain, diarrhea, fever, weight loss - center can undergo caseous
- three outcomes: necrosis
- complete resolution with scar formation - surrounded by lymphocytes, plasma
- massive necrosis of a tubercle cells, and fibroblast
- disseminated disease - fibroblasts produce outside layer
- Secondary Tuberculosis: of connective tissue
- reinfection or reactivation of previous infection - tubercle: granuloma with
- tubercle erosion  releases dormant bacteria necrosis center and
- Increase risk with age, health fibrous tissue
- more granulomas (may spread to other parts of lungs surrounding
and through blood to other organs)
- cavitation can occur from caseous necrosis Treatment:
- disseminated TB: spread to other organs - 9  24 mnth with multiple antibiotics
- malaise, headache, weight loss/anorexia - start with 2 or more of isoniazid
- wasting, night sweats, fever (INH), rifampin, pyrazinamide,
- cough with or without blood and ethambutol for 2 months
Other clinical Presentations: - then 4-6 months with INH
- scrofula- cervical adenitis with swollen non - BCG Vaccine
tender lymph nodes - controversial vaccine for M. bovis
- erythema nodosum - tender nodules or extensor interferes with PPD test  false
surfaces of ulna and tibia positive, need chest X Ray
- military tuberculosis- disseminated meningitis
- osteomyelitis- ‘potts disease‟
- oropharyngeal TB:
- dysuria - diffuculty (pain) when urinating
- hematuria - blood in urine
- flank pain
- Meningitis
 Bacteriology 8
Bacterial G General Characteristics Species Species Characteristics/ Clinical Diseases Virulence/Treatment/Other
Genus +/- Epidemiology Lab Diagnosis
Atypical Non-chromogens: Photo- - group 1 mycobacteria
- found in bodies of water chromagens - slow growing
- exposure via aerosols or - pigment formation only in
ingestion light
Scoto- - group 2 mycobacteria
chromogens - slow growing
- pigment formation in dark
or light
Non- - group 3 mycobacteria - overwhelming disseminated diseases Treatment:
chromogens - slow growing - for M. avium complex uses:
- no pigment formation - clarithromycin, azithromycin,
- include M. avium- ethambutol, rifabutin
intracellulaire of
tuberculosis

Rapidly - group 4 mycobacteria - RARELY cause human diseases Treatment:

growing - Low virulence - Nosocomial Infection - resistant to most drugs
mycobacteria - stain irregularyl – post surgery, catheters, prosthetic heart valves etc.. - DOC: Clarithromycin, imipenenm,
amikacin, cefoxitin, sulfonamides
- remove iatrogenic agent
MAC: Avium and - M. avium – disease In Hiv Patients Treatment:
- disease in immune- intracellulare - Three forms of disease - calithromycin or azithromycin w/
competent - 1. Middle age older men w/ smoking, pulmonary disease ethambutol and rifampin
- 2. Lady Windermeres Syndrome
- elderly women who suppress cough reflex
- inflammatory change   infections with MAC
- 3. Solitary Pulmonary Nodule
- in terminal HIV patients
Leprae: leprae - optimal temp.: 30˚C H ansen‟s Disease: Treatment:
- RESV: armadillo, humans - cannot grown in labs, - chronic infection affesct skin and peripheral nerves - Tuberculoid leprosy:
- MOT: respiratory, wound needs cell culture - Tuberculoid Leprosy – PauBacillary (PB) - (1-5 lesions); treat 6 months
- 2003 endemic Africa, - grow in footpads of - Non-Progressive, Sudden onset - Dapsone with or without rifampin
Asia mice or armadillos - seen in persons with good cell mediated immunity - Lepromatous leprosy:
- Few erythematous or hyperpigmented plaques with - (> 5 lesions); treat 1 year
Diagnosis: raised borders (macular lesions) - add clofazimine to above
- clinical presentation - Severe peripheral nerve damage -*prompt recognition and treatment of
- histopathology with complete sensory loss infected persons to halt spread
- skin test reactivity or - Low Infectivity
presence of acid-fast - Normal/Weak AB Response; Th1, IL2, IFNγ, IL12
bacilli in skin lesions - Lepromin Reactive
- Lepromatous leprosy – MultiBacillary (MB)
- Progressive
- seen in persons with defective cell mediated
responses to M. leprae, slow onset
- erythematous macules, papules, nodules,
thickened skin, hypopigmented
- extensive tissue destruction with
patchy sensory loss
- extensive tissue loss in face, hands, fingers
- high infectivity
- Strong/Hyper-Ab Respons; Il4, IL10
- Lepromin Non- Reactive

Bacterial G General Characteristics Species Species Characteristics/
Genus +/- Epidemiology Lab Diagnosis
Treponem
a
- Thin Spiral Spirochete
Microaerophilic
pallidum - Motile: endoflagella
- Not grown on media or in
cell culture – too thin
- Killed by drying and
- RESV: Strictly human increase in temperature
pathogen - thin, spiral, flexible rods
- MOT: Sexual,
Transplacental, - Diagnosis:
blood rare - Specific Ab’s & Non-
specific Ab’s (regain)
- DF microscopy
- Fluorescent stain
- Histologic Silver Stain
- Nontreponemal Test:
- Serological
- Non-Specific Test
- Beef cardiolipin reacts w/
patient IgG, IgM (recent
vs,chronic infection)
(regain)
- VDRL (serum)
- RPR (preferred, plasma)
- Revert to negative after
treatment
- False positives occur w/
leprosy, hepatitis B,
infectious mononucleosis,
and autoimmune
diseases
- For Screening
- Treponemal Test:
- Specific tests
- Treponemal Ag reactive
w/ patient AB
- FTA - ABS
(immunofluorescence)
- TPHA or MHA-TP
(hemagglutination)
- Positive for life
- Expensive
- Confirmatory test
Bacteriology 9
Clinical Diseases Virulence/Treatment/Other
- Primary Syphilis
- Multiplication at site  “hard” chancre in 2-10 wks
Virulence:
- No LPS
- Infectious but not painful - Endoflagella (axial filaments)
- Secondary Syphilis: - under outer sheath, external to
- Spirochetes spread  maculopapular rash outer membrane
- On palms and soles @ 1-3 months after inoculation - No toxins!!!
- Moist lesions on genitalia (condyloma lata) - Hyaluronidase: Spreads in tissue
- Many spirochetes present with high infectivity - Infects endothelium of small blood
- Cure: 1/3 of primary and secondary vessels - invasive
- Latency: 1/3 no lesions but Ab’s present Treatment:
- Early (1-2 yrs): Secondary Syphillis, recurrent, - Benzathine Pen G
infectious - No resistance observed
- Late: No symptoms; no infectivity - Jarisch-Herxheimer reaction:
Tertiary Syphillis: - 2° syphilis patient w/ Pen G
- Progresses 30 yr, treponemes infrequent, 30% mortality - Flu-like symptoms
- Gummas (granulomas): - Mediated by TNF
- In skin, bones (fractures, joint immobilization), and liver - Can occur after treatment
- Neurosyphillis (CNS): of other spirochetes
- Mononuclear infiltration w/ endoarteritis, gummas - Pen G Allergy:
- Paresis from atrophy of the entire brain - Tetracycline or erythromycin
- Tabes dorsalis, ARP Prevention:
- Atrophy of posterior roots of the lumbar region  - condoms, prophylactic antibiotics
locomotor ataxia - scan all preganant women
- Cardiovascular:
- Aortitis, aortic aneurysm
- Congenital Syphillis
- Mother  Fetus @ 10 - 15 wks
- Fetal death, abortion, stillbirth
- Multiple fetal abnormalities:
- Fulminate infection
- Diffuse rash w/ desquamation
- Impairment of liver and lungs
- Keratitis in eyes
- Affects bones and teeth
- Saddle nose, Sabre shins
- Hutchinsons Teeth - notched incisors

Nocardiac + Aerobic Bacilli
eae Acid Fast
Actinomycetes
Nocardia:
- RESV: animals and
humans, found in
soil and decaying
vegetation
- MOT: inhalation
- exogenous infections
-Most coming in HIV,
organ transplant,
immunocompromised,
pulmonary disease
patients
Rhodococcus: rhodococcus
-rhodococcus equi is most
important human
pathogen
- formerly cornybacterium
- seen in HIV patients
- no soil or animals!
Gordonia:
- RESV: soil
- MOT: Nosocomial tsukamurella
-rare opportunisitc
infection
dermatop
hilus
+ Other Actinomycetes
tropherym Dermatophilus:
a - soil
-animal exposure:
butches, veterninarians,
thermophi Thermactino
llic
Saccharopoly
Saccharomon
nocardia - Catalase Pos.
- partially Acid Fast
- stain poorly
- dry waxy, white  orange
colonies
- Some have delicate
filamentous forms called
aerial hyphae as they
are similar to fungal
hyphal forms
Diagnosis:
- Microscopy
- stain poorly with gram
stain
- aerial hyphae
- acid fast
- BCYE agar
- week long culture
- Molecular analysis to
confirm diagnosis
- Sabourauds Dextrose
agar
- weakly acid fast
- initially appear rod then
revert to coccoid forms
- Diagnosis:
- Aerobic
- no selective media
- mucoid colonies
- slow growth
gordonia - similar to rhoddococcus
& - partially acid fast
Whipplii - PAS stain Pos
- Serological
yces/
spora/
ospora
Bacteriology
- Bronchopulmonary Disease Virulence: 10
- cough, dyspnea, fever, cavitation  into pleura - cell wall similar to mycobacteria
- in immunocompromised, pneumonia w/ cavitation and - cell wall w/ shorter mycolic acids
dissemination (CNS spread) - Intracellular Organism
- Cutaneous Infections - Prevent phagolysosome fusion via
- Primary infection cord factor (trehalose)
- mycetoma, lymphocutaneous infections, cellulitis, - prevent acidification of phagosome
subcutaneous abscess - superoxide dismutase
- Secondary Infection: if it spreads from lung - protective
- Lymphocutaneous Infection
- cutaneous nodules, ulceration along lymphatic Treatment:
- (Compare: similar to Sporothrix Fungi) - surgicial
- 1/3 of all patients: CNS involvement, meningitis, - DOC: sulfonamides
brain abscess
- Actinomycotic Mycetoma
- mycetoma refers to disease via fungi or bacteria
- Painless, chronic  localized subcutaneous swelling,
suppuration, and formation of multiple sinus tracts
- defective drainage of connective tissue possible
- Caused by N brasiliensi in America’s
- Immmunocompromised Patients: Virulence:
- invasive pulmonary disease (nodules, lung abscess, - Facultative intracellular
dissemination to lymph nodes, meninges, pericardium - survives in macrophages
and skin) - causes granulomas  abscess
- opportunistic infections
Treatment:
- erythromycin, rifampin, ciproflaxin
- vancomycin, imipenem,
aminoglycosides
- Resistant to penicillin and
cephalosporins
- Gordonia: - mycolic acid
- pulmonary and cutaneous infections
- noscomial via catheters
- Tsukamurella:
- nosocomial via catheters
- Exudative Dermitits w/ encrustations involving hands and
feet
Treatment:
- penicillin + aminoglycoside
- Whipples Disease: Treatment:
-arthralgia, diarrhea, abdominal pain, weight loss, - penicillin, streptomycin, tri-sulfa
lymphadenopathy, fever, increased skin pigmentation
- foamy macrophages in l. propria of small intestine
- Allerigic Pneumonitis:
- farmers lung
-hypersensitivity reaction to repeated exposure to
thermophillic actinomycetes found in decaying vegetation
-lung granuolomas w/ pulmonary edema, eosinophilia,
and excess IgE

Bacterial G General Characteristics Species Species Characteristics/
Genus +/- Epidemiology Lab Diagnosis
Treponem
a
- Thin Spiral Spirochete
Microaerophilic
pallidum - Motile: endoflagella
- Not grown on media or in
cell culture – too thin
- Killed by drying and
- RESV: Strictly human increase in temperature
pathogen - thin, spiral, flexible rods
- MOT: Sexual,
Transplacental, - Diagnosis:
blood rare - Specific Ab’s & Non-
specific Ab’s (regain)
- DF microscopy
- Fluorescent stain
- Histologic Silver Stain
- Nontreponemal Test:
- Serological
- Non-Specific Test
- Beef cardiolipin reacts w/
patient IgG, IgM (recent
vs,chronic infection)
(regain)
- VDRL (serum)
- RPR (preferred, plasma)
- Revert to negative after
treatment
- False positives occur w/
leprosy, hepatitis B,
infectious mononucleosis,
and autoimmune
diseases
- For Screening
- Treponemal Test:
- Specific tests
- Treponemal Ag reactive
w/ patient AB
- FTA - ABS
(immunofluorescence)
- TPHA or MHA-TP
(hemagglutination)
- Positive for life
- Expensive
- Confirmatory test
Bacteriology 20
Clinical Diseases Virulence/Treatment/Other
- Primary Syphilis
- Multiplication at site  “hard” chancre in 2-10 wks
Virulence:
- No LPS
- Infectious but not painful - Endoflagella (axial filaments)
- Secondary Syphilis: - under outer sheath, external to
- Spirochetes spread  maculopapular rash outer membrane
- On palms and soles @ 1-3 months after inoculation - No toxins!!!
- Moist lesions on genitalia (condyloma lata) - Hyaluronidase: Spreads in tissue
- Many spirochetes present with high infectivity - Infects endothelium of small blood
- Cure: 1/3 of primary and secondary vessels - invasive
- Latency: 1/3 no lesions but Ab’s present Treatment:
- Early (1-2 yrs): Secondary Syphillis, recurrent, - Benzathine Pen G
infectious - No resistance observed
- Late: No symptoms; no infectivity - Jarisch-Herxheimer reaction:
Tertiary Syphillis: - 2° syphilis patient w/ Pen G
- Progresses 30 yr, treponemes infrequent, 30% mortality - Flu-like symptoms
- Gummas (granulomas): - Mediated by TNF
- In skin, bones (fractures, joint immobilization), and liver - Can occur after treatment
- Neurosyphillis (CNS): of other spirochetes
- Mononuclear infiltration w/ endoarteritis, gummas - Pen G Allergy:
- Paresis from atrophy of the entire brain - Tetracycline or erythromycin
- Tabes dorsalis, ARP Prevention:
- Atrophy of posterior roots of the lumbar region  - condoms, prophylactic antibiotics
locomotor ataxia - scan all preganant women
- Cardiovascular:
- Aortitis, aortic aneurysm
- Congenital Syphillis
- Mother  Fetus @ 10 - 15 wks
- Fetal death, abortion, stillbirth
- Multiple fetal abnormalities:
- Fulminate infection
- Diffuse rash w/ desquamation
- Impairment of liver and lungs
- Keratitis in eyes
- Affects bones and teeth
- Saddle nose, Sabre shins
- Hutchinsons Teeth - notched incisors
 Bacteriology 21
Leptospira - Thin Coiled Spirochete
Aerobic
Interrogans - Motile
- thin tightly coiled
Leptospirosis:
- Mild febrile onset
Treatment:
- Severe disease(Weils/icteric):
Zoonotic spirochete - High bacteria count in CSF and Blood - IV Pen G or tetracycline
- NOT gram stained - Headache, muscle ache - Mild disease:
- Hook at one or both ends - Systemic disease: - ampicillin, amoxicillin, or
- RESV: Rodents, dogs, hockey stick appearance - aseptic meningitis, rash and jaundice doxycycline
farm animals - Overwhelming disease: Prevention:
- MOT: Breaks in skin, - Culture: - Icteric / Weil‟s disease - Control rats, vaccinate pets
water w/ urine, - Fletcher -above symptoms w/ renal disease, multi organ
feces, handling - EMJH hemorrhage especially liver and kidneys, mental change
infected tissues, - Tween 80 albumin - also congenital disease
food - Slow growers Leptospirosis:
- Tropical climates - Incubation 4 months: deal - excreted in animal urine
- Occur in warm months results in 2 weeks. - bacteria circulate though body in blood
recreational exposure to - Present in blood or CSF - fever, dysfunction in various organs
contaminated water during first 10 days of - biphastic:
(lakes, rivers, infection and in urine after - fever, chills, intense headache, conjuctival suffusion
contaminated with animal 1st week and as long as - short period of resolution followed by asceptic
urine) 3 months. meningitis, with possible liver and kidney damage
Diagnosis:
- PCR, DNA probes
- Serology:
MAT, microscopic
agglutination test -
agglutinate live
leptospires
- Elisa test
- Cross Rxn w/ other
spirochetal infections
(syphilis,relapsing fever
and lyme disease)
Microscopy:
- Unreliable: light
microscopy, gram stain,
silver stain, DF

Bacterial G General Characteristics
Genus +/- Epidemiology
Borrelia - Loose, Coiled Spirochete
Microaerophilic
burgdorferi
Zoonotic
Burgdorferi:
- RESV: white-footed
mouse; deer
(mammals impt for
tick life cycle)
- MOT: Tick bites
(Ixodes dammini
and I. pacificus)
- Require 24-48 hours of
feeding
- Most often from nymphs
than adults or larvae
- Most common vector-
borne disease in U.S.
- In U.S. – Atlantic
seaboard, northern
Midwest, and West Coast
Recurrentis
Recurrentis:
- RESV: Humans
- MOT: Vector = Human
body louse
- Crowded, unsanitary
conditions (war, natural
disasters)
Other:
- RESV: Rodent, small
mammals
- MOT: Soft ticks Vector
w/ animal bite
- Ethiopia, Rwanda, Andes
Species Species Characteristics/
Lab Diagnosis
- Irregular, loosely coiled;
larger than other
spirochetes
- Motile: endoflagella
(axial)
- Gram Stain
- Giesma Stain
- Culture w/ serum or
tissue extract, not useful
- Lab Confirmation:
- Isolation
- IgM, IgG levels
- Significant in Ab titer
between acute and
convalescent serum
samples
Diagnosis:
- Erythema chronicum
migrans (ECM)
- Isolation is low, especially
in early disease
- Serology:
- ELISA
- Indirect for IgM or rise in
IgG preferred
- Abs are slow to appear
(2-4 weeks after ECM)
- False positives in patients
with syphilis
- Confirm w/ Western blot
& others
Bacteriology 22
Clinical Diseases Virulence/Treatment/Other
Pathogenisis:
- Blood  Organs, systemic; Abs cause Clearance
- No toxins or virulence factors!!!
- Slow immune response Treatment:
Lyme Disease: - Early: doxycycline or amoxicillin
-Stage 1: - Late: Pen G or ceftriaxone given IV
- ECM: Erythema chronicum migrans (“bulls eye”) - Neurologic and musculoskeletal
- Nonpruritic, painless circular rash with clear center - requires prolonged treatment
and red edges
- Flu like symptosm and Athralgias Prevention:
- Stage 2: Cardiac or neurologic - Avoid ticks, protective clothing, insect
- Cardio: Myocarditis, heart block repellant
- Neuro: Aseptic meningitis or cranial neuropathies
- Latency
- Stage 3:
- Mainly chronic arthritis of large joints;
- CNS disease may progress
- Summary of Late Manifestations (in 80% after weeks)
- Neurologic: meningitis, encephalitis, peripheral
nerve neuropathy
- Cardiac: heart block, myocarditis, congestive
heart failure
- Arthralgias and arthritis persist for years
- Epidemic relapsing fever: Virulence:
- Clinically endemic and epidemic are the same - Antigenic variation  evade immune
- 1 week incubation - via VMP lipoprotein
- Abrupt onset Fever: - Febrile and afebrile periods
- Shaking chills, fever, muscle aches and headaches , - No toxins!!!
sweats, rash, corresponding to bacteremia
- Bacteremia & fever recur (relapse) - Treatment:
- Single in epidemic relapsing fever - Doxycycline or erythromycin
- Repeated in endemic relapsing fever - Jarisch-Herxheimer Rxn possible
- Prevention:
- Rodent, sprays, hygiene, no vaccine
 Bacteriology 23
Bacterial G General Characteristics Species Species Characteristics/ Clinical Diseases Virulence/Treatment/Other
Genus +/- Epidemiology Lab Diagnosis
 Bacteriology 24
Bacterial G General Characteristics Species Species Characteristics/ Clinical Diseases Virulence/Treatment/Other
Genus +/- Epidemiology Lab Diagnosis
Mycoplas Pleomorphic Acid Fast pneumoniae - Motile - Mycoplasma pneumoniae Virulence Factors:
ma Fac. Anaerobic - round, oblong shape - Upper respiratory tract - Adherence:
- Diagnosis: - Sore throat or earache - P1: Polar tip structures/adhesins
- no gram stain - Low-grade fever - adherence to respiratory epithelium
Pneumonia: - fried egg appearance - Dry, nonproductive cough; occasionally paroxysmal - loss of cilia
- RESV: Human only - Culture - Malaise - Hydrogen Peroxide Production
- MOT: Droplets, - Microaerophilic solid - Tracheobronchitis - direct cytotoxic effects
respiratory media - Infiltration with lymphocytes and plasma cells - Immobilizes cilia
- Most common in school- - Aerobic Special Broth - Atypical (“walking”) pneumonia - Necrosis of ciliated epithelium
age children and young media - Patchy bronchopneumonia with myalgias - Superantigen: increase inflammation
adults - Serologic tests - Secondary complications can occur - No cell walls!!!
- Smallest free-living - complement fixation - Slow resolution - Cannot be treated with β-lactams
organism!!! (CF) - Plasma membrane with three layers
- +ve = No Lysis and sterols
- Cold agglutinin Pos.
- group O human RBCs
- Not a very good test!

Genitalium - Some cases of nongonococcal urethritis (NGU) - No cell walls

& - bringing at urination, discharge
Ureaplasma
urealyticum

hominis - Pyelonephritis, pelvic inflammatory disease (PID), and

postpartum fever
 Bacteriology 25

Bacterial G General Characteristics Species Species Characteristics/ Clinical Diseases Virulence/Treatment/Other

Genus +/- Epidemiology Lab Diagnosis
Rickett-
sieae
- - very small coccobacilli
- stain poorly
Rickettsii - most common rickettsial
pathogen in U.S.
- minimal peptidoglycan
- weak endotoxin
- obligate intracellular - Hardticks (Dermacentor)
parasites (need are reservoir and vector
cell’s energy) - transmission requires
prolonged feeding
- animal reservoirs
- transmitted by athropods
Prowazekii - humans are reservoir
- occurs under crowded,
unsanitary conditions
- C. & S. America, Africa,
Asia
Typhi - rodents are reservoirs
- rat fleas: vectors
- U.S. Gluf States, S.
California, Asia, Africa,
Europe, S. America
Ehrlichia - Chaffeensis - reservoirs: white tailed
deer and pet dogs
- vector: lone star tick
Ewingii - reservoirs: small
& mammals
Phago- - vector: ixodes ticks
cytophila
Coxiella - Burnetii - transmission:
- inhalation of airborne
particles from infected
cattle, sheep, goats
Rocky Mountain Spotted Fever-
- incubation of 2-6 days
Virulence:
- stimulation of phagocytosis
- fever, chills, headache, myalgias - intracellular growth
- petechiae rashes- minute hemorrhagic spots - spotted fever group in nucleus
- spreads from extremities to trunk - typhus group in cytoplasm
- may occur in palms and soles - coxiella in cytoplasmic vacuoles
- complications: - replicates in endothelium
- GI symptoms, repiratory failure, encephalitis, renal failure - causes vasculitis
Diagnosis: - leads to petechiae &
- stain with Giemsa or fluorescent-labeled antibody hemostatic disturbances
- do this instead of gram stain - exception: coxiella
- culture at reference labs
- *serologic diagnosis:
- weil-felix test:
- causes agglutination of proteus O Antigens
- indirect fluorescent antibody test:
- sensitive and specific ,4-fold rise in titer Treatment:
- Doxycycline and chloamphenicol
- no vaccine
Epidemic or Louse-Borne Typhus:
- high fever, chills, severe headaches, myalgias
- arthralgias- severe (non-inflammatory) joint pain
- <40% have petechial rashes
- complications: myocarditis, CNS dysfunction
Diagnosis: indirect fluorescent antibodies
Treatment:: tetracyclines or chloramphenicol
Endemic or Murine or Flea-borne typhus:
- 50% have rash
- similar symptoms to epidemic typhus
Diagnosis: indirect fluorescent antibodies
Treatment:: tetracyclines or chloramphenicol
Human monocytic ehrlichiosis:
- similar to Rocky mountain spotted fever
Treatment:
- doxycycline
- similar to Rocky mountain spotted fever - avoid ticks
- 1-3 week incubation period
- high fever, headache, malaise, myalgia
- destruction of WBCs and platelets
- Rash in 20% of patients
- more common in monocytic form
Human Granulocytic Ehrlichiosis: Treatment:
- similar to Rocky mountain spotted fever - doxycycline
- 1-3 week incubation period - avoid ticks
- high fever, headache, malaise, myalgia
- destruction of WBCs and platelets
- Rash in 20% of patients
- more common in monocytic form
Q Fever:
- proliferation of bacteria in respiratory tract before they
Virulence:
- associated with antigenic variation of
disseminate LPS antigen
- influenza like syndrome, atypical pneumonia Treatment:
- granulomatous hepatitis, encephalopathy - tetracyclines
- phase I antigen vaccine in Australia

Chlamydi
aceae
- Small Bacilli
Trachomatis
RESV: Human pathogen,
children
MOT: Eye  Eye droplets,
hands, clothing,
flies,aerosols, fecal
contamination,
Mother  fetus
- Most common STD in
U.S.
- Caused by types D-K
- 80% women; 25% men
- #1 cause of blindness in
the world
- LGV: Endemic in Middle
East, North Africa, and
India
Pneumonia:
- RESV: Human pathogen
- MOT: PP
Psittaci:
- RESV: any bird
- MOT: dried bird
excrement
inhalation
trachomatis Diagnosis:
- difficult
- Immunofluorescent (DFA)
- ELISA
- Molecular probes
- Probe 16S rRNA
- Two morphological forms:
- Elementary body (EB)
- Infectious
- resistant to harsh
conditions, env stablitiy
- no division
- infects mononuclear
phagocytes
- prevents phago-
lysosome fusion
- Reticulate body (RB)
- non-infectious
- metabolically active
- (binary fission) inside
phagosome
- only intracellular
Lifecycle:
- 18-24 hours RBs  EBs
- 24-48 hours  cell
ruptures  EBs released
pneumoniae
psittaci - Diagnosis:
- Serological
Bacteriology 26
- Trachomatis Biovar:
- Involves non-ciliated columnar, cuboidal, and transitional
Virulence:
- Obligate intracellular parasites (RB)
epithelial cells - Cannot make their own ATP
- Pathogenesis: destruction of infected cells and - Intracellular replication
inflammatory response - Prevent Phago-Lysosome Fusion
- Infection through minute abrasions or lacerations - Plasma membrane and outer
- Often asymptomatic membrane
- Urogenital Infections: - no peptidoglycan layer
- Epididymitis, prostatitis, proctitis, nongonococcal urethritis - Attach to microvilli and actively
(NGU) penetrate
- Cervicitis, salpingitis, PID, infertility, and ectopic - Two human biovars:
pregnancy - trachoma
- Reiter‟s Syndrome/Urogenital Infection: - lymphogranuloma venerueum
- Urethritis, conjunctivitis, polyarthritis, and
mucocutaneous lesions Treatment:
- Autoimmune disorder caused by cross-reactive Abs - LGV, pneumonia, psittacosis:
- Mostly in young white males - doxycycline
- Adult conjunctivitis: - STD:
- Preceded by genital infection - azithromycin recommended
- Autoinoculation and oral genital contact - Newborn conjunctivitis & pneumonia:
- Ocular Trachoma: - prophylactic erythromycin
- Begins w/ follicular conjunctivitis  corneal ulceration
and scarring  blindness
- Nenonatal Conjunctivitis:
- @ birth from infected mother, can lead to blindness
- Infant Pneumonia:
-Pulmonary in newborns 2-3 weeks after birth
- Lymphogranulosum venereum (LGV)
- Chronic STD endemic in Africa, Asia, and S. America
-1° painless papule or ulcer  2°inflammation and
swelling of regional lymph nodes  can rupture and form
fistulas systemic: fever, chills, anorexia, headache,
myalgias, arthralgias
- Atypical Pneumonia: Treatment:
- Bronchitis, pneumonia, sinusitis, or asymptomatic infection - Macrolides
- Persistent cough and malaise
- Pneumonia in single lobe
- most patients are not hospitalized
- Psittacosis (parrot fever): Treatment:
- Atypical Pneumonia - Tetracyclines or macrolides
- Disease of parrots that can be transmitted to humans - Controlled by treating pet birds
-Starts in respiratory tract and spreads to phagocytic cells or limiting contact
in liver and spleen
- Headache, high fever, chills, malaise, and myalgia
- Nonproductive cough, rales, and consolidation
- Multiplication -> necrosis
- secondary inflammation in lungs and other organs
Bacteriology 27
Bacteriology 27