AEROBIC GRAM + COCCI

Staphylococc Coagulase - Staph Group A Group B Non-enterococ

us aureus B-hemolytic B-hemolytic Streptococcu cal, Group D Viridians
streptococci streptococci s pneumoniae streptococci Streptococcu
s
Staphylococc Staphylococ Streptococcus Streptococcu Streptococcu
us cus pyogenes s agalactiae s bovis
epidermidis saprophytic
us

Lab ● Catalase + ● Catalase + ● Catalase + ● Catalase - ● Catalase - ● Catalase - ● Catalase - ● Catalase -

Identification ● Coagulase + ● Coagulase - ● Coagulase - ● B-hemolytic ● B-hemolytic ● Encapsulated ● Esculin + ● A-hemolytic
● B-hemolytic ● Not hemolytic ● Novobiocin ● Bacitracin ● BAP: large ● Non-motile ● A-hemolytic Y-hemolytic
● MSA ● MSA colorless resistant sensitive white colonies ● A-hemolytic Y-hemolytic
● Grapelike ● Novobiocin ● BAP: small white ● Hydrolyze ● Lancet-shape ● NOT grow in
clusters susceptible colonies sodium d, pairs NaCl
● BAP: hippurate ● Enhanced by ● Sensitive to
yellow/golden ● Sensitive to 5-10 CO2 penicillin
colonies penicillin and (candle jar) ● Ferments
● Facultative ampicillin ● Optochin arabinose,
● Slight halophilic inhibited raffinose,
● Mannitol + ● Lysed by bile starch
● Quellung rxn
(for capsules)

Pathogenesis ● Skin, anterior ● Virulence factor ● ● Nasopharyngeal ● Polysaccharid ● In ● ● Oral flora

, Toxins nares, mucous cell envelope carriage; e capsule nasopharynx ● avirulent
membranes ● Low virulence transient ● Capsule,
● Exotoxins ● HCAI/HAI resident of autolysin,
(superantigens) eyelashes pneumolysin
: Enterotoxins, ● Capsule w HA ● Adhere to
TSST-1, EFT ● M protein: major phosphorychol
virulece factor ine
● Streptococcal ● Stimulate IL-1
pyrogenic
exotoxins SPE
(antigens)
● Streptolysin O
(ASO titer)
● Cellulitis,
pharyngitis,
puerperal
sepsis,
erysipelas (slap
cheek)
Diseases ● Localized skin ● Implant ● Nonspecific ● Strep throat ● Neonatal ● Pneumonia ● Streptococcus
infections: infections urethritis in ● Poststreptococc infection and mutans (Dental
furuncles, men al immunologic respiratory carries)
carbuncles, ● UTI and disorders infections ● Streptococcus
impetigo dysuria in (rheumatic fever anginosus
● Deep localized sexually and (neonatal
infections: active glomerulonephrit sepsis)
osteomyelitis, adolescent is)
acute women
endocarditis,
septicemia,
pneumonia with
multiple lung
abscesses,
food
intoxication,
SSSS, TSS

Treatment ● Penicillin ● B-lactamase + ● Resistant to ● Type specific ● Penicillin ● ●

resistant (B ● Resistant to nalidixic immunity resistance due
lactamace methicillin, acid, ● Drainage to PBP
resistant oxacillin, sulfonamides ● Antibiotics ● 3rd gen
penicillin like nafcillin , (penicillin, cephalosporin
coamoxiclav) nitrofurantoin macrolides) s
● Vancomycin
● Polysaccharid
e
Pneumococcal
Vaccine
(older)
● Pneumococcal
Conjugated
vaccine
(young)
 AEROBIC GRAM + BACILLI
Bacillus anthracis
Lab Identification ● Regular, spore forming, aerobic
● Facultative
● Non motile
● Non B-hemolytic
Pathogenesis, Toxins ● Antiphagocytic capsule:
poly-D-glutamic acid
● Exotoxin: Anthrax toxin
(Protective antigen, lethal factor
[zinc cleave kinase], edema
[INC cAMP])
Diseases ● Anthrax (skin, GI or respiratory
[woolsorter])
● Septicemia in all 3
● Widened mediastinum
● Fourfold in acute and
convalescent sera or greater
than 1:32 is +
Bacillus cereus
● Regular, spore forming, aerobic
● Motile
● Catalase +
● B-hemolytic
● Grows in NaCl andi n
Sabouraud
● Root-like outgrowths
● Emetic toxin (Cereulide)
● Enterotoxin
● Emetic food poisoning
(cereulide; heat stable faster)
● Diarrheal food poisoning
(enterotoxin; heat labile slower)
● Fried rice syndrome
● Eye (Endophthalmitis <
panophthalmitis [orbit[ <
keratitis [cornea])
● Bacteremia, endocarditis,
osteomyelitis,
meningoencephalitis,
penumonia
Listeria monocytogenes Corynebacterium
diphtheriae
● Regular, non spore forming, ● Irregular, non spore forming,
aerobic aerobic
● Coccobacillus rod ● Club looking
● Non branching ● Albert’s stain:green w
● Facultative metachromatic granules
● Facultative intracellular ● Fastidious
pathogen ● Elek’s test
● Catalase +
● Oxidase +
● Bile-esculin agar + (black)
● Hippurate hydrolysis -
● CAMP +
● B-hemolytic
● Motile (Extracellular [tumbling
37 below] Intracellular [actin])
● Cold then selective to isolate
from feces
● Oxford agar
● SIM (umbrella)
● Nasopharyngeal carriage; ● All subspp start as non
transient resident of eyelashes toxigenic
● Capsule w HA ● Becomes pathogenic with
● M protein: major virulece factor Beta-bacteriophage for DT
● Streptococcal pyrogenic ● DT has subunit A (active; EF2)
exotoxins SPE (antigens) and B (binding to cell)
● Streptolysin O (ASO titer)
● Cellulitis, pharyngitis,
puerperal sepsis, erysipelas
(slap cheek)
● Food borne; survives at low ● pseudomembrane
temp ● Pharyngeal diphtheria
● Virulence (Listeriolysin O) ● Cutaneous diphtheria
● Listeriosis limited to intestinal ● Myocarditis
mucosa ● Acute tubular necrosis
● Disseminate listeriosis (oliguria)
● Liver abscess ● Oculomotor palsy (diplopia)
● Meningitis
● Spontaneous abortion
● Endocarditis
● Neonatal listeriosis

Treatment ● First line: ciproflaxacin,
clindamycin, linezolid
● Raxibacumab, oblitoxaximab: 2
monoclonal antibodoes
● More than 10^5 CFU
● Bacteremia: vancomycin; ● Disseminated listeriosis: IV
imipenem gentamicin ampicillin or penicillin G;
gentamycin
● Co trimoxazole
● Treatment starts even before
diagnostic confirmation
● Penicillins and macrolides
(erythrocytes)
● DT present = diphtheria
antitoxin
● Vaccine: toxoid
● With tetanus and whooping
cough DTaP
● DTaP for young
● TdaP or preteens
● Td booster for adults
 ANAEROBIC GRAM + BACILLI
Clostridium botulinum
Lab Identification ● Obligate
Pathogenesis, Toxins ● In canned food
● Botulinum toxin: A-H (a and b
less toxic): cleaves snare
proteins = FLACCIDITY
● Used as botox
Diseases ● Botulism
● Bulbar palsy (cranial nerves
9-12)
● Infant botulism (Floppy baby
syndrome): honey consumption
Treatment ● Antitoxin
● Trivalent (ABE)
● Pentavalent (A-G)
Clostridium difficile
● Stool and colonoscopy
● obligate
● Fecal oral route
● High antibiotic + elementa diet
● Virulence (Enterotoxin A [disrupt
junction] and Cytotoxin B [enter
neutrophils]
● Pseudomembranous colitis:
bloody diarrhea: result of toxin a
and b
● If not treated: toxic megacolon
● Metronidazole, vancomycin
● Avoid loperamide
● Fecal transplant
● probiotics
Clostridium perfringens
● obligate
● One of the fastest growing
rates; spores can survive
cooking
● Enterotoxin heat labile
● Alpha toxin
● Cafeteria germ
● Clostridial myconecrosis (gas
gangrene): by alpha toxin
crepitus
● Food poisoning
● Enteritis necrotans
● Diagnosis long for gas
gangrene
● Gas gangrene: surgical
excision; penicillin V or
clindamycin
● Hyperbaric oxygen therapy
Clostridium tetani
● obligate
● Tetanospasmin: inhibit
Renshaw cell, cleave snare
proteins = MUSLCE SPASMS
● Puncture wounds
● Tetanus: only affects skeletal
muscles
● Types: general, localized (not
deadly), cephalic (deadly),
neonatal
● Symptom: Tetanic triad
(trismus lock jaw, risus
sardonicus saridnian grin,
opisthotonos) also sympathetic
overactivity
● Diagnose thru spatula test + if
bite
● Tetanus immune globuline
(TIG): antitoxin
● Tetanus Toxoid Vaccine (w/
diphtheria and pertussis DTP)
 ANAEROBIC GRAM - BACILLI
Bacteroides Fusobacteria Pigmenting Gram - Pigmenting Gram -
Bacilli Bacilli
Porphyromonas Prevotella

Bacteroides fragilis Fusobacterium Fusobacterium Poryphyromonas Prevotella bivia

nucleatum necrophorum gingivalis

● ● ● ● ●

Lab Identification ● Saccharolytic ● Spindle shaped; fusiform ● Broad rounded ends ● assarcharolytic ● saccharolytic
● Pleomorphic with with pointed tapered ends ● A-hemolytic or ● Sensitive to bile ● Some non pigmented
vacuoles and swellings ● Scattered wheat straw B-hemolytic ● Small coccobacillus
● Low convex, white to ● Sometimes A-hemolytic ● ● Pairs or short chains
gray, semi opaque, ● Convex, translucent with ● Requires HEMIN
glistening, some internal flecking or ● B-lactamase
hemolytic mottling or more
● Bile-esculin agar + umbonate, heaped, dull,
● LKV: resistant to opaque (breadcrumb)
Kanamycin and ● Bile esculine agar -
Vancomycin ● Indole +
● Moderate anaerobe
● Superoxide dismutase +
● Catalase +

Pathogenesis, Toxins ● GI flora ● Mouth and Urogenital ● Found in GI ● Virulence: ● Virulence: proteolytic
● Natural B-lactamases tract ● Virulence polysaccharide capsule, enzyme,
● Common not fragile (lipopolysaccharide, collagenase, butyrate chymotrypsinase,
● Polysaccharide capsule hemolysin and lipase) trypsinase
(major virulence)
● Lipopolysaccharide
(abscess)

Diseases ● Septicemia ● Oral, pleuro pulmonary, ● Abdominal infection, liver ● Periodontal disease ● OB GYN infections
● Intra abdominal amniotic fluid infection abscesses ● Pleuropulmonary
infectioms ● Lemierre’s syndrome: infections
forgotten disease

Treatment ● Metronidazole, ● Metronidazole, ● Penicillin G ● metronidazole

clindamycin, clindamycin, ● imipenem
chloramphenicol cephalosporin
● Drainage, debridement,
exposure wound to
oxygen
 ANAEROBIC COCCI
Gram + non spore forming cocci Gram - non spore forming cocci

Peptostreptococcus spp. Veillonella spp.

Lab Identification ● Endogenous ● Endogenous

● Non motile, cocci in chains ● Part of normal flora in mouth, upper RT, GI, vagina
● opportunist

Pathogenesis, Toxins ● Cause: puerperal infection, pelvin peritonitism cerebral ● Rarely cause infection
and other abscesses ● Infections of mouth,BITE WOUNDS, head neck
pulmonary infection

GRAM - COCCI
Neisseria gonorrhoeae Neisseria meningitidis

Lab Identification ● G- diplococci ● Intracellular G- diplococci

● Coffee bean shaped ● Kidney or coffee bean shaped
● Non spore forming, non motile, non hemolytic, non ● Non spore forming, non motile, non hemolytic, non
pigmented pigmented
● Beta lactamase production: rare ● Beta lactamase production: common
● Specimen: urethral, cervical smears ● Specimen: CSF, nasopharyngeal swab
● Culture: aerobic; modified thayer-martin, martin-lewis ● Culture: choc agar, BAP, MTM
● Oxidase + ● Oxidase +
● Glucose + ● Glucose +
● Maltose - ● Maltose +
● Brudzinski’s and Kernig’s signs

Pathogenesis, Toxins ● Virulence: ● Have POLYSACCHARIDE CAPSULES

● Pili (attachment), ● Virulence:
● Por (pores), Opa ● capsular polysaccharide A and C (anti phagocytic),
● Protein (adhesion), ● Pili (bind), LPS (toxic effect; MAJOR);
● Rmp (Protein III) (pores), ● outer membrane Por A and B (nutrient diffusion);
● LPS (Endotoxic) ● IgA1 protease (inactivate antibody activity);
● Iron (INC pathogenicity)

Diseases ● Urethritis (gonorrhea) cervicitis ● Meningococcemia, meningitis

Treatment ● Ceftriaxone ● Chloramphenicol

● Ciprofloxacin ● 3rd gen cephalosporins