Type of clinical infections Gram stain Examples of important bacterial pathogens

morphology
Skin and tissue infections GPC Staphylococcus aureus, Streptococcus pyogenes,
Enterococcus sp.
GPB Bacillus anthracis, Clostridium sp. (esp. C. perfringens)
GNR Enterobacteriaceae:
- Escherichia coli, Klebsiella pneumoniae, Proteus sp.
Enterobacter sp.

Non-enterobacteriaceae:
- Pseudomonas aeruginosa (infected burn wounds,
ecthyma gangrenosum), Stenotrophomonas sp.
Bone/join Osteomyelitis GPC Staphylococcus epidermidis, Staphylococcus aureus
infections GNR Salmonella sp., Pasteurella multocida
GNCB Brucella sp., Haemophilus influenzae, Pasteurella
multocida
Septic arthritis GPC Staphylococcus aureus, beta-haemolytic streptococci
Central Meningitis GPC Staphylococcus epidermidis, Staphylococcus aureus,
nervous Streptococcus pneumoniae, Streptococcus pyogenes
system (GAS), Streptococcus agalactiae (GBS), Enterococcus
species
GPR Listeria monocytogenes
GNC Neisseria meningitidis
GNR Escherichia coli, Klebsiella pneumoniae, Enterobacter
sp., Pseudomonas aeruginosa
Upper Acute otitis media GPC Streptococcus pneumoniae
respiratory GNC Moraxella catarrhalis
tract infections GNCB Haemophilus influenzae
Chronic otitis GNR Pseudomonas aeruginosa
media
Pharyngitis GPC Streptococcus pyogenes (GAS)
GPR Arcanobacterium haemolyticum, Corynebacterium
diphtheriae
GNC Neisseria gonorrhoeae
Bacteria that Chlamydia pneumonia
can’t be Gram
stained
Lower respiratory tract infection GPC Staphylococcus aureus, streptococcus pneumoniae
(pneumonia) GPR Bacillus anthracis
GNC Moraxella catarrhalis
GNR Enterobacteriaceae:
- E. coli, Klebsiella pneumonia, Proteus sp., Enterobacter
sp.

Nonenterobacteriaceae:
- Pseudomonas aeruginosa, Stenotrophomonas
maltophilia, Burkholderia pseudomallei
GNCB Haemophilus influenzae
Endocarditis GPC Staphylococcus epidermidis, Staphylococcus aureus,
Streptococcus sp., Enterococcus sp.

Bacteraemia/bloodstream
infection/septicaemia
GPR Listeria monocytogenes
GNR HACEK organisms
- Haemophilus aphrophilus (subsq. Called
Aggregatibacter aphrophilus & Aggregatibacter
paraphrophilus )
- Aggregatibacter actinomycetemcomitan
- Cardiobacterium hominis
GPC Staphylococcus epidermidis, Staphylococcus aureus,
Streptococcus sp., Enterococcus sp.
GPR Listeria monocytogenes
GNR Enterobacteriaceae:
- E. coli, Klebsiella pneumonia, Proteus sp., Salmonella
sp.

Nonenterobacteriaceae:
- Pseudomonas aeruginosa, Stenotrophomonas
maltophilia, Burkholderia pseudomallei, Pasteurella
multocida
GIT Gastroenteritis GPC Staphylococcus aures
GPR Bacillus anthracis, Bacillus cereus, Clostridium difficile,
Listeria monocytogenes
Straight E.coli (pathogenic strains), Salmonella sp., Shigella sp.
GNR
Curved Campylobacter sp., Vibrio sp.
GNR
Botulism GPR Clostridium botulinum
Intraabdominal GPC Enterococcus sp.
abscess GPR Actinomyces sp.
Urinary tract infection (UTI) GPC Staphylococcus saprophyticus, Enterococcus sp.
GNR Enterbacteriaceae:
- E. coli, Klebsiella pneumoniae, Proteus mirabilis

Nonenterobacteriaceae:
- Pseudomonas aeruginosa
Genital infections GNC Neisseria gonorhoeae
GNCB Haemophilus ducreyi
Bacteria that Chalmydia trachomatis, Treponema pallidum
can’t be Gram
stained
Eye infections Acute GPRC Staphylococcus aureus. Streptococcus pneumoniae
conjunctivitis GNC Moraxella catarrhalis, Neisseria gonorrhoeae
GNCB Haemophilus influenzae
Bacteria that Chlamydia trachomatis
can’t be Gram
stained
Endophthalmitis GPC Staphylococcus aureus
Ear infections Otitis externa GPC Staphylococcus aureus
GPR Corynebacterium sp.
GNR Pseudomonas aeruginosa
Nematodes (roundworms)
Ascaris lumbricoides Diisease: ascariasis
Habitat: small intestine
Infective stage: infective eggs
Transmission: ingestion of egg in contaminated food/water, from soil

Symptoms:
- provoke pneumonitis; Loeffler’s syndrome (transient resp. illness)
- abdominal discomfort, anorexia, nausea and diarrhoea
- Protein energy malnutrition (PEM)
- vit. A deficiency
- intestinal abstruction

Examine stool for eggs

- have thin internal memb. with thick shell surrounded by mamillated outer
cover
Treatment:
- albendazole, mebendazole (anthelminthic drug)

Prevention & control:

- periodical deworming, sanitation to reduce soil contamination, surgery
Trichuris trichiura Disease: trichuriasis
Habitat: caecum
Infective stage: infective eggs
Transmission: ingestion of barrel shaped infective eggs in contaminated
food/water, directly from soil

Symptoms:
- light whipworm infections, abdominal, diarrhoea, nausea, vomiting, vit A
deficiency
- prolapse of rectum (heavy infections in children)
- stool examination for barrel shaped eggs with bipolar plugs

T. trichiura in large intestine:

- anterior end embedded in intestinal mucosa
- posterior end hanging out in the lumen
Treatment:
- albendazole, mebendazole

Prevention:
- similar with Ascaris lumbricoides
Hookworms: Disease: hookworm infection
- Necator americanus Habitat: small intestine
- Ancylostoma duodenale Transmission: skin penetration by infective filariform larvae (L3)

Common site of infection:

- thin skin btw toes
- dorsum of the feet
- inner side of soles
- Gardeners & miners – skin of hand
 Clinical signs: Intestinal phase (adult)
- nausea, vomiting, abdominal pain, diarrhoea
- malnourished, iron deficiency anaemia (microcytic hypochromic type) – look
pale, hypoproteinemia

Symptoms by migrating larvae:

- Ancylostome dermatitis or Ground itch – occurs at site of site entry
Buccal capsule of adults:
- N. americanus – has a pair of cutting plates
- A. duodenale – has 2 pairs of ventral teeth

Diagnosis:
- ellipsoidal egg with thin transparent shell enclosing the embryo
- clear space is apparent btw eggshell and developing embryo
Treatment:
- albendazole, mebendazole, iron replacement therapy (for anaemia), blood
transfusion (for severe anaemia)

Prevention & control:

- wear shoes, sanitary disposal of faeces, antihelminthic treatment
Strongyloides stercoralis Disease: strongyloidiasis
Habitat: small intestine
Transmission: Skin penetration by infective filariform larvae (L3)

Symptoms:
- Loeffler’s syndrome – during larval migration through lungs
- intestinal phase – abdominal discomfort, nausea, vomiting, diarrhoea
In immunocompromised patients – serious clinical manifestations due to
hyperinfection and disseminated strongyloidiasis
Diagnosis:
- examination of stool, sputum, bronchial washing and tracheal aspirate (in
case of hyper infection) for L3 with notched tail (V or W shaped); ELISA test
Treatment:
- thiabendazole, albendazole

Prevention:
- wear shoes, antihelminthic treatment

Important before starting immunosuppressive treatment – may cause

hyperinfection and is fatal. Check if patient have strongyloidiasis before giving
immunosuppressive drug
Enterobius vermicularis Disease: Enterobiasis
Habitat Colon
Infective stage: Infective eggs

Signs: due to migration of worm

- perianal, perineal and vaginal itching (pruritis), worsens at night
- insomnia and restlessness
- nocturnal enuresis – inability to control urination
 Diagnosis:
- scotch tape technique
- white pin like worm, D shaped eggs
Treatment:
- albendazole, mebendazole

Filarial worms:
- Brugia malayi (nocturnal)
- Wuchereria bancrofti
Prevention:
- personal hygiene, avoid crowded places, antihelminthic
Disease: Lymphatic filariasis
Habitat: Lymphatic system
Infective stage: Infective L3
Transmission: bitten by infected mosquito (e.g., Mansonia sp.) containing the
larvae

Signs:
- acute: local inflammation inv skin, lymph nodes and lymphatic vessels. Often
accompany chronic lymphoedema or elephantiasis
- chronic: lymphoedema (tissue swelling) or elephantiasis (skin/tissue
thickening) of limbs; hydrocele (fluid accumulation). Inv. of breast and genital
organs (common)
Diagnosis
- microfilariae in blood smear stained with Giemsa stain

Brugia malayi Wuchereria bancrofti

Bends in kinky curves
Terminal and subterminal nuclei
Contains indiscrete/uncountable
body nuclei
Sheath stain dark purple
Length:width of ant. Cephalic
space is 2:1
Treatment:
- albendazole in single dose treatment with Diethylcarbamazine (DEC) or
Ivermectin
Bends in smooth curves
No terminal nuclei
Contain discrete/countable body
nuclei
Sheath does not stain
Length:width of ant. Cephalic
space is 1:1

Prevention and control:

Trichinella spiralis
- mass drug administration (MDA), mosquito control, insecticide-treated nets or
indoor residual spraying
Disease: Trichinosis
Habitat: encysted larvae in muscle tissue
Transmission: ingestion of larvae-contaminates tissue

Symptoms:
- myalgia and tenderness, palpebral oedema, eosinophilia
Diagnosis:
- larvae in muscle tissue, coiled larvae
- Muscle biopsy, autopsy, serology
Treatment: mebendazole
Prevention: cook meats at 77 deg. celcius
Cestodes (tapeworms)
Taenia saginata (beef
tapeworm)
- has 15-30 lateral urine
branches
Taenia solium (pork
tapeworm)
- 7-12 lateral urine branches
Diphyllobothrium latum
(Broad fish tapeworm)
Disease: Taeniasis
Habitat: Small intestine
Infective stage: infective larvae = cysticercus bovis)
Transmission: consumption of undercooked beef
Asymptomatic or some abdominal discomfort
Diagnosis: finding eggs or segments or scolex (head) in shit
- egg is rounded or subspherical with thick radially striated brown shell
- inside each egg is an embryonated oncosphere with 6 hooklets (hexacanth
embryo)
Treatment: praziquantel
Prevention and control: check yo beefs
Taeniasis:
- definitive host – man acquired via ingestion of cysticercus larva in
undercooked pork
Cysticercosis:
- intermediate host – acquired via ingestion of eggs
Taeniasis:
- deprivation of nutrition
- GIT disturbances, abdominal pain, vomiting/diarrhoea
- intestine obstruction
Cysticercosis (T. solium):
- common site of encystment: CNS, eye, heart, muscle and skin
- common manifestation: CNS
- headache, dizziness, epilepsy, blurred vision, subcutaneous nodule
Diagnosis
Taeniasis:
- fecal exam to find egg and proglottid
Cysticercosis:
- Biopsy (subcutaneous nodule), serology (ELISA)
- Radiology (X-Ray/CT/MRI) – cerebral cysticercosis
- Ophthalmoscopy – ophthalmic cysticercosis
Treatment: Praziquantel, niclosamide
Prevention: avoid consume raw meat, surgery
Disease: Diphyllobothriasis
Habitat: Small intestine
Infective stage: infective plerocercoid larva
Transmission: consumption of undercooked fish containing infective
plerocercoid larva
Signs – bloating, vague abdominal discomfort, anorexia, nausea, vomiting
diarrhoea, megaloblastic anaemia (vit. B12 deficiency)
Diagnosis: identification of eggs in faeces
Finding operculated eggs or spatulated scolex (head fragment)
Treatment: Praziquantel, in presence of macrocytic anaemia – vit B12 given
Prevention: avoid eating raw fish, sanitary disposal of shit
Echinococcus granulosus Disease: unilocular hydatid dz
(dog tapeworm) Infective stage: infective eggs
Habitat: hydatid cyst (larva) can be found in various organs
Transmission: ingestion of infective eggs

- hydatid cysts enlarge at 1cm/yrs

- can grow to size of a coconut and contain 2L of fluid. If rupture
(spontaneously/during surgery), anaphylaxis can occur
Signs:
- brain – focal epilepsy
- lung – chest pain, cough and dyspnea (obstruction/rupture)

Diagnosis:
- radiography showing space occupying lesion and serology test
Treatment: surgical treatment
Prevention: control of feral dogs
Trematodes (flukes)
Schistosoma mansoni Disease: schistosomiasis
Habitat: veins draining large intestine
One intermediate host: fresh water snail
Infective stage: free-living cercaria (larva) (skin penetration)

Symptoms: (Katayama fever)

- hepatosplenomegaly, lymphadenopathy, eosinophilia
Diagnosis: identification of eggs in faeces
- egg w/ lateral spine
Treatment: praziquantel
Prevention: destruction of snail
Schistosoma haematobium Disease: schistosomiasis
Habitat: veins of urinary bladder plexus
Intermediate host – fresh water snail
Infective free living cercaria (skin penetration)

Symptoms: urinary schistosomiasis

- bladder wall infiltrated with eggs – bleeding
- inflammation and fibrosis – obstruction of ureter and neck of bladder –
bacterial infections = hematuria
Diagnosis: identification of eggs in urine
- egg w/ terminal spine
Treatment: praziquantel
Prevention: destruction of snail
Schistosoma japonicum Disease: schistosomiasis
Habitat: veins of urinary small intestine
Intermediate host – fresh water snail
Infective free living cercaria (skin penetration)

Symptoms:
- cerebral atrophy – eggs trapped in brain
- CNS symptoms – lodgment of eggs in nerve tissue
- chronic stage: hepatic and pulmonary cirrhosis
 Diagnosis: identification of eggs in faeces
- egg w/ small hook-like spine (rudimentary spine)/knob. Contains fully
developed mirocidium when leaves the host
Treatment: praziquantel
Prevention: destruction of snail
Clonorchis Disease: clonorchiasis/opisthorchiasis
sinensis/Opisthorcis Habitat: bile duct
viverrine 1st intermediate host – snails (produce cercariae), 2nd IH – fresh water fish
(produce metacercariae)
Infective stage: metacercariae in fresh water fish
Transmission: consumption of undercooked fish containing metacercariae

Signs:
- bile duct obstruction
- fatigue, abdominal discomfort, anorexia, wt loss, dyspepsia, diarrhoea
- obstructive jaundice, pancreatitis, recurrent cholangitis and
cholangiocarcinoma (cancers that begin in bile duct)
Diagnosis:
- identification of eggs in faeces or aspirate of duodenal fluid
- operculated jug-shaped w/ prominent shoulder around operculum, consisting
of miracidium.
Treatment: praziquantel
Prevention: avoid uncooked, dried or salted fish
Fasciolopsis buski Disease: fasiolopsiasis
Habitat: intestine
1st IH – snails (produce cercariae), 2nd IH – water plants (produce
metacercaria) (e.g., bamboo, lotus) (infective stage)

Signs:
- abdominal pain, diarrhoea, nausea
- haemorrhage, epigastric pain
Diagnosis: identification of egg in feaces
- large ellipsoidal unembryonated egg w/ thin shell and small indistinct
operculum
Treatment: praziquantel
Prevention: avoid eating raw veggies and rearing pigs (reservoirs) near
plantation ponds
Paragonimus westermani Disease: paragonimiasis
Habitat: lung
1st IH – snail (cercariae), 2nd IH – crab, crayfishes (metacercariae) (infective)

Sign:
- pulmonary dz resembling pulmonary TB
-chest pain, cough, night sweats, diff. breathing, blood-tinged sputum
Diagnosis:
- unembryonated operculated egg in rust coloured sputum/faeces
- egg is yellow-brown, ovoidal w/ thck shell, often asymmetrical, one end
slightly flattened. At large end, operculum is clearly visible
Treatment: praziquantel
Prevention: avoid ingestion of poorly cooked crabs