GRAM POSITIVE COCCI:-

• Staphylococcus aureus - Skin Abcesses (Toxic shock syndrome), Enterotoxin (Food poisoning), Scalded
skin syndrome (Scalded skin syndrome toxin) *B-hemolytic yellow or gold colonies on blood agar*
• Staphylococcus epidermidis - Normal skin flora (patients own strain causes infection). Colonization on
prosthesis by glycocalyx producing strains. Non B-hemolytic colonies on blood agar. *NOVOBIOCIN
SENSITIVE*
• Staphylococcus saprophyticus - UTI in young sexually active women. Non B-hemolytic colonies.
*NOVOBIOCIN RESISTANT*
• Streptococcus pyogenes (A) - Pus producing infections (cellulitis and pharyngitis), immunologic
diseases (Rheumatic fever and acute glomerulonephritis) and scarlet fever. B-hemolytic colonies on
blood agar. *BACITRACIN SENSITIVE*
• Streptococcus agalactiae (B) - neonatal meningitis and sepsis. B-hemolytic colonies on blood agar.
*BACITRACIN RESISTANT, CAMP TEST POSITIVE*
• Enterococcus faecalis - UTI, Biliary tree infection (because bile insoluble) and endocarditis. Non B-
hemolytic colonies on blood agar. *Bile insoluble, grows is 6.5% NaCl (remember this) *
• Streptococcus pneumoniae - NUMBER 1 CAUSE OF MOPS (Meningitis, Otitis media, pneumoniae and
sinusitis), Lancet shaped diplococci (remember), one of the three classic encapsulated bacteria (neisseria
and haemophilus other two) *OPTOCHIN SENSITIVE*. **ALPHA-Hemolytic colonies** Quellung reaction
occurs.
• Viridans group of streptococci (Streptococcus mutans) - Endocarditis and dental caries -> organism will
enter through dental procedure. (Because it is the normal flora of oropharynx) **ALPHA-Hemolytic
colonies** *OPTOCHIN RESISTANT.*

GRAM NEGATIVE COCCI:-

• Neisseria meningitis - Meningitis. Kidney shaped diplococci. LARGE POLYSACCHARIDE CAPSULE

(antiphagocycotic). People with deficiency in late complement components (C5-C9) predisposed to
infections. **Oxidase positive colonies on chocolate agar, FERMENTS glucose** Vaccine against group B
meningococci

• Neisseria gonorrhea - Gonorrhoea (STD). Kidney bean shaped diplococci. INSIGNIFICANT CAPSULE
(differentiating factor) **Oxidase positive colonies on Thayer-Martin's agar, DOES NOT FERMENT
MALTOSE, NAATs for screening** Silver nitrate for prevention of conjunctivitis.

GRAM POSITIVE RODS :-

**CLOSTRIDIUM AND BACILLUS SPECIES ARE SPORE FORMING RODS**

• Bacillus anthracis - Anthrax, *Capsule made of protein (poly-D-glutamate)* <- ONLY ORGANISM WITH
PROTEIN/AMINO ACID CONTAINING CAPSULE REST HAVE POLYSACCHARIDES. Non-motile compared to
other bacillus species.

• Bacillus cereus - Gastroenteritis (food poisoning), spores survive boiling preparation of rice then
germinate when rice held at warm temp. Two enterotoxins: one like cholera toxin (inc cAMP) other like
staphylococcal enterotoxin.
• Clostridium tetani - Tetanus, Spore at one end of rod (tennis racket appearance). transmission via
wounds. GABA and Glycine release inhibited. Extreme muscle contractions leading to rigidity, Lock jaw
and risis sardonicus are important examples. *Clinical diagnosis* Toxoid vaccine combined with
diphtheria and pertussis vaccine (DTaP)

• Clostridium Botulinum - Botulism (flaccid/descending paralysis-> starting from upper parts of

body),and Floppy baby syndrome in babies (via ingestion of honey)
*TRANSMISSION - IMPROPERLY PRESERVED FOOD* mostly canned food association. **presence of toxin
in stool or food**

• Clostridium perfringens - Gas gangrene (myonecrosis) and food poisoning.

Transmission-> contamination of wounds. **Lecithinase produce on egg yolk agar** **Double zone on
blood agar**

• Clostridium difficle - Pseudomembranous colitis (hospital acquired/nosocomial infection) **Exotoxin in

stool detected via ELISA or PCR)**

• Cornybacterium diphtheriae - Diphtheria **CLUB SHAPED ARRANGED AS V OR L** **GRANULES STAIN

METACHROMATICALLY**
**Black colonies on tellurite plate** Toxoid vaccine (DTaP)

• Lisseria monocytogenes - Meningitis and sepsis in newborns and immunocompromised adults +

Gastroenteritis. **INGESTION OF UNPASTEURISED MILK PRODUCTS**
Cell to cell transmission via actin rockets **B-hemolytic colonies on blood agar, Tumbling motility**

• Gardnerella vaginilis - Just remember Clue cells (Vaginal cells covered with organism) and *POSITIVE
WHIFF TEST*

GRAM NEGATIVE RODS (ENTERIC TRACT):-

Escherichia coli - Number 1 cause of UTI and "traveler's diarrhoea". Also cause sepsis, neonatal
meningitis and HUS (Hemolytic Uremic Syndrome). **FERMENT LACTOSE** ETEC (two enterotoxins,
heat labile and heat stable)-> watery diarrhoea, Shiga-like toxin-> bloody diarrhoea. **GREEN SHEEN ON
EMB AGAR** **TSI SHOWS ACID SLANT AND ACID BUTT NO H2S**

Salmonella typhi - Typhoid. **DOES NOT FERMENT LACTOSE** Chronic carrier state established in
gallbladder. TSI shows alkaline slant and acid butt with H2S.
**WIDAL TEST** Two vaccines: 1) purified polysaccharide capsule 2) live attenuated

Salmonella enterica - Enterocolitis *Motile compared to shigella* Infectious dose must be very large to
cause infection b/c organism is inactivated by stomach acid.
TSI shows alkaline slant and acid butt with H2S. **WIDAL TEST**

Shigella species -> Enterocolitis (dysentery) Non motile compared to Salmonella. Infectious dose is
smaller (resists stomach acid) *TSI agar shown alkaline slant with acid butt and H2S*

Vibrio Cholerae -> Cholera (MASSIVE WATERY DIARRHEA UP TO 10-20L) Habitat is human colon and
**SHELL FISH** (if patient in qs has a history of consuming sea food and complains of massive watery
diarrhea safely jump to vibrio species) Comma shaped gram negative rod. *Agglutination of the isolate
with known antisera confirms the identification*

Other two Vibro species (parahaemolyticus and vulnificus)

Parahaemolyticus -> Water diarrhoea (ingestion of contaminated raw seafood)
Vulnificus -> life threatening sepsis and cellulitis (traumas in skin, especially in Shell fish handlers or by
ingestion of same)

Campylobacter jejuni -> Enterocolitis. Microaerophilic. Comma shaped gram negative rod, oxidase
positive, *THERMOPHILIC* <- grows and resists high temperatures. **SKIRROW's AGAR - 42^C HIGH
CO2 LOW O2**

Helicobacter pylori -> Peptic ulcer (risk factor for gastric carcinoma). Curved/Helical gram negative rod.
Urease positive -> helps organism grow in acidic environment of stomach by neutralising.
**UREA BREATH TEST (VV IMP)**

Klebsiella pneumoniae -> Pneumoniae, UTI. Immotile. *Ferments lactose* **LARGE POLYSACCHARIDE
CAPSULE** <-impedes phagocytosis. **CHARACTERISTIC MUCOID COLONIES BECAUSE OF ABUNDANT
POLYSACCHARIDE CAPSULE**

Enterobacter cloacae -> Similar to K.pneumoniae, except it is motile.

Serratia marcescens -> Similar to K.pneumoniae, except it is motile. Red pigmented colonies.

Proteus species (Proteus mirabilis)-> UTI and sepsis. Urease positive.

**HIGHLY MOTILE (V IMP)** Forms struvite stones causing urine obstruction. Stone formation because
of raised pH by urease. **SWARMING (SPREADING EFFECT) all over blood agar plate because of active
motility (v imp factor)** -> remember the word swarming.

Pseudomonas aeruginosa -> UTI, Pneumoniae and sepsis, hospital acquired infections especially in burn
pts and cystic fibrosis pts. Non lactose fermenting and oxidase positive.
**PRODUCES PYOCYANIN (Blue-green pigment also seen in sputum of cystic fibrosis pts) **

Bacteroides fragilis - Sepsis, Peritonitis and abdominal abcess. -> infection usually after bowel surgery or
penetrating abdominal wounds **Biochemical reactions and gas chromatography for identification **

GRAM NEGATIVE RODS (RESPIRATORY TRACT):-

• Haemophilus influenza - Most important cause of epiglottitis (although this is rare), sepsis, otitis media
and pneumoniae. **COCCOBACILLARY SHAPED** Requires Factor V (NAD) and X (hemin). Six capsular
polysaccharide types (type b is polyribitol phosphate and causes 95% invasive disease). Grown on
chocolate agar need factor V and X for growth.
Conjugated vaccine given 2-18 months of age (important)

• Bordatella pertussis - Whooping cough (also 100-day cough). Culture on *Bordet-Gengou agar*
Acellular vaccine, given in combination with diphtheria and tetanus toxoid (DTaP)
• Legionella pneumophila - Legionnaire's disease-> Atypical pneumoniae (Also called Walking
pneumoniae because even though the infection seems serious on a chest X-ray the patient seems to
show no obvious symptoms). **Require Iron and cysteine for growth in culture** NO PERSON TO
PERSON TRANSMISSION HERE.
**Microscopy with silver impregnation stain** **CULTURE ON CHARCOAL YEAST AGAR**

GRAM NEGATIVE RODS (ZOONOTIC ORGANISMS):-

• Brucella species - Brucellosis (undulant fever -> occurring as waves of high and low fever)
**INGESTION OF UNPASTEURISED MILK PRODUCTS OR DIRECT CONTACT WITH LIVESTOCK)** Culture on
blood agar

• Francisella tularensis - Tularemia *Main reservoir are Rabbits, transmission via tick bite (Dermacentor).
*Ulceroglandular lesion at the site of inoculation* Live attenuated vaccine

• Pasteurella multocida - Wound infection (cellulitis) *Reservoir - mouth of many animals, transmission
is via animal bites (i.e. cats and dogs)*

• Yersinia pestis - pneumonic and bubonic plagues. **Reservoir - Rodents (rats, prairie dogs, squirrels),
transmission via flea bite. **ONE OF THE MOST VIRULENT (VERY LOW ID50)** **BIPOLAR "SAFETY PIN"
STAINING (takes up stain at two ends** Swollen lymph nodes (Bubo) ->in region of flea bite.

• Bartonella henslae - Cat scartch disease (in immunocompetent pts) and Bacillary Angiomatosis (in
immunocompromised pts). **Reservoir - Cat's mouth, transmission via animal bites** Biopsy of BA
lesion shows pleomorphic rods using **Warthin-Starry stain**

MYCOBACTERIA:-

• Mycobacterium tuberculosis - Tuberculosis

High lipid content in cell wall (prevent dyes used in gram-stain from staining organism) Lipid includes
*Mycolic acids and wax D* **SLOW GROWTH**
Acid fast rods seen with Ziehl-Neelsen stain
*Slow growing colony on Lowenstein-Jensen medium*
Induration due to delayed hypersensitivity reaction after 48hrs of inoculation -> positive Purified Protein
Derivative test (PPD)

• Atypical mycobacteria - Main difference, they are in the environment M. Tuberculosis is found in
humans

• Mycobacterium leprae - Leprosy

*Grows on cooler parts of body* Transmission via nasal secretions of pt.
*Lepromin skin test positive in tuberculoid leorosy* A serologic test for IgM against *phenolic glycolipid-
1* diagnosis of lepromatous leprosy.

ACTINOMYCETES:-

Actinomyces israelii - Actinomycosis (abcesses with draining sinus tracts) *BRANCHING FILAMENTOUS
RODS*
Habitat is human mouth, anaerobic gingival crevices, transmission is then via dental disease or trauma
Sinus tracts open onto skin and contain *SULFURE GRANULES (MATS OF INTERWINED FILAMENTS OF
BACTERIA)
*Sulfur granules in pus*

Nocardia asteroides - Nocardiosis (brain and lung abcess)

*BRANCHING FILAMENTOUS RODS* *Weakly acid fast* *Ziehl-Neelsen stain is used*

MYCOPLASMA:-

• Mycoplasma pneumoniae:- Atypical pneumonia (meaning explained in legionella species)

*NO CELL WALL, HENCE NO STAIN TAKEN*
Hence, cell wall inhibitors are of no use.
*CHOLESTEROLS IN CELL MEMBRANE (VV CHARACTERISTIC)*
Positive cold-agglutinin test

SPIROCHETES:-

• Treponema pallidum - Syphillis. Spirochetes, very thin, not seen on gram stain. Primary (painless
chancre), Secondary (Condyloma lata and maculopapular rash on palms and soles) and Tertiary (gumma
formation, aortitis, CNS inflammation)
**FTA-ABS SPECIFIC TEST ANTIGEN IS KILLED ORGANISM**
In VRDL and RPR beef heart cardiolipin is antigen.
Slow growth.

• Borrelia burgdorferi - Lyme's disease

Spirochete,
*Reservoir - White-footed mouse, transmission via ixodid tick and very small nymph stafe of ixodid tick
(deer tick) is most common vector*
Bull's eye rash (erythma migrans), involved heart, joints, CNS.
**Confirmatory positive serologic test with Western blot assay**

• Leptospira interrogans - Leptospirosis. Transmission via animal urine. (Swimming in contaminated

water. *Diagnosis made by serologic testing for antibodies in patient's serum.*
Biphasic: 1) fever, chills, headache, conjuctivital suffusion.
Resolution of symptoms then: 2) Aseptic meningitis, sever cases, jaundice.

• Borrelia recurrentis - relapsing fever. Transmission via human body louse.

*Large spirochetes in stained smears of peripheral blood*

CHLAMYDIAE:-

• Chlamydia trachomatis - Nongonococcal utheritis, cervicitis, conjunctivitis, lymphogranuloma

venereum(ulcerative disease of the genital area, pain in anus), trachoma and pneumoniae in infants
Obligate intracellular.
Two forms: 1) Elementary metabolically active form - not dividing. 2) Reticulate form, intercellular -
dividing form
**GRAM STAIN OF URETHRAL EXUDATE SHOW NEUTROPHILS BUT NO GRAM NEGATIVE GONOCOCCI ->
major evidence for diagnosis**
*cytoplasmic inclusions on Giemsa stain.

• Chlamydia pneumoniae - Atypical pneumoniae

*Serologic tests*

• Chlamydia psittaci - Psittacosis (Asymptomatic or high fever with pneumoniae)

*Cytoplasmic inclusions seen with Giemsa stain*
*NAATs or PCR to diagnose chlamydial sexually transmitted disease using patient's urine*
*Chlamydiae grown in cell cultures treated with cycloheximide*

• C. Trachomatis cytoplasmic inclusions - contain glycogen

• C. Psittaci and C. pneumoniae cytoplasmic inclusions - do not contain glycogen

RICKETTSIAE:-

OBLIGATE INTRACELLULAR

• Rickettsia rickettsii - Rocky Mountain spotted fever.

Very short rods, divide by binary fission (chlamydia, also obligate intracellular but divide distinctively)
*ELISA, most commonly. Weil-Felix no longer used.*
Transmission - bite of arthropod
Rash -> appears first on hand and feet then inwards towards trunk.

• Rickettsia prowazekii - typhus

Rash -> difference: in prowazekii infection rash starts on the trunk and then moves peripherally.
Transmission - human body louse
When a bacteremic patient is bitten, organism is ingested by louse and multiplies in the gut epithelium,
it is excreted in the feces of the louse during the act of biting the next person and autoinoculated by the
person while scratching the bite area
*ELISA most commonly used, Weil-Felix is no longer used*

• Coxiella burnettii - Q fever.

Very low ID50
Transmission- aerosol of cattle (main reservoir) urine, feces, placental tissue and amniotic fluid.
Flu like symptoms + pneumonia
*COMBINATION WITH PNEUMONIAE AND HEPATITIS SUGGESTS Q FEVER*
*PCR done or indirect immunoflorescence assay*