MICP211 MIDTERM REVIEWER
WEEK 7: BACTERIA AND DISEASE upper and lower extremities. It starts as a vesicle then
pathogenic bacteria possess characteristics that enable them to
circumvent the body's defenses and exploit its resources, resulting in
infection. It spreads by a variety of mechanisms. A significant number of
organisms must survive in the environment and reach a vulnerable host for
it to spread.
BACTERIAL SKIN INFECTIONS
STAPHYLOCOCCI:
 Staphylococcus aureus
o Gram-positive coccus; arranged in grapelike clusters.
o Produce enzymes & d toxins for its pathogenicity and
through direct invasion and destruction of tissues.
o Found in the skin and nasopharynx.
o Mode Of Transmission
 Skin infections are transmitted through: direct
contact with person having purulent lesions,
 from hands of healthcare or hospital workers
 fomites like bed linens, contaminated clothing
o Clinical Findings
 Folliculitis - a pyogenic pus-producing infection
involving the hair follicle. It is characterized by
localized painful inflammation and heals rapidly after
draining the pus
 Furuncle - an extension of folliculitis and is also known
as BOIL. It is characterized by larger and painful
nodules with underlying collection of dead and
necrotic tissue.
 Carbuncle – represents a coalescence of furuncles
that extends into the subcutaneous tissue with
multiple sinus tracts.
 Sty or Hordeolum - folliculitis occurring at the base of
the eyelids.
 Impetigo - Infections is common in young children
and primarily involves the face and the limbs. Initially
it starts as a flattened red spot (macule) which later
becomes a pus-filled vesicle that ruptures and forms
crust (honey-colored crust). It may be caused by both
S. aureus and S. pyogenes.
 Staphylococcal scalded skin syndrome (SSSS / Ritter’s
disease) - found in newborns and young children. It is
manifested by sudden onset of perioral erythema
(redness) that covers the body within 2 days. When
slight pressure is applied over the skin. Bullae and
cutaneous blister formation will soon follow and will
later undergo desquamation. Antibodies against the
exfoliative toxin are produced within 7-10 days
enabling the skin to become intact again. The toxin
responsible for these manifestations is EXFOLIATIVE
TOXIN. Outer layer only so there will be no scarring.
o Laboratory Diagnosis
 by microscopic examination of Gram-stained
specimen and culture.
o Treatment And Prevention
 Beta-lactam antibiotics like penicillin – treatment of
choice
 S. aureus readily develops resistance to penicillin &
other penicillin derivatives like methicillin and
nafcillin.
 Oxacillin - only penicillin-derived antibiotic that has
remained active against S. aureus.
o Patient Care
 Use Standard Precautions for skin, burn, and wound
infections if they are minor.
 Contact Precaution if major, SSSS
 Standard Precautions for infections caused by
methicillin-resistant S. aureus (MRSA); add Contact
Precautions if wounds cannot be contained by
dressing.
 Staphylococcus epidermidis
o part of the skin's normal flora.
o linked to "stitch abscess," UTI, and endocarditis.
o causes infections in people who utilize prosthetic
equipment.
STREPTOCOCCI
 Streptococcus pyogenes
o Gram-positive cocci, group A beta-hemolytic (cause
complete hemolysis of blood)
o M protein--- major virulence factor (anti-phagocytic)
o Produces enzymes and toxins responsible for the
pathogenesis of infections caused by the organism.
o Mode Of Transmission
 Soft tissue infections are acquired through direct
contact with an infected person or fomite.
o Clinical Findings:
 Pyoderma (impetigo) – a purulent skin infection that
is localized and commonly involves the face, and the
progresses to pustules. The lesions rupture and form
honey-colored crusts. There may be an enlargement
of the regional lymph nodes but no signs of systemic
infection.
 Erysipelas (St. Anthony’s fire) –follows a respiratory
tract or skin infection caused by s.pyogenes. Patients
manifest with localized raised areas associated with
pain, erythema, and warmth. It is grossly distinct from
normal skin. There is accompanying
lymphadenopathy and systemic manifestations.
 Cellulitis –- involves the skin and subcutaneous tissue.
Unlike erysipelas, the infected and the normal skin are
not clearly differentiated. It is also manifested as local
inflammation with systemic signs.
 Necrotizing fasciitis - involves the deep
subcutaneous tissue and is also known as “flesh-
eating or streptococcal gangrene”. It starts as
cellulitis then becomes bullous and gangrenous. It
spreads to fascia then the muscle and fat. It may
become systemic Abd cause multi-organ failure
leading to death.
o Complications
 Acute glomerulonephritis- non-suppurative, immune-
mediated complications and skin infections
 Rheumatic fever- usually associated with S.
pyogenes throat infection.
o Laboratory Diagnosis
 Microscopy
 Culture
 Bacitracin test
o Treatment And Prevention
 Penicillin- drug of choice
 Erythromycin or cephalosporin are alternative drugs
in case of penicillin allergy.
o Patient Care
 Standard Precautions for skin, burn, and wound
infections (minor or limited), and Contact or Droplet
Precautions if they are (major)
 Pseudomonas aeruginosa
o Gram negative bacillus; arranged in pairs; encapsulated.
o produces water soluble pigments like pyocyanin and is
resistant to most antibiotic.
o opportunistic aerobic pathogen;
o Antibiotic resistance
o prevalent source of hospital-acquired infections,
(Nosocomial infection)
o Virulence - adhesins, toxins, enzymes
o Mode of Transmission - colonization of injured skin
o Clinical Findings
 Blue-green pus; sweet grape -like odor –
 Folliculitis –
 Secondary infection to acne and nail infection –
 Osteochondritis
 ocular keratitis in contact lens wearers, endocarditis,
and osteomyelitis in IV drug users
 external otitis (swimmer's ear) in healthy people, and
severe external otitis in diabetics.
 Many persons with cystic fibrosis die of respiratory
failure caused by P. aeruginosa infection.
 P. aeruginosa frequent infects extensive skin burns,
which can lead to sepsis.
o Laboratory Diagnosis Gram stain; Culture
o Treatment - Sensitivity is done
o Prevention - Prevent contamination of sterile equipment
and cross – contamination
 Clostridium perfringens
o gram-positive bacillus, anerobic
o producing endospores
o produces four lethal toxins: alpha, beta, iota, and epsilon
toxins
 Alpha- most lethal because it causes massive
hemolysis, bleeding and tissue destruction
o Mode Of Transmission - Colonization of the skin following
trauma or surgery
o Clinical Finding - GAS GANGRENE (Clostridial Myonecrosis).
 causes soft tissue infections like cellulitis,
suppurative myositis and myonecrosis (gas
gangrene)
 -Gas gangrene- is a life-threatening infection
following trauma or surgery and is characterized
by massive tissue necrosis with gas formation,
shock, renal failure, and death within 2 days of
onset.
o Laboratory Diagnosis - Microscopic detection of gram-
positive bacilli and culture under an anaerobic condition.
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o Treatment And Prevention
 Surgical wound debridement and high-dose penicillin
therapy are the main approaches to the
management of the diseases.
o Patient Care. Use Standard Precautions
 Bacillus anthracis
o gram-positive bacilli, encapsulated, arranged in long
chains.
o large, aerobic, spore forming
o characteristics: bamboo rod or medusa head appearance
o able to grow slowly in soil types that meet specific moisture
conditions. Endospores survived in soil tests for up to60 years
o virulence factors of B. anthracis are two exotoxins (1)
edema toxin, causes local edema (swelling) and interferes
o with phagocytosis by macrophages (2) lethal toxin,
specifically targets and kills macrophages, which disables
an
o essential defense of the host. Both toxins share a third toxic
component, a cell receptor–binding protein called
protective antigen which binds toxins to target cells and
permits entry.
o CLINICAL FINDINGS
o 1. Anthrax
 bacterial disease caused by bacillus anthracis that
can affect skin, lungs, or gastrointestinal tract
depending on the portal of entry of the etiologic
agent.
 The disease strikes primarily grazing mammals, such as
cattle and sheep - People at risk are those who
handle animals, hides, wool, and other animal
products
o Three forms of Anthrax disease:
 Cutaneous anthrax – results from contact with
materials containing anthrax endospores.
 Inhalational (pulmonary) anthrax – most dangerous
form of anthrax in humans. Endospores inhaled into
the lungs have high probability of entering
bloodstream.
 Gastrointestinal anthrax - caused by ingestion of
undercooked food containing endospores. Sx. Are
nausea, abdominal pain, bloody diarrhea. Ulcerative
lesions occur in GIT from mouth, throat to intestine
o Mode of transmission:
 Through inoculation into the open skin from either the
soil or infected animal products, ingestion of infected
meat or milk and inhalation of aerosolized spores.
o Laboratory Diagnosis:
 blood tests detect both inhalational and cutaneous
cases of anthrax within an hour. The peripheral blood
contains many B. anthracis which is easily seen on
gram- stain. Spores can be done using Dorner stain or
Wirtz Conklin stain.
o Treatment and prevention - Antibiotics like penicillin or
doxycycline are the drugs of choice.
o Vaccination of livestock in endemic areas.; single
dose of live, attenuated vaccine is used, which is unsafe for
use in humans.
 Vaccine approved for humans: contains inactivated
form of antigen toxin to prevent entry of 2 toxins into
the host’s cells
 For people who have been exposed to B. anthracis: 3
doses of the vaccine over 4 weeks, along with
antibiotic treatment, are recommended.
o Patient Care. Standard Precautions. Add Contact
Precautions for cutaneous anthrax pt. if there is a large amt.
of uncontained drainage. Use soap, water for
handwashing; alcohol does not have sporicidal activity.
bacteria are generally associated with many types of OCULAR INFECTIONS.
If left untreated, ocular infections can harm the structures of the eye,
resulting in blindness and visual impairment. This part of the module aimed
to discuss the bacterial profile of ocular infections.
CONJUNCTIVITIS is the inflammation/infection of conjunctiva and may
have several clinical findings. An inflammation/infection of cornea is
KERATITIS while the inflammation / infection of conjunctiva & cornea is
KERATOCONJUNCTIVITIS.
BACTERIAL INFECTIONS OF THE EYES
BACTERIAL CONJUNCTIVITIS (“PINKEYE”).
o involves irritation, reddening of conjunctiva; edema of
eyelids, mucopurulent discharge, sensitivity to light; highly
contagious
o Pathogens - Common are Haemophiles influenzae subsp.
Aegyptus and Streptococcus
o pneumoniae, but there are other bacteria as well.
o Patient Care - Standard Precaution.
o -Reservoirs and Mode of Transmission. Infected humans.
Human-to-human transmission occurs via contact.
 Haemophilus influenzae bio group Aegyptus
o known as the Koch-Weeks bacillus; Gram-negative
bacterium; rod shape (coccobacillus)
o causative agent of acute and often purulent
conjunctivitis;
o caused worldwide seasonal epidemics (summer)
o virulence – pili
o Transmission - mechanical
 Streptococcus pneumoniae
o gram-positive, facultatively anaerobic pathogen, in pairs,
encapsulated.
o alpha hemolytic if aerobic; beta hemolytic if anerobic
o lancet shaped
o virulence: adhesin, capsule, toxin neurolysin and IgA
protease.
o Gram-negative bacterium and obligate intracellular
pathogen.; cell with high lipid.
o susceptible to sulfonamides
o associated with eye infections such as: conjunctivitis,
inclusion conjunctivitis, trachoma (Note: Descriptions are
located below)
o Clinical Findings
o 1. Conjunctivitis
o Also called “ swimming pool conjunctivitis” -
o Transmission: Acquired in non/poor chlorinated swimming
pool, In adults,
o occur w/ non-gonococcal urethritis or cervicitis (genital to
eyes transfer),
o there is mucopurulent eye discharge
o occurs with pneumonia or chlamydial nasopharyngitis.
o 2. Inclusion conjunctivitis (Chlamydial Conjunctivitis, Para
trachoma)
o Caused by serotypes D to K.;
o In adults, asso w/ genital infection;
o In newborn acquired upon passage in birth canal;
o s/s: swelling of eyelids w/ mucopurulent, keratitis, corneal
infiltrates & corneal vascularization
o 3. Trachoma - (Chlamydia Keratoconjunctivitis).
o Also called as “chronic keratoconjunctivitis.
o Caused by serotypes A,B & C;
o Transmitted eye-to-eye by droplets, fomites & eye-seeking
flies. In poor living cond.;
o s/s: follicular conjunctivitis w/ diffuse inflammation involving
entire conjunctiva, then progress to conjunctiva scarring
producing in-turned eyelids.; In-turned eyelids causes
constant abrasion of cornea leading to ulceration,
scarring, invasion of vessels into cornea &loss of vision
(frequent cause of blindness)
 Neisseria gonorrhea
o a kidney bean–shaped, Gram-negative diplococcus
o Also called as gonococcus, Common cause of STD
o In neonates- “ophthalmia neonatorum” – acquired upon
passage in birth canal.
o In adults, transmitted through finger-to eye contact
involving infectious genital secretions
o s/s: redness, swelling of conjunctiva w/ purulent eye
discharge
o If untreated – leads to corneal ulceration, perforation &
blindness
o PREV (neonate): 1% silver nitrate (Creed’s prophylaxis) after
birth or 1% tetracycline eye ointments or 0.5%erythromycin
eye ointments.
FOODBORNE DISEASE can arise from either infection or intoxication. It may
leads to:
1. Gastritis-
2. Enteritis-
3. Colitis-
4. Gastroenteritis -
5. Hepatitis-
6. Dysentery-
Establishment of infectious disease in digestive system is:
1.Pharmacologic action
2. Local inflammation
3.Deep tissue invasion
4.Perforation
Bacterial infections:
1. Bacterial enterocolitis (food poisoning): Bacterial food poisoning is
defined as an illness caused by the consumption of food contaminated
with bacteria or bacterial toxins
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- . Bacteria cause are Bacillus cereus, Staph. aureus, Clostridium per fringes,
Vibrio parahaemolyticus
2. Gastroenteritis (Diarrhea): is an inflammation of the lining of the intestines.
- Bacterial are Escherichia coli, Salmonella sp. Shigella supersonic
enterocolitica, Vibrio cholera, Clostridium per fringes, Clostridium difficile,
Bacillus anthracis, Mycobacterium tuberculosis

GIT
BACTERIAL INFECTIONS
BACTERIAL ENTEROCOLITIS (Food poisoning)
3 mechanisms of Food poisoning:
1.Ingestion of preformed toxin- present in contaminated food. S/s dev hrs.
consisting of explosive diarrhea, Abd pain. Staph aureus, Vibrio. Clostridium
per fringes
2.Infection by toxigenic organisms- involves secretory enterotoxin,
dysentery
3.Infection by enter invasive organisms- proliferate, invade, destroy
epithelial cells- dysentery

Diarrhea

MOUTH
1.Dental caries (tooth decay)- Streptococcus mutans
Periodontal disease-inflammation of structures that support teeth
Gingivitis-
Periodontitis- chronic gum disease can cause bone destruction & tooth loss.
Acute necrotizing ulcerative gingivitis or Vincent’s disease or Trench mouth
Causative agent: Prevotella intermedia. Treatment: Metronidazole

1. With tenesmus V. Cholera/ Salmonella/Shigella

2.Prevention include vaccination with BCG vaccine
M. tuberculosis /Shigella/E.coli
3. Prevention include Pasteurization of milk
M. tuberculosis/V. Cholera/Salmonella
4. Causes Traveler’s diarrhea
Yersinia/ Salmonella/ E.coli
5. Causes Typhoid fever
Cholera/Salmonella/Shigella
6.. Control measure is Immunization off domestic animals
B. anthracis/ Shigella/ E.coli
7. Causes Severe Dehydration & shock
B. Anthracis/ Cholera/ C. difficile

TERMINOLOGIES
1. Meningeal Infection - An infection of the protective membranes
that cover the brain and spinal cord, known collectively as the
meninges.
2. Staph Infection - An infection caused by any one of several
harmful species or subspecies of bacteria of the genus
Staphylococcus.
3. Urogenital Disease - Disease of the organs involved in the
excretion of fluids and reproduction.

WEEK 8
GENITOURINARY BACTERIAL INFECTIONS
PREDISPOSING FACTORS
1. Gender – women. AGE: 60& above ; school-aged girls
2. MECHANICAL FACTORS – catheterization, sexual intercourse, kidney
stones, improper use of tampons & douches
3. METABOLIC DISORDER- increased sugar content or urine in diabetes,
making it conducive to bacterial growth
4. ANATOMIC ABNORMALITY OF URINARY TRACT – cause obstruction or
incomplete voiding of urine or reflux of
urine.

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COMMON ETIOLOGIC
 Enterobacteriaceae – E. coli; K. pneumoniae
 Staphylococcus saprophyticus
 Enterococci (Enterococcus faecalis)
 Pseudomonas, Proteus, Serratia (Opportunistic pathogens)
PROTEUS MIRABILIS
 GRAM (-) bacilli of Enterobacteriaceae.
 Produces urease – causes alkalinization of urine –
 2nd common cause of community – acquired UTI; major cause
of HAI.
 a. greenish discharge b. cheesy discharge c. foamy discharge
SERRATIA SP.
 Gram (-) bacilli of Enterobacteriaceae.
 Most frequent is Serratia marcescens
 Associated w/ outbreaks of UTI, wound infections, pneumonia &
septicemia
ENTEROCOCCUS FAECALIS
 Part of enteric normal flora
 Belongs to Enterobacteriaceae
 Most common among the Enterococci. Frequent cause of HAI.
 Transmitted from 1 pt to another primarily on the hands of
hospital personnel.
 Most common site of infection: urinary tract, wounds, biliary tract
& blood.
PATHOGENESIS
 M.o. Derived from own fecal flora.
 2 routes bacteria reaches kidney: (1) through bloodstream (2)
ascending infection fr. Lower urinary tract. – most
 common cause of clinical pyelonephritis
 Urine statis
CYSTITIS – inflammation of urinary bladder
 Most common type of UTI
 Most caused by E. Coli
 Other causes: Proteus, Klebsiella, Enterococcus, Pseudomonas,
Enterobacter, Staphylococcus saprophyticus,
 Staphylococcus epidermidis & Candida albicans
URETHRITIS
 Inflammation of urethra
 Sexually transmitted, most common cause: Neisseria gonorrhea
& Chlamydia trachomatis (non-gonococcal
 urethritis or NGU)
PYELONEPHRITIS
 Inflammation of kidney, particularly tubules
 E. coli – frequent cause
COMPLICATIONS
o Bacteremia
o Septic shock
o Severe renal damage or end-stage chronic pyelonephritis
leading to renal failure
s/s: lower UTI
URETHRITIS: Dysuria, frequency , urgency
CYSTITIS: suprapubic pain & tenderness, frequency, occasional hematuria
URETHROCYSTITIS: may be asymptomatic, malodorous urine, incontinence.
s/s : upper UTI: acute pyelonephritis
Flank pain, fever, chills, hematuria, (+) kidney punch
DIAGNOSIS
o Urinalysis
o Dipstick analysis
o Collect urine using these methods:
o Clean voided mid-stream tech
o Suprapubic aspiration
o Diagnostic catheterization
o From indwelling catheter
o During cystoscopy, urethral catheterization or retrograde
pyelography
TX.
 E. coli: DOC – trimethoprim-sulfamethoxazole
 Proteus & Pseudomonas : DOC is fluoroquinolones
 For acute pyelonephritis – fluoroquinolones or third-generation
cephalosporins
Common Sexually Transmitted infections
from: N. gonorrhea, H. ducreyi, T. pallidum, C. trachomatis
 Gonorrhea is a sexually transmitted disease (STD) caused by
infection with the Neisseria gonorrhoeae bacterium. N.
gonorrhoeae infects the mucous membranes of the
reproductive tract.
 H. ducreyi is a facultative anaerobic, gram-negative bacillus
that usually produces ulcers on epithelia, including the outer
surface of the genitalia and the genital mucosae.
 Treponema pallidum is the microaerophilic spirochete
responsible for syphilis, a chronic systemic venereal disease with
multiple clinical presentations.
 Chlamydia trachomatis is a gram-negative bacterium that
infects the columnar epithelium of the cervix, urethra, and
rectum
1. Candida
2. Syphilis
a. chancre b. chancroid c. herpes d. Condyloma acuminata
3. Neisseria
a. greenish discharge b. cheesy discharge c. foamy discharge
4. Vesicles
a. chancre b. chancroid c. herpes
5. Depletes CD4 helper cells
a. Herpes Simplex virus b. Human Papilloma virus c. HIV virus
6. Chancroid
a. Gonorrhea b. H. ducreyi c. C. trachomatis d.T. pallidum
7. warty lesions
a. chancre b. chancroid c. herpes d. Condyloma acuminata
BACTERIAL INFECTIONS OF THE NERVOUS SYSTEM
Definition of Terms
ENCEPHALITIS – inflammation involving the brain parenchyma.
ENCEPHALOMYELITIS – inflammation or infection involving the brain and
spinal cord.
MENINGITIS – inflammation or infection involving the leptomeninges (pia
mater and arachnoid mater)
MENINGOENCEPHALITIS – inflammation involving the brain and meninges.
MYELITIS – inflammation of the spinal cord
Bacterial infections that affect the nervous system are serious and can be
life-threatening. They are listed below.
 CLOSTRIDIUM TETANI: Clostridium tetani is a gram-positive spore-
forming rod that causes tetanus, which is a medical emergency
and cause severe tightening of muscles all over the body and
can cause locking of the jaw making the mouth impossible to
open.
 Clostridium botulinum is an anaerobic, spore forming bacteria
that produces a neurotoxin.
 Mycobacterium leprae is a rod-shaped bacterium which was
first discovered in 1873 by Hansen. Mycobacterium leprae is a
nontuberculous mycobacterium and it causes a disease called
leprosy Several types of bacteria can cause meningitis. Leading
causes include,
o Streptococcus pneumoniae
o Group B Streptococcus
o Neisseria meningitidis
o Haemophiles influenzae
o Listeria monocytogenes
BACTERIAL INFECTIONS OF NERVOUS SYSTEM
ACUTE BACTERIAL MENINGITIS – is a suppurative infection of the meninges
and subarachnoid space with associated inflammation of CNS.
 It is manifested by the classic triad of FEVER, HEADACHE and
NUCHAL RIGIDITY
 Positive Kernig’s and Brudzinski sign.
NEISSERIA MENINGITIDIS
 also known as MENINGOCOCCUS; transient flora of nasopharynx
 It will enter the blood stream causing bacteremia and go into
meninges causes MENINGITIS.
 MENINGOCOCCEMIA
Terminologies:
Aspiration - The swallowing of foreign matter into the lungs.
Alveolar macrophages - The special cells in the lungs that attack bacteria
and other germs.
Bronchial pneumonia - Type of pneumonia that spreads from the bronchi
to several patches in one or both lungs.
Lobar Pneumonia - Pneumonia that affects only one lobe, or section, of the
lung.
Mucus - Sticky airway secretion that prevents lung damage by trapping
foreign particles. When infection makes your lungs produce too much
mucus, it clogs the airways.
Pulmonary Function Test - A test used to measure how well the lungs work.
RESPIRATORY BACTERIA INFECTIONS
Bacterial Infections of the Upper Respiratory Tract
Diphtheria.
acute, contagious, potentially serious upper respiratory tract disease.
Tonsils, pharynx, larynx, and nose are affected.
A tough, asymmetrical, adherent gray-white membrane in the throat with
surrounding inflammation is a characteristic lesion. The membrane may
obstruct the airway.
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Sore throat, swollen, tender cervical lymph nodes, tonsillitis, and neck
swelling are all common symptoms.
has a cutaneous form that is more common in the tropics.
Pathogen.
caused by toxigenic (toxin-producing) strains of Corynebacterium
diphtheriae. A pleomorphic, Gram- positive bacilli that form distinctive V-,
L-, and Y-shaped bacilli arrangements.
Only strains infected with a specific Coryne bacteriophage are toxic; the
exotoxin (diphtheria toxin) is encoded by a bacteriophage gene.
Reservoirs and Mode of Transmission.
Infected humans are reservoirs.
Transmission: via airborne droplets, direct contact, contaminated fomites.
Laboratory Diagnosis.
nasopharyngeal swab and throat swab (containing sample of
membrane, should be sent to the microbiology lab for culture)
Special media called Loeffler serum medium and cystine-tellurite or
Tindale medium are used for culture and identification of C. diphtheriae
Streptococcal Pharyngitis (Strep Throat).
acute bacterial infection of the throat
Sx: Soreness, chills, fever, headache, beefy red throat, white patches of
pus on the pharyngeal epithelium, enlarged tonsils, and enlarged and
tender cervical lymph nodes
infection has the potential to spread to the middle ear, sinuses, or hearing
organs.
Scarlet fever (caused by erythrogenic toxin), rheumatic fever, and
glomerulonephritis can occur if not treated. The latter two conditions are
caused by immune complex deposition beneath heart and kidney tissue,
respectively.
Some strains produce pyrogenic exotoxin that causes toxic shock
syndrome. Others (known as flesh-eating bacteria) can cause necrotizing
fasciitis.
Pathogen.
caused by Streptococcus pyogenes, a beta-hemolytic, catalase-
negative, Gram positive coccus in chains.
It is also known as group A streptococcus, GAS, or Strep A.
Reservoirs and Mode of Transmission.
Infected humans are reservoirs.
Human-to-human transmission occurs through direct contact.
Typically, hands, aerosol droplets, secretions from patients and nasal
carriers, and contaminated dust, lint, or handkerchiefs have been linked to
food-borne outbreaks of streptococcal pharyngitis.
Laboratory Diagnosis.
Routine throat culture to determine whether or not a patient has strep
throat. When beta-hemolytic streptococci are isolated, they are tested to
see if they are group A streptococci.
Rapid strep tests (based on antigen detection) on throat swabs can be
performed.
If Rapid strep tests is negative, a throat culture and bacitracin
susceptibility is performed.
BACTERIAL INFECTIONS OF THE LOWER RESPIRATORY TRACT
Legionellosis (Legionnaires’ Disease, Pontiac Fever).
an acute bacterial pneumonia
Sx.: Anorexia, malaise, myalgia, headache, high fever, chills, and dry
cough, followed by a productive cough, shortness of breath, diarrhea, and
pleural and abdominal pain.
Pontiac fever, an influenza-like, less severe form of legionellosis, is not
associated with pneumonia death.
More likely to be affected: elderly persons; with preexisting respiratory
disease, diabetes mellitus, renal disease, or malignancy;
immunocompromised; or people who smoke or drink heavily.
Pathogen.
Etiologic agent: Legionella pneumophila, a poorly staining, Gram-
negative bacillus.
Other Legionella spp. and organisms within related genera can also
cause the disease.
Reservoirs and Mode of Transmission.
Reservoirs: environmental water sources (ponds, lakes, and creeks; hot-
water and air-conditioning
systems, cooling towers, and evaporative condensers; whirlpool spas, hot
tubs, shower heads, humidifiers, tap water, and water distillation systems;
decorative fountains; and perhaps dust.)
Found in freshwater sources all over the world, but in insufficient quantities
to cause disease. Legionella can multiply in water systems in built
environment, depending on the conditions.
Factors associated with amplification: warm water temperatures [25°C–
42°C]; water stagnation; presence of scale, sediment, and biofilm in pipes
and fixtures; and absence of disinfectant. To cause disease: Legionella spp.
must then be aerosolized and inhaled.
Most common route of transmission: by inhalation of aerosolized water
containing the bacteria. Most common sources of transmission: Potable
water (via showerheads and faucets), cooling towers, hot tubs, and
decorative fountains
Transmission can sometimes occur through aspiration of water containing
the bacteria.
Not transmitted from person to person.
Laboratory Diagnosis.
Sputum and blood specimens should be sent to the microbiology lab for
C&S.
Legionella spp. stain poorly and require cysteine and other nutrients to
grow.
recommended culture medium is buffered charcoal yeast extract agar.
Immunodiagnostic procedures are available, such as antigen detection
in urine
Mycoplasmal Pneumonia (Primary Atypical Pneumonia).
Gradual onset
Sx.: headache, malaise, dry cough, sore throat, and less often, chest
discomfort.
Sputum is scant first, but increase as disease progresses. Illness may last
from few days to month or more.
Most common in people 5–35 years of age.
Pneumonias produced by mycoplasmas & chlamydias are the most
common types of atypical pneumonias
(i.e., pneumonias usually caused by organisms other than those that are the
typical causes of pneumonia).
Pathogen.
Etiologic agent: Mycoplasma pneumoniae, a tiny, Gram-negative
bacterium, lacking cell walls.
Reservoirs and Mode of Transmission.
Infected humans are reservoirs.
Transmission: via droplet inhalation or direct contact with an infected
person, or articles contaminated with nasal secretions or sputum from an ill,
coughing patient.
Laboratory Diagnosis.
Diagnosed by demonstration of rise in antibody titer between acute and
convalescent sera.
On artificial media, produces tiny “fried egg” colonies, having dense
central area & less-dense periphery.
Patient Care.
Use Droplet Precautions
Tuberculosis (TB).
Acute or chronic mycobacterial infection of lower respiratory tract
Sx.: malaise, fever, night sweats, weight loss, and productive cough.
Sx in advanced stages: Shortness of breath, chest pain, hemoptysis
(coughing up blood), and hoarseness.
Widespread tuberculosis, known as military tuberculosis, involves many
lesions throughout the body.
Pathogens.
Etiologic agent: Mycobacterium tuberculosis, bacterium that belongs to
the group of bacilli. They are rod- shaped, slow growing and acid-fast
M. tuberculosis is referred to as tubercle bacillus.
Virulence: Peculiar cell wall structure, that provides exceptionally strong
impermeable barrier to noxious
compounds and drugs (CDC).
Reservoirs and Mode of Transmission.
Infected humans are primary reservoirs.
rarely, primates, cattle, and other infected mammals can serve as
reservoirs.
Transmission: via airborne droplets produced by infected people during
coughing, sneezing, talking, or singing; usually following prolonged direct
contact with infected individuals.
Bovine tuberculosis results from exposure to infected cattle or ingestion of
unpasteurized, contaminated milk or other dairy products.
Laboratory Diagnosis.
Demonstration of acid-fast bacilli (AFB) in sputum specimens provides a
rapid, presumptive diagnosis of tuberculosis.
Isolation of M. tuberculosis on Lowenstein-Jensen or Middlebrook culture
media takes about 3–6 weeks because of the organism’s long generation
time (about 18–24 hours).
Rapid techniques are available for isolation and identification of M.
tuberculosis, including automated and semi-automated instruments,
molecular diagnostic procedures, and gas–liquid chromatography.
Susceptibility testing. Performed because many strains of M. tuberculosis
are multidrug resistant.
Mantoux purified protein derivative [PPD] tuberculin skin test. Infected
patients show a positive delayed hypersensitivity skin test. A positive TB skin
test result may indicate past infection, present infection, or receipt of
Bacillus Calmette-Guérin (BCG) vaccine.
pulmonary tubercles may be seen on chest radiographs.
Whooping Cough (Pertussis).
highly contagious, acute bacterial childhood (usually) infection.
First stage (prodromal or catarrhal stage). Involves mild, cold-like
symptoms.
Second stage (paroxysmal stage). Produces severe, uncontrollable
coughing fits. Coughing often ends in a prolonged, high-pitched, deeply
indrawn breath (the “whoop,” from which whooping cough gets its name).
The coughing fits produce a clear, tenacious mucus and vomiting. Can be
so severe as to cause lung rupture, bleeding in eyes &brain, broken ribs,
rectal prolapse, or hernia.
Third stage (recovery or convalescent stage). Usually begins within 4
weeks of onset.
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Parapertussis is a similar but milder disease.
Pathogen.
caused by Bordetella pertussis, a small, encapsulated, nonmotile, Gram-
negative coccobacillus that produces endotoxin and exotoxins.
Parapertussis is caused by Bordetella parapertussis.
A related organism, Bordetella bronchiseptica, causes respiratory
infections in animals, including kennel cough in dogs.
Reservoirs and Mode of Transmission.
Infected humans serve as reservoirs.
Transmission occurs via droplets produced by coughing.
Laboratory Diagnosis.
Nasopharyngeal aspirates or swabs should be sent to the microbiology
lab.
Special media, such as Bordet-Gengou agar (a potato-based medium)
or Regan-Lowe agar (a
charcoal/horse blood medium), are used to isolate B. pertussis.
Molecular diagnostic and immunodiagnostic procedures are also
available.
Terminologies:
Hemoptysis. Hemo- refers to blood or blood vessels. -ptysis refers to spitting
of matter. Means coughing up of blood from the respiratory tract.
Hypoxia. Hypo- means insufficient. Oxia- refers to oxygen. Means
inadequate oxygen in the body.
WEEK 9
VIRUS GENERAL CHARACTERISTICS
Viruses are obligatory intracellular parasites. Viral genes carried in the
genomes of other organisms provide a record of viral evolution.
Viruses characteristics are the ff:
o Contain only one form of nucleic acid, either DNA or RNA.
o Contain a protein coat that covers the nucleic acid (which is
sometimes surrounded by an envelope of lipids, proteins, and
carbohydrates).
o Multiply inside living cells by utilizing the cell's synthesis
mechanism.
o Cause the formation of specialized structures capable of
transferring viral nucleic acid to other cells.
Host Range. Invertebrates, vertebrates, plants, protists, fungi, and
bacteria are all infected by viruses.
Size. Viruses are extremely small. The tiniest viruses have a diameter of
around 20 nm, whereas influenza and the human immunodeficiency virus
have a more usual size of about 100 nm. Human cells have a diameter of
10–30 m (microns), which implies they are 100–1000 times larger than the
viruses that infect them.
Viruses are classified by their nucleic acid and by differences in the
structures of their coats.
o Viral genes are encoded by either DNA or RNA—but never both.
o The genome of a virus can be single-stranded or double-
stranded. Depending on the virus, the nucleic acid can be linear
or circular. In some viruses (such as the influenza virus), the
nucleic acid is in several separate segments.
Structure.
o Capsid and Envelope. The nucleic acid of a virus is protected
by a protein coat called the capsid, A capsid is a protein shell
that encloses the viral genome (RNA, DNA, etc.).
o Capsids come in about three different shapes, although there
can easily be more complex ones. The most common shapes are
icosahedral, prolate, and helical.
o Each capsid is composed of protein subunits called capsomeres
Helical viruses are made up of a single type of capsomer
Helical viruses are made up of a Prolate - An icosahedron
single type of capsomer that is extended along one axis, which is
stacked around a central axis to. a common arrangement of
produce a helical structure with a bacteriophage heads.
central cavity or hollow tube.
The icosahedral virus is made up
of identical subunits that form
equilateral triangles that are then
stacked symmetrically
Capsid is the external protein coat Capsomeres is the individual
or covering of a virion protein subunits that make up the
capsid of some virions
Envelope – Some viruses have an extra layer outside of their capsule
called an envelope. Another name for the envelope is membrane. They
may help viruses avoid the host immune system.
Complex viruses contain capsids that are neither entirely helical nor
purely icosahedral, and they may include additional structures like protein
tails or a complex outer wall
Skin Viral Infections
Measles (Hard Measles, Rubeola).
Fever, conjunctivitis, cough, (light sensitivity), Koplik spots in the mouth,
and a red blotchy skin rash are all symptoms of this common, & highly
contagious childhood exanthem.
It is associated with serious complications. Pathogen is measles virus (also
known as rubeola virus). It is an RNA virus in the family Paramyxoviridae.
German Measles (Rubella).
A mild, febrile viral disease. One or two days following the start of
symptoms, a fine, pinkish, flat rash appears.
Rubella virus is the pathogen.
Roseola Infantum.
Sixth disease caused by Human Herpes virus 6.
Manifests as sudden onset of high-grade fever followed by a generalized
rash that lasts for two days.
Erythema Infectious.
A common childhood infection causing a slapped cheek appearance
and a rash.
It is also known as fifth disease;
caused by human parvovirus B19.
Chickenpox.
Caused by the varicella-zoster virus (VZV)
Also known as varicella is an acute, generalized viral infection, with fever
and a skin rash.
Vesicles also form in mucous membranes; mild, self-limiting; can be
severely damaging. to a fetus, serious complications include pneumonia,
secondary bacterial infections, hemorrhagic complications, and
encephalitis.
Shingles.
Also known as herpes zoster.
A reactivation of the varicella virus; result of immunosuppression; involves
inflammation of sensory ganglia of cutaneous sensory nerves, producing
fluid-filled blisters, pain, and paresthesia (numbness & tingling).
Smallpox.
Fever, malaise, headache, prostration, severe backache, and a
distinctive skin rash are all symptoms of this systemic viral infection.
caused by 2 strains of variola virus: variola minor (with a fatality rate of
1%), & variola major.
Warts.
Common warts (verrucae vulgaris), venereal warts, and plantar warts are
among the many types of skin and mucous membrane lesions.
Most are harmless, but some can become cancerous.
As for pathogens, warts are caused by at least 70 types of human
papillomaviruses (HPV). They are classified in the genus Papillomavirus
within the family Papovaviridae.
Oral Region Viral Infections
Cold Sores (Fever Blisters, Herpes Labialis)
A superficial clear vesicle on an erythematous (reddened) base; may
appear on the face or lips; crust and heal within a few days.
Reactivation may be caused by trauma, fever (hence the name),
physiologic changes, or disease.
Can be severe and extensive in immunosuppressed individuals.
Pathogens: usually caused by herpes simplex virus type 1 (HSV-1 / known
as human herpesvirus 1), although they can also be caused by herpes
simplex virus type2 (HSV-2/human herpesvirus 2).
They are DNA viruses belonging to Herpesviridae family. (Both viruses can
infect vaginal tract, while HSV-2 is the most common cause of genital
herpes infections).
Terminologies:
CORYZA. Sneezing, lacrimation, and profuse secretion of watery mucus are
all symptoms of acute mucous membrane inflammation, which is usually
caused by infection with one of the common cold viruses.
ENCEPHALITIS is an acute infection and inflammation of the brain tissue.
MACULE is a non-elevated discolored skin patch on the skin.
MALAISE. A general feeling of discomfort, disease, or a lack of well-being is
referred to as malaise. Malaise is a symptom that can accompany
practically any illness.
PAPULE is an elevated white lesion that is smaller than 0.5cm in diameter.
VESICLES are small fluid-filled sacs that appear on skin.
WEEK 10
VIRAL INFECTIONS
Eyes Viral Infections
Adenoviral Conjunctivitis and Keratoconjunctivitis.
Acute viral infections that causes the ff. in one or both eyes: inflammation
of the conjunctiva, edema of the eyelid & periorbital tissue, pain,
photophobia, and blurred vision
Cornea is involved in 50% of cases, with permanent scarring of the cornea
in severe cases.
As for the pathogens, these are caused by various types of adenoviruses.
Herpes simplex and varicella-zoster viruses can also cause
keratoconjunctivitis.
Hemorrhagic Conjunctivitis.
With sudden onset, with redness, swelling, and pain in one or both eyes.
Small, discrete subconjunctival hemorrhages may enlarge to form
confluent subconjunctival hemorrhages.
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One adenoviral syndrome, called pharyngoconjunctival fever, is
characterized by upper respiratory disease, fever, and minor degrees of
corneal epithelial inflammation.
Gastrointestinal Tract Viral Infections
Viral Gastroenteritis (Viral Enteritis, Viral Diarrhea)
Sometimes referred to as “stomach flu” or “24-hour flu.”
Symptoms include nausea, vomiting, diarrhea, abdominal pain, myalgia,
headache, malaise, and low-grade fever; it can be fatal in an infant or
young child.
Although viral gastroenteritis (particularly when caused by a rotavirus) is
usually a self-imiting sickness lasting 24 to 48 hours.
Pathogens are the various; most common viruses infecting children in their
first years of life are enteric adenoviruses, astroviruses, caliciviruses
(including noroviruses), and rotaviruses. Those infecting children and adults
include norovirus-like viruses and rotaviruses.
Viral Hepatitis
Inflammation of the liver is Hepatitis; causes are: alcohol, drugs, and
viruses.
Viral hepatitis refers to hepatitis caused by any one of the ff: hepatitis A
virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus
(HDV), hepatitis E virus (HEV), hepatitis G
virus (HGV), hepatitis GB virus A (HGBV-A), hepatitis GB virus B (HGBV-B), and
hepatitis GB virus C (HGBV-C).
As a result of viral diseases such as infectious mononucleosis, yellow fever,
and cytomegalovirus infection, hepatitis can also occur.
Lower Respiratory Tract Viral Infections
Acute, Febrile, Viral Respiratory Disease.
Characterized by fever and one or more of the following systemic
reactions: chills, headache, general aching, malaise, anorexia, and
sometimes gastrointestinal disturbances in infants.
May include rhinitis, pharyngitis, tonsillitis, laryngitis, bronchitis, pneumonia,
conjunctivitis, otitis media, and/or sinusitis.
Pathogen can be caused by one of many viruses such as: parainfluenza
viruses, respiratory syncytial virus (RSV), adenovirus, rhinoviruses, certain
coronaviruses, coxsackieviruses, and echoviruses.
The major viral respiratory tract pathogen of early infancy is RSV which
could cause pneumonia, croup, bronchitis, otitis media, and death
Influenza (Flu).
Acute, viral respiratory infection with fever, chills, headache, aches, and
pains throughout the body (most noticeable in the back and legs), sore
throat, cough, nasal drainage.
Particularly in children, in severe circumstances, it can cause bronchitis,
pneumonia, and death. Nausea, vomiting, and diarrhea may occur.
Note that although the term stomach flu is often heard, influenza viruses
rarely cause GI symptoms. Stomach flu, also known as the 24-hour flu, is
caused by viruses other than influenza viruses.
Pathogens that cause it are Influenza viruses A, B, and C. They are single-
stranded RNA viruses in the family Orthomyxovirus.
Influenza A virus cause severe symptoms and is associated with
pandemics and severe disease and more localized outbreaks. Influenza C
virus usually does not cause epidemics or significant disease.
Avian Influenza (Bird Flu).
Commonly referred to as bird flu, primarily a disease of birds, but can
cause human disease.
The virus causes a respiratory infection in humans, with symptoms ranging
from influenza-like symptoms (fever, cough, sore throat, and muscle aches)
to eye infections, pneumonia, acute and severe respiratory distress, and
other severe and life-threatening complications.
Pathogen of avian influenza virus type A causes bird flu; three prominent
subtypes of the virus are H5, H7, and H9. H5N1 is the most virulent strain.
Severe Acute Respiratory Syndrome (SARS).
SARS was first reported in Asia in February 2003 and spread in countries
Europe, South America, and North America.
A viral respiratory illness with the following manifestations: high fever, chills,
headache, a general feeling of discomfort, body aches, and sometimes
diarrhea.
Most patients develop a dry cough followed by pneumonia.
Pathogen of SARS is caused by SARS-associated coronavirus (SARS-CoV)
Sexually Transmitted Viral Infections
Anogenital Herpes Viral Infections (Genital Herpes).
Herpes simplex infections are characterized by a localized primary lesion,
latency, and a tendency to localized recurrence, in general
Female: principal sites of primary anogenital herpes virus infection are
cervix and vulva, with recurrent disease affecting the vulva, perineal skin,
legs, and buttocks.
Male: lesions appear on the penis, & in anus & rectum of those engaging
in anal sex.
Itching, tingling, & soreness are the initial symptoms. Usually followed by
small patch of redness & then group of small, painful blisters. The blisters
break and fuse to form painful, circular sores, which become crusted after
a few days. The sores heal in about 10 days but may leave scars.
Initial outbreak is more painful, prolonged, and widespread than
subsequent outbreaks and may be associated with fever.
Genital herpes is usually caused by HSV-2, but is occasionally caused by
HSV-1.
Genital Warts (Genital Papillomatosis, Condyloma Acuminatum).
Start as tiny, soft, moist, pink or red swellings, which grow rapidly and may
develop stalks.
Rough surfaces give the appearance of small cauliflowers. Multiple warts
often grow in same area
Most often on penis in men & vulva, vaginal wall, cervix, & skin surrounding
the vaginal area in women. Also develop around anus & in rectum in men
or women who engage in anal sex.
These warts can become malignant.
Pathogens: Genital warts are caused by HPVs of Papovaviridae family of
DNA viruses (human wart viruses). HPV genotypes 16 & 18 are associated
with cervical cancer
HIV Infection and AIDS.
The signs and symptoms of acute HIV infection (i.e., infection with “the
AIDS virus”) usually occur within several weeks to several months after
infection with HIV.
Initial sx. include: acute, self limited mononucleosis-like illness lasting 1 or
2 weeks.
Acute HIV infection is often undiagnosed or misdiagnosed because anti-
HIV antibodies are usually not present in a high enough concentration to
be detected during this early phase of infection. Other signs and symptoms
of acute HIV infection include fever, rash, headache, lymphadenopathy,
pharyngitis, myalgia (muscle pain), arthralgia (joint pain), aseptic
meningitis, retro-orbital pain, weight loss, depression, GI distress, night
sweats, and oral or genital ulcers.
Without appropriate anti-HIV treatment, approx.90% of HIV-infected
develop AIDS.
AIDS is a severe, life-threatening syndrome that represents the late clinical
stage of infection with HIV. Invasion and destruction of helper T cells leads
to suppression of the patient’s immune system (immunosuppression).
Secondary infections caused by viruses (e.g., cytomegalovirus, herpes
simplex), protozoa (e.g., Cryptosporidium, Toxoplasma), bacteria (e.g.,
mycobacteria), and/or fungi (e.g., Candida, Cryptococcus, Pneumocystis)
become systemic and cause death.
Persons with AIDS die because of overwhelming infections caused by
variety of pathogens, often opportunistic pathogens: Kaposi’s sarcoma, a
previously rare type of cancer, is a frequent complication of AIDS.
Considered to be a universally fatal disease.
Certain combinations of drugs, referred to as cocktails, are extending the
life of some HIV- positive patients. In the absence of effective anti-HIV
treatment, the AIDS case–fatality rate is very high—approaching 100%.
Pathogens. AIDS is caused by HIV. Two types have been identified: type
1 (HIV- 1), which is the most common type, and type 2 (HIV-2). HIV viruses
are single-stranded RNA viruses in the family Retroviridae (retroviruses).
Infectious Mononucleosis.
Also called “mono” or the “kissing disease” is an acute viral disease.
May be asymptomatic or may characterized by fever, sore throat,
lymphadenopathy (especially posterior cervical lymph nodes),
splenomegaly (enlarged spleen), and fatigue.
Usually self-limited disease of 1 to several weeks’ duration. It is rarely fatal.
Pathogen is Epstein-Barr virus (EBV), also known as human herpesvirus 4.
A DNA virus in family Herpesviridae. EBV infects and transforms B cells,
although it also infects other types of cells.
EBV is known as oncogenic (cancer causing), causing or associated with
lymphomas (e.g., Hodgkin disease and Burkitt lymphoma), carcinomas
(e.g., nasopharyngeal carcinoma and gastric carcinoma), and sarcomas,
among other cancers.
Mumps (Infectious Parotitis).
Acute viral infection characterized by fever and swelling and tenderness
of the salivary glands.
Complications: orchitis (inflammation of the testes), oophoritis
(inflammation of the ovaries), meningitis, encephalitis, deafness,
pancreatitis, arthritis, mastitis, nephritis, thyroiditis, and pericarditis.
Pathogen: caused by mumps virus, an RNA virus in the genus Rubulavirus,
family Paramyxoviridae.
Viral Hemorrhagic Diseases.
Considered extremely serious acute viral illnesses.
Initial symptoms are sudden onset of fever, malaise (a feeling of general
discomfort; feeling “out of sorts”), myalgia, and headache, followed by
pharyngitis, vomiting, diarrhea, rash, and internal hemorrhaging.
Includes Marburg virus infection and Ebola virus infection which has 25%
and 50%–90%, respectively. All known cases of both diseases occurred in or
could be case fatality rates in Africa before
Pathogens are caused by different viruses: dengue virus, yellow fever
virus, Crimean-Congo hemorrhagic fever virus, Lassa virus, Ebola virus, and
Marburg virus.
Ebola virus and Marburg virus are filamentous viruses in the family
Filoviridae. Both are extremely large viruses. Ebola virus is about 80 nm in
width and up to 1 mm or longer in length.
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Marburg virus is about 80 nm in width and 790 nm in length.
Central Nervous System Viral Infections
Lymphocytic Choriomeningitis.
Lymphocytic choriomeningitis is a rodent-borne viral disease that
presents as aseptic meningitis, encephalitis, or meningoencephalitis.
Asymptomatic or mild febrile disease also occurs. Some patients develop
fever, malaise, suppressed appetite, muscle aches, headache, nausea,
vomiting, sore throat, coughing, joint pain, chest pain, and salivary gland
pain.
Possible complications of CNS involvement include deafness and
temporary or permanent neurological damage.
An association between lymphocytic choriomeningitis virus infection and
myocarditis has been suggested.
Pathogen is Lymphocytic choriomeningitis is caused by lymphocytic
choriomeningitis virus (LCMV), a member of the family Arenaviridae.
Poliomyelitis (Polio, Infantile Paralysis).
Poliomyelitis causes a minor illness with fever, malaise, headache,
nausea, and vomiting in most patients
In about 1% of patients, the disease progresses to severe muscle pain,
stiffness of the neck and back, with or without flaccid paralysis.
Major illness is more likely to occur in older children and adults.
Pathogens: Caused by polioviruses, RNA viruses in the family
Picornaviridae (pico small, RNA viruses).
Rabies.
Fatal, acute viral encephalomyelitis of mammals, with mental depression,
restlessness, headache, fever, malaise, paralysis, salivation, spasms of throat
muscles induced by a slight breeze or
drinking water, convulsions, and death caused by respiratory failure.
Paralysis usually starts in the lower legs and moves upward through the
body.
Pathogen is a rabies virus, a bullet-shaped, enveloped RNA virus in the
family Rhabdoviridae.
Viral Meningitis.
Also known as aseptic meningitis and nonbacterial or abacterial
meningitis; a common but rarely serious.
characterized by sudden onset of febrile illness with the signs and
symptoms of meningeal involvement; acute illness rarely lasts longer than
ten days.
In CSF findings: presence of mononuclear white blood cells, increased
protein levels, normal glucose levels, and the absence of bacteria.
A rash may develop. When caused by an enterovirus, GI and respiratory
symptoms may occur.
Pathogens that is most common causes of viral meningitis are
enteroviruses (in the United States). Other causes include coxsackie viruses,
arboviruses, measles virus, mumps virus, herpes
simplex and varicella-zoster viruses, lymphocytic choriomeningitis virus, and
adenoviruses.
Leptospirosis (a bacterial disease) can also cause aseptic meningitis.
Viral Encephalitis (Arthropod-borne Viral Encephalitis
An acute inflammatory viral disease; may be asymptomatic or have mild
fever and headache. Severe infection is also possible, with headache, high
fever, stupor, disorientation, coma, tremors, occasional convulsions, spastic
paralysis, and death.
Arboviruses are viruses spread by arthropods.
Pathogens. In the United States, the St. Louis encephalitis virus is the most
frequent mosquito- borne infection. The West Nile Virus took up the top slot
in 2002. Dengue virus in the Philippines
Terminologies:
ANIMAL VIRUS. can infect one or more animal species.
ANTIGENIC DRIFT. A progressive shift in a virus's antigenicity caused by
mutations in the genes. that code for surface proteins, which might lead to
new virus strains that are less effectively blocked by the same host
antibodies that prevented infection by the original strain.
ANTIGENIC SIN, ALSO KNOWN AS ANTIGENIC IMPRINTING OR THE HOSKINS
EFFECT. When a second slightly different version of a foreign pathogen (e.g.,
a virus or bacterium) is encounter. red, original antigenic sin, also known as
antigenic imprinting or the Hoskins effect refers to the body's immune
system's predisposition to preferentially use immunological memory based
on a previous infection. This prevents the immune system from mounting
potentially more effective responses during successive infections because
it is "locked" by the first reaction it has mounted to each antigen. Antibodies
or T-cells generated during infections with the pathogen's first variety are
prone to repertoire freeze, a type of original antigenic sin.
ANTIGENIC SHIFT. A reassortment event involving two or more different
strains of a virus, or two or more different viruses, which exchange genetic
material and so combine to generate a new subtype with a mixture of the
surface antigens of the original strains
ANTIVIRAL DRUG. Often simply called an antiviral. Antimicrobial
medications that are used to treat diseases caused by viruses rather than
bacteria or other infectious organisms. Antivirals, unlike most antibiotics,
restrict the growth of their target viruses rather than killing them
ASSEMBLY. The virus's construction within the host cell, which is fueled by the
host's metabolism.
ATTACHMENT. The first stage of a virus's infection of a host cell, in which a
viral particle meets an appropriate receptor area on the cell's surface by
coincidence, allowing the
viral particle to physically attach to the cell by electrostatic forces.
Absence of suitable attachment areas can give a cell immunity from
infection.
COINFECTION. The simultaneous infection of a cell or host by more than one
pathogen, i.e. by more than one species or strain of virus, or by a virus and
another type of microorganism such as a bacterium.
EMERGENT VIRUS. Any virus that has recently adapted and emerged as a
novel causative disease agent. Emergent viruses are often the result of
transmission between different species or a rapid increase in the incidence
or severity of the associated disease within a host population.
HELPER VIRUS. allows an otherwise deficient coinfecting virus to replicate.
These can be naturally occurring as with Hepatitis D virus, which requires
Hepatitis B virus to coinfect cells to replicate. Helper viruses are also
commonly used to replicate and spread viral vectors for gene expression
and gene therapy.
HOST TROPISM is the infection specificity of certain pathogens to hosts and
host tissues. This type of tropism explains why most pathogens are only
capable of infecting a limited range of host organisms.
ICOSAHEDRAL. Having the symmetry of an icosahedron.
LATENCY. The ability of a pathogenic virus to lie dormant or latent within a
cell for a period of time before reactivating and producing new,
independent virions; The phase in the life cycle of
certain viruses in which, after initial infection, proliferation of virus particles
ceases while the viral genome remains silently assimilated into the host cell's
genome, sometimes indefinitely.
NANOMETER (NM). A unit of length frequently used in describing the size of
a virus or viral particle. One nanometer is equal to 10−9 meter.
NUCLEOCAPSID. The capsid of a virus together with the viral genome
contained within it. Replication. Any of the various processes by which a
virus reproduces.
SLOW VIRUS is a disease that, after an extended period of latency, follows
a slow, progressive course spanning months to years, frequently involves the
central nervous system, and in most cases progresses to death. Examples of
slow virus diseases include HIV/AIDS, caused by the HIV virus, subacute
sclerosing panencephalitis, the rare result of a measles virus infection, and
Paget's disease of bone (osteitis deformans), which may be associated with
paramyxoviruses, especially the measles virus and the human respiratory
syncytial virus.
SUPERINFECTION. The process by which a cell that has previously been
infected by a virus becomes co-infected by a different strain or species of
virus because of the treatment being used to manage the first virus. The
second virus has often evolved a resistance to antiviral drugs used to treat
the original infection, or an ability to overcome the host's immune response.
VIRAL ENVELOPE. A lipid casing present in some viruses which surrounds the
capsid and helps to penetrate the host's cell wall.
VIRAL LOAD. Also called viral burden and viral titer. A numerical expression
of the quantity of virus in each volume, typically expressed as the number
of individual viral particles per unit volume but also by quantifying other
factors that are closely related to or influenced by viral concentration. Viral
load often correlates with the severity of an active viral infection.
WEEK 11 - Mycology
▪ Mycology, the study of fungi, a group that includes the mushrooms and
yeasts. Many fungi are useful in medicine and industry.
▪ Fungi are eukaryotes that have cell walls, are heterotrophs that feed by
absorbing their food, and use spores to reproduce. Fungi are heterotrophs
and absorb food through hyphae that grow in the food source. After the
hyphae has grown in the food source the digestive chemicals ooze from
the hyphae into the food.
▪ The chemicals break down the food into small substances that can be
absorbed by the hyphae. Some fungi feed on dead organisms and others
are parasites that break down the chemicals in organisms.
▪As fungi, yeasts are eukaryotic organisms. They typically are about 0.075
mm (0.003 inch) in diameter and have many forms, from spherical to egg-
shaped to filamentous.
▪ Most yeasts reproduce asexually by budding: a small bump protrudes from
a parent cell, enlarges, matures, and detaches.
I. MEDICALLY IMPORTANT PHYLA OF FUNGI
1.Phylum Zygomycota
1. A group of FUNGI that form ZYGOSPORES when SEXUAL REPRODUCTION
by conjugation takes place. Certain HYPHAE, called gametangia, grow
towards each other and conjugate, resulting in the formation of
zygospores.
2. ASEXUAL REPRODUCTION generally involves the production of
sporangiospores in a SPORANGIUM or sporangium-like structure. The
Zygomycota are sometimes called the conjugation fungi.
3. They are typically SAPROTROPHS, or PARASITES or PATHOGENS of animals,
plants or other fungi. Examples include the bread MOULDS, Mucor and
Rhizopus.
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1.1. Mucor
The Mucor fungi cause the group of infections referred to as zygomycosis
(mucormycosis). Mucor is a filamentous fungus found in soil, plants, and
decaying fruits. The genus has several species, the more common ones
being Mucor amphibiorum, M. Mucormycosis (previously called
zygomycotic) is a rare but serious angio-invasive infection caused by a
group of fungi called mucoromycetes. Spores of these ubiquitous fungi
(commonly found in soil, fallen leaves, compost, animal dung and air) can
be inhaled and then infect the lungs, sinuses, and extend into the brain and
eyes. Less often, infection may develop when the spores enter the body
through a cut or an open wound.
Mucor mycosis is not a contagious disease, it cannot be spread from one
person to another. It mainly affects people who are immunocompromised,
or patients already infected with other diseases. High risk groups include
people with diabetes (especially diabetic ketoacidosis), solid organ
transplantation, neutropenia (low neutrophils, a type of white blood cells),
long-term systemic corticosteroid use, and iron overload
(hemochromatosis). The risk is high for people living with HIV, and those
using immunomodulating drugs, including the anti-fungal voriconazole in
some high-risk groups.
Clinical presentation is classified according to the organ involvement. It can
be rhino-orbital cerebral, pulmonary, cutaneous, gastrointestinal, or
disseminated.
Mucormycosis is an aggressive, life-threatening infection requiring prompt
diagnosis and early treatment. Treatment usually consists of antifungal
medications and surgery.
Transmission of mucormycosis
1. It is not contagious and does not spread by contact of person to person.
This fungus is found in the environment. Transmission occurs through
inhalation, inoculation, or ingestion of spores from the environment.
Although most cases are sporadic, healthcare-associated outbreaks have
been linked to adhesive bandages, wooden tongue depressors, hospital
linens, negative pressure rooms, water leaks, poor air filtration, non-sterile
medical devices, and building construction.
2. It most commonly affects the sinuses or the lungs after inhaling fungal
spores from the air. In such cases, it may spread to brain and eyes.
3. It may also occur on the skin after a cut, burn, or other type of skin injury
gets infected.
4. The symptoms of mucormycosis depend on where in the body the fungus
is growing. The most common presentation is a sinus infection (sinusitis) that
is accompanied by nasal congestion, nasal discharge, and sinus pain. A
fever and headache may also occur.
COVID-19 associated mucormycosis
1. Fungal infections, including mucormycosis, aspergillosis and invasive
candidiasis, have been reported in patients with severe COVID-19 or those
recovering from the disease and have been associated with severe illness
and death.
2. India has reported a recent surge in mucormycosis cases. Prevention of
COVID-19 associated mucormycosis needs to focus on aiming for better
glycaemic control in COVID-19 patients and monitoring the use of systemic
corticosteroids in treating severe cases.
3. Outpatient use of systemic corticosteroids/other immunomodulating
drugs for mild or moderate patients with COVID-19 should be avoided.
Health care facilities need to strengthen their infection prevention and
control (IPC) programmes to prevent healthcare-associated outbreaks.
- Treatment. Mucormycosis is a serious infection and needs to be treated
with prescription antifungal medicine, usually amphotericin B,
posaconazole, or isavuconazole.
- These medicines are given through a vein (amphotericin B, posaconazole,
isavuconazole) or by mouth (posaconazole, isavuconazole). Other
medicines, including fluconazole, voriconazole, and echinocandins, do not
work against fungi that cause mucormycosis. Often, mucormycosis requires
surgery to cut away the infected tissue
2.Phylum Microsporidia
1. A phylum of ubiquitous spore-forming unicellular parasites, which have
been reclassified as fungi.
2. Microsporidia have a long polar filament and a polar cap that serves as
a means of extrusion.
3. They primarily infect insects, but crustaceans, fish and humans are not
immune. Of the estimated million species of Microsporidia, 1500 have been
formally named. Microsporidia genera that cause human disease:
• Brachiola—B algerae, B connori, B vesicularum.
• Encephalitozoon—E cuniculi, E hellem, E intestinalis.
• Enterocytozoon—E bieneusi (prolonged production of intra- and
extracellular spores by Enterocytozoon bieneusi is not always associated
with systemic disease).
• Microsporidium—M ceylonensis, M africanum.
• Pleistophora species.
• Trachipleistophora—T hominis, T anthropophthera.
• Vittaforma species—V corneae.3
3.Phylum Ascomycota
- A diverse group of FUNGI that includes moulds with septate (see SEPTUM)
HYPHAE and YEASTS.
- They are called ‘sac fungi’ because their sexual SPORES, ASCOSPORES,
are produced in a sac-like ASCUS. Their asexual spores are usually
CONIDIOSPORES, formed in long chains at the end of the
CONIDIOPHORE. The term conidia means dust, and these spores are easily
detached from the conidiophore and float on the air like dust. The group
includes the yeasts Saccharomyces, used in brewing and bread making;
Aspergillus, which produces such products as citric acid used in foods;
Penicillium which produces PENICILLIN, the ANTIBIOTIC, and which can also
be used in making certain cheeses; and Neurospora which is used in
genetic studies. Other less beneficial members include some that attack
valuable plants, for example one ASCOMYCETE is responsible for DUTCH
ELM DISEASE, others are PATHOGENS of CEREALS.
3.1. Genus Aspergillos
1. Aspergillus is a filamentous, cosmopolitan and ubiquitous fungus found in
nature. It is commonly isolated from soil, plant debris, and indoor air
environment. While a teleomorphic state has been described only for some
of the Aspergillus spp., others are accepted to be mitosporic, without any
known sexual spore production.
2. “Macroscopic Features: The major macroscopic features remarkable in
species identification are the growth rate, color of the colony, and
thermotolerance. Except for Aspergillus nidulans and Aspergillus glaucus,
the growth rate is rapid to moderately rapid.
3. While Aspergillus nidulans and Aspergillus glaucus grow slowly and reach
a colony size of 0.5-1 cm following incubation at 25°C for 7 days on Czapek-
Dox agar, those of the remaining species are 1-9 cm in diameter in the
specified setting. These variations in growth rate help in species
identification.
- Aspergillus colonies are downy to powdery in texture. The surface color
may vary depending on the species. The reverse is uncolored to pale yellow
in most of the isolates. However, reverse color may be purple to olive in
some strains of Aspergillus nidulans and orange to purple in Aspergillus
versicolor.
- Aspergillus fumigatus is a thermotolerant fungus and grows well at
temperatures over 40°C. This property is unique to Aspergillus fumigatus
among the Aspergillus species. Aspergillus fumigatus can grow at a
temperature range of 20 to 50 °C.
Microscopic Features: COMMON TO ALL SPECIES: Hyphae are septate and
hyaline. The conidiophores originate from the basal foot cell located on the
supporting hyphae and terminate in a vesicle at the apex.
Vesicle is the typical formation for the genus Aspergillus. The morphology
and color of the conidiophore vary from one species to another. Covering
the surface of the vesicle entirely (“radiate” head) or partially only at the
upper surface (“columnar” head) are the flask-shaped phialides which are
either uniseriate and attached to the vesicle directly or are biseriate and
attached to the vesicle via a supporting cell, metula.
Over the phialides are the round conidia (2-5 μm in diameter) forming radial
chains.
Pathogenicity and Clinical Significance: Aspergillus spp. are well-known to
play a role in three different clinical settings in man: (a.) opportunistic
infections; (b.) allergic states; and (c.) toxicoses.
• Immunosuppression is the major factor predisposing to development of
opportunistic infections. These infections may present in a wide spectrum,
varying from local involvement to dissemination and as a whole called
aspergillosis. Among all filamentous fungi, Aspergillus is in general the most
commonly isolated one in invasive infections.
• It is the second most commonly recovered fungus in opportunistic
mycoses following Candida. Almost any organ or system in the human
body may be involved. Onychomycosis, sinusitis, cerebral aspergillosis,
meningitis, endocarditis, myocarditis, pulmonary aspergillosis, osteomyelitis,
otomycosis, endophthalmitis, cutaneous aspergillosis, hepatosplenic
aspergillosis, as well as Aspergillus fungemia, and disseminated aspergillosis
may develop.
• Nosocomial occurrence of aspergillosis due to catheters and other
devices is also likely. Construction in hospital environments constitutes a
major risk for development of aspergillosis particularly in neutropenic
patients.
Aspergillus spp. may also be local colonizers in previously developed lung
cavities due to tuberculosis, sarcoidosis, bronchiectasis, pneumoconiosis,
ankylosing spondylitis, or neoplasms, presenting as a distinct clinical entity,
called aspergilloma. Aspergilloma may also occur in kidneys.
- some Aspergillus antigens are fungal allergens and may initiate allergic
bronchopulmonary aspergillosis particularly in atopic host. Some Aspergillus
spp. produce various mycotoxins. These mycotoxins, by chronic ingestion,
have proven to possess carcinogenic potential particularly in animals.
- Among these mycotoxins, aflatoxin is well-known and may induce
hepatocellular carcinoma. It is mostly produced by Aspergillus flavus and
contaminates foodstuff, such as peanuts.
1. Aspergillus spp. can cause infections in animals as well as in man. In birds,
respiratory infections may develop due to Aspergillus. It may induce
mycotic abortion in the Cartland the sheep. Ingestion of high amounts of
aflatoxin may induce lethal effects in poultry animals fed with grain
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contaminated with the toxin. Since Aspergillus spp. are found in nature,
they are also common laboratory contaminant.
3.2. Genus Blastomyces.
•The genus Blastomyces is the causative organism of a condition known as
Blastomycosis.
•The fungus lives in the environment, particularly in moist soil and in
decomposing matter such as wood and leaves. The fungal spores hare
inhaled after the soil or decomposing materials are disturbed.
•While this inhalation does not affect people in general,
Immunocompromised individuals can develop severe types of infection
beginning with lower respiratory infection, and later other organs such as
the skin, bones, joints, and the central nervous system.
• Symptoms: Symptoms of blastomycosis usually appear between 3 weeks
and 3 months after a person breathes in the fungal spores. These symptoms
include Fever, cough, night sweats, muscle aches or joint pain, weight loss,
chest pain and fatigue.
•Diagnosis and Testing requires assessment of travel history, symptoms,
physical examinations; Laboratory tests for blood or urine sample and
culture; and Tissue biopsy.
•Treatment and Prevention: Most people with blastomycosis will need
treatment with prescription antifungal medication. Itraconazole is a type of
antifungal medication that is typically used to treat mild to moderate
blastomycosis.
• Amphotericin B is usually recommended for severe blastomycosis in the
lungs or infections that have spread to other parts of the body. Depending
on the severity of the infection and the person’s immune status, the course
of treatment can range from six months to one year.
3.3 Genus Histoplasma
▪ Histoplasma is a genus of dimorphic fungi commonly found in bird and
bat fecal material.
▪Histoplasma contains a few species, including—Histoplasma capsulatum—
the causative agent of histoplasmosis; and Histoplasma capsulatum var.
Histoplasmosis is caused by the reproductive cells (spores) of the fungus
Histoplasma capsulatum.
▪ Airborne microconidia float into the air when contaminated dirt or other
material is disturbed. The fungus thrives in damp soil that's rich in organic
material, especially the droppings from birds and bats; cleaning coops or
construction
▪ Diagnosis: Histoplasma antigen detection in urine and/or serum is the most
widely used and most sensitive method for diagnosing disseminated
histoplasmosis and acute pulmonary histoplasmosis following exposure to a
large inoculum. 1 Other method include antibody tests, culture, and
microscopy.
▪ Culture can be performed on tissue, blood, and other body fluids; a
positive result may take up to 6 weeks to show; a culture is most useful in the
diagnosis of the severe forms of histoplasmosis. A commercially available
DNA testing can be used to confirm this.
▪ Microscopy can help detection of budding yeast in tissue or body fluids,
low sensitivity, but can provide a quick proven diagnosis if positive.
▪Treatment. Treatment is indicated for moderate to severe acute
pulmonary, chronic pulmonary, disseminated, and central nervous system
(CNS) histoplasmosis. Antifungal agents proven to be effective are
amphotericin B (including liposomal and lipid formulations) and
itraconazole (for mild-to-moderate infections).
3.4. Family: Saccharomycetaceae Genus: Candida
▪ Candida species are the most common causes of fungal infection.
Approximately 90% of infections are caused by five species: Candida
albicans, Candida glabrata, Candida tropicalis, Candida parasitosis, and
Candida krusei. Candidiasis.
▪ Candidiasis is a fungal infection caused by a yeast (a type of fungus).
Some species of Candida can cause infection in people; the most
common is Candida albicans.
▪ Candida normally lives on the skin and inside the body, in places such as
the mouth, throat, gut, and vagina, without causing any problems.
▪Infections can occur with its overgrowth or if it enters deep into the body
via the bloodstream or internal organs
▪ Candidiasis in the mouth and throat is also called thrush or oropharyngeal
candidiasis.
▪ Candidiasis in the esophagus (the tube that connects the throat to the
stomach) is called esophageal candidiasis or Candida esophagitis.
Esophageal candidiasis is one of the most common infections in people
living with HIV/AIDS.
▪ Candidiasis in the mouth, throat, or esophagus is uncommon in healthy
adults. People who are at higher risk for getting candidiasis in the mouth
and throat include babies, especially those younger than 1 month of age,
and people with at least one of these: dentures, diabetes, cancer
(leukemia and lymphoma) , HIV/AIDS; Those who are taking antibiotics or
corticosteroids, including inhaled corticosteroids for conditions like asthma;
and those who are taking medications that cause dry mouth or have
medical conditions that cause dry mouth and smokers
Diagnosis:
▪ The genus Candida is characterised by globose to elongate yeast-like
cells or blastoconidia that reproduce by narrow-based multilateral
budding. Pseudo hyphae and occasionally true hyphae may also be
present. Colony pigmentation is usually absent. Ballistoconidia are not
formed.
▪ Various Candida species can be detected by observing the changes in
the indicator colour when the yeast cultures utilize 1% carbohydrates such
as glucose, maltose, sucrose, trehalose and raffinose.
▪Esophageal candidiasis is diagnosed by doing endoscopy. Care providers
may prescribe an antifungal medicine without the endoscopy and monitor
for changes in the patient’s condition.
Treatment:
▪ Candidiasis in the mouth, throat, or esophagus is usually treated with
antifungal medicine.
▪ The treatment for mild to moderate infections in the mouth or throat is
usually an antifungal medicine applied to the inside of the mouth for 7 to
14 days. These medications include clotrimazole, miconazole, or nystatin.
▪For severe infections, the most common treatment is fluconazole (an
antifungal medication) taken by mouth or through a vein. If patient does
not get better after taking fluconazole, healthcare providers may prescribe
a different antifungal.
▪ The treatment for candidiasis in the esophagus is usually fluconazole.
Other types of prescription antifungal medicines can also be used for
people who can’t take fluconazole or who don’t get better after taking
fluconazole.
4. Phylum Basidiomycota
▪ A group of FUNGI generally with septate (see SEPTUM) HYPHAE and
CLAMP CONNECTIONS.
▪ They are commonly called ‘club fungi’ because of the club-shape of the
BASIDIUM that bears the sexual SPORES (basidiospores).
▪ The spores are exposed on the basidium. Members of the group include
RUSTS, SMUTS, MUSHROOMS, TOADSTOOLS, PUFFBALLS and BRACKET FUNGI.
▪Many members form associations with ROOTS.
4.1. Cryptococcus
1. The genus Cryptococcus is characterized by globose to elongate yeast-
like cells or ballistoconidia that reproduce by narrow-necked budding.
2. Pseudo hyphae are absent or rudimentary. Most species are
encapsulated, although the extent of capsule formation depends on the
medium.
3. Cryptococcus neoformans and Cryptococcus gatti are the most
common causes of fungal meningitis. Other causes are Histoplasma
capsulatum and Cocci diodes immitis.
4. C. Neoformans is an encapsulated yeast, a common saprophyte of the
soil particularly soil enriched with pigeon droppings. It is monomorphic (exist
only as yeast) and of low virulence. It is distributed worldwide.
5. The fungus is opportunistic and only cause infection in
immunocompromised individuals and infections tend to be severe and
fatal. Its virulence is mainly due to its capsule and its ability to produce
melanin, both of which protect C. neoformans from phagocytosis. It can
grow at 370C.
- Mode of Transmission: Cryptococcal meningitis is acquired by inhalation
of the fungus from the environment. Infection spreads from the lungs into
the blood, affecting the central nervous system.
-. Clinical Findings: The patients may experience headaches, nausea,
vomiting, loss of vision, and other focal neurologic findings of several weeks’
duration. The classical manifestation of meningitis is usually absent in
cryptococcosis.
- Diagnosis: Diagnosis is made by direct examination of the CSF fluid stained
with India ink or Nigrosine to demonstrate the capsule of the fungus.
Cerebro-spinal fluid examination will show high opening pressure,
mononuclear cell pleocytosis, increased protein concentration and low
glucose concentration.
- Treatment and Prevention: Treatment consists of Amphotericin B and
Flucytosine for 4-8 weeks followed by fluconazole. Lifelong maintenance
therapy is required.
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