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Nplex Micro Chart
Nplex Micro Chart
transferred by respiratory Deeper infection of the skin and subcutaneous tissue. Most commonly face and trunk. Erythema, warmth, tenderness. No clear distinction
Streptococcal Cellulitis
droplets or break in skin after between infected and non-infected tissue. Systemic signs and symptoms are more common than with erysipelas. Peau d'orange.
contact with vector Caused by mutant form of S. pyogenes in susceptible people. Possibly fatal. Unexplained localized redness, swelling and pain. May have flu
Necrotizing Fasciitis
symptoms. Rapid spread, descruction of tissue. TSS develops if not aggresively treated.
Complication of Srep A associated URI. Damage to HT valve predisposes patient to bacterial endocarditis. CHANCE: Chorea, migratory Jones Criteria 1) Supporting evidence for preceding Group A strep infection (+ throat swab, rising ASO
Rheumatic Fever
polyArthritis, subcutaneous Nodules, Carditis, Erythema marginatum titers) 2) at least 1 major and 2 minor manifestations (see notes)
Acute Glomerulonephritis Complication of Strep A disease. Cause of renal failure. Generalized edem, oligouria, dark urine, fatigue, ab pain Document group A strep infection. Blood: Anti DNAse B+, Urine: frank hematuria, proteinuria, RBC casts
Early Onset Neonatal Disease Endogenous infection acquired in utero or in 1st 7 days of lige. Pneumonia, meningitis, bacteremia with neurological squelae. Risk factors: heavily colonized birth canal. Maternal disseminated group B Strep infection
CAMP test: used to Late Onset Neonatal disease Exogenous disease within 1 week - 3 months after birth. Meningitis. Risk factor: contact with heavily colonized persons. Breastfeeding is important!!
Group B Strep - S. In the normal flora of the
Penicillin-resistant differentiate group B from A condition of the mother. Rise in temperature to greater than 38 on any 2 consecutive days after the 1st 24 hours post-partum. Fever, chills,
agalactiae femail genital tract Postpartum (peurpural) feverl Risk factors: Unsterile obstetric techniques!! Hand washing!
group A strep. malaise…foul smelling, yellow green/blood tinged lochia (discharge)
UTI
Group D Strep - S. Resistant to bile salts. ABC
Normal gut flora. Normal gut flora. URTI in immunocompromised. Needle stick.
Enterococcus resistant.
Physical exam: increased fremitus (vibration), dullness on percussion, Adventitious sounds (crackles) on
Very rapid onset. Single severe shaking chill with persistently high fever. Productive cough: hemoptysis, copious purulent "rust" colored
Lobar Pneumonia auscultation. CXR: dense uni-lobar consolidation with typical air bronchograms. Rapid onset of visible
sputum. May have URI before and immunocompromized have minimal symptoms. MC R middle lobe.
signs. Lab: Gram +, lancet shaped, encapsulated
Sinusitis Facial pain, tightness, H/A. Decreased valsalva (defection) and dependency (gravity). Tenderness. Low fever and mucopurulent discharge Many causes: Strep pneumonia, H. influenza, Moraxella catarrhalis.
85 antigenically distinct sub- Lancet-shaped in diplococci Otaglia (pain in ear), otorrhea, tinnitus, vertigo, nystagmus. Reduced acuity. Bulging, erythematous TM with reduced visible landmarks, gluid
S. pneumoniae Otitis Media Increased risk with dietary sensitivites, ABC,s…
types or short chains. line and displaced COL
Sudden onset of fever, nuchal rigidity (stiff neck), blinding H/A, n/v. Irritability, malaise, restlessness, delerium. Petechial rash. Seizures. S. Common causes: N. meingitides, H. influenza, S. pneumonia. CSF culture +, decreased CSF glucose,
Meningitis pneumonia is 4-20x more likesly to cause neruological complications than other bacterial meningitis. Sequele : defness, blindness, mental predominate cells are PMNs. Viral mengitis is less severe/quick and is culture -, increased CSF protein
retardation, memory loss, SIADH (syndrome of inappropriate ADH secretion) and lymphocytes in CSF
Bacteremia endocarditis, arthritis, or peritonitis
Poor flossing/brushing --> S. mutans sticks to enamel --> acidic environment --> plaque. Carie develops if demineralization is greater than
S. mutans and dental carries Risk: inadequate salivary flow (And all the usual stuff like hygiene and high sucrose)
S. viridans minteralization
Bacteremia, abcess Wound or traumatic injuries
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Gram-positive endospore-forming rods (4%)
Clostridium
Inadequate sterilization of food: home canned foods, preserved fish. 2h-72 hour incubation. No GI distress - unlike other food poisonings,
Inhibits acetylcholine Food borne botulism "Intoxication" Dilated, fixed pupils; dry/ "furry" tongue. Bilateral descending weakness - of neck, face, throat. Respiratory paralysis (mortality 32-40%.) No
release at presynaptic permanent immunity - can get repeated occurances. MC complete recovery in months to years.
terminals and therefore,
flaccid paralysis
(opposite Consumption of honey contaminated with spores. MC form of Botulism in the USA. MC in 1-6 months because infant GIT doesn't have as
Ubiquitous - soil, sedaments tetanospasmin) many competitive bowel microbes. Can resemble SIDS iff rapid onset. Non-specific signs: constipation, weak cry, failure to to thrive, weak
of lakes and ponds, and Infant botulism "infection-intoxication"
sucking. Floppy baby: acude flaccid paralysis (head, fact, throat), descent to extremities/trunk. Death reom respiratory paralysis (low 1-2%
decaying vegetation. Home- Gram (+) bacillus, mortality)
C. botulinum
canned foods are the MC "sausage shaped"
source. Honey is the MC
source of infant botulism. Botulinum toxin: one of the
most potent neurotoxins.
Two parts: B - protects Very rare, little evidence of clinical infection. Limited paralysis. Same sx's of food borne botulism but long incubation (1-4 days) and no
Wound botulism
from ST acid. A part - abdominal pain or constipation
neurotoxin specific to
irreversible binding to
cholinergic neurotoxins
Unclassified botulism People over 1 year who have had symptoms of botulism but no documented vehicle of transmission. DDX is important.
Can be normal gut flora.
Replicated in 10 min! Simple wound infection People over 1 year who have had symptoms of botulism but no documented vehicle of transmission. DDX is important.
Found in soil, air and water.
C. perfringens need Trauma and favourable conditions. Organism spread through subQ tissue - spares fascia and deep muscles. Pain, redness, inflammation,
devitalized tissue to grow Anaerobic cellulitis superficial skin discoloration and skin necrosis. Gas forms develop suppurative myostitis - foul smelling discharge. No muscle necrosis, no
best systemic signs and symptoms.
Gram (+) "plump,
C. perfringens
rectangular" rod Rapid worsening of cellulitis. Trauma and 1 week incubation. Rapid onset of intense pain, extensive muscle necrosis (blue black, edematous,
Disease MC after trauma that Alpha toxin lecithinase Fast growth of culture on sheep's blood agar. Nagler's reaction on egg yolk agar. Gram (+) rods in tissue
C. perfringens myonecrosis "Gas gangrene" does not bleed or contract on stimulation), toxic delerium. Progress to shock, renal failur, death within 48hrs if untreated. Much damage due to
causes ischemia: lowered specimens with no leukocytes.
alpha toxin and gas bubbles. MC in areas of poor blood supply. Need to perform debridement and examine inderlying tissue.
pO2 and pH favors C.
perfringens growth Ingest meat (refrigerating and re-heating destroys enterotoxins) Large infective dose. Short incubation: 8-24 hrs. Abdominal cramps. Self
C. perfringens food poisoning
limiting > 24 hrs. Watery diarrhea, no fever or vomiting.
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Listeria
>50% of women are asymptomatic or mild symtoms. Infection site MC'ly cervix (cervicitis). 2-7 day incubation. Vaginal discharge or abnormal
IgA Protease - neutralizes
2nd most common STD in the Gonorrhoeae in females vaginal bleeding, dysuria, urgency, swollen painful abdomen (RUQ). If untreated an ascending infection can develop. Major cause of infertility
N. gonorrhoeae secretory IgA
US (chlamydia is #1) iff chronic. Secondary: Fitz Hughe Curtis syndrome: periphepatitis (affects liver - symptomatic gonorrhea). Can lead to PID.
Need intimate sexual contact.
Facultative anaerobe Rare but MC in women (1-3%). Systemic symptoms or complex syndrome with fever, migratory arthralgias, tender papillary lesions/ rash on
MC in 15-24 year olds. Disseminated gonorrhoeae
extremities. Arthritis: MC'ly mono-articular - knee in females. N. gonorrhoeae is the #1 cause of purulent arthritis in young adults
LOS endotoxin
MC'ly caused by N. gonorrhoeae or C. trachomatis. 2-5 days after vaginal birth. Purulent conjunctivitis in newborns infected during vaginal
Opthalmia neonatorum
delivery. Sticky discharge, edema/ inflammation. Can lead to scarring and blindness. Reason why newborns get eye drops of 1% sulver nitrate.
MC cause of baterial
meningitis in infants
N. meningitidis
through adolescence and in Can ferment glucose and URI infection then 1-3 day incubation. Small, petechial rash on trunk and lower extremities that can coalesce to form larger bullae (due to
young adults transferred via close contact maltose (onlke N. Capsule - resists thrombosis of small blood vessels). Iff untreated can progress to DIC or hammorhage into adrenal glands (Waterhous-Friderichsen syndrome).
with respiratory droplets (e.g. Meningiococcemia - marked disease
gonorrhoeae which only phagocytosis Sequelae: none or large areas of necrosis. Deafness. Mortality 100% if untreated, 25% if treated. Occurs with or without meningitis. Rapid
daycares, military barracks). ferments glucose). onset fever.
Classmates in school not
close enough.
IgA Protease - neutralizes N. mengintidis is 2nd MC cause of adult bacterial meningitis. Triad: fever, nuchal rigidity, blinding HA. Neurological sequelae (hearing
Catalase and oxidase + Meningococcal meningitis Clinical signs and symptoms and CSF analysis. High number of Gram (-) diplococci in PMNs.
secretory IgA deficits, arthritis, memory loss) low compared to H. influenzae or S. pneumonia
Gram negative rods (14%)
Escherichia
1) Adhesins: colonize GTU
Part of the normal flora of the Most commonly caused by E. coli and group B strep. Most isolated strains from babies have K1 capsular
or GIT despite voiding or Neonatal Meningitis Colonization of infants with E. coli is common but rarely leads to disease
GIT: opportunistic pathogen Ags (maternal anti-K1 Abs are protective).
peistalsis
2) Exotoxins Septicemia Usually results from spread from GIT or GTU. Increased mortality if immunocompromised or due to complication of intestinal perforation. E. coli is most common cause of enterobacterial septicemia (45%), then K. pnemonia
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Citrobacter
Similar to salmonella, whithout
C. freundii Occurs in normal flora UTI's
causing salmonellosis
Salmonella
Humans are the only known
Most commonly due to S. typhi and S. paratyphi but also seen with S. enteritidis. Increased risk with AIDS,
animal host. GB infxn = Gram (-) bacillus Salmonella induced septicemia Symptomology similar to other Gram (-) septicemia: 10% of patients develop arthritis, osteomyelitis, and endocarditis
geriatrics and pediatrics.
carrier state.
S. Typhi Disease in NA primarily
MC spread is by food handlers infected with S. typhi (typhoid fever) or S. paratyphi (paratyphoid fever).
associated with foreign travel. Non-specific systemic symptoms (H/A, malaise, myalgias, and anorexia). Rose coloured spots on abdomen (erythematous, maculopapular,
Bacteria pass directly through intestinal walls. Enter thoracic duct and then blood stream to replicated in
Spread by food or water Facultative anaerobe Enteric fever blances with pressure, only 50% of patients). Complications: GI lesions, Toxemia, meningitis, osteomyelitis, endocarditis. 1-3% become chronic
Sp, LV, bone marrow and GB. Back into the intestine to cause increased inflammation. This is NOT
contaminated by infected carries. Increasing, remittant fever.
typhus.
food handlers
Humans most commonly get
Animals are the primary
Salmonellosis from: Requires a high infective
reservoirs for S. enteritides:
undercooked poultry, dose - killed by gastric Occurs 6-48 hours after ingestion of contaminated food or water. Abdominal cramps, h/a, myalgia. Most commonly self limiting (2 days to 1
S. enteritidis livestock, fish, poultry/ birds, Gram (-) bacillus S. enteritidis gastroenteritis Most common type of Salmonellosis
contaminated cutting boards, acid. Antacids inc risk of week). Low mortality but increased risk with elderly and children. Nausea, fever and non-bloody diarrhea.
rodents, humans, reptiles
egg salad, undercooked/ raw infxn.
(turtles)
eggs
Shigella
Very low inoculum (only
Humans are the only carriers
10-100 baccili)
Attach and invade M cells GI symptoms are caused by Shiga toxin. Enterotoxic, neurotoxic and cytotoxic. 1-3 day incumation. Fever and diarrhea proceeds to tenesmus,
S. dysenteriae Gram (-) rod Shigellosis - bacillary dysentery Bacteremia rare. Infection self-limited. 5% can asymptomatically carry.
in PP abdundant blood and pus in stool. Profuse watery diarrhea.
Transmission due to fecal-
oral route Shiga toxin (only S.
dysenteria) disrupts protein
synthesis
S. sonnei Bloody diarrhea Usually produces a mild watery diarrhea in children. In more virulent strains it can progress to abdominal cramping and bloody mucoid stools.
Proteus
Can be normal flora of the
Highly motile colonies,
P. mirabilis colon. Opportunistic - enter
outgrow other organisms
via catheterization UTI Once there is an infection, urease can lead to stone formation.
Urease + (Urea --> ammonia
P. vulgaris Main microbe.
and CO2)
Yersinia
Get bitten by infected flea, 2-6 days later get high fever, chills. Not large but painful buboes in groin, axilla, neck. Prostration with rapid, Black plague 2 types: Urban: affects humans and can cause 3 types of plague. Rats are the main
Ubiquitous Gram (-) rod or coccobacillus Bubonic plague thready pulse, delerium. Bubonic purperea: vasculitis of superficial blood vessels cause bleeding into skin - black death. Can spread to blood reservoir, rat flea (Xeopsylla cheopsis) is main vector. 2) Sylvatic (Woodland): disease of wild rodents
then to lungs. Fatal within days (75% mortality) found everywhere but Australia
Invades through lymphatics
Org clots in flea's stomach
causing them to swell
by enzyme coagulase then
Y. pestis (buboes). Can also cause
Zoonotic: most common is regurgitated into the
hemorrhaging --> DIC or
septic shock. vectors are rodents: rats, Bipolar staining: "safety pin" human at next meal. Hematogenous spread from infected buboes or aerosols from infected person. Only 2-3 day incubation. Fever, malaise, hemoptysis, dyspnea.
Pneumonic plauge
ground squirrels, rabbits, appearance Highly virulent, rapidly fatal form of bronchopneumonia (90% mortality)
mice, prairie dogs, cats, ect.
Gram - rod that is oval in Need a large infective dose, ingest contaminated food product. 4-6 day incubation. Right sided abdominal pain. Lasts for 1-2 weeks. Can
Assoc with polyarthritis with Enterotoxin similar to E.
Y. enterocolitica shape and larger than Y. Yersinia entrolytica gastroenteritis/ Yersinosis progress to perforation of ilum and skin rash (erythema nodosum). Can get mesenteric adenitis in children (mimics acute signs of appendicitis).
diarrhea coli ST toxin.
pestis. Fever. Watery or bloody diarrhea. - mimics appendicitis
Pseudomonas
Most common cause of bacterial keratitis and neonatal opthalmia. Increased risk iff immunocompromised,
Blue-green pus: 2 pigments:
Unilateral, acutely painful, photophobic, intensely injected eye. Decreased visual acuity. Profuse tearing, thick ropey mucopurulent discharge. contaminated eye drops (contacts), hypoxic damage from prolonged contact wearing, corneal trauma, eye
pyocyanin (blue) and Gram (-) baccilus Bacterial Keratitis
Edematous cornea and eyelid operations. Can lead to blindness. Most common bacteria is S. aureus unless contact wearer, then P.
pyoverdin (green)
aeruginosa.
Sweet, grape-like fruity
Ubiquitous - soil, water, UTI's 3rd leading cause of nosocomial UTIs. Prolonged indwelling catheters.
odor
plants, hospital sinks and
respiratory equipment, GIT infections Any part of the tract. Eg. Perirectal, pediatric diarrhea, gasteroenteritis, necrotizing enteritis
P. aeruginosa
swimming pools, raw
Goes to the lungs in CF vegetables. Can be a part of Minimal nutritional
patients --> pneumonia normal flora. Initial pruritis and fullness in ear. Increased pain/tenderness on palpation. Otorrhea (?), Possible hearing loss (mild erythema and edema of Can get chronic supporitive OM, malignant otitis externa or Swimmer's ear (acute diffuse otitis externa).
requirements - can grow in Swimmer's Ear
external auditory canal. Dull injected TM with displaced COL). No systemic signs. Weber test: laterlize to affected side. Rinne test: AC>BC.
distilled water. Strickly
aerobic. Bactermia Primarily nosocomial. Increased risk if immunocompromised. Similar clinical presentation as other bacteremias but with higher mortality.
Hot tub folliculitis After breakdown in skin integrity (burns, trauma, cuts, dermatitis). High moisture conditions or immunocompromised.
Pathognomic Pseudomonas skin infection. Erythematous vessels become hemorrhagic, necrotic and ulcerated with a fruity odor. Can have
Ecthyma gangernosum
rapid necrosis to adjacent tissue (potentially fatal)
Legionella
Contaminated central water Thin, flagellated, non-
Discovered in 1976 systems, especially AC sporulating gram - Incubation is 2-10 days. Spread through contaminated central water systems (especially AC). NOT person to person spread. Flu-like symptoms
L. pneumophila Legionellosis, legionella pneumonia Culture, serological tests for rising serum IgM
legionnaire's conference Not person to person - just with rising fever, cough, pneumonia, diarrhea, and delerium.
Aerobic
inhalation
Gram-negative curved rods (4%)
Helicobacter
Found in stomach of humans,
Epigastric pain, abdominal tenderness, bloating, nausea, anorxia, dyspepsia. Epigastric tenderness on percussion, foul smelling breath, 30-50% of people with gastritis have H. pylori but most commonly asymptomatic. Lab Dx: 13C urea breath
primates, pigs, cheetas, Microaerophillis, urease + Type B (infective) gastritis
hematemesis (coffee grounds) (Type A gastritis is autoimmune AKA pernicious anemia) test, anti-H. pylori Abs (IgG), gastroscopy with biopsy, CLO test (+(
dogs, cats, ferrets, mice, rats
Only found in gastric antrum Closely resembles Expecially dodenal ulcers. Burning, gnawing upper GI pain 1-3 hours after meals. < night, > eating or > antacids. Anemia, epigastric
Peptic ulcer disease (PUD) Endoscopy, urea breath test, serology (anti-H. pylori Abs)
and body campylobacter tenderness.
H. pylori
Gram (-) bacillus: gram stain
is variable. Sprial shape in Sequelae of untreated chronic gastritis. Classifies as a class I carcinogen. Fatigue, weight loss, low grade fever, night pain.
Developing countries high Gastric adneocarcinoma
fresh culture, coccoid in older Epigastric/abdominal mass. Hemoccult (+) stools, anemia.
colonization, developed culture
countries low colonization
Flagellated, highly motile Gastric mucosa-associated lymphoid type (MALT) Chronic H. pylori infection assoc with B-cell lymphoma. No evidence that eradicating H. pylori prevents the
Dysphagia, dyspepsia, weight loss, GI bleeding - hematemesis.
"corkskrew motion" B cell lymphomas progression of gastritis to carcinomas
Page 4 of 12
Campylobacter
Some strains can produce
2-11 day incubation. Foul smelling, watery diarrhea progressing to profuse bloody diarrhea. Resolution in 3 days - 3 weeks. Residual
Microaerophilic an enterotoxin similar to Gastroenteritis
Transmission is recal-oral histological damage to mucosa of jejuni, ileum and colon.
Not recognized as a pathogen cholera.
C. jejuni route of animal-contaminated
until 1973
food or water Low infectious dose.
Idiopathic, peripheral polyneuritis 1-3 weeks after mild above conidition. Progressive, symmetric pain and weakness in extremities - might Many causes. Also immunizations, pregnancy, URI, EBV, CMV, Hodgkin's lymphoma. Autoimmune link:
Comma or S-shaped Resistant to penicillins and Guillian Barre syndrome
ascend to trunk, face, thorax. Self limiting (few weeks to months) with complete recovery. cross reactivity with glycosphingolipids on surface of neural tissue
cephalosporins.
Vibrio
O1 antigen causes
Fecal-oral via contaminated epidemics, non-O1 antigen
Can have human carriers. Comma shaped
food or water are non pathogenic or
cause mild diarrhea
2-3 day incubation. Abrupt onset of watery diarrhea and vomiting. Rice water stools. Severe fluid and electrolyte loss.Hypovolemic shock leads Cam resemble ETEC induced gastroenteritis. Lab Dx: rarely seen in Fram stained stool or wound
V. cholerae O1 --> entrotoxin Cholera
oxidase positve to cardiac arrhythmia, renal failure, muscle cramps. 60% mortality iff untreated, self limiting within a week. No abdominal cramps or fever. specimens. Dark field/ phase contrast microscopy: characteristing darting motility.
production
Epidemics in SE Asia, Europe Large animal reservoir in
and Africa marine shellfish Need large infective dose.
Facultative anaerobic Simulates G protein -->
cAMP --> water in intestine
Lives in salt water in costal Manifests after 24-48 hr incubation. Occurs after eating contaminated seafood. Sx include painful abdominal cramps and watery diarrhea as
V. parahemolyticus Food poisoning
areas globally well as, sometimes, flu-like syndrome. Self limiting. ABC not helpful.
Gram-negative coccobacilli (4%)
Haemophilus
Coccobacillus with a Pili - damage respiratory Same signs and symptoms as other bacterial meningitis - but more insidious onset and increased risk of neurological sequelae. Used to be
Menigitis Gram stain of CSF. Chocolate agar culture. Agglutination reaction to PRP capsule in CSF and urine.
polysaccharide capsule ciliated epithelium MC pediatric meningitis, before Hib vaccine
Epiglottitis Medical emergency, MC'ly in boys 2-4 yo. Dysphagia, drooling, muffled voice, minimal cough. Severe dyspnea. HIGH fever. "Thumb sign" on lateral X-ray of neck
Can be normal flora of the Cellulitis Reddish/ blue patch on cheek or peri-orbital. Fever. Gram stain of blood
H. influenzae Requires factor X (heme) and LPS - responsible for
URT Arthritis Monoarticular. Large joint. Gram stain of blood
factor V (NAD) found on mengitis. Protease digests
chocolate agar for growth secretory IgA. Otitis media / Sinusitis Three MC causes: H. influenzae, S. pneumonia, Moraxella catarrhalis. Unexplained fever in children. Gram stain of blood
Pneumonia Might be secondary to influenzae virus damage to respiratory epithelium. Secondary bacterial infection is more life-threatening than primary. Gram stain of blood
STD, most common to developing world. Unlike primary syphilis which causes hard chancre. Soft, purulent, painful ulcer (genitalia). MC
H. ducreyi Common in tropical countries Non-encapsulated. Chancroid males, uncircumcised, tropical & sub-tropical (female MC asymptomatic). 5-7 day incubation. Progress to painful buboes, phimosis, urethral
stricture.
Indicater of dysbiosis in
H. vaginalis (Gardnerella) vaginal flora. Appearance of Gram-variable rod. Bacterial vaginosis Positive whiff test (pungent, fishy odor with the application of 10% KOH). Trichomoniasis can also cause a positive whiff test.
clue cells.
Bordetella
Pertussis toxin - increase
Adenylate cyclase. cAMP
Can only cause disease in respiratory secretions/
humans - reportable Strictly aerobic mucous. Binds ciliated
disease epithelium and kills NK
cells, monocytes,
macrophages, neutrophils
Tracheal cytotoxin - part
of the PG layer. Cause Incubation: 7-10 days, sub-clinical. Catarral phase: 2 weeks, looks like common cold: rhinorrhea, sneezing, low grade fever, anorexia, malaise Bacteria are best isolated using nasopharyngeal aspirates during catarrhal stage. Culture: difficult
B. pertussis and Spread by infectious ciliostasis and then
Coccobacillary Whooping cough (most infectious stage). Paroxymal stage: 1-2 weeks, dry non-productive repetitive "whooping" cough. Cough ends in vomiting and exhaustion. humitidy, 35 C, 7 days, specialized agar (Bordet-Gengou medium) (only 50% of infected people are
parapertussis
droplets. damage to ciliated Convalescent stage: 2-4 weeks. Cough resolves, secondary complications: aspiration pneumonia, seizures, encephalopathy. culture (+). Throat swabs not as good - need synthetic fiber swabs. PCR. Lymphocytosis (not specific)
epithelial cells - cough -
IL-1 = fever
Filamentous
No long term imminity - can haemagglutin and other
Encapsulated
get disease more than once adhesins: attachment to
ciliated epithelial cells and
"protection" in developed PMNs. Intracellular survival
countries due to DPT vaccine protects against clearance
by humoral immunity
Acid-fast rods (4%)
Mycobacterium
No toxin produced, it is
Causes more deaths phaocytosed and secretes
worldwide than any other Obligate, aerobic, acid-fast an exported protein that
bacteria. Infects 1/3 of the rod prevents fusion of the "TB is the master impersonator." Primary infection (only 5% get active TB within 2 years): insidious onset: malaise/ listlessness, night sweats, CXR: cavitations in one or more upper lobes of lung. Sputum sample: acid fast bacillus. Fastidious
population. lysosome with the low grade fever, unexplained weight loss and progressive fatigue. Productive purulent cough progressing to hemoptysis, dyspnea. Apical rales, growth requirements, PCR.. Skin test (Mantoux test/PPD) - intradermal injection, wait 48 hours and
M. tubercylosis TB
phagosome cyanosis. Secondary TB (reactivation): haematogenous spread anywhere: miliaty TB (no pulmonary signs). Destroys tissues - liver, measure induration/ erythema (type IV hypersensitivity). Doesn't tell whether TB is active or not. False
adrenals... positives due to BCG vaccine.
Humans are natural Produces caseous
reservoir. Spread via One of the slowest growers granulomas. Ghon
aerosolized droplets. complex on x-ray.
Armadillos are naturally 3-6 year incubation. Strong cellular response, weat humoral. Not infectious. <5 cutaneous macular lesions with hypopigmented centers. Some
Similar to M. tuberculosis but: Tuberculoid (paudibacillary) Will react to skin test - lepromin
infected and provide reservoir nerve enlargement and damage.
Page 5 of 12
Borrelia
Larger than other spirochetes
and more complex nutrition Dormant in glial cells Unlike othr Borrelia diseases - non relapsing. Tick bite - must stay attached for >48 hrs. 7-30 day incubation. Stage 1: erythema migrans rash
vector: deer tick (Ioxdes required "bull's eye lesion". Annular rash with central clearing (40-60% don't get this!) Painless, non-infectious, H/A, myalgia, lymphadenopathy.
Clinical signs and symptoms and patient history. Culture and IFA stain of biopsy of initial rash (30% don't
B. burgdorferi scapularis/ Ioxdes Microaerophilic Spirochetes release Lyme disease Resolves 1-2 months. Stage 2: iff untreated develop into neurologic signs (meningitis, Bell's palsy, etc.), conjunctivitis or cardiac dysfunction.
get rash and cross-reactivity with Treponema). Indirect ELISA. PCR. IgM or IgG Ab to spirochete.
pacificus) Internal flagella neurotoxins that affect pre Stage 3: 2 months to 2 years after stage 1: migratory arthralgias/arthritis (knees, large joint, TMJ), encephalitis. Resolves in months, years or
Contain cholesterol in cell and post-synaptic never. )Can manifest as popliteal cyst. ) If neurologic symptoms: neruoborelliosis.
wall (unlike other bacteria) membranes
Leptospira
Zoonotic - rodent (rat) and
domestic animal (dog) obligate aerobe
reservoirs
Range from mild, febrile disease to LV/KI failure (Weil's disease iff icteric) No skin lesion at site of entry. Septic phase: aprupt onset fever,
Humans are accidental hosts: Leptospirosis (Weil's disease) --> jaundice and
L. interrogans Survive moist, slightly HA, myalgia, nausea, lasts 1 week. Immune phase - two days asymptomatic, then aseptic meningitis with severe HA, NV, myalgia. Weil's Too small for light microscope and Gram stain. Microscopic agglutination.
MC'ly acquire disease via aseptic meningitis
disease (icteric) - jaundice, scleral and conjunctival hemmorhages and KI failure (MC cause of death)
contact with infected urine alkaline environment for
many days (up to 6 weeks in
Swimming or drinking urine soaked soil).
contaminated water
Wall-less bacteria (2%)
Mycoplasma
Instead of a cell wall, have a
Human pathogen only. 3 layer membrane (which Cause ciliostasis MILD URI/pharyngitis Symptoms similar to RSV, group A strep Most difficult pathogenic organisms to grow (fastidious growth). "Fried egg colonies". Cold agglytination
contains cholesterol)
Acute tracheobronchitis Persistant dry cough that might become paroxysmal
"Walking pneumonia", "Eaton's agent"
M. pneumonia Smallest free-living organism Prolonged, mild form of pneumonia. Initial symptoms "non specific". Increases in severity over a few days. C XRAY before symptoms felt
pneumona
Respiratory droplets "Fried egg" appearance Incomplete immunitiy Erythema multiforme Hypersensitivity syndrome (vasculitis). Bulls-eye lesions, associated with HSV.
Stevens-Johnson Syndrome Severe, sometimes fatal, bullous form of erythema multiforme
OM Common
Hemolytic anemia auto-immune destruction of RBCs
Meningitis, pericarditis
Ureaplasma
Very similar to mycoplasma KI stones Produce urease
U. urealyticum but urease + (breaks urea
into ammonia and CO2) Urethritis no progression to PID (non gonococcal). Might be asymptomatic
Obligate intracellular bacteria (4%)
Rickettsia
Need arthropod vectors - Painless tick bite leaves no mark (very low inoculum - <10 organisms) 1 week incubation - rapid fever, severe HA, nausea. 5 days later: rash -
MC in children and in summer DDX with Typhoid. (Typhus is Rickettsia). DFA stain of skin biopsy. IFA stain for LPS. Complement fixation
R. rickettsii hard ticks (dog tick or wood Rocky Mountain Spotted Fever diffuse, maculopapular rash, MC spread from trunk to extremities (inclusing palms and soles). Respiratory symptoms. Iff untreated spread to
months tests, (+) iff <4x increase in Ab titer.
tick) - Dermacentor CNS (confusion), SP, GIT, LV. Encephalitis, DIC, shock, death (up to 20% mortality)
Chlamydia
Virus-like properties -
Intimate contact. Vertical and Must have spscific attachment to conjuctiva - resist flushing from tears. Begins as conjunctivits. Entropian - eyelashes chronically irritate
filterable and obligate Trachoma disease One of the leading causes of blindness in the world.
horizontal transmission. cornea causing ulceration
intracelular parasites
Bacteria-like properties -
Spread by droplets, hands,
inner/ outer membranes, Adult. Most common 18-30. Genital infection 1st then unilateral mucopurulent discharge in eye. Neonatal: infected mother and vaginal birth.
contaminated clothing, eye Trachoma inclusion conjunctivitis
bacterial ribosomes, contain Bilateral, intense papillary conjunctivitis with lid swelling, chemosis, and mucopurulent discharge
make-up, flies
DNA, RNA and LPS
Women: termed Chlamydia (the drip?) Most commonly asymptomatic (80%) but risk of intertility, miscarriage, ectopic pregnancy. Can cause
Unlike other bacteria there
urethritis, conjunctivits, perihepatitis (pain in RUQ). Pain/ cramping in lower abdomen, dyspaerunia, bleeding between menses. Men: NGU
C. trachmatis MC STD in the US is no PG layer, therefore no No long term immunity Chlamydia urogenital infections Currently MC bacterial STD in USA.
(non gonoccocal urethritis). MC symptomatic (75%) - yellow clear discharge, pain/ tenderness of genitals. Ractive arthritis (Reiter's syndrome) -
Gram stain
can't see, can't pee, can't dance with me! Can cause cervicitis and PID.
Can get from toilet seat - EB Seronegative (Rh-) spondyloarthropathy. MC in young men (20-40 years) that are HLA-B27 positiv. C. trachomatis is MC bacterial pathogen.
is resistant to the Reactive arthritis (Reiter's syndrome) Unexplained diarrhea, low grade fever. 2-4 weeks later conjunctivits, superficial lesions on palms/ sole/ oral mucosa, asymptomatic Clear yellow discharge (gonorrhea is yellow/purulent)
environment! Unique growth cell cycle polyarthritis, urethritis
within host cell - EBs
(elementary body) and RBs Also termed LGC. MC in Africa, Asia, South America (male homosexuals). Need adequeate sample of
(reticylite body) Reportable STD. Initial lesion: small painless papule on penis, urethra, glans, scrodtum, vaginal wall. 2nd stage: buboes --> painful, can infected cells (specimen of pus/ discharge is inapproptirate since they are in the cells). Culture: most
Lymphogranuloma vererum
rupture and drain spontaneously. Systemic. Mimics IBS. Can get proctitis in men and women. specific method, only infects certain cell lines; formation of inclusion bodies. DFA (direct fluorescent)
staining. PCR.
Infects only humans. Spread TWAR isovar. Human pathogen that can cause atypical pneumonia (mild, persistent cough/ malaise that might progress to lobar pneumonia).
C. pneumoniae Form of walking pneumonia. Chlamydiophilia pneumonia Difficult: PCR, Microimmunoflorescence
by respiratory droplets. Potential link to atherosclerosis, CAD, MS, asthma, Alzheimer's disease? MC in adults. Spread via respiratory droplets. Many cases subclinical.
Page 6 of 12
Coccidioides immitis
Apergillus
Aspergillosus flavus (on Mycotoxicoses hypersensitivity pneumonitis Skin sensitivity testing (wheal and flare reactions). IgE antibodies. Monitor with spirometry to detect
Allergic broncophulmonary asperfillosis associated with asthma (10-20%)
peanuts, corn and other (allergic bronchopulmonary aspergillosis) development of progressive fibrosis
Extremely common. V- no yeast-like form - only a Aspergillus Secondary colonization Aspergillus colonizes pre-existing cavity. Minimal distress, hemoptysis. Fungus ball on CXR - moves with dependency
strict pathogen (unlike grains) produces
Aspergillus shaped branching and mold form (form spore
Candida) aflatoxin - very potent Paranasal granuloma Chronic sinusitus due to Aspergillus colonization of paranasal sinuses.
septate hyphae. bearing hyphae)
carcinogen: Otitis externa/sinusitis
hepatocellular carcinoma Sepsis Indistinguishable from bacterial sepsis.
Cryptococcus neoformans
Ubiquitous: soil, pigeon
droppings (dessicated NO dimorphism in
Cryptococcosis (also Busse-Buschke disease or MC self-limiting mild pulmonary infection. Can lead to pulmonary nodule which mimics carcinoma or pnemonia with diffuse pulmonary infiltrates Microscopy: examine CSF after treating with 10% KOH and India ink. Serology: look for capsular Ags
alkaline rich, N2 rich, pathogenesis (unlike other Capsule (anti-phagocytic)
torulis) (mc in males) (unlike other systemic mycoses that look for Abs)
C. neoformans hypertonic), poultry farms, systemic mytotic agents)
eucalyptus trees
MC cause of fungal meningitis. Insidious onset of HA, low grade pyrexia, focal neurological changes. Immunocompromised also get skin
Infection via inhalation Encapsulated yeast Produces urease Cryptococcosis meningitis
lesions or osteolytic bone lesions (e.g. lymphoma)
Pneumocystis carinii (P. jirovecci)
Attaches to alveolar cells -
Included with fungi only Opportunistic infection -
inducing an inflammatory Pneumonia Non-specific. Plasma cell infiltrates with "ground glass appearance" Microscopy: typical octonucleate cysts.CXR: diffuse infiltrates with ground glass appearance
because of molecular traits common in environment
response
P. carinii also found in rodents (not
Has features like protozoans
reservoir for human disease) Damages BM --> frothy
Extrapulmonary In AIDS - eye, ear, liver, bone marrow
Most people exposed by age Transmission is via exudate
4. Seen in AIDS. respiratory droplets
Environmental Molds
Stachybotris
Unusual black, slimy molds
Toxin produces pulmonary Infection may be prefaced by nose bleeds, cough or chest congestion and worsened by concomitant cigarette exposure. Small areas may be
Stachybotris that grow on wet paper or Systemic poisoning
hemorrhage cleaned with bleach; larger infestations require professional removal.
wood
Mucor spp
Form large, fluffy white
Associated with allergy to its spores (including hypersensitivity pneumonitis) and opportunistic infections of the sinuses, skin, and lungs in
Mucor spp colonies that turn gray/brown Allergic reactions
immunosuppressed patients
with age
Penicillium spp
Grow as variably colored
Penicillium spp colonies, depending on Contain mycotoxins Allergic reactions To toxins.
species
Aspergillus - see above
Rhizopus spp
Colonies are like white cotton
Rhizopus spp Allergic reactions
candy and brown with age
Alternaria spp
Common indoor and outdoor Colonies are velvety, ranging
Alternaria spp Allergic reaction and hypersensitivity pneumonitis
mold from dark green to brown.
Page 7 of 12
Like Herpes simplex: causes
blister-like lesions (but
Incubates for 14-21 days. One of the 5 childhood exanthems: rubella, roseola, 5th disease, measles/rubeola. Inhalation: maculopapular rash
Peak occurrence of chicken different sizes and stages,
Primary infection: 2-4 days ("dew drop on rose petal"), intense pruritus, rapid development and spread from back/chest to scalp. Within 12 hours: successive crops of Tzanck smear: giant, multinucleate cells - syncytia. Cowdry Type A inclusion bodies: "drop like masses of
pox: spring time and 5-10 deeper, more painful and can Chicken pox
after: to lympatics lesions. Prolonged low grade fever. extremem irriability/malaise. Much more harmful to adults - scarring. More severe on trunk than acidophilic material surrounded by a clear halo within the nucleus"
years old cause scarring), establish
extremeties, also on mouth, conjunctiva, vagina. complications: 1) secondary bacterial infections.2) Reye's syndrome, CNS symptoms.
latent infections in nerves,
CMI
Ultimate B lymphocyte Triad of: fever, pharyngitis and lymphadenopathy for 1-4 weeks. Downey cells. Monospot test (+)
kissing disease - heterophile (+) mono. Symtoms: high fever, malaise, pharyngitis, tonsils with whitish exudate, lymphadenopathy,
pathogen. Mitogenic and Heterophile Abs - polyclonal activation of B cells produces wide reportoire of abs that recognize
Very common virus Mononucleosis hepatosplenomegaly, fatige. Spleen rupture - avoid contact sports, hepatitis. Cyclic recurrent disease. (if lasts over 6 months) EbV induced
immortalizing. Viral capsid "paul Bunnel" Ags on horse, sheep, cow, RBCs but not guinea pig. High IgM = acute. High IgG = past
lymphoproliferative dease(looks like leukemia)
Ag helps ID it in tissues. infection
Infection first in
A DNA enveloped herpes
Ebstein-Barr virus Transmitted MC'ly by saliva oropharynx, shed in saliva African Burkitt's Lymphoma Tumor cells are from lymphocytes and contain EBV DNA. Malaria is a co-carcinogen. Large lesions - osteolytic - on jaw
virus. A gamma herpesvirus
or from contaminated - saliva remains infectious
glassware - "kissing disease" for months after clinical
recovery
Chronic Fatigue Syndrome Proposed to be one of the causitive factors of chronic fatigue
To cause neoplasms - need Iiff overactive immune
Nasopharyngeal carcinoma Epithelial cell tumor. Co-factor: ingested nitrosamines.
other cofactors system --"infectious mono"
iff lack of immune
Immunity to EBV is lifelong response --"lymphoma" Hairy oral leukoplakia Opportunistic infection in HIV AIDS patients. Vertically ribbed keratinized plaques on lateral borders of the tongue
e.g. burkitt's
URT - lymphotropic -
Opportunistic pathogen - MC viral agent of congenital disease in US. Clinical disease in 10%: microencephaly, hearing loss(SNL) rash, hepatosplenomegaly. Fetus is
infected cells (leukocytes,
rarely causes disease in congenital - cytomegalic inclusion disease infected either: placenta or recurrent mother infection - ascending infection from cervix. Appearance of multinucleated giant cells with Confirm by isolating CMV from child's urine in 1st week of life.
lymphocytes) spread CMV
immuno-competent hosts intranuclear inclusions.
throughout the body
Transmitted as STD, DNA Enveloped herpes virus. Similar to Herpesviridae: 1)
Cytomegalovirus contains both mRNA and Infectection of fetus or newborn by any of the TORCH agents. Toxoplasmosis, other, rubella virus, cytomegalovirus, histoplasmosis. Outcome
transfusion/ syncytia, 2) latent state, 3) TORCH syndrome
is abortion, stillbirth, or premature delivery. Fever, lethargy, poor feeding…..
transplantation, oral, DNA --> unlike other viruses reactivation in
congenital immunosuppressed state CMV mono, CMV hepatitis
Through vaginal birth with infected cervix or colostrum or milk. 2 outcomes: asumptomatic or symptomatic if immunocompromised. Very
Can be latent in T cells, Heterophile (-) mono. Clinical signs and symptoms too vague to be that useful. Biopsy: owl's eye
Peri-natal common cause of failure of KI transplants. IFF immunocompromised: Retinitis: "pizza pie retina" --> scotoma, "blind spot". Esophagitis: mimic
macrophages, other cells nuclease. Cell culture: characteristic CPE in diploid fibroblastic cells
CRC esophagitis
Ubiquitous. Cause life long Lymphotropic Roseola infantum Rapid onset of high fever. Fever subsides and then get maculopapular rash. Also termed exanthum subitum. "Slapped cheeck appearance"
Human herpes virus-6
infections
latent infection in t cells Mononucleosis type illness progression time of HIV to aids. Assoc with neurological disorders: might be linked to MS, cronic fatigue. Heterophile (-) mono.
Adenovirus
Respiratory droplets, fecal DNA non-enveloped (naked) Hemagglutinin fiber - aids
Pharyngitis (acute respiratory disease) mild URI with fever, rhinorrhea and cough. #4 on viral respiratory diseases. #1: RSV, #2: parainfluenza #3: Rhinovirus Similar to owl's eye inclusion body (in CMV). Increased CRP (unique to viruses --> similar to bacteria)
oral, direct fomite inoculation virus in attachment
Atypical pneumonia pertussis-like illness
Adenovirus 41 antigenic types Used as a vector for gene conjunctivitis Associated with swimming pools, dust/ debris.
Can get through birth canal Icosahedral nucleocapsid therapy - help stimulate 2nd only to rotaviruses as cause of acute gastroenteritis in children. Serotypes 40 and 41 are thought to cause up to 15% of
bone growth Gastroenteritis
gastroenteritis in children.
Hemorrhagic cystitis Usually occurs in epidemics
Papillomaviruses
Through breaks in skin and cause lytic, chronic, latent Common flat wart (verruca plana or verucca
MC on hands and feet. Surface is studded with black dots. Plantar is painful because it grows on pressure points
mucosa or transforming infections vulgaris)
transferred by fomites - direct
contact into small breaks in transformation occurs bc Oral papillomas
Human papilloma virus skin/ mucosa Naked capsid virus
proteins bound by
HPV16&18 bind tumor Laryngeal papillomas MC epithelial tumor in the larynx. Infected birth cana. Hoarseness or abnormal cry. HPV 6 & 11.
Also infected birth canal suppressor molecules Condyloma acuminata (anogenital warts) HPV 6 and 11. STD, vaginal birth, or ?. Rarely regresses spontaneously. Plaque-like flesh colored lesions. Can be pre-neoplastic. Lesions turn white with acetic acid
(STD transmission)
Cervical dysplasia and cervical CA 2nd MC canver in women in USA. HPV 16 & 18 & 31. Need cofactors to progress to CA PAP smear - presence of Koilocytes. Topical 5% acetic acid.
Paramyxoviruses
Page 8 of 12
No hemagglutininor
Common cold causes: 1) Ubiquitous - virtually
neuraminidase. F
rhinorhea virus. 2) everyone in NA is infected by URI with marked rhinorrhea In older children/adults 4x increase in anti-RSV indicates disease
glycoprotein in envelope
coronavirus 3) RSV age 4 (very contagious)
causes cells to fuse
Epidemics in every winter in
Respiratory Syncytial Form syncytia Bronchiolitis OM also is common. These 2 in infants. Respiratory secretions or detection of syncytium. Rising Ab titers.
cold, temperate climate Enveloped RNA virus
Virus #1 cause of severe lower
Infection localized to upper
respiratory tract infection in
Transmitted via hands, or lower respiratory tracts.
young children (Day cares,
fomites and respiratory No systemic spread/ Severe pharyngitis In older children and adults, croup, severe pharyngitis or URI symptoms occur
nurseries)
secretions viremia
No long term immunity
4 serotypes: Types 1-3:
2nd most common cause
of severe respiratory
Ubiquitous Enveloped RNA virus Laryngitis
distress in infants and
young children, can cause
croup
Parainfluenza Virus Initial site of infection is the
upper respiratory tract -
Transmission is person to
epithelial cells. Usually
person and respiratory Parainfluenzae range from mild cold-like URI to bronchitis and pneumonia. Milder disease in older children and adults
contained here and rarely
droplets 4 serotypes. No antigen drift. becomes systemic (unlike
measles/ mumps)
Only partial immunity Laryngeotracheobronchitis - "sound worse than they look". Seal bark - harsh brassy cough. MC self limiting - 48 hours. Xray: steeple sign. Lab DDX epiglottitis (caused by H. influenzae). "Look worse than they sound" Medical emergency, drooling.
MC in infants and children <5 Croup
(unlike measles) Dx: Serology >>false -. Presence of syncytia. Hamadsorb guinea pig RBCs. Xray: thumb sign.
Hepatitis viruses
Ingested (contaminated Naked icosahedral ssRNA
Differences from HBV:
shellfish, clams, oysters) genome
HAV can not initiate a chronic Pathology due to immune
extremely stable capsid
infection mediated hepatocyte damage
Person-to-person, fecal-oral
and sewage contaminated
HAV not associated with
food/water (often traceable
hepatic CA
source, can live in water for slow replication, transient Children: often asymptomatic (only 1-2% get jaundice). Adults: abrupt onset of fever/chills. Symptoms decrease in 4-6 days. Jaundice in 67%. Patient history - source of infection. Acute or recent: anti HAV igM by ELISA or RIA. IgM rises early in
Hepatitis A (HAV) many months) Hepatitis A
viremia 99% full recovery. 1-3/1000 progress to fulminant hepatitis. disease, IgG persist for life. Serum LIV enzymes usually elevated
rarely get immune complex Children most common.
related rash and polyarthritis Usually from restaurants. Not stable to chlorine
rarely fatal (fulminant hepatitis)
Hep A vaccine can prevent
1 month incubation --> abrupt
infection
onset of icteric symptoms
fecal-oral spread
MC'ly in blood or blood
differences from HAV:
products (serum hepatitis)
Chronic carrier - test + for
hepDNA vuris
HbsAg 2 occasions
transmitted by over 1/3 of the world is
blood/needles/STD/perinatal infected HBsAg (surface antigen): rises in acute infection. Assoc with infectivity. HBeAg (e antigen): occurs
during active infection; associated with infectivity and risk of progression to chronic liver disease. Anti-
Partially double-stranded Infects hepatocytes --> immune response. CD8+ T cells recognize viral particles and start attacking virus-filled hepatocytes. Ag-Ab complexes
longer incubation (3 months) HBsAb (Anti-sruface antibody): appears weeks after recovery. Suggests past infection. Anti-HBcAb
Hepatitis B (HBV) DNA enveloped Hepatitis B form, which probably explain arthralgias and arthritis, immune-complex glomerulonephritis, and vasculitis. Incubation is 10-12 weeks --> fever,
and then insidious onset of (anti-core antibody): appears at onset of clinical symptoms. Suggests current or previous infection. Anti-
hepadnavirus fatigue, nausea, jaundice with hepatosplenomegaly.
symptoms HBeAb (anti-e antibody): suggests low risk of infectivity and good chance of avoiding chronic liver
disease.
can get chronic hepatitis unusally stable for an
carriers enveloped virus
can cause primary
hepatocellular carcinoma
(PHC)
not as resistant
IV drug users - transmitted
through blood Similar to hep B. Tends to not have jaundice symptoms. Chronic state usually involves low-grade, intermittent symptoms of fatigue and
Hepatitis C (HCV) RNA enveloped flavivirus CMI response Hepatitis C arthralgies. Increased rate of AI disease in carriers. Low risk of developing cirrhosis and hepatocellular carcinoma. Hepatitis, cirrhosis, liver
Chronic carrier state cancer, carrier state.
Incomplete viral particle Coinfection with Hepatitis B needed (HBsAg required) --> acute hepatitis and also fulminant hepatitis. Increased likelihood of
Hepatitis D (HDV) Hepatitis D
(Delta particle) cirrhosis.
Rhinovirus
over 100 serotypes - can get MC common cause (>50%) Gradual antigenic drift (like
common cold more than once! of the common cold influenza A)
Influenza Viruses
1) Influenzae A: epidemics,
Enveloped virus - wash your
pandemics, bird reservoirs Haemagglutinin Influenzae A Abrupt onset of fever (38-41C for 1-5 days). Non-productive cough, severe myalgia, rhinorrhea, anorexia Usually symptomology and community history of outbreak is enough for diagnosis
hands! Destroyed with soaps
(ducks, chickens)
Epidemic --> antigenic drift. Neuramidase - allows
2) Influenzae B: stomach flu Small mutations. Will re-infect spread through mucous Influenzae B Milder, more GI symptoms
every 2-3 years ssRNA genome in 8 membranes
Orthomyxovirus Pandemic --> antigenic shift. segments: facilitates
first strain known to cross
Only in influenzae A, major rearrangement species barrier from Secondary Bacterial pneumonia In young children
recombinations. Every 10
chicken to human - H5N1
3) Influenzae C - mild URTI years.
Also zoonoses - a new strain Encephalopathy
Limited viremia - very
is formed that can be spread
rarely spread beyond lung Reye Syndrome Linked to ASA
to humans
Enteroviruses
Picornaviridae - One of the
largest families: Includes Damage is direct to viral
enteroviruses (HAV, Naked capsid virus pytopathology NOT Asymptomatic Most common (90%). Limited to oropharynx and GIT.
Coxsackie virus, polio virus, immunopathology
echo virus) and rhinovirus
Page 9 of 12
Coxsackie A --> usually
Herpangina Coxsackie A and echovirus (not Hsv). No external skin lesions --> unlike hand-foot-mouth disease. Self limiting. White lesions inside mouth Enterovirus lab dx: CPEs on monkey KI tissue culture. RT-PCR in CSF/ other fluids.
vesicular lesions
Coxsackie B --> myocarditis,
Hand-foot-mouth disease Caused by Cosdackie A16. Mild febrile disease with vesicular lesions on hands, foot, tongue
pleurodynia
Acute hemorrhagic conjunctivitis Extremely contagious
Can cause permanent
Coxsackie virus Fecal oral spread RNA virus
nerve damage Pleurodynia (Bornholm's disease) "devil's grip" --> severe pleuritis chest pain --> unilateral intercostal myalgia --> "stich-like pain"
60% of infections are Myocarditis/ Pericarditis MC in adult males. Mistaken for MI. Children - sudden unexplained heart failure
subclinical IDDM possible link if Cosxsackie B infects pancreas
Aseptic meningitis # 1 cause is echo virus
MC cause of nonbaverial CNS infection in the US. Causes self-limiting meninigitis lasting 5-14 days or progressing to encephalitis
Paralytic disease, Encephalitis, URTI
with potentially permanent nerve damage and paralysis. Can mimic paralytic polio
Other enteroviruses Gastroenteritis
Rhabdoviruses
zoonoses. MC bite of rabid
dog (also cats, foxes,
raccoons, coyotes, skinks, Long incubation phase: asymptomatic. Delay is important for treatment. Prodrome: retrograde axoplasmic flow and dorstal root ganglia. No
one of the most deadly viral Once there is evidence of infection (symptoms or Abs) it is too late for effective intervention. Post mortem
Rabies virus bats). Body fluids Enveloped RNA virus Infects sensory nerve cells Rabies detectable Abs. ..................Neurologic phase: travel to infect brain/encephalitis. Hydrophobia, aerophobia, hyperactivity, aggressiveness,
diseases - 100% mortality Negri bodies.
"furius rabies" (death in 1 week). "Dumb rabies" - progress to death by cardiac ......Then back down to salivary glands (where is its spread)
Does not penetrate intact
mucosal membranes
Togaviridae
Live attenuated vaccine has Incubation 14-21 days. Prodrome of malaise and lymphadenopathy for 1-5 days. "3 day measles" regional lymphadenopathy (esp sub-occipital
provided immunity for up to 10 Rubella glands). Spread to skin: rash - small erythematous nodules that spread from face to trunk/limbs, gone in 3 days. Rubella disease has
years RNA enveloped virus with similar severity even if immunosuppressed. More severe in adults than children due to more vigorous immunopathology.
Respiratory droplets or
Rubivirus (Rubella) hemagglutinin to aid
across placenta Polyarthritis MC in adult females. Symmetrical polyarthritis of fingers, ankles, wrists and knees
Exterminated from the US in attachment
2005 Increased risk (70% babies infected) if mother infected in 1st trimester (if 4th month just sensorineural deafness). Iff no maternal Abs
Rubella congenital TORCH agent Difficult to diagnose clinically. Highly specific anti-rubella IgMs. NO CULTURE - no characteristic CPE.
teratogenic effects. Classic triad: eyes, ears, heart. Also microencephaly, IDDM. Highly infectious for 1st few months of life.
Alphaviruses -> arboviruses
(arthropod borne), similar Enveloped, linear ssRNA vectors -> mosquitoes Flu-like syndromes Serology: problem: false +, RT-PCR
antigenicity
Reservoirs ->
Mosquito control helps
Flavivirus -> Hep B, Hep C "immunologically naïve" Meningitis/ encephalitis West nile
controlling the virus
birds
Alpha and Flavi Viruses similar pathogenesis and Humans - dead end hosts Hepatitis, hemorrhagic fever, shock, viral arthritis Dengue fever/yellow fever
(Arthropod-borne viruses) epidemiology
Jungle fever, Aedes aegypti mosquito. Not contagious - no person to person spread. 3-6 days incubation, then organ pathology. Jaundice,
Yellow fever has a live Yellow Fever
haemorrhage, encephalitis is rare.- africa and S. america
cause lytic infections in attenuated vaccine puddles, ditches, artificial
vertebrate hosts ponds, toys, trash cans Aedes aegypti mosquito. Primary infection --> bone pain. Enlarged lymph nodes, maculopapular rash, leukopenia. Seen in Middle East,
Dengue (break bone) Fever
Arfrica, Caribeean
Dengue hemorrhagic shock syndrome Hypersensitivity reactions --> weaken, rupture vasculature. No bone pain.
Retroviruses
HIV-1: 70% men. 42% Sexual intercourse
homosecual men. Geveloping (anal/vaginal) - HIV enters Delicate outer envelope - Affinity for CD4+ T cells --> Acute retroviral syndrome: viremia. Mono-like syndrome (heterophile -), mucocutaneous sores. Illness subsides spontaneously. 60%+ become
countries: relative increase and infects Langerhands hard to get! loss of CMI asymptomatic. Mouth ulcers, oral candidiasis, EBV-like.
among heterosexuals. DC's in epithelium or GIT?
gp120 (Ag and receptor
Infects monocytes/
specificity leads to high
Peri-natal - from birth macrophages (Especially Mid stage - ACR (AIDS related complex). Insiduous onset - weight loss. Night sweats, fatigue,opportunistic infections
amount of antigenic drift). Initial screen: indirect ELISA for gp120 or gp41 (2x to confirm). New- Ora Quick Rapid HIV-1 Ab test.
brain)
HIV Virus Changes all the time! HIV Western blot: for gp120 or p24 or p31 proteins (confirmatory). Active viral replication (Recent infection or
Blood: IV drug users, needle AIDS: 1) presence of anti-HIV gp120 abs, 2) decreased CD4+ t cells, 3) wasting syndrome 4) presence of opportunistic infections. Primary late stage) - direct ELIZA for p24, viral load in Rt or in blood via PCR. Culture - difficult, looking for syncitia
HIV-2: mostly west africa stick injuries, blood defence against opportunistic pathodens is progressively diminised. Diseases: hairy oral leukoplakia, oral thrush, kaposi's sarcoma,
transfusions HIV gp41 and gp120 help pneumocystis pneumonia, CMV retinitis
Problem: long, prodromal RNA virus virus enter the cell
asymptomatic period. (envelope glycoproteins)
AIDS related dementia: sub-acute encephalopathy. Slow, progressive deterioration of mental abilities. Can minic alzheimer's disease
Infectious before identifiable
symptoms.
Poxviruses
Eradicated except in lab variola is inhaled (4-19 days asymptomatic and not contagious). Prodrome (2-4 days). Skin rash (most contagious) Think opaque fluid filled
Very large enveloped DNA
Smallpox virus samples since 1979. Vaccine No asymptomatic carriers Smallpox center with "belly button-like depression in center". Infectious until all scabs fall off. Unlike chicken pox, in smallpox all the lesions are at MC clinical only.
virus
no longer given due to risks. the same stage at the same time. 35% mortailty.
Page 10 of 12
Flagellated protozoa
Giardia lamblia
Worldwide sylvatic
ST acid induces changes
(wilderness): Beavers and
to trophozoites
muskrats are local reservoirs
Forms cyst in dueodenim.
contaminated water: resist 1) Asymptomatic carriers- 50%
Trophozoites attach anywhere
Giardia lamblia chlorination (unlike Very rarely spread beyond "beaver fever" - Gastroenteritis 2) Symptomatic: range from mild diarrhea to severe mal-absorption syndromes. 1-4 week incubation and then sudden onset of: DDX: Isospora belli in HIV/ AIDS. Cysts in stool. ELiSA.
along the gut wall. Interferes
Entamoeba but like the GIT foul smelling, watery diarrhea, abdominal cramps, flatulence and steatorrhea
with nutrient absorption
Cryptosporidia)
person to person spread via
fecal-oral or oral- anal no tissue necrosis
practices
Trichomonas vaginalis
MC protozoal disease in
Worldwide STD - can get with
Trichomonas vaginalis Monomorphic- no cyst stage developed nations. Vaginitis 1) Females: M/C’ly asymptomatic or profuse frothy vaginal discharge 2) Males: M/C’ly asymptomatic Microscopic examination of urine. Culture is also possible.
infected towels as well.
Urogenital protozoan
Trypanosomes
1 week after being bitten, trypomastigotes spread to the bloodstream and lymph. Cycle of replication and lysis. Found in the myocardium and
African sleeping sickness (african
Trypanosomes (T. brucei) Transmitted by tsetse flies CNS. Can cause death within 9 months - 2 years. Within 3-14 days, painful, indurated red nodule (trypanosoma chancre) develops and Wet mount on ir in Giemsa stained smears. Anemia, monocytosis and elevated IgM.
trypanosomiases)
remits. Fever, HA, rigors, edema. Chronic dz can progress to meningoencephalitis.
transmitted by triatomine
(reduvid, kissing, or
assassin) bugs
Kissing bug deposits feces on skin while biting and enters through mucous membranes. Parasites invade macrophages, where they transform
"Tom Cruise likes to Shag Reservoirs: dogs, cats, into amastigotes, multiply and are released as trypomastigotes into blood and tissue. Infect nervous system, RE cells, myocardium, and muscle
T. cruzi Chagas disease (american trypanosomiases) Culture of blood or lymph node. PCR.
and Kiss" opossums, rats, other cells. Initially asymptomatic. 1-2 weeks later: fever, hepatomegaly, lymphadenopathy. Chronic: cardiomyopathy, atipcal aneuryisms, heart
mammals failure, Stokes-Adams attacks, thromboembolism, mesaesophagus, or megacolon.
Can be transmitted by
transfusion or
transplacentally
Leishmania
Caused by L. tropica (Asia, Africa) or L. mexicana (Latin America). Papules that itch eventually, over months, ulcerate painlessly then
Hematoflagellated, Oriental sore, chiclero ulcer Intracellular amastigotes and Lieshman-Donovan bodies
Vector: phlebotomine Invade macrophages. Ab ultimately heal (again, over months), leaving pitted scars. Lymphadenopathy accompaines initial manifestation.
L. tropica, L. mexicana, L. unicellular, obligate,
sandflies. Reservoir: wild not protective - result in
braziliensis, L donovani intracellular, zoonotic
mammals glomeruloN
parasite Semi-epidemic disease. Caused by L. donovani. Incubation is 3-12 months. Fever, hepatosplenomegaly, lymphadenopathy, diarrhea,
Visceral leishmaniasis (kala azar)
malabsorption, gray skin discoloration "black disease", anemia, thrombocytopenia, agranulocytosis. Mortality 90% without treatment.
Sporozoa
Plasmodium species
female Anopheles
Scizogony - invasion and Periodic episodes of high fever, shaking chills followed by profuse sweating. Other sx: anemia, hepatomegaly, splenomegaly (Brain/LU/KI
P. falciparum, P. vivax, P. Sickle cell trait confers mosquito feeds on a person
rupture of RBC - cause Malaria damage with P falciparum). Tertian: sx every 48 hours (P. vivax and P. ovale). Quartan: sx every 72 hours (P. malariae). P. Falciparum is MC Giemsa stain. IgM and then IgG antibodies.
ovale, P. malariae resistance with malaria and then feeds
symptoms and most deadly. Black water fever - dark red or black urine.
on an uninfected person
Toxoplasma gondii
•microbe present in heterophile negative mononucleosis like syndrome
cat feces
fecal-oral spread chorioretinitis
1) improperly cooked
Tosoplasma gondii contaminated meat/ meat iff 2nd or 3rd trimester: microencephaly, chorioretinitis +/- blindness, anemia, jaundice, neurological signs (retardation, seizures,
juices microencephaly, hearing loss). Can be asymptomatic at birth and develop disease months to years later. One of the major cause of
congenital disease Microscopy of biopsy sample.
2) contaminated soil encephalitis in AIDS. One of the TORCH agents. Can be asymptomatic.
3) contaminated cat feces
Cryptosporidium parvum
Worldwide zoonotic
three consecutive stool samples:
Cryptosporidium parvum Waterborne- resistant to usual Fecal- oral, person to person Cryptosporidosis Iff immunocompromised (HIV/AIDS) --> Severe diarrhea
Un-concentrated (HIV/ AIDS) or concentrated (centrifuge, etc.). Diagnosis made by O&Px3
water purification (MC) - Oral-anal: MSM (Flagship in
highly resistant to chlorine AIDS)
Babesia microti
Transmitted by ticks Fatigue Prolonged fever and hemolytic anemia
Babesia microti Malaria-like protozoa Lives in RBC
MC in New England islands Arthritis
Roundworms
Ascaris lumbricoides (giant intestinal roundworm)
Ingested infected egg -
develops into larval worm Concentrated stool - knobby coated, bile stained, oval egg
Can grow up to 25cm or
that penetrates duodenal Bowel obstruction/appendicitis Adult worm in feces (20- 35 cm long)
longer
Ascaris lumbricoides wall
Eggs transmitted through
(giant intestinal
inhalation or ingestion Larvae in alveoli are
roundworm) Thousands of eggs produced
coughed up and
daily --> pass out in stool and Pneumonitis Asthma-like attack. Eosinophilia and micratory pulmonary inflitrates seen on plain films help differentiate it from asthma or bronchitis. Worms in stool/ larvae and eosinophils in sputum
reswallowed -->
infect soil
malnutrition/blockage
Enterobius vermicularis (pinworm)
Female lives in cecum but
migrates out of anus at
Enterobius vermicularis Female is 1 cm long, pin
night to lay 20,000 eggs on Perianal itching Periodic nocturnal anal itch (When eggs are laid). No intestinal damage or immune reaction. Spreads easily and rapidly Observation of eggs
(pinworm) shaped, off-white worm.
bedding and peri-anally
every 2 weeks.
Necator americanus, Ancylostoma duodenale (hookworm)
Larvae migrate to lungs.
Necator americanus, Coughed up and
"Naked american hookers skin reaction/ rash at site of entry. If progress to LU --> pneumonitis. Iff large amount of adult worms: microcytic hypochromic anemia, Characteristic eggs in stool
Ancylostoma duodenale Burrow through skin and feet swallowed. Slice intestinal Hookworm clinical disease
working barefoot at night" fatigue, nutritional deficiencies.
(hookworm) wall and feed on blood of
intestinal capillaries.
Trichinella spiralis (trichinosis)
Larvae migrate to striated
Trichinella spiralis Pigs are the major source. if many migrating --> splinter hemorrhages, persistent fever, GI distress, periorbital edema. Iff >1000 to 5000 larvae/ gm tissue - Can be lethal.
muscle but also cardiac T. spirales clinical syndrome encysted larvae in implicated meat
(trichinosis) Undercooked pork. Acute inflammation and myositis.
and nervous tissue
Filariasis
2-5cm long. 2000
bite from infected
Reservoir is humans. Vector microfilariea daily for 15
Ochocerca volvus mosquitoe: migrate to River blindness
- black fly years - burrow in the eye for
lymphatics
2 years.
chronic symptoms are due
Vector: mosquito
Wucheria bancrofti to: physical blockage of Elephantiasis Swelling of legs and genitals due to lymph blockage
(anopheline or Culex)
lymphatic vessels
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Flukes
Schistosoma spp.
develop in intrahepatic
portal system or in vesical,
prostatic, rectal and uterine
Snail as intermediate host plexuses and veins
skin penetrating cercariae Immediate and delayed hypersensitivity reactions. Katayama syndrome. Chronic stage: hepatosplenomegaly with portal HT and
Schistosoma spp. --> burrows through skin to Shitstomiasis Characteristic eggs in stool and urine
liberated from snails hematemesis. retained eggs cause extensive inflammation and scarring. Urinary bladder, bowel, and liver dysfunction.
enter bloodstream
Host response to eggs:
intense, inflammatory
reaction
Tapeworms
Taenia
Form cystericeri are SOL's
Ingestion of undercooked
Taenia: T. saginata, T. (imp in BRAIN) . No
beef (saginatum) or pork Malnutrition, cysticerciasis
solium intestinal damage except
(solium)
absorption problems.
Diphyllobothrium latum
Fish tapeworm
Diphyllobothrium latum From raw, freshwater fish Clinical disease low serum levels of Vitamin B12 --> megaloblastic anemia bile stained, operculated egg with knob-like projection on posterior
one of the longest
tapeworms - 45cm
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