Differential analysis of diseases:

1.Gastroenteritis

Common Causative Bacteria: Campylobacter jejuni, Salmonella spp., Vibrio

cholerae

Clinical Presentation

 Campylobacter jejuni:
o Symptoms: Diarrhea (often bloody), abdominal cramps, fever,
nausea, vomiting
o Complications: Guillain-Barré syndrome, reactive arthritis
 Salmonella spp.:
o Symptoms: Diarrhea (non-bloody), abdominal cramps, fever, nausea,
vomiting
o Complications: Bacteremia, reactive arthritis
 Vibrio cholerae:
o Symptoms: Profuse watery diarrhea ("rice-water" stools),
dehydration, abdominal cramps
o Complications: Severe dehydration leading to shock and death if
untreated

Pathogenesis

 Campylobacter jejuni:
o Mechanisms: Invasion of intestinal epithelial cells, cytotoxin
production
o Infection Site: Small intestine and colon
 Salmonella spp.:
o Mechanisms: Invasion of intestinal epithelial cells, inflammatory
response
o Infection Site: Small and large intestines
 Vibrio cholerae:
o Mechanisms: Cholera toxin production leading to increased cAMP
and secretion of chloride and water into the intestinal lumen
o Infection Site: Small intestine

Diagnosis
  Campylobacter jejuni:
o Tests: Stool culture (Campylobacter agar), PCR
o Additional Tests: Fecal leukocytes
 Salmonella spp.:
o Tests: Stool culture, serotyping, PCR
o Additional Tests: Blood culture in systemic cases
 Vibrio cholerae:
o Tests: Stool culture (TCBS agar), PCR
o Additional Tests: Rapid dipstick test in outbreaks

Treatment

 Campylobacter jejuni:
o Supportive Care: Hydration and electrolyte replacement
o Antibiotics: Azithromycin or fluoroquinolones in severe cases
 Salmonella spp.:
o Supportive Care: Hydration and electrolyte replacement
o Antibiotics: Generally not recommended for uncomplicated cases;
severe cases may use ciprofloxacin or azithromycin
 Vibrio cholerae:
o Supportive Care: Aggressive rehydration with oral rehydration salts
(ORS) or intravenous fluids
o Antibiotics: Doxycycline, azithromycin, or ciprofloxacin to reduce
severity and duration

2.Otitis Media

Common Causative Bacteria: Streptococcus pneumoniae, Haemophilus

influenzae, Moraxella catarrhalis

Clinical Presentation

 Streptococcus pneumoniae:
o Symptoms: Ear pain, fever, irritability, hearing loss, otorrhea in case
of tympanic membrane rupture
o Complications: Mastoiditis, meningitis
 Haemophilus influenzae:
o Symptoms: Similar to S. pneumoniae, often with conjunctivitis
o Complications: Mastoiditis, hearing loss
 Moraxella catarrhalis:
o Symptoms: Ear pain, fever, irritability, hearing loss
 o Complications: Less common but similar to S. pneumoniae

Pathogenesis

 Streptococcus pneumoniae:
o Mechanisms: Capsule to evade phagocytosis, pneumolysin damages
tissues
o Infection Site: Middle ear
 Haemophilus influenzae:
o Mechanisms: Capsule (in type b strains), pili and adhesins for
attachment
o Infection Site: Middle ear
 Moraxella catarrhalis:
o Mechanisms: Biofilm formation, β-lactamase production
o Infection Site: Middle ear

Diagnosis

 Streptococcus pneumoniae:
o Tests: Clinical diagnosis with otoscopy, culture of middle ear fluid (if
performed)
o Additional Tests: Tympanometry
 Haemophilus influenzae:
o Tests: Clinical diagnosis with otoscopy, culture of middle ear fluid (if
performed)
o Additional Tests: Tympanometry
 Moraxella catarrhalis:
o Tests: Clinical diagnosis with otoscopy, culture of middle ear fluid (if
performed)
o Additional Tests: Tympanometry

Treatment

 Streptococcus pneumoniae:
o First-line Antibiotics: Amoxicillin, amoxicillin-clavulanate for
resistant cases
o Additional Care: Analgesics for pain, tympanostomy tubes in
recurrent cases
 Haemophilus influenzae:
o First-line Antibiotics: Amoxicillin-clavulanate, cephalosporins
(cefuroxime)
 oAdditional Care: Analgesics for pain, tympanostomy tubes in
recurrent cases
 Moraxella catarrhalis:
o First-line Antibiotics: Amoxicillin-clavulanate, cephalosporins
o Additional Care: Analgesics for pain, tympanostomy tubes in
recurrent cases

3.Skin and Soft Tissue Infections (SSTIs)

Common Causative Bacteria: Staphylococcus aureus, Streptococcus pyogenes,

Pseudomonas aeruginosa

Clinical Presentation

 Staphylococcus aureus:
o Symptoms: Abscesses, cellulitis, impetigo, furuncles, carbuncles
o Complications: MRSA infections, sepsis
 Streptococcus pyogenes:
o Symptoms: Cellulitis, erysipelas, impetigo, necrotizing fasciitis
o Complications: Streptococcal toxic shock syndrome, post-
streptococcal glomerulonephritis
 Pseudomonas aeruginosa:
o Symptoms: Hot tub folliculitis, ecthyma gangrenosum, wound
infections, cellulitis in immunocompromised patients
o Complications: Sepsis, especially in neutropenic patients

Pathogenesis

 Staphylococcus aureus:
o Mechanisms: Toxin production (e.g., Panton-Valentine leukocidin),
biofilm formation, protein A to evade immune response
o Infection Site: Skin and subcutaneous tissues
 Streptococcus pyogenes:
o Mechanisms: M protein to evade phagocytosis, exotoxins causing
tissue damage, streptolysins
o Infection Site: Skin and subcutaneous tissues
 Pseudomonas aeruginosa:
o Mechanisms: Exotoxin A, elastase, biofilm formation, efflux pumps
o Infection Site: Skin, particularly in moist environments

Diagnosis
  Staphylococcus aureus:
o Tests: Clinical diagnosis, culture of wound or abscess
o Additional Tests: Sensitivity testing for MRSA
 Streptococcus pyogenes:
o Tests: Clinical diagnosis, culture of wound or skin lesion
o Additional Tests: Rapid antigen detection test for streptococcal
pharyngitis (if present)
 Pseudomonas aeruginosa:
o Tests: Clinical diagnosis, culture of wound or skin lesion
o Additional Tests: Sensitivity testing, particularly for multidrug-
resistant strains

Treatment

 Staphylococcus aureus:
o First-line Antibiotics: Dicloxacillin, clindamycin, TMP-SMX for
non-MRSA; vancomycin, linezolid, or daptomycin for MRSA
o Additional Care: Incision and drainage of abscesses
 Streptococcus pyogenes:
o First-line Antibiotics: Penicillin, amoxicillin, clindamycin for severe
infections
o Additional Care: Surgical debridement for necrotizing fasciitis
 Pseudomonas aeruginosa:
o First-line Antibiotics: Piperacillin-tazobactam, ceftazidime,
ciprofloxacin
o Additional Care: Wound care and debridement, especially for severe
or chronic infections

4.Pneumonia:

Clinical Presentation

 Streptococcus pneumoniae:
o Onset: Sudden onset
o Symptoms: High fever, chills, productive cough with rusty sputum,
pleuritic chest pain
o Physical Examination: Consolidation signs (e.g., dullness to
percussion, increased tactile fremitus, bronchial breath sounds)
 Haemophilus influenzae:
o Onset: Gradual onset
 oSymptoms: Fever, cough (productive or non-productive), shortness of
breath, pleuritic chest pain
o Physical Examination: Similar to S. pneumoniae but often less
pronounced
 Mycoplasma pneumoniae:
o Onset: Insidious onset
o Symptoms: Low-grade fever, dry cough, headache, malaise, sore
throat, sometimes ear pain
o Physical Examination: Often unremarkable, sometimes fine crackles
or wheezing

Pathogenesis

 Streptococcus pneumoniae:
o Pathogenic Mechanisms: Capsule prevents phagocytosis,
pneumolysin damages epithelial cells and activates complement, IgA
protease
o Infection Site: Alveoli, causing lobar pneumonia
 Haemophilus influenzae:
o Pathogenic Mechanisms: Capsule (in type b strains), pili and
adhesins for attachment, endotoxin (LPS) causes inflammation
o Infection Site: Typically affects the bronchi and may lead to
bronchopneumonia
 Mycoplasma pneumoniae:
o Pathogenic Mechanisms: Adhesion to respiratory epithelial cells,
production of hydrogen peroxide and superoxide radicals, immune-
mediated damage
o Infection Site: Interstitial space, leading to atypical pneumonia

Diagnosis

 Streptococcus pneumoniae:
o Laboratory Tests: Sputum Gram stain (Gram-positive diplococci),
blood culture, urine antigen test, chest X-ray (lobar consolidation)
o Additional Tests: CBC (leukocytosis with left shift)
 Haemophilus influenzae:
o Laboratory Tests: Sputum Gram stain (Gram-negative coccobacilli),
blood culture, PCR, chest X-ray (bronchopneumonia or lobar
consolidation)
o Additional Tests: Culture on chocolate agar
  Mycoplasma pneumoniae:
o Laboratory Tests: PCR, serology (cold agglutinins, Mycoplasma-
specific antibodies), chest X-ray (diffuse interstitial infiltrates)
o Additional Tests: Lack of findings on Gram stain, as Mycoplasma
lacks a cell wall

Treatment

 Streptococcus pneumoniae:
o First-line Antibiotics: Beta-lactams (penicillin, amoxicillin),
macrolides (azithromycin, clarithromycin), fluoroquinolones
(levofloxacin)
o Resistance Considerations: Penicillin-resistant strains may require
alternative or combination therapy
 Haemophilus influenzae:
o First-line Antibiotics: Amoxicillin-clavulanate, cephalosporins
(ceftriaxone, cefotaxime), macrolides, fluoroquinolones
o Resistance Considerations: Beta-lactamase producing strains require
beta-lactamase inhibitors
 Mycoplasma pneumoniae:
o First-line Antibiotics: Macrolides (azithromycin, clarithromycin),
tetracyclines (doxycycline), fluoroquinolones (levofloxacin,
moxifloxacin)
o Resistance Considerations: Macrolide-resistant strains may
necessitate alternative therapy (e.g., tetracyclines or fluoroquinolones)

5. Urinary Tract Infections (UTIs)

Common Causative Bacteria: Escherichia coli, Staphylococcus saprophyticus,

Proteus mirabilis

Clinical Presentation

 Escherichia coli:
o Symptoms: Dysuria, frequency, urgency, suprapubic pain, hematuria
o Complications: Pyelonephritis, characterized by fever, flank pain,
and chills
 Staphylococcus saprophyticus:
 o Symptoms: Similar to E. coli, but often in sexually active young
women
o Complications: Less common for pyelonephritis compared to E. coli
 Proteus mirabilis:
o Symptoms: Similar to E. coli, can cause strong ammonia-smelling
urine
o Complications: Increased risk of kidney stones due to urease
production leading to alkaline urine

Pathogenesis

 Escherichia coli:
o Mechanisms: Adhesins (fimbriae) allow attachment to urinary
epithelium, hemolysin production
o Infection Site: Urethra, bladder (cystitis), and kidneys
(pyelonephritis)
 Staphylococcus saprophyticus:
o Mechanisms: Adhesion to uroepithelium, urease production
o Infection Site: Urethra and bladder, less common in kidneys
 Proteus mirabilis:
o Mechanisms: Urease production leading to stone formation, motility
aids in ascending infection
o Infection Site: Bladder and kidneys

Diagnosis

 Escherichia coli:
o Tests: Urinalysis (pyuria, bacteriuria, nitrites), urine culture (lactose
fermenting Gram-negative rods)
o Additional Tests: Sensitivity testing for antibiotic resistance
 Staphylococcus saprophyticus:
o Tests: Urinalysis, urine culture (Gram-positive cocci in clusters)
o Additional Tests: Novobiocin resistance test (differentiates from
other Staphylococci)
 Proteus mirabilis:
o Tests: Urinalysis (alkaline pH), urine culture (swarming motility,
urease positive)
o Additional Tests: Imaging if kidney stones are suspected

Treatment
  Escherichia coli:
o First-line Antibiotics: Nitrofurantoin, trimethoprim-
sulfamethoxazole (TMP-SMX), fosfomycin
o Resistance Considerations: Extended-spectrum beta-lactamase
(ESBL) producing strains may require carbapenems
 Staphylococcus saprophyticus:
o First-line Antibiotics: Nitrofurantoin, TMP-SMX
o Resistance Considerations: Generally less resistant compared to E.
coli
 Proteus mirabilis:
o First-line Antibiotics: TMP-SMX, ciprofloxacin, amoxicillin-
clavulanate
o Resistance Considerations: Urease production may lead to different
treatment strategies in cases with kidney stones

6. Meningitis

Common Causative Bacteria: Neisseria meningitidis, Streptococcus pneumoniae,

Haemophilus influenzae type b (Hib)

Clinical Presentation

 Neisseria meningitidis:
o Symptoms: Acute onset of fever, headache, neck stiffness,
photophobia, altered mental status, petechial rash
o Complications: Septicemia, disseminated intravascular coagulation
(DIC)
 Streptococcus pneumoniae:
o Symptoms: Fever, headache, neck stiffness, altered mental status
o Complications: Neurological deficits, hearing loss, seizures
 Haemophilus influenzae type b (Hib):
o Symptoms: Fever, headache, neck stiffness, altered mental status
o Complications: Neurological deficits, hearing loss

Pathogenesis

 Neisseria meningitidis:
o Mechanisms: Capsule to evade phagocytosis, pili for adhesion,
endotoxin release causing severe inflammation
o Infection Site: Nasopharynx to bloodstream to meninges
 Streptococcus pneumoniae:
 oMechanisms: Capsule, pneumolysin, and other virulence factors
facilitating blood-brain barrier penetration
o Infection Site: Respiratory tract to bloodstream to meninges
 Haemophilus influenzae type b (Hib):
o Mechanisms: Capsule, IgA protease, other virulence factors aiding in
invasive disease
o Infection Site: Nasopharynx to bloodstream to meninges

Diagnosis

 Neisseria meningitidis:
o Tests: Lumbar puncture (CSF analysis: elevated white cells, low
glucose, high protein), Gram stain (Gram-negative diplococci),
culture, PCR
o Additional Tests: Blood culture
 Streptococcus pneumoniae:
o Tests: Lumbar puncture (CSF analysis), Gram stain (Gram-positive
diplococci), culture, PCR
o Additional Tests: Blood culture, urine antigen test
 Haemophilus influenzae type b (Hib):
o Tests: Lumbar puncture (CSF analysis), Gram stain (Gram-negative
coccobacilli), culture, PCR
o Additional Tests: Blood culture

Treatment

 Neisseria meningitidis:
o Antibiotics: Empirical treatment with ceftriaxone or cefotaxime;
penicillin G or ampicillin for confirmed cases
o Supportive Care: Fluids, monitoring for complications
o Prophylaxis: Rifampin, ciprofloxacin, or ceftriaxone for close
contacts
 Streptococcus pneumoniae:
o Antibiotics: Empirical treatment with ceftriaxone or cefotaxime;
vancomycin plus ceftriaxone or cefotaxime if penicillin-resistant
o Supportive Care: Fluids, monitoring for complications
o Vaccination: Pneumococcal vaccines for prevention
 Haemophilus influenzae type b (Hib):
o Antibiotics: Empirical treatment with ceftriaxone or cefotaxime
o Supportive Care: Fluids, monitoring for complications
o Vaccination: Hib vaccine for prevention