Gram Positive Cocci

Treatment Characteristics Associated Disease(s) Pathogenesis Treatment

Staphylococcus aureus Gram + cocci in clusters,immotile human
skin and nares,body alls o!! in!ection "a
!ibrinous barrier# S$ aureus causes pus
!ormation$
%n&asi&e' suppurati&e skin in!ections' minor trauma pimples
,carbuncles, impetigo# ma(or osteomyelitis, !asciitis, cellulitis$
hematogenous in!$, nosocomial in!ection$
To)inoses' *ood Poisoning (enteroto)in), e)!oliati&e skin
disease (+itter,s disease o! neborns), TSS
-ulti!actorial# secrete . hemolysins that lyse cells# /hemolysin
lyses cell similar to pore !orm$ by complement, also'coagulase +,
e)!oliatin$ Protein A is a sur!ace molecule that binds %gG to
camou!lage the bacterium$ Also able to respond to en&$ "signal
molecule$
penicillin
&ancomycin
0erythromycin1
(-any strains are multi/
ab) resistant$
and make /lactamase)
Staphylococcus epidermidis Gram + cocci in clusters, human skin
(alays),
2pportunistic in!ections, large number o! nosocomial in!ections'
bacteremia, endocarditis, endophthalmitis, osteomyelitis
(!olloing surgery), in!ections o! indelling !oreign de&ices,
neonatal necroti3ing enterocoloitis$
Coagulase negati&e

Staphylococcus saprophyticus Gram + cocci in clusters, skin"genitourinary
tract
%n!ections outside o! hospital, causes 456 o! all urinary tract
in!ections in young omen$
Coagulase negati&e

Streptococcus pyogenes
(Group A, /hemolytic)
Gram + cocci in chains, catalase neg$, Group
A causes most strep disease, asymptomatic
carriers, causes suppurati&e in!ections$
Suppurati&e' Pharyngitis, Scarlet *e&er, erysipelas, streptococcal
pyoderma (impetigo)$
7on/suppurati&e' Acute +heumatic *e&er, Acute
Glomerulonephritis$
Sur!ace molecules con!er adherence to tissues and resistance to
phagocytosis$
-/protein(pre&ents phag$), Protein * (adherence/!ibronectin), *c
receptor (like Prt$A), C8a peptidase, etc$ Secreted e)oto)ins'
erythrogenic to)in, Streptolysin S, Streptolysin 2, Streptokinase,
D7Ase$
9ery sensiti&e to penicillin$
%! patient is allergic, gi&e
erythromycin$
Streptococcus agalactiae
(Group :, /hemolytic)
Gram + cocci in chains, catalase neg$, loer
G% tract ; !emale genital tract$
Puerperal sepsis (a!ter childbirth) , neonatal meningitis (early
onset "856 mortality or late onset "456 !atality)
Capsular polysaccharide (pre&ent phag$), <emolysin (like
streptolysin S), %gA receptor (camou!lage), *ibronectin binding
protein (adherence)$
penicillin
&ancomycin
chloramphenicol
9iridans Streptococci
(/hemolytic)
Gram + cocci in chains, catalase neg$, oral
ca&ity (up to =56 o! normal oral !lora)
dental caries, subacute bacterial endocarditis (on pre/e)isting
heart &al&e lesions),enter bloodstream &ia decayed teeth or
!olloing oral surgery$

penicillin
>nterococcus !aecalis
(/hemolytic, non/hemolytic)
Gram + cocci, lo pathogenicity, normal
!lora o! human gut, &ery hardy$
subacute bacterial endocarditis, !emale urinary tract in!ections,
peritoneal abscess, bacteremia (!rom abo&e !oci)$
Antibiotic resistance to e&ery knon antibiotic due to con(ugal
trans!er o! antibiotic resistance genes ithin and across species
???
Streptococcus pneumoniae
(@the pneumococcusA)
Gram +, encapsulated, lancet shaped cocci
in pairs, usually community acBuired,
sporadic$
Transmitted by droplet nuclei or aspiration
by carrier$ *acultati&e anaerobes, /
hemolytic$
Pneumonia (Cobar and :ronchopneumonia, most common
cause o! meningitis in adults, most common cause o! otitis
media and sinusitis in children, can cause septicemia, esp$ in
the &ery old or &ery young$ (%mmunity to rein!ection is type/
speci!ic against capsule$)
Capsule con!ers path' inhibits phagocytosis by inhibiting alt$pathay,
must be present !or &irulence$ Capsule also stimulates production o!
type/speci!ic opsonic Ab that results in killing by P-7s$ 7o to)ins
in&ol&ed in path$ D8 di!!erent serotypes$
penicillin
amo)icillin
cephalosporins
&ancomycin
9accine !or people at risk
a&ailable$

Gram Positive Rods
2rganism Characteristics Disease(s) Pathogenesis Treatment
Cisteria monocytogenes







(see <2, lots o! details !or this one)
Gram+, non/encapsulatedrod "a
characteristic @tumblingA motility,
!acultati&e intracellular parasite, gros
under many conditions, !ound nearly
e&eryhere, transmitted through
improperly pasteuri3ed milk"products, oral/
!ecal contamination o! any source (ie/ <45
contamination, &egetable !ertili3ed
"manure, meat, etc)$
Cisteriosis is disease$ +arely causes disease but hen it does is
se&ere esp to !etus, neborn, pregnant omen and the immuno/
compromised$ E5/F56 !atality i! untreated, G5/856 !atality
"treatment depending on status o! host and clinical signs$ Can be
carried in G% tract or !emale genital to lead to disease$ %s able to
enter a ide &ariety o! cells here it can sur&i&e and multiply$
%mmunity to re/in! " sur&i&ors$ Septicemia, meningitis, abscesses,
granulomas, lymphadenitis$ Cead cause o! meningitis in CA"renal tp
patients
>)tracellular product listeriolysin 2 is responsible !or
pathogenicity/ a cytolysin that speci!ically dissol&es the
endosomal membrane so that it e&ades the ma(or anti/ bacterial
acti&ity o! the cell, this ay the org$ can also get into
cytoplasm$ Cell sur!ace &irulence includes %nternalin !or
attachment and in&asion and Act A !or directional actin polym$
o! host cell,s actin$ Actin polym$ allos bacteria to mo&e in
cytoplasm and is reBuired !or cell/cell spread, also makes it
resistant to humoral immunity$
Ampicillin,
penicillin ith an
aminoglycoside,
erythromycin$
Hse only pasteuri3ed milk
products b"c o! this
bacteriumIII
:acillus anthracis Gram +, spore!orming, non motile rod ith
characteristic sBuare cut ends (bo)car),
encapsulated, spores can li&e in the soil !or G5
years, !ound carried in G% tract o! animals,
transmitted by spores or respiratory droplets$
Anthra) (cutaneous or inhalational)$-ostly a disease o!
animals or people ho ork ith animals$Cutaneous enters
thru cut on skin, causes a malignant pustule that is a necrotic
black lesion then rapidly disseminates and causes death &ery
Buickly$ %nhalational is !rom organisms directly to lung that
release e)o/to)in and cause pulmonary necrosis, septicemia,
meningitis and death "in 4.h$
>)oto)in produces pathogenesis$ To)in is a heat labile protein
composed o! G components' protecti&e antigen, lethal or to)ic
!actor and edema !actor$ Polypeptide capsule made e)clusi&ely o!
D/glutamic acid gi&es anti/phagocytic acti&ity but does not
stimulate protecti&e antibody
9accine (but is only 856 e!!)
Penicillin and tetracycline
are e!!ecti&e only hen
gi&en early
:acillus cereus Gram+, motile, non encapsulated, beta
hemolytic, e)ists as a saprophyte in ater and
soil, trans$ in contaminated rice or meat dishes
Sel! limiting type o! !ood poisoning$ %ncubation period and
clinical s)$ resemble staph$ !ood poisoning$ Can also cause
disseminated, usually !atal, disease in immuno compromised
pts$(usually post/operati&ely)$
Secretes enteroto)ins

Corynebacterium diphtheriae Gram +, non spore!orming, non motile, &y$
distinct (beaded, barred or clubbed),
!acultati&e anaerobes, obligate parasite o!
humans, carried in H+T, transmitted by
droplet nuclei or contaminated milk, people
can be carriers$
Diphtheria$ *e&er, chills, pharyngitis, cer&ical lymphadenitis,
massi&e neck edema (se&ere cases) and a thick, closely
adherent dirty gray pharyng$, tonsillar or laryng$
pseudomembrane
Death due to resp$ paralysis or myocarditis$ Cutaneous
diphtheria results in an ulcerati&e lesion "a dirty gray
pseudomembrane$ J"both there can be to)emic degeneration
and death$
K antigen on sur!ace is anti/phagocytic$ >)oto)in is o! 4
polypeptide !ragments' : !ragment is !or transport into cell and A
!rag ment is to)in !or ADP/ribosylation and inacti&ation o!
elongation !actor >*/4 hich inhibits protein synthesis$ Cysogeny
" a beta prophage carrying the to) gene is essential !or
to)igenicity$
9accination pre&ents disease
Acti&e disease' gi&e anti/
to)in immediately, penicillin
or eryth
romycin !or killing bacteria$
@DiphtheroidsA Same habitat, may ha&e same morphological
and biochemical properties as C$diphtheriae
but they do not produce e)oto)in
Can cause septicemia in rare instances in immunosuppressed
indi&iduals ith a high !atality rate$
2!ten ha&e multiple antibiotic resistance, but do not produce
e)oto)in


Gram Positive, Anaerobic, Sporeforming Rods
2rganism Characteristics Disease(s) Pathogenesis

Clostridium botulinum Gram+, anaerobic, spore !orm/ ing,
multiplies in uncooked meat, sausage, !ish
and badly canned items, d)$ by animal
in(ection, cultures sho characteristic @light
bulbA appearance$ Spores do not produce
to)in, only &egetati&e !orm does$
:otulism$ Caused by into)ication "bacteria$ Clinical s)$ LD/G=h
a!ter ingestion, ptosis, mydriasis, blurred &ision, dysphagia,
dysphonia, urinary retention, muscle eakness (descending),
respiratory paralysis$ Death can occur "in LDh$ This results !rom
Ach presynaptic blockade$ %n!ant :otulism results in !loppy
in!ant, may be cause o! S%DS in some cases$
:otulinus to)in causes path$ +eleased by lysis o! bacterial cells in
medium$ To)in has to subunits'</chain causes receptor
mediated endocytosis by host cell, once in cell the < and C/chain
are separated and the C/chain mo&es by retrograde transport to the
presynaptic terminal here it pre&ents !usion o! the synaptic
&esicles "the presynaptic membrane$ All to)ins are destroyed by
boiling at L55C !or L5 minutes$
*ree to)in can be inacti&ated
ith a speci!ic antiserum$
Gi&e a poly&alent antito)in$
Do not gi&e penicillin b"c it
causes cell lysis and more
to)in$
Clostridium tetani Gram+, anaerobic, spore !ormi/ing, !ound
all o&er the place, typical entry through
ounds (puncture ound or laceration, but
also burns, ulcers, cpd !), operati&e
ounds, in(ection sites o! %9DAs, D)$ is
clinical, appear on culture as gram+ rods
"spore !ormation at tip !orming a
@drumstickA
Tetanus$ Caused by into)ication, may take se&eral days to eeks
!or symptoms to occur$ 2nset o! s)$ may be muscular
contractions in the &icinity o! the ound !olloed by spastic
contraction o! the masseter muscle (trismus) resulting in @locked
(aA, generali3ed rigidity and se&ere spasms o! the limbs and
trunk$ Cater signs' risus sardonicus, spasmic contractions o!
back(opisthotonus) and o! the resp$muscles hich may lead to
death$
Secretes tetanus to)in hich is a dimer similar to botulinus to)in
(< and C chain) C chain !unctions as a synaptobre&in on the
sur!ace o! synaptic &esicles that inhibits their !usion ith the
presynaptic membrane$ Tetanus to)in speci!ically blocks the
inhibitory neurons o! spinal motor neurons pre&enting release o!
GA:A and glycine hich results in uninhibited transmission o!
e)citatory impulses and muscular spasms$
%mmuni3ation M 4,.,= mos$
and boosters e&ery 8/L5 y$
Antito)in + immune globu/
lin gi&en to ounded people
"o immun$ immediatelyI
Clostridium per!ringens Gram+, anaerobic, spore !orming, occur
normally in soil and seage, normal in human
G%, bo) shaped organisms ith gram stain,
positi&e blood cultures(!or gas gangrene),
!ound also in !eces !or other in!ections
Gas gangrene$ Destroys tissues esp$ muscle,%n!ects poorly
per!used, in(ured tissues, incubation =/E4h, se&ere edema, bron3e
discoloration, bullous lesions "dark thin !luid, then <4 gas
production leading to crepitations, ischemia, shock and death$
-ost common organism to cause gas gangrene$
Also' Anaerobic cellulitis, uterine in!ection, necroti3ing enteritis,
!ood poisoning (sel! limiting diarrhea)$
Produces e)toto)ins$ -ost important to)in is /to)in hich
clea&es lecithin in host cell membranes and is lethal and
necroti3ing on in(ection$ Per!ringolysin 2 (similar to strep/
tolysin 2, pore comple)es)$ The combined action o! /to)in and
streptolysin 2 may be the cause !or the intra&ascular hemolysis
associated " in!ections$ b/to)in important in necrosis o!
necroti3ing enteritis$ Spores in !ood germinate ; release to)in in
!ood pois$
surgical e)cision o! in!$
skin and muscle, limb amp
utation, hyper/baric 24$
Ab) to ell per!used
tissues, no time to ait !or
culturesI Surg$!or boel in
enteritis$
Clostridium di!icile Gram+, anaerobic, spore !orming, normal
commensal o! human gut, results !rom
superin!ection !olloing antibiotic treatment
Pseudomembranous colitis$ Diarrhea and to)ic megacolon$
>ndoscopy shos multiple small pseudomembranous colon
plaBues$ -ilder !orm is antibiotic associated diarrhea " same
clinical !indings but less se&ere
Produces to heat labile to)ins' A and :$ The to)ins are released
by &egetati&e cells and together cause !luid loss, mucosal damage
and necrosis o! intestinal mucosa$ To)in can be id by >C%SA$
Stop pre&ious ab) t)$
9ancomycin or
metronida3ol to stop in!$
Surg/ery !or megacolon

Gram Negative Coccobacilli
2rganism Characteristics Disease(s) Pathogenesis Treatment
:ordetella pertussis
Gram neg, coccobacillus, non motile, non
spore!orming, piliated, CPS, obligate aerobe,
slo groing, hard to gro, human
respiratory tract, no knon animal or
en&ironment/al reser&oir, transmitted by
respiratory droplets, highly communicable,
mostly children
Pertussis (hooping cough)$ . phases' L$ incubation# 4$ catarrhal
(mild cold/like s)$ , mild cough o! se&erity,most in!ectious phase)
G$ paro)ysmal (se&ere, !orce!ul, spasmodic coughing " @hoopA
!olloing and then &om/iting, complicated by otitis media,
sei3ures, apnea, pneumonia)# .$ con&alescent (less !r$ paro)ysms,
reco&ery)$ L6 death rate, mental retardation and paralysis can
occur$
Attaches (!irmly) to ciliated resp$epithelial cells(using *<A,pili
and peritactin), secretes to)ins to inhibit phago$cells (adenylate
cyclase to)in, pertussis to)in ); inhibit muco/ciliary
de!ense(tracheal to)in), multiplies and causes local damage,
systemic disease results (lymphocytosis, insulin, glycemia) See
<2 !or details o! to)ins$
>rythromycin !or acti&e
disease$
9accination to pre&ent
disease$ 9accine can cause
some se,s but is sa!e and
pre&ents epidemics$
<aemophilus in!luen3ae Gram neg, coccobacillus, non spore, non
motile, encapsulated and nonencapsulated
strains, !astidious, !acultati&e anaerobe,
reBuires hemin and 7AD, !ound in human
respiratory tract, transmitted by respiratory
droplets$
-eningitis, epiglottitis (in kids), not seen o!ten any more b"c o!
&accine, E86 unencapsulated causes otitis media, sinusitis,
bronchopneumonia, 86 encapsulated causes pneumonia,
epiglottitis, bacteremia, meningitis
-ost common !rom Gmos to . yr a!ter maternal ab,s ha&e orn o!!
and T cell response not acti&e$ Complications are se&ere$
Capsule is antiphagocytic ma(or &irulence !actor (P+P polymer,
most adults ha&e anti/ P+P Ab), pili may ha&e a role in
attachment, CPS, outer membrane proteins, %gA protease
(speci!ic role not yet established)
9accination
*or acti&e disease gi&e
cephalospor/ins, ampicillin
+ chloramphenicol$

Gram Negative Cocci
7ame Characteristics Disease(s) Pathogenesis Treatment
7eisseria meningitidis gram/, diplococci, !astidious, habitat is
human mucosal sur!aces, poor
en&ironmental sur&i&al, symptomatic ;
asymp in!$ Spread by respiratory droplets$
Detect by gram st, serum Ag, culture,
clinical d)$
-eningococcal disease' meningitis and"or
septicemia(!e&er,ha,chills, malaise, kness, hemorrhagic skin
lesions"petechiae"purpura, D%C, Thrombocytopenia, leukocytosis,
hypotension, septic shock (CPS/A)$ Can be epidemic, bacteremia
in susceptible people (asplenic pts, children), carrier state in others
Attaches to non/ciliated cells o! the nasopharyngeal mucosa and
undergo T+A7SCNT2S%S to cross the basement membrane$
*eatures' Pilus(attachment), %gAL protease(clea&es %gA),
antiphagocytic capsule, CipidA(septic shock)$
%9 antibiotics, manage
complications, prophyla)is
during epidemics
7eisseria gonorrheae
gram/ diplococci, !astidious, human
mucosa"poor en&iron$ sur&i&al,
sympt"asympt in!$
Spread by se)ual contact or perinatal in!$
Gram st o! e)udate in males can d)$ but !or
sure culture to con!irm !rom any source$
Gonorrhea' Hrethritis (males), cer&icitis (!emales), rectal in!,
pharyngeal in!, ophthalmia neonatorum (mother to in!ant
gonococcal con(uncti&itis)$
Complications' P%D, Disseminated gonococcal in!ection (DG%,
only 5$8/G6 o! in!) leading to arthritis, dermatitis,
tenosyno&itis(Co&er,s heels), !e&er, o!ten mild systemic to)icity$
Attachment' by a pilus that shos Ag &ariation to e!!ecti&ely
e&ade the immune system and by an opacity protein that also has
Ag &ariation, Cipooligosaccharide(C2S) to)ic also shos Ag
&ariation, %gAL protease to e&ade %gA on mucosal sur!aces, PL
porin shos resistance$ %n!lammation is intense, dissemination
can occur but not as prone as in 7$meningitidis
Hncomplicated ce!tria)one
+ do)ycycline$
-any pcnase producing
strains, t) !or chlamydia
too, t) !or se)ual partner,
no &a), use a condom
Gram Negative Rods (Zoonotic)
7ame Characteristics Disease(s) Pathogenesis Treatment
:rucella melitensis
(and suis and abortus)
gram/ nonmotile coccobacilli, aerobic (may
reBuire C24 !or groth), all are pathogenic
in their natural host, pasteuri3/ation kills,
people in close contact "animals are most
likely to be in!ected
:rucellosis' Hndulating !e&ers (daily cycling), night seats,
malaise, chills, eakness, myalgia, <A$ -ay ha&e enlaged spleen
and li&er, &ertebral spondylitis, bacteremia (456) and epididymitis
7eurological s)$ may occur as may endocarditis$ Causes chronic
illness " an acute onset$
>nter through alimentary tract, con(uncti&ae, or skin and are
engul!ed by P-7,s that carry bact to the lymphatics, there they
enter mononuclear cells and multiply "in by inh$ o!
phagolysosomal !usion, cells die, bact are released into blood
and go to reticuloendo/thelial system, cause granulomatous
lesions
Hsusally combo t)
"tetracycline and
streptomycin or ri!ampin#
or co/trimo)a3ole, &acc !or
cattle but not people$
*rancisella tularensis

Pasteurella multocida

Nersinia pestis gram/ bacillus, short non/motile, non/spore
!orming, tends to stain bipolar (@sa!ety
pinA), rats are the primary reser&oir and
trans$ is by the bite o! their !leas, bact
multiply in !lea gut and cause !lea to
regurgitate onto ne)t animal, also can be
spread by people &ia respiratory droplets$
Plague' :ubonic !orm is by bacteria spreading to regional lymph
nodes causing a &ery pain!ul selling (bubo) high !e&er, malaise,
then bacteria spread to li&er, spleen and lungs$ D%C can occur$
Secondary pneumonia leads trans$ by respiratory
droplets$Pneumonic !orm !rom resp drops is &ery conta/gious and
L556 !atal "o t)$ Septicemic plague is caused by bite but no bubo
!orms and pt presents "!e&er and dies o! bacteremia since hard to
d)$ all &ery !atalI
%n !lea gut at loer temps and lo Ca the bact can multiply but
does not secrete to)ins$ %n host M GE and incr Ca, chaperone
prts allo the translocation o! N2PS (&irulence !actors) out o!
the cell$ To cytoto)ins are also secreted into the host cell as
ell as Nop- that binds to human a/thrombin and is thought to
produce the hemorrhagic lesion Killing !leas "insecticide and
Buarantining &ictims is e!!ecti&e !or pre&ention
start asap, !or pneumonic,
gi&e streptomycin,
tetracycline(good
prophylactic) or
chloramphenicol !or
meningitis$ +educes
mortality i! started &y
early, &accine a&ailable$
Nersinia pseudotuberculosis Does not display bipolar staining, more
motile at 44C but not at GEC, reser&oir in
ild and domesticated animals and !ol$
-esenteric adenitis and pseudoappendicitis syndrome, usually a
sporadic in!ection
2n entry the bact bind to integrin receptors on the host cell ith
in&asin proteins on their sur!ace, this allos them to be
phagocytosed$
ampicillin,
chloramphenicol,
tetracycline, or
aminoglycosides
Nersinia enterocolitica Does not display bipolar staining, in
contaminated !ood and ater, mostly milk
and meat
Diarrhea in children' acute sel!/limiting gastroenteritis,
enterocolitis and lymphadenitis
Adults, e)udati&e pharyngitis, +eiter syndrome and erythema
nodosum in pts$ "<CA :/4E marker
same as abo&e tetracycline,
chloramphenicol, co/
trimo)a3ole, and
gentamicin
Gram Negative Rods (Nosocomial)
7ame Characteristics Disease(s) Pathogenesis Treatment
>scherichia coli
(e)traintestinal in!ections)
Gram / rods, !acultati&e anaerobes, !erment
lactose, !ound in human colon, &agina,
urethra$ Transmitted during birth in neonatal
meningitis, tra&els !rom urethra in HT% and
pyelonephritis$
-eningitis o! neborn
Hropathogenic'HT%(cystitis or pyelonephritis) Hntreated
pyelonephritis is a chronic in!ection that can last !or many months$
(Di!!erent strains o! >$coli ha&e acBuired traits that allo them to
be in!ecti&e to these regions)
-eningitis o! neborn' Strains "KL poly/saccharide,!orms a
capsule that is poorly immunogenic(like 7$meningitidis)$-om
" >$coli KL(carrier)con!ers risk to the neborn
Cystitis'<a&e @common piliA that allo binding to D/mannose
on bladder epithelial sur!acesecrete hemolysin,a cytoto)ic prt$
that damages bladder ; causes s)$o! cystitis$
Pyelonephritis':ind to renal epithelium by a Pap pilus'binds to
,L/. digalactoside (only on renal epith), has PapG adhesin only
on tip, (&ery small), also secretes hemolysin$

>scherichia coli
Gram / rods, !acultati&e anaerobes, !erment
%n!ant diarrhea' >nteropathogenic >$coli (>P>C)$ Chronic diarrhea
o! children, can cause dehydration and malnutrition$ 7on/
in!lammatory enteritis " atery diarrhea "o !ecal leukocytes$
Attachment by >P>C' G stages# Lst nonintimate adherence to the
epithelial cell sur!ace by pili$ 4nd is induction o! micro&illi
e!!acement (!lattening out)$ Grd is intimate adherence and host
+ehydration is e!!ecti&e !or
tra&eler,s diarrhea, co/
trimo)a3ole can shorten
(enteric pathogens) lactose, enteroto)igenic >$coli are not
usually part o! the normal !lora o! the
human gut$ >nteroto)igenic strains are
!ound in parts o! the orld " poor
sanitation and can also be in !ood (!ecal/
oral)$
Tra&eler,s diarrhea (dehydrating diarrhea)' >nteroto)igenic >$coli
(>T>C)$ 7on/in!lammatory enteritis (as !or in!ant diarrhea)
<emolytic Hremic Syndrome, blood and non bloody diarrhea'
>nterohemorrhagic >$coli (><>C)$ Diarrhea is dysenteric "!ecal
leukocytes$ <HS is hemolytic anemia, renal !ailure " uremia,
thrombocytopenia and neurological s)$ (>$coli 5L8E'<E)
Dysentery'>nteroin&asi&e >$coli (>%>C), similar to shigellosis,
!ecal leukocytes present$
cell cytoskeletal rearrangement by intimin, a bacterial adhesin
encoded by the eaeA gene$
>$coli 2L8E'<E is probably !rom acBuisition o! the Shiga to)in
gene by >P>C (maybe &ia bacteriophage), trans!orming it into
><>C
duration o! s)$
2nly eat cooked !ood and
boiled ater in certain
countries, prophy/lactic
Pepto :ismol or
do)ycycline may be
pre&enti&e$
Pseudomonas aeruginosa gram/ rod, obligate aerobe,ubiBuitous in
en&ironment, not !ound in G% tract o!
healthy people, an opportunistic in!ection
and a common nosocomial pathogen$
9ery rare in healthy people, causes li!e threat/ening and !atal
in!ections in burn pts, Cystic !ibrosis, and immunocompromised
pts$ Also a common cause o! surgical ound in!ection$ Causes
rapid tissue destruction and"or sepsis, !oci o! in!ection on man
made de&ices (indelling catheters, prosthetic heart &al&es,
prosthetic (oints) is &ery di!!icult to cure$
Antibiotic resistance is &ery common and tends to de&elop
during the course o! therapy, so to antibiotics are alays used$
-ulti!actorial &irulence' secretes a slime that inh$ J:C
acti&ities, secretes hemolysins and proteolysins that damage cells
and tissues, also secretes e)oto)in A (m$a$ is the same as
diphtheria to)in "inhibition o! prt synthesis
Combination antibiotic
chemotherapy
Cegionella pneumophila


(See <2, lots o! in!o !or this one)
gram/ aerobic, tough to stain,
!lagellated,intracellular path, catalase+,
o)idase+, gelatinase+, /lactamase+, lots o!
branched chain !atty acids, transmitted by
aerosoli3ation o! contaminated ater,
reser&oir is aBuatic unicellular organisms,
humans are accid/ental hosts
Cegionnaires, Disease' Pneumonia, o!ten se&ere and !atal#Stage
L'mild illness (!lu like), Stage 4'moderately serious pneumonia,
non remitting !e&er, bradycardia, chest pain, hemoptysis,
c)r'di!!use or lobar in!iltrate, Stage G'Se&ere multilobar
pneumonia, resp !ailure, disorientation, li&er abnormalities,
hyponatremia and hypophosphatemia$
Pontiac *e&er' *ebrile illness "o pneumonia, mild and non/!atal
Cung' al&eoli !illed "pmn,s, -, ; !ibrin, many intra and
e)tra cellular bacteria in - (inside &acuoles) and pmn,s$
-ultiplies intra cellularly in al&eolar - and monocytes until
host cell destroyed, enters by @coiling phagocytosisA mediated
by complement rec$ on phagocyte and CG component on bact
called -a(or 2uter -embrane Protein, inh !usion o! phagosome
"host cell lysosomes, inhibits acidi!ication o! phagosome$needs
*e
>rythromycin (or neer
analogs), and ri!ampin,
only bacteriostatic <ost
immune system must kill
maybe by cytoto)ic T
cells?

Gram Negative Rods (Enteric)
2rganism Characteristics Associated Disease(s) Pathogenesis Treatment
9ibrio cholerae gram/,cur&ed rod, single polar
!lagellum(motile), endemic, epidemic,
pandemic, trans in contaminated !ood"<45
(!ecal/oral trans),li&es in brackish
ater"shell!ish, human is transitory habitat$
Cholera' %n!$ is asymptomatic to acute in nature, can be spread by
asymp people, early signs' &omiting, cramps, then P+2*HS>
secretory diarrhea (rice ater stools), massi&e !luid loss o! L5C"day
leads to dehydration, electrolyte de!iciency and hypo&olemic
shock$ J"o t)$ =56 !at$, "t)$ only L6 !at$
+aising p< o! stomach encourages in!ection$
L)coloni3ation' ingestion, gastric acid barrier, attachment to
sm$boel (micro&illi)
4) cholera to)in' ADP ribosylates G prt$ to @turn onA adenylate
cyclase, loss o! salt and <45 by di!!usion into lumen, loss o!
bicarb can lead to acidosis$
+eplace !luids ;
electrolytes po or i&,
tetracycline duration,
&accine under de&$ T)$ is
&ery e!!ecti&e ; easy to
gi&e$
9ibrio parahaemolyticus <alophilic (salt lo&ing), marine habitat
(coastal aters)
*ood poisoning' undercooked sea!ood, causes secretory diarrhea

9ibrio &ulni!icus Seaater Septicemia in compromised host, cellulitis in healthy host

Campylobacter (e(uni gram/,cur&ed,spiral or comma shaped rods,
motile, micro/aerophilic, orldide
3oonosis in G% tract o! dom$ animals, trans
by cont !ood"ater, common, est 4-cases"yr
in HS
Common cause o! diarrhea$
Acute enteritis' diarrhea, malaise, !e&er, abd$ pain$ +ange o!
diarrhea !rom loose to atery to bloody$ Hsusally sel! limiting,
bacteremia rare, d)$ by stool culture$
Pathogenic mechanisms uncertain *luid and electro/lyte
replacement, antibiotics
may be indicated(bloody
stool), usually no t) is
necessary$
Campylobacter !etus !airly rare Systemic disease in immunocompromised host

<elicobacter pylori gram/,spiral rods, motile, produce urease,
habitate the gastric epithelium
Gastritis"ulcers' thought to be cause o! much gastritis and predisp
to stomach CA, ab)$ t)$ against clears up ulcers and gastritis$
9irulence' motility, urease, cytoto)in, e)act cause o!
in!lammation is unknon, in!ection remains !or li!e i! not
treated$
triple t)' pepto,
metronida3ole,
amo)icillin$
Salmonella enterica
(serotypes re!erred to as i! they are
species)
Gram/ rods, motile, !acultati&e intracellular,
usually aBuired by contaminated !ood or
animals esp$ poultry meat or eggs, in!ections
are typically animal associated, !ecal oral
transmission as ell$
Acute enterocolitis' -ost common disease syndrome o!
salmonella, !ollos =/D hr incub/ation, most pts$ ha&e nausea,
&omiting, diarrhea$ *e&er and abd cramping also common, in!
in&ol&es small boel and colon (di!!erent site !rom shigella), *ecal
P-7,s are present, d)$ by stool culture !or enteric pathogens, death
is rare$ %n!ections can spread beyond intestinal mucosa to produce
bacter/emia and seed distant tissues that can result in later !ocal
in!ections (osteomyelitis in sickle cell pts$ occurs " increased
!reBuency)
%n&ades epithelial cells by contact " micro/&illi o! host, then
bact cell assembles in&asomes (in&asion organelles) hich
triggers host cell memb$ ru!!ling, the bact then shed their
in&asomes !olloed by host cell uptake$ Salmonella can turn on
and o!! genes according to i! they are in a host cell or not, PhoO
is a sensor molecule (e)' lo p< inside a phagolysosome) that
regulates genes !or transcriptional regulation and turns o!! other
genes$ Pag C is essential !or resistance to killing by
macrophages$
Antibiotics not
recommended !or
uncomplicated
enterocolitis, ce!tria)one
!or sepsis$ Pre&ent "
public health measures (ie
restaurant sa!ety) no
&accine a&ailable
Salmonella typhi Gram / rods, motile, !acultati&e intracellular,
in!ects only man, get !rom people ho are
chronic carriers and e)creters (Typhoid
-ary) a condition that occurs in L/G6 o!
untreated cases$ *ecal oral transmission
Typhoid !e&er (enteric !e&er)' %ncubation L/G eeks, gradual onset
o! !e&er, abd pain and hepatosplenomegaly, duration usually .
eeks "o t)$ D)$ by culture o! blood, bone marro and stool$
bone marro gi&es the highest yield o! organisms b"c it is a
systemic in!ection o! mononuclear phagocytes$ Death may occur
despite use o! antibiotics b"c o! the !atal comp/lication o! intestinal
per!oration and peritonitis
S$ typhi !irst in&ades small boel epithelial cells or - cells in
Peyer,s patches trans/cytosis across epithelial
cellsendocytosis by lamina propria -$ :act sur&i&e in
@spacious phagosomesA and reach systemic circulation &ia
thoracic duct reticuloendo/thelial system (phagocytes in li&er,
spleen and bone marro)$ Gall bladder in! leads to the chronic
carrier state$ %n! dose is large$
Ce!tria)one (Lst ),
ampicillin or co/
trimo)a3ole i! not se&ere$
Pre&ent by public health
measures$ Killed and li&e
/attenuated &accine
a&ailable$
Shigella
(dysenteriae, !le)neri, boydii or sonnei)
Gram/ rods, not normal !lora, !acultati&e
intracellular,motile e)clusi&e to primates, &y
!e needed to in!ect, e&ade host de! like
gastric acid, !ecal/oral transmission' The
*our *,s'
!ood, !ingers, !eces, !lies$ 2nly person to
person$
Shigellosis' suspect in any diarrhea lasting P .D hours$ Abd cramps,
may ha&e !e&er$ Stools ha&e P-7,s, blood, mucous$ Lk is a&g$
time$ D)$ by stool culture, produce disease at &ery lo inoculation$
%ntracellular, Lst in&ades - cells o! gut lymphoid !ollicles, kill
resident macrophages in&ade intestinal epith cells on basolateral
sur!ace, then spread cell/cell$ Hse host cell,s actin to rocket !rom
cell/cell (like Cisteria), e)press %csA protein$ %n&asion plasmid is
essential !or pathogenicity$ Secrete shiga to)in, causes
endothelial damage$ >)pression o! proteins is temp$ controlled$



bligate !ntracell"lar Parasites
7ame Characteristics Disease(s) Pathogenesis Treatment
Chlamydia trachomatis only gros in eukaryotic cells,
de&elopmental cycle ith to groth !orms,
spread by se)ual contact, peripartum or
close personal contact
Genitourinary tract in!ection'cer&icitis, non gonococcal urethritis,
P%D, neonatal ophthalm/orrhea and pneumonia, lymphogranuloma
&enereum, Trachoma (ocular in!), chronic seBuelae' tubal
in!ertility, ectopic preg/nancy, blindness$
(D)' serology, culture, PC+, direct hybridi3ation, CC+ " urine) Tetracycline or
do)ycycline,
erythromycin,
a3ithromycin, atypical
pneum/onia d"d)
Chlamydia psittaci only gros in eukaryotic cells,
de&elopmental cycle ith to groth !orms,
aerosol spread, 3oonosis (in certain birds)
Psittacosis' !e&er, respiratory symptoms, systemic in!ection

Tetracycline
+ickettsia rickettsii obligate intracellular o! &ascular
endothelium, trans by tick bite, southeast
and south central HS
+ocky -ountain Spotted *e&er' A!!ects &ascular endothelium
(&asculitis), multi/system presentation "!e&er, myalgias, <A, rash
on palms"soles G/8 days post !e&er, serious compl' gangrene, renal
!ailure, neurological in&ol&ement, D%C in &ery se&ere cases$
(D)$ by serology, isolation, direct immuno!luorescence) Chloramphenicol,
tetracyline, ri!ampin,
cipro!lo)acin
+ickettsia proa3ekii obligate intracellular o! &ascular
endothelium, trans by human louse (close
personal contact), unsanitary cond, military
campaigns
>pidemic Typhus' &asculitis leading to intense <A, chills,!e&er,
myalgia ("o eshcar), rash begins in a)illary !olds and the upper
trunk$
(D)$ by serology, clinical h))
Chloramphenicol ;
tetracycline$
Control human body louse
and sanitation
+ickettsia typhi obligate intracellular o! &ascular
endothelium, trans by the rat !lea, in urban
and suburban dep on rodent e)pos$
>ndemic Typhus' <A, myalgia and !e&er, a rash occurs in =5/D56
o! cases and is central in distribution

same as other typhus
+ickettsia tsutsugamushi obligate intracellular o! &ascular
endothelium, trans by chiggers (lar&al
mites), humans are accidental hosts (usually
rodents)
Scrub Typhus' :ite site ulcerates and !orms a black crust called an
eschar, regional lymphadenopathy ne)t ./8 days, !e&er, <A and
myalgia, rash occurs on the trunk and spreads to e)tremities, may
be C7S symptoms

same as other typhus
Co)iella burnetii obligate intracellular pathogen, in
urine,!eces, milk and birth products o! cattle,
sheep and goats, trans by inhalation o!
contaminated aerosols
O !e&er' Typically an acute sel!/limiting !ebrile
illness'<A,!e&er,chills,!atigue,myalgia# rash almost ne&er occurs,
may cause atypical or rapidly progressi&e pneumonia$ @ChronicA
in! can result in endocarditis or hepatitis " a @donut granulomaA o!
a !ibrin ring around a central lipid &acuole$
Tetracycline
D)$ by serology and
history


#$coplasma (%all&less Cells)
7ame Characteristics Disease(s) Pathogenesis Treatment
-ycoplasma pneumoniae no cell all, reBuire sterols !or groth,
many commensal mucosal species, L5/456
o! pneumonias, 856 o! summer
pneumonias, school children and young
adults$
Atypical pneumonia' a prolonged @!luA or bronchitis, c)r shos
loer lobe bronchial pneumonia, P-7,s# malaise, cough may
persist !or 4/= eeks, tracheobronchitis is most common
complication$
(D)$ by culture, serology ith rising titers, complement !i)ation
is the gold standard serology)
>rythromycin or
tetracycline
resistant to penicillin b"c
lacks cell all
Hreaplasma urealyticum no cell all, reBuire sterols !or groth, able
to metabolise urea (ha&e urease), genital
mycoplasm
7ongonococcal urethritis' can progress to prostatitis"epididymitis,
or postpartum !e&er"abortion"chorioamnionitis(?)

Tetracycline (L56 resist)
or erythromycin
-ycoplasma hominis same as abo&e, coloni3ation rates 5/GL6 Pyelonephritis, P%D, salpingitis, postabortal" postpartum !e&er, may
contribute to nongonococcal urethritis

Tetracycline

Spiroc'etes ((le)ible, t'in *alled cells)
7ame Characteristics Disease(s) Pathogenesis Treatment
:orrelia burgdor!eri highly motile(by endo/!lagella in
periplasmic space), cork/scre shaped
(spirochete), must use dark!ield microscope,
does not ha&e CPS$ Jorldide, spread by
bite o! %)odes tick,it inters in the !ur o!
deer and !eeds on the hite/!ooted mouse,
in! in mouse skin is ma(or reser&oir o! bact$
-ost common in mid est and northeast
HS$
Cyme disease' Chronic in!ection, disseminates to many organs$
>rythema migrans (>-) is most distincti&e !eature (=56)$ >arly
disease shos locali3ed >-, disseminated lympho/cytoma
(selling ear or nipple), arthritis attacks, migratory
musculoskeletal and (oint pain, chronic meningitis, heart problems,
se&ere malaise and !atigue$ Chronic disease on skin shos ACA$
-usculoskeletal recurrent oligoarthritis or chronic arthritis, chronic
parenchymal brain in!$ Chronicity de!ined by PLyr o! (oint
in!ection$ Assoc "<CA/D+/.$
<allmarks o! Cyme disease are dissemin/ation and persistence o!
bacteria, dissem/ination is mediated by the spirochete,s ability to
in&ade endothelial intercellular (unctions, relati&e lo amounts
o! outer membrane spanning proteins is possibly a !actor in
ability o! bacteria to cause chronic disease$
Therapies are being
de&eloped
:orrelia hermsii (as abo&e !or spirochetes), predominantly
!ound the estern HS, most o!ten at
ele&ations abo&e 8555 !t$
+elapsing !e&er (alternating periods o! !e&er and illness alternate
ith periods o! ellness)
an uncommon in!ection
<as the capacity to undergo antigenic &ariation o! 9ariable
-a(or Protein (9-P), periods o! illness and ellness alternate
as bact goes through antigenic repertoire
D)$ by blood smear and
serology
Ceptospira interrogans (as abo&e !or spirochetes) rare in HS, o!ten
in de&eloping nations
Acute !ebrile illness, sometimes !atal systemic illness marked by
hepatic in&o&ement in !atal cases$
Contains a lipopolysaccharide like material (CCS) in the outer
membrane

Treponema pallidum
(this one has a lot too)
spirochete characteristics, stains ell ith
Sil&er stain$ obligate parasite o! humans,
does not appear in nature or in animals$ Can
be se)ually trans/mitted or congenital, trans$
is greatest during L or 4 stage, e)ogenous
routes, endogenous acti&ation o! latent
disease may also occur
Syphilis' L' appearance o! painless, indurated, ell circumscribed
ulcer (chancre) and regional lymphadenopathy (disease is
communicable at this stage), lesions heal$
4' bact in circulation (septicemia) go to lymph nodes and
tissues'!e&er, <A, lymphaden/opathy, generali3ed rash
(palms"soles), mucous patches in oral ca&ity, condylomata
(commun/icable lesions), alopecia$ Also hepatoslpen/omegaly,
nephritis, periostitis$ Catency' 4 stage may occur again$ A%DS pts
ha&e higher rate o! recur, rapidly progr C7S in&ol&ement$
G (or late stage)' anyhere !rom months to P85 years$
neurosyphilis !rom treponemes in C7S, C9 (aneurysm, aortic
endocarditis), benign gummas$
>nter through abraded skin or mucous membranes, attach by
their tips to host cells and coloni3e, "in hours organisms go to
lymph nodes, then disseminate to li&er, spleen ; bone marro
&ia circulation, bact e)it through tight (unctions o! endothelial
cells sets up chronic in!lammatory response$
0Congenital syphilis' Thru placenta LDth eek, damage depends
on stage o! disease in mom"Q o! treponemes$ Hsusally
miscarriage or stillbirth$ LS)$ can present up to age 4$ -ucous
membrane lesions, osteochondritis, anemia, organomegaly, C7S
disease$ Cate s)' keratitis, Dth ner&e dea!$, abn 4nd tooth d&lp
(raspberry molars), abn long bones (sabre shins), per! nasal
septum, gummas$1
D)' <)$ o! pt, can mimic
other diseases$ Dark/!ield
microscopy$
9D+C or +P+ serology
tests, G56 may sho !alse
neg, !alse + "autoimmune
diseases (SC>)$
T)' penicillin or
do)ycycline, tetracycline,
erythromycin$ >ducate,
cond/oms, screening$

#$cobacteria (Acid fast, aerobic rods, fac"ltative intracell"lar)
7ame Characteristics Disease(s) Pathogenesis Treatment
-ycobacterium tuberculosis
(see <2 !or sure, this one has a lot o!
detailI)
*acultati&e,intracellular, obligate aerobe,
slightly bent rods, slo groing, !our
uniBue sur!ace layers,trans$ by respiratory
droplets, acid/!ast (red) bacilli, dry
cauli!loer like colonies
Positi&e PPD' documents in!ection but not
state o! T:
7egati&e T:' doesn,t say much pt$ may be
anergic (A%DS), ha&e to re/test i! still
suspected
Tuberculosis' LT:' e)udati&e response, bacteria are phagocyti3ed
by P-7,s but remain inside the cytoplasm, !olloed by !orm/ation
o! a producti&e lesion "granuloma and tubercule resulting(caseous
necrosis)$ Ghon comple) is hilar lymph node granuloma, caseous
lesions can heal "!ibrosis$ <umoral immunity makes dormant but
doesn,t elim$bact
+eacti&ation T:' !rom caseous lesion can be/come acti&e,
liBue!action, spread through lung, !e&er,cough, malaise, t$loss,
night seats
-iliary T: hen bacteria disseminates (A%DS)
Chronic asymptomatic in!ections' bact$ enter and multiply inside
macrophages and ne&er escape$ Hnknon cues cause
multiplication o! bacteria and release !rom macrophages$
Sur&i&al' resistance to o)idati&e killing, inhibition o!
phagosome/lysosome !usion, resistance to lysosomal en3ymes$
A%DS is a common cause o! reacti&ation by mechanisms
unknon$
Also' stress, o&ercroding, age, silicosis
:est treatment is pre&ention$
>)act pathogenesis unknon$
. drug regimen'
%7<, ri!ampin,
pyra3inamide, ethambutol
(last 4 !or only Lst G mo)
gi&e !or Fmos, L4 mos in
A%DS pts
Combination t)$ b"c o!
-D+$
Check "c)r and
sputum culture$
-ycobacterium bo&is same characteristics as -$T:, caused by
in!ected dairy products, eradicated by
pasteuri3ation
Tuberculosis in cattle$ %n man enters through G%, in!ects lymph
nodes (scro!ula), can also in!ect &ertebrae and (oints, collapse o!
&ertebrae (Pott,s disease)
Disease is pretty much eradicated in the HS due to
pasteuri3ation$
source o! :CG &accine, no
longer used, only E56
e!!ecti&e
-ycobacterium leprae Acid/!ast rods, aerobic, !acultati&e
intracellular,cannot be cultured in &itro, &ery
slo groing, optimal groth at less than
body temperature, carried on armadillos
(lo body temp), also trans by
nasopharyngeal secretions or contact o! skin
ounds "bacilli in the soil$ 9ery long
Tuberculoid leprosy' Annular lesions in e)tremities (cooler) " red,
raised border$ +ed area has most bact$ Cesioned areas ha&e
sensiti&ity$ Destructi&e lesions$Damage to !ingers can occur b"c o!
sensation$ C-% is e!!ecti&e at stemming spread o! bacteria$
Cepromatous leprosy'-ore contagious$ C-% lost or alloing
spread o! bacteria$S)'di!!use thickening o! skin' eyebro alopecia,
enlarged earlobes, broadening o! nose, selling o! !ingers,
-$ leprae is an intracellular pathogen$ The clinical s)$ correlate
ith the immune response to the pathogen$ Tuberculoid pts ha&e
good C-%, lepromatous pts ha&e decr C-% and their disease is
disseminated$ C-% is assessed by skin testing' *ernande3 r)n,
-itsuda r)n'characteri3ed by presence o! granulomas, org$
lymphocytes and macro/phages (competent C-%), + in
tuberculoid pts"neg$ in lepromatous pts$ %n re&ersal r)n -itsuda
Dapsone + ri!ampin !or the
tuberculoid !orm$
Clo!a3imine is added !or
lepro/matous !orm or i!
organism is resistant to
dapsone$ T)$ is !or at least
4 yr$ Gi&e dapsone !or
incubation o! L/45 years, hard to contract$
-ust ha&e prolonged contact$ *ound in
human skin and ner&es$
hypopigmentation$
+e&ersal +eaction(lepromatoustuberculoid)
>rythema 7odosum Ceprosum (systemic)
Cucio,s reaction(hemorrhagic in!arcts)
goes !rom neg to + (DT<)$ Pts " <CA/D+ 4,G tend to get
tuberculoid !orm, <CA/DO L assoc " lepromatous !orm$
close !amily contacts,
&accine being researched$