Resumen Micro y Parasito

GENERAL FEAUTURES OF MEDICALLY IMPORTANT BACTERIA
OXYGEN
MICROSCOPIC GROWTH
BACTERIA GRAM-STAINING
MORPHOLOGY
MOTILITY HABITAT REQUIREMENT
REQUIREMENTS
CULTURE MEDIA
S
Staphylococcus Normal flora of skin / Facultative ENRICHED: Blood/broth
aureus anterior nares / vagina anaerobe SELECTIVE: Mannitol-salt Agar (10% NaCl)
Staphylococcus Cocci Normal flora of skin /
Non-motile
epidermidis POSITIVE (grape-like clusters) anterior nares
Staphylococcus (darkly stained) ENRICHED MEDIA:
Normal vaginal flora
saprophyticus Blood Agar
Listeria Short rods (diplobacilli Motile Soil / Stream-water /
monocytogenes or short chains) (TUMBLING) Sewage / Food
POSITIVE Small pleomorphic Non-motile Lffler's Medium (diptheroids)
Corynebacterium Skin / Nasopharynx
club-shaped rods Tinsdale Agar (SELECTIVE): Potassium tellurite
diphtheriae (patients / carriers)
Chinese letters inhibitor of other respiratory flora
Genital tract ()
Streptococcus Oval / spherical
Urethral mucosa ()
agalactiae (GBS) (pairs / chains)
GIT (rectum)
Streptococcus Lancet-shaped in
Nasopharynx
pneumoniae pairs (Pneumococci)
Blood Agar
S. mitis / S. mutans
Oval / spherical
/ S. salivarius Normal oral flora
(chains)
(Viridans group)
Streptococcus Oval / spherical
Skin / Nasopharynx
pyogenes (GAS) (pairs / chains)
Enterococcus Round-to-ovoid Normal fecal flora SELECTIVE: Bile Esculin Agar (6.5% NaCl)
faecalis / faecium (pairs / chains)
(Streptococcus D)
Lactobacillus sp. Rod shaped Normal vaginal flora de Man, Rogosa and Sharpe (MRS) Agar
Bacillus Soil / infected animal

Aerobe Blood Agar
anthracis products (spores)
Clostridium Normal flora of

perfringens vagina / GIT
Bacilli (blunt-ended) Normal flora of large
Clostridium difficile + Endospores intestine (minor) Blood Agar
Clostridium Soil sediments / (ANAEROBICALLY)

Motile STRICT
botulinum Vegetables (spores) anaerobe
Clostridium tetani Soil (spores)
Filamentous Non-motile
Actinomyces Normal human Blood Agar
(branched) rods +
israelii oral / intestinal flora (Slow growing: 10-14 days for visible colonies)
Yellow sulfur granules
POSITIVE
Nocardia Filamentous Oral microflora found in Easily growing on most commonly used media
(Weakly stained)
asteroides (branched) rods healthy gingiva (3-5 days)
Acid-fast
NEGATIVE
Brucella Animal pathogen survive
Aerobe Blood Agar
species Small coccobacilli within host macrophages
Bordetella (singles or pairs) Ciliated epithelia of upper Regan-Lowe Agar

pertussis respiratory tract (SELECTIVE)
Small coccobacilli Normal resident of upper Facultative
Haemophilus Hemin (Factor X) NAD+
or long filaments respiratory tract anaerobe Chocolate Agar
influenzae (Factor V)
(pleomorphic) (Opportunistic)
Pasteurella Coccobacilli Normal respiratory Blood Agar
multocida (bipolar stained) microbiota in animals
Normal flora of human / MacConkey Agar /
Escherichia coli Small rods
animal colons Eosin Methylene Blue (EMB) Agar
Widely distributed in Minimal requirements (can
Pseudomonas Blood/MacConkey
Rod-shaped nature (soil / water / even grow in distilled
aeruginosa Agar
plants / animals) water)
Salmonella Typhi: Human feces /
enterica subsp. Short flagellated rods Typhimurium: Human or MacConkey / Salmonella-Shigella Agar
enterica animal feces
Curved / Spiral / Rods
Campylobacter Normal flora in cattle / Skirrow's Agar (SELECTIVE)
sea-gulls shaped +
jejuni swine / birds (optimum growth at 42 oC)
Fecal leukocytes Microaerophilic
Helicobacter Human stomach SELECTIVE with antibiotics to inhibit growth of
Helical / Spiral / Rods Motile
pylori (non-invasive) fecal flora / Slow growing (5-7 days) at 37 oC
Facultative
Capnocytophaga Long thin Normal flora of Capnophilic require Blood/MacConkey
anaerobe
species Fusiform rods oral cavity CO2 (5-10%) Agar
Vibrio
Non-halophilic
cholerae
Thiosulfate-citrate-
Aquatic
Vibrio Comma-shaped bile salts-sucrose
parahaemolyticus Environments Halophilic
(TCBS)
(7-10% NaCl)
Vibrio vulnificus
Proteus species Pleomorphic bacilli Human / animal stool Nutrient / MacConkey Agar
Klebsiella Non-motile Normal flora of mouth /

Large rods MacConkey Agar
pneumoniae skin / intestines
Short ovoid rods Endemic in mammals Blood / MacConkey Agar
Yersinia pestis
(bipolar stained) (rats / rodents) CIN Agar (SELECTIVE)
Shigella species Rod-shaped Human stool MacConkey / Salmonella-Shigella / Hektoen Agar
Slender rods / cocco- Normal flora of oral cavity
Bacteroids Blood Agar
bacilli (in mixed flora) / female genital tract / Anaerobe
fragilis (ANAEROBICALLY)
+ Debris + PMNL lower GIT
Kidney bean-shaped
Neisseria Human Thayer-Martin Agar
diplococci within
gonorrhoeae genital tract (SELECTIVE)
neutrophils
CO2 (5%)
Blood / Chocolate
Neisseria Kidney bean-shaped
Nasopharyngeal mucosa Agar Require no
meningitidis diplococci + PMNL
Hemin/NAD
Moraxella Common commensal of Aerobe
Diplococci Fastidious Chocolate Agar
catarrhalis upper respiratory tract
Francisella RARELY
Small coccobacilli Animal pathogen Cysteine
tularensis CULTURED
Intracellular parasite Buffered Charcoal
Legionella NEGATIVE L-cysteine / Fe / Alpha-
Coccobacilli Motile of amoeba in water Yeast Extract
pneumophila (faintly stained) ketoglutarate
distribution systems (SPECIALIZED)
Borrelia Mice / small rodents
Difficult and time-consuming to culture
burgdorferi (reservoir)
Leptospira Long / Spiral / Rods Highly Motile Wild / domestic animals

Fletcher Serum Medium (SPECIALIZED)
interrogans (corkscrew-shaped) (SPIROCHETES) (reservoir)
Treponema NEGATIVE Human genitals

pallidum (poorly stained) (skin and mucosa)
Rickettsia
rickettsii Obligate intra-
Small coccobacilli Non-motile UNCULTURABLE in vitro
cellular parasite
Coxiella burnetii
Chlamydia Obligate intracellular parasites

Not Routinely Stained Small round-to-ovoid
species (cytoplasmic inclusion bodies)
Mycobacterium Alveolar macrophages Lowenstein-Jensen Agar (SELECTIVE)
tuberculosis (lungs) (require 6 - 8 weeks to grow)
Non-stainable STRICT
Long / Slender / Rods Non-motile
(Acid-fast) Aerobe
Mycobacterium Skin nodules of patients
UNCULTURABLE in vitro
leprae with leprosy
Mycoplasma Normal flora of human RARELY CULTURED

pneumoniae Non-stainable Pleomorphic mouth / urinogenital tract (Difficult and expensive)
(No peptidoglycan cell (Neither rods
CULTURABLE
Ureaplasma walls) nor cocci)
Normal genital flora Urea (forming tiny
urealyticum
colonies)
Gardnerella Coccobacilli + Vaginal Female vagina in small Facultative
Variable Non-motile Blood / starch Agar (ENRICHED)
vaginalis epithelial clue cells numbers anaerobe
LABORATORY IDENTIFICATION OF MEDICALLY IMPORTANT BACTERIA
COAGULAS CARBOHYDRATE
TEST COLONIES CATALASE
E
OXIDASE
FERMENTATION
SEROLOGY / IMMUNOLOGY OTHER
Large grayish
Bacillus non-hemolytic
Direct immunofluorescence
anthracis irregular borders
(Blood agar)
Black surrounded NEGATIVE
Corynebacterium Precipitation reaction
by a brown halo
diphtheriae for toxin production
(Tinsdale agar)
Narrow zone CAMP-positive
Listeria
of -hemolysis POSITIVE Tumbling motility
monocytogenes
(Blood agar) (wet mount)
Deep-yellow
Staphylococcus
Hemolytic POSITIVE MANNITOL
aureus
(Blood agar) Novobiocin-sensitive
Staphylococcus
White
epidermidis
Non-hemolytic NEGATIVE MANNITOL
Staphylococcus
(Blood agar) Novobiocin-resistant
saprophyticus
-hemolytic NEGATIVE CAMP-positive
Streptococcus
(Blood agar) Hippurate-positive
agalactiae (GBS)
Bacitracin-resistant
Streptococcus ASO test CAMP-negative
pyogenes (GAS) (Streptolysin-O Abs titer) Hippurate-negative
Bacitracin-sensitive
Positive quelling reaction
Streptococcus
Optochin-sensitive
pneumoniae
-hemolytic Bile-soluble
S. mitis (Blood agar) Negative quelling reaction
S. mutans Optochin-resistant
(Viridans) Bile-insoluble
Enterococcus
-hemolytic or Salt tolerant (survive in 6.5%
faecalis / faecium
non-hemolytic NaCl) / Bile esculin-positive
(Streptococcus D)
-hemolytic with a
Clostridium unique DOUBLE
perfringens zone of hemolysis
(Blood agar)
Enterotoxin detection Pseudomembrane
Clostridium difficile
(stool samples) (colon endoscopy)
Toxin detection
Clostridium botulinum
(food samples / intestinal contents)
Pink Glucose-fermentor (A+ / G+)
(MacConkey) IMViC (+ / + / - / -)
Escherichia coli
Green Metallic Urease-negative
(EMB) LACTOSE H2S-negative
FERMENTORS Glucose-fermentor (A+ / G+)
Pink IMViC (- / - / + / +)
Klebsiella pneumoniae POSITIVE
(MacConkey) Urease-positive
H2S-negative
Proteus species Swarming NON-LACTOSE Glucose-fermentor (A+ / G+)
(Nutrient agar) FERMENTORS Urease-positive
Colorless (Except S. sonnei H2S-positive
(MacConkey) ferments lactose very
Glucose-fermentor (A+ / G-)
Shigella species Urease-negative
H2S-negative
Colorless Widal test Glucose-fermentor (A+ / G+)
Salmonella enterica weakly)
(MacConkey) (somatic O antigen Urease-negative
subsp. enterica
flagellar H antigen) H2S-positive
Yersinia pestis BIOPOLAR staining
Colorless / Pale POSITIVE GLUCOSE

Neisseria gonorrhoeae
(Thayer-Martin) MALTOSE
Colorless / Pale GLUCOSE
Neisseria meningitidis
(Blood/Chocolate) MALTOSE
SUCROSE
Yellow
Vibrio cholerae LACTOSE
(TCBS)
(Late fermentor)
SUCROSE
Vibrio vulnificus
Green LACTOSE
Vibrio (TCBS) SUCROSE
parahaemolyticus LACTOSE
NO
Moraxella catarrhalis CARBOHYDRATE
FERMENTATION
Darting motility
Colorless / Gray Hippurate-positive
Campylobacter jejuni
(Skirrow's agar) Growth at 42 oC
Urease-negative
Helicobacter pylori ELISA for Abs (serum) for diagnosis Gastric biopsy
Stool antigen test for diagnosis as Corkscrew motility
well as for monitoring treatment Urease-positive
(Urease Breath Test)
Blue pyocyanin and
Pseudomonas Colorless
fluorescent green pyovirdin
aeruginosa (MacConkey)
pigments + Fruity odor
Haemophilus Pale / gray Immunofluorescence
Positive quelling reaction
influenzae (Chocolate agar) for capsular Ags (CSF)
Pinpoint
Immunofluorescence for Ags
Bordetella pertussis Hemolytic
(nasopharyngeal specimens)
(Regan-Lowe)
Small Non-
Pasteurella multocida Hemolytic
(blood agar)
Buff-yellow
Mycobacterium rough wrinkled
NEGATIVE
tuberculosis (Lowenstein-
Jensen agar)
Chlamydia
Tissue culture in HeLa cells
pneumoniae
Abs titer
Chlamydia psittaci
(complement fixation)
Direct immunofluorescence for
Chlamydia trachomatis
cytoplasmic inclusion bodies
Abs monitoring / Indirect Nucleic acid amplification
Rickettsia rickettsii
immunofluorescence (PCR)
Serology tests not useful
Borrelia burgdorferi
(false positive results)
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Treponema pallidum
PAGE -
Dark-field Microscopy
Leptospira interrogans Agglutination tests
Mycoplasma Complement fixation test

DNA probes for sputum
pneumoniae Cold agglutinin test (positive)
Legionella Antigen detection in respiratory
pneumophila samples (rapid diagnosis)
Positive Whiff test
Gardnerella vaginalis
(10% KOH)
VIRULENCE FACTORS OF MEDICALLY IMPORTANT BACTERIA
FACTOR CAPSULE PILI FLAGELLA ENZYMES TOXINS SPORES OTHER

Actin-based motility /
Listeria
Listeriolysin protein ActA
monocytogenes
Absent (cell-to-cell passage)
Pilin Antigenic Variation
Neisseria gonorrhoeae Endotoxin
IgA protease (Immune evasion)
Antiphagocytic (Immune evasion) LOS endotoxin
Attachment
Neisseria meningitis
pili / fimbriae (Tissue damage)
Pseudomonas (Enhance Proteases Endotoxin / Exotoxins Pyocyanin
Single polar
aeruginosa adherence) (Local invasion) (Cytotoxic / Hemolysin) (Tissue damage)
Streptococcus Autolysin
Choline-binding protein A
pneumoniae Pneumolysin
Catalase Cytolytic exotoxins
Protein A (Antiphagocytic) /
Staphylococcus Coagulase (Hemolysins / Leukocidin)
Fibronectin-binding protein
aureus Hyaluronidase + 3 Superantigen exotoxins
(Tissue attachment)
Fibrinolysin (Enterotoxin)
Streptococcus
agalactiae
Streptokinase M protein
Pyrogenic exotoxins
Streptococcus Streptodornase (Antiphagocytic) /
Streptolysin O
pyogenes C5a peptidase Fibronectin-binding protein
Streptolysin S
Hyaluronidase (Tissue attachment)
Bacillus anthracis
DNases
Endospores
Proteases 12 Exotoxins (Cytotoxic /
(Highly resistant)
Clostridium perfringens Hyaluronidase Hemolytic / Necrotic) +
Collagenases Enterotoxin
(Infection spread)
Haemophilus
influenzae
Cytotoxin
Bordetella pertussis
(Disrupt ciliary activity)
Yersinia pestis
Klebsiella pneumoniae
Staphylococcus SLIME BIOFILM formation

epidermidis (Surface attachment)
Mycobacterium Lipid-rich cell wall /
NO TOXINS PRODUCED
tuberculosis Highly resistant
Endoflagella
(axial filaments) Hyaluronidase
Treponema pallidum
(Infection spread)
Campylobacter jejuni Single polar Enterotoxin (Cholera-like) Adhesions
Cytotoxin (Colonization)
Vibrio cholerae Cholera enterotoxin
Mucinase (degrades gastric

mucus) / Urease (release of Cytotoxin
Multiple polar
Helicobacter pylori NH ions neutralize
4
+
(Damage mucus-
(4-6 flagella)
gastric acidity) / CagA producing gastric cells)
protein (gastric cancers)
Legionella
Monotrichous Chlorine Tolerant
pneumophila
Mycoplasma Exotoxin Cytoadhesion (P1)
pneumoniae (pertussis-like) (Ciliary action inhibition)
Ability to survive within
Brucella species ABSENT
host phagocytes
Pseudomonas aeruginosa is an opportunistic pathogen. Virtually any organ/tissue may be infected. It causes urinary tract infections, respiratory system
infections (secondary pneumonia), skin/soft tissue infections, bacteremia, bone and joint infections, gastrointestinal infections, CNS infections, and a variety of
systemic infections, particularly in patients with severe burns and in cancer and AIDS patients who are immunosuppressed. It is primarily a nosocomial
pathogen. According to the CDC, the bacterium is the 4th most commonly-isolated nosocomial pathogen accounting for 10.1 percent of all hospital-acquired
infections. It is also among the most antibiotic-resistant clinically important bacteria.
Staphylococcus aureus is one of the most common causes of hospital-acquired (nosocomial) infections. Resistance to penicillin is due to the production of
the penicillinase (beta-lactamase) enzyme.
The capsule of S. pyogenes is composed of hyaluronic acid (like host connective tissue) so it is non-antigenic
Not all strains of Haemophilus influenzae produce capsules.
Tuberculosis pathogenic mechanism: Cell-mediated hypersensitivity
Vibrio cholerae is susceptible to acids and non-invasive.
Mycoplasma pneumoniae has a 3-layer cell membrane containing sterols.
Brucella abortis can be detected by dye sensitivity test (inhibited by dye thionine). It is believed that brucellosis causes fewer spontaneous abortions in
humans than it does in animals because of the absence of erythritol in the human placenta and fetus.
IMPORTANT BACTERIAL TOXINS
TOXIN ORGANISM TYPE MODE OF ACTION EFFECT REMARKS
Anthrax Edema Factor Elevation of intracellular cAMP Severe edema

PLASMID-CODED
Bacillus anthracis
EXOTOXINS Disruption of cellular signaling /
Anthrax Lethal Factor Tissue necrosis
Induction of cytokines
Clostridium Degrading lecithin in mammalian cell membranes
HEMOLYTIC / Tissue necrosis
perfringens -toxin Clostridium perfringens Lysis of Endothelial cells / RBCs /
NECROTIC (Gas gangrene)
Lecithinase WBCs / Platelets
Staphylococcus
aureus -toxin Attacking mammalian cells (RBCs) Osmotic lysis
Hemolysins Staphylococcus aureus CYTOLYTIC
Panton-Valentine Produced by community-
Pore-forming toxin attacking PMNs Cell lysis
Leukocidin acquired MRSA strains
Inhibition of eukaryotic protein synthesis Only encoded by C. diphtheriae
Myocarditis / Neuritis /
Diphtheria toxin Corynebacterium diphtheriae CYTOTOXIN (via inactivating eukaryotic polypeptide chain strains containing a lysogenic
Muscle paralysis
elongation factor EF-2 by ADP-ribosylation) bacteriophage
Nausea / vomiting /
Staphylococcus Superantigen / Divided into six
Staphylococcus aureus Stimulating the vomiting center in the brain diarrhea (Food
aureus enterotoxin major antigenic types (A G)
poisoning)
Clostridium Diarrhea
perfringens Clostridium perfringens Disruption of ion transport in ileum (Acute Food Heat-labile toxin
enterotoxin (CPE) Poisoning)
Catalyzing glucosylation of host guanosine Diarrhea
Clostridium difficile
Clostridium difficile ENTEROTOXINS triphosphate-binding proteins Cyto-skeleton (Pseudomembranous
toxins A and B
rearrangement / Cell death colitis)
Encoded by S. dysenteriae
Diarrhea
Shiga toxin Shigella dysenteriae Inhibition of protein synthesis (Cytotoxic) strains containing lambdoid
(Shigellosis)
prophages
Only encoded by V. cholerae
Activation of adenylate cyclase Diarrhea
Cholera toxin Vibrio cholerae strains containing a lysogenic
(via ADP-ribosylation) (Cholera)
bacteriophage
Activation of adenylate cyclase Increased mucus
Pertussis toxin Bordetella pertussis
(via ADP-ribosylation) production
Inhibition of acetylcholine release at
Flaccid paralysis
Botulinum toxin Clostridium botulinum neuromuscular junctions
(Botulinum)
NEUROTOXINS Preventing muscle contraction
Blockage of neurotransmitter release at inhibitory Muscle spasm
Tetanospasmin Clostridium tetani
synapses (Tetanus)
Toxic Shock Syndrome
Classic cause of Toxic Shock Syndrome
Toxin SUPERANTIGEN
Staphylococcus aureus
Exfoliative toxin EXOTOXINS Cleavage of desmosomes (structures responsible
Skin desquamation
(Exfoliatin) for cell-to-cell adhesion)
PYROGENIC Causes extensive rash
Streptococcal toxin Streptococcus pyogenes
EXOTOXIN (Scarlet Fever)
Types include streptolysin O
HEMOLYTIC (SLO), which is oxygen-labile,
Streptolysins Damage mammalian cells Cell lysis
EXOTOXIN and streptolysin S (SLS), which
is oxygen-stable
MEMBRANE-
Listeriolysin Listeria monocytogenes Help bacteria escape phagocytic vacuoles
DAMAGING TOXIN
GASTROINTESTINAL INFECTIONS
CAUSATIVE DISEASE DESCRIPTION /

DISEASE ORGANISM
TRANSMISSION
CLINICAL MANIFESTATIONS
PROGNOSIS / COMPLICATIONS
Decreased mucus production in stomach

If untreated Chronic gastritis
Helicobacter Person-to-person contact Gastric mucosa: Chronically inflamed via inflammatory cell o Duodenal / gastric ulcers
Acute Gastritis
pylori (contagious) activation / damaged via ammonium ions produced by o Gastric carcinoma
o Gastric B-cell lymphoma
urease
Entamoeba Ingestion of cysts in Colonic ulcerations Bloody stool

Amebic Dysentery 80% asymptomatic (source for infection) INVASION Liver / lung abscesses
histolytica contaminated food / water Diagnosis: Motile trophozoites / 4-nucleate cysts (stool)
Ascariasis Ascaris Abdominal symptoms / May be asymptomatic Intestinal obstruction

Ingestion of eggs
(Roundworm disease) lumbricoides Diagnosis: Characteristic eggs in stool Lung infection
Ingestion of cysts in Asymptomatic / Mild diarrhea Colonic ulcerations Perforation
Balantidiasis Balantidium coli Acute dysentery (blood / pus in stool)
contaminated food / water Diagnosis: Motile trophozoites / 4-nucleate cysts (stool) Peritonitis
Biliary duct fibrosis and hyperplasia Biliary duct obstruction

Clonorchis sinensis Ingestion of larvae in raw /
Clonorchiasis Liver enlargement / jaundice Cholangiocarcinoma (a neoplasm of biliary
(Chinese liver fluke) undercooked fish Diagnosis: Characteristic eggs in stool system)
Cryptosporidium Ingestion of cysts in Intracellular parasite / infects villi of lower small intestine
Cryptosporidiosis Asymptomatic / self-limited diarrhea in immunocompetent / Severe in AIDS patients
parvum contaminated food / water Diagnosis: Modified acid-fast stain (stool)
Diphyllobothrium Mostly asymptomatic / abdominal discomfort / diarrhea / vomiting / weight loss / vitamin B12 deficiency
Ingestion of larvae in raw /
Diphyllobothriasis latum Adult worm in host intestine can be as long as 15 meters
undercooked fish Diagnosis: Characteristic eggs in stool
(Fish tapeworm)
Echinococcus Production of large hydatid cysts in tissues
Echinococcosis Ingestion of eggs in dogs Cyst rupture due to trauma
granulosus Liver is the most common organ involved followed by lungs
(Hydatid disease) or sheep feces No diarrhea is observed Anaphylactic shock
(Dog tapeworm)
Enterobiasis Enterobius Itching in anal area (perianal pruritus)

Ingestion of eggs Diagnosis: Characteristic eggs + white worms in stool / perianal region
(Pinworm disease) vermicularis Most common helminthic infection in the US
Mild duodenal infection / 10-days incubation period / Children / Traveler diarrhea

Ingestion of cysts in Acute infection Foul-smelling / watery / greasy stool with increased fat and mucus
Giardiasis Giardia lamblia Mal-absorption syndrome weight loss / anorexia / abdominal cramps
contaminated food / water High prevalence among homosexual men
Diagnosis: Motile trophozoites or 4-nucleate cysts (stool)
Ancylostoma
Hookworm Disease duodenale / Direct skin penetration Abdominal pain / intestinal cramps / ulcer-like symptoms
Chronic intestinal blood loss Anemia
(Ground itch) Necator by soil larvae Diagnosis: Characteristic eggs in stool
americanus
Necrotizing Pseudomonas Opportunistic infection High RISK GROUPS: Premature infants / Neutropenic cancer patients
Enterocolitis (NEC) aeruginosa
Individuals on antibiotic treatment Depletion of intestinal normal flora C. difficile overgrowth in colon:
Pseudomembranous Clostridium
Watery / explosive inflammatory diarrhea
Colitis difficile
Pseudomembrane formation in colon
Schistosoma
Liver damage
Schistosomiasis mansoni / GI bleeding / diarrhea / bloody stool
Direct skin penetration Periportal fibrosis Portal hypertension /
(Bilharzia) Schistosoma Diagnosis: Characteristic eggs with lateral spine in stool
Splenomegaly
japonicum
Patients with corticosteroids / immune-
suppressive medication: Dissemination to
Immunocompetent individuals:
Uncomplicated disease / frequently asymptomatic CNS (Hyperinfection syndrome)
o GI system symptoms (abdominal pain / diarrhea)
Strongyloidiasis Strongyloides Direct skin penetration Neurological complications / organ
o Pulmonary symptoms (Lffler's syndrome) occur
(Threadworm disease) stercoralis by soil larvae dysfunction Death
during pulmonary migration of filariform larvae Diagnosis: Identifying larvae in stool
o Dermatologic manifestations (urticarial rashes in
Blood eosinophilia is generally present
buttocks / waist areas)
during the acute and chronic stages, but
may be absent with dissemination
Ingestion of larvae in Diarrhea / Mostly asymptomatic

Taenia solium Cysticerci in brain / eyes
undercooked pork Diagnosis: Detetion of proglottids in stool
Taeniasis
Ingestion of larvae in Mostly asymptomatic
Taenia saginata
undercooked / raw beef Diagnosis: Detetion of proglottids in stool
Usually asymptomatic (<100 worms)

In those who are infected with many worms, there may be abdominal pain / distension / bloody or mucus-filled
Trichuriasis Ingestion of eggs
Trichuris trichiura diarrhea / weight loss / nutritional (vitamin A) deficiencies / anemia
(Whipworm disease) from soil
Rectal prolapse may occur in severe cases
Diagnosis: Characteristic eggs in stool
Visceral Larva Migrans Ingestion of eggs from Larvae migrates from intestine Infects liver / brain / eyes
Toxocara canis
(VLM) dog feces RISK GROUPS: Young children with "pica" (eating non-food substances) and poor hygiene practices
BACTERIAL FOOD-BORNE ILLNESSES
CAUSATIVE CONTAMINATED CLINICAL MANIFESTATIONS /

DISEASE ORGANISM
TRANSMISSION INCUBATION PERIOD
SOURCES PROGNOSIS
Ulcerative inflammatory edematous lesions
Campylobacteriosis Fecal-oral route /
Campylobacter One to several days Meat (especially poultry) Fever / headache / diarrhea (may be bloody)
(Food infection / Consumption of contamin-
jejuni (self-limiting) unpasteurized milk / abdominal cramps Bacteremia / Septic
Travelers diarrhea) ated food and water
abortion / Guillian-Barre syndrome
Ingestion of improperly
Acute Clostridial Clostridium cooked food that failed to Nausea / abdominal cramps / diarrhea /
8 - 18 hours Meat products
Food Poisoning perfringens inactivate bacterial spore vomiting (rare)
germination
Inflammatory diarrhea + BLOODY PUS
Flies contaminated
MUCUS (currant jelly stools) / painful
Bacillary Dysentery with human stool / Low
Person-to-person abdominal cramping / No blood invasion or
(Food infection) Shigella sonnei One to several days infectious dose required for
Contaminated food / water bacteremia / In very young children /
Shigellosis diseases / Crowdness / Poor
malnourished persons SEVERE
sanitary conditions
dehydration / Death
Vomiting / diarrhea / NO FEVER or SEPSIS
Botulism
Ingestion of toxin- Difficulties in focusing vision / swallowing /
(Classic Food 12 - 36 hours Vegetables / meat / fish
containing food cranial nerve functions / flaccid paralysis
Poisoning) Clostridium Respiratory failure
botulinum Toxin produced in vivo
Infantile Botulism
Ingestion of spores- Constipation / feeding problems / Lethargy /
(Floppy Baby Raw Honey
containing food Poor muscle tone Sudden Infant Death
Syndrome)
Syndrome
Raw (undercooked) seafood Profuse watery non-inflammatory diarrhea
Consumption of water and harvested from contaminated (rice-water stool) / No fecal leucocytes /
Cholera
Vibrio cholerae food contaminated with One to several days water (outbreaks in hurri- Fever is uncommon
(Food infection)
Vibrio bacteria canes / floods / national Complications: RENAL FAILURE
disasters) If untreated Fatal shock (50% mortality)
Bacillus cereus Ingestion of preformed

Bacillus cereus 2-12 hours Rice and other cereals Vomiting / diarrhea
Food Poisoning enterotoxin
Ingestion of contaminated
Salmonellosis Salmonella enterica Nausea / vomiting / abdominal cramps /
food products / contact 1-2 days Egg and raw milk
(Food infection) (Typhimurium) diarrhea (ends spontaneously within a week)
with pet turtles
Ingestion of food Protein-rich / salty foods
Staphylococcal
Staphylococcus contaminated with S. Very short improperly refrigerated
Gastroenteritis Nausea / vomiting / diarrhea
aureus aureus preformed heat- (2-3 hours) (e.g. potato salad /
Food Poisoning
stable enterotoxin egg salad / ham)
Fever / headache / malaise / cough
Typhoid Fever Ingestion of food / water Rose spots on chest (30% of cases)
Salmonella enterica Carrier food handlers Abdominal pain / hepatosplenomegaly
Enteric fever contaminated with infected 1 - 3 weeks Bacteremia / bloody inflammatory diarrhea
(Typhoon) (no animal reservoirs)
(Food infection) human feces Complications: Intestinal perforation /
hemorrhage / metastatic abscesses / death
Vibrio
Ingestion of contaminated
parahaemolyticus Vibrio Oysters Nausea / vomiting / abdominal cramps
raw or undercooked One day
Gastroenteritis parahaemolyticus Crab food products Explosive watery diarrhea
seafood
(Food infection)
Yersinosis Yersinia Ingestion of contaminated Undercooked meat (pork) / Fever / nausea / vomiting / bloody diarrhea
4-7 days
(Food infection) enterocolitica food or water unpasteurized milk Abdominal pain mistaken for appendicitis
E. COLI INTESTINAL INFECTIONS
VIRULENCE
E. COLI STRAIN SYNDROME TRANSMISSION ENTEROTOXINS SIGNS / SYMPTOMS THERAPY
FACTORS
Heat-stable (ST) toxin Watery diarrhea with
Enterotoxigenic Travelers diarrhea Food / water contaminated
Pili (for adherence) [cGMP ] / Heat-labile loss of Na and Cl ions
E. coli (ETEC) (Developing world) with human waste
(LT) toxin [cAMP ] (for several days)
BfpA (bundle-forming pili Watery diarrhea in children Antibiotics may be useful
Enteropathogenic Pediatric diarrhea Prenatal transmission for adherence) / Type III NO TOXINS (no blood): Fever / microvilli
E. coli (EPEC) (Developing world) (Poor sanitation) secretion system (inject PRODUCED destruction + characteristic
effector proteins) intestinal lesions
Enterohemorrhagic Hemorrhagic colitis / Eating improperly cooked Avoid antibiotics because
BfpA (bundle-forming pili Shiga-like toxins Copious bloody
E. coli (EHEC) Hemolytic uremic hamburger / drinking of the possible risk of
for adherence) (verotoxins) 1 or 2 inflammatory diarrhea
(Serotype O157:H7) syndrome (HUS) unpasteurized milk potentiating HUS
Hemolysin
Enteroinvasive Dysentery-like Ipa (for cell invasion)
Bloody diarrhea / Fever
E. coli (EIEC) syndrome Actin-based motility
Rehydration and correcting
Oral-fecal route (for intercellular spread)
electrolyte imbalances
Enteroaggregative Aggressive Adherence Heat-stable toxin Watery diarrhea persistent
Travelers diarrhea
E. coli (EAEC) Fimbrie (for adherence) (plasmid encoded) in children and HIV-patients
N.B: The incubation period for all E. coli intestinal infections is at least 24 hours (food infection).
Hemolytic uremic syndrome is characterized by fever, acute renal failure, hemolytic anemia and thrombocytopenia. Most cases of HUS develop in children (younger than 5)
after 2-14 days of diarrhea.
VIRAL DIARRHEAL INFECTIONS
VIRUS EPIDEMIOLOGY CLINICAL MANIFESTATIONS DIAGNOSIS
Infantile gastroenteritis (serotypes 40-41)

Adenoviruses Watery diarrhea ELISA for antigens (stool)
5-15% of viral diarrheal diseases in children
Watery diarrhea Appear as star-shaped particles

Astroviruses Affect all ages
Illness duration: 3-4 days in electron microscopy (EM)
Affect all ages (adults and children)
Outbreaks of diarrhea in schools restaurants Nausea / Watery diarrhea
Noroviruses ELISA
Illness duration: Only 24-72 hours
hospitals cruise ships etc
Most common cause of diarrhea in infants and Low-grade fever / watery non-bloody diarrhea with no pus / Vomiting ELISA for viral capsid antigens
Rotaviruses
young children / Adults rarely affected Illness duration: 3-8 days resulting in severe dehydration (stool)
VIRUS HEPATITIS A HEPATITIS B HEPATITIS C HEPATITIS D HEPATITIS E
Classification Picornavirus (Hepatovirus) Hepadnavirus Flavivirus Delta virus Hepevirus

Fecal-oral route (sewage- Blood transfusion / Sexual / Vertical
Blood transfusion / Sexual / Fecal-oral route
Transmission contaminated water / uncooked transmission / Via all body fluids Same routes as HBV
Vertical transmission (Waterborne hepatitis
shellfish) / rarely blood transmission (saliva / tears / milk / semen)
Acute Hepatitis (preicteric, icteric) / Acute Hepatitis with jaundice Hepatitis
Disease Infectious Hepatitis Acute Hepatitis
Jaundice / Enlarged tender liver (25% of cases) (esp. in young adults
Intravenous drug users / Sexual Intravenous drug users / Chronic Pregnant women
Risk groups Children / Crowded camps
intercourse with infected persons Renal dialysis patients HBV-positive patients (High morbidity)
Common although sometimes
Persistent infection Uncommon Common Uncommon
complete recovery is achieved
Chronic carriers No Yes Yes with liver cirrhosis Yes No

HBV chronic hepatitis +
Fulminant Hepatitis (extensive liver
Hepatocellular carcinoma HDV super-infection Fulminant hepatic failu
Complications Uncommon necrosis) with renal dysfunction
after several years Acute hepatitis episode in pregnant women
Hepatocellular carcinoma (HCC)
(Extensive damage)
Culture (poor growth) Liver function tests / ELISA for viral Ags
Diagnosis HCV Abs / RT-PCR
/ Ab titer (anti-HAV IgM) and Abs (see diagnosis table)
(Pegylated) interferon / Tenofovir /
-interferon (induce antiviral
Adefovir / Entecavir / Lamivudine /
Immunoglobulins as a post- state) + Ribavirin for chronic
Treatment Telbivudine / Immunoglobulins for post No specific treatment available
exposure prophylaxis hepatitis / Liver transplant for
exposure prophylaxis and for infants
severely damaged liver
born to HBV-positive women
HBsAg first marker for HBV / HBeAg Fluctuating levels of liver
Defective virus requires
REMARKS secreted by infected cells (detected = enzymes / RT-PCR used to
HBV coinfection
patient is highly contagious) evaluate antiviral therapy
VIRAL HEPATIC INFECTIONS
RESPIRATORY TRACT INFECTIONS

DISEASE ORGANISM
TRANSMISSION
Acute Febrile RISK GROUPS: Infants / children

Adenoviruses Respiratory droplets Pharyngeoconjunctival fever (pharyngitis + eye infection) / children
Pharyngitis Serotype identification: Neutralization / Hemagglutination inhibition
Aspergilloma: Fungus ball in lung cavities (TB patients):
Inhalation of conidia in Non-invasive / less severe

Aspergillus Dx: Septated hyphae with 45-degree angle (V-shaped) Acute invasive lung infection Multi-
Aspergillosis dust soli (Hospital
fumigatus branches + small conidia organ dissemination (FATAL)
outbreaks) RISK GROUPS: Immunosuppressed pateints (BMTU) /
patients treated with broad-spectrum antibiotics
Chlamydia Significant cause of community-acquired respiratory
Clinical relapse may occur after treatment
pneumoniae infections with epidemic outbreaks
Respiratory droplets
Mycoplasma Walking pneumonia: Minimal signs and symptoms CNS disturbances / rash / hemolytic anemia
Most common among older children / young adults
pneumoniae (6-20 years) (rare)
Atypical Pneumonia Inhalation of dust

Psittacosis (Ornithosis): Dry cough / Flu-like
Chlamydia psittaci contaminated with feces of Hepatosplenomegaly (common)
symptoms / pulmonary infiltrates
infected birds (parrots)
Contaminated aerosols
Legionnaires Disease:
Legionella from air conditioners / o Acute lobar pneumonia
pneumophila humidifiers / cooling o Multisystem symptoms (Watery non-bloody diarrhea / nausea / vomiting / neurologic symptoms)
o Predisposing factors: age immunosuppression chronic lung diseases
systems
Respiratory Most common cause of bronchiolitis in infants
Syncytial Virus Rx: ribavirin (aerosol) / palivizumab Abs for prophylaxis
Bronchiolitis
Human Para- Respiratory droplets
(Viral) Have both H and N activity (but no antigenic shift)
influenza Virus
RISK GROUPS: Infants / children
(Types 1-4)
Bronchitis Chlamydia Respiratory droplets
pneumoniae
Mycoplasma
pneumoniae
Moraxella
Bronchopneumonia Opportunistic infection RISK GROUPS: Elderly patients / long-term heavy smokers with chronic pulmonary disease
catarrhalis
Exudate may extend to respiratory passages
Corynebacterium Thick / grayish / adherent exudate (pseduomembrane) Airway obstruction Suffocation
Diphtheria Bacterial toxin dissemination:
diphtheriae coating throat
Heart Myocarditis / Heart Failure
Cranial nerves Neuritis / Paralysis
Reye syndrome: Rare complication of viral
High fever / chills / muscle aches (4-5 day course)
Dx: Ags detection in respiratory sample (rapid) / RT-PCR infection in children resulting from FEVER +
Flu Influenza virus
Respiratory droplets
(sensitive) ASPIRIN
Acetaminophen usually recommended
Haemophilus Fever / enlarged tonsils
Laryngotracheitis
influenzae (Type b) Sever epiglottitis (beefy red / edematous)
Laryngotracheobronchiti Human Para-
Throat swelling / "Barking" cough / Hoarseness
s influenza Virus
RISK GROUPS: Infants and children
(Croup) (Types 1-4)
Paragonimus Ingesting encysted larvae
Cough + bloody / brown sputum (due to inflammatory response)
Paragonimiasis westermani in undercooked infected
Diagnosis: Characteristic eggs in sputum / stool
(Lung fluke) crab / crayfish
Catarrhal phase: Non-specific symptoms / Dry cough Encephalopathy / Seizures

Pertussis Bordetella pertussis Cough droplets
Paroxysmal phase: Whooping cough with mucous Pneumonia
Streptococcus
Strep Throat: Acute sore throat / Common in ages between 2-20 years
pneumoniae
Chlamydia
Pharyngitis Respiratory droplets
pneumoniae
Mycoplasma
pneumoniae
Pneumocystis World-wide / Exposure: Very common with 100% seroprevalence in children
Pneumocystis Interstitial pneumonia (100% FATAL if untreated)
pneumonia Opportunistic infection
jiroveci Dx: Cysts / trophozoites on H&E / Silver / Giemsa (biopsied lung tissues) / Non-culturable pathogen
(PCP) RISK GROUPS: AIDS patients / Malnourished infants
Streptococcus Endogenous or exogenous Most frequent cause of pneumonia / High viscosity of respiratory secretions
pneumoniae (respiratory droplets) Common cause of DEATH among older adults / persons with impaired resistance
Haemophilus Blood dissemination Systemic / CNS

Respiratory droplets Primarily in older adults / immunocompromised
influenzae infection
Pneumonia Klebsiella Necrotizing / lobar pneumonia / "jelly-like" sputum
(Community-acquired) pneumoniae RISK GROUPS: Alcoholic / Diabetic patients
Staphylococcus Necrotizing / severe pneumonia

aureus Most common cause of SECONDARY bacterial pneumonia following influenza DEATH (old patients)
Bacterial dissemination
Streptococcus (Opportunistic infection)
RISK GROUPS: Elderly / Diabetic patients (rare)
agalactiae
VENTILATOR-ASSOCIATED PNEUMONIA: Diffuse bronchopneumonia / Greenish-yellow sputum
Pseudomonas
RISK GROUPS: Patients with chronic lung diseases / congestive heart failure / cystic fibrosis / patients on
Pneumonia aeruginosa
ventilators for days (common)
(Nosocomial)
Proteus species RISK GROUPS: Immunocompromised patients
Pneumonia Respiratory droplets

RISK GROUPS: Infants / Elderly / Immunocompromised / Patients with congenital heart or chronic lung
(Viral) Influenza virus
diseases
Respiratory
Syncytial Virus
Human Para- RISK GROUPS: Infants / Young children
influenza Virus
(Types 1-4)
Adenoviruses RISK GROUPS: Infants (10% mortality) / Military / Crowded camps (Epidemics)
Human Major cause of death in bone marrow transplantation units
Cytomegalovirus RISK GROUPS: Immunocompromised / Transplant recipients / AIDS patients (common)
Varicella-zoster
RISK GROUPS: Adults / Immunosuppressed patients
virus
Spore inhalation from
Pulmonary Anthrax Progressive / Hemorrhagic pneumonia
Bacillus anthracis infected animals (sheep / If untreated DEATH (100%)
(Wool-Sorters disease) Lymphadenitis
goats / horses etc)
Most common cause of common cold
Rhinovirus Hand-to-hand contact Multiply only in upper respiratory tract
No vaccine available (multiple serotypes > 100)
Rhinopharyngitis Human Para-
(Common cold) influenza Virus
(Types 1-4) Respiratory droplets
Coronavirus
Streptococcus Endogenous or exogenous

pneumoniae (respiratory droplets)
Nasal congestion
Haemophilus
Sinusitis Respiratory droplets Nasal discharge If untreated Chronic sinusitis
influenzae Facial pain (children)
Moraxella
Opportunistic infection
catarrhalis
Prolonged bad cough for 3 weeks or longer with bloody
Miliary tuberculosis (disseminated" TB)
Mycobacterium
Tuberculosis (TB) Respiratory droplets sputum / Chest pain If left untreated, miliary tuberculosis is almost
tuberculosis Weakness or fatigue / Weight loss / No appetite
always fatal
Fever / Chills / Night sweating
Because the organism is so ubiquitous, external contamination of clinical samples can give false-positive results.
Because the organism lacks ergosterol (the essential component of most fungal cell membranes), amphotericin is ineffective against it.
Most infections do not have symptoms, known as latent tuberculosis. About one in ten latent infections eventually progresses to active disease which, if left untreated, kills
more than 50% of those so infected.
CUTANEOUS / SUBCUTANEOUS INFECTIONS

DISEASE ORGANISM
TRANSMISSION
Actinomyces Skin penetration during Chronic / suppurative / granulomatous inflammation with multiple abscesses / sinus tracts
Actinomycosis
israelii dental / GIT procedures Most common manifestation: Oral-cervicofacial osteomyelitis (lumpy jaw)
Blastomyces Primary infection: Asymptomatic / mild pulmonary

Blastomycosis Inhalation of microconidia Disseminated infection: Ulcerated granuloma skin infections (70%)
dermatitidis RISK GROUPS: Diabetic patients / Farmers / Forestry workers / Hunters / Campers
Staphylococcus
Carbuncles Skin penetration Large / deep subcutaneous infection Bacteremia
aureus
Streptococcus
Direct skin contact Diffuse / spreading cellular inflammation + fever / chills / fatigue
pyogenes
Cellulitis
Clostridium Spore inoculation
Anaerobic / connective tissue infection
perfringens into skin wounds
Mainly childhood disease
Chicken-pox Varicella-zoster
Respiratory droplets Fever / headache / malaise / abdominal pain (10-23 days) Virus-containing body vesicles (crops)
(Varicella) virus
beginning on head / face / trunk proceeding to extremities / oropharynx / conjunctiva
Skin breach from Caused by dematiaceous fungi

Cladosporium sp. Slowly progressive pigmented warty nodules Crusty
Chromoblastomycosis vegetative material Difficult in treatment
Phialophora sp. abscesses + (Sclerotic cells / Medlar bodies)
(thorns / splinters) Most commonly in tropical / subtropical / rural areas
Cutaneous
Acanthamoeba sp. Skin penetration RISK GROUPS: Immunosuppressed patients
Acanthamoebiasis
Contact with infected
Bacillus Painless / black / severally swollen malignant pustule If lymph nodes / blood invasiveness occur
Cutaneous Anthrax animal products / Spore
anthracis Crusting over (eschar) fatal septicemia (20% mortality rate)
inoculation into skin cuts
Dracunculus Drinking water containing
Dracunculiasis Skin inflammation / ulceration
medinensis copepods in which the
(Guinea worm disease) Diagnosis: Seeing worms emerging from lesions on the legs of infected individuals
(Guinea worm) larvae lives
Epidermodysplasia Human
Direct skin contact Genetic disorder / continuous wart spread (rare) Squamous carcinoma
verruciformis Papillomavirus
Erysipales Streptococcus Fiery-red erythema (face / lower limbs)

Direct skin contact
(St. Anthony's fire) pyogenes Affect all ages
Corynebacterium Uniform brown-colored patches (groin / armpits / under breasts)

Erythrasma Direct skin contact
minutissimum More common among overweight people / elderly / diabetics / people in warm moist climates
Localized abscesses (usually on feet) pus / serum /

Eumycetoma Madurella sp. Skin breach blood discharge through sinuses + colored grains Destruction of deeper tissues / deformity /
(Madura foot) Exophiala sp. (thorn prick) (granules) in exudate loss of function in affected areas
Endemic: India / Africa / Central and South Americas
Furuncles Staphylococcus
Skin penetration Subcutaneous abscesses
(Boils) aureus
Painful oral ulcers + intense throat swelling

Herpangina Coxsackievirus A Saliva
Common childhood infection
Pseudomonas Skin penetration /

Hot Tub Folliculitis Infection of hair follicles
aeruginosa contaminated water pools
Streptococcus
Impetigo pyogenes Highly contagious / superficial / pus-forming infection Honey-colored (yellow-brown) crust
Direct skin contact
(Pyoderma) Staphylococcus Most common in children (face / limbs)
aureus
Kaposi Sarcoma Herpesvirus type 8 Saliva Most common opportunistic skin disease seen in AIDS male patients palate
Mycobacterium Close contact with patients Extensive skin and peripheral nerve lesions:
Lepromatous Leprosy Raised areas on face-arms-legs / Sensory loss in toes and fingertips
leprae for relatively long periods Cell-mediated immune response severely depressed
Exotoxin dissemination Shock / Renal
Myonecrosis Clostridium Spore inoculation Fermentation of organic compounds in infected tissues
Gas bubbles + increased capillary permeability failure / Intravascular hemolysis (due to
(Gas gangrene) perfringens into skin wounds Common after lower limb amputations in diabetics
lecithinase) DEATH
Acute muscle inflammation
Myositis Coxsackievirus A Fecal-oral route
Muscular pain / tenderness / swelling / weakness
Necrotizing Streptococcus Invasive infection

Bacterial tissue invasion Bacteremia Sepsis
Fasciitis / Myositis pyogenes Group A Streptococcal (GAS)
Oral Candidiasis Raised white (ulcerated) plaques on oral mucosa / tongue / gums / throat
Candida albicans Opportunistic infection
(Thrush) RISK GROUPS: AIDS patients
Fever + Oropharyngeal vesicular ulcers

Gingivostomatitis (Young children)
Herpes Simplex
Oral Herpes Saliva / Direct contact Pharyngitis - tonsillitis (Adults) Encephalitis / Corneal blinding
Type I Latent infection Reactivation Herpes labialis cold
sores (fever blisters) around lips
Paracoccidioidomycosi Paracoccidioides Primary infection: Asymptomatic / mild pulmonary

Inhalation of conidia Disseminated infection: Painful destructive lesions in mouth / nasal mucosa
s brasiliensis RISK GROUPS: Immunosuppressed patients (mature males are more susceptible than females)
Tender / edematous / erythematous nail infection + purulent discharge

Paronychia Candida albicans Opportunistic infection
RISK GROUPS: Diabetic patients
Staphylococcus Exfoliative toxin Epithelial Desquamation (children)

Scaled Skin Syndrome
aureus production Mild cases: Bullous impetigo
Skin Candidiasis
Candida albicans Opportunistic infection Red plaques in skin folds (axillae / groin) with satellite pustules
(Candidal intertrigo)
Extinct since 1977 / Potential bio-terrorism agent

Smallpox Variola virus
Inclusions: Guarnieri bodies
Skin puncture while
Sporotrichosis Sporothrix Granulomatous ulcer Secondary lesions along Chronic infection
handling vegetation
(Rose Gardener's schenckii Dissemination to distant sites (AIDS /
draining lymphatics (Mostly self-limited)
containing fungal spores /
disease) (Dimorphic) Affects farmers / gardeners / agricultural workers lymphoma patients)
Scratch from infected cat
Staphylococcus
Sty Skin penetration Small / superficial abscesses involving sweat glands / hair follicles
aureus
Eating raw or Coiled encysted larvae in muscles
Trichinellosis Trichinella spiralis Periorbital edema / swollen eyelids + Eosinophilia
undercooked pork Diagnosis: Muscle biopsy
Eating contaminated In immunocompromised patients with chronic liver
seafood (raw undercooked Fever / vomiting / diarrhea / abdominal pain
disease:
Painful skin vesicles / bullae / blistering dermatitis
Vibriosis Vibrio vulnificus oysters) / Skin penetration
Large disfiguring ulcers Septicemia / sever sepsis
into open wounds while Endemics: Gulf of Mexico Multi-organ dysfunction syndrome
swimming in seawater Septic shock DEATH )50% mortality)
Human
Common / flat / plantar (verruva) hyperkerotic benign lesions
Warts Papillomavirus Direct skin contact
Rx: Surgical removal
(types 1 / 4)
Molluscum Non-painful
Water warts Direct contact
Contagiosum virus Flesh-colored / dome-shaped / pearly skin lesions with central depression
Pseudomonas
Opportunistic infection Seen in burns victims
aeruginosa
Wound Infections
Proteus species Skin penetration
Zoster Varicella-zoster Vesicles / Sensory ganglia damage Neuralgia

Viral reactivation
(Shingles) virus Contributing factors: old age / depressed immunity
DERMATOPHYTOSIS
CAUSATIVE
DISEASE FUNGUS
CLINICAL MANIFESTATIONS DIAGNOSIS REMARKS
Wood's lamp examination: Bright green

Tinea capitis Trichophyton tonsurans Scaling patches + Hair loss
to yellow-green fluorescence of hairs Predominantly seen in pre-pubertal children
(Scalp ringworm) Microsporum canis 'black dot' pattern
infected by M. canis
Trichophyton rubrum
Tinea cruris Itching sensation in groin area / thigh Affected areas may appear red / tan / brown with
Epidermophyton
(Jock itch) moist skin folds / genital areas flaking / rippling / peeling / cracking skin
floccosum
Trichophyton
Maceration / crusting of skin between
mentagrophytes
Tinea pedis toes onychomycosis + secondary Transmitted in moist communal areas where people
Trichophyton rubrum
(Athlete's foot) bacterial infections lymph node walk barefoot (such as showers / bathhouses)
Epidermophyton
inflammation
floccosum
Trichophyton Direct microscopy of a KOH preparation
Tinea corporis Microsporum canis Enlarging raised red rings with a of a skin / nail scraping: Hyaline hyphae Common on glabrous skin of the trunk; however,
(Ringworm) Epidermophyton central area of clearing (ringworm) + arthroconidia in tissue specimens it may occur on any part of the body
floccosum
As infection progresses the nail become brittle with
Tinea unguium Affect toenails / fingernails
Trichophyton rubrum pieces breaking off or coming away from the toe
(Onychomycosis) Thickened / discolored nails
or finger completely
Tinea manuum Trichophyton rubrum
Typically just affects one hand Often develops after the occurrence of
(Two feetone hand Epidermophyton
Scaling and redness are prominent tinea pedis or tinea unguium
syndrome) floccosum
Tinea nigra
Hortaea werneckii Dark brown / black painless patches Microscopy of skin scrapings:
(Superficial
(Dematiaceous) on hand palms and feet soles Brownish filaments
phaeohyphomycosis)
Yeast cells + short hyphae in skin Prevalence is high in hot humid climates. Risk factors:
Tinea versicolor Malassezia furfur Hypopigmented / hyperpigmented
scrapping (spaghetti and meatballs oral contraceptive use / heredity / systemic cortico-
(Pityriasis versicolor) (Yeast) plaques on chest / back / arms / neck
appearance) steroid use / immunosuppression / malnutrition
Microsporum canis is zoophilic dermatophyte. Pet animals especially cats are the main source of infection.
Trichophyton rubrum is anthropophilic dermatophyte (occurring in man as a natural habitat) responsible for recurrent episodes of tinea pedis.
SKIN RASH INFECTIONS

DISEASE ORGANISM
TRANSMISSION
Slapped-check / bright red macular rash / most common in children (fifth disease)
Erythema Infectiosum Parvovirus B19 Respiratory droplets
Parvovirus B19 + Chronic hemolytic anemias (e.g. sickle-cell anemia) Reticulocytopenia (aplastic crisis)
Clinically mild / mostly subclinical

German Measles o Generalized maculopapular rash
Rubella virus Respiratory droplets
(3-days rash) o Lymphadenopathy
Dx: Ab titer / Pregnant women with IgM = recent exposure
Hand-foot-and- Coxsackievirus A16

Saliva / Mucus Maculopapular rash involving skin of hands / feet / oral cavity
mouth Disease Enterovirus 71
First stage: Red circular rash with a clear center (ERYTHEMA MIGRANS) at site of tick-bite
+ Fever / flu-like symptoms Lymph / blood dissemination
Lyme Disease Borrelia burgdorferi Ixodes tick-bite
Second stage: Arthritis + Neurological / Cardiac complications
Third stage: Chronic arthritis + progressive CNS diseases (Years later)
Extremely infectious (all infected individuals develop a clinical illness) / Children are susceptible (esp.
Measles malnourished / immunosuppressed) / Vitamin A enhance protection against infection
Fever + cough / coryza + conjunctivitis (2-3 days) KOPLIK SPOTS (mouth / throat) + generalized
(Rubeola / Hard Measles virus Respiratory droplets
MACULAR rash (from head to lower extremities)
measles)
Encephalomyelitis: Rare autoimmune complication appear within 2 weeks after rash
Dx: Ab titer (four-fold rise)
Sudden onset of high fever / headache / malaise rash
Rocky Mountain (maculopapular / petechial / hemorrhagic / beginning at If untreated myocardial / renal failure
Rickettsia rickettsii Tick-bite
Spotted Fever High mortality in individuals > 40 years
periphery then extending centripetally)
Thrombocytopenia
Roseola Infantum Exanthema subitum / Rose rash (sixth disease)
Herpesvirus type 6 Respiratory droplets
(3-days fever) Most common in infants (<2 years)
Streptococcus Aerosols from carrier /

Scarlet Fever Syndrome Sunburn-like rash caused by toxigenic strains
pyogenes infected person
Toxic Shock Syndrome High fever + sunburn-like rash skin desquamation
Staphylococcus
Toxic Shock Syndrome Toxin production (Tampons Vomiting / diarrhea / hypotension / multi-organ involvement (gastrointestinal renal hepatic damage)
aureus Toxigenic infection: no organism is isolated
of menstruating women)
CARDIAC INFECTIONS

DISEASE ORGANISM
TRANSMISSION
S. mitis / S. mutans Following dental

SUB ACUTE bacterial endocarditis (in previously damaged heart valves)
(Viridans) extraction
Enterococcus
Following pelvic /
faecalis / faecium SUB ACUTE bacterial endocarditis
abdominal surgery
Bacterial Endocarditis (Streptococcus D)
Staphylococcus
ACUTE bacterial endocarditis
aureus Bacterial
Pseudomonas dissemination
Seen in IV drug users / patients with prosthetic heart valves
aeruginosa
Myocarditis Fecal-oral route

Coxsackievirus B (ingestion of contaminated Most common cause of unexpected sudden death Heart failure
Pericarditis food or water)
Prosthetic Implants
Staphylococcus
(Heart valves) Bacterial blood invasion / opportunistic infection
epidermidis
Infection
NEURO INFECTIONS

DISEASE ORGANISM
TRANSMISSION
Coxsackievirus A Most common cause of viral meningitis

Fecal-oral route Replicate in GIT / oropharynx Blood Peripheral tissues
Coxsackievirus B (ingestion of contaminated Dx: Culture from stool or CSF / serology (Ab titer )
food or water) Mainly target CNS

Echovirus
Aseptic One of leading causes of acute febrile illness in infants / young children
Viral Meningitis
1\3 of cases subclinical
Pancreas infection
Mumps virus Respiratory droplets Painful swelling of salivary glands (parotid)
Testes infection (orchitis) Sterility
Dx: Serology (Abs detection) / Culture
RISK GROUPS: Children

West Nile Virus Mosquito-bites
Temperate regions: Europe / Africa / Middle East / United States
Bacterial Streptococcus
Delivery via birth canal Most common among neonates (< 2 months) High mortality rate
Meningitis agalactiae
Haemophilus
Most common among infants / very young children
influenzae
Respiratory droplets Purulent meningitis: Fever / malaise / headache / rigid
Neisseria
neck / vomiting / light sensitivity Coma
meningitidis
Most common in ages between 2-18 years
Streptococcus Endogenous or exogenous
Most common among adults High mortality rate
pneumoniae (respiratory droplets)
Listeria Maternally / Food-borne Most common among fetuses / newborns / pregnant If transmitted to fetus Abortion
monocytogenes (Epidemics: unpasteurized women / older adults / immunocompromised individuals
milk products)
Neonatal meningitis
Escherichia coli Septicemia after delivery
Main virulence factor: K1 capsule
Coccidioidal Meningitis Coccidioides Inhalation of arthoconidia Primary infection: Fever with varying degrees of respiratory illnesses (usually mild)
Disseminated infection: Meningitis and bone infections
(Valley Fever) immitis (arid areas) RISK GROUPS: Immunosuppressed patients
Cryptococcal Cryptococcus Inhalation of yeast in soil RISK GROUPS: AIDS pateints / Patients on systemic corticosteroids (FATAL)
Otherwise healthy individuals: Mild subclinical lung infection (common)
Meningitis neoformans (Bird / pigeon droppings) Dx: Yeast surrounded with large polysaccharide capsule easily seen on India ink staining in CSF samples
Ingestion of eggs from Presence of cysticerci (cysts) in the brain (causing headache / seizures / vomiting)
Cysticercosis Taenia solium
human feces Diagnosis: Brain MRI
Fever / Headache / Nausea

Nasal cavity Brain necrotic lesions
Naegleria fowleri Primary Amebic Meningoencephalitis (PAM) in
(Fresh water) Respiratory failure DEATH (95%)
immunocompetent individuals
Encephalitis Acanthamoeba Skin lesions or via Granulomatous Amebic Encephalitis (GAE) in
(Amebic) castellanii inhalation of airborne cysts immunocompromised patients
DEATH
Balamuthia Skin lesions Balamuthia Amebic Encephalitis (BAE) in both
mandrillaris (Soil or water) immunocompetent and immunocompromised patients
Fever / Headache / Malaise

West Nile Virus Acute FLACID paralysis (adults)
RISK GROUPS: Immunocompromised / Elderly persons > 60 years
St. Louis Fever / Headache / Malaise

Tremors / Convulsions / SPASTIC paralysis
Encephalitis Virus RISK GROUPS: Elderly persons > 70 years
Encephalitis
Mosquito-bites Coma
(Viral) Fever / Headache / Nausea / Vomiting
La Crosse Virus Seizures / Paralysis / Brain damage
RISK GROUPS: Children < 16 years
Western / Eastern Fever / Headache / Malaise Seizures / sequelae in infants / children
Equine Encephalitis RISK GROUPS: Infants / Children / Elderly
Virus
Lymphocytic
Fever / Flu-like symptoms
Choriomeningitis Rodent (mice) excreta Biphasic illness Meningoencephalitis
Lymphadenopathy / Rash
Virus
Herpes Simplex
Saliva Temporal lobe encephalitis with focal lesions DEATH
Virus Type I
Varicella-zoster
Respiratory droplets RISK GROUPS: Adult / immunocompromised individuals
Virus
Human
Body fluids RISK GROUPS : AIDS patients
Cytomegalovirus
Encephalitis Toxoplasma Weakness / confusion / seizures / coma

Reemergence of cysts
(Protozoal) gondii Most common cause of focal encephalitis in AIDS patients
Guillian-Barre Campylobacter Following abdominal Acute Idiopathic Demyelinating Polyneuropathy

Respiratory failure DEATH
Syndrome (GBS) jejuni (O19) surgical procedures (AIDP): autoimmune disease / ascending paralysis
Fecal-oral route Mostly asymptomatic

Replicate in oropharynx / GI lymphoid tissues blood Lower limbs FLACCID paralysis
Poliomyelitis Poliovirus (ingestion of contaminated
CNS infection Brainstem Respiratory paralysis
food or water) Dx: Culture from stool or CSF / serology (Ab titer )
Progressive Creutzfeldt-Jakob disease (CJD)

Prions (small infectious particles composed of Variant Creutzfeldt-Jakob disease (vCJD)
Neurodegenerative
abnormally folded proteins) Fatal Familial Insomnia
Disorders Kuru
Progressive Multifocal Progressive damage or inflammation of the white matter of the brain at multiple locations
JC virus Respiratory droplets
Leukoencepalophathy Common among immunocompromised (Transplant recipients / AIDS patients)
Incubation period: Variable (1-8 weeks)
Inoculation Local viral replication Retrograde Once patient has clinical symptoms, no
transport within peripheral nerves Brain (replication) treatment is effective Fatal encephalitis
Animal bite Travel along autonomic nerves Infection of lungs / Treatment: post-exposure prophylaxis /
Rabies Rabies virus (Raccoons / squirrels / kidneys / adrenals / salivary glands should start soon after animal bite / includes
foxes / bats / cats / dogs) Symptoms: Hydrophobia / Hallucinations / Seizures / passive immunization with antirabies
Mental dysfunction / Paralysis / Coma immunoglobulins + active immunization with
Eosinophilic intracytoplasmic inclusions: Negri bodies
HDCV
(Brain or nuchal skin biopsies)
Rhizopus oryzae FATAL infection (Patients with burns / leukemia / acidosis - diabetes mellitus)
Rhinocerebral
Rhizomucor sp. Dx: Non-septated hyphae with 90-degree angle branches
Mucormycosis Ubiquitous mould fungi found on rotting fruit and old bread
Absidia sp.
Subacute Sclerosing Chronic / progressive encephalitis Behavior change / Dementia Death
Respiratory
Panencephalitis Measles virus Affects primarily children and young adults
droplets Caused by a persistent infection with measles virus
(SSPE)
Spore inoculation Severe prolonged muscle spasms
Tetanus Clostridium tetani Respiratory failure DEATH
into skin wounds Trismus lockjaw sign
Human T-
Tropical spastic Spinal cord infection resulting in paraparesis, weakness of the legs.
Lymphotropic Virus Sexual contact
paraparesis (TSP) As the name suggests, it is most common in tropical regions, including the Caribbean and Africa
Type I (HTLV-1)
Wound Clostridium Wound contamination
Flaccid paralysis Respiratory failure DEATH
Botulism botulinum by bacteria / spores
Healthy people who become infected with Toxoplasma gondii often do not have symptoms because their immune system usually keeps the parasite from causing illness. When
illness occurs, it is usually mild with "flu-like" symptoms (e.g., tender lymph nodes, muscle aches, etc.) that last for several weeks and then go away. However, the parasite
remains in their body in an inactive state. It can become reactivated if the person becomes immunosuppressed. The primary host is the felid (cat) family. Humans are infected by
eating infected meat, by ingestion of feces of a cat that has itself recently been infected , and by transmission from mother to fetus.
DENTAL / BONE / JOINT INFECTIONS

DISEASE ORGANISM
TRANSMISSION
Streptococcus Highly cariogenic

Main cause of tooth decay
mutans Uses sucrose to produce a sticky dextran-based polysaccharide that allows them to cohere forming plaque
Dental Caries Actinomyces Opportunistic infection

Cariogenic pathogen Tooth decay
viscosus
Lactobacillus sp. Convert lactose and other sugars to lactic acid
Staphylococcus Bacterial dissemination

Osteomyelitis Hematogenous / Traumatic (acute / chronic) osteomyelitis especially in children
aureus to bones (opportunistic)
Periodontal Capnocytophaga
Opportunistic infection Gingivitis mainly in patients with poor oral hygiene Fever / Sepsis
Disease species
Staphylococcus
Most common cause of the septic joint / Persons with prosthetic joints are at risk
aureus Bacterial dissemination
Septic Arthritis
Neisseria to joint spaces
Most common cause of infectious arthritis in sexually active adults
gonorrhoeae
OCULAR INFECTIONS

DISEASE ORGANISM
TRANSMISSION
Acanthamoeba Traumatic eye injuries

Acanthamoeba Corneal damage is a prerequisite to infection (immunocompetent individuals)
Keratitis (Contact lens solutions)
Rubbing hands into eyes
Neisseria
after contacting infected Redness / Thick yellow discharge
gonorrhoeae
urethral discharges
Adult Conjunctivitis
Adenoviruses Watery / non-purulent conjunctivitis (self-limited)
Contact with infected
individual / object
Coxsackievirus A Acute / hemorrhagic conjunctivitis
Contaminated hands /
Adenoviruses ophthalmic instruments / Corneal opacity / photophobia (Epidemics)
swimming pools
Herpes Simplex
Keratoconjunctivitis Direct skin contact Dendritic corneal ulcers
Type I
Chlamydia Direct contact with infected Blindness
Trachoma (chronic keratoconjunctivitis)
trachomatis persons / contaminated
Most common cause of blindness due to infection
(A / B / C) surfaces / towels
Loiasis Worms observed in subconjunctival tissues of eye
Loa loa Deerfly-bite Red itchy swellings below skin "calabar swellings"
(African Eyeworm) Diagnosis: Microfilariae in blood
Subcutaneous nodules + pruritic skin rash

Onchocerciasis Onchocerca Second most common cause of blindness due to infection,
Blackfly-bite Blindness
(River blindness) volvulus after trachoma
Diagnosis: Microfilariae in skin biopsy
Human
Retinitis Infected body fluids RISK GROUPS: AIDS patients Blindness
Cytomegalovirus
OTITIS INFECTIONS

DISEASE ORGANISM
TRANSMISSION
Streptococcus Endogenous or exogenous Earache / Vertigo / Hearing loss / Middle ear effusion
pneumoniae (respiratory droplets) Most common causative organism in children
Haemophilus
Acute Respiratory droplets Second most common bacterial cause of acute otitis media
influenzae
Otitis Media Moraxella
Opportunistic infection Responsible for 15%-20% of acute otitis media episodes in children
catarrhalis
Proteus species Mainly in immunocompromised patients
Otitis Externa Pseudomonas Inflammation of the outer ear / more common in swimmers
Swimmers ear aeruginosa In older diabetic patients invasive / necrotizing infection
URINARY TRACT INFECTIONS

DISEASE ORGANISM
TRANSMISSION
Urinary Tract Most common cause of UTIs especially in women

Uropathogenic
Infections Symptoms: Dysuria / Hematuria / Pyuria / Urinary urgency
Escherichia coli Opportunistic infection UPEC uses P fimbriae (pyelonephritis-associated pili) to bind urinary tract endothelial cells and colonize the
(UPEC)
bladder. UPEC also produces alpha- and beta-hemolysins
Klebsiella
Associated with immunocompromised patients
pneumoniae
Enterococcus
faecalis / faecium Associated with patients in intensive care units
(Streptococcus D) Nosocomial infections
Pseudomonas
Associated with urinary tract catheterization
aeruginosa
Proteus species Associated with immunocompromised patients
Staphylococcus Most leading cause of cystitis in women

saprophyticus Second leading cause of UTIs in sexually active females
Schistosoma Direct skin peneteration Schistosomiasis (Bilharzia) / Hemorrhagic cystitis Urinary bladder fibrosis / granulomas
haematobium Diagnosis: Characteristic eggs with terminal spine in Urinary bladder cancer
urine
Hemorrhagic cystitis
BK Virus
RISK GROUPS: Bone marrow transplant recipients
GENITAL INFECTIONS

DISEASE ORGANISM
TRANSMISSION
Anaerobic Gardnerella Disruption of vaginal

Vaginal discharge / vaginal irritation + "fish-like" odor
Vaginosis vaginalis normal flora
Human
High malignancy risk lesions (viral DNA integration)
Cervical Carcinoma Papillomavirus
Dx: Immunoassays / PCR (Unculturable virus) / Cervical Pap smear screening test: Koilocytes
(types 16 / 18)
Chancroid Haemophilus Painful / ulcerative lesions + lymphadenopathy If untreated BUBO
Sexual contact
(Soft chancre) ducreyi Common in developing countries (swollen painful lymph nodes)
Human
Condyloma
Papillomavirus Anogenital warts (lower malignancy risk lesions)
Acuminatum
(types 6 / 11)
Endometritis Streptococcus Genital tract sepsis
Puerperal fever: purulent vaginal discharge + high fever
pyogenes (contaminated equipments)
Streptococcus Sexual contact

Occasional in postpartum women
agalactiae
Ureaplasma Postpartum fever
urealyticum
Neisseria : Urethritis: Purulent discharge + Dysuria : Salpingitis / Pelvic Inflammatory Disease
Gonorrhea
gonorrhoeae : Purulent vaginal discharge (PID) / Fibrosis Infertility
Latent infection: Reactivation (with or no
Herpes Simplex Fever / malaise / myalgia + Vesiculo-ulcerative genital
Herpes Genitalis symptoms) Viral shedding
Type II lesions (very painful)
Transmission / infection
Transient genital papules (1-2 months) painful
Chlamydia
Lymphogranuloma swelling of inguinal and perirectal lymph nodes groin-
trachomatis Blockage of regional lymphatic drainage
Venereum (LGV) swelling + discharged pus from multiple sinus tracts
(L1 / L2 / L3)
Distribution: Asia / Africa / S. America
Chlamydia Most common bacterial STD in USA

Nongonococcal : White urethral discharge
trachomatis : Repeated / chronic exposure Ectopic pregnancy / PID / Sterility
Urethritis
(NGU) Ureaplasma : Painful urination + urethral discharge
urealyticum : Endometritis (postpartum fever) / Chorioamnionitis
Chancre: Hard / painless ulcer (Primary syphilis) If untreated Tertiary syphilis:
Maculopapular rash (palm/soles) + anogenital Degenerative nervous system
Treponema Sexual contact
Syphilis condyloma + systemic manifestations (Hepatitis / Cardiovascular lesions
pallidum Granulomatous lesions in skin / liver / bones
Retinitis / Meningitis / Nephritis) (Secondary syphilis)
Both 1o and 2o lesions are extremely infectious (gummas)
Most common protozoal urogenital infection / Grow at alkaline pH (6.0)
Tricomonas : Vaginitis + copious yellow malodorous (foul-smelling) discharge
Trichomoniasis
vaginalis : White urethral discharge (less common)
Dx: Motile (flagellated) bear-shaped trophozoites in vaginal / urethral discharges (NO CYST)
Vaginal
Candida albicans (Antibacterial antibiotics Vaginitis (itching / burning pain of vagina and vulva) + white discharge
Candidiasis
Candida overgrowth)
The counterpart in men is balanitis, characterized by shiny reddish plaques on the glans penis, which can affect the scrotum.
CONGENITAL / NEONATAL INFECTIONS
CAUSATIVE DISEASE DESCRIPTION / CLINICAL

DISEASE ORGANISM
TRANSMISSION
MANIFESTATIONS
Fetal damage esp. in first trimester :

o Congenital Heart Diseases (e.g. Patent ductus arteriosus)
Congenital Rubella Rubella virus
o CNS problems: Mental retardation / Motor dysfunction / Deafness
o Hepatitis / Cataract
Treponema Spontaneous abortion / Stillbirth

Congenital Syphilis
pallidum In case of fetal survival CNS / Structural Abnormalities
Congenital Miscarriage / Stillbirth

Toxoplasma gondii Placental
Toxoplasmosis In case of fetal survival Brain lesions / Hydrocephaly / Blindness
Varicella-zoster
Congenital Varicella Multiple fetal developmental anomalies (uncommon)
virus
Most common intrauterine virus infection:
Cytomegalic Inclusion Human o Liver and spleen damage (Hepatosplenomegaly)
o Hear loss / Mental retardation (Microcephaly)
Disease (CID) Cytomegalovirus o Intracranial calcifations
o Fetal death
Neonatal Herpes Herpes Simplex Delivery via an Can be prevented by delivery via C-Section If untreated CNS dissemination with
Type II infected birth canal Rapid Dx: Direct immunofluorescence
high mortality rate
Listeria
A relatively common cause of newborn meningitis (Listeriosis)
monocytogenes
Neonatal Meningitis Streptococcus

agalactiae Leading causes of neonatal meningitis
Escherichia coli
Streptococcus
Bacterial blood stream infection (septicemia) High mortality rate
agalactiae
Neonatal Sepsis
Escherichia coli Sepsis due to lack of IgM
Neisseria
Opthalmia Neonatorum gonorrhoeae Delivery via an Purulent conjunctivitis : Red eyes / pus discharge / Appear 4-10 days after birth
(Neonatal conjunctivitis) Chlamydia infected birth canal swelling of eye-lids If untreated blindness
trachomatis
BLOOD INFECTIONS

DISEASE ORGANISM
TRANSMISSION
Ixodes tick-bite Fever / fatigue / RBCs infection Erythrocyte lysis

High RISK GROUPS: Splenectomized patients
Babesiosis Babesia microti (same ticks transmitting Diagnosis: Blood smear showing ring-like trophozoites Severe Hemolytic Anemia / Jaundice
Lyme disease)
within RBCs
Bacteremia
Bacteroids fragilis If introduced into abdominal cavity Peritonitis / abdominal abscesses (with foul-smell discharge)
Endogenous
Enterococcus (from colon)
Nosocomial infection in immunocompromised / ICU patients Intra-abdominal abscesses
faecalis / faecium
Pseudomonas Bacterial blood invasion Mainly in immunocompromised patients
aeruginosa through GI tract
Klebsiella Dissemination
pneumoniae
Candida: Dimorphic / Normal flora in skin / mouth / vagina / intestine
Candida albicans Systemic Candidiasis: Potentially life-threatening infection Multi-organ dissemination
Candidemia Candida tropicalis RISK GROUPS: Neutropenic cancer patients / patients on systemic corticosteroids / patients treated with
Candida glabrata broad-spectrum antibiotics / catheters (biofilm formation)
Diagnosis: Yeast / Hyphae / pseudohyphae (Germ tubes)
Signs and symptoms of malaria typically begin 8-25 days
following infection: Hemolytic anemia Jaundice
o Flu-like symptoms: Fever / headache / sweating
Splenomegaly / hepatomegaly
/ shivering / joint pain / vomiting / convulsions Hypoglycemia
Female Anopheles o Paroxysm (Malaria classic symptom) Renal failure
mosquito bite / Blood- Severe malaria with persistent high fever / orthostatic Respiratory distress
Malaria Plasmodium sp.
contaminated needles / hypotension is caused by P. falciparum Retinal damage
Affected areas: Tropical / subtropical regions Encephalopathy Coma
Blood transfusion
Diagnosis: Giemsa-stained blood smear showing ring- Capillary obstruction
Circulatory shock
like trophozoites within RBCs + cresent-like
Death
gametocytes (most sensitive test)
Chemoprophylaxis / Treatment: Chloroquine
Staphylococcus
aureus
Dissemination Mainly in immunocompromised patients
Proteus species
Food-borne (Dairy
Listeria
Septicemia products / ground meat / Listeriosis: Immunocompromised patients are most susceptible
monocytogenes
unpasteuralized milk)
Meningococcemia
Neisseria Respiratory droplets Waterhouse-Friderichsen Syndrome: Disseminated Intravascular Coagulation /
meningitidis followed by blood invasion o Acute septicemia + Adrenal hemorrhage circulatory collapse Fatal shock
o Seen mainly in young children
The parasite is relatively protected from attack by the body's immune system because for most of its human life cycle it resides within the liver and blood cells and is
relatively invisible to immune surveillance. However, circulating infected blood cells are destroyed in the spleen. To avoid this fate, the P. falciparum parasite displays adhesive
proteins on the surface of the infected blood cells, causing the blood cells to stick to the walls of small blood vessels, thereby sequestering the parasite from passage through the
general circulation and the spleen.
Paroxysm - a cyclical occurrence of sudden coldness followed by shivering and then fever and sweating, occurring every two days (tertian fever) in P. vivax and P. ovale
infections, and every three days (quartan fever) for P. malariae. P. falciparum infection can cause recurrent fever every 36-48 hours or a less pronounced and almost continuous
fever
FEBRILE INFECTIONS

DISEASE ORGANISM
TRANSMISSION
Acute Streptococcus Aerosols from carrier / Autoimmune: 2-3 weeks post pharyngitis infection / Cross-reaction between heart/joint tissue antigens (e.g.
Rheumatic Fever pyogenes infected person myosin) and streptococcal antigens (M-protein)
African Trypanosoma First stage or haemolymphatic phase (multiplication in

Neurological or meningoencephalic phase:
Trypanosomiasis brucei Tsetse fly-bite subcutaneous tissues / blood / lymph): Fever / Headache
Lethary / Sleep cycle disturbance / Death
(Sleeping sickness) gambiense Diagnosis: Motile trophozoites in Giemsa-stained smears
American Granulomatous lesion at the site of entry

Trypanosoma Insect feces contaminating Cardiomyopathy
Trypanosomiasis Fever / Hepatosplenomegaly
cruzi conjunctiva / skin break Megacolon
(Chagas disease) Diagnosis: Motile trophozoites in Giemsa-stained smears
Brucellosis (Malta or Brucella Ingestion of unpasteurized Non-specific (flu-like) symptoms + Undulant fever Gastrointestinal / skeletal / neurological /
Mediterranean fever) melitensis milk from infected animals Depression cardiac / pulmonary infection
Colorado Tick Fever Tick bites / Two-staged fever Aseptic meningitis / Encephalitis /
Colorado Tick Fever Headache / general malaise / pain behind eyes
virus (Coltivirus) Blood transfusion Campers / young males / high mountain areas Hemorrhagic fever (rare)
BIPHASIC fever + Headache / Lymphadenopathy / Muscle
Dengue Fever virus pain / Macular rash (3rd - 5th day)

Dengue Hemorrhagic Fever
Dengue Fever Mosquito-bites SUSCEPTIBLE GROUPS: Children (50% mortality)
(Flavivirus) Dengue Shock Syndrome (Low BP)
Tropical regions: India / Southeast Asia / Central
America / Caribbean
Lassa Hemorrhagic Lassa virus Rodent (mice) excreta Fever / Nausea / Hepatitis
Fever (Arenavirus) (West Africa) Bloody diarrhea
Ingestion of food and water Alternative names: Infectious jaundice / Weils disease / Swineherds disease
Leptospirosis Leptospira First phase (1-2 weeks after infection) Fever + Jaundice / Hemorrhage / Tissue necrosis /
contaminated with infected
(Marsh fever) interrogans Kidney infection Organisms in urine
animal excreta Second phase: rise in IgM titer + Aseptic meningitis / hepatitis
Coxiella Aerosol inhalation of Acute flu-like illness (Fever / malaise / headache .. etc)
Atypical pneumonia
Q Fever Cattle raisers / Congenital heart diseases patients
burnetii infected animal secretions Endocarditis
Highly infectious / 50% asymptomatic
Flies (mosquito) bites / BIPHASIC fever Hemorrhagic fever / Hepato-renal failure /
Rift Valley Virus
Rift Valley Fever contact with blood of an Flu-like symptoms / Photophobia / Petechial rash Blindness / Encephalitis DEATH
(Bunyavirus) Sub-Saharan Africa / Epidemic: Egypt Kenya S. Africa
infected animal Abortion in animals
Arthropod-bite / Contact Flu-like symptoms: Fever / headache / chills / malaise / fatigue / anorexia
Tularemia Francisella
with infected animal Ulceroglandular tularemia: Painful papule at the site of bite Ulcerative skin lesion with necrotic center
(Rabbit fever) tularensis Lymphadenopathy Multi-organ involvement
tissues
Trench Fever Bartonella

Human body lice Severe headache / pain in long bones / 5-day fever interval (Homeless individuals)
(Five-day fever) quintana
Fever / Headache / Malaise
Yellow Fever Virus Jaundice (Very high transaminases levels) Hepato-renal failure
Yellow Fever Mosquito-bites Tropical rainforests of Africa / S. America (not found in Thrombocytopenia / Leucopenia
(Flavivirus) Systemic bleeding
Asia)
The surface of the trypanosome is covered by a dense coat of Variable Surface Glycoprotein (VSG). This coat enables an infecting T. brucei population to persistently evade
the host's immune system, allowing chronic infection.
Infected persons should be prohibited from blood donation of since the virus has the ability to live in blood cells for up to 120 days.
LYMPHADENITIS / LYMPH INFECTIONS

DISEASE ORGANISM
TRANSMISSION
Non-oncogenic retrovirus
Target: Helper T cells
Surface host cell receptor: CD4+ molecule
Sexually (found in seminal Site of virus persistence: Lymph nodes
Acquired Immune Human vaginal secretion) / Blood Acute phase (viremia):
o Lymphadenopathy
Deficiency Syndrome Immunodeficiency transfusion / Perinatally
o Clinically similar to infection mononucleosis LATENCY (Asymptomatic / diarrhea / weight loss)
(AIDS) Virus (HIV) (transplacentally / birth Acquired Immune Deficiency Syndrome:
canal / breastfeeding) o CD4+ count < 200/l + opportunistic infection (e.g. pneumocystis)
o Indications for a successful treatment: CD4+ count + viral load
o Dx: RT-PCR (most sensitive) / ELISA for p24 (CA) antigen / ELISA for HIV Abs (if positive with no risk
factors for exposure, repeat test for second time)
Human T-
Adult T-cell Sexual contact / Blood Rare and often aggressive (fast-growing) T-cell lymphoma that can be found in the blood (leukemia), lymph
Lymphotropic Virus
Leukemia / Lymphoma transfusion nodes (lymphoma), skin, or multiple areas of the body
Type I (HTLV-1)
Bartonella Small abscesses (at scratch site)
Cat Scratch Disease Cat scratch
henselae Fever / localized lymphadenopathy (Enlarged painful lymph nodes)
Histoplasmosis Histoplasma Inhalation of microconidia Primary infection: Acute self-limited pulmonary / chronic progressive fatal one (macrophage infection)
Disseminated infection: Invasion of liver / spleen / lymph nodes / bone marrow (reticuloendothelial cells)
(Cave disease) capsulatum in birds or bats droppings RISK GROUPS: AIDS patients in endemic areas (Kentucky, US)
Fever
Epstein-Barr virus Saliva Pharyngitis
Infectious Lymphadenopathy Episodes of asymptomatic virus shedding
Mononucleosis Human B-cell proliferation Atypical Lymphocytosis (carriers)
Body fluids Hepatosplenomegaly (with risk of spleen rupture)
Cytomegalovirus Incubation period: 1-2 months
Wuchereria
Lymphatic Filariasis Blockage of lymph flow Edematous arms / legs / scrotum
bancroft Mosquitoes-bite
(Elephantiasis) Diagnosis: Microfilariae in blood
Brugia malayi
Mycobacterium avium- M. avium / M. Lymphadenitis
Via gastrointestinal tract Most common systemic bacterial infection in AIDS-patients
Serious pulmonary diseases
intracellulare Infection intracellulare Fever / night sweats / chills
or lungs Chronic osteomyelitis
(MAI) (MAC) Weight loss / cough with sputum
Skin infections
Pasteurella Fever / localized cellulitis
Pasteurellosis Cat / dog bite Bacteremia Osteomyelitis / arthritis
multocida Lymphadenopathy
Non-specific symptoms within 2-8 days after bite: When reaching lungs Pneumonic
o High fever / chills / headache / myalgia plague:
Infected flea-bite or
Plague Yersinia pestis Bubonic plague: Painful buboes in groin / axillae / neck o Highly contagious (person-to-
respiratory droplets Spread to blood Tissue hemorrhagic lesions
person respiratory droplets)
(Septicaemic plague) BP drops Fatal septic shock o Rapidly fatal if untreated
Replication Cycle: Entry by fusion RNA released in cytoplasm REVERESE TRANSCRIPTION DNA-RNA hybrid molecule Double-stranded DNA (provirus)
Nucleus Provirus integration with host chromosome Release by budding Host cell killed
PARASITIC WORMS - HELMINTHS

WORM CESTODES (TAPEWORMS) TREMATODES (FLUKES) NEMATODES (RINGWORMS)
Ribbon-like body consisting of a scolex (head) Elongated body tappered at both ends and
BODY DESCRIPTION Small flat leaf-like body
with hooks and suckers protected by a tough non-cellular cuticle
SEGMENTATION Segmented into many proglottids Non-segmented
Absent Present but simple Present and complete

DIGESTIVE SYSTEM
(absorb soluble nutrients directly through cuticle) (sac with a mouth) (includes mouth / intestine / anus)
SEXES Hermaphrodites Hermaphroditic or separate (blood flukes) Separate
Snail + Fish or crustacean (hermaphroditic flukes)

INTERMEDIATE HOST
Only freshwater snail (blood flukes)
INFECTION Primarily intestinal infections Intestinal veins / urinary bladder / liver / lung Can infect almost any part of the body
Taenia Fasciola Ascaris

EXAMPLES
Echinococcus Schistosoma (blood flukes) Ancylostoma
HERPES VIRUSES
HERPES SIMPLEX TYPE I HERPES SIMPLEX EPSTEIN-BARR VIRUS HUMAN CYTO-MEGALOVIRUS VARICELLA-ZOSTER
(HSV-1) TYPE II (HSV-2) (EBV) (HCMV) VIRUS (VZV)
B lymphocytes Non-neural tissues (lympho-reticular Sensory nerve ganglia
LATENCY Trigeminal ganglia Sacral / lumbar ganglia
(Lymph nodes) cells / glandular tissues) (trigeminal / dorsal root)
ELISA for IgM / IgG seroconversion
Monospot test:
T. Culture (several days) / immunofluorescence (24 hrs) / PCR for (distinguish primary from recurrent T. Culture (several days) /
Positive Heterophile Ab
DIAGNOSIS HSV-1 nucleic acids in CSF can aid in diagnosing cases of infection) / urine culture (3 weeks) immunofluorescence (24 hrs) /
Ag detection:
encephalitis (Distinguishing feature: absence in situ hybridization (more rapid)
EA / VCA / EBNA
of Heterophile Abs)
Varicella: ACYCLOVIR / ASFAM-
GANCICLOVIR + FOSCARNET
CICLOVIR / VALACYCLOVIR
TREATMENT ACYCLOVIR* / PENCICLOVIR (topical) No specific treatment (Acyclovir is ineffective as HCMV lacks
Zoster: ACYCLOVIR /
thymidine kinase activating it)
FAMCICLOVIR
Known as Herpes Virus
Known as Herpes Virus type 5 /
type 4 / Causes neoplasms Known as Herpes Virus type 3 /
Relatively slow replication cycle /
REMARKS (Burkitt lymphoma / Hodgkin Inclusion in lungs with pneumonia:
Inclusion bodies: Owls Eye
disease / Nasopharyngeal Cowdry A inclusion bodies
(Multinucleated giant cells)
carcinoma)
* Guanosine analogue (Interfere with viral DNA elongation): Acyclovir (inactive) VIRAL THYMIDINE KINASE (HSV-1/2 / VZV) Phosphorylated acyclovir (ACTIVE form)
Guanosine analogue (Interfere with viral DNA elongation): Ganciclovir (inactive) VIRAL KINASE (HCMV) Phosphorylated ganciclovir (ACTIVE form)
Inhibits the pyrophosphate binding site on viral DNA polymerases
TREPONEMAL DIAGNOSTIC SEROLOGY TESTS

NON-TREPONEMAL ANTIBODIES ANTI-TREPONEMAL ANTIBODIES TESTS
(CARDIOLIPIN-BASED) TESTS (CONFIRMATORY TEST)
Reagin directed against cardiolipin
ANTIBODIES Specific antibodies directed only against treponemal surface proteins
(a normal phospholipid component of mammalian membranes)
VDRL / RPR / TRUST

EXAMPLES OF TESTS FTA-ABS / TPHA (or MHA-TP)
(The test become positive in 2-3 weeks after initial infection)
SPECIFICITY Non specific Highly specific
Yes... in case of auto-immune diseases or other infections

FALSE POSITIVE RESULTS May be
(e.g. malaria / measles / hepatitis etc)
USEFULNESS IN Useful since reagin antibodies usually disappear after about one year Not useful since these tests remain positive for many years even after
MONITORING TREATMENT of successful treatment effective treatment
COST Low cost High cost

Some pateints, especially those with autoimmune diseases, will still have both of the non-specific (RPR) and specific tests (FTA) positive even if they dont have
IMPORTANT syphilis. The resolution of such condition can be done by either performing PCR for T. pallidum or by Treponema pallidum immobilization (TPI) test. In this test, an
NOTICE antibody other than Wassermann antibody is present in the serum of a syphilitic patient; in the presence of complement, the patient's serum causes the immobilization
of actively motile Treponema pallidum obtained from testes of a rabbit infected with syphilis.
BACTERIAL ANTIBIOTICS
CLASS SUB-CLASSES: SUSCEPTIBLE BACTERIA: REMARKS:
Clostridium perfringens Doxycycline is also useful in high doses
Clostridium tetani Given with tetanus immune globulin / sedatives / muscle relaxants
Given in combination with aminoglycoside

Enterococcus species
Vancomycin is used for resistant strains
Staphylococcus saprophyticus Sensitive to most antibiotics
Streptococcus pneumoniae Ceftriaxone / Vancomycin are used for resistant strains

PENICILLIN Penicillin G
Streptococcus pyogenes (GAS) A macrolide can be used as an alternative in penicillin-allergic patients
Aminoglycoside is added for life-threatening infections

Streptococcus agalactiae (GBS) Given intravenously to pregnant women 4 hours before delivery to reduce
GBS infection to the fetus
Treponema pallidum Tetracyclines / Erythromycin are used for penicillin-allergic patients
Leptospira interrogans Doxycycline is also useful
Second generation drugs

CEPHALOSPORINS Escherichia coli Given with gentamicin for cases of meningitis
(Ceftriaxone / Cefotaxime)
TETRACYCLINES Doxycycline Effective in early stages of Lyme disease
Amoxicillin or cephalosporins can be also used
Brucella species Prolonged therapy (6 weeks) given with rifampin

Erythromycin is also a good agent often used in young children
Chlamydia pneumoniae
Chlamydia psittaci
For young children and pregnant women, erythromycin is used
Chlamydia trachomatis For newborns at high risk, erythromycin or silver nitrate (ointment / eye
drops) is used as a prophylaxis
Francisella tularensis Given with streptomycin / gentamicin
Rickettsia rickettsii Effective in early stages of the illness
Bordetella pertussis Trimethoprim-sulfamethoxazole for treatment failure

Erythromycin
MACROLIDES A single dose of horse serum antitoxin is necessary in inactivating any
Azithromycin Corynebacterium diphtheriae
circulating unbound toxin
Effective in early stages of cutaneous anthrax
Bacillus anthracis
Multidrug therapy is recommended in pulmonary anthrax
Ciprofloxacin
FLUOROQUINOLONES Campylobacter jejuni Erythromycin for resistant strains
Levofloxacin
(DNA gyrase inhibitors) Escherichia coli Effective against uropathogenic and enteropathogenic strains
(Prohibited in children)
Shigella species Azithromycin can also help in reducing the duration of illness
Clostridium difficile Metronidazole is added for severe cases
Vancomycin continues to be the drug of choice for most MRSA infections

Vancomycin Methicillin-resistant
GLYCOPEPTIDES Extended use of vancomycin for MRSA lead to the appearance of
(Nephrotoxic drug) Staphylococcus aureus (MRSA)
vancomycin-intermediate Staphylococcus aureus (VISA)
Staphylococcus epidermidis Vancomycin-resistant isolates have been reported
ANTI-FUNGAL DRUGS
DRUG TYPE MODE OF ACTION INDICATIONS SIDE EFFECTS
May bind to cholesterol in human cell
Binding with Ergosterol Systemic infections
Amphotericin B Polyenes membranes / Nephrotoxic causing
Fungal cell lysis (cryptococcal meningitis)
severe irreversible kidney damage
May inhibit many mammalian cytochrome
Inhibition of P-450 14-alpha demethylase
Imidazoles / Triazoles Azoles Candidal infections P450-dependent enzymes involved in
Blockage of ergosterol biosynthesis
hormone synthesis or drug metabolism
Terbinafine Allylamines Inhibition of squalene epoxidase Dermatophytes
Tolnaftate Thiocarbamates Blockage of ergosterol biosynthesis (ringworm infections)
Inhibition of Glucan biosynthesis Systemic infections

Caspofungin Echinocandins
Cell wall damage (immunocompromised patients)
Diarrhea / nausea / vomiting / bone

Flucytosine Antimetabolites Inhibition of DNA/RNA synthesis Systemic infections
marrow suppression
Nikkomycin / Polyoxin Targeting chitin synthase Not available in markets
Used for pregnant women with coccidioidomycosis to prevent risk of fungal dissemination
Should be used with care in early pregnancy (possible teratogenic effects)
Fungal resistance mechanisms: Over-expression or mutation in drug target / Alterations in uptake and metabolism / Alterations or decrease in ergosterol content /
Drug efflux pumps
IDENTIFICATION OF PATHOGENIC DIMORPHIC FUNGI

FUNGUS MORPHOLOGY IN ENVIRONMENT MORPHOLOGY IN TISSUES
Coccidioides immitis Septated hyphal filaments + barrel shaped arthoconidia (HAZARDOUS) Large spherules filled with many endospores
Blastomyces dermatitidis Septated hyphae with globose conidia on stalks Large yeast cells with broad-based buds
Histoplasma capsulatum Septated hyphae with tuberculate macroconidia + small microconidia Small oval budding yeasts in reticulo-endothelial cells
Paracoccidioides brasiliensis Septated hyphae with round conidia Central fungal cell with a series of buds (Wheel-spokes)
EXPECTED CSF FINDINGS IN MENINGITIS
PREDOMINANT CELLS PROTEIN LEVEL GLUCOSE LEVEL OPENING PRESSURE STAINING
BACTERIAL Neutrophils (PMN) H L H Gram-stain
Early: Neutrophils
VIRAL N or slightly H N N or slightly H -
Late: Lymphocytes
FUNGAL India-ink
Lymphocytes H L H
TUBERCULAR Acid-fast
VACCINES
PATHOGEN VACCINE TYPE REMARKS
New FDA approved

Adenovirus (Type 4/7) LIVE unattenuated vaccine
For oral administration by military personnel
Rotavirus Given orally for infants
For routine childhood immunization and immunodeficient adults

Varicella-Zoster virus
Zostavax (High-potency version)
Measles virus
LIVE attenuated vaccines For routine childhood immunization
Mumps virus Administered in the form of Measles-Mumps-Rubella (MMR) vaccine
Not to be given to pregnant / immunocompromised / young babies
Rubella virus
BCG (Bacillus CalmetteGurin) vaccine is prepared from a strain of the attenuated

Mycobacterium tuberculosis
(virulence-reduced) live bovine tuberculosis bacillus, Mycobacterium bovis
Influenza virus LIVE ATTENUATED or KILLED vaccine Should contain the specific subtypes of the virus present in population
Poliovirus LIVE ATTENUATED (Sabin) or KILLED (Salk) vaccine USA now only uses the killed type
Rabies virus KILLED HDCV vaccine Given as a pre-exposure prophylaxis for high risk individuals (Vets)
Yersinia pestis Formalin-KILLED vaccine For high risk individuals
Recommended for all children age 12 months and older, for travelers to certain
Hepatitis A virus Formaldehyde-KILLED vaccine
countries, and for people at high risk for infection with the virus
Corynebacterium diphtheriae Diphtheria Toxoid
Clostridium tetani Tetanus Toxoid Given in combination as DTP triple vaccine
Bordetella pertussis KILLED or acellular purified proteins vaccine
Bacillus anthracis Cell-free vaccine Given to workers in high risk occupations

Hepatitis B virus Recombinant HbsAg vaccine For routine infant immunization and adults in healthcare professions
Borellia burgdorferi Recombinant B. burgdorferi outer surface protein vaccine No longer available (withdrawn from market)
Pneumovax is 23-valent polysaccharide vaccine (PPVSV23) that is currently

recommended for use in all adults who are older than 65 years of age and for
Streptococcus pneumoniae Pneumococcal capsular polysaccharide vaccine
persons who are 2 years and older and at high risk for disease (e.g., sickle cell
disease, HIV infection, or other immunocompromising conditions)
Haemophilus influenzae Conjugated capsular polysaccharide type b (Hib) vaccine For routine infant immunization
Quadrivalent conjugated capsular vaccine

Neisseria meningitidis Recommended for adolescents and young adults
targeting serogroups A, C, W-135 and Y
Capsid proteins of types 16-18 (High risk types) Recommended for both young females and males to prevent HPV-associated
Papillomavirus
and types 6-11-16-18 vaccine cancers
DEFINITIONS:
An attenuated vaccine is a vaccine created by reducing the virulence of a pathogen, but still keeping it viable (or "live").
An inactivated vaccine (or killed vaccine) consists of virus particles which are grown in culture and then killed using a method such as heat or formaldehyde.
A toxoid is a bacterial toxin (usually an exotoxin) whose toxicity has been inactivated or suppressed either by chemical (formalin) or heat treatment, while
other properties, typically immunogenicity, are maintained.
HEPATITIS B RESULTS INTERPRETATION

HBsAg HBeAg Anti-HBcAg IgM Anti-HBcAg IgG Anti-HBsAg
ACUTE + + + - -
CHRONIC + + - + -
RESOLVING
(window period of acute - - + - -
infection)
RESOLVED - - - + +
VACCINATED - - - - +
NON-VACCINATED - - - - -
LATENT VS. ACTIVE TUBERCULOSIS

Latent TB Infection Active TB Infection
Skin / Blood Test Positive Positive
Chest X-Ray Normal Abnormal
Sputum / Culture Negative Positive
Disease Symptoms Absent Present
Present in body and active

Presence of TB Bacteria Present in body but inactive
(reproducing and spreading)
Possibility of Infecting Others Not possible Possible
Treatment Required to prevent conversion to active disease Required to treat the active disease
A person who is exposed to TB may not necessarily develop the disease. Most people are able to fight the infection using various components of their
immune system. In fact, healthy people who are infected with TB only have a 10% chance of converting to active disease over their lifetime. Some are able to
control the infection, but unable to completely remove it from their bodies. In these cases, the infection remains, lying in an inactive or latent state. This is often
described as Latent TB Infection or LTBI. LTBI may develop into active disease someday, often when the person's immune system becomes weakened.
Tuberculin Skin Testing
The Mantoux tuberculin skin test (TST) is the standard method of determining whether a person is infected with Mycobacterium tuberculosis. It is
performed by injecting 0.1 ml of tuberculin purified protein derivative (PPD) into the inner surface of the forearm. The injection should be made with a tuberculin
syringe, with the needle bevel facing upward. The TST is an intradermal injection. When placed correctly, the injection should produce a pale elevation of the
skin (a wheal) 6 to 10 mm in diameter.
The skin test reaction should be read between 48 and 72 hours after administration. A patient who does not return within 72 hours will need to be
rescheduled for another skin test. The reaction should be measured in millimeters of the induration (palpable, raised, hardened area or swelling). The reader
should not measure erythema (redness). The diameter of the indurated area should be measured across the forearm (perpendicular to the long axis).
Skin test interpretation depends on two factors:

Measurement in millimeters of the induration
Persons risk of being infected with TB and of progression to disease if infected
Classification of Tuberculin Skin Test Reaction
Considered As Positive Reaction In The Following Groups:
HIV-infected persons
A recent contact of a person with TB disease
Induration of 5 or more millimeters Persons with fibrotic changes on chest radiograph consistent with prior TB
Patients with organ transplants
Persons who are immunosuppressed for other reasons
Recent immigrants (< 5 years) from high-prevalence countries

Injection drug users
Residents and employees of high-risk congregate settings
Induration of 10 or more millimeters Mycobacteriology laboratory personnel
Persons with clinical conditions that place them at high risk
Children < 4 years of age
Infants, children, and adolescents exposed to adults in high-risk categories
Induration of 15 or more millimeters Any person with no known risk factors for TB
False-positive reactions:
Some persons may react to the TST even though they are not infected with M. tuberculosis. The causes of these false-positive reactions may include, but are not
limited to, the following:
Infection with nontuberculosis mycobacteria

Previous BCG vaccination
Incorrect method of TST administration
Incorrect interpretation of reaction
Incorrect bottle of antigen used
False-negative reactions:
Some persons may not react to the TST even though they are infected with M. tuberculosis. The reasons for these false-negative reactions may include, but are
not limited to, the following:
Cutaneous anergy (anergy is the inability to react to skin tests because of a weakened immune system)
Recent TB infection (within 8-10 weeks of exposure)
Very old TB infection (many years)
Very young age (less than 6 months old)
Recent live-virus vaccination (e.g., measles and smallpox)
Overwhelming TB disease
Some viral illnesses (e.g., measles and chicken pox)
Incorrect method of TST administration
Incorrect interpretation of reaction
DNA Viruses
Double-stranded DNA Incompletely dsDNA Single-stranded DNA
Double-stranded RNA Viruses
Circular DNA Circular DNA Linear DNA
Papovaviridae Hepadnavirida Parvoviridae

Papillomaviruses e (Erythrovirus)
Parvovirus B19
Polyomaviridae
BK polyomavirus
JC polyomavirus
Linear DNA
Adenoviridae
Adenoviruses
Herpesviridae
Epstein - Barr virus
Herpes simplex type 1
Herpes simplex type 2
Human cytomegalovirus
Human herpesvirus type
6
Human herpesvirus type
Poxviridae All DNA viruses replicate in the host cell nucleus EXCEPT poxviruses
Vaccinia virus All Herpes viruses can enter a latent state following primary infection, to
Smallpox (Variola) be reactivated at a later time
Molluscum contagiosum
Segmented RNA
Single-stranded RNA Viruses
Reoviridae
(NEGATIVE sense)
(Rotavirus)
Rotaviruses
(Coltivirus)
Colorado Tick Fever virus
(10-12 segments)
Non-segmented RNA Segmented RNA

Circular RNA Orthomyxoviridae
Influenza virus
Delta Virus (8 segments)
Hepatitis D virus
Bunyaviridae
Linear RNA Rift Valley virus
La Crosse virus
California Encephalitis
Paramyxoviridae virus
Measles virus
Mumps virus
Parainfluenza virus Arenaviridae
Respiratory syncytial Lassa virus
virus Lymphocytic
choriomeningitis virus
Rhabdoviridae (2 segments)
(Lyssavirus)
Rabies virus
All RNA viruses replicate in host cytoplasm EXCEPT influenza viruses

Filoviridae (-)ssRNA viruses require viral RNA polymerase within the virions
Ebola virus (-)ssRNA viruses are enveloped viruses
Single-stranded RNA Viruses (POSITIVE sense)
Retroviridae Picornaviridae
(Lentivirus) (Enterovirus)
Human Immunodeficiency virus Coxsackievirus A
(Deltaretrovirus) Coxsackievirus B
Human T-lymphotropic virus Type 1 Enterovirus 71
Poliovirus
(2 copies / virion)
Echovirus
Rhinovirus
Togaviridae
(Hepatovirus)
(Alphavirus) Hepatitis A virus
Chikungunya virus
Eastern Equine Encephalitis virus Hepeviridae
Western Equine Encephalitis virus Hepatitis E virus
Venezuelan Equine Encephalitis virus
(Rubivirus)
Rubella virus Astroviridae
Human Astrovirus
Flaviviridae
Hepatitis C virus Calciviridae
Dengue Fever virus
(Norovirus)
Yellow Fever virus Norwalk virus
West Nile virus
St. Louis Encephalitis virus
Coronaviridae (+)ssRNA viruses: Genomic RNA serve as a messenger RNA

HIV has 2 copies of RNA / virion (DIPLOID)
Coronavirus
Both HIV and HBV have a reverse-transcriptase enzyme
All Togaviruses are arthropod-borne EXCEPT Rubella virus
All Flaviviruses are arthropod-borne EXCEPT Hepatitis C virus

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GENERAL FEAUTURES OF MEDICALLY IMPORTANT BACTERIA

Bacillus Soil / infected animal

Clostridium Normal flora of

Clostridium Soil sediments / (ANAEROBICALLY)

Clostridium tetani Soil (spores)

Bordetella (singles or pairs) Ciliated epithelia of upper Regan-Lowe Agar

Klebsiella Non-motile Normal flora of mouth /

Leptospira Long / Spiral / Rods Highly Motile Wild / domestic animals

Treponema NEGATIVE Human genitals

Chlamydia Obligate intracellular parasites

Mycoplasma Normal flora of human RARELY CULTURED

Yersinia pestis BIOPOLAR staining

Colorless / Pale POSITIVE GLUCOSE

Mycoplasma Complement fixation test

VIRULENCE FACTORS OF MEDICALLY IMPORTANT BACTERIA

FACTOR CAPSULE PILI FLAGELLA ENZYMES TOXINS SPORES OTHER

Staphylococcus SLIME BIOFILM formation

Mucinase (degrades gastric

Not all strains of Haemophilus influenzae produce capsules.

Tuberculosis pathogenic mechanism: Cell-mediated hypersensitivity

Vibrio cholerae is susceptible to acids and non-invasive.

Mycoplasma pneumoniae has a 3-layer cell membrane containing sterols.

TOXIN ORGANISM TYPE MODE OF ACTION EFFECT REMARKS

Anthrax Edema Factor Elevation of intracellular cAMP Severe edema

CAUSATIVE DISEASE DESCRIPTION /

Decreased mucus production in stomach

Entamoeba Ingestion of cysts in Colonic ulcerations Bloody stool

Ascariasis Ascaris Abdominal symptoms / May be asymptomatic Intestinal obstruction

Biliary duct fibrosis and hyperplasia Biliary duct obstruction

Enterobiasis Enterobius Itching in anal area (perianal pruritus)

Mild duodenal infection / 10-days incubation period / Children / Traveler diarrhea

Ingestion of larvae in Diarrhea / Mostly asymptomatic

Usually asymptomatic (<100 worms)

CAUSATIVE CONTAMINATED CLINICAL MANIFESTATIONS /

Bacillus cereus Ingestion of preformed

E. COLI INTESTINAL INFECTIONS

VIRAL DIARRHEAL INFECTIONS

VIRUS EPIDEMIOLOGY CLINICAL MANIFESTATIONS DIAGNOSIS

Infantile gastroenteritis (serotypes 40-41)

Watery diarrhea Appear as star-shaped particles

VIRUS HEPATITIS A HEPATITIS B HEPATITIS C HEPATITIS D HEPATITIS E

Classification Picornavirus (Hepatovirus) Hepadnavirus Flavivirus Delta virus Hepevirus

Chronic carriers No Yes Yes with liver cirrhosis Yes No

RESPIRATORY TRACT INFECTIONS

Acute Febrile RISK GROUPS: Infants / children

Inhalation of conidia in Non-invasive / less severe

Atypical Pneumonia Inhalation of dust

Catarrhal phase: Non-specific symptoms / Dry cough Encephalopathy / Seizures

Haemophilus Blood dissemination Systemic / CNS

Staphylococcus Necrotizing / severe pneumonia

Pneumonia Respiratory droplets

Streptococcus Endogenous or exogenous

CAUSATIVE DISEASE DESCRIPTION /

Blastomyces Primary infection: Asymptomatic / mild pulmonary

Skin breach from Caused by dematiaceous fungi

Erysipales Streptococcus Fiery-red erythema (face / lower limbs)

Corynebacterium Uniform brown-colored patches (groin / armpits / under breasts)

Localized abscesses (usually on feet) pus / serum /

Painful oral ulcers + intense throat swelling

Pseudomonas Skin penetration /

Necrotizing Streptococcus Invasive infection

Fever + Oropharyngeal vesicular ulcers

Paracoccidioidomycosi Paracoccidioides Primary infection: Asymptomatic / mild pulmonary

Tender / edematous / erythematous nail infection + purulent discharge