Organism Disease/Condition Notes

Adenovirus Pharyngoconjunctivitis Adenoviral ―pink eye‖ is not purulent

Keratoconjunctivitis (unlike the bacterial pink eye)
Interstitial pneumonitis
Adenovirus 40 & 41: the most serious interstitial pneumonitis in
Gastroenteritis immunocompromised px  ARD

Anesaki spp. Gastritis, gastric ulcer, gastric MOT: fondness of eating raw fish (e.g.
CA Japanese restaurant)
TX: fiberoptic gastroscopy with forceps
extraction of the mass containing the worm

Ascaris lumbricoides Ascariasis Giant intestinal worm

Loeffler’s pneumonitis
(a.k.a. eosinophilic
pneumonia)
Obstruction to the gallbladder
and appendix
Largest of the intestinal nematode
Female is bigger than the male
“wandering” behavior: larvae hatch and
attach in the small intestine, migrate to the
bloodstream, lungs,
alveoli (heart-lung migration)

Anemia, intestinal obstruction,  the ―scariest‖ intestinal worm

malnutrition  ―tram way appearance‖ in xray
 MC in the Philippines
 DOC: Mebendazole/Pyrantel pamoate

Aspergillus fumigatus Aspergillosis Tissue form: dichotomously branching

hyphae
3 forms:
Invasive pulmonary aspergillosis
Aspergilloma (fungus balls)
Otomycosis (especially in elderly diabetic:
looks like cotton balls)

Babesia microti Babesiosis MOT: ixodes tick bite  hemolytic disease

(commonly misdiagnosed as
malaria due to its malaria-like
symptoms)
“maltese cross” appearance on blood smear
Common names of the disease include Texas
cattle fever, redwater fever, tick fever, and
Nantucket fever
Tx: Atovaquone and Azithromycin

Bacillus anthracis Cutaneous anthrax Gram (+), non-motile, rectangular, aerobic,

Pulmonary anthrax
Gastrointestinal anthrax
rod-shaped bacterium with square ends
toxins: Lethal Toxin and Oedema Toxin
Black, necrotic lesion: eschar
Microscopic: locks of matted hair called
“medusa head” appearance
Growth in the presence of penicillin: inverted
fir tree and string of pearls appearance

Balantidium coli Largest protozoan ciliophora

The only ciliate that parasitizes man
DOC: Iodoquinol

Bartonella henselae ―Cat-scratch fever‖ Inoculation lymphoreticulosis

Subacute regional lymphadenitis
Foshay-Mollaret syndrome
 BK virus Kidney disease associated
(a Papovirus with kidney transplant
Polyomavirus)

Blastom yces Blastom ycosis Tissue form: broad-based single budding

dermatitidis North American yeast cell
Blastom ycosis
Chicago disease
Gilchrist‘s disease

Bordetella pertussis Whooping cough Adenylate cyclase toxin

Secondary bacterial
pneumonia (Complication)
Pertussis toxin
Tracheal cytotoxin
 Catarrhal – infective stage
Bordet-Gengou medium: bisected pearls or
mercury drops with aluminum paint
Humans (even vaccinated) are the only
reservoir

Borrelia burgdorferi Lyme disease MOT: ixodes tick bite

Brucella abortus Brucellosis  Undulant fever; influenza-like disease

Brucella canis GUT infection of goats, pigs,
Brucella melitensis cattle
(a.k.a. Bang‘s disease,
Crimean fever, Gibraltar fever,
Malta fever, Maltese fever,
Mediterranean fever, rock
fever, Relapsing fever)
 MOT: direct mucosal contact,
traumatic skin implantation, ingestion
of unpasteurized dairy products
 Occupational hazard for veterinarians,
farmers, slaughterhouse workers

Brucella suis May be associated with

depression that lasts for many
years

Brugia malayi Malayan lymphatic filariasis Seen more in children than adults
 Elephantiasis is below the knee, not
the whole lower extremity
Has a more rapid course
MOT: bite of anopheles, aedes, culex and
mansonia
 Lab diagnosis: Thick and thin blood
smear (taken at close to midnight)
(NOTE: only thick blood smear for W.bancrofti)
DOC: Diethylcarbamazine (DEC)
Alternative: Ivermectin

Campylobacter jejuni Acute enteritis  Oxidase (+), microaerophilic

 ―nose to nose‖ pairs that look like
flying seagull wings or ―Gull Wings‖
 MOT: ingestion of raw or undercooked
poultry
 Skirrow‘s or Campy or Butzler‘s
medium at 42˚C
 Self-limiting
  Arthritis or Guillain Barre as sequelae

Capillaria Barrel-shaped or peanut shaped

philippinensis Bipolar plugs; thick egg shell with radial
a.k.a. striations
small whipworm or Natural host: fish-eating birds
Pudoc worm Capillariasis Pathology: intestinal gurgling
DOC: Mebendazole
‖Borborygm y‖ Endemic: Luzon, Compostela valley, Bohol,
Leyte, Mindanao

Chilomastix mesnili  Shepherd’s crook

 Cyst: lemon or pear-shaped due to a
nipple-like protuberance
 Normal flora of colon and cecum

Chlam ydia Community-acquired

pneumoniae respiratory infection

st
Chlam ydia psittaci Psittacosis 1st week: mimics typhoid fever
nd
―parrot fever‖ 2 week: pneumococcal pneumonia 
(atypical pneumonia) meningitis, encephalitis, hepatitis, m yocarditis
Acquired from bird droppings
Tx: doxycycline/tetracycline

Chlam ydia Nongonococcal urethritis Obligate intracellular organism

trachomatis Trachoma
Inclusion conjunctivitis of the produces inclusion bodies that contain
newborn glycogen in tissue culture
Lymphogranuloma venereum
susceptible to sulfonamides

MC sexually transmitted organism

Clonorchis sinensis Clonorchiasis Chinese liver fluke

 Cholangiocarcinoma
Ingestion of raw or undercooked fish
Small brown, operculated eggs
DOC: Praziquantel

Clostridium botulinum Botulism Botulinum neurotoxin C2 and C3 toxins:

blocks release of acetylcholine  flaccid
paralysis

Clostridium difficile Pseudomembranous colitis Clostridium difficile toxins A and B

 Prolonged antibiotic treatment
grayish membrane
 DOC: Metronidazole
 Alt: Vancomycin

Clostridium Gas gangrene Alpha toxin (lecithinase)

perfringens Acute food poisoning Epsilon toxin
Anaerobic cellulitis Perfringolysin O
Subcutaneous emphysema ―Death March of Bataan‖
(+) crepitations on the skin

Clostridium tetani Tetanus Slender, Gram (+) rod

Tetanolysin
Tetanospasmin toxin: acts on the
cholinergic nerve endings to block the release
of inhibitory neurotransmitters glycine and
 gamma-amino butyric acid  synaptobrevin
unopposed muscle contraction and spasm

Toxin reaches CNS through the Renshaw

cell: spinal inhibitory neuron
Risus sardonicus
(opisthotonus: excitation of Trismus: the presentation in adults
extensors and flexors Poor suck: the earliest manifestation in
spasm exaggerated neonate
curvature)  “drum stick” or tennis racket
appearance of terminal spore
 punctured wound or laceration
 proliferates in devitalized tissues

only in the Phils: acquired from fish bones,

fish hooks, home deliveries, dental procedures
(unautoclaved instruments)

 DOC: Metronidazole,
not PCN G (a known inhibitory of GABA, just
like Tetanospasmin)
Heat stable; cannot survive in the presence of
oxygen (obligate anaerobe); hence,
hyperbaric oxygenation is part of the
management
Spores are very resistant to heat and usual
antiseptics (phenol); can survive autoclaving
at 121˚C for 10-15 minutes
Diagnosis: History and Clinical findings

Coccidiodes ―mariner pilot’s wheel‖ appearance

brasilienses

Coccidiodes immitis San Joaquin valley fever Barrel-shaped arthroconidia

Highest endemism: in semiarid areas

Corynebacterium Diphtheria Diphtheria toxin: inactivates EF-2 by ADP

diphtheriae ―bull neck‖ appearance due ribosylation
a.k.a. Loeffler‘s to marked adenitis ―Chinese letters‖ microscopic appearance
bacillus Pseudomembranous pharyngitis(grayish-
white): can bleed and cause asphyxiation and
death
Uses Tellurite agar/Loffler‘s medium for culture
Metachromatic granules (Babes Ernst
granules)

Stain: methylene blue

ELEK‘s test

Vaccine: DPT
DOC: Penicillin

Coxsakie A virus Hand, foot, mouth disease Herpangina: gray-white papulo-vesicles on

( H F MD ) anterior tonsillar pillars and tonsils, soft palate,
uvula

May also cause: meningitis, hemorrhagic

conjunctivitis

Coxsakie B virus Myopericarditis Chest pain, fever, m yalgia, fatigue, arrhythmia

Bornholm disease:
pleurodynia

Cryptococcus Cryptococcosis An encapsulated yeast cell

neoformans Meningitis  An opportunistic organism; almost
always associated with AIDS
 MOT: pigeon droppings and eucalyptus
trees
Stained by india ink preparation
Diagnosis: CALAS (cryptococcal antigen latex
agglutination serology)
DOC: Trimethoprim-Sulfamethoxazole

Cytomegalovirus Retinitis DNA Herpes virus

Interstitial pneumonitis in Mononucleosis-like in adults
immunocompromised MOT: placenta, sexual contact, blood

Inclusion bodies surrounded by a halo:

“owl’s eyes”
(NOTE: Giardia lamblia also has “owl’s eyes)

Dengue virus Break bone fever Vector: Aedes aegypti (with white speckles)
Gastrocnemius m yalgia
Periorbital edema
DEN-2 & DEN-3: the two ―Asian genotypes‖

Dientamoeba fragilis Dientamoebiasis  Cyst: binucleated

(abdominal pain, diarrhea,  A trichomonad: flagellated
weight loss, and fever)  Leaf-like appearance
 Large intestines

Diphyllobothrium Diphyllobothriasis  Fish tapeworm

latum Megaloblastic anemia 2˚  Longest of the tapeworms
to Vit.B12 def.  Rosette appearance of uterus
 Operculated eggs
 DOC: Praziquantel

Dracunculus Cyclops contain the infective larvae

medinensis No reservoir host
a.k.a. guinea worm TX: manual extraction
Give steroids, antibiotics and anti-tetanus
vaccine

Dracunculiasis

Echinococcus Unilocular hydatid cyst  Dog tapeworm

granulosus (a space occupying lesion that
contains fluid and numerous
protoscoleces)
(when the cyst ruptures 
anaphylactic reaction)
 Definitive hosts: sheeps & dogs
 Ingestion of sheep’s entrail
 Larvae: 60% in the ® liver
 Casoni skin test
 Protoscoleces: hydatid sand
 DOC: Albendazole  surgical

Echinococcus Alveolar echinococcosis Small fox tapeworm

multilocularis Migrates to the lungs

Echinostoma Echinostomiasis Garrison’s fluke

ilocanum (ulceration  bloody Has an oral sucker surrounded with
diarrhea) collarette of spines
Prevalent in Luzon, Leyte, Samar and
Mindanao
 Metacercaria encysted in snails

Eikenella corrodens The MC organism implicated in

“HUMAN bites”

(NOTE: in animal bites, it is usually Pasteurella

multilocida)

Entamoeba histolytica Amoebic liver abscess  Ingested RBC

Amoebic colitis  Ring and dot appearance of nuclei
Amoebic pericarditis (the  Quadrinucleate c yst
deadliest)  Anchovy paste
 Flask-shaped ulcer
 Right posterior lobe of liver: MC
affected lobe; via portal vein

Enterobius Enterobiasis Ingestion of eggs hatch small intestine 

vermicularis larvae are produced  migrate to the colon
(a.k.a. pinworm/ Pruritus ani
seatworm/ Female migrate to the anus at night
threadworm) (nocturnal): time to collect the specimen; close
to midnight

Notorious for AUTOINFECTION

MC in the U.S.A.

Diagnosis: “Scotch tape technique”

Graham Cellophane Method

DOC: Mebendazole or Pyrantel pamotae

Enterococcus Nosocomial infections Growth requirement: 6.5% NaCl (salty)

faecalis/faecium Peritonitis
(Group D) Biliary tract infection

Epstein Barr virus Infectious mononucleosis Infects by binding to CD21 molecules on

human B lymphoc ytes
“kissing disease” (hence common in 15-25
years old)
 Fatigue, pharyngitis/tonsillitis,
postcervical lymphadenopathy,
hepatomegaly, splenomegaly
(+)Reactive Downey type II cells (atypical
lymphocytes; thymus derived) and formation of
heterophile antibodies (unique to EBV
infections)
 Heterophile antibody test (Monospot)
or Paul Bunnel test: test for specific
EBV antibodies: early antigens (EA),
and viral capsid antigen (VCA) 
Other antigen: EBNA (EB nuclear antigen)

Escherichia coli MC cause of: Urinary tract  “greenish metallic sheen”

infections (UTI) colonies
Enterohemorrhagic Traveler's diarrhea:  The bacteriologic index of water
(EHEC) a.k.a. Shiga- (―Montezuma’s revenge‖) Escherichia coli toxins:
toxin-producing E.coli  Cytotoxic Necrotizing Factor (CNF),
(STEC) or Hemolytic-uremic syndrome: Heat-labile
Verocytotoxin E.coli 0157:H7  Enterotoxin (LT), Heat-stable
(VTEC) renal failure, microangiopathic  Cytolethal distending toxin (CLDT) and
Enterotoxigenic hemolytic anemia and  Shiga-like toxin 1 (ST-1)
(ETEC) thrombocytopenia
Enteropathogenic Meningitis in infants E.coli K1 Capsular Polysaccharide Antigen:
(EPEC) Diarrhea in infants
the antigen responsible for causing E.coli
Enteroinvasive Hemorrhagic colitis meningitis
(EIEC)
Enteroaggregative  Profuse diarrhea, high STEC (Shiga-toxin producing E.coli):0104 H4:
(EAEC) grade fever (Shigella- 2011 Germany E.coli outbreak; from sprouts of
Diffusely adherent like) fenugreek seeds
E.coli (DAEC) Source: Center for Disease Control and Prevention

STEC (O157:H7)  in organic spinach and

spring mix blend

Fasciola hepatica Fascioliasis Hepatica Sheep liver fluke

Sheep Liver Rot  “cephalic cone” with its shoulders
 HALZOUN’s disease: due to the
practice of eating raw sheep‘s liver
 Resides in biliary passages and
gallbladder
 Tx: Bithionol, Triclabendazole

Fasciolopsis buski Fasciolopsiasis  GIANT intestinal fluke

 largest intestinal fluke
 malabsorption VitB12 def
 ova appearance: Hen’s egg
 MOT: ingestion of metacercaria
encysted on freshwater vegetation
such as bamboo shoots or water
chestnuts

Francisella tularensis Ulceroglandular  Zoonotic (rabbits)

Tularemia
Fever, chills, mailaise and an
ulcerating papule at the
inoculation site
 MOT: animal blood into a cut/wound
while skinning the animal or
inhalation of aerosol
 Tick or deerfly bite
 Ingestion of meat

Giardia lamblia Giardiasis Falling leaf motility

Gay bowel syndrome
Smiling face with prominent owl‘s eyes
Habitat: jejunum, duodenum
(+) String test/enterotest capsule
DOC: Quinacrine, Metronidazole (for
trophozoite stage)

H1N1 type A Swine flu The new pandemic influenza virus

swine and human flu viruses further combined

with a Eurasian pig flu virus leading to the term
―swine flu‖

respiratory droplets ARDS

Tx: oseltamivir/zanamivir ASAP!

Haemonchus A very common parasite and one of the most

contortus pathogenic nematode of ruminants (horses,
a.k.a. red stomach cows, carabaos, sheeps, goats etc.)
worm, wire worm,
Barber poles
worm

Haemophilus ducreyi Chancroid Sexually transmitted

Appear as “school of fish” on Gram stain
Culture – the gold standard for diagnosis
Painful ulcerative lesion with a necrotic base
and ragged edge on the genitalia; referred as
the “soft chancre”

Haemophilus Epiglottitis
influenzae type b bacterial Meningitis
(Otologic meningitis)
Otitis media
Pneumonia, bronchitis
Helicobacter pylori Peptic and duodenal ulcer
disease
Gastritis
Risk factor for gastric
carcinoma (type 1 carcinogen)
Gastric B-cell lymphoma
HEPATITIS Hep A: asymptomatic
Hep B: the only DNA virus
 HBSAg: the ―surface‖
antigen; the first one
detected
 HBCAg: the ―core‖
antigen; the window
period
 HBeAg: period of
infectivity; a
qualitative marker
Hep C: blood transfusion;
HCV RNA= the most sensitive
indicator
 The most frequent
indication for liver
transplant
Hep D: requires co-infection
or superinfection with Hep B
Hep E: Enteric, expectant
mothers
Herpes Simplex HSV-1: gingivostomatitis,
keratoconjunctivitis,
meningitis
HSV-2: STD
(NOTE: chancre is a firm lesion seen in
syphilis)
DOC: single dose Azithromycin
1000mg/1gram or
Single IV dose of Ceftriaxone or
Erythrom ycin oral x 7 days
Phosphoribosyl phosphate capsule
Produces IgA protease
Culture on Chocolate agar medium
requires factors V (NAD) and X (hemin)
Urease (+) in urease breath test
Exhibits urease motility, mucinase invasive
Penetrates gastric mucous layer
Biopsy of the ulcer
Tx: {bismuth (used to be)} amoxicillin +
metronidazole+ clarithromycin +
omeprazole
 Fulminant hepatitis: the most feared
complication
Lamivudine: Tx for HepB (reverse
transcriptase inhibitor)
Interferon, Ribavirin: Tx for HepC
 Both HepB and Hep C can cause liver
CA, but B is the most prevalent
Dane particle: mature HepB virion
Sanded nuclei
Hep B: DNA hepadna virus
 More associated with fulminant
hepatitis than Hep C
DNA Herpes virus
HSV-1 usually above the waist; HSV-2 below
 Latent in the trigeminal nerve
 Recur periodically: cold sores or fever
blisters
 PCR on CSF- diagnostic method of
choice
 gladiatorum
 May infect finger: herpetic
whitlow
 MC cause of sporadic encephalitis
 Anti-HSV drugs (acyclovir) which
inhibits DNA polymerase, do not wipe
out latent infection
HSV-2 localizes in the sacral nerve ganglia
 Painful primary outbreaks
 Tingling prior to new outbreaks of
vesicular lesions which ulcerate
 Regional lymphadenopathy
 Screening test: Tzanck smear
Culture (isolation): the most definitive
Cowdry A bodies: multinucleated giant
cells

Heterophyes Heterophyiasis Minute “teardrop” intestinal fluke

heterophyes  Eggs filtered in the heart provokes
tissue reaction  cardiac failure
or cardiac beri-beri
Ingestion of undercooked or raw fish
DOC: Praziquantel

Histoplasma Histoplasmosis Ironically, NOT ENCAPSULATED

capsulatum Spelunker’s disease: Resembles PTB on xray: with apical infiltrates
Guano Can be acquired form caves
 “Bird droppings”
(NOTE: pigeon droppings are Cryptococcus
neoformans)

Hookworms Ancyclostoma duodenale (old Filariform larvae in soil penetrate the skin
world) “ground itch”
Enter the bloodstream and migrate to the
Necator americanus (new lungs
world) Become adult in the small intestine and attach
to the wall via teeth (ancylostoma) and
cutting plates (necator) blood loss 
microcytic (iron deficiency) anemia

Ancyclostoma caninum (dog “creeping reaction” : larvae penetrates the

hookworm) skin and migrate through subcutaneous tissue
causing this inflammatory lesion which is very
Ancyclostoma braziliense (cat pruritic
hookworm)
―wandering‖ larvae in the skin
―sandworms‖
CUTANEOUS LARVA MIGRANS
―plumber‘s itch‖
Parasite lacks the enzyme required to penetrate
through the basement membrane: hence, only
in the outer layer of the skin

DOC: Thiabendazole (oral or topical)

Alt: Albendazole, Ivermectin

th
Human Herpes virus HHV-6 6th disease; roseola infantum

HHV-8 Kaposi’s sarcoma

Primary effusion lymphoma
Castleman‘s disease
Test: PCR

Human Papilloma HPV1,2 & 4: plantar warts Condyloma acuminata (other name for
Virus anogenital warts)
(a Papovirus) HPV6 & 11: anogenital
warts, laryngeal warts in Koiloc ytes: enlarged keratinocytes with clear
children haloes around shrunken nuclei

HPV16 & 18: cervical Early proteins of oncogenic HPVs E6 & E7

intraepithelial carcinoma inactivate tumor suppressor functions of p53
and p110-Rb

DNA Papovirus

Human Parvovirus Erythema infectiosum Erythroid precursor

B19 Fifth disease DNA Parvovirus
“slapped cheek” May cause chronic anemia in
immunocompromised px
Aplastic crisis in sickle cell px
Hydrops fetalis
Clinical basis: PCR

Hymenolepsis nana Hymenolepsiasis  Dwarf tapeworm

 MC tapeworm in humans
 MC tapeworm in the Philippines
(endemic)
 Host: mice
 hermaphroditic
 DOC: praziquantel

Hymenolepsis Rat tapeworm

diminuta DOC: Niclosamide (very old drug for
tapeworms) or Quinacrine (newer)

Japanese Japanese B Encephalitis A member of Flaviviridae

encephalitis virus (+) single-stranded RNA virus in a capsid
Deafness, hemiparesis, emotional lability,
swelling of testicles
Vector: culex mosquito
Reservoir: domestic pigs and herons

JC virus Progressive multifocal Reactivation of the virus with the use of

(a Papovirus  encephalopathy (PML) immunosuppressive drugs: Rituximab,
Polyomavirus) Natalizumab, Efalizumab, among
immunocompromised or in AIDS patients

DOC: Mefloquine

Klebsiella pneumonia Capsule

pneumoniae “currant jelly sputum”
W ill also exhibit currant jelly colonies
Alcoholic‘s pneumonia

Legionella Legionnaire's Disease Necrotizing, multifocal pneumonia,

pneumophila Pontiac fever characterized by m yalgia, fever, headache,
diarrhea, and initially non-productive cough

Airconditioning/cooling towers systems

No human-to-human transmission

Leishmania donovani Visceral Leishmaniasis ―Black fever‖ or Dumdum fever

Kalaazar There is blackening of the skin (not found in
other strains); may be misdiagnosed as
malaria
Vector: Sandfly (Phlebotomus or Lutzom yia)
Zoonosis
DOC: Sodium stibogluconate
antimony compounds (Meglumine antimonite)
(NOTE: in the US, if infection is acquired from
india: DOC now is Amphotericin B (liposomal))
Post Kalaazar Dermal Initially, a small measle-like skin lesion on the
Leishmaniasis face  gradually ↑ in size  spread all over
(a secondary form after a the body  may coalesce to form a disfiguring
successful treatment)

Leptospira Leptospirosis
interrogans
(MC pathogenic) pre-Tibial fever, Canicola
fever, canefield fever
Leptospira biflexa Nanukayami fever, 7-day
(MC non-pathogenic) fever, Rat catchers‘ yellow
fever, Fort Bragg fever, Black
jaundice
Weil’s disease
(severe leptospirosis)
A hepatorenal condition with a
fast course
Listeria Listeriosis
monocytogenes Neonatal sepsis
(granulomatous infantiseptica)
Loa loa Loaiasis
Calabar swelling: a
hypersensitivity reaction that
causes transient localized
swelling and edema in the
subcutaneous tissue
swollen structure (resembling lepros y)  may
cause blindness if they spread to the eyes
Increase in the # of cases during rainy/typhoon
season; average of 680 cases/year
 Typically cultivated at 28˚C - 30˚C in
Ellinghausen-McCullough-Johnson-
Harris (EMJH) medium
(+) history of wading in floodwaters
Exposure to rat’s urine or infected tissue
 Entry is through break/abrasion on the
skin, intact mucous membrane, or
ingestion of contaminated food or
water
DOC: penicillin as treatment in children and
adults; also as prophylaxis for children;
because doxyc yline is a tetracycline; ‗cannot
be given to children
Mild infection: Dox yc yline
Severe infection: Penicillin G 1.5 million units
IV QID
Doxycycline (not routinely given)
as prophylaxis in adult (200mg, to be taken
two days before exposure, then once a week
for the duration of the exposure or travel to
endemic areas)
calf pain: swelling and vacuolation of
myofibrils and focal necrosis
vasculitis: damage to blood vessels 
capillary leakage
renal failure: MC cause of death in W eil‘s
disease;
 interstitial nephritis and tubular
necrosis
 organism migrates to interstitium,
renal tubules, tubular lumen
liver: centrilobular necrosis with proliferation of
Kuppfer cells
 hepatocellular dysfunction
conjunctival suffusion: looks like sore eyes
but no itchiness
chorioretinitis, very rare (more of CMV &
Toxopl.)
rhabdomyolysis hence there‘s elevated
CPK MM
Listeriolysin O toxin
 “tumbling motility” in broth
 “actin jet motility” in cells
Sources: unpasteurized milk products,
cabbage (coleslaw)
The only Gram (+) rod that has endotoxin
Attacks extremes of ages (neonate/elderly)
A tissue nematode
Pointed tail that contains nuclei
MOT: deerfly (mango fly) bite
Lab diagnosis: Blood smear – visualization of
microfilariae in the blood
(NOTE: if it is microfilariae – always do blood
smear)
Adult worms can be seen crawling on the
conjunctiva
Tx: Diethylcarbamazine and surgical excision
 of the worm in the eye

Mastigophora Villous atrophy

(flagellates) malabsorption, lactose
intolerance, steatorrhea

Measles virus 3 Cs : A param yxovirus

Cough Koplik’s spots
Coryza Complications: Giant Cell Pneumonia and
Conjunctivitis Subacute Sclerosing Panencephalitis (SSPE)

Vaccine: MMR

Metagonimus Metagonimiasis Japanese fluke or Yokogawai fluke

yokogawai Diarrhea and colick y
abdominal pain Adult worm: small, elongate, pyriform-shaped,
Eggs may embolize in the broadly rounded posteriorly and pointed
brain, sp. Cord, and heart anterior end

Ingestion of raw or undercooked fish

DOC: praziquantel

Molluscum Benign, pincushion-like, Large, eosinophilic cytoplasmic inclusion

contagiosum pink tumors with nipple-like bodies: ―molluscum bodies‖
(a Poxvirus) indentations

Mucor and Rhizopus Mucorm ycosis >90˚ branching

Common in px with ketoacidosis and leukemia
Typical px: diabetic with black nasal
discharges

Mycobacterium Leprosy Tuberculoid leprosy: characterized by a few

leprae (Hansen‘s disease) flat or slightly raised skin lesions of various
sizes that are typically pale or slightly red, dry,
hairless, and numb to touch (anesthetic)

Lepromatous leprosy: more generalized

disease, diffuse involvement of the skin,
thickening of many peripheral nerves, and at
times involvement of other organs, such as
eyes, nose, testicles, and bone

Leonine facies
Microscopic “pack of cigar” appearance

Cannot grow on artificial media; footpads of

armadillos and mice

DAPSONE: preferred bactericidal; not

Rifampicin

Mycobacterium Tuberculosis Lowenstein Jensen Middlebrook serpentine

tuberculosis growth
 Sputum culture: rough, dry and buff
colored
No serodiagnosis
Obligate aerobe, Niacin (+), Catalase (-)
@68˚C, Nitrate reduction (+)

Cord factor: its virulence factor

Sulfatides: responsible for caseous necrosis

Has a predilection for the apices of the lungs,

but in children, it is more on the middle to base
Mycoplasma Mycoplasma
pneumoniae (primary atypical) pneumonia
a.k.a. Eaton‘s agent
MC in young adults and
school aged children
Fever, malaise, headache,
hacking cough
Naegleria fowleri Primary Amoebic
(Acanthamoeba) Meningoencephalitis (PAM )
Cutaneous amoebiasis
Acanthamoeba keratitis
Neisseria Gonorrhea
gonorrhoeae
Ophthalmia neonatorum
Septic arthritis  knee pain
Cervicitis  PID
Urethritis, epididymitis in
males
Anorectal lesions
Pharyngitis in anal-oral sex
Neisseria meningitidis Meningococcal disease
including meningitis
W aterhouse-Friderichsen
syndrome
Onchocerca volvulus Onchocerciasis
Black river blindness
disease
Sclerosing keratitis
Mazzotti reaction:
a skin reaction that occurs in
humans when the
microfilariae of Onchocerca
volvulus in the cutaneous
sites are killed by the
administration of DEC;
onchocerca releases toxins
before it dies; manage with IV
methylprednisolone
“the walking pneumonia”
Requires cholesterol (sterol) for growth
(+) Cold agglutinin; obligate intracellular
organism
uses Eaton‘s agar for culture  ―fried egg”
appearance of colonies
(NOTE: fried egg appearance is also seen in
Oligodendroglioma, a brain tumor)
Smallest free-living bacteria
No cell wall; hence, not Gram stained; no
definite shape
Brain eating amoeba
In ponds, unchlorinated swimming pools
Headache, sz => unconscious after swimming
nd
2nd MC sexually transmitted organism
Oxidase (+); no capsule;
Virulent factors: Pili, IgA protease, OM
proteins, Endotoxin
Gram (-) “coffee bean” diplococci
Crede’s prophylaxis: 1% Silver nitrate
solution or 1% tetracycline ointment or solution
or 0.5% erythrom ycin drops withon one hour
after birth, as prophylaxis against opthalmia
neonatorum
 Thayer Martin agar
(NOTE: non-pathogenic strains of Neisseria do
not grow in Thayer-Martin)
 N. gonorrhea ferments glucose
 N. meningitides ferments maltose
DOC: Penicillin
Ceftriaxone 250mg IM for PCN resistant or
Spectinom ycin 2gm IM or Cefixime 400mg po
Both partners must be treated!
Capsule – it‘s major virulent factor
B & C are the MC serotypes
Fulminant meningococcemia + adrenalitis
Human nasopharynx is the only reservoir
 resp. spread
MC cause of meningitis in adults
Routine vaccination in military: YW CA vaccine
MOT: bite of a female black fly (genus
simuluim)
 Microfilaria in the eye causes
blindness
(NOTE: Chlamydia trachomatis is still the MC
infectious cause of blindness worldwide)
Adult worms are found in the subcutaneous
tissues; live 10-15 years; approximately takes
12 months to mature to adult form and
subsequent microfilariae
PE: “leopard skin”
TX: (depends on the stage)

Opportunistic Pneumocystis jiroveci
organisms in Pneumocystis carinii
Immunocompromised Mycobacterium tuberculosis
Mycobacterium avium
intracellulare
#1 cause of death in AIDS:
Pneumocystic pneumonia
#2: TB
#3: MAI pneumonia
Parainfluenza virus Laryngitis
Croup
(laryngotracheobronchitis)
Paragonimus Paragonimiasis
westermani Pulmonary distomiasis
Diarrhea, fever, cough,
hemoptysis, eosinophilia,
urticaria, hepatosplenomegaly
Pityrosporum ovale Malasezzia furfur
Pityriasis
Tinea versicolor
PRIONS Mad Cow disease
Scrapie (sheep/goat)
Kuru (cannibals)
Creutzfeldt Jakob disease
Gertsmann-Straussier-
Scheinker
Proteus vulgaris and Urinary calculi
mirabilis
Ivermectin: if still microfilaria stage, not adult
worms
Suramin: for adult worms and for those with
eye disease already
Infection with the organism is an AIDS–
defining disease
 MOT: droplet inhalation, close contact
 pneumonitis, spreading from hilar
areas
 Diagnosis: Transbronchial lung Biopsy
(careful! Always observe strict
universal precaution)
Gomori‘s Methanamine Silver stain  “flying
saucer” appearance of fungi
DOC: Trimethoprim-sulfamethoxazole or
Pentamidine (aerosol)
Steeple sign on Xray
Lung fluke
 Mimics pulmonary TB
Ingestion of raw or undercooked crab meat
or crayfish
 Adult worm: thick, fleshy, egg-shaped,
reddish-brown
 Eggs become encapsulated in the
lungs
DOC: Praziquantel
Hypopigmented spots on the chest and back
 Affected areas do not darken in the
s un
 Common among adolescent and in
young males
―lipid-dependent” – requires fat to grow 
with many sebaceous glands (dandruff,
itching)
“spaghetti and meatballs” appearance of
budding yeast cells and hyphae
No RNA or DNA; they are PROTEINS
Associated with ―spongiform
encephalopathy‖: common in mad cow‘s
and CJD  rapidly progressive dementia
MOT: unknown; hence observe universal
precautions when handling specimen
Produces urease, phenylalanine deaminase
 Alkaline urine: staghorn urinary calculi
 “coffin-lid appearance”
“swarming phenomenon” because of the
peritrichous flagella
 Has cross reaction with Rickettsiae
Pseudoallescheria Madura foot: the farmer with a big foot
boydii A chronic, specific fungal infection that affects
the feet

MOT: contact with fungus spores in the soil

“yogurt-like discharge‖ upon the
maturation of the infection
Mycetoma pedis

Pseudomonas Shanghai fever  Grape-like odor or fuity odor

aeruginosa Localized infection of eye,
ear, skin esp. in burns,
urinary, respiratory
Gastrointestinal tract infection
Central Nervous System
infection
Systemic infection with
bacteremia
Secondary pneumonia
Bone and joint infections
Endocarditis
 Swimmer’s ear
 Pyocyanin (blue phenazine) blue-
green pus
 Pyoverdin (yellow-green) Flourescein
 Pyorubin (red-brown)
obtain energy from carbohydrates using the
oxidative rather than the fermentative pathway
inactivates EF-2 by ADP ribosylation
(NOTE: same MOA with Diptheria toxin)
Echthyma gangrenosum: black necrotic
center with a raised erythematous margin)

DOC: Ceftazidime

Rabies virus Family: Rhabdoviridae Incubation period: 3-4 weeks to 3-4 months
Genus: Lyssavirus Domestic dogs
Sylvatic rabies  rabbits

Bullet-shaped capsule
“Negri bodies”

Respiratory Syncitial Bronchiolitis

virus

Rhinovirus MC cause of COLDS Over 100 serotypes

RNA virus; no envelope

Rickettsia rickettsii Rock y mountain spotted fever

Rotavirus Infantile gastroenteritis MC cause of acute diarrhea in infants

Case: 6 months old with diarrhea
Viral culture: the gold standard to detect
rotavirus, not stool exam

Rubella German measles RNA Param yxovirus

(the ―3-day measle‖) Maculopapular rash
Retroauricular lymphadenopathy

Congenital rubella “blueberry muffin” rash

Cataract, MR, deafness
(NOTE: blueberry muffin rash is also seen in
AML and ALL)

Salmonella typhi Typhoid fever type Bone marrow culture (90%)

Salmonellosis Dysentery
Colitis
Osteomyelitis in Sickle Cell
disease
(Coma vigil, muttering
the most sensitive test for Salmonella typhi
Blood culture the most common and most
immediate test for Salmonella
 delirium, rose spots,
Peyer‘s patch hyperplasia)
DOC: Ceftriaxone
nd
2 line drug: Chloramphenicol
W IDAL TEST Typhi Dot
(NOTE: this test is for board exam purposes
only; it is no longer being used these days)
Carriers: in their gallbladder

Salmonella Salmonellosis with

typhimurium gastroenteritis and
enterocolitis

Schistosoma Urinary schistosomiasis a Blood fluke

haematobium Bulinus truncatus – the snail vector
Urinary Bladder CA Endemic in Africa, Middle East
Causes pre-sinusoidal obstruction 
splenomegaly
Has a terminal spine
(+) urinary sediment cellular metaplasia

Schistosoma Schistosomiasis a Blood fluke

japonicum a.k.a. Bilharziasis, has a very small or vestigial lateral spine
Katayama fever, or Snail fever
Katayama reaction: patient becomes
Claypipe stem fibrosis febrile when the organism lays its eggs (4-8
weeks after infection; first cycle of egg
*same pathology as deposition)
S.mansoni Egg output: 1500-3500 eggs per day
Endemic in: Diagnosis:
#1- Agusan fecal material : Kato Katz technique
#2-Northern Samar, Eastern
Samar, Leyte Serum: Circum Oval Precipitin Test (COPT)

Rectal biopsy:
proctosigmoidoscopy  bite of the
granulomatous lesion

Oncomelania quadrasi / Oncomelania

hupensis/ Oncomelania philippinensis snail:
the intermediate host

Human: definitive host

Schistosoma mansoni Schistosomiasis a Blood fluke

 adult habitat: inferior mesenteric
Pathology: granulomata veins
formation bloody diarrhea, rectal polyps (not
prolapse), claypipe stem fibrosis, portal
hypertension, esophageal varices,
splenomegaly
 Biomphalaria glabrata snail

DOC: Praziquantel for all spp.

Schistosoma mekongi Swimmer‘s itch Mekong river basin (Laos, Kampuchea,

Thailand)

Serratia marcescens Red Diaper syndrome  3 enzymes: gelatinase, DNAse, Lipase

 Produces a “salmon red”
pigment

Shigella sp.: Bacillary Shigatoxin

Sonnei dysentery/Shigellosis Very virulent
Dysenteriae Lowest infecting dose: 50-100
 Flexneri Dysentery means blood in the stool
Boydii

Sporothrix schenckii Rose gardener’s disease Dimorphic fungus (has a yeast and a mold
form)
“cigar-shaped” yeast
(NOTE: cigar-packed microscopic appearance is in
Mycobacterium leprae)

St. Louis virus St. Louis encephalitis Mosquito-spread encephalitis

(a Flaviviridae) Most severe in the elderly

Staphylococcus Necrotizing pneumonia  ß-hemolytic; Coagulase-(+)

aureus Pneumatocoele on Xray
due to Panton Valentin
Leukocidin
Localized skin infections
Diffuse skin infection
(Impetigo)
Septicemia
Infections of implanted
prostheses e.g. heart valves
and catheters
Toxinoses
Osteomyelitis
Acute mastitis
Ritter’s disease (the most
severe form of SSSS)
Habitat: nasopharynx
the only Staphylococci that is Catalase (+)
 forms a “golden yellow” colony
due to Staphyloxanthine
pigment
 Protein A (inhibits complement
fixation and phagoc ytosis)
HANDW ASHING: still the best preventive
measure against its spread
Toxins produced:
Alpha toxins (pore forming cytolysin) rapidly
damage the heart  Acute infective
endocarditis in IV drug users; commonly
involves the tricuspid valve
Staphylococcal enterotoxins 
Staphylococcal food poisoning (food with
mayonnaise/custard/salad); starts quickly
and ends quickly(2-12 hours)
Staph aureus TSS toxin-1
(superantigens that cause polyclonal T-
cell activation) Toxic shock syndrome;
associated with ―tampons‖ or surgical
packing; typical px has high grade fever,
hypotension, scarlatiniform rash,
desquamation, multi-organ failure and
menstruation

Exfoliatin  Staphylococcal Scalded Skin

Syndrome (SSSS) : splitting of the skin at the
basement membrane  sloughing off

Staphylococcus Used to be the MC cause of A normal flora of the skin

epidermidis infections of implanted Can also cause infective endocarditis among
prostheses e.g. heart valves IV drug users
and catheters

Staphylococcus Cystitis in women Young, sexually active female’s UTI

saprophyticus ―honeymoon c ystitis‖

Streptococcus Meningitis and septicemia

agalactiae in neonates
(Group B Strep) Endometritis in postpartum
women
Opportunistic infections with
septicemia and pneumonia
Streptococcus bovis Colon cancer

Streptococcus MC cause of lobar Gram (+); lancet-shaped

pneumoniae pneumonia in adults
Otitis media and sinusitis in
children
can also commonly cause
meningitis in adults
Alpha hemolytic (partial hemolysis)
Optochin (+)
(NOTE: Strep. pneumo. lives in the lungs
because they are “afraid of the chin”; hence
Optochin sensitive)
Bile solubility (+)
Rusty sputum
(+) Quellung reaction: capsular swelling
– this will differentiate Strep.pneumoniae from
other Streps
Encapsulated
Produces IgA protease

Streptococcus Streptococcal pharyngitis Streptolysin O

pyogenes Rheumatic fever M protein
Puerperal fever Pyrogenic exotoxin
Group A (GABS) Necrotizing fasciitis Beta hemolytic (complete hemolysis)
Acute glomerulonephritis PYR (pyrrolidonylarylamidase) test
Impetigo and erysipelas
Strep impetigo golden crusted lesions

Scarlet fever Erythrogenic toxin: Dick, Scarlatinal, or

pyrogenic toxin in scarlet fever
“boiled lobster/sandpaper rash”;
strawberry tongue
(NOTE: strawberry tongue is also seen in
Kawasaki disease)

Streptococcus Dental caries Alpha hemolytic

viridians Endocarditis Produces dextran
(NOTE: Strep. mutans also causes dental
caries)

Strongyloides Malabsorption Causes internal autoinfection

stercoralis steatorrhea Infective stage: filariform larva
(a.k.a. dwarf or Diagnostic stage: rhabditiform larva
thread Diagnosis: fecalysis
threadworm) Harada-Mori Culture technique
DOC: Albendazole / Thiabendazole

Taenia saginata Cysticercosis  Beef tapeworm

 Migrates to the skeletal muscle
(biops y)
 Ingestion of raw/undercooked beef

Taenia solium Taeniasis (by the adult worm)  Pork tapeworm

Neurocysticercosis (by
the larvae form)
 Rostellar hooks
 Muscle spasm, dizziness, headache,
seizure
 DOC: Praziquantel;
 Albendazole – back up
 Surgical excision

Toxocara canis/ Visceral larva migrans Definitive hosts:

Toxocara cati Canis  dog
Cati  cat
Ocular larva migrans Organs affected: liver, heart, CNS
(eye and optic nerve
 involvement; caused by T. Granuloma formation in the sclera and retina
canis)

Toxoplasmosis Toxoplasmosis: First line and 1˚ prophylaxis:

gondii  Encephalitis, Pyrimethamine + Sulfamethoxazole
neurologic diseases (Dapsone)
 Chorioretinitis Sulfadiazine
 Can affect the heart,
liver and inner ears “cat feces”
Dangerous in Part of the TORCH syndrome
immunocompromised and Can cause hydrocephalus and multiple birth
pregnant patients defects

Dictum: if it is not congenital, Cerebral calcifications can be seen on

presume that px has AIDS CT Scan

Sabin Feldman Dye test (live

toxoplasma)
Serology: increased IgM

Treponema pallidum Syphilis DOC: Penicillin

Congenital syphilis Congenital: Hutchinson‘s teeth
Primary s yphilis: chancre
Secondary s yphilis: Condyloma
Tertiary syphilis: Gumma

Trichomonas Trichomoniasis Anaerobic, flagellated protozoan

vaginalis Sexually transmitted
“Strawberry cervix” (colpitis
macularis, an erythematous cervix with
punctate areas of exudation)
Yellow-green frothy (purulent) discharge,
dyspareunia
DOC: Metronidazole, single dose, 2grams
Both partners must be treated

Trichinella spiralis Trichinosis Intestinal nematode that encysts in tissue:

“encysted larvae”
Eating raw or undercooked meat
Diarrhea, fever, muscle pain, periorbital
edema
Muscle biopsy: gold standard
Bachman intradermal test: extract of
Trichinella larvae is suspended in saline and
injected intradermally
Serology: Bentonite Flocculation test
DOC: Thiabendazole

Trichuris trichura Trichuriasis Bipolar plugged or lemon-shaped

a.k.a. human Abdominal pain, bloody ova or football-shaped eggs (with nipple-like
whipworm diarrhea, anemia, protuberance on both ends)
rectal prolapse
Final habitat: cecum and ascending
colon

Tripanosoma cruzi Early: Chagoma (+) Romaña’s sign: unilateral painless

Late: Tripanosomiasis periorbital edema
“MEGAstar Tom cruz”
American sleeping Vector: Rhodnius or triatomine bug: “the
sickness kissing bug” or Riduviid bug

Chagas cardiomegaly: a Late dse: Determinate chronic Chagas

 neurogenic cardiomegaly disease: cardiomegaly (more marked on the
―cardiopathia right side of the heart), megaesophagus,
parasympathicopriva‖ megacolon, CNS mx: changes in personality,
seizure, confusion, slurred speech, difficulty in
walking

Tripanosoma African sleeping sickness Vector: Tsetse fly

gambiense African (Gambia, Rhodesia)

Tripanosoma (+) Kerandel’s sign: exaggerated pain;

rhodesiense deep hyperesthesia after some slight blow
upon a bony projection of the body

DOC: Suramin (for early hemolymphatic

stage)
Metarsoprol not metorpolol!!!(for late stage;
with CNS involvement)

Pentamidine (3rd line drug)

Varicella-zoster Primary: Varicella or  DNA Herpes virus

chickenpox  Incubation time: 13-17 days
 Contagious up to 6 days after all
Secondary: herpes zoster or lesions have dried
shingles
 Vaccine is attenuated (―live‖ but
modified)
 Shingles lesions: usually along a
single sensory dermatome
 Thoracic: MC dermatome involved
 Tx: VZ Immunoglobulin and oral
acyclovir

Variola virus Smallpox Extinct since 1977 (thank God!)

“Pharaoh Rameses” Typical intrac ytoplasmic inclusion bodies:
Guarnieri bodies
Molluscum  Appear as pink blobs in the cytoplasm
contagiosum  B type: site of viral replication: the
only DNA virus that replicates in the
cytoplasm (should be in the nucleus)

Vaccinia virus- the immunogen in the vaccine

 responsible for the eradication of smallpox
Just one case considered as an EPIDEMIC

Vibrio cholerae Cholera Gram (-); oxidase (+); single polar flagellum
01-Eltor serotype Choleragen toxin
Medium: Thiosulfate citrate bile salt
sucrose agar (TCBS) in alkaline pH up to 9
Has two subunits: A & B(responsible for
binding)
“fish in stream” colonies
“Rice water” stools or “pea soup”
stools with fishy smell
Washerwoman’s hands (loss of skin
elasticity)
Dehydration: the MC cause of death
DOC: tetracycline

Vibrio Diarrhea Oysters (seafoods)

parahemolyticus Gastroenteritis Hemolysin toxin
Grows best at pH 7.6 - 9
Gram (-); oxidase (+)
Vibrio vulnificus Gangrene of the hands Affects the skin, muscle and bones

W uchereria bancrofti Filariasis Recurrent fever, hydrocoele, chyluria, tropical

Podonconiosis
Bancroftian lymphatic filariasis
pulmonary eosinophilia
A roundworm: adult worms cause inflammation
that blocks lymphatic vessels  edema
elephantiasis (whole lower extremity)
 Pointed tail free of nuclei
(NOTE: Loaloa tail contains nuclei)

 Most prevalent filariasis worldwide and

in the Philippines

MOT: bite of a female mosquito: anopheles,

aedes, culex
(NOTE: culex bite is more associated with
Japanese encephalitis)
Lab diagnosis: Thick blood smear (taken at
night) demonstrate microfilaria
 TX: Diethycarbamazine (DEC)

Yellow fever virus Yellow fever MOT: aedes mosquito (arthropod-borne virus)
( a Flaviviridae) Vaccine is attenuated

Yersinia enterocolitica Mesenteric adenitis in children “bull’s eye target” colonies

Mimics appendicitis
Associated with pica (eating of
unusual/peculiar inanimate objects)
W ill present with “poppy feces”

Yersinia pestis Plague (3 forms:) Facultative anaerobe with bipolar staining and
Pneumonic plague produces V and W antigens  “safety
Septicemic plague pin” appearance
Bubonic plague Justinian Plague in 542 A.D.; Black Death

A category A pathogen (biological

warfare)
―boubon‖ – greek for groin; inguinal lymph
nodes are most commonly affected

MOT: flea bite

Reservoir: rodents
st
DOC: Streptomycin or Gentamicin (1
line)
Chloramphenicol (for the critically ill)

SOME SHORTCUTS

CYSTIC FIBROSIS Staphylococci Two organisms that px with CF is very prone

Pseudomonas to get infected with

CYSTS
Binucleated cyst Dientamoeba fragilis
Hydatid cyst Echinococcus granulosus

Lemon or pear-shaped (with Chilomastix mesnili

nipple-like protuberance)

Quadrinucleate Entamoeba hystolitica

DEFINITIVE HOST Dogs/sheep Echinococcus granulosus

 Dogs Toxocara canis
Ancyclostoma caninum

Cats Toxocara cati

Ancysclostoma braziliense
Toxoplasmosis gondii

DO T S James‘ dots Plasmodium ovale

Maurer‘s dots Plasmodium falciparum
Ring and dot appearance of
nuclei Entamoeba hystolitica
Schuffner‘s dots Plasmodium vivax

INTERMEDIATE Aedes mosquito Dengue virus, Yellow fever virus

HOST/ VECTOR Anopheles minimus Plasmodium falciparum
flavirostris
Black fly (female) Onchocerca volvulus
Bulinus truncatus Schistosoma hematobium
Culex mosquito Japanese encephalitis, W uchereria bancrofti
Deerfly (mango fly) Loa loa; Francisella tularensis
Ixodes ticks Borellia burgdorferi (Lyme disease), Babesia
micoti
Mice Hymenolepsis nana
Oncomelania quadrasi/ Schistosoma japonicum
hupensis/philippinensis
Bulinus truncates Schistosoma haematobium
Biomphalaria truncata Schistosoma mansoni
Rabbit Franciscella tularensis
Rat Hymenolepsis diminuta
Riduviid bug (kissing Trypanosoma cruzi
bug)/Rhodnius/ Triatomine (American sleeping sickness)
bug
Sandfly Leishmania donovani: Kalaazar
Tsetse fly Trypanosoma gambiense
Trypanosoma rhodesiense
(African sleeping sickness)

DRUG S
Albendazole Echinococcus granulosus
Strongyloides stercoralis

Bithionol Fasciola hepatica

DEC Trypanosoma cruzi (Chagas)

Trypanosoma gambiense/rhodesiense

Iodoquinol Balantidium coli

Metronidazole Giardia lamblia

Trichomonas vaginalis

Mebendazole/Pyrantel Enterobius vermicularis

pamoate Ascaris lumbricoides
Ancylostoma duodenale
Necator americanus

Niclosamide (very old drug) Tapeworms

Praziquantel (newer) Tapeworms

Quinacrine best drug for Giardia lamblia; also for

tapeworms

Sodium stibogluconate Leishmania donovani

Thiabendazole Trichinella spiralis

EGG/OVA Bipolar plugs or lemon- Trichuris trichura

shaped ova Capillaria philippinensis
 Cephalic cone Fasciola hepatica

Hen‘s egg Fasciolopsis buski

Operculated egg Chlonorchis sinensis

Diphyllobothrium latum
Heterophyes heterophyes
Metagonimus yokogawai
Paragonimus westermani

FEVER Black/Dumdum fever Leishmania donovani

Breakbone fever Dengue virus
Cat-scratch fever Bartonella henselae
Katayama fever Schistosoma japonicum
Parrot fever Chlam ydia psittaci
Pontiac fever Legionella (legionnaire‘s)
Q fever Coxiella burnetti
Shanghai fever Pseudomonas aeruginosa
Yellow fever Aedes mosquito

Texas cattle fever, redwater Babesia microti

fever, tick fever, Nantucket
fever

Pre-tibial fever Leptospira

(canicola fever, canefield
fever, Nanukayami fever, 7-
day fever, Rat-catcher‘s
yellow fever, Fort-Bragg fever,
Black jaundice)

Undulant fever (Crimean Brucella

fever, Bang’s disease,
Gibraltar fever, Malta fever,
Maltese fever, Mediterranean
fever, rock fever, Relapsing
fever)

ITCH Jock itch Fungi

Ground itch Necator americanus
Ancylostoma duodenale
Plumber‘s itch Ancyclostoma caninum/braziliense
Swimmer‘s itch Schistosoma

HABITAT Biliary passage & GB Fasciola hepatica

Gallbladder Salmonella typhi
Colon Enterobius vermicularis
Breastfed babies: Bifidobacterium
Formula-fed babies: Lactobacillus acidophilus

Colon, Cecum Trichuris trichura

Inferior mesenteric vein Schistosoma mansoni
Jejunum/Duodenum Giardia lamblia
Lungs Echinococcus multilocularis
Nasopharynx Staphylococcus aureus
Skin Staphylococcus epidermidis
Vagina Lactobacillus

HERPES VIRUSES CMV Infectious mononucleosis, congenital infection

(TORCH), pneumonia
EBV Burkitt‘s lymphoma, infectious mononucleosis,
nasopharyngeal CA, Hodgkin‘s lymphoma
HHV-6&7 Exanthem subitum (roseola)
HHV-8 Kaposi‘s sarcoma in AIDS
HSV-1 Temporal lobe encephalitis, herpes labialis
HSV-2 Genital herpes, neonatal herpes
VZV Chicken pox, Shingles, encephalitis
MENINGITIS, #1: E.coli
PNEUMONIA, #2: Strep. agalactiae
SEPSIS #3: Listeria monocytogenes

OSTEOMYELITIS MC cause  Staphylococcus aureus

In sexually active  Neisseria gonorrhea (septic arthritis)
In Sickle cell disease Salmonella
Prosthetic replacements Staphylococcus aureus
Vertebral osteom yelitis Mycobacterium tuberculosis

CULTURE MEDIUM/ Antigen detection test Chlam ydia trachomatis (screening)

STAIN/TEST
Auramine-Rhodamine stain Mycobacteria (Acid-fast bacilli)

Bachman‘s intradermal test Trichinella spiralis (extract of the larvae)

Bentonite Flocculation test Trichinella spiralis (serologic test)

Blood smear Microfilariae

Bordet-Gengou medium Bordetella pertussis

CANNOT BE Gram STAINED Mycoplasma pneumoniae (no cell wall)

Casoni Skin test Echinococcus granulosus

Chocolate agar w/Factor V Haemophilus influenza

(NAD) & Factor X (Hemin)

Circum Oval Precipitin Schistosoma japonicum

Darkfield microscopy Spirochetes (then do Silver impregnation)

Eaton‘s agar Mycoplasma pneumoniae

ELEK‘s Test Corynebacterium diphtheriae

ELISA HIV screening

Ellinghausen McCullough Leptospira (28˚C-30˚C)

Johnson Harris (EMJH)

Footpads of armadillos Mycobacterium leprae

Giemsa and W right stain For staining blood or bone marrow films

Gomori‘s Pneumocystis carinii & jeroveci

Methanamine Silver stain

Graham Cellophane Enterobius vermicularis

Method (scotch tape)

Harada-Mori Culture Strongyloides stercoralis

Heterophile antibody test EBV will be (+); CMV will be (-)

(Paul Bunnel)

India ink Cryptococcus neoformans

Kato katz thick smear Schistosoma spp

KOH wet mount Gardnerella vaginalis, Mycoplasma hominis

Lowenstein Jensen Mycobacterium tuberculosis

Middlebrook

Mc Coy culture Chlam ydia trachomatis (confirmatory)

Modified Kinyoun‘s acid Cryptosporidium

 Muscle biopsy Taenia saginata (cysticercosis)
Trichinella spiralis (gold standard)

NSS wet mount Trichomonas vaginalis

Pyrrolidonylarylamidase test Streptococcus pyogenes (GABS)

(PYR)

Sabin Feldman dye Toxoplasma gondii

Saboraud‘s agar Culture medium for FUNGI

Skirrow‘s or Butzler‘s medium Campylobacter jejuni

String test (enterotest) Giardia lamblia; (Crohn’s disease)

Tellurite agar/Loffler‘s Corynebacterium diphtheriae

Thayer-Martin broth Neisseria gonorrhea

Thick blood smear (night) W uchereria bancrofti

Thick and thin smears Brugia malayi

Thiosulfate citrate bile salt Vibrio spp.

sucrose agar (TCBS)

TPHA FTA-Abs T.pallidum (syphilis confirmatory test)

Tzanck smear Herpes simplex virus 1&2 (screening)

Urease breath test Helicobacter pylori

VDRL, RPR Treponema pallidum (syphilis screening)

W estern blot HIV confirmatory

W IDAL test Salmonella typhi

Ziehl-Neelsen acid fast Mycobacteria

FLUKES Blood fluke Schistosoma spp.

Chinese liver fluke Chlonorchis sinensis
Garrison‘s fluke Echinostoma ilocanum
Giant intestinal fluke Fasciolopsis buski
Japanese fluke Metagonimus yokogawai
Lung fluke Paragonimus westermani
Minute intestinal fluke Heterophyes heterophyes
Sheep liver fluke Fasciola hepatica

―POOP‖ MATTERS Bird droppings Chlam ydia psittaci, Histoplasma capsulatum

Cat feces Toxoplasma gondii
Pigeon droppings Crytococcus neoformans
Poppy feces Yersinia enterocolitica
Rice water/pea soup Vibrio cholera

REACTIONS/SIGNS Calabar swelling Loaloa

Chandelier sign PID; cervical motion tenderness
Creeping reaction Ancyclostoma caninum/brazilense
Inoculation lymphoreticulosis Bartonella henselae (cat-scratch fever)
st
Jarisch-Herxheimer Leptospira (1 2hrs of antibiotic treatment)
Katayama reaction Schistosoma japonicum
Kerandel‘s sign Trypanosoma gambiense, rhodesiense
Mazzotti reaction Onchocerca volvulus; Tx with DEC
Romaña‘s sign Trypanosoma cruzi (Chagas‘ disease)

TAPEW ORMS Dog tapeworm Echinococcus granulosus

Small fox tapeworm Echinococcus multilocularis
 Beef tapeworm Taenia saginata
Pork tapeworm Taenia solium
Dwarf tapeworm Hymenolepsis nana
Rat tapeworm Hymenolepsis diminuta
Fish tapeworm Diphyllobothrium latum

UNPASTEURIZED Brucella
MILK Listeria monocytogenes

ACNE
 altered expression of hormones

 Androgens stimulate the enlargement of the sebaceous glands and the resulting production of
more oil

 Proprionibacterium acnes, Staphylococcus epidermidis, Propionibacterium granulosum

 in the androgen-altered hair follicles, the cells lining the cavity shed more frequently, stick
together, mix with the excess oil that is being produced, and pile up in clumps inside the cavity

 the bacteria contain enzymes that can degrade the oil from the oil glands into what are known as
free fatty acids

 A hallmark of acne is often the pus that is exuded from the crusty sores on the skin.

 can be stimulated by factors other than the altered hormone production of puberty; external
environment, particularly a warm and moist one, is one factor
 Oil production can be slowed in the presence of 12-cis-retinoic acid (Accutane)
 benzoyl peroxide is very active against Proprionibacterium acnes
 there is no ―cure‖ for acne; the bacteria that cause it are normal flora

ACTINOMYCES Ac
 rod-like in shape; Gram positive
  are not able to form the dormant form known as a spore; are able to grow in the absence of
oxygen
 are normal residents of the mouth, throat, and intestinal tract
 formation of an abscess—a process ―walling off‖ the site of infection as the body responds to the
infection—and by swelling
 the symptoms and appearance of the infection is reminiscent of a tumor or of a tuberculosis
lesion
 the slow growth of the bacteria can make the treatment of infection with antibiotics very difficult
 colonies of Actinom yces are often described as looking like bread crumbs

ADENOVIRUSES
 have twenty sides; called icosahedrons
 contain deoxyribonucleic acid (DNA) as their genetic material; DNA encodes 20 to 30 proteins
 infect the membranes that line the respiratory tract, the eyes, the intestines, and the urinary tract
 respiratory and intestinal illnesses and conjunctivitis (commonly called ―pink eye‖); also, a more
severe eye malady called keratoconjunctivitis
 eye infections are very contagious and are typically a source of transmission
 produce proteins that interfere with host‘s anti-oncogenes;
 by disrupting the anti-oncogene proteins, this stop signal is eliminated,  continued and
uncontrolled growth of the cell tumor is produced.
 adenoviruses have become important as one of the central triggers of cancer development
 most children will have antibodies to at least four types of adenovirus

AEROBES
 Bacteria, yeasts, fungi, and algae are capable of aerobic growth
 Those that absolutely require oxygen are known as obligate aerobes.
 Facultative aerobes prefer the presence of oxygen but can adjust their metabolic machinery so as
to grow in the absence of oxygen.
 Microaerophilic organisms are capable of oxygen-dependent growth but cannot grow if the
oxygen concentration is that of an air atmosphere (about 21% oxygen). The oxygen content must
be lower.
 common food source for microorganisms is the sugar glucose
 pyruvic acid (from glucose) is broken down via a series of reactions that collectively are called the
tricarboxylic acid cycle, or the Kreb‘s c ycle
 A principle product of the Kreb‘s cycle is a compound called nicotinamide adenine dinucleotide
(NADH2) that feed into another chain of reactions of which ox ygen is a key
 Oxygen is the final electron acceptor in the process
 an electron acceptor other than oxygen: alternate acceptors is nitrate, and the process involving it
is known as denitrification
 complete breakdown process yields 38 molecules of adenine triphosphate (ATP) for each
molecule of the sugar glucose
 fermentative type of energy generation is a fall-back mechanism to permit the organism‘s survival
in an ox ygen-depleted environment

HIV - AIDS
 Retroviruses: their genetic material is RNA instead of DNA
 Patients with AIDS most often die from opportunistic infections
 HIV retrovirus uses an enzyme called reverse transcriptase to make a DNA copy of its genetic
material. The single strand of DNA then replicates and, in double stranded form, integrates into
the chromosome of the host cell where it directs synthesis of more viral RNA
 the inner core of the AIDS virus, which is called the nucleocapsid, is held together by structures
known as “zinc fingers”
 HIV destroys the immune system by invading lymphocytes and macrophages, replicating within
them, killing them, and spreading to others
 these viruses mutated to HIV in the bodies of humans who ate the meat of monkeys, and
subsequently caused AIDS
 a fifteen-year-old male with skin lesions who died in 1969 is the first documented case of AIDS
 first spread in the United States through the homosexual community by male-to- male contact
 HIV is transmitted in bodily fluids: through sexual contact, specifically vaginal and anal
intercourse, and oral to genital contact (small abrasions during sexual intercourse), direct
injection with an infected needle among intravenous drug users who share needles, through
breast-feeding, transfusions of infected blood or blood-clotting factors
 Infected individuals pass HIV-laden macrophages and T lymphocytes in their bodily fluids to
others
 a person who has had another sexually transmitted disease is more likely to contract AIDS
 test for HIV-1 that is called Enzymelinked immunosorbant assay (ELISA)
 monitored by the declining number of particular antibodies called CD4-T lymphocytes and by the
amount of HIV in the patient‘s blood
  diagnosis of AIDS in which the CD4 T-cell count is below 200 cells per cubic mm of blood, or an
opportunistic disease has set in
 the cocktail combines zidovudine (AZT), didanosine (ddi), and a protease inhibitor
 reverse transcriptase, mistakenly incorporates the drugs into the viral chain, thereby stopping
DNA synthesis
 Proteases are enzymes that are needed by HIV to reproduce, and when protease inhibitors are
administered, HIV replicates are no longer able to infect cells
 saquinaviras, the first protease inhibitor to be used in combination with nucleoside drugs such as
AZT; other protease inhibitors: ritonavir and indinavir
 are not cured due to the persistence of inactive virus left in the body

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe idiosyncratic
reactions, most commonly triggered by medications, which are characterized by fever and
mucocutaneous lesions leading to necrosis and sloughing of the epidermis. SJS and TEN are
distinguished chiefly by severity and percentage of body surface involved.

Stevens-Johnson syndrome — SJS is the less severe condition, in which skin sloughing is limited to
less than 10 percent of the body surface; characterized by a prodrome of malaise and fever, followed by
the rapid onset of erythematous or purpuric macules and plaques. The skin lesions progress to epidermal
necrosis and sloughing. Mucosal membranes are affected in 92 to 100 percent of patients, usually at two
or more distinct sites (ocular, oral, and genital).

Toxic epidermal necrolysis — Toxic epidermal necrolysis (TEN), or Lyell's syndrome, involves
sloughing of greater than 30 percent of the body surface area. TEN also begins with a prodrome of fever
and malaise, although temperatures are typically higher than those seen with SJS, often exceeding 39
degrees Celsius. Mucous membranes are involved in nearly all cases. The skin lesions are widely
distributed erythematous macules and patches, although about 50 percent of cases begin with diffuse
erythema. In the early stages, skin pain may be prominent and out of proportion to clinical findings. The
skin lesions progress to full-thickness epidermal necrosis leads. The ultimate appearance of the skin has
been likened to that of extensive thermal injury.

SJS/TEN overlap syndrome — SJS/TEN overlap s yndrome describes patients with involvement of
greater than 10 percent, but less than 30 percent of body surface area.

NOT MINE(My Personal Survival Kit)

 lifted from the passion and compassion of

JARUNGCHAI ANTON S. VATANAGUL, M.D., DPCP, FPNA

Internal Medicine-Adult Neurology

our

Mentor
Critic
Relentless Aid
Rescuer
Friend

MESCap