Microbiology

REVIEW

Gram-Nega)ve Bacteria
Gram-nega)ves Cocci Rods Obligate intracellulars

Chlamydia

Spirochetes

Neisseria

(see next page)

Ricke2sia

Bartonella

Treponema pallidum

Neisseria meningi+dis

Neisseria gonorrhoeae

Chlamydia trachoma+s

Chlamydia pneumoniae

Chlamydia psi2aci

Borellia

Leptospira

Obligate aerobe Aerobe Microaerophilic Faculta)ve anaerobe Anaerobe

Gram-Nega)ve Rods
Gram-nega)ve rods Enterobacteriac eae Fas)dious GNRs Bordatella pertussis Legionella pneumophila Bacteroidaceae Vibrionaceae Campylobacterales

Non-fermenters
Oxidase- posi)ve Oxidase- nega)ve Acinetobacter baumanii Stenotromona s maltophilia

(See next page)

Bacteroides fragilis

Vibrio cholera Vibrio parahaemoly+ cus Vibrio vulnicus

Campylobacter

Helicobacter pylori

Pseudomonas aeruginosa
Burkholderia cepacia complex Burkholderia pseudomallei

Haemophilus

Haemophilus inuenzae Haemophilus parainuenzae Haemophilus ducreyi

Obligate aerobe Aerobe Microaerophilic Faculta)ve anaerobe Anaerobe

Enterobacteriaceae
Enterobacteriaceae
Escherichia coli Opportunis)c pathogens

Aeromonas*

Salmonella

Shigella

Klebsiella
Klebsiella granulomatosis

Proteus
Proteus vulgaris

Yersinia
Yersinia enterocoli+ca Yersinia pseudotubercu losis Yersinia pes+s

Enterobacter

Serra+a

Klebsiella pneumoniae

Proteus mirabilis

Citrobacter

Obligate aerobe Aerobe Microaerophilic Faculta?ve anaerobe Anaerobe

Atypical Bacteria
Atypicals Mycobacteria Mycoplasma

Mycobacterium tuberculosis

Mycobacterium leprae

Non-tuberculoid Mycobacteria

Mycoplasma genitalium

Mycoplasma pneumoniae

Slow-growers

Fast-growers

Mycobacterium avium complex

Mycobacterium kansasii

Mycobacterium abscessus

Mycobacterium chelonae

Obligate aerobe Aerobe Microaerophilic Faculta?ve anaerobe Anaerobe

Mycobacterium marinum

Mycobacterium ulcerans

Mycobacterium fortuitum

Klebsiella pneumoniae
Characteris)cs Gram-nega)ve rods Gamma-hemoly)c Indole-nega)ve Lactose-fermenter Non-mo)le Environmental, normal skin and GI ora, common nosocomial infec)on, causes infec)on in alcoholics and diabe)cs Virulence Factors O an)gen (soma)c) cell wall LPS K an)gen (capsular) capsular polysaccharide Pili promote coloniza)on Diagnosis Gram stain (GPRs) Culture on MacConkey agar Treatment CeSriaxone Ciprooxacin

Pathogenesis

Clinical Findings Necro)c cavitary pneumonia UTIs Sepsis

Klebsiella granulomatosis
Characteris)cs Gram-nega)ve rods Gamma-hemoly)c Indole-nega)ve Lactose-fermenter Non-mo)le Sexually transmiTed Endemic in Southeast Asia and Africa Diagnosis Tissue biopsy Treatment Doxycycline

Virulence Factors O an)gen (soma)c) cell wall LPS K an)gen (capsular) capsular polysaccharide Pili promote coloniza)on

Pathogenesis

Clinical Findings Granuloma inguinale (donovanosis) Painless ulcera)ve lesion

Proteus mirabilis
Characteris)cs Gram-nega)ve rods Gamma-hemoly)c Indole-nega)ve Non-lactose fermenter Highly mo)le Environmental, common nosocomial infec)on Diagnosis Gram stain (GPRs) Swarming colonies on MacConckey agar culture Treatment Ampicillin CeSriaxone

Virulence Factors O an)gen (soma)c) cell wall LPS K an)gen (capsular) capsular polysaccharide H an)gen (agellar) agellar proteins Pili promote coloniza)on Urease alkalinizes urine, leading to kidney/bladder stones

Pathogenesis

Clinical Findings UTIs Urolithiasis Sepsis

Proteus vulgaris
Characteris)cs Gram-nega)ve rods Gamma-hemoly)c Indole-posiive Non-lactose fermenter Highly mo)le Environmental, common nosocomial infec)on, usually seen in immunocompromised individuals Virulence Factors O an)gen (soma)c) cell wall LPS K an)gen (capsular) capsular polysaccharide H an)gen (agellar) agellar proteins Pili promote coloniza)on Urease alkalinizes urine, leading to kidney/bladder stones Diagnosis Gram stain (GPRs) Swarming colonies on MacConckey agar culture Treatment Ampicillin CeSriaxone

Pathogenesis

Clinical Findings UTIs Urolithiasis Sepsis

Pseudomonas aeruginosa
Characteris)cs Gram-nega)ve rods Catalase-posi)ve Oxidase-posi)ve Non-fermenter Mo)le Environmental, common cause of nosocomial infec)ons Virulence Factors O an)gen (soma)c) cell wall LPS Pili promote coloniza)on Alginate forms biolms (immune evasion and adhesion) Pyocyanin ROS damage Pyoverdin iron uptake Exotoxins (A,S) cytotoxic Elastase )ssue destruc)on Diagnosis Gram stain Culture on MacConkey agar (green colonies) Treatment Piperacillin (with tazobactam) Cefepime Meropenem

Pathogenesis Greater risk of infec)on in hospitalized pa)ents, CF pa)ents, diabe)cs, IV drug users, pa)ents with breach of airway (tracheostomy, endoscopy)

Clinical Findings Respiratory infec)ons Necro)zing bronchopneumonia Chronic respiratory tract infec)ons Skin infec)ons Burn wound infec)ons Ecthyma gangrenosum Folliculi)s Community acquired infec)ons Kera))s (corneal ulcers) Endophthalmi)s Endocardi)s IV drug users Hot tub folliculi)s Malignant o))s externa Osteomyeli)s UTIs Sepsis

Neisseria gonorrhoeae
Characteris?cs Gram-nega)ve cocci in pairs Catalase-posi)ve Oxidase-posi)ve Non-mo)le Faculta)vely intracellular Strictly pathogenic Virulence Factors O an)gen (soma)c) cell wall LPS K an)gen (capsular) capsular polysaccharide Pili promote coloniza)on Opa proteins promote adherence Porins promote invasion Pathogenesis
Invasive infec)on

Diagnosis Gram stain (doughnut-shaped diplococci) Culture on chocolate agar PCR Treatment CeFriaxone Cefepime Clinical Findings
Women Mucopurulent cervici)s Urethral syndrome Dysuria Pyuria Pelvic inammatory disease Neonates Ophthalmia neonatorum Gonococcal scalp abscesses Systemic infec)ons Men Urethri)s Epididmy)s Rectal and oropharyngeal infec)ons Disseminated gonococcal infec)on Erythematous lesions on palms and soles Gonococcal tenosynovi)s

Disseminated infec)on in individuals with complement deciency

Neisseria meningi+dis
Characteris)cs Gram-nega)ve cocci in pairs Catalase-posi)ve Oxidase-posi)ve Non-mo)le Faculta)vely intracellular Strictly pathogenic Diagnosis CSF Gram stain (doughnut-shaped diplococci) CSF culture on chocolate agar Treatment CeSriaxone Cefepime Vaccine

Virulence Factors O an)gen (soma)c) cell wall LPS K an)gen (capsular) capsular polysaccharide Pili promote coloniza)on IgA1 protease cleaves Abs

Pathogenesis Invasive infec)on

Clinical Findings Meningi)s Bacteremia Meningococcemia meningi)s with sepsis Meningococcemia rash Waterhouse-Frederichsen syndrome -adrenal gland hemorrhage

Haemophilus inuenzae
Characteris)cs Pleiomorphic Gram-nega)ve rods Catalase-posi)ve Oxidase-posi)ve Non-mo)le Normal respiratory ora Diagnosis Gram stain (GNRs) Culture on specialized chocolate agar Treatment CeSriaxone (invasive) Amoxicillin and clavulanate (non-invasive) Vaccine

Virulence Factors O an)gen (soma)c) cell wall LPS Capsule (a-f) capsular polysaccharide Pili promote coloniza)on IgA1 protease cleaves Abs

Pathogenesis Colonizes nasopharynx Pneumonia worse in pa)ents with COPD Encapsulated stains capable of invading mucosal, hematogenous distribu)on Seen in H. inuenzae biogroup aegyp+us

Clinical Findings Epiglo^)s Sinusi)s Pneumonia Meningi)s Sep)c arthri)s Sepsis Acute conjunc)vi)s

Haemophilus parainuenzae
Characteris)cs Pleiomorphic Gram-nega)ve rods Catalase-posi)ve Oxidase-posi)ve Non-mo)le Normal respiratory ora Diagnosis Gram stain (GNRs) Culture on specialized chocolate agar Treatment CeSriaxone Amoxicillin and clavulanate

Virulence Factors O an)gen (soma)c) cell wall LPS Capsule (a-f) capsular polysaccharide Pili promote coloniza)on

Pathogenesis

Clinical Findings Epiglo^)s Endocardi)s

Haemophilus ducreyi
Characteris)cs Pleiomorphic Gram-nega)ve rods Catalase-posi)ve Oxidase-posi)ve Non-mo)le Strictly pathogenic Diagnosis Gram stain (coccobacilli) Culture on specialized chocolate agar Treatment Azithromycin CeSriaxone

Virulence Factors O an)gen (soma)c) cell wall LPS Capsule (a-f) capsular polysaccharide Pili promote coloniza)on

Pathogenesis

Clinical Findings Chancroid painful genital ulcer Unilateral regional luppura)ve lymphadeni)s

Bordatella pertussis
Characteris)cs Gram-nega)ve coccobacilli Catalase-posi)ve Oxidase-posi)ve Non-mo)le Strictly pathogenic Virulence Factors O an)gen (soma)c) cell wall LPS Pili promote coloniza)on Filamentous hemagglu)nin (FHA) adhesion Pertussis toxin (A,B) upregula)on of cAMP, immune dysregula)on Extracytoplasmic cAMP Diagnosis Gram stain (GNRs) Culture on specialized chocolate agar Treatment Suppor)ve care Erythromycin Vaccine Pathogenesis Clinical Findings Adherence to respiratory Whooping cough (pertussis) epithelium and release of Incuba)on (1-3 weeks) exotoxins Catarrhal stage Rhinorrhea Malaise Fever Sneezing Paroxysmal stage Paroxysmal coughs with inspiratory whoops Vomi)ng Air hunger, apnea, cyanosis Convalescent stage resolu)on Sequelae Secondary bacteria infec)on Pulmonary hemorrhage Encephalopathy

Legionella pneumophila
Characteris)cs Gram-nega)ve coccobacilli Catalase-posi)ve Oxidase-posi)ve Mo)le Faculta)vely intracellular Environmental, waterborne, immunocompromised at greater risk, outbreaks possible Virulence Factors O an)gen (soma)c) cell wall LPS Pili promote coloniza)on Diagnosis Legionella urinary an)gen Culture on specialized agar Treatment Azithromycin Clarithromycin Levooxacin

Pathogenesis Adherence to respiratory epithelium, invasion

Clinical Findings Legionella pneumonia lower lobar pneumonia, cavitary in immunocompromised Legionnaires disease systemic manifesta)ons Non-produc)ve cough Watery diarrhea and abdominal pain Neurological symptoms

Treponema pallidum
Characteris)cs Gram-nega)ve spirochete Few membrane proteins Mo)le Diagnosis Darkeld microscopy Non-treponemal tests (RPR, VDRL) Treponemal tests Treatment Penicillin Pathogenesis Spirochetes penetrate skin, disseminate through blood and lympha)cs, divide and grow slowly
Clinical Findings Primary syphilis Chancre (lasts 3-6 weeks) Secondary syphilis Skin manifesta)ons Condylomata lata Mucus patches Rash on soles and palms Systemic involvement Latency Ter)ary syphilis Cardiovascular syphilis endarteri)s obliterans of vasa vasorum, aor)c aneurysms Gummatous syphilis benign granulomatous gummas Late neurosyphilis Meningovascular strokes and seizures Parenchymatous tabes doralis, demen)a, Argyll Roberston pupil
Congenital syphilis Early congenital syphilis Snues rhini)s Condylomatous rash Hepatosplenomegaly Osteochondri)s Late congenital syphilis Neurosyphilis Deafness Kera))s Arthropathy Ostei)s saddle nose, Hutchinsons teeth, saber shins

Virulence Factors

Leptospira
Characteris)cs Gram-nega)ve spirochete Few membrane proteins Mo)le Diagnosis Darkeld microscopy Non-treponemal tests (RPR, VDRL) Treponemal tests Treatment Penicillin Pathogenesis Clinical Findings

Virulence Factors

Spirochetes penetrate Primary syphilis skin, disseminate through Chancre (lasts 3-6 weeks) blood and lympha)cs, Secondary syphilis divide and grow slowly Skin manifesta)ons Condylomata lata Mucus patches Rash on soles and palms Systemic involvement

Borrelia
Characteris)cs Gram-nega)ve spirochete Few membrane proteins Mo)le Diagnosis Darkeld microscopy Non-treponemal tests (RPR, VDRL) Treponemal tests Treatment Penicillin Pathogenesis Clinical Findings

Virulence Factors

Spirochetes penetrate Primary syphilis skin, disseminate through Chancre (lasts 3-6 weeks) blood and lympha)cs, Secondary syphilis divide and grow slowly Skin manifesta)ons Condylomata lata Mucus patches Rash on soles and palms Systemic involvement

Chlamydia trachoma+s
Characteris)cs Gram-nega)ve coccobacilli Catalase-posi)ve Oxidase-posi)ve Mo)le Obligate intracellular Virulence Factors No pep)doglycan Diagnosis Tissue cell culture PCR (for serovars D-K, L1-L3) Treatment Doxycycline Erythryomycin Azithromycin Pathogenesis Clinical Findings

Elementary bodies (Ebs) Serovars A-C invade epithelial cells, Trachoma proliferate as ini)al bodies (IBs), release more Serovars D-K EBs Genital infec)ons Women Cervici)s Ectopic pregnancy PID Men epididymi)s Urethri)s Proc))s Infants pneumonia Conjunc)vi)s Serovars L1-L3 Lymphogranulomata venereum (LGV) Genital lesion Regional lymphadenopathy Elephan)asis, stulas, strictures

Chlamydia pneumoniae
Characteris)cs Gram-nega)ve coccobacilli Catalase-posi)ve Oxidase-posi)ve Mo)le Obligate intracellular Diagnosis Serology Treatment Doxycycline Erythryomycin

Virulence Factors No pep)doglycan

Pathogenesis

Clinical Findings

Elementary bodies (Ebs) Atypical pneumonia invade epithelial cells, proliferate as ini)al bodies (IBs), release more EBs

Chlamydia psi2aci
Characteris)cs Gram-nega)ve coccobacilli Catalase-posi)ve Oxidase-posi)ve Mo)le Obligate intracellular, common in birds Diagnosis Serology Treatment Doxycycline Erythryomycin

Virulence Factors No pep)doglycan

Pathogenesis

Clinical Findings

Elementary bodies (Ebs) Atypical pneumonia invade epithelial cells, Fever proliferate as ini)al Splenomegaly bodies (IBs), release more EBs

Chlamydia psi2aci
Characteris)cs Gram-nega)ve coccobacilli Catalase-posi)ve Oxidase-posi)ve Mo)le Obligate intracellular, common in birds Diagnosis Serology Treatment Doxycycline Erythryomycin

Virulence Factors No pep)doglycan

Pathogenesis

Clinical Findings

Elementary bodies (Ebs) Atypical pneumonia invade epithelial cells, Fever proliferate as ini)al Splenomegaly bodies (IBs), release more EBs

Zoono)c Bacteria
Brucellosis Leptospirosis Livestock Mammal Brucella Leptospira Bartonella Granulomatous histopathology Fever, pulmonary hemorrhage Parinauds oculoglandular syndrome, granulomatous lymphadeni)s Bubonic, pneumonic, or sep)cemic plague Erythema migrans, early disseminated, late infec)on (arthri)s and rarely encephali)s) Lymphohis)ocy)c vasculi)s, pulmonary and cerebral edema Culture Serology

Cat-scratch fever Cat

Plague Lyme disease

Flea Tick

Yersinia Borrelia

Rocky mountain spoTed fever

Dog )ck, wood )ck

RickeTsia

Biopsy, culture, PCR

Bacterial Causes of Meningi)s

Within rst 3 months Listeria monocytogenes Escherichia coli Streptococcus agalac+ae 6 months to 3 years Neisseria meningi+dis Haemophilus inuenzae Adults Neisseria meningi+dis Streptooccus pneumoniae Elderly Listeria monocytogenes Neisseria meningi+dis Streptooccus pneumoniae
First 3 6 months months to 3 years Listeria monocytogenes Escherichia coli Streptococcus agalac+ae Streptococcus pneumoniae Neisseria meningi+dis Haemophilus inuenzae Adults Elderly

Bacterial Diarrheagenic Virulence Factors

Bacteria Bacillus cereus Listeria monocytogenes STEC/EHEC EIEC ETEC Vibrio cholerae Salmonella Shigella Campylobacter Yersinia enterocoli+ca O K an?gen an?gen H an?gen Shiga toxin Cholera toxin Heat-labile toxin Heat-stabile toxin Invasive

DNA Viruses
dsDNA viruses ssDNA viruses Herpesviruses
Hepadnaviruses

Adenoviruses

Papilloma viruses

Polyomaviruses

Parvoviruses

Herpes simplex viruses (HSV-1 and HSV-2)

Varicella-zoster virus

Hepa??s B virus

High risk papillomaviruses (HPV-16 and HPV 18)

BK polyoma virus

Erythrovirus (parvovirus B-19)

Cytomegalovirus

Epstein-Barr virus

Low-risk papillomaviruses
(HPV-6 and HPV-11)

JC polyomavirus

Dependoviruses (adeno-associated viruses)

Roseolovirus (HHV-6 and HHV-7)

Kaposis sarcoma- associated herpes virus (KSHV/HHV-8)

Bocavirus

Capsulated Non-capsulated

Double-Stranded and Nega)ve-Strand RNA Viruses

dsRNA viruses Nega?ve-strand ssRNA viruses

Reoviruses

Orthomyxoviruses

Deltaviruses

Paramyxoviruses

Rhabdoviruses

Rotavirus

Inuenza viruses

Hepa??s D virus

Respiratory sync?al virus (RSV)

Parainuenza viruses

Rabies virus

Human metapneumovirus

Mumps virus

Measles virus Capsulated Non-capsulated

Posi)ve-Strand Viruses
Posi)ve-strand ssRNA viruses

Picornaviruses

Caliciviruses

Togaviruses

Flaviviruses

Coronaviruses

Enteroviruses

Rhinoviruses

Hepa))s A virus

Hepa))s E virus

Rubella virus Alpha viruses (equine encephali)s)

West Nile virus (WNV) Yellow fever virus Dengue fever virus Hepa))s C virus

SARS

Coxsackieviruses (A and B)

Norwalk virus

Poliovirus

Echoviruses

Capsulated Non-capsulated

Respiratory Viruses
Virus Inuenza Clinical Findings Orthomyxovirus Headache, fever, nonproduc)ve cough, sore throat, no rinorrhea; (- ssRNA) inters))al pneumoni)s and secondary bacterial pneumonia poten)al complica)ons Paramyxovirus (-ssRNA) Paramyxovirus (-ssRNA) Croup in children O))s media, bronchi)s, croup, pneumonia, lower respiratory tract infec)ons (dyspnea, hypoxemia) Similar to RSV, in children Respiratory infec)on -> lymph nodes -> primary viremia -> endothelium -> secondary viremia (symptoma)c) Fever, cough, coryza, conjunc)vi)s, Koplik spots, rash Inamma)on of glandular epithelium paro))s, orchi)s; pancrea))s, ovarian infec)on, and meningi)s infequent Rash, snies, mild lymphadenopathy Congenital rubella syndrome spontaneous abor)on, mental retarda)on, heart defects, cataracts and blindness

Parainuenza Respiratory syncy)al virus

Human Paramyxovirus metapneumovirus (-ssRNA) Measles (rubeola) Paramyxovirus (-ssRNA) Paramyxovirus (-ssRNA) Togavirus (+ ssRNA)

Mumps Rubella (German measles)

Respiratory Virus Seasonality

Spring Rhinoviruses Enteroviruses Adenoviruses Inuenza Parainuenza RSV Summer Fall Winter

Hepa))s Viruses
Virus Hepa))s A Classica?on Picornavirus (+ ssRNA) Hepadnavirus (ds DNA) Flavivirus (+ ssRNA) Deltavirus (- ssRNA) Transmission Fecal-oral Acute/Chronic Acute Treatment Vaccina)on, pooled serum immunoglobulin Vaccina)on, interferon Interferon

Hepa))s B Hepa))s C Hepa))s D

Sexual, blood- borne, ver)cal Blood-borne Sexual, blood- borne, ver)cal

10% chronic, 90% asymptoma)c Chronic Acute (superinfec)on with HBV) Acute

Hepa))s E

Calicivirus (+ ssRNA) Fecal-oral

Herpesviruses
Virus Transmission Clinical Findings Treatment Acyclovir Herpes Sexually, Herpes labialis, genital herpes, gingivostoma))s, herpes simplex virus direct contact whitlow, kera))s, encephali)s Neonatal herpes (SEM, CNS, or disseminated) Varicella zoster virus Aerosolized respiratory droplets

Varicella (chicken pox) systemic lesions, varicella pneumonia Acyclovir in adults, disseminated varicella (pneumonia and encephali)s) in immunodecient Herpes zoster (shingles) lesions in innervated dermatome (dissemina)on in immunodecient) Gancyclovir

Cyto- megalovirus

Sexually, Healthy individuals asymptoma)c or mononucleosis person-to- Congenital jaundice, hepatosplenomegaly, developmental person, disorders if maternal primary infec)on, hearing loss if transplacental reac)va)on Immunodecient re)ni)s, encephali)s, coli)s Sexually Asymptoma)c or mononucleosis Malignant transforma)ons BurkiTs , Hodgkins, and post- transplant lymphomas, nasopharyngeal carcinoma Roseola infantum lacy erythematous rash Kapsosis sarcoma neovascular prolifera)on (purple lessions) Primary eusion lymphoma in AIDS coinfec)on with EBV

Epstein-Barr virus HHV-6, -7 HHV-8 (KSHV)

Saliva Sexually

Opportunis)c Infec)ons in HIV

Disease Herpes zoster virus Tuberculosis Oral candidiasis (thrush) Pneumocys+s jirovecii pneumonia Cryptococcal meningi)s Mycobacterium avium complex Cytomegalovirus CD4 Count 400 350 300 200 100 50 50

Fungi
Fungi
Zygomycetes Ascomycetes Basidiomycetes Deuteromycetes

Rhizopus

Dermatophytes

Aspergillus

Pneumocys=s jirovecii

Dimorphic fungi

Cryptococcus neoformans

Candida

Microsporum

Trichophyton

Epidermophyton occsum

Histoplasma capsulatum

Coccidiodes immi=s

Microsporum canis

Trichophyton tonsurans

Blastomyces derma==dis

Paracoccidiodes brasiliensis

Microsporum gypseum

Trichophyton rubrum

Penicillium marneei

Sporothrix schenkii

Opportunis)c Fungi
Species Candida Infec?on Mucocutaneous candidiasis Pa?ents Diminished T cell func)on Clinical Findings Oropharyngeal (thrush), cutaneous, vulvovaginal erythematous lesions and white plaques Candidemia, endocardi)s, hepatosplenic and renal disease Saprophy)c coloniza)on of TB lung cavi)es, rhinocerebral zygomycosis in ketoacido)c diabe)cs Allergic reac)ons, saprophy)c coloniza)on of TB lung cavi)es (fungal ball), necro)zing pneumonia, aatoxin- mediated hepatotoxicity Alveolar-inters))al pneumonia with fever, non-produc)ve cough, dyspnea, hypoxia Pulmonary infec)on, meningoencephali)s, systemic disease Pathology Yeast, hyphae, pseudo-hyphae, and germ tubes Yeast, hyphae, pseudo-hyphae, and germ tubes Ribbon-like non- septate hyphae branching at right angles Angular dichotomously branching septate hyphae Cyst-like structures on GMS Yeast with gela)nous Treatment Fluconazole

Candida

Invasive candidiasis

Diminished phagocytosis/ neutropenia Diminished phagocytosis/ neutropenia Diminished phagocytosis/ neutropenia

Amphotericin B

Zygomyces

Zygomycosis

Amphotericin B

Aspergillus

Aspergillosis (allergic asperillosis, aspergilloma, invasive aspergillosis) Pneumocystosis

Voriconazole

Pneumocys+s jirovecii Cryptococcus neoformans

Diminished T cell func)on Diminished T cell func)on

Trimethoprim- sulfamethoxazole

Cryptococcosis

CAPSULE

Amphotericin B with/without uorocysteine

Dimorphic Fungi
Species
Coccidioides immi+s Blastomyces derma++dis Histoplasma capsulatum

Geography
Desert soil of southwestern US Near waters of north central and eastern US Caves near Ohio and Mississippi River Valleys South America Southeast Asia Global distribu)on

Clinical Findings
Pneumonia, disseminated disease can aect skin, bone, and meninges Pneumonia, night sweats, weight loss, skin ulcers Pneumonia with tuberculosis-like granulomas (poorly formed in immunodecient), RES dissemina)on possible

Yeast
Spore-lled spherules Large budding yeast Tiny budding yeast in macrophages

Mold
Segmented arthroconidia Filamentous hyphae Tuberculoid macroconidia

Treatment
Itraconazole Fluconazole Amphotericin B Itraconazole Amphotericin B Itraconazole Amphotericin B

Paracoccidioides brasiliensis Penicillium marneei Sporothrix schenkii

Vaccines
Inuenza
Inac)vated virus Live aTenuated virus

Hepa))s A
Inac)vated vaccine

Hepa))s B
Recombinant vaccine

Modes of Transmission
Sexual Neisseriea gonorrhoeae Treponema pallidum Chlamydia trachoma+s Haemophilus ducreyi Klebsiella granuloma+s HIV Hepa))s B Hepa))s D Herpes simplex virus Cytomegalovirus Epstein-Barr virus Trichomonas vaginalis Bloodborne
HIV Hepa))s B Hepa))s C Hepa))s D Cytomegalovirus Salmonella (undercooked chicken) Vibrio parahaemoly+cus (seafood) Escherichia coli Taenia solium (undercooked pork) Taenia saginata (undecooked beef) Trichinella (undercooked meat) Toxoplasma (undercooked meat) Viral Transmission PlacentalHIV, HBV, HDV, HCV, Rubella (before 4th mo. of preg), CMV, VZV (rarely), HSV-1,2 (rarely),Fecal/OralHAV, HEV, Enteroviruses (Poliovirus, Cocksackie, Echo)Inhala)onOrthomyxovirus (inuenzae), Paramyxoviridae (parainuenza, RSV, Mumps, Measles), VZV, Adenovirus, Parvovirus B19 (Shs disease), Rubella, RhinovirusMucocutaneous ContactHSV-1,2, HPV (only inoculates dividing cells), Oral Secre)onsHSV-1,2, HHV, EBV, CMV (and urine) Arthropod VectorsFlaviviridae (WNV, Yellow Fever, Japanese Encephali)s and Dengue) mosquitoes like the avor of blood, Alphaviridae (Chickunganya, EEE, WEE...) Bacterial Transmission Person to Person
Shigella, Cryptosporidium, STEC/EHEC,

Foodborne Listeria monocytogenes (dairy) Brucella (dairy) Bacillus anthracis Bacillus cereus (reheated rice) Clostridium botulinum (improper canning, fresh honey for infants) Clostridium perfringens (undercooked pork) Yersinia enterocoli+ca (undercooked pork) Campylobacter (undercooked chicken)

Waterborne Vibrio cholerae Salmonella Legionella Fecal-oral Hepa))s A Hepa))s E Poliovirus Enterovirus Respiratory Parvovirus B-19 Varicella zoster virus Bacillus anthracis Cutaneous Bacillus anthracis Vibrio vulnicus Zoono)c

PlacentalSyphillis (aSer 4th mo. of preg.) Inhala)onAnthrax, C. Diptheriae, Nocardia, TB, Bordatella, Legionella Furry VectorBartonella hensalae (cat bite),Arthropod VectorBorrelia burgforferi (ixodes vector), Yersinia pes)s (ea vector), RMSF (dermacantor vector)Animal UrineLeptospirosis Parasite Transmission PlacentalToxoplasmosis Inges)on of Eggs in PorkTaenia solium, Trichinella, ToxoplasmosisInges)on of Eggs in Beef MeatTaenia Saginata, ToxoplasmosisInge)on of Eggs in Water/Dirt/HandsGiardia, Cryptosporidium, Enterobius, Ascaris, Trichuris, Toxocara, Entamoeba, Toxoplasmosis,Ingest LarvaeDraculiansisInvades via SkinHookworm, Strongyloides, SchistostomaMosquito VectorFiliarisis (or y), MalariaOther VectorLeishmaniasis (sandy), Fungal Transmission Inhala)onHistoplasmosis, Blastomyces, Rose ThornSporotrichosis

Infec)ous Causes of Pneumonia

Bacterial Viral Inuenza virus Gram-posi)ves (treat with beta-lactams if Respiratory syncy)al virus possible)
Streptococcus pneumoniae Staphylococcus aureus Parainuenza virus Adenovirus Coronavirus

Gram-nega)ves (treat with cephalosporins)

Haemophilus inuenzae Klebsiella pneumoniae Escherichia coli Pseudomonas aeruginosa

Fungal (mostly in immunocompromised)

Histoplasma capsulatum Coccidioides immi+s Blastomyces Pneumocys+s jeroveci Cryptococcus neoformans (encapsulated)

Atypicals (treat with macrolides or uoroquinolones)

Legionella pneumophila Mycoplasma pneumoniae Chlamydia pneumoniae Chlamydia psi2aci

Addi)onal Infec)ons
Hematogenous spread via RES
Listeria monocytogenes Salmonella typhi Yersinia Brucella Legionella Mycobacterium Parvovirus STEC EHEC Salmonella Campylobacter Shigella

UTIs

Entamoeba histoly+ca Escherichia coli Klebsiella pneumoniae (in older individuals) Staphylococcus saprophy+cus (in younger individuals) Escherichia coli Streptococcus agalac+ae Streptococcus pneumoniae Neisseria meningi+dis Klebsiella pneumoniae Haemophilus inuenzae

Meningi)s

Bloody diarrhea

Cell Wall Inhibitors

Penicillins Amino- penicillins Aminoacyl- penicillins Penicillinase- resistant penicillins Cephalo- sporins Penicillin G Penicillin V Ampicillin Amoxicillin Piperacillin Methicllin Oxacillin Cefotetan (2nd) CeSiaxone (3rd) Cefepime (4th) CeSaroline (5th) cidal cidal cidal cidal cidal Time- Hypersensi)vity, dependent GI problems Time- Hypersensi)vity, dependent GI problems, rash Time- Hypersensi)vity, dependent GI problems Time- Hypersensi)vity, dependent GI problems Time- Hypersensi)vity, dependent GI problems Time- dependent Time- dependent Time- Skin rash, red dependent man syndrome GPCs GPCs and some GNs (H. inuenzae) GPCs, GNRs, anaerobes (Pseudomonas, B. fragilis) Resistant GPCs GPCs GPCs GPCs GPCs GPCs

1st gen GPCs, GNRs 2nd gen longer half-life 3rd gen Pseudomonas 4th gen MRSA GPCs, GNs, anaerobes, except MRSA, VRE GNs

Carbapenems Meropenem Ertapenem Monobactam Vancomycin Aztreonam

cidal cidal cidal

GPCs, GNs

Ribosomal Inhibitors
Amino- glycosides Tetracyclines Gentamicin Amikacin Tetracylcine Doxycycline cidal sta)c Time- Nephrotoxicity, dependent ototoxicity Conc- Chelates calcium dependent Time- Bone marrow dependent suppression severe GNs, synergy with beta lactams, TB Broad spectrum and atypicals (Chlamydia, Lyme disease, H. pylori) Select organisms GNs, anaerobes GPs and GNs

Chloram- phenicol Clindamycin

cidal sta)c sta)c sta)c Erythromycin sta)c Azithromycin

Time- Pseudomembranous GPCs, anaerobes dependent coli)s Time- Hypersensi)vity, GI dependent problems Time- Nausea and dependent vomi)ng Resistant GPs

Linezolid

Macrolides

Atypicals, Strep. pyogenes

An)-Mycobacterials
Drug name Isoniazid Mechanism Inhibits mycolic acid synthesis via a free radical ac)ve form Inhibits bacterial RNA polymerase Structural analog of nictonamide Mechanism unknown Toxicity Hepa))s, peripheral neuropathy (preventable with vitamin B6), hypersensi)vity, drug-induced lupus Orange discolora)on of secre)ons, hepa))s, u-like hypersensi)vity, light chain proteinuria Hepatotoxicity (rare), hyperuricemia, photosensi)vity derma))s Peripheral neuropathy, retrobulbar op)c neuri)s

Rifampin

Pyrazinamide Ethambutol

P-aminosalicylic Inhibits folate synthesis Hypersensi)vity, GI toxicity, drug-induced rash acid Dapsone Rifabu)n Inhibits folate synthesis Hemoly)c anemia, hypersensi)vity Inhibits bacterial RNA polymerase Orange discolora)on of secre)ons, hepa))s, u-like hypersensi)vity, light chain proteinuria

Sulfonamides and Quinolones

Sulfonamides Sulfamethoxazole E. coli, Nocardia Hypersensi)vity, drug fever, Stevens-Johnson syndrome, neonatal toxicity (kernicterus) Inhibit folate synthesis

Trimethoprim

Rash, nausea, Inhibit folate vomi)ng, anemia synthesis Ciprooxacin (2nd) 1st gen GN UTIs Moxioxacin (4th) 2nd gen GNs, and some GPs 3rd gen GN and GPs 4th gen anaerobes GI, CNS (hallucina)ons and depression), phototoxicify Inhibit topoisomerase/ gyrase

Quinolones

An)virals
Lamivudine Hepa))s B, HIV Reverse transcriptase inhibitor Blocks virion release Neuraminidase inhibitor Thymidine kinase inhibitor DNA polymerase inhibitor cDNA Amantadine Inuenza Rimantadine Zanamivir Oseltamivir Acyclovir Gancyclovir Foscarnet Fomivirsen Inuenza

Herpes virus

Herpes virus (CMV) Herpes virus (CMV)

An)-Retrovirals
Drug Class Mechanism Toxici?es Bone marrow suppression (anemia and granulocytopenia), rarely myopathy and lac)c acidosis/ steatosis Nausea, vomi)ng and diarrhea common, fat redistribu)on, hepa)c transaminits, parathesias, potent P450 inducer Resistance Slow, with limited cross-resistance towards other NRTIs Zidovudine Nucleoside-analog Thymidine (AZT) reverse transcriptase analog inhibitor

Ritonavir

Protease inhibitor

Transi)on state pep)domim e)c inhibitor

Nevirapine Non-nucleoside- analog reverse transcriptase inhibitor

Inhibits viral Rash, Stevens-Johnson syndrome reverse (severe diuse body rash), transcriptas hepatotoxicity, potent P450 inhibitor e

Primary muta)on is slow to develop and minor, stronger secondary muta)ons can accumulate Rapid and strong

An)-Fungals
Drug Amphotericin B Mechanism Spectrum Toxici?es Primarily renal, but also fevers, chills, and hypotension P450 inhibitor, GI, rash Binds to ergosterol and forms Broad spectrum, but used only ionic pores in cell membrane against severe Candida and Aspergillus because of toxicity Inhibits ergosterol synthesis, makes cell membrane more permeable Inhibits ergosterol synthesis, makes cell membrane more permeable Broad spectrum, but used against Candida albicans and Cryptococcus Broad spectrum, but used against Aspergillus and Histoplasma

Fluconazole

Itraconazole

P450 inhibitor, GI, rash (although less prominent)

5-uorocytosine Inhibits ergosterol synthesis, makes cell membrane more permeable Caspofungin Inhibits glucan synthesis

Used in combina)on with Bone marrow depression, amphotericin B to treat Candida GI, reversible and Cryptococcus hepatotoxicity Used to treat resistant fungi and Few, including fever, severe Candida and Aspergillus nausea, and vomi)ng