Grampositive cocci + Streptococci/ Enterococci

Staphylococci COAGULASE
(fribinogenfibrin) *agglutination: bound coagualse *test tube: free coagulase

CATALASE
H2O2H2O + O2 *found in peroxisomes

S. aureus
Normal colonization of anterior nares opportunist infection Salt tolerant haloduric Facultative anaerobe -hemolytic Infects open wounds Mannitol salt agar (turns yellow) Toxins: Bound coagulase Alpha-toxin: forms pores SEC B & SEC C Teichoic acids: binds to fibronectin Protein A : binds Fc of Ig to inhibit phagocytosis Binds fibrnogen and fibronectin endocarditis Food poisoning (N/V) Bollous Impetigo (will bubble with H2O2 addition) Scalded Skin Syndrome: exfoliants split epidermis b/n spinosum and granulosum layers TSST1: dec LPS clearance, pyrogenic, hypotension Osteomyelitis in healthy pts Soinal epidural abscess Causes styes Orbital cellulitis Sticky eye in neonates

Streptococci
Naturally competent (genetic exchange) Lancefield antibodies Cause endocarditis S. pyogenes Facultative anaerobe Facultative intracellular B-hemolytic Lancefield grp A Virulence factors M-protein Hemolysin: Streptolysin S & O Hyaluronidase Exotoxin A Cardiotoxic Dec LPS clearance, capillary leakage, fever, shock Leads to rheumatic heart dz Causes scarlet fever (strawberry tongue) Strep Throat Necrotizing fascitis Mediated by SPEA (exotoxin A) S. pneumoniae Facultative anaerobe Extracellular Capsule Transient normal flora of nasopharynx Alpha hemolytic Seen via quelling rxns Optochin + Bile sensitive Crosses BBB Causes otitis media MCC of CA pneumonia (lobar & typical) MCC of meningitis in adults Viridans Streptococci A hemolytic S. mutans Bacterial biofilms on teeth polymicrobial abscess and osteomyelitis

Enterococci
Lancefield Group D antigen positive Normal GI flora Nosocomial infections PYR test positive Alpha hemolytic Bile esculin agar Resistant to bile salts Spinal epidural abscess E. faecalis Causes UTI Leukocyte test positive Nitrate nitrite test negative Resistant to vancomycin (binds to D-ala Dala glycopeptide and inhibits transpeptidases and transglycosylases

Coagulase-negative Staphylococci S. epidermidis

Endocarditis Non hemolytic Novobiocin sensitive Indwelling catheters and IV drug abusers

S. saphrophyticus
Novobiocin resistant Leukocyte Esterase Test + Nitrate nitrite test negative honeymoon cystitis Lower UTI Young, sexually active female Late summer, early fall

S. agalactiae
Grp B, Beta-hemolytic Hydrolyzes hippurate Resistant to Bacitracin MCC of meningitis and sepsis in neonates Causes premature rupture of membranes in pregnancy

Gram positive rods

* Spores are formed when cell is stressed (decd alanine conc)

Spore-forming

Non spore-forming Anaerobic

Aerobic Bacillus sp.

* Found in soil and water

Clostridium sp.
Catalase neg;opportunist

Aerobic
Erysipelothrix rhusropathiae Encapsulated Facultative anaerobe Cellulitis

Anaerobic
Actinomyces sp.
Filamentous, branching bacteria Part of normal flora but can cause infections Non acid-fast Trophemya whipelli Causes Whipples dz: malabsorptn, reactive arthirits, lymphadenopathy PAS positive Tx: Broad spectrum antibiotics

B. cereus
Catalase positive Emetic form Heat stabile Cerulide toxin Starchy food Diarrheal form Heat labile Toxin inc cAMP Food held warm

C. difficile
Enterotoxin A: chemotactic for PMN, fluid hypersecrtn, hemorhage, cytokine release cytotoxin B: depolymerize actin filaments Pseudomembranous colitis (post antibiotic use) MCC nosocomial diarrhea Tx: metrandazole

C. tetani
Spastic paralysis Blocks Ach degradation Tetanospasmin (neurotoxin): Blocks release of GABA and glycine and causes spastic paralysis Sardonicus, trismus, opisthotonus Lock jaw

Lactobacillus
Part of normal flora (mouth, vagina, GI) *maintains acidic pH of vaginal lumen

C. perfringens
Heat labile toxin Alpha toxin: PLC/lechinasehemolyzes RBC, WBC, platelets Theta toxin: targets cardiac mm, causes cell leakage Watery diarrhea, no N/V Cellulitis, gas gangrene (H2S), supprative myositis

C. botulinum
Flaccid paralysis Canned foods Blocks Ach release

Corynebacterium
Club shaped Catalse positive Telurite agar grey colonies Stains partially acid-fast

Listeria
Grows at low temps (4 C) Facultative intracellular anaerobe Tumbling motility Can withstand pH/salt extremes

Nocardia
Filamentous, branching bacteria Found in soil & water Opportunistic infections Stains partially acid-fast

C. diphtheriae
Causes gray membranes in mouth Cystinase activity turns agar brown

L. monocytogenes
Catalse positive; chromogenic agar B-hemolytic Heat resistant Uses ZIPPER method for invasion Unpasturized dairy, soft cheeses, deli meats Crosses placenta and causes abortion, premature delivery, stillbirths Causes meningitis, meningoencephalitis, septicemia, pneumonia in neonates usually targets immunocompromised Hemolytic cytolysin LISTERIOLYSIN O (allows it to escape the endosome after engulfment

Gram-negative cocci

Neisseria Often associated with PMNs in direct

smear Naturally competent in genetic exchange Grows best on chocolate agar in atmosphere of 5% CO2 Chocolate agar or Thayer-Martin agar (chocolate agar plus antibiotics often used to inhibit growth of normal flora and nonpathogenic neiserria) Oxidase-positive Ferment glucose

Acinetobacter
Resemble Neisseria Nosocomial infections Can colonize skin Antibiotic resistant Oxidase negative Does not ferment glucose Gingivitis and peridontal dz (+HIV =trench mouth)

Moraxella

Oxidase positive Does not ferment glucose Normal upper respiratory flora Causes otitis media, bacteremia, meningitis

N. Meningitides
Maltose and glucose fermenting Non motile Encapsulated Seen via quelling rxn Kidney bean shaped Transmission: resp droplets IgA protease: attach and invade mucosa Endotoxin : fever, septic shock Pili to colonize nasopharynx MCC of bacterial meningitis in kids 2-18 y/o Meningitis Sxns: fever, headache, stiff neck Positive Kernigs and Brudzinska signs Petechiae purpura Incd ICP Meningococcemia Leads to multi organ failure and Waterhouse Fredchelson syndrome

N. Gonorrhea
Diplococci Facultattive intracellular Non-encapsulated Coffee bean shaped Asmptomaitc infections or cervicitis, urethritis, proctitis, PID Human pathogen Doesnt survive in cold, dry palces

Gram-negative rods
ENTEROBACTERIACEAE Ferment glucose Oxidase-negative Normal habitat is GI tract of humans Endotoxins: O,H,K Nitrate nitrite test positive

NON- ENTEROBACTERIACEAE

Lactose-fermenting
(McConkey agar- pink) * EMB agar blue metabolic sheen Serratia sp. Causes UTI DNAse- red pigment Enterobacter sp. Motile Nosocomial ESCHERICHIA sp. Motile; opportunist; contaminated food Catalse pos O157.H7 cannot ferment Sorbitol MCC of community acqd UTI EPEC, EAEC, ETEC, EHEC, EIEC KLEBSIELLA sp Non motile Polysaccharide capsule (mucoid) K. granulomatis Granuloma inguinale K. Pnuemoniae H2O organism Causes UTI

Non-lactose fermenting

H2S -producing
Proteus sp.

Swarming motility
Urease-positive Common cause of UTI Kidney stones Salmonella sp. Motile; TRIGGER mech for invasion Facultatitive anaerobe HE agar black dots Survive acidi env Causes osteomyelitis in sickle cell anemia pts facultative intracellular S. enterica, S. Bangori Large infectious dose Resevoir: reptiles, poultry, dairy Killed extraintestinally

Non-H2S -producing
Shigella sp. Non-motile; uses TRIGGER mechanism for invasion Low infectious dose HE agar Facultative anaerobe Bloody diarrhea ; high fever S. sonnei, S. flexneri, S. dysenteriae Yersinia sp. Y. Pestis Bipolar stain Uses ZIPPER mechanism for invasion Bubonic plague (resevoir-rodents) Facultative intracellular

S. Typhi Causes enteric fever Rose spots (macular rash) Lymphadenopathy, splenomegaly, reactive arthirits Small infectious dose F/O Capsule, endotoxin

Curved and Spiral rods

Campylobacter sp. Gull-wing appearance Microaerophilic Oxidase positive 42C; low O2, high CO2 C.Jejuni Single polar flagellum at each end Campy/skirow agar Assoc w/ Guillan barre & reiters syndrome H2O foul diarrhea blood, pus Most common cause of bacterial enterocolitis in U.S. (Tx supportive) Vibrio sp. Comma shaped, Oxidase positive V. Cholera Single polar flagellum Alkalinophile, halophile O-antigen; cholera, mucinase, adhesin TCBS agar Heat-labile enterotoxin (cAMP) High infectious dose (>1 billion) Mucous flecks, rice water stools Mm aches, pain Helicobacter sp. H. Pylori Flagella Microaerophilic Oxidase pos, urease pos, cat pos Chocolate or thayer martin agar Duodenal ulcers, gastritis, cancer

A successful opportunist

Pathogens of the respiratory tract

Zoonses

Haemophilus sp. Pseudomonas sp.

P. Auerginosa
Colonizes GIT; grows in distilled H2O Nosocomial Cetrimide agar Does not ferment glucose Strict Aerobic (oxidase pos) Biofilm, exopolysacharide Fruity odor Exotoxin A: stops protein synthesis Causes diarrhea Causes otitis externa in diabetics Osteomyelitis in pts w/ traumatic wounds MCC of keratitis Causes erythema gangrenosum Causes psuedomonal folliculitis Via hot tubs Meningitis, resp infections, sepsis Cellulitis in burn pts Blue/green pus (pyocyanin) Requires factor X (heme) and factor V (NAD); naturally competent in GE Chocolate agar

Pasturella sp.
Bipolar staining

P. multicida, canis

H. Influenzae
Normal URT flora; 6 serotypes (A-F) Polyribitol phosphate PS capsule IgA protease; capsule LPS endotoxin Causes conjuctivitis, otitis media, typical pneumonia, epiglottitis, cellulitis

Brucella sp. Pleomorphic rods

Facultative intracellular Fastidious slow growing Inhibit phagolysosome fusion B. Abortus (cattle)

H. ducryei
Cause painful genital lesions

B. Melentis (goat, sheep) B. Suis (swine)

Francisella sp.
Inhibits phagolysosome fusion Highly contagious Facultative intracellular

Bordetella sp.
Fastidious Requires specialized media to remove inhibitory substances

F. tularensis
Rabbit fever Cysteine rich media encapsulated

B. Pertussis
Causes whooping cough

Legionella sp.
L. Pneumoniae
BCYE agar; fac. intracellular Requires L-cysteine for growth & Fe Chlorine resistant; lives in macroph. Found in warm moist areas (AC, shower head, closed quarters) Atypical pneumonia Lengioanres dz

Bartonella sp.
B. Hensale
Cat scratch dz Bacillary angiomatis

Virulence factors *Urease CagA VacA

B. quintana
Urban trench fever (homeless, 4 lice) endocarditis

Organisms that stain poorly with Gram-stain

Obligate Intracellular
Stain poorly, but have Gram-negative cell wall Cannot culture on semisolid media

Spirochetes
Helical shaped Endoflagella Stain poorly, but have Gram-negative cell wall Dark field microscopy

Mycobacteria sp.
Small rods poor Gram staining Cell wall- waxy mycolic acids Resistant to drying, chemical agents, germicides Slow growing

Mycoplasma sp.
Lack a cell wall - Mollicute Membrane contains sterols Pleomorophic Sensitive to environmental conditions Hard to grow in laboratory requires cholesterol in media Normal flora in mucosa Atypical pneumonia GU infections IgM- diagnostic Extracellular pathogen

Treponema sp.
Has never been cultured Syphilis

Chlamydia & Chlamydiophila sp.

Cannot make their own ATP

Sexually transmitted Sinusitis, atypical pneumonia Assoc w/ atherosclerosis Elementary body- contagious Has PM/OM but no PG layer

M. tuberculosis
Strict aerobe; acid fast Facultative Intracellular Lives in macrophages Causes TB; assoc with Granulomas MCC of chronic meningitis Stains: Ziehl Neelson, Kinyoun acid fast (viable bacteria), Flourochrome (dead and viable bacteria) Dx: culture on Middlebrook agar or Lowenstein Jensen Egg agar (very slow-growing!)

T. pallidum
Obligate pathogen Assoc with Granulomas resevoir: genital tract Crosses placenta Flexible wall- lipoproteins Endoflagellum Dark field (chancre fluid) or fluorescent ab turns green Not cultured in vivo Gram neg, but poorly staining Transmit through sexual contact Mucosal chancres gumma

C. trachomatis
Obligate intracellular Cant make ATP Elementary body- extracellular infective form Serotypes A, B, Ba, C : Trachoma blindness Serotypes D K neonatal conjunctivitis pneumonia Adult trachoma inclusion conjunctivitis (TRIC) Female: cervicitis, urethritis, PID Male: proctitis, epidiymitis

Mycoplasma hominis
vaginitis, cervicitis

Ureaplasma urealythicum
Grows on special medium with urea Found in lower urinary tract Found in neonates resp tract vaginitis, cervicitis, salpingitis, chorioamnionitis, infertility Sexually transmitted Self resolving

M. leprae
does not grow in culture Obligate intracellular Results in leprosy (CMI response gives the Tuberculoid form [IL-12]; Ag response gives the Lepromatous form [IL-4])

Borrelia sp. Ixodes tick

Lyme disease among others

B. burgdorferi
Erythema migrans (bulls eye rash) myocarditis meningitis scleroderma Neuroborreliosis

Rickettsia sp.
Use PLA to cleave endosome Live in cytoplasm

R. rickettsiae
Rocky mt spot fever D. variablis and D. andersoni

R. akari
Mites

Anaplasma sp.
Ixodes tick Forms morulae Infects PMNs preferentially Prevents phago-lysosome fusion

R. prowazeki
Epidemic Louse born

R. typhi
Endemic typhus rodent flea

Ehrlichia sp.
Infects monocytes preferentially Prevents phago-lysosome fusion

Coxiella sp.

Resistant to drying Highly infectious Zoonosis Lives in phagolysosome (req. low pH) Targets macrophages C. burnetti Q fever (interstital pneumonia) Parturition areas: mammary glands, breast)

Viruses

+ ssRNA
*NAKED*: Picornavirdae
Naked

- ssRNA
Influenzae
Segmented

dsRNA
Segmented Naked

dsDNA
Adenaviridae
Naked spiked Pink eye Swimming pool conjunctivitis shipyard keratoconjunctivits

ssDNA
Parvovirdae
Small Naked

*All are enveloped* Reovirdae Rotovirus Orthomyxovirdae

Rhinovirus Enterovirus Type 70 conjunctivitis Echovirus Hep A Coxsackie Type A24 conjunctivitis

Parvo B19 Erythrovirus

Paramyoxyviridae
Parainfluenza RSV Metapneumovirus

Herpesviridae
HSV
MCC of viral encephalitis HSV 1= encephalitis HSV 2= meningitis

Filoviridae
Filamentous Pleomorphic

Calcivirdae
Naked

Norvovirus Hep E

Bunyviridae
Arbovirus
segmented

Astroviridae
Naked

Astrovirus

Arenaviridae Hepatitis D
Defective

CMV EBV VZV Conjunctivitis Vesicular lesions on eyelid

Hepatitis B
Gapped Enveloped

*ENVELOPED*: Retrovirdae
Capsule

HIV

Rhabdovirus
Bullet shaped G-protein spikes

Polyomaviridae
BK/JC virus

Flaviviridae
Capsule

Papillomaviridae
HPV
Naked

Hepatitis C Arbovirus

Coronaviridae
Capsule

Coronavirus

Roseolovirus (HHV6)
Linear Enveloped

Togaviridae
Capsule

Togavirus
Rubella (congenital: cataracts, microcephaly)

Poxviridae
Small pox (variola) Linear Most complex virus Replicates in cytoplasm