ID Board Review

Angsana Phuphuakrat
3 Dec 2013

Bacteria

Haemophilus species
Gram negative coccobacilii

Neisseria spp.
Moraxella catarrhalis
Acinetobacter species.

Neisseria gonorrhoeae
Male urethral discharge
Many gram negative diplococci, intracellular

Gram negative rod

Fusobacterium sp

Gram-negative bacilli
Glucose fermenter
Yes

No
Glucose oxidizer

Oxidase
Yes
Vibrio
Aeromonas
Plesiomonas
Pasteurella

Yes
Oxidase

No
Enterobacteriaceae
Lactose fermenter
Yes
E. coli
Klebsiella
Enterobacter
Citrobacter
Serratia

No
Salmonella
Shigella
Edwardsiella
Morganella
Proteus
Providencia
S. marcescens

Yes

No
Oxidase
No

P. aeruginosa
B. cepacia
Shewanella
B. pseudomallei
Sphingomonas

Acinetobacter
B. cepacia
S. maltophilia
Sphingomonas
P. lukola

Yes
Neisseria
Moraxella
Alcaligenes
Bordetella

No
Bordetella
A. lwoffii

Group A Streptococcus
Gram positive cocci in chain
NF type 2
Penicillin, beta-lactams, clindamycin

Umbella-like
motility pattern

Best seen when the

culture is incubated
at room
temperature

Listeria monocytogenes

Consumption dairy products

Meningitis, bacteremia
Risk: neonate, elderly, pregnancy, steroid
Rx: ampicillin + aminoglycoside
Penicillin allergy: co-trimoxazole

Erysipelothrix rhusiopathiae

Clostridium tetani

Gram positive bacilli

Corynbacterium diptheriae
Listeria monocytogenes
Erythrepelothrix rhusiopathiae
Bacillus anthracis, cereus
Clostridium tetani
Clostridium perfringens
Clostridium difficile

Polymicrobial/Anaerobic
Infection
Mixed of gram positive, gram
negative, rods and cocci
Variable shape

Modified AFB and AFB staining of sputum

Nocardia
Mycobacteria
Rhodococcus
Legionella micdadei
Aerobic actinomyces: Gordona, Tsukamurella

Nocardia or Actinomyces species

Long irregular beaded gram positive filaments
Branching

Rhodococcus equi

Gram positive coccobacilli and

diplococci
Positive modified acid-fast
Treatment
Erythromycin 2 gm/day
Vancomycin 15 mg/kg q 12 hr
Imipenem plus rifampicin 10mg/kg/day
Others: quinolones, azithromycin,
clarithromycin, aminoglycosides,
meropenem

Legionella micdadei

mAFB staining of pleural fluid showing short acid-fast rods

Fungus

Aspergillus species
Septate hyphae
Acute angle (dichrotomus)
branching

Mucor
Right angle,
rare septate,
board hyphae

Pythium insidiosum
Broad, nonseptate hyphae, shape-angle branching,
ribbin-like appearance
Risk: thalassemia, hemoglominopathy, occupational
Arterial occlusion
Rx: surgery, terbinarfine, itraconazole, immunotherapy

Wright-S 1000x

Histoplasma capsulatum
Yeast-like organisms
(budding)
Round-oval shape
Grape-like appearance
Extracellular, intracellular,
within macrophage

Cryptococcus neoformans
Large round
Encapsulated budding yeast
Budding yeast with negatively
stained halos (dense
polysaccharide capsules) and
narrow necked buds

Penicillium maneffei
Yeast like organism
Pleomorphic: round to
sausage shape
Central clear septum or binary
fission

Fungal septate hyphae

Fusarium spp.

P. Jiroveci (Pneumocystis carinii)

Giemsa stain
Trophozoites form
Foamy appearance
Amorphous dusty smoke like
clumping

GMS stain
Cyst form
Intracystic bodies inside

Parasite

Helminth eggs

Capillaria philippinensis
Colorless/brown color
Peanut-shaped with flattened
bipolar plugs
Striated shell

Treatment
Mebendazole 200 mg bid x 20 days
Albendazole 400 mg bid X 10 days

Ascaris lumbricoides
Slightly oval shape, mamilated
thick shell
Golden brown color
Fertilized egg: a mass of
uniformly coarse lecithin
granule
Unfertilized egg: a mass of
Treatment
disorganized, highly refractile
Mebendazole 100 mg bid x 5 days granules of various sizes
or 500 mg once
Albendazole 400 mg once

Enterobius vermicularis
D-shape, coloress
thick shell containing larva
Treatment
Mebendazole 100 mg x 1
Albendazole 400 mg x 1

Scotch tape technique

SCHISTOSOMA MANSONI
Asymptomatic
Intestinal
schistosomiasis
Hepatic schistosomiasis
Neurologic complication
Pulmonary complication
Bacterial infection

SCHISTOSOMA JAPONICUM

Asymptomatic
Intestinal schistosomiasis
Hepatic schistosomiasis
Neurologic complication
Pulmonary complication
Bacterial infection

SCHISTOSOMA HAEMATOBIUM

Asymptomatic
Chronic cystitis
Chronic hematuria
Obstructive uropathy
Bladder cancer

Sputum gram stain

Protozoa

Isospora belli oocyst modified AFB 20X

Isospora belli
Elongated ellipsoidal shape with 1-2 sporocysts inside
25-30 micron in size
Cotrimaoxazole is effective treatment
1 DS *4 - 10 d then 1 DS*2 - 3 weeks

mAFB x40

Cyclospora oocyst
7.5 10 micron
Spherical oocysts
Cotrimoxazole is treatment of choice
- 1 DS * 4 times / day * 7 days
- long term suppressive

STOOL MODIFIED ACID FAST STAIN

Cryptosporidium oocyst modified AFB 100X

Cryptosporidium

Deep red oocysts

4-5 micron
No effective ATB
HAART
Antidiarrheal drugs

Stool modified trichrome stain

Microsporidium oocyst
modified trichrome stain

Toxoplasma gondii

Intracellular protozoa
Infection since childhood --> latent
Most adult disease caused by reactivation
Worldwide distribution

P. ovale

BLOOD SMEAR: P.V.

P.vivax

P.vivax

BLOOD SMEAR: P.M

P.malariae

P.falcipar
um

P.falcipar
um

Uncomplicated PF
Oral artesunate (600) 12 tabs + mefloquine 3-5 tabs *2-3 days
Oral quinine 600 mg q 8 h + doxy (100) 1*2 - 7 days
Oral artesunate (50) 4 tabs OD x 3 days + mefloquine (250) 4 tabs
on day 2 and 2 tabs on day 3

Complicated PF
Artesunate 2.4 mg/kg at 0, 12, 24 h
then 2.4 mg/kg OD until D7
Quinine 20 mg/kg IV load
then 10 mg/kg q 8 h + doxycycline

PV, PO, PM
Chloroquin 4-2-2-2 at 0, 6, 24, 48 h
Primaquin 15-30 mg OD * 14 days
(except PM)

Virus

Skin scraping smear Wrights stain

CMV intranuclear inclusion body