Dracunculus medinesis 

Found in copepods and humans

IA? CD?

Tissue nematode or the 

"Guinea/ Medinia" worm

Dracunculiasis - "Guinea worm, fiery serpent"

Name? Reservoir?

Chronic cutaneous ulcers from which the worm protrudes (1 year after exposure)

Hives, GI issues when worm erupts (takes 2-3 mos)

Secondary bacterial infections may occur

Name? Risk?

Dracunculiasis - Fiery serpent

Clinical presentation

Elevated IgE

Eosinophilia

Name? Secondary issues?

Clinical presentation

Elevated IgE

Eosinophilia

Treated by slowly removing the worm as it emerges from the ulcer over days and weeks

Name? IA?

Franisella tularensis 

Zoonotic - wild animals

IA? CD?

Facultative intracellular 

Gram negative rod

Requires external source of cysteine

Tularemia

Name? Reservoir?

Ulceraoglandular (70-85%)

Papule ulcerates with necrotic center and raised border

(Due to cell-mediated immune response)

Fever, chills, sweating and coughing

Also in the Respiratory and GI tracts

Name? CD? Transmission? Infectious dose? Risk?

Franisella tularensis 

Zoonotic

Chocolate - Cystine Agar

IgM on serology

CD? IA? Tx?

Spirillum minus 

Rats or other rodents 

IA? CD?

Gram negative

Spiral rod

Rate bite fever aka Spirillar Fever aka Sodoku

Name? Reservoir?

Infected sites ulcerate, lymphadenopathy, rash and relapsing fever

Rash lasts 48 hours

In untreated patients symptoms subside then reappear in 3 to 9 days

Joint manifestations are RARE

Name? CD? Dx?

Ulceration at bite site, regional lymphadenopathy, rash, relapsing fever

Dark-field microscopy

Gram negative

Spiral rod

Name? Risk area? Transmission? Tx?

Gram negative rod

North America, Europe

Rat bite

No ulceration

Arthiritis

NO regional lymphadenopathy

Rash, Relapsing fever

Name?

Streptobacillus moniliformis 

IA? Geo area? Transmission? Ulceration, arthritis, regional lymphadenopathy, rash, relapsing fever?

S. moniliformis has polyarthritis, in S. minus joint manifestations are rare

What is the difference between Spirillum minus and Streptobacillus moniliformis rashes?

Spirillum minus 

Radiates from wound site and lasts 48 hours; red-brown macular with plaques or urticarial lesions

Streptobacillus moniliformis 

Nonpuritic rash erupts over palms, soles, extremities; maculopapular, petechial or purpuric

Joint manifestation differences?

Leishmania spp. 

Bite of sand fly

Anyone exposed is at risk (different spp. all over)

IA? CD?

Flagellated protozoan

Intracellular replication

Intracytoplasmic growth

Cutaneous leishmaniasis

Mucocutaneous Leishmaniasis

Name? Transmission? Risk?

Red papule at bite

Ulcerating skin sores (1 or more) which may form granulmomas which progress to nodular lymphangitis

Spontaneously heal but leave SCARS

Name? CD? Dx?

Leishmania spp. 

Cutaneous Leishmaniasis

Hx of exposure, intracellular amstigote speciments

DFA, serological tests

Symptoms? Scars?

Flagellated protozoan

Intracellular replication

Intracytoplasmic growth

Mucocutaneous Leishmaniasis

Name? Symptoms? Tx?

Leishmania spp. 

Destruction of mucous membranes

Infects tissue at mucosal-dermal junctions

Does SERIOUS damage

Pentamidine

IA? CD? 

Myobacterium spp.

Direct contact with contaminated fresh or salt water or aquariums and soil

IA? Structural features?

Acid Fast

Pleomorphic rod

Facultative intracellular

Trehalose dimycolate

Antigens of outer coat

Name? Transmission?

Acid fast pleomorphic rod

Facultative intracellular bacteria

Ranges from self-limiting verrucal lesions to ulcerations to non-caseating granulomas to nodular lymphangitis

Name? Dx?

Mycobacterium spp. 

Excision and/or Minocycline, Ethambutol

Causes a variable range of clinical expressions

Which do the Antigens of the outer coat do?

What is the specific Culture used?

Ags of outercoat stimulate actively self-destructive host immunity-T cell mediated chronic inflammation --> possible granuloma formation

Lowenstein Jensen Media

Name? Tx? What about the CDs?

Sporothrix schenckii 

Rose thorns, timber, etc.

Exposure to other thorny vegetation

IA? CD? 

Thermally dimorphic fungi

Mold at 25 °C

Cigar shaped yeast at 35 °C

Sporotrichosis

Name? Reservoir? Transmission?

Sporotrichosis

On culture branching, septate and very delicate with pyriform conidia forming a typical arrangement in groups

Tissue shows cigar shaped yeast

Name? Symptoms?

Sporotrichosis

People working in the woods 

Branching septate pyriform conidia in groups

Cigar shaped yeast in tissue

Name? Symptoms?

Bacillus anthracis 

Found in soil; spores viable for decades

IA? Structural features?

Gram positive spore forming rod

Polypeptide capsule - repeating glutamic acid

Name? Reservoir?

Edema Factor - calmodulin-dependent adenylate cyclase

Lethal Factor - Zinc metalloprotease 

Protective Antigen - cell binding protein (acts as B unit)

Name?

CD?

Red, itchy papules

Central necrosis going purple to black necrotic eschar

Swollen surrounded by purplish vesicles

Name? CD?

Spore entry into wounds/ abrasions

Ranchers, meat packers, taxidermists, tanners

Name? Dx?

Gram positive 

Spore forming Rod

Polypeptide capsule

Cutaneous Anthrax

Name? Tx? How long?

Lesion may be confused with bite of Brown recluse spider or Orf Viral infection

Vaccine for high risk populations

Name? VFs?

Spores entry into wounds/abrasions or contact or consumption of infected animal products

Painful lymphadenopathy, massive edema --> may progress to toxemia

Name? CD?

Poxviridae Orf Virus

Zoonotic: Sheep, goats, reindeer, oxen

IA? CD?

ds DNA virus
Replicates in CYTOPLASM!

Malignant Pustule/ Eschar

Name? Reservoir?

Direct contact w/ infected animals/fomites

AND skin trauma

Farm workers

Confused with brown recluse bite or Bacillus anthracis

Name? CD? Tx?

Malignant Pustule/ Eschar

Negative stain electron microscopy

ONLY PCR works!

Name? Prevention?

Pseudomonas aeruginosa 

Ecythema gangrenosa

Symptoms? Color change?

Upon closer inspection?

Malignant pustule/eschar

Small, painful, reddish, maculopapular, well circumscribed lesion 

Pink --> Purple --> Black and Necrotic

Shows vascular invasion (hemorrhagic vasculitis)

Name? CD?

Ecythema gangrenosa

Malignant pustule/eschar

Shows Vascular invasion

Small, painful, reddish maculopapular

Name? Tx? 

Pseudomonas aeruginosa 

 For this CD you use arm water/showers to soften "eschar" for removal

CD? Symptoms?

HPV

E6 and E7

IA? CD?

ds circular DNA

non-enveloped

Replicates in NUCLEUS

Cutaneous and Mucosal warts

Name? VFs?

Verrucal (rough/scaly) warts

Skin colored but can also be dark, flat and smooth

Transmitted through Direct contact, often sexual

Name? CD? Dx?

HPV

Cutaneous and Mucosal warts

Pap smear

KOILOCYTIC CELLS

Symptoms? Transmission?

ds circular DNA

non-enveloped

Replicates in Nucleus

Guardasil (6,11)- subunit vaccine

(also Cevarix for 16,18)

Name? CD? Risk?

HPV

Cutaneous and Mucosal warts

Anyone

Co-infections often occur

IA? Vaccines?

Poxviridae: Mulluscipoxvirus:

Mulluscum Contagiosum Virus

Humans

IA? Transmission? CD?

ds linear DNA

Double envelope

Replicates in CYTOPLASM

Direct contact or shared clothing/equipment

Fomites

Mulluscum Contagiosum

Name?

Benign papular eruption (may be in groups)

Replicates in stratum basale

Extends down into dermis

Skin tone --> white --> yellowish, waxy, smooth, translucent with a central induration

Name? What body areas are they common?

Mulluscum Contagiosum Virus

Adults: lower abdomen, genitals, inner thighs

Children: face, trunk, extremities

Symptoms? Color change? Induration?

Mulluscum Contagiosum Virus

Contact sports players and sexual partners of infected

Dx? Tx?

Clinical expression

Oval, eosinophilic cytoplasmic inclusion bodies aka

HENDERSON-PATERSON BODIES!!!!

Usually resolves itself in a few months

Name? Risk?

HSV

Vesicles due to infection of epithelial cells

Dx? Tx?

Tzanck smear

Multinucleated cells

Acyclovir

Dermatophytes

Monomorphic fungi (as molds); septated hyphae

Soil, animals, humans

Three Dermatophyte species? Transmission?

Microsporum, Trichophyton & Epidermophyton

Direct contact

Introduction of arthrospores which adhere to keratinocytes

Name? IA? Reservoir?

Tinea corporis - ringworm

Tinea pedis - athlete's foot

Tinea cruris - jock itch

Tinea capitis - scalp hair

Tinea manuum - hands

Tinea barbae - beard hair

Tinea unguium (onychomycosis) - Nail

Caused by? IA? What happens to nails?

Dermatophytes

Microscopy

KOH prep

Infected hairs glow under WOODS LAMP

Malassezia species (furfur)

Tinea Versicolor

IA? VFs?

Dimorphic fungi (yeast on skin, mold pathogenic), mixed forms appear on skin

Mold produces Azaleic acid and Malassezin

Name? CD?

Hypo-pigmented maculae on skin

"SHIFTING CLOUDS"

Sun may be a trigger

Name? CD? Reservoir?

Dimorphic fungi (yeast on skin, mold pathogenic)

Mixed forms appear on skin

Microscopy - mix of hyphae and yeast

Woods Lamp POSITIVE

Ketoconazole, topical selenium sulfate products

Name? VFs? Where on body does it occur?

Enterococcus faecalis 

Gram positive cocci

Catalase negative

Group D

Reservoir? Transmission?

Autoinoculation, nosocomial

Endogenous due to perforation of the bowel

Name? IA?

Intra-abdominal abscesses

Abdominal surgical site infections

Risk from hospitalization, catheterization, surgery

Name? Dx?

Enterococcus faecalis

 Catalase negative

Culture on ENT (Bile Esculin Agar)

Lancefield Group D positive

Survives in elevated salt (6.5%)

CDs?

Enterococcus faecalis 

Gram positive cocci 

Catalase negative

Group D

Dual (combo) treatment with high dosage antibiotics

CDs? Dx? 

Intra-abdominal abscesses

Abdominal surgical site infections

Catalase negative

Culture on ENT (Bile Esculin Agar)

Name? IA? Tx?

Bacteroides fragilis 

Gram negative

Obligate anaerobe

Natural flora in urogenital and GI tracts

VFs? CD?

Succinic acid 

Heparinase

LPS has little to NO endotoxic activity

Intra-abdominal abscesses, peritonitis, genital infections and PID in females (soft abscesses)

Name? IA? Reservoir?

Bacteroides fragilis 

IA? VFs? Transmission?

Bacteroides fragilis 

Bacteroides Bile Esculin agar

Endogenous due to perforation of bowel or vagina for any reason

CD? Tx?

Intra-abdominal abscess, peritonitis, genital infections, PID in females (soft abscesses)

Drainage and debridement

Metronidazole

Hyperbaric oxygen

Name? Dx? Transmission?

Prevotella melaninogenica 

Normal flora in mouth, oropharynx; GI tract

IA? CD?

Obligate anaerobic

Gram negative rod

Soft tissue infections, periodontal disease

ALSO causes infections in dog and cat bites

Capsule

Heparinase

Collagenase

Normal flora in mouth, throat, GI tract

Soft Tissue infections; Periodontal Disease

Name? Other infections? Dx?

Prevotella melaninogenica 

Infections in cat and dog bites

Multiple tests needed to differentiate from Bacteroides

Structural features? Reservoir? CD?

Prevotella melaninogenica 

Obligate anaerobe 

Gram negative rod

Multiple tests needed to differentiate from Bacteroides 

Soft Tissue and Skin infections

Dog and cat bite infections

VFs? Transmission? Risk?

Capsule

Heparinase

Collagenase 

Endogenous due to overgrowth

Introduced via trauma

People with poor dental hygiene

Name? IA? Dx? CD?

Soft Tissue infections

Dog and Cat bite infections

Ex. Submandibular subcutaneous abcess

Name? Risk? VFs?

Prevotella melaninogenica

People with poor dental hygiene

Capsule

Heparinase

Collagenase

CD? Example?

Acinetobacter baumanii 

Gram negative rod

Facultative anaerobe

CD? Risk?

Wound infections

Outbreaks tend to occur in ICUs and healthcare settings

WOUNDED SOLDIERS

Name? IA?

Gram negative rod

Facultative anaerobe

Biofilm 

Phospholipase

Multi-drug resistant

Name? Transmission? Reservoir?

Outbreaks occur in ICUs

Wounded soldiers

Immunocompromised patients

Oxidase negative

GAMMA hymolysis on BAP

Lactose non-fermentor

Name? CD?

Oxidase negative

Gamma hemolysis on BAP

Lactose non-fermentor

Wounded soldiers, immunocompromised

Name? IA? VFs?

Osteomyelitis

From open injury to the bone or a chronic open wound

Risk groups are diabetes, hemodialysis, IV drug abuse, poor peripheral perfusion

Bugs? Transmission?

Staphylococcus aureus (most common)

Pseudomonas (trauma/diabetics)

Salmonella (sicke cell patients)

CD? Risk factors/ groups?

Staphylococcus aureus (most common)

Pseudomonas (trauma/diabetics)

Salmonella (sicke cell patients)

CD? Symptoms?

Osteomyelitis

Swelling, pain in infected area

Fever, +/- drainage thru skin

Sweating, chills, swelling, limping

Bugs?

Osteomyelitis

Blood tests for WBC, ESR, and CRP

Blood culture, needle aspiration or biopsy

Bone scan: Technetium-99 pyrophosphate

Bugs? Tx?

Staphylococcus aureus (most common)

Pseudomonas (trauma/diabetics)

Salmonella (sickle cell patients)

IV antibiotics for 4-6 weeks, surgery, bone graft

CD? Dx?

Salmonella spp. (non-typhoidal)

Gram negative rod

Non-spore forming

Lactose non-fermentor

Reservoir? CD?

Animal reservoir (reptiles, chickens, grimy people)

Osteomyelitis

Name? IA?

Gram negative rod

Non-spore forming

Lactose non-fermentor

Osteomyelitis

Name? Transmission? Dx?

Salmonella spp. (non-typhoidal)

Endogenous/Hematogenous

Following food borne infection and/or carriage condition

Hektoen Agar

IA? CD?

Salmonella spp. (non-typhoidal)

Hektoen Agar

Animals (reptiles, chickens, grimy people)

CD? Risk?

Osteomyelitis

Children with sickle-cell anemia

Name? Dx? Reservoir?

Swelling, pain, tenderness in infected area

Fever

Pus drainage thru skin

Gram negative rod

Lactose non-fermentor

What two agents could it be? Dx difference?

Pseudomonas aeruginosa

Salmonella

Check under UV light or grow on Hektoen Agar

Green colonies with black centers --> H2S production by Salmonella

Symptoms? Similar IAs?

Trichinella spiralis 

Nematode

Helminthic roundworm

Consumption of raw or undercooked meats (WILD)

CD? Reservoir? Risk?

Fever, myositis, periorbital edema

First is GI Distress

If infection is HEAVY, patients will experience difficulty moving, breathing and heart problems

Name? CD? Dx? Can it be fatal?

Nematode

Helminthic roundworm

Eating raw or undercooked wild game meats (Swine!)

Freeze pork at least 20 days and COOK WILD GAME MEAT THOROUGHLY!

Name? Dx? Tx?