Gardnerella Vaginalis

(usually co-infection with mobiluncus a anaerobe) 

F. anaerobe, Overgrows along other anaerobes 

Bacterial Vaginosis

Not STD, associated w/ new partner

whiff +, pH > 4.5

gray discharge, clue cells

Trichomonas Vaginalis 

(40% also have gonorrhea) 

Protozoan anaerobic, 4 flagellas from one point

STI of UTI (vaginitis, pruritis)

Men: asymptomatic maybe urethritis

women: foul smell, green discharge, strawberry cervix, pH = 5-6 

wet mount shows corkscrew motility of trophozoite 

Tx: Metronidazole 

intracellular, no ATP, Giemsa stain, NAAT, hybridization no muramic acid = no gram stain

Elementary bodies infect epithelial cells--> reticulate bodies replicate

serotype D-K:  

Women:  PID + urethritis etc (all -itis)

 neonate (infected at birth):  pneumonia (staccato cough-short sudden out burst ) & conjunctivitis 

Male: urethritis, reiter syndrom

Tx: Doxycycline, Azithromycin 

Neisseria Gonorrhea  

(common co-infection w/ chlamydia)

G- ox+, diplococci, pili pull cells in, ferments gluc, OPA surface proteins (binds immune cell receptors) show rapid antigenic variation

Choco-(NAD, hemin) Thayer Martin/VPN

purulent discharge,urethritis, PID

 fitz hugh curtis (inflammed liver capsule),septic arthritis w/ non painful pustules, C6-9 deficiency

 Neonatal conjunctivits (at birth),

Tx: Ceftriaxone + Doxycycline or Azithromycin

G-, spirochete, slow motility 

Syphilis

Painless chancre--> condylomata lata, generalized lymphadenopathy, rash on palms, feet--> neurosyphilis, damage to vasa casorum, aortitis, gummata (skin lesion looks like flesh eating) 

In utero: asymptomatic--> shedding rash, chorioretinitis,keratitis, cataracts, malformed teeth

Tx: Penicillin

G-, coccobacillis pleomorphic (Histo: parrallel chains)

painful Chancroid, buboes (enlarged inguinal node--> erode skin--> draining ulcer) 

Tx:Azithromycin or Ceftriaxone

db DNA, enveloped, sacral ganglia 

Tzank smear= multinucleated giant cells, cowdry A inclusion

Neonate, in utero or infected at birth: Delayed sepsis, seizures (temporal), vesicular lesions  

Togavirus, + ssRNA envelope, icosahedral-vaccine MMR

MOM TRAVELS

3 day measles, postauricular tenderness, rash on face--> trunk, extremeties, POLYARTHRITIS  

In utero: patent ductus arteriosus,cataract, purpuric skin lesion, sheds virus for 5 days 

High risk in first 3 months, 25% develop DM I 

linear db DNA enveloped

Roseola

children: high fever--> goes away--> Exanthem: macular rash begins and tends to stay in trunk .... (seizures in some)

(-)ssRNA virus, exanthem (head--> toe) 

measles (unlike rubella, rash darker and confluent) 

Prodrome (48 hrs): koplik spots (near molars)

3C's: cough, Coryza (rhinitis), Conjunctivitis (maybe photophobia) 

7-10 yrs post infection: subacute sclerosing panencephalitis 

immunoC: giant cell pneumonia (macro wall, like Tb, rubeola)

Warthin-Finkeldey multinucleated giant cell : multi nuclei, grape like in nodes or reticuloendothelial system

Vitamin A deficiency ^ risk also helps symptoms

herpes 3, db DNA enveloped linear, multinucleated giant cells, cowdry A inclusion

chicken pox (rash trunk--> everywhere)

Adults: primary= pneumonia, encephalitis, 2nd: shingles lays dormant in trigeminal and dorsal root ganglia-- shingles begins with burning pain in dermatome--> vesicle

enveloped, db DNA, linear

smallpox, cowpox, mulluscum contagiosum (from toilet pimple w/ dimple, tan color)

Protozoan (most asymptomatic--> cysts in your muscles--> Ig--> protection

Meat, cat feces

HIV mom with flu like, nodes

In utero: Intracranial calcification, chorioretinitis, hydrocephaly

HIV: multi-ring abscess in brain 

naked, circular dlb DNA (all dna dlb except parvo) 

reactivated in prego, genital = infected at birth

6,11- warts  vs 16,18 (cervix, penile squamous cell carcinoma, head & neck cancers ) 

Condylomata acuminata 

Neonate: laryngeal warts 

Clear halo = koilocytes 

^ Risk of cancer: ^ HIV, smoker

Mold in soil--> US southwest earthquake----> endospores inhaled--> Spherules rupture containing endospores--> pneumonia --> systemic (bone, meningitis, erythema nodosum in legs) 

Histo: granuloma caseous necrosis 

Increased severity in prego 

Herpes 4, dbl DNA linear, enveloped (CD21 of B cell) 

Mononucleosis (fever, ^ liver & spleen,pharyngitis, P. cervical lymphadenopathy, heterohile +, rash if treated w/ ampicillin)

Nasapharyngeal carcinoma, burkitts & hodgkin lymphoma 

reactivated in pregnancy 

ssDNA linear, naked (B-19 infects humans)

Fetus: hydrop fetalis 

Children: slapped checked rash, erythema infectiosum

Adults: arthritis

Replicates in erythroid cells, so if person has anemia, sickle cell etc--> aplastic crisis 

cross placenta but most due to breast milk 

oral thrush, diarrheas, pneumonia

Dx: NAAT 

infected at birth

septicemia--> CNS--> Death 

G+, anaerobe rod, spore (looks like sperm)

soil, trauma / unvaccinated

neurotoxin on renshaw cells of spinal cord, blocks GABA, Gly release--> rigid, locked jaw

Tx: Anti-toxin, anti spasmolytics,metronidazole or Pen G

G- curved rod, Ox+

hot salty water,  oysters

 rapidly advancing cellulitis (hot tender, red),headache, fever, chills

G-, pleomorphic rod, pericellular

Henselae = cat scratch

Henselae, Quintana = tick bites 

fever -->  Bacilary angiomatosis in AIDS, mimic kaposi sarcoma, fatal if not treated

G+ rod, capsule, F. anaerobe

People that butcher meat, veterinarians

cellulitis in hand

group A, G+ cocci, B-hemolytic, Cat -, PYR+, Bacitracin sensitive

Strepto- kinase(fibrolytic) , dornase (DNA)lysin O,S (hemolysin), *Hyaluronidase*, Hyaluronic capsid = no Ig develop against it, Exotoxins A-C come from a bacteriophage. SPEA-necrotizing fasciitis,

pyogenic: pharynx (strep throat), skin (impetigo, *cellulitis*), erysipelas(upper dermis)

Toxin mediated: scarlet fever

Immuno: R. fever antibodies to M protein (Inhibits phagocytosis), acute glomerulonephritis

G- coccobacilli, polysac capsule, F1 antigen, VW antigen (anti-phag), Plasminogen activator protease, coagulase (clotting, flea puke) 

prairie dogs (rervoir,SW), fleas (vector) 

Buboes (nodes swell, painful) -->sepsis, pneumonia, black cutaneous hemorrhagic lesions (if in blood) 

G- coccobacili, slow grower

Brucellosis (unpasterizes milk, goat cheese, placenta of animals)

in macros, if not cleared--> granulomas

undulating(wave like) fever, drenching sweat in evening, back + hip pain --> abscess in organs 

Doxycline, gentamicin

G-, giemsa, intracellular from rickettsia species but no athropod vector, no rash

Very resistant, highly infectious 

Peopple from Iraq, afganistan

inhalation of spores from cattle,sheep, goat  --> Q fever (flu, vomit, diarrhea) pneumonia, chronic Q in valvular heart disease, MCC of culture (-) endocarditis

G- coccobacilli, cysteine in medium (BCYE agar) , slow, F. intracellular

tulerimia: ulceroglandular (papule--> ulcer, ucler not painful + lymphadenopathy)--> pneumonic form (or primary)--> typhoidal (systemic) 

transmited by deer fly and dermacentor wood tick (rabbit-too)  passed on in rabbit skinning, cats  = multiple routes of transmission 

Missouri, Arkansas, Oklahoma

G- coccobacillus, choco agar, bipolar staining (not on mac conkey agar)

mouths of cats, dogs (usually polymicrobial)

Sx: <24 hrs swelling, edema, cellulitis

Tx: amoxicillin + clavulanate 

G- bacillus (very pleomorphic, beads) ,serum medium, slow growth

Rat bite fever (all rodents) or urine 

Sx: fever ( up and down), migratory polyarthralgia--> maculopapular rash PALMS AND SOLES ( days later) or petechial rash 

spirochete, flagella at both ends--> burrows into skin

slow

rodents (reservoir, urine)--> water, dogs (accidental) 

50% cases in hawaii

flu--> systemic, red eye --> liver and kidney failure (weil's syndrome) petechiel rash

Cytomegalovirus 

(virus reactivate in pregnancy also HSV, EBV)

Herpes dsDNA w/ envelope, owl eyes

poor T cell proliferation, transplant  = ^ risk to infect fetus 

Mono-like but - heterophile Ig test

Paraventricular calcification, deaf, CNS Ca,mental retard (in utero)

AIDs: retinits, esophagitis 

G+, coccibacillus, F. intracellular, Cat +, B-hemolytic

4C, soft cheeses,monocytes in CSF 

actin rocket, tumbling, only G+ w/ endotoxin like structure

Rare in US except prego: flu, G.I, spontanous abortion in 2,3 trimester

in utero: granulomatous, meningitis 

G+ rod, anaerobe, spore

Meat, gravy, deli, in vivo toxin, heat liabile

Skin:

soil, colon----Trauma

Alpha toxin (lecithinase--> myconecrosis + gas = gangrene)Theta toxin (hemolysin focused on heart, capillary)  

lesion has bac no WBC, Naegler's Rxn (egg + antibiotic)

n

G+ rod, anaerobe, spore, tennis

heat labile invitro toxin--> inhibits Ach release in NMJ--> descending flaccid paralysis (canned food, honey)

deep wounds IV drug users (antibiotics) vs infant (no)

diplopoa, ptosis, floppy baby, constipation

G+ Cat + cocci, clustered, B-hemolytic, fermants mannital in ^ salt conc.

ProteinA: binds IgG on Fc (anti-phagocytosis)

eggs,ham (salty), cream filled, SEA exotoxin --hrs 

skin (pimples, impetigo**,cellulitis, abscesses, feruncles)

pneumonia (usually following viral influenza) Acute bacterial endocarditis, Osteomylitis

** Strep (small clusters, honey crust) vs Staph (large) can be mixed

Some strains :

TSST 1- binds MHC II + T-cell = ^activation of all Tcells

Exfoliative toxin= split b/t spinosum and granulosum

Panto-valentine leukocidin =MRSA

enterotoxin- (diarhea, rapid onset ham, salty)

oral, genital rash

yeast + pseudohyphe-20C

germ tube-37C (in body)

at risk: Immunocomp, antibiotics, OC 

Vaginitis*, diaper, esophageal thrush, endocarditis, oral thrush in neonate-- infected at birth 

* normal pH, thick yellow white, no smell, satellite lesion, ^ severity during preg

G- rod, Cat+, Ox+, curved, polar flagellum, microaerophilic 

Needs: Urease (urea--> ammonia: NH3, CO2 --> ^ pH), cytotoxin (vac A), CagA protein --does not invade

ulcers--> gastric adenocarcinoma, MALT lymphoma

Dx: stool antigen, urease breath test, IgG, biopsy

G+ rod, Cat +,B-hemolytic , 

soil dwellind, fried rice 

Emetic: incub 1-6 hrs, vomit, heat stable protein, superantigen binds serotonin receptors on vagus nerve 

Diarrheal form: + Meats, heat liable in vivo, activates adenylate cyclase

G- rod, glucose fermenting, non lactose, Ox+, comma shaped, ^ pH, TCBS agar 

crabs, oyster:  rice water diarrhea 

1) heat liabile AB toxin (ADP ribosylating) --> Gs activated --> ^ cAMP--> ^ Cl into gut

2) inhibits Na reabsorption 

Bacteria needs high dose if person has normal acid secretion, tcp (receptor for CTX phage + adherence) , ToxR= transmembrane toxin regulator 

Enterotoxigenic Escherichia coli (ETEC)

MCC of traverlers, toxin mediated 

ST (heat stable, ^ cGMP) vs LT (heat labile, ^ cAMP) 

both invitro 

watery diarrhea

toxin mediated 

Presistent diarrhea (wks) in < 6 yrs & HIV

Bioflim (bac floating above cells)

cytotoxin destruction of microvilli 

<1 yr 

BFP- bundle forming pili  (sits on microvilli--> malabsorption) no toxin 

diarrhea 

Invasive

bloody, no fever

shiga toxin binds glomerular endothelium--> apoptosis

--> immune--> toxin becomes thrombogenic + inactivates ADAMTS13  (protein normally deactivates von willebran factor) --> Thrombotic thrombocytopenic purpura (small clots) --> clots destroy RBC as they pass, schistocyte--> hemolytic anemia

Intimin: A/E lesions: bacterial attachment nd effacement of microvilli 

SLT: inhibits 60s ribosome (lysogenic phage) 

invasive 

G+ rod, anaerobic

Severe Diarrhea, MCC Pseudomembranous colitis --> megacolon, MCC of nosocomial diarrhea

overgrowth due to: Clindamycin, ampicillin 

Toxin A ( damages brush border) Toxin B (induces actin depolymerizatio) 

Dx: toxins in stool, not culture

Tx: metronidazole, vancomycin 

Invasive 

G- rod, comma, Ox +, polar flaggella, cork screw motility, 42C

Undercooked chicken, unpasteurized milk, puppies w/ diarhhea

Bloody diarrhea + pus

Triggers Gullain-barre (ascending paralysis), Reiter syndrome (inflammation of joints, eyes, urethritis)

G- rod, Flagella, Ox -, non lactose fermenting, white colonies on Mac Conkey, HS producing

Chickern, turtles are reservoir 

diarrhea (can progress to dysentery), fever,vomit

 monocytic responds, C/I antibiotics 

Osteomyelitis 

G- rod, Flagella, Ox -, non lactose fermenting, white colonies on Mac Conkey, HS producing 

food, water--> M cells in peyer patch take them up--> little diarhea or constipation --> nothing --> bacterimia--> typhoid fever,headache, bradycardia, reactive arthritis, rose spots on abdomen, gallbladder (chronic carrier)

Osteomyelitis 

G- rod 

Pork, raw milk, pet feces, day care centers

Bloody diarrhea, mesenteric adenitis, granulomatous microabscess in mesenteric lymph nodes, reiter rare 

mimics appendicitis

G- rod, non lactose fermenting, white on macconkey, Ox-, non H2S producing

Day care center (G.I ), high virulence, replicates intracellular, actin rockets

Bloody diarrhea + mucus, pus, fever, seizures

shiga toxin (inhibits 60S, HUS, thrombocytopenia, acute renal failure) 

G- rod, curved Ox+

Oysters 

explosive, watery diarrhea, nausea vomiting - 3day 

Reovirus: naked db RNA linear, double icosahedral, segmented genome

MCC of profuse watery diarrhea in infants  (winter), vomiting, fever

fecal -oral

Villis atrophy

+ ssRNA, naked Norwalk virus - acute gastroenteritis 

< 5 yrs 

^vomiting, little diarrhea

Protozoa

Campers, mental hospitals, day care center-->Ingestion cysts-->

Explosive watery diarrhea bloating, flatulence, fatty stool, vomiting

Histo: crecent shaped protoza next to brush border

^^ risk if low igA 

Protozoa: 4 nuclei

Amebiasis: cysts ingested-->

Bloody diarrhea + pus,vomit, fever , liver abscess,

 flask shaped ulcer, ingested RBCs in cytoplasm of trophozoite 

Protozoa AIDs & zoonosis , acid fast cysts 

outbreak in water supply

oocysts ingestion--> mild but severe watery diarrhea in AIDS

terminal ileum, proximal colon 

intraceellular but bumps on PM 

protozoa: AIDS, zoonosis 

Meronts form spores rupture cell

distal duodenum, proximal jejunum 

watery diarrhea 

protoza, AIDs 

watery chronic (2-3 wks) diarrhea 

Dx: oocysts in stool 

Protozoa

Travelers, US restaurant 

watery diarrhea lasts 6 wks 

G- rod, purple + green metalic, lactose ferment (pink mc conkey), F. anaerobe 

*Lipid A (septic shock),

*P. pili (binds disaccharide of urogenital epithelium),

*K antigen (capsule neonate meningitis) H antigen (flagellum)

#1 in cystitis, pyelonephritis

*In some strains, not in all 

G- rod, Lac -, swarming motility, Nitrite +, Urease + (^ pH, may have ammonia odor, staghorn) 

nosocomial UTI's 

G- rod, normal intesinal flora, polysac capsule (anti-phag), Quellung rxn +, Ox -, fast lactose fermenter---pink macConkey agar

Alcoholics, diabetics  nosocomial UTI 

Aspiration pneumonia, red currant jelly sputum, lung abscess

G-, rod, aerobic, Ox+, Cat+ (pyocyanin secreted= green-blue, grape odor), non lactose fermenting

water source

Polysaccharide capsule, endotoxin, exotoxin A (inactivates EF2)

Ecthyma gangrenosum (neutropenic), folliculits (hot tubs),malignant otitis media (DM),  Burn victims

G+ cocci, Cat +, Cog -, Novobiocin resistance (diff epidermitis)

UTI

G+ cocci, Cat-, NaCl + bile ok

UTI

subacute endocarditis, many penicillin resistant, VRE increasing 

naked, linear db DNA

Acute hemorrhagic cystitis 

public pools, daycare center

Pharyngitis, conjunctivitis, fever, pneumonia 

Fluke (flat red worm) 

contaminated water in Mediterrinean, Asia

snails are intermediate host  --> human skin --> blood --> lungs--> veins--> bladder wall 

enveloped partial db DNA , RT 

IV drugs,sex, M--> fetus (90% become chronic), 3 month incubation 

Membranous glomerulonephritis, polyarteritis nodosa, serum sickness like syndrome 

Hepatocellular carcinoma, cirrhosis

naked, db DNA, circular

BK virus: immunoC patient gets a organ transplant--> renal damage, In BM transplant = hemorrhagic cystitis 

JC virus: In ImmunoC, Progressive multifocal leukoencephalopathy ( virus in oligodendrocytes---make myelin sheath) 

enveloped dlb DNA, linear, 

smallpox,cowpox, mulluscum contagiosum 

fungi

w/in macrophages

bat feces, starling bird feces

caves in Ohio  and mississipi river

Pneumonia

caseating necrosis granuloma, erythema nodosum

latin america (Brazil) 

budding yeast that looks like old ship steering wheel 

Asymptomatic, Pneumonia--> dessimination 

hyphae in cold, yeast in warm

encapsulated, thick doubly refractive walls 

east of Mississippi river & great lakes 

weak: Pneumonia*, skin ulcerative lesions w/ pustules, lytic lesions in bone

* In normal people too, looks like bacterial pneumonia since its to large to ingest causing continued recruitment of neutros 

Malassezia furfur degrades FA that produce other FA that damage melanocytes--> hypopigmented patches, hyperpigmented patches

Spagetti and meatballs 

Hot humid weather

Miconazole, Selenium Sulfide

oral thrush 

tinea pedis 

reactivation of zoster

reactivation TB

Bacterial infection

Reactivation of herpes 

cryptosporidiosis 

Isospora

Disseminated coccidiodomycosis 

Pneumocystis Pneumonia 

Candidial esophagitis 

Toxoplasmosis 

Histoplasmosis 

CMV: retinitis, esophagitis 

Disseminated Mycobacterium avium intracellular

Cryptococcal meningoencephalitis 

picornavirus: short incubation of 3 wks

fecal oral: day care centers, travel

asymptomatic or only acute: jaundice, fever, vomiting 

 enveloped, +ssRNA linear

IV drug use 

progression to chronic 70% --> cirrhosis, HCC

Associated with MPGN type I and porphyria cutanea tarda

enveloped (bullet shaped) , (-)ssRNA 

wound--> binds Ach receptor --> endosome-->cytosol--> retrograde axonal transport (dynein)--> to CNS from PNS--> saliva

Neurons have negri bodies (ribonuclear protein from virus)

Purkinje cells (GABA) of cerebellum (tremors etc)

US: bats, skunks, raccoons    Int: dogs

Symptoms: agitation, paralysis, hydrophobia,photophobia

enveloped ssRNA linear 

Parotitis (^ serum amylase)

Orchitis & Oophoritis

Aseptic meningitis 

Pancreatitis (rare)

Croup (Upper resp): bark due to swelling of airways less than 6 yrs --> Inspiratory stridor (obstruction, medical emergency)

croup = Steeple sign (subglottic tracheal narrows

enveloped, (-)ssRNA

Surface fusion protein: entry, multinulceated cells

measles, mumps, parainfluneza

RSV=bronchiolitis (wheezing) in infants, children

Orthomyxovirus, enveloped, -ssRNA  (so needs RNA pol) 

Hemagglutinin (entry, RBC clumping) 

Neuraminidase: enzyme, hydrolysis of sialic acid from new virions 

shift: Reassortment when 2 diff strains infect same cell

Drift: mutations 

Reye Syndrome w/ aspirin: rash, vomit, liver 

Gullain-Barre: hands or feet to head

Flavivirus: enveloped, +ssRNA

Aedes mosquitos (female) 

monkey, humans

fever, jaundice, black vomit (blood)= bleeding in GI, mouth,eyes

naked, +ssRNA...

proteases cleave long multiprotein

Rhinovirus (cold): too many serotypes for vaccine, destroyed by low pH, unlike the others

poliovirus (motor neurons) 

Coxsackievirus  ( foot in mouth, aseptic meningitis, febrile pharyngitis)... ,myocarditis----> dilated cardiomyopathy, DM I after infection

Hepatitis A: acute

Echovirus: aseptic meningitis 

Protoza: reduviid bug/kissing bug = painless bite, feces + scratch = entry 

Chagas: acute (swelling at site)--> chronic (dilated cardiomyopathy, megacolon, megaesophagus) due to auerbach plexus damage

south america

Romana's sign: swelling of eye

Dx: blood smear

Nifurtimox

Protozoa transmitted by Ixodes tick (same for borrelia burgdorferi, Ehrlichiosis)

fever, lives in RBC = hemolytic anemia 

smear: maltese cross ( 4 merozoites, budding asexually) 

NE USA

Protozoa, Anopheles mosquito, Malaria 

Vivax/ovale** = mild, duffy antigen is binding site and often not present in blacks 

Falciparum: severe, daily cycles of fever, occluded capillaries (brain, lungs, kidney) 

**cyclic fever every 3 days ( merozoites escape RBC and infect RBC)= anemia = headache

Dx: blood smear

Chloroquine or Mefloquine if resistant 

Primaquine treats dormant form in liver 

Protozoa, Tsetse fly (painful bite)

 African sleeping sickness (confusion, altered sleep cycles= fatigue, mania repeat) 

Recurring fever (antigenic variation), winterbottom's sign (back neck nodes), encephalitis 

T. Gambiense: west, central africa, 95% of cases, barely any symptoms for mo/yrs then advanced 

T. Rhodesiense: east, south Africa: acute signs are seen

Suramin (blood) or Melarsoprol (CNS infection) 

fungi, dimorphic

rose thorn or packaging peat moss = local pustule or ulcer

Nodules on nodes, ascending lymphangitis 

Itraconazole or K I

fungi

ImmunoC or AIDs

loves the lung so = hyoxemia 

Dx: bronchoalveolar lavage, biopsy (methenamine silver)

CXR: diffuse interstitial pneumonia  

Trimethoprim/sulfamethoxazole (treat and prophylactis if CD4 < 200)

Mucormycosis  (black necrotic eschar)

@ risk: leukemic patients, diabetic ketoacidosis (loves ketones, glucose)

irregularly wide non septate hyphae, branching > 90 degrees

Penetrates cribriform--> frontal lobe abscess and/or stroke 

Monomorphic, encapsulated, polysaccharide capsule*

ImmunoC

latex agglutination, india ink (clear halo), mucicarmine stain (*red) 

inhailing pigeon droppings

Meningitis, soap bubble lesions in brain, pneumonia

Fluconazole (prophylactis), Treat: Amphotericin + Flucytosine

fungi, monomorphic, septate hyphae, branch at acute, fruting bodies

@risk: immunoC,chronic granulomatous disease (no NADPH oxidase) = invasive aspegillosis -->--> necrotizing bronchopneumonia (usually superimposed in infarcts) 

allergic aspergillosis: ^ IgE to aspergillus (type I hypersensitivity)

Lung Aspergilloma w/in cavity like TB = hemoptysis

Hemorrhagic infarction in lungs (dual)

aerobic, acid fast, cool temp (skin, extremeties)

 tuberculoid leprosy= normal Th1, (+) lepromin skin test, scaly lesions, lack sensation so ^ IL-2, IFN --> granulomatous inflammation... 

Dapsone (hemolysis, methemoglobinemia) , Rifampin 

Lepromatous leprosy: ImmunoC, leonine facies, (-) lepromin test since no immune response

Tx: same as above + Clofazimine 

carbolfuchsin stain red = Mycolic acid wall, acid fast

serpentine cord factor 

Primary: contained, asymptomatic --> ghon focus 

peri hilar lobar node most commonly involved 

Ghon complex: ghon focus + lymph node involvement 

Secondary: reactivation, in apex, caseating granulomatous 

systemic cytokine: fever, weight loss, night sweats, hemoptysis(50%)

Miliary TB: Addison's, intestinal TB (if swallow sputum), meningitis, liver, osteomyelitis, Potts (if vertebrae are involved) 

aerobic, G+, branching, acid fast, in soil

ImmunoC

lung cavity, brain abscess, kidney abscess

Trimethoprim-sulfamethoxazole 

G+ rod, anaerobe, branching, normal oral flora

Dental work, oral trauma--> draining sinus tract --> facial abscess 

can spread to GU

colonies look like yellow bumps

associated with IUD

Penicillin

G+, rod, tellurite agar, chinese letters, methylene blue= rod is blue but metachromatic granules are red 

Pseudomembranous pharyngitis (cell necrosis), nodes-->-->--> myocarditis in some, polyneuritis (PNS)

Diptheria exotoxin*: ADP ribosylation of EF2 (uses GTP for translocation) (like pseudomonas exotoxin A)

* Beta prophage, lysogenization 

G+ cocci, Cat (-) 

Diff from strep= ^ NaCl, bile 

E. Faecalis, Faecium normal colonic flora

UTI--> subacute endocarditis 

resistant to pencillin, some VRE 

Group B, G+, B hemolytic, Cat (-), bacitracin resistant unlike (pyogenes)

Normal GI, 20% vagina (neonates: pneumonia--dont have alveolar macros, meningitis--atypical vomiting & irritability, sepsis)

CAMP factor: enlarges staph B-hemolysis 

Prego IV pencillin

G+, cocci, Cat (-), alpha hemolytic, optochin resistant, wont lyse in bile (unlike S. pneumonia)

normal mouth flora, membrer S. mutans = dental cavities

Subacute bacterial endocarditis especially in peeps w/ damaged heart valves.. Its dextrans adhere to fibrin platelet aggregates 

G+, Alpha hemolytic, diplococci, lancet shape, optochin sensitive and bile soluble, capsule,

IgA protease ( also n. gonnorrhea, haemophilus influenza type B)

Pneumonia (rusty sputum), otitis media, sinusitis, meningitis, sepsis (if splenectomy)

G+,Cat +, Coag -, Novobiocin sensitive

in normal skin flora 

infects prosthetic devices and IV catheter, contaminates blood cultures

biofilm 

G-, anaerobe

normal G.I flora, produces vit K 

G.I abscess, gas in tissue, foul smell

Clindamycin, metronidazole 

Intracellular (needs NAD, CoA)

*Rocky mountain spotted fever

*typhus

*ehrlichosis 

Q fever-atypical

*arthropod vector

*fever, headache, rash

weil-felix rxn: patient anti-rickettsia react to proteaus antigen 

doxycycline

Rickettsia rickettssi 

wood tick, east coast 

fever, headache, rash in wrisk, ankle--> trunk

thrombocytopenia, low Na, elevated liver enzymes AST,ALT 

spirochete: dark field microscopy, giemsa stain, silver stain

lyme disease 

deer--> ixodes tick (also babesia, ehrlichosis)

erythema migrans, flu, --> bilateral bells, conduction defect--> arthropathy

doxycycline or ceftriaxone 

G-, coccobacilli, IgA protease, quellung, choco agar (V= NAD, H=hematin)...S.aureus hemolytic zones provide V

PRP capsule in type B

Pneumonia, meningitis, otitis media, cherry red epiglottitis( thumb print) 

COPD exacerbation

G-, Ox+, glucose+maltose fermentation diplococci, Choco agar, endotoxin: lipooligosaccharide=LOS (shock, destroy RBC)

Thayer Martin = VPN = vancomycin, polymyxin, nystain 

Polysac capsule, IgA protease

waterhouse friderichsen syndrome, petechial rash

ceftriaxone, rifampin for exposed 

G-, coccobacillus

Bordet Gengou agar- blood, potatoe extract, penicillin

AB toxin (ADP ribosylating)--> inhibits Gi--> increase in cAMP--> high insulin,lymphocytosis (lymphocytes locked in blood)

catarrhal phase: infectious 

Paroxysmal phase: symptomatic, whooping cough

Erythromycin

No cell wall no gram stain, Eaton's agar 

cholesterol membrane, fried egg (binary fission)

atypical pneumonia/walking 

close quarters (college, military)

cold IgM autoimmune hemolytic anemia 

erythema multiforme (also HSV)

tetracyline, erythromycin 

rod, poor stain 

charcoal yeast w/ iron & cysteine 

silver stain 

water sources, smokers & heavy drinkers

antigen in urine

diarrhea, liver enzymes,

Type IV renal tubular acidosis: interstitial kidney disease--> destroys juxtaglomerular apparatus--> no renin--> no aldosterone--> acidosis, hyponatremia

severe atypical pneumonia or pontiac fever (flu)

fluroquinolones, Macrolides