ID bug chart-DK

Organism Microbiology DiseasesGRAM POSITIVES

Streptococcus (general)

pneumoniae

pharyngitis, possibly nephritis

Gram(+) catalase(-)alpha hemolysis, optichin susceptible, lysed by bile salts

pneumonia, sinusitis, otitis, meningitis

viridans group (salivarius, mitis, mutans, sanguis)

alpha hemolysis, optichin resistant, Lancefield+, biochemicals, antigen tests

endocarditis, dental caries, abscesses

pyogenes (Group A) beta hemolysis, Bacitracin susceptible, Lancefield+, antigen tests, capsule/M-protein is antiphagocytic, hyaluronidase, DNAse B

pharyngitis, cellulitis, metastatic infxns rheumatic carditis, pyoderma/ impetigo, erysipelas, pneumonia, otitis media, bacteremia, puerperal sepsis, acute rheumatic fever, carditis, arthritis, chorea, erythema marginatum, inflammatory nodules, mitral stenosis, acute glomerulonephritis, guttate psoriasis, necrotizing fasciitis

agalactiae (Group B) beta hemolysis, Bacitracin resistant, CAMP test, Lancfield+, antigen tests

neonatal bacteremia, meningitis, pneumonia. Post-partum women chorioamnionitis, endometritis, bacteremia. UTI, cellulitis, bacteremia, pneumonia, septic arthritis in immunocompromised hosts

dysgalactiae subsp. equisimilis, equi subsp. zooepidemicus (Group C)

beta hemolysis, Lancefield+, biochemicals; antigen tests

endocarditis

Any hemolysis, Lancefield+, complex biochemicals, abscesse, empyema

beta hemolysis, Lancefield+, biochemicals

iniae beta hemolysis cellulitis, bacteremia

Enterococcus

faecalis

faecium nosocomial infxns IV lines, UTI

Staphylococcus Gram (+)

bovis/gallolyticus (Group D) alpha or gamma hemolysis, grows in bile, hydrolyzes esculin, Lancefield+ ; antigen tests

aginosus/milleri group (intermedius, constellatus, morbillorum)

Group G (canis, anginosus) localized abcess, puerperal sepsis, endocarditis, pharyngitis, cellulitis, bone & joint infections in compromised hosts

Gram(+)Grows in bile, hydrolyzes esculin, growth in 6.5% NaCl

intra-abdominal abscesses, endocarditis

PeptococciFinegoldia magna (anaerobic staph)

abscess, pulmonary/pleura, septic abortion, endometritis, tubo-ovarian abcess.

PeptostreptococciP. anaerobius (anaerobic strep)

aureus beta

beta (small zone)

Anaerobic cocci Gram (+)

"SHORT RODS"Corynebacterium diphtheriae diphteria

Other corynebacteria called diphtheroids

Listeria monocytogenes

RODSClostridiumperfringens

septicum

tetani

cellulitis, osteomyelitis, pneumonia, impetigo, endocarditis, IV lines and devices, nosocomial and community acquired infxns, toxin-mediated dzcoagulase negative

(epidermidis, saprophyticus)implants, esp vascular, prosthetic valve endocarditis, UTI

requires special media (Loeffler's); club shaped. Metachormatic granules; Reduces tellurite

as part of mixed flora in dental, lung abscesses

beta-hemolytic, motile at 22oC (NOT 37). Facultative anaerobe, non-spore forming.

neonatal sepsis, post-partum; meningitis in immune-compromised pts

obligate anaerobes; distinguish by appearance of spore, gas chromatography gas gangrene (wounds from battle

or other trauma)-- exotoxins. Cellulitis/wound infxn; clostridial myonecrosis; diarrheal illness

gas gangrene, bacteremia in cancer ptstetanus --> tetany (locked in contraction)

botulinum botulinism (Gi, Wound) --> flaccid

difficile colitis esp post-antibiotics, chemoActinomyces israelii Culture anaerobically Abscesses jaw, lungs, w/in abdBacillusanthracis

cereus

GRAM NEGATIVESCOCCI

Neisseriagonorrhoeae gonorrheameningitidis

Moraxella catarrhalis

COCCOBACILLIHaemophilus obligate human parasiteinfluenzae

parainfluenzae Requires X factor, grows on blood agar

ducreyi Fastidious

obligate anaerobes; distinguish by appearance of spore, gas chromatography

obligate aerobes,motile, spore-forming, long end to end chains anthrax: cutaneous, respiratory, GI

and bacteremicbacteremia, other infxns- only in severely compromised hosts; ophthalmitis; foodborne, toxin-mediated GI dz

Cell walls of Gram(-) cocci and coccobacilli contain lipooligosaccharidePairs of bacteria like kidney beans, growing side by side. Require chocolate agar and CO2

meningitis, bacteremia, rarely pneumonia

Resembles Neisseria on Gram stain but grows on blood agar

sinusitis, pneumonia, exacerbation bronchitis in pts w/ COPD

requires X and V factor; growth on chocolate but not blood agar

otitis, sinusitis, pneumonia, exacerbation bronchitis in pts w/ COPD, meningitis (esp young children)- often leading to permanent neurologic deficits. Septic arthritis (infants), acute epiglottitis, sepsisnormal flora, occasionally causing sinusitis, exacerbation of COPDchancroid (STD), possibly swollen inguinal lymph nodes

Bordatella pertussis Fastidious (including special swab)

Coxiella burnettiRickettsia rickettsi small, non-motile, obligate intracellular

Ehrlichia chaffensis

Anaplasma phagocytophilum

Pasteurella multocida NOT a facultative intracellular org

Capnocytophaga canimorsus

Francisella tularensis

Brucella melitensis, abortus

Bartonella fastidioushenselae

quintana NOT an aobligate intracellular org

whooping cough. 1-2 wk w/ typical URI symptoms followed by characterisitic whooping cough

Rocky Mountain Spotted Fever: fever, conjunctival redness, severe headache, rash (wrists, ankles, soles, palms). Proliferates in endothelial cells.

Ehrlichial dz (infect WBCs)- Human monocytotropic ehrlichiosisEhrlichial dz- Human granuloctytropic anaplasmsosiskin, soft tissue infxn post dog or cat bite; septic arthritis or osteo post cat bite

Relatively rare. Causes devastating sepsis syndrome following dog or cat exposure. Worse in alcoholic or splenectomized pts

tularemia - resembles bubonic plague: ulceroglandular, pneumonic, oculoglandular, typhoidal, glandularbrucellosis: systemic Sx (undulant fever, chills, sweats, anorexia, backache, headache, lymphadenopathy)

cat scratch dz (enlarged lymph node), bacillary angiomatosistrench fever; endocarditis in homeless, bacillary angiomatosis

RODS

EnterobacteriaceaeEscherichia coli

Shigella dysenteriae non-lactose fermenter invades colonic mucosa; dysenterySalmonellae non-lactose fermentertyphi typhoid fever

nontyphi diarrheal dzKlebsiella lactose fermenter

Enterobacter lactose fermenter

Serratia marcescens non-lactose fermenter; unique red pigment

Yersiniapestis "safety pins" bipolar staining

enterocolitica Can grow at 4oC

Proteus Non-lactose fermenters, urease+Proteus mirabilis swarms on blood agar plate UTI, struvite stones in urinary tractMorganella morganii doesn't swarm UTI, nosocomialProvidencia stuartii doesn't swarm UTI, nosocomialVibrio curved rods, motilecholerae cholera

Cell walls contain LPS. Nearly all grow +/- O2 (facultative) except Pseudomonas

lactose fermenter; borad range of virulence characteristics

UTI (cystitis or pyelonephritis +/- bacteremia depending on virulence characteristics)

pneumoniae, oxytoca, etc. UTI, pneumonia, intra-abdominal infxnsSame as Klebsiella; nosocomial infxns

cloacae, aerogenes, etc.UTI, nosocomial, immune compromised host

Citrobacter (diversus, freundii, koseri)

catheter-assoc'd UTI, meningitis and brain abscess in neonates

plague- bubonic, pneumonic. Swollen lymph nodes!enterocolitis; mesenteric adenitis; reactive polyarthritis, erythema nodosum

parahaemolyticus

vulnificus

alginolyticusCampylobacter diarrheal dz

jejuni

fetus

Helicobacter pylori peptic ulcer dz, gastric cancer

Pseudomonas aeruginosa

Aeromonas

Burkholderia cepacia nosocomial infxn, esp respiratory

Acinetobacter (baumannii)

Stenotrophomonas maltophila nosocomial infxn

gastroenteritis, rarely soft tissue invasionSepticemia, necrotizing wound infxn. invasive dz GI tract, compromised host; soft tissue post-exposure to brackish water

cellulitis, otitis externa, otitis mediamicroaerophilic. Motile and non-spore forming.

Comma-shaped. Multiply slowly. grows best at 42oC but can survive at 4oC for weeks. Multiplies in bile rich environment

non-specific colitis, acute enteritis, occasionally bacteremia; pseudoappendicitis

Diarrheal illness, bacteremia, vascular infxns, CNS infxns

urease+, highly motile, rapid corkscrew motion, microaerophilic, slow growerobligate aerobe; oxidase+, pyocyanin (blue-green pigment)

nosocomial pneumonia, UTI and pyelonephritis, bacteremia, endocarditis, other infxns esp in compromised host, osteomyelitis, sepsis w/ high mortality,

diarrheal dz, soft tissue infxn; persistent diarrhea and dysentery

ventilator-assoc'd pneumonia; nosocomial infxns. Catheter-related bacteremia, skin and soft tissue infxns; intra-abdominal infxns. Necrotizing pneumonia and bacteremia

Legionella pneumophila

Mycoplasma

Chlamydophila

trachomatis

pneumoniae TWAR agent acute bronchitis and pneumoniapsittaci

ANAEROBIC BACTERIABacteroides fragilis, others No lipid A (endotoxin), but does have a capsule

Fusobacterium

Prevotella, Porphyromonas abscesses lung, pharynx, mouth

SPIROCHETESTreponema pallidum

Borrelia Can be seen by light microscoperecurrentis relapsing fever

burgdorferi Lyme dz

Not seen on Gram stain! Grows on charcoal yeast extract

atypical pneumonia (Legionnaire's dz), much more common in certain parts of US; Pontiac fever (non-pneumonia)

lack cell wall. Capable of free-living or intracellular growth. Fastidious. Cold agglutinin test.

walking pneumonia, cold agglutination dz

obligate intracellular bacteria. Unique life cycle- elementary body and reticulr body.

ocular trachoma; lymphogranulomas venereum; neonatal conjunctivitis;

psittacosis (zoonosis, atypical pneumonia); usually lung (or other organ) involvement.

abscesses lung, intra-abdominal; decubitus ulcerabscesses lung, pharynx, mouth, neck; bacteremia

Darkfield microscopy. Shaped like a corkscrew, distinctive motility (like someone in a potato sack)

syphilis: chancre (painless). Primary, secondary, and tertiary stages. Can be congenital.

Leptospira long, thin- hook at end(s), wound up in a tight coil

NEITHERMycobacteria

tuberculosis tuberculosis

leprae

avium (MAC)

kansasii closely resembles MTB.Nocardia

leptospirosis: enters mucosa or break in skin. Range of illness: non-specific febrile illness to fatal jaundice, renal failure, hemorrhage. Biphasic illness.

non-spore forming, nonmotile, aerobic bacilli; unusual cell walllacks pigmentniacin+

leprosy: lepromatous (TH2) or tuberculoid (TH1)chronic pulmonary dz: fibrocavitary or fibronodulary. Disseminated dz in AIDS pts.

aerobic actinomycete. Ubiquitous saprophytic soil orgs. Slow growth, gram(+), beaded, branching filaments, "weakly acid fast"- growth is slower than conventional bacteria- hold onto plates so it will grow thru!

immunocompetent: pulmonary dz, cutaneous infxn (from traumatic inoculation).Immuocompromised: invasive pulmonary infxn, disseminated dz

Important pointsGRAM POSITIVES

normal human oral and bowel flora

#1 cause of pneumonia, otits media, sinusitis; Vaccines (Pneumovax {polysaccharide}, Prevnar {conjugated})

strep throat, scarlet fever, ASO titer, anti-hyaluronidase Ab, anti-DNAse B titer, treat w/ PCN or macrolides (erythromycin, azithromycin, & clarithromycin)

normal to bowel/vagina, immunization, pre-natal screening, treat w/ aminoglycoside + PCN

"pyogenes-like"; uncommon, streptokinase breaks blood clots

normal bowel flora, pyogenic foci

fish pathogen

strong assoc'n b/tw bacteremia/endocarditis and colonic neoplasms. Very sensitive to PCN

normal flora of pharynx, skin, GI tract, vagina

Not terribly virulent, normal bowel flora, hands of health care personnel; ABX resistant, treat w/ ampicillin/vancomycin + aminoglycoside (gentamicin/streptomycin)

normal constituents of GI tract and female GU tract

most common cause of osteomyelitis and septic arthritis; TSS and food poisoning; MRSA, VISA, VRSA

saprophyticus- #2 cause of UTI in young women. S. epidermidis is normal flora an a frequent contaminant

Significant carrier state. No invasion. AB Exotoxin pdt'n. Pseudomembrane. Need antitoxin, vaccine

Can multiply at 4oC. Contaminated food- dairy pdts, deli meat. Pregnant women at high risk, fetus and neonate, elderly and immunocompromised

Puncture wound w/ rusty nail; toxin = tetanospasmin; lock jaw. Immunization.

pseudomembranous enterocolitis

sporeseschar

fried rice

GRAM NEGATIVES

STD

#3 cause of otitis media, sinusitis

means "blood-loving"

chancroid (PAINFUL)

Botulinum Toxin A, honey and infants; adults and canned stuff (particularly home-canned)

At risk: infants (6 mos-2 yrs), army recruits and anyone in close quarters. Petechial rash! Watch out for meningococcemia

#2 cause of pneumonia, otitis media, sinusitis; Vaccine for HITB. Frequent infxns in COPD

Q fever

Cat scratch dz

trench fever. Louse-borne

can see necrotizing pneumonia w/ hemorrhage. Toxin mediated. Emesis often follows coughing spell. Now a freq cause of chronic unexplained cough in adolescents and adults, DPT

ticks, south-central US. Inc'd vascular permeability! Must treat before Dx by serology.

tick-borne, inc'd incidence in NE and upper Midwest. Similar to RMSF but rash less common

colonizes the mouths of cats (other mammals, birds). Most freq wound infxn following a cat bite- do not close wound!

common colonizer of oropharynx of dogs, sometimes cats.

rabbits via ticks and deerflies. DANGEROUS to lab workers!

cheese, meat, infected animal (Goats, cows, pigs, dogs). Mexico

invasive infxn.Think turtles, reptiles.

opportunistic pathogens

US southwest.

extensive carrier state; aortitis. Gallbaldder!

inherent resistance to ampicillin; alcoholism!

widespread in environment. Opportunistic.

Iron overload states predispose; assoc'd w/ unpasteurized milk. Clinically indistinguishable from appendicitis

water-borne, seasonal. Rice water stool. Death by dehydration

marine flora

water-assoc'd

most common species in US. Shellfish.

most common bacterial cause of diarrhea in US. PEB1 antigenGuillain-Barre. Pseudoappendicitis, can be confused w/ Crohn's

most common cause of duodenal ulcers and chronic gastritis. water. Burn pt's, CF pt's. Biofilm formation, multi-drug resistance

Pts w/ CF, chronic granulomatous dz, burn pts. Biofilm formation.outbreaks in hospitals serving soldiers injured in Iraq.

pt's w/ malignancy. CARBAPENEMS promote dz!

birds (turkeys)

periodontal dz

Cardiolipin, TPHA or MHA-TP

warm water (aerosolized). Inhibits phagosome-lysosome fusion (replicates intracellularly). Amoebas. Can survive in a biofilm.

Stevens-Johnson syndrome and other autoimmune dz's. part of normal flora.

Life cycle: elementary body, reticulate body.Reiter's syndrome; leading cause of preventable blindness! Most common STD

colonize mouth, vagina. Intestinal lacerations!

louse; poor and crowded lving conditions. WWII. ticks. White-footed mouse. NE, MW, NW US.

Acid fast staining

older men who smoke

worldwide in warm climates (Malaysia, Central America). Excreted in urine of animals. Biphasic illness.

old smokers, Lady Windermere syndrome.

DDx for pulmonary-CNS syndrome in compromised pt!!!

Name Group Shape Gram Hemolysis Other Normal flora Metabolic Toxins/Virulant factors Clinical Presentation Diagnosis Treatment Key Points

Staphylococcus aureus +

Staphylococcus epidermidis B (small) vancomycin + remove prosthetic device MRSE = methicillin resistant, PBP 2a

Staphylococcus saprophyticus B (small) nasopharynx, skin

Staphylococcus haemolyticus VRSH = vancomycin resistant

+ anaerobic usually mixed w/ other bugs

Streptococcus pyogenes A cocci + B microaerophilic: -catalase M-protein

Streptococcus agalactiae B cocci + B facultative anaerobe: -catalase capsule aminoglycoside + PCN

Streptococcus dysgalactiae C cocci + B animals facultative anaerobe: -catalase pharyngitis, nephritis (?)Streptococcus equisimilisStreptococcus equiStreptococcus zooepidemicusStreptococcus bovis D cocci + G GI facultative anaerobe: -catalase capsule PCNStreptococcus gallolyticusEnterococcus faecalis

Enterococcus faecium

Streptococcus pneumoniae + A nasopharynx pneumolysin, autolysin, lipoteichoic acid (adherence), capsule Pneumovax {polysaccharide}, Prevnar {conjugated} mosaic PBP 1a, 2x, 2b

Streptococcus mitis Viridans cocci + A oral, bowel facultative anaerobe: -catalase PCNStreptococcus sanguisStreptococcus mutansStreptococcus salivariusStreptococcus intermedius Milleri cocci + A GI microaerophilic: -catalase PCNStreptococcus morbillorumStreptococcus constellatusStreptococcus anginosusStreptococcus canis G cocci + BStreptococcus anginosusStreptococcus iniae cocci + B fish

+ anaerobic capsule usually mixed w/ other bugs

Veillonella cocci + anaerobic osteomyelitis, periodontitis

Bacillus cereus B aerobic Gram stain

Bacillus anthracis G facultative anaerobe culture, serology, PCR

Clostridium tetani + soil, animal feces anaerobic anaerobic culture lock jaw from puncture wound

Clostridium botulinum rod + soil anaerobic anaerobic culture canned food

Clostridium difficile rod + anaerobic

Clostridium perfringens rod + soil, Gi (humans, animals) anaerobic (O2 tolerant) anaerobic culture

Clostridium speticum

Clostridium novyi

Listeria monocytogenes + facultative anaerobe: +catalase

cocci (cluster) B (gold) +coagulase, Novobiocin succeptable

nasopharynx (higher chance in people who use

injectable drugs, atopic dermatitis, eczema)

facultative anaerobe: +catalase protein A (binds Fc of Ab except IgG3), coagulase, hemolysin, leukocidins, B-lactamase, penicillin binding protein 2a = MRSA, hyaluronidase, staphylokinase, lipase, protease, exfoliatin (scalded skin syndrome), enterotoxin (ST), toxic shock syndrome toxin, MSCRAMM, P pili, capsule, A/B/G/D toxins (disrupt cell membranes), agr gene

gastroenteritis (2-7 hr incubation), toxic shock syndrome, scalded skin syndrome (hemorrhagic bullae), pneumonia, empyema, otitis media, meningitis, acute endocarditis (R side = IV drug addict; fulminant, large friable vegetations, native valve, valve ring abscess = BBB, splenic abscess, murmur louder w/ inspiration), osteomyelitis (#1), septic arthritis, uncomplicated skin infection (cellulitis, impetigo, bullous impetigo, local abcess, folliculitis, furuncle, carbuncle, hidradentitis suppurativa {apocrine sweat glands}), bacteremia (UTI, arthritis), food poisoning (explosive diarrhea/vomiting), nosocomial infections (IV/Catheter), pyelonephritis (renal tuberculosis, abcess of renal cortex), lower respiratory tract infection, peritonitis

dicloxacillin, methicillin, nafcillin, vancomycin (MRSA), clindamycin, tetracycline/minocycline + trimethoprim/sulfamethoxazole (VISA)

MRSA = methicillin resistant, PBP 1, 2, 2a (Staphlococcus sciuri), 3, 4, 5, hospital = SCCmec Type 2 & 3 gives multi-drug resistance; community = SCCmec Type 4, USA300 strain; VISA = vancomycin intermediate; VRSA = vancomycin resistant; 5 PBP, B-lactamase

-coagulase, Novobiocin succeptable

nasopharynx, skin capsule (biofilm), MSCRAMM nosocomial infections (IV/Catheter), prosthetic devices w/in body, UTI, osteomyelitis, endocarditis (IV drug addict, abnormal heart valves, >60 dys after prosthetic valve)

-coagulase, Novobiocin resistant

UTI (#2; acute, uncomplicated), nosocomial infections (IV/Catheter), prosthetic devices w/in body, osteomyelitis, endocarditis (IV drug addict, abnormal heart valves)

PCN, 3rd gen cephalosporin, fluoroquinolone, nitrofurantoin, trimethoprim/sulfamethoxazole

PeptococcusFinegoldia magna (staph)

cocci (cluster) GI, vagina abscess, pulmonary/pleura, septic abortion, endometritis, tubo-ovarian abcess, cellulitis (crepitis)

Bacitracin susceptible streptolysin O (binds cholesterol; ASO titer), streptolysin S, pyrogenic exotoxin (erythrogenic toxin) = scarlet fever/toxic shock syndrome, streptokinase, hyaluronidase (dish water pus), DNAse B (titer), anti-C5a peptidase, M-protein, lipoteichoic acid, exotoxin B, capsule

pharyngitis (tonsillar exudate & cervical lymphadenopathy), uncomplicated skin infection (cellulitis{~24 hrs after surgery}, pyoderma, impetigo, erysipelas, lymphangitis {over hours!!!}, necrosis), metastatic infxns, pneumonia, otitis media, bacteremia, puerperal sepsis, rheumatic fever (acute endocarditis {fulminant, large friable vegetations}, arthritis, chorea, erythema marginatum, inflammatory nodules, mitral stenosis), acute glomerulonephritis, guttate psoriasis, necrotizing fasciitis, strep throat (strawberry tongue, sandpaper rash), scarlet fever, toxic shock syndrome, dishwater pus, lymphangitis (breast cancer patients)

ASO titer (cant use for skin infection), anti-hyaluronidase Ab, anti-DNAse B titer, rapid antigen detection test (RADT)

PCN, dicloxacillin, or macrolides (erythromycin, azithromycin, & clarithromycin), surgical debridement, hyperbaric O2, IVIG

Bacitracin resistant bowel, vagina neonatal meningitis/bacteremia/pneumonia, post-partum chorioamnionitis, endometritis, bacteremia, UTI, cellulitis, bacteremia, pneumonia, septic arthritis

streptokinase, capsule

Bile resistant, hydrolyzes esculin

subacute endocarditis, colonic neoplasms

Bile resistant, hydrolyzes esculin, grows in 6.5%

NaCl

B-lactamase, capsule intra-abdominal abscesses, subacute endocarditis (elderly w/ GU procedure, young woman w/ OB procedure, IV drug addicts), nosocomial infections, UTI (#3), biliary tract infection, peritonitis (pancreatic abscess)

ABX resistant: ampicillin/vancomycin + aminoglycoside (gentamicin/streptomycin), linezolid

PBP 5 = low affinity for B-lactams, vancomycin resistant gene from transposon

ABX resistant: ampicillin/vancomycin + aminoglycoside (gentamicin/streptomycin), dalfopristine/quinupristine, linezolid

cocci (pairs/chain)

Optochin susceptible, bile salt susceptible

microaerophilic: -catalase, -peroxidase, +superoxide dimutase

pneumonia (#1), sinusitis, otitis (#1), meningitis, acute endocarditis (fulminant, large friable vegetations, splenic abscess), primary peritonitis (children, due to nephrotic syndrome; splenic abscess), bacteremia

Binax, CXR, Gram stain sputum, blood culture

Optochin resistant dextran (exopolysaccharide, bind to heart valve), capsule subacute endocarditis (insiduous, small vegetations attacks pre-existing damage), dental caries (prophylax w/ amoxicillin), abscesses

Optochin resistant abscesse (pyogenic foci), empyema

pharynx, skin, GI tract, vagina

localized abcess, puerperal sepsis, endocarditis, pharyngitis, cellulitis, bone & joint infections, bacteremia

cellulitis, bacteremiaPeptostreptococcusP. anaerobius (strep)

cocci (chain) GI, vagina brain abscess, lung abcess, septic abortion, endometritis, tubo-ovarian abcess, aspiration pneumonia, cellulitis (crepitis)

GI, vagina

bacilli (chain) variable

soil (saprophyte) spores (very hardy), no capsule, motile, lecithinase (cleaves lipids), cereulide (emetic toxin, heat stable, in fried rice/caterers), gastrointestinal toxin (heat labile = produced by germinating spores, in meat/veges, 8-24 hrs delayed diarrhea; heat stabile = short incubation, severe nausea/vomiting, limited diarrhea), infects animals but can infect humans (aerosols)

gastroenteritis (2-7 hr incubation; reheating fried rice, emetic toxin, gastrointestinal toxin), cellulitis (immunocompromised), eye infection (trauma, heroin addicts), pulmonary infection (immunocompromised)

Resistant to B-lactams; Tet, Cm, Gm (for non emetic/gastrointestinal), don’t treat food poisoning, [vancomycin, clindamycin?]

spores (very hardy), capsule (anti-phagocytic; poly-B-D-glutamic acid, polypeptide capsule encoded by pOX2 plasmid), tripartite toxin (anthrax toxin on pOX1 plasmid, lethal factor {LF} + edema factor {EF} + protective agent {PA}), infects animals but can infect humans (aerosols), non-motile

anthrax = spore phagocytosed, germinate w/in macrophage, vegetative bacteria released into lymph, multiply, enter blood, septicemia, toxemia, shock; cutaneous (via breaks in skin, papule ulcerates to black eschar w/ edema; 80% resolve, 20% progress), intestinal (ingestion, abdominal pain, bloody diarrhea, vomiting; 100% mortality), pulmonary (starts w/ flu-like symptoms 3-10 days, pulmonary edema, hemorrhagic pneumonitis, septicemia; ~100% mortality)

6wks w/ ciprofloxacin or doxycycline for spores; PCN susceptible (too late at this point), vaccine (AVA = PA, recombinant PA, attenuated live), decontamination, PA inhibitors (Ab or small molecule inhibitors)

saprophyte grows on simple carbon/nitrogen sources, activated @ 37C

rod (drumstick) spores (rusty nail), tetanospasmin (exotoxin, causes tetany by irreversibly inhibiting Renshaw cell interneurons, no GABA/glycine release), flagella

tetanus (tetany, trismus {lock jaw}, risus sardonicus {joker smile}, respiratory paralysis) DPT vaccine (w/ booster every 10 yrs), tetanus = human tetanus immunoglobulin + DPT + surgical debridement + PCN + support

spores (contaminate canned food), botulinum toxin (A {botox}, B, E, F; muscle paralysis), flagella

botulism (food = diplopia {double vision}, dysphagia {trouble swallowing}, descending muscle weakness, respiratory paralysis; infant = eat honey, constipation, dysphagia, muscle weakness {floppy baby}; puncture wound = longer incubation, fever, elevated white count)

food = antitoxin + support; infant = human botulism immunoglobulin intravenious (no anaphylaxis, serum sickness); puncture wound = antitoxin + ABX + surgical debridement + hyperbaric O2

GI, hospitals, nursing homes

spores, toxin A (diarrhea, hypoalbuminemia), toxin B (cytotoxic to colonic cells), binary toxin CDT (epidemic C. difficile)

pseudomembranous enterocolitis (#1 nosocomial diarrhea; associated with use of broad spectrum abx {ie ampicillin, especially clindamycin, cephalosporins}, pseudomembrane = red inflamed mucosa + areas of white exudate, necrosis underneath, dysentery, fever, leukocytosis)

anaerobic culture, B toxin test on stool sample, colonoscopy, ELISA, cell cytotoxic assay

stop ABX, rchydrate, oral vancomycin, metronidazole, isolation, some strains are fluoroquinolone resistant

spores, alpha toxin (lecithinase, tissue destruction), tissue invasive toxins, cytotoxic toxins, enterotoxin

gas gangrene (cellulitis/wound infection = crepitus {moist, spongy, pockets of gas, crackling}; clostridial myonecrosis = trauma, gas pockets, black fluid exudes from wound, fatal if untreated; diarrhea = watery or hemorrhagic necrosis of jejunum), emphysematous cholecystitis, emphysematous cystitis, enteritis necroticans (type C bug, B-toxin; highlands of Papau New Guinea; segmental necrosis of small intestine), enteritis (food poisoning, 8-14 hr incubation; mild diarrhea, cramps, fever, nausea, rare vomitig)

cellulitis/wound infection = PCN + surgical debridement; clostridial myonecrosis = hyperbaric O2 + PCN + surgical debridement; enteritis necroticans = ABX + surgery

clostridial myonecrosis = trauma, gas pockets, black fluid exudes from wound, fatal if untreated; diarrhea = watery or hemorrhagic necrosis of jejunum, bacteremia (associated w/ GI malignancy), neutropenic enterocolitis (typhlitis; necrosis of cecum + adjacent bowel)

cellulitis/wound infection = PCN + surgical debridement; clostridial myonecrosis = hyperbaric O2 + PCN + surgical debridement; neutropenic enterocolitis = bowel rest + abx + surgery

clostridial myonecrosis = trauma, gas pockets, black fluid exudes from wound, fatal if untreated; diarrhea = watery or hemorrhagic necrosis of jejunum

cellulitis/wound infection = PCN + surgical debridement; clostridial myonecrosis = hyperbaric O2 + PCN + surgical debridement

bacilli (club) listeriolysin (weak)

tellurite resistant, bile resistant

ubiquitous (enters through GI, 10% transient carriers)

LPS, flagella (@22C), tumbling motility, invasin/internalin (complement mediated endocytosis into macrophages, can multiply w/in macrophages), capsule, listeriolysin O (escape phagosome, heat labile, antigenic), actin filaments encapsidate and assist in crossing into neighboring cells

maternal listeriosis (influenza-like, cross placenta = granulomatosis infantiseptica, bacteremia), perinatal listeriosis (can cross placenta, early onset <5days = sepsis, late onset >5days = meningitis), focal infection, sepsis/meningitis (immunocompromised patients), immunocompromised listeriosis (#2 meningitis); endocarditis

easily decolorized, can be isolated form normally sterile blood/spinal fluid, PCR, immunofluorescence, genetic fingerprinting, potassium tellurite agar (Loeffler)

cellular immunity, sensitive to most ABX except a few B lactams (cephalosporin), ampicillin or rifampicin (can enter eukaryotic cells), trimethoprim/sulfamethoxazole, pasteurize food, pregnant/immunocompromised should avoid unpasteurized food

grow @ 4C (incubate 1-6 months), contaminate food products, facultative intracellular pathogen, motile @ 22C but not @ 37C

Corynebacterium diphtheriae G tellurite resistant normal human flora

Corynebacterium jeikeiumCorynebacterium urealyticum

Corynebacterium amycolatum

Corynebacterium striatum+ necrotizing pneumonia (immunocompromised patients)

Actinomyces israelii + microaerophilic

Nocardia asteroides Actinomycete ubiquitous soil saprophyte aerobic

Nocardia brasieliensis

Nocardia farcinciaNocardia novaPropionibacterium + skin, oral, GI, GU anaerobic brain abcess (linked to chronic otitis media, mastoiditis, chronic sinusitis, tooth abcess)Lactobacillus acinomycosis + skin, oral, GI, GU anaerobicBifidobacterium + skin, oral, GI, GU anaerobicNeisseria meningitidis Neisseriaceae - nasopharynx, oral cavity

Neisseria gonorrhoeae

Kingella kingae Neisseriaceae coccobacilli - +oxidase throat culture for 2 weeks cephlasporinKlebsiella pneumoniae Enterobacteriaceae rod - colon facultative anaerobe: +catalase urine dip-stick (nitrate into nitrite), MacConkey's agar

Klebsiella oxytoca

Escherichia coli Enterobacteriaceae rod - B colon facultative anaerobe: +catalase 8 PBP, TEM-1 B-lactamase

colon urine dip-stick (nitrate into nitrite), MacConkey's agar Fluoroquinolone

colon, animals (US) urine dip-stick (nitrate into nitrite), MacConkey's agar don't give ABX doesn’t ferment sorbitol

colon, animals (food) urine dip-stick (nitrate into nitrite), MacConkey's agar don't give ABX ferments sorbitol

colon urine dip-stick (nitrate into nitrite), MacConkey's agar

colon urine dip-stick (nitrate into nitrite), MacConkey's agar breastfeeding protects

colon similar to EAEC urine dip-stick (nitrate into nitrite), MacConkey's agar

colon urine dip-stick (nitrate into nitrite), MacConkey's agar

Enterobacter cloacae Enterobacteriaceae rod - colon facultative anaerobe: +catalase LPS, fimbriae (pili), siderophore (iron), plasmids, flagella all over, capsule urine dip-stick (nitrate into nitrite), MacConkey's agarEnterobacter aerogenes

Citrobacter freundii Enterobacteriaceae rod - colon facultative anaerobe: +catalase LPS, fimbriae (pili), siderophore (iron), plasmidsCitrobacter koseriCitrobacter diversus

Serratia marcescens Enterobacteriaceae rod - facultative anaerobe: +catalase LPS, fimbriae (pili), siderophore (iron), plasmids, flagella all over, capsule

Salmonella enterica Enterobacteriaceae rod - animal colon facultative anaerobe: +catalase

Salmonella typhimurium

bacilli (club, Chinese letters)

variable

facutatively anaerobic: +catalase polymetaphosphate granules (seen w/ methylene blue), can colonize (tonsils, pharynx, or abrasions), diphtheria toxin (A-B; encoded by lysogenic bacteriophage; iron limitation leads to more production of toxin; enters cell throught receptor mediated endocytosis, ADP ribosylation, inhibits protein synthesis; 40ng can be fatal), tellurite resistant, capsule

respiratory (droplets) & cutaneous (abrasion) diphtheria (sore throat, low grade fever <102, pseudomembrane of necrotic epithelium can cause suffocation, bull neck, arrythmia/myocarditis in respiratory @ 2-3 weeks, soft palate/ocular neuropathy, impetigo-like lesions on arms/legs, endocarditis

Pseudomembrane!!!, media (w/ nicotinic acid, pantothenic acid, & other vitamins), Loeffler coagulated serum media, tellurite media, black colonies (gravis, mitis, & intermedius morphologies); polymetaphosphate granules (seen w/ methylene blue), Elek immunodiffusion/PCR (tox gene), Schick test (DTH)

prompt treatment: diphtheria antitoxin (DAT) + PCN or erythromycon + isolation + vaccination (DTaP, Td, "Tripedia"); respiratory diease is not immunizing

nosocomial infections (surgical wounds, catheter, prosthetic devices, native/prosthetic valve endocarditis,

Rhodococcus equi (Corynebacterium equi)

rod (branched, filament, beaded)

oral, colon, vagina, water/soil saprophyte

densely fibrotic lesion (wooden) that grows slowly, overlying skin has red-blue hue, central purulence w/ neutrophils surrounding sulfur granules, oral-cervicofacial (lumpy jaw), thoracic (chronic pneumonia or neoplasm, pleuritic chest pain, fever, weight loss), abdominal (incited by surgery, diverticulitis, appendicitis, extension from female GI), pelvic (due to IUD, fever, abdominal pain, weight loss)

thoracic disease = bronchoscopy; abdominal disease = abcess or sinus tract draining to abdominal wall or perianal area; sulphur granules, anaerobic culture

surgery & drainage + abx (6-12 mos; penicillin, amoxicillin, ceftriaxone, clindamycin)

rod (branched, filament, beaded)

+, acid fast

pneumonia, lung/brain/kidney abscess, cavatations w/ contigous spread, indolent course, hematogenous dissemination, immunocompromised are especially succeptible (pulmonary infection - bacteremia {brain abscess, skin/subcutaneous tissue, kidney, bone/joint, heart})

notify lab of Nocardia, sputum, skin biopsy, aspirate of deep collections, slow growth on culture (can be hidden by other bacteria)

surgical drainage (brain abscess) + prolonged therapy; trimethoprim/sulfamethoxazole, amikacin, carbapenems, cephalosporins,

pulmonary to CNS in immunocompromised has high likelyhood of Nocardia

lymphocutaneous infection, abscess/cellulitis, mycetoma (chonic, localized, slow progression, subcutaneous disease w/ discharging sinus tracts), immunocompromised are especially succeptible (pulmonary infection - bacteremia {brain abscess, skin/subcutaneous tissue, kidney, bone/joint, heart})

diplococci (doughnut)

aerobic: +catalase, +cytochrome oxidase

lipooligosaccharide (petechiae rash, DIC, shock), capsule (polysaccharide + N-acetyl neuraminic acid, anti-phagocytic), IgA1 protease, Opa protein (adherence & invasion into epithelial cells), can extrace Fe from transferrin/lactoferrin/hemoglobin, pili, integrated prophage

meningitis (sero-group A, C, W-135 in adults/adolescents; B #1 cause in infants = <1 yr; triggered by viral (influenza) infection, fever, vomiting, irritability, lethargy, bulging anterior fontanelle, stiff neck, petechial rash, positive Kernig/Brudzinski signs), meningococcemia (complement deficiency or slpenectomy increase risk; w/o meningitis most deadly; abrupt spiking fevers, chills, arthralgia, myalgia, petechial rash), fulminant meningococcemia (septic shock, adrenal insuffiency {Waterhouse-Friderichsen syndrome = bilateral adrenal hemorrhage}, hypotension, tachycardia, rapid enlargement of petechiae, DIC, coma, death; w/in 6-8 hrs), bacteremia, septic arthritis, pneumonia, DIC, tissue necrosis, endocarditis (fulminant, large friable vegetations, valve ring abscess, loud murmur, CHF, nephritis)

Thayer-Martin VCN (chocolate agar + vancomycin + colistin {polymyxin} + nystatin + high concentration of CO2), maltose/glucose metabolism, culture (blood, CSF, petechial scrapings), cytochrome oxidase (tetramethylphenylene diamin dye goes from clear to deep pink/purple), Gram stain, PCR, immunoelectrophoresis

PCN or ceftriaxone (@ first indication of meningococcemia), rifampin/ceftriaxone/ciprofloxacin (those in close contact), immunization (sero-groups A, C, Y, W135 conjugated w/ mutant piphtheria toxin or tetanus toxoid; not sufficient for <2 yrs; adult immunity lasts 2-4 yrs; tetravalent protein conjugate most effective)

intracellular, TEM-1 B-lactamase, N. men = mosaic PBP

lipooligosaccharide (sloughing of cilia, inflammation), capsule (polysaccharide + N-acetyl neuraminic acid, anti-phagocytic), pili type 4 (hypervariable, prevent phagocytosis), PorA & Por B (outer membrane porin; promote invasion into epithelial cells), Opa protein (adherence & invasion into epithelial cells), IgA1 protease, TEM-1 plasmid (B-lactamase), tetM gene on plasmid (tetracycline resistant), mtr gene (efflux pump), penA locus (mutation of penicillin binding protein 2A), gyrA & gyr B (mutated DNA gyrase resistant to ciprofloxacin), can extrace Fe from transferrin/lactoferrin/hemoglobin, multiplies in endocytotic vacuole

gonorrhea (men = urethritis, purulent discharge, epidydymitis, prostatitis, urethral stricture; rectal gonococcal infection = back-door, anal pruritis, tenesmus, rectal bleeding, purulent discharge, bacteremia, septic arthritis; women = asymptomatic or urethritis, purulent discharge, cervicitis {red, friable, purulent exudate}, low abdominal discomfort, dyspareunia (painful sex), PID {endometritis, salpingitis, oophoritis, abnormal menstral bleeding, cervical motion tenderness, perironitis, peri-hepatitis [Fitz-Hugh-Curtis syndrome, liver capsule, RUQ pain], abscesses, sterility, ectopic pregnancy}, bacteremia, septic arthritis, pharyngitis; infant = ophthalmia neonatorum, soft tissue/joint infection, proctitis; acute endocarditis (fulminant, large friable vegetations, blow out valve; aortic annular abscess = AV block)

Thayer-Martin VCN (chocolate agar + vancomycin + colistin {polymyxin} + nystatin + high concentration of CO2), maltose metabolism negative, glucose metabolism, cytochrome oxidase (tetramethylphenylene diamin dye goes from clear to deep pink/purple), culture (blood, CSF, petechial scrapings), Gram stain (w/in WBCof urethral exudate in men), PCR

gonorrhea = treatment dependent on sensitivity; ceftriaxone, fluoroquinolones, spectinomycin (if allergic, treat w/ spectinomycin or ciproflozacin), sulfonamide, PCN, ciprofloxacin, tetracycline resistant; ophthalmia neonatorum = erythromycin + ceftriaxone

septic arthritis (children), osteomyelitis (children), endocarditis (native & prosthetic valves) HACEK (culture negative endocarditis)+lactose, -oxidase, -

indoleLPS, fimbriae (pili), siderophore (iron), plasmids, capsule (mucoid), ESBL (extended spectrum B-lactamase)

UTI (catheter), lobar pneumonia (nosocomial/community esp. alcoholics, chronic lung disease, intubated; bloody sputum), bacteremia (#2 gram -)

ampicillin resistant (B lactamase), nosocomial strains are MDR (multi-drug resistant)/ESBL (extended spectrum B lactamase), 3rd gen cephalosporin, ciprofloxacin, fluoroquinolone, nitrofurantoin, trimethoprim/sulfamethoxazole

+lactose, -oxidase, +indole UTI (catheter), lobar pneumonia (nosocomial/community esp. alcoholics, chronic lung disease, intubated), bacteremia

+lactose, -oxidase, +indole LPS, fimbriae (P pili & type 1), hemolysin, siderophore (iron), plasmids, flagella (H) all over, adhesins, capsule (K)

diarrhea, UTI (#1; acute, uncomplicated; dysuria, frequency, urgency), neonatal meningitis (K1 capsule), pyelonephritis (#1; P pili; acute, uncomplicated; fever, flank pain, nausea, vomiting, frequency +/- dysuria), cystitis (type 1 fimbriae; confined to urethra), primary peritonitis (adults, ascites related to cirrhosis, pancreatic abscess), appendicitis, intra-abdominal abscess, nosocomial pneumonia, bacteremia (#1 gram -), endocarditis, pancreatic abscess

urine dip-stick (nitrate into nitrite), MacConkey's agar (pink/purple), EMB agar (deep purple/black), metallic green, pyelonephritis = UA w/ WBC + cast

3rd gen cephalosporins, aminoglycosides (gentamicin, amikacin), trimethoprim/sulfamethoxazole, fluoroquinolones, nitrofurantoin

Enterotoxigenic E coli (ETEC) LPS, fimbriae (pili), hemolysin, siderophore (iron), plasmids, flagella (H) all over, adhesins, capsule (K), enterotoxin (LT {A-B toxin, makes cAMP; like cholera toxin} / ST {makes cGMP}), colonization factor antigens (CFA)

cholera (LT), travelers diarrhea (high dose; local children; ST); diarrhea, nausea, cramps, no vomiting, no fever, no stool blood/mucus/leukocytes

Enterohemorrhagic E coli (EHEC) LPS, fimbriae (pili), hemolysin, siderophore (iron), plasmids, flagella (H) all over, SLT1, SLT2 (HUS), capsule (K)

dysentery (low dose), severe cramps, no fever, hemolytic uremic syndrome (HUS; thrombocytopenia, hemolytic anemia, nephropathy, SLT2), SLT1

Shiga Toxin-producing E coli (STEC) LPS, fimbriae (pili), hemolysin, siderophore (iron), plasmids, flagella (H) all over, SLT1, SLT2 (HUS), capsule (K), shiga toxin, O157:H7 strain is 60% in US

dysentery (low dose), severe cramps, no fever, hemolytic uremic syndrome (HUS; #1; thrombocytopenia, hemolytic anemia, nephropathy, SLT2), SLT1

Enteroinvasive E coli (EIEC) LPS, fimbriae (pili), hemolysin, siderophore (iron), plasmids, flagella (H) all over, SLT1, SLT2, capsule (K)

similar to shigellosis (invade intestinal epithelial cells; travelers diarrhea), FEVER

Enteropathogenic E coli (EPEC) LPS, fimbriae (pili), hemolysin, siderophore (iron), plasmids, flagella (H) all over, adhesins, capsule (K)

accute diarrhea (infants) in developing countries, lose intestinal epithelial microvilli, breastfeeding protects

Diffuse adhereing E coli (DAEC) LPS, fimbriae (pili), hemolysin, siderophore (iron), plasmids, flagella (H) all over, adhesins, capsule (K), enterotoxin

Enteroaggregative E coli (EAEC) rod (brick wall) LPS, fimbriae (pili), hemolysin, siderophore (iron), plasmids, flagella (H) all over, adhesins, capsule (K)

chronic diarrhea (children) in HIV infected in developing countries, acute travelers diarrhea

+lactose, -oxidase UTI (catheter), IV infection, nosocomial pneumonia, bacteremia ampicillin resistant (B lactamase inducible), nosocomial strains are MDR (multi-drug resistant)/ESBL (extended spectrum B lactamase)

+lactose, -oxidase UTI (catheter), nosocomial pneumonia, bacteremia urine dip-stick (nitrate into nitrite), MacConkey's agar

UTI (catheter), nosocomial pneumonia, bacteremia, neonatal meningitis/abscess

-lactose, -oxidase vials/IV solutions UTI (catheter), nosocomial pneumonia, bacteremia, endocarditis (injection drug users, San Francisco)

urine dip-stick (nitrate into nitrite), MacConkey's agar some strains produce red pigment

-lactose, -oxidase LPS, fimbriae (pili), siderophore (iron), plasmids, flagella all over, enterotoxin (diarrhea), Vi antigen (prevents Ab opsinization), capsule

nosocomial pneumonia, bacteremia, gastroenteritis (med dose; invade intestinal mucosa, fecal WBC, diarrhea (med dose) w/o blood, fever, nausea, vomiting, chills, abdominal cramps, myalgia, dysuria, 4-5 weeks), bacteremia, endovascular infection (aortitis), osteomyelitis

urine dip-stick (nitrate into nitrite), MacConkey's agar fluoroquinolones, cephalosporins, [no abx, fluid/electrolyte replacement?]

facultative intracellular parasites, TEM-1 B lactamase

LPS, fimbriae (pili), siderophore (iron), plasmids, flagella all over, enterotoxin (diarrhea), Vi antigen (prevents Ab opsinization), capsule

nosocomial pneumonia, bacteremia, gastroenteritis (med dose; invade intestinal mucosa-necrosis, fecal WBC, diarrhea (med dose) w/o blood, fever, nausea, vomiting, chills, abdominal cramps, myalgia, dysuria, 4-5 weeks), bacteremia, endovascular infection (aortitis), osteomyelitis

Salmonella serovar typhi

Enterobacteriaceae rod - facultative anaerobe: +catalase

Salmonella enteritidis

Shigella dysenteriae Enterobacteriaceae rod - primates facultative anaerobe: +catalase

Shigella flexneri first identify as Shigella. Avoid anti-motility drugs + ABX male-male sexShigella boydii first identify as Shigella. Avoid anti-motility drugs + ABXShigella sonnei first identify as Shigella. Avoid anti-motility drugs + ABX most common in USProteus mirabilis Enterobacteriaceae rod - colon facultative anaerobe: +catalase

Proteus vulgaris

Providencia stuartii Enterobacteriaceae rod - colon facultative anaerobe: +catalase

Providencia rettgeriMorganella morganii Enterobacteriaceae rod - colon facultative anaerobe: +catalase

Vibrio cholerae Vibrionaceae -

Vibrio parahaemolyticus B LPS, hemolytic cytotoxin, capsule, single polar flagella thiosulfate + bile salts tetracycline, fluoroquinolone, doxycycline

Vibrio vulnificus sea water LPS, capsule surgical debridement, tetracycline, quinolone, cephalosporin

Vibrio alginolyticus sea waterPhotobacterium damselae anaerobic necrotizing cellulitis (sea water)Pseudomonas aeruginosa Pseudomonadaceae rod - obligate aerobic

Burkholderia cepacia Pseudomonadaceae rod -

Stenotrophomonas maltophila Pseudomonadaceae rod -

Acinetobacter baumannii Pseudomonadaceae - -lactose

Legionella pneumophila rod -

Yersinia enterocolitica Enterobacteriaceae rod - facultative anaerobe: +catalase

Yersinia pseudotuberculosis rod animal colon LPS, fimbriae (pili), plasmids, flagella all over, capsule

Yersinia pestis

Helicobacter pylori Vibrionaceae - +urease microaerophilic: +catalase, +oxidase +urease

Campylobacter jejuni Vibrionaceae - +oxidase poultry microaerophilic

Campylobacter fetus Gram stain, longer to culture

Bacteroides fragilis Bacteroidaceae rod - GI drain abcess + clindamycin, metronidazole, chloramphenicol, etc.

oral, GI, vaginal LPS clindamycin, metronidazole black pigment

Porphyromona oral LPSFusobacterium necrophorum Bacteroidaceae rod - oral, GI, vaginal penicillin G

-lactose, -oxidase facultative intracellular parasites, TEM-1 B lactamase

colon (only humans) LPS, fimbriae (pili), siderophore (iron), plasmids, flagella (H) all over, Vi antigen (prevents Ab opsinization), capsule

nosocomial pneumonia, bacteremia, typhoid fever (initially present w/ enterocolitis; invade intestinal mucosa, multiply w/in macrophages, spread to liver/gall bladder{reservoir}/spleen/bone marrow, necrosis of Peyer's patches, perforation {@ 3-4 wk}, malaise, fever, abdominal pain {RLQ}, hepatosplenomegaly, headache, diaphoresis, delirium, chills, constipation or diarrhea, faint salmon colored macropapular rash on trunk), bacteremia, endovascular infection (aortitis), osteomyelitis

urine dip-stick (nitrate into nitrite), leucopenia, anemia, elevated liver enzyme, blood culture (50-70% positive), bone marrow culture (90% positive), MacConkey's agar

fluoroquinolones, cephalosporins, remove gall bladder/kidney stones, ciprofloxacin, ceftriaxone, trimethoprim/sulfamethoxazole, azithromycin, live attenuated & Vi vaccine

animal colon (turtle) LPS, fimbriae (pili), siderophore (iron), plasmids, flagella all over, enterotoxin (diarrhea), Vi antigen (prevents Ab opsinization), capsule

nosocomial pneumonia, bacteremia, gastroenteritis (med dose; invade intestinal mucosa, fecal WBC, diarrhea w/o blood, fever, nausea, vomiting, chills, abdominal cramps, myalgia, dysuria, 4-5 weeks), bacteremia, endovascular infection (aortitis), osteomyelitis

urine dip-stick (nitrate into nitrite), MacConkey's agar fluoroquinolones, cephalosporins, [no abx, fluid/electrolyte replacement?]

-lactose, -oxidase LPS, fimbriae (pili), siderophore (iron), plasmids, Shiga-toxin (A-B toxin; 60S ribosome), capsule

diarrhea (low dose), nosocomial pneumonia, bacteremia, colonic ulcers lead to dysentery (stool w/ blood/mucus, strain/pain defecation), fever, erythema nodosum, hemolytic uremic syndrome (HUS; thrombocytopenia, hemolytic anemia, nephropathy; Reiter's syndrome)

urine dip-stick (nitrate into nitrite), MacConkey's agar, stool toxin/WBC assay

first identify as Shigella. Avoid anti-motility drugs + ABX, [fluoroquinolones, azithromycin, trimethoprim/sulfamethoxazole]?

IgA best immunity, daycare diarrhea

-lactose, -oxidase, -indole LPS, fimbriae (P pili), siderophore (iron), plasmids, flagella all over (swarms), capsule, urease, capsule (biofilm)

UTI (long-term catheter, alkali pH), nosocomial pneumonia, pyelonephritis (P pili; acute, uncomplicated; fever, flank pain, nausea, vomiting, frequency +/- dysuria), bacteremia, struvite (nidus)

urine dip-stick (nitrate into nitrite), MacConkey's agar ampicillin, trimethoprim/sulfamethoxazole, 3rd gen cephalosporin, fluoroquinolone, nitrofurantoin, aminoglycoside (gentamicin, amikacin)

rapid-acting urease, Weil-Felix test (Ab for certain strains can test for Rickettsia)

-lactose, -oxidase LPS, fimbriae (pili), siderophore (iron), plasmids, flagella all over (swarms), urease, capsule

UTI (catheter), nosocomial pneumonia, bacteremia 3rd gen cephalosporin, ciprofloxacin, fluoroquinolone, nitrofurantoin, trimethoprim/sulfamethoxazole

rapid-acting urease (staghorn colliculi)

-lactose, -oxidase LPS, fimbriae (P pili), siderophore (iron), plasmids, flagella all over, capsule, urease, capsule (biofilm)

UTI (long-term catheter), nosocomial pneumonia, pyelonephritis (P pili; acute, uncomplicated; fever, flank pain, nausea, vomiting, frequency +/- dysuria), bacteremia, struvite (nidus)


rapid-acting urease

-lactose, -oxidase LPS, fimbriae (P pili), siderophore (iron), plasmids, capsule (biofilm), urease UTI (long-term catheter), nosocomial pneumonia, pyelonephritis (P pili; acute, uncomplicated; fever, flank pain, nausea, vomiting, frequency +/- dysuria), bacteremia, struvite (nidus)


rapid-acting urease

rod (comma) glucose fermenter, +oxidase

contaminated water/food (seasonal = warm

weather)

LPS, single polar flagella, choleragen (A-B toxin), mucinase, fimbriae cholera (high dose; rice water diarrhea, no pus in stools, dehydration, vomiting, acute renal failure, no strain/tenesmus/abdominal pain; seizures, fever in children; abortion in pregos)

fiat yellow colonies (thiosulfate-citrate-bile-salts-sucrose media)

doxycycline + fluid/electrolytes (Ringer's lactate), anti-motility agents not recommended, trimethoprim/sulfamethoxazole, erythromycin, ciprofloxzcin, azithromycin, fluoroquinolone

increased risk for type O blood, decreased gastric acid, Ogawa/Inaba serotypes, classic/El Tor (South/Central America) biotypes

halophilic (likes salts), +oxidase

fish, shellfish gastroenteritis (sushi, shellfish; explosive diarrhea/dysentery, cramping, abdominal pain)

halophilic (likes salts), +oxidase

bacteremia (ingesting undercooked food seafood), necrotizing wound infection (open wound exposed to sea water; soft tissue infection, abrupt fever/chills, hypotension, hemorrhagic bullae, necrotic ulcers)

chronic liver disease increases risk of infection, high mortality rate

cellulitis (necrosis), otitis media, otitis externa (sea water)

-lactose, +oxidase environmentally ubiquitous including

water sources (except in humans/animals)

LPS, exotoxin A (similar to diphtheria toxin, ADP ribosylates EF2), immpermeable outer membrane, flagella, P pili, efflux pump, can rapidly mutate,capsule(biofilm; antiphagocytic), ABX resistant (B-lactams, quinolones, macrolides, tetracyclines, sulfa drugs), hemolysin, collagenase, elastase, fibrinolysin, phospholipase C, DNAase,

prefer colonization, pneumonia (cystic fibrosis, neutropenic, ventilator), osteomyelitis (diabetics, IV drug addict, children w/ puncture wounds to foot), burn wound/post operative infection, sepsis, UTI/pyelonephritis (catheter), endocarditis (R side = IV drug addict, Detroit), malignant external otitis, corneal infections (contacts), mortality (chronic lung disease, hospitalized patients), bacteremia (catheter), nosocomial infection (related to water), erythyma gangrenosum, folliculitis (hot tub)

fluorescein (green fluorescent pigment), pyocyanin (blue pigment), sweet grape scent

ABX resistant (B-lactams, quinolones, macrolides, tetracyclines, sulfa drugs): remove catheter + anti-pseudomonas-PCN + piperacillin/gentamicin, tazaobactam, ceftazidine, cefipime, imipenem, meropenem, aminoglycosides, timentin, aztreonam, ciprofloxacin, ceftazideme, carbapenen, cephlasporin, poly myxn; resistant to cleaning chemicals

fluorescein (green fluorescent pigment), pyocyanin (blue pigment), sweet grape scent, generate energy from diverse sources, perfer colonization, quinolone resistance = alter gyrA gene, increase porin/OmpF, efflux pumps, plasma encoded Qnr

-lactose, +oxidase environmentally ubiquitous (except in

humans/animals)

LPS, immpermeable outer membrane, efflux pump, biofilm, ABX resistant (B-lactams, quinolones, macrolides, tetracyclines, sulfa drugs); treatment based on testing (minocycline, levofloxacin, Meropenem, Ceftazidine, Inhaled tobramycin, resistant to cleaning chemicals, multi-chromosomal (encode multi-virulence), capsule (biofilm)

prefer colonization, pneumonia (cystic fibrosis 5%, chronic granulomatous disease), necrotizing pneumonia/bacteremia (cystic fibrosis), mortality (#2 for chronic granulomatous disease)

ABX resistant (B-lactams, quinolones, macrolides, tetracyclines, sulfa drugs); treatment based on testing (minocycline, levofloxacin, meropenem, ceftazidine, inhaled tobramycin), resistant to cleaning chemicals, [trimethoprim/sulfamethoxazole, ticarcillin +/- aztreonam]

generate energy from diverse sources, perfer colonization

-lactose, -oxidase environmentally ubiquitous including

water sources (except in humans/animals)

LPS, immpermeable outer membrane, efflux pump, ABX resistant (B-lactams {except ticarcillin, clavulante, ceftazidine}, quinolones, macrolides, tetracyclines, sulfa drugs, especially carbapenems), resistant to cleaning chemicals, capsule (biofilm)

prefer colonization, pneumonia (ventilator), nosocomial infections (cancer patients), bacteremia (catheter), skin infections, meningitis (nosocomial post surgery), UTI (catheter)

ABX resistant (B-lactams, quinolones, macrolides, tetracyclines, sulfa drugs, especially carbapenems); hospital dependent: trimethoprim/sulfamethoxazole or sometimes quinolones + remove catheter , resistant to cleaning chemicals


rod (coccobacilli)

environmentally ubiquitous especially

hospitals

immpermeable outer membrane, efflux pump, can rapidly mutate, live in unfavorable environments, ABX resistant (especially quinolones), rapidly transmitted, capsule (biofilm)

prefer colonization, pneumonia (ventilator), nosocomial infections (Iraq veterans), bacteremia (catheter), skin infections, meningitis (nosocomial), intra-abdominal infections

ABX resistant (B-lactams, quinolones, macrolides, tetracyclines, sulfa drugs);hospital dependent: imipenem (but not meropenem), sulbactam (B-lactamase inhibitor), polymyxin (colistin; when pan-resistant), resistant to cleaning chemicals


free living (associated w/ warmer man-made water

systems), amoeba

aerobic: +catalase, +Cu-Zn superoxide dimutase, +peroxidase

Resistant to B-lactams and aminoglycosides, Dot/lcm type 4 secretion system (inhibits phagosome/endosome + lysosome fusion), Cu-Zn superoxide dimutase, pili, flagella, RNAse, phospholipase A/C, capsule (biofilm)

Legionnaires' disease (pneumonia, headache, altered mental status, severe diarrhea, high fever, nonproductive cough, high mortality), Pontiac fever (headache, myalgia, fatigue, fever/chills, resolves 1 wk, low mortality), pneumonia (community acquired, high fever, bradycardia, severe headache, confusion, myalgia, rhabdomyolysis, cough, +/- sputum, hyponatremia, hypophosphatemia, elevated liver enzymes, diarrhea, abdominal pain)

impossible to culture, difficult to see on Gram stain, silver stain, direct fluorescent antibody (DFA) test on sputum, urine antigen test, buffered charcoal yeast extract agar (Fe + L-cysteine)

Resistant to B-lactams and aminoglycosides; Can enter eukaryotic cells: macrolides (azithromycin), quinolones, tetracycline

facultative intracellular (can live in amoebas, alveolar macrophages), infect through aerosolized bugs

-lactose, -oxidase animal (pig) colon LPS, fimbriae (pili), plasmids, flagella all over (@25C), V & W antigens, enterotoxin (ST, activated @ 37C), capsule

nosocomial pneumonia, bacteremia, acute enterocolitis (focal ulcerations in ileum & mesenteric lymph nodes), fever / bloody diarrhea / abdominal pain / nausea / vomiting for 1-3 wks, mesenteric adenitis (RLQ pain, > 5 yo), Reiter's syndrome, (adults), erythema nodosum

urine dip-stick (nitrate into nitrite), MacConkey's agar (cold temperature), colonoscopy (check for ulcers)

prolonged treatment with aminoglycoside (gentamicin, streptomycin) + doxycycline, [fluroquinolone, trimethoprim/sulfamethoxazole, cephalosporin resistant?]

Strive in diabetics, alcoholics, malnutrition, and iron-overload, grow @ 4C, facultative intracellular

diarrhea, nosocomial pneumonia, bacteremia, mesenteric adenitis (RLQ pain) occurs but very rare

urine dip-stick (nitrate into nitrite), MacConkey's agar (cold temperature)

prolonged treatment with aminoglycoside (gentamicin, streptomycin) + doxycycline

rod (safety pin) colon, fleas LPS, fimbriae (pili), siderophore (iron), flagella all over, F1 capsule (antiphagocytic), V antigen, W antigen, plasmid (activated @ 37C + Ca2+, pesticin {kills other bacteria}, intracellular murine toxin {toxic to mice})

diarrhea, nosocomial pneumonia, bacteremia, plague, bubonic plague (SW US; flea bite; fever, chills, headache, weakness, inflamed painful bubo lymph nodes, bacteremia), pneumonic plague (inhalation; respiratory failure, bloody sputum), DIC, septicemic plague (no bubo)

urine dip-stick (nitrate into nitrite), MacConkey's agar, culture blood/buboaspirate, serology, anti-F1 titer

primary = streptomycin, gentamicin; secondary = tetracycline (doxycycline), chloramphenicol, ciprofloxacin, vaccine (effective for few mos), aminoglycosides

rod (comma) stomach / duodenum LPS, corkscrew, polar flagella, cagA island (interferes w/ cell cycle/cytoskeleton; associated w/ gastric cancer & duodenal ulcers), VacA (vacuolating cytotoxin; downregulates T-cell activation; S1 genotype = cag A positivity), urease, downregulates proinflammatory cytokines, Ure1 channel (opens at low pH), BabA (adhesin)

acute infection (nausea, upper abdominal pain, vomiting, fever; gastritis + hypochlorhydria), peptic ulcer, duodenal/gastric ulcer, atrophic gastritis, gastric cancer, mucosal associated lymphoid tumor (MALToma; B-cell)

rapid corkscrew motion, urease breath test, serology, stool antigen test

bismuth subsalicylate + metronidazole/ampicillin/tetracycline, clarithromycin + omeprazole, clarithromycin + rantidine bismuth citrate

rod (comma) LPS, bipolar flagella, corkscrew, LT toxin, cytotoxin (invasive), plasmid, PEB1, capsule

dysentery (#3, med dose; fever, headache, abdominal cramps, bloody, tenesumus, invades small intestine mucosa, bacteremia), pseudoappendicitis (fever, RLQ pain, no diarrhea), Guillain-Barre syndrome (symetric ascending paralysis), Reiter's syndrome

Gram stain, culture @ 42C optimal temp fluid/electrolytes + azithromycin, macrolides, tetracyclines, quinolones (resistance is on the rise), aminoglycosides, clindamycin, ampicillin, imipenem

42C optimal temp, can grow in bile, can survive @ 4C for weeks, increased risk with decreased gastric acid, can be confused w/ Crohn's disease

cattle, sheep LPS, single polar flagella, capsule (S-layer protein) dysentery ( mid dose; fever, headache, abdominal cramps, bloody, tenesumus, invades small intestine mucosa, bacteremia {w/ relapsing fever/chills/myalgia}), endocarditis, thrombophlebitis, mycotic aneurysm, meningoencephalitis (neonates)

obligate anaerobic (aerotolerant): +catalase, +superoxide dimutase

polysaccharide capsule (anti-phagocytotic), B-lactamase, pili, hyaluronidase, collagenase, neuraminidase, heparinase, No lipid A (LPS)

peritoneal abcess (trauma, septic abortion, pelvic inflammatory disease, intrauterine device), cellulitis (crepitis)

No Lipid A (LPS)

Prevotella melaninogenicus (Bacteroides melaninogenicus)

pulmonary abscess, periodontal disease, brain abcess (linked to chronic otitis media, mastoiditis, chronic sinusitis, tooth abcess), cellulitis (crepitis)

black pigment on blood agar

anaerobic (aerotolerant)obligate anaerobic (aerotolerant) necrotizing anaerobic pneumonia, periodontal disease (Lemierre syndrome, Ludwig's

angina, Vincent's angina), aspiration pneumonia, abdominal/pelvic abcess, otitis media, brain abcess (linked to chronic otitis media, mastoiditis, chronic sinusitis, tooth abcess)

Haemophilus influenzae type b coccobacilli - nasopharynx

Haemophilus influenzae aegyptius coccobacilli - nasopharynx

Haemophilus ducreyi coccobacilli -

Haemophilus parainfluenzae coccobacilli - Ab/complement, cephalosporin

Haemophilus aphrophilus coccobacilli - endocarditis (rare) Ab/complement, cephalosporin

Haemophilus paraphrophilus coccobacilli - endocarditis (rare) Ab/complement, cephalosporin

rod - metronidazole, Ab/complement, cephalosporin

Neisseriaceae - nasopharynx LPS, B-lactamase

rod - cephalosporin

Cardiobacterium hominis rod - endocarditis cephalosporin

Bordetella pertussis coccobacilli - aerobic: +catalase, +oxidase

Brucella melitensis coccobacilli - goat obligate aerobe capsule, nonmotile facultative intracellularBrucella abortus cow w/ abortionBrucella suis pigsBrucella canis dog

Francisella tularensis coccobacilli - capsule (anti-phagocytic) non-motile facultative intracellular

Pasteurella multocida coccobacilli - domestic & wild animals capsule, nonmotile culture in standard media

humans

Mycobacterium leprae rod +phenolase ubiquitous nonmotile, non-spore forming

slow growth rate

Mycobacterium kansasii

Mycobacterium xenopiMycobacterium simiaeMycobacterium malmoense

+/- capsule (type b; polyribitol ribose phosphate), LPS, IgA protease, ampicillin resistant plasmid, lipooligosaccharide (LOS; stimulates inflammation = invasion into septic spaces), pili

encapsulated = meningitis/cellulitis/acute epiglottitis/septic arthritis (children 6 mo - 4 yr), bacteremia (splenectomy), pneumonia (#2); non-encapsulated = otitis media (#2), acute sinusitis, acute purulent tracheobronchitis (#1; acute exacerbation of chronic bronchitis), pneumonia (#2, adults w/ COPD + recent influenza viral infection), meningitis (sinus focus), puerperal fever/sepsis (biotype 4; newborn); endocarditis (rare)

chocolate agar (X and V factor +/- CO2), ELSA, +Quellung test (capsule Ab causes swelling)

cefotaxime or ceftriaxone (amoxicillin resistant strains), ampicillin or amoxicillin (otitis media), Hib (conjugated, polyribosyl ribitol phosphate; pregos @ 8 mo)

obligte human parasite, colonize children from age 3-5, HACEK (culture negative endocarditis), TEM-1 B-lactamase

+/- capsule (type b; polyribitol ribose phosphate), LPS, IgA protease, ampicillin resistant plasmid, lipooligosaccharide (LOS; stimulates inflammation = invasion into septic spaces), pili

Brazilian hemorrhagic fever, conjunctivitis, bronchopneumonia, bacteremia, shock, DIC, endocarditis (rare)

chocolate agar (X and V factor +/- CO2), ELSA, +Quellung test (capsule Ab causes swelling)

cefotaxime or ceftriaxone (amoxicillin resistant strains), ampicillin or amoxicillin (otitis media), Hib (conjugated; pregos @ 8 mo; 3x in children under 6 mo), Ab/complement

LPS, IgA protease, ampicillin resistant plasmid, lipooligosaccharide (stimulates inflammation = invasion into septic spaces), pili, capsule

chancroid (painful genital ulcer + swollen inguinal nodes; like syphilis but painful) chocolate agar (X factor +/- CO2) PCR azithromycin/erythromycin, ceftriaxone (IM), ciprofloxacin, Ab/complement, cephalosporin

obligte human parasite, HACEK (culture negative endocarditis)

LPS, IgA protease, ampicillin resistant plasmid, lipooligosaccharide (LOS; stimulates inflammation = invasion into septic spaces), pili, capsule

sinusitis, bronchitis, pneumonia (rare), endocarditis (rare) blood agar (V factor +/- CO2; grow for 2 wks)


chocolate agar (X and V factor +/- CO2; grow for 2 wks)


chocolate agar (X and V factor +/- CO2; grow for 2 wks)

Gardnerella vaginalis (Haemophilus vaginalis)

LPS, IgA protease, ampicillin resistant plasmid, lipooligosaccharide (LOS; stimulates inflammation = invasion into septic spaces), pili, capsule (?)

vaginitis (itching, dysuria, fishy discharge) clue cells (vaginal epithelial cells w/ pleomorphic bacilli)

Moraxella (Branhamella subgenera) catarrhalis

cocci (pair) otitis media (#3), acute sinusitis (#3), tracheobronchitis, pneumonia (#3), bacteremia (almost never), meningitis (very rare)

azithromycin/clarithromycin, amoxicillin w/ clavulanate, cephalosporin (oral), trimethoprim/sulfamethoxazole; PCN resistant

Aggregatibacter actinomycetemcomitans (Actinobacillus actinomycetemcomitans )

peridontitis, endocarditis HACEK (culture negative endocarditis)

-catalase, +oxidase, +indole

HACEK (culture negative endocarditis)

LPS, capsule, pertussis toxin (A-B; ADP ribosylation inactivates Gi-increases cAMP, inhibits WBC migration/phagocytosis), adenylate cyclase toxin (increases cAMP, calmodulin dependant; impaired chemotaxis/ROS formation, hemolytic), filamentous hemagglutinin (FHA; pili rod), fimbriae (adhesion), pertactin (adhesion), dermonecrotic toxin (heat labile; tissue necrosis), tracheal cytotoxin (peptidoglycan fragment, destroys cilliated epithelial cells), B-lactamase

pertussis (TOXIN MEDIATED = symptoms last until toxins/epithelial cells are shed; prodromal = 1 wk incubation; catarrhal = 1-2 wks, similar to URI; paroxysmal = ~1 mo, nonproductive whooping cough; convalescent = ~1 mo, symptoms regress; bronchopneumona, necrotizing pneumonia w/ hemorrhage in worst case)

calcium alginate swab (nasopharynx) onto Bordet-Gengou media (potato + blood + glycerol + PCN), Regan-Lowe agar (charcoal + 10% horse blood + cephalexin + high humidity), ELSA, direct fluorescent antibody (DFA), PCR, WBC count

erythromycin (prodromal and catarrhal stages), NO antitoxin, macrolides, vaccination (DPT = heat killed pertussis + formalin inactivated tetanus/diphtheria toxoids; DTap = filamentous hemagglutinin, pertactin, fimbriae, inactivated pertussis toxin; not entire bug; Tdap = adults & adolescents), close contacts given ABX

brucellosis (direct contact, inhalation, eating unpasteurized animal products; imitates syphilis/tuberculosis, onset can be insiduous/acute, lymphatic spread, undulant fever {high in evening, low in morning}, osteoarticular findings, chills, sweats, loss of appetite, backache, headache, lymphadenopathy sometimes, depression, infection lasts mos-yrs, rarely fatal), aseptic meningitis, endocarditis (culture negative), osteomyelitis (culture negative)

culture (must grow for a long time; blood, bone marrow, liver, lymph nodes), anti-Brucella titer (prozone effect = too many Ab, need to dilute), brucellergin skin test, erythritol tropic (sugar found in animal placenta); fever of unknown origin, culture negative (endocarditis, osteomyelitis, aseptic meningitis, epididymoorhcitis)

aminoglycosides + tetracycline, doxycycline + gentamicin/streptomycin/rifampin

ticks/deerflies (rabbits, animals)

obligate aerobe, requires cysteine ulceroglandular tularemia (well defined ulcer w/ black base at site of bite, skin/tissue infection w/ lymphadenopathy {become red, swollen, painful, drain pus}, fever, bacteremia), pneumonic tularemia (inhalation), oculoglandular tularemia (eyes), typhoidal tularemia (ingestion w/ intestinal infection), pharyngeal tularemia (ingestion), glandular tularemia w/o lymphadenopathy (cant find bite)

DTH skin test, Ab titer, NOT cultured (too dangerous), skin/tissue infection w/ lymphadenopathy, pharyngitis unresponsive to PCN, typhoidal fever of unknown origin, pneumonia of unknown origin

DO NOT DRAIN lymph nodes (too dangerous), amonoglycosides + quinolones, gentamicin, streptomycin, doxycycline, B-lactam resistant, vaccine (attenuated)

facultative anaerobe: +catalase, +oxidase

cat bite/scratch & dog bite (#1 wound infection, can cause necrotizing fascitis, septic arthritis, osteomyelitis, cellulitis, disseminate in patients w/ underlying liver disease, meningitis)

DO NOT CLOSE WOUND!, B-lactam + B-lactamase inhibitor, doxycycline, cephalosporin, (ampicillin/sulbactam)

Mycobacterium tuberculosis complex (M. tuberculosis + M. bovis + M. bovis bacillus Calmette-Guerin)

rod (serpentine cording)

acid fast

(Kinyoun,

auramine-

rhodamine)

+niacin, lacks pigment obligate aerobe: +catalase lipid laden cell wall, mycotic acid (large fatty acid), mycoside (mycolic acid + carbohydrate = glycolipid), cord factor (2 mycolic acid + trehalose; in virulent strains; inhibits neutrophil migration & damages MT), sulfatide (sulfates + disaccharides; like cord factor; prevents phagosome/lysosome fusion; allows facultative intracellular), wax D (adjuvant), mycobactin (siderophore), nonmotile, np capsule, no pili, LPS (no lipid A), droplet nuclei

tuberculosis (weight loss, low grade fever, phase 1 = typically asymptomatic, inhalation of droplet nuclei-phagocytosis by alveolar macrophage-proliferation; phase 2 = lyse alveolar machrophage-WBC invade- necrosis-pneumonitis in mid lung zone, spread to hilar nodes {Ghon/Ranke complex}-thoracic duct-blood {apical lung/renal cortex/vertebral body, subependymal brain}; phase 3 = immune response-caseous granuloma, not completely eradicated, +PPD; phase 4 = reactivation, Simon focus{apical lung, night sweats, productive cough, liquefaction/cavitation}); progressive primary tuberculosis = young/old/immunosuppressed, apical caseous foci liquify-cavitation w/ enormous number of bacilli-spread, children can have large hilar/mediastinal nodes-bronchial obstruction; extrapulmonary tuberculosis = reactivation, pleuritis/pericarditis, scrofula {cervical lymph nodes swell, mat together, nodes drain lungs}, basilar meningitis {basilar meningeal/subependymal granulomas rupture; first clinical presentation of TB in children; increased WBC/protein, decreased glucose, -AFB}, GU {renal cortex-medulla/pelvis/ureter/bladder, sterile pyuria except in early morning urine, 90% positive, iv pyelogram = renal calcification/calyces blunting/ureteral stricture/beading}, miliary {shotgun blast of granulomas}, peritonitis {results from miliary, fluid = exudate}, Pott's disease {destruction of thoracic/lumbar discs/vertebral bodies, gibbus deformity}, chronic arthritis)

acid fast stain (kinyoun or auramine-rhodamine) of 3 morning sputum/gastric contents/fiberoptic bronchoscopy/midstream urine/tissue/body fluids, slow groth rate (Middlebrook 7H11 or Lowenstein-Jensen media), Bactec radiometric culture system, colonies clump together; Mantoux (PPD, tuberculin) skin test (15mm induration = positive for no risk; 10mm induration = positive for medium risk {foreign born/prison/nursing home/IV drug addicts/low income}; 5mm induration for high risk {AIDS patients/TB contact/abnormal CXR}; false positive w/ BCG vaccine, another Mycobacterium; false negative = immunosuppressed/viral infection/ overwhelming TB/ malnutrition / eldery/ on steroids; test has booster effect for those infected), QuantiFERON-TB & ELISPOT (no false positive for BCG vaccine; measures IFN-g response to specific antigens), CXR, PCR, Mycobacterium Tb Direct Test (MTDT; RNA amplification), GenProbe

isoniazid (liver toxicity, peripheral neuropathy {treat w/ vitamin B6 / pyridoxime}) + rifampin (can decrease effectiveness of contraceptives, liver toxicity, red secretions) + streptomycin (parenteral; bugs have chromosomal mutations that confers resistance; must treat > 6 mos; directly observed therapy), pyrazinamide (liver toxicity, check uric acid), ethambutol (check visual acuity & red-green color-blindness, check uric acid), piridoxine (anti-toxicity); check for toxicity w/ hepatic enzymes, bilirubin, serum creatinine, CBC, & platelet count; treatment of latent disease prevents progression (especially HIV / close TB contacts / abnormal CXR and not treated / IV drug addicts / foreign born / low income / nursing homes / prisons / children < 4 yo)

facultative intracellular, great imitator; increased risk (HIV, substance abuse, recent infection w/ M. tuberculosis, untreated previous TB, diabetes mellitus, silicosis, low body weight, cancer of head/neck, hematologic/reticuloendothelial malignancies, end stage renal disease, intestinal bypass/gastrectomy/malabsorption syndrome, prolonged corticosteroid/immunosuppressive therapy

lepromatous leprosy (LL, TH2 response, bacteremia, leonin facies, infiltrative skin lesions, saddlenose deformity, infertility, blindness, hypoesthesia/peripheral neuropathy {palpable nerves, chronic damage, glove/stocking distribution, repetitive trauma/infection, resorption of fingers/toes}, borderline lepromatous / borderline / borderline tuberculoid (BL more numerous and greater shape diversity than BT), tuberculoid leprosy (TT, TH1 response = milder, skin lesions (localized superficial unilateral skin/nerve involvement, well defined hypopigmented elevated, alopecia, noninfectious, anesthetic, spontaneouly recover), immune reactions (reversal = appropriate TH1 response; erythema nodosum leprosum = panniculitis {inflammation of fat} + arthralgia/arthritis, fever, proteinuria, mouth ulcers)

lepromin skin test (prognostic of class of leprosy), skin/nerve biopsy w/ Fite stain, grow on footpads of immunodeficient mice

rifampin, dapsone, clofazimine, microlides, minocycline, quinolones, prednisone (TH2 to TH1), thalidomide (erythema nodosum leprosum)

prefer cooler areas (skin, nerves, eyes, nose, testes), facultative intracellular, transmission requires prolonged & intimate contace

Mycobacterium avium complex (MAC = M. avium + M. intracellulare)

chronic pulmonary disease (fibrocavitary {upper lobe, elderly male smokers w/ predispositions; unresponsivem, reinfection}, fibronodular {non-smoking females >50yo w/o Lady Windermere Syndrome, scoliosis, pectus excavatum, mitral valve prolapse; responsive, new strain}, disseminated disease (immunocompromised, chronic wasting, bacteremia, hepatitis (high alkaline phosphatase), spleen, anemia (bone marrow), chronic watery diarrhea), scrofula, infection (rice bodies; tendon sheath, bones, bursae, & joints; catheter)

X ray, multiple sputum/BAL smear & culture (+) specimens, granulomas, biopsy/ culture skin/tissue/blood, notify lab for mycobacterium, PCR

resembles TB on CXR, clarithromycin, refampin, ethambutol

chronic pulmonary disease (older smoking males w/ underlying lung disease), infection (rice bodies; tendon sheath, bones, bursae, & joints; catheter), bacteremia (immunocompromised)

resembles TB on CXR, environmental contaminant

infection (rice bodies; tendon sheath, bones, bursae, & joints; catheter)

Mycobacterium ulcerans

rod ubiquitous

slow growth rate

Mycobacterium marinum intermediate growth rate

Mycobacterium gordonae

Mycobacterium fortultum infects normal hosts rapid growth rate

Mycobacterium abscessusMycobacterium chelonei

Mycobacterium scrofulaceum

Treponema pallidum Spirochaetales corkscrew - humans microaerophilic Like cool environments,

Treponema pallidum endemicum

Treponema pallidum pertenue

Treponema pallidum carateum

Borrelia burgdorferi Spirochatales corkscrew - microaerophilic

Borrelia recurrentis doxycycline, erythromycin, PCN

Borrelia hermsii

Leptospira interrogans Spirochatales - aerobic

Leptospira interrogans canicolaMycoplasma pneumoniae Mycoplasmataceae facultative anaerobe

Mycoplasma hominis normal genital flora

Mycoplasma genitalium normal genital flora

Ureaplasma urealyticum +urease normal genital flora +urease

Chlamydia psittaci -

Chlamydia trachomatis humans

Chlamydia pneumoniae humans

Rickettsia rickettsii coccobacilli -

Rickettsia akari mites (on house mice)

Rickettsia prowazekii doxycycline/tetracycline, chloramphenicol, sanitation, eradicate lice

acid fast

(Kinyoun,

auramine-

rhodamine)

obligate aerobe: +catalase

X ray, multiple sputum/BAL smear & culture (+) specimens, granulomas, biopsy/ culture skin/tissue/blood, notify lab for mycobacterium, PCR

chronic skin ulcers w/ necrotic centers that start from violet papules, infection (rice bodies; tendon sheath, bones, bursae, & joints; catheter)

skin granuloma @ site of abrasion (papule-ulcers), infection (rice bodies; tendon sheath, bones, bursae, & joints; catheter)

fish tank/swimming pool

infection (rice bodies; tendon sheath, bones, bursae, & joints; catheter)

skin abscess @ site of trauma, corneal ulcer, chronic pulmonary disease (fibronodular), uderlying predisposing factors (cystic fibrosis, lipoid pneumonia, espophageal dysmotiolity), infection (rice bodies; tendon sheath, bones, bursae, & joints; catheter) infects immunocompromised, nail salons

scrofula (painless anterior cervical lymphadenopathy), infection (rice bodies; tendon sheath, bones, bursae, & joints; catheter)

LPS, additional phospholipid-rich outer membrane w/ exposed proteins & glycosoaminoglycans, 6 axial periplasmic flagella (corkscrew motion), peptidoglycan layer, cardiolipin (phosphatidylcholine, from host acquired membrane, altered = auto-Ab), No LPS, express very few surface proteins, transverse fission replication

syphilis (primary = papule-chancre {painless ulcer} @ 3-6 wks after inoculation, resolves in 3-6 wks, hematogenous dissemination; secondary = widespread rash {small, red, macular, flat, papular, pustular lesions, palms/soles/oral cavity, alopecia, resolves in 6 wks}, bacteremia, lymphadenopathy, condyloma lata {painless, flat lesion, vulva/scrotum, ulceration = extremely contagious, resolves in 6 wks}, skin infection {bald spots}, weightloss, malaise, fever, multi-organ {CNS, eyes, kidneys, bones, liver}; latent = asymptomatic, 33% = cured, 33% = remain latent, 33% = tertiary; tertiary = develops @ 6 - 40 yrs after infxn w/o Tx, gummatous syphilis = 17%, granulomatous infection - necrosis - fibrosis, skin {painless, sharp borders}, bone {deep gnawing pain}, liver testis, hard palate, cardiovascular syphilis = 9%, chronic inflammatory destruction of vasa vasorum - necrosis - aortic aneurysm/aortic valve insuffiency {diastolic aneurysm}/coronary artery occlusion; neurosyphilis = 7%, asymptomatic {CNS +}, subacute meningitis {fever, stiff neck, headache, high WBC/protein + low glucose + positive CSF}, meningovascular syphilis = cerebrovascular occlusion - infarction - neurologic impairment, tabes dorsalis = posterior columns + DRG {lose vibration/proprioception/fine touch/reflex/pain/temp} + Argyll-Robertson pupil {prostitute's pupil}, general paresis = metal deterioration/ psychiatric symptoms/Argyll-Robertson pupil {prostitute's pupil; accomodates but doesn't react to light});

darkfield microscopy (primary, immunofluorescence, silver stain), nonspecific treponemal Ab test (lecithin/cardiolipin; VDRL {CNS} / RPR {rapid, some false positives}; 80% in primary 1:8; 100% in seconday 1:64; false positive = infectious mononucleosis, chicken pox, malaria, kala-azar, lupus erythematosus; only active during disease), specific treponemal test (FTA-ABS, MHA-TP, TPHA, ELISA; 90% in primary, 100% in secondary; once positive always positive), Enzyme Linked Immunoassay (EIA), PCR

PCN or erythromycin + doxycycline; Jarisch-Herxheimer Phenomenon (acute worsening of symptoms after starting ABX due to endotoxin release; mild fever, chills, malaise, headache, muscle aches)

congenital syphilis (still birth/abortion, early {occurs w/in 2 yrs, like secondary, wide-spread rash, condyloma lata, snuffles, lymph node/liver/spleen enlargement, osteeitis}, late {like tertiary w/o cardiovascular, neurosyphilis [CN8 deafness], saddle nose, saber shins, tooth gap, Huchinson's teeth, mulberry molars, corneal inflammation)

treat before 4 mos gestation, PCN, DO NOT USE Doxycycline (TOXIC!)

endemic syphilis (bejel, desert zones Africa/Middle East, oral mucosa, gummas {skin, bones})

long-acting PCN (IM)

yaws (moist tropics, papule - wart {mother yaw} - gangosa {secondary lesions on face}, gummas {skin, long bones})

pinta (rural Latin America, papule - red lesion {blue in sun lgiht} - white lesion {@ 1 yr}, lesions DO NOT ulcerate)

tick (Ixodes), white foot mouse, white-tail deer

LPS, additional phospholipid-rich outer membrane w/ exposed proteins, 6 axial periplasmic flagella (corkscrew motion), transverse fission replication

lyme disease (NE/MW/NW US; stage 1 = localized, 10 dys after tick bite, lasts 4 wks, erythema chronicum migrans{round flat red rash that migrates, center turns blue - necrose - normal, flu-like illness, regional lymphadenopathy; stage 2 = disseminated, spread to skin, neurologic (brain, cranial nerves, motor/sensory nerves, meningitis, Bell's palsy, peripheral neuropathy), carditis (AV block, myocarditis, LV dysfunction), arthritis (migratory), myalgia (migratory); stage 3 = chronic arthritis, chronic neurologic damage, encephalopathy (memory impairment, irritability, somnolence), cardiac disease

Giemsa/Wright stain, clinical findings, biopsy of erethema chronicum migrans, ELISA, Western Blot, all labs are unreliable!

doxycycline, B-lactam, vaccine (OspA recombinant protein, withdrawn from market), ceftriaxone (for neurologic disease), removing the tick w/in 24 hrs prevents disease

body lice (Pediculus humanus), humans

LPS, additional phospholipid-rich outer membrane w/ exposed proteins, 7-20 axial periplasmic flagella (corkscrew motion), transverse fission replication, Vmp lipoprotein (anti-opsonin/phagocytotic), can mutate antigens

relapsing fever (W US, rustic mountain cabins; high fever, chills, headache, muscle ache, rash, meningitis, drenching sweats, splenomegaly, meningitis, lasts 4-10 dys, afebrile for 8 dys, relapses {shorter/milder})

Giemsa/Wright stain of blood during febrile periods, dark field microscopy, serology

antigenic variation = relapses

tick (Ornithodoros), rodents, small mammals

corkscrew (tight coil, hooks at ends, ice tongs)

animal urine, contaminated water,

warm climates

LPS, additional phospholipid-rich outer membrane w/ exposed proteins, 2 axial periplasmic flagella (corkscrew motion), transverse fission replication

leptospirosis (first phase = invade blood/CSF, high-spiking temperatures, headache, malaise, severe muscle ache, red conjunctiva, photophobia, abnormal liver enzymes, lasts 1 wk, afebrile period, relapse; second phase = IgM, meningismus, elevated WBC in CSF, hemorrhagic pneumonia)

first phase = culture blood/CSF; second phase = culture urine; ELISA, PCR, clinical history, organ labs, dark field microscopy

initiate treatment immediately, PCN or doxycycline

Leptospira interrogans icterohaemorrhagiae

Weil's disease = infectious jaundice, renal failure, hepatitis w/ jaundice, mental status change, hemorrhage in many organs

free living/intracellular lack cell wall/unique sterol membrane (resistant to B-lactams, cephalosporin, erythromycin, tetracycline), protein P1 (adhesion)

walking pneumonia (tracheobronchitis, pronounced coughing!, low mortality, community acquired), extra-pulmonary autoimmune (Stevens-Johnson syndrome {erythmatous vesicles and bullae @ mucocutaneous junctions}, aseptic meningitis, encephalitis, cold agglutinin disease), non-gonococcal urethritis, PID, non-pneumonic lung infection

takes a long time to culture (cholesterol/nucleic acid enriched media, 2-3 wks, fried egg or mulberry{more pathogenic} colonies), family transmission (2-3 wk incubation), CXR worse than clinical findings, cold-agglutinin test (IgM against RBC @ 4C), acute/convalescent IgM/IgG, PCR, DNA probe,

Resistant to B-lactams, aminoglycosides, cephalosporin, erythromycin, tetracycline; Can enter eukaryotic cells: macrolides (azithromycin/clarithromycin), quinolones (ciprofloxacin/levofloxacin), azithromycin, tetracycline (doxycycline)

smallest free living organism, usually affects young people

Resistant to B-lactams, lack cell wall, unique sterol membrane non-gonococcal urethritis (20% cases in men), mucopurulent cervicitis/pelvic inflammatory disease (women)

takes a long time to culture (cholesterol/nucleic acid enriched media, 2-3 wks, fried egg or mulberry{more pathogenic} colonies), family transmission (2-3 wk incubation), CXR worse than clinical findings, cold-agglutinin test, acute/convalescent IgM/IgG, PCR

Resistant to B-lactams and aminoglycosides; Can enter eukaryotic cells: macrolides, quinolones, azithromycin, tetracycline

birds (turkey, parrot) LPS, Resistant to B-lactams, lacks cell wall (no peptidoglycan, no muramic acid {lysozyme resistant}), cytochrome system, ATP/ADP translocator, prevent phagosome/lysosome fusion

minimal viral-like illness, typhoidal disease, psittacosis (atypical pneumonia = dry cough, fever, less sick appearing), hepatitis / heart / CNS involvement

impossible to culture, difficult to see on Gram stain, serologic testing (high IgM or increasing IgG)

Resistant to B-lactams; Can enter eukaryotic cells: 10-21 days w/ doxycycline, quinolones, erythromycin

obligate intracellular: elementary body (EB) exist extracellularly, enter columnar epithelial cell and forms reticulate body (RB) that occupies entire cell, sheds new EBatypical pneumonia (15% community axquired), ocular trachoma (chronic follicular

conjunctivitis, scarring, inverted eyelid, corneal opacity, blindness), STD (lymphogranuloma venereum {painless ulcer}, non-gonococcal urethritis, epididymitis, proctitis, PID = cervivitis / salpingitis / endometritis {infertility}), neonatal conjunctivitis, neonatal pneumonia (@ ~8 wks), Reiter's syndrome, liver capsule infection (Fitz-Hugh-Curtis syndrome = RUQ pain)

impossible to culture (culture in McCoy's cells), difficult to see on Gram stain, serologic testing (high IgM or increasing IgG), PCR

Resistant to B-lactams; Can enter eukaryotic cells: single dose of azithromycin (infants & pregos)/cephalosporin (IM) + 7-14 days of macrolide (doxycycline; adults) or quinolone;

acute bronchitis, mild pneumonia (15% community accquired pneumonia, TWAR), upper respiratory infection

impossible to culture, difficult to see on Gram stain, serologic testing (high IgM or increasing IgG)

Resistant to B-lactams; Can enter eukaryotic cells:5-10 days w/ macrolides, quinolones, erythromycin

tick (Demacentor andersoni = wood,

Dermacentor variabilis = dog)

rocky mountain spotted fever (south/central US; 6-10 hr tick feeding to transmit; fever, conjunctival redness, severe headache, myalgia, 7 days after bite; rash {wrists/ankles, soles/plams, trunk} after 3-5 days of fever; thrombocytopenia, hyponatremia, can be fatal if not treated early); endocarditis

Weil-Felix test (cross rxn w/ OX-2, OX-19 {Proteus vulgaris antigens}; test is not sensitive/specific), indirect immunofluorescence test (IFA), complement fixation test (CF), ELISA, serology (2-3 wks to get results; start therapy before results)

doxycycline, chloramphenicol (ABX must enter cells) obligate intracellular (endothelial cells), fever/pneumonia of unknown origin

rickettsial pox (self limiting, papule, vescicle, fever, headache, other vescicles); endocarditis indirect immunofluorescence test (IFA), complement fixation test (CF), ELISA,

doxycycline, chloramphenicol, eliminate rodents

lice (Pediculus corporis = body lice), fleas (flying

squirrela)

epidemic typhus (2 wk incubation, small pink macules @ 5 day, on upper trunk, covers body except palm/sole/face, delirium, stupor, risk of gangrene to hands/feet, resolve in 3 wks, ocassionally fatal), Brill-Zinsser disease (latent bug reactivates, milder symptoms); endocarditis

Weil-Felix test (cross rxn w/ OX-19 {Proteus vulgaris antigens}; test is not sensitive/specific), indirect immunofluorescence test (IFA), complement fixation test (CF), ELISA, Brill-Zinsser Diease = IgG titer, +/- OX-19

Rickettsia typhi

coccobacilli -

doxycycline, chloramphenicol, control rat/flea population

Rickettsia tsutsugamushi doxycycline, chloramphenicol

Rickettsia parkeri tick/louse/flea (SE US) fever, headache, eschars, regional lymphadenopathy, endocarditis doxycycline, chloramphenicol

Rickettsia africae doxycycline, chloramphenicol

Coxiella burnetii coccobacilli + doxycycline. erythromycin, pasturize milk @ 60C obligate intracellular

Bartonella quintana coccobacilli - body lice serologic doxycycline, chloramphenicol, azithromycin

Bartonella henselae cat serologic doxycycline, azithromycin

Ehrlichia chaffeensis -

Ehrlichia ewingii

Anaplasma phagocytophilum -

Babesia acute febrile disease

Capnocytophaga canimorsus - domestic animals B-lactam + B-lactamase inhibitor (ampicillin/sulbactam)

Aeromonas hydrophila rod - anaerobic aerolysin cytotoxic enterotoxin (ACT)

Plesiomonas shigelloides rod - +oxidase animalsEikenella corrodens oral cephalosporin

Shewenella cellulitisSTARI (souther tick associated rash illness, Missouri/Arkansas; erythema migrans)

Cryptosporidium

Microsporidia infection associated w/ AIDSCyclospora

Entamoeba histolytica amoebic colitis, hepatic abscessGiardia parasite, chronic diarrheaDiphtheroids endocarditisAspergillusHistoplasma capsulatam native valve endocarditisCandida albicans

Onychomycosis nail fungus

Herpes virus STD

Fournier's gangrene polymicrobial

Meleney's gangrene polymicrobial

Ludwig's angina polymicrobial

Lemierre syndrome

Clenched Fist anaerobicDiabetic Foot Ulcer polymicrobial

Diabetic Fetid Foot polymicrobial vascular surgery, ABX

Chronic diarrhea

obligate intracellular (endothelial cells), fever/pneumonia of unknown origin

flea (Xenopsylla cheopis = rat)

endemic/murine typhus (similar to epidemic typhus but symptoms not as severe, 10 dy incubation, fever, headache, flat/bumpy maculopapular rash); endocarditis

Weil-Felix test (cross rxn w/ OX-19 {Proteus vulgaris antigens}; test is not sensitive/specific), indirect immunofluorescence test (IFA), complement fixation test (CF), ELISA,

mite (mice; larvae = chiggers, in soil; Asia/SW

Pacific)

tsutsugamushi fever/scrub typhus (2 wk incubation, high fever, headache, scab at site of bite, flat/bumpy maculopapular rash, endocarditis

Weil-Felix test (cross rxn w/ OX-K {Proteus vulgaris antigens}; test is not sensitive/specific), indirect immunofluorescence test (IFA), complement fixation test (CF), ELISA,

Weil-Felix test (cross rxn w/ OX-2, OX-19, OX-K {Proteus vulgaris antigens}; test is not sensitive/specific), indirect immunofluorescence test (IFA), complement fixation test (CF), ELISA,

tick/louse/flea (sub-Sahara Africa)

African tick bite fever (ATBF, unemplained fever), endocarditis Weil-Felix test (cross rxn w/ OX-2, OX-19, OX-K {Proteus vulgaris antigens}; test is not sensitive/specific), indirect immunofluorescence test (IFA), complement fixation test (CF), ELISA,

tick (farm mammals) feces/spores

endospore (hardy), can grow in phagolysosome (pH = 4.5) Q fever (inhaled; abrupt fever/soaking sweats @ 2-3 wks after infection, pneumonia, no rash), granulomatous hepatitis, endocarditis (culture negative)

complement fixation test, negative Weil-Felix test

trench fever (high fever, rash, headache, severe back/leg pain, recover and relapse in 5 days), bacteremia, endocarditis, bacillary angiomatosis (proliferation of blood vessels in skin/organ of AIDS patients)

cat-scratch disease (cat bite/scratch, regional lymph nodes enlarge, low-grade fever, malaise, resolves in a few months) , bacteremia, endocarditis (culture negative), bacillary angiomatosis (proliferation of blood vessels in skin/organ of AIDS patients)

tick (Ixodes), dog, white foot mouse, white-tail

deer

Human Monocytic Ehrlichiosis (similar to rocky mountain spotted fever, rash less common, thrombocytopenia, leukopenia, monocytes)

Ab titer, blood smear (ehrlichial inclusion body on leukocytes), WBC count, serology (must treat before results available)

doxycycline, rifampin, chloramphenicol & B-lactam resistant obligate intracellular (WBC), found in NE & MW US

Ehrlichiosis (similar to rocky mountain spotted fever, rash less common, thrombocytopenia, leukopenia)

tick (Ixodes), dog, white foot mouse, white-tail deer

Human Granulocytic Anaplasmosis (similar to rocky mountain spotted fever, rash less common, thrombocytopenia, leukopenia, granulocytes)

Ab titer, blood smear (ehrlichial inclusion body on leukocytes), WBC count, serology (must treat before results available)

doxycycline, rifampin, chloramphenicol & B-lactam resistant obligate intracellular (WBC), found in NE & MW US

tick (Ixodes), dog, white foot mouse, white-tail deer

devastating sepsis syndrome (cat bite/scratch & dog bite, alcoholics & splenectomy patients at higher risk)

medical leeches, tropical areas

necrotizing cellulitis (fresh water), diarrhea, dysentery

traveller's diarrhea (fish)cellulitis (necrosis), endocarditis HACEK (culture negative endocarditis)

parasite, infection associated w/ AIDS, chronic diarrhea

parasite, infection associated w/ AIDS, chronic diarrhea

prosthetic valve endocarditis, septicemia

Dermatophyte infection (athlete's foot), UTI, lower respiratory tract

infection, septicemia, endocarditis (prosthetic valve, IV drug addicts, long-

term IV lines)

replace heart valve, anti-fungal

pulse itraconazole, pulse turbinafine

perineal infection in diabetics

post-surgical abdominal infection

submandibular/submental spacethromboplebitis of jugular vein

thrombosis of small arteries (gangrene) + neuropathy (85%; hammer toes {motor}, change in foot shape, decrease in sweat & rocker bottom foot{autonomic})

chlorpactin, chlorox bleach, ABX (Gram +)

cellulitis (necrosis, bullae, gas, purple/black discoloration, myonecrosis, fasciitis )

Giardia, Cryprosporium, cyclospora, disacchridase deficiency, EAEC, Shigella, Salmonella, Campylobacter, Yersinia, Brainerd diarrhea, post infectious irritable bowel syndrome, sprue syndrome, malnutrition, zinc edficiency, vitamin A deficiency

proctits

gastroenteritis (norovirus, toxin) vomiting + diarrhea

enteritis (giardia, ETEC, EAEC, virus) diarrhea (small # + large volume)

colitis (invasive pathogens) diarrhea (large # + small volume)

fever = inflammation

Blood agar grows everythingChoclate agar

McConkey's agar suppress gram +CNA plate suppress gram -

Abx susceptibility tube dilutions

blood cultures

aramine stain mycobacteriumcalcofluor fungiFluorescent labeled Ab

specific agar leigionellacultured cells viruseselisa

pcr

serology

KNOW THE LAB TESTS!!!

Case Control Study determine source of nosocomial outbreak

Semiquantitative Culture Method

Peripherl v. Cathether Blood Cultureechocardiogram not definitiveendocarditis

CT scan best for peritonitisperitonitis

apendicitis E.coli, Enterococci, Bacteroides

niesseria gonorrhea, chlamydia trachomatis, herpes simplex,

treponema pallitus

everything especially H influenzae, N. Meningitidus

kirby-bauer = disc on plate

automated

2 sets (1 aerobic + 1 anaerobic)

anaerobe = clostridium, bacteroides

aerobic =

pseudomonas, candid

a

leigionella, pneumocystis, respiratory viruses

rapid influenza, rapid strep, leigionella, C. difficile, respiratory syncytial virus, histoplasma antigen, cryptococcal antigen, pneumococcal C polysacchride

B. pertussis, mycobacteria, herpes virus, hiv, hepC, hepB

st louis encephalitis, west nile virus, hepA, hepB, hepC, brucella,

if there isnt a good indication for a diagnosis, don’t order a lab test!

Test catheter as source of nosocomial infection

Blood culture time reveals source of infection

FROM JANE(fever, Roth spots, Osler's nodes, murmur, Janeway's lesions, anemia, splinter hemorrhages, embolis), splenomegaly, mycotic aneurysm, clubbing, valve rupture, BBB, splenic abscess, glomerulonephritis

cidal IV abx (synergy, 4-6 wks), valve replacement if

needed

E. coli (primary, adults), S. pneumoniae (primary, children), apendicitis (RLQ pain), hepatic abscess (polymicrobial, enlarged liver), cholecystitis (palpable gall bladder), emphasematous cholecystitis (diabetics, E. coli), cholangitis (Charcot's triad = pain, jaundice, fever; Reynold's pentad = Charcot's triad, AMS, septic shock), diverticulitis (LLQ pain), pancreatic abscess (E. coli, Enterococci); rebound tenderness, ileus, obstruction, volvulus, air under diaphragm (perforation)

Site Class Generic Commercial T 1/2cell wall B-lactam PCN-G (benzyl-PCN) 20 mins

PCN-V (phenoxy-PCN)procaine-PCN daysbenzathine-PCN weeks

probenecid

ampicillin

amoxicillin 45 mins

methicillinnafcillin

oxacillincloxacillindicloxacillinflucloxacillinpiperacillin

ticarcillin

cephalosporin cefazolin Ancef, Kefzol 90 minscephalexin Keflexcefoxitin Mefoxincefotetan Cefotancefuroxime Ceftin

cefotaxime Claforan 1 hr

ceftriaxone Rocephin 6-8 hrs

ceftazidime

cefpodoxime Vantin

cefepime

ceftobiprole

penicillin (1ug = 1.6 units)

Unasyn (ampicilline + sulbactam)

Augmentin (amoxicillin + clavulanic acid)

Zosyn (piperacillin + tazobactam)

Timentin (ticarcillin + clavulanic acid)

carbapenem imipenem

meropenemdoripenemertapenem

monobactam aztreonam

cephamycin cefoxitinclavulanic acid

tazobactam

sulbactam

glycopeptides vancomycin 2 hrs

teicoplanin

cycloserine cycloserine

bacitracin bacitracin

aminoglycoside streptomycin

gentamicin

amikacin

kanamycintobramycin

Primaxin (imipenem + cilastatin)

B-lactamase inhibitor

Augmentin (amoxicillin + clavulanic acid), Timentin (ticarcillin + clavulanic Zosyn (piperacillin + tazobactam)

Unasyn (ampicilline + sulbactam)

Neosporin (bacitracin + polymyxin / neomycin)

protein synthesis

2.5 hrs (normal renal)

aminoglycoside

neomycintetracyclines doxycycline

minocycline

tigecycline

macrolide erythromycin long

carbomycin

clarithromycin

azalide azithromycin

lincosamide clindamycin

ketolide telithromycin

cethromycinoxazolidinone linezolid

chloramphenicol chloramphenicol

2.5 hrs (normal renal)

Z-pack (azithromycin, clarithromycin, erythromycin)

Biaxin, Z-pack (azithromycin, clarithromycin, erythromycin)

Zithromax, Z-pack (azithromycin, clarithromycin, erythromycin)

Benzeclin (topical for acne)

fusidic acidsulfonamide sulfonamide 12 hrs

trimethoprim trimethoprim

fluoroquinolone ciprofloxacin

levofloxacin

moxifloxacin

macrocyclic rifampin

rifabutinpolymixin polymixin

colistinlipopeptide daptomycin

lipoglycopeptide televancin

folic acid metabolism

Bactrim, Septra, Cotrimoxazole

DNA synthesis

RNA synthesis

disrupt membrane

metronidazole metronidazole Flagyl

mupurocinnitrofurantoin furadantin

macrodantin

hippuric acid cranberry juice

ChloroquineIsoniazid

RifaximinNitazoxanide

SulfamethoxazoleQuinupristin/dalfopristin

Action Side Effects Notescrystalline, destroyed by gastric acids

not destroyed by gastric acids

> 0.1 ug/mL for 2 wks

IV, PBP 2, PBP 3

1st Genoral cefazolin

oral

oral

4th Gen

binds PBP 2a

binds active site of PBP, excreted by kidneys (delayed by probenecid / procaine / benzathine), succeptible to B-lactamase (penicillin >>> dicloxacillin > cloxacillin > oxacillin > nafcillin)

skin rashes, neutropenia w/ newer B-lactams, anaphylaxis > 0.01%

peak = 1-2 ug/mL, after 24 hrs = 0.2 ug/mL

delays excretion of PCN @ renal tubules

oral, 2 hrs for absorption, common oral PCN, PBP 1a. PBP 2

IV, resists B-lactamaseIV, resists B-lactamase, more common, excreted by liver alsooral, resists B-lactamaseoral, resists B-lactamaseoral, resists B-lactamaseoral, resists B-lactamase

binds PBP, very little cross antigenicity w/ PCN

neutropenia, increased risk for bleeding 2nd Gen, prophylaxis for surgery

commonly used, can cross BBB, resistant to TEM B-lactamase, PBP 33rd Gen, commonly used, can cross BBB, resistant to TEM B-lactamase

seizures

cilastatin not necessary

diarrhea oral

IV equivalent of Augmentin

must penetrate membrane

IV, better activity, less toxicityinhalation

binds all known PBP, resists nearly all B-lactamase, no cross antigenicity w/ PCN

cilastatin prevents inactivation by renal peptidase

binds PBP, no cross antigenicity w/ PCN or cephalosporin, resists B-lactamase

PBP 3, little toxicity, good for renal fragile patients

inhibits B-lactamase, synergy w/ PCN

binds D-ala, inhibits bridging, renal clearance, synergy w/ gentamicin, antagonism w/ rifampin, DON’T USE unless infection is serious and you suspect abx resistant bug

redman (diffuse flushing; prevent w/ slow infusion), nephrotoxic, ototoxic, thrombophlebitis

D-ala analog that blocks D-ala ligase

blocks peptidoglucan synthesis

toxic parenteral

topical (+/- polymyxin)

binds 30s (irreversible) and prevents 50s binding, transported through porin (active), synergy w/ PCN, decreased renal function requires decreased dosage/freq, peak = efficacy; trough = toxicity; monitor serum levels; IV

damage hair cells/vestibule, nephrotoxic (PCT, damage abated by clusterin, serum trough)

IV, susceptible to deactivation at many sites, first AM, for TB (multi drug resistant bugs)

IV, fewer sites where deactivation can occur, resistance has emerged more slowly, still in use

IV, fewest sites where deactivation can occur, most common AM

topicalinexpensive

binds peptidyl transferase

very little resistance

binds 30s (irreversible) and prevents 50s binding, transported through porin (active), synergy w/ PCN, decreased renal function requires decreased dosage/freq, peak = efficacy; trough = toxicity; monitor serum levels; IV

damage hair cells/vestibule, nephrotoxic (PCT, damage abated by clusterin, serum trough)

binds 30s and prevent tRNA binding, fecal excretion (good for renal failure patients)

rash in sun, vaginal thrush, diarrhea, discolors teeth / inhibits bone growth (children), contra-indicated for pregos

concentrates in nasal secretions, impregnate IV catheters (+rifampin; decreases bacteremia)

binds 50s (V domain) 23s rRNA nausea / vomiting (erythromycin >> azithromycin or clarithromycin), irritates veins (erythromycin >> azithromycin or clarithromycin), prolonged QT interval, liver failure, blurred vision

concentrates in lungs, macrophage uptake (intracellular bugs)

macrophage uptake (intracellular bugs)

macrophage uptake (intracellular bugs)

blocks cytokine release from macrophages, macrophage uptake (intracellular bugs)

C. difficile colitis, Bacteriodes resistance

macrophage uptake (intracellular bugs), S. aureus, CA-MRSA, polymicrobial infection above the diaphragm

binds 50s (II and V domains) liver failure, blurred vision, prolnged QT intervals, myalgia, CPK elevation

macrophage uptake (intracellular bugs), pneumonia only

macrophage uptake (intracellular bugs)IV, oral, expensive!

binds peptidyl transferase (chloramphenicotransferase)

anaplastic anemia (kill cell lines RBC, WBC, etc.), gray baby syndrome

binds EF-G

blocks DNA gyrase

inhibits RNA polymerase

inhibits nucleotide synthesis (dihydropteroate synthase = first enzyme in pathway)

skin rashes, Stevens Johnson syndrome (idiosyncratic), renal insufficiency (dose related but rarely causes hyperkalemia), RBC hemolysis (G6PD deficiency)

oral (well absorbed, 95%), IV, G6PD deficiency (glucose 6 phosphate enzyme deficiency; hemolysis of RBC)

inhibits nucleotide synthesis (dihydrofolate reductase = late enzyme in pathway)

prolonged Q-T interval (use with caution w/ Ca channel blockers), tendonitis (achilles tendon rupture), increased risk of bleeding (warfarin patients via Vitamin K from gut flora), C. difficlie colotis, contraindicated for pregos

oral (well absorbed; higher concentrations in macrophages, lung, soft tissue), IV, less expensive, excreted in urine (very high concentration), bugs are becoming resistant (direct connection to overuse), effectiveness linked to concentration above MIC (?), respiratory quinolones (levofloxacin, moxifloxicin)

liver toxicity, red secretions, neutralize contraceptives

must be used synergistically because of rapid emergence of resistance, can be used against bugs in biofilms (w/ fluoroquinolones)

disrupt phospholipid structure of cytoplasmic membrane

neurotoxic, nephrotoxic,

IV, inhalation, not absorbed in GI tract, DO NOT GIVE ORALLY

depolarizes bacteria by causing release of intracellular ions

myalgia, CPK elevation

inactivated by surfactants (not for pneumonia), low serum concentration (binds serum proteins), expensive!

binds D-ala, depolarizes bacteria by causing release of intracellular ions

blocks peptidoglycan synthesis (like vancomycin), depolarizes cell membranes

not recommended

malariaTB

antibiotic; acidic

bad taste, vomiting

relatively nontoxic, polymicrobial infection below the diaphragm

topical, much resistancefully absorbed in GI, rapid excretion into urine

does not appear to generate bowel flora resistance, underutilized today

block E. coli adherence to bladder mucosa via P1 fimbriae

liver tocicity, peripheral neuropathy

Bug/Disease

S. aureus

determine if bug is MRSA

S. aureus (NOT MRSA), S. pyogenesoutpatient infections, UTI

Pseudomonas

S. pneumoniae (B-lactam resistant), UTI

T. pallidum (syphilis), S. pyogenes (rheumatic fever)

Gram -, Haemophilus, E. coli, Proteus, Streptococci (pneumonia, intraabdominal infection)

Haemophilus (otitis, sinusitis), Moraxella (otitis, sinusitis), S. pneumoniae (otitis, sinusitis), P. multocida (cat/dog bites), polymicrobial (lung abscess, human bite), S. aureus (skin/soft tissue; NOT MRSA), Streptococci

Klebsiella, Enterobacter (intraabdominal infections), Pseudomonas

broad range Gram -, anaerobes, S. aureus (prophylaxis for surgery)S. pneumoniae, Haemophilus, Moraxella (otitis medial, bacterial bronchitis)Streptococci, Haemophilus, Moraxella, N. gonorrhoeae (gonorrhoeae), Gram - rods (NOT Pseudomonas), B. burgdorferi (Lyme disease), H. ducreyi (chancroid), S. aureus, NOT ANAEROBES, bacterial meningitis

Streptococci, Haemophilus, Moraxella, N. gonorrhoeae, Gram - rods, Pseudomonas, B. burgdorferi (Lyme disease), H. ducreyi (chancroid), S. aureus, NOT ANAEROBES, bacterial meningitis

Streptococci, Haemophilus, Moraxella, N. gonorrhoeae, Gram - rods, Pseudomonas, B. burgdorferi (Lyme disease), H. ducreyi (chancroid), S. aureus, NOT ANAEROBES, bacterial meningitis, MRSA

Gram + (NOT MRSA), E. faecalis, Gram -, Pseudomonas, anaerobes

Gram - rods (UTI in patients w/ poor renal function)

S. aureus, MRSA (synergy w/ gentamicin anatagonism w/ rifampin), Staphylococci, S. pneumoniae (meningitis, synergy w/ ceftriaxone), Enterococcus faecium (NOT VRE), C. difficile (colitis, metronidazole is cheaper but less reliable)

S. aureus (skin & soft tissue infection), Streptococci (skin & soft tissue infection), Gram +/-, nasal carriage

Gram - rods (first line for serious UTI), Pseudomonas, Gram + (synergy w/ PCN)

meningitis

Gram - rods (first line for serious UTI), Pseudomonas, Gram + (synergy w/ PCN)

Gram - (bacteriostatic), N. meningitidis (nasal carrier, minocycline), S. pneumoniae (85%), Haemophilus, Moraxella, S. aureus, MRSA (chronic osteomyelitis), Legionella, Mycoplasma, C. psittaci (psittacosis), C. pneumoniae (atypical pneumonia), C. trachomatis (lymphogranuloma venereum), Brucella (brucellosis, w/ other abx), Rickettsiae (Rocky Mountain spotted fever), Ehrlichia, Anaplasma, T. pallidum (2nd line, PCN allergy), Coxiella (Q fever)

Gram - rods, MRSA, bugs w/ extended spectrum B-lactamase, Gram + rods

S. aureus (NOT MRSA, bacteriostatic, clindamycin), S. pneumoniae (pneumonia, ketolide, azithromycin, clarithromycin, bactericidal), S. pyogenes (ketolides, clindamycin), Anaerobes (clindamycin), H. influenzae (clarithromycin, azithromycin, ketolide, bactericidal), H. ducreyi (chancroid, azithromycin, clarithromycin, bactericidal), Moraxella (ketolide, azithromycin, clarithromycin), Legionella (atypical pneumonia, ketolide, azithromycin, clarithromycin), Mycoplasma (atypical pneumonia, ketolide, azithromycin, clarithromycin), Chlamydia (atypical pneumonia, azithromycin, ketolide), Ureaplasma (azithromycin), MAC (clarithromycin w/ ethambutol or rifabutin, AIDS), T. pallidum (syphilis, second line, azithromycin resistant), B. burgdorferi (Lyme disease, second line), intraabdominal infection (clindamycin + gentamicin + ampicillin), aspiration pneumonia (pneumonia), streptococcal gangrene (clindamycin w/ PCN), P. acnes (acne, clindamycin)

S. aureus (soft tissue infection), MRSA, staphylococci, S. pneumoniae (macrolide resistant), Enterococci, TB

Gram + cocciGram +/-, S. pneumoniae (25% resistant), S. aureus, MRSA, Haemophilus, Neisseria, Legionella, Chlamydia, Nocardia, Pneumocystis carinii (fungal pneumonia), Plasmodia, Toxoplasma gondii (AIDS patients), Isospora, Cyclospora, S. saprophyticus (uncomplicated UTI), Klebsiella (uncomplicated UTI), Proteus (uncomplicated UTI)

Pseudomonas, UTI, intraabdominal infection, Shigella, Salmonella, biofilm bugs (ciprofloxacin + rifampin), Legionella, Mycoplasma, Chlamydiae, M. leprae (leprosy), M. tuberculosis (tuberculosis), nontuberculous Mycobacteria, prophylaxis (prolonged neutropenia, cirrhosis, ascites, prior spontaneous bacterial peritonitis)Pseudomonas, UTI, intraabdominal infection, Shigella, Salmonella, biofilm bugs (ciprofloxacin + rifampin), Legionella, Mycoplasma, Chlamydiae, M. leprae (leprosy), M. tuberculosis (tuberculosis), nontuberculous Mycobacteria, prophylaxis (prolonged neutropenia, cirrhosis, ascites, prior spontaneous bacterial peritonitis), S. pneumoniae (pneumonia)

S. aureus (prosthetic infection, w/ PCN or vancomycin, coat device w/ rifampin and minocycline), Staphylococci, Streptococci, Haemophilus, Neisseriae (meningitis, prophylaxis / treat nasal carriage), Mycobacteria (TB, w/ another abx)

MAC (w/ macrolide)Gram - rods, Acinetobacter, superficial infection

S. aureus (skin & soft tissue infection), MRSA (difficult cases, soft tissue infections), Gram +,

complicated skin/soft tissue infection, nosocomial pneumonia

Staphylococci, S. aureus (nasal carriage)

Trichomonas vaginalis, anaerobes (below diaphragm), intraabdominal infections, C. difficile (colitis, first line), Entamoeba histolytica

E. coli (UTI), S. saprophyticus (UTI)

E. coli (UTI)

ResistanceTEM B-lactamase (chromosomal, plasmid, transposon), penicillinase (chromosome, plasmid), mutate/mosaic PBP, bypass PBP (mecA), acquire new PBP, efflux pump, porin

Extended Spectrum B-lactamase (chromosomal, plasmid, transposon; treat w/ AM or carbapenems), cephalosporinase (chromosomal, plasmid), mutated porin

PBP-2a (MRSA), carbapenemase

TEM & SHV B-lactamase (plasmid)

mutation to create new enzyme (D-ala + D-lactate), VanA (plasmid, terminal D-lactate), Van B, Van C, Gram - (abx too big to enter), VISA (thicker cell wall binds abx), VRSA (from VRE)

aminoglycoside modifying enzyme (plasmid, nucleotidyltransferase, phosphotransferase, acetly transferase), mutate 30s, mutate porin (can only enter through electron transport chain, not effective against anaerobes)

mutate 23s rRNA

aminoglycoside modifying enzyme (plasmid, nucleotidyltransferase, phosphotransferase, acetly transferase), mutate 30s, mutate porin (can only enter through electron transport chain, not effective against anaerobes)

efflux pump (tetracefflux, plasmid), Tet binding protein (plasmid)

erythromycin ribosome methylase (erm, plasmid, alters 23s rRNA target, clindamycin resistant; 30% bugs), efflux pump (mef, remains clindamycin and ketolide susceptible; 70% bugs), D-test (test erythromycin resistance, if + don’t use clindamycin)

chloramphenicol transacetylase (plasmid), efflux pump

mutate EF-G gene (chromosome)acquire new enzymes (dihydropteroate synthase & dihydrofolate reductase; mutation, plasmid)

mutate gyraA (chromosome), downregulate porin (OmpF), efflux pump, Qnr (binds fluoroquinolones, plasmid)

mutate RNA polymerase (chromosome)

ID bug chart-DK

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