Microbiology Step 1 weird

exceptions and forgotten detail

Introduction

Prokaryotes: have a nucleoid instead of a nucleus

Mycoplasma has cholesterol in membrane and no peptidoglycan
o Cant gram stain it and beta-lactams dont work (so use
macrolides)
o Cholesterol needed to grow it
Fungi have ergosterol except PCP ( therefore need to use TMP/SMX
trimethoprim/ sulfamethoxazole )
o PCP visualized by SILVER STAIN
Polycistronic DNA only bacteria and viruses
o One mRNA carry many proteins (have multiple SHINE
DELGARNO sequences)
Sterile organs (detection any organism= pathological)
o Blood
o CSF
o Stomach
Candida is normally present in the mouth, when decreased immune
it over grows and causes oral thrush
Breast fed only= bifidobacterium ( BB= breastfed baby)

Pathogenicity
Antigenic Variation
o N.gonorrhea pili
o Trypanosome brucie (African sleeping sickness)
o Enterobacteriaceae: capsular and flagellar antigen
o HIV : antigenic drift of gp120
IgA protease : SHiN
Strep pyogenes M protein = degrade C3b
Survive intracellular
o TB : sulfatides prevent fusion phago and lysosome
o Listeria: listerolysin O escape phagosome
Physical damage
o Entamoeba histolytica: ulceration intestine and liver
abscess
o Cysticerosis causes brain lesions seizure
Endotoxins
LPS = Gram negative (LIPID A toxic potion)

o
o
o
o

T cell independent antigen

Causes release of cytokines IL-1 IL-6 TNF-alpha
Leads to SEPSIS (septic shock)
* works the same mechanism as superantigen from
Straph aureus and strep pyogenes = high cytokines
they activate many CD4 T cells = polyclonal
activation T cells
sunburn rash and involves palms and soles

Exotoxins
Protein synthesis
o EF2 ADP ribosylation(stops translation): C.dipthernia,
Pseudomonas aueriginosa
o 28S of the 60S ribosome : Shigella, EHEC
Neurotoxin: by inhibit release NT
o C.tetani: prevent release glycine and GABA
o C.botulinum: prevent release Ach
Superantigen: staph aureus and strep pyogenes
CAP : cholera, anthrax, Ecoli ETEC, Pertusis
o CA: work via Gs
o P works via Gi
Cytolysins: ALPHA TOXIN
o Clostridium perfringens: lecithinase = GAS gangrene
o Straph aureus: cell membrane leaky

Bacteria
Structure
Cell wall protect from osmotic damage (peptidoglycan)
o Therefore penicillin will break this down
Capsule protects (only removed by OPSINIZATION)
o Bacillus anthracis made from polyglutamate can activate T
cell
Spores: bacillus and clostridium
o Diplicolinic acid, calcium dipicolinate , keratin
o Spores are made in the stationary phase when
birth=death
Growth on medias
Thioglycolate : anerobes cant breath air : clostridium,
bacterioides, actinomyces
Chocolate agar
o Neisseria ( Thayer-Martin, VNP : vancomycin, colistin,
nystatin)

o Haemophilus influenza. * also grows SATELLITE colony

with Staph aureus
Need vactors X and V ( protoporphyrin and NAD)
Atypical pneumonia ( all dont stain with gram)
o Mycoplasma pneumonia = grows MALBURY colony on
sterol agar
o Legionella: grows on cysteine and iron
o Chlamydia : intracellular
Oxygen special
Anerobes: cant breath air = clostridium. Bacteroides,
actinomycin
Obligate aerobes: mycobacterium, Nocardia, and pseudomonas
aeruginosa, bacillus
Microaerophil: campylobacter and Helicobacter
o They will say SPECIAL INCUBATOR
Stains
Acid fast : cryptosporidium
Gomoris methamine silver stain = PCP
Auramine rhodamine fluorescent dye: TB
Dont stain with GRAM
1. Mycobacteria due to waxy cell wall
2. Spirochetes thin
3. Chlamydia and rickettsia intracell
4. Legionella (use silver)
Top nosocomial infections
1. Staph aureus : IV, skin,
2. Pseudomonas * ventilator
DTP : all TOXOID VACCINE (toxin inactivated by formaldehyde)
SHiN: strep pneumonia, Haemophilus influenza, Neisseria meningitides
All have capsule, and VACCINE that is conjugated to protein
(diphtheria toxoid)
IgA proteinase
Transformation takes up material from outside
Latex agglutination
Latex agglutination
Strep pneumonia
Neisseria meningitides
Hemophilus infuelnzae
Cryptococcus
Granulomas
Listeria ( also only Gram + with LPS)

Gram Positive cocci

Strep agalactiae : CAMP test + HIppucrate

Staph aureus
o Coagulase forms abscess bc fibrinogen fibrin
Yersinia other who has coagulase
o Scalded skin syndrome : epidermis peal (exfoliative toxin)
Nikolski +
o Draining sinus from osteomyelitis predispose to
squamous cell cancer
o ACUTE ENDOCARDITIS (HIGH fever, fatigue, murmer)
Subacute: splinter hemorrhage, osler nodes,
roth spots, weighloss, night sweats
o Treatment
1. Nafcillin and oxacillin
2. MRSA: vancomycin
3. VISA and VRSA: quinupristin, linezolin, streptogramin,
daptomycin
Strep pneumonia
o Serotype via capsule
o Strep Pneumonia : #1 MOPS ( meningitis, otitis media,
Pneumonia, sinusitis)
o RUSTY sputum, with consolidation whole lobe, or whole
lung
Strep pyogenes
o Serotype via M protein
M12 = glomerulonephritis
o PYR + (pyrrolidonyl arylamidase)
o ASO + ( streptolysin O)
o DNAse B
o Streptokinase ( break down clots)
Enterococcus
o Subacute endocarditis after GI or GU procedure
(Transurethral resection, colonoscopy)

Gram Positive rods

Bacillus anthracis boxcar large gram
Wool sorter disease ( animals) + postal worker (bioterrorism)
Skin: MALIGNANT pustules= central eschar(black) and red
border
Pneumonia: mediastial widening, dyspnea and FACIAL EDEMA
Clostridium tetani and botulinum
Both PREVENT THE RELEASE of NT (damage the SNARE protein)

Tetanus
Spores germinate in tissues
Treatment if symptomatic or no vaccine= Ig +
metronidazole(anaerobe) + diazepam for spasm
Tetanus prone
o If didnt get primary vaccination or unknown: vaccine + Ig
o If had vaccine : give vaccine if booster was 5 years ago
Perfringens
Stormy fermentation for milk + double zone hemolysis
Crepitus
ALPHA toxin/ phospholipase C = lecithinase
Identify on EGG YOLK agar
Hyperbaric chamber after debridement and clindamycin bc its
anerobic therefore die from high O2
Difficile
Autoclave things to kill spores
If rxn need
1. Stop antibiotic
2. Give metronidazole
3. Give vancomycin
4. Remove infected tissue
Listeria
PREGNANT AND HIV DONT EAT SOFT CHEESE OR DELI
Causes spontaneous abortion
Granulomatosis infantisepticum
Tumbling motility + facultative intracellular + cold grow
Corynebacterium diphtheria
Club shaped, chinese letter
Phage carried toxin ( EF2 ADP ribosylation= stop elongation
translation)
Myocarditis , ECG change, hoarsness of voice (recurrent
laryngeal)
Tinsdale/ tellurite agar
Elek test= toxin
Loeffler serum
Nocardia
1. Asteroides: causes pulomary like TB mimicks it
2. Brasiliensis = cutaneous only
Mycobacteria TB
Produces B3= niacin
Pathogenesis
o Sulfatides: prevent fusion phago and lysosome
o Cord factor= serpentile growth , inhibit WBC migration
Correlates with virulence

o Tuberculin :surface protein + mycolic cause PPD

Zone of induration = MEANS EXPOSED (not diseased)
o 5mm : HIV or recent exposure
o 15 mm : normal people
Mycobacteria leprae:
Tuberculoid = Lepromin + test, granuloma, Th1, little acid fast
Leptromatous: test -, Th2, many acid fast

Gram Negative
Facultative intracell
Legionella
Francisella - granulomatous
Brucella- granulomatous
Rifampin prophylactic exposure
N.meningitisis
Hemophilus
Oxidase positive (all enterobacteriacea negative for oxidase)
Neisseria
Pseudomonas
Helicobacter
Campylobacter
Urease + PUNCH
-proteus
-urea plasma
- nocardia
-cryptococcus
-h.pylori
Spontaneous peritonitis : CHEMOTHERAPY PATIENTS ( the
epithelium damaged) enter in cause peritonitis ( also
nephrotic)
-Bacteriodes fragillis
-E.coli

Bacteria
Neisseria meningitides
Usually associated with DIC bc only gram negative to RELEASE
LPS since it over produces it
Vaccine only (YWCA) NOT B which is 50% of meningitis in US bc
capsule nonimunogenic
Gonorrhea
Gram negative diplococci INTRACELLULAR
SEPTIC arthritis in sexually active young KNEE
Causes ophthalmia like chlamydia
o Chlamydia also has PNEUMONIA

Pseudomonas aeruginosa
In respirators, in flowers and water, and raw vegetables therefore
not allowed in burn units
LIVER PRIMARY TARGET ( Diptheria was <3 and nerves with same
toxin)
Capsule
Colonize eschar in burn victim
Neutropenia, burn patient, and CGD
Legionella
Pool boy, air conditioner, fountains
Pathy infiltrate = atypical pneumonia
Diagnose: DFA ( direct fluorescent antibody)
Silver stain, and CYE/BCYE ( buffer charcoal yeast extract=
cysteine and iron))
Francisella tularensis
Tick bite or traumatic= ulceroglandular = ulcer and regional
lymph
Pneumonia if inhaled
Serology diagnose ( NEVER CULTURE, ALSO BRUCELLA AND
YERSINIA)
Brucella
Unpasteurized dairy (GOATS MILK)
SWEATING AND HEPATOMEGALLY ( leptospira other
hepatomegaly)
Chronic: DEPRESSION + sweating
Bordetella pertussis
Unvaccinated (immigrant, Jehovahs, religious)
Have filamentous hemagglutinin
Camp by inhibit Gi
Also tracheal cytotoxin: interfere with cilia ( therefore need to
cough hard to get it up)
o Whooping cough= paroxysmal cough ending with
gasp(whoop)
o Repetitive cough with GASP at end, and may vomit
Causes hypoglycemia
Campylobacter jejuni
Curved, microaerophile, oxidase + (like Helicobacter)
Grows at 42 degrees
Polar flagella (gulls wings)
Guillain barre( O:19 serotype) and Reiter
Vibrio cholera = a lot of fluid loss
Ringers lactate give them = replenish the K+ and HCO3 Vibrio vulnificus : from swimming salty water ( oysters etc)
o Get cellulitis and gastroenteritis(if ingested)

Enterbobacteriaceae
1.
2.
3.
4.

All ferment glucose

Nitrates nitrites
Catalase +
OXIDASE

-H= flagella
-K= capsule
-K1: E.coli
-Vi: Salmonella typhi
Lactose: CEEK
Motile and H2S: Salmonella, Proteus
Nonmotile and no H2S: Shigella and Yersinia
E.coli

UTI: Pili is virulence factor

Neonatal meningitis: capsule
Sepsis: LPS
Gastroenteritis: toxin
EHEC: DONT FERMENT SORBITOL (other do)
o Only NONINVASIVE(no pus or fever) bloody diahrea
o DONT GIVE ANTIBIOTICS (increase HUS)
Klebsiella
Mucoid colony, red gelatinous sputum ( wont say red current
jelly), large polysaccharide capsule
Alcoholic, homeless, elderly
o * even alcoholic #1 pneumonia still strep pneumonia
form abscess
Yersinia
1. Pestis
Bipolar staining ( look like safety clip) = stain at both ends
Flea bite from rodent
Bubonic plague: high fever and BUBOES sepsis and death
Pneumonic plague: HIGHLY CONTAGIOUS
TREAT: aminoglycosides
2. Enterocolitica: unpasteurized milk and pork
Multiplies in cold
Pseudoappenidx: appendix normal, but MESENTERIC LN
enlarged
Proteus mirabilis or vulgaris:
Swarming (due to peritrichous flagella: all over)
WEIL-FELIX TEST for ricketssia
Same treatment as E.coli: fluoroquinolones and TMP-SMX
Salmonella = Vi capsule

1. Typhi

= TYPHOID FEVER
* never cause of gastroenteritis or osteomyelitis
only btw humans
Lives in macrophages bc prevent fusion phago and
lysosome like TB
Concentrated in gall bladder where bile
concentrated ( therefore resistant to bile)
Week 1 in blood, rose coloured spots
Week 3 in stool
CONSTIPATION more common than diahrea
2. Others: typhimurium, enteritidis
Widal test: antibodies to antigen O,H, Vi
Chickens and reptile pets
Osteomyelitis in sickle cell ( kid played with turtle)
Haemophilus influenza
Type b capsule ( polyribitol phosphate )
3 month- 2 years not vaccinated
o meningitis
o epiglottitis (thumb print on lateral Xray)
o pneumonia
* still cause otitis media + sinusitis by nontypable (but strep penumo
#1)
HACEK endocarditis subacute
- Haemophilus aphrophilus
- Actinobacillus actinomycetemcomitans
- Cardiobacterium homonis
- Eikenella corrodens : HUMAN BITES
- Kingella kingae: HUMAN BITES
Treponema Pallidum
Primary
Painless chancre (open sore)
Secondar
y

Rash macuopapular diffuse include

soles and palms
-condyloma lata : flat

Tertiary

Gummas(granulomas)
Aortitis
CNS
Tabes dorsalis
Argyll Roberston pupil

Dark field
Fluorescent
microscopy
1) Serology : VDRL
sensitive (Ab to
cardiolipin)
2)Specific: FTA-ABS
Only FTA-ABS

Congenit
al

accommodate but dont react

Still birth
Deaf, notched teeth, rash, saber
shin( new bone on periosteum)

Jarisch-Herxheimer rxn: increase temp, decrease BP, rigors,

leukopenia

Lyme disease (lyme on FACE= facial palsy, arthralgia, cardiac,

erythemia migrans)
Stage 1
Target rash ( hyperemic concentric rash)
2
Muscle and joint pain, headache, fatigue, fever and
chills (flu like)
3
Bell palsey (bilateral), arrhythmia, arthritis immune
complex, meningitis
Chlamydia
Obligate intracellular
No ATP
Modified
peptidoglycan
(lacks muramic)

Rickettsia
Obligate
No ATP
Normal

Mycoplasma
No
Normal ATP
No peptidoglycan has
cholesterol instead

Chlamydia penumoniae:
ATHEROSCLEROSIS
Atypical pneumonia #2 ( after mycoplasma)
Intracytoplasmic inclusions

Diseases

Chlamydia trachomatis
o Causes conjunctivitis and atypical pneumonia in neonate
o Staccato cough : inspiration btw each cough
o Need erythromycin drops after birth into eye (N.gonorrhea
also causes conjunctivitis but NO PNEUMONIA
Listeria can cause SPONTANEOUS abortions, or infant
granulomas all over
Lymphogranuloma venereum : chlamydia L1-L3
o PAINLESS, lymph nodes large painful buboes
o Genital elephantiasis
o Enlarged abscess lymph node = Buboes
Chancroid: painful nonindurated
Syphilis primary :PAINLESS chancre heals spontaneously
o No buboes

Granuloma inguinale: klebsiella granulomatis PAINLESS ulcer

that develop into granulomatous ulcer that bleeds easy
STELLATE GRANULOMA: bartonella henselae

Virus

Paramyxoviridae: Measles, mumps, parainfluenza, rsv ( all kid

diseases)
CMV congenital: blueberry muffin. Thrombocytopenic purpura,
jaundice, hepatosplenomegally, and intracerebral calficication
If they have mononucleosis and u give them ampicillin they get
maculopapular rash