Infect|ons |n |mmunocomprom|sed

athogen Structure Lp|dem|o|ogy athogenes|s D|sease |n Immunocomprom|sed Immunocompetent

seudomonas
aerug|nosa
Cram negaLlve rod
Aeroblc
olar flagella
Cx|dase pos|t|ve
D|st|nct|ve grape
||ke fru|ty odour
roduces b|ue green
(pyocyan|n),
f|uoresce|n
plgmenL, dlffuslble
Crows on Mac
Conkey med|a (non
lacLose fermenLlng)
8eslsLanL Lo
dlslnfecLanLs,
anLlbloLlcs, soaps

ublqulLous
envlronmenLal
organlsm
WaLer, soll,
planLs
SLandlng waLer
Water faucets
AeraLors
uralns
8esplraLory
equlpmenL
S||my bar soap
ulslnfecLanL [ars
MolsL hosplLal
envlronmenL

lll : adherence Lo hosL eplLhellal cells
olysacharlde sllme layer (alglnaLe)
anLlphagocyLlc,
co|on|sat|on (cyst|c f|bros|s), adherence
to trachea| ep|the||um and muc|n
LxoLoxln A :lnhlblLs proLeln synLhesls,
Au rlbosylaLlon of LI-2, s|m||ar to
d|phther|a tox|n
Lxoenzyme S lnhlblLs proLeln synLhesls
LlasLase damages collagen, elasLln, lgA
hosphollpase C damages membranes,
necrosls
LndoLoxln
MulLldrug reslsLance
roduce b|of||ms-can adhere Lo
caLheLer
8reach ln local defense, 8urns, CuLs
Cyst|c f|bros|s (stas|s]mucus),caLheLerlzaLlon
System|c breach,-PosplLallzaLlon and anLlbloLlc
Lherapy(reducLlon ln normal flora and lncreased
colonlz aLlon),neuLropenla ,ulabeLes, IV drug
abuse,Mallgnancy
Ce||u||t|s ,8urn vlcLlms w/ b|ue green pus, grape
llke odor, hosplLallzed pLs w/ wounds
neuLropenlc, Csteomye||t|s ln fooL puncLure
wounds (dlabeLlc fooL)
Sept|cem|a-PemaLogenous spread from focal
leslons, Cram negaLlve shock
Lcthyma gangrenosum, skln leslon w/ cenLral
necrosls and eryLhemaLous margln, dlrecL lnvaslon
of desLrucLlon of blood vessel
leukemlc, LransplanL or neuLropenlc pLs
neumon|a- pts w] cysLlc flbrosls, mlcrocolonles
ln capsular sllme blofllm, poor peneLraLlon of
anLlbloLlcs
Ls on venLllaLor, neuLropenlc pLs
U1I, Ls on long Lerm caLheLer
IV drug abusers: endocard|t|s, osteomye||t|s,
arthr|t|s
D|abet|cs : ma||gnant ot|t|s externa
Cornea| u|cer: followlng
corneal Lrauma,
exLended contact |ens
use
panophLhalmlLls
Ct|t|s externa (
swlmmer's ear)
PoL Lub folllcullLls
(below neck)
looL wounds Lhrough
sporLs shoes
1reatment
Amlnoglycosldes or
fluoroqulnolone plus
AnLlpseudomonal beLa
lacLam (ureldopenlclllln)
1hlrd generaLlon
cephalosporln
carbapenem

Lnterococcus
spp.
Lnterococcus
faeca||s
Lnteroccus
faec|um
C(+), cat (-) cocc| |n
pa|rs, short cha|ns,
pa|rs |n acute ang|e,
'spectac|es'
Carb. anLlgen u,
formerly Croup u of
Lancefleld group
CrowLh on sheep
b|ood agar
Alpha , beLa or non
hemolyLlc(gamma)
ulsLlngulshed from
oLhers by
Growth |n 6.S
NaC|
nydro|ys|s of b||e
escu||n
1o|erance to 40
b||e

lnLesLlnal flora,
fecal flora
Co|on|se the
per|neum and
sk|n be|ow the
wa|st, mucous
membranes

Lndogenous lnfecLlon
erson Lo person ln hosplLal
Low vlrulence organlsm
MulLlple anLlbloLlc reslsLance
Plghly reslsLanL Lo envlronmenLal
facLors, chemlcal agenLs and anLlbloLlcs (
naLural reslsLanL cephalosporlns)
Can survlve on fomlLes
Cause |nfect|ons |n pat|ents on
pro|onged ant|b|ot|c therapy espec|a||y
cepha|ospor|ns

Cause lnfecLlon ln hosplLallsed paLlenLs when hosL
defense lowered and breach ln local defense
rolonged anLlbloLlc Lherapy
ulsrupLlon of lnLegrlLy ln Lhe Cl1 or u1
8owel surgery, perlLoneal shunLs
CaLheLerlzaLlon of u1, vascular caLheLer
Spread Lo sLerlle slLes and cause lnfecLlons
U1I (|ndwe|||ng catheter)
8acLeremla (vascular caLh, lv caLh)
Sub acute endocard|t|s (damaged heart va|ves)
8|||ary and |ntra-abdom|na| abscess
osL operaLlve (abdomlnal) wound lnfecLlons
perlLonlLls

1herapy for serlous
lnfecLlons
combo of
am|nog|ycos|des w] ce||
wa||-act|ve ant|b|ot|c
(pen|c||||n, amp|c||||n, or
vancomyc|n)
newer agenLs llnezolld,
qulnuprlsLln/dalfoprlsLln,
and selecLed
fluoroqulnolones
Acqulred reslsLance
lasmld and
chromosomal Lo
Amlnoglycosldes
vancomyclns (modlfled
cell wall penLapepLlde
precursor d-ala-d-ala Lo
d-lacLaLe-d-lacLaLe

neha's Mlcro 1A noLes
!"#$ &'(#)*+' #&#'",-*. -#.*//* #&0 .,..*
1#.)'",*0'2 3"#(*/*2, 4"'+,)'//# $'/#&*&,('&*.# 53,"$'"/6 1#.)'",*0'27, 892,-#.)'"*9$ 2::
1#.)'",*0'2
3"#(*/*2
Cram negaLlve,
pleomorphlc rod
roduce beta
|actamase enzyme (
LreaLmenL of
lnfecLlons)
MulLlple anLlbloLlcs:
mlxed lnfecLlons
roduce fou|
sme|||ng pus

Iorm abscess
Anaeroblc colonlzer of Lhe resplraLory,
gasLrolnLesLlnal( 23) and genlLourlnary
LracL
Ant|-phagocyt|c capsu|e:
Pelps adhere Lo mucosal surface
CC complex (abscess formaLlon)
Lnzymes
romoLe Llssue desLrucLlon
roduce superoxlde dlsmuLase and
caLalase

Surgery or trauma promote endogenous spread
of norma| f|ora to ster||e s|tes
8upLured bowel
8upLure appendlx
Abdomlnal surgery
olymlcroblal lnfecLlon of sLrlcL anearobes and
faculLaLlve anaerobes (!"#$%&' )"*+,-&%&.' closLrldla,
anaeroblc coccl)
Intra-abdom|na| abscess
erlLonlLls, pelvlc abscess, 8acLeremla
Lung/pleural abscess, 8raln abscess ( from lnfecLed
masLlodlLls/slnus)

Iusobacter|um
Nuc|eatum
Cram negaLlve
bacLerla wlLh
Lapered ends
normal flora of oral
mucosa, Cl1
V|ncents ang|na (oropharyngea| u|cerat|ve
d|sease] trench mouth)
Mlxed lnfecLlon wlLh splrochaeLes from oral
mucosa
8raln abscess

Nocord|a
astero|des
Cram poslLlve
f||amentous
bacter|a (break up
|nto rods)
arLlally acld fasL (
dlsLlngulsh from
acLlnomyceLes
whlch has slmllar
morphology, noL
acld
CpporLunlsLlc lnfecLlons
u|monary nocard|os|s
ln paLlenLs wlLh low Cu4 counLs, AluS,
neuLropenla, on chemoLherapy, mallgnancy
8esembles Luberculosls, dlssemlnaLe Lo oLher
organs and braln
8raln abscess

1reaLmenL
sulfonamldes
Act|nomyces Gram pos|t|ve rods
to branch|ng
f||aments
Non ac|d fast
(d|st|ngu|sh from
Nocard|a)

Norma| co|on|zer of ora| mucosa,
g|ng|va| crev|ces and fema|e gen|ta|
tract
Infect|ons (endogenous)
When mucosal barrler compromlsed
as ln oral Lrauma, denLal exLracLlon,
manlpulaLlon of luu (lnLrauLerlne
devlce)
Crows rapldly ln Llssues
Cerv|cofac|a| act|nomycos|s (|umpy [aw)
Lrauma Lo oral cavlLy, denta| extract|on w|th poor
ora| hyg|ene
1lssue swelllng and flbrosls aL Lhe angle of [aw and
neck
1horaclc acLlnomycosls
lnvolves lungs and rlbs
AsplraLlon from oral cavlLy or from oLher focus
Lhrough muscle fascla
Abdomlnal/pelvlc acLlnlmycosls
Arlse from pelvls (luu) ln women or lleocecal
reglon followlng surgery or Lrauma
8raln abscess, menlnglLls
Spread from oLher focl
MyceLoma ,SubcuLaneous lmplanLaLlon Lhrough
Lraumaslnus LracLs openlng Lo Lhe skln
Su|fur granu|es |n pus
1reaLmenL: penlclllln