ID Bug chart-DK

Organism
Streptococcus (general)
pneumoniae
Microbiology
Diseases
GRAM POSITIVES
Gram(+)
catalase(-)
alpha hemolysis, optichin susceptible, lysed by bile
pneumonia, sinusitis, otitis,
salts
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, beta hemolysis, Lancefield+, biochemicals; antigen

equi subsp. zooepidemicus
tests
(Group C)
pharyngitis, possibly nephritis
bovis/gallolyticus (Group D)
alpha or gamma hemolysis, grows in bile, hydrolyzes endocarditis

esculin, Lancefield+ ; antigen tests
aginosus/milleri group
(intermedius, constellatus,
morbillorum)
Any hemolysis, Lancefield+, complex biochemicals,
abscesse, empyema
Group G (canis, anginosus)
beta hemolysis, Lancefield+, biochemicals
localized abcess, puerperal sepsis,

endocarditis, pharyngitis, cellulitis,
bone & joint infections in
compromised hosts
iniae
beta hemolysis
cellulitis, bacteremia
Enterococcus
Gram(+)
Grows in bile, hydrolyzes esculin, growth in 6.5%
NaCl
faecalis
faecium
Peptococci
Finegoldia magna (anaerobic
staph)
Peptostreptococci
P. anaerobius (anaerobic strep)
Staphylococcus
Gram (+)
intra-abdominal abscesses,
endocarditis
nosocomial infxns IV lines, UTI
abscess, pulmonary/pleura, septic
abortion, endometritis, tuboovarian abcess.
aureus
beta
coagulase negative
(epidermidis, saprophyticus)
beta (small zone)
Anaerobic cocci
Gram (+)
"SHORT RODS"
Corynebacterium diphtheriae
Other corynebacteria
Listeria monocytogenes
RODS
Clostridium
perfringens
septicum
tetani
cellulitis, osteomyelitis, pneumonia,

impetigo, endocarditis, IV lines and
devices, nosocomial and
community acquired infxns, toxinmediated
dz vascular, prosthetic
implants, esp
valve endocarditis, UTI
requires special media (Loeffler's); club shaped.

Metachormatic granules; Reduces tellurite
diphteria
called diphtheroids
as part of mixed flora in dental,

lung abscesses
beta-hemolytic, motile at 22oC (NOT 37). Facultative neonatal sepsis, post-partum;
anaerobe, non-spore forming.
meningitis in immunecompromised 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 pts
tetanus --> tetany (locked in
contraction)
botulinum
difficile
Actinomyces israelii
Bacillus
anthracis
botulinism (Gi, Wound) --> flaccid
Culture anaerobically
obligate aerobes,motile, spore-forming, long end to
end chains
cereus
COCCI
Neisseria
gonorrhoeae
meningitidis
Moraxella catarrhalis
COCCOBACILLI
Haemophilus
influenzae
parainfluenzae
ducreyi
colitis esp post-antibiotics, chemo

Abscesses jaw, lungs, w/in abd
anthrax: cutaneous, respiratory, GI
and bacteremic
bacteremia, other infxns- only in
severely compromised hosts;
ophthalmitis; foodborne, toxinmediated GI dz
GRAM NEGATIVES
Cell walls of Gram(-) cocci and coccobacilli contain
lipooligosaccharide
Pairs of bacteria like kidney beans, growing side by
side. Require chocolate agar and CO2
gonorrhea
meningitis, bacteremia, rarely
pneumonia
Resembles Neisseria on Gram stain but grows on

blood agar
obligate human parasite
requires X and V factor; growth on chocolate but not
blood agar
Requires X factor, grows on blood agar

Fastidious
sinusitis, pneumonia, exacerbation

bronchitis in pts w/ COPD
otitis, sinusitis, pneumonia,

exacerbation bronchitis in pts w/
COPD, meningitis (esp young
children)- often leading to
permanent neurologic deficits.
Septic arthritis (infants), acute
epiglottitis,
sepsis
normal flora,
occasionally causing
sinusitis, exacerbation of COPD
chancroid (STD), possibly swollen
inguinal lymph nodes
Bordatella pertussis
Fastidious (including special swab)
whooping cough. 1-2 wk w/ typical

URI symptoms followed by
characterisitic whooping cough
Coxiella burnetti
Rickettsia rickettsi
small, non-motile, obligate intracellular
Rocky Mountain Spotted Fever:

fever, conjunctival redness, severe
headache, rash (wrists, ankles,
soles, palms). Proliferates in
endothelial cells.
Ehrlichia chaffensis
Anaplasma phagocytophilum
Pasteurella multocida
NOT a facultative intracellular org
Ehrlichial dz (infect WBCs)- Human

monocytotropic ehrlichiosis
Ehrlichial dz- Human
granuloctytropic anaplasmsosi
skin, soft tissue infxn post dog or
cat bite; septic arthritis or osteo
post cat bite
Capnocytophaga canimorsus
Relatively rare. Causes devastating

sepsis syndrome following dog or
cat exposure. Worse in alcoholic or
splenectomized pts
Francisella tularensis
tularemia - resembles bubonic

plague: ulceroglandular,
pneumonic, oculoglandular,
typhoidal,
brucellosis:glandular
systemic Sx (undulant
fever, chills, sweats, anorexia,
backache, headache,
lymphadenopathy)
Brucella melitensis, abortus
Bartonella
henselae
fastidious
quintana
NOT an aobligate intracellular org
cat scratch dz (enlarged lymph

node), bacillary angiomatosis
trench fever; endocarditis in
homeless, bacillary angiomatosis
RODS
Enterobacteriaceae
Escherichia coli
Shigella dysenteriae
Salmonellae
typhi
nontyphi
Klebsiella
Cell walls contain LPS. Nearly all grow +/- O2

(facultative) except Pseudomonas
lactose fermenter; borad range of virulence
characteristics
non-lactose fermenter
non-lactose fermenter
UTI (cystitis or pyelonephritis +/bacteremia depending on virulence

characteristics)
invades colonic mucosa; dysentery
typhoid fever
diarrheal dz
lactose fermenter
pneumoniae, oxytoca, etc.

Enterobacter
lactose fermenter
cloacae, aerogenes, etc.

Serratia marcescens
non-lactose fermenter; unique red pigment
Citrobacter (diversus, freundii,

koseri)
Yersinia
pestis
"safety pins" bipolar staining
UTI, pneumonia, intra-abdominal

infxns
Same as Klebsiella; nosocomial
infxns
UTI, nosocomial, immune
compromised host
catheter-assoc'd UTI, meningitis
and brain abscess in neonates
enterocolitica
Can grow at 4oC
plague- bubonic, pneumonic.

Swollen lymph nodes!
enterocolitis; mesenteric adenitis;
reactive polyarthritis, erythema
nodosum
Proteus
Proteus mirabilis
Morganella morganii
Providencia stuartii
Vibrio
Non-lactose fermenters, urease+

swarms on blood agar plate
doesn't swarm
doesn't swarm
curved rods, motile
UTI, struvite stones in urinary tract

UTI, nosocomial
UTI, nosocomial
cholerae
cholera
parahaemolyticus
gastroenteritis, rarely soft tissue

invasion
Septicemia, necrotizing wound
infxn. invasive dz GI tract,
compromised host; soft tissue
post-exposure to brackish water
vulnificus
alginolyticus
Campylobacter
jejuni
fetus
Helicobacter pylori
Pseudomonas aeruginosa
Aeromonas
Burkholderia cepacia
cellulitis, otitis externa, otitis media

diarrheal dz
microaerophilic. Motile and non-spore forming.

Comma-shaped. Multiply slowly.
grows best at 42oC but can survive at 4oC for weeks. non-specific colitis, acute enteritis,
Multiplies in bile rich environment
occasionally bacteremia;
pseudoappendicitis
Diarrheal illness, bacteremia,
vascular infxns, CNS infxns
urease+, highly motile, rapid corkscrew motion,
peptic ulcer dz, gastric cancer
microaerophilic, slow grower
obligate aerobe; oxidase+, pyocyanin (blue-green
nosocomial pneumonia, UTI and
pigment)
pyelonephritis, bacteremia,
endocarditis, other infxns esp in
compromised host, osteomyelitis,
sepsis w/ high mortality,
diarrheal dz, soft tissue infxn;
persistent diarrhea and dysentery
nosocomial infxn, esp respiratory
Acinetobacter (baumannii)
ventilator-assoc'd pneumonia;
nosocomial infxns. Catheterrelated bacteremia, skin and soft
tissue infxns; intra-abdominal
infxns. Necrotizing pneumonia and
bacteremia
Stenotrophomonas maltophila
nosocomial infxn
Legionella pneumophila
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 (nonpneumonia)
Mycoplasma
lack cell wall. Capable of free-living or intracellular

growth. Fastidious. Cold agglutinin test.
walking pneumonia, cold

agglutination dz
Chlamydophila
obligate intracellular bacteria. Unique life cycleelementary body and reticulr body.
trachomatis
pneumoniae
psittaci
ANAEROBIC BACTERIA
Bacteroides fragilis, others
TWAR agent
No lipid A (endotoxin), but does have a capsule
abscesses lung, intra-abdominal;

decubitus ulcer
abscesses lung, pharynx, mouth,
neck; bacteremia
abscesses lung, pharynx, mouth
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.
Fusobacterium
Prevotella, Porphyromonas
SPIROCHETES
Treponema pallidum
Borrelia
recurrentis
burgdorferi
ocular trachoma;
lymphogranulomas venereum;
neonatal conjunctivitis;
acute bronchitis and pneumonia
psittacosis (zoonosis, atypical
pneumonia); usually lung (or other
organ) involvement.
Can be seen by light microscope

relapsing fever
Lyme dz
Leptospira
NEITHER
Mycobacteria
tuberculosis
leprae
avium (MAC)
kansasii
Nocardia
long, thin- hook at end(s), wound up in a tight coil
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 wall
lacks pigment
tuberculosis
niacin+
leprosy: lepromatous (TH2) or
tuberculoid (TH1)
chronic pulmonary dz: fibrocavitary
or fibronodulary. Disseminated dz
in AIDS pts.
closely resembles MTB.
aerobic actinomycete. Ubiquitous saprophytic soil
immunocompetent: pulmonary dz,
orgs. Slow growth, gram(+), beaded, branching
cutaneous infxn (from traumatic
filaments, "weakly acid fast"- growth is slower than
inoculation).
conventional bacteria- hold onto plates so it will grow Immuocompromised: invasive
thru!
pulmonary infxn, disseminated dz
Important points
#1 cause of pneumonia, otits

media, sinusitis; Vaccines
(Pneumovax {polysaccharide},
Prevnar {conjugated})
normal human oral and bowel flora
strep throat, scarlet fever, ASO

titer, anti-hyaluronidase Ab, antiDNAse 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
strong assoc'n b/tw

bacteremia/endocarditis and
colonic neoplasms. Very sensitive
to
PCN bowel flora, pyogenic foci
normal
normal flora of pharynx, skin, GI

tract, vagina
fish pathogen
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.
Botulinum Toxin A, honey and

infants; adults and canned stuff
(particularly home-canned)
pseudomembranous enterocolitis
spores
eschar
fried rice
STD
At risk: infants (6 mos-2 yrs), army
recruits and anyone in close
quarters. Petechial rash! Watch out
for meningococcemia
#3 cause of otitis media, sinusitis
means "blood-loving"
#2 cause of pneumonia, otitis
media, sinusitis; Vaccine for HITB.
Frequent infxns in COPD
chancroid (PAINFUL)
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
Q fever
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
Cat scratch dz
trench fever. Louse-borne
invasive infxn.
Think turtles, reptiles.
extensive carrier state; aortitis.
Gallbaldder!
inherent resistance to ampicillin;
alcoholism!
opportunistic pathogens
widespread in environment.
Opportunistic.
US southwest.
Iron overload states predispose;
assoc'd w/ unpasteurized milk.
Clinically indistinguishable from
appendicitis
water-borne, seasonal. Rice water

stool. Death by dehydration
most common species in US.
Shellfish.
marine flora
most common bacterial cause of
diarrhea in US. PEB1 antigen
Guillain-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
water-assoc'd
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!
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
birds (turkeys)
colonize mouth, vagina. Intestinal

lacerations!
periodontal dz
Cardiolipin, TPHA or MHA-TP
louse; poor and crowded lving

conditions. WWII.
ticks. White-footed mouse. NE,
MW, NW US.
worldwide in warm climates

(Malaysia, Central America).
Excreted in urine of animals.
Biphasic illness.
Acid fast staining
old smokers, Lady Windermere

syndrome.
older men who smoke
DDx for pulmonary-CNS syndrome
in compromised pt!!!
Name
Group
Staphylococcus aureus
Shape
cocci
(cluster)
Gram Hemolysis
+
Other
Normal flora
Metabolic
B (gold)
+coagulase,
Novobiocin
succeptable
nasopharynx
facultative anaerobe:
(higher chance in +catalase
people who use
injectable drugs,
atopic dermatitis,
eczema)
Staphylococcus epidermidis
B (small)
-coagulase,
Novobiocin
succeptable
nasopharynx, skin
Staphylococcus saprophyticus
B (small)
-coagulase,
Novobiocin
resistant
nasopharynx, skin
Staphylococcus haemolyticus
Peptococcus
Finegoldia magna (staph)
cocci
(cluster)
GI, vagina
Streptococcus pyogenes
cocci
Bacitracin
susceptible
Streptococcus agalactiae
cocci
Bacitracin
resistant
Streptococcus
Streptococcus
Streptococcus
Streptococcus
Streptococcus
Streptococcus
cocci
cocci
dysgalactiae
equisimilis
equi
zooepidemicus
bovis
gallolyticus
Bile resistant,
hydrolyzes esculin
anaerobic
microaerophilic: -catalase
bowel, vagina
facultative anaerobe:
-catalase
animals
facultative anaerobe: -catalase
GI
cocci
Enterococcus faecalis
Streptococcus pneumoniae
Bacillus cereus
cocci
(pairs/chain
)
Optochin
susceptible, bile
salt susceptible
nasopharynx
Viridans
cocci
Optochin resistant
oral, bowel
Milleri
cocci
Optochin resistant
GI
cocci
pharynx, skin, GI
tract, vagina
cocci
cocci
(chain)
cocci
+
+
fish
GI, vagina
anaerobic
GI, vagina
anaerobic
bacilli
(chain)
varia
ble
Bacillus anthracis
Clostridium tetani
Clostridium botulinum
Bile resistant,
hydrolyzes esculin,
grows in 6.5% NaCl
Enterococcus faecium
Streptococcus mitis
Streptococcus sanguis
Streptococcus mutans
Streptococcus salivarius
Streptococcus intermedius
Streptococcus morbillorum
Streptococcus constellatus
Streptococcus anginosus
Streptococcus canis
Streptococcus anginosus
Streptococcus iniae
Peptostreptococcus
P. anaerobius (strep)
Veillonella
GI
microaerophilic: -catalase,
-peroxidase, +superoxide
dimutase
microaerophilic: -catalase
soil (saprophyte) aerobic
facultative anaerobe
rod
(drumstick)
soil, animal feces
anaerobic
rod
soil
anaerobic
Clostridium difficile
rod
Clostridium perfringens
rod
Listeria monocytogenes
bacilli (club)
Corynebacterium diphtheriae
bacilli (club, varia

Chinese
ble
letters)
GI, hospitals, nursing anaerobic

homes
soil, Gi (humans,
animals)
anaerobic (O2 tolerant)
Clostridium speticum
Clostridium novyi
Corynebacterium jeikeium
Corynebacterium urealyticum
Corynebacterium amycolatum
Corynebacterium striatum
Rhodococcus equi
(Corynebacterium equi)
listeriolysin tellurite resistant,

(weak)
bile resistant
tellurite resistant
ubiquitous (enters
through GI, 10%
transient carriers)
facultative anaerobe: +catalase
normal human flora facutatively anaerobic:

+catalase
Actinomyces israelii
Nocardia asteroides
Actinomycete
rod
(branched,
filament,
beaded)
oral, colon, vagina, microaerophilic

water/soil saprophyte
rod
(branched,
filament,
beaded)
+,
acid
fast
ubiquitous soil
saprophyte
+
+
+
-
skin, oral, GI, GU

skin, oral, GI, GU
skin, oral, GI, GU
nasopharynx, oral
cavity
aerobic
Nocardia brasieliensis
Nocardia farcincia
Nocardia nova
Propionibacterium
Lactobacillus acinomycosis
Bifidobacterium
Neisseria meningitidis
Neisseria gonorrhoeae
Neisseriaceae
diplococci
(doughnut)
anaerobic
anaerobic
anaerobic
aerobic: +catalase,
+cytochrome oxidase
Kingella kingae
Klebsiella pneumoniae
Neisseriaceae
coccobacilli
Enterobacteriaceae
rod
+oxidase
+lactose, -oxidase,
-indole
Klebsiella oxytoca
Escherichia coli
throat
colon
colon
+lactose, -oxidase,
+indole
Enterobacteriaceae
rod
+lactose, -oxidase,
+indole
Enterotoxigenic E coli (ETEC)
colon
Enterohemorrhagic E coli
(EHEC)
colon, animals (US)
Shiga Toxin-producing E coli

(STEC)
colon, animals (food)
Enteroinvasive E coli (EIEC)
colon
Enteropathogenic E coli (EPEC)
colon
Diffuse adhereing E coli (DAEC)
colon
Enteroaggregative E coli (EAEC)
rod (brick
wall)
colon
Enterobacter cloacae
Enterobacter aerogenes
Enterobacteriaceae
rod
+lactose, -oxidase
colon
Citrobacter freundii
Citrobacter koseri
Citrobacter diversus
Enterobacteriaceae
rod
+lactose, -oxidase
colon
Serratia marcescens
Enterobacteriaceae
rod
-lactose, -oxidase
vials/IV solutions facultative anaerobe: +catalase
Salmonella enterica
Enterobacteriaceae
rod
-lactose, -oxidase
animal colon
Salmonella typhimurium
Salmonella serovar typhi
colon (only
humans)
Salmonella enteritidis
animal colon
(turtle)
Shigella dysenteriae
Enterobacteriaceae
rod
-lactose, -oxidase
primates
Shigella flexneri
Shigella boydii
Shigella sonnei
Proteus mirabilis
Enterobacteriaceae
rod
-lactose, -oxidase,
-indole
colon
Proteus vulgaris
-lactose, -oxidase
Providencia stuartii
Enterobacteriaceae
rod
-lactose, -oxidase
colon
Providencia rettgeri
Morganella morganii
Enterobacteriaceae
rod
-lactose, -oxidase
colon
Vibrio cholerae
Vibrionaceae
rod
(comma)
glucose fermenter,
+oxidase
contaminated
water/food
(seasonal = warm
weather)
halophilic (likes
salts), +oxidase
fish, shellfish
Vibrio parahaemolyticus
Vibrio vulnificus
halophilic (likes
salts), +oxidase
sea water
Vibrio alginolyticus
Photobacterium damselae
Pseudomonas aeruginosa
sea water
Pseudomonadaceae
rod
-lactose, +oxidase
environmentally
ubiquitous including
water sources
(except in
humans/animals)
Burkholderia cepacia
Pseudomonadaceae
rod
-lactose, +oxidase
environmentally
ubiquitous (except
in humans/animals)
Stenotrophomonas maltophila
Pseudomonadaceae
rod
-lactose, -oxidase
environmentally
ubiquitous including
water sources
(except in
humans/animals)
Acinetobacter baumannii
Pseudomonadaceae
rod
(coccobacill
i)
-lactose
environmentally
ubiquitous
especially hospitals
rod
rod
Legionella pneumophila
Yersinia enterocolitica
Enterobacteriaceae
anaerobic
obligate aerobic
free living (associated aerobic: +catalase, +Cu-Zn

w/ warmer man- superoxide dimutase,
made water
+peroxidase
systems), amoeba
-lactose, -oxidase
animal (pig) colon
Yersinia pseudotuberculosis
Yersinia pestis
rod
animal colon
rod (safety
pin)
colon, fleas
Helicobacter pylori
Vibrionaceae
rod
(comma)
Campylobacter jejuni
Vibrionaceae
rod
(comma)
Campylobacter fetus
Bacteroides fragilis
stomach /
duodenum
+oxidase
poultry
microaerophilic: +catalase,
+oxidase
microaerophilic
cattle, sheep
Bacteroidaceae
rod
Prevotella melaninogenicus
(Bacteroides melaninogenicus)
Porphyromona
Fusobacterium necrophorum
+urease
GI
oral, GI, vaginal
rod
oral
oral, GI, vaginal
Haemophilus influenzae type b
coccobacilli
nasopharynx
Haemophilus influenzae
aegyptius
coccobacilli
nasopharynx
Haemophilus ducreyi
coccobacilli
Haemophilus parainfluenzae
coccobacilli
Bacteroidaceae
obligate anaerobic
(aerotolerant): +catalase,
+superoxide dimutase
anaerobic (aerotolerant)
obligate anaerobic
(aerotolerant)
Haemophilus aphrophilus
coccobacilli
Haemophilus paraphrophilus
coccobacilli
rod
cocci (pair)
Aggregatibacter
actinomycetemcomitans
(Actinobacillus
actinomycetemcomitans )
rod
Cardiobacterium hominis
rod
Bordetella pertussis
coccobacilli
Brucella
Brucella
Brucella
Brucella
coccobacilli
Francisella tularensis
coccobacilli
Pasteurella multocida
coccobacilli
Gardnerella vaginalis
(Haemophilus vaginalis)
Moraxella (Branhamella
subgenera) catarrhalis
melitensis
abortus
suis
canis
Neisseriaceae
nasopharynx
-catalase, +oxidase,
+indole
aerobic: +catalase, +oxidase
goat
cow w/ abortion
pigs
dog
obligate aerobe
ticks/deerflies
obligate aerobe, requires
(rabbits, animals) cysteine
domestic & wild

animals
facultative anaerobe: +catalase,

+oxidase
Mycobacterium tuberculosis
complex (M. tuberculosis + M.
bovis + M. bovis bacillus
Calmette-Guerin)
Mycobacterium leprae
rod
acid
(serpentine fast
cording)
(Kiny
oun,
aura
mine
rhod
amin
e)
rod
+niacin, lacks
pigment
humans
+phenolase
ubiquitous
obligate aerobe: +catalase
Mycobacterium avium complex

(MAC = M. avium + M.
intracellulare)
Mycobacterium kansasii
Mycobacterium
Mycobacterium
Mycobacterium
Mycobacterium
xenopi
simiae
malmoense
ulcerans
Mycobacterium marinum
Mycobacterium gordonae
Mycobacterium fortultum
Mycobacterium abscessus
Mycobacterium chelonei
Mycobacterium scrofulaceum
Treponema pallidum
Spirochaetales
corkscrew
Spirochatales
corkscrew
humans
microaerophilic
Treponema pallidum endemicum

Treponema pallidum pertenue
Treponema pallidum carateum
Borrelia burgdorferi
Borrelia recurrentis
tick (Ixodes), white microaerophilic

foot mouse, whitetail deer
body lice (Pediculus

humanus), humans
Borrelia hermsii
Leptospira interrogans
Spirochatales
corkscrew
(tight coil,
hooks at
ends, ice
tongs)
tick (Ornithodoros),
rodents, small
mammals
animal urine,
aerobic
contaminated
water, warm
climates
Leptospira interrogans
icterohaemorrhagiae
Leptospira interrogans canicola
Mycoplasma pneumoniae
Mycoplasmataceae
free
facultative anaerobe
living/intracellular
Mycoplasma hominis
normal genital flora
Mycoplasma genitalium
Ureaplasma urealyticum
Chlamydia psittaci
+urease
birds (turkey,
parrot)
Chlamydia trachomatis
humans
Chlamydia pneumoniae
humans
Rickettsia rickettsii
coccobacilli
Rickettsia akari
tick (Demacentor
andersoni = wood,
Dermacentor
variabilis = dog)
mites (on house

mice)
Rickettsia prowazekii
lice (Pediculus
corporis = body lice),
fleas (flying squirrela)
Rickettsia typhi
flea (Xenopsylla
cheopis = rat)
Rickettsia tsutsugamushi
mite (mice; larvae =

chiggers, in soil;
Asia/SW Pacific)
Rickettsia parkeri
tick/louse/flea (SE US)
Rickettsia africae
tick/louse/flea (subSahara Africa)
Coxiella burnetii
coccobacilli
tick (farm mammals)

feces/spores
Bartonella quintana
coccobacilli
body lice
Bartonella henselae
Ehrlichia chaffeensis
Ehrlichia ewingii
cat
tick (Ixodes), dog,

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

white foot mouse,
white-tail deer
tick (Ixodes), dog,
white foot mouse,
white-tail deer
domestic animals
Babesia
Capnocytophaga canimorsus
Aeromonas hydrophila
rod
Plesiomonas shigelloides
Eikenella corrodens
rod
medical leeches,
tropical areas
+oxidase
Shewenella
Cryptosporidium
Microsporidia
Cyclospora
Entamoeba histolytica
Giardia
Diphtheroids
Aspergillus
Histoplasma capsulatam
Candida albicans
Onychomycosis
Herpes virus
parasite, infection associated

w/ AIDS, chronic diarrhea
infection associated w/ AIDS
parasite, infection associated
w/ AIDS, chronic diarrhea
amoebic colitis, hepatic
abscess
parasite, chronic
diarrhea
endocarditis
prosthetic valve endocarditis,
septicemia
native valve
endocarditis
Dermatophyte infection
(athlete's foot), UTI, lower
respiratory tract infection,
septicemia, endocarditis
(prosthetic valve, IV drug
addicts, long-term IV lines)
nail fungus
STD
replace heart valve,

anti-fungal
pulse itraconazole,
pulse turbinafine
animals
oral
anaerobic
Fournier's gangrene
polymicrobial
perineal
infection in
diabetics
Meleney's gangrene
polymicrobial
post-surgical
abdominal
infection
Ludwig's angina
polymicrobial
submandib
ular/subme
ntal
space
thromboplebi
Lemierre syndrome
Clenched Fist
Diabetic Foot Ulcer
anaerobic
polymicrobial
Diabetic Fetid Foot
polymicrobial
tis of jugular
vein
thrombosis of small arteries
chlorpactin, chlorox
(gangrene) + neuropathy (85%; bleach, ABX (Gram +)
hammer toes {motor}, change
in foot shape, decrease in
sweat & rocker bottom
foot{autonomic})
cellulitis (necrosis, bullae, gas,

purple/black discoloration,
myonecrosis, fasciitis )
Chronic diarrhea
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
niesseria gonorrhea, chlamydia

trachomatis, herpes simplex,
treponema pallitus
gastroenteritis (norovirus, toxin)
vomiting + diarrhea
vascular surgery, ABX
enteritis (giardia, ETEC, EAEC,

virus)
diarrhea (small # + large

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

volume)
fever = inflammation
Blood agar
Choclate agar
McConkey's agar
CNA plate
grows everything
everything
especially H
influenzae, N.
Meningitidus
suppress gram +
suppress gram -
Abx susceptibility
tube dilutions
blood cultures
aramine stain
calcofluor
Fluorescent labeled Ab
specific agar
cultured cells
elisa
kirby-bauer auto
= disc on mate
plate = aero
d
2 sets (1 aerobic + anaerobe
1 anaerobic)
clostridium, bic =
bacteroides pseu
domo
nas,
candi
da
mycobacterium
fungi
leigionella,
pneumocystis,
respiratory
leigionella viruses
viruses
rapid influenza,
rapid strep,
leigionella, C.
difficile, respiratory
syncytial virus,
histoplasma
antigen,
cryptococcal
antigen,
pneumococcal C
pcr
serology
B. pertussis,
mycobacteria,
herpes virus, hiv,
hepC, hepB
st louis
encephalitis, west
nile virus, hepA,
hepB, hepC,
if there isnt a good indication for

a diagnosis, dont order a lab
test!
KNOW THE LAB TESTS!!!
Case Control Study
Semiquantitative Culture
Method
Peripherl v. Cathether Blood
Culture
echocardiogram
endocarditis
CT scan
peritonitis
apendicitis
determine source of nosocomial

outbreak
Test catheter as source of
nosocomial infection
Blood culture time reveals source
of infection
not
definitive
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
best for peritonitis

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)
E.coli, Enterococci, Bacteroides
cidal IV abx (synergy,

4-6 wks), valve
replacement if
needed
Toxins/Virulant factors
Clinical Presentation
Diagnosis
protein A (binds Fc of Ab except IgG3), coagulase, hemolysin,

gastroenteritis (2-7 hr incubation), toxic shock syndrome, scalded
leukocidins, B-lactamase, penicillin binding protein 2a =
skin syndrome (hemorrhagic bullae), pneumonia, empyema, otitis
MRSA, hyaluronidase, staphylokinase, lipase, protease, exfoliatin media, meningitis, acute endocarditis (R side = IV drug addict;
(scalded skin syndrome), enterotoxin (ST), toxic shock
fulminant, large friable vegetations, native valve, valve ring abscess =
syndrome toxin, MSCRAMM, P pili, capsule, A/B/G/D toxins
BBB, splenic abscess, murmur louder w/ inspiration), osteomyelitis
(disrupt cell membranes), agr gene
(#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
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)
UTI (#2; acute, uncomplicated), nosocomial infections (IV/Catheter),
prosthetic devices w/in body, osteomyelitis, endocarditis (IV drug addict,
abnormal heart valves)
abscess, pulmonary/pleura, septic abortion, endometritis, tuboovarian abcess, cellulitis (crepitis)
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, Mprotein, lipoteichoic acid, exotoxin B, capsule
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)
neonatal meningitis/bacteremia/pneumonia, post-partum
chorioamnionitis, endometritis, bacteremia, UTI, cellulitis, bacteremia,
pneumonia, septic arthritis
streptokinase, capsule
pharyngitis, nephritis (?)
capsule
subacute endocarditis, colonic neoplasms
ASO titer (cant use for skin infection),

anti-hyaluronidase Ab, anti-DNAse B titer,
rapid antigen detection test (RADT)
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)
pneumolysin, autolysin, lipoteichoic acid (adherence), capsule
pneumonia (#1), sinusitis, otitis (#1), meningitis, acute endocarditis Binax, CXR, Gram stain sputum, blood
(fulminant, large friable vegetations, splenic abscess), primary
culture
peritonitis (children, due to nephrotic syndrome; splenic abscess),
bacteremia
dextran (exopolysaccharide, bind to heart valve), capsule
subacute endocarditis (insiduous, small vegetations attacks preexisting damage), dental caries (prophylax w/ amoxicillin), abscesses
abscesse (pyogenic foci), empyema
localized abcess, puerperal sepsis, endocarditis, pharyngitis, cellulitis,

bone & joint infections, bacteremia
capsule
cellulitis, bacteremia
brain abscess, lung abcess, septic abortion, endometritis, tuboovarian abcess, aspiration pneumonia, cellulitis (crepitis)
osteomyelitis, periodontitis
spores (very hardy), no capsule, motile, lecithinase (cleaves gastroenteritis (2-7 hr incubation; reheating fried rice, emetic toxin,
lipids), cereulide (emetic toxin, heat stable, in fried rice/caterers), gastrointestinal toxin), cellulitis (immunocompromised), eye infection
gastrointestinal toxin (heat labile = produced by germinating (trauma, heroin addicts), pulmonary infection (immunocompromised)
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)
Gram stain
spores (very hardy), capsule (anti-phagocytic; poly-B-Dglutamic 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), nonmotile
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)
culture, serology, PCR
spores (rusty nail), tetanospasmin (exotoxin, causes tetany by

irreversibly inhibiting Renshaw cell interneurons, no GABA/glycine
release), flagella
spores (contaminate canned food), botulinum toxin (A
{botox}, B, E, F; muscle paralysis), flagella
tetanus (tetany, trismus {lock jaw}, risus sardonicus {joker smile}, anaerobic culture
respiratory paralysis)
botulism (food = diplopia {double vision}, dysphagia {trouble
anaerobic culture
swallowing}, descending muscle weakness, respiratory paralysis;
infant = eat honey, constipation, dysphagia, muscle weakness {floppy
baby}; puncture wound = longer incubation, fever, elevated white count)
spores, toxin A (diarrhea, hypoalbuminemia), toxin B (cytotoxic pseudomembranous enterocolitis (#1 nosocomial diarrhea;
to colonic cells), binary toxin CDT (epidemic C. difficile)
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)
spores, alpha toxin (lecithinase, tissue destruction), tissue
gas gangrene (cellulitis/wound infection = crepitus {moist, spongy,
invasive toxins, cytotoxic toxins, enterotoxin
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)
anaerobic culture, B toxin test on stool

sample, colonoscopy, ELISA, cell
cytotoxic assay
anaerobic culture
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)
clostridial myonecrosis = trauma, gas pockets, black fluid exudes from
wound, fatal if untreated; diarrhea = watery or hemorrhagic necrosis of
jejunum
LPS, flagella (@22C), tumbling motility, invasin/internalin
maternal listeriosis (influenza-like, cross placenta = granulomatosis
easily decolorized, can be isolated form
(complement mediated endocytosis into macrophages, can
infantiseptica, bacteremia), perinatal listeriosis (can cross placenta, normally sterile blood/spinal fluid, PCR,
multiply w/in macrophages), capsule, listeriolysin O (escape
early onset <5days = sepsis, late onset >5days = meningitis), focal immunofluorescence, genetic
phagosome, heat labile, antigenic), actin filaments encapsidate infection, sepsis/meningitis (immunocompromised patients),
fingerprinting, potassium tellurite agar
and assist in crossing into neighboring cells
immunocompromised listeriosis (#2 meningitis); endocarditis
(Loeffler)
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
nosocomial infections (surgical wounds, catheter, prosthetic devices,

native/prosthetic valve endocarditis,
necrotizing pneumonia (immunocompromised patients)
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)
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
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})
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})
notify lab of Nocardia, sputum, skin

biopsy, aspirate of deep collections, slow
growth on culture (can be hidden by
other bacteria)
brain abcess (linked to chronic otitis media, mastoiditis, chronic sinusitis,

tooth abcess)
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
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
LPS, fimbriae (pili), siderophore (iron), plasmids, capsule

(mucoid), ESBL (extended spectrum B-lactamase)
septic arthritis (children), osteomyelitis (children), endocarditis (native & culture for 2 weeks
prosthetic
valves)
UTI
(catheter),
lobar pneumonia (nosocomial/community esp.
urine dip-stick (nitrate into nitrite),
alcoholics, chronic lung disease, intubated; bloody sputum),
MacConkey's agar
bacteremia (#2 gram -)
UTI (catheter), lobar pneumonia (nosocomial/community esp.
alcoholics, chronic lung disease, intubated), bacteremia
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), urine dip-stick (nitrate into nitrite),
neonatal meningitis (K1 capsule), pyelonephritis (#1; P pili; acute,
MacConkey's agar (pink/purple), EMB agar
uncomplicated; fever, flank pain, nausea, vomiting, frequency +/- dysuria), (deep purple/black), metallic green,
cystitis (type 1 fimbriae; confined to urethra), primary peritonitis pyelonephritis = UA w/ WBC + cast
(adults, ascites related to cirrhosis, pancreatic abscess), appendicitis,
intra-abdominal abscess, nosocomial pneumonia, bacteremia (#1
gram -), endocarditis, pancreatic abscess
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

MacConkey's agar

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

MacConkey's agar

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

MacConkey's agar

flagella (H) all over, SLT1, SLT2, capsule (K)
similar to shigellosis (invade intestinal epithelial cells; travelers

diarrhea), FEVER

MacConkey's agar

flagella (H) all over, adhesins, capsule (K)
accute diarrhea (infants) in developing countries, lose intestinal

epithelial microvilli, breastfeeding protects

MacConkey's agar

flagella (H) all over, adhesins, capsule (K), enterotoxin
similar to EAEC

MacConkey's agar

flagella (H) all over, adhesins, capsule (K)
chronic diarrhea (children) in HIV infected in developing countries,

acute travelers diarrhea

MacConkey's agar
LPS, fimbriae (pili), siderophore (iron), plasmids, flagella all over,

capsule
UTI (catheter), IV infection, nosocomial pneumonia, bacteremia

MacConkey's agar
LPS, fimbriae (pili), siderophore (iron), plasmids
UTI (catheter), nosocomial pneumonia, bacteremia

MacConkey's agar

capsule
UTI (catheter), nosocomial pneumonia, bacteremia, neonatal

meningitis/abscess
UTI (catheter), nosocomial pneumonia, bacteremia, endocarditis
(injection drug users, San Francisco)

MacConkey's agar

enterotoxin (diarrhea), Vi antigen (prevents Ab opsinization),
capsule
nosocomial pneumonia, bacteremia, gastroenteritis (med dose; invade urine dip-stick (nitrate into nitrite),
intestinal mucosa, fecal WBC, diarrhea (med dose) w/o blood, fever, MacConkey's agar
nausea, vomiting, chills, abdominal cramps, myalgia, dysuria, 4-5 weeks),
bacteremia, endovascular infection (aortitis), osteomyelitis

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
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
LPS, fimbriae (pili), siderophore (iron), plasmids, flagella (H) all

over, Vi antigen (prevents Ab opsinization), capsule

capsule

leucopenia, anemia, elevated liver
enzyme, blood culture (50-70%
positive), bone marrow culture (90%
positive), MacConkey's agar
nosocomial pneumonia, bacteremia, gastroenteritis (med dose; invade urine dip-stick (nitrate into nitrite),
intestinal mucosa, fecal WBC, diarrhea w/o blood, fever, nausea,
MacConkey's agar
vomiting, chills, abdominal cramps, myalgia, dysuria, 4-5 weeks),
bacteremia, endovascular infection (aortitis), osteomyelitis
LPS, fimbriae (pili), siderophore (iron), plasmids, Shiga-toxin (A-B diarrhea (low dose), nosocomial pneumonia, bacteremia, colonic
toxin; 60S ribosome), capsule
ulcers lead to dysentery (stool w/ blood/mucus, strain/pain
MacConkey's agar, stool toxin/WBC assay
defecation), fever, erythema nodosum, hemolytic uremic syndrome
(HUS; thrombocytopenia, hemolytic anemia, nephropathy; Reiter's
syndrome)
LPS, fimbriae (P pili), siderophore (iron), plasmids, flagella all over UTI (long-term catheter, alkali pH), nosocomial pneumonia,
(swarms), capsule, urease, capsule (biofilm)
pyelonephritis (P pili; acute, uncomplicated; fever, flank pain, nausea,
vomiting, frequency +/- dysuria), bacteremia, struvite (nidus)
LPS, fimbriae (pili), siderophore (iron), plasmids, flagella all over
(swarms), urease, capsule

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

MacConkey's agar
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)
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)

MacConkey's agar
gastroenteritis (sushi, shellfish; explosive diarrhea/dysentery,

cramping, abdominal pain)
thiosulfate + bile salts
LPS, single polar flagella, choleragen (A-B toxin), mucinase,

fimbriae
LPS, hemolytic cytotoxin, capsule, single polar flagella
fiat yellow colonies (thiosulfate-citrate-bilesalts-sucrose media)
LPS, capsule
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)
cellulitis (necrosis), otitis media, otitis externa (sea water)

necrotizing cellulitis (sea water)
LPS, exotoxin A (similar to diphtheria toxin, ADP ribosylates EF2), prefer colonization, pneumonia (cystic fibrosis, neutropenic,
immpermeable outer membrane, flagella, P pili, efflux pump, can ventilator), osteomyelitis (diabetics, IV drug addict, children w/
rapidly mutate,capsule(biofilm; antiphagocytic), ABX resistant puncture wounds to foot), burn wound/post operative infection,
(B-lactams, quinolones, macrolides, tetracyclines, sulfa drugs),
sepsis, UTI/pyelonephritis (catheter), endocarditis (R side = IV drug
hemolysin, collagenase, elastase, fibrinolysin, phospholipase C, addict, Detroit), malignant external otitis, corneal infections
DNAase,
(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
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)
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 (cystic fibrosis 5%, chronic

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

impossible to culture, difficult to see on
status, severe diarrhea, high fever, nonproductive cough, high
Gram stain, silver stain, direct
mortality), Pontiac fever (headache, myalgia, fatigue, fever/chills,
fluorescent antibody (DFA) test on
resolves 1 wk, low mortality), pneumonia (community acquired, high fever, sputum, urine antigen test, buffered
bradycardia, severe headache, confusion, myalgia, rhabdomyolysis,
charcoal yeast extract agar (Fe + Lcough, +/- sputum, hyponatremia, hypophosphatemia, elevated liver
cysteine)
enzymes, diarrhea, abdominal pain)
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
prefer colonization, pneumonia (ventilator), nosocomial infections

(cancer patients), bacteremia (catheter), skin infections, meningitis
(nosocomial post surgery), UTI (catheter)

MacConkey's agar (cold temperature),
colonoscopy (check for ulcers)
LPS, fimbriae (pili), plasmids, flagella all over, capsule
diarrhea, nosocomial pneumonia, bacteremia, mesenteric adenitis (RLQ urine dip-stick (nitrate into nitrite),
pain) occurs but very rare
MacConkey's agar (cold temperature)
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 urine dip-stick (nitrate into nitrite),
(SW US; flea bite; fever, chills, headache, weakness, inflamed painful MacConkey's agar, culture
bubo lymph nodes, bacteremia), pneumonic plague (inhalation;
blood/buboaspirate, serology, anti-F1 titer
respiratory failure, bloody sputum), DIC, septicemic plague (no bubo)
LPS, corkscrew, polar flagella, cagA island (interferes w/ cell

acute infection (nausea, upper abdominal pain, vomiting, fever; gastritis + rapid corkscrew motion, urease breath
cycle/cytoskeleton; associated w/ gastric cancer & duodenal
hypochlorhydria), peptic ulcer, duodenal/gastric ulcer, atrophic
test, serology, stool antigen test
ulcers), VacA (vacuolating cytotoxin; downregulates T-cell
gastritis, gastric cancer, mucosal associated lymphoid tumor
activation; S1 genotype = cag A positivity), urease,
(MALToma; B-cell)
downregulates proinflammatory cytokines, Ure1 channel (opens at
LPS, bipolar flagella, corkscrew, LT toxin, cytotoxin (invasive),
dysentery (#3, med dose; fever, headache, abdominal cramps,
Gram stain, culture @ 42C optimal temp
plasmid, PEB1, capsule
bloody, tenesumus, invades small intestine mucosa, bacteremia),
pseudoappendicitis (fever, RLQ pain, no diarrhea), Guillain-Barre
syndrome (symetric ascending paralysis), Reiter's syndrome
LPS, single polar flagella, capsule (S-layer protein)
polysaccharide capsule (anti-phagocytotic), B-lactamase, pili,

hyaluronidase, collagenase, neuraminidase, heparinase, No lipid
A
(LPS)
LPS
dysentery ( mid dose; fever, headache, abdominal cramps, bloody,

Gram stain, longer to culture
tenesumus, invades small intestine mucosa, bacteremia {w/ relapsing
fever/chills/myalgia}), endocarditis, thrombophlebitis, mycotic
aneurysm, meningoencephalitis (neonates)
peritoneal abcess (trauma, septic abortion, pelvic inflammatory disease,
intrauterine device), cellulitis (crepitis)
pulmonary abscess, periodontal disease, brain abcess (linked to
chronic otitis media, mastoiditis, chronic sinusitis, tooth abcess), cellulitis
(crepitis)
black pigment on blood agar
LPS
+/- capsule (type b; polyribitol ribose phosphate), LPS, IgA

protease, ampicillin resistant plasmid, lipooligosaccharide
(LOS; stimulates inflammation = invasion into septic spaces), pili
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)
encapsulated = meningitis/cellulitis/acute epiglottitis/septic
chocolate agar (X and V factor +/- CO2),
arthritis (children 6 mo - 4 yr), bacteremia (splenectomy), pneumonia
ELSA, +Quellung test (capsule Ab
(#2); non-encapsulated = otitis media (#2), acute sinusitis, acute causes swelling)
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)
+/- capsule (type b; polyribitol ribose phosphate), LPS, IgA

Brazilian hemorrhagic fever, conjunctivitis, bronchopneumonia,
protease, ampicillin resistant plasmid, lipooligosaccharide (LOS; bacteremia, shock, DIC, endocarditis (rare)
stimulates inflammation = invasion into septic spaces), pili
chocolate agar (X and V factor +/- CO2),

ELSA, +Quellung test (capsule Ab causes
swelling)
LPS, IgA protease, ampicillin resistant plasmid, lipooligosaccharide chancroid (painful genital ulcer + swollen inguinal nodes; like
(stimulates inflammation = invasion into septic spaces), pili,
syphilis but painful)
capsule
LPS, IgA protease, ampicillin resistant plasmid, lipooligosaccharide sinusitis, bronchitis, pneumonia (rare), endocarditis (rare)
(LOS; stimulates inflammation = invasion into septic spaces), pili,
capsule
chocolate agar (X factor +/- CO2) PCR

blood agar (V factor +/- CO2; grow for 2
wks)
LPS, IgA protease, ampicillin resistant plasmid, lipooligosaccharide endocarditis (rare)

capsule
chocolate agar (X and V factor +/- CO2;

grow for 2 wks)
LPS, IgA protease, ampicillin resistant plasmid, lipooligosaccharide endocarditis (rare)

capsule
chocolate agar (X and V factor +/- CO2;

grow for 2 wks)
LPS, IgA protease, ampicillin resistant plasmid, lipooligosaccharide vaginitis (itching, dysuria, fishy discharge)
capsule (?)
clue cells (vaginal epithelial cells w/

pleomorphic bacilli)
LPS, B-lactamase
otitis media (#3), acute sinusitis (#3), tracheobronchitis,

pneumonia (#3), bacteremia (almost never), meningitis (very rare)
peridontitis, endocarditis
endocarditis
LPS, capsule, pertussis toxin (A-B; ADP ribosylation inactivates pertussis (TOXIN MEDIATED = symptoms last until toxins/epithelial cells
Gi-increases cAMP, inhibits WBC migration/phagocytosis),
are shed; prodromal = 1 wk incubation; catarrhal = 1-2 wks, similar to
adenylate cyclase toxin (increases cAMP, calmodulin
URI; paroxysmal = ~1 mo, nonproductive whooping cough;
dependant; impaired chemotaxis/ROS formation, hemolytic),
convalescent = ~1 mo, symptoms regress; bronchopneumona,
filamentous hemagglutinin (FHA; pili rod), fimbriae (adhesion), necrotizing pneumonia w/ hemorrhage in worst case)
pertactin (adhesion), dermonecrotic toxin (heat labile; tissue
necrosis), tracheal cytotoxin (peptidoglycan fragment, destroys
cilliated epithelial cells), B-lactamase
capsule, nonmotile
capsule (anti-phagocytic) non-motile
capsule, nonmotile
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
brucellosis (direct contact, inhalation, eating unpasteurized animal culture (must grow for a long time; blood,
products; imitates syphilis/tuberculosis, onset can be
bone marrow, liver, lymph nodes), antiinsiduous/acute, lymphatic spread, undulant fever {high in evening,
Brucella titer (prozone effect = too many
low in morning}, osteoarticular findings, chills, sweats, loss of
Ab, need to dilute), brucellergin skin
appetite, backache, headache, lymphadenopathy sometimes,
test, erythritol tropic (sugar found in
depression, infection lasts mos-yrs, rarely fatal), aseptic meningitis,
animal placenta); fever of unknown origin,
endocarditis (culture negative), osteomyelitis (culture negative)
culture negative (endocarditis,
osteomyelitis, aseptic meningitis,
epididymoorhcitis)
ulceroglandular tularemia (well defined ulcer w/ black base at site of DTH skin test, Ab titer, NOT cultured
bite, skin/tissue infection w/ lymphadenopathy {become red, swollen, (too dangerous), skin/tissue infection
painful, drain pus}, fever, bacteremia), pneumonic tularemia
w/ lymphadenopathy, pharyngitis
(inhalation), oculoglandular tularemia (eyes), typhoidal tularemia
unresponsive to PCN, typhoidal fever
(ingestion w/ intestinal infection), pharyngeal tularemia (ingestion),
of unknown origin, pneumonia of
glandular tularemia w/o lymphadenopathy (cant find bite)
unknown origin
cat bite/scratch & dog bite (#1 wound infection, can cause
necrotizing fascitis, septic arthritis, osteomyelitis, cellulitis,
disseminate in patients w/ underlying liver disease, meningitis)
culture in standard media
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 auraminerhodamine) 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
nonmotile, non-spore forming
lepromatous leprosy (LL, TH2 response, bacteremia, leonin facies,

lepromin skin test (prognostic of class
infiltrative skin lesions, saddlenose deformity, infertility, blindness, of leprosy), skin/nerve biopsy w/ Fite
hypoesthesia/peripheral neuropathy {palpable nerves, chronic
stain, grow on footpads of
damage, glove/stocking distribution, repetitive trauma/infection,
immunodeficient mice
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)
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)
chronic pulmonary disease (older smoking males w/ underlying
lung disease), infection (rice bodies; tendon sheath, bones,
bursae, & joints; catheter), bacteremia (immunocompromised)
infection (rice bodies; tendon sheath, bones, bursae, & joints;
catheter)
chronic skin ulcers w/ necrotic centers that start from violet papules,
catheter)
skin granuloma @ site of abrasion (papule-ulcers), infection (rice
bodies; tendon sheath, bones, bursae, & joints; catheter)
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)
scrofula (painless anterior cervical lymphadenopathy), 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
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 darkfield microscopy (primary,
inoculation, resolves in 3-6 wks, hematogenous dissemination;
immunofluorescence, silver stain),
secondary = widespread rash {small, red, macular, flat, papular,
nonspecific treponemal Ab test
pustular lesions, palms/soles/oral cavity, alopecia, resolves in 6
(lecithin/cardiolipin; VDRL {CNS} / RPR
wks}, bacteremia, lymphadenopathy, condyloma lata {painless,
{rapid, some false positives}; 80% in
flat lesion, vulva/scrotum, ulceration = extremely contagious, resolves primary 1:8; 100% in seconday 1:64; false
in 6 wks}, skin infection {bald spots}, weightloss, malaise, fever, multi- positive = infectious mononucleosis,
organ {CNS, eyes, kidneys, bones, liver}; latent = asymptomatic, 33% chicken pox, malaria, kala-azar, lupus
= cured, 33% = remain latent, 33% = tertiary; tertiary = develops erythematosus; only active during
@ 6 - 40 yrs after infxn w/o Tx, gummatous syphilis = 17%,
disease), specific treponemal test
granulomatous infection - necrosis - fibrosis, skin {painless, sharp
(FTA-ABS, MHA-TP, TPHA, ELISA; 90% in
borders}, bone {deep gnawing pain}, liver testis, hard palate,
primary, 100% in secondary; once
cardiovascular syphilis = 9%, chronic inflammatory destruction of vasa positive always positive), Enzyme
vasorum - necrosis - aortic aneurysm/aortic valve insuffiency {diastolic Linked Immunoassay (EIA), PCR
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});
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)
endemic syphilis (bejel, desert zones Africa/Middle East, oral
mucosa, gummas {skin, bones})
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)
LPS, additional phospholipid-rich outer membrane w/ exposed

proteins, 6 axial periplasmic flagella (corkscrew motion),
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!

proteins, 7-20 axial periplasmic flagella (corkscrew motion),
transverse fission replication, Vmp lipoprotein (antiopsonin/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

proteins, 7-20 axial periplasmic flagella (corkscrew motion),
transverse fission replication, Vmp lipoprotein (antiopsonin/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

proteins, 2 axial periplasmic flagella (corkscrew motion),
leptospirosis (first phase = invade blood/CSF, high-spiking

first phase = culture blood/CSF; second
temperatures, headache, malaise, severe muscle ache, red
phase = culture urine; ELISA, PCR, clinical
conjunctiva, photophobia, abnormal liver enzymes, lasts 1 wk, afebrile history, organ labs, dark field microscopy
period, relapse; second phase = IgM, meningismus, elevated WBC in
CSF, hemorrhagic pneumonia)
Weil's disease = infectious jaundice, renal failure, hepatitis w/ jaundice,
mental status change, hemorrhage in many organs
lack cell wall/unique sterol membrane (resistant to B-lactams, walking pneumonia (tracheobronchitis, pronounced coughing!, low
cephalosporin, erythromycin, tetracycline), protein P1
mortality, community acquired), extra-pulmonary autoimmune
(adhesion)
(Stevens-Johnson syndrome {erythmatous vesicles and bullae @
mucocutaneous junctions}, aseptic meningitis, encephalitis, cold
agglutinin disease), non-gonococcal urethritis, PID, nonpneumonic lung infection
Resistant to B-lactams, lack cell wall, unique sterol membrane non-gonococcal urethritis (20% cases in men), mucopurulent
cervicitis/pelvic inflammatory disease (women)
LPS, Resistant to B-lactams, lacks cell wall (no peptidoglycan, minimal viral-like illness, typhoidal disease, psittacosis (atypical
no muramic acid {lysozyme resistant}), cytochrome system, pneumonia = dry cough, fever, less sick appearing), hepatitis / heart /
ATP/ADP translocator, prevent phagosome/lysosome fusion CNS involvement
takes a long time to culture

(cholesterol/nucleic acid enriched media, 23 wks, fried egg or mulberry{more
pathogenic} colonies), family
transmission (2-3 wk incubation), CXR
worse than clinical findings, coldagglutinin test (IgM against RBC @ 4C),
acute/convalescent IgM/IgG, PCR, DNA
probe,
takes a long time to culture
(cholesterol/nucleic acid enriched media, 23 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
Gram stain, serologic testing (high IgM
or increasing IgG)
atypical pneumonia (15% community axquired), ocular trachoma

(chronic follicular conjunctivitis, scarring, inverted eyelid, corneal opacity,
blindness), STD (lymphogranuloma venereum {painless ulcer}, nongonococcal 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
acute bronchitis, mild pneumonia (15% community accquired

pneumonia, TWAR), upper respiratory infection

Gram stain, serologic testing (high IgM
or increasing IgG)
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
rickettsial pox (self limiting, papule, vescicle, fever, headache, other
vescicles); endocarditis
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), BrillZinsser disease (latent bug reactivates, milder symptoms); endocarditis
endemic/murine typhus (similar to epidemic typhus but symptoms not
as severe, 10 dy incubation, fever, headache, flat/bumpy maculopapular
rash); endocarditis
tsutsugamushi fever/scrub typhus (2 wk incubation, high fever,
headache, scab at site of bite, flat/bumpy maculopapular rash,
endocarditis
endospore (hardy), can grow in phagolysosome (pH = 4.5)
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)
indirect immunofluorescence test (IFA),
Weil-Felix test (cross rxn w/ OX-19
complement fixation test (CF), ELISA, BrillWeil-Felix test (cross rxn w/ OX-19
complement
fixation
test
ELISA,
Weil-Felix test
(cross
rxn(CF),
w/ OX-K

fever, headache, eschars, regional lymphadenopathy, endocarditis
Weil-Felix test (cross rxn w/ OX-2, OX-19,
OX-K {Proteus vulgaris antigens}; test is
not sensitive/specific), indirect
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
Q fever (inhaled; abrupt fever/soaking sweats @ 2-3 wks after
complement fixation test, negative Weilinfection, pneumonia, no rash), granulomatous hepatitis, endocarditis Felix test
(culture negative)
trench fever (high fever, rash, headache, severe back/leg pain, recover serologic
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- serologic
grade fever, malaise, resolves in a few months) , bacteremia,
endocarditis (culture negative), bacillary angiomatosis (proliferation
of blood vessels in skin/organ of AIDS patients)
Human Monocytic Ehrlichiosis (similar to rocky mountain spotted fever, Ab titer, blood smear (ehrlichial inclusion
rash less common, thrombocytopenia, leukopenia, monocytes)
body on leukocytes), WBC count, serology
(must treat before results available)
Ehrlichiosis (similar to rocky mountain spotted fever, rash less
common, thrombocytopenia, leukopenia)
Human Granulocytic Anaplasmosis (similar to rocky mountain spotted Ab titer, blood smear (ehrlichial inclusion
fever, rash less common, thrombocytopenia, leukopenia,
body on leukocytes), WBC count, serology
granulocytes)
(must treat before results available)
acute febrile disease
devastating sepsis syndrome (cat bite/scratch & dog bite, alcoholics

& splenectomy patients at higher risk)
aerolysin cytotoxic enterotoxin (ACT)
necrotizing cellulitis (fresh water), diarrhea, dysentery

traveller's diarrhea (fish)
cellulitis (necrosis), endocarditis
cellulitis
STARI (souther tick associated rash illness, Missouri/Arkansas; erythema
migrans)
Treatment
Key Points
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, Blactamase
vancomycin + remove prosthetic device
MRSE = methicillin resistant, PBP

2a
PCN, 3rd gen cephalosporin, fluoroquinolone,

nitrofurantoin, trimethoprim/sulfamethoxazole
VRSH = vancomycin resistant
usually mixed w/ other bugs
PCN, dicloxacillin, or macrolides (erythromycin,
azithromycin, & clarithromycin), surgical debridement,
hyperbaric O2, IVIG
aminoglycoside + PCN
PCN
M-protein
ABX resistant: ampicillin/vancomycin + aminoglycoside PBP 5 = low affinity for B-lactams,

(gentamicin/streptomycin), linezolid
vancomycin resistant gene from
ABX resistant: ampicillin/vancomycin + aminoglycoside transposon
(gentamicin/streptomycin), dalfopristine/quinupristine,
linezolid
Pneumovax {polysaccharide}, Prevnar {conjugated}
mosaic PBP 1a, 2x, 2b
PCN
PCN
usually mixed w/ other bugs
Resistant to B-lactams; Tet, Cm, Gm (for non

emetic/gastrointestinal), dont treat food poisoning,
[vancomycin, clindamycin?]
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
DPT vaccine (w/ booster every 10 yrs), tetanus = human lock jaw from puncture wound
tetanus immunoglobulin + DPT + surgical
debridement + PCN + support
food = antitoxin + support; infant = human botulism
canned food
immunoglobulin intravenious (no anaphylaxis, serum
sickness); puncture wound = antitoxin + ABX + surgical
debridement + hyperbaric O2
stop ABX, rchydrate, oral vancomycin, metronidazole,

isolation, some strains are fluoroquinolone resistant
cellulitis/wound infection = PCN + surgical debridement;

clostridial myonecrosis = hyperbaric O2 + PCN + surgical
debridement; enteritis necroticans = ABX + surgery

debridement; neutropenic enterocolitis = bowel rest +
abx + surgery
debridement
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
prompt treatment: diphtheria antitoxin (DAT) + PCN
or erythromycon + isolation + vaccination (DTaP,
Td, "Tripedia"); respiratory diease is not immunizing
grow @ 4C (incubate 1-6

months), contaminate food
products, facultative
intracellular pathogen, motile
@ 22C but not @ 37C
surgery & drainage + abx (6-12 mos; penicillin,

amoxicillin, ceftriaxone, clindamycin)
surgical drainage (brain abscess) + prolonged therapy;

pulmonary to CNS in
trimethoprim/sulfamethoxazole, amikacin, carbapenems, immunocompromised has high
cephalosporins,
likelyhood of Nocardia
PCN or ceftriaxone (@ first indication of

intracellular, TEM-1 Bmeningococcemia), rifampin/ceftriaxone/ciprofloxacin lactamase, N. men = mosaic PBP
(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)
gonorrhea = treatment dependent on sensitivity;

ceftriaxone, fluoroquinolones, spectinomycin (if allergic,
treat w/ spectinomycin or ciproflozacin), sulfonamide,
PCN, ciprofloxacin, tetracycline resistant;
ophthalmia neonatorum = erythromycin +
ceftriaxone
cephlasporin
ampicillin resistant (B lactamase), nosocomial
strains are MDR (multi-drug resistant)/ESBL
(extended spectrum B lactamase), 3rd gen
cephalosporin, ciprofloxacin, fluoroquinolone,
HACEK (culture negative

endocarditis)
3rd gen cephalosporins, aminoglycosides (gentamicin,

amikacin), trimethoprim/sulfamethoxazole,
fluoroquinolones, nitrofurantoin
8 PBP, TEM-1 B-lactamase
Fluoroquinolone
don't give ABX
doesnt ferment sorbitol
don't give ABX
ferments sorbitol
breastfeeding protects
ampicillin resistant (B lactamase inducible), nosocomial

strains are MDR (multi-drug resistant)/ESBL (extended
spectrum B lactamase)
some strains produce red

pigment
fluoroquinolones, cephalosporins, [no abx,

fluid/electrolyte replacement?]
facultative intracellular
parasites, TEM-1 B lactamase
fluoroquinolones, cephalosporins, remove gall

bladder/kidney stones, ciprofloxacin, ceftriaxone,
trimethoprim/sulfamethoxazole, azithromycin, live
attenuated & Vi vaccine
fluoroquinolones, cephalosporins, [no abx,

fluid/electrolyte replacement?]
first identify as Shigella. Avoid anti-motility drugs +

[fluoroquinolones, azithromycin,
trimethoprim/sulfamethoxazole]?
ampicillin, trimethoprim/sulfamethoxazole, 3rd gen
cephalosporin, fluoroquinolone, nitrofurantoin,
aminoglycoside (gentamicin, amikacin)
ABX,
IgA best immunity, daycare

diarrhea
ABX
ABX
ABX
male-male sex
most common in US
rapid-acting urease, Weil-Felix
test (Ab for certain strains can
test for Rickettsia)
3rd gen cephalosporin, ciprofloxacin, fluoroquinolone,

rapid-acting urease (staghorn

colliculi)

rapid-acting urease

doxycycline + fluid/electrolytes (Ringer's lactate),
anti-motility agents not recommended,
trimethoprim/sulfamethoxazole, erythromycin,
ciprofloxzcin, azithromycin, fluoroquinolone
rapid-acting urease
tetracycline, fluoroquinolone, doxycycline
increased risk for type O blood,

decreased gastric acid,
Ogawa/Inaba serotypes, classic/El
Tor (South/Central America)
biotypes
surgical debridement, tetracycline, quinolone,

cephalosporin
chronic liver disease increases

risk of infection, high mortality
rate
ABX resistant (B-lactams, quinolones, macrolides,

tetracyclines, sulfa drugs): remove catheter + antipseudomonas-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

tetracyclines, sulfa drugs); treatment based on testing
sources, perfer colonization
(minocycline, levofloxacin, meropenem, ceftazidine,
inhaled tobramycin), resistant to cleaning chemicals,
[trimethoprim/sulfamethoxazole, ticarcillin +/- aztreonam]
tetracyclines, sulfa drugs, especially carbapenems);
hospital dependent: trimethoprim/sulfamethoxazole or
sometimes quinolones + remove catheter , resistant to
cleaning chemicals

sources, perfer colonization

tetracyclines, sulfa drugs);hospital dependent: imipenem sources, perfer colonization
(but not meropenem), sulbactam (B-lactamase inhibitor),
polymyxin (colistin; when pan-resistant), resistant to
cleaning chemicals
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
prolonged treatment with aminoglycoside (gentamicin,

Strive in diabetics, alcoholics,
streptomycin) + doxycycline, [fluroquinolone,
malnutrition, and iron-overload,
trimethoprim/sulfamethoxazole, cephalosporin resistant?] grow @ 4C, facultative
intracellular
prolonged treatment with aminoglycoside (gentamicin,

streptomycin) + doxycycline
primary = streptomycin, gentamicin; secondary =
tetracycline (doxycycline), chloramphenicol,
ciprofloxacin, vaccine (effective for few mos),
aminoglycosides
bismuth subsalicylate +
metronidazole/ampicillin/tetracycline, clarithromycin +
omeprazole, clarithromycin + rantidine bismuth citrate
+urease
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
drain abcess + clindamycin, metronidazole,

chloramphenicol, etc.
No Lipid A (LPS)
clindamycin, metronidazole
black pigment
penicillin G
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 Blactamase
cefotaxime or ceftriaxone (amoxicillin resistant strains),

ampicillin or amoxicillin (otitis media), Hib (conjugated;
pregos @ 8 mo; 3x in children under 6 mo),
Ab/complement
azithromycin/erythromycin, ceftriaxone (IM), ciprofloxacin, obligte human parasite, HACEK
Ab/complement, cephalosporin
(culture negative
endocarditis)
metronidazole, Ab/complement, cephalosporin
azithromycin/clarithromycin, amoxicillin w/ clavulanate,

cephalosporin (oral), trimethoprim/sulfamethoxazole;
PCN resistant
cephalosporin
cephalosporin

endocarditis)

endocarditis)
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
aminoglycosides + tetracycline, doxycycline +

gentamicin/streptomycin/rifampin
DO NOT DRAIN lymph nodes (too dangerous),

amonoglycosides + quinolones, gentamicin,
streptomycin, doxycycline, B-lactam resistant,
vaccine (attenuated)
DO NOT CLOSE WOUND!, B-lactam + B-lactamase

inhibitor, doxycycline, cephalosporin,
(ampicillin/sulbactam)
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 (antitoxicity); 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/malabsorptio
n syndrome, prolonged
corticosteroid/immunosuppressive
therapy
rifampin, dapsone, clofazimine, microlides, minocycline, prefer cooler areas (skin,

quinolones, prednisone (TH2 to TH1), thalidomide
nerves, eyes, nose, testes),
(erythema nodosum leprosum)
facultative intracellular,
transmission requires
prolonged & intimate contace
resembles TB on CXR, clarithromycin, refampin,

ethambutol
slow growth rate
resembles TB on CXR, environmental contaminant
fish tank/swimming pool
intermediate growth rate
infects normal hosts
rapid growth rate
infects immunocompromised, nail salons
PCN or erythromycin + doxycycline; JarischHerxheimer Phenomenon (acute worsening of

symptoms after starting ABX due to endotoxin release;
mild fever, chills, malaise, headache, muscle aches)
Like cool environments,
treat before 4 mos gestation, PCN, DO NOT USE

Doxycycline (TOXIC!)
long-acting PCN (IM)
doxycycline, B-lactam, vaccine (OspA recombinant

protein, withdrawn from market), ceftriaxone (for
neurologic disease), removing the tick w/in 24 hrs
prevents disease
doxycycline, erythromycin, PCN
antigenic variation = relapses
doxycycline, erythromycin, PCN
antigenic variation = relapses
initiate treatment immediately, PCN or doxycycline
Resistant to B-lactams, aminoglycosides,

smallest free living organism,
cephalosporin, erythromycin, tetracycline; Can enter usually affects young people
eukaryotic cells: macrolides
(azithromycin/clarithromycin), quinolones
(ciprofloxacin/levofloxacin), azithromycin, tetracycline
(doxycycline)
Resistant to B-lactams and aminoglycosides; Can

enter eukaryotic cells: macrolides, quinolones,
azithromycin, tetracycline
+urease
Resistant to B-lactams; Can enter eukaryotic cells: obligate intracellular:

10-21 days w/ doxycycline, quinolones, erythromycin elementary body (EB) exist
extracellularly, enter columnar
Resistant to B-lactams; Can enter eukaryotic cells: epithelial cell and forms
reticulate body (RB) that
single dose of azithromycin (infants &
occupies entire cell, sheds
pregos)/cephalosporin (IM) + 7-14 days of macrolide
new EB
(doxycycline; adults) or quinolone;
Resistant to B-lactams; Can enter eukaryotic

cells:5-10 days w/ macrolides, quinolones,
erythromycin
doxycycline, chloramphenicol (ABX must enter cells)
obligate intracellular
(endothelial cells),
fever/pneumonia of unknown
origin
doxycycline, chloramphenicol, eliminate rodents

doxycycline/tetracycline, chloramphenicol, sanitation,
eradicate lice
doxycycline, chloramphenicol, control rat/flea population
doxycycline, chloramphenicol
doxycycline. erythromycin, pasturize milk @ 60C
obligate intracellular
doxycycline, chloramphenicol, azithromycin
doxycycline, azithromycin
doxycycline, rifampin, chloramphenicol & B-lactam

resistant
obligate intracellular (WBC),

found in NE & MW US
doxycycline, rifampin, chloramphenicol & B-lactam

resistant
obligate intracellular (WBC),

found in NE & MW US
B-lactam + B-lactamase inhibitor (ampicillin/sulbactam)
cephalosporin

endocarditis)
Site
cell wall
B-lactam
Class
Generic
Commercial
penicillin
PCN-G (benzyl-PCN)
(1ug = 1.6
units)
PCN-V (phenoxy-PCN)
procaine-PCN
benzathine-PCN
probenecid
ampicillin
Unasyn
(ampicilline +
sulbactam)
amoxicillin
Augmentin
(amoxicillin +
clavulanic
acid)
T 1/2
20 mins
days
weeks
45 mins
methicillin
nafcillin
oxacillin
cloxacillin
dicloxacillin
flucloxacillin
piperacillin
ticarcillin
cephalosporin cefazolin
cephalexin
cefoxitin
cefotetan
cefuroxime
Zosyn
(piperacillin +
tazobactam)
Timentin
(ticarcillin +
clavulanic
acid)
Ancef, Kefzol 90 mins
Keflex
Mefoxin
Cefotan
Ceftin
cefotaxime
Claforan
1 hr
ceftriaxone
Rocephin
6-8 hrs
ceftazidime
cefpodoxime
cefepime
Vantin
ceftobiprole
carbapenem
imipenem
monobactam
meropenem
doripenem
ertapenem
aztreonam
cephamycin
B-lactamase
inhibitor
cefoxitin
clavulanic acid
tazobactam
sulbactam
glycopeptides
Primaxin
(imipenem +
cilastatin)
Augmentin
(amoxicillin +
clavulanic
acid),
Timentin
(ticarcillin +
clavulanic
Zosyn
acid)
(piperacillin +
tazobactam)
Unasyn
(ampicilline +
sulbactam)
vancomycin
2 hrs
teicoplanin
protein
synthesis
cycloserine
cycloserine
bacitracin
bacitracin
aminoglycoside
streptomycin
gentamicin
amikacin
kanamycin
tobramycin
Neosporin
(bacitracin +
polymyxin /
neomycin)
2.5 hrs
(normal
renal)
tetracyclines
neomycin
doxycycline
minocycline
tigecycline
macrolide
erythromycin
Z-pack
long
(azithromycin,
clarithromycin,
erythromycin)
carbomycin
clarithromycin
Biaxin, Z-pack
(azithromycin,
clarithromycin,
erythromycin)
azalide
azithromycin
Zithromax, Zpack
(azithromycin,
clarithromycin,
erythromycin)
lincosamide
clindamycin
Benzeclin
(topical for
acne)
ketolide
telithromycin
oxazolidinone
cethromycin
linezolid
chloramphenicol
chloramphenicol
folic acid
metabolism
DNA
synthesis
fusidic acid
sulfonamide
sulfonamide
trimethoprim
trimethoprim
fluoroquinolone
ciprofloxacin
levofloxacin
moxifloxacin
RNA
synthesis
macrocyclic
disrupt
polymixin
membrane
rifampin
rifabutin
polymixin
lipopeptide
colistin
daptomycin
lipoglycopeptide
televancin
Bactrim,
12 hrs
Septra,
Cotrimoxazole
metronidazole
metronidazole
nitrofurantoin
mupurocin
furadantin
macrodantin
hippuric acid
Chloroquine
Isoniazid
Sulfamethoxaz
ole
Quinupristin/dalf
opristin
Rifaximin
Nitazoxanide
Flagyl
cranberry juice
Action
binds active site of PBP,
excreted by kidneys (delayed by
probenecid / procaine /
benzathine), succeptible to Blactamase (penicillin >>>
dicloxacillin > cloxacillin >
oxacillin > nafcillin)
Side Effects
skin rashes,
neutropenia w/
newer Blactams,
anaphylaxis >
0.01%
Notes
crystalline, destroyed by gastric acids
not destroyed by gastric acids
peak = 1-2 ug/mL, after 24 hrs = 0.2
ug/mL
> 0.1 ug/mL for 2 wks
delays excretion of PCN @ renal
tubules
IV, PBP 2, PBP 3
oral, 2 hrs for absorption, common oral

PCN, PBP 1a. PBP 2
IV, resists B-lactamase

IV, resists B-lactamase, more
common, excreted by liver also
oral, resists B-lactamase
binds PBP, very little cross

antigenicity w/ PCN
neutropenia,
increased risk
for bleeding
1st Gen
oral cefazolin
2nd Gen, prophylaxis for surgery
oral
commonly used, can cross BBB,
resistant to TEM B-lactamase, PBP 3
3rd Gen, commonly used, can cross
BBB, resistant to TEM B-lactamase
oral
4th Gen
binds PBP 2a
binds all known PBP, resists

nearly all B-lactamase, no
cross antigenicity w/ PCN
seizures
cilastatin prevents inactivation by

renal peptidase
cilastatin not necessary
binds PBP, no cross

antigenicity w/ PCN or
cephalosporin, resists Blactamase
PBP 3, little toxicity, good for renal

fragile patients
inhibits B-lactamase, synergy diarrhea

w/ PCN
oral
IV equivalent of Augmentin
binds D-ala, inhibits bridging,

renal clearance, synergy w/
gentamicin, antagonism w/
rifampin, DONT USE unless
infection is serious and you
suspect abx resistant bug
D-ala analog that blocks Dala ligase

blocks peptidoglucan
synthesis
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
redman (diffuse
flushing; prevent
w/ slow infusion),
nephrotoxic,
ototoxic,
thrombophlebit
is
must penetrate membrane

toxic
parenteral
topical (+/- polymyxin)
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
IV, better activity, less toxicity
inhalation
dosage/freq, peak = efficacy; serum trough)

trough = toxicity; monitor
serum levels; IV
topical
inexpensive
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),
contraconcentrates in nasal secretions,
indicated for
impregnate IV catheters
pregos
(+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)
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
binds peptidyl transferase
binds peptidyl transferase
(chloramphenicotransferase)
macrophage uptake (intracellular bugs)

blocks cytokine release from

macrophages, macrophage uptake
(intracellular bugs)
macrophage uptake (intracellular

bugs), pneumonia only

IV, oral, expensive!
anaplastic
very little resistance
anemia (kill cell
lines RBC, WBC,
etc.), gray baby
syndrome
binds EF-G
inhibits nucleotide synthesis skin rashes,
(dihydropteroate synthase = first Stevens
enzyme in pathway)
Johnson
syndrome
(idiosyncratic),
renal
insufficiency
inhibits nucleotide synthesis
(dose related but
(dihydrofolate reductase = late
rarely causes
enzyme in pathway)
hyperkalemia),
RBC hemolysis
(G6PD
deficiency)
oral (well absorbed, 95%), IV,

G6PD deficiency (glucose 6
phosphate enzyme deficiency;
hemolysis of RBC)
blocks DNA gyrase
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)
inhibits RNA polymerase
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
depolarizes bacteria by
causing release of
intracellular ions
binds D-ala, depolarizes
bacteria by causing release of
intracellular ions
neurotoxic,
nephrotoxic,
IV, inhalation, not absorbed in GI

tract, DO NOT GIVE ORALLY
myalgia, CPK
elevation
inactivated by surfactants (not for

pneumonia), low serum concentration
(binds serum proteins), expensive!
blocks peptidoglycan synthesis
(like vancomycin), depolarizes cell
membranes
bad taste,
vomiting
relatively nontoxic, polymicrobial

infection below the diaphragm
topical, much resistance
does not appear to generate bowel
flora resistance, underutilized
today
not recommended
fully absorbed in GI, rapid

excretion into urine
block E. coli adherence to
bladder mucosa via P1
fimbriae
malaria
TB
antibiotic; acidic
liver tocicity,
peripheral
neuropathy
Bug/Disease
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
S. aureus
determine if bug is MRSA
Klebsiella, Enterobacter (intraabdominal

infections), Pseudomonas
S. aureus (NOT MRSA), S. pyogenes

outpatient infections, UTI
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
Pseudomonas
S. pneumoniae (B-lactam resistant), UTI
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)
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
meningitis
Gram + cocci
Gram +/-, 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
Trichomonas vaginalis, anaerobes (below

diaphragm), intraabdominal infections, C. difficile
(colitis, first line), Entamoeba histolytica
Staphylococci, S. aureus (nasal carriage)
E. coli (UTI), S. saprophyticus (UTI)
E. coli (UTI)
Resistance
TEM 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 + Dlactate), 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)
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 + dont use clindamycin)
mutate 23s rRNA

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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Organism

viridans group (salivarius,

alpha hemolysis, optichin resistant, Lancefield+,

endocarditis, dental caries,

beta hemolysis, Bacitracin susceptible, Lancefield+,

pharyngitis, cellulitis, metastatic

beta hemolysis, Bacitracin resistant, CAMP test,

neonatal bacteremia, meningitis,

dysgalactiae subsp. equisimilis, beta hemolysis, Lancefield+, biochemicals; antigen

pharyngitis, possibly nephritis

alpha or gamma hemolysis, grows in bile, hydrolyzes endocarditis

Any hemolysis, Lancefield+, complex biochemicals,

Group G (canis, anginosus)

beta hemolysis, Lancefield+, biochemicals

localized abcess, puerperal sepsis,

beta (small zone)

cellulitis, osteomyelitis, pneumonia,

requires special media (Loeffler's); club shaped.

as part of mixed flora in dental,

obligate anaerobes; distinguish by appearance of

gas gangrene (wounds from battle

botulinism (Gi, Wound) --> flaccid

colitis esp post-antibiotics, chemo

Resembles Neisseria on Gram stain but grows on

Requires X factor, grows on blood agar

sinusitis, pneumonia, exacerbation

otitis, sinusitis, pneumonia,

Fastidious (including special swab)

whooping cough. 1-2 wk w/ typical

small, non-motile, obligate intracellular

Rocky Mountain Spotted Fever:

NOT a facultative intracellular org

Ehrlichial dz (infect WBCs)- Human

Relatively rare. Causes devastating

tularemia - resembles bubonic

Brucella melitensis, abortus

NOT an aobligate intracellular org

cat scratch dz (enlarged lymph

Cell walls contain LPS. Nearly all grow +/- O2

UTI (cystitis or pyelonephritis +/bacteremia depending on virulence

pneumoniae, oxytoca, etc.

cloacae, aerogenes, etc.

non-lactose fermenter; unique red pigment

Citrobacter (diversus, freundii,

UTI, pneumonia, intra-abdominal

Can grow at 4oC

plague- bubonic, pneumonic.

Non-lactose fermenters, urease+

UTI, struvite stones in urinary tract

gastroenteritis, rarely soft tissue

cellulitis, otitis externa, otitis media

microaerophilic. Motile and non-spore forming.

Not seen on Gram stain! Grows on charcoal yeast

atypical pneumonia (Legionnaire's

lack cell wall. Capable of free-living or intracellular

walking pneumonia, cold

No lipid A (endotoxin), but does have a capsule

abscesses lung, intra-abdominal;

Darkfield microscopy. Shaped like a corkscrew,

syphilis: chancre (painless).

Can be seen by light microscope

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