MicroCases Organi sm MicroBio Properties *culture, IgM in Susceptible / Identification/ Resistant ELISA, & Key Diagnostic Persons complement

fixation tests *physical diagnosis *leukopenia, lymphocytosis, parotitis *(rule out Staph aur. Or other bacteria because of lack of purulent infection extending into susceptible to adjacent soft unvaccinated tissue) antigen persons (MMR) 1. Rapid detection (for -RSV) 2. Viral cultures of nasopharyngeal susceptible to swab (Ab which children under detect Ag in 2 y/o -- no secretions of vaccine -- late cultures); fall and early barking cough winter detection by enzyme immunoassay/dr ct fluorescence Ab stain 2. Virus culture (observe syncitia)/PCR of nasopharyngeal secretions; age, viral culture, low blood gases -commonly in distinguishable Jan/Feb, frequently from B. pertusiss by lack infants 2-6mos (there is no of lymphocytosis?? vaccine)

Disease

Signs/Symptoms

Transmission

Pathology (mechanism)

Treateme nt & Preventio n Special Features

paramyxovirus, enveloped -Paramy nonsegmented, xovirida negstrand, ssRNA, e culture-> (mumps multinucleated giant virus) cells paramyxovirus, enveloped -hemagglutinin and fusion proteins; 4 Parainfl antigenic types -uenza cultivatable -- inf cells virus produce syncytia (cell(PIV) cell fusions)

Mumps

*2-3wk incubat.*swelling & tenderness at the parotid and submaxillary areas *difficult to open jaw (talk, swallow, eat) *lymphedema of neck and upwards dispacement of ears *fever, headache, earache

*acquired via exposure to respiratory secretions

virus infects and multiplies primarily in epithelial cells of oropharynx; invasion into parotid and submaxillary glands (perivascular mononuclear&lymphocytic infiltrates in affected glands)

*hematologic dissemination -> encephalitis, pancreatitis, orchitis and ductal obstrxn Supportive (ad. Males) *vaccine=>only Tx: 90% coverage in 1 dose, so analgesics 2 doses (15mos, 5yrs) humidificati on, epi via nebulizer and glucocortic oids (systemic steroids)

*inhalation of *hoarseness, barking, infected brassy, harsh cough, respiratory Viral Croup low-gd fever *visible droplets (laryngotra upper airway -->portal of cheobronc narrowing on chest entry in hilitis) Xray (steeple sign) nasopharynx

H surface protein attaches to host neuraminic factors--> F protein allows fusion *inflammatory changes in superfivial mucous membrane (airway compromise) *edema of vocal cords, larynx->hoarseness and barklike cough

*steeple sign requires neck Xray to rule out epiglottitis *bacterial croup would show necrotizing inflam. Rxn w/ mucosal ulcerations and microabescesses

*cough, respiratory difficulty, insiratory wheezes, hyperinflation of Respirat paramyxovirus (env, chest, atelectasis ory (-)ssRNA non-seg) -->in *chest Xray shows Syncytia vitro show fusion of hyperinflation & l Virus cells=> multinucleated Bronchiolit peribronchiolar (RSV) syncytium is infiltrates

*infectious material contacts mucous membranes of eyes, nose, mouth

incubae 2-8d, spreads from nasophar to bronchioles--> inflam term brnchls, necrosis, sloughing of epith cells of brnchls (dec airway diam: wheezing, hyperinflation); necrotizing bronchiolitis, peribrnchl infiltratn->interstitial pneumonitis

G+ anaerobic rod forms terminal spores which Clostridi germinate in wound um sites --> exotoxin tetani (tetanospasmin) Tetanus

*inability to open jaw (trismus) *foulsmelling, yellow/green discharge from umbilical cord *trismus, opisthotonus, hyperresponsiveness to stimuli

*toxin produced in wound travels peripheral motor neurons, up to spinal *open laceration cord, and diffuses in brain stem to contact with C. other terminal neruons (no entry to bot spores in central nervous system) *toxin is Zn+ ubiquitous soil + dependent endopeptidase, blocks (acute injury) gly/GABA (inhib) neruons--> rigidity

susceptible to those not vaccinated

antifebrile, O2 therapy if severe compromis e; prevent by contact isolation; Ribavirin only for pts with preexisting conditions maintain airway (intubate), passive immunizati on (human tetanus Ig) and active immun (tetanus toxoid); Metronidaz ole

*reinfections are common *cancer, cong heart, chronic lung disease pts at risk for serious pneumonia, encephalopathy *severe complications of disease in immunsupressd and elderly *contact isolation used in hospital to avoid nosocomial outbreaks

*child DPT +booster /10yrs *recovery from tetanus fails to render pt immune since lethal dose of toxin is too small to induce immune response *strychnine poisoning is a concern (bioterror)

updated 06/22/2011 22:42:26

Organi sm MicroBio Properties

Disease

Morbilliv pleomorphic virions, irus linear ss (-) RNA, (Paramy enveloped, only one x serotype (8 genotypes family) worldwide)

Measles

Treateme Susceptible / nt & Identification/ Resistant Preventio Key Diagnostic Persons n Signs/Symptoms Transmission Pathology (mechanism) Special Features vaccine (MMR) with life attenuated viruses (2 doses at susceptible to 12/15mos those not and *contagious from first resp vaccinated, not preschool symptoms to 4 days after endemic in age)-rash onset *LIFELONG >95%immu immunity post infection *prodrome: fever direct contact *virus infects and multiplies primarily nasophrgl swab USA/Canada; (high>40C), cough, with nasal and in epithelial cells of URT-->spreads via to isolate virus; common in nity (humoral and cellmediated) conjunctivitis, coryza, throat secretions lymph-->blood; multinucleated giant ELISA for Ab India, ***vaccine *HIV pts-->giant cell & Koplik spots on (respiratory cells - incubate 7-8d preced rash, titers, Koplik developing in 72hrs of pneumonia, subacute buccal mucosa *then droplets) of virus-specific Tcells attack virus-infec spots on buccal countries exposure sclerosing panencephalitis maculopapular rash infected persons vascular endothel cells (koplik spots mucosa, *epidemics in will provide leading to CNS complicatins (red and splotchy: -- **highly are hence an immune response, not exanthematous unvaccinated protection!! (fatal) (nrml pop: SSPE !*** face-->trunk) contagious!** viral) fever for grp A school pops 1:1000cases) (RADT

MicroCases

G+ cocci in chains--:>clear, sharp beta-hemolysis on blood agar culture -catalase (-), bacitracin Streptoc sensitive. AKA grp A occus beta-hemolyutic strep pyogen GABHS (grpA carb es antigen)

Staphyl Gram+ grape-like ococcus clusters, catalase+, aureus coagulase +,

carb antigen), throat culture on sheep blood agar-->in vitro sensitive to bacitracin (disting from *high fever, itchy other G+ also throat, difficulty catalase(-), swallowing *extracellular pyogenic bacteria invade white exudate *pharyngeal erythema phrng mucosal; M protein (main on tonsils, high with petechiae on virulence factor &Ag) has fever, s.palate, patchy greyantiphagocytic properties to fight PMNs ant.cer.lymphad white tonsillar recruited to fight; Immune response-- enopathy cooler months, exudates *enlarged, person-person >pyogenic inflammation; long-term predicts over temperate virus ***grp A ag climate; peak Streptococ tender ant.cervical respiratory type-specific humoral immunity to cal lymphnodes (no droplet 1Mtype, but recurrent infection with is key!!! As well incidence in as B-hemolysis kids 5-15yrs pharyngitis cough) transmission another type common sputum, conjunct swab, If G(-) in swab, ELISA for Chlamydia *fever, S.O.B., rales, trachomatis, productive cough, high IgG specific 2nd bact. chest pain, thick aspiration mode to influA pneumonia yellow discharge from or (concurrent) with acute eyes, ChestXray: hematogenous *in influenza pt, virus destroys ciliary abscess (like the conjunctivi infiltrate in post (illicit IV drug defense--> colonization of one in the tis segment of LLLobe use) opportunistic bacteria chestXray) *virus infects villus tip in S.I. and damages cells-->replacement with immature crypt cells that cannot absorb carbs or nutrients-->osmotic diarrhea

Sensitive to penicillins, cephalospo rins (no resistance)

Complicatns from pus formation: 1) Abscess. pyogenic cmplctn 2)Scarlet Fever (strawberry tongue toxigenic cmpltn) 3)Acute Rheumatic Fever ARF (carditis, polyarthr, chorea)or 4)RheumaticHeart Disease RHD (late sequelae) also molecular mimicry (like3) -- immune response to myocardial sarcolemma

naked RNA virus (Reoviridae), two concentric shell capsids shaped like wheels, 11 Infantile *vomiting, watery Rotaviru seg dsRNA (no genetic gastroente diarrhea, fever, mm s reassortment) ritis were dry

fecal-oral transmission (person-person or fomites)

high dose IV antistaphyl getting flu shot will prevent ococcal dec immunity and prevent penicillin predisposition to secondary (nafcillin - staph **staph aureus and CONDM) for strep pneumonia are the min 2wks most common causes of or post-viral pnuemonia vancomycin particularly in elderly focus; rotaviruses are #1 cause of enteric bact during winter, handsevere dehydrationdiarrhea cult., stool viral **infants, washing is in infants; often seen in Ag test, viral ag children <3yrs, important conjunction with respTract test in stool for and elderly in symptoms; can have one of nine compromised prevention* reinfection with different serotypes are susceptible * serotype

updated 06/22/2011 22:42:26

Organi sm MicroBio Properties (+)ssRNA virus, Caliciviridae, spherical non-env, 27nm virus,G12; human Ab required to concentrate Noroviru and visualize virus s (sporadic in stool)

G(+) cocci in chains, grp B carb antigen on Streptoc surface, encapsulated, occus catalase (-), Beta agalacti hemolysis, bacitracin ae resistant

Gram(+) cocci in chains in body fluid; facult Steptoc anaerobes, catalase (-), occus bacitracin sensitive; Bpyogen hemolysis grp A carb es Ag. (BHGAS)

motile, flagellated, pleomorphic rods, faint G stain(-); culture nutritionally fastidious, aerobic slow growing, selective media (buffered charcoal Legionel yeast extract); more la than 14 serotypes, pneumo most cases are serogrp phila 1

Herpes simplex virus (HSV) type 2

env icosahedral, lin dsDNA; infected cells-> multinucleated giant cells on Tzanck smear

naked, icosahedral dsDNA, no culture, >100serotypes, Human including genital and Papillom cutaneous; genital= a Virus high risk and low risk

Treateme Susceptible / nt & Identification/ Resistant Preventio Key Diagnostic Persons n Disease Signs/Symptoms Transmission Pathology (mechanism) Special Features microscopy, oral with low rates of fever, high stool Ag for rehydration rates of N/V, diarrhea; fecal-oral virus, RT-PCR (IV if **incubation period of 24necessary); 48hrs before symptoms--> epidemic transmission *highly contagious (only 10 needed!), (RNAtype), nonbact (consumption of shortening and atrophy of villi, crypt 27nm virus-like handwashin foods eaten shortly before particles in stool g symptoms begin are unlikely gastroente *GI symptoms, N/V, cont. food or hyperplasia, inflitration of lamina ritis diarrhea, abdom pain water propria by PMNs and mononuclear cells sample prevention to be source *preterm infant or amp, (<37wks), vanco, and premature 3rd gen path depends on time of onset (post rupture of cephalospo birth): 1)(early 24hrs-7d) pneumonia, CSF analysis, memb <37wks, rins; bacteremia, 2)(late 1wk-3mos) blood cultures, rupture membr prevent by meningitis, 3)(maternal, Gram and 18+ before IV penicillin delivery, and Grp B postpartum)bacteremia 4) culture CSF, strep (nonpregnant pts)skin and bacteremia; detect bact vaginal ampicillin delivery, heavy during (GBS) type *fever, poor feeding, skin&mm exposed during vaginal birth; capsular III irritability, seizure, during vaginal type III capsular polysac-> major antigen, PCR of maternal delivery for leading cause of disease and colonization carriers meningitis nuchal rigidity virulence factor herpes in CSF death in newborns *pain and swelling on delivery 1)impetigo (local abscess thigh, progressed -epiderm only) 2)erysipelas rapidly, high fever, *enter wound from trauma, multiple (dermal lymphatics unable to walk (weak), direct contact virulence factors--> abscess, resist Penicillin G, spreading abscesses) redness at site of with pts or phagocytosis using M proteins-Gram and or 3)cellulitis (SQ fat) injury on thigh-->grey, carriers (strep M >dermis and fascia (hyaluronidase)-- culture wound erythromyc 4)necrofasc and 5)myositis streptococ thigh is dark purple, types (M1, M3) >acute pyogenic inflammation at aspirate, blood hand-washing in and 6)nosocomial 7)acute postcal swollen and tense, have provocation of bact products by culture, labs and gloving clindamcyin strep glomerulonephritis necrotizing edema of soft tissues predilection for immune sys; toxins and show kidney when in in pen(APSGN), or 8) strep toxic fasciitis (CT) skin ischemia=>necrosis damage contact with pt allergic pts shock STSS (super ag) humidifiers *1)Legionnaires (more severe; hard to infect: clarithromy need dec mucociliary cin or function) 2-10d post *enter compromised mm easily, microscopic lavofloxacin exposure, inflicts lungs, *fever, inspiratory flagellated organisms penetrate mucus examination & or l.nodes,brain,kidney,liver,spl rales, productive layer in lower respiratory direct gatifloxacin een,bonemarrow,myocardiu cough of scanty, clear org living in epi.*INTRAcellular bacteria via flourescece Ab susceptible: or m. Slow recovery sputum, serum chem water-phagocytosis; cell-mediated immunity of smokers, doxycycline (15%fatality) 2)Pontiac remarkable: sodium >aerosolized is primary defense: cytokines and bronchoscopic >50yrs, (macrolide Fever (high attack!! acute onset, flu-like non126 mmol/L; chest and spread via other reactive mediators from PMNs specimen, alcoholics, or Xray shows bilateral airborne routes; and Tcells that inflict lung damage -sputum cultures, immunocompr quinolone) pneumonic illness -- no legionellos lobe patchy NOT personhost response leads to patchy diffuse direct antigenin msed (esp. {penecillin pneumonic infiltrates, is (interstitial) infiltrates person infiltrates on chestxray urine** key COPD) resistant} 1%fatality pregnancy--> spont *painful, itchy abortion, prematurity, and vesicular sores on cong neonatal herpes; shaft of penis (anus if delivery during active *individual must be actively schedding oral sex, women:on sexual contact virus to be contagious; contact with Tzanck smear, oral genital infections are high cervix and vulva), and vertical mm or open skin; primary lesions are cultures for HSVacyclovir risk; tx acyclovir for last headache, transmission cytolytic (mucocutaneous epithelium), 2 and Haemo for first4wks of prgnnc to decr risk; unprotected sex 3 d during viruses travel to few sensory neurons-- dur, direct episode complications: meningitis in prior, inguinal adults with decrease cellgenital pregnancy to transient suppression, recurrent fluorescence unprotected and herpes lymphadenopathy newborns disease Abtst sex recurrences med immunity 16 & 18, unprotected carcinoma HPV sex; risk for genome integrated into host cervical cell DNA, proteins E6&7 carcinoma if physical tx inactivate tumor supresor infect squamous epithelial cells, not Pap smear, sex before 15, (cryotherap proteins p53 and cytolytic, infected cells--> high degree ELISA for HPV multiple y, laser retinoblastoma (rb) *small, raised lesions of nuclear atypia, perinuclear clearing IgG,DNA therapy) partners, ***vaccine against type on cervix, friable, and shrunken nucleus; proliferatiion hybridization, smoker; and 16,18 (dysplasia) and 6,11 eyrthematous cervix; and thickening of basal layer rapid plasma chemicals (warts) has been approved prevent with HPV Pap--> atypical cells genital contact -->appear as wart reagin regular Paps to rid warts for young women updated 06/22/2011 22:42:26

MicroCases

MicroCases Organi sm MicroBio Properties Disease central icosahedral nucleocapsid, enveloped, ssRNA with surface spikes on envelope containing Rubella hemaglutanin. One ONE German Virus serotype Measles Susceptible / Identification/ Resistant Key Diagnostic Persons Signs/Symptoms Transmission Pathology (mechanism) hematog spread, replicate in isolation of virus from nasophar droplet spreador reticloendothelial sys; febrile state; *low grade fever, direct contact virus-specific T cells attack virusswab and urine; serology for IgM lymphadenopathy, with pts, vertical infected vascular endothelial cells of diffuse maculopapular transmission to dermal caps (rash) and vasculitis may for acute => febrile exanthem illness (prodrome infection and rash over trunk and cong rubella susceptible if extremities syndrome fever then rash for 3 days) IgG not veccinated

Treateme nt & Preventio n Special Features but still imported; humans supportive are only nat'l hosts, causes care; live Congenital Rubella vaccine (no Syndrome in first trimester immunoco (malformation possible, mpromised confirm with IgM in baby, pts) Doxycyclin IgG can be only from mom!) most common vector-borne infection; 1)early Dissem LD (stage2): arthralgias, meningitis, CN & perif neuropathy, 2)Late D (stage 3): arthritis, numbness, pain, Bell palsy, chronic encephalomyelitis

spirochete, flexible, motile bacterium; grown only in BSK Borrelia media; ***infection is burgdor not immediate following Lyme feri tick bite! Disease

*fever, myalgia, arthralgia, expanding erythematous skin Black-legged igrans (lesion) under ticks (Ixodes axilla scapularis)

live in tick midgut and become Serologic activated during blood meal, migrate (ELISA-to salivary glands and incoulated in >Western Blot), host; cutaneous migration--> erythema PCR for target migrans; several weeks for sero(+) DNA in urine, response,many false negatives, blood, synovial humoral response may make autoAb(!) fluid

long, thin motile Leptospi spirochetes with ra hooked ends** use interrog darkfield microscopy, ans G(-), >200 serotypes,

hooked ends are adhesion factors, and use flagella to burrow into tissues; multiply in blood stream-->bacteremia to cause flu symptoms; second "immune" with vasculitis and conjunctivitis; dir cell cytotoxicity=> *high fever, myalgias, indir contact endothelial damage; can go to aspetic severe headache, with urine of meningitis, renal failure, severe leptospiros erythematous and infected animals hemorrhages and hypoT with vascular is swollen conjunctiva (rats) collapse (Weil syndrm)

cultures of blood, CSF, urine; serology for IgM and microagglutinati on test

*cough for more than 2 wks, turn blue after seris of coughing small, nonmotile, spells--> vomit; Bordetel aerobic Gram(-), paroxysmal cough, la nutritionally fastidious, pertussis whoop, post-tussive respiratory route pertussi require special growth (whooping vomiting; CXR reveals of respiratory s media cough) no pulm infiltrates droplets require (X) heme and (V) NAD factors; polysaccharide capsule (grp 1; /s = grp2, nontypable H inf NTHi); acute H. inf type B (HiB) has exacerbati *low fever, productive Haemop polyribitol phosphate on of (yellow, green hilus capsule and was (in chronic sputum) cough, SOB, dir contact with influenz past) major invasive bronchitis hx of COPD; no respiratory a pathogen (AECB) infiltrates*1)dry droplets progress on CXR cough-->produc--> clear sputum, pharyngeal erythema, min cervical wall-less bacteria; no adenopathy but no gram stain; outermem "walking exudates; *2)CXR Mycopla has CHOLESTEROLS; pneumonia patchy infiltrates sma culture on Eaton's agar " primary *3)no bacteria on pneumo (not useful in atypical smear *4)no response nia identifying) pneumonia to beta lactam Atbtcs

attach to resp cilia in nasoph, end up in Direct bronchi/oles; non-invasion; toxins fluorescence ab paralyze cilia: irreversibly inactivates (DFA) of nasoph; Gi-protein complex via ADP culture of ribosylation--> stimulation of adenyl nasoph cyclase and increase in cAMP(--> cell secretns, PCR of protein kinase activity); tracheal swabs or cytotoxin, hemolysin aspirates

increased # of NTHi, S. pneu, M. catarr.--> COPD exacerbations; IgA protease assoc with NTHi for colonization in respir mucosa; NTHi have low path, but=> acute exacerb of gram stain and COPD (excessive tracheobronchial culture sputum, mucus production) blood cultures

e; prevent by protective measures against insects; doxy right after tick *summer, NE- bite--> can prevent LD MW USA IV penicillin); prevent with avoidance of exposure to water sources that may recreational be exposures in contaminat rafting, ed and kayaking, wild vectors like reservoirs rats care (suction of mucus, pressurized O2); macrolide b4 cough= abort/elimi infants are high nate risk pertussis disease in adults, grp 1--> children; no macrolides, NTHi vaccine; cephalospo conugate HiB rins vaccine (severe= **reduced parenteral invasive 3rd gen disease due to cephalospo this pathogen** rin) quinolones, tetracycline s, macrolides (erythrocy/ doxy**), don't use wall inhibitors!

Zoonotic disease in subtropical world;

premature infants and pts with cardiac/pulm/neuro disease are high risk for complications (pneumonia, seizures, encephalopathy, death); acellular pertussis vaccine is part of DTP Complications: 1)otitismedia/sinusitus (nasoph-->midear or sinuses) 2)epiglottitis 3)meningitis (fatal if untx) 4)pneumonia; in COPD, commonly see triad Strp. pne, Mor catar., H. infl common community-acqu LRTI in adults; complictns: 1)tracheobronchitis 2) heart problems 3)neruo 4)extensive rash (in mm=erythema multiforme) "Stevens-Johnson" 5) digital necrosis ; can be fatal in elderly

gram stain of resp specimen in lower tracts, adhesins allow and blood person-person colonization and inhibit ciliary culture; cold by inhale aerosol movement--> prolonged cough; agglutination; 4particles or produce H2O2 which is cytotoxic; stim fold rise in IgG contact /c IgM autoAb (ex: erythrocytes) detected ab over 2secretns as cold agglutinin 3weeks

risk 5-20 y/o; outbreaks are common in crowded military and institutional settings

updated 06/22/2011 22:42:26

Organi sm MicroBio Properties

Disease

Signs/Symptoms

Transmission

Neisseri a meningi tis

Cytome galoviru s

Gram (-) diplococci, surface capsule (antiphagocytic), outermem lipooligosach (LOS)-assoc endotoxin=virulance factors; oxidase(+), fermentation of glucose and maltose herpes virus, antigenically diff from other herpesvv, infected cells--> cytomegalic (giant) cells, with intranuc and intracyto inclusions which contain viral particles in target organ; can be cultured form urine, throat swabs, biopsies

*fever, chills, severe headache, purpuric skin rash on extremities, hypotensive, stiff meningoco neck, high WBCs, also person-person ccal in CSF with glucose via respiratory meningitis (could have N/V) droplets *persistnt high fever, dry cough, worsening SOB, acute myelogenous leukemia Dx 6 mos before, received allogenic bone marrow transplant CMV 6wks before; lowWBC, pneumonit CXR: bilateral is interstitial infiltrates

Treateme Susceptible / nt & Identification/ Resistant Preventio Key Diagnostic Persons n Pathology (mechanism) Special Features congenital deficiency of Penincillin terminal complement components (c5-9) G (can penetrate predisposes individuals to ~; could be blood&meninges or inflamed meninges); only blood; rapidly polyvalent progressing lethal disease incubate 2-10d; 1)nasoph colonizatn vaccine vs due to shock/cardiac failure; possible complications:MR, (IgA protease helps) 2)bact invasion capsular of/survival in blood stream 3)penetrt bWinter months, polysacch deafness, hemiparesis, arthritis,ischemic necrosis; bbarrier, egress to CSF 4)local release common in grps of pyogenic inflamm cytokin in CSF sporadic cases, A,C,Y,&W13 adrenal gland failure in 5)adhesion of leukocytes to brain school, 5 for kids kids--> bleeding into ad endothel and diaped into CSF Gram stain & institution >2y/o; NO gland "waterhouse6)exudation of albumin thru opened culture CSF, groups; risk vaccine Friderichsen syndrome"; Purpuric rash looks just intercell junxns of meningeal venules blood cultures, with functional for 7)brain edema, inc cranial pressure, direct ag or anatomical serotype like rocky mtn spotted fever!! altered cerebral blood flow detection asplenia B

MicroCases

West Nile Virus

Campyl obacter jejuni

Salmon ella typhimu rium

Gram stain, acid-fast, silver stain; virus isolation form bronchlavage, CMV ag detction in serum, CMV DNA detection by PCR neurotropic virus in CSF, direct cryptococal ag transmitted bite by infective mosquito, replicates in in CSF, among wild birds lympathic cells of reticuloendotheilial **required!! *fever, headache, by mosquitoes of sys--> 1ry viremia, in eldery and **specific IgM in vomiting, weakness, genus Culex, immcmpsd, viral replicatn in blood to CSF or acute flavivirus of Flaviviridae confusion, coarse emerged in hematogenous dissemination to serum, arboviral family (Japanese tremor in chin, upper, N.america in localize 1rily in CNS; brain IgG or PCR am encephalitis antigenic lower extremities; recent yrs pathology=scattered microglial of DNA from CSF complex), env, encephaliti Brain MRI: inc signal (ANOTHER nodules and perivascular inflmtry to rule out HSVicosahedral, (+)ssRNA s in basal gangli AVIAN VIRUS!!!) infiltrates 1 (comma or sea-gull low infectious dose (500), 2-5d shaped), virulence= incubation, colonize the intestinal flagella; growth mucosal layer mediated by flagella; enteric bact. requires selective *severe abdominal acute nonspecific neutrophilic and Culture, wet improper food mount exam to media, microaerophilic campyloba cramping, diarrhea, monocytic inflam reaction causing conditions, incubate at cter gross blood in stools, handling and damage in jejunal epithelium (similar rule out enteritis low fever, prep of poultry to Crohn's and ulcerative colitis) parasitic causes 42C 2 d of low fever, 10^5 (gastric acid sensitive); adhere Gram (-) rods, undergo abdominal cramps, poultry, eggs, to distal portion os S. int; localized phase variation to make dairy products, invasion in intestinal epithelial cells; vomiting, diarrhea, new substrains, motile, dry mucous pet repiles?; overwhelming influx of neutrophils to stool cultures on all serotypes except S. aquired by selective media, membranes, difuse the intestines; invasion into blood typhi are abdominal ingestion of stream; LPS and cytokines mediate blood culture noncapsulated, do not salmonella tenderness; contaminated systemic inflamm response syndrome (febrile and ferment lactose enteritis leukocytes in stool food (sepsis) sepsis?) most common post-transplant infxn; if healthy pts who acquire post birth,few symp, no long-term consequences; multiple cell types and various organs are targeted, characteristic ability to remain dormant; lung biopsy=> cytomegalic inclusions with surrounding halo ("owl's eye")

close contact with person excreting virus in saliva, urine or other body fluids (transplanted organs), breast milk, STD,

Ganciclovir /c/s most common postantiCMV Ig transplnt infxn; for complications: 1)congenital immcmpsd; (part of TORCHES-List) Foscarnet 2)infectious mononucleosis risk: immfor 3)infectious colitis, supprssd, AIDS, ganciclovir- esophagitis, (opprtnstc in fetuses resis strains AIDS) 4)Retinitis (in AIDS) supportive tx only; prevent by 1)detect presence of WVS in area 2)sustained immunocompro mosquito mised and control elderly at risk (eliminate for serious standing (if healthy, viremia=fever, infection H20, DEET) no CNS involved) IV fluid diarrheal illness in US; (self-limited sporadic cases; infection); complications: reactive prevent by arthritis with pts with ~ and prep of HLA-B27, or Guillain-Barre poultry syndrome (ascending properly muscle weakness) immncmprs d and neonates, >50y/o, Fluoroquino risk: pts with line should reduced gastric be second to Camp jejuni in acid considered foodborne disease;

updated 06/22/2011 22:42:26

Organi sm MicroBio Properties

Disease

Signs/Symptoms *severe abdominal cramping, watery diarrhea /15-30 min with gross blood; nausea *fever, jaundice, dark yellow urine, pale stools, sigh of good--> nauseated; hepatomegaly, no splenomegaly, ALT and AST very high

Transmission ground beef and unpastuerized milk (unpast apple cider); & fecal-oral fecal-oral (contaminated water and food, shellfish in Atlantic and Gulf coasts

Escheric hia coli O157:H 7 EHEC

indole(+), lactose (+), sorbitol non-fermenting, Enterohem Shiga-toxin producing, orrhagic E Gram (-) coli

small, RNA virus, ss(+)RNA, naked icosahedral, heat resistant; only one Hepatiti serotype and very hard s A virus to culture Hepatitis A (Orthohepadnavirus of Hepadnaviridae); large round bodies are full assembly viruses, enveloped, hep B surface antigen (HBsAg, part of vaccine--> protective neutralizing Ab), hep B core ag, hep B e ag (HBcAg and HBeAg) all three are Hepatiti specific Ab, diagnostic s B virus markers Hepatitis B

*fevers, chills, scleral icterus and jaundice, enlarged and tender liver, generalized itching, IV drugs use in past yrs, shared needles; high lymphocytes, really high ALT and AST; HBsAg in serum

parenteral (IV drug abuse, needles), sex contact, perinatal (vertical transmission)

*fever, sore throat, respiratory stridor, exudative pharyngitis, small, club-shaped bilateral cervical (coryne) G+ bacteria adenopathy (bull Coryneb with metachromatic neck), yellowish, acteriu granuels, catalase +, leathery, thick m immunoprepicitation on membrane on uvula diphther agar to detect toxigenic and s. palate, high ia strain of bug diphtheria WBC, really nigh PMN

exposure to upper respiratory droplets and direct contact with skin lesions

acid-fast bacteria, cell wall is 60% lipid, SLOW growing on selective Lowenstein Jensen agar, cord factor Mycoba (virulence)-cterium >serpentine colonies, tubercul LAM is big virulent postosis factor; obligate aerobes primary TB

*cough, weight loss, night sweats, coughing blood-tinged sputum, CXR: RU lobe infiltrates;

exposure to airborne organismis from symptomatic pt

Treateme Susceptible / nt & Identification/ Resistant Preventio Key Diagnostic Persons n Pathology (mechanism) Special Features stool cultures, states and Canada; toxin testing for complications: 1)hemolytic C diff, uremic syndrome (HUSmicroscopic Shiga toxin binds in kidney) virulence factors attach and efface Fluid and brush border of intest epithlium, loss of exam for electrolyte and 2)thrombotic protozoal agent microvilli, use phage-encoded Shiga replacemen thrombosytopenic purpura toxin, Sx last one week or stool antigens t (TTP) (both in young or old) microscopically from other ciral hepatides; HAV-specific cytotoxic T cells destroy virus-infected serology risk: travelers Passive immunization admin hepatocytes; IgM HAV ab present 5including to high/mod <2wks after exposure 10d before onset Sx, no longer hepatitis panel, endemic supportive prevents 80-90% cases; detectable 6mo later, chronic infection RT-PCR (HAV countries; treatment killed vaccine available with does no occur and no chronic carrier and HCV in children in day and IV immunity for 10-30yrs (2 state blood care centers fluids injections 6-12mo apart) for recent exposure; HBiG for post-exposur prophylaxis; in chronic HBV HBsAg and IgG HBcAb are incubation 45-210d, virus becomes detectable (for >6mos) blood borne producing sustained 1)chronic persistent hep viremia; virus-specific cyto Tcells risk: multiple (milder both s and c, no e) or responsible for clincal Sx and eventual sex partners, IV 2) chronic active hep resolution; appear: HBsAg first (then drug use, supportive, (jaundice, variable course, gone with recovery), HBeAg prevent in if chronic: death with s, c and high (transiently), IgM HbcAb at clinical serology, hospital by INFalpha, HBeAg, greater infectivity); onset and persistent for marker of past hepatitis proper needle lamivudine only Hep D found in pt with infection serology panel disposal or adefovir HBV antitoxin (equine) given within 4d onset illness, complications:1) if untx, antibiotics extend pseudmembrane into reduce larynx, trach-->air obstrxn, severity but 2)myocarditis with colonizes phaynx of healthy person, selective toxin: A part inhibits protein synthesis cultures(grew don't cure, arrythmias and circ collapse, prophylaxis 3)laryng nerve palsy while B part attaches to sell surface dark colonies on receptor, -->necrosis in resp tract-tellurite media), and vaccine ***vaccination does not >grey brown adherent ELISA, PCR, unvaccinated to those prevent an asymptomatic psuedomembrane monospot persons around pt carrier state*** antibiotics, 2. Longterm tx; isoniazid (INH), rifampin PPD skin test, risk: >3y/o, pt over 50y/o risk hepatic (RIF), small infectious inoculum, disease only gram/acid-fast adolescents, purasinami toxicity by INH; post-1ry TB-in higly O2 tissue, LAM: receptor to be stain of very old, imm de (PZA), >progress to miliary TB picked up by macrophage, cord factor secretions, compromised; theambutal (CXR: millet seeds scattered kills PMNS-->chronic granuloma encap cultures (broth BCG vaccine in (EMB); to tx in all lung fields),easily with fibrin (tubercle), heal by and agar for superendemic drug gotten in elderly, HIV, fibrosis/calcification;CXR: lobar (Ghon mycobacterial areas can help resistant tb immcompsd pts; untx infxn-focus), perihilar lymph node cultures), fungal but USA has use more > midthoracid vertebral involvement, reflects 1ry infxn; 90% serologies, low prevelence aggressive bodies (osteomyelitis) "Pott are latent infections-->reactivated fungal cultures rate rx disease"

MicroCases

updated 06/22/2011 22:42:26

MicroCases Organi sm MicroBio Properties

Signs/Symptoms *3mo Hx of fever, chills, green sputum, headache, antibiotics didn't help, COPD history and chronic steroids for 6mo; CXR: filamentous (beaded) Nocardi bacteria, aerobic extensive nodular a actinomycetes, weak infiltrates in R,M,Ulobes and aseroid G+ on acid fast stain, es grow slowly Nocariosis cavitary disease *3wk Hx of moderate filamentous, Gram +, fever, cough, SOB, wt non-acid fast, loss, draining lesion anaerobic, form dense on left chest wall with masses "sulfer yellow granules, granules"; "Molar tooth" severe periodontal Actinom colonies from sulfur thoracic disease, foul-smelling yces granules of draining actinomyc sputum, CXR: left lung israelii sinus**diagnostic osis infiltrates

Disease

Transmission

Pathology (mechanism)

Treateme Susceptible / nt & Identification/ Resistant Preventio Key Diagnostic Persons n Special Features

live in inactivated phagocytic cells; uncontrolled infection influding inhale inflammatory endobronchial masses or contaminated diffuse pneumonitis and abscess; CNS dust from soil normal flora of involvement is common oral cavity and orgs cannot cause infection alone, GI tract, need synergistic presence (who endogenous facilitate anaerobic growth), transmission polymicrobial infection--> with poor oral inflammatory response-->chronic, hygeine, women suppurative abscess spreads mainly by with intrauterine extension to other tissue planes contraceptive involving the chest wall forming sulfer devices granules that drain from sinus 3-8wk incubation period, severity of wound plays role in this and time it takes to get from bite to brain; viral glycoproteins bind Ach receptors, contributing to neurovirulence of rabies, moves up neuron, replicates exclusively in grey matter in brain--> travels down peripheralnerves to salivary glands and other; pathologic: intracytoplasmic inclusions "Negri urban rabies= bodies" in neurons; CD8 cells induced dogs; sylvatic by glycoprotein kill infected neurons, rabies= bats, or cause brain damage-->encephalitis; organtransplant painful swallowing= hydrophobia; apparently 100% fatal

pts receiving immsprsive (steroids) or gram/acid fact cytoxic drugs stains, cultures, and AIDS pts sputum smear are at risk

complications: Madura foot, SQ infection with slow Sulfonamid extension along lymphatics es to destroy deep tissue

examine sulfur granules in puss from sinus tract; gram stain, good hygeine tissue stain prevents

Rabies virus

nvCJD

*visual hallucinations, malaise, back pain, working on road-sidecleanup, muscle pains, vomiting, Rhabdoviridae family, hyperesthesi over bullet-shaped right side body, very nucleocapsid, envelope agitated, less and less glycoproteins are knoboriented, like structures, hydrophobia, mononegavirale, no rabies hypersalivation, wide cytopathic effect in encephaliti flucuations in body culture s temp and pressure able spongifor m *increasing encephalot forgetfulness (46y/o), pathy depression, sporadic, {new personality changes, famililal, variant abnormal proteaseincrease confusion, acquired, resistant conformer Creutzfeldt ataxia, extremities perhaps bovine protein PRPsc (lots Beta -Jakob movement tremors, neuronal sheets) of nl cell PRPc (Maddddd lived in UK, myoclonus products d Cow)} (alpha helices) when startled (hamburgers) activity, listless, dry oral mucosa, sluggish pupillary response, significant hypotonia, decreased oral intake, upper airway congestion, general irritability, no fever nor vomiting, 2wks ago->honey for constipation ingestion of honey; adult botulism from home-canned fruit (bulging cans); wound botulism when contaminated lesion

DFA staining of nuchal kin biopsy sections, RT-PCR of CSF, saliva, viral serology blood cultures, CSF examinination, culture, histopathology of brain biopsy or immunochemica l assay, PCR

prolonged high-dose IV penicillin then oral ampicillin for 6-12 mo, antivirals; prevent: preexposur e immunizati on (human diploid cell rabies vaccine), 3step postexp prophylaxis (clean wound, Ig, active HDCV)

risk groups to be immunized: vets, park rangers, peace corps members

conversion of alpha helix in PrPc to Beta sheet in PrPsc and deposition in brain tissue; only damage in CNS, 1) diffuse loss of neurona, 2) intense fibrotic gliosis 3) intracyto vacuolization (spongiform degen) 4) swellong of neruonal and astroglial processes ingest spores germinate in GI tract and produce neurotoxin (adults and older kids don't germinate spores); toxin absorbed and blood transports to peripheral cholinergic nerve terminals (NMJ, post-gang PS endings, peripheral ganglia); goes into cell, acts as zincmetalloprotease irriversibly prevents ACh from NMJ: DECSENDING FLACCID PARALYSIS

crazy kinds of prevent: sterilization: autocalve for don't eat 4.5 hrs, immerse in 1N beef brains NaOH 30minX3 therapy

Gram (+), sporeforming rod, anaerobe, potent heat-labile Clostridi neurotoxin causes um paralysis, distinguis A-G botulinu by antigenic specificity infant m of toxin botulism

with trivalent equine antitoxin blood culture, serum; no culture CSF, don't give antibiotics detect food-born honey to as can lyse toxin in stool, babies, don't bact and serum, eat food out of release implicated food bulging can more toxin

if unsure, treat as bact sepsis or meningitis until conclusive Dx; most frequent infant botulism! Bioterror potential; **Toxin is not in honey, SPORES are

updated 06/22/2011 22:42:26

MicroCases Organi sm MicroBio Properties

Disease

anaerobic G (+) sporeforming rod, Clostrix toxigenesis: produce um toxin A and B detected difficile by ELISA

large box-shaped G (+) rods, anaerobic, sporeforming, catalase negative, produce superoxide dismutase, Clostridi anaerobes which fail to um grow on solid media in perfring 10%CO2 in air, double ens zone of Beta-hemolysis

Signs/Symptoms (6- part of large Transmission Pathology (mechanism) cramping, diarrhea 9x/d) for 4d, skin has intestinal flora: decreased tugor, dry endogenous take clinamycin, cephalosporins, oral mucosa, was in infection in ampicillin which suppress other good hopsital for hip precolonized pt normal flora and C.diff can take over; replacement, had exposed to produce toxins A and B (B is worse) antibiotics or Clostridiu nosocomial which bind to GTP-binding proteins m difficile- pneumonia tx with exogenous which mess up cytoskeleton in epi transmission of cells--> mess up cell lining of bowel associated cefuroxime and diarrhea clindamycin (no Sx in spores in wall and cause erythrmatous friable wife) hospital (CDAD) colonic mucosa carcinoma, 2d later severe pain at surgical wound site, local part of normal cellulitis with progression to gas edema, tenderness, flora, only gangrene; removing solid tumor aids in thin brownish pathogenic when movement of these guys into discharge, local leave niche of anaerobic environment, smtms with discoloration of skin, colon and find fact aerobes who help rid of O2, can hemmorhagic bullae, anaerobic place; live in essentially any tissue, seroganuineous exogenous toxigenesis at new location; Clostridial discharge from infection when alpha-toxin is cytolytic owing to wound, affected soil activity of phospholipase C activity on muscles show failure contamination of cell membanes; yeild gas in tissues--> gas to blood, extensive deep wound crepitance ; muscle grows black and gangrene gas in soft tissues from trauma gangrenous normal barriers of appendix rupture,

Treateme Susceptible / nt & Identification/ Resistant Preventio Key Diagnostic Persons with n Special Features those txed clindamycin, cephalosporins, ampicillin are discontinue most at risk; offending prevent antibiotic exogenous and infections with supportive good hygeine tx; in hospital metronidaz personnel ole

detection of toxins in diarrheal stool

complication: pseudomembranous colitis in untreated cases with multiple elevated yellowish-white plaques in colon

risk: pt with vascular stasis (inc risk for anaerobic infxn): gram stain, carcinoma, cultures, aerobic diabetes cultures, mellitus, anaerobic colonic cultures obstruction;

surgical drainage and debrideme nt; antibiotic therapy

C. perfringens is part of normal flora; C. septicum can often be cultured from septic patients with colon cancer or leukemic cecitic

*high spiking fevers, severe diffuse pain over lower abdomen, G (-), non-spore loss of appetite, forming, 1-2% normal anorexia, tenderness flora of GI tract, O2 polyin right lower quad of sensitive (anaerobic), microbial abdomen, rebound Bacteroi thick polysaccharide infection tenderness; CT: des capsule (LSP is (ruptured abscess in RL fragilis nontoxic) appendix) quadrant of ab fever, headache, muscle aches, indurated very tiny G (-), erythematous rash nonmotile and ulcerated lesion coccibaccillus, thin on right hande which polysach capsule, has not healed and fastidious pathogen on painful adenopathy in Francise chocolate agar, Dx by R axilla, lived in lla IgG-class Ab; LPS is Oklahoma and tularens major toxin in systemic skinned and tanned is infection; tularemia rabbit hides for fun

obligate intracellular parasite in two forms: 1)banana shaped tachyzoites Toxopla (proliferative) 2)slowsma growing bradyzoites gondii (cyst- asymp);

*severe headache, nausea, vomiting, seizures for past 2d, HIV past 3yrs, AIDs before this epidose, failing current AIDS antivirals, low RBCs, Toxoplasm CD4 64/uL, ringa enhancing lesions in encephaliti Lparietal lobe and s Rfrontal lobe on MRI

allow localized pocket of infection, synergistic presence of facultatic anaerobe is required to cause disease= redox potential lowered and allows anaerobic environment for B. Gram stain of endogenous fagilis, rapid molilization of PMNs, peritoneal fluid, infection spilling attracted by IL-8, but thick capsule aerobic and into peritoneum allows growth, use complement, but anaerobic from ruptured still grow, adhere to ICAM-1 in some cultures, blood appendix cells and abscess develops "walled off" cultures bite of infective ticks by direct skin contact potential bioterrorism extremely low infective does of 10-50 agent due to extreme organisms--> pepetrates skin-->3-5d incubate, ulcer has "punched out" gram stain, infectivity; easy appearance, transport via lymphatics, cultures, dissemination; LN become necrotic "ulceroglandular serology (rise in person-to-person type" can --> pneumonia, easily IgG class RARE confused with plague antibodies) ingest disseminate, receptor mediated pseudocysts in invasion, lives as INTRACELLULAR undercooked organism in phagosome (vacuole), meat (mutton, inhibit lysosome fusion, differentiate in pork, beef) this vacuole, divide rapidly, 2)accidentaly (immcmptnt pple have humoral and ingestion of CMI to slow dividison down), in material immnocomprsd pts, intracerebral mass contaminated lesions, if less than 200CD4 with cat feves bradyzoites reactive and trasnform into blood and CSF containing tachyzoites, replicatd tachysoites culture and CSF, oocysts; 3) rupture brain cells resulting in focal serology, transplacental necrosis, very high IgG v T gondii histology of crossing strongly suggests Dx brain biopsy

surgical drainage and debrideme nt; antibiotic therapy

risk: people in contact with wild animals in streptomyci those states n for 7-14d pyrimetha mononucleosis-like Sx, mine immunity screen of (reduce pregnany or child-bearing severity women is important 2) and length, congenital toxoplasmosis doesnt asymptomatic at birth but eradicate later get things like infection), chorioretinitis, epilepsy, tx in psychomotor retardation, neonates or brain may be damaged will develop causing hydrocephalus, congenital significant titer of IgM v T in AIDs patients toxoplasmo cord blood is indicative of are very at risk sis infection updated 06/22/2011 22:42:27

Treateme Susceptible / nt & Organi Identification/ Resistant Preventio sm Key Diagnostic Persons n MicroBio Properties Disease Signs/Symptoms Transmission Pathology (mechanism) Special Features tapeworm, attach and lives for years, c: CSF release eggs or gravid adult into feces, shunting if *severe headaches, adult pork tapeworm two gen seizures, high prevelance penetrate mucosa carry to circulation gram stain, acidhydrocepha uses scolex to attach recent immigrant from in Africa. Ingest into brain, deposited into cerebral fast stain of CSF, lus, parenchyma, mass effect of larval cyst culture blood praziquante can cause subQ masses, (suckers), long chain of Mexico, 12% uncooked or segments, mature eosinophils, CT: inadequately on brain causes seizures, appearance and CSF, l or ocular cystericosis, of scolex on MRI--> Dx, IgG v T.s. Taenia worms have male and neurocysti intracranial calcified cooked meat antibody risk around bad antiepilepti intraventricular cysts cause solium female sex organs cercosis cyst with larvae confirms clinical diagnosis sanitation, pigs cs hydrocephalus cutaneous 1)antiphagocytic acidic capsule, 2) two detection (contact with toxins: lethal factor, edema factor and infected animals, protective antigen (AB exotoxin), EF is gram stain and *fever, chills, malaise, bites, infective an adenylate cyclase targets culture of large, G(+) nonmotile anorexia, headache, flies), inhalation, macrophages; CXR is pathognomonic sputum, pleural spore-forming rods in dry cough for past 2d, gastrointestinal with widening of mediastinum with fluid, CSF, blood chains, aerobic, grow not orientated to anthrax pleural effusion without infiltrates (LF culture,direct well on blood agar, no place, person or time, (consume and EF are for cutaneous anthrax, antige ciprofloxaci cases must be reported Bacillus hemolysis on blood widened mediastinum contaminated detection, n and to local or state bacteremia can occur in all types of antracis agar antrax on CXR meat) B.a. and can lead to meningitis serology bioterrorism doxycicline departments of health *chicken-pox-like of smallpox, 2)early rash (contag) small red spongs rash, hx of vzv, fever, prolonged face- starts in mouth, skin, more on face and large, complex DNA headache, back pain, to-face contact extremities, palms, soles than trunk, virus, dumbbell shaped papulovesicular with someone bumps fill with thick stuff and at times Tzanck smear, core, complex lesions, bumpy lesions with it or direct have depression in it; 3)pustular rash EM examination no known Variola membrane system, full of thick opaque contact with (ctngs) firm pustules 4)scabbing of vesicular vaccinated tx but major linear dsDNA, major fluid, all at same infected bodily (contgs) 5) scabs resolved (not fluid, PCR, persons are vaccination virus and minor (mild) strains small pox stage in development fluids contagious) isolation of virus resistant will prevent last case in 1977 in Somalia nonmotile non*fever, weakness, a)antiphagocytic glycoprotein sporeformer, G(-), pain in left groin, b)protease to degrade serum all contacts bipolar ovoid "safety diarrhea, lives in complement c)coagulase d)exotoxin, blood cultures, with patient pin shaped" oxidase Arizona, left groin monocytes can carry them without bacterial should receive negative, ferment mass tender, small zoonotic destroying them, diffuse hemorrhage cultures of chemophrophyl Yersinia glucose and reduce hemorrhages on skin pathogen: bite of due to intravascular coagulation and lymph nodes axis of streptomyci pestis nitrates to nitrites plague of right leg infected flease vacular necrosis aspirate tetracycline n potential for bioterror Peyer's patches, migrate to terminal ileum into submucosal lymph nodes; *3d of shaking, chills, survive and multiply in macrophages, high fever, diarrhea, infiltrate mononuclear cells into colonic 3wk visit to India, mucosa-->enteric fever; resist tachycardia, diffusely phagocytic killing by capsular Vi tender liver and antigen; facultative intracellular abdomen, microbes carried to liver and spleen; Gram (-) rods, erythematoud LPS--> systemic inflammtory response Chloramph facultative anaerobes, maculopapular lesions (septicemia); "rose spots" from culture blood, enicol, Salmon no not ferment lactose, ("rose spots"), low thrombocytopenia and leakage; stool, viral risk in ampicillin, these guys are resistant to ella encapsulated with "K" typhoid WBCs, platelets; XR: evenutally reenter intestine to cause serology, blood international TMP/SMX or bile!; 5% of infections lead typhi antigen fever hepatosplenomegaly in Asia, Africa, fecal-oral diarrhea smears travelers cipro to chronic carrier state Latin America since '61; O:1classica biotype replaced O:1 El Tor biotype; ingest contaminated water, food **consume raw shellfish Hypochlorhydria is a significant risk factor; V.c. needs big inoculum since its not acid resistance; colonize via long pili; uses AB enterotoxin--> A activates adenyl cyclase cascade system (B attaches)-->raise intracell concentration cAMP which inhibits absorptive Na and activates Cl- (water follows)--> rice-water stools rehydration , especially electrolyte risk: pts with replacemen microscopic achlorhydria, t; exam of stools, taking doxycycline fecal cultures, antacids, rx is only of (20-50% of untreated tests for enteric that reduce secondary cases die due to virus gastric motility value dehydrattion)

MicroCases

comma-shaped, G (-) rods, highly motile, oxidase +, facultative anaerobes, agglutinate Vibrio in 0:1 antiserum; cause cholera of epidemics and e pandemics cholera

*trip to Bandladesh, profuse watery diarrhea, rice-water stools, on H2-blocker for ulver

updated 06/22/2011 22:42:27

Organi sm MicroBio Properties Gram + cocci, grapelike clusters, resistant Staphyl to high salt ococcus concentration, heataureus stable enterotoxins

Disease

food poisoning

Signs/Symptoms *ill in 3hrs of eating meal, nausea, vomiting, crampy abdominal pain, precooked packaged ham, served cold at the party next day

Hepatiti sC Virus

Listeria monocy togenes

Brucella meliten sis

*routine physical after many years: elevated Flaviviridae, enveloped, transaminases, blood icosahedral capsid, ss- HCV transfusion 25yrs poly-adenylated-(+)RNA hepatitis before fever, headache, Gram + small rods with confusion, history of rounded edges, Rheumatoid arthritis, facultative anaerobe, taking predinisome narrow zome of Beta daily for past several hemolysis, motile, months, nuchal "tumbling motility" in Listeria rigidity, no focal wet mounts poor-staining, small G(-) meningitis neurological defects sweats, 30lb wt loss, coccobaccillus seen as depression, pain in single cells appearing joints, esp. lower like "fine sand", back, recovered from blood, lymphadenopathy, after prolonged splenomegaly, incubation, on blood tenderness in agar--> colonies are sacroiliac joint, drank small convex nonunpasteurized goat hemolytic translucent brucellosis milk

herpes family, dsDNA, ability to persist indefinitely in latent form after acute infection with subsequent Epstein- reactivation, oncogenic Barr virus with tropism for B virus lymphocyte IM

*college student, fever, sore throat, kissing in history, enlarged tonsils with exudates, posterior cervical lymph nodes enlarged/tender, hepatosplenomegaly, faint jaundice, 12% atypical lymphocytes in hematology

Treateme Susceptible / nt & Identification/ Resistant Preventio Key Diagnostic Persons n Transmission Pathology (mechanism) Special Features ingesting food, search contaminated food handlers food (improper toxin in food, usually from human with skin proper food food-handling, infections and origin from purulent discharges of preparation inadequate infected finger or eye, abscesses, face, cultures of ; no tx, refridge, lesions, nasal nasal secretions; some toxins are maybe IV cooking) stable at boiling swabs fluids humans only, 14-180d incubation period; either parenteral (IV), asymptomatic or mild clinical illness permucosal (indistinguishable from other viral (sex), perinatal hepatites; usually resolve without contact, most sequelae or progression to chronic associated with disease; 50% end up as chronic carrier; serology, illegal injection to test for Dx measure HCVAb, or hepatitis drug use detecting HCV RNA with RT-PCR serology panel infections in CMI-deficient pts, induce host cell engulfment with "internalin;" risk: pregnant food-borne women, virulent strains produce listeriolysin O illness in adults and phospholipases (permit vacuole fetuses, and meningitis escape into cytoplasm); cell-cell spread CSF analysis, G neonates, ampicillin in newborns, soil via pseudopods which extend into stain and culture immunocompro with and animal adjacent host cells; "actin tails" CSF, blood mised pts, aminoglyco reservoirs cultures elderly side needed from spread as well zoonotic tiny inoculum (<100), opsonized upon pathogen: maintained in entry, survive phagocytic killing by suppression of doxycycline cattle, swine, dogs, goats, myeloperoxide/H2O2/SOD; with either disseminate throughout the body via skin tests (PPD, streptomyci complications: sheep; also aerosols are blood stream and multi-system etc), G/acid fast n or osteoarticular (sacroiliac, highly infectious infections; disease can linger for stains, cultures, rifampin for etc), genitourinary, orchitis, (bioterrorism!) months if not tx properly serology >6wks epididymitis, endocarditis enter oropharynx, secondary infection HHV-6,7 3. gammaHHVs: of Bcells, during latency, some Bcells EBV, KSHV; EBV go back to oropharynx and undergo complications include viral amplification; symptomology Burkitt's lymphoma in Africa depends on host immune response--> supportive and nasopharyngeal subclinical in kids (big cytotoxic T cell care; carcinoma in Asia, CNS response CTL) or in adults (tired steroids in lymphoma in AIDS pts with salivary immune system) with more symptoms; cases of low CD4 (brain lesions), OHL secretions; CTL are in peripheral (some with airway oral hairy leukoplakia subclinical suppressor and cytotoxic duties)--> thoat cultures, obstruction, (acanthosis (thicker epi), infection in kids, atypical cells; blood shows IgM to VCA HIV viral load, thrombocyt koilocytic changes "IM" in 15-20y/os and long lasting IgG, also heterophile monospot test, openia, (perinuclear vacuolation in (industrialized Ab (for MOnospot) vs RBCs of other EBV and CMB hemolytic epi), Non-Hodgkins countries) animals serology anemia lymphoma

MicroCases

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MicroCases Organi sm MicroBio Properties

Disease

Signs/Symptoms

Transmission

*67y/o abrupt onset shaking, chills, fever, rust-colored sputum, diabetic, 2pack/d smoker 20yrs, no vaccinations in 20yrs, G(+) lancet shaped dullness to percussion Streptoc diplococci, alpha in RU thorax, occus hemolytic in blood agar, pneumoco 24%band neutrophils, pneumo catalase (-), optochin ccal CXR: consolidation of nia sensitive, 23 serotypes pneumonia Rulobe short, plump G(-) rods, lactose fermenting, *66y/o cough, fever, urease (+), indole (-), chest pain, homeless, non-motile, prominent 2pts vodka/d, polysaccharide capsule worsened over 1mo, Klebsiell (77 "K" ag) is a major blood-tinged (currant a virulence factor and jelly) sputum, Rulobe pneumo antiphagocytic, LPS has bacterial infiltrate with cavitary nia lipid A endotoxin pneumonia lesion

Pathology (mechanism) host defenses to clear bacteria 4. Bacterial proliferation 5. Inflammatory response--> pathology; S.p. make IgA protease that cleaves human IgA--> easy mucosal colonization, polysaccharide capsule is major risK: AIDS, virulent factor and antiphagocytic; lung asplenia, pathology: a) congestion (serous influenza, exudate, vasc engorgement and bact sickle cell, proliferation) b) red hepatization (liver multiple like appearances in lung, alveoli with crowded myeloma, conditions, PMNs, congestion, RBC extravasation-alcoholism, aerosol, most >red sputum) c) grey hepatization smoking, common (accumulate fibrin, inflammatory CXR, Gstain diabetes, community exudates) d) resolution (resorb sputum, cultures hypogammaglo exudate); intraalveolar exudates--> of blood and acquired bulinemia, pneumonia spread until entire lobe is sputum, nephrotic consolidated impaired host defenses serology (CAP) syndrome associated with in alcoholics, aspirate, K.pn have part of intestinal capsular polysaccharide (CPS) as main flora of humans, virulence (inhibits complement), acute oropharyngeal inlammatory infiltrates from bronchiles colonization and into adjacent alveoli, cause bronchopneumonia--> lung abscess aspiration; common results in necrotic destruction and blood cultures, cavity formation with blood-tinged nosocomial sputum Gstain pathogen sputum like Mo, dendritics, Bcells) by and cultures risk: alcoholics marker binding gp120 to CD4 and costim CXCR4 or CCR5 2) integrates genome into host's 3) burst of viremia in early acute infection 4) mono-like infection acutely 5) clinical latency (not viral latency; always active replication) 6) chronic infection leads to depressed immune system susceptible to 7) opportunistic infections and AIDs defining illnesses

Treateme Susceptible / nt & Identification/ Resistant Preventio Key Diagnostic Persons n Special Features

penecillin; prevent by immunizati on in risk grps (23 caps types) piperacillin, some have plasmid Blactamase, so use cephalospo rin with aminoglyco side RTIs (AZT, ddI, lamivudine, NNRTIs (nevirapine ), Pis (ritonovir, saquinovir, indinavir)

complications: acute otitis media, acute exacerbations of chronic bronchitis, empyema, bacteremia (+blood culture--> cardiac failutre and death), endocarditis, meningitis (most common adult meningitis)--> neurologic sequelae complications: bacteremia (endotoxin mediated sepsis), nosocomial infections associated with K.pn: respiratory tract manipulations (tracheostomy), UTI, wound infections, intraabdominal infections

Human immuno deficien cy virus type 1

lenti-virus family, cytopathic virus, capsid, matrix, envelope, gp120 made of three gp41, includes RT, integrase, protease HIV-1

*27y/o male: fever headache, sore throat, malaise over a week and rash, unprotected permucosal sex with other men; (sex), parenteral cervical and axillary (IV drug use), lymphadenopathy, vertical (in diffuse maculopapular utero) rash transmission *42y/o man with fever, muscle aches, malaise, SOB, rural caming in New Mexico, deer mice around tent, LOW BP, 22% band neutrophils, low platelets, CXR: bilateral interstitial infiltrates *fever, cough, myalgias, mild SOB,diarrhea, in contact with people in severe resp illness, CXR: bilateral lower lobe interstitial infiltrates

bunyavirus family, rodent borne, enveloped spherical Sin virus, genome of 3segs, Nombre circular ss(-)RNA, virus helical nucleocapsid corona virus, large, enveloped, (+)RNA outer envelope has club SARSshaped peplomers associat "crown" appearance, ed single strand, virus in coronavi urine, nasoph aspirate, rus stool

hantavirus pulmonary syndrome HPS

rodent urine or droggpings in tight environment (tent), aerosols of virus for potential weaponization and bioterrorism large dropley aerolization and contact (direct/fomite) fecal-oral, mechanical transmission

incubate for 1-5 weeks, activated CD8 produce holes in infected pneumocytes, non-specific prodrome illness, followed by bilateral pulmonary infiltrates and respiratory compromise (like ARDS), thrombocytopenia, left shift (>15%bands), pulmonary edema and hemoconcentration

severe acute respiratory syndrome (SARS)

viral pneumonia encompassing the LRT, path: diffuse alveolar damage (DAD), multinucleated giant cells with no conspicuous viral includsions

serodiagnosis of HIV (ELISA->Western Blot), risk: those with plasma HIV RNA risky behavior by RT-PCR, cell (needle culture to sharing, differentiate unprotected from HIV1-2 sex) detection/ direct immunofluoresc nce Ab staining of naso secretions, G/acid stain resp secretions, sputum culture, serology, PCR from blood clots and lung specimens and culture, urinary ag testing for legionella, virus cultures, DFA of older and those nasosecretions, with underlying disease have serology, RTPCR poor prognosis

Opportunistic Infections: HSV1,2, EBV,VZV, CMV, Kaposis, JC virus, TB, MAC, treponema pallidum, candida albicans, pneumocystis, cryptococcus neoformans, histoplasma, toxoplasma, cryptosporidium

supportive with ventilator and vasopresso rs

supportive care

updated 06/22/2011 22:42:27

MicroCases Organi sm MicroBio Properties

Escheric hia coli

Trepone ma pallidu m

Neisseri a gonorrh oeae

Chlamy dia trachom atis

Trichom onas vaginali s

Pathology (mechanism) passage of bacteria, colonizating urinary tract from urethra to bladder; "P-fimbriae" and type-1 fimbriae allow adherance, local pyogenic infection leads to Sx, rare invasion of bladder and urethral mucosa; if untx, ascend to ureters and kidneys via flagella; urease Enterobacteriaceae family, G(-) rods, allows kidney stone formation by alkalinizing urine; hemolysin produced facultative anaerob, *25y/o sexually active ferment glucose, woman, dysuria, inc endogenous can cause damage, high fever, shaking chills, local flank or low back pain in oxidase (-), 1)somatic O frequency, urgency contamination more common antigen (LPS), 2)H uncomplic for 1 day, blood from sex, severe infection, white cell casts in in females due antigen (flagellum), 3)K ated stained clothes after improper wiping, urine mean pyelonephritis urine culture, to shorter antigen (capsule), UTI/cystitis urination etc (complicated UTI) urinanalysis urethra, etc lipoproteins are principal proinflam Tzank smear mediators of syphilis, 1)painless (HSV), serologic ulcer/chancer, evade immune tests, culture, 1) *31y/o fever, malaise, recognition and elimination by Ab by nonspecific rash, painless ulcers membrane rich in lipid; enter antibodies on vulva 1mo ago--> lymphatics and blood, 2) (cardiolipin), resolved, 4 sex maculopapular rash on skin, mm, 2)nontreponema lymph nodes, palm/sole rash, l screening RPR partners in mo; inguinal condylomata lata 3) (wks-yrs can be and VDRL, 3) fluorescence lymphadenopathy, obligate human latent) gummatous ulcerations, generalized rash on pathogen by cardiovascular problems, trep Ab-abs FTAAbs, 4) spirochetes, thinpalms and sloles, intimate contact neurosyphilis--> ataxia by tabes walled, flexible, spiral pustular cutaneous (sex), dorsalis, Argyll Robertson pupils 4) microhemagglut congenital by vertical transmission inin-T.p MHA-TP rods, only visible by lesions and transplacental dark-field illumination, secondary condylomata lata on (congenital) (S in (blindness, CNS abnlties, abortion or (specific stillbirth) antibodies) endoflagella syphilis her face torches) pairs of bean-shaped, G- in neutrophil on smear (dx), NO polysacch capsule but pili, cell-wall Lipooligosacch, outermembrane Gram stain and colonizes mucosal epithelium, binds culture proteins (OMP) for virulence, fastidous, *dysuria, yellowish columnar cells by pili and OMP, has IgA discharge, DNA penile discharge, protease, gonococcal OMPs (protein I) probe, direct multiple sex only grow on Thayer Martin medium, oxidase sexually active with strict human protect vs phagocytosis, local invasion antigen partners at (+), sugar fermenters gonorrhea several partners pathogen, sex around epi cells high risk infect minute abrasions on mm as inert detection *lower abdominal elementary bodies into columnar epi pain, vaginal cells (become cytoplasmic inclusion), discharge, dysuria, differentiate into metabolically active risk: young age obligate intracellular at first fevers, chills, multiple reticulate bodies, multiply by binary bacteria, energy sex partners, fission; proinflammatory cytokines intercourse, depends on cells (can't multiple sex reddened cervical os, released from destroyed cells, bring make ATP), serotypes D adnexal tenderness, neutrophils and mononucs--> gram stain, partners, IUD, to K considered STD chlamydia cervical motion STD, vertical progression to chronic inflammatory giemsa stain, tobacco pathogens PID tenderness transmission disorder with systemic symptoms DFA, cultures smoking foamy vaginaly found in vagina, cervix, urethra, motile (visible flagella), discharge with foul bladder, Bartholin and Skene glands, pear-shaped, odor, multiple sex may be asymptomatic carriers, or mildprotozoan, larger than partners, diffuse to-fulmanint inflammatory disease, PMNs, identified by macular erythematous incubate 4-28d, cause inflammatory gram stain, wet ameboid mobility, NO trichomoni lesion of the cervis direct contact reaction (vaginitis), numerous PMNs, mount of vaginal risk: multiple cyst form asis sex partners ("strawberry cervix") (STD) most men who carry are asymptomatic secretions

Disease

Signs/Symptoms

Transmission

Treateme Susceptible / nt & Identification/ Resistant Preventio Key Diagnostic Persons n Special Features

other E. coli infections: acute bacterial meningitis, oral pneumonia, intraabdominal amocicillin, infections, enteric infections, TMSXL, osteomyelitis, endocarditis, fluoroquinol sinusitis, skin/soft tissue ones, infections, septic arthritis

Benzathine penicillin G, or doxy, or ceftriaxone single injection ceftriaxone, also tx for chlamydia (doxy or in women: cervicitis, azithromyci pharyngitis, epididymitis, n) due to PID, gonoccocal coinfection conjunctivitis, disseminated rates gonococcal infections (DGI)

cefoxitin for anaerobes (concurrent vertical transmission: ) and doxy neonatal conjunctivits and (for chlam) pneumonia

metronidaz ole

updated 06/22/2011 22:42:27

MicroCases Organi sm MicroBio Properties

Disease

Signs/Symptoms

Transmission

Gram (+) cocci in chains or pairs, alphahemolytic, resistant to Optochin, nl human flora for some, multiple blood cultures Steptoc necessary to occus demonstrate viridans continuous bacteremia

*fevers, night sweats, fatigue for 3 wks, extraction of impacted wisdom toot recently, nativeno antibiotics prior, valve "splinter hemorrhage" normal flora of endocardit in nail, conjunctival oral cavity is petechiae (trauma) abdominal pain, watery diarrhea, gtes tenesmus and mucus in stool, stools became grossly bloody; rectal exam showed gross blood and was painful; XR show ulcers and direct or indirect bacillary erythematous friable fecal-oral dysentery mucosa transmision,

Pathology (mechanism) or S pyo or pneumo, large vegetations and anscesses--> fulminant) or 2)subacute bacterial endocarditis (SBE) with small vegetations on abnl valves {either a) native valve due to dental procedure trauma or b) prosthetic valve [staph] during surgery to place it}; can also have Native valve endocarditis when turbulence to the endothelial surface of the hearth which leads to minor trauma, deposit fibrin and platelets; transient bacteremia can lead to seeding of lesions with adherent bacteria; in addition, pathology in else organs results in deposition of circulating immune complexes; IVDU: right-sided disease usually with tricuspid valve; "Janeway" lesions (small erythematous lesions on palms or soles), "Osler nodes" (painful raised lesions on finger and toe pads), echo, blood "Roth spots" (retinal lesions), "splinter cultures, hemorrhages" on nail bed serology very low infectious dose necessary, in colonic mucosa invasion breaks through M cells, go into macro, local spread with breakage of tight junctions, etc; when enough invaded cells die owing to intracell multiplication of bacteria, colonic mucosa sloughs off causes an ulcer; in severe forms Shiga toxin contributes to severity of S. dysenteriae; inflammation in stomach (chronic gastritis) with immune response 4) rare spontaneous clearance; cloud of ammonia with buffering function from urease activity; virulence factors: vacuolating cytotocin VacA and cag pathogenicity island; path includes mononuclear inflammatory cell infiltration associated with neutrophilic infiltration into lamina propria; host response includes IgG response, they evade elimination by virtue of protected location

Treateme Susceptible / nt & Identification/ Resistant Preventio Key Diagnostic Persons n Special Features

bactericidal drug (48wks of IV) (pen G for strep viridans); prevent by antibiotic prophylaxis for GI endoscopy, biopsy, urologic procedures, dental procedures

nonmotile, noncapsulate, Shigella facultative anaerobes, flexneri do not ferment lactose

Helicob Gram neg curved rod, ater urease producer, pylori microaerophilic

St. Louis virus arbo-virus; flavivirus

Fluid and electrolyte replacemen culture fecal t; antibiotic specimen, toxin tx may testing for C. reduce diff, microscopic number of exam for ova organisms and parasite, but isn't colonic biopsy necessary two antimicrobi als with PPI *54y/o /c abdominal for 2-4wks pain worsening over (metro or 2wks, improved after tetracycline meals or taking histologic or antacids, occassional (biopsy amoxicillin heartburn, worked endoscopic), with under stressful some pple nlly culture results, risk: increasing clarithromy conditions; carry it, fecally fecal ag test, age and poor cin and peptic midepigastric contaminated 13C urea-breath socioeconomic omeprazole ulcer tenderness water test, serology conditions (PPI)) cultures for neurotropic virus in CSF, *July, 61y/o homeless after mosquito bite, virus comes in man with fever, mosquito through saliva, enters endothelial cells, direct cryptococcal ag malaise, worsening transmission localize in vascular endo, replicate prevent: heahache, nausea, (mosquitos feed there, primary viremia--> lovalizes in in CSF, viral minimize serology looking St. Louis vomiting, slight on viremic birds endthelial cells in brain or choroid standing encephaliti tremors on face and then infect plexus--> virus-Ab complexes may for IgG or IgM, water; tx: complications: CN palsies, s extremities humans) trigger complement activation process PCR amp of CSF supportive hemiparesis, convulsions,

updated 06/22/2011 22:42:27

MicroCases Organi sm MicroBio Properties icosahedral nucleocapsid, linear dsDNA genome, lipoprotein envelope, multinucleated giant cells, latency is characteristic feature of HSV-1 all herpes viruses

Signs/Symptoms *changes in personality, more irritable and confused, fevers, headache, leftsided weakness, herpes simplex seizure, head MRI: encephaliti hemorrhagic necrosis s HSE in R temporal lobe fever, chills, pain while walking, spreading boils on L leg, painful, tender boils, warm, red Gram (+) cocci in multiple necroticgrapelike clusters, appearing lesions on catalase (+), colonies left leg; SED rate, XR: are beta hemolytic and soft-tissue edema, Staphyl pigmented on blood bone scans of the lef ococcus agar, coagulase activity osteomyeli show intense uptake aureus (clot plasma) tis in proximal femur

Disease

Transmission

Pathology (mechanism) exposed person's entire life, either in trigemincal ganglion or autonomic nerve roots; reactivation may occur in older adults, cause direct damage (necrosis) to the brain parenchyma; close contact perivascular inflammation--> virus isolation (kissing) person hemorrhages in R temporal lobe--> from CSF, PCR of shedding virus; confusion and seizures CSF seed the bacteria in the bone by: hematogenous dissemination or local extension from skin infection; carriage in fibronectin-binding protein responsible anterior nares for colonization of organisms in skin (small portion of breaks; virulence factors facilitate population), invasion across mucosal barriers, either adherence to materials in extracell endogenous or matrix, evasion or neutralization of gram stain and contact with host defenses, destruction of host cultures, blood carrier tissues culture

Treateme Susceptible / nt & Identification/ Resistant Preventio Key Diagnostic Persons n Special Features

high dose acyclovir

risk: newborns, chronically ill, elderly, surgical wound infections

penicillinas e-resistant pen (CONDM), or vanco if resistant

updated 06/22/2011 22:42:27