IV. BACTERIOLOGY

MORPHOLOGY:

1. Cocci (Spherical)

Clusters: Staphylococci Chains: Streptococci Pairs: Diplococci

2. Bacilli (Rod)

May have SQUARE CUT ends Short round cells No clusters

COCOBACILLI Very short bacilli appearing like cocci.

3. Vibrio (Curved)

Bacteria w/ SINGLE TURN Comma shaped

4. Spirochetes (spiral)

AKA: SPIRILLUM Have regular / irregular shape May have hook on one or both ends Series of turns and twist

A. Gram Positive MO:

1. Staphylococcus:

1.1. Staphylococcus Aureus

MANNITOL FERMENTER Catalase positive Coagulase positive Normal Flora: Abundantly found in anterior nares (Nostrils) CM: Abcess formation / Suppuration Food Poisoning Toxin: ENTEROTOXIN SSxs: Nausea and Projectile Vomiting TOXIC SHOCK SYNDROME (TSS): Toxin: TSST 1 Assoc. with women in childbearing age who is regularly menstruating who uses: TAMPONS. Skalded Skin Syndrome (SSS) Assoc. with infants SSxs: Abnormal desquamation of skin. Osteomytis

1.2. Staphylococcus Epidermidis

Cant ferment Mannitol Porcelain white Catalase +, Coagulase Less virulent Normal flora: Skin Common contaminants of lab samples CM: Infections assoc. with implanted and prosthetic devices especially with young, old and immunocompromised.

1.3. Staphylococcus Saprophyticus Cant ferment Mannitol No visible rxn Catalase +, Coagulase Opportunistic Pathogen CM: Urinary Tract Infection in WOMEN who are SEXUALLY ACTIVE.

2. Streptococci:

2.1. Streptococcus Pyogenes CM: Pharyngitis (Bacterial) Antigen: M PROTEIN

M Protein Forms complex with antibodies.

Complications: Heart and Kidney: Peritonsilar Abcess Formation Otitis Media -> Mastoiditis Scarlet Fever Rheumatic Heart Disease. (Tricuspid valves) Acute post streptococcal glomerulonephritis SSxs: HEMATURIA, Hypertension

2.2. Streptococcus Mutans Dental carries

2.3. Streptococcus Agalactiae

CM: Neonatal Sepsis, Neonatal meningitis NF: Female Genitourinary Tract

2.4. Streptococcus Pneumoniae Unclassified / No group Lancet shape Encapsulated: QUELLUNG RXN. (+) CM: Bacterial Pneumonia, Typical Pneumonia Tx: Penicillin, Amoxicillin Alt: Erythromycin

3. Aerobic Gram Positive Bacilli

3.1. Coryne Bacterium Diptheriae Club shape Bacteria Metachromatic Granules: Babes Ernst Granules Chinese letters in appearance CM: Diptheria Toxin: DIptheria Toxin SSxs: Pseudomembrane Formation Formation of Gray patches (Necrotic Tissue)

3.2. Listeria Monocytogenes CM: GRANULOMATOSIS, Infantiseptica Meningitis

4. Mycobacterium4.1. Mycobacterium Leprae CM: Leprosy (Hansens Disease / Cutaneous Tuberculosis) 2 Types:

A. Tuberculoid: Lesions: FLAT lesions Lepromine test: (+) LOWER amt. of MO in the lesions

B. Lepromatous: Lesions: NODULAR lesions Well ventilated areas (Nasal Septum) Lepromine test: (-) HIGHER amt. of MO in the lesions

Tx: Dapsone (DOC) Rifampicine Clofazimine4.2. Mycobacterium Tuberculosis CM: Pulmunary Tuberculosis SSxs: Cough > 2 weeks Unexplainable wt. loss Chest pain Back pain Fever at night Hemoptysis -> Bright Red Dx:1. Chest X-Ray: Primary Infection: BASE of lungs Reactivation: APEX of lungs2. Sputum test / AFB test- 3 samples / day, 40 days3. Ziehl Neelsen staining method

3.1. Hot Method Carbolfuschin + HEAT + Acid alcohol + Meth. Blue VR: (+) AFB -> RED

3.2. Cold Method - Carbolfuschin + Acid alcohol + Meth. Blue

4. Culture: Lowenstein Jensen Media Lowenstein Jensen Media Former Dx of choice Very selective & expensive Extrapulmonary TB: Bone and Ovary5. PPD skin test/ Tuberculin test/ Mantoux test Interpretation: >15 mm Current infection Exposure Previous Infection Immunity Program: Directly Observed Treatment Short Course 5 Pillars:1. Proper recording2. LGU support3. Treatment partner -> RPh4. Proper tool for Dx5. Steady drug supply

5. Anaerobic Gram Positive Spore Formers:A. Bacillus: A.1. Bacillus AthracisA.2. Bacillus Cereus

B. Clostridium: Anaerobic

B.1. Clostridium Botulinum- CM: Flaccid Paralysis- Toxin: BOTULINUM TOXIN (Acts as a ligand)- MOA: INH. Of ACETYLCHOLINE- MOT: Ingestion of contaminated fruits and vegetables- Canned goods with anaerobic growth- Ingestion of HONEY: CM: Floppy Baby SyndromeB.2. Clostridium Tetani- CM: Spastic Paralysis- Toxin: TETANOPLASMIN- MOA: INH. Of: 1. GABA & 2. GLYCINE- SSxs:

Ophisthotonus Arching of the back Trismus* Lock jaw, Inc. Sensitivity to sound and light.

B.3. Clostridium Perfringens- Common in DB patients CM: GAS GANGRENE Liquefactive necrosis + Bacteria Toxin: ALPHATOXIN (Lecithinase)

B.4. Clostridium Dificile Pseudomembraneous colitis Drug Inducer

1. Common Clindamycin2. Other Cephalosporin

DOC: Tx: Metronidazole

B. Gram Negative MO:1. SpirochetesA. Treponema Pallidium MOT: Horizontal transmission (Sex) Vertical transmission (Congenital) Incubation Period: 3 weeks CM: PRIMARY SYPHILIS, Congenital syphilis.

A. Primary Syphilis: (3 stages)

1. Primary CM: Primary Hard Chancre Hard Chancre: Painless Ulcer Sore Swelling of Groin Area2. Secondary Latent Stage Can last from 3-33 years Asymptomatic Reactivation: Elederly Pxs, Immunocompromised3. Tertiary CM: Multiple organ damage GUMMAS FORMATION Permanent Ulcers CNS manifestations

B. Congenital Syphilis Transferred by the mother to the baby at: 2ND TRIMESTER OF PREGNANCY CM: Still birth If infant survives: Physical / congenital deformities fully observed at age of 2 HUTCHINSON TRIAD: Teeth: Hutchinson teeth Eyes: Interstitial Keratitis Ears: 8th CN deafness Saddle Nose Malberry Molars Scaphold Scapula Dx: Serology Prod Antibodies

1. Non Treponemal:A. VDRLB. RPR2. TreponemalA. TPHAB. ETA-ABS

Tx: PEN G (DOC) Alt: Erythromycin, Doxycycline, Tetracycline

B. Leptospira Interrogans CM: Leptospirosis Primary source: Rodents Transmission: Contact with contaminated soil, water and vegetables. Direct contact with LEPTOSPIRE urine.

2 Types of Leptospirosis:A. Amicteric NON LIVER involvementB. Icteric LIVER involvement SSxs: Jaundice, Hemorrhage, Proteinuria

Tx: Doxycycline (DOC)

C. Borrelia1. Borrelia Burgdorferi CM: LYMES DISEASE MOT: VECTOR: IXODES (Tick)2. Borrelia Recurrentis Relapsing fever2.1. Endemic Form Host: Rodents Vector: Tick2.2. Epidemic Form-- Host: Rodents-- Vector: Tick

2. NEISSERIAa. Neisseria Gonorrhea-Gram (-) Intracellular diplococcic-MOT: 1. Sexually Transmitted 2. Congenital Transmitted-Incubation: 3-7 days-CM: -opthalmia neonatumMx: 1% erythromycin/tetracyclineBefore: 1% AgnO3-OCCURS w/n 2 hrs-Gonnorhea: penile/ vaginal discharge(tab)-risk of infection (single intercourse)-women (50%)-men (20%)-PID (Women) pelvic

Inflammatory disease:*more common Chlamydia trachomatis-tx: DOC > cefixime-penicillin, ceftriaxone, ciprofloxacin-before: Spectinomycin

b. Neisseria meningitis ( meningococci)Charac: G (-) diplococcic-shape: kidney bean shapeCM: -meningitis-meningococcemiaTX: DOC > ceftriaxoneCefotaxime

-ONLY AG active against N. GONORRHEA

B. Bordetella Bordetella pertussisCM: whooping coughToxin: pertussis toxinMost infectious stage: Catarrhal stage-toxin productionCharac: -strict aerobe-Bordet. Gengou: Mercury drop/ pearl colony

4. Haemophilus

a. haemophilus influenza-most infectious: Type B-CM: -bacteremia-acute bacterial epiglottitis-acute bacterial meningitis-osteomyelititis-joint infections*-pneumonia

(2) encapsulated:-N. meningitidis-H. influenza

b. Haemophilus ducreyiMOT: Sexually transmittedCM: SOFT CHANCRE / CHANCROID-painful ulceration on the genitals

b. Chlamydiaea. Chlamydia

Chlamydia trachomatis-MOT: horizontal transmission-vertical transmission-Symptomatic: Men-Asymptomatic: Women-CM: Men conjunctivitus-prostitis-urethritis-epidydimitis Ophtalmia neonatorum-manifest w/n 3 days Common: pelvic inflammatory disease-tx: DOC > Tetracyclineb. Chlamydophilia Chlamydia psittaci-Source: Psittacine birds (eg: parrots)-CM: psitacossis

Chlamydia pneumonia-CM: -Bronchitis-Sinusitis-Pneumonia-Atherosclerosis (possible)

6. Mycoplasma and Ureaplasmaa. Mycoplasma pneumoniaeCharac: -small, pleomorphic MO-wall-less MO BUT they contain sterolsGram stain cant be used for DxDx: Dienes staining-VR: Fried egg colony-dark blue: center-light blue: periphery/ surroundingCM: -CAP (community-acquired pneumonia)-Atypical Pneumonia-walking pneumonia-can still walk but has feverTx: DOC > Tetracycline

b. Ureaplasma urealyticumCm: non-gonnococcal urethritis in MEN-lung infection/disease in INFANTS with low birth weight

7. Enterobacteriaceaea. shigella-CA: Shigella dysenteriae *-S. flexperi-S. boydii-S. sonnei-MOT: fecal oral :improper hand washing-CM: DysenteryS/sx: Bloody diarrhea with scanty stool & mucus-tx: -Mx: ORS-DOC > Fluoroquinolones; Ampicillinb. Escherichia coli5 STRAINS: ETEC Enterotoxigenic E. coliCM: Travellers diarrhea EPEC Enterohepatic E. coliCM: Infantile diarrhea EIEC Enteroinvasive E. coliCM: shigella like diarrhea EAEC Enteroagreggative E. coliCM: diarrhea commonly assoc. w/ AIDS PATIENTS EHEC Enterohemorrhagic E. coli-aka: 0157: H7-toxin: Shigatoxin/ Veratoxin-CM: > bloody coprius diarrhea (w/o fever)>HUS (Hemolytic Uremic Syndrome)

c. Salmonella typhi-MOT: Infection of contaminated food-poultry products (ex. Chicken, eggs)-CM: Salmonellolis/ bacterial gastroenteritis-S/Sx: abdominal cramps-body malaise

Typhoid fever-enteric fever-most severe salmonella diseasetx: DOC: Chloramphenicol

8. Pseudomonaceae Pseudomonas aeruginosa-obligate aerobe-MOT: Source/ inhibit soil, water, vegetation-CM: Infection in burn woundsodor: Sweet/ Corn taco/ Grape-like odorPigments: pyocyanin colonization/ damaging the endothelium and the tissues pyoverdin fluorescent pigment pyorubrin red pyomelarin black

9. Campylobacter & Helicobactera. Campylobacter jejuniCharac:Shape: -S shape-gull whing shape-comma shapeCM: -acute onset of abdominal pain w/ profused diarrhea with bloodTx: DOC > Erythromycin

b. Helicobacter pyloriCharac: Urease producer*ureaseUREA NH3 (alkalinize)

-CM: -peptic ulcer disease (PUD)*-Gastric carcinoma

2 TYPES OF PUD: Duodenal ulcer-90% of cases-relieve by food (pain) OBESE

Gastric ulcer-70% of cases

-Dx: Dx of disease ENDOSCOPY-Urea breathe test-culture-tx: a. Monotherapy-obsolete

b. Double therapy-seldomly used

c. Triple therapy-PPI + 2 ABX (Amoxicillin + Metronidazole)

d. Quadruple therapy-PPI + 2ABX + surface coating-Bisubsalicylate-Sucralfate

10. Vibrionaceae

a. Vibrio choleraCharac: -comma shaped-curved rod-*** actively motile w/ polar flagellum

MOT:-Ingestion of contaminated raw shellfish (Halophiles)

Toxin: Cholera toxinMOA: inc. in conc. CAMP inc. in Cl channelsCM: Rice watery stoolCulture: TCBS Thiosulfate citrate bile sucrose agar V. cholera yellow colony

Tx: Mx: ORS-DOC: Doxycycline

b. Vibrio parahemolyticusMOT: Ingestion of OYSTERCM: Cholera like diarrheaCulture: TCBS GREEN COLONY

c. Vibrio vulniticusCM: Severe wound infectionCulture: TCBS BLUE GREEN COLONY

V. IMMUNOLOGY

A. Introduction1. Immunity physiological process in w/c the body (SELF) recognizes itself from the nonself (foreign)

2. TYPES OF IMMUNITY Non-specific immunity does not require recognition-the response is IMMEDIATE-it does not result to anti-body production-not specific to antigen-it does not result to immunologic memory (non-repetitive manifestation)

Specific immunity-requires recognition-there is LAG TIME BEFORE THE RESPONSE-results to antibody production-specific to antigen-results to immunologic memoryB. Cells involved in immunity

1. Granulocytes (BEN)a. Basophils-present in allergic rxns-fxn: release of histamine granules*Mast cells-found in the visceral organs-fxn: release of histamine granule(BOARD EXAM: INTAL cromolyn sodium)

b. Eosinophils-present: Type I Hypersensitive rxn (allergic rxn) Helminthic infection

c. Neutrophils-fxn: 1 Phagocytosis-present: -bacterial infection-acute inflamm.

2. Agranulocytesa. Monocytes & Macrophages

Monocytes-immature/ young macrophages-NO phagocytic action Macrophages-mature monocytes-present: chronic inflamm.-fxn:-1 phagocytosis-Antigen presentation

b. Lymphocytes B lymphocytes (B-cells)-fxn: -Antigen presentation-Matures plasma cells (ABY production)-Memory cells-immunologic memory

T lymphocytes (T cells)-2 TYPES:a. Helper t-cell (CD4 cells)-fxn: Stimulate the production of B-cells & cytotoxic t-cells

b. Cytotoxic T-cell (CD8 t-cells)-fxn: binds to microbial surfaces and initiates an attack

C. Non specific immunity: 3 Types1. Inflammation2. Phagocytosis3. Complement system

3. COMPLEMENT SYSTEM-1 goal: create the MAC (Membrane Attack Complex)-series: C1 C4 C2 C3 C5 C6 C7 C8 C9

1. CLASSICAL PATHWAY-starts: C1-mediated by antibodies (IgG, IgM)

2. Alternative pathway-starts: C3-not mediated by antibodies

3. Mannose binding lectin pathway-starts: C4C2-not mediated by antibodies

D. Specific immunity

1. TWO TYPES OF SPECIFIC IMMUNITYa. humoral immunity-B cells- Antibody production

b. cellular- mediated immunity-T cells

2. LYMPHOID ORGANSa. primary lymphoid organs-fxn: maturation of lymphocytes-ex. Bone marrow B cellsThymus T cells

b. secondary lymphoid organs-fxn: activation of lymphocytes-ex: -lymph nodes (cervical, inguinal)-spleen-tonsils-peyers patches small intestines

3. Immunoglobulin (antibodies)

4. Types of Immunoglobulina. IgE-present in type I HS rxns (allergy)

b. IgM (malaki, mauuna)-largest immunoglobulin (Macroglobulin)-first to respond

c. IgG-can cross the placental barrier

d. IgA-secretory immunoglobulin found in body fluids & secretion: tears, saliva, sweat

e. IgD-no known function-found in B-cell receptors

5. Types of hypersensitivity rxnsa. Antibody mediated HS rxn: -Type 1, 2, 3

a.1 Type 1: Hypersensitivity rxn:-mediated by: IgE-aka: immediate HS rxn-ex: -allergic rxns-anaphylactic rxn-bronchial asthma

a.2 Type 2: Hypersensitivity rxn:-mediated by: IgG, IgM-Ig binds to the surface of MO-ex:

Erythroblastosis fetalis -Rh mother incompatible w/ the body Rh (-) mother; Rh (+) baby Rx: Rhogam

Graves disease Hyperthyroidism Antibody mimics the actions of TSH

a.3 Type 3: Hypersensitivity rxn-mediated by: IgG-antigen antibody complex formation-ex:-kidney acute postretococcal glomerulonephritis-arthus rxn

b. Cellular mediated HS rxn Type 4 HS rxn-mediated by: helper T1 cells-aka: delayed type of HS rxn-ex:-tuberculin skin tets-contact dermatitis