** The following are some of the charts that I made during my preparation for the Micro Shelf examination. Though they are NOT exhaustive, I would HIGHLY recommend MEMORIZING EVERYTHING in the Clinical Features, Pathogenicity, and Diagnosis columns since that will be the bulk of your block 3 and shelf examination. – OsamaNOTE: The highlighted text doesn’t necessarily reflect any high-yield material but is information that I had trouble memorizing.

Species (Type) Clinical Features Pathogenicity Epidemiology/Transmission Structure/Features Diagnosis/TreatmentChlamydia trachomatis 1) Inclusion conjunctivitis Non-

gonococcal urethritis; cervicitis; pain on urinating + fever + exudate 2) Lymphogranuloma venarum = Elephantitis due to swollen LNs3) Follicular conjunctivitis (Trachoma) = Inversion of eye-lashes corneal scarring + blinding

Obligate Intracellular aerobe

Elementary + Reticulate body

STD

Trachoma Hand to eye + Flies

Cell – Wall w/ muramic acid Cytoplasmic inclusion bodies

Treponema Pallidum 1) Non-tender chancer2) Maculopapular rash (on

extremeties) + condylomata lata + patchy alopecia

3) CNS inflammation

(Tabes Dorsalis); aortitis; gummas

Disseminated –

Notched Teeth + infectious rhinitis + Maculopapular rash

Obligate Extracellular Pathogen

Chronicity

STD

Transplacental

Gram (–) ve

Axial filaments

Spirochetes

REDO

Haemophilus Influenza 1) Otitis Media2) Epiglottitis3) Children meningitis4) Bronchitis5) Pneumonia

Polysaccharide capsule – Type B

IgA protease

Respiratory Droplets Gram (–) ve bacilli

Pleiomorphic

Chocolate Agar Factors X and V

Satellite Phenomenon – Staph Aureus

Diagnosis:Latex Particle Agglutination

Rickettsia Ricketsii Rocky Mountain spotted fever- Influenza-like

symptoms- Centripetally spreading

petechial rash (starts from extremities)

- Ankle + wrist swelling

Obligate intracellular aerobe

Vasculitis - invading endothelial cells

Dermacentor tick bite

Occurs in the Spring/summer

Gram (–) ve bacilli Treatment w/out confirmation

Serologic IFA test

Yersinia Pestis Bubonic plague - Rapid fever- Conjunctivitis

Facultative intracellular (granulomatous response) w/ coagulase

Reservoir: Zoonotic rodents

Transmission: Flea bite +

Gram (–) ve bacilli Diagnosis:Blood culture/LN BiopsyCoagulase (+)ve

- Regional buboes

Pneumonic plague- Patient-to-patient local

spread

Praire dog (disease ) – flea bites and gets it – coagulase causes the content to stick together and be regurgitated when biting the next person – infection spread – person has disease progression -- swollen LNs – axilla + groin – disseminated intravascular coagulation – blackening of peripheral digits etc. – person w/ disseminated disease can spread bug pneumonic plague

F1 envelope Ag inhibits phagocytosis

Respiratory droplets (human to human for pneumonic plague)

Bipolar staining

Treatment – Aminoglycosides

Vaccine: Army

Escherichia coli 1) UTI – Frequency, urgency, hematuria

2) Neonatal Septicemia/meningitis – K Capsule: important

3) Sepsis LPS – Lipid A – Triggers shock

4) Diarrhea ETEC, EHEC, EPEC, EIEC, EAEC, DAEC

ETEC: Mexico – Watery Diarrhea- LT toxin: Adenylate

cyclase- ST toxin: guanylate

cyclaseColony Factor Adhesins: Allows binding

EPEC: Second most-common cause of diarrhea in infants

EIEC: Invasive E. Coli inflammatory response Bloody Diarrhea, Jet-trails

EHEC: NON-invasive Bloody Diarrhea (VTEC) Hemorrhagic Uremic syndrome (<5 yo children)

NON-inflammatory thus no PMNs or fever

Toxins: Shiga-like toxin does

Facultative anaerobes

Pilli

Toxins: LT ST Shiga-Toxin 1/2

Reservoir: Colon, vagina, urethra

Transmission: Oral-fecal, endogenous, maternal fecal, bovine substances, catheters (UTIs + Sepsis), cytotoxic drugs increase endogenous transmission

Gram (–) ve bacilli

Lactose Fermenters

Oxidase (–) ve

UTI: DOC: Sulfanomides

DiarrheaETEC: Self-limiting

Diagnosis: EHEC : non-sorbitol fermenter Smack plate

- Normal Flora: Pink- EHEC: Clear

the damage that causes dysentery DO NOT use antibiotics will release toxins

Bordetella pertussis 1) Whooping Cough Toxins:1. Pertussis Toxin

cAMP inducing Blocks immune cells Increased Histamine

Sensitivity2. Filamentous Hemagglutinin

Ciliated epithelium3. Adenylate Toxin 4. Tracheal Toxin

Stages:Incubation – Catarrhal – Paroxysmal – Convalescent Complications

Secondary infection Encephalopathy

Reservoir: Vaccinated Humans (older)

Transmission: Respiratory Droplets

Gram (–) ve bacilli Vaccine: DTaP (acellular)/DTP immunity vanes after 4-6 years (trying to protect children)

Diagnosis: Culture Best chance during Catarrhal stage

Media:

Regan- Lowe

Neisseria meningitidis 1) Meningitis Fever Stiff Neck Vomitting Rash Later

2) Waterhouse Friderichsen syndrome

1) Capsule – Type B

2) IgA protease

3) Endotoxin (LPS) septic shock

4) Complement Deficiency More susceptible

Diplococci – Flattened sides

Oxidase (+)

Encapsulated

Vaccine: (+) NOT Type B

Diagnosis: Thayer- M artin (Chocolate Agar w/ antibiotics)

Maltose Fermenter

Neisseria gonorrhea 1) Urethritis + Proctitis Pain upon urination (male)

2) Endocervicitis3) Ophthalmia blindness 4) Pharyngitis

Pilli: Antigenic variation Lengthy infection

Invasive triggers inflamm.

PMNs in Urethral exudate inflammation

Birth-canal Diplococci – Flattened sides

Oxidase (+)

Vaccine: (-)

Beta-Lactamases

Diagnosis: Thayer- M artin (Chocolate Agar w/ antibiotics)

NON-Maltose Fermenter

Differential: w/ Chlamydia (more common than Gonorrhea)

non-gonococcal urethritis

NON-purulent (whitish)

Treatment: Ophthalmia Erythromycin at birth

Moraxella Otitis Media (3rd) Sinusitis

Bronchitis + Bronchopneumonia COPD patients + Elderly

Respiratory Pathogen Gram (-) Diplococci

Corynebacterium Diphtheriae

1) Diphtheria: Pseudo-membrane

(grey) Bull-neck Recurrent laryngeal n.

palsy Respiratory obstruction

possible

Toxin: Protein-synthesis inhibition – prophage w/ transduction, effects

Psuedomembrane Possible trachea

obstruction Heart + Nerves

Non-invasive organism

Normal Flora: Respiratory Tract

Transmission: Respiratory Droplet

Gram (+) rod Diagnosis: Chinese-Letter formation – Tellurite Media

ELEK Test differentiate normal + pathogenic

Clostridium Obligate anaerobe (ABC)Spore-forming

Gram (+) rod

“Tennis Racquets” – due to spores at ends

Clostridium tetani Tetanus Spastic paralysis:

1) Locked jaw (risus sardonicus)

2) Extreme muscle spasms

Lack of inhibition: GABA + Glycine

Toxin: Tetanus toxin – via infection by spores vegetative cells toxin production

Transmission: Spores

Soil etc.

Anti-toxin + Antibiotic - Toxin binds irreversibly

so must go through half life

Vaccine: (+) – Toxoid so can’t cause disease

Clostridium botulinum Flaccid Paralysis – Prevents ACh release

Adult Botulism Canned Foods usually TOXIN ingestion (reversible

paralysis)Symptoms:

1) Flaccid Paralysis2) Vision problems3) Nausea/vomiting4) Respiratory arrest

Infant Botulism Honey SPORES ingestion Floppy baby syndrome

(reversible paralysis)

Toxin: Botulinum toxin

Toxin genes – Transduction

Transmission: Spores (heat-sensitive)

Food Borne (canned foods) Honey

Treatment: Adult Antitoxin (Igs)

Infant Antitoxin (Igs)

NOT Antibiotics

Clostridium Perfringens Gas Gangrene

Toxin: Alpha toxin – Phospholipase C

Lecithinase Enterotoxin – watery diarrhea

Transmission: Traumatic Implantation

Reservoir:

Media:1) Milk – STORMY

fermentation

self-resolving (reheated meats)

Soil Feces

2) Blood agar – Double Hemolysis zone

Diagnosis: Nagler Reaction

Treatment: Antibiotics Delay closure Self-limiting

gastroenteritis

Prevention: Debridement Antibiotic

administrationClostridium dificile Toxin Related Diseases:

Diarrhea Colitis Pseudomembranous

Colitis

***Growth following antibiotic administration

Resistant to Broad-spectrum Antibiotics

Toxin: Toxin A Toxin B

Normal Flora: GI Tract

Transmission: Endogenous

Diagnosis: Toxin Assay **Part of normal flora

Treatment: 1) Stop antibiotics2) Use = Metronidazole

+ Vancomycin

Streptococcus Carbohydrates in Cell-Wall used in serotyping

Chain-FormGram (+) CocciCatalase (-)

Group A Strep. (pyogenes)

1) Pharyngitis - Fever - Malaise- Sore throat

2) Scarlet-Fever :- Sand-paper rash - NOT on

palms or soles (Exotoxins)- Strawberry Tongue- Nausea/Vomiting- Impetigo – Honey Crusted

lesions- Very red at groin

3) Glomerulonephritis – Type 3 HSR immune mediated

4) Rheumatic Fever – Type 2 HSR Ab mediated

5) Cellulitis/Necrotizing Fasciitis – VERY fast-acting

Virulence Factor : M Protein

- Anti-phagocytic manner- Glomerulonephritis

Streptolysin O Streptolysin S

Spreading Factor : Streptokinase Hyaluronidase DNAse Exotoxins

- Scarlet Fever- Super-Antigens

Reservoir: Throat

Transmission: Respiratory Droplet Direct Contact

Diagnose:PYR-positive Bacitracin SensitiveBlood Agar - Beta-hemolytic Streptolysin O Antibodies (ASO) > 200Treatment:Beta-LactamsProphylaxs Rheumetic fever patients

Group B Strep. (agalactiae)

Neonatal Meningitis (# 1 Cause) Beta-hemolytic Reservoir: Vaginal Mucosa

Transmission:

Diagnose:CAMP positive Bacitracin Resistant

Birth Canal Blood Agar - Beta-hemolytic Treatment:- Treat During Delivery

Streptococcus Pneumo. MOST Common cause of:- Typical Pneumonia- Otitis Media- Adult Meningitis – CSF

w/ neutropenia and hypoglycemia

Capsule – VERY important Predisposing Factors:- Asplenia- Alcoholism- COPD- CHF

Diagnose:Alpha-HemolyticOptochin SensitiveQuelling PositiveLatex-Agglutination capsule in CSF

Prevention:Vaccine – Strep. Pneumo - Children: Fewer

serotypes- Adults/at risk

individuals: More serotypes

Streptococcus Viridans MOST Common cause of:- Cavities- Subacute endocarditis

Reservoir: Oral Pharynx

Transmission: Endogenous

Diagnose:Optochin ResistantAlpha-hemolyticPrevention:Prophylax after dental work

Enterococcus Endocarditis (Similar to viridans)

UTI – Catheter Associated

Drug Resistance (Vancomycin) Reservoir: Colon

Transmission: Endogenous

Gram (+) CocciCatalase (-)

Diagnose:PYR-positiveBile Esculin – turns blackPrevention:Prophylax when undergoing surgery

Pseudomonas Healthy- GI infections - Hot-tub folliculitis (leading

cause – S. aureus) - Eye infections

Burn Patients- Cellulitis (blue-green pus)

septicemia

Neutropenic patients

Catheterized Patients

Cystic Fibrosis- Recurrent pneumonias

thick slimy mucous

Chronic granulomatous disease- Sepsis- Ecthyma gangrosum

STRICT Aerobe – Non fermenter

Virulence Factors - Encapsulated - Pseudomonas Exotoxin

– Protein inhibiting- Endotoxin (LPS)

Risk Groups:- Burn Patients- Neutropenic patients

Transmission:- Water (ubiquitous)

Gram (-) RodsOxidase (+)

Blue-Green appearance – Grape-like Odor

Diagnose:- Non-lactose fermenting

on McConkey Agar

Prevention:Prevent contact w/ water

Salmonella Typhi (typhoid fever)

Typhoid Fever (enteric fever) - Constipation

Serotypes – O antigen Reservoir: Chronic humans only (typhi) Gall-bladder

Gram (-) RodsOxidase (-)

Diagnose:Week 1: 80% blood culture +

- Peyer’s patch necrosis- Cholecystitis

M-cell transfer Infects Macrophages underneath mucosa travels through blood seeds organs (liver, spleen) primary septicemia chronic infection of gall-bladder secondary septicemia

Virulence:Macrophage survival:

- decreased fusion of phagosome + lysosome

- complement survival- etc.

Transmission: Oral-fecal – since gall bladder infected constant release

Typhoid Mary

Flagella

Motile

Week 3: 85% stool culture +

H2S producerNon-lactose fermentingRose-spots on trunkAcid-sensitiveMotile

Prevention:Vaccine present (3 types)

Salmonella enterica Enterocolitis/gastroenteritis (campylobacter # 1 cause in USA, salmonella # 2 cause of bacteria gastroenteritis)

- Nausea- Vomiting- Bloody sometimes

Osteomyelitis – Sickle Cell patients (typhi can cause this)

Sepsis (NOT enterica)

Virulence- INVASIVE organisms:

watery diarrhea dysentery

- NO TOXIN - Diarrhea from Invasion

Reservoir: Chickens, turtles

Transmission: Oral-fecal – since gall bladder infected constant release

Diagnose:

Black on Hektoen (HE) Agar – to differentiate between shigella and salmonella H2S producerNon-lactose fermentingAcid-sensitiveMotile

Bacillus Anthracis Pulmonary Anthrax:- Inhalation of spores- Highly fatal- Mediastinal widening

Cutaneous Anthrax- Necrotizing lesion- Black Escher formation

Virulence: Toxins- Lethal factor- Edema factor cAMP- Protective antigens

Reservoir: Animals + large events

Transmission: Inhalation + direct contact w/ spores

Gram + Aerobic Bacillus

Bacillus Cereus Uncomplicated non-bloody gastroenteritis

INTOXICATION (not an infection)

Virulence: Toxins- Emetic toxin

Reservoir: Chinese fried-rice

Transmission: Food-borne

Listeria Monocytogenes Healthy individuals:- Uncomplicated

Gastroenteritis

Pregnant females:- Early: Septicemia +

disseminated granulomas in baby

- Post-delivery: Neonatal

meningitis (#3)

Facultative Intracellular organism

Actin Jet Motility

Tumbling motility

Cold growth

Reservoir: Cold meats + cheese + ice cream

Transmission: Food-borne

Gram + Rods – Aerobic Diagnose:CSF wet mount – Tumbling motilityCold-growthBeta-hemolyticBlood culture – in sepsisCSF culture – in baby

Legionella Atypical pneumonia- Pneumonia

Facultative intracellular organism Reservoir: Air-conditioners Gram – Rods – Aerobic Diagnose:Buffered charcoal yeast

Pneomophilus - Mental Retardation- Diarrhea (no bacteria in

GI)Pontiac fever

- Pneumonitis

Transmission: Inhalation of aerosolized water

Risk Groups: Smokers

extractFluorescent Antibody test