Microbiology 2 chart

7/28/2019 Microbiology 2 chart

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ystem Affected

Pharyngitis

Sinusitis

Epiglottitis

Otitis externa

Otitis media

Conjunctivitis

Keratitis

Endophthalmitis

Bronchitis

Empyema

Pneumonia

Cystitis and pyelonephritis

Upper Respiratory Infections

Ear Infections

Eye Infections

Pleuropulmonary and Bronchia

Urinary Tract Infections


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Renal calculi

Renal abscess

Prostatitis

Peritonitis

Dialysis-associated peritonitis

Endocarditis

Myocarditis

Pericarditis

General sepsis

Transfusion-associated sepsis

Septic thrombophlebitis

Cardiovascular Infections

Sepsis

Central Nervous System Infecti

Intraabdominal Infections


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Meningitis

Encephalitis

Brain abscess

Subdural empyema

Impetigo

Folliculitis

Furuncles and carbuncles

Paronychia

Erysipelas

Cellulitis

Necrotizing cellulitis andfasciitis

Bacillary angiomatosis

Infections of burns

Bite wounds

Surgical wounds

Traumatic wounds

Gastritis

Skin and Soft-Tissue Infections

Gastrointestinal Infections


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Gastroenteritis

Food intoxication

Proctitis

Osteomyelitis

Arthritis

Prosthetic-associatedinfections

Genital ulcers

Urethritis

Vaginitis

Cervicitis

General

Genital Infections

Granulomatous Infections

Bone and Joint Infections


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Pathogens

Streptococcus pyogenes, group C Streptococcus, Arcanobacterium haemolyticum, Chlamydophila

pneumoniae, Neisseria gonorrhoeae, Corynebacterium diphtheriae, Corynebacterium ulcerans,

Mycoplasma pneumoniae, Francisella tularensis

Streptococcus pneumoniae, Haemophilus influenzae, mixed anaerobes and aerobes, Moraxella

catarrhalis, Staphylococcus aureus, group A Streptococcus, Chlamydophila pneumoniae,

Pseudomonas aeruginosa and other gram-negative rods

Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus

Pseudomonas aeruginosa, Staphylococcus aureus, group A Streptococcus

Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus

aureus, group A Streptococcus, mixed anaerobes and aerobes

Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus aegyptius, Neisseria

gonorrhoeae, Pseudomonas aeruginosa, Francisella tularensis, Chlamydia trachomatis

Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, group A

Streptococcus, Proteus mirabilis and other Enterobacteriaceae, Bacillus species, Neisseria

gonorrhoeae

Bacillus cereus, Staphylococcus aureus, Pseudomonas aeruginosa, coagulase-negative

Staphylococcus, Propionibacterium species, Corynebacterium species

Moraxella catarrhalis, Haemophilus influenzae, Streptococcus pneumoniae, Bordetella pertussis,

Mycoplasma pneumoniae, Chlamydophila pneumoniae

Staphylococcus aureus, Streptococcus pneumoniae, group A Streptococcus, Bacteroides fragilis,

Klebsiella pneumoniae and other Enterobacteriaceae,Actinomyces species, Nocardia species,

Mycobacterium tuberculosis and other species

Streptococcus pneumoniae, Staphylococcus aureus, Klebsiella pneumoniae , other

Enterobacteriaceae, Moraxella catarrhalis, Haemophilus influenzae, Neisseria meningitidis,

Mycoplasma pneumoniae, Chlamydia trachomatis, Chlamydophila pneumoniae, Chlamydophila

psittaci, Pseudomonas aeruginosa, Burkholderia species, Legionella species, Francisella tularensis,

Bacteroides fragilis, Nocardia species, Rhodococcus equi, Mycobacterium tuberculosis and other

species, Coxiella burnetii, Rickettsia rickettsii, and many other bacteria

Escherichia coli, Proteus mirabilis, other Enterobacteriaceae, Pseudomonas aeruginosa,

Staphylococcus saprophyticus, Staphylococcus aureus, Staphylococcus epidermidis, group B

Streptococcus, Enterococcus species,Aerococcus urinae, Mycobacterium tuberculosis

l Infections


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Proteus mirabilis, Morganella morganii, Klebsiella pneumoniae, Corynebacterium urealyticum,

Staphylococcus saprophyticus, Ureaplasma urealyticum

Staphylococcus aureus, mixed anaerobes and aerobes, Mycobacterium tuberculosis

Escherichia coli, Klebsiella pneumoniae, other Enterobacteriaceae, Enterococcus species,

Neisseria gonorrhoeae, Mycobacterium tuberculosis and other species

Escherichia coli, Bacteroides fragilis and other species, Enterococcus species, Klebsiella

pneumoniae, other Enterobacteriaceae, Pseudomonas aeruginosa, Streptococcus pneumoniae,

Staphylococcus aureus, Fusobacterium species, Clostridium species, Peptostreptococcus species,

Neisseria gonorrhoeae, Chlamydia trachomatis, Mycobacterium tuberculosis

Coagulase-negative Staphylococcus, Staphylococcus aureus, Streptococcus species,

Corynebacterium species, Propionibacterium species, Escherichia coli and other

Enterobacteriaceae, Pseudomonas aeruginosa, Acinetobacter species

Viridans Streptococcus, coagulase-negative Staphylococcus, Staphylococcus aureus,

Aggregatibacter species, Cardiobacter hominis, Eikenella corrodens, Kingella kingii, Streptococcus

pneumoniae, Abiotrophia species, Rothia mucilaginosa, Enterococcus species, Bartonella species,

Coxiella burnetii, Brucella species, Erysipelothrix rhusiopathiae, Enterobacteriaceae, Pseudomonas

aeruginosa, Corynebacterium species, Propionibacterium species

Corynebacterium diphtheriae, Clostridium perfringens, group A Streptococcus, Borrelia burgdorferi,

Neisseria meningitidis, Staphylococcus aureus, Mycoplasma pneumoniae, Chlamydophilapneumoniae, Chlamydophila psittaci, Rickettsia rickettsii, Orientia tsutsugamushi

Streptococcus pneumoniae, Staphylococcus aureus, Neisseria gonorrhoeae, Neisseria meningitidis,

Mycoplasma pneumoniae, Mycobacterium tuberculosis and other species

Staphylococcus aureus, coagulase-negative Staphylococcus, Escherichia coli, Klebsiella species,

Enterobacter species, Proteus mirabilis, other Enterobacteriaceae, Streptococcus pneumoniae and

other species, Enterococcus species, Pseudomonas aeruginosa, many other bacteria

Coagulase-negative Staphylococcus, Staphylococcus aureus, Yersinia enterocolitica, Pseudomonasfluorescens group, Salmonella species, other Enterobacteriaceae, Campylobacter jejuni and other

species, Bacillus cereus and other species

Staphylococcus aureus, Bacteroides fragilis, Klebsiella species, Enterobacter species,

Pseudomonas aeruginosa, Fusobacterium species, Campylobacter fetus

ns


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Group B Streptococcus, Streptococcus pneumoniae, Neisseria meningitidis, Listeria

monocytogenes, Haemophilus influenzae, Escherichia coli, other Enterobacteriaceae,

Staphylococcus aureus, coagulase-negative Staphylococcus, Propionibacterium species, Nocardia

species, Mycobacterium tuberculosis and other species, Borrelia burgdorferi, Leptospira species,

Treponema pallidum, Brucella species

Listeria monocytogenes, Treponema pallidum, Leptospira species,Actinomyces species, Nocardia

species, Borrelia species, Rickettsia rickettsii, Coxiella burnetii, Mycoplasma pneumoniae,

Mycobacterium tuberculosis and other species

Staphylococcus aureus, Fusobacterium species, Peptostreptococcus species, other anaerobic

cocci, Enterobacteriaceae, Pseudomonas aeruginosa, viridans Streptococcus, Bacteroides species,

Prevotella species, Porphyromonas species,Actinomyces species, Clostridium perfringens, Listeria

monocytogenes, Nocardia species, Rhodococcus equi, Mycobacterium tuberculosis and other

species

Staphylococcus aureus, Streptococcus pneumoniae, group B Streptococcus, Neisseria

meningitidis, mixed anaerobes and aerobes

Group A Streptococcus, Staphylococcus aureus

Staphylococcus aureus, Pseudomonas aeruginosa

Staphylococcus aureus

Staphylococcus aureus, group A Streptococcus, Pseudomonas aeruginosa

Group A Streptococcus

Group A Streptococcus, Staphylococcus aureus, Haemophilus influenzae, many other bacteria

Group A Streptococcus, Clostridium perfringens and other species, Bacteroides fragilis, otheranaerobes, Enterobacteriaceae, Pseudomonas aeruginosa

Bartonella henselae, Bartonella quintana

Pseudomonas aeruginosa, Enterobacter species, Enterococcus species, Staphylococcus aureus,

group A Streptococcus, many other bacteria

Eikenella corrodens, Pasteurella multocida, Pasteurella canis, Staphylococcus aureus, group A

Streptococcus, mixed anaerobes and aerobes, many gram-negative rods

Staphylococcus aureus, coagulase-negative Staphylococcus, groups A and B streptococci,

Clostridium perfringens, Corynebacterium species, many other bacteria

Bacillus species, Staphylococcus aureus, group A Streptococcus, many gram-negative rods,

rapidly-growing mycobacteria

Helicobacter pylori


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Salmonella species, Shigella species, Campylobacter jejuni and other species, Vibrio cholerae,

Vibrio parahaemolyticus, other Vibrio species, Yersinia enterocolitica, Escherichia coli (ETEC, EIEC,

EHEC, EPEC, others), Edwardsiella tarda, Bacillus cereus, Pseudomonas aeruginosa, Aeromonas

species, Plesiomonas shigelloides, Bacteroides fragilis, Clostridium botulinum, Clostridium

perfringens, Clostridium difficile

Staphylococcus aureus, Bacillus cereus, Clostridium botulinum, Clostridium perfringens

Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum

Staphylococcus aureus, Salmonella species , Mycobacterium tuberculosis and other species, -

hemolytic Streptococcus, Streptococcus pneumoniae, Escherichia coli, and other

Enterobacteriaceae, Pseudomonas aeruginosa, many less common bacteria

Staphylococcus aureus, Neisseria gonorrhoeae, Streptococcus pneumoniae, Salmonella species,

Pasteurella multocida, Mycobacterium species

Staphylococcus aureus, coagulase-negative Staphylococcus, group A Streptococcus, viridans

Streptococcus, Corynebacterium species, Propionibacterium species, Peptostreptococcus species,

other anaerobic cocci

Treponema pallidum, Haemophilus ducreyi, Chlamydia trachomatis, Francisella tularensis,

Klebsiella granulomatis, Mycobacterium tuberculosis

Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum

Mycoplasma hominis, Mobiluncus species, Gardnerella vaginalis

Neisseria gonorrhoeae, Chlamydia trachomatis, Neisseria meningitidis, group B Streptococcus,

Mycobacterium tuberculosis, Actinomyces species

Mycobacterium tuberculosis and other species, Nocardia species, Treponema pallidum,

Treponema carateum Brucella species, Francisella tularensis, Listeria monocytogenes,

Burkholderia pseudomallei, Actinomyces species, Bartonella henselae, Tropheryma whippelii,

Chlamydia trachomatis, Coxiella burnetii


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Selected Bacteria Associated with Foodborne Diseases

Organism Implicated Food(s)

Aeromonas species Meats, produce, dairy products

Bacillus cereus Fried rice, meats, vegetables

Brucella species Unpasteurized dairy products, meat

Campylobacter species Poultry, unpasteurized dairy products

Clostridium botulinum Vegetables, fruits, fish, honey

Clostridium perfringens Beef, poultry, pork, gravy

Escherichia coli

Enterohemorrhagic Beef, unpasteurized milk, fruit juices

Enterotoxigenic Lettuce, fruits, vegetables

Enteroinvasive Lettuce, fruits, vegetables

Francisella tularensis Rabbit meat

Listeria monocytogenesUnpasteurized dairy products,

coleslaw, poultry, cold-cut meats

Plesiomonas shigelloides Seafood

Salmonella species Poultry, unpasteurized dairy products

Shigella species Eggs, lettuce

Staphylococcus aureus Ham, poultry, egg dishes, pastries

Streptococcus, group A Egg dishes

Vibrio cholerae Shellfish

Vibrio parahaemolyticus Shellfish

Vibrio vulnificus Shellfish

Yersinia enterocolitica Unpasteurized dairy products, pork


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Selected Bacteria Associated with Waterborne Diseases

Organism Disease

Aeromonas speciesGastroenteritis, wound infections,

septicemia

Campylobacter species Gastroenteritis

Escherichia coli Gastroenteritis

Francisella tularensis Tularemia

Legionella species Respiratory disease

Leptospira species Systemic disease

Mycobacterium marinum Cutaneous infection

Plesiomonas shigelloides Gastroenteritis

Pseudomonas species Dermatitis

Salmonella species Gastroenteritis

Shigella species Gastroenteritis

Vibrio speciesGastroenteritis, wound infection,

septicemia

Yersinia enterocolitica Gastroenteritis


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Arthropod-Associated Disease

Arthropod Organism Disease

Tick Anaplasma phagocytophilum

Human anaplasmosis (formerly

called human granulocytic

ehrlichiosis)

Borrelia afzelii Lyme disease

Borrelia burgdorferi Lyme disease

Borrelia garinii Lyme disease

Borrelia, other species Endemic relapsing fever

Coxiella burnetii Q fever

Ehrlichia chaffeensis Human monocytic ehrlichiosis

Ehrlichia ewingiiCanine (human) granulocytic

ehrlichiosis

Francisella tularensis Tularemia

Rickettsia rickettsii Rocky Mountain spotted fever

Flea Rickettsia prowazekii Sporadic typhus

Rickettsia typhi Murine typhus

Yersinia pestis Plague

Lice Bartonella quintana Trench fever

Borrelia recurrentis Epidemic relapsing fever

Rickettsia prowazekii Epidemic typhus

Mite Orientia tsutsugamushi Scrub typhus

Rickettsia akari Rickettsialpox

Sandfly Bartonella bacilliformis Bartonellosis (Carrin disease)


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Basic Mechanisms of Antibiotic Action

Antibiotic

Penicillins

Cephalosporin

Cephalosporins

Cephamycins

Carbapenems

Monobactams

-Lactam/-lactamase inhibitor

Vancomycin

Daptomycin

Bacitracin

Polymyxins

IsoniazidEthionamide

Ethambutol

Cycloserine

Aminoglycosides

Tetracyclines

Glycylcyclines

Oxazolidinone

Macrolides

Ketolides

Disruption of Cell Wall

Inhibition of Protein Synthesis


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Clindamycin

Streptogramins

Quinolones

Rifampin

Rifabutin

Metronidazole

Sulfonamides

Dapsone

Trimethoprim

Antimetabolite

Inhibition of Nucleic Acid Synthesis


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Action

Binds -lactamases and prevents enzymatic inactivation

of -lactam

Inhibits cross-linkage of peptidoglycan layers

Causes depolarization of cytoplasmic membrane,

resulting in disruption of ionic concentration gradients

Inhibits bacterial cytoplasmic membrane and movement

of peptidoglycan precursors

Inhibits bacterial membranes

Inhibits arabinogalactan synthesis

Inhibits cross-linkage of peptidoglycan layers

Produces premature release of aberrant peptide chains

from 30S ribosome

Prevents polypeptide elongation at 30S ribosome

Binds to 30S ribosome and prevents initiation of protein

synthesis

Prevents initiation of protein synthesis at 50S ribosome

Binds PBPs and enzymes responsible for peptidoglycan

synthesis

Inhibits mycolic acid synthesis


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Binds subunit of DNA gyrase

Disrupts bacteria DNA (is cytotoxic compound)

Inhibits dihydropteroate synthase and disrupts folic acid

synthesis

Inhibits dihydropteroate synthase

Inhibits dihydrofolate reductase and disrupts folic acid

synthesis

Prevents transcription by binding DNA-dependent RNA

polymerase


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Penicillins

Antibiotics

Natural penicillins: benzylpenicillin (penicillin G),phenoxymethyl penicillin (penicillin V)

Penicillinase-resistant penicillins: methicillin,

nafcillin, oxacillin, cloxacillin, dicloxacillin

Broad-spectrum penicillins: aminopenicillins

(ampicillin, amoxicillin); carboxypenicillins

(carbenicillin, ticarcillin); ureidopenicillins

(piperacillin)

-Lactam with -lactamase inhibitor (ampicillin-sulbactam, amoxicillin-clavulanate, ticarcillin-

clavulanate, piperacillin-tazobactam)


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Spectrum of Activity

Active against all -hemolytic streptococci and most other

species; limited activity against staphylococci; active againstmeningococci and most gram-positive anaerobes; poor

activity against aerobic and anaerobic gram-negative rods

Similar to the natural penicillins, except enhanced activity

against staphylococci

Activity against gram-positive cocci equivalent to the

natural penicillins; active against some gram-negative rods,

with piperacillin the most active

Activity similar to natural -lactams, plus improved activity

against -lactamase producing staphylococci and selected

gram-negative rods; not all -lactamases are inhibited;

piperacillin/tazobactam is the most active


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Inhibitors of Protein Synthesis

Antibiotics

Aminoglycosides (streptomycin, kanamycin, gentamicin,

tobramycin, amikacin)

Aminocyclitol (spectinomycin)

Tetracyclines (tetracycline, doxycycline, minocycline)

Glycylcyclines (tigecycline)

Oxazolidinone (linezolid)

Macrolides (erythromycin, azithromycin, clarithromycin,

roxithromycin)

Ketolides (telithromycin)

Lincosamide (clindamycin)

Streptogramins (quinupristin-dalfopristin)


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Spectrum of Activity

Primarily used to treat infections with gram-negative rods; kanamycin

with limited activity; tobramycin slightly more active than gentamicin

versus Pseudomonas; amikacin most active; streptomycin and

gentamicin combined with cell wallactive antibiotic to treat

enterococcal infections; streptomycin active versus mycobacteria and

selected gram-negative rods

Active versus Neisseria gonorrhoeae

Broad-spectrum antibiotics active against gram-positive and some

gram-negative bacteria ( Neisseria , some Enterobacteriaceae),

mycoplasmas, chlamydiae, and rickettsiae

Spectrum similar to tetracyclines but more active against gram-

negative bacteria and rapidly growing mycobacteria

Active against Staphylococcus (including methicillin-resistant and

vancomycin-intermediate strains), Enterococcus , Streptococcus , gram-

positive rods, and Clostridium and anaerobic cocci; not active against

gram-negative bacteria

Broad-spectrum antibiotics active against gram-positive and some

gram-negative bacteria, Neisseria, Legionella, Mycoplasma, Chlamydia,

Chlamydophila, Treponema, and Rickettsia; clarithromycin and

azithromycin active against some mycobacteria

Broad-spectrum antibiotic with activity similar to macrolides; active

against some macrolides-resistant staphylococci and enterococciBroad-spectrum activity against aerobic gram-positive cocci and

anaerobes

Primarily active against gram-positive bacteria; good activity against

methicillin-susceptible and -resistant staphylococci, streptococci,

vancomycin-susceptible and -resistant Enterococcus faecium (no

activity against E. faecalis), Haemophilus, Moraxella , and anaerobes

(including Bacteroides fragilis ); not active against Enterobacteriaceae

or other gram-negative rods


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uinolones

Antibiotics Spectrum of Activity

Narrow spectrum (nalidixic acid)Active against selected gram-negative

rods; no useful gram-positive activity

Broad spectrum (ciprofloxacin,

levofloxacin)

Broad-spectrum antibiotics with activity

against gram-positive and gram-

negative bacteria

Extended spectrum (gatifloxacin,

moxifloxacin)

Broad-spectrum antibiotics with

enhanced activity against gram-positive

bacteria (particularly streptococci and

enterococci) compared with early

quinolones; activity against gram-

negative rods similar to that of

ciprofloxacin and related quinolones


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able 141 Major Bacterial Pathogens

Type of Organism Genus

Readily Gram-stained

Gram-positive cocci Staphylococcus, Streptococcus,

Enterococcus

Gram-negative cocci Neisseria

Gram-positive rods Corynebacterium, Listeria,

Bacillus, Clostridium,

Actinomyces, Nocardia

Gram-negative rods

Enteric tract organisms

Pathogenic inside and outside tract Escherichia, Salmonella

Pathogenic primarily inside tract Shigella, Vibrio,

Campylobacter, Helicobacter

Pathogenic outside tract KlebsiellaEnterobacterSerrati

a group, Pseudomonas,

ProteusProvidenciaMorganel

la group, Bacteroides

Respiratory tract organisms Haemophilus, Legionella,

Bordetella

Organisms from animal sources Brucella, Francisella,

Pasteurella, Yersinia

Not readily Gram-stained

Not obligate intracellular parasites Mycobacterium, Mycoplasma,

Treponema, Leptospira

Obligate intracellular parasites Chlamydia, Rickettsia


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Table 472 Common Localized Bacterial

Infections and Nocardiosis

Disease Specimen Common Causative Agents

Cellulitis of skin Punch biopsy Group A -hemolytic

streptococci, S aureus

Impetigo Swab As for cellulitis (above)

Skin ulcers Punch biopsy; deep;

tissue aspirate or

biopsy

Mixed flora

Streptococcus pneumoniae

Group B streptococci

Escherichia coli and other

Enterobacteriaceae

Haemophilus influenzae

Meningitis CSF Neisseria meningitidis


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Listeria monocytogenes

Pharyngitis Swab Group A streptococci

Corynebacteriumdiphtheriae

Whooping cough (pertussis) Swab Bordetella pertussis

Perioral abscess Pus Mixed flora of mouth andpharynx

Epiglottitis Swab Haemophilus influenzae

Brain abscess Pus Mixed infection; anaerobic

gram-positive and gram-

negative cocci and rods,

aerobic gram-positive cocci


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Pneumonia Sputum or other

invasively obtained

respiratory samples

Streptococcus pneumoniae


Enterobacteriaceae and

other gram-negative rods

Mixed anaerobes and

aerobes

Chest empyema Pus Same as pneumonia, or

mixed flora infection

Liver abscess Pus Escherichia coli;

Bacteroides fragilis ; mixed

aerobic or anaerobic flora

Cholecystitis Bile Gram-negative enteric

aerobes, also Bacteroides

fragilis

Abdominal or perirectal abscess Pus Gastrointestinal flora

Enteric fever, typhoid Blood, feces, urine Salmonella Typhi

Enteritis, enterocolitis, bacterial diarrheas,

"gastroenteritis"

Feces Salmonella species other

than Shigella typhi


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Campylobacter jejuni

Vibrio cholerae

Other vibrios

Yersinia enterocolitica

Hemorrhagic colitis and hemolytic uremic

syndrome

Feces Escherichia coli O157:H7

and other serotypes

Shigella species

Urinary tract infection Urine (clean catch

midstream specimen

or one obtained by

bladder

catheterization or

suprapubic aspiration)

Escherichia coli;

Enterobacteriaceae; other

gram-negative rods


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Urethritis/cervicitis Swab Neisseria gonorrhoeae

Chlamydia trachomatis

Genital ulcers Swab Haemophilus ducreyi

(chancroid)

Treponema pallidum

(syphilis)

Pus aspirated from

suppurating lymph

nodes


(lymphogranuloma

venereum)

Pelvic inflammatory disease Cervical swab Neisseria gonorrhoeae


Aspirate from cul-de-sac or by laparoscope

Neisseria gonorrhoeae


Mixed flora

Neisseria gonorrhoeae

Arthritis Joint aspirate, blood Staphylococcus aureus


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Osteomyelitis Pus or bone specimen

obtained by

aspiration or surgery

Multiple; often


Others


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Usual Microscopic Findings Culture Media

Occasionally gram-positive

cocci

Blood agar

As for cellulitis (above) and

pharyngitis (below)

Mixed flora Blood, MacConkey, or EMB

agar; anaerobe media

Gram-positive cocci in pairs Blood agar

Gram-positive cocci in pairs

and chains

Blood agar

Gram-negative rods Blood agar

Small gram-negative

coccobacilliChocolate agar

a

Gram-negative intracellular

diplococciChocolate agar

aand blood

agar for CSF cultures


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Gram-positive rods Blood agar

Not recommended Blood agar or selective

medium

Not recommended Loeffler's or Pai's medium,then cysteine-tellurite or

Tinsdale's medium

Not recommended Regan-Lowe agar

Mixed flora Blood agar, chocolate agar,a

MacConkey or EMB agar;

anaerobic media

Usually not helpful Chocolate agara

(also use

blood agar)

Gram-positive cocci or mixed

floraBlood agar, chocolate agar,

a

anaerobe media
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Many PMNs, gram-positive

cocci in pairs or chains.

Capsule swelling with

omniserum (quellung test)

Blood agar; also MacConkey,

EMB, and chocolate agars

Gram-positive cocci in pairs,

tetrads, and clusters

Blood agar; also MacConkey,

EMB, and chocolate agars

Gram-negative rods Blood agar; MacConkey or

EMB agar

Mixed respiratory tract flora;

sometimes many PMNs

Blood, MacConkey, or EMB

agar; anaerobe agar



Gram-negative rods and

mixed flora

Blood, MacConkey, or EMB


Gram-negative rods Blood, MacConkey, or EMB

agar; anaerobic conditions



Not recommended MacConkey, Hektoen,

bismuth sulfite agars; others

Gram stain or methylene blue

stain may show PMNs

MacConkey, Hektoen,

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"Gull wing-shaped" gram-

negative rods and often PMNs

Campy BAP or similar medium

Not recommended Thiosulfate citrate bile salts(TCBS) sucrose agar; others.

Taurocholate-peptone broth

for enrichment

Not recommended As for Vibrio cholerae

Not recommended MacConkey, CIN

Not recommended Sorbitol MacConkey medium

Gram stain or methylene blue

stain may show PMNs

MacConkey, Hektoen,


Gram-negative rods seen on

stained smear of

uncentrifuged urine indicate

more than 105

organisms/mL

Blood agar; MacConkey or

EMB agar
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Gram-negative diplococci in or

on PMNs. Specific for urethral

discharge in men; less reliable

in women

Modified Thayer-Martin or

similar antibiotic-containing

selective medium

PMNs with no associated

gram-negative diplococci

Culture in McCoy cells treated

with cycloheximide

Mixed flora Chocolate agar with

IsoVitaleX and vancomycin

Darkfield or fluorescent

antibody examination shows

spirochetes

None

PMNs with no associated

gram-negative diplococci

Culture pus in cell culture (as

for urethritis)

PMNs with associated gram-

negative diplococci; mixed

flora may be present

Modified Thayer-Martin or

similar antibiotic-containing

selective medium; nucleic

acid amplification test

preferred

See above; nucleic acid

amplification test preferred

Cell culture (as for urethritis)

Gram-negative diplococci in oron PMNs

Modified Thayer-Martinmedium

See above Cell culture (as for urethritis)


agar; anaerobic medium

Gram-negative diplococci in or

on PMNs

Modified Thayer-Martin

medium

Gram-positive cocci in pairs,

tetrads, and clustersBlood agar; chocolate agar

a
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Morphology depends upon

organisms

Blood agar, MacConkey, EMB

agar; anaerobic medium

Morphology depends upon

organismsBlood agar, chocolate agar;

a

anaerobic medium


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Comments

Biopsy at leading edge of erythema may

yield the organism

Culture rarely indicated

Skin ulcers below the waist often contain

aerobes and anaerobes like

gastrointestinal flora

Latex agglutination (bacterial antigen

detection) is a poor test to diagnose the

cause of meningitis;

immunochromatographic assay is more

sensitiveLatex agglutination (bacterial antigen


cause of meningitis

Mainly in newborns; no need for selective

media in CSF culture



cause of meningitis



cause of meningitis


35/41

-Hemolytic; may be confused with Group B

Streptococci

-Hemolytic

Granular rods in "Chinese character"patterns in smears from culture; toxicity

testing required

Fluorescent antibody test identifies

organisms from culture and occasionally in

direct smears; PCR is more sensitive than

culture

Haemophilus influenzae is part of normal

flora in nasopharynx

Usually mixed bacterial infection; rarely,actinomycosis

Specimen must be obtained surgically and

transported under strict anaerobic

conditions


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Streptococcus pneumoniae is part of

normal flora in nasopharynx. Blood

cultures specific (positive) in 1020%

Uncommon cause of pneumonia. Usually -

hemolytic, coagulase-positive

Causes of hospital-associated pneumonia

Specimens must be obtained by

bronchoscopy using a protected brush or

transtracheal aspiration; expectorated

sputum is unsatisfactory for anaerobes

Usually pneumonia; mixed aerobic and

anaerobic flora derived from oropharynx

Commonly enteric gram-negative aerobes

and anaerobes; consider Entamoeba

histolytica infection

Usually gram-negative rods from

gastrointestinal tract

Aerobic and anaerobic bowel flora; often

more than five species grown

Nonlactose-fermenting colonies onto TSIa

slants: Nontyphoid salmonellae produce

acid and gas in butt, alkaline slant, and H2S

Multiple specimens should be cultured;

lactose negative. H2S produced


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Incubate at 42C; colonies oxidase-

positive; smear shows "gull wing-shaped"

rods

Yellow colonies on TCBS. Vibrio cholerae isoxidase-positive

Differentiate from Vibrio cholerae by

biochemical and culture tests

Enrichment at 4C helpful; incubate

cultures at 25C

Look for sorbitol-negative colonies; type

with antisera for O antigen 157 and

flagellar antigen 7; EIA for shiga-like toxins

are the preferred tests

Nonlactose-fermenting colonies onto TSIa

slants: Shigellae produce alkaline slant,

acid butt without gas
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Positive stained smear diagnostic in men.

Culture or nucleic acid amplification tests

needed in women. Gonococci are oxidase-

positive

Crescent-shaped inclusions in epithelial

cells by stains or immunofluorescence.

Direct EIA or fluorescent antibody tests

can be helpful; nucleic acid amplification

tests are more sensitive

Differential diagnosis of genital ulcers

includes herpes simplex infection

Causative organisms may be gonococci,

anaerobes, others. Anaerobes always

present in endocervix; thus, endocervical

specimen not suitable for anaerobic

culture

Usually mixed anaerobic and aerobioc

bacteria

Occurs in both children and adults;

coagulase-positive; usually -hemolytic


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Usually aerobic organisms; Staphylococcus

aureus is most common; gram-negative

rods frequent; anaerobes less common

Includes streptococci, gram-negative rods,

and anaerobes


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linical Finding/Disease Major Pathogenetic Factor

Findings within the intestinal tract

Watery, nonbloody diarrhea (traveler's

diarrhea)

Enterotoxin that increases cyclic AMP

Bloody diarrhea caused by E. coli O-157;

hemolytic-uremic syndrome (HUS)

Shiga toxin (verotoxin) inhibits protein

synthesis

Findings outside of intestinal tract

Urinary tract infection Gal-gal pili bind to bladder mucosa

Neonatal meningitis K-1 capsular polysaccharide is

antiphagocytic

Sepsis, especially in hospital Endotoxin induces fever, hypotension,

and DIC1


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Main Laboratory Result

No RBC or WBC in stool

RBC in stool; schistocytes in blood smear

WBC in urine, positive urine culture

WBC in spinal fluid, positive CSF culture

Leukocytosis, positive blood culture

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Microbiology 2 chart