Bacterial Pathogens

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Bacterial Pathogens

• IMEC INC.
• Quick Learning
• Technique

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WHAT STARTEDMICRIOBIOLOGY

• Louis Pasteur and MILK
• They even named this Bacteria after himNAME IT?

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General Bacterium
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Reproduction of Bacteria

• Most of the time bacteria go through Binary
  Fission
• Yet some can transfer genetic material via
  transduction, transvection, conjugation and viral
  phage

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FTS Proteins
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Transduction
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Glycolysis

• Most bacteria require energy just like eukaryotic
  cells via production of ATP
• Glycolysis is the make form of ths production
• Simple glycolysis is call the Emben-Meyerhof
  pathway

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Pentose Pathway
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Other energy forms

• Alternative forms with with various common
  bacteria- The Pentose Pathway, also know as the
  hexo-monphosphate shunt
• THE IS IMPORTANT WITH E-COLI ENTEROCOCCUS
• The next being very important as well, because
  some are common related NOSCOMIAL infections- The
  Entner-Dourdoroff pathway
• PSEUDOMONAS

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BACTERIAL RESISTANCE

• Cell Membrane/Cell Wall Structure
• Flagella/Pili
• Capsule Enzymes
• Endospore state

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TOXINS

• EXOTOXINS
• Both Gram ve/ negative organism
• Plasmids, chomosomes, phage DNA
• ENDOTOXINS
• Gram Negative only
• Only by plasmids

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Bacterial Pathogens

• Small (0.5-3.0 um) size
• Have no nuclear membrane
• No micro-organelle (except ribosomes)
• Small ribosomes with (70s)sub-unit 50 S 30S
  for protein synthesis
• Have a single circular dsDNA(haploid) and a
  smaller circular plasmid

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REMINDERS
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Metabolism

• Bacteria tends to be either aerobic or anaerobic
  in origin.
• This helps diagnostically and can sometimes be
  assimilated via a good history and physical

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Normal Flora

• Skin---S. Epidermitis
• Nose S. aureus
• OropharnxViridans Strep
• Colon Fragilis.gtE.coli
• Vagina--Lactobacillus

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Common Causes of Pneumonia

• Children
• Viral (RSV)
• Mycoplasma
• Chlamydia
• S. Pneumoniae
• Young Adults
• Mycoplasma
• S. Pneumoniae
• Adults over 40
• S.pneumoniae
• H.Influenza
• Viral

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Special Pneumoniae Groups

• Aspiration
• Anaerobes
• Nosocomial
• Staphylococcus. / P. Auriginosa/ Klebsiella
• Neonatal
• Group B Streptococci/ E.coli
• Alcoholic
• S. Pneumoniae
• Immnocomprimised
• Staphylococci, Gram (-ve), Pneumocystis in HIV

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Causes of Meningitis

• Newborn
• Group B Streptococci
• E.Coli
• Listeria
• Children
• S. pneumoniae
• N. Meningitidis
• Older than 6YO
• N. Menengitidis
• Enteroviruses

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Causes of UTIs

• Ambulatory
• E.coli (50-80)
• Klebsiella (8-10)
• Staphylococcus saprophyticus (10-30 in young
  ambulatory women
• Hospitalized
• E-coli
• Proteus
• Klebseilla
• Serratia
• Pseudomonas

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Bacterial Pathogen Growth Phases

• LAG PHASE
• Turning on enzymes
• LOG PHASE
• Exponential Growth Phase
• STATIONARY PHASE
• Nutrients Used Up/Toxic products form
• May also be due to pH
• DEATH AND DECLINE

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BACTERIAL CLASSIFIED

• GRAM STAIN
• MORPHOLOGY
• Organism, Colony in Culture
• METABOLIC CHARACTER
• Hemolytic Property, Nutritional requirements
• SEROLOGY
• Genetic make-up, Phage typing,

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BACTERIAL GENETICS

• DNA
• Purines (Adenine) (Guanine)
• Pyrimidine (Thymine) (Cytosine)
• The bacterial Chromosome is a dsDNA loop without
  a membrane
• Only One Copy (HAPLOID)
• Multiplication by Binary Fision

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BACTERIAL GENETICS

• PLASMIDS
• Extra chromosomal genetic material not needed for
  bacterial growth-
• Can replicate by themselves
• Mostly Circular dsDNA
• Some may be linear
• Transmitted via F-Pili by Conjugation
• R-plasmid similar to F
• Can induce a resistance as in E-Coli

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BACTERIAL GENETICS

• VIRULENCE PLASMIDS
• Transfer Virulence Factors
• Example
• E-COLI LT ST TOXINS
• STAPH AUREUS SSS
• STEPTOCOCCI HEMOLYSIN

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BACTERIAL GENETICS

• BACTERIOPHAGE
• Contains Head
• Sheath capsid
• Tail Fibers
• PHAGE IS SPECIFIC TO
• BACTERIA, AND BACTERIA
• MUST BE IN PROPER RATIO

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Phage Assembly
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BACTERIAL GENETICMATERIAL EXCHANGE

• TRANSFORMATION
• Only occurs in a few Genera-
• Usually between same species
• FREES DNA RELEASE
• TAKEN UP BY ANOTHER
• EXAMPLE
• (Hemophilus, strep.Pneumonia)

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BACTERIAL GENETICMATERIAL EXCHANGE

• TRANSDUCTION
• Specialized via temperate phage
• Integrated then spliced out
• Generalized via virulent phage
• Transfer of DNA through Phage

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BACTERIAL GENETICMATERIAL EXCHANGE

• CONJUGATION
• THIS IS TRANSFER VIA SEX PILI
• Donor (F)/ Recipient (F-)

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Sex Pili of E-Coli
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Polysaccarhide Information

• Bacterial surface or secreted polysaccharides are
  molecules that can function as barriers to
  protect bacterial cells against environmental
  stresses, as well as act as adhesins or
  recognition molecules. In some cases, these
  molecules are immunodominant antigens eliciting a
  vigorous immune response, while in other cases
  the expression of polysaccharides camouflages the
  bacteria from the immune system. Until recently,
  most studies on the enzymatic steps and
  regulation of these molecules were performed on
  the enteric gram negative bacteria Escherichia
  coli and Salmonella typhimurium. With the advent
  of modern bacterial genetics, techniques such as
  construction and characterization of
  polysaccharide mutants, cloning of genes and
  complementation of these mutations, and
  expression of polysaccharides in heterologous
  bacterial hosts has prompted investigations into
  the roles and functions of these molecules for
  many different bacteria.

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BACTERIAL CLASSIFIED

• Other factors for Gram Positive
• Cocci
• Catalase Positive-?Staph
• Catalase Negative?Strep
• Bacillus
• Spore forming
• Bacillus (aerobic)
• Clostridium (anaerobic)
• Non Spore forming
• Cornyobacterium (non motile)
• Listeria (motile)

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GRAM-POSITIVE () ORGANISMS
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GRAM POSITIVE

• Contain Cell Envelope with a Rigid Cell Wall and
  a lipid bilayer cytoplasmic membrane
• Cell Wall is made of Petidoglycan layer (Thick)
  with Teichoic acid
• Peptidoglycan is made of polysaccarrides
• (N-acetyl glucosamine acetyl muramic acid)
• Which is covered interwoven with Lipoteichoic
  Acid
• Thicker and Three dimensional compared Gram (-)

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GRAM POSITIVE WALL
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PEPTIDOGLYCAN
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Aerobic Gram Positive Cocci

• Staphylococci aureus
• Staphylococci epidermidis
• Staphylacoccus sp (coagulase negative)
• Streptococcus pneumoniae (viridans group)
• Streptococcus agalactiae
• Streptococcus pyogenese
• Enterococcus

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GRAM () STAPH
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STAPH AUREUS Small Clusters
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• Staphylococcus aureus
• Illness caused
• Food Poisoning
• Pneumonia (often nosocomial)
• Other possibilities
• Skin and integumentary infections , Bacteremia,
  Toxic Shock Syndrome , Meningitis ,Osteomyelitis
  ,Renal abscess
• Endocarditis ,Septic arthritis ,Impetigo
• Description
• Gram positive
• Cocci (grape-like clusters)
• Facultative anaerobes
• Non-spore-forming
• Non-motile
• Normal human flora
• When growth occurs in prepared food, enterotoxins
  are produced that cause food poisoning.
• Symptomology
• Food Poisoning symptoms (symptoms occur between 2
  to 4 hours after ingestion)
• Diarrhea ,Nausea ,Vomiting ,Self limiting
• CAUSES

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STAPH AUREUS Small Clusters
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STREP PYOGENESE Classic Chains
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STAPH EPIDERMATIS (Common skin bacteria)
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STREP PYOGENESE

• GROUP A (beta hemolytic)
• Viridan (y a)
• Impetigo
• Rheumatic fever (M18 M3 Serotypes)
• Mitral Stenosis (Ascoff bodies)
• Pancarditis
• Very complex enzyme structure
• SCARLET FEVER
• May cause Toxic Shock Syndrome
• Glomerulonephritis

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IMPETIGOSTREP
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Strep Pyogenes
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• Group A Beta-hemolytic Streptococci
• Illness caused
• Pharyngitis (strep-throat)
• Other possibilities
• Scarlet fever
• Pyoderma
• Streptococcal toxic shock syndrome
• Rheumatic fever
• Description
• Gram positive
• Coccus (spherical)
• Facultative anaerobes
• 0.5 to 1.0um in diameter
• Beta hemolysis
• Mucoid appearance
• Symptomology
• Symptoms develop 2 to 4 days after exposure to
  the pathogen
• Fever , headache, malaise, sore throat
• Demographics

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STREP PNEUMONIAE Small chains in tissue
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STREP BACILLUS
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• Streptococcus pneumoniae
• Illness caused
• Pneumonia
• Description
• Gram positive
• Encapsulated diplococcus (oval or lancet shaped)
• Facultative aerobes or microaerophilic
• 0.5 to 1.2 um in diameter
• Symptomology
• Blood stained sputum
• Chest pain
• Cough
• Severe shaking chill
• Sustained fever
• Demographics
• Age and sex
• Children
• Both sexes affected equally
• Area and seasonality

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Gram Positive Bacilli

• Bacillus anthracis
• Bacillus cereus
• Lactobacillis sp.
• Listeria monocytogenes
• Nocardia sp.
• Coccobacillus Rhodococcus
• Cornyebacterium diptheriae
• Proiombacterium Acnes

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Lactobacilli
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BACILLIS ANTHRAX
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ANTHRAX INHALED 5
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ANTHRAX

• SPORE FORMING ROD
• NON-MOTILE
• HERBIVORE ANIMALS?HUMANS
• TOXIN
• LE-Lethal Factor?Pulmonary Edema
• EF-Extra-cellular form of Adenyl
  Cyclase?increases intracellular cAMP
• PA- Promote EF and LE into cell
• (95 of Cases CUTANEOUS)
• TREATMENT--PENICILLIN

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Bacillus Cereus
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Bacillus Cereus

• FOOD POISONING
• (RICE VEGETABLES)
• SPORE SURVIVES COOKING
• Both ENTEROTOXINS
• HEAT LABILEsimilar to CHOLERA
• HEAT STABILEsimilar to Staph
• TOXINS USUALLY lt 24HRS DIARRHEA

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Aerobic Gram Positive Rods
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CORYNEBACTERIUM DIPTHERIA
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CORYNEBACTERIUM DIPTHERIA

• Club Shaped, arranged in letter V, Y
• Infection (DROPLET NUCLEI) direct contact
• STRICT RESPIRATORY ISOLATION
• AEROBIC---USUALLY ON TONSILS (coagulated)
  vascular congestion
• DO NOT SCRAPE
• ELK TEST----LOEFFLERS MEDIUM
• Toxin-EXOTOXIN that inhibits EF2
• Pseudomembranous Respiratory
• Heart MyocarditisFibrosis
• Neural DamagePolyneuritis
• ANTI-TOXIN IS EQUINE Severe Reaction
• TX-Penicillin/E-mycin to prevent spread

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Listeria-Monocytogens

• Produces Endotoxin
• MOVES IN A TUMBLING MOTION
• Can Multiply in cold (CHEESE, CABBAGE)
• Listeriolysin-O (Beta-Hemolysis)
• Immunocomprimized-may develop Meningitis (3rd
  most common) septicemia
• New Born-Granulomatous septicum
• TX-Ampicillin, or SMX/TMP

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Listeria Picture
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NOCARDIA

• AEROBIC AFB
• Source-Decaying Organic Material
• N. asteroids (pulmonary)
• N. brasiliensis (sub-Q)
• Abscess
• May effect eyes
• DX-Sputum
• TX- Sulfa Drugs/ Amikacin

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NocardiaAcid fast stain, high power to show the
long, filamentous acid fast organisms
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Aneorobic Gram Positive Rods

• Actinomyces sp.
• Closteridium botulism
• Closteridium deficile
• Closteridium perfringens
• Closteridium tetani

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ACTINOMYCETES

• GRAM () Filamentous
• ANAEROBIC?Crevices around Teeth
• Many Strains
• Produces Abscesses (sub-Q tissue)
• Upper angle of Jaw
• Thoracic Empyema
• Abdominal-any organ
• Pelvis-Associated with IUDs PID
• DX-SULFER GRANULES
• Treat Penicillin/Ampicillin

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ACTINOMYCETESNote Filaments
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Botulism effects this pathway
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C. Botulism-THE MOST POTENT TOXIN

• Extremely Lethal Preformed Toxin
• NeurotoxinBlocks Ach release at Presynaptic
  terminal
• Flaccid Descending Paralysis?
• Double vision, ptosis, general muscle weakeness
  ?Resp failure
• Spores- if left in anaerobic condition
• JARS/ DENTED CANS
• TX- IgG to neutralize unbound toxin/respiratory
  support
• ANTIBIOTICS not effective

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• Clostridium botulinum
• Botulism
• 25 foodborne
• 72 infant botulism
• 3 wound botulism
• Description
• Gram positive
• Bacillus (rod shaped) , ANAEROBIC, SPORE FORMING
• Spore former
• Neuro-toxin is produced
• Symptomology
• Symptoms begin between 18 to 36 hours on average
  after eating contaminated foods
• Early symptoms (as soon as 6 hours)
• Blurred or double vision
• Dry mouth
• Difficulty in swallowing or speaking
• General weakness , Short of Breath
• Late symptoms (as late as 10 days)
• Complete paralysis

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Closteridium Tetani
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Clostridium Tetani

• Terminal spore (drum-stick)
• Found in Soil, excrement of animals
• EXOTOXIN
• Tetanospasmin?nerve terminals
• Lack of inhibition? sustained contraction
• Localized tetanus
• Jaw Trismus/ Laryngeal Spasm
• Neonatal-unhygenic umbilical section
• TX- Immediate DPT Booster
• Never Immunized-Give IgG plus Booster
• Clean Wound, Ventilate, Diazapam
• Antibiotics Metronidozole/Penicillin

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CLOSTERIUM PERFRINGES
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C. Perfringes

• Non-motile , encapsulated
• Grows in necrotic tissue
• Gas Gangrene (myonecrosis)
• CHO fermentation?crepitus at site
• Reservoir-Colon/Soil
• PIGBEL food type NEW GUINEA
• TX-Hyperbaric O2, Debridement

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Closteridium Perfringes
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• Clostridium perfringes
• Illnesses caused
• Gas gangrene , necrosis of muscle
• Description
• Gram positive
• Bacillus (rod shaped)
• Anaerobic-Spores only produced in adverse
  conditions
• Non-motile (rapid growth resembles motile
  organisms)
• Entero-toxins are produced
• Symptomology
• Gas formation, necrosis of muscle
• Food poisoning
• Average of 8 to 22 hours after eating
  contaminated food
• Diarrhea
• Intestinal cramps
• Demographics
• Age and sex
• All ages affected equally
• Both sexes affected equally

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CLOSTERIDIUM DIFFICILE
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C. Difficile

• Caused by broad spectrum antibiotics
  (CLINDAMYCIN, CEPHALOSPORINS)
• Release exotoxins
• Pseudomembranous Ulcerative Colitis
• TEST STOOL FOR EXOTOXIN
• Treat with Oral Vancomycin
• REMEMBER VAN/TRAIN

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AneorobicGram-positive cocci

• Peptostreptococcus sp

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GRAM-NEGATIVE ORGANISMS
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Gram (-) Cell Membrane much thinner-no
wall (but more virulent)
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AerobicGram Negative Cocci

• Neisseria Gonorrhea
• Neisseria Meningitidis
• Moraxella catarrhalis

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GRAM NEGATIVE(-) NEISSERIA
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GRAM NEG COCCI Neisseria
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GRAM NEGATIVE(-) NEISSERIA GONOCCOCCUS

• Sexually Transmitted (STD)
• 2nd most common-Chlamydia is 1st
• Can present intracellular (inside Neutrophils)
• Urethritis and attaches with pili
• Prostatitis in Male
• PID in Women
• LPS Endotoxin with IgA1 Protease on Pili
• PURULENT DISCHARGE
• Can Cause Fitz-Hugh-Curtis Syndrome
• CULTURE-THAYER/MARTIN
• TX 3rd Generation Cephalosporins

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GRAM NEGATIVE(-) NEISSERIA MENINGITIDIS

• Pili-Capsule-(Bacteremia)
• Enters via Respiratory Droplets
• 5 Normal Flora
• Virulence in Capsule
• 9 capsular PS serotypes (A, B, C, D, X, Y, Z,
  W135, 29E) Meningitis is by ABC
• IgA Protease splits IgA?Helps Adhesion
• ARMY RECRUITS
• Fulminate cases?Adrenal Hemorrhage
• Waterhouse-Freidrichsen sydrome
• TX-Ceftriaxone,or Pen G(When Sensitive)
• REMEMBER AX TO THE HEAD

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Aerobic Gram Negative Rods

• BIG CLASS-MUST BE BROKEN DOWN
• Fastidious, Gram-negative Rods
• Enterbacteriaceae-(Glucose Fermenting)
• Oxidase Positive
• Glucose-Nonfermenting

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AGNR-Enterobactericae (CHO ferm) Glucose

• Citrobacter
• Enterobacter
• Escherichia Coli
• Klebsiella pneumonia
• Proteus
• Salmonella Typhi, Salmonella Enteritis
• Serratia Marcescens
• Shigella
• Yersina Pestis, Yersinia entercolitica

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Citrobacter
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ESCHERICHIA COLI

• Gram (-) Rods
• Catalase ()
• Oxidase (-)
• (90 of UTIs)-pneumonia sepsis
• EXOTOXIN
• LT (heat labile)?watery cholera like (adenyl
  cyclase)
• ST (heat stabile)---(guanyl cyclase)
• Shiga like toxin due to Plasmid Sharing
• ENDOTOXIN
• Lipid A of LPS
• EH-EC Most Common? inhibit 60S ribosome

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ESCHERICHIA COLI
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E-Coli
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• Escherichia coli 0157H7
• Illnesses caused
• Hemorrhagic colitis
• Other Possibilities
• Urinary tract infections and neonatal meningitis
• Description
• Gram negative
• Bacillus (rod shaped)
• Facultative anaerobe
• Non-spore-forming
• Shiga-toxin (verotoxin) is produced
• Symptomology
• Severe cramping
• Watery diarrhea that ends up grossly bloody
• Low fever (occasionally)
• Vomiting (occasionally)
• Demographics
• Age and sex
• All ages affected equally

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Klebsiella Pneumoniae

• FloraColon and URT
• Major Cause of Nosocomial Infections
• Polysaccharide capsule
• K--O antigen
• Lactose Fermenter
• Non-motile- (NO FLAGELLUM)
• Pulmonary-
• ALCOHOLIC, COPD, ICP, DM
• SPUTUM-RED CURRENT JELLY
• Urinary-indwelling (Foley)
• HIGH MOTALITY- SPITE OF A/B THERAPY

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Klebsiella Pneumoniae Lung Tissue
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• Klebsiella pneumoniae
• Illness caused
• Pneumonia
• Opportunistic
• Description
• Gram negaitive
• Bacillus (rod shaped)
• Non-motile
• Airborne
• Normal intestinal and skin flora
• Nosocomial
• Infectous in the upper respiratory tract
• Symptomology
• Chest pain
• Difficulty breathing
• Fever
• Thick bloody sputum (current jelly sputum)
• Sample(s) to be collected

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Proteus Vulgaris (EM)
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Proteus Vulgaris Miribalis

• Very Motile
• SWARMIMG
• UREASE POSITIVE-OXIDASE NEG
• Urea?Ammonia?Alkaline Urine?Stones
• Proteus cross react with Rickettsia
• WEIL-FELIX REACTION
• OX-19
• Culture-Blood Agar
• TX-KANAMYCIN

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Salmonella

• Unlike Shigella Very Motile
• Produces H2S
• Uncooked eggs/ PET TURTLE
• TYPHOID FEVER
• Vi Antigen. Diagnose with O-H-Vi antigen
• S-Typhi can cause Osteomyolitis and and is
  notorious in Asplenic patients
• May show effects at Peyers Patch?Bleeding?week
  3-4
• Liver effects may present _at_ weeks 2-3
• TX- Ciprofloxine, Ceftriaxone

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• Salmonella
• Description
• Gram negative
• Bacillus (rod shaped)
• Facultative anaerobe
• Non-spore-forming
• Motile with flagellum
• Enterotoxins produced
• Hosts are animal and human
• Symptomology
• Main symptoms
• Abdominal cramps ,Diarrhea (2 to 7 days) Flu-like
  symptoms
• Nausea
• Vomiting
• Possible symptoms
• Chills
• Fever
• Transmission
• Eating foods contaminated with animal feces

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SERRETIA MARSCESENS

• Gram (-)
• Common Nosocomial infection in Urinary Track
  infections
• If becomes pathogenic can be aggressive
  respiratory and systemic

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Shigella

• Non H2S Producing
• Non MOTILE
• Evades Gastric Acid, by somehow having ability to
  live in HCl
• Fecal Contamination
• Gay Bowel Syndrome
• ANTI-O agglutination
• TX-CIPRO, SMX/TMP
• Fluid Replacement

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Shigella
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• Shigella
• Illness caused
• Shigellae
• Description
• Gram negative
• Bacillus (rod shaped)
• Facultative anaerobe
• Non-spore-forming
• Non-motile
• Produces shiga toxin
• Hosts are humans, rare in animals
• Symptomology
• Main symptoms
• Abdominal pain
• Blood, pus or mucus in stool
• Diarrhea
• Additional symptoms
• Cramps
• Fever

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Yersinia Pestis Note-Safety Pin Appearance
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Yersinia Pestis Bubonic Plague
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• Yersinia pestis
• Illnesses caused
• Bubonic plague
• Pneumonic plague
• Description
• Gram negative
• Non-motile
• Non spore forming
• Bacillus (rod-shaped)
• Humans and animals are hosts
• Fleas are vectors
• Symptomology
• Malaise
• Fever
• Pain in lymph nodes (possibly due to swelling)
• Bloody vomit
• Bloody diarrhea
• Skin mottling
• Petechiae

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AGNR-Fastidious

• Bordetella pertussis
• Brucella sp.
• Camplyobacter
• Francisella
• Haemophilis influenza, Haemophilis ducreyi
• Heliobacter pylori
• Legionella pneumophila

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B. Pertussis

• Filimentous
• Agglutinin stimulates cilia
• G-Proteins stimulate adenyl cyclase?cAMP
• Cough severe (Whooping cough)
• Highly Contagious
• B of BCG Vaccine
• Only 1000-4000 a year now
• DX-Agglutinin via ELISA

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Haemophilus
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Haemophilus influenza

• Gram Negative
• Loves factor X(hematin) and V (NAD)
• PS Capsule (poly ribitol) a-f
• Risk ½ -3 years
• Meningitis
• Acute Epiglottitis (Major Cause)
• Septic Arthritis
• Sepsis
• DX-Latex Agglutination/Chocolate Agar
• TX-Ceftriaxone / Amoxicillin
• Immunize mother during 8th month

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• Haemophilus influenzae
• Illness caused
• Pneumonia
• Other possibilities
• Ear and sinus infections
• Meningitis
• Arthritis
• Pulmonary disease in the elderly
• Description
• Gram negative
• Bacillus
• Aerobic or faculatative anaerobic
• Non-spore-forming
• Non-motile
• Encapsulated
• 0.2 um in length by 0.3 to 2.0 um in diameter
• Symptomology
• Chest pain
• Cough

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Camplyobacter Jejuni
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• Campylobactor jejuni
• Gasteroenteritis
• Other possibilities
• Meningitis
• Description
• Gram negative
• Bacillus (curved) Motile
• .3 to .6 um in diameter
• Microaerophilic
• Enterotoxins, cytopathic toxins, and endotoxins
  are produced
• Symptomologymamaast 1 week or longer
• Abdominal pain, diarrhea, fever, mailase, gross
  bloody stool possible
• Bowel movements may be up to 10 per day during
  peak of disease
• Self-limiting
• Area and seasonality
• Worldwide
• Underdeveloped areas have less severity

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Camplyobacter Jejuni

• CURVED ROD with POLAR FLAGELLUM
• Very common cause of Intestinal disorders
  (Bacterial Enteritis)
• Villus blunting
• Mucosal inflammation
• Usually self limited to 3-5 days
• From Milk, Pork and animal contact
• Has toxin, nothing PS, Purelent exudative
• TX- Erythromycin

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H-Pylori
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Heliobacter Pylori

• Has a capsule (S) SLIMY LAYER
• 1st Duodenel Ulcer
• 2nd Gastric
• Can be systemic, endocardic
• Attacks Vascular tissue
• Urease Producing
• Has Flagella,Motile
• TX- Bismuth, Metrodiazonole
• Key neutralize and treat

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H-Pylori/Spirality
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H-Pylori
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Francisella
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F. Tuleremia

• Arthrop Vector? Hunting Season
• Minnesota, Arizona, Oklahoma
• Ulcero-glandular/Pneumonic/Ocular/
• Ulcero Glandular common- 80
• Pneumonic-15

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Brucella

• UNDULENT FEVER-MALTA FEVER
• Dr. David Bruce
• Highly virulent
• Contact with meat placenta of animal
• ALSO SEEN ON DAIRY FARMS
• Caseating Granulomatous lesions
• DX-Blood/lymph(SA)
• Tx-Doxycyclin--Gentamycin

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Pasteurella P. Multicida

• CATS/DOG BITES
• CELLULITIS
• Seen with DF2 Canimorus ()
• Rat bite fever
• TX-Long Term A/B
• Keep Clean---DO NOT SUTURE

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Erysipeloid

• Human Bite Fishing
• Painful with swelling
• Keep Clean---DO NOT SUTURE

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AGNR- OXIDASE (CHO FERM)

• Aeromonas sp.
• Vibrio Cholerae
• Vibrio parahaemolyticus
• Vibrio vulnificus

137
Vibro Cholera
138
Vibrio Cholera

• El Tor classic (Ogawa, Inaba)
• Lives in coastal brackish water (Ganges River)
• Caused many (7) pandemic
• O139 ,O1 Serotypes
• Non invasive yet very powerful LT toxin
• Effects cAMP?Crypt cells of intestinal lumen
• Changes Osmolarity (Na-Cl-K-HCO3 are lost)
• Rice water diarrhea
• Death in hours if untreated
• TX-Doxycycline

139
Non-Glucose Fermenting

• Actinobacter sp.
• Flavobacterium menengosepticum
• Pseudomonas aeruginosa
• Burkholderia cepacia,
• B. psudomallei

140
PSEUDOMONADACAE

• P. Aeruginosa
• Nosocomial-Water in Hospital
• Common Respiratory Therapy Problem
• Grape like Scent- very prodominant
• Green /blue flourescence
• Exotoxin A?activating EF2
• Cystic Fibrosis
• COPD
• Diabetic Patients
• Burns Wounds

141
PSEUDOMONADACAEProtegrin binding with p.
Aeruginosa
142
ANAEROBIC Gram-Neg Rods

• Bacteroides Fragilis
• Bacteroides Sp.
• Fusobacterium sp.
• Prevotella sp.

143
B. Fragilis

• Not seen as Primary
• But is seen in many intra-abdominal and
  retro-peritoneal infection septic infections
• It may also be present in Lung Abscesses
• Lesion usually resemble common pyogenic (pus
  forming) infections

144
Many difficult to stain

• Borrelia burgodorferi, Borrelia recurrents
• Bartonella
• Chlamydia
• Calymatobacterium
• Coxiella burnetti
• Legionella sp
• Leptospira sp

145
Chlamydia-Note Inclusions
146
CHLAMYDIA

• Is Gram negative, but no muramic acid in
  Peptidoglycan
• Obligate Intracellular
• Needs host ATP
• Has both DNA and RNA
• Infects Columnar cells
• Inclusion bodies
• 3 types
• C. Trachoma
• Most common STD-URETHRITIS
• INCLUSION CONJUNCTIVITIS (Pannus)
• Infantile Pneumonia
• C. Pneumoniae
• Taiwan Group (TWAR)
• C. Psittaci
• Atypical Pneumonia
• PARROT FEVER
• TX-ERYTHROMYCIN, DOXYCYCLIN

147
Legionella pneumophilia

• In 1976, Philadephia, Am. Legion
• Small pleomorphic coccobacillus
• Source-Water-(coolers/Air units)
• 3rd most Common cause of CABP
• Pt had recently been incarcerated
• Increased incidence in Hairy Cell Leukemia
• PONTIAC FEVER
• Resolves in a week
• TX-Erythromycin / Rifampin
• Biggest mistake in American Medicine

148
Legionella
149
Many ACID FAST or Difficult

• Mycobacterium Tuberculosis
• Mycobacterium Leprosy
• Mycobacterium Avium,
• Mycobacterium Intracellulare
• Rickettsia Rickettsii
• Trepenema pallidum

150
Mycobacterium Tuberculosis
151
TB-Acid Fast bacilli.
152
Mycobacteria can also be stained with Auramine
153
MYCOBACTERIUM

• ACID FAST STAIN
• Mycolic Acid in cell wall lipids
• Zeihl-Neilsen Stain (need heat)
• KINYOUN STAIN
• No Heat
• FLOURESCENT STAIN
• Auramine-apple green flouro on a dark background

154
M. Tuberculosis

• Slender, grooved granular Rod
• Slow Growth (3-6) weeks
• OBLIGATE AEROBENeeds O2
• Resistant to Drying
• Primary TB
• Caseating Granulomatous infection that is
  produces by Macrophage release of TNF
• Cheesy necrotic cell?. May calcify? increased
  collegen
• Hilar Lymph (GHON FOCUS)
• 2ndary TB (10 Risk)
• Reactivated? Chronic low grade fever
• MILIARY (ALL ORGANS)

155
M. Tuberculosis

• MAY BE SEEN ON CHEST X-RAY
• PPD (TUBERCULIN TEST) ve
• 5 units Intra-dermal
• BCG required in many countries
• Bacillus Calmette-Guerine (attenuated Bovine)

156
M. Tuberculosis

• POPULATIONS of INFECTIONS
• OLD AGE
• URBAN POOR (LOW SOCIO CLASS)
• AIDS

157
TB DRUGS

• ISONIAZID
• RIFAMPIN
• PYRAZIAMIDE
• ETHAMBUTOL
• STREPTOMYCIN
• AMINOSALICYCLIC ACID
• ETHONAMIDE
• CYCLOSERINE

158
M. Leprae (Hansens Disease)

• World wide
• US-200 new cases ayear
• Cooler parts of body (face)
• Testis, and superficial nerves
• 2 types
• Lepramatous (increased CD8, DQ1)
• Lepromin Skin Test (NEG)
• Severe, Highly infectious, blocks T-4 helper
  response? Disfigured Skin
• Cartilage destroyed, testicular atrophy, nerve
  damage, loss of digits
• Tuberculoid (increased CD4, DR2)
• Lepromin Skin Test (POS)
• Localized, may have hair loss

159
Mycobacterium avium-intracellulare infection is
marked by numerous acid fast organisms growing
within macrophages. Lots of bright red rods are
seen, particularly in macrophages, in this acid
fast stain of lymph node.
160
M. Avium Intercellulare

• AIDS PATIENTS
• OCCURS LATE IN DISEASE WHEN CD4 COUNT IS LOW
• Watery Diarrhea, wieght loss

161
RICKETSIACLASS
162
Rickettsia Rickettsi Intracellular
163
Rickettsia Rickettsi

• ROCKY MOUNTAIN SPOTTED FEVER
• Dock tickEastern states
• Wood tick-Western states
• Profilerates in the endothelium and attacks
  smooth muscle cells
• Hemorrhage may be serious
• Ankle, soles, palms, wrist
• Severe cases, cardiac renal,encephalitis
• DX-If recent tick exposure, do latex test, If a
  skin lesion PCR
• Treat-Doxycyclin

164
Rickettsia (Typhus Group)

• Endemic and Epidemic
• Large Populations, During War-time, also world
  wide distributiion
• Rash-leading to collapse and delerium, Mortality
  is low
• Agents-
• R.Prowazacki
• R. Typhi ( RAT RELATED)
• Vectors
• Louse
• Reservior
• Flying squirrel (FLEA RELATED)

165
Bartonella

• Trench Fever
• R. Quinata
• (louse born?human)
• Cat Scratch Fever
• B. Hensele
• (papules, pustules, crusts)
• Oroyo Fever
• B. Bacilliformus (Sand Fly)
• Deforms RBCs, marked Anemia, seen in high
  altitudes like the ANDES MOUNTAINS

166
DONAVANOSIS Granuloma Inguinale

• Calymmatobacterium granulomatis
• STD
• Increased in Tropics
• Sub Q swelling
• TX-Tetracyclin, Erythromycin

167
Mycoplasma

• Smallest Free living organism known
• No cell wall
• Aerosolized respiratory droplets
• WALKING PNEUMONIA
• Atypical
• X-ray looks extremely bad
• TX- Erythromycin, Tetracyclin

168

• Mycoplasma pneumoniae
• Illness caused
• Mild upper respiratory tract disease
• Primary atypical pneumonia
• Description
• Classified as gram negative due to no cell wall
• Facultitive anaerobe
• Varried shapes
• Pleomorphic
• Spherical
• Pear-shaped
• Filamentous
• Smallest free-living cells
• Requires a complex media
• Symptomology
• Mild upper respiratory tract disease
• Headache
• Low fever
• Predominant cough

169
SPIROCHETES
170
Treponema Pallidum Spirochete-Syphilis
171
SYPHILIS (T. Pallidium)

• STD-Can enter via mucosa or dermal abrasion
• 3 stages
• Primary Syphilis (CHANCRE)
• Secondary-Mucosal Lesions (palms, sole, tongue)
• Condylomata-cluster of warts (perineum, anus,
  vulva)
• Latent
• After 6 weeks
• STS remains Positive
• Tertiary
• 6-40 years
• (GUMMA) 15---?skin and bone
• Cardiovascular 10
• Neuro-syphilis 8
• VDRL/HemaglutinJarisch-Herxheimer reaction

172
Leptospira (Weils DX)

• Smaller than Treponema Pallidum
• Hooked end
• Organisms in Blood and CSF
• FEVER
• PHOTOPHOBIA

173
Borrelia Burgodorferi

• LYME DISEASE
• NE,NW, and Midwest
• Most common vector borne infection in the U.S.
• Vector-Ixodes Tick
• Three Stages
• 1. AcuteErythema
• 2. Dissemination, encephalopathy, (CN VII-Bells
  Palsy)---Mycocarditis
• 3. Late. Destructive Arthritis, neuropathy
• Culture-Modified Kellys

174
Borrelia Burgodorferi Difficult to Stain
175
Ixodes Tick-Female
176
Ixodes Tick-Female/Male/Nymph
177
REMINDERS
178
Normal Flora

• Skin---S. Epidermitis
• Nose S. aureus
• OropharnxViridans Strep
• Colon Fragilis.gtE.coli
• Vagina--Lactobacillus

179
Common Causes of Pneumonia

• Children
• Viral (RSV)
• Mycoplasma
• Chlamydia
• S. Pneumoniae
• Young Adults
• Mycoplasma
• S. Pneumoniae
• Adults over 40
• S.pneumoniae
• H.Influenza
• Viral

180
Special Pneumoniae Groups

• Aspiration
• Anaerobes
• Nosocomial
• Staphylococcus. / P. Auriginosa/ Klebsiella
• Neonatal
• Group B Streptococci/ E.coli
• Alcoholic
• S. Pneumoniae
• Immnocomprimised
• Staphylococci, Gram (-ve), Pneumocystis in HIV

181
Causes of Meningitis

• Newborn
• Group B Streptococci
• E.Coli
• Listeria
• Children
• S. pnemoniae
• N. Meningtidis
• Older than 6YO
• N. Menengitidis
• Enteroviruses

182
Causes of UTIs

• Ambulatory
• E.coli (50-80)
• Klebsiella (8-10)
• Staphylococcus saprophyticus (10-30 in young
  ambulatory women
• Hospitalized
• E-coli
• Proteus
• Klebseilla
• Serratia
• Pseudomonas

183
Pyogenic Cocci Bacteria

• Staphylococcus aurues
• Streptococcus pyogenes
• Streptococcus Pneumoniae
• Neisseria Menegitidis
• Neisseria Gonorrhoeae

184
Common Gram Negative Infections

• Escherichia Coli
• Klebsiella Pneumonae
• Enterobacter Aerogenes
• Proteus spp.
• Pseudomonas sp.
• Legionella spp.

185
Rare Gram Negative Infections

• Calymmatatobacterium donavons
• Heamophilis ducreyi
• Klebseilla rhinoschleromatis
• Bartonella bacilliforms

186
Contagious Childhood Bacteria

• Hemophilus influenze
• Hemophilus pertusis
• Cornyobacterium diptheria

187
Enteropathic Infections

• Enterpathogenic E-coli
• Shigella Sp
• Vibrio cholera
• Campylobacter jejuni
• Yersinia enterocolitica
• Salmonella spp (1000 strains)

188
Zoonotic Bacteria Infections

• Bacillus Anthracis
• Listeria monocytogenes
• Yersinia pestis
• Franciella tuleremia
• Brucella sp
• Lerptospira sp (many groups)
• Borrelia burgodorferi