OTHER GRAM-NEGATIVE BACILLI: NON-ENTERICS

VIRULENCE BIOCHEMICAL
ORGANISM DISEASE/Sx TRANSMISSION PATHOGENESIS CULTURE/Dx TREATMENT PREVENTION IMAGE/NOTES
FACTORS TESTS
Nosocomial and Thrives in moist Pili, fimbriae, Colonizes Mucous Gram (-) (-) lactose fermenter Resistant to almost Prevent Motile, aerobic
hospital-acquired environments endotoxin, flagellum membranes, GIT, MHA: green (-) carb fermenter every antibiotic! contamination of Sweet, grape-like
infections Type III secreted Respiratory Tract colonies (+) oxidize glucose equipment odor
RISK FACTORS: toxin, biofilm, beta- MAC: no pink (+) oxidase Piperacillin +
Associated with: Px who underwent lactamase, Skin and mucous colonies Tazobactam Pyocyanin: blue
Wounds and burns, invasive procedures, aminoglycoside- membrane Aztreonam, Pyoverdine: green
Meningitis, UTI/ (+) catheter modifying disruption Carbapenems, Pyorubin: red
Pyelonephritis, enzymes, elastases, Intravenous or Fluoroquinolones, Pyomelanin: brown-
Necrotizing proteases, urinary catheter use Cephalosporins black
Pseudomonas Neutropenia
pneumonia, Chronic hemolysins
aeruginosa pneumonia, Otitis MDR due to:
Exotoxin A: tissue
externa, Infection of necrosis; inactivates Beta-lactamases
eye, Fatal sepsis, EF2 ESBLs
Ecthyma Pyocyanin: releases Porin channel
gangrenosum, Hot H2O2, superoxide, mutations
tub folliculitis, IL-8 Efflux pumps
Osteomyelitis, Pyoverdin:
Endocarditis, siderophore binding
Bacteremia shock iron
Melioidosis Through Gram (-) (+) oxidase Surgical drainage of Motile, aerobic
(Whitmore’s contamination of Bipolar staining: localized infection Natural saprophyte
Disease) skin abrasion or safety pin Category B agent of
inhalation appearance in Susceptible to: bioterrorism
Pulmonary infection Wright’s stain Ceftazidime,
(most common) Serologic test: Meropenem,
Chronic suppurative helpful Imipenem,
infection Amoxicillin-
Burkholderia
Latent infection Presumptive for px Clavulanic acid,
pseudomallei Ceftriaxone,
who has fulminant
upper lobe Cefotaxime
pulmonary or
unexplained Initial intensive
systemic disease therapy:
ceftazidime,
imipenem,
meropenem
Glanders (in horses, Inhalation (may lead Gram (-) Same as melioidosis Non-motile, aerobic
but transmissible to to primary Can be isolated from Category B agent of
humans) pneumonia) blood, sputum, bioterrorism
Burkholderia mallei urine, or skin lesions
Ulcers leading to
lymphangitis and Established with:
sepsis Increased agglutinin
Chronic Close contact Gram (-) (+) oxidase Usually MDR
Burkholderia
granulomatous (+) lysine
cepacian complex
disease in Cystic RISK FACTORS: Selective media decarboxylase Drug of choice:
Burkholderia Cystic fibrosis containing colistin (+) acid from glucose TMP-SMX
Fibrosis px
gladioli patients
Commonly BA: lavender-green (-) oxidase Susceptible to TMP- Free-living
associated with use or gray colonies (+) lysine SMX and ticarcillin- Ammonia-like odor
Stenotrophomonas of indwelling plastic decarboxylase, clavulanic acid Maltophilia because
maltophilia IV catheters DNase strong maltose
(+) glucose and oxidation
maltose oxidation
MHA: Mueller-Hinton Agar; MAC: MacConkey Agar; MDR: Multi-drug resistance; ESBLs: Extended Spectrum Beta-Lactamases; BA: Blood Agar

PPLP 1
 OTHER GRAM-NEGATIVE BACILLI: NON-ENTERICS
VIRULENCE BIOCHEMICAL
ORGANISM DISEASE/Sx TRANSMISSION PATHOGENESIS CULTURE/Dx TREATMENT PREVENTION IMAGE/NOTES
FACTORS TESTS
Nosocomial Acinetobacter Cultured from skin, (+) catalase Often MDR Aerobic
infections baumanii: most mucous (-) oxidase May appear as
commonly isolated; membranes, Susceptible to: Gram-Positive
device-associated secretions and Gentamicin,
infections hospital environment Amikacin, May resemble
Tobramycin, ES Neisseria
Acinetobacter spp. Acinetobacter Penicillins, (difference in
johnsonii: plastic IV Cephalosporins oxidase test!; (+)
catheters oxidase)

Originate in water of
room humidifiers
and vaporizers
Meningitis in Via respiratory route Polysaccharide Found in mucous Chocolate Agar: Resistant to: Blood of persons Capsule is used for
children capsule: type b is membranes of URT flat, grayish brown Ampicillin, older than 3-5 yo is typing this organism
most common colonies Chloramphenicol bactericidal for this
Otitis media in Satellite organism Non-encapsulated
children Polyribose phenomenon: For less serious strains lack the
phosphate capsule growns on Sheep infection: Vaccine with Hib virulent
Respiratory of type b: major Blood agar when Ampicillin or capsule and invasiveness
disease in adults virulence factor Staphylococci Amoxicillin diphtheria toxin
colonies are present H. haemolyticus and
Haemophilus Type b: meningitis, For serious Immunization of H. parahaemolyticus
influenzae pneumonia, Factor X: acts as infections: women in 8th month are hemolytic
empyema, hemin Cefotaxime or of pregnancy variants of H.
epiglottitis, cellulitis, Factor V: replaced Ceftriaxone influenzae and H.
septic arthritis by NAD parainfluenzae,
Hematin: necessary respectively
Nontypeable: for its cytochrome
chronic bronchitis, system
otitis media,
sinusitis,
conjunctivitis
Highly
communicable
Haemophilus form of
aegyptius conjunctivitis
(pinkeye) in
children
Painful genital Sexually transmitted 1g of Azithromycin, Must be
ulcer orally (CDC) differentiated from
Chancroid syphilis, herpes
Haemophilus
Unilateral painful Other regimens: simplex infection,
ducreyi swollen inguinal IM Ceftriaxone, and
lymph nodes Ciprofloxacin, lymphogranuloma
Erythromycin venereum
URT: Upper Respiratory Tract; NAD: Nicotinamide Adenine Dinucleotide; STD: Sexually Transmitted Disease

PPLP 2
 OTHER GRAM-NEGATIVE BACILLI: NON-ENTERICS
VIRULENCE BIOCHEMICAL
ORGANISM DISEASE/Sx TRANSMISSION PATHOGENESIS CULTURE/Dx TREATMENT PREVENTION IMAGE/NOTES
FACTORS TESTS
Whooping cough Via respiratory Pertussis toxin: Catarrhal stage: Requires enriched (+) oxidase Erythromycin during 3 injections of
secretions on the histamine most contagious media: (+) catalase catarrhal stage pertussis vaccine
hand or in an sensitization, stage; fever, runny Bordet-Gengou (-) nitrate, citrate, during 1st year of life
aerosolized form increase in insulin nose, sneezing, mild medium or Regan urea + booster series
synthesis, cough Lowe (preferrable)
lymphocyte Paroxysmal stage:
Bordetella
production, bursts of
pertussis increases cAMP nonproductive
cough, increased
Filamentous lymphocyte count
hemagglutinin (FHA), Convalescent
Tracheal cytotoxin stage: not
contagious
Brucellosis Direct contact with Capsule From blood bone Doxycycline and Pasteurization of Reservoir:
contaminated Non-motile marrow, liver, or Gentamicin milk B. melitensis: goats
Fever, chills, livestock or aborted Tropism for erythritol lymph nodes B. abortus: cattles
Brucella spp. weakness, lethargy, placentas (found in animal Immunization of B. suis: pigs
muscle and joint placentas) cattle B. canis: dogs
aches, headaches Ingestion of infected
milk products Obligate aerobe

CURVED GRAM-NEGATIVE RODS AND OTHER UNUSUAL BACTERIA

VIRULENCE BIOCHEMICAL
ORGANISM DISEASE/Sx TRANSMISSION PATHOGENESIS CULTURE/Dx TREATMENT PREVENTION IMAGE/NOTES
FACTORS TESTS
CURVED RODS (Vibrio spp., Helicobacter spp., Campylobacter spp.)
Cholera Ingestion of Serogroups O1 and Infectious dose: Comma-shaped with (+) catalase Prevent dehydration Immunity: sIgA, Classical biotype:
Acute secretory contaminated O139: cholera toxin ≥1010 organisms polar flagellum (+) oxidase and electrolyte loss gastric acid now eradicated
diarrhea drinking water or production For people with (+) sucrose, El Tor biotype:
food Achlorhydria: 100- Routine agars: BA mannose fermenter Antimicrobials: Vaccination: current
Severe: rice water Toxin-Coregulated 10,000 organisms and MAC (-) arabinose Tetracyclines, Pre-travel cholera
stools Pilus (TCP): Selective agars: fermenter Fluoroquinolones, vaccination offers Facultative anaerobe
important for Increased cAMP > TCBS and broth Doxycycline, TMP- incomplete Halophilic
colonization secretion of Cl- > (-) alkaline peptone Classical biotype: SMX, Macrolides protection and Temp: 14-40ºC
of NaCl absorption = broth (-) VP preferred to travelers pH: 8.5-9.5
O-polysaccharide: profuse watery (+) polymyxin B zone For children and who aid refugees
Vibrio cholerae confers serologic diarrhea (-) agglutination pregnant women: and are health care
TCBS: yellow Classified based on
specificity colonies Erythromycin, workers O antigen
TTGA: flat, gray with El Tor biotype: Azithromycin differences
cloudy halo opposite of classical

Darkfield and
phase contrast
microscopy: typical
darting or shooting
stage motility
Seafood- Contaminated Vp-TDH: beta Acute BA: beta hemolysis (-) sucrose fermenter Self-limiting; Avoid consumption Facultative anaerobe
associated seafood hemolysis on gastroenteritis: TCBS: green restoration of water of raw/undercooked Halophilic
diarrheal illness modified BA or nausea, vomiting, colonies and electrolyte shellfish Inc. in temp = inc. in
Wound infections in Wagatsuma agar abdominal cramps, balance Minimize V. parahaemolyticus
Wound infections marine activities fever and explosive mishandling of fish
Vibrio may lead to (swimming, shore Vp-TRH watery diarrhea Antimicrobials: and shellfish
parahaemolyticus septicemia walking) For px with Avoid cross-
Wound infections: unresolved diarrhea contamination of
Common vehicles: mild; for 5d; doxycycline cooked foods by
oysters, clam, With underlying liver and/or raw seafood
shrimp, crab and disease: may lead to fluoroquinolones
cooker crayfish septicemia
TCBS: Thiosulfate-Citrate-Bile Salts-Sucrose agar; TTGA: Taurocholate Tellurite Gelatin Agar; Vp-TDH: Thermostable Direct Hemolysin; Vp-TRH: Thermostable Direct Hemolysin-Related Hemolysin

PPLP 3
 CURVED GRAM-NEGATIVE RODS AND OTHER UNUSUAL BACTERIA
VIRULENCE BIOCHEMICAL
ORGANISM DISEASE/Sx TRANSMISSION PATHOGENESIS CULTURE/Dx TREATMENT PREVENTION IMAGE/NOTES
FACTORS TESTS
Severe wound and Skin/soft tissue Polysaccharide Primary BA and MAC (-) sucrose fermenter Aggressive Avoid eating raw or Growth Is
soft tissue injuries in contact capsule, Cytolysin/ Bacteremia: TCBS: blue-green resuscitation and undercooked dependent on
infections, with contaminated Hemolysin, Erythematous colonies nutritional support shellfish availability of iron
bacteremia/sepsis water Metalloprotease, discoloration of skin
and diarrhea Iron availability and rapidly progress to A presumptive Antimicrobials: Handwash with soap
Iron acquisition hemorrhagic diagnosis is Fluoroquinolones, 3rd after handling raw
Vibrio vulnificus Initially as erythema systems vesicles and bullae important due to gen Cephalosporins, shellfish
and swelling, then then into necrotic potential severity of Doxycycline
intense cellulitis with MARTX: for ulcerations infection Wear protective
bullous skin lesions, bacterial Debridement of all clothes when in salt
myositis, ulceration dissemination from devitalized and/or or brackish water
and necrosis intestine necrotic tissue,
amputation, if any
Leading cause of Close contact with Polar flagellum: Infectious dose: 104 Colorless, appear (-) oxidize and Mild, self-limited Sensitive to gastric
acute diarrhea and domesticated pet enables to organisms watery, spreading or ferment acidity
systemic illness dogs w/ diarrhea “corkscrew” their round and convex carbohydrates Hydration and S-shaped, polar
worldwide way thru mucous Invades the correction of flagellum
Consumption of membrane intestinal epithelium BA: no hemolysis C. jejuni & C. coli: electrolyte Microaerobic
Gastroenteritis: C. unpasteurized or raw via flagella, HMW Campylobacter (+) oxidase abnormalities Easily destroyed by
jejuni, coli milk plasmids, Blood Agar & (+) catalase heat, desiccation,
Bacteremia and superficial Skirrow’s media: Drug of choice: acidity, irradiation,
Campylobacter Feco-oral, person- Azithromycin
extraintestinal adhesins, contains C. jejuni: and disinfectants
spp. to-person vancomycin, (+) Hippurate Alternate drug:
infection: C. fetus chemotactic
Bacteremia and factors = produce polymyxin B, TMP hydrolysis Fluoroquinolones
Prototype: C. jejuni Diarrhea: C. inflammation that
upsaliensis results in RBC and Dark field or phase
GBS: C. jejuni, WBC in stools contrast
upsaliensis microscopy: darting
Reactive arthritis motility
and Reiter’s
syndrome: may
follow
Peptic ulcer Oral-to-oral, Flagella, Utilizes its urease to BA: gray to (+) catalase Triple therapy: 7- Practice good Fusiform rod-shaped
disease and intrafamilial Lipopolysaccharides neutralize the gastric translucent colonies (+) oxidase 14d; Proton Pump hygiene and Microaerophilic
gastritis infection, feco-oral , BabA, SabA, acid (+) urease (strong Inhibitor, Macrolides, handwashing Able to survive
Mucinase, NH3 is converted to Histology is more producers) Amoxicillin acidic environment
Acute: upper GI Humans are Phospholipase, NH4+ = sensitive than Quadruple therapy: Proper food Grows optimally at
illness, nausea, primary host Lipase, VacA neutralization culture 4-10d; PPI, handling and pH 6-7.0
vomiting, abdominal reservoir Metronidazole, preparation
Helicobacter pylori Urease: neutralize Able to colonize the Tetracycline,
pain, fever Serology: to detect
Chronic: benign gastric acid (urea to gastric but not IgG Abs Bismuth Drink clean water
gastric ulceration, NH3 and CO2) epithelial cells
intestinal metaplasia, CagA: induces IL-8 Urease Breath
atrophic gastritis production = Test: for
neutrophil attraction presumptive
diagnosis
OTHER UNUSUAL BACTERIA (Legionella spp., Bartonella spp., Pasteurella spp.)
Community Inhalation of Serogroup 1: most Infectious dose: Wartin-Starry L. pneumophilia: Should not be Hyperchlorination Aerobic,
acquired aerosols derived common >1000 Dieterle: silver stain (+) catalase discontinued until ans superheating of intracellular,
nosocomial from water or soil Mip: adherence and Infects to detect legionella (+) oxidase patient becomes water pleomorphic
Legionella spp. pneumonia phagocytosis macrophages, embedded in tissues (+) Hippurate afebrile around 48-
Environmental Dot/Icm type Iv inhibits phagosome hydrolysis 72 hrs Iron is important for
Prototype: L. Legionnaire’s reservoirs: lakes, secretion system: lysosome fusion, BCYE: selective intracellular growth
pneumophilia disease streams, artificial inhibits phagosome flagella triggers media; grows slowly Other Legionella: Macrolides,
aquatic lysosome fusion caspase 1 = (after 3d) (+/-) oxidase Quinolones,
Pontiac fever environments apoptosis, (-) Hippurate Tetracyclines
dissemination hydrolysis
MARTX: Multifunctional Auto-Processing Repeats-In-Toxin; HMW: High Molecular Weight; GBS: Guillain-Barre Syndrome; NH3: ammonia; NH4+: ammonium; BCYE: Buffered Charcoal Yeast Extract agar; Mip: Macrophage Potentiator
Protein

PPLP 4
 CURVED GRAM-NEGATIVE RODS AND OTHER UNUSUAL BACTERIA
VIRULENCE BIOCHEMICAL
ORGANISM DISEASE/Sx TRANSMISSION PATHOGENESIS CULTURE/Dx TREATMENT PREVENTION IMAGE/NOTES
FACTORS TESTS
South American Bites from infected Deformin: deformity Initial stage: oroya Semi-solid agar Ciprofloxacin, Elimination of Intracellular,
Bartonellosis or sandflies or RBC membranes fever containing 10% Doxycycline, sandfly vectors pleomorphic
Carrion’s disease Flagella: mechanical Severe anemia, rabbit serum and Macrolides, TMP- Insecticides, insect stained with
force to invade hepatosplenomegaly 0.5% Hgb; turbidity SMX for at least 10 repellants Warthin-starry
Biphasic illness RBCs , hemmorhage into develops days silver impregnation
Bartonella
lymph nodes stain
bacilliformis
Second stage:
verruga peruana
Vascular nodular
skin lesions
Cat-scratch Cat scratch, licking Self-limited illness Indirect (-) oxidase Mainly supportive Avoid cat sratches, Intracellular,
disease of open wound manifested by fever Fluorescent (-) catalase Aspiration of pus wash hands after pleomorphic
and Antibody (IFA) test (-) carb utilization Antimicrobials: handling a cat stained with
Bacillary Reservoir: domestic lymphadenopathy Tetracycline, Warthin-starry
Bartonella henselae Primary skin lesion,
angiomatosis cats Azithromycin, TMP- silver impregnation
papule or pustule SMX, Rifampin, stain
develops at site Gentamicin,
Fluoroquinolone
Trench fever Bite of infected Fever, headache, Isolated from (-) oxidase Oral erythromycin Do not share Bacillary
human body louse malaise, biopsies of onvolved (-) catalase personal items to angiomatosis
Bacillary restlessness, shin tissue (-) carb utilization For very ill px: person who might presents in
Bartonella quintana angiomatosis Human and body pain Doxycycline and have body lice immunocompromise
louse are only Definitive Gentamicin d px (AIDS)
known as identification: PCR
reservoirs
Soft tissue Dog or cat bites Bacterial capsule: Cellulitis, respiratory Sheep blood agar: (+) oxidase Drug of choice: Facultative anaerobe
infections Kissing of animals invades and spreads infections, serious 1-2 mm in diameter; (+) catalase Penicillin G
Pasteurella
without being invasice infection opaque or grayish Alternatives:
multocida detected by host Tetracycline,
Fluoroquinolones

ANAEROBES
VIRULENCE BIOCHEMICAL
ORGANISM DISEASE/Sx TRANSMISSION PATHOGENESIS CULTURE/Dx TREATMENT PREVENTION IMAGE/NOTES
FACTORS TESTS
ANAEROBIC GRAM-NEGATIVE BACILLI (Bacteroides fragilis, Prevotella spp., Gardnerella vaginalis, Fusobacterium spp.)
Anaerobic Fimbriae, Intra-abdominal BBE: dark colonies (+) acetate Metronidazole in Obligate anaerobes,
peritoneal LPS/endotoxin, infections, skin and with brown-black (+) succinate combination with with vacuoles and
infections capsule, enterotoxin, soft tissue halos Carbapenems, swellings
FA production, infections, GLC: foul-smelling (+) bile esculin Cefepime or
Superoxide gynecologic FA end products Tigecycline Bile resistant, non-
Bacteroides fragilis dismutase infections, spore-forming
Heat-labile toxin: gastroenteritis, colon Resistant to:
induces Cl- inflammation Penicillin and
secretion, IL-8 Clindamycin
secretion
May cause bacterial Clindamycin Part of normal
vaginosis vaginal flora
Resistant to:
P. melaninogenica: Penicillin G and
Prevotella spp. older
URTI
P. bivia, disiens: Cephalosporins
female genital tract
infections
BBE: Bacteroides Bile Esculin agar; GLC: Gas Liquid Chromatography; URTI: Upper Respiratory Tract Infections

PPLP 5
 ANAEROBES
VIRULENCE BIOCHEMICAL
ORGANISM DISEASE/Sx TRANSMISSION PATHOGENESIS CULTURE/Dx TREATMENT PREVENTION IMAGE/NOTES
FACTORS TESTS
Bacterial vaginosis Sexual contact Vaginal epithelial Metronidazole or Facultative anaerobe
cells covered with Clindamycin
clue cells Part of normal
vaginal flora
Gardnerella
Whiff test: distinct
vaginalis fishy odor after
addition of KOH

pH: >4.5 (N: <4.5)

Lemierre’s disease LPS endotoxin High C-Reactive Metronidazole or Obligate anaerobe
Human Leukocidin: Protein (CRP) Clindamycin
necrobacillosis, inactivates WBCs Part of normal flora
Postanginal sepsis Aggregates human Chest X-ray: or URT of animals
Fusobacterium platelets: multiple peripheral and humans
spp. intravascular round and wedge-
thrombus shaped opacities
Beta-lactamase that progress to
production cavitation
CT Scan
ANAEROBIC GRAM-POSITIVE BACILLI (Clostridium spp., Actinomyces spp., Others)
Botulism Food-borne: Botulinum toxin: Food-borne: 3Ds BA: beta hemolysis For food-borne, Prevent spore Potential
Potent neurotoxin; digestion of blocks release of (diplopia, dysphagia, (except G strain) infant, iatrogenic germination: bioterrorism agent
Neuroparalytic preformed botulinum ACh dysphonia) botulism: Maintain food at
disease involving toxin; usually green Dx based on clinical Trivalent Equine acidic pH, high Motile with
muscles of beans Infant: flaccid presentation (A,B,E) botulinum sugar content, store peritrichous flagella
respiration; Flaccid paralysis of head, Food-borne: food antitoxin at 4ºC
paralysis Infant botulism: neck, throat, trunk Infant: infant’s feces Produces spores
ingestion of muscles For wound
unprocessed honey botulism: Strict anaerobe
Clostridium with spores Metronidazole,
botulinum Penicillin
Wound: rare;
contamination of Ventilatory support
traumatic wound or
drug addicts (heroin)

Iatrogenic:
overdose of
botulinum toxin for
cosmetic purposes
Tetanus Tetanospasmin: Generalized: Risus Dx is based on Metronidazole, Prophylaxis: proper Obligate anaerobe
blocks release of Sardonicus and clinical Penicillin G, wound care Spore-forming
inhibitory NTs – Trismus (lockjaw), presentations Intrathecal Baclofen (drumstick
spastic paralysis generalized (muscle relaxant), Active immunization appearance)
muscular spasms, Human Tetanus IG, with toxoids,
opisthonic posturing Tetanus toxoid, aggressive wound
Benzodiazepine (for care
Localized: rigidity of sedation)
muscles
Clostridium tetani
Cephalic: facial
nerve paresis

Neonatal: infection
of umbilical stump;
rigidity and spasms,
apnea; 90%
mortality

PPLP 6
 ANAEROBES
VIRULENCE BIOCHEMICAL
ORGANISM DISEASE/Sx TRANSMISSION PATHOGENESIS CULTURE/Dx TREATMENT PREVENTION IMAGE/NOTES
FACTORS TESTS
Anaerobic cellulitis Ingestion of spores Alpha toxin: major; Anaerobic cellulitis: Food poisoning: 106 Debridement or Cook food to safe Boxcar shape
can split cell edema, erythema, CFU in food or feces prompt removal or temperatures Spore-forming
Clostridial Type A strain: membrane; cause of necrotic tissue; gas necrotic tissue (drumstick
myonecrosis responsible for most clostridial formation in soft NECROTIZING Refrigerate foods at appearance)
human infections myonecrosis tissues; not painful ENTERITIS: Hyperbaric O2 4ºC or lower
Uterine infection Beta toxin: Clostridial Mousy odor,
necrotizing enteritis myonecrosis: gas BA (target Drug of choice:
Clostridial Epsilon toxin: gangrene, mousy hemolysis) High dose of
septicemia edema and odor, skin is black Nagler reaction/ Penicillin G
hemorrhage with necrosis; Lecithinase test: (+)
Clostridium Food poisoning Iota toxin: necrotic; painful opalescence around Alternatives:
perfringens inc. vascular Uterine infection: colonies Clindamycin,
Necrotizing permeability myonecrosis in Milk media: stormy Metronidazole
enteritis gravid uterus = fermentation
Enterotoxin (CPE), induced abortion
Theta toxin, Theta, Food poisoning:
Kappa, and Mu Ags diarrhea, abdominal
cramps; self-limiting
Necrotizing
enteritis:
destruction of
jejunum
Nosocomial Enterotoxin A: Antibiotic- PCR: for pseudo Antibiotic should be Motile
infections infiltration of PMNs associated colitis; detection of discontinued Subterminal spores
to ileum diarrhea: brief and Toxin B in stool
Cytotoxin B: self-limiting Severe:
destruction of Pseudomembranou Cell cytotoxicity Metronidazole,
epithelial s colitis: most assay Vancomycin,
Clostridium difficile cytoskeleton; severe; profuse Fidaxomicin
pseudomembranes diarrhea, abdominal Colonoscopy: (+)
cramps; fever with pseudomembranes Fecal transplants
whitish plaques
(pseudomembrane
s) over intact colonic
tissue
Human Endogenous: no Interlinked branched Human: Chronic, Sulfur granules: Surgical drainage A. israelii, A.
actinomycosis person-to-person chains = inhibits slow-growing confirmatory gerencseriae
spread phagocytosis granulomatous characteristic Drug of choice: Spore-forming
Orocervicofacial Can form biofilm disease Penicillin for 6-12 Normal flora of
actinomycosis Orocervicofacial: BA: bread crumb or months mouth, gut and
most common; molar tooth colonies vagina
Abdominal “lumpy jaw” Resembles fungi
actonimycosis Abdominal: can
Actinomyces spp. follow ruptured
Cutaneous appendicitis or ulcer
actinomycosis Cutaneous:
hematogenous
Thoracic spread, first sign of
actinomycosis HIV infection
Thoracic:
destruction of lung
tissue

PPLP 7
 SPIROCHETES
VIRULENCE BIOCHEMICAL
ORGANISM DISEASE/Sx TRANSMISSION PATHOGENESIS CULTURE/Dx TREATMENT PREVENTION IMAGE/NOTES
FACTORS TESTS
Syphilis (Acquired Human-to-human Cardiolipin: ACQUIRED Cannot be cultured VDRL: (+) Rapidly immobilized Follow-up check- Slender spirals,
and Congenital) contact important SYPHILIS in vitro flocculation and killed by ups microaerophilic,
component of Ag Primary stage: hard microscopically trivalent arsenical, Early: remain actively motile
T. pallidum Sexual contact: Hyaluronidase: chancre (painless); Darkfield mercury, and contagious for 3-5
subspecies acquired syphilis tissue invasion highly infectious microscopy: tissue RPR: (+) clumping/ bismuth years Does not have
pallidum: syphilis Corkscrew motility: ulcer; no systemic fluid before antibiotic flocculation Late: 5 yrs; not transposable
Vertical move in thick signs or symptoms treatment; motility macroscopically Penicillin: contagious elements
T. pallidum transmission: substances Secondary stage: can be observed treponemicidal in
subspecies congenital syphilis Fibronectin: prevent red maculopapular Immunofluorescen TP-PA: (+) minute Prompt and Px with primary
endemicum: bejel phagocytosis rash, condylomas; ce: motility cannot agglutination concentrations adequate treatment syphilis may still be
Contact with palmar lesions; be observed of all cases re-infected even
T. pallidum infected lesions: highly infectious TPHA/MHA-TP: (+) For all stages: Practice safe sex after treatment
subspecies yaws, bejel and Latent stage: SEROLOGIC agglutination Penicillin
pertenue: yaws pinta asymptomatic; only TESTS: blood or If <1 yr: 1 IM
evidence is positive CSF specimens FTA-ABS: detect injection
T. carateum: pinta Humans are the serologic test Nontreponemal reactive Abs If older or latent: IM
only reservoir Tertiary stage: very tests: detects 3 times at weekly
rare; non- reagin; for screening EIA/CIA: (+) color intervals
Treponema spp. contagious; change or If neurosyphilis:
(VRDL, RPR)
gummas, Treponemal tests: chemiluminescence larger doses
degenerative detection of anti-
changes in CNS, treponemal Abs; for REVERSE If allergic:
cardiovascular confirmatory; IgG- SYPHILIS Tetracycline or
lesions based TESTING: Erythromycin
(TP-PA, TPHA/MHA- If (+) RPR: current/
CONGENITAL TP, FTA-ABS, past infection w/
SYPHILIS EIA/CIA) syphilis
Begins at 10-15th If (-) RPR: test w/
week AOG; Reverse syphilis TP-PA; if (+) TP-PA
Hutchinson’s triad testing (syphilis), if (-) TP-
(peg-shaped teeth, PA (not syphilis)
interstitial keratitis,
deafness); saddle
nose; makes IgM
anti-treponemal
antibody
Anicteric Water contaminated LPS: determines ANICTERIC PHASE 1 Don’t wait for la Vaccination of One end is often
Leptospirosis with rodent urine specificity of human Phase 1: flu-like, Blood, CSF, or results to come domestic livestock bent, forming a
Icteric enters body through immune response; headache, fever and peritoneal dialysate before beginning and pet dogs hook
Leptospirosis breaks in skin and triggers antibody myalgia (calves); specimens; treatment! Rodent control Smallest of the
(Weil’s disease) mucous membranes production establishment in Dark field Protective clothing spirochetes
Biphasic illness liver and kidneys; microscopy (detect Mild: Oral
Important mild or subclinical corkscrew motility), Doxycycline, Immunity is LCFA oxidation is
L. interrogans: reservoir: rodents Phase 2: immune culture, molecular Ampicillin, serotype-specific the main energy
most prevalent stage; IgM starts to methods; Amoxicillin source
Leptospira spp. Human infections rise; aseptic Around 10 days
are accidental meningitis, nephritis, Moderate to
myalgia (calves) PHASE 2 Severe: IV Penicillin,
Urine, liver or kidney Ampicillin,
ICTERIC: severe biopsy; Ceftriaxone
form; end organ or Culture, serology
multi-organ (agglutinating Abs); Supportive
dysfunction; 2nd week of illness management
jaundice, azotemia up to 1 month (hydration and
nutrition)
VRDL: Veneral Disease Research Laboratory; RPR: Rapid Plasma Reagin; TP-PA: T. pallidum-Particle Agglutination test; TPHA/MHA-TP: T. pallidum Hemagglutination/Microhemagglutination T. pallidum; FTA-ABS: Fluorescent Treponemal
Antibody Absorption; EIA/CIA: Enzyme Immunoassay/Chemiluminescence Immunoassay

PPLP 8
 SPIROCHETES
VIRULENCE BIOCHEMICAL
ORGANISM DISEASE/Sx TRANSMISSION PATHOGENESIS CULTURE/Dx TREATMENT PREVENTION IMAGE/NOTES
FACTORS TESTS
Relapsing Fever Via ticks and louse Numerous axial RELAPSING RELAPSING FEVER RELAPSING FEVER Relapsing Fever: Not seen in the
Tick-borne bites filaments: propels FEVER: antigenic Specimen: Tetracycline, Avoid exposure to PH—vectors do not
(endemic): B. thru blood and ECM, structure changes in peripheral blood Erythromycin, vectors live in the country
hermsii, turicatae, Lyme disease: bite escape from the course of a Penicillin Wear protective
miyamotoi, of Ixodes tick phagocytosis single infection = Dark field clothing Larger than
hispanica, duttoni, Reservoir: white- Osp A: attachment relapsing microscopy: stained Tx for a day may be Treponema
persica footed mouse and to midgut of ticks; Febrile stage: (+) with Wright or sufficient to Lyme disease: Moves by rotation
Louse-borne deer spring and winter spirochetes in blood; Giemsa stain; large, terminated an Control of reservoir and twisting
(epidemic): B. Osp B: digests fibrin chills, fever loosely coiled individual attack animals
recurrentis and glycoproteins Afebrile stage: (-) spirochetes moving Avoid exposure to Only spirochete
Osp C: attachment spirochetes in blood; rapidly LYME DISEASE ticks seen in blood
Lyme Disease to humans; summer Immunity develops microscopy
B. burgdorferi, VMPs: provide Second attack of LYME DISEASE slowly because they are
afzelii, garinii antigenic variation chills, fever, intense Early Dx: Erythema large enough
headache migrans Early stage:
Specimen: blood, Doxycycline, No endotoxins or
Attacks will only CSF, joint fluid Amoxicillin, exotoxins
stop when the body Nucleic Acid Cefuroxime
Borrelia spp. has produced Stage 2: Oral
Amplification: to
enough Ab to fight detect B. burgdorferi Doxycycline,
all antigenic variants DNA in blood Amoxicillin, IV
1st stage: enzyme Penicillin,
LYME DISEASE immunoassay Ceftriaxone
Stage 1: erythema 2nd stage:
migrans; “bull’s immunoblot assay
eye” or “target rash”;
3 days to 4 weeks
Stage 2: arthralgia,
arthritis, neurologic
manifestations,
cardiac disease;
weeks to months
Stage 3: chronic
skin lesions, arthritis,
neurologic defects;
months to years
Osp: Outer surface proteins; VMPs: Variable Major Proteins

SPIROCHETES
VIRULENCE BIOCHEMICAL
ORGANISM DISEASE/Sx TRANSMISSION PATHOGENESIS CULTURE/Dx TREATMENT PREVENTION IMAGE/NOTES
FACTORS TESTS

PPLP 9