UNIT 3

Common Pathogenic Microorganisms

Pathogenic microorganisms are organisms which can cause disease on human. These are bacteria, fungi and
viruses.
Bacteria
31. Gram Positive bacteria
There are two genera of gram positive cocci:
1. genus staphylococci 2. genus streptococci
3.1.1.1 Genus Staphylococcus
General characteristics
 All staphylococci appear as gram-positive cocci, Non-sporulating, non-motile.
 Some of them are normal flora of the skin and mucus membrane of human
 It can produce catalase, which differentiate it from the streptococcus
 Several species, exist in the genus but only three are human pathogens
1. Staphylococcus aureus
2. Staphylococcus epidermides
3. Staphylococcus saprophytics
1. Staphylococcus aureus
 It is most important pathogens in the genus
Habitat
S. aureus is normal inhabitant of human oropharynx with a carrier rate of 15% to 25%
Transmission
 Contact with skin lesions, hands of carrier
 Ingestion of contaminated food with enterotoxins
Toxin production
S. aureus produces large number of extra cellular toxins.
Clinical Feature /diseases
 Superficial infections: abscesses, conjunctivitis, wound infections (including post operative sepsis).
 Deep infection: septicemia, osteomyelities, pneumonia, endocarditis.
 Food poisoning
 Is characterized by a short incubation period (1-8 hours) with violent nausea, vomiting, diarrhea
and rapid convalescence. There is no fever.
 Toxic shock syndrome
 Have an abrupt onset of high fever, vomiting, diarrhea, myalgias, a scarletin form rash, and
hypertension with cardiac and renal failure.
2. Staphylococcus Epidermids
 It is normal component of the skin flora
 It is coagulase Negative
3. Staphylococcus Saprophyticus
 It is not photogenic
Laboratory DX
 Specimen- surface swabs of wound, pus, blood sputum, CSF, Faces
 Gram stains- Gram positive cocci in cluster
 Culture –Grow well aerobically and in CO2 enriched media at 37 oC
1. Prevention of contact with S-aureus is almost impossible
2. RX= penicillin, Ampicillin- for penicillin sensitive staphylococci
RX= Cloxacillin, Floxacillin- for penicillin resistant staphylococci

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 Genus Streptococcus
General characteristics
 It is non motile, non- spore forming gram positive spherical celll
 Grows well on ordinary solid media enriched with blood, serum or glucose
 Catalase- Negative
 They are a part of normal flora of man
Classification of streptococcus
Based on:
1. Hemolytic reaction
2. Lance field carbohydrate group
3. Biochemical reaction
Classification based on lancefield system
Many streptococci possess a polysaccharide in their cell wall which is chemically and antigenically distinct
form the cell wall polysaccharide in other bacteria in their genus. This was discovered by Rebecca Lance field.
Enable the use of specific antisera to identify specific organisms
 It is designated A-H and K-V
 Clinically important are A,B,C,D,F,G
The main species and groups of Medical importance
1. S Pyogens ----------- Lance field group A
2. S agalactae ----------- Lance field group B
3. Enterococci ----------- Lance field group D
Streptococcus pyogenes
 The most pathogenic member of the genus
Habitat
Nasopharynx of healthy carriers or ill persons
Transmission
Transmission is by sneezing, coughing and other activates that generate aerosol dissemination of the bacteria
Toxin production: these bacteria produce the following toxins
 Streptolysin O
 Streptolysin S
Disease /clinical features
 Skin infection
 Acute tonsillophargnaities
 Ear infection : Acute otitis media
 Post streptococcal Rheumatic fever- is characterized by joint pain, heart, Kidney(because
immunologoical damge)
Laboratory DX
 Specimen- throat swab, pus, blood
 Smear- Non motile gram positive cocci in chains
 Serological Diagnosis
 By latex agglutination (ASO- antistreptolysin O)
Prevention
Exposure to group a streptococcus can not be avoided
Treatment
- Penicillin
Group B streptococci
- Represented by streptococcus agalactiae
- Approximately 25% of healthy women harbor group B streptococci in their vaginal flora and suffer no
resulting ill effects. But immunosuppressed patient and new borne are susceptible to group B infection
 Clinical Features
- Neonatal sepsis, pneumonia and meningitis
 Lab DX

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  Smear- Non motile gram positive cocci in chains
 Culture- grow in aerobic and anaerobic environment at temp 35-37%
 RX -Penicillin
Streptococcus Pneumonia
General property
 They are fastidious, lancet shaped gram-positive diplococcic
 They possess capsule of polysaccharide
Habitats
 Found as a normal flora in the upper respiratory tract 5% of health carrier and ill persons
Transmission
 Aerosols are major means of dissemination
Clinical Feature/ Disease
 Pneumonia
 Meningitis
 Otitis Media More common in children
 Sinusitis
 Endocardits
Laboratory DX
 Specimen: Sputum, blood, CSF, Ear discharge
 Smear - Lancet shaped gram positive diplococci
 Treatment- penicillin, cephalosporin
 Prevention: Exposure to the pneumococci can not be avoided
6.1.2. Gram Positive Rods
Gram positive rods are classified in to:
Spore forming
o Aerobic –Genus Bacillus and
o Anaerobic–Genus Clostridium
Non-spore forming
oGenus Corynebacterium
3.1.2.1. Genus- Bacillus
General characteristics
 Aerobic, spore forming, gram-positive rods
 If grows in ordinary media as a typical colorless with away margin and small projection
 If grow in temperature range for growth of 12-45oc
 B.anthracis is important pathogens for human
Bacillus Anthracis
General characteristics
 The organism is a zoonotic pathogen able to cause disease in several domestic animals and human
 It is non-motile, aerobic, spore forming gram positive rod ( bacillus)
 It grow in temp rang 12-45o (Optimum = 35oc)
Habitat
 The organism is a natural pathogen of cattle, sheep , goats other Mammals that come in contact with this
animal could get the infection
Transmission
 Spores of B. anthrasis are found in the soil and on the wool, hide and pellet of animal. human contact with
the pathogen is by either or two means
1. Contact of the spores or vegetative cells of the bacteria with broken skin
2. Inhalation of spores or vegetative cells
Virulence factor
 Capsule
 Exotoxin (Anthrax toxin)
Clinical feature

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Its infection is characteristically septicaemic with splenic enlargement. Spores can remain viable for years in
contaminated soil and are very heat resistant in the dry state up to 150 oC for 1 hour. Human disease occurs in
three forms:
Coetaneous anthrax: Transmission of the disease is through contamination of skin with spores from animal
product through skin trauma leading coetaneous anthrax.
Pulmonary (inhalation) anthrax: Through inhalation the spore enters in to respiratory tract causing pulmonary
anthrax which is not transmitted person to person.
Gastrointestinal anthrax: Feeding on contaminated food especially under cooked meat lead to gastrointestinal
anthrax. GIT anthrax produces vomiting, abdominal pain and bloody diarrhea.
Laboratory DX
 Specimen: Fluid or pus from skin lesion, blood, sputum
 Smear:- Non capsulated gram positive rod with terminal spores form culture
Treatment: Penicillin
3.1.2.2. Genus Clostridium
General characteristics
 Clostridia are anaerobic spore forming gram positive rods
 Spore of clostridia are not found in infected tissue
 They inhibit human and animal intestine, soil, water, decaying animal and plant matter
 The pathogenic species produces one or more powerful exo-toxins that are responsible for most symptoms
of disease
Species of Medical Importance
1. C. Perfringens
2. C. Tetani
3. C. Botulinum
C. Perfringens
 are capsulated, non-motile, short-gram positive rods
Habitat
 Spores of C. perfringens are found in soil
Transmission
Transmission of C .perfringes and other clostridia depends on the entrance of their spores into deep puncture,
wands, fractures and other injures in which fissures are contaminated with soil.
Virulence factors
 Enzymes:
 Toxins
Clinical feature
 Gas gangrene
- Bacterial spores damaged tissue germinate and release numerous cytolytic toxins, and also ferment
several sacharides and produce gas bubble
 food poisoning
Laboratory DX
 Specimen: infected tissue pus
 Smear: non-motile capsulate gram positive rods
 Culture: Blood agar medium
 Treatment- penicillin
Clostridium Tetani
General characteristics
 Longer and thinner gram-positive rods with round terminal spores giving characteristics "drum-stick"
appearance
 Produce toxin (Neurotoxin) which cause the disease tetanus also known as Lock Jaw
Habitat
 The natural habitat of the spore is soil
Transmission

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 The spore is the infective stage of the organism spores enter into puncture wounds or minor scratches
contaminated with spore-bearing soil. The spore germinates under the favorable conditions of anaerobic and
local tissue death and secretes the tetanus toxin.
Virulence factor
1. Tetanus toxin
Clinical Manifestation
The bacterium cause tetanus which manifest with the following symptoms and signs
1. Lock jaw
2. Fever and sweating
3. Muscle spasm and rigidity
Laboratory DX
 The bacteria can be cultured in a media with anaerobic atmosphere
 Diagnosis is exclusively by clinical manifestation of the disease
Prevention
 Vaccine (DPT)
 Given in child hood at age of 2, 4, 6, and 18 months. The vaccine contains tetanus toxoid.
 If an injured person has never been immunized, them human Immuno anti tetanus globulin should
be administrated.
Treatment
 Penicillin tetanus
Clostridium Butulinum
General Characteristics
 If found in soil and vegetation
 Produced a neurotoxin which is the most active known poison
Habitat
Spores of the botulism bacillus are found in soil
Transmission
 Toxin in the food produced by vegetative bacteria can cause a disease when it ingested
Virulence factor
 Botulinum toxin
Clinical Feature
 Food intoxification
 Muscles Weakness blurred vision and mucosal dryness
DX
 Demonstration of toxin in patients serum and leftover food
Treatment
 Administration of antitoxin intravenously.
Genus Corynebacterium
Are Gram-positive bacilli with a characteristic morphology: non-sporing, non-capsulated; non-motile.
Corynebacterium diphtheria
Habitat: commensal of the throat and nose of man.
Laboratory characteristics:
 Specimen for laboratory diagnosis is swab: (throat swab and swab from coetaneous lesion).
 Laboratory diagnosis: includes Culture, immunological test.
Toxin production: Diphtheria toxin -responsible for the virulence
Pathogenicity
C. diphtheriae is the cause of diphtheria; usually affect the mucous membranes of the upper respiratory
tract. They multiply and produce toxin at the local site then produce respiratory diphtheria and
coetaneous diphtheria.
Antibiotic sensitivity
It is sensitive to penicillin, erythromycin, and other antibiotics.

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Prevention and treatment
Antitoxin
Antibiotics- Penicillin, Cephalosporin, erythromycin, Tetracycline.
Immunization with DPT

Gram negative bacteria

Gram Negative Cocci
The two pathogenic species are:
 Niesseria gonorrhea. Also referred to as the gonococcus and
 Niesseria meningitides .Also referred to as the meningococcus
General characteristics
 N. meningitides causes meningitis and meningococcemia in children.
 N. gonorrhoeae causes gonorrhoea, neonatal conjunctivitis (opthalmia neonatorium) and pelvic
inflammatory disease PID.
 They are gram negative intracellular diplococcal bacteria's which contain endotoxin in their
outer membrane.
 Natural host is human.
Neisseria gonorrhea
Route of infection- infants during delivery and adults through sexual intercourse
Pathogenicity
 The sites of infection include the urethra (in men) and the cervix (in women).
 Causes symptomatic infections in males and asymptomatic infection in females which is usually
detected in their male partner
 it causes painful urination (Urethritis) and discharge of white pus from the penis in men
 Approximately 9-15% of affected women contract Pelvic Inflammatory Disease (PID) as a
consequence of gonorrhea
 Infected infants develop serious eye infection (conjunctivitis) which can lead to blindness
 untreated gonorrhea can cause permanent sterility
Lab diaghosis
Sample: Urethral swab, cervical swab, eye swab
1, Microscopy
2, culture
3, Serologic
Treatment
 Ceftriaxon for uncomplicated infection, Spectinomycine/ Ciprofloxacin for penicillin allergy. TTC if
mixed with C. trachomatis. Follow up after one month finishing the treatment.
Neisseria meningitides
Habitat: human is the only natural host, it is present in 10-20% of the nasopharynex of healthy people.
Transmission- by air borne droplets.
Pathogenecity
 Meningococcal meningitis (fever, headache, stiff neck and increased PMN in spinal fluid).
 Meningococcemia-(meningococcal septicemia) is life threatening having high fever, shock, wide
spread purpura, and disseminated intravascular coagulation.
 80 % of meningitis in <2 month aged infants is due to N. meningitis and S. pneumonia.
 The second cause of meningitis next to S. pneumonia in individuals between 2 and 18 years.
Virulence of N. meningitidis is associated with its antiphagocytic capsule.
Laboratory characteristic
Specimen: cerebrospinal fluid, blood.
1, Microscopy
2, culture

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 3, Serologic
Treatment -Penicillin G is treatment of choice.
Prevention:
 Chemoprophylaxis and immunization.
 Penicillin allergic patients are treated with third generation of cephalosporin or Chloramphenicol.
2. Gram Negative Bacilli
 It comprises the following bacterial groups
I.OXIDASE –NEGATIVE
Enterobacteriacae
 Escherichia Species
 Klebsiella Species Lactose Fermentors
 Enterobacter Species
 Citrobacter Species

 Salmonella Species
 Shigella Species Non Lactose Fermentors
 Proteus Species
II.OXIDASE –POSITIVE
 Pseudomonas
 Vibrio
 Campylobacter
Enterobacteriaceae
General characteristics
These genera include numerous interrelated bacterial flora of the intestine.
Are also named as coliforms or enterobacilli.
Most of the Enterobacteriaceae are intestinal parasites of man and animals.
 Gram-Negative, non-spore forming, aerobic and facultative anaerobic bacteria.
 Most are motile
 Release endotoxisin from their cell wall
Genus Escherichia
Main species of medical importance is Escherichia coli
Escherichia coli
General Characteristic
 Normal flora in human and animal gastrointestinal tract
 Most are motile, some are capsulated
 Different strains of E-coli differ in their ability of secrete exo-toxins that are critical to the type of
disease they cause.
Habitat
 E-coli does not survive for long periods of time out side the human intestine
Transmission
 E-coli are spread from person to person by fecal-oral means and at time by sexual or direct contact.
Virulence factor
 Exotoxin
 Pilli
 Endotoxin
Clinical features /disease/
 Urinary tract infection (UTI) - 80% of UTI.
 Specially equipped strains of E-coil cause special form of intestinal disease. These are
A. Entertoxigenic E-coli (ETEC)
 Causes toxin mediated watery diarrhea in infants and young adults
 It is an important causes of traveler’s diarrhea
B. Enteropathogenic E-coli (EPEC)

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  Cause out breaks of infantile diarrhea
C. Entero Invasive E-coli (EIEC)
 It produce dysentery (bloody diarrhea together with mucus)
D. Enterohemorrhagic E-coli (EHEC)
 E-coli strains with the ability to cause a sever bloody diarrhea and abdominal cramps
 These strains cause hemolytic anemia. This can be life threatening.
Lab diagnosis
 Microscopy
 -Culture
Treatment
 For diarrheas : oral rehydration
 Antibiotic:-Sulfonamides and other antibiotic

Genus Klebsiella
General Characteristics
 Non-motile, lactose fermenting, capsulated Gram negative rods
 Main species of medical importance is Klebsiella pneumonia
Klebsiella pneumonia
General Characteristics
 It is found as a commensal in the intestinal tract
 Also found in moist environment in hospitals
 It is an important nosocomial pathogen(acquired in hospitals)
Virulence factor
 Capsule
Clinical feature
 Pneumonia
 Urinary tract infection
 Wound infection and peritonitis
Laboratory DX
 Specimen =Sputum, urine, pus, body fluid
 Gram stain
 Culture
 Seroloy
Rx: - Based on sensitivity pattern.
Genus salmonella
General characteristics
 Species of salmonella are determined by antigenic difference e.g. O, H and K
Medical importance species are
 Salmonella typhi
 Salmonella paratyphi
 Salmonella enteritidis
Salmonella typhi
General Characteristics
 Salmonella typhi is the ethologic agent of typhoid fever, one of the most serious Salmonellosis.
 Typhoid fever is classified as an enteric fever because the organism invades the intestinal tract.
Habitat
 Human are the only source of S.typhi
Transmission: - is by the fecal oral route via food, flies and fomaites
Virulence factor
 Pilli
 Endotoxin
 Cytotoxin that impairs protein synthesis

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  Enterotoxins
Clinical Feature
 Typhoid fever is an invasive disease caused by only S.typhi. This pathogen enters many organs and has
the capacity to survive with in phagocyte cell and cause both gastrointestinal and generalized
symptoms.
 Fever, headache, malaise, chill, skin rash, enlargement of the liver, spleen, loss of mental alertness
 Recovery from typhoid fever may appear to be rapid but many patients shed the bacteria in their stool
for years
Laboratory DX
 Specimen
 Blood, stool, urine, serum for typhoid fever
 Blood =80% positive in the first week
 Stool=70-80% positive in the second and 3rd week
 Urine =20% positive in the third and fourth week
 Serum for widal test –Positive after second week of illness
 Culture
 Serology -Widal test
Treatment
Chloramphenicol (CAF)

Genus Shigella
General Characteristics
 They lack flagella and are non-motile
 It’s infection are called shigellosis
 Species of Medical Importance are
 Shigella dysenteriae
 Shigella Flexneri
 Shigella boydii
 Shigella sonnei
Shigella dysenteriae
General Characteristics
 It is etiologic agents of bacterial dysentery
 It is highly infections- less than 100 bacteria can cause dysentery
Habitat
 The habitat of S- dysenteriae is restricted to the human intestinal tract
Transmission
 Fecal-oral route
 Flies and fomites in contact with fecal matter may disseminate this bacteria
Virulence factor
 Pili
 Endotoxin
 Cytotoxin (shiga toxin)
Clinical feature
 In developing countries shigellosis (bacillary dysentery) is caused by S- dysenteriae and S-flexneri
 The shigella bacillus invade superficial epithelial cell of the gut
 Abdominal cramp
 Fever
 Muscle weakness
Lab DX
 Specimen -Stool, Serum
 Gram stain-Gram Negative ,non motile rods
 Culture

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  Serology
Treatment
 Treatment relies on rehydration therapy
 Antibiotic therapy based of sensitivity pattern

Other Shigellas
 Shigella boydii, shigella flexneri and shigella sonnei cause an intestinal infection that is common in
preschool children because of the difficulty of maintaining the high standard of hygiene among the
children.
Genus Proteus
General Characteristics
 Proteus species are found in the intestinal tract of humans and animals, soil, sewage & water
 They are gram- Negative, motile, non-capsulated polymorphic rods
Species of Medical Importance
 Proteus mirabilis
 Proteus vulgaris
Habitat
 It is recovered from urinary tract
Clinical Features
P. mirabilis
 Urinary tract infection
 Septicemia
 Abdominal and wound infections
 Secondary invade of ulcer burn
P. vulgaris
 Important Nosocomial pathogen
 Isolated in wound infection and urinary tract infection
Laboratory DX
 Specimen:-Urine, pus, blood, ear discharge
 Gram Stain:-Gram- Negative Rods
 Culture
 Serology
Some of the antigens of proteus strain (OX19, OXK, and OX2) agglutinate with sera from patient with
Rickettsial disease. These reaction forms the basis of the Weil-felix test
Treatment
 Based on sensitivity testing
Genus Pseudomonas
General Characteristics
 Gram-Negative , motile, aerobic rods having very simple growth requirement
 Can be found in water, soil, sewage, vegetation, human and animal intestine.
Species of medical importance
 Pseudomonas-aeruginosa
 Pseudomonas-pseudomallei
Pseudomonas aeruginosa
General Characteristics
 Found in human and animals intestine, water, soil and moist environment in hospital
 It is an important Nosocomial pathogens
Habitat
 P. aeruginosa is a normal inhabitant of the intestinal tract.
Transmission

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  All pseudomonas are resistant to the environment and survive for long period of time in water, air
and article of bed clothing.
Virulence Factor
 Toxin
 Phospholipase
 Protease
 Cytotoxin
Clinical Feature
 Urinary tract infection -chronic complicated UTI associated with indwelling catheter
 Wound infection of burn sites, pressure sores and ulcer
Lab DX
 Specimen:-Pus, urine, blood, surface swab
 Gram stain:-Gram- Negative rods
Culture
Treatments
 Aminoglicoside
Genus Vibrio
General Characteristics
 Actively motile, gram-Negative curved rods
 Species of medical importance Vibrio cholera
Vibrio cholera
General Characteristics
 Actively motile gram-Negative curved rods
 Species of medical importance vibrio cholera 01
 Found in fresh water, shell fish and other sea food
 Man is the major reservoir of V. cholera 01 which causes epidemic cholera.
 Survive in clean stagnant water
Habitat
 Human are the only animal infected with V. cholera
Transmission
 Water contaminated with the organism or food exposed to contaminated water maintains the fecal-
oral route of spread.
Virulence Factor
 Pili
 Cholera toxin.
Clinical Feature
 A heavy watery diarrhea is typical of cholera (rice water stool)- if left uncontrolled, results in death
from dehydration
Lab DX
 Specimen:-Stool
 Smear:-Gram- Negative motile curved rods
 Cultures
RX (Treatment)
 Tetracycline, CAF
Genus Campylobacter
General Characteristic
 Small, delicate, spirally curved, S shaped gram negative bacteria
 Motile
 Strictly micro aerophilic bacteria
Species of Medical Importance
 Campylobacter jejuni
 Campylobacter coli

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C. jejuni
Habitat
 Wild and domestic animals are source for human infection because these animal harbor c.jejuni in their
intestinal flora.
Transmission
 contaminated food, drink, un pasteurized milk
Virulence factor
 Endotoxin (Lipopolysaccharide)
Clinical feature
 Fever
 Abdominal pain and bloody diarrhea
Laboratory diagnosis
 Specimen :- stool
 Microscopy
 Culture
Treatment:-Erythromycin
Helicobacter pylori
 H. pylori is a curved bacillus and it has become accepted as microbial cause of gastric (peptic) or
duodenal ulcer and cancer.
 This organism is an inhabitant of the stomach where its potent urease creates a microenvironment that
permits survival.
Laboratory Diagnosis
 Tissue culture
 Serological Test .H.pylori antibody detection test
Treatment
 Antimicrobial therapy eliminates the bacteria from the stomach and cures peptic ulcers and gastritis
that were formerly believed to be caused by excess stomach acidity.
Genus Haemophilus
Habitat: found in the upper respiratory tract.
oThe main species that cause disease:
Haemophilus influenza, Haemophilus ducrey, Haemophilus agypticus, Haemophilus parainfluenza.
Pathogencity:
 H. influenza causes meningitis in young children.
 H. aegypticus causes sexually transmitted disease called chancroids.
 H. parainfluenza causes respiratory tract infection.
Genus Bordetella
Habitat: usually respiratory tract of human.
o The main species that causes disease in human is Bordetella pertussis that causes whooping cough.
Pathogencity: Bordetella pertussis causes whooping cough: a disease mainly seen in children less than one
year age. It affects the lower respiratory tract. Treatment by most antibiotics is not much effective, but
vaccination is effective method of control. The vaccine is prepared from whole cell killed Bordetella pertussis.
It is given together with toxoid of tetanus and diphtheria [DPT].
6.1. Acid-fast Bacilli
General Characteristics
 Strictly aerobic acid fast bacilli
 The main reservoir is an infected human
 40% - 60% of their cell wall is in the form of lipid.
 Infections by the mycobacterium are often slowly progressing disease with gradually increase
symptoms.
Species of Medical Importance
 Mycobacterium Tuberculosis
 Mycobacterium Leprae

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  Mycobacterium Bovis (Cattle )
 Mycobacterium Africanum
 Mycobacterium Ulcerance
MYCOBACTERIUM TUBERCLOSIS (MTB)
General Characteristics
 It is thin rod shape
 They are acid fast due to their cell wall which is composed of waxes and lipids that have high content of
mycolic fatty acids
 It can be stained by Ziehl-Neelson Acid fast technique
 Gram stain poorly or not at all stain mycobacterium but if it stain it seems Gram positive
 It is slow growing bacteria
Habitat
 It is restricted to humans
Transmission
 M. tuberculosis is spread from infected person by air borne inhalation directly or droplet nuclei
Virulence factor
 Lipid mycolic acid, waxes, phospholipids responsible for acid fastness, tumor necrosis
 Proteins:-Elicits the tuberculin reaction and antibody production.
 Polysaccharides:- Immediate type of hyper sensitivity
Clinical feature
 Incubation period 4-6 week
 Causes pulmonary and extra pulmonary tuberculosis
 The disease generally manifests with low grade persistent fever, Night sweating, significant weight loss,
fatigue and generalized weakness.
Lab diagnosis
 Specimen :-Sputum, pleural fluid, peritoneal fluid, CSF
 Smear :-Acid fast bacilli from primary specimen
 Culture
 Serology :- Tuberculin skin test
 It is intradermal test that use an antigen PPD (Purified Protein derivative}
Prevention
 BCG (Bacillus of Calmett and Guerin) vaccine at child hood
 Avoiding respiratory rout of transmission
Treatment
Requires multidrug therapy to prevent the emergence of drug resistance (mutants) during long (6-9 months)
duration of treatment.
 Pulmonary Tb treatment – mainly treated with three drugs: INH, Rifampin and Pyrizinamide (INH
and Rifampin are given for 6 months and Pyrazinamide have to be stopped after 2 months).
 Immunocompromised patients likely have INH resistance and have to be treated with four drugs for
9-12 months (ethambutol is additional). Patient's sputum becomes non-infective with in 2-3 Weeks after
treatment.
 DOT- direct observed treatment is given to avoid complication of treatment.
Mycobacterium Leprae
General Characteristics
 Typical acid fast bacilli arranged in singly parallel
 It can not grown in non-living bacteriological media
 Characteristic lesions are grown in laboratory animals e.g. foot pads of mice
Habitat
 Mycobacterium leprae is pathogen only in human.
Transmission
 The manner by which M. lepreae is spread from person to person is still unclear.

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 Direct contact and respiratory route are most probable- prolonged contact with lepromatus leprosy
patient who discharge bacteria:
o From skin lesion
o Nasal secretions.

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Virulence factor
 Numerous lipids
Clinical feature
 Leprosy (Incubation period months to years)
It is also called (Hansen’s disease)
Type of leprosy
1. Lepromatous leprosy:-is the most rapidly progressing and disfiguring form, it cause
deformities of the hand, skin, nose.
2. Tuberculoid leprosy:-the disease which is less virulent and not destructive
Laboratory diagnosis
 Specimen:- Skin scraping from the ear lobe (skin slit )
 Smear:-Acid fast bacilli from the primary specimen
Treatment:-Anti- leprosy drugs
 Dapsone
 Rifampicin
 Clofazimine
o Combination of drugs is used to treat patients due to drug resistance.
 For lepromatus patient: combination of Dapsone, Rifampin and clofazimine is given.
 For tuberculoid patients: combination of Dapsone, Rifampin is given.
Prevention
 No vaccine is available
Isolation and chemoprophylaxis with dapson for exposed children
6.4. OTHER IMPORTANT BACTERIA's
6.4.1. Spirochetes
General Characteristics
 Long, slenderically coiled, spiral or cork screw shaped and resembles gram- negative rods
but it can not be stained by gram stain.
 Move by bending and rotating movement
 Motility of these bacteria is based on the axial filament.
Spirochetes of Medical Importance
 Treponema
 Borellia
 Leptospira
Genus Treponema
Species of Medical Importance
 Trponema Pallidium
Treponema Pallidium
General characteristics
 Slender spiral microarophilic
 Not cultured in artificial media
 It is a causative agent of syphilis
Habitat
 Only human
Transmission
 Sexual contact
 Transpalcentally to the fetus from infected mother.

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Virulence factor
 Membrane protein
 Outer sheath protein
Clinical features
 Incubation period is 3-4 week
 T. palladium is a causative agent of syphilis
There are two type of syphilis
A. Acquired syphilis
B. Congenital syphilis
A. Acquired Syphilis:
- Rout of transmission is sexual contact
 It has four stage
1. Primary stage
 Hard chancre, genital ulcer with inguinal lymphadenopathy
2. Secondary stage
 Manifest with generalized Maculopapular rash and white patches in the mouth.
There may be syphilitic meningitis, nephritis
NB. Primary and secondary syphilis are rich in spirochete from site of the lesion and patient is
highly infectious
3. Latent stage
 Patients are symptom free but relapse can occur. In early stage patient is
infectious but in late stage of latent syphilis , patients are none infectious
4. Tertiary stage
 Manifesting with destructive granulomatous lesion(gumma) in bone, skin, and
liver.
Out come of acquired syphilis in untreated case:
 1/3 of cases spontaneously cured during primary or secondary syphilis
 1/3 become positive for serological test of syphilis
 1/3 of cases develop tertiary
B. Congenital Syphilis
 Route of transmission – Mother to child during pregnancy
Out come:
Abortion Early neonatal death
Fetal death Organ damage
Still birth Deafness
Lab DX
- Specimen - Tissue from skin lesion
- Dark field Microscopy
- Motile spirochetes in dark filed illumination
- Serological test for syphills
- Specimen is Serum-VDRL, RPR, CFT, TPHA (Treapnema pallidum
hemagglutination test}, TPI (Treponema pallidum immobilization test)
Prevention and control measures
- Treatment of cases and screen contacts
- Practice safe sex
- Health education

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Treatment-Penicillin
Genus Borrelia
Borellia recurrentis
 Is the cause of epidemic louse-borne relapsing fever (RF).
General characteristics
 Highly flexible irregular spiral organism
 Habitat: The human body louse and Ticks
Transmission
The disease is transmitted from rodents to humans by ticks. Human to human infection
occurs when the borrelia enter damaged skin following the crushing of an infected body
louse

Virulence factor
 Antigenic variation due to their membrane
Clinical features
 Fever
 Headache
 Malaise
Lab DX
Specimen - Blood
Smear - Gimrsa stain /wright stain
Treatment -Penicillin,Tetracycline
Prevention
 Delousing with insecticides
 Improve personal and family hygiene
Condition favoring disease transmission
 Over crowding
 Poverty
 Famine /drought
Genus Leptospira
The main pathogenic species is: Leptospira interrogans.
Habitat: it is harborated in the kidney of some rodents and animals.
Pathogencity: the cause of Zoonotic disease called Leptospirosis.
Genus Mycoplasma
Mycoplasmas are bacteria that do not have cell walls. The most common human pathogenic
species is Mycoplasma pneumonia.
Mycoplasma pneumonia
 It is a major cause of pneumonia in young age groups (5-20yrs)
 M. pneumonia is a pleomorphic organism with out cell wall. The prolonged bursting
cough seen in this disease is due to the inhibition of ciliary movement of the respiratory
tract.
 Habitat: human respiratory tract.
 Treatment:Tetracycline,Erythromycin
Genus Rickettsia and Chlamydia
The rickettsiae and Chlamydiae are obligate intracellular organisms.

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Chlamydia trachomatis causes trachoma; the disease is transmitted from infected person by
contaminated fingers, towels, or by house flies.
Rickettsia
Rickettsial disease is referred as arthropod transmitted disease. Thick, lice, fleas, and mites are
vectors of a variety of diseases caused by rickettsias.

Disease Agent Vector Reservoi Geographical Positive Weil- Treatment

r distribution Felix
Agglutination
Epidemi R. prowazecki Body Humans World wide OX-19 Tetracycline
c typhus louse
Endemic R. typhi Flea Rats World wide OX-19 Tetracycline
typhus
Scrub R. Mite Mites, Southeast OX-K Tetracycline
typhus tsutsugamushi rats Asia,
southwest
pacific

Fungal disease (Mycoses)

 The principal mycoses (fungal infection) affecting man can be distinguish by the sit of
the body affected
 Each type has different pattern of disease characteristics
1. Superficial mycoses
 These affect the skin ,hair ,or nails
 They are confined to the body surface and don’t directly involve living tissue
 The important superficial mycoses are Ring worm (dermatophytosis) which is caused by
the following Dermatophyte
 Microsporum species
 Trichophyton species
 Epidermiphyton floccosum
2. Subcutaneous mycoses
 It is refer to as mycoses of implantation because they are acquired when pathogen is
inoculated through the skin by minor scratch or cut
 The principal subcutaneous mycoses are
 Chromomycosis caused by

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  phialophora spp
 cladosporium carrinonii
 Mycetoma caused by
 Actionmycetes spp
3. Systemic mycoses
 also referred to as deep mycoses
 they are acquired by inhalation and may spread from lung and involve any part of the
body
 wide spread infection may be fatal
 the common systemic mycoses are
 Histoplasmosis caused by
 Histoplasma capsulatum
 Blastomycosis caused by
 Blastomyces dermatitids
4. Opportunistic mycoses
 are those that are considered as non pathogenic and which infect only immuno
compromised patient
 Candidiasis caused by
 Candia Albicans
 Crytococcosis caused by
 Cryptococcus neoformans
Laboratory diagnosis of fungal disease
Source of specimen can be urine, blood, sputum, nails, hair, skin etc.
Methods
1. Microscopy – wet mount, KOH and stained smear.
2. Culture - mostly carried out in specialist mycology center.
- Disadvantage is it may take several weeks before a culture report is received
because some fungal pathogens are slow growing.
3. Serology
- Antibody tests
- Antigen tests
Treatment – Topical or systemic Antifungal drugs

Viral diseases
DNA VIRUSES
Enveloped
Herpes viruses
 Herpes Simplex virus (HSV)
 HSV-1= oral- facial lesions
 HSV-2= Genital lesions
 Varicella Zoster Virus (VZV)
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  Varicella or chicken pox and
 Herpes zoster or shingles
 Cytomegalovirus (CMV)- rarely cause disease in healthy people
 EBV
 HHV – 8
Hepatitis B Virus (HBV)
Pox virus – Smallpox
Non enveloped
- Adeno virus – cause upper & lower respiratory tract infections, including pharyngitis &
pneumonia.
- Popilloma virus- Cause papilloma on skin & mucous membrane on the skin. Also cause
cancer (cervix.)
RNA VIRUSES
Enveloped viruses
 Respiratory viruses
1. Influenza A& B viruses
– Influenza A viruses is the major cause of recurrent epidemics of influenza.
2. Para influenza virus
– Cause of croup in children & important causes of common cold in adults
3. Respiratory syncytial virus - Cause of bronchitis & pneumonia in infants
 Measles, mumps & rubella virus - Cause complications in pregnancy.
 Rabies - Cause fatal encephalitis
 Hepatitis C virus - Causes chronic hepatitis & hepatic carcinoma
 Human immunodeficiency virus(HIV)
-HIV 1 was introduced in to human from chimpanzees
-HIV 2 was introduced in to human from monkey
Lab diagnosis
-direct demonstration of the antigen
-Serology (Antibody test) - For Screening
- E.g. ELISA test
-Western blot (For confirmation)
Non Enveloped viruses
- Entero viruses - Infect the intestinal tract by fecal-oral transmission.
- Rhino virus - Cause respiratory infection – common cold
- Hepatitis A virus - Enteric
- Reo virus
Prevention of Viral diseases – Vaccine and no effective treatment for most viral infections.

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