day 1 bacteria

MICROBIOLOGY MICROBIOLOGY Day 1Day 1

BACTERIABACTERIA

Function/Composition of peptidoglycan?Function/Composition of peptidoglycan?

BACTERIABACTERIA

Function/Composition of peptidoglycan?Function/Composition of peptidoglycan?

Gives rigid supportGives rigid support

Protects against osmotic pressureProtects against osmotic pressure

Sugar backbone, cross-linked peptide side Sugar backbone, cross-linked peptide side chainschains

BACTERIABACTERIA

Function/Composition of cell wall/cell Function/Composition of cell wall/cell membrane?membrane?

BACTERIABACTERIA

Function/Composition of cell wall/cell Function/Composition of cell wall/cell membrane?membrane?

Gram positive: major surface antigenGram positive: major surface antigen

Teichoic acid induces TNF and IL-1Teichoic acid induces TNF and IL-1

BacteriaBacteria

Function/Composition of Outer Function/Composition of Outer Membrane?Membrane?

BacteriaBacteria

Function/Composition of Outer Function/Composition of Outer Membrane?Membrane?

Gram negative: site of endotoxin (LPS)Gram negative: site of endotoxin (LPS)

Major surface antigenMajor surface antigen

Lipid ALipid A: induces TNF alpha and IL-1: induces TNF alpha and IL-1

BacteriaBacteria

Function/Composition of Plasma Function/Composition of Plasma Membrane?Membrane?

BacteriaBacteria

Function/Composition of Plasma Function/Composition of Plasma Membrane?Membrane?

Site of oxidative and transport enzymesSite of oxidative and transport enzymes

Lipoprotein bilayerLipoprotein bilayer

BacteriaBacteria

Function/Composition of Ribosomes?Function/Composition of Ribosomes?

BacteriaBacteria

Function/Composition of Ribosomes?Function/Composition of Ribosomes?

Protein SynthesisProtein Synthesis

50S and 30S 50S and 30S

BacteriaBacteria

Function/Composition of Periplasm?Function/Composition of Periplasm?

BacteriaBacteria

Function/Composition of Periplasm?Function/Composition of Periplasm?

Space between the cytoplasmic membrane Space between the cytoplasmic membrane and the outer membrane in and the outer membrane in GRAM GRAM NEGATIVE RODSNEGATIVE RODS

Contains many hydrolytic enzymes Contains many hydrolytic enzymes

(B-lactamases)(B-lactamases)

BacteriaBacteria

Function/Composition of Capsule?Function/Composition of Capsule?

BacteriaBacteria

Function/Composition of Capsule?Function/Composition of Capsule?

Protects against phagocytosisProtects against phagocytosis

Polysaccharides Polysaccharides

(except (except B. anthracis composed of?B. anthracis composed of?))

BacteriaBacteria

Function/Composition of Capsule?Function/Composition of Capsule?

Protects against phagocytosisProtects against phagocytosis

PolysaccharidesPolysaccharides

(except (except B. anthracis:B. anthracis: D-glutamate) D-glutamate)

BacteriaBacteria

Function/Composition of Pilus/Fimbria?Function/Composition of Pilus/Fimbria?

BacteriaBacteria

Function/Composition of Pilus/Fimbria?Function/Composition of Pilus/Fimbria?

Mediates adherence of bacteria to cell Mediates adherence of bacteria to cell surfacesurface

Sex pilus forms between 2 bacteria Sex pilus forms between 2 bacteria (conjugation)(conjugation)

GlycoproteinGlycoprotein

BacteriaBacteria

Function/Composition of Flagellum?Function/Composition of Flagellum?

BacteriaBacteria

Function/Composition of Flagellum?Function/Composition of Flagellum?

MotilityMotility

ProteinProtein

BacteriaBacteria

Function/Composition of Spore?Function/Composition of Spore?

BacteriaBacteria

Function/Composition of Spore?Function/Composition of Spore?

Provides resistance to dehydration, heat Provides resistance to dehydration, heat and chemicalsand chemicals

Keratin-like coat; Keratin-like coat; dipicolinic aciddipicolinic acid

BacteriaBacteria

Function/Composition of Plasmid?Function/Composition of Plasmid?

BacteriaBacteria

Function/Composition of Plasmid?Function/Composition of Plasmid?

Contains genes for antibiotic resistance, Contains genes for antibiotic resistance, enzymes and toxinsenzymes and toxins

DNADNA

BacteriaBacteria

Function/Composition of Glycocalyx?Function/Composition of Glycocalyx?

BacteriaBacteria

Function/Composition of Glycocalyx?Function/Composition of Glycocalyx?

Mediates adherence to surfaces (e.g. Mediates adherence to surfaces (e.g. indwelling catheters)indwelling catheters)

PolysaccharidesPolysaccharides

BacteriaBacteria

Activity in Lag Phase?Activity in Lag Phase?

BacteriaBacteria

Activity in Lag Phase?Activity in Lag Phase?

Metabolic activity without divisionMetabolic activity without division

BacteriaBacteria

Activity in Log Phase?Activity in Log Phase?

BacteriaBacteria

Activity in Log Phase?Activity in Log Phase?

Rapid cell divisionRapid cell division

BacteriaBacteria

Activity in Stationary Phase?Activity in Stationary Phase?

BacteriaBacteria

Activity in Stationary Phase?Activity in Stationary Phase?

Nutrient depletion slows growthNutrient depletion slows growth

BacteriaBacteria

Activity in Death Phase?Activity in Death Phase?

BacteriaBacteria

Activity in Death Phase?Activity in Death Phase?

Prolonged nutrient depletion and build up of Prolonged nutrient depletion and build up of waste product waste product cell death cell death

BacteriaBacteria

Bacterial Growth Curve : Bacterial Growth Curve :

BacteriaBacteria

PROPERTYPROPERTY EXOTOXINEXOTOXIN ENDOTOXINENDOTOXIN

SOURCESOURCE

SECRETED SECRETED FROM CELLFROM CELL

CHEMISTRYCHEMISTRY

LOCATION LOCATION OF GENESOF GENES

TOXICITYTOXICITY

BacteriaBacteria

PROPERTYPROPERTY EXOTOXINEXOTOXIN ENDOTOXINENDOTOXIN

SOURCESOURCE Gram +/-Gram +/-

SECRETED SECRETED FROM CELLFROM CELL

CHEMISTRYCHEMISTRY

LOCATION LOCATION OF GENESOF GENES

TOXICITYTOXICITY

BacteriaBacteria

PROPERTYPROPERTY EXOTOXINEXOTOXIN ENDOTOXINENDOTOXIN

SOURCESOURCE Gram +/-Gram +/- Most Gram -Most Gram -

SECRETED SECRETED FROM CELLFROM CELL

CHEMISTRYCHEMISTRY

LOCATION LOCATION OF GENESOF GENES

TOXICITYTOXICITY

BacteriaBacteria

PROPERTYPROPERTY EXOTOXINEXOTOXIN ENDOTOXINENDOTOXIN

SOURCESOURCE Gram +/-Gram +/- Most Gram -Most Gram -

SECRETED SECRETED FROM CELLFROM CELL

YESYES

CHEMISTRYCHEMISTRY

LOCATION LOCATION OF GENESOF GENES

TOXICITYTOXICITY

BacteriaBacteria

PROPERTYPROPERTY EXOTOXINEXOTOXIN ENDOTOXINENDOTOXIN

SOURCESOURCE Gram +/-Gram +/- Most Gram -Most Gram -

SECRETED SECRETED FROM CELLFROM CELL

YESYES NONO

CHEMISTRYCHEMISTRY

LOCATION LOCATION OF GENESOF GENES

TOXICITYTOXICITY

BacteriaBacteria

PROPERTYPROPERTY EXOTOXINEXOTOXIN ENDOTOXINENDOTOXIN

SOURCESOURCE Gram +/-Gram +/- Most Gram -Most Gram -

SECRETED SECRETED FROM CELLFROM CELL

YESYES NONO

CHEMISTRYCHEMISTRY PolypeptidePolypeptide

LOCATION LOCATION OF GENESOF GENES

TOXICITYTOXICITY

BacteriaBacteria

PROPERTYPROPERTY EXOTOXINEXOTOXIN ENDOTOXINENDOTOXIN

SOURCESOURCE Gram +/-Gram +/- Most Gram -Most Gram -

SECRETED SECRETED FROM CELLFROM CELL

YESYES NONO

CHEMISTRYCHEMISTRY Polypeptide Polypeptide LPSLPS

LOCATION LOCATION OF GENESOF GENES

TOXICITYTOXICITY

BacteriaBacteria

PROPERTYPROPERTY EXOTOXINEXOTOXIN ENDOTOXINENDOTOXIN

SOURCESOURCE Gram +/-Gram +/- Most Gram -Most Gram -

SECRETED SECRETED FROM CELLFROM CELL

YESYES NONO

CHEMISTRYCHEMISTRY Polypeptide Polypeptide LPSLPS

LOCATION LOCATION OF GENESOF GENES

Plasmid/Plasmid/BacteriophagBacteriophagee

TOXICITYTOXICITY

BacteriaBacteria

PROPERTYPROPERTY EXOTOXINEXOTOXIN ENDOTOXINENDOTOXIN

SOURCESOURCE Gram +/-Gram +/- Most Gram -Most Gram -

SECRETED SECRETED FROM CELLFROM CELL

YESYES NONO

CHEMISTRYCHEMISTRY Polypeptide Polypeptide LPSLPS

LOCATION LOCATION OF GENESOF GENES

Plasmid/Plasmid/BacteriophagBacteriophagee

Bacterial Bacterial chromosomechromosome

TOXICITYTOXICITY

BacteriaBacteria

PROPERTYPROPERTY EXOTOXINEXOTOXIN ENDOTOXINENDOTOXIN

SOURCESOURCE Gram +/-Gram +/- Most Gram -Most Gram -

SECRETED SECRETED FROM CELLFROM CELL

YESYES NONO

CHEMISTRYCHEMISTRY Polypeptide Polypeptide LPSLPS

LOCATION LOCATION OF GENESOF GENES

Plasmid/Plasmid/BacteriophagBacteriophagee

Bacterial Bacterial chromosomechromosome

TOXICITYTOXICITY High (1 ug)High (1 ug)

BacteriaBacteria

PROPERTYPROPERTY EXOTOXINEXOTOXIN ENDOTOXINENDOTOXIN

SOURCESOURCE Gram +/-Gram +/- Most Gram -Most Gram -

SECRETED SECRETED FROM CELLFROM CELL

YESYES NONO

CHEMISTRYCHEMISTRY Polypeptide Polypeptide LPSLPS

LOCATION LOCATION OF GENESOF GENES

Plasmid/Plasmid/BacteriophagBacteriophagee

Bacterial Bacterial chromosomechromosome

TOXICITYTOXICITY High (1 ug)High (1 ug) Low (100’s)Low (100’s)

BacteriaBacteria

PROPERTYPROPERTY EXOTOXINEXOTOXIN ENDOTOXINENDOTOXIN

AntigenicityAntigenicity

VaccinesVaccines

Heat StabilityHeat Stability

Typical Typical DiseasesDiseases

BacteriaBacteria

PROPERTYPROPERTY EXOTOXINEXOTOXIN ENDOTOXINENDOTOXIN

AntigenicityAntigenicity High High (antitoxins)(antitoxins)

VaccinesVaccines

Heat StabilityHeat Stability

Typical Typical DiseasesDiseases

BacteriaBacteria

PROPERTYPROPERTY EXOTOXINEXOTOXIN ENDOTOXINENDOTOXIN

AntigenicityAntigenicity High High (antitoxins)(antitoxins)

Poorly Poorly antigenicantigenic

VaccinesVaccines

Heat StabilityHeat Stability

Typical Typical DiseasesDiseases

BacteriaBacteria

PROPERTYPROPERTY EXOTOXINEXOTOXIN ENDOTOXINENDOTOXIN

AntigenicityAntigenicity High High (antitoxins)(antitoxins)

Poorly Poorly antigenicantigenic

VaccinesVaccines Toxoids Toxoids

Heat StabilityHeat Stability

Typical Typical DiseasesDiseases

BacteriaBacteria

PROPERTYPROPERTY EXOTOXINEXOTOXIN ENDOTOXINENDOTOXIN

AntigenicityAntigenicity High High (antitoxins)(antitoxins)

Poorly Poorly antigenicantigenic

VaccinesVaccines ToxoidsToxoids NoneNone

Heat StabilityHeat Stability

Typical Typical DiseasesDiseases

BacteriaBacteriaPROPERTYPROPERTY EXOTOXINEXOTOXIN ENDOTOXINENDOTOXIN

AntigenicityAntigenicity High High (antitoxins)(antitoxins)

Poorly Poorly antigenicantigenic

VaccinesVaccines ToxoidsToxoids NoneNone

Heat StabilityHeat Stability Destroyed at Destroyed at 60C(except 60C(except staph staph enterotoxin)enterotoxin)

Typical Typical DiseasesDiseases

BacteriaBacteriaPROPERTYPROPERTY EXOTOXINEXOTOXIN ENDOTOXINENDOTOXIN

AntigenicityAntigenicity High High (antitoxins)(antitoxins)

Poorly Poorly antigenicantigenic

VaccinesVaccines ToxoidsToxoids NoneNone

Heat StabilityHeat Stability Destroyed at Destroyed at 60C(except 60C(except staph staph enterotoxin)enterotoxin)

Stable at Stable at 100C for 1 100C for 1 hourhour

Typical Typical DiseasesDiseases

BacteriaBacteriaPROPERTYPROPERTY EXOTOXINEXOTOXIN ENDOTOXINENDOTOXIN

AntigenicityAntigenicity High High (antitoxins)(antitoxins)

Poorly Poorly antigenicantigenic

VaccinesVaccines ToxoidsToxoids NoneNone

Heat StabilityHeat Stability Destroyed at Destroyed at 60C(except 60C(except staph staph enterotoxin)enterotoxin)

Stable at Stable at 100C for 1 100C for 1 hourhour

Typical Typical DiseasesDiseases

Tetanus, Tetanus, botulism, botulism, diphtheriadiphtheria

BacteriaBacteriaPROPERTYPROPERTY EXOTOXINEXOTOXIN ENDOTOXINENDOTOXIN

AntigenicityAntigenicity High High (antitoxins)(antitoxins)

Poorly Poorly antigenicantigenic

VaccinesVaccines ToxoidsToxoids NoneNone

Heat StabilityHeat Stability Destroyed at Destroyed at 60C(except 60C(except staph staph enterotoxin)enterotoxin)

Stable at Stable at 100C for 1 100C for 1 hourhour

Typical Typical DiseasesDiseases

Tetanus, Tetanus, botulism, botulism, diphtheriadiphtheria

MeningococcMeningococce-mia, sepsis e-mia, sepsis by gram - by gram - rodsrods

BacteriaBacteria

Gram positive bacteria with exotoxin?Gram positive bacteria with exotoxin?

BacteriaBacteria

Gram positive bacteria with exotoxin?Gram positive bacteria with exotoxin?- Corynebacterium diphtheriaeCorynebacterium diphtheriae- Clostridium tetaniClostridium tetani- C. botulinumC. botulinum- C. perfringensC. perfringens- Staphylococcus aureusStaphylococcus aureus- Streptococcus pyogenesStreptococcus pyogenes

BacteriaBacteria

Gram negative bacteria with exotoxin?Gram negative bacteria with exotoxin?

BacteriaBacteria

Gram negative bacteria with exotoxin?Gram negative bacteria with exotoxin?

- EE. coli. coli- BB. pertussis. pertussis- VV. cholerae. cholerae

BacteriaBacteria

Bacteria with superantigen?Bacteria with superantigen?

BacteriaBacteria

Bacteria with superantigen?Bacteria with superantigen?

S. aureusS. aureus

S. pyogenesS. pyogenes

BacteriaBacteria Bacteria with superantigen?Bacteria with superantigen?

S. aureus : TSST-1S. aureus : TSST-1 binds to MHCII and T cell receptor binds to MHCII and T cell receptor IL-1 & IL-2 IL-1 & IL-2 Toxic ShockToxic Shock

(other toxins: enterotoxin, exfoliatin)(other toxins: enterotoxin, exfoliatin)

S. pyogenes:S. pyogenes:

BacteriaBacteria Bacteria with superantigen?Bacteria with superantigen?

S. aureus : TSST-1S. aureus : TSST-1 binds to MHCII and T cell receptor binds to MHCII and T cell receptor IL-1 & IL-2 IL-1 & IL-2 Toxic ShockToxic Shock

(other toxins: enterotoxin, exfoliatin)(other toxins: enterotoxin, exfoliatin)

S. pyogenes: Erythrogenic toxinS. pyogenes: Erythrogenic toxinScarlet FeverScarlet Fever

Streptolysin O (hemolysin) : antigen for Streptolysin O (hemolysin) : antigen for ASO ASO titers for titers for Rheumatic FeverRheumatic Fever

BacteriaBacteria

Bacteria with ADP ribosylating toxinsBacteria with ADP ribosylating toxins

BacteriaBacteria

Bacteria with ADP ribosylating toxinsBacteria with ADP ribosylating toxins

- C. diphtheriaeC. diphtheriae- EE. coli. coli- BB. pertussis. pertussis

- - VV. cholerae. cholerae

BacteriaBacteria

Bacteria with ADP ribosylating toxinsBacteria with ADP ribosylating toxins

- C. diphtheriae: inactivates EF2 C. diphtheriae: inactivates EF2 - E. coliE. coli- B. pertussisB. pertussis

- V. cholerae- V. cholerae

BacteriaBacteria Bacteria with ADP ribosylating toxinsBacteria with ADP ribosylating toxins

- C. diphtheriae: inactivates EF2 C. diphtheriae: inactivates EF2 - E. coli: E. coli: heat labile toxinheat labile toxin-- stimulates stimulates

adenylateadenylate cyclase cyclase

heat stable toxinheat stable toxin- stimulates - stimulates guanylateguanylate cyclase cyclase

- B. pertussisB. pertussis- V. choleraeV. cholerae

BacteriaBacteria Bacteria with ADP ribosylating toxinsBacteria with ADP ribosylating toxins

- C. diphtheriae: inactivates EF2 C. diphtheriae: inactivates EF2 - E. coli: E. coli: heat labile toxinheat labile toxin-- stimulates stimulates

adenylateadenylate cyclase cyclase

heat stable toxinheat stable toxin- stimulates - stimulates guanylate guanylate cyclase cyclase

- B. pertussis: stimulates adenylate cyclase (Gi)B. pertussis: stimulates adenylate cyclase (Gi)- V. choleraeV. cholerae

BacteriaBacteria Bacteria with ADP ribosylating toxinsBacteria with ADP ribosylating toxins

- C. diphtheriae: inactivates EF2 C. diphtheriae: inactivates EF2 - E. coli: E. coli: heat labile toxinheat labile toxin-- stimulates stimulates

adenylateadenylate cyclase cyclase

heat stable toxinheat stable toxin- stimulates - stimulates guanylate guanylate cyclase cyclase

- B. pertussis: stimulates adenylate cyclase (Gi)B. pertussis: stimulates adenylate cyclase (Gi)- V. cholerae: stimulates adenylate cyclase(Gs)V. cholerae: stimulates adenylate cyclase(Gs)

BacteriaBacteria

Actions of Endotoxin (Actions of Endotoxin (especially lipid Aespecially lipid A)?)?

BacteriaBacteria

Actions of Endotoxin (Actions of Endotoxin (especially lipid Aespecially lipid A)?)?

Activates MacrophagesActivates Macrophages

Activates Complement Activates Complement (alt pathway)(alt pathway)

Activates Hageman FactorActivates Hageman Factor

BacteriaBacteria

Actions of Endotoxin (Actions of Endotoxin (especially lipid Aespecially lipid A)?)?

Activates Macrophages:Activates Macrophages: IL-1 IL-1 Fever Fever

TNF TNF Fever, tissue necrosis Fever, tissue necrosis

Nitric Oxide Nitric Oxide Hypotension Hypotension

Activates Complement Activates Complement (alt pathway):(alt pathway):

Activates Hageman Factor:Activates Hageman Factor:

BacteriaBacteria

Actions of Endotoxin (Actions of Endotoxin (especially lipid Aespecially lipid A)?)?

Activates Macrophages:Activates Macrophages: IL-1 IL-1 Fever Fever

TNF TNF Fever, tissue necrosis Fever, tissue necrosis

Nitric Oxide Nitric Oxide Hypotension Hypotension

Activates Complement Activates Complement (alt pathway):(alt pathway):

C3aC3a hypotension, edema hypotension, edema

C5aC5a neutrophil chemotaxis neutrophil chemotaxis

Activates Hageman Factor:Activates Hageman Factor:

BacteriaBacteria

Actions of Endotoxin (Actions of Endotoxin (especially lipid Aespecially lipid A)?)?

Activates Macrophages:Activates Macrophages: IL-1 IL-1 Fever Fever

TNF TNF Fever, tissue necrosis Fever, tissue necrosisNitric Oxide Nitric Oxide Hypotension Hypotension

Activates Complement Activates Complement (alt pathway):(alt pathway):

C3aC3a hypotension, edema hypotension, edema C5aC5a neutrophil chemotaxis neutrophil chemotaxis

Activates Hageman Factor:Activates Hageman Factor: Coagulation cascadeCoagulation cascade DIC DIC

BacteriaBacteria

Bacteria that don’t Gram stain well?Bacteria that don’t Gram stain well?

BacteriaBacteria Bacteria that don’t Gram stain well?Bacteria that don’t Gram stain well?

- TreponemaTreponema- RickettsiaRickettsia- MycobacteriaMycobacteria- MycoplasmMycoplasm- Legionella pneumophilaLegionella pneumophila- Chlamydia Chlamydia

These Rascals May Microscopically Lack ColorThese Rascals May Microscopically Lack Color

BacteriaBacteria

Bacteria that don’t Gram stain well?Bacteria that don’t Gram stain well?

- Treponema Treponema too thin (Darkfield & FTABS) too thin (Darkfield & FTABS)- RickettsiaRickettsia- MycobacteriaMycobacteria- MycoplasmMycoplasm- Legionella pneumophilaLegionella pneumophila- Chlamydia Chlamydia

BacteriaBacteria

Bacteria that don’t Gram stain well?Bacteria that don’t Gram stain well?

- Treponema Treponema too thin (Darkfield & FTABS) too thin (Darkfield & FTABS)- Rickettsia Rickettsia intracellular parasite intracellular parasite- MycobacteriaMycobacteria- MycoplasmMycoplasm- Legionella pneumophilaLegionella pneumophila- Chlamydia Chlamydia

BacteriaBacteria

Bacteria that don’t Gram stain well?Bacteria that don’t Gram stain well?

- Treponema Treponema too thin (Darkfield & FTABS) too thin (Darkfield & FTABS)- Rickettsia Rickettsia intracellular parasite intracellular parasite- Mycobacteria Mycobacteria high lipid content (Acid Fast) high lipid content (Acid Fast)- MycoplasmMycoplasm- Legionella pneumophilaLegionella pneumophila- Chlamydia Chlamydia

BacteriaBacteria

Bacteria that don’t Gram stain well?Bacteria that don’t Gram stain well?

- Treponema Treponema too thin (Darkfield & FTABS) too thin (Darkfield & FTABS)- Rickettsia Rickettsia intracellular parasite intracellular parasite- Mycobacteria Mycobacteria high lipid content (Acid Fast) high lipid content (Acid Fast)- Mycoplasm Mycoplasm no cell wall no cell wall- Legionella pneumophilaLegionella pneumophila

- Chlamydia - Chlamydia

BacteriaBacteria

Bacteria that don’t Gram stain well?Bacteria that don’t Gram stain well?

- Treponema Treponema too thin (Darkfield & FTABS) too thin (Darkfield & FTABS)- Rickettsia Rickettsia intracellular parasite intracellular parasite- Mycobacteria Mycobacteria high lipid content (Acid Fast) high lipid content (Acid Fast)- Mycoplasm Mycoplasm no cell wall no cell wall- Legionella pneumophila Legionella pneumophila intracellular (Silver Stain) intracellular (Silver Stain)

- Chlamydia - Chlamydia

BacteriaBacteria Bacteria that don’t Gram stain well?Bacteria that don’t Gram stain well?

- Treponema Treponema too thin (Darkfield & FTABS) too thin (Darkfield & FTABS)- Rickettsia Rickettsia intracellular parasite intracellular parasite- Mycobacteria Mycobacteria high lipid content (Acid Fast) high lipid content (Acid Fast)- Mycoplasm Mycoplasm no cell wall no cell wall- Legionella pneumophila Legionella pneumophila intracellular (Silver Stain) intracellular (Silver Stain)- Chlamydia Chlamydia intracellular parasite intracellular parasite

BacteriaBacteria

Fermentation pattern of Neisseria species?Fermentation pattern of Neisseria species?

BacteriaBacteria

Fermentation pattern of Neisseria species?Fermentation pattern of Neisseria species?

N . Meningococci N . Meningococci Maltose & Glucose Maltose & Glucose N. Gonococci N. Gonococci Glucose Glucose

BacteriaBacteria

Pigment Producing Bacteria?Pigment Producing Bacteria?

BacteriaBacteria

Pigment Producing Bacteria?Pigment Producing Bacteria?

- S. aureus S. aureus - P. aeruginosaP. aeruginosa- S. marcescens S. marcescens

BacteriaBacteria

Pigment Producing Bacteria?Pigment Producing Bacteria?

- S. aureus S. aureus yellow yellow- P. aeruginosaP. aeruginosa- S. marcescens S. marcescens

BacteriaBacteria

Pigment Producing Bacteria?Pigment Producing Bacteria?

- S. aureus S. aureus yellow yellow - P. aeruginosa P. aeruginosa blue/green blue/green- S. marcescens S. marcescens

BacteriaBacteria

Pigment Producing Bacteria?Pigment Producing Bacteria?

- S. aureus S. aureus yellow yellow - P. aeruginosa P. aeruginosa blue/green blue/green- S. marcescens S. marcescens red red

BacteriaBacteria

IgA Protease producing bacteria?IgA Protease producing bacteria?

BacteriaBacteria

IgA Protease producing bacteria?IgA Protease producing bacteria?

S. pneumoniaeS. pneumoniae

N. meningitidisN. meningitidis

N. gonorrhoeaeN. gonorrhoeae

H. influenzaeH. influenzae

BacteriaBacteria

Gram Positive Cocci?Gram Positive Cocci?

BacteriaBacteria

Gram Positive Cocci?Gram Positive Cocci?

StaphylococcusStaphylococcus

StreptococcusStreptococcus

BacteriaBacteria

How to differentiate Staph from Strep?How to differentiate Staph from Strep?

BacteriaBacteria

How to differentiate Staph from Strep?How to differentiate Staph from Strep?

Staphylococcus = Catalase positiveStaphylococcus = Catalase positive

Streptococcus = Catalase negativeStreptococcus = Catalase negative

BacteriaBacteria

How to differentiate staphylococcus?How to differentiate staphylococcus?

BacteriaBacteria

How to differentiate staphylococcus?How to differentiate staphylococcus?

Coagulase positive Coagulase positive S. aureus S. aureus

Coagulase negative Coagulase negative S. saprophyticus S. saprophyticus

S. epidermidis S. epidermidis

BacteriaBacteria

How to differentiate staphylococcus?How to differentiate staphylococcus?

Coagulase positive Coagulase positive S. aureus S. aureus

Coagulase negative Coagulase negative S. saprophyticus S. saprophyticus Novobiocin - Novobiocin -

S. epidermidis S. epidermidis Novobiocin + Novobiocin +

BacteriaBacteria

How to differentiate Streptococcus?How to differentiate Streptococcus?

BacteriaBacteria

How to differentiate Streptococcus?How to differentiate Streptococcus?

Alpha hemolytic Alpha hemolytic

Beta hemolyticBeta hemolytic

Gamma hemolyticGamma hemolytic

BacteriaBacteria

How to differentiate Streptococcus?How to differentiate Streptococcus?

Alpha hemolytic Alpha hemolytic S. pneumoniaeS. pneumoniae

S. viridansS. viridans

Beta hemolyticBeta hemolytic

Gamma hemolyticGamma hemolytic

BacteriaBacteria

How to differentiate Streptococcus?How to differentiate Streptococcus?

Alpha hemolytic Alpha hemolytic S. pneumoniae S. pneumoniae

S. viridansS. viridans

Beta hemolytic Beta hemolytic S. pyogenes S. pyogenes

S. agalactiaeS. agalactiae

Gamma hemolyticGamma hemolytic

BacteriaBacteria

How to differentiate Streptococcus?How to differentiate Streptococcus?

Alpha hemolytic Alpha hemolytic S. pneumoniaeS. pneumoniae S. viridansS. viridans

Beta hemolytic Beta hemolytic S. pyogenes S. pyogenes S. agalactiaeS. agalactiae

Gamma hemolytic Gamma hemolytic Enterococcus Enterococcus PeptostreptococcusPeptostreptococcus

BacteriaBacteria

How to differentiate between alpha How to differentiate between alpha hemolytic streptococci?hemolytic streptococci?

BacteriaBacteria

How to differentiate between alpha How to differentiate between alpha hemolytic streptococci?hemolytic streptococci?

S. Pneumoniae S. Pneumoniae Optochin sensitive Optochin sensitive

Bile solubleBile soluble

Viridans streptococci Viridans streptococci Optochin resistant Optochin resistant Not bile soluble Not bile soluble

BacteriaBacteria

How to differentiate beta hemolytic How to differentiate beta hemolytic streptococci?streptococci?

BacteriaBacteria

How to differentiate beta hemolytic How to differentiate beta hemolytic streptococci?streptococci?

S. Pyogenes (Group A) S. Pyogenes (Group A) Bacitracin Bacitracin sensitive sensitive

S. Agalactiae (Group B) S. Agalactiae (Group B) Bacitracin Bacitracin resistant resistant

BacteriaBacteria

Gram positive rods?Gram positive rods?

BacteriaBacteria

Gram positive rods?Gram positive rods?

- Clostridium (anaerobe)Clostridium (anaerobe)- CorynebacteriumCorynebacterium- ListeriaListeria- BacillusBacillus

BacteriaBacteria

Gram negative “Coccoid” rods?Gram negative “Coccoid” rods?

BacteriaBacteria

Gram negative “Coccoid” rods?Gram negative “Coccoid” rods?

- H. influenzaeH. influenzae- PasteurellaPasteurella- BrucellaBrucella- B. pertussisB. pertussis

BacteriaBacteria

Fast Lactose fermenters?Fast Lactose fermenters?

BacteriaBacteria

Fast Lactose fermenters?Fast Lactose fermenters?

- KlebsiellaKlebsiella- E. coliE. coli- EnterobacterEnterobacter

BacteriaBacteria

Slow Lactose Fermenters?Slow Lactose Fermenters?

BacteriaBacteria

Slow Lactose Fermenters?Slow Lactose Fermenters?

- CitrobacterCitrobacter- SerratiaSerratia

BacteriaBacteria

Lactose Nonfermenters?Lactose Nonfermenters?

BacteriaBacteria

Lactose Nonfermenters?Lactose Nonfermenters?

Oxidase Positive:Oxidase Positive:

PseudomonasPseudomonas

BacteriaBacteria

Lactose Nonfermenters?Lactose Nonfermenters?

Oxidase Positive:Oxidase Positive: Oxidase Oxidase Negative:Negative:

PseudomonasPseudomonas ShigellaShigella

SalmonellaSalmonella

ProteusProteus

BacteriaBacteria Special Culture Requirements?Special Culture Requirements?

H. InfluenzaH. InfluenzaN. GonorrhoeaN. GonorrhoeaB. PertussisB. PertussisC. DiphtheriaeC. DiphtheriaeM. TuberculosisM. TuberculosisLactose Fermenting EntericsLactose Fermenting EntericsLegionellaLegionellaFungiFungi

BacteriaBacteria

Special Culture Requirements?Special Culture Requirements?

H. InfluenzaH. Influenza Chocolate Agar Factor V (NAD) & Chocolate Agar Factor V (NAD) &

X (Hematin)X (Hematin)

N. Gonorrhoea N. Gonorrhoea

B. PertussisB. Pertussis

C. DiphtheriaeC. Diphtheriae

M. TuberculosisM. Tuberculosis

Lactose Fermenting EntericsLactose Fermenting Enterics

LegionellaLegionella

FungiFungi

BacteriaBacteria

Special Culture Requirements?Special Culture Requirements?

H. InfluenzaH. Influenza Chocolate Agar Factor V (NAD) & Chocolate Agar Factor V (NAD) &

X (Hematin)X (Hematin)

N. Gonorrhoea N. Gonorrhoea Thayer-Martin (VCN) Thayer-Martin (VCN)

B. PertussisB. Pertussis

C. DiphtheriaeC. Diphtheriae

M. TuberculosisM. Tuberculosis

Lactose Fermenting EntericsLactose Fermenting Enterics

LegionellaLegionella

FungiFungi

BacteriaBacteria

Special Culture Requirements?Special Culture Requirements?

H. InfluenzaH. Influenza Chocolate Agar Factor V (NAD) & Chocolate Agar Factor V (NAD) &

X (Hematin)X (Hematin)

N. Gonorrhoea N. Gonorrhoea Thayer-Martin (VCN) Thayer-Martin (VCN)

B. Pertussis B. Pertussis Bordet- Gengou (potato) agar Bordet- Gengou (potato) agar

C. DiphtheriaeC. Diphtheriae

M. TuberculosisM. Tuberculosis

Lactose Fermenting EntericsLactose Fermenting Enterics

LegionellaLegionella

FungiFungi

BacteriaBacteria

Special Culture Requirements?Special Culture Requirements?

H. InfluenzaH. Influenza Chocolate Agar Factor V (NAD) & Chocolate Agar Factor V (NAD) & X (Hematin)X (Hematin)

N. Gonorrhoea N. Gonorrhoea Thayer-Martin (VCN) Thayer-Martin (VCN)B. Pertussis B. Pertussis Bordet- Gengou (potato) agar Bordet- Gengou (potato) agarC. Diphtheriae C. Diphtheriae Tellurite plate, Loffler’s medium, blood Tellurite plate, Loffler’s medium, blood

agar agarM. TuberculosisM. TuberculosisLactose Fermenting EntericsLactose Fermenting EntericsLegionellaLegionellaFungiFungi

BacteriaBacteria

Special Culture Requirements?Special Culture Requirements?

H. InfluenzaH. Influenza Chocolate Agar Factor V (NAD) & Chocolate Agar Factor V (NAD) & X (Hematin)X (Hematin)

N. Gonorrhoea N. Gonorrhoea Thayer-Martin (VCN) Thayer-Martin (VCN)B. Pertussis B. Pertussis Bordet- Gengou (potato) agar Bordet- Gengou (potato) agarC. Diphtheriae C. Diphtheriae Tellurite plate, Loffler’s medium, blood Tellurite plate, Loffler’s medium, blood

agar agarM. Tuberculosis M. Tuberculosis Lowenstein-Jensen agar Lowenstein-Jensen agarLactose Fermenting EntericsLactose Fermenting EntericsLegionellaLegionellaFungiFungi

BacteriaBacteria

Special Culture Requirements?Special Culture Requirements?

H. InfluenzaH. Influenza Chocolate Agar Factor V (NAD) & Chocolate Agar Factor V (NAD) & X (Hematin)X (Hematin)

N. Gonorrhoea N. Gonorrhoea Thayer-Martin (VCN) Thayer-Martin (VCN)B. Pertussis B. Pertussis Bordet- Gengou (potato) agar Bordet- Gengou (potato) agarC. Diphtheriae C. Diphtheriae Tellurite plate, Loffler’s medium, blood Tellurite plate, Loffler’s medium, blood

agar agarM. Tuberculosis M. Tuberculosis Lowenstein-Jensen agar Lowenstein-Jensen agarLactose Fermenting Enterics Lactose Fermenting Enterics Pink colonies on Pink colonies on

MacConkey’s agar MacConkey’s agarLegionellaLegionellaFungiFungi

BacteriaBacteria

Special Culture Requirements?Special Culture Requirements?

H. InfluenzaH. Influenza Chocolate Agar Factor V (NAD) & Chocolate Agar Factor V (NAD) & X (Hematin)X (Hematin)

N. Gonorrhoea N. Gonorrhoea Thayer-Martin (VCN) Thayer-Martin (VCN)B. Pertussis B. Pertussis Bordet- Gengou (potato) agar Bordet- Gengou (potato) agarC. Diphtheriae C. Diphtheriae Tellurite plate, Loffler’s medium, blood Tellurite plate, Loffler’s medium, blood

agar agarM. Tuberculosis M. Tuberculosis Lowenstein-Jensen agar Lowenstein-Jensen agarLactose Fermenting Enterics Lactose Fermenting Enterics Pink colonies on Pink colonies on

MacConkey’s agar MacConkey’s agarLegionella Legionella Charcoal yeast extract agar buffered with Charcoal yeast extract agar buffered with

increased iron & cysteine increased iron & cysteineFungiFungi

BacteriaBacteria

Special Culture Requirements?Special Culture Requirements?

H. InfluenzaH. Influenza Chocolate Agar Factor V (NAD) & Chocolate Agar Factor V (NAD) & X (Hematin)X (Hematin)

N. Gonorrhoea N. Gonorrhoea Thayer-Martin (VCN) Thayer-Martin (VCN)B. Pertussis B. Pertussis Bordet- Gengou (potato) agar Bordet- Gengou (potato) agarC. Diphtheriae C. Diphtheriae Tellurite plate, Loffler’s medium, blood Tellurite plate, Loffler’s medium, blood

agar agarM. Tuberculosis M. Tuberculosis Lowenstein-Jensen agar Lowenstein-Jensen agarLactose Fermenting Enterics Lactose Fermenting Enterics Pink colonies on Pink colonies on

MacConkey’s agar MacConkey’s agarLegionella Legionella Charcoal yeast extract agar buffered with Charcoal yeast extract agar buffered with

increased iron & cysteine increased iron & cysteineFungi Fungi Sabouraud’s agar Sabouraud’s agar

BacteriaBacteria

StainsStains

Congo Red Congo Red Giemsa’sGiemsa’sPASPASZiehl- NeelsenZiehl- NeelsenIndia inkIndia inkSilver stainSilver stain

BacteriaBacteria

StainsStains

Congo Red Congo Red Amyloid; apple-green birefringence Amyloid; apple-green birefringence in polarized light in polarized light

Giemsa’sGiemsa’sPASPASZiehl- NeelsenZiehl- NeelsenIndia inkIndia inkSilver stainSilver stain

BacteriaBacteria StainsStains

Congo Red Congo Red Amyloid; apple-green birefringence Amyloid; apple-green birefringence in polarized light in polarized light

Giemsa’s Giemsa’s Borrelia, Plasmodium, trypanosomes, Borrelia, Plasmodium, trypanosomes, Chlamydia Chlamydia

PASPASZiehl- NeelsenZiehl- NeelsenIndia inkIndia inkSilver stainSilver stain

BacteriaBacteria StainsStains

Congo Red Congo Red Amyloid; apple-green birefringence Amyloid; apple-green birefringence in polarized light in polarized light

Giemsa’s Giemsa’s Borrelia, Plasmodium, trypanosomes, Borrelia, Plasmodium, trypanosomes, Chlamydia Chlamydia

PAS PAS stains glycogen, mucopolysaccharides stains glycogen, mucopolysaccharides used to dx Whipple’s diseaseused to dx Whipple’s disease

Ziehl- NeelsenZiehl- NeelsenIndia inkIndia inkSilver stainSilver stain

BacteriaBacteria StainsStains

Congo Red Congo Red Amyloid; apple-green birefringence Amyloid; apple-green birefringence in polarized light in polarized light

Giemsa’s Giemsa’s Borrelia, Plasmodium, trypanosomes, Borrelia, Plasmodium, trypanosomes, Chlamydia Chlamydia

PAS PAS stains glycogen, mucopolysaccharides stains glycogen, mucopolysaccharides used to dx Whipple’s diseaseused to dx Whipple’s disease

Ziehl- Neelsen Ziehl- Neelsen Acid-fast bacteria Acid-fast bacteriaIndia inkIndia inkSilver stainSilver stain

BacteriaBacteria StainsStains

Congo Red Congo Red Amyloid; apple-green birefringence Amyloid; apple-green birefringence in polarized light in polarized light

Giemsa’s Giemsa’s Borrelia, Plasmodium, trypanosomes, Borrelia, Plasmodium, trypanosomes, Chlamydia Chlamydia

PAS PAS stains glycogen, mucopolysaccharides stains glycogen, mucopolysaccharides used to dx Whipple’s diseaseused to dx Whipple’s disease

Ziehl- Neelsen Ziehl- Neelsen Acid-fast bacteria Acid-fast bacteriaIndia ink India ink Cryptococcus neoformans (also red on Cryptococcus neoformans (also red on

mucicarmine stain)mucicarmine stain)Silver stainSilver stain

BacteriaBacteria StainsStains

Congo Red Congo Red Amyloid; apple-green birefringence Amyloid; apple-green birefringence in polarized light in polarized light

Giemsa’s Giemsa’s Borrelia, Plasmodium, trypanosomes, Borrelia, Plasmodium, trypanosomes, Chlamydia Chlamydia

PAS PAS stains glycogen, mucopolysaccharides stains glycogen, mucopolysaccharides used to dx Whipple’s diseaseused to dx Whipple’s disease

Ziehl- Neelsen Ziehl- Neelsen Acid-fast bacteria Acid-fast bacteriaIndia ink India ink Cryptococcus neoformans Cryptococcus neoformansSilver stain Silver stain Bartonella, P. jiroveci, H. pylori, Bartonella, P. jiroveci, H. pylori,

Legionella Legionella

Congo RedCongo Red

AmyloidAmyloid

GiemsaGiemsa

Plasmodium ovalePlasmodium ovale

Periodic acid Schiff (Periodic acid Schiff (PASPAS) ) stainstain

Tropheryma whippeliiTropheryma whippelii

Ziehl-Neelson StainZiehl-Neelson Stain

M. tuberculosisM. tuberculosis

India InkIndia Ink

CryptococcusCryptococcus

Silver stainSilver stain

Pneumocystis jiroveci pneumoniaPneumocystis jiroveci pneumonia

BacteriaBacteria

ConjugationConjugationTransductionTransductionTransformationTransformation

BacteriaBacteria

Conjugation:Conjugation: DNA (chromosomal or DNA (chromosomal or plasmid) transferred from one bacterium plasmid) transferred from one bacterium to anotherto another

TransductionTransductionTransformationTransformation

BacteriaBacteria

ConjugationConjugation:: DNA (chromosomal or DNA (chromosomal or plasmid) transferred from one bacterium plasmid) transferred from one bacterium to anotherto another

Transduction:Transduction: DNA transferred by a virus DNA transferred by a virus from 1 bacterium to anotherfrom 1 bacterium to another

TransformationTransformation

BacteriaBacteria

Conjugation:Conjugation: DNA (chromosomal or DNA (chromosomal or plasmid) transferred from one bacterium plasmid) transferred from one bacterium to anotherto another

Transduction:Transduction: DNA transferred by a virus DNA transferred by a virus from 1 bacterium to anotherfrom 1 bacterium to another

Transformation:Transformation: Purified DNA taken up Purified DNA taken up by a cell (pro/eukaryotic)by a cell (pro/eukaryotic)

BacteriaBacteria

Obligate Aerobes?Obligate Aerobes?

BacteriaBacteria

Obligate Aerobes?Obligate Aerobes?

NocardiaNocardia

PseudomonasPseudomonas

M. tuberculosisM. tuberculosis

BacillusBacillus

(Nagging Pests Must Breathe)(Nagging Pests Must Breathe)

BacteriaBacteria

Obligate Anaerobes?Obligate Anaerobes?

BacteriaBacteria

Obligate Anaerobes?Obligate Anaerobes?

ActinomycesActinomyces

BacteroidesBacteroides

ClostridiumClostridium

(Lack catalase and/or superoxide dismutase)(Lack catalase and/or superoxide dismutase)

BacteriaBacteria

Obligate Intracellular Bacteria?Obligate Intracellular Bacteria?

BacteriaBacteria

Obligate Intracellular Bacteria?Obligate Intracellular Bacteria?

RickettsiaRickettsia

ChlamydiaChlamydia

BacteriaBacteria

Facultative intracellular bacteria?Facultative intracellular bacteria?

BacteriaBacteria Facultative intracellular bacteria?Facultative intracellular bacteria?

SalmonellaSalmonella

BrucellaBrucella

MycobacteriumMycobacterium

ListeriaListeria

FrancisellaFrancisella

LegionellaLegionella

YersiniaYersinia

(some bugs may live facultatively) (First Aid-Salmonella, Neisseria, Brucella, (some bugs may live facultatively) (First Aid-Salmonella, Neisseria, Brucella, Mycobacterium, Listeria, Francisella, Legionella = SoMe NEISe BRUtes Mycobacterium, Listeria, Francisella, Legionella = SoMe NEISe BRUtes MaY LIve FacultativeLI.)MaY LIve FacultativeLI.)

BacteriaBacteria

Encapsulated bacteria?Encapsulated bacteria?

BacteriaBacteria

Encapsulated bacteria?Encapsulated bacteria?

SalmonellaSalmonellaS. pneumoniaeS. pneumoniaeK. pneumoniaeK. pneumoniaeH. influenzaeH. influenzaeP. aeruginosaP. aeruginosaN. meningitidisN. meningitidisCitrobacterCitrobacter

(some strange killers have pretty nice capsules)(some strange killers have pretty nice capsules)

BacteriaBacteria

Spore forming bacteria?Spore forming bacteria?

BacteriaBacteria

Spore forming bacteria?Spore forming bacteria?

B. anthracisB. anthracisC. perfringensC. perfringensC. TetaniC. TetaniCoxiella burnettiiCoxiella burnettii

((

WHAT IS CONTAINED WITHIN THEIR CORE?WHAT IS CONTAINED WITHIN THEIR CORE?

BacteriaBacteria

Spore forming bacteria?Spore forming bacteria?

B. anthracisB. anthracis

C. perfringensC. perfringens

C. tetaniC. tetani

(diplicolinic acid in core)(diplicolinic acid in core)

BacteriaBacteria

Beta hemolytic bacteria?Beta hemolytic bacteria?

BacteriaBacteria

Beta hemolytic bacteria?Beta hemolytic bacteria?

S. AureusS. Aureus

S. PyogenesS. Pyogenes

S. AgalactiaeS. Agalactiae

L. MonocytogenesL. Monocytogenes

BacteriaBacteria

S. AureusS. Aureus

BacteriaBacteria

S. Aureus Virulence?S. Aureus Virulence?

BacteriaBacteria

S. Aureus Virulence?S. Aureus Virulence?

Protein A Protein A (virulence factor) (virulence factor)

TSST-1TSST-1

Exfoliative toxinExfoliative toxin

Enterotoxin (preformed)Enterotoxin (preformed)

BacteriaBacteria

S. Aureus Virulence?S. Aureus Virulence?

Protein A Protein A (virulence factor) (virulence factor) binds Fc- binds Fc-IgG, inhibiting complement and IgG, inhibiting complement and phagocytosisphagocytosis

TSST-1TSST-1

Exfoliative toxinExfoliative toxin

Enterotoxin (preformed)Enterotoxin (preformed)

BacteriaBacteria

S. Aureus Virulence?S. Aureus Virulence?

Protein A Protein A (virulence factor) (virulence factor) binds Fc- binds Fc-IgG, inhibiting complement and IgG, inhibiting complement and phagocytosisphagocytosis

TSST-1 TSST-1 superantigen superantigen

Exfoliative toxinExfoliative toxin

Enterotoxin (preformed)Enterotoxin (preformed)

BacteriaBacteria

S. Aureus Virulence?S. Aureus Virulence?

Protein A Protein A (virulence factor) (virulence factor) binds Fc- binds Fc-IgG, inhibiting complement and IgG, inhibiting complement and phagocytosisphagocytosis

TSST-1 TSST-1 superantigen superantigen

Exfoliative toxinExfoliative toxin scalded skin scalded skin

Enterotoxin (preformed)Enterotoxin (preformed)

BacteriaBacteria

S. Aureus Virulence?S. Aureus Virulence?

Protein A Protein A (virulence factor) (virulence factor) binds Fc- binds Fc-IgG, inhibiting complement and IgG, inhibiting complement and phagocytosisphagocytosis

TSST-1 TSST-1 superantigen superantigen

Exfoliative toxinExfoliative toxin scalded skin scalded skin

Enterotoxin (preformed)Enterotoxin (preformed) food poisoning food poisoning

BacteriaBacteria

S. Pyogenes (Group A beta hemolytic)S. Pyogenes (Group A beta hemolytic)

BacteriaBacteria

S. Pyogenes (Group A beta hemolytic) S. Pyogenes (Group A beta hemolytic) Virulence?Virulence?

BacteriaBacteria

S. Pyogenes (Group A beta hemolytic) S. Pyogenes (Group A beta hemolytic) Virulence?Virulence?

Pyogenic toxin Pyogenic toxin Toxigenic toxinToxigenic toxinImmunologic toxinImmunologic toxin

BacteriaBacteria

S. Pyogenes (Group A beta hemolytic) S. Pyogenes (Group A beta hemolytic) Virulence?Virulence?

Pyogenic toxin Pyogenic toxin cellulitis, pharyngitis, cellulitis, pharyngitis, impetigo impetigo

Toxigenic toxinToxigenic toxinImmunologic toxinImmunologic toxin

BacteriaBacteria

S. Pyogenes (Group A beta hemolytic) S. Pyogenes (Group A beta hemolytic) Virulence?Virulence?

Pyogenic toxin Pyogenic toxin cellulitis, pharyngitis, cellulitis, pharyngitis, impetigo impetigo

Toxigenic toxin Toxigenic toxin Scarlet fever, TSS Scarlet fever, TSS

Immunologic toxinImmunologic toxin

BacteriaBacteria

S. Pyogenes (Group A beta hemolytic) S. Pyogenes (Group A beta hemolytic) Virulence?Virulence?

Pyogenic toxin Pyogenic toxin cellulitis, pharyngitis, cellulitis, pharyngitis, impetigo impetigo

Toxigenic toxin Toxigenic toxin Scarlet fever, TSS Scarlet fever, TSS

Immunologic toxin Immunologic toxin RF, Acute GN RF, Acute GN

(Antibody to M protein enhances host defenses)(Antibody to M protein enhances host defenses)

BacteriaBacteria

Rheumatic Fever?Rheumatic Fever?

BacteriaBacteria

Rheumatic Fever?Rheumatic Fever?

PP

EE

CC

CC

SS

BacteriaBacteria

Rheumatic Fever?Rheumatic Fever?

PolyarthritisPolyarthritis

EE

CC

C C

SS

BacteriaBacteria

Rheumatic Fever?Rheumatic Fever?

PolyarthritisPolyarthritis

Erthema marginatumErthema marginatum

CC

CC

SS

BacteriaBacteria

Rheumatic Fever?Rheumatic Fever?

PolyarthritisPolyarthritis

Erthema marginatumErthema marginatum

Chorea Chorea

CC

SS

BacteriaBacteria

Rheumatic Fever?Rheumatic Fever?

PolyarthritisPolyarthritis

Erthema marginatumErthema marginatum

Chorea Chorea

Carditis Carditis

SS

BacteriaBacteria

Rheumatic Fever?Rheumatic Fever?

PolyarthritisPolyarthritis

Erthema marginatumErthema marginatum

Chorea Chorea

Carditis Carditis

Subcutaneous nodulesSubcutaneous nodules

BacteriaBacteria

Modified Jones Criteria for Rheumatic Modified Jones Criteria for Rheumatic Heard Disease?Heard Disease?

BacteriaBacteria

Modified Jones Criteria for Rheumatic Modified Jones Criteria for Rheumatic Heard Disease?Heard Disease?

PolyarthritisPolyarthritis

Erthema marginatumErthema marginatum

Chorea Chorea

Carditis Carditis

Subcutaneous nodulesSubcutaneous nodules

BacteriaBacteria

Major:Major: Minor:Minor:

PolyarthritisPolyarthritis FeverFever

Erthema marginatumErthema marginatum ArthralgiasArthralgias

Chorea Chorea Increased ESRIncreased ESR

Carditis Carditis Increased CRPIncreased CRP

Subcutaneous nodulesSubcutaneous nodules Increased PRIncreased PR

Recent Strep Recent Strep infectioninfection

2 major or 1 major an 2 minor = DX2 major or 1 major an 2 minor = DX

BacteriaBacteria

Grows on 6.5% NaCl?Grows on 6.5% NaCl?

BacteriaBacteria

Grows on 6.5% NaCl?Grows on 6.5% NaCl?

Enterococcus (Lancefield Group D) Enterococcus (Lancefield Group D) UTI , SBE UTI , SBE

BacteriaBacteria

S. Viridans types?S. Viridans types?

BacteriaBacteria

S. Viridans types?S. Viridans types?

S. mutans S. mutans dental caries dental caries

S. sanguis S. sanguis SBE SBE

BacteriaBacteria

Clostridia Exotoxins?Clostridia Exotoxins?

C. tetaniC. tetani

C. botulismC. botulism

C. perfrigensC. perfrigens

C. difficileC. difficile

BacteriaBacteria

Clostridia Exotoxins?Clostridia Exotoxins?

C. tetani C. tetani exotoxin exotoxin tetanus tetanus

C. botulismC. botulism

C. perfrigensC. perfrigens

C. difficileC. difficile

BacteriaBacteria

Clostridia Exotoxins?Clostridia Exotoxins?

C. tetani C. tetani exotoxin exotoxin tetanus tetanus

C. botulism C. botulism heat-labile heat-labile botulism botulism

C. perfrigensC. perfrigens

C. difficileC. difficile

BacteriaBacteria

Clostridia Exotoxins?Clostridia Exotoxins?

C. tetani C. tetani exotoxin exotoxin tetanus tetanus

C. botulism C. botulism heat-labile heat-labile botulism botulism

C. perfrigens C. perfrigens alpha toxin (lecithinase) alpha toxin (lecithinase) gas gangrene, hemolysisgas gangrene, hemolysis

C. difficileC. difficile

BacteriaBacteria

Clostridia Exotoxins?Clostridia Exotoxins?

C. tetani C. tetani exotoxin exotoxin tetanus tetanus

C. botulism C. botulism heat-labile heat-labile botulism botulism

C. perfrigens C. perfrigens alpha toxin (lecithinase) alpha toxin (lecithinase) gas gangrene, hemolysisgas gangrene, hemolysis

C. difficile C. difficile cytotoxin, exotoxin cytotoxin, exotoxin pseudomembranous colitispseudomembranous colitis

BacteriaBacteria

C. Diphtheriae C. Diphtheriae

BacteriaBacteria

C. Diphtheriae Virulence?C. Diphtheriae Virulence?

BacteriaBacteria

C. Diphtheriae Virulence?C. Diphtheriae Virulence?

Exotoxin: encoded by B-prophage ,inhibits protein Exotoxin: encoded by B-prophage ,inhibits protein synthesis via ADP ribosylation of EF-2 synthesis via ADP ribosylation of EF-2 pseudomembranous pharyngitis pseudomembranous pharyngitis

BacteriaBacteria

5 times skin infection is S. pyogenes and 5 times skin infection is S. pyogenes and not staph?not staph?

LLIINNEESS

BacteriaBacteria

5 times skin infection is S. pyogenes and 5 times skin infection is S. pyogenes and not staph?not staph?

Lymphangitis: Red streaksLymphangitis: Red streaks

BacteriaBacteria

5 times skin infection is S. pyogenes and 5 times skin infection is S. pyogenes and not staph?not staph?

Lymphangitis: Red streaksLymphangitis: Red streaks

Impetigo: Honey crusted lesionsImpetigo: Honey crusted lesions

BacteriaBacteria

5 times skin infection is S. pyogenes and 5 times skin infection is S. pyogenes and not staph?not staph?

Lymphangitis: Red streaksLymphangitis: Red streaks

Impetigo: Honey crusted lesionsImpetigo: Honey crusted lesions

Necrotizing fascitisNecrotizing fascitis

BacteriaBacteria

5 times skin infection is S. pyogenes and 5 times skin infection is S. pyogenes and not staph?not staph?

Lymphangitis: Red streaksLymphangitis: Red streaksImpetigo: Honey crusted lesionsImpetigo: Honey crusted lesionsNecrotizing fascitisNecrotizing fascitisEryseplis: Infection of SQ fat; noEryseplis: Infection of SQ fat; no blanching, raised bordersblanching, raised borders

BacteriaBacteria 5 times skin infection is S. pyogenes and not staph?5 times skin infection is S. pyogenes and not staph?

Lymphangitis: Red streaksLymphangitis: Red streaks

Impetigo: Honey crusted lesionsImpetigo: Honey crusted lesions

Necrotizing fascitisNecrotizing fascitis

Eryseplis: Infection of SQ fat; noEryseplis: Infection of SQ fat; no

blanching, raised bordersblanching, raised borders

Scarlet Fever: Sand paper like rash; “palms & soles”Scarlet Fever: Sand paper like rash; “palms & soles”

(LINES)(LINES)

BacteriaBacteria

END OF DAY 1END OF DAY 1

Questions:Questions: A pharyngeal exudates sample from a 20-year old female is placed A pharyngeal exudates sample from a 20-year old female is placed

on an enriched medium containing vancomycin, colistin and on an enriched medium containing vancomycin, colistin and trimethoprim. The media would favor growth of which of the trimethoprim. The media would favor growth of which of the following bacteria?following bacteria?

a.) E. colia.) E. coli

b.) S. pyogenesb.) S. pyogenes

c.) S. pneumoniaec.) S. pneumoniae

d.) K. pneumoniaed.) K. pneumoniae

e.) N. gonorrhoeaee.) N. gonorrhoeae

f.) C. diphtheriaef.) C. diphtheriae

Questions:Questions: A pharyngeal exudates sample from a 20-year old female is placed A pharyngeal exudates sample from a 20-year old female is placed

on an enriched medium containing vancomycin, colistin and on an enriched medium containing vancomycin, colistin and trimethoprim. The media would favor growth of which of the trimethoprim. The media would favor growth of which of the following bacteria?following bacteria?

a.) E. colia.) E. coli

b.) S. pyogenesb.) S. pyogenes

c.) S. pneumoniaec.) S. pneumoniae

d.) K. pneumoniaed.) K. pneumoniae

e.) N. gonorrhoeaee.) N. gonorrhoeae

f.) C. diphtheriaef.) C. diphtheriae

Thayer-Martin agar: Vancomycin inhibits gram + , colistin and TMP Thayer-Martin agar: Vancomycin inhibits gram + , colistin and TMP inhibits gram - , Nystatin inhibits fungi inhibits gram - , Nystatin inhibits fungi

Questions:Questions: Gram stain of a CSF sample from a 21 year old Caucasian male Gram stain of a CSF sample from a 21 year old Caucasian male

army recruit with fever and headache demonstrates bean-shaped army recruit with fever and headache demonstrates bean-shaped gram negative cocci in pairs. Which of the following is the most gram negative cocci in pairs. Which of the following is the most likely route of meningeal contamination in this patient?likely route of meningeal contamination in this patient?

A.) pharynx A.) pharynx lymphatics lymphatics meninges meninges

B.) middle ear B.) middle ear contigous tissues contigous tissues meninges meninges

C.) traumatic wound C.) traumatic wound leaking CSF leaking CSF meninges meninges

D.) pharynx D.) pharynx blood blood choroid plexus choroid plexus meninges meninges

E.) primary lung focus E.) primary lung focus blood blood meninges meninges

Questions:Questions: Gram stain of a CSF sample from a 21 year old Caucasian male Gram stain of a CSF sample from a 21 year old Caucasian male

army recruit with fever and headache demonstrates bean-shaped army recruit with fever and headache demonstrates bean-shaped gram negative cocci in pairs. Which of the following is the most gram negative cocci in pairs. Which of the following is the most likely route of meningeal contamination in this patient?likely route of meningeal contamination in this patient?

A.) pharynx A.) pharynx lymphatics lymphatics meninges meninges

B.) middle ear B.) middle ear contigous tissues contigous tissues meninges meninges

C.) traumatic wound C.) traumatic wound leaking CSF leaking CSF meninges meninges

D.) pharynx D.) pharynx blood blood choroid plexus choroid plexus meninges meninges

E.) primary lung focus E.) primary lung focus blood blood meninges meninges

Questions:Questions: Gram stain of a CSF sample from a 21 year old Caucasian male Gram stain of a CSF sample from a 21 year old Caucasian male

army recruit with fever and headache demonstrates bean-shaped army recruit with fever and headache demonstrates bean-shaped gram negative cocci in pairs. Which of the following is the most gram negative cocci in pairs. Which of the following is the most likely route of meningeal contamination in this patient?likely route of meningeal contamination in this patient?

A.) pharynx A.) pharynx lymphatics lymphatics meninges (H. influenza) meninges (H. influenza)

B.) middle ear B.) middle ear contigous tissues contigous tissues meninges ( S. pneumoniae) meninges ( S. pneumoniae)

C.) traumatic wound C.) traumatic wound leaking CSF leaking CSF meninges ( S. aures) meninges ( S. aures)

D.) pharynx D.) pharynx blood blood choroid plexus choroid plexus meninges (N. meningitidis) meninges (N. meningitidis)

E.) primary lung focus E.) primary lung focus blood blood meninges ( M.tuberculosis) meninges ( M.tuberculosis)

Questions:Questions: A toxic substance produced by C. perfringens induces massive A toxic substance produced by C. perfringens induces massive

hemolysis and tissue necrosis when injected into mice. The lethal hemolysis and tissue necrosis when injected into mice. The lethal effect observed in the experiment correlates with substance’s ability effect observed in the experiment correlates with substance’s ability to split:to split:

A. CollagenA. Collagen

B. Hyaluronic acidB. Hyaluronic acid

C. PhospholipidsC. Phospholipids

D. CarbohydratesD. Carbohydrates

E. PlasminogenE. Plasminogen

Questions:Questions: A toxic substance produced by C. perfringens induces massive A toxic substance produced by C. perfringens induces massive

hemolysis and tissue necrosis when injected into mice. The lethal hemolysis and tissue necrosis when injected into mice. The lethal effect observed in the experiment correlates with substance’s ability effect observed in the experiment correlates with substance’s ability to split:to split:

A. CollagenA. Collagen

B. Hyaluronic acidB. Hyaluronic acid

C. Phospholipids (Lecithinase/alpha toxin)C. Phospholipids (Lecithinase/alpha toxin)

D. CarbohydratesD. Carbohydrates

E. PlasminogenE. Plasminogen

Questions:Questions: An outbreak of water-born gastroenteritis reported in Latin America An outbreak of water-born gastroenteritis reported in Latin America

is caused by oxidase-positive, gram -, comma shaped rods that can is caused by oxidase-positive, gram -, comma shaped rods that can survive on alkaline media. Stool microscopy in these patients is survive on alkaline media. Stool microscopy in these patients is expected to demonstrate:expected to demonstrate:

A. Mucus and some epithelial cellsA. Mucus and some epithelial cells

B. Many leukocytes, neutrophils predominantB. Many leukocytes, neutrophils predominant

C. Many leukocytes, eosinophils predominantC. Many leukocytes, eosinophils predominant

D. Many leukocytes , lymphocytes predominantD. Many leukocytes , lymphocytes predominant

E. Many erythrocytes and some leukocytesE. Many erythrocytes and some leukocytes

Questions:Questions: An outbreak of water-born gastroenteritis reported in Latin America An outbreak of water-born gastroenteritis reported in Latin America

is caused by oxidase-positive, gram -, comma shaped rods that can is caused by oxidase-positive, gram -, comma shaped rods that can survive on alkaline media. Stool microscopy in these patients is survive on alkaline media. Stool microscopy in these patients is expected to demonstrate:expected to demonstrate:

A. Mucus and some epithelial cells – V. choleraeA. Mucus and some epithelial cells – V. cholerae

B. Many leukocytes, neutrophils predominantB. Many leukocytes, neutrophils predominant

C. Many leukocytes, eosinophils predominantC. Many leukocytes, eosinophils predominant

D. Many leukocytes , lymphocytes predominantD. Many leukocytes , lymphocytes predominant

E. Many erythrocytes and some leukocytesE. Many erythrocytes and some leukocytes

Questions:Questions: An outbreak of water-born gastroenteritis reported in Latin America is An outbreak of water-born gastroenteritis reported in Latin America is

caused by oxidase-positive, gram -, comma shaped rods that can survive caused by oxidase-positive, gram -, comma shaped rods that can survive on alkaline media. Stool microscopy in these patients is expected to on alkaline media. Stool microscopy in these patients is expected to demonstrate:demonstrate:

A. Mucus and some epithelial cells – V. choleraeA. Mucus and some epithelial cells – V. cholerae

B. Many leukocytes, neutrophils predominant - SalmonellaB. Many leukocytes, neutrophils predominant - Salmonella

C. Many leukocytes, eosinophils predominant – intestinal parasitesC. Many leukocytes, eosinophils predominant – intestinal parasites

D. Many leukocytes , lymphocytes predominant D. Many leukocytes , lymphocytes predominant

E. Many erythrocytes and some leukocytes – EIEC, ShigellaE. Many erythrocytes and some leukocytes – EIEC, Shigella

* This morphology may be confused by C. jejuni, one of the most common * This morphology may be confused by C. jejuni, one of the most common causes of diarrhea worldwide, which is a curved motile gram -, oxidase + causes of diarrhea worldwide, which is a curved motile gram -, oxidase + rod, but this organism is unable to survive alkaline enrichmentrod, but this organism is unable to survive alkaline enrichment

Questions:Questions: A 7-year old Caucasian boy is brought to your office with blisters on A 7-year old Caucasian boy is brought to your office with blisters on

his face. Some of the blisters have broken and are covered with his face. Some of the blisters have broken and are covered with golden yellow crusts. Exudate microscopy reveals gram + cocci in golden yellow crusts. Exudate microscopy reveals gram + cocci in chains. Which of the following would be a component of the chains. Which of the following would be a component of the clinical syndrome that may follow such a infection?clinical syndrome that may follow such a infection?

A. Joint pain and eye rednessA. Joint pain and eye redness

B. Fatigue and heart murmursB. Fatigue and heart murmurs

C. Face puffiness and dark urineC. Face puffiness and dark urine

D. Bilateral facial nerve palsyD. Bilateral facial nerve palsy

E. Abdominal pain and jaundiceE. Abdominal pain and jaundice

Questions:Questions: A 7-year old Caucasian boy is brought to your office with blisters on A 7-year old Caucasian boy is brought to your office with blisters on

his face. Some of the blisters have broken and are covered with his face. Some of the blisters have broken and are covered with golden yellow crusts. Exudate microscopy reveals gram + cocci in golden yellow crusts. Exudate microscopy reveals gram + cocci in chains. Which of the following would be a component of the chains. Which of the following would be a component of the clinical syndrome that may follow such a infection?clinical syndrome that may follow such a infection?

A. Joint pain and eye rednessA. Joint pain and eye redness

B. Fatigue and heart murmursB. Fatigue and heart murmurs

C. Face puffiness and dark urine – Impetigo (S. pyogenes, S.aureus)C. Face puffiness and dark urine – Impetigo (S. pyogenes, S.aureus)

D. Bilateral facial nerve palsyD. Bilateral facial nerve palsy

E. Abdominal pain and jaundiceE. Abdominal pain and jaundice

Questions:Questions: A 7-year old Caucasian boy is brought to your office with blisters on A 7-year old Caucasian boy is brought to your office with blisters on

his face. Some of the blisters have broken and are covered with his face. Some of the blisters have broken and are covered with golden yellow crusts. Exudate microscopy reveals gram + cocci in golden yellow crusts. Exudate microscopy reveals gram + cocci in chains. Which of the following would be a component of the chains. Which of the following would be a component of the clinical syndrome that may follow such a infection?clinical syndrome that may follow such a infection?

A. Joint pain and eye redness – Sjoren’s, lupus, Reiter’s SyndromeA. Joint pain and eye redness – Sjoren’s, lupus, Reiter’s Syndrome

B. Fatigue and heart murmurs – RF does not occur in relation to B. Fatigue and heart murmurs – RF does not occur in relation to Streptococcal skin infectionsStreptococcal skin infections

C. Face puffiness and dark urine – Impetigo (S. pyogenes, S.aureus)C. Face puffiness and dark urine – Impetigo (S. pyogenes, S.aureus)

D. Bilateral facial nerve palsy – Lyme’s disease (B. burgdorferi)D. Bilateral facial nerve palsy – Lyme’s disease (B. burgdorferi)

E. Abdominal pain and jaundice – Hep AE. Abdominal pain and jaundice – Hep A

Questions:Questions: A 46 year old male who just returned from a mission trip to Latin A 46 year old male who just returned from a mission trip to Latin

America presents to your office complaining of fever, myalgias, dull America presents to your office complaining of fever, myalgias, dull abdominal pain, and a week-long history of watery diarrhea that has abdominal pain, and a week-long history of watery diarrhea that has recently become bloody. Physical examination reveals a fever of recently become bloody. Physical examination reveals a fever of 102F, hepatosplenomegaly, and rose-colored spots at the 102F, hepatosplenomegaly, and rose-colored spots at the periumbilical area. Which of the following is the most likely cause of periumbilical area. Which of the following is the most likely cause of this patient’s symptoms?this patient’s symptoms?

A. E . coliA. E . coli

B. S. typhiB. S. typhi

C. S. flexneriC. S. flexneri

D. V. choleraeD. V. cholerae

C. C. jejuniC. C. jejuni

Questions:Questions: A 46 year old male who just returned from a mission trip to Latin A 46 year old male who just returned from a mission trip to Latin

America presents to your office complaining of fever, myalgias, dull America presents to your office complaining of fever, myalgias, dull abdominal pain, and a week-long history of watery diarrhea that has abdominal pain, and a week-long history of watery diarrhea that has recently become bloody. Physical examination reveals a fever of recently become bloody. Physical examination reveals a fever of 102F, hepatosplenomegaly, and rose-colored spots at the 102F, hepatosplenomegaly, and rose-colored spots at the periumbilical area. Which of the following is the most likely cause of periumbilical area. Which of the following is the most likely cause of this patient’s symptoms?this patient’s symptoms?

A. E . coliA. E . coli

B. S. typhi (Typhoid fever)B. S. typhi (Typhoid fever)

C. S. flexneriC. S. flexneri

D. V. choleraeD. V. cholerae

C. C. jejuniC. C. jejuni

Questions:Questions: A 4 year old immigrant boy is brought to the pediatric ER with a A 4 year old immigrant boy is brought to the pediatric ER with a

swollen right knee, accompained by fever and malaise. He is swollen right knee, accompained by fever and malaise. He is hypotensive and tachycardic. His past medical history is nothing hypotensive and tachycardic. His past medical history is nothing significant except for one episode of otitis media. Some of his significant except for one episode of otitis media. Some of his vaccinations are not up-to-date. Synovial fluid and blood cultures vaccinations are not up-to-date. Synovial fluid and blood cultures grew pleomorphic gram – rods on hematin containing medium. The grew pleomorphic gram – rods on hematin containing medium. The pathogenesis of the organism responsible for his condition is most pathogenesis of the organism responsible for his condition is most likely related to which of the following?likely related to which of the following?

A. EndotoxinA. EndotoxinB. FimbriaeB. FimbriaeC. CapsuleC. CapsuleD. Cytotoxic exotoxinD. Cytotoxic exotoxinE. HemolysinsE. HemolysinsF HyaluronidaseF Hyaluronidase

Questions:Questions: A 4 year old immigrant boy is brought to the pediatric ER with a A 4 year old immigrant boy is brought to the pediatric ER with a

swollen right knee, accompained by fever and malaise. He is swollen right knee, accompained by fever and malaise. He is hypotensive and tachycardic. His past medical history is nothing hypotensive and tachycardic. His past medical history is nothing significant except for one episode of otitis media. Some of his significant except for one episode of otitis media. Some of his vaccinations are not up-to-date. Synovial fluid and blood cultures vaccinations are not up-to-date. Synovial fluid and blood cultures grew pleomorphic gram – rods on hematin containing medium. The grew pleomorphic gram – rods on hematin containing medium. The pathogenesis of the organism responsible for his condition is most pathogenesis of the organism responsible for his condition is most likely related to which of the following?likely related to which of the following?

A. EndotoxinA. EndotoxinB. FimbriaeB. FimbriaeC. Capsule – H. influenzae (polysaccharide capsule)C. Capsule – H. influenzae (polysaccharide capsule)D. Cytotoxic exotoxinD. Cytotoxic exotoxinE. HemolysinsE. HemolysinsF HyaluronidaseF Hyaluronidase

Questions:Questions: Group A Streptococci demonstrate significant resistance to Group A Streptococci demonstrate significant resistance to

phagocytic killing when placed in fresh human blood. This phagocytic killing when placed in fresh human blood. This resistance can be most effectively overcome by adding antibodies resistance can be most effectively overcome by adding antibodies to which of the following?to which of the following?

A. HyaluronateA. Hyaluronate

B. Streptolysin OB. Streptolysin O

C. DnaseC. Dnase

D. Protein MD. Protein M

E. Teichoic AcidE. Teichoic Acid

F. StreptokinaseF. Streptokinase

Questions:Questions: Group A Streptococci demonstrate significant resistance to phagocytic Group A Streptococci demonstrate significant resistance to phagocytic

killing when placed in fresh human blood. This resistance can be most killing when placed in fresh human blood. This resistance can be most effectively overcome by adding antibodies to which of the following?effectively overcome by adding antibodies to which of the following?

A. HyaluronateA. Hyaluronate

B. Streptolysin OB. Streptolysin O

C. DnaseC. Dnase

D. Protein M – S. pyogenes D. Protein M – S. pyogenes

E. Teichoic AcidE. Teichoic Acid

F. StreptokinaseF. Streptokinase

Protein M inhibits phagocytosis and complement activation, mediates Protein M inhibits phagocytosis and complement activation, mediates bacterial adherence, and is the target of type-specific humoral immunity to bacterial adherence, and is the target of type-specific humoral immunity to S. Pyogenes. S. Pyogenes.

Questions:Questions: E. coli strains isolated from a 4 year old Caucasian female with E. coli strains isolated from a 4 year old Caucasian female with

bloody diarrhea produce a substance that inhibits protein synthesis bloody diarrhea produce a substance that inhibits protein synthesis in human cells. The substance shares many properties with the in human cells. The substance shares many properties with the toxin produced by:toxin produced by:

A. S. dysenteriaeA. S. dysenteriae

B. V. choleraeB. V. cholerae

C. C. difficileC. C. difficile

D. P. mirabilisD. P. mirabilis

E. S. typhiE. S. typhi

F. P. aeruginosaF. P. aeruginosa

Questions:Questions: E. coli strains isolated from a 4 year old Caucasian female with bloody E. coli strains isolated from a 4 year old Caucasian female with bloody

diarrhea produce a substance that inhibits protein synthesis in human cells. diarrhea produce a substance that inhibits protein synthesis in human cells. The substance shares many properties with the toxin produced by:The substance shares many properties with the toxin produced by:

A. S. dysenteriae – Vero cytotoxinsA. S. dysenteriae – Vero cytotoxins

B. V. choleraeB. V. cholerae

C. C. difficileC. C. difficile

D. P. mirabilisD. P. mirabilis

E. S. typhiE. S. typhi

F. P. aeruginosaF. P. aeruginosa

Shiga-like toxins are produced by EHEC. These toxins function to inhibit Shiga-like toxins are produced by EHEC. These toxins function to inhibit the 60s ribosomal subunit in human cells thereby blocking protein the 60s ribosomal subunit in human cells thereby blocking protein synthesis.synthesis.

Questions:Questions: An 18 year old college freshman is brought to the ER with a high An 18 year old college freshman is brought to the ER with a high

fever, confusion, and headaches. Physical examination reveals fever, confusion, and headaches. Physical examination reveals nuchal rigidity and a purpuric rash on his lower extremities. This nuchal rigidity and a purpuric rash on his lower extremities. This infection could have been prevented by a vaccine containing:infection could have been prevented by a vaccine containing:

A. Heat-killed bacteriaA. Heat-killed bacteria

B. Bacterial outer membane proteinB. Bacterial outer membane protein

C. Capsular polysaccharideC. Capsular polysaccharide

D. Inactivated toxinD. Inactivated toxin

E. Live attenuated bacteriaE. Live attenuated bacteria

Questions:Questions: An 18 year old college freshman is brought to the ER with a high An 18 year old college freshman is brought to the ER with a high

fever, confusion, and headaches. Physical examination reveals fever, confusion, and headaches. Physical examination reveals nuchal rigidity and a purpuric rash on his lower extremities. This nuchal rigidity and a purpuric rash on his lower extremities. This infection could have been prevented by a vaccine containing:infection could have been prevented by a vaccine containing:

A. Heat-killed bacteriaA. Heat-killed bacteria

B. Bacterial outer membane proteinB. Bacterial outer membane protein

C. Capsular polysaccharide –N.meningitidisC. Capsular polysaccharide –N.meningitidis

D. Inactivated toxinD. Inactivated toxin

E. Live attenuated bacteriaE. Live attenuated bacteria

Questions:Questions: A 5 year old boy is found to have high serum level of antibodies A 5 year old boy is found to have high serum level of antibodies

against polyribitol ribose phosphate (PRP). The antibodies would against polyribitol ribose phosphate (PRP). The antibodies would most likely carry protection against:most likely carry protection against:

A.A. PyelonephritisPyelonephritis

B.B. Miliary tuberculosisMiliary tuberculosis

C.C. Rheumatic feverRheumatic fever

D.D. OsteomyelitisOsteomyelitis

E.E. EpiglottitisEpiglottitis

F.F. Malignant pustuleMalignant pustule

Questions:Questions: A 5 year old boy is found to have high serum level of antibodies A 5 year old boy is found to have high serum level of antibodies

against polyribitol ribose phosphate (PRP). The antibodies would against polyribitol ribose phosphate (PRP). The antibodies would most likely carry protection against:most likely carry protection against:

A.A. PyelonephritisPyelonephritis

B.B. Miliary tuberculosisMiliary tuberculosis

C.C. Rheumatic feverRheumatic fever

D.D. OsteomyelitisOsteomyelitis

E.E. Epiglottitis – H. influenzae (type b)Epiglottitis – H. influenzae (type b)

F.F. Malignant pustuleMalignant pustule

Vaccine is composed of polyribosyl-ribitol-phosphate (PRP), a Vaccine is composed of polyribosyl-ribitol-phosphate (PRP), a componet of Hib capsule, conjuaged with diphtheria or tetanus componet of Hib capsule, conjuaged with diphtheria or tetanus toxoid. toxoid.

Questions:Questions: A 6 year old male is brought to the pediatric ER with fever and sore A 6 year old male is brought to the pediatric ER with fever and sore

throat. The parents tell you that the child has not received any throat. The parents tell you that the child has not received any immunizations. Physical exam reveals a grey pharyngeal exudate immunizations. Physical exam reveals a grey pharyngeal exudate and Gram stain shows scant Gram positive organisms. Which of and Gram stain shows scant Gram positive organisms. Which of the following culture types would facilitate the growth of this the following culture types would facilitate the growth of this organism?organism?

A. MacConkey AgarA. MacConkey Agar

B. Thayer-Martin VCN mediumB. Thayer-Martin VCN medium

C. Blood agar containing bile and hyerptonic salineC. Blood agar containing bile and hyerptonic saline

D. Cysteine-tellurite agarD. Cysteine-tellurite agar

E. Bordet-Gengou mediumE. Bordet-Gengou medium

Questions:Questions: A 6 year old male is brought to the pediatric ER with fever and sore A 6 year old male is brought to the pediatric ER with fever and sore

throat. The parents tell you that the child has not received any throat. The parents tell you that the child has not received any immunizations. Physical exam reveals a grey pharyngeal exudate immunizations. Physical exam reveals a grey pharyngeal exudate and Gram stain shows scant Gram positive organisms. Which of and Gram stain shows scant Gram positive organisms. Which of the following culture types would facilitate the growth of this the following culture types would facilitate the growth of this organism?organism?

A. MacConkey AgarA. MacConkey Agar

B. Thayer-Martin VCN mediumB. Thayer-Martin VCN medium

C. Blood agar containing bile and hyerptonic salineC. Blood agar containing bile and hyerptonic saline

D. Cysteine-tellurite agar – C. diphtheriae (black colonies)D. Cysteine-tellurite agar – C. diphtheriae (black colonies)

E. Bordet-Gengou mediumE. Bordet-Gengou medium

Questions:Questions: A 6 year old male is brought to the pediatric ER with fever and sore A 6 year old male is brought to the pediatric ER with fever and sore

throat. The parents tell you that the child has not received any throat. The parents tell you that the child has not received any immunizations. Physical exam reveals a grey pharyngeal exudate immunizations. Physical exam reveals a grey pharyngeal exudate and Gram stain shows scant Gram positive organisms. Which of and Gram stain shows scant Gram positive organisms. Which of the following culture types would facilitate the growth of this the following culture types would facilitate the growth of this organism?organism?

A. MacConkey Agar A. MacConkey Agar Gram + enterics Gram + enterics

B. Thayer-Martin VCN medium B. Thayer-Martin VCN medium Niesseria species Niesseria species

C. Blood agar containing bile and hyerptonic saline C. Blood agar containing bile and hyerptonic saline Enterococci Enterococci

D. Cysteine-tellurite agar – C. diphtheriae (black colonies)D. Cysteine-tellurite agar – C. diphtheriae (black colonies)

E. Bordet-Gengou medium E. Bordet-Gengou medium B. pertussis B. pertussis

Questions:Questions: A 38-year old male intravenous drug user hospitalized for high-A 38-year old male intravenous drug user hospitalized for high-

grade fever, fatigue and dyspnea dies in the ICU. His lung autopsy grade fever, fatigue and dyspnea dies in the ICU. His lung autopsy findings are shown on the slide below. This patient most likely findings are shown on the slide below. This patient most likely suffered from:suffered from:

A. Mycotic aortic aneurysmA. Mycotic aortic aneurysm

B. Tricupsid valve endocarditisB. Tricupsid valve endocarditis

C. Severe small airway obstructionC. Severe small airway obstruction

D. Miliary TBD. Miliary TB

E. Venous thromboembolismE. Venous thromboembolism

Questions:Questions: A 38-year old male intravenous drug user hospitalized for high-grade fever, A 38-year old male intravenous drug user hospitalized for high-grade fever,

fatigue and dyspnea dies in the ICU. His lung autopsy findings are shown fatigue and dyspnea dies in the ICU. His lung autopsy findings are shown on the slide below. This patient most likely suffered from:on the slide below. This patient most likely suffered from:

A. Mycotic aortic aneurysmA. Mycotic aortic aneurysm

B. Tricupsid valve endocarditis – S. aureusB. Tricupsid valve endocarditis – S. aureus

C. Severe small airway obstructionC. Severe small airway obstruction

D. Miliary TBD. Miliary TB

E. Venous thromboembolismE. Venous thromboembolism

MCC of tricuspid endocarditis in IVDA is S. aureus. These patients can MCC of tricuspid endocarditis in IVDA is S. aureus. These patients can develop multiple septic emboli in lungs. Pulmonary infarcts are almost develop multiple septic emboli in lungs. Pulmonary infarcts are almost always hemorrhagic due to the dual blood supply to the lungs.always hemorrhagic due to the dual blood supply to the lungs.

Questions:Questions: There is a specific bacterial product that , when injected locally into There is a specific bacterial product that , when injected locally into

the muscles of patients with relentless focal dystonias such as the muscles of patients with relentless focal dystonias such as torticollis, produces a dramatic but temporary relief of symptoms. torticollis, produces a dramatic but temporary relief of symptoms. This substance is produced by bacteria that demonstrate:This substance is produced by bacteria that demonstrate:

A. Antiphagocytic capsuleA. Antiphagocytic capsule

B. Hypervariable piliB. Hypervariable pili

C. IgG-binding outer membrane proteinC. IgG-binding outer membrane protein

D. Intracellular polyphosphate granulesD. Intracellular polyphosphate granules

E. Subterminal spore formationE. Subterminal spore formation

Questions:Questions: There is a specific bacterial product that , when injected locally into There is a specific bacterial product that , when injected locally into

the muscles of patients with relentless focal dystonias such as the muscles of patients with relentless focal dystonias such as torticollis, produces a dramatic but temporary relief of symptoms. torticollis, produces a dramatic but temporary relief of symptoms. This substance is produced by bacteria that demonstrate:This substance is produced by bacteria that demonstrate:

A. Antiphagocytic capsuleA. Antiphagocytic capsule

B. Hypervariable piliB. Hypervariable pili

C. IgG-binding outer membrane proteinC. IgG-binding outer membrane protein

D. Intracellular polyphosphate granulesD. Intracellular polyphosphate granules

E. Subterminal spore formation – C.botulism E. Subterminal spore formation – C.botulism

Questions:Questions: A community hospital is experiencing an increased incidence of A community hospital is experiencing an increased incidence of

nosocomial pneumonias. Most cases occur in patients with long nosocomial pneumonias. Most cases occur in patients with long hospitalizations. The microorganism isolated in several cases is hospitalizations. The microorganism isolated in several cases is visualized with silver stains and demonstrates slow growth on visualized with silver stains and demonstrates slow growth on complex media such a charcoal-yeast extract supplemented with complex media such a charcoal-yeast extract supplemented with cysteine. Which of the following is most likely implicated in the cysteine. Which of the following is most likely implicated in the increased incidence of nosocomial pneumonias in the hospital?increased incidence of nosocomial pneumonias in the hospital?

A. Infection carriers among the hospital staffA. Infection carriers among the hospital staff

B. Poor isolation of the infected patientsB. Poor isolation of the infected patients

C. Failed sterilization of mechanical ventilatorsC. Failed sterilization of mechanical ventilators

D. Colonization of the hospital water systemD. Colonization of the hospital water system

E. Widespread use of antimicrobial agentsE. Widespread use of antimicrobial agents

F. Widespread us of intravascular devicesF. Widespread us of intravascular devices

Questions:Questions: A community hospital is experiencing an increased incidence of A community hospital is experiencing an increased incidence of

nosocomial pneumonias. Most cases occur in patients with long nosocomial pneumonias. Most cases occur in patients with long hospitalizations. The microorganism isolated in several cases is hospitalizations. The microorganism isolated in several cases is visualized with silver stains and demonstrates slow growth on visualized with silver stains and demonstrates slow growth on complex media such a charcoal-yeast extract supplemented with complex media such a charcoal-yeast extract supplemented with cysteine. Which of the following is most likely implicated in the cysteine. Which of the following is most likely implicated in the increased incidence of nosocomial pneumonias in the hospital?increased incidence of nosocomial pneumonias in the hospital?

A. Infection carriers among the hospital staffA. Infection carriers among the hospital staff

B. Poor isolation of the infected patientsB. Poor isolation of the infected patients

C. Failed sterilization of mechanical ventilatorsC. Failed sterilization of mechanical ventilators

D. Colonization of the hospital water system - L. pneumophiliaD. Colonization of the hospital water system - L. pneumophilia

E. Widespread use of antimicrobial agentsE. Widespread use of antimicrobial agents

F. Widespread us of intravascular devicesF. Widespread us of intravascular devices

Questions:Questions: A 74 year-old previously healthy Caucasian male comes to this A 74 year-old previously healthy Caucasian male comes to this

physician’s office complaining of abrupt onset fever, headache, physician’s office complaining of abrupt onset fever, headache, mayalgias, malaise, cough and throat pain . His two mayalgias, malaise, cough and throat pain . His two granddaughters missed several days of school because of similar granddaughters missed several days of school because of similar symptoms. Examination demonstrates mild hyperemia of the throat symptoms. Examination demonstrates mild hyperemia of the throat without any exudate, and the patient is sent home on conservative without any exudate, and the patient is sent home on conservative management. Five days later, he is admitted to the hospital with management. Five days later, he is admitted to the hospital with progressive dyspnea, chest pain and productive cough. Which of progressive dyspnea, chest pain and productive cough. Which of the following pathogens is most likely to be isolated from this the following pathogens is most likely to be isolated from this patient’s sputum?patient’s sputum?

A. Listeria moncytogenesA. Listeria moncytogenesB. Klebsiella pneumoniaeB. Klebsiella pneumoniaeC. Staphylococcus aureusC. Staphylococcus aureusD. Nontuberculous mycobacteriaD. Nontuberculous mycobacteriaE. CytomegalovirusE. Cytomegalovirus

Questions:Questions: A 74 year-old previously healthy Caucasian male comes to this physician’s office A 74 year-old previously healthy Caucasian male comes to this physician’s office

complaining of abrupt onset fever, headache, mayalgias, malaise, cough and throat complaining of abrupt onset fever, headache, mayalgias, malaise, cough and throat pain . His two granddaughters missed several days of school because of similar pain . His two granddaughters missed several days of school because of similar symptoms. Examination demonstrates mild hyperemia of the throat without any symptoms. Examination demonstrates mild hyperemia of the throat without any exudate, and the patient is sent home on conservative management. Five days later, exudate, and the patient is sent home on conservative management. Five days later, he is admitted to the hospital with progressive dyspnea, chest pain and productive he is admitted to the hospital with progressive dyspnea, chest pain and productive cough. Which of the following pathogens is most likely to be isolated from this cough. Which of the following pathogens is most likely to be isolated from this patient’s sputum?patient’s sputum?

A. Listeria moncytogenesA. Listeria moncytogenes

B. Klebsiella pneumoniaeB. Klebsiella pneumoniae

C. Staphylococcus aureusC. Staphylococcus aureus

D. Nontuberculous mycobacteriaD. Nontuberculous mycobacteria

E. CytomegalovirusE. Cytomegalovirus

In order, the pathogens most often responsible for secondary (Influenza In order, the pathogens most often responsible for secondary (Influenza Virus) bacterial pneumonia are S. pneumoniae, S. aureus, and H. Virus) bacterial pneumonia are S. pneumoniae, S. aureus, and H. influenzae. influenzae.

Questions:Questions: A 62 year old Caucasian male who recently underwent a mitral A 62 year old Caucasian male who recently underwent a mitral

valve replacement is having low-grade fevers. He also complains valve replacement is having low-grade fevers. He also complains of dyspnea and malaise. Repeated blood cultures grow Gram + of dyspnea and malaise. Repeated blood cultures grow Gram + cocci in clusters that are catalase + and coagulase - Which of the cocci in clusters that are catalase + and coagulase - Which of the following is the best initial treatment for this patient?following is the best initial treatment for this patient?

A. Pencillin GA. Pencillin G

B. NaficillinB. Naficillin

C. VancomycinC. Vancomycin

D. CiprofloxacinD. Ciprofloxacin

E. ErythromycinE. Erythromycin

F. CefriaxoneF. Cefriaxone

Questions:Questions: A 62 year old Caucasian male who recently underwent a mitral A 62 year old Caucasian male who recently underwent a mitral

valve replacement is having low-grade fevers. He also complains valve replacement is having low-grade fevers. He also complains of dyspnea and malaise. Repeated blood cultures grow Gram + of dyspnea and malaise. Repeated blood cultures grow Gram + cocci in clusters that are catalase + and coagulase - Which of the cocci in clusters that are catalase + and coagulase - Which of the following is the best initial treatment for this patient?following is the best initial treatment for this patient?

A. Pencillin GA. Pencillin G

B. NaficillinB. Naficillin

C. Vancomycin S. epidermidis (nosocomial)C. Vancomycin S. epidermidis (nosocomial)

D. CiprofloxacinD. Ciprofloxacin

E. ErythromycinE. Erythromycin

F. CefriaxoneF. Cefriaxone

Questions:Questions: A 24-year old female presents to your office with burning during urination, A 24-year old female presents to your office with burning during urination,

urine clouding and urinary frequency. She denies fever, chills and flank urine clouding and urinary frequency. She denies fever, chills and flank pain. She had similar episodes before that was treated with antibiotics. pain. She had similar episodes before that was treated with antibiotics. She has no other medical problems and does not use tobacco, alcohol or She has no other medical problems and does not use tobacco, alcohol or drugs. Her vital signs are stable. Physical examination shows suprapubic drugs. Her vital signs are stable. Physical examination shows suprapubic tenderness. Which of the following bacteria is most likely to be isolated tenderness. Which of the following bacteria is most likely to be isolated from this patient’s urine?from this patient’s urine?

A. Klebsiella pneumoniaeA. Klebsiella pneumoniae G. Yersinia enterocoliticaG. Yersinia enterocolitica

B. Salmonella typhiB. Salmonella typhi H. Haemophilus influenzaeH. Haemophilus influenzae

C. Salmonella enteritidisC. Salmonella enteritidis I. Vibrio choleraeI. Vibrio cholerae

D. Campylobacter jejuniD. Campylobacter jejuni J. Streptococcus pyogenesJ. Streptococcus pyogenes

E. Shigella dysenteriaeE. Shigella dysenteriae K. Esherichia coliK. Esherichia coli

F. Proteus mirablisF. Proteus mirablis L. Streptococcus pneumoniaeL. Streptococcus pneumoniae

Questions:Questions: A 24-year old female presents to your office with burning during urination, A 24-year old female presents to your office with burning during urination,

urine clouding and urinary frequency. She denies fever, chills and flank urine clouding and urinary frequency. She denies fever, chills and flank pain. She had similar episodes before that was treated with antibiotics. pain. She had similar episodes before that was treated with antibiotics. She has no other medical problems and does not use tobacco, alcohol or She has no other medical problems and does not use tobacco, alcohol or drugs. Her vital signs are stable. Physical examination shows suprapubic drugs. Her vital signs are stable. Physical examination shows suprapubic tenderness. Which of the following bacteria is most likely to be isolated tenderness. Which of the following bacteria is most likely to be isolated from this patient’s urine?from this patient’s urine?

A. Klebsiella pneumoniaeA. Klebsiella pneumoniae G. Yersinia enterocoliticaG. Yersinia enterocolitica

B. Salmonella typhiB. Salmonella typhi H. Haemophilus influenzaeH. Haemophilus influenzae

C. Salmonella enteritidisC. Salmonella enteritidis I. Vibrio choleraeI. Vibrio cholerae

D. Campylobacter jejuniD. Campylobacter jejuni J. Streptococcus pyogenesJ. Streptococcus pyogenes

E. Shigella dysenteriaeE. Shigella dysenteriae K. Esherichia coli - UTIK. Esherichia coli - UTI

F. Proteus mirablisF. Proteus mirablis L. Streptococcus pneumoniaeL. Streptococcus pneumoniae

Questions:Questions: A 23 year old Caucasian female presents to clinic with lower A 23 year old Caucasian female presents to clinic with lower

abdominal pain and scant bloody vaginal discharge. She has been abdominal pain and scant bloody vaginal discharge. She has been sexually active multiple partners and uses condoms on occasion. sexually active multiple partners and uses condoms on occasion. She has been treated for “genital infections” in the past but denies She has been treated for “genital infections” in the past but denies any history of pregnancy. Her blood pressure is 112/70 mm Hg any history of pregnancy. Her blood pressure is 112/70 mm Hg while supine and 96/60 mm Hg while standing. A pregnancy test is while supine and 96/60 mm Hg while standing. A pregnancy test is positive. Which of the following microorganisms is most likely positive. Which of the following microorganisms is most likely responsible for this patient’s current condition?responsible for this patient’s current condition?

A. Gardnerella vaginalisA. Gardnerella vaginalisB. Neisseria gonorrhoeaeB. Neisseria gonorrhoeaeC. Trichomonas vaginalisC. Trichomonas vaginalisD. Treponema pallidumD. Treponema pallidumE. Staphylococcus saphrophyticusE. Staphylococcus saphrophyticusF. F. Esherichia coliEsherichia coli

Questions:Questions: A 23 year old Caucasian female presents to clinic with lower abdominal A 23 year old Caucasian female presents to clinic with lower abdominal

pain and scant bloody vaginal discharge. She has been sexually active pain and scant bloody vaginal discharge. She has been sexually active multiple partners and uses condoms on occasion. She has been treated for multiple partners and uses condoms on occasion. She has been treated for “genital infections” in the past but denies any history of pregnancy. Her “genital infections” in the past but denies any history of pregnancy. Her blood pressure is 112/70 mm Hg while supine and 96/60 mm Hg while blood pressure is 112/70 mm Hg while supine and 96/60 mm Hg while standing. A pregnancy test is positive. Which of the following standing. A pregnancy test is positive. Which of the following microorganisms is most likely responsible for this patient’s current microorganisms is most likely responsible for this patient’s current condition?condition?

A. Gardnerella vaginalisA. Gardnerella vaginalisB. Neisseria gonorrhoeae -PIDB. Neisseria gonorrhoeae -PIDC. Trichomonas vaginalisC. Trichomonas vaginalisD. Treponema pallidumD. Treponema pallidumE. Staphylococcus saphrophyticusE. Staphylococcus saphrophyticusF. F. Esherichia coliEsherichia coli

PID: commonly caused by N. gonorrhoeae or C. trachomatis and is strongly PID: commonly caused by N. gonorrhoeae or C. trachomatis and is strongly assoicated wih an increased incidence of ectopic pregnancy.assoicated wih an increased incidence of ectopic pregnancy.

Questions:Questions: A 23 year old Caucasian female is brought to the ER with fever, A 23 year old Caucasian female is brought to the ER with fever,

vomiting, diarrhea and muscle pain. Her blood pressure is 90/50 vomiting, diarrhea and muscle pain. Her blood pressure is 90/50 mm Hg and pulse is 120/min. Physical examination reveals mm Hg and pulse is 120/min. Physical examination reveals erythroderma, and pelvic exam reveals a tampon in the vagina. erythroderma, and pelvic exam reveals a tampon in the vagina. The activation of which of the following cells is primarily responsible The activation of which of the following cells is primarily responsible for this patient’s condition?for this patient’s condition?

a. Mast cells and eosinophilsa. Mast cells and eosinophils

b. Basophils and macrophagesb. Basophils and macrophages

c. Neutrophils and B lymphocytesc. Neutrophils and B lymphocytes

d. Macrophages and T lymphocytesd. Macrophages and T lymphocytes

e. Platelets and mast cellse. Platelets and mast cells

Questions:Questions: A 23 year old Caucasian female is brought to the ER with fever, vomiting, A 23 year old Caucasian female is brought to the ER with fever, vomiting,

diarrhea and muscle pain. Her blood pressure is 90/50 mm Hg and pulse is diarrhea and muscle pain. Her blood pressure is 90/50 mm Hg and pulse is 120/min. Physical examination reveals erythroderma, and pelvic exam 120/min. Physical examination reveals erythroderma, and pelvic exam reveals a tampon in the vagina. The activation of which of the following reveals a tampon in the vagina. The activation of which of the following cells is primarily responsible for this patient’s condition?cells is primarily responsible for this patient’s condition?

a. Mast cells and eosinophilsa. Mast cells and eosinophils

b. Basophils and macrophagesb. Basophils and macrophages

c. Neutrophils and B lymphocytesc. Neutrophils and B lymphocytes

d. Macrophages and T lymphocytes (TSST-1)d. Macrophages and T lymphocytes (TSST-1)

e. Platelets and mast cellse. Platelets and mast cells

Enterotoxins, exfoliative toxins and TSST-1 are the toxins with super Enterotoxins, exfoliative toxins and TSST-1 are the toxins with super antigen activity. antigen activity.

Questions:Questions: A sample of contaminated moist soil is heated to 100C for 15 A sample of contaminated moist soil is heated to 100C for 15

minutes. Which of the following bacteria is most likely to be minutes. Which of the following bacteria is most likely to be recovered from the soil sample following heat exposure?recovered from the soil sample following heat exposure?

A. Streptococcus pyogenesA. Streptococcus pyogenes

B. Listeria monocytogenesB. Listeria monocytogenes

C. Escherichia coliC. Escherichia coli

D. Bacillus anthracisD. Bacillus anthracis

E. Brucella melitensisE. Brucella melitensis

Questions:Questions: A sample of contaminated moist soil is heated to 100C for 15 A sample of contaminated moist soil is heated to 100C for 15

minutes. Which of the following bacteria is most likely to be minutes. Which of the following bacteria is most likely to be recovered from the soil sample following heat exposure?recovered from the soil sample following heat exposure?

A. Streptococcus pyogenesA. Streptococcus pyogenes

B. Listeria monocytogenesB. Listeria monocytogenes

C. Escherichia coliC. Escherichia coli

D. Bacillus anthracis – spore forming bacteriaD. Bacillus anthracis – spore forming bacteria

E. Brucella melitensisE. Brucella melitensis

Questions:Questions: Microscopic examination of a sputum sample from a 34 year old Microscopic examination of a sputum sample from a 34 year old

male with fever and cough reveals gram + lancet-shaped cocci in male with fever and cough reveals gram + lancet-shaped cocci in pairs. These bacteria are likely to be:pairs. These bacteria are likely to be:

A. Catalase positiveA. Catalase positive

B. Optochin positiveB. Optochin positive

C. Bile solubleC. Bile soluble

D. Capable of complete hemolysisD. Capable of complete hemolysis

E. Bacitracin sensitiveE. Bacitracin sensitive

F. Able to grow in 6.5% NaClF. Able to grow in 6.5% NaCl

Questions:Questions: Microscopic examination of a sputum sample from a 34 year old Microscopic examination of a sputum sample from a 34 year old

male with fever and cough reveals gram + lancet-shaped cocci in male with fever and cough reveals gram + lancet-shaped cocci in pairs. These bacteria are likely to be:pairs. These bacteria are likely to be:

A. Catalase positiveA. Catalase positive

B. Optochin positiveB. Optochin positive

C. Bile soluble – S. pneumoniaeC. Bile soluble – S. pneumoniae

D. Capable of complete hemolysisD. Capable of complete hemolysis

E. Bacitracin sensitiveE. Bacitracin sensitive

F. Able to grow in 6.5% NaClF. Able to grow in 6.5% NaCl

End of Questions DAY 1End of Questions DAY 1