seminar1 micro para review template

8/17/2019 SEMINAR1 Micro Para Review Template

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SEMINAR 1: MICROBIOLOGY & PARASITOLOGY Dr. Erwin BenedictoMa !" #$1!BATC% #$1

S'B(ECT:LECT'RER:DATE:

PARASITOLOGY

Scientific Name

Common Name Infective Stage Diagnostic Stage Definitive Host Intermediate Host (1o

!o etc"

C#inica# Presentation or

Disease

Prevention and

Treatment

Intestinal Nematodes

Ascaris Round worm / GiantIntestinal Round worm

Embroyanted egg Adult: female-prominent genitalgirdleUnfertilized Egg:coarse mammilatedalbuminous coating

an None Ascariasis● !ung

infiltration● "ague

abdominal pain● eosinop#ilia● $e%ere

colic&y pain 'biliaryascariasis(

● Ascarispneumonitis

● !actoseintolerance anddecreased growt# ratein c#ildren

● Albendazole )** mg (DOC"singe dose

● ebendazole +** mg singledose

● ,yrantelpamoate * mg/&g

● I%ermectin● $anitary

disposal of #umanfeces

● .ealt#education

● assc#emot#erapy

ric#iuris 0#ip worm Embryonated eggs Eggs in feces

- 1ipolars#aped wit#plug li&etranslucentpolarprominences

Adult: male-23*caudalEgg: bipolar mucusplug

- football

an 4lies5 Rat Trichuriasis

● Abdominal,ain

● ,etec#ial#emorr#age

● Amebicdysentery

● Rectalprolapse

● Appecndicitis5granulomas

● ebendazo

le +** mg (DOC"● Albendazol

e )** mg singledose

● $anitarydisposal of #umanfeces

● .andwas#ing wit# soap and

water● #oroug#

was#ing 6 scaldingof uncoo&ed

%egetables● .ealt#education

.oo&worm Necator americanus

.oo&worm 4ilariform lar%a Eggs in feces- 1luntlyrounded wit#t#in #yalines#ell- orula

Adult: $emi-lunarcutting plate

an None Uncinariasis● aculopapul

ar lesions and localizederyt#ema

● Ground itc#/dew itc#

● .oo&wormanemia d/t bleeding

● ,apulo%esicular eruption

● 1ronc#itis/pn

Albendazole )** mg(DOC" ebendazole or,yrantel pamoate

●

● Ironsupplements

● $anitarydisposal of #umanfeces

● 0earing ofs#oes or slippers


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PARASITOLOGY

Scientific Name Common Name Infective Stage Diagnostic Stage Definitive Host Intermediate Host (1o!o etc"

C#inica# Presentation orDisease

Prevention andTreatment

eumonia● 7iarr#ea

● .ealt#education

.oo&worm Ancyclostoma duodenale

8ld world #oo&worm 4i lariform lar%a Egg: In morula

ale: ripartitedorsal ray

an --- 0a&ana dse Albendazole5ebendazole or,yrantel pamoate

$trongyloides #readworm 4ilariform lar%a 4ilariform lar%a-bifid or notc#ed end

an None ● Anemia5constipation5 coug#diarr#ea5 eosinicpneumonitis

● Nausea5ras#e in waist andbuttoc&s

● $tomac#ac#e5 %omiting weig#loss

● Eryt#emaand pruritic ele%ated#emorr#agic papules

● !obarpneumonia

● 9oc#in 9#inadiarr#ea 'intractable5painless5 intermittentdiarr#ea(

● Albendazole )** mg 2 days

● I%ermectin● #iabendaz

ole +* mg/&g● 0earing of

s#oes and slippers● $anitary

7isposal of #umanfeces

Enterobius ,inworm5 $eatworm58yuris

Embryonated eggs 7-s#aped eggs -!op-sidedappearance; letter7

an None ● inuteulcerations or abscessesin cecal mucosa- uponattac#ment of t#e worm

● ,erianalpruritus- upon eggdesposition in t#eperianal area

● ,yrantelpamoate * mg/&g (DOC"

● Albendazi&e )** mg

● ebendazole +** mg

● 9leanliness

and personal#ygiene

● .andwas#ing

● 9utfingernails

Capillaria philippinensis ,udo& worm !2 !ar%a Eggs in feces- ,eanut-s#aped wit#striated s#ellsand flattenedbipolar plugs

an 4res#water or brac&is# water fis#

Intestinal Capilliariasis

● Abdominal pain● 9#ronic diarr#ea● Gurgling stomac#● .ypo&alemia● $e%ere protein-

● ebendazole


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PARASITOLOGY




- 4lat mucusplugs; coarselypitted s#ells

losing enteropat#y● fluid5 protein and

electrolyte malabsorption● 0eig# loss5

malaise5 anoreia5%omiting 6 edema

replacement● .ig# protein

diet● A%oid

eating raw fis#

1lood NematodesWucheria bancrofti 1ancroft=s filarial worm 2rd stage lar%a / !2

4iliform lar%ae$#eated microfilaria an

!ymp#atics1loodstream,erip#eral 1lood

● 9ulefatigans

● Anop#elesspp>

● Aedes spp>● ansonia

spp

● !ymp#edema● Elep#antiasis● .ydrocele● 4ilariasis

1ancrofti; 1ancroft=s4ilariasis

● 0uc#ereriasis;

● 7iet#ylcarbamazine citate'7E9( 3mg/&g

● indi%iduals● os?uito

nets● Insecticide

use● Albendazol

e● $urgical

remo%al ofelep#antoid tissue;pressure bandaging

Brugia malayi alayan fi lar ia l worm 2rd stage lar%a $#eated an!ymp#atics,erip#eralbloodstream

Mansonia spp. Aedes togoi Anopheles spp.

● alayan filariasis● !ymp#edema● Elep#antiasis

● 7iet#ycarbamazine citrate'7E9( 2-3 mg/&g

● ,ersonalpre%enti%emeasures againstmos?uito bites

I%ermectinAlbendazole$urgical remo%al ofelep#antoid tissue

● ,ressurebandaging

issue NematodesTrichenella spiralis ric#ina worm Encysted lar%a '@( lar%a in muscle

biopsy,igRat

● an Asymptomatic if lig#t infections;Intestinal in%asion wit#diarr#ea5 abdominal pain5%omiting; !ar%al migration tomuscles: periorbital5 facialedema5 conuncti%itis5 fe%er5myalgias5 splinter#emorr#ages5 ras#es5eosinop#iliayocarditis5 9N$ in%ol%ement5

● #iabendazole


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PARASITOLOGY




pneumonitis● $e%ere myalgia● ,eriorbital edema● Eosiop#ilia● 7ifficulty c#ewing● Etremity

paralysis

● 4reezing ofmeat

AnalgesicsAntipyretics

!oa loa African Eye worm!oa wormEye worm

!2 4il iform lar%ae $#eated microfi laria an -$ubcutaneoustissue

Chrysops dimidia andsilacea 'ango-fly andday-biting fly(

9alabar or fugiti%e swelling.ypersensiti%ityigrating worm insubconuncti%al tissue

● 7iet#ylcabamazine

● I%ermectin● Albendazol

e● 9orticostero

ids● $urgery

8nc#ocerca %ol%olus 1linding filarial !2 4iliform lar%ae $#eated microfilaria an -$ubcutaneoustissue

Simulium spp.1lac& fly1uffalo gnat

8nc#ocerciasis8nc#erial dermatitis8cular manifestations

● Eosinop#ilia● Urticaria● 8nc#ocercomata● ,#otop#obia● !acrimation● Ceratitis● 1lindness

● 7iet#ylcabamazine

● I%ermectin● Albendazol

e

● 9orticosteroid

● $urgery

7racunculus medinensis Guinea 0orm !ar%a insidecopepods

!ocal lesion0orm/!ar%ae9alcifi ?ed 0ormsby -ray

an - esentericissues; migrate olower et

9yclops'copepods(

● 1lister wit# serouseudates

● Ulceration● ,seudoperitoneal

syndromes

● etronidazole

● #iabendazole

● ,ro%ision ofsafe water supply

● 1oiling water before drin&ing

● 7iscouraging t#e use of step

wells

9estodesaenia solium ,or& tapeworm 9ycticercus in

muscleI$ to st I.:'taeniasis solium 69ystercuscellulose(embryonated egg

● Eggsin feces

● Gra%idproglottid

an aeniasis solium: ,ig9ystercus cellulose: an

● ild nonspecificabdominal complaints

● 9ycticercosis● Neurocycticersosi

s● Retinal

detac#ment● 9#orioretinitis

● ,razi?uantel +-* mg/&g

● NIclosamide

● 4reezing at-


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PARASITOLOGY




● Autoinfection s D ,razi?uantel +*-B+ mg/&g 2* days

aenia saginata 1eef tapeworm 9ysticercus bo%isin muscle of cattleI$ to st I.:embryonated egg

● Egg infeces

● Gra%idproglottid

an 9attle IrritationIntestinal disturbance

● Epigastric pain● ,erianal itc#ing●

0eig#t loss● !oss of appetite● .unger pangs

,razi?uantel +-* mg/&g

7ip#yllobot#rium latum 4is# / 1road tapeworm ,lerocercoid lar%aencysted in fis#

8perculated eggs;,roglottids

an9ats and 7ogs

st: icrocrustaceans'copepods(


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PARASITOLOGY




li&e #oo&lets- 1ipolar

t#ic&enings

control● Elimination

of insect intermediate#ost

● 4oodprotection

7ipyli dium caninum 7ouble-pored dogtapeworm I$ to I.:embryonated eggI$ to 7.:cystercoid lar%a

Egg in stool an ● 7og flea● 9at flea● .uman flea● 7og louse

●

$lig#t intestinaldiscomfort● Epigastric pain● 7iarr#ea

,razi?uantel +-* mg/&g,eriodic deworming

rematode

4asciola ● .umanfascioliasis

● emperate !i%er flu&e'asciolahepatica(

● ropicalli%er flu&e'asciolagigantica(

etacercaria Unembryonatedegg in feces

an o D !ymnaea philippinensis " snail(

# !. auriculariarubiginosa


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PARASITOLOGY




fe%er5 let#argy and coma● 7ermatitis● $uperficial lung

petec#iae● ,neumonitis● ,ortal

#ypertension● Ascites● .epatosplenomeg

aly● 9or pulmonale● otor/sensory

disturbances

● .ealt#education

● 9ontrol ofoncomelania snails

● En%ironmental sanitation

9lonorc#is 9#inese li%er flu&e Embryonated egg ● Egg'biliary duodenalaspirate(

an o D &arafossarulus spp. 'snail( and Bithynia spp>'snail(


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PARASITOLOGY




iulcer in colon

'ntamoeba coli 9yst rop#ozoite: dirtycytoplasm

9ystic stage:Fagged or

splintered endc#romatoidal bodies

an N8NE 9ommensal etronidazole

Giardia lamblia Giardiasis; ra%eller =sdiarr#eaGay bowel syndrome!amblia duodenalis

uadrinucleatecyst

rop#ozoite:"entral suc&ing disc'old man wit#eyeglasses(

9ystic:Retractedcytoplasm wit# )pairs of aoneme

anammals

Giardiasis; ra%eller=s diarr#ea9oating/carpeting of intestinalmucosa leading to fatmalabsorption

● Abdominal pain● 7iarr#ea● Rotten egg-li&e

flatus

● etronidazole


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PARASITOLOGY




7isease● American

rypanosomiasis

trypomastigote blood 'Triatoma) *hodnius)&anstrongylus(

● 4e%er● Generalized

lymp#adenopat#y● Romana=s sign

'eyelid and conuncti%aledema(

●1enznidazole

● Insecticidespraying

●"ectorcontrol

rypanosoma bruceigambiense

Gambian0est African $leepingsic&ness

etacyclic rypomastigoterypomastigote in blood5 9$45 !N aspirate

an setse fly "+lossina spp.( ● 9#ancre● .eadac#e● ac#ycardia● Irregular fe%er● 0interbottom=s

sign 'enlarged post>9er%ical !N5 non-tender(

● Cerandel=s sign'tremors5 #yperest#esia(

●,entamidine

●$uramin●elarsoprol●748●Eflornit#ine

rypanosoma bruceir#odiense

9entral R#odesianEast African $leeping$ic&ness

ooplasma gondii ooplasmosis ature oocyst1radyzoitestac#yzoites

Immature oocyst 9at Rodents,igsan

● Encep#alitis● yocarditis● 4ocal pneumonia● Retinoc#oroiditis● !ymp#oreticular

#yperplasia● .epatosplenomeg

aly● $tillbirt#● abortion

● ,yrimet#amine

● $ulfadiazine

● 4oodprotection

● A%oidunpasteurized mil&

● #oroug#lycoo&ed mean andeggs

alaria&lasmodium falciparum

alignant tertian$ubtertian

$porozoites Gametocyte andring stage in blood

- "i%aand o%ale D$c#uffner dots

- alari

ae D band-s#aped

- 4alciparum Dsausage-s#aped

R$C%

- "i%a

an Anop#eles ● 9#ills● !ow grade fe%er● $pi&ing fe%er at

)* 9 'ecept falciparum(● Nep#ritic

syndrome 'uartan

nep#rosis( D ,> malariae

&a#ci'arm

- 9erebral malaria- alarial

#yperpyreia- Algid malaria- 1lac&water fe%er- .epatomegaly

● 9#loro?uine'789(

● ,rima?uineD for eoeryt#rocyticforms

● ,arenteral

?uininedi#ydroc#loride

● uininegluconate

● eflo?uine● .alofantrine

alaria

&lasmodium ,i,a-

1enign tertian

alaria&lasmodium o,ale

8%ale malaria


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PARASITOLOGY




D young- alari

a D old- 4alcip

arum - all

- Normocyticanemia

Intermittent fe%er

Increased susceptibility: 7uffy

factor

7ecreased susceptibility:G3,7 trait5 ,A1A deficiency5$ic&le cell anemia

alaria&lasmodium malariae

uartan malaria

edically Important Art#ropodermatophagoids farinae

ermatophagois pteronyssinus

ic&s/mites !ar%ae !ar%ae .uman 9auses Allergy ● A%oidinfestation wit#organisms

● ,re%enti%eclot#ing

&ediculus humanuscapitis

!ice Adult lice Nymp# or adult lice'scalp(

.uman None 'direct life cycle( Red papules5 2 to ) mm indiameter

,urpuric #alo

,yret#rin

Sarcoptes scabei $cabies 1urrowed eggs 1urrowed eggs .uman 4omites Intense itc#ing 'may lead tosecondary infection(1urrows and papules w#eremites are located> Generalizedras# may occur in ot#er areas9rusted5 ecoriated pruriticpapules on t#e penis orbuttoc&s is pat#ognomonic

● ,ermet#rin+ K

● !indane

I9R81I8!8GL$cientific name 9ommon name ,at#ologic 4actors .ost=s Immune

Response7iagnostics 9linical presentation or

disease,re%ention/reatment

1acteriology

9orynebacteria M9oryneformsMdip#t#erioid bacteriaM7ipt#eria toin

Di')t)eria to*in D in#ibitsprotein synt#esis in all cells

4ragement A- in#ibits polypeptidec#ain elongation by inacti%atingt#e elongation of factor E4-<

o gene

Resistance depends ont#e a%ailability ofspecific neutralizingantitoin in t#ebloodstream andtissues

Immunity is based ondocumented c#ild#ood

7iagnosis is usually clinical>!aboratory tests ser%e toconfirm t#e clinicalimpression and are ofepidemiologic significance>

Dacron s+a,s D swabss#ould be collected frombeneat# any %isible

Respiratory Dpseudomembrane formation>4orceful remo%al will resultinto bleeding> embranecoug#ed up after +-* days

M1ullnec& appearance Dcaused by t#e enlargementof t#e regional lymp# nodes

Acti%e immunization wit#dip#t#eria tooid yieldsade?uate antitoin untiladult#ood D combined wit#tetanus tooid and pertussis%accine '7,5 7a,5 d(9#ildren D primaryimmunization '2 doses(;booster '< doses(


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I9R81I8!8GL

$cientific name 9ommon name ,at#ologic 4actors .ost=s ImmuneResponse

7iagnostics 9linical presentation ordisease

,re%ention/reatment

"irulence is due to:- 9apacity to

establis# infection- Rapid growt#- oin

7oes not acti%ely in%ade deeptissues

7oes not enter t#e blood stream

immunizations andbooster s#ots

Antibody response todip#t#eria toinfollowing clinical

disease or to dipt#eriatooid

membrane> $pecimen mustbe obtained beforeantimicrobial drugs areadministered

odified E!EC met#od D

testing for toin production

,9R-based met#ods Dtesting for toin production

E!I$A

$c#ic& test D intracutaneouss&in test

of t#e nec&

yocardium D myocarditis

Renal D Acute ubularNecrosis

,erip#eral ner%e cells Ddelayed conduction

9utaneous dip#t#eria

Adults D primaryimmunization '2 doses(;booster e%ery * years

Eryt#romycin and ,enicillin

$upporti%e treatment D restand airway management

$treptococci and,neumococci

Mstrep t#roat Gro' A% - 9apsule D composed of#yaluronic acid- protein D antip#agocytic5

anticomplementary- 4 protein D bacterial attac#ment- !ipoteic#oic acid D mediatedad#erence to epit#elial cells- Eryt#rogenic or pyogenic toin- $$ toin

Gro' D:Etracellular detran D #elps tobind to #eart %al%es

Pnemococci%,neumolysin D binds to

c#olesterol of #ost cellmembranes

9apsular .yaluronicAcid - w#en presentin#ibits p#agocytosis

Group $pecific,olysacc#aride Antigenype $pecific Antigenoins- .emolysins5,yrogenic eotoin

Enzymes-$trepto&inase57eoyribonucleases5Nicotinamide Adenine7inucleotidase5.yaluronidase

Gro' A%In#ibited by bacitracin,LR positi%e7ic& test D used to confirm

scarlet fe%er9-carb D used for lancefieldgroupings

Gro' $%

Gram stain9ulture of urine5 9$45 orblood.ippurate #ydrolysis test'positi%e(9A, reaction 'positi%e(

Gro' D%Gram stain9ulture 'non-enterococci canonly grow in bile; enterococcigrow in )*K bile and 3>+KNa9l(

S- viridians%

Resistant to optoc#in

S- 'nemoniae:

Gro' A,#aryngitis

$carlet fe%er

oic s#oc& syndrome

Acute post-streptococcalglomerulonep#ritisR#eumatic fe%er D may followstreptococcal p#aryngitis

Gro' $%

Neonatal meningitisNeonatal pneumoniaNeonatal sepsis

Gro' D%$ubacute bacterialendocarditis1iliary tract infectionsUI

S- viridians%$ubacute bacterialendocarditis7ental caries 'by $> mutans(1rain or li%er abscess

,enicillin G (DOC"

,enicillin "

Ampcillin

Eryt#romycin

ceftriaone


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I9R81I8!8GL



,re%ention/reatment

uelling test 'positi%e(7oes not grow in t#epresence of optoc#in and bile

7ic& est- once commonlyused to confirm $carlet fe%er

9-9arbo#ydrate- used for!ancefield groupings

Pnemococci%,neumoniaeningitis$epsis8titis media 'c#ildren(

$tap#ylococci M$tap#MR$A for t#e met#icillin-resistant $> aureus

S- ares%9apsule D in#ibits c#emotaisand p#agocytosis; facilitatesad#erence,rotein A D binds to t#e 4cportion of t#e IgG moleculeseic#oic acid D mediatesattac#ment to mucosal surfaces9lumping factor D bindsfibrinogen resulting in t#eclumping of t#e w#ole

stap#ylococci in t#e presence ofplasma9oagulase D clots plasma!ipases D lipid #ydrolyzingenzymes.yaluronidases D spreadingfactorEotoin D superantigenEnterotoin D %omiting anddiarr#ea$$- D toic s#oc& syndrometoinEfoliatin D scalded s&in

syndrome

S- e'idermidis%,olysacc#aride capsules

S- sa'ro').tics

$electi%ely ad#eres to urot#elialcells %ia specific oligosacc#aridereceptors

,#agocytosis isin#ibited

Gram stain: re%eals grampositi%e cocci in clusters9ulture:1eta #emolytic,roduces a golden yellowpigment for $tap# aureus9atalase postiti%e1eta #emolytic

S- ares%9oagulase positi%e

annitol fermentationpositi%e$usceptible to no%obiocin

S- e'idermidis%

9oagulase negati%e$usceptible to no%obiocinS- sa'ro').tics9oagulase negati%eNot susceptible to no%obioci

S- ares%$uperficial localized- folliculitis5 furuncles5carbuncles5 impetigo

7eep localized- osteomyelitis5 pneumonia5bacteremia endocarditis5pyoart#ritis5

Gastroenteritis 'onset


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I9R81I8!8GL



,re%ention/reatment

Mmeningococci 4imbriae/pili D ad#erence!ipooligosacc#aride D elicitsinflammatory response8p a 'protein II( D in%asion; outermembrane protein,or 'protein I( D pre%ent

p#agolysosome formation inneutrop#ils; reduce oidati%eburstRm p 'protein III( D bloc&bacterial antibodiesbp 6 < D outer membranereceptors for transferring!bp D outer membrane receptorfor lactoferrinEtracellular IgA proteases Dclea%es t#e . c#ain

N- meningitides,olysacc#aride capsule D

antip#agocytic5 antigenic,or proteins8pa class,ili!,$

surfaces culture and smear

9ulture:Nonselecti%e medium Dc#ocolate agar 'fromnormally sterile sites(

$electi%e media:- modified #eyer-artin- artin-!ewis- NL9 agar

8idase positi%e D &ey foridentifying neisseria

N- meningitides%+K $1A9#ocolate agar,resumpti%e D oidasepositi%e5 gram negati%e

diplococci

8cular gonococcal infections- op#t#almia neonatorum'neonates(- Ceratoconuncti%itis 'adults(

Uret#ritis

Genital infections- gonococcal uret#ritis Dscanty5 clear/cloudy5 copiousand purulent disc#arge- gonococcal cer%icitis D%aginal disc#arge; mostcommon form ofuncomplicated gonorr#ea in

women"ul%o%aginitis

7isseminated gononcoccalinfections

- dermatitis-art#ritissyndrome- 4itz-.ug#-9urtis syndromeD peri#epatitis- ,I7- AR7$eningitis

N- meningitides

eningococcal pneumonia

Anogenital infections

eningococcemia D mildestform; resol%e spontaneouslyAcute meningococcemia Dmore serious; @meningitis4ulminant meningococcemiaD strains t#at causedisseminated infectionseningitis D most serious;


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I9R81I8!8GL



,re%ention/reatment

Enteric 1acilli M#oneymoon cystitis D E>coli Mtra%eller=s diarr#ea DEE9

M4reidlander=s bacillus D C>pneumoniae

Mpeptic ulcer D .> pylori

Mrice-watery diarr#ea D ">c#olera

- co#i%9ommon pili, piliAmfibrial ad#esins9apsular polysacc#aride

$iderop#ores$ fimbriae8 antigens. antigens

2- 'nemoniae%,olysacc#aride capsuleEndotoinEnterotoin

ntero,acter%9ep#alosporinases

/i,rio%

9#olera toin

$pecific antibodiesde%elop in systemicinfections

- co#i%Gram negati%e bacillusIndole positi%e1eta #emolytic4erments lactose

9ulture D smoot#5 motile5 flat5non%iscous colonies wit#distinct edges

'@(sugar fermentation'@( $I'-( citrate test

2- 'nemoniae%Gram negati%e coccobacillus!actose fermentingIndole negati%e

9ulture D E1 or c9on&ey

ntero,acter%

'@( citrate'@( %ogues-pros&auer

Cam'.#o,acter%

1iology D G'-(5 spiral9ulture D microaerop#ilic

H- '.#ori%issue biopsy and cultureUrea breat# test

/i,rio%$tool culture

- co#i%7iarr#eal diseases- E,E9 D pediatric diarr#ea- EE9 D tra%eller=s diarr#ea- EIE9 D in%asi%e diarr#ea

- E.E9 D #emorr#agic colitis5#emolytic uremic syndrome

UINeonatal meningitis

2- 'nemoniae%

Epidemic diarr#ea'newborns(UI!ung abscess$epticemia

Cam'.#o,acter%

4e%er5 cramping abdominalpain5 diarr#ea5 dysenteryGastroenteritisGuillain-1arre syndrome

H- '.#ori%,eptic ulcer disease,redisposition to gastriccarcinoma

/i,rio%0atery stools wit# intestinalmucus and epit#elial cells

"iolent %omiting$#oc&No fe%er

E> coli:reatment is usually basedon symptoms

C> pneumoniae:

Aminoglycosides#ird generation9ep#alosporins9iprofloacin

Enterobacter:1-lactamase in#ibitors9arbapenemsAminoglycosides

1acteroides64usobacterium

Gram- negati%e 1acilli $acteroides%1-lactamaseGlycosidase enzymes9apsular polysacc#aride

&so,acterim%

!eu&otoin

Infection is usuallyenteric in nature

-cell dependentimmune response

4oul smelling disc#arge;Infection in proimity to amucosal surface;Gas in tissuesNegati%e aerobic culture

$acteroides%1iological c#aracteristics Dobligate anaerobe5 gram

$acteroides%,eritoneal infections1acteremia,eritonitis following rupture of%iscus$ubcutaneous abscess

&so,acterim%Ulcerati%e colitis

$urgical drainage andantimicrobial t#erapy

1acteroides:etronidazole9arbapenems

4usobacterium:9#loramp#enicol


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I9R81I8!8GL



,re%ention/reatment

negati%e5 rod-s#aped

9ulture from blood5 pleuralfluid5 peritoneal fluid5

wounds5 brain abscesses

,eriodontal diseases!emierre=s syndrome9olon cancer

,seudomonas andot#er nonfermenting1acilli

,seudomonas Aeruginosa Psedomonas%,ili D ad#esion

Alginate 'eopolysacc#aride( Dprotects from p#agocytosis inlung infections; producessepticemia in neutropenics

Elastase

Eoenzyme $ D lung tissue

destruction and bacterialdissemination

Eotoin A D causes tissuenecrosis

.emolysin D #eat labilep#osp#olipase 9; #eat stableglycolipid

,igments:- pyocyanin D Mblue pus- pyo%erdin

- pyorubin D red pigment- pyomelanin D blac& pigment

S)ige##a%

!arge multi-gene %irulenceplasmid

$#iga toin D similar to E.E9;enterotoic5 cytotoic5 neurotoic

Sa#mone##a%EndotoinIn%asions

Psedomonas%$weet/grape-li&e/taco-li&e odor

Usual sites of infectionare t#e respiratory tractand burn lesions

Recruitment ofneutrop#ils

Psedomonas%Grows well on most labmedia:- $I- c9on&ey agar- E1 agar- ueller-.inton agar

Nonlactose fermenter

8idase positi%e

1eta #emolytic

9olony types:- fried egg appearance Dlarge smoot#5 flat edges andele%ated- mucoid appearance Dalginate slime5 usually fromrespiratory and urinary tractinfections

S)ige##a%

Rectal swab or directly fromulcer

$ereny=s test

!ysine negati%e5 nonmotile

Sa#mone##a%

1lood/stool culture

yp#idot test0idal test

Psedomonas%ost common sites ofinfection:- urinary tract- burns

$ubacute bacterialendocarditis

$wimmer=s ear D eternalotitis media

1acteremia and sepsis

Eye infections:- bacterial &eratitis- neonatal op#t#almia

9#ronic contiguousosteomyelitis

UI

S)ige##a%

0atery diarr#ea 'early stage(

alabsorption

4e%er and abdominal cramps

$e%ere &eratoconuncti%itisand ulceration

Sa#mone##a%

Enteric fe%ersEnteritisEnterocolitis

,seudomonas:Antipseudomonal penicillin @aminoglycoside

Aseptic tec#ni?ue on #ospitalinstruments and procedures

$#igella:AmpicillinAmoicillin

rimet#oprim-sulfamet#oazole

$anitational and personal#ygiene

$almonella:9#loramp#enicol

Ampicillin,-$O

uinolones

$urgical remo%al of gallbladder

"accine 'attenuated strain(


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,re%ention/reatment

4lagella"i antigenResistance to acidic p.

1acteremia/septicemia wit#focal lesions

.emop#ilus .emop#ilus Influenza 9apsular polysacc#aride- typable D #as B sero%ars

- nontypable D lac&s specificpolysacc#arides

$omatic antigens- lipooligosacc#aride- outer membrane proteins

IgA protease

In#alation of bacteriaJ colonization in t#e

nasop#aryn Jpenetration of t#eepit#elium J in%asionof capillaries

Infants younger t#an 2mont#s may #a%eserum antibodiestransmitted from t#eirmot#ers

1y age 2-+ years 5many unimmunizedc#ildren #a%e naturally

ac?uired anti-,R,antibodies t#at promotecomplement-dependentbactericidal &illing andp#agocytosis

,ositi%e uellung test

9#ocolate agar incubatedaerobically at *K 98<

Gram stain specimen- 9$4- middle ear aspirates- t#oracentesis- art#rocentesis

E!I$A

9ounterimmunoelectrop#oresis

H- inf#en3ae%

Encapsulated:

- bacteremia- acute bacterial meningitis- cellulitis- osteomyelitis- oint infection- pneumonia

Nontypable:- otitis media- sinusitis- pneumonia

H- 'arainf#en3a%Usually after dental

procedures

Endocarditis

H- aeg.'ts

,in& eye D communicablepurulent conuncti%itis1razilian purple fe%er

H- dcre.i1uboes D suppurati%einguinal lymp# nodes9#ancroid D seually

transmitted painful genitalulcers

,urified type b capsularpolysacc#aride %accine

.ib ,R, %accine

Rifampicin$ulfonamides9#loramp#enicolrimetop#rim9efotaime

Aerobic $pore-forming1acilli

Mcutaneous ant#raMin#alation ant#raMgastrointestinal ant#ra D1acillus ant#racis

$- ant)racis%

-,rotecti%e antigen ',A(-Edema 4actor 'E4(5 -!et#al4actor '!4(>

,A binds to specific cellreceptors5 after proteolyticacti%ation5 membrane c#annel isformed t#at mediates entry of E4and !4 to cell> E4 is adenylate

$- ant)racis%

$pores germinate in t#etissue at t#e site ofentry> Growt# of t#eorganisms result information of agelatinous edema andcongestion> 1acillispread %ia lymp#aticsto bloodstream5 w#ere

$- ant)racis%

Immunofluorescence stainingtec#ni?ues5 ,9R5 E!I$A

$pecimen:4luid or pus from local lesion5blood5 pleural fluid5 and 9$4in in#alational ant#ra5 stoolor ot#er intestinal contents ingastrointestinal ant#ra

$- ant)racis%

9utaneous ant#ra: -,ruriticpapule de%elops -B daysafter spore entry>-blac& esc#ar lesion>-ar&ed edema-!ymp#angitis andlymp#adenopat#y>-After B-* days esc#ar isfully de%eloped> It dries5

$- ant)racis%

must be started early>9iprofloacin isrecommended for treatment>,enicillin G5 Gentamicin5 or$treptomycin were pre%iouslyused>

,rop#ylais wit# ciprofloacinor doycycline s#ould be


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cyclase; wit# ,A5 it forms edematoin> !4 plus ,A is let#al toin5 amaor %irulence factor and causeof deat# to t#ose w#o areinfected>

8rganisms proliferate at t#e siteof entry> #e capsules remainintact5 t#e organisms aresurrounded by proteinaceousfluid w/ few leu&ocytes from

w#ic# t#ey rapidly disseminate>

$- ceres%

oins t#at cause disease t#at ismore of an intoication t#an afoodborne infection>

t#ey multiply s#ortlybefore and after #ost=sdeat#>

In woolsorters= disease5t#e in#aled spores arep#agocytosed in t#elungs5 transportedt#roug# lymp#atics tot#e mediastinal lymp#nodes5 w#eregermination occurs>

$- ceres%

$pores germinate5%egetati%e cellsproduce toins duringlog-p#ase growt# orduring sporulation>

$- ceres%4presence of bacteria inpatient=s stool is not sufficientto ma&e a diagnosis becauseit may be present in normalspecimens

loosens5 and separates>

In#alation ant#ra:-Incubation period- 3 wee&s>-ar&ed #emorr#agicnecrosis-Edema of t#e mediastinum>-$ubsternal pain andpronounced mediastinal

widening %isible on 9OR>-.emorr#agic pleuraleffusions follow>

Gastrointestinal ant#ra:Rare in #umans>-Abdominal pain-%omiting-bloody diarr#ea4ood poisoning:Emetic form:

- to + #rs after ingestion ofrice-nausea-%omiting-abdominal cramps-occasional diarr#ea

7iarr#eal form:--

$- ceres%Resistant to ,enicillin and9ep#alosporins>

$erious non-foodborneinfections s#ould be treated

wit# %ancomycin orclindamycin>


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,re%ention/reatment

-pneumonia

Anaerobic spore-forming bacilli

Mbotulism D 9> botulinum C- ,ot#inm%7uring autolysis of bacteria5 toinis liberated>

Antigenic %arieties:ypes A5 15 E5 4 '#umans(

ypes A and 1-%ariety of foodsype E-fis# products

C- tetani%4lagellar antigens

C- 'erfringensAlp#a toin of 9 perfringens typeA: let#icinase

-splits lecit#in top#osp#orylc#oline anddiglyceride>

7Nase and #yaluronidase5 acollagenase t#at digests $tissue and muscle are alsoproduced>

C- diffici#e-,seudomembranes5microabscesses-9> difficile toins

C- ,ot#inm%1otulinum toin isabsorbed from t#e gutand binds to receptor ofpresynaptic membranesof motor neurons of t#eperip#eral ner%oussystem and cranialner%es> ,roteolysisin#ibits t#e release ofAc# at t#e synapse5resulting in lac& ofcontraction andparalysis>

C- tetani%oin binds to receptorson presynapticmembranes of motor

neurons> igrates byretrograde aonaltransport to cell bodiesof neurons to $9 andbrainstem> oindiffuses to terminals ofin#ibitory cells5including glycinergicinterneurons andGA1A-secretingneurons frombrainstem> Release ofglycine and GA1A is

bloc&ed5 motor neuronsnot in#ibited>

C- 'erfringens%

#e spores germinateat low oidation-reduction potential>"egetati%e cellsmultiply5 fermentcarbo#ydrates presentin tissue5 and producegas> 7istention oftissue5 interference wit#

C- ,ot#inm%E!I$A5 ,9R

$pecimen:-serum-gastric secretions-stool-lefto%er food

C- tetani%

Anerobic culture,rimary differential d:stryc#nine poisoning>

C- 'erfringens.emolysis and colonymorp#ology5 lecit#inaseacti%ity5 toin production5neutralization

C- diffici#e-7etection of one or bot# 9>difficile toins in stool-endoscopy

C- ,ot#inm%--


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blood supply5 secretionof necrotizing toin and#yaluronidase fa%or t#espread of infection>

C- diffici#e%9ytotoic acti%ity:-binds to t#e brus#border membranes oft#e gut at receptorsites>

ycobacteria Macid Dfast bacilli

Mtuberculosis D >tuberculosisMleprosy D > lepraeMAI D > a%ium-intercellulareMA9- > a%ium comple

0- t,erc#osis: production andde%elopment of lesions-number of mycobacteria in t#einoculum-type of #ost

< principal lesions:-eudati%e type-producti%e type

0- avim com'#e*% ubi?uitous

0- #e'rae% uni?ue o-dip#enoloidase

0- t,erc#osis% 0#enin#aled5 organisms aredeposited in al%eoli>Immune systemresponds by release ofcyto&ines andlymp#o&ines t#atstimulate monocytesand macrop#ages>

ycobacteria begin tomultiply wit#inmacrop#ages> -< mos>after eposure5pat#ogenic lesionsappear in lungs>

0- avim com'#e*%8pportunistic infection>97)-positi%elymp#ocyte countdeclines to below **microliters>

0- #e'rae:9ell mediated immunityis mar&edly deficient5s&in is infiltrated wit#suppressor cells

0- t,erc#osis% tuberculintest5 sputum culture5 ,9R5

0- avim com'#e*% cultureA9 organisms from bloodor tissue>

0- #e'rae%$pecimen is smeared on

slide and stained by t#ePie#l-Neelsen tec#ni?ue

0- t,erc#osis% -,ulmonaryuberculosis-clinical manifestations areprotean:-fatigue-weig#t loss-fe%er-nig#t sweats-c#ronic coug#

-spitting of blood

0- avim com'#e*%

8rgan dysfunction:-pericarditis-soft tissue abscesses-s&in lesions-lymp# node in%ol%ement-bone infection-9N$ lesions

0- #e'rae%-!eprosy

-8nset: insidious-Neurologic disturbances:anest#esia5 neuritis5parest#esia5 trop#ic ulcers5bone resorption5 s#orteningof digits>

0- t,erc#osis%st line drugsRifampicinIsoniazid,yrazinamideEt#ambutol$treptomycin


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$ulfur granules ,yogranulomatousreaction

re?uired for specie-le%elidentification>

$un ray appearance %iagram stain of granulesobtained from pus

-fe%er-weig#t loss-c#est pain-spread from t#e lung oftenin%ol%es 9N$5 w#ere brainabscess de%elops

0.cetoma%-adura foot-painless-begins at $ tissue andspreads to adacent tissues>>

-imipinem-minocycline-linezolid-cefotaime

0.cetoma%

-streptomycin-trimet#oprim Dsulfamet#oazole-dapsone

$urgical debridement5penicillin

$piroc#etes Myaws D > pallidumsubspecies pertenueMbeel Mendemic syp#ilis D> pallidum subspeciesendemicumMpinta- > carateum

M!yme 7isease D 1orreliaburgdorferri

T- 'a##idm%-.yaluronidase: en#ancesin%asi%eness-9ardiolipin

$orre#iae%

-antigenic structure %ariation

$- ,rgdorferri%

-bite of a small Iodes tic&-!arge number of se?uences forlipoproteins including outersurface proteins 8spA to 4>

T- 'a##idm%-9an penetrate intactmucous membranes>-$pread to nearbylymp# nodes and t#enreac# blood stream

$orre#iae%-Antibodies appearduring febrile state5attac& is probablyterminated by t#eiragglutinating ang lyticeffects>

$- ,rgdorferri%-after inection by t#etic&5 organismmaigrates out of t#e

site5 producingc#aracteristic s&inlesion-dissemination bylymp#atics or blood toot#er sites

T- 'a##idm%-7ar&-field eamination-Immunofluoresence-Nucleic acid amplificationtests

$orre#iae%-t#in or t#ic& blood smearsstained wit# 0rig#t orGiemsa stain-serology-animal inoculation

$- ,rgdorferri%immuno#istoc#emicalmet#ods-,9R-EIA or I4A @ immunoblotassay

Indian in&$il%er impregnation met#odsRegain detection %ia nonspecific serological tests'0assermen5 Ca#n5 "7R!(

T- 'a##idm%- papule de%elops at site ofinfection after


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a&ariMueensland tic& typ#us-Ric&ettsia australis

-cells become swollenand necrotic

!ymp#ocytic infiltratesin tissues>,olymorp#onuclearleu&ocytes5macrop#ages5 andlymp#ocytes areassociated wit# blood%essels in t#e graymatter>

li%er

R- 'ro+a3e5ii%-lasts for about < wee&s-more fatal in patients oldert#an )* y/o

R- ric5ettsia%-ras# appears in etremitiesfirst5 mo%es centripetally

R- a5ari%-ras# t#at resembles %aricella-firm red papule appears atbite site-de%elops into a deep seated%esicle-forms blac& esc#ar

9#lamydia Mrac#oma D 9>trac#omatis

Mpsittacosis D #uman 9>psittaci disease ac?uiredfrom contact wit# birds

C- trac)omatis%-.eparin sulfate-li&e

proteoglycans

C- 'nemoniae%

-glycan negati%e inclusions-sulfonamide resistant

C- 'sittaci%

-#eat-stable-resists proteolytic enzymes-!ipopolysacc#aride

C- trac)omatis%- acute inflammatory

c#anges in conuncti%a5scarring5 eyeliddeformities

C- 'nemoniae%

- no signs andsymptoms t#atspecifically differentiatefrom t#ose caused byot#er agents

C- 'sittaci%-enters t#roug#

respiratory tract-causes patc#yinflammation of lungs5consolidated areas ares#arply demarcated-eudates arepredominantlymononuclear>

C- trac)omatis- specimen stained wit#

fluorescent antibody or byt#e Giemsa met#od-inoculation of specimen intocyclo#e-imide-treatedc9oy cell cultures-Immunofluorescence-,9R

>C- 'nemonia% microimmunofluorescencetest

C- 'sittaci%

-,9R-74A staining-immunoassay-complement-fiing ormicroimmunofluorescentantibodies in serum

C- trac)omatis%-incubation period: 2-* days

-lacrimation-mucopurulent disc#arge-conucti%al #yperemia-follicular #ypertrop#y

-$ER8"AR$ 7-C: causeseually transmitted diseasesen:-nongonococcal uret#ritis-epididymitis0omen:-uret#ritis-cer%icitis

-,I7

C- 'nemonia%-upper and lower airwaydisease occurs-,#aryngitis-$inusitis-8titis media

C- 'sittaci%

-sudden onset of illness5incubation of * days ina%erage

C- trac)omatis-azit#romycin

-treatment must besimultaneous for bot# separtnersC- 'nemonia%-macrolides-tetracycline

C- 'sittaci%- treated based only onclinical diagnosis- doycycline5 ert#romycin


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-malaise-fe%er-anoreia-sore t#roat-p#otop#obia-se%ere #eadac#e

ycoplasma Matypical pneumonia D >pneumoniae

0- 'nemoniae%

-attac#ment to organism by aspecific ad#esion protein on t#edifferentiated terminal structure oft#e organism- no cell wall5 pleomorp#ic5 canappear oblong s#aped5 motile

6rea'#asma rea#.ticm%-re?uires *K urea for growt#-no cell wall5 pleomorp#ic5

0- 'nemoniae%

-clinical spectrumranges fromasymptomatic infectionto serious pneumonitis5

wit# occasionalneurologic and#ematologicin%ol%ement>

0- 'nemonia%

4 clinical recognition of t#esyndrome-,9R-EIA

0- genita#im%

-NAAs-serology

0- 'nemonia%

-incubation period: -2 wee&s-insidious onset-malaise-#eadac#e-fe%er-sore t#roat-coug# 'paroysmal(-blood-strea&ed sputum-c#est pain-trac#eobronc#itisM0al&ing pneumonia- a&aatypical pneumonia5 fe%er

wit# a dry non producti%e

#ac&ing coug#

0- )ominis%

-salpingitis-tubo-o%arian abscesses

6- rea#.ticm%4nongonococcal5 nonuret#ritisin men-lung disease in prematurelow-birt# weig#t infants

0- genita#im%

-acute/c#ronicnongonoccocal uret#ritis inmen-cer%icitis5 endometritis5salpingitis5 infertility in

women>

0- 'nemonia%

can produce clinicalimpro%ement but do noteradicate:-tetracyclines-macrolides-fluoro?uinolones

/iro#og.

#e 7NA %iruses I

Adeno%irus Adeno%iruses oic acti%ity associated wit#pentons

Replication in nucleus ofepit#elial cells

"iral isolation from t#e eyes5t#roat5 or urine;

E!I$A on fecal specimens onpatients wit# GI infection

!ocalized infecion of eye5respiratory tract5 GI tract5 andurinary bladder

subclinical infections and can

9ontact and dropletprecautions5 and promptlyrespond to and report clustersof cases>


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cause latent infections oflymp#oid tissue

,o%irus "accina5 %ariola5 mollluscumcontagiosum5 cowpo %irus5para%accinia %irus5 orf %irus

,roduce eosinop#ilic inclusionbodies called Guarnieri bodies

Replication in t#ecytoplasm of t#e cell

Inoculation of embryonatedeggs 'traditional(;

Genome se?uencing ormicroarray assays

"ariola - smallpo

"accinia - mild disease

olluscum contagioum %irus- causes seually transmitteddisease mimic&ing genital#erpes

"accine: a%irulent po %irus toinduce immunity to %irulentpo %irus;

9ontact and dropletprecautions5 and promptlyrespond to and report clustersof cases>

7NA "irus II

.erpes %irus .erpes $imple "irus type and <

"aricella-Poster %irus's#ingles(

9ytomegalo%irus

Epstein-1arr %irus

.erpes %iruses 3 and B

Ability to establis# life-longpersistent infections;

ability to undergo periodicreacti%ation

.$": Upper and lowerrespiratory tract; .$"


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disease 'epidemic myalgia(5myocarditis5 pericarditisParec)ovirs% GI andrespiratory illness5meningoencep#alitis5 otitismedia5 neonatal diseaseR)inovirs: !RI5 sneezing5nasal obstruction5 nasaldisc#arge5 sore t#roat5#eadac#e5 mild coug#5malaise5 c#illy sensation5otitis media5 sinusitis5bronc#itis5 pneumoniaA')t)ovirs: fe%er5sali%ation5 %esiculation of t#emucous membranes of t#eorop#aryn and of t#e s&in oft#e pams5 soles5 fingers5 andtoesCardiovirs% 9N$

in%ol%ement wit#outmyocarditis5 flaccid paralysis

%accine

,aramyo%irus Param.*ovirs% ,arainfluenza -)5 mumps5Newcastle disease %irus5simian %irus +0or,i#ivirs: easles'rubeola(5 canine distemper%irusPnemovirs% Respiratory$yncytial "irus 'R$"(0eta'nemovirs% .umanmetapneumo%irusRes'irovirs% No commonnameR,#avirs% No commonnameHeni'avirs% .endra %irus5Nipa# %irus5 9edar %irus

"irus replication is limited to t#erespiratory epit#elium; in%ol%ingnose and t#roat 'most common(5laryn and upper trac#ea;production of %irus-specific IgEantibodies during primaryinfections; release of mediatorsof inflammation w#ic# alterairway function

Rubeola: interaction of cells wit# %irusR$": IgA

R,eo#a% .istory5multinucleated giant cells'0art#in-4in&eldy cells(5lumbar tapParainf#en3a% nasal

was#ings and respisecretions0m's% #istory5 glandenlargement5 culture5multinucleated giant cell5serology

R,eo#a% fe%er5 respiinfections5 maculopapularras#5 &opli&=s spot'pat#ognomonic(5 coug#5coryza5 conuncti%itisParainf#en3a% !aryngotrac#eo-bronc#itis/croup5bronc#iolitis5 pneumonia5common cold in subclinicalform0m's% acute inflammationof t#e parotid glands5 orc#itisRS/% common colds5pneumonia5 bronc#iolitis5respiratory failure5 otitismedia5 r#initis5 p#aryngitis

R,eo#a% supporti%e5 %itaminA5 do not gi%e aspirinParainf#en3a% supporti%etreatment5 Riba%irin s#owsacti%ity0m's% supporti%e5 li%eattenuated %accineRS/% Riba%irin 'in#alation(5standard precaution5 no%accine

8rt#omyo%rus Influenza A5 15 9#ogoto%irus.N

.emaglutinin5 glycoprotein on%iral surface5 binds to sialic acidon R19s or cells of UR; andNeuraminidase5 clea%es sialicacid to release newly formed%irions from #ost cell

IgA5 serum IgG5 andcellular immunity

9ell culture in ,C or79C5 #emadsorption toinfected cells5 Ab in#ibition of#emadsorption5 .$45 E!I$A5.I

H1N1% nucleic acid

Inf#en3a A% fe%er5 malaise5#eadac#e5 myalgia5 anoreia5sore t#roat5 dry coug#5 otitismedia5 myositis5 croup5 GIsymptomsInf#en3a $% milder 2-dayfebrile wit# systemic

Amantadine #ydroc#loride5Rimantadine5 Panami%ir58seltami%ir

H1N1% 8seltami%ir 'amiflu(5Panami%ir 'in#alation(


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amplification test5 Rapidinfluenza diagnostic test

symptoms5 gastric fluInf#en3a C% afebrile URI5confined to young c#ildren

H1N1% fe%er5 coug#5 soret#roat5 runny nose5 bodyac#es5 #eadac#es5 c#ills5fatigue5 %omiting5 anddiarr#ea

"accines:!i%e attenuated nasal sprayCilled inectable 'I(:ri%alent '< A strains @ 1strain( or ?uadri%alent '< Astrains @ < 1 strains(

RNA "irus II9orona%irus 9orona%irus: $e%ere Acute

Respiratory $yndrome'$AR$(oro%irus: enteric

$ome %iruses contain a t#irdglycoprotein '#emagglutininesterase(; infections in #umansusually remain in t#e upperrespiratory tract

,resence of spi&es t#at form aMcorona around t#e %irion>

Replication ta&es place in

cytoplasm

E#ibits #ig# fre?uency ofmutation and recombinationduring eac# round of replication

Resistance toreinfection may lastse%eral years butreinfections wit# similarstrains are common>

Immunity is notabsolute>ost patients 'S+K(de%eloped antibody

response to %iralantigens detectable byflourescent antibody testor by E!I$A>

"irus isolation '#umanembryo &idney5 diploid celllines(5 direct antigendetection5 nucleic aciddetection5 serodiagnosis

Nucleic Acid and Antigen7etection by E!I$A

$pecimen: Respiratory

$ecretions

4e%er5 coryza5 coug#5dizziness5 '-( sore t#roat5c#ills/rigor5 myalgia5#eadac#e5 e%idence ofleucopenia5 wit# absolutelymp#openia5 rapidrespiratory distress

9olds 'afebrile(5 nasaldisc#arge5 malaise

Incubation period: 4or t#e lower RI:-2rd gen cep#alosporin-oral clarit#romycin-riba%irin-corticosteroid

Isolate t#e patients5?uarantine t#e eposed

Reo%irus 8rt#oreo%irus5 Rota%irus59olti%irus5 8rbi%irus

,at#ogenic properties areprimarily determined by t#eprotein species found on t#eouter capsid of t#e %irion

$table at +* 9p.: 2-S

Replicates at cytoplasm

Genetic reassortment occursreadily

0ide range of #osts

'@( #emaglutinnin fir #uman 8eryt#rocytes

Acute Gastro Enteritis "iral isolation using primaryon&ey Cidney issueculture5 neutralization tests5E!I$A

!ow grade fe%er5 r #inorr#ea5p#aryngitis5 pneumonia5diarr#ea5 abdominal cramps5eant#ema5 asepticmeningitis5 encep#alitis

No treatment5 wait for t#eclinical course to finis#

Epidemic AcuteGastroenteritis "iruses

Rota%iruses-Groups A5 15 9

Enteric adeno%ius

8uter capsid proteins ",) and",B carry epitopes important inneutralizing acti%ity5 wit# ",Bglycoprotein being t#e

"iral replication leads toincreased intracellular9a


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,re%ention/reatment

9alici%irus-Noro%irus-$apo%irus

Astro%irus

predominant antigen>

0ide #ost range

Infect cells of t#e %illi of t#einstestine

ultiply in t#eir cytoplasm anddamage t#eir transportmec#anisms

secretion5 and s#ut-offof #ost cell proteinsynt#esis 'effected byN$,2(5 resulting inacute osmotic andsecretory diarr#ea

Nonspecific 'innate( andac?uired %irus-specific#umoral and cellularimmune responses

Impaired sodium andglucose transportation

7amaged cells sloug#off to t#e lumen andrealease many %iralparticles

immunoassay or re%ersetranscriptase polymerasec#ain reaction5 but suc#testing is not commonlydone>

Immunoflourescence5 E!I$A5immune electron microscopy

-Group A: $ingle mostimportant cause of endemicse%er diarr#eal illness ininfants and young c#ildren

worldwide-Group 1: 7iarr#eal illness inadults and c#ildren in 9#ina-Group 9: $poradic casesand occasional outbrea&s ofdiarr#eal illness in c#ildren

nteric adenovirs: $econdmost important %iral agent ofendemic diarr#eal illness ofinfants of young c#ildren

worldwide

Ca#icivirs-Noro%irus: Important cause

of outbrea&s of %omiting anddiarr#eal illness in olderc#ildren and adults-$apo%irus: $poradic casesand occasional outbrea&s ofdiarr#eal illness in infants5young c#ildren5 and elderlyadults

Astrovirs: $poradic casesand occasional outbrea&s ofdiarr#eal illness in infants5young c#ildren5 and elderlyadults

incidence(

8ral li%e attenuatedpenta%alent #uman- bo%inereassortant rota%irus %accine

#e RNA %iruses III

R#abdo%irus !yssa%irus 'Rabies( ,eplomers 'spi&es( composed oftrimers of %iral glycoprotein> Gglycoprotein w#ic# is a maorfactor in neuroin%asi%eness-bullet s#aped-negati%e single stranded RNA-Non segmented- .elical5 non capsid and iscoiled into a bullet s#ape- replication in t#e cytoplasm

.as predilection for t#e#ippocampus 'Ammon=s#orn cells(

7irect 4lourescent antibodystaining of biopsy ornecropsy 'standarddiagnostics(R-,9R5 R44I5 tissuestaining to demonstrate Negri1odies5 corneal imprint5 95RI

Prodroma#%-malasie5 fatigue5 #eadac#e5anoreia5 n/%5 restlessness5ill-defined aniety5 soret#roat5 fe%er5 pain orparest#esia 'close to t#e siteof eposure(

nce')a#itic9 nero#ogic(&rios" t.'e%-ecessi%e restlessness5

No effecti%e treatment

ilwau&ee ,rotocol/0isconsin ,rotocol:c#emically induced coma plusriba%irin and amantadine 'stillcontro%ersial(

,ost eposure prop#ylaisconsisting of passi%eimmunization wit# rabies


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uncontrollable ecitement5agitation5 confusion5#allucination5 combati%eness5seizures5 opist#otonus5#ydrop#obia5 foaming ofmout#5 aerop#obia

Para#.tic (Dm," t.'e%-flaccid ascending symmetricparalysis5 sensoryabnormalities5 decreasedtendon refle5 coma5respiratory and circulatorycollapse w#ic# lead to deat#

immunoglobulin andimmunization wit# a %accine

oga%irus > Alp#a%irus-AR18%irus-9#i&ungunya-ayaro %irus-8= Nyong Nyong %irus-Ross Ri%er "irus

-$emli&i 4orest "irus-$indbis %irus-Eastern E?uineEncep#alitis 'EEE(-"enezualan E?uineEncep#alitis '"EE(-0estern E?uineEncep#alitis '0EE(

Rubi%irus-Rubella %irus 'Germaneasles(

After subcutaneous inoculation5%irus replication occurs in localtissues and regional lymp#nodes> #en5 %irus enters t#eblood stream and isdisseminated> "irus crosses t#e

blood-brain barrier; widespreadneuronal degeneration

Alp#a%irus: 1ite of a mos?uitot#at #as fed on animal %iralreser%oir

Rubi%irus: 4etuses infectedduring first * wee&s ofpregnancy

Anti%iral antibodiesappear in blood in -)days of t#e onset ofsymptoms> 9ellmediated immunity andinterferon> IgG rubella

antibodies persist forlife>

9linical e%idence and #istory5isolation and identification of%irus during %iremic p#ase>.I5 E!I$A5 I4 test5 Nt test>Rise in IgG5 presence of Ig>

-$yndromes range frombenign febrile illness tose%ere systemic disease wit##emorr#agic manifestationsor maor organ in%ol%ement-neurotrop#ic alp#a%iruses

can produce se%eredestructi%e 9N$ disease wit#serious se?uelae-9#i&ungunya5 Ross Ri%er5and ayaro: cause painfulart#ritis t#at persist for wee&safter t#e initial febrile illness-.uman illness diseasepatterns:C)i5ngn.a virs: t#eprototype for t#ose causingan acute febrile illness wit#malaise5 ras#5 se%ereart#ralgias5 and sometimesart#ritis>O:N.ong N.ong 0a.aroand Ross River causessimilar identical clinicalmanifestations-%iremia coincident wit#abrupt onset of fe%er5 c#ills5malaise5 and oint ac#es>$ubsides in 2-+ days>

R,e##a (German 0eas#es"

reatment is supporti%e>"accine is a%ailable 'R(


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-lymp#adenopat#y5 andmaculopapular ras#5 swollenglands5 art#ralgia5 art#ritis5t#rombocytopenia5postinfectious encep#alitis>orbilliform ras#>

Congenita# R,e##aS.ndrome%

7eafness5 %isual defects5cataract5 corneal opacity5 allse%ere and bilateral-RIA7: eyes5 ears5 #eart

4la%i%irus 0est Nile %irus5dengue %irus5yellow fe%er %irus> $t> !ouieencep#alitis %irus5 .epatitis9 %irus

"irus replication occurs in localtissues and regional lymp#nodes after subcutaneousinoculation> Enters t#e bloodstream and is disseminated>9rosses t#e blood-brain barrier;

widespread neuronal

degeneration

#e %irion RNA is infectious andser%es as bot# t#e genome andt#e %iral messenger RNA> #e

w#ole genome is translated in apolyprotein5 w#ic# is processedco- and post-translationally by#ost and %iral proteases>

In#ibit/ e%ade innateand adapti%e immuneresponse.umoral and cellmediated immunity

8est Ni#e: $erology of bloodserum and 9$4; detectionof%irus specific Ig anneutralizing antibodies

Denge: cell culture5 ,9R5%iral antigen detection5

serology

Ye##o+ &ever: E!I$A5 i%erbiopsy

0est Nile: 0est Nile 4e%er50est Nile Neuroin%asi%edisease 'meningitis5encep#alitis5meningoencep#alitis5poliomyelitis-li&e syndrome(5ras#es

7engue:-4ebrile p#ase: sudden-onsetfe%er5 #eadac#e5 mout# andnose bleeding5 muscle and

oint pains5 %omiting5 ras#5diarr#ea- 9ritical p#ase: #ypotension5pleural effusion5 ascites5 GIbleeding- Reco%ery: altered le%el ofconsciousness seizures5itc#ing5 slow .R

Lellow 4e%er: fe%er5#eadac#e5 c#ills5 bac& pain5fatigue5 loss of appetite5muscle pain5 nausea5 and%omiting> !i%er damage'aundice5 abdominal pain(>1leeding in t#e mout#5 t#eeyes5 and t#e gastrointestinaltract will cause %omitcontaining blood

0est Nile: No specifictreatment; supporti%e care 'I"fuids5 respiratory support(

7engue: symptomatic relief

Lellow 4e%er:

.ospitalization5 intensi%e carefor rapidly deteriorating cases

1unya%irus 8rt#obunya%irus '9aliforniaEncep#alitis "irus(

"ector borne %irus 'mos?uitos5tic&s5 sandflies(

Replicate wit#in t#ecytoplasm and bud from

.I5 E!I$A5 Nt test5 ,9R Ort)ovirs% se%ere bifrontal#eadac#e5 fe%er5 %omiting5

HR&S% $upporti%e treatment5rodent control>

http://en.wikipedia.org/wiki/Yellow_feverhttp://en.wikipedia.org/wiki/Yellow_feverhttp://en.wikipedia.org/wiki/Yellow_fever


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.anta%irus '.emorr#agicfe%er wit# Renal $yndromeQ.R4$ and .anta%irus,ulmonary $yndromeQ.,$(,#lebo%irus '$andfly fe%erand Rift "alley 4e%er(

Interact wit# %iruses t#at areclosely related serologically toproduce recombinant %iruses bygenetic reassortment

t#e membranes of Golgiapparatus

let#argy5 con%ulsions5seizures5 aseptic meningitisHR&S% interstitial nep#ritis5generalized #emorr#age5s#oc&5 nep#ropat#iaepidemicaHPS% prodromal fe%er5

myalgia5 coug#5 #eadac#e5rapidly progressi%epulmonary edema5 functionalimpairment of %ascularendot#eliumSandf#. fever% mista&en formalaria5 #eadac#e5 malaise5nausea5 fe%er5 p#otop#obia5stiffness of t#e nec& andbac&5 abdominal pain5 andleucopeniaRift /a##e. &ever: mild febrileillness5 retinitis5 encep#alitis5

#emorr#agic fe%er

HPS% ade?uate oygenation5Riba%irinSandf#. fever% all patientsreco%er5 no treatment neededRift /a##e. &ever% mos?uitocontrol

Arena%irus -!assa 4e%er-$out# American.emorr#agic 4e%er-Funin .emorr#agic 4e%er-Argentine .emorr#agic4e%er-ac#upo .emorr#agic4e%er-"enezuelan .emorr#agic4e%er-!ymp#ocytic9#oriomeningitis

Infectious t#roug# aerosols Dgreat caution is needed in#andling t#e specimens1ot# %ertical and #orizontaltransmission possibleNo cytopat#ic effects

-9ell mediatedinflammatory response

E!I$A5immuno#istoc#emistry5re%erse transcriptasepolymerase c#ain reactionassays

!assa 4e%er: fe%er5 mout#ulcers5 se%ere muscle ac#es5s&in ras# wit# #emorr#ages5pneumonia5 #eart and &idneydamage!ymp#ocytic9#oriomeningitis: fe%er5c#ills5 malaise5 generalizedmuscle ac#es and pains5

wea&ness5 #eadac#e5 andsore t#roat5 #ydrocep#alus5blindness5 fetal deat#>

!assa 4e%er: ade?uateoygenation5 Riba%irin>"accine is a%ailable for Funin"irus>

ycology

alassezia globosa ,tyriasis "ersicolor 'An-An(

,ityriasis foliculitis

$eborr#eic dermatitis and7andruff

!ipop#ilic yeast in%ading t#estratum corneum

Inflammation 'minimalresponse(

C8. stain or 9alcofluor0#ite

9osmetic fungal infection ofs&in and #air s#aft7iscrete5 serpentine5#yper/#ypopigmentd maculeson s&in

Cetoconazole s#ampoo'dandruff(opical Imidazole

.ortaea wernec&ii/Eop#iala wernec&ii

inea nigra Infection of t#e stratum corneum 9an be asymptomatic !ig#t microscopy '*K C8.( 7ar& discoloration often ont#e palms 'brown to blac&(

Ceratolytics5 salicylic acid andazole deri%ati%es5 benzoicacid compound

,iedraia #ortai

ric#osporon spp>

1lac& ,iedra

0#ite ,iedra

Infection of t#e #ai r s#af t inimal response !ig#t microscopy '*K C8.( $uper ficial nodu lar infectionof t#e #air!arger5 softer yellowis#

Remo%al of t#e #air andtopical antifungal


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nodules0#ite ,iedra: ailla or scalp;soft w#itis# granules1lac& ,iedra: #ard5 blac&nodules of t#e scalp5 facial#air and pubic #air

9UANE8U$

7ermatop#ytosis icrosporum

ric#op#yton

Epidermop#yton

inea/Ringworm

inea ,edis D foot Mat#elete=s foot

inea anus - #and

inea 9ruris D t#ig#s andbuttoc&s

inea Unguium - nails'7ermatop#yteonyc#omycosis(

inea 9orporis D s&in on t#ebody

inea 9apitis - scalp

Utilization of Ceratin as nutrientsource> Ceratinised stratumcorneum is simply colonized>

Allergic andinflammatoryeczematous response

7irect microscopy '*KC8.( of s&in and scalpscrapings9ulture: $7A

inea / Ringworm of t#escalp5 glaborous s&in andnails>

opical antigungal agent$ystemic #erapy

$U19UANE8U$$porotric#osis Sporo thri- schen/ii

Gardener=s 7isease/ RoseGardener=s 7isease

#ermotoerance5 ad#esion5melanin production5 ergosterolperoide

Innate 'complementsystem acti%ation(5Ac?uired immunity'acti%atedmacrop#ages(5 .umoralresponse dri%en by I!-<

C8. ount Nodular lesions in t#e s&in atpoint of entry and alonglymp# nodes and %essels>ay de%elop into c#roniculcer

,ulmonary sporotric#osis

7isseminated sporotric#osis'osteoarticular sporotric#osis5sporotric#osis meningitis(

,otassium Iodine 'oral(ItraconazoleAmp#otericin 1Newer riazoles

9#romoblastomycosis &hialophora,errucosa onsecaea pedrosai

7irect icroscopy '*KC8.( Infection of t#e cutaenouesand subcutaneous7ematiaceous5 planate-di%iding5 rounded scleroticbodies9rusted5 %errucose5 wart-li&elesion

$urgical ecision4lucystosine

!obomycosis !oboa loboi

!obo=s disease $timulates transforming growt#factor T and I!-* w#ic#

Granulomatous reaction C8. ount 9#ronic &eloidal lesions>,ainless5 but may become

$ulfa drugs


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in#ibitst#e cellular immuneresponse and5 as aconse?uence5 t#e acti%ation ofmacrop#ages

%eruccous an ulcerati%e

R#inoentomop#t#oromycosis

'ntomophthoracoronate

1iopsy5 $erology .ard nodules de%eloping int#e nasal area leading to alarge disfiguring tissue mass

$urgery5

S0ST'MIC AN$&&$*TUNISTIC

Blastomycesdermatides

Gilc#rist=s disease #ic& cell wall; 1A7- ,#agocytosis and &illingby neutrop#ils5monocytes5 and al%eolarmacrop#ages

C8. mount5 9ulture5 EIA5Imaging

,ulmonary manifestationsmay mimic ,b

Granulomatous lesions andabscess

9rusty cutaneous esions

I

traconazole

&aracoccidiodesbrasilensis

$out# Americanbastomycosis

9ell wall Granuomatousinfitration

9ulture5 serology5 direstmicroscopy

embrane ulceration andspread t#roug# t#elymp#atics

Amp#otericin 1Itraconazole

Coccidioides imitis $an Foa?uin "alley fe%er $p#erules trigger acuteinflammatory reaction and isresistant to eradication by #ost=simmune system

9omplement acti%ation;-cell and cyto&inesfacilitate &illing of t#eorganism; acrop#ages&ills spores

7irect microscopy 4lu-li&e symptoms5 eryt#emanodosum5 well defined lungca%itation5 dissemination intoot#er organs5 %errucouspla?ues

Amp#otericin 1

1istoplasmacapsulatum

.istoplasmosis Leasts may produce proteinst#at in#ibit t#e acti%ity oflysosomal proteases>

Inflammatory response producescalcified fibrinous granulomas

wit# areas of caseous necrosis>

4ungistatic properties ofneutrop#ils andmacrop#ages>

lymp#ocytes are crucialin limiting t#e etent ofinfection>

$erology5 antigen testing ,neumonia5 disseminateddisease inimmunocompromised

persons5 ca%itary pulmonarylung disease5 calcified lymp#nodes5 mediastinal fibrosis5eryt#ema nodosum5eryt#ema multiforme5 andt#rombocytopenia

Itraconazole5 amp#ot#ericin

Candida albicans 9andidiasis • $urface molecules

t#at permit ad#erence of t#eorganism to ot#er

•

• Acid proteases and

p#osp#olipases t#at in%ol%e

• Intact

mucocutaneousbarriers

•

• ,#agocytic

cells

0et mount5 scrapings5smears5 endoscopy5urinalysis 'depending on t#emanifestation(

Chronic mucocutaneouscandidiasis: disfiguringlesions of t#e face5 scalp5#ands5 and nails> 9#ronicmucocutaneous candidiasisis occasionally associated

wit# oral t#rus# and %itiligo>

ucocutaneous: nystatin5clotrimazole5 ticonazole5fuconazole5 &etoconazole

$ystemic: amp#otericin 15oral flucytosine5 fluconazole5caspofungin


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penetration and damage of cellen%elopes

•

• Ability to con%ert to a

#yp#al form 'p#enotypicswitc#ing(

•

• ,olymorp#on

uclear leu&ocytes

•

• onocytic

cells

•

• 9omplement

•

• Immunoglob

ulins

•

• 9ell-

mediated

•

• ucocutane

ous protecti%ebacterial flora

amage% deficiency ofthe aforementionedincreases the li/elihoodand se,erity ofinfection.

$ropharyngeal candidiasis:$ore and painful mout#5burning mout# or tongue5dysp#agia5 t#ic&5 w#itis#patc#es on t#e oral mucosa5diffuse eryt#ema and w#itepatc#es t#at appear on t#e

surfaces of t#e buccalmucosa5 t#roat5 tongue5 andgums>

'sophageal candidiasis:7ysp#agia5 odynop#agia5retrosternal pain5 epigastricpain5 nausea and %omiting

Nonesophagealgastrointestinal candidiasis:epigastric pain5 nausea and%omiting5 abdominal pain5fe%er and c#ills5 abdominalmass 'in some cases(

+enitourinary tractcandidiasis

•

9ryptococcusneoformans

9ryptococcosis 9ryptococcal polysacc#aridecapsule #as antip#agocyticproperties and may beimmunosuppressi%e>

#e antip#agocytic properties oft#e capsule bloc& recognition of

t#e yeast by p#agocytes andin#ibit leu&ocyte migration intot#e area of fungal replication>

9ell-mediated immunity 7irect eamination5 culture5#istopat#ology5 serology

• 9oug# wit# t#e

production of scant mucoidsputum5 pleuritic c#estpain5 ow-grade fe%er5dyspnea5 weig#t loss5 andmalaise

eningitis andmeningoencep#alitis:

.eadac#e5 confusion5let#argy5 obtundation5 coma5normal or mildly ele%atedtemperature5 nausea and%omiting 'wit# increasedintracranial pressure(5 fe%erand stiff nec& 'wit# anaggressi%e inflammatoryresponse; less common(5

Amp#otericin 15fluorocytosine5 fluconazole


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blurred %ision5 p#otop#obia5and diplopia5 #earing defects5seizures5 ataia5 ap#asia5and c#oreoat#etoidmo%ements

Aspergillus sp. Aspergillosis acrop#ages and neutrop#ilsencompass5 engulf5 anderadicate t#e fungus>

oic metabolites t#atin#ibit macrop#age andneutrop#ilp#agocytosis>

7irect eamination5 culture5C8. mount 'dependin on t#emanifestation(

• Ranges from

#ypersensiti%ity reactionsto direct angioin%asion:

•

• Allergic

bronc#opulmonaryaspergillosis 'A1,A(

•

• 9#ronic

necrotizing Aspergillus pneumonia

• Aspergilloma

•

• In%asi%e

aspergillosis

$urgical remo%al

Amp#otericin 15 itraconazole

Rhizopus, Mucor,Cunninghamella,

Apophysomyces, Absidia, Saksenaeand Rhizomucor sp.’s

ucormycosis Neutrop#ils are t#e &ey #ostdefense against t#ese fungi>

7irect eamination5 culture R#inocerebralmucormycosis: 't#rombosis5necrosis5 in%asion of t#esinuses5eyes5 cranial bonesand brain5 1" and ner%edamage5 edema of t#e facial

area5 bloody nasal eudatesand orbital cellulitis(

#oracic mucormycosis:'in%asion of lung parenc#ymaand %asculature5 causingisc#emic necrosis and tissuedestruction(

$urgical debridement

Amp#otericin 1

seminar1 micro para review template

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