Microbiology

Eukaryotes & Prokaryotes

Nucleoid - DNA packaging structure of prokaryotes

Cell envelope more complex structure in prokaryotic cells than eukaryotes
Cell wall results in single inactivation (single hit) or death curve
Glycolcalyx polysaccharide slime layer; attachment of bacteria to human cells; biofilm
Endotoxin/Lipopolysaccharide main inducer of septic shock
Lipid A fever & hypotension
Exotoxins toxicity is due to its lipid component
Bacterial flagella non-antigenic in humans because it closely resemble human flagella in chemical composition
Plasmids extrachromosomal circular DNA that encode exotoxins & enzymes that accounts for
antibiotic resistance
20,000 to 30,000 characteristic molecular weight of prion protein

Bacterial Growth

Growth curve antimicrobials that attack single target of bacteria to cause death is reflected as this
Exponential growth phase transferred to another medium; ideal to transfer bacteria
30 to 37 0C optimum growth temperature for most organisms

Viral Growth

Capsid viral component most important to facilitate attachment & entry into host cells
Interferon acts like circulating phagocyte to digest viral particles
Cell multiplication in viruses exemplifies growth
Downey cells atypical epithelial cells infected by a virus
Virus causes disease by altering the growth properties of the cell
10-fold increased risk for a 2nd dengue infection

Immunology

Type I: Immediate hypersensitivity anaphylaxis, allergies, bronchial asthma (atopic forms)

Type II: Ab-mediated hypersensitivity AIHA, Goodpasture syndrome
Type III: Immune Complex Acute poststreptococcal glomerulonephritis; SLE, Serum sickness; Arthus reaction
Type IV: Cell-mediated Contact dermatitis, multiple sclerosis, type 1 diabetes, transplant rejection, TB
C3a & C5a complement system proteins stimulating mast cell to release histamine
B cells immunity factor lacking in patient w/ recurrent otitis media & bronchitis
Opsonizing kind of Ab that helps enhance phagocytosis by coating an Ag for better uptake by phagocyte
Anesthetic skin lesion (+) for lepromin skin test skin infiltrated w/ helper T cells
Delayed hypersensitivity lysis
Delayed hypersensitivity characterized by infiltrate composed of lymphocytes & macrophages
Toxin neutralization serologic test that could be used to dtetct Ab to tetanus toxin, to determine whether
px responds to vaccine

Basic Principles
 Application of occlusive dressing significantly modifies microbial flora
Diarrhea bacterial content of the bowel expected to diminish
Acne Propionibacterium
> 25 PMNs/lpf & < 10 squamous cells/lpf good sputum smear
Cord factor tihexa
Aflatoxin commonly contaminated food: peanuts
Washing might be expected to reduce skin flora by 90 % but normal return by 16 hours
Spirochetes considered prokaryotic cells because they contain both RNA & DNA in their nucleus
Normal bowel flora most common source of organisms that cause urinary tract infection
Air conditioning most common source of hospital acquired infections
Resistant organism inhibited but not killed by Penicillin

Culture Medium

Glucose, lactose, sucrose important component of Triple Sugar Iron Agar aside from ferrous sulfite

Characteristic Morphology & Growth

Obligate anaerobe large nodule on right jaw oozing a yellowish grainy material described as sulfur granules
Peptostreptococcus strictly aerobic & microaerophilic

Exceptions

All cells contain both DNA & RNA except viruses

Viruses are not part of the normal microbial flora
All bacteria have peptidoglycan layer except Mycoplasma

Staphylococcus aureus

Mannitol fermentation distinguishes S. aureus from other staphylococci

Coagulase production distinguishes staphylococcus aureus from other species
M protein not part of armony of S. aureus (coagulase, leukocidin, protein A)
Staphylococcus aureus causative agent among intravenous drug users diagnosed w/ endocarditis
Exotoxin responsible for Staphylococcal Saclded Skin Syndrome
Stapholococcus aureus can produce food poisoning that result from ingestion of enterotoxin
Transposon-mediated production of depsipeptide mechanism best explains resistance of S. aureus
to vancomycin
Transposons small pices of DNA that move freely between chromosomal DNA & plasmid DNA carrying genes
of resistance

Staphylococcus epidermidis

Staphylococcus epidermidis normal flora of the skin

Staphylococcus epidermidis considered a contaminant only & is not associated w/ clinically significant
infections

Streptococcus pyogenes

Diphosphopyridine nucleotidase factor responsibly for the ability of S. pyogenes to kill leukocytes
 Fibronectin lipotechoic ligand of S. pryogenes
Dicks test necessary for confirming the diagnosis of scarlet fever

Streptococcus pneumonia

Streptococcus pneumonia patient w/ pneumonia showed gram (+) cocci in pairs & alpha hemolysis on BAP

Streptococcus viridians

Streptococcus viridians predominant bacterial flora in mucosal membrane

Streptococcus viridians most abundant normal flora of the oral cavity
Streptococcus viridians causes only partial hemolysis; alpha-hemolytic

Streptococcus mutans

Streptococcus mutans responsible for the development of dental caries

Corynebacterium dipththeria

Restricted blood flow to affected area responsible for cgaracteristic appearance of gray-white membrane
over the tonsils of Corynebacterium diphtheria infected patient

Mycobacterium tuberculosis

Psychrophilic not a characteristic of Mycobacterium tuberculosis (acid-fast, bacilli, shape, obligate aerobe)
Hematuria usual manifestation of tuberculosis of the kidney

Neisseria

Opacity associated proteins adherent factors of N. gonorrheae enhancing invasion of host target cells
Gonococcus non-motile, oxidase positive, gram (-) coccus, usually in pairs, facultative anaerobe, focus is the
urethralepithelium in male
Latent syphilis absence of clinical lesions, negative darkfield examination, normal CSF, (+) treponemal
serologic test

Nocardia

Nocardia asteroids stains pink at the end of modified acid fast staining method

Clostridia

Tetanus caused by a spore forming bacterial species

Tetanus toxin a neurotoxin acting at the level of synapses in the CNS
Lecithinase virulence factor of C. perfringens responsible for production & tissue spread of gas gangrene
Clostridium botulinum exotoxin inhibits acetylcholine release at neural junction
Erythromycin best drug of choice in management of Diphtheria
Phages assist in gene transfer of Diphtheria toxin to succeeding generations of Diphtheriae
Pseudomembranous colitis toxin-mediated disease caused by Clostridium difficile

Bacillus

Bacillus anthracis has an anti-phagocytic capsule made uniquely of poly-D-glutamic acid

Escherichia coli

Escherichia coli facultative anaerobe

O, H, K 3 antigens of E. coli used to identify the organism in epidemiological investigation
Sulfisoxazole most suitable for UTI for the 1 st time w/ urine culture growth of Escherichia coli

Salmonella

Salmonella differs from Shigella in motility

Rose spots seen in typhoid fever

Shigella

Shigella dysenteriae does not produce an enterotoxin impairing absorption of Na & Cl in the large intestine
Shigella dysenteriae yellowish-green, mucoid & blood-streaked stool, numerous pus cells & 15-20 RBC/hpf

Vibrio

Vibrio cholera non-0139 curved, gram (-) rods, transmitted by fecal contamination of water & food, human is
the usual carrier & watery diarrhea in large volume is the clinical picture of this incurable strain
Acidic pH of stomach most effective in preventing Vibrio cholerae from establishing infection
Cholera toxins yields increased levels of intracellular cAMP

Helicobacter pylori

Helicobacter pylori does not present w/ recurrent non-bloody diarrhea

Haemophilus

Haemophilus aegyptius not known to cause sexually transmitted infection

Haemophilus influenzae pink short rods w/ capsule
Chancroid painful genital ulcer, palpable superficial inguinal lymphadenopathy, fluctuant & tender,
no vesicles, endourethral smear: cocci in clusters w/ scanty gram (-) rods; negative VDRL & RPR
Haemophilus ducreyi etiologic agent of chancroid

Bacteroides

Bacteroides fragilis accidental spillage of colonic contents into peritoneal cavity during surgery causing
abscess formation
Bacteroides species most frequent isolates in anaerobic infections

Bordetella

Chocolate agar with X & V factors not a culture medium for B. pertussis

Chlamydia

Very thick capsule surrounding the cell makes Chlamydia difficult to visualize after G/S

Treponema
 Gumma seen during tertiary stage of syphilis
Penicillin drug of choice for sexually transmitted syphilis
Most accurate of Treponema pallidum despite of therapeutic use of penicillin for many years, no
penicillin-resitant strains of Treponema pallidum have been isolated

Leptospirae

Meningitis least likely seen in Leptospirosis

Mosquito least likely involved in the transmission of Leptospirosis
Lumen of nephritic tubules nesting site for leptospirae in natural host

Pseudomonas aeruginosa

Pseudomonas aeruginosa wounds smell like rotting fruit & oozing greenish-yellow pus; gram (-), non-lactose
Fermenting bacilli grown on McConkey Agar.

Yersinia

Bubonic plague caused by Yersinia pestis

Gardnerella

Gardnerella vaginalis many epithelial cells w/ numerous adhering bacteria (clue cells)
Blood agar culture medium for pneumococcal organism causing lobar pneumonia

Drug Interaction & Treatment

Ethylene oxide chemical agents most suitable for sterilization of heat-sensitive surgical instruments
such as those used by ophthalmologists
Quinolones inhibit bacterial DNA synthesis by blocking DNA gyrase
Clindamycin induces pseudomembranous enterocolitis if taken chronically
Tetracycline drug of choice in a px who developed bloody diarrhea, presence of Clostridium difficile toxin
was detected, after 10-day course of Clindamycin & Gentamicin following repair of perforated
colon secondary to diverticulitis
Cephalosporin resembles Nalidixic acid inhibiting both gram negative & gram positive organism by binding
to DNA gyrase thereby inhibiting DNA replication
Chloramphenicol aplastic anemia (idiosyncratic effect); gray-baby syndrome
Cotrimoxazole Steven-Johnsons Syndrome
Rifampicin hepatotoxicity
Penicillin In px w/ UTI, resistance to cephalosporins, least rational antibiotic to cause antibiotic resistance
Metronidazole antiprotozoal & active against most anaerobes
INH & Ampicillin + Gentamicin household prophylactic treatment most appropriate to prevent spread of
meningococcemia

Preventive Measures

Prevention against Listeriosis eat only pasteurized dairy products

Viral
 Rubella vertically transmited congenital infection most preventable by vaccination of the mother
Rubella caused by Togavirus
Molluscum contagiosum diagnosis can be made clinically
Killed (inactivated) virus vaccines stimulate secretory AB at portals of entry most important concept of viral
vaccine preparation
Amantadine most useful for preventing Influenza A infection
Cytomegalic inclusion disease caused by Human Herpesvirus
Poliomyelitis affects only humans, not animals
Aedes mosquito vector for virus causing dengue fever
Respiratory Syncytial Virus : croup not correct ( EBV IM, Coxsackie pleurodynia, Paramyxovirus Mumps)
Subacute sclerosing panencephalitis fatal sequel of measles causing CNS symptoms
Rotavirus less likely to cause pneumonia, px developing persistent cough & fever

Epstein Barr Virus

Epstein Barr Virus associated w/ thymic carcinoma, B-cell lymphoma, Human Herpesvirus 4
Epstein barr - would not provide lifelong immunity

Herpes Zoster

Herpes zoster - dorsal root ganglion

Herpes zoster has high recurrence rate, typically begins as fe erythematous papules & macules, incubation
period of 12 days

Paramyxovirus

Paramyxoviridae measles & mumps

Paramyxovirus 3 day hx of fever, conjunctivitis, cough, runny nose & diffuse erythematous macular rash
over face, neck & back, rash apper confluent, tiny gray-white areas on bright red base of mouth

HIV/AIDS

HIV/AIDS CD4 cells <200 (normally >1000)

HIV virus icosahedral, formed by 2 major enveloped proteins: gp120 (external) & gp41 (transmembrane)

Rabies Infection

Rabies bullet-shaped
Incubation period shorter in adults than in children not an accurate statement regarding rabies
Neuraminidase - In H5N1, N stands for
CCR5 - predominant co-receptor for macrophage-tropic strains of HIV-1
SARS coronaviridae

Hepatitis Infection

Hepatitis B has double stranded DNA nucleic acid core

Hepatitis E causes fulminant hepatitis w/ high mortality rate in pregnant women
HBV DNA serologic marker that most likely indicate level of infectivity

Fungal
 Pneumocystis jirovecii - fungi
Dextrose sugar incorporated in Sabourauds agar for growth of fungi
Amphotericin IV drug of choice for systemic fungal infections
Amphotericin B disrupts cell membrane by binding at the site of ergosterol in the membrane
Azoles inhibit ergosterol synthesis
Capsulated blastospheres Crptococcal subacute meningitis
Candida albicans an opportunistic fungus
Aspergillosis cavitary tuberculosis w/ chest x-ray showing cottony infiltrates in the area of cavity (fungus ball)
Malassezia furfur - most common cause of mild chronic superficial skin mycoses
Cryptococcus fungal species with wide CHO capsule
SDA for primary isolation & replication of fungi
Candidiasis erythematous vesioco-pustules w/ some area of maceration involving genito-crural areas, satellite
lesions