2nd SHIFTING SUMMARY.

INTRODUCTION TO ANAEROBIC BACTERIA o Gram(-) rods  Metronidazole – penetrates BBB

 Normal indigenous flora on SKIN and MEMBRANE surfaces o Gram(+) cocci  Imipenem – stable in presence of B-lactamase
 Opportunistic pathogens  URTI (e.g., periodontal dse)  AMP + Sulbactam & Ticarcillin + CA – broad-spectrum
 Oxygen intolerance due to: o Porphyromonas  Clindamycin – does not penetrate BBB; with resistance
o Lack of catalase o Prevotella  Chloramphenicol – for brain absecesses, and severe
o Lack of superoxide dismutase  Oropharyngeal infections infections
 Variable Oxygen intolerance (may require ≥5% CO2): o Actinomyces
o Strict anaerobes: PO2 ≥ 0.5% (rare infections) o Prevotella NON-SPORE FORMERS
o Moderate anaerobes: PO2 ≥ 3.0% (most infections) o Fusobacterium
 Bacteroides fragilis
 Pleuopulmonary infections
o Gram(-) rods
LABORATORY CULTURE AND IDENTIFICATION o Peptrostreptococci
o Bile-resistant
o Fusobacterium
 Very fastidious growth o Colonies: low convex, white to gray, semi-opaque,
o Prevotella
 Slow growth d/t lower energy yields from fermentative glistening, hemolytic
o B. fragilis
metabolism o Survives prolonged O2 exposure in presence of blood
 Soft tissue infections (gangrene, ulcer, necrotizing cellulitis
o 18-24 hours: C. perfringens o In presence of hemin: (+) superoxide dismutase and
and fasciitis)
o 5-7 days: Actinomyces, Eubacterium, Propionibacterium catalase
o S. pyogenes
 Mixture of gases in culture systems o Pathogenic factors: LPS, polysaccharide capsule,
o Propionibacterium acnes
o 10% H2 enterotoxin
o Gram(+) cocci
o 5-10% CO2 o Disease: pelvic inflammatory dse, ovarian abscesses
 Septicemia
o N2  Pigmenting gram(-) bacilli: Prevotella and Porphyromonas
o Gram(+) cocci
 To achieve anaerobic systems: o Colonies of BAP: convex, smooth, circular, B-hemolytic,
o Prevotella
o Anaerobic jar (Brewer’s gas Pak, no O2) – for obligate (C. tan to black in 2-21 days
o B. fragilis
sporogenes) and facultative anaerobes (E. coli) o Stimulated by Vit. K and hemin
o Peptrostreptococci
o Candle jar (6-7% oxygen) – not for obligate anaerobes o Pathogenic factors: polysaccharide capsule, collagenase,
o Propionibacterium
o Anaerobic glove chamber B-lactamase, LPS
o Fusobacterium
 Genus identification can be done by Gas-Liquid o Infections: upper respiratory tract, female genital tract
o Clostridium
Chromatography by selective binding to short-chained fatty  Fusobacterium nucleatum
 Brain abscesses
acids o Scattered wheat straw (thin, pointed ends, very long)
o Peptrostreptococci
o Colonies: a-hemolytic, convex, translucent, flecking or
o Fusobacterium
DETERMINANTS OF PATHOGENICITY mottling, or more umbonate, heaped, dull and opaque
 Endocarditis o Infections: oral, lung abscess and other pleuropulmonary,
 Polysaccharide capsule (since they have capsule, expect o B. fragilis amniotic fluid, obstetric, periodontal, brain abscess
these organisms in organs exposed to oxygen) o Actinomyces  Fusobacterium necrophorum
o B. fragilis
o Broad, round ends, filamentous, bulbous swelling, round
o Prevotella DIAGNOSIS bodies
o Porphyromonas
 Signs of infection: o Colonies: a or B-hemolytic
o Foul-smelling discharge o Lipase and leukocidal toxins
INFECTIONS o In proximity to mucosal surface o Infections: abdominal, liver abscess, Lemierre’s disease
 Intraabdominal infections (e.g., liver abscess) o Gas in tissues o Tx: Pen G, cephalosporins
o B. fragilis  Specimens from site of infection  Gram (+) bacilli
o Clostridium  For complicated cases: CSF and urine o Eubacterium
o Fusobacterium  Growth on complex media, incubated at 35-37OC  Periodontitis
o Anaerobic gram(+) cocci  Most common isolate from non-oral clinical
 Ob/Gyn infections (e.g., tubo-ovarian, pelvic abscesses) specimens
o Prevotella TREATMENT o Actinomyces
o Peptostreptococcus (vulvar, pelvic abscess)
  Slow-growing o K – capsular; heat labile, agglutination by O antisera,  Hard to differentiate non-LF from each other
 Actinomycosis: chronic suppurative and virulence factor  Triple Sugar Iron (TSI) agar
granulomatous infection  pyogenic lesions with o H – flagellar; denatured by hear of alcohol, agglutinate with o Test for carbohydrate fermentation
sinus tracts anti-H IgG o Incubation at 35OC, 18-24 hours
 Cervicofacial (lumpy jaw)  Toxins: o Components: lactose, sucrose, glucose, ferrous sulfate,
 Thoracic (subacute pulmonary infection) Exotoxin Endotoxin Na thiosulfate, phenol red, amines and peptides
 Abdominal (follows a ruptured appendix or ulcer) Released from cell Integral part of cell wall o Results and interpretation
o Propionibacterium Protein LPS (lipid A = toxic component)  Slant color/Butt color +
Heat labile Heat stable  R/Y+ = red slant and yellow butt, with gas formation
 Normal flora of GIT and skin
Antigenic and immunogenic Antigenic
 Closely resemble Actinomyces  Red = alkaline (no fermentation); yellow = acid
Toxoids produced No toxoids produced
 Acne vulgaris, postsurgical wound infections Specific effects on host Many effects on host  Slant contains glucose, butt contains
o Lactobacillus Produced by G(+) and G(-) Produced by G(-) sucrose/lactose
 Normal flora of mouth, GIT, vagina  Fermentation  acid production w/ or w/o gas
o Mobiluncus INFECTIONS formation
 Gram-variable  GI – Yersinia, Escherichia, Salmonella, Shigella (YESS)  Glucose fermentation  yellow butt
 Bacterial vaginosis  Lactose/sucrose fermentation  yellow slant and
 Blood and lower RT – Escherichia, Enterobacter, Klebsiella
o Bifidobacterium (EEK)
butt
 Peptostreptococcus and Streptococcus  Non-fermenter  R/R (P. aeruginosa)
 CNS – E. coli
o Gram (+) cocci  Non-LF but glucose fermenter  R/Y (Shigella);
 UTI – Proteus, Escherichia, Providencia, Klebsiella (PEPK)
o Pleuropulmonary disease, brain abscesses, OB-Gyn R/Y+ (Salmonella, Citrobacter, Proteus)
infections, necrotizing fasciitis  LF  Y/Y (EEK)
IDENTIFICATION  Urease test
o Tx: B-lactams
 Veillonella  Lactose fermentation o Urease hydrolyze urea  ammonia
o Gram (-) cocci o Rapid LF – Escherichia, Enterobacter, Klebsiella (EEK) o Ammonia + carbonate  alkaline pH  pink-red color!
o Normal flora of mouth, nasopharynx, intestine o Slow LF – Citrobacter, Hafnia, Arizonae, Serratia, o (+): Proteus, Klebsiella
Edwardsiella (CHASE)  Sulfur indole motilitly (SIM) medium
o Non-LF – Proteus, Salmonella, Shigella (PSS) o Test for sulfur production, indole production, motility
INTRODUCTION TO ENTEROBACTERIACEAE
 Culture media o Sulfur (+)  black precipitate
 GIT infections: bacillary dysentery, typhoid, food poisoning
o MacConkey agar o Indole (+)  red color (ring) upon addition of Ehrlich’s or
 Small, gram (-) rods
 Differential for enterobacteriaceae Kovac’s reagent (p-dimethylaminobenzaldehyde)
 Most motile with peritrichous flagella except Shigella and  Bile salts and crystal violet (-) growth of G(+)  Tryptophanase + tryptophan pyruvate, ammonia,
Klebsiella  Lactose as sole sugar source and indole
 Opportunistic pathogens: E. coli  LF  red colonies  (+): E. coli, Proteus
 True pathogens:  Non-LF  colorless colonies o Motility (+)  diffuse zone of growth flaring out from line of
o Yersinia o EMB agar inoculation
o E. coli  Differential  Pseudomonas – spreading film on surface
o Salmonella  Aniline dyes inhibit G(-) and indicate acid production  Proteus – swarming
o Shigella  LF  green-black colonies with metallic sheen  E. coli, Salmonella, Enterobacter, Morganella,
 Distinguishing characteristics:  Non-LF  transparent colorless colonies Edwardsiella
o Grow on peptone w/o NaCl  Can distinguish Salmonella and Shigella from  Citrate Utilization test (Simmon’s Citrate)
o Grow on MacConkey agar others o Test for citrate utilization (citrate permease +)
o Ferment glucose with gas production o Hektoen agar o Citrate  pyruvate + CO2 (+ Na + H2O)  Na2CO3 which
o Catalase (+)  Bile salts and acid indicators (bromthymol blue & is alkaline
o Oxidase (-) acid fuchsin) o Alkaline  bromthymol blue turns blue
o Reduce nitrate to nitrite  (-) Gram(+) o (+): Citrobacter, Salmonella, Klebsiella
 Antigens:  LF  orange colonies
o O – somatic; heat stable, detected by agglutination,  Non-LF  green to blue-green
neutralized by IgM
Organism Biology Colony morphology Tests Disease Virulence and antigenic factors Meds
Streptococcus Gram(+), cocci in Selective agar: Catalase(-), group A Pyogenic diseases:  M protein (antiphagocytic, Penicillin G
pyogenes (A) chains, capsulated sulfamethoxazole and antigen, B-hemolytic,  Pharyngitis (5-15 y.o., beefy anticomplementary) Erythromycin or
(hyaluronic acid) trimethoprim PYR(+) (red), bacitracin red tonsils, palata petechiae,  T protein (trypsin resistant) azithromycin
BAP: small colonies with B- susceptibility(+) (zone of posterior pharynx  F protein (fibronectin binding:
hemolysis inhibition) erythematous with exudates) attachment to epithelium)
 Cellulitis (pink/red erythema,  Lipoteichoic acid (adherence)
Dick test (erythema) and swelling, heat, pain; may lead  Hyaluronidase (spreading, antigenic)
Shultz Charlton reaction to septicemia)  Streptokinase (fibrinolysin, debridement)
(localized blanching) for  Erysipelas (salmon red  Streptodornase (DNase, debridement)
exotoxin C erythema in butterfly  Pyogenic toxins
distribution) o Exotoxin A (TSS)
 Impetigo/Pyoderma (vesicles o Exotoxin B (cystein protease:
to weeping lesions with amber necrotizing fasciitis)
crust and purulent exudates) o Exotoxin C (rash in scarlet fever)
 Hemolysins
Toxigenic diseases: o Streptolysin S (O stable)
 Scarlet fever (diffuse o Streptolysin O (antigenic)
erythema, circumoral pallor)
 TSS (desquamation of skin,
hypotension, erythoderma)

Immunologic diseases:
 Rheumatic fever (complication
of pharyngitis; damage to
heart muscles and valves)
 Acute glomerulonephritis
(complication of impetigo;
edema of face and ankles,
smoky urine)
Streptococcus Gram(+), cocci in 5% sheep blood agar: large Catalase(-), group B In utero or at delivery:  DNase Penicillin G
agalactiae (B) pairs of short colonies, B-hemolytic zones antigen, B-hemolytic,  Bacteremia  Hyaluronidase (spreading) Ampicillin +
chains, capsulated CAMP(+) (arrowhead  Fulminant sepsis  Neuraminidase Aminoglycoside
shaped B-hemolysis), Na  Pneumonia  Protease
hippurate (+)(purple)  Respiratory distress  Hippurase
syndrome  Hemolysin
 Meningitis  Capsule (antiphagocytic, antigenic)

Postpartum:
 Bacteremia
 Meningitis
 Osteomyelitis
Enterococcus / Gram(+), cocci in 5% Sheep BAP: raised, Bile esculin(+) (black Hospital-acquired UTI and Penicillin or
Streptococcus pairs or short white to gray, non-hemolytic slant), 6.5% NaCl(+) (turbid endocarditis Vancomycin
faecalis (D) chains yellow broth), PYR(+) (red)
Viridans Gram(+), cocci in Optochin susceptibility(-) Bacterial endocarditis Penicillin
Streptococci long chains (no zone of inhibition)
S. pneumoniae, Gram(+), lancet 5% Sheep blood agar: Optochin susceptible (clear Pneumonia  Capsule (antiphagocytic, antigenic) Penicillin
Diplococcus cocci in pairs or young colonies round, zone >14 mm diameter), Otitis media  Pneumolysin Erythromycin
pneumoniae, short chains, complete edges, mucoid, bile solubility(+), Quellung Bacteremia/sepsis  Purpura-producing principle (dermal
Pneumococcus capsulated alpha-hemolytic; older reaction (capsule swelling) Meningitis hemorrhage)
colonies with central  Neuraminidase (spreading)
indentation  flattened  Amidase (autolysin for cell division)
Chocolate agar: quite flat,  IgA protease
alpha-hemolysis  C-substance (reacts with CRP)
Staphylococcus Gram(+), cocci in Facultative anaerobe Catalase(+) (bubble Localized skin infections  Capsule (antiphagocytic, anti Localized
aureaus grape-like clusters, Smooth, opaque, round, formation), coagulase(+)  Folliculitis (domed pustules
nonmotile, low, convex, yellow golden Mannitol fermenter (red around hair follicles)
capsulated (carotenoids) to yellow discoloration),  Furuncles or boils
Penicillin resistant (subcutaneous tissues focal
BAP: cream/buff colored Growth in 7.5% NaCl suppurative or abscess
with B-hemolytic zone Serologic: antibodies lesion)
against teichoic acid  Carbuncles (coalescence of
furuncles)
 Impetigo (macule  pus filled
vesicle  crust)
Deep and localized infections:
 Osteomyelitis
 Pyoarthrosis
 Bacteremia
 Endocarditis
 Pneumonia (necrosis +
multiple abscesses)
 Metastatic infection
Diseased caused by Exotoxin:
 TSS (via tampons;
scarlatiniform rash 
desquamation)
 Food poisoning
(gastroenteritis w/o fever;
vomit before diarrhea)
 Scalded skin syndrome
o Ritters dse / toxic
epidermal necrolysis /
generalized exfoliative
dermatitis (painful
erythema, bullous
desquamation, (+)
Nikolsky sign)
o Bullous impetigo (-)
Nikolsky, in the face)
o Scarlet fever (generalized)
Staphylococcus Gram(+), cocci in White, nonhemolytic Catalase(+), coagulase(-), Infections associated with
epidermidis grape-like clusters, Mannitol non-fermenter implanted devices e.g., cardiac
with slime layer Novobiocin susceptible valve, hip replacement
Peritonitis
Bacteremia
UTI (elderly male)
Staphylococcus Gram(+), cocci in Nonhemolytic Catalase(+), coagulase(-) UTI in sexually active young
saprophyticus grape-like clusters Novobiocin resistant, women
agglutinate sheep blood
Corynebacterium Gram(+), bacilli, Facultative anaerobe Schick test (distinguish Diphtheria
diphtheria slender, straight or BAP: small, granular, gray, susceptible from resistant) 1. Local infection
chemotaxis, adherence to synthetic infection:
materials) B-lactamase if
 Peptidoglycan layer (chemoattractant, resistant to
endotoxin-like activity, localized Penicillin
Schwartzman phenomenon:
thrombosis, (+) complement, (+) Cutaneous
humoral and cellular immune response infection:
 Protein A (chemotaxis, anticomplement, Cloxacillin,
antiphagocytic, hypersensitivity, platelet dicloxacillin
injury) Erythromycin
 Teichoic acids (A: ribitol; attachment to Methycillin
mucosa, antigenic)
 Clumping factor (fibrinogen binding
 Cytoplasmic membrane (osmotic
barrier)
 Surface receptors
o Polysaccharides (antiphagocyte)
o Protein receptors (surface binding:
fibronectin (adherence of vital cells),
laminin (metastasis-like potential),
collagen)
 Extracellular enzymes
o Coagulase (binds and (+)
prothrombin  clots plasma)
o Hyaluronidase (spreading)
o Staphylokinase (fibrinolytic)
o Nuclease (phosphodiesterase)
 Toxins
o Cytolytic toxins (α, β, γ, δ)
 α (hemolytic, lethal,
dermonecrotic)
 β (sphingomyelinase C; abscess
formation)
 γ (hemolytic, interact with
leukocidin)
 δ (nonionic detergents: disrupts
biologic membranes; (-) ileum
water absorption)
o Leukocidin / Panton-Valentine
o Pyrogenic protein toxins
(superantigens)
 Enterotoxin (vomiting, diarrhea)
 TSST
 Exfoliatin (staphylococcal
scalded skin syndrome)
 Teichoic acids (B: glycerol; attachment Aminoglycoside
to mucosa, antigenic) Vancomycin
 Glycocalyx (adhesion to prosthetics) Or both
 Oligosaccharide receptor (adherence) Penicillin
 Extracellular enzyme complex (suppress Cloxacillin, then
growth of other bacteria, e.g., N. vancomycin if
gonorrheae, S. aureus) not responding
 Toxin (TOX gene regulated by Diphtheria
Corynebacterial iron-binding depressor) antitoxin
 curved, irregular irregular edges, zones of ELEK test (+) – fine 2. Toxin production (gene o Domain A (active, heat labile;
swelling at one end hemolysis precipitin lines at 45O carried by phage) inhibits polypeptide chain elongation Penicillin or
(club-shaped),  Cutaneous diphtheria: by EF-2 inactivation in host cell  Erythromycin
metachromatic K tellurite agar: brown to epithelial destruction (-) protein synthesis)
granules within black with brown-black halo  Graying o Domain B (binding to host cell CD9
cytoplasm (Babes- Loeffler’s serum: growth pseudomembrane
Ernst bodies) and HB-EGF  toxin entry via
production that may
(beaded Morphologies: endocytosis)
extend from oropharynx to
 Gravis – large, irregular, o Domain T (hydrophobic; release A
appearance) larynx to trachea (don’t
gray into cytoplasm)
remove!) + bullneck
 Intermedius – small, flat, appearance
gray 3. Complications:
 Mitis – small, round,  Myocarditis
convex, black  Neuritis
 Toxemia
Bacillus subtilis Gram(+), bacilli, Aerobic Catalase(+) Not a human pathogen
square ends, BAP: flat, dull, ground- Rarely cause food poisoning
central spore glass appearance
Bacillus cereus Gram(+), bacilli, Aerobic Non-fastidious Food-borne illness with 2 Enterotoxin Vancomycin
square ends, Horse BAP: cream to white, BAP hemolysis(+) syndromes:  Heat-stable (vomiting) Clindamycin
central spore, filamentous Lecithinase(+)  Emetic (0.5-6 hrs incubation,  Heat-labile (diarrhea) Carbapenems
motile, PEMBA: crenated, turquoise Mannitol(-) from preformed heat-stable Ciprofloxacin
nonencapsulated to peacock blue, zone of toxin in fried or recooked rice,
egg yolk ppt Dx: lasts 8-10 hrs)
≥ 105 CFU/g food  Diarrheal (6-24 hrs
Toxin testing incubation, from heat-labile
enterotoxin producing spores
in meat or veggies, lasts 20-
36 hrs)
Endophthalmitis, keratitis,
panophthalmitis
Bacteremia
Bacillus Gram(+), bacilli, Aerobic, nonhemolytic Anthrax Capsule (D-glu polypeptide; pX02 Penicillin G
anthracis square ends, Horse BAP: gray-white, flat,  Cutaneous (vesicular papule, plasmid-coded – antiphagocytic) (endemic
central spore, form slightly convex, irregular, blue black edema  black Exotoxins (pX01 plasmid-coded) anthrax)
long chains gound-glass appearance, eschar)  Edema factor (EF; acts as adenylate Ciprofloxacin
(Bamboo cane- undulated outgrowths of  Inhalational anthrax cyclase) Doxycycline
like), nonmotile, filamentous chains (transmission via highly stable  Lethal factor (LF; (+) macrophages and
encapsulated in 5% (Medusa-head) spores) cytokines)
CO2 (D-glutamate  GI (with hemorrhagic brain  Protective antigen (PA; binds to surface
capsule) Round, cut-glass infiltration) receptors on host)
appearance Woolsorter’s disease
(inhalation of infected dust)
Clostridium Gram(+), bacilli, Large, raised, double zone Nagler reaction (lollipop Wound infections (foul- Toxins Gas gangrene:
perfringens box car-shaped of hemolysis shape: phospholipase (+)) smelling discharge w/o PMNs)  α (lecithinase) Penicillin,
rectangular spore,  Myonecrosis  θ (hemolytic, necrotizing) metronidazole
nonmotile, Food poisoning: spore  Gas gangrene (d/t release of  DNase +
capsulated 106/g feces within 48 hrs exotoxins and toxins)  Hyaluronidase (collagenase) aminoglycoside
OR 105/g in food implicated Food poisoning (d/t spore Enterotoxin (A protein; marked jejunal or clindamycin
ingestion; crampy, midepigastric and ileal hypersecretion)
pain)
Clostridium tetani Gram(+), bacilli, Small Tetanus Exotoxin (antigenic) Penicillin or
squash racket Thin film on BAP  Risus sarcodicus  Tetanospasmin ((-) inhibitory Gly and Metronidazole
terminal spores,  Trusmus (lockjaw) GABA; hyperreflexia, spasms)
peritrichous flagella  Opisthotonus  Tetanolysin (hemolysin)
Clostridium Gram(+), bacilli, Botulism (afebrile, symmetric Exotoxins A-G ((-) release of excitatory Antitoxin
botulinum peritrichous flaccid paralysis) ACh at neural synapses  flaccid (trivalent toxins
 flagella, oval  Food-borne (preformed toxin) paralysis + respiratory failure) A, B, E) IV
subterminal spores  Infant (source: honey; floppy
baby syndrome)
 Wound (traumatized tissues)
 Human (severe, fatal; from
preserved food)
Clostridium Gram(+), bacilli, Pseudomembranous colitis Toxin A (enterotoxin; mucosal damage  Vancomycin or
difficile slender, (gray, white or yellow patches fluid leakage, then accumulation) Metronidazole
peritrichous on necrotic mucosa; d/t removal Toxin B (cytotoxin; depolymerize actin)
flagella, large oval of normal intestinal flora by Adhesion factor
subterminal spores antibiotics)
Mycobacterium Waxy cell wall of Obligate aerobes Ziehl-Neelsen stain: red Tuberculosis Serpentine cords (bacilli in parallel) Isoniazid
tuberculosis mycolic acid, Slow-growing, small, dry, rods in blue background  Primary complex (usu. involve  Trehalose dimycolate Rifampin
slender, straight or scaly, with uncorrugated the base of lung)  Catalase Pyrazinamide
curved, nonmotile, surfaces Tuberculin skin test  Reactivation TB (begins at  Tuberculoproteins Ethambutol
non-sporogenous, (Mantoux): evokes a DTH apex of lung)
non-encapsulated, response, (+) for  Relapse (d/t treatment failure)
acid-fast individuals with active TB
Mycobacterium Waxy cell wall of Obligate intracellular: Lepromatous: (-) lepromin Leprosy (macules, papules, O-diphenoloxidase Multibacillary:
leprae mycolic acid, acid requires armadillo tissue for skin test nodules, painless ulcers, rings Dapsone,
fast, pleomorphic culture without feeling inside rifampin,
Tuberculoid: (+) lepromin (peripheral neuritis) clofazimin
skin test  Tuberculoid
o Non-progressing Paucibacillary:
o Macules with few bacilli Rifampicin,
o CD4+ helper T-cells dapsone
o IL2, IFNγ, IL12 (+) healing
o Sudden onset Prophylaxis:
o Severe asymmetric nerve Dapsone
involvement
o Intact CMI
 Lepromatous
o Progressive
o Nodules with abundant
bacilli
o CD8+ suppressor T-cells
o IL4, IL10 (-) healing
o Slow onset
o Symmetric nerve involved
o Deficient CMI
Neisseria Gram(-), diplococci, Enriched media (MH, TM): Aerobic>anaerobic, Ocular infections:  Pili (binding to epithelial cell); *Crede’s
gonorrhoeae non-motile, small, convex, glistening, ferment glucose, (+)acid,  Ophthalmia  Opa or Protein II (invasion) prophylaxis
plasmid(+), found elevated, mucoid, opaque gas(-), (+)oxidase test neonotarium*  Por or Protein I (prevent phagolysosome
inside PMNs, (Opa+), nonpigmented, (purple/black), media with  Keratoconjunctivitis formation) 3rd gen
fimbriae/pili, highly nonhemolytic; piliated on heated blood, hemin and Genital infections  LOS (inflammation) cephalasporins:
branched selective subculture animal protein, 5% CO2  Gonorrhea (scanty, clear  Rmp or Protein III (block bactericidal  Ceftriaxone
lipooligosaccharide or cloudy to copious and antibodies against P.I and LOS)  Cefixime
(no O antigen) purulent discharge;  Tbp1&2 (iron acquisition) Fluoroquinolone
dysuria; 1-10 d incubation)  Lbp (iron acquisition) :
Disseminated infection  IgA1 proteases  Doxycycline
 Dermatitis-arthritis  Erythromycin
 Fitz-Hugh-Curtis  Ciprofloxacin
 Endocarditis  Ofloxacin

Neisseria Gram(-), diplococci, Enriched media (MH, TM): Aerobic>anaerobic, Meningitis, meningococcal  Capsule (anti-phagocytic, antigenic) Penicillin
meningitides non-motile, convex, glistening, elevated, ferment glucose and pneumonia (URT),  LOS (endotoxin, suppress leu B4) Chloram-
capsulated, found mucoid, 1-5um, transparent maltose, (+)acid, gas(-), meningococcemia (skin rash, phenicol or 3rd
 inside PMNs or opaque, nonpigmented, (+)oxidase test petechiae) gen.
nonhemolytic (purple/black), media with cephalasporins:
5% SBA: round, smooth, heated blood, hemin and  Cefotaxime
opaque, glistening, animal protein, 5% CO2  Ceftriaxone
grayish/pink Rifampin
Chocolate agar:
gray>yellow, nonhemolytic,
greenish cast in older
colonies

Bordetella Gram(-), Strict aerobe, forms acid, Oxidase(+), urease(-) Whooping cough:  Pertussis toxin (cough) Erythromycin
pertussis coccobacillus, hemolytic (virulent)  Incubation (7-10d)  Adenylate cyclase (exotoxin, hemolysin,
bipolar  Catarrhal (1-2w) impairs phagocytes)
metachromatic Culture in Bordet-Gengou  Paroxysmal (2-4w)  Tracheal toxin (inhibits ciliary
granules upon medium (potato-glycerol-  Convalescence (>3w) movement, kills epithelial cells; cough)
toluidine blue stain, blood agar medium)  Dermonecrotic toxin (vasoconstrictor)
capsulated,  Filamentous hemagglutinin (binding to
nonmotile epith cell)
 LPS (endotoxin, +cytokines &
complement)
Treponema Gram(-), spiral Pathogenic strain cannot be Dx: Antigen test Syphilis (disease of blood and  Endoflagella Penicillin
pallidum rods, motile, central cultured. (Cardiolipins), antibody test perivascular areas):  Hyaluronidase (invasion)
proplasmic Microaerophilic (1-4% O2) 1. Hard chancre (painless
cylinder, Viable in blood at least 24 area of ulceration w/ hard
peptidoglycan, axial hrs at 4C base)
fibrils, endoflagella Motile for 3-6d at 25C 2. Condyloma lata (moist
pale papules with red
maculopapular rash)
3. Gummas (granulomatous
lesions in skin, bones, liver)
Congenital syphilis
 Saddle nose, Hutchinson’s
teeth,CNS anomalies
Early Congenital
 Hydrops fetalis, Pemphigus
symphiliticus (vesicular
eruptions of palms and soles)
Late Congenital
 Hutchinson’s triad:
Hutchinson’s teeth, interstitial
keratitis, 8th nerve deafness
Leptospira Gram(-), tightly Aerobic, 28-30C Dx: (+) in blood, CSF, Leptospirosis Penicillin
interrogans and coiled, thin, flexible, urine; (+) microscopic  Mild: mud/swamp/sugar Doxycycline
L. biflexa fine spirals, motile, Fletcher’s medium: agglutination test; PCR cane/bragg fever (anicteric Tetracycline
(saprophytic) central proplasmic septicemic stage in Others: Lepto dipstick, syndrome) Mild: Ampicillin
cylinder, blood/CSF, immune stage in ELISA, microcapsule  Severe: Weil’s disease Amoxicilline
peptidoglycan, axial urine agglutination test (icteric syndrome): jaundice, Mod. to severe:
fibrils, endoflagella hemorrhage, proteinuria Ampicillin

Borrelia Gram(-), irregular Dx: Serological tests: IFA, Lyme disease (vector: Ixodes  Undergoes several antigenically distinct Doxycycline or
burgdorferi spirals, motile, ELISA, Western blot tick): variations! amoxicilline (+
central proplasmic  Erythematous skin rash probenecid in
cylinder, (erythema migrans) lyme arthritis)
peptidoglycan, axial  Arthralgia, arthritis, neuro
fibrils, endoflagella manifestations + meningitis,
facial nerve palsy
 Chronic skin, CNS, or joint
 involvement
Haemophilus Gram(-), Growth in chocolate agar Antigen detection tests: Encapsulated:  Capsule (polyribosylribitol phosphate; Amoxicillin
influenzae coccobacillary, with factors X (hemin) and V Phadebact, Wellcogen Bacteremia, acute bacterial invasion) Ampicillin
nonmotile, some (NAD) mengitis, acute bacterial  Outer membrane proteins (attachment,
capsulated BAP: tiny, satellite colonies epiglotittis, cellulitis, invasion, resistance to phagocytosis) Chloramphenic
(quellung rxn), may Isovitalex enriched osteomyelitis, joint infection,  LOS (paralyze ciliated epith, promotes ol
appear as long chocolate agar: flat, grayish typical pneumonia proliferation) 3rd gen
threads and brown, no hemolysis Unencapsulated:  Adherence factors (infection) Cephalosporins
filaments Facultative anaerobic (5% Otitis media, sinusitis,  IgA protease (against IgA1)
CO2) pneumonia Chemoprophyla
xis:
Rifampicin
Mycoplasma No cell wall “Fried egg” and granular Serology tests: Atypical pneumonia  P1 pili (adherence) Tetracycline
pneumoniae (membrane 3 appearance  Complement fixation (4- Tracheobronchitis  Peroxide and superoxide metabolic Erythromycin
layers + sterol), 6w) Joint infections products
flask-like or  Cold agglutinins  Polar tips or adhesins
filamentous, polar
tip (adherence)
Chlamydia Obligate Iodine-staining inclusions Antigen detection on Trachoma Tetracycline
trachomatis intracellular ELISA or DIF  Follicle or scar on conjunctiva (adults)
(Reticulate bodies);  serovars A, B, Ba, C Erythromycin
extracellular Urogenital infections, (neonates)
(Elementary bodies Conjunctivitis, Pneumonia Sulfonamides
- round); glycogen  B, Ba, D to K (endemic
inclusion present STD (D to K) areas)
LGV (STD) (L1, 2, 3) Azithromycin
 1. Painless vesicle (mass
 2. Painful buboes, marked treatment)
inflammation of draining LN
Reiters Syndrome Triad:
conjunctivitis, polyarthritis,
genital or GI inflammation
Chlamydophila Obligate Serology: complement Psittacosis (patchy Tetracycline or
psittaci intracellular fixation test inflammation of lungs) (Parrot erythromycin
(Reticulate bodies); Fever)
extracellular
(Elementary bodies Ornithosis
- round)
Chlamydiophilia Obligate Serology: 4-fold titer Atypical pneumonia (Walking Tetracycline or
pneumoniae intracellular increase pneumonia) erythromycin
(Reticulate bodies); Microimmuno- Pharyngitis, bronchitis, sinusitis
extracellular fluorescence, IgG and IgM
(Elementary bodies detection
– pear-shaped)
RAPID LACTOSE FERMENTERS
Escherichia coli Gram(-), rods Smooth, flat, non-viscuous, Sugar fermentation, TSI, Urinary tract infection  Type 1 common pili (mannose binding in
distinct edges, metallic IMViC(++ --), lysine(+), the host)
sheen on differential media acetate(+), lactose(+);  P pili (agglutinate RBC)
MacConkey and EMB for Sereny’s test for  Adhesions
isolation invasiveness
Escherichia coli Gram(-), rods Smooth, flat, non-viscuous, Sugar fermentation, TSI, Neonatal meningitis  K1 capsule (antiphagocyte)
distinct edges, metallic IMViC(++ --), lysine(+),  Siderophores
sheen on differential media acetate(+), lactose(+);  S fimbriae (binding to vascular
MacConkey and EMB for Sereny’s test for endothelium and brain epith)
isolation invasiveness
Escherichia coli Gram(-), rods Smooth, flat, non-viscuous, Sugar fermentation, TSI, Opportunistic infections  Capsule
distinct edges, metallic IMViC(++ --), lysine(+),  Hemolysins
 sheen on differential media acetate(+), lactose(+);  Siderophores
MacConkey and EMB for Sereny’s test for  Adherence pili
isolation invasiveness
Escherichia coli Gram(-), rods Smooth, flat, non-viscuous, Sugar fermentation, TSI, Diarrheal diseases: ETEC: EPEC:
distinct edges, metallic IMViC(++ --), lysine(+),  Enteropathogenic (infants)  Adhesions (specialized pili called gentamycin
sheen on differential media acetate(+), lactose(+);  Enterotoxigenic (traveler’s) colonization factor antigens)
MacConkey and EMB for Sereny’s test for  Enteroinvasive (invasive)  Enterotoxin (heat labile – Fluid
isolation invasiveness  Enterohemorrhagic O157:H7 hypersecretion; hear stable – blocks replacement all
(hemorrhagic colitis and fluid uptake) cases
hemolytic uremic syndrome)  EHEC:
 Attachment
 Shiga-like toxins / verotoxins
Klebsiella Gram(-), EMB / MacConkey: large, TSI (AIA with gas), IMViC Community acquired and  Capsule Aminoglycoside
pneumoniae coccobacillus, mucoid, pink; lactose (-- ++), urease(+ slow), nosocomial pneumonia, lung  Endotoxin s and third gen
encapsulated fermenter, nonhemolytic, tend ornithine(-), LIA lysine abscess, UTI, wound infection,  enterotoxin cephalosporins
to coalesce decarboxylation, citrate(+) epidemic diarrhea, septicemia,
ankylosing spondylitis
Enterobacter Gram(-), rods, Facultative anaerobe TSI (A/A with gas), IMViC Nosocomial infections: UTI,  resistance to cephalosporins (B- B-lactamase
Peritrichous flagella Raised, motile, viscous (-- ++), lysine(+), bacteremia, sepsis lactamase production) inhibitors –
Large, mucoid, pink to ornithine(+) piperacillin
purple, no metallic sheen on Carbapenems
EMB Aminoglycoside
SLOW LACTOSE FERMENTERS
Serratia Gram(-), rod, motile, Red, pigmented Lysine(+), ornithine(+), Pneumonia, nosocomial  lipase Aminoglycoside
marcesens produces red citrate(+), indole(-), infections, septicemia, UTI,  gelatinase Chloram-
pigment DNase(+) wound infection, endocarditis  DNase phenicol
(prodigiosin)  Resistance to colistin and cephalothin Ciproflaxin
Trimethoprim-
sulfa
Citrobacter Gram(-), nonspore Facultative anaerobes Ferment glucose with gas UTI, wound infections, Third gen
forming rods, Gray, opaque with strong and acid production, pneumonia, abscesses, cephalosporins
peritrichous flagella fetid odor oxidase(-), catalase and septicemia, meningitis, Aminoglycoside
methyl red(+), voges- endocarditis Carbapenems
proskauer(-), lysine(-),
citrate(+), hydrolyzes
urea
Edwardsiella Gram(-), rod, motile Facultative anaerobe H2S production, indole(+), Bacterial gastroenteritis, wound B-lactams
tarda Produces hydrogen sulfide nonfermenter of mannitol, infections, systemic diseases Cephalosporins
Smooth, glistening, sucrose, arabinose, Aminoglycoside
semitranslucent trehalose Fluoroquinolone
chloram-
phenicol
Arizona Gram(-), rods, Facultative anaerobe Urease(-), lysine(+), Gastroenteritis
hinshawii nonspore forming, arginine(+), ornithine(+),
peritrichous lactose fermenter
Hafnia alvei Gram(-), rods Facultative anaerobe Indole(-), catalase(+), Enteritis (diarrhea) Third gen
Blood or MacConkey agar: oxidase(-), lysine(+), Extraintestinal infections cephalosporins
gray-white, slightly elevated, ornithine(+), motile, Wound abscesses Aminoglycoside
glistening, strong scent of ferments mannitol and
human feces maltose, no acid
formation, no lipase or
DNase
NON-LACTOSE FERMENTERS
Shigella Gram(-), nonmotile Non-motile, no gas formation No gas production Shigellosis (stages: (1) watery  Invasiveness (attachment and Ampicillin,
from glucose, inert Sereny’s test for diarrhea, (2) invasion of large internalization) amoxicillin
invasiveness intestine)  Shiga toxin (exotoxin: enterotoxic, Trimethoprim-
Lysine(-), nonmotile, -/+ Bacillary dysentery (severe neurotoxic, cytotoxic) sulfameth-
 TSI, acetate(-), abdominal cramps, bloody and  Intracellular survival and multiplication oxazole
lactose(-) mucous stools)
Hemolytic-uremic syndrome
Salmonella Gram(-), rods HE agar: blue green, with Gas production Salmonellosis  Capsule Chloramphenic
Facultative black deposits at the center Typhidot test IgM(+), Enteritis, enteric fever,  Endotoxin QI
intracellular, (d/t H2S production) widal test (4x increase in septicemia, asymptomatic  Invasins Ampicillin
peritrichous flagella Motile, acid and gas from titer), lysine(+), H2S(+), carriage (gall bladder)  Catalase Trimethoprim-
glucose formed TSI (-/+ with gas),  Superoxide dismutase sulfa
indole(+), citrate(+),  Defensins Quinolones
ONPG(-), malonate(-)  Intracellular survival and multiplication
Proteus Ovoid or slightly Uniform film of growth Deaminate Phe P. mirabilis: hospital acquired  Endotoxin Ampicillin
curved rods, extending over whole plate Urease(+ cerise color or UTI, wound infection, Cephalosporins
peritrichous OR series of concentric hot); P. mirabilis pneumonia, septicemia, eye and
(swarming circles of growth around point ornithine(+); P. vulgaris ear infection, pleuritis and Aminoglycoside
phenomenon) of inoculation indole(+) peritonitis, suppurative abscess, TMP-SMZ
Swarming on agar, rapidly GIT infection, bacteremia
hydrolyse urea  ammonia
Morganella Indole(+), ornithine(+), Aminoglycoside
morganii citrate(+) TMP-SMZ
Providencia Indole(+), H2S(-), Nosocomial infections: UTI,
citrate(+), lysine(-), Respiratory tract infections,
lactose(-) wound infections
Yersinia pestis Gram(-), short rods, Microaerophilic or facultative Catalase(+), oxidase(-) Bubonic plague (with swollen  Yops Ampicillin
bipolar staining, anaerobe and painful axillary and inguinal  Envelope F-1 antigen (antiphagocytic) Streptomycin
facultative LN: buboes; rodent reservoir,  Coagulase Tetracycline
intracellular arthropod vector)  Fibrinogen activator
 Protein V and W (proliferation)

LESS CLINICALLY SIGNIFICANT MICROORGANISMS

Other Mycobacteria
M. kansasii Group I; Pigment: Complex media, 37C Lung and systemic disease Rifampin, isoniazid,
photochromogen identical to TB ethambutol
M. Group II; Pigment: Scrofula (granulomatous
scrofulaceum scrotochromogen adenitis enters through
oropharynx, infects draining LN)
M. avium- Group III; Disease in AIDS Macrolide +
intracellulare Non-chromogenic clofazimine, rifabutin,
complex fluoroquinolone,
amikacin
M. fortuitum- Group IV Rapidly grow, optimal at 41C Disease in immuncompromised, Clarithromycin or
chelonae Smooth, soft, non-pigmented those with prosthetic hip joints azithromycin +
complex and indwelling catheters ethambutol
M. abscessus Chronic lung infections,
infections of skin, bone, joints
M. ulcerans 31C growth Buruli ulcer Antibiotics

Other Neisseriaceae
Moraxella Gram(-), Rough surface, friable Aerobic, produce B- Otitis media and sinusitis, Amoxicillin
catarrhalis streptococcus consistency, pinkish-brown, lactamase, DNase(+) bronchitis, pneumonia, sinusitis, Unresponsive:
opaque, grow wellat 28C (red to yellow), butyrate conjunctivitis coamoxyclav,
esterase(+) cephalosporins,
macrolides,
cotrimoxazole,
quinolones
Kingella kingae Gram(-), rods/ Oxidase(+), hemolytic Bone, joints, and tendon PCN, ampicillin,
and K. coccobacilli, on BAP infections erythromycin
denitrificans nonmotile, fastidious
Kingella kingae Gram(-), rod / Oxidase(+), hemolytic Suppurative arthritis and Penicillin
diplococcic, on BAP osteomyelitis, diskitis,
nonmotile endocarditis, meningitis, occult
bacteremia, pneumonia
Eikenella Gram(-) rod 50% form pits in agar Oxidase(+), fastidious, Mixed flora infections Ampicillin, newer
corrodens non-fermenter, requires penicillin and
CO2; some strains B- cephalosporins
lactam(+)
Other Bordetella
Bordetella Larger colonies, more rapid Oxidase(-), urease(+) Similar to whooping cough but Pertussis toxin (silent)
parapertussis growth than B. pertussis less severe
Bordetella Gram(-), bacillus Oxidase(+), urease(+) Chronic respiratory tract Pertussis toxin (silent)
bronchiseptica infections
Other Spirochaetes
Treponema Bejel Penicillin
pallidum bejel
T. carateum Pinta (non ulcerating papule)
T. pertenue Yaws (ulcerating papule) Penicillin
Other Haemophilus spp.
H. ducreyi Gram(-), rods, Chocolate agar: with factor X Chancroid (soft chancre: ragged Erythromycin
school of red fish (not V) ulcer on genitalia with swelling &
tenderness)
 Buboes (suppurative inguinal
lymph nodes)
H. influenzae Gram(-)  Purulent conjunctivitis (Pink Erythromycin
aegyptius Eye)
 Brazillian Purpuric Fever
(nausea, vomiting,
hemorrhagic skin lesions,
fever and shock)
H. para- Gram(-) Endocarditis, pneumonia, Ampicillin
influenzae meningitis, bacteremia
Other Mycoplasmas
Haemophilus Pyelonephritis, pelvic Tetracycline,
hominis inflammatory disease, erythromycin
postpartum fever
H. genitalium Non-gonococcal urethritis Tetracycline,
erythromycin
Ureaplasma Requires 10% urea for growth Non-gonococcal urethritis Tetracycline,
urealyticum erythromycin
*IMViC – Indole test, Methyl red test, Voges-Proskauer test, Citrate test. See Exercise 8 for details.

Organism Biology Colony morphology Tests Disease Virulence and antigenic factors Meds
Pseudomonas  Gram negative, Natural isolates from  Grows well on most of lab  Endocarditis  Adhesins  Anti-pseudomonal
aeruginosa aerobic bacilli soil or water- small, media  Respiratory Tract Infections o Glycocalyx (antiphagocytic) penicillin +
 non lactose rough colony  Non Lactose Fermenter o Primary pneumonia o Alginate slime (antiphagocytic) Aminoglycoside
fermenter  Oxidase (+) o Bacteremic pneumonia o N-methyl-Phe pili (type 4 –
Clinical Samples  Beta-hemolytic o LRT colonization of cystic similar to N. gonorrhea and V.
 Fried egg  Characteristic odor (fruity – fibrosis cholerae Tcp pili; bind to GM1
appearance, large, grapes)  Bacteremia and Septicemia of epithelial cells)
smooth, flat edges  Color: blue, fluorescence  CNS infections (meningitis)  Invasins
and elevated under UVL  Ear infections (Otitis Externa o Pyocyanin (iron acquisition)
 Mucoid appearance o Elastase
 in healthy persons) o Alkaline protease (defense vs.
 Eye infections (bacterial immune response)
keratitis) o Elastase + Alkaline
 Bone and Joint infections phosphatase (degrades
 Urinary Tract Infections ground substance, (-) IFN-y
(hospital-acquired UTI) and TNF)s
 Gastrointestinal infections o Cytotoxin (leukocidin – lethal
 Abscesses for WBC; pore forming)
o Hemolysin (phospholipase,
lecithinase)
3 DISTINCT STAGES: o Siderophores
1. Attachment  Flagella
2. Local invasion  Toxins
3. Disseminated systemic o LPS (antiphagocytic)
disease o Exoenzyme S (septicemia;
impair phagocyte function)
o Exoenzyme A (tissue
necorsis, (-) protein synthesis)
 Resistance plasmid and factors
 Adaptability to minimal nutrition
 Survival in various habitats
 Metabolic diversity
Stenotrophomonas  Non  Distinguished from  Frequent colonizer in  Few pathogenic mechanisms  Unnecessary if
maltophila fermentative Pseudomonas: respiratory tract in patients  Predominantly results in colonization only
 Aerobic o Lysine (+) with cystic fibrosis colonization rather than infection  Resistant to many
 Gram (-) o DNAase test (+)  Catheter associated  Invasive medical devices – antibiotics
bacillus o Oxidase (-) bacteruria vehicles by which the organism considered
 IV line infections bypasses normal host defenses effective for
 Urosepsis Pseudomonas
 Bacteremia  Resistant to
 Pseudobacteremia aminoglycoside,
antipseudomonal
SOURCES: penicillins,
 Fluids in hospitals antipseudomonal
 Respiratory equipment 3rd gen
 IV lines and fluids cephalosporins
 Urine  Sensitive to TMP-
SMX or Cefepime

Burkholderia cepacia  Aerobic  Growth slower than  Culture B. cepacia from  Pneumonia  Has the ability to grow in wide  TMP-SMX (Co-
 EO1,  Gram (-) enteric Gram(-) rods body fluids  Bacteremia (entry: respiratory range of microenvironment in the trimoxazole)
 P. multivorans bacillus  3 days before  PCR- with genotyping tract, central venous catheter) hospital because of minimal growth  Chloramphenicol
 P. kingie colonies are visible o 7 genovars  Skin and Soft tissue infections requirements (e.g., povidone  Cefepime
(burns and wounds) iodine catheters)  3rd gen
 GUT infections  Has resistance to commonly used cephalosporins,
 Frequent colonizer of fluids antimicrobial disinfectant agents: esp. ceftazidime
in hospital (e.g., irrigant  Ureidopenicillin
solutions)  Quinolones
 Meropenem
 Imipenem
 Varying
susceptibility to
fluoroquinolones

B. pseudomallei  Meliodiosis
B. mallei  Glanders
Vibrio cholerae  Comma-shaped  TCBS agar: yellow  Ferments glucose  Cholera (major pandemics by  Cholera toxin with A (active) and B  Fluid and electro-
O1, O139 bacilli colonies  Diagnosis by culturing fresh O1 and O139; spread by (binding) subunits  diarrhea lyte replacement
 Facultative  18-87OC stool consumption in high dose  Adherence factors (colonization)  Doxycycline (adult)
anaerobe  pH 7.9-9.0 contaminated food and water)  Pilus  TMP-SMX (pedia)
 Simple nutrition  Mucinase  Furazolidone
 Growth even w/o salt  Siderophores (pregnant)
 Neuraminidase  Killed parenteral
vaccine
Vibrio  Comma-shaped  TCBS agar: yellow  Ferments glucose  Explosive watery diarrhea  Hemolysin  Self-limited
parahaemolyticus  Facultative  18-87OC  Halophilic (mild to cholera-like)  Adhesion
anaerobe  pH 7.9-9.0  Diagnosis by culture fresh  Wound infection
 Simple nutrition stool  Bacteremia
 Halophilic  Infection by consumption of
contaminated shellfish
Vibrio vulnificus  Comma-shaped  TCBS agar: yellow  Ferments glucose  Infection associated with  Serum resistance  Tetracycline
 Facultative  18-87OC  Halophilic exposure of wound to  Antiphagocytic polysaccharide  Aminoglycoside
anaerobe  pH 7.9-9.0  Diagnosis by culture fresh contaminated sea water: may  Cytolysin
 Simple nutrition stool progress to bullae and tissue  Collagenase
 Halophilic necrosis  Protease
 Septicemia (via ingested  Siderophore
contaminated shellfish)
Campylobacter jejuni  Gram (-)  Non sugar fermenter or  Gastroenteritis  Endotoxins  Fluid & electrolyte
 Helical or oxidizer o Crampy abdominal pain  Flagella replacement
corkscrew  Microaerophilic o Profuse bloody diarrhea  Adhesions (attachment to mucosa)  Erythromycin
 Long-sheathed  Capnophilic  Guillain-Barre syndrome  Cytopathic toxins  Fluoroquinolones
polar flagellum  Thermophilic o Acute inflammatory  Azithromycin
 “Gull wing”  Oxidase (+) demyelinating neuropathy
 Catalase (+) o Acute axonal
Helicobacter pylori  Gram (-)  Skirrow’s medium or  Non sugar fermenter of  Gastritis  Flagella (motility)  Bismuth
 Helical chocolate medium oxidizer  Peptic ulcer disease  Adhesin (attachment)  Metronidazole
 Blunt/round (isolation):  Microaerophilic  Mucinase (degradation of gastric  Tetracycline
ends translucent, 1-2 mm  Strong urease producer mucus)  Triple therapy: PPI
 Lophotrichous colonies (stain: (rapid test; breath test)  Urease (acid neutralization) + antibiotic +
flagella Giemsa or special  Oxidase (+)  Vacuolating cytotoxin (epithelial bismuth
silver stain)  Catalase (+) cell damage)
 Mucinase (+)  Superoxide dismutase and
catalase (antioxidant)