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Bacterial Microbiology (Clinical (Strep pneumo (lancet shaped …
Bacterial Microbiology
structures
Gram +
Lipoteichoic acid as spore
ATB test
Stap
NO(Novobiocin) S(Saprophyticus)tRE(Epidermidis)Ss
catalase Positve, Beta hemolysis
Strep
O(Optochin)V(viridans)RP(pneumoniae)S
catalase neg,alpha hemolysis
B(Bacitracin)-B(Strep gr B)RA(gr A)S
catalase neg,Beta hemolysis
Gram -
Outer membrane(LPS)
induce TNF,IL1,IL6 ไม่ได้สร้างจากเซลล์ ทนร้อน
O antigen
core polysaccharide
Lipid A(Endotoxin)
Macrophage activation(TLR4)
IL1,IL6
fever
TNF-alpha
fever&hypotension
NO
Hypotension
Tissue factor activation
coag cascade
DIC
Compliment activation
C3a
Histamine
edema&hypotension
C5a
neutrophil chemotaxis
B-lactamase space
Exotoxin
:red_cross: Protein synth
C.diptheriae
Diphtheria toxin
:no_entry: EF2
pharyngitis pseudomemb
Pseudo
Exotoxin A
:no_entry: EF2
host cell death
shigella
Shiga toxin
:no_entry:60s ribosome by remove adenosine rRNA
HUS
dysentery(GI cell invade)
EHEC
Shiga-like toxin
:no_entry:60s ribosome by remove adenosine rRNA
HUS
:point_up: fluid secretion
ETEC
Heat labile toxin
:arrow_up: cAMP
watery diarrhea
Heat stable toxin
:arrow_up:cGMP
N/V
Bacillus anthracis
Edema toxin
mimic :arrow_up:cAMP
edema border of black eschar
Vibrio cholerae
cholera toxin
:arrow_up:cAMP by activate Gs
rice water diarrhea
:red_cross: phagocytic ability
Pertussis toxin
:arrow_up:cAMP by disable Gi
Whooping cough
:red_cross:NTs release
C.tetani
tetanospasmin
Cleave SNARE(SNAP receptor)
:no_entry: GABA&Glycine from Renshaw cell in SC
lockjaw/Spastic paralysis
C.botulinum
botulinum toxin
:no_entry:ACh
flaccid paralysis/floppy baby
Lyse Cell memb
C.perfringens
Alpha toxin
phospholipase
gas gangrene&double hemolysis on blood agar
Strep pyogenases
StreptolysinO
Proteiase
B-hemolysis,rheumatic fever
Superantigen causing shock
S.aureus
TSST-1
TSS
Strep pyogenases
ExotoxinA
bind MHC2&TCR
:arrow_up:IL1,IL2,TNFalpha,IFNg
shock
polyclonal T-cell activation
toxic shock like syndrome ; scarlet fever
taxonomy
Gram+
coccus
clustures
Stap
chain/pairs
strep
enterococcus
bacilli
bacillus, lactobacillus ,clostridium, corynebact,gardnerella,mycobact,listeria
branching filamentous
actinomyces
Norcardia
Gram-
coccus
moraxella
Neisseria
bacilli
enteric
respi
zoonotic
pleomorphic(no cell wall)
anaplasma, ehrlichia
spiral
spirochetes(Borrelia,leptospira,treponema)
Stains
G/S
These Little Microbes May Unfortunately Lack Real Color But Are Everywhere(TL/M/MU/LRCBAE)
Giemsa
Certain Bugs Really Try my Patience
PaS
Whipple disease
Ziehl Neelsen stain
Mycobacteria ,Nocardia, protozoa ; Cryptosporidium
India ink
Cryptococcus neoforman
Silver stain
Fungi, Legionella, H. pylori
FTA-ABS
syphilis
Media
Chocolate agar
H. influenzae
Thayer martin agar
Neisseria
EMB green metallic sheen
E. coli
MacConkey agar
lactose ferment
Aerobes
TB, Nocardia, Pseudomonas
Anaerobes
Actinomyces, Bacteroides, Clostridium, Fusobacterium
Facultative anaerobes
Gram+
intracellular
Obligated
Ricketsia, Chlamydia, Coxiella
Facultative
Salmonella,Neisseria,Brucella,Mycobact,Listeria,Legionella,Yersinia
Encapsulated (ทำให้ antiphagocyte แย่กับคนไร้ม้าม)
Pls SHINE my SKiS(Pseudo,Strep pneumo,HiB,Neisseria,E.coli,Salmonella,Klebsiella,Strep B
Urease positive
Pee CHUNKSS(Proteus,Crypto,H.pylori,Ureaplasma,Nocardia,Klebsiella,S epidermidis/saprophyticus)
Catalase positive
Cat Need PLACESS to Belch Hairballs(Nocardia,Pseudo,Listeria,Asper,Candida,E.coli,Stap,Serratia,B cepacia,H.pylori
Clinical
S.aureus
Inflammatory disease
skin infection
organ abscess
pneumonia
toxin disease
TSS(TSST-1)
Hx of prolong Vg tampons/nasal packing
SSS(exfoliative toxin)
non-blooding food poisoning(entertoxin)
heat stable,rapid onset
cocci in cluster
Strep pneumo
lancet shaped ,encapsulated diplococci, IgA protease. Optochin+
Meningitis
Otitis media
Bacterial pneumonia(Pneumococcus) :warning:
Rusty sputum
sinusitis
Viridans Strep(mutan/mitis/sanguinis)
dental carries(NF)
Subacute bacterial endocarditis ถ้ามีheart valve
S.pyogenases(Gr.A)
cocci in chains, ASO titer, anti-DNase B Ab,PYR+,Ab to M protein
pyogenic
pharyngitis
cellulitis,impetigo( :star:
Honey crust
),Erysipelas
toxigenic
Scarlet fever(erythrogenic toxin)
Blanching sandpaper like body rash, strawberry tongue
toxic shock like syndrome
NF
Immunologic
Rheumatic fever
J :<3:ones criteria
glomerulonephritis
S.agalactiae(Gr.B)
Babies
S.bovis
colonized in gut, assoc.Colon CA
Enterococci(E.faecalis,E.faecium)
PenG resist,NF in colon
UTI,biliary tract infections,subacute endocarditis
Bacillus anthracis
spore forming rod,anthrax toxin,polypeptide capsule, Medusa head/halo colonies
cutaneous anthrax
Painless papule to ulcer with
Black eschar
Pulmonary anthrax
inhale spores
Bacillus cereus
Reheated rice syndrome
emetic type
waterry diarrhea
Gram+ rod
Costridia
Tetani
Spastic paralysis
Botulinum
Botulism(Flaccid paralysis, floppy baby syndrome)
4D's
:red_flag:
Diplopia, Dysarthria, Dysphagia, Dyspnea
perfringens
gas gangrene&hemolysis(alpha toxin)
food poisoning(heat libile entherotoxin)
spore forming,obligate anaerobic rods
Difficile
ToxinA(enterotoxin) เกาะbrush border
diarrhea
Pseudomembranous colitis
ToxinB(cytotoxin) ทำลาย actin
ประวัติใช้ Clinda,vanco,Ampi,PPI use
:warning: diag by Ag PCR
Corynebacterium diphtheriae
club shaped,Chinese letter
,Gr+ rod, black colonies on cystine-tellurite agar,
Elek test+
Diphtheriae
cause : exotoxin, B-prophage,ADP-ribosylation of EF2
Pseudomembranous pharyngitis
(grayish-white membrane)
+LN+myocarditis+arrhythmias :
Listeria monocytogenes
Gr+ facultative intracellular rod,
กินนมไม่พาสเจอไรซ์ เนื้อแช่แข็ง
, ผ่านรก
Nocardia
Aerobe,weak AFS,in soil, คล้ายTBแต่ PPD negative, ก่อโรคในimmunocom
Actinomyces
long branching filament
Tx : SNAP(sulfonamides-Nocardia/Actinomyces-pen)
Mycobacterium
Tuberculosis
Primary TB
Ghon complex
Hilar nodes+Ghon focus at lower lobe
Secondary TB
Fibrocaseous cavity(upper lobe)
caseating granulomas with central necrosis, Langhans giant cell
Progressive in AIDs,malnu
Bacteremia+Progressive lung disease
Miliary TB
Leprae
Leprosy(Hansen diseases)
Glove and stocking loss sensation
Diag : skin bx/tissue PCR
Lepromatous
Diffused skin, Lion face,ติดต่อได้ ตายได้ CMI Th2
Tx : +clofazimine
Tuberculoid
hairless skin plaques,CMI Th1
Tx: dapsone&rifampin
Bacilli
lactose ferment
+
fast
Klebsiella
Lobar pneumonia in Aspirate, Alcoholics, Diabetics :
Currant jelly sputum
Abscess in lung&Liver
Nosocomial UTIs
E.coli
EIEC(invade mucosa)
Dysentery
ETEC(enterotoxin)
Traveler's watery diarrhea
EPEC(เกาะผิวGI)
เด็กท้องเสีย
EHEC(Shiga like toxin)
HUS(triad of anemia, thrombocytopenia, ARF เจอ schistocytes), Dysentery
O157:H7 ติดผ่าน undercooked meat,raw leafy vegy
Enterobacter
slow
Citrobacter
Serratia
-
oxidase+
Pseudomonas
Aerobic motile, pyocyanin(สร้างROS), endotoxin(fever,shock), exotoxinA( :no_entry:EF2), phospholipaseC(ทำลายCM)
Chronic pneumonia in cystic fibrosis เพราะเชื้อสร้าง
biofilm
wound infection in
burn
corneal ulcer/keratitis : คนใส่
contact lens
hot tub folliculitis
Ecthyma gangrenosum in immunocom
AOE:
swimmer ear
TX : CAMPFIRE(carbapenem,Aminogly,monobactam,colistin,fluoro,3rd gen,piperacillin) :checkered_flag:
oxidase-
H2S production+
Salmonella
Typhi
typhoid fever (rose spots on abdomen, constipation, ปวดท้อง,fever)
Tx : cef3/fluoro
not typhi
Gastroenteritis(Samonellosis) มักถ่ายเป็นเลือด , no vaccine, no ATB
สร้างH2S,salmon swim,endotoxin,hemato spread
Proteus
no H2S
Shigella
F4(fingers,flies,food,feces)
Bloody diarrhea จาก shiga toxin(enterotoxin invade M cell)
Yersinia
pet fecies,cont milk,pork
acute diarrhea,pseudoappendicitis
Test on MacConkey agar : pink colony
Coccobacilli
H.influenzae
mucosal infection
สร้าง IgA protease,culture on choc agar
Vaccine HiB ให้ตอนอายุ 2-18 mo
Cherry red ในเด็ก,X-ray thumb sign
Bordetella pertussis
pertussis toxin,tracheal cytotoxin
Prevent : Tdap, DTaP
Whooping cough
Pasteurella
จากหมาแมวกัด
cellulitis, osteomyelitis
Brucella
จากนมไม่พาสเจอไรซ์
Diplococci
Maltose utilization +
N.meningitidis
ferment maltose&glucose
มี Polysac capsule, แพร่ทางrespi&secretion
meningococcemia with petechial hemor
toes gangrene,meningitis
Waterhouse-Friderichsen syndrome (AI,fever,DIC,shock)
Tx : Cef3/penG
no maltose utilize
N.gonorrhea
STDs
gonorrhea,SA,PID,Fitz-Hugh-Curtis syndrome,neonatal conjunctivitis
Tx : Cef3 + azithro/doxy(มักมีchlamydiaร่วม)
ferment glucose,IgA,LOS
Moraxella
Comma-shaped rod+oxidase
H.pylori
Curved flagellated,triple+(oxidase,catalase,urease)
Diag : urea breath test+ / fecal Ag test
Gastritis,PU,DU
Tx : triple therapy ; Amox/Metroถ้าแพ้ + Clarithro + PPI
Vibrio cholerae
Comma flagellated, oxidase+, enterotoxin จาก น้ำปนเปื้อน ไม่สุก
Rice water diarrhea
Tx : ORS
Campylobacter jejuni
Bloody diarrhea จากอึเปื้อน
Gardnerella vaginalis : Bacterial vaginosis
Pleomorphic gram variable rod
gray vaginal d/c with fishy
smell, not pain
No STDs
clue cell(strippled margin), Amine whiff test, KOH fishy odor
Tx : Metronidazole/Clinda
Chlamydiae trachomatis
cause RA(Reiter syndrome), follicular conjunctivitis,nonGC urethrtis, PID
Type D-K
Urethritis
/PID/ectopic pregnancy
Neonatal pneumonia with eosinophilia (Staccato cough)
Neonatal conjunctivitis
Type L1,2,3
Lymphogranuloma venerum
Small painless ulcers on genitals
Swollen
painful injuinal LN
(Buboes)
Tx
: Azithro or Doxy
Spirochetes
Leptospira
hook-shaped end
water cont,animal urine
Leptospirosis
flu เมื่อย เหลือง กลัวแสง ตาแดงเยิ้ม ไปป่ามา
Weil disease
หนักแล้ว organ failแล้ว
Treponema
dark field MC/DFA
Syphilis
primary
painless chancre,VDRL+
Secondary(systemic)
MP rash at palm&sole
condyloma lata(smooth moist painless ,wart like)
LN,patchy hair loss
confirm by FTA-ABS
tertiary
Gumma
Aortitis
neurosyphilis
tabes dorsalis,general paresis
ตรวจspinal fluid VDRL,FTA-ABS,PCR
Argyll Robertson pupil
accom+แต่ไม่สนองต่อไฟ
congenital
rhagades,snuffle,saddle nose,Hutchinson teeth,CN7 deaf
Spiral-shaped
Mycoplasma pneumoniae
atypical/walking pneumonia
gradual onset, headache, nonproductive cough,patchy/diffuse infiltrate, อายุ<30
Worse X-ray
High titer of cold IgM
no cell wall
Tx
: macrolides, doxy, fluoro