Bacteria Study tips 5 most common pediatric rashes: measles, rubella, scarlet fever, roseola, erythema infectiosum (B19)

) Neonatal meningitis: B strep, E coli, listeria Pneumonia in adults: strep pneumo, H influenza, legionella Pneumonia in 18-40 years: mycoplasma, C pneumonia, S pneumonia Elderly pneumonia: strep pneumo, gram rods, H influenza Meningitis 6 months 6 years: S pneumonia, N meningitides, H influenza Meningitis >60 years: strep pneumo, G- rods, listeria Neonatal pneumonia: B strep, E coli Atypical pneumonia: mycoplasma, legionella, chlamidya, viruses Palm and sole rash: RMSF, syphilis, coxsackie G+ Cocci: staph, strep, enterotoccus Bacilli: bacillus, clostridium, listeria, corneo, actinomyces, norcardia Has teichoic acid, thick cell wall Structure Capsule: against phago, polysacc B anthracis has aa capsule Spores: clostridium and bacillus G LPS, outer membrane, periplasmic space (site of beta lactamases), thin cell wall LPS: lipid A + polysacc o A: endotoxin o Polysacc: surface Ag, aka O Ag GRAM POSITIVES Staph aureus Toxin mediated: TSS, scalded skin syndrome, food poisoning. Blood cultures will be negative and antibiotic wont help TSS: fever, rash, palm and sole dequamation, hypotension Food poisoning: self limited Local: impetigo, cellulitis, folliculitis, furuncle, carbuncle, pneumonia with cavitations Systemic: endocarditis, meningitis, osteomyelitis, arthritis Normal in skin and nasopharynx Staph epidermidis Endocarditis on prosthetic valve within 60 days Normal on skin Strep pyogenes Pharyngitis, impetigo, erysipelas, cellulitis Normal in skin and pharynx Pharyngitis: food and resp, have pili o Complications: otitis, meningitis Toxins: scarlet fever, TSS Ab-Ag: glomerulonephritis, rheumatic Skin infection kidney and not heart

M protein resists phagocytosis Scarlet: pharyngitis release exotoxins. Rash on trunk and spread out. Strawberry tongue. Palm and sole desquamation Fasciitis: from trauma or surgery. Exotoxin B along fascial planes. Muscles ok ASO in toxin disease Tx: penicillin G, clindamycin Immune mediated: glomerulonephritis (from skin or pharynx) and rheumatic fever (only from pharyngitis, not skin)

S agalactiae Neonatal meningitis, pneumonia, sepsis In maternal genital tract Most common meningitis in newborns Ampicillin to mom, baby penicillin G Enterococci Local: UTI Systemic: subacute endocarditis Normal in GI, GU o Cephalosporin overgrow, enters blood when disrupt epithelium Ampicillin, vanco. All resistant to cephalosporin 2nd most common nosocomial On damaged valves Strep bovis Subacute endocarditis, indicates colon cancer of IBD Strep pneumonia (pneumococci) Local: lobar pneumonia, otitis, sinusitis Systemic: meningitis, osteomyelitis, arthritis, endocarditis Resp droplet spread. Capsule and IgA protease Penicillin and cephalosporins Strep viridians Local: dental caries, brain and abdominal abscess Systemic: subacute endocarditis Normal in oropharyx Penicillin G Bacillus cereus Food poisoning vomit or diarrhea Vomit: 1-5 hours after, heat stable toxin Diarrhea: 15-20 hours after, heat labile toxin Reheated rice! Treat: rehydration Bacillus anthracis Local: cutaneous (most common), malignant pustules , GI (dysentery) Systemic: inhalation Spores from herbivore products through cutaneous abrasion, ingest, or inhale Toxin: PA (binds cell, mediates endocytosis), EF (increases AC edema), LF for cell death G+ rod in chains Protein capsule

Clostridium tetani Spastic paralysis, lockjaw, risus sardonicus Spores enter skin injury release toxin retrograde on PNS axons and blood block GABA and gly on interneurons Masseter mm most sensitive Progresses proximal to distal because of axon length Spore shaped like tennis racket Clostridium botulinum Adult: food poisoning: anaerobic heat labile toxin in canned foods block Ach release symmetric descending paralysis from head to extremities, dysphagia Infant: floppy baby: spores in honey spores germinate in LI block Ach release No invasion no fever Most potent toxin Can enter wounds Clostridium dificile Pseudomembranous colitis and diarrhea Normal in GI overgrow with clindamycin Toxin A alters fluid secretion watery diarrhea Toxin B kills epithelium pseudomembrane (yellow white plaque), present in feces Treat with metro or vanco Clostridium perfringens Cellulitis, gas gangrene, food poisoning Normal in GI Cellulitis: enter wound degrade ish: painless, gas under skin crepitus Gas gangrene: spores in soil wound. Alpha toxin muscle necrosis. Black exudates leaks, can lead to shock Food poisoning: meat and poultry, spores survive cooking. Heat labile enterotoxin released in GI o No fever or vomit Only non-motile clostridium Listeria monocytogenes Only G+ with endotoxin Neonates, IC: meningitis, sepsis In milk penetrates and invade GI blood neural tissue tropism -> meningitis Normal in vaginal tract, can cross placenta or infect during birth Tumbling motility Ampicillin and gentamycin Can survive inside and outside cell, in cold temperatures Corneybacterium diphtheria Local: pseudomembrane, airway obstruction Systemic: myocarditis, polyneuritis Respiratory gray pseudomembrane AB toxin: ribosylate EF2 no PS Toxin is carried by a phage Actinomyces israelii Absceses: GI, GU Draining sinus tracts Forms sulfur granules Normal in oral, GI, GU trauma disrupt mucosa pus abscess

Beaded filaments, hyphae, often confused with neoplasms, IUD is a risk

Norcardia asteroides Acid fast, beaded filaments Pneumonia, brain and kidney abscesses Inhale from soil. Mycolic acid wall. Caseous granulomas pneumonia with cavitations, resembles TB Most infections in IC GRAM NEGATIVES Diplococcic: neisseria Bacilli: klebsiella, e coli, salmonella, shigella, proteus, vibrio, pseudomonas, yersinia, helicobacter, c jejuni, bacteroides Coccobacilli: hemophilus, l pneumophila, bordatella, brucella, francisella, p multicoda

Neisseria meningitides Meningococcemia with petechial rash, meningitis Waterhouse when fulminant Normal in nasopharynx. IgA protease Endotoxin vascular necrosis and hemorrhage in adrenal glands Located in PMNs Metabolize maltose and glucose Neisseria gonorrhea Ag surface variation (so wont be immune to next infection), prevent phagocytosis. Use pili to attach to mucosa. IgA protease GU infection: can have no symptoms. Ophthalmia neonatorum Septic arthritis Complications: PID, ectopic pregnancy, sterility, peritonitis Metabolizes glucose, grows on Thayer Martin media only Risk during menstruation or IUD use Klebsiella pneumonia Bacillus Pneumonia, nosocomial UTI Antiphagocytic capsule, necrosis, cavitations E coli Enteritis, UTI, pneumonia, neonatal meningitis, septic shock, HUS Normal in GI. Fecal-oral transmission, pili ETEC: heat labile and stabile toxins EPEC: malabsorption diarrhea EHEC: no invade. Shiga like toxin. Inflammation, bleeding bloody stool. HUS EIEC: invade leukocytes in stool LT toxin: like cholera, ADP ribosylate Gs Ac secrete Cl Watery diarrhea ST toxin: like yersinia: GC NaCl cotransport watery diarrhea SLT: verotoxin: inactivate ribosome cell death Most common cause of UTI and G-sepsis HUS: fever, hemolytic anemia, thrombocytopenia, acute renal failure K: capsule. O: part of LPS. H: flagella Salmonella typhi H ag: flagella

Bacillus Asymptomatic, typhoid fever, osteomyelitis Only in humans. Fecal-oral. Penetrate mucosa Vi in capsule survives. Endotoxin rose spots on abdomen Carrier state

Salmonella enteridis Human and animals. Fecal-oral. Gastroenteritis Motile (shigella is not) Turtles and uncooked chicken Risk in people with less acid secretion Shigella dysenteriae O polysaccharide in outer membrane Dysentery: bloody diarrhea Shiga toxin inactivates 60S damage mucosa Small amount needed, so people with less gastric acid are not at more risk Toxin can cause HUS Proteus mirabilis O antigen, G- rod, makes urine alkaline UTI, nosocomial Normal GI flora. Enters through urinary tract Has urease, ppt ish urinary stones Vibrio cholera In water, food, shellfish AB toxin ribosylates Gs AC Comma shapes Pseudomonase aeruginosa Pneumonia, UTI, burn infections, sepsis, endocarditis, osteomyelitis, otitis, folliculitis Enters breaches (wounds, burns, catheters). Pili, secrete toxin Exotoxin A ADP ribosylation of EF2 paralyze host cell protein machinery PLC, elastase, endotoxin Pycocyanin to pigment Pneumonia in CF Yersinia enterocolitica Enterocolotis, mesenteric adenitis Raw milk, oral-fecal ileum secrete heat stable enterotoxin Invade, inflammation. Self limiting Bloody diarrhea. Arthritis in adults. Appendicitis like pain in minors Yersinia pestis Safety pin shape. F1 Ag generates Ab response Bubonic plague: flea vector. Rodents carry. Regional lymphadenitis (buboes, in groin) DIC, endotoxin, hemorrhagic necrosis Helicobacter pylori Acute: gastritis Chronic: antral gastritis, pangastritis, peptic ulcers Does not invade Punched out ulcer with smooth borders

Campylobacter jejuni Bloody and secretory diarrhea In domestic animals. Fecal-oral or unpast milk, choler like toxin. Bacteroides fragilis Inactive LPS so does not cause shock Peritonitis, GI and pelvic abscesses Normal GI flora, penetrate ish. Only G- without typical endotoxin Haemophilus influenza Local: epiglottitis, otitis media, pneumonia Systemic: meningitis, septic arthritis, cellulitis Only in hymans. Aerosol. IgA protease. Need factors V and X, chocolate agar Need capsule to be invasive Legionella pneumophila Pontiac fever, Legionnaires Aeorosol use pili to adhere to respiratory epithelium. Survive in phagosome Pontiac: acute flu like illness 2-5 days Legionnaires: Micro-abscess, severe atypical pneumonia Bordatella pertussis Only in humans. Airborne. Hemagglutinin. ADP ribosylate Gi cAMP Catarrhal stage (contagious, flulike), paroxysmal (whooping) Complications: hypoxia neuro problems Brucella species Eat goat cheese RES caseating granulomas, abscess Undulating fever Osteomyelitis most common complication Francisella tularensis Rabbits carry. Transmit through rabbit skin, insects Papule ulcer with black base. Ulceroglandular tularemia Live attenuated vaccine (along with TB) Arkansas, Oklahoma, Missouri Pasteurella mulocida In cat and dog mouths get through bite Cellulitis and osteomyeleitis Mycobacterium tuberculosis Mycolic acid wall: acid fast, resistant, prevent phagosome fuse lysosome Primary: deposit in lower lobes, mycolic acid allows for survival in macrophages Ghon complex: calcified pulmonary tubercles and hilar nodes Mycobacterium leprae Infects cells of nerve sheaths Tuberculoid: granuloma, local damage, thickened nerves, hypopigmented and hairless lesions Lepromatous: especially at cooler skin, sensoty loss, secondary insults. Saddle nose, leonine, infertile

Dont discontinue drugs

Spirochetes Too thin to see with LM, need dark field microscopy, corkscrew shape, periplasmic flagella Treponema pallidum Primary: painless chancre Secondary: condyloma lata, maculopapular rash on palms and soles. Tertiary: gummas, ascending aortic, tabes dorsalis Only in hymans. From skin lesions or sex. Borrelia burgdorferi Lyme disease, spirochete Stage 1: erythema chronicum migrans Stage 2: CNS, CV, skin, joints Stage 3: chronic arthritis, encephalopathy Mice carry, ixodes tick transmits Leptospira interrogans In animal pee. Enters abrasions 1st phase: flu like, photophobia 2nd stage: meningitis, vasculitis with hemorrhage (Weils disease) Mycoplasma Smallest living organisms Amorphous because no cell wall Mycoplasma pneumonia Fried egg appearance. Resistant to beta lactams. No gram stain Tracheobronchitis, atypical pneymonia Only in hymans. Respiratory. No invasion. Auto-Ab can cause complications Chlamydia and Rickettsia Obligate intracellular Chlamydia psittaci Atypical pneumonia Carried in birds, get through poop and aerosol. Invades Elementary body EC, reticular body IC EB is infective, phago become RB, multiply Chlamydia trachomatis Can cause PID, ectopic, infect liver in Fitz Hugh Curtis Men: infect joints Conjunctivitis, pneumonia Most common STD, cause of blindness, often silent in men Rickettsia ricettsii RMSF Rash, fever, headache Dermacenter tick. Proliferate in endothelium maculopapular rash on palms and cols. Centripetal spread. Widespread necrotic vasculitis