IV.

BACTERIOLOGY

CM: Infections assoc. with implanted

and prosthetic devices especially with
young, old and immunocompromised.

1.3.
-

Staphylococcus Saprophyticus
Cant ferment Mannitol
No visible rxn
Catalase +, Coagulase
Opportunistic Pathogen
CM: Urinary Tract Infection in WOMEN
who are SEXUALLY ACTIVE.

MORPHOLOGY:
1.

Cocci (Spherical)
-

2.

3.

Bacilli (Rod)
-

May have SQUARE CUT ends

Short round cells
No clusters

COCOBACILLI
Very short bacilli appearing like cocci.

1.

Streptococci:
2.1. Streptococcus Pyogenes
CM: Pharyngitis (Bacterial)
Antigen: M PROTEIN

Bacteria w/ SINGLE TURN

Comma shaped

Spirochetes (spiral)
-

A.

2.

Vibrio (Curved)
-

4.

Clusters: Staphylococci
Chains: Streptococci
Pairs: Diplococci

AKA: SPIRILLUM
Have regular / irregular shape
May have hook on one or both ends
Series of turns and twist
-

Gram Positive MO:

M Protein

Forms complex with

antibodies.

Complications:
Heart and Kidney:

Peritonsilar Abcess Formation

Otitis Media -> Mastoiditis

Scarlet Fever

Rheumatic Heart Disease.

(Tricuspid valves)

Acute post streptococcal

glomerulonephritis
SSxs: HEMATURIA, Hypertension

2.2. Streptococcus Mutans

Dental carries

Staphylococcus:
1.1. Staphylococcus Aureus
-

MANNITOL FERMENTER
Catalase positive
Coagulase positive
Normal Flora: Abundantly found in
anterior nares (Nostrils)
CM: Abcess formation / Suppuration
Food Poisoning
Toxin: ENTEROTOXIN
SSxs: Nausea and Projectile Vomiting
TOXIC SHOCK SYNDROME (TSS):

Toxin: TSST 1

Assoc. with women in

childbearing age who is
regularly menstruating who
uses: TAMPONS.
Skalded Skin Syndrome (SSS)

Assoc. with infants

SSxs: Abnormal desquamation

of skin.
Osteomytis

1.2. Staphylococcus Epidermidis

-

Cant ferment Mannitol

Porcelain white
Catalase +, Coagulase
Less virulent
Normal flora: Skin
Common contaminants of lab samples

2.3. Streptococcus Agalactiae

-

CM: Neonatal Sepsis,

Neonatal meningitis
NF: Female Genitourinary Tract

2.4. Streptococcus Pneumoniae

Unclassified / No group
Lancet shape
Encapsulated: QUELLUNG RXN. (+)
CM: Bacterial Pneumonia, Typical
Pneumonia
Tx: Penicillin, Amoxicillin
Alt: Erythromycin
3.

Aerobic Gram Positive Bacilli

3.1. Coryne Bacterium Diptheriae
Club shape Bacteria
Metachromatic Granules:
Babes Ernst Granules

Chinese letters in appearance

CM: Diptheria
Toxin: DIptheria Toxin
SSxs:
Pseudomembrane Formation

Formation of Gray patches

(Necrotic Tissue)


3.2. Listeria Monocytogenes
CM: GRANULOMATOSIS,
Infantiseptica Meningitis
4.

Mycobacterium
4.1. Mycobacterium Leprae
CM: Leprosy (Hansens Disease /
Cutaneous Tuberculosis)
2 Types:
A.
-

Tuberculoid:
Lesions: FLAT lesions
Lepromine test: (+)
LOWER amt. of MO in the lesions

B.
-

Lepromatous:
Lesions: NODULAR lesions
Well ventilated areas (Nasal Septum)
Lepromine test: (-)
HIGHER amt. of MO in the lesions

Tx: Dapsone (DOC)

Rifampicine
Clofazimine
4.2. Mycobacterium Tuberculosis
CM: Pulmunary Tuberculosis
SSxs:

Cough > 2 weeks

Unexplainable wt. loss

Chest pain

Back pain

Fever at night

Hemoptysis -> Bright Red

Dx:
1. Chest X-Ray:
Primary Infection: BASE of lungs
Reactivation: APEX of lungs
2. Sputum test / AFB test
- 3 samples / day, 40 days
3. Ziehl Neelsen staining method
-

3.1. Hot Method

Carbolfuschin + HEAT + Acid alcohol +
Meth. Blue
VR: (+) AFB -> RED
3.2. Cold Method
- Carbolfuschin + Acid alcohol + Meth.
Blue
4.

Culture: Lowenstein Jensen Media

Lowenstein Jensen Media

Former Dx of choice

Very selective & expensive

Extrapulmonary TB: Bone and

Ovary
5. PPD skin test/ Tuberculin test/
Mantoux test
Interpretation: >15 mm

Current infection

Exposure

Previous Infection

Immunity
Program: Directly Observed Treatment
Short Course

5.

5 Pillars:
1. Proper recording
2. LGU support
3. Treatment partner -> RPh
4. Proper tool for Dx
5. Steady drug supply

Anaerobic Gram Positive Spore Formers:

A. Bacillus:
A.1. Bacillus Athracis
A.2. Bacillus Cereus
B. Clostridium:
Anaerobic
B.1. Clostridium Botulinum
- CM: Flaccid Paralysis
- Toxin: BOTULINUM TOXIN (Acts as a ligand)
- MOA: INH. Of ACETYLCHOLINE
- MOT: Ingestion of contaminated fruits and
vegetables
- Canned goods with anaerobic growth
- Ingestion of HONEY:

CM: Floppy Baby Syndrome

B.2. Clostridium Tetani
- CM: Spastic Paralysis
- Toxin: TETANOPLASMIN
- MOA: INH. Of: 1. GABA & 2. GLYCINE
- SSxs:

Ophisthotonus

Arching of the back

Trismus
* Lock jaw, Inc. Sensitivity to
sound and light.

B.3. Clostridium Perfringens

Common in DB patients
CM: GAS GANGRENE

Liquefactive necrosis +
Bacteria
Toxin: ALPHATOXIN (Lecithinase)
B.4. Clostridium Dificile
Pseudomembraneous colitis
Drug Inducer
1.
2.
-

Common Clindamycin
Other Cephalosporin

DOC: Tx: Metronidazole

B. Gram Negative MO:

1. Spirochetes
A. Treponema Pallidium
MOT: Horizontal transmission (Sex)
Vertical transmission
(Congenital)
Incubation Period: 3 weeks

1.
2.

CM: PRIMARY SYPHILIS, Congenital

syphilis.

A.

Primary Syphilis: (3 stages)

1. Primary
CM: Primary Hard Chancre
Hard Chancre: Painless Ulcer Sore
Swelling of Groin Area
2. Secondary
Latent Stage
Can last from 3-33 years
Asymptomatic
Reactivation: Elederly Pxs,
Immunocompromised
3. Tertiary
CM: Multiple organ damage
GUMMAS FORMATION

Permanent Ulcers

CNS manifestations
B. Congenital Syphilis
Transferred by the mother to the baby
at: 2ND TRIMESTER OF PREGNANCY
CM: Still birth
If infant survives: Physical / congenital
deformities fully observed at age of 2
HUTCHINSON TRIAD:

Teeth: Hutchinson teeth

Eyes: Interstitial Keratitis

Ears: 8th CN deafness

Saddle Nose

Malberry Molars

Scaphold Scapula
Dx: Serology Prod Antibodies

Non Treponemal:
A. VDRL
B. RPR
Treponemal
A. TPHA
B. ETA-ABS
-

Tx: PEN G (DOC)

Alt: Erythromycin, Doxycycline,
Tetracycline

B. Leptospira Interrogans
CM: Leptospirosis
Primary source: Rodents
Transmission: Contact with
contaminated soil, water and
vegetables. Direct contact with
LEPTOSPIRE urine.

2 Types of Leptospirosis:
A. Amicteric
NON LIVER involvement
B. Icteric
LIVER involvement
SSxs: Jaundice, Hemorrhage,
Proteinuria
Tx: Doxycycline (DOC)
C. Borrelia
1. Borrelia Burgdorferi

CM: LYMES DISEASE

MOT: VECTOR: IXODES (Tick)
2. Borrelia Recurrentis
Relapsing fever
2.1. Endemic Form

Host: Rodents

Vector: Tick
2.2. Epidemic Form
-- Host: Rodents
-- Vector: Tick

2. NEISSERIA
a. Neisseria Gonorrhea
-Gram (-) Intracellular diplococcic
-MOT:
1. Sexually Transmitted
2. Congenital Transmitted
-Incubation: 3-7 days
-CM: -opthalmia neonatum
Mx: 1% erythromycin/tetracycline
Before: 1% AgnO3
-OCCURS w/n 2 hrs
-Gonnorhea: penile/ vaginal discharge
(tab)
-risk of infection (single intercourse)
-women (50%)
-men (20%)
-PID (Women) pelvic
Inflammatory disease:
*more common Chlamydia trachomatis
-tx: DOC > cefixime
-penicillin, ceftriaxone, ciprofloxacin
-before: Spectinomycin
b. Neisseria meningitis ( meningococci)
Charac: G (-) diplococcic
-shape: kidney bean shape
CM: -meningitis
-meningococcemia
TX:
DOC > ceftriaxone
Cefotaxime
-ONLY AG active against N. GONORRHEA
B. Bordetella
o

Bordetella pertussis
CM: whooping cough
Toxin: pertussis toxin
Most infectious stage: Catarrhal stage
-toxin production
Charac: -strict aerobe
-Bordet. Gengou: Mercury drop/
pearl colony

4. Haemophilus
a. haemophilus influenza
-most infectious: Type B
-CM: -bacteremia
-acute bacterial epiglottitis
-acute bacterial meningitis
-osteomyelititis
-joint infections
*-pneumonia

(2) encapsulated:
-N. meningitidis
-H. influenza

-MOT: fecal oral :improper hand washing

-CM: Dysentery
S/sx: Bloody diarrhea with scanty stool
& mucus
-tx: -Mx: ORS
-DOC > Fluoroquinolones; Ampicillin

b. Haemophilus ducreyi
MOT: Sexually transmitted
CM: SOFT CHANCRE / CHANCROID
-painful ulceration on the genitals

b. Escherichia coli
5 STRAINS:
o ETEC Enterotoxigenic E. coli
CM: Travellers diarrhea
o EPEC Enterohepatic E. coli
CM: Infantile diarrhea
o EIEC Enteroinvasive E. coli
CM: shigella like diarrhea
o EAEC Enteroagreggative E. coli
CM: diarrhea commonly assoc. w/ AIDS
PATIENTS
o EHEC Enterohemorrhagic E. coli
-aka: 0157: H7
-toxin: Shigatoxin/ Veratoxin
-CM: > bloody coprius diarrhea (w/o
fever)
>HUS (Hemolytic Uremic Syndrome)

b. Chlamydiae
a. Chlamydia
o

Chlamydia trachomatis
-MOT: horizontal transmission
-vertical transmission
-Symptomatic: Men
-Asymptomatic: Women
-CM:

Men conjunctivitus
-prostitis
-urethritis
-epidydimitis

Ophtalmia neonatorum
-manifest w/n 3 days

Common: pelvic inflammatory

disease
-tx: DOC > Tetracycline

b. Chlamydophilia
o Chlamydia psittaci
-Source: Psittacine birds (eg: parrots)
-CM: psitacossis
o

Chlamydia pneumonia
-CM: -Bronchitis
-Sinusitis
-Pneumonia
-Atherosclerosis (possible)

6. Mycoplasma and Ureaplasma

a. Mycoplasma pneumoniae
Charac:
-small, pleomorphic MO
-wall-less MO BUT they contain sterols
Gram stain cant be used for Dx
Dx: Dienes staining
-VR: Fried egg colony
-dark blue: center
-light blue: periphery/ surrounding
CM: -CAP (community-acquired pneumonia)
-Atypical Pneumonia
-walking pneumonia
-can still walk but has fever
Tx: DOC > Tetracycline
b. Ureaplasma urealyticum
Cm: non-gonnococcal urethritis in MEN
-lung infection/disease in INFANTS with low
birth weight
7. Enterobacteriaceae
a. shigella
-CA: Shigella dysenteriae *
-S. flexperi
-S. boydii
-S. sonnei

c. Salmonella typhi
-MOT: Infection of contaminated food
-poultry products (ex. Chicken, eggs)
-CM:

Salmonellolis/ bacterial gastroenteritis

-S/Sx: abdominal cramps
-body malaise

Typhoid fever
-enteric fever
-most severe salmonella disease
tx: DOC: Chloramphenicol

8. Pseudomonaceae
o Pseudomonas aeruginosa
-obligate aerobe
-MOT: Source/ inhibit soil, water, vegetation
-CM: Infection in burn wounds
odor: Sweet/ Corn taco/ Grape-like odor
Pigments:

pyocyanin colonization/ damaging the

endothelium and the tissues

pyoverdin fluorescent pigment

pyorubrin red

pyomelarin black
9. Campylobacter & Helicobacter
a. Campylobacter jejuni
Charac:
Shape: -S shape
-gull whing shape
-comma shape
CM: -acute onset of abdominal pain w/ profused
diarrhea with blood
Tx: DOC > Erythromycin
b. Helicobacter pylori
Charac: Urease producer
*urease
UREA NH3 (alkalinize)
-CM: -peptic ulcer disease (PUD)

*-Gastric carcinoma

-it does not result to anti-body

production
-not specific to antigen
-it does not result to
immunologic memory (nonrepetitive manifestation)

2 TYPES OF PUD:
o Duodenal ulcer
-90% of cases
-relieve by food (pain) OBESE
o

Gastric ulcer
-70% of cases

-Dx: Dx of disease ENDOSCOPY

-Urea breathe test
-culture
-tx:
a. Monotherapy
-obsolete
b. Double therapy
-seldomly used
c. Triple therapy
-PPI + 2 ABX (Amoxicillin + Metronidazole)
d. Quadruple therapy
-PPI + 2ABX + surface coating
-Bisubsalicylate
-Sucralfate
10. Vibrionaceae
a. Vibrio cholera
Charac: -comma shaped
-curved rod
-*** actively motile w/ polar flagellum
MOT:
-Ingestion of contaminated raw shellfish
(Halophiles)
Toxin: Cholera toxin
MOA: inc. in conc. CAMP inc. in Cl channels
CM: Rice watery stool
Culture: TCBS Thiosulfate citrate bile sucrose agar
V. cholera yellow colony
Tx: Mx: ORS
-DOC: Doxycycline
b. Vibrio parahemolyticus
MOT: Ingestion of OYSTER
CM: Cholera like diarrhea
Culture: TCBS GREEN COLONY
c. Vibrio vulniticus
CM: Severe wound infection
Culture: TCBS BLUE GREEN COLONY

Specific immunity
-requires recognition
-there is LAG TIME BEFORE THE
RESPONSE
-results to antibody production
-specific to antigen
-results to immunologic
memory

B. Cells involved in immunity

1. Granulocytes (BEN)
a. Basophils
-present in allergic rxns
-fxn: release of histamine granules
*Mast cells
-found in the visceral organs
-fxn: release of histamine granule
(BOARD EXAM: INTAL cromolyn sodium)
b. Eosinophils
-present:

Type I Hypersensitive rxn

(allergic rxn)

Helminthic infection
c. Neutrophils
-fxn: 1 Phagocytosis
-present: -bacterial infection
-acute inflamm.
2. Agranulocytes
a. Monocytes & Macrophages

Monocytes
-immature/ young
macrophages
-NO phagocytic action
Macrophages
-mature monocytes
-present: chronic inflamm.
-fxn:
-1 phagocytosis
-Antigen presentation

V. IMMUNOLOGY
A. Introduction
1. Immunity physiological process in
w/c the body (SELF) recognizes itself from the nonself
(foreign)
o

2. TYPES OF IMMUNITY
Non-specific immunity
does not require recognition
-the response is IMMEDIATE

b. Lymphocytes

B lymphocytes (B-cells)

-fxn: -Antigen presentation

-Matures plasma cells (ABY
production)
-Memory cells
-immunologic memory

T lymphocytes (T cells)
-2 TYPES:
a. Helper t-cell (CD4 cells)
-fxn: Stimulate the production
of B-cells & cytotoxic t-cells

D. Specific immunity
1.

TWO TYPES OF SPECIFIC IMMUNITY

a. humoral immunity
-B cells
- Antibody production
b. cellular- mediated immunity
-T cells

2.

b. Cytotoxic T-cell (CD8 t-cells)

-fxn:
binds
to
microbial
surfaces and initiates an attack
C. Non specific immunity: 3 Types
1. Inflammation
2. Phagocytosis
3. Complement system

LYMPHOID ORGANS
a. primary lymphoid organs
-fxn: maturation of lymphocytes
-ex. Bone marrow B cells
Thymus T cells
b.

secondary lymphoid organs

-fxn: activation of lymphocytes
-ex: -lymph nodes (cervical, inguinal)
-spleen
-tonsils
-peyers patches small intestines

3.

Immunoglobulin (antibodies)

4.

Types of Immunoglobulin
a. IgE
-present in type I HS rxns (allergy)

3. COMPLEMENT SYSTEM
-1 goal: create the MAC (Membrane Attack
Complex)
-series: C1 C4 C2 C3 C5 C6 C7 C8 C9
1.

2.

CLASSICAL PATHWAY
-starts: C1
-mediated by antibodies (IgG, IgM)

Alternative pathway
-starts: C3
-not mediated by antibodies

5.

3.

Mannose binding lectin pathway

-starts: C4C2
-not mediated by antibodies

b.

IgM (malaki, mauuna)

-largest immunoglobulin (Macroglobulin)
-first to respond

c.

IgG
-can cross the placental barrier

d.

IgA
-secretory immunoglobulin found in body
fluids & secretion: tears, saliva, sweat

e.

IgD
-no known function
-found in B-cell receptors

Types of hypersensitivity rxns

a. Antibody mediated HS rxn: -Type 1, 2, 3
a.1 Type 1: Hypersensitivity rxn:
-mediated by: IgE
-aka: immediate HS rxn
-ex:
-allergic rxns
-anaphylactic rxn

-bronchial asthma
a.2 Type 2: Hypersensitivity rxn:
-mediated by: IgG, IgM
-Ig binds to the surface of MO
-ex:
o

Erythroblastosis fetalis
-Rh mother incompatible w/ the body
Rh (-) mother; Rh (+) baby
Rx: Rhogam

Graves disease
Hyperthyroidism
Antibody mimics the actions of TSH

a.3 Type 3: Hypersensitivity rxn

-mediated by: IgG
-antigen antibody complex formation

-ex:

-kidney acute postretococcal

glomerulonephritis
-arthus rxn
b.

Cellular mediated HS rxn

o Type 4 HS rxn
-mediated by: helper T1 cells
-aka: delayed type of HS rxn
-ex:
-tuberculin skin tets
-contact dermatitis