Documenti di Didattica
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REVIEW NOTES
MEDPGNOTES
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CONTENTS
CULTURE AND STERILISATION ...................................................................................................................................... 9
CULTURE ................................................................................................................................................................... 9
STERILISATION........................................................................................................................................................... 9
DISINFECTION ......................................................................................................................................................... 10
BACTERIAL GENETICS .................................................................................................................................................. 11
GENERAL FEATURES OF BACTERIA.......................................................................................................................... 11
GRAM POSITIVE AND GRAM NEGATIVE ORGANISMS............................................................................................. 12
LIGAND AND HOST RECEPTORS FOR MICROORGANISMS ...................................................................................... 12
MULTIPLICATION OF BACTERIA .............................................................................................................................. 13
BACTERIAL RESISTANCE .......................................................................................................................................... 13
BIOTERRORISM AND VESICANTS ............................................................................................................................ 14
BACTERIOLOGY ........................................................................................................................................................... 15
GENERAL FEATURES OF BACTERIA.......................................................................................................................... 15
FEATURES OF STAPHYLOCOCCUS ........................................................................................................................... 17
SPECIES OF STAPHYLOCOCCUS ............................................................................................................................... 18
DISEASES CAUSED BY STAPHYLOCOCCUS ............................................................................................................... 19
TOXINS OF STAPHYLOCOCCUS ................................................................................................................................ 19
STAPHYLOCOCCAL FOOD POISONING .................................................................................................................... 20
FEATURES OF STREPTOCOCCUS.............................................................................................................................. 20
SPECIES OF STREPTOCOCCUS.................................................................................................................................. 21
DISEASES CAUSED BY STREPTOCOCCUS ................................................................................................................. 22
TOXINS OF STREPTOCOCCUS .................................................................................................................................. 22
CROSS SENSITIVITY OF STREPTOCOCCAL ANTIGEN ................................................................................................ 23
ENTEROCOCCUS...................................................................................................................................................... 23
PNEUMOCOCCUS.................................................................................................................................................... 23
GENERAL FEATURES OF NEISSERIA ......................................................................................................................... 24
NEISSERIA GONORRHOEA ....................................................................................................................................... 24
NEISSERIA MENINGITIDIS........................................................................................................................................ 25
GENERAL FEATURES OF CLOSTRIDIA....................................................................................................................... 26
CLOSTRIDIUM PERFRINGENS .................................................................................................................................. 26
GAS GANGRENE ...................................................................................................................................................... 27
CLOSTRIDIUM TETANI ............................................................................................................................................. 27
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CHOLERA ................................................................................................................................................................. 47
HALOPHILIC VIBRIO ................................................................................................................................................. 47
ATYPICAL MYCOBACTERIA ...................................................................................................................................... 48
GENERAL FEATURES OF RICKETTSIA ....................................................................................................................... 49
ENDEMIC TYPHUS ................................................................................................................................................... 49
EPIDEMIC TYPHUS................................................................................................................................................... 49
SCRUB TYPHUS........................................................................................................................................................ 50
RICKETTSIAL POX..................................................................................................................................................... 50
ROCKY MOUNTAIN SPOTTED FEVER ....................................................................................................................... 50
Q FEVER................................................................................................................................................................... 51
EHRILICHIA .............................................................................................................................................................. 51
CHLAMYDIA............................................................................................................................................................. 51
MYCOPLASMA......................................................................................................................................................... 52
NON VENERAL TREPONEMES.................................................................................................................................. 53
Yaw and Pinta ............................................................................................................................................................. 53
LEPTOSPIRA............................................................................................................................................................. 54
BORRELIA ................................................................................................................................................................ 54
VIROLOGY ................................................................................................................................................................... 55
GENERAL FEATURES OF VIRUS ................................................................................................................................ 55
HERPES VIRUS ......................................................................................................................................................... 57
PARVOVIRUS ........................................................................................................................................................... 58
EBSTEIN BARR VIRUS............................................................................................................................................... 58
CYTOMEGALOVIRUS ............................................................................................................................................... 59
ROSEOLA INFANTUM .............................................................................................................................................. 59
VARICELLA ZOSTER VIRUS ....................................................................................................................................... 59
ADENOVIRUS........................................................................................................................................................... 60
ROTAVIRUS ............................................................................................................................................................. 61
SMALL POX.............................................................................................................................................................. 61
PAPOVA VIRUS ........................................................................................................................................................ 61
POLIO VIRUS............................................................................................................................................................ 62
ENTEROVIRUS ......................................................................................................................................................... 63
COXSACKIE VIRUS.................................................................................................................................................... 63
INFLUENZA VIRUS ................................................................................................................................................... 63
MEASLES ................................................................................................................................................................. 64
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MUMPS ................................................................................................................................................................... 65
RABIES ..................................................................................................................................................................... 66
GENERAL FEATURES OF ARBOVIRUS....................................................................................................................... 67
DENGUE .................................................................................................................................................................. 67
CHIKUNGUNYA........................................................................................................................................................ 68
YELLOW FEVER ........................................................................................................................................................ 68
JAPANESE ENCEPHALITIS ........................................................................................................................................ 68
WEST NILE FEVER .................................................................................................................................................... 69
KYASANUR FOREST DISEASE ................................................................................................................................... 69
HANTA VIRUS .......................................................................................................................................................... 69
RESPIRATORY SYNCITIAL VIRUS .............................................................................................................................. 70
REOVIRUS................................................................................................................................................................ 70
RUBELLA .................................................................................................................................................................. 70
FEATURES OF HIV .................................................................................................................................................... 71
TRANSMISSION OF HIV ........................................................................................................................................... 72
EPIDEMIOLOGY OF HIV ........................................................................................................................................... 73
MANIFESTATIONS OF AIDS ..................................................................................................................................... 73
KAPOSIS SARCOMA ................................................................................................................................................ 74
DIAGNOSIS OF AIDS ................................................................................................................................................ 75
TREATMENT OF AIDS .............................................................................................................................................. 75
PREVENTION OF HIV ............................................................................................................................................... 77
PRIONS AND SLOW VIRUS....................................................................................................................................... 78
MYCOLOGY ................................................................................................................................................................. 79
GENERAL FEATURES OF FUNGI ............................................................................................................................... 79
DIMORPHIC FUNGI.................................................................................................................................................. 80
DERMATOPHYTES ................................................................................................................................................... 80
CRYPTOCOCCUS ...................................................................................................................................................... 80
CANDIDA ................................................................................................................................................................. 81
PNEUMOCYSTIS JEROVECI ...................................................................................................................................... 82
BLASTOMYCOSIS ..................................................................................................................................................... 82
HISTOPLASMOSIS .................................................................................................................................................... 82
ASPERGILLUS........................................................................................................................................................... 83
MUCOR ................................................................................................................................................................... 83
MADURELLA ............................................................................................................................................................ 84
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SPOROTRICHOSIS .................................................................................................................................................... 84
CHROMOBLASTOMYCOSIS...................................................................................................................................... 84
PROTOZOA .................................................................................................................................................................. 84
GENERAL FEATURES OF PROTOZOA ....................................................................................................................... 84
ENTAMOEBA HISTOLYTICA ..................................................................................................................................... 85
AMOEBIC MENINGOENCEPHALITIS ........................................................................................................................ 86
GIARDIA................................................................................................................................................................... 86
LEISHMANIA............................................................................................................................................................ 86
TRYPANOSOMA....................................................................................................................................................... 88
TOXOPLASMA.......................................................................................................................................................... 89
BABESIOSIS.............................................................................................................................................................. 90
CRYPTOSPORIDIOSIS ............................................................................................................................................... 90
ISOSPORA ................................................................................................................................................................ 90
CYCLOSPORA ........................................................................................................................................................... 90
BALANTIDIUM COLI................................................................................................................................................. 90
FEATURES OF PLASMODIUM .................................................................................................................................. 91
FEATURES OF MALARIA .......................................................................................................................................... 92
EPIDEMIOLOGY OF MALARIA .................................................................................................................................. 93
DIAGNOSIS OF MALARIA ......................................................................................................................................... 93
TREATMENT OF MALARIA ....................................................................................................................................... 93
HELMINTHS ................................................................................................................................................................. 95
GENERAL FEATURES OF HELMINTH ........................................................................................................................ 95
CLONORCHIS ........................................................................................................................................................... 96
DIPHYLLOBOTHRIUM LATUM ................................................................................................................................. 96
FASCIOLA HEPATICA................................................................................................................................................ 96
FASCIOLOPSIS BUSKI ............................................................................................................................................... 96
ASCARIS................................................................................................................................................................... 97
TAENIA SOLIUM ...................................................................................................................................................... 97
NEUROCYSTICERCOSIS ............................................................................................................................................ 97
TAENIA SAGINATA................................................................................................................................................... 98
ECHINOCOCCUS ...................................................................................................................................................... 98
FEATURES OF FILARIASIS......................................................................................................................................... 99
MANAGEMENT OF FILARIASIS .............................................................................................................................. 100
ENTEROBIUS.......................................................................................................................................................... 100
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Robert Koch
M.leprae, T.pallidum, N.gonorrhea, E.coli
(cannot be grown in cell free media also)
Antibiotics cure the disease
200 nm
1,00,000
Fluorescence microscope
Basal media
Enrichment media
Differential media
Blood Agar
Bacteriostatic
Promotes growth of staphylococcus aureus and candida
4-6
Virus, Chlamydia, Rickettsia
Treponema pallidum, Pneumoystis jiroveci,
Rhinosporidium seeberi
M. leprae, Rickettisa, T. pallidum
M.leprae, Treponema pallidum
Chemically defined media
Pneumocystis jiroveci, Rhinosporidium
seeberi
STERILISATION
Asepsis means
Process of destroying all microbes including spores
NOT a complete sterilization
Most resistant to antiseptics
Decreasing order of resistance to sterilization
Sterilization of prion
Reliably used for hand washing
Savlon contains
Algae growth in water controlled by
NOT true about Phenol
Sporicidal agents
Sporicidal
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Chlorhexidine
Incineration
Hot air oven
Syringes
Bronchoscope
DISINFECTION
Disinfectants
Disinfectant destroys
NOT true about disinfectants
Rideal and walker coefficient is employed for
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BACTERIAL GENETICS
Phenol
Precurrent disinfection
Hand washing, pasteurization of milk,
chlorination of water
Bleaching powder, Halozone tablets, Sodium
hypochlorite
50 gm/lit
Boiling, autoclaving, burning, cresol
Sodium hypochlorite
Lysol
Intermediate disinfectant
Ammonium compounds
Phenol, resorcinol, basic fuschin, boric
acid, acetone
2450 MHz
Chorhexidine
Semi critical items need low level disinfection
100% alcohol
Hugh Leifson test (to differentiate micrococci from
staphlococci)
Clostridia
BACTERIAL GENETICS
GENERAL FEATURES OF BACTERIA
Smallest size that can be seen by naked
eye
Smallest size that can be seen by light
microscope
Smallest size that can be seen by electron
microscope
Dye used in fluorescent microscopy
Total number of microbes
Rearing of animals under sterile conditions
Prokaryotic organism have
Prokaryotes refers to organism with
Prokaryotes are characterized by
Prokaryotes have
Prokaryotic counterpart of mitochondria
200 micron
0.3 micron
10^(-4) micron
Auramine
10^30
Gnotobiotics
DNA without Nucleus
Chromosome
Absence of nuclear membrane
DNA
Mesosomes
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BACTERIAL GENETICS
GRAM NEGATIVE
3 layers (inner cytoplasmic membrane,
thin peptidoglycan, LPS)
High lipid
Endotoxin
Aromatic aminoacids, indole ring (eg.
Cholera), periplasmic space, porin channel,
resistant to penicillin and lysozyme attack
Associated with Pili, Fimbriae
ORGANISM
LIGAND
Erythrocyte binding protein 175
Merozoite
Surface lectin
Hemagglutin
Hemagglutin
Glycoprotein C
HOST RECEPTOR
Glycophorin A
Duffy antigen
N acetyl glucosamine
Sialic acid (N acetylneuramic acid)
CD 46/mosein
Heparin sulphate
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BACTERIAL GENETICS
MULTIPLICATION OF BACTERIA
Phase of bacterial growth during which growth rate of
bacteria is constant
Sporulation occurs in
Sporulation does NOT occur in
A bacterium can divide every 20 minutes. how many
bacteria will be there if there is exponential growth for
3 hours
Substance when added to a culture causes inhibiton of
multiplication but on removal enhanced growth
Area of Lysis produced by Bacterial Lawn Culture
True about bacteriophage
Lambda phage
Stationary phase
Stationary phase
Live organisms
512
Bactericidal
Plaque
It imparts toxigenicity to bacteria
In lysogenic phase it fuses with host chromosome and
remain dormant, in lytic phase it fuses with host
chromosome and replicates, in lytic phase it cause cell
lysis and releases virus particles
Type C response
Lytic and lysogenic phase occur together
Virus that invade bacteria
Transduction
BACTERIAL RESISTANCE
Bacteria may acquire characteristics by
Antibiotic resistance
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BACTERIAL GENETICS
Fimbriae
Pili
Staphylococcus aureus, Vibrio cholera,
Shigella dysenteriae
Salmonella
Streptococci
Transposons
Transposons
Conjugation
Conjugation
Conjugation
Bacteriophage
Transformation
Bacillus, hemophilus, pneumococcus
Transduction
Bacteria
Transferred by conjugation, mediate drug resistance,
determine pili production
Involved in conjugation and multidrug resistance
transfer, Imparts capsule and pili formation, Eliminated
by heating with radiation, Transmission of different
species, Can cause lysogenic conversion
R.Plasmid
Drug resistance
Extrachromosomal
Sexduction
Minimum inhibitory concentration
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BACTERIOLOGY
Hyaluronidase
BACTERIOLOGY
GENERAL FEATURES OF BACTERIA
Bacteria
Bacteria does NOT divide by binary
fission
Bacterial cell wall is composed of
Zwitter ionic pattern of capsular
polysaccharide is responsible for
Responsible for inherent virulence of organism
Bacteria survive intracellularly by inhibiting
Shape of Cocci
Normal microbial flora
Normal bacterial flora
Pharyngoscleroma is a
Difference between gram positive and gram negative
organisms is that gram negative organisms contain
Steps in gram staining
Grams stain is NOT useful in diagnosing
Which is NOT present in gram negative bacteria
NOT gram negative
Acid fast organisms
Acid fast organisms
Bipolar staining
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BACTERIOLOGY
Bacteroides fragilis
Bacteroides may cause
Bacteroides cause
Bacteroides melaninogenica is associated
with
Bacteremia due to bacteroides fragilis do NOT cause
NOT useful in anaerobic infection
Drug of choice for bacteroides infection
Meleney gangrene
PAPA
Exotoxins are
Exotoxin
NOT true about exotoxins
Endotoxin from gram negative organism
Gram negative bacteria without endotoxin
Act by increasing c-AMP level
Heat labile toxin is associated with
Heat stable toxin is associated with
Preformed toxin is important in food poisoning due to
Preformed toxin
Heat stable enterotoxin
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BACTERIOLOGY
FEATURES OF STAPHYLOCOCCUS
Staphylococcus aureus
Staphylococci
Staphylococcus
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BACTERIOLOGY
Antiteichoic acid
Hyaluronidase
5,8
Transduction
S.aureus is coagulase positive
Coagulase test
Staphylococci
Most common source of infection is by cross infection
from infected patients
Catalase negative
Chromosomally mediated
Staphylococcus
Alteration in penicillin binding protein (MeCA gene)
30 degree Celsius
Resistance may be produced because of
hyperproduction of beta lactamase, expression of
resistance is enhanced by incubating at 37*C during
susceptibility testing
Chromosomal MecA gene
Necrotizing fasciitis, necrotizing pneumonia, sepsis with
Waterhouse Friedrichson syndrome, Purpura fulminans
Necrotizing fasciitis
Vancomycin, Teichoplanin, Linezolid
Quinupristin/dalfopristin, Linezolid, Teicoplanin
Teicoplanin
Cotrimoxazole, Ciproflaxacin, Vancomycin
Vancomycin given empirically to all patients
Glycopeptides
Carbapenem
Cefaclor
SPECIES OF STAPHYLOCOCCUS
Staphylococcus aureus differ from staphylococcus
epidermidis by
ICU on CVP line, gram positive cocci, catalase positive
and coagulase negative
MC gram positive cause of UTI among sexually active
women
Gram positive cocci
Coagulase positive
Staphylococcus epidermidis
Staphylococcus saprophyticus
Staphylococcus saphrophyticus cause UTI in female.
micrococci are oxidase positive, pneumococci are
capsulated
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BACTERIOLOGY
Staphylococcus
Staphylococcus aureus
Staphylococcus
Staphylococcus aureus
Staphylococcus aureus
Furuncle, sycosis barbae
Staphylococcus aureus
Staphylococcus aureus
Staphylococcus
Staphylococcus aureus
Staphylococcus aureus
Hair follicle
Staphylococcus
Lower neck
Incision and drainage
Staphylococcus aureus
Coagulase positive staphylococci aureus
Staphylococcus aureus
Coagulase negative staphylococci
Coagulase negative staphylococci (Staphylococcus
epidermidis)
Coagulase negative staphylococci
Infect indwelling prosthesis
Forgotten tampon
Clostridium sordelli (endometrium)
Infected measles vaccine
Large amount IL-2
Staphylococci
TOXINS OF STAPHYLOCOCCUS
Superantigens
Staphylococcus infection spreads by
Synergohymenotrophic toxin of staphylococci consists
of
Panton valentine leucocidin toxin is associated with
Panton valentine (leucocidin) toxin is
associated with
Hot cold phenomenon in staphylococcus is due to
Staphlococcal toxic shock syndrome is due to
Ritters syndrome is caused by
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BACTERIOLOGY
Exfoliative toxin
Erythrogenic toxin
FEATURES OF STREPTOCOCCUS
Differentiation of streptococci from staphylococci
Streptococci
Streptococci
Lancefield group of streptococci is done using
Lancefield group A contains
PYR positive
Lancefield classification based on
Streptococcus pyogenes is classified on the basis of
Mainly responsible for virulence in streptococci
Nephritogenic strain of Streptococci identified by
Classification of pathogenic streptococci into group
A,B,C,D,G is based on
Streptococcus pyogenes with type 12 M protein cause
Micrococci are
A child had a skin infection, a catalase negative
organism was isolated which showed haemolysis
andwas sensitive to bacitracin. Another doctor isolated
a similar organism from the throat of the child. The
correct statement is
Boy with skin ulcer on leg reveals beta hemolysis. Sore
throat culture also revealed beta hemolysis. Similarity is
Infective skin lesions of leg in infants, gram positive
Catalase test
M protein responsible for virulence, mucoid colonies
are virulent, no resistance to penicillin has been
reported
Streptodornase cleaves DNA, Streptolysin O is active in
reduced state (oxygen labile)
Group C carbohydrate antigen
Streptococcus pyogenes alone
Enterococcus, streptococcus pyogenes
Carbohydrate antigen
M protein
M protein
M typing
Antigenicity of cell wall carbohydrate
Soft tissue infection resembling TSS of Staphylococcus
Oxidase positive
Skin infection by group D
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BACTERIOLOGY
Bacitracin test
Capsular hyaluronic acid
Virulent but M protein is NOT responsible
for production of mucoid colonies
Lipoteichoic acid of streptococcus pyogenes
Capsule of hyaluronic acid
Low in acute glomerulonephritis
Serotype A,C,K
Pyrogenic toxin A is plasmid mediated
Pikes media
SPECIES OF STREPTOCOCCUS
Streptococci with no lancefield antigen
classification
A patient with RHD developed infective endocarditis
after dental extraction. Most likely organism
Causative organism of late prosthetic valve endocarditis
Features of streptococcus viridans
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BACTERIOLOGY
S. salivarius
Blood agar
Streptococci
Streptococcus pyogenes
Bacitracin sensitive
Group A beta hemolytic streptococci
Infection of fascia and subcutaneous tissue, MC group A
beta hemolytic streptococci, surgical debridement is
mandatory
Beta hemolytic Streptococci
Peu de orange texture
Streptococcus pyogenes
Streptococcus pyogenes
Erysipelas
Contagious and infectious, Common in tropics
Epidermolysis bullosa
Neonatal meningitis
UTI
Anerobic streptococci
Puerperal infection
Microaerophilic streptococci
Penicillin
Injection benzathine penicillin
Debridement, penicillin, clindamycin
TOXINS OF STREPTOCOCCUS
Toxin produced by S.pyogenes
Toxin of streptococcus causing hemolysis
Toxin involved in streptococcal toxic shock syndrome
Streptococcal toxic shock syndrome is due
to
Antigenically similar to Streptolysin O
Streptolysin O is inactivated by
Post streptococcal infection is best diagnosed by
Serological marker for retrospective diagnosis of
infection due to streptococcus pyogenes
Streptococcal glomerulonephritis is best diagnosed by
Enterotoxin is NOT produced by
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BACTERIOLOGY
Synovial fluid
Cardiac valves
Vascular intima
Myocardium
Skin antigen
ENTEROCOCCUS
Enterococcus
Beta hemolytic bacteria resistant to vancomycin,
growth in 6.5% NaCl, Non bile sensitive
ICU, central venous line 1 week, ceftazidime and
amikacin. Spike of fever, blood culture positive for gram
positive cocci in chains catalase negative. Vancomycin
started culture remained positive even after 10 days of
therapy
Organism when isolated in blood require synergistic
activity of penicillin plus an aminoglycoside for
appropriate therapy
Intrabdominal abscess. Vancomycin, gentamycin,
ampicilin resistant. Grows well in presence of 6.5% NaCl
and arginine. Bile ascenlin hydrolysis is positive
Treatment of enterococcus infection
Drugs approved for vancomycin resistant enterococci
Enterococcus resistance
Enterococcus fecalis
Enterococcus fecalis
Ampicillin
Linezolid, Quinopristin/Dalfopristin
Chromosomally mediated
PNEUMOCOCCUS
Discovery of gene transformation come
from study of
Most virulent type of pneumococci
Pneumococcus
Pneumococci
Streptococci pneumonia
Streptococcus pneumonia
Enolase binds to
Streptococcus pneumonia
Type 3
Capsule aids in virulence, commonest cause of otitis
media, respiratory tract carriers are most common
source of infection
Pneumolysin is a thiol activated toxin, exerts a variety
of events on ciliary and PMNs action, Autolysin can
contribute to pathogenesis of pneumococcal disease by
lysing bacteria, Anticapsular antibodies are serotype
specific
Bile insoluble and optochin sensitive
Alpha hemolytic, greenish color on blood agar due to
reduction of iron in hemoglobin
Fibronectin
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BACTERIOLOGY
Pneumococcus
Transformation
Capsular polysachharide
Pneumolysin
Pneumococcus
Pneumococcus
Triad of meningitis, pneumonia and
endocarditis. Caused by Streptococcus
pneumonia
Optochin test
Optochin
Bile solubility
Gram positive cocci in pairs, catalase negative bile
soluble
Pneumococci
Capsular swelling (Pneumococcus)
Pneumococcal
Streptococcus pneumonia
Virulence of pneumococci depend only on production
of capsular polysachharides
Catalase positive
Pneumococcal vaccine
NEISSERIA GONORRHOEA
Features of Neisseria gonorrhea
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BACTERIOLOGY
NEISSERIA MENINGITIDIS
Features of Neisseria meningitides
Intracellular gram negative diplococci
Only reservoir meningococci
Protein expressed in choroid plexus of
meningeal epithelium for binding of
meningococcal endotoxin
Skin reaction in meningococcal meningitis
is due to
Subcutaneous injection of gram negative organism
evokes hemorrhagic reaction after 24 hours. On
intravenous injection of same give rise to
Neisseria meningitides is associated with
NOT found in meningococci
Female with fever, red spot on applying BP cuff
Source of infection in menigococcus is mainly
MC cause of meningitides in children
NOT a cause of neonatal meningitis
Death from meningococcal disease is due to
Prophylaxis of meningococcal infection
Meningococcal meningitis
Endotoxin
Schwartzmann reaction
IgA1 protease
Plasmid
Neisseria meningitis
Carriers
Neisseria meningitides
Neisseria meningitides
Hypovolemic shock
Penicillin, sulfonamide, rifampicin
Disease is more common in dry and cold months,
Chemoprophylaxis of close contacts of cases is
recommended, Vaccine is not effective in children
below 2 years
Cephalosporin
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BACTERIOLOGY
Rifampicin
Capsular polysaccharide
A, C, Y, W135
Group B meningococci
CLOSTRIDIUM PERFRINGENS
Non motile clostridia
Clostridium perfringens
Clostridium perfringens
Clostridium welchii
Clostridium perfringens
Alpha toxin of clostridium perfringens
Food poisoning in Clostridium perfringens
NOT true about clostridium perfringens
NOT true about clostridium perfringens and gas
gangrene
NOT motile
Opacity around colonies of clostridium perfringes
Nagler reaction is shown by
Naglers reaction is due to
Clostridium perfringens
Commonest cause of gas gangrene, Normally present in
human feces, Principal toxin is alpha toxin, Gas
gangrene producing spores are NOT heat resistant,
Food poisoning producing spores are heat resistant, Gas
is invariably present in muscle compartment
Found in intestinal tract of some healthy
patients
Capsulated, non motile, type A causes gastroenteritis
A food poisoning, necrotizing enterocolitis, B and D
epsilon toxin, C enteritis necroticans, theta toxin perfringolysin
Liberation of phosphoryl choline from
lecithin and hemolysis
Stimulating calcium dependent alteration
in permeability
Gas gangrene producing strains of C.perfringens
produce heat resistant spores
Most important toxin is hyaluronidase
Clostridium perfringens
Lecithinase
Clostridium perfringens
Lecithinase
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BACTERIOLOGY
Cl.perfringens
Necrotizing enteritis
Clostridium perfringes
MC site is perineum
Clostridium welchi
GAS GANGRENE
Gas gangrene is caused by
Toxins responsible for gas gangrene
Clostridium perfringes causes
Not a cause of Gas gangrene
Gas gangrene is NOT caused by
Incubation period of clostridium septicum
gas gangrene
Incubation period of clostridium novyi gas
gangrene
Foaming liver
Hyperbaric oxygen is used in
Best way to prevent gas gangrene
Hypotension in case of gas gangrene is treated by
Treatment of gas gangrene after contaminated road
traffic accident
Treatment of gas gangrene
CLOSTRIDIUM TETANI
Clostridium tetani
Clostridium tetani
Clostridium tetani
Spherical and terminal bulging spore are seen in
Swarming growth of gram positive bacilli
Non flagellated Clostridium tetani
NOT true regarding clostridium tetani
Incomplete immunity
Wounds contaminated with fecal matter
Exotoxin bound to motor end plate
Spread through nerve, Variable incubation period
First symptom to spasm
Delayed
None
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BACTERIOLOGY
MANAGEMENT OF TETANUS
Drug used for tetanus
Metronidazole
PREVENTION OF TETANUS
Vaccine preventable neonatal disease
Vaccine routinely indicated in pregnancy
Maternal antibody does NOT protect neonate from
Tetanus
Immunization 10 years age, presents with clean wound
without laceration
A 37 weeks pregnant woman attends an antenatal clinic
at a primary health centre. She has not any antenatal
care till now. Best approach regarding tetanus
immunization in this case would be
Previously unimmunized against tetanus, clean non
penetrating wound sustained 2 hours before
Pregnant women, full course of tetanus immunization,
again to deliver within 11 months, she will require
No of tetanus toxoid injection to vaccinate all pregnant
woman in one year in a village with population of 1000
with birth rate of 30/1000 in one year
A full course of immunization against tetanus with 3
doses of toxoid confers immunity for
Booster dose of tetanus should be given
every
Neonatal tetanus best prevented by
Most effective way of PREVENTING tetanus
NOT done to prevent tetanus
NOT a strategy for prevention of neonatal tetanus
Dose of human tetanus Immunoglobulin for post
exposure prophylaxis
Best preventive measure against Tetanus Neonatorum
Tetanus
Tetanus
Tetanus
TT and Ig both may be given in suspected cases
Single dose of tetanus toxoid
Give a dose of tetanus toxoid and explain to her that it
will not protect the newborn and she should take
second dose after 4 weeks even if she delivers in the
meantime
Tetanus toxoid complete course
0 doses of TT
60
10 years
5 years
Toxoid to mother
Tetanus toxoid
Injection penicillin to all neonates
Giving penicillin to newborn
250 units
Active immunization of mother
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BACTERIOLOGY
CLOSTRIDIUM BOTULINUM
Cl.botulinium causing human disease
Botulinium causing human disease
Non neurotoxic type of clostridium
botulinium
Contaminant in home canned vegetables and smoked
fish
Food poisoning associated with
constipation instead of diarrhea
Food poisoning in canned food is due to
Paralytic food poisoning is caused by
Botulinum toxin acts by
Most potent biological toxin
Botulinum toxin is
Botulinum toxin produce skeletal muscle paralysis by
A (severe), B, E
A, B, C, F
Type G (enterotoxic)
Clostridium botulism
Clostridium botulinium
Clostridia
Clostridia
Closure of ca++ channels at presynaptic membrane
Botulinium toxin
Phage mediated
Inhibiting release of acetylcholine
BOTULISM
Botulism
Botulism
Botulinum affects
Feature of botulism
Feature of Botulism
Infant botulism is caused by
Type of paralysis in botulism
Botulinium toxin
Most Powerful exotoxin
Botulinium toxin acts by
Mechanism of action of botulism toxin
Non Neurotic toxin of Botulism
Gene for botulism toxin is coded by
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BACTERIOLOGY
Botulism
Clostridium botulinum
Botulism
Respiratory Failure
Stool
Diarrhea
Ascending paralysis
Clostridial myonecrosis
Infant botulism is caused by ingestion of preformed
toxin
Corynebacterium
Corynebacterium jeikeium
Corynebacterium miniutissimum
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BACTERIOLOGY
Corynebacterium urealyticum
C.diphtheria gravis
C.striatum
CORYNEBACTERIUM DIPHTHERIA
Diphtheria
Corynebacterium diphtheria
Corynebacterium diphtheria
Corynebacterium diphtheria
Clostridium diphtheria
Kleb Loefflers bacteria (KLB)
Eleks gel precipitation test
Non motile
Albert staining, Ponders staining
Volutin granules
Metachromatic granules made of
Metachromatic granules are stained with
Tellurite plates should be incubated for
Corynebacterium diphtheria are cultured on
NOT true about corynebacterium diphtheria
Does NOT produce spore
Diphtheroids
Preisz Nocard bacillus
Non hemolytic frogs egg colony on
cysteine tellurite blood agar
FEATURES OF DIPHTHERIA
Diphtheria
Diphtheria
Diphtheria
Diphtheria is
Diphtheria
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BACTERIOLOGY
Diphtheria toxin
Skin test based on Neutralisation reaction
Shick test does NOT indicate
Positive Schick test indicate that person is
A negative schick test indicate
Immunization against diphtheria
Percentage of herd immunity required to prevent
endemic spread of diphtheria
2-5 years
Punched out ulcer
Diphtheria
Lymphadenopathy
Diphtheria
Laryngeal
Gray
Carriers
2-6 days
Diphtheria
Diphtheria
Myocarditis
Paralysis of accommodation
Lifelong immunity
Rash
Endotoxemia
Hepatic failure
Exotoxin
Protein synthesis (blocks elongation of protein)
Exotoxin, Toxin production depends on optimal
concentration of iron, Inhibiting protein synthesis,
Schick test demonstrates circulating antitoxin
Phage mediated
Schick test
Carrier of diphtheria
Susceptible to diphtheria
Immunity to diphtheria
Will prevent toxemia but NOT a carrier state
70%
MANAGEMENT OF DIPHTHERIA
Loeffler/Tinsdale selective medium
Child present with white patch over tonsils, diagnosis
made by culture in
Diphtheroids grow on
Selective media for isolation of diphtheria from carriers
Corynebacterium diphtheria can be grown within 6-8
hours on
Investigation of choice for diphtheria carrier
Investigation of choice for diphtheria carrier
Investigation NOT done for a child with fever and
pharyngitis
Prophylaxis of household contacts of diphtheria
Prophylaxis of diphtheria
Drug of choice for Diphtheria carrier
Drug for unimmunized contacts in Diphtheria
One unit of diphtheria antitoxin is defined as the
Diphtheria
Loeffler medium
Potassium tellurite medium
Potassium tellurite medium
Loefflers serum slope
Throat swab culture
Culture in tellurite blood agar
Widal test
Erythromycin
Erythromycin
Erythromycin
Erythromycin + Antitoxin + Toxoid
100 MLD of toxin
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BACTERIOLOGY
HEMOPHILUS
Hemophilus influenza
Hemophilus influenza produces
Hemophilus influenza
BORDETELLA PERTUSSIS
Bordetella pertussis
Bordetella pertussis is
Bordetella pertussis is associated with
Organism in which capsule does not have virulence
factor
Piracy of adhesins is associated with
Aluminum paint appearance
Whooping cough
Pertussis
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BACTERIOLOGY
BRUCELLA
Brucella
Brucella melitensis is common in
Brucella
Capnophilic brucella
Brucellosis
Pyrexia of unknown origin in veterinary doctor, gram
negative short bacilli, oxidase positive
Malta fever is caused by
Undulant fever
Disease occurring both in man and animals
Brucella commonly affect
Brucella infection
NOT a method of transmission of brucella
Brucella is NOT transmitted by
Medium for Brucella
Milk ring test for
Coombs test may be useful in
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BACTERIOLOGY
BARTONELLA
Bartonella henslae
Bacillary peliosis primarily involve
Bartonella Quintana
Trench fever
Intermediate host for trench fever
Bartonella bacilliformis
Stages of carrion disease
Carrion disease is transmitted by
Cat flea
Bacillary angiomatosis is caused by
Cat scratch disease is caused by
Macular scar
Mollaret debra test for
Cats are NOT associated with
Incubation period of Bartonellosis
Bacillary angiomatosis
Verruca peruana is caused by
ACTINOMYCES
True of Actinomyces
Mycetoma
Granules discharged in mycetoma contains
Actinomyces is
Most common actinomyces
Actinomycetoma is caused by
Actinomycotic mycetoma is caused by
Actinomycosis is caused by
Commonest form of actinomycosis
Actinomycosis
Actinomycosis
Rivalta disease
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BACTERIOLOGY
Actinomyces israeli
Actinomycosis
Wooden fibrotic masses
Actinomyces viscosus
Pelvic actinomycosis
Organism
Misnomer, inflammatory cells with
filaments of bacteria
Yellow
Actinomyces
Actinomyces Israeli
Actinomycosis
Actinomycosis
Acinomycosis
Towards the skin
Responds to antibiotics
Does NOT respond to antibiotics
Penicillin
Penicillin
NOCARDIA
Nocardia resemble actinomyces but morphologically
NOT true about nocardia
Causative organism of mycetoma
MC cause of mycetoma in India
MC cause of mycetoma in India
Persistent fever and cough. Features suggestive of
pneumonia. Aerobic branching gram negative filaments
that are partially acid fast
MC form of Nocardia
Characteristic infection of Nocardia asteroids
Stains for Nocardia
Nocardia is stained by
Best method for selective isolation of Nocardia
Nocardia is susceptible to
Aerobic
Penicillin is the drug of choice
Nocardia
Nocardia brasiliensis
Actinomadura madurae
Nocardia asteroids
Pneumonia
Brain abscess
Acid fast, alcian blue, mucin stain
Acid fast (Ziehl Nielson stain)
Paraffin bait technique
Amikacin
LISTERIA
Listeria is a
Temperature for listeria
LLO means
Listeria
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BACTERIOLOGY
BACILLUS ANTHRACIS
Anthrax bacilli is differentiated from
anthracoid bacilli by
Features of anthrax
Anthracoid bacilli
Only bacterium with capsule having
protein
Anthrax bacilli
Factors in bacillus anthracis
Non motile
Capsulated, non motile, response to
penicillin
Non capsulated, motile, no response to
penicillin
Bacillus anthracis (poly D glutamic acid)
Non motile, no flagella
Factor I edema factor, factor II
protective antigen, factor III lethal
factor
Bacillus anthracis
Plasmid is responsible for toxin production, Cutaneous
anthrax generally resolve spontaneously, Capsular
polysaccharide aids virulence by inhibiting phagocytosis
Non motile
Polypeptide capsule
Bacillus anthracis
McFadyean reaction
Bacillus
Bacillus anthrax
Bacillus anthracis
Bacillus anthracis
Anthrax
Bacillus anthracis
cAMP liberate edema factor, capsular polysaccharide
aids virulence by inhibiting phagocytosis, plasmid
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BACTERIOLOGY
BACILLUS CEREUS
A patient present with vomiting he had eaten rice 6
hours before. Most probable cause
Non invasive diarrhea is caused by
Characteristic of Bacillus cereus food poisoning
Selective medium for Bacillus cereus
Bacillus cereus
Bacillus cereus
Abdominal pain
Mannitol egg yolk phenol red polymyxin
agar (MYPA)
LEGIONELLA
Legionella is
Legionella
Transmission of Legionella
MC serotype isolated from humans
Toxicity of legionella through
Contaminated water source is associated
with infection of
Legionella by
28 year female, diarrhea, confusion, high grade fever,
bilateral pneumonitis
Pontiac fever is caused by
Causative agent of Pneumonia associated with Aerosols
spread
Epidemics are associated with
Legionella pneumophilia is associated with
Legionnaires disease cause
Good media for Legionnaires disease
Growth on charcoal yeast medium
Test for legionella in community
Treatment of choice for legionairres disease
Treatment for Legionella infection
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BACTERIOLOGY
CAMPYLOBACTER
Microaerophilic bacteria
Microaerophilic bacteria
Campylobacter jejuni
Alpha chain disease
Campylobacter associated with seagull
NOT true about Campylobacter
Fecal leucocytes are present in
One of the leading causes of travellers diarrhea
Method of choice for culture of stool for campylobacter
jejuni
Culture media for campylobacter
DOC fo Campylobacter Jejuni associated Diarrhoea
10 % CO2
Campylobacter
Microaerophilic, tumbling motility, Invasive
Immunoproliferative small intestine disease associated with
campylobacter jejuni
Campylobacter luri
Human is the only reservoir, Spore forming
Campylobacter
Campylobacter
Culture on Skirrows medium incubated at 42*C under
microaerophilic condition
CVA medium, Skirrow medium, Campylobacter blood
agar, Regan Lowe media
Erythromycin
HELICOBACTER
Helicobacter pylori
H.pylori
H. pylori
H.pylori found in
NOT true about H.pylori
Helicobacter pylori NOT associated with
Most sensitive test for H.pylori
PASTEURELLA
Mode of infection of Pasturella multocida
Common organism isolated from cat bite
Gram negative bacilli sensitive to penicillin
Features of pasteurella multocida
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BACTERIOLOGY
FRANSCIELLA
Ulcerated inguinal lymphadenopathy
Fransciella tularensis is related to
Tularemia
Parinaud complex is associated with
Treatment of tularemia
Fransciella
Rabbit
Ulcer with black base, chancriform lesion, buboes
Preauricular lymphnode enlargement
Gentamycin
YERSINIA
Yersinia pestis
Stalactite growth in ghee broth agar
Fermentation of glycerol is the basis of classification of
Bioterrorism agent
Plague is
Plague
Girl from shimla, fever, hypotension, malaise, axillary
and inguinal lymphadenopathy, culture in glucose broth
show stalactite growth
Most efficient vector for plague
Plague in Surat in 1995 has occurred after a silence
period of
Most dangerous type of Plague
Highly infectious clinical form of plague
Isolation is strictly recommended for
Incubation period of pneumonic plague
MC type of plague
Main reservoir of plague in India
Lifelong immunity NOT seen with
Maximum explosiveness of plague is determined by
Cheopsis index
Most effective method to break transmission chain in
plague in
Flea bite in wheat godown. Axillary lymphadenopathy
Plague patient is kept isolated till
Longest and shortest incubation period of plague are 7
days and 2 days respectively. time required to declare
an area free from plague is
Plague epidemic is controlled by
NOT done to control epidemic in plague
Treatment of plague
Drug of choice in chemoprophylaxis in contacts of a
patient of pneumonic plague
MC presentation of Yersinia enterocolitica
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BACTERIOLOGY
PSEUDOMONAS
Pseudomonas aeroginosa
Pseudomonas
Strictly anaerobic
Organism having considerable resistance to antiseptics,
disinfectants, antibiotics
Bacteria act by inhibiting protein synthesis
NOT true about pseudomonas
NOT a coccobacilli
Blue pus
Green coloured colonies
Gunmetal colonies
Fruity odour
Species of pseudomonas commonly associated with
intravenous catheter related infection
Puncture wound through sneakers in children is associated
with
Other Pseudomonas
Pseudomonas septicemia cause
Ecthyma gangrenosum is caused by
Shock associated with bullous skin lesion
Hot tub folliculitis is associated with
Green nail is due to
Does NOT cause food borne infection
Cetrimide agar for
Pseudomonas is eradicated by local
application of
Effective against pseudomonas
Pseudomonas producing extended spectrum beta
lactamase enzyme
Antibiotic potent against Pseudomonas
Drug of choice for Pseudomonas septicemia
Penicillin effective against proteus and pseudomonas
Cephalosporin active against Pseudomonas
Antipseudomonal penicillin
Antipseudmonal action
Carbenicillin
In treatment of pseudomonas infection, cabenicillin is
frequently combined with
NOT used in pseudomonas infection
NOT used for pseudomonas
NOT having good activity against pseudomonas
aerugenosa
NOT used against pseudomonas
NOT antipseudomonal
NOT an antipseudomonal
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BACTERIOLOGY
BURKHOLDERIA
Melidiosis is caused by
Chronic alcoholic agricultural worker, chills rigor,
bilateral crepitation with scattered rhochi, multiple
subcutaneous nodules on extensor surface. Gram
negative bacilli with bipolar staining, distinct rough
corrugated grey white colonies on blood agar. motile
oxidase positive
Melidiosis
Syndrome of respiratory distress and septicemia in cystic
fibrosis (Cepacia syndrome)
Burkholderia psedomallei
Melidiosis
E.COLI
Many E.coli isolated from UTI
E.coli
E.coli
E.coli
E.coli attached to surface with the help of
Lactose fermenting colonies on EMB agar
Serotype of E.coli causing hemorrhagic colitis
Enterohemorrhagic E.coli
EHEC
Enteroaggregative E.coli
Stacked brick pattern of adherence
Enterotoxigenic E.coli
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BACTERIOLOGY
Precipitin test
Decreasing protein synthesis
Vibrio cholera
E.coli food poisoning
ETEC
E.coli
McConkey medium
Sorbitol McConkey media
Enteroinvasive E.Coli
PROTEUS
Proteus
Phenylalanine deaminase positivity is
shown by
Proteus
Dienes phenomenon
Maximum urease production
Seminal smell on culture
Swarming growth
To prevent swarming, the percentage of Nutrient agar is
increased to
SALMONELLA
Organism requiring tryptophan for
growth
Microorganism that can enter freshly laid eggs
Feature common to all species of Salmonella
Antigen blocking agglutination of salmonella by O
antiserum
S.typhi
Salmonella
Indole negative
Vi
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BACTERIOLOGY
TYPHOID
Both lactose positive and lactose negative
colonies on EMB agar
NON gas producing salmonella
Agglutination with O antigen of S.typhi is inhibited by
Infective dose of Salmonella typhi
Food poisoning after 24 hours
Salmonella gastroenteritis
Salmonellosis
Typhoid
Typhoid
Incubation period of typhoid
Reserve and source of infection are same
for
10 year old child 10 days continuous fever, enlarged
spleen
Rose spot
Erythema marginatum
Coma vigil is seen in
Typhoid in children
Salmonella typhi infection in intestine
Pea soup stool
Muttering delirium is associated with
Salmonella typhi
Salmonella typhi
Vi antigen
10^2 to 10^5 bacilli
Salmonella gastroenteritis
Caused by animal products, Symptoms appear between
4 to 48 hours
Increased incidence in developed countries, Antacid
and prolonged antibiotic administration promote
infection, Food borne to man and animal
Urinary carriers are more dangerous, Vi ab is used for
detecting carrier, Urine carrier is associated with
anomalies
Male carriers though less are more dangerous
3 21 days
Enteric fever
Enteric fever
Enteric fever
Enteric fever
Enteric fever
Mild splenomegaly is usual
Affects Peyer patches
Typhoid
Typhoid
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BACTERIOLOGY
Antibody to H antigen
Widal test is an
rd
Diagnosis of typhoid in 3 week
st
Typhoid is diagnosed on 1 week by
NOT true about widal test
NOT true about Widal test
Typhoid carriers are NOT detected by
Drug of choice for carriers of typhoid
Most successful method for treatment of
typhoid carriers
Drug of choice for treatment of typhoid fever in
pregnancy
Treatment of salmonella typhi
Treatment of Chloramphenicol resistant typhoid
infection
NOT commonly used against enteric fever
Chemoprophylaxis is NOT done for
Ty21a is a
Typhoid oral vaccine is given
Immunization of choice for typhoid in India
Typhoid
Typhoid
Non involvement of ileum
Constipation
5-19 years
10-14 days
Stool culture negative for three times
Till three consecutive negative urine/stool culture
samples are obtained from the patient
Selenite F broth
Isolation of Vi antigen
Vi agglutination test
Tube agglutination test, Previous infection affects Widal
test, H antigen titre remains positive for several months
and reaction to it is rapid
Appears first and persists for long period
Agglutination test
Widal test
Blood culture
O antibodies are least useful
First test is confirmatory
Widal test
Ampicillin
Cholecystectomy with ampicillin
Ceftriaxone
Ciprofloxacin
Ciprofloxacin
Amikacin
Typhoid
Oral vaccine
1,3,5 days
Monovalent vaccine
SHIGELLA
Role of plasmid in conjugation first
described by Lederberg and tatum in
Shigella can be differentiated from E.coli by
Shigella
MC species of shigella in India
Most virulent shigella
Exotoxin is produced by
Shigella are subdivided based on their ability to ferment
Shigella dysenteriae
Shigella does not produce gas from glucose, Shigella
does not ferment lactose, Shigella is non motile
SMALL dose can cause infection, Associated with HUS,
causes bloody diarrhea, Gut pathology is due to toxin
Shigella flexneri
Shigella dysenteriae
Shigella dystenteriae
Mannitol
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BACTERIOLOGY
H antigen
Shigella sonnei
Shigella dysenteriae, shigella sonnei, shigella boydii
Shigella dysenteriae
Shiga toxin
Toxic megacolon
Isolation from feces
Stool culture
Deoxycholate citrate agar
Hektoen enteric agar
Triple sugar iron agar
FEATURES OF VIBRIO
Robert Koch discovered Vibrio cholera in
Vibrio cholera first isolated by
Cholera caused by
O139 vibrio is derived from
Vibrio cholera O139
Stain of vibrio cholera in Bengal
Pathogenecity of O139 vibrio is due to
Recent infection of cholera in india is caused by
Types of O1 vibrio
Eltor vibrio differentiated from classical cholera by
El tor cholera
El tor vibrio
El tor vibrio
Seventh pandemic of cholera caused by
Vibrio cholera
Vibrio cholera
Africa
Koch
Vibrio cholera 0.01
El tor
Clinical manifestations are similar to O1 el tor strain,
epidemiologically undistinguished from O1 El tor strain
O:139
O antigen
O139 vibrio ogawa
Classical, El tor
Chick erythrocyte agglutination
Infection is mild and asymptomatic, resistant to
polymyxin unit disc, chronic carriers are common
Humans are only reservoir, can survive in cold water for
2-4 weeks, killed by boiling for 30 seconds
More subclinical cases, less mortality, able
to survive longer, harder
E1 tor
Transported in alkaline medium, gram negative aerobic,
ferments glucose, grows on simple media, non
halophilic, man is only natural host
Has marked tolerance of alkaline pH, El tor is milder
than classical, Produces indole and reduces nitrate,
Synthesize neuraminidase
Vibrio cholera
0.5 1%
7% NaCl
Quorum sensing
Incessant chatting of microbes
Vibrio cholera
ETEC (but more potent)
Vibrio cholera
Motility, Binds to specific receptors
Neutophilia, Occurrence of many cases in the same
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BACTERIOLOGY
locality
Sulphuric acid
TCBS
VR Medium
TCBS-Thiosulphate, Citrate, Bile salt, Sucrose
CHOLERA
Incubation period less than 1 week
Prevalence of cholera measured by
Cholera transmission by
Mode of spread of cholera
Cholera
A convalescent case of cholera remain infective for
Cholera toxin acts by
Cholera toxin in small intestine acts by
Cholera toxin
Cholera
Vibriocidal antibody
Food and healthy carriers
John snow
Culture medium TCBS agar, produces indole and reduce
nitrate, synthesize neuraminidase
14-21 days
Stimulation of adenylate cyclase
ADP Ribosylation of G regulatory protein
Oligomeric protein composed of one A subunit and five
B subunits (AB5). A subunit detaches and becomes
activated by proteolytic cleavage, allowing it to catalyze
the ADP ribosylation of the Gs subunit of the
heterotrimeric G protein resulting in constitutive cAMP
production.
To bind GM1 ganglioside receptor
ADP ribosylation
Causes continued activation of adenylate cyclase
Neutrophilia
Cholera
Life threatening diarrhea
Hypovolemic shock
Furazolidone
Cotrimoxazole
Doxycycline
Continuous transmission in man
Safe water and sanitation
Cholera
Tetracycline
Mass chemoprophylaxis
Cresol
HALOPHILIC VIBRIO
Halophilic vibrio
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BACTERIOLOGY
Shell fish
Food borne enteritis, Kanagawa phenomenon hemolysis on
Wagatsuma agar
Vibrio parahemolyticus
Vibrio vulnificus
Vibrio vulvifuncus
Wound maker
ATYPICAL MYCOBACTERIA
Mycobacterial species differentiated by
Mycobacterium other than tuberculosis
Tubercle bacilli showing yellow orange pigment
MC cause of non tubercular mycobacteria pulmonary
disease
Mycobacterium avium
NOT photochromogen
Lady windermere syndrome is caused by
Prevention of MAC in HIV
Second most common cause of non tubercular mycobacteria
pulmonary disease
Can cause disease indistinguishable from tuberculosis
Exposure to the organism having antagonistic effect on
BCG
Rapidly growing atypical organism NOT involved in lung
infection
Scotochromogens
Photochromogens
Mycobacterium siniae is
Rapid growers
Rapid grower and pathogenic to humans
Cutaneous lesions produced by
Mycobacterium can be grown in 1-2 weeks
Pedicure bath and leg shaving is associated with
Swimming pool granuloma (fish tank)
Mycobacterium that grows best at 45*C
Battey bacillus
Mycobacterium ulcerans
Non pathogenic
Mycobacterium vaccae
Most useful in treatment of mycobacterium avium
complex
Active against atypical mycobacteria
Drug of choice for treatment of skin infection with
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BACTERIOLOGY
Pyrazimanide
ENDEMIC TYPHUS
Endemic typhus
Vector for endemic typhus
Mooser bodies
EPIDEMIC TYPHUS
Epidemic typhus is also known as
Only rickettsial disease showing
recrudescence
Man presents with fever, chills 2 weeks after a louse
bite, maculopapular rash on trunk, which spreads
peripherally
Chills and fever following louse bite 2 weeks before,
rashes all over body, delirious at the time of
presentation. vasculitis due to Rickettsial infection
Sutama (Crouching)
Epidemic typhus
Epidemic typhus
R.prowazekii
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BACTERIOLOGY
Rickettsia prowazekii
Rickettsia prowazeki
Louse
Louse
Recrudescence
SCRUB TYPHUS
Scrub typhus
RICKETTSIAL POX
Rickettsial pox is caused by
Rickettsial pox transmitted by
Vector for Rickettisal pox
Herald spot
R.akari
Mite
Gamasid mite
Rickettsial pox
Rickettsia rickettsii
R.rickettsii
Tick
Dog tick (Dermacentor)
Pinpoint, petechial lesions of palm and volar aspect of wrist
Bacterial meningitis
Rocky mountain spotted fever
Rocky mountain spotted fever
Rocky mountain spotted fever
Indirect immunofluorescence
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BACTERIOLOGY
Q FEVER
Q fever is caused by
Q fever
Q fever
Coxiella burnetti
Rash is absent in
Mode of transmission of Q fever
Lice is NOT a vector for
Organism NOT needing vector for transmission
Coxiella burnetti
Zoonotic disease, Human disease is characterized by an
interstitial pneumonia, No rash is seen
Highly infectious zoonotic disease, mode of
transmission is by inhalation, no rash or local lesion
Transmitted by inhalation of aerosol of unpasteurized milk
Q fever
Inhalation of aerosol
Q fever
Coxiella burnetti
EHRILICHIA
Ehrilichiosis
Human granulocytic ehrilichiosis is caused by
Human monocytic ehrlichiosis is caused by
Cytoplasmic mulberries (morula) are seen
in blood granulocyte in which of the
following
CHLAMYDIA
Chlamydia
Chlamydia is also known as
Chlamydia
Obligate parasite
Infectious part of chlamydia
Chlamydia escape killing by
Chlamydia grow in
Hep2 cells are example of
Ornithosis is caused by
NOT true about Chlamydia
Young male with UTI, pus cells but no organisms
45 year female, lower abdominal pain and vaginal
discharge, cervicitis along with mucopurulent cervical
discharge. best approach to isolate possible causative
organism
Fitz Hugh Kurtis syndrome
Chlamydia is associated with
Chlamydia does NOT cause
Chlamydia does NOT cause
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BACTERIOLOGY
MYCOPLASMA
Mycoplasma
Mycoplasma
Mycoplasma differ from Rickettsia by
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BACTERIOLOGY
Mycoplasma
Mycoplasma
Dienes method
Mycoplasma in cell culture
Mycoplasma
Mycoplasma
Mycoplasma
Mycoplasma
Mycoplasma
Mycoplasma
Mycoplasma
Mycoplasma
Obligate intracellular parasites
Inhibited by penicillin
Resistant
The ability of its colonies to adsorb sheep
blood cells
Mycoplasma hominis
Treponema
Yaws, Pinta, Endemic syphilis
T.pertenue, T.carateum
Treponema pertenua
NOT sexually transmitted, Caused by T.perteune,
Secondary yaw can involve bone
Treponema pertunae, non venerally, secondary yaws
can involve bone
T. pertenue, skin to skin transmission, occurs in early
childhood, ulcerative papilloma in extremities, destructive
gumma
Also known as pian, framboesia, bouba, raspberry like, crab
like gait, gangosa
Later stages involve heart and bone
Spread by sexual transmission
CANNOT be differentiated by serological tests
T.carateum
T. carateum, skin to skin transmission, late childhood, non
ulcerative papule, non destructive, dyschromic or achromic
macule
Purpura
Treponema endemicum
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BACTERIOLOGY
LEPTOSPIRA
Most widespread zoonotic disease in world
Rat, rain, rice fields
True about leptospirosis
Reservoir of Leptospirosis
Transmitted by Rat urine
Characteristic feature of Leptospira
Leptospira
Disease seen in Sewer worker
Leptospirosis
Accidental and dead end host in leptospirosis
Leptospirosis
Leptospirosis
High grade fever, altered sensorium, comatosed and
conjunctival hemorrhage, elevated serum bilirubin and
serum urea, negative peripheral blood for malarial
parasite
Weils disease caused by
Features of Weils disease
NOT true about Leptospirosis
NOT used in leptospirosis
NOT true about leptospirosis
EMJH medium
Korthof culture media for
Culture medium for Leptospirosis
14 year boy, icterus, conjunctival effusion, hematuria.
serological test
Diagnosis of Leptospirosis
Treatment of leptospirosis
Drug having no effect of leptospira
Leptospirosis
Leptospirosis
Rats are prime reservoirs
Rat
Leptospira
Hooked ends
Viable as long as 10 days at room temperature in blood
Leptospirosis
Zoonosis, Man acts as accidental host and dead end,
Rats are the reservoir, person to person transmission is
rare
Man
Urine may show microscopic hematuria, Incubation
period in leptospirosis ranges from 2 20 days
Infection acquired by direct contact with infected urine.
mortality is 5-15% in severe cases, penicillin, antibodies
NOT usually detectable in first week
Weils disease
Leptospira icterohemorrhagica
Hepatorenal damage, jaundice, renal failure,
albuminuria, bleeding diathesis, purpuric hemorrhages,
pyrexia
Quinolones are drug of choice
Weil felix reaction
Lice act as vector
Leptospirosis
Leptospirosis
Korthof
Microscopic agglutination test
Microscopic agglutination test
Penicillin G
Erythromycin
BORRELIA
Lymes disease
Lyme disease
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VIROLOGY
Lymes diseae
Lyme disease
Acrodermatitis chronic atrophica
Intrathecal specific IgA antibodies is diagnostic
Polymorphonuclear lymphocytes in CSF suggest
meningitis
Tick borne relapsing fever (Ornithodoros tick), Louse borne
relapsing fever also known as epidemic relapsing fever
caused by Borrelia recurrentis
Headache
Chloramphenicol, doxycycline, erythromycin, penicillin
Borrelia recurrentis
Borrelia recurrentis
Borrelia recurrentis
Borrelia duttoni, Borrelia hermsii, Borrelia parkeri
Borrelia
Borrelia
Borrelia
Stain for inculsion bodies within the cells
involved in rash
Chronic fatigue syndrome
Doxycycline (oral), Ceftriaxone (IV)
VIROLOGY
GENERAL FEATURES OF VIRUS
National institute of virology is located in
Viroids
Viroids
Virion
Virus contains
Virus
DNA covering material of virus is called
Virus grows well on
Von magnus phenomen
nd
Pune
Resistant to heat
Infectious nucleic acid
Extracellular infectious virus particle
Either DNA or RNA
Form extracellular infectious particle, heat labile, NOT
affected by antibiotics
Capsid
Cell culture
Virus yields high hemagglutinin titre but
low in infectivity
Viral interference
Invade and multiply
Viruses
Quantitative assay of infectivity of virus
Measuring the number of infectious virus particles
Quantitative assay of infectivity of virus
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VIROLOGY
Budding
Detection of viral hemagglutinin
inhibiting antibodies in single serum
specimen
Papova virus
Pox virus, reovirus
Requires a special polymerase in virion
Rhabdoviridae, Filoviridae,
Paramyxoviridae, Orthomyxoviridae,
Bunyaviridae, Arenaviridae, Reoviridae
Retrovirus, orthomyxovirus
Reovirus
Adenovirus, Parvo virus, Papova virus
DNA virus
SV40
Rhinovirus
33*C
Rotavirus, Adenovirus, Norwalk virus, Enterovirus
CMV,HIV,HBV
Herpes virus, Retrovirus, Papova virus
Burkitts Lymphoma, Hairy cell leukemia
Nipah virus, Corona virus, SARS
HSV 2, HIV, EBV, CMV
Astrovirus, Picorna virus, Rota virus
Adenovirus
Direction of viral hemagglutinin inhibiting HAI
antibodies in single serum specimen
Vero, Hela, Hep2
Rota virus, Norwalk virus, Molluscum contagiosum
Corona virus
Corona virus
2 7 days
2003
Nairo virus
Zoonosis, Develop petechial patches, Recently reported
in Gujarat, Has high fatality
Lassa fever
Condyloma lata
Vaccinia
Adenovirus
Parapox virus
Old world virus eg. Lassa virus, Lymphocytic
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VIROLOGY
choriomeningitis
Bunyaviridae eg. Nairo virus, Hanta virus
Orapouche, Punta toro infection, Sandfly fever, Toscana
fever
Bunyaviridae
Heamagogus virus
Flavivirus
Ebola virus
Bromide green dye for PCR
HERPES VIRUS
Herpes group virus
Lipid envelope is found in
HSV is a
Varicella, EBV belong to
Focal degeneration (pocks in
chorioallantoic membrane)
Cold sore is caused by
Encephalitis is caused by
Scrum pox is common in
HSV II
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VIROLOGY
PARVOVIRUS
Parvovirus
Parvovirus B19
Parvovirus B19
Virus with smallest genome
Smallest DNA virus
Target for parvovirus
Parvovirus cause
th
5 disease is caused by
Predominant route of parvovirus
Common manifestation of Parvovirus infection in adult
Erythema infectiosum
Lazy reticular rash is associated with
Slapped cheek appearance
Glove and stock syndrome is a variant of
HHV 4
Herpes group
Double stranded DNA virus
Gp350 binds to CD21
EBV
Epstein barr virus
Infectious mononucleosis, Nasopharyngeal carcinoma,
Oral hairy leukoplakia, Hodgkins and Non Hodgkins
lymphoma, Ca tonsil, Burkitts lymphoma
EBV
EBV
Epstein Barr virus
EBV
EBV
EB virus
Polyclonal B cell activation
EBV
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VIROLOGY
CYTOMEGALOVIRUS
Cytomegalovirus is
Post kidney transplantation caused by
Mononucleosis like syndrome is caused by
MC presentation of congenital CMV
Maternal viremia most commonly spreading to fetus in
utero
CMV rarely cause
In CMV infection of brain, viruses are present in
Owl eye appearance on picture
Congenital CMV infection
Great concern for CMV infection
Congenital CMV infection in infant established by
Does NOT establish diagnosis of congenital CMV in
neonate
Drug used in CMV infection
Famciclovir is a prodrug of
HHV 5
CMV
CMV
Hepatosplenomegaly
CMV
CNS infection
WBC
CMV
Hepatosplenomegaly
2nd month after transplantation
Urine culture of CMV, Intranuclear inclusion bodies in
hepatocytes, CMV viral DNA in blood by polymerase
chain reaction
IgG CMV antibodies in blood
Gancyclovir
Penciclovir
ROSEOLA INFANTUM
A patient had fever and coryza for last 3 days developed
maculopapular erythematous rash which lasted for 48
hours and disappeared without leaving behind
pigmentation is commonly due to
Roseola infantum
Fever stops and rash begins is diagnostic of
Roseola infantum
HHV 3
Herpes virus
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VIROLOGY
Chicken pox
Chicken pox
Rash of chickenpox
Rash pattern in chickenpox
Dew drop on petal appearance
Pleomorphic rash
Incubation period of Varicella Zoster
Infectivity of chickenpox lasts for
Varicella zoster remains latent in
MC extraskin manifestation of Varicella
Intrauterine infection associated with limb reduction
defects and scarring of skin
Hypoplasia of limb and scarring caused by
MC complication of chickenpox in children
Known complication of chicken pox
NOT a complication of chicken pox
NOT true about chicken pox
NOT true about chickenpox
NOT true about varicella infection
Multiple calcification in chest X ray
Sensitive test for VZV
Prevention of VZV in HIV
ADENOVIRUS
Adenovirus
Grape clump appearance is associated
with
Virus with space vehicle appearance
Basophilic inclusion body
Disease caused by Adenovirus
Shipyard eye is caused by
Virus causing hemorrhagic cystitis, diarrhea,
conjunctivitis
Pharyngoconjunctival fever is caused by
Serotype 1,2
Serotype 3,7
Serotype 4, 7
Serotype 40, 41
Serotype 11,12
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VIROLOGY
Epidemic keratoconjunctivitis
Adenovirus
ROTAVIRUS
Rota virus
Segmented gene
Rota virus
Reassortment is typically seen in
Virus enterotoxin detected as a possible mechanism of
action
Rota virus commonly affects
Rota virus infection in children below
MC cause of gastroenteritis in children
Rota virus
Diarrhea in Rotavirus infection due to
Rota virus are responsible for
Rota virus detected by
Rota virus is diagnosed by
Best vaccine for Rota virus
SMALL POX
Largest DNA virus
DNA virus with complex capsid
symmetery
Pox virus
Inclusion bodies in cytoplasm is seen with
Pox virus
Guarneri bodies are seen in
Most sensitive method for diagnosis of small pox
Protection against small pox by previous infection with
cowpox represents
Successful eradication of small pox because of
Small pox eradication was NOT due to
India become small pox free in
Bollinger bodies
Pox virus
Poxviridae
Double standed DNA virus encoding
DNA dependent RNA polymerase
Pox virus
Complex shape, relicate and assemble in cytoplasm (unique
feature)
Small pox
Smear test
Antigenic cross reactivity
Subclinical cases did not transmit the disease, A highly
effective vaccine was available, Infection provided
lifelong immunity
Cross immunity with animal pox virus
April
Fowl pox
PAPOVA VIRUS
Papova virus
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VIROLOGY
papilloma, SV 40 is oncogenic
Viral warts resolve spontaneously, Plantar warts should
not be excised, Callosity are formed occupationally
Warts
POLIO VIRUS
Picorna viruses
Polio virus
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VIROLOGY
Under 5 years
Poliomyelitis in recipients, Poliomyelitis in contacts of
recipient
Poor growth in stable cell line of monkey kidney
3,00,000 TCID 50
Prevent paralysis, Oral polio can be given as booster,
Easily transported
ENTEROVIRUS
Total sheet degeneration is associated with
MC cause of Rubelliform(discrete) rash
Epidemic hemorrhagic conjunctivitis caused by
Enterovirus associated with
Enterovirus 71 is associated with
Bornholm disease
Hallmark of pleurodynia
Summer grippe
Virus shed in stool in
Enterovirus does NOT cause
Enterovirus
Echovirus 9
Picorna virus (enterovirus which is a subtype of Picorna
virus)
Myocarditis, Pleurodynia, Herpangina
Hand foot mouth disease, herpangina
Pleurodynia
Servere muscle pain
Non specific febrile illness seen in enterovirus infection
Herpangina
Hemorrhagic fever
COXSACKIE VIRUS
Coxsackie virus causes
Cox sackie group A commonly causes
Cox sackie A 16 is associated with
Herpangina is caused by
Cox sackie virus does NOT cause
Coxsackie virus does NOT cause
Suckling mice is used for culture of
INFLUENZA VIRUS
Segmented RNA virus
M protein in orthomyxovirus maturation
Influenza A
All pandemic of influenza by
Pandemic of influenza is caused by
Influenza
Influenza
Influenza virus
Serves as a recognition site for
nucleocapsid at the inner face of plasma
membrane
Hemagglutinin and neuraminidase is strain specific
Influenza A only
Antigenic shift
Primary infectious pneumonia is less common than
secondary bacterial pneumonia
Major epidemics are due to antigenic SHIFT, Antigenic
drift is gradual antigenic change over a period of time,
Antigenic shift is due to genetic recombination of virus,
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VIROLOGY
Segmented RNA
H5N1
H1N1 swine flu was found on
Gradual and sequential change in antigenic structure at
regular intervals
Influenza causes new epidemic by
Antigenic shift
Shift occurs only with
Reye syndrome is associated with
Antigenic variation NOT seen in
Influenza
Influenza is associated with
Most serious complication of Influenza B
Immunofluorescence
Amantidine and rimantidine are active against
Amantidine is most effective for
Which is a Neuraminidase Inhibitor
Avian influenza treated by
Oseltamivir is used to treat
Oseltamivir inhibit
Mechanism of action of oseltamivir
MEASLES
Moribilli
Measles
Measles virus
Syncitium formation is associated with
NOT a teratogenic virus
Measles
Measles
Measles
Measles
Epidemiology of measles
Measles
Single stranded negative sense RNA virus
Paramyxovirus
Measles
Measles
Higher secondary attack rate, Only one strain cause
infection, Infectious in prodromal period, Infections
confer lifelong immunity, Meningoencephalitis can
precede parotitis, Flaring up of TB
Fever occurs 7-10 days after occurrence of infection,
immunity develops after 7 days of vaccination, single
dose of vaccine gives 95% protection
Immunosuppression
Koplik spots appear in prodromal stage, Fever stops
after onset of rash
Secondary attack rate of measles is less than that of
rubella
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VIROLOGY
MUMPS
Mumps virus belongs to
Virus easily cultured from CSF
Virus NOT causing pneumonia
NOT transmitted transplacentally
Presternal edema is seen in
Mumps
Mumps cause
Commonest complication of mumps
MC complication of mumps in children
MC ocular manifestation of mumps
NOT a complication of mumps
Paramyxovirus
Mumps
Mumps
Mumps
Mumps
Menigoencephalitis can precede parotitis
Aseptic meningitis in children
Orchitis and oophoritis
Aseptic meningitis
Dacroadenitis
Parotid abscess
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VIROLOGY
RABIES
Vesicular stomatitis virus
Rabies virus RNA
Rabies
Shape of rabies virus
Rabies
Rabies
Rabies virus inactivated by
Paralytic rabies is caused by bite of an infected
Incubation period of rabies depends on
Characteristic manifestation of rabies
MC type of pathological change in Rabies
Rabies is transmitted by
Rabies NOT transmitted by
Mode by which Rabies virus NOT transmitted
Foaming at mouth is associated with
Rabies free area
FALSE about Rabies
Bite of which of the following animals do not result in
human rabies
Rabies free country
Rabies is NOT found in
Most suitable clinical sample that can confirm the
antemortem diagnosis of Rabies
Rabies best diagnosed by
Intracytoplasmic inclusion bodies
Negri body seen in
Negri bodies commonly seen in
Negri body
Babes nodule in rabies
Negri bodies are NOT found in
NOT used for confirming rabies
encephalitis
In case of dog bite, biting animal observed for
NOT done for dog bite
Class II exposure in animal bite
Which should be injected in and around wound in class
II rabies bite
NOT a treatment of class III bite
Antiseptic/disinfectant is best for local
wound application in case of dog bite
Rabies vaccine first developed by
Commercially available rabies vaccine
NOT a commercially available rabies vaccine
Rhabdoviridae
Negative polarity
Multiple strains are seen
Bullet shape
Intracytoplasmic basophilic inclusion bodies are seen in
brain cells
Vaccine virus has fixed incubation period, IP depends on
site of bite, All bites on fingers with laceration are class
III injuries
Phenol, UV radiation, BPL
Vampire bat
Site of bite
Meningitis
Brainstem encephalitis
Dogs, Vampire bat, Jakal
Ingestion
Sexual
Rabies
No indigenously acquired case for 2 years
Limited to brain
Mouse
Australia, Britain
Lakshwadeep, Andaman Nicoar islands
Corneal impression smear for immunofluorescence
stain
Immunofluorence study
Rabies
Rabies
Cerebellum > Hippocampus
Eosinophilic cytoplasm
Microglia
White matter
PCR
10 days
Immediate wound closure
Licks on a fresh wound
Antirabies serum
Immediately stitch wound under antibiotic coverage
Alcohol
Louis Pasteur
Killed sheep brain vaccine, Human diploid cell vaccine,
Vero continuous cell vaccine
Recombinant glycoprotein vaccine
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VIROLOGY
Rabies
3
0,7,28 and booster dose after 2 years
HDCV 0,3,7,14,30 booster dose 90 days
DENGUE
Break bone fever caused by
Dengue virus is a
In India, dengue viruses associated with human
infections
Dengue virus appears to have direct man to man cycle
in India. mechanism of dengue virus survival in the inter
epidemic period
Dengue
Infective fever of aedes mosquito for classical dengue
fever
Infective period of Aedes mosquito in Dengue
Dengue fever
Dengue
Classical dengue fever
Saddle back temperature
Classical dengue fever is transmitted by
Dengue hemorrhagic fever is caused by
5 year petechial rash, Lymphadenopathy, Reduced air
entry into Right lung
Dengue hemorrhagic fever is due to
NOT true about dengue hemorrhagic fever
NOT a feature of dengue shock syndrome
Minimum platelet count for diagnosis of Dengue
Most sensitive diagnostic test for dengue
Most specific dengue diagnosis
Arbovirus
Flavi virus
All 4 types
Transovarian transmission of virus
Endemic in india
Life long
Till death
Most common arboviral infection, Can be both
epidemic as wall as endemic, Can survive in ambient
temperature, Vector is Aedes aegypti
Increased hematocrit, Decreased platelet, Positive
tourniquet test, Vector aedes aegypti usually bite
during day time, Pleural effusion present
Case fatality is low, break bone fever, self limiting
disease
Dengue fever
Aedes mosquito
Reinfection with different serotype of dengue virus
Dengue hemorrhagic fever
Infection by another strain of dengue virus
Shock
Decreased hemoglobin
100000
Neutralization test
IgM ELISA
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VIROLOGY
CHIKUNGUNYA
Chikungunya
Epidemic caused by Type A arbovirus in India
Vectors for Chikungunya
Vector for Chikungunya fever
Alpha virus
Chikungunya
Aedes, culex, mansonia
Aedes
YELLOW FEVER
Arboviral disease NOT reported in India
Yellow fever
Yellow fever
Yellow fever
Subclinical cases present, One attack gives lifelong
immunity, Hepatic and renal involvement in severe
cases, Caused by flavi virus, Case fatality rate upto 80%,
Transmitted by aedes, Incidence is increased by
humidity, Vaccine is 17D
Incubation period is 3-6 days, Validity of international
certificate lasts up to 10 years, Urban form is controlled
by 17D vaccine, Aedes aegypti index should be less than
1%
Virus is NOT present
3-6 days
6 days
Yellow fever
Central institute kasauli
1%
400 m
10 years starting 10 days after vaccination
JAPANESE ENCEPHALITIS
Old name for Japanese encephalitis
Mosquito borne encephalitis caused by
JE does NOT cross react with
Japanese encephalitis
Japanese encephalitis
Japanese encephalitis
Japanese encephalitis
Subclinical infection is common with
Japanese encephalitis commonly seen in
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VIROLOGY
Pig
Horses
Dead end host
Culex vishnui
Culex tritaeniorhynchus
Culex tritaenorrhyunchus
Japanese encephalitis
Culex
2-3 cases in a village
Japanese encephalitis
Man to man transmission
Four doses of vaccine
90-100% mortality rate
Infected pigs manifest symptom of encephalitis
Large inapparent infections
KFD
Zoonosis, affects monkeys, caused by virus
KFD
Kyasanur forest disease
Hard tick Hemophysalis
Deforestation
HANTA VIRUS
Sin Nombe virus
Hanta virus
Hanta virus pulmonary syndrome is caused by
Hanta virus
RNA virus, Caused by rodents, Causes recurrent
respiratory infection, Hemorrhagic fever with renal
failure
Inhalation of rodent urine and feces
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VIROLOGY
RSV
Bronchitis
REOVIRUS
Virus composed of two distinct capsules enclosing
double stranded RNA
Segmented double stranded RNA is found in
Reovirus
Reovirus
RUBELLA
rd
3 day disease
8 years following URTI developed maculopapular rash
rd
on jaw spreading on to trunk which cleared on 3 day
without desquamation and tender postauricular and
suboccipial lymphadenopathy
Maculopapular rash on jaw cleared on 3rd day without
desquamation and tender postauricular and
suboccipital lymphadenopathy
Exanthema spreads from hairline to downwards and clears
as it spreads
Rubella causes
Multiple sites of narrowing of peripheral pulmonary
arteries
Forscheimer spots are seen in
Incubation period of rubella
Complications of Rubella
Uncommon clinical feature of Rubella
Most severely affected in Rubella infection
MC age group affected by rubella
Average incubation period of Rubella is equal to that of
Features of Congenital rubella
Congenital rubella syndrome is associated with
Multiple sites of narrowing of peripheral pulmonary artery
NOT true about congenital rubella
Risk of fetal damage in rubella is maximum if mother
gets infected in
Chance of transmission of rubella In 9 10 weeks
pregnancy
Rubella infected a mother at 10-14 weeks of Gestation,
Chances of congenital malformation
NOT true about rubella
Rubella
Rubella
Rubella
Rubella
Microphthalmia, Congenital cataract, Salt pepper
fundus
Rubella
Rubella, infectious mononucleosis, scarlet fever
2-3 weeks
Arthritis, Arthralgia, Encephalitis
Encephalitis
Unborn child
Women of child bearing age
Sleeping sickness
PDA, Deafness, Cataract
VSD, PDA
Rubella embryopathy
Infection after 16 weeks of gestation results in major
congenital defects
6-12 weeks of pregnancy
40%
5-10%
Incubation period more than 10 days
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VIROLOGY
FEATURES OF HIV
Retrovirus
DNA form of retroviral genome
Retrovirus contain
HIV 1 and HIV 2
HTLV 1
HIV discovered in
AIDS
HIV belongs to
Retrovirus
Main HIV in India
MC subtype of HIV in India
HIV belongs to
HIV
HIV virus has
HIV is
HIV
Accessory proteins associated with HIV
Relation between HIV and CCR5 with
homozygous mutation in an individual is
Primary receptor for HIV
Receptors for HIV
Co receptor for HIV
T cell trophic HIV needs the following co receptor for
entry and fusion
Gp120 in HIV helps in
P17
Gp160
Genes present in HIV genome
Viral gene NOT associated with HIV
Gag encodes for
Reverse transcriptase endoded by
Tat encodes
HIV is inhibited by
Reverse transcriptase sequence in HIV
Reverse transcriptase
Unusual mode of replication is seen in
CCR 5 mutation in HIV is related to
NOT true about HIV
Isolation NOT needed for
HIV is common in
HIV commonly affects
NOT a target for initiation and maintenance of HIV
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VIROLOGY
4 weeks
Antibody is absent
3-12 weeks
Period between onset of infection and clinically
detectable level of antibodies
Antibody enhancement, bystander killing
Cryptococcus,Toxoplasma
CNS
Microglial nodule
Primary CNS Lymphoma
Dementia
Recurrent chest infection with typical
organisms
Vasculitis
PML
Inclusion bodies
Kaposi sarcoma
Non specific enlargement of lymphnode
Pericardial effusion, cardiac tamponade,
cardiomyopathy
Aortic aneurysm
Kaposi sarcoma, CNS lymphoma, Non hodgkins
lymphoma
Carcinoma Colon
50
200
Cryptosporidiosis
Toxocara uveitis
Rhizopus
Aspergillus
Kaposi sarcoma
Breastmilk
2 major signs and 1 minor sign
TRANSMISSION OF HIV
HIV
MC mode of HIV infection worldwide
Commonest transmission of HIV from mother to baby
Chance of acquiring HIV infection following needle prick
Percentage of risk of HIV transmission by needle stick
injuries
Transmission of AIDS in India in descending order
MC mode of HIV transmission from mother to child
Perinatal transmission of HIV
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VIROLOGY
mothers milk
30-40%
Blood transfusion
High risk group
Healthcare workers
Intact skin
Homosexual
Vaginal cleansing before delivery
EPIDEMIOLOGY OF HIV
Epidemiology of AIDS
MANIFESTATIONS OF AIDS
Cells infected by HIV virus
HIV commonly infects
HIV infection
HIV infection
CD4+ T lymphocytes
CD4 cells
Following needle stick injury,infectivity is reduced by
administration of nucleoside analogues, P24 is used for
early diagnosis, Lysis of infected CD4 cells, Macrophage
is a reservoir for the virus
Caused by enveloped RNA virus, Rate of killing is
directly proportional to T4 molecules on cell surface,
Decreased delayed hypersensitivity activity reaction,
Gamma interferon is acid STABLE
Glandular fever like illness, Generalized
lymphadenopathy, Gonococcal septicemia, Presenile
dementia
Cannot be diagnosed accurately by current methods,
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VIROLOGY
KAPOSIS SARCOMA
Kaposi sarcoma
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VIROLOGY
Lymphadenopathic type
Vascular tissue
Vascular
Skin
Lower limb
HIV
KSHV associated lymphoproliferative disorder, onion skin
appearance
Angiofollicular lymph node hyperplasia
IL 6
Occurs in AIDS patient only
DIAGNOSIS OF AIDS
Unlinked anonymous serological testing is
carried out in
Antenatal material in HIV diagnosis is of importance in
Full blown immunodeficiency syndrome is
Screening test for HIV
Marker of HIV infection in blood
Most sensitive test for test for diagnosis of AIDS in one
year old child
HIV can be detected and confirmed by
P24 antigen disappears from blood after
P24 antigen
Direct detection of HIV by
Sore throat, diarrhea, sexual contact 2 weeks before.
best investigation to rule out HIV
Best method for diagnosis of HIV in childhood
Compared to western blot, ELISA is
Characteristic western blot pattern in
AIDS
NOT a method of diagnosis of HIV infection in 2 month
old child
HIV
To prevent vertical transmission
High viral titres with low CD4 count
ELISA
Reverse transcriptase
HIV RNA PCR
Reverse transcriptase PCR
6-8 weeks of infection of HIV
High false positivity
P24 antigen capture assay, NASBA technique (isothermic)
P24 antigen assay
P24 antigen
More sensitive, Less specific
Absence of p24, loss of other activities
ELISA
TREATMENT OF AIDS
WHO stage I and II
WHO stage III and IV
Anti HIV never given as rechallenge once history of
allergic reaction to that drug in known
Nucleoside Reverse transcriptase Inhibitor
Abacavir is
Side effect of Abacavir
Abacavir hypersensitivity is associated with
Nucleoside reverse transcriptase inhibitor
Nucleoside reverse transcriptase inhibitior
ARV prophylaxis
ART
Abacavir
Abacavir
Guanosine analogue
Hypersensitivity
HLA-B57
Zalcitabine, Stavudine
Zidovudine, Didanosine
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VIROLOGY
Nevirapine
AZT therapy
Protects against acquiring HIV infection
Nausea, Vomiting, Steatosis, Anemia
Neutropenia
Anemia
Granulocytopenia
Zidovudine
Peripheral neuropathy
Increased MCV
Mutation at reverse transcriptase
Mutations at reverse transcriptase
Stavudine
Stavudine
Thymidine analogue
Lamivudine
Cytidine analogue
Didanosine
Efavirenz, nevirapine, delaviridine
Abacavir, tenofovir
Dysphoria
Non nucleoside reverse transcriptase inhibitor
Effective for repeated pregnancies also
Steven Johnson syndrome
Nucleotide reverse transcriptase inhibitor,
asthenia is a common side effect, indicated
in combination with other retroviral
agents
Acute renal failure
Lamivudine
Acts a substrate for p glycoprotein and action is
mediated by mdr 1 gene, Undergo hepatic oxidative
metabolism
Powerful enzyme inhibitors, cause hepatotoxicity, all
protease inhibitors are substrate for P glycoprotein
coded by MDR gene
Protease Inhibitors
Saquinavir, nelfinavir
Amprenavir
Ritonavir
Ritonavir
Ritonavir
Saquinavir
Saquinavir
Saquinavir
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VIROLOGY
PREVENTION OF HIV
Universal precaution is applied to
Right method to discard dressing of HIV positive patient
A poverty striken mother suffering from active
tuberculosis delivers a baby. advice
HIV infection following needle stick infection reduced
by
HIV prophylaxis for rape victim
Post exposure prophylaxis of HIV blood infected needle
stick injury
For prevention of parent to child transmission of HIV,
the NACO recommendation is to give
Semen
Put in appropriate bag and send for incineration
Breast feeding and isoniazid administration
Nucleoside analogues
Combivir (zidovudine with lamivudine) 1
BD for 28 days
Zidovudine + Lamivudine + Indinavir for 4 weeks
Nevirapine 200 mg in active labour to mother and syrup
nevirapine 2mg/kg body weight to newborn within 24
hours of delivery
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VIROLOGY
200 mg
HAART, elective caesarean section, intrapartum
zidovudine
Cesarean section
Vaginal delivery
Providing ART
Prions
Infectious proteins
Lack nucleic acids
Abnormal folding of protein
Misfolding of proteins
Protein only
-helix
Kuru, Scrapie, Cruetzfeldt Jacob disease, Fatal Familial
Insomnia
Caused by infectious protein, brain biopsy is diagnostic,
commonly manifests as dementia
Lack of inflammation
Alzheimers disease
Sporadic Cruetzfeldt Jacob Disease
Prion and Genetic factors
Cruetzfeldt Jacob disease
Vacuoles in neutrophil
Variant CJD
Beta sheets
Microglia
PRPsc
Cortical ribboning
Myoclonus rarely seen
Myoclonus is seen only in 10% of patients
Slow virus
Prions
Kuru
Kuru
Shivering
Prion virus
Prion disease
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MYCOLOGY
MYCOLOGY
GENERAL FEATURES OF FUNGI
Fungi are
Sporangium contains
Yeast reproduce by
Rate of reproduction of yeast is
Types of fungi
Neurotrophic fungus
Endemic fungal infection is caused by
Antigen in Maple bark disease
Valley fever/Desert Rheumatism
In tissue, coccidiodes immitis produce
Treatment of coccidiomycosis
Side effects of amphotericin reduced by
NOT a fungal infection
Galactomannan antigen test for
Drug approved for fungal infection in febrile neutropenic
patients
Prevention of fungal infection in HIV
Posconazole
Eukaryotes
Sporangiospores
Budding
Slower than bacteria
Ascomyces eg Tinea, Basidiomyces eg
Cryptococcus, Deuteromyces (Fungi
imperfecti) no sexual spores
Candida, Geotrichum, Cryptococcus,
Penicillium marneffi
Mycelium
Coccidiodes
Ascospores
Arthrospores, Chlamydospores, Blastospores
Basidispore
Chlamydospore
Fungi imperfecti
Deuteromycetes
Aspergillus, Trichophyton
PAS
Glycogen, Lipid, fungal cell wall
Cause tuberculosis like disease, at 25* C
produces rose color pigment, at 37* C
produce yeast
Cryptococcus neoformans, Histoplasmosis, Candida,
Aspergillosis
Coccoides immitis, Blastomyces
Cryptosoma coricale
Coccidioidomycosis
Spherules and endospores
Amphotericin
Incorporating it in liposomal complex
Mycosis fungoides
Fungus
Itraconazole
Fluconazole/ Itraconazole
Approved for prophylaxis of aspergillosis and candidiasis in
high risk groups
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MYCOLOGY
DIMORPHIC FUNGI
Feature of dimorphic fungi
Dimorphic fungi
Dimorphic fungi
Dimorphic fungi
NOT a dimorphic fungi
NOT thermally dimorphic
DERMATOPHYTES
Dermatophytosis is caused by
Spreads from animal to man
Fungal culture slow growing colony, few small
microconidia
Black dot worm is caused by
NOT a subcutaneous mycosis
Organism that do NOT affect hair
Tinea capitis (endothrix) is caused by
Kerion is caused by
Favus is caused by
Tinea cruris is caused by
Tinea pedis is caused by
Characteristic feature of epidermophyton
floccosum
Tinea nigra is caused by
Pityriasis versicolor is caused by
Difficult to isolate from culture
Does NOT cause dermatophytosis in India
Hair perforation test is positive with
Trichophyton
T. verrucosum
Trichophyton
Trichophyton
Trichophyton rubrum
Epidermiphyton
T.tonsurans, T.violaceum
Dermatophytes
Trichophyton schenleinii
Epidermiphyton, Trichophyton
Epidermophyton floccosum
Clavate macroconidia
Exophiala Werneckii
Malassezia furfur
Malassezia furfur
Microsporum distortum
Trichophyton
CRYPTOCOCCUS
Trojan horse invaders
Cryptococcus neoformans
Cryptococcosis
Urease positive, 4 serotypes, superficial skin infection,
anticapsular antigen is detected in CSF, common in
immunocompromised, strongly positive mucicarmine
stain is usually diagnostic
A and D
Urease positive, inositol accumulation,
phenol oxidase and melanin production
Grows at 5* and 37* C, Has 4 serotypes
Capsular antigen is detected in CSF, Common in
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MYCOLOGY
CANDIDA
Predisposing factors for candida infection
Candida albicans infection is seen in
Candida is NOT frequently associated with
MC fungal infection in febrile neutropenia is
Fungal infection spread in infants by hand spread
HIV patient, indurated ulcer over tongue, growth in
cornmeal agar at 20*C, hyphae and growth in serum at
37*C showing budding yeast.
Pseudohyphae in culture
Germ tube is diagnostic for
Reynolde Braude phenomenon
Candida albicans
Candida glabrata
Pericae
Median rhomboid glossitis is caused by
Mucocutaneous candidiasis is associated
with
Bulls eye lesion in USG abdomen
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MYCOLOGY
PNEUMOCYSTIS JEROVECI
Pneumocystis carnii is a fungus because
Pneumocystis jiroveci
Tree in bud appearance in bone marrow transplant
recipient
Pneumocystitis carnii infection in HIV, if CD4 count
Pneumocystis jeroveci
Pneumocystis carnii diagnosed by
Prevention of pneumocystis jiroveci in HIV
Treatment of Pneumocystis carnii
Treatment of pneumocystis carnii
BLASTOMYCOSIS
Blastomycosis
North American blastomycosis
Fungal infection resembling squamous cell
carcinoma
South American blastomycosis
European blastomycosis
Treatment of blastomyces dermatides
HISTOPLASMOSIS
Histoplasma capsulatum infection is
commonly associated with
Histoplasma capsulatum
Histoplasma capsulatum
Histoplasmosis
Histoplasmosis
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MYCOLOGY
fungus
Histoplasmosis
Histoplasmosis
Tuberculate macroconidia
Histoplasmosis
Healed histoplasmosis
Histoplasma
Cryptococcus, histoplasma, pneumocystis
Culture
ASPERGILLUS
Aspergillus
Dichomotous branching
Aflatoxin is produced by
Aspergillus niger produce
Most probable entry of aspergillus
MC aspergillus causing human infection
Malt worker lung is associated with
Common fungus causing corneal ulcer
MC etiological agent in paranasal sinus mycoses
Corneal sample revealed narrow angled septate
hyphae. Etiology is
Culture of periorbital pus showed branching septate
hyphae
Halo sign is characteristically seen in
Monad sign
Crescent sign of chest X ray
Drug of choice for aspergillus lung infection
Drug NOT used for Aspergillus infection
HEPA (high efficiency particulate filters are protective
against
Fumagillin is used for
Septate hyphae
Aspergillus
Aspergillus flavus
Oxalate
Lungs
Aspergillus fumigates
Aspergillus clavatus
Aspergillus, Fusarium
Aspergillus
Aspergillus
Aspergillus
Aspergillosis
Aspergilloma
Invasive aspergillosis
Amphotericin B
Fluconazole
Aspergillosis
Aspergillus fumigates, microsporidium
MUCOR
Mucor mycosis
Non septate hyphae with wide angle
branching
Ribbon like hyphae
Voriconazole NOT effective against
Voriconazole
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PROTOZOA
MADURELLA
Farmer multiple discharging sinus in leg not responding
to antibiotics
Madura foot
Madurella
Can erode bone, Slow growing
SPOROTRICHOSIS
Sporotrichosis
Pricking ulcer on finger with axillary lymphadenopathy
Series of ulcers in lower extremities in sub Himalayan
area is often caused by
Himachal Pradesh, series of ulcer in row in leg. cultured
on sabourads dextrose agar
Gardener, multiple vesicles on hand, along lymphatics
Asteroid bodies
Cigar shaped globi and asteroid bodies seen in
Definite diagnosis of sporotrichosis
Postassium iodide useful in treatment of
CHROMOBLASTOMYCOSIS
Phaehyphomycosis
Chromoblastomycosis is caused by
Brown, spherical and septate bodies
Sclerotic bodies
Brown spherical septate bodies from pus
NOT a zoonotic disese
PROTOZOA
GENERAL FEATURES OF PROTOZOA
Protozoa belong to kingdom
Cyst phase is NOT seen in
Chief source of major parasitic diseases in
humans
Hematophagus trophozoite is
demonstrated by
Loefflers syndrome
Monera
Dientamoeba, E.gingivalis, trichomonas
Man
Stool test
Toxocara, strongyloides stercoralis, L.tryptophan
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PROTOZOA
ENTAMOEBA HISTOLYTICA
Entamoeba histolytica
Entamoeba has
Entamoeba coli
Most important enzyme associated with
entamoeba histolytica
Entamoeba cyst has
Mature cyst of entamoeba
Entamoeba histolytica is antigenically
different from
Entamoeba which is NOT found in gut
Mature cyst of entamoeba histolytica
Trophozoite of entamoeba histolytica
Erythrophagocytosis is a feature of
Ingested erythrocytes seen only in
Main reservoir for Entamoeba histolytica
MC form of amoebiasis
Commonly affected by invasive amoebiasis
Characteristic shape of amoebic ulcer
Amoebic colitis
Amoebic colitis commonly occurs in
Teacher presents with profuse bloody diarrhea fever
104*, many children studying in the same school had
similar episodes
Intestinal amoeba can cause
MC extraintestinal site of amoebiasis
Seizures NOT commonly seen in
NOT a method of transmission of amoebiasis
Culture medium for Entamoeba histolytica
Pathogenic and non pathogenic strains of entamoeba
histolytica can be differentiated by
Invasive amoebiasis can be best diagnosed by
Amoebic lung abscess is diagnosed by
Diagnostic test for amoebic hepatitis
Amoebic liver abscess can be diagnosed by
Gastrointestinal bleed, ulcers in sigmoid, flask shaped
ulcer
Intraluminal amoebicide of choice
Treatment of luminal infection
Drug used for extraintestinal amoebiasis
Chloroquine is effective only in
Drug used against entamoeba histolytica
NOT a luminal amoebicide
Peritonitis
Liver
Amoebiasis
Vertical transmission
Boeck Drbohlav medium
Electrophoretic study of zymodenes
ELISA
Trophozoite in pus
Indirect hemagglutination test
Demonstrating trophozoites in pus
Intravenous metronidazole
Diloxanide furoate
Paromycin, Iodoquinol
Chloroquine
Hepatic amoebiasis
Emetine (derived from ipepac)
Ementine
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PROTOZOA
AMOEBIC MENINGOENCEPHALITIS
Parasites causing encephalitis
Parasitic encephalitis is caused by
Most fatal amoebic encephalitis
Neuropathogenic amoeba
Brain eating amoeba
Primary amoebic encephalitis is caused by
30 year patient, features of acute meningoencephalitis.
CSF on wet mount microscopy revealed motile
unicellular organism
Humidifier fever by
Acute primary amoebic meningoencephalitis
Naegleria floweri
Diagnosed by trophozoite in CSF
GIARDIA
Normal habitat of giardia
MC site of lodgement of giardia
Giardia lamblia
Giardia
Trophozoite of giardia
Trophozoite of giardia
Mature cyst of giardia has
Infection leading to Malabsorption
Diarrhea, stool in wet mount shows mobile protozoa
with pus and without RBC
Giardia
Digestion in intestinal mucosa is inhibited
by
Recurrent giardiasis associated with
String test for
Giardiasis is best diagnosed by
Drug used for giardiasis and amoebiasis
Drug used for giardiasis
Drug used for giardiasis
LEISHMANIA
Amatigote forms are seen in
Leishmania
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PROTOZOA
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PROTOZOA
TRYPANOSOMA
Amphixenosis is seen in
Trypanosomiasis
East African trypanosomiasis
West African Trypanosomiasis
Acute disease is associated with
Poverty disease
Chagas disease
Chagas disease involve
Romana sign
Most commonly affected organ in Chagas
disease
Commonest cardiac defect in Chagas myocarditis
Vector for Chagas disease
Mega disease
Winter bottom sign (enlargement of nodes of posterior
cervical triangle) is seen in
NOT found in India
Diagnosis fo chagas disease
Xenodiagnosis is helpful in diagnosis of
Drug used for Chagas disease
Drug used for Trypanosomiasis
Treatment of East african trypanosomiasis with normal CSF
Treatment of East African trypanosomiasis with abnormal
CSF
Treatment of West African trypanosomiasis with normal CSF
Treatment of West African trypanosomiasis with abnormal
CSF
Side effect of suramin
Trypanosoma cruzi
Sleeping sickness
Rhodesience
Gambiense
High parasitemia
Chagas disease
Trypanosoma cruzi
Esophagus and colon
Unilateral painless edema of palpebral and periocular
region. Seen in chagas disease
Heart
RBBB
Reduvid bug
Chaga disease of GIT
Trypanosomiasis
Sleeping sickness
Microhematocrit tube containing acridine orange
Chagas disease
Nifurtimox, Benznidazole
Eflornithine, Melasoprol, Suramin (urea derivative),
Arsenical
Suramin
Melasoprol
Pentamidine
Eflornithine
Renal damage
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PROTOZOA
TOXOPLASMA
Parasite affecting eye
Toxoplasmosis
Toxoplasmosis
Toxoplasmosis
Cerebral calcification and hydrocephalus in a newborn
A 2 years old child with head circumference of 55 cm is
likely to have intrauterine infection due to
Hydrocephalus and intracerebral calcification
Adult toxoplasmosis resemble
Macula is commonly involved in
Headlight in fog appearance, cracked mud
appearance
Trophozoite
Oocysts develop only in
Freshly passed oocyst
Oocyst of toxoplasma found in
Cat is the definite host for
Tachyzoites are seen in
Bradyzoites has
Route of transmission of Toxoplasma
Transmission of toxoplasmosis
Dissemination of toxoplasmosis via
Main route of transmission of toxoplasmosis
MC manifestation of acute toxoplasmosis
NOT true about toxoplasmosis
False about congenital toxoplamosis
Sabin Feldman reaction for
Goldmann Witmer coefficient for diagnosis of
Local cerebral lesion with ring on CT scan
Toxoplasmosis in fetus can be best diagnosed by
Prevention of toxoplasmosis in HIV
Drug of choice for treatment of toxoplasma infection in
st
1 trimester of pregnancy
Drug added to Pyrimethamine in treatment of
Toxoplasma gondii infection
Used in therapy of toxoplasmosis
Toxoplamosis is NOT treated by
Toxoplasmosis
Usually asymptomatic in adults, Anthroponotic disease,
Encephalitis is rare in immunocompetent individuals
Laboratory tests are useful for making diagnosis,
Infection is severe and progressive in
immunocompromised patients
Oocyst in freshly passed cats feces is NOT infective,
May spread by organ transplantation, Maternal
infection after 6 months has high risk of transmission
Toxoplasmosis
Toxoplasmosis
Toxoplasmosis
Infectious mononucleosis
Toxoplasmosis
Toxoplasmosis of eye
Asexual form, invades nucleated cells
Intestine of definite host
Non toxic
Cat
Toxoplasma gondii
Toxoplasma
Slowly multiplying round parasites
Blood
Ingestion of Bradyzoites
Blood
Oral
Cervical lymphadenopathy
IgG antibodies are diagnostic of congenital
toxoplasmosis
Avidity testing must be done to differentiate between
IgA and IgM
Toxoplasma
Ocular toxoplasmosis
Toxoplasmosis
IgM antibodies against Toxoplasma in fetus
TMP/SMX
Spiramycin
Clindamycin
Pyrimethamine
Erythromycin
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PROTOZOA
BABESIOSIS
Obligate parasite of red blood cells
Babesiosis
Babesiosis is transmitted by
NOT an intestinal protozoa
Maltese crossing is characteristic of
NOT responsible for pulmonary
eosinophilia
Babesiosis is transmitted by
Treatment of mild babesiosis
Treatment of severe babesiosis
Atovoquone is used for
Babesiosis
Caused by Babesia microti, Resides in RBC
Tick (Isodex scapularis)
Babesia microti
Babesia microti
Babesia microti
Tick
Azithromycin
Clindamycin + Quinine
Toxoplasmosis, babesiosis
CRYPTOSPORIDIOSIS
Cryptosporidium parvum
Acid fast organism with oocyte of size 5 micron on stool
examination causing diarrhea in HIV positive patient
Treatment of cryptosporidiosis
ISOSPORA
In HIV patient with malabsorption, fever, chronic
diarrhea, with acid positive organism. what is the
causative organism
Autofluorescence
Isospora
Isospora
CYCLOSPORA
25 year male diarrhea 6 month. acid fast with 12
micrometer diameter
Treatment of isospora and cyclospora
Cyclospora
Trimethoprim and Sulphamethoxazole
BALANTIDIUM COLI
Largest intestinal protozoa
Bigger size
Ciliated large intestine pathogen
Drug used for Balantidiasis
Balantidium coli
Balantidium coli
Balantidium coli
Tetracycline
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PROTOZOA
FEATURES OF PLASMODIUM
JSB stain is used for
Stage of Falciparum NOT seen in peripheral blood
smear
Schuffners dot in malaria is due to
Schuffners dot is associated with
Malarial pigment is mainly formed by
Exoerythrocytic Schizogony
Radical cure is required form malaria caused by
Enlarged erythrocytes
Plasmodium falciparum cause
Plasmodium falciparum infection in man is
characterized by
Incubation period for Plasmodium
falciparum
Plasmodium with shortest incubation period
Black water fever
Only ring and gamete forms are found in
Banana shaped gametocyte
Maurers dots
NOT seen in plasmodium falciparum
malaria
Accole forms are seen in
Complications of malaria is common with
Cerebral malaria is caused by
Parasitemia is highest in
Multiple ring and double chromatin dots
Persistent exoerythrocytic cycle is absent in
Post transfusion malaria is caused by
Plasmodium malariae affects
Band RBC are seen in
Organ NOT affected by plasmodium falciparum
35 year male, sudden onset of high grade fever, on
malarial slide examination all stages of parasites seen
with schizonts of 20 microns size with 14 to 20
merozoites per cell and yellow brown pigment
Plasmodium vivax attacks
Senescent RBC mainly attacked by
Older RBCs are preferred by
Reticulocytes are preferred by
Duffy blood group antigen negativity confers protection
against infection by
Size of RBC are enlarged in
Fimbriated RBCs are seen in
Infective stage of mosquito in case of plasmodium vivax
Incubation period of plasmodium vivax
Fever every third day is associated with
Plasmodium
Schizont
Pigment released from breakdown of hemoglobin
Plasmodium vivax and ovale
Hemoglobin
P.vivax, P.ovale, P.malariae
Vivax and ovale
Vivax and ovale malaria
Thrombocytopenia, hemolysis, hematemesis, DIC
Multiple infection of erythrocytes seen
12 days
Plasmodium falciparum
Plasmodium falciparum
Plasmodium falciparum
Plasmodium falciparum
Plasmodium falciparum
Schizont
Plasmodium falciparum
Plasmodium falciparum
Plasmodium falciparum
Falciparum malaria
Falciparum malaria
Plasmodium falciparum
Plasmodium malariae
Older cells
Plasmodium malariae
Liver
Plasmodium vivax
Young RBC
Quartan malaria
Plasmodium malariae
Plasmodium ovale and vivax
Plasmodium vivax
Plasmodium vivax infection
Plasmodium ovale
Gametocyte
10 14 days
Plasmodium vivax
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PROTOZOA
FEATURES OF MALARIA
Cycle of malarial parasite is in sequence of
Infective form for mosquito in plasmodium
Gametocytes
Gametocytic stage
Gametozoites
Appear in blood 4-5 days after the appearance of
asexual parasite, in vivax infection, 10-12 days in
falciparum, in early stage of infection, density may
exceed 1000 per cu mm of blood
Gonotrophic cycle
Time between blood meal and laying of
eggs. 48 hours
Malaria
Man
Sporozoite
Sporozoites
Sporozoites
Sporozoite
Anopheles fluvitalis
Female anopheles mosquito
Stephensi, dirus
Antigenic variation
Intracellular persistency
Thalassemia, sickle cell anaemia, G6PD deficiency
Hypnozoites
Hypnozoites
Appearance of gametocytes again
Drug resistance in parasite, drug resistance in vector,
antigenic variations in parasite
Use of bed nets
Hematocrit more than 15
Splenomegaly, nephrotic syndrome
Cytoadhesion, sequestration of cerebral vessels by RBC
Thick smear is used to diagnose parasite
One hour after the height of paroxysm
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PROTOZOA
EPIDEMIOLOGY OF MALARIA
Epidemiology of malaria
Most sensitive index of recent transmission of malaria
in a community
Most sensitive index for recent
transmission of malaria
Best indicator for malaria prevalence in a community
API
Annual Parasite Incidence
Infective form of malarial parasite through blood
transfusion
Peak of fever in malaria coincide with the successive
broods of
Plasmodium ovale in India has been reported from
NOT a malarial parasite in India
Antimalaria month
If API>2, vector is resistant to DDT, malathion spray
should be done
Malathion is used once
Goal reduction in morbidity and mortality due to
malaria in 2010
DIAGNOSIS OF MALARIA
Jaswanth singh Bhattacharya stain and
field stain for
Blood smear in malaria used to identify
Detected by antigen detection test for falciparum
malaria
Fluorescent antibody test for diagnosis of falciparum
Malaria
Type of parasite
Histidine rich protein II
Immunochromatographic test, Detects aldolase
antigens, Detects LDH antigen, Detects histidine rich
protein II, detection of glutamate dehydrogenase
antigen
TREATMENT OF MALARIA
Chemoprophylaxis for Malaria is given
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PROTOZOA
in ECG
Hypotensive shock, retinopathy
Quinine
Quinine
Trophozoite stage
Quinine
Clindamycin
Sulphadoxine + pyrimethamine
Pyrimethamine
Sulphalene and pyrimethamine
Pyrimethamine
Mefloquine
Mefloquine
Mefloquine
Halofantrine
Mefloquine
Intravenous artesunate
Artesunate
Artesunate + quinine
Rapid recrudescence of malaria
Primaquine
Primaquine
0.25 mg/kg body weight
Primaquine
Primaquine
Primaquine
Proguanil + chloroquine
Proguanil
Proguanil
Atovoquone + Proguanil
Atovoquone/proguanil
1-2 weeks before travel
Type 2 resistance
Falciparum malaria
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HELMINTHS
HELMINTHS
GENERAL FEATURES OF HELMINTH
Nematodes are differentiated from other worms by
Cestode (tapeworm)
Most anterior segment of tapeworm
Helminthic infection resembling Crohns disease
Dwarf tapeworm
Smallest tapeworm
Hymenolepis nana
Egg containing polar filaments arising
from either end of embropore
Organisms with filariform larva as infective agent
Heterophyes heterophyes is an
Transmission of biliary flukes, intestinal flukes and
paragonimus westermani
Dew itch/Ground itch produced due to larva of
Eggs concentrated in saturated salt
solution
Float in saturated salt solution
Does NOT float in saturated salt solution
Eggs having hexacanth embryo
7 year boy intermittent abdominal cramps, loose stools
on stool examination ova of size 100 micrometre. NOT a
cause
African eye worm
Calabar swelling is caused by
Lizard skin
Observation of worm under conjunctiva and Calabar
swellings is diagnostic for
Raccoon ascaris
Helminth found in mesentry
Visceral larva migrans caused by
Visceral larval migrans is treated by
Drug of choice for Cutaneous larva migrans
Small intestine helminth
Larva found in stool in
Parasites penetrate through skin and enter into body
Parasites causing lung infection
Pigs are reservoir for
Fish act as intermediate host in
Post saline purge is used in
Intermediate host for Paragonimus
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HELMINTHS
Paragonimus westermani
Jammu and Kashmir
Praziquantel
Cryptosporidium
Interferes with pyruvate ferredoxin dependent electron
transfer reaction
CLONORCHIS
Parasite passing through three hosts
Intermediate host for clonorchis sinensis
Organism causing bile duct obstruction
Biliary obstruction
Helminthiasis is caused by
Cholangiocarcinoma is caused by
A traveler present with conjugated hyperbilirubinemia
and on investigation, an egg was found in his biliary
tract
Ingestion of raw fish leads to gall bladder cancer due to
Liver is the target organ for
Clonorchis sinensis
Fish
Clonorchis sinensis, Ascaris, Fasciola
Clonorchis
Clonorchiasis
Clonorchis sinensis
Clonorchis sinensis
Clonorchis sinensis
Clonorchis sinensis
DIPHYLLOBOTHRIUM LATUM
Diphyllobothrium Latum Infection is caused by ingestion
of
Human diphyllobothriasis results from
consuming infected
Second intermediate host for
diphyllobothrium latum
Megaloblastic anemia is caused by
Plerocercoid Larva
Fresh water fish
Fresh water fish
Diphyllobothrium latum
FASCIOLA HEPATICA
Man invertebrate host cycle is seen in
Treatment of biliary fluke
Fasciola hepatica
Praziquantel, Triclabendazole
FASCIOLOPSIS BUSKI
Largest trematode infecting man
NOT an inhabitant of liver
Drug used for fasciolopsis hepatica
F. buski
F.buski
Bithinol
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HELMINTHS
ASCARIS
Source of infection of Ascaris lumbricoides in man
Associated with normal hemoglobin and
hemocrit
Does NOT cause malabsorption
Ascaris lumbricoides cause deficiency of
Medusa head colony on X ray
Drug of choice for ascariasis
Round worm infection best treated with
Mechanism of action of albendazole
Causes flaccid paralysis of ascariasis
Drug of choice in worm colic due to ascariasis
Adult dose of bephenium hydroxynaphthoate in the
form of single dose
TAENIA SOLIUM
Longest worm
Man is both intermediate and definite
host for
On microscopic examination, eggs are seen, but on
saturation with salt solution no eggs are seen. the eggs
are likely to be of
Larval form of Taenia referred to
Consumption of uncooked pork is likely to cause
Commonest parasite of CNS in India
Cysticercus cellulose seen in
Cysticercosis is caused by larva of
Autoinfection is a mode of transmission in
Most likely to be invaded by Cysticercus
Comma shaped calcification in X ray
Treatment of taenia solium
Drug of choice for tapeworm infection
Tenia solim
Taenia solium
Taenia solium
Cysticercus
Tenea solium
Cysticercosis
Taenia solium
Taenia solium
Cysticercosis
Muscle
Cysticercosis
Praziquantel
Praziquantel
NEUROCYSTICERCOSIS
MC central nervous system parasitic infection
Neurocysticercosis is caused by
Neurocysticercosis
Multiple cystic lesion with calcified borders and
contrast enhancement in CT scan
MC Site of Neurocysticercosis
MC manifestation of Neurocysticercosis
Neurocysticercosis
Taenia solium
Acquired by eating contaminated vegetables, Caused by
regurgitation of larva, Acquired by orofecal route,
Acquired by eating pork
Neurocysticercosis
nd
rd
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HELMINTHS
Cysticercosis cellulosae
TAENIA SAGINATA
Longest worm
Ova of t.saginata and t.solium
Intermediate host for taenia saginata
Man is NOT dead end in
Drug of choice for Taenia saginata
Dose of niclosamide in tenia saginata infection in
children
Taenia saginata
Can NOT be differenriated
Cow
Taeniasis
Niclosamide
40 mg/kg single dose
ECHINOCOCCUS
Special feature of echinococcus among cestodes
Tinea echinococcus causes
Hydatid cyst of liver is caused by
Hydatid cyst is caused by
Transmitted by egg ingestion
Intermediate host for Hydatid disease
Vital layer of hydatid cyst
Only living part of Hydatid cyst
Fluid filling hydatid cyst is secreted by
Hydatid cyst commonly occur in
Hydatid cyst of lung common in
Dropping water lilly sign is seen in
Signs of hydatid cyst
Sensitivity of casoni test
Hydatid cyst
ARE-C5 in countercurrent mechanism
NOT a scolicidal agent
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HELMINTHS
Albendazole
Echinococcus multilocularis
FEATURES OF FILARIASIS
Filiariasis is endemic in
Percentage of persons examined showing microfilaria in
blood or disease manifestation or both
Organism commonly causing genital filariasis in most
parts of Bihar and Eastern UP
Hydrocele and edema of foot occur in
Wuchereria bacrofti
Types of microfilaria
Non sheathed microfilaria
Sheathed microfilaria
Wuchereria bancrofti
Sheathed microfilaria with nuclei upto tail tip
Microfilaria with sheath and two nuclei at the end
Nuclei in brugia malayi
MC nematode in south india
Brugia malayi
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HELMINTHS
MANAGEMENT OF FILARIASIS
Filaria dance sign is seen with
Method used to detect low density
microfilaria
Microfilaria does NOT multiple in
Drug of choice for Filariasis
Difference between action of DEC and ivermectin in
case of scrotal filariasis
DEC is most effective against
Currently given regimen for bancroftian filariasis
Dose of DEC in mass prophylaxis of filariasis in India
DEC mediated salt for mass treatment in lymphatic
filariasis was shown to be safe, cheap and effective in
Mass chemotherapy is used in
Target year for elimination of filariasis
Ultrasonography
Xenodiagnosis, membrane filter
concertration method
Humans
Diethylcarbamazine
DEC acts on adults, Ivermectin on microfilaria
Microfilariae
DEC 6 mg/kg/day for 12 days
6 mg/kg for 2 days
Lakshadweep Islands
Filariasis
2015
ENTEROBIUS
Seatworm
MC presenting symptom of threadworm infection
Autoinfection is seen in
Nematode residing in caecum and appendix
Eggs causing intense pruritis in perianal skin
Does NOT pass through lung
Cellophane test for
Feces examination NOT useful in diagnosing
Enterobius
Abdominal pain
Enterobius
Enterobius vermicularis
Enterobius vermicularis
Enterobius vermicularis
Enterobius vermicularis
Enterobius
TRICHINELLA
Viviparous
Trichinella
Larvae found in muscle
Larvae found in muscle in
Trichinellosis
MC muscle group involved in Trichinella spiralis infection
Viviparous
Does NOT enter human body via skin
NOT a neuroparasite
Parasite causing myocarditis
Muscle biopsy is indicated in
Treatment of trichinella spiralis infection
Trichinella spiralis
Larva rest in nurse cell
Trichinella spiralis, Taenia saginata,
echinococcus
Trichinella spiralis
Ova encysted in muscle with hyalinised capsule, associated
with splinter hemorrhage and subconjunctival hemorrhage
Extraocular muscles
Trichinella spiralis
Trichinella spiralis
Trichinella spiralis
Trichinella
Trichinella spiralis
Albendazole, glucocorticoids
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HELMINTHS
GUINEA WORM
Dragon / serpent worm
Dracunculiasis
Definite host of guinea worm
Dracunculus medinensis is transmitted by
Dracunculiasis is more common in
Guinea worm infection is common in workers of
Comma shaped calcification in tissue
Guinea worm infection
Drug preventing transmission of
dracunculiasis
Concentration of abate used in killing
Cyclops
Dracunculiasis
Parasite does NOT enter the body by skin penetration
Dracunculiasis
Infection through ingestion of water
containing cyclops
Man
Cyclops
Rajasthan
Step wells
Guinea worm
Metronidazole
No drug
1 mg/L
Eradicated in India, limited to tropical and subtropical
region, no animal reservoir
Dracunculus
STRONGYLOIDES
Stronglyoidosis is associated with
Infection associated with colitis
Unique feature of strongyloides stercoralis
Larva currens is seen in
Autoinfection seen with
NOT transmitted by fecooral route
Does NOT transmitted through egg
NOT a water borne disease
Diagnostic feature of uncomplicated strongloidiasis
Enterotest for
Treatment of strongyloidiasis
Immunodeficiency
Strongyloides
Replicate in human host
Strogyloides stercoralis
Strongyloides
Strongyloides stercoralis
Strongyloides
Strongyloidosis
Rhabditidiform larva
Strongyloidosis
Ivermectin
SCHISTOSOMA
Cercaria
Natural habitat of Schistosoma
NOT a cestode
Redia stage is NOT seen in
Painless terminal hematuria is associated
with
Katayama fever is caused by
Swimmers itch is associated with
Transmission of Schistosomiasis
Liver manifestations of schistosoma hematobium
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HELMINTHS
Schistosoma hematobium
Cystoscopy
Schistosoma hematobium
Schistosoma mansoni
Schistosoma mansoni eggs incite a fibrotic
response in portal vein
S.japonicum, S.mansoni
Schistosoma mansoni
S.mansoni
Splenic vein
Schistosoma japonicum
Small hook like spine
Schistosomiasis
Schistosomiasis
Schistosomiasis
Nuclear pore filter
Schistosomiasis
Praziquantel
Metrifonate
Oxamniquine
TRICHURIS
Trichuris trichura
Trichuris trichura maintains its position
in the intestinal tract by
Trichuris trichura resides in
Lemon shaped eggs
Eggs look like football with bumbs on each
end
Man is the only host in
Trichuris trichura infection is associated
with
Rectal prolapse is associated with
Infection does NOT affect eye
Sputum examination is NOT useful in diagnosis of
Does NOT pass through human lung
HOOKWORM
Old world hookworm
Ancylostoma enters human body by
Ancylostoma
Penetration of skin
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HELMINTHS
103
Jejunum
Ancylostoma brasiliensis
Ancylostoma brasiliensis, Ancylostoma carinum
Asymptomatic infection
Hook worm
0.2 ml/day
Hook worm
Ancylostoma duodenale
Anclyostoma duodenale
Ancylostoma duodenale
Chandlers Index
No of hookworms per gram of stool
Dangerous
Necatar americanus
Albendazole
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