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Plasmodium (Malaria)

From mosquitoes (Female Anopheles)


Plasmodium malariae
 Band shaped nucleus.
 Has regular symptoms
 Treated with Chloroquine
Plasmodium Vivax and Ovale
 Similar presenting symptoms which are random and inconsistent
 Both make the cell swell
 Ovale has some oval nucleus and vivax has a thick signet ring
 Both produce hypnozoites which stay in the liver. (dormant) Hypnozoites are treated with
Primaquine
 Treated with Chloroquine
Plasmodium Falciparum
 Has a double ringed trophozoite
 Symptoms are persistent and do not go down
 Treated with Artemether/Lumefantrine and Quinidine.
 All Malaria presents with hepatosplenomegaly and anemia
 Falciparum presents with CNS symptoms ( caused by Schizonts in CNS )
 Ataquavone and proguanil help prevent malaria

Wusheria Bancroftii- Filariasis


- Common cause for elephantitis and Hydrocele
- Tests include Lymphoscintigraphy for the Elephantitis and Ultrasound for the Hydrocele.
- Can get Filarial fevers
- Tested with the ICT test (thick blood film not as effective)
- Takes 10 days to mature
- Treat with ivermectin and albendazole as well DEC
- Doxycycline kills Wolbachia (Gram negative bacteria) which is needed for wusheria to
survive (TLR4 )
Yersinia Pestis
- Comes from a bug that infects rodents and dogs
- Gram negative bacteria
- Transferred through bite and causes 3 types of plagues
- Bubonic- Buboes near inguinal, Chest and neck nodes (fever as well)
- Septicemic- Fever with dark spots at distal limbs and shock
- Pneumonic- Lungs affected. Fever and pneumonic cough with blood in it.
- Detection with Waysons stain and Anti F1 serology
- Ymt gives toxicity
- F1 gives survival , Pla destroys organs

Marburg and Ebola virus (Filoviridae) ssRNA


- Causes viral hemorrhagic fever
- Infection from primates, bats and pigs
- Can be detected by ELISA and Real time PCR
- Ebola will cause the Hemorrhage and have myalgia
- Marburg will be presented with Maculopapular rash
- Both show up after 5-10 days

Cardio

Bacteria can attach to NBTE, and biofilm made by more bacteria


Acute vs subacute, IVDU, Hospital acquired
Venturi effect – Moving through a small opening ( valve ) causes lower pressure and higher
velocity. Lower pressure areas = bacterial vegetations
Fever and Murmur
Septic emboli break off and cause Splinter haemmorages, Janeway, Osler, Roth spots and even
glomerulonephritis
Acute caused by B haemolytic strep.
Subacute caused by Alpha strep-viridans

Streptoccocus viridans ( most prominent )


- Found in mouth
- Affect previously affected valves (subacute)
Staphyloccocus Aureus
- Found on skin
- Causes of IVDU
- Affects tricuspid
- Coagulase positive cause acute endo carditis
Pseudomonas Auriginosa
- Cause of IVDU
- Affects tricuspid
Staphyloccous Epidermidis
- Affects prosthetic valves
- Nosocomial
- Coagulase negative
Coxiella Burnetti
- From cows and goats and other farm animals
- Q FEVER
- Causes culture negative endocarditis
- Usually person has previous heart defects
- Bartonella, legionella, chlamydia, Borrelia also causes culture negative
HACEK
- Haemophilus, Aggribacter, Cardiobacterium, Eikenella, Kingella
- Gram negative bacteria. Normal flora of mouth and throat
- Aggregatibacter- Catalse positive Oxidase negative. Grows on 5% CO2 identified with
16S rRna. Dog bite
- Cardiobaccterium Catalise negative Oxidase positive. Grow on 5-10% Co2
Libmans sacks endocarditis
- Caused by SLE and is not caused by microbes 4
- Autoimmune disease
Strep bovis associated with GI carcinoma. Enteroccus arises from GI procedures
Myocarditis- other viral causes may be Adenovirus, parvovirus b19, Enterovirus,
Influenza A, HIV, polio, Rubella.
Protozoa myocarditis: Trpanosoma cruzi, Toxoplasma Gondii, Leishmania
Paragonimus Westermani- parasitic myocarditis other causes are toxocara and
baylisacaris
Toxocara and baylisacaris- worm, Causes Hyper gamma globulinemia and bleeding.
Internal organ damage. Baylisacarisis will cause speech defect and other CNS symptoms.
Both do not produce eggs
Toxocara travels are Visceral Larva Migrans (VLM)
Baylisacarisis travels as Neural Larva Migrans (NLM)
Respiratory Microbes
Viruses – Rhino adeno and Corona cause
- Pharyngitis (viral and bacterial etiology)
- Rhinitis
- Flu
- Bronchial pneumonia
Rhinovirus
- Picornaviride
- Icosahedral and small non-enveloped virus (lives longer on fomites)
- +ssRNA
- Labile at acidic ph.
- Can case exacerbation of asthma and COPD through respiratory epithelium remodeling
using ICAMs and LDR
- Usually presents in Summer months
Adenovirus
- Masadenovirus
- Medium sized
- Non-enveloped icosahedral
- Linear dsDNA
- Contains fiber (attachment) and penton bases on its surface
- Has a Lytic phase (in mucoepithelial cells) and a latent phase (in adenoid cells)?
- Once you see GI and eye symptoms think adenovirus
- Will present in people who swim at parties or share pillows/towels.
- Presents throughout the year
Corona virus
- Large Virus
- +ssRNA
- Enveloped (doesn’t last long on fomites) Takes the Endoplasmic Reticulum for its
envelope
- Winter Virus
- Contain spike proteins (E2) and polymerases (L)
- Cause SARS (endemic to Asia and found in bats/civet cats) and MERS (Saudi Arabia and
poor prognosis)
- SARS has nonproductive cough and respiratory failure
- MERS has an extremely high fever with hemoptysis
Enterovirus
- Affects children (<20) who have asthma
- Causes flaccid paralysis
- During the summer and fall
Influenza Virus
- Orthomoxyviridae
- Has A, B and C strain which have 7 (C only) or 8 (A and B) segments of -ssRNA
- Segmented genome can lead to genetic diversity
- Enveloped so it doesn’t stay long on fomites
- Influenza A is the most virulent and has Hemagglutinin (attachment) and Neuraminidase
(release)
- Must be cleaved from the neuraminidase by cellular proteases to become active
- DO NOT give aspirin to patients with influenza because Reyes syndrome will cause more
brain and liver damage. Can also cause Guillan barre and encephalitis
- Influenza presents with high fever, otitis, croup, pain and convulsions
- Systemic symptoms caused by cytokine and interferons
- Localized symptoms cause by epithelial damage
- Can culture and grow in eggs which can be bad for people with allergies
- Treat with Amantadine & Rimantadine (inhibit M2 uncoating) which only works on
influenza A
- Treatment with Zanamivir & Oseltamivir which prevents Neuraminidase from releasing.
Only works on A and B
Human parainfluenza virus 1 (Causes Croup, Bronchitis, Bronchopneumonia, Pneumonia)
- From the Paramyxovirinae family (HPIV 1,2,3,4) -ssRNA
- F protein, Hemagglutinin and neuraminidase, L protein, N (nucleoprotein), M (matrix
protein). P/F protein for inhibition of INFY and immune suppression
- Causes Croup which affects lower respiratory tract and small children
- Croup has hoarseness and a cough that sounds like a dog
- Look for Steeple sign or a Subglottic narrowing
- Vitamin A deficiency and no breastfeeding will put child at risk to get HPIV
Respiratory Syncytial virus
- From the pneumoviriniae family
- G protein (glycoprotein) used for entry into cell, F protein
- Causes Bronchiolitis- Risk factors include= Prematurity, complicated birth, Congenital
Heart disease, Passive smoking, overcrowding. Down syndrome
- Bronchiolitis (RALES important ), wheezing and fever with cough. Will only affect
respiratory tract
- Formalin inactivated vaccination causes worse disease later

Hantavirus (Four corners disease)


- Bunyaviridae, RNA virus, spherical lipd envelope with 2 glycoproteins
- Disease that enters through respiratory system
- Comes from Rodents through their droppings and urine. Typically happens in the Fall.
Rats hide for winter in sheds and homes.
- Sin Nombre virus is the most common strain (Hantaan virus less common)
- Sin nombre transferred through the Deer mouse
- Prodromal- normal symtoms , Cardiopulmonary- Lung edema and cardiac collapse with
Oliguric renal failure, Convalescent-Diuresis and improvement
- Symptoms show up because of the bodies response to the virus
Bacterial
- Pharyngitis
- Otitis media
- Sinusitis
- Epiglottitis
- COPD
- Lobar pneumonia
Streptococcus Pyogenes
- Group A strep (determined by Lancefield Hyaluronic acid) and does B hemolysis and
Gram+ve.
- Lacks catalase but has Superoxide dismutase making it aerotolerant
- Contain Leukocidin to make the pus
- Contain M protein (virulence) and F protein for attachment/
- C5a Peptidase helps avoid phagocytosis and it has strep toxins.
- Selectively grows on Blood agar 5% with Yeast and peptone
- Causes pharyngitis, scarlet fever also done by (Arcanobacterium haemolyticum),
Rheumatic fever and glomerulonephritis
- Symptoms include redness, fever and swelling.
Corynebacterium
- Usually native in human flora Gram +ve
- Grows on Tinsdale or Cysteine Terrulite agar
- Becomes C. diphtheriae after bacteriophage does lysogenic conversion
- Causes respiratory Diphtheria which makes pseudomembranes on throat and pharyngitis
- Diphtheria can be toxoided as a vaccine
- E2f destroyed by diphtheria toxin which inhibits protein synthesis through ADP
ribosylation
- Eleks test can be doing for toxigenicity
Haemophilus Influzenzae
- Causes Epiglottitis, Otitis media and sinusitis
- Gram -ve and normal part of the flora
- Contains P-2 for attachment and Polyribose ribitol phosphate for avoiding phagocytosis
- Catalase positive (Aerophilic) and NEEDS X (hemin) and V (NAD) to grow’
Moraxella Catarrhalis
- Causes COPD, Otitis media and sinusitis
- Gram -ve diplococcus
- Contain B lactamases and is resistant to penicillin
- Grows on chocolate agar and has a “hockey puck sign”
- Differentiate from Neisseria by testing DNAse positive and Nitrate reduction positive
Bordetella pertussis
- Gram -ve coccobacillus
- Lack of immunization
- Whooping cough (Mucous attaching to cilia causing coughing fit)
- FHA (filamentous Hemagglutinin)
- Need to swab with a special nasopharyngeal swab
- Fastidious organism. Needs charcoal blood agar with cephalosporin (Bordet Genou agar)
- The pertussis toxin causes increased camp due to mutation of adenylate cyclase and has
increased mucous as a result
- Would see increased T cells in circulation due to pertussis toxin
Streptococcus Pneumoniae
- Alpha Hemolysis
- Happens more in winter early spring
- Can cause Pneumonia, Otitis media and Sinusitis
- Typical pneumonia (one lobe with high fever and Consolidation)
- RUSTY sputum
- At risk individuals will have HIV, be alcoholics and have splenectomy’s
- Treat with capsular polysaccharide vaccine and prevent with 7-Valent Conjugated
vaccines
Klebsiella Pneumonia
- Gram negative Enterobacteriaceae O antigen(LPS)
- Typical Pneumonia (One lobe with consolidation and high fever.)
- FOUL smelling sputum Red currant jelly in colour
- Spread through touch
- Iron hungry pathogen (uptake through Aerobactin and Enterochelin)
- Impedes C3b
- Carbepenemase- inhibits Carbapenem

Mycoplasma Pneumonia
- Atypical (walking Pneumonia)
- <40 age
- Short rod that doesn’t have a rigid cell wall (so it will not pick up gram stain)
- B lactamase resistant
- P-1 adhesin
- Damages the base of cilia (pertussis immobilizes cilia with mucous)
- Can make H2O2 to damage respiratory epithelium
- Diagnosed more readily with Serology
- Treat with a Macrolide, tetracycline or Fluoroquinolone (not tested in micro course)

Chlamydophila Pneumonia
- Atypical (walking Pneumonia)
- Very similar to Mycoplasma
- Obligate intracellular
- Presents with Inclusion bodies
- Elementary body is the infectious body but it is NOT metabolically active
- Reticulate body Metabolically active after invasion NOT infectious

Legionella pneumophilia
- Gram -ve rod
- Can cause Legionaries disease or Pontiac fever
- Most common infection is with L. pneumophilia serogroup 1
- Cultured on Buffered charcoal yeast extract (BCYE)
- Symptoms will include GI and CNS problems along with Hematuria
- Comes from a water source such as aerosols or sprinklers
- Live in alveolar cells and inhibit phagolysosome formation
- Urinary antigen test will be looking for the serogroup 1 (if negative and legionarres is
still suspected a lung culture will need to be done)
- Can do Direct Fluorescent Antibody stains, PCR and serology

Pseudomonas Aeruginosa
- Found in fresh water
- Can cause Otitis externa (swimmers ear)
- Risk for acquiring this bacterium is higher when you have Cystic Fibrosis and burn
wounds (CF also makes it easier Burkholderia Cepacia to infect the person)
- Strictly aerobic and does B and Y hemolysis with mucoid colonies
- Makes a green pigment called pyocyanin and Fluorescein in agars and sputum
Mycobacterium Tuberculosis
- Cough that lasts more than 6 weeks
- Aerobic
- Takes a very long time to grow (2-8 weeks)
- M. Bovis can be used to make a vaccine for TB
- Mycolic acid on the cell wall can be destroyed by heat
- Immunocompromised and patients with AIDS (low CD4 count) are more susceptible to
TB infection
- CD4 with the alpha interferon protect against TB
- Survives intracellularly in alveolar macrophages (inhibits phagolysosome like
Legionella) Mycolic acid have sulfolipids that help with this process
- Cell wall lipids, Lipoarabinomannan and superoxide dismutase helped resist lysosomal
enzymes and ROS
- Also have siderophores: Exochelins
- Requires Lownstein Jensen agar and Oleic acid-albumin broth for culturing
- For microscopy, it needs Ziehl-Neelsen stain and Rhodamine Auramine fluorescent stain

Chlamydophilia Psittaci
- Causes Ornithosis or Parrot fever
- Obligate intracellular bacteria which enters through respiratory system
- Can be transferred from any bird through inhalation of shit and urine
- Has the Elementary body (virulent) and Reticulate body (reproductive) forms
- No Peptidoglycan despite being a bacterium but uses Outer Membrane Proteins which is
found on all Chlamydia
- LPS for endotoxicity
- Affects the Reticuloendothelial cells of the body
- Causes Edema, infiltration of macrophages and necrosis. Mucous in Bronchioles can
cause Cyanosis.
- Main symptoms to look for are CNS and GI with hepato and splenomegaly and Follicular
keratoconjunctivitis
Burkholderia Pseudomallei ( Melioidosis)
- Gram -ve bacteria, facultatively intracellular
- Found in SOIL and fresh water and enters through SKIN (can enter through respiration
too)
- Endemic to Asia and north Australia
- High risk individuals have: CF (like P.Auriginosa), Alcoholism, Renal disease, Lung
disease, Thalassemia
- Use Ashdowns Agar to culture B. Pseudomallei
- Bipolar staining on Microscopy

Coxiella Burnetti (Q Fever)


- Gram -ve intracellular bacteria
- Zoonotic disease that it gotten by inhalation of animal particles (waste)
- Comes from Cattle, sheep, goats and can come from ticks(rarely)
- Presents with influenza like symptoms, Flu, pneumonia, Hepatitis.
- Shows phase variation ( LPS changes according to environment )
- Chronic cases will present with osteomyelitis, encephalitis, endocarditis.
- Culture negative endocarditis
- At risk individuals have had previous heart defects, Pregnancy and immunocompromised
- Serology used for diagnosis
Fungal

Histoplasmosa Capsulatum
- Endemic to the Mississippi river valley and the Ohio river Valley
- 2 types H. Capsulatum Var capsulatum (Pulmonary and disseminated infections) and Var
Duboisii ( Skin and bone lesions )
- Var capsulatum is found in east US and Latin America and affects thinner cell walls. Var
Duboisii is found in Africa and affects large cell walls
- Found in soil with high nitrogen content and Bird or bat droppings
- Can affect immunocompetent or immunocompromised patients
- Presents with Hilar lymphadenopathy (like TB )
- Grows inside macrophages and increases pH of phagolysosome
- Microscopically: non-encapsulated thick walled budding yeast within macrophages
Blastomyces Dermatitis
- Endemic to the Mississippi river valley and the Ohio river Valley
-Can affect immunocompetent or immunocompromised patients
- Granulomatous Lesions on the skin or mucous membranes
- Very similar to histoplasmosis
- Microscopically it will have a single broad based bud in a yeast

Coccidioides immitis (Valley fever)


- Endemic to Southwest United States and northwestern Mexico
- Can affect immunocompetent or immunocompromised patients
- Only fungal infection that can be detected by Delayed hypersensitivity ( Type 4) through
coccidiodin and spherulin antigens
- Exposure through inhilation of arthroconidia from soil
- Will have Spherules formed on Calcofluor stain which is a protective mechanism from
phagocytosis

Cryptococcus Neoformans
- Affects immunocompromised individuals
- Encapsulated
- Transmission through inhalation of the yeast. When inhaled it will produce a capsule
made of GMX (Glucuronoxylomannan). Capsule can be found in blood and body fluids
which downregulate immune system even further
- Oxidizes catecholamines to Melanin to prevent oxidative damage.
- Can cause sarcoidosis and liver disease
Pneumocystis Jirovecci
- Affects immunocompromised individuals
- Usually affects patients with a CD4 count of < 200 cells
- Lacks ergosterol in the cell wall
Aspergillus
- Found in decaying matter, air and soil
- Found in a septal hyphae form at an acute angle
- Has 2 forms: Allergic- asthmatic and cystic fibrosis and an Invasive form: hyphae
invaded tissue.
- “Fungal balls” can form – Aspergilloma
- Can cause acute pneumonia
- HEMOPTYSIS is a common symptom
Gastrointestinal
Remember that Aerobic bacteria are found closer to mouth and Anaerobic closer to the stomach.
Ecoli and streptococci obtained from mother upon birth.
Bifidobacterium kept in baby if it is fed breast milk ( needs this microbe to break down breast
milk)
Lactobacilli are needed to break down the sugars in formula
Eruption of your first teeth you will have Porphyromonas and prevotella and fusobacterium but
growth of teeth gives strep. Sanguis mutans and salvarius which give you dental plaque
Oesophagus has : Streptoccous, Prevotella and Veillonella
Stomach has: H. Pylori
Duodenum: Streptocci, Staphylocci, Lactobacilli, yeast
Jejunum-Ileum: Strep and staph lactobacillus, Bacteroides, Bifidobacterium and clostridium
Large intestine: BACTERIODES AND CLOSTRIDIUM. As well as Bifidobacterium,
Eubacterium, peptostreptoccocus and enterobacteriacea
Increased bacteriodes and decreased enterococci in meat eaters- opposite for vegetarians

Candida albicans will cause whitish plaques on throat


Herpes simplex virus 1 will cause multiple small ulcers (volcano like)
CMV will cause Single large ulcers
H. Pylori
- Cause of Gastritis and gastric cancer
- Gram -ve and non-spore forming. MOTILE, Catalase positive and urease positive
- When paired with other things like NSAID use the risk of getting Gastritis increases
- Gastric ulcers give pain right after eating while duodenal ulcers give pain hours after
eating
- vacA is the component which is virulent and makes exotoxins
- Has a type 4 secretion system which injects effectors to remodel actin.
- Effectors: cagA
- Detected by serology, Faecal antigen and gastric biopsy
- Can use Carbon Urea test but it is expensive
- Must use triple or quadruple therapies to treat
- Triple: PPI+Amoxicillin+Clarithromycin
- Quadruple: PPI+Bismuth+antibiotics like metronidazole and tetracycline
- Vaccine: oral recombinant H.pylori vaccine
Diarrhea
Acute- Noninflammatory (watery and non-bloody) or inflammatory (WBCSs and blood and
pus) <2 weeks usually due to bacteria
Food poisoning: toxins made by bacteria are ingested
Chronic >4 weeks and usually due to parasites
Campylobacter and salmonella: Dairy and chicken
Ground beef STEC
Seafood and oysters: Vibrio cholerae and Calicivirus
Giardia from camping
Water has Shigella Giardia and cryptosporidium
Medication: C dificile