sl 2013

Bacteria
Neisseria
gonorrheae

Neisseria
meningitidis

GRAM-NEGATIVE BACTERIA
Characteristic
s
Gram diplococci in
pairs
(flattened
sides)
Oxidase +
Non-motile
Ferments
glucose
STD

Gram diplococci in
pairs (kidney
bean)
Oxidase +
Non-motile
Ferments
glucose and
maltose
**Most
common
cause of
meningitis
from ages 218

Moraxella
catarrhalis

Gram coccobacilli
in pairs
Aerobic

Epidemiology

Pathogenesis and Virulence

Diseases

Spread: sexual
contact
Location:
urogenital tract,
rectum
Risk Factors:
1. Unprotected
sex
2. Multiple sex
partners
3. Homosexual
male sex
At Risk:
1. Prostitutes
2. Adolescents
and young
adults

1. Pilin: cell adhesion; can easily

vary antigenic sequence!!!
Immunity improbable
2. Lipooligosaccharide: endotoxin
3. IgA1 protease: cleaves
neutralizing IgA Ab; prevent
neutralization in mucosa
4. Por protein (I): prevent
phagolysosome fusion in
neutrophils
5. Opa protein (II): firm attachment
to eukaryotes
6. Rmp protein (III): protects from
bacteriocides
7. Transferrin, lactoferrin,
hemoglobin binding proteins:
iron acquisition from host

Spread: aerosol
Location:
nasopharynx
Risk Factors:
1. Cold, dry
months
2. Crowded
areas (schools,
barracks)
3. Developing
nation
At Risk:
1. Children <5
yo
2. Late
complement
deficiencies
Strain: Serogroup
A: developing
countries
Serogroup B &
C: North
America
Spread:
endogenous
Location: mucosa
of RT

1. Polysaccharide capsule:
prevent phagocytosis
2. Pili: has receptors to colonize
nasopharynx
3. Lipooligosaccharide:
endotoxin
4. IgA1 protease
5. Transferrin-binding protein

1. Gonorrhea: purulent
discharge from genitalia;
painful urination
2. Gonococcemia: disseminated
infection; pustular
erythematous rash; fever,
arthralgia, suppurative arthritis
(leading cause in adults)
3. Opthalmia neonatorum
(conjunctivitis): purulent eye
infection at birth; in utero
transfer of N. gonorrhoeae
4. Perihepatitis (Fitz-Hugh-Curtis
Syndrome): pelvic inflammatory
disease
5. Anorectal gonorrhea: men who
have sex with men
6. Pharyngitis: oral sex
7. Adult onset arthritis
1. Meningitis: purulent
inflammation of meninges;
headache, nuchal rigidity,
fever; high mortality unless
treated properly
2. Meningococcemia:
disseminated infection;
thrombosis, multi-organ
involvement; petechial skin
rashes fuse together to form
patches
3. Waterhouse-Friedrichsen
Syndrome: overwhelming
meningococcemia; hallmark:
bilateral adrenal failure!
4. Pneumonia: occurs with preexisting condition; bacteria
spreads to lungs
5. Arthritis

1. Capsule: evades phagocytosis

2. Endogenously infect
immunocompromised host

1. URT infections:
immunocompromised
2. LRT infections:
immunocompromised

Lab
Diagnosis
Urethral
exudate:
neutrophils
with
diplococci
Enhanced
CO2
ThayerMartin
agar:
chocolate
agar with
NCTV
PCR
Fermentati
on: g vs.
g/m

Treatment
Ceftriaxone
Add doxy and
azi if
chlamydia
is
coexisting
Protected sex
**PPNG
penicillinas
e producing
N.
gonorrheae
(resistant to
penicillin)

Urethral
exudate:
neutrophils
with
diplococci
Enhanced
CO2
Chocolate
agar
PCR
Fermentati
on: g vs.
g/m

Ceftriaxone &
rifampin
Meningococc
al vaccine
Serology: Ab
against
serogroup Ag
(A, C)

Oxidase test
Similar to
Neisseria
but no

Antibiotic
resistant
watchful
waiting

**Serogroup
B is self-Ag
no immune
reaction

 sl 2013

GRAM-NEGATIVE BACTERIA

Oxidase +
Non-motile

At Risk:
1. Elderly and
immunocomp

Gram coccobacilli
in pairs
Aerobic
Oxidase Non-motile
Gram - rod
Anaerobic
Spore forming
Capsulated

Spread:
nosocomial
Location: soil
At Risk:
1. Elderly and
immunocomp
Spread: soil or
endogenous
Location: vagina
and GIT, soil
Risk Factors:
1. Open wounds
and fractures
2. Devicerelated
3. Penetrating
injuries, severe
trauma
Strain: Type A has
toxin and
enterotoxin
most virulent

1. Capsule: evades phagocytosis

2. Endogenously infect
immunocompromised host

1. Nosocomial pneumonia
2. Bacteremia and meningitis

1. Exotoxin: -toxin (lecithinase)

cleaves lecithin; hemolytic,
cytotoxic, necrotic effects; toxin (perfringolysin O)
2. Enterotoxin: binds to receptors
in small intestine; disrupts ion
transport; diarrhea
3. Enzymes: proteases, DNase,
hyaluronidase, collagenase

Clostridium
tetani

Gram - rod
O2 sensitive!!
Anaerobic
Spore forming

Tetanoplasmin: heat labile

neurotoxin spread through
neurons or blood; blocks
GABA/glycine release;
prolonged muscle spasms

Clostridium
botulinum

Gram - rod
Anaerobic
Spore forming

Spread: puncture
wound
Location: soil,
garden,
barnyard
Risk Factors:
1. Splinter
formation
2. Unvaccinated
At Risk:
1. Elderly with
outdated
vaccine
Spread: food,
vegetables
Location: soil,

1. Myonecrosis (gas
gangrene): spread of bacteria
into an open wound release
of -toxins and exotoxins
muscle and tissue necrosis
fermentation leads to gas
bubble formation
dissemination leads to shock,
renal failure, DIC
2. Cellulitis: bacterial growth
along fascia
3. Gastroenteritis: enterotoxin
4. Food poisoning: failure of heat
to inactivate Clostridium
spores; meat products and
gravy
5. Necrotizing enteritis: acute,
necrotizing destruction of
jejunum with abdominal pain,
vomiting and diarrhea
Tetanus: generalized or localized
muscle spasms; triad: trismus,
opisthotonos, risus sardonicus;
spastic paralysis (lack of
inhibitory NT excessive firing
of AP)

Acinetobacter
baumanii

Clostridium
perfringens

3. Otitis media and sinusitis

Botulinum: prevents
presynaptic ACh release; no
muscle contraction; patient

1. Food borne botulism:

consumption of spore-forming
foods (canned foods, raw

bacteremia
(localized)
and
doesnt
ferment
carbs
Oxidase test
Similar to
Neisseria
but doesnt
ferment
carbs
Clinical
presentatio
n!

Antibiotic
resistant
Carbapenem

Wound
debridemen
t
O2 therapy
High dose
penicillin

Serology: Ab
against
tetanoplas
min

Vaccination:
neutralizing
Ab
Metronidazole
Wound
debridemen
t

Toxin in stool
and food
Cultured by

Metronidazo
le
Penicillin

 sl 2013

GRAM-NEGATIVE BACTERIA
**7 distinct
exotoxins

vegetables,
meat, fish
Risk Factors:
1. Raw
unpasteurized
honey

recovers only when there is

generation of new nerve endings
Acts on NMJ

Clostridium
difficile

Gram - rod
Anaerobic
Spore forming
Antibiotic
resistant

Spread:
endogenous
Location: GIT
Risk Factors:
1. Antibiotic
therapy
2. Immunocomp

Minor component of gut flora; only

predominates when commensal
flora is killed in GIT
1. Enterotoxin (toxin A): attracts
neutrophils and stimulates
cytokine release, intestinal
hemorrhage
2. Cytotoxin (toxin B): increases
permeability of intestinal wall;
diarrhea, mucosal membrane
damage

Haemophilus
influenzae

Gram coccobacilli
Pleomorphic
(cocci in
sputum,
bacilli in
CSF)
Anaerobic
Fermentative
Require factor
X and V

Spread: aerosol
Location: normal
flora
Risk Factors:
1. Low levels of
protective Ab
2. Depleted
complement
3. splenectomy
At Risk:
1. Unvaccinated
child
H. ducreyi (STD)
Spread: sexual
contact

Type B most virulent!!

1. Capsule: containing polyribitol
phosphate (PRP) target for
vaccination
2. Pili
3. Endotoxin
4. IgA1 protease

H. ducreyi
H.
aphrophilus
H. aegyptius

Same as H.
influenzae

Same as H. influenzae

unpasteurized honey), blurred

vision, dry mouth, constipation
2. Infant botulism: flaccid
paralysis; most common type
of botulism in NA
3. Wound botulism
4. Inhalation botulism: spore
inhalation, rapid onset of
symptoms, high mortality
1. Antibiotic-associated diarrhea:
acute diarrhea after antibiotic
treatment; self-limiting
2. Pseudomembranous colitis:
profuse diarrhea, abd cramp,
fever, dirty white plaques; seen
in colonoscopy
**pseudomembrane leads to dec
absorption in GIT

1. Meningitis: only in
unimmunized children (3 mo 6
years) (Hibtiter)
2. Epiglottitis: chokes entire
airway; pharyngitis, fever,
dyspnea, epiglottal swelling
3. Pneumonia
4. Otitis media
5. COPD

H. ducreyi
Chancroid (chancre-like
lesion): progressive painful
ulceration on genitalia with
lymphadenopathy; STD
H. aphrophilus
Subacute endocarditis: damage
to heart valves (rare)
H. aegyptius
1. Brazilian purpuric fever:
children
2. Purulent conjunctivitis: pink
eye with pus

anaerobic
methods

Colonoscopy
Fecal sample
of toxins

Chocolate
agar (with
Factor X
and V)
Serology: Ag
detection
for HIB
*Factor X
hemin
Factor V
NAD
Same as H.
influenzae

Trivalent
botulinum
antitoxin

Metronidazo
le
Oral
vancomycin
(resistant
strains)
Repopulate
gut with
probiotics
Stop
antibiotics
Fluid
replacemen
t
Ampicillin
Cephalospori
n

Same as H.
influenzae

 sl 2013
Bordetella
pertussis

GRAM-NEGATIVE BACTERIA

Gram
coccobacilli
(small)
Aerobic
Nonfermentativ
e
Grow in media
with
charcoal,
starch,
blood or
albumin

Spread: aerosol
Location: human
reservoir
Risk Factors:
1. Unvaccinated
At Risk:
1. Infants
2. Unimmunized
older children

1. Adhesins: filamentous
hemagglutinin, fimbriae
2. Toxins: pertussis toxin
(lymphocytosis, histamine
sensitization, insulin production),
hemolysin, dermonecrotic toxin,
tracheal cytotoxin, adenylyl
cyclase toxin

Whooping cough (Pertussis)

Incubation: 7-10 days
Stages:
1. Catarrhal stage: resembles
common cold (1-2 weeks)
2. Paroxysmal stage: repetitive
cough and whoops;
leukocytosis (2-3 weeks)
3. Convalescence stage:
diminishing paroxysms;
secondary complications may
arise (2-3 weeks)

DFA test: vs.

bacterial
Ag (rapid!)
Culture
specific:
special
media
Serology: IgG
and IgA;
confirmato
ry

Pertussis
vaccine to
prevent!!
Erythromycin
TMP-SMX

Legionella
pneumophila

Gram
coccobacilli
(small)
Pleomorphic
Aerobic
Require Lcysteine for
growth!

Spread: aerosol
via URT
Location: bodies
of water, cooling
towers
Risk Factors:
1. Immunocomp
At Risk:
1. Elderly

Prevent phagolysosome fusion in

macrophages
Infects respiratory tract
Usually from a common source

Silver
stain!
DFA test: vs.
bacterial
Ag
Grown in
BCYE agar
Apple green
fluorescenc
e
ELISA:
urinary Ag

Erythromycin
Ciprofloxacin
Levofloxacin

Escherichia
coli

Gram - bacilli
Anaerobic
Non-spore
forming
Oxidase Ferments
glucose;
reduce
nitrate
Enterobacteri
a

Spread: feco-oral
Location: GIT
(normal flora),
contaminated
food/water

1. Endotoxin: LPS release;

stimulate adenylyl cyclase
cAMP efflux of NaCl
diarrhea
2. Capsule: prevent phagocytosis
3. Antigen phase variation:
protects bacteria from Abmediated cell death
a. K antigen: capsule
b. O antigen: somatic
c. H antigen: flagellin
4. Sequestration of growth factors
(iron): produce own siderophores
(iron gathering)
5. Resistance to serum killing
6. Antimicrobial resistance
7. Type III secretion system:
molecular syringe mechanism to
deliver various virulence factors
8. Adhesin: adhere E. coli to
surface

1. Pontiac fever
(immunocompetent): selflimiting, 1-2 day incubation;
fever and chills; no lung
involvement!
2. Legionnaires Disease or
legionellosis
(immunocompromised):
pneumonia with multilobar
consolidation &
microabscesses; spread to GIT,
kidney, CNS, liver; severe
course & considerable mortality
1. Diarrhea: acute bloody
diarrhea, abdominal tenderness
and absence of fever
2. Gastroenteritis
3. Septicemia: usually
nosocomial in nature
4. Neonatal meningitis: K1 strain
5. UTI: P fimbriae, hemolysin,
colicin V allow pathogenic
infection of E. coli

Generally
difficult
part of
normal
flora
Culture on
MacConkey
agar

Fluid and
electrolyte
replacemen
t
Antibiotic
sensitivity
test
UTI: cipro or
TMP-SMZ
Local disease:
ampicillin
Meningitis:
cefotaxime

**E. coli K1 strain: increasing

incidence of neonatal
meningitis
K1 Ag penetrates BBB leading
to infection of meninges

 sl 2013

GRAM-NEGATIVE BACTERIA

Strains of E.
coli

EPEC
Spread: perinatal,
person-person
Location: small
intestine

EPEC
ETEC
EHEC
EIEC
EAEC

ETEC
Spread: feco-oral
Location: small
intestine
EHEC (O157:H7)
Spread: cattle
products;
developed
countries
Location: large
intestine
EIEC
Spread:
developing
countries
Location: large
intestine
EAEC
Spread: children
and HIV patients
Location: small
intestine

Salmonella
enteritidis

Gram - bacilli
Anaerobic
Non-spore
forming
Oxidase Motile
Ferments
glucose
Enterobacteri
a

Spread: improper
food handling
Location: animals
(turtles) and
foods; Typhi:
human
Risk Factors:
1. Crowded
areas
2. Low gastric

9. Exotoxin
Enteropathogenic E. coli
(EPEC)
1. Pili (BfpA): attaches to mucosa
of SI
2. Type III SS: injection of effector
proteins; destroy microvilli
malabsorption
Enterotoxigenic E. coli (ETEC)
1. Heat stable (cGMP) and heat
labile (cAMP) enterotoxins:
hypersecretion of Cl- and water
by mucosal cells
Enterohemorrhagic E. coli
(EHEC)
1. Pili (BfpA): attaches to mucosa
of SI
2. Shiga-like toxins: inhibit
protein synthesis (16S ribosomal
subunit)
Enteroinvasive E. coli (EIEC)
1. Shiga-like toxins: inhibit
protein synthesis (16S ribosomal
subunit)
2. Ipa: invasion of epithelium
3. Hemolysin
Enteroaggregative E. coli
(EAEC)
1. Heat stable toxin
2. Fimbriae: aggregative
adherence to SI; resemble
stacked bricks; shortened
microvilli
1. Low dose required for S. typhi
2. Capsule: evades phagocytosis
3. ATR gene: protective from
gastric acidity and phagocytosis
4. Invade mesenteric lymph
nodes via M cell
phagocytosis

Enteropathogenic E. coli
(EPEC)
1. Infant diarrhea
2. Watery diarrhea, vomiting,
non-bloody stool

EHEC: does
not
ferment
sorbitol
(SMac
agar)

Enterotoxigenic E. coli (ETEC)

1. Travellers diarrhea
Enterohemorrhagic E. coli
(EHEC)
1. Bloody diarrhea: abdominal
cramps with fever
2. Hemolytic Uremic
Syndrome: fever, acute renal
failure, microangiopathic
hemolytic anemia and
thrombocytopenia in children
Enteroinvasive E. coli (EIEC)
1. Bloody diarrhea: abdominal
cramps with fever
2. Dysentery: fever and bloody
stools
Enteroaggregative E. coli
(EAEC)
1. Persistent watery diarrhea:
children and HIV patients
2. Travellers diarrhea

Non-typhoid strains (S.

enteritidis, typhimurium)
Gastroenteritis
(salmonellosis): localized to
GIT; nausea, vomiting, nonbloody diarrhea, from
contaminated food or water;
self-limiting
Typhoid strains (S. typhi,

Culture on
MacConkey
agar
Rose spots!

GE: not
needed
Typhoid fever:
ceftriaxon
e

 sl 2013

GRAM-NEGATIVE BACTERIA
acidity
3. HIV
At Risk:
1. Young
children
2. Elderly

Shigella spp.

Gram - bacilli
Anaerobic
Non-motile
Ferments
glucose
Enterobacteri
a

Yersinia
pestis

Gram bacilli
Stains bipolarly
Anaerobic
Enterobacteri
a

Yersinia
enterocolitica

Gram bacilli
Stains bipolarly
Anaerobic
Enterobacteri
a

Klebsiella
spp.

Gram - bacilli
Oxidase Non-motile
Enterobacteri
a

6
paratyphi)
Enteric (typhoid) fever:
severe, life-threatening illness;
preluded by diarrhea; chills,
sweats, headache, rose spots
on trunk; septicemia

Spread:
contaminated
hands
Location:
humans,
contaminated
stool
Risk Factors:
1. Crowded
areas
2. Poor
sanitation
At Risk:
1. Young
children
Spread: flea bite
Location:
zoonotic;
humans are
accidental
Risk Factors:
1. Geographic
location (high
density of
wildlife)

1. Shiga toxin: inhibit protein

synthesis (16S ribosomal
subunit)
2. Cell to cell spread: evades
immune clearance; Ab cannot
neutralize
3. Induce apoptosis to survive
phagocytosis (IL-1)
4. Low dose required for infectivity
5. Adhesion, invasion, intracellular
replication

Shigellosis: initial profuse

watery diarrhea bloody
diarrhea; increase neutrophils
in stool (pus-filled); abdominal
cramps; HUS complication

Culture from
stools

Ciprofloxacin
Azithromycin

1. Protein capsule:
antiphagocytic capsule; prevent
phagocytotic migration and
movement
2. Adherence
3. Type III secretion system:
secretes Yops; host cell paralysis
4. Lymph node tropism

1. Bubonic plague: high fever,

painful bubo in groin and axilla
2. Pneumonic Plague: fever,
malaise, pulmonary infection
systemic spread back to
lungs; patient highly infectious

Clinical
presentatio
n: bubo
XLD agar

Streptomyci
n
Doxycycline

Spread: cattle
products
Location: cattle,
wildlife
Risk Factors:
1. Cold
temperature
At Risk:
1. Young
children
Spread:
endogenous,
nosocomial
Location: GIT
normal flora

1. Adhesin (TAA)

1. Enterocolitis (yersinosis)
2. Pseudoappendicitis: painful
enlargement of mesenteric LN
3. Reactive arthritis: common
complication

XLD agar

Usually selflimiting

Luxurious capsule: enhanced

virulence and mucoid
appearance of colonies

K. pneumoniae
Pneumonia: currant-tinged
sputum; necrotic destruction of
alveolar spaces cavitated
pneumonia

Culture in
MacConkey

Antibiotic
sensitivity
test

S. sonnei: infections in
developed countries
S. dysenteriae: more severe
infections, rare in USA
S. flexneri: homosexual
intercourse

GRAM-NEGATIVE BACTERIA

sl 2013

Lac+

Risk Factors:
1. Immunocomp

Proteus
mirabilis

Gram - bacilli
Enterobacteri
a

Urease: cleaves urea to increase

pH; ammonia-flavored urine

UTI: formation of urinary stones

lead to UTI; nosocomial in
nature

Culture in
MacConkey
agar:
swarming
colonies

Antibiotic
sensitivity
test

Vibrio
cholerae

Gram curved
rod
Oxidase +
Anaerobic
Rapidly Motile
Fermenter
Enterobacteri
a

Spread:
endogenous,
nosocomial
Location:
uroepithelium
Risk Factors:
1. Immunocomp
Spread:
contaminated
water and food
Location: aquatic
reservoir
(crustaceans)
Risk Factors:
1. Raw
undercooked
seafood
2. Natural
disasters
Spread:
contaminated
shellfish
Risk Factors:
1. saltwater

1. Cholera toxin: binds to GM1

ganglioside stimulates cAMP
production hypersecretion of
electrolytes and water
diarrhea
2. Adhesion: chemotaxis protein
3. Accessory cholera toxin
4. Zonula occludens toxin
increase interstitial permeability
5. Neuraminidase increase GM1
ganglioside

1. Cholera: abrupt onset of ricewater diarrhea and vomiting

severe dehydration, metabolic
acidosis, hypokalemia, shock
2. Gastroenteritis: milder form,
toxin negative O1 and non-O1

Growth in
TCBS agar
(green
media,
yellow
colonies)

Fluid and
electrolyte
replacemen
t
Improvement
in
sanitation
Doxycycline

Spread:
contaminated
water
Location: fresh
and brackish
water
Spread:
improperly
prepared
poultry
Location:
zoonotic
Risk Factors:
1. High

Potential virulence factors poorly

defined

Halophilic
Vibrios
[Link]
ticus
V. vulnificus

Gram curved
rod
Oxidase +
Anaerobic
Rapidly Motile
Fermenter
Enterobacteri
a

Aeromonas
spp.

Gram rod
Microaerophili
c
Fermenter

Campylobacte
r jejuni

Gram Sshaped rod

Oxidase Anaerobic
Rapidly Motile
Nonfermenting
Enterobacteri

K. granulomatis
Granuloma inguinale: grow in
monocytes, affects
genitalia/inguinal area; mimic
syphilitic chancre; STD

Potential virulence factors poorly

defined
1. Monotrichous flagella: high
motility
**Most common bacteria
isolated from diarrhea in USA

**O1- most frequent cause of

outbreaks, capsulated
O139 strain after natural
disasters
V. parahemolyticus
1. Gastroenteritis: self-limiting,
explosive onset of watery
diarrhea; nausea, vomiting,
fever, headache
2. Wound infection: exposure to
contaminated water
V. vulnificus
1. Wound infection: septicemia
1. Diarrhea: acute, self-limiting
2. Wound infection
3. Opportunistic systemic
disease: immunocompromised
patients
1. Gastroenteritis: self-limiting
diarrhea, malaise, fever,
abdominal pain
2. Pseudoappendicitis: results
in inflammatory diarrhea
**C. fetus causes septicemia

Ciprofloxacin

Culture: gold
standard
High temp,
72 hour
incubation

Fluid
replacemen
t
Macrolides

GRAM-NEGATIVE BACTERIA

sl 2013
a

Helicobacter
pylori

Gram
curved,
spiral rod
Multiple polar
flagellum
(tuft)
Microaerophili
c
Corkscrew
motility
Enterobacteri
a

Treponema
pallidum

Gram helical
rod
Spirochete
STD

Borrelia spp.
B. recurrentis
B. burgdorferi

Gram helical
rod
Highly Motile
Microaerophili
c
Spirochete

temperature
**Polar
flagellum!
Spread: feco-oral
Location: humans
Risk Factors:
1. Low
socioeconomic
groups
2. High gastric
pH
3. Antacid use

1. Urease: cleaves urea; makes

stomach alkaline (increase pH);
survives gastric acidity
2. Mucinase: disrupts mucus
3. Heat shock protein: increase
urease expression
4. Acid Inhibitory Protein: maintain
basic environment
5. Flagella
6. Adhesins
7. Superoxide dismutase &
catalase
8. Vacuolating cytotoxin: induces
vacuolation

1.
2.
3.
4.

Acute and Chronic Gastritis

Peptic Ulcer
Gastric Adenocarcinoma
Gastric MALT B-cell Lymphoma

Spread: sexual
contact
Location:
urogenital tract,
rectum
Risk Factors:
1. Unprotected
sex
2. Multiple sex
partners
3. Homosexual
male sex
At Risk:
1. Sexually
active
adolescents
2. Infants with
affected
mothers

1. Adherence: outer membrane of

host
2. Hyaluronidase: perivascular
infiltration
3. Fibronectin: prevents
phagocytosis
4. Tissue Destruction: host immune
response to infection
5. Epithelial breaks: bacteria
enters and colonizes

Venereal Syphilis: 3 stages

1. Primary Syphilis: painless
chancre development (1
month); inguinal LN
enlargement; highly infectious;
ulcer heals
2. Secondary Syphilis:
generalized mucocutaneous
rash (condylomata lata); rash
recovers slowly (weeks to
months)
3. Tertiary Syphilis: chronic
inflammatory reaction destroys
any organ/tissue; aortitis;
gummas found in bone, skin,
tabes dorsalis (neurosyphilis)
Congenital Syphilis: in utero
infection; serious fatal disease,
widespread maculopapular rash

Spread: tick bite

Location:
zoonotic

Tick bite: spreads the bacteria

into hosts blood
B. recurrentis
Antigenic shift: escape immune
clearance permit relapsing of
fever
B. burgdorferi
Immune reactivity to bacteria

B. recurrentis
Relapsing fever: abrupt onset of
chills, fever, myalgia;
bacteremia
1. Epidemic severe single
relapse
2. Endemic milder repeated
relapse

Urease test
Urea breath
test
Ag detection
in stool
Culture:
same as C.
jejuni

Omeprazole
+
Clatritromy
cin +
Amoxicillin
for 2 weeks

Dark field
microscop
y
Serology:
Screening:
VDRL &
RPR (nontrep)
Confirmatory
:
FTA-ABS &
TPHA
(trep)

Penicillin G

**SLE px
false
positive for
syphilis
anticardiolipin
Ab
Giemsa or
Wright
stain
Serology:
IgM or IgA
vs.
spirochete
s

Doxycyline

 sl 2013

GRAM-NEGATIVE BACTERIA

causes disease manifestations

**no exotoxins or endotoxins

Leptospira
interrogans

Gram
hooked rod
Highly Motile
Spirochete

Spread: food
contamination,
animal urine
Location: cattle,
rodents, canine

Enter body via small abrasions or

conjunctiva

Pseudomonas
aeruginosa

Gram rods
Oxidase +
Highly Motile
Aerobic

Spread:
opportunistic,
nosocomial
Location:
ubiquitous, RT,
GIT
Risk Factors:
1. Broad
spectrum
antibiotics
2. Post-surgery
3. Burn
victims!
4. Hospitalized
5. Respiratory
equipment
At Risk:
1. Immunocomp
px

1. Pyocyanin (blue pigment):

impairs ciliary function; increase
IL-8 release inflammatory
response; tissue damage free
radicals
2. Capsule: prevent phagocytosis
3. Flagella
4. Pili
5. LPS
6. Exotoxin A & S: inhibits protein
synthesis
7. Cytotoxin: eukaryotic membrane
damage
8. Elastase: destroy elastin
9. Antibiotic resistance: mutation
of porin channels; antibiotic
cannot pass through; lactamase
10. Slime layer

Chlamydia
trachomatis

Gram like
ovoid
Intracellular
parasites
(energydependent)

Spread: sexual
contact
Location:
urogenital tract,
conjunctiva
Risk Factors:
1. Unprotected
sex

Morphologic Forms:
1. Elementary Body: attaches to
the host cell; small extracellular
infectious form; resistant to
harsh conditions
2. Reticulate Body: grows and
takes over host; replicates in
target cell; kills host and EB is

B. burgdorferi
Lyme disease: 2 stages
1. Early stage: erythema
migrans (bullseye rash); fever,
chills, malaise (4 weeks)
2. Late stage: hematogenous
dissemination congestive
heart failure, meningitis, Bells
palsy, arthritis
1. Fever
2. Jaundice, hemorrhage, tissue
necrosis, aseptic meningitis:
result of spirochete bacteremia
3. Weils disease: overwhelming
disease; vascular collapse,
thrombocytopenia,
hemorrhage, hepatorenal
dysfunction
1. Pulmonary infection: mild to
severe; tracheobronchitis to
necrotizing bronchopneumonia;
severe infection in cystic
fibrosis patients
2. Primary skin infection: burn
patients, folliculitis (hot tub
folliculitis, swimmers itch)
3. UTI: catheter exposure or
broad-spectrum antibiotic
treatment
4. Eye and Ear Infection:
cauliflower ear drainage
5. Septic shock: burn victims
and immunocompromised

1. Urogenital Infections
(Urethritis/Cervicitis):
serotypes D-K, acute mucoid
discharge (**Gonorrheal
discharge is purulent)
2. Lymphogranuloma
venereum (LGV): serotypes L1L3; painless papules on external

Serology:
MAT &
ELISA
Culture:
blood or
CSF

Penicillin (1st
stage only)

Characteristi
c fruity
odor
(pyocyanin
)

Aztreonam
Imipenem
Carbecillin
Aminoglycosi
de

PCR

Erythromycin
Doxycycline
Azithromycin

GRAM-NEGATIVE BACTERIA

sl 2013

2. Multiple sex
partners
3. Homosexual
male sex
At Risk:
1. Sexually
active
adolescents
2. Infants with
affected
mothers

10

secreted.

*most common
STD in NA

Other
Chlamydia
spp.

Spread:
C. pneumoniae
community
acquired; C.
pscittaci
acquired from
birds
Location: RT

Chlamydophil
a pneumoniae
Chlamydia
pscittaci
Rickettsia
spp.

Gram
curved rod
Obligate
Parasite
Non-Motile
Pleomorphic

Spread: tick
Location: animal
reservoir
Risk Factors:
1. Warmer
months

1. Phospholipase C: degradation of
phagosome membrane
2. Cytoplasmic growth: until host
cell dies, releasing the bacteria
3. Bacteremia: invasion of LN
4. Thrombi formation: leading to
hemodynamic disturbances

Ehrlichia
chaffeensis

Resemble
Rickettsia

Resemble
Rickettsia

Parasitize monocytes

Coxiella
burnetii

Resemble
Rickettsia

Spread: handling
contamination
Location: cattle
wool

Gram

Spread: contact

1. Resistant to heat and drying

2. Stimulated by low pH of
phagolysosome
3. Resistant to host degenerative
enzymes
1. Small infectious dose

Francisella

genitalia and painful

lymphadenitis
3. Trachoma: serotypes A-C,
chronic inflammatory
granulomatous process in eye
surface (keratoconjunctivitis);
scarring leads to permanent
opacities
4. Adult Inclusion Conjunctivitis:
acute mucopurulent discharge;
dermatitis; corneal
vascularization
5. Neonatal Conjunctivitis: acute
mucopurulent discharge
6. Infant Pneumonia: rhinitis,
bronchitis, cough
C. pneumoniae
1. Atypical Pneumonia: mild to
severe
2. Atherosclerosis: inflammatory
plaques
C. pscittaci
1. Parrot fever: mild to severe

Difficult to
diagnose

Erythromycin
Doxycycline

1. Rocky Mountain spotted fever

(R. ricketsii): abrupt inward
spreading macular rash
2. Epidemic typhus (R.
prowazekii): abrupt outward
spreading rash; arthralgia
3. Endemic typhus (R. typhi):
gradual macular rash
4. Ricketsiall pox (R. akari)
5. Scrub typhus (O.
tsutsugamushi)
Erlichosis: fever, headache, chills,
nausea, rash development;
complications could lead to
leukocytopenia and
thrombocytopenia
Q fever: interstitial pneumonitis
without rash; usually selflimiting
Endocarditis: main cause if
culture negative
Tularemia: abrupt flu-like

Serology:
Rickettsia
specific Ab
PCR

Doxycycline

Antibody
assays
PCR

Doxycycline

Serologic
assays

Doxycycline

Clinical

Streptomyci

 sl 2013
tularensis

Brucella spp.

GRAM-NEGATIVE BACTERIA
coccobacilli
Anaerobic

with rabbits
Risk Factors:
1. Geo: AK, MO
2. Occupational
(vets, meat
handlers,
hunters)

Gram
coccobacilli

Spread: animal
products, food,
aerosol
Location: animal
reservoir (cattle,
goats)

2. Multiply in host macrophages

3. Antiphagocytotic capsule
4. Resistant to phagocyte killing

11
symptoms, respiratory and GI
symptoms
1. Ulceroglandular: contact with
rabbits, lymphadenopathy
2. Oculogranular: painful
conjunctivitis
3. Pneumonic: pneumonitis
develops with high mortality
Undular fever (brucellosis) :
subacute, acute or chronic;
undulating pattern of fever

presentatio
n and
history
BCYE agar
(Lcystiene)

Doxycycline
Gentamycin
+ TMP-SMZ

Other notable gram negative bacteria:

Bartonella henselae: cat scratch disease; fever, septicemia, endocarditis, benign regional lymphadenopathy
Pasturella multocida: cat bite disease
Burkholderia cepacia: RTI in cystic fibrosis or CGD patients; UTI and septicemia in catheterized patients
Burkholderia pseudomallei: saprophyte found in Asia and India; asymptomatic but may cause meliodosis: localized purulent infection, may lead to
lymphadenopathy, sepsis and necrotizing pneumonia. Treat with TMP-SMZ
Stenotrophomas maltophila: nosocomial, infect patients with impaired defense mechanism; bacteremia, pneumonia, meningitis, UTI. Treatment: TMP-SMZ
Acinetobacter baumanii & iwoffii: capsulated, opportunistic pathogen, survives on dry and moist surfaces; UTI, wound infection, RTI
Bacteriodes fragilis: non-spore forming, capsulated, -lactamase, intra-abdominal abscess, cellulitis and gastroenteritis