Viruses Bacteria Fungi Parasites

1.Acellular Prokaryotes Eukaryotes Eukaryotes

2.No nucleus Nucleiod region but Nucleus with nuclear Nucleus with
nuclear membrane membrane nuclear membrane
absent
3.Can be DNA & RNA DNA & RNA DNA & RNA DNA & RNA
4.Replicates only in
host cell
6.No Ribosomes 70s Ribosomes 80 ribosomes 80 ribosomes
(50s+30s) (60s+40s)
7.Few viruses are Cell membrane does Cell membrane Cell membrane have
enveloped not have sterols. contains ergosterol cholesterol

8.Do not have cell wall Bacteria cell wall is Cell wall made up of No cell wall in
made of peptidoglycan chitin parasites & human
cells

Normal flora in body

• On Skin - Staph epidermidis
• In Nose – Staph Aureus
• Oropharynx - Strep Viridens like strep mutans
• In Stomach, blood, CSF – No bacteria
• Colon - Bacteroids, Ecoli
• Vagina: Lacto bacillus
Major pathogenic mechanisms of bacteria:
• Adherence to cell surface
o Pili /Fimbriae are seen in most Gram –ve
o Techoic acid is seen in most Gram +ve bacteria
• Strep Pneumonia, Neisseria, and H.Influenza produce IgA proteases
• Biofilm produced by Strep mutans, Staph epidermidis
Anti-phagocytic Nature of bacteria:
• Capsule / Slime layer inhibits phagocytic uptake
• Strep pyogens has M-proteins that act as anti-phagocyte component
• Pili of Neisseria gonorrhea inhibits phagocytosis
• Protein A of Staph Aureus inhibits phagocytosis by binding to FC fragment of Ig prevents
phagocytosis.
• Intracellular bacteria like Mycobacterium Tuberculosis inhibit phagosome & lysosome fusion.
• Listeria escapes from phagosome before phagosome & lysosome fusion.
Capsulated Organisms:
Strep pneumonia, Klebsiella pneumonia, Haemophilus influenza, Pseudomonas aeroginosa,
Neisseria meningitides, Cryptococcus neoformans, B.Anthracis, Salmonella, E.coli
Quellung Reaction: Swelling up of capsule when specific anti serum is added

Toxins:
Exotoxin Endotoxin
1.Exotoxin are protein toxin Lipopolysaccharides (LPS)
2. Secreted by gram –ve & +ve Secreted by gram –ve bacteria only
[Gram +ve bacteria- Listeria]
3. Secreted outside cell wall 3. Endotoxin are structural components of
outermember of cell wall, released only when
cell is dead or during lysis.
[Neisseria Meningitidis overproduces endotoxin
and can secrete it]
4. Heat labile 4. Heat stable
5. Immunogenic 5. Not Immunogenic
 6. Toxic component are 6. Active component is lipid A
A- active component
B- Component helps to bind to receptors
Mechanism of Action of Toxins:
Protein synthesis inhibitors
• Diptheria Toxin has ADP ribosyl transferase activity and inactivates elongation factor ii Major targets
heart, nerves, epithelium
• Pseudomonas Aeroginosa also acts by ADP ribosyl transferase activity and inhibits EF ii
o Primary target is Liver.
• Shiga toxin produced by shigella dysentery interferes with 60s ribosomal subunit and inhibits protein
synthesis.
• EHEC [Entero haemorrhagic E.coli] produce verotoxin called as “ shiga like toxin” & interferes with
60s ribosome.
Neurotoxins
• Clostridium botulinum produces Botulinum toxin that inhibit release of Ach.
• Clostridium tetani produce tetanus toxin that block or inhibit the release of inhibitory
neurotransmitters.
C-AMP inducers
• Vibrio cholera, Bacillus Anthracis, ETEC [EnteroToxic E.coli], Pertussis toxin
Cyto toxins
• Clostridium Perfringens produces (alpha) toxins, which has lecithinase activity that causes
myonecrosis.
• Staph Aureus produces (alpha) toxins, which damages the cells
Super antigens
• Toxic shock syndrome toxin of Staph Aureus (TSST1)
• Erythrogenic toxin Strep pyogenes

Gram +ve Gram –ve

Cocci Cocci

• Staphylococcus Neisseria meningitidis/gonorrhoea

• Streptococcus Moraxella
Veilonella

Gram +ve Bacilli Gram -ve Bacilli

• Actinomyces Pseudomonas aeruginosa
• Bacillus Bacteroides
• Clostridium Spirochetes
• Corynebacterium diptheriae Ella
• Listeria Enterobacteraciae
• Mycobacterium
• Nocardia

Organism not staining with gram stain: Treponema pallidum, Rickettsia, Chlamydia,
Mycobacterium, Mycoplasma
Cell-wall deficient forms:
L-forms are produced by cell wall inhibiting drugs like Penicillin. They revert back to normal cells
when stimulus is removed unlike Mycoplasma
Acid-fast bacilli:
Mycobacterium (tuberculosis, leprae), Oocyst (cryptosporidium & isospora), Legionella
Nocardia is partially acid fast

Bacterial growth curve:

Log phase: there is high metabolic activity without cell division
No of cells before log phase = no of cells after end of log phase
 Log phase/Exponential phase: rapid cell growth & rapid cell division.
Stationary phase: No of new cells= no of dying cells
Nutrients start getting used up & spore formation begins in stationary phase.
Death phase: its due to depletion of nutrients & build up of waste products.
Growth based on O2 requirement:
Obligate aerobes: B.Anthracis, M.Tuberculosis,Pseudomonas Aeroginosa
Obligate anaerobes: Actinomyces, Bacteroides, Clostridium
Micro Aerophilic Bacteria: H.Pylori, Campylobacter jejuni

Growth based on temperature requirement:

Psychrophiles – growth below 20C Ex- Saprophytes
Mesophiles – growth between 25 to 40C Ex- most of the pathogenic bacteria
Thermophiles – growth above 55 to 80C Ex- Bacillus stearothermophilus

Urease +ve bacteria: Proteus, Ureoplasma, Klebsiella, H.pylori, Cryptococus neoformans, Nocardia
Spore forming bacteria: Bacillus, Clostridium, Coxiella burnetii

Pigment Producing Bacteria:

• Staph Aureus produces golden yellowish pigment
• Pseudomonas Aeruginosa produces pyocyanin & fluorescin
• Actinomyces Israeli produces yellow sulphur granules
Types of Motility:
• Tumbling motility: Listeria
• Gliding motility - Mycoplasma
• Swarming motility: Proteus
• Darting motility: Vibrio cholera(shooting star motility also), Campylobacter jejuni
• Stately motility: Clostridium
• Cork- screw, Lashing, Flexion extension motility: Spirochetes
• Falling leaf motility: Giardia
Catalase +ve organisms: Staph Aureus, Pseudomonas aeroginosa, Aspergillus, Candida, E.coli,
Listeria
Phage coded toxins: ShigA like toxin, Botulinum, Cholera, Diphtheria, Erythrogenic toxin of Strep
Pyogenes
Bacteriocins – antibiotic like substances produced by certain bacteria against other strains
Ex: Colicin – E.coli, Pyocin – Pseudomonas, Dipthericins – C.diptheriae

Culture media: Basic constituents of a culture media are

• Peptone – digested proteins
• Agar – Its used to solidify the media but doesn’t have nutritional properties. Its preferred
over gelatine as gelatine melts at room temperature

❖ Simple/Basal Media: They support growth of non-fastidious bacteria Ex: Peptone water,
Nutrient agar, Nutrient broth
❖ Enriched media: When basal media is added with additional nutrients like blood, serum or
egg. It supports fastidious bacteria Ex: Blood agar, Chocolate agar, Loeffler’s serum slope
❖ Enrichment broth: Liquid media allow pathogens to grown and inhibit normal flora
▪ Ex: Selenite F & Tetrathionate broth for Salmonella & Shigella
▪ Alkaline peptone water for Vibrio cholera
❖ Selective media: Same as Enrichment broth but it’s a solid media Ex: LJ media, TCBS etc
❖ Transport media: Keep the delicate specimens viable or store them longer
▪ Ex: Pike’s, Amies, Stuart’s, VR, Cary-blair, Autoclaved sea water etc
❖ Differential media: Differentiate between 2 groups of bacteria
• Ex: Mac-Conkey – LF & NLF, Acid fast – AF & NAF, CLED- LF & NLF for urine specimens, Gram
– G+ & G-
❖ Anaerobic media: Ex: Robertson’s cooked meat (RCM) broth, Thioglycollate broth etc
 Bacteria Culture Media, Stains
Mycobacterium TB Lowenstein Jenson media, ZN stain
C. diptheria Potassium tellurite agar, Lofflers Serum slope, Albert stain
Vibrio cholera TCBS (Transport – VR/Cary blair)
Bordetella Pertussis Regan Lowe, Bordet Genjou
Streptococci Blood agar, (transport – Pikes media for S.pyogenes)
Neisseria Thayer Martin media, Blood/Chocolate agar
Hemophilus Blood agar with Satellism, Chocolate agar
Pseudomonas Cetrimide agar, Kings media (Pyocyanin & Fluorescin)
Campylobacter, Helicobacter Campys or Skirrows agar
Leishmania Romanowosky stain, Novy-mcneal-nicolle media(NNN)

Scientists and their discoveries:

Louis Pasteur (father of microbiology):
• Proposed “germ theory of disease”, contributed in vaccines for Cholera, Anthrax, Rabies
• Introduced techniques like Hot air oven, Autoclave, Pasteurization of milk, liquid media
Robert Koch (father of medical microbiology):
• Discovered Cholera, Anthrax, TB organisms
• Introduced Solid media (agar), Staining (Aniline) techniques, Hanging drop method (motility)
• Koch’s postulates
 Causative microbe should be constantly associated with the disease
 Isolation of organism from lesion of disease in pure culture should be possible
 Isolated organism when inoculated in lab animal should produce same disease
 Re-isolation from lab animal in pure culture should be possible
 Antibody should be produced in patient’s serum against the antigen
 Exceptions: M.leprae, T.pallidum cant be grown in vitro but can be maintained in lab animals

Paul Ehrlich (father of chemotherapy): acid fast stain, standardized toxin & antitoxin
Anton Van Leeuwenhoek- microscope, Ernst Ruska – Electron microscope
Edward Jenner (father of vaccination)– Small pox vaccine, Karl Landsteiner – Human blood groups,
Alexander Fleming – Penicillin (1929), Kary B Mullis – PCR, Joseph lister – antiseptic sugery

 Light microscope – to visualize Gram & Acid- fast stain, Slide agglutination test, Capsule stain,
Slide culture for fungi
 Dark field microscope - motility of Spirochetes
 Electron microscope – direct visualization of viruses from specimens
 Phase contrast microscope – motility, endospores, inclusion bodies
Bacterial genetics
▪ Bacterial gene transfer happens vertically (parent to offspring) & horizontally i.e by Transformation,
Transduction and Conjugation
▪ Plasmid: extrachromosomal, circular ds-DNA that exist freely in cytoplasm & are capable of replicating
independently. When they integrate with chromosomal DNA such plasmids are k/a Episome
Classes of plasmids:
•F-plasmid – code for sex pili that forms the conjugation tube
•R-plasmid – code for resistance to various antibiotics
•Virulence plasmid – code for virulence factors like toxins
•Col plasmid – code for bacteriocins

TransformationQ: process of random uptake of free/naked DNA from surrounding media to bacterial cell
Ex: Streptococcus, Neisseria, Hemophilus, Pseudomonas
•Griffith first demonstrated this in Pneumococci

TransductionQ: transmission of part of DNA from one bacteria to another by a bacteriophage

Role of transduction:
•Method of transfer of chromosomal DNA, Plasmid, Episome
•Drug resistance – plasmid coded penicillin resistance in S.Aureus
•Lysogenic conversion

ConjugationQ: transfer of genetic material from one bacterium (male/donor) to another (recipient/female)
through conjugation tube by mating
•F+ & F- mating: Finally F- becomes F+
HFR conjugation: F- do not become F+
TranspositionQ: process by which some pieces of DNA move around the genome.
•DNA segments that carry the genes for this process move around the chromosome k/a Transposons
(jumping genes)*Q

Sterilization & Disinfection

❖ Sterilization: destroys all microbes including spores
❖ Disinfection: destroys all microbes except spores
❖ Asepsis: chemical agent (antiseptics) applied to body surfaces which kills pathogenic microbes on skin
❖ Decontamination (Sanitization): reduction of microbes to such a level which is safe to handle. Spores
are not killed
1. Physical methods:
Heat- kills by denaturation of proteins
 Dry heat (oxidative damage): Flaming, Inceneration, Hot air oven
 Moist heat (coagulation & denatures protein):
a. Temp<100 C - Pasteurization, Insipissation (For egg/serum Ex: LJ media, Lofflers serum slope)
b. Temp at 100C - Boiling, Steaming, Tyndallization (For Sugar/Gelatin
c. Temp>100C - Autoclave
 Filteration: Candle filters, Membrane filters
 Radiation
a. Ionizing radiation (Cold sterilization): X,Y & cosmic rays
b. Non-ionizing radiation (Hot sterilization): UV and IR rays
2. Chemical methods:
 Alcohols- Ethyl alcohol
 Aldehydes- Formaldehyde
 Halogens- Iodine, Chlorine
 Oxidising agents- Hydrogen peroxide
 Dyes- Aniline and Acridine dyes
 Gas- Betapropionolactone (BPL)

Dry Heat (Hot air oven): Holding temp: 160C for 2 hours
Materials sterilized:
• Glassware- syringes, petri dish, flask, test tubes
• Surgical instruments- scapels, scissors, forceps
• Chemical-liquid parrafin, gycerol etc
• Sterilization control- Nontoxic C.tetani, B.subtilis

Moist heat <100C:

• Pasteurization: used for fruit/veg juices, dairy etc.
• Holder method (63C for 30 mins). Coxiella burnetti survives being heat resistant
• Flash method (72C for 20 seconds followed by cooling to 13C)
• All non-sporing pathogens are killed

Moist heat >100C (Autoclave):

• Temp-121C for 15 min at pressure of 15 psi
• Uses- Its used for surgical instruments and culture media & those materials that can’t withstand
the higher temp of hot air oven or media containing water that can’t be sterilized by dry heat
• Control- B.stereothermophilus (also for Plasma sterilization)
 • Prions are most resistant. Recommended methods are Autoclaving at 134C for 1-1.5 hour, NaOH
for 1 hour, 0.5% Na hypochlorite for 2 hours. Enveloped viruses are least resistant
Autoclaving Culture media except LJ & LSS, all sutures except
catgut
Hot air oven Paraffin, Glass syringe, Flask, Grease, Fat
Isopropyl alcohol Clinical thermometers, stethescope
Formaldehyde Operation theatre, lab fumigation
Ionising radiation Plastic syringe, Catgut, Catheter
Filteration Vaccine, Sera, Antibiotics, Sugar
Orthopthaldehyde, Glutaraldehyde Bronchoscope, Cytoscope
Gas sterilization (Ethylene oxide) Heat sens items like plastic petri dishes, syringes,
Heartlung machines, Dental equipments, Respirators

Slow viral diseases

▪ They are group of neurodegenerative diseases that include prion diseases
Characteristic features are:
❑ Long IP
❑ Predilection for CNS
❑ Strong genetic predisposition
❑ Lack of antigenicity – no immune response or inflammation
Examples:
 SSPE (Warthin Finkeldey bodies) – measles virus
 PML – polyoma, JC virus
 Kuru, CJD (spongiform encephalopathies) - Prions

MYCOLOGY
• Study of fungi is k/a mycology.
• All fungal spores are reproductive.
• Fungi are eukaryotes with 80s ribosomes.
• Cell wall consists of Chitin, mannan & other polysaccharides.
• Cell membrane contains ergosterol.
• Some fungi are useful to man such as edible mushrooms. Certain yeasts are used in fermentation and
some fungi in elaborating antibiotics (Penicillium).
Classification of fungi:
Based on morphology:
➢ Yeast is single celled. Ex: Cryptococcus neoformans, Saccharomyces.
➢ Yeast like contains pseudohyphae. Ex: Candida albicans.
➢ Moulds have branching filaments called hyphae. Ex: Dermatophytes, Aspergillus, Rhizopus, Mucor,
and Penicillium.
➢ Dimorphic fungi exist in 2 forms i.e Yeast in tissues [i.e at 37® C] & moulds in soil & culture [at 25®C]
Ex: Histoplasma capsulatum, Sporothrix schenckii, Blastomyces dermatitidis, Coccidiodis immitis,
Paracoccidiodis brasiliensis.
Based on sex spores:
➢ Zygomycetes- zygospores Ex: Zygomycosis agents
➢ Ascomycetes- ascospores Ex: Aspergillus
➢ Basidiomycetes- basidiospores Ex: Cryptococcus
➢ Deuteromycetes/ Fungi imperfecti- most medically imp fungi
Asexual spores can be vegetative spores or aerial spores.
➢ Vegetative spores- Blastospores, Arthrospores, Chlamydospores
➢ Aerial spores- Conidiospores, Microconidia, Macroconidia, Sporangiospores
Dx:
• Direct examination:
• 10% KOH wet mount, Gram stain,India Ink preparation, Wood’s lamp exam
• Culture:
• Sabouraud’s dextrose Agar (SDA), Brain heart infusion (BHI)

Fungal Infections
❖ Superficial Fungal Infections

Pityriasis versicolor/Tinea Versicolor:

• Caused by Malassezia furfur (Pityrosporum oribiculare)
• Presents with hypogigmented spots on back, chest, abdomen & neck
• Its also responsible for Seborrheic dermatitis (dandruff)
• KOH staining shows characteristic sphegetti & meat balls/ banana & grape appearance.
Rx: Topical Selinum sulphide/ketoconazole shampoo

❖ Cutaneous fungal infections

➢ It can be in the form of dermatophytes or cutaneous candidiasis.

Dermatophytes:
• Dermatophytoses are also k/a Tinea or Ring Worm.
• Itching is the m/c symptom of Tinea infection.
• They are of 3 types –Trichophyton, Microsporum, Epidermophyton.
Epidermophyton Trichophyton Microsporum
Tissue inv: Skin & Nails. Skin, Hair, Nails. Skin & Hair.
On SDA: No microconidia Micro > Macro Micro < Macro
Shape (macroconidia): Pear shaped Pencil shape Spindle shape

• Tinea capitis is the ringworm infection of scalp, Tinea barbae/barber’s itch is seen in beard area,
Tinea corporis is the infection of the non-hairy skin of the body,Tinea cruris involves groin area
,Tinea pedis is infection around foot, Tinea unguam is infection around nail
Dx:
▪ Wood lamp examination with UV light of infected hair shows fluorescence.
▪ KOH mounting shows hyphae & arthroconidia.
▪ Culture is by Sabouraud’s Dextrose Agar
Rx: Oral Terbinfine is DOC, Oral Griseofluvin is alternative

❖ Sub-Cutaneous Infections

Sporotrichosis:
• Sporothrix schenckii causes Sporotrichosis aka Rose Garden’s Disease that presents with ulcers along
the lymphatics and LN enlargement
• Rare forms are osteoarticular or pulmonary type
• Its prevalent in Himalayan hilly areas
Dx:
• On H& E shows Cigar shaped asteroid bodies
Rx: DOC- Intraconazole (cutaneous sporotrichosis), Amphoteracin B (extra cutaneous)

Mycetoma:
• It is a chronic granulomatous infection of the subcutaneous tissue, usually affects foot and rarely the
other parts of body. Types- Bacterial (Actinomadura, Streptomyces, nocardia) & Fungal (Madurella
mycetomatis,grisea), Botryomycosis (S.Aureus)
• Presents as subcutaneous swelling of foot, characteristic abscess with multiple sinuses discharging
pus that contains granules
Dx:
• Diagnosis is made from examination of granules
• Eumycotic mycetoma-black-brown granules with hyphae >2μm seen
• Actinomycotic mycetoma- white-yellow granules <2μm bacteria are seen
Rx: Surgery is the mainstray
 Chromoblastomycosis:
• It’s caused by Dematiaceae gorup (dark pigmented fungi)
• It causes Verrucous type lesions most commonly
Dx:
• On H&E staining, they characteristically show Sclerotic bodies/Medlar bodies/Muriform cells
Rx: Itraconazole DOC

Rhinosporidiosis:
• It is caused by Rhinosporidium seeberi (fungus or Aquatic protist)
• It is a chronic granulomatous disease characterized by formation of friable polpys on the nose k/a
strawberry polyps.
• The infection is seen mainly seen on coastal areas of India & Sri Lanka and is acquired by swimming
or frequent contact with stagnant water or aquatic life
Dx: The fungus has not been cultivated
Rx: Surgical removal of polyps, Dapsone can be used

❖ Deep Fungal Infections

Histoplasmosis (Darling’s disease):

• It is caused by Histoplasma capsulatum, a dimorphic fungus
• Infection is acquired from inhalation of spores from soil/dust contaminated with birds/bats
droppings
• Pulmonary histoplasmosis is the mc form, disseminated in HIV
• Its endemic in USA (Ohio and Mississippi river) and frequently in India from West Bengal near
Ganga river
Dx: Tissue samples shows yeast forms that typically show narrow based budding
Rx: Meningeal- Amp B, Non-meningeal- Itraconazole

Coccidiomycosis:
• It is caused by Coccidiodes immitis a dimorphic fungus
• Its aka Desert rheumatism, Valley fever, California fever as its endemic in California, Arizona, Texas,
New Mexico, Northern Mexico
• Pulmonary form, Erythema nodosum, arthritis is the presentation
• Dx: Biopsy or culture on SDA shows yeast form, which is a thick double walled spherule, filled with
endospores
Rx: Amp-B DOC

Blastomycosis:
• It is caused by Blastomyces dermatitidis a dimorphic fungus
• It’s aka North American Blastomycosis/Chicago/Gilchrist’s disease
Dx: Broad based buddung with figure of 8 appearance
Rx: Itraconazole (mild), Amphoteracin B (severe)

Paracoccidiodomycosis:
• It is caused by Paracoccidiodes brasiliensis a dimorphic fungus
• It is also k/a South American Blastomycosis
Dx: It produces buds with Captain/Pilot wheel/Mickey mouse appearance
Rx: Itraconazole DOC

❖ Oppurtunistic infections:
Candidiasis:
• M/c agent responsible is candida albicans.
• Candida albicans forms pseudo-hyphae
• Its normal inhabitant of skin, GI tract, oral & vaginal cavities
• Predisposing factors: Diabetes, AIDS, Pregnancy, Infants & elderly, prolonged administration of
antibiotics, patients on immunosuppressive drugs
Mucocutaneous lesions: Oral thrush, Vulvovaginitis, Balanitis, Conjunctivitis, Keratitis, Esophageal
candidiasis
Systemic candidiasis: UTI, Intestinal candidiasis, pulmonary candidiasis, endocarditis, meningitits,
osteomyelitis
Dx:
• On KOH mount shows pseudohyphae & budding yeast.
• Tests to differentiate C.albicans from other species are:
o Germ tube test/Reynold’s Braude phenomenon: formation of germ tubes when incubated in human
serum (at 37®)
Rx: Albicans- Esophageal & Vulvovaginal candidiasis- Fluconazole
Disseminated- Amphoteracin B is DOC
C. glabrata, Krusei – Caspofungin DOC

Cryptococcosis:
• Its caused by C.neoformans, a capsulated, urease +ve fungus
• Infection is acquired by contaminated soil from pigeon droppings
• It can cross BBB either directly or carried inside macrophages k/a Trojan horse
• Pulmonary cryptococcosis is the MC form, Meningitis in AIDS
Dx:
• India ink staining (negative staining) for the capsule
• Gram staining show budding yeast
• Latex particle agglutination test detects polysaccharide capsular antigen from CSF (95% sensitivity)
Rx: Amphoteracin B (induction 2 weeks) + Flucytosine (maintanence 8 weeks) for Meningitis
Fluconazole is DOC (without CNS involvement)

Pneumocystis jiroveci [Pneumocystis carinii pneumonia]:

• It was previously classified as protozoa
• It produces pneumonia in HIV patients
• Dx: Gomori methenamine silver stain shows black colored crushed pingpong balls appearance
• Rx: DOC for prevention & treatment is Cotrimoxazole

Aspergillosis:
• Aspergillus fumigatus is the main opportunistic pathogen
• It is an opportunistic fungus that shows septate hyphae with dichotomous branching-45® angle
Types of Aspergillus
• Aflatoxin – A.flavus ,Otomycosis – A.niger, Keratitis – A.fumigatus
• Pulmonary aspergillosis is MC form existing as Allergic Broncho pulmonary aspergillosis [ABPA],
Fungus ball/Aspergilloma, Asthma
• Invasive sinusitis, Ocular (Keratitis), Ear (otitis externa) are other forms
Rx:
• Lobe-ectomy for aspergilloma
• Voriconazole for Invasive Aspergillosis

Zygomycosis/Mucormycosis:
• Rhizopus, Mucor, and Absidia cause it, They are non-septate, filamentous fungi
• Predisposing conditions are Diabetic ketoacidosis [DKA], Renal disease
• Rhizopus causes zygomycosis & otomycosis
• M/c presentation is Rhinocerebral zygomycosis, followed by pulmonary zygomycosis seen in
leukemic patients
Dx:
• On SDA medium Rhizopus has nodal rhizoids & sporangiophores arise in groups directly above the
rhizoids.
• Absidia also has rhizoids but sporangiphores arise from the aerial mycelium in between the rhizoids.
 • In Mucor, sporangiophores are present but rhizoids are absent
Rx: Amp B DOC, Posaconazole can also be used

PARASITOLOGY
Classes of hosts:
▪ Definitive: adult stage or sexual cycle takes place
▪ Intermediate: larval stage or asexual cycle takes place

Protozoans:
Amoebae – Naegleria, Acanthamoeba, Entamoeba
Flagellates – Giardia (intestinal), Trichomonas (vaginal), Leishmania & Trypanosoma (blood & tissue)
Apicomplexa – Plasmodium, Babesia
Coccidian – Toxoplasma, Cryptosporidium

❖ Entamoeba histolytica:
• Infective form is Quadrinucleate cyst by feco-oral route. Its causes amoebic dysentery
• Classical lesion is inverted flask shaped ulcers with anchovy sauce
• MC site of extraintestinal amoebiasis – Liver > Lungs > Brain
• Trophozoites or cysts in the stool for diagnosis
• Rx: Asymptomatic (DOC-Diloxanide Furoate*/Paromomycin), Symptomatic (DOC – Metronidazole)

❖ Giardia lamblia:
• Transmission is by Quadrinucleate cysts through feco-oral route
• It causes fatty foul smelling diarrhea and fat malabsorption (steatorrhea)
• Trophozoite (tennis racket or tear drop shaped) or cysts in the stool for Dx, String/Entero test to
demonstrate trophozoites, Falling leaf motilityQ
• DOC – Metronidazole/Tinidazole

❖ Cryptosporidum & Isospora:

• Diarrhea in AIDS patients
• Oocysts/Cysts are infective, For Dx Modified Acid fast (Kinyoun) oocysts are +ve
• DOC – Nitazoxanide (Crypto), Cotrimoxazole (Iso)

❖ Naegleria fowleri:
• It causes Primary Ameobic meningoencephalitis which presents with high fever, altered smell. Often
fatal acquired while swimming in fresh waterQ. Dx with Motile trophozoites in CSF
• DOC – Amphoteracin B

❖ Acanthamoeba:
• It causes Keratitis in conatact lens users. Hematogenous route can cause encephalitis
• Free living amoebae like Naegleria, Acanthamoeba and Balamuthia cause encephalitis

❖ Trichomonas vaginalis:
• No cyst stage, only trophozoite which are sexually transmitted
• It causes trichomoniasis with frothy vaginal discharge
• Trophozoites with twitching/cork screw motility seen for Dx
• DOC - Metronidazole

Hemoflagellates: Infective forms for Leishmania (promastigote), Trypanosoma (Metacyclic trypomastigote)

❖ Leishmania Donovani:
• It causes Visceral Leishmaniasis or Kala azar which presents with Fever, Hepato-splenomegaly,
Hyperpigmentation, Pancytopenia, Hypergammaglobulinemia
 • Humans get infected with bite of a sandfly releasing promastigote forms that turns into amastigote
forms in human body and start replicating
• Dx: Romanowosky stain, Novy-mcneal-nicolle media(NNN),
• Compliment fixation test with WKK antigen, RK-39 antigen test by card method Q
• Chopras antimony test/ Napiers aldehyde test for hypergammaglobulinemia
• Montenegro skin test (Type IV HSN), LDQ bodies on biopsy

❖ Leishmania Tropica:
• It causes cutaneous leishmaniasis known as Oriental/Tropical sore or Delhi/Baghdad boil
• Leishmanin test (skin test) can be done for Dx

❖ Leishmania brasiliensis:
• It causes mucocutaneous leishmaniasis known as Espundia
DOC for Muco-Cutaneous leishmaniasis/Visceral (Kala Azar) – i.v Liposomal Amp BQ, Post Kala
Azar Dermal Leishmaniasis – oral Miltefosine, overall MC used drug is Sodium Stibogluconate

❖ Trypanosoma Cruzi:
• It causes Chagas diseaseQ (American trypanosomiasis) that presents with swelling around eyelid
(Romana sign) and Myocarditis, Megacolon, Megaesophagus, Chagoma (swelling at entry point)
• Its transmitted by Reduviid bugQ (kissing bug) that transmits the trypomastigote forms
• Dx is done with tryposmastigote forms in blood films
• DOC - Benznidazole

❖ Trypanosoma Brucei: Gambiense (west African type ), Rhodisiense (east African type)
• It causes sleeping sickness transmitted by tsetse fly (glossina species). Stage I causes cervical
lymphadenopathy k/a Winterbottom’s signQ, Stage II causes somnolence (day) and insomnia (night)
• DOC *Eastern African (Early – Suramin, Late – Melarsoprol)
West African (Early – Pentamidine, Late – Eflorithine)

❖ Babesia:
• It causes babesiosis which is hemolytic, malaria like disease
• It transmitted by Ixodis tick so coinfection with Borellia is common
• Giemsa stain shows maltese crossQ appearance in RBC’s
• DOC – Clindamycin + Quinine

❖ Toxoplasma gondi: Def host – cat, Intermediate host - Man

• In healthy individuals Toxoplasmosis is asymptomatic
• Congenital toxo presents with intracerebral calcifications, chorioretinitis, hydro/microcephaly
• In AIDS patients it causes ring enhancing lesions and seizures
• DOC – Sulfadizine + Pyrimethamine, Spiramycin (Pregnancy)

Trematodes(flukes): requires 3 hosts

 QIntermediate
host: 1st – Snail, 2nd – Aquatic plants (F.hepatica, F.buski), Cray/Crab fish (Paragonimus,
Clonorchis). Def host: Man
 QInfective stage: ingestion of Metacercaria larva for all except Schistosomes which is by skin penetration
of Cercaria larva present in contaminated water

❖ Schistosoma Hematobium (blood fluke):

• It causes shistosomiasis or bilharziasis. Symptoms associated are Allergic dermatitis d/t cercariae
known as swimmers itch. Symptoms d/t Eggs are Egg granuloma and Hematuria
• It causes bladder cancer (Squamous > Transistional)

❖ Schistosoma mansoni (blood fluke):

• It causes intestinal bilharziasis (dysentery), Katayama fever
 ❖ Schistosoma japonicum (blood fluke):
• It causes hepatic/oriental shistosomiasis or Katayama fever
• Dx for Schistoma species is done by demonstration of non operculatedQ eggs in stool or
urine(hematobium). Q*Eggs with terminal spine (hematobium), lateral spine (mansoni), lateral knob
(japonicum)

❖ Chlonorchis sinesis (Oriental / Chinese Liver Fluke): acquired by eating fish containing metacercaria
• Its associated with cholangiocarcinoma (bile duct ca)

❖ Fasciola hepatica (Sheep liver fluke): acquired by eating aquatic plant containing metacercaria
❖ Fasciolopsis buski (Giant intestinal fluke): can cause B12 malabsorption

❖ Paragonimus westermani (Lung fluke): acquired by eating Cray/Crab fish containing metacercaria
• It produces red to brown hemoptysis

 Dx - QAll trematodes have operculated eggs (with lid) with no spine except Schistosomes who have non –
operculated eggs with spines or knob
➢ DOC for Trematodes is Praziquantel except Fasciola (Triclabendazole)

Cestodes (tapeworms): requires 2 hosts except Hymenolepis, Diphyllobothrium

▪ Humans are def host for intestinal Cestodes like Taenia, Diphyllobothrium, Hymenolepis whereas
humans are Intermediate host for for tissue cestodes like Echinococcus
▪ They exist as adult tapeworm or eggs. Adult is made of Head (scolex), neck and segments k/a proglottids
or strobila. Some bear hooklets in scolex k/a armed tapework Ex: H.nana, Echinococcus, T.solium
▪ Eggs: All cestodes eggs have egg shell and 3 pairs of hooklets except D.latum eggs (operculated)
▪ Larva: Eggs develop to larva k/a Hydatid cyst in Echinococcus and Cysticercus in Taenia ( saginata –
Cysticercus bovis, solium - Cysticercus cellulosae), Cysticercoid in Hymenolepis

❖ Taenia saginata: Intermediate host - cattle, Def host- man

• Transmission is by ingesting cysticercus in uncooked beef not by ingestion of eggs
• Usually asymptomatic or abdominal discomfort with diarrhea may be seen
• Dx is by proglottids / eggs in faeces (hexacanthembryo)
❖ Taenia solium: Intermediate host - Pig, Def host - man
• Trasmitted by ingesting uncooked pork containing cysticercus causing diarrhea
• Cysticercosis: transmitted by ingesting eggs in contaminated food & water. It may develop to
Neurocysticercosis which is a very common cause of seizuresQ in India

❖ Diphyllobothrium latum (fish tapeworm): Intermdiate host – 1st (Cyclops) 2nd (Fish), Def host-man
• Infection acquired by drinking pond water. It can cause megaloblastic anemiaQ
• Dx is with proglottids or eggs in feces

❖ Echinococcus granulosus (Dog tapeworm): Intermediate host – Man, Def host - Dog
• Acquired by ingestion of eggs
• It causes Hydatid cyst disease. It can involve liver and lungs. Water-Lily sign +ve (detached cyst
floats within the cavity). Casonis test can be done for Dx

❖ Hymenolepis nana (Dwarf tapeworm): Both Def and Int host is man
• Cysticercoid larva acquired by f/o route, convert to adult releasing eggs. Some eggs passed out
through feaces some hatch in lumen penetrating back into circulation causing autoinfection Q
• Dx – Non bileQ stained eggs containing central hooks and polar filamentsQ

➢ DOC for Cestodes is Praziquantal except Hydatid disease & Neurocysticercosis (Albendazole)

Nematodes
 Necator, Enterobius, M=Wuchereria, Brugaia, Ancylostoma & Ascaris, Trichuris & Trichinella,
Onchocerca, Dracunculus(Guinea/Medina/Dragonworm), Eye worm (loa loa), Strongyloides
Transmission by eggs: Enterobius, Ascaris, Trichuris (Mnemonic – EAT)
Transmission by penetration through foot, maturing in lungs and causing cutaneous larva migrans:
Strongyloides, Ancylostoma, Necator (Mnemonic – SANd)

❖ Enterobius vermicularis (Pin/Thread/Seatworm):

• MC effect children causing perianal itching, transmission is by ingesting eggs or autoinfection
• Dx – demonstration of eggs by non-bile stained eggs with tadpole shaped larva by taking a NIH swab
of perianal area by scotchtape

❖ Trichuris trichuria (whipworm):

• Its associated with rectal prolapse. Dx is by Qbarrel/dumbell shaped eggs

❖ Ascaris lumbricoides:
• MC helminth worldwide and largest roundworm. Ascariasis occurs by ingestion of eggs, larvae
migrate through lungs & get down to intestine and mature
• Symptoms d/t larvae- Ascaris pneumonia (Loeffler’s syndrome)
• Symptoms due to adult worm- appendicitis, intusucception, intestinal obstruction

❖ Necator Americanus (New world hookworm):

• Infection is acquired by walking barefoot in which filariform larvae penetrates intact skin
• Lung migration produces pneumonitis, Bloodsucking (0.03 ml/worm/day) leads to Anaemia

❖ Ancylostoma duodenale (Old Hookworm):

• Infection by penetration of filariform larva through skin causing grounditch
• Cutaneous larva migrans (MC seen with Ancylostoma braziliense)
• Visceral larva migrans seen with Toxocara Canis, catis
• Adult worm causes Iron deficiencyAnemia, blood loss (0.20 ml/worm/day)
• QChandler’s index: no of hookworm eggs present per gram of faeces in population (<200 eggs is not of

much significance, >300 eggs is important health problem)

❖ Strongyloides stercoralis: No male worms

• Larva penetrates through skin causing cutaneous larva migrans (Larva Currens)
• Causes QHyperinfection in HIV patients

❖ Wuchereria bancrofti:
• L3 filariform larvae transmitted by Culex(mainly), Aedes, Anopheles mosquito
• Adult worm causes Classical filariasis. Acute filariasis causes fever, lymphadenitis whereas Chronic
causes QElephantiasis, Hydrocele
• Occult filariasis is d/t microfilariae that cause Tropical pulm eosinophilia ( IgE as well)
• Dx – Blood smear exam (collected at night d/t nocturnal periodicity). Examination of micofilarial tail
tipQ (No nuclei in Wuchereria, 2-3 terminal nuclei in Brugia malayi)
• DEC (Diethylcarbamazine) provocative test

❖ Onchocerca volvulus: causes River blindness (by black/simulum fly), Onchocerchoma (s.c nodule)
❖ Loa Loa(eyeworm): by chrysops fly, causes Calabar swelling (skin), subconjunctival loasis
❖ Trichinella spiralis (muscleworm):
• Transmitted by eating uncooked pork containing larve that mature to adult form settling in muscles

➢ DOC for Nematodes is Albendazole except Wuchereria Bancrofti, Brugaia malayi (Filariasis –
Diethylcarbamazine), Strongyloides and Onchocerca (ivermectin)
➢ Mnemonic: DOC for Platyhelminths (cestode & tremode) is Praziquantal with 3 exceptions
➢ Scabies (caused by Sarcoptes scabiei mites): DOC Topical Permethrin (In preg also), Oral Ivermectin
 Random points:
Non Bile stained Eggs:
• Ancylostoma duodenale
• Hymenolepsis nana
• Enterobius vermicularis
• Necator Americanus

Bile stained eggs:

• Trichuris trichura
• Ascaris
• T.saginata & solium

Eggs that float on saturated solution of salt:

• Fertilised eggs of Ascaris
• Enterobius vermicularis
• Ancylostoma
• Trichuris
• Hymenolepsis
• Er
Mnemonic: QA HEN lays non bile stained eggs TAT (bile stained) floats like FEATHER

QAutoinfection caused by (Mnemonic – CHEST)

Cryptosporidium parvum
Hyemenolepis nana
Enterobius Vermicularis
Strongyloides stercoralis
Taenia solium