General Microbiology

Bacterial Structure, Growth, and Genetics

• Flagella: Classify bacteria based on flagella with examples, describe the
structure of a flagellum, and discuss common methods for its demonstration.
Other key bacterial components include the bacterial cell wall [14], bacterial
capsule [17], bacterial spore [17], fimbria, and inclusion bodies [77].
• Bacterial Motility: Discuss the methods to demonstrate bacterial motility [17-
18].
• Gene Transfer and Genetics: Name the various methods of horizontal gene
transfer and discuss the mechanism of conjugation in detail. Other important
genetic concepts include mutation [44] and the role of plasmids [44].
• Bacterial Growth and Diagnostics: Understand the stages of the bacterial
growth curve and the principles of Koch's postulates [04].
Culture and Sterilization
• Culture Media: Discuss various types of media, including LJ media [520],
transport media [28], enrichment media [27], and selective media.
• Sterilization: Describe methods like the use of bacteriological filters.
Virology and Mycology
• Virology: Explain cytopathogenic effects (CPE) and their role in viral
diagnosis [80].
• Mycology: Discuss opportunistic mycoses [105] and the procedure for the
germ tube test.
Immunology
Immunity and Hypersensitivity
• Components of Immunity: Detail the components of innate immunity,
differentiate it from adaptive immunity, and describe the components of the
adaptive immune system. The complement system is a key component;
define it, mention its activation pathways (including the alternate pathway),
and discuss its regulators and inhibitors.
• Immune Response: Describe the primary immune response [123].
• Hypersensitivity Reactions: Define hypersensitivity and discuss the
mechanisms of various types:
 o Type I (Anaphylaxis): Describe the mechanism of anaphylaxis and
enumerate the chemical mediators released and their roles. A specific
short note is on Type 1 Hypersensitivity reaction [175].
o Type II Hypersensitivity [177]
o Type III Hypersensitivity [178]
o Type IV Hypersensitivity: Discuss this type and the role of complement
in it.
• Cellular Components: Discuss the role of cytokines [162] and NK cells.
Antibodies and Antigens
• Immunoglobulins: Describe the structure and function of IgA [132], IgE
[133], and IgM [131].
• Antibodies: Explain the concept of monoclonal antibodies [133].
• Antigens: Define and discuss heterophile antigens [126].
Diagnostic Immunology
• Serological Tests: Explain diagnostic techniques like ELISA [140] and the
prozone phenomenon [139].
Hospital Infection Control
Hospital-Acquired Infections (HAIs) and Prevention
• Ventilator-Associated Pneumonia:
o Clinical Presentation: A 60-year-old diabetic lady on a ventilator in the
ICU following a road traffic accident develops an elevated temperature,
neutrophilia, and signs of bilateral basal consolidation in the chest five
days after admission; her initial chest x-ray was normal.
o Management: Name some HAIs and how they can be prevented. For
this case, identify the likely etiological agents, describe the factors
leading to pneumonia, discuss the laboratory diagnosis, and enumerate
the types of HAIs.
• Biomedical Waste (BMW): Define BMW, give an account of its categorization
for disposal, and discuss the disposal process.
• Needle Stick Injury (NSI): Define NSI, mention the major blood-borne viruses
transmitted and their respective risks of transmission, and explain how to
prevent NSI.
Sterilization and Disinfection
 • Cold Sterilization: Describe cold sterilization with examples and mention five
commonly used disinfectants and their recommended concentrations.
• General Concepts: Discuss the principles of sterilization [220], fumigation
of the operation theatre [229], the use of virucidal disinfectants and
sporicidal disinfectants in hospitals, and general disinfectants in hospital
use.
Bloodstream and Cardiovascular System
Malaria
• Clinical Presentations:
o A 3-year-old girl presents with a history of convulsion, decreased oral
intake, listlessness, and fever for the last 3 days. She is febrile with a
depressed level of consciousness, but Kernig's sign is negative.
o A 25-year-old male is brought to the emergency with altered sensorium,
with a history of high fever for the last 3 days accompanied by headache
and vomiting. Mild hepatosplenomegaly is also present.
o A middle-aged man presents with alternate-day sudden onset fever with
chills and rigor for the last 10 days. The fever subsides with sweating.
On examination, he is anemic and has mild hepatomegaly.
o A 30-year-old cachectic male migrant laborer presents with fever, severe
weakness, pallor, and palpitation. Examination reveals hepatomegaly
and huge splenomegaly.
o A 35-year-old security guard presents with fever, headache, and
diarrhea. The fever has been intermittent with chills and rigor for the last
10 days and comes down with profuse sweating. His spleen is palpable.
o A middle-aged male patient complains of alternate-day fever with chills
and rigor for five days.
o A 25-year-old male presents with symptoms of high fever, rigor, profuse
sweating, headache, and vomiting.
• Management: Discuss the pathogenesis, complications, and the difference
between relapse and recrudescence. Describe the laboratory diagnosis,
including sample collection for benign tertian malaria with a labeled diagram of
a parasite form. Discuss the drug resistance status of the organism.
Leishmaniasis (Kala-azar)
• Clinical Presentations:
 o A male patient from Bihar presents with fever, anemia, and a hugely
enlarged spleen for the last 6 months, along with black discoloration of
the skin.
o A farmer from Bihar presents with fever and gradual weight loss for the
last three months. He has developed blackish pigmentation of the skin,
loss of appetite, and is found to have splenomegaly.
o A 30-year-old male from Pakur, Bihar, is admitted with a history of
continuous fever, weakness, blackening of the skin, and huge hepato-
splenomegaly.
• Management: Enumerate the morphological forms of the organism, including
the LD Body, and describe the immunopathogenesis and laboratory
diagnosis. Provide a note on Post-Kala-azar Dermal Leishmaniasis (PKDL)
[313].
Lymphatic Filariasis
• Clinical Presentation: A 60-year-old man presents with huge progressive
swelling of his right leg and scrotum for the last 3 months. On examination, he
has inguinal lymphadenopathy, a hydrocele, and non-pitting edema on the
right leg. A patient may also present with elephantiasis of one leg.
• Management: Name the causative organisms and vector, and describe the
multifactorial pathogenesis and laboratory diagnosis.
Acute Rheumatic Fever
• Clinical Presentation: An 8-year-old child presents with swollen, red, and
tender joints that migrate from one joint to another. A past history of a sore
throat 3 weeks back is reported. On auscultation, a murmur is heard over the
mitral valve area.
• Management: Identify the clinical diagnosis and etiological agent, enlist the
different toxins and enzymes produced by the organism, describe the
pathogenesis, and mention the serological tests to be done with their
significant titers.
Enteric (Typhoid) Fever
• Clinical Presentations:
o A 9-year-old girl is admitted with a gradually increasing fever for the past
6 days that is not touching the baseline. She also has abdominal pain,
loss of appetite, and general weakness. On examination, she has a
temperature of 101°F, pallor, a coated tongue, mild splenomegaly, and
abdominal tenderness.
 o A 40-year-old man comes to the OPD with a history of fever for 2 weeks.
He has a coated tongue, relative bradycardia, mild hepatosplenomegaly,
and a rash of Roseola spots.
o A 25-year-old female has been suffering from fever and weakness for
the last 10 days. Physical examination reveals a raised body
temperature, relative bradycardia, a coated tongue, splenomegaly, and
hepatomegaly.
o An adult male suffering from continuous fever for five days is brought to
the hospital. On physical examination, he has a coated tongue, mild
splenomegaly, and relative bradycardia.
o A patient is admitted with a history of fever for 7 days, headache,
anorexia, mild GI disturbance, and a rash over the trunk and abdomen.
The tongue is coated, the temperature is 104°F, and there is relative
bradycardia.
o A 43-year-old male patient is brought to the OPD with fever for 11 days,
a coated tongue, relative bradycardia, hepatomegaly, and a roseola rash
on the front of the chest and abdomen.
o A 40-year-old female patient is brought to the OPD with fever for 10
days, a coated tongue, relative bradycardia, hepatosplenomegaly, and a
roseolar rash on the front of the chest and abdomen.
• Management: Discuss the likely bacterial agents, how to establish the
etiological diagnosis in the laboratory, outline treatment guidelines, and
mention how such infections can be prevented.
HIV/AIDS
• Clinical Presentations:
o A 40-year-old woman comes to the OPD with unexplained fever, severe
weight loss of more than 10%, and chronic diarrhea for more than 1
month. Her husband, a 48-year-old truck driver, has a history of
repeated unprotected sexual exposure.
o A 38-year-old woman presents with a similar clinical picture, and her
husband, a 45-year-old truck driver, gives a history of repeated
exposure.
o A 30-year-old man, a truck driver by profession, complains of
generalized weakness along with persistent diarrhea for one month and
loss of weight. He has a history of exposure a few months back.
 o An IV drug abuser presents with fatigue, malaise, weight loss, fever,
shortness of breath, and chronic diarrhea for the last 1 month.
• Management: Name the causative organism, describe the laboratory
diagnosis, list the fungal, parasitic, and viral opportunistic infections that
might develop [287], and define the "window period". Discuss the NACO
strategies for HIV testing [290].
Arboviral Infections
• Management: Enumerate the arboviruses prevalent in India, discuss the
epidemiology of one, list the causative agents of viral hemorrhagic fever, and
describe the immunopathogenesis of Dengue Shock Syndrome and Dengue
Haemorrhagic Fever [296].
Other Infections and Topics
• Transfusion Transmitted Infections (TTIs): Name some TTIs and discuss
how to diagnose a suspected case of benign tertian malaria.
• Arthropod-Borne Parasitic Diseases: Enumerate these diseases, draw a
schematic diagram of the life cycle of one, and describe its laboratory
diagnosis.
• Scrub Typhus: Short note on this topic [272].
• Mycology: Discuss the morphology of Candida albicans [321] and the
characteristics of dimorphic fungi [322].
Gastrointestinal (GI) System
Dysentery
• Clinical Presentations:
o A 27-year-old patient presents with frequent passage of stool mixed with
blood and mucus and occasional tenesmus for the last 2 days.
o A 10-year-old boy is brought to the OPD with complaints of passing stool
mixed with mucus and occasional blood more than 10 times for the last
2 days. He has abdominal pain and cries on defecation.
o A middle-aged male patient comes to the OPD with a history of frequent
passage of stool mixed with mucus and blood.
• Management: Discuss the clinical condition, enlist the bacterial and protozoal
pathogens associated, mention clinical samples and the role of routine
examination, and describe the pathogenesis, laboratory diagnosis, and two
systemic complications.
Food Poisoning
• Clinical Presentation: Two friends go to a Chinese restaurant and have soup,
fried rice, and chilly chicken. After 2 hours, they start vomiting, followed by
diarrhea. They also develop a fever. On examination, their blood pressure is
found to be low.
• Management: State the diagnosis, explain the mechanism behind the
manifestation, and describe how to diagnose the case in the laboratory.
Cholera
• Clinical Presentations:
o A child has been brought to the hospital emergency with the passage of
rice water stool and severe dehydration, accompanied by tachycardia
and a feeble pulse.
o A 12-year-old boy has been brought to the emergency with severe
dehydration and cold, clammy extremities, and a history of frequent
passage of painless watery stool.
o A 10-year-old child presents in the OPD with a history of frequently
passing loose, rice-water stools without blood. She has cold, clammy
skin with hypotension.
o A large number of patients have been brought to a primary health center
with complaints of effortless vomiting followed by watery diarrhea 10-15
times a day, along with severe cramps all over the body. The stool is rice
watery in nature.
• Management: State the provisional diagnosis and etiological agent. Discuss
the pathogenesis, laboratory diagnosis, and prevention by vaccine. Mention
other bacterial agents that can produce watery diarrhea.
Helminthic Infections
• Clinical Presentations:
o A 10-year-old child residing in a rural area with a low socioeconomic
status attends the OPD with complaints of indigestion, weakness, and
occasional pain in the epigastrium. On examination, he is found to be
anemic with a low hemoglobin level.
o A 40-year-old man attends the OPD with complaints of vague abdominal
discomfort and chronic indigestion with diarrhea alternating with
constipation. He also gives a history of passing something in the stool a
few days back which looked like a segment of a tapeworm.
 o A 7-year-old child presents with microcytic hypochromic anemia. On
routine stool examination, non-bile-stained ova are found.
• Management: Name the probable helminths causing the condition, discuss
the pathogenesis and complications, and describe the laboratory diagnosis,
including the use of an NIH swab [383]. Explain the life cycle of the parasites
with a diagram and the morphological differences between Ancylostoma
duodenale and Necator americanus.
Viral Gastroenteritis
• Clinical Presentation: A child is brought to the OPD with a history of
increased frequency of loose stool for 2 days.
• Management: Name the viruses responsible for it, such as Rotavirus [359],
and describe the laboratory diagnosis.
Other Topics
• Diarrheagenic E. coli: Discuss the different strains [340].
• Halophilic Vibrios: Discuss their characteristics [346].
Hepatobiliary System
Viral Hepatitis (Transfusion-Associated)
• Clinical Presentations:
o A multi-transfused thalassemic child presents with icterus, nausea,
vomiting, anorexia, and fever.
o A 10-year-old thalassemic boy with a history of multiple blood
transfusions develops jaundice with fever for the last 7 days.
o A 10-year-old boy suffering from thalassemia with a history of multiple
blood transfusions is admitted with complaints of anorexia, indigestion,
and yellow discoloration of the eyes and urine. He has moderate
jaundice on examination.
o A girl, while playing, sustains an injury and receives one dose of Tetanus
Toxoid. After a few weeks, she develops jaundice, loss of appetite, and
fever.
o A 40-year-old man complains of anorexia, indigestion, hematemesis,
and on-and-off jaundice and fever associated with hepatomegaly. He
has a history of blood transfusion about 6 years ago.
• Management: Discuss the most likely clinical diagnosis and possible
etiological agents (Hepatitis C & E virus). Describe the laboratory diagnosis
 following national guidelines, including the use of serological markers for
Hepatitis B Virus [401]. Mention available vaccines, prophylactic measures,
and the role of Interferons.
Hydatid Cyst
• Clinical Presentation: A 40-year-old patient comes to the hospital OPD
complaining of heaviness in the right hypochondrium. A C.T. scan reveals a
cystic mass on the undersurface of the liver.
• Management: Describe the structure of the hydatid cyst [411], state the
provisional diagnosis and causative agent, name possible complications, and
explain how to confirm the diagnosis in the laboratory.
Retroviral Infection (Transfusion-Associated)
• Management: Write an account of the disease stages and associated
opportunistic infections and malignancies in a case of transfusion-associated
retroviral infection.
Larva Migrans
• Management: Short note on this topic [414].
Skin, Soft Tissue, and Musculoskeletal System
Mycetoma (Madura Foot)
• Clinical Presentation: A 35-year-old male farmer presents to the OPD with a
3-month history of swelling on the left leg and foot, which has multiple
discharging sinuses and small granules.
• Management: Explain the pathogenesis and laboratory diagnosis of
Mycetoma foot [481].
Leprosy
• Clinical Presentations:
o A patient attends the skin OPD with complaints of loss of sensation and
depigmentation over an area on the back for the last few months.
o A 40-year-old man presents with tingling and numbness of the left little
and ring fingers. On examination, there is a hypopigmented patch on the
left interscapular region.
• Management: Describe the different bacterial indices and their interpretations
for diagnosis. Discuss the probable clinical diagnosis, causative agent,
laboratory diagnosis, which structures are primarily affected, and suitable
experimental animal models for the disease.
Gas Gangrene
• Clinical Presentations:
o A 50-year-old person is admitted 6 days after a crash injury to his left leg
from a road traffic accident. The wound, which was bandaged with soiled
gauze, appears heavily contaminated with soil, and local muscles seem
to be crushed. At the site, tenderness, edema, and crepitus are found.
o A 40-year-old soldier with an extensive injury in the right leg is admitted
to the hospital with a foul-smelling discharge from the wound. The
surrounding area is blackish in color with palpable crepitation.
o An army personnel is brought to the emergency with an extensive
lacerated injury on the left leg, with blackening of the skin, a foul-
smelling odor, and crepitation.
• Management: Identify the clinical condition and etiological agents. Briefly
discuss the pathogenesis and the procedure for laboratory diagnosis, including
the Nagler's reaction [440].
Dermatophytosis and Other Fungal Infections
• Management: Discuss the characteristics of Dermatophytes [479, 480] and
their macroconidia [480]. Explain the differences between measles and
German measles (Rubella).
Other Infections
• Toxic Shock Syndrome: Short note on the topic [423].
• Yaws: Discuss Treponema pertenue [455].
Respiratory Tract
Pneumococcal Pneumonia
• Clinical Presentation: A 15-year-old boy presents to the Emergency
Department with complaints of high-grade fever, productive cough, and chest
pain for the past 3 days. Physical examination reveals a dull note on
percussion. A chest X-ray shows consolidation over the right lower lobe. A
Gram stain of the sputum sample shows gram-positive cocci in pairs.
• Management: State the clinical diagnosis and causative agent. Briefly discuss
the laboratory diagnosis and how to choose the most appropriate treatment.
Hospital Acquired Pseudomonas Infection
• Clinical Presentation: An indoor burn patient complains of a bluish-green
discharge from a wound 14 days after admission to the hospital.
 • Management: Identify the type of infection, define it, and name the most
probable organism. Describe how to proceed with lab diagnosis and the
precautions to be taken to prevent such an infection.
Tuberculosis (TB)
• Clinical Presentations:
o A 45-year-old lady comes to the medicine OPD with a history of
productive cough for the last 3 weeks and an evening rise in
temperature. She also reports weight loss over the previous few months
and two episodes of coughing up blood-tinged sputum 3 days back.
o An 8-year-old child has been brought to the chest OPD with complaints
of fever for a month (not exceeding 100°F), cough with occasional
hemoptysis, and weakness.
o A 30-year-old man has been brought to the hospital OPD with the
complaint of cough, fever, and hemoptysis for the last one month.
o A female aged about 53 years presents with an evening rise of
temperature (not exceeding 100°F) for about a month, accompanied by
cough, expectoration, and occasional hemoptysis. A chest X-ray shows
an opacity in the apical region of the right lung.
o A middle-aged person is suffering from a low-grade fever for 2 months,
along with cough and occasional hemoptysis and gradual weight loss.
Acid-fast bacilli are found on sputum smear examination.
o A 35-year-old male presents with fever, hemoptysis, dyspnea, pain in the
right intercostal regions, and weight loss. Clinical examination reveals
crepitations and rhonchi.
• Management: Name the members of the Mycobacterium tuberculosis
complex, including atypical/environmental mycobacteria [527]. Discuss
molecular methods for diagnosis, the most probable causative bacteria, and
how to diagnose the case in the laboratory, including the Mantoux test. Write
in brief about different drug-resistant patterns and discuss immune prophylaxis
and how the immune status of a patient can be assessed.
Influenza
• Management: Describe the reason for the emergence of new strains of the
influenza virus and discuss the consequences of such emergence. Discuss
which types and subtypes of influenza virus are in circulation, how influenza is
diagnosed in the laboratory, and enumerate the vaccines available to prevent
it.
Pharyngitis with Tonsillitis
• Clinical Presentation: A 10-year-old child has been brought to the OPD with
fever for the last 3 days, pain in the throat, and difficulty in swallowing. On
examination, the child has a 100°C fever, the throat is congested, cervical
lymph nodes are enlarged and tender, and pus points are seen over the
tonsillar follicles.
• Management: State the clinical diagnosis, name the different bacteria causing
the condition, and describe how you will proceed to identify the agent(s) and
how the clinician would be benefited from the laboratory report. Mention what
complications can occur following such infections.
Diphtheria
• Clinical Presentations:
o An eight-year-old boy comes to the hospital emergency with fever,
asphyxia, and toxemia. On examination, a pseudomembranous patch is
found over the faucial area.
o A 3-year-old child presents to the OPD with an acute sore throat,
dysphagia, salivation, and mild fever. On examination, an adherent thick
grayish patch is found over the tonsil and oropharynx which bleeds on
removal.
o A two-year-old girl presents with fever, swelling of the neck, pharyngitis,
and difficulty in deglutition. A greenish-black membrane is seen in the
throat on examination.
• Management: State the provisional diagnosis and causative organism.
Describe how to perform laboratory diagnosis, including one in vivo and one in
vitro test to determine the virulence of the isolated organism, and mention the
method of prevention. Discuss the toxins produced, such as the Diphtheria
Toxin.
Other Topics
• Aspergillosis: Short note on this topic [565].
• Satelitism: Explain this phenomenon, particularly for Haemophilus.
• Occult Filariasis: Short note on this topic [562].
Central Nervous System
Acute Bacterial Meningitis
• Clinical Presentations:
 o A 10-year-old boy is admitted to the Medicine unit with acute onset high
fever, severe headache, photophobia, and neck stiffness.
o A male baby of 4 weeks has been admitted to the hospital with fever,
drowsiness, irritability, vomiting, and photophobia. On examination, there
is neck rigidity, and the CSF is turbid.
o A two-year-old boy has been brought to the emergency with high fever,
vomiting, and headache. On physical examination, there is neck rigidity.
o A baby of four weeks is admitted to the hospital with fever, drowsiness,
irritability, and photophobia. On examination, he is found to have neck
rigidity. On lumbar puncture, the CSF is found to be turbid.
o A 25-year-old man presents in the emergency with severe headache,
vomiting, fever, drowsiness, irritability, neck stiffness, and photophobia of
1-day duration.
o A 3-year-old child is brought to the OPD with complaints of high fever,
headache, convulsions, and vomiting. Examination reveals neck rigidity
and a positive Kernig's sign.
• Management: Enumerate the causative organisms of neonatal and acute
pyogenic meningitis. Discuss the laboratory diagnosis and the available
vaccines to prevent such conditions.
Tetanus
• Clinical Presentations:
o A 40-year-old male patient attends the emergency with trismus.
Relatives inform that he also has muscular pain, stiffness, back pain,
and difficulty in swallowing. He got a bullet injury one week back.
o A male patient, after a road traffic accident, is clinically diagnosed as
having tetanus.
o A 13-year-old boy is brought to the hospital following tonic & clonic
convulsions. He gives a history of a minor road traffic accident 21 days
back. On examination, he is found in opisthotonos.
• Management: State the probable clinical diagnosis and causative agent.
Briefly discuss its morphology, pathogenesis (including the role of
Tetanospasmin [584]), and how to isolate the organism in the laboratory.
Explain why a toxigenicity test is needed, outline the laboratory diagnosis and
immunoprophylaxis, and name the model animal for pathogenicity testing.
Rabies
 • Clinical Presentations:
o A 10-year-old boy is brought to the emergency in a state of restlessness.
On examination, it is noted that he has repetitive facial movements and
a repulsion to drinking water. The mother gives a history of the boy being
bitten by a dog on the left ankle about 6 months back.
o A boy with a history of a dog bite 3 weeks ago has been admitted to the
hospital with fever, headache, and muscle spasms, particularly while
trying to drink water.
• Management: State the clinical diagnosis and causative agent. Describe the
pathogenesis, outline the laboratory diagnosis (including identification of Negri
bodies [603]), and describe the post-exposure prophylaxis [603].
Amoebic Meningoencephalitis
• Management: Identify the etiological agent of Primary Amoebic
Meningoencephalitis (PAM) [609], the mode of infection, and how it is
diagnosed in the lab.
Poliomyelitis
• Clinical Presentation: A non-immunized child with a history of fever and
loose motion presents with left-sided deltoid paralysis.
• Management: Name the clinical condition and etiological agent. Discuss how
to diagnose the case in the laboratory, the vaccine against this agent, and the
principle behind the recent mass immunization strategy in the country.
Japanese Encephalitis
• Clinical Presentations:
o An epidemic of high fever with severe headache followed by progressive
loss of consciousness occurs in several districts. Lumbar puncture
shows no evidence of pyogenic meningitis.
o A 7-year-old child attends the OPD with high fever, headache,
disorientation, and altered sensorium.
o An epidemic of high fever, severe headache, and progressive
drowsiness has been notified in several areas. Lumbar puncture of some
cases shows clear CSF.
• Management: State the probable clinical diagnosis, etiological agents, and
modes of spread. Describe the laboratory diagnosis, prophylaxis, and the
epidemiology of Japanese Encephalitis [598].
Fungal Meningitis
• Clinical Presentations:
o A middle-aged man presents at the emergency with high fever, vomiting,
neck stiffness, and convulsive episodes. He was tested to be HIV
seropositive six months back. On examination, there is neck rigidity and
a positive Kernig's sign.
o A 30-year-old HIV-positive male complains of headache, fever, vomiting,
and altered sensorium. He shows signs of meningitis. CSF examination
shows a capsulated budding organism.
o A middle-aged person is brought to the OPD with fever and sudden loss
of consciousness. He has a history of fever, weakness, gradual loss of
weight, and swelling in the axilla and inguinal regions. He is seropositive
for HIV.
• Management: State the probable diagnosis, the common fungal agent
responsible, and the route of transmission. Describe how to proceed with the
laboratory diagnosis.
Other CNS Topics
• Prion Disease: Short note on this topic [606].
• Cysticercosis: Short note on this topic [613].
Urogenital Tract
Syphilis
• Clinical Presentations:
o Primary Syphilis: A 30-year-old man presents with a painless, hard,
indurated ulcer over the external genitalia and non-tender, firm, enlarged
inguinal lymph nodes, with a history of unprotected sexual exposure 3
weeks prior. Other similar presentations include a painless penile ulcer
for 7 days with a history of exposure, a painless ulcer with recent
exposure history, a painless ulcer with swollen non-tender inguinal
nodes with exposure history 2 months back, and a painless, avascular,
indurated ulcer on the glans penis 3 weeks after visiting a red-light area.
o Secondary Syphilis: A young pregnant woman presents with a skin
rash and moist, cauliflower-like lesions around her external genitalia.
Examination reveals widespread maculopapular skin rashes with typical
condylomatous lesions around the vulva.
 • Management: Discuss the provisional diagnosis, causative agent, and how
the disease can be confirmed in the laboratory using tests like the VDRL test
[634]. Mention the drugs for treatment, how to assess the response, and other
important tests to rule out co-infections. Discuss prophylaxis.
Gonorrhea and Other STIs
• Management: Enumerate the bacteria causing sexually transmitted infections
(STIs) and the methods for laboratory diagnosis. For gonococcal urethritis
[638], discuss the virulence factors of N. gonorrhoeae and how it is diagnosed
in the lab in males.
Urinary Tract Infection (UTI)
• Clinical Presentations:
o A 25-year-old newly married female presents with fever, frequency of
micturition, and a burning sensation during micturition for the last three
days, with tenderness over the loin.
o A 23-year-old recently married lady presents with fever with chills,
increasing urinary frequency with urgency, and dysuria for the past 24
hours.
• Management: Enumerate the causative agents, including the
Enterobacteriaceae family. Discuss the probable clinical diagnosis, common
causative microorganisms, and the laboratory diagnosis of a suspected case.
Non-gonococcal Urethritis (NGU)
• Clinical Presentation: A 35-year-old man with a history of contact with a
female sex worker presents with urethral discharge that does not show any
gram-negative diplococci.
• Management: Discuss the diagnosis, possible etiological agents (like
Trichomonas vaginalis), how to proceed with laboratory diagnosis for one of
these agents [640-644], and the definition of L-forms.
Miscellaneous Infections
Congenital and Oncogenic Infections
• Congenital Toxoplasmosis: Short note on this topic [659].
• Oncogenic Viruses: Short note on this topic [665].
Emerging and Zoonotic Diseases
• Zika Virus: Short note on this topic [663].