Virulence Factors

• Corynebacterium à Exotoxins
• Listeria à (listerolysins) in addition to some phospholipases.
• Bacillus anthracis à Capsule: (polypeptide) is antiphagocytic & Anthrax toxins
• Bacillus cereus à Emetic (heat stable toxin), diarrheal (heat labile toxin)
• Clostridium tetani à tetanospasmin is a neurotoxin
• Clostridium botulinum à botulinum
• Clostridium perfringes à Alpha toxin, theta toxin
• Clostridium diAicile à Exotoxin A (watery diarrhea), Exotoxin B (damage gut mucosa)
• Streptococcus pyogenes à C carbs, M protein. Enzymes & toxins
• Neisseria Meningitidis à Lipopolysaccrides (Endotoxin)
• Neisseria Gonorrhoeae à Lipooligosaccrides
• Brucella à Lipopolysaccrides (intracellular survival)
• Haemophilus influenzae à Lipopolysaccrides
• Shigella à Lipopolysaccrides
Fastidious: organism can't grow on ordinary medium
1. Streptococci (enriched medium)
2. Corynebacterium
3. Neisseria
4. Moraxella catarrhalis
5. Brucella
6. Haemophilus influenzae
7. Bordetella pertussis
Oxidase positive organisms Catalase positive
1. Neisseria 1. Staphylococcus
2. Pseudomonas aeruginosa 2. Pseudomonas aeruginosa
3. Moraxella catarrhalis 3. Vibrio cholerae
4. Pasteurella multocida. 4. Campylobacter
5. Vibrio cholerae
6. Campylobacter Urease positive
1. Proteus
Tests for susceptibility 2. Helicobacter pylori
1. Shick’s test (Corynebacterium) 3. Ureaplasma urealyticum
2. Dick test (streptococcus pyogenes)
Organisms causing neonatal meningitis
1. Streptococcus agalactiae
2. E. Coli
3. Listeria
4. Haemophiles influenzae

- Streptococcus pyogenes is pus forming & highly pathogenic

- Streptokinase can be used therapeutically
 Bacteria causing Necrosis
1. Corynebacterium
2. Bacillus anthracis
3. Clostridium perfringes (gas gangrene)
4. Streptococcus pyogenes (Necrotizing fasciitis)
Indicators for water pollution
1. E coli - Bacillus anthracis à polysaccharide capsule
2. Clostridium diAicile - Streptococcus à polysaccharide capsule
3. Streptococcus Bovis - Neisseria Meningitidis à polysaccharide capsule
Zoonotic diseases Occupational disease
1-Bacillus anthracis 1-Bacillus anthracis
2-Pasteurella multocida 2- Brucella
3- Brucella. 3- Chlamydia psittaci
4-Yersinia 4- leptospira
5-Campylobacter
6-Chlamydia psittaci
7-Coxiella burnetti (Q fever)
8-leptospira
Foodborne illnesses Food Poisoning
1. Listeria (not food poisoning) 1- Bacillus cereus
2. Bacillus cereus 2- Clostridium perfringes
3. Clostridium botulinum 3- Salmonella enteritidis / typhimurium
4. Clostridium perfringes 4- Staphylococcus aureus
5. Staphylococcus aureus
Fecal Pollution
1- Clostridium perfringes
2- Enterococcus faecalis
3- Lactose fermenter (E. coli, Klebsiella, Enterobacter)
Streptolysin O Streptolysin S
- Antigenic -Non antigenic
- O2 labile -O2 stable
Surgical Debridement
1. Clostridium perfringes
2. Streptococcus pyogenes (Necrotizing fasciitis)

à To Diagnose carrier for Neisseria, use west nasopharyngeal swab ONLY

Pyogenic produce pus à Neisseria, strept pyogenes, Staph

- Post streptococcal manifestation due to type 2 hypersensitivity not because of actual bacteria
(not treated well so antibodies exist)

- Streptococcus viridians don't have Lancefield classification

 Serological tests
- Corynebacterium
Virulence test (Test for Toxigenicity)
A. In vivo (Guinea pig inoculation)
B. In-vitro (Elek’s test) gel precipitation
C. Tissue culture test
- Bacillus anthracis
A. Ascoli’s thermos precipitation test
B. ELISA or hemagglutination assay

Sexually transmitted/venereal disease

1. Neisseria gonorrhea 2. Chlamydia 3. Haemophilus ducreyi 4. Treponema pallidum
Staphylococcus aureusà acute endocarditis
streptococcus viridians à subacute endocarditis
Neisseria Meningitidis à Epidemic meningitis
Neisseria gonorrhoeae à Gonococcal urethritis
Chlamydia à Non gonococcal urethritis
Legionella à Transmitted by Air conditioner
Chlamydia trachomatis à Contain glycogen inclusion bodies
- A positive Quellung or capsule swelling test with anticapsular precipitins for
Strept. pneumoniae & Haemophilus influenzae
Mention Major cause of nosocomial infections (Pseudomonas aeruginosa)???
1. Nutritional requirements are minimal
2. The organism can grow on a wide variety of organic substrates.
3. Grow at wide range of temperatures.
4. Can even grow in laboratory water baths, hot tubs, wet IV tubing.
5. Highly resistant to a variety of antimicrobial age
UTI Cause wound infection
1. E. coli. 1. Staph aureus (gold pus)
2. Klebsiella 2. Pseudomonas (green pus)
3. Proteus
Special in ordinary media
1. Klebsiella produces mucoid (slime) colonies
2. Pseudomonas produce green color
3. Proteus produce swarming motility
Vaccines
1- DTP à Corynebacterium, Clostridium tetani, Bordetella pertussis
2- Pasteur ‘s vaccines, Sterne’s vaccine, Anthrax Vaccine Adsorbed à B. anthracis
3- Polysaccharide vaccine à Streptococcus pneumoniae
Cause Epidemic
1. Yersinia pestis (plague/Black Death)
2. Vibrio cholerae (cholera)
3. Neisseria meningitides (epidemic cerebrospinal meningitis) (in Africa gp A)
Cause Enterocolitis
1. Campylobacter
2. Salmonella typhi
3. Yersinia enterocolitica
Atypical pneumonia/ walking pneumonia Typical pneumonia
1. Chlamydia pneumoniae 1. Haemophiles influenza
2. Legionella 2. strept pneumoniae
3. Mycoplasma pneumoniae 3. klebsiella pneumoniae

Interpretation
1- How to avoid complications happen from antitoxic serum (Corynebacterium)
à pre ttt with cortisone, antihistamine, epinephrine injection to avoid sensitivity testing
2- Haemophiles influenzae can grow in symbiosis with Staphylococcus aureus on 5%
sheep blood agar.
à Staphylococcus aureus is hemolytic, & its presence in the blood agar medium makes
V-factor (NAD) available in the medium this phenomenon Satellitism
3- People taking antacid medication are at higher risk of contracting
campylobacteriosis from a smaller number of organisms // Reduced stomach acid
e.g., malnutrition, antacid use is risk factor for developing the infection in vibrio cholera
à Organism grows in alkaline media, sensitive to acidity so if acid decrease for any cause
the organism will grow
4- Chlamydia & Rickettsiae not cultured on non-living artificial media?
à Bec they are Obligatory intracellular parasites
5- Why serological tests are better for diagnosing mycoplasma rather than culture?
à Bec isolation of the organism requires incubation for a week or longer as of its slow growth
6- Rational strept pyogenes make autoimmune disease.
7- à Bec: Strept Ag immunologically similar to protein in heart valves so Ab against Strept
cause cardiac damage
8- Why penicillins are ineQective against mycoplasma
à Bec mycoplasma don’t have cell wall
9- Why are Sulfonamides contraindicated in Rocky Mountain spotted fever?
à Bec, it Enhance disease process
10- Why starting location of rash is important in diagnosing diQerent types of rickettsia?
à rickettsia rickettsi starts from extermities & moves to trunk while rickettsia prowazeki
starts from trunk and spread to extremities
11- Mycobacterium tuberculosis can’t be stained with simple stain.
à due to high lipid content of mycolic acid
12- Blood culture is carried in duplicate, where one is incubated in 10%Co2?
à Bec brucella abortus grow better in environment with 10% Co2
13- Treponema pallidum is diQicult to grow on culture media
à Bec, it dies rapidly in environment & can’t be sub cultured
14- Treponema pallidum is transmitted rapidly by direct contact
à it dies rapidly in environment
15- Why treponemal test antibody titers should not be used to assess treatment
response?
à Bec treponemal tests remain positive
16- Why patient should be advice not to stop syphilis treatment if fever happens?
àThis is called the Jarisch Herxheimer phenomenon which is self-limiting reaction due to
organism releasing pyrogens
17- Conducting a treponemal test on neonatal serum is not recommended
à Bec it is diAicult to interpret as maternal treponemal antibodies can persist in neonatal
serum 15 months after delivery.
Special treatment
1. Pre ttt with cortisone, Antihistamine, Epinephrine injection à Corynebacterium
2. Raxibacumab or Obiltoxaximab à pulmonary anthrax
3. Poly valent antitoxin iv à Clostridium botulinum
4. TIG & Diazepam & Mg iv & Tracheotomy à Severe case in Clostridium tetani
5. Fidaxomicin à Clostridium di=icile
6. Benzathine penicillin à Systemically of Streptococcal Toxic Shock Syndrome
7. Fucidic acid à Topically of Streptococcal Toxic Shock Syndrome
8. Selenium sulphide or Zinc pyrithione shampooà Tinea versicolor
9. Imidazole agent àWhite piedra to prevent reinfection
10. Terbinafine à Onychomycosis & Black piedra
11. Keratolytic agent (salicylic acid) à Tinea nigra
12. Griseofulvin or Itraconazole à Refractory infections of Fungai
13. Systemic Mycoses à Amphotericin B
14. Oral or Vaginal Candidiasis à Nystatin or Clotrimazole
15. Itraconazole à Sporotrichosis
16. Surgery à in case of pulmonary structural abnormalities & fungal balls (Aspergillus)
17. IM cefotaxime single dose à Neisseriae Meningitidis
18. Combination therapy involving doxycycline & gentamicinà Brucella
19. Erythromycin & Trimethoprim/sulfamethoxazole à Haemophilus Ducreyi
20. Erythromycin & Trimethoprim/sulfamethoxazole is alternative à Bordetella Pertussis
21. Trimethoprim/sulfamethoxazole, Nitrofurantoin, Ciprofloxacin à [Link] (UTI)
22. Antipseudomonal penicillin (ticarcillin or piperacillin) à P. aeruginosa
23. Metronidazole à Bacteroides & All Clostridium except botulinum
24. PPi / clarithromycin / amoxicillin à H. Pylori
25. Isoniazid , rifampin, pyrazinamide, ethambutol (combine 2-3) à Tuberculosis
26. Streptomycin, isoniazide, & [Link] salicylic acid à Atypical maycobacterium
27. Dapson, rifampin & clofazamine à Leprosy
28. Chalmydia & Neisseria gonorrhoeaeà Tetracyclines as doxycycline & erythromycin
29. Rickettsiaeà Doxycycline & chloramphenicol
30. Mycoplasma pneumoniaeà Erythromycin & tetracycline
31. Treponema pallidumà long acting Benzathine penicillin G
Selective Media
1. Corynebacterium àBlood tellurite media
2. Bacillus anthracis à PLET media
3. Staphylococcus à Mannitol salt agar (MSA) & Milk agar
4. Fungaià Sabouraud’s dextrose agar
5. Histoplasma Capsulatum à Tuberculate macroconidium (enriched)
6. Neisseria à Thayer martin media
7. Brucella à Trypticase broth or Liver infusion medium
8. Bordetella pertussis à Bordet-Gengou media (potato-blood-glycerol agar)
9. Legionella à Buffered charcoal yeast extract agar
10. E. coli à Eosin methylene blue (metallic sheen)
11. Salmonella à Salmonella-Shigella {SS} or deoxycholate & citrate agar
12. Salmonella à Selenite F or tetrathionate (enrichment medium)
13. Pseudomonas aeruginosa à Cetrimide agar
14. Vibrio cholerae à Thiosulphate-citrate-bile salt-sucrose (TCBS) agar
15. Bacteroides à Blood agar containg Kanamycin & Vancomycin
16. Campylobacter & [Link] à Skirrow′s
17. Ureaplasma urealyticum à urea-plasma agar media
18. Mycobacterium tuberculosis à Inspissated Egg Media (Löwenstein-Jensen)