MICROBIOLOGY

PERSONALITY CONTRIBUTION

Robert Hooke Cell Theory

Anton Van Leewenhoek Animalcules

Robert Koch Koch’s postulates

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Rudolf Virchow Biogenesis theory

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Edward Jenner Smallpox Vaccine “Poxpok ang mga Jenner”

Ignaz Semmelweiss hand washing

Joseph Lister Carbolic acid

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Alexander Fleming Penicillin

Paul Erlich Father of chemotherapy, 606, Salvarsan, Arsphenamine (Magic bullet)

ru
FEATURE STERILIZATION DISINFECTATION
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Kill spore Yes No
ga

Kill Vegetative yes Yes

FEATURE ANTISEPTIC DISINFECTANT

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Target Animate objects Inanimate objects

Example Iodine= #1 skin antiseptic Chlorine= for municipal water

@

supplies

STAINS

Simple DIfferential Special

aqueous / alcoholic solution Classify organisms 1. Capsule: India

of single dye - Gram stain ink/Nigrosin
Chromophore - Acid fast stain 2. Spores: Schaffer-fulton,
- Anion: acidic Ziehl Neelsen Malachite green
 - Cation- basic Kinyoun 3. Flagella: Carbol fuschin

Physical Requirement Nutritional Requirement Oxygen Requirement

Tempera Psychro/Cryophiles: Energy Phototrophs: light Obligate AEROBES (PNBMC)

ture cold temp source - Requires O2
*Chemotrophs:
Mesophile: body redox potential P Pseudomonas (AIRuginosa)

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temp
M Mycobacterium
(tubAIRculosis)
Thermophiles: hot

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temp N Nocardia

L Leptospira
*clinically important

gl
pH Acidophiles: acidic Carbon *Heterotrophs/Org Obligate ANAEROBES (ABCEP)
pH Requirem anotrophs: organic - Grow only in absence of
ent carbon O2
ru Neutrophiles:
neutral pH (7.2-7.6) Autotrophs/Lithotro A Actinomyces
phs: inorganic
B Bacteriodes
Alkali/Basophiles: carbon
ld
Basic pH C Clostridium
*clinically important
ga

Osmotic Halophiles: high salt MIcroaerophiles

Pressure content/osmotic (Micro-BACTER)
pressure - Low O2, high O2 (toxic)

CampyloBACTER
le

HelicoBACTER

Aerotolerant (LP)
@

- Tolerates O2 but cannot

replicate in its presence

L Lactobacillus

P Propionibacterium

Facultative anaerobes (the

REST)
- Could thrive with or
 without O2

z
od
Culture Media

Simple Media Nutrient Agar/Broth

Enriched Media Milk agar Require high PROTEIN diet

(MCB)

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Blood Agar Plate (BAP) Require high NUCLEIC ACID
content
ru Chocolate Agar Plate (CAP) Require MOLYBDENUM from
diet (present in hemoglobin)

Selective Medium MCA, EMB: Enterobacteriaceae

ld
CM Lactose fermenters Non-lactose fermenters

MCA Pink colonies Colorless

ga

EMB Purple Black colonies Colorless

[Link]: green metallic sheen Shigella
Klebsiella Salmonella
Enterobacter citrobacter Yersinia
Serratia Proteus
le

Pseudomonas
@

Collistin-Nalidi+ic agar (CAN) Gram + org

Thayer-MartiN Neisseria spp.

LOWenstein- Jensen Mycobacterium tubercuLOWsis

LOEffler’s Serum Medium, TELlurite Medium CORYnebacterium DIPHtheria

(LoeTel CoryDiph)

Campy BAP, Skirrow’s agar CampylobacterSeSuni (S looks

like J)
 Bordet-Gengou Medium Bordetella pertussis

THIOsulfate citrate bile salts sucrose (TCBS) Vibrio spp. (THIOVIBRIO)

Differential Medium
BAP- for
Organis Type of ZOI
Streptococcus spp.
ms hemolysis

Alpha pArtial Green

z
Beta Complete (Buo) Clear

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gamma NON-hemolytic Red

Reducing Medium Thioglycolate Broth ONLY reducing medium

- Obligate

gl
anaerobes Simple Media using Candle Jar/GasPak Provides ANAEROBIC
environment
ru
ORGANISM CULTURE MEDIUM

Strep. spp Blood Agar Plate

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C. diphtheriae Loeffler’s, Tellurite
ga

Neisseria spp Thayer Martin

E. coli Eosin Methylene Blue

Vibrio cholerae Thiosulfate-citrate-bile sucrose

le

Campylobacter jejuni Skirrow’s

H. influenzae Chocolate agar

@

Bordetella pertussis Bordet- gengou, Regan-Lowe

M. tuberculosis Lowenstein- jensen

Fungi Sabouraud Dextrose

Anaerobes Thioglycolate agar

S. typhi Bismuth sulfite agar

Legionella pneumophila Charcoal yeast agar

Gram + organisms Colistin-Nalidixic agar

Prokaryote Eukaryote

True nucleus X Yes

DNA enclosed in X Yes

membrane

z
Membrane-boun X Yes

od
d organelles

Ribosomes 70s: 50s and 30s 80s: 60s and 40s

Cell division Binary fission Mitosis

gl
Examples Bacteria Fungi, animals. Protists, dinoflagellate

ru Bacteria Fungi Man

Cell Wall Peptidoglycan Chitin XXX

ld
Cell Membrane Present- NO STEROL Ergosterol Cholesterol
ga

Droplet Airborne Vector borne

<1m >1m Toxoplasma

Others-varicella
le

Surgical mask N95 mask Rubella

Cytomegalovirus
The rest Measles
HErpes, Hepa B, HIV
Tuberculosis
@

Syphilis
Varicella

STAGES OF MICROBIAL GROWTH

Lag

Log/ Exponential Target of bactericidal

Stationary Balance growth

Decline

STAGES OF INFECTIOUS DISEASE

Incubation period Pre-pathogenesis, NOsigns and symptoms

Prodrome WITH signs and symptoms

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Acme/ Peak of Illness Acute: Flu, Hepa A & E
Chronic: Hepa B, C, D

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Decline subsides

Recovery/ Convalescence Body is restored to its normal and healthy condition

gl
OCCURRENCE OF DISEASE

Endemic
ru Particular place, people
Ex: Palawan- Malaria
Samar and Leyte- Schistosomiasis
Albay and Mindoro- Filariasis
ld
Epidemic No of cases is greater than expected frequency
OUTBREAK
ga

Sporadic Scattered, irregular interval

Pandemic Worldwide
Ex: HIV/AIDS
COVID-19
le
@

Natural/ Innate Acquired

Before an infection (+) infection

1st line= epithelial barrier 3rd line= WBC/ leukocytes

- Skin Granulocyte (BEN)
- Mucus membrane - Basophil
2nd line - Eosinophil
- Natural killer cells - Neutrophil
- Phagocytes Agranulocyte
 - Dendritic cells - Monocyte
- Lymphocyte

Cell MediaTed Humoral

T Cells B Cells

CD4 + T cells- MHC Class II Plasma cells -> antibodies

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- Helper, memory Role: Go PHAGOCYTOSIS
- HIV vs CD4 + T cells

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Hapten: incomplete antigen, no Ab
CD8 + T cells- MHC Class I response
- cytotoxic
Hapten + Carrier CHON: Ab response

gl
IMMUNOGLOBULINS

IgG
ru PreGGy, chronic/ past infection

IgA secretions
ld
IgM Acute infection, Malaki, Mauuna

IgE EllErgy
ga

IgD B cells -> plasma cells

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Acquired Immunity

Naturally Artificially
@

Active Passive AcTiVe- Slow onset- Passive- Fast onset,

Long DOA Short DOA

Prior infection Maternal antibody Toxoid, Vaccine Immunoglobulin

Antiserum, antitoxin
 z
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Types of Vaccine

gl
Live attenuated IMactivated/Killed

Mimic the actual disease

ru XXX

Affected by circulating Ab XXX

Do not give if:

- Pregnant
ld
- Immunocompromised
- <6 months (exception: oral vaccine,
measles vaccine)
ga

Usually single dose Usually multiple dose

Multiple routes Usually IM

Measles, Mumps, Ribellla Recombinant: Hepa B (1st anticancer vax- Liver),

le

Varicella vaccine Influenza/Flu vaccine (C/I: allergic to egg)

Adenovirus Toxoid: toxin inactivated by formaldehyde,
Polio vaccine (PO) Diphtheria, Tetanus
@

Smallpox Whole cell: Pertussis, Rabies

Yellow fever Subunit: “conjugate” Haemophilus Influenzae B,
Bacillus-Calmette-Guerin Pneumococcal vaccine

LEVEL OF PREVENTION

Primordial All people Patterns of living, general, policy, law

Prevent trends
Primary At risk/ susceptible Prevent disease in a well person
Health promotion
Protection- PPE
Immunization
Environment

Secondary Early symptoms Early detection

Asymptomatic Ex. Screening Test
(+) tissue changes HIV: ELISA

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Tertiary Established disease Limit disability and promote rehabilitation
Symptomatic

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Public Health Programs

gl
4 o'clock habit Prevent dengue spread

Sangkap Pinoy Seal Program Encourage food manufacturers to fortify processed food and
(SPSP)
ru food products

Sentrong Sigla Availability of healthcare centers

ld
Herbal and Traditional Medicine Backyard gardening

National Objectives for Health ● Roadmap for Universal Healthcare

● Partnership with different sector
ga

National Drug Policy Program Guarantees better health outcomes by using policy instruments
and setting strategic directions aimed at improving access to
quality essential medicines
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DOH Nutrition Program Objective is to improve the survival of infants and young children by
improving their nutritional status, growth, and development through
optimal feeding and programs e.g. micronutrient supplementation,
salt iodization, food fortification, etc.
@

● Overnutrition
● Undernutrition - Primary, Secondary

Gram Staining

Steps (VIAS) Gram + Gram -

Crystal Violet Primary Stain Violet Violet

Gram’s Iodine Mordant Violet Violet

Alcohol Decolorizer Violet White/No color

Safranin O Secondary/counterstain Violet Red

General Rules ALL COCCI ALL BACILLI

Exceptions: NVM Exceptions: BANSCEL MP

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N Neisseria B Bacillus

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V VeilloNella A Ac+inomyces

M Moraxella N Nocardia

S Strep+omyces

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C Corynebac+erium,
ru Clos+ridium

E Erysipelo+hrix

L Lis+eria,
Lac+obacillus
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M Mycobac+erium
ga

P Propionibac+erium

Gram-POSITIVE Gram-NEGATIVE Remarks

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Gram reaction Blue/Violet Red/Pink

Peptidoglycan Thicker (7-8) Thinner (1-2) Mas makapal tingnan ang + compared
@

Layer to -

+eichoic acid Present Absent kung ano present kay +, absent naman
kay - and vice versa
Periplasmic Absent Present
space - Enzymes
- lysozymes

PorIns Absent Present

Toxin produces Exotoxin eNdotoxin Flip mo lang yung x to make +

 (E+otoxin) N for Negative

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PARAMETER EXOTOXIN ENDOTOXIN

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Producer Gram + Gram -
Gram - Listeria monocytogenes

Part of the cell wall? No Yes

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Toxicity More toxic Less toxic

Potencyru MOre potent Less potent

Heat Heat-labile Heat-stable

Regions A: activity —
B: binding
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Clinical Correlate Source of toxoids Septic shock
Primary defense: IgM, IgG
ga

Acid Fast Staining (CHAM)

Carbol-Fuschin Fuchsia dye: Frimary

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stain
Carbolic acid: Chemical
mordant
@

Heat Physical mordant

Acid Alcohol Decolorizer

Methylene blue Secondary/counterstain

 Virulence Factors

Flagella(H)
● Forward movement
○ Chemotaxis
● H antigen

Atrichous Shigella spp

Monotrichous Vibrio cholerae

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Lophotrichous Helicobacter pylori

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Amphitrichous Campylobacter jejuni

Peritrichous E. coli

Pili Fimbriae

gl
Longer, few Shorter, many

Sex pili P fimbriae

●
●
ru Adhesion pili - Attach to the
urinary tract
- E. coli
ld
Capsule
- Firmly attached, organized (unlike slim layer:
loosely attached, not organized)
ga

- Polysaccharide except B. anthracis

(D-glutamic acid)
- Prevent phagocytosis
- K antigen (Kapsule)
Tests: Quellung rxn – swelling
le

Encapsulated Bacteria
“Some Killers Have Pretty Nice Capsule”
@

S Streptococcus pneumoniae

K Klebsiella pneumoniae

H Haemophilus influenzae

P Pseudomonas aeruginosa

N Neisseria meningitidis
C Cryptococcus neoformans
(only encapsulated fungi)

Spores
- Highly resistant to heat and chemicals
- Calcium dipicolinate/ dipicolinic acid
Sporulation: Vegetative form to Spore

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Germination: Spore to Vegetative form
Stain: Schaffer-fulton, Malachite green
Spore forming: Bacillus, Clostridium (anaerobe)

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Genetics

Plasmid Extrachromosomal DNA

gl
● F plasmid- sex pili
● R plasmid- antibiotic Resistance
○ RTF
ru ○ R determinant

Transposon “Jumping genes”

Antibiotic resistance
ld
Gene transfer

Conjugation Sex pili, donor to a recipient by cell-to-cell contact

ga

Transduction Bacteriophage, virus

Transformation Direct uptake of DNA

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Gram Positive Cocci

@

Catalase Positive Catalase Negative

Staphylococcus (bubbles) Streptococcus

Coagulase Test Blood Agar Plate

+ - (novobiocin) Alpha-hemolytic Beta-hemolytic Gamma-hemolyti

NoSRES (green) Optochin (clear) Bacitracin c (non hemolytic)
OVRPS BaBRAS 6.5% NaCl
Staph. Sensitive Resistant Sensitiv Resistant Sensitive Resistant + -
Aureus e
(clumps)
Staph. Staph. Strep. VIridans Strep. Strep. Enteroco Strep.
epidermi saprophytic pneum Streptoc Pyogene Agalacti ccus spp. bovis
dis us oniae occus s (Grp A) ae (Grp
B)

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Gram Positive Bacilli

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Spore Forming Non-spore
forming
(CLEANP)

Bacillus Clostridium COrynebacteri

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(CAT) (BoTePeDi) um
Listeria,
B. cereus
ru C. botulinum Lactobacillus
B. C. tetani Erysipelothrix
anthracis C. perfringens Actinomyces
B. C. difficile Nocardia
thuringien Propionibacteri
ld
sis um
ga

Bacteria Brief Description Palatandaans

Gram POSITIVE COCCI

S. aureus Reservoir: Nares Aureus

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1. Acute endocarditis (araw)-

2. Staph. Food poisoning golden yellow
3. Pneumonia- air filled cyst
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4. Scalded skin (4th disease)- exfoliation

5. Osteomyelitis and septic arthritis
6. Skin and soft tissue infection
a. Impetigo- honey
b. Abscess- purulent
c. Mastitis
d. Folliculitis
e. Furuncle/Boil- SQ layer
f. Carbuncle- multiple furuncle
7. Staph Toxic Shock Syndrome- tampon use- stimulate T
 cells - High cytokines
+ Hypotension
+ Rashes
- Blood culture
MSA: golden yellow colonies

MSSA MRSA VRSA

Methicillin X Vancomycin Linezolid

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Oxacillin ///

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Nafcillin X

S. epidermidis #1 skin flora

gl
WOF: stitch abscess, forms biofilms in foreign devices such as
implant and prosthetic

Staph. MSA: colorless colonies “May UTI is

ru
saprophyticus #2 UTI in sexually active young women
[Link]: #1 UTI in ALL population
Fluor and
Sap”
Tx: Fluoroquinolones
ld
Strep. Aka Pneumococcus “Swelling ang
pneumoniae Lancet-shaped diplococci lungs ni Lance
Capsule (Quellung rxn: swelling) bc of
ga

WOF: #1 CAP (droplet) PENumonia”

WTD? Co-amox with or without macrolide
Prev: PCV, PPV
WOF: #1 Otitis media
WTD? Amox
le

Strep. Group A Streptococci (GABHS) “Scarlet ang

pyogenes Scarlet fever: Dick’s Test & Schulze-Charlton Test) Dick ni A-Pyo”
@

VF: M protein = Most important, NO phagocytosis

Source of Streptokinase (CHON not enzyme)

SUPPURATIVE DISEASES
a. Strep. pharyngitis/ Sore throat
b. Scarlet fever (2nd disease)
c. Strep. Toxic shock syndrome (no tampon use)
d. Skin and soft tissue

NON-SUPPURATIVE DISEASE
 a. Rheumatic Heart disease (molecular mimicry)- JONES
b. Post-strep glomerulonephritis (serotype 12)

Strep. Group B Streptococci (GBS) “B-agalactiae

agalactiae ROT: passage in the birth canal ”= respiratory
WOF: Neonatal Sepsis and meningitis
WTD? Ampicillin + Gentamicin
Respiratory distress syndrome

z
Group D Strep Gamma hemolytic
1. Enterococcus- E. faecalis: endocarditis after abdominal
surgery

od
2. Non-enterococcus- S. bovis: marantic endocarditis

Nosocomial Enterococcus faecium ESKAPE

Staphylococcus aureus
Klebsiella pneumoniae

gl
Acinetobacter baumanii
Pseudomonas aeruginosa
Enterobacter spp
ru
Viridans strep S. sanguis: Subacute endocarditis after oral surgery
S. mutans: dental caries
S. intermedius: brain abscess
ld
Strep. Smell like butterscotch or caramel “Angi’s faves:
anginosus butterscotch/
caramel”
ga

Gram POSITIVE BACILLI

B. anthracis Box car shaped

Capsule: D-glutamic acid
le

Toxin: Protective, edema, lethal factors

1. Pulmonary: Woolsorters
2. Cutaneous: Malignant pustule
@

3. Gastrointestinal
WTD? Ciprofloxacin, Doxycycline

B. cereus (+) motile

Reheated rice- heat stabile toxin -> diarrhea
“Chinese fried rice syndrome
WTD? Vancomycin, Clindamycin

C. tetani Tennis racket/ Lollipop/ drumstick (mukhang etits) “Mapapasmil

Tetanospasmin: inhibit GABA → Tetanus → SPASTIC paralysis e ka sa TeTe”
 (Opisthotonos, Abdominal rigidity, Sardonic smile)
WTD?
- Antiserum
- Tetanus toxoid
- Diazepam
- Metronidazole
Prev: DPT, Tdap

C. perfrinGeNs Alpha toxin “PerfPen”

z
INvasive clostridia
Necrotizing effect

od
Gas GangreNe
WTD? Amputation, hyperbaric O2
Tx: Penicillin

C. difficile Chronic antibiotic use

gl
Cephalosporin
Clindamycin
Ciprofloxacin
Toxin A -> colitis
ru WOF: PSeudomembranous colitis
WTD? STOP antibiotic, Vancomycin (PO), Metronidazole, Fecal
transplant (50% efficacy)
ld
C. botulinum Canned goods
Botulinum toxin → inhibit release of ACh → FLACCID paralysis
WTD?
ga

- Antitoxin
- Airway support
Botox: lessen wrinkles

Corynebacteriu Chinese character arrangements/palisades/ club shaped “Chinese si

le

m diphtheriae Loeffler’s agar LoeDi Cory”

(+) metachromatic granules
Tests:
@

1. Elek Test: toxigenicity

2. Schick test- susceptibility
Toxin A → inhibit CHON syn elongation factor 2 - pharynx
+ Bull neck
+ Dyspnea
WTD?
- Antitoxin
- Pen G
- Erythromycin
Prev: DPT, Tdap
Listeria Tumbling motility “Nag
monocytogene Umbrella growth pattern Tumbling si
s Survives phagocyte Lister habang
Endotoxin naka-umbrella
WOF: Sepsis and meningitis ”
WTD? Cotrimoxazole

Erysipelothrix Wheal/ seal finger

rhusiopathiae

z
Fungus-like bacteria

od
Actinomyces israelii Nocardia asteroides

anaerobe aerobe

NOT acid fast Acid fast

gl
NOT FOUND in normal flora Normal flora

Trauma → abscess = FALSE mycetoma madura

ru
foot
*TRUE mycetoma: Pseudallescheria boydii

WTD? SNAP WTD? SNAP

ld
Penicillin Sulfamethoxazole + Trimethoprim =
Cotrimoxazole
ga

Prop. acnes Lipase (oil sebum → FA) = inflammation

WTD? Doxycycline, Clindamycin, Tretinoin/Isotretinoin
le

ORGANISM EXOTOXIN MOT

S. aureus TSST-1 Increase T cell

@

C. tetani Tetanospasmin Inhibit GABA

C. botulinum Botulinum toxin Inhibit release if ACh

Corynebacterium Diphtheria toxin Inhibit protein synthesis elongation factor 2

V. cholerae Choleragen Increase cAMP

DISEASE GRAM POSITIVE BACTERIA WTD?S

Food poisoning, TSS, boils S. aureus MON

MRSA Vancomycin

RHD S. pyogenes Pen G

CAP and Otitis Media S. pneumoniae Co-amoxiclav

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Woolsorter’s disease B. anthracis Doxycycline, Ciporfloxacin

Chinese Fried Rice syndrome B. cereus Vancomycin, Clindamycin

od
Gas gangrene C. perfringens Hyperbaric O2

P. colitis C. difficile Metronidazole (alt), Vancomycin (PO)

gl
Tetanus C. tetani Toxoid, Antitoxin

Botulism
ru C. botulinum Antitoxin, airway support

Diphtheria C. diphtheria Antitoxin, Pen, Erythromycin

ld
Bacteria Brief Description Palatandaans

Gram NEGATIVE COCCI (Neisseria)

Carbohydrate fermentation
ga

- N. m- maltose, glucose
- N. g- glucose
Oxidase (+)
Capnophile
le

Culture: Thayer-Martin
ID: Kidney-shaped diplococci
C3a- ANaphylaxis
C3b- Binding of IgG, neutrophils
@

C5-C9- Membrane attack complex (lysis of Neisseria spp)

N. gonorrhoeae Fermentation test: Glucose only NO ANIMAL MODELS

VF: Pili, IgA protease, Capsule, Endotoxin
Donut-shaped
ROT: Vertical
Purulent/ Nana
**Chlamydia- Clear
WTD? CeftRIAxone + Azithromycin/Doxycycline
*Gonococcal septic arthritis (adolescents)
 ROT: Horizontal
WOF: Ophthalmia neonatorum gonorrhea
Prophy: 1% AgNO3 (old), Erythromycin (new)

N. meningitidis Fermentation test: Glucose and Maltose

VF: Pili, capsule (glycocalyx)
Nasopharynx
- Meningitis

z
- Meningococcemia: (+) hemorrhagic
rash, “purpura fulminans”, necrosis

od
WTD? CeftRIAxone
Prophylaxis: Ceftriaxone, Ciprofloxacin,
Azithromycin
Prev: Meningococcal conjugate vaccine

gl
Gram NEGATIVE BACILLI

A. Enterics (GIT)
ru
Enterobacteriaceae

E. coli VF:
- Capsule K Ag
ld
- SOmatic O Ag
- Flagella H Ag
- P fimbriae- attach to UT
- Capsule- prevents phagocytosis
ga

- Heat stable toxin- Increase cGMP

- Heat labile toxin- increase cAMP
WOF:
1. Acute gastroenteritis
le

Pathotypes

ETEC EnteroToxigenic Traveler’s diarrhea

@

EPEC EnteroPathogenic Pediatric (infantile diarrhea)

EIEC EnteroInvasive Identical to shIgellosis (bloody)

EAEC EnteroAggregative AIDS, persistent infant diarrhea

EHEC EnteroHemorrhagic 0157: H7, sHiga-like toxin/ Verotoxin

WOF: Hemolytic uremic syndrome
WTD?
- Hydration
 - Zinc sulfate
- Erceflora- Bacillus clausii
2. UTI
- Cystitis: Urinary bladder = Nitrofurantoin, Fosfomycin
- Pyelonephritis: Kidney → (+)fever = Ciprofloxacin
* Asymptomatic bacteriuria- no need for antibiotic except if px is
pregnant or will urologic procedure

Kleb. Capsule- “mucoid colony”

z
pneumoniae Candle-like, Currant jelly
4A

od
- Alcoholic
- diAbetic
- Aspiration pneumonia
- Abscess (liver, lung)
Extended spectrum beta- lactamase

gl
WTD? Carbapenem

Proteus spp (+) urease

SWARMING motility
ru WOF: UTI, nephrolithiasis

Shigella (-) H2S

dysenteriae (-) motile
ld
Shiga toxin (60s) → Shigellosis (+) dysentery,
fever
WTD? Hydration, Ciprofloxacin
ga

S. typhi (+) H2S (rotten egg)

Putrefaction: CHON → H2S
(+) motile
Vi antigen
le

- Salmonellosis
- Typhoid fever (prolonged fever: 2
weeks, rose spots in the abdomen)
@

Dx: Culture (blood, urine, stool)

- BEST: bone marrow
Widal test
WTD?
- Empiric (X culture): Ceftriaxone,
Ciprofloxacin
- Cipro-susceptible
- Alternative: Amox, Chloramphenicol
(Nitro Reduction: Aplastic anemia,
Glucuronidation: Gray baby syndrome)
 Prev: Vaccine (50% efficacy)

Vibrio spp and related orgs

Vibrio cholerae Comma-shaped (monotrichous) SHOOlerae

Shooting star motility
Choleragen (heat labile toxin) High cAMP →
Cholera
+ Rice watery stools

z
+ Washer woman hand sign
WTD?
- Hydration

od
- Doxycycline
Culture: Thiosulfate citrate bile sucrose agar (+)
yellow colonies

C. jejuni Gullwing (amphitrichous)

gl
Culture: Skirrow’s medium
WOF:
+ Dysentery- Hydration, Erythromycin
ru + Guillain-barre syndrome- IVIg

H. pylori Lophotrichous
VF:
ld
- Urease (Urea → ammonia)
- Protease (alters mucus)
WOF: PUD
ga

Dx: Endoscopy
WTD?
- Triple (PBA)
- PPI
- Bismuth subsalicylate
le

- Antibiotics (Metronidazole,
Amoxicillin, Clarithromycin
Monitoring: Urea breath test
@

P. aeruginosa Exotoxin A → liver

Pigments: Pyocyanin, Pyoverdin
Sweet fruity odor
#1 nosocomial pathogen (ESKAPE)
WOF:
- Ecthyma gangrenosum
- Hot tub folliculitis
- Malignant otitis externa
- #2 cause BURN infections (#1: S. aureus)
 WTD? Ceftazidime

Bacteroides #1 colonic flora

fragilis WOF: Abscess, peritonitis
WTD? Metronidazole

B. Predominantly Respiratory

H. influenzae Coccobacilli, Chocolate agar plate

VF: capsule (serotype B)

z
WOF:
- Epiglottitis

od
- Meningitis
- Otitis media
- Pneumonia
WTD? 2nd/3rd gen ceph
Prev: HiB conjugate vaccine

gl
H. duCreyi Uncircumcised american
Soft, ChanCroid, genital ulCer
ru WTD? Ceftriaxone

B. pertussis Coccobacilli, Bordet- Gengou agar

Tracheal cytotoxin, Pertussis toxin → destroy
ld
cilia
WOF: WHOOPING COUGH
WTD? Erythromycin
Prev: DPT, Tdap
ga

Legionella Water-based bacteria, atypical

pneumophila Inhalation from AIRCON → atypical
pneumonia
le

WOF:
- Legionnaires disease
- Pontiac fever
WTD?
@

- Macrolide
- Quinolone

C. Zoonotic
infection

BrUcella abortus Brucellosis- cow

- Undulating fever
- Gastric remittent fever
WTD? Doxycycline
F. tularensis Rabbit, ticks
Tularemia
- Ulceroglandular
- Pneumonia
- oculoglandular

P. multocida Dogs, cats

WTD? Pen or Ceph

z
Yersinia spp 1. Y. enterocolitica
- Pigs → diarrhea
2. Y. pestis

od
- Rats → flea → human
WOF: Plague
- Bubonic- buboes, lymphadenopathy
- Pulmonic

gl
- Septicemic- Black death

Others ru
Calymmatobac Donovanosis
terium/ - Beefy red velvety ulcer
Klebsiella
granulomatis
ld
Gardnerella Shift in vaginal flora → bacterial vaginosis
vaginalis - Fishy odor
- Milk like discharge
ga

- Clue cells
WTD? Metronidazole
le

PARAMETER N. MENINGITIDIS N. GONORRHEA

@

Virulence factors Pili Pili

Capsule IgA protease
Capsule
Endotoxin

ROT droplet Sexual

Passage in birth canal

Disease Meningococcemia Gonorrhea: pus

 ONG

WTD? CeftRIAxone CeftRIAxone

+ Azithromycin + Doxycycline
Erythromycin

PARAMETER S. TYPHI S. DYSENTERIAE

z
Produce H2S Yes No

od
Motility Yes No

ROT Fecal-oral Fecal-oral

Disease Typhoid fever Shigellosis

gl
Salmonellosis

WTD? Empiric: Ceftria, Azithro Hydration

Cipro-susceptible: Cipro Cipro
ru Alt: Chloram, Amox
ld
DISEASE GRAM NEGATIVE BACTERIA WTD?

Meningococcemia N. meningitidis Ceftriaxone

ga

Gonorrhea N. gonorrhoeae

Cystitis, Pyelonephritis [Link] Cystitis: Nitrofurantoin, Fosfomycin

Pyelonephritis: Ciprofloxacin
le

Typhoid fever S. typhi Empiric: Ceftriaxone, Azithromycin

Cipro-suscp: Cipro

Cholera V. cholerae Hydration, Doxy

@

Peptic ulcer disease H. pylori PPI

Bismuth
Antibiotic
- Clarithro
- Amox
- Metro

Whooping cough B. pertussis Erythromycin

Pontiac Fever, Legionnaire’s L. pneumophila Macrolides, Quinolones

Brucellosis B. abortus Doxy

Tularemia F. tularensis Streptomycin

Bubonic plague Y. pestis Aminogly, Doxy

Bacterial vaginosis Gardnerella vaginosis Metronidazole

z
PH
1. Strep. Pneumonia

od
2. H. influenzae
3. M. catarrhalis

Bacteria that cannot be seen on Gram Staining

gl
Thin or absent cell wall: Thick mycotic acid layer:
ru MCLRT CLINM

M Mycoplasma C Cryptosporidium
(absent) (protozoan)

C Chlamydia L Legionella micdadei

ld
(intracellular)

L Legionella I Isospora (protozoan)

pneumophila
ga

R Rickettsia N Nocardia (weakly acid

(intracellular) fast)

T Treponema M Mycobacterium
le

(Gram-variable)
@

Bacteria Brief Description Palatandaans

GRAM STAIN LIMITATION

A. Spirochete

Lepto. interrogans Ice tongs, shepherd’s crook, ?? shaped

Periplasmic flagella
ROT: direct contact w/ infected fluids
LEPTOSPIROSIS
 1. Leptospiremic
- Fever, calf tenderness, conjunctival suffusion
2. Leptospiuric
- acute kidney injury
Weil syndrome: AKI, Pulmonary hemorrhage, jaundice
Dx: Culture: blood, CSF, urine, Lepto-MAT
WTD?
MIld: Doxycycline
Mod/Severe: Pen G

z
Prophylaxis: Doxycycline

od
T. pallidum Testes of rabbits
Axial filaments
ROT: horizontal → syphilis
1. Primary- hard chancre, painless
- Early dx: scrapings - dark field microscopy

gl
2. Secondary- mucocutaneous lesions
- 1 month after chancre
ru - Condylomata lata
3. Tertiary
- Neurosyphilis
- Gumma formation
- Argyll- robertson pupils “prostitute eyes”
ld
ROT: Vertical → congenital syphilis
- Mucus patches
ga

- Hutchinson’s teeth
- Saddle test

Dx:
1. Screening- non treponemal
le

- Rapid plasma reagin

- Venereal DIsease Research Laboratory
2. Confirmatory- treponemal
@

- Fluorescent Treponemal Ab absorbed

- Microhemagglutination assay
WTD? Pen G

Borrelia Largest medically important bacteria

burgdorferi Vector: Ixodes or ticks
Reservoir: Forest animals
LYME DISEASE
- Erythema chronicum migrans = migrating rash
WTD? Doxycycline
B. Mycobacterium spp
- Acid fast- Ziehl Neelsen

M. tuberculosis ROT: airborne

Pulmonary TB
1. Primary TB
- Initial infection
- Ghon complex
2. Secondary TB

z
- Post-primary
- Reactivation

od
- Affects apex
3. Miliary TB- disseminated
Extrapulmonary TB
1. Lymph node TB- #1, scrofula
2. Laryngeal TB- most contagious

gl
3. Spinal TB- Pott disease
Dx:
ru Culture- Lowenstein- Jensen
- Serpentine cords
- Chest x-ray
- TB GeneXpert/ Xpert MTB/Rif (active or inactive)
- Direct Sputum Smear Microscopy (red)
ld
- Mantoux/ Tuberculin Skin test- purified CHON der. ID
CM:
- cough for more than 2 weeks
ga

- Weight loss
- Night sweats
- Low Grade fever
- Hemoptysis
WTD?
le

Directly Observed Therapy SHort course

1st line agents (HRZES)
1. Isoniazid
@

- inh. Mycolic acid synthesis (CIDAL- rapid)

- Enzyme inhibitor
- Vit. B6 def → VIt. B6 supp (Pyridoxine)
2. Rifampicin
- Inh. RNA synthesis (CIDAL-slow)
- Enzyme inducer
- Red-orange body fluids
3. Pyrazinamide → Pyrazinoic acid
- CIDAL- weak
- MOST HEPATOTOXIC
 - Gouty arthritis
4. Ethambutol
- Inh. arabinosyl transferase
- STATIC
- Not given if TB meningitis
- WOF: color blindness (red, green), optic
neuritis
5. Streptomycin
- Misreading of mRNA

z
- CIDAL
- Given for Pulmonary TB (retreatment)

od
- Given IM
- WOF: ototoxicity, vestibulotoxicity

MDR-TB- 2nd line agents

1. Quinolones

gl
2. Aminoglycosides
- Kanamycin
- Amikacin
ru - Capreomycin
3. Cycloserine
4. Ethionamide
5. P-aminosalicylate
ld
M. leprae LEPROSY or Hansen's disease
- Hypopigmented areas
ga

- Hypoesthesia
- Wrist drop
- Claw hands
#1 infectious cause of hand deformity
Dx: Culture (armadillo, mouse foot pad), skin and nerve
le

biopsy
- Palisade arrangement
@

Tuberculoid LeproMatous

paucibacillary Multibacillary

<5 lesions More than 5 lesions

cell- mediaTed huMoral

+ Lepromin Test - Lepromin Test

Lion-like face (loss of

 eyebrows, saddle nose)

Wtd?
1. Dapsone
- folate antagonist
- WOF: Hemolysis, Megaloblastic anemia
2. Clofazimine
- Binds DNA

z
- WOF: skin discoloration
3. Rifampin

od
- Added if Lepromatous
Duration: 2 years
Culion island- leprosarium

M. bovis Milk pathogen

gl
M. avium Infection in AIDS

C. Mycoplasma pneumoniae
ru
Mycoplasma Atypical - NO cell wall, smallest free living
pneumoniae ROT: droplet → Atypical/ Walking pneumonia
(immunocompetent)
ld
Dx: COld Agglutinin detection
Culture: “fried egg” colonies
WTD? Macrolide, Quinolone
ga

D. Rickettsia spp
- Geographic area specific
- Dx: Weil-Felix test

Rickettsia rickettsii Ixodes spp ticks

le

Invades vascular endothelium

ROCKY MOUNTAIN SPOTTED FEVER
@

Rickettsia Body louse

prowazekii Epidemic typhus

E. Chlamydia spp
- Strict INTRACELLULAR parasite
- Requires host for energy, CHON
- DNA, RNA
- NO arthropod vector

C. trachomatis Multiple serotypes

 Eyes Genital

Trachoma Chlamydia- clear, chronic

Inclusion conjunctivitis- Lymphogranuloma venereum

horizontal

WTD?

z
Azithromycin/ Doxycycline
+ceftriaxone

od
C. psittaci One serotype
Bird → human
- Psittacosis

gl
- Ornithosis
- Parrot fever

C. pneumoniae One serotype

ru Human → human = ATYPICAL pneumonia
WTD? Macrolide, Quinolone
ld
DISEASE GRAM STAIN LIMITATION WTD?
ga

Syphilis Treponema Pen G

Leptospirosis L. interrogans Mild: Doxy

Severe: Pen G

Lyme disease B. burgdorferi Doxy

le

Tuberculosis M. tuberculosis HRZES

@

Hansen disease M. leprae Dapsone, Clofazimine

Rocky Mountain Spotted Fever R. ricketsii Doxy

Epidemic typhus R, prowazekii Doxy

Parrot Fever/ Ornithosis C. psittaci Macrolides, Quinolones

Organism Antibiotic
Penicillium notatum Penicillin

P. griseofulvum Griseofulvin

Strep. erythreus Erythromycin

S. griseus Streptomycin

S. orientalis Vancomycin

z
S. noursei Nystatin

B. polymyxa Polymyxin

od
C. acremonium Cephalosporin

S. cattleya Thienamycin

gl
S. venezuelae Chloramphenicol

S. lincolnensis
ru Lincomycin

S. nodosus Amphotericin B

S. mediterranei Rifampicin
ld
B. brevis Gramicidin

B. subtilis Bacitracin
ga

C. violaceum Aztreonam

M. purpurea Gentamicin

S. aureofaciens CHlortetracycline
(Aureomycin)
le

S. avermitilis Ivermectin
@

S. caespitosus Mitomycin C

S. capreolus Capreomycin

S. fradiae Neomycin

S. kanamyceticus Kanamycin

S. natalensis Natamycin

S. orchidaceous/ garyphalus Cycloserine

S. parvulis Dactinomycin

S. peucetius Doxurubicin

S. pristinaespiralis Quinapristin/ Dalfopristin

S. roseosporus Daptomycin

S. spectabilis Spectinomycin

z
S. tenebrarius Tobramycin

S. toxytricini Orlistat

od
S. verticillus Bleomycin

gl
Beta-Lactamase Acid
Penicillins
ru Sensitive Resistant Sensitive Resistant

Pen G ✔ ✔

Carbenicillin ✔ ✔
ld
Mezlocillin ✔ ✔

Ticarcillin ✔ ✔
ga

Piperacillin ✔ ✔

Pen V ✔ ✔

Ampicillin ✔ ✔
le

Amoxicillin ✔ ✔

Methicillin ✔ ✔
@

Nafcillin ✔ ✔

Dicloxacillin ✔ ✔

Oxacillin ✔ ✔

Cloxacillin ✔ ✔
● GCMTP= Beta-lactamase sensitive and Acid sensitive
● VAA= Beta-lactamase sensitive and Acid Resistant
● Methicillin= Beta-lactamase resistant and Acid sensitive
 ● NDOC= Beta-lactamase resistant and Acid resistant

Bactericidal Bacteriostatic

kill Retard, slow growth

Cell wall synth. Inhibitor- Cotri

Aminoglycosides

z
Metronidazole

od
Polymyxin

Quinolone

gl
CELL WALL SYNTHESIS INHIBITOR

Beta-lactam
ru
Limitation: MRSA, Atypicals

Penicillin
PKIN PDYNA
ld
Absorption is decreased by food Inhibits transpeptidase → NO
except AMOXicillin crosslinking
ga

Increased Pen - Probenecid Beta lactam ring- antigenicity,

antibiotic

Beta lactamase
Pen → Penicilloic acid
le

WOF: allergic reaction

Pen acts as hapten
@

WTD? SKin test (wheal)

1. Natural penicillin
- Pen V- Phenoxymethyl- PO
- Pen G- Benzyl- IM
● Aqueous Pen G- short DOA
● Procaine Pen G- longer DOA
● Benzathine Pen G- vs. RHD, syphilis, leptospirosis
Limitations: gram negative, acid-labile, beta-lactamase
 2. Beta-lactamase resistant penicillin
- Antistaphyloccus
- Methicillin- kidney prob
- Oxacillin
- Nafcillin- rashes
3. Extended spectrum for gram + and -

Aminopencillin Anti-pseudomonas

z
Amoxicillin- best ORAL BA Carboxy
- Vs pneumonia and otitis media - Carbanicillin

od
- Ticarcillin

Ampicillin Ureido
- Combined with gentamicin - Piperacillin

gl
- Vs. neonatal sepsis and - Mezlocillin
meningitis - Azlocillin
ru 4. Beta-lactamase inhibitor combination (1 + 0 = 2)
- Amoxicillin + Clavulanic acid = Co-amoxiclav (Augmentin)
- Ampicillin + Sulbactam - for pelvic and abdominal infections
- Ticarcillin + Clavulanic acid
ld
- Piperacillin + Tazobactam (PipTaz)- BIG 3 - can’t kill ESBL (klebsiella)

Cephalospor Inhibits transpeptidase

ga

in Less affected by beta-lactamase

WOF:
- Serum sickness
- P. colitis
- Disulfiram-like reactions
le

Generalization:
1st gen - gram +
5th gen - gram -
@

Vs. pseudomonas
- Cefepime
- Cefpirome
- Ceftazidime
Vs. anaerobes
2nd gen: Cefoxitin, Cefotetan
3rd gen: Ceftizoxime, Ceftriaxone, Cefotaxime
 GENERATIONS

1st Ceph except Cefazolin- surgical prophylaxis, vs. severe MSSA

2nd Cef NOTHING ends in -ONE and -IME except

CEFUROXIME - UTI (pregnancy), pneumonia

3rd Cef EVERYTHING ends in -ONE and -IME except Moxalactam, Ceftibuten,
Cefdinir

z
● Ceftriaxone- vs. Neisseria
● Ceftazidime- vs. pseudomonas

od
4th Cefepime (BIG 3) can’t kill anaerobe, Cefpirome
- Vs. severe gram negative

5th Ceftobiprole, Ceftaroline, Ceftolozane (+ Tazobactam)= Zerbaxa - vs.

severe UTI, severe pneumonia

gl
Monobacta Aztreonam
m
ru - Vs. gram negative only
- Not assoc with renal failure
- NO cross sensitivity
ld
Carbapene Doripenem
m Meropenem (BIG 3)
Imipenem (+cilastatin)= Tienam
ga

Broadest spectrum
*Ertapenem- NOT ACTIVE against Pseudomonas
WOF: seizures, psychosis
le

Glycopeptide

Teicoplanin
@

Vancomycin Inhibits D-Ala-D-Ala

DOC vs MRSA
Vs. pseudomembranous colitis (PO)
WOF: Red man syndrome- rapid infusion, allergic rxn

Others

Fosfomycin Inhibits N-acetylmuramic acid (NAM)

Vs. cystitis UTI

Bacitracin Bacillus subtilis

 Vs gram +
Topical
nephrotoxic

Protein synthesis inhibitor

Aminoglyc 30s
osides Misreading of mRNA

z
CIDAL vs gram NEGATIVE

od
-mycin -micin

Streptomyces spp. Micromonospora spp.

Streptomycin Gentamicin

gl
- 1st line vs TB (IM) - Combined with ampicillin
- Vs tularemia - Vs. neonatal sepsis and
ru meningitis

Tobramycin
- Vs, bacterial conjunctivitis
ld
WOF:

Nephrotoxic Ototoxic Vestibulotoxic

ga

Neomycin Neomycin Streptomycin

Gentamicin Amikacin Gentamicin

Tobramycin Kanamycin
le

Tetracyclin 30s
@

e Inhibit binding of aminoacyl tRNA

Broad spectrum
Vs atypical, unusual, zoonotic infection

1. Doxycycline
- Vs. Lyme disease
- Vs. brucellosis
- Vs. Mild leptospirosis
- Vs. malaria
2. Demeclocycline
 - No antibiotic
- Vs. SIADH- concentrated urine, high ADH
- WOF: Photosensitivity
3. Glycylcycline- Tigecycline
- Vs MRSA

WOF:
- Complexation with Al, Mg, Ca
- Impaired bone growth

z
- Teeth discoloration
- Photosensitivity

od
- Steatosis and hepatotoxicity

Macrolides 50s
Inhibits aminoacyl translocation
Vs. ATYPICAL

gl
Enzyme INHIBITOR except Azithromycin
1. Erythromycin
ru - Natural macrolide- “Ilosone or Ilotycin”
- Best prep: estolate
- Vs. penicillin- allergic
- Prophylaxis vs ophthalmia neonatorum gonorrhea
- Prokinetic- Low GET, High GER
ld
2. Clarithromycin
- Vs. PUD
- Vs. [Link] complex
ga

3. Roxithromycin
- Vs. respiratory tract infection
4. Azithromycin (Zithromax)
- Best vs typical
- Penetrates tissues rapidly & slowly released
le

- URTI: 3 days
- Pneumonia: 5 days
- WOF: QT prolongation
@

ChlorampP 50s
HEnicol Inhibits PEptidyltransferase
- Vs. typhoid fever
WOF:
- Nitro Reduction- Aplastic anemia
- Glucuronidation- Gray baby syndrome
Prep: Palmitate (PO), succinate (IV)

Lincosamid 50s
e Clindamycin
- Dalacin-C, Klindex
- Vs. ANAEROBES above the diaphragm
- Vs. gram + cocci MRSA
WOF: pseudomembranous colitis

Others Linezolid: 23s 50s

- DOC vs. VRSA
- WOF: low platelet, serotonin syndrome

z
Streptogramin

od
A: Dalfropristin
B: Quinopristin
WOF” Myalgia, Arthralgia

gl
Nucleic Acid Synthesis Inhibitor

Folate Sulfonamides -static

ru
antagonists - Inhibit dihydropteroate synthase
- Sulfadiazine
WOF:
- Stevens-Johnson syndrome
ld
- Hemolysis in G6PD deficiency

Trimethoprim- static
ga

- Inhibit dihydrofolate reductase

*Sulfamethoxazole + Trimethoprim = Co-trimoxazole (Bactrim)- CIDAL

- DOC vs Pneumocystis carinii pneumonia
WOF:
le

- SJS
- Anemia
- High Creatinine
@

QUinolones Inhibit DNA gyrase and Topo IV

Excellent ORAL BA
- Vs. ATYPICAL
- Vs. TB

GENERATIONS

1st Nalidixic acid: prototype, Cinoxacin (NiCe)

 2nd Ciprofloxacin
- Best for gram negative
- Vs. YTI pyelonephritis
Enoxacin
Ofloxacin
NOrfloxacin
(NO, CEO)

3rd Levofloxacin

z
-respiratory, pneumonia
Sparfloxacin

od
Gatifloxacin
(LSG)

4th Trovafloxacin
Moxifloxacin

gl
- Best vs. gram +
- Bestvs. Atypical
ru - Best vs. anaerobes
Gemifloxacin
(TMG)

WOF: QT prolongation, tendon rupture

ld
ga

OTHERS

Metronidazole Formation of free radical → DNA damage

Interferes with ETC
- Vs. Anaerobes BELOW the diaphragm
le

- DOC vs. Amoebiasis, Giardiasis, Trichomoniasis

WOF: Metallic aftertaste, Disulfiram-like rxns

Nitrofurantoin MOA: ??
@

- Vs. UTi cystitis

WOF: Pulmonary fibrosis

Methenamine Converted to formaldehyde

- Vs. recurrent UTI

VIRUS MORPHOLOGY
Nucleic acid DNA or RNA

Protein coat
Cubic/ Icosahedral Helical Complex

Rhino Tobacco Mosaic virus Pox

Adeno Coronavirus Bacteriophage
Polio

z
Envelope Naked: difficult to kill

od
VIRUS LIFE CYCLE

gl
Attachment

Penetration
ru Uncoating

VIRION synthesis

Packaging, assembly RELEASE: lytic, lysogenic

ld
ga

DNA VIRUS
- Double stranded
- Icosahedral
- Nucleus
Exceptions:
le

Complex- Pox
Single-stranded- Parvo
@

Naked Enveloped

Parvo Pox

Adeno Herpes

Papova Hepa B
- Papilloma
- Polyma

Parvovirus B19 Erythema infectiosum - 5th disease

Adenovirus Type 40 #1 cause of pharyngoconjunctival fever

Papilloma virus Direct contact

1. Warts
- Common warts/ verruca vulgaris (HPV 1, 2, 4, 7)
- Genital warts (HPV 6, 11, 16, 18)
Note: Condyloma acuminata: HPV
Condylomata lata: Syphilis
Dx: Clinical: cauliflower-like

z
WTD?
- Excision

od
- Liquid nitrogen
- Podophyllin
- Salicylic acid
2. Anal/Penile/Cervical Cancer (HPV 16, 18)
- Dx: Papanicolaou Smear (fried egg cells)

gl
- WTD? Chemo, Rad, Surgery
- Prev: HPV vaccine
ru Bivalent: Cervarix
Quadrivalent (Gardasil)

PoXvirus Most compleX symmetry

1. Molluscum contagiosum
ld
- #1 pox infection in humans
- Flesh colored umbilicated papules
- WTD? Extraction, Cidofovir
2. Smallpox
ga

- WHO: eradicated already (last case 1977)

- Lesions: synchronous, centripetal spread
- Prev: Vaccine

Herpes virus Latent stage in the nerves

le

1. HHV1/HSV1→ oral herpes, encephalitis

2. HHV2/HSV2 → genital herpes, meningitis
ROT: direct contact
@

Dx: Tzanck smear

WTD? Acyclovir - inh DNA polymerase → chain termination
3. HHV3/ Varicella Zoster Virus
a. Varicella/ Chicken Pox
- Airborne, direct contact
- Vesicular rash: Dew drop on a rose petal
- WTD? Acyclovir, Valacyclovir
- Prev: Vaccine- live
b. Shingles/ Herpes Zoster
 - Reactivation
- Dermatomal rash
- Post herpetic neuralgia
- WTD? Pregabalin, Gabapentin
4. HHV4 - Epstein-Barr Virus
- Kissing
- Adolescent, infants
a. Infectious mononucleosis (fever, sore throat,
lymphadenopathy)

z
b. Oncogenic virus (Burkitt’s lymphoma)
- Dx: Viral capsid antigen, Monospot test, EBV antibodies

od
5. HHV5 Cytomegalovirus
- Vertical: Chorloretinitis, Ganciclovir (Inh DNA polymerase)
- Horizontal: blood transfusion, pneumonia (HIV/AIDS)
6. HHV 6, & Roseolovirus
- Roseola/ Exanthem subitum (6th disease)

gl
- Fever → no fever, rashes, nagayama spots
7. HHV-8 Kaposi sarcoma-assoc
- HIV/AIDS
x
ru
OTHER NAME DISEASE
ld
HHV1 Herpes Simplex Virus 1 Oral herpes

HHV 2 Herpes Simplex Virus 2 Genital herpes

ga

HHV 3 Varicella Zoster VIrus Primary: Chicken pox

Reactivation: Shingles/ Herpes
Zoster
le

HHV 4 Epstein-Barr virus Infectious mononucleosis

HHV 5 CytomegaloVirus retinitis

@

HHV 6-7 Roseolovirus Rosela, nagayama

HHV 8 Kaposi sarcoma associated herpesvirus

DISEASES

1st Measles

2nd Scarlet fever

3rd German Measles

4th Scalded SKIN

5th Erythema infectiosum

(EryLIMA)

6th Roseola

z
od
RNA VIRUS
- Helical
- Eveloped
- Cytoplasm

gl
- Single-stranded
Exceptions:
ru
Icosahedral Naked Nucleus Double stranded

Flavi Picorna Retro Reo

ld
Toga Reo Orthomyxo

Picorna Calici
ga

Reo

Calici
Individual models of health behavior EXCEPT
le

a. Transtheoretical Model
b. Theory of Planned Behavior
c. Health Belief Model
@

Social Cognitive Theory

Positive sense (PiCoTCaFlaRe) Negative sense

+RNA → mRNA → CHON -RNA → +RNA (RNA polymerase) → CHON

Picorna Paramyxo

Corona Filo
Toga Arena

Calici Bunya

Flavi Orthomyxo

Retro, Reo Rhabdo

Picorna Smallest RNA virus

1. Rhinovirus

z
- ROT: droplet, direct contact
- Common cold, rhinitis

od
- WTD? Supportive, Decongestant
2. Enterovirus
- GIT
a. Poliovirus
- ROT: fecal-oral

gl
- Human- only hosts
- Poliomyelitis
Abortive #1- fever
ru Paralytic
Non-paralytic- viral/aseptic meningitis
Post-polio syndrome
- Prev: Salk/ Sabin
ld
b. Coxsackievirus

A B
ga

A16- Herpangina (oral ulcers) Myocarditis

Hand, foot, mouth disease Type 1 DM

le

WTD? Supportive,
Carbenoxolone (Rowagel)
@

Corona Sars-COV 1: 2022

Sars- COV 2: 2019

ROT: droplet, airborne, direct contact???

Dx: RT-PCR
WTD?
- Supportive (mild)
Antivirals
- Remdesivir - inh RNA polymerase
 - Molnupiravir- increase frequency viral mutations
Targeted Therapy
- ToCilizumab- vs. Interleukin-6
- Baricitinib- modulates signaling at JAK
Others
- Hemoperfusion- reduce cytokines
- Convalescent plasma- antibody
Not used anymore
- Ivermectin

z
- Hydroxychloroquine
Prev: Vaccine

od
Togaviridae a. Rubivirus
- German measles/ Rubella
- Droplet
- 3 day fever, rashes (Forchheimer spots- soft

gl
palate)
- WTD? Supportive
ru - Vertical
- Congenital Rubella
- Mental retardation, blueberry muffin spots
- Prev: MMR
b. Chikungunya virus
ld
- Aedes aegypti
- Fever + severe joint pain (6 months)

Caliciviridae Norovirus
ga

- Most common cause of Acute Gastroenteritis in adults

- WTD? Hydration

Flaviviridae a. Japanese Encephalitis: Asia

West Nile virus: America
le

Vector: Culex mosquito

Host: Birds
Accidental Host: Humans
@

Vaccine: SE vaccine
b. Yellow Fever virus
Vector: Aedes aegypti
Dr. Walter Reed= Panama Puzzle (fever, jaundice)
Prev: Vaccine
c. Dengue Virus (DENV 1, 2, 3, 4)
Vector: Aedes aegypti
Dengue fever = fever
Types of Dengue fever
 - DF w/out warning sign - Home
- DF w/ warning sign - Hospital
Abdominal pain
Bleeding
Clinical signs of fluid
Persistent vomiting
Lethargy
Liver enlargement
Lab: low platelet, high hematocrit

z
No urine
- Severe dengue - hospital

od
+ Plasma leakage
+ Bleeding
+ Organ damage
Sages: Febrile (+fever) → Critical (no fever)
Dx:

gl
CBC - low WBC, low platelet, high hematocrit
NS1 antigen= if Day 1-4 illness
Dengue IgM, IgG- if Day 5 onwards
ru Tourniquet Test- (+) 10-20 petechiae/square inch

WTD? Supportive (hydration), Tawa tawa (DOST: Euphorbia hirta),

(BE: Grammatophyllum scriptum)
ld
Prev: 4 o'clock habit, Operation Kaya-kulub, ABKD,
4S
- Search and destroy
ga

- Self-protection
- Seek early consult
- Support fogging
DOH campaign vs. WILD
- Waterborne-illness
le

- Influenza
- Leptospirosis
- Dengue
@

Vaccine: Dengavaxia

Retroviridae Human T cell leukemia virus

Lentivirus- HIV 1 and 2
ROT: sexual (high risk: anal, recipient), vertical, parenteral (shooting
gallery)
HIV vs CD4 T cells (immunity)
- Acute retroviral syndrome
- Latent/Asymptomatic stage
- Acquired immunodeficiency syndrome → opportunistic
 infection (PCP, Toxoplasmosis, Cryptococcosis)
Dx:
ELISA screening test
Confirmatory- Western Blot (Protein) SNOW=DROP
WTD?
Highly active antiretroviral therapy
1. Nucleoside Reverse Transcriptase Inhibitor
- Didanosine
- Abacavir

z
- Zidovudine - 1st (Azidothymidine)
- Zalcitabine

od
- Lamivudine
- Entecavir
- Stavudine
- Tenofovir
2. Non- Nucleoside Reverse Transcriptase Inhibitor

gl
- Nevirapine
- Efavirenz
- Delavirdine
ru 3. Protease Inhibitor
- Ritonavir
- Saquinavir
- Indinavir
ld
4. Fusion Inhibitor
- Enfuvirtide
5. Integrase inhibitor
ga

- Raltegravir

Combi: 2 NRTI + 1 NNRTI (HAART)

Tenofovir, Lamivudine + Efavirenz
le

Reoviridae Rotavirus: #1 cause of AGE in children

Prev: Vaccine

Paramyxoviridae a. Measles virus

@

- Airborne
- Measles/ Rubeola
- Stepladder fever
- Cough, Coryza, Conjunctivitis
- Koplik spots - buccal cavity
- WOF: Otitis media, Pneumonia, Subacute sclerosing
panencephalitis
- WTD? Supportive, Vit. A
- Prev: MMr, Measles Vaccine (early as 6 months)
 b. Mumps virus
- Droplet, direct, indirect- fomite
- Lungs → pneumonia, parotitis (inflammation of
parotid gland), orchitis → sterility
- WTD? Supportive
- Prev: MMR- Jeryl Lynn Strain

Filoviridae Long filamentous threads

Ex: Marburg

z
Ebola virus
- Direct contact

od
- Fruit bat
- Hemorrhagic fever → multiorgan failure
- WTD? Inmazeb
- Prev: Ervebo

gl
Arenaviridae 1. Lassa virus
- Rodents
- Hemorrhagic fever
2. Junin
ru 3. Machupo virus

Bunyaviridae With arthropod vector except Hantavirus

ARBOVIRUS
ld
- Toga
- Flavi
- Reo
ga

- Bunya

Orthomyxoviridae Influenza virus

- Droplet
- flu/ influenza
le

- Structure
- Neuraminidase= expose sialic acid
- Hemagglutinin= binds sialic acid
@

A B C

Pandemic Outbreak

Antigenic shift and

drift
AH1N1- Swine flu
AH5N1- avian/bird flu
WTD?
 Oseltamivir (Tamiflu)
Inhibit neuraminidase
Amantadine
Inhibit uncoating
WOF: Psychosis, livedo reticularis

Rhabdoviridae Bullet shaped

ROT:
bite: cat, dog, fox

z
Nonbite: aerosol
1. Prodrome- fever, pain

od
- Paralytic- quadriparesis
- Encephalitic/ Furious- hydrophobia, hypersalivation
→ DEATH (brain: NEGRI BODIES)

WHO CATEGORY OF EXPOSURE

gl
I II III
ru Touching, licking Bite → induced
bleeding
Bats→ spontaneous
bleeding

WTD? None WTD? Vaccine WTD?

- Whole cell Vaccine
ld
- Grown in Ig- HRIg, ERIg
human cell (Equine)- risk of
culture- lower allergy
ga

allergy

WTD?
- Soap and water
le

- Pasteurella multocida- Pen or Ceph

- Tetanus immunization
@

Positive sense (PiCoTCaFlaRe) Negative sense (ParFABOR)

+RNA → mRNA → CHON -RNA → +RNA (RNA polymerase) → CHON

Picornavirus Paramyxovirus

Coronavirus Filovirus

Togavirus Arenavirus
Calicivirus Bunyavirus

Flavivirus Orthomyxovirus

Retrovirus, Reovirus Rhabdovirus

VIRAL HEPATITIS

z
Hepatitis A (Picorna) Acute only
Initial site: GIT

od
Children: asymptomatic
Dx: Anti-HAV IgM= acute
IgG= past infection
WTD? Supportive treatment
Prev: Hepa A Vaccine

gl
Hepa B (Enveloped, Reverse transcriptase
Hepadna)
ru ROT: Horizontal, Vertical, Parenteral
Dx:
Hepa B profile
Acute Chronic
ld
<6 months >6 months

Cirrhosis, Liver cancer

ga

HBsAg - surface= general marker of infection

Anti-HBsAg= recovery OR immunity
HBcAg- core= actual infection
Anti HBcAg IgM= acute, IgG= chronic or past infection
le

HBeAg- envelope- infectious, active replication

AntiHBeAg
@

DANE particle- intact, complete Hep B virus

WTD?
Acute: RTI (Tenofovir, Entecavir)
Prev: Hep B vaccine, Hep B Ig

Hepa C (Flavi) Parenteral

Chronic infection
+ Waxing and waning sx
Dx: HCV-RNA, Genotyping
WTD?
 - #1 Liver Transplant
- Interferon- inh mRNA
- Ribavirin- inh replication
Prev: NONE, no immunity

Hepa D (Delta) 1. Coinfection: HBV + HDV

2. Superinfection: HBV then HDV, HBV

Hep E (Hepe) #1 cause of Acute Hepatitis

z
Epidemic
WTD? Supportive

od
HEPATITIS VIRUS DNA or RNA ROT PRESENTATION

Hepa A Picorna RNA Fecal-oral Acute only

gl
Hepa B Hepadna DNA Sexual, vertical, Acute, chronic
ru parenteral

Hepa C Flavi RNA Sexual, vertical, Chronic

parenteral

Hepa D Delta- same as Hepa B Coinfection

ld
superinfection

Hepa E Hepe RNA fecal-oral Acute only

ga

FUNGI

Properties 80s (60s and 40s)

le

Saprophyte Feed on decaying matter

@

Structure Cell wall: chitin

Cell membrane: ergosterol
Capsule: India ink/ Nigrosin

YEAST MOLD DIMORPHIC FUNGI

Unicellular Filamentous Body temp- yeast

- Brain-Heart infusion agar
Budding Hyphae Room temp - molds
- Sabouraud's Dextrose
agar

Elongates → Pseudohyphae Mycelium

FUNGAL INFECTIONS

z
Dermatophytosis Trichophyton spp
Epidermophyton spp

od
Microsporum spp
- Secretes keratinase → tinea infection
1. Tinea corporis = ringworm “buni”
2. Tinea cruris = jock itch
3. Tinea pedis = athlete’s foot

gl
4. Tinea unguium= nails
5. Tinea capitis = scalp
Dx:
ru Clinical
Wood’s lamp= (+)green fluorescence
KOH smear- +hyphae
WTD? Keep the area dry, Clotrimazole
ld
Pityriasis CA: Malassezia furfur - An-an
versicolor/ Tinea Hypopigmented macules
ga

versicolor Dx: KOH smear “spaghetti and meatballs”

WTD?
- Topical imidazole
- Selenium sulfide
le

Sporotrichosis CA: SPorothrix schenckii

thorn prick → Rose Gardener’s disease
+ Nodules
@

+ Ulcer along lymphatics

WTD?
- Itraconazole
- KISS

SYSTEMIC FUNGAL INFECTIONS

Candidiasis CA: Candida albicans (normal flora: GIT, Skin, Vagiina)

WOF:
- Diaper rash
- Intertriginous dermatitis (inframammary)
 - Oral thrush/ Moniliasis (Nystatin: binds ergosterol- Swish and spit)
- Esophageal candidiasis
- Vaginitis (+) cottage cheese discharge
Dx:
- Beta-D-glucan test
WTD? FLuconazole

Aspergillosis CA: Aspergillus fumigatus (peanut, soil)

Aspergillosis

z
+ aspergilloma= fungus ball
+ CT scan- halo sign

od
Aflatoxin → liver cancer
Dx: Galactomannan Ag Test
WTD? Voriconazole

Cryptococcosis CA: Cryptococcus neoformans (pigeon droppings)

gl
Meningitis in HIV/AIDS
Dx:
CSF analysis → India ink/Nigrosin + capsule
Antigen Test
ru WTD?
Induction: Amphotericin B, FLucytosine
Maintenance: FLuconazole
ld
DIMORPHIC FUNGAL INFECTION

Histoplasma Spelunker’s disease - bat droppings

ga

capsulatum NO capsule

Blastomyces NORTH American blastomycosis - rotten wood (RAREST)

dermatitidis
le

Coccidioides Inhaled SPORES

immitis San Joaquin valley fever “Cocc ni Joaquin”
Defense: Cell-mediated
Dx: Culture + arthroconidia
@

Paracoccidioides SOUTH American blastomycosis

brasiliensis Similar to TB
“SOUTH BRASIL”

Tinea capitis Scalp

TInea barbae Beard

Tinea corporis Trunk “buni”

TInea imbricata Trunk/limbs in a concentric pattern

Tinea manuum Hand

Tinea unguium Nail

Tinea cruris Groin “jock itch”

z
Tinea pedis Foot “athlete’s foot”

od
ANTIFUNGAL

Amphotericin B Binds ergosterol → increased cell permeability

DOC: Severe systemic fungal infection
WOF:

gl
- Fever
- Nephrotoxicity
- Low potassium and Magnesium
ru
Flucytosine Converted to 5-fluorouracil = NO NA synthesis
NOT used ALONE
WOF: bone marrow toxicity
ld
Azoles Inhibit 14 alpha steroldemethylase
ga

IMIDAZOLE TRIAZOLE

Less specific MORE specific

MORE toxic LESS toxic

le

Ketoconazole Fluconazole vs. candida

- 1st oral azole
- enzyme inhibitor
@

- WOF: hepatotoxic,
gynecomastia

Miconazole Voriconazole vs. aspergillus

Clotrimazole Itraconazole vs. Indolent infection,

negative inotrope

Posaconazole
Echinocandin Inhibit glucan synthase
CaspoFUNGIN
MicaFUNGIN
AnidulaFUNGIN
- OK for liver, kidney
- CIDAL vs. Candida
- STATIC vs. Aspergillus

Allylamine Inhibit squalene epoxidase

z
Terbinafine vs Tinea (disease)

Griseofulvin Inhibit mitotic spindle formation

od
Vs. Tinea

PARASITE HOST VECTOR

gl
Endo- vs. ecto- Definitive- sexual maturity “adult” transmit
ru
Obligate vs. facultative Intermediate- development
Paratenic
Reservoir- continual source of org
ld
PARASITE
ga

Protozoa Metazoa/ Helminth

- Sarcodina- Nema-helminths Platy-helminths

pseudopod ROUNDWORM FLATWORM
- Ciliata
le

- Mastigophora- Trematode- FLUKE CEStode- TAPEWORM

flagella SEXTAPE
- Sporozoa-
@

parasitic

PROTOZOA
New environment → CYST → Trophozoite (growing, motile)

A. GIT

Entamoeba Amoebiasis
histolytica a. Intestinal- dysentery, NO fever, flask-shaped ulcers
 b. Extraintestinal- liver abscess, anchovy-like discharge
Dx: Fecalysis
Precyst (Cigar/Sausage shaped, chromatoid bodies) → Cyst (1-4 nuclei) →
Trophozoite (hematophage)
DOC: Metronidazole (1 year incubation period)

Giardia Giardiasis
lamblia - Steatorrhea
- Flatus

z
- Malnutrition
Dx: Fecalysis

od
Trophozoite- old man’s eyeglasses
DOC: Metronidazole

Cryptosporidi Watery diarrhea in HIV/AIDS

um parvum WTD?

gl
- If HIV + → HAART
- Ig HIV - → Nitazoxanide

B. Reproductive tract
ru
Trichomonas Sexual “ping-pong”
vaginalis Trichomoniasis
+ Yellowish green frothy discharge
ld
+ Strawberry cervix
DOC: Metronidazole

C. Blood and Tissues

ga

Plasmodium spp
Malaria - MOST IMPORTANT protozoal infection
le

P. falciparum P. malariae P. vivax P. ovale

Periodicity 48h, Tertian 72h, Quartan 48h, Terttian 48h, Tertian

@

Severity Malignant Benign Benign Benign

+ Cerebral
malaria

RBC ALL old young/ young/

reticulocytes reticulocytes

ID Axostyle, Maurer’s cleft Hypnozoite- Hypnozoite-

Crescent-shaped dormant stage in dormant stage in
gametocyte the liver the liver
 Enlarged RBC
Lemon cyst
Schauffer dots

LIFE CYCLE
Human

z
- Intermediate host
- Site of schizogony (asexual phase)

od
Sporozoite Infective stage to human

Merozoite Liver/Tissue stage

gl
Trophozoite RBC/Blood stage, growing

Gametocyte Infective stage to the mosquito

Anopheles
ru - Definitive host
- Site of sporogony (sexual phase)
ld
Dx:
Blood smear (before fever paroxysm)
- Thick- Dx
- Thin- identify species
ga

WTD?
- Falciparum: Artemether + Lumefantrine = Co-artem
- Prophylaxis: Chloroquine, Doxycycline

Toxoplasma ROT:
le

gondii - EAT oocyst (meat)

- INHALE oocyst (cat feces)
- Vertical
@

Toxoplasmosis
- Retinitis
- Encephalitis
Dx: Fluorescent Ab Test
WTD? Sulfadiazine + Pyrimethamine

Trypanosoma
spp.
American Sleeping Sickness African Sleeping Sickness
 Protozoa T. cruzi T. brucei
- Gambiense- West
- Rhodesiense- East

Vector Reduviid/Kissing bug Tse-tse fly

Triatoma spp Glossina spp

Disease Chaga’s disease African sleeping sickness

+ Chagoma + Daytime drowsiness

z
+ megacolon + fever

od
WTD? NifurTOMox- inhibit West
trypanothione reductase - Early: Pentamidine
- CNS: Eflornithine
East
- Early: Suramin

gl
- CNS: Melarsoprol

spp
ru
Leishmania Sandfly

1. Cutaneous- L. tropica
2. Mucocutaneous- L. brasiliensis
ld
3. Visceral/ Kala azar- L. donovani

WTD? Na stibogluconate
ga

Others

Balantidium Pigs
coli Ciliated
Dysentery + ulcers
le

Entamoeba Non-pathogenic
coli Trophozoite with nucleus
@

Seen unstained

Iodamoeba Iodine cyst = NO glycogen

butschlii

FEATURES PROTOZOA

Ingests RBC E. histolytica

Cysts has 1-4 nuclei
Cigar-sausage-shaped chromatoid bodies

Trophozoite with old man’s glasses G. lamblia

Diarrhea in AIDS px C. parvum

Cysts without glycogen vacuoles Iodamoeba butschlii

Trophozoite with nucleus seen w/o difficulty in E. coli (nuCOLIous)

fresh, unstained preparation

z
od
DENGUE FEVER MALARIA

Vector Aedes aegypti Anopheles (female)

Causative agent Dengue virus Plasmodium spp

gl
Type of organism virus protozoa

WTD? Supportive Coartem

ru Hydration Prophylaxis:
C/I: Aspirin - Chloroquine
- Doxycycline
ld
Helminths
ga

Quantify: Kato-katz, Stool dilution

A. Nematode/ Roundworm (INTESTINE)

Via INGESTION of egg

le

Ascaris lumbricoides Giant Intestinal Roundworm

Intestine: ENterocolitis
Lungs: Loeffler’s syndrome
@

Mammillated egg, curved tail (male)

WTD?
Albendazole= binds B-tubulin

Trichuris trichiura/ Same ROT as ascaris

Whipworm WOF:
- High peristalsis → rectal prolapse
Barrel-shaped egg
WTD?
 Albendazole= binds B-tubulin

Enterobius vermicularis/ D-shaped egg, piano- shaped egg

Pinworm/ seatworm + Pruritus
+ Insomnia
+ Enterocolitis
+ Pseudoappendicitis
Dx: Graham scotch tape Test
WTD?

z
Pyrantel pamoate (Combantrin)
- Neuromuscular blocker

od
Capillaria philippinensis Eggs from fish (bagsit: Ilocos)
WOF:
+ Enterocolitis
+ protein -losing enteropathy

gl
WTD?
Albendazole= binds B-tubulin

Via PERCUTANEOUS (SKIN)

ru
Ancylostoma Hypochromic, Microcytic anemia
duodenale/ Old world 2-8 cell stage
Hookworm Albendazole= binds B-tubulin
ld
Necator americanus/
New world hookworm
ga

Strongyloides + Enterocolitis
stercoralis/Threadworm + Paradoxical asthma
Dx: Harada-Mori culture
Rhabditiform larva
le

WTD? Ivermectin - Increased GABA

B. Nematode/ Roundworm (BLOOD & TISSUE)

@

FIlarial parasites
At risk: Abaca plantation

Wuchereria bancrofti Brugia malayi

Vector: Culex, Aedes, Anopheles Vector: Mansonia, Aedes

WOF: Lymphatic obstruction WOF: Lymphatic obstruction

+ Hydrocele - scrotum + Elephantiasis - limbs
 Dx: DEC Provocation Test

WTD? Diethylcarbamazine (DEC)

Trichinella spiralis Pork → Encyst in muscle (myositis, myalgia)

Dx: Muscle biopsy, high creatine kinase
VIVIPAROUS- lay live larva (VIVI TRICHI)
WTD? Albendazole

z
Onchocerca volvulus Simulium spp, black fly

od
WOF:
- Liver blindness
- Lizard skin
- Nodules
WTD? Ivermectin

gl
Toxocara canis/ Dog Visceral Larva migrans
roundworm
ru WTD? Albendazole

B. Platyhelminths/ Flatworms
- FLuke
- Tapeworm
ld
WTD? Praziquantel- High permeability to Ca

Trematode/Fluke
ga

Schistosoma spp Intermediate host: snail

Dx: Circumoval Precipitin Test
ROT: Percutaneous

S. haemaTobium S. mansoni S. japonicum

le

Terminal spine Lateral spine Lateral knob

EgypTian hematuria
@

Schistosomiasis
Acute
+ Katayama fever
+ Swimmer’s itch
Chronic
+ Cirrhosis→ liver cancer

Others
Fluke AKA Remarks

Fasciola hepatica Sheep liver fluke Ingest watercress

Clonorchis sinensis Oriental liver fluke Ingest rawfish

Cholangiocarcinoma- 6
months

z
Fasciolopsis buski Giant intestinal fluke Opening water chestnut via
teeth

od
Paragonimus westermani Oriental lung fluke Ingest crab
+ hemoptysis

gl
Cestode/ Tapeworm

Taenia solium Pork tapeworm

ru + Neurocysticercosis
Scolex = head with hooks

Taenia saginata Beef tapeworm

ld
Intestinal obstruction
Scolex= head with suckers

Diphyllobothrium latum FIsh tapeworm

ga

Vit. B12 deficiency

Operculated egg

Hymenolepsis nana Dwarf tapeworm

le

Dipylidium caninum Flea tapeworm

Def host: dogs
Int host: flea
@

Accidental host: man

Asymptomatic

Echinococcus Dog tapeworm

granulosus Def host: dogs
Int host: sheep
Accidental host: man
Hydatid cyst → anaphylaxis
NEMATODE/ ROUNDWORM OTHER NAME DISEASE

Ascaris lumbricoides GIANT intestinal roundworm Ascariasis

Loeffler’s syndrome

Ancylostoma duodenale Old worm hookworm Anemia,

Necator americanus New world hookworm Anemia

- Microcytic
- hypochromic

z
Trichuris trichuria whipworm Rectal prolapse

od
Enterobius vermicularis Pinworm/ seatworm Pruritus ani → insomnia

Strongyloides stercoralis Threadworm Paradoxical asthma

Trichinella spiralis Pork Worm Myalgia

gl
ru
TREMATODE/ FLUKE IDENTIFICATION REMARKS

S. haematobium Terminal spine Egyptian hematuria

S. mansoni Lateral spine Schistosomiasis

ld
Acute: Katayama
S. japonicum Lateral knob Chronic: Cirrhosis
ga

F. hepatica Sheep liver fluke Ingest watercress

Clonorchis sinensis Oriental liver fluke Ingestion of raw fish

F. busKi Giant intestinal fluKe Peeling water chestnut by teeth

le

P. westermani Oriental lung fluke Ingest crab

@

CESTODE/ TAPEWORM OTHER NAME REMARKS

Taenia solium Pork tapeworm neurocysticercosis

Taenia saginata Beef tapeworm Intestinal obstruction

Diphyllobothrium latum Fish tapeworm B12 def

operculated

H. nana Dwarf tapeworm

Dipylidium caninum FLEA tapeworm asymptomatic

E. granulosus DOG tapeworm Hydatid cysts

Product Contaminant

Antiseptic mouthwash Coliforms

Surgical dressings Clostridium spp.

z
Intravenous fluids Pseudomonas, Erwinia, and Enterobacter spp.

od
Plague vaccine, Talcum powder Clostridium tetani

Hand cream Klebsiella pneumoniae (Kamay)

Fluorescein eye drops Pseudomonas aeruginosa

gl
Chloroxylenol disinfectant
Antibiotic eye ointment
Peppermint water
ru
Iodophor solution
Thymol mouthwash

Chlorhexidine-cetrimide antiseptic solution Pseudomonas cepacia

ld
Aqueous soap Pseudomonas stutzeri

Serum vaccine Staphylococcus aureus

ga

Pancreatin powder Salmonella agona

Thyroid tablets Salmonella muenchen

Carmine powder Salmonella cubana

le

Saline solution Serratia marcescens

Contact lens solution Serratia & Enterobacter spp.

@

PASTEURIZATION

Batch Method/ Home Pasteurization 63 deg C for 30 minutes

Flash Method/ High Temperature- Short Time 72-73 deg C for 15 seconds
(HTST) Pasteurization
Ultra High Temperature (UHT) Pasteurization 74 deg C- 141 deg C - 74 deg C in 5 seconds

z
od
gl
ru
ld
ga
le
@
QA/QC

TERM REMARKS

Assay Determines the % purity of a drug

Titration Determine when equivalent amounts of

reactants have reached together

z
Standardization Determine exact concentration of solution

od
Primary standard Substance that has a high degree of purity
Used to standardize another concentration

gl
REACTION FACTOR DEPENDS ON THE

Neutralization
ru No of replaceable H+/OH-

RedOx Amount of e lost or gained

Precipitation Mole ratio bw the analyte and titrant

ld
Complexation Ratio of metal with EDTA (1:1)
ga

HLB System

1-3 Anti-foaming

3-6 W/O emulsifying agent (SPAN)

le

7-9 Wetting agent

8-18 O/W emulsifying agent (TWEEN)

@

13-16 Detergent

15-20 Solubilizing agent

Solubility (mL of solute required to dissolve 1g of solute)

Descriptive Term Parts of Solvent Required for 1 part of solute (mL)

Very soluble <1

Freely soluble 1-10

Soluble 10-30

Sparingly soluble 30-100

Slightly soluble 100-1000

z
Very slightly soluble 1000-10000

Insoluble >10000

od
Types of Granules
Coarse Retained at mesh 20
Good Passed mesh 20 but

gl
retained at mesh 40
Fine Pass mesh 20 and 40
ru
Method I
Bulk Density
Graduated Cylinder
Method
Method II ScoTT volumeter
ld
Method III Stainless Steel Vessel

Flowability Angle of Repose (θ) Carr’s Index (CI) Hausner’s ratio (HR) Notes
ga

“Excellent
GF’s PP”

Excellent <30 <10 1.00-1.11 Non-cohesive

le

Good 31-35 5 11-15 5 1.12-1.18

Fair 36-40 5 16-20 5 1.19-1.25 Cohesive

@

Passable 41-45 5 21-25 5 1.26-1.34

Poor 46-55 10 26-31 6 1.35-1.45

Very Poor 56-65 10 32-37 6 1.45-1.59 Very cohesive

Very very >66 + >38 + 1.60

poor 1 1
Acceptance criteria Each container

Aerosols <60g or 60mL: >90%

≥ 60g or 60mL (but NMT 150g or 150mL): >95%

Non-aerosols Net content > labeled content

z
od
SAMPLING

MIL-STD-105E (Military Standard) Most common (OLD)

ANSI/ASQ Z1.4-2008 Most common (NEW)

gl
Square root system Easier (use in exam)
ru
CONTROL CHARTS

p-chart Proportion of defectives (dePectives), more

ld
common

np-chart Non-proportion (number of defectives)

ga

X-bar chart For measurable characteristics

le

PRODUCT DEFECTS

According to Magnitude Critical Defect Mat endanger life of patient

@

Major Defect Does not endanger life of patient but

affects the function of the product

Minor Defect Does not endanger life of patient and

does not affect the function of the
product

According to Variable Defect Measured by an instrument

Measurability
Attribute Defect Measured by inspection
According to Nature Ocular Defect Can be seen by the naked eye

Internal Defect Cannot be seen by the naked eye

z
PRODUCT RECALL

od
Class I Recall May cause DEATH or SERIOUS adverse health consequences

Class II Recall May cause TEMPORARY/MEDICALLY reversible adverse health consequences

Class III Recall NOT LIKELY to cause adverse health consequences

gl
ru STABILITY STUDIES

Stability CAPACITY of a drug to remain within

specification

Minimum acceptable potency: 90%

ld
Shelf life PERIOD OF TIME during which a product is
expected to remain within specification
ga

Estimated using the arrhenius equation

Expiration date TIME or DATE prior to which a product is

expected to remain stable and after which it
le

must not be used

ED= Manuf date + Shelf life

@

Types of Stability Studies

Long Term Studies Normal conditions, Real time

Follow ZERO order kinetics
FDA requirement: 1 year
30 ± 2 deg C, 75 ± 5% RH

Accelerated Studies Increased rate of chemical degradation

Exaggerated storage conditions
Follow FIRST order kinetics
 FDA requirement: 6 months
40 ± 2 deg C, 75 ± 5% RH

Stress Testing Under more severe conditions

Climatic Zone Type of Climate

Zone I Temperate
(Canada, Germany, Russia)

z
Zone II MediteRRanean/ Subtropical
(USA, Japan, Italy, France, Australia)

od
Zone III Hot and dry (try)
(Iraq, Jordan)

Zone IVA Hot and humid

gl
(UAE, Saudi Arabia)

Zone IVB Hot and very humid

(Philippines and other Asian countries)
ru
Climatic Zone Type of Climate
ld
Zone I Temperate 21 ± 2 °C and 45 ± 5% RH
(Canada, Germany, Russia)
ga

Zone II MediteRRanean/ Subtropical 25 ± 2 °C and 60 ± 5% RH

(USA, Japan, Italy, France,
Australia)

Zone III Hot and dry (try) 30 ± 2 °C and 35 ± 5% RH

le

(Iraq, Jordan)

Zone IVA Hot and humid 30 ± 2 °C and 65 ± 5% RH

@

(UAE, Saudi Arabia)

Zone IVB Hot and very humid 30 ± 2 °C and 75 ± 5% RH

(Philippines and other Asian
countries)

QA QC
 Ensures that quality policies are followed Conducts sampling and testing of RM and FP

Audit and monitoring Inspects PM components

Primary contact with regulatory agencies Performs environmental monitoring

Prepares SOP

z
ANIMAL ASSAY

od
Digitalis Pigeon Pigitalis

Tubocurarine Rabbit Tubocurabbit

Insulin Rabbit Rabbinsulin

gl
Glucagon Cat Glucatgon

Corticotropin
ru Rat CorRat

Cod liver oil Rachitic rat CodRaRat

Chorionic Gonadotropin Female Rat

ld
Vasopressin Male Rat

Oxytocin Chicken Oxytochicken

ga

PTH Dogs Paradogs

Heparin Sheep Sheeparin

Protamine SO4 Sheep

le
@

MICROBIAL ASSAY

Penicillin G Staphylococcus aureus PenStaph

Bacitracin Micrococcus luteus BaciMI

Streptomycin Klebsiella pneumoniae StrepKleb

Chloramphenicol Escherichia coli ChlorEsch

Vancomycin Bacillus subtilis VancoBaSu

Antifungal Saccharomyces
cerevisiae

z
Vitamin Assay

od
Niacin Lactobacillus plantarum
Ca Pantothenate

CyanocobaLamin Lactobacillus Leichmannii

gl
ru Limit Test Chemical Impurity Reagent Used

Gross Dirt or insoluble Heavy metals Hydrogen sulfide TS

Biological microorganism Arsenic Silver Diethyldithiocarbamate

TS
ld
Chemical By products, Iron Ammonium thiocyanate TS
degradation products,
reagents, catalysts, Chloride Silver Nitrate TS
ga

ligands, heavy metals

Sulfate Barium Chloride TS
le

PHYSICAL TESTS

Specific gravity ratio of the DENSITY of a substance to that of a reference substance at 25

deg C
@

Unitless

App: Pycnometer (USP official), Mohr-Westphal balance

Alcohol: Hydrometer at 15.56 deg C

Refractive Index (n) Ratio of the VELOCITY of light in AIR to the velocity of light in the
SUBSTANCE at 25 deg C

n= sin i/ sin r
 App: Abbe refractometer

Optical rotation (α) Measure of its ABILITY to ROTATE an INCIDENT PLANE of polarized light
Dextro or Levo

App: Polarimeter

Solubility Ex: Very soluble – 1 g of sample is soluble in less than 1 mL of solvent

z
Boiling Point/ Melting Indicates presence of impurities
point

od
Loss on Drying Determine the amount of volatile matter driven off after drying

Water determination Official Methods

gl
Method I Karl Fischer KFR Components
Titrimetry Sulfur dioxide (SO2)
IA: Direct Iodine
ru IB: Residual
IC: Colourmetric
Pyridine
Anhydrous methanol

Method II A2eotropic Toluene or Xylene

ld
Method III Gravime3 loss on drying
Inorganic: 110-120 deg C
Organic: 105 deg C
ga

Types of Glass
le

Type Description Use Type of Test (Old)

I Highly resistant Buffered or non-buffered Powdered Glass test
borosilicate glass aqueous parenteral Surface Glass test
@

*Limit: 1mL
*Arsenic Limit: 0.1 ug per g
II Treated soda lime Acidic and neutral aqueous Water Attack test (2big)
glass parenteral -inner surface of glass
*Titrated with 0.02N H2SO4 VS
III Soda lime glass Non-aqueous or dry solid Powdered Glass: inner surface
parenteral Surface Glass: titrated with 0.1N
HCl VS
Limit: 8.5mL
Arsenic Limit: 0.1 ug per g
IV/NP General purpose,
non-parenteral

New USP tests

Type Test Use
I, II, III Glass Grains Test Distinguishes Type I from Type II
and III
I, II, III Surface Glass Test Distinguishes Types I and II from

z
Type III
I, II Surface Etching test Distinguishes Type I from Type II

od
Biological Reactivity Tests in Vivo

Test Sample Animal used

gl
Infusion plastic White mice
sets ru
SysteMIC Parenteral containers Albino mice
injection

Intracutaneous Parenteral containers Albino rabbits

ld
Eye irritation Ophthalmic containers Albino rabbits

Implantation Material in direct contact with tissue Rabbits

ga

Biological Reactivity Tests in Vitro

Agar Diffusion
Cell or tissue
le

DIrect Contact Elastomeric material culture

Elution
@

IPQC Tests for Powders and Granules

Particle size 1. Optical Microscopy- more reliable

distribution analysis a. Feret- 2 tangents
b. Martin- bisects
c. Projected area of circle- circle diameter
2. Sieving- official method
 Sieve/Mesh No- SOLI
a. Mechanical agitation > 75um
b. Air jet < 75um
c. Sonic sifting < 75um

Coarse Retained at mesh 20

Good Passed mesh 20, retained at mesh 40

z
Fine Passed mesh 20 and 40

od
Density
Bulk Density Tapped density

Method I 250 mL graduated cylinder

gl
Method II Scott volumeter 250 mL graduated cylinder

Method III Vessel (100mL stainless steel, cylindrical)

ru
Powder flow 1. Angle of repose- measure of FLOWABILITY, max angle , 3D angle cone
ld
like pile of material
App: Fixed funnel, fixed cone, free standing cone, tilting box, revolving
cylinder
Tan θ = h / r
ga

2. Carr’s index- measure of COMPRESSIBILITY

3. Hausner’s ratio
4. Flow through orifice- flow rate
le

5. Shear cell

Moisture content
@

Content uniformity

Shape

IPQC for Tablet

Tablet Hardness Crushing strength/ breaking force

Ability to RESIST mechanical shocks
 Hardness Tester

Rule of Thumb Crude method/ sharp snap (acceptable)

Stokes (Monsanto) Spring

Strong cobb Air pump/hydraulic pressure

Pfizer Pliers (like)

z
ErWeka Suspended motor-driven Weight

od
Schleuniger/Heberle Motor driven anvil crushes horizontally, most WIDELY
in USED

gl
Conventional/Compressed/ Ordinary coated tablet 4-10 kg

ru SL, chewable (CHEW=2) 2-3 kg

Buccal (8uccal) 8-10 kg

MODified tablets >10 kg

ld
Tablet thickness App: Micrometer or Vernier caliper/ thickness gauge
AC: ± 5% of the standard thickness
ga

FPQC TESTS FOR TABLETS AND CAPSULES

Friability Tablet durability

le

(for tablets only) Ability to WITHSTAND mechanical shocks

No capping or chipping/cracking/breakage
@

Sample size:
≤ 650 mg: take a sx corresponding to 6.5g
> 650 mg: 10 whole tab (uncoated)

App: Roche/ Vanderkamp Friabilator

Specification: 25 rpm x 4 mins= 100 revolutions

Accepted Criteria:
 Old formulation: ≤ 1%
New formulation: ≤ 0.8% (unofficial)

Dosage Unit Sample size:

Uniformity- Old: ≥ 50mg API
Weight variation New: ≥ 25mg API

Sample size:
20 uncoated compressed tab

z
Acceptance criteria:

od
< 130 mg ± 10%
130-324 mg ± 7.5%
>324 mg ± 5%
*NMT 2 units are outside AC
*No unit is outside twice the AC

gl
Dosage Unit Ensures formulation potency
Uniformity- Old: <50 mg API
ConTENt New: <25 mg API
ru
Uniformity
Sample size:
10 units (individual), 20 units on retest
ld
Acceptance criteria:
Individual: 85-115% API (100 ± 15%)
Assay (average): 90-100%
ga

DIsintegration Measure of the time req for a tab to break up into small particles (PO)

Complete disintegration- …soft mass having no palpably film core…

le

App: Basket-Rack assembly

Media Temp: 37 ± 2 deg C (35-39 deg C)
Cycle/min: 29-32
@

Media type: water, simulated gastric fluid, simulated intestinal fluid

Fluid volume: Upward stroke: remains at least 15mm below fluid surface
Downward stroke: NLT 25mm below the vessel

Sample size: 18 units

Stage 1/Initial: 6 tablets
Stage 2/Retest: 12 tablets
Disintegrates (NONE remained on the mesh)
 If 1-2 did not disintegrate proceed to Stage 2

Stage 2: NMt 2/ 18 fail to disintegrate

Dissolution Measure the amount of time req for a given % of drug subs in a tab to go into
soln

Apparatus: Vessel with cover, H2O bath maintained at 36.5-37.7 deg C (37 ±
0.5 deg C), metallic drive shaft

z
Initial: 6 units

od
Retest: 6 units
Final retest: 12 units

Bloom Strength of Measure of the force in grams reqd to push a plunger into the gelatin
Gelatin

gl
Soft: 150g
Hard: 200g- 250g
ru DISINTEGRATION

Tablet type Medium Temp Time

ld
Uncoated/IR Water 37 ± 2 deg C 30 mins
tablet
ga

Capsule

SL tablet 2-3 mins

Buccal tablet 4 hrs

le

Enteric coated Water Room Temp 5 mins

tablet
Simulated 37 ± 2 deg C After 1hr: No sign of
Gastric fluid disintegration
@

Simulated 1 hr: Complete

Intestinal fluid disintegration

DISSOLUTION

Type Accessory Remarks

I Basket (100 rpm) BaskeI

II PaDDle (50 rpm)

III Reciprocating Cylinder “tREciprocating”

IV Flow-Through Cell F4

V-TDDS Paddle oVer Disk

z
VI-TDDS Revolving Cylinder 6 syllables

VII-TDDS Reciprocating Holder 7 syllables

od
DISSOLUTION

gl
Stage No. Tested Acceptance criteria

1 ru 6 units Each unit is NLT Q + 5%

2 + 6 (12) Ave (12) is NLT Q

No unit <Q -15%

3 + 12 (24) Ave (24) is NLT Q

ld
NMT 2 units <Q - 15%
No unit <Q - 25%
ga

FPQC TESTS FOR SEMISOLID DF

pH
le

Spreadability

Spatula feel
@

Consistency Penetrometer

Viscosity Brookfield viscometer

Melting range

Microbial content Ophthalmic: Sterile

Topical: (-) P. aeruginosa, S. aureus
Urethra, Vagina, Rectal: (-) molds and yeasts
Minimum fill For semisolids w/ labeled content of NMT 150g or 150 mL

Sample size:
Initial/Individual: 10 containers
Retest: 20 containers

Net content: Initial wt - final wt

AC Each container

z
Aerosols <60g or 60mL: >90%

od
≥60g or 60 mL (but NMT 150g or 150mL: >95%

Non-aerosols Net content > labeled content

gl
Metal Particles in Sample size: 10 tubes
Ophthalmic Heat at 85 deg C for 2 hrs then cool
ointment
ru Acceptance criteria:
Total # of metal particles in all 10 tubes in n< 50
NMT 1 tube contains > 8 metal particles
ld
Single use: Sterility test
Multiple test: Antimicrobial effectiveness test
ga

FPQC TESTS FOR LIQUID DF

pH
le

Appearance Color, Odor, Taste

Deliverable Applicable for NMT 250mL

@

volume
Sample size:
10 containers, 20 containers on retest

Procedure:
30 angle prevent air bubble formation

Single unit: drain in 5 sec

Multiple unit: drain in ≤ 30 min
FPQC TESTS FOR SUSPENSION

Particle size 1. Optical microscopy- ostwald ripening

determination 2. Sedimentation rate: Andreasen pipette based on Stokes law
a. High particle size= faster sedimentation rate

Sedimentation Ideal: F=1

volume - No sediment is present

z
- Caking is absent
- Suspension is aesthetically pleasing

od
Degree of
flocculation
Suspension Flocculated (Ideal) Deflocculated

Particles Larger Smaller

gl
uniform Varying

Sedimentation rate High Low

and volume
ru Supernatant Clear Turbid

Sediment Porous Non-porous (Hard cake)

ld
Redispersibility Yes (by agitation) No

Flocculating agent= Decreases zeta potential = Flocs

ga

Redispersibility Ideal: 100% w/ minimum agitation

Rheological Measure of resistance to flow

properties:
le

Viscosity

Zeta potential Repulsive forces between particles

@

Ideal: High Zeta potential= Decreased settling =deflocculation

Temperature & Temp: 40 deg C

gravitational stress Centrifugation: Crystal growth

FPQC TESTS FOR EMULSIONS

Emulsion Type Test

 Dilution Test W/O (separation) O/W (homogenous)

Dye solubility Sudan red- lake Amaranth red: Red

RED globule BG
Methyl red: H2O
soluble

UV fluorescence (UV Yes No

light)

z
Conductivity (Light No Yes

od
Bulb)

Cobalt Chloride Blue Pink

(Lover’s Pink)

gl
Instability Test 1. Creaming- upward
2. Cracking/Breaking- separation
3. Phase separation/inversion- O/W-> W/O
ru
Temperature & Temp: 50-70 deg C
Gravitational stress
ld
ga

FPQC TESTS FOR STERILE DF

Sterility To see absence of viable MO in product

Sterilization Tests Incubation Notes

le

Membrane Filtration 7 days Primary

technique
@

Direct inoculation Soybean casein digest Aerobes (eg fungi- total

medium- SCDM (20-25 yeast and molds count)
deg C, 5-7days)

Fluid thioglycollate Anaerobes (also used

medium- FTM (30-35 in total aerobic count)
deg C, 2-3 days)

Biological indicators Preferred for

 sterilizations processes

MOA Method Biological Indicator

Moist Heat Protein Autoclave (121 deg B.

OK: Water, coagulation C, 15 psi, 15-30 mins) stearothermophilus
Glassware,

z
Culture
medium

od
NOT OK:
Olive oil,
Solvents

Dry Heat Oxidation Oven (160 deg C, B. subtilis

gl
2-4hrs)

Membrane Physical 0.2- micron filter P. diminuta

Filtration separation “Cold sterilization”
ru (toxin,
vaccine,
enzymes)
ld
Gas Alkylation Ethylene oxide B. subtilis
extemporan (Carboxide” 10%
eous EtOH + 90 CO2)
ga

compoundi
ng)

Ionizing DNA mutation Gamma rays B. pumilus

le

radiation
@

Pyrogen test From gram negative bacteria which can cause fever and hypotension
Thermostable (non-autoclavable)

1. Bacterial endotoxin/ Limulus amebocyte Lysate Test (in vitro)

a. Source: Horseshoe crab (L. polyphemus)
b. Detect and quantify endotoxins from G - bacteria
c. Techniques:
i. Gel-clot
ii. Turbidimetric
iii. Chromogenic
 2. Rabbit test (in vivo)
Rabbit Test

Prior Tests Samples: 3 healthy, mature rabbits (37 ± 0.2 deg

C)
Apparatus: Depyrogenated at 250 deg C

During Test Inj. 10 mL/kg TS in the ear vein, completing inj.

within 10 mins after start of administration

z
After 1 hour, record the rectal temperature (30
mins/1 hr intervals for 3 hours)

od
AC Sum rise:
(Non-pyrogenic) - AC 1: <1.5 deg C for 3 rabbits (provided
no individual rise of ≥ 0.5 deg C
*if 1 rabbit ≥ 0.5 deg C + 5 rabbits

gl
- AC 2: ≤ 3.3 deg C for 8 rabbits (provided
NMt 3 rabbits have individual rise of ≥ 0.5
ru deg C)

Safety Bioassays
ld
Clarity Visual inspection

Particulate matter Presence of extraneous mobile undissolved particles - Emboli phlebitis

ga

Method I Method II

Light obscuration particle count test Microscopic particle count test

Adv: Automatic
le

Disadv: for clear and non-viscous

soln only
@

Leaker’s test Negative pressure w/n incompletely sealed ampule while submerged in dye
soln (1% methylene blue)

Environmental Control Tests for Sterile Areas

Air sampling Slit to agar sampler

1. Agar plate exposure
 2. Rodac plates- agar plates having convex surface, roll the raised
agar surface over the flat or irregular to be tested

Media fill Process simulation testing

1. Sterile trypticase soy broth- 3000 sterile containers - incubated at
20-25 deg C for 14 days
AC: NMT 0.1% of units is (+) for growth

Electronic/ Determines PS by means of shadow casted by particles as it passes

z
Automated particle through a high intensity beam
counter Disadv: nonspecific

od
1. Coulter counter- electrical resistance
2. Gelman counter- Tyndall effect
3. Hiac/Royco- light blockage

Membrane filtration COllects particle size greater than the membrane pore size

gl
technique Disadv: saturable, slow counting

HEPA filter
ru - 99.97%; ≤ 0.3 um
Efficiency tests:
- Dioctyl phthalate (DOP) test
- Henkel Corp emery (HC) test
ld
ga

Quali/Quanti

TYPES OF ANALYSIS

Based on the AMOUNT of sample

le

By SAMPLE SIZE Constituents types by ANALYTE LEVEL

1. Ultra Micro- <1 mg 1. Major- 1-100%
@

2. Micro- 1-10 mg 2. Minor- 0.01 (100 ppm) to 1%

3. Semimicro/Meso- 10-100 mg 3. Trace- 1 ppb to 100 ppm
4. Macro- 100 to 1000 mg 4. Ultra trace- <1 ppb

Based on the EXTENT

For CRUDE DRUGS For CHEMICAL DRUGS

1. Proximate- total of class, group 1. Proximate
2. Ultimate- specific component 2. Partial- selected or trace
3. Complete- each constituent
 Based on the NATURE of method

1. Chemical/ Classical/ General Methods

- titration , gravimetry
2. Instrumental Methods
- UV-vis, IR, MS, Chromatography
3. Special Methods
- For natural products, ash content, water content, constants for fats and fixed oils

z
Based on MATERIAL USED

1. Chemical

od
2. Physical
- MP, BP, optical purity, refractive index
3. Biological analysis
- Animal models

gl
TYPES OF ERRORS
ru
Random (Indeterminate) Error Due to UNCONTROLLABLE
Affects PRECISION
ld
Systematic (Determinate) Error With DEFINITE VALUE & IDENTIFIABLE cause
Affects ACCURACY
1. Instrumental error
ga

2. Method error
3. Personal error

Gross Error Occur OCCASIONALLY

Often large
le

Lead to outliers
Product of HUMAN ERRORS
@

Accuracy Closeness of an actual value to the true value

Precision Closeness of 2 or more actual measurements

1. Repeatability- intra-assay
2. Intermediate precision- WITHIN interlaboratory
3. Reproducibility- expressed variation BETWEEN laboratory

Robustness Remained unaffected by deliberate variations

Specificity Assess the analyte in the PRESENCE of OTHER substances

Sensitivity Ability to DISCRIMINATE between small difference in analyte concentration

GENERAL METHODS

Titrimetry Volume of a solution of known concentration consumed during analysis is taken as

z
the amount of active constituent in the sample

1. Titrant- Volumetric/ Standard solution

od
- Reagent of known concentration
2. Titrand- Analyte/ Active constituent
- Sample being analyzed
3. Indicators- change colors near or at the end point

gl
a. Equivalence Point- Stoichiometric point, THEORETICAL point where
analyte and titrant have reacted
ru b. End Point- ACTUAL point, physical change

Standardization Determines the EXACT concentration of a solution

1. Primary standard
- High degree of purity
- Reference material (standard)
ld
- Used in DIRECT standardization purposes
- Requirements:
- High Purity
ga

- Atmospheric stability
- Absence of hydrate of H2O
- Modest cost
- Reasonable solubility
- Large Molar mass
le

2. Secondary Standard
- Purity determined by CHEMICAL ANALYSIS
- Used in INDIRECT standardization purposes
@

Classification based on the NUMBER OF TITRATION

Direct Titration 1 titrant or VS

Indirect/ 2 titrant or VS
Residual/ Back - 1st VS added in excess
Titration - 2nd VS used to titrate the excess (unreacted) 1st VS
(back titrant)
Indications:
 - Insoluble
- VOlatile sample
- Reaction is too slow
- Does not give a sharp end point

Residual Titration Repeat and omit analyte

with Blank - For correction
- To enhance the reliability of the end point

z
Classification based on REACTIONS INVOLVED

Acid-Base 1. Acidimetry- measurement of a BASE by a STANDARD

od
(Neutralization) ACID

Aqueous Non-aqueous

gl
VS HCl/ H2SO4 HClO4 in GAA

1st std Na2CO3, TRIS/THAM KHP

ru 2nd std

Indicator
NaOH VS

MO/MR
-

Crystal Violet

Example Direct: NaOH, KOH Direct: Methacholine,

ld
Residual: ZnO Diphenoxylate, Diazepam

2. Alkalimetry- measurement of an ACID by a STANDARD

ga

BASE

Aqueous Non-aqueous
le

VS NaOH Na/Li methoxide

1st std KHP Benzoic acid

@

2nd std HCl/ H2SO4 VS -

Example Residual: Aspirin, Direct: Phenytoin,

Parabens Ethosuximide,
Amobarbital

3. Non-aqueous- non polar solvent, very weak acid/base

REDOX
 Permangano Diazotization Cerimetry
metry

Titra
tion

VS KMnO4 NaNO2 Ceric sulfate

1st Sodium Sulfanilamine Old: Arsenic trioxide

z
std oxalate New: Sodium
oxalate

od
2nd HCl/ H2SO4 VS – –
std

Indi Self indicating – O-phenanthroline

cat (ferroin)

gl
or

ru End Slight pink Red to Blue

poi
nt

Exa Indirect: Malic Direct: FeSO4,

ld
mpl acid of cherry Hydroquinone,
e juice Menadione
Residual
(Oxalic acid
ga

back titrant):
NaNO2,
KMnO4
le

Precipitation Determination of HALIDES- ARGENTOMETRIC

@

MOHR FAJANS VOLHARD

Titration Direct Direct Direct or

Residual

VS AgNO3 AgNO3 AgNO3

NH4SCN

1st std NaCl NaCl Direct: Hg

Residual:
 NaCl

Condition Ph 8 via CaCO3 DCF- pH 4 Acidic in 0.1 N

s Eosin Y- pH 2-3 NItric acid

Indicator K2CrO4 TS Dichlorofluore Ferric

scein, Eosin Y, ammonium
TEE SO4

z
End point Brick red ppt Green to Pink Reddish
brown

od
Complexation VS: EDTA
1st std: CaCO3
Indicator: EBT, HNB, DT

gl
Eriochrome black T Mg, Zn
ru Hydroxynaphthol blue

Dithizone
Ca

Al, Bi
ld
Example: Direct- ZnO, CaCO3 —- Residual: Bi
ga
le

Masking Agents
@

Triethanolamine Fe, Mn, Al

Thioglycols Hg, Cu, Pb, Bi

Cyanide Cu, Co, Ni, Zn

Fluoride Ca, Mg, Al

Gravimetry Dry wt
 Constant wt: 2 consecutive wts NMT 0.5mg/g (USO
Jenkins’: 0.0002 d or 0.2 mg

Test Infectious
Disease/Pathogen

z
Weil-Felix Test Rickettsia

od
Widal Test Typhoid

Elek Test, Schick Test, Dacron Swab Diphtheria

gl
Mantoux Test aka Von Pirquet Test, Tuberculosis
GeneXpert
ru
Spatula Test Tetanus

Nagler Reaction Gas Gangrene

ld
Ascoli Test Anthrax

Western Blot Test HIV

ga

NS1 Test, Dengue IgM Test, Tourniquet Test Dengue

le

Iodimetry IodOOOmetry

Direct Indirect
@

IODIne SOOOdium thiOOOsulfate

Arsenic trioxide K DichrOOOmate

- -

Starch: start Starch: BEFORE reaching endpoint

(STRAW-COLORED)

Appearance of blue Disappearance of blue

For RA For OA
DIrect: Vit. C, Lugol’s Direct: CuSO4, NaOCl
Residual: Methionine Residual: Phenol, resorcinol, SeS2

ACID-BASE TITRATION

WA SA SB

z
WB – MR/MO -

od
SA – – P/MR/MO

SB P P/MR/MO -

gl
NEUTRALIZATION
ru Acidimetry Alkalimetry

Titrant (buret) Acidic basic

ld
Titrand (erlenmeyer flask) Basic acidic

Sample analyte NaOH Citric acid

ga

Caffeine Acetylsalicylic acid/ Aspirin

Zinc oxide - Old: Residual

INSTRUMENTAL METHODS
le

Spectroscopy

Interaction between electromagnetic radiation and matter

@

Radiant energy transmitted , reflected, or emitted = concentration of the chemical species that
absorbs the energy

Chromophore- FG that absorbs max radiation in the UV or visible regions

Auxochrome- FG that does not give rise to absorption band itself, but upon being attached to a
chromophore

Electromagnetic Wave and particle properties

Radiation Sinusoidal wave model

Planck’s equation
E= h v
h= 6.6 x 10^-34
E directly proportional to frequency
E inversely proportional to wavelength

Region Wavelength (nm)

z
Ultraviolet 180-380

od
Visible 380-780

Near IR 780-3000

gl
Medium IR (fingerprint) 3000-15000

Far IR 15000-30000
ru
Fundamental Laws 1. Beer’s/Bernard Law
- Transmittance is inversely proportional to concentration
- “CONCENTRATED ang BEER ni BERNARD”
ld
2. LamberT’s/ Bouger’s Law
- Transmittance is inversely proportional to thickness
3. Beer-Lambert Law
ga

- Absorbance is directly proportional to concentration

Instrumentation
Source of radiation
le

Continuum UV: Deuterium lamp

Vis: Tungsten lamp (V-W)
IR: Nernst glower (nIRnst)
@

Line AAS: Hollow cathode lamp

Wavelength Selector

Filters Single band of wavelength

Monochromators Spectral scanning (prisms, gratings)

Sample cell
 Quartz cuvette UV or Vis (cUVISte)

Silicate glass or Vis

plastic cell

NaCl or KBr IR

Radiation detector

Phototubes

z
Photomultipliers

od
Photodiodes More sensitive

Signal processor and readout

Charge transfer

gl
devices
ru
Analytical
methods
Method Application
ld
Mass Spectrometry GASEOUS ions (MSG)

Nuclear Magnetic Resonance STRUCTURE elucidation

ga

UV-VIs QUALITATIVE and QUANTITATIVE analysis

Infrared Spectroscopy Determination of FUNCTIONAL GROUPS

Atomic absorption Determination of METALS in MULTIVITAMINS

Spectrometry
le

Other
@

Method Description Application

Fluorometry Measurement of excess energy Vit. B1 and B2

loss by emission (fluorescence)

Turbidimetry Measurement of transmitted light Antibiotics, Vit. B3, B5,

in a suspension B12

Nephelometry Reflected light in a suspension Immunoassays

 Chromatography
Solutes are separated by a differential migration process in a system consisting of 2 or more phases

Stationary Phase Fixed bed

May be porous or finely divided solid or a liquid
Particle should be as small and homogenous as possible

Mobile Phase Fluid that moves

z
May be liquid or gas

od
Solute mixture Relative affinity of the solutes for each of the phases must be reversible

Chromatographic Methods

gl
Nature of SP Normal phase: SP is polar
Reverse phase: SP is nonpolar

Equilibration 1. Adsorption (S-L, S-G)

Process
ru - SP is solid, MP may be liquid or gas
a. TLC - SP: silica gel, alumina, CaCO3, MP: hexane, ethyl
acetate
b. Column (Elution)- SP: silica gel, alumina, CaCO3, MP:
ld
hexane, ethyl acetate
c. HPLC- widely used
SP: column packed with glass or plastic beads coated
ga

with silica derivatized with nonpolar FG

MP: liquid pumped through the column with high pressure
Reverse: H2O, methanol, acetonitrile
Normal: hexane, diethyl ether
*Column- heart of HPLC
le

d. Gas- volatile
SP: either a solid adsorbent or a liquid on an inert support
MP: Helium or nitrogen inter gas
@

2. Partition- 2 immiscible solvent, SP & MP are liquid

a. Paper
SP: H2O bound to cellulose of the filter paper
MP: nonpolar or hydrophobic solvent
3. Ion exchange- separation of charged molecules, used in water
purification, separation of AAs
SP: cationic or anionic exchanger
4. Pore Penetration/ Permeation- according to size by their ability to
penetrate as a sieve-like structure
Ex: Size exclusion chromatography
 5. Affinity- highly specific interaction between one kind of solute molecule
and a second molecule covalently attached to the SP
Ex: Protein affinity chromatography

SPECIAL METHODS

z
Assay of Volatile oils

od
Alcohol Acetylation method
Ex: Peppermint

Aldehyde and Ketone Bisulfite (Cassia)

Hydroxylamine (Titration)

gl
Ex: Cinnamon oil

Phenol KOH (Cassia)

ru
Volatile oil in spirit Babcock bottle

Assay of Fats and Fixed oils

Acid Value Mg of KOH to NEUTRALIZE free acids in 1g of sample

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Ester Value Mg of KOH to SAPONIFY esters in 1g of sample
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Saponification Value/ Mg of KOH to NEUTRALIZE free acids and SAPONIFY esters in 1g of sample
Koettsdorfer Number SV= AV + EV

Iodine Value G of Iodine ABSORBED by 100 g of sample

Measure of UNSATURATED FA
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Iodine Value Oxidation Film-forming Examples

Range
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NON-drying <100 No No Olive, Almond

“NOA”

Semi-drying 100-120 Yes (mild) Yes (thin) Cottonseed,

Sesame
“SeCotSe”

Drying >120 Yes Yes (tough) Linseed, Cod liver

“Dry ang LiCod”
 METHODS (Residual Titration with Blank determination)

USP Method I HANUS IodoBROmide TS

USP Method II Wijs Iodochloride TS

Unofficial Method Hubl Method HgCl2 + I2

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Ash and Moisture Content Determination

Ash Content Residue left after incineration of an organic material which represents the

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amount of inorganic impurity
1. Total ash- 675 ± 25 deg C
2. Acid-insoluble ash- residue after boiling the total ash with 3 HCl and
igniting the remaining insoluble matter

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3. Water-soluble ash- difference in weight between total ash and
residue after tx of total ash with water
ru Flame color

Very dull red

Temp (deg C)

500-550

Dull red 550-700

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Bright red 800-1000
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Yellow red 1000-1200

White 1200-1600
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Moisture content
Method I Karl Fischer Titrimetry KFR Components
IA: Direct Sulfur dioxide (SO2)
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IB: Residual Iodine

IC: Coulometric Pyridine
Anhydrous methanol

Method II A2eotropic Toluene or Xylene

Method III Gravime3 loss on drying

(most common) Inorganic: 110-120
deg C
Organic: 105 deg C
Kjeldahl Method Determination of NITROGEN in organic subs

MOISTURE CONTENT DETERMINATION

Method I Karl Fischer Titrimetry KFR Components

IA: Direct Sulfur dioxide (SO2)
IB: Residual Iodine

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IC: Coulometric Pyridine
Anhydrous methanol

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Method II A2eotropic Toluene or Xylene

Method III Gravime3 loss on drying

(most common) Inorganic: 110-120 deg C

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Organic: 105 deg C

Method Description Application

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Fluorometry Measurement of excess energy loss by Vit. B1 and B2
emission (fluorescence)
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Turbidimetry Measurement of transmitted light in a Antibiotics, Vit. B3, B5, B12
suspension

Nephelometry Measurement of reflected light in a Immunoassays

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suspension
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RISKS FACTORS FOR MRSA

Prolonged hospitalization Admission to nursing homes

ICU admission Open wounds

Recent hospitalization Hemodialysis

 Recent antibiotic use Discharge with long-term central venous access or
long term indwelling urinary catheter

MRSA colonization Healthcare workers in direct contact with patients

infected with MRSA

Invasive procedures Use of PPIs

HIV infections

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6. Adsorption (S-L, S-G)
- SP is solid, MP may be liquid or gas

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e. TLC - SP: silica gel, alumina, CaCO3, MP: hexane, ethyl acetate
f. Column (Elution)- SP: silica gel, alumina, CaCO3, MP: hexane, ethyl acetate
g. HPLC- widely used
SP: column packed with glass or plastic beads coated with silica derivatized with
nonpolar FG

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MP: liquid pumped through the column with high pressure
Reverse: H2O, methanol, acetonitrile
Normal: hexane, diethyl ether
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h. Gas- volatile
SP: either a solid adsorbent or a liquid on an inert support
MP: Helium or nitrogen inter gas
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7. Partition- 2 immiscible solvent, SP & MP are liquid
b. Paper
SP: H2O bound to cellulose of the filter paper
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MP: nonpolar or hydrophobic solvent

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Type of Chromatography Stationary Phase Mobile Phase

Thin Layer Chromatography Silica gel, Alumina, CaCO3 Hexane, Ethyl acetate

Column Chromatography Silica gel, Alumina, CaCO3 Hexane, Ethyl acetate

High Performance Liquid Column packed with glass or Liquid pumped through the
Chromatography plastic beads coated with silica column with high pressure
derivatized with nonpolar FG

Gas Chromatography Either a solid adsorbent or a Helium or nitrogen inter gas

liquid on an inert support

Paper Chromatography H2O bound to cellulose of the Nonpolar or hydrophobic solvent

filter paper

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Disintegration Dissolution

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Equipment Basket-Rack Assembly Covered vessel with different
accessories (Types I-VII)

Temp. Range 37 ± 2 °C 37 ± 0.5 °C

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Definition Measures the time that only a soft Measures the time for the drug
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remains

Sample Size Stage 1: 6 units Stage 1: 6 units

Stage 2: 12 units Stage 2: +6 units
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Stage 3: +12 units
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Term Definition

Quality Totality of features or conformance to specifications of a

product
 Total Quality Combined team effort to develop, produce, market,
Management distribute, and control products that are safe and will be
effective for the time they remain in the marketplace

Quality Assurance Totality of the organized arrangements made with the

objective of ensuring that products are of the quality
required for their intended use

Current Good Part of QA which ensures that products are consistently

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Manufacturing produced and controlled to the quality standard
Practices (cGMP) appropriate to their intended use

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Quality Control Part of cGMP concerned with sampling, specifications,
testing, organization, documentation, and release
procedures

Product Quality Review Regular periodic quality reviews of all registered drug

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products to identify product and process improvements

Quality Risk Systematic process for the assessment, control,

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Management communication, and review of risks to the quality of the
product
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ANIMAL ASSAY
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Digitalis Pigeon

Tubocurarine Rabbit

Insulin Rabbit
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Glucagon Cat

Corticotropin Rat
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Cod liver oil Rachitic rat

Chorionic Gonadotropin Female Rat

Vasopressin Male Rat

Oxytocin Chicken

PTH Dogs
Heparin Sheep

Protamine SO4 Sheep

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MICROBIAL ASSAY

Penicillin G
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Bacitracin Micrococcus luteus

Streptomycin Klebsiella pneumoniae

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Chloramphenicol Escherichia coli

Vancomycin Bacillus subtilis

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Antifungal Saccharomyces cerevisiae

Vitamin Assay
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Niacin Lactobacillus plantarum

Ca Pantothenate

CyanocobaLamin Lactobacillus Leichmannii

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 BIOTERRORISM AGENTS (according to CDC)

Category A

Anthrax Smallpox

Botulism Tularemia

Plague Viral hemorrhagic fevers, including Filoviruses (Ebola,

Marburg) and Arenaviruses (Lassa, Machupo)

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Category B

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Brucellosis Q fever (C. burnetii)

Epsilon toxin (C. perfringens) Ricin Toxin (Ricinus communis)

Food safety threats (Salmonella, E. coli Staphylococcal enterotoxin B

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O157:H7, Shigella)

Glanders (Burkholderia mallei)

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Melioidosis (Burkholderia pseudomallei) Viral Encephalitis (alphaviruses)

Psittacosis (C. psittaci) Water safety threats (V. cholerae, Cryptosporidium

parvum)
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Category C

Nipah Virus Hantavirus

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CLASSIFICATION OF CONTAINERS
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Well-closed Solids

Tight Solids, Liquids, Vapors

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Hermetic Impervious to air/gas

Light resistant Protects from photochemical degradation

(amber)

Child resistant Difficult for children under 5yo to open

Tamper resistant Shrink seal, breakable cap, tape seal, bottle seal
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