Microbiology Viruses and Bacterial Diseases ch.13

SS DNA, Nonenveloped Human Parvovirus B19 Disease: erythema infectiosum (fifth disease) Route of Transmission: respiratory droplet

-Symptoms: causes a mild disease in children with a "slapped cheek" rash, rash begins with separate, rose-red raised spots which then converge. Spreads with lacy pattern to trunk, buttocks and limbs, may be accompanied by mild fever, Causes aplastic crisis in those with sickle cell anemia, Intrauterine infection can cause fetal death, can infect bone marrow cells -Vaccine: No treatment, no vaccine

Enterobacteriaceae or enterics

-inhabit the intestinal tracts of animals and are usually active glucose fermenters -motile with peritrichous flagella and have fimbriae allowing them to attach to mucous membranes -Endotoxin is found in the outer membrane of all members of this group -sex pili -Bacteriocins (proteins causing lysis of related species of bacteria) are also produced -Common cause of Septicemia -microbes actively reproducing in blood or lymphatic system Red streaks extending up from the affected area, fever -toxemia and septic shock are complications

microaerophile

-organism which requires reduced oxygen levels and carbon dioxide for growth -a subtype of aerobe and absolutely require oxygen, but just in small amounts - best way to grow a microaerophile in the lab is in a candle jar. The growth requirement must also be addressed in a clinical lab were patient samples must be grown in reduced oxygen levels in order to confirm one of these organisms

Pseudomonas

-rod shaped with polar flagella and often produce diffusible pigments. -opportunistic pathogen -grow ubiquitously -grow at refrigerator temperatures and decomposing chemicals which kill most microbes -grow in soaps, adhesives and even in some antiseptics -often capable of anaerobic respiration using nitrate as the terminal electron acceptor -contribute to the conversion of nitrates from the soil into a form useable by plants

Secondary Syphilis

1-3 months later secondary syphilis appears as wide spread skin rash even on palms mild fever flu-like symptoms - sore throat, lymphadenopathy (swollen lymph nodes), myalgia (sore muscles) highly infectious

These are some of the most commonly produced toxins or virulence factors

1. endotoxin , LPS (found in all E. coli becase they are Gram Neg) 2. Adhesins , associated with UTI 3. Capsule (Strains with capsule are more virulent) 4. Enterotoxin (cholera or shiga-like toxin found in diarrhea causing strains) 5. Verotoxin (only found in 0157:H7 which is the Jack-In-The-Box E. coli) causes inflammation and bleeding of the colon and kidney damage. Can shut down the kidneys in children in 24 hours.

Known Oncogenic Viruses

Adenoviruses, Herpesviruses, Poxviruses and Papovaviruses,Papilloma ,Herpesviruses (Epstein Barr virus) ,Burkitt's Lymphoma, a cancer of the lymphatic system; nasopharyngeal cancer, and Hodgkin's Disease another lymphatic cancer,HHVI, HHVII,Varicella zoster virus,HBV virus

Vibrionaceae

Comma shaped bacteria

families of acultative anaerobic, Gram negative rods

Enterobacteriaceae, Vibrionaceae and Pasteurellaceae.

Some of the most important genera of enterics are...

Escherichia, Salmonella, Shigella, Klebsiella, Serratia, Proteus, Yersinia, Erwinia and Enterobacter

Pasteurellaceae Haemophilus influenzae capsular type b (Hib) Disease: Meningitis, earaches, epiglottitis, septic arthritis, bronchitis and pneumonia Route of Transmission: airborne transmission

Features: Haemophilus species commonly inhabit the mucous membranes of the upper respiratory tract, mouth, vagina and intestinal tract of humans. Acute otitis media caused by the organism often follows viral upper respiratory tract infections. Congestion of the eustachian tubes results in fluid buildup in the middle ear and allows H. influenzae to colonize. The pressure building up within the area of the middle ear results in pain, and may lead to bulging and perforation of the tympanic membrane with discharge of pus. This organism is also a leading cause of epiglottitis in children who are not vaccinated. The epiglottis may swell and cause airway obstruction. A radiograph of the epiglottic region is necessary in a case of epiglottitis because it will identify any foreign bodies. X ray is preferred at all times in a suspected case of epiglottitis because physical examination of the throat and pharynx may cause the epiglottis to obstruct the trachea. It may be necessary to intubate and ventilate the patient if there is severe respiratory distress. Anesthetic will probably be necessary for intubation. H. influenzae is now the third most common bacterial meningitis in children. Progressive CNS infection leading to blindness, deafness, paralysis, coma and sometimes death Begins with intense headache, light sensitivity, fever and neck stiffness. This organism is the leading cause of contracted mental retardation in the U.S. This organism also causes earaches, epiglottitis, septic arthritis, bronchitis and pneumonia. (This organism does not cause influenza) Haemophilus species lack the cytochrome system necessary for respiration and must be supplied with blood hemoglobin in order to grow. In addition the cofactor (electron acceptor), NAD, must be provided. H. influenzae type B is most common (six types total), CSF may be used to culture or Gram stain Mortality rate 5% 35% of survivors develop permanent neurological problems such as seizures, deafness and mental retardation. Vaccine: a vaccine directed against the capsular polysaccharide is available, HibTITER given to infants, may also be given as TETRAIMMUNE vaccine which is Hib, diphtheria, pertussis and tetanus combined, Ampicillin for non-beta-lactamase producers, Cephalosporin or chloramphenicol as alternatives. Rifampicin recommended as prophylactic. New Comvax vaccine provides children with protection against Hib and Hepatitis B Virus combined. -Until recently, this was the #1 cause of meningitis in children. Because of the HIB vaccine, it has dropped to three; but it is still a very common cause of childhood ear aches and other more minor infections.

Legionella pneumophila Disease: Legionnaire's disease or legionellosis Route of Transmission: Respiratory route

Features: These microbes colonize streams, water lines in hospitals, showers and cooling towers of air conditioning systems grows in macrophages Legionnaire's disease is an atypical pneumonia which means it is a pneumonia not caused by the 3 leading bacterial agents. It is a severe, quickly fatal disease in older people particularly if they are smokers and heavy drinkers. Also causes Pontiac fever (flu-like illness) in young previously healthy individuals Vaccine: None

Borrelia recurrentis Disease: relapsing fever Route of Transmission: soft tick bite and body lice

Features: This spirochete is endemic (indigenous) in rodents and is transmitted to humans by tick bite and body lice. After a 3-10 day incubation, an individual will develop sudden chills and fever which will last for 3-5 days. The fever will lapse for ~1 week before the next bout. 3-10 fever episodes will usually be seen. Relapses are due to antigenic variation of the spirochetes. Diagnosis is by blood smear. Vaccine: Tetracycline for treatment Recurring bouts of fever about 1 week apart.

Bordetella pertussis Disease: Whooping cough Route of Transmission: Respiratory route

Features: Three stages of disease in children: 1) Initial phase called catarrhal stage resembles a cold. 2) Paroxysmal phase is caused by destruction of mucociliary escalator. Accumulation of mucus in trachea and lungs causes characteristic whooping cough. 3) Convalescence phase may last months. -Adults can also contract whooping cough especially if childhood vaccines are withheld. The complications can be serious. -Bronchopneumonia, which may be a secondary infection by Haemophilus influenzae, atelectasis (collapse of the lung) resulting in bronchiectasis. -Bronchiectasis is distortion and stretching of one or more bronchi resulting in chronic lung infections which may extend into later life. -Convulsions may also occur after a serve paroxysm of coughing may lead to intracerebral hemorrhage. -Bronchopneumonia is a leading type or pneumonia in which the inflammations is spread throughout the lungs in small patches rather than confined to one lobe as in pneumococcal pneumonia. -The pressure of paroxysmal coughing may cause conjunctival hemorrhage and epistaxis (nose bleed). -A frenal ulcer may also appear on the tongue in the early stages of disease. The frenum is the fold of skin on the underside of the tongue. Vaccine: DTaP vaccine (diphtheria, tetanus and acellular pertussis). Acellular boosters may be given Immunization is recommended for all children unless the patient shows evidence of progressive neurological deficit such as epilepsy or there is a family history of such disease. Known for the destruction of the mucociliary escalator

Campylobacter jejune Disease: outbreaks of food borne intestinal disease Route of Transmission: food borne

Features: associated with poultry, milk and water. Household pets may serve as a reservoir invades GI epithelium produces cytotoxin (bacterial toxins that kill host cells) Incubation 2-11 days Duration 3 days- 3 wks Diarrhea, abdominal cramps and fever no vomiting Vaccine: No vaccine, self-limiting disease Helical organisms with flagella

Pseudomonas aeruginosa Disease: Dermatitis (inflammation of the skin), Outer ear infections, infections of burn and Cystic Fibrosis patients Route of Transmission: Water borne, direct contact, nosocomial infections

Features: opportunistic pathogen can colonize hair follicles and cause self limiting rash Can be transmitted in pools, hot tubs, loofa sponges Infected areas may exhibit blue-green pus due to pigment Very distinctive putrid, grape-like odor Vaccine: None Known for its flourescent green pigment, heavy pigment and very characteristic odor.

Francisella tularensis Disease: tularemia (rabbit fever) Route of Transmission: Spread to humans by handling infected meat, eating undercooked meat or deer fly bites, Respiratory route is less common

Features: plague-like disease in animals, reservoir in small animals, Highly infectious ulceration at site of entry then septicemia (bacteria in blood), swollen painful lymph nodes and pneumonia, organisms resist phagocytosis Vaccine: Streptomycin is drug of choice, Cannot be treated with penicillins or cephalosporins, Live attenuated vaccine is available for people at high risk such as trappers; ticks should be avoided Known for being a zoonotic disease.

Helicobacter pylori Disease: Gastritis (inflammation of the stomach) and gastric ulcers Route of Transmission: Unknown

Features: produce cytotoxins as well as ammonia as a result of urease (an enzyme that changes urea into ammonium carbonate) to neutralize stomach acid in the localized regions of the colony. As the colony grows, the cytotoxins form the ulceration. Responsible for 100% of all duodenal ulcers and 80% of peptic ulcers. Where do you think the other 20% come from? It is not stress or spicy foods. The rest come from over the counter drugs like NSAIDS, aspirin, and even alcohol abuse. also strongly associated with stomach cancer Vaccine: No vaccine , treat with antibiotics. Ulcers should not be treated with anti-acids as this will only exacerbate the growth of the organism. Responsible for almost all ulcers. Have been proven using Koch's postulates.

reponema pallidum Disease: syphilis Route of Transmission: sexually or congenitally (acquired at birth) transmitted

Features: Can't be seen by light microscopy Cannot be grown in vitro very susceptible to heat and drying 2-3 week incubation Congenital syphilis transmission usually occurs after first trimester, outcome may range from intrauterine death congenital abnormalities or silent infections which do not show up until about 2 years of age as facial and tooth deformities. Diagnosis usually by dark field microscopy and serology. Vaccine: no vaccine, Penicillin for treatment

Moraxella lacunata Disease: conjunctivitis (pink eye). This is one of the most common bacterial causes of pink eye. Route of Transmission: Direct contact

Features: strictly aerobic coccobacillus, an inflammation of the membrane that covers the eye and lines the eyelids. Vaccine: None

Features of Spirochetes

Helical in shape Long and thin Axial Filaments Cannot be seen by compound microscope Must use Darkfield microscope Fragile, easy to kill with antibiotics Hard to grow in culture

Arboviruses

Includes yellow fever virus, dengue fever virus and west nile virus. Arbo stands for arthropod borne which means these viruses are transmitted by insect. In this case all by the mosquito.

DS DNA, Enveloped Poxviruses Variola (Smallpox Virus) Disease: Smallpox Route of Transmission: Direct contact, fomites or respiratory route of infection

Incubation Period (Duration: 7 to 17 days) Not contagious Exposure to the virus is followed by an incubation period during which people do not have any symptoms and may feel fine. This incubation period averages about 12 to 14 days but can range from 7 to 17 days. During this time, people are not contagious. Initial Symptoms (Prodrome) (Duration: 2 to 4 days) Sometimes contagious* The first symptoms of smallpox include fever, malaise, head and body aches, and sometimes vomiting. The fever is usually high, in the range of 101 to 104 degrees Fahrenheit. At this time, people are usually too sick to carry on their normal activities. This is called the prodrome phase and may last for 2 to 4 days. Early Rash (Duration: about 4 days) Most contagious Rash distribution: Rash distribution of smallpox vs chickenpox A rash emerges first as small red spots on the tongue and in the mouth. These spots develop into sores that break open and spread large amounts of the virus into the mouth and throat. At this time, the person becomes most contagious. Around the time the sores in the mouth break down, a rash appears on the skin, starting on the face and spreading to the arms and legs and then to the hands and feet. Usually the rash spreads to all parts of the body within 24 hours. As the rash appears, the fever usually falls and the person may start to feel better. By the third day of the rash, the rash becomes raised bumps. By the fourth day, the bumps fill with a thick, opaque fluid and often have a depression in the center that looks like a bellybutton. (This is a major distinguishing characteristic of smallpox.) Fever often will rise again at this time and remain high until scabs form over the bumps. Pustular Rash (Duration: about 5 days) Contagious The bumps become pustules—sharply raised, usually round and firm to the touch as if there's a small round object under the skin. People often say the bumps feel like BB pellets embedded in the skin. Pustules and Scabs (Duration: about 5 days) Contagious The pustules begin to form a crust and then scab. By the end of the second week after the rash appears, most of the sores have scabbed over. Resolving Scabs (Duration: about 6 days) Contagious The scabs begin to fall off, leaving marks on the skin that eventually become pitted scars. Most scabs will have fallen off three weeks after the rash appears. The person is contagious to others until all of the scabs have fallen off. Scabs resolved Not contagious Scabs have fallen off. Person is no longer contagious. * Smallpox may be contagious during the prodrome phase, but is most infectious during the first 7 to 10 days following rash onset.

leading causes of bacterial meningitis

Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae

Gram-negative aerobic bacterial diseases

Pseudomonads

HHV6 Disease: Exanthem subitum (Roseola infantum) Route of Transmission: Probably saliva

Symptoms: Discovered in 1988, Infects nearly all humans during the first 3-5 years of life. Virus replicates in T and B cells and in the throat and is shed in saliva, 85% of healthy adults have the virus in their saliva for life, Causes a maculopapular rash, two week incubation followed by mild fever for a few days with swollen cervical lymph nodes, rash appears 1-2 days after fever disappears, the rash appears to be an immune reaction to the virus and there is no viral invasion of the skin or shedding of virus from infected skin.

HHV7 Disease: roseola infantum in infants and young children

Symptoms: Found in T cells. Virus is present for life and is found in 75% of adult saliva samples. Like its cousin HHV-6, an HHV-7 primary infection causes roseola infantum in infants and young children, which is an undifferentiated, febrile illness that typically lasts for 6 days. Symptoms include a rash on the neck and trunk, as well as mild upper respiratory infection and cervical lymphadenopathy. Complications include febrile seizures, meningitis and encephalitis, as well as neurological complications (in individuals with active CNS infection). HHV-7 is typically acquired prior to age 5, and is thought to affect over 95% of the population. After primary infection, HHV-7 establishes latency in the host, which predisposes individuals to reactivation during periods of time when their immune systems are not functioning properly.

Filovirus Disease: Ebola Hemorrhagic Fever Route of Transmission: Blood or fluid transfer, depending on the strain

Symptoms: Four Ebola viruses (Ebola-Zaire, Ebola-Sudan, Ebola-Ivory Coast and Ebola-Reston. Only Ebola-Reston is airborne and only causes disease in primates. In humans, the incubation period for Ebola HF ranges from 2 to 21 days. The onset of illness is abrupt and is characterized by fever, headache, joint and muscle aches, sore throat, and weakness, followed by diarrhea, vomiting, and stomach pain. A rash, red eyes, hiccups and internal and external bleeding may be seen in some patients. Patients develop fever, hemorrhage, rash and intravascular coagulation. When clotting factors are used up, the blood continually streams from every orifice. Virus multiplies in connective tissue and dissolves the tissue promoting hemorrhage, Researchers do not understand why some people are able to recover from Ebola HF and others are not. However, it is known that patients who die usually have not developed a significant immune response to the virus at the time of death. Vaccine: None

DS DNA, Nonenveloped Human Papillomaviruses (HPV) Disease: papillomas (skin and genital warts) Route of Transmission: direct contact, sometimes sexually

Symptoms: Genital HPV is a common virus that is passed on through genital contact, most often during vaginal and anal sex. About 40 types of HPV can infect the genital areas of men and women. While most HPV types cause no symptoms and go away on their own, some types can cause cervical cancer in women. These types also have been linked to other less common genital cancers— including cancers of the anus, vagina, and vulva (area around the opening of the vagina). Other types of HPV can cause warts in the genital areas of men and women, called genital warts. Virus infects epithelial cells and multiplies, after 1-2 months, virus stops multiplying and lies dormant in basal epithelium. It may reactivate, sexually transmitted warts can cause throat cancer in children infected via the birth canal, high association with cervical cancer and cancers of the penis, vulva and rectum, Approximately 20 million people are currently infected with HPV. At least 50 percent of sexually active men and women acquire genital HPV infection at some point in their lives. By age 50, at least 80 percent of women will have acquired genital HPV infection. About 6.2 million Americans get a new genital HPV infection each year. Vaccine: The vaccine, Gardasil®, protects against four HPV types, which together cause 70% of cervical cancers and 90% of genital warts. The Food and Drug Administration (FDA) recently licensed this vaccine for use in girls/women, ages 9-26 years. The vaccine is given through a series of three shots over a six-month period. It is not yet known if the vaccine is effective in boys or men. It is possible that vaccinating males will have health benefits for them by preventing genital warts and rare cancers, such as penile and anal cancer. It is also possible that vaccinating boys/men will have indirect health benefits for girls/women. Studies are now being done to find out if the vaccine works to prevent HPV infection and disease in males. When more information is available, this vaccine may be licensed and recommended for boys/men as well. Skin warts are removed by freezing with liquid nitrogen, Genital warts by laser treatment, Condoms should be used to prevent transmission of genital warts

HHV8 Disease: Kaposi's Sarcoma

Symptoms: HHV-8, also known as Kaposi's sarcoma associated herpesvirus, is a gammaherpesvirus found only in humans. AIDS-related Kaposi's sarcoma (KS) was first discovered in 1981, and the association with HHV-8 was identified through DNA sequencing in 1994. HHV-8 has subsequently been identified in all types of KS, including classic, endemic, posttransplant and AIDS-related KS, all of which have identical histological features Research has shown a possible role for HHV-8 in the development of two rare lymphoproliferative disorders, multicentric Castleman's disease (MCD) and primary effusion lymphoma (PEL). A primary HHV-8 infection presents as a fever and rash. The fever typically lasts from 2-14 days, and a maculopapular rash persists for 3-8 days. When HHV-8 reactivates, it is in the form of Kaposi's sarcoma. KS was first identified in 1872 by Moriz Kaposi, and has since been characterized into 4 well-documented clinical variants: Classic KS primarily affects older males of Eastern European and Mediterranean lineage, and typically presents as cutaneous lesions on the lower extremities. Endemic KS occurs in Africa, and may involve the lymph nodes in addition to typical skin lesions. This variant is often seen in HIV-negative individuals and in children. Iatrogenic KS occurs in recipients of solid organ transplants who are being treated with immunosuppressive medications.This form of KS occurs more commonly in individuals of Mediterranean descent. AIDS KS is a very aggressive form that was first identified in the early 1980s in homosexual men who were otherwise healthy. In addition to cutaneous and lymphatic involvement, this variant often spreads to the lungs, GI tract, liver and spleen. When AIDS KS was originally identified, the lifetime incidence was approximately 50% in gay men. Because of antiviral therapy advances in the late 1990s, the incidence has declined markedly.

Flaviviruses Hepatitis C Virus (HCV) Disease: Hepatitis Route of Transmission: blood transfusion, IV drug use, Sexually, needle-stick injuries, hemodialysis, mother to child, body piercing/tattooing, also suspected are oral, anal/oral sex and family member transmission

Symptoms: Incubation 2-4 months, most infections subclinical or mild, 85% of cases become chronic carriers, 20% develop severe liver damage, 150,000 new cases each year. 3.5 million Americans currently are chronic carriers. Vaccine: None, interferon treatment somewhat successful, Prevention: always practice safe sex and never share objects such as needles, razors, toothbrushes, nail files and clippers. When getting a manicure, tattoo or body piercing, make sure sterile instruments are used. Treatment: Depending on the strain of HCV, there is now a high rate (98%) of cure. The drugs include Harvoni, Viekira Pak, Olysio and Sovaldi.

Epstein-Barr virus(EBV) or (HHV4) Disease: Encephalitis, Hepatitis, Burkitt's lymphoma, Hodgkin's Disease and Infectious mononucleosis Route of Transmission: respiratory droplets, saliva, fomites

Symptoms: Incubation 2-6 weeks, Usually a pharyngeal infection, virus infects lymph nodes, spleen and other blood rich tissues, multiplies in parotid gland, Enlarged lymph nodes, mild fever, sore throat, swollen spleen, jaundice, ruptured spleen and heart defects can occur, virus linked to Burkitt's lymphoma (tumor of connective tissues of the jaw), causes increased B cell proliferation then destruction by T cells. Diagnosed by high count of atypical lymphocytes, Latency in B cells, Reactivation is subclinical Vaccine: None

Yellow Fever Virus Disease: Yellow Fever Route of Transmission: Aedes mosquito

Symptoms: Jungle yellow fever is mainly a disease of monkeys. It is spread from infected mosquitoes to monkeys in the tropical rain forest. People get jungle yellow fever when they put themselves in the middle of this natural cycle and are bitten by mosquitoes that have been infected by monkeys. Jungle yellow fever is rare and occurs mainly in persons who work in tropical rain forests. Urban yellow fever is a disease of humans. It is spread by mosquitoes that have been infected by other people. Aedes aegypti is the type of mosquito that usually carries yellow fever from human to human. These mosquitoes have adapted to living among humans in cities, towns, and villages. They breed in discarded tires, flower pots, oil drums, and water storage containers close to human dwellings. Urban yellow fever is the cause of most yellow fever outbreaks and epidemics. Incubation period 3-6 days, Virus infects lymph nodes, then viremia, then necrotic lesion in liver, bone marrow, spleen and other organs, Symptoms included Anorexia, malaise, bloody vomitus, jaundice, waves of high fever, bleeding gums, delirium and high mortality Vaccine: Vaccine yields long term immunity

Zika Virus Disease: Zika Virus Disease It is a flavivirus, + stranded RNA virus with envelope. Other flaviviruses include West Nile virus, dengue virus, yellow fever virus. Disease called Zika virus disease. First isolated in 1947 in the Zika forest, Uganda. Route of Transmission: Zika virus spreads to people primarily through the bite of an infected Aedes species mosquito (Ae. aegypti and Ae. albopictus). People can also get Zika through sex with a man infected with Zika and it can be spread from a pregnant woman to her fetus. People can protect themselves from mosquito bites and getting Zika through sex. This fact sheet explains who's most affected and why, symptoms and treatment, and how to protect against Zika. The mosquitoes that carry Zika are aggressive daytime biters, but they can also bite at night. A mosquito becomes infected when it bites a person already infected with Zika. That mosquito can then spread the virus by biting more people. Zika virus can also spread: During sex with a man infected with Zika. From a pregnant woman to her fetus during pregnancy or around the time of birth. Through blood transfusion (likely but not confirmed).

Symptoms: Many people infected with Zika won't have symptoms or will only have mild symptoms. The most common symptoms are fever, rash, joint pain, or red eyes. Other common symptoms include muscle pain and headache. Symptoms can last for several days to a week. People usually don't get sick enough to go to the hospital, and they very rarely die of Zika. Once a person has been infected with Zika, they are likely to be protected from future infections Vaccine: None

Gram positive Cocci Staphylococcus aureus Disease: Folliculitis (pimples) Impetigo in neonates Sty (follicle of lash) Boils (furuncle) Carbuncles (progressively expanding infections, hard, round deep inflamed regions) postoperative infections catheter infections scalded skin syndrome TSS Staphylococcal food poisoning Route of Transmission: Normal flora and post-operative infections

Symptoms: Most common species Neonates particularly susceptible because of naive immune system A variety of toxins can be produced causing, other exfoliative conditions TSS, and food poisoning typical skin lesions are pus-filled with red margins bugs may be cultured and Gram stained from the discharge Positive coagulase test confirms the presence of the organism. Antibiotics usually work well, Lesions may require lancing. Food poisoning occurs by enterotoxin which remains active after boiling, symptoms of nausea, vomiting and diarrhea begin 1-24 hours after eating Vaccine: None, IV rehydration may be necessary

Neisseria gonorrhoeae Disease: Ophthalmia neonatorum, Gonorrhea and PID Route of Transmission: Via birth canal or sexually

Symptoms: Organism susceptible to drying and survives poorly outside human host Transmission occurs more readily male to female than female to male. Transmission from female to infant during childbirth is seen as an eye infection (ophthalmia neonatorum) in newborns Pelvic Inflammatory Disease (infection of uterus and uterine tubes) Incubation period 2-7 days more than 70,000 cases per year bind to cells by fimbriae in males painful urination and pus discharge females may be asymptomatic unless spreads to PID may include abdominal/pelvic pain, discharge, salpingitis (uterine tube infection) and cervix infection Diagnosis rests on microscopy and culture of discharge Samples should be collected in the clinic or at the bedside and transferred to warmed media immediately, Endocarditis (inflammation of the lining of the heart), meningitis (inflammation of the membranes covering the spinal cord) and arthritis can develop if untreated. Vaccine: drug of choice is beta-lactamase-stable cephalosporin, spectinomycin for beta-lactam resistant strains. -As STD, known for what is called the "drip" or the "clap".

West Nile Virus Disease: WNV Route of Transmission: Mosquito

Symptoms: People who contract WNV usually experience only mild symptoms-fever, headache, body aches, skin rash, and swollen lymph glands. If WNV enters the brain, however, it can cause life- threatening encephalitis (inflammation of the brain) or meningitis (inflammation of the lining of the brain and spinal cord). Most cases of disease occur in elderly people and those with impaired immune systems. Most human cases are mild or asymptomatic. Greatest risk to horses and birds in the crow and jay family. Vaccine: none

Respiratory Syncytial Virus Disease: RSV Route of Transmission: Respiratory route

Symptoms: Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis and pneumonia among infants and children under 1 year of age. Illness begins most frequently with fever, runny nose, cough, and sometimes wheezing. During their first RSV infection, between 25% and 40% of infants and young children have signs or symptoms of bronchiolitis or pneumonia, and 0.5% to 2% require hospitalization. Most children recover from illness in 8 to 15 days. The majority of children hospitalized for RSV infection are under 6 months of age., transmitted by respiratory route, 4-5 day incubation, virus infects respiratory epithelium, Symptoms include respiratory distress with bronchiole infection and pneumonia, Acute fever, cough, rhinitis, nasal congestion. Often croup like symptoms in children, mild disease in adults, G (large glycoprotein spike) binds virus to host, F (fusion protein) fuses viral envelope and cytoplasmic membrane of host cell, Also causes fusion of cytoplasmic membranes of infected cells. Results in syncytia or multinucleated masses of fused cells. Vaccine: None, aerosol Ribavirin is given. Cases are always isolated. New injectable vaccine, RespiGam, has been approved by the USDA

Clostridium difficile Disease: Pseudomembranous Colitis (antibiotic associated diarrhea) Route of Transmission: normal gut flora or fecal/oral route

Symptoms: Thrives under antibiotic selection rapidly fatal in compromised hosts produces several toxins which damage gut wall Vaccine: No vaccine, Antibiotic therapy, Prevention in hospital setting depends on hygiene

Chlamydia pneumoniae Disease: Pneumonia, Atherosclerosis? Route of Transmission: Respiratory route

Symptoms: Typical symptoms of pneumonia. Organism found in 90% of coronary arteries with atherosclerotic plaque and only 4% of patients with no atherosclerosis. Vaccine: None

Yersinia pestis Disease: bubonic plague and pneumonic plague Route of Transmission: Flea bite in bubonic form, respiratory route for pneumonic form

Symptoms: With human to human transmission the LD50 is less than 1 symptoms may include bruising and buboes (enlarged lymph nodes) Childhood poem, Ring around the Rosie, dedicated to the bubonic plague rash Tet and streptomycin are effective if administered promptly after exposure endemic in rodent populations Vaccine: Killed vaccine gives partial protection, Prophylaxis by strict quarantine, rodent control, strict isolation of patients, prophylactic antibiotics -in the pneumonic form, inhaling one cell results in death in 24 hours. Is a zoonotic disease.

Hepatitis F Virus (HFV) Disease: Hepatitis Route of Transmission: blood transmission

Symptoms: causes 10%? of hepatitis cases, may be a mutation of HBV Vaccine: None

Yersinia enterocolitica Disease: childhood diarrheal disease Route of Transmission: Contaminated water or foods, from dogs also possible

Symptoms: infect intestinal lining causing ulcerations spreads to lymph system where ulcerations also develop fever, diarrhea and abdominal pain which may be mistaken for appendicitis arthritic symptoms may develop Vaccine: self-limits in 1-3 weeks, antibiotics may speed recovery

Vibrio parahaemolyticus Disease: gastroenteritis (inflammation of stomach and intestine) Route of Transmission: raw or undercooked shellfish

Symptoms: produces a cytotoxin and hemolysin diarrheal disease with abdominal pain burning sensation, nausea, vomiting and watery stool prevented by cooking fish symptoms after 24 hours Vaccine: No vaccine, Without treatment recovery in few days, rehydration therapy rarely

Gardnerella vaginalis Disease: vaginitis (inflammation of the vagina) Route of Transmission: normal flora in most women or their sexual partners

Symptoms: sensitive to pH changes, foul odor and discharge It along with several other genera is classified as a Gram variable organism and may be found in either the Gram positive or Gram negative facultatively anaerobic rod grouping Also classified with Gram Negative, Facultative anaerobes in text Considered a Gram variable organism) Vaccine: None

Klebsiella pneumoniae Disease: Urinary and respiratory tract infections Route of Transmission: Normal flora or by direct contact

Symptoms: survives very well on hands a major cause of septicemia in children and pneumonia in alcoholics On the rise, may replace current as #1 bacterial pneumonia cause Vaccine: No vaccine, very resistant to antibiotics, aseptic technique and handwashing are prophylactic

Salmonella typhi Disease: typhoid fever Route of Transmission: fecal/oral route

Symptoms: 2 week incubation, high fever, headache, diarrhea and malaise for 1-2 weeks Harbored in gall bladder of carriers, Carriers are treated by gall bladder removal 10% mortality if untreated Vaccine: Killed vaccine, Ampicillin, chloramphenicol, cotrimoxazole, ciprofloxacin -Known for the formatin of carriers with the organism harbored in their gall bladders.

Dengue Fever Virus and Dengue Hemorrhagic Fever Virus Disease: Dengue Fever (Breakbone Fever) and Dengue Hemorrhagic Fever, respectively Route of Transmission: Aedes Mosquito

Symptoms: A pandemic of dengue began in Southeast Asia after World War II and has spread around the globe since then. The Ae. aegypti eradication program, which was officially discontinued in the United States in 1970, gradually weakened elsewhere, and the mosquito began to reinfest countries from which it had been eradicated. As a result, the geographic distribution of Ae. aegypti in 2002 was much wider than that before the eradication program, 2-15 day incubation, Virus infects lymph nodes, then viremia, necrotic lesions in bone marrow, spleen and other organs then appear, Symptoms include fluctuating fever, sharp pain in muscles and joints, possible skin rash with desquamation, possible shock syndrome upon recurrent infections, Considered a tropical disease, however the mosquito which transmits the disease has now migrated to the U.S. and it has been predicted that we are overdue for an outbreak Vaccine: No vaccine just supportive care and bed rest for 1-2 weeks.

Herpesviruses Herpes Simplex Virus I (HSVI) or (HHV1) Disease: cold sores Route of Transmission: Transmitted by saliva, vesical fluid, sexual contact and by birth canal

Symptoms: Axonal travel to latency sites in sensory ganglia (trigeminal nerve), can cause herpetic keratitis (corneal infection), treat with Trifluridine Vaccine: No vaccine, Acyclovir used in treatment

SS RNA, Enveloped, Antisense Strand Rhabdoviruses (bullet shaped, Rabies). Rhabdoviruses are antisense RNA viruses. The first thing that happens in the cytoplasm is the antisense strand serves as template for + strand synthesis. The + sense then serves as a template for more - strand viral RNA and a mRNA. bullet shaped rhabdovirus Rabies virus Disease: Rabies Route of Transmission: Lick or bite

Symptoms: Fatal encephalitis with progressive CNS involvement, multiplies in skeletal muscle and connective tissue, then travels to CNS, Incubation 6 days to 1 yr, Immune system can't reach virus in CNS, Symptoms: abnormal sensations at bite location, agitated behavior, hallucination, muscle spasms, stupor. Eventually salivation, aggressive behavior, hydrophobia (water and drafts cause mouth and pharynx to spasm), paralysis and coma, Two forms, furious and paralytic (dumb) rabies, Diagnosed by serology or fluorescent antibodies against brain tissue and presence of Negri bodies, Usually less than 10 cases in U.S. per year. Vaccine: Human diploid cell vaccine (inactivated virus), 5-6 injection, IM, 28 day period along with passive antibody, Field trials on subunit vaccine in Vaccinia virus.

Hantavirus Disease: Hantavirus Pulmonary Syndrome Route of Transmission: Respiratory Particles shed by mice, Not spread person to person

Symptoms: Hantavirus pulmonary syndrome (HPS) is a deadly disease from rodents. Humans can contract the disease when they come into contact with infected rodents or their urine and droppings. HPS was first recognized in 1993 and has since been identified throughout the United States. Although rare, HPS is potentially deadly. Rodent control in and around the home remains the primary strategy for preventing hantavirus infection. Patients with HPS typically present in a very nonspecific way with a relatively short febrile prodrome lasting 3-5 days. In addition to fever and myalgias, early symptoms include headache, chills, dizziness, non-productive cough, nausea, vomiting, and other gastrointestinal symptoms. Malaise, diarrhea, and lightheadedness are reported by approximately half of all patients, with less frequent reports of arthralgias, back pain, and abdominal pain. Patients may report shortness of breath, (respiratory rate usually 26 - 30 times per minute). Typical findings on initial presentation include fever, tachypnea and tachycardia. The physical examination is usually otherwise normal. Within 24 hours of initial evaluation, most patients develop some degree of hypotension and progressive evidence of pulmonary edema and hypoxia, usually requiring mechanical ventilation. The patients with fatal infections appear to have severe myocardial depression which can progress to sinus bradycardia with subsequent electromechanical dissociation, ventricular tachycardia or fibrillation. Causes lungs to fill with fluid in 33% of patients, infects cells beneath the lung epithelium, 35% mortality rate Vaccine: None

Rhinovirus Disease: Common Cold Route of Transmission: respiratory droplets and possibly nasal secretions and hand to hand contact

Symptoms: Incubation 3-5 days, Virus infects upper respiratory tract tissues Vaccine: None

Paramyxovirus Disease: Mumps Route of Transmission: saliva, respiratory route and urine.

Symptoms: Infects respiratory epithelium, then general viremia, infects multiple organs including Parotid glands, swelling, blocks ducts of gland causing saliva accumulation and swollen facial tissues, Meningitis occurs in 1 out of 10 children with mumps and can lead to deafness and other damage. Orchitis in post puberty males, over 4,000 cases in U.S. annually Vaccine: MMR, mumps, measles, and rubella vaccine, attenuated live vaccine

Irregular nonsporing gram-positive rods Corynebacterium diphtheriae Disease: diphtheria Route of Transmission: spread by respiratory aerosol

Symptoms: Infects throat or skin iron regulated toxin production from lysogenic phage symptoms are sore throat, fever, malaise and swelling of the neck, all are directly related to the toxin produced. Pseudomembrane: fibrous membrane containing dead host and bacterial cells can form leathery blockage of trachea The exotoxin inhibits host protein synthesis and can result in heart, kidney or nerve damage The disease is uncommon in industrialized countries because of vaccine use. Vaccine: antitoxin and penicillin or erythromycin are given, part of DPT vaccine as toxoid (inactivated toxin

Morbillivirus Disease: Rubeola (measles) Route of Transmission: Respiratory route

Symptoms: Measles symptoms generally appear in two stages. In the first stage, the individual may have a runny nose, cough and slight fever. The eyes may become reddened and sensitive to light, while the fever consistently rises each day. The second stage begins on the third to seventh day, and consists of a temperature of 103° to 105°. and a red, itchy rash lasting four to seven days. The rash usually begins on the face and then spreads over the entire body. Koplik spots (little white spots) may also appear on the gums and inside of cheeks. Incubation 9-12 days, Pneumonia occurs in up to 6 percent of reported cases and accounts for 60 percent of deaths attributed to measles. Encephalitis (inflammation of the brain) may also occur. Other complications include middle ear infection and convulsions. It can lead to ear infection, seizures (jerking and staring), brain damage, and death. Vaccine 95% effective if given prior to symptoms, Can cause fatal encephalitis in children, Most cases today occur in infants too young to vaccinate and in inner city children who receive no vaccinations. Approximately 10,000 U.S. cases annually Vaccine: MMR - live attenuated vaccine

SS RNA, Nonenveloped + Strand Picornaviruses Poliovirus Disease: Poliomyelitis (Polio) Route of Transmission: fecal/oral route of transmission

Symptoms: Most cases (10% clinical cases) are flu-like (headache, sore throat, fever, nausea), gastrointestinal distress, only 1% are paralytic, stable in food and water, 1-3 day incubation, infects throat, small intestine and motor nerve cells in upper spinal cord causing paralysis and death from respiratory failure, 3 serotypes, Less than 10 cases per year in U.S. The last cases of indigenously acquired polio in the United States occurred in 1979. Vaccine: Salk vaccine 1954 was inactivated (killed ) viruses of all 3 types (trivalent) called IPV, 90% effective, injection, requires a booster: Sabin 1963 attenuated oral vaccine (OPV). Attenuated viruses shed in feces are hazardous to immunocompromised. To eliminate the risk of vaccine-associated paralytic poliomyelitis, OPV is no longer recommended for routine immunization in the United States as of January 1, 2000. OPV is no longer available in this country, although it continues to be used in the majority of countries and for global polio eradication activities.

B. cereus Disease: Food poisoning Route of Transmission: associated with ingestion of reheated rice

Symptoms: Produces two toxins heat stable toxin associated with germination of spores and causes food poisoning 1-5 hours after ingestion (intoxication) heat labile enterotoxin produced by vegetative cells causes diarrhea 10-15 hours later (infection). most commonly associated with reheated rice dishes Vaccine: No Vaccine, most illness is self-limiting

Rickettsia rickettsii Disease: Rocky mountain spotted fever Route of Transmission: tick bite

Symptoms: Rickettsias multiply inside the host cell cytoplasm. Rickettsial disease in humans results in damage to the permeability of capillaries, and potential collapse of the cardiovascular system causes a rash similar to measles but also on the soles and palms (viral infections do not produce rashes here). also have a fever and headache death often as a result of kidney and heart failure Vaccine: Tet and chloramphenicol very effective early, no vaccine

Rotavirus Disease: Diarrhea Route of Transmission: Fecal/Oral

Symptoms: Rotavirus is the most common cause of severe diarrhea among children, resulting in the hospitalization of approximately 55,000 children each year in the United States and the death of over 600,000 children annually worldwide. The incubation period for rotavirus disease is approximately 2 days. The disease is characterized by vomiting and watery diarrhea for 3 - 8 days, and fever and abdominal pain occur frequently. Immunity after infection is incomplete, but repeat infections tend to be less severe than the original infection. A rotavirus has a characteristic wheel-like appearance when viewed by electron microscopy (the name rotavirus is derived from the Latin rota, meaning "wheel"). Rotaviruses are nonenveloped, double-shelled viruses. The genome is composed of 11 segments of double-stranded RNA, which code for six structural and five nonstructural proteins. The virus is stable in the environment. Vaccine: In a report issued February 3rd, 2006, the U.S. Food and Drug Administration approved a live, oral vaccine (RotaTeq™) for use in children.

obligate intracellular bacteria Microscopic image of intracellular bacteria Coxiella burnetii Disease: Q fever Route of Transmission: transmitted by aerosols from animals or by contaminated milk from cows

Symptoms: This organism is also the only known Gram-negative endospore producer Not transmitted by insects like the other Rickettsias resistant to drying, heat and sunlight main site of action is the lung fever, severe headache, atypical pneumonia can develop into hepatitis and endocarditis disease may self-limit in 1-2 weeks May also become chronic and fatal if untreated Vaccine: Killed vaccine available for high risk groups, Killed by pasteurization, Antibiotic therapy available -Only known Gram negative endospore producer.

Cytomegalovirus (CMV) or (HHV5) Disease: Encephalitis, mononucleosis, hepatitis , CMV retinitis, Heart disease? Route of Transmission: fomites and possibly respiratory droplets, virus is shed in saliva, urine, semen, cervical secretions and breast milk

Symptoms: Virus can infect blood cells and blood-rich organs, Usually a pharyngeal infection, 80% of population is infected, most show fever and malaise but no serious symptoms, Virus can pass to fetus in pregnant women and damage fetal tissues, In immunocompromised persons, serious infection of multiple organs including lung, liver, brain, kidney and eye, CMV retinitis sometimes has a classical appearance of ketchup and cottage cheese (white, clumpy infiltrates and hemorrhages)., cytomegaly (swollen, enlarged cells) often seen in diagnosis, latency in macrophages and T cells, may be linked with the buildup of plaque in arteries leading to heart disease Vaccine: None

Herpes Simplex Virus II (HSVII) or (HHVII) Disease: Genital Herpes Route of Transmission: vesical fluid, sexual contact and by birth canal

Symptoms: Virus infects subcutaneous tissues, Axonal travel to latency sites in sensory ganglia (sacral ganglia), primary infection slight burning sensation, urination is painful, vesicles contain virus-laden fluid, urethral discharge, neonatal herpes is a real concern, Many infants infected at birth die or have severe mental retardation, cesarian sections have been used in the past as a preventative but do not work particularly well. New studies show use of acyclovir to suppress outbreaks during delivery have a better chance of preventing transfer, virus can cross the placenta, can cause rare herpes encephalitis Vaccine: no vaccine but acyclovir can help relieve symptoms, Use of condoms decreases transmission risk

Salmonella species Disease: salmonellosis Route of Transmission: fecal/oral route

Symptoms: all species are potential pathogens Salmonella are also involved in many severe, food-borne gastrointestinal diseases called salmonellosis causes 70% of all food borne diarrheal diseases in the United States Source is often uncooked eggs, nausea, abdominal pain diarrhea 12-36 hours after ingestion fever from endotoxin a variety of species cause this syndrome salmonella may be harbored in the human body Vaccine: rehydration therapy may be needed

Clostridium botulinum Disease: botulism Route of Transmission: Ingestion of toxin or bacilli

Symptoms: caused by ingesting preformed exotoxin which is destroyed by proper boiling ( an intoxication, not a true infection) Symptoms include nausea, diplopia (double vision) and dysphagia (difficulty in swallowing) toxin is acid stable and survives stomach, Toxin is heat labile acts at neuromuscular junctions by inhibiting acetylcholine release so nerve impulses are blocked blurred vision occurs within the first 1-2 days followed by flaccid paralysis and often death due to respiratory failure as a result of paralysis of the diaphragm. Wound botulism may also occur when the organism grows anaerobically in deep wounds. Vaccine: Treatment is antitoxin, Supportive therapy essential, Until 1993, the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) kept one horse named First Flight and injected him with 7 serotypes of botulism toxoid. He was the United States only source of heptavalent botulinum antitoxin and donated more than 1,600 liters of blood during his duty. He was the only source of antitoxin for our troops during the Gulf War when Saddam Hussein had botulism in his germ warfare arsenal. First Flight has now been retired.

Vibrio cholerae Disease: cholera Route of Transmission: Contaminated water or foods

Symptoms: causes profuse, watery diarrhea produces exotoxin (toxin secreted by bacteria) which alters membrane permeability of intestinal mucosa and causes massive watery diarrhea (rice water stool; 3-5 gallons/day) and vomiting fever usually absent, incubation 3 days, symptoms last several days 50% mortality if untreated, death as a result of severe dehydration 300,000 people died of cholera in Rwanda in 1995 Vaccine: Tetracycline shortens the symptoms, a whole cell vaccine is available but of limited use -Known for the large volume of diarrhea produced per day and death due to the secondary effects of dehydration.

Acid-fast, aerobic, non-spore-forming, nonmotile, rod-shaped bacteria Mycobacterium leprae Disease: Leprosy Route of Transmission: close, prolonged contact

Symptoms: chronic degenerative infection that leads to gradual tissue destruction Leprosy also called Hansen's disease pathogenesis mostly due to host's immune response rather than bacterial toxicity M. leprae only bacterium that grows in peripheral nervous system and also grows in skin cells. prefers cooler temps of the extremities. Two forms of leprosy. Tuberculoid (neural) form results in loss of nerve sensation in an area surrounded with nodules. Organisms can be detected in cool areas such as earlobes. Usually this form is self limiting because of immune system effectively clears the infection. The lepromatous (progressive) form results when the person's immune system does not respond effectively to the disease and nodules spread to all parts of the body. Necrosis of tissue also occurs. Vaccine: Antibiotics can render victims noncommunicable in a few days (Dapsone, Rifampicin, Clofazimine), there is a vaccine in trials, BCG vaccine is 50% effective

Mycobacterium tuberculosis Disease: tuberculosis Route of Transmission: respiratory droplet transmission

Symptoms: chronic progressive lung infection weight loss, coughing, rust colored sputum (only in an advance case), chest pain, malaise, night sweats pathogenesis mostly due to host's immune response rather than bacterial toxicity Lesions called tubercles form from dead macrophages and bacteria and appear on X ray hollow cavity is then formed in the tubercle where MTB can grow, chemotherapy of multiple drugs given over a long period of time multiple drug resistant strains exist A positive skin test can mean many things, Smoking, aging, overcrowded living conditions, substance abuse and immunosuppression predisposes individuals to TB Vaccine: Drugs include Isoniazid, ethambutol, Rifampin, Pyrazinamide, Ciprofloxacin and Streptomycin, M. bovis is BCG vaccine, live, attenuated

Hepatitis E Virus (HEV) Disease: Hepatitis Route of Transmission: fecal/oral

Symptoms: clinically similar to HAV and exists in contaminated water, May be responsible for 50% of sporadic hepatitis cases in developing countries, Incubation 6-8 weeks, for some reason high mortality rate in pregnant women (20%) in the third trimester with disseminated intravascular coagulation. Vaccine: None, antibodies may be helpful

Regular nonsporing gram-positive rods Listeria monocytogenes Disease: Listeriosis (meningitis in neonates and immunocompromised) Route of Transmission: Food-borne or in utero

Symptoms: contaminant of dairy foods which can be very damaging to pregnant women resulting in stillbirth or meningitis and sepsis in newborns infects immunocompromised, cancer patients can cross placenta causing spontaneous abortion or stillbirth Found in cow's milk and infected foods such as cheese may be asymptomatic in healthy people Pregnant women advised against eating any uncooked foods. Vaccine: No Vaccine, Antibiotic therapy

Endospore-forming Gram-positive rods Bacillus anthracis Disease: anthrax Route of Transmission: respiratory route or spore entrance through abrasions

Symptoms: endospores can survive up to 60 years cattle acquire spores by grazing, humans get disease by handling cow products or respiratory site of entry often develops black necrotic pustule (eschar) followed by septicemia results in pneumonia Vaccine: Penicillin is drug of choice, vaccine is available

Enterococcus faecium and faecalis Disease: urinary tract infection, endocarditis, post operative infections Route of Transmission: Normal flora or nosocomial

Symptoms: frequent painful/burning urination, difficulty voiding bladder, cloudy foul-smelling urine, blood in urine, abdominal pain, fever, Diagnosed by urine culture, inflammation of heart lining Vaccine: No vaccine, Antibiotic therapy, Many strains resistant to vancomycin (VRE)

Hepadnaviruses Hepatitis B Virus (HBV) Disease: Hepatitis Route of Transmission: transfusion and secretion of any body fluids, IV drug use, between mother and fetus, tattooing, earpiercing, acupuncture, between family members, in institutions. Needle-stick injuries, hemodialysis, orally, anal/oral sex

Symptoms: goes through an RNA intermediate instead of replicating its DNA directly, similar to HIV, 60-90 day incubation, Infectious particle is called Dane particle, spherical and filamentous particles which are contain unassembled components without nucleic acids but do have HB surface antigen for identification, Most cases are asymptomatic, loss of appetite, fever, joint pains and jaundice, swollen tender liver, clay colored stools and darkening of urine. 10% of cases become chronic carriers and there is high incidence of liver cancer in carriers possible due to integration of HBV DNA into liver cell chromosomes, 1.25 million Americans are chronic carriers, incidence has declined from about 200,000 cases per year in U.S. before the vaccine, to ~60,000 per year now. Vaccine: HBV subunit vaccine is now produced in yeasts, vaccination is needed for anyone exposed to blood in their work, (health care workers, laboratory technicians, dentists, surgeons, nurses, emergency service workers, police, fire fighters, paramedics, military and those living with infected individuals). interferon treatment is promising, Prevention: always practice safe sex and never share objects such as needles, razors, toothbrushes, nail files and clippers. When getting a manicure, tattoo or body piercing, make sure sterile instruments are used.

Multiple SS RNA strands, antisense Influenzae virus Disease: Influenzae Route of Transmission: respiratory route and hand to hand contact

Symptoms: headaches, chills, abrupt fever, muscle aches, nasal discharge, sore throat, pneumonia, dangerous in elderly, Infects humans, pigs, geese, horses, N (neuraminidase) and H (hemagglutinin) proteins are present in envelope, no such thing as stomach flu, major changes called antigenic shifts, minor changes by antigenic drift Vaccine: Flu vaccine are based on the best guess and the earliest cases, Amantadine (antiviral) somewhat useful for Influenzae B not A. The drug GG167 developed in 1992 interferes with the virus' ability to replicate and spread to new respiratory cells and can be given as a nasal spray or tablet. GS4104 is given in pill form and promises the same action. Tamiflu (oseltamivir) is for treating influenza A and B virus infections in adults and children 1 year and older. Relenza (zanamivir) is for treating influenza A and B virus infections in children 7 years and older and adults who have an uncomplicated flu infection and who have had symptoms for no more than 2 days.

Hepatitis A Virus (HAV) Disease: Hepatitis Route of Transmission: Fecal/oral route, between family members, in institutions, IV drug use, transfusions, orally, anal/oral sex, sexually suspected.

Symptoms: infects epithelial lining of intestinal tract, spreads to liver, kidneys and spleen, 2-4 wk incubation, most of viruses are shed prior to symptoms, survive several days on surfaces, harbored in oysters, many cases are subclinical, symptoms are anorexia, malaise, nausea, diarrhea, abdominal discomfort, fever, chills, jaundice, dark colored urine, clay colored stool, no chronic form, Over 150,000 cases in U.S. per year. Adults will have signs and symptoms more often than children. Once you have had hepatitis A you cannot get it again. Vaccine: Passive antibody may be given, there is an inactivated virus vaccine which was licensed by the FDA in February 1995, vaccine recommended for day care workers, anyone coming in contact with an infected person, travel to locations with poor sanitation, or living in an area of a recent outbreak.

Adenoviruses Disease: Common cold, Conjunctivitis, ARD Route of Transmission: respiratory droplets and skin contact

Symptoms: infects epithelium of respiratory tract, eyes and intestine, cough, nasal congestion, pneumonia, intestinal illnesses and eye infections, causes about 5% of viral respiratory illness in U.S., Conjunctivitis can be spread by pool water. Acute respiratory disease (ARD), first recognized among military recruits during World War II, can be caused by adenovirus infections during conditions of crowding and stress. Vaccine: None

Coronavirus Disease: Acute coryza (Common cold) Route of Transmission: indirect contact (fomite)

Symptoms: nasal and sinus congestion, runny nose, sore throat, coughing, recovery time one to two weeks, usually no fever, sinusitis, laryngitis and otitis media esp. in children are complications, most common in children and elderly Vaccine: None

Hepatitis G Virus (HGV) Disease: Hepatitis Route of Transmission: Blood transfer and possible other routes

Symptoms: newly discovered, 0.3% acute viral hepatitis. About 900 - 2000 mostly asymptomatic cases of infection per year (U.S.A., U.K.). 90 - 100% persons with HGV infection has chronic infection. may first appear as mild infection which subsides, followed by years of cumulative liver damage, Probably develops carriers, found in complex research assays to contaminate 2% of today's blood donors which is more than carry HBV or HCV. There is currently no rapid blood test used by blood banks. 20% of patients with HCV will also have HGV Vaccine: none

Brucella melitensis Disease: brucellosis or undulant fever Route of Transmission: Direct handling of infected animals

Symptoms: nonmotile coccobacillus which is an obligate intracellular bacterium Undulate fever is a zoonotic disease (where a non-human vertebrate serves as reservoir of infection, and humans are only accidental hosts). The reservoir is domesticated animals such as cows, pigs, goats; bacteria enter through skin or mucosa, capable of surviving phagocytosis by macrophages. spread via lymph to liver, spleen or bone marrow, signs are malaise (general weakness and tiredness) swollen lymph nodes and fever that undulates or spikes every evening Also called Bang's Disease, Malta Fever,rock fever of Gibraltar and undulant fever. Vaccine: vaccine is available for cattle and high risk groups; Farmers, ranchers, vets, meat packers are risk groups, Erythromycin and tetracycline Known for abortion storms in pregnant cows.

Streptococcus pneumoniae Disease: Pneumococcal pneumonia Route of Transmission: Respiratory droplet transmission

Symptoms: normal flora at some times, 4% of population are carriers Capsulated symptoms are fever, fluid accumulation, difficulty breathing, chest pain and rust colored sputum Sickle cell patients are more susceptible to pneumococcal pneumonia and should be vaccinated, increased susceptibility is due to atrophy of the spleen Vaccine for pneumonia may provide some protection against Pneumococcal meningitis, relatively rare but causes high mortality rate 15% mortality Second most common cause of bacterial meningitis in children and young people, but one of the fastest to kill. Can kill within 24 hours. The most common cause of meningitis in adults. Vaccine: Capsular polysaccharide vaccine, Penicillin treatment of choice for sensitive strains

Hepatitis D Virus (HDV) Disease: Hepatitis Route of Transmission: Probably same as HBV and HCV

Symptoms: occurs as a coinfection with HBV (get both at the same time from the same source) or as superinfection (you have HBV first and get HBV later from a different source), requires the envelope of HBV to be infectious. Infected persons have high rate of liver damage Vaccine: None, but HBV prevention will prevent HDV infection

Neisseria meningitidis Disease: Meningococcal meningitis Route of Transmission: grows in throats of healthy carriers, spread by respiratory droplets

Symptoms: once in blood, the organism crosses the blood-brain barrier symptoms due to endotoxin diagnosis of meningitis is based on cultures made on blood agar which are incubated at reduced oxygen tension Cells look like coffee-beans microscopically causes most of meningitis cases 10-15% mortality 10-15% of infected individuals have long term complications such as deafness, mental retardation, etc. The Rash of this disease differentiates it from other menigitis causes. Vaccine: purified capsular polysaccharide is used as vaccine for some strains (type A and C; Not B), Penicillin or cephalosporin first treatment, maybe along with chloramphenicol, Rifampicin for prophylaxis -Known for the rash associated with the meningitis

Varicella Zoster virus(VZV) or (HHV3) Disease: chicken pox and shingles Route of Transmission: respiratory aerosol, fomites and direct contact

Symptoms: one of the most contagious diseases, about 150,000 cases annually in U.S., localized infection in the skin with fever, malaise, teardrop-shaped fluid filled vesicles after 3-4 days, Vesicles itch intensely and yield virus-laden fluid; crust and fall off usually with no scar, highly virulent strains can cause fatal encephalitis, DNA stays latent in neurons, Herpes Zoster (shingles) may occur many years later, the first shingles attack may occur as isolated pain, localized numbness, tingling or burning or shooting pain. Mild flu-like symptoms may also occur. Lesions ( a blotchy rash) appear 1-14 days later usually in a band on one side of the body or extremities or clustered on one side of the face or scalp. The lesions become fluid-filled blisters which slowly crust, scab and heal. Once healed, some people experience pain for months longer. The pain is called neuropathic pain because of viral damage to nerves. In some patients particularly the elderly, the pain becomes chronic. This is called post-herpetic neuralgia (PHN) and in some victims the pain is so intense, the slightest touch, contact with clothing or even a breeze may be unbearable. Discoloration and scarring of the skin is also possible. A person cannot acquire shingles from someone with shingles; however, someone who has never had chicken pox can get it from a shingles patient. Vaccine: Acyclovir may be used in treatment, Varicella-zoster immune globulin (VZIG) used in immunocompromised patients exposed to the virus, Reyes syndrome (brain dysfunction due to swelling, coma and death) associated with giving aspirin to reduce fever, transmission is common in schools and day care, Now live, attenuated vaccine.

Clostridium perfringens Disease: Gas gangrene and food poisoning Route of Transmission: wound

Symptoms: progressive necrotizing infection Produces at least 12 toxins and tissue-destroying enzymes in wounds organisms then use nutrients released Bacterial fermentation may produce gas pockets in tissue Food poisoning occurs when cells are ingested and sporulate in the gut releasing toxin. Does not usually require treatment Vaccine: No vaccine, Treatment includes penicillin, Metronidazole, antitoxin, Debridement, hyperbaric chambers and amputation used to treat gas gangrene

Chlamydia trachomatis Disease: trachoma (infection of the conjunctiva of the eye), nongonococcal urethritis, PID and lymphogranuloma venereum Route of Transmission: STD (sexually transmitted disease) or transmitted by direct contact

Symptoms: scar tissue forms on cornea the leading infectious cause of blindness in the world most common sexually transmitted disease and leading cause of infertility 75% of females often asymptomatic bacteria easily infect warm, moist cervix and can cause permanent reproductive organ damage, infection of lymph nodes and inflammation of the genitalia, spreads to fallopian tubes resulting in PID In women symptoms include: unusual vaginal discharge, burning when urinating, lower abdominal pain or pain during intercourse, and bleeding between menstrual periods. In men: discharge from the penis, burning when urinating, burning and itching around penis opening, pain and swelling of testicles Serology inefficient in diagnosis because organisms are intracellular Advanced infections become LGV with buboes, often ruptured, strictures and fistulas Vaccine: None, Tetracycline and Erythromycin used, Fluoroquinolones useful.

Shigella dysenteriae Disease: bacillary dysentery or shigellosis and traveler's diarrhea Route of Transmission: fecal/oral route

Symptoms: small dose required invasion of ileum and colon causes bloody mucoid diarrhea abdominal cramps, fever, intense inflammation also produces a neurotoxin (bacterial toxin that affects the nervous system) Mortality 20% if untreated Vaccine: No vaccine, antibiotics should be avoided because of high degree of resistance, Hand washing is prophylactic

Escherichia coli Disease: Urinary tract infection and Traveler's diarrhea Route of Transmission: Fecal/oral route

Symptoms: the most well known enteric. It is a common inhabitant of the intestinal tract and is a workhorse in molecular biology/biotechnology. The presence of E. coli in water and foods is often an indication of fecal contamination. Although it is not usually pathogenic, many pathogenic strains exist, and the organism is very opportunistic as are most microbes. E. coli is a major contributor to UTI (urinary tract infections) UTI: frequent painful/burning urination, difficulty voiding bladder, cloudy foul-smelling urine, blood in urine, abdominal pain, fever Diagnosed by urine culture Caused by a number of organisms from this group and others many strains produce an enterotoxin (a bacterial toxin that causes inflammation of the stomach and intestine) which is associated with traveler's diarrhea. Vaccine: None -The Jack-in-the-Box E. coli (O157:H7) is the deadliest strain.

Clostridium tetani Disease: Tetanus or lockjaw Route of Transmission: Puncture wound

Symptoms: the organism reaches the anaerobic environment it prefers after puncture wound 72 hours with headaches, fever, irritability and paralysis of face and neck severe disease noted by muscle spasms and convulsions endospores widespread in soil, produces a neurotoxin called tetanospasmin (LD50 = 20ng) which causes spastic paralysis convulsive contractions of voluntary muscles death results from spasms of respiratory muscles Vaccine: Immunization by DPT (Diphtheria, Pertussis and Tetanus) includes tetanus toxoid (inactivated toxin), booster is often given, if you have never been immunized before, tetanus immune globulin is given, Debridement (removal of tissue) and antibiotics may be necessary to clear the organisms

SS RNA, Enveloped + Strand Togaviruses - Rubivirus Disease: Rubella or German Measles Route of Transmission: respiratory route

Symptoms: Pale pink rash, light fever, short duration, serious in congenital cases, Usually occur during first trimester with infections of eyes, ears and heart, possibly congenital deformity and/or stillbirth, About 1500 cases annually in U.S., 50 congenital Vaccine: MMR vaccine (Measles, Mumps and Rubella), vaccines developed in 1969 and 1979

Streptococcus pyogenes Disease: strep throat ear, sinus and tonsil infections Puerperal sepsis Impetigo in older children and adults erysipelas **Scarlet fever **Rheumatic fever Route of Transmission: Respiratory or direct contact

Symptoms: Beta hemolytic Alpha-hemolytic species produce alpha-hemolysin which reduces hemoglobin( red) to methemoglobin (green) resulting in a greenish zone around the colonies. Beta-hemolytic species produce hemolysin which forms a clear zone when blood cells are lysed. Some species have no apparent hemolysis and are classified as gamma-hemolytic. produce a variety of toxins Impetigo, Purulent (pus-filled) lesions with honey-colored crusts, lesions near mucous membranes Red skin discolorations (erysipelas) may result from strep producing erythrogenic toxin (toxin that causes abnormal redness due to inflammation) spread by direct contact or overgrowth of flora responds well to antibiotic therapy Scarlet fever- toxin gene carried on a prophage, causes rash (not on soles or palms) which is pin-point and rough (sand paper) to the touch, "Strawberry tongue" is red, enlarged and raw, followed by desquamation Rheumatic fever caused by cross reactive antibodies between strep and heart. Endocarditis is infection of inner lining of the heart, tissue, acute glomerulonephritis (inflammation of the kidney) and inflammation Streptococci are usually absent by this point, so anti-inflammatory drugs are given Vaccine: No vaccine, Antibiotic therapy

Disease: Sudden Acute Respiratory Syndrome (SARS) Route of Transmission: Close person to person contact

Symptoms: Common cold like sytmptoms. Elderly and immunocompromised most at risk. Only 8 cases diagnosed in the U.S. Vaccine: None

Reoviruses Disease: Common cold Route of Transmission: respiratory route

Symptoms: Respiratory tract infection, like common cold and infantile gastroenteritis. Vaccine: No vaccine

Bacteria Without Cell Walls Mycoplasma pneumonia Disease: primary atypical pneumonia Route of Transmission: Respiratory route

Symptoms: also known as "walking pneumonia", contains no peptidoglycan, but does have outer membrane, cells attach to ciliated respiratory epithelium in the respiratory tract, lasts for weeks but is usually not severe enough to require hospitalization, a very common cause of pneumonia in previously healthy middle aged individuals. Vaccine: None, Tet and erythromycin

Rickettsia typhi Disease: endemic murine typhus (not the same as typhoid fever caused by Salmonella) Route of Transmission: rat fleas

Symptoms: less severe Vaccine: None, usually self-limiting

Rickettsia prowazekii Disease: epidemic typhus Route of Transmission: transmitted in the feces of human lice

Symptoms: rash, prolonged high fever, and stupor Vaccine: treatable with antibiotics

medically important group of bacteria

acultative anaerobic, Gram negative rods

Enveloped viruses can exit a host cell by a process called

budding

Bacterial Pneumonias

fluid accumulation, fever, chest pain and impairment of respiratory function

Endotoxin causes

high fever and shock, activation of complement, blood clotting, inflammation and stimulation of immune cells through the release of cytokines

Tertiary syphilis

may occur decades later neurological symptoms circulatory involvement and gummas (large lesions) Accommodation of pupils but no reaction to light is known as Argyll Robertson pupils. Dorsal root column demyelination causes tabes dorsalis which causes abnormalities of sensation, sharp pains, incoordination and incontinence. Also called "slapped foot walking" because of the loss of feeling in the feet. It causes a distinctive way of walking.

It requires a large dose of Salmonella to make you sick. You only have to swallow ______ shigella to get extremely sick.

one

Bacterial meningitis

progressive impairment of CNS (central nervous system) leading to coma and death, Intense headaches, photophobia (light sensitivity), fever and stiff neck. How do these symptoms differ from viral, fungal or protozoan meningitis? They do not; however, remember viral meningitis will not cause turbidity in CSF, where "cellular" meningitis of any kind can. Since bacterial meningitis is more common that protozoan or fungal, it is test for first. Bacterial meningitis is also a faster killer and should be evaluated right away.

among the RNA viruses only the __________ seem to be oncogenic

retroviruses

Primary syphilis infection

small hard based chancre (ulceration or sore) for a few days Painless, many patients do not even know it is there.

Borrelia burgdorferi Disease: Lyme disease Route of Transmission: transmission by hard ticks

symptoms: diagnosis usually serology difficult to see Lyme disease slowly progressing characteristic bull's eye skin lesions in 50% of cases organisms are harbored in mice and deer 1 week incubation fever, headache, myalgia (muscle pain), lymphadenopathy (swelling of lymph nodes), joint pain, fatigue later neurological and cardiac problems pets also susceptible Vaccine: No vaccine, Tetracycline, erythromycin and penicillin Bull's eye lesion in 50% of cases, arthritic symptoms otherwise.

Human Immunodeficiency Virus (HIV) Disease: Acquired Immunodeficiency Syndrome (AIDS) Route of Transmission: Sexually, IV drug use, Tissue transplant, blood transfusion

ymptoms: Remember for all the RNA viruses, fidelity in the replication of RNA is not as high as for DNA so more mistakes occur. Therefore there is higher rate of change. The stages of cellular infection are as follows: 1. HIV attaches to receptors on a host cell and release HIV RNA into the cytoplasm. 2. An enzyme called reverse transcriptase converts the SS viral RNA into DS viral DNA which travels to the nucleus. 3. The enzyme called integrase splices the viral DNA into the host cells DNA. 4. The infected cell produces more viral RNA which in turn can be translated to form large viral proteins. 5. A protease enzyme cuts the viral proteins into functional protein shorter in length. 6. New viral proteins and RNA come together to form new viral particles. 7. New HIV particles bud from the surface of the infected cell and infect new cells. Vaccine: None