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CATALASE POSITIVE, GRAM- POSITIVE COCCI Organism General Characteristics Diseases Diagnostic Tests Micrococcacea  Catalase + Staphylococcus...

CATALASE POSITIVE, GRAM- POSITIVE COCCI Organism General Characteristics Diseases Diagnostic Tests Micrococcacea  Catalase + Staphylococcus  Gram + cocci in  Toxic shock syndrome  Catalase + clusters with PMN  Scalded skin syndrome  Coagulase + cells (Ritter’s disease)  B-hemolytic  Grape-like clusters  Most common cause of  PENICILLIN  Staphyloxanthin septic arthritis in RESISTANT (yellow or golden on prepubertal children  B-lactamase Staphylococcus aureus BA)  Common cause of nosocomial pneumonia  Acute endocarditis (IV drug user; tricuspid valve) Virulence Factors: Toxins:  Polysaccharide capsule  Alpha toxin  Slime layer or biofilm  Beta toxin  Peptidoglycan  Delta toxin  Protein A  Gamma toxin  Coagulase  Heat stable  Hyaluronidase enterotoxin  Lipase  TSST-1  PVL  Exfoliative toxin or epidermolytic toxin  Gram + cocci in  Most common cause of  Catalase + clusters prosthetic valve  Coagulase – endocarditis  Staphylococcus epidermidis  Small-medium,  Implantation of  NOVOBIOCIN opaque, gray white medical devices SENSITIVE colonies, slime-  Non-hemolytic producing strains are extremely sticky Virulence Factors:  Polysaccharide capsule  Slime layer or biofilm  Peptidoglycan  Delta toxin  Gram + cocci in  Second most common  Catalase + clusters cause of UTI in young  Coagulase – Staphylococcus saprophyticus  Large, entire very females  NOVOBIOCIN glossy, smooth, RESISTANT opaque butyrous,  Non-hemolytic covex Virulence Factor:  Peptidoglycan  Dog bite wound  Misidentified as S. Staphylococcus intermedius infections aureus (Coagulase -)   Staphylococcus lugdunensis Staphylococcus scheliferi Micrococcus  Normal Flora  Catalase +  Coagulase –  Modified oxidase test +  BACITRACIN SENSITIVE  FURAZOLIDONE RESISTANT  Stomatococcus  Normal Flora CATALASE NEGATIVE, GRAM- POSITIVE COCCI Streptococcus  Catalase -  Gram + cocci in chains  Scarlet fever (SPEs)  Catalase –  Round to oval shaped Rheumatic fever (M  B-hemolytic occasionally forming protein)  BACITRACIN elongated cells  Necrotizing fasciitis SENSITIVE resembles  Honey-colored crusts  PYR + Streptococcus pyogenes (Group pleomorphic (impetigo) A) corynebacterial or  Most common lactobacilli bacterial cause  Honey-colored crusts pharyngitis Virulence factors  Streptlysin O  Streptolysin A  SPEs  M protein  Hyaluronidase  C5a peptidase  Erythrogenic toxin  Streptokinase  Protein f  DNASeB  Exotoxin B  Capsule (most  Pneumonia  Catalase – important virulence)  35-37 days of gestation  B-hemolytic  Grayish-white mucoid tests for GBS  BACITRACIN Streptococcus agalactiae colonies surrounded RESISTANT (Group B)  PYR –  by a small zone of  CAMP + βhemolysis  Hippurate hydrolysis +  SXT R Virulence Factors  Capsule (Important)  DNASe, hyaluronidase  Leukocytosis, lancet-  Leading cause of  Catalase – shaped in pairs, singly, bacterial meningitis in  A-hemolytic Streptococcus pneumoniae or short chains infants, young children,  Bile solubility S  Round, glistening, wet, and adults ( N. (soluble) mucoid, dome shaped meningitidis, H.  Optochin S appearance influenzae)  Quellung + Virulence Factors  Capsule  Pneumolysin  Phosphorylcholine Enterococcus (Group D)  UTIs  PYR + a. Enterococcus faecalis  Bacteremia  6.5% NaCl growth  Endocarditis  LAP + b. Enterococcus faecium  Cephalosporins, aminoglycosides R (VRE) Virulence Factors  Aggregation substance  Capsular polysaccharides  Surface carbohydrates  Ability to translocate across intact intestinal mucosa  Hemolysis   Lipoteichoic acid  Gelatinase  Superoxide production  Peptide inhibitors  Ability to adhere to extracellular matrix proteins  Butterscotch smell on  Dental caries (S. Viridans Streptococci CA mutans)  Subacute bacterial endocarditis CATALASE POSITIVE, NON- BRANCHING, GRAM-POSITIVE BACILLI Bacillus  Aerobic  Catalase +  Spore-forming rods Bacillus anthracis  Large, in singles, pairs  Cutaneous anthrax or serpentine chains  Gastrointestinal  Spore-forming (ingestion) anthrax  BA: medium-large,  Inhalation anthrax – gray, flat irregular Wool sorter’s disease swirling projections and ragpickers’  Box car-like rods disease  “comet tails” or  Injectional anthrax Medusa Head” or ground glass colonies Virulence Factors  Lethal toxin  Edema toxin   Large, in singles, pairs  Ingestion of fried rice  BCYE or serpentine chains  Food poisoning: Bacillus cereus diarrhea and abdominal pain Toxins  Hemolysin BL  Nonhemolytic enterotoxin  Cytotoxin K  Cereulide LISTERIA, CORYNEBACTERIUM, and Similar Organisms  Non-spore forming  Catalase –  Short rod, occurs  Listeriosis  VP + Listeria monocytogenes singly or short chains  Stillbirth  CAMP + (resembles  Esculin + streptococci)  PCR  End-over-end  Elek Test tumbling motility  Umbrella-shaped pattern Virulence Factors  Lesteriolysin O  Act A Corynebacterium  Not normal microbiota  Respiratory diphtheria  Ribotyping, pulse-field  Arranged singly in (pseudomebrane) gel electrophoresis, palisades of parallel, multilocus sequence or in pairs of cells typing Corynebacterium diptheriae forming V or L shapes   Chinese letters  Brown-black colonies with a gray-brown halo in TIN  Improper care of IV Corynebacterium jeikeium catheters  Urological Corynebacterium urealyticum manipulation  Red coccus Rhodococcus CATALASE NEGATIVE, NON- BRANCHING, GRAM-POSITIVE BACILLI  Short rods and long  Cellulitis (erysipeloid)  Catalase – Erysipelothrix spp filaments  H2S +  “bottle brush”  Delicate, curved, rods  Pharyngitis Arcanobacterium spp with pointed ends, occasional rudimentary branching  T. bernerdiae:  CAMP - Trueperella spp necrotizing fasciitis  Highly pleomorphic,  Maintaning pH balance  A-hemolytic Lactobacillus spp long chaining rods in  Dental caries coccobacilli and spiral forms   Small, pleomorphic,  Bacterial vaginosis  B-hemolytic gray, opaque, gram- variable/gram –, Gardnerella vaginalis coccobacilli and short rods  Clue cells  Fishy odor BRANCHING OR PARTIALLY ACID-FAST, GRAM-POSITIVE BACILLI Nocardia  Strictly aerobic  Catalase +  Beaded appearance  Acid Fast (V)  Pleomorphic  Pulmonary  Acid fast  Dry and heaped (immunocompromised) Nocardia asteroides colonies, similar to fungus  Soil or musty basement odor Actinomadura  Mycetoma  Not Acid fast Streptomyces GRAM-NEGATIVE BACILLI AND COCCOBACILLI  Greenish metallic  Most common cause of  IMViC: ++ – – Escherichia coli sheen on EMB or MAC UTI in females  Lactose +  Pili  Oxidase –   Watery diarrhea, HE a. ETEC and HS  Watery diarrhea (long) b. EPEC  Bloody diarrhea,  (Triad: c. EHEC hemorrhagic colitis Thrombocytopenia,  HUS uremia, hemolytic anemia)  Bloody diarrhea d. EIEC  Persistent watery e. EAEC diarrhea (w/ HIV)  Bacillary dysentery  Lactose – Shigella  Fever, watery then  100, 000 (high Salmonella  Enterocolitis infective dose)  H2S +  Lysine +  Indole –  Urea – Proteus  “burnt chocolate” or  Urea + chocolate cake odor  Deaminase +  Motile  Indole + Proteus vulgaris  H2S +  “swarming motility”  Complicated UTI  Indole – Proteus mirabilis (staghorn calculi)  Urease +  Contaminated medical  Motile Enterobacter devices  Lactose fermenter  Mucoid colony  Red pigment  Motile Serratia (prodigiosin)  Slow lactose fermenter: ONPG +  DNAse, gelatinase +  VP + Yersinia  Rods with bipolar  Bubonic plague Yersinia pestis (safety pin) staining  Invasive, toxigenic  Cold enrichment Yersinia enterocolitica  Acute mesenteric Yersinia pseudotuberculosis lymphadenitis and “pseudotubercles” Environmental niche (water or soil)  Plump coccobacilli,  Non-lactose fermenter resist alcohol  Purplish hue (mistaken decolorization for lactose fermenter)   BA: Smooth, plaque, raised, creamy, and Acinetobacter spp. smaller than Enterobacteriaceae  Water organism, Irrigating and IV solutions  Short-medium straight  RF: Cystic fibrosis  Non-lactose fermenter rods  BA: Large, smooth, Stenotrophomonas maltophilia glistening colonies with uneven edges and underneath growth  Ammonia smell GRAM-NEGATIVE BACILLI AND COCCOBACILLI Burkholderia spp.  Not normal microbiota  BCSA  Cystic fibrosis or CGD Burkholderia cepacian complex  Coccobacillius  Severe infections in Burkholderia mallei horses and related animals  Bipolar staining  Survives in human  BA: cream to yellow- macrophages Burkholderia pseudomallei orange, smooth,  Melioidosis mucoid  MAC: pink   BA: Dry and wrinkled  Putrid odor  Obligate aerobe  Pneumonia: ventilator-  Oxidase + Pseudomonas spp.  Biofilm acquired pneumonia  Pyocyanin, pyoverdin,  BA: spreading, flat,  Third most common cause pyorubrin, serrated edges, of nosocomial UTI pyomelanin on confluent growth,  Associated with disrupted Mueller-Hinton often with metallic epidermis, cystic fibrosis sheen; bluish greed,  Immunocompromised: red, or brown ecthyma gangrenosum, pigment diabetes, malignant otitis  Sweet grape-like media odor or corn tortilla- like odor  Pyocyanin (blue phenazine pigment) Virulence factors  Exotoxin A  Exoenzyme S and C  Proteolytic enzymes (Elastases)  Hemolysis (Phospholipase C)  Pili and adhesins  Alginate  Pyocyanin  catalases Alcaligenes  Strict aerobic rods  Bacteremia, ocular  Catalase + Alcaligenes faecalis  Medium-long rods infections, pancreatic  Oxidase +  BA: feathered edge abscess, bone infection,  Motile (1-12 Alcaligenes aquatiis colonies surrounded urine and ear discharge peritrichous flagella)  by zone of green  Non-glucose utilizer discoloration  Fruity odor resembling apples or strawberries Vibrio  Straight or slightly  Oxidase + curved rods  Glucose fermenter  Rapid or darting  Cary-Blair Medium shooting-star motility  Pandemic: V. cholera  Cholera, bacteremia.  B-hemolytic Vibrio cholera 01 biotype El Tor Septicemia (V. vulnificus),  Rice-water stools gastroenteritis and would Vibrio parahaemolyticus: raw infection (V. seafood parahaemolyticus, V. vulnificus) Vibrio vulnificus: raw shellfish Virulence factors/Toxins  Cholera toxin  Toxin coregulated pili  Zona occludens toxin  V. cholera O1  V. cholera O139  Straight rods with  Gastroenteritis in children  Contain no to little Aeromonas spp. rounded ends or  Severe watery diarrhea WBC coccobacilli  HUS and kidney disease  Modified CIN  Slightly curved, Chromobacterium violaceum medium to long, with rounded ends  Almond-like odor (ammonium cyanide)   Violacei (ethaol soluble violet pigment)  Facultative anaerobe  From human bites or  Assacharolytic Eikenella corrodens  Slender, medium- clenched fist wounds  Oxidase + length, with rounded  Dental plaque  Catalase – ends  Subacute endocarditis  Reduces nitrate to  Pit or corrode the (HACEK) nitrite agar  Hydrolyzes ornithine  Chlorine bleach odor and lysine Pasteurella  Oxidase +  Ferment glucose  Short, straight bacilli  Respiratory disease   BA: convex, smooth,  Endocarditis and gray, nonhemolytic, septicemia (RF: liver P. multocida subsp. multocida rough and mucoid cirrhosis)  Must or mushroom odor  Short, plump  Throat of children younger  Ferment glucose Kingella kingae coccobacilli with than 4 years old squared-off ends in  HACEK pairs or cluster, or form in chains  BA: small, with B- hemolysis, may pit GRAM-NEGATIVE BACILLI AND COCCOBACILLI Haemophilus  Small, pleomorphic,  Non-motile coccobacillary or short rods   Smooth, flat, or convex, buff, or slightly yellow colonies  Requires protoporphyrin IX: X and V Factor, NAD or NADP  Pleomorphic Haemophilus influenza coccobacilli or small rods  Typable  Nontypable (NTHi)  Hib  Not part of normal  Chancroid, Sexual Haemophilus ducreyi microbiota contact  “school of fish”  Painful genital ulcer  A. small, pleomorphic a. Haemophilus parainfluenza rods or long filamentous forms b. Haemophilus  B. small coccobacilli or parahaemolyticus short rods with occasional cells appearing as tangled filaments Bartonella  Facultative,  Culture-negative  Catalase – intracellular fastidious endocarditis  Oxidase – organisms  Urease –  Short, pleomorphic,  Nitrate reductase – rod-shaped  Multiply and persist in RBC   Acute hemolytic Bartonella bacilliformis bacteria (Oroya fever) or chronic vasoproliferative disease (chronic: Carrison disease)  Trench fever Bartonella Quintana  Bacillary angiomatosis  Bacteremia, endocarditis, chronic lymphadenopathy; HIV patients  Irregular, dry, white  Focal suppurative Bartonella henselae colonies that pit agar reaction (cat scratch  Small, circular, tan disease) moist colonies  Multicocal  “cauliflower-like” angioproliferative lesion (bacillary angiomatosis  Bacteremia, endocarditis, rheumatic, bacillary peliosis hepatitis or splenic peliosis Afipia felis  CD MICROAEROBIC (5-10% OXYGEN) ATMOSPHERE Campylobacter spp.  Slow growing,  Febrile systemic  Asaccharolytic fastidious disease  Catalase +  Small, curved, or  Periodontal disease  Oxidase + seagull-winged, faintly  Gastroenteritis  Unable to grow 3.5% staining  Extraintestinal NaCl  Gray to pink or yellow infections gray and slightly  Meningitis, mucoid endocarditis,  Tailing effect along the septic arthritis streak lines (AIDS)  Post: Reactive arthritis and Guillain-Barre Syndrome  Acute imflammatory C. jejuni, (& C. coli) enteritis Arcobacter spp.  Slow growing,  Persistent watery  Asaccharolytic fastidious diarrhea Arcobacter cryaerophilus  Gastroenteritis  Bacteremia, endocarditis, peritonitis Helicobacter spp.  Curved, helical or  Gastric ulcer  Catalase + spiral, or fusiform  Peptic ulcer disease  Oxidase + Helicobacter pylori microaerophilic with or  Gastric cancer  Produce urease without periplasmic  Atrophic gastritis  Motile fibers  Urea breath test +  Small, translucent, circular colonies Legionella  Mesophilic (20-45C)  Multiply within amoeba  Utilize protein   Obligate aerobic  Legionnaire’s disease  Motile  Faintly staining, thin,  Pontiac fever fastidious  Extrapulmonary  Facultative intracellular  Small, filamentous Brucella  Small coccobacilli that  Brucellosis  Catalase + resemble fine grains of  Urease + sand  Most strains are Brucella abortus oxidase +  Hydrolyzes urea Brucella melitensis  Relative ability to produce H2S Brucella suis  Titer of 1:160 Brucella canis Bordotella  Minute, faintly staining  Pertussis (whooping  Direct fluorescent coccobacilli singly or in cough) antibody test Bordotella bronchiseptica pairs  Whole cell  Small and shiny, agglutination reactions Bordotella pertussis resembling mercury  Titer greater than 100- drops 125 IU/mL Bordotella parapertussis  Facultative,  Human and animal  Oxidase + Francisella intracellular organism tularemia  Urease –  Strict aerobes  Rabbit fever, deer fly  W Catalase +  Transparent, mucoid, fever, market man’s  Carbohydrate and easily emulsified disease fermenter  “rabbits” Streptobacillus moniliformis  Facultative, Nonaerobe  Rat-bite fever  Indole –   Pleomorhic, long,  Haverhill fever:  Catalse – tangled chains and humans  Oxidase – filaments with bulbar  rash on the palms,  Nitrate – swelling soles of the feet, and  Nonmotile  “fried egg” appearance other extremities  Urea – with a dark center and  Complications:  Lysine decarboxylase a flattened lacy edge  endocarditis, septic – L-phase arthritism, pneumonia,  Broth: “fluff balls” or pericarditis, brain ”breadcrumbs” abscess, amnionitis, prostatitis, and pancreatitis Spirillum minus  Gram-negative, helical,  Rat-bite fever  strictly aerobic  Asia: sodoku organism  Same with arthritis  Thick, spiral, with 2 or  Swollen lymph nodes 3 coils and polytrichous polar flagella Neisseria gonorrhea  Diplococci with  Oxidase + adjacent sides flattened  Diplococci inside PMNs  ”kidney- or coffee bean-shaped” Neisseria gonnorhoeae  2nd most commonly reported STI  Sexually transmitted Neisseria meningitides  Respiratory droplets Neisseria sicca and Neisseria  Infectious endocarditis lactamica or bacteremia   Leading cause of fatal  Oxidase + bacterial meningitis in  Reduces nitrate to children and adults nitrite  Young children: otitis  Unable to utilize media carbohydrates Moraxella catarrhalis  Older adults: chronic  Production of DNAse upper respiratory tract infections ANAEROBIC BACTERIOLOGY  Strict anaerobes (0% oxygen)  Aerotolerant organisms (5% oxygen)  Foul odor  Sulfur granules  Brick red fluorescence under long wavelength UV light GRAM-POSITIVE, SPORE FORMING BACILLI, ANAEROBIC Clostridia  Obligately anaerobe  Catalase - (or aerotolerant)  Produces yellow,  Antibiotic-associated Clostridia difficile ground glass colonies diarrhea and on CCFA pseudomembranous  chartreuse enterocolitis fluorescence upon exposure to UV light  Horse stable odor   Botulism Clostridia botulinum  Infant botulinum (Floppy Baby Syndrome)  Rods with round,  Tetanus (lockjaw) Clostridia tetani terminal spores  Drumstick or tennis racket appearance  C. perfringens: double Clostridia perfringes, Clostridia zone hemolysis on septicum, Clostridia anerobic BA and sporogenes, Clostridia novyi reverse CAMP test positive  C. septicum: medusa head appearance  Fresh liquid or Suspected C. difficile infection unformed stools (CDI) should be processed GRAM-POSITIVE, NON-SPORE FORMING BACILLI  Eggerthella and  Periodontal disease Actinomyces Paraeggerthella  Gram-positive filaments when crushed  “sulfur granules”  Gram-variable, curved  Bacterial Vaginosis Mobiluncus rods with tapered ends   Rod-shaped facultative Actinobaculum spp. anaerobes  P. acnes Propionibacterium spp.  Anaerobic diphtherioids  Pleomorphic  Strictly anaerobic or Bifidobacterium spp microaerophilic  Rods or are branched or club-shaped  Catalase – Lactobacillus spp.  Lactic acid from glucose fermentation Eubacterium  Normal intestinal and  Nitrate + oral flora  Catalase – E. lentum: Eggerthella and  Intraabdominal and Paraeggerthella periabdominal infections GRAM-NEGATIVE RODS  Mucosal surfaces of  Saccharolytic Bacteroides fragilis Group the human oral cavity  BILE RESISTANT and GIT  Nonpigmented  Dental biofilms  BILE SENSITIVE Nonpigmented Prevotella spp.  KANAMYCIN RESISTANT   Brick red or produce  Asaccharolytic and Pigmented Porphyromonas and brown to black pigmented Prevotella spp pigment  Large, grey, and  KANAMYCIN Fusobacteriaceae convoluted SENSITIVE  Most strains fluoresce chartreuse  Resembles  D. orale: periodontal  Asaccharolytic Proteobacteria Campylobacter disease  BILE RESISTANT ureolyticus  Desulfomicrobium spp.: motile, spiral- shaped organisms capable of reducing sulfate ANAEROBIC GRAM-POSITVE AND GRAM-NEGATIVE COCCI Gram-negative anaerobic cocci  Peptrostreptoccocus  Gram-positive cocci: anaerobius and VANCOMYCIN SENSITIVE Veillonela Parvimonas micra: S to COLISTIN RESISTANT sodium polyanethol  Gram-negative cocci sulfate (SPS) VANCOMYCIN RESISTANT  P. micra: milky halo around the colonies on BA MYCOBACTERIUM Mycobacterium tuberculosis  Primary TB  Tuberculin skin test or complex  Meningeal or military purified protein TB   Latent TB derivative test (PPD)  Reactivation TB test  T-Spot TB test  Niacin Test +  GIT mucosa or invade Mycobacterium bovis the lymphatic tissue of the oropharynx  between M. Mycobacterium africanum tuberculosis and M. bovis  31% of the cases of  PYRAZINAMIDE Mycobacterium caprae human TB SENSITIVE  TB in both Mycobacterium microti immunocompetent and immunosuppressed patients  lymphadenitis and Mycobacterium canetti generalized tuberculosis in immunocompromised individuals  granulomatous lesions Mycobacterium pinnipedii in the lymph nodes, lungs, pleura, and spleen  banded mongoose Mycobacterium mungi  large mammals Mycobacterium orygis (gazelle, antelopes, and oryxes) Nontuberculous Mycobacteria a. Photochromogens Mycobacterium kansasii b. Scotochromogens c. Nonphotochromogens Mycobacterium terrae complex (M. terrae, M. triviale, M. nonchromogenicum) Mycobacterium gastri Mycobacterium avium complex  Opaque, glossy, white,  Respiratory disease (MAC) colony morphology or clinically similar to TB produce smaller in adults, translucent colony lymphadenitis in morphology children, and disseminated infection in patients with HIV d. Rapid growers  Weakly gram-positive  medical interventions rods resembling (BM transplantation), Mycobacterium abscessus sbsp. diphtheriods wound infections, and abscessus, Mycobacterium catheter sepsis chelonae, Mycobacterium fortuitum NONCULTIVATABLE NONTUBERCULOUS MYCOBACTERIA  slender, poorly  Leprosy (Hansen  Footpads of armadillo Mycobacterium leprae stained, beaded, gram- disease) and footpads of mice positive bacilli  Tuberculoid leprosy:  “gram neutral,” or localized form “gram ghosts,”  Lepromatous leprosy:  ZN: appear red or have disseminated form a red or blue, beaded appearance Niacin M. tuberculosis Nitrate Reduction M. tuberculosis, M. kansasii, M. szulgai, and M. fortuitum Catalase + except f M. tuberculosis complex (some isoniazid-resistant strains) and M. gastri Tween 80 Hydrolysis nonpathogenic, slow-growing scotochromogens and nonphotochromogens Tellurite reduction MAC (3-4 dys) Arylsulfatase  3-day test: rapid growers M. fortuitum and M. chelonae  14-day test: M. marinum and M. szulgai Growth Inhibition by Thiophene-2- only M. bovis is unable to grow Carboxylic Acid Hydrazide OBLIGATE INTRACELLULAR AND NONCULTURABLE BACTERIAL AGENTS Chlamydia  Most common sexually  Glycogen: Yes Chlamydia trachomatis transmitted bacterial  Plasmid: Yes pathogen and a major  Sulfonamides S: Yes  cause of pelvic inflammatory disease (PID), ectopic pregnancy, and infertility  Trachoma  Lymphogranuloma Venereum  Oculogenital Infections  Endemic pathogen of  Glycogen: No Chlamydia psittaci all bird species  Plasmid: Yes  Sulfonamides S: No  Single IgM titer of 1:32  Pear-shaped EB  Pneumonia, bronchitis,  Glycogen: No Chlamydia pneumoniae pharyngitis, sinusitis,  Plasmid: No and a flu-like illness  Sulfonamides S: No RICKETTSIA, ORIENTA, ANAPLASMA, and EHRLICHIA Rickettsia  Fastidious bacteria  Triad of fever,  Obligate, intracellular headache, and rash parasites  Ticks  Mediterranean and R. conorii Israeli spotted fecers  Ticks  Rocky mountain R. ricketsii spotted fever  Mild R. parkeri  Ticks   Lice  Epidemic typhus R. prowazekii  Fleas  Murine typhus R. typhi  Chiggers  Scrub typhus Orienta tsutsugamushi  Human monocytic Ehrlichia chaffeensis ehrlichiosis (HME)  Human granulocytic Anaplasma phagocytophilum anaplasmosis (HGA)  Q fever Coxiella  Whipple disease Trophryma whipplei  Encapsulated,  Granuloma inguinale Klebsiella granulomatis pleomorphic, gram- or donovanosis negative bacillus  form beefy,  Donovan body: groups erythematous, of organisms seen granulomatous, within mononuclear painless lesions endothelial cells that bleed easily  Safety pin appearance: organism stains as a blue rod with prominent polar  granules surrounded by a large, pink capsule CELL WALL-DEFICIENT BACTERIA Mycoplasmas  M. pirum, M. fermentans, and M. penetrans: isolated from patients infected with HIV  M. genitalium: 15% to 20% of nongonococcal urethritis; females: associated with cervicitis and pelvic inflammatory disease (PID)  spherical, grainy, Mycoplasma pneumoniae yellowish forms that are embedded in the agar, with a thin outer layer  “fried egg” appearance  Urease – Mycoplasma hominis Ureaplasma urealyticum  A8 agar; urease  Pregnancy-related production with complications; calcium chloride commonly colonizes indicator; infants   colonies appear as  Ureaplasma and dark brownish Mycoplasma spp.: clumps isolated from the internal organs of stillborn, premature, and spontaneously aborted fetuses SPIROCHETES  axial fibrils and an outer sheath  slender with tight coils Venereal syphilis Treponema  Primary Syphilis: chancre  Secondary Syphilis”: “moth- eaten” area  Tertiary syphilis: neurosyphilis and gummas Congenital syphilis  “saber shin” bowing of the tibia  “bull dog” appearance of a deformed maxilla  somewhat thicker with  Borreliosis: relapsing  S+ Hippurate Borrelia, B. burgdorferi fewer and looser coils fever hydrolysis  Lyme disease  W indole  resemble Borrelia  Leptospirosis Leptospira except for their hooked ends   spinning motility or a rapid back-and-forth movement  comma-shaped or Brachyspira helical, with tapered ends with four flagella at each end  “false brush border”