Microbiology & Public Health Module 6 PDF

  Toxoplasmosis Prophylaxis for Streptococcal Infections Adverse Effects  Crystalluria – dehydrated patients are susceptible  Acute Hemolytic Anemia – G6PD deficiency  Agranulocytosis  Aplastic Anemia  Kernicterus  Steven-Johnson’s Syndrome Classes of Sulfonamides CLASS Absorbed and excreted...

  Toxoplasmosis Prophylaxis for Streptococcal Infections Adverse Effects  Crystalluria – dehydrated patients are susceptible  Acute Hemolytic Anemia – G6PD deficiency  Agranulocytosis  Aplastic Anemia  Kernicterus  Steven-Johnson’s Syndrome Classes of Sulfonamides CLASS Absorbed and excreted rapidly Poorly absorbed-active in bowel lumen Topically used Long-acting SULFONAMIDE Sulfisoxazole Sulfamethoxazole Sulfadiazine Sulfasalazine Sulfacetamide Silver sulfadiazine Sulfadoxine MYCOLOGY FUNGI -plant- like organisms -filamentous & branching -cell wall contains antigenic component -staining is same with G(+) microorganisms 4 TYPES OF FUNGAL CONDITIONS 1. Hypersensitivity Reaction 2. Mycotoxicosis 3. Mycetismus 4. Mycoses: fungal infection TYPES OF MYCOSES A. Superficial B. Cutaneous C. Subcutaneous D. Systemic/ Deep A. SUPERFICIAL MYCOSIS 1. Black Piedra - Piedra hortae - Sx: firm black nodules in the hair shaft 2. White Piedra - Trichosporon beigelii -Sx: soft friable, beige, white nodule 3. Pityriasis versicolor/ Tinea versicolor - Malassezia furfur 15 | Prepared by: Santi Raphael B. Lledo, RPh -Sx: multicolor 4. Tinea Nigra - Pheaoanellomyces wernickii -Sx: Silver nitrate like stains on the palms & soles B. CUTANEOUS MYCOSIS -dermatophytes & dermatomycoses *Identification for Dermatophytes 1. KOH Mount 2. Wood’s Lamp *Dermatophyte/ Ringworm Infections - T. capitis - T. corporis - T. faciei - T. barbae - T. manuum - T. ungium - T. axillaris - T. cruris - T. pedis *Dermatomycoses/ Mucocutaneous Candidiasis -manifest as: 1. Oral thrush 2. Vaginitis 3. Diaper Rash C. SUBCUTANEOUS MYCOSIS 1. Chromomycosis CA: Fonseceae spp (F. pedrosae, F. compacta) : Cladosporium spp (C. carrionnii) : Phialophora spp (P. verrucosa) Sx: muriform cells -benign: it will not spread to bones, muscles & other tissues 2. Mycetoma CA: Pseudolescheria boydii :Nocardia brasiliensis Sx: melanin- like pigments -malignant: spreads to the bones then goes to the muscles & then the connective tissues 3. Sporotrichosis CA: Sporothrix shenckii -occupational disease of florists & gardeners - Sx: Ulcerative skin lesions & arthritis D. SYSTEMIC/ DEEP MYCOSIS ANTIFUNGALS 2 Groups: PRIMARY PATHOGENS 1. Coccidioidomycosis CA: C. immitis -1st epidemic: San Joaquin Valley, California -Clinical Manifestation: respiratory failure *CLASSIFICATION I. Superficial Antifungal: cutaneous & subcutaneous II. Less Serious: systemic mycoses III. Life- Threatening: serious type of systemic mycoses 2. Histoplasmosis CA: H. capsulatum - aka Spelunker’s Disease -CM: TB- like disease 3. Blastomycosis CA: B. dermatitidis -aka North American Blastomycosis -similar to histoplasma -CM: respiratory disease (primarily) 4. Paracoccidioides CA: P. brasiliensis -aka South American Blastomycosis -CM: enlargement of lymph nodes, lesions in the lungs *OPPORTUNISTIC PATHOGENS 1. Cryptococcosis -CA: C. neoformans -acquired by inhalation of dried plasma droppings -Identification: India Ink -common among patients w/ AIDS 2. Candidiasis -CA: C. albicans - most common opportunistic fungal infection -acquired through inhalation & IV catheters 3. Aspergillosis -CA: Aspergillus flavus, Aspergillus fumigates - CM: asthma- like condition 4. Zygomucor -CA: Zygomycetes -aka: Mucormycosis - CM: rhinocerebral syndrome 5. Pneumocystis Carinii Pneumonia (PCP) -CA: P. carinii -new name: P. jiroveci -leading cause of death for AIDS patients 16 | Prepared by: Santi Raphael B. Lledo, RPh I. SUPERFICIAL 1. Griseofulvin MOA: unknown Proposed MOA: inhibit microtubule synthesis 2. Nystatin MOA: binds to ergosterol DOC for mucocutaneous candidiasis 3. AZOLES MOA: inhibit ergosterol synthesis Use: Mucocutaneous candidiasis Examples: Ketoconazole Clotrimazole Tioconazole *KETOCONAZOLE -MOA: inhibits ergosterol synthesis - inhibit enzyme lanosterol C14 demethylase -inhibit Cytp450 affects synthesis of testosterone causing anti- androgenic effects 4. Ap- ap Solution 5. Whitfields Ointment 6. Selenium Sulfide 7. KISS II. LESS SERIOUS/ SYSTEMIC: Systemic Mycoses 1. DOC for Systemic Mycoses: Amphothericin B - IV Infusion -oldest known antifungal 2. Azole a. Ketoconazole b. Fluconazole -DOC for Cryptococcosis & Candida lusetaniae c. Itraconazole -best alternative for systemic mycoses, second to Amphothericin B III. LIFE-THREATENING MYCOSES 1. DOC: Amphothericin B *MOA: binds to ergosterol *Use: Hospital acquired fungal infection, all systemic infections -2-3 month therapy *ADRs: Reversible Azotemia *Lipid forms: less ADRs 2. Itraconazole 3. Fluconazole 4. Caspofungin 5. Voriconazole 6. Flucytosine -MOA: inhibits fungal DNA synthesis thereby no binding & elongation -Use: yeast, candida, Cryptococcus VIROLOGY Virus - Obligatory intracellular parasites - Passes through bacteriological filters Possess either DNA or RNA Sensitive to interferons No organelles and ribosomes Composed of a protein coat that surrounds genetic material Viral Structure Nucleic Acid DNA or RNA Single stranded or double stranded Linear or circular Capsid Protein coat composed of single or several types of capsomeres Viral protection, stimulates production of antibodies, aids in introducing viral DNA/RNA into suitable host cell Envelope Composed of lipid, proteins and carbohydrates Naked virus Enveloped virus Classification DNA Viruses Resemble host DNA for transcription and replication DNA is not transient Viral genomes remain in the infected cell and reside inside the nucleus DNA polymerases require a primer to replicate the viral genome Hepadna, Papova, Parvo, Adeno, Herpes, Pox 17 | Prepared by: Santi Raphael B. Lledo, RPh RNA Viruses Most replicate in the cytoplasm RNA is labile and transient Must encode RNA dependent RNA polymerase Genome structure determines the mechanism of transcription and replication Prone to mutation Paramyxo, Corona, Retro, Birna, Toga, Arteri, Orthmyxo, Arena, Flavi, Bunya Picorna, Reo, Calici DNA (Naked) Viruses Parvoviridae Aka B19 virus Fifth disease, aplastic anemia Erythema infectiosum Papovaviridae Papilliomavirus, polyomavirus HPV1 to HPV4: skin/plantar warts HPV4: conyloma acuminata HPV16 & HPV18: CA of uterine cervix JC Virus: progressive multifocal leukoencephalopathy Adenoviridae URTI DNA (Enveloped) Viruses Hepadnaviridae Aka Hepa B virus Hepatocellular carcinoma DOC: Lamivudine, Interferon Herpesviridae HSV 1: Fever blister, cold sores HSV 2: Genital herpes VZV: Chickenpox, shingles HHV 5: Cytomegalovirus HHV 8: Kaposi’s sarcoma EBV: Infectious mononucleosis Poxvidirae Largest virus Variola virus Vaccinia virus Molluscum contagiosum virus RNA (Naked) Viruses Picomaviridae Poliovirus: poliomyelitis Coxsackievirus: Hand-foot-mouth disease HAV: Short term hepatitis Rhinovirus: Common cold Caliciviridae Norwalk virus: Norwalk virus syndrome HEV Reoviridae Rotavirus: Viral enteritis in children Colorado tick fever virus RNA (Enveloped) Viruses Togaviridae Eastern equine encephalitis virus Western equine encephalitis virus Yellow fever virus St. Louis encephalitis virus Rubella virus Flaviviridae Dengue Fever virus West nile feer virus HCV Filoviridae Ebola/Marburg virus Orthomyxoviridae Influenza A Influenza B Paramyxoviridae Parainfluenza virus Mumps virus Measles virus Respiratory syncytial virus: common cold virus Rhabdoviridae Rabies virus Retroviridae Human T-cell lymphotropic virus HIV 1 HIV 2 18 | Prepared by: Santi Raphael B. Lledo, RPh Arenaviridae Lassa virus Coronaviridae Infectious bronchitis virus Enteric corona virus SARS virus Antiviral Agents Virus Mechanism Herpes DNA Polymerase Inhibitors Acyclovir, Valacyclovir, Ganciclovir NRTI Zidovudine, Abacavir, Dideoxynosine, Lamivudine, Stavudine, Tenofovir, Disoproxil, Fumarase, Zalcitabine NNRTI Delavirdine, Efavirenz, Nevaripine Protease Inhibitors Amprenavir, Indinavir, Lopinavir, Nalfinavir, Ritonavir, Saquinavir Inh of Viral Uncoating Amantadine, Rimantadine, Olsetamivir HIV (Antiretroviral) Influenza Examples PARASITOLOGY INTESTINAL AND LUMINAL PROTOZOA Organism Entamoeba histolytica Transmission Oro-fecal Symptoms Dysentery with blood and necrotic tissue. Chronic: abscesses Treatment GI: Iodoquinol or Metronidazole Abscess: Metronidazole Giardia lamblia Oro-fecal Fowl-smelling, bulky diarrhea; blood or necrotic tissue rare. Iodoquinol or Metronidazole. Balantidium coli Oro-fecal; zoonotic Dysentery with blood and necrotic tissue but no abscesses. Iodoquinol or Metronidazole. Cryptosporidium parvum Oro-fecal Diarrhea Paromycin (investigational) Isospora belli Oro-fecal Giardiasis-like Sulpha drugs Trichomonas vaginalis Sexual Vaginitis; occasional urethritis/prostatitis. Mebendazole 19 | Prepared by: Santi Raphael B. Lledo, RPh BLOOD AND TISSUE PROTOZOA Organism Transmission Disease/symptoms Treatment Trypanosoma brucei Tsetse fly. Sleeping sickness; cardiac failure. Blood stage: Suramin or petamidine isothionate; T. cruzi Reduvid (kissing) bug. Chagas disease: megacolon, cardiac failure. CNS: melarsoprol Nifurtimox and Benzonidazole. Leishmania donovani Sand fly Visceral leish-maniasis, granulo-matous skin lesions. Pentosam; Pentamidine isethionate. L. tropica Sand fly. Cutaneous lesions. As for L. donovani. L. braziliensis Sand fly Mucocutaneous lesions. As for L. donovani. Female anopheline mosquito. Malarial paroxysm: chills, fever, headache, nausea cycles. Tick Hemolytic anemia, Jaundice and fever Plasmodium falciparum P. ovale, P. malariae and P. vivax Babesia microti Toxoplasma gondii Oral from cat fecal material; or meat Pneumocystis jiroveci 20 | Prepared by: Santi Raphael B. Lledo, RPh Cough droplets Quinine derivatives Proguanil Lariam None; self resolving. Adult: flu like; congenital: abortion, neonatal blindness and neuropathies. Pneumonia Sulphonamides, pyemethamine, possibly spiramycin (non-FDA). Trimethoprim and sulphamethoxazole. NEMATODES Organism Transmission Symptoms Treatment Ascaris lumbricoides Oro-fecal Abdominal pain, weight loss, distended abdomen Mebendazole Trichinella spiralis Poorly cooked pork Depends on worm location and burden: gastroenteritis; edema, muscle pain, spasm; eosinophilia, tachycardia, fever, chill headache, vertigo, delirium, coma, etc. Corticosteroid and Mebendazole Trichuris trichiura Oro-fecal Abdominal pain, bloody diarrhea, prolapsed rectum Mebendazole Enterobius vermicularis Oro-fecal Peri-anal pruritus, rare abdominal pain, nausea vomiting Pyrental pamoate or Mebendazole Soil-skin, autoinfection Itching at infection site, rash due to larval migration, verminous pneumonia, midepigastric pain, nausea, vomiting, bloody dysentery, weight loss and anemia Ivermectin or Thiabendazole Oro-fecal (egg); skin penetration (larvae) Maculopapular erythema (ground itch), broncho-pneumonitis, epigastric pain, GI hemorrhage, anemia, edema Mebendazole Oral: cyclops in water Blistering skin, irritation, inflammation Mebendazole Mosquito bite Recurrent fever, lymphadenitis, splenomegaly, lymphedema, elephantiasis Mebendazole; Diethylcarbamazine Onchocerca volvulus Black fly bite Nodular and erythematous dermal lesions, eosinophilia, urticaria, blindness Mebendazole; Diethylcarbamazine Loa loa Deer fly As in onchocerciasis Diethyl-carbamazine Strongyloides stercoralis Necator americanes; Ancylostoma duodenale (Hookworms) Dracunculus medinensis Wuchereria bancrofti; W. brugia malayi (elephantiasis) 21 | Prepared by: Santi Raphael B. Lledo, RPh CESTODES Organism Transmission Symptoms Treatment Taenia saginata Cyst in beef Epigastric pain, vomiting, diarrhea Praziquantel Taenia solium Cyst in pork Epigastric pain, vomiting, diarrhea Praziquantel T. solium Cysticercosis Oro-fecal Muscle pain and weakness, ocular and neurologic problems Praziquantel Cyst in fish Abdominal pain, loss of weight, anorexia, malnutrition and B12 deficiency problems Praziquantel Echinococcus granulosus Oro-fecal Large cysts produce various symptoms depending on the location of the organism. Surgery, formalin injection and drainage, Praziquantel Echinococcus multiloculoris Oro-fecal As above Surgery, Albendazole Transmission Symptoms Treatment Schistosoma mansoni, S. japonicum skin penetration by cercaria Dermatitis, abdominal pain, bloody stool, periportal fibrosis, hepatosplenomegaly, ascites, CNS Praziquantel Schistosoma hematobium skin penetration by cercaria Dermatitis, urogenital cystitis, urethritis and bladder carcinoma Praziquantel Fasciolopsis buski Metacercaria on water chestnut Epigastric pain, nausea, diarrhea, edema, ascites Praziquantel, Cysts in fish Inflammation and deformation of bile duct, hepatitis, anemia and edema Praziquantel Cyst in crab meat Cough (dry / rusty brown sputum), pulmonary pain, pleurisy, tuberculosis-like Praziquantel Diphyllobothrium latum TREMATODES Organism Chlonorchis sinensis, Opisthorchis felinus, or O. viverini Paragonimus westermani 22 | Prepared by: Santi Raphael B. Lledo, RPh