Microbiology & Public Health Module 6 PDF

MICROBIAL GROWTH 4 2 3 2 Y Prepared and Presented By: Santi Raphael B. Lledo, RPh FO SE U R L N O F O Y P M R HA A 2 33 OUTLINE A. Notable Scientists B. Microbial Growth 4 2 3 2 Y Requirements C. Culture Media F O Y D. Staining Methods FO SE U R L N O P M R HA A 2 33 HISTORY and NOTABLE SCIENTISTS R...

MICROBIAL GROWTH 4 2 3 2 Y Prepared and Presented By: Santi Raphael B. Lledo, RPh FO SE U R L N O F O Y P M R HA A 2 33 OUTLINE A. Notable Scientists B. Microbial Growth 4 2 3 2 Y Requirements C. Culture Media F O Y D. Staining Methods FO SE U R L N O P M R HA A 2 33 HISTORY and NOTABLE SCIENTISTS Robert Hooke Cell theory Antonie van Leeuwenhoek Father of Microbiology Louis Pasteur ‘Microorganisms are present in air, but air itself does not create microbes’(Pasteur Flask) Coined “vaccine” (developed immunity for anthrax, rabies, cholera) Fermentation, Pasteurization Joseph Lister Father of Antiseptic Surgery (Phenol/Carbolic acid) Robert Koch Father of Microbiological Techniques, Koch Postulate, Germ Theory M. tuberculosis (Koch’s bacilli) Ignaz Semmelweis Surgical handwashing to prevent Puerperal Childbirth Fever MODERN CHEMOTHERAPY Paul Ehrlich Father of Chemotherapy (Salvarsan) Emil von Behring Diphtheria toxin Domaqk Prontosil Alexander Fleming Penicillin Florey and Chain Penicillin use in therapy Selman Waksman Streptomycin Edward Jenner SE U Smallpox vaccine R FO L N O F O Y P M R HA A 2 33 4 2 3 2 Y 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Microbial Growth Physical Requirements 4 2 3 2 Y 1. Temperature A 2 33 2. pH RM A H 3. Osmotic Pressure/Salt F P Concentration O Y L R FO N O E US Microbial Growth Chemical Requirements 1. Carbon A 2 2. N, S, P, Trace Elements M 33 AR H 3. Oxygen FP 4 2 3 2 Y O Y L R FO N O E US Bacterial Physiology Growth Curve 1. 2. 3. 4. 4 Lag Phase 2 3 2 AY Log Phase/Exponential Phase 2 33 Stationary Phase RM A PH Death Phase/Logarithmic Phase F O R FO EO S U Y L N Types of Culture Media Synthetic/Chemically Defined Media Composition is exactly known A 2 33 Purpose: Growth of Chemoautotrophs, RM A Photoautotrophs, & Biological Assays. PH F O Y E FO S U R L N O 4 2 3 2 Y Types of Culture Media Non-synthetic/ Complex Media 4 2 3 2 Y Composition is NOT exactly known A 2 Purpose: Growth of most Chemoheterotrophs 33 M R A organisms. PH F O Y E FO S U R L N O Types of Culture Media Differential Media 4 2 3 differentiate organisms, using color reactions 2 AY 2 Ex: MacConkey Agar, Mannitol Salt Agar, 33 Eosin M R A Methylene PH F O Y L N EO S U R FO Types of Culture Media Selective Media 4 2 3 2 Y inhibits the growth of some. A 2 Purpose: Suppression of unwanted microbes; 33 M R A encouraging desired microbes.PH F O Y E FO S U R L N O Examples of Selective Media Microorganism Grown McConkey Agar G(-)organism Mannitol Salt Agar Staphylococci Eosin Methylene Blue lactose and sucrose fermentation Brilliant GreenAagar Bismuth Nitrate Agar Salmonellla Sauboraud’s Dextrose Agar Fungi Loefflers Serum Corynebacterium diphtheriae 4 2 3 2 Y Middle Brook Agar Lowenstein- Jensen M. tuberculosis Thayer-Martin Agar Neisseria Bordet-Gengou Agar Bordetella pertussisO Campy-BAP Skirrow’s Agar Y L N O E S Campylobacter U R FO FP M R HA A 2 33 Types of Culture Media Enrichment Media cultivation of Fastidious Organisms. 4 2 3 2 Purpose: Similar to selective media but designed AY 2 33 to to increase numbers of desired microbes M R A detectable levels. PH F Ex: Chocolate Agar, Blood LAgar YO N O E FO S U R 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 BACTERIOLOGY PART 1 4 2 3 2 Y Prepared and Presented By: Santi Raphael B. Lledo, RPh FO SE U R L N O F O Y P M R HA A 2 33 GRAM-POSITIVE BACTERIA 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 GRAM-POSITIVE COCCI 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Staphylococcus aureus Folliculitis 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Staphylococcus aureus Furuncle 4 2 3 2 Y Carbuncle F O Y FO SE U R L N O P M R HA A 2 33 Staphylococcus aureus Impetigo Aka pyoderma 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Staphylococcus aureus Toxic Shock Syndrome (TSS) 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Staphylococcus aureus Staphylococcal Scalded Skin Syndrome (SSSS) 4 2 3 2 Y A 2 Staphylococcal Food Poisoning 33 RM Caused by ingestion of enterotoxin A H F O Y FO SE U R L N O P Streptococcus pneumoniae Pneumonia Mucopurulent Sputum 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Streptococcus mutans Halitosis Dental carries 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Streptococcus pyogenes Scarlet Fever Impetigo Sepsis 4 2 3 2 Y Infectious Endocarditis Pharyngitis F O Y Tonsilitis Strep Throat FO SE U R L N O P M R HA A 2 33 Streptococcus pyogenes Necrotizing Fasciitis Enzymes responsible: Deoxyribonuclease Streptokinase Hyaluronidase 4 2 3 2 Y Treatment PCN Clindamycin F O Y FO SE U R L N O P M R HA A 2 33 Streptococcus pyogenes Rheumatic Fever Rheumatic Heart Disease (RHD) Acute Glomerulonephritis Treatment F O Y PCN FO SE U R L N O P M R HA A 2 33 4 2 3 2 Y Streptococcus agalactiae Neonatal Sepsis Meningitis Streptococcus bovis 4 2 3 2 Y F O Y P M R HA A 2 33 Common microorganism isolated L N O SE colon cancer among patients with U R FO GRAM-POSITIVE BACILLI 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Bacillus anthracis Anthrax Only bacteria with amino acid capsule Respiratory: Woolsorter’s Disease 4 2 3 2 Cutaneous: Black eschar lesions AY 2 GI: Diarrhea 33 F O Y FO SE U R L N O P M R HA Bacillus cereus Food Poisoning 4 2 3 2 Y Bacillus subtilis FP UTI O Y L N O Source of Bacitracin E US R FO M R HA A 2 33 Clostridium botulinum Botulism Inhibit release of Acetylcholine in skeletal muscles 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Clostridium botulinum Flaccid Paralysis Treatment: Trivalent antitoxin 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Clostridium botulinum Botox 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Clostridium tetani Tetanus Spastic paralysis Risus sardonicus Opisthothonus Lock Jaw 4 2 3 2 Y F O Y Virulence: Tetanospasmin FO SE U R L N O P M R HA A 2 33 Clostridium perfringens Gas Gangrene Treatment Options: Amputation Maggots Hyperbaric Chambers 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Clostridium difficile Pseudomembranous colitis Associated with the use of broad spectrum antibiotics -24 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Corynebacterium diphtheriae Diphtheria V-shaped or palisades “Chinese lettering” Screening Test: Schick Test Lab Diagnosis: Loeffler’s slant Virulence: Diphtheria toxin F O Y FO SE U R L N O 4 2 3 2 Y P M R HA A 2 33 Listeria monocytogenes Human Perinatal Listeriosis Meningitis Has tumbling motility 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 BACTERIOLOGY PART 2 4 2 3 2 Y Prepared and Presented By: Santi Raphael B. Lledo, RPh FO SE U R L N O F O Y P M R HA A 2 33 GRAM-NEGATIVE BACTERIA F O Y FO SE U R L N O 4 2 3 2 Y P M R HA A 2 33 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Escherichia coli EPEC ETEC EIEC EHEC 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Klebsiella pneumoniae Pneumonia 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Proteus mirabilis UTI Very motile Will alkalinize urine 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Shigella dysenteriae Shigellosis Dysentery 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Salmonella typhi Typhoid Fever Form acid in glucose and mannose Most produce H2S F O Y FO SE U R L N O P M R HA A 2 33 4 2 3 2 Y Vibrio cholerae Watery diarrhea: “Rice water” stools 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Helicobater pylori Gastric and Duodenal Ulcers Produce large amounts of urease 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Haemophilus influenzae Meningitis Small uniform coccobacillus Lab diagnosis: Chocolate agar F O Y FO SE U R L N O P 4 2 3 2 Y M R HA A 2 33 Haemophilus aegyptius Conjunctivitis 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Haemophilus ducreyi Chancroid (soft chancre) 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Bordetella pertussis Pertussis Aka Whooping cough Strictly aerobic 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Legionella pneumophila Legionnaire's Disease Natural habitat is water Aka Pontiac Fever 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Brucella spp. Brucellosis Aka Malta Fever, Undulant fever, Bang’s disease B. abortus 4 2 3 2 B. suis AY 2 B. cannis 33 RM B. melitensis A H F O Y FO SE U R L N O P Yersinia pestis Bubonic Plague Aka black death, black plague 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Yersinia pestis Bubonic Plague S/sx: buboes 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Francisella tularensis Tularemia Aka rabbit fever, deer fly fever S/sx: swollen lymph glands F O Y FO SE U R L N O 4 2 3 2 Y P M R HA A 2 33 Neisseria meningitidis Meningococcemia Glucose and lactose fermenter 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Neisseria gonorrhoeae Gonorrhea Ophthalmia neonatorum Pelvic Inflammatory Disease F O Y FO SE U R L N O P M R HA A 2 33 4 2 3 2 Y Pseudomonas aeruginosa UTI Pneumonia Does not ferment carbohydrates Produces pigments F O Y FO SE U R L N O P 4 2 3 2 Y M R HA A 2 33 Chlamydia trachomatis Trachoma Inclusion Conjunctivitis Intracellular microorganism F O Y FO SE U R L N O 4 2 3 2 Y P M R HA A 2 33 Chlamydia pneumoniae Atypical pneumonia This Photo by Unknown Author is licensed under CC BY-SA Chlamydia psittaci F O Y Psittacosis Aka Ornithosis FO SE U R L N O P 4 2 3 2 Y M R HA A 2 33 Rickettsia prowazekii Brill-Zinser’s Disease Vector: Louse 4 2 3 2 Y Rickettsia typhi F O Y Murine Typhus Vector: Rat flea FO SE U R L N O P M R HA A 2 33 Orientia tsutsugamushi Scrub Typhus Vector: Mite Rickettsia rickettsii 4 2 3 2 Y M R HA A 2 33 F PFever Rocky Mountain Spotted O LY Aka Spotted Fever R FO Vector: Tick N O E US Rickettsia akari Rickettsial Pox Vector: Mite Rickettsia australis F O Y Queensland Tick Fever NL Vector: Tick R FO EO S U P 4 2 3 2 Y M R HA A 2 33 Treponema pallidum Syphilis Seen in dark field microscopy 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Treponema pallidum Hard Chancre Treatment: PCN G 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Leptospira interrogans Leptospirosis Aka Weil’s Disease Culture: 4 2 3 2 Y Fletcher’s media Treatment: Doxycycline F O Y FO SE U R L N O P M R HA A 2 33 Borrelia recurrentis Relapsing Fever Vector: White footed mouse, white tailed deer 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Borrelia burgdorferi Lyme Disease Vector: Ixodes tick S/sx: Bull’s eye rash 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Mycoplasma pneumoniae Walking pneumonia Smallest free-living prokaryotic cell Lack peptidoglycan 4 2 3 2 Highly resistant to CW inhibitors AY 2 Resistant to PCN, Cephalosporin, Vancomycin 33 F O Y FO SE U R L N O P M R HA ACID-FAST BACTERIA 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Mycobacterium tuberculosis Pulmonary Tuberculosis (PTB) Extrapulmonary Tuberculosis (EPTB) Diagnosis: PPD Treatment: TB-DOTS 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Mycobacterium leprae Leprosy Aka Hansen’s Disease Types: 1. Tuberculoid Leprosy (TL) 2. Lepromatous Leprosy (LL) RM A Dapsone (but has SE: erythemaF nodosum leprosum) PH O Y L N EO S U R FO Treatment: A 2 33 4 2 3 2 Y ANTI-INFECTIVES 4 2 3 2 Y Prepared and Presented By: Santi Raphael B. Lledo, RPh FO SE U R L N O F O Y P M R HA A 2 33 A. Introduction ANTI-INFECTIVES ▪ Agents that treat infection ▪ Destroys the causative microorganisms –bacteria, mycobacteria, fungi, protozoa, or viruses ANTIBIOTICS ▪ Natural anti-infectives 4 2 3 2 Y A ANTIMICROBIALS 2 33 M R HA ▪ Synthetic Fanti-infectives P O Y L R FO N O E US A. Introduction SPECTRUM OF ACTIVITY ▪ Broad-spectrum VS Narrow Spectrum 4 2 3 2 Y ▪ -Cidal VS –Static ▪ Susceptibility Test: ▪ MIC & MBC Kirby-Bauer Disk-diffusion Technique FO SE U R L N O F O Y P M R HA A 2 33 CELL WALL INHIBITORS 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 B. Cell Wall Inhibitors 1. BETA-LACTAM ANTIBIOTICS 4 2 3 2 Y ▪ Possess beta-lactam ring structure ▪ Bactericidal ▪ Low toxicity F O Y FO SE U R L N O P M R HA A 2 33 B. Cell Wall Inhibitors 1. BETA-LACTAM ANTIBIOTICS ▪ Include the following antibiotic classes: 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 B. Cell Wall Inhibitors i. PENICILLINS ▪ Synthesized from mold ▪ Discovered by Alexander Fleming 4 2 3 2 Y ▪ MOA: Prevents transpeptidation reaction during cell wall synthesis → leaky cells F O Y FO SE U R L N O P M R HA A 2 33 B. Cell Wall Inhibitors a. Natural b. Extended-spectrum ▪ Pen G: benzylpenicillin ▪ Pen G Depot forms: ▪ ▪ ▪ Pen G benzathine Pen G procaine Pen G hydrabamine ▪ Pen V: phenoxymethylpenicillin ▪ Acid-stable → Orally administered ▪ Aminopenicillins ▪ ▪ Ampicillin – IV & PO Amoxicillin – PO RM ▪ Antipseudomonal A H 4 2 3 2 Y A 2 33 P F O ▪ Carbenicillin Y & Ticarcillin L N O ▪ Mezlocillin, Azlocillin, Piperacillin E S U R FO B. Cell Wall Inhibitors c. Penicillinase-Resistant - Aka Antistaphylococcal PCNs - Counteracts B-lactamase activity ▪ ▪ ▪ ▪ ▪ 4 2 3 2 Y Methicillin: DOC for PRSA Nafcillin: Nephrotoxic Oxacillin Cloxaxillin: +Cl Flucloxacillin: +F +Cl F O Y FO SE U R L N O P M R HA A 2 33 B. Cell Wall Inhibitors 4 2 3 2 Y F O Y Clavulanic acid SE U R FO Sulbactam P M R HA A 2 33 L N O Tazobactam B. Cell Wall Inhibitors ii. CEPHALOSPORINS ▪ Synthesized from mold ▪ Discovered by Giuseppe Brotzu 4 2 3 2 Y ▪ MOA: Prevents transpeptidation reaction during cell wall synthesis → leaky cells F O Y FO SE U R L N O P M R HA A 2 33 B. Cell Wall Inhibitors 1st ii. CEPHALOSPORINS 2nd 3rd ▪ Broad-spectrum ▪ More resistant towards betalactamase 4th 4 2 3 2 Y F O Y ▪ Classified by generations: 1st to 4th F OR E US L N O P M R HA A 2 33 Gram (+) Gram (-) B. Cell Wall Inhibitors ii. CEPHALOSPORINS ▪ ▪ ▪ ▪ ▪ 1st Gen: Cefadroxil, Cephalexin, Cefazolin 4 2 2nd Gen: Cefaclor, Cefoxitin, Cefuroxime 3 2 Y A rd 2 3 Gen: Ceftriaxone, Cefixime, Cefpodoxime, Cefotaxime 33 RM 4th Gen: Cefepime, Cefpirome A PH F O 5th Gen: Ceftaroline, Ceftobiprole Y L R FO N O E US B. Cell Wall Inhibitors ii. CEPHALOSPORINS ▪ Untoward Effects: ▪ ▪ ▪ ▪ 4 2 3 2 Y Hypersensitivity reactions Hypoprothrombinemia Nephrotoxicity Alcohol intolerance: disulfiram-like F O Y FO SE U R L N O P M R HA A 2 33 B. Cell Wall Inhibitors iii. CARBAPENEMS ▪ Broad-spectrum ▪ Has Beta-lactamase resistance 4 2 3 2 Y ▪ Imipenem: marketed with Cilastatin RM A H P F ▪ Meropenem: not destroyed by renal dehydropeptidase O Y L N ▪ Ertapenem: once daily dosing EO FO S U R A 2 33 B. Cell Wall Inhibitors iv. MONOBACTAMS ▪ ▪ MOA: Interacts with Gram (-) cell wall and induce formation of filamentous bacterial structures Effective only in Gram (-) bacteria ▪ ▪ ▪ ▪ 4 2 3 2 Y Enterobacteriaceae Pseudomonas Aztreonam Tigemonam F O Y FO SE U R L N O P M R HA A 2 33 B. Cell Wall Inhibitors 2. VANCOMYCIN ▪ MOA: inhibit the synthesis of the cell wall in sensitive bacteria by binding with high affinity to cell wall precursor units 4 2 3 2 Y A 2 33 ▪ Bactericidal against a variety of gram (+) strains; DOCRfor M MRSA F O Y A H P L N ▪ may cause red man or red neck syndrome → O SLOW IV infusion FO SE U R B. Cell Wall Inhibitors 3. BACITRACIN ▪ MOA: interferes with the lipid compound, bactoprenol which carries peptidoglycans to growing cell wall ▪ Effective against a variety of Gram (+) FP O cocci and bacilli Y L N O ▪ Highly Nephrotoxic → TOPICAL use only SE F U R O 4 2 3 2 Y M R HA A 2 33 PROTEIN SYNTHESIS INHIBITORS F O Y FO SE U R L N O P 4 2 3 2 Y M R HA A 2 33 C. Protein Synthesis Inhibitors 1. AMINOGLYCOSIDES ▪ “-micins & -mycins” ▪ MOA: binds to 30s ribosomal subunit ▪ Cidal and Broad-spectrum ▪ Poorly absorbed orally ▪ Reserved for systemic infections ▪ ▪ ▪ ▪ ▪ ▪ Streptomycin: most ototoxic Tobramycin: ophthalmic use-24 3 2 Neomycin: nephrotoxicAY 32 3 Spectinomycin: most M inferior R A H P nephrotoxic Gentamicin:Fless O Y broadest spectrum L Amikacin: N O E of activity US R FO C. Protein Synthesis Inhibitors 2. TETRACYCLINE ▪ “-cyclines” ▪ MOA: binds to 30s ribosomal subunit ▪ Bacteriostatic and Broad-spectrum ▪ Active against G(+)MRCS ▪ Used widely in animal feeds ▪ ADRs ▪ ▪ ▪ 4 GI irritation 2 3 2 Photosensitivity AY 2 33 Ca++ chelation RM F O Y FO SE U R L N O A H P C. Protein Synthesis Inhibitors 3. CHLORAMPHENICOL ▪ MOA: binds to 50s ribosomal subunit ▪ Bacteriostatic and broadspectrum ▪ ADRs ▪ ▪ 4 Aplastic anemia 2 3 2 Gray baby syndrome AY F O Y FO SE U R L N O P M R HA 2 33 C. Protein Synthesis Inhibitors 4. MACROLIDES ▪ “-thromycins” ▪ MOA: binds to 50s ribosomal subunit ▪ Bacteriostatic and broadspectrum ▪ Activity resembles PCNs Erythromycin ▪ ▪ Estolate salt: cholestatic hepatitis Clarithromycin ▪ ▪ ▪ F 4 2 3 2 ▪ 6-methyl ether erythromycin AY 2 Azithromycin 33 M ROD A ▪ Unique dosing: for 3d H FP O Telithromycin Y L N ▪ Ketolide; for macrolide-resistant O E S strains U OR C. Protein Synthesis Inhibitors 4. LINCOSAMIDES ▪ MOA: binds to 50s ribosomal subunit ▪ Bacteriostatic and broadspectrum (bactericidal in high doses) ▪ DOC for Gram (+) soft tissue infections Lincomycin: prototype Clindamycin ▪ ▪ ▪ F 4 2 3 2 ▪ 7-chloro-7-deoxy lincomycin AY 2 33 RM A ADR: pseudomembranous colitis PH F O Y L N EO S U R O SYNTHETIC ANTI-INFECTIVES F O Y FO SE U R L N O 4 2 3 2 Y P M R HA A 2 33 D. Synthetic Anti-infectives 1. QUINOLONES ▪ “-floxacins” ▪ MOA: target bacterial DNA gyrase and topoisomerase IV → overwinding of DNA ▪ Cidal against Gram (-) mostly ▪ Also active against atypical MOs ▪ ADRs: ▪ ▪ ▪ ▪ FO SE U R QT prolongation 4 2 3 2 Achilles tendon rupture AY 2 Enzyme induction: 33 Cipro RM A Chelation H with P F multivalent cations O Y L N O D. Synthetic Anti-infectives 2. SULFONAMIDES ▪ PABA derivatives ▪ MOA: inhibits dihydropteroate synthase → folic acid (Vit B9) synthesis inhibition ▪ ADRs: ▪ ▪ ▪ Crystalluria Hemolytic anemia (if G6PD 4 deficient) 2 3 2 Y Steven-Johnson-Syndrome 2A M 33 AR ▪ Sulfamethoxazole (Bactrim®) H FP O ▪ Widespread AMR → not commonly ▪ Silver Lsulfadiazine Y N O (Flammazine®) prescribed SE U R F▪O Dapsone: antileprotic MYCOLOGY 4 2 3 2 Y Prepared and Presented By: Santi Raphael B. Lledo, RPh FO SE U R L N O F O Y P M R HA A 2 33 FUNGI 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Types of Mycoses A. Superficial Mycosis B. Cutaneous Mycosis 4 2 3 2 Y C. Subcutaneous Mycosis D. Systemic Mycosis F O Y FO SE U R L N O P M R HA A 2 33 Types of Mycoses A. Superficial Mycosis B. Cutaneous Mycosis 4 2 3 2 Y C. Subcutaneous Mycosis D. Systemic Mycosis F O Y FO SE U R L N O P M R HA A 2 33 Piedra hortae Black Piedra Black nodules in the hair shaft 4 2 3 2 Y Trichosporon beigelii332 A White Piedra L N O F O Y P M R HA SE U Large, yellowish, Osoft R nodules on the hair F Treatment: Flucytosine Malassezia furfur Ptyriasis versicolor Hypo or hyperpigmentation Treatment: -azoles Exophiala wernickii Tinea nigra F O Y SE U R P 4 2 3 2 Y M R HA A 2 33 L N O O Pheaoanellomyces wernickii Formerly known Fas Types of Mycoses A. Superficial Mycosis B. Cutaneous Mycosis 4 2 3 2 Y C. Subcutaneous Mycosis D. Systemic Mycosis F O Y FO SE U R L N O P M R HA A 2 33 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Candida albicans Oral candidiasis Vulvovaginitis Paronychial Infection 4 2 3 2 Y A Very motile 2 33 Will alkalinize urine RM A PH Treatment: Imidazole, Nystatin, Fluconazole, F O Y L Itraconazole ON FO SE U R Types of Mycoses A. Superficial Mycosis B. Cutaneous Mycosis 4 2 3 2 Y C. Subcutaneous Mycosis D. Systemic Mycosis F O Y FO SE U R L N O P M R HA A 2 33 Phialophora verrucose Cladosporium carrionii Fonsecaea compacta Chromomycosis 4 2 3 2 Y Benign RM A PH Sx: Muriform cells F O Y Treatment: Flucytosine,OItraconazole NL FO SE U R A 2 33 Pseudollescheria boydii Mycetoma Malignant 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Sporothrix schenckii Sporotrichosis Aka Gardener’s Disease Treatment: 4 2 3 2 Y KISS F O Y FO SE U R L N O P M R HA A 2 33 Types of Mycoses A. Superficial Mycosis B. Cutaneous Mycosis C. Subcutaneous Mycosis 4 2 3 2 Y D. Systemic Mycosis F O Y a. Primary Pathogens b. Opportunistic Pathogens FO SE U R L N O P M R HA A 2 33 Blastomyces dermaditidis Blastomycosis Aka North American Blastomycosis Pulmonary infection 4 2 Treatment: Itraconazole, Amphotericin BY 23 F O Y FO SE U R L N O P M R HA A 2 33 Paracoccidioides brasiliensis Paracoccidioiomycosis 4 2 3 2 Y Aka South American Blastomycosis A 2 Ulcerative granulomata 33 M Treatment: Itraconazole AR R FO EO S U Y L N P OF H Histoplasma capsulatum Histoplasmosis Grows in bird droppings/ bat droppings Aka Spelunker’s Disease 4 2 Treatment: Amphotericin B, Itraconazole,Y 23 A 2 Fluconazole 33 F O Y FO SE U R L N O P M R HA Coccidioides immitis Coccidioidomycosis Pulmonary infection may complicate to Meningitis 4 2 Treatment: Ketoconazole, Fluconazole Y 23 A F O Y FO SE U R L N O P M R HA 2 33 Types of Mycoses A. Superficial Mycosis B. Cutaneous Mycosis C. Subcutaneous Mycosis 4 2 3 2 Y D. Systemic Mycosis a. Primary Pathogens F O Y b. Opportunistic Pathogens FO SE U R L N O P M R HA A 2 33 Cryptococcus neoformans Cryptococcus gattii Cryptococcosis 4 2 3 2 Y Pigeon feces A 2 Diagnosis: India ink (capsule staining) 33 RM One of the marker diseases of AIDS A H P F Treatment: Amphotericin B, OFlucytosine R FO EO S U Y L N Aspergillus fumigatus Aspergillosis Fungal ball Treatment: Amphotericin B, Caspofungin 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Pneumocystis jirovecii Pneumocystis Carinii Pneumonia Previously classified as Pneumocystis carinii One of the marker diseases for AIDS 4 2 3 2 Treatment: Co-Trimoxazole Y F O Y FO SE U R L N O P M R HA A 2 33 ANTIFUNGALS 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Griseofulvin Proposed MOA: Inhibits Microtubule 4 2 3 2 Synthesis AY F O Y FO SE U R L N O P M R HA 2 33 Nystatin MOA: binds to ergosterol DOC for cutaneous candidiasis 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Amphotericin B MOA: binds to ergosterol A 2 DOC for systemic mycoses 33 RM Oldest known antifungal A H P F Very potent O Y L N ADR: reversible azotemia O 4 2 3 2 Y FO SE U R AZOLES MOA: inh. Ergosterol synthesis 4 2 3 2 Y A 2 33 Examples: Ketoconazole RM A H Itraconazole – alternative OtoF PAmphotericin B Y L Tioconazole N O E Fluconazole – DOC US for Cryptococcosis R FO Flucytosine MOA: inhibits fungal DNA synthesis 4 2 3 2 thereby no binding and elongation AY 2 33 RM A Could be used for Candida and H Cryptococcus P F O infection Y L N O SE U R FO VIROLOGY 4 2 3 2 Y Prepared and Presented By: Santi Raphael B. Lledo, RPh FO SE U R L N O F O Y P M R HA A 2 33 VIRUSES 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Classification of Viruses DNA Viruses (Naked) RNA Viruses (Naked) Papova Picorna Adeno Calici Parvo Reo DNA Viruses (Enveloped) RNA Viruses (Enveloped) Pox Herpes Hepadna 4 2 3 2 Y A 2 Toga Paramyxo 33 RM A PH Orthomyxo Corona F O Y L Rhabdo Retro N EO S Arena FlaviR U FO Filo Classification of Viruses DNA Viruses (Naked) Papova Adeno Parvo 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Parvoviridae Erythema infectiosum Fifth disease 4 2 3 2 Y Slapped cheek appearance F O Y FO SE U R L N O P M R HA A 2 33 Papovaviridae Papillomavirus HPV4 Polyomavirus HPV16 &HPV18 Human wart virus Human wart virus Genital/anal warts A CA of uterine cervix 2 3 RM HPV1 F O Y Skin plantar warts SE U R FO 4 2 3 2 Y L N O A H P 3 Adenoviridae URTI No purulent sputum 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Classification of Viruses 4 2 3 2 Y DNA Viruses (Enveloped) Pox Herpes Hepadna F O Y FO SE U R L N O P M R HA A 2 33 Hepadnaviridae Hepatitis B Virus Hepatocellular carcinoma 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Herpesviridae HSV1 HHV5 HSV2 HHV8 VZV Fever blisters, cold sores Genital herpes Cytomegalovirus 4 2 3 2 Y Kaposi’s Sarcoma 2A EBVY OF P M R HA 33 L N Infectious O SE U mononucleosis R Chickenpox, shingles FO Poxviridae Variola Virus Smallpox 4 2 3 2 Y Vaccinia Virus Cowpox P Molluscum contagiosum Virus L STD R FO N O E US F O Y M R HA A 2 33 Classification of Viruses RNA Viruses (Naked) Picorna Calici Reo 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Picornaviridae Poliovirus Rhinovirus poliomyelitis Common cold 4 2 3 2 Y Coxsackievirus Hand-foot-mouth Disease Hepatitis A Virus F O Y Short term hepatitis FO SE U R L N O P M R HA A 2 33 Caliciviridae Norwalk Virus Norwalk virus syndrome (N&V) 4 2 3 2 Y Hepatitis E Virus Same with HAV F O Y FO SE U R L N O P M R HA A 2 33 Reoviridae Rotavirus Viral enteritis in children 4 2 3 2 Y Colorado tick fever virus Vector: Dermacentor andersoni F O Y FO SE U R L N O P M R HA A 2 33 Classification of Viruses RNA Viruses (Enveloped) 4 2 3 2 Y A 2 Toga Paramyxo 33 RM A PH Orthomyxo Corona F O Y L Rhabdo Retro N EO S Arena FlaviR U FO Filo Togaviridae Equine Encephalitis Virus Rubella Virus German Measles Affects brain parenchyma Yellow Fever Virus 4 2 3 2 Y Mosquito-borne; jaundice St. Louis Encephalitis VIrus neurologic F O Y FO SE U R L N O P M R HA A 2 33 Flaviviridae Dengue Fever Virus Breakbone fever West Nile Fever Virus Mosquito-borne; encephalitis, convulsion 332 Hepatitis C Virus F O Y STD, blood transfusion FO SE U R L N O P M R HA A 4 2 3 2 Y Filoviridae Ebola/Marburg Virus Hemorrhagic fever occurs in blood and tissue 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Orthomyxoviridae Infuenza A AH1N1 4 2 3 2 Y Influenza B F O Y FO SE U R L N O P M R HA A 2 33 Paramyxoviridae Parainfluenza Virus “barking seal” sounds Respiratory Syncytial Virus3-24 Mumps Virus Viral parotitis Measles Virus 2 Common cold AY F O Y Rubeola; Koplik Spots FO SE U R L N O P M R HA 2 33 Rhabdoviridae Rabies Virus Bullet-shaped Neurologic Negri bodies 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 Retroviridae HIV 1 More common HIV 1 4 2 3 2 Y West Africa F O Y FO SE U R L N O P M R HA A 2 33 Arenaviridae Lassa Virus Lassa fever Fever, HA, hemorrhage, inc. heart and kidney failure F O Y FO SE U R L N O P M R HA A 2 33 4 2 3 2 Y Coronaviridae Infectious Bronchitis Virus Coronavirus SARS-CoV Pneumonia; contact with infectious material Coronavirus COVID-19 Droplet Flu-like symptoms F O Y FO SE U R L N O P M R HA A 2 33 4 2 3 2 Y Virus Mechanism Examples Herpes DNA Polymerase Inhibitors Acyclovir, Valacyclovir, Ganciclovir NRTI Zidovudine, Abacavir, Dideoxynosine, Lamivudine, Stavudine, Tenofovir, Disoproxil, Fumarase, Zalcitabine NNRTI Delavirdine, Efavirenz, Nevaripine Protease Inhibitors A 2 Amprenavir, Indinavir, Lopinavir, 33 Nalfinavir, Ritonavir, Saquinavir RM HIV (Antiretroviral) Influenza 4 2 3 2 Y F O Y A H P L Amantadine, Rimantadine, N O Olsetamivir E Inh of Viral Uncoating FO S U R PARASITOLOGY 4 2 3 2 Y Prepared and Presented By: Santi Raphael B. Lledo, RPh FO SE U R L N O F O Y P M R HA A 2 33 PARASITES 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 INTESTINAL AND LUMINAL PROTOZOA Organism Entamoeba histolytica Transmission Symptoms Treatment Oro-fecal Dysentery with blood and necrotic tissue. Chronic: abscesses Oro-fecal Fowl-smelling, bulky diarrhea; blood or necrotic tissue rare. Balantidium coli Oro-fecal; zoonotic Dysentery with blood and necrotic tissue but no abscesses. Cryptosporidium parvum Oro-fecal Diarrhea Isospora belli Oro-fecal Giardiasis-like LY Trichomonas vaginalis Sexual Giardia lamblia ON Metronidazole Abscess: Metronidazole P OF Vaginitis; SE occasional U urethritis/prostatitis. R FO GI: Iodoquinol or Iodoquinol or Metronidazole. H 4 2 Iodoquinol or 3 Y2 Metronidazole. A 2 33 M AR Paromycin (investigational) Sulpha drugs Mebendazole BLOOD AND TISSUE PROTOZOA Organism Transmission Disease/symptoms Treatment Trypanosoma brucei Tsetse fly. Sleeping sickness; cardiac failure. Blood stage: Suramin or petamidine isothionate; Reduvid (kissing) bug. Chagas disease: megacolon, cardiac failure. CNS: melarsoprol Nifurtimox and Benzonidazole. Visceral leishmaniasis, granulomatous skin lesions. Pentosam; Pentamidine A 2 isothionate. 33 T. cruzi Leishmania donovani Sand fly 4 2 3 2 Y P L. tropica Sand fly. Cutaneous lesions. L. braziliensis Sand fly Mucocutaneous ON lesions. F O Y R FO E US L M R HA As for L. donovani. As for L. donovani. BLOOD AND TISSUE PROTOZOA Organism Transmission Disease/symptoms Treatment Plasmodium falciparum P. ovale, P. malariae and P. vivax Female anopheline mosquito. Malarial paroxysm: chills, fever, headache, nausea cycles. Quinine derivatives Proguanil Lariam Babesia microti Tick Hemolytic anemia, Jaundice and fever None; self resolving. Toxoplasma gondii Oral from cat fecal material; or meat Adult: flu like; congenital: abortion, neonatal blindness and neuropathies. F O Y FO SE U R L N O 4 2 3 2 Y Sulphonamides, A 2 pyemethamine, possibly 33 RM spiramycin A H P NEMATODES Organism Transmission Symptoms Treatment Ascaris lumbricoides Oro-fecal Abdominal pain, weight loss, distended abdomen Mebendazole Trichinella spiralis Poorly cooked pork spasm; eosinophilia, tachycardia, fever, chill headache, vertigo, delirium, coma, etc. Corticosteroid and Mebendazole Trichuris trichiura Oro-fecal Abdominal pain, bloody diarrhea, prolapsed rectum Enterobius vermicularis Oro-fecal Peri-anal pruritus, rare abdominal pain, nausea vomiting Mebendazole 24 P Strongyloides stercoralis Soil-skin, autoinfection R A pamoate Pyrental 2 33Mebendazole or M R HA F Itching at infection site, rash due to larval O Y midmigration, verminous pneumonia, L N bloody O epigastric pain, nausea, vomiting, SE and anemia dysentery, weightUloss FO 32 Y Ivermectin or Thiabendazole NEMATODES Organism Transmission Symptoms Treatment Necator americanes; Ancylostoma duodenale Oro-fecal (egg); skin penetration (larvae) Maculopapular erythema (ground itch), bronchopneumonitis, epigastric pain, GI hemorrhage, anemia, edema Mebendazole Oral: cyclops in water Blistering skin, irritation, inflammation Mebendazole Mosquito bite Recurrent fever, lymph-adenitis, splenomegaly, lymphedema, elephantiasis Mebendazole; Diethyl4 2 carbamazine 23 (Hookworms) Dracunculus medinensis Wuchereria bancrofti; W. brugia malayi (elephantiasis) Onchocerca volvulus Black fly bite Y A 2 33 Nodular and erythematous M Mebendazole; Diethyldermal lesions, eosinophilia, AR carbamazine H urticaria, blindness F P O Y L Loa loa Deer fly ON As in onchocerciasis SE F U R O Diethyl-carbamazine 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 Oro-fecal Large cysts produce various AR H symptoms depending F P on the O location of the Y organism. Diphyllobothrium latum M Echinococcus granulosus Echinococcus multiloculoris Oro-fecal FO SE U R L N O As above 4 2 Praziquantel 3 2 AY 2 33 Surgery, formalin injection and drainage, Praziquantel Surgery, Albendazole TREMATODES Organism Transmission Symptoms Treatment skin penetration by cercaria Dermatitis, abdominal pain, bloody stool, peri-portal 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, 4 Schistosoma mansoni, S. japonicum Inflammation and deformation of bile duct, hepatitis, anemia andRM edema PHA Chlonorchis sinensis, Opisthorchis felinus, or O. viverini Cysts in fish Paragonimus westermani Cyst in crab meat FO F O Cough (dry Y/ rusty brown L Npulmonary pain, sputum), O SE tuberculosis-like pleurisy, U R -2 3 Y2 A 2 33 Praziquantel Praziquantel ANTHELMINTICS Pyrantel Pamoate a depolarizing blocking agent that causes spastic paralysis to susceptible helminths Thiabendazole MOA: Inhibits the helminth-specific enzyme fumarate reductase Mebendazole MOA: -Irreversibly blocks glucose uptake in susceptible helminths -Inhibits Microtubule synthesis 4 2 3 2 Y A 2 33 Ivermectin RM A PH MOA: Blocks Interneuron-motor neuron transmission in nematodes by stimulating the F O release of the inhibitory neurotransmitter GABA. LY N O E US Praziquantel OR considered as the DOC for most Cestodal & Trematodal FInfection IMMUNOLOGY 4 2 3 2 Y Prepared and Presented By: Santi Raphael B. Lledo, RPh FO SE U R L N O F O Y P M R HA A 2 33 IMMUNITY 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33 4 2 3 2 Y F O Y FO SE U R L N O P M R HA A 2 33