Microbiology Disease-athon (TCU - Dr. Jones)

Acute Bacterial Pharyngitis ("strep throat") *

Upper Respiratory Tract

Bacterial

Organism - Streptococcus pyogenes (group A, Gram pos., facultative anaerobe)

Virulence - C5a peptidase (break down complement enzyme C5a), hyaluronic acid capsule (protects/hide from phagocytes), streptokinase (break down blood clots), M protein (destabilize compliment/block opsonization), pyrogenic toxin (erythrogenic, stimulate leukocyte release cytokine, fever, rash, shock), streptolysin (a/B/y hemolysis of RBC, WBC, platelet)

Signs/Symptoms - sore red throat, difficult swallowing, swollen lymph nodes, fever, cough, malaise

Epidemiology - respiratory droplets, winter/spring

Treatment - test antigens, check WBC's, throat culture, check for viral, Penicillin, Erythromycin, Cephalosporin

Scarlet Fever

Upper Respiratory Tract

Bacterial

Organism - STREPTOCOCCAL*

Virulence - STREP*

Signs/Symptoms - sandpaper like red rash on neck and body, strawberry tongue, headache, fever, chills, myalgia/muscle aches

Epidemiology - 1 or 2 days following A.B.P. symptoms

Treatment - STREP*

Rheumatic Fever

Upper Respiratory Tract

Bacterial

Organism - STREPTOCOCCAL*

Virulence - STREP*

Signs/Symptoms - rheumatic heart disease, complications affect heart and joints, permanent

Epidemiology - 20 day incubation, impaired adaptive immunity or bacteria spread to heart

Treatment - STREP*

Acute Glomerulonephritis

Upper Respiratory Tract

Bacterial

Organism - STREPTOCOCCAL*

Virulence - STREP*

Signs/Symptoms - inflammation of glomeruli in nephrons causing permanent renal/kidney damage (M protein)

Epidemiology - impaired adaptive immunity

Treatment - STREP*

Diphtheria

Upper Respiratory Tract

Bacterial

Organism - Corynebacterium diphtheriae (Gram pos., pleomorphic) Chinese lettering/palisade arranged

Virulence - Diphtheriae toxin prevents protein synthesis

Signs/Symptoms - pseudo membrane blocks airways, oozing fluid, pain, spread to nervous system or heart via bloodstream

Epidemiology - respiratory droplets or direct contact; symptomatic in infants, elderly, and Immunocompromised

Treatment - Antitoxin and Antibiotic (Penicillin/Erythromycin); DTaP vaccine/TDaP booster

Sinusitis OR Otitis Media

Upper Respiratory Tract

Bacterial

Organism - Streptococcus pyogenes/Staphylococcus aureus/Haemophilus influenzae/Moraxella catarrhalis (SP - 35%, SA ~ 1.5%, HI ~ 25%, MC ~ 12.5%)

Virulence - Alpha-hemolysis, spread to ears, sinus, and even mucous membrane/microbiome

Signs/Symptoms - inflamed sinus, tonsil, or auditory canal pain/pressure in head with malaise

Epidemiology - pharynx spread to sinus via throat; sinusitis (adults) otitis (kids)

Treatment - Penicillin for Otitis Media or lacing ear drums with plastic tubes; no known cure for sinusitis (remove tonsils)

Pneumococcal Pneumonia

Lower Respiratory Tract

Bacterial

Organism - Streptococcus pneumoniae (Gram pos., chains or pairs of cocci)

Virulence - Adhesins, Capsule, Phosphorylcholine, Pneumolysin

Signs/Symptoms - short rapid breathing, flehm, rusty sputum if untreated

Epidemiology - inhalation of bacteria, replication damage

Treatment - Penicillin, Cephalosporin, Erythromycin, Chloramphenicol and the PCV vaccination (2, 4, 6, and 12 to 15 months)

Primary Atypical Pneumonia

Lower Respiratory Tract

Bacterial

Organism - Mycoplasma pneumoniae (aerobic, "walking pneumonia")

Virulence - Pleomorphic, encapsulated, no cell wall, adhesion protein, sterols in cell membrane, smallest fee living microbe (.1 to .8 um)

Signs/Symptoms - fever, malaise, sore throat, excessive sweating

Epidemiology - spread by nasal secretion, leading pneumonia in children and young adults

Treatment - hard to treat, can be asymptomatic; Tetracycline and Erythromycin

Klebsiella Pneumonia

Lower Respiratory Tract

Bacterial

Organism - Klebsiella pneumoniae (gram neg. rod)

Virulence - Endotoxin (cells die lead to cytokine shock), capsule, mucoid appearance

Signs/Symptoms - pneumonia symptoms with thick bloody sputum, recurrent chills

Epidemiology - #1 Nosocomial acquired pneumonia, common in at risk populations

Treatment - Antimicrobials and Aseptic Technique (also involved in Meningitis, wound infection, and UTIs)

Legionnaire's Disease

Lower Respiratory Tract

Bacterial

Organism - Legionella pneumophila (gram neg. slender)

Virulence - aerobic, pleomorphic, buffered charcoal yeast extract agar (iron salts and cysteine)

Signs/Symptoms - florescent antibody; pneumonia, fever, chills, GI/CNS/Liver/Kidney damage, headache, pleurisy

Epidemiology - kills lung cells (smokers), lives in domestic water and invades protozoa, invades GI / macrophages

Treatment - Quinolones or Macrolides; reduce presence in water, 50% mortality if untreated

Tuberculosis

Lower Respiratory Tract

Bacterial

Organism - Mycobacterium tuberculosis (rods)

Virulence - MDRTB, XDRTB, cell wall with Mycolic Acids (waxy lipid, acid fast stain)

Signs/Symptoms - PRIMARY (minor cough, mild fever, hard breathing, fatigue)

SECONDARY (tubercle burst in lungs, weight loss, chest pain, bloody cough) TERTIARY (enter macrophages 55% mortality)

Epidemiology - Aerosol drops, kill most, pandemic in Asia/Africa (1/3), 9 million new cases per year

Treatment - Skin Purified Protein Derivative tuberculosis test (PPD TB) (Mantoux) chest x-ray tubercles, 6 to 12 months of Isoniazid drug combo cures

Pertussis (Whooping Cough)

Lower Respiratory Tract

Bacterial

Organism - Bordetella pertussis (Gram neg., small coccobacillus)

Virulence - Aerobic, Adhesins (filamentous hemaglobin), Pertussis toxin (increase mucous in ciliated epithelium), Adenylate cyclase (mucous increase/inhibit phagocytes), derminecrotic toxin (constrict/hemorrhage vessels) tracheal cytotoxin (inhibits cilia/cell movement)

Signs/Symptoms - cough after 1 to 2 weeks, vomiting, diarrhea, choking, cyanosis; 4 PHASES = 1. incubation 2. catarrhal 3. paroxysmal 4. convalescent) 40-50 spells of 2-3 cough/whoop a day

Epidemiology - high contagious through airborne droplets, pediatric can be life threatening

Treatment - DTaP/TDaP vaccine, primarily supportive care

Inhalation Anthrax

Lower Respiratory Tract

Bacterial

Organism - Bacillus anthracis (Gram pos. rod)

Virulence - aerobic, endospore, capsule, Anthrax Toxin

Signs/Symptoms - resembles cold/flu at first, myalgia, cough, fever, progress to nausea, lethargy, shock, faint, and death

Epidemiology - Cutaneous, GI, or Inhalation of endospores; contact, not person to person, concern of bioterrorism

Treatment - identify in sputum, vaccinate before, aggressive Penicillin, Doxycycline, Ciprofloxacin

Common Cold

Upper Respiratory Tract

Viral

Organism - Enteroviruses (rhinovirus, picornaviridae, adenovirus, paramyxovirus)

Virulence - replicate in then kill infected cells, 1 mL of mucus has 100,000 virion

Signs/Symptoms - sneeze, local inflammation, coughing, mucus

Epidemiology - mucus produce sneeze for aerosol droplets and fomite infection; inflammation (highly infective for hours)

Treatment - Pleconaril can reduce duration (block attachment) rest, fluids, hand washing, antihistamine, decongestant can prevent or reduce symptoms

Influenza**

Lower Respiratory Tract

Viral

Organism - Orthomyxoviridae named based on Type (A/B), Location, date of index case, and antigens

Virulence - Hemagglutinin to attach, Neuraminidase to release, 8 -ssRNA segments can mutate in new hosts (drift within a strain ~2 years, shift is new strains ~10 years)

Signs/Symptoms - Sudden fever, pharyngitis, cough, myalgia, congestion; due to immune response

Treatment - antigen test diagnostic, relieve only (tamiflu/Relenza) ;70% effective vaccine ~6mo live and attenuated

Swine Flu (H1N1)

Lower Respiratory Tract

Viral

Organism - Type A Influenza; H1N1

Virulence - Genes similar to influenza in pigs

Signs/Symptoms - INFLUENZA**

Epidemiology - less deadly and less contagious in humans; Pandemic of 2009

Treatment - INFLUENZA**

Avian Flu

Lower Respiratory System

Viral

Organism - Type A influenza; H5N1 or H7N9 (China, March 2013, 136 cases, 45 confirmed deaths)

Virulence - kills birds swiftly, fatality over 50% in humans

Signs/Symptoms - INFLUENZA**

Epidemiology - Asia, Europe, Africa, North America; contact with birds zoonotic (no human spread)

Treatment - INFLUENZA**

Severe Acute Respiratory Syndrome (SARS)

Lower Respiratory System

Viral

Organism - SARS Virus

Virulence - enveloped, +ssRNA, helical capsules

Signs/Symptoms - high fever, shortness of breath, difficulty breathing, later develop dry cough and pneumonia

Epidemiology - Respiratory Droplets, adheres and destroys lung, heart, and kidney cells

Treatment - mainly supportive; CHINA spring 2003, by December 29 countries and 774 deaths

Respiratory Syncytial Virus (RSV)

Lower Respiratory Tract

Viral

Organism - Paramyxoviridae Pneumovirus RSV

Virulence - envelope, helical, -ssRNA, 5 hour fomite, 2 hour on tissue (droplets are less time)

Signs/Symptoms - fever, runny nose, coughing; leading cause of bronchitis and pneumonia; mild cold-like in older people, tracheobronchitis (croup) in babies and plug bronchi (98% by age 3)

Epidemiology - syncytia in lungs (multinucleated) cytotoxic T response further damages; fall through spring

Treatment - most common child respiratory disease; Immunoassay WBC count, supportive treatment for young kids (oxygen, IV, fever drug antibiotics) aseptic technique

Hantavirus Pulmonary Syndrome (HPS)

Lower Respiratory Tract

Viral

Organism - Bunyaviridae Hantavirus

Virulence - enveloped, segmented -ssRNA; widespread inflammation and shock

Signs/Symptoms - Fever, fatigue, aches (thigh, hip, back) headache, chills, vomit, diarrhea, ~4-10 day cough/shock; inflamed capillaries leak into tissues

Epidemiology - From deer-mice via inhalation of dried urine, feces, or saliva, 50% mortality, control rodents

Treatment - no specific treatment, High Leucocyte count, low platelet, sudden fever, muscle ache; intubation, fever drugs pain meds, oxygen tubes

Coccidiodomycosis (Valley Fever)

Lower Respiratory Tract

Fungal

Organism - Coccidioides immitis

(Ascomycota)

Virulence - yeast form at human body temp, mycelium to arthroconidia (asexual)

Signs/Symptoms - like pneumonia or TB, can become systemic in immunocompromised, some have trunk rash; <1% have CNS invasion

Epidemiology - asexual spore (arthroconidia) forms in soil and enters by inhalation; endemic Mexico/USA border, South America (3%)

Treatment - Spherules in specimen, skin test, healthy resolves on own, Amphotericin-B (Itraconazole / Fluconazole prevent release) wear mask

Blastomycosis

Lower Respiratory Tract

Fungal

Organism - Blastomyces dermatitidis

Virulence - spore to yeat form, grow in rich soil, form at body temp

Signs/Symptoms - high mortality in immunocompromised; flu like symptoms, system lesion (60-70%), necrosis (30%)

Epidemiology - Inhalation of dust with spores, human cases increasing, endemic USA east coast up to Canada

Treatment -Amphotericin-B (10 weeks to treat), Itraconazole (3-6 months), relapse common w/ AIDS

Histoplasmosis

Lower Respiratory Tract

Fungal

Organism - Histoplasma capsulatum (Ascomycota)

Virulence - pathogenic yeast at body temp

Signs/Symptoms - asymptomatic in most; coughing with bloody sputum/lesions

Epidemiology - Soil w/ high nitrogen (bat/bird dropping); inhale airborne spores, immunity kills, Ohio River Valley; endemic USA east coast, central and south America, mid and west africa

Treatment - Fungus in clinical samples, spiny spores, immunocompetent no help needed, Itraconzole, Amph-B

Pneumocytis Pneumonia (PCP)

Lower Respiratory Tract

Fungal

Organism - Pneumocystis jirovecii (carnii); Ascomycota

Virulence - Lesions in lymph nodes, spleen, liver, and bone marrow

Signs/Symptoms - Hard to breathe, fever anemia, hypoxia; n.p. cough, destroy lungs

Epidemiology - needs a host, common with AIDS, inhalation of droplet containing fungus; Member of normal microbiota, axenic infection deadly; impossible to prevent

Treatment - Microscope findings, chest x-ray (fluid) Trimethoprim (TMP/SMX) Sulfamethoxazole

Dental Caries, Gingivitis, and Periodontal Disease

Digestive System

Bacterial

Organism - Streptococcus mutans (carries) Porphyromonas gingivalis (periodontal)

Virulence - (mutans): Dextran and pili make a biofilm (gingivalis): proteases break down gum tissue

Signs/Symptoms - cavities in the teeth, inflammation of the gums, redness/infection/bleeding gums

Epidemiology - most adults have experienced dental carries; sucrose increases risk factors

Treatment - visual inspection, fill cavities, scale/use antimicrobial rinse, daily oral hygiene

Peptic Ulcer

Digestive System

Bacterial

Organism - Helicobacter pylori (Gram neg., curved helical rod, highly motile, microaeorophile)

Virulence - Flagella to burrow, Adhesins attach to gastric cell, urease degrades stomach urea make NH3 (more neutral pH)

Signs/Symptoms - Abdominal Pain, intestinal ulcers

Epidemiology - fecal oral transmission, stress may worsen ulcer

Treatment - X ray exam and H. pylori treat with Prilosec or Omeprazole (inhibit HCl) avoid fecal oral passage

Bacterial Gastroenteritis (BGE)

Digestive System

Bacterial

Organism - SEE BELOW

Virulence - SEE BELOW

Signs/Symptoms - inflammation of stomach/intestine, nausea, vomiting, diarrhea, cramps, abdominal pain; Dysentery (loose frequent stool w/ mucus and blood)

Epidemiology - contaminated food or water and poor living, Haiti 2010 earthquake (8300 deaths by cholera)

Treatment - rice water stool, vaccine short lived, hygiene, Tetracycline, clean water replacement and fluids, proper handling/storage/prep of food

Cholera (BGE)

Digestive System

Bacterial

Organism - Vibrio cholerae (Gram neg., slightly curved bacillus)

Virulence - polar flagella, estuarine and marine life, cholera toxin A and B

Signs/Symptoms - severe diarrhea (1L/hr.) dehydration acidosis, cramping, hypokalemia, hypovolemic shock, lethargy, sunken eyes, irregular heartbeat, kidney failure, coma, death; A activates Adenylate Cyclase for ATP/cAMP, B attaches

Epidemiology - historically pandemic

Treatment - tetracycline, short vaccine, hygiene, treat water

Shigellosis

Digestive System

Bacterial

Organism - 4 types: S. dysenteriae, S. flexneri, S. boydii, S. sonnei (Gram neg.)

Virulence - Type III secretion (20 polypeptides, channels in host) Enterotoxin (water and electrolyte loss) Shiga-toxin (stops host protein synth.) Actin fibers to move

Signs/Symptoms - mucosal abscess, BGE symptoms

Epidemiology - colonizes the small, then large intestine; non motile, triggers endocytosis

Treatment - presence in stool, supportive care, Antimicrobials (Ciprofloxacin, Azithromycin, Rifaximin)

Traveler's Diarrhea

Digestive System

Bacterial

Organism - Escherichia coli (O, K, and H antigens)

Virulence - aerobic/facultative anaerobe; ferment lactose to form gas; O157, O111, H8, H7 (O157:H7 shiga-like toxin)

Signs/Symptoms - Diarrhea mediated by enterotoxins (inhibit protein synthesis, kill cells, cause kidney failure)

Epidemiology - drinking unclean water or food cooked with contaminated water

Treatment - based on signs/symptoms, treatment of fluid and electrolyte replacement (NO ANTIDIARRHEAL)

Campylobacter Diarrhea

Digestive System

Bacterial

Organism - Campylobacter jejuni (Gram neg.)

Virulence - polar flagella, Adhesins, Cytotoxins, Endotoxins

Signs/Symptoms - bleeding lesions, inflammation, BGE symptoms, Guillian-Barre syndrome after infection

Epidemiology - poultry is primary source, colonize jejunum, ileum, and colon, most common cause to go to doctor in GI

Treatment - most resolve without treatment, prevent with proper hygiene and handling of raw chicken

Antimicrobial-Associated Diarrhea

Digestive System

Bacterial

Organism - Clostridium difficile (Gram pos.)

Virulence - endospore, anaerobic, Toxin A (break down cell junctions, lose fluid, inflammation) Toxin B (kill colon cells, induce lesion form)

Signs/Symptoms - pseudo membrane lesions (connective, dying leukocyte, dead colon cells) 5-10 clear watery foul smelling poops/day

Epidemiology - toxins mediate inflammation and pseudo membrane formation, antimicrobial use facilitate overgrow (byproduct of modern medicine) CDC estimates 500,000 cases/year (15,000 deaths) shed in feces and spread

Treatment - colonoscopy reveals yellowish lesions, fecal transplant, avoid unnecessary clean; Metronidazole, Vancomycin, Cholestyramine

Salmonellosis and Typhoid Fever

Digestive System

Organism - Salmonella enterica (Typhi/Paratyphi cause fever) (Enteritidis/ Typhimurium cause salmonellosis) (Gram neg.)

Virulence - motile, peritrichous bacilli, tolerate acidity, toxins distrupt mitochondria, inhibits phagocytosis, and induce apoptosis

Signs/Symptoms - fever, abdominal cramps, diarrhea, BGE symptoms; carried via blood to liver, splee, bone marrow, and gall bladder(semi-permanent) delirium if fever develops, may last 4 weeks

Epidemiology - Typhoid (food and water 1000-10000 cells infectious)

Salmonellosis (contaminated eggs, meat during processing of raw chicken)

Treatment - usually self limiting within a week(salmonellosis), treated with anti-microbial drugs (typhoid)(Ampicillin, Ciprofloxacin)

Bacterial Food Poisoning (Intoxication)

Digestive System

Bacterial

Organism - Staphylococcus aureus

Virulence - five enterotoxins (A-E) trigger contractions and nausea/vomit; heat stable at 100 C for up to 30 mins

Signs/Symptoms - nausea, vomiting, diarrhea, cramping

Epidemiology - social functions, foods, processed meats, custard pastries, potato salad, ice cream

Treatment - treat with fluid and electrolyte replacement, proper hygiene

Oral Herpes

Digestive System

Viral

Organism - Human Herpesvirus1 (HHV1)

Virulence - avoid immune system by forming syncytia, latent in the trigeminal nerve ganglia (reactivate)

Signs/Symptoms - initial flu-like (malaise, fever, pain) fluid filled lesions, stress, fever, sun, trauma, sunlight, disease, periods

Epidemiology - infection occurs by casual contact, or skin to skin (early)

Treatment - diagnosis based on characteristic lesions, topical/oral Acyclovir; avoid direct contact /sharing

Mumps (Parotitis)

Digestive System

Viral

Organism - Mumps virus(Paramyxovirus)

Virulence - humans are only natural host

Signs/Symptoms - swelling of Parotid salivary gland, face pain, fever, headache, sore throat/testes (orchitis) meningitis, pancreatitis, hearing affected

Epidemiology - common in kids 2-12 but now is almost gone due to vaccine

Treatment - no specific treatment, infected develop life long immunity, MMR Vaccine (12 mo. and 4/6 yrs.)

Viral Gastroenteritis

Digestive System

Viral

Organism - Norovirus (calicivirus) 90%, Rotvirus (infant), Astrovirus

Virulence - calicivirus AND astrovirus (+ssRNA, small, naked, star shape); Rotavirus (dsRNA, spherical, naked, wheel-like)

Signs/Symptoms - similar to BGE, abdominal pain, cramping, diarrhea, nausea, vomiting

Epidemiology - death most common in developing country, about 600,000/yr., more cases in winter, cruises

Treatment - incubate in 24 hour, resolve in 12-60 hours; Serological test, treatment w/ fluid and electrolyte replacement, oral attenuated Rotavirus vaccine

Viral Hepatitis

Digestive System

Viral

Organism - Hepatitis A, B, C, delta, E viruses

Virulence - can appear years after infection

Signs/Symptoms - jaundice, abdominal pain, fatigue, vomit, appetite loss; immune response causes liver damage (cirrhosis)

Epidemiology - A is fecal/oral, B is needles/sex/fluid, C is Needles/Sex, delta is Needles/sex E is fecal/oral; SEE CHART ON PPT

Treatment - diagnosed by observation of jaundice/liver failure; serological test (Dane Particle) alpha interferon and Ribavirin (HBV/HBC) safe sex, food safety, hygiene; Vaccines for HAV/HBV/HCV

Giardiasis

Digestive System

Protozoan

Organism - Giardia intestinalis (two equal nuclei)

Virulence - trophozoite form (motile) cyst form (dormant/resistant) adhesive disk

Signs/Symptoms - severe, greasy, frothy, fatty, stinky, diarrhea/stools

Epidemiology - ingested in water (hikers/campers), AKA Beaver Fever; excyst in small intestine wall, interfere with intestinal absorption causing flatus

Treatment - Metronidazole or Furazolidone; replace fluids; prevent by filtering water/good hygiene

Cryptosporidiosis

Digestive System

Protozoan

Organism - Cryptosporidium parvum

Virulence - Sporozoites form oocysts (thick shell), Apical complex of organelles for penetration of host

Signs/Symptoms - severe watery diarrhea with bad complications

Epidemiology - infection from drinking contaminated water with oocysts (4 sporozoites form)

Treatment - presence of oocysts in feces, treated with fluid and electrolyte replacement, good hygiene

Amebiasis

Digestive System

Protozoan

Organism - Entamoeba histolytica

Virulence - Trophozoite to cyst,

Virulence factors include adhesion proteins, proteases, proteins that create channels in host cells, cytotoxic proteins, Trophozoites use pseudopodia; invade peritoneal cavity/blood

Signs/Symptoms - Luminal amebiasis (asymptomatic)

Invasive amebic dysentery (severe diarrhea, colitis, appendicitis, ulceration of intestinal mucosa)

Invasive extraintestinal amebiasis (necrotic lesions in liver, lungs, spleen, kidneys or brain)

Epidemiology - Transmitted by consumption of contaminated food or water, from contaminated hands, or oral-anal intercourse, Majority of individuals develop luminal amebiasis

Treatment - Entamoeba in stool or intestinal biopsy, Treat with oral rehydration therapy and antiamebic drugs (Iodoquinol and Paromomycin - asymptomatic infections; (Metronidazole followed by Iodoquinol for symptomatic forms)

Human Immunodeficiency Virus/ Acquired Immunodeficiency Syndrome

Viral

Organism - HIV 1 (USA and Europe), HIV 2 (west Africa) Retrovirus

Virulence - decrease CD4 cells (<200), opportunistic infections follow

Signs/Symptoms - AIDS: primary infection spike, clinical latency low plateau, disease, death

Epidemiology - worldwide; in blood, semen, vaginal secretions, and breast milk (can be through tears in skin/mucous); Africa, Americas, Europe, Asia, Australia, Middle East

Treatment - avoid anal, lots of sex, needle drugs, sex with people who do this stuff; detect HIV antibodies, not AIDS, w/PCR test, small % do not progress to AIDS b/c of mutation,

ART - A "cocktail" of several antiviral drugs

Nucleoside analogs, Integrase inhibitors, Protease inhibitors, Reverse transcriptase inhibitors

Reduces viral replication, but infection remains

Those infected can live normal lives on anti-viral drugs, Preventative Antiviral Drugs

PrEP - Truvada, 100% effective in preventing contraction of HIV from an infected individual

Diseases associated with AIDS are treated individually Individuals can slow the AIDS epidemic with numerous personal decisions

History - 1981 among homos in US worldwide pandemic; likely arose from mutation of simian immunodeficiency virus, estimated to emerge 1930's

2017 = 36.9 million w/ HIV, 21.7 million with ART, 1.8 million new cases, 940,000 died AIDS related death 77.3 million infected since the start, 35.4 million have died since the start

Replication -

ATTACHMENT: glycoprotein gp120, attach to Helper T CD4 cells, macrophages, smooth muscle, and dendritic cells

ENTRY/UNCOAT: gp41 for fusion w/ cell cytoplasmic membrane, uncoats ssRNA

SYNTHESIS: Reverse transcriptase synthesizes DNA from RNA, errors contribute to many variant

INTEGRATION: latent virus, integrate as provirus into chromosome using integrase

REPLICATION: transcript/translate HIV genes, viral polypeptides made including attachment proteins, integrase, inactive RT, and capsomeres

RELEASE: immature HIV buds from host membrane w/ RNA and tRNA

ASSEMBLE/MATURE: non virulent buds, protease cleaves and releases RT and capsomeres

Folliculitis

Skin and Wounds

Bacterial

Organism - Staphylococcus aureus/epidermidis (Gram pos.)

Virulence - facultative anaerobe, tolerant of salt and desiccation

SA - coagulase, staphylokinase, lipase, B-lac., Polysacc slime, protein A, cytolytic toxins, leucocidin, differentiation inhibitor exfoliative(some), TSST (some)

SE - lipase, polysacc. slime

Signs/Symptoms - infected hair follicle, pimple/sty, spread to furuncles/carbuncles

Epidemiology - unclean hands, proper procedure to minimize MRSA infection

Treatment - isolate from pus, Dicloxacillin or Vancomycin for resistant strains

Staphylococcal Scalded Skin Syndrome (SSSS)

Skin and Wounds

Bacterial

Organism - Staphylococcus aureus

Virulence - exfoliative toxins cause SSSS

Signs/Symptoms - sloughing skin looks like burns, epidermal, death rare (secondary infections)

Epidemiology - mostly infants, person to person spread

Treatment - antimicrobial drugs that kill S. aureus

Impetigo (Pyoderma)

Skin and Wounds

Bacterial

Organism - Staphylococcus aureus (Gram pos.)

Virulence - coagulase, hyaluronidase, staphylokinase, salt tolerant

Signs/Symptoms - small flat red patches w/ oozing pus vesicles in broken skin and nose that is raw

Epidemiology - person to person or fomites, mostly in kids

Treatment - vesicles are diagnostic, Mupirocin and oral Erythromycin/ Dicloxacillin; hygiene

Erysipelas

Skin and Wounds

Bacterial

Organism - Streptococcus pyogenes (Gram pos.)

Virulence - M protein blocks phagocytosis, hyaluronic acid capsule, pyrogenic toxins

Signs/Symptoms - infection spread to lymph nodes and causes painful inflammation in face arms and legs; swollen lymph nodes, pain, fever, chills, leukocytosis, death

Epidemiology - redness with margins, person to person or fomite, mainly elderly

Treatment - Mupirocin and oral Erythromycin /Dicloxacillin

Necrotizing Fasciitis (Flesh Eating)

Skin and Wounds

Bacterial

Organism - Streptococcus pyogenes

Virulence - DNAses, Streptokinase, Hyaluronidase facilitate invasion; Endotoxin A and Streptolysin S

Signs/Symptoms - digestion of muscle fascia, enter through wounds in the skin, nonspecific

Epidemiology -person to person spread

Treatment - Clindamycin and Penicillin

Acne

Organism - Propionibacterium acnes (Gram pos. rod)

Virulence - normal microbe, diphtheroid

Signs/Symptoms - scarring/pus filled pimples

Epidemiology - normal microbiota invade skin (puberty)

Treatment - Doxycycline, Benzoyl Peroxide (exfoliate) Accutane if severe, blue light to destroy

Pseudomonas Infection

Organism - Pseudomonas aeruginosa

Virulence - Adhesins, Endotoxin (mediate fever vasodilation and shock), Exotoxin A/Exoenzyme S (inhibit protein synthesis) Elastase (break down elastic fibers, IgA, and IgG), Pyocyanin (triggers reactive forms of oxygen to cause tissue damage), polysacc. capsule

Signs/Symptoms - swimmers ear (otitis externa); grow under burn surface, kills cells, destroy tissue, trigger shock

Epidemiology - burn or Cystic Fibrosis patients cause infections inside (bacteremia, endocarditis, urinary, eye, ear, CNS, GI, muscle, and skeletal)

Treatment - MDR so Aminoglycosides and Beta-Lactams

Rocky Mountain Spotted Fever (RMSF)

Organism - Rickettsia reckettsii (Gram neg.)

Virulence - avoids phagosome digestion

Signs/Symptoms - damage to blood vessels, non-itchy spotted rash on body, fever, headache, chills, pain, nausea, vomiting; respiratory failure, GI, CNS, and Renal failure

Epidemiology - epidemic in south and south east USA, rising; transmit via infected tick (Dermacentor)

Treatment - serological test, antimicrobials, tick repellants/avoid ticks

Cutaneous Anthrax

Organism - Bacillus anthracis

Virulence - endospores

Signs/Symptoms - black painless ulcer called eschar

Epidemiology - disease in animals or soil penetrates skin

Treatment - Ciprofloxacin, Penicillin, Erythromycin

Gas Gangrene

Organism - Clostridium perfringes

Virulence - endospores, 11 toxins, Hemolysin, leucocidin (increase permeability, reduce BP, kill cells)

Signs/Symptoms - intense pain, blackened skin and muscle, gas bubbles

Epidemiology - trauma introduces endospores in dead tissue (+40% dead)

Treatment - surgical removal of dead tissue and antitoxin and penicillin

Poxviruses (Smallpox)

Skin and Wounds

Viral

Organism - Orthopoxviruses like Smallpox, Cowpox, and Monkeypox; Variola virus

Virulence - Macule (epidermis), Papule (raise, dermis), vesicle (fill w/ fluid), Pustule, Crust, Scar

Signs/Symptoms - macules, papules, vesicles, pustules, high fever (42 C/107 F)

Epidemiology - first disease eradicated in 1980; increase Monkeypox in 10 yr.

Treatment - immediate vaccination, discontinued in 1980, no new cases since

Warts

Skin and Wounds

Viral

Organism - various Papillomaviruses

Virulence - mainly harmless

Signs/Symptoms - epithelial growths on skin and mucous membranes

Epidemiology - skin to skin or fomite contact

Treatment - freeze, burn, chemical, excise

Chicken Pox/Shingles

Skin and Wounds

Viral

Organism - Varicella zoster virus (both)

Virulence - infect dermal cells (rash), latent in nerve ganglia to reactivate like herpes (stress)

Signs/Symptoms - lesions on back and trunk that spread by touch; Shingles are localized to the infected latent nerve

Epidemiology - mostly in kids, sever in adults/ reappear as shingles

Treatment - Diagnosis based on lesions/pox, relief of symptoms, vaccine available

Rubella (German/Three Day Measles)

Skin and Wounds

Viral

Organism - Rubella virus; Togaviridae Rubivirus

Virulence - respiratory secretions

Signs/Symptoms - mild rash in children, can kill fetus

Epidemiology - human infection only, droplet

Treatment - MMR vaccine (especially pregnant women), serological test

Measles (Rubeola)

Skin and Wounds

Viral

Organism - measles virus; Paramyxoviridae Morbillivirus

Virulence - adhesion and fusion proteins avoid immune system, highly contagious

Signs/Symptoms - immune response causes; fever, sore throat, headache, dry cough, Koplik's spots, and conjunctivitis; subacute sclerosing panencephalitis

Epidemiology - spread via droplets of lungs, only human hosts, more severe complication in adults

Treatment - diagnosis on signs, no treatment, part of MMR vaccine

Erythema Infectiosum (Slap Cheeks)

Skin and Wounds

Viral

Organism - Parvoviridae erythrovirus

Virulence - fifth disease (???)

Signs/Symptoms - facial rash

Epidemiology - respiratory droplets

Treatment - immune response is enough

Roseola

Organism - human herpesvirus 6 (HHV-6)

Virulence - high fever, fever break, then rash

Signs/Symptoms - rose colored rash on trunk and arms/legs

Epidemiology - children 6 mo. to 2 yr.

Treatment - immune response is enough

Coxsackievirus infection

Skin and Wounds

Viral

Organism - coxsackie A virus

Virulence - herpes like with lesions

Signs/Symptoms - lesions, hand foot and mouth disease, fever, sore throat, low appetite, red blisters followed by a rash

Epidemiology - direct contact/skin to skin

Treatment - recovery in 7 to 10 days

Piedra/Pityriasis (Superficial Mycoses)

Skin and Wounds

Fungal

Organism - Piedraia hortae (black), Trichosporon beigelii (white), Malassezia furfur (pityriasis)

Virulence - keratinase, transmitted via brush or comb with spores

Signs/Symptoms - irregular nodules on hair shaft (Piedra) wrong pigment of scaly skin (pityriasis)

Epidemiology - most common fungal, transmitted via brush or comb with spores

Treatment - shaving infected hair (Piedra) green under UV light and topical/oral Metronidazole or Antifungals (Pityriasis)

Cutaneous Mycoses (Dermatophytes)

Skin and Wounds

Fungal

Organism - Tinea pedis (athlete foot) Tinea cruris (jock itch) Tinea ungulum (nails) Tinea corporis (skin or ringworm) Tinea capitis (hair/scalp)

Virulence - SEE OTHER FUNGALS

Signs/Symptoms - manifest as cutaneous lesions or white "cheese" on skin

Epidemiology - dermatophytoses; spread from skin to skin or fomite contact

Treatment - KOH preparation of skin and nails to confirm, widespread infection w/ oral drugs, limited with topicals

Leishmaniasis

Skin and Wounds

Protozoan

Organism - Leishmania (protozoa)

Virulence - insect vector by female sand fly to humans

Signs/Symptoms - cutaneous (painless lesions), Mucocutaneous (encompass mucous membrane) Visceral (parasite in body by macrophages)

Epidemiology - infected macrophages stimulate inflammatory response, endemic in tropics and subtropics

Treatment - most heal without treatment, severe needs antimicrobials (Amphotericin B) reduce exposure to reservoir host

Bacterial Meningitis

Nervous System

Bacterial

Organism - Neisseria meningitidis (Gram -) Streptococcus pneumoniae (Gram +) Haemophilus influenzae, Listeria monocytogenes (Gram +), Streptococcus agalactiae (Lancefield group B strep)

Virulence - NM (13 strains, fimbriae, LOS, Lipid A blebbing, shock, fever, inflammation endotoxin, capsule) SP (pneumococcal pneumonia, 92 strains, capsule, secretory IgA protease, pneumolysin suppress lysosome, phosphorylcholine binds endocytosis) HItb (pleomorphic, 6 strains ~95%, polysacc capsule)

LM (bind epithelial or macrophage cells triggers endocytosis, Listeriolysin O opens phagosome before fuse with lysosome, actin pseudopods)

SAg (capsule avoids phagocytosis)

Signs/Symptoms - sudden high fever, rapid meningeal inflammation, encephalitis, behavior change, coma, death; SAg bacteremia and pneumonia in babies

Epidemiology - infect nervous cells, S. pneumoniae in throat of 75% of humans lead adults, not spread by casual contact, Meningococcal meningitis (NM) can become epidemic, typical risk population

Treatment - culture from CSF, intravenous Ceftriaxone, Ampicillin Erythromycin, Chloramphenicol, Aminoglycosides; vaccines for SP, HItb, and NM; avoid high risk foods; HiB vaccine LM raises monocytes

Botulism

Nervous System

Bacterial

Organism - Clostridium botulinum (Gram pos.)

Virulence - 7 neurotoxins that are ingested, endospore

Signs/Symptoms - blurred vision, dry mouth, constipation, nausea, vomiting, paralysis of muscles/diaphragm

Epidemiology - foodborne, infant, wound; blocks synaptic clefts ~50 cases per year USA, infant most common from inhalation/honey

Treatment - washing intestinal tract, botulism immunoglobulin (BIG-IV) antibiotics; destroy endospores, no honey for babies <1 year

Tetanus

Nervous System

Bacterial

Organism - Clostridium tetani

Virulence - neurotoxin called tetanospasmin

Signs/Symptoms - prolonged contraction of skeletal muscle fibers; lockjaw (trismus), spasms (hearbeat, curl arms, opisthotonos, diaphragm contracts)

Epidemiology - mortality is ~50% untreated, bind to nerve to force action; break in skin or mucous membrane distance from CNS determines incubation

Treatment - Ig antitoxin/passive immunotherapy, Penicillin, DTaP vaccine Tetanus toxoid (5 doses at 2 months, booster every 10 years for life)

Viral Meningitis

Nervous System

Viral

Organism - Enterovirus Coxsackie A and B, Echovirus

Virulence - respiratory and fecal oral route to the bloodstream; milder than fungal and bacterial meningitis

Signs/Symptoms - damage to meninges, fever, stiff neck, headache, drowsy, nausea, vomit, skin rash sore throat, colds

Epidemiology - more common than bacterial and fungal meningitis

Treatment - signs and symptoms, no bacteria in CSF, no treatment

Poliomyelitis (Polio)

Nervous System

Viral

Organism - Enterovirus Picornaviridae family

Virulence - drinking contaminated water

Signs/Symptoms - 90% asymptomatic, minor (nonspecific) nonparalytic (spasm and muscle pain) paralytic (paralysis)

Epidemiology - Not in the Americas, almost eradicated except for upper Africa and India

Treatment - Vaccines (Salk and Sabin)

Rabies

Nervous System

Viral

Organism - Rhabdoviridae Lyssavirus Rabies

Virulence - helical capsids surrounded by bullet envelopes

Signs/Symptoms - itch and pain initially, fever, malaise, anorexia, CNS (hydrophobia, seizure, disorient, paralyze, hallucinate) die from respiratory paralysis

Epidemiology - bite or scratch from infected animal, muscle replicate to neurons; dogs, foxes, badgers, racoons (east), cats, feral dogs, bats, skunks (epidemic in USA)

Treatment - negri bodies In brain after death, treat with human rabies, immunoglobin (HRIG) vaccine injections, cleanse infection; Human Diploid Cells Vaccine (HDCV) intramuscular 0, 3, 7, and 14 days after

West Nile Virus / Arboviral Encephalitis

Nervous System

Viral

Organism - Arbovirus (arthropod borne) Flaviviridae

Virulence - encephalitis enters CNS, confusion, disorientation, coma

Signs/Symptoms - high fever weakness nausea, vomiting, abrupt headache, change in mental state

Epidemiology - blood sucking transmitted via blood sucking insects; zoonotic vector to humans, 360 in 2009 in continental US (not in ME and NH) bird (6) mosquito (6) small mammals (2) horse (1)

Treatment - supportive treatment, prevent mosquito bite (netting/repellant, eliminate still water) only horse vaccines (EEE, WEE, VEE, WNV)

Primary Amebic Meningoencephalopathy

Nervous System

Protozoan

Organism - Naegleria fowleri, Acanthamoeba

Virulence - drugs have limited success

Signs/Symptoms - same as meningitis and encephalitis, diarrhea

Epidemiology - enter abrasions in skin, eyelid, or through water reservoir

Treatment - Miconazole, Sulfadiazine, Tetracycline

Septicemia, Bacteremia, and Toxemia

Cardiovascular and Systemic

Bacterial

Organism - Various Gram Negative Bacteria

Virulence - Exotoxins (all) Endotoxins (Gram negatives only, Lipid A /LPS to PAF to shock) capsule, siderophore (capture iron)

Signs/Symptoms - fever, chills, nausea, vomiting, diarrhea, malaise, septic shock, lesions (petechiae) osteomyelitis

Epidemiology - nosocomial or opportunistic; inoculation in blood, more severe gram neg

Treatment - administer antibiotics immediate, especially immune compromised patients

Endocarditis

Cardiovascular and Systemic

Bacterial

Organism - Viridans streptococci

Virulence - opportunistic infection

Signs/Symptoms - fever, fatigue, malaise, tachycardia

Epidemiology - obvious source of infection; abnormal heart increases risks

Treatment - intravenous antibiotics or Prophylactic for high risk patients

Lyme Disease

Cardiovascular and Systemic

Bacterial

Organism - Borrelia burgdoferi, spirochete

Virulence - alters membrane proteins to avoid immune detect

Signs/Symptoms - 3 phases... Expanding Bullseye rash (ECM) 80% last for weeks, malaise, headache, dizzy, stiff neck, tired, fever, chill, pain, lymphadenopathy; Neurological menin, encephalitis, neuropathy, cardiac dysfunction;

Severe Arthritis 80% infected, last for years, immune causes, not usually fatal

Epidemiology - infected deer tick; epidemic in the north east and great lakes; movement to woodlands, deer protection coyotes not controlling mice like foxes, most report

Treatment - use of manganese instead of iron circumvents hot defense

Infectious Mononucleosis

Cardiovascular and Systemic

Viral

Organism - Epstein-Barr virus (EBV) or Human Herpes Virus-4 (HHV-4)

Virulence - dsDNA, latency, implicated in hairy tongue (lack) F (Burkett's Lymphoma) Normal (None) Vigorous (Mono!); infect B lymphocyte

Signs/Symptoms - severe sore throat and fever initially, swollen lymph nodes, fatigue, appetite loss

Epidemiology - transmit via saliva; infects throat/gland epithelium; majority of adults have EBV antibodies, 50% symptomatic; widespread epidemics

Treatment - low neutrophil, B cell atypical nuclei, relieve, 2-4 weeks, fatigue and inability to focus

Yellow Fever

Cardiovascular and Systemic

Viral

Organism - Flaviviridae, Flavivirus yellow fever virus

Virulence - enveloped +ssRNA virus

Signs/Symptoms - 1. fever, headache, muscle ache, vomit; 2. remission 3. 15%, delirium, seizure, jaundice, coma degenerate liver, kidney, and heart hemorrhaging

Epidemiology - Aedes mosquito, liver replicate 3 to 6 days, kills 20%; South America and Africa

Treatment - supportive, vaccine (live attenuated), DEET

Dengue Fever and Dengue Hemorrhagic Fever

Cardiovascular and Systemic

Viral

Organism - dengue viruses 1, 2, 3, 4

Virulence - Aedes mosquito vector

Signs/Symptoms - DF: fever edema pain in head/muscle (breakbone fever) DHF: shock, internal bleeding, death

Epidemiology - secondary infection causes DHF from APC DF is usually mild

Treatment - no specific treatment, control mosquitos, avoid endemic areas

African Viral Hemorrhagic Fever (Ebola)

Cardiovascular and Systemic

Viral

Organism - Ebolavirus and Marburgvirus

Virulence - Filoviridae (fam) -ssRNA genome

Signs/Symptoms - fever fatigue dizzy pain exhaustion; perechiae, small blood lesions, progress to sever internal hemorrhaging

Epidemiology - West Africa, incubate Ebola 2-21 days, incubate Marbutgivirus 5-10 d., bats are natural host, body fluid contact 90% fatal (E) 25% (M)

Treatment - virus in blood and treatment by fluid and electrolyte replace; zMAPP tried, Vaccines being studied

Zika

Cardiovascular and Systemic

Viral

Organism - Flaviviridae Zika virus; Aedes aegypti, Aedes albopictus

Virulence - often asymptomatic or mild, causes birth defects

Signs/Symptoms - fever, rash, joint pain, headache; infection during pregnancy can cause microcephaly, miscarriage, stillbirth, poor brain , poor eye, hearing defect, low growth (ok once clear)

Epidemiology - spread by mosquito bite; pregnant to fetus, sex with infected, lab exposure, transfusion, NOT breastfeeding; before 2015 Zika occurred in Africa, SE Asia, Pacific Islands now all around world

Treatment - avoid travel or sex with travelers to endemic areas; test all pregnant women and risk travelers; blood test, no vaccine, rest, fluids, no NSAIDS, take Tylenol to reduce fever (acetaminophen) control insects inside and outside

Bacterial Urinary Tract Infection

Urinary and Reproductive Tract

Bacterial

Organism - Escherichia coli, Proteus, Klebsiella, Pseudomonas, Staphylococcus (enteric)

Virulence - flagella and attachment fimbriae

Signs/Symptoms - frequent urgent painful urination, cloudy with foul odor

Epidemiology - self inoculate with fecal bacteria in urethra, more in females

Treatment - usually resolves in 24-48 hours; urinalysis, Cephalosporin, Sulfonamide Penicillin, lots of fluids, urinate after sex

Leptospirosis

Urinary and Reproductive Tract

Bacterial

Organism - Leptospira intterrogans (Gram neg.)

Virulence - asymptomatic in animals in the wild; rare in USA

Signs/Symptoms - abrupt fever, myalgia, stiffness, headache, 50% eject, 25% dry coughs, rarely fatal (due to kidney/liver failure, meningitis, or respiratory)

Epidemiology - zoonotic mostly in animals, urine or urine contaminated water from infected animals; worldwide in water, farmers, ranchers, vets, butchers, lake

Treatment - antibody test, IV Ampicillin, Oral Doxycycline, Chloramphenicol, Erythromycin, avoid rodents and contaminated water

Streptococcal Acute Glomerulonephritis

Urinary and Reproductive Tract

Bacterial

Organism - group A streptococci

Virulence - antibody antigen complexes not removed

Signs/Symptoms - bacterial complexes deposited into the kidneys glomeruli, hypertension, low output

Epidemiology - usually secondary from another infection

Treatment - Irreversible kidney damage

Staphylococcal Toxic Shock Syndrome

Urinary and Reproductive Tract

Organism - Staphylococcal aureus (Gram pos.)

Virulence - Toxic Shock Syndrome Toxin (TSST overproduce cytokines)

Signs/Symptoms - sudden onset fever, chills, eject, low BP, confusion, severe rash

Epidemiology - mostly in menstruating females, decreasing cases, absorb toxin into blood

Treatment - emergency removal or material and drainage, IV fluid to raise BP, anti TSST immunoglobin, avoid tampons

Bacterial Vaginosis

Urinary and Reproductive Tract

Bacterial

Organism - Gardnerella vaginalis; Mycoplasma hominis

Virulence - clue cells, anaerobic

Signs/Symptoms - white fishy discharge, itching/irritation, 50% asymptomatic

Epidemiology - decline in Lactobacillus results in higher pH than 4.5, many sex partners/douching

Treatment - oral or vaginal metronidazole or clindamycin

Candidiasis (Thrush)

Urinary and Reproductive Tract

Fungal

Organism - Candida albicans (Ascomycete) yeast

Virulence - normal microbiota of skin and mucous membranes, opportunistic as yeast, forms pseudohyphae

Signs/Symptoms - vaginal itching/burning, white mucoid colonies in vagina, sex can be painful, curd like and slight discharge

Epidemiology - overgrows from vaginal pH or microbiota changes

Treatment - budding yeast and branching pseudohyphae, Azole, Fluconazole, avoid excess antimicrobials

Gonorrhea

Urinary and Reproductive Tract

Bacterial

Organism - Neisseria gonorrhoeae (Gram neg.) diplococci

Virulence - fimbriae, capsule, endotoxin, LOS from Lipid A endotoxin, protease that breaks down secretory IgA

Signs/Symptoms - painful discharge, purulent discharge, not in epididymis or prostate, asymptomatic women, PID may develop, meningitis, arthritis, endocarditis, ophthalmia neonatorum

Epidemiology - epithelial cells, incubate 2-5 days or less, few as 100 cells can cause disease, only in humans, vaginal/anal/oral sex risk; ages 20-24; rates on the rise lately (resistant)

Treatment - combo of Ceftriaxone 250mg intramuscular, azithromycin (1g) or doxycycline for 7 days 2 per day, safe sex, no long term immunity

Syphilis

Urinary and Reproductive Tract

Bacterial

Organism - Treponema pallidum (spirochete)

Virulence - adhesion factor, hyaluronidase, glycocalyx

Signs/Symptoms - 1. small painless hard chancre (10-21 days in genitals, mouth, etc), 2. sore throat, headache, mild fever, malaise, myalgia, rash (hands and feet); latent is no symptoms; 3. hyperimmune response, Gummas (rubbery swollen lesions in bones, skin, CNS) dementia, insanity, blind, paralysis, heart failure

Epidemiology - sexual contact, not fomite, some get mother to child (birth defects) most not 4th stage; worldwide pandemic

Treatment - MHA-TP antibody test, tertiary had to detect, Penicillin G used for all but tertiary, safe sex

Chlamydial Infections

Urinary and Reproductive Tract

Bacterial

Organism - Chlamydia trachomatis

Virulence - non motile, very small, no cell wall; Elementary body (infective) Reticulate bodies (reproductive)

Signs/Symptoms - women asymptomatic, males painful urination and pus from penis, epididymitis, orchitis, serility, small painless lesions, lymphogranuloma venereum (lesion and bubo is severe form; fever, chills, anorexia, muscle pain), Proctitis, LVG Strain, PID

Epidemiology - most common reportable STD in the USA, adolescent increases cervical cancer, infect Trachoma, infects epithelium of all tubes, can enter through scrape or cut

Treatment - detection of DNA with PCR, Tetracycline, Azithromycin, Erythromycin, abstinence, mutual monogamy

Chancroid

Urinary and Reproductive Tract

Bacterial

Organism - Haemophilus durcreyi (Gram neg.)

Virulence - toxin kills epithelial cells, small, pleomorphic

Signs/Symptoms - soft chancres, pain of urination for women, painful sores with yellow gray base, men one ulcer, women four or more, may spread to lymph nodes (purulent buboes)

Epidemiology - incubation 1 to 4 days must cases due to travel aid (Africa/Asia)

Treatment - Azithromycin, Erythromycin, Ceftriaxone, Ciprofloxacin; abstinence, mutual monogamy

Genital Herpes

Urinary and Reproductive Tract

Viral

Organism - Human herpesvirus 2 (HHV-2) in most cases, HHV-1 in 15%

Virulence - latent in nerve ganglia, tingle pain, burn, itch, stress, trauma, fatigue, sun, fever, immunosuppress

Signs/Symptoms - congenital (eyes, esophagus, or skin) whitlow (fingers) small blisters on or around genitals and rectum, fever, malaise, myalgia, low appetite

Epidemiology - quadruples risk of HIV infection

Treatment - PCR of viral DNA, Acyclovir, no cure, condoms not very helpful, abstinence or mutual monogamy

Genital Warts

Urinary and Reproductive

Viral

Organism - Human Papillomavirus (HPV) 30 strains

Virulence - invade skin or mucous membrane cells, cause cancer by integrating into human chromosome (50%)

Signs/Symptoms - warts on genitalia and surrounding, large condylomata acuminata

Epidemiology - invade skin/ mucous membrane during sex, 3-4 month incubation, most common viral STD in young adults

Treatment - DNA probes for strain, variety of methods to remove warts (surgery, burn, freeze, burn, laser, chemical) Gardasil vaccine against HPV strain (cervical caner)

Trichomoniasis

Urinary and Reproductive Tract

Protozoan

Organism - Trichomonas vaginalis (protozoan)

Virulence - leaf shaped, 5 anterior flagella, pH 5 to 6

Signs/Symptoms - vaginal discharge and irritation (foul smelling, yellow green) males asymptomatic

Epidemiology - sexual intercourse, most common curable STD in women, increases risk of HIV infection

Treatment - single dose of oral Metronidazole, avoid sex with the infected