Exam 1 Health Microbiology: Dr. Richard Watkins

Bartonella henselae

NO VACCINE

» General Characteristics: Cause of "Cat Scratch Fever"

» Transmission: Flea to Cat to Human

» Symptoms/Signs: Low-grade fever, red marks on skin, endocarditis (not common)

» Treatment: Antibiotics are not needed in most cases (unless endocarditis)

» Prevention: Treat cats for fleas, immunocompromised shouldn't own kittens

» Population: kids, immunocompromised

Bartonella quintana

NO VACCINE

» General Characteristics: "Trench Fever," "5 Day Fever," not directly deadly

» Transmission: Body lice bone, not washing body, (very easily transmittable)

» Symptoms/Signs: Fever, Headache, Endocarditis, Weakness, Rash, Joint/bone pain, low mortality

» Population: Homeless and their caregivers

» Epidemiology (US): Not a common pathogen, spikes of it in homeless individuals

» Treatment/Prevention: Antibiotics

Brucella spp.

NO HUMAN VACCINE ONLY ANIMAL

» General Characteristics: Causes Brucellosis, travel associated pathogen, not a high morality rate

» Transmission: Zoonosis/Zoonatic. Carried by several host (Cattle, sheep and goat, swine, dogs), transferred to humans via infected meat, unpasteurized dairy, inhalation, cuts in skin, food-borne is most common

» Symptoms/Signs: Short term- fatigue, headaches, fever/chills, and back pain

» Long term- arthritis, organ swelling, chronic fatique, recurring fevers

» Duration: Several weeks/months

» Epidemiology (US): roughly 100 cases per year, rates have dropped off since 1940s, rates still high globally

» Treatment/Prevention: Antibiotics

Rickettsia rickettsii

NO VACCINE

General Characteristics: "Rocky mountain spotted fever"

Transmission: Bite of a tick

Symptoms/Signs: Headache and sudden fever, rash

- early stage: small flat, pink sports (first on extremities)

- late stage: red or purple splotches, vasculitis, amputation

*Rash has early stage and late stage. 90% will show early stage, 50% late stage. Late stage: darker. Early stage: lighter*

Location: Rocky Mountains/south

Time: summer months (May-August)

Epidemiology (US): App. 3,000-5,000 cases per year, cases rise with age

Treatment/Prevention: Antibiotics, avoid tick bites

Neisseria gonorrhoeae

NO VACCINE

» General Characteristics:

‣ Very common STD

‣ more common in MSM

‣ 10% of men are asymptomatic while 50% of women are

‣ going untreated can affect the Reproductive System

‣ elevated # of cases with minorities

» Transmission: Via sexual intercourse, can be passed to infants through the birth canal

» Location: genitals, mouth, anus, eyes (pregnancy)

» Symptoms/Signs: Green/yellow discharge, painful urination, women can have abdominal pain

» Epidemiology (US): Cases rose until mid 1970's. Decrease between 70's-90's.

» ID: 100 cells

»Treatment/Prevention: Antibiotics (2-4 rounds), abstinence, condoms

Neisseria meningitis

» General Characteristics:

‣ Cause of "Meningococcal disease",

‣ 10-15% die with treatment, 50% die without

‣ 20% show permanent symptoms w/o treatment

‣ 10% of people are carriers with no symptoms

» Transmission: Human to Human. High among places with large groups of people living together, having HIV increases the risk

» Affected: infants and older people

» Signs/Symptoms: Light sensitivity, headache, stiff neck, confusion, children may show different signs, which can be fatal, and death can be rapid

» Kids symptoms: irritability, inactivity, vomiting, poor reflexes

» Locations: dorms, barracks,

» Mode of action: lungs - bloodstream - blood barrier, meninges

» Epidemiology: (U.S.) rates are decreasing

(World) Found globally in hot areas, 100,000+ deaths in African meningitis belt over last 20 years

» Treatment/Prevention: Vaccine, avoidance of crowded areas

» Precautions: Droplet

Bordetella pertussis

» General Characteristics:

‣ Highly contagious

‣ Only found in humans

‣ "Whooping cough"

‣ Increase in cases

‣ can only transmit during the first stage and 2-3 weeks of the second stage (1/2 the second stage)

‣ "HOT ZONES" in sub-Saharan Africa and India

» Mode of Action: targets dilated cells - mucus builds up - causes cough

» Duration: months (several)

» Transmission: Airborne transmission (happens during stage 1)

» Signs/Symptoms: Stage 1 (Catarrhal) - Fever, mucus, cough, about 2 weeks, CAN SPREAD

Stage 2 (Paroxysm) - violent coughing, mucus fills airways, vomiting, hemorrhaging and rib fractures can occur,

‣ Infants: airways are hard to open, last 4-6 weeks, CAN TRANSMIT 2-3 WEEKS INTO THIS STAGE

» Stage 3 (Convalescent) - Milder cough for months, "100-day cough (Chinese)," secondary infections are common in this stage

» Epidemiology: (US) Numbers are increasing

(World) MAJOR health problem in developing countries, about 15 million cases per year

» Prevention/treatment: Possibly a vaccine

Burkholderia cepacia

NO VACCINE

» GC: Very resilient to environmental stress and several antibiotics, colonizes in lungs of cystic fibrosis patients, "Cepacia syndrome"

‣ People with CF are very susceptible

‣ Cepacia syndrome - stems from existing infection, necrotizing pneumonia

‣ Most healthy people don't get it

» L: Bacteria enter the lungs through the mouth and nose

» T: bacteria enters lungs through mouth and nose, Person-to-person contact (CF)

» S/S: Cough, difficulty breathing, reduced chance of lung transplant (CF)

» Epidemiology: (US) target is people with CF

» T/P: Limit contact with people with CF

» Precaution HICPAC: Contact

Burkholderia pseudomallei

NO VACCINE

» GC: High mortality rate, 30%, 90,000 deaths per year

‣ commonly seen in military personnel, tourists/travelers, immigrants

‣ usually acquired from other countries

» L: Localized (one area), Pulmonary (lungs), bloodstream, disseminated (more than one place)

» Transmission: skin inoculation from contaminated soil and water, inhalation, drink it, person to person is rare

» S/S: 30-40% fatality, some suggest as high as 70%

» E: (US) Very few in US, normally acquired when visiting other countries

(World) Endemic to tropics areas around the world, hot and humid, could be as high as 150,000+ cases per year

» Prevention: Limit travel to at-risk areas and take precautions

» Treatment: long-term antibiotics (all depends on location)

Helicobacter Pylori

NO VACCINE

» GC: Found in the gastric mucous layer that attaches to the lining of the stomach, causes 90% of duodenal ulcers, 80% of gastric ulcers (stomach)

» L/T: Unknown on transmission, likely fecal-oral or oral-oral

» S/S: Burning pain in the upper abdomen, generally presents when the stomach is empty, relief from eating or antacids, presence does not always lead to symptoms, infection increases the risk of gastric cancer

» Mode of Action: damages cells that make mucus layer in the stomach

» E: millions of cases

» T/P: 2 weeks of antibiotics, concurrent acid suppression by proton pump inhibitor

Campylobacter jejuni

NO VACCINE

» GC: Curved bacterium, two polar flagella, found in jejunum in intestines, causes the most cases of bacterial-caused diarrhea in US

» L/T: Raw poultry, unpasteurized milk, contaminated water, contact with human infected with the bacterium (fecal-oral)

» S/S: Cramps, diarrhea, headache, fever, malaise/listless, symptoms 2-5 days after exposure and symptoms last 5-7 days

» E: 1 to 2 million estimated cases per year, 80% food-borne, 20% travel associated, 10,000 diagnosed a year

» Treatment: Usually self-limiting, requires rehydration and electrolytes to replace those lost, antibiotics may be required in severe cases, over time body will clear itself

» P: Cooking food well, clean food prep, use pasteurized milk, control waste water from farms, chicken houses, etc.

Shigella spp. (species: multiple)

NO CURRENT VACCINE

» GC: Four cases that cause illness, a major cause of dysentery

‣ low ID (200-1,000 viable bacteria)

‣ infectious dose of about 100-200 bacteria

» L: present in stool 2 weeks after diarrhea has ended, very contagious, can get from touching contaminated surfaces, persons, food, water

» Transmission: fecal-oral, very contagious, contact with infected food or water

» S/S: 1-4 days after exposure, lasts for 7-10, Diarrhea, fever, abdominal pain

» E: (US) around 500,000 cases per year estimated and confirmed 10,000-20,000 a year

(Worldwide) 80-150 million yearly, kills 700,000-1,000,000 yearly, 60-70% of deaths occur in ages 5 or younger

» T/P: No vaccine currently, clean water, sanitary food handling, rest and fluids, sometimes antibiotics, palliative care

» Precautions HICPAC: Standard, diapered patients - contact

Escherichia coli (non-diarrheagenic) (ExPec)

NO VACCINE

» GC: Major cause of UTI's

‣90% from UTIs, 10% from ER, 30% catheter-associated, 90% cause issues with Kidneys

» Location: Urinary tract, bloodstream (bacteremia), Neonatal CNS (meningitis), lower respiratory tract, skin/soft tissue

‣ Bacteremia: more common in the elderly, with HIGH fatality, 60% death with elderly while 15% with all cases, 50,000-80,000 deaths per year

» Transmission: Women are most susceptible - shorter urethra (bloodstream-) comes from other injections and surgical procedures, UTI

» S/S: Severe stabbing pain, exhaustion, dark color urine, burning during urination, urge to pee, exhaustion, fever, chills, back pain, lower abdominal pain

» E: (US) Causes 90% of UTIs, cases are more common in women, fatality is high

» T/P: Antibiotics are common, no vaccine - too many strains/variables, treat ASAP or it can progress to other places ex. Kidney

Escherichia coli (diarrheagenic) (ETec)

NO VACCINE

» GC: Enterotoxigenic, a.k.a Travelers' diarrhea, has a toxin that makes it more pathogenic

» Location: Usually found in enteric system (gut) - relating to the intestines

» Transmission: Food or water contaminated with animal or human feces.

» Shiga Toxin: producing E. coli (STEC) | Enterohemorrhagic E. Coli (EHEC)

» E: (US) Cases are more common in elderly, fatality is high

» T/P: Antibiotics are common, no vaccine

Yersinia enterocolitica

NO VACCINE

» General Characteristics: prevalent in pork (pigs), low mortality rate

» Location/Transmission: 90% oral transmission, large ID (100 mil - 1 bil), spike in cases due to chitterlings, more common in children and during winter months, can grow in refrigeration

» Signs/Symptoms: Fever, abdominal pain, bloody diarrhea, severe cramping on right, can mimic appendicitis. Symptoms appear after 4-7 days and can last 10-21 days

» E: 1,000 confirmed cases, 100 - 200,000 estimated cases, 25-50 deaths per year

» Treatment: supportive care/fluids, antibiotics (if needed)

» Prevention: clean work surfaces, monitor outbreaks

» Precautions HICPAC: standard, diapered patients - contact

Yersinia pestis

VACCINE BUT NOT IN U.S.

» GC: cause of the plague, 2 forms: Bubonic and Pneumonic

» Location/ Transmission:

» Signs/Symptoms: Bubonic - appearance of buboes, bulbuses usually appear in groin/armpit area. Fever, chills, muscular pain, severe headache, subcutaneous hemorrhaging: death of tissues. 50% fatal if untreated, incubation period 1-7 days, LONGER than Pneumonic. Pneumonic - fever, malaise, severe cough, bloody and frothy sputum, difficulty breathing, incubation period 1-4 days, 99% death rate if untreated.

» Epidemiology: (US) 10-15 cases, mostly in the western U.S. (Worldwide) most rural Africa, India, South Asia, around 1,000-2,000 cases

» Treatment/Prevention: antibiotics, isolate carriers, reduce rodent habitats

» Precautions: Bubonic - standard and Pneumonic - droplet

Vibrio vulnificus

NO VACCINE

» General characteristics: food borne and tissue form (and blood born), and Marine organisms (salt water)

‣ V.V. - Bacterium: High mortality rate, increases with age. Location: Bloodstream. Transmission: either food or wounds.

‣ Vibrio parahaemolyticus: more common but less severe than V.V. Symptoms: diarrhea (non-bleeding), nausea and vomiting

» Location/Transmission: food, wounds, bacteremia

‣ Food-borne : commonly from ingesting raw oysters, highly acid environment in stomach kills most bacteria before they cause disease

‣ Wounds : brackish or salt water, transmits via wounds / cuts in the skin (tattoos), very rapid onset necrotizing fasciitis, could be considered "flesh eating bacteria"

» Signs/Symptoms: fever and chills, diarrhea, abdominal cramping, vomiting, Symptoms can appear after 1 day and last 3 days. (Food-borne) - diarrhea and sometimes death; oysters and shellfish. (Tissue form) - usually amputation: cuts in the ocean. (wounds) - extreme pain

» Epidemiology: (U.S.) several hundred cases

» Treatment/Prevention: oral fluid replacement (loss due to diarrhea), antibiotics can help a little. (wound) - broad spectrum antibiotics, removal of necrotic tissue (amputation, skin grafts), clean wounds thoroughly, avoid marine water if you have cuts.

Legionella pneumophila

NO VACCINE

» General characteristics: "Legionnaires' disease", resistant heat and chlorination, Risk Factors; men over 60, people that smoke, immunosuppressive treatment, certain steroids

» Location/Transmission: Warm water - when water is stagnant, biofilm forms, it houses the bacteria

» Signs/Symptoms: incubation period 2-10 days and last weeks

» Epidemiology: around 20,000 cases, only hundreds diagnosed

» Precautions HICPAC: standard

Pseudomonas aeruginosa

NO VACCINE

» General characteristics: found in burn units, can cause ear infections, has a sweet sick smell (grape vomit smell), greenish-blue pigment, part of ESKAPE groups of bact. w/MDR

» Location/Transmission: burn units - transmission *nosocomial - hospital or healthcare associated transmitted (getting from burn unit, not water.

» Epidemiology: (US) 50,000 healthcare, 5,000 MDR strain, 400 deaths per year

» Treatment/Prevention: antibiotics (unless MDR)

Haemophilus influenza

ONE STRAIN HAS VACCINE

» General characteristics: Several different types (A, B, C), does not cause influenza, Hib vaccination is for type B

» Transmission: Spread via coughing / sneezing, really young and really old, age and immune state goes into transmission, immunodeficiency, HIV, chemo,

» Location: Larynx, epiglottis, ear, lungs, blood, meninges (meningitis)

» Signs/Symptoms: vary for place. (EX: Lungs - respiratory, Blood - Sepsis-like syrup)

» Epidemiology: (US) Young (<5) or old (65+), Rates have decreased since Hib vaccine, 600-700 cases per year

» Treatment/Prevention: Vaccine and antibiotics

» Precautions HICPAC: Adults - standard, Infants/Children - contact, Epiglottis - droplet

Bacterial Anatomy

» Outer/External Structures: Cell wall is outside cell membrane in most bacteria, most porous does not significantly regulate entry of materials.

‣ Cell wall: defines bacterial shape, protects against osmotic stress but is limited, made mostly of peptidoglycan which is a supporting net / Long chain of carbohydrates connected to a short train of amino acids. monomers are linked covalent to one another and alternating pattern.

‣ Gram Positive: have a thicker cell wall.

‣ Gram Negative: have a thin cell wall. Has periplasmic space which is a Zone located between cytoplasmic membrane and outer membrane. LPS - outer bilayer studded with lipopolysaccharides. When LPS Is released it is called endotoxins or lipid A

‣ Cell Membrane: made of phospholipids and bacteria and Form bilayer membrane. of bilayer membrane has two layers a top and a bottom which make up the membrane. permeability of the membrane: prevents leakage of ions and molecules out or in the bacterium; essentially what comes in and out. ATP Production: location to build up proton motive Force for ATP synthesis

‣ Cell Wall / Cell Membrane: acid fast bacterium: thick like that of gram-positive bacterium. much more lipid around 60% and much less peptidoglycan then gram-positive and negative. can be stained by Gram stain and it stains as a gram positive. there can be structures outside of the cell.

‣ Glycocalyx - Carbohydrate Protein Goo: some cells produce a gelatinous substance that surrounds outside of the cell. two different structures: capsules and slime layers. Capsules: when glycocalyx Of bacteria composed of organic chemicals firmly attached to the cell surface. slime layer: when glycocalyx forms a more loose water soluble layer. Functions prevent dying, pathogenic role, biofilms, attachment mechanism- viscous slime layer allows bacteria attached to surface. detection avoidance- capsules May delay or prevent the host immune system from detecting bacteria.

‣ Bio films: Unity of microbes growing on Surface that are typically encased in polysaccharide gelatinous material or glycolyx as a binding agent. forms complex communities, can have medical consequences, can form antibiotic resistant colonies.

‣ Fimbriae and Pili: allow bacteria to stick to surface

Borrelia burgdorferi

NO VACCINE, BUT USED TO BE

» GC: "Lyme disease", a new vaccine is undergoing late clinical trials, causes Lyme disease, transmitted by the black-legged tick, the longer the tick is on you the higher the risk of infection

» Transmission: Tick

» S/S: Initial flu-like symptoms, bulls-eye rash

» T/P: Antibiotics, wear appropriate attire

Francisella tularensis

NO VACCINE

» GC: "Tularemia", "Rabbit fever", possible bacteria for biological warfare, highly infectious

» L/T: Zoonosis, several hosts, no human-to-human, most commonly in Rabbits

» S/S: headache, fever

» E: Cases decreasing, 5-20 cases per year (usually an outbreak)

» T/P: Gentamicin

Serratia marcescens

NO VACCINE

» GC: Named in honor of Serafino Serrati, produces red pigment, people thought it was blood, tends to be a nosocomial pathogen

» L/T: Usually through hospital, burns or wounds, catheters, can grow in bread and soaps and disinfectants

» S/S: UTI, damage to heart, spesis, endocarditis

» E: Cases vary yearly, common to see as outbreaks

E. Coli 0157:H7

NO VACCINE

» General characteristics: 10% kidney failure. STEC and EHEC describe the same bacterium. Refers to the features outside the bacterium. causes deadly outbreaks of bloody diarrhea. E. coli got disease from shigella - became very toxic.

» Location/Transmission: found in small number of cattle intestines. several foodborne infections. Uncooked ground beef- common source. Few cases from Apple Cider.

» Signs/Symptoms: 100 cells needed to start an infection. incubation period 3 to 4 days following infection. can cause kidney damage and failure

» Epidemiology: 3,000 infections per year.

» Treatment/Prevention: Veggies, petting zoo - wash hands afterwards

» Precautions: standard. diapered patients: contact