INFECTIOUS
DISEASES
AAA
Categories of

INFECTIOUS AGENTS

• Prions

• *Viruses
• Bacteriophages, Plasmids, Transposons

• *Bacteria
• Chlamidiae, ...
Classes of Human Pathogens and Their Habitats
Taxonomic

Size

Site of
Propagation

Sample Species

Disease

Viruses

20–3...
PRIONS, “BSE” (Cows), “CJD”, Kuru (Humans)
NON-Nucleic Acid
PrP = Prion Protein
Diagnostic Test : NL-COW MAD-COW
http://ww...
Bovine

Spongiform Encephalitis, Creutsfeldt-Jakob Disease
VIRUSES

• Less than ½ micron, usually MUCH
less
• DNA/RNA “CORE” (genome)
• Protein “CAPSID” (protein –NA “coat”)
• Somet...
Respiratory
Adenovirus

Adenoviridae

DS DNA

Upper and lower respiratory tract
infections, conjunctivitis, diarrhea

Rhin...
Digestive
Mumps virus

Paramyxoviridae SS RNA

Mumps, pancreatitis, orchitis

Rotavirus

Reoviridae

DS RNA

Childhood dia...
Systemic with Skin Eruptions
Measles virus

Paramyxoviridae SS
RNA

Measles (rubeola)

Rubella virus

Togaviridae

SS
RNA
...
Systemic with Hematopoietic Disorders
Cytomegalovirus

Herpesviridae DS DNA

Cytomegalic inclusion disease

Epstein-Barr v...
Warty Growths
Papillomavirus Papovaviridae DS DNA Condyloma; cervical carcinoma,
squamous proliferations in
general

Centr...
BACTERIOPHAGES
PLASMIDS
TRANSPOSONS

• INFECT BACTERIA, but may
make a bacteria more difficult
to treat because it may
inc...
BACTERIA

• GRAM staining with CRYSTAL VIOLET
– POSITIVE: THICK wall, ONE phospholipid layer
– NEGATIVE: THIN wall, TWO ph...
Species

Infections by
pyogenic cocci

Staphylococcus aureus, S.
epidermidis

Frequent Disease Presentations
Abscess, cell...
Contagious childhood
bacterial diseases

Meningitis, upper and lower respiratory
tract infections

Bordetella pertussis

W...
Zoonotic
bacterial
infections

Bacillus anthracis

Anthrax (malignant pustule)

Listeria monocytogenes

Listeria meningiti...
Human treponemal Treponema pallidum
infections
Treponema pertenue

Venereal, endemic syphilis
(bejel)
Yaws (frambesia)

Tr...
Chlamydiae
Rickettsiae
Mycoplasmas
• Like Bacteria, but…..
– NO cell wall (mycoplasma [MANY
pneumonias])
– NO ATP (chlamyd...
FUNGI
• YEASTS, HYPHAE

• CANDIDA, by far, the MOST
PREVALENT ONE
• DERMATOPHYTES(superficial),
(“tinea”), i.e., epidermop...
YEASTS, HYPHAE
PARASITES
• PROTOZOA
• “META”-ZOA
(HELMINTHS)
• “ECTO”-PARASITES,
i.e., ARTHROPODS
PROTOZOA
SINGLE CELL

INTESTINAL or BLOOD

• PLASMODIUM
(MALARIA)
• LEISHMANIA
• ENTAMOEBA
• TRYPANOSOMA
• TOXOPLASMA
• GI...
Species

Order

Form, Size
Luminal or Epithelial

Disease

Entamoeba histolytica

Amebae

Trophozoite 15–20 µm

Amebic dys...
HELMINTHS
(ROUND[nematode]), FLAT[cestode])

• Roundworms, Tapeworms
• Complex Life Cycles: sexual, asexual
• ROUNDWORMS (...
Ascaris life cycle

In small intestine TWICE
ARTHROPODS:
INSECTS: = 6 legs
• LICE
• BEDBUGS
• FLEAS

ARACHNIDS: = 8 legs
• MITES (chiggers)
• TICKS
• SPIDERS
CLASS INSECTA,
C L

L

R O

O

U

U

S

S

E

E

A
B

BEDBUG

FLEA

6 legs
CLASS ARACHNIDA,

TICK
BLACK
WIDOW

ADULT MITE

8 legs

LARVAL MITE
BROWN
<--RECLUSE
S
C
A
B
I
E
S
BARRIERS
• ALL ANATOMIC MUCOSAL
POSSIBILITIES
–SKIN
–GI
–RESPIRATORY
–UROGENITAL
SPREAD
SAME AS TUMOR?

• DIRECT EXTENSION
• LYMPHATICS
• BLOOD
• NERVE
RELEASE
(TRANSMISSION)
•
•
•
•
•
•

SKIN SHEDDING
COUGHING/SNEEZING
URINE
FECES
BLOOD
VECTORS, e.g., insects, “zoonosis”

...
I=V/R
INFECTIVITY, GENERAL
• AGENT HOST CELL
• AGENT TOXINS NECROSIS
• AGENTHOST CELLULAR
REACTIONDAMAGE/DEATH
INFECTIVITY, VIRAL

• ATTACHMENT
• ENTRY
• TRANSCRIPTION (forw./rev.)
• TRANSLATION
– INCLUSIONS
– REDUCED HOST CELL FUNCT...
INFECTIVITY, BACTERIAL
• ADHERENCE
• ENTRY
• TOXINS
–ENDO, Gram - , bacterial
components (LPS)
–EXO, Gram -/+, secreted
pr...
IMMUNE EVASION
• INACCESSIBILITY to host defense (Mr.
Myagi, “no be there”)
• VARYING (mutating) antigens
• SHEDDING antig...
INFECTIONS
of IMMUNOSUPPRESSED HOSTS
• Protozoal/Helminthic:
Cryptosporidium, PCP
(Pneumocystis Carinii [Jirovecii]
Pneumo...
DIAGNOSTIC TECHNIQUES
• DIRECT PATHOGEN IMAGING, gross/micro
• GRAM STAIN
• “SPECIAL” (NOT H&E) STAINS, e.g., PAS
• AGAR, ...
CELLULAR HOST RESPONSES

• SUPPURATIVE (NEUTROPHILS,
PMNs) (cultures may be positive)

• MONO-NUCLEAR, i.e.,
Lymphocytes, ...
ACUTE APPENDICITIS
ABSCESS
CHRONIC “MONONUCLEAR”
INFLAMMATION
GRANULOMA
FIBROSIS
H
E
M
O
S
I
D
E
R

H&E

I

PRUSSIAN BLUE
Calcification
The 4 Biggies
• VIRAL
• BACTERIAL
• FUNGAL
• PARASITIC
VIRAL

• TRANSIENT, ACUTE, e.g. Measles,
Mumps, Polio, West Nile

• CHRONIC LATENT (HERPES
FAMILY), HSV, CMV, VZ
• CHRONIC...
BACTERIAL

• Gram+
• Gram•
•
•
•

MYCO-bacteria
SPIROCHETES
ANAEROBIC
“OBLIGATE” INTRACELLULAR
FUNGAL

• YEASTS

– CANDIDA
– CRYPTOCOCCOSIS

• MOLDS (HYPHAL)
– ASPERGILLIS
– MUCORMYCOSIS (ZYGOMYCOSIS)
PARASITES
• PROTOZOA (GI,
BLOOD)
• METAZOA
(WORMS)
VIRAL

• TRANSIENT, ACUTE

– Measles: Skin, URI, Lung, GI, Cornea, Brain
– Mumps: Parotitis, Orchitis, Pancreas, CNS
– Pol...
VIRAL

• CHRONIC LATENT
(HERPES FAMILY), HSV,
CMV, VZ

–Herpes Simplex Virus
–CytoMegalo Virus

–Varicella-Zoster Virus (D...
HSV
CONGENITAL
IMMUNOSUPPRESSED

BASOPHILIC

CMV (HHV-5) pneumonia
VZ Virus
VIRAL

• CHRONIC (HEPATITIS), Hep. A, B, C

–A, Mildest, most universal
–B, Most dangerous in the acute
phase, but most ar...
NORMAL LIVER
ACUTE VIRAL HEPATITIS
VIRAL
“TRANSFORMING”
Epstein-Barr, EBV,

lymphoma

(Burkitts), nasopharyngeal

Human Papilloma, HPV,
cervical cancer (squa...
PHARYNX
NODES
SPLEEN
LIVER
HETEROPHILE

MONONUCLEOSIS, caused by EBV
“MALIGNANT” cells on PAP smear, caused by HPV
BACTERIAL

• Gram+ (Staph, Strep)
• Gram- (rods)
•
•
•
•

MYCO-bacteria (TB)
SPIROCHETES (SYPHILIS)
ANAEROBIC (ABSCESSES)
...
BACTERIAL

• Gram+ cocci (Staph,
Strep)
SKIN
RESPIRATORY
TRACT
S
T
A
P
H
STREP:
SKIN
RESPIRATORY

ERISIPELAS
GRAM POSITIVE
RODS

• DIPTHERIA
• LISTERIA
• ANTHRAX------
• NOCARDIA
• CLOSTRIDIUM
GRAM NEGATIVE COCCI

•Neisseria
–GONORRHEA
–MENINGITIS
GRAM NEGATIVE RODS
•
•
•
•
•

Bordetella pertussis
Pseudomonas aeruginosa
Klebsiela/Aerobacter
Yersinia pestis (plague)
He...
MYCOBACTERIA
(acid fast)

• Tuberculosis

• “Atypical” mycobacteria, the
most important of which is
MAC (Mycobacterium Avi...
MORE ACID-FAST BACILLI, AFB (MAC)
SPIROCHETES
• SYPHILIS (
Treponema pallidum)
• RELAPSING FEVER (Borrelia
sp., via lice and ticks)
• LYME DISEASE (Borrelia...
SYPHILIS

• PRIMARY (CHANCRE)

• SECONDARY (MANY skin
manifestations)
• TERTIARY (GUMMAS, CNS,
BONE)
• CONGENITAL
ANAEROBES
• Clostridium (Gram

+ bacillus)

– Cause of many/most cases of “gas”
gangrene
“OBLIGATE”
intracellular bacteria
• Chlamydia trachomatis
– Conjunctivitis
– LGV (LymphoGranuloma Venerium)
– Urethritis

...
RMSF
FUNGAL

• YEASTS

– CANDIDA
– CRYPTOCOCCOSIS

• MOLDS (HYPHAL)
– ASPERGILLIS
– MUCORMYCOSIS (ZYGOMYCOSIS)
Candida albicans
• Oral
• Vaginal
• Esophageal
• All of the above are “moist” nonkeratinized squamous mucosa, aren’t
they?...
Budding Yeasts and “PSEUDO” hyphae
CRYPTOCOCCUS
NEOFORMANS

Budding cryptococcal yeasts, India ink prep, CSF
MOLDS

• Aspergillus

• Zygomycosis
(Mucormycosis)
DERMATOPHYTES
(“TINEAS”)
(superficial fungi)

• EPIDERMOPHYTON
• MICROSPORUM
• TRICHOPHYTON
SIGNIFICANT FUNGI
(deep)
• HISTOPLASMOSIS, tiny
granules within
macrophages, ~3μ
• BLASTOMYCOSIS, ~20μ

• COCCIDIOMYCOSIS,...
PROTOZOA

• MALARIA (Plasmodium sp., of which
falciparum is the most serius)
• Babesiosis, transmitted by deer tick,
• Lei...
GAMETOCYTES
Are COMMON
And SAUSAGE
shaped
S
C
H
U
F
F
N
E
R
‘S
D
O
T
S
Affected RBC’s are NOT enlarged
NO SCHUFFNER’s DOTS
S
C
H
U
F
F
N
E
R
‘
S
D
O
T
S
“comets”
TRYPANOSOMIASIS
METAZOA
(ROUNDworms/FLATworms)
• Strongyloides (microscopic
roundworm)
• Tapeworms (Beef, Pork, flatworm)
• Trichinosis (l...
Ascaris life cycle
Minarcik robbins 2013_ch8-infectious
Minarcik robbins 2013_ch8-infectious
Minarcik robbins 2013_ch8-infectious
Minarcik robbins 2013_ch8-infectious
Minarcik robbins 2013_ch8-infectious
Minarcik robbins 2013_ch8-infectious
Minarcik robbins 2013_ch8-infectious
Minarcik robbins 2013_ch8-infectious
Minarcik robbins 2013_ch8-infectious
Minarcik robbins 2013_ch8-infectious
Minarcik robbins 2013_ch8-infectious
Minarcik robbins 2013_ch8-infectious
Minarcik robbins 2013_ch8-infectious
Minarcik robbins 2013_ch8-infectious
Minarcik robbins 2013_ch8-infectious
Minarcik robbins 2013_ch8-infectious
Minarcik robbins 2013_ch8-infectious
Minarcik robbins 2013_ch8-infectious
Minarcik robbins 2013_ch8-infectious
Minarcik robbins 2013_ch8-infectious
Minarcik robbins 2013_ch8-infectious
Minarcik robbins 2013_ch8-infectious
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  • The “Personality” of Chapter 8:
  • 1) Availability
    2) Affable
    3) Able
  • The classification of infectious pathogens seems to follow, more or less, the evolutionary tree.
    A bacteriophage is any one of a number of viruses that infect bacteria
    A plasmid is a DNA molecule that is separate from, and can replicate independently of, the chromosomal DNA
    A transposon is a DNA sequencethat can change its relative position (self-transpose) within the genome of a single cell
  • Note that Pathogens can also be classified as to whether they stay mucosal, extracellular, intracellular, or are “obligate intracellular”.
    I think you should be able to give an example of one of these categories in each taxonomic division.
  • Interest in “infectious” diseases caused by prions, i.e., NON-nucleic acid infectious agents, seems to be growing rapidly.
    PrP, also called prion related protein, or protease resistant protein, is the infectious substance, and discovering it led to a Noble Prize in 1997.
    PRI-ON itself Stands for PRO-teinaceous IN-fectious particle. Prions arise due to CONFORMATIONAL CHANGES in NORMAL prion proteins. The then cause conformational changes in OTHER normal prion proteins.
    Kuru is an incurable degenerative neurological disorder (brain disease) that is a type of transmissible spongiform encephalopathy, caused by a prion found in humans. Taken from the Fore word &quot;kuria/guria&quot;, &apos;to shake&apos;. It is also known as the laughing sickness due to the pathologic bursts of laughter people would display when afflicted with the disease. Kuru was probably transmitted among members of the Fore tribe of Papua New Guinea via cannibalism.
  • BSE, or “Mad Cow” diease is the animal counterpart to human CJD or Creutsfeld-Jakob Disease, also commonly called Jakob-Creutsfeld Disease.
    Vacoulization (sponginess) of CNS tissue is the consistent diagnostic finding (identify the vacuoles). Where are they? Cells? Fibers?
  • Nucleic acid “core”, capsid, envelope are the three common features of all viruses. Humans~20,000, Viruses~20, Bacteria~200 genes.
  • Most viral classifications are totally illogical, but can be based on 1) system or organ they may infect, 2) common name, 3) proper “family” name, 4) strandedness (single or double), 5) DNA vs. RNA, and 6) common site of infection.
  • The hepatitis viruses were named in the order in which the virus was discovered and isolated, A E
  • These primitive organisms are not often implicated in human diseases DIRECTLY, but indirectly.
    Great fleas have little fleas upon their backs to bite &apos;em, And little fleas have lesser fleas, and so ad infinitum. And the great fleas themselves, in turn, have greater fleas to go on; While these again have greater still, and greater still, and so on.
    A bacteriophage is any one of a number of viruses that infect bacteria
    A plasmid is a DNA molecule that is separate from, and can replicate independently of, the chromosomal DNA
    A transposon is a DNA sequence that can change its relative position (self-transpose) within the genome of a single cell
  • * Most common contaminant of blood cultures, staph epidermidis
  • ZOONOSES are infectious diseases in which a third party “animal” (ZOO) vector, usually mammal, is involved. This classification is INDEPENDENT of their gram staining abilities.
    Anthraxherbivores
    Listeriameats, dairy products
    Yersiniarodents
    Tularemiarabbits
    Brucelladairy products
    Burkholderiaequines, etc.
    Leptospiramany animals, urine, soil
    Borreliaticks, lice
    Bartonellafleas, etc.
    Spirillumrat
  • Gram + bacilli (rods) and Gram – cocci
    Remember the exception rule: All common Cocci are Gram+ EXCEPT for neisseria. Bacilli are Gram- EXCEPT for Bacillus (anthracis), Cornyebacterium, Clostridium, Lactobacillus, Listeria, Propionibacterium (acne) (ABCCLLP)
  • The OBLIGATE intracellular organisms, because they are obliged to live IN human cells to survive.
    They have no cell walls, and no mitochondria, and therefore no ATP.
  • Fungi occur in tissues, and are generally classified into superficial (i.e., skin dermatophytes), and deep.
  • Fungi, like bacteria, are also classified into balls and rods, but NOW they are called yeasts and hyphae, rather than cocci and bacilli. The balls may have budding balls as well.
  • ONE celled parasites are (Proto-zoans), multi-celled parasites (META-zoan) are worms (i.e., helminths) and arthropods
  • Leishmaniasis is a disease caused by protozoans that belong to the genus Leishmania and is transmitted by the bite of certain species of sand flies. Often infects skin and soft tissues but may go deeper.
    Amoebiasis, or Amebiasis, refers to a diarrheal infection caused by the amoeba Entamoeba histolytica
    Trypanosomiasis or trypanosomosis is the name of several diseases caused by trypanosomes of the genus Trypanosoma. 36 countries of sub-Saharan Africa suffer from trypanosomiasis which is caused by either Trypanosoma brucei gambiense or Trypanosoma brucei rhodesiense. The other human form of trypanosomiasis, called Chagas Disease, causes 21,000 deaths per year mainly in Latin America
    Toxoplasmosis is a disease in cats and humans caused by the protozan Toxoplasma gondii.
    Giardiasis in humans is a diarrtheal infection of the small intestine by a single-celled organism Giardia lamblia.
  • You can also classify PROTOZOAN infections on the basis of HOW DEEP they go.
    LUMEN
    EPITHELIUM
    BLOOD
    INTRACELLULAR
  • Classical (top 4) human helminth diseases
    Key points of differentiation: Round or Flat, whole or segmented, nematodes or cestodes, Phylum Nematoda or Platyhelminthes. Does the phylum Annelida have many human parasites? NO
  • Roundworms
  • Ascaris (lumbricoides) life cycle, the most common and clinically important roundworm parasite in the world.
    Notice the difference between the friendly (non-government) diagram and the CDC confusing version!
  • Taenia solium (cysticercosis) life cycle:
    Scolex, Proglottids.
  • T solium, T saginata, D latum, H nana. Corresponding To Beef, Pork, Fish, and arthropod co-hosts, respectively.
    Do you get the feeling of columnar, cuboidal, and squamous geometries here, regarding the proglottids?
    Because quick ID of the parasite is usually based on proglottid identification:
    BIG COW = TALLEST
    MEDIUM PIG = CUBOIDAL
    DWARF (tapeworm) = most SQUAMOUS
  • What are “chiggers”? What is a phylum, what is a class?
  • Pediculosis (capitis, corporis)
    Phthirus (pubis)
  • Ticks
    Scabies mite, Demodex (folliculorum) larval mite
    Mortality black widow spider bite &lt;1%
  • Scabies is a MITE, causes a HUGE array of dermatoses, but the most likely place to ID them on a scrape is the dorsal M-P area.
  • Is it surprising that the most common anti-pathogen areas are also the same as the epithelia and mucosae protecting humans from EVERYTHING nasty?
    Is it also surprising that these areas are also rich in MALT? (Mucosal Associated Lymphoid Tissue)
  • Infectious agents spread geographically in the body exactly via the same routes which tumor cells do. Is this surprising? NO!
  • “WASH YOUR HANDS!” is the sign seen everywhere!
    Does an STD transmission overlap with several of the previous?
    It is surprising that the transmission routes are the same as the barrier locations? Ans: NO
  • A pathogen’s “I”nfectivity is DIRECTLY proportional to its intrinsic “V”irulence, and inversely proportional to its host’s “R”esistance.
    Does this look like Ohm’s law, I=V/R?
    Which of these three letters is the primary one in diseases of immunocompromised hosts?
  • An infectious “agent” can attack a host cell directly, damage a host cell by its toxins, or by creating a host inflammatory response which damages host tissues, so in this last case, an inflammatory reaction against a pathogen can actually cause further damage to the host.
    Can you think of any other possible ways a pathogen, any pathogen, can do damage? Not me.
  • Can you think of ANY other thing a virus can do? I can’t.
    Is infectivity the same as “virulence”? Sorta
  • Main concepts of an infectious agent’s immune evasion. Do these also look like mechanisms for tumor proliferation?
    You betcha?
  • By no surprise the common infections in immunosuppressed hosts theoretically, parallels the common opportunistic infections seen in AIDS patients.
    ANY usually non infective pathogen can do damage in immunocompromised (immunosuppressed) hosts, BUT here are the most likely ones!
  • Common diagnostic techniques for identifying infectious agents.
  • The spectrum pattern of host responses parallels the entire spectrum of ALL inflammatory morphologies.
    Notice these are all TYPICAL of ANY acute or chronic inflammatory process and NOT specific for infectious pathogens.
  • Does a specific organism cause this? NO
    Is it related to lack of blood flow and necrosis and secondary enteric invaders? YES
    Does the “acuteness” histologically relate to “acuteness” clinically as well? USUALLY
  • Is an abscess nothing more than a walled off or localized pocket of pus?
  • A CHRONIC inflammatory reaction is LESS likely to culture organisms than an ACUTE one. Why?
    Would I blame you if you called this “organizing” rather than “chronic”? Ans.: NO
  • Granulomatous reactions are commonly seen with mycobacteria, fungi, sarcoid, foreign bodies, and rarely with almost anything. Acid fast or fungal cultures are routinely done in granulomas and may possibly be positive in “fresh” granulomas, gram positive or gram negative bacteria are NOT common causes of granulomas. A granuloma which has a lot of fibrosis or calcification, is not “fresh” and much less likely to yield organisms.
  • Fibrosis often follows ANY kind of inflammatory process. Would this type of pattern imply ACUTE exposure to the pathogen? Ans.: NO
  • Hemosiderin (old hemorrhage) often accompanies fibrosis. Dystrophic or metastatic? Ans: Dystrophic
  • Calcification!
    Would a DENSELY calcified granuloma, seen radiologically, be likely to be active, or infectious, or yield positive cultures? NO!
    Why is this pic a great example of calcification, but a poor example of an infectious process?
  • Four types of common viral infections, classified clinically: 1) Transient acute, 2) Chronic latent, 3) Chronic, 4) Transforming.
    There is no consistent uniformity for viral taxonomy, so viral diseases can be classified according to their severity and/or acuteness or recurrence or sequelae of clinical expressions.
    Luckily, the classification is NOT based on viral taxonomy.
  • The common types of bacteria which infect humans. This is not at all a totally logical classification.
  • Morphologic types of fungi: yeasts and mold, independent of whether they are superficial, deep, or systemic.
    Coincidentally, just at bacteria are classified as balls (cocci) or rods (bacilli), fungi are morphologically classified into balls (yeasts) or rods (hyphae).
  • Protozoans are single celled organisms. Although metazoans technically are any multicellular organisms, they are often generally used synonymously with the word “worms”.
  • Classical viral infections which are TRANSIENT and ACUTE
  • Measles “giant” cell in measles pneumonia. The measles virus is a highly contagious airborne pathogen which spreads primarily via the respiratory system. The virus is transmitted in respiratory secretions, and can be passed from person to person via aerosol droplets containing virus particles, such as those produced by a coughing patient. Once transmission occurs, the virus infects the epithelial cells of its new host, and may also replicate in the urinary tract, lymphatic system, conjunctivae, blood vessels, and central nervous system. What are Koplik’s spots?
  • Parotitis, orchitis.
    Mumps (infectious or epidemic parotitis is a viral disease of the human species, caused by the mumps virus. Before the development of vaccination and the introduction of a vaccine, it was a common childhood disease worldwide. It is still a significant threat to health in the third world, and outbreaks still occur sporadically in developed countries. Spread via respiratory secretions also.
  • Poliovirus enters the body through the mouth (primarily fecal-oral), infecting the first cells it comes in contact with—the pharynx and intestinal mucosa. It gains entry by binding to a immunoglobulin-like receptor, known as the poliovirus receptor or CD-155, on the cell surface. The virus then hijacks the host cell’s own machinery, and begins to replicate. Poliovirus divides within gastrointestinal cells for about a week, from where it spreads to the tonsils (specifically the follicular dendritic cells residing within the tonsilar germinal centers), the intestinal lymph nodes including the M cells of Peyer’s patches, and the deep cervical and mesenteric lymph nodes, where it multiplies abundantly. The virus is subsequently absorbed into the bloodstream. The most feared consequence would be infections of the anterior horn cell neurons, and most deaths occurred due to diaphragm involvement.
  • Lymphocytic infiltrates in the “Virchow-Robbins” space IS classic for encephalitis.
    Notice that even though the clinical expression of “acute” encephalitis is acute, most of the inflammatory cells are “chronic”, i.e., “mono”-nucleated cells.
  • These viruses are all in the “Herpes” family and are CHRONIC and LATENT, often recurrent, and often travel along nerves and involve skin.
    What does ubiquitous mean?
  • Intranuclear INCLUSIONS and VESICLES are charactistic of herpes family viruses, herpes, varicella, zoster, CMV.
    Herpes doe NOT mean vesicle, it means SNAKE, because of the slithering pattern of the vesicles.
  • The intranuclear inclusions of herpesvirus CMV are characteristically describes as BASOPHILIC, as opposed to the inclusions of Herpes simplex and zoster which are EOSINOPHILIC.
    Are these inclusions the viruses themselves? NO Why? No virus is bigger than ½ micron!
    Could the BASOPHILIC intranuclear inclusions have viruses IN THEM however? YES!
  • VZ is so named because it causes both Chicken Pox (Varicella) in children, and Heepes Zoster (shingles) in adults. The neurotropic virus in adults travels along dermatome routes, and is famous for being latent often for many years, with occurrences related to immune impairment conditions.
    VZ loves to hang out in DRG’s! (Dorsal Root Ganglia)
  • The hepatitis viruses are classified as chronic!
    Are B and C the most likely to cause cirrhosis and hepatoma? YES
  • Which area do you think would bear the brunt of an early hepatitis infection, the are around the PORTAL vein, or the area around the CENTRAL vein?
    Ans: PORTAL
  • The arrowed “Councilman” bodies are thought by some to be rather diagnostic of viral (B) hepatitis. They are apoptotic hepatocytes.
    The inflammatory pattern is periportal at first but can soon become PAN-lobular. Chronic hepatitis is chiefly periportal.
  • Transforming viruses cause tumors.
  • “Mono” is severe pharyngitis, adenopathy, splenomegaly, and hepatitis. The classical “mono” cells are really lymphocytes, and “heterophile” antibodies are fairly diagnostic. “Hetero”-phile means crossing species, i.e., human antibodies causing horse RBC agglutination.
  • Bridging the gap between infection and neoplasms, HPV viruses cause squamous cell cancer of the cervix.
    Can you say then that squamous cell cancer is a STD or at least infectious disease? YES
    Could these cells be only CIN-III or HSIL or CIS only?
  • Gram + bacilli (rods) and Gram – cocci
    Remember the exception rule: Cocci are Gram+ EXCEPT for neisseria. Bacilli are Gram- EXCEPT for Bacillus (anthracis), Cornyebacterium, Clostridium, Lactobacillus, Listeria, Propionibacterium (acne) (ABCCLLP)
  • Common STAPH infections
  • A strep infection in immunocompromised hosts, often the very old and very young.
  • Diphtheria (Greek διφθέρα (diphthera) &quot;pair of leather scrolls&quot;) is an upper respiratory tract illness caused by Corynebacterium diphtheriae, a facultative anaerobic, Gram-positive bacterium. It is characterized by sore throat, low fever, and an adherent membrane (a pseudomembrane) on the tonsils, pharynx, and/or nasal cavity. A milder form of diphtheria can be restricted to the skin. Less common consequences include myocarditis (about 20% of cases) and peripheral neuropathy (about 10% of cases).
    Listeriosis, a serious infection caused by eating food contaminated with the bacteria. The disease affects primarily pregnant women, newborns, adults with weakened immune systems, and the elderly.
    Bacillus anthracis can form dormant endospores (often referred to as &quot;spores&quot; for short, but not to be confused with fungal spores) that are able to survive in harsh conditions for decades or even centuries. Such spores can be found on all continents, even Antarctica. When spores are inhaled, ingested, or come into contact with a skin lesion on a host, they may become reactivated and multiply rapidly, usually lethal.
    Nocardia are found worldwide in soil that is rich with organic matter. In addition, Nocardia are oral microflora found in healthy gingiva as well as periodontal pockets. Most Nocardia infections are acquired by inhalation of the bacteria or through traumatic introduction.
    Clostridium: botulinum, dificile, perfringens, tetani
  • “MAC” is the most common and serious “atypical” mycobacterium, seen very often in AIDS patients.
  • Necrotizing (i.e., caseating) granulomas filled with acid fast bacilli. This is CLASSIC for TB.
  • The acid fast stain for acid fast bacteria is also called the Ziehl-Neilson stain, or simply AFB stain
  • Relapsing fever is an infection caused by certain bacteria in the genus Borrelia. It is a vector-borne disease transmitted through the bites of lice or soft bodied ticks.
  • A leading cause of worldwide blindness, this keratoconjunctivitis affects 100 million people world wide. It is spread by direct contact with infected individuals, such as towels. Trachoma is the Greek word for “rough eye”.
  • The agent of RMSF is an obligate intracellular Rickettsia rickettsii organism carried by the tick Dermacentor andersoni and Dermacentor variabilis, evoking microvasculitis and thrombosis of small vessels. Other rickettsia (prowazekii, typhi)cause typhus.
  • Yeasts are balls, hyphae are long cylindrically shaped structures, often arising from yeasts.
    Think of FOUR things when you hear FUNGUS:
    BALL (yeast) vs. ROD (hyphae)
    Superficial (i.e., dermatophyte, i.e., tinea) vs. Deep (Big 3: Histo-, Blasto-, Coccidio-)
    Probably granulomatous infection
    Immunocompromised host?
  • Without a doubt, by far, the most common and ubiquitous of all fungal agents.
  • Classical patterns of Candida, budding yeasts and PSEUDO-hyphae, staining very RED with the PAS stain and many others. The upper photo of budding yeasts could be from a culture because it has no tissue in it.
    Why are these termed, by the purists, as “pseudo”-hyphae? Ans: NO septae
  • India ink preps have been a standard part of CSF fluid taps for many years, especially in meningitis workups.
    These can be done within a minute of a LP with the simplest of reagents (i.e., India ink and microscope).
  • Both of these “mold” (hyphal) diseases can cause human diseases often in immunocompromised hosts.
  • Submit this to memory.
  • Tinea capitis, or Ringworm of scalp
  • Tinea barbae
  • Tinea corporis, or Ringworm of body
  • Tinea cruris, or jock itch
  • Tinea pedis, or Athlete’s foot. Is the 4-5 interspace by far the most common location? YES
    Is the 5th toe the most like to undergo frosbite or ischemic necrosis?
  • Onychomycosis
    What are the three most common specific organisms? ANS: the same as the one which cause ANY tinea!
  • These usually evoke granulomatous reactions in tissues. Histoplasmosis organisms are very small and often pack histiocytes, blastomycosis and coccidiomycosis are much larger round balls.
  • Histoplasmosis, best lab stain you will ever see, thanks to somebody on the Patho-L internet forum. I wish I could remember her name.
  • These should all be recognized as protozoal diseases.
  • Anopheles species mosquito of malaria
  • Do not make the mistake of confusing an overlying platelet with a malarial organism on a RBC.
    250 million cases per year, world-wide, a health problem of immense importance!
    Gametes fusing starts a SEXUAL cycle.
    Sporozoites, merozoites multiplying is an ASEXUAL cycle.
  • The various types of malaria are differntiated by the appearance of the RBCs and the forms of the parasites in them. Plasmodium falciparum is potentially the most deadly, and is gives rise to “blackwater fever”, i.e., marked hemoglobinuria and renal failure. Gametocytes (upper) are commonly seen in falciparum, much more commonly than in any of the other 3 varieties.
  • “Comets” are rather diagnostic of P. ovale.
  • This is a very serious concern in Africa, in which the bite of the tsetse fly transmits the protozoan.
    This is a classical diagnostic appearance on a routine blood smear. South American trypanosomiasis is called “Chagas” disease.
  • Ascaris life cycle: Very simple:
    Larvae to MouthDuodenumBloodLiverHeartPulmonarySmall IntestineFertilizationSoil
  • Taenia solium (cysticercosis) life cycle:
  • Minarcik robbins 2013_ch8-infectious

    1. 1. INFECTIOUS DISEASES
    2. 2. AAA
    3. 3. Categories of INFECTIOUS AGENTS • Prions • *Viruses • Bacteriophages, Plasmids, Transposons • *Bacteria • Chlamidiae, Rickettsiae, Mycoplasmas • *Fungi: Yeasts, Hyphae • Parasites: Protozoa, Worms, Arthropods
    4. 4. Classes of Human Pathogens and Their Habitats Taxonomic Size Site of Propagation Sample Species Disease Viruses 20–300 nm Obligate intracellular Poliovirus Poliomyelitis Chlamydiae 200–1000 nm Obligate intracellular Chlamydia trachomatis Trachoma, urethritis Rickettsiae 300–1200 nm Obligate intracellular Rickettsia prowazekii Typhus fever Mycoplasmas 125–350 nm Extracellular Mycoplasma pneumoniae Atypical pneumonia Bacteria 0.8–15 µm Cutaneous Staphylococcus aureus Wound Mucosal Vibrio cholerae Cholera Extracellular Streptococcus pneumoniae Pneumonia Facultative intracellular Mycobacterium tuberculosis Tuberculosis Cutaneous Trichophyton sp. Tinea pedis (athlete's foot) Mucosal Candida albicans Thrush Extracellular Sporothrix schenckii Sporotrichosis Facultative intracellular Histoplasma capsulatum Histoplasmosis Mucosal Giardia lamblia Giardiasis Extracellular Trypanosoma gambiense Sleeping sickness Facultative intracellular Trypanosoma cruzi Chagas disease Obligate intracellular Leishmania donovani Kala-azar Mucosal Enterobius vermicularis Enterobiasis Extracellular Wuchereria bancrofti Filariasis Intracellular Trichinella spiralis Trichinosis Fungi Protozoa Helminths 2–200 µm 1–50 µm 3 mm–10 m
    5. 5. PRIONS, “BSE” (Cows), “CJD”, Kuru (Humans) NON-Nucleic Acid PrP = Prion Protein Diagnostic Test : NL-COW MAD-COW http://www.youtube.com/watch?v=w5aAPEY IL9A
    6. 6. Bovine Spongiform Encephalitis, Creutsfeldt-Jakob Disease
    7. 7. VIRUSES • Less than ½ micron, usually MUCH less • DNA/RNA “CORE” (genome) • Protein “CAPSID” (protein –NA “coat”) • Sometimes a lipid “ENVELOPE” • Limited number of genes coding for all other structures • NO consistent naming system
    8. 8. Respiratory Adenovirus Adenoviridae DS DNA Upper and lower respiratory tract infections, conjunctivitis, diarrhea Rhinovirus Picornaviridae SS RNA Upper respiratory tract infection Coxsackievirus Picornaviridae SS RNA Pleurodynia, herpangina, handfoot-and-mouth disease Coronavirus Coronaviridae SS RNA SARS, URIs Influenza viruses A, B Orthomyxoviridae SS RNA Paramyxoviridae SS RNA Respiratory syncytial virus Influenza Bronchiolitis, pneumonia
    9. 9. Digestive Mumps virus Paramyxoviridae SS RNA Mumps, pancreatitis, orchitis Rotavirus Reoviridae DS RNA Childhood diarrhea Norwalk agent Caliciviridae SS RNA Gastroenteritis Hepatitis A virus Picornaviridae SS RNA Acute viral hepatitis Hepatitis B virus Hepadnaviridae DS DNA Acute or chronic hepatitis Hepatitis D virus Viroid-like SS RNA Hepatitis C virus Flaviviridae SS RNA With HBV, acute or chronic hepatitis Acute or chronic hepatitis Hepatitis E virus Norwalk-like SS RNA Enterically transmitted hepatitis
    10. 10. Systemic with Skin Eruptions Measles virus Paramyxoviridae SS RNA Measles (rubeola) Rubella virus Togaviridae SS RNA German measles (rubella) Parvovirus Parvoviridae SS DNA Vaccinia virus Poxviridae DS DNA Erythema infectiosum, aplastic anemia Smallpox vaccine Varicella-zoster virus Herpesviridae DS DNA Chickenpox, shingles Herpes simplex virus 1 Herpesviridae DS DNA "Cold sore" Herpes simplex virus 2 Herpesviridae DS DNA Genital herpes
    11. 11. Systemic with Hematopoietic Disorders Cytomegalovirus Herpesviridae DS DNA Cytomegalic inclusion disease Epstein-Barr virus Herpesviridae DS DNA Infectious mononucleosis HTLV-I Retroviridae HIV-1 and HIV-2 Retroviridae Dengue virus 1–4 Yellow fever virus Adult T-cell leukemia; tropical spastic paraparesis SS RNA AIDS SS RNA Arboviral and Hemorrhagic Fevers Togaviridae SS RNA Dengue, hemorrhagic fever Togaviridae SS RNA Regional hemorrhagic Filoviridae fever viruses SS RNA Hantavirus SS RNA Yellow fever Ebola disease Korean pneumonia
    12. 12. Warty Growths Papillomavirus Papovaviridae DS DNA Condyloma; cervical carcinoma, squamous proliferations in general Central Nervous System Poliovirus Picornaviridae SS RNA Poliomyelitis JC virus Papovaviridae DS DNA Progressive Multifocal Leukoencephalopathy (opportunistic) Arboviral encephalitis viruses Togaviridae SS RNA Eastern, Western, Venezuelan, St. Louis
    13. 13. BACTERIOPHAGES PLASMIDS TRANSPOSONS • INFECT BACTERIA, but may make a bacteria more difficult to treat because it may increase its “virulence” or its susceptibility to antibiotics
    14. 14. BACTERIA • GRAM staining with CRYSTAL VIOLET – POSITIVE: THICK wall, ONE phospholipid layer – NEGATIVE: THIN wall, TWO phospholipid layers • SHAPE – COCCI (balls) – BACILLI (rods) • OXYGEN requirements – AEROBIC (NEED O2) – ANAEROBIC (do NOT NEED O2) – “FACULTATIVE” AEROBIC, makes ATP if O2 is present.
    15. 15. Species Infections by pyogenic cocci Staphylococcus aureus, S. epidermidis Frequent Disease Presentations Abscess, cellulitis, pneumonia, septicemia * Streptococcus pyogenes, βhemolytic Gram-negative infections, common Upper respiratory tract infection, erysipelas, scarlet fever, septicemia Streptococcus pneumoniae (pneumoccoccus) Neisseria meningitidis (meningococcus) Neisseria gonorrhoeae (gonococcus) Escherichia coli Lobar pneumonia, meningitis Cerebrospinal meningitis Gonorrhea Urinary tract infection, wound infection, abscess, pneumonia, septicemia, endotoxemia, endocarditis Klebsiella pneumoniae “ Enterobacter (Aerobacter) “ aerogenes Proteus spp. (P. mirabilis, P. “ morgagni) Serratia marcescens “ Pseudomonas spp. (P. “ aeruginosa) Bacteroides spp. (B. fragilis) Anaerobic infection Legionella spp. (L. pneumophila) Legionnaires disease
    16. 16. Contagious childhood bacterial diseases Meningitis, upper and lower respiratory tract infections Bordetella pertussis Whooping cough Corynebacterium diphtheriae Enteropathic infections Haemophilus influenzae Diphtheria Enteropathogenic E. coli Invasive or noninvasive gastroenterocolitis, some with septicemia Shigella spp. Vibrio cholerae Campylobacter fetus, C. jejuni Yersinia enterocolitica Salmonella spp. (1000 strains) Salmonella typhi Clostridial infections Typhoid fever Clostridium tetani Tetanus (lockjaw) Clostridium botulinum Botulism (paralytic food poisoning) Clostridium perfringens, C. septicum Gas gangrene, necrotizing cellulitis Clostridium difficile Pseudomembranous colitis
    17. 17. Zoonotic bacterial infections Bacillus anthracis Anthrax (malignant pustule) Listeria monocytogenes Listeria meningitis, listeriosis Yersinia pestis Francisella tularensis Bubonic plague Tularemia Brucella melitensis, B. suis, B. abortus Burkholderia mallei, B. pseudomallei Leptospira spp. (many groups) Borrelia recurrentis Borrelia burgdorferi Bartonella henselae Brucellosis (undulant fever) Spirillum minus, Streptobacillus moniliformis Glanders, melioidosis Leptospirosis, Weil disease Relapsing fever Lyme borreliosis Cat-scratch disease; bacillary angiomatosis Rat-bite fever
    18. 18. Human treponemal Treponema pallidum infections Treponema pertenue Venereal, endemic syphilis (bejel) Yaws (frambesia) Treponema carateum (T. Pinta (carate, mal pinto) herrejoni) Mycobacterial infections Tuberculosis M. leprae (Hansen bacillus) M. kansasii, M. Avium (Complex), M. intracellulare Actinomycetaceae Mycobacterium tuberculosis, M. bovis (Koch bacillus) Leprosy M. ulcerans Nocardia asteroides Buruli ulcer Nocardiosis Actinomyces israelii Actinomycosis Atypical mycobacterial infections
    19. 19. Chlamydiae Rickettsiae Mycoplasmas • Like Bacteria, but….. – NO cell wall (mycoplasma [MANY pneumonias]) – NO ATP (chlamydia [STD, worldwide blindness]) – NO life outside a cell (obligate intracellular, rickettsiae [RMSF])
    20. 20. FUNGI • YEASTS, HYPHAE • CANDIDA, by far, the MOST PREVALENT ONE • DERMATOPHYTES(superficial), (“tinea”), i.e., epidermophyton, trichophyton, microsporum • DEEP FUNGI (GRANULOMAS) – HISTOPLASMOSIS – BLASTOMYCOSIS – COCCIDIOMYCOSIS
    21. 21. YEASTS, HYPHAE
    22. 22. PARASITES • PROTOZOA • “META”-ZOA (HELMINTHS) • “ECTO”-PARASITES, i.e., ARTHROPODS
    23. 23. PROTOZOA SINGLE CELL INTESTINAL or BLOOD • PLASMODIUM (MALARIA) • LEISHMANIA • ENTAMOEBA • TRYPANOSOMA • TOXOPLASMA • GIARDIA
    24. 24. Species Order Form, Size Luminal or Epithelial Disease Entamoeba histolytica Amebae Trophozoite 15–20 µm Amebic dysentery; liver abscess Balantidium coli Ciliates Trophozoite 50–100 µm Colitis Naegleria fowleri Ameboflagellates Trophozoite 10–20 µm Meningoencephalitis Acanthamoeba sp. Ameboflagellates Trophozoite 15–30 µm Meningoencephalitis or ophthalmitis Giardia lamblia Mastigophora Trophozoite 11–18 µm Diarrheal disease, malabsorption Isospora belli Coccidia Oocyst 10–20 µm Chronic enterocolitis or malabsorption or both Cryptosporidium sp. Coccidia Oocyst 5–6 µm Trichomonas vaginalis Mastigophora Trophozoite 10–30 µm Urethritis, vaginitis Bloodstream Plasmodium species Hemosporidia Babesia microti, B. bovis Hemosporidia Trypanosoma species Trophozoites, schizonts, Malaria gametes (all small and inside red cells) Trophozoites inside red cells Hemoflagellates Trypomastigote 14–33 µm Babesiosis African sleeping sickness Intracellular Trypanosoma cruzi Hemoflagellates Trypomastigote 20 µm Chagas disease Leishmania donovani Hemoflagellates Amastigote 2 µm Kala-azar Leishmania species Hemoflagellates Amastigote 2 µm Cutaneous and mucocutaneous leishmaniasis Toxoplasma gondii Coccidia Toxoplasmosis Tachyzoite 4–6 µm (cyst larger)
    25. 25. HELMINTHS (ROUND[nematode]), FLAT[cestode]) • Roundworms, Tapeworms • Complex Life Cycles: sexual, asexual • ROUNDWORMS (nematodes): ASCARIS, TOXOCARA (VLM), STRONGYLOIDES, ENTEROBIUS • TAPE(FLAT)WORMS (cestodes): TAENIA (solium vs. saginata), DIPHYLLOBOTHRIUM, HYMENOLEPSIS
    26. 26. Ascaris life cycle In small intestine TWICE
    27. 27. ARTHROPODS: INSECTS: = 6 legs • LICE • BEDBUGS • FLEAS ARACHNIDS: = 8 legs • MITES (chiggers) • TICKS • SPIDERS
    28. 28. CLASS INSECTA, C L L R O O U U S S E E A B BEDBUG FLEA 6 legs
    29. 29. CLASS ARACHNIDA, TICK BLACK WIDOW ADULT MITE 8 legs LARVAL MITE BROWN <--RECLUSE
    30. 30. S C A B I E S
    31. 31. BARRIERS • ALL ANATOMIC MUCOSAL POSSIBILITIES –SKIN –GI –RESPIRATORY –UROGENITAL
    32. 32. SPREAD SAME AS TUMOR? • DIRECT EXTENSION • LYMPHATICS • BLOOD • NERVE
    33. 33. RELEASE (TRANSMISSION) • • • • • • SKIN SHEDDING COUGHING/SNEEZING URINE FECES BLOOD VECTORS, e.g., insects, “zoonosis” • “STDs” (Sexually Transmitted Diseases)
    34. 34. I=V/R
    35. 35. INFECTIVITY, GENERAL • AGENT HOST CELL • AGENT TOXINS NECROSIS • AGENTHOST CELLULAR REACTIONDAMAGE/DEATH
    36. 36. INFECTIVITY, VIRAL • ATTACHMENT • ENTRY • TRANSCRIPTION (forw./rev.) • TRANSLATION – INCLUSIONS – REDUCED HOST CELL FUNCTION – CELL INJURY, LYSIS, DEATH – LATENCY – NEOPLASM?, aka, “transforming”
    37. 37. INFECTIVITY, BACTERIAL • ADHERENCE • ENTRY • TOXINS –ENDO, Gram - , bacterial components (LPS) –EXO, Gram -/+, secreted proteins
    38. 38. IMMUNE EVASION • INACCESSIBILITY to host defense (Mr. Myagi, “no be there”) • VARYING (mutating) antigens • SHEDDING antigens, like jet or sub tactics • RESISTING INNATE (NATURAL) immunity • IMPAIRING T-CELLS
    39. 39. INFECTIONS of IMMUNOSUPPRESSED HOSTS • Protozoal/Helminthic: Cryptosporidium, PCP (Pneumocystis Carinii [Jirovecii] Pneumonia), Toxoplasmosis • Fungal: Candida, and the usual 3 • Bacterial: TB, Nocardia, Salmonella • Viral: CMV, HSV, VZ
    40. 40. DIAGNOSTIC TECHNIQUES • DIRECT PATHOGEN IMAGING, gross/micro • GRAM STAIN • “SPECIAL” (NOT H&E) STAINS, e.g., PAS • AGAR, e.g., CULTURES • TISSUE CULTURE, CPE (CytoPathological Effect) • ANTIBODIES (SEROLOGY) • PCR, POLYMERASE CHAIN REACTION, e.g., viral “LOAD” amazingly specific and sensitive. WHY?
    41. 41. CELLULAR HOST RESPONSES • SUPPURATIVE (NEUTROPHILS, PMNs) (cultures may be positive) • MONO-NUCLEAR, i.e., Lymphocytes, Macrophages (i.e., Monocytes), GRANULOMAS • FIBROSIS • HEMOSIDERIN • CALCIFICATION
    42. 42. ACUTE APPENDICITIS
    43. 43. ABSCESS
    44. 44. CHRONIC “MONONUCLEAR” INFLAMMATION
    45. 45. GRANULOMA
    46. 46. FIBROSIS
    47. 47. H E M O S I D E R H&E I PRUSSIAN BLUE
    48. 48. Calcification
    49. 49. The 4 Biggies • VIRAL • BACTERIAL • FUNGAL • PARASITIC
    50. 50. VIRAL • TRANSIENT, ACUTE, e.g. Measles, Mumps, Polio, West Nile • CHRONIC LATENT (HERPES FAMILY), HSV, CMV, VZ • CHRONIC (HEPATITIS), Hep A, B, C • “TRANSFORMING” (Epstein-Barr EBV, Human Papilloma, HPV)
    51. 51. BACTERIAL • Gram+ • Gram• • • • MYCO-bacteria SPIROCHETES ANAEROBIC “OBLIGATE” INTRACELLULAR
    52. 52. FUNGAL • YEASTS – CANDIDA – CRYPTOCOCCOSIS • MOLDS (HYPHAL) – ASPERGILLIS – MUCORMYCOSIS (ZYGOMYCOSIS)
    53. 53. PARASITES • PROTOZOA (GI, BLOOD) • METAZOA (WORMS)
    54. 54. VIRAL • TRANSIENT, ACUTE – Measles: Skin, URI, Lung, GI, Cornea, Brain – Mumps: Parotitis, Orchitis, Pancreas, CNS – Polio: Myelitis (Anterior horn motor neurons) – West Nile (arbo-): Meningoencephalitis
    55. 55. VIRAL • CHRONIC LATENT (HERPES FAMILY), HSV, CMV, VZ –Herpes Simplex Virus –CytoMegalo Virus –Varicella-Zoster Virus (DRG)
    56. 56. HSV
    57. 57. CONGENITAL IMMUNOSUPPRESSED BASOPHILIC CMV (HHV-5) pneumonia
    58. 58. VZ Virus
    59. 59. VIRAL • CHRONIC (HEPATITIS), Hep. A, B, C –A, Mildest, most universal –B, Most dangerous in the acute phase, but most are SUB-clinical –C, Most common cause of persistent transaminitis – D, E…
    60. 60. NORMAL LIVER
    61. 61. ACUTE VIRAL HEPATITIS
    62. 62. VIRAL “TRANSFORMING” Epstein-Barr, EBV, lymphoma (Burkitts), nasopharyngeal Human Papilloma, HPV, cervical cancer (squamous cell), types 16 and 18 are always at the top of the list!
    63. 63. PHARYNX NODES SPLEEN LIVER HETEROPHILE MONONUCLEOSIS, caused by EBV
    64. 64. “MALIGNANT” cells on PAP smear, caused by HPV
    65. 65. BACTERIAL • Gram+ (Staph, Strep) • Gram- (rods) • • • • MYCO-bacteria (TB) SPIROCHETES (SYPHILIS) ANAEROBIC (ABSCESSES) “OBLIGATE” INTRACELLULAR
    66. 66. BACTERIAL • Gram+ cocci (Staph, Strep) SKIN RESPIRATORY TRACT
    67. 67. S T A P H
    68. 68. STREP: SKIN RESPIRATORY ERISIPELAS
    69. 69. GRAM POSITIVE RODS • DIPTHERIA • LISTERIA • ANTHRAX------ • NOCARDIA • CLOSTRIDIUM
    70. 70. GRAM NEGATIVE COCCI •Neisseria –GONORRHEA –MENINGITIS
    71. 71. GRAM NEGATIVE RODS • • • • • Bordetella pertussis Pseudomonas aeruginosa Klebsiela/Aerobacter Yersinia pestis (plague) Hemophilus ducreyi (chancroid) •E. COLI
    72. 72. MYCOBACTERIA (acid fast) • Tuberculosis • “Atypical” mycobacteria, the most important of which is MAC (Mycobacterium Avium Complex, in HIV patients) • Leprosy
    73. 73. MORE ACID-FAST BACILLI, AFB (MAC)
    74. 74. SPIROCHETES • SYPHILIS ( Treponema pallidum) • RELAPSING FEVER (Borrelia sp., via lice and ticks) • LYME DISEASE (Borrelia burgdorferi, via deer ticks)
    75. 75. SYPHILIS • PRIMARY (CHANCRE) • SECONDARY (MANY skin manifestations) • TERTIARY (GUMMAS, CNS, BONE) • CONGENITAL
    76. 76. ANAEROBES • Clostridium (Gram + bacillus) – Cause of many/most cases of “gas” gangrene
    77. 77. “OBLIGATE” intracellular bacteria • Chlamydia trachomatis – Conjunctivitis – LGV (LymphoGranuloma Venerium) – Urethritis • Rickettsia (Rocky Mountain Spotted Fever, Typhus) • Mycoplasma (very common cause of community acquired pneumonias)
    78. 78. RMSF
    79. 79. FUNGAL • YEASTS – CANDIDA – CRYPTOCOCCOSIS • MOLDS (HYPHAL) – ASPERGILLIS – MUCORMYCOSIS (ZYGOMYCOSIS)
    80. 80. Candida albicans • Oral • Vaginal • Esophageal • All of the above are “moist” nonkeratinized squamous mucosa, aren’t they? • Immunocompromised, e.g., HIV, Diabetes
    81. 81. Budding Yeasts and “PSEUDO” hyphae
    82. 82. CRYPTOCOCCUS NEOFORMANS Budding cryptococcal yeasts, India ink prep, CSF
    83. 83. MOLDS • Aspergillus • Zygomycosis (Mucormycosis)
    84. 84. DERMATOPHYTES (“TINEAS”) (superficial fungi) • EPIDERMOPHYTON • MICROSPORUM • TRICHOPHYTON
    85. 85. SIGNIFICANT FUNGI (deep) • HISTOPLASMOSIS, tiny granules within macrophages, ~3μ • BLASTOMYCOSIS, ~20μ • COCCIDIOMYCOSIS, ~50μ
    86. 86. PROTOZOA • MALARIA (Plasmodium sp., of which falciparum is the most serius) • Babesiosis, transmitted by deer tick, • Leishmaniasis • Trypanosomiasis (sleeping sickness) • Chagas disease (also a trypanosome) • Entamoeba histolytica
    87. 87. GAMETOCYTES Are COMMON And SAUSAGE shaped
    88. 88. S C H U F F N E R ‘S D O T S
    89. 89. Affected RBC’s are NOT enlarged NO SCHUFFNER’s DOTS
    90. 90. S C H U F F N E R ‘ S D O T S “comets”
    91. 91. TRYPANOSOMIASIS
    92. 92. METAZOA (ROUNDworms/FLATworms) • Strongyloides (microscopic roundworm) • Tapeworms (Beef, Pork, flatworm) • Trichinosis (larva in skeletal muscle) • Schistosomiasis (bladder cancer) • Filariasis (elephantiasis) • VERY OFTEN, COMPLEX LIFE CYCLES
    93. 93. Ascaris life cycle

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