Ratirath Samol, MD. BACTERIAL DISEASE RATIRATH SAMOL, MD

Content Pyogenic gram positive cocci Bacterial infection of childhood Sexually transmitted bacterial disease Enteropathogenic bacteria Clostridial infection Bacterial infection with animal reservoirs or insect vectors Bacterial infection with immunocompromised host Filamentous bacteria Mycobacterial infection Clamydia infection Mycoplasma infection Rickettsia infection

Pyogenic gram positive cocci

Bacterial infection of childhood

Sexually transmitted bacterial disease

Enteropathogenic bacteria

Clostridial infection

Bacterial infection with animal reservoirs or insect vectors

Bacterial infection with immunocompromised host

Filamentous bacteria

Mycobacterial infection

Clamydia infection

Mycoplasma infection

Rickettsia infection

Pyogenic gram positive cocci

Pyogenic gram positive cocci Staphylococcal infection - coagulase positive (S. aureus) - coagulase negative (S. epidermidis, S. saprophyticus ) Streptococcal infection - S. pyogenes - S. agalactiae - S. pneumoniae - S. mutans

Staphylococcal infection

- coagulase positive (S. aureus)

- coagulase negative (S. epidermidis,

S. saprophyticus )

Streptococcal infection

- S. pyogenes

- S. agalactiae

- S. pneumoniae

- S. mutans

Staphylococcus spp.

Streptococcus spp.

Staphylococcus aureus Furuncles - infection in and around hair follicles - common in scalp, face, axillary Carbuncles - infection around hair follicle and produce draining sinuses Hydradenitis suppurativa - infection in sweat gland

Furuncles

- infection in and around hair follicles

- common in scalp, face, axillary

Carbuncles

- infection around hair follicle and produce

draining sinuses

Hydradenitis suppurativa

- infection in sweat gland

carbuncles furuncles

Staphylococcus aureus Osteomyelitis - infection in bone Toxic shock syndrome (TSS) - infection in surgical wound, tampons produce high fever, nausea, vomiting and shock

Osteomyelitis

- infection in bone

Toxic shock syndrome (TSS)

- infection in surgical wound, tampons produce high fever, nausea, vomiting and shock

Staphylococcus aureus Food poisoning - diarrhea, nausea, vomiting - symptom present < 6 hours after contaminated food

Food poisoning

- diarrhea, nausea, vomiting

- symptom present < 6 hours after

contaminated food

Staphylococcus aureus Staphylocoocal scalded skin syndrome (SSSS) - severe skin infection - organism produce exfoliatin that destroys desmogelin-1 (granulosa) of epidermis  bullae, rupture, skin scald - other organs : lung, heart valve, bone

Staphylocoocal scalded skin syndrome (SSSS)

- severe skin infection

- organism produce exfoliatin that destroys

desmogelin-1 (granulosa) of epidermis 

bullae, rupture, skin scald

- other organs : lung, heart valve, bone

SSSS

Staphylococcus epidermidis causes opportunistic infections in catheterized patients, patients with prosthetic cardiac valves, and drug addicts.

causes opportunistic infections in catheterized patients, patients with prosthetic cardiac valves, and drug addicts.

Staphylococcus saprophyticus common cause of urinary tract infections in young women.

common cause of urinary tract infections in young women.

Streptococcal infection 3 types -  hemolytic streptococci eg. S. pneumoniae, S. viridans, S. mutans -  hemolytic streptococci eg. S. pyogenes (group A), S. agalactiae (group B) -  hemolytic streptococci (non-hemolytic) eg. S. faecalis (group D)

3 types

-  hemolytic streptococci

eg. S. pneumoniae, S. viridans, S. mutans

-  hemolytic streptococci

eg. S. pyogenes (group A), S. agalactiae (group B)

-  hemolytic streptococci (non-hemolytic)

eg. S. faecalis (group D)

 -hemolytic streptococci S. pneumoniae is a common cause of community-acquired pneumonia and meningitis in adults S. viridans are part of the normal oral flora but are also a common cause of endocarditis S. mutans is the major cause of dental caries

S. pneumoniae is a common cause of community-acquired pneumonia and meningitis in adults

S. viridans are part of the normal oral flora but are also a common cause of endocarditis

S. mutans is the major cause of dental caries

 -hemolytic streptococci S. pyogenes (group A) - pharyngitis - scarlet fever - erysipelas - impetigo - cellulitis

S. pyogenes (group A)

- pharyngitis

- scarlet fever

- erysipelas

- impetigo

- cellulitis

Pharyngitis Infection in throat (tonsillitis) Clinical: high grade fever, sore throat Complication : - glomerulonephritis, rheumatic fever - cross reaction of immune system to M protein of bacteria

Infection in throat (tonsillitis)

Clinical: high grade fever, sore throat

Complication :

- glomerulonephritis, rheumatic fever

- cross reaction of immune system to M

protein of bacteria

Tonsillitis

Scarlet fever Common in childhood Erythematous rash at trunk, extremities and face except around the mouth (circumoral pallor), strawberry tongue Cause by erythrogenic toxin

Common in childhood

Erythematous rash at trunk, extremities and face except around the mouth (circumoral pallor), strawberry tongue

Cause by erythrogenic toxin

Scarlet fever strawberry tongue circumoral pallor

Erysipelas Erythematous rash, rapid distribution at face, particullary both cheek Rash at trunk, extremities (uncommon)

Erythematous rash, rapid distribution at face, particullary both cheek

Rash at trunk, extremities (uncommon)

Erysipelas

Impetigo Infection in epidermis Erythematous papule  pustule May be caused by S. pyogenes or S. aureus

Infection in epidermis

Erythematous papule  pustule

May be caused by S. pyogenes or S. aureus

Cellulitis Infection in deep dermis S. pyogenes invade through wound Pustule in deep dermis Clinical : fever, erythematous skin lesion

Infection in deep dermis

S. pyogenes invade through wound

Pustule in deep dermis

Clinical : fever, erythematous skin lesion

Cellulitis

 -hemolytic streptococci S. agalactiae (group B) - meningitis - chorioamnionitis - septicemia

S. agalactiae (group B)

- meningitis

- chorioamnionitis

- septicemia

Bacterial infection of childhood

Bacterial infection of childhood Diphtheria Pertussis (Whooping cough) Haemophilus influenzae infection Neisseria meningitidis infection

Diphtheria

Pertussis (Whooping cough)

Haemophilus influenzae infection

Neisseria meningitidis infection

Diphtheria Caused by Corynebacterium diphtheriae (gram positive bacilli) Transmitted as respiration Immunization with diphtheria toxoid (formalin-fixed toxin) does not prevent colonization with C. diphtheriae but protects immunized people from the lethal effects of the toxin.

Caused by Corynebacterium diphtheriae (gram positive bacilli)

Transmitted as respiration

Immunization with diphtheria toxoid (formalin-fixed toxin) does not prevent colonization with C. diphtheriae but protects immunized people from the lethal effects of the toxin.

Diphtheria Tracheal colonization may lead to - Mucosal erosion - Formation of a suffocating pharyngeal fibrinosuppurative exudate (pseudomembrane)  obstruct airway Toxin-mediated damage to the heart, nerves, liver, or kidneys Microscopic: necrotic tissue, neutrophil, fibrin, bacteria

Tracheal colonization may lead to

- Mucosal erosion

- Formation of a suffocating

pharyngeal fibrinosuppurative exudate

(pseudomembrane)  obstruct airway

Toxin-mediated damage to the heart, nerves, liver, or kidneys

Microscopic: necrotic tissue, neutrophil, fibrin, bacteria

Diphtheria

Pertussis Bordetella pertussis infection(gram negative coccobacilli ) Common in childhood (<5 yrs) Causes as laryngotracheobronchitis, ciliated respiratory epithelium necrosis, enlarged regional LN Clinical: severe cough (whooping)

Bordetella pertussis infection(gram negative coccobacilli )

Common in childhood (<5 yrs)

Causes as laryngotracheobronchitis, ciliated respiratory epithelium necrosis, enlarged regional LN

Clinical: severe cough (whooping)

Haemophilus influenzae infection gram negative coccobacilli 6 serotype (a-f), type b causes as severe disease Caused by - pneumonia - meningitis - upper respiratory infection (otitis media, sinusitis, epiglottitis)

gram negative coccobacilli

6 serotype (a-f), type b causes as severe disease

Caused by

- pneumonia

- meningitis

- upper respiratory infection (otitis media,

sinusitis, epiglottitis)

Haemophilus influenzae infection Mechanism - pilli of bacteria attached to respiratory epithelium  secrete agent interfere cilia function, destroy IgA  hematogenous spreading - peptidoglycan destroy vascular and BBB  meningitis

Mechanism

- pilli of bacteria attached to respiratory epithelium  secrete agent interfere cilia function, destroy IgA  hematogenous spreading

- peptidoglycan destroy vascular and BBB  meningitis

Neisseria meningitidis infection Gram negative diplococci Caused by - meningitis (fever, stiff neck, headache, shock and dead) - vasculitis (petechiae and purpura at skin and internal organs)

Gram negative diplococci

Caused by

- meningitis (fever, stiff neck, headache,

shock and dead)

- vasculitis (petechiae and purpura at skin

and internal organs)

Neisseria meningitidis infection Caused by -Waterhouse-Friderichsen syndrome: vasculitis and thrombosis produce hemorrhagic necrosis of both adrenal glands

Caused by

-Waterhouse-Friderichsen syndrome:

vasculitis and thrombosis produce

hemorrhagic necrosis of both adrenal

glands

Neisseria meningitidis

Bacterial meningitis เชื้อที่เป็นสาเหตุ Streptococcus pneumoniae 50% Neisseria meningitidis 25% Group B streptococci 15% Listeria monocytogenes 10% Haemophilus influenzae (type b) <10% From Harrison ed. 16th

Streptococcus pneumoniae 50%

Neisseria meningitidis 25%

Group B streptococci 15%

Listeria monocytogenes 10%

Haemophilus influenzae (type b) <10%

Bacterial meningitis: เชื้อที่เป็นสาเหตุแยกตามกลุ่มอายุ Neonates (<1 month) - group B streptococci, L. monocytogenes Children, young adults (2-20 yrs) - N. meningitidis - clinical presenting of petechial or purpuric skin lesion Adults (>20 yrs) - S. pneumoniae - predisposing condition of increase risk infection is pneumococcal pneumonia From Harrison ed. 16 th

Neonates (<1 month)

- group B streptococci, L. monocytogenes

Children, young adults (2-20 yrs)

- N. meningitidis

- clinical presenting of petechial or purpuric

skin lesion

Adults (>20 yrs)

- S. pneumoniae

- predisposing condition of increase risk

infection is pneumococcal pneumonia

Bacterial meningitis: เชื้อที่เป็นสาเหตุแยกตามกลุ่มอายุ S. aureus : follows invasive neurosurgical procedures Enteric gram negative bacteria (eg. E. coli ): increase risk infection in patients with chronic disease eg. DM, cirrhosis, alcoholism From Harrison ed. 16 th

S. aureus : follows invasive neurosurgical procedures

Enteric gram negative bacteria (eg. E. coli ): increase risk infection in patients with chronic disease eg. DM, cirrhosis, alcoholism

Sexually transmitted bacterial disease

Sexually transmitted bacterial disease Gonorrhea Chancroid (soft chancre) Granuloma inguinale Syphilis

Gonorrhea

Chancroid (soft chancre)

Granuloma inguinale

Syphilis

Gonorrhea Neisseria gonorrhoeae (gram negative diplococci) Caused by - male: urethritis, epididymitis - female: endometritis, salpingitis, PID - neonatal infection: conjunctivitis, blindness

Neisseria gonorrhoeae (gram negative diplococci)

Caused by

- male: urethritis, epididymitis

- female: endometritis, salpingitis, PID

- neonatal infection: conjunctivitis,

blindness

Neisseria gonorrhoeae

Chancroid (soft chancre) Haemophilus ducreyi (gram negative bacilli) Clinical feature: - painful multiple genital ulcer and dirty based ulcer - 50% inguinal lymphadenitis - suppurative inguinal lymphadenitis (bubo)

Haemophilus ducreyi (gram negative bacilli)

Clinical feature:

- painful multiple genital ulcer and dirty

based ulcer

- 50% inguinal lymphadenitis

- suppurative inguinal lymphadenitis

(bubo)

Chancroid (soft chancre)

Granuloma inguinale Calymmatobacterium granulomatis (gram negative coccobacilli) Clinical feature: - raised, soft red papule and ulcer at genital area  chronic inflammation  scar Microscopic: - neutrophil, lymphocyte, hyperplasia

Calymmatobacterium granulomatis (gram negative coccobacilli)

Clinical feature:

- raised, soft red papule and ulcer at

genital area  chronic inflammation  scar

Microscopic:

- neutrophil, lymphocyte, hyperplasia

Syphilis Treponema pallidum (spirochete) 3 stages - primary syphilis - secondary syphilis - tertiary syphilis

Treponema pallidum (spirochete)

3 stages

- primary syphilis

- secondary syphilis

- tertiary syphilis

Syphilis Primary syphilis - chancre : painless, a clean based ulcer and regression 3-6 weeks - inguinal lymphadenopathy - microscopic: chronic inflammation (plasma cell, lymphocyte, macrophage) and organisms

Primary syphilis

- chancre : painless, a clean based ulcer

and regression 3-6 weeks

- inguinal lymphadenopathy

- microscopic: chronic inflammation

(plasma cell, lymphocyte, macrophage)

and organisms

Primary syphilis

Syphilis Secondary syphilis - systemic dissemination to many organs eg. skin, LN, meninges, liver, mucous membrane - common presentation: rash at trunk, extremities, palm, sole appears from 2 wks to 6 months after chancre heals

Secondary syphilis

- systemic dissemination to many organs eg. skin, LN, meninges, liver, mucous membrane

- common presentation: rash at trunk, extremities, palm, sole appears from 2 wks to 6 months after chancre heals

Syphilis Secondary syphilis - condyloma lata (exudative plaques in perineum, vulva, scrotum) - white mucous patch (rash at mucous membrane at mouth, genital organs) - fever, anorexia, alopecia - microscopic: chronic inflammation, obliterative endarteritis, many organisms

Secondary syphilis

- condyloma lata (exudative plaques in

perineum, vulva, scrotum)

- white mucous patch (rash at mucous

membrane at mouth, genital organs)

- fever, anorexia, alopecia

- microscopic: chronic inflammation,

obliterative endarteritis, many organisms

Secondary syphilis

Syphilis Tertiary syphilis - 1/3 of untreated patient develop tertiary syphilis (no organisms) - syphilitic aortitis (80%)  aortic regurgitation, aneurysm - neurosyphilis  paralysis, seizure - gumma : granulomatous inflammation in any organs eg. skin, bone, liver

Tertiary syphilis

- 1/3 of untreated patient develop tertiary

syphilis (no organisms)

- syphilitic aortitis (80%)  aortic

regurgitation, aneurysm

- neurosyphilis  paralysis, seizure

- gumma : granulomatous inflammation in

any organs eg. skin, bone, liver

Tertiary syphilis Aortic aneurysm

Congenital syphilis Intrauterine infection of fetus Common in primary and secondary syphilis (many organisms) of pregnant women Organisms transferred to fetus by placenta Causes late abortion, stillbirth, or death soon after delivery 2 stages - early syphilis - late syphilis

Intrauterine infection of fetus

Common in primary and secondary syphilis (many organisms) of pregnant women

Organisms transferred to fetus by placenta

Causes late abortion, stillbirth, or death soon after delivery

2 stages

- early syphilis

- late syphilis

Congenital syphilis early syphilis (< 2 yrs) - extensive cutaneous rash containing many spirochetes - Osteochondritis with collapse of the bridge of the nose (saddle nose) - Periostitis with bowing of the tibia

early syphilis (< 2 yrs)

- extensive cutaneous rash containing many spirochetes

- Osteochondritis with collapse of the bridge of the nose (saddle nose)

- Periostitis with bowing of the tibia

Congenital syphilis late syphilis (> 2 yrs) - Hutchinson triad eighth nerve deafness interstitial keratitis (blindness) notched central incisors (hutchinson teeth)

late syphilis (> 2 yrs)

- Hutchinson triad

eighth nerve deafness

interstitial keratitis (blindness)

notched central incisors (hutchinson

teeth)

notched central incisors

Laboratory diagnosis Nontreponemal antibody test - detect Ab againt cardiolipin in blood - RPR, VDRL - screening test, follow up - positive in secondary syphilis - false positive : SLE, acute infection, leprosy, hypergammaglobulinemia - cure  negative result

Nontreponemal antibody test

- detect Ab againt cardiolipin in blood

- RPR, VDRL

- screening test, follow up

- positive in secondary syphilis

- false positive : SLE, acute infection,

leprosy, hypergammaglobulinemia

- cure  negative result

Laboratory diagnosis Antitreponemal antibody test - detect Ab againt T. pallidum - FTA-Abs, MHATP - positive after infection 4-6 wks and continuous positive until cure

Antitreponemal antibody test

- detect Ab againt T. pallidum

- FTA-Abs, MHATP

- positive after infection 4-6 wks and

continuous positive until cure

Enteropathogenic bacteria

Enteropathogenic bacteria Salmonella infection and typhoid fever Shigella infection Campylobacter infection Cholera Helicobacter pylori Escherichia coli

Salmonella infection and typhoid fever

Shigella infection

Campylobacter infection

Cholera

Helicobacter pylori

Escherichia coli

Salmonella infection and typhoid fever Gram negative bacilli Salmonella enteritidis, Salmonella typhimurium - contaminated food (water, beef, chicken) - intestinal infection - s/s: diarrhea, abdominal pain - microscopic: erosion of epithelium and neutrophils

Gram negative bacilli

Salmonella enteritidis, Salmonella typhimurium

- contaminated food (water, beef, chicken)

- intestinal infection

- s/s: diarrhea, abdominal pain

- microscopic: erosion of epithelium and

neutrophils

Salmonella infection and typhoid fever Salmonella typhi - caused by typhoid fever - contaminated food and water - organisms contaminates in feces of carrier human

Salmonella typhi

- caused by typhoid fever

- contaminated food and water

- organisms contaminates in feces of

carrier human

Salmonella infection and typhoid fever Salmonella typhi (typhoid fever) - 1 wk : septicemia, fever - 2 wks: bacterial replication in macrophages of Peyer patches of terminal ileum  intestinal nodule, abdominal pain - 3 wks: bacteria invades in intestinal epithelium  ulcer along the intestine  mucous bloody diarrhea  shock - Microscopic: necrotic epithelium, erythrophagocytosis

Salmonella typhi (typhoid fever)

- 1 wk : septicemia, fever

- 2 wks: bacterial replication in

macrophages of Peyer patches of terminal

ileum  intestinal nodule, abdominal pain

- 3 wks: bacteria invades in intestinal

epithelium  ulcer along the intestine  mucous bloody

diarrhea  shock

- Microscopic: necrotic epithelium, erythrophagocytosis

Typhoid fever

Shigella infection Gram negative bacilli S. boydii, S. flexneri, S.dysenteriae Caused by shigellosis Transmitted by fecal-oral route s/s: dysentery (cramping, tenemus, mucous bloody diarrhea)

Gram negative bacilli

S. boydii, S. flexneri, S.dysenteriae

Caused by shigellosis

Transmitted by fecal-oral route

s/s: dysentery (cramping, tenemus, mucous bloody diarrhea)

Shigella infection Infection in small and large intestine Shiga toxin induce hemorrhagic colitis Microscopic: ulcer of intestine covered by neutrophils, enlarged mucosal lymphoid follicles

Infection in small and large intestine

Shiga toxin induce hemorrhagic colitis

Microscopic: ulcer of intestine covered by neutrophils, enlarged mucosal lymphoid follicles

Campylobacter infection Comma shaped, flagellated gram negative Common pathogen: C. jejuni Transmitted by contaminated food Inflammation of jejunum continues to anus s/s: diarrhea, fever Microscopic: ulcer, neutrophils Complication: reactive arthritis, Guillain-Barre syndrome

Comma shaped, flagellated gram negative

Common pathogen: C. jejuni

Transmitted by contaminated food

Inflammation of jejunum continues to anus

s/s: diarrhea, fever

Microscopic: ulcer, neutrophils

Complication: reactive arthritis, Guillain-Barre syndrome

Cholera Vibrio cholerae (comma shaped, flagellated gram negative) Many serotypes (01 serotype=pathogen) s/s: massive rice-watery diarrhea Gross: non-specific intestine Micro: scant neutrophils

Vibrio cholerae (comma shaped, flagellated gram negative)

Many serotypes (01 serotype=pathogen)

s/s: massive rice-watery diarrhea

Gross: non-specific intestine

Micro: scant neutrophils

Mechanism of cholera

Escherichia coli Gram negative bacilli Flora in lower in testines (colon) assists with waste processing, vitamin K production, and food absorption cause several intestinal and extra-intestinal infections eg. urinary tract infections (UTI), meningitis , mastitis , pneumonia

Gram negative bacilli

Flora in lower in testines (colon)

assists with waste processing, vitamin K production, and food absorption

cause several intestinal and extra-intestinal infections eg. urinary tract infections (UTI), meningitis , mastitis , pneumonia

Escherichia coli At least 4 types of pathogenic E. coli enterotoxigenic (ETEC) enterohemorrhagic (EHEC) enteroinvasive (EIEC) enteropathogenic (EPEC). Bacteria produce toxins  damage enterocytes and vascular endothelial cells Clinical features: - abdominal pain and diarrhea - some children infected EHEC may develop life-threatening hemolytic-uremic syndrome ( hemolytic anemia, renal failure, and thrombocytopenia)

At least 4 types of pathogenic E. coli

enterotoxigenic (ETEC)

enterohemorrhagic (EHEC)

enteroinvasive (EIEC)

enteropathogenic (EPEC).

Bacteria produce toxins  damage enterocytes and vascular endothelial cells

Clinical features:

- abdominal pain and diarrhea

- some children infected EHEC may develop life-threatening hemolytic-uremic syndrome ( hemolytic anemia, renal failure, and thrombocytopenia)

Watery diarrhea, cholera, pandemic spread Water, shellfish, person-to-person spread Enterotoxin, no invasion Vibrio cholerae , other Vibrios Fever, pain, diarrhea, dysentery, epidemic spread Person-to-person, low-inoculum Invasion, local spread, toxin Shigella Fever, pain, diarrhea or dysentery, bacteremia, extraintestinal infection, common source outbreaks Milk, beef, eggs, poultry Invasion, translocation, lymphoid inflammation, dissemination Salmonella Fever, pain, diarrhea, dysentery Cheese, water, person-to-person Invasion, local spread • EIEC Watery diarrhea, infants and toddlers Weaning foods, water Attachment, enterocyte effacement, no invasion • EPEC Hemorrhagic colitis, hemolytic-uremic syndrome Undercooked beef products Shiga-like toxin, no invasion • EHEC Watery diarrhea Food, water Cholera-like toxin, no invasion • ETEC Traveler's diarrhea, including: Escherichia coli Clinical Features Source Pathogenic Mechanism Organism

Helicobacter pylori Curvilinear gram negative bacilli Caused by chronic gastritis, peptic ulcer Clinical features: epigastric pain, nausea, vomiting Associated with gastric carcinoma and gastric lymphoma

Curvilinear gram negative bacilli

Caused by chronic gastritis, peptic ulcer

Clinical features: epigastric pain, nausea, vomiting

Associated with gastric carcinoma and gastric lymphoma

Helicobacter pylori

Clostridial infection

Clostridial infection Clostridium perfringens Clostridium tetani Clostridium botulinum Clostridium difficile

Clostridium perfringens

Clostridium tetani

Clostridium botulinum

Clostridium difficile

Clostridium perfringens Gas gangrene (myonecrosis) - organisms invade through ulcer - toxin destroy RBC, platelet, muscle (myonecrosis with gas forming) - spingomyelinase destroy myeline sheath

Gas gangrene (myonecrosis)

- organisms invade through ulcer

- toxin destroy RBC, platelet, muscle

(myonecrosis with gas forming)

- spingomyelinase destroy myeline sheath

Clostridium perfringens Food poisoning Necrotizing enteritis - enterotoxin of C. perfringens (type C) induces necrosis and hemorrhage of small intestine - s/s : abdominal pain, n/v, bloody diarrhea, dead (24 hrs)

Food poisoning

Necrotizing enteritis

- enterotoxin of C. perfringens (type C) induces necrosis and hemorrhage of small intestine

- s/s : abdominal pain, n/v, bloody diarrhea, dead (24 hrs)

Clostridium tetani Caused by tetanus Organisms invades to the wound Tetanus neonatorum : contaminated instruments

Caused by tetanus

Organisms invades to the wound

Tetanus neonatorum : contaminated instruments

Mechanism of C. tetani Organisms produces neurotoxin (tetanospasmin) Toxin travel along peripheral nerve to anterior horn cells of spinal cord Inhibit neurotransmitter from inhibitory neuron Continuous muscle contraction Trismus or lockjaw, risus sardonicus , opisthotonos, dysphagia, dyspnea

Organisms produces neurotoxin (tetanospasmin)

Toxin travel along peripheral nerve to

anterior horn cells of spinal cord

Inhibit neurotransmitter from inhibitory neuron

Continuous muscle contraction

Trismus or lockjaw, risus sardonicus , opisthotonos, dysphagia, dyspnea

Clostridium botulinum grows in inadequately sterilized canned foods and releases a potent neurotoxin (botulinum) that blocks synaptic release of acetylcholine and causes a severe paralysis of respiratory and skeletal muscles

grows in inadequately sterilized canned foods and releases a potent neurotoxin (botulinum) that blocks synaptic release of acetylcholine and causes a severe paralysis of respiratory and skeletal muscles

Clostridium difficile overgrows other intestinal flora in broad spectrum antibiotic-treated patients, releases toxins, and causes pseudomembranous colitis

overgrows other intestinal flora in broad spectrum antibiotic-treated patients, releases toxins, and causes pseudomembranous colitis

Pseudomembranous colitis

Bacterial infection with animal reservoirs or insect vectors

Bacterial infection with animal reservoirs or insect vectors Plague Anthrax Leptospirosis Cat-scratch disease

Plague

Anthrax

Leptospirosis

Cat-scratch disease

Plague Caused by Yersinia pestis (gram negative intracellular bacilli) Reservoir: fleas Infected by fleas bite 3 syndrome - bubonic plague - septicemic plague - pneumonic plague

Caused by Yersinia pestis (gram negative intracellular bacilli)

Reservoir: fleas

Infected by fleas bite

3 syndrome

- bubonic plague

- septicemic plague

- pneumonic plague

Plague Bubonic plague - enlarged LN with hemorrhagic necrosis  involved skin  shock Septicemic plague - septicemia  DIC, no enlarged LN  dead Pneumonic plague - respiratory droplet transmission  pneumonia with hemorrhagic necrosis and pleuritis  dead

Bubonic plague

- enlarged LN with hemorrhagic necrosis  involved skin  shock

Septicemic plague

- septicemia  DIC, no enlarged LN  dead

Pneumonic plague

- respiratory droplet transmission  pneumonia with hemorrhagic necrosis and pleuritis  dead

Anthrax Bacillus anthracis (gram positive bacilli) Reservoirs: goat, sheep, cattle, dog, pig Spores form in soil, dead animals 3 group - cutaneous anthrax - inhalational anthrax - gastrointestinal anthrax

Bacillus anthracis (gram positive bacilli)

Reservoirs: goat, sheep, cattle, dog, pig

Spores form in soil, dead animals

3 group

- cutaneous anthrax

- inhalational anthrax

- gastrointestinal anthrax

Anthrax cutaneous anthrax (95%) - spores invade wound  painless papule and vesicle  ulcer, regional enlarged LN  cure inhalational anthrax - inhaled spores  hemorrhagic mediastinitis  sudden dead gastrointestinal anthrax (rare) - eating spores contaminated meat  GI symptom  high mortality rate

cutaneous anthrax (95%)

- spores invade wound  painless papule and vesicle  ulcer, regional enlarged LN  cure

inhalational anthrax

- inhaled spores  hemorrhagic

mediastinitis  sudden dead

gastrointestinal anthrax (rare)

- eating spores contaminated meat  GI symptom  high mortality rate

Leptospirosis Leptospira interrogans (spirochete) Reservoir: rodent, cattle, cat, dog Bacteria secrete in animal urination and contamination in environment (water) Transmitted by abrasion wound

Leptospira interrogans (spirochete)

Reservoir: rodent, cattle, cat, dog

Bacteria secrete in animal urination and contamination in environment (water)

Transmitted by abrasion wound

Leptospirosis Composed of 2 symptom 1.Anicteric leptospirosis - leptospiremic phase: fever, headache, myalgia, hepatosplenomegaly - leptospiruric phase: aseptic meninigitis

Composed of 2 symptom

1.Anicteric leptospirosis

- leptospiremic phase: fever, headache,

myalgia, hepatosplenomegaly

- leptospiruric phase: aseptic meninigitis

Leptospirosis 2. Severe leptospirosis (Weil syndrome) - severe jaundice, hepatosplenomegaly - acute renal failure (dead) - bleeding in GI, skin, brain

2. Severe leptospirosis (Weil syndrome)

- severe jaundice, hepatosplenomegaly

- acute renal failure (dead)

- bleeding in GI, skin, brain

Cat-scratch disease Bartonella henselae (gram negative bacilli) Transmitted by scratch or bite of cat s/s : red papule or pustule skin, enlarged LN (axilla, neck) Microscopic: granulomatous inflammation and abscess

Bartonella henselae (gram negative bacilli)

Transmitted by scratch or bite of cat

s/s : red papule or pustule skin, enlarged LN (axilla, neck)

Microscopic: granulomatous inflammation and abscess

Bacterial infection with immunocompromised host

Bacterial infection with immunocompromised host Pseudomonas infection Legionnaires infection

Pseudomonas infection

Legionnaires infection

Pseudomonas infection Pseudomonas aeruginosa (gram negative bacilli) Nosocomial infection Common in severe burn, cystic fibrosis, leukopenia

Pseudomonas aeruginosa (gram negative bacilli)

Nosocomial infection

Common in severe burn, cystic fibrosis, leukopenia

Pseudomonas aeruginosa Necrotizing pneumonia Keratitis (contact lens) Vulvular disease (IVDU) Otitis externa (swimming) Ecthyma gangrenosum (severe burn)

Necrotizing pneumonia

Keratitis (contact lens)

Vulvular disease (IVDU)

Otitis externa (swimming)

Ecthyma gangrenosum (severe burn)

Legionnaires infection Legionella pneumophila (gram negative bacilli) Reservoir: water source, air condition 2 symptom - pontiac fever (URI, fever  cure) - legionnaires disease (severe pneumonia)

Legionella pneumophila (gram negative bacilli)

Reservoir: water source, air condition

2 symptom

- pontiac fever (URI, fever  cure)

- legionnaires disease (severe pneumonia)

Legionnaires infection legionnaires disease (severe pneumonia) - scattered lung lesions, particularly bronchiole and alveoli - microscopic : mixed inflammatory cells, vasculitis, thrombosis

legionnaires disease (severe pneumonia)

- scattered lung lesions, particularly

bronchiole and alveoli

- microscopic : mixed inflammatory cells,

vasculitis, thrombosis

Filamentous bacteria

Order Actinomycetales (Actinomycetes) Aerobic actinomycetes - cell wall with mycolic acid Nocardia, Mycobacterium, Corynebacterium - cell wall without mycolic acid Actinomadura, Streptomyces Anaerobic actinomycetes - cell wall without mycolic acid Actinomyces, Propionibacterium, Lactobacillus * เชื้อที่ cell wall มี mycolic acid จะย้อมติด AFB และ modified AFB

Aerobic actinomycetes

- cell wall with mycolic acid

Nocardia, Mycobacterium, Corynebacterium

- cell wall without mycolic acid

Actinomadura, Streptomyces

Anaerobic actinomycetes

- cell wall without mycolic acid

Actinomyces, Propionibacterium, Lactobacillus

* เชื้อที่ cell wall มี mycolic acid จะย้อมติด AFB และ modified AFB

Filamentous bacteria infection Actinomycosis เกิดจากเชื้อ - Actinomyces spp. Nocardiosis เกิดจากเชื้อ - Nocardia spp. Actinomycotic mycetoma เกิดจากเชื้อ - Nocardia, Actinomadura, Streptomyces spp. - organism pass the wound

Actinomycosis เกิดจากเชื้อ

- Actinomyces spp.

Nocardiosis เกิดจากเชื้อ

- Nocardia spp.

Actinomycotic mycetoma เกิดจากเชื้อ

- Nocardia, Actinomadura, Streptomyces spp.

- organism pass the wound

Actinomycosis Actinomyces israelii Flora in oral, pharynx, GI, vagina Caused by lump jaw, osteomyelitis, intra-abdominal infection, pelvic inflammatory disease (IUD)

Actinomyces israelii

Flora in oral, pharynx, GI, vagina

Caused by lump jaw, osteomyelitis, intra-abdominal infection, pelvic inflammatory disease (IUD)

Actinomycosis Gross: sulfur granules (grains) Microscopic: organisms surrounded by neutrophils, histiocytes, giant cells Special stains (GMS): filamentous shaped bacteria

Gross: sulfur granules (grains)

Microscopic: organisms surrounded by neutrophils, histiocytes, giant cells

Special stains (GMS): filamentous shaped bacteria

Actinomycosis sulfur granules

Actinomycosis Filamentous bacteria by GMS Cluster of filamentous bacteria

Nocardiosis Oppotunistic infection in immunocompromised host Nocardia asteroides - lobar pneumonia or abscess - organisms found in soil - transmitted by inhaled organisms - s/s : fever, cough, dyspnea

Oppotunistic infection in immunocompromised host

Nocardia asteroides

- lobar pneumonia or abscess

- organisms found in soil

- transmitted by inhaled organisms

- s/s : fever, cough, dyspnea

Nocardiosis Microscopic : neutrophil, macrophage, necrosis, organisms and may be giant cells Special stains : modified acid fast stain (red filament or branching)

Microscopic : neutrophil, macrophage, necrosis, organisms and may be giant cells

Special stains : modified acid fast stain (red filament or branching)

Nocardia spp. (Modified AFB stain)

Mycetoma Actinomycotic mycetoma : caused by - Actinomadura spp. - Streptomyces spp. - Nocardia spp. Eumycotic mycetoma : caused by - fungi e.g. Pseudallescheria spp., Madurella spp.

Actinomycotic mycetoma : caused by

- Actinomadura spp.

- Streptomyces spp.

- Nocardia spp.

Eumycotic mycetoma : caused by

- fungi e.g. Pseudallescheria spp.,

Madurella spp.

Actinomycotic mycetoma Localized multiple nodules with sinuses and swelling lesions Involving cutaneous and subcutaneous tissues, fascia and bone Occurs on foot or hand Results from traumatic implantation of soil organisms into the tissues

Localized multiple nodules with sinuses and swelling lesions

Involving cutaneous and subcutaneous tissues, fascia and bone

Occurs on foot or hand

Results from traumatic implantation of soil organisms into the tissues

Actinomycotic mycetoma Lesions are composed of suppurating abscesses and sulfur granules (grains) Microscopic : organisms surrounded by neutrophils, histiocytes, giant cells Special stains (GMS): filamentous shaped bacteria

Lesions are composed of suppurating abscesses and sulfur granules (grains)

Microscopic : organisms surrounded by neutrophils, histiocytes, giant cells

Special stains (GMS): filamentous shaped bacteria

Actinomycotic mycetoma

Actinomycotic mycetoma Cluster of filamentous bacteria Filamentous bacteria by GMS

Mycobacterial infection

Mycobacterium spp. Mycobacterium tuberculosis complex - M. tuberculosis , M. bovis, M. africanum, M. microti - causes pulmonary and extrapulmonary tuberculosis Nontuberculous mycobacteria (NTM) - Mycobacterium avium complex (MAC) (M. avium, M. intracellare) Mycobacterium causes leprosy - M. leprae

Mycobacterium tuberculosis complex

- M. tuberculosis , M. bovis, M. africanum,

M. microti

- causes pulmonary and extrapulmonary

tuberculosis

Nontuberculous mycobacteria (NTM)

- Mycobacterium avium complex (MAC)

(M. avium, M. intracellare)

Mycobacterium causes leprosy

- M. leprae

Pulmonary tuberculosis Caused by M. tuberculosis Classified 2 types - Primary pulmonary tuberculosis - Secondary pulmonary tuberculosis

Caused by M. tuberculosis

Classified 2 types

- Primary pulmonary tuberculosis

- Secondary pulmonary tuberculosis

Primary pulmonary tuberculosis P rimary infectio n at lungs composed of “ Ghon complex ” - Lung infection at lower segment of u pper lobe or upper segment of l ower lobe  Ghon focus - Infection of hila node Most of infected persons  healed scar Most of asymptomatic

P rimary infectio n at lungs composed of “ Ghon complex ”

- Lung infection at lower segment of u pper lobe or upper segment of l ower lobe  Ghon focus

- Infection of hila node

Most of infected persons  healed scar

Most of asymptomatic

Primary pulmonary tuberculosis

Secondary pulmonary tuberculosis R eactivation or reinfection of primary TB with asymptomatic Common infection at high O2 (apex of lung) Severe lung damage and produces cavity s/s: low-grade fever, chronic cough, night sweat, weight loss, anorexia

R eactivation or reinfection of primary TB with asymptomatic

Common infection at high O2 (apex of lung)

Severe lung damage and produces cavity

s/s: low-grade fever, chronic cough, night sweat, weight loss, anorexia

Secondary pulmonary tuberculosis Clinical course - recovery if normal immune or treatment - lymphatic or hematogenous spread to other organs eg, liver, spleen, pancreas  miliary TB

Clinical course

- recovery if normal immune or treatment

- lymphatic or hematogenous spread to

other organs eg, liver, spleen, pancreas

 miliary TB

Secondary pulmonary tuberculosis

Miliary TB

Caseous granulomas

Pulmonary TB AFB stain

Extrapulmonary tuberculosis TB at any organs eg. LN, GI, skin, meninges, bone, liver spleen etc. Transmitted by TB lung spreading or direct invasion to any organs Gross and microscopic similar to TB lung

TB at any organs eg. LN, GI, skin, meninges, bone, liver spleen etc.

Transmitted by TB lung spreading or direct invasion to any organs

Gross and microscopic similar to TB lung

Diagnostic test for TB Special stains - AFB : reddish bacilli - Gram stain : indistinct gram positive bacilli - Fluorochromic auramine-rhodamine Culture PCR

Special stains

- AFB : reddish bacilli

- Gram stain : indistinct gram positive bacilli

- Fluorochromic auramine-rhodamine

Culture

PCR

Nontuberculous mycobacteria Common in immunocompromised host eg. AIDS, leukemia Organisms contain in soil and water M. avium complex (MAC) Infection in any organs eg. lung, GI, bone s/s : depend on location

Common in immunocompromised host eg. AIDS, leukemia

Organisms contain in soil and water

M. avium complex (MAC)

Infection in any organs eg. lung, GI, bone

s/s : depend on location

Nontuberculous mycobacteria infection Gross: non-specific Microscopic: clusters of macrophages contain many organisms (AFB stain)

Gross: non-specific

Microscopic: clusters of macrophages contain many organisms (AFB stain)

MAC AFB stain

Leprosy Mycobacterium leprae Transmitted by respiration Causes skin lesion - tuberculoid leprosy - lepromatous leprosy

Mycobacterium leprae

Transmitted by respiration

Causes skin lesion

- tuberculoid leprosy

- lepromatous leprosy

Tuberculoid leprosy Asymmetry erythematous plaque with sharp outer margins fading centrally to a flattened clear zone of healing that is rough, anhidrotic, hairless, hypopigmented, and anesthetic Muscle atrophy, ulcer, contracture Slow progressive Micro: granulomatous inflammation, rare organisms

Asymmetry erythematous plaque with sharp outer margins fading centrally to a flattened clear zone of healing that is rough, anhidrotic, hairless, hypopigmented, and anesthetic

Muscle atrophy, ulcer, contracture

Slow progressive

Micro: granulomatous inflammation, rare organisms

Tuberculoid leprosy

Lepromatous leprosy More severe The early lesions of lepromatous leprosy are multiple, symmetrically distributed, erythematous ill - defined macules and papules Muscle atrophy Micro: clusters of macrophages containing organisms (AFB stain)

More severe

The early lesions of lepromatous leprosy are multiple, symmetrically distributed, erythematous ill - defined macules and papules

Muscle atrophy

Micro: clusters of macrophages containing organisms (AFB stain)

Lepromatous leprosy

Chlamydia infection

Chlamydia infection Chlamydia trachomatis Chlamydia psittaci Chlamydia pneumoniae

Chlamydia trachomatis

Chlamydia psittaci

Chlamydia pneumoniae

Chlamydia trachomatis trachoma acute inclusion conjunctivitis urogenital infection lymphogranuloma venereum

trachoma

acute inclusion conjunctivitis

urogenital infection

lymphogranuloma venereum

Chlamydia psittaci Caused by animal disease Human infected by respiration of secretion of affected animal Clinical features: upper respiratory tract infection, atypical pneumonia

Caused by animal disease

Human infected by respiration of secretion of affected animal

Clinical features: upper respiratory tract infection, atypical pneumonia

Chlamydia pneumoniae Transmitted by respiration Caused by atypical pneumonia Micro : lymphocytes infiltration in interstitium

Transmitted by respiration

Caused by atypical pneumonia

Micro : lymphocytes infiltration in interstitium

Mycoplasma infection

M. pneumoniae No cell wall  no Gram staining Transmitted by respiration Common in child, young adult Caused by - pharyngitis - sinusitis - laryngotrachebronchitis - atypical pneumonia

No cell wall  no Gram staining

Transmitted by respiration

Common in child, young adult

Caused by

- pharyngitis

- sinusitis

- laryngotrachebronchitis

- atypical pneumonia

Rickettsia infection

Rickettsia infection Animal reserviors: tick, mite, flea, louse 3 groups: - spotted fever group - typhus group - scrub typhus group

Animal reserviors: tick, mite, flea, louse

3 groups:

- spotted fever group

- typhus group

- scrub typhus group

spotted fever group Rocky Mountain spotted fever - R. rickettsii - Tick bite Rickettsiapox - R. akari - Mite bite

Rocky Mountain spotted fever

- R. rickettsii

- Tick bite

Rickettsiapox

- R. akari

- Mite bite

typhus group Epidermic typhus Brill-Zinsser disease - R. prowazekii - Louse feces Murine typhus - R. typhi - Rat flea feces

Epidermic typhus Brill-Zinsser disease

- R. prowazekii

- Louse feces

Murine typhus

- R. typhi

- Rat flea feces

scrub typhus group Scrub typhus - Orientia tsutsugamushi - Chigger bite

Scrub typhus

- Orientia tsutsugamushi

- Chigger bite

Rickettsia infection Pathology - destroy arteriole and capillary - necrotizing vasculitis spotted fever and scrub typhus groups : eschar typhus group: no eschar

Pathology

- destroy arteriole and capillary

- necrotizing vasculitis

spotted fever and scrub typhus groups : eschar

typhus group: no eschar

Eschar

THE END