SKETCHY MICRO BZZ BZZ BZZ 🧪🧪 🧪🧪

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Bacteria Basic shape/stain Other/Unique Characteristics Complications Diagnosis + Treatment
Post-viral pneumonia
Cat+ Coag+ Vancomycin – MRSA
Septic arthritis, osteomyelitis, abscesses
Staphylococcus B-hemolytic Nafcillin – MSSA
Gram+ coccus Acute bacterial endocarditis (tricuspid)
aureus Ferments mannitol agar (yellow) Cefazolin (pre-/post-surgical
SSSS, TSS
Protein A (binds Fc) PPx)
Rapid-onset food poisoning
Cat+ Coag- Urease+
Prosthetic joint infx
Staphylococcus Biofilms
Gram+ coccus Catheter infx Vancomycin
epidermitis Part of normal skin flora
MCC prosthetic heart valve endocarditis
Novobiocin-sensitive
Staphylococcus Cat+ Coag-
Gram+ coccus UTI in sexually active pts
saprophyticus Novobiocin-resistant
Hyaluronic acid capsule Impetigo
B-hemolytic Pharyngitis (strep throat)
Strep pyrogenic exotoxin (SPE) Cellulitis & erysipelas
Streptococcus Encapsulated M-protein Scarlet fever (from SPE) PGSN – penicillin
pyogenes (GAS) Gram+ coccus Streptolysin O (ASO Ab = against) Toxic-shock-like-syndrome (TSLS)
Streptokinase Necrotizing fasciitis
DNase Rheumatic fever (M-protein, JNES)
Bacitracin-sensitive PSGN
Hippurate+
Polysaccharide capsule MCC neonatal meningitis Intrapartum penicillin PPx to
Streptococcus Encapsulated
CAMP test+ (NOT cAMP-related!!) Neonatal sepsis pregnant mother w/ GBS
agalactiae (GBS) Gram+ coccus
B-hemolytic Pneumonia (babies, adults) colonization in vaginal canal
Bacitracin-resistant
a-hemolytic
MCC community-acq pneumonia (CAP) Macrolides
Encapsulated, Polysaccharide capsule (VF)
Streptococcus MCC MOPS: Meningitis, Otitis media, Ceftriaxone
Lancet-shaped Optochin-sensitive
pneumoniae Pneumonia, Sinusitis 23-valent adult vaccine (IgM)
Gram+ diplococcus Bile-soluble
Sickle cell pts susceptible (asplenia) 7-valent child vaccine (IgG)
IgA protease
a-hemolytic
Streptococcus No capsule Associated w/ dental caries (S mutans +
Gram+ coccus
viridans Optochin-resistant S sanguinis) → subacute endocarditis (mitral)
Bile-resistant
Enterococcus Grows in 6.5% NaCl UTIs
Tigecycline
faecalis + Gram+ coccus Bile-resistant Endocarditis
Linezolid
faecium VRE – multidrug resistance Biliary tree infx
Protein capsule (poly-d-glut) Black eschar (tissue necrosis)
Bacillus Large Gram+ rod Obligate aerobe Wool sorter’s disease Fluoroquinolones
anthracis “in chains” Spore-forming (temp/chem resis) ↑cAMP → edema Doxycycline
LF + EF toxins (lethal + edema factor) Hemorrhagic mediastinitis (widened MS)
Bacteria Basic shape/stain Other/Unique Characteristics Complications Diagnosis + Treatment
Gram+ bacillus Facultative anaerobe
Bacillus cereus Food poisoning → reheated fried rice
(aka rod) Spore-forming (temp/chem resis)
Spastic paralysis → rigidity
Clostridium Obligate anaerobe Risus sardonicus (lockjaw) + Opisthotonos
Gram+ rod Toxoid vaccine
tetani Spore-forming (rusty nails, soil) (arched back)
Renshaw cells: GABA/glyc trapped
Flaccid descending paralysis (PNS only)
Obligate anaerobe
Clostridium ACh motor neuron inhib (SNARE cleave)
Gram+ rod Spore-forming w/ heat-stable toxin
botulinum Ptosis + diplopia
Transmitted via improper canning
Floppy Baby Syndrome (honey spores)
Obligate anaerobe
Clostridium Spore-forming (hospital) Nosocomial, watery diarrhea (clindamycin, ExoA) Oral vancomycin (gets to gut)
Gram+ rod
difficile Exotoxin A: brush border enzymes Pseudomembrane (ExoB) Metronidazole
Exotoxin B: actin depolymerization
Obligate anaerobe Gas gangrene (lecithinase ⍺-toxin) aka clostridial
Clostridium
Gram+ rod Spore-forming (dirt, soil) myonecrosis IV penicillin G
perfringens
Double zone hemolysis on blood agar Food poisoning (late-onset diarrhea)
Non-spore forming
Pseudomembranes (via inhib EF-2) TDAP vaccine (toxoid; IgG)
Club shaped Metachromatic granules
Resp droplet transmission
Corynebacterium Gram+ rod, V/Y formation
Airway obst, lymphadenopathy (Bull’s neck) Passive immunization for
diphtheriae Stain w/ aniline Exotoxin A/B (active/binding domains)
Myocarditis, arrythmia, heart block unvaccinated person
dyes Tellurite agar + Loeffler’s medium
Nerve deficits: oropharynx → spread (antitoxin administration)
Elek’s test
Cat+
B-hemolytic w/ narrow zone hemolysis Food contamination (even refrigerated) →
Facultative intracellular anaerobe unpasteurized milk, soft cheeses, meats Ampicillin
Listeria
Gram+ rod Tumbles at RT (extracellular) Pregnant women ↑ risk (add to vancomycin +
monocytogenes
Survive/multiply at near-freezing temps Meningitis: newborns, adults >60 ceftriaxone empirical Tx)
Motile (flagella/actin rockets Pregnancy termination
intracellular)
Obligate anaerobe
Actinomyces Gram+ filamentous Cervicofacial actinomyces infx → abscess + sinus Penicillin G
Oral cavity flora (assoc w/ jaw trauma +
israelii branching rod tract formation → pus w/ sulfur granules Surgical drainage
dental work)
Gram+ filamentous Obligate aerobe Immunocompromised pts ↑risk
branching rod; Found in soil Men > women
Nocardia spp. Sulfonamides
Weakly acid-fast w/ Non-spore-forming Cavitary lung lesions → brain abscesses
carbolfuchsin stain Cat+ Urease+ Cutaneous nocardiosis → indurated lesions
Bacteria Basic shape/stain Other/Unique Characteristics Complications Diagnosis + Treatment
Polysaccharide capsule Pts w/ C5-C9 deficiency↑risk (no MAC)
Type B strain causes infx
Resp droplet transmission → college dorm
Lipo-oligosaccharide proteins (LOS) Vaccine (capsule A, C, D)
Neisseria Oxidase+ Pts w/ sickle cell↑risk 3rd-gen cephalosporin w/ BBB
meningitidis
Gram- diplococcus
Chocolate agar (VPN/Thayer Martin) Nasopharynx infx → inflamm response (LOS) penetration: Ceftriaxone
Pilli w/ antigenic variation Hypovolemia + shock Close-contact PPx: Rifampin
IgA protease (virulence factor) Petechial rash → purpura, ecchymoses → DIC
Ferments maltose + glucose Waterhouse-Friderichsen syndrome
Facultative intracellular (PMNs) Pts w/ C5-C9 deficiency at higher risk (no MAC)
Does not have a capsule STI → purulent discharge
Ceftriaxone
Oxidase+ ♂︎: urethritis + prostatitis/orchitis
Neisseria
Gram- diplococcus Chocolate agar (VPN/Thayer Martin) ♀︎: PID (→infert, ectop preg)
gonorrhea Give macrolide or doxycycline
Pilli w/ antigenic variation Fitz-Hugh-Curtis Syndrome (violin-string adhes) to cover chlamydia as well
IgA protease (virulence factor) Polyarthritis
Ferments only glucose Neonatal conjunctivitis (immediate)
Harbored in gall bladder
Motile
Typhoid fever
Acid-labile Fluoroquinolone
Salmonella typhi Gram- rod MCC osteomyelitis in pts w/ SCD
Encapsulated Live-attenuated vaccine
Constipation or diarrhea (“pea soup”)
H2S+ → black colonies Hektoen agar
Facultative intracellular - M⏀s
Type III secretion system (T3SS)
Motile
Salmonella Acid-labile
Gram- rod Inflammatory diarrhea (Undercooked chicken)
enteritidis Encapsulated
H2S+ → black colonies Hektoen agar
Facultative intracellular - M⏀s
S sonnei MC USA
Green colonies on Hektoen agar
Shigella sonnei Type III secretion system
Bloody diarrhea
+ Immotile
Gram- rod Hemolytic-uremic syndrome (<10yo, not MCC)
Shigella Acid-stable
Schistocytic hemolysis
dysenteriae Facultative intracellular
M-cell invasion + actin use (for motility)
Toxin binds 60S-ribosomal subunit
Thermophilic – 42ºC
Guillain-Barré Syndrome
Campylobacter Poultry reservoir → fecal-oral tmn
Curved Gram- rod Bloody diarrhea
jejuni Oxidase+
Reactive arthritis
Invasive
Motile Duodenal ulcers
Helicobacter Curved (“helical”) PPI + amoxicillin + macrolide
Urease+ (urea breath test) ↑risk gastric adenocarcinoma
pylori Gram- rod (clarithromycin)
Oxidase+ MALToma
Bacteria Basic shape/stain Other/Unique Characteristics Complications Diagnosis + Treatment
Commonly affects toddlers
Gram- rod w/ Encapsulated
Yersinia Mimics appendicitis (“pseudo-appendicitis”)
bipolar (“safety- Resistant to cold temperatures Aminoglycosides
enterocolitica Bloody diarrhea, fever, leukocytosis, abscesses
pin”) stain Puppy feces + contaminated milk
Rare: intestinal perforation, intussusception
YOPs (Yersinia outer proteins)
Streptomycin (aminoglycoside)
Type III secretion system Bubonic plague → buboes, DIC, cutaneous
Yersinia pestis Gram- rod + tetracycline
Rodent + prairie dog reservoirs hemorrhage, necrosis
Killed vaccine (not common)
Flea vector
Motile
Enterobacter Multidrug-resistant (MDR)
Gram- rod Nosocomial pneumonia + UTI Carbapenem
cloacae Ferments lactose → pink colonies on
MacConkey
Motile
Multidrug resistance
Serratia
Gram- rod Produces red pigment (shower drain) Nosocomial pneumonia + UTI Carbapenem
marcescens
Ferments lactose → pink colonies on
MacConkey agar
Immotile
Polysaccharide capsule
“Currant-jelly” sputum Nosocomial pneumonia + UTI
Klebsiella
Gram- rod Urease+ AAA: Alcohol use, Abscesses, Aspiration Carbapenem
pneumoniae
MDR Cavitary lesions on CXR
Ferments lactose → pink colonies on
MacConkey agar
Cat+
Fimbriae
Facultative anaerobe MCC UTI
Escherichia coli Gram- rod Encapsulated (K antigen) MCC Gram- sepsis (LPS endotoxin)
Metallic green on EMB agar Neonatal meningitis (only w/ K antigen)
Ferments lactose → pink colonies on
MacConkey agar
**All E. coli characteristics PLUS:
Undercooked meat
Enterohemorrhagic Bloody diarrhea
E. coli (EHEC)** Gram- rod Does not ferment sorbitol
HUS
Shiga-like toxin (60S ribosomal SU)
O157:H7 serotype → outbreaks
**All E. coli characteristics PLUS:
Enterotoxigenic Transmitted via water
Gram- rod Heat-Labile toxin (↑cAMP) “Montezuma’s revenge” → watery diarrhea
E. coli (ETEC)**
Heat-Stabile toxin (↑cGMP)
Bacteria Basic shape/stain Other/Unique Characteristics Complications Diagnosis + Treatment
Fimbriae
Oxidase+
Comma-shaped Acid-labile Profuse, watery diarrhea (“rice-water” stool)
Vibrio cholerae Cholera toxin (↑Gs → ↑AC → ↑cAMP) Oral rehydration
Gram- rod Endemic to developing countries (ex: SE Asia)
Fecal-oral tmn via water or↓sanitation
Grows on alkaline media
Vibrio
parahaemolyticus Gram- rods Can contaminate seafood (esp. oysters)
+ vulnificus
Hot-tub folliculitis
Cat+ Oxidase+
Chronic granulomatous disease pts↑risk
Encapsulated Piperacillin + tazobactam
Blue-green pigment when plated MCC Gram- nosocomial pneumonia
Pseudomonas (pyocyanin + pyoverdine) In CF pts: CC pulmonary infx, MCC resp failure Aminoglycosides (use in
Gram- rod Osteomyelitis w/ IVDU, diabetes
aeruginosa Fruity grape-like odor combo with B-lactam)
Obligate aerobe Feared complication of burn injuries – often fatal
Nosocomial UTI (indwelling catheter)
Thrives in aquatic environments Fluoroquinolones (UTIs)
Ecthyma gangrenosum
Exotoxin A (ribosylates EF-2)
Otitis externa (swimmer’s ear)
Urease+ Staghorn calculi
Proteus Facultative anaerobe Struvite stones (in alkaline environments)
Gram- rod Sulfonamides
mirabilis Swarming motility when plated Recurrent kidney stones
Fishy odor UTI
Ceftriaxone (or B-lactam)
Rifampin (meningitis cPPx)
Pleomorphic Aerosol tmn → pneumonia, epiglottitis, otitis med
Haemophilus Gram- coccobacillus Vaccine against Type B
Grows on chocolate agar w/ Meningitis (Type B capsular form)
influenzae (btw coccus + rod) capsular antigen (conjugated
factor 5 (NAD) + factor 10 (hematin) Sepsis/septic arth (asplenic pts, SCD)
to diphtheria toxoid)
Vaccinate btw 2-18mos.
Weakly Gram- Oxidase+ Pontiac fever (self-limited) Rapid urine antigen test (Dx)
Legionella
pneumophila
coccobacillus Agar: buffered, charcoal yeast extract Legionnaire’s disease** (smoker, pneumonia) Macrolides
(use silver stain) w/ cysteine + iron **Hyponatremia + diarrhea, neuro Sx, fever Fluoroquinolones
Peptidoglycan wall (encapsulated)
Filamentous hemagglutinin pili Resp droplet tmn → highly contagious Macrolides + droplet protection
Bordetella Lymphocytosis Acellular Pertussis vaccine
Gram- coccobacillus Pertussis toxin (ribosylate Gi → ↑cAMP)
pertussis
Adenylate cyclase toxin (↑cAMP) Whooping cough** (“hundred-day” cough) (USA, TDAP)
**Stages: catarrhal → paroxysmal (whoop) → convalescent Killed vaccine (N/A in USA)
Tracheal toxin (pep wall)
Gram- but requires
Bartonella Cat-scratch fever in immunocompetent Azithro/macrolide for either
Warthin-Starry stain Facultative intracellular
henselae Bacillary angiomatosis in immunocompromised Doxycycline for BA
(silver stain)
Facultative intracellular 1º Sx: fever (+/-undulant), chills, anorexia
↑risk direct contact w/ animals Tetracycline (doxy)
Brucella Gram- coccobacillus Hepatosplenomegaly + Lymphadenomegaly
Rifampin (adjunctive)
↑risk ingestion unpasteurized dairy Osteomyelitis
Bacteria Basic shape/stain Other/Unique Characteristics Complications Diagnosis + Treatment
Facultative intracellular Tularemia
Francisella Rabbit reservoir Contact spread or tick vector (Dermacentor)
Gram- coccobacillus Streptomycin (aminoglycoside)
tularensis Nonmotile + Non-spore-forming Ulceration → granuloma w/ caseating necrosis
Can be aerosolized → bioterrorism Regional lymphadenopathy
Cat+ Oxidase+
Gram- coccobacillus Penicillin + B-lactamase
Pasteurella Capsule = virulence factor Cellulitis/Osteomyelitis after dog/cat bite
w/ bipolar (“safety- inhibitor
multocida Resp tract dog/cat reservoir Necrotizing fasciitis (rare)
pin”) stain Ex: amoxicillin + clavulanic acid
Grows on 5% sheep blood agar
Resp droplet tmn → resides in M⏀s
Walled-off granuloma (↑cord factor →↑M⏀ act) “RIPE”
1º infx can lead to: - Rifampin
- Healed latent infx → latent w/ fibrosis - Isoniazid
Obligate aerobe - Systemic infx (military TB) → deadly - Pyrazinamide
Mycobacterium Acid-fast w/ Lowenstein-Jensen agar - Reactivation TB → immunosuppression (↓TNF⍺) - Ethambutol
tuberculosis carbolfuchsin stain Cord factor VF → serpentine shape Ghon complex (after 1º TB)
Sulfatide VF → inhib phagolysosomes Hilar lymphadenopathy PPx for latent TB:
Tubercule: granuloma w/ cent caseating necro (9-mo. Tx)
Cachexia d/t TNF⍺ - Rifampin
Pott’s disease (vertebral) - Isoniazid
Tuberculoma (cavitary lesion) in CNS
Leprosy (aka Hansen’s Disease)
- Tuberculoid presn (Th1, M⏀s); contained Tuberculoid: dapsone +
- Lepromatous presn (Th2, humoral); classic: rifampin 6mo.
Mycobacterium Acid-fast w/ Thrives in cool temps (distal extrems)
- Human-human tmn (exact mode unknown)
leprae carbolfuchsin stain Armadillo reservoir (USA)
- Symmetric stocking-glove neuropathy (lepro) Lepromatous: dapsone +
- Poorly demarc’d raised lesions on extensor sfs rifampin + clofazimine 2-5yrs
- Facial deformity (“leonine facies”)
Weakly Gram- Northeastern USA (NH, CT)
Tickborne (Ixodes scapularis) Lyme disease → 3 stages
Borrelia spirochete; use 1. Bulls-eye rash + flu-like Sx Doxycycline early (ASAP!)
- White-footed mouse = tick reservoir
burgdorferi Wright-Giemsa or 2. Heart block + bilateral Bell’s palsy (facial nerves) Ceftriaxone (severe/late presn)
- White-tailed deer = obligatory host 3. Migratory polyarthritis (Lg joints) + encephalopathy
safranin stain
Obligate aerobe Leptospirosis → fever + conjunctival suffusion
Leptospira Gram- spirochete
Endemic tropically → Hawaii Weil’s disease (severe Lepto) → renal dysfn
interrogans (?-shaped)
Water contam w/ animal urine (azotemia), liver dysfn + jaundice
STI Syphilis:
1º: painless genital chancre
2º: hand/sole macpap rash & condyloma lata Treat with PENICILLIN*
Visualize w/ darkfield micro
3º: gummas, aortitis (tree-barking, vasa vasorum dmg), (ALL STAGES, AGES)
Treponema VDRL = screening (not specific)
Gram- spirochete posterior SC damage + Argyll-Rob pupil
pallidum FTA-Ab = confirmatory test
Congenital syphilis: *may see Jarisch-Herxheimer
Saber shin + Saddle nose rxn (fever, chills, headache)
Hutchinson Teeth + Mulberry Molars
Deafness
Bacteria Basic shape/stain Other/Unique Characteristics Complications Diagnosis + Treatment
Prodromal headache + fever
Weakly Gram- Tmn via tick bites (Dermacentor) Vasculitis
Rickettsia Doxycycline + other
(“Gram-intermediate”) Obligate intracellular (needs NAD+, CoA) Rash: extremities → trunk (opposite prowa)
ricketsii tetracyclines
coccobacillus Weil-Felix agglut test Rocky mountain spotted fever
Headache, fever, myalgias
Prodromal headache + fever
Tmn via lice feces Vasculitis
Weakly Gram-
Rickettsia Obligate intracellular (needs NAD+, CoA) Rash: trunk → extremities (opposite ricketsii) Doxycycline + other
(“Gram-intermediate”)
prowazekii Weil-Felix agglut test Spares hands, feet, head tetracyclines
coccobacillus
Affects military recruits/POWs Epidemic typhus:
Myalgia, arthralgia, pneumonia, encephalitis, coma
Obligate intracellular NO RASH!!! Self-limiting: no AntiBx needed
Gram- pleomorphic
Coxiella burnetii Spore-forming → survives harsh enviro Q-fever → pneumonia, headache, hepatitis Prevention via pasteurization +
rod (coccobacillus)
Tmn via animal droppings → aerosol Chronic Q fever → endocarditis (rare) acellular vaccine (vets)
No cell walls, Culture on Eaton’s agar Atypical, “walking” pneumonia
Mycoplasma spindle-shaped Cholesterol in cell membrane CAP in young adults (military, resp droplet tmn) Macrolides
pneumonia coccobacillus
(technically Gram-)
Cold agglutination (IgM, ~4ºC): RBC lysis Reticulonodular or patchy infiltrate on CXR
Obligate intracellular (needs ATP) A-C: blindness (MC worldwide) → hand-eye tmn
Tx: macrolides (azithromycin)
Lacks muramic acid in cell wall D-K: STI (MC USA) → watery discharge, PID;
Poorly staining or doxycycline
Life cycle: elementary → reticular Congenital D-K: neonatal conjunctivitis +
Chlamydia coccobacillus “Elementary enters” → infectious
No topical for newborns →
trachomatis (technically Gram-) pneumonia (1-2wk onset)
“Reticular replicates” → binary fission must give oral form
Giemsa stain L1-L3: lymphogranuloma venereum (LGV) Ceftriaxone for gonorrhea
Inclusion bodies found in infxd cells Reactive arthritis: arthritis + uveitis + urethritis coverage
Diagnose via NAAT (“can’t see/pee/climb tree”)
Poorly staining Tetracycline 1st line
Chlamydophila coccobacillus Atypical, “walking” pneumonia Macrolide 2nd line
All Chlamydia features above^
pneumoniae (technically Gram-) MC elderly > young adults (opposite Mycoplasma) Ceftriaxone for gonorrhea
Giemsa stain coverage
Poorly staining Tetracycline 1st line
Chlamydophila coccobacillus All Chlamydia features above^
Pneumonia Macrolide 2nd line
psittaci (technically Gram-) Tmn via bird-droppings (parrots) Ceftriaxone for gonorrhea
Giemsa stain coverage
Gardnerella Fishy odor Bacterial overgrowth disrupts normal flora
Gram-variable rod Metronidazole
vaginalis Dx via +Whiff test +Clue cells Grayish-white discharge pH 4.5+ (~5 - 6.5)
Virus Genetics Other/Unique Characteristics Complications Diagnosis + Treatment
Naked → no envelope
Hep A: hepatosplenomegaly
Fecal-oral tmn*
Picornavirus +ss RNA Enterovirus: MCC aseptic meningitis (young kids)
Long polyprotein → viral proteases → active
Rhinovirus: URI, resp tmn (*not fecal-oral)
Cytoplasmic replication (all +ss RNA)
Anterior horn LMN cell bodies → paralysis
All Picornavirus features above^ plus: None → prevent w/ vaccine
Poliovirus Asymmetric paralysis, myalgias, ↓DTRs
+ss RNA Acid-stable → enters GI tract Salk: killed, parenteral (USA)
(Picornavirus) Respiratory insufficiency → death
Replicate tonsil + Peyer’s patch (2-3wks) Sabin: live attenuated (riskier)
Aseptic meningitis (like all enteroviruses)
“Hand-foot-mouth disease” → rash
All Picornavirus features above^ plus:
Coxsackievirus Aseptic meningitis
+ss RNA Acid-stable → enters GI tract Supportive
(Picornavirus) Dilated cardiomyopathy
Type A + Type B (see “complications”) →
“Devil’s Grip” (aka Bornholm’s Dx/pleurodynia)
All Picornavirus features above^ plus:
May be clinically silent/subclinical
Acid-stable → enters GI tract
Acute viral hepatitis → fever, hepatomegaly, jaundice Inactivated vaccine
Hepatitis A Contaminated water supplies (feces) Adults → jaundice / Children → anicteric
+ss RNA
(Picornavirus) Chlorine, bleach, UV, or boil to purify water
Aversion to smoking in pts who smoke Self-limiting → no chronic state
Contaminated shellfish tmn USA (+dev world)
Sx duration: one month
Travel to endemic areas
Most Picornavirus features above^ but…
Acid-labile (not acid-stable)
Rhinovirus URI (upper respiratory tract infx)
+ss RNA Tmn via fomites + inhalation None
(Picornavirus) 113 serotypes → no vaccine
ICAM-1 attachment → host cell entry
Grows at cooler temps (upper resp tract)
Naked → no envelope
Calicivirus +ss RNA Long polyprotein → viral proteases → active See Norovirus (below)
Cytoplasmic replication (all +ss RNA)
Most common Calicivirus
Norovirus
+ss RNA Crowded quarters: cruise ships, daycares, schools Diarrheal illness → explosive viral gastroenteritis
(Calicivirus)
Consumption of shellfish / buffets
Broad-spectrum antibiotics,
“Not a super high-yield virus.” LOL Common cold
Ribavirin, corticosteroids
Coronavirus +ss RNA Helical capsule SARS, MERS, SARS-Cov-2 (COVID-19)
2020: dexamethasone,
Replicates in cytoplasm Acute bronchitis / pneumonia → ARDS
remdesivir, mRNA vaccine
Dengue fever (“break-bone” fever)
Aedes aegyptei vector
Thrombocytopenia, hemorrhagic fever, renal failure Dengue + West Nile:
Yellow fever supportive Tx, hydration
Enveloped virus
Flavivirus +ss RNA Aedes aegyptei vector
Non-segmented RNA (single segment) Jaundice, backache, bloody diarrhea Yellow fever: L/A vaccine
West Nile virus
Mosquito vector (Culex pipiens)
Encephalitis, myelitis → flaccid paralysis, seizures, coma
Virus Genetics Other/Unique Characteristics Complications Diagnosis + Treatment
Tmn via infxd blood
- Blood transfusions before 1990
Member of Flaviviridae - IVDU, Sex, Breastfeeding, Placenta
Enveloped w/ non-segmented RNA Ribavirin + IFN⍺
Hepatitis C Acute: jaundice, RUQ pain, hepatomegaly, ↑Les
+ss RNA Protease inhibitors
(Flavivirus) Tmn via infxd blood
60-80% chronicity → cirrhosis, hepatocellular carc Sofosbuvir (polymerase inhib)
No 3→5 exonuclease →↑antigenic var.
Abs become ineffective → viral RNA persists
Cryoglobulins → IgM precipitation in cold
Togavirus +ss RNA Cytoplasmic replication (all +ss RNA) See Arbovirus and Rubella below See Arbovirus and Rubella
Arbovirus Type of Togavirus Equine Encephalitis: Western, Eastern, or None → use netting, protective
+ss RNA
(Togavirus) Arthropod vector (mosquitoes) Venezuelan subtypes clothing, sprays
Congenital rubella (TORCHeS)
Main triad: cataracts, sensorineural deaf, PDA
Type of Togavirus Other Sx: jaundice, Blueberry Muffin rash
AKA “German measles” Lower yield Sx: mental rtd, microcephaly, pulm stenosis, bone lesions MMR vaccine → live,
Rubella Enveloped Childhood exanthem (rash) attenuated
+ss RNA
(Togavirus) Long polyprotein → viral proteases → active Postauricular + occipital lymphadenopathy Do not give during pregnancy or for
Anti-vaxxers or immigrants from countries w/o Maculopapular rash spreads face → downward immunocompromised pts
immunizations at ↑risk Rash moves quickly + does not darken
Resp droplet spread
Adult rubella
Enveloped retrovirus
Diploid RNA → two identical RNA strands Tmn via sexual contact, vertical, or blood Screening: ELISA
Genes → products TORCHeS Confirmation: Western blot (Dx)
Human - gag → p24 capsule Initially infx macrophages/CD4+ Helper Ts Tx: HAART
+ss RNA
immunodeficiency - env → gp41 (transmembrane protein) Prodrome: flu/mono-like, cervical lymphadeno NRTIs: zidovudine (preg-safe)
virus (HIV) → DNA int. - env → gp120 (outer glycoprotein) CD4+ < 200 or AIDS-def-illness = AIDS NNRTIs: efavirenz
- pol → reverse transcriptase Diffuse large B-cell lymphoma (DLBCL) Protease inhib: lopinavir/ritonavir
CCR5 = early-stage cell entry Genotype testing prior to therapy CCR5 inhib: maraviroc
CXCR4 = late-stage cell entry
ONLY RNA virus to replicate in nucleus
Enveloped
Orthomyxovirus -ss RNA See Influenza virus below See Influenza virus below
Segmented (BOAR)
Antigenic variations (antigenic drift, shift)
Note: All -RNA viruses bring own polymerase
Orthomyxovirus family (nucleus replication)
A → epidemics, pandemics (drift + shift) Oseltamivir (Tamiflu): inhib NA
Strains A, B, and C
B → endemic outbreaks (just drift) Influenza vaccines → L/A nasal,
Tmn via resp droplet
Pneumonia = major complication killed injectable: trivalent (2A, 1B) or
Influenza virus -ss RNA Hemagglutinin (H1/2/3, etc.) → RBC clumping S. aureus superinfx
- HA binds sialic acid residues on cells quadrivalent (2A, 2B)
Reye’s syndrome if aspirin given to children Amantadine/rimantadine → no M2
M2 protein → creates pH for viral uncoating uncoating (no longer used)
Guillain-Barre syndrome
Neuraminidase (NA) → releases virions
Virus Genetics Other/Unique Characteristics Complications Diagnosis + Treatment
Enveloped
Paramyxovirus -ss RNA See Measles, Mumps, RSV, Parainfluenza below MMR: L/A vaccine (C/I preg)
Tmn via resp droplet
4 “C’s” = cough, coryza, conjunctivitis, Koplik spots
Paramyxovirus family Maculopapular rash: spreads face → downward MMR: L/A vaccine (C/I preg)
Measles virus -ss RNA HA+ NA- FP+ Pneumonia Vit A reduces mortality/morbidity
Fusion protein (FP) forms multinuc giant cells (syncytia)
SSPE (subacute sclerosing pan-encephalitis)
Paramyxovirus family Parotitis
Mumps virus -ss RNA Replicates in parotid glands Orchitis (unilateral) MMR: L/A vaccine (C/I preg)
HA+ NA+ FP+ Meningitis
Respiratory Paramyxovirus family
Infx infants < 6mo. Ribavirin (adults; C/I preg, kids)
Syncytial Virus -ss RNA Attaches to G-prot to infx resp epithelium
(RSV) MCC pneumonia, bronchiolitis in infants Palivizumab (high risk kids/bbz)
HA- NA- FP+
Croup → “seal-bark” cough, inspiratory stridor
Parainfluenza Paramyxovirus family - croup AKA “laryngotracheobronchitis”
-ss RNA X-ray “steeple sign” → narrow subglottic region
virus HA+ NA+ FP+
Severe cold in adults
Rabies → bats (MC), dogs, squirrels, skunks, foxes, raccoons Passive immunization after
Enveloped w/ Helical capsid Binds N-ACh post-synp motor endplate @ NMJ
“Bullet-shaped” capsule exposure + killed vaccine
Rhabdovirus -ss RNA - Tingling, muscle spasms, salivation, dysphagia, spasms in
Replicated in motor neurons throat, fever, encephalitis
(active immunization)
Negri bodies → eosino cytoplasmic inclusions Give even if unsure of bite/no bite
Retrograde from periphery → DRG Post-exp PPx not effective
- Found in hippocamp pyramidal + Purkinje cells
Enveloped Ebola + Marburg viruses = members of Filo family
Helical capsid Hemorrhagic fever + petechiae + shock
Filovirus -ss RNA Supportive
Tmn via direct animal contact (monkeys, bats) Progresses to end-organ failure + death
Tmn to healthcare workers via bodily fluids Highly contagious, rapid spread
Enveloped → obtained from Golgi body See Hantavirus below
Bunyavirus -ss RNA Segmented (BOAR) → 3 circular segments Rift Valley Fever + California Encephalitis
Arboviruses (arthropod-borne) - Seizures, encephalitis, fever, myalgia
Bunyavirus family Pulmonary edema (via capillary leak)
Hantavirus -ss RNA Tmn via contact w/ deer mice urine/feces Prerenal azotemia
Robovirus (rodent-borne) Hemorrhagic fever
Enveloped w/ helical capsid
“Ambisense” → can be pos or neg
LCV → lymphocytic choriomeningitis virus Inactivate virus by heating, low
Arenavirus -/+ss RNA Segmented (BOAR) → 2 segments
- Febrile, aseptic meningoencephalitis pH, irradiation, detergents
“Sandy” AKA granular outer capsid on EM
Rodent tmn to humans
Double-stranded RNA (no pos/neg sense)
See Rotavirus below
Reovirus ds RNA Non-enveloped (naked) Supportive
Colorado tick virus → fever, vomiting, myalgia, no rash
Segmented (BOAR) → btw 9-12, 11 on avg.
Reovirus family Toxin-mediated, explosive, secretory diarrhea Supportive + oral rehydration
Rotavirus ds RNA Tmn via fecal-oral route NSP4 toxin → ↑Cl- permeability Oral L/A vaccine → first dose
Outbreaks most often in wintertime Children at high risk (MCC severe diarrhea) < 3mo, can↑risk intussusception
Virus Genetics Other/Unique Characteristics Complications Diagnosis + Treatment
“Slapped-cheek rash” → fever breaking to rash
Naked - Also called “Fifth’s disease” or “erythema infectiosum”
Smallest DNA virus (in this table, at least) Lacy rash: face → body progression
Parvovirus B19 ss DNA Adults: joint pain, arthritis, edema
Tmn via resp droplets
TORCHeS (in the “Other” category) Aplastic anemia (in pts w/ sickle cell Dx)
Neonatal: hydrops fetalis (trimesters 1-2)
Typically infx upper half of body
Gingivostomatitis (1st) → cold sores (herpes labialis)
Herpesvirus family Keratoconjunctivitis → serpiginous corneal ulcers PCR for Dx
Temporal lobe encephalitis
Enveloped Scrape ulcer + Tzank smear
Herpes simplex Linear - MCC sporadic encephalitis in USA
Replicates in nucleus (old Dx test)
virus 1 (HSV-1) ds DNA Latent in trigeminal ganglia
Intranuclear Cowdry bodies Acyclovir + valacyclovir to
Rash = “dew-drop on rose petal” (vesicular)
Tmn via sex, saliva, vertical (TORCHeS) prevent breakouts
Herpetic whitlow on finger → common in dentists
Erythema multiforme (HSV-1 > HSV-2)
Multinucleated giant cells
Herpes genitalis → painful, “vesicular”
Herpesvirus family - Inguinal lymphadenopathy PCR for Dx
Enveloped Latent in sacral ganglia Scrape ulcer + Tzank smear
Herpes simplex linear
Replicates in nucleus Aseptic meningitis → adolescents + adults (old Dx test)
virus 2 (HSV-2) ds DNA
Intranuclear Cowdry bodies Herpetic whitlow on finger → common in dentists Acyclovir + valacyclovir to
Tmn via sex, saliva, vertical (TORCHeS) - Or via HSV-2 genital → hand tmn prevent breakouts
Multinucleated giant cells
Infectious mononucleosis (mono) → “the kissing Dx”
Tender lymphadenopathy → posterior cervical, general Blood smear → Downey/atypical
Herpesvirus family Reactive cytotoxic CD8+ T → proliferation cells seen
Enveloped Splenomegaly Amoxicillin/ampicillin may
Epstein-Barr Targets B-lymphos in new host → latency Pharyngitis + tonsillar exudates cause adverse reaction
ds DNA
Virus (EBV) Envelope glycoprotein → binds B-cell CD21 Risk factor for 3 cancers: Monospot for rapid Dx
Agglutinates sheep/horse RBCs → - B-cell lymphoma (Hodg/Non-Hodg) Supportive Tx
monospot test (IgM) - Burkitt lymphoma (t8:14)
Avoid contact sports
- Nasopharyngeal carcinoma
Assoc w/ oral hairy leukoplakia (if HIV+)
MCC ↓intellect, SNHL from congenital viral infx
Congenital:
Herpesvirus family Blueberry muffin rash
Enveloped Hepatosplenomegaly + jaundice 1st-line: Ganciclovir
Cytomegalovirus Latent in mononuclear WBCs (lymphos, monos, M⏀s) Sensorineural hearing loss
ds DNA 2nd-line: Foscarnet
(CMV) Tmn via blood, sex, saliva, breast milk, urine Intracranial calcifications → seizures, ↓ intellect
Monospot test negative (Dx)
80-90% asymptomatic Ventriculomegaly + Hydrops fetalis
Owl’s eye inclusion bodies Reactivation upon immunosuppression:
Transplant pts → ↑ risk CMV pneumonia
AIDS w/ CD4<50 → ↑ risk CMV → retinitis, esophagitis, colitis
Virus Genetics Other/Unique Characteristics Complications Diagnosis + Treatment
Chickenpox → childhood exanthem
Rash = “dew-drop on rose petal” (vesicular) Chickenpox:
Herpesvirus family Pneumonia + enceph in adults or children - L/A chickenpox vaccine
Enveloped Stress → reactivation (Shingles) - Acyclovir for >12yo, adults,↓
Varicella zoster immuno pts
ds DNA Tmn via resp droplet Immunocompromised → diffuse Shingles (across mid)
virus (VZV)
Latency in DRG Postherpetic neuralgia Shingles:
Tzank smear (old Dx test) Herpes zoster ophthalmicus (Trigeminal V1) - L/A zoster vaccine (CD4 > 200)
TORCHeS → congenital varicella syndrome - Famciclovir or valacyclovir
- Limb hypoplasia, cutaneous scars, blindness
Roseola → “Sixth disease” (“Ro-six-ola”) Self-limiting
Human Herpes Herpesvirus family - Kids 6mo-2yrs: fever + macular rash (no face)
ds DNA - Fever = 4 days + febrile seizures
No FDA-approved meds
Virus 6 (HHV-6) Enveloped
CD4 cells infected → immunosuppression Supportive: cooling + fluids
Kaposi’s sarcoma → AIDS-def illness
Herpesvirus family
Enveloped Violaceous lesions (nose, mucus membs, extrems)
Human Herpes VEG-F dysreg → vessel proliferation ART for HIV+ pts → lesions
ds DNA ↑risk elderly Russian men, African people
Virus 8 (HHV-8) GI lesions (intra-intestinal; hard palate = MC lesion) should shrink
DDx: Kaposi can look similar to bacillary
Primary Effusion Lymphoma (B-cell)
angiomatosis (caused by B. henselae)
Tmn via sex, saliva
circular Naked PML (progressive multifocal leukoencephalopathy)
Polyomavirus JC - JC present in many ppl → reactivated if CD4 <200
ds DNA Often fatal - Non-enhancing multifocal lesions
circular Nephropathy, hemorrhagic cystitis
Polyomavirus BK Naked
ds DNA - MC in transplant pts (kidney, bone marrow)
1-4: verruca vulgaris (common wart)
Naked
Papillomavirus MC STI
6, 11: laryngeal papillomatosis - tmn: vertical; HPV vaccine → 6, 11, 16, 18
condyloma acuminata - tmn: sex Condoms, abstinence prevent spread
(HPV 1-4, 6, 11, ds DNA E6 → p53 breakdown
16, 18, 31, 33: cervical, vulvar, vaginal, penile Pap smear → detection (Dx)
16, 18, 31, 33) E7 → Rb breakdown - Koilocytes at tfmn zone
squam cell carc - tmn: sex
↑ risk if immunosuppressed
Post-coital bleed = cervical cancer
MCC adenoiditis, tonsilitis
Naked Affects children, military recruits, public pools
Adenovirus ds DNA L/A vaccine for military recruits
Tmn via resp droplets, fecal-oral Hemorrhagic cystitis
Viral conjunctivitis (pink eye)
Largest
Intracytoplasmic inclusion (“Guarnieri”) bodies in
Poxvirus known
Enveloped → make own envelopes infected cells → diagnostic of infx
ds DNA
Replicates in cytoplasm
Smallpox ds DNA Variola → raised blisters/lesions (lesions are same “age”) No vaccine – eradicated
- Has own DNA-dependent RNA polymerase
Cowpox ds DNA Dumbbell-shaped core Tmn via contact w/ infected cow utters
Molluscum Flesh-colored, dome-shaped, umbilicated lesions
ds DNA
contagiosum virus - Diffuse in children + ↓ immuno adult (no palm/sole)
Virus Genetics Other/Unique Characteristics Complications Diagnosis + Treatment
TORCHeS
Chronicity: Newborns have 90-95%; adults 5-10%
Glomerulonephritis
Hepadnavirus family MGN, MPGN
Enveloped ↓GFR, HTN Lamivudine + other NRTIs
Intranuclear + cytoplasmic replication Polyarteritis nodosa + arthralgias IFN⍺
circular,
Partially ds → ss RNA → ds DNA ALT > AST in adult viral hep, <<ALT in neonates
Hepatitis B partially ds
- (uses reverse transcriptase) Antigens + Antibodies in order of time: Give newborn IgG + Hep B
DNA
Sex, drug use, vertical tmn (via blood) 1. HbsAg → active infx – infectious, Sx-atic vaccination for neonatal
Immunized pts ONLY HAVE Anti-HBs 2. HBeAg → infectivity correlate – infectious, Sx-atic hepatitis
Recovered pts have Anti-HBs +/- Anti-HBe/c 3. Anti-HBc (core) → + in HBs window period
4. Anti-HBe
5. Anti-HBs (surface) → recovery
Hepatocellular carcinoma RF
Enveloped Coinfection: both viruses tmn at same time
circular
Hepatitis D Circular genome Superinfection: Hep D tmn atop Hep B infection
-ss RNA
Requires HBsAg to be infectious - Superinfection has worse outcomes than coinfection

↓↓↓ Continue for information on fungi + parasites ↓↓↓

Fungi Basic class Other/Unique Characteristics Complications Diagnosis + Treatment
“Mold in cold, yeast in heat” Macrophages w/ intracellular oval bodies
Serum rapid antigen test
Tmn: resp droplets Mostly asymptomatic infx
Dimorphic Urine rapid antigen test
Histoplasma Geo: Midwest, MS/OH river valleys Granuloma + pneumonia → calcification
systemic Local Tx: Fluconazole,
capsulatum Bird/bat droppings Chronic → cavitary lesions, nodules w/ fibrotic scars
mycosis ketoconazole
Caves, spelunking, chicken coops Erythema nodosum
Systemic Tx: amphotericin B
Much smaller than RBC Hepatosplenomegaly w/ calcifications
“Mold in cold (soil), yeast in heat (body)”
Tmn: via aerosolized spores Patchy alveolar infiltrate (“haziness”) on CXR KOH prep/culture for Dx
Dimorphic
Blastomycosis Geo: Great Lakes/OH river Cavitary lesions on CXR Urine antigen test for Dx
systemic
dermatitidis valley/Southern USA Local Tx: itraconazole
mycosis If↓immuno → Skin ulcerations, osteomyelitis
Replicates via broad-based budding Systemic Tx: amphotericin B
~Same size as RBC
“Mold in cold, [spherules w/
San Joaquin fever
endospores] in heat” KOH prep/culture for Dx
Dimorphic Cough, fever, arthralgia (may mimic pneumonia)
Coccidioides Spherules larger than RBCs Serology for Ab titers (IgM) - Dx
systemic May show cavities/nodules on imaging
immitis Tmn: dust spores Local Tx: conazoles
mycosis Erythema nodosum → shins, healthy pts
Geo: SW USA, San Joaquin river valley Systemic Tx: amphotericin B
If↓immuno → osteomyelitis, meningitis
Earthquake → ↑risk infx spread
“Mold in cold, yeast in heat”
Cervical, axillary, inguinal lymphadenopathy
Dimorphic Yeast has “captain’s wheel” shape
Paracoccidioides Granulomas in lungs Local Tx: itraconazole
systemic Yeast = very large (>>RBC size)
brasiliensis Mucocutaneous lesions/ulcers → ragged borders, Systemic Tx: amphotericin B
mycosis Geo: South America
hemorrhage in mouth
Tmn: resp droplets
Causes pityriasis versicolor
- hypo/hyper-pigmented patches, no pruritis
KOH prep skin scrapings (Dx)
Cutaneous “Spaghetti + meatball” appearance (KOH) - melanocyte damage via lipid degradation
Malassezia furfur - affects stratum corneum
Topical selenium sulfide
mycosis Thrives in heat/humidity
Malassezia fungemia in neonates w/ TPN (↓immuno) (“Selsun Blue”)
- sepsis, thrombocytopenia via lipid infusion
“Mold in cold, yeast in heat”
“Rose Gardener’s disease”
Dimorphic Branching hyphae at 25ºC Culture/biopsy for Dx
Sporothrix Local pustules/ulcers at trauma site
cutaneous Cigar-shaped yeast Tx: itraconazole
schenckii Ascending nodules (track up draining lymphatics)
mycosis Found on thorns, tree bark, bushes Old Tx: potassium iodide (90s)
Granulomas: histocytes, multinuc giant cells, cigar yeast
Tmn via physical trauma
Causes tinea (ringworm) → pruritic lesions
- Tinea capitis → head
KOH prep (Dx)
Trichophyton, Epidermophyton, Microsporum
Wood’s lamp (for Microsporum Dx)
Dermatophytes Cutaneous Live on skin - Tinea corporis → body
Topical azoles (clotrimazole)
(Greek: “skin plants”) mycosis Tmn via pets → younger kids esp. - Tinea cruris → groin (“jock itch”)
Terbinafine for onychomycosis
Hyphae on KOH prep skin scrapings - Tinea pedis → foot (athlete’s foot) Oral griseofulvin for severe infx
Onychomycosis → nail infx
Fungi Basic class Other/Unique Characteristics Complications Diagnosis + Treatment
↑ risk infx in pts w/ chronic granulomatous Dx
Diaper rash in babies KOH prep – oral scrapings (Dx)
Dimorphic OPPOSITE “Mold in cold, yeast in heat”
cutaneous + - Cold (20ºC): pseudo-hyphae
Oral candidiasis (↓immuno, oral steroid use) Local Tx: conazoles
- can be scraped off, unlike leukoplakia
Candida albicans systemic - Heat (37ºC) → cell + germ tube (hyphae) Systemic/resistant Tx:
Cat+ Esophagitis (AIDS-def): white psuedomem, CD4 <100
opportunistic amphotericin B, capsofungin
Present in ~40% pts normal flora Vaginal candidiasis (happens at normal pH <4)
mycosis - predisposed by Rx antibiotics, birth control, diabetes
Oral/esophageal: nystatin
Endocarditis (IVDU) → tricuspid valve
Acute bronchopulmonary aspergillosis (ABPA)
Always mold form - T1 HSR → fever, wheezing, migratory pulm infiltrate
Cat+ Aspergillomas → fungus “ball” in lung Mild/moderate infx: conazoles
Aspergillus Monomorphic Hyphae w/ acute angle branching, septae - Assoc w/ TB; gravity-dependent deposits (specifically voriconazole)
fumigatus systemic (acute angle = diff from mucor) Angioinvasive aspergillosis → ↓immuno pts Angioinvasive/severe infx:
opportunistic Tmn: inhalation via conidiophores w/ - Quick dissem; leukemia/lymphoma pts Amphotericin B
mycosis fruiting bodies - Kidney failure, endocarditis, ring-enhancing brain lesions Surgical debridement
- Paranasal necrosis
Aspergillus
Aflatoxins Hepatocellular carc (aflatoxins are ↑↑↑carcinogenic)
flavus
Bronchopulm washings (Dx)
- Mucicarmine stain
Heavily encapsulated yeast Primary focus lungs → disseminates elsewhere - Methenamine silver stain
Encapsulated Repeating polysaccharide antigen (VF) Assoc w/ HIV (+ ↓immuno pts) LP + India ink stain (Dx)
Cryptococcus - Yeast w/ capsular halos
opportunistic Found in pigeon droppings Pneumonia, cough, dyspnea
neoformans Latex agglutination test (Dx)
mycosis Tmn via inhalation MCC fungal meningitis → often permanent deficits, death
- “soap-bubble” lesions in gray matter on imaging - Detects polysacch antigen
Urease+
Tx in two stages:
1. Amphotericin B + flucytosine
2. Fluconazole maintenance
Assoc with leukemia/neutropenia (↓immuno)
Non-septate, 90º branching hyphae ↑↑risk w/ diabetes → DKA = MC predisposing factor
Mucormycosis Opportunistic Bread mold Brain infx (via cribriform plate penetration) Surgical debridement
(Mucor/Rhizopus) mycosis Tmn via spore inhalation Rhinocerebral mucormycosis → frontal cortex Amphotericin B
Proliferates in blood vessels abscesses (necrotic) via↑BV proliferation
Nasal cavity/eye necrosis (late-stage, BAD prognosis)
Bronchoalveolar lavage (Dx)
PCP (PneumoCystis Pneumonia) if CD4 < 200 Methenamine silver stain (Dx)
Pneumocystis Opportunistic No Sx in immunocompetent pts
- Nonproductive cough, ground-glass infiltrate CXR Tx + PPx (if CD4<200) same:
jirovecii mycosis Ovoid/disc-shaped yeast
- (sometimes nothing seen on CXR) - Bactrim (TPM/SMX)
- Pentamidine (if sulfa algy)
Parasite Basic class Other/Unique Characteristics Complications Diagnosis + Treatment
Tmn via cysts: travel/camping + drinking “Beaver fever”
Stool O&P - trophozoites (Dx)
Intestinal unfiltered water (fecal-oral tmn) Bloating, flatulence
Giardia lamblia ELISA stool antigen (Dx)
protozoan “Shield” trophozoite shape Foul-smelling diarrhea + steatorrhea (↓fat absp)
Tx: Metronidazole
Troph does not invade intestinal wall Vit A, D, E, K deficiencies (d/t ↓fat absp)
Stool O&P – cysts/trophos (Dx)
Tmn via cysts: contaminated water, anal sex Amoebic liver abscesses – trophozoite stage Trophos w/ endo RBCs (Dx)
Entamoeba Intestinal (fecal/anal-oral tmn) - “Anchovy paste” pus, RUQ pain, hepatomegaly ELISA antigen (stool/serum Dx)
histolytica protozoan Trophozoite stage endocytoses RBCs (Dx) Intestinal amebiasis → flask-shaped ulcers in colon Biopsy specimens (look for lesions)
- Bloody diarrhea (dysentery) Tx: Metronidazole
Paromomycin, Iodoquinol (luminal)
Unicellular, Fecal-oral tmn via oocysts in stool MCC HIV+ severe, unrelenting diarrhea (CD4 < 100) Filtration of oocysts
partially acid- Dirty water swim, camper, animal workers Chronic cryptosporidiosis = AIDS-def Chlorination
Cryptosporidium fast intestinal “Amethyst crystals in water” appearance Sporozoites attach to intestinal wall → cause Tx: Nitazoxanide, spiramycin
protozoa Each oocyst = 4 motile sporozoites damage + diarrhea (macrolide, not FDA approved)
TORCHeS (Toxoplasmosis) Brain biopsy (Dx)
Tmn via: - Chorioretinitis, intracranial calcifications,
Intracellular - Raw/undercooked meat (cysts) hydrocephalus, seizure, sensorineural deafness
Intramuscular cyst biopsy (Dx)
Toxoplasma CNS - Oocytes: CAT/animal feces (water, veggies)
Ring-enhancing lesions on CT/MRI (↓immuno pts) Tx: sulfadiazine, pyrimethamine
gondii protozoan - Transplacental
Encephalitis (↓immuno pts) PPx if CD4<100 + Anti-toxo IgG
Flu-like Sx in healthy pts (mostly asymptomatic) - Give TMP-SMX

Tmn via tsetse fly vector Sleeping sickness Blood smear, lymph, CSF →
Trypanosoma Flagellate - Stage 1: malaise pruritis, arthralgia
Endemic to Gambia, Zimbabwe see trypomastigotes (Dx)
brucei gambiense + CNS - Stage 2: ataxia, day somnolence, night insomnia, coma
Variable surface glycoprots (evade host) Cervical + axillary lymphadenopathy Tx: Melarsoprol (CNS) +
rhodesiense protozoan
Motile → single flagella Recurrent fever (chronic) suramin (peripheral blood)
Assoc w/ fresh water + watersports
Primary amoebic meningoencephalitis → rapidly fatal
CNS Trophozoite → CNS via cribriform plate LP → see amoeba in CSF (Dx)
Naegleria fowleri - Nuchal rigidity, fevers, AMS
amoeba Nasal irrigation systems + contact lens Tx: Amphotericin B
High mortality rate, poor prognosis
solutions may cause exposure
Chagas disease → megacolon, dilated Blood smear (Dx) if active
Trypanosoma Blood Reduviid (“kissing bug”) bite → deposits
cardiomyopathy, megaesophagus Tx (active): Nifurtimox
cruzi protozoan feces → human scratches T. cruz into bite
Burrows into endocardium No known Tx for chronic Chagas
Subclinical/mild in 25-50% pts
Coinfection w/ B burgdorferi common “Thick” blood smear (Dx)
Severe cases: malaria-like Sx, fever, death
Blood Geo: Northeast (esp Rhode Island) “Maltese cross” RBC (Dx)
Babesia Hemolytic anemia
protozoan Tmn via Ixodes (deer tick) Tx (active): Atovaquone,
Hemoglobinuria + Jaundice
↑↑risk w/ SCD (asplenia) azithromycin
Irregularly cyclic fever
Parasite Basic class Other/Unique Characteristics Complications Diagnosis + Treatment
Tmn via Anopheles mosquito
Plasmodium Blood LIFE CYCLE: Sporozoite in mosquito → Blood smear + Giemsa (Dx)
Quartan fever → every 72 hours (days 1, 4, 7, 10…)
malariae protozoan trophozoite in liver → schizont → hepatocyte Tx: primaquine for dormant infx,
rupture → merozoite release → infect RBC Chloroquine (but ↑↑resistance),
Tmn via Anopheles mosquito Mefloquine (also for travel PPx)
Plasmodium Blood
Dormant hypnozoites in hepatocytes Tertian fever → every 48 hours (days 1, 3, 5, 7…) Atovaquone + proguanil (Tx/PPx)
vivax + ovale protozoan
See LIFE CYCLE above (P malariae)
Tmn via Anopheles mosquito
Most severe malarial illness All of the above ↑ PLUS
“Banana-shaped” organisms on peripheral
Plasmodium Blood Irregular fever patterns Artemisinins: artesunate, artemether
blood smear
falciparum protozoan Neurologic Sx → cerebral malaria IV Artesunate + Quinidine for
SCD protective against P falciparum
Kidney, lung vessel occlusion severe and/or resistant spp.
See LIFE CYCLE above (P malariae)
Visceral leishmaniasis aka Black fever/kala azar
Leishmania Blood
Mediterranean, Middle East, Africa Pancytopenia (when bone marrow infx) Amphotericin B
donovani protozoan
Hepatosplenomegaly
Tmn: sandfly vector (carries promastigote)
Leishmania Blood
Vertebrate host (esp humans → amastigote Cutaneous leishmaniasis → disfiguring skin ulcers Stibogluconate
braziliensis protozoan
inside M⏀s)
Wet mount (Dx)
Trichomonas
STI parasite
Motile trophozoites on wet mount Vaginitis, cervicitis (“Strawberry cervix”)
vaginalis Grows in vaginal pH > 4.5 (“elevated”) - Burning, itching, malodorous yellow-green discharge Tx: metronidazole
(treat both partners!)

Enterobius Intestinal “Pinworm” Typically affects children > adults

Scotch tape test (Dx)
Tmn via fecal-oral route (scratch anus) Tx: pyrantel pamoate,
vermicularis nematode Infx over & over again
- Female worms lay eggs in anus at night albendazole
Ancylostoma “Hookworm”
duodenale + Intestinal Eggs in stool (Dx)
Tmn: barefoot walking (larvae) Iron-deficiency anemia (microcytic)
nematode Larvae: feet → blood → lungs → bronchus →
Eosinophilia (Dx)
Necator
swallowed → small intestine (maturation) Tx: pyrantel pamoate,
americanus
albendazole**
“Giant Roundworm” Malnutrition
Ascaris Intestinal Tmn: contaminated food/water (eggs) Respiratory Sx (worms in bronchus) **Beware: albendazole may worsen
lumbricoides nematode Eggs: food → blood → lungs → bronchus → obstruction in A lumbricoides infection
swallowed → small intestine (maturation)
Intestinal obstruction @ ileocecal valve
Tmn: barefoot walking (larvae) Auto-infection: larvae hatch from eggs in intestinal wall, Larvae in stool (Dx) NOT EGGS
Strongyloides Intestinal
Larvae: feet → blood → lungs → bronchus → repenetrate → may cause hyper infection (esp in Eosinophilia (Dx)
stercoralis nematode swallowed → small intestine (maturation) ↓immuno pts) Tx: albendazole, ivermectin
Tmn: undercooked meat (pork, bear)
Trichinella Intestinal Fever, Vomiting, Periorbital edema Eosinophilia (Dx)
Ingestion cysts → larvae → blood → cysts
spiralis nematode Severe myalgias Tx: albendazole
in striated muscle cells
Parasite Basic class Other/Unique Characteristics Complications Diagnosis + Treatment
Dracunculus Tissue Tmn: contaminated water (copepods) Peripheral eosinophilia Coax worm out & twist slowly
Ingest copepods → cpds die → larvae release
medinensis nematode → mature → migrate to skin
Ulcer in skin w/ worm emerging Metronidazole
Tmn: blackfly vector Microfilaria on skin biopsy (Dx)
Onchocerca Tissue Scattered pruritic papules (hypo + hyperpigmented)
Blackfly bite → larvae in skin → adults → Eosinophilia (Dx)
volvulus nematode microfilariae → migrate thru body (note: eye)
River blindness (via microfilariae → eye)
Tx: Ivermectin
Tmn: mosquito (intmd host) Thick blood smear (Dx)
Wuchereria Tissue Elephantiasis, lymphadenopathy
Mosq bite → larvae on skin → penetrate → Eosinophilia (Dx)
bancrofti nematode lymphatics → microfilariae
Microfilariae in lungs → HSR
Tx: Diethylcarbamazine
Tissue Tmn: dog/cat feces contam food Visceral larva migrans (larvae never mature) Eosinophilia (Dx)
Toxocara canis
nematode Ingest larvae → circulate via blood Ocular larva migrans → blindness Tx: Albendazole
Thick blood smear (Dx)
Tmn: deer fly Calabar swellings (local subcutaneous)
Tissue Eosinophilia (Dx)
Loa loa Fly bite → larvae enter → maturation → “African eyeworm” → worm migrates to eye
nematode microfilariae → subcutaneous tissue migration
Tx: Diethylcarbamazine,
Microfilariae in blood
albendazole
Tmn: undercooked meats (cysts) → GI
Taeniasis → asymptomatic, maybe GI malabsp Proglottid in stool O&P (Dx)
Taenia solium + Cestode Tmn: contam water (eggs) → neuro
Neurocysticercosis → seizures, lesions in brain, eyes, skin Tx: Praziquantel +/-
saginata (tapeworm) Solium = pig // Saginata = cattle
- “Swiss cheese” brain on MRI albendazole (neuro)
Solium proglottid heads have hooks
Diphyllobothrium Cestode Tmn: undercooked fish → GI Diarrhea Proglottid in stool O&P (Dx)
latum (tapeworm) Largest tapeworm (up to 10m) B12 deficiency → megaloblastic anemia Tx: Praziquantel, niclosamide
Hydatid cysts in liver, elsewhere
Echinococcus Cestode Tmn: water contam w/ dog feces Eosinophilia (Dx)
“Eggshell calcifications” on CT
granulosis (tapeworm) Sheepdogs (host) + Sheep (intmd host) Tx: surgical cyst removal
Cyst rupture → anaphylaxis, acute abdomen
↑risk Tmn: swimming
Eggs: large, lateral spine Swimmer’s itch (where larvae penetrate skin)
Schistosoma Blood fluke Free-living cercariae → penetrate skin → liver*
Portal HTN
mansoni (trematode) (via blood) → maturation → defecation into
water → snail = intmd host GI hemorrhage + abd pain
*Worms migrate against portal flow Jaundice
Schistosoma Blood fluke Same life cycle/route as above Cirrhosis + liver failure Eggs on stool O&P (Dx)
japonicum (trematode) Eggs: small, smooth spine NOTE: Look for specific shapes
of eggs to Dx
Urogenital/
Schistosoma Eggs: large, terminal spine Hematuria
blood fluke
haematobium Worms migrate against portal flow ↑risk bladder cancer Tx: Praziquantel
(trematode)
Snails intmd host → fish → eat uncooked Biliary tract fibrosis
Clonorchis Liver fluke
→ larvae mature → biliary system Pigmented gallstones
sinensis (trematode)
“Operculated” eggs Cholangiocarcinoma
Snails intmd host → crab → eat uncooked
Paragonimus Lung fluke
→ larvae mature → lung Chronic cough w/ bloody sputum
westermani (trematode)
“Operculated” eggs