Dr. Marrie ..


 


Microscopical Exam. Is Sufficient for Diagnosis of :

Acute gonorrhoea in male patients
Secondary cases of cholera during an epidemic
Leprosy
Vincent angina
Syphilis during the primary stage (chancre)
Relapsing fever during the febrile stage
Bacterial vaginosis
Zoonotic Diseases " primary infect animal & transmited to human occasionally " :
Bacterial :
Viral :
Listeria monocytogenes .. Neonatal Meningitis
Aphthovirus .. foot-and-mouth disease
Bacillus anthracis .. Anthrax
Rabies
Mycobacterium bovis .. Tuberculosis
Yellow Fever Virus .. Jungle Yellow Fever
Yersinia pestis .. Bubonic Plague
Rift Valley Fever
Yersinia enterocolitica .. Yersiniosis
Haemorrhagic Fever Viruses
Brucella abortus & Brucella melitensis & Brucella suis ..
Brucellosis or Malta Fever or Undulant Fever
Borrelia duttoni & Borrelia hermsii ..
Tick-borne (endemic) Form of Relapsing Fever
Borrelia burgdorferi .. Lyme Disease
Leptospira interrogans serovar icterohaemorrhagiae ..
Leptospirosis or Weils Disease (Infectious Jaundice)
Coxiella burnetii .. Q Fever
Rickettsia typhi .. Endemic Typhus
Neonatal Meningitis :
Streptococcus agalactiae
Listeria monocytogenes
Escherichia coli
Klebsiella pneumoniae
Meningitis :
1) Neisseria meningitidis
2) Streptococcus pneumoniae
3) Haemophilus influenzae

The Virulence Factor

is
Capsule

The ONLE
3
Conjugate Vaccine

Bioterrorism Organisms : (( Category A ))

Bacterial :
Viral :
Bacillus anthracis .. Anthrax
Smallpox (Variola or Alastrim) Viruse .. Smallpox
Yersinia pestis .. Plauge
Hemorrhagic Fever Viruses.. Viral hemorrhagic fever (VHFs)
Clostridium botulinum .. Botulism
All Viruses are Interference viruses .. *EXCEPT
[Inhibition of the replication of a virus by a previous infection with another virus ] :
Hepatitis D Virus (HDV)
Influenza Virus A
Retrograde Axonal Transport :
Bacterial :
Viral :
Clostridium tetani Toxin Rabies Virus
Herpesviruses

Membranous Inflammation :
Steptococcus pyogenes
Opportunistic Pathogen :
Staphylococcus saprophyticus
Non-Tuberculous Mycobacteria (NTM)
Escherichia & E. coli (*certain strains)
Klebsiella
Proteus
Citrobacter
Enterobacter
Serratia
Cryptococcus neoformans
Motile Bacteria :
Listeria
Clostridium tetani
Clostridium botulinum
Escherichia coli
Citrobacter
Enterobacter
Serratia
Salmonella
Proteus
Providencia
Morganella
Pseudomonas
Vibrio cholerae
Campylobacter
Aeromonas
Helicobacter
Legionella
Spirochaetes
Borrelia
Leptospira

Carriers :
Bacterial :
Viral :
Staphylococcus aureus (more than 40% in adults are Nasal Carriers)
Hepatitis B Virus (HBV)
Streptococcus agalactiae (25% of pregnant women are Vaginal Carriers)
Poliovirus
Streptococcus pneumoniae ( of adults are Nasopharynx Carriers)
Neisseria meningitidis (5-30% of healthy population are Nasopharynx Carriers)
Corynebacterium diphtheriae (Throat Carriers)
Listeria (about 10% of humans may be Intestinal Carriers of L. monocytogenes)
Salmonella
Shigella
Food Poisoning :
Staphylococcus aureus
Listeria monocytogenes
Bacillus cereus
Clostridium perfringens
Clostridium botulinum
Salmonella ( S. Enteritidis & S. Typhimurium ) << * No Toxin
Vibrio parahaemolyticus

* The ONLY Gram-variable :

Gardenrella vainalis
Indicators of Faecal Pollution of water :
Enterococcus faecalis
Clostridium perfringens
Escherichia coli
A/B .. Structural/Function Model of Toxin :
Corynebacterium diphtheriae .. exotoxin
Bacillus anthracis .. anthrax toxin
Escherichia coli .. heat-labile (LT) enterotoxin
Vibrio cholerae .. cholera toxin
Bordetella pertussis .. pertussis toxin (PTx)
DISEASES which " diagnosis should be clinical & laboratory for confirmation " :
Bacterial :
Viral :
Toxic Shock Syndrome (TSS) .. Staphylococcus aureus Measles .. Measles (Rubeola) Virus
Diphtheria .. Corynebacterium diphtheriae
Anthrax .. Bacillus anthracis
Gas Gangrene .. Clostridium perfringens
Tetanus .. Clostridium tetani
Botulism .. Clostridium botulinum
Leprosy .. Mycobacterium leprae
Plague .. Yersinia pestis
Cholera .. Vibrio cholera
Pseudo-Membrane Formation " Necrosis in mucous membrane "
In Throat ::
Corynebacterium diphtheriae .. Diphtheria
Fuso-Spirochaetal .. Vincents Angina
In Intestine ::
Clostridium difficile .. Pseudomembranous Colitis
Shigella .. Pseudomembrane formation
Bacteria that RESISTE Intra-Cellualr Killing inside Phagocytic Cells
Staphylococcus aureus .. via
Catalase
" Break down of H2O2 insde phagocytes "
Neisseria gonorrhoeae .. via
Outer membrane porin
" Prevent fusion of phagosomes & lysosomes "
Mycobacterium tuberculosis .. via
Mycobacterial sulfolipids
" Prevent fusion of phagosomes & lysosomes "
Yersinia pestis .. via
Catalase
" Break down of H2O2 insde phagocytes "
Brucella abortus & Brucella melitensis & Brucella suis
Bacteria that cause Urinary Tract Infection (UTI) :
Staphylococcus saprophyticus
Enterococcus faecalis
Escherichia coli
Klebsiella
Proteus mirabilis
Morganella morganii
Providencia rettgeri

Heat-Stable Enterotoxin
Staphylococcus aureus enterotoxin
Bacillus cereus Enterotoxin in Emetic Form Food Posoning

Enterobacteriaceae
Lactose Fermenters :
Escherichia coli
Klebsiella
Citrobacter
Enterobacter

Lactose Non-Fermenters :
Salmonella
Shigella * except S. sonnei Late Lactose Fermenters
Proteus
Yersinia

Bacteria with Anti-Phagocytic action

Staphylococcus aureus .. via
StaphyloCoagulase
" Convert plasma fibrinogen to Fibrin "
Streptococcus pyogenes .. via
M Protein
C5a Peptidase
" Breaks down C5a "
Hyaluronic Acid Capsule
" act as an Immunological Mask "
Streptococcus agalactiae & Streptococcus pneumoniae .. via
Polysaccharide Capsule
Neisseria gonorrhoeae .. via
Outer membrane proteins
" Invasion "
Neisseria meningitidis .. via
Polysaccharide Capsule
Bacillus anthracis .. via
Polypeptide Capsule
Bordetella pertussis .. via
Pertussis Toxin (PTx)
Diseases transmeted by ( Person-to-Person Transmission ) " due to it's LOW infective dose " :
Bacterial :
Viral :
Salmonella .. Enteric Fever ( Typhoid & Paratyphoid Fever ) Norwalk Viruses .. Acute Gastro-Enteritis
Shigella .. Bacillary Dysentery
Astroviruses .. Sporadic Gastro-Enteritis
Campylobacter jejuni .. Campylobacter Enteritis
Varicella-Zoster Virus (VZV)
Local diseases " the organism localized in organs & produce it's toxin into blood stream "

Not diagnosed by Blood Culture Technique :
Disease :
Organism :
Localized in :
Toxin Produced :
Upper resp. tract ..
Diphtheria
Corynebacterium diphtheriae
Diphtheria Exotoxin
commonest in Tonsil
Tetanus
Clostridium tetani
Necrotic tissue " Wounds "
Tetanospasmin Toxin
Bacillary Dysentery
Shigella dysenteriae type 1
Large Intestine
Shiga Toxin
Cholera
Vibrio cholerae
Small Intestine
Cholera Toxin ( Choleragen )
Whooping Cough
Pertussis Toxin (PTx)
Bordetella pertussis
Resp. tract " Nasopharynx "
(Pertussis)
& Tracheal Cytotoxin (TCT)
Uses of Methylene Blue :
 Corynebacterium diphtheriae
give Characteristic Beaded Appearance
 Ziehl-Neelsen Stain
as Counterstain which give Blue Background
 Bacillus anthracis
(McFadyean reaction) .. to stain the Capsule of Bacillus anthracis
 Yersinia
responsible for Bipolar Staining Properties

Viruses which have Cyto-Pathogenic Effect CPE :

Poliovirus
Organisms that cause Hospital acquired ( Nosocomial ) Infections :
Bacterial :
Viral :
Staphylococcus aureus
Adenoviruses
Enterococcus faecalis
M. abscessus (NTM)
Escherichia coli
Klebsiella
Proteus
Pseudomonas aeruginosa
Acinetobacter
Legionella
Self-Limited DISEASES No specific ttt is needed :
Bacterial :
Staphylococcal Food Poisoning .. Staphylococcus aureus
Clostridium perfringens Food Poisoning .. Clostridium perfringens
Food Poisoning .. Vibrio parahaemolyticus

Viral :
Hepatitis A Virus (HAV)
Hepatitis E Virus (HEV)
Rubella ( German Measles )
Influenza Viruses

* if there is no other complication
Adenoviruses

Sexually Transmitted DISEASES :

Bacterial :
Viral :
Neisseria gonorrhoeae acute male
Hepatitis B Virus (HBV)
Haemophilus ducreyi
Human Immunodeficiency Viruses (HIV)
Treponema pallidum
Adenoviruses
Genital Mycoplasma
Herpesviruses :
[ M. hominis, M. genitalium & Ureaplasma urealyticum ] [ 2 Herpes Simplex Viruses (HSV) & Cytomegalovirus (CMV) ]
Chlamydia Trachomatis [ Serotype (L1,2,3) & (D-K) ]
Human Papillomaviruses
Molluscum Contagiosum Virus (MCV)
Organisms which have NOT been cultured in Vitro :
Bacterial :
Viral :
Mycobacterium leprae
Hepatitis C Virus (HCV)
Treponema pallidum
Norwalk Viruses
Human Papillomavirus (HPV)
Viruses which infect the Salivary Glands :
Mumps
Human Herpes Virus 7 (HHV7)
VACCINES ( VIRUSES )
 Hepatitis A Virus (HAV) :
Havrix Vaccine :

An Inactivated Vaccine
- composition : Killed Virus
- preparation : virus 1st killed by Formaldehyde then injected into body
- route of administration : Intramuscular injection
Vaccine schedule :
Two doses at 0 and 6 months
Is given to :
High-Risk Individuals [ Children above 2 Years of age who live in Endemic Countries ]

 Hepatitis B Virus (HBV) :

Hepatitis B Vaccines :

Recombinant Vaccine
- composition : HBsAg
- preparation : produced by using HBsAg synthesized by yeast, into which a plasmid containing the gene for HBsAg has
been inserted .. purified HBsAg is obtained by lysing the yeast cells .. HBsAg Ptn is then Adsorbed to Alum
- route of administration : Intramuscular injection
* the vaccine should be administered only in the Deltoid ms. of Adults & Children /
or in Antero-lateral Thigh ms. of Neonates & Infants
* Never give it in Gluteus Region due to its  vascularity   Absorption
Vaccine schedule :
Three doses at 0, 1 and 6 months
 Poliovirus :
Sabin & Salk Vaccine :
- composition : Three Antigenic Types
Vaccine schedule :
2,4,6, and 18 months of age with a booster dose at school entry (6 years)
* see the table in page 26 Vol. III
 Influenza Viruses :
Inactivated (Killed) Influenza Virus Vaccine :
Live Attenuated Vaccine :

An Inactivated Vaccine

Live attenuated Vaccine
- composition : Strains of Types A & B Viruses
Being developed as alternatives
- route of administration : Intramuscular injection
to inactivated vaccine
Vaccine schedule :
- route of administration :
in Un-vaccinated Infants & Children <9 Years : Two doses with One Month interval
Intranasal spray
in Adults : only One dose
* a booster dose is NOT recommended
# this vaccine should renewal yearly .. due to the Variants which occur
 Mumps ( Alone ) :
Live Attenuated Vaccine :
- route of administration : Intramuscular injection
Vaccine schedule :
Single dose for Children >1 Year
 Mumps & Measles & Rubella :
MMR Vaccine :

Live attenuated Vaccine
- route of administration : Intramuscular injection
Vaccine schedule :
Two doses .. 1st at 15 months
2nd at school age (4-6 years)
 Rotavirus :
Rotavirus Vaccine :

Live attenuated Vaccine
- route of administration : Orally
Vaccine schedule :
Three doses at 2, 4 and 6 months
 Rabies Virus :
* minimized in page 40 & 41 Vol. III

 Yellow Fever Virus :

17D Vaccine :

Live attenuated Vaccine
- preparation : Live attenuated Virus grown in Chick Embryo
- route of administration : SubCutaneous injection
Vaccine schedule : Single dose
Is given to : Travelers to Endemic Areas
* its very effective & Protection persists for 10 years
 Varicella-Zoster (VZV) :
Varicella Vaccine :

Live attenuated Vaccine
Vaccine schedule :
Two doses for Children 1-12 Years of age
* for persons aged above 13 years .. the minimum interval between the doses is 28 Dayes
 Human Parvoviruses Virus :
Human Parvoviruses Vaccine :

Recombinant Vaccine
- composition : Capsid Proteins is under Evaluation
Vaccine schedule :
Three doses at 0, 1 and 6 months
 Human Papillomavirus Virus (HPV) :
HPV Vaccine :

Recombinant Vaccine

Quadrivalent HPV ( Type 6, 11, 16 & 18 )
* it Protects against development of most cervical cancers & genital warts
- composition : Recombinant Non-infectious HPV-like Particles (VLP)
- route of administration : Intramuscular injection
Vaccine schedule :
Three doses at 0, 2 and 6 months & we start this schedule with Females at age 11 or 12 Years ;
however, vaccine series can be started at 9 Years of age
* Catch-up Vaccination is Recommended for 13-26 years old Females
* its Preferable to give the vaccine before the beginning of active sexual life .. before contracting HPV
 Poxviruses :
Vaccinia virus (VACV) :

Live attenuated Vaccine
VACCINES ( BACTERIA )
 Streptococcus pneumoniae :

Capsular Polysaccharide vaccine

New Pneumococcal Conjugate vaccine
- composition : Antigens from the most common 23
- composition : Capsular Polysaccharide Complex +
Pneumococcal Serotypes
Protein Carrier
Recommended to :
Recommended to :
Splenectomy
All Children less than 2 Years
Elderly
Immunosuppressed Patients
 Not in Children its Thymus Independent
 Neisseria meningitidis :

Polyvalent vaccines

Protein Conjugate vaccines
- composition : Capsular polysaccharide
- composition : Capsular Polysaccharide Complex +
from Serotype A & C ( bivalent ) or
Protein Carrier
from Serotype A, C, W-135 & Y ( quadrivalent, WYAC )
Recommended to :
Recommended to :
groups at risk ( military recruits, school children, collage
Children less than 2 Years
students & travelers e.g. pilgrims to certain areas )

 Corynebacterium diphtheriae :
predictable DT or adult Td Vaccine / The Triple (DPT) Vaccine :

Diphtheria Toxoid
- composition : Toxoid C. diphtheriae + Aluminum Salt ( Adjuvant )
- preparation : growing Toxigenic C. diphtheria in a liquid medium then incubated with Formaldehyde to convert it to
Toxoid .. it adsorbed onto an Aluminum Salt
- route of administration : Intramuscular injection
Vaccine schedule :
2,4,6, and 18 months of age with a booster dose at school entry (6 years)
a booster dose is recommended every 10 years
 for close contacts, a booster dose of Diphtheria Toxoid should be given + Antibiotics
 Diphtheria Toxoid alone is not available.
its combined with Tetanus Toxoid ( pediatric DT or adult Td )
or with both Tetanus Toxoid & Pertussis Vaccine ( DPT )
 Clostridium tetani :
The Triple (DPT) Vaccine :

Tetanus Toxoid
- composition : Tetanus Toxoid + Aluminum Salt ( Adjuvant )
- preparation : treatment of the Exotoxin with Formaldehyde & addition of Aluminum Salt ( Adjuvant )
- route of administration : Intramuscular injection
Vaccine schedule :
2,4,6 months of age and with a booster dose at 18 months & school entry (6 years)
a booster dose is recommended every 10 years ,
more frequent booster are Unnecessary & may cause Hypersensitivity reaction
Is given to :
Infants in the 1st year of life
People at high risk e.g. military personnel
Pregnant Females to prevent Tetanus Neonatorum
A booster dose is given to wounded people with a history of vaccination more than 5 years & less than 10 years ago
 Mycobacterium tuberculosis
Bacille Calmette-Gurin (BCG) Vaccine :

Live attenuated vaccine
- composition : Live attenuated vaccine prepared from M. bovis
- route of administration : Intradermally .. in the skin over the Left Deltoid Region
Is given to : Newborns
 Salmonella
TAB Vaccine :

Heat Killed vaccine
- composition : Salmonella Typhi + Salmonella Para-Typhi A + Salmonella Para-Typhi B
- preparation : killing the organisms at 60C for 30 Min. with 0.5% Phenol added as Preservative to avoid
contamination
- route of administration : SubCutaneous (S.C.)
Vaccine schedule :
2 S.C. doses 0.5 ml. & 1 ml. with One Month interval, then a booster dose some months later
Acetone-Killed bacterial suspension of Salmonella Typhi :
Vaccine schedule :
2 S.C. doses followed by a booster dose some months later
Oral Typhoid Vaccine :
Vi Capsular Polysaccharide of S. Typhi :

Live Avirulent Mutant strain of S. Typhi
- route of administration : Orally
- route of administration : Intramuscular injection

 Vibrio cholerae :
Cholera (Kolls) Vaccine :
Whole Cell/B Subunit Vaccine :
- composition : Killed Bacteria
- composition : Killed Bacteria + B Subunit of Cholera Toxin
- route of administration : Intramuscular injection - route of administration : Orally
  
Vaccine 
Live attenuated Vaccine :
- Produce Toxin
- route of administration : Orally
- Dont Invade Bloodstream
 Haemophilus influenzae :
H. influenzae type b Vaccine :

Protein Conjugate vaccines
- composition : Capsular Polysaccharide Complex + Protein Carrier
Recommended to :
Children less than 2 Years
 Bordetella pertussis :
Killed Whole Cell Vaccine :

Heat Killed vaccine
- route of administration : Intramuscular injection
- Vaccine schedule :
2,4,6, and 18 months of age withOUT a booster dose
 Why the value of the whole cell vaccine has been questioned ?
1- about 20% of the children that recive it experience Mild Side Effects
2- very small number of cases Sever or Irreversible Brain Damage may occur
Acellular Vaccine :

Recombinant Vaccine
- composition :
Pertussis Toxoid Genetically Inactivated Toxin + Filamentous Haemagglutinin + Other Virulence Factors
- route of administration : Intramuscular injection
- Vaccine schedule :
2,4,6, and 18 months of age withOUT a booster dose
 Why acellular vaccine is currently recommended for use combined with diphtheria & tetanus toxoid as DTaP ?
due to its Fewer Side Effects than the whole cell vaccine
 Coxiella :
Q Fever (Q-Vax) Vaccine :

Whole Cell Inactivated Vaccine
- composition : Killed, Purified Phase I Coxiella burnetii whole Cells
Recommended to :
People at risk
Bacteria that cause Cellulitis :
Steptococcus pyogenes
Clostridium perfringens
Aeromonas hydrophila
Diseases transmitted by Ingestion of Milk from infected animal :
Bovine tuberculosis .. Mycobacterium bovis
Brucellosis or Malta Fever or Undulant Fever.. [ Brucella abortus & Brucella melitensis & Brucella suis ]
Q Fever .. Coxiella burnetii
* The ONLY Exo-toxin which is NOT Protein in nature :
Tracheal Cyto-Toxin (TCT) .. Peptidoglycan fragment
Bacteria that have IgA1 protease :
Neisseria
Haemophilus influenzae

* The ONLY Poly-peptide Capsule :

Bacillus anthracis Capsule
Strict Aerobic Bacteria :
Neisseria
Corynebacterium diphtheriae
Mycobacterium tuberculosis
Pseudomonas aeruginosa
Bordetella pertussis
Brucella
Legionella
Leptospira
Aerobic Actinomycetes [ Nocardia, Actinomadura & Streptomyces ]
Strict Anaerobic Bacteria :
Clostridium perfringens
Clostridium tetani
Clostridium botulinum
Bacteroides; B. fragilis
Fusobacterium
Propionibacterium; P. acne
Lactobacillus; L. odontolyticus, L. acidophilus, L. rhamnosus & L. doderleins
Treponema pallidum
Anaerobic Actinomycetes [ Actinomyces ]
Bacteria that cause Atypical Bacterial Pneumonia :
Legionella pneumophila
Mycoplasma pneumoniae
Chlamydophila pneumoniae
Chlamydophila psittaci
Coxiella burnetii * Acute Q Fever
Viruses which have a Characteristic Microscopic Appearance :
Corona-Viruses
Crown like
Rota-Virus
Wheel like
Norwalk Viruses
Star of David appearance + Calici (Calyx)
Astro-Viruses
Pointed Star shaped
Rabies Virus
Bullet shaped
Negative (-) Sense RNA :
Hepatitis D Virus (HDV)
Orthomyxoviridae [ Influenza Viruses ]
Paramyxoviridae [ Parainfluenza Viruses, Mumps, Measles, Respiratory Syncytial Virus (RSV) ]
Rabies Virus
Filoviridae
Arenavirus
Heat-Stable Exotoxin :
Staphylococcus aureus Enterotoxin
Bacillus cereus the Emetic Toxin
Escherichia coli ; ST of Enterotoxigenic E. coli
Escherichia coli ; Enterotoxin of Enteroaggregative E. coli
Only Viruses which required Arthropod-borne Transmission :
Arboviruses

Organisms
Staphylococcus aureus

STREPTOCOCCUS :
Steptococcus pyogenes
Streptococcus agalactiae
Viridans Streptococci
Streptococcus pneumoniae
Neisseria gonorrhoeae

Culture Media
- Mannitol Salt Agar
- Blood Agar
- Nutrient Agar
- Blood Agar

- Enriched : Chocolate Agar

- Selective : Modified Thyer-Martin Media (MTM)
Neisseria meningitidis
- Enriched : Chocolate Agar, Blood Agar
- Selective : Modified Thyer-Martin Media (MTM)
Corynebacterium diphtheriae
- Enriched : Lofflers Serum Medium, Blood Agar
- Selective : Blood Tellurite
Bacillus anthracis
- Simple Nutrient Media
- Blood Agar
Clostridium perfringens
- Blood Agar
Clostridium tetani
- Simple Media
- Blood Agar
- Cooked Meat Media
Clostridium botulinum
- Cooked Meat Media
Mycobacterium tuberculosis
- Selective : Lowenstein-Jensen (L-J) Medium
- Middlebrooks Medium
Non-Tuberculous Mycobacterium (NTM) - Selective : Lowenstein-Jensen (L-J) Medium
- Middlebrooks Medium
Mycobacterium leprae
* CanNOT be cultivated In-Vitro
- Cultivated In-Vivo [ Armadillo & Mice ]
ENTEROBACTERIACEAE :
MacConkey Agar
Escherichia coli
- MacConkey Agar
- Blood Agar
Klebsiella
- MacConkey Agar
Salmonella
- MacConkey Agar
- Deoxycholate Citrate Agar (DCA)
- S-S Agar
Shigella
- MacConkey Agar
- Deoxycholate Citrate Agar (DCA)
- S-S Agar
Yersinia pestis
- MacConkey Agar
- Blood Agar
Vibrio cholerae
- Thiosulphate-Citrate-Bile salts-Sucrose (TCBS) Agar
Campylobacter
- Selective : media with added Antibiotics e.g. Skirrows Medium
Helicobacter
- Enriched : Fresh Blood or Serum Agar Media
- Selective : media with added Antibiotics e.g. Skirrows Medium
- Non-Selective : Chocolate Agar
Pseudomonas aeruginosa
- Simple Media
- MacConkey Agar
Haemophilus influenzae
- Chocolate Agar
- Blood Agar * Only if the S. aureus is grown at the same time
Providing V-factor [ requires both X-factor & V-factor ]
Haemophilus ducreyi
- Chocolate Agar [ requires X-factor]
Bordetella pertussis
- Bordet-Gengou Agar
- Charcoal Blood Agar

Brucella
Legionella
Treponema pallidum
Borrelia
Leptospira
Mycoplasma pneumoniae
Chlamydia
Coxiella

Rickettsia

Mycology

- Serum Dextrose Agar

- Blood Agar
- Buffered Charcoal Yeast Extract (BCYE) Agar
* CanNOT be cultivated In-Vitro
- Inoculated into [ Rabbit Testicles ]
- Highly Enriched : (BSK) II Medium
- Protein-Rich Semisolid Media [ Fletchers or Stuarts Medium ]
- Serum Enriched Media
- Yolk Sac of Chick Embryo
- Tissue Culture
- Yolk Sac of Chick Embryo
- Tissue Culture
- Inoculated into [ Mice & Guinea Pigs ]
- Yolk Sac of Chick Embryo
- Tissue Culture
- Inoculated into [ Mice & Guinea Pigs ]
- Sabourauds Dextrose Agar (SDA)
* with or without Chloramphenicol

Viruses which produce Haemorrhagic Fever :

Yellow Fever Virus
Dengue Fever Virus
Rift Valley Fever Virus
Hantaan Virus
Ebola Virus
Marburg Virus
Lessa Fever Virus
Junin and Machupo Viruses
Viruses which have a Clinical Latency :
True Latency
Herpesviruses :
[ Herpes Simplex Virus (HSV), Varicella-Zoster Virus (VZV) &
Cytomegalovirus (CMV) ]
Adenoviruses
Human Polyomaviruses

Not a True Latency (Clinical Latency)

Human Immunodeficiency Viruses (HIV)

Organisms that cause Endocarditis :

Bacterial :
Viral :
Staphylococcus aureus
Haemophilus influenzae
Staphylococcus epidermidis
Coxiella burnetii
Viridans Streptococci
Streptococcus pneumoniae
Enterococcus faecalis
Neisseria gonorrhoeae rare
Neisseria meningitidis rare
Moraxella catarrhalis
Brucella abortus & Brucella melitensis & Brucella suis
Defective Viruses
Defective Virus
Helper Virus
Hepatitis D Virus (HDV) Hepatitis B Virus (HBV)
Dependovirus
Adenoviruses

Microscopically Exam. Is Sufficient for Diagnosis of :

Disease & Organism : :
Stain :
Microscopy :
Relapsing Fever during the
Febrile Stage
- Borrelia

Dark-Field
Microscopy
or
Phase Contrast
Microscopy

Wet
Unstained
Preparation
Giemsa or
Leishman Stain

Acute Gonorrhoea in Male

patients
- Neisseria gonorrhoeae
Vincents Angina
- Fusospirochaetal
Gram Stain
Ordinary
Microscopy

Bacterial Vaginosis
- Gardnerella vaginalis

Leprosy
- Mycobacterium leprae

Modified ZiehlNeelsen Stain

Syphilis during the Primary

Stage (Chancre)
Treponema pallidum

Silver Stain e.g.

Fontana Stain

Secondary cases of Cholera

during an Epidemic
- Vibrio cholerae

Wet
Unstained
Preparation

Dark-Field
Microscopy

Wet Mount

Ordinary
Microscopy

Fluorescein

Immunoflurescence

Non-Immunogenic Capsule :
Neisseria meningitides .. Group B
Bacillus anthracis Capsule
Hyaluronic Acid Capsule of Streptococcus pyogenes
Bacteria which cause Haemolytic Uraemic Syndrome (HUS) :
Escherichia coli
Shigella dysentery serotype 1

Morphology :

Why its
Sufficient:
Highly Motile organisms
Because there
with Flat & Helical Waves is Characteristic
Symptoms
[ I.P. 2 days 2
weeks
&
Fever
for 3-7
days ]
Gram ve Diplococci ,
Male has No
Kidney shaped intraDischarge,
cellular
NO Flora
Gram ve Fusiform
Due to its
Bacilli & Spirochaetes +
Characteristic
Pus Cells
Appearance

Vaginal Epithelium Cells
Due to its
Clue Cells covered with Characteristic
G. vaginalis bacilli, and
Appearance
[ Clue Cells ]
almost absence of
Lactobacilli
Blue background with
Pink Globi Acid Fast
Bacilli in Bundles
Organism
Slender Spirochaetes,
CanNOT be
Regular Coils with Pointe
cultivated InEnds
Vitro
Characteristic Rapid
Corckscrew Movement
Curved Bacilli with
Darting Movement
Fluorescent Rods in Dark
background

In Endemic
area + its
Dangerous
Diseases

Test :

Tuberculin Skin
Test (TST)

Widal Test

For :

Human
Tuberculosis

Enteric Fever

The Lepromin
Skin Test

Standard Tube
Agglutination
Test (STAT) for
total antibody
(IgG + IgM)

Leprosy

Why its NOT a Good Diagnostic Test

& How to Overcome if its possible :
# False +ve Reactions :

Anergy

Recent TB Infection
# False -ve Reactions :

Infection with Non-Tuberculous Mycobacteria

Vaccination with BCG

NonTreponemal
Tests

Syphilis

Cold Agglutinin

Mycoplasma
pneumoniae
infections

To Diagnose Latent Tuberculosis

Infection

# False -ve Reactions :

Endemic Areas

Vaccination People

Infection with other members of
Enterobacteriaceae .. due to Cross-Reacting
Antibodies
# False +ve Reactions :

during 1st Week of Illness

in People under Antibiotic Therapy

Enteric Fever : demonstration of

agglutinating antibodies against
antigens O-somatic and H.flagellar in the Serum

There is False ve Reactions

It has Prognostic Value

* if Positive : Tuberculoid
Leprosy
* if Negative : Lepromatous
Leprosy

# False -ve Results may be obtained, due to :

Zone Phenomena,
overcome by [ Wide Range of Serum Dilution ]

Blocking Antibody (IgA),
overcome by [ Anti-Brucella Coombs Test ]

Undulant
Fever

Significance of Test :

# False +ve Reactions in :

others diseases with Massive Tissue Damage [
Leprosy, Viral Infections & Autoimmune
Diseases ]

Pregnancy
# False -ve Reactions :

in 50% of M. pneumoniae infections
# False +ve Reactions in some diseases :

Viral Infections

Malaria

Haemolytic Anaemia

Serodiagnosis of Undulant Fever

( Brucellosis )

For Screening & Follow up of

Treatment

Indicative of Recent Infection

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