Family:

Rickettsiaceae
Spotted fever group: Rickettsia
ricketssii, Rickettsia akari, Rickettsia
australis, Rickettsia conorii, Rickettsia
sibirica

Genus:Rickettsia, Orientia, Coxiella, Ehrlichia

Typhus group: Rickettsia prowazekii,
Ehrlichia: Ehrlichia chaffeensis, Ehrlichia
Rickettsia typhi, Orientia tsutsugamushi
ewingii, Anaplasma phagocytophilum,
Neorickettsia sennetsu
Q fever: Coxiella burnetii

Organism

Disease

Signs & Symptoms

Mode of
Transmission

Target Host /
Organ

Distinguishing
Char / Diagnosis

Treatment /
Prevention

Others

Rickettsiaceae
- Rickettsia
- Orientia
- Coxiella
- Ehrlichia

Rickettsial
diseases

Rashes*, high fever,

headache, malaise,
prostration, spleen &
liver enlargement

Arthropod
vector*

humans

Non-spore
former*

Tetracycline

Surface
proteins
(OmpA,
OmpB)

Chlorampheni
col

Rickettsia akari
(R. australis,
R. conorii,
R. sibirica)
Rickettsia
prowazekii

Rickettsia typhi
- Orientia
Orientia
tsutsugamushi
- Coxiella
Coxiella
burnetii

- Ehrlichia
Ehrlichia
chaffeensis

Stain

Culture
Medium

Giemsa

Enhanced with
sulfonamides

Gram (-)

Not well
with Gram
stain

Obligate
*except Coxiella

- Rickettsia
Rickettsia
ricketssii

Descriptio
n/
Function
Small

Rocky
mountain
spotted fever
Rickettsialpox

fever, conj redness,

severe headache, rash

Wood tick
Dog tick

papulevesicle, fever

Mites that
live on house
mice

Epidemic
typhus
Brill-Zinsser
Disease
(reactivation
from lymph
nodes)
Endemic or
Murine typhus

Rash (except in palms,

soles, face), fever (2
wk), delirious,
stuporous, fatal > 40
y/o

louse

Cytoplasm
(typhus
group)

Milder dse, rarely fatal

in elderly pts

Rat flea
(Xynopsylla
cheopis)

Cytoplasm
(typhus
group)

Scrub typhus

Generalized
lymphocytosis, severe
cardiac and cerebral
involvement

Larvae
(chiggers) or
mites

Cytoplasm
(typhus
group)

Resembles influenza,
pneumonia, hepatitis,
encephalopathy
(acute)
Infective endocarditis
(chronic)

Inhalation of
contaminate
d dust
(placenta,
dried feces,
urine, milk)
or aerosols

Fever, headache,
myalgia, nausea,
vomiting, anorexia,

ticks

Q fever

Human
monocyte
ehrlichiosis

Nucleus
(spotted fever
group)
Nucleus
(spotted fever
group)

NO eschar
formed
Eschar
formation

Chlorampheni
col

Multiply in
small BV
(endothelial
cells)
vasculitis of
skin & many
organs

Tetracycline
Chlorampheni
col
Endospore form
NO rash

Infect
circulating
leukocytes,

Tetracycline

Share
antigenic
properties
with Proteus
vulgaris
strains (WeilFelix rxn)

NO rash

Tetracycline
(given early,
3-4 days after
defervescenc
e) growth
suppression
Tetracycline
(Doxycycline)

Intracellul
ar
parasites
Coccobaci
lli

Ehrlichia
ewingii

Human
granulocyte
ehrlichiosis
Human
granulocyte
anaplasmosis
Human
monocyte
ehrlichiosis

weight loss

Organism

Disease

Signs & Symptoms

Mode of
Transmission

Target Host /
Organ

Distinguishing
Char / Diagnosis

Treatment /
Prevention

Others

Legionella
Legionella
pneumophila

Legionnaires
Disease

Fever, chills,
headache, diarrhea,
vomiting, pain in the
chest and abdomen,
fluid in lungs

Inhalation of
bacteria
(aerosols,
shower
heads)

Lungs

Hydrolyzes
hippurate

Erythromycin

Catalase (+)
Oxidase (+)

Anaplasma
phagocytophilu
m
Neorickettsia
sennetsu

Pontiac fever

ticks
ticks
Trematodeinfected fish

Fever, chills, myalgia,

malaise, headache (612 hr)

NO personperson
transmission

Less prominent resp

symptoms

Bartonella
Bartonella
bacililformis

Oroya fever

Verruca
peruana

Bartonella
quintana

Bacillary
angiomatosis

inside
phagocytic
vacuoles =
morulae
(clusters of
ehrlichia)

Serious infective
anemia due to RBC
destruction, liver &
spleen enlargement,
hemorrhage to lymph
nodes

Sandflies

Lobar,
segmental,
patchy
pulmonary
infiltration
(little interstitial
infiltration),
minimal
infiltration of
upper resp
tract

Recovered from
bronchial
washings,
pleural fluid,
lung biopsy,
NOT sputum

American
Andes only

Penicillin
Streptomycin
Chlorampheni
col

RBC
Endothelial
cells

Human, body
louse

Most
Legionella
produce
gelatinase &
b-lactamase
except L.
micdadei

Moist
warm
envt
(water)

Stain

Culture
Medium

Very
poorly
(use basic
fuchsin
rather
than
safranin)

Buffered YeastCharcoal
Extract (BYCE)
agar (2-10
days)
With aketoglutarate,
pH 6.9, 35 C
temp, 90%
humidity

Proteases,
phosphatase,
lipase,
DNAse,
RNAse

Elimination of
sandfly
vectors

Vascular occlusion,
thrombosis
Eruptive stage (2-8 wk
later)
Vascular skin lesions,
successive crops (up
to 1 yr)
Circumscribed lesions
(lobular capillary
proliferation), round
open vessels (cuboidal
endothelial cells

Adequate Cl
levels in
water
sources,
periodic
cleaning of
moist
equipments

Descriptio
n/
Function
Fastidious
Aerobic
Gram (-)

Immunosuppre
ssed (AIDS)

Relatively inert
biochemically

Virtually every
organ

16S ribosomal
RNA gene

Oral
erythromycin
Doxycyclin
(min 2 mos)

Blood culture
(2 wk)

Protein that
deforms RBC
Flagella
enabling
invasion to
endothelial
cells

Silver
stain
Giemsa

Semisolid
nutrient agar
(>10 days)
With 10%
rabbit serum,
0.5% Hg, 28 C
temp

Isolated from
direct culture
of infected
tissues and
blood (lysis-

Silver
stain

5% CO2, 36 C
temp (3 wk)

protruding into lumen)

Trench fever
Bartonella
henselae

Cat-scratch
disease

Enlarged red papule

(scale and erythema),
may ulcerate
Benign, self-limited
Fever,
lymphadenopathy,
papule/pustule (3-10
days), enlarged lymph
nodes (wk-mos)

Liver & spleen

(peliosis
hepatis)
Domestic
cats (thru
skin lesions)

Walls of
capillaries near
follicular
hyperplasia

Bacillary
angiomatosis*

Microabscesses
in infected
tissues and
lymph nodes

*see B.
quintana
Organism

Disease

Mycobacterium
leprae

Staying away
from cats

Aspiration of
pus from lymph
nodes (NO
bacteria)

Supportive
with
reassurance,
hot moist
soaks,
analgesics

Granulomatous
lesions on
biopsy (bacteria
in silver stain)

centrifugation
method)

Silver
stain

Aspiration of
pus, surgical
removal of
lymph node
Tetracycline
Erythromycin

Signs & Symptoms

Mycobacteria
Mycobacterium
tuberculosis

Immunocompet
ent persons

sequencing
(PCR)

Mode of
Transmission

Target Host /
Organ

Distinguishing
Char / Diagnosis

Inhalation

Lungs, apical /
upper portion

Cell wall
contains large
amts of lipids
More resistant
to cheml
agents
(hydrophobic
cell surface)

Tuberculosis
*Exudative Type
- Acute inflammatory rxn (edema fluid,
neutrophils, monocytes)
- Resemble bacterial pneumonia
- May resolve, lead to necrosis, or
develop into productive type
*Productive Type
- Chronic granuloma
- 3 zones:
1. central area (giant cells) 2. mid-zone
(epithelioid cells) 3. peripheral zone
(fibroblasts, lymphocytes, monocytes)
- Peripheral fibrous tissue central
caseation necrosis (tubercle) break
into a bronchus cavity may spread
to other organs
- Healing via fibrosis / calcification

Types of infection:
1. Primary infection
- childhood, base of lung
- acute oxidative lesion, lymph
node caseation, (+) tuberculin
test
2. Reactivation
- survived tubercle bacilli, lung
apex
- chronic tissue lesions,
tubercles, caseation, fibrosis

Leprosy (Hansens Disease)

*Tuberculoid Form (2-5 yr)
- anesthetic form; skin lose pigment and

Nasal
secretions,
pus

Sensitive to
sunlight,
resistant to
drying (6-8 mos
viable)
Virulent strains
form
serpentine
cords

*for TUBERCULIN TEST &

others, read the lecture notes
Endothelial
cells,
mononuclear

Intracellular
location
(microbial
persistence)
Destroy
peripheral
nerve tissue,

Treatment /
Prevention

Others
Acid-fast
bacilli

Isoniazid +
Rifampin
(1 yr)

Cell wall
(hypersensitiv
ity rxn)

Pyrazinamide
Ethambutol
Streptomycin
(6-9 mos)

Lipids (acidfastness):
Mycolic acid
(granuloma
formation),
waxes,
phospholipids
(caseation
necrosis;
Proteins
(tuberculin
rxn);
Polysaccharid
es (antigenic
rxn)

Treatment
(active and
asymptomatic
)
Increase host
resistance
BCG
vaccination
Cattle TB
eradication
Dapsone
Rifampicin

AF bacilli from
scrapings of
skin and

Descriptio
n/
Function
Rodshaped
Aerobic
Obligate
aerobes
(sensitive
to O2
conc)

Stain

Culture
Medium

ZiehlNeelsen
technique
(sputum,
exudates)

Selective and
non-selective
media (8-12
wk)

Energy
from
oxidation
of simple
C cpds

Flourochrome
(yelloworange
fluorescen
ce)

Slow
growth
rate (18
hr)

More
sensitive:
auraminerhodamine
stain

Dx: sputum
culture, chest
X-rays, PPD
skin test (4872 hr)
Techniques for
speciation:
Highperformance
liquid
chromatograph
y (HPLC); PCR
NOT in
nonliving
bacteriologic

sensation
*Lepromatous Form (9-12 yr)
- nodular form; enlarged skin lesions
(granuloma)
Mycobacterium
aviumintracellulare
(MAI) complex

Opportunistc
pathogen in
the immunocompromised
(AIDS)

cells
Cooler parts
(nose, ears,
fingers)

Organ dysfunction
(lung infiltrates,
pericarditis, soft
tissues abscesses,
bone infection, CNS
lesions)

skin and
mucous
membranes
Tissue and
blood culture

Avoid
exposure
Chemotherap
eu-tic
prophylaxis
Clarithromyci
n/
Azithromycin
+
Ethambutol
Rifabutin

mucous
membrane

media
PCR

NO vaccine
Resistant to
first anti-TB
drugs

Ubiquitou
s (water,
food, soil,
birds)

CD4
lymphocytes
< 100/L

Additional Notes
Vaginosis common to reproductive age women; assoc w/ premature rupture of membranes, preterm labor / birth
Bacteria:

Gardnerella vaginalis clue cells in smears; fish-smelled vaginal discharge; pH>4.5; METRONIDAZOLE

Mobiluncus motile, curved, Gram (-) to Gram variable, ANaerobic rods

SPIRAL MICROORGANISMS
Organism
Disease

Signs & Symptoms

Mode of
Transmission

Spirochetes
- Spirochaetaceae (free-living)
- Treponemataceae (pathogens)
Treponema pallidum
Stages:
*subsp. pallidum Syphi 1. Incubation Stage (2-6 wks)
2. Primary Stage - chancre; hard painless
lis
ulceration (4-6 wk), NO scar
*subsp.
Yaws
3. Primary Latent Period - all signs disappear;
pertenue
(+) blood test
*subsp.
Bejel
4. Secondary Stage - symptoms appear,
endemicum
disappear, reappear (5 yr); rashes, skin
T. carateum
Pinta
eruptions (condyloma lata)
5. Secondary Latent Stage - symptoms
disappear; (-) blood test
6. Tertiary Stage - permanent damage (CV,
nervous systems); formation of gummas;
mental illness
Diseases Related to
Signs & Symptoms

Target Host /
Organ

Humans
MOT: Sexual
exposure
Bloody fluids,
saliva
Early syphilis
(3-5 yr)
contagious
Late syphilis
(>5 yr) NOT
contagious

Distinguishing
Char / Diagnosis

DX: reagin,
antitreponemal
Ab from tissue
fluid, blood
serum

Treatment /
Prevention

Penicillin
Tetracycline
Erythromycin
NO vaccine

Immobilized /
killed by
arsenical,
mercury,
bismuth

Mode of Transmission

Treatment,
follow-up,
safe sex

Others

Descriptio
n/
Function

Long, slender
Helically-coiled, spiral
Gram (-) bacilli, motile
Viable in
Slender
whole blood /
Spiral
plasma (4 C
Rotate
temp, 24 hr)
steadily
around
Hyaluronidase endoflage
Cardiolipin
lla
Reagin
Drying,
raising temp
to 42 C

Target Host / Organ

Endemic Area

Stain

Culture
Medium

Immunoflo
u-rescent
stain,
darkfield
microscop
y - thin
(NOT
readily
seen)

NOT cultured
contly in
artificial media
or tissue
culture

*for
SEROLOGIC
TESTS &
others, see
lecture notes
Treatment /

Syphilis
Yaws (T. pallidum
pertenue)

Prevention

Bejel (T. pallidum

endemicum)
Pinta (T. carateum)
Other Spirals
Organism
Leptospira
Leptospira
interrogans

Ulcerating papule (arms, legs)

Scarring, bone destruction
Visceral, nervous system complication (rare)
Skin lesions

Direct contact
NO congenital infection

Children

Humid hot tropical

countries

Direct contact

Children

NON-ulcerating papule (flat, hyperpigmented appearance

months; depigmentation, hyperkeratosis years)

Direct contact
Flies, gnats

Dark-skinned races

Africa, Middle East, SE

Asia
Central, S. America,
Pacific

Disease

Signs & Symptoms

Mode of
Transmission

Target Host /
Organ

Distinguishing
Char / Diagnosis

Treatment /
Prevention

Others

Leptospirosis

Fever (onset at 10-12

days)
Uneventful, recovery
in 2-3 wks

Dogs, cats,
wild
mammals
thru
contaminate
d urine
directly or in
water and
soil

Humans via
mucous
membranes,
skin abrasions

DX: direct
microscopic
exam of blood

Any antibiotic

Blood, CSF,
tissues,
serum
(agglutination
tests 5-8
wk)

Weils
syndrome
(virulent form)
jaundice,
significant liver
disease

Biphasic 2nd phase

manifested as aseptic
meningitis
Hepatitis, kidney
(chronic)

Borellia

Relapsing fever

Sudden onset of fever,

chills (3-5 days); more
fever with intervals of
relief
Dangerous to pregnant
women (fetal infection)
Cause meningitis
(occasionally)

Continued on next page

Organism
Disease
Borellia
burgdorferi

Lyme disease

BACTERIA WITHOUT CELL WALLS

Arthropodborne:
*Soft ticks
(Ornithodoro
s) endemic
RF
*Human
louse
(Pediculus)
epidemic RF
(B.
recurrentis)

Parenchymatou
s organs (liver,
kidneys) hemorrhage,
tissue necrosis,
organ
dysfunction
Necrotic foci in
parenchymatou
s organs (liver,
spleen)
Hemorrhagic
foci in kidneys
and GIT

Avoiding
contact with
contaminated
water

Alternating
fever and nonfever periods

Tetracycline
Erythromycin
Penicillin

DX: spirochetes
in blood
specimens

Chlorampheni
col

*Rodents
main reservoir

NO vaccine
Tick and louse
control

Immunity is
short-lived

Others

Signs & Symptoms

Mode of
Transmission

Target Host /
Organ

Distinguishing
Char / Diagnosis

Treatment /
Prevention

Shortly after bite, flulike symptoms; bullseye rash (erythema

migrans); skin lesion

Tick-borne
(deer tick
Ixodes
dammini)

Dogs, horses,
cows, humans

Skin lesion

Doxycycline
Antibiotics (6
wk) chronic
arthritis

Arthritis, myocarditis

*Mice, deer
main
reservoirs

Vaccine
available ONLY
for dogs

DX: blood for

serologic tests,
NOT stained
smears
(insensitive),
PCR

Antigenic
structure
changes in
the course of
a single
infection

Avoid tick
exposure,
long
sleeves/pants

Penicillin

Descriptio
n/
Function
Tightly
coiled
Flexible
Actively
motile
Bent on
one end
hook

Stain

Culture
Medium

NOT
stained
readily,
impregnat
ed with
silver darkfield
microscop
y

Fletchers /
Stuarts
medium
(blood/urine
8 wk)

Irregular
spirals
Highly
flexible
Actively
motile

Stains
readily
with
bacteriolo
gic dyes
and blood
stains
(WrightGiemsa)

Descriptio
n/
Function

Stain

Energy from
FA, can survive
in water with
alkaline pH

Culture
Medium
NOT performed
(6-8 wk, lack
sensitivity)

Organism

Disease

Mycoplasma
Mycoplasma
pneumonia
Mycoplasma
genitalium

Mycoplasma
pneumonia

Mycoplasma
hominis

Nongonococcal
urethritis

Ureaplasma
urealyticum

Signs & Symptoms

Mode of
Target Host /
Distinguishing
Treatment /
Transmission Organ
Char / Diagnosis Prevention
Mild pneumonia,
NO cell wall; extreme pleomorphism; DX: serologic tests, require
insidious onset,
rising Ab titers
atypical, walking
Respiratory
Young (5-19
Alveoli decrease Erythromycin
pneumonia
secretions
y/o)
in size (inward
Tetracycline
Fever (8-10 days),
(droplet
IP: 12-14 days
swelling), do
cough, chest pain
form)
Sputum,
NOT fill with
Avoid contact
nasophafluid
ryngeal swab
PID, spontaneous abortion, low birth rate, ectopic
Normal flora in
pregnancy (women)
women
Opportunistic urethritis (men)
Major cause of fetal death, recurrent miscarriage,
50-80% pts
Tetracycline
prematurity, low birth weight (women)
have STD
Infertility (low sperm counts, poor sperm mobility in
males)

Others

Description / Function

Smallest
organisms
that can be
living in
nature and
selfreplicating in
lab media

Very small (450 nm)

Pleomorphic
NO flagella
Facultative anaerobes

Growth
inhibited by
specific Ab

Penicillin-resistant (NO
cell wall)

Affinity for mammalian

cell membranes,
mesothelial cells

Culture
Medium
Heart infusion
paptone broth
(2% agar, 30%
human ascetic
fluid / animal
serum)
Sterol
(parasitic
forms); glucose
as energy
source (10 %
urea for
Ureaplasma)