UNUSUAL BACTERIAL PATHOGENS-MYCOBACTERIUM, MYCOPLASMAS, RICKETTSIAS, CHLAMYDIAS, SPIROCHETES, AND VIBRIOS

Mycobacterium tuberculosis (causative organism)

One third of the world’s population is infected with Mycobacterium tuberculosis

Small, aerobic, non-motile bacillus

Waxy lipid (mycolic acid) in cell wall, acid fast stain

Mycolic acid protects them against lysis once phagocytized

Waxy prevents desiccation, airborne transmission

Skin test to screen people. Positive indicates past infection or vaccination.

Administer test
This image depicts the hands of a clinician, that were in the process of correctly placing a Mantoux tuberculin skin test in this recipient’s forearm, which will cause a 6mm to10mm wheal, i.e., a raised area of skin surface, to form at the injection site. The Mantoux tuberculin skin test is used to evaluate people for latent tuberculosis (TB) infection. In the United States, this skin test consists of an intradermal injection of exactly one tenth of a milliliter (mL) of tuberculin, which contains 5 tuberculin units. Correct placement of this intradermal injection involves inserting the needle bevel slowly at a 5° to 15° angle. The needle bevel is advanced through the epidermis, the superficial layer of skin, approximately 3mm so that the entire bevel is covered and lies just under the skin surface. A tense, pale wheal that is 6mm to 10mm in diameter appears over the needle bevel.
TB skin test
This image depicts the left forearm of a person who had received a Mantoux skin test, or PPD test (purified protein derivative), having been inoculated with an extract of the tubercle bacillus, administered intradermally. This was the appearance of the site 48-hours after the test was administered. Since this person had been previously exposed to the Mycobacterium tuberculosis bacterium, the recipient produced an immune response at the injection site in the form of some degree of inflammation, as was seen in this case, whereupon, this test returned a positive result. Here, the erythematous reaction measured 15mm in diameter.
Tuberculosis = Disease

Not very virulent (5% exposed get disease)

Latent TB = Do not feel sick, asymptomatic, not infectious, positive TB test.  Bacteria can become active so must treat with antibiotics (6-9 months)

TB Disease = Bacteria is active and dividing, transmitting bacteria. Signs and symptoms bad cough (3 weeks or more), chest pain, coughing up blood/sputum, weakness or fatigue, weight loss, no appetite, chills, fever, night sweats.

Kills 50% of infected if not treated

Drug resistance an issue because antibiotic regimen is long

Vaccine not used in US (low number or cases), 66% of cases in the U.S. are foreign born persons

Leading killer of HIV/AIDS patients

Mycoplasma pneumoniae (causative organism)

Lack cell walls, variety of shapes

Have sterols in cell membrane

Smallest, free-living microbe

Adhesin attaches it to lining of respiratory tract

Attachment decreases cilia motion, decreases mucus removal

Eventually kills epithelial cells

Atypical or walking pneumonia = Disease

Most common form of pneumonia kids ages 5-15

Occurs throughout the year; not seasonal

2 million cases per year in the US

1-4-week incubation period

Signs and symptoms fever, malaise, headache, sore throat, persistent unproductive cough (may last several weeks)

Transmitted via respiratory droplets (nasal)

Difficult to diagnose via staining

Rickettsia rickettsia (causative organism)

Obligate, intracellular parasite

Non-motile

Aerobe

American dog tick and rocky mountain wood tick are vector and reservoir bacteria in salivary glands

Rocky mountain spotted fever = Disease

1 week incubation period

Signs and symptoms fever, headache, chills, muscle pain, nausea, vomiting

90% get a spotty, non-itchy rash on trunk, appendages, palms and soles

Rickettsia rash
Rocky Mountain Spotted Fever Rash

50% of rash patients get subcutaneous hemorrhages called petechiae

Severe cases organ systems fail; 5% die

Chlamydia trachomatis (causative organism)

Non-motile

Obligate, intracellular parasites

No cell wall

Chlamydia = Disease

Most common reportable STD in U.S. (over 1.7 million cases per year)

Transmitted by unprotected sex and to babies via the birth canal

Chlamydia is known as a “silent” disease because about three quarters of infected women and about half of infected men have no signs or symptoms. If symptoms do occur, they usually appear within one to three weeks after infection

Women signs and symptoms abnormal vaginal discharge or a burning sensation when urinating.  PID, infertility

Men signs and symptoms discharge from their penis or a burning sensation when urinating, burning and itching around the opening of the penis, infertility

Chlamydial infection in the rectum, throats

Chlamydia poster

Treponema pallidum (causative organism)

Spirochete

Can’t be cultured

Glycocalyx

Syphilis = Disease

Approximately 115,000 cases per year in U.S.

Transmitted by unprotected sex and to babies (via the placenta)

PRIMARY SYPHILIS-Chancre small, painless, ulcer-like lesion 10-90 days (average 21) after infected at the portal of entry, Chancres lasts 3-6 weeks then disappear.

Chancre on the face
Chancre on the face

 

Chancre on the tongue
Chancre on the tongue
Chancre on the penis
Chancre on the penis

SECONDARY SYPHILIS-Signs and symptoms sore throat, headache, mild fever, malaise, muscle pain, widespread rash including palms and soles; persists for months.

Syphilis rash

LATENT SYPHILIS-Clinically inactive, most do not advance beyond this.

TERTIARY OR LATE SYPHILIS-15% of people with untreated syphilis get this; 10-30 years after infection. Dementia, blindness, paralysis, heart failure, gummas (rubbery painfully swollen lesions) on bones, nervous tissue, skin.

Gumma
Syphilis gumma lesion

CONGENTIAL SYPHILIS-Mother to fetus (mom in latent), premature delivery, low birth weight, still birth, cataracts, deafness, seizures, death.

Borrelia burgdorferi (causative organism)

Spirochete

Transmission via deer tick (vector) bite, tick must stay attached 36-48 hours to transmit

Lyme disease = Disease

30,000 cases per year in the U.S.

Signs and symptoms expanding bullseye rash (12 inches or more) at site of infection within 3-30 days post tick bite (average 7 days) for 70%-80% of patients.  Rash lasts several weeks. Other signs and symptoms malaise, headache, stiff neck, fatigue, fever, chills.

Lyme disease bulls eye rash
Lyme disease bulls eye rash

Neurological and cardiac issues in 10% of patients

Can lead to arthritis

Vibrio cholera (causative organism)

Vibrio (slightly curved bacillus)

Gram negative

Produced an exotoxin (enterotoxin) causes severe fluid and electrolyte loss

Oxidase positive

Motile

Cholera = Disease

Recent outbreaks in Africa, SE Asia, Haiti

Seven pandemics since 1800

3-5 million cases per year worldwide 100,000 deaths

Transmitted fecal-oral ingest contaminated food/water, often poor sewage treatment

Incubation period few hours to 5 days (2-3 days average)

Signs and symptoms abrupt, watery mucus diarrhea (rice water stool), vomiting, rapid heart rate, low blood pressure, thirst, muscle cramps. one liter of fluid lost per hour.

5% get severe disease dehydration/shock/death

No vaccine in the U.S. but there are 2 vaccines used in other countries

Cholera painting

Campylobacter jejuni (causative organism)

Gram negative

Produced an exotoxin (enterotoxin)

Vibrio (slightly curved bacillus)

Oxidase positive

Motile

Normal flora of gastrointestinal tract of birds

Campylobacteriosis = Disease

2.5 million per yr. in US

Undercooked meat and poultry, unpasteurized dairy products

Incubation period 2-5 days

Signs and symptoms diarrhea (may be bloody), cramping, abdominal pain, fever, nausea, vomiting

50% raw chicken in contaminated. One drop of raw chicken juice has enough bacteria to cause illness

Self-limiting, usually resolves in 7 days

Proper food prep, cook thoroughly, pasteurize dairy products

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