1. CONTENTS

4. Aerobic Gram negative Bacilli - Non-spore forming bacteria - Wide range of habitats - Highly diverse in metabolism and pathogenicity - complex cell wall : lipopolysaccharide(LPS) --> endotoxin

7. Pseudomonas

8. 01 Pseudomonas - Habit Soil, Seawater (free-living bacteria) Plants, animals, contaminants in home, clinical setting - Shape A single-polar flagellum, gram (-) rods - Produce water soluble pigment  change medium color

9. - Characteristic - Oxidase (+) & Catalase (+) - No ferment carbohydrate  oxidation metabolism (anaerobic condition  salt such as nitrate) - Important decomposers and bioremediators 01 Pseudomonas

10. 02 Pseudomonas aeruginosa - Habit : soil, water and intestinal resident (about 10% of normal people) - Resistance in soaps, dyes, disinfectants, drugs and drying (frequent contaminant) - Opportunistic (invade weakened host defenses) - Virulence factor  exotoxin  phagocytosis-resistance slime layer  endotoxic shock

11. 02 Pseudomonas aeruginosa Characteristics of infection Blue-green or yellow pigment (pyocyanin) - Grapelike odor - Exudate

12. 03 Pseudomonas aeruginosa as pathoggen as pathoggen - Community infection - Nosocomial infection Characteristic of infection (grape-like odor : blue pus)

13. 04 Treatment of Pseudomonas aeruginosa Pseudomonas aeruginosa Multidrug resistance - Cephalosporins - Aminoglycosides - Carbenicillin - Polymixin - quinolones, - Monobactams

15. - Genera * Burkholderia, Acinetobacter, Stenotrophomonas - Similar to pseudomonads - Living in soil, water, and related environments - Oxidase (+) - Opportunistic infection - Culture in blood agar and MacConkey agar

16. 01 Burkholderia cepacia - Isolated from moist environment - Toxic substance biodegradation - Resistance in antimicrobic drugs - Co-infection with Pseudomonas → severe respiratory compromise - Opportunistic infection

17. 02 Burkholderia pseudomallei - Resides in soil and water of tropical climate - Produce both exotoxins and endotoxins -melioidoses : Prevalent in Southeast Asia, Africa, India, Middle East -symptoms : wound infection – skin nodules along with symtoms of fever and muscle aches lung infection - bronchitis, pneumonia -Chronic infection : septicemia, endotoxic shock, abscesses in liver, brain.

18. 03 Acinetobacter baumanii - soil and water - resistant to environment - nosocomial & community-acquired infections - multidrug-resistant(MDR) strains (combination of carbapenem, colistin, polymyxin B, ampicillin) - control : isolation procedure, environmental disinfection 등

19. 04 Stenotrophomonas maltophilia - Living in water, soil associated with plant root - Contaminant - Formation of biofilm - High resistance to multidrugs - Effective in cephalosporin, Tetracycline, fluoroquinolone, newer penicillin

21. Brucella

22. 01 Brucella -Synonyms → uldulant fever → malta fever → Bang disease - Gram-negative - Coccobacilli - 2 species → Brucella abortus (cattle) → Brucella suis (pig)

23. 02 Brucellosis - Animal brucellosks : cause abortion - Human brucellosks : cause sever febrile illness but not abortion - Human infection enters through damaged skin or mucous membranes of the digestive tract, respiratory tract → infected macrophages → transport into the bloodstream → focal lesion → fluctuating pattern of fever

24. 03 diagnosis, treatment of Brucellosis Diagnosis patient’s history serological test ( Agglutination titer test ) blood cultures Newer genetic test Treatment Combination of tetracycline and rifampin or streptomycin

25. Francisella tularensis

26. 01 Francisella tularensis -Gram-negative -coccobacilli - Similar to Yersinia pestis - Rabbit fever

27. 02 Infection of Tularemia - contact with infected animals, water and dust or bites by vectors - not communicated from human to human

28. 03 Symptoms of Tularemia - Headache, fever, chills, malaise - Ulcerative skin lesion - Swollen lymph glands - Sore throat - Intestinal disruption

29. 04 treatment, prevention of Tularemia Treatment gentamicin, tetracycline Prevention Live attenuated vaccine Protective glove, mask, eyewear

31. Bordetella

32. 01 Bordetella pertussis -Gram-negative -Encapsuled coccobacillus - Responsible for pertussis (whooping cough) - Direct contact with inhaled droplets of aerosols

33. 02 Virulence factor of Pertussis (whooping cough) of Pertussis (whooping cough) - receptors : recognize ciliated respiratory epithelial cells - toxin : destroy and dislodge ciliated cells → the loss of the ciliary mechanism → build up of mucus and blockage of the airways

34. 03 treatment, prevention of Pertussis Treatment erythromycin azithromycin septra Prevention Vaccine (DTap) Acellular vaccine contains toxoid and other Ags Boostrix diphtheria, tetanus, pertussis

35. Legionella

36. 01 Legionella - gram-negative motile rods - Catalase( + ), oxidase (+) - Fastidious nutrient requirements (BCYE →pH about 6.9) - Ability to survive and persist in natural habitats

37. 02 Infection of Legionella - D istributed in aqueous habitats - Tap water, cooling towers, spas, pond etc. → living intracellular in free-living ameba - Transmitted by aerosol from air conditioner, cooling tower, etc. - Can be carried for long distances - Not communicable from person to person

38. 03 Symptoms of Legionella -Legionnaires disease → Fever(41 ℃ ), cough, diarrhea, abdominal pain → Lung consolidation, impaired respiration & organ (fatality rate : 3~30%) -Pontiac fever → Fever(41 ℃ ), cough, diarrhea, abdominal pain → Does not lead to pneumonia and rarely cause death

39. 04 Diagnosis, treatment of Legionella Treatment Erythromycin with rifampin Diagnosis Fluorescent antibody staining Cultivation on charcoal yeast extract (CYE) agar, DNA probes Symptom&patient’s history

40. PseudomonasBrucellaFrancisellaBordetellaLegionella 기회감염균동물병원균 ( 가축 ) 동물병원균 ( 야생토끼 ) 인간감염균 - 녹농균 -flagellum 有 - 산화작용 -free-living -p.aeruginosa -Brucellosis - 유산유발 ( 동물 ) - 파상열발생 - 동물접촉주의 ( 장갑, 옷, 안경 ) -Tularemia - 사람간감염 X - 피부, 림프선 증상나타남 -Whooping cough - 발병의근원은 receptor&toxin -Legionellosis - 폐렴유발 - 물에잘삼 Aerobic Gram-negative Nonenteric Bacilli

42. - The enteric Yersinia - Y. enterocolitica, - Y. pseudotuberculosis - Noneneric Yersinia - Y. pestis Pasteurella spp. - P. multocida - Haemophilus spp. - H. influenzae - H. aegyptius - H. parainfluenzae

44. 01 Enteric Yersinia - Y.enterocolitica & Y.pseudotuberculosis intestinal inhabitants of wild and domestic animals → enteric infections in humans

45. 02 Yersinia enterocolitica - Healthy and sick farm animals, fish, fruits & vegetables, drinking water → invade the small intestinal mucosa → lymphatics → intracellularly in phagocytes → inflammantion of the ileum & mesenteric lymph nodes → severe abdominal pain (mimics appendicitis) 03 Yersinia pseudotuberculosis - Similar to Y.enterocolitica - Lymph node inflammation

46. - Gram-negative rods - Bipolar staining -Capsules (+) - Facultative anaerobes -Spore (-) -flagella (–) - Pandemics of plague - Zoonotic disease 04 Nonenteric Yersinia pestis

47. - Capsular and envelope proteins → protect against phagocytosis → foster intracellular growth - Coagulase : clots blood → obstructing blood vessels in human → clogging the esophagus in fleas - Endotoxin & intracellular murine toxin 05 Virulence factors of nonenteric Yersinia pestis of nonenteric Yersinia pestis

48. Plague bacillus : naturally in many animal hosts Endemically : Africa, South America, the Mideast, Asia, the former USSR, India Attributed to increased populations of rats, flea vectors No human to human transmission since 1924 Humans can develop plague : Through contact with wild animals (Sylvatic plague) : Domestic or semidomestic animals, or infected humans (Urban plague) 06 The complex epidemiology

50. 07 The infection cycle -Endemic reservoir hosts → harbor the organism but do not develop the disease -Amplifying hosts → become infected, massive die-offs during epidemics spread the disease to other mammals → sources of human plague -Flea vector - tiny, blood sucking insects, the bacilli multiply in its gut - The esophagus becomes blocked → unable to feed → ravenous flea jumps from animal to animal → regurgitated infectious material into the bite wound - by inhaling droplet in infected human

51. Plague infectious dose : 3 to 50 cells Bubonic plague Septicemic plague Pneumonic plague 08 Pathology of plague

52. - The plague bacillus multiplies in the bite → necrosis & swelling of the local lymph nodes (bubo) - Typically in the groin and less often in the axilla - 2~8days after fever, chills, headache, nausea, weakness, tenderness of bubo. 09 Bubonic plague

53. -Bubonic plague progress to massive bacterial growth in the blood - Disseminated intravascular coagulation(DIC), subcutaneous hemorrhage, purpura → necrosis & gangrene → darkening of the skin “black death” 10 Septicemic plague black death

54. - Localized to the lungs - Highly contagious through sputum, aerosols 11 Pneumonic plague

55. 12 Diagnosis, treatment, prevention of plague of plague Treatment Streptomycin Tetracycline Chloramphenicol Prevention Killed vaccine (effective only for a few month) Attenuated vaccine (more effective but also has more side effects) Diagnosis The patient’s history Death as quickly as 2 to 4 days after the appearance of symptoms Culture of bubo aspirate

57. - Oxidase (+) Nonenteric Pathogens - Gram-negative rods - Normal flora in animals - Facultative anaerobes - Optimal temperature : 33 ~ 37 ℃ - Motility (-) - Bipolar staining - Grow well on blood or chocolate agar, but not MacConkey agar - Virulent factor : endotoxin (LPS), capsule - Most common in human disease : Pasteurella multocida 01 Pasteurella

58. - Normal flora in animals - Zoonotic infection - Opportunistic infections - Poultry & wild fowl : cholera-like outbreaks - Cattle : outbreaks of hemorrhagic septicemia or pneumonia “shipping fever” - Cats & dogs : nasopharynx, tonsils 02 Pasteurella multocida

59. - Animal bites or scratches → local abscess → immunocompromised patients : septicemic complication (Central nerve system, heart) -Treatment Penicillin, Tetracycline, Cepahlosporin 03 Infection of Pasteurella multocida

60. Haemophilus H. influenzae, H. aegyptius, H. ducreyi, H. parainfluenzae, H. aphrophilus

61. - Tiny, gram-negative coccoid bacilli - Filamentous, spherical bodies - Fastidious & sensitive to dry, temperature, disinfectants -Not grow on blood agar, require for Blood factor * factor X: necessary component of cytochromes, caralase, peroxidase * factor V: important coenzyme - Chocolate agar, Filed medium 04 Haemophilus - Blood loving Bacilli

62. - Nonvirulent species : normal colonist of the upper respiratory tract or vagina - Virulent species H. influenzae H. aegyptius ( conjunctivitis ) H. ducreyi ( chancroid ) H. parainfluenzae ( childhood miningitis ), H. aphrophilus 05 Nonvirulent & Virulent

63. - Isolated from patients with ‘flu’, but the causative agent → influenza virus -Acute bacterial meningitis : By the ‘b’ serotype, children ( 3 months ~ 5 years ) 06 Haemophilus influenzae

64. - Haemophilus meningitis → Not associated with epidemics, but sporadic cases or cluster in daycare & family settings → Very similar symptom to meningococcal meningitis - Haemophilus infections → Transmitted by close contact, nose & throat discharges → Healthy adult carriers : reservoirs of the bacillus → Untreated cases : fatality rate is 90%

65. - Epiglottitis → In older children & young adults → Immediate intubation or tracheostomy - Otitis media, Sinusitis, Pneumonia, Bronchitis Treatment chloramphenicol + ampicillin rifampin prophylaxis combination with DTaP Prevent vaccination - subunit vaccine ( Hib ) → based on type ‘b’ polysaccharide

66. 07 Haemophilus aegyptius - Koch - Weeks bacillus - Diseases : acute communicable ‘conjunctivitis’(pinkeye) - In children, by contaminated fingers & shared personal items, gnats & flies - Treatment : antibiotic eyedrops

67. 08 Haemophilus ducreyi - Diseases : chancroid ( soft chancre ) : STD -In the tropics & subtropics, mostly males -direct contact with infected lesions unclean personal habits. - Treatment : cotrimoxazole 09 Haemophilus parainfluenzae & Haemophilus aphrophilus & Haemophilus aphrophilus - Normal oral & nasopharyngeal flora - Diseases : infective endocarditis in adults (underlying congenital or rheumatic heart disease) - Periodontal disease, oral injury

68. 최신 진단미생물학 / 서흥출판사 / 정윤섭 외 6 명 Microbiology / Macgrawhill / Kathleen Park Talaro 진단미생물학 / 현문사 / 김양호 외 5 명 병원미생물학 / 청구문화사 / 김영권 REFERENCE

69. THANK YOU :D