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Microbiology Lab Final – TA Review

The Helminths I. Nematoda

a. Trichinella i. Eating uncooked meat ii. Eating wild game (polar bear) iii. Travel to Mexico + Asia iv. LAB

1. Muscle biopsy – encysts in muscle

v. TX

1. Albendazole b. Ascaris

i. Children of tropical/developing countries ii. LAB

1. Stool for eggs

iii. TX

1. Albendazole

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c. Strongyloidiasis i. LAB

1. Larvae in stool

ii. TX

1. Ivermectin d. Enterobiasis

i. Pinworm ii. LAB

1. Scotch tape test 2. NIH swab

iii. TX 1. Albendazole

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II. Cestoda a. Taenia saginata

i. Beef tapeworm

ii. TX

1. Niclosamide 2. Praziquantel

b. Taenia solium i. Pork tapeworm ii. Causes Cysticerosis – cysts in brain

iii. LAB 1. Swiss cheese appearance – Giant brain lesion

iv. TX

1. Niclosamide 2. Albendazole + Prednisolone

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c. Diphyllobothrium latum i. Fish tapeworm ii. Competes w/host for Vit B12 iii. TX

1. Praziquantel d. Echinococcus granulosus

i. Dog tapeworm ii. Contaminated w/canine feces

iii. LAB 1. Hydatid cyst in tissues

iv. TX 1. Albendazole

III. Trematoda a. Schistosomiasis

i. Blood flukes ii. Snail host

iii. LAB 1. Eggs in stool/urine

iv. TX 1. Praziquantel

IV. Entamoeba Histolytica a. Liver abscess, bloody diarrhea b. Flask shaped ulcers c. LAB

i. Bloody stool – cysts w/4 nuclei

d. TX

i. Metronidazole

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V. Giardia Lamblia a. Hiker’s diarrhea b. Bloating flatulence, foul smelling diarrhea c. LAB

i. Trophozoite/cyst

d. TX

i. Metronidazole VI. Trichomonas Vaginalis

a. Sexually transmitted flagellate b. Pear shaped, 4 anterior flagella c. Corkscrew motility d. Foul smelling greenish, yellow frothy discharge e. TX

i. Metronidazole

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Mycoses I. Superficial Mycoses

a. ONLY cosmetic problem* b. Pityriasis Versicolor

i. Caused by Malassezia Furfur ii. Dry, scaly, hyper/hypopigmented lesions on torso, arms, and abdomen

iii. LAB 1. Spaghetti + meatball appearance – KOH prep

iv. TX

1. Selenium Sulfide 2. Topical Miconazole

II. Cutaneous Mycoses a. Dermatophytosis

i. Trichophyton – hair, skin, nails

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ii. Microsporum – skin, hair

iii. Epidermophyton – skin, nails

iv. Diseases

1. Tinea capitis – caused by T. tonsurans 2. Tinea barbae – area of alopecia 3. Tinea pedis – caused by T. rubrum 4. Tinea cruris – caused by T. rubrum

v. LAB

1. Digested with KOH see septate hyphae & calcofluor white

2. Wood’s light (UV light)

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vi. TX 1. Skin – Ketaconazole, Miconazole, Clotrimazole 2. Hair – Ketoconazole shampoo 3. Nail – Oral Terbinafine/Itraconazole

III. Subcutaneous Mycoses a. Sporotrichosis

i. Rose Gardner’s Disease 1. Caused by sporothrix schenkii 2. Dimorphic

ii. LAB 1. Tissue biopsy: cigar shaped budding yeast 2. Room temperature: daisy shaped conidia

iii. TX

1. Oral potassium iodide 2. Systemic – Itraconzaole/Amphotericin B

IV. Systemic Mycoses a. Coccidiomycoses

i. Cali, Arizona, New Mexico ii. Inhalation of arthroconidia

iii. LAB 1. Tissue biopsy: spherules w/endospores 2. Room temperature: branched hyphae w/arthrospores

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iv. TX

1. Fluconazole 2. Amphotericin B 3. Itraconazole

b. Histoplasmosis i. Ohio, Mississippi ii. Bat feces, soil contaminated with bird droppings

iii. LAB

1. Giemsa/Wright stain 2. Tissue biopsy: Yeast w/in macrophage

3. Room temperature: tuberculated macronida on hyphae

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iv. TX

1. Self limiting 2. Itraconazole/Amphotericin B

c. Blastomycosis i. North, Central, Southeast USA ii. Decaying vegetation, soil contaminated w/beaver exreta

iii. LAB 1. Tissue biopsy: Broad based budding yeast in KOH

2. Room temperature: branched hyphae iv. TX

1. Itraconazole 2. Amphotericin B

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d. Paracoccidiomycosis i. Central + South America

ii. LAB 1. Pilot/captain wheel

2. Yeast w/multiple buds

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Opportunistic Mycoses I. Candidiasis

a. Caused by C. albicans b. Diseases

i. Oral thrush ii. Diaper rash iii. Vaginitis

c. LAB i. Culture: smooth, creamy, pasty colonies

ii. Gomorri silver methanamine

iii. ELISA iv. Stain: yeast like budding cells w/pseudohyphae

d. TX

i. Fluconazole ii. Itraconazole iii. Voricanazole iv. Nystatin (oral) v. Amphotericin B vi. Caspofungin

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II. Cryptococcosis a. Caused by C. neoformans

b. Capsule = halo ONLY opportunistic fungi w/capsule c. Pigeon droppings d. LAB

i. India Ink ii. Budding cells w/halo and prominent capsule

e. TX

i. Amphotericin B ii. Flucytosin iii. Oral fluconazole

III. Aspergillosis a. Diseases

i. Invasive aspergillosis ii. Farmer’s lung iii. Bronchopulmonary aspergillosis

b. LAB i. Tissue biopsy: dichotomous branching hyphae w/45° septate

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c. TX

i. Itraconazole ii. Amphotericin B iii. Caspofungin

IV. Zygomycosis a. Found in soil, strawberries, moist bread b. Diseases

i. Rhinocerebral zygomycosis c. LAB

i. KOH w/calcofluor white stain ii. Broad, ribbon like, nonseptate hyphae @ 90°

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d. TX

i. Amphotericin B V. Pneumocystis

a. Diseases i. Pneumocystis pneumonia – ground glass appearance

b. LAB i. H&E: Alveoli w/foamy honeycomb appearance

ii. Lung biopsy: cysts-dark oval bodies on silver stain iii. Toluidine blue-Ostain iv. Giemsa stain v. Calcofluor white

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c. TX i. TMP-SMX i. Pentamidine

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Virology I. DNA Viruses

a. Breakdown i. Enveloped

1. Double stranded a. Herpes b. Hepadno c. Pox*

ii. Naked 1. Double stranded

a. Papova b. Adeno

2. Single stranded* a. Parvo*

b. Herpes i. Enveloped, Icosahedral

ii. Alpha 1. HSV-1

a. Latent in DRG b. Syncitium formation c. Giant cell formation d. Cowdry bodies

2. HSV-2 a. Latent in lumbosacral region b. Diseases

i. Herpes Whitlow ii. Herpes Encephalitis iii. Herpes Genitalis iv. Neonatal Herpes

c. LAB i. Cowdry Type A inclusion bodies

ii. PCR = gold standard method d. TX

i. Acyclovir 3. VZV

a. Latent in sensory nerve ganglion b. Diseases

i. Chicken pox dew drop rose petal vesicular lesions

ii. Herpes Zoster c. LAB

i. Tzanck smear – intranuclear inclusion bodies d. TX

i. Acyclovir ii. Foscarnet

iii. Beta 1. CMV (HHV-5)

a. Latent in monocytes, macrophages, lymphocytes* b. Diseases

i. Mononucleosis like syndrome – Heterophil Ab NEGATIVE

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c. LAB i. Owl’s eye basophilic inclusion bodies

d. TX i. Gancyclovir ii. Foscarnet iii. Cidofavir

2. HHV 6 + 7 (Roseola) a. Biphasic

iv. Gamma 1. EBV

a. Latent in B cells b. Downey cells (atypical T cells) c. LAB

i. Monospot test – Heterophile Ab POSITIVE d. Diseases

i. Infectious Mononucleosis ii. Burkitt’s lymphoma iii. Hairy oral leukoplakia

2. HHV-8 a. Kaposki sarcoma b. AIDS

c. Hepadna i. Enveloped ii. Dane particle* iii. Ground glass appearance* iv. Serology

1. 3 antigens a. HbsAg – ACUTE b. HbcAg – Viral multiplication c. HbeAg – BEWARE (HIGH infectivity)

2. 4 antibodies a. Anti HBs/HbsAb – immunized b. Anti HbcAg-IgM – active infection c. Anti hbcAg-IgG – chronic/post infection d. Anti Hbe – low infectivity

d. Pox i. Replicates in cytoplasm* ii. Bullet shaped iii. Enveloped iv. Diseases

1. Smallpox – cytoplasmic inclusion bodies 2. Molluscum contagiosum – pearly freshly colored benign nodule

v. TX 1. Prednisone, Methotrexate

e. Papova i. Polyoma

1. Naked, circular 2. Latent in kidney 3. Diseases

a. BK

b. JC PML

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ii. Papilloma 1. HPV 6,11; 16,18; 1,4 2. Diseases

a. Plantar/palmar warts – HPV 1,4 b. Condyloma acuminate – HPV 6, 11 c. Cervical intraepithelial neoplasia – HPV 16, 18

i. Koilocytes in PAP smear 3. TX

a. Cidofavir f. Adeno

i. Naked ii. Spikes iii. Diseases

1. Acute febrile pharyngitis 2. Acute respiratory diseases – military 3. Pharyngocojunctival fever 4. 2nd MCC of infantile diarrhea

iv. Intranuclear inclusion bodies g. Parvo

i. ssDNA, naked ii. Smallest iii. Erythroid progenitor cell of BM = target iv. Diseases

1. Erythema infectiosum 2. Aplastic anemia 3. Hydrops fetalis

II. RNA Viruses a. Breakdown

i. Single stranded 1. (-) stranded

a. Enveloped i. Filo ii. Orthomyxo/influenza iii. Bunya iv. Rhabdo v. Arena vi. Paramyxo

2. (+) stranded a. enveloped

i. Toga ii. Flavi iii. Corona iv. Retro

b. Naked

i. Picorna ii. Calici

ii. Double stranded 1. Naked

a. Reo

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Antimicrobial Susceptibility Testing I. Disc Diffusion susceptibility test – Kirby- Bauer Test

a. Compares susceptibility of antibiotics

II. MIC – Minimum Inhibitory Concentration

a. Tells minimum concentration of drug that kills bacteria III. MBC – Minimum Bacteriocidal Concentration

a. Tells minimum concentration of drug that inhibits bacteria

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IV. E Test a. Arrow MIC

i. Where inhibition of growth starts

Serological Diagnosis

I. Immunological tests a. Agglutination b. Flocculation c. Immunofluorescense

i. Chlamydia ii. HSV iii. Legionella iv. Mycoplasma v. Toxoplasma

d. ELISA i. Antigens (direct) – HBV antigen ii. Antibodies (indirect) – HIV iii. Sensitive test, used for screening iv.

e. Complement fixation f. Western blot

i. Detection of protein ii. Confirmation of HIV infection iii. Specific test

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II. HIV diagnosis a. ELISA – used as a sensitive test b. Western blot – used to confirm dx c. PCR – viral load d. EXCEPTION IN NEW BORNS

i. p24 antigen test III. NO staining used in:

a. Rickettisa b. Chlamydia c. Mycoplasma d. Mycobacterium e. Spirochetes

Random Must Knows

I. NO Cell wall a. Mycobacterium

i. Tuberculosis 1. TX

a. Isoniazid b. Rifampin c. Ethambutol d. Pyrazindamide

ii. Leprae 1. TX

a. Dapsone b. Rifampin

b. Mycoplasma i. COLD agglutinin ii. Fried egg appearance

II. Spirochete a. Borrelia burgdorferi – Lyme disease

i. Bulls-eye rash ii. LAB

1. Wright Giema stain iii. TX

1. Doxycycline b. Treponema pallidum - Syphilis

i. LAB 1. Dark field microscopy – primary syphilis 2. VDRL, FTA tests

ii. TX 1. Penicillin G

c. Leptospira i. Question mark

III. Campylobacter a. Sea gull wing appearance b. Microaerophilic @ 42°

IV. Yersinia a. Safety pin appearance