Microbiology

MICROBIOLOGY
REVIEW NOTES
CULTURE AND STERILISATION 2
MICROBIOLOGY REVIEW NOTES
CONTENTS
CULTURE AND STERILISATION ...................................................................................................................................... 9
CULTURE ................................................................................................................................................................... 9
STERILISATION........................................................................................................................................................... 9
DISINFECTION ......................................................................................................................................................... 10
BACTERIAL GENETICS .................................................................................................................................................. 11
GENERAL FEATURES OF BACTERIA.......................................................................................................................... 11
GRAM POSITIVE AND GRAM NEGATIVE ORGANISMS............................................................................................. 12
LIGAND AND HOST RECEPTORS FOR MICROORGANISMS ...................................................................................... 12
MULTIPLICATION OF BACTERIA .............................................................................................................................. 13
BACTERIAL RESISTANCE .......................................................................................................................................... 13
BIOTERRORISM AND VESICANTS ............................................................................................................................ 14
BACTERIOLOGY ........................................................................................................................................................... 15
GENERAL FEATURES OF BACTERIA.......................................................................................................................... 15
FEATURES OF STAPHYLOCOCCUS ........................................................................................................................... 17
SPECIES OF STAPHYLOCOCCUS ............................................................................................................................... 18
DISEASES CAUSED BY STAPHYLOCOCCUS ............................................................................................................... 19
TOXINS OF STAPHYLOCOCCUS ................................................................................................................................ 19
STAPHYLOCOCCAL FOOD POISONING .................................................................................................................... 20
FEATURES OF STREPTOCOCCUS.............................................................................................................................. 20
SPECIES OF STREPTOCOCCUS.................................................................................................................................. 21
DISEASES CAUSED BY STREPTOCOCCUS ................................................................................................................. 22
TOXINS OF STREPTOCOCCUS .................................................................................................................................. 22
CROSS SENSITIVITY OF STREPTOCOCCAL ANTIGEN ................................................................................................ 23
ENTEROCOCCUS...................................................................................................................................................... 23
PNEUMOCOCCUS.................................................................................................................................................... 23
GENERAL FEATURES OF NEISSERIA ......................................................................................................................... 24
NEISSERIA GONORRHOEA ....................................................................................................................................... 24
NEISSERIA MENINGITIDIS........................................................................................................................................ 25
GENERAL FEATURES OF CLOSTRIDIA....................................................................................................................... 26
CLOSTRIDIUM PERFRINGENS .................................................................................................................................. 26
GAS GANGRENE ...................................................................................................................................................... 27
CLOSTRIDIUM TETANI ............................................................................................................................................. 27
GENERAL FEATURES OF TETANUS........................................................................................................................... 27

MANAGEMENT OF TETANUS .................................................................................................................................. 28
PREVENTION OF TETANUS ...................................................................................................................................... 28
CLOSTRIDIUM BOTULINUM .................................................................................................................................... 29
BOTULISM ............................................................................................................................................................... 29
CLOSTRIDIUM DIFFICLE AND PSEUDOMEMBRANOUS COLITIS .............................................................................. 30
GENERAL FEATURES OF CORYNEBACTERIUM......................................................................................................... 30
CORYNEBACTERIUM DIPHTHERIA........................................................................................................................... 31
FEATURES OF DIPHTHERIA...................................................................................................................................... 31
MANAGEMENT OF DIPHTHERIA ............................................................................................................................. 32
HEMOPHILUS .......................................................................................................................................................... 33
BORDETELLA PERTUSSIS ......................................................................................................................................... 33
BRUCELLA................................................................................................................................................................ 34
BARTONELLA ........................................................................................................................................................... 35
ACTINOMYCES......................................................................................................................................................... 35
NOCARDIA............................................................................................................................................................... 36
LISTERIA .................................................................................................................................................................. 36
BACILLUS ANTHRACIS ............................................................................................................................................. 37
BACILLUS CEREUS.................................................................................................................................................... 38
LEGIONELLA ............................................................................................................................................................ 38
CAMPYLOBACTER.................................................................................................................................................... 39
HELICOBACTER ........................................................................................................................................................ 39
PASTEURELLA .......................................................................................................................................................... 39
FRANSCIELLA ........................................................................................................................................................... 40
YERSINIA.................................................................................................................................................................. 40
PSEUDOMONAS ...................................................................................................................................................... 41
BURKHOLDERIA....................................................................................................................................................... 42
GENERAL FEATURES OF ENTEROBACTERIACEAE .................................................................................................... 42
E.COLI ...................................................................................................................................................................... 42
PROTEUS ................................................................................................................................................................. 43
SALMONELLA .......................................................................................................................................................... 43
TYPHOID.................................................................................................................................................................. 44
SHIGELLA ................................................................................................................................................................. 45
FEATURES OF VIBRIO .............................................................................................................................................. 46
CHOLERA ................................................................................................................................................................. 47
HALOPHILIC VIBRIO ................................................................................................................................................. 47
ATYPICAL MYCOBACTERIA ...................................................................................................................................... 48
GENERAL FEATURES OF RICKETTSIA ....................................................................................................................... 49
ENDEMIC TYPHUS ................................................................................................................................................... 49
EPIDEMIC TYPHUS................................................................................................................................................... 49
SCRUB TYPHUS........................................................................................................................................................ 50
RICKETTSIAL POX..................................................................................................................................................... 50
ROCKY MOUNTAIN SPOTTED FEVER ....................................................................................................................... 50
Q FEVER................................................................................................................................................................... 51
EHRILICHIA .............................................................................................................................................................. 51
CHLAMYDIA............................................................................................................................................................. 51
MYCOPLASMA......................................................................................................................................................... 52
NON VENERAL TREPONEMES.................................................................................................................................. 53
Yaw and Pinta ............................................................................................................................................................. 53
LEPTOSPIRA............................................................................................................................................................. 54
BORRELIA ................................................................................................................................................................ 54
VIROLOGY ................................................................................................................................................................... 55
GENERAL FEATURES OF VIRUS ................................................................................................................................ 55
HERPES VIRUS ......................................................................................................................................................... 57
PARVOVIRUS ........................................................................................................................................................... 58
EBSTEIN BARR VIRUS............................................................................................................................................... 58
CYTOMEGALOVIRUS ............................................................................................................................................... 59
ROSEOLA INFANTUM .............................................................................................................................................. 59
VARICELLA ZOSTER VIRUS ....................................................................................................................................... 59
ADENOVIRUS........................................................................................................................................................... 60
ROTAVIRUS ............................................................................................................................................................. 61
SMALL POX.............................................................................................................................................................. 61
PAPOVA VIRUS ........................................................................................................................................................ 61
POLIO VIRUS............................................................................................................................................................ 62
ENTEROVIRUS ......................................................................................................................................................... 63
COXSACKIE VIRUS.................................................................................................................................................... 63
INFLUENZA VIRUS ................................................................................................................................................... 63
MEASLES ................................................................................................................................................................. 64
MUMPS ................................................................................................................................................................... 65
RABIES ..................................................................................................................................................................... 66
GENERAL FEATURES OF ARBOVIRUS....................................................................................................................... 67
DENGUE .................................................................................................................................................................. 67
CHIKUNGUNYA........................................................................................................................................................ 68
YELLOW FEVER ........................................................................................................................................................ 68
JAPANESE ENCEPHALITIS ........................................................................................................................................ 68
WEST NILE FEVER .................................................................................................................................................... 69
KYASANUR FOREST DISEASE ................................................................................................................................... 69
HANTA VIRUS .......................................................................................................................................................... 69
RESPIRATORY SYNCITIAL VIRUS .............................................................................................................................. 70
REOVIRUS................................................................................................................................................................ 70
RUBELLA .................................................................................................................................................................. 70
FEATURES OF HIV .................................................................................................................................................... 71
TRANSMISSION OF HIV ........................................................................................................................................... 72
EPIDEMIOLOGY OF HIV ........................................................................................................................................... 73
MANIFESTATIONS OF AIDS ..................................................................................................................................... 73
KAPOSI’S SARCOMA ................................................................................................................................................ 74
DIAGNOSIS OF AIDS ................................................................................................................................................ 75
TREATMENT OF AIDS .............................................................................................................................................. 75
PREVENTION OF HIV ............................................................................................................................................... 77
PRIONS AND SLOW VIRUS....................................................................................................................................... 78
MYCOLOGY ................................................................................................................................................................. 79
GENERAL FEATURES OF FUNGI ............................................................................................................................... 79
DIMORPHIC FUNGI.................................................................................................................................................. 80
DERMATOPHYTES ................................................................................................................................................... 80
CRYPTOCOCCUS ...................................................................................................................................................... 80
CANDIDA ................................................................................................................................................................. 81
PNEUMOCYSTIS JEROVECI ...................................................................................................................................... 82
BLASTOMYCOSIS ..................................................................................................................................................... 82
HISTOPLASMOSIS .................................................................................................................................................... 82
ASPERGILLUS........................................................................................................................................................... 83
MUCOR ................................................................................................................................................................... 83
MADURELLA ............................................................................................................................................................ 84
SPOROTRICHOSIS .................................................................................................................................................... 84
CHROMOBLASTOMYCOSIS...................................................................................................................................... 84
PROTOZOA .................................................................................................................................................................. 84
GENERAL FEATURES OF PROTOZOA ....................................................................................................................... 84
ENTAMOEBA HISTOLYTICA ..................................................................................................................................... 85
AMOEBIC MENINGOENCEPHALITIS ........................................................................................................................ 86
GIARDIA................................................................................................................................................................... 86
LEISHMANIA............................................................................................................................................................ 86
TRYPANOSOMA....................................................................................................................................................... 88
TOXOPLASMA.......................................................................................................................................................... 89
BABESIOSIS.............................................................................................................................................................. 90
CRYPTOSPORIDIOSIS ............................................................................................................................................... 90
ISOSPORA ................................................................................................................................................................ 90
CYCLOSPORA ........................................................................................................................................................... 90
BALANTIDIUM COLI................................................................................................................................................. 90
FEATURES OF PLASMODIUM .................................................................................................................................. 91
FEATURES OF MALARIA .......................................................................................................................................... 92
EPIDEMIOLOGY OF MALARIA .................................................................................................................................. 93
DIAGNOSIS OF MALARIA ......................................................................................................................................... 93
TREATMENT OF MALARIA ....................................................................................................................................... 93
HELMINTHS ................................................................................................................................................................. 95
GENERAL FEATURES OF HELMINTH ........................................................................................................................ 95
CLONORCHIS ........................................................................................................................................................... 96
DIPHYLLOBOTHRIUM LATUM ................................................................................................................................. 96
FASCIOLA HEPATICA................................................................................................................................................ 96
FASCIOLOPSIS BUSKI ............................................................................................................................................... 96
ASCARIS................................................................................................................................................................... 97
TAENIA SOLIUM ...................................................................................................................................................... 97
NEUROCYSTICERCOSIS ............................................................................................................................................ 97
TAENIA SAGINATA................................................................................................................................................... 98
ECHINOCOCCUS ...................................................................................................................................................... 98
FEATURES OF FILARIASIS......................................................................................................................................... 99
MANAGEMENT OF FILARIASIS .............................................................................................................................. 100
ENTEROBIUS.......................................................................................................................................................... 100
TRICHINELLA ......................................................................................................................................................... 100

GUINEA WORM ..................................................................................................................................................... 101
STRONGYLOIDES ................................................................................................................................................... 101
SCHISTOSOMA ...................................................................................................................................................... 101
TRICHURIS ............................................................................................................................................................. 102
HOOKWORM......................................................................................................................................................... 102
KEY TO THIS DOCUMENT
Text in normal font – Must read point.

Asked in any previous medical entrance
examinations
Text in bold font – Point from Harrison’s

text book of internal medicine 18th
edition
Text in italic font – Can be read if

you are thorough with above two
CULTURE AND STERILISATION
CULTURE
Father of medical microbiology Robert Koch

Exceptions to Koch’s postulates M.leprae, T.pallidum, N.gonorrhea, E.coli
(cannot be grown in cell free media also)
NOT true about Koch’s postulates Antibiotics cure the disease
Resolution provided by light microscope 200 nm
Magnification of electron microscope up to 1,00,000
Ultraviolet source is used in Fluorescence microscope
Nutrient broth is Basal media
Fastidious organisms are grown by Enrichment media
McConkey’s agar medium is Differential media
NOT a selective media Blood Agar
A substance when added to culture causes inhibition of Bacteriostatic
multiplication but on removal causes enhanced growth
In patient with UTI CLED cysteine lactose electrolyte Promotes growth of staphylococcus aureus and candida
deficient media is preferred over McConkey media
because
pH of Sabroud’s dextrose agar adjusted to 4-6
Intracellular Virus, Chlamydia, Rickettsia
Organisms can NOT be cultured in cell free medium Treponema pallidum, Pneumoystis jiroveci,
Rhinosporidium seeberi
Does NOT grow in cell free media M. leprae, Rickettisa, T. pallidum
Viable non cultivable is used for M.leprae, Treponema pallidum
NOT a method of cultivation of viruses Chemically defined media
Organism cannot be cultured Pneumocystis jiroveci, Rhinosporidium
seeberi
STERILISATION
Asepsis means Absence of pathogenic microbes

Process of destroying all microbes including spores Sterilization
NOT a complete sterilization Sodium hypochlorite
Most resistant to antiseptics Prion
Decreasing order of resistance to sterilization Prions, bacterial spores, bacteria
Sterilization of prion Heating at 134*C for 5 hours, 2N
concentration NaOH
Reliably used for hand washing Chlorhexidine, Isopropylalcohol, Cresol
Savlon contains Cetrimide + chlorheximide
Algae growth in water controlled by Bleaching powder
NOT true about Phenol Phenol require organic matter to act
Sporicidal agents Glutaraldehyde, Formaldehyde, Ethylene oxide,
Halogens
Sporicidal Glutaraldehyde, Formaldehyde, Chlorine dioxide
Spores of bacteria are destroyed by Autoclaving at 120*C for 15 mins

Glutaraldehyde is Sporicidal
Hypochlorites are Virucidal
Principle of autoclave Denaturation and Protein coagulation
Autoclaving is done at 120 degree Celsius for 30 minutes
Operating temperature in a ethylene oxide sterilization 49-63 degree Celsius
during warm cycle
Used as control during plasma gas sterilization Bacillus stearothermophilus
Radiation can be used to sterilize Bone graft, artificial tissue graft, suture
Rays used for Cold sterilization UV rays
Endoscope disinfected by 2% glutaraldehyde for 20 minutes
Proctoscope is sterilized by Glutaraldehyde
Heat labile instruments such as plastic syringes Ethylene oxide
sterilized by
Plastic syringes are sterilized by Ionising radiation
Glassware and syringes sterilized by Hot air oven
Lippe’s loop is sterilized by 1/2500 solution of iodine
Infant feeding bottle is sterilized by Sodium hypochlorite
Egg containing culture media are Tyndallisation
sterilized by
Best method for sterilizing liquid paraffin Dry heat
Oil and grease are sterilized by Hot air oven
Culture media sterilized by Autoclaving
Vaccines are sterilized by Seitz filter
Sterilization method for catgut suture Radiation
Surgical instruments are sterilized by Radiation
Heat labile instruments for use in surgical procedures Ethylene oxide gas
can be best sterilized by
Heart Lung machine is sterilized by Ethylene Oxide gas
Operation theatre is sterilized by Formaldehyde gas
In operation theatre, by using filter of 5 200 CFU/m3
mm pore size with 20 air changes and
adequate ventilation, bacterial count can
be reduced to
NOT a best way to sterilize sputum Chlorhexidine
Hospital waste are disposed by Incineration
Best method to sterilize by dry heat Hot air oven
Gamma radiation are used for sterilizing Syringes
Irradiation NOT used to sterilize Bronchoscope
DISINFECTION
Disinfectants Hypochlorites are bactericidal and inactivated by

organic matter, glutaraldehyde is sporicidal and NOT
inactivated by organic matter, formaldehyde is
bactericidal, sporicidal and virucidal
Disinfectant destroys All harmful microbes but not spores
NOT true about disinfectants Phenol usually requires organic matter to act
Rideal and walker coefficient is employed for Germicidal power of disinfectant
BACTERIAL GENETICS 11
assessment of
Standard against which disinfectants are measured Phenol
Disinfection of water by routine chlorination can be Precurrent disinfection
classified as
Precurrent disinfection Hand washing, pasteurization of milk,
chlorination of water
Chlorine exerts disinfectant action in Bleaching powder, Halozone tablets, Sodium
hypochlorite
Required amount of bleaching powder necessary to 50 gm/lit
disinfect choleric stools
Disinfection of sputum by Boiling, autoclaving, burning, cresol
Disinfectant used for blood spills Sodium hypochlorite
Most powerful chemical disinfectant Lysol
Ethylene oxide is an Intermediate disinfectant
Disinfectant acting by causing plasma membrane Ammonium compounds
damage
Castellani’s paint for disinfecting skin Phenol, resorcinol, basic fuschin, boric
contains acid, acetone
Frequency of microwaves for disinfection 2450 MHz
Sputum can NOT be disinfected by Chorhexidine
NOT true about spaulding’s criteria Semi critical items need low level disinfection
NOT an disinfectant 100% alcohol
NOT a test to test the efficiency of disinfectant Hugh Leifson test (to differentiate micrococci from
staphlococci)
Most likely cause of infection after Clostridia
disinfection procedure that killed
vegetative cells but does not kill spores
BACTERIAL GENETICS
GENERAL FEATURES OF BACTERIA
Smallest size that can be seen by naked 200 micron

eye
Smallest size that can be seen by light 0.3 micron
microscope
Smallest size that can be seen by electron 10^(-4) micron
microscope
Dye used in fluorescent microscopy Auramine
Total number of microbes 10^30
Rearing of animals under sterile conditions Gnotobiotics
Prokaryotic organism have DNA without Nucleus
Prokaryotes refers to organism with Chromosome
Prokaryotes are characterized by Absence of nuclear membrane
Prokaryotes have DNA
Prokaryotic counterpart of mitochondria Mesosomes
Prokaryotic DNA differ from eukaryotic organism by No complex with proteins

Muramic acid is present in Prokarytoes
Steroids are present in Eukaryotes
Doth DNA and RNA found in Bacteria
Absent in bacteria Mitochondria
Bacteria lacks in Sterol
Bacterial flagella confers Specific antigenecity
Lophotrichous Tuft of flagella at one pole
Dark ground microscopy used to see Flagella
Peritrichous flagella E.coli, salmonella, proteus, listeria,
bacillus, clostridium
Peritrichous flagella is NOT seen in Vibrio cholera
Bacteria growing between 25 – 40 * C Mesophilic
Bacterial genome completely recognized for H.pylori
Lyophilisation means Preserving microorganisms
Bacteriocins are Antibiotic like substance produced by Coliform bacteria
Dipicolinic acid is found in Spores
Few gram negative organisms inject toxin directly to host Type III secretion (Salmonella, Yersinia, Pseudomonas)
target cells by means of complex set of proteins
Should NOT be refrigerated before primary inoculation CSF
Gold standard for bacterial strain analysis Pulsed field gel electrophoresis
GRAM POSITIVE AND GRAM NEGATIVE ORGANISMS
GRAM POSITIVE GRAM NEGATIVE

2 layers (inner cytoplasmic membrane, 3 layers (inner cytoplasmic membrane,
outer thick peptidoglycan) thin peptidoglycan, LPS)
Low lipid High lipid
No endotoxin except listeria Endotoxin
monocytogenes
Teichoic acid Aromatic aminoacids, indole ring (eg.
Cholera), periplasmic space, porin channel,
resistant to penicillin and lysozyme attack
Associated with protein F Associated with Pili, Fimbriae
LIGAND AND HOST RECEPTORS FOR MICROORGANISMS
ORGANISM LIGAND HOST RECEPTOR

P. falciparum Erythrocyte binding protein – 175 Glycophorin A
P. vivax Merozoite Duffy antigen
E. histolytica Surface lectin N – acetyl glucosamine
Influenza Hemagglutin Sialic acid (N – acetylneuramic acid)
Mealses Hemagglutin CD 46/mosein
HSV Glycoprotein C Heparin sulphate
MULTIPLICATION OF BACTERIA
Phase of bacterial growth during which growth rate of Stationary phase

bacteria is constant
Sporulation occurs in Stationary phase
Sporulation does NOT occur in Live organisms
A bacterium can divide every 20 minutes. how many 512
bacteria will be there if there is exponential growth for
3 hours
Substance when added to a culture causes inhibiton of Bactericidal
multiplication but on removal enhanced growth
Area of Lysis produced by Bacterial Lawn Culture Plaque
True about bacteriophage It imparts toxigenicity to bacteria
Lambda phage In lysogenic phase it fuses with host chromosome and
remain dormant, in lytic phase it fuses with host
chromosome and replicates, in lytic phase it cause cell
lysis and releases virus particles
Lytic phase of bacteriophage is an Type C response
example for
NOT true about lambda phage Lytic and lysogenic phase occur together
Bacteriophage is Virus that invade bacteria
Bacteriophage replication occurs through Transduction
BACTERIAL RESISTANCE
Bacteria may acquire characteristics by Taking up soluble DNA fragments across their cell wall,
through bacteriophage, through conjugation
Antibiotic resistance MC mechanism is production of neutralizing enzymes
by bacteria, Complete elimination of target is the
mechanisms by which enterococci develop resistance to
vancomycin, Alteration of target lesions lead to
development of resistance in pneumococci, Drug
resistance commonly acquired horizontally
Bacterial drug resistance in tuberculosis is via Mutation
MDR acts by Cause efflux of drug
Tranferable resistance High degree of resistance, Involves resistance to
multiple drug, Plasmids play a role
F factor integrates with bacterial chromosome to form Hfr
Ability to form or grow in multicellular masses Biofilm
Phenomenon responsible for antibiotic resistance in Biofilm formation
bacteria due to slime production
Bacteria can NOT acquire characteristics by Incorporating part of host DNA
NOT true about antibiotic resistance Plasmid mediated antibiotic resistance is always
transmitted vertically
Not used to introduce genome into the bacteria FISH
NOT true about Bacteriophage It transfers only by chromosomal gene
Does NOT transfer drug resistance Hfr
Organ of attachment of bacteria Fimbriae
Surface appendage of bacteria function as organ of Fimbriae

adhesion
Organ of bacterial adherence Pili
Phage typing is used as an epidemiological Staphylococcus aureus, Vibrio cholera,
tool for Shigella dysenteriae
Phage typing is NOT useful in Salmonella
Phage typing NOT used as an epidemiological tool in Streptococci
Segment of DNA between chromosomal and Transposons
extrachromosomal DNA molecules within the cell
Jumping gene Transposons
Horizontal transfer of R factor occurs from one bacteria Conjugation
to other
Multidrug resistance is transmitted through Conjugation
Transmitted through pili Conjugation
Conjugation does NOT involve Bacteriophage
Free DNA across cell membrane transferred by Transformation
Transformation is seen in Bacillus, hemophilus, pneumococcus
Virus mediated transfer of host DNA from one cell to Transduction
another is known as
In transduction, DNA transmitted by vector belongs to Bacteria
Plasmid Transferred by conjugation, mediate drug resistance,
determine pili production
Plasmid Involved in conjugation and multidrug resistance
transfer, Imparts capsule and pili formation, Eliminated
by heating with radiation, Transmission of different
species, Can cause lysogenic conversion
Drug resistance most commonly transmitted by R.Plasmid
Plasmid is responsible for Drug resistance
NOT true regarding plasmid Extrachromosomal
Process of host gene transfer through F Sexduction
factor
E strip method is used for Minimum inhibitory concentration
BIOTERRORISM AND VESICANTS
Category A bioterrorism agents Anthrax, Botulism, plague, small pox, tularemia, viral
hemorrhagic fever
Category B bioterrorism agents Brucellosis, Epsilon of clostridium perfringens, Glanders
(Burkholderia mallei), Melidiosis, Psittacosis, Q fever,
Ricinus communis, Straphylococcal enterotoxin B, Typhus
fever, viral encephalitis, food safety threat, water safety
threat
Category C bioterrorism agents Nipah, Hanta, SARS and emerging infections
Strain used in anthrax bioterrorism Ames strain
Vesicants Mustard, lewisite, phosgene
Vesicants Mechlorethamine, vincristine,
doxorubicin, BAL, phosgene oxime
Treatment of mechlorethamine induced Thiosulphate
vesicles
BACTERIOLOGY 15
Treatment of vincristine induced vesicles Hyaluronidase
BACTERIOLOGY
GENERAL FEATURES OF BACTERIA
Bacteria Mitochondria always absent, Divide by binary fission

Bacteria does NOT divide by binary Chlamydia, Spirochete (Transverse fission,
fission Complex fission)
Bacterial cell wall is composed of Muramic acid, glucosamine, mucopeptide
Zwitter ionic pattern of capsular Abscess formation
polysaccharide is responsible for
Responsible for inherent virulence of organism Adhesion, capsule, lipids
Bacteria survive intracellularly by inhibiting Formation of phagolysosome
Shape of Cocci Spherical
Normal microbial flora Can NOT be eradicated by antimicrobial agents
Normal bacterial flora Established only after neonatal period
Pharyngoscleroma is a Bacterial Disease
Difference between gram positive and gram negative Aromatic amino acids
organisms is that gram negative organisms contain
Steps in gram staining Crystal violet, iodine, decolorisation,
safranin
Gram’s stain is NOT useful in diagnosing Streptococcal pharyngitis
Which is NOT present in gram negative bacteria Teichoic acid
NOT gram negative Acinetobacter
Acid fast organisms Mycobacteria, Nocardia, Spores, Isospora,
Cryptosporidium, Cyclospora
Acid fast organisms Legionella, eggs of tenia saginata, head of
sperm, rhodococcus
Bipolar staining Hemophilus ducreyi, Yersinia pestis,
pseudomonas mallei, pseudomonas
pseudomallei, campylobacter
granulomatis
Craige’s tube differentiates Motile and non motile
Non motile organism Klebsiella
Darting motility V.cholera, Campylobacter jejuni
Stain not taken by capsule if it contains Polysaccharide, protein
Capsulated organism Klebsiella, Cryptococci
Polysaccharide capsule related antigen antibody Pneumococcus, Meningococcus, Hemophilus influenza
responses present in
Pigment produced by serratia Prodigiosin
Safety pin appearance Chlamydia, hemophilus ducreyi
Organism arranged in cubical pocket of Sarcina
eight cocci
Bacteremia is associated with Pneumococci, staphylococci, E.coli
BACTERIOLOGY 16
Toxins inhibiting protein synthesis Verotoxin of E.coli, Shigella toxin,

Exotoxin A of pseudomonas
Toxins mediated by cAMP Vibrio cholera O1, Vibrio cholera O137,
Heat labile E. coli toxin
Heat stable E. coli toxin is mediated by cGMP
Heat labile toxin is mediated by cAMP
Obligate aerobe Superoxide dismutase (SOD), peroxidase
(POD) and catalase present
Obligate anaerobe SOD, POD, catalse negative
Facultative anerobe Two enzymes present, one absent
Facultative aerobe One enzyme present, two absent
Ratio of anaerobe to aerobe in stool 1000:1
Anaerobes grow in CDC anerobic blood agar
Obligatory anerobes Clostridium botulinum, Bacteroides
Bacteroides fragilis Frequent anaerobe isolated from clinical samples, NOT
uniformly sensitive to metronidazole, LPS formed by
bacteroides fragilis is structurally and functionally
different from conventional endotoxin
Bacteroides fragilis Gram negative anaerobic non sporing bacillus
Bacteroides may cause Peritonitis
Bacteroides cause Carbuncle, peritonitis, necrotizing fasciitis
Bacteroides melaninogenica is associated Red fluorescence when exposed to UV
with light
Bacteremia due to bacteroides fragilis do NOT cause Shock and DIC
NOT useful in anaerobic infection Penicillin
Drug of choice for bacteroides infection Metronidazole
Meleney gangrene Anaerobic bacterial synergistic gangrene
PAPA Pyoderma gangrenosum, acne, septic pyogenic arthritis
Exotoxins are Highly antigenic
Exotoxin Heat labile, by both gram positive and
gram negative organisms
NOT true about exotoxins Heat stable
Endotoxin from gram negative organism Lipopolysaccharide
Gram negative bacteria without endotoxin Cholera
Act by increasing c-AMP level Proteus, E.Coli, Vibrio cholera
Heat labile toxin is associated with cAMP
Heat stable toxin is associated with cGMP (exception S.aureus – vagal action)
Preformed toxin is important in food poisoning due to S.aureus, Clostridium botulism, emetic type of B.cereus
Preformed toxin Longer incubation period
Heat stable enterotoxin Staphylococcus enterotoxin, enterotoxin of
klebsiella pneumonia, emetic type of
bacillus cereus, ST of ETEC, Yersinia
enterocolitic toxin, Clostridium botulinum
toxin
Diarrhea type of Bacillus cereus Heat labile
Heat stable enterotoxin causing food poisoning Bacillus cereus, Yersinis enterocolitica, Staphylococcus
produced by
Food poisoning with shortest incubation period Staphylococcus aureus
BACTERIOLOGY 17
Stool examination is required for diagnosis of infection Staphylococcal food poisoning, Clostridia, Shigella,
with Campylobacter, Enterobius vermicularis
Pus cell in diarrhea seen in Shigella, campylobacter
Microorganisms invading GIT causing gasteroenteritis Shigella, Vibrio parahemolyticus, Campylobacter,
Salmonella
Biosafety precaution grade III is followed in Human influenza virus, Coxiella burnetti,
Mycobacterium tuberculosis
Organism known to survive intracellularly N.meningitits, Salmonella typhi, legionella
pneumophilia
Intracellular organisms Virus, Chlamydia, rickettsia
Obligatory intracellular Chlamydia
Obligate intracellular parasites Prions, virus, rickettsia, chlamydia
Rhabdomyolysis is associated with Clostridium perfringens, Streptococcus, Clostridium
tetani
F fever Spirillium minus, Leptospira canicola, streptobacillus
moniliformis
Sodoku Spirillum infection
Rat bite fever is caused by Spirillum minus
Rat bite fever is caused by Streptobacillus moniliformis
Haverhill fever is caused by Streptobaciilus moniliformis
Strongly urease positive H.pylori > Proteus
Urease positive bacteria Proteus, klebsiella, staphylococci
Ureaplama urealyticum Non gonococcal urethritis, epididymitis, bacterial
vaginosis
Acinetobacter baumannii Combat related infection in Iraq and Afghanistan, resistant,
treated with sulbactam, carbopenem resistant
Acinetobacter baumannii is treated with colistin and
polymyxin
Superinfection is common with Immunocompromised host
Treatment for aeromonas infection Ciprofloxacin
Treatment for chrysobacterium infection Fluoroquinolones
FEATURES OF STAPHYLOCOCCUS
Staphylococcus aureus 30% of population is healthy nasal carriers,

epidermolysin and TSS toxin are superantigens,
methicillin resistance is chromosomally mediated
Staphylococci Majority of infection caused by coagulase negative
staphylococci are due to staphylococcus epidermidis.
beta lactamase production in staphylococci is under
plasmid control, methicillin resistance in staphylococcus
aureus in independent of beta lactamase production
Staphylococcus Gram positive, blood agar, clear zone of
hemolysis, coagulase positive,
pathogenicity is indicated by coagulase
positivity
Important virulent factor in Coagulase
staphylococcus aureus
Abnormal neutrophil function is Staphylococcus aureus
BACTERIOLOGY 18
associated with recurrent infections

caused by
Antibody marker in serum for staphylococcal Antiteichoic acid
endocarditis
Staphylococcus remains in skin for longer period Hyaluronidase
because of
MC human staphylococcus aureus infection is due to 5,8
capsular subtype
MC mechanism of drug resistance in Staphylococcus Transduction
Staphylococcus aureus differs from staphylococci S.aureus is coagulase positive
epidermidis by
Differentiation of staphylococcus aureus from other Coagulase test
staphylococci
Protein A is the component of cell wall of Staphylococci
NOT true about Staphylococcus aureus Most common source of infection is by cross infection
from infected patients
NOT true about staphylococcus Catalase negative
Methicillin resistance Chromosomally mediated
Methicillin resistant bacteria are Staphylococcus
Resistance in MRSA is produced by Alteration in penicillin binding protein (MeCA gene)
Methicillin resistance by Staphylococci is expressed 30 degree Celsius
when incubated at
MRSA resistance Resistance may be produced because of
hyperproduction of beta lactamase, expression of
resistance is enhanced by incubating at 37*C during
susceptibility testing
MRSA resistance primarily mediated by Chromosomal MecA gene
Infections caused by community acquired MRSA Necrotizing fasciitis, necrotizing pneumonia, sepsis with
Waterhouse Friedrichson syndrome, Purpura fulminans
Streptococcal gangrene is same as Necrotizing fasciitis
Drug of choice for MRSA Vancomycin, Teichoplanin, Linezolid
Drug of choice for MRSA Quinupristin/dalfopristin, Linezolid, Teicoplanin
Drug of choice for MRSA Teicoplanin
Useful for MRSA Cotrimoxazole, Ciproflaxacin, Vancomycin
MRSA infection in ward. Best way to control infection Vancomycin given empirically to all patients
Drug of choice for MRSA Glycopeptides
MRSA NOT expected to respond to Carbapenem
NOT used for MRSA Cefaclor
SPECIES OF STAPHYLOCOCCUS
Staphylococcus aureus differ from staphylococcus Coagulase positive

epidermidis by
ICU on CVP line, gram positive cocci, catalase positive Staphylococcus epidermidis
and coagulase negative
MC gram positive cause of UTI among sexually active Staphylococcus saprophyticus
women
Gram positive cocci Staphylococcus saphrophyticus cause UTI in female.
micrococci are oxidase positive, pneumococci are
capsulated
BACTERIOLOGY 19
Novobiocin susceptible staphylococci Staphylococcus hemolyticus, Staphylococcus

epidermidis
DISEASES CAUSED BY STAPHYLOCOCCUS
Oppurtunistic infection most commonly seen in children Staphylococcus

with neutropenia
MC cause of surgical wound infections Staphylococcus aureus
MC caue of pyopneumothorax and Staphylococcus
pyopericarditis in infants
Botryomycosis is caused by Staphylococcus aureus
Pedal botyromycosis is caused by Staphylococcus aureus
Staphylococci can cause Furuncle, sycosis barbae
Pyomyositis is caused by Staphylococcus aureus
Postoperative parotitis is caused by Staphylococcus aureus
Lymphangitis is caused by Staphylococcus
Common cause of acute borne infections Staphylococcus aureus
Ritter’s disease is caused by Staphylococcus aureus
A boil in staphylococcal infection of Hair follicle
Carbuncle caused by Staphylococcus
Carbuncle are common in Lower neck
Carbuncle is treated by Incision and drainage
MC cause of epidural abscess Staphylococcus aureus
MC cause of sepsis in India within 2 months Coagulase positive staphylococci aureus
Right sided endocarditis in IV drug abusers Staphylococcus aureus
MC cause of primary bacterial infection Coagulase negative staphylococci
MC cause of endocarditis in prosthetic valve Coagulase negative staphylococci (Staphylococcus
replacement within one year epidermidis)
MC catheter induced blood infection due to Coagulase negative staphylococci
Non coagulase staphylococci Infect indwelling prosthesis
Toxic shock syndrome is due to Forgotten tampon
Toxic shock syndrome is caused by Clostridium sordelli (endometrium)
Toxic shock syndrome caused by Infected measles vaccine
Toxic shock syndrome is associated with Large amount IL-2
Toxic shock syndrome is mainly caused by Staphylococci
TOXINS OF STAPHYLOCOCCUS
Superantigens Epidermolysin, TSS toxin

Staphylococcus infection spreads by Hyaluronidase
Synergohymenotrophic toxin of staphylococci consists Gamma toxin, Panton valentine toxin
of
Panton valentine leucocidin toxin is associated with Necrotizing fascitis
Panton valentine (leucocidin) toxin is Furunculosis
associated with
Hot cold phenomenon in staphylococcus is due to Beta hemolysin
Staphlococcal toxic shock syndrome is due to Enterotoxin B and Enterotoxin C (heat stable)
Ritter’s syndrome is caused by Exfoliative toxin
BACTERIOLOGY 20
Toxin responsible for SSSS Exfoliative toxin

NOT a toxin of staphylococcus Erythrogenic toxin
STAPHYLOCOCCAL FOOD POISONING
Staphylococcal food poisoning Optimal temperature for formation of toxin 37* C,

intradietetic toxins are responsible for intestinal
symptoms, incubation period 1-6 hours
Incubation period of Staphylococcal food Poisoning 1-6 hours
Staphylococcus in stool occurs in Staphylococcal food poisoning
Food poisoning within 6 hours of intake of milk is Staphylococcus aureus
caused by
Vomiting and diarrhea within few hours after taking Staphylococcus
food
MC cause of food poisoning Staphylococcus aureus
Gastroenteritis 4 to 6 hours after consumption of food Staphylococcus aureus
Mechanism of vomiting in Staphylococcal food Vagal stimulation
poisoning
NOT true about staphylococcal food poisoning Fever common
NOT true about staphylococcal food poisoning Toxins can be destroyed by boiling for 30 minutes
FEATURES OF STREPTOCOCCUS
Differentiation of streptococci from staphylococci Catalase test

Streptococci M protein responsible for virulence, mucoid colonies
are virulent, no resistance to penicillin has been
reported
Streptococci Streptodornase cleaves DNA, Streptolysin O is active in
reduced state (oxygen labile)
Lancefield group of streptococci is done using Group C carbohydrate antigen
Lancefield group A contains Streptococcus pyogenes alone
PYR positive Enterococcus, streptococcus pyogenes
Lancefield classification based on Carbohydrate antigen
Streptococcus pyogenes is classified on the basis of M protein
Mainly responsible for virulence in streptococci M protein
Nephritogenic strain of Streptococci identified by M typing
Classification of pathogenic streptococci into group Antigenicity of cell wall carbohydrate
A,B,C,D,G is based on
Streptococcus pyogenes with type 12 M protein cause Soft tissue infection resembling TSS of Staphylococcus
Micrococci are Oxidase positive
A child had a skin infection, a catalase negative Skin infection by group D
organism was isolated which showed haemolysis
andwas sensitive to bacitracin. Another doctor isolated
a similar organism from the throat of the child. The
correct statement is
Boy with skin ulcer on leg reveals beta hemolysis. Sore C carbohydrate antigen is same
throat culture also revealed beta hemolysis. Similarity is
Infective skin lesions of leg in infants, gram positive Bacitracin sensitivity
BACTERIOLOGY 21
chain cocci, hemolytic colonies. Test identifying

organism
Differentiation of group A streptococci from other beta Bacitracin test
hemolytic streptococci
Component of streptococci pyogenes having cross Capsular hyaluronic acid
reactivity with synovium of human
Mucoid colonies Virulent but M protein is NOT responsible
for production of mucoid colonies
Function of adherence factor for Lipoteichoic acid of streptococcus pyogenes
colonization of mucous membrane
Mucoid colonies are due to production of Capsule of hyaluronic acid
Antistreptolysin titre Low in acute glomerulonephritis
Streptokinase is produced from Serotype A,C,K
NOT true about streptococcus Pyrogenic toxin A is plasmid mediated
Transport medium for streptococci Pike’s media
SPECIES OF STREPTOCOCCUS
Streptococci with no lancefield antigen Viridans group, pneumococci

classification
A patient with RHD developed infective endocarditis Streptococcus viridians
after dental extraction. Most likely organism
Causative organism of late prosthetic valve endocarditis Streptococcus viridans
Features of streptococcus viridans Negative quellung test, negative inulin
fermentation, negative bile solubility,
intraperitoneal inoculation in mice is non
pathogenic
Streptococcus causing dental caries Streptococcus mutans
Bacteria causing neonatal meningitis, shows beta Streptococcus agalactiae
hemolysis, bacitracin resistance, CAMP positive.
Meningitis acquired through birth canal is due to Streptococcus agalactiae
Child presents with sepsis. Beta hemolysis on blood S.agalactiae
agar, resistance to bacitracin and positive CAMP test.
Streptococcus pneumonia is Alpha hemolytic
MC cause of meningitis in 1 year old child Group B streptococcus
Group B streptococcus produce CAMP factor
Group B streptococcus Cause neonatal meningitis, hydrolyse
hippurate
Pathogenesis of group B streptococcal In the absence of a specific antibody,
disease in neonate opsonization, phagocyte recognition and
killing do not proceed normally
Does not affect fetus by transplacental Group B streptococcus
spread
To show identified organ group A streptococci Bacitracin sensitivity
Bacitracin sensitivity Specific for S. pyogenes
Enterococci and non enterococci belong to Group D streptococci
Streptococcus bovis grows in 40% bile
Longest streptococcal chain Streptococcus salivarius
BACTERIOLOGY 22
NOT a medically important streptococci S. salivarius
DISEASES CAUSED BY STREPTOCOCCUS
Causative agent of subacute bacterial endocarditis is Blood agar

cultured in
MC cause of Subacute bacterial endocarditis Streptococci
MC organism causing cellulitis Streptococcus pyogenes
Streptococcus pyogenes Bacitracin sensitive
Impetigo contagiosa is caused by Group A beta hemolytic streptococci
Necrotizing fasciitis Infection of fascia and subcutaneous tissue, MC group A
beta hemolytic streptococci, surgical debridement is
mandatory
Erysipelas is caused by Beta hemolytic Streptococci
Erysipelas Peu de orange texture
Primary pyomyositis is caused by Streptococcus pyogenes
Erythema marginatum can be caused by Streptococcus pyogenes
Millian sign Erysipelas
NOT true about erysipelas Contagious and infectious, Common in tropics
Group A Streptococcus does NOT cause Epidermolysis bullosa
Group B cause Neonatal meningitis
Group D cause UTI
MC agent responsible for human bite infections Anerobic streptococci
Infection caused by anaerobic gram positive cocci Puerperal infection
Chronic burrowing ulcer Microaerophilic streptococci
Drug of choice for sore throat caused by group A beta Penicillin
Used in prophylaxis of streptococcal sore throat Injection benzathine penicillin
Treatment of streptococcal necrotizing Debridement, penicillin, clindamycin
fasciitis
TOXINS OF STREPTOCOCCUS
Toxin produced by S.pyogenes Streptolysin O, Erythrogenic toxin, Hyaluronidase

Toxin of streptococcus causing hemolysis Streptolysin S
Toxin involved in streptococcal toxic shock syndrome Pyrogenic exotoxin
Streptococcal toxic shock syndrome is due M protein
to
Antigenically similar to Streptolysin O Clostridium perfringens toxin, Tetanolysin
Streptolysin O is inactivated by Oxygen
Post streptococcal infection is best diagnosed by Streptozyme test
Serological marker for retrospective diagnosis of Anti DNAase antibody
infection due to streptococcus pyogenes
Streptococcal glomerulonephritis is best diagnosed by Anti-DNAase, Anti-hyaluronidase
Enterotoxin is NOT produced by Streptococcus pyogenes
BACTERIOLOGY 23
CROSS SENSITIVITY OF STREPTOCOCCAL ANTIGEN
Capsular hyaluronic acid Synovial fluid

Group A carbohydrate antigen Cardiac valves
Cytoplasmic membrane antigen Vascular intima
Cell wall protein Myocardium
Peptidoglycan Skin antigen
ENTEROCOCCUS
Enterococcus Common species are enterococcus fecalis and

enterococcus faecium, cause for peritonitis, cause for
intrabdominal abscess
Beta hemolytic bacteria resistant to vancomycin, Enterococcus
growth in 6.5% NaCl, Non bile sensitive
ICU, central venous line 1 week, ceftazidime and Enterococcus fecalis
amikacin. Spike of fever, blood culture positive for gram
positive cocci in chains catalase negative. Vancomycin
started culture remained positive even after 10 days of
therapy
Organism when isolated in blood require synergistic Enterococcus fecalis
activity of penicillin plus an aminoglycoside for
appropriate therapy
Intrabdominal abscess. Vancomycin, gentamycin, Enterococcus fecalis
ampicilin resistant. Grows well in presence of 6.5% NaCl
and arginine. Bile ascenlin hydrolysis is positive
Treatment of enterococcus infection Ampicillin
Drugs approved for vancomycin resistant enterococci Linezolid, Quinopristin/Dalfopristin
Enterococcus resistance Chromosomally mediated
PNEUMOCOCCUS
Discovery of gene transformation come Streptococcus pneumonia

from study of
Most virulent type of pneumococci Type 3
Pneumococcus Capsule aids in virulence, commonest cause of otitis
media, respiratory tract carriers are most common
source of infection
Pneumococci Pneumolysin is a thiol activated toxin, exerts a variety
of events on ciliary and PMN’s action, Autolysin can
contribute to pathogenesis of pneumococcal disease by
lysing bacteria, Anticapsular antibodies are serotype
specific
Streptococci pneumonia Bile insoluble and optochin sensitive
Streptococcus pneumonia Alpha hemolytic, greenish color on blood agar due to
reduction of iron in hemoglobin
Enolase binds to Fibronectin
BACTERIOLOGY 24
Griffith demonstrated biotransformation with Pneumococcus

Property demonstrated by Griffith with experiments on Transformation
mice using Pneumococcus
Virulence in pneumococci due to Capsular polysachharide
Thiol activated toxin Pneumolysin
Orbital cellulitis, greenish colonies and Optochin Pneumococcus
sensitivity
8 year old child, pain and discharge from ear, fever neck Pneumococcus
rigidity and positive Kernig’s sign. gram positive cocci
Austrian syndrome Triad of meningitis, pneumonia and
endocarditis. Caused by Streptococcus
pneumonia
Differentiation of pneumococci from other alpha Optochin test
High grade fever respiratory distress at the time of Optochin
presentation. Alpha hemolytic colonies. gram positive
cocci, susceptible to
65 year male, chest pain, fever, cough with sputum. Bile solubility
Gram positive cocci. Blood agar positive result.
differentiate this from other gram positive cocci
Sputum of 70 years old male cultured on 5% sheep Gram positive cocci in pairs, catalase negative bile
blood agar. alpha hemolytic colonies next day soluble
Draughtsman colonies Pneumococci
Quellung phenomenon is due to Capsular swelling (Pneumococcus)
MC infection after splenectomy Pneumococcal
MC cause of pyogenic meningitis in 6 months to 2 years Streptococcus pneumonia
of age
NOT true about pneumococci Virulence of pneumococci depend only on production
of capsular polysachharides
NOT true about pneumococci Catalase positive
Prevention of pneumococcal infection in HIV Pneumococcal vaccine
GENERAL FEATURES OF NEISSERIA
Neisseria is a Gram negative cocci

Most abundant gonococcal surface protein Porin
Type IV pili is associated with Neisseria
Differentiation between Neisseria gonorrhea and Maltose fermentation
Neisseria meningitides by
Complement deficiency associated with Neisseria C5-C9 (late complement)
Thayer Martin Media for Neisseria
Gas liquid chromatography Neisseria
NOT true about neisseria All strains are highly sensitive to penicillin
NEISSERIA GONORRHOEA
Features of Neisseria gonorrhea Kidney shaped, non capsulated, ferment

glucose only
BACTERIOLOGY 25
Neisseria gonorrhea Exclusive human pathogen, Some strains may cause

disseminated disease, Acute urethritis is the most
common manifestation in males, Most patients present
with symptoms of dysuria
Kidney shaped organism Gonococci
Virulence factor of Neisseria gonorrhea include Outer membrane protein, Pili, IgA1 protease
IgA1 protease is associated with Pneumococci, neisseria
Opacity associated protein is associated with Neisseria gonorrhoea
Most abundant gonococcal surface protein Porin
Neisseria gonorrhea ferments Glucose only
Incubation period of Gonorrhoea 2-8 days
Watercan perineum caused by Neisseria gonorrhea
NOT a virulence factor for Neisseria gonorrhea M protein
NOT true about Neisseria gonorrhea Highly sensitive to penicillin
NOT a metastatic complication of gonococci Nephritis
Diagnosis of gonorrhea established by Complement fixation tests
Gonorrhea can be diagnosed by Pili agglutination test
Treatment of penicillinase producing neisseria Ciprofloxacin, Cefotaxime
gonorrhea
Gonorrhea shows Marked resistance to multidrug therapy
QRNG means Quinolone resistant Neisseria gonococci
NEISSERIA MENINGITIDIS
Features of Neisseria meningitides Lens shaped, capsulated, ferments both

glucose and maltose
Intracellular gram negative diplococci Neisseria meningitides
Only reservoir meningococci Nasopharynx
Protein expressed in choroid plexus of CD46
meningeal epithelium for binding of
meningococcal endotoxin
Skin reaction in meningococcal meningitis Endotoxin
is due to
Subcutaneous injection of gram negative organism Schwartzmann reaction
evokes hemorrhagic reaction after 24 hours. On
intravenous injection of same give rise to
Neisseria meningitides is associated with IgA1 protease
NOT found in meningococci Plasmid
Female with fever, red spot on applying BP cuff Neisseria meningitis
Source of infection in menigococcus is mainly Carriers
MC cause of meningitides in children Neisseria meningitides
NOT a cause of neonatal meningitis Neisseria meningitides
Death from meningococcal disease is due to Hypovolemic shock
Prophylaxis of meningococcal infection Penicillin, sulfonamide, rifampicin
Meningococcal meningitis Disease is more common in dry and cold months,
Chemoprophylaxis of close contacts of cases is
recommended, Vaccine is not effective in children
below 2 years
Treatment of meningococcal infection Cephalosporin
BACTERIOLOGY 26
Chemoprophylaxis of meningococcal meningitis carrier Rifampicin

Vaccine against Neisseria meningitides contain Capsular polysaccharide
Meningococcal vaccines are available for A, C, Y, W135
Vaccine NOT available for Group B meningococci
GENERAL FEATURES OF CLOSTRIDIA
Sacchrolytic clostridium Cl. Welchi, Cl. Septicum

Sub terminal spores Cl.botulinium, Cl.sporogenes, Cl.sordelli
Clostridium novyi Subterminal spores
Drum stick appearance cl.tetani, cl.tetanomorphum, cl.sphenoids
Oval bulging terminal spore Cl.tertium
Tennis racket spores Clostridium difficle, clostridium tertium,
clostridium cochleum
Gas in tissue should be differentiated with Clostridium novyi
Post abortal sepsis causing renal failure is likely due to Clostridium
Toxins of Clostridium septicum Alpha – lethal, hemolytic, necrotizing. Beta – DNAase.
Gamma – hyaluronidase. Delta - septicoysin
Citron bodies Clostridium septicum
Septicemic orchitis is caused by Clostridium tertium
Management of clostridium tertium Vancomycin, metronidazole
CLOSTRIDIUM PERFRINGENS
Non motile clostridia Clostridium perfringens

Clostridium perfringens Commonest cause of gas gangrene, Normally present in
human feces, Principal toxin is alpha toxin, Gas
gangrene producing spores are NOT heat resistant,
Food poisoning producing spores are heat resistant, Gas
is invariably present in muscle compartment
Clostridium perfringens Found in intestinal tract of some healthy
patients
Clostridium welchii Capsulated, non motile, type A causes gastroenteritis
Clostridium perfringens A – food poisoning, necrotizing enterocolitis, B and D –
epsilon toxin, C – enteritis necroticans, theta toxin -
perfringolysin
Alpha toxin of clostridium perfringens Liberation of phosphoryl choline from
lecithin and hemolysis
Food poisoning in Clostridium perfringens Stimulating calcium dependent alteration
in permeability
NOT true about clostridium perfringens Gas gangrene producing strains of C.perfringens
produce heat resistant spores
NOT true about clostridium perfringens and gas Most important toxin is hyaluronidase
gangrene
NOT motile Clostridium perfringens
Opacity around colonies of clostridium perfringes Lecithinase
Nagler reaction is shown by Clostridium perfringens
Nagler’s reaction is due to Lecithinase
BACTERIOLOGY 27
Gastrointestinal enteritis necroticans caused by Cl.perfringens

Pigbel is Necrotizing enteritis
Vomiting and diarrhea 6-10 hours after party Clostridium perfringes
NOT true about necrotizing fasciitis MC site is perineum
Administration of immunoglobulins is life saving in Clostridium welchi
GAS GANGRENE
Gas gangrene is caused by Cl.perfringes, Cl.septicum, Cl.novyi, Cl.histolyticum,

cl.fallax
Toxins responsible for gas gangrene Alpha toxin, theta toxin
Clostridium perfringes causes Gas gangrene
Not a cause of Gas gangrene Clostridium difficle
Gas gangrene is NOT caused by Clostridium sporogenes
Incubation period of clostridium septicum 1-3 days
gas gangrene
Incubation period of clostridium novyi gas 4-6 days
gangrene
Foaming liver Gas gangrene
Hyperbaric oxygen is used in Gas gangrene
Best way to prevent gas gangrene Proper wound debridement
Hypotension in case of gas gangrene is treated by Ringer lactate
Treatment of gas gangrene after contaminated road IV administration of anti gas gangrene serum, Penicillin,
traffic accident Surgical debridement
Treatment of gas gangrene Clindamycin
CLOSTRIDIUM TETANI
Clostridium tetani Gram positive, Produce heat resistant spores, NO man

to man transmission
Clostridium tetani Aerobic, Gram positive, Motile
Clostridium tetani Swarming growth
Spherical and terminal bulging spore are seen in Clostridium tetani
Swarming growth of gram positive bacilli Clostridium tetani
Non flagellated Clostridium tetani Type 6
NOT true regarding clostridium tetani Seen commonly in winter and dry season
GENERAL FEATURES OF TETANUS
Cause of Localised tetanus Incomplete immunity

Tetanus is noticed usually in Wounds contaminated with fecal matter
Tetanus is due to Exotoxin bound to motor end plate
Tetanus Spread through nerve, Variable incubation period
Period of tetanus refers to time between First symptom to spasm
If incubation period of tetanus is more than 30 days Delayed
Communicable period in tetanus None
BACTERIOLOGY 28
Main site of action of tetanus toxin Presynaptic terminal of spinal cord

Premonitary symptoms of tetanus Sleeplessness, Anxious expression, Headache
Sardonic grin Tetanus
Risus sardonicus Tetanus
8 day old extensor posture Neonatal tetanus
3 day old excessive cry, suckling difficulty, umbilical Neonatal tetanus
sepsis, generalized stiffness
NOT true regarding tetanus Man to man transmission
NOT true about tetanus Neonatal tetanus develops after passage through
contaminated birth canal
Diagnosis of tetanus is made Clinically
Indicators of elimination of neonatal tetanus includes Incidence rate < 0.1/1000 live births, TT2 injection
coverage in pregnant mothers > 90%
MANAGEMENT OF TETANUS
Drug used for tetanus Metronidazole
PREVENTION OF TETANUS
Vaccine preventable neonatal disease Tetanus

Vaccine routinely indicated in pregnancy Tetanus
Maternal antibody does NOT protect neonate from Tetanus
Tetanus TT and Ig both may be given in suspected cases
Immunization 10 years age, presents with clean wound Single dose of tetanus toxoid
without laceration
A 37 weeks pregnant woman attends an antenatal clinic Give a dose of tetanus toxoid and explain to her that it
at a primary health centre. She has not any antenatal will not protect the newborn and she should take
care till now. Best approach regarding tetanus second dose after 4 weeks even if she delivers in the
immunization in this case would be meantime
Previously unimmunized against tetanus, clean non Tetanus toxoid complete course
penetrating wound sustained 2 hours before
Pregnant women, full course of tetanus immunization, 0 doses of TT
again to deliver within 11 months, she will require
No of tetanus toxoid injection to vaccinate all pregnant 60
woman in one year in a village with population of 1000
with birth rate of 30/1000 in one year
A full course of immunization against tetanus with 3 10 years
doses of toxoid confers immunity for
Booster dose of tetanus should be given 5 years
every
Neonatal tetanus best prevented by Toxoid to mother
Most effective way of PREVENTING tetanus Tetanus toxoid
NOT done to prevent tetanus Injection penicillin to all neonates
NOT a strategy for prevention of neonatal tetanus Giving penicillin to newborn
Dose of human tetanus Immunoglobulin for post 250 units
exposure prophylaxis
Best preventive measure against Tetanus Neonatorum Active immunization of mother
BACTERIOLOGY 29
Complete immunization against tetanus 10 years ago, Human tetanus globulin and single dose of toxoid
clean wound without any laceration injury sustained 2.5
hours ago
Active immunity offered by tetanus toxoid is effective 100% of patients
nearly
Administration of Tetanus antitoxin serum Neutralizes toxin
Neonatal tetanus is said to be eliminated when the rate < 0.1 per 1000
is
CLOSTRIDIUM BOTULINUM
Cl.botulinium causing human disease A (severe), B, E

Botulinium causing human disease A, B, C, F
Non neurotoxic type of clostridium Type G (enterotoxic)
botulinium
Contaminant in home canned vegetables and smoked Clostridium botulism
fish
Food poisoning associated with Clostridium botulinium
constipation instead of diarrhea
Food poisoning in canned food is due to Clostridia
Paralytic food poisoning is caused by Clostridia
Botulinum toxin acts by Closure of ca++ channels at presynaptic membrane
Most potent biological toxin Botulinium toxin
Botulinum toxin is Phage mediated
Botulinum toxin produce skeletal muscle paralysis by Inhibiting release of acetylcholine
BOTULISM
Botulism Caused by Exotoxin, Honey ingestion can cause infant

botulism, Constipation is seen, Detection of antitoxin in
serum can aid in diagnosis
Botulism Symmetric descending flaccid paralysis
Botulinum affects Neuromuscular junction, preganglionic junction,
postganglionic nerves
Feature of botulism Afebrile, Clear sensorium, Cranial nerve palsy
Feature of Botulism Diplopia, constipation, No fever, Exaggerated tendon
reflexes
Infant botulism is caused by Ingestion of spores
Type of paralysis in botulism Descending paralysis
Botulinium toxin Effective for 3-4 months, Used in treatment of
Blepharospasm, static and dynamic wrinkles, Invariably
decreased Ach in Neuromuscular junction
Most Powerful exotoxin Botulinium toxin
Botulinium toxin acts by Inhibiting release of acetylcholine
Mechanism of action of botulism toxin Complete failure of all cholinergic
neurotransmission
Non Neurotic toxin of Botulism D
Gene for botulism toxin is coded by Bacteriophage
BACTERIOLOGY 30
18 year old male, acute onset of descending paralysis 3 Botulism

days duration. blurring of vision, quadriparesis,
areflexia, both pupils NON reactive
In a 6 months old baby, floppy infant syndrome is seen Clostridium botulinum
commonly due to infection with
Disease not associated with antitoxin Botulism
antibodies in serum of recovering patients
MC cause of death in Untreated Botulism Respiratory Failure
Best sample for clostridium botulinium food poisoning Stool
NOT a feature of botulism Diarrhea
NOT true about botulism Ascending paralysis
NOT a differential diagnosis of Botulism Clostridial myonecrosis
NOT true about botulism Infant botulism is caused by ingestion of preformed
toxin
CLOSTRIDIUM DIFFICLE AND PSEUDOMEMBRANOUS COLITIS
Clostridium difficle infection is associated Prolonged antibiotic therapy,

with pantoprazole, rectal thermometer,
increase in proportion of hospital stay
Commonly associated with clostridium difficle colitis Clindamycin
Antibiotic induced colitis Clindamycin
Pseudomembranous colitis associated with Ampicillin
Pseudomembranous colitis is caused by Clostridium difficle
Clostridium difficle Normal commensal of gut
Toxins involved in Pseudomembranous colitis Toxin A (Enterotoxin), Toxin B (Cytotoxin)
Pseudomembranous colitis Organism is normal commensal of gut, treated by
vancomycin
Pseudomembrane Gram positive bacillus
Punctuate yellow exudates in colon on endoscopic Antibiotic colitis
examination
Pathological appearance in pseudomembranous colitis Small ulceration with slough
Mushroom cloud appearance of intestinal Pseudomembranous colitis
mucosa
Most sensitive test for Clostridium difficle infection Stool culture
Most specific investigation for Clostridium difficle infection Cell culture, cytotoxic test, PCR for C.difficle toxin B gene
Treatment of Pseudomembranous colitis (severe) Vancomycin
Treatment of clostridium difficle associated diarrhea Metronidazole
(mild)
Duration of antibiotic therapy for antibiotic induced 10 days
diarrhea
GENERAL FEATURES OF CORYNEBACTERIUM
Ehrlich phenomenon is seen in Corynebacterium

Multidrug resistant Corynebacterium responding only Corynebacterium jeikeium
to Vancomycin
Erythrasma is caused by Corynebacterium miniutissimum
BACTERIOLOGY 31
Alkaline encrusted cystitis is caused by Corynebacterium urealyticum

Daisy head colonies are produced by C.diphtheria gravis
MDR resistant corynebacterium sensitive to vancomycin C.striatum
CORYNEBACTERIUM DIPHTHERIA
Diphtheria Club shaped bacillary appearance, palisades, Chinese

characters
Corynebacterium diphtheria Gram positive, lysogenic phase cause
disease
Corynebacterium diphtheria Deep invasion is NOT seen, Elek gel PRECIPITATION test
is done for toxigenecity, Metachromatic granules are
seen
Corynebacterium diphtheria Iron is required for toxin production, Local reaction is
due to membrane, Systemic effects are due to toxin,
Non sporing, Non motile, Non capsulated, Toxin
production is by Lysogenic conversion
Clostridium diphtheria Organism may be identified by tests of toxigenicity,
toxin act by inhibiting protein synthesis, toxin may
affect heart and nerves
Kleb Loeffler’s bacteria (KLB) Corynebacterium diphtheria
Elek’s gel precipitation test Corynebacterium diphtheria
Non motile Diphtheria
Albert staining, Ponder’s staining Corynebacterium diphtheria
Volutin granules Metachromatic granules, seen in
mycobacteria, gardenella, diphtheria
Metachromatic granules made of Polymetaphosphate
Metachromatic granules are stained with Toluidine blue
Tellurite plates should be incubated for Atleast 2 days before considering negative
Corynebacterium diphtheria are cultured on Loeffler’s serum slope, tellurite blood agar
NOT true about corynebacterium diphtheria Toxin mediated by chromosomal gene
Does NOT produce spore Corynebacterium diphtheria
Diphtheroids Rhodococcus equi, Corynebacterium pseudotuberculosis
Preisz Nocard bacillus Corynebacterium pseudotuberculosis
Non hemolytic frog’s egg colony on Corynebacterium intermedius
cysteine tellurite blood agar
FEATURES OF DIPHTHERIA
Diphtheria Laryngeal diphtheria mandates tracheostomy, Child is

infectious with faucial diphtheria, Myocarditis may be a
complication
Diphtheria Endemic in india
Diphtheria Lysogenic conversion by β phage
Diphtheria is Toxemia
Diphtheria Incubation period 2-6 days, schick test detects
susceptibility, portal of entry is through an infective
agent
BACTERIOLOGY 32
Diphtheria susceptibility 2-5 years

Diphtheria Punched out ulcer
Bull neck adenitis Diphtheria
Bull neck in Diphtheria is due to Lymphadenopathy
The term Leather is used for Diphtheria
Type of diphtheria with highest mortality Laryngeal
Colour of diphtheric membrane is Gray
Common source of diphtheria Carriers
Incubation period of diphtheria 2-6 days
Short incubation period Diphtheria
Babes Ernst Granules associated with Diphtheria
Commonest cause of death in diphtheria Myocarditis
MC ocular complication of diphtheria Paralysis of accommodation
Single infection in diphtheria does NOT give Lifelong immunity
Diphtheria NOT associated with Rash
Diphtheria is NOT characterized by Endotoxemia
NOT a complication of Diphtheria Hepatic failure
Diphtheria toxin is a powerful Exotoxin
Diphtheria toxin inhibitis Protein synthesis (blocks elongation of protein)
Diphtheria toxin is Exotoxin, Toxin production depends on optimal
concentration of iron, Inhibiting protein synthesis,
Schick test demonstrates circulating antitoxin
Diphtheria toxin Phage mediated
Skin test based on Neutralisation reaction Schick test
Shick test does NOT indicate Carrier of diphtheria
Positive Schick test indicate that person is Susceptible to diphtheria
A negative schick test indicate Immunity to diphtheria
Immunization against diphtheria Will prevent toxemia but NOT a carrier state
Percentage of herd immunity required to prevent 70%
endemic spread of diphtheria
MANAGEMENT OF DIPHTHERIA
Loeffler/Tinsdale selective medium Diphtheria

Child present with white patch over tonsils, diagnosis Loeffler medium
made by culture in
Diphtheroids grow on Potassium tellurite medium
Selective media for isolation of diphtheria from carriers Potassium tellurite medium
Corynebacterium diphtheria can be grown within 6-8 Loeffler’s serum slope
hours on
Investigation of choice for diphtheria carrier Throat swab culture
Investigation of choice for diphtheria carrier Culture in tellurite blood agar
Investigation NOT done for a child with fever and Widal test
pharyngitis
Prophylaxis of household contacts of diphtheria Erythromycin
Prophylaxis of diphtheria Erythromycin
Drug of choice for Diphtheria carrier Erythromycin
Drug for unimmunized contacts in Diphtheria Erythromycin + Antitoxin + Toxoid
One unit of diphtheria antitoxin is defined as the 100 MLD of toxin
BACTERIOLOGY 33
smallest amount of antitoxin required to neutralize
HEMOPHILUS
Hemophilus influenza Gram negative, grow on chocolate agar

Hemophilus influenza produces Immunogenic antiphagocytic capsule
Hemophilus influenza Serotyping is based on capsular polysaccharide, Can be
a part of normal flora in some persons, Requires hemin
and NAD for growth in culture medium, Type b is
responsible for invasive disease
Gram negative coccobacilli, culture only on chocolate Hemophilus influenza
agar not on blood agar
Types of hemophilus Type b (capsulated) is associated with meningitis and
epiglottis. Non typable (non capsulated) is associated with
otitis media, LRI, sinusitis
Pfeifers bacillus Hemophilus
Features of hemophilus Satellitism on Flide medium, iridescence
on Levinthal medium
Important role in pathogenesis Capsular polysaccharide
Satellitism is seen in culture of Hemophilus
Pleomorphism is most commonly seen in Hemophilus influenza
Bacterial vitamins X and Y are required for H.influenza
NOT true about influenza Capsular polypeptide protein is responsible for
virulence
Diseases caused by H.influenza Chancroid, Acute epiglottitis, Brazilian purpuric fever,
Meningitis
Brazilian purpuric fever is caused by Hemophilus influenza biogroup aegypticus
Prophylaxis of H.influenza Rifampicin
Beta lactamase producing hemophilus influenza, Third generation cephalosporins
resistant to chloramphenicol
Hemophilus ducreyi Chocolate agar with isovitale X
BORDETELLA PERTUSSIS
Bordetella pertussis Strict human pathogen, Can be cultured from patient

during catarrhal stage, Leads to invasion of respiratory
mucosa, Infection is NOT prevented by acellular vaccine
Bordetella pertussis is Aerobic
Bordetella pertussis is associated with Filamental hemagglutinin, fimbria, pertactin
Organism in which capsule does not have virulence Bordetella pertussis
factor
Piracy of adhesins is associated with Bordetella (promotes coating of H.
influenza, Pneumococci)
Aluminum paint appearance Bordetella
Whooping cough Affect children of 1 year of age, contagious in catarrhal
stage, secondary attack rate is high
Pertussis Erythromycin prevent spread of disease between
children
BACTERIOLOGY 34
Pertussis Associated with inspiratory wheeze, Droplet infection,

Pneumonia is most common complication,
Parapertussis is less severe than pertussis
Pertussis Erythromycin should be given to contacts
Mechanism of pertussis toxin ADP ribosylation of protein associated with receptors,
increase cyclic AMP, acts through G alpha subunit
Incubation period of pertussis 7-14 days
Pertussis affect Less than 5 years
100 day cough Cough due to Bordetella pertussis
A child with pertussis should be isolated for 3-4 weeks
Secondary attack rate of pertussis 90%
NOT a feature of pertussis Cerebellar ataxia
Congenital passive immunity is NOT observed in Pertussis
Newborns does NOT have transplacental immunity Pertussis
against
Post exposure prophylaxis NOT useful in Pertussis
Recurrent bouts of severe cough, audible whooph, best Nasopharyngeal swab
specimen to isolate organism and confirm diagnosis
Child cough, inspiratory whoop. NOT immunized. Nasopharyngeal swab
sample for investigation
Cough plate is used for Bordetella pertussis
Regan Lowe characoal medium for Bordetella
Treatment of pertussis contacts children Prophylactic antibiotic for 10 days
Drug of choice in pertussis Erythromycin
Treatment of bordetella infection Macrolide
BRUCELLA
Brucella Brucella abortis is capnophilic, Transmitted by aerosol

can occur occasionally, Pasteurization can occur
occasionally
Brucella melitensis is common in Camel, sheep, goat
Brucella Melitensis in goat, abortis in cow, suis in
pig
Capnophilic brucella Brucella abortus
Brucellosis Transmitted by ingestion of milk, cause spinal
spondylitis, causes GE
Pyrexia of unknown origin in veterinary doctor, gram Brucella
negative short bacilli, oxidase positive
Malta fever is caused by Brucella melitensis
Undulant fever Brucella melitensis
Disease occurring both in man and animals Brucella abortis
Brucella commonly affect Lumbar spine
Brucella infection Anterosuperior epiphysitis (Pedro Pon sign)
NOT a method of transmission of brucella Person to person transmission
Brucella is NOT transmitted by Person to person
Medium for Brucella Serum dextrose agar, Trypticose soy agar
Milk ring test for Brucellosis
Coomb’s test may be useful in Brucellosis
BACTERIOLOGY 35
Investigation for Brucellosis Standard agglutination test

Serological tests for brucellosis 2 mercaptoethanol test, Complement fixation test,
Coomb’s test
2 mercaptoethanol is used to detect IgG
NOT a serological test for diagnosis of Brucellosis Standard agglutination test
Treatment of brucellosis Streptomycin
Drugs used for Brucellosis Rifampicin,Streptomycin,Doxycyline
NOT a treatment of Brucellosis Penicillin
BARTONELLA
Bartonella henslae Cat scratch disease, bacillary angiomatosis, bacillary

peliosis
Bacillary peliosis primarily involve Liver
Bartonella Quintana Trench fever
Trench fever 5 day fever, Quintan fever
Intermediate host for trench fever Louse
Bartonella bacilliformis Carrion disease (Bartonellosis)
Stages of carrion disease Oroya fever, Verruga peruana
Carrion disease is transmitted by Lutzomyia
Cat flea Ctenocephalides felis
Bacillary angiomatosis is caused by Bartonella Henslae, Bartonella quinatana
Cat scratch disease is caused by Bartonella henslae
Macular scar Cat scratch disease
Mollaret debra test for Cat scratch fever
Cats are NOT associated with Bartonella quintana
Incubation period of Bartonellosis 14 – 21 days
Bacillary angiomatosis Multiple hemangioma like lesion on AIDS patient, Biopsy
with Warthin starry stain shows bacilli
Verruca peruana is caused by Bartonella bacilliformis
ACTINOMYCES
True of Actinomyces Causes endogenous infection

Mycetoma Can affect upper and lower extremities, Caused by
actinomycetes and filamentous fungi, Diagnosis is by
examination of pus
Granules discharged in mycetoma contains Fungal colonies (erodes bone)
Actinomyces is Gram positive bacteria
Most common actinomyces Actinomyces israeli
Actinomycetoma is caused by Bacteria
Actinomycotic mycetoma is caused by Actinomyces, Nocardiosis, Streptomyces
Actinomycosis is caused by Gram positive organism
Commonest form of actinomycosis Cervicofacial
Actinomycosis Usually respond to antibiotics
Actinomycosis Demonstration of filaments, actinomycosis Israeli,
suphur granules in pus, can be cultured
Rivalta disease Actinomycosis
BACTERIOLOGY 36
Spidery colonies on solid media and fluffy Actinomyces israeli

ball in thioglycollate liquid media
Sunray appearance Actinomycosis
Actinomycosis is associated with Wooden fibrotic masses
Maxillary osteomyelitis is associated with Actinomyces viscosus
Frozen pelvis Pelvic actinomycosis
Most predominant constituent of sulphur granules of Organism
Actinomycosis
Sulphur granules Misnomer, inflammatory cells with
filaments of bacteria
Colour of granules of actinomyces Yellow
Sulphur granules is a feature of Actinomyces
Bread crumb colony appearance is of Actinomyces Israeli
Lumpy jaw is seen in Actinomycosis
Discharging sinus Actinomycosis
A patient with fistula and chronic pain discharge from Acinomycosis
lower face and mandible is most commonly suffering
from
In actinomycosis of spine, abscess usually erode Towards the skin
Actinomycetoma Responds to antibiotics
Madurella Does NOT respond to antibiotics
Actinomycosis is sensitive to Penicillin
Drug of choice for thoracic actinomycosis Penicillin
NOCARDIA
Nocardia resemble actinomyces but morphologically Aerobic

NOT true about nocardia Penicillin is the drug of choice
Causative organism of mycetoma Nocardia
MC cause of mycetoma in India Nocardia brasiliensis
MC cause of mycetoma in India Actinomadura madurae
Persistent fever and cough. Features suggestive of Nocardia asteroids
pneumonia. Aerobic branching gram negative filaments
that are partially acid fast
MC form of Nocardia Pneumonia
Characteristic infection of Nocardia asteroids Brain abscess
Stains for Nocardia Acid fast, alcian blue, mucin stain
Nocardia is stained by Acid fast (Ziehl Nielson stain)
Best method for selective isolation of Nocardia Paraffin bait technique
Nocardia is susceptible to Amikacin
LISTERIA
Listeria is a Gram positive bacilli

Temperature for listeria 1 – 45*C
LLO means Listeriolysin
Listeria Gram positive but produces exotoxin and
endotoxin
BACTERIOLOGY 37
Listeria monocytogenes d-xylose negative, d-methyl d-mannoside

positive
Tumbling motility (end over end motility) is seen in Listeria
Not true about listeria Gram negative bacteria
Listeria transmitted by Refridgerated food
Main step in pathogenesis of listeriosis Survival and multiplication of L.monocytogenes within
mononuclear phagocytes and host epithelial cells
Zipper type of phagocytosis in Listeria
Listeriosis in pregnancy Granulomatus infantiseptica
Culture media for Listeria Blood agar
After 5 days of birth, baby developed poor feeding, Listeria monocytogenes
convulsions, fever with low protein, low sugar, high
chloride in CSF
Gram positive small to medium coccobacilli that are Listeria monocytogenes
pleomorphic occurring in short chains. direct wet
mount from culture show tumbling motility
BACILLUS ANTHRACIS
Anthrax bacilli is differentiated from Non motile

anthracoid bacilli by
Features of anthrax Capsulated, non motile, response to
penicillin
Anthracoid bacilli Non capsulated, motile, no response to
penicillin
Only bacterium with capsule having Bacillus anthracis (poly D glutamic acid)
protein
Anthrax bacilli Non motile, no flagella
Factors in bacillus anthracis Factor I – edema factor, factor II –
protective antigen, factor III – lethal
factor
Largest pathogenic bacilli Bacillus anthracis
Anthrax Plasmid is responsible for toxin production, Cutaneous
anthrax generally resolve spontaneously, Capsular
polysaccharide aids virulence by inhibiting phagocytosis
Anthrax bacilli differs from anthracoid bacilli by being Non motile
Virulence of bacillus anthracis is associated with Polypeptide capsule
McFadyean reaction Bacillus anthracis
Methylene blue discolours the capsule of bacillus McFadyean reaction
anthracis, this reaction is called
String of pearl colonies on nutrient agar Bacillus
Medusa head colonies Bacillus anthrax
Frosted glass appearance Bacillus anthracis
Inverted fir tree appearance of culture Bacillus anthracis
Ascoli thermoprecipitation test Anthrax
Gram positive bacilli in long chains, McFaydean reaction Bacillus anthracis
Anthrax bacillus toxin cAMP liberate edema factor, capsular polysaccharide
aids virulence by inhibiting phagocytosis, plasmid
BACTERIOLOGY 38
responsible for toxin production

Commonest form of anthrax Cutaneous
Anthrax McFadyean reaction shows capsule, Humans are usually
resistant to infection, Sputum microscopy helps in
diagnosis
Gasteroenteritis with high fatality is caused by Anthrax
Malignant pustule (Hide Porter disease) Anthrax of skin
Cutaneous anthrax Painless, Whole area is congested and edematous,
Central crustation with black eschar, Satellite nodule
around inguinal region
Person working in Abattoir presented with papule on Trichrome methylene blue helps in diagnosis
hand which turned in to an ulcer
BACILLUS CEREUS
A patient present with vomiting he had eaten rice 6 Bacillus cereus

hours before. Most probable cause
Non invasive diarrhea is caused by Bacillus cereus
Characteristic of Bacillus cereus food poisoning Abdominal pain
Selective medium for Bacillus cereus Mannitol egg yolk phenol red polymyxin
agar (MYPA)
LEGIONELLA
Legionella is Gram negative, Uncapsulated, Oxidase positive

Legionella Can be grown on complex media, legionella
pneumophila is NOT effectively killed by
polymorphonuclear leukocyte
Transmission of Legionella No man to man transmission
MC serotype isolated from humans L.pneumophilia serogroup 1
Toxicity of legionella through Toxin
Contaminated water source is associated Legionella
with infection of
Legionella by Inhalation of aerosol in the air conditioned room
28 year female, diarrhea, confusion, high grade fever, Legionella
bilateral pneumonitis
Pontiac fever is caused by Legionella
Causative agent of Pneumonia associated with Aerosols Legionella
spread
Epidemics are associated with Legionella
Legionella pneumophilia is associated with Hyponatremia, temperature > 40%
Legionnaire’s disease cause Acute respiratory infection
Good media for Legionnaire’s disease BCYE agar
Growth on charcoal yeast medium Legionella
Test for legionella in community Urinary antigen testing
Treatment of choice for legionairre’s disease Erythromycin
Treatment for Legionella infection Macrolides, respiratory quinolones
BACTERIOLOGY 39
CAMPYLOBACTER
Microaerophilic bacteria 10 % CO2

Microaerophilic bacteria Campylobacter
Campylobacter jejuni Microaerophilic, tumbling motility, Invasive
Alpha chain disease Immunoproliferative small intestine disease associated with
campylobacter jejuni
Campylobacter associated with seagull Campylobacter luri
NOT true about Campylobacter Human is the only reservoir, Spore forming
Fecal leucocytes are present in Campylobacter
One of the leading causes of traveller’s diarrhea Campylobacter
Method of choice for culture of stool for campylobacter Culture on Skirrow’s medium incubated at 42*C under
jejuni microaerophilic condition
Culture media for campylobacter CVA medium, Skirrow medium, Campylobacter blood
agar, Regan Lowe media
DOC fo Campylobacter Jejuni associated Diarrhoea Erythromycin
HELICOBACTER
Helicobacter pylori Even with chronic infection, urease breath test remains
positive. H.pylori remains life long if untreated,
Endoscopy is diagnostic. Toxigenic strains usually cause
ulcer, 75% of ulcers associated with H.pylori, Medical
therapy is the treatment of choice
H.pylori Gram negative bacilli, curved rod, flagellated. Causes
chronic gastritis in adults due to reinfection, Treatment
prevents gastric lymphoma, C14 urease breath test is
used in diagnosis, Transmitted from man to man,
fecoorally and by orogastric route. Common in adults of
developing countries, Controlled urease breath is
negative with massive infection, Anti urease antibody
are produced only by invasive strains, Urease activity
provide protective environment to the bacilli
H. pylori Vacuolated cytotoxin
H.pylori found in Mucosa
NOT true about H.pylori It should be eradicated in all cases whenever detected
Helicobacter pylori NOT associated with Gastric leiomyoma
Most sensitive test for H.pylori Rapid urease test
PASTEURELLA
Mode of infection of Pasturella multocida Animal bite or scratches

Common organism isolated from cat bite Pasteurella multocida
Gram negative bacilli sensitive to penicillin Pasteurella multocida
Features of pasteurella multocida Gram negative bacilli, non motile, acid
from sucrose, indole positive, oxidase
positive, urease negative
BACTERIOLOGY 40
FRANSCIELLA
Ulcerated inguinal lymphadenopathy Fransciella

Fransciella tularensis is related to Rabbit
Tularemia Ulcer with black base, chancriform lesion, buboes
Parinaud complex is associated with Preauricular lymphnode enlargement
Treatment of tularemia Gentamycin
YERSINIA
Yersinia pestis Gram negative non motile cocco bacilli, Repeated

cultures is diagnostic
Stalactite growth in ghee broth agar Yersinia
Fermentation of glycerol is the basis of classification of Yersinia
Bioterrorism agent Plague
Plague is Metazoonotic
Plague Both sexes of rat flea bite to transmit disease, IP for
bubonic plague is 2-6 days, Infants under 6 months are
not given killed vaccine
Girl from shimla, fever, hypotension, malaise, axillary Yersinia pestis
and inguinal lymphadenopathy, culture in glucose broth
show stalactite growth
Most efficient vector for plague Xenopsylla cheopis
Plague in Surat in 1995 has occurred after a silence 28 years
period of
Most dangerous type of Plague Pneumonic plague
Highly infectious clinical form of plague Pneumonic plague
Isolation is strictly recommended for Pneumonic plague
Incubation period of pneumonic plague 1 – 3 days
MC type of plague Bubonic plague
Main reservoir of plague in India Tatera indica
Lifelong immunity NOT seen with Plague
Maximum explosiveness of plague is determined by Cheopsis index
Cheopsis index Average no of cheopsis per rat
Most effective method to break transmission chain in Control of rat flea
plague in
Flea bite in wheat godown. Axillary lymphadenopathy Wayson staining
Plague patient is kept isolated till 48 hours of treatment
Longest and shortest incubation period of plague are 7 14 days
days and 2 days respectively. time required to declare
an area free from plague is
Plague epidemic is controlled by Isolation of patients
NOT done to control epidemic in plague Vaccination of susceptible
Treatment of plague Streptomycin
Drug of choice in chemoprophylaxis in contacts of a Tetracycline
patient of pneumonic plague
MC presentation of Yersinia enterocolitica Self limiting diarrhea
BACTERIOLOGY 41
PSEUDOMONAS
Pseudomonas aeroginosa Oxidase positive, Polar flagellate, Obligate aerobe

Pseudomonas Pili, flagella, LPS, Type III secretion system, proteases,
phospholipases, exotoxin
Strictly anaerobic Pseudomonas
Organism having considerable resistance to antiseptics, Pseudomonas
disinfectants, antibiotics
Bacteria act by inhibiting protein synthesis Pseudomonas
NOT true about pseudomonas Ferments glucose forming acid and gas
NOT a coccobacilli Pseudomonas
Blue pus Pseudomonas
Green coloured colonies Pseudomonas
Gunmetal colonies Pseudomonas
Fruity odour Pseudomonas
Species of pseudomonas commonly associated with Pseudomonas aeruginosa
intravenous catheter related infection
Puncture wound through sneakers in children is associated Pseudomonas osteomyelitis
with
Other Pseudomonas Burkholderia, Stenotrophomonas (soil organism)
Pseudomonas septicemia cause Ecthyma gangrenosum
Ecthyma gangrenosum is caused by Pseudomonas
Shock associated with bullous skin lesion Pseudomonas
Hot tub folliculitis is associated with Pseudomonas
Green nail is due to Pyocyanin
Does NOT cause food borne infection Pseudomonas
Cetrimide agar for Pseudomonas
Pseudomonas is eradicated by local Acetic acid
application of
Effective against pseudomonas Colistin, Piperacillin, Ciprofloxacin, Cefoperazone,
Ceftazidime
Pseudomonas producing extended spectrum beta Imipenem and amikacin
lactamase enzyme
Antibiotic potent against Pseudomonas Colistin
Drug of choice for Pseudomonas septicemia Tobramycin + Ticarcillin
Penicillin effective against proteus and pseudomonas Carbenicillin
Cephalosporin active against Pseudomonas Ceftazidime
Antipseudomonal penicillin Cloxacillin
Antipseudmonal action Cefoperazone
Carbenicillin Effective in pseudomonas infection
In treatment of pseudomonas infection, cabenicillin is Gentamicin
frequently combined with
NOT used in pseudomonas infection Vancomycin
NOT used for pseudomonas Azithromycin
NOT having good activity against pseudomonas Cephadroxil
aerugenosa
NOT used against pseudomonas Oxacillin
NOT antipseudomonal Vancomycin
NOT an antipseudomonal Cephalexin
BACTERIOLOGY 42
BURKHOLDERIA
Melidiosis is caused by Burkholderia psedomallei

Chronic alcoholic agricultural worker, chills rigor, Melidiosis
bilateral crepitation with scattered rhochi, multiple
subcutaneous nodules on extensor surface. Gram
negative bacilli with bipolar staining, distinct rough
corrugated grey white colonies on blood agar. motile
oxidase positive
Melidiosis Common form pulmonary infection, bipolar staining of
etiological agent is with methylene blue stain, gram
negative aerobic bacteria
Syndrome of respiratory distress and septicemia in cystic Burkholderia cepacia
fibrosis (Cepacia syndrome)
GENERAL FEATURES OF ENTEROBACTERIACEAE
Enterobacteriaceae Glucose is NOT fermented by all members of the family,

All are oxidase negative
Flagellar pattern in enterobacteriaceae Peritrichous
Enterobacteriaceae Glucose in NOT fermented by all members of the family
Non lactose fermenters Shigella, salmonella
Fever, leucopenia, DIC and hypotension Lipid A
caused by members of enterobacteriaceae
family are strongly associated with
ELISA for virulence marker antigen(VMA) is done to Enteroinvasive E.coli, shigella
detect virulence in
E.COLI
Many E.coli isolated from UTI Attach to uroplakin by mannose binding type I pili
E.coli Labile toxin in ETEC act via CAMP, UTI causing E.coli
attaches through pili, EIEC invasiveness under plasmid
control
E.coli Aerobe and facultative anaerobe, E.coli is motile by
peritrichate flagella
E.coli Non capsulated
E.coli attached to surface with the help of Fucose
Lactose fermenting colonies on EMB agar E. coli
Serotype of E.coli causing hemorrhagic colitis O157:H7
Enterohemorrhagic E.coli Hemolytic uremic syndrome
EHEC Ferments sorbitol, Causes HUS, Elaborates shiga like
exotoxin
Enteroaggregative E.coli Persistent diarrhea
Stacked brick pattern of adherence Enteroaggregative E. coli
Enterotoxigenic E.coli Traveller’s diarrhea
BACTERIOLOGY 43
ETEC Common cause of acute watery diarrhea in children in

developing countries
ETEC Heat labile enterotoxin
ETEC spread by Contaminated water
Enteroinvasiveness of E. coli is under Plasmid
control of
Enteroinvasive E.coli Produce disease similar to Shigellosis
Sereny test is positive in EIEC
EPEC is associated with Epidemic
Enteropathogenic E.coli Cause acute gastroenteritis in infants
A microbiologist wants to develop a vaccine for P1 pili
prevention of attachment of diarrheagenic E.coli to
specific receptors in GIT. Fimbrial adhesion NOT a
appropriate candidate
Eiken test for E.coli Precipitin test
Verocytotoxin of E.coli act by Decreasing protein synthesis
E.coli heat labile toxin resembles action of Vibrio cholera
Incubation period 6-7 hours for E.coli food poisoning
Preformed toxin is NOT important in food poisoning ETEC
due to
MC cause of liver abscess E.coli
E.coli gives pink colour with McConkey medium
Culture media used for EHEC O157:H7 Sorbitol McConkey media
ELISA for Virulence Marker Antigen is done to detect Enteroinvasive E.Coli
virulence
PROTEUS
Proteus Forms struvite stone, Proteus cause deamination of

phenylalanine to phenylpyruvic acid
Phenylalanine deaminase positivity is Proteus
shown by
Proteus Urease positive
Diene’s phenomenon Proteus mirabilis, Proteus vulgaris
Maximum urease production Proteus
Seminal smell on culture Proteus
Swarming growth Proteus mirabilis
To prevent swarming, the percentage of Nutrient agar is 4%
increased to
SALMONELLA
Organism requiring tryptophan for S.typhi

growth
Microorganism that can enter freshly laid eggs Salmonella
Feature common to all species of Salmonella Indole negative
Antigen blocking agglutination of salmonella by O Vi
antiserum
BACTERIOLOGY 44
Salmonella is associated with Type III secretion

Ebeth Gaffky Bacillus Salmonella typhi
Only salmonella not producing H2S Salmonella typhi
Only non motile salmonella S. gallinarum pyllorum
Fever for 3 weeks, splenomegaly, hypoechoic shadow in Salmonella
spleen near hilum. Gram negative bacilli isolated on
culture
Salmonella infection Blood culture is positive in 3-7 days
Food poisoning after 16 hours Salmonella
Enrichment media of choice for Salmonella Selenite F broth
DT104 strain belong to Salmonella typhimurum
Prolonged salmonella septicemia is caused Salmonella cholera suis
by
Non typhoid salmonella Transmission is most commonly associated with eggs,
poultry and undercooked meat, common in
immunocompromised individuals, resistance to
fluoroquinolones are emerged
NOT true about non typhoid salmonella Blood culture is more sensitive than stool culture in
gastroenteritis in adults
TYPHOID
Both lactose positive and lactose negative Salmonella typhi

colonies on EMB agar
NON gas producing salmonella Salmonella typhi
Agglutination with O antigen of S.typhi is inhibited by Vi antigen
Infective dose of Salmonella typhi 10^2 to 10^5 bacilli
Food poisoning after 24 hours Salmonella gastroenteritis
Salmonella gastroenteritis Caused by animal products, Symptoms appear between
4 to 48 hours
Salmonellosis Increased incidence in developed countries, Antacid
and prolonged antibiotic administration promote
infection, Food borne to man and animal
Typhoid Urinary carriers are more dangerous, Vi ab is used for
detecting carrier, Urine carrier is associated with
anomalies
Typhoid Male carriers though less are more dangerous
Incubation period of typhoid 3 – 21 days
Reserve and source of infection are same Enteric fever
for
10 year old child 10 days continuous fever, enlarged Enteric fever
spleen
Rose spot Enteric fever
Erythema marginatum Enteric fever
Coma vigil is seen in Enteric fever
Typhoid in children Mild splenomegaly is usual
Salmonella typhi infection in intestine Affects Peyer patches
Pea soup stool Typhoid
Muttering delirium is associated with Typhoid
BACTERIOLOGY 45
Perforation of gut associated with Typhoid

Massive splenomegaly is NOT seen in Typhoid
NOT a feature of typhoid Non involvement of ileum
NOT common in typhoid Constipation
Highest incidence of typhoid fever 5-19 years
Incubation period of typhoid 10-14 days
Isolation in salmonellosis done till Stool culture negative for three times
Maximum isolation period of enteric fever Till three consecutive negative urine/stool culture
samples are obtained from the patient
Enrichment media for Salmonella typhi Selenite F broth
Which gives strong evidence of typhoid fever carrier Isolation of Vi antigen
status
Chronic carrier state in typhoid is diagnosed by Vi agglutination test
Widal test Tube agglutination test, Previous infection affects Widal
test, H antigen titre remains positive for several months
and reaction to it is rapid
Antibody to H antigen Appears first and persists for long period
Widal test is an Agglutination test
rd
Diagnosis of typhoid in 3 week Widal test
st
Typhoid is diagnosed on 1 week by Blood culture
NOT true about widal test O antibodies are least useful
NOT true about Widal test First test is confirmatory
Typhoid carriers are NOT detected by Widal test
Drug of choice for carriers of typhoid Ampicillin
Most successful method for treatment of Cholecystectomy with ampicillin
typhoid carriers
Drug of choice for treatment of typhoid fever in Ceftriaxone
pregnancy
Treatment of salmonella typhi Ciprofloxacin
Treatment of Chloramphenicol resistant typhoid Ciprofloxacin
infection
NOT commonly used against enteric fever Amikacin
Chemoprophylaxis is NOT done for Typhoid
Ty21a is a Oral vaccine
Typhoid oral vaccine is given 1,3,5 days
Immunization of choice for typhoid in India Monovalent vaccine
SHIGELLA
Role of plasmid in conjugation first Shigella dysenteriae

described by Lederberg and tatum in
Shigella can be differentiated from E.coli by Shigella does not produce gas from glucose, Shigella
does not ferment lactose, Shigella is non motile
Shigella SMALL dose can cause infection, Associated with HUS,
causes bloody diarrhea, Gut pathology is due to toxin
MC species of shigella in India Shigella flexneri
Most virulent shigella Shigella dysenteriae
Exotoxin is produced by Shigella dystenteriae
Shigella are subdivided based on their ability to ferment Mannitol
BACTERIOLOGY 46
Shigella does not have H antigen

Lactose fermenter Shigella sonnei
Acrogenic shigella Shigella dysenteriae, shigella sonnei, shigella boydii
Enterotoxin produced by Shigella dysenteriae
Toxin acts by inhibiting protein synthesis Shiga toxin
Shigella is associated with Toxic megacolon
Gold standard test for Shigella dysentery Isolation from feces
Shigellosis is best diagnosis by Stool culture
Medium for shigella Deoxycholate citrate agar
Selective media for shigella Hektoen enteric agar
Differential media for shigella Triple sugar iron agar
FEATURES OF VIBRIO
Robert Koch discovered Vibrio cholera in Africa

Vibrio cholera first isolated by Koch
Cholera caused by Vibrio cholera 0.01
O139 vibrio is derived from El tor
Vibrio cholera O139 Clinical manifestations are similar to O1 el tor strain,
epidemiologically undistinguished from O1 El tor strain
Stain of vibrio cholera in Bengal O:139
Pathogenecity of O139 vibrio is due to O antigen
Recent infection of cholera in india is caused by O139 vibrio ogawa
Types of O1 vibrio Classical, El tor
Eltor vibrio differentiated from classical cholera by Chick erythrocyte agglutination
El tor cholera Infection is mild and asymptomatic, resistant to
polymyxin unit disc, chronic carriers are common
El tor vibrio Humans are only reservoir, can survive in cold water for
2-4 weeks, killed by boiling for 30 seconds
El tor vibrio More subclinical cases, less mortality, able
to survive longer, harder
Seventh pandemic of cholera caused by E1 tor
Vibrio cholera Transported in alkaline medium, gram negative aerobic,
ferments glucose, grows on simple media, non
halophilic, man is only natural host
Vibrio cholera Has marked tolerance of alkaline pH, El tor is milder
than classical, Produces indole and reduces nitrate,
Synthesize neuraminidase
Napiform liquefaction in gelatin swab Vibrio cholera
Optimal growth of Vibrio cholera 0.5 – 1%
Growth of Vibrio cholera is inhibited by 7% NaCl
Virulence is controlled by Quorum sensing
Quorum sensing Incessant chatting of microbes
Endotoxin of the following gram negative bacteria does Vibrio cholera
not play any part in pathogenesis of natural disease
Vibrio cholera toxin is similar to ETEC (but more potent)
Bacteria acts by increasing cAMP Vibrio cholera
V.cholera able to stay in GIT because of Motility, Binds to specific receptors
Diarrhea due to vibrio cholera Neutophilia, Occurrence of many cases in the same
BACTERIOLOGY 47
locality
Cholera red reaction is tested by adding Sulphuric acid
Selective media and best suitable media for vibrio TCBS
Transport medium for Cholera VR Medium
Selective medium for vibrio cholera TCBS-Thiosulphate, Citrate, Bile salt, Sucrose
CHOLERA
Incubation period less than 1 week Cholera

Prevalence of cholera measured by Vibriocidal antibody
Cholera transmission by Food and healthy carriers
Mode of spread of cholera John snow
Cholera Culture medium TCBS agar, produces indole and reduce
nitrate, synthesize neuraminidase
A convalescent case of cholera remain infective for 14-21 days
Cholera toxin acts by Stimulation of adenylate cyclase
Cholera toxin in small intestine acts by ADP Ribosylation of G regulatory protein
Cholera toxin Oligomeric protein composed of one A subunit and five
B subunits (AB5). A subunit detaches and becomes
activated by proteolytic cleavage, allowing it to catalyze
the ADP ribosylation of the Gαs subunit of the
heterotrimeric G protein resulting in constitutive cAMP
production.
Function of B subunit of cholera toxin To bind GM1 ganglioside receptor
Modification occurring in Gs subunit leading to watery ADP ribosylation
diarrhea in cholera
Cholera toxin Causes continued activation of adenylate cyclase
Vibrio cholera diarrhea is associated with Neutrophilia
Washerwoman skin is associated with Cholera
Cholera gravis Life threatening diarrhea
Death in cholera is due to Hypovolemic shock
Drug of choice for treating cholera in pregnant woman Furazolidone
Drug of choice for treating cholera in children Cotrimoxazole
Antibiotic of choice for treating cholera in an adult is a Doxycycline
single dose of
Mechanism by which cholera might be maintained Continuous transmission in man
during intervals between peak cholera session is
Best approach to prevent cholera epidemic in a Safe water and sanitation
community
Tetracycline used in prophylaxis of Cholera
Drug of choice for chemoprophylaxis of cholera Tetracycline
NOT a measure recommended for controlling outbreak Mass chemoprophylaxis
of cholera
Best disinfectant for cholera stools Cresol
HALOPHILIC VIBRIO
Halophilic vibrio Vibrio parahemolyticus, V.alginolyticus, V.flovalis

BACTERIOLOGY 48
Vibrio parahemolyticus associated with Shell fish

Vibrio parahemolyticus Food borne enteritis, Kanagawa phenomenon – hemolysis on
Wagatsuma agar
Toxin is NOT a pathogenic mechanism in Vibrio parahemolyticus
Recently visited sea coast presented with ulcer over left Vibrio vulnificus
leg
Cellulitis is associated with Vibrio vulvifuncus
Vulfincus means Wound maker
ATYPICAL MYCOBACTERIA
Mycobacterial species differentiated by Catalase test, Niacin, Amidase

Mycobacterium other than tuberculosis Causes decreased efficacy of BCG due to cross immunity
Tubercle bacilli showing yellow orange pigment Atypical
MC cause of non tubercular mycobacteria pulmonary Mycobacterium avium complex
disease
Mycobacterium avium Do NOT form pigment
NOT photochromogen Mycobacterium avium
Lady windermere syndrome is caused by Mycobacterium avium complex
Prevention of MAC in HIV Azithromycin
Second most common cause of non tubercular mycobacteria M.kansasii
pulmonary disease
Can cause disease indistinguishable from tuberculosis M.kansasii
Exposure to the organism having antagonistic effect on M.kansasi
BCG
Rapidly growing atypical organism NOT involved in lung M.kansasi
infection
Scotochromogens M.szulgai, M.scrofulaceum, M.gordonae/acquae
Photochromogens M.kansasii, M.marinum, M.asiaticum, M.siniae
Mycobacterium siniae is Photochromogen
Rapid growers M.fortuim, M.chelonei, M.smegmatis
Rapid grower and pathogenic to humans M.chelonei
Cutaneous lesions produced by M.tuberculosis, M.leprae, M.ulcerans, M.marinum,
M.hemophilum
Mycobacterium can be grown in 1-2 weeks M.fortuitum
Pedicure bath and leg shaving is associated with M. fortuitum
Swimming pool granuloma (fish tank) M.marinum
Mycobacterium that grows best at 45*C M.smegmatis
Battey bacillus Mycobacterium intracellulare
Mycobacterium ulcerans Tropic zone geographic distribution, cause
chronic progressive ulcer, no pigment
production in light, rarely cause ulcer in
mouse foot pad
Non pathogenic M.smegmatis, M.paratuberculosis, M.phlei
Mycobacterium vaccae Immunomodulator
Most useful in treatment of mycobacterium avium Clarithromycin
complex
Active against atypical mycobacteria Clarithromycin, Rifabutin, Ciprofloxacin
Drug of choice for treatment of skin infection with Cotrimoxazole
BACTERIOLOGY 49
M.marinum
NOT a treatment of MAC (avium) Pyrazimanide
GENERAL FEATURES OF RICKETTSIA
Rickettsia Gram negative, non motile

Primary site of multiplication of Rickettsial organisms Endothelial cells of small vessels
Transovarial transmission occurs in Rickettsiae
Only rickettsiae able to grow in cell free media R.quintana
Oriental Spotted fever is caused by Rickettsia japonica
Rash starting peripherally is a feature of Indian tick typhus
Murine typhus R. typhi (transmitted by Xenopsylla)
Mediterranean spotted fever is caused by R.conori
Vector for R.conori Mite
African tick bite fever R.africae
Maculatum disease R.parkeri
Tick borne lymphadenopathy is caused by R.slovaca
Flea borne spotted fever R.felis
Tunica reaction R. mooseri
Antigen used for Weil felix reaction obtained from Proteus
Typhus fever is diagnosed by Weil Felix reaction
Weil felix reaction is POSITIVE in Epidemic typhus
Weil felix reaction is Agglutination reaction
Weil Felix reaction is NEGATIVE in Q fever, R.pox and trench fever
Neil Mooser reaction given by Rickettsial infection
Neil Mooser reaction is positive in R.typhi
OK-19 is positive in Epidemic typhus, endemic typhus, Brill
Zinser disease
ENDEMIC TYPHUS
Endemic typhus Caused by R.typhi, Transmitted by bite of fleas (rat flea)

Vector for endemic typhus Flea
Mooser bodies Endemic typhus
EPIDEMIC TYPHUS
Epidemic typhus is also known as Sutama (Crouching)

Only rickettsial disease showing Epidemic typhus
recrudescence
Man presents with fever, chills 2 weeks after a louse Epidemic typhus
bite, maculopapular rash on trunk, which spreads
peripherally
Chills and fever following louse bite 2 weeks before, R.prowazekii
rashes all over body, delirious at the time of
presentation. vasculitis due to Rickettsial infection
BACTERIOLOGY 50
Vasculitis due to rickettsia by Rickettsia prowazekii

Jail fever is associated with Rickettsia prowazeki
Rickettsiae prowazeki is transmitted by Louse
Epidemic typhus is transmitted by Louse
Brill Zinser disease Recrudescence
SCRUB TYPHUS
Scrub typhus Adult mite feeds only on plants, R.tsutusgamushi

Vector is trombiculid mite, Tetracycline is the drug of
choice, Eschar indicates the location of mite bite,
Spread by infected chigger
Rash starting peripherally Scrub typhus
Disease caused by mite Scrub typhus
Which transmit both rickettsial disease(R pox) and Trombiculid mite
oriental disease (scrub typhus)
Leptotrombidium deliensis Trombiculid mite
Transovarian transmission is associated Scrub typhus
with
NOT true about scrub typhus Transmitted by adult mites when feed on hosts
Weil felix reaction is OX-K
Weil felix reaction with OXK R.tsutsugamushi
RICKETTSIAL POX
Rickettsial pox is caused by R.akari

Rickettsial pox transmitted by Mite
Vector for Rickettisal pox Gamasid mite
Herald spot Rickettsial pox
ROCKY MOUNTAIN SPOTTED FEVER
Most severe form of Rickettsial infection is Rickettsia rickettsii

caused by
Rocky mountain spotted fever is caused by R.rickettsii
RMSF transmitted by Tick
RMSF is transmitted by Dog tick (Dermacentor)
Rocky mountain spotted fever Pinpoint, petechial lesions of palm and volar aspect of wrist
RMSF resembles Bacterial meningitis
OX-2 and OX-19 positive in Rocky mountain spotted fever
Rumpel Leede test for Rocky mountain spotted fever
NOT a viral hemorrhagic fever Rocky mountain spotted fever
MC serological test for RMSF Indirect immunofluorescence
BACTERIOLOGY 51
Q FEVER
Q fever is caused by Coxiella burnetti

Q fever Zoonotic disease, Human disease is characterized by an
interstitial pneumonia, No rash is seen
Q fever Highly infectious zoonotic disease, mode of
transmission is by inhalation, no rash or local lesion
Coxiella burnetti Transmitted by inhalation of aerosol of unpasteurized milk
Rash is absent in Q fever
Mode of transmission of Q fever Inhalation of aerosol
Lice is NOT a vector for Q fever
Organism NOT needing vector for transmission Coxiella burnetti
EHRILICHIA
Ehrilichiosis Tick borne bacterial infection

Human granulocytic ehrilichiosis is caused by Anaplasma phagocytophilum
Human monocytic ehrlichiosis is caused by Ehrlichia chaffeensis
Cytoplasmic mulberries (morula) are seen Ehrlichiosis
in blood granulocyte in which of the
following
CHLAMYDIA
Chlamydia Gram negative but do not have

peptidoglycan, do not have muramic acid
Chlamydia is also known as Basophilic viruses
Chlamydia Their cell wall lacks a peptidoglycan layer, Can NOT
grow in cell free media, Obligate intracellular bacteria
Obligate parasite Chlamydia
Infectious part of chlamydia Elementary body
Chlamydia escape killing by Molecular mimicry
Chlamydia grow in HeLa,HeP2,McCoy
Hep2 cells are example of Continuous cell lines
Ornithosis is caused by Chlamydia
NOT true about Chlamydia Can grow in cell free culture media
Young male with UTI, pus cells but no organisms McCoy culture
45 year female, lower abdominal pain and vaginal Culture on McCoy cells
discharge, cervicitis along with mucopurulent cervical
discharge. best approach to isolate possible causative
organism
Fitz Hugh Kurtis syndrome Perihepatitis in female caused by Chlamydia
trachomatis
Chlamydia is associated with Coronary artery disease
Chlamydia does NOT cause Parotitis
Chlamydia does NOT cause Community acquired pneumonia
BACTERIOLOGY 52
Isolation of Chlamydia from tissue specimen is done by Yolk sac inoculation

Method of isolation of Chlamydia from clinical Yolk sac inoculation, Tissue culture using irradiated
specimen McCoy cells and BHK cells
NOT a method of isolation of Chlamydia from clinical Enzyme immunoassay
specimens
NOT useful for Chlamydia Blood culture
Chlamydia Nucleic acid amplification
Chlamydia can NOT grow in Ordinary media
Drug of choice of Chlamydia infection in Pregnancy Azithromycin
NOT useful in Chlamydia treatment Cefotaxime
Chlamydia trachomatis is a Bacteria
Chlamydia trachomatis Elementary body is NOT metabolically active, biphasic,
reticulate body divides by binary fission, evades
phagocytosis inside the cell, genital chlamydial
infections are often asymptomatic, can be cultured,
inclusion conjunctivitis caused by C.trachomatis
serotype D and K
In reticulate body of Chlamydia RNA > DNA
Halber Steadter Prowazeki bodies Chlamydia trachomatis
Chlamydia trachomatis serovars D-K cause Urethritis
Burning micturition in sexually active male, ulcer in Chlamydia trachomatis
genitals, 50 WBC, leucocyte esterase positive.
gonococcal culture negative
Chlamydia trachomatis is NOT associated with Group specific antigen is responsible for production of
complement fixing antibodies
Chlamydia trachomatis NOT associated with Community acquired pneumonia
Chlamydia is isolated by Yolk sac inoculation
Most sensitive test for detecting cervical Chlamydia Polymerase chain reaction(Nucleic acid amplification)
trachomatis infection
Serology of choice for Chlamydia Microimmunofluorescence
Drug of choice for Chlamydia trachomatis infection in Azithromycin
pregnancy
Chlamydia pneumonia Group specific antigen is responsible for the production
of complement fixing antibodies
Chlamydia showing only one serotype Chlamydia Pneumoniae
Chlamydia psittaci Acquired from bird droppings, pneumonia. tetracycline
Levinthal colle lille bodies Psittacosis
NOT true about Chlamydia psittaci Cause non gonococcal urethritis
MYCOPLASMA
Mycoplasma NOT obligate intracellular organism, Smallest

prokaryotic organisms that can grow in cell free media,
Lack cell wall, Resistant to beta lactams, Affinity for
mammalian cell membrane, Can pass through filters of
450 mm pore size, Multiply by binary fission, Requires
sterols for their growth, Raised ESR, Diagnosed by
serum cold antibody
Mycoplasma May be commensal in growth, L form is commonest
Mycoplasma differ from Rickettsia by No cell wall
BACTERIOLOGY 53
Positive cold agglutination test is seen in infections with Mycoplasma

Gliding motility Mycoplasma
Mycoplasma is stained by Dienes method
Dappe’s stain Mycoplasma in cell culture
Diene’s method Mycoplasma
Cell wall deficient organisms Mycoplasma
Eaton agent Mycoplasma
Fried egg colonies Mycoplasma
L forms are found in Mycoplasma
Pleomorphic organism Mycoplasma
Pleuropneumonia like organisms Mycoplasma
Multiply by binary fission, can grow in cell free media, Mycoplasma
require sterol for growth
NOT true about mycoplasma Obligate intracellular parasites
NOT true about mycoplasma Inhibited by penicillin
Mycoplasma and Penicillin G Resistant
Mycoplasma pneumonia is differentiated The ability of its colonies to adsorb sheep
from other forms of mycoplasma and blood cells
other L forms of bacteria by
Metabolizes arginine Mycoplasma hominis
NON VENERAL TREPONEMES
Does NOT develop resistance to penicillin Treponema

Non veneral treponemal infection Yaws, Pinta, Endemic syphilis
Non veneral treponemas T.pertenue, T.carateum
Yaws caused by Treponema pertenua
Yaws NOT sexually transmitted, Caused by T.perteune,
Secondary yaw can involve bone
Yaws Treponema pertunae, non venerally, secondary yaws
can involve bone
Yaw T. pertenue, skin to skin transmission, occurs in early
childhood, ulcerative papilloma in extremities, destructive
gumma
Yaw Also known as pian, framboesia, bouba, raspberry like, crab
like gait, gangosa
NOT true about Yaw Later stages involve heart and bone
NOT true about Yaws Spread by sexual transmission
Yaw and Pinta CANNOT be differentiated by serological tests
Pinta caused by T.carateum
Pinta T. carateum, skin to skin transmission, late childhood, non
ulcerative papule, non destructive, dyschromic or achromic
macule
Pinta is associated with Purpura
Bejel is caused by Treponema endemicum
BACTERIOLOGY 54
LEPTOSPIRA
Most widespread zoonotic disease in world Leptospirosis

Rat, rain, rice fields Leptospirosis
True about leptospirosis Rats are prime reservoirs
Reservoir of Leptospirosis Rat
Transmitted by Rat urine Leptospira
Characteristic feature of Leptospira Hooked ends
Leptospira Viable as long as 10 days at room temperature in blood
Disease seen in Sewer worker Leptospirosis
Leptospirosis Zoonosis, Man acts as accidental host and dead end,
Rats are the reservoir, person to person transmission is
rare
Accidental and dead end host in leptospirosis Man
Leptospirosis Urine may show microscopic hematuria, Incubation
period in leptospirosis ranges from 2 – 20 days
Leptospirosis Infection acquired by direct contact with infected urine.
mortality is 5-15% in severe cases, penicillin, antibodies
NOT usually detectable in first week
High grade fever, altered sensorium, comatosed and Weil’s disease
conjunctival hemorrhage, elevated serum bilirubin and
serum urea, negative peripheral blood for malarial
parasite
Weil’s disease caused by Leptospira icterohemorrhagica
Features of Weil’s disease Hepatorenal damage, jaundice, renal failure,
albuminuria, bleeding diathesis, purpuric hemorrhages,
pyrexia
NOT true about Leptospirosis Quinolones are drug of choice
NOT used in leptospirosis Weil felix reaction
NOT true about leptospirosis Lice act as vector
EMJH medium Leptospirosis
Korthof culture media for Leptospirosis
Culture medium for Leptospirosis Korthof
14 year boy, icterus, conjunctival effusion, hematuria. Microscopic agglutination test
serological test
Diagnosis of Leptospirosis Microscopic agglutination test
Treatment of leptospirosis Penicillin G
Drug having no effect of leptospira Erythromycin
BORRELIA
Lyme’s disease Borrerlia burgdorferi, Transmitted by Ixodes tick (deer

tick), Rodents act as natural host, Erythema chronicum
migrans may be a clinical feature
Lyme disease Borrelia burgdorferi replicates locally and invades
locally, Infection progresses inspite of good humoral
immunity, Intrathecal IgA confirms meningitis
Bull’s eye lesion Lyme’s disease
Lyme disease CSF pleocytosis
VIROLOGY 55
Bannwarth syndrome(meningopolyneuritis) is Lyme’s diseae

Erythema migrans is a feature of Lyme disease
Skin feature of lyme disease Acrodermatitis chronic atrophica
NOT true about lyme’s disease Intrathecal specific IgA antibodies is diagnostic
NOT true about Lyme disease Polymorphonuclear lymphocytes in CSF suggest
meningitis
Relapsing fever Tick borne relapsing fever (Ornithodoros tick), Louse borne
relapsing fever also known as epidemic relapsing fever
caused by Borrelia recurrentis
MC symptom of tick borne relapsing fever Headache
Treatment of relapsing fever Chloramphenicol, doxycycline, erythromycin, penicillin
Organism using antigenic variation as a major means of Borrelia recurrentis
invading host defences
Louse borne relapsing fever caused by Borrelia recurrentis
NOT associated with tick borne relapsing Borrelia recurrentis
fever
Tick borne relapsing fever caused by Borrelia duttoni, Borrelia hermsii, Borrelia parkeri
Noguchi medium Borrelia
Barber Stonner Kelly medium Borrelia
Kelly’s medium Borrelia
Borrelia infection is confirmed by Stain for inculsion bodies within the cells
involved in rash
Misdiagnosis of Lyme disease Chronic fatigue syndrome
Treatment of Lyme disease Doxycycline (oral), Ceftriaxone (IV)
VIROLOGY
GENERAL FEATURES OF VIRUS
National institute of virology is located in Pune

Viroids Resistant to heat
Viroids Infectious nucleic acid
Virion Extracellular infectious virus particle
Virus contains Either DNA or RNA
Virus Form extracellular infectious particle, heat labile, NOT
affected by antibiotics
DNA covering material of virus is called Capsid
Virus grows well on Cell culture
Von magnus phenomen Virus yields high hemagglutinin titre but
low in infectivity
nd
One virus particle prevents multiplication of 2 virus. Viral interference
this phenomena is called
Virulent strain has ability to Invade and multiply
Electron microscope is used to study the morphology of Viruses
Plaque formation in virus is done for Quantitative assay of infectivity of virus
Plaque assay is done for Measuring the number of infectious virus particles
Viral plaque made for Quantitative assay of infectivity of virus
VIROLOGY 56
Pocks on chick embryo is formed by Variola, vaccinia, cowpox

Hemadsorption is exhibited by Rabies virus, measles vaccine
Property of elution (reversal of Myxovirus
hemagglutin due to presence of
neuraminidase that destroys receptor)
NOT a cytopathic effect of virus Budding
NOT a test for lab diagnosis of viral Detection of viral hemagglutinin
respiratory track infection inhibiting antibodies in single serum
specimen
Single stranded viruses Papova virus
Double stranded viruses Pox virus, reovirus
Negative stranded viral RNA Requires a special polymerase in virion
Negative stranded RNA viruses Rhabdoviridae, Filoviridae,
Paramyxoviridae, Orthomyxoviridae,
Bunyaviridae, Arenaviridae, Reoviridae
RNA viruses undergoing replication in Retrovirus, orthomyxovirus
nucleus
Segmented double stranded RNA virus Reovirus
Non enveloped DNA virus Adenovirus, Parvo virus, Papova virus
Simian virus 40 is DNA virus
Cytoplasmic vacuolation is associated with SV40
MC cause of URI Rhinovirus
Ideal temperature for Rhinovirus 33*C
Virus causing gasteroenteritis Rotavirus, Adenovirus, Norwalk virus, Enterovirus
Viruses showing renal involvement CMV,HIV,HBV
Virus associated with malignancy Herpes virus, Retrovirus, Papova virus
Virus is definitely associated with Burkitt’s Lymphoma, Hairy cell leukemia
New infectious agents Nipah virus, Corona virus, SARS
Latent infection is associated with HSV 2, HIV, EBV, CMV
Reverse transcriptase PCR is used in diagnosis of Astrovirus, Picorna virus, Rota virus
Reverse transcriptase polymerase chain reaction can Adenovirus
NOT aid in diagnosis of
NOT a method for detection of viral respiratory tract Direction of viral hemagglutinin inhibiting HAI
infection antibodies in single serum specimen
Continuous cell lines for virus are Vero, Hela, Hep2
Non cultivable virus Rota virus, Norwalk virus, Molluscum contagiosum
SARS is caused by Corona virus
Super spreaders are associated with Corona virus
Incubation period of SARS 2 – 7 days
SARS is identified on 2003
Crimean congo fever is caused by Nairo virus
Crimean Congo Hemorrhagic fever Zoonosis, Develop petechial patches, Recently reported
in Gujarat, Has high fatality
NOT common in India Lassa fever
Virus etiology is NOT implicated in Condyloma lata
Vector for vaccine preparation Vaccinia
Used for vaccine preparation Adenovirus
Orf Parapox virus
Arena virus Old world virus eg. Lassa virus, Lymphocytic
VIROLOGY 57
choriomeningitis
Transovarian transmission is seen in Bunyaviridae eg. Nairo virus, Hanta virus
Bunyaviridiae cause Orapouche, Punta toro infection, Sandfly fever, Toscana
fever
Ganjam virus belongs to Bunyaviridae
Mayor fever is transmitted by Heamagogus virus
Ebola virus Flavivirus
Bowl of sphagetti appearance Ebola virus
Ebola virus is diagnosed by Bromide green dye for PCR
HERPES VIRUS
Herpes group virus Ether sensitive, may cause malignancy, HSV II involve
below diaphragm
Lipid envelope is found in Herpes virus
HSV is a Double stranded DNA virus
Varicella, EBV belong to Herpes virus
Focal degeneration (pocks in Herpes
chorioallantoic membrane)
Cold sore is caused by HSV-1
Encephalitis is caused by HSV 1
Scrum pox is common in Rugby players
HSV II Primary infection is usually widespread, Recurrent
attacks are due to reactivation of latent infection,
Encephalitis can be caused by HSV II, Newborn can
acquire infection via birth canal at the time of labour,
Treatment is with acyclovir
Neonatal herpes is caused by HSV II
Virus B6-7 is causative agent in Focal encephalitis
Roseola infantum or Exanthem subictum is caused by HHV 6
HHV 6B cause Focal encephalitis
Nagayama spot Exanthema subictum
Rash usually appears after fever has Exanthema subictum and erythema
subsided infectiosum
Kaposi sarcoma caused by HHV8
Castleman disease is caused by HHV- 8
Herpetic whitlow in Finger
NOT a treatment of herpetic whitlow Surgery
Herpetic gladiatorum Wrestler
Herpes virus may remain dormant in Sacral ganglia
Genital herpes simplex can be diagnosed by Tzank smear
Biopsy of herpes simplex viral lesion Multinucleated keratinocytes
Cowdry A intranuclear acidophilic Herpes simplex, varicella zoster
inclusion bodies
Drug of choice for Herpes simplex Acyclovir
Acyclovir Inhibits DNA synthesis and viral replication, low toxicity
for host cells, renal impairment necessitates dose
reduction
VIROLOGY 58
Mechanism of action of acyclovir Inhibits HSV polymerase

Famcicyclovir Prodrug of peniclovir
Valacyclovir Prodrug of acyclovir
PARVOVIRUS
Parvovirus Non enveloped, SINGLE stranded DNA virus, linear DNA,

icosahedral symmetry
Parvovirus B19 DNA virus, severe anemia, aplastic crisis, crosses
placenta frequently
Parvovirus B19 Spread by respiratory route, Has affinity for erythrocyte
progenitor cells, Causes transient aplastic crisis,
Transplacental transfer occur in 30% of cases
Virus with smallest genome Parvovirus
Smallest DNA virus Parvovirus
Target for parvovirus Immature cells in erythroid lineage
Parvovirus cause Erythema infectiosum, Aplastic anemia, Arthropathy
th
5 disease is caused by Parvovirus B19
Predominant route of parvovirus Repiratory route
Common manifestation of Parvovirus infection in adult Arthropathy
Erythema infectiosum Parvo virus, Slapped cheek appearance
Lazy reticular rash is associated with Erythema infectiosum (Parvovirus)
Slapped cheek appearance Erythema infectiosum
Glove and stock syndrome is a variant of Erythema infectiosum
EBSTEIN BARR VIRUS
EBV HHV 4
EBV belongs to Herpes group
EBV Double stranded DNA virus
EBV Gp350 binds to CD21
Virus spreading through both EBV
hematogenous and neural route
Infectious mononucleosis is caused by Epstein barr virus
Diseases associated with EBV Infectious mononucleosis, Nasopharyngeal carcinoma,
Oral hairy leukoplakia, Hodgkin’s and Non Hodgkin’s
lymphoma, Ca tonsil, Burkitt’s lymphoma
Infectious mononucleosis is caused by EBV
Oral hairy leukoplakia is associated with EBV
Patient with sore throat having positive paul bunnel Epstein Barr virus
test
Lymphoid interstitial pneumonitis in HIV infected EBV
individual is commonly caused by
Epitrochlear lymphadenopathy is EBV
associated with
African Burkitt’s lymphoma is caused by EB virus
EBV cause autoimmunity by Polyclonal B cell activation
Sore throat and positive paul bunnel test EBV
VIROLOGY 59
EBV is associated with Post transplant lymphoreticular disease,

Non Hodgkin’s lymphoma, Bell’s palsy,
carcinoma tonsil
NOT caused by EBV Kaposi’s sarcoma
Ebstein Barr Virus does NOT cause Adult T cell Leukemia
EBV is NOT associated with Thrombocytopenia
Inclusion bodies are NOT seen in Infectious Mononucleosis
Paul bunnel test is done for Infectious mononucleosis
Most sensitive test for diagnosis of infectious Monospot test
mononucleosis
Ampicillin NOT given in EBV infection because of Skin rash
CYTOMEGALOVIRUS
Cytomegalovirus is HHV 5
Post kidney transplantation caused by CMV
Mononucleosis like syndrome is caused by CMV
MC presentation of congenital CMV Hepatosplenomegaly
Maternal viremia most commonly spreading to fetus in CMV
utero
CMV rarely cause CNS infection
In CMV infection of brain, viruses are present in WBC
Owl eye appearance on picture CMV
Congenital CMV infection Hepatosplenomegaly
Great concern for CMV infection 2nd month after transplantation
Congenital CMV infection in infant established by Urine culture of CMV, Intranuclear inclusion bodies in
hepatocytes, CMV viral DNA in blood by polymerase
chain reaction
Does NOT establish diagnosis of congenital CMV in IgG CMV antibodies in blood
neonate
Drug used in CMV infection Gancyclovir
Famciclovir is a prodrug of Penciclovir
ROSEOLA INFANTUM
A patient had fever and coryza for last 3 days developed Roseola infantum
maculopapular erythematous rash which lasted for 48
hours and disappeared without leaving behind
pigmentation is commonly due to
Roseola infantum HHV 6 and 7, Rash appear in trunk, During
deferverescence rash appears
Fever stops and rash begins is diagnostic of Roseola infantum
VARICELLA ZOSTER VIRUS
Varicella zoster virus HHV 3

Varicella are classified under Herpes virus
VIROLOGY 60
Virus causing chicken pox belongs to Herpes virus (HHV3)

NOT a pox virus Chicken pox virus
Herpes zoster is caused by Varicella
Varicella No recurrence(single infection gives lifelong immunity),
All stages of rash are seen at same time, Rash
commonly seen in flexor area, Secondary attack rate is
90%
Chicken pox Centripetal rash, Pleomorphic rash, Rapid progression
from macule to vesicle, Lesion appear in crops
Chicken pox Rash appears on first day, Rash can occur in axilla
Rash of chickenpox Quick prodromal period, quick evolution, rash begins on
trunk
Rash pattern in chickenpox Centripetal
Dew drop on petal appearance Varicella
Pleomorphic rash Chicken pox
Incubation period of Varicella Zoster 1 – 2 weeks
Infectivity of chickenpox lasts for 6 days after onset of rash
Varicella zoster remains latent in Trigeminal ganglion
MC extraskin manifestation of Varicella CNS
Intrauterine infection associated with limb reduction Varicella
defects and scarring of skin
Hypoplasia of limb and scarring caused by Varicella
MC complication of chickenpox in children Secondary bacterial infection
Known complication of chicken pox Pancreatitis
NOT a complication of chicken pox Enteritis
NOT true about chicken pox Scabs are infective
NOT true about chickenpox Crusts contain live virus
NOT true about varicella infection Only single stage infection found at a time
Multiple calcification in chest X ray Following chickenpox
Sensitive test for VZV FAMA (Fluorescent antibody to membrane antigen), ELISA
Prevention of VZV in HIV VZ immunoglobin
ADENOVIRUS
Adenovirus Double stranded DNA virus

Grape clump appearance is associated Adenovirus
with
Virus with space vehicle appearance Adenovirus
Basophilic inclusion body Adenovirus
Disease caused by Adenovirus Pneumonia, Pharyngitis, conjunctivitis
Shipyard eye is caused by Adenovirus
Virus causing hemorrhagic cystitis, diarrhea, Adenovirus
conjunctivitis
Pharyngoconjunctival fever is caused by Adenovirus
Serotype 1,2 Respiratory disease
Serotype 3,7 Pharyngoconjunctival fever (swimming pool conjunctivitis)
Serotype 4, 7 Military recruits respiratory distress
Serotype 40, 41 Diarrheal illness in children
Serotype 11,12 Hemorrhagic cystitis in children
VIROLOGY 61
Serotype 8, 19, 37 Epidemic keratoconjunctivitis

Cowdry B intranuclear basophilic bodies Adenovirus
ROTAVIRUS
Rota virus Culture can NOT be done, Rota B can grow in cell
culture, Rota C can cause diarrhea in children
Segmented gene Rota virus
Rota virus VP6, virus shed in stool
Reassortment is typically seen in Rotavirus
Virus enterotoxin detected as a possible mechanism of Rota virus
action
Rota virus commonly affects Children
Rota virus infection in children below 5 years
MC cause of gastroenteritis in children Rotavirus
Rota virus Terminal ileum villi destroyed
Diarrhea in Rotavirus infection due to Decreased absorption by villi
Rota virus are responsible for Infantile diarrhea
Rota virus detected by Antigen in stool
Rota virus is diagnosed by Presence of antigen in stools by ELISA
Best vaccine for Rota virus Genetic reassortment
SMALL POX
Largest DNA virus Pox virus

DNA virus with complex capsid Poxviridae
symmetery
Pox virus Double standed DNA virus encoding
DNA dependent RNA polymerase
Inclusion bodies in cytoplasm is seen with Pox virus
Pox virus Complex shape, relicate and assemble in cytoplasm (unique
feature)
Guarneri bodies are seen in Small pox
Most sensitive method for diagnosis of small pox Smear test
Protection against small pox by previous infection with Antigenic cross reactivity
cowpox represents
Successful eradication of small pox because of Subclinical cases did not transmit the disease, A highly
effective vaccine was available, Infection provided
lifelong immunity
Small pox eradication was NOT due to Cross immunity with animal pox virus
India become small pox free in April
Bollinger bodies Fowl pox
PAPOVA VIRUS
Papova virus DNA virus, non enveloped icosahedral virus, warts and
VIROLOGY 62
papilloma, SV 40 is oncogenic
Warts Viral warts resolve spontaneously, Plantar warts should
not be excised, Callosity are formed occupationally
POLIO VIRUS
Picorna viruses Polio virus, foot and mouth virus, encephalomyocarditis

Polio virus Transmitted by fecooral route, Asymptomatic infections
are common in children, Live attenuated vaccine
produces herd immunity, Increased muscular activity
leads to increased paralysis
Type I polio virus Responsible for most epidemics, very difficult to
eliminate, responsible for vaccine induced paralytic
polio
Type II polio virus Highly antigenic
Type III polio virus Vaccine induced paralysis due to
mutation
Main portal of polio virus GIT
Wide polio outbreak in 2nd half of 2007 Type 3
Polio IM injection and increased muscular activity increases
the risk of paralytic polio
Polio Paralytic polio is most common
Disease transmitted by water Polio
Virus that spread by both hematogenous and Neural Polio virus
route
Isolation NOT needed for Polio
Bilateral phrenic nerve palsy Polio
Neuronophagia is seen in Poliomyelitis
Biot’s respiration Bulbar poliomyelitis
Acute stage of poliomyelitis lasts for 1-5 days
NOT seen in non paralytic polio Extensor plantar
NOT a feature of poliomyelitis Progressive course
NOT true about polio patient who had paralysis Can transmit it by nasal discharge
Acute flaccid paralysis in children aged 0-15 years
Under AFP surveillance, follow up examination is done 60 days of onset of paralysis
after
Epidemiological trend of Polio Sporadic to epidemic, increasing in tropics, Affects
higher age groups
Prevalence of all clinical cases of polio can be estimated 1.33
by multiplying the no of residual paralytic cases
For every case of poliomyelitis, the subclinical cases of 1000 children and 75 adults
poliomyelitis to be estimated
Sample used to isolate polio virus earliest Stool
Cowdry B intranuclear acidophilic Polio
inclusion bodies
Kenny packs were used in treatment of Poliomyelitis
Best way to stop epidemic poliomyelitis spread OPV drops to all children
Pulse polio immunization All children between 0-5 years of age on a single day,
irrespective of their previous immunization status
VIROLOGY 63
Target age group under pulse polio programme Under 5 years

OPV Poliomyelitis in recipients, Poliomyelitis in contacts of
recipient
OPV strain Poor growth in stable cell line of monkey kidney
Concentration of type 3 virus in OPV 3,00,000 TCID 50
Salk vaccine Prevent paralysis, Oral polio can be given as booster,
Easily transported
ENTEROVIRUS
Total sheet degeneration is associated with Enterovirus

MC cause of Rubelliform(discrete) rash Echovirus 9
Epidemic hemorrhagic conjunctivitis caused by Picorna virus (enterovirus which is a subtype of Picorna
virus)
Enterovirus associated with Myocarditis, Pleurodynia, Herpangina
Enterovirus 71 is associated with Hand foot mouth disease, herpangina
Bornholm disease Pleurodynia
Hallmark of pleurodynia Servere muscle pain
Summer grippe Non specific febrile illness seen in enterovirus infection
Virus shed in stool in Herpangina
Enterovirus does NOT cause Hemorrhagic fever
COXSACKIE VIRUS
Coxsackie virus causes Herpangina, Hand foot mouth disease, Infantile

myocarditis
Cox sackie group A commonly causes Aseptic meningitis
Cox sackie A 16 is associated with Vesicles on hand
Herpangina is caused by Cox sackie A virus
Cox sackie virus does NOT cause Bornholm disease
Coxsackie virus does NOT cause Erythema subictum
Suckling mice is used for culture of Coxsackie virus
INFLUENZA VIRUS
Segmented RNA virus Influenza virus

M protein in orthomyxovirus maturation Serves as a recognition site for
nucleocapsid at the inner face of plasma
membrane
Influenza A Hemagglutinin and neuraminidase is strain specific
All pandemic of influenza by Influenza A only
Pandemic of influenza is caused by Antigenic shift
Influenza Primary infectious pneumonia is less common than
secondary bacterial pneumonia
Influenza Major epidemics are due to antigenic SHIFT, Antigenic
drift is gradual antigenic change over a period of time,
Antigenic shift is due to genetic recombination of virus,
VIROLOGY 64
Influenza A is subjected to frequent antigenic variations

Segmented RNA Influenza
H5N1 Bird flu virus
H1N1 swine flu was found on 2009
Gradual and sequential change in antigenic structure at Antigenic drift
regular intervals
Influenza causes new epidemic by Antigenic drift
Antigenic shift Gradual
Shift occurs only with Influenza A
Reye syndrome is associated with Influenza B
Antigenic variation NOT seen in Influenza C
Influenza Affects all sexes and ages, Incubation period 18 – 72
hours
Influenza is associated with Myositis and rhabdomyolysis
Most serious complication of Influenza B Reye syndrome
Immunofluorescence Detection of influenza
Amantidine and rimantidine are active against Influenza A only
Amantidine is most effective for Influenza A
Which is a Neuraminidase Inhibitor Oseltamivir
Avian influenza treated by Oseltamivir
Oseltamivir is used to treat Influenza A & B
Oseltamivir inhibit Neuraminidase
Mechanism of action of oseltamivir Inhibition of a viral enzyme that aids the
spread of virus through respiratory mucus
and is required for release of progeny
virus
Dose of oseltamivir in adults 75 mg BD
Newer influenza vaccine Split virus vaccine, Neuraminidase, Recombinant
vaccine
MEASLES
Moribilli Measles
Measles Single stranded negative sense RNA virus
Measles virus Paramyxovirus
Syncitium formation is associated with Measles
NOT a teratogenic virus Measles
Measles Higher secondary attack rate, Only one strain cause
infection, Infectious in prodromal period, Infections
confer lifelong immunity, Meningoencephalitis can
precede parotitis, Flaring up of TB
Measles Fever occurs 7-10 days after occurrence of infection,
immunity develops after 7 days of vaccination, single
dose of vaccine gives 95% protection
Measles Immunosuppression
Measles Koplik spots appear in prodromal stage, Fever stops
after onset of rash
Epidemiology of measles Secondary attack rate of measles is less than that of
rubella
VIROLOGY 65
Epidemiological determinants of measles Epidemiological determinants of measles

Reservoir for measles Man
Incubation period of measles 10 days
Measles is infectious 4 days before rash and 5 days after rash
Koplik spot appear 1 day before rash
Clinical manifestation of measles appearing last Rash
Rash in measles occur first in Post auricular region
Fever with centrally distributed maculopapular eruption Measles
Macular rash with red margins Measles
Remission in Nephrosis Measles
Comphy’s sign (white patches due to degenerated Measles
squamous epithelium occurring on buccal mucosa and
gums)
A line of conjunctival inflammation in lower eyelid Measles
margin is diagnostic of
Warthin finkedly cells (giant cells) Measles
Bolognini symptom (a feeling of crepitation occurring Measles
from gradual increasing pressure on the abdomen)
Hetch giant cell pneumonia Measles
MC complication of measles in children ASOM
Infection having most neurological complications Measles
Least common complication of measles SSPE
MC cause of post measles death Diarrhea
Cause of death in measles Pneumonia
Bronchopneumonia in measles due to Immunomodulation
Ice berg phenomenon NOT seen in Measles
Chronic carrier NOT seen in Measles
NOT true about measles Not infectious In prodromal stage
NOT a complication of Measles Pancreatitis
Chemoprophylaxis not done in Measles
Measles vaccination strategy in 9 months to 4 years Catch up
Catch up, keep up, follow up for Measles
MUMPS
Mumps virus belongs to Paramyxovirus

Virus easily cultured from CSF Mumps
Virus NOT causing pneumonia Mumps
NOT transmitted transplacentally Mumps
Presternal edema is seen in Mumps
Mumps Menigoencephalitis can precede parotitis
Mumps cause Aseptic meningitis in children
Commonest complication of mumps Orchitis and oophoritis
MC complication of mumps in children Aseptic meningitis
MC ocular manifestation of mumps Dacroadenitis
NOT a complication of mumps Parotid abscess
VIROLOGY 66
RABIES
Vesicular stomatitis virus Rhabdoviridae

Rabies virus RNA Negative polarity
Rabies Multiple strains are seen
Shape of rabies virus Bullet shape
Rabies Intracytoplasmic basophilic inclusion bodies are seen in
brain cells
Rabies Vaccine virus has fixed incubation period, IP depends on
site of bite, All bites on fingers with laceration are class
III injuries
Rabies virus inactivated by Phenol, UV radiation, BPL
Paralytic rabies is caused by bite of an infected Vampire bat
Incubation period of rabies depends on Site of bite
Characteristic manifestation of rabies Meningitis
MC type of pathological change in Rabies Brainstem encephalitis
Rabies is transmitted by Dogs, Vampire bat, Jakal
Rabies NOT transmitted by Ingestion
Mode by which Rabies virus NOT transmitted Sexual
Foaming at mouth is associated with Rabies
Rabies free area No indigenously acquired case for 2 years
FALSE about Rabies Limited to brain
Bite of which of the following animals do not result in Mouse
human rabies
Rabies free country Australia, Britain
Rabies is NOT found in Lakshwadeep, Andaman Nicoar islands
Most suitable clinical sample that can confirm the Corneal impression smear for immunofluorescence
antemortem diagnosis of Rabies stain
Rabies best diagnosed by Immunofluorence study
Intracytoplasmic inclusion bodies Rabies
Negri body seen in Rabies
Negri bodies commonly seen in Cerebellum > Hippocampus
Negri body Eosinophilic cytoplasm
Babes nodule in rabies Microglia
Negri bodies are NOT found in White matter
NOT used for confirming rabies PCR
encephalitis
In case of dog bite, biting animal observed for 10 days
NOT done for dog bite Immediate wound closure
Class II exposure in animal bite Licks on a fresh wound
Which should be injected in and around wound in class Antirabies serum
II rabies bite
NOT a treatment of class III bite Immediately stitch wound under antibiotic coverage
Antiseptic/disinfectant is best for local Alcohol
wound application in case of dog bite
Rabies vaccine first developed by Louis Pasteur
Commercially available rabies vaccine Killed sheep brain vaccine, Human diploid cell vaccine,
Vero continuous cell vaccine
NOT a commercially available rabies vaccine Recombinant glycoprotein vaccine
VIROLOGY 67
Vaccine prepared by embryonated hen’s egg Rabies

Number of HDCV for pre exposure prophylaxis of rabies 3
Pre exposure prophylaxis of rabies 0,7,28 and booster dose after 2 years
Post exposure prophylaxis for rabies HDCV 0,3,7,14,30 booster dose 90 days
GENERAL FEATURES OF ARBOVIRUS
Arboviral disease KFD, West Nile fever, Ganjam virus, Puumala virus
Arboviruses are Heat labile
Suckling mice used for cultivation of Arbovirus
Arboviral diseases Yellow fever, Japanese encephalitis, Dengue
Only group A arbovirus causing epidemic disease in Dengue, Chikungunya fever
India
DENGUE
Break bone fever caused by Arbovirus

Dengue virus is a Flavi virus
In India, dengue viruses associated with human All 4 types
infections
Dengue virus appears to have direct man to man cycle Transovarian transmission of virus
in India. mechanism of dengue virus survival in the inter
epidemic period
Dengue Endemic in india
Infective fever of aedes mosquito for classical dengue Life long
fever
Infective period of Aedes mosquito in Dengue Till death
Dengue fever Most common arboviral infection, Can be both
epidemic as wall as endemic, Can survive in ambient
temperature, Vector is Aedes aegypti
Dengue Increased hematocrit, Decreased platelet, Positive
tourniquet test, Vector aedes aegypti usually bite
during day time, Pleural effusion present
Classical dengue fever Case fatality is low, break bone fever, self limiting
disease
Saddle back temperature Dengue fever
Classical dengue fever is transmitted by Aedes mosquito
Dengue hemorrhagic fever is caused by Reinfection with different serotype of dengue virus
5 year petechial rash, Lymphadenopathy, Reduced air Dengue hemorrhagic fever
entry into Right lung
Dengue hemorrhagic fever is due to Infection by another strain of dengue virus
NOT true about dengue hemorrhagic fever Shock
NOT a feature of dengue shock syndrome Decreased hemoglobin
Minimum platelet count for diagnosis of Dengue 100000
Most sensitive diagnostic test for dengue Neutralization test
Most specific dengue diagnosis IgM ELISA
VIROLOGY 68
CHIKUNGUNYA
Chikungunya Alpha virus

Epidemic caused by Type A arbovirus in India Chikungunya
Vectors for Chikungunya Aedes, culex, mansonia
Vector for Chikungunya fever Aedes
YELLOW FEVER
Arboviral disease NOT reported in India Yellow fever

Yellow fever Subclinical cases present, One attack gives lifelong
immunity, Hepatic and renal involvement in severe
cases, Caused by flavi virus, Case fatality rate upto 80%,
Transmitted by aedes, Incidence is increased by
humidity, Vaccine is 17D
Yellow fever Incubation period is 3-6 days, Validity of international
certificate lasts up to 10 years, Urban form is controlled
by 17D vaccine, Aedes aegypti index should be less than
1%
Yellow fever is NOT present in India because Virus is NOT present
Incubation period of yellow fever 3-6 days
Quarantine period for Yellow fever 6 days
Torres bodies Yellow fever
Yellow fever reference centre Central institute kasauli
No risk of yellow fever if aedes aegypti index remains 1%
below
Vector control for yellow fever around an airport is 400 m
done upto a distance of
Validity of yellow fever vaccination certification 10 years starting 10 days after vaccination
JAPANESE ENCEPHALITIS
Old name for Japanese encephalitis Von economo encephala

Mosquito borne encephalitis caused by Group B Arbovirus (Flavivirus)
JE does NOT cross react with Dengue virus
Japanese encephalitis Man is incidental dead end host, Culicine and anopheles
vectors involved, 85% of cases occur in children <15
years of age
Japanese encephalitis Pigs are amplifiers for flavivirus, Rice fields are breeding
places, Transmitted by culex, Primary doses of vaccine
consists of two doses
Japanese encephalitis Two or three cases per village suggest epidemic,
children frequently affected, ratio of inapparent to
apparent infection >100:1
Japanese encephalitis Zoonoses
Subclinical infection is common with Japanese encephalitis
Japanese encephalitis commonly seen in Pigs
VIROLOGY 69
Amplifier host of Japanese encephalitis Pig

Only domestic animal showing signs of encephalitis due Horses
to JE virus
Man in Japanese encephalitis Dead end host
Japanese encephalitis in India is associated with Culex vishnui
Most important vector of Japanese encephalitis in Culex tritaeniorhynchus
south India
Japanese encephalitis is associated with Culex tritaenorrhyunchus
Aedes does NOT transmit Japanese encephalitis
Vector for Japanese encephalitis Culex
Epidemic in Japanese encephalitis is declared if 2-3 cases in a village
Abnormal signals in bilateral thalami on Japanese encephalitis
MRI brain
NOT true about Japanese encephalitis Man to man transmission
NOT true about Japanese encephalitis virus Four doses of vaccine
NOT true about Japanese encephalitis 90-100% mortality rate
NOT a feature of Japanese encephalitis Infected pigs manifest symptom of encephalitis
Major deterrant in elimination of Large inapparent infections
Japanese encephalitis
WEST NILE FEVER
Found in India West Nile fever

Culex transmit West nile fever
Polio like encephalopathy West Nile fever
KYASANUR FOREST DISEASE
Flavivirus closely related to Russian spring summer KFD

encephalitis causing virus
KFD Zoonosis, affects monkeys, caused by virus
Viral encephalitis KFD
Viral infection transmitted by tick Kyasanur forest disease
KFD transmitted by Hard tick – Hemophysalis
NOT useful in prevention of KFD Deforestation
HANTA VIRUS
Sin Nombe virus Hanta virus

Hanta virus RNA virus, Caused by rodents, Causes recurrent
respiratory infection, Hemorrhagic fever with renal
failure
Hanta virus pulmonary syndrome is caused by Inhalation of rodent urine and feces
VIROLOGY 70
RESPIRATORY SYNCITIAL VIRUS
Virus lacking hemagglutinin and neuraminidase but RSV

have membrane fusion protein
RSV does NOT cause Bronchitis
REOVIRUS
Virus composed of two distinct capsules enclosing Reovirus

double stranded RNA
Segmented double stranded RNA is found in Reovirus
RUBELLA
rd
3 day disease Rubella
8 years following URTI developed maculopapular rash Rubella
rd
on jaw spreading on to trunk which cleared on 3 day
without desquamation and tender postauricular and
suboccipial lymphadenopathy
Maculopapular rash on jaw cleared on 3rd day without Rubella
desquamation and tender postauricular and
suboccipital lymphadenopathy
Exanthema spreads from hairline to downwards and clears Rubella
as it spreads
Rubella causes Microphthalmia, Congenital cataract, Salt pepper
fundus
Multiple sites of narrowing of peripheral pulmonary Rubella
arteries
Forscheimer spots are seen in Rubella, infectious mononucleosis, scarlet fever
Incubation period of rubella 2-3 weeks
Complications of Rubella Arthritis, Arthralgia, Encephalitis
Uncommon clinical feature of Rubella Encephalitis
Most severely affected in Rubella infection Unborn child
MC age group affected by rubella Women of child bearing age
Average incubation period of Rubella is equal to that of Sleeping sickness
Features of Congenital rubella PDA, Deafness, Cataract
Congenital rubella syndrome is associated with VSD, PDA
Multiple sites of narrowing of peripheral pulmonary artery Rubella embryopathy
NOT true about congenital rubella Infection after 16 weeks of gestation results in major
congenital defects
Risk of fetal damage in rubella is maximum if mother 6-12 weeks of pregnancy
gets infected in
Chance of transmission of rubella In 9 – 10 weeks 40%
pregnancy
Rubella infected a mother at 10-14 weeks of Gestation, 5-10%
Chances of congenital malformation
NOT true about rubella Incubation period more than 10 days
VIROLOGY 71
FALSE about rubella infection Rose spots on soft palate

Recommended vaccination strategy of rubella is to Women of 15-49 years
vaccine first
FEATURES OF HIV
Retrovirus RNA dependent DNA polymerase

DNA form of retroviral genome Provirus
Retrovirus contain Large terminal repeats
HIV 1 and HIV 2 Lentivirus (Retrovirus)
HTLV 1 Delta virus (Retrovirus)
HIV discovered in 1983
AIDS HTLV III E AII
HIV belongs to Retrovirus
Retrovirus Thermolabile
Main HIV in India HIV 1
MC subtype of HIV in India C
HIV belongs to Lentivirus
HIV ssRNA
HIV virus has Single stranded RNA
HIV is Enveloped RNA
HIV P24 early diagnosis, lysis of infected CD4, macrophage is
the reservoir for virus
Accessory proteins associated with HIV Vpu, Vpx
Relation between HIV and CCR5 with Protective against HIV infection
homozygous mutation in an individual is
Primary receptor for HIV CD4
Receptors for HIV CCR 5, CXCR 4
Co receptor for HIV CCR 5
T cell trophic HIV needs the following co receptor for CXCR4
entry and fusion
Gp120 in HIV helps in Virus attachment
P17 Matrix protein
Gp160 Envelop protein
Genes present in HIV genome Gag, pol and env
Viral gene NOT associated with HIV Tat
Gag encodes for Core antigen
Reverse transcriptase endoded by Pol
Tat encodes Transactivator protein
HIV is inhibited by 0.3% H2O2
Reverse transcriptase sequence in HIV RNA – DNA - RNA
Reverse transcriptase RNA dependent DNA polymerase
Unusual mode of replication is seen in Retrovirus
CCR 5 mutation in HIV is related to High resistance to infection
NOT true about HIV Increased release of acid labile interferon
Isolation NOT needed for AIDS
HIV is common in Males than females
HIV commonly affects Helper cells
NOT a target for initiation and maintenance of HIV Neutrophil
VIROLOGY 72
infection
Seroconversion in HIV 4 weeks
Window period Antibody is absent
Window period of AIDS 3-12 weeks
Window period in HIV Period between onset of infection and clinically
detectable level of antibodies
HIV antibodies show Antibody enhancement, bystander killing
CNS infection in HIV is caused by Cryptococcus,Toxoplasma
MC site of lymphoma in AIDS patient CNS
Most characteristic CNS lesion of HIV Microglial nodule
MC CNS Neoplasm in HIV Primary CNS Lymphoma
Common late CNS complication of HIV Dementia
Most common in childhood AIDS Recurrent chest infection with typical
organisms
NOT a feature of CNS involvement in AIDS Vasculitis
NOT a cause of seizure in HIV patient PML
NOT found in CNS in case of AIDS Inclusion bodies
Most common vascular tumour in AIDS patient Kaposi sarcoma
In AIDS, lymphadenopathy is most often due to Non specific enlargement of lymphnode
Cardiovascular complication of HIV Pericardial effusion, cardiac tamponade,
cardiomyopathy
NOT a cardiovascular complication of HIV Aortic aneurysm
Malignancy associated with AIDS Kaposi sarcoma, CNS lymphoma, Non hodgkin’s
lymphoma
Cancer NOT seen in AIDS Carcinoma Colon
CMV retinitis in HIV when CD4 below 50
Cryptococcus neoformans infection in HIV 200
when CD4 below
Cotrimoxazole prophylaxis in AIDS in indicated Cryptosporidiosis
NOT a feature of AIDS Toxocara uveitis
NOT an opportunistic infection of AIDS Rhizopus
NOT common in HIV infection Aspergillus
NOT seen in childhood AIDS Kaposi sarcoma
Body fluid having maximum HIV load Breastmilk
Diagnosis of AIDS according to WHO 2 major signs and 1 minor sign
TRANSMISSION OF HIV
HIV Male to female transmission is more common than

female to male transmission
MC mode of HIV infection worldwide Heterosexual
Commonest transmission of HIV from mother to baby During delivery through vagina
Chance of acquiring HIV infection following needle prick 0.3%
Percentage of risk of HIV transmission by needle stick 0.5 to 1%
injuries
Transmission of AIDS in India in descending order Heterosexual, transplacental, homosexual
MC mode of HIV transmission from mother to child Perinatal
Perinatal transmission of HIV Cannot be diagnose by routine confirmatory test, Infant
rate transmission <50%, virus can be isolated from
VIROLOGY 73
mother’s milk
Percentage of transplacental transmission of AIDS 30-40%
Maximum risk of transmission of HIV Blood transfusion
Intravenous drug abusers in HIV is a High risk group
NOT a high risk group for HIV transmission Healthcare workers
NOT a method of transmission of HIV Intact skin
Least common mode of HIV transmission Homosexual
NOT an effective strategy to prevent mother to child Vaginal cleansing before delivery
transmission of HIV
EPIDEMIOLOGY OF HIV
Epidemiology of AIDS Seminal secretion are highly infectious than vaginal

secretion, Infectious in window period, Southern Africa
have 72% of total global burden, Children are rarely
affected
First country in South East Asian region to report AIDS Thailand
Maximum number of AIDS cases in India Tamil nadu
From epidemiological point of view of AIDS which of the Nagaland
following states in India put in group I (epidemiological
cases of HIV > 5%)
World AIDS day December 1
Age group of highest number of AIDS cases in India 30-44 years
First case of AIDS reported in India 1981
If prevalence of HIV is constantly >1% in pregnant Generalised epidemic
woman
Without any specific intervention of HIV positive 15-30 %
mother, from conception, term, preterm, after delivery,
lactation and non lactation, risk of transmission to child
NOT a OSHA guideline for needle stick injury Pre exposure prophylaxis
3 by 5 implementation by WHO in 2003 Providing treatment to 3 million sufferers by 2005
Achieve zero level transmission of HIV by 2010
MANIFESTATIONS OF AIDS
Cells infected by HIV virus CD4+ T lymphocytes

HIV commonly infects CD4 cells
HIV infection Following needle stick injury,infectivity is reduced by
administration of nucleoside analogues, P24 is used for
early diagnosis, Lysis of infected CD4 cells, Macrophage
is a reservoir for the virus
HIV infection Caused by enveloped RNA virus, Rate of killing is
directly proportional to T4 molecules on cell surface,
Decreased delayed hypersensitivity activity reaction,
Gamma interferon is acid STABLE
HIV infection associated with Glandular fever like illness, Generalized
lymphadenopathy, Gonococcal septicemia, Presenile
dementia
HIV in neonate Cannot be diagnosed accurately by current methods,
VIROLOGY 74
Failure to thrive may be presentation, Transmission

vertically from mother
Characteristic finding in HIV in children Recurrent chest infection
AIDS defining criteria Generalized lymphadenopathy, Fever, weight loss and
fatigue, Pneumocystis carnii pneumonia,
Mycobacterium avium infection, Persistent diarrhea
Major signs for AIDS case definition according to WHO Generalized lymphadenopathy, Prolonged fever more
than 1month, Chronic diarrhea > 1 month, Weight loss
> 10%
A patient with AIDS related complex is most likely Opportunistic infection
suffering from
Lesion associated with HIV Hairy leukoplakia
Oral ulcer in HIV patients commonly due to Candida
MC genital lesion in HIV patient Herpes
Cutaneous manifestation of AIDS Seborrhoic dermatitis
MC psychological feature of AIDS Depression
Painful articular syndrome is associated with HIV
MC hematological manifestation of HIV Anemia
Diffuse infiltrative lymphocytosis syndrome (DILS) in HIV
Fungal infection associated with AIDS patient Pneumocystis carnii, Penicilliuea marneffi, Candida,
Cryptococcus
Meningitis due to cryptococcal meningitis occurs when CD4+ < 100/microliter
Oral candidiasis Stage III
Stage IV Esophageal candidiasis, pneumocystis
carni pneumonia, wasting syndrome
NOT an AIDS defining illness Oropharyngeal candidiasis
WHO stage IV does NOT include Oral thrush
NOT associated with HIV infection Hypogammaglobulinemia
CMV retinitis in HIV occurs when CD4 counts fall below 50
In HIV patient, complains of visual disturbance, fundal Cytomegalovirus
examination shows bilateral renal exudates and
perivascular hemorrhages
MC causative agent of diarrhea in HIV patient Cryptosporidium
A patient with HIV has diarrhea with AFB positive Mycobacterium avium intracellulare
organism in stool
Diarrhea syndrome in AIDS children can be due to Rotavirus, Cryptospora
NOT associated with persistent diarrhea in AIDS patient Giardia, Cryptococcosis
Commonest helminthic infection in AIDS Strongyloides
NOT a common infection in HIV Aspergillosis
Prophylactic therapy in P.carni infection in HIV if CD4 <200/microlitre
KAPOSI’S SARCOMA
Kaposi sarcoma Microscopically lesion similar to granulation tissue,

Dilated and irregular blood vessels with interspread
infiltrate of lymphocyte and plasma cells, Atypical blood
vessels have solid spindle cell appearance
Multifocal tumor of vascular origin in a patient of AIDS Kaposi’s sarcoma
Endemic kaposi’s sarcoma associated with Lymphadenopathy
Virus associated with Kaposi sarcoma HHV 8
VIROLOGY 75
MC type of Kaposi sarcoma in African children Lymphadenopathic type

Kaposi sarcoma is tumour arising from Vascular tissue
Tissue of origin of Kaposi sarcoma Vascular
MC site of Kaposi sarcoma Skin
Kaposi sarcoma common in Lower limb
Kaposi’s sarcoma associated with gut seen in HIV
Multicentric castleman disease KSHV associated lymphoproliferative disorder, onion skin
appearance
Castleman disease Angiofollicular lymph node hyperplasia
Most important in prognosis of castleman IL 6
disease
NOT true about Kaposi sarcoma Occurs in AIDS patient only
DIAGNOSIS OF AIDS
Unlinked anonymous serological testing is HIV

carried out in
Antenatal material in HIV diagnosis is of importance in To prevent vertical transmission
Full blown immunodeficiency syndrome is High viral titres with low CD4 count
Screening test for HIV ELISA
Marker of HIV infection in blood Reverse transcriptase
Most sensitive test for test for diagnosis of AIDS in one HIV RNA PCR
year old child
HIV can be detected and confirmed by Reverse transcriptase PCR
P24 antigen disappears from blood after 6-8 weeks of infection of HIV
P24 antigen High false positivity
Direct detection of HIV by P24 antigen capture assay, NASBA technique (isothermic)
Sore throat, diarrhea, sexual contact 2 weeks before. P24 antigen assay
best investigation to rule out HIV
Best method for diagnosis of HIV in childhood P24 antigen
Compared to western blot, ELISA is More sensitive, Less specific
Characteristic western blot pattern in Absence of p24, loss of other activities
AIDS
NOT a method of diagnosis of HIV infection in 2 month ELISA
old child
TREATMENT OF AIDS
WHO stage I and II ARV prophylaxis

WHO stage III and IV ART
Anti HIV never given as rechallenge once history of Abacavir
allergic reaction to that drug in known
Nucleoside Reverse transcriptase Inhibitor Abacavir
Abacavir is Guanosine analogue
Side effect of Abacavir Hypersensitivity
Abacavir hypersensitivity is associated with HLA-B57
Nucleoside reverse transcriptase inhibitor Zalcitabine, Stavudine
Nucleoside reverse transcriptase inhibitior Zidovudine, Didanosine
VIROLOGY 76
NOT a nucleoside reverse transcriptase inhibitor Nevirapine

Infant of HIV positive mother AZT therapy
Zidovudine in post exposure prophylaxis Protects against acquiring HIV infection
Complication of zidovudine Nausea, Vomiting, Steatosis, Anemia
Zidovudine causes Neutropenia
MC side effect of zidovudine Anemia
Main side effect of Zidovudine Granulocytopenia
Anti HIV drug known to cause myopathy Zidovudine
resembling mitochondrial myopathy with
ragged red fibers
NOT a side effect of zidovudine Peripheral neuropathy
Zidovudine is associated with Increased MCV
Resitance to zidovudine develops due to Mutation at reverse transcriptase
Resistance to zidovudine develops due to Mutations at reverse transcriptase
In ART, zidovudine should NOT be combined with Stavudine
Maximum peripheral neuritis is caused by Stavudine
Stavudine is Thymidine analogue
ART not causing peripheral neuropathy Lamivudine
Lamivudine is Cytidine analogue
Maximum risk of pancreatitis Didanosine
Non nucleoside reverse transcriptase inhibitor Efavirenz, nevirapine, delaviridine
Nucleoside nucleotide reverse Abacavir, tenofovir
transcriptase inhibitor
Side effects of efavirenz Dysphoria
Nevirapine Non nucleoside reverse transcriptase inhibitor
Nervirapine Effective for repeated pregnancies also
Nevirapine is associated with Steven Johnson syndrome
Tenofovir Nucleotide reverse transcriptase inhibitor,
asthenia is a common side effect, indicated
in combination with other retroviral
agents
Side effects of tenofovir Acute renal failure
Not a NNRTI Lamivudine
Protease inhibitor Acts a substrate for p glycoprotein and action is
mediated by mdr 1 gene, Undergo hepatic oxidative
metabolism
Protease inhibitors Powerful enzyme inhibitors, cause hepatotoxicity, all
protease inhibitors are substrate for P glycoprotein
coded by MDR gene
Hypertriglyceridemia and Hypercholesterolemia seen in Protease Inhibitors
Human Immunodeficiency Virus-1-Infected Treated
with
Protease inhibitors Saquinavir, nelfinavir
Protease Inhibitor in treatment of HIV Amprenavir
Protease inhibitor having boosting effect Ritonavir
Protease inhibitor with maximum enzyme inhibition Ritonavir
Strongest inhibitor of CYP3A Ritonavir
Weakest CYP3A inhibitor Saquinavir
First licensed protease inhibitor Saquinavir
Protease inhibitor with least enzyme inhibition Saquinavir
VIROLOGY 77
Basis of combining ritonavir with lopinavir CYP3A4 inhibition by ritonavir

NOT a protease inhibitor Abacavir
Ritonavir Interacts with terfenadine, GI symptoms
Antiretroviral drug avoided in ATT with rifampicin Ritonavir
First protease inhibitor whose clinical efficacy is Ritonavir
demonstrated
First protease inhibitor used in combination Indinavir
Non peptidic protease inhibitor Tipranavir, Darunavir
NOT a CYP3A inhibitor Saquinavir
Drug causing lipodystrophy Saquinavir
Side effects of saquinavir, lopinavir, ritonavir PR, QT prolongation
Side effect of indinavir Nephrolithiasis
Antiviral drug NOT causing dyslipidemia Atazanavir
Integrase inhibitor Raltegavir
Virus HIV intergrase inhibitor Raltegravir
Enfuvirtide Fusion inhibitor
Enfuvirtide act at Gp41
Maraviroc Entry inhibitor
Side effects of maraviroc Postural hypotension, allergic reaction
associated hepatotoxicity
Triple nucleoside regimen is recommended Patients with HIV 2 infection
for
Bone marrow depressive drug in AIDS treatment Dapsone, Cotrimoxazole, Ganciclovir
Treatment of chorioretinitis in AIDS patient Ganciclovir, Cidofovir
Drug avoided with retroviral drugs Rifampicin
NOT useful for AIDS Famcicyclovir
Does NOT act against HIV 2 Efavirenz
Triple ARV prophylaxis Lamivudine, Efavirenz, Tenofovir
IRIS Immune reconstitution inflammatory syndrome, seen in ART
given in tuberculosis patient
Immune reconstitution inflammatory 2 – 12 weeks
syndrome occurs how many days after
ART
PREVENTION OF HIV
Universal precaution is applied to Semen

Right method to discard dressing of HIV positive patient Put in appropriate bag and send for incineration
A poverty striken mother suffering from active Breast feeding and isoniazid administration
tuberculosis delivers a baby. advice
HIV infection following needle stick infection reduced Nucleoside analogues
by
HIV prophylaxis for rape victim Combivir (zidovudine with lamivudine) 1
BD for 28 days
Post exposure prophylaxis of HIV blood infected needle Zidovudine + Lamivudine + Indinavir for 4 weeks
stick injury
For prevention of parent to child transmission of HIV, Nevirapine 200 mg in active labour to mother and syrup
the NACO recommendation is to give nevirapine 2mg/kg body weight to newborn within 24
hours of delivery
VIROLOGY 78
Dose of nevirapine during labor 200 mg

Interventions to prevent mother to child transmission HAART, elective caesarean section, intrapartum
of HIV zidovudine
Vertical transmission of HIV to mother to child Cesarean section
prevented by
All are done to prevent maternal to fetal transmission Vaginal delivery
of HIV except
NOT a part of targeted intervention in preventive Providing ART
strategy in spread of AIDS
PRIONS AND SLOW VIRUS
Most resistant to antiseptics Prions

Prions are Infectious proteins
Prions Lack nucleic acids
Prion protein catalyse Abnormal folding of protein
Prions cause Misfolding of proteins
Prions are made of Protein only
Human prions (Non Infectious) rich in α-helix
Prion associated diseases Kuru, Scrapie, Cruetzfeldt Jacob disease, Fatal Familial
Insomnia
Prion protein disease Caused by infectious protein, brain biopsy is diagnostic,
commonly manifests as dementia
Microscopic feature of prion disease Lack of inflammation
NOT a prion disease Alzheimer’s disease
MC Human Prion disease Sporadic Cruetzfeldt Jacob Disease
Cruetzfeldt Jacob disease is caused by Prion and Genetic factors
60 year old man, progressive dementia of recent onset, Cruetzfeldt Jacob disease
intermittent irregular jerky movements, periodic sharp
biphasic waves in EEG
Spongiform degeneration Vacuoles in neutrophil
Florid pattern Variant CJD
Secondary structure of prion protein in CJD Beta sheets
In CJ disease viruses are present in Microglia
Cruetzfeldt Jacob Disease IOC PRPsc
T2W FLAIR in sporadic CJD Cortical ribboning
NOT true about Cruetzfeldt Jacob disease Myoclonus rarely seen
NOT true about Prion disease Myoclonus is seen only in 10% of patients
Mad cow disease is due to Slow virus
Mad cow disease is due to Prions
Human cannibalism is associated with Kuru
Defect in folding of protein Kuru
Kuru is associated with Shivering
Spongiform encephalopathy Prion virus
Familial fatal insomnia associated with Prion disease
MYCOLOGY 79
MYCOLOGY
GENERAL FEATURES OF FUNGI
Fungi are Eukaryotes

Sporangium contains Sporangiospores
Yeast reproduce by Budding
Rate of reproduction of yeast is Slower than bacteria
Types of fungi Ascomyces eg Tinea, Basidiomyces eg
Cryptococcus, Deuteromyces (Fungi
imperfecti) – no sexual spores
Yeast like fungus Candida, Geotrichum, Cryptococcus,
Penicillium marneffi
Tangled mass of hyphae Mycelium
Barrel shaped spores Coccidiodes
Sexual spores Ascospores
Asexual spores of fungi Arthrospores, Chlamydospores, Blastospores
NOT an asexual spore Basidispore
Thick walled resting spores formed by round shape and Chlamydospore
thickening of hyphal segments is a feature of
Fungi without sexual cycle are classified as Fungi imperfecti
Fungi of medical importance belong to Deuteromycetes
Does NOT show yeast like morphology Aspergillus, Trichophyton
Dye most suitable for fungal demonstration in biopsy PAS
PAS stains Glycogen, Lipid, fungal cell wall
Penicillium marneffi Cause tuberculosis like disease, at 25* C
produces rose color pigment, at 37* C
produce yeast
Neurotrophic fungus Cryptococcus neoformans, Histoplasmosis, Candida,
Aspergillosis
Endemic fungal infection is caused by Coccoides immitis, Blastomyces
Antigen in Maple bark disease Cryptosoma coricale
Valley fever/Desert Rheumatism Coccidioidomycosis
In tissue, coccidiodes immitis produce Spherules and endospores
Treatment of coccidiomycosis Amphotericin
Side effects of amphotericin reduced by Incorporating it in liposomal complex
NOT a fungal infection Mycosis fungoides
Galactomannan antigen test for Fungus
Drug approved for fungal infection in febrile neutropenic Itraconazole
patients
Prevention of fungal infection in HIV Fluconazole/ Itraconazole
Posconazole Approved for prophylaxis of aspergillosis and candidiasis in
high risk groups
MYCOLOGY 80
DIMORPHIC FUNGI
Feature of dimorphic fungi At body temperature yeast, at 25* C mould

Dimorphic fungi Candida, blastomyces, coccidioidomycosis,
sporotrichosis, histoplasma, philaspora, sporothrix
shenkii
Dimorphic fungi Sprothrix shenkii
Dimorphic fungi Sporotrichosis, Coccidioidomycosis, Blastomycosis
NOT a dimorphic fungi Cryptococcus neoformans, Phialospora, Aspergillus
niger
NOT thermally dimorphic Cryptococcus neoformans
DERMATOPHYTES
Dermatophytosis is caused by Trichophyton

Spreads from animal to man T. verrucosum
Fungal culture slow growing colony, few small Trichophyton
microconidia
Black dot worm is caused by Trichophyton
NOT a subcutaneous mycosis Trichophyton rubrum
Organism that do NOT affect hair Epidermiphyton
Tinea capitis (endothrix) is caused by T.tonsurans, T.violaceum
Kerion is caused by Dermatophytes
Favus is caused by Trichophyton schenleinii
Tinea cruris is caused by Epidermiphyton, Trichophyton
Tinea pedis is caused by Epidermophyton floccosum
Characteristic feature of epidermophyton Clavate macroconidia
floccosum
Tinea nigra is caused by Exophiala Werneckii
Pityriasis versicolor is caused by Malassezia furfur
Difficult to isolate from culture Malassezia furfur
Does NOT cause dermatophytosis in India Microsporum distortum
Hair perforation test is positive with Trichophyton
CRYPTOCOCCUS
Trojan horse invaders Cryptococcosis

Cryptococcus neoformans Urease positive, 4 serotypes, superficial skin infection,
anticapsular antigen is detected in CSF, common in
immunocompromised, strongly positive mucicarmine
stain is usually diagnostic
Serotype of Cryptococcus causing most infections A and D
Cryptococcus neoformans Urease positive, inositol accumulation,
phenol oxidase and melanin production
Cryptococcus Grows at 5* and 37* C, Has 4 serotypes
Cryptococcus Capsular antigen is detected in CSF, Common in
MYCOLOGY 81
immunocompromised patient, Strongly positive

mucicarmine stain of organism in tissue is diagnostic
Cryptococcus neoformans produce Melanin
Eucalyptus camaldulensis is associated with Cryptococcus
transmission of
Fungi that possess a capsule Cryptococcus
Torulosis Cryptococcal infection of skin
Phagocytosis is inhibited by Cryptococcal capsular material
Cryptococcus has predilection for Lung and meninges
Cryptococcus neoformans has special affinity for CNS
Cryptococcus is least likely to cause infection of Kidney
MC form of deep mycosis in India Cryptococcosis
Common organism causing meningitis in AIDS patient Cryptococcus
Cryptococcal meningitis is common in Renal transplant patient
Pitted keratolysis Micrococcus sedentarius (Cryptococcus)
Soap bubble lesion in virchow robbin Cryptococcus
perineural space of brain
NOT true about Cryptococcus neoformans Anticapsular antibody prevents recurrence
Latex agglutination test of the antigen in CSF helps in Cryptococcus
diagnosis of
Maltese crossing in polarizing microscopy Cryptococcus neoformans
Feature for identification of Cryptococcus neoformans Hydrolyse urea
Capsule of Cryptococcus neoformans in CSF is best seen Indian ink preparation
by
CANDIDA
Predisposing factors for candida infection Diabetes, OCP, Pregnancy

Candida albicans infection is seen in Myeloperoxide deficiency
Candida is NOT frequently associated with IUCD user
MC fungal infection in febrile neutropenia is Candida
Fungal infection spread in infants by hand spread C. parapsilosis
HIV patient, indurated ulcer over tongue, growth in Candida albicans
cornmeal agar at 20*C, hyphae and growth in serum at
37*C showing budding yeast.
Pseudohyphae in culture Candida albicans
Germ tube is diagnostic for Candida albicans
Reynolde Braude phenomenon Seen in candida albicans, formation of
germ tube
Candida albicans Candida shows mycelia and
chlamydospore on corn meal agar, present
in nomal feces
Candida glabrata Only yeast form
Pericae Candidiasis
Median rhomboid glossitis is caused by Candida albicans
Mucocutaneous candidiasis is associated Adrenal insufficiency
with
Bull’s eye lesion in USG abdomen Candidiasis
MYCOLOGY 82
NOT true about candida Blastomeres are seen in isolates

Czapek Dox media Candida albicans
Drug of choice in Systemic Candidiasis Amphotericin
Treatment of Oral and esophageal candidiasis Fluconazole
Treatment of mucocutaneous candidiasis in HIV Fluconazole
patients
Treatment of disseminated candidiasis Amphotericin, azoles, echinocandins
PNEUMOCYSTIS JEROVECI
Pneumocystis carnii is a fungus because rRNA, mitochondrial protein gene sequence and
presence of thymidylate synthase, cell wall contains
glucans
Pneumocystis jiroveci May be associated with pneumatocele, diagnosed by
sputum examination, cause disease only in
immunocompromised host
Tree in bud appearance in bone marrow transplant Pneumocystis
recipient
Pneumocystitis carnii infection in HIV, if CD4 count <200
Pneumocystis jeroveci Diagnosis is by sputum microscopy
Pneumocystis carnii diagnosed by Silver nitrate staining (Methaneamine silver)
Prevention of pneumocystis jiroveci in HIV TMP/SMX
Treatment of Pneumocystis carnii Cotrimoxazole
Treatment of pneumocystis carnii Pentamidine, dapsone, cotrimoxazole
BLASTOMYCOSIS
Blastomycosis Yeast like fungus, dimorphic fungus, Commonly involves

lung and skin, Common in north America
North American blastomycosis Blastomyces dermatidis
Fungal infection resembling squamous cell Blastomyces dermatidis
carcinoma (pseudoepitheliomatous hyperplasia)
South American blastomycosis Paracoccidioidomycosis
European blastomycosis Cryptococcosis
Treatment of blastomyces dermatides Liposomal amphotericin B
HISTOPLASMOSIS
Histoplasma capsulatum infection is Bird and bat dropping, cave exploring

commonly associated with
Histoplasma capsulatum Thermal Dimorphic fungus
Histoplasma capsulatum Non encapsulated
Histoplasmosis In early stage indistinguishable from TB
Histoplasmosis In earlier stage,it is indistinguishable from tuberculosis,
Common in AIDS patient, Bone marrow is involved,
Gomori methamine silver stain is used, Dimorphic
MYCOLOGY 83
fungus
Disseminated small nodules in chest with calcification Histoplasmosis
Clinical History of farmer, mimics Tuberculosis, Picture Histoplasmosis
of Organism given
Histoplasmosis is associated with Tuberculate macroconidia
Microconidia as well as macroconidia is Histoplasmosis
associated with
Broncholithiasis is associated with Healed histoplasmosis
Methaneaamine silver is used to stain Histoplasma
Metheneamine silver is used to stain Cryptococcus, histoplasma, pneumocystis
Gold standard for diagnosis of histoplasmosis Culture
ASPERGILLUS
Aspergillus Septate hyphae

Dichomotous branching Aspergillus
Aflatoxin is produced by Aspergillus flavus
Aspergillus niger produce Oxalate
Most probable entry of aspergillus Lungs
MC aspergillus causing human infection Aspergillus fumigates
Malt worker lung is associated with Aspergillus clavatus
Common fungus causing corneal ulcer Aspergillus, Fusarium
MC etiological agent in paranasal sinus mycoses Aspergillus
Corneal sample revealed narrow angled septate Aspergillus
hyphae. Etiology is
Culture of periorbital pus showed branching septate Aspergillus
hyphae
Halo sign is characteristically seen in Aspergillosis
Monad sign Aspergilloma
Crescent sign of chest X ray Invasive aspergillosis
Drug of choice for aspergillus lung infection Amphotericin B
Drug NOT used for Aspergillus infection Fluconazole
HEPA (high efficiency particulate filters are protective Aspergillosis
against
Fumagillin is used for Aspergillus fumigates, microsporidium
MUCOR
Mucor mycosis Angioinvasion, Longterm desferioxamine therapy is a

predisposing factor, May lead to blindness
Non septate hyphae with wide angle Mucor
branching
Ribbon like hyphae Mucormycosis
Voriconazole NOT effective against Mucormycosis
Voriconazole Inhibits cortisol biosynthesis, active
against aspergillosis, available and
effective as oral and intravenous therapy
PROTOZOA 84
MADURELLA
Farmer multiple discharging sinus in leg not responding Madurella

to antibiotics
Madura foot Can erode bone, Slow growing
SPOROTRICHOSIS
Sporotrichosis Sporothrix schenkii, spread along lymphatics, Potassium

iodide is the drug of choice
Pricking ulcer on finger with axillary lymphadenopathy Sporothrix
Series of ulcers in lower extremities in sub Himalayan Sporothrix schenckii
area is often caused by
Himachal Pradesh, series of ulcer in row in leg. cultured Sporothrix schenckii
on sabourad’s dextrose agar
Gardener, multiple vesicles on hand, along lymphatics Sporothrix schenckii
Asteroid bodies Sporotrichosis
Cigar shaped globi and asteroid bodies seen in Sporotrichosis
Definite diagnosis of sporotrichosis Culture

Postassium iodide useful in treatment of Sporotrichosis
CHROMOBLASTOMYCOSIS
Phaehyphomycosis Any infection with pigmented mould

Chromoblastomycosis is caused by Cladosporium
Brown, spherical and septate bodies Chromoblastomycosis
Sclerotic bodies Chromoblastomycosis
Brown spherical septate bodies from pus Chromomycosis
NOT a zoonotic disese Chromoblastomycosis
PROTOZOA
GENERAL FEATURES OF PROTOZOA
Protozoa belong to kingdom Monera

Cyst phase is NOT seen in Dientamoeba, E.gingivalis, trichomonas
Chief source of major parasitic diseases in Man
humans
Hematophagus trophozoite is Stool test
demonstrated by
Loeffler’s syndrome Toxocara, strongyloides stercoralis, L.tryptophan
PROTOZOA 85
ENTAMOEBA HISTOLYTICA
Entamoeba histolytica Cysts are necessary for transmission of infection from

one host to other, Cysts are found in submucosa of the
lower intestinal wall
Entamoeba has 22 zymodenes (10 invasive and 12 non
invasive)
Entamoeba coli 8 nuclei
Most important enzyme associated with Phosphoglucomutase
entamoeba histolytica
Entamoeba cyst has 4 nuclei
Mature cyst of entamoeba Nuclear structure retains characteristics
of trophozoites
Entamoeba histolytica is antigenically E.dispar
different from
Entamoeba which is NOT found in gut Entamoeba gingivalis
Mature cyst of entamoeba histolytica Nuclear structure retains characteristic of trophozoite
Trophozoite of entamoeba histolytica Show erythrophagocytosis
Erythrophagocytosis is a feature of Entamoeba histolytica
Ingested erythrocytes seen only in Entamoeba histolytica
Main reservoir for Entamoeba histolytica Man
MC form of amoebiasis Asymptomatic cyst passage
Commonly affected by invasive amoebiasis Young adult male of low socioeconomic status
Characteristic shape of amoebic ulcer Flask shaped
Amoebic colitis Caused by Entamobea histolytica, Flask shaped ulcers,
Caecum is the most common site
Amoebic colitis commonly occurs in Caecum
Teacher presents with profuse bloody diarrhea fever Entamoeba histolytica
104*, many children studying in the same school had
similar episodes
Intestinal amoeba can cause Peritonitis
MC extraintestinal site of amoebiasis Liver
Seizures NOT commonly seen in Amoebiasis
NOT a method of transmission of amoebiasis Vertical transmission
Culture medium for Entamoeba histolytica Boeck Drbohlav medium
Pathogenic and non pathogenic strains of entamoeba Electrophoretic study of zymodenes
histolytica can be differentiated by
Invasive amoebiasis can be best diagnosed by ELISA
Amoebic lung abscess is diagnosed by Trophozoite in pus
Diagnostic test for amoebic hepatitis Indirect hemagglutination test
Amoebic liver abscess can be diagnosed by Demonstrating trophozoites in pus
Gastrointestinal bleed, ulcers in sigmoid, flask shaped Intravenous metronidazole
ulcer
Intraluminal amoebicide of choice Diloxanide furoate
Treatment of luminal infection Paromycin, Iodoquinol
Drug used for extraintestinal amoebiasis Chloroquine
Chloroquine is effective only in Hepatic amoebiasis
Drug used against entamoeba histolytica Emetine (derived from ipepac)
NOT a luminal amoebicide Ementine
PROTOZOA 86
AMOEBIC MENINGOENCEPHALITIS
Parasites causing encephalitis Toxoplasma gondii, Angiostrongylus cantonensis.

Trypanosoma cruzi
Parasitic encephalitis is caused by Naegleria, Acanthamoeba, Balamuthia
Most fatal amoebic encephalitis Naegleria, Acanthomoeba
Neuropathogenic amoeba Acanthamoeba, Entamoeba, naegleria
Brain eating amoeba Naegleria
Primary amoebic encephalitis is caused by Naegleria floweri
30 year patient, features of acute meningoencephalitis. Naegleria fowleri
CSF on wet mount microscopy revealed motile
unicellular organism
Humidifier fever by Naegleria floweri
Acute primary amoebic meningoencephalitis Diagnosed by trophozoite in CSF
GIARDIA
Normal habitat of giardia Duodenum and jejunum

MC site of lodgement of giardia Duodenum
Giardia lamblia Malabsorption commonly seen, Trophozoite form is
binucleate pear shaped, Diarrhea is seen
Jejunal wash fluid is diagnostic, Trophozoites and cyst
are seen in man
Giardia Flagellate, binucleated
Trophozoite of giardia Binucleated
Trophozoite of giardia Tennis racket shaped, non infectious,
motility resembles falling leaf
Mature cyst of giardia has 4 nuclei
Infection leading to Malabsorption Giardia
Diarrhea, stool in wet mount shows mobile protozoa Giardiasis
with pus and without RBC
Giardia Do not invade intestinal wall, no blood in
stool
Digestion in intestinal mucosa is inhibited Giardia
by
Recurrent giardiasis associated with Common variable immunodeficiency
String test for Giardia lamblia
Giardiasis is best diagnosed by Cyst and trophozoite in stool
Drug used for giardiasis and amoebiasis Metronidazole
Drug used for giardiasis Furazolidone (MAO inhibitor)
Drug used for giardiasis Quinacrine (only drug approved for giardia)
LEISHMANIA
Amatigote forms are seen in Leishmania

PROTOZOA 87
Amastigote Nucleus contains kinetoplast (multiplies copies of

mitochondrial DNA)
Amastigote Without flagella
Promastigote Flagellate, infective
Glycoprotein in Leishmania promastigote Gp63
Leishmania is associated with Abnormal T regulatory action
Leishmania use Trypnothione rather than glutathione
Espundia Leishmaniasis
Mucous leishmaniasis Lesions around mouth and nose (Espundia)
Leishmaniasis Aldehyde test is NOT good for diagnosis, Co infection
with AIDS in now emerging, Indian leishmaniasis in non
zoonotic infection with man as sole reservoir, No drugs
for personal prophylaxis
Leishmaniasis is associated with Hyperalbuminemia, loss of protein and
fall in protein synthesis, reversal of
albumin globulin ratio
Napier aldehyde test is associated with Raise in gamma globulin levels
Aldehyde test of Napier for Surveillance
Indian kala azar Transmitted by bite of infected sandfly, Causative
parasite is cultivated in NNN medium, Disease is
endemic in Bihar, Man is the only reservoir in India
Kala azar is caused by Leishmania donovani
Meaning of kala azar Black fever
Visceral leishmaniasis is caused by Leishmania donovani
Oriental sore is caused by Leishmania tropicalis
Chiclero ulcer caused by L.mexicanaum
Visceral leishmanisis characterized by fever malise, L.tropica
hepatosplenomegaly, Hyperpigmentation
Clinical history of person from Bihar with Biphasic fever Leishmaniasis
with Hepatosplenomegaly and Bone marrow aspirate
study Picture is given
Mucocutaneous leishmaniasis is caused by Leishmania brasiliensis
Vector for Kala azar Sand fly
Most important reservoir for leishmaniasis Case of post kala azar dermal leishmaniasis
More prevalent in india Kala azar
Double rise of temperature within 24 hours Kala azar
Most severely affected in Kala Azar Spleen
NOT an example for human dead end disease Leishmaniasis
Reservoir for Indian Kala azar Man
Kala azar is transmitted by Phlebotomus argentipus
Transovarian transmission Phlebotomus
Which DOES NOT cause brain lesion Leishmania
Aldehyde test for Leishmania
Aldehyde test in Kala azar positive after 12 weeks
Leishmanin test in NOT useful in Indian leishmaniasis
Montenegro skin test Leishmanin test
rK 39 Rapid test
Medium for Leishmania NNN medium
Tobies medium Only for promastigote
Scheider liquid culture For both promastigote and amastigote
PROTOZOA 88
Visceral leishmaniasis Diagnosed by blood smear, Antimonials are useful

NOT a lab test in Kala azar Immobilization test
Amphotericin used in treatment of Kala azar
NOT used Leishmaniasis Rifabutin
Drug of choice for kala azar Sodium stibugluconate
Drug used for leishmaniasis Miltefosine
Only drug approved for visceral leishmaniasis Liposomal amphotericin B
Treatment of cutaneous leishmaniasis Pentavalent antimony
Treatment of mucous leishmaniasis Pentavalent antimony
Treatment of L. guyanensis Pentamidine isethionate
Aminoglycoside used in treatment of Paromomycin
Kala azar
Kala azar is NOT responding to primary treatment. Now Amphotericin B
the treatment should include
NOT used in treatment of visceral leishmaniasis Hydroxychloroquine
Prevention of leishmaniasis Leishmanisation (inoculation of L.major – Iran)
TRYPANOSOMA
Amphixenosis is seen in Trypanosoma cruzi

Trypanosomiasis Sleeping sickness
East African trypanosomiasis Rhodesience
West African Trypanosomiasis Gambiense
Acute disease is associated with High parasitemia
Poverty disease Chaga’s disease
Chaga’s disease Trypanosoma cruzi
Chaga’s disease involve Esophagus and colon
Romana sign Unilateral painless edema of palpebral and periocular
region. Seen in chaga’s disease
Most commonly affected organ in Chaga’s Heart
disease
Commonest cardiac defect in Chaga’s myocarditis RBBB
Vector for Chaga’s disease Reduvid bug
Mega disease Chaga disease of GIT
Winter bottom sign (enlargement of nodes of posterior Trypanosomiasis
cervical triangle) is seen in
NOT found in India Sleeping sickness
Diagnosis fo chaga’s disease Microhematocrit tube containing acridine orange
Xenodiagnosis is helpful in diagnosis of Chaga’s disease
Drug used for Chaga’s disease Nifurtimox, Benznidazole
Drug used for Trypanosomiasis Eflornithine, Melasoprol, Suramin (urea derivative),
Arsenical
Treatment of East african trypanosomiasis with normal CSF Suramin
Treatment of East African trypanosomiasis with abnormal Melasoprol
CSF
Treatment of West African trypanosomiasis with normal CSF Pentamidine
Treatment of West African trypanosomiasis with abnormal Eflornithine
CSF
Side effect of suramin Renal damage
PROTOZOA 89
TOXOPLASMA
Parasite affecting eye Toxoplasmosis

Toxoplasmosis Usually asymptomatic in adults, Anthroponotic disease,
Encephalitis is rare in immunocompetent individuals
Toxoplasmosis Laboratory tests are useful for making diagnosis,
Infection is severe and progressive in
immunocompromised patients
Toxoplasmosis Oocyst in freshly passed cat’s feces is NOT infective,
May spread by organ transplantation, Maternal
infection after 6 months has high risk of transmission
Cerebral calcification and hydrocephalus in a newborn Toxoplasmosis
A 2 years old child with head circumference of 55 cm is Toxoplasmosis
likely to have intrauterine infection due to
Hydrocephalus and intracerebral calcification Toxoplasmosis
Adult toxoplasmosis resemble Infectious mononucleosis
Macula is commonly involved in Toxoplasmosis
Headlight in fog appearance, cracked mud Toxoplasmosis of eye
appearance
Trophozoite Asexual form, invades nucleated cells
Oocysts develop only in Intestine of definite host
Freshly passed oocyst Non toxic
Oocyst of toxoplasma found in Cat
Cat is the definite host for Toxoplasma gondii
Tachyzoites are seen in Toxoplasma
Bradyzoites has Slowly multiplying round parasites
Route of transmission of Toxoplasma Blood
Transmission of toxoplasmosis Ingestion of Bradyzoites
Dissemination of toxoplasmosis via Blood
Main route of transmission of toxoplasmosis Oral
MC manifestation of acute toxoplasmosis Cervical lymphadenopathy
NOT true about toxoplasmosis IgG antibodies are diagnostic of congenital
toxoplasmosis
False about congenital toxoplamosis Avidity testing must be done to differentiate between
IgA and IgM
Sabin Feldman reaction for Toxoplasma
Goldmann Witmer coefficient for diagnosis of Ocular toxoplasmosis
Local cerebral lesion with ring on CT scan Toxoplasmosis
Toxoplasmosis in fetus can be best diagnosed by IgM antibodies against Toxoplasma in fetus
Prevention of toxoplasmosis in HIV TMP/SMX
Drug of choice for treatment of toxoplasma infection in Spiramycin
st
1 trimester of pregnancy
Drug added to Pyrimethamine in treatment of Clindamycin
Toxoplasma gondii infection
Used in therapy of toxoplasmosis Pyrimethamine
Toxoplamosis is NOT treated by Erythromycin
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BABESIOSIS
Obligate parasite of red blood cells Babesiosis

Babesiosis Caused by Babesia microti, Resides in RBC
Babesiosis is transmitted by Tick (Isodex scapularis)
NOT an intestinal protozoa Babesia microti
Maltese crossing is characteristic of Babesia microti
NOT responsible for pulmonary Babesia microti
eosinophilia
Babesiosis is transmitted by Tick
Treatment of mild babesiosis Azithromycin
Treatment of severe babesiosis Clindamycin + Quinine
Atovoquone is used for Toxoplasmosis, babesiosis
CRYPTOSPORIDIOSIS
Cryptosporidium parvum Common opportunistic infection in AIDS, AFB positive

cyst
Acid fast organism with oocyte of size 5 micron on stool Cryptosporidium
examination causing diarrhea in HIV positive patient
Treatment of cryptosporidiosis Nitrazoxanide
ISOSPORA
In HIV patient with malabsorption, fever, chronic Isospora

diarrhea, with acid positive organism. what is the
causative organism
Autofluorescence Isospora
CYCLOSPORA
25 year male diarrhea 6 month. acid fast with 12 Cyclospora

micrometer diameter
Treatment of isospora and cyclospora Trimethoprim and Sulphamethoxazole
BALANTIDIUM COLI
Largest intestinal protozoa Balantidium coli

Bigger size Balantidium coli
Ciliated large intestine pathogen Balantidium coli
Drug used for Balantidiasis Tetracycline
PROTOZOA 91
FEATURES OF PLASMODIUM
JSB stain is used for Plasmodium

Stage of Falciparum NOT seen in peripheral blood Schizont
smear
Schuffner’s dot in malaria is due to Pigment released from breakdown of hemoglobin
Schuffner’s dot is associated with Plasmodium vivax and ovale
Malarial pigment is mainly formed by Hemoglobin
Exoerythrocytic Schizogony P.vivax, P.ovale, P.malariae
Radical cure is required form malaria caused by Vivax and ovale
Enlarged erythrocytes Vivax and ovale malaria
Plasmodium falciparum cause Thrombocytopenia, hemolysis, hematemesis, DIC
Plasmodium falciparum infection in man is Multiple infection of erythrocytes seen
characterized by
Incubation period for Plasmodium 12 days
falciparum
Plasmodium with shortest incubation period Plasmodium falciparum
Black water fever Plasmodium falciparum
Only ring and gamete forms are found in Plasmodium falciparum
Banana shaped gametocyte Plasmodium falciparum
Maurer’s dots Plasmodium falciparum
NOT seen in plasmodium falciparum Schizont
malaria
Accole forms are seen in Plasmodium falciparum
Complications of malaria is common with Plasmodium falciparum
Cerebral malaria is caused by Plasmodium falciparum
Parasitemia is highest in Falciparum malaria
Multiple ring and double chromatin dots Falciparum malaria
Persistent exoerythrocytic cycle is absent in Plasmodium falciparum
Post transfusion malaria is caused by Plasmodium malariae
Plasmodium malariae affects Older cells
Band RBC are seen in Plasmodium malariae
Organ NOT affected by plasmodium falciparum Liver
35 year male, sudden onset of high grade fever, on Plasmodium vivax
malarial slide examination all stages of parasites seen
with schizonts of 20 microns size with 14 to 20
merozoites per cell and yellow brown pigment
Plasmodium vivax attacks Young RBC
Senescent RBC mainly attacked by Quartan malaria
Older RBC’s are preferred by Plasmodium malariae
Reticulocytes are preferred by Plasmodium ovale and vivax
Duffy blood group antigen negativity confers protection Plasmodium vivax
against infection by
Size of RBC are enlarged in Plasmodium vivax infection
Fimbriated RBCs are seen in Plasmodium ovale
Infective stage of mosquito in case of plasmodium vivax Gametocyte
Incubation period of plasmodium vivax 10 – 14 days
Fever every third day is associated with Plasmodium vivax
PROTOZOA 92
Stages seen in peripheral smear of falciparum malaria Gametocytes, accole form and ring form
Band shaped trophozoites are seen in Plasmodium malariae
Nephrotic syndrome is caused by Plasmodium malariae
Fever every 4th day is associated with Plasmodium malariae
NOT seen in falciparum malaria Schizonts
Monkey malaria of human is caused by Plasmodium knowlesi
FEATURES OF MALARIA
Cycle of malarial parasite is in sequence of Gametocytic stage

Infective form for mosquito in plasmodium Gametozoites
Gametocytes Appear in blood 4-5 days after the appearance of
asexual parasite, in vivax infection, 10-12 days in
falciparum, in early stage of infection, density may
exceed 1000 per cu mm of blood
Period between blood meal and laying of Gonotrophic cycle
egg
Gonadotrophic cycle in anopheles Time between blood meal and laying of
eggs. 48 hours
Man is NOT dead end host in Malaria
Secondary host for malaria Man
Infective form of Malaria in vertebrate host Sporozoite
Mosquito injects in to man Sporozoites
Infectious stage of Malaria Sporozoites
Stage of malarial parasite transmitted to man Sporozoite
Among various species of mosquitoes belonging to Anopheles fluvitalis
anopheles genus, one that is highly anthrophilic and
transmits even at low density
Malaria transmitted by Female anopheles mosquito
Anopheles transmitting malaria in urban area Stephensi, dirus
Prolonged parasitism in malaria is due to Antigenic variation
Persistence of malaria infection is due to Intracellular persistency
Malaria resistance is seen in Thalassemia, sickle cell anaemia, G6PD deficiency
Malaria relapse is due to Hypnozoites
Recurrence in malaria Hypnozoites
Recrudescence in malaria Appearance of gametocytes again
Contribute to Resurgence of malaria Drug resistance in parasite, drug resistance in vector,
antigenic variations in parasite
Factor NOT responsible for resurgence of malaria Use of bed nets
NOT true about severe malaria Hematocrit more than 15
Chronic complication of malaria Splenomegaly, nephrotic syndrome
Pathogenesis of cerebral malaria Cytoadhesion, sequestration of cerebral vessels by RBC
Feature of Malaria Thick smear is used to diagnose parasite
Malarial parasites are easily detected if blood films are One hour after the height of paroxysm
taken and examined
PROTOZOA 93
EPIDEMIOLOGY OF MALARIA
Epidemiology of malaria Mosquito acts as definite host

Most sensitive index of recent transmission of malaria Infant parasite rate
in a community
Most sensitive index for recent Infant parasite rate
transmission of malaria
Best indicator for malaria prevalence in a community Spleen rate
API Annual parasite incidence
Annual Parasite Incidence cases during one year
∗ 1000
Population Under Surveillance
Infective form of malarial parasite through blood Trophozoite
transfusion
Peak of fever in malaria coincide with the successive Merozoite into blood stream
broods of
Plasmodium ovale in India has been reported from Gujarat, Orissa
NOT a malarial parasite in India Ovale (but now reported in india)
Antimalaria month June
If API>2, vector is resistant to DDT, malathion spray 3 round of malathion every 3 months
should be done
Malathion is used once 3 months
Goal reduction in morbidity and mortality due to 50% reduction
malaria in 2010
DIAGNOSIS OF MALARIA
Jaswanth singh Bhattacharya stain and Malaria

field stain for
Blood smear in malaria used to identify Type of parasite
Detected by antigen detection test for falciparum Histidine rich protein II
malaria
Fluorescent antibody test for diagnosis of falciparum Immunochromatographic test, Detects aldolase
antigens, Detects LDH antigen, Detects histidine rich
protein II, detection of glutamate dehydrogenase
antigen
TREATMENT OF MALARIA
Chemoprophylaxis for Malaria is given Workers for short period in endemic area, traveler’s
from non endemic to endemic area, pregnant woman in
high endemic area
NOT used for prophylaxis of malaria Doxycycline
Pyronaridine is Antimalarial
Best associated with lumefantrine Antimalarial
Drug of choice for malaria in pregnancy Chloroquine
Bull’s eye maculopathy Chloroquine
Long term use of chloroquine Lichenoid eruptions,visual deterioration,T wave change
PROTOZOA 94
in ECG
Side effects of chloroquine Hypotensive shock, retinopathy
Antimalarial of choice in chloroquine resistant pregnant Quinine
woman
Treatment for drug resistance in malaria Quinine
Quinidine acts mainly on Trophozoite stage
Can cause hypoglycemia in a patient of severe cerebral Quinine
malaria on treatment
Resistant falciparum malaria in the pediatric age group Clindamycin
is treated by
In chloroquine resistant zone the presumptive Sulphadoxine + pyrimethamine
treatment of malaria to be given is
Antimalarial which is a slow acting schizonticide Pyrimethamine
Presumptive treatment of malaria in a chloroquine Sulphalene and pyrimethamine
resistant area
Drug of choice in chloroquine resistant pregnant Pyrimethamine
woman in 1st trimester
Prophylaxis of chloroquine resistant malaria Mefloquine
Treatment of Multidrug resistant Plasmodium Mefloquine
falciparum
Food enhances the rate and absorption of Mefloquine
Drug that be given simultaneously or with Halofantrine
in 3 weeks of mefloquine
Antimalarial causing neuropsychiatric adverse reaction Mefloquine
Treatment of choice for severe falciparum malaria Intravenous artesunate
Drug of choice in severe complicated falciparum malaria Artesunate
NOT an accepted regimen Artesunate + quinine
Drawback of artesunate Rapid recrudescence of malaria
Tissue schizonticide preventing relapse of vivax malaria Primaquine
Radical cure of malaria is done with Primaquine
In high risk areas, the radical treatment for plasmodium 0.25 mg/kg body weight
vivax infection after microscopic confirmation is
administration of tablets primaquine in the daily dosage
of
Used for radical cure of malaria Primaquine
Contraindicated in pregnancy Primaquine
Prophylaxis of malaria in an area with P.vivax Primaquine
Person wants to visit a malaria endemic of low level Proguanil + chloroquine
chloroquine resistant falciparum malaria
Safe for use in pregnancy Proguanil
Antimalarial effective in pre erythrocyte phase in liver Proguanil
Malrone Atovoquone + Proguanil
Prophylaxis of chloroquine, mefloquine resistant malaria Atovoquone/proguanil
Prophylaxis for malaria 1-2 weeks before travel
Marked reduction in asexual parasitemia in 48 hours Type 2 resistance
without complete clearance in 7 days
Synthetic cocktail vaccine SPf66 has shown potential for Falciparum malaria
protection against
HELMINTHS 95
HELMINTHS
GENERAL FEATURES OF HELMINTH
Nematodes are differentiated from other worms by Absent fragmentation, Separate sexes, Cylindrical body,
GIT is formed completely
Cestode (tapeworm) Progressively elongating chain of proglottids (Strobilia),
length can be upto 1000 – 2000 proglottids
Most anterior segment of tapeworm Scolex
Helminthic infection resembling Crohn’s disease Anisakiasis
Dwarf tapeworm Hymenolepis nana
Smallest tapeworm Hymenolepis nana
Hymenolepis nana No intermediate host
Egg containing polar filaments arising Hymenolepis nana
from either end of embropore
Organisms with filariform larva as infective agent Hookworm, Strongyloides
Heterophyes heterophyes is an Intestinal fluke
Transmission of biliary flukes, intestinal flukes and Metacercaria, ingestion by fish
paragonimus westermani
Dew itch/Ground itch produced due to larva of Strongyloides stercoralis, Ankylostoma, Necatar
Eggs concentrated in saturated salt Trichuris, H. nana, E.granularis
solution
Float in saturated salt solution Fertilized eggs of ascaris, Larva of strongyloides,
Trichuris trichura, H.nana
Does NOT float in saturated salt solution Clonorchis sinensis
Eggs having hexacanth embryo Taenia solium, Taenia saginata, Hymenolepis nana
7 year boy intermittent abdominal cramps, loose stools Opisthorcis viverrani
on stool examination ova of size 100 micrometre. NOT a
cause
African eye worm Loa loa
Calabar swelling is caused by Loa Loa
Lizard skin Loa loa
Observation of worm under conjunctiva and Calabar Loiasis
swellings is diagnostic for
Raccoon ascaris Baylisascarias procyonis
Helminth found in mesentry Mansonella
Visceral larva migrans caused by Toxocara canis
Visceral larval migrans is treated by Thiabendazole
Drug of choice for Cutaneous larva migrans Thiabendazole
Small intestine helminth Ascaris, Ankylostoma, Necatar
Larva found in stool in Ankylostoma, Necatar, Strongyloides
Parasites penetrate through skin and enter into body Ankylostoma, Strongyloides, Necatar
Parasites causing lung infection Paragonimus westermani, Echinococcus granulosus and
Echinococcus multilocularis
Pigs are reservoir for Taenia solium, Trichinella spiralis
Fish act as intermediate host in Diphyllobothrium latum, Clonorchis sinensis
Post saline purge is used in Niclosamide and T.solium infection
Intermediate host for Paragonimus Fish
HELMINTHS 96
westermani
Man snail crab man cycle in Paragonimus westermani
Paragonimus westermani is NOT seen in Jammu and Kashmir
Treatment of lung fluke Praziquantel
Nitrazoxanide is appoved for Cryptosporidium
Mechanism of action of Nitrazoxanide Interferes with pyruvate ferredoxin dependent electron
transfer reaction
CLONORCHIS
Parasite passing through three hosts Clonorchis sinensis

Intermediate host for clonorchis sinensis Fish
Organism causing bile duct obstruction Clonorchis sinensis, Ascaris, Fasciola
Biliary obstruction Clonorchis
Helminthiasis is caused by Clonorchiasis
Cholangiocarcinoma is caused by Clonorchis sinensis
A traveler present with conjugated hyperbilirubinemia Clonorchis sinensis
and on investigation, an egg was found in his biliary
tract
Ingestion of raw fish leads to gall bladder cancer due to Clonorchis sinensis
Liver is the target organ for Clonorchis sinensis
DIPHYLLOBOTHRIUM LATUM
Diphyllobothrium Latum Infection is caused by ingestion Plerocercoid Larva

of
Human diphyllobothriasis results from Fresh water fish
consuming infected
Second intermediate host for Fresh water fish
diphyllobothrium latum
Megaloblastic anemia is caused by Diphyllobothrium latum
FASCIOLA HEPATICA
Man invertebrate host cycle is seen in Fasciola hepatica

Treatment of biliary fluke Praziquantel, Triclabendazole
FASCIOLOPSIS BUSKI
Largest trematode infecting man F. buski

NOT an inhabitant of liver F.buski
Drug used for fasciolopsis hepatica Bithinol
HELMINTHS 97
ASCARIS
Source of infection of Ascaris lumbricoides in man Vegetables contaminated with eggs containing larval
forms
Associated with normal hemoglobin and Ascaris
hemocrit
Does NOT cause malabsorption Ascariasis
Ascaris lumbricoides cause deficiency of Vitamin A
Medusa head colony on X ray Round worm infestation
Drug of choice for ascariasis Albendazole
Round worm infection best treated with Albendazole
Mechanism of action of albendazole Binds to beta tubulin and inhibits polymerization
Causes flaccid paralysis of ascariasis Piperazine
Drug of choice in worm colic due to ascariasis Mebendazole
Adult dose of bephenium hydroxynaphthoate in the 5 gm
form of single dose
TAENIA SOLIUM
Longest worm Tenia solim

Man is both intermediate and definite Taenia solium
host for
On microscopic examination, eggs are seen, but on Taenia solium
saturation with salt solution no eggs are seen. the eggs
are likely to be of
Larval form of Taenia referred to Cysticercus
Consumption of uncooked pork is likely to cause Tenea solium
Commonest parasite of CNS in India Cysticercosis
Cysticercus cellulose seen in Taenia solium
Cysticercosis is caused by larva of Taenia solium
Autoinfection is a mode of transmission in Cysticercosis
Most likely to be invaded by Cysticercus Muscle
Comma shaped calcification in X ray Cysticercosis
Treatment of taenia solium Praziquantel
Drug of choice for tapeworm infection Praziquantel
NEUROCYSTICERCOSIS
MC central nervous system parasitic infection Neurocysticercosis

Neurocysticercosis is caused by Taenia solium
Neurocysticercosis Acquired by eating contaminated vegetables, Caused by
regurgitation of larva, Acquired by orofecal route,
Acquired by eating pork
Multiple cystic lesion with calcified borders and Neurocysticercosis
contrast enhancement in CT scan
nd rd
MC Site of Neurocysticercosis Brain Parenchyma, 2 Subcutaneous tissue, 3 Eye
MC manifestation of Neurocysticercosis New onset Partial Seizures
HELMINTHS 98
35 year old male presented with 15 day history of Cysticercosis cellulosae

proptosis in right eye and pain on eye movement. There
is difficulty in moving upwards and downwards. CT scan
showed cystic lesion with a hyperdense opacity within
it, located in the superior oblique muscle
Cysticercosis is associated with Cigar shaped soft tissue calcification
Investigation for Neurocysticercosis CT scan
Oedema in CT absent in which stage of Calcified nodular stage
Neurocysticercosis?
Diagnosis of cysticercosis Immunoblast assay using lentil – lectin purified glycoprotein
Drug of choice for Neurocysticercosis Albendazole
Neurocysticercosis Albendazole superior to praziquantel
Treatment of Neurocysticercosis Praziquantel, albendazole, flubendazole
Treatment of neurocysticercosis Albendazole and praziquantel
Drug of choice for neurocysticercosis Albendazole
NOT used in treatment of neurocysticercosis Niclosamide, Ivermectin
TAENIA SAGINATA
Longest worm Taenia saginata

Ova of t.saginata and t.solium Can NOT be differenriated
Intermediate host for taenia saginata Cow
Man is NOT dead end in Taeniasis
Drug of choice for Taenia saginata Niclosamide
Dose of niclosamide in tenia saginata infection in 40 mg/kg single dose
children
ECHINOCOCCUS
Special feature of echinococcus among cestodes Both intermediate and definite host are animals
Tinea echinococcus causes Hydatid cyst
Hydatid cyst of liver is caused by Echinococcus granulosus and Echinococcus
multilocularis
Hydatid cyst is caused by Echinococcus granulosus
Transmitted by egg ingestion Hydatidosis
Intermediate host for Hydatid disease Man
Vital layer of hydatid cyst Germinal layer
Only living part of Hydatid cyst Germinal epithelium
Fluid filling hydatid cyst is secreted by Germinal layer
Hydatid cyst commonly occur in Liver
Hydatid cyst of lung common in Lower lobe
Dropping water lilly sign is seen in Liver
Signs of hydatid cyst Cart wheel appearance, cyst in cyst sign,
floating membrane sign
Sensitivity of casoni test 90%
Hydatid cyst ELISA, Casoni test, False positive reaction in CFT
ARE-C5 in countercurrent mechanism Hydatidosis
NOT a scolicidal agent 0.5 % Silver nitrate
HELMINTHS 99
Used in hydatid disease Albendazole

Infection resembling malignancy Echinococcus multilocularis
FEATURES OF FILARIASIS
Filiariasis is endemic in UP, Bihar, Gujarat

Percentage of persons examined showing microfilaria in Filarial endemicity rate
blood or disease manifestation or both
Organism commonly causing genital filariasis in most Wuchereria bancrofti
parts of Bihar and Eastern UP
Hydrocele and edema of foot occur in Wuchereria bancrofti
Wuchereria bacrofti Body is long and slender, Terminal nuclei absent
Types of microfilaria Long and thick – type I, short and thick –
type II, long and thin – type III - infective
Non sheathed microfilaria Mf.malayi
Sheathed microfilaria W. bancrofti, Loa loa, B. malayi
Wuchereria bancrofti Terminal nuclei absent
Sheathed microfilaria with nuclei upto tail tip Brugia malayi
Microfilaria with sheath and two nuclei at the end Brugia
Nuclei in brugia malayi Blurred and difficult to count
MC nematode in south india Brugia malayi
Brugia malayi Intermediate host in India are Mansoni, Nuclei are
blurred and so counting is difficult, Adult worm is found
in lymphatic system, Enveloped sheath, Nocturnal
periodicity
Brugia malayi is common in Bihar and eastern UP
NOT true about Brugia malayi Smooth curved in stain preparation
Tail tip of microfilaria free from nuclei Mf.ozzardi
Clinical incubation period of filariasis 8-16 months
Lymphatic filariasis is NOT caused by Dirofilaria imitis
Filariasis Man is definite host, Caused by Wuchereria bancrofti,
Involves lymphatic system, DEC is used in treatment
Stage of filariasis in which microfilaria are seen in Early lymphangitis stage
peripheral blood
Meyer Kouvenaor syndrome Occult filariasis
Meyer Kouvenaor body Filariasis
River blindness is caused by Onchocerca volvulus
Subcutaneous itchy nodules over left iliac crest, firm, Onchocerca volvulus
non tender and mobile. skin scraping contain
Subcutaneous nodules are diagnostic of skin snip which Onchocerciasis
is taken in
Sowdah Localized onchodermatitis in onchocerciasis
Onchocerciasis is associated with Papular eruption, snowflake opacities in eye, hanging groin
lymphnodes
Adult worm of O.volvulus is found in Subcutaneous tissue
Skin snip for Onchocerca volvolus, Mansonella
HELMINTHS 100
MANAGEMENT OF FILARIASIS
Filaria dance sign is seen with Ultrasonography

Method used to detect low density Xenodiagnosis, membrane filter
microfilaria concertration method
Microfilaria does NOT multiple in Humans
Drug of choice for Filariasis Diethylcarbamazine
Difference between action of DEC and ivermectin in DEC acts on adults, Ivermectin on microfilaria
case of scrotal filariasis
DEC is most effective against Microfilariae
Currently given regimen for bancroftian filariasis DEC 6 mg/kg/day for 12 days
Dose of DEC in mass prophylaxis of filariasis in India 6 mg/kg for 2 days
DEC mediated salt for mass treatment in lymphatic Lakshadweep Islands
filariasis was shown to be safe, cheap and effective in
Mass chemotherapy is used in Filariasis
Target year for elimination of filariasis 2015
ENTEROBIUS
Seatworm Enterobius
MC presenting symptom of threadworm infection Abdominal pain
Autoinfection is seen in Enterobius
Nematode residing in caecum and appendix Enterobius vermicularis
Eggs causing intense pruritis in perianal skin Enterobius vermicularis
Does NOT pass through lung Enterobius vermicularis
Cellophane test for Enterobius vermicularis
Feces examination NOT useful in diagnosing Enterobius
TRICHINELLA
Viviparous Trichinella spiralis

Trichinella Larva rest in nurse cell
Larvae found in muscle Trichinella spiralis, Taenia saginata,
echinococcus
Larvae found in muscle in Trichinella spiralis
Trichinellosis Ova encysted in muscle with hyalinised capsule, associated
with splinter hemorrhage and subconjunctival hemorrhage
MC muscle group involved in Trichinella spiralis infection Extraocular muscles
Viviparous Trichinella spiralis
Does NOT enter human body via skin Trichinella spiralis
NOT a neuroparasite Trichinella spiralis
Parasite causing myocarditis Trichinella
Muscle biopsy is indicated in Trichinella spiralis
Treatment of trichinella spiralis infection Albendazole, glucocorticoids
HELMINTHS 101
GUINEA WORM
Dragon / serpent worm Dracunculiasis

Dracunculiasis Infection through ingestion of water
containing cyclops
Definite host of guinea worm Man
Dracunculus medinensis is transmitted by Cyclops
Dracunculiasis is more common in Rajasthan
Guinea worm infection is common in workers of Step wells
Comma shaped calcification in tissue Guinea worm
Guinea worm infection Metronidazole
Drug preventing transmission of No drug
dracunculiasis
Concentration of abate used in killing 1 mg/L
Cyclops
Dracunculiasis Eradicated in India, limited to tropical and subtropical
region, no animal reservoir
Parasite does NOT enter the body by skin penetration Dracunculus
STRONGYLOIDES
Stronglyoidosis is associated with Immunodeficiency

Infection associated with colitis Strongyloides
Unique feature of strongyloides stercoralis Replicate in human host
Larva currens is seen in Strogyloides stercoralis
Autoinfection seen with Strongyloides
NOT transmitted by fecooral route Strongyloides stercoralis
Does NOT transmitted through egg Strongyloides
NOT a water borne disease Strongyloidosis
Diagnostic feature of uncomplicated strongloidiasis Rhabditidiform larva
Enterotest for Strongyloidosis
Treatment of strongyloidiasis Ivermectin
SCHISTOSOMA
Cercaria Mature schistosomal larvae

Natural habitat of Schistosoma Veins of urinary bladder, portal and pelvic veins, vesical
plexus
NOT a cestode Schistosoma
Redia stage is NOT seen in Schistosoma
Painless terminal hematuria is associated Schistosoma hematobium
with
Katayama fever is caused by Schistosoma hematobium
Swimmer’s itch is associated with Schistosoma
Transmission of Schistosomiasis Cercaria from snail by skin penetration
Liver manifestations of schistosoma hematobium Symmer’s clay pipe stem fibrosis (Periportal)
HELMINTHS 102
Helminth entering skin by penetration Schistosoma hematobium

Investigation contraindicated in children Cystoscopy
coming with hematuria due to
Schistosoma hematobium
Peripheral smear is NOT useful in Schistosoma hematobium
Cercarial dermatitis is caused by Schistosoma mansoni
Pipestem cirrhosis Schistosoma mansoni eggs incite a fibrotic
response in portal vein
Swimmer’s itch is associated with S.japonicum, S.mansoni
Rectal snip for Schistosoma mansoni
Egg with lateral spine S.mansoni
Schistosoma japonicum resides in Splenic vein
Jacksonian epilepsy may be caused by Schistosoma japonicum
Egg of schistosoma japonicum Small hook like spine
Parasitic infection is transmitted by direct penetration Schistosomiasis
of larva
Urinary bladder calcification radiologically which Schistosomiasis
resemble fetal head in pelvis
Hematuria, renal calculi, calcifications in the wall of Schistosomiasis
bladder and small contracted bladder
Quantification of infection in Schistosoma hematobium Nuclear pore filter
Metrifonate is effective against Schistosomiasis
Drug of choice for schistosomiasis Praziquantel
Drug used for schistosoma hematobium Metrifonate
Drug used for Schistosoma mansoni Oxamniquine
TRICHURIS
Trichuris trichura No filariform stage, no invasion so

eosinophil count is increased
Trichuris trichura maintains its position Anchorage with its anterior portion
in the intestinal tract by
Trichuris trichura resides in Caecum
Lemon shaped eggs Trichuris trichura
Eggs look like football with bumbs on each Trichuris trichura
end
Man is the only host in Trichuris trichura
Trichuris trichura infection is associated Chronic dysentery, abdominal pain, rectal
with prolapsed in children
Rectal prolapse is associated with Trichuris trichura (whip worm)
Infection does NOT affect eye Trichuris
Sputum examination is NOT useful in diagnosis of Trichuris trichura
Does NOT pass through human lung Trichuris trichura
HOOKWORM
Old world hookworm Ancylostoma

Ancylostoma enters human body by Penetration of skin
HELMINTHS 103
Habitat of ancylostoma Jejunum

Major cause of cutaneous larva migrans Ancylostoma brasiliensis
Creeping eruptions commonly seen in Ancylostoma brasiliensis, Ancylostoma carinum
Anclyostoma cause Asymptomatic infection
Anemia, skin rash in in a child Hook worm
Average blood loss associated with hook 0.2 ml/day
worm
Ground itch Hook worm
Does NOT cause biliary tract obstruction Ancylostoma duodenale
Transmammary transplacental transmission is reported Anclyostoma duodenale
in
Chandler’s index used for Ancylostoma duodenale
Warm load in community is measured by Chandler’s Index
Chandler’s index No of hookworms per gram of stool
Chandler’s index water containing 200-250 eggs should Dangerous
be considered
Nematode present in jejunal mucosa Necatar americanus
Drug of choice for hookworm infection Albendazole

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What are some important features of Staphylococcus and Streptococcus bacteria?

What are some important features of Staphylococcus and Streptococcus bacteria?

What are the different types of helminth infections described in the notes?

What are the different types of helminth infections described in the notes?

MICROBIOLOGY

GENERAL FEATURES OF TETANUS........................................................................................................................... 27

TRICHINELLA ......................................................................................................................................................... 100

KEY TO THIS DOCUMENT

Text in normal font – Must read point.

Text in bold font – Point from Harrison’s

Text in italic font – Can be read if

CULTURE AND STERILISATION

Father of medical microbiology Robert Koch

Asepsis means Absence of pathogenic microbes

Spores of bacteria are destroyed by Autoclaving at 120*C for 15 mins

Disinfectants Hypochlorites are bactericidal and inactivated by

GENERAL FEATURES OF BACTERIA

Smallest size that can be seen by naked 200 micron

Prokaryotic DNA differ from eukaryotic organism by No complex with proteins

GRAM POSITIVE AND GRAM NEGATIVE ORGANISMS

GRAM POSITIVE GRAM NEGATIVE

LIGAND AND HOST RECEPTORS FOR MICROORGANISMS

ORGANISM LIGAND HOST RECEPTOR

Phase of bacterial growth during which growth rate of Stationary phase

Surface appendage of bacteria function as organ of Fimbriae

BIOTERRORISM AND VESICANTS

Treatment of vincristine induced vesicles Hyaluronidase

GENERAL FEATURES OF BACTERIA

Bacteria Mitochondria always absent, Divide by binary fission

Toxins inhibiting protein synthesis Verotoxin of E.coli, Shigella toxin,

Staphylococcus aureus 30% of population is healthy nasal carriers,

associated with recurrent infections

Staphylococcus aureus differ from staphylococcus Coagulase positive

Novobiocin susceptible staphylococci Staphylococcus hemolyticus, Staphylococcus

DISEASES CAUSED BY STAPHYLOCOCCUS

Oppurtunistic infection most commonly seen in children Staphylococcus

Superantigens Epidermolysin, TSS toxin

Toxin responsible for SSSS Exfoliative toxin

STAPHYLOCOCCAL FOOD POISONING

Staphylococcal food poisoning Optimal temperature for formation of toxin 37* C,

Differentiation of streptococci from staphylococci Catalase test

chain cocci, hemolytic colonies. Test identifying

Streptococci with no lancefield antigen Viridans group, pneumococci

NOT a medically important streptococci S. salivarius

DISEASES CAUSED BY STREPTOCOCCUS

Causative agent of subacute bacterial endocarditis is Blood agar

Toxin produced by S.pyogenes Streptolysin O, Erythrogenic toxin, Hyaluronidase

CROSS SENSITIVITY OF STREPTOCOCCAL ANTIGEN

Capsular hyaluronic acid Synovial fluid

Enterococcus Common species are enterococcus fecalis and

Discovery of gene transformation come Streptococcus pneumonia

Griffith demonstrated biotransformation with Pneumococcus

GENERAL FEATURES OF NEISSERIA

Neisseria is a Gram negative cocci

Features of Neisseria gonorrhea Kidney shaped, non capsulated, ferment

Neisseria gonorrhea Exclusive human pathogen, Some strains may cause

Features of Neisseria meningitides Lens shaped, capsulated, ferments both

Chemoprophylaxis of meningococcal meningitis carrier Rifampicin

GENERAL FEATURES OF CLOSTRIDIA