Micro Danica Frias

Study hard and Pray harder. Make this season a season for growing.
Dont let fear & anxiety surround you; instead ask for His peace that transcends all understanding.
Take the board exam not by your might and strength, but by His grace and favor, and to Him give all the praises.
I. MICROBIOLOGY l. Edward JENNER - developed the VACCINE for
small pox
MICROBIOLOGY is the study of microorganisms
which are large and diverse group of microscopic m. John ENDERS - first person who artificially
organisms that can occur as either single cell or in CULTURED viruses (lead to the mass
cluster arrangement, including the viruses which are production of vaccines)
microscopic but acellular.
n. Paul EHRLICH - Father of CHEMOTHERAPY
HISTORY discovered Salvarsan aka asphenamine,
compound 606 or magic bullet
a. Anton van Leeuwenhoek
Father of MICROBIOLOGY o. Gerhard DOMAGK - discovered
Developed the first simple microscope SULFONAMIDES
1st Sample: feces (Giardia lamblia)
p. Paul WAKSMAN - discovered STREPTOMYCIN
b. Robert HOOKE - Father of CYTOLOGY
q. Alexander FLEMMING - discovered Penicillin
c. John NEEDHAM - Spontaneous Generation
Theory or Theory of ABIOGENESIS non-living Note: CHAIN & FLOREY - discovered the
things can give rise to living organisms clinical use of Penicillin
d. Aristotle - small invertebrates can give rise to TYPES OF MICROORGANISMS
living organisms
EUKARYOTES
e. Francesco REDI - first opponent of the True nucleus enclosed by nuclear membrane
Theory of Abiogenesis proposed: Theory of
BIOGENESIS where only living things can give 1. Fungi
rise to living organisms molds, yeast multicellular
except YEAST (UNICELLULAR) ; filamentous
f. Lazzaro SPALLANZANI - entry of
microorganism can be prevented by boiling 2. Animals
parasites
g. Louis PASTEUR - “pasteurization” - heating at ENDOparasites - helminths, worms
60C at around 30 minutes “Swan-Neck Flask ECTOparasites - insects, arachnids
Experiment”
3. Plants
h. John TYNDALL Tyndallization / MOIST heat Photosynthetic - Algae (Japanese Isinglass)
sterilization / intermittent sterilization Cell wall - contain CHITIN (Echinocandin -
targets chitin ex. Micafungin)
i. Joseph LISTER - Father of ASEPTIC
Technique discovered carbolic acid/phenol 4. Protozoans
(phenol coefficient) unicellular, free-living microorganisms
(endoparasites)
j. Friedrich HENLE - propes: GERM Theory of ***viruses - small intracellular parasites
Disease (obligate) acellular entities
k. Robert KOCH - 1st microorganism: G(+) Eukaryotic Cell Structure

aerobic microorganism Bacillus anthracis
(DOC: Ciprofloxacin) o Plasma Membrane (phospholipid bilayer)
o Cytoplasm (composed of fluids and
1. Causative Agent – the suspected organelles)
microorganism must be present in all stages o Organelles
of the disease
Golgi Apparatus - packaging center; post-
translational modifications
2. Pure Culture media - identifiescthe
suspected microorganism; the suspected Mitochondria - powerhouse center;
microorganism must be grown in a pure oxidative phosphorylation; 1% DNA
culture media
Endoplasmic Reticulum - Rough (ribosomal
3. Healthy Host - the suspected microorganism attachment) Smooth (lipid attachment)
must cause the same disease when
introduced to a healthy host Ribosomes - site of protein synthesis
(translation); primary RSU is 80s (60 & 40)
4. Disease Host - the suspected microorganism Nucleus composed of genetic material
when inoculated from the disease host, Biochemical processes: DNA Replication
must be the same microorganism Transcription
Study hard and Pray harder. Make this season a season for growing. Dont let fear & anxiety surround you; instead ask for His peace that transcends all understanding.
PROKARYOTES antigenicity of organism where it could
Relatively small in size (>1mcm in diameter) stimulate antibody production
ABSENCE of nuclear membrane or true nucleus and 2 Types: LIPOTEICHOIC Acid &
important organelles (ER, mitochondria, golgi Membrane Teichoic Acid
apparatus)
PERIPLASMIC Space - only found in G(-); function is it
1. Bacteria (Eubacteria) contains hydrolytic enzymes (eg B-lactamase)
cell wall: Peptidoglycan (MUREIN /
MUCOPEPTIDE) as primary component GLYCOCALYX - extracellular polysaccharide material
found outside the cell
reproduction: BINARY fiSSION pathogenic /
disease causing lives at temperature 40-45 C CAPSULE - organized structure, firmly
attached to the cell, excludes particles;
2. Archaea (Archaebacteria) function: bacterial virulence, can escape
NO cell wall phagocytosis
NON-pathogenic
SLIME layer - unorganized structure, loosely
lives in EXTREME environmental conditions
attached to the cell, does not exclude particles.
function : bacterial attachment. ex: Neissereae
THERMOphiles (>85 C) live in high temp (DOC: 3rd gen Ceftriaxone)
environment,
General Rule:
BAROphiles (live in high pressure environment)
a. All cocci are nonencapsulated except:
METHANOGENS (live in high methane STREPTOCOCCI
concentration),
b. All bacilli are nonencapsulated except:
HALOPHILES live in high salt concentration. KLEBSIELLA, HAEMOPHILUS, BACILLUS
PROKARYOTIC CELL STRUCTURE Cell Appendages:

Flagella - for movement or locomotion. highly
Cellular / Plasma Membrane - acts like a fluid (fluid antigenic structure (H antigen). its protein unit
mosaic model); phospholipid bilayer is flagellin.
LAMP:
Cytoplasm - fluid intracellular matrix LOPHOtrichous - tuft of flagella at one end
AMPHItrichous - single polar flagella at both
Gas Vacuole* - only found in cyanobacteria; function: ends
buoyancy effect MONOtrichous - single polar flagella at one end
PERITRIchous - flagella all over the cell
Cytoplasmic Inclusion Bodies - different organelles
(compartmentalized); primary storage of energy
Pili - hair-like rigid structure; shorter than flagella;
twitching movement; only found in G(-) organisms
Nucleoid - contains the genetic material
Ordinary Pili (FIMBRIAE) - for attachment
Ribosomes - primary site of protein synthesis
(30s, 50s RSU)
Sex Pili - for bacterial conjugation
Endospores only found in BACILLUS and
AXIAL Filament - used by spirochetes for spiral
CLOSTRIDIUM ; dormant stage in bacteria’s life
motion
cycle
Rationale: sense that the environment is Spirochetes:
depleted with nutrition 1. Treponema pallidum - causative agent
Heat resistant; dissociaton resistant for syphilis
ID test: MALACHITE GREEN 2. Leptospira interrogans - causative agent
(+)VR Green (-) Red for leptospirosis
Bacillus ; nonswollen
Clostridium; swollen 3. Borrelia burdorferi - causative agent for
Lyme disease
PLASMIDS - extrachromosomal genetic
material found in the cytoplasm (ex. R Factor 4. Borrelia recurrentis - causative agent for
or R Plasmids indicate antibiotic resistance) relapsing fever
TEICHOIC ACID only found in G(+) organisms ***binary fission is their primary method
primary surface antigen of G(+) of reproduction
function: responsible for the negative
cell surface; contribute to the
B. ACID FAST STAINING AKA ZIEHL-NEELSEN
Transfer of DNA
Conjugation CARBOL FUSCHIN PRIMARY STAIN
transfer of genetic material using HEAT MORDANT
PLASMIDS
ETHANOL DECOLORIZER
Transduction
BACTERIOPHAGE mediated transfer of METHYLENE BLUE COUNTERSTAIN
genetic material
Bacterial Transformation Staining 2 Methods: Hot & Cold Primary Stain:
direct transfer of genetic material from the Carbol Fuschin Modant: heat Decolorizer:
donor cells to the receptor cell ethanol Counterstain: Methylene Blue / Malachite
green
OPTICAL METHODS
C. NEGATIVE STAINING
A. LIGHT MICROSCOPE cell or specimen appears colorless
Primary Stain: NIGROSIN
1. Bright field Microscope
Magnification: 1000x D. FLAGELLA STAINING STAIN
Ocular Lens (10x) unstable COLLOIDAL suspension of tannic acid
Objectives (100x) precipitates in the presence of flagella
difference in contrast between the specimen
and surrounding medium killed and stained
E. CAPSULE STAINING STAINS
specimen
HOT solution of CRYSTAL VIOLET then rinsing
2. Phase Contrast Light Microscope provides with COPPER SULFATE
magnification of living cells which are
UNSTAINED INDIA INK - used for Cryptococcus neoformans
(DOC: Fluconazole)
3. Dark Field Light Microscope lighting system is
just able to reach the sides of the specimen F. NUCLEOID STAINING STAIN
ex: Spirochete (Treponema pallidum) FEULGEN STAIN (sensitive for DNA)
4. Fluorescent Light Microscope used for G. SPORE STAINING STAIN

specimen that fluoresce (able to absorb short MALACHITE GREEN
wavelengths of light and emit long Carbolfuschin (alt.)
wavelengths naman)
STAGES OF MICROBIAL GROWTH
Used in clinical
diagnostic microbiology
ex: AURAMIN O - for staining M. tuberculosis
5. Differential Interference Contrast Microscope

(DIC) employs a polarizer provides a 3D
structure of spores, vacuoles, granules
B. ELECTRON MICROSCOPE
Transmission Electron Microscope uses an electron

beam from an electron gun, focused by an electron
condenser into a thin specimen
Scanning Electron Microscope provides a 3D
structure of microscopic surfaces of
microorganisms 1. LAG PHASE
Phase of Adjustment synthesis of important
STAINING METHODS biomolecules susceptible to the action of
antibiotics
A. GRAM STAINING
2. LOG PHASE
Reagent Function G(+) G(-) Exponential Growth Phase double in number at a
CRYSTAL primary stain Blue-violet Blue-violet constant maximum rate rapid increase in number
VIOLET
STAIN of microorganisms accumulation of toxic waste
IODINE mordant Blue-violet Blue-violet 3. STATIONARY PHASE
ETHANOL decolorizer Blue-violet colorless Equilibrium Phase cell reproduction = cell death
SAFRANIN counterstain Blue-violet Red/pink
4. DECLINE
cell death > cell reproduction
STAGES OF INFECTIOUS DISEASE 3. MILK AGAR - for microorganisms that require
high protein nutrition
1. INCUBATION PERIOD
entry of microorganism into DIFFERENTIAL MEDIA
the systemic circulation
pathogenesis period; no presence of VISIBLE color reaction; subdivides a large
signs and symptoms but group of microorganisms into classifications
varies depending on the
characteristic of the 1. BLOOD AGAR PLATE
organism classify groups of STREPTOCOCCI (G+ in chains)
based on hemolytic reactions
2. PRODROMAL PERIOD
appearance of mild signs and symptoms which ALPHA-Hemolytic - partial hemolysis VR=Green
are not pathognomic with the disease eg. fever,
headache BETA-Hemolytic - complete ; VR=Colorless
further classified into Lancefield classification
3. ACME PERIOD Group A: Streptococci PYROGENES
peak of the illness ; appearance of the major signs (pharyngitis)
and symptoms which are pathognomic with the
disease Group B: Streptococcus AGALACTIAE
(most common cause of meningitis)
4. PERIOD OF DECLINE major signs and symptoms
subsides Gamme-Hemolytic - no VR
5. CONVALESCENCE PERIOD body is restored to its 2. MACCONKEY AGAR (MCA)
normal healthy condition Eosin Methylene Blue Agar (EMB)
classify ENTEROBACTERIACEAE whether they
OCCURRENCE OF INFECTIOUS DISEASE are lactose or non-lactose fermenters
a) ENDEMIC Lactose Fermenter PINK Colonies METALLIC
number of cases all year round sheen green (E.coli)
January to December; (ex. schistosomiasis –
Samar, Leyte; malaria – Palawan, Mindoro; filariasis Non-lactose Fermenter N/A N/A
– Bicol)
Classification of Enterobacteriaceae
b) SPORADIC 1. RAPID LACTOSE FERMENTER (EKE)
scattered number of cases in a certain time period E. coli
and place Klebsiella
Enterobacter spp.
c) EPIDEMIC
outbreak sudden increase in number of cases in a 2. SLOW LACTOSE FERMENTERS (SLOW SCAPE
certain time period and place OF EDWARD WHO IS A HALF VAMPIRE)
Serratia
d) PANDEMIC Citrobacter
sudden increase in number of cases from one Arizona
continent to another (more than one continent) Providencia
Erwinia
highest level: level 6; (ex. 2009 – influenza AH1N1; Edwardsiella
2014 – Ebola virus = level 4) Hafnia
CULTURE MEDIA 3. NON-LACTOSE FERMENTERS (SPPS)
Salmonella Proteus
SIMPLE MEDIA (most common cause of acne vulgaris)
for NONFASTIDIOUS microorganism; does not require Pseudomonas
special nutrients Shigella all -ella are non-motile except for
NUTRIENT AGAR, NUTRIENT BROTH Salmonella
ENRICHED MEDIA
for FASTIDIOUS microorganism; contains special
vitamins & minerals 3. MANNITOL SALT AGAR (MSA)
1. BLOOD AGAR PLATE (BAP) - for s. AUREUS Þ GOLDEN yellow

microorganisms that require high nucleic acid s. EPIDERMIDIS Þ PORCELAIN white
nutrition s. SAPROPHYTICUS Þ NO visible reaction
2. CHOCOLATE AGAR - for microorganisms that
require high hemoglobin nutrition (sheep’s blood)
ex. THER MARTIN
SELECTIVE MEDIA
allows the growth of ONE GROUP of microorganisms

and inhibits the OTHER
1. EMB AND TCA

BOTH differential and selective media
2. SABORAUD DEXTROSE AGAR (SDA)

selective only for fungal growth provides an
acidic pH which is very suitable for fungal
growth (PH5.6) fungi are
keratophilic/acidophilic
3. COLISTIN-NALIDIXIC ACID MEDIUM (CNA)

selective only for gram POSITIVE organisms
only
4. THAYER-MARTIN
selective for the gram negative DIPLOCOCCI
NEISSERIAE modified chocolate agar
5. LOWENSTEIN-JENSSEN MEDIA
very selective only for the culture of the acid
fast M. tuberculosis PREVIOUS gold-
standard for the diagnosis of tuberculosis (3-
5 months)
DSSM - DIRECT SPUTUM DIRECT

MICROSCOPY is now the gold standard very
expensive used only if there is suspected
extrapulmonary TB
6. THIOSULFATE CITRATE BILE SUCROSE

(TCBS)
selective only for VIBRIOnaceae
7. LOEFFLER’S SERUM MEDIA & TELLURITE

MEDIA
selective only for CORYnbacterium
diphtheriae
8. SKIRROW’S AGAR & CAMPY BAP

selective only for Campylobacter JEJUNI
9. BORDET-GENGOU AGAR
selective only for BORDETELLE perussis the
causative agent for whooping cough
ANAEROBIC MEDIA
CANDLE JAR METHOD - obsolete

THIOGLYCOLLATE AGAR
GASPAK
Outline
I. Microbiology
II. Bacteriology
III. Bacteria
IV. Antibacterial
V. Virology
VI. Antivirals
VII. Mycology
II. BACTERIOLOGY
4. GRAM STAIN
1. GENERAL MORPHOLOGY
Nucleoid single circular : dsDNA, no nuclear
membrane, no nucleolus, no mitotic
spindle, and no histones
Ribosomes 50s 30s
Plasmids extrachromosomal, double-stranded,
circular DNA molecules
replicating independently
Cytoplasm An amorphous matrix
An inner, nucleoid region composed of + -
DNA. Gram Staining Violet Red
Cytoplasmic Only prokaryotes that have sterols in
Peptidogylcan Thick Thin
Membrane their membranes : Mycoplasma
(1) active transport of molecules into the Teichoic Acid Present Absent
cell, (2) energy generation by oxidative septic shock
phosphorylation, (3) synthesis of Periplasmic space Absent Present
precursors of the cell wall, and (4) Outer Membrane Absent Present
secretion of enzymes and toxins.
Capsule gelatinous layer covering the entire LPS Low High
bacterium. Composed of polysaccharide, Toxins Exotoxin Endo & Exo
except in the anthrax bacillus, which has
a capsule of polymerized D-glutamic
acid 5. Toxins
determinant of virulence
anti-serum : quellung reaction
vaccines EXO ENDO
Slime Layer polysaccharide coating. It covers Relation to MO Metabolic prod. LPS
surfaces like a film and allows the bacteria
to adhere firmly to various structures, Chemistry Thick Lipid A : Toxic
e.g., skin, heart valves Effect Specific General
glycocalyx-producing strains of
Pseudomonas aeruginosa: RTI cystic Toxicity High Low
fibrosis patients Antigen ✔ ✕
Staphylococcus epidermidis Viridans
streptococcis : endocarditis.
Streptococcus mutans, to the surface of 6. BACTERIAL GENETICS
teeth: plaque, the precursor of dental
caries. Chromosome • Plasmid • Transposons ‘jumping genes’
Flagella Chemotaxis, Proton Motive Force
Spirochetes : axial filament Conjugation DNA Transferred Chromosomal Or
Fimbriae hairlike ; shorter ; straighter, thinner than From One F Plasmid
flagella ; for adherence Bacterium To Sex pilus
Pili longer & fewer than fimbriae ; locomotion & Another
DNA transfer Transduction DNA Transferred Bacteriophage,
Endospores Spore formation (sporulation) occurs By A Virus From Phage
when nutrients, such as sources of C & One Cell To Lysogenic
N, are depleted This resistance may be Another Conversion
mediated by dipicolinic acid, a calcium Transformation Purified DNA Any DNA
ion chelator found only in spores. Taken Up By A
Cell
2. SHAPE & ARRANGEMENT
A: Cocci in clusters (e.g., A. Gram + COCCI
Staphylococcus; A-1);
B. Gram - COCCOBACCILI
chains (e.g., Streptococcus; A-2);
in pairs with pointed ends (e.g., C. Gram - COCCI
Streptococcus pneumoniae; A-3); D. Enteric Gram - BACILLI
in pairs with kidney bean shape
(e.g., Neisseria; A-4).
E. Other Gram - BACILLI
F. Spore forming Gram + BACILLI
B: Rods (bacilli): with square G. Non-spore forming Gram + BACILLI
ends (e.g., Bacillus; B-1); with H. Bacteria with Elementary & Reticulate
rounded ends (e.g., Salmonella; B-2); Body
club-shaped (e.g., Corynebacterium; B-3); I. Spirochetes
fusiform (e.g., Fusobacterium; B-4); J. Mycobacteria
comma-shaped (e.g., Vibrio; B-5).
K. Bacteria that cause Atypical Pneumonia
C: Spirochetes: relaxed coil (e.g., Borrelia; C-1); L. Obligate Intracellular, Arthropod Borne
tightly coiled (e.g., Treponema; C- 2) M. Other
III. BACTERIA
STREPTOCOCCUS
A. Gram + COCCI LANCEFIELD BAP
STAPH STREP ENTERO PYOGENES A b
Catalase + Catalase- Catalase- AGALACTIAE B b
Cluster Chain Chain
ENT. FAECALIS D a b none
BOVIS D a / none
STAPHYLOCOCCUS PNEUMONIAE
VIRIDANS
-
-
a
a
Aureus Epidermidis Saprophyticus
BAP
b d d a. S. PYOGENES
Coagulase + - -
Mannitol + - - Group A b hemolytic
Virulence factors SMASHED: Streptolysins M protein Anti-C5a
Novobiocin S S R peptidase Streptokinase Hyaluronidase Exotoxin DNAses
M protein - major virulence factor ; antiphagocytic ;
a. S. AUREUS rheumatogenic & nephritogenic
Necrotizing Fascitis Strep. gangrene

Skin Infections Impetigo, Furuncles, Impetigo Pyoderma ; “honey” colored
Carbuncles, Paronychia, crusted lesion
Cellulitis, Folliculitis, Pharyngitis Inflammation, Exudate,
Hydradenitis Suppurativa, Fever, Leukocytosis, And
Conjunctivitis, Eyelid Tender Cervical Lymph
Infections (Blepharitis And Nodes > RHF
Hordeolum), And Pneumonia
Postpartum Breast
Infections (Mastitis) Lymphangitis
Scalded Skin Syndrome Erysipelas & Cellulitis
Osteomyelitis a toxin, hematogenous Scarlet Fever / RHF Immunologic Rxn
Food Poisoning Enterotoxin
Toxic Shock Syndrome Nasal or vaginal tampons Post Strep Disease:
most common cause of o Rheumatic Heart Fever - “strawberry” tongue, sand
Pneumonia
nosocomial pneumonia paper rash, check ASOT
MSSA, MRSA (2019) o Acute Glomerulonephritis - antigen-antibody
Acute Endocarditis IV drug users complexes on the glomerular basement membrane
Infective Arthritis distant infected focus
Necrotizing Fascitis a toxin Penicillin G
Sepsis originate from lesion Erythromycin
Benzathine benzyl penicillin (IM q21d)
Conjunctivitis - Sta. aureus is the most common cause
overall but Strep. pneumoniae and Haemophilus influenzae
are more common in children. b. S. AGALACTIAE
Kawasaki Syndrome
Group B b hemolytic ; CAMP/Hippurate(+)
b. S. EPIDERMIDIS Normal vaginal & lower GI flora
o Neonatal sepsis and Meningitis - neonates born
Opportunistic pathogen, Facultative Anaerobe without transplacentally acquired IgG have a high
Hospital-acquired rate of neonatal sepsis
o Infections of intravenous catheter sites and
prosthetic devices ? Glycocalyx
o Most common bacterium to cause cerebrospinal fluid IV Ampicillin
shunt infections
c. S. SAPROPHYTICUS c. GROUP D
a. Enterococcus
2nd cause of UTI in women Bileesculin 6.5%NaCl(+)
One of the most highly resistant G(+) cocci
o This organism is second to Escherichia coli as a Tx: Vancomycin
cause of community-acquired urinary tract Alt: Streptogrammins
infections in young women
o Community-acquired Normal flora of intestine
E. faecalis - feces , E. faecium – feces
E. durans ,
GI sx: diarrhea, liver abscess, UTI
b. Non-enterococcus
Streptococcus brevis
Bile-esculin 6.5 % NaCl (-)
2. BORDETELLA
• Normal flora of colon
• Assoc with colon cancer
PERTUSSIS
Whooping cough ‘pertussis’
Catarrhal: mild cough sneeze, contagious
d. S. PNEUMONIAE Paroxysmal: WBC “whooping”
Prevention: DTaP
Pneumococcus (diplococci)
Polysaccharide capsule swell (Quelling rxn)
Erythromycin
Azithromycin
Most common cause of TYPICAL pneumonia & Clarithromycin
otitis media 70%
COMPS: Conjunctivitis Otitis media Meningitis

Pneumonia Sinusitis 3. BRUCELLA
Prevention: Pneumococcal conjugated vaccine Brucellosis ‘undulant fever’
? undulating fall ; rises in the afternoon
falls at night
Penicillin G Goat, sheep, cattle, pigs – reservoir
Mild : Pen V
Anti-pneumococcal : Levofloxacin Obligate intracellular parasites
Allergic : Erythromycin
Tetracycline + Rifampin
e. VIRIDANS
Most common cause of dental caries 4. FRANCISELLA

TULARENSIS
? enter the bloodstream (bacteremia) from the
oropharynx, typically after dental surgery.
Tularemia ‘rabbit fever’

Zoonotic – ticks, mites, lice, deerfly bite
B . Gram - COCCOBACCILI
Streptomycin
1. HAEMOPHILUS
a. H. INFLUENZAE
C. Gram - COCCI
Most common cause of meningitis : 5mos – 5yrs
GONORRHEA MENINGITIS CATARRHALIS
2nd most common cause of otitis media
GONOCOCCI MENINGOCOCCI
+ Sinusitis & Pneumonia : URT SHAPE COFFEE BEAN KIDNEY BEAN KIDNEY BEAN
? Encapsulated pyogens : Type B ARRANGEMENT DIPLOCOCCUS
Prevention: Hi B OXIDASE + + +
✕ produce b lactamase
CULTURE CHOCOLATE/ BAP / CAP BAP / CAP
THAYER
Ceftriaxone
b. H. PARA INFLUENZAE
Infective endocarditis & urethritis
NEISSERIA
a. N. GONORRHEA
c. H. AEGYPTUS
Sexually transmitted; Pili
Koch-Weeks bacillus Salpingitis, Proctitis, STD, Gonorrhea,
Brazilian purpuric fever Ophthalmia neonatorum
Conjunctivitis (pink eye) in children
Ceftriaxone
d. H. DUCNEYI Eryhtromycin
Chancroid (SOFT chancre) PAINFUL
b. N. MENINGITIDIS
Meningitis & Meningococcemia – fever,
SHIGELLA
headache, stiff neck, PMNs in spinal fluid
‘Waterhouse-Friderichsen syndrome’ DYSENTERIAE
Enterocolitis ; bacillary dysentery ; bloody diarrhea
Cefotaxime, Ceftriaxone, And Shiga toxin – cytotoxic, enterotoxic, neurotoxic
Penicillin : Initial
Ceftriaxone, Ciprofloxacin, Or
Rifampin Is Necessary To Eliminate
Nasopharyngeal Carriage SALMONELLA TYPHI
Most common cause of bacterial enterocolitis
MORAXELLA Enterocolitis ; Enteric fever – typhoid fever ; Septicemia

Antibody titer in the patient's serum : Widal Test
CATARRHALIS
Old: Branhamella –> Moraxella
Bronchitis, Pneumonia, Blepharitis (eyelid
YERSINIA PESTIS
Rodents by fleas ;
infection), Otitis media, Sinusitis Plague:
o Bubonic plague – swollen lymph nodes, lymphadenopathy
o Septicemic plague
o Pneumonic plague
D. Enteric Gram - BACILLI

LACTOSE FERMENTER NON-LACTOSE FERMENTER
OTHERS
PINK : macConKEE's COLORLESS
a. K. PNEUMONIAE – nosocomial infection
ESCHERICHIA SALMONELLA
KLEBSIELLA SHIGELLA
ENTEROBACTER PROTEUS b. CITROBACTER
CITROBACTER PSEUDOMONAS Enterobacteriaceae; human colon
SERRATIA (SLOW) YERSINIA Can cause sepsis in immunocompromised pt.
VIBRIO (SLOW)
UTI
EOSIN METHYLENE BLUE AGAR c. PROTEUS

P. vulgaris, P. mirabilis
E. COLI METALLIC SHEEN UTI
KLEBSIELLA MUCOID CAPSULE, VISCOUS COLONIES
SERRATIA RED PIGMENT d. ENTEROBACTER , SERRATIA
PROTEUS SWARMING ; PRODUCES UREASE
MIRABILIS
Tests to differentiate coliforms
P. AURUGINOSA BLUE-GREEN PIGMENT & FRUITY ODOR 1. Indole
2. Methyl Red
3. Voges-Proskauer
4. Citrate Utilization
ESCHERICHIA COLI
Straight gram– rod; Most abundant facultative E. Other Gram - BACILLI
anaerobe in colon and feces < outnumbered by
obligate anaerobe, Bacteroides
Most common cause of UTI & Gram– sepsis

VIBRIO
a. Vibrio cholerae
Diarrheal Disease:
o Entero toxigenic ETEC – traveler’s diarrhea ; watery Fecal contamination
o Entero invasive EIEC – shiga toxin ; bloody diarrhea Cholera : rice water stool
o Entero pathogenic EPEC – diarrhea in infants Cultre media: Thiosulfate Citrate Blue Sucrose Agar
o Entero hemorrhagic EHEC – bloody diarrhea,
abdominal cramping & fever similar to shigella
o Hemolytic-Uremic Syndrome HUS – Shiga Toxin
b. Vibrio parahaemolyticus
enters bloodstream O157:H7 strains
o Entero aggregative EAEC – persistant diarrhea HIV Ingestion of raw or undercooked seafood
CAMPYLOBACTER
a. B. SUBTILIS – Source of Bacitracin
b. B. CEREUS – Reheated fried rice

JEJUNI c. B. ANTHRACIS – Anthrax
Comma- or S-shaped; domestic animals; fecal-oral 1. Cutaneous anthrax:
spores in soil enter wound
Disease:
o Profuse Diarrhea – watery, foul-smelling 2. Pulmonary anthrax:
o Post–Diarrheal spores are inhaled into lung
o Guillain-Barre syndrome ; Ascending paralysis ;
Acute neuromuscular paralysis
CLOSTRIDIUM
Ery/Azi/Clari -thromycin
G-, Anaerobic, Spore-forming bacilli
Swollen sporangium
HELICOBACTER a. C. BOTULINUM
PYLORI Botulism ; canned food ‘preformed’

Prevent by sufficient cooking
Urease-positive ; urea breath test ; produce NH3
Blocks release of acetylcholine
Diseases: Botox : exotoxin A ; remove wrinkles
o Gastritis
o Peptic ulcer disease 1. Wound botulism; wound, germinate, and
o Gastric cancer produce toxin at the site
Mucosal-Associated Lymphoid Tissue (MALT) 2. Infant botulism ; gut and produce the toxin
Lymphomas there. Ingestion of honey “floppy baby”
3. Descending weakness and paralysis,
including diplopia, dysphagia, and
Amoxicillin + Metronidazole + Bi salts
respiratory muscle failure
PPI + Metronidazole + Bi salts +
Tetracycline Trivalent antitoxin (Type A,B & E)
Respiratory support
PSEUDOMONAS b. C. TETANI
Tetanus ; “tennis racket”

AUREGINOSA Blocks release of inhibitory transmitters :
Glycine & GABA
Non-fermenters, Oxidase+, grape/sweet/corn taco
Fluorescent blue-green ; Nosocomial pathogen 1. Lockjaw / Trismus
Exotoxin A – tissue necrosis 2. Risus sardonicus – grimace, exaggerated
Diseases: 3. Opisthotonos – arching of the back
o Nosomial Infections – Pus ; UTI ; catheter
o Necrotizing Pneumonia – cystic fibrosis
4. Tetanus Neonatorum
o Ecthyma Gangrenosum – black, necrotic lesions 5. Respiratory Paralysis
Prevention: Tetanus immune globulin (tetanus

Carbe/ Ticar/ Mezlo/ Azlo/ Pipera -cillin antitoxin), DPT
Anti-pseudomonal penicillin
Metronidazole, Pen G
Benzodiazepine – spasm
Respiratory support
F. Spore forming Gram + BACILLI
c. C. PERFRINGENS
BACILLUS Gas gangrene (myonecrosis, necrotizing fasciitis)

2nd: Food poisoning - superantigen
G+, Aerobic, Spore-forming bacilli
Non swollen sporangium Spore: Soil, Normal flora of colon ang vagina
a toxin : Lecithinase ; Egg yolk agar
Carbohydrate fermentation:
o Myonecrosis Listeriolysin : suppression of cell mediated immu.
o Hemolytic anemia Meningo enchephalitis : newborns, pregnant,
o Jaundice immunosuppressed adults
o Shock Also causes outbreaks of febrile gastroenteritis
o Death
1. Across the placenta or during delivery
Penicillin G, Debridement, Amputation 2. Pregnant women and Immunosuppressed
adults, Renal transplant patients
d. C. DIFFICILE Co-trimoxazole
Ampicillin + Gentamicin
Normal flora of stomach, GIT Ampicillin + Co-trimoxazole
Fecal-oral route
Antibiotics suppress normal flora
Pseudomembranes: yellow white plaques
Toxic megacolon can occur
✔ ELISA
ERYSIPELOTHRIX
Antibiotic-associated pseudomembranous colitis
RHUSIOPATHIAE
Clindamycin, 1st & 3rd Gen Cephalosporins
Ampicillin, Fluoroquinolones Erysipeloid – skin infection that resembles
erysipelas (caused by streptococci). Occurs
Initial: Metronidazole on the hands of persons who handle meat
Vancomycin and fish
ACTINOMYCETES
G. Non-spore forming Gram + BACILLI Long, branching filaments : resemble the
hyphae of fungi
CORYNEBACTERIUM a. NOCARDIA ASTEROIDES
DIPHTHERIAE Aerobes, weakly acid-fast

Nocardiosis – chronic lobar pneumonia, lung
abscess with cavity formation, lung nodules, or
Tellurite plate : Loeffler’s medium empyema
Inhibits protein synthesis by ADP-ribosylation of
elongation factor 2 (EF-2) Co-trimoxazole
1. Gray Pseudomembrane – throat, tonsils
2. Cutaneous Diptheria – ulcerating skin lesions b. ACTINOMYCES ISRAELII
covered by a gray membrane
Anaerobes, normal flora of oral cavity
Prevention: Diphtheria Toxoid (boosters q 10yrs) Hard, yellow sulfur granules ; sinus tract
Diphtheria toxin properties ABCDEF: Actinomycosis
A/B-type toxin CD ,which binds to EF-2
(elongation factor 2).
Penicillin G
Antitoxin
Penicillin G c. ACTINOMADURA MADURAE
Erythromycin
Madura foot ; actinomycetoma
LISTERIA H. Bacteria with Elementary & Reticulate
MONOCYTOGENES CHLAMYDIA
Tumbling : Mueller-Hinton agar
gram+ rods resembles diptheroids Obligate Intracellular Bacteria
b hemolytic resemble streptococci Sexually Transmitted Diseases
The cycle begins when the extracellular, metabolically
inert, “sporelike” elementary body enters the cell and 4. Tertiary
reorganizes into a larger, metabolically active reticulate Granulomas (Gummas), Skin & Bones;
body. The latter undergoes repeated cycles of binary CNS Involvement (Tabes, Paresis);
fission to form daughter reticulate bodies, which then CV (Aortitis, Aneurysm Of The Ascending Aorta)
develop into elementary bodies, which are released from
the cell. o Congenital: Placenta ; stillbirth
o Skin & Bone lesions – Desqua. Of palm & sole
o Hepatosplenomegaly
ALL : DOXYCYCLINE o Multiple Fetal Abnormalities – Hutchinson’s
C. trachomatis – Doxy / Erythromycin teeth ; all molar no incisors
o Diagnosis:
a. C. TRACHOMATIS Nontrepomenal – SCREENIG ; cardiolipin from beef
heart react with antibodies in serum samples
Sexually , birth canal ; finger/fomite-to-eye contact ;
Asymptomatic genital ; Produces compact VDRL Venereal Disease Research Laboratory
intracytopasmic inclusions that contain glycogen RPR Rapid Plasma Reagin Tests
Usually inhibited by sulfonamides TRUST Tolouidine Red Unheated Serum
o Urethritis – STD Trepomenal – use of treponemal antigens and therefore
o Pneumonia are more specific ; CONFIRMATORY
o Conjunctivitis – eye infection
o Lymphogranuloma Venereum – systemic FTA-ABS Fluorescent Treponemal Antibody -
o Trachoma Absorbed Test
TPHA T. Pallidum Hemagglutination Assay
b. C. PNEUMONIAE
Benzathine Penicillin G
Infects only humans and is transmitted from person to Neurosyphilis: Penicillin G
person by aerosol Allergic: Doxycycline
ATYPICAL PNEUMONIA Note: Jarisch-Herxheimer reaction – Tumor necrosis

factor (TNF) ; mediator ; passive immunization with
antibody against TNF can prevent its symptoms
c. C. PSITTACI
Infects birds, e.g., parrots, pigeons, and poultry, and BORRELIA
many mammals. Humans ; dry bird feces ; ornithosis Irregular, Loosely Coiled Spirochetes
Stain readily with Giemsa and other stains
PSITTACOSIS PNEUMONIA Transmitted by arthropods.
I. Spirochetes a. B. BURGDORFERI
Thin-Walled, Flexible, Spiral Rods Ixodes scapularis ; East Coast & Midwest
Ixodes pacificus ; West Coast ; 2%
Axial Filaments ; Darkfield Microscope
LYME DISEASE
TREPONEMA o STAGE 1
Erythema chronicum migrans ;
PALLIDUM erythematous, macular rash ; "target" or
"bull's eye"
Opportunistic pathogen; Hospital-acquired Flu-like symptoms + Arthralgia
;Sexually Transmitted:
o STAGE 2
1. Primary Myocarditis
Nontender ulcer – Chancre Acute Meningitis
Heals Facial Nerve Palsy (Bell’s Palsy)
2. Secondary Doxycycline / Amoxicillin

Bloodstream Late stage: Ceftriaxone
Maculopapular rash ; palms & soles –
Condylomata Lata
b. B. RECURRENTIS & B. HERMSII
3. Latent Recurrent Fever ; louse ; White footed
No lesions appear, but positive serologic tests mouse / deer ; malaria like cycle
PRIMARY
LEPTOSPIRA Primary Lesion Of Tuberculosis ; Lungs.
Parenchymal Exudative Lesion and the draining
INTERROGANS
Lymph Nodes together are called a Ghon Complex
Tightly Coiled, Fine Spirochetes that are not SECONDARY

stained with dyes ; Darkfield microscopy Reactivation lesions ; usually occur in the apices
Reactivation lesions ; well-oxygenated sites such as
o Leptospirosis the kidneys, brain, and bone
1. Leptospir emia Brain; Meningitis : POTTS DISEASE
2. Leptospi uria
3. Anicteric Leptospirosis Diagnosis :
4. Icteric Leptospirosis – aseptic meningitis,
jaundice, impaired kidney function
o Inspissated Egg/ Löwenstein-Jensen medium
¬ gold std.
Doxycycline o Acid fast Smear
o Chest X-ray
o Mantoux Test
J. Mycobacteria PPD Purified protein derivative
Tuberculin Skin test
Aerobic, Acid-Fast Bacilli (Rods)
Prevention : BCG vaccine ; attenuated M. bovis
"Acid-Fast" refers to an organism's ability to retain the ; Bacillus Calmette-Guérin
carbolfuchsin stain despite subsequent treatment with
an ethanol–hydrochloric acid mixture. The high lipid
content (approximately 60%) of their cell wall makes
mycobacteria acid-fast.
2. LEPRAE
HANSEN
Ziehl Neelsen Stain/Acid Fast Stain o Acquired by prolonged contact with patients who
(+)red, (-)blue discharge M. leprae in large numbers in nasal
Carbolfuschin, Heat, Acid Alcohol, MethyleneBlue secretions and from skin lesions
No definite shape ; smallest among bacteria o Replicates intracellularly, typically within skin
histiocytes, endothelial cells, and the Schwann cells
of nerves.
1. TUBERCULOSIS o The nerve damage in leprosy is the result of two

processes: damage caused by direct contact with
KOCH
the bacterium and damage caused by CMI attack on
Fever, fatigue, night sweats, and weight loss the nerves
Chronic cough & hemoptysis.
TUBERCULOID LEPROMATOUS
Type of Lesion Few Many
o Obligate aerobe; highly oxygenated tissues such
# of Acid-fast bacilli Few Many
as the upper lobe of the lung and the kidney Cell-mediated Present Absent
response
o Long-chain (C78–C 90) fatty acids called mycolic Lepromin skin test Positive Negative
acids, which contribute to the organism's acid- Likelihood of Low High
fastness transmitting
Drug Dapsone Dapsone
o Wax D, one of the active components in Freund's Rifampin & Rifampin
adjuvant, which is used to enhance the immune Clofazimine
response to many antigens in experimental animals
o Leonine (lion-like) facies
o Phosphatides, which play a role in caseation o Erythema Nodosum Leprosum ENL
necrosis. o Skin Anesthesia
HOW? o Resorption of bone
Infects macrophages and other reticuloendothelial o Infiltration of the skin and nerves
cells. Survives and multiplies within a cellular vacuole leads to thickening and folding of the skin
called a phagosome. Prouces protein called "exported
repetitive protein" that prevents the phagosome from Severe ENL: THALIDOMIDE
fusing with the lysosome, thereby allowing the
organism to escape the degradative enzymes in the NO VACCINE!
lysosome.
AVIUM 3. 2. MYCOPLASMA
INTRACELLULARE PNEUMONIA
MAI , MAC
MOST COMMON TYPE OF ATYPICAL PNEU.
Most common bacterial cause of disease in AIDS WALKING PNEUMONIA
PRIMARY ATYPICAL PNEUMONIA
Highly resistant to antiTB drugs ;
Clarithromycin + Ethambutol/Rifabutin/ Absence of cell wall ; Smallest free-living

Ciprofloxacin
organisms; many are as small as 0.3 µm
"fried-egg" shape; + coagulate cold agglutinin
Culture media: Beef heart infusion + Horse

serum + Nucleic Acid
K. Bacteria that cause Atypical Pneumonia L. Obligate Intracellular, Arthropod Borne
"Atypical" means that a causative bacterium cannot Rickettsia and Orienta – vector: arthropods Coxellia
be isolated on routine media in the diagnostic – airborne
laboratory or that the disease does not resemble
pneumococcal pneumonia Like virus ; affected by ATP synthesis inhibitors
TYPICAL ATYPICAL SPOTTED FEVERS
Limited to lungs Systemic
Rocky R. rickettsii Ticks
Responds to bLactams Does not responds to Mountain
bLactams Spotted
Fever
Lobar Pneumonia Diffuse Pneumonia
Rickettsial R. akari Mites
STREPTOCOCCUS MYCOPLASMA pox
PNEUMONIAE PNEUMONIAE TYPHUS GROUP
Epidemic R. prowazekii Lice
HAEMOPHILUS LEGIONELLA Typhus
INFLUENZAE PNEUMOPHILIA fever/Brill-
Zinser’s
KLEBSIELLA CHLAMYDIA disease
PNEUMONIAE PNEUMONIAE
Endemic R. typhi Fleas
Murine
NO VACCINES thyphus
Scrub R. Mites
LEGIONELLA
1.
Q fever
tsutsugamushi
C. burnetii None
PNEUMOPHILIA M. Others
American Legion convention in Philadelphia in 1976
(legionnaires' disease) a. BARTONELLA
CAT- SCRATCH disease; B. henselae
Culture media: Buffered Charcoal Yeast Agar with a b. GARDNERELLA
KG & FC + high concentration of iron and cysteine Bacterial vaginosis
Disease:
o Pontiac Fever – mild, flu-like
o Legionnaires’ Disease – Atypical Pneumonia
Azi / Ery -thromycin

Fluoroquinolones
IV. ANTIBACTERIALS
4. Pharmacodynamic Interaction
A. GENERAL PRINCIPLES a. Autonomous/Indifferent
1. Source Two drugs : most effective
a. Synthetic
b. Antagonism
b. Antibiotic cidal + static
Rifampicin S. mediterranei c. Addition
Cycloserine S. capreolus cidal + cidal
S. garyphalus
Plicamycin S. tanashiensis d. Synergism
Steptozocin S. achromegenes static + static = cidal
Doxorubicin S. peucetius
Bleomycin S. verticullis e. Potentiation
Bacitracin B. subtilis
Teicoplanin Actino planes teicho 5. Mode of Action
miceticus Polymycin B a. Cell Wall Synthesis Inhibitor
Polymycin B B. polymyxa b. Cell Membrane Disruption
Daptomycin S. roseusporous c. Protein Synthesis
Quinopristine S. pristinaespiralis d. Nucleic Acid Synthesis
Penicillin P. notatum P.
chrysogenum B. CELL WALL SYNTHESIS
Cephalosorins Cephalosporium spp.
Clavulanic Acid S. clavuligeris Peptidoglycan/murein – synthesized by
Thienamycin S. cattleya transpeptidase enzyme
Streptomycin S. griseus
Neomycin S. fradiae Transpeptidase enzyme aka penicillin-binding proteins
Kanamycin S. kanamyceticus (PBPs) – important proteins in the production of
Tobramycin S. tenebrarius peptidoglycan; primary target of cell wall synthesis
Gentamicin Micromonospora
purpurea
Netilimicin M. inyoensis
1. b LACTAMS
Chlortetracycline S. aureofaciens
Oxytetracycline S. rimosus inhibit/bind to PBPs
Erthtromycin S. erythraeus block synthesis of peptidoglycan
Lincomycin S. lincolnensis
Vancomycin S. orientalis
Gramicidin B. brevis
Aztreonam Chromobacterium
violaceum
Chloramphenicol S. Venezuelae
Novobiocin S. spheroides
S. riveus
Mupirocin Pseudomonas
fluorescens
Amphotericin B S. nodosus
Nystatin S. noursei
Natamycin S. natalensis
Griseofulvin S. griseofulvum
2. Spectrum
a. PENICILLINS
3. Effect
o B-lactam ring – 4-membered ring, target site
CIDAL STATIC for hydrolysis by B-lactamase
30s 50s o B-lactamase enzyme – primary mechanism
Macrolides for antibiotic resistance
The rest Tetracycline Lincosamide o Thiazolidine ring – 5-membered ring,
Aminoglycosides Chloramphenicol R-grp – point of substitution
Streptogramins o Bind covalently to PBPs no longer available
Quinupristine for cross-linking
Dalfopristin
Oxazolidinones
Linezolid
o Jarische-Herxheimer Rxn – sudden onset fever during
use of antibiotic (broad spec b Lactams lysis of
NATURAL bacteria massive release of endotoxins =
lipopolysaccharide = lipid A = pyrogen)
Narrow – 1st Gen - Natural
Penicillin Benzyl Syphilis IV IM o Thrombocytopenia – Methicillin and Mezlocillin
G Gas PO + withdrawn
gangrene antacid
Procaine 1,009 IV – 1 DRUG INTERACTIONS
units/mg day Pens + aminoglycoside – cidal + cidal but not addition
Benzathine 1,695 PO – 14
units/mg days
(exception) instead synergistic
Penicillin V Phenoxy ENT PO
methyl infection Pens + tetracycline – cidal + static = antagonistic
(PKDI)
Very Narrow – 1st Gen – Isoxazoyl – P. RESISTANT
METHICILLIN Dimethoxy Insterstitial Pens + probenecid – potentiation (1+0=2 PKDI), renal
phenyl nephritis excretion of Except: Cefazolin, Cefadroxil
Nafcillin 2-ethoxy-1- Kidney PO
naphthyl failure
Minor: bile
Carboxypenicillins - pen reduced by probenecid
Major: ? prolonged DOA of Pencillins
kidney
Oxacillin Methyl phenyl PO
H-H
Cloxacillin o-chlorophenyl PO b. CEPHALOSPORINS
Cl-H 2nd ring – DIHYDROTHIAZINE ring
Dichloxacillin o- PO 2 R groups = 2 substitution pairs ® more diverse
dichlorophenyl
Cl-Cl MORE RESISTANT TO B-LACTAMASE
Broad – 2nd Gen – Alpha amino

1ST 2ND 3RD 4TH 5TH
AMPICILLIN Aminophenyl Prodrug: IV or
acetamido Heta Listeriosis Poor CEFALEXIN CEFUROXIME –IME –ONE CEFPIROME CEFTABIPROL
Bacam bio: E
Cycla PO CEFADROX CEFPODOXIME –EN –AM CEFEPIME CEFTAROLINE
40% CEFBUPERAZO
CEFAZOLIN LOCARBEF –IR –ET CEFESOLIS
Bacampicillin Ethoxycarbonyl PO
CEPH- CEFECIDIN
oxyethyl ester
Amoxicillin Hydroxy against PO ↑↑↑ G+ ↑↑ G+ ↑ G+
phenylacetamido G+ 75% ↓G- ↓↓G- ↓↓↓G- EXTENDED EXTENDED
Listeris,
H.pylori, ✖ BBB ✖ BBB ✓ BBB ✓ BBB ✓ BBB
Borrdia ✓ CEFUROXIME
ANTI ANTI
SEMI SYNTHETIC PSEUDOMO PSEUDOMO
Antistaphylococcal AEROBES WEAK
ANAEROBES
Extended – 3rd Gen – Carboxyl - anti PSEUDOMONAL PECK WEAK: DOC:
HENPECK HENPECK
CARBENI Carboxy Prodrug + IV
benzyl : Heta AMINOGLY CEFAZOLIN CEFUROXIME HAEMPHILES
Bacam CO DOC ENTEROBACT.
Cycla SURGICAL COMMUNITY NEISSERIA
ACQUIRED PROTEUS
synergism PROPHYLAXIS
PNEUMONIA
✖incompat. ECOLI
KLEBSIELLA
Ticarcillin Carboxy Higher P. IV
Thienyl Serum, aureginos CEPHAMYCINS DOC: BAC.
Greater B. fragilis ENCEPHALITIS
Potency ANAEROBIC
INFECTION
DOC: CEFTAROLINE
ANTI PSEUDOMONAL CEFOXITIN, CEFTRIAXONE MRSA
CEFOTETAN, SALMONELLO.
CEFMETAZOLE GONORRHEA
Extended – 4TH Gen – Carboxyl - anti PSEUDOMONAL MENINGOCOCC.
Mezlocillin carboxy Prodrug: IV
benzyl Heta CEFTRIAXONE
CEFOTAXIME
Bacam
Cycla
MENINGITIS
Piperacillin Anaerobe IV IM
NOT LISTERIA
Providencia
K. pneumoniae
Azlocillin ADR/SE
o Allergy/hypersensitivity – cross allergenicity (class
ADR/SE effect) uncommon (5-20%)
o Hypersensitivity for Pen allergic – give Erythromycin
o Thrombophlebitis when given via parenteral route ?toxic
o GI distress
rxn of vein to drug
o Antibiotic induced colitis – PSEUDOMEMBRANOUS
COLITIS (also caused by Clindamycin etc.) o GI upset remedy: take with food
DOC for pseudomembranous colitis: Metronidazole o Antibiotic induced colitis
Alternative: Vancomycin o Serum sickness: Cefaclor
o Hypoprothrombinemia (dec in CF IIa ® predisposition to 2. GLYCOPEPTIDES
bleeding): cefamandole, cefotetan, moxalactam,
cefoperazone a. VANCOMYCIN
Drug Interactions “reserve antibiotic”
Alcohol-disulfiram-like rxn for cephalosporins w/ AZO in
name: cefoperazone, cefmetazole, cefazolin, exception Inhibit translocation of
cefotetan
peptidoglycan
Probenecid + cepha – INCREASE renal toxicity
Water-soluble
Furosemide/aminoglycoside + cepha – nephrotoxic, Poor gastric absorption,
never combined ? cause acute kidney disease
Given parenterally
c. CARBAPENEM
Narrow spectrum:
BROADEST SPECTRUM b Lactams primarily indicated for G(+) resistant orgs, MRSA, MRSE,
Enterococci
Class I - prolonged inactivation
Clavulanic Oxa Penam S.

Vanco + cefotaxime, ceftriaxone, rifampicin; Meningitis
acid clavuligeris
+ PO Pen G/V ® Methicillinc(MRSA) ® Vancomycin
Amoxicillin AUGMENTIN
+ Ticarcillin TIMENTIN IV ADR/SE

Sulbactam Di Oxo /
+ Ampicillin Sulfone IV o Red neck/man syndrome with sudden rapid
UNASYN admin remedy: slow infusion not IV push
Tazobactam Di Oxo / More
Sulfone potent o Pseudomembranous colitis
+ PIPTAZ, IV DOC: Metronidazole, Alt: Vancomycin
Piperacillin ZOSYN
Class II - transient inactivation o Pain on injection site, Nephrotoxic, Ototoxic

Thienamyci Fused S. Cattleya Inactivation: IV
Bicyclic Conc. b. Teicoplanin – safer
3 Dependent
Carboxy Renal DHP-I c. Dalbavancin
l
d. Televancin
Imipenem Formimi G+ G- ↑ Nephrotoxic (Vibativ) – safer
doyl Anaerobes Metabolite
↑ SEIZURES
semisynthetic lipoglycopeptide derived from
Vancomycin
Problem: Acted Upon By An Enzyme In Both do not cause oto/nephrotoxicity Block
Kidney: DEHYDROPEPTIDASE ® Dec
Bioa And Toxic Nephrotic Metabolite
cross linking of peptidoglycan D-ala D-ala
+ Primaxin Inhibitor Of +Aminoglycosid IV
CILASTATIN DHP- I e
But Not Chem. 3. FOSFOMYCIN
Compatible Phosphonomycin
Meropenem Merrem More IV
Active Trometamol
Against G- Inhibit enolpyruvate transferase
G+,
Anaerobes
Ertapenem G+ G- ✖Pneudomonas 4. BACITRACIN
Anaerobes ✖Enterobacter B. subtilis tracey
Biapenem strain – isolated
from leg wound of
Margarette Tracey
d. MONOBACTAM Inhibit
dephosphorylation
AZTREONAM of carriers of the
peptidoglycan
Prototype unit prevents
elongation of layer
Bactericidal (this is due to the presence of a
4-methyl group in the beta-lactam ring) Active against a wide of Gram (+) organisms
Increased stability against many gram- Cyclic peptide or a mixture of polypeptide

negative bacteria Poorly absorbed in the GI tract Systemically toxic
antibiotic ; limited to topical use
Narrow spectrum: for G(-) aerobic orgs
SE: Phototoxic, Nephtrotoxic: hematuria, proteinuria
Adv: small chance of cross-alergenicity
5. CYCLOSERINE OTO TOXICITY NEPHRO TOXICITY
D-ala analogue Most: Least: Most: Least:
Inhibit cross-linking ® inhibit alanine racemase & Streptomycin Netilmicin Neomycin Streptomycin
alanyl alanine ligase Vestibular Auditory
Vertigo Neomycin Neuromuscular
Ataxia contact paralysis
2nd line for Tubercolosis Tinnitus dermatitis ↓ acetylcholine
Gentamicin Kanamycin + Ca
Streptomycin Neomycin gluconate,
Amikacin Neostigmine
C. CELL MEMBRANE DISRUPTION (least)
Both V&A: Tobramycin
POLYMYXIN
Only antibacterial
STREPTOMYCIN NEOMYCIN
COLISTIN E
Spectrum of activity:
for G(-) orgs
Problem: reacts with eukaryotic cell S.

fradiae
Ocular inf. Oral
✖ systemic
membrane cannot distinguish from bacterial cell S. Plague IM
griseus Tularemia +++
+++ GI & skin
TB nephro
Not absorbed in GIT – used for gut +TCN = otoves
infections
peritonitis
- oto-audi
---
decontamination Acute
Brucellosis nephro
ADR: Nephrotoxic Not Used Systemically, Topical AMIKACIN Gentamicin – prototype for G(-)
Only For Wound Irrigation, Bladder Washout infxn
Tobramycin (Tobradex) –
preferred for pseudomonas
infxn = sore eyes (adenoviruses)
D. PROTEIN SYNTHESIS
1-N- Broa Genta/ Topica
amino- dest Tobra Oral Amikacin – derivative of
1. Aminoglycosides -cidal a- spec
trum
resistant ✖ syste kanamycin (withdrawn),
hydroxy mic alternative to Gentamicin
2. Macrolides butyryl
kanamy --- (Gentamicin-resistant)
3. Lincosamide cin oto-
G- audi Netilmicin – best safety profile,
4. Tetracycline semi- bacillary least SE
infectio
5. Chloramphenicol synth
ns Neomycin – toxic
6. Streptogramins
7. Oxazolidinones ✓ Klebsiella Tobramycin
Gentamicin
✓ Enterobacter
Amikacin
✓ Pseudomonas – Tobra > Genta Netilmicin
1. AMINOGLYCOSIDES ✓ Serratia – Genta > Tobra
“mycin”: Streptomyces
“micin”: Micromonospora
“acin” : Semi synthetic
MOA:
1. Inhibit the initiation of protein syn 30s -
static
2. Interfere with the translation -cidal
3. Bind to the 30S rib. subunit & cannot
initiate proper amino acid polymerization
Resistance
Conjugation • Efflux • Low uptake
Synergistic with beta- lactam antibiotics
Highly polar structure prevents adequate

absorption after oral administration (administer
parenterally) ; Acid-labile
2. MACROLIDES 3. LINCOSAMIDE
Macrolides
Salts: Base PK: Legionnaire’s q6h
SULFUR- containing antibiotics isolated from
ERY Stereate
Ethyl Poor
disease
TID
Streptomyces lincolnensis • Resemble
macrolides in antibacterial spectrum and
succinate GI abs Mycoplasma QID
Estolate pneumoniae biochemical mechanism of action
Lactobionate Unstable
in acid Campylobac
pH ter Lincomycin
Chlamydial CLINDAMYCIN (DALACIN C)
stability infections Alt to
absorption Pen
Diphtheria allergic o Soft skin and tissue infxn
¯ less altered
by food Pertrussis
o Prophy for endocarditis
GI upset Chole Digoxin and Tolbutamide o DOC for ANAEROBIC INFECTIONS ABOVE
static Warfarin QT DIAPHRAGM;
Potent jaundice cardio prolong.
enzyme (estolate toxicity arrhythmi
inhibitor form) bleeding a o Life-threatening G(+) Grp A B-hemolytic
PK: Haemophilus o Strep Pharyngitis

CLA 6-methyl
ether
better
abs.
meningitis 2x
1day
o Bone infxn and osteomyelitis
CAP (Strep. BID
Longer Pneumonia
t1/2 and H. o Pneumocystis carinii (jiroveci) pneumonia/PCP
influenza)
More alternative – Clinda + Primaquine
acid Omepra
stable Lanzo o Alt for TOXOPLASMOSIS (DOC: Co-trimoxazole)
+ H. pylori
Weak Prophylaxis:
o Alt for MALARIA –also an antiprotozoal
enxyme Ophthalmia Neonatorum
inhibitor Mycobacterium Avium
Complex/MAC o Most potent agents available against non- spore
forming anaerobic bacteria (Bacteroides fragilis)
UTI, Pneumonia, Prophylaxis: OD
AZI Soft-Skin Tissue Infection MAC for 3days ADR/SE
PSEUDOMEMBRANOUS COLITIS
Meningococcal urethritis caused by chlamydia
Lower Respiratory Tract Infection (LRTI)
Pelvic inflammatory disease (PID)
Pharyngitis
Legionnaire’s disease
4. TETRACYCLINE
Does not inh Long Deposited in
CYP450 t1/2 lungs, tonsil,
skin, cervix Broadest spectrum antibiotic
Safer 68hrs
Inc conc in
Improved px tissues than Contain four fused rings with a system of conjugated
compliance blood
double bonds- NAPHTHACENE
TRO one of oldest macrolides, 1st introduced in the
market ® weak bacteriostatic effect, rapid devt of
LEAN bacterial resistance Activity Against Gram (+), Gram (-), SPIROchetes,
MYCOplasma, RICKEttsia, CHLAmydia, WALL LESS,
DO INTRACELLULAR parasites, PLASMOdium
Dirithromycin – prodrug active: erythromycylamine
Telithromycin – ketolide
Absorption:
o High pH, dec absorption ® do no give with antacids
o CATIONS (Mg2+, Ca2+, Al3+) ® insoluble chelates
o Highly distributed in tissues with high levels of
Ca2+: bone, teeth, cartilage
ADR/SE
Deposition in the bones and primary dentition causing
discoloration and hypoplasia of the teeth and stunting of
growth
Hepatotoxicity
Most PHOTOTOXICITY (DEMEclocycline),
VESTIBULAR problems (MINOcycline)
FANCONI-LIKE syndrome – expired tetracycline ®

acute tubercular necrosis ® protein and blood leaks out
of kidney
Short Intermediate Long
Tetra Demeclo Doxy
Oxytertra Metha Mino
6. STREPTOGRAMINS
Interferes with a distinct step of protein

synthesis
Ratio: 70(A) 30(B)

A : QUINUPRISTIN
B : DALFOPRISTIN (SYNERCID) – G+, VRSA,
VRSE, Enterococcus
Pen G/V ® Methicillin ® Vancomycin ®

SYNERCID
7. OXAZOLIDINONES
Initially developed as MAOI (revesible, non-

selective)
Interfere with INITIATION of protein synthesis
Linezolid (Zyvox)
5. CHLORAMPHENICOL
One of the first broad spectrum antibiotic ; >50kg/mg/day
Highly lipophilic compound ®

penetrates BBB ® I: MENINGITIS, CNS infections
MOA: prevents peptide bonds from being formed

(blocks peptidyl transferase)
Contains a nitrobenzene ® suppression of bone

marrow ® SE: APLASTIC Anemia
GRAY baby syndrome – inability to of neonates

(<28days) to metabolize due to lack of glucuronsyl 8. MISCELLANEOUS
transferase
Primary metabolism: glucuronidation Mupirocin – similar to macrolides

Metabolic system in neonates: sulfation only Use: soft skin and tissue infection, impetigo (honey-
colored encrustation)
Antibacterial resistance: chloramphenicol
ACETYLTRANSFERASE enzyme ® inactivate Spectinomycin – similar to aminoglycosides Use:
chloramphenicol PenG resistant syphilis, Penicillinase producing N.
gonorrhea
+ KERNICTERUS (jaundice)
Fusidic acid – inhibit elongation factor ; G+
E. NUCLEIC ACID SYNTHESIS USE
GONORRHEA: β-lactam resistant strains Diarrhea:
1. FLUOROQUINOLONES caused by Shigella, toxigenic E. coli, Salmonella,
Inhibits DNA gyrase/topoisomerase II IV typhoid
G(-) Inhibit DNA GYRASE /TPII – relaxation of supercoiled DNA
G(+) Inhibit TOPOISOMERASE IV – separates DNA strand RESPIRATORY infection: Bacterial (Haemophilus,
Unwind ® unzip ® supercoil Strep spp., Pseudomonas) and non bacterial like
1st FLUOROQUINOLONES
Chlamydia, Mycoplasma and Legionella
Nalidixic Proteus, E coli, Gram– But Not Highly protein
Acid Klebsiella
(PEcK)
Pseudomonas
Species
bound Soft skin and tissue infection
Cinoxacin
2nd CIPRO × OFLO × NORFLO × LOME × ENOXACIN Complicated UTI
GRAM– (Including Pseudomonas Spp., Some Gram+ (S. Aureus) And Some Atypical
Microorganisms
2nd line for TB Urethritis (L-ligo, I-ihi, G-goma, O-ofloxacin
NORFLO Single 800-mg dose for Uncomplicated Gonorrhea
Enoxacin Acute and chronic UTI STD (Uncomplicated gonococcal urethritis) prophy)
DOC Use: + Food delays
CIPRO Anthrax Ceftriaxone: absorption
Compli & Disseminated IBD • Respiratory: LEVO GATI GEMI MOXI
Uncompli gonorrhea Binds
DOC UTI divalent
Gastroenteritis + cation Pseudomonas & Mycobacterial – Cipro / Oflo
Caused By G- VD Doxycycline: (decrease
Bacilli Gonococal absorption)
NOT effective
chronic
infections;
urethritis
Increase effect
Typhoid fever
against syphilis renal of warfarin
OFLO Uses: Prostatitis + Superior oral ADR SE CI

Doxycycline: absorption
LRTI: bronchitis Infection of Gonococal and o Pregnant or breastfeeding women and children
& pneumonia the skin and urethritis bioavailability
soft tissues (CDC)
PID UTI Food delays
absorption
o Cystic fibrosis children infected with
NOT effective Pseudomonas spp. is an exception; monitoring
against syphilis
LOME Use: Most Primarily used Only o Enterohemorrhagic E. coli because they can
for quinolone that
Acute cystitis
phototoxic
is taken OD INDUCE the cytotoxic Shiga- like toxin
Halogenation Acute Bacterial suffices
Chronic UTI at 8th Exacerbations
position Of Chronic o CHILDREN® prevent lengthening of bone end
Chronic Bronchitis
bronchitis: plates : CIPRO & LEVO
Moraxella Prophylaxis:
catarrhalis Transurethral o Less than 18 y.o women® deposited in
Surgery
bones ® inc risk of osteoarthritis ®
3rd LEVO × MOXI × GEMI × GATI × SPARFLO × GREPA
OSTEOMYELITIS
Grepa: photoxic Gati: induce DM hyperglycemia
Use: Legionella EXTENDED G+ Blood glucose
LEVO pneumophila, ATYPICAL disturbances DRUG INTERACTION
Chronic Coverage in DM patients
bronchitis Atypical +antacid or other divalent metals
CAP
respiratory
pathogens
G-, G+ (S.
aureus
QT
prolongation complexation; ¯ efficacy of quinolones
including
Nosocomial M. MRSA and S. Torsades de
pneumonia tuberculosis pneumoniae) pointes +warfarin or didanosine or phenytoin
SSTIs Least Arrhythmias ¯absorption and metabolism
phototoxic
Intra- ? N&V
abdominal
infections
due to
methoxy / 5-
GI Upset Ciprofloxacin + Theophylline theophylline
Prostitis
amino group
that
NOT
ENZYME
QT prolongation
E.coli counteracts INHIBITOR
halogen at 8th
position OD Enzyme inhibition except Levofloxacin
dosing
Use: M. G- (S. aureus Safety and
MOXI tuberculosi including efficacy not
Chronic MRSA and S. established in
bronchitis G- pneumoniae) patients < 18
anaerobes y/o
CAP Atypical
respiratory Blood glucose
Bacterial pathogens disturbances
conjunctivitis (Legionella in DM patients
Vigamox pneumophila,
+ Dexa C. pneumoniae QT
and M. prolongation
Sinusitis pneumoniae)
Torsades de
pointes
Arrhythmias
N&V
GI Upset
Use: Skin and soft Higher Phototoxic

SPAR tissue potency Cardiotoxic
Bacterial infection in against G+
gastroenteritis LRTI and PID bacteria
Cholecystitis
4th Broad Toxic

Anaerobic Hepatotoxic
ALATRO Coverage
TROVA Study hard and Pray harder. Make this season a season for growing. Dont let fear & anxiety surround you; instead ask for His peace that transcends all understanding.
FOLIC ACID SYNTHESIS : MOA NON ABSORBABLE
(WOOD FIELDS THEORY) SulfaSALAZINE Ulcerative colitis
Inflammatory Bowel Syn.
DMARD
ORAL SINGLE ABSORABLE
SHORT
SulfiSOXAZOLE
SulfaCYTINE
SulfaMETHIZOLE
GTP INTERMEDIATE
DIHYDROPTEROATE SYNTHASE
(-) Sulfamethoxazole SulfaMETHOXAZOLE Bacteriostatic
Dapsone +Trimethoprim
Bactrim®
¯
DOC
Dihyropteroate
PNEUMOCYSTIS CARINII
¯ FIRST ATTACK ; UTI
dTMP ® dTP Dihyfrofolate BACTRIM®
DIHYDROFOLATE REDUCTASE
(-) Trimethoprim Alt: Pentamidine
Pyrimethamine
Methotrexate (DMARD) Compli/Uncompli
¯ UTI (E.coli resistance
dUMP ® Tetrahydrofolate increase)
+PCP
2. SULFONAMIDES Nocardia
Enterobacter
Block PABA incorporation;
SulfaDIAZENE ; IBD
Inhibit dihydropteroate SYNTHASE
SulfaPYRIDINE
Antibacterials that are ANILINE substituted LONG
sulfonamides (sulfanilamides) SulfaDOXINE Bacteriostatic
PRODRUGS that react to generate active ORAL MIX ABSORABLE
sulfanilamides (Sulfasalazine) Trisulfapyrimidine Sulfadiazine, Sulfamerazine,
Oral Susp, Tablet And Sulfamethazine
Non-aniline sulfonamides (mefenide acetate)
Haemophilus vaginalis
Other sulfonamides: Sulfadoxine + DOC
Tolbutamide PYRIMETHAMINE CHLOROQUINE RESISTANT
Furosemide P. FALCIPARUM
Chlorthalidone FANSIDAR
ADR SE DOC
CHRAANKS TOXOPLASMOSIS
CRYSTALLURIA ® Bleeding and kidney obstruction Treatment of chloroquine-resistant malaria (a
® Nephrotoxic combination of quinine, pyrimethamine and
sulfadoxime)
HEMOLYTIC anemia ® G6PD deficient patients TOPICAL
MAFENIDE Acetate Clostridium welchii ; wounds
RASHES ® hypersensitivity reaction Sulfamylon
AGRANULOCYTOSIS or Thrombocytopenia SILVER SULFA Pseudomonas
Aplastic Anemia DIAZINE + Zn salt
In burn therapy to prevent and treat bacterial
N/V infection (Silver Sulfadiazine & Mafenide)
KERNICTERUS ® toxic encephalopathy ®
hyperbilirubinemia in neonates Treatment of conjunctivitis and related superficial
ocular infections (Sodium SulfACETAMIDE)
Unconjugated – highly lipophlic cross ® BBB ® N
wastes (NH3)
DRUG INTERACTION
Highly protein bound
SJS ® (<30% of skin SA) ® Toxic Epidermal Tx: Phenobarbital (Enzyme Inducer)
Necrolysis/TEN (>30%)
a. DAPSONE (AVLOSULFON)
4,4'-Diaminodiphenylsulfone
Most widely used sulfone for the long-term
therapy of leprosy
Photosensitive ; Discoloration Dermatitis
herpetiformis
Treatment and prevention of Pneumocystis

carinii pneumonia in AIDS patients who are
allergic to or intolerant of trimethoprim–
sulfamethoxazole
3. TRIMETOPRIM
Acedapsone ; Long-acting intramuscular
repository form of dapsone with a half-life of
4. CO-TRIMOXAZOLE 46 days
b. RIFAMPICIN
c. CLOFAZIMINE
Dye Unknown but may involve mycobacterial
DNA BINDING
Treat SULFONE-RESISTANT LEPROSY

Intolerant to sulfones
Advantage: exerts an ANTI-INFLAMMATORY

and prevents erythema nodosum leprosum
Most Common Adr: Red-brown discoloration

of the skin
d. Ethionamide and Prothionamide

5. NITROMIDAZOLE Alternatives to clofazimine in the treatment of
MDR leprosy
a. TINIDAZOLE
b. METRONIDAZOLE
Antiamebic, Antigiardiasis, And G. URINARY ANTISEPTIC
Antitrichomonal
1. METHENAMINE
GET GAP ON THE METRO
Giardia Hydrolyzed at an acid pH (6) to liberate
Entamoeba ammonia and the active alkylating agent
Trichomonas formaldehyde
Gardnerella vaginalis Denature protein ; bactericidal
Anaerobes (Bacteroides, Clostridium)
H. Pylori (use with bismuth and amoxicillin or Administered as a salt ; mandelic (Mandelamine)
tetracyclin for triple therapy) or hippuric (Hiprex, Urex) acid
Unpleasant METALLIC taste Give urinary acidifier – Vit. C
+ ALCOHOL , A DISULFIRAM-LIKE Long-term prophylactic or suppressive therapy

of recurring UTIs ? not a primary drug for
therapy of acute infections
F. ANTI MYCOBACTERIAL DRUGS +sulfonamide ® antagonism
1. Tubercolosis
2. Leprosy 10 to 30% decomposes in the stomach ®
enteric-coated
HANSEN DISEASE
2. NITROFURANTOIN
Structural analogues of PABA and Nitrofurans (Nitrofurantoin)

competitive inhibitors of folic acid synthesis Treatment and/or prophylaxis of urinary tract
Reduction of the 5-nitro group to the nitro anion
3. MUPIROCIN RNA VIRUS
HEPE A
Bactroban® B
Pseudomonas fluorecens C
D
Used topically for impetigo, eczema, E
staphylococcal and beta hemolytic G
streptococcal infections PARA Measles Non
Mumps segmented
MOA: inhibition of staphylococcal isoleucyl Para influenza genome
tRNA synthesis Respiratory
syncytial Larger
same spike
V. Virology ORTHO Influenza A Segmented
Influenza B genome
Influenza C
A. Introduction Smaller
B. Morphology
C. Mumps diff. spike
D. Poxviridae FILO Ebola
E. Herpes Viridae Marburg
ARBO TOGA Eastern Enc
F. Viral Gastroenteritis Western Enc
G. Hepatitis Rubella
H. Arbovirus FLAVI Hepa C
I. Rodent-Borne/ Hemmorhagic Yellow Fever
J. Rabies Dengue
K. Enteroviruses West Nile
St. Louis
L. Prions/Spongiform Japanese
M. HIV Encephalitis
N. Respiratory Viruses BUNYA
O. Human Cancer Virus ORBI
PICORNA RHINO
DNA VIRUS ENTERO POLIO
COXSACKIE
POX Smallpox ECHO
Vaccinia CALCI Norovirus
Cowpox REO ROTA
RETRO HIV
Monkeypox RHABDO Rabies
Tanapox CORONA
Yabapox ARENA Lymphocytic
Choriomeningitis
Molluscum Virus
Contagiosum Lassa Fever Virus
PAPOVA Papilloma MINOR ENVELOPED Cache Valley
Virus,
Polyoma Chikungunya
Vacuolating Virus,
Hantaviruses,
PARVO Hendra Virus,
ADENO Human
Metapneumovirus,
HERPES Hsv 1 , Lujo Virus, Nipah
Hsv 2 Virus,
Spumaviruses,
Varicella Zoster Tacaribe Complex
Cytomegalo Of Viruses (E.G.,
Junin And
Hhv 6 Machupo
Hhv 7 Viruses),
Kaposi Whitewater
Arroyo Virus, Zika
HEPNADA Hepa B Virus
NON Astrovirus ,
ENVELOPED Encephalomyo..
V. VIROLOGY 4. Terms
VIRION
A. INTRODUCTION Mature viral particle w/ nucleic acid,
protein coat, capsomere ; Virulent -
1. Features capable of affecting other cells
OBLIGATE INTRACELLULAR parasite VIRIOD

Requires a living host Contain RNA only ; The RNAs are not
Replicates through host cell packaged, do not appear to code for
Proteins and nucleic acids any proteins ; have only been shown to
EITHER DNA or RNA (never both) affect plants
NO organelles or ribosomes
Acellular 1. Hepatitis-delta virus – closest
human virus that is viroid, acquired
2. Morphology if already w/ Hepa B, cannot
produce infxn by itself since RNA
NUCLEOCAPSID ; nucleic acid + capsid only
NUCLEIC ACID – basis for 2. Tobacco mosaic virus/TMV – RNA
classification only, well studied
DNA
RNA PRIONS
(+) sense/(+) strand – Contain protein only
automatically assume functions of Prion-caused human diseases
mRNA 1. Kuru - meningitis, psychosis, briain
(-) sense – need prior activation ® liquefaction
enzyme: RNA dependent RNA 2. Creutzfeldt-Jakob disease -
polymerase spongiform brain disease, brain
shrinkage
*retroRNA – enzyme: reverse 3. German-Straussfer Syndrome – mad
transcriptase – DNA® RNA ® DNA cow disease in sheep
(normal: DNA ® RNA ® protein)
5. Viral Multiplication
CAPSID – protein coat LYTIC LYSOGENIC
Protects NA core Attachment
“uncoat” ® NA Release ® Penetration/Fusion
Reassemble Uncoating
Expression ; Integration
Replication. Viral nucleic acid wih
Mucocapsid = NA + capsid Transcription, host DNA
Translation
Capsomer – building unit of capsid
Assembly Host replicates with
ENVELOPE – results from the method Release viral nucleic acid (no
of release from the host lysis)
LYSOGENIC – bud out of cell and
retain envelope 6. General properties
LYTIC – lysis of cell, naked (no a. DNA
envelope)
4P AHH PROPERTIES EXCEPT
Symmetry PARVO Double Parvo
Icosohedral (20 sides – 12 corner) stranded
Helical (long rods ; flexible/rigid)
POLYOMA
Complex (Poxcirus) PAPILLOMA Icosahedral Pox
POX Naked Pox
3. Taxonomy ADENO Hepadna
Family ; viridae HEPADNA Herpes
Genus ; virus HERPES
Species ; common name Nucleus Pox
b. RNA Complication: Subsclerosing
Panencephalitis (SSPE)
+ SENSE - SENSE
Prevention: MMR Vaccine
PICORNA PARAMYXO
CORONA FILO b) GERMAN/SOFT MEASLE/RUBELLA
TOGA ARENA Toga viridae
CALCI BUNYA Rubi virus
FLAVI ORTHOMYXO Mildest exanthem
RETRO Non-vector transmitted,
RHABDO Spread by respiratory secretions
HEPE
Congetinal ® Rubella Syndrome
ASTRO Deaf, Cataract, Heart
abnormalities
Single stranded REO
ENVELOPED CALCI Prevention: MMR Vaccine
HEPA C. MUMPS
ASTRO Paramyxo viridae
REO Non suppurative enlargement of
PICORNA salivary gland
Cytoplasm RETRO Parotitis ® Parotid gland
Orchitis® Testes ® infertility
ORTHOMYXO Oophoritis ® Ovaries
Prevention: MMR Vaccine

B. EXANTHEMS
D. POXVIRIDAE
1st Rubeola, MEASLE Virus
Measles 1. SMALLPOX
14-day measle Caused by variola ; eradicated
2nd SCARLET Fever S. pyogenes Most severe
3rd Rubella, RUBELLA 2. Vaccinia ; used vs. variola
German Measle Virus
– 3-day measle 3. COWPOX
4 th
SSS, Ritter S. aureus Used as vaccine for smallpox
Skin manifestation
Disease
5th ERYTHEMA Erythrovirus 4. Monkey pox
infectiosum Parvovirus
B19 5. ORF
6 th
Exanthem Human herpes sheep and cattle ; commonly found
in humans
Subitum virus 6B17
Roseola sx: mouth sores (contagious
infantum pustular dermatitis)
6. MOLLUSCUM CONTAGIOSUM
a) HARD MEASLES/RUBEOLA Benign epidermal tumors; dimpled
lesion, genitals
Paramyxo viridae
Maculopapular rash
Cough, Coryza, Conjunctivitis 7. TANAPOX
Koplik spots – bluish white spots on 8. YABAPOX
buccal mucosa
E. HERPES VIRIDAE
Life-long infections 1 of leading causes of mental
retardation in children
HHV 1 Herpes Oropharyngeal
Simplex 1 Herpes Pneumonia – upon rxn w/
immunocompromised pxs
HHV 2 Herpes Genital Herpes Vertical transmission ® can cross
Simplex 2 placenta: ToRCHeS
HHV 3 Varicella Chicken Pox/ To – toxoplasma R – rubella
Zoster Shingles C – cytomegalovirus
HHV 4 Epstein-Barr Infection- He – herpes, HIV
Mononucleosis Hepa B S – syphilis
HHV 5 Cytomegalo Retinitis
F. VIRAL GASTROENTRITIS
HHV 6 Human Exanthem
Herpes 6 Subitum 1. ROTAVIRUS
HHV 7 Human Reoviridae
Herpes 7
HHV 8 Kaposi Kaposi MOST COMMON CAUSE OF VIRAL
GASTROENTERITIS IN CHILDREN/3rd WORLD
Sarcoma- Sarcoma
associated
Herpes Prevention: Oral Live Attenuated
Vaccines
Rotashield ® ; withdrawn ?b.obstruction
1. VARICELLA ZOSTER VIRUS Rotateq ®
Rotavix ®
Chicken Pox • Varicella
Fluid-filled vesicular ® painless 2. CALICIVIRUS
Norovirus
Shingles • Zoster
Dermatomal pain MOST COMMON CAUSE OF DIARRHEA IN
ADULTS
2. EPSTEIN-BARR VIRUS
a. Norwalk virus/NOROVIRUS
KISSING DISEASE b. Sapovirus
Infectious mononucleosis
3. ASTROVIRUS
BURKITT’S lymphoma Star-like morphology
associated with CA (maxilla and
eye)
4. ENTERIC ADENOVIRUSES
PAUL-BUNNEL /MONOSPOT TEST
Serum + sheep blood ® clumping 5. CORONAVIRUS
Heterophile Ab rxn with Ag in Torovirus
sheep blood
Common colds
3. CYTOMEGALOVIRUS Severe acute respiratory syn./SARS
Gastroenteritis
MOST COMMON VERTICALLY
TRANSMITTED INFECTION 6. PARVOVIRUS
Parvovirus
CM: retinitis ® blindness, mental Children ; “slapped cheek “rash,
retardation, mononucleosis like (EBV) erythema infectiosum = 5th
® respiratory sx disease
Microcephaly, hepatosplenomegaly Adult ; Arthritis
BAD hepa – SILENT killer
Prophylaxis: Parvovirus B19 vaccine DANE particles - immature Hepa B
Complication: transient aplastic virus (HBV), seen in all body fluids
anemia (reversible) (semen – STD)
PaPoVa viridae HBsAg/Hepa B surface antigen

Papilloma Virus (+) indicates infxn
Warts, verruca: skin, (+) Anti-HBsAg (Ab) –immunity
genital, cervical (most
common cause of cervical HBcAg/Hepa B core antigen
CA) (+) Anti-HBcAg IgM - acute – first to
be produced by the body
“Tree Man” - Dede (+) Anti-HBcAg IgG - chronic infxn
Koswara
HBeAg – soluble portion of the core
Vulva - Condyloma (+) highly infectious
acuminate (+) Anti HBeAg – non-infectious
state
Polyoma
BK virus – asymptomatic Acute <6months
or mild symptoms Chronic >6months
Prevention: Hep B VACCINE
JC virus – CNS infections, Hep B IMMUNOGLOBULIN
attack white matter
Treatment of Hepa B:
Vacuolating : non pathogenic IFN-alpha + Lamivudine,
Pegylated IFN w glycerin
G. HEPATITIS
s/sx: Titer test for Hepa B – measures
Jaundice how much Ab body produced
A, E – immediate 1⁄2 1⁄4 1/8(x) 1/16 1/32(x)
B, C, D – asymptomatic 1/64 1/128 1/256 (x)
until liver cirrhosis ® often
leads to liver cancer Inc chance of infection
8 titer value
Elevated liver function Titer value – reciprocal of
enzymes(ALT,AST,GPT,alkaline dilution
phosphatase, bilirubin)
2. HEPATITIS C
A,E – Hyperbilirubinemia ® FLAVI viridae – Arbovirus
deposited SQ = yellow Non-A, non-B hepatitis
Obtained from NEEDLE stick injury
A B C D E CHRONIC ; Silent killer
Family PILORN HEPADNA FLAVI UNCLAS HEPE Tx: IFN-alpha + Ribavirin
Genome ssRNA dsRNA ssRNA ssRNA ssRNA
MOST COMMON CAUSE OF
TSM fecal parenterally fecal LIVER TRANSPLANT, IV DRUG USER
oral sexual oral
water blood borne water
born borne 3. HEPATITIS D
Chronic acute chronic acute Delta agent
Oncogenic no yes ? no Defective virus
Smallest known human pathogen
Requires HBV infection:

1. HEPATITIS B Coinfection – simultaneous
Hepnadavirus Superinfection – HBV infection
H. ARBOVIRUS b. EASTERN EQUINE ENCEPHALITIS
Not a family MOST SEVERE arboviral
Arthropod-borne encephalitis
Consists of:
Toga , Flavi , Reo, Bunya c. WESTERN EQUINE
ENCEPHALITIS
1. FLAVIVIRIDAE
3. BUNYA VIRIDAE
a. DENGUE California encephalitis
Breakbone fever, Painful fever
5 serotypes Phlebovirus - Rift Valley Fever
Vector: sandfly
Vectors: Aedes aegypti Nairovirus – Crimean-Congo Heme
Aedes albopictus Fever
s/sx: Malaise, Chills, Headache Hantavirus – Korean Heme Fever
Myalgia, Arthralgia, Rash
¯ platelets hemorrhage,
thrombocytopenia, septic I. RODENT-BORNE/HEMORRHAGIC FEVER
shock VIRUS
1. Arenaviridae
Dengue hemorrhagic fever/
Dengue shock syndrome – non 2. Hantavirus
neutralizing dengue antibodies
3. FILOVIRIDAE
Prevention: Dengvaxia ; dengue
history ; 4 serotypes a. MARBURG VIRUS
b. JAPANESE B ENCEPHALITIS
b. EBOLA VIRUS
Leading ; encephalitis in Asia Fruit bats
Body fluids/ fomites;
Vector: CULEX species contaminated blood
Prevention: Ixiaro
s/sx: Meningitis/ Encephalitis Causes hemorrhagic disease
c. WEST NILE FEVER Sentinel case: Kikuit, Zaire
CULEX species
Philippines: Ebola-Reston
s/sx: Meningitis, Encephalitis subtype ® contact with sick swine
d. YELLOW FEVER J. RABIES
PROTOTYPE of flaviviridae
Vector: mosquito Rhabdoviridae
BULLET shaped
e. ZIKA VIRUS
AEDES species Bite of rabid animal
Dangerous in pregnancy
MICROCEPHALY Centripetal
Virus multiply at site of bite ® enter
2. TOGAVIRIDAE PNS ® CNS ® fatal ENCEPHALITIS
a. CHIKUNGUNYA
AEDES species Centrifugal
CNS PNS
s/sx: Dengue-like ; more Salivary glands & other tissues
severe joint pain
Pathology: Negri bodies in nerve cells
s/sx: L. ENTEROVIRUSES
Prodromal Stage: Headache, Member of Picornaviridae
Photophobia, N/V, sore throat Transient inhabitants of GIT but does
not cause disease
Acute Neurologic Phase:
Hydrophobia, Aerophobia, 1. POLIOVIRUS
Hallucination, Bizarre, Behavior, Enters mouth multiply in GIT
Sympathetic, Overactivity, Ciculation CNS lower motor neuron
Throat spasm
Coma Seizure Death Disease:

Abortive/Mild – common ;
Prevention: recovery
VACCINE (Active Immunity)
Pre-exposure prophylaxis Nonparalytic poliomyelitis –
stiffness & pain in the back &
IMMUNOGLOBULIN (Passive neck
Immunity)
Paralytic poliomyelitis – flaccid
I Touch, Feed, None paralysis
Lick
II Minor Vaccine Progressive post-myelitis –
scratches muscle atrophy
Abrasions
Prevention:
III Bite, Licks on Vaccine SALK / Inactivated Polio Vaccine
broken skin ; Immunoglobulin Parenteeak
contact with Produces igG igM
bats
SABIN / ORAL Polio Vaccine
K. PRION/ SPONGIFORM
Neurodegeneration 2. COXSACKIEVIRUS
Spongiform changes A – herpangina ; “Hand-foot-mouth”
Amyloid plaques disease
Long incubation period ; progressive ; B – myocarditis
fatal
1. SCRAPIE 3. ECHOVIRUS
Sheep & Goat
Enteric cytopathogenic human
2. MAD COW DISEASE orphan virus
BOVINE Spongiform Encelopathy
Cattle Acute hemorrhagic conjunctivitis
3. KURU M. HUMAN IMMUNODEFICIENCY VIRUS

Cannibalism
Retroviridae
4. CREUTZFELDT-JAKOB DISEASE HIV 1 & 2
Dementia, Ataxia, Myoclonus, Death
Sexual, Vertical, Body fluids
Iatrogenic CJD: growth hormone
preparations from CADAVERS VIRAL REPLICATION CYCLE
Attachment via glycoprotein 120
with CD4 cell – with co
receptors CCR5 & CXCR4
Penetration/fusion via 3. INFLUENZA
glycoprotein 41 Orthomyxoviridae
Uncoating INFLUENZA A
Pandemic ; animal reservoir
Gene Expression Antigenically highly variable
Reverse Transcriptase After 1 year
Integration of viral DNA to host
DNA via integrase 16H hemagglutinin
9N neuraminidase
Clinical Manifestation:
Stage 1 : Acute HIV infection INFLUENZA B
2-4 weeks after exposure May exhibit antigenic changes
Viremia Infects human only ; epidemic
Flu-like symptoms &
lymphadenopathy INFLUENZA C
>500 CD4/µL Antigenically stable ; common
colds, humans only
Stage 2 : Clinical Latency
Asymptomatic Composition:
200-499 CD4/µL HEMAGLUTININ
Binds virus to cells ; major
Stage 3 : Acquired antigen to which antibodies are
Immunodeficiency Syndrome directed; variability is responsible
<200 CD4/µL for epidemics
Atleast one: Pneumocystis
neumonia, MAC, NEURAMINIDASE
Cryptococcosis, Removes sialic acid from
Coccidiiodomycosis, glycoconjugates ; facilitates
Candidiasis of the lungs release of the virus
Diagnosis: ANTIGENIC CHANGES:
Enzyme Linked Immunosorbent Assau Antigenic shift – major change ,
WESTERN blot – confirmatory epidemic
(+) after 3 months
Antigenic drift – minor change
Treatment: Highly Active Anti –
Retroviral Therapy (HAART) H5N1 – bird flu
H1N1 – swine flu
N. RESPIRATORY VIRUSES
3 human influenza viruses: H1N1,
1. RHINOVIRUS H2N2, H3N2
Picorna viridae
Major cause of common colds Bird ® swine ® human
2. CORONAVIRUS Tx: Amantadine(Symmetrel),

Also causes common colds Oseltamivir, Rimantadine
a. SEVERE ACUTE RESPIRATORY 4. PARAINFLUENZA

SYNDROME (SARS) Paramyxoviridae
Pharyngitis, Pneumonia
b. MIDDLE EAST RESPIRATORY

SYNDROME (MERS)
Bats Camels Humans
5. RESPIRATORY SYNCYTAL VIRUS VI. ANTIVIRAL
Paramyxoviridae
Most common cause of LRTI in A. HSV VZV
children B. CMV
C. INFLUENZA
Treatment: D. ANTIRETROVIRALS
Ribavirin E. ANTIHEPATITIS
Pavilizumab F. INOSINE PRABONEX
O. HUMAN CANCER VIRUS
1. HUMAN PAPILLOMA VIRUS

A. HSV VZV
Papillomaviridae
Drugs are PHOSPHORYLATED by viral
Clinical manifestation: THYMIDINE-KINASE, then metabolized
Common WARTS – HPV 2 & 4 by host cell kinases to NUCLEOTIDE
analogs.
Anogenital warts/ CONDYLOMA
acuminate (syphilis) – HPV 6 & 11 Analog inhibits DNA-POLYMERASE
Cervial CARCINOMA – HPV 16 & Terminates DNA CHAIN ELONGATION

18 ; HPV16 – most common after acyclovir incorporation into viral
DNA ; except Docosanol
Diagnosis:
Papanicolauou smear 1. ACYCLOVIR
(+) loilocytes – at 21 y/o or 3 yrs
after 1st sexual contact DOC:
Acetic acid HSV Genital infections, HSV encephalitis,
HSV infections in immunocompromised
Prevention: patient
CERVARIX – HPV 16 & 18
GARDASIL – HPV 6, 11, 16 & 18 Analogue of Guanosine
Lacks hydroxyl groups
2. POLYOMAVIRIDAE in its sugar molecule(3’-
hydroxyl group)
3. RETROVIRIDAE
Short- term treatment
Human T-lymphotropic viruses HTLV of Genital Herpes,
1 T – cell LEUKEMIA lymphoma Shingles & Chicken Pox)
RNA enveloped
HIV–KAPOSI sarcoma, Lymphomas

AE (High IV dose)
GI upset, dizziness, HA, lethargy, joint
4. HERPESVIRIDAE pain, crystallize in renal tubules
Gamma
EPSTEIN-BARR IV PO Topical
Infectious mono nucleosis :
Burkitt lymphoma 2. VALACYCLOVIR
KAPOSI SARCOMA
Kaposi Sarcoma Tx of Herpes Zoster (Shingles) in
Immunocompromised pts.)
5. HEP B & C
Liver cancer Prodrug of Acyclovir
L-valyl ester
6. TRUFLUORIDINE
Inc.
bioavailability TRIFLUOROTHYMIDINE
of acyclovir by modified form of
inc. lipophilicity deoxyuridine,
incorporated into viral
DNA replication, but the –
PO CF3 group added to the
uracil component blocks
base pairing, thus
3. PENCICLOVIR interfering with viral DNA
replication.
GUANINE nucleoside TOPICAL EYEDROPS
analog ACYCLOVIR RESISTANT
HSV
Rapidly metabolized
by deacetylation in
GUT and liver
B. CMV
Penciclovir is similar
to acyclovir (except 1. GANCICLOVIR
the side O2 is
replaced with C & an extra hydroxyl group) Analogue of
acyclovir with an
Found longer in tissues compared to additional
acyclovir HYDROXYMETHYL
GROUP on the acyl
Inhibits viral DNA synthesis side chain ;
Competes for viral DNA POLYMERASE DEOXYGUANOSINE
NOT AN OBLIGATE chain terminator but
inhibits DNA elongation Uses viral-encoded
phosphotransferase produced in CMV
PO infected cells for 1st phosphorylation
Topical Tx of recurrent Herpes labialis Activated by human thymidine kinase

(Cold Sores)
SE/Blackbox warning:
Bone marrow MYELOSUPRESSION,
4. FAMCICLOVIR Neutropenia, Thrombocytopenia,
Anemia
DIACETYL-6-Deoxy
Toxicity Limits is use to:
Analog Of Penciclovir
PO Tx & suppress SIGHT-THREATENING

CMV RETINITIS in
Immunocompromised pts.
PO, IV, Intraocular
5. DOCOSANOL 2. VALGANCICLOVIR - PO
Saturated 22 CARBON ALCOHOL 3. FOSCARNET IV

Inhibits Penetration / Fusin
TOPICAL Trisodium phosphonoformate: organic
analogue of INORGANIC
PYROPHOSPHATE
Pre-treatment with PROBENECID &
prehNephrotoxic (common)
DOES NOT REQUIRE
biochemical Pre-treatment with PROBENECID &
activation by viral or
cellular enzyme, prehydration with IV NSS can be used to
hence, can be used reduce nephrotoxicity
to RESISTANT
strains of viruses. 5. FOMIVERSEN
Oligonucleotide directed against CMV

Mechanism Of Action: mRNA • Blocks translation of CMV
• Non-competitive inhibition of gene • First anti-sense anti-viral
viral DNA polymerase
• Cessation of the incorporation of
nucleoside triphosphates into the
DNA
C. INFLUENZA
Spectrum of Activity:
HSV-1, HSV-2, VZV, CMV and HIV 1. OSELTAMIVIR
Tamiflu PO
AE: ZANAMIVIR : INHALATION
Nephrotoxic & can cause Electrolyte NEURAMINIDASE INHIBITORS prevent
Imbalance (good metal ligand) the release of new virions and their
spread from cell to cell.
2nd line drug for the treatment of CMV
retinitis in AIDS patients SIALIC acid analogues
4. CIDOFOVIR IV Active against both INFLUENZA A and
B virus
IV
Toxicity:
monophosphate NV (Oseltamivir)
nucleotide BRONCHOSPASMS (Zanamivir)
analogue of CI to patient with COPD or ASTHMA
dCTP
2. AMANTADINE , RIMANTADINE
Different from other nucleoside analogue
because it is a Phosphonic Acid Derivative
No phosphorylation required.
MECHANISM OF ACTION
• Inhibits viral DNA Polymerase
• DNA Chain Terminator
USE
High therapeutic index against CMV resistant
to ganciclovir; tx for CMV Retinitis in TRICYCLIC AMINE compounds related
immunocompromised pts. HSV and VZV to adamantanes/ adamantanamine
resistant to acyclovir nhibit an early step in viral replication,
most likely VIRAL UNCOATING. In
AE: some strains: viral assembly by
NEPHROTOXIC (common) INTERFERING with HEMAGGLUTININ
processing.
Amantadine USES
1- adamantanamine hydrochloride Recommended for the
(Symmetrel®); txof PARKINSON management of adult pts.with
disease; has greater CNS activity symptomatic HIV infections,
(ANTICHOLINERGIC effects): anxiety, with 3’ AZIDO GROUP CD4+
insomnia, seizures count below 200/MM3 &
iith history of Pneumocystis
Rimantadine carinii (opportunistic)
METHYL-1-adamantane methylamine
hydrochloride (Flumadine®) ADR
4-10 times more active than ANEMIA &
amantadine, has great GI problems GRANULOCYTOPENIA limits
AZT for asymptomatic pts.
INFLUENZA A c. DIDANOSINE
GUANINE
Analogue
D. ANTI RETROVIRALS
Deoxy
1. NUCLEOSIDE REVERSE adenosine
TRANSCRIPTASE INHIBITORS
Dideoxyinosine
Analogs of ribosides (nulceosides) but
lack 3-OH group ; no phosphodieaster Mechanism Of Action
o Competitively inhibits RT
bond: 2’3’- DIDEOXY nucleoside o Incorporated into the DNA to
analogues causes DNA termination.
Reverse transcriptase converts the USES
viral RNA into a DSDNA, ready for Tx for pts with advanced HIV
integration into the host chromosome infections
ADR
o Requires phosphorylation Painful Peripheral NEUROPATHY
o Competitively inhibits reverse PANCREATITIS
transcriptase Food INTERFERES with absorption
o DNA chain termination UNSTABLE in acidic environment
Inhibitors of RT block ACUTE INFECTION of d. STAVUDINE

cells but are only WEAKLY ACTIVE in
CHRONICALLY INFECTED ones THYMIDINE
analogue
a. ABACAVIR
GUANOSINE Analogue Acid stable & well
absorbed (about
b. ZIDOVUDINE 90%) oral
1st approved antiretroviral
Azidodideoxythymidine Similar to AZT •
(AZT) Inhibits RT • Cause DNA termination of
the elongating viral DNA
THYMIDINE analogue
First- line drug Usually USES

combined with Tx for pts with advanced HIV
Lamivudine (Combivir infections who are INTOLERANT to
®)
other therapies
Competitively inhibits
RT with respect to ADR
thymidine triphosphate Peripheral NEUROPATHY
e. ZALCITABINE : ddC h. TENOFIR
CYTOSINE analogue ADENOSINE

Analogue
Combined with AZT
for the tx of ADV HIV HIV-1 and HBV
infections
Enters the cell through

CARRIER-MEDIATED
processes 2. NON-NUCLEOSIDE REVERSE
Inhibits RT • Cause DNA termination of o Do not require bioactivation
the elongating viral DNA o Do not incorporate itself into the
growing DNA chain
USES o Do not inhibit DNA polymerase.
Tx for pts with advanced HIV infections
who are INTOLERANT to AZT alone.
DISTORTS THE ENZYME so that it
ADR cannot form an enzyme- substance
PAINFUL peripheral neuropathy & complex.
Pancreatitis
Inhibits HIC-1 selectively (not able to
f. LAMIVUDINE inhibit other retrovirus)
CYTOSINE analogue High TI (in contrast to nucleosides)

Similar to ddC ; Zalcita
Chief problem
It contains a substitution Rapid emergence of resistance among
of sulfur atom in place of HIV isolates
a methylene group at
the 3’ position of the Requires combination
ribose ing. NNRTIs with at least 2 additional
antiretroviral agents.
MORE EFFECTIVE than ddC a. NEVIRAPINE

VIRAMUNE®
If combined with AZT, it increases the
CD4+ counts MOA:
• Transformed by P450 (CYP) to
MOA: similar to ddC inactivate hydroxylated
metabolites
If combined with Interferon- alpha, used • Undergo hepatic recycling
for the treatment of HEPATITIS B (HBV) blocks the RNA-dependent and
DNA-dependent
g. EMTRICITABINE • DNA polymerase activities
Fluorinated ADR:
Lamivudine RASH (17%)
Nausea & vomiting
Category C drug for pregnant
women
HEPATITIS (8-18%)
Risk is greatest in first 6 weeks of

therapy
Could be benign or fatal a. SAQUINAVIR
CYP INDUDER INVIRASE® (hard capsule)
Readily absorbed (greater than FORTOVASE ® (soft capsule)
90%) after oral administration
Absorption is increased with a FATTY
meal
b. DELAVIRDINE
RESCRIPTOR® SE: GI upset
Cross- resistance is common and
additive
Used with at least two additional
antiretroviral agent to treat HIV-1 b. INDINAVIR
infection
Rapidly absorbed in the fasting state
98% protein bound SE: GI upset, nephrolithiasis
RARELY USED
ADR
DYSLIPEDEMIA
MOA: Similar to NVP Redistributes Fats Causing Protease POUCH
BUFFALO Hump, Facial ATROPHY
ADR: Rash BREAST Enlargement
HYPERGLYCEMIA
c. EFAVIRENZ
Mandated for use with at least TWO 4. FUSION INHIBITORS
antiretroviral agents
99% protein bound a. ENFUVIRTIDE
WIDELY USED NNRTI Interfere with PENETRATION of

HIV-1 in the cells
MOA: Similar to NVP
Chemokine Receptor Binders /
Toxicity: INHIBITION OF GP41
CNS Changes (52%) o gp120 mediates viral attachment
RASH (15-27%) usually does not by binding to host receptors
require discontinuation; o gp41 acts as the anchor for
Hepatotoxicity gp120 in the virus
d. EFRAVIRINE 90 mg every 12 hours by

SUBCUTANEOUS injection
e. RILPIVIRINE
b. MARAVIROC
3. PROTEASE INHIBITORS Chemokine receptor antagonist

Act against HIV by interfering
PROTEASE - Enzyme that cleaves gag- with the INTERACTION between
pro to yield active enzymes that HIV and CCR5
function in the maturation &
propagation of new virus 5. INTEGRASE INHIBITORS
All have the same MOA but differing RALTEGRAVIR • DOLUTEGRAVIR • ELVITEGRAVIR
PHARMACOKINETIC parameters
INTEGRASE - Integration of the HIV-1
SAQUINAVIR • INDINAVIR • RITONAVIR • viral DNA generated by reverse
AMPRENAVIR • NELFINAVIR • ATAZANAVIR • transcription of the RNA genome into the
DAVUNAVIR • FOSAMPRENAVIR • LOPINAVIR host cell chromosomes is a key step of
• TIPRANAVIR
viral replication, catalyzed by the viral
integrase
E. ANTIHEPATITIS 2. HEPATITIS B
1. INTERFERONS L LAMIVUDINE
A ADEFOVIE
Interferons (IFNs) are natural
proteins produced by the cells of T TELBIVUDINE
the immune systems in response to T TENOFOVIR
challenges by foreign agents such E ENTACAVIR
as viruses, bacteria, parasites and
tumor cells.
3. HEPATITIS C
ANTIVIRAL, IMMUNE modulating
and ANTI- PROLIFERATIVE actions RIBAVIRIN
α and β interferons — produced by
GUANOSINE analogue
all the cells in response to viral
infections
Only effective in early
stages of viral hemorrhagic
γ interferons — produced only by T fevers including Lasser
lymphocyte and NK cells in fever, Crimean-Congo
response to cytokines – immune hemorrhagic fever,
regulating effects Venezuelan hemorrhagic
fever, and Hantavirus
γ — less anti-viral activity infection.
compared to α and β interferons PRODUG that is metabolized into nucleoside
analogs that blocks viral synthesis and viral .
MOA
o Bind to MEMBRANE receptors on Primarily used as an ADJUNCT therapy to various
cell surface first-line and second-line combination ? It
o INHIBITS viral penetration, decrease RELAPSING rates by accelerating viral
uncoating, transcription, clearance early in the treatment course
translation, virion assembly and
release. Hepatitis C: ALWAYS in combination ? Ribavirin
o Stimulation of the CYTOTOXIC Monotheraphy is not efficacious
activity of lymphocytes, NK cells Increase the risk of ANEMIA
and macrophages
Spectrum of Activity
Interferon α
HBV, HCV and HPV
F. INOSINE PRABONEX
Anti-PROLIFERATIVE : Kaposi sarcoma and
hairy cell leukemia. MOA
Exact mechanism of action is unknown
Therapeutic Uses Inosine pranobex appears to act as a THYMUS
hormone analog; following administration,
• Chronic hepatitis B and C
• HZV infection in cancer patients Induce T-CELL differentiation and potentiate
• CMV infections in renal transplant LYMPHOPROLIFERATIVE responses against
patients transformed or virally-infected cells
• CONDYLOMATA ACUMINATA (given by
intralesional injection) ; Complete IMMUNOSTIMULANT ; Cell-mediated
clearance is seen ~ 50%.
• HAIRY cell leukemia (with Zidovudine) Monitor uric acid levels in patients with renal
• AIDS related KAPOSI’S sarcoma impairment, gout or hyperuricaemia.
• As an adjuvant to surgical treatment of
follicular MELANOMA
• VENEREAL warts, MS
VII. MYCOLOGY d. Phyla
GLOMERULOMYCOTA ASCOMYCOTA BASIDIOMYCOTA

Zygomycota Sac Club
Conjugation
Septate
Zygospore Ascospore Basidiospore
Sporangium Conidiospore Conidiospore
Rhizopus Pathogenic Mushroom
Mucor Yeast Cryptococcus
Lictheimia Saccharomyces
Cunninghamella Candida
Mold
Coccidoides
Blastomyces
Trichophyton
Largest Phylum Most Yeast
MEDICAL MYCOLOGY
study of fungal diseases (mycosis) and associated
treatment
1. HYPERSENSITIVITY ; fungal spores
2. MYCOTOXICOSIS
Ingestion of preformed fungal toxin
Aflatoxin from stale peanuts acted upon by
A. INTRODUCTION Aspergillus potent carcinogen (hepatocellular
carcinoma)
Molds Yeast
Ergotoxin wheat acted upon by Claviceps purpurea
Generally MULTIcellular UNIcellular
filamentous (Hyphae) NONfilamentous 3. MYCETISMA
Can Live At Live At Ingestion of a poisonous fungi
ROOM Temperature BODY Temperature Amanita phalloides - most toxic
(20-25C) (37C)
Causes Different 4. FUNGAL INFECTIONS
Opportunistic Infections
Part Of Our Normal A. SUPERFICIAL MYCOSES (EPIDERMIS)
FLoRA skin, hair, nails
CHARACTERISTICS MYCOSES CAUSATIVE CLINICAL

o Generally Multicellular and filamentous, BLACK Piedraia Black nodules
except yor yeast. PIEDRA
o Saprophytic
hortae found on
o Parasitic or Pathogenic
TINEA hairshaft
o Plant-Like NODOSA
WHITE Trichosporon Beige nodules
Morphology PIEDRA beigelii found on
a. HYPHAE (means filamentous)
microtubular structures found specifically hairshaft
in molds PITYRIASIS Malasssezia
TINEA VESI furfur
Hypo/hyperpigm
ented serpentine
b. SEPTUM COLOR skin lesions
cross-wood structures found inside a
single hyphae
TINEA Exophiala Brown to black
c. CONIDIA and SPORES NIGRA werneckii lesions found on
primary method of asexual reproduction ; palms and soles
basis of their classification
B. CUTANEOUS MYCOSES (DERMIS) SPOROTRICHOSIS
CA: Dermatophytes Rose gardeners’ disease ; horticuturist
Sporothix SCHENCKII
EPIDERMOPHYTON : MICROSPORON
affects the skin and nails Mode of Transmission: rose thorns, tree
TRICHOPHYTON barks, and soil (usually anaerobic areas)
affects all areas of the skin, nails and Occupational disease of gardeners
hair
CM: Tinea/Ringworms Nodules found along the draining of the lymphatics
TINEA PEDIS FEET T. rubrum; SATURATED SOLUTION OF

E. mentagrophytes; POTASSIUM IODIDE,
ORAL ITRACONAZOLE, AMPHOTERICIN
E. Acossum
TINEA CRURIS GROIN T. rubrum; PHAEOHYPHOMYCOSIS

JOCK ITCH AREA E. mentagrophytes;
Phialophora RICHARDsiae
E. Acossum Wangiella DERMAtitides
Bipolaris SPICIfera
TINEA UNGUIUM NAIL T. rubrum; Exophalia JEANselmei
Alternaria, CURVUlaria,
ONCHOMYCOSIS HANDS E. mentagrophytes; Exhorilium roSTRATUM
E. Acossum
Solitary encapsulated cyst found on the skin
TINEA CORPORIS TRUNK T. rubrum; SATURATED SOLUTION OF
BODY E. flocossum POTASSIUM IODIDE,
ORAL ITRACONAZOLE, AMPHOTERICIN
TINEA BARBAE BEARD E. mentagophytes
TINEA CAPITIS SCALP E. mentagophytes; D. SYSTEMIC / ENDEMIC MYCOSES
Thermally dimorphic fungi
M. canis Respiratory transmission (initial site: lungs)
COCCDIO Coccidioides VALLEY Spherules

C. SUBCUTANEOUS MYCOSES immitis Fever containing
introduces into the SQ/Hypodermis area via a San JOAQUIN endospores
Valley, Coccidioides DESERT
skin incision/trauma
California posadasii Rheumatism ERYTHEMA
multiforme/
CHROMOBLASTOMYCOSIS nodosum
Phialophora verruCOSA
Fonsacaea PEDROsoi HISTOPLAS Histoplasma Most Oral yeasts
Fonsacaea COMPACTa capsulatum PREVALENT inside
Rhinocladiela AQUASpersa pulmonary macrophages
Cladophialophora CARRIONII SPELUNKER’S fungal
Disease; infection
Warty-like/verrucous skin lesions of spores; Paracoccidioides PTB
PARACOCCI
Inh. Chronic,
(cough Large,
found along the draining of the lymphatics DIO
bat droppings brasiliensis progessive
hemolysis) multiple
pulmonary budding
ITRACONAZOLE, FLUCYTOSINE disease
South yeast
LOCAL HEAT, SURGICAL EXCISION American P haryngeal
ulcers Painful
mouth
MYCETOMA / MADURA FOOT (AFRICA)
BLASTO Blastomyces PULMONARY Thick walled
associated with barefoot individuals
dermatitidis /LUNG yeast with
North Chronic broad
Pseudallescheria BOYDII American Granulomatous based
Madurella mycetomatis suppurative single bud
Madurella grisea Gilchrist’s lesions
Exophiala JEANselmei Disease
Acremonium falciFORME
Suppuration, Abscess formation, Granuloma formation Mode of Treatment

Mild to Moderate: ITRACONAZOLE
P. BOYDII – NYSTATIN ; MICONAZOLE Moderate to Severe: AMPHOTERICIN B
MADURELLA – ITRA/KETO CONAZOLE,
AMPHOTERICIN
E. Opportunistic Mycoses
Immunocompromised
VIII. ANTIFUNGAL
CANDIDIASIS albicans Cutaneous NYSTATIN
Mucosal (DOC);
KETOCO
A. Topical Antifungal
(+) 1. Skin
formation of glabrata Oral THRUSH NAZOLE
Diaper rash 2. Propionic Acid
GERM tube; Vaginosis Non-irritating, non-toxic ; present in
tropicalis Onychomycosis perspiration ; 0.01% fungicidal
Systemic 3. Zinc Propionate
krusei prosthetic Standard Fungicide on adhesive tapes
devices Treatment –
AMPHO 4. Sodium Caprylate
lusetanei TERICIN Cream colored granules used topically to
Chronic
mucocutaneous + Flucytosine; treat superficial dermatomycoses
immunocompro
mised state Alternative – 5. Zinc Caprylate
endocrino FLUCO 6. Undecylenic Acid
pathies (DM) NAZOLE 10-undecenoic acid
Denex, Cruex
CRYPTOCOCCOSIS Crypto Cryptococcus Meningitis Obtained from destructive distillation of
coccus MENINGITIS Fluconazole castor oil
spores inhaled (DOC); (ricinoleic acid)
from PIGEON
neo Encephalitis
droppings; formans Systemic: 7. Triacetin
Flu-like AMPHO Glyceryl triacetate, Enzactin, Fungacetin
Capsule Staining: TERICIN Colorless oily liquid that release acetic acid
INDIA INK + upon hydrolysis
Nigrosine FLUCYTOSINE
8. Salicylic Acid — antifungal, keratolytic
9. Resorcinol — antiseptic, keratolytic
PNEUMOCYSTIS Pneumonia COTRI 10. Benzoic Acid
Pneumo Only antifungal that cannot penetrate the
JIROVECI MOXAZOLE
Pneumonia cystis AIDS-defining (DOC) skin; use in combination
jiroveci condition
Pentamidine 11. Haloprogin
12. Clioquinol
13. Ciclopirox olamine
ASPERGILLOSIS Common in
B. NUCLEOSIDE ANTIFUNGAL
fumigatus
leukemia, stem VARI
cell patients & CONAZOLE FLUCYTOSINE
flavus steroid users (DOC)
(Mold)
Allergy / ANCOBAN®
PULMONARY
Invasive
aspergillosis; PYRIMIDINE
analogue
Aspergilloma –
fungal BALL
Prodrug activated
MYCORMYCOSIS Zygo Common in POSA into 5-fluorouracil
acidotic CONAZOLE
mucor patients (DOC)
DM, leukemia MOA:
Rhizopus lymphoma AMPTHO taken up by cytosine PERMEASE
Mucor steroid user TERICIN
burn patients
¯
Lictheimia
Cunning
converted to 5-FU
hamella RHINO ¯
CEREBELLAR FDUMP - Fluorodeoxyuridine
mycormycosis
sinuses,eyes monophosphate
brain ¯
PENICILLIOSIS Amphotericin FUTP - Fluorouridine triphosphate
marneffei
Itraconzole
Clinical Use:
C. NEOFORMANS (meningitis) +
Amphotericin ; SYNERGISTIC
CHROMOBLASTOMYCOSIS + Itraconazole
C. ANTIFUNGAL ANTIBIOTICS c. NATAMYCIN
Hypokalemia
POLYENE Cell lysis
a. AMPHOTERICIN
SYSTEMIC MYCOSIS: DOC OF LIFE
THRETENING INFECTIONS
d. GRISEOFULVIN
ORAL SYSTEMIC
MUCOCUTEOUS
INFECTIONS
FUNGISTATIC
MOA
Interacts with the MICROTUBULES within the
FUNGICIDAL ; FUNGIZONE® fungus to disrupt the mitotic spindle and
Binds to ergosterol present in the cell inhibit MITOSIS (arrests cell division in
membrane disrupting membrane function, metaphase)
allowing electrolytes to LEAK out (pores)
from the cell, resulting in cell death. Absorption is increased by FATTY meals
ADR: Rash, GI upset, HEADACHE (most
USE
common) dizziness, insomnia
BROADEST spectrum antifungal
PO : GI infections ; IV : systemic USE: Dermatophytes ® replaced (Itra, Terbina)
Intrathecal : fungal meningitis
LIMITATION AZOLES
o Immediate: INFUSION-related toxicity ;
chills, FEVER, spasm, hypokalemia, SYSTEMIC MYCOSIS
anemia, thrombophlebitis — slow down
infusion rate
Inhibition of cytochrome P-450 enzyme that catalyzes
o Cumulative: NEPHROTOXICITY (80%), 14-α DEMETHYLATION OF LANOSTEROL to ergosterol,
Hemolysis, neurotoxicity : SEIZURE — accumulation of 14-methylated sterols cause
intrathecal, Inhibition of Ergosterol permeability disturbance
synthesis, Acute RENAL failure with
wasting of K+ and Mg+ (electrolyte IMIDAZOLE TRIAZOLE
imbalace)
b. NYSTATIN
More selective in inhibiting human Less selective in inhibiting CYP450

CYP450
POTENT ENZYME INHBITOR
KETO Nizoral ITRA Sporanox

MICO Daktarin FLU Difflucan
CLOTRIMA Canesten VORI Vfend
TIO Vagistat POSA Noxafil
CLO Topical ITRA DOC
MYCOSTATIN® tinea and
candidiasis ;
Dimorphic fungi
Endemic mycosis
Inhibition of Ergosterol synthesis vulvovaginal Primary systemic
candidiasis mycosis
PK: Poorly absorbed in systemic + Food ; Acidic
circulation; Routes: TOPICAL KETO 1st orally active FLU Cryptococcal
broad spectrum Mengititis
Clinical Use:
Cutaneous Mucosal CANDIDASIS
MICO Systemic fungal POSA Broadest IX. PARASITOLOGY
infection and Only azole active vs
chronic MUCORMYCOSIS
mucocutaneous
candidiasis
I. FUNDAMENTALS
SUBCUTANEOUS & SYSTEMIC SUPERFICIAL MYCOSES

Ketoconazole Clotrimazole
Itraconazole Miconazole
Fluconazole Econazole
ADR
KETO Inhibits ANDROGEN and adrenal
STEROID synthesis :
Gynecomastia • Decreased libido •
Impotence • Menstrual irregularities
HEPATOXIC
Caution: Antacids, H2- histamine

antagonists and anticholinergics
? increase plasma conc.
ITRA Lacks ENDOCRINOLOGIC effects of
ketoconazole
D. ECHINOCANADINS
SYSTEMIC MYCOSIS
MOA
Interferes with cell wall
synthesis/permeability via inhibition of
Β- (1,3)-D-GLUCAN synthesis effective
against most species of Candida but not
Cryptococcus
Treat aspergillosis, disseminated,

mucocutaneous
CaspoFUNGIN
MicaFUNGIN
AnidulaFUNGIN
E. AUREOBASIDINS
Aureobasidins are cyclic depsipeptide by
Aureobasidium PULLULANS
MOA
Act as tight binding noncompetitive
inhibitor of the enzyme INOSITOL
PHOSPHORYLCERAMIDE SYNTHASE
IPC synthase — essential for fungal

SPHINGOLIPID biosynthesis
F. Other Antifungal
MORPHOLINES — e inhibits D14 reductase

& D7 D8 isomerase
Chitin Synthse Inhibitors — POLYOXINS,

NIKKOMYCINS
C-mann binding antifungals —

PRADImicins, BENANOmicins
II. PROTOZOA falciparum 50% MALIGNANT tertian all RBC
q48h most severe capillary
blockage
INTESTINAL PROTOZOA
VIVAX 40% benign tertian young RBC
AMEBIASIS Enta Fecal-oral Amebic METRO q48h
moeba BLOODY NIDAZOLE
histolytica, Ingestion dysentery (DOC)
dispar of malaria 10% QUARTAN malaria old RBC
cyst Amebic LIVER Tinidazole q72h
abcess / Iodoquinol OVALE benign tertian young RBC
Hepatitis
STOOL Exam Life Cycle: sporozoites → MEROZOITES (liver) →
TROPHOZOITES (erythrocytes) → gametocytes
Fresh Water Naegleria FOWLERI Primary amebic
Amoeba MENINGOENCEPALOPATHY Chloroquine + Fansidar® Quinine + Doxycycline
(PAM) (Sulfadoxine + DOC as THIRD line agent
Acanthamoeba GRANULOMATOUS amebic Pyrimethamine) for SEVERE malaria
CASTELLANI encephalopathy (GAE) DOC as FIRST line agent
for P. falciparum → non- PRIMAQUINE
GIARDIASIS Giardia Fecal-oral TRAVELLER’S METRO Radical cure; DOC to
resistant and severe
lamblia diarrhea NIDAZOLE prevent transmission and
Ingestion Bowel syndrome (DOC) relapse
Arthemeter + Lumenfantrine
of cyst abdominal pain
DOC as SECOND line
STRING Test CHLOROQUINE
treatment for plasmodium
Old man’s FOUL– DOC for ERYTHROCYTIC
resistant to first line
eyeglasses SMELLING stage of malaria; DOC for P.
GREASY vivax
diarrhea Protective conditions:
G6PD Deficiency • Sickle cell anemia • Thalassemia
Malabsorption
of ADEK BARBESIA Babesiosis
(steatorrhea) MICROTA
BLOOD & TISSUE FLAGELLATES
CYCLO Cylcospora ingestion Abdominal pain CO-
SPORIDIASIS cayeta of cyst- NV TRIMOXAZ LEISH Vector: SAND FLY (Phlebotomus spp)
nensis conta OLE MANIASIS Causative Agent: Leishmania spp.
minated Diarrhea (DOC) Treatment: STIBOGLUCONATE, Meglumine,
fruits, Antimoniate, Pentamidine, Ampothericin
vegetables Weight loss Nitrozoxanide
Tropica, Major, CUTANEOUS leishmaniasis
ANOREXIA Mexicana rolled-edge ulcerations
SEXUALLY TRANSMITTED PROTOZOA Braziliensis MUCOCUTANEOUS leishmaniasis
(espundia)
TRICHO vaginalis sexual Dysuria; METRONID esorion
MONIASIS contact AZOLE
Burning (DOC) Donovani, Chagasi VISCERAL leishmaniasis (Kala-
sensation during azar) extreme weith loss,
urination hyperplasia
TRYPANOSIOMASIS
Severe
VAGINAL AFRICAN gambi WEST African Non-Nervous:
pruritis ense SURAMIN,
TSE
YELLOW- TSE fly
green/yellow rhode EAST African Pentamidine
curdy vaginal siens Nervous:
discharge with MELARS
FISHY odor PROL
TISSUE APICOMPLEXA
AMERICAN cruzi KISSING CHAGA’S NIFUR
TOXO gondii Ingestion of RETINITIS SULFA bug disease TIMOX
PLASMOSIS cyst from Encephalitis DIAZINE + redwild
CAT’S PNEUMONITIS PYRIMETHA BENZ
feces; MINE nidazole
Congenital: (DOC);
ingestion of Stillbirth + Leucovirin
RAW pork Hydro ? prevent
under CEPHALY bone marrow
cooked Microcephaly suppression
Clindamycin
(Alternative)
BLOOD APICOMPLEXA
MALARIA Vector: Anopheles mosquito (FEMALE)
Causative Agent: Plasmodium spp.
III. ANTI PROTOZOA B. OTHER
A. MALARIA a) Amebiasis
DOC (symptomatic): Nitroimidazole
“mala aria” : bad air Metronidazole → Tenidazole
Peak transmission occurs at the
beginning and end of rainy season b) Leishmaniasis
Diagnosis → Gold standard → DOC: Pentavalent animonial
Microscopy → Thin and Thick blood Stibogluconate → Meglumine →
smears stained with Giemsa or Antimonite → Ampho B
Wright’s stain (may observe,
trophozoites or gametocytes c) Pneumocystis carnii
DOC: Co-trimoxazole
1. Classification Alt: Atovaquone → Dapsone →
Pentamidine
Tissue Schizonticide Prophylaxis: Co-trimoazole → Dapsone
Eliminates development of dormant → Pentamidine
liver forms: PRIMAQUINE
Blood Schizonticide
Eliminates erythrocytic forms:
Chloroquine • Mefloquine • Quinine •
Artemisinin • Pyrimethamine
Gametocide
Kill sexual stages & prevent
transmission to mosquitoes:
Primaquine • Chloroquine •
2. Terminologies
Casual Prophylaxis
Prevents infection; tissue
schizonticide (exoerythrocytic)
Suppressive Treatment
Prevent clinical manifestation; blood
schizonticide (erythrocytic)
Clinical Cure
Terminate clinical manifestation;
blood schizonticide (erythrocytic)
Radical Cure
Eradicate all stages : P. vivax / P.
ovale ? reinvade liver cells producing
hypnozoites (dormant)
3. Drugs
Cinchona Alkaloids
4-Aminoquinolines
8-Aminoquinolines
Polycyclic Antimalarial Drugs
Fixed Combination
IV. HELMINTHS B. TREMATODES
Flukes ; Flat, leaf- shaped flatworms
A. NEMATODES
Characterized by the tissues they infect (ex.
ENTERO Enterobius Ingestion Severe PYRANTEL
BIASIS Vermicularis Of Eggs Nocturnal PAMOATE; Lung, liver, blood)
Human Perianal Albendazole; Hermaphrodites, having both male and female
PINWORM Itching organs
SCOTCH
Trichuris PRURITIS Tape Swab
Trichuira Test; Morning Intestine Fasciolopsis GIANT intestinal fluke
WHIPWORM Before Bowel BYSTEI
Movement
Fasciolopsis eating aquatic vegetation
ASCA Ascaris Ingestion LOEFFLER Albendazole;
RIASIS Lumbricoides Of Eggs Syndrome: Mebendazole BUSKI
Liver CLONAR Asian liver fluke ; undercooked
Giant ASTHMA- KATO-KATZ CHUS FISH
Round Like Larvae Technique
worm In Lungs
sinendis hepatomagaly,anorexia,
HOOK Necator Direct Ground Itch ALBEN cirrhosis,jaundice
WORM Americanus Penetration DAZOLE;
Mebendazole
Faasciola eating watercress
(New World) Of Larvae IRON
Into Skin Deficiency HEPATICA hepatomegaly, ascites, jaundice
Ancylo Anemia Sheep Liver
stoma
Duodenale Loeffler
Lung Para undercooked CRAB MEAT
(Old World) Syndrome gonimus bloody sputum ; pneumonia ;TB
WESTER like
Strong Strong Direct Massive IVER
LOIDI lyoides Penetration Autoinfection MECTIN MANI
ASIS Stercoralis Into Skin Blood Schistosoma
Of Larvae LOEFFLER
THREAD Syndrom free-swimming, fork-tailed CERCARIAE
Worm penetrate the skin
TRICHI Trichinella Ingestion Muscle ; THIABEN Secondary: ciliated larvae (miracidia) penetrate
NELLOSIS Spiralis Of Eggs MYALGIA, DAZOLE
Encysted In Weakness
SNAILS and undergo further development
RAW
PORK Loeffler Cercariae leave the snails, enter fresh WATER,
Syndrome and complete the cycle by penetrating human
CAPILLA Capillaria Ingestion ALBEN skin.
RIASIS Philippinensi Of Raw DAZOLE
s FISH Immediate "SWIMMER'S itch," pruritic
papules
BLOOD & TISSUE NEMATODES Delayed KATAYAMA fever/ Snail fever
FILI Wuchereria MOSQUIT Lymphangitis DIETHYL Chronic depends on species; due to eggs
RIASIS Bancrofti O Bites: Painful CARBA
LYMPH MAZINE JAPO inferior & Hepato & Stool
Brugia Anopheles Nodes NICUM superior Spleno Exam
Malayi Aedes mesenteric -MEGALY
Culex Edema
vein
ELEPHANTI SMALL Portal
ASIS Intestine HYPER
Tropical
Eosinophilia MAN Inferior TENSION
ONCHO Onchocerc BLACK RIVER IVER SONI mesenteric
CERCA a Volvus FLY Blindness MECTIN veins Ascites
VOLVUS Simulium LARGE
LOIASIS Loa Loa MANGO CALABAR DIETHYL Intestine GI
FLY Swellings CARBA hemorrhage
African Eye Chrysops MAZINE
Worm
Ruptured
OTHER BLOOD & TISSUE NEMATODES
varices
DRACUN Roundworm Painful Ulcer
CULIASIS Dracunculus
(Guinea Medinensis. Death
Worm
Disease) HAEMA veins of HEMATURIA Urine
TOBIUM URI Dysuria Exam
LARVA Ancylo ACCI Erythe
MIGRANS stomatidae DENTAL matous, NARY Bladder
(Hookworm) Serpiginous, bladder obstruction
Sub Pruritic,
sequent Cutaneous
Migration Eruption
Of Larvae
Tri THIABEN Treatment of MOA: Inhibits
chinosis
C. CESTODES strongyloidiasis cell division by
(threadworm interfering with
Taenia Cause Raw BRAIN PRAZI infection) MICROTUBUL
SOLIUM Cysticer Pork Space- quantel E assembly
cosis Lesion AE:
Larvae ALBEN Common- dizziness,
CYSTI Uveitis Or dazole anorexia, nausea,
CERCI RETINITIS vomiting Rarely-
Surgical erythema
multiforme, and
SEIZURES Excision
Stevens- Johnson
Taenia NOT Raw GI Prazi syndrome (fatal)
SAGINATA Cause BEEF Distrubanc quantel Pin PYRANTEL Promotes Piperazine +
Cysticer es PAMOATE DEPOLARIZATIO Pyrantel =
cosis NICLO N- SPASTIC ANTAGONIST
SAMIDE paralysis and loss of IC effect
muscle activity
DIPHYLLOB FISH LONG MEGALO PRAZI
OTHRIUM Worm EST BLASTIC quantel Thread IVERMECTIN Act as GABA agonist or as an inducer
Letum Tape Anemia ? of chloride ion inlfux leading to
Elong.
River IVERMECTIN hyperpolarization and muscle paralysis
Sucking Worm Vitamin NICLO blindness
Grooves 13m B12 SAMIDE Filariasis DIETHYLCA Inc susceptibility of microfilaria to
Deficiency RBAMAZINE PHAGOCYTOSIS,
: Uptake Of
The SE: Mazzotti rxn when given for
Vitamin By onchocerciasis
The Worm
ECHINO Echino DOG LIVER ALBEN
Coccosis coccus Tape Cyst dazole
B. Trematodes (flukes)
Granul worm Surgery
osus Oriental Increases cell membrane
Other: Blood PRAZIQUANTEL permeability of susceptible worms,
Sheep Lung resulting in the loss of extracellular
Asian CALCIUM causing massive
Liver contraction and ultimate
SMAL PARALYSIS
LEST
DOGS & Dipy Barrel- Diarrhea NICLO Sheep Tricalbendazole Bithionol
Liver or BITHIONOL uncoupler of OXIDATIVE
CATS lidium Shaped Pruritis Ani samide
phosphorylation
CANI Prog
NUM lottids Giant Praziquantel or NICLOSAMIDE
Intestinal
DWARF Hymenol Eggs: Stool Exam PRAZIQ
Tape epis Direct UANTEL
Worm NANA C. Cestodes (tapeworm)
NICLOSAMIDE – inhibition of glucose uptake;
uncoupling oxidative phosphorylation or by
V. ANTI HELMINTICS activating ATPases
A. Nematodes (roundworm)
Round ALBEN ALBEN MEBEN Trust in the Lord with all your heart
MEBEN
Hook ALBEN Broad spectrum Irreversibly
MEBEN blocks glucose Do not lean on your own
Whip MEBEN Absorption is uptake ; understanding.
enhanced by a fatty
meal depleting
glycogen stored In all your ways acknowledge Him,
Irreversibly impairs in the parasite
glucose uptake for He will make straight your paths.
formation of ATP; KATZUNG: acts
by selectively
Inhibits microtubule inhibiting RPH 2019
synthesis microtubule
synthesis and
glucose uptake
DBF

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Study hard and Pray harder. Make this season a season for growing.

k. Robert KOCH - 1st microorganism: G(+) Eukaryotic Cell Structure

PROKARYOTIC CELL STRUCTURE Cell Appendages:

4. Fluorescent Light Microscope used for G. SPORE STAINING STAIN

5. Differential Interference Contrast Microscope

Transmission Electron Microscope uses an electron

1. BLOOD AGAR PLATE (BAP) - for s. AUREUS Þ GOLDEN yellow

allows the growth of ONE GROUP of microorganisms

1. EMB AND TCA

2. SABORAUD DEXTROSE AGAR (SDA)

3. COLISTIN-NALIDIXIC ACID MEDIUM (CNA)

DSSM - DIRECT SPUTUM DIRECT

6. THIOSULFATE CITRATE BILE SUCROSE

7. LOEFFLER’S SERUM MEDIA & TELLURITE

8. SKIRROW’S AGAR & CAMPY BAP

CANDLE JAR METHOD - obsolete

Necrotizing Fascitis Strep. gangrene

COMPS: Conjunctivitis Otitis media Meningitis

Most common cause of dental caries 4. FRANCISELLA

Tularemia ‘rabbit fever’

MORAXELLA Enterocolitis ; Enteric fever – typhoid fever ; Septicemia

D. Enteric Gram - BACILLI

EOSIN METHYLENE BLUE AGAR c. PROTEUS

Most common cause of UTI & Gram– sepsis

b. B. CEREUS – Reheated fried rice

PYLORI Botulism ; canned food ‘preformed’

Tetanus ; “tennis racket”

Prevention: Tetanus immune globulin (tetanus

BACILLUS Gas gangrene (myonecrosis, necrotizing fasciitis)

DIPHTHERIAE Aerobes, weakly acid-fast

LISTERIA H. Bacteria with Elementary & Reticulate

ATYPICAL PNEUMONIA Note: Jarisch-Herxheimer reaction – Tumor necrosis

2. Secondary Doxycycline / Amoxicillin

Tightly Coiled, Fine Spirochetes that are not SECONDARY

1. TUBERCULOSIS o The nerve damage in leprosy is the result of two

Clarithromycin + Ethambutol/Rifabutin/ Absence of cell wall ; Smallest free-living

Culture media: Beef heart infusion + Horse

K. Bacteria that cause Atypical Pneumonia L. Obligate Intracellular, Arthropod Borne

Azi / Ery -thromycin

Broad – 2nd Gen – Alpha amino

Clavulanic Oxa Penam S.

+ Ticarcillin TIMENTIN IV ADR/SE

Class II - transient inactivation o Pain on injection site, Nephrotoxic, Ototoxic

Increased stability against many gram- Cyclic peptide or a mixture of polypeptide

Problem: reacts with eukaryotic cell S.

Synergistic with beta- lactam antibiotics

Highly polar structure prevents adequate

PK: Haemophilus o Strep Pharyngitis

Most PHOTOTOXICITY (DEMEclocycline),

VESTIBULAR problems (MINOcycline)

FANCONI-LIKE syndrome – expired tetracycline ®

Interferes with a distinct step of protein

Ratio: 70(A) 30(B)

Pen G/V ® Methicillin ® Vancomycin ®

Initially developed as MAOI (revesible, non-

Interfere with INITIATION of protein synthesis

Highly lipophilic compound ®

MOA: prevents peptide bonds from being formed

Contains a nitrobenzene ® suppression of bone