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Medical Bacteriology Review

Alan R. Hauser
Depts. of Microbiology/Immunology
and Medicine
Overview of Medically Important Bacteria

Extracellular & Facultative Obligate Intracellular


Rickettsia Chlamydia Mycoplasma*

Gram-positive Gram-negative Mycobacteria Spirochetes

Cocci Bacilli Cocci and Bacilli


coccobacilli Borrelia
Enterobacteriaceae
Staphylococci Pseudomonads Treponema
Streptococci Haemophilus Legionella
Enterococci Leptospira
Bordetella Vibrio
Francisella Helicobacter
Aerobes Strict
Anaerobes Brucella
Campylobacter
Listeria Pasteurella
Bacillus Clostridia Neisseria
Corynebacteria
Actinomycetes
A bacterium is living in
A
a glass of pina colada
B
being held by a medical C
student vacationing in
Mexico. A cross-
section of its structure D

is shown below. Which


structure prevents it E
from lysing due to
osmotic pressure?
1. A
2. B
3. C
4. D
5. E 0%

1
0%

2
0%

3
0%

4
0%

5
A bacterium is living in
A
a glass of pina colada cell wall
B
being held by a medical C
(peptidoglycan)

student vacationing in
Mexico. A cross-
section of its structure D

is shown below. Which


structure prevents it E
from lysing due to
osmotic pressure?
NAMA NAGA NAMA NAGA

PBP PBP
NAMA NAGA NAMA NAGA
G G
GG GG
G G
G G

Peptidoglycan Synthesis
A
B
C

Which structure allows


it to swim around in D
the drink?
E

1. A
2. B
3. C
4. D
5. E 0%

1
0%

2
0%

3
0%

4
0%

5
A
B
C

Which structure allows


it to swim around in D
flagellum
the drink?
E
Flagella

• Listeria monocytogenes: Flagella cause characteristic


tumbling motility at 25C. This is useful diagnostically, but
these flagella are not expressed at 37C and probably do
not play a role in disease.
•Enterohemorrhagic Escherichia coli (EHEC): flagella
important in identification (O157:H7)
•Proteus mirabilis and P. vulgaris: important in
identification (swarming motility)
•Helicobacter pylori: allow movement through mucous
layer lining the stomach
•Treponema pallidum: periplasmic flagella
A
B
C
Is this bacterium most
likely to stain Gram-
positive or Gram- D

negative?
E

1. Gram-positive
2. Gram-negative

0% 0%

1 2
A
B
C
Is this bacterium most
likely to stain Gram-
positive or Gram- D

negative?
E

1. Gram-positive
2. Gram-negative
The bacterium is metabolizing nutrients it takes
up from the drink. Oxygen that has diffused
into the drink is used as an electron receptor in
this process, which is called what?

1. fermentation
2. chemotaxis
3. twitching motility
4. respiration
5. inebriation

0% 0% 0% 0% 0%

1 2 3 4 5
The bacterium is metabolizing nutrients it takes
up from the drink. Oxygen that has diffused
into the drink is used as an electron receptor in
this process, which is called what?

1. fermentation
2. chemotaxis
3. twitching motility
4. respiration
5. inebriation
Nutrients are plentiful, so the bacteria are
multiplying rapidly. What is this phase of
growth referred to?

1. lag phase
2. exponential phase
3. stationary phase
4. phase of the moon
5. puberty

0% 0% 0% 0% 0%

1 2 3 4 5
Nutrients are plentiful, so the bacteria are
multiplying rapidly. What is this phase of
growth referred to?

1. lag phase
2. exponential phase
3. stationary phase
4. phase of the moon
5. puberty
Bacterial Growth Phases
•Lag phase: bacteria adapt to new environment
•Exponential (or log) phase: bacteria are rapidly dividing
•Stationary phase: exhaustion of nutrients and
accumulation of waste-->bacterial numbers plateau
The energy produced by the metabolism allows
the bacterium to manufacture new proteins. It
starts by using RNA polymerase to manufacture
what?

1. mRNA
2. tRNA
3. siRNA
4. rRNA
5. DNA

0% 0% 0% 0% 0%

1 2 3 4 5
The energy produced by the metabolism allows
the bacterium to manufacture new proteins. It
starts by using RNA polymerase to manufacture
what?

1. mRNA
2. tRNA
3. siRNA
4. rRNA
5. DNA
The mRNA is translated into protein by what?

1. DNA polymerase
2. RNA polymerase
3. ribosome
4. mitochondria
5. Rosetta stone

0% 0% 0% 0% 0%

1 2 3 4 5
The mRNA is translated into protein by what?

1. DNA polymerase
2. RNA polymerase
3. ribosome
4. mitochondria
5. Rosetta stone
...which is composed of the following subunits:

1. 80s = 60s + 40s


2. 90s = 70s + 30s
3. 70s = 50s + 30s
4. 80s = 50s + 30s
5. e = mc2

0% 0% 0% 0% 0%

1 2 3 4 5
...which is composed of the following subunits:

1. 80s = 60s + 40s


2. 90s = 70s + 30s
3. 70s = 50s + 30s
4. 80s = 50s + 30s
5. e = mc2
The medical student A
takes a drink from the B
glass. The bacterium C
finds itself in a human
intestine. Its first order
D
of business is to bind to
mucosal epithelial cells
to prevent being E

flushed out by
peristalsis. Which of 1. A
the shown structures
plays a prominent role 2. B
in binding to epithelial 3. C
cells?
4. D
5. E 0%

1
0%

2
0%

3
0%

4
0%

5
The medical student A
takes a drink from the B
glass. The bacterium C
finds itself in a human
intestine. Its first order
D
of business is to bind to
mucosal epithelial cells
to prevent being E pili
flushed out by
peristalsis. Which of
the shown structures
plays a prominent role
in binding to epithelial
cells?
Adhesins
Listeria monocytogenes: internalin
Escherichia coli: P-pili (pyelonephritis) and type 1 pili
enteropathogenic E. coli (EPEC): intimin
Pseudomonas aeruginosa: pili
Bordetella pertussis: pili and filamentous hemaglutinin
Neisseria gonorrheae and N. meningitidis:
pili (antigenic variation)
opacity-associated proteins (Opa’s)
Vibrio cholerae: toxin-coregulated pili (TCP)
Yersinia pestis: Ail
Klebsiella pneumoniae: pili
Rickettsia rickettsii: OmpA
Next, the adherent bacteria secrete toxins.
Name a general mechanism by which toxins are
secreted and/or get into host cells.

1. AB toxins
2. trojan horse
3. flagella
4. sporulation
5. biofilms
0% 0% 0% 0% 0%

1 2 3 4 5
Next, the adherent bacteria secrete toxins.
Name a general mechanism by which toxins are
secreted and/or get into host cells.

1. AB toxins
2. trojan horse
3. flagella
4. sporulation
5. biofilms
Bacteria that secrete AB toxins

Corynebacterium diphtheriae: diptheria toxin


Bordetella pertussis: pertussis toxin
Clostridium tentani: tetanus toxin
Clostridium botulinum: botulinum toxin
Vibrio cholerae: cholera toxin
Bacillus anthracis: anthrax toxin
Type III Secretion Systems

Pseudomonas aeruginosa: ExoS, ExoT, ExoU, ExoY


Yersinia spp.: YopE, YopH
Shigella spp.
Salmonella spp.
enteropathogenic E. coli (EPEC)
Which bacterium secretes an A-B toxin that
ADP-ribosylates a GTP-binding regulatory
component of adenylate cyclase, which leads to
diarrhea?

1. Campylobacter jejuni
2. Shigella spp.
3. Salmonella enterica
4. Vibrio cholera
5. rotavirus
0% 0% 0% 0% 0%

1 2 3 4 5
Which bacterium secretes an A-B toxin that
ADP-ribosylates a GTP-binding regulatory
component of adenylate cyclase, which leads to
diarrhea?

1. Campylobacter jejuni
2. Shigella spp.
3. Salmonella enterica
4. Vibrio cholera (cholera toxin)
5. rotavirus
Which organism secretes a toxin that is similar
to cholera toxin and stimulates adenylate
cyclase in gut epithelial cells?

1. enterotoxigenic E. coli
2. Shigella spp.
3. Staphylococcus aureus
4. Clostridium difficile
5. rotavirus
0% 0% 0% 0% 0%

1 2 3 4 5
Which organism secretes a toxin that is similar
to cholera toxin and stimulates adenylate
cyclase in gut epithelial cells?

1. enterotoxigenic E. coli (heat labile toxin, LT)


2. Shigella flexneri
3. Staphylococcus aureus
4. Clostridium difficile
5. rotavirus
Which bacterium secretes an enterotoxin that
also has superantigen properties?

1. Salmonella enterica
2. Shigella spp.
3. Staphylococcus aureus
4. Clostridium difficile
5. rotavirus
0% 0% 0% 0% 0%

1 2 3 4 5
Which bacterium secretes an enterotoxin that
also has superantigen properties?

1. Salmonella enterica
2. Shigella spp.
3. Staphylococcus aureus (enterotoxins A,B,C,D,E)
4. Clostridium difficile
5. rotavirus
Superantigen Toxins

Staphylococcus aureus
•TSST-1
•Enterotoxins A-E
Streptococcus pyogenes
•Streptococcal pyogenic exotoxin (SPEs)
Which organism uses a type III secretion system
to cause attachment and effacement lesions?

1. Salmonella enterica
2. Shigella spp.
3. Clostridium difficile
4. enteropathogenic E. coli
5. rotavirus

0% 0% 0% 0% 0%

1 2 3 4 5
Which organism uses a type III secretion system
to cause attachment and effacement lesions?

1. Salmonella enterica
2. Shigella spp.
3. Clostridium difficile
4. enteropathogenic E. coli
5. rotavirus
Which bacterium secretes shiga-toxin, which
contributes to diarrhea by inhibiting sodium
absorption from the intestinal lumen?

1. Salmonella enterica
2. Shigella spp.
3. Clostridium difficile
4. enterotoxigenic E. coli
5. enterohemorrhagic E. coli

0% 0% 0% 0% 0%

1 2 3 4 5
Which bacterium secretes shiga-toxin, which
contributes to diarrhea by inhibiting sodium
absorption from the intestinal lumen?

1. Salmonella enterica
2. Shigella spp.
3. Clostridium difficile
4. enterotoxigenic E. coli
5. enterohemorrhagic E. coli
Which organism secretes a toxin that is not
destroyed by heating and that stimulates
guanylate cyclase?

1. Salmonella enterica
2. Yersinia enterocolitica
3. Clostridium difficile
4. enterotoxigenic E. coli
5. enterohemorrhagic E. coli

0% 0% 0% 0% 0%

1 2 3 4 5
Which organism secretes a toxin that is not
destroyed by heating and that stimulates
guanylate cyclase?

1. Salmonella enterica
2. Yersinia enterocolitica
3. Clostridium difficile
4. enterotoxigenic E. coli (heat stabile toxin; ST)
5. enterohemorrhagic E. coli
Which bacterium secretes shiga-like toxin?

1. Salmonella enterica
2. Yersinia enterocolitica
3. Clostridium difficile
4. Bacillus cereus
5. enterohemorrhagic E. coli

0% 0% 0% 0% 0%

1 2 3 4 5
Which bacterium secretes shiga-like toxin?

1. Salmonella enterica
2. Yersinia enterocolitica
3. Clostridium difficile
4. Bacillus cereus
5. enterohemorrhagic E. coli (EHEC)
Which bacterium uses a type III secretion
system to invade intestinal epithelial cells by
inducing ruffling on their surfaces and is
associated with chickens?

1. Salmonella enterica
2. Yersinia enterocolitica
3. Clostridium difficile
4. Bacillus cereus
5. enterohemorrhagic E. coli

0% 0% 0% 0% 0%

1 2 3 4 5
Which bacterium uses a type III secretion
system to invade intestinal epithelial cells by
inducing ruffling on their surfaces and is
associated with chickens?

1. Salmonella enterica
2. Yersinia enterocolitica
3. Clostridium difficile
4. Bacillus cereus
5. enterohemorrhagic E. coli
Which bacterium is identified by its ability to
produce two cytotoxins (A & B) thought to be
important in causing diarrhea?

1. Salmonella enterica
2. Yersinia enterocolitica
3. Clostridium difficile
4. Bacillus cereus
5. enterohemorrhagic E. coli

0% 0% 0% 0% 0%

1 2 3 4 5
Which bacterium is identified by its ability to
produce two cytotoxins (A & B) thought to be
important in causing diarrhea?

1. Salmonella enterica
2. Yersinia enterocolitica
3. Clostridium difficile
4. Bacillus cereus
5. enterohemorrhagic E. coli
Which bacterium secretes a toxin that
resembles the staphylococcal enterotoxins and
also causes an illness characterized by vomiting
and a short incubation period?

1. Salmonella enterica
2. Yersinia enterocolitica
3. Clostridium difficile
4. Bacillus cereus
5. enterohemorrhagic E. coli

0% 0% 0% 0% 0%

1 2 3 4 5
Which bacterium secretes a toxin that
resembles the staphylococcal enterotoxins and
also causes an illness characterized by vomiting
and a short incubation period?

1. Salmonella enterica
2. Yersinia enterocolitica
3. Clostridium difficile
4. Bacillus cereus
5. enterohemorrhagic E. coli
The organism causing the diarrhea is a Gram-
negative bacterium and it invades intestinal
epithelial cells. Which of the following bacteria
might it be?

1. Salmonella enterica
2. Yersinia enterocolitica
3. Clostridium difficile
4. Bacillus cereus
5. enterohemorrhagic E. coli

0% 0% 0% 0% 0%

1 2 3 4 5
The organism causing the diarrhea is a Gram-
negative bacterium and it invades intestinal
epithelial cells. Which of the following bacteria
might it be?

1. Salmonella enterica (also Shigella spp.)


2. Yersinia enterocolitica
3. Clostridium difficile
4. Bacillus cereus
5. enterohemorrhagic E. coli
... and following invasion, the causative
bacterium may disseminate to the bloodstream.
Which is it?

1. Salmonella enterica
2. Shigella spp.

0% 0%

1 2
... and following invasion, the causative
bacterium may disseminate to the bloodstream.
Which is it?

1. Salmonella enterica
2. Shigella spp.
In the intestine, a small abscess forms in one of
the mucosal crypts. The oxygen content in this
abscess is very low. What process might the
bacteria use to generate energy in this
environment?

1. fermentation
2. respiration
3. chemiosmosis
4. electron transport
5. nuclear fission

0% 0% 0% 0% 0%

1 2 3 4 5
In the intestine, a small abscess forms in one of
the mucosal crypts. The oxygen content in this
abscess is very low. What process might the
bacteria use to generate energy in this
environment?

1. fermentation
2. respiration
3. chemiosmosis
4. electron transport
5. nuclear fission
So this bacterium can both respire and ferment.
What is the term used to refer to bacteria that
can do both?

1. obligate intracellular
2. anaerobic
3. aerobe
4. facultative anaerobe
5. really cool

0% 0% 0% 0% 0%

1 2 3 4 5
So this bacterium can both respire and ferment.
What is the term used to refer to bacteria that
can do both?

1. obligate intracellular
2. anaerobic
3. aerobe
4. facultative anaerobe
5. really cool
Type of Bacteria Grow Grow Superox ide Comment
with without dismutase
oxygen? oxygen? and catalase
Aerobe + - + Requires oxygen ;
(strict aerobe) canno t ferment
Anae robe - + - Kill ed by oxygen ;
(strict anaerobe) ferme nts in absence of oxygen
Facultative + + + Respir es wit h oxygen ;
ferme nts in absence of oxygen
Indifferent (aerotolerant + + + Ferments in presence or absence
ana erobe) of oxygen
Adapted from Sherris Medical Microbiology, 3rd ed., Ryan, Champoux, Drew et al. ed., Applet on & Lange, CT, 1994.

Some authors define an additional group, called "microaerophilic bacteria." These are
bacteria that grow best in an environment with less oxygen than is normally found in air.
The medical student develops profuse diarrhea
that has a “rice-water” appearance. What is the
causative organism?

1. Clostridium perfringens
2. Salmonella enterica
3. Vibrio cholerae
4. Staphylococcus aureus
5. enterotoxigenic E. coli
0% 0% 0% 0% 0%

1 2 3 4 5
The medical student develops profuse diarrhea
that has a “rice-water” appearance. What is the
causative organism?

1. Clostridium perfringens
2. Salmonella enterica
3. Vibrio cholerae
4. Staphylococcus aureus
5. enterotoxigenic E. coli
Which organism is the most common bacterial
cause of Traveler’s diarrhea?

1. Clostridium perfringens
2. Salmonella enterica
3. Vibrio cholerae
4. Staphylococcus aureus
5. enterotoxigenic E. coli
0% 0% 0% 0% 0%

1 2 3 4 5
Which organism is the most common bacterial
cause of Traveler’s diarrhea?

1. Clostridium perfringens
2. Salmonella enterica
3. Vibrio cholerae
4. Staphylococcus aureus
5. enterotoxigenic E. coli
Which organism causes diarrhea and is also
associated with gas gangrene?

1. Clostridium perfringens
2. Salmonella enterica
3. Vibrio cholerae
4. Staphylococcus aureus
5. enterohemorrhagic E. coli
0% 0% 0% 0% 0%

1 2 3 4 5
Which organism causes diarrhea and is also
associated with gas gangrene?

1. Clostridium perfringens
2. Salmonella enterica
3. Vibrio cholerae
4. Staphylococcus aureus
5. enterohemorrhagic E. coli
Which organism causes gastroenteritis that is
associated with ingestion of rice?

1. Bacillus cereus
2. Salmonella enterica
3. Vibrio cholerae
4. Staphylococcus aureus
5. enterohemorrhagic E. coli
0% 0% 0% 0% 0%

1 2 3 4 5
Which organism causes gastroenteritis that is
associated with ingestion of rice?

1. Bacillus cereus
2. Salmonella enterica
3. Vibrio cholerae
4. Staphylococcus aureus
5. enterohemorrhagic E. coli
Which organism is associated with
gastroenteritis that typically has a short
incubation period (1-5 hours) and usually
causes vomiting?

1. Bacillus cereus
2. Salmonella enterica
3. Vibrio cholerae
4. Staphylococcus aureus
5. enterohemorrhagic E. coli
0% 0% 0% 0% 0%

1 2 3 4 5
Which organism is associated with
gastroenteritis that typically has a short
incubation period (1-5 hours) and usually
causes vomiting?

1. Bacillus cereus
2. Salmonella enterica
3. Vibrio cholerae
4. Staphylococcus aureus
5. enterohemorrhagic E. coli
Which organism can lead to hemolytic-uremic
syndrome (HUS)?

1. Bacillus cereus
2. Salmonella enterica
3. Vibrio cholerae
4. Staphylococcus aureus
5. enterohemorrhagic E. coli
0% 0% 0% 0% 0%

1 2 3 4 5
Which organism can lead to hemolytic-uremic
syndrome (HUS)?

1. Bacillus cereus
2. Salmonella enterica
3. Vibrio cholerae
4. Staphylococcus aureus
5. enterohemorrhagic E. coli
Shigella spp. can be transmitted by the 5 F’s.
Which one of the following is NOT one of the 5
F’s?

1. fingers
2. flies
3. food
4. fomites
5. fish
0% 0% 0% 0% 0%

1 2 3 4 5
Shigella spp. can be transmitted by the 5 F’s.
Which one of the following is NOT one of the 5
F’s?

1. fingers
2. flies
3. food
4. fomites
5. fish (feces)
This organism is often carried by chickens, can
be contracted through eating raw eggs, and
frequently causes large outbreaks of diarrhea?

1. Bacillus cereus
2. Salmonella enterica
3. Yersinia enterocolitica
4. Clostridium difficile
5. Campylobacter jejuni
0% 0% 0% 0% 0%

1 2 3 4 5
This organism is often carried by chickens, can
be contracted through eating raw eggs, and
frequently causes large outbreaks of diarrhea?

1. Bacillus cereus
2. Salmonella enterica
3. Yersinia enterocolitica
4. Clostridium difficile
5. Campylobacter jejuni
Which organism causes a bloody diarrhea that
on rare occasions may be followed by Guillain-
Barre syndrome?

1. Bacillus cereus
2. Salmonella enterica
3. Yersinia enterocolitica
4. Clostridium difficile
5. Campylobacter jejuni
0% 0% 0% 0% 0%

1 2 3 4 5
Which organism causes a bloody diarrhea that
on rare occasions may be followed by Guillain-
Barre syndrome?

1. Bacillus cereus
2. Salmonella enterica
3. Yersinia enterocolitica
4. Clostridium difficile
5. Campylobacter jejuni
Which organism causes food poisoning and
survives quite well at 4C?

1. Bacillus cereus
2. Salmonella enterica
3. Yersinia enterocolitica
4. Clostridium difficile
5. Campylobacter jejuni
0% 0% 0% 0% 0%

1 2 3 4 5
Which organism causes food poisoning and
survives quite well at 4C?

1. Bacillus cereus
2. Salmonella enterica
3. Yersinia enterocolitica
4. Clostridium difficile
5. Campylobacter jejuni
Which organism causes diarrhea that is
associated with pseudomembrane formation?

1. Bacillus cereus
2. Salmonella enterica
3. Yersinia enterocolitica
4. Clostridium difficile
5. Campylobacter jejuni
0% 0% 0% 0% 0%

1 2 3 4 5
Which organism causes diarrhea that is
associated with pseudomembrane formation?

1. Bacillus cereus
2. Salmonella enterica
3. Yersinia enterocolitica
4. Clostridium difficile
5. Campylobacter jejuni
Inflammatory vs. Noninflammatory Diarrhea
Inflammatory Diarrhea
•Mucous or blood in stool
•Leukocytes and RBCs on microscopic examination
•Results from local tissue destruction by a pathogen that
invades the intestinal mucosa
•Fever
•Longer incubation period (2-4 days)
Noninflammatory Diarrhea
•Watery or loose stools without mucous or blood
•No leukocytes or RBCs on microscopic examination
•Most often toxin-mediated or caused by viruses
•No fever
•Shorter incubation period (1-12 hours)
Infectious Diarrhea

INFLAMMATORY NONINFLAMMATORY
• Shigella spp. • Vibrio cholerae
• Salmonella spp. • Enterotoxigenic
• Campylobacter jejuni Escherichia coli
• enterhemorrhagic E. • Clostridium perfringens
coli • Bacillus cereus
• enteroinvasive E. coli • Staphylococcus aureus
• enteropathogenic E. coli • Rotavirus
• Yersinia enterocolitica • Norwalk-like viruses
• Clostridium difficile • Giardia lamblia
• Entamoeba histolytica • Cryptosporidium
The medical student goes to the restroom and
the organism is released back into the
environment, where it persists in the form of
spores. Which one of the following causes of
diarrhea can form spores?

1. Bacillus cereus
2. Salmonella enterica
3. Yersinia enterocolitica
4. Shigella spp.
5. Campylobacter jejuni
0% 0% 0% 0% 0%

1 2 3 4 5
The medical student goes to the restroom and
the organism is released back into the
environment, where it persists in the form of
spores. Which one of the following causes of
diarrhea can form spores?

1. Bacillus cereus (& Clostridia spp.)


2. Salmonella enterica
3. Yersinia enterocolitica
4. Shigella spp.
5. Campylobacter jejuni
The medical student goes to his physician and
gets some antibiotics for his diarrhea. Which
antibiotics would target the RNA polymerase?

1. rifampin
2. aminoglycoside (e.g.
gentamicin)
3. fluoroquinolone (e.g.
ciprofloxacin)
4. penicillin
5. carbapenem 0% 0% 0% 0% 0%

1 2 3 4 5
The medical student goes to his physician and
gets some antibiotics for his diarrhea. Which
antibiotics would target the RNA polymerase?

1. rifampin
2. aminoglycoside (e.g.
gentamicin)
3. fluoroquinolone (e.g.
ciprofloxacin)
4. penicillin
5. carbapenem
…the ribosome?

1. rifampin
2. aminoglycoside (e.g.
gentamicin)
3. fluoroquinolone (e.g.
ciprofloxacin)
4. penicillin
5. carbapenem 0% 0% 0% 0% 0%

1 2 3 4 5
…the ribosome?

1. rifampin
2. aminoglycoside (e.g. gentamicin) (also chloramphenicol,
macrolides, clindamycin, streptogramins, tetracyclines)
3. fluoroquinolone (e.g. ciprofloxacin)
4. penicillin
5. carbapenem
…the cell wall?

1. rifampin
2. aminoglycoside (e.g.
gentamicin)
3. fluoroquinolone (e.g.
ciprofloxacin)
4. penicillin
5. metronidazole 0% 0% 0% 0% 0%

1 2 3 4 5
…the cell wall?

1. rifampin
2. aminoglycoside (e.g. gentamicin)
3. fluoroquinolone (e.g. ciprofloxacin)
4. penicillin (all beta-lactams: penicillins, cephalosporins,
carbapenems, monobactams; also non-beta lactams--
vancomycin)
5. metronidazole
Antibacterial Agents

beta-lactams (penicillin)
trimethoprim vancomycin
sulfamethoxazole
quinolones

DNA gyrase &


folic acid
DNA polymerase

protein
ribosome

chromosome
RNA polymerase
50s 30s
mRNA

rifampin tetracyclines
chloramphenicol
macrolides
see Hauser, Antibiotic Basics for Clinicians, clindamycin aminoglycosides
Lippincott, 2007, for details streptogramins
linezolid
A bacterium is living in the oropharynx of an elderly
woman and is suddenly aspirated into the lungs. The
individual develops pneumonia. Which bacteria commonly
cause pneumonia?

Streptococcus pneumoniae
Haemophilus influenzae
Mycoplasma pneumoniae
Chlamydia pneumoniae
Legionella pneumophila
Klebsiella pneumoniae and other
Enterobacteriaceae
Pseudomonas aeruginosa
Staphylococcus aureus
Mycobacterium tuberculosis
...and it’s acute pneumonia?

Streptococcus pneumoniae
Haemophilus influenzae
Mycoplasma pneumoniae
Chlamydia pneumoniae
Legionella pneumophila
Klebsiella pneumoniae and other
Enterobacteriaceae
Pseudomonas aeruginosa
Staphylococcus aureus
...in an outpatient?

Streptococcus pneumoniae
Haemophilus influenzae
Mycoplasma pneumoniae
Chlamydia pneumoniae
Legionella pneumophila
Klebsiella pneumoniae
Staphylococcus aureus
The bacteria disseminate to the bloodstream,
where they are protected against complement
deposition and phagocytosis by their LPS.
Which part of LPS prevents complement
deposition and phagocytosis?

1. lipid A
2. core
3. O-antigen
4. peptidoglycan
5. capsule
0% 0% 0% 0% 0%

1 2 3 4 5
The bacteria disseminate to the bloodstream,
where they are protected against complement
deposition and phagocytosis by their LPS.
Which part of LPS prevents complement
deposition and phagocytosis?

1. lipid A
2. core
3. O-antigen (or O-side chain)
4. peptidoglycan
5. capsule
Which respiratory pathogen is a “lancet-
shaped” diplococcus?

1. Streptococcus pyogenes
2. Streptococcus pneumoniae
3. Haemophilus influenzae
4. Corynebacterium diphtheriae
5. Mycobacteria tuberculosis

0% 0% 0% 0% 0%

1 2 3 4 5
Which respiratory pathogen is a “lancet-
shaped” diplococcus?

1. Streptococcus pyogenes
2. Streptococcus pneumoniae
3. Haemophilus influenzae
4. Corynebacterium diphtheriae
5. Mycobacteria tuberculosis
Which respiratory pathogens secrete a toxin
that ADP-ribosylates EF-2?

1. Streptococcus pyogenes
2. Streptococcus pneumoniae
3. Haemophilus influenzae
4. Corynebacterium diphtheriae
5. Mycobacteria tuberculosis

0% 0% 0% 0% 0%

1 2 3 4 5
Which respiratory pathogens secrete a toxin
that ADP-ribosylates EF-2?

1. Streptococcus pyogenes
2. Streptococcus pneumoniae
3. Haemophilus influenzae
4. Corynebacterium diphtheriae (& Pseudomonas aeruginosa)
5. Mycobacteria tuberculosis
ADP-ribosylating toxins

Corynebacterium diphtheriae: diphtheria toxin (EF-2)


Pseudomonas aeruginosa
•exotoxin A (EF-2)
•ExoS and ExoT
Vibrio cholerae: cholera toxin (GTP-binding regulatory
component of adenylate cyclase--> cAMP)
Eschericia coli: heat-labile toxin
Bordetella pertussis: pertussis toxin (G-protein-->cAMP)
Which respiratory pathogen occasionally causes
life-threatening epiglottitis?

1. Streptococcus pyogenes
2. Streptococcus pneumoniae
3. Haemophilus influenzae
4. Corynebacterium diphtheriae
5. Mycobacteria tuberculosis

0% 0% 0% 0% 0%

1 2 3 4 5
Which respiratory pathogen occasionally causes
life-threatening epiglottitis?

1. Streptococcus pyogenes
2. Streptococcus pneumoniae
3. Haemophilus influenzae
4. Corynebacterium diphtheriae
5. Mycobacteria tuberculosis
Which respiratory pathogen lacks a cell wall?

1. Streptococcus pyogenes
2. Mycoplasma pneumoniae
3. Chlamydophila pneumoniae
4. Legionella pneumophila
5. Mycobacteria tuberculosis

0% 0% 0% 0% 0%

1 2 3 4 5
Which respiratory pathogen lacks a cell wall?

1. Streptococcus pyogenes
2. Mycoplasma pneumoniae
3. Chlamydophila pneumoniae
4. Legionella pneumophila
5. Mycobacteria tuberculosis
Which common respiratory pathogen is an
obligate intracellular pathogen?

1. Streptococcus pyogenes
2. Mycoplasma pneumoniae
3. Chlamydophila pneumoniae
4. Legionella pneumophila
5. Mycobacteria tuberculosis

0% 0% 0% 0% 0%

1 2 3 4 5
Which common respiratory pathogen is an
obligate intracellular pathogen?

1. Streptococcus pyogenes
2. Mycoplasma pneumoniae
3. Chlamydophila pneumoniae
4. Legionella pneumophila
5. Mycobacteria tuberculosis
Which respiratory pathogen is internalized by a
process called coiling phagocytosis?

1. Streptococcus pyogenes
2. Mycoplasma pneumoniae
3. Chlamydophila pneumoniae
4. Legionella pneumophila
5. Mycobacteria tuberculosis

0% 0% 0% 0% 0%

1 2 3 4 5
Which respiratory pathogen is internalized by a
process called coiling phagocytosis?

1. Streptococcus pyogenes
2. Mycoplasma pneumoniae
3. Chlamydophila pneumoniae
4. Legionella pneumophila
5. Mycobacteria tuberculosis
Which respiratory pathogen secretes pyrogenic
exotoxins that are superantigens?

1. Streptococcus pyogenes
2. Mycoplasma pneumoniae
3. Chlamydophila pneumoniae
4. Legionella pneumophila
5. Mycobacteria tuberculosis

0% 0% 0% 0% 0%

1 2 3 4 5
Which respiratory pathogen secretes pyrogenic
exotoxins that are superantigens?

1. Streptococcus pyogenes
2. Mycoplasma pneumoniae
3. Chlamydophila pneumoniae
4. Legionella pneumophila
5. Mycobacteria tuberculosis
Which respiratory pathogen causes a chronic
pneumonia that is characterized by weight loss,
fevers, and night sweats?

1. Streptococcus pyogenes
2. Mycoplasma pneumoniae
3. Chlamydophila pneumoniae
4. Legionella pneumophila
5. Mycobacteria tuberculosis

0% 0% 0% 0% 0%

1 2 3 4 5
Which respiratory pathogen causes a chronic
pneumonia that is characterized by weight loss,
fevers, and night sweats?

1. Streptococcus pyogenes
2. Mycoplasma pneumoniae
3. Chlamydophila pneumoniae
4. Legionella pneumophila
5. Mycobacteria tuberculosis
Mycobacterium tuberculosis

•exposure
•infection
•disease
•primary
•reactivation
The patient is treated with a penicillin derivative. However,
the organism had previously acquired a beta-lactamase gene
from another inhabitant of the oropharynx. What are the
different mechanisms by which this beta-lactamase gene
may have been acquired?

Transformation
Transduction
Conjugation
The gene encoding the beta-lactamase is on a plasmid
that was acquired through conjugation. Interestingly,
this bacterial isolate is also resistant to quinolones and
TMP-SMX. Name a mechanism that would account
for this bacterium being resistant to all these
antibiotics.

The plasmid carries multiple resistant genes


A microbe inhabits the genital tract of a female prostitute
and is passed onto a male during sexual intercourse. What
are some of the common causative organisms?

Chlamydia trachomatis
Neisseria gonorrhoeae
Haemophilus ducreyi
Treponema pallidum
herpes simplex virus
human papillomavirus
HIV
Trichomonas vaginalis
Which of these are bacterial?

Chlamydia trachomatis
Neisseria gonorrhoeae
Haemophilus ducreyi
Treponema pallidum
How is each of these diagnosed?

Chlamydia trachomatis -DFA or EIA or nucleic acid


amplification
Neisseria gonorrhoeae -Gram-stain, growth, or
nucleic acid amplification
Haemophilus ducreyi
-growth

-dark field, serologies


Treponema pallidum (VDRL, RPR, MHA, FTA)
... and the organism is an obligate intracellular
microbe. What is it?

1. Chlamydia trachomatis
2. Neisseria gonorrheae
3. Haemophilus ducreyi
4. Treponema pallidum

0% 0% 0% 0%

1 2 3 4
... and the organism is an obligate intracellular
microbe. What is it?

1. Chlamydia trachomatis
2. Neisseria gonorrheae
3. Haemophilus ducreyi
4. Treponema pallidum
An 8-year-old girl presents to the ER with fever
and severe abdominal pain. She also reports
diarrhea for the past two days. An abdominal
CT shows mesenteric lymphadenopathy. Your
attending suspects appendicitis, but you state
that the differential also includes this bacterial
infection:

1. Yersinia pestis
2. Yersinia enterocolitica
3. Clostridium difficile
4. Leptospira interrogans
5. Francisella tularensis

0% 0% 0% 0% 0%

1 2 3 4 5
An 8-year-old girl presents to the ER with fever
and severe abdominal pain. She also reports
diarrhea for the past two days. An abdominal
CT shows mesenteric lymphadenopathy. Your
attending suspects appendicitis, but you state
that the differential also includes this bacterial
infection:

1. Yersinia pestis
2. Yersinia enterocolitica
3. Clostridium difficile
4. Leptospira interrogans
5. Francisella tularensis
A 68-year-old woman is admitted with urosepsis due to
Eschericia coli. She initially responds to intravenous ampicillin,
but after a week of therapy again develops fever, malaise, and
an elevated peripheral white blood cell count. She also reports
diarrhea. What do you think is causing her illness?

1. Her E. coli is now resistant to ampicillin


2. The initial susceptibilities of her E. coli
were performed incorrectly.
3. She actually initially had a Pseudomonas
aeruginosa infection, since P. aeruginosa
is resistant to ampicillin.
4. She has endocarditis, which responds very
slowly to antibiotics
5. She has Clostridium difficile colitis.
0% 0% 0% 0% 0%

1 2 3 4 5
A 68-year-old woman is admitted with urosepsis due to
Eschericia coli. She initially responds to intravenous ampicillin,
but after a week of therapy again develops fever, malaise, and
an elevated peripheral white blood cell count. She also reports
diarrhea. What do you think is causing her illness?

1. Her E. coli is now resistant to ampicillin


2. The initial susceptibilities of her E. coli
were performed incorrectly.
3. She actually initially had a Pseudomonas
aeruginosa infection, since P. aeruginosa
is resistant to ampicillin.
4. She has endocarditis, which responds very
slowly to antibiotics
5. She has Clostridium difficile colitis.
A 55 year-old-man is hospitalized with fevers of
unclear etiology. Blood cultures are drawn, which
soon grow Gram-positive cocci. Which organisms are
you suspicious of?

Staphylococcus aureus
Staphylococcus epidermidis
Streptococcus pyogenes
Streptococcus agalactiae
viridan streptococci
Streptococcus bovis
Streptococcus pneumoniae
Enterococcus faecalis
Enterococcus faecium
The isolate is catalase-negative. Which organisms
are now most likely?

Streptococcus pyogenes
Streptococcus agalactiae
viridan streptococci
Streptococcus bovis
Streptococcus pneumoniae
Enterococcus faecalis
Enterococcus faecium
Following growth on a sheep blood agar plate,
the area around the bacterial colonies are
partially cleared and have a greenish tint. What
is this called?

1. alpha-hemolysis
2. beta-hemolysis
3. gamma-hemolysis
4. delta-hemolysis
5. alpha-omega-alpha

0% 0% 0% 0% 0%

1 2 3 4 5
Following growth on a sheep blood agar plate,
the area around the bacterial colonies are
partially cleared and have a greenish tint. What
is this called?

1. alpha-hemolysis
2. beta-hemolysis
3. gamma-hemolysis
4. delta-hemolysis
5. alpha-omega-alpha
Which bacteria are now most likely?

1. Streptococcus pyogenes
2. Streptococcus agalactiae
3. Streptococcus pneumoniae
4. Enterococcus faecalis
5. Enterococcus faecium

0% 0% 0% 0% 0%

1 2 3 4 5
Which bacteria are now most likely?

1. Streptococcus pyogenes
2. Streptococcus agalactiae
3. Streptococcus pneumoniae (viridans streptococci)
4. Enterococcus faecalis
5. Enterococcus faecium
An optochin-susceptibility test is performed.
The result is negative. Which organism is most
likely now?

1. Streptococcus pyogenes
2. Streptococcus agalactiae
3. Streptococcus pneumoniae
4. Enterococcus faecalis
5. viridans streptococci

0% 0% 0% 0% 0%

1 2 3 4 5
An optochin-susceptibility test is performed.
The result is negative. Which organism is most
likely now?

1. Streptococcus pyogenes
2. Streptococcus agalactiae
3. Streptococcus pneumoniae
4. Enterococcus faecalis
5. viridans streptococci
Hemolysis is sometimes the result of secretion of
pore-forming toxins. Which of the following is
NOT a pore-forming toxin?

1. Streptococcus pyogenes: streptolysin O


(SLO)
2. Listeria monocytogenes: listeriolysin O
3. Streptococcus pneumoniae: pneumolysin
4. Pseudomonas aeruginosa: exotoxin A
5. Staphylococcus aureus: alpha-toxin
(alpha-hemolysin)
0% 0% 0% 0% 0%

1 2 3 4 5
Hemolysis is sometimes the result of secretion of
pore-forming toxins. Which of the following is
NOT a pore-forming toxin?

1. Streptococcus pyogenes: streptolysin O


(SLO)
2. Listeria monocytogenes: listeriolysin O
3. Streptococcus pneumoniae: pneumolysin
4. Pseudomonas aeruginosa: exotoxin A
5. Staphylococcus aureus: alpha-toxin
(alpha-hemolysin)
Upon further questioning, the patient tells you
that he had rheumatic fever as a child and that
a dental procedure preceded the onset of his
fevers. What is your most likely diagnosis?

1. Catheter-related bloodstream infection


2. Pneumonia leading to bacteremia
3. Urinary tract infection leading to
bacteremia
4. Subacute bacterial endocarditis
5. Lab error

0% 0% 0% 0% 0%

1 2 3 4 5
Upon further questioning, the patient tells you
that he had rheumatic fever as a child and that
a dental procedure preceded the onset of his
fevers. What is your most likely diagnosis?

1. Catheter-related bloodstream infection


2. Pneumonia leading to bacteremia
3. Urinary tract infection leading to
bacteremia
4. Subacute bacterial endocarditis
5. Lab error
Name the members of the group of bacteria called the
Enterobacteriaceae.

Escherichia coli
Klebsiella spp.
Proteus mirabilis and P. vulgaris
Enterobacter spp.
Citrobacter spp.
Serratia marcescens
Salmonella enterica and S. typhi
Shigella dysenteriae, S. flexneri, S. boydii, S. sonnei
Yersinia enterocolitica, Y. pseudotuberculosis, and Y. pestis
A 22-year-old man presents to the ER with
fever following a recent hike in the woods. He
reports noting a tick bite. Which of the
following is NOT associated with tick bites?

1. Rickettsia rickettsia
2. Ehrlichia chaffeensis
3. Borrelia burgdorferi
4. Yersinia pestis
5. Francisella tularensis

0% 0% 0% 0% 0%

1 2 3 4 5
A 22-year-old man presents to the ER with
fever following a recent hike in the woods. He
reports noting a tick bite. Which of the
following is NOT associated with tick bites?

1. Rickettsia rickettsia
2. Ehrlichia chaffeensis
3. Borrelia burgdorferi
4. Yersinia pestis
5. Francisella tularensis
On further questioning, he also reports hiking
through a pasture where lambs were being
born. Now what do you suspect?

1. Yersinia pestis
2. Coxiella burnetii
3. Chlamydia psittaci
4. Leptospira interrogans
5. Francisella tularensis

0% 0% 0% 0% 0%

1 2 3 4 5
On further questioning, he also reports hiking
through a pasture where lambs were being
born. Now what do you suspect?

1. Yersinia pestis
2. Coxiella burnetii
3. Chlamydia psittaci
4. Leptospira interrogans
5. Francisella tularensis
He also says that he drank some water from a
livestock drinking tank in the pasture. Now
what do you suspect?

1. Yersinia pestis
2. Bartonella henselae
3. Chlamydia psittaci
4. Leptospira interrogans
5. Francisella tularensis

0% 0% 0% 0% 0%

1 2 3 4 5
He also says that he drank some water from a
livestock drinking tank in the pasture. Now
what do you suspect?

1. Yersinia pestis
2. Bartonella henselae
3. Chlamydia psittaci
4. Leptospira interrogans
5. Francisella tularensis
At the edge of the pasture, he shot a rabbit,
which he later skinned. Now what do you
suspect?

1. Yersinia pestis
2. Bartonella henselae
3. Chlamydia psittaci
4. Pasteurella multocida
5. Francisella tularensis

0% 0% 0% 0% 0%

1 2 3 4 5
At the edge of the pasture, he shot a rabbit,
which he later skinned. Now what do you
suspect?

1. Yersinia pestis
2. Bartonella henselae
3. Chlamydia psittaci
4. Pasteurella multocida
5. Francisella tularensis
While hiking back towards his car, which was
parked at the “four corners” monument, he
noticed some flea bites on his legs. Now what do
you suspect?

1. Yersinia pestis
2. Bartonella henselae
3. Chlamydia psittaci
4. Pasteurella multocida
5. Brucella spp.

0% 0% 0% 0% 0%

1 2 3 4 5
While hiking back towards his car, which was
parked at the “four corners” monument, he
noticed some flea bites on his legs. Now what do
you suspect?

1. Yersinia pestis
2. Bartonella henselae
3. Chlamydia psittaci
4. Pasteurella multocida
5. Brucella spp.
He states that he then drove back home to his
newly acquired pet parrot...

1. Yersinia pestis
2. Bartonella henselae
3. Chlamydia psittaci
4. Pasteurella multocida
5. Brucella spp.

0% 0% 0% 0% 0%

1 2 3 4 5
He states that he then drove back home to his
newly acquired pet parrot...

1. Yersinia pestis
2. Bartonella henselae
3. Chlamydia psittaci
4. Pasteurella multocida
5. Brucella spp.
and kitten, which scratched him...

1. Yersinia pestis
2. Bartonella henselae
3. Mycobacterium marinum
4. Pasteurella multocida
5. Brucella spp.

0% 0% 0% 0% 0%

1 2 3 4 5
and kitten, which scratched him...

1. Yersinia pestis
2. Bartonella henselae
3. Mycobacterium marinum
4. Pasteurella multocida
5. Brucella spp.
and his dog, which bit him.

1. Yersinia pestis
2. Bartonella henselae
3. Mycobacterium marinum
4. Pasteurella multocida
5. Brucella spp.

0% 0% 0% 0% 0%

1 2 3 4 5
and his dog, which bit him.

1. Yersinia pestis
2. Bartonella henselae
3. Mycobacterium marinum
4. Pasteurella multocida
5. Brucella spp.
He then cleaned his acquarium...

1. Clostridium botulinum
2. Bartonella henselae
3. Mycobacterium marinum
4. Pasteurella multocida
5. Brucella spp.

0% 0% 0% 0% 0%

1 2 3 4 5
He then cleaned his acquarium...

1. Clostridium botulinum
2. Bartonella henselae
3. Mycobacterium marinum
4. Pasteurella multocida
5. Brucella spp.
and, before leaving for his veterinarian job, had
a glass of unpasteurized milk...

1. Clostridium botulinum
2. Bartonella henselae
3. Mycobacterium marinum
4. Pasteurella multocida
5. Brucella spp.

0% 0% 0% 0% 0%

1 2 3 4 5
and, before leaving for his veterinarian job, had
a glass of unpasteurized milk...

1. Clostridium botulinum
2. Bartonella henselae
3. Mycobacterium marinum
4. Pasteurella multocida
5. Brucella spp. (Brucella abortus, B.
melitensis, B. suis)
and some home-canned vegetables.

1. Clostridium botulinum
2. Bartonella henselae
3. Mycobacterium marinum
4. Pasteurella multocida
5. Brucella spp.

0% 0% 0% 0% 0%

1 2 3 4 5
and some home-canned vegetables.

1. Clostridium botulinum
2. Bartonella henselae
3. Mycobacterium marinum
4. Pasteurella multocida
5. Brucella spp.
Good luck!

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