Appendix: Tables

OpenStax

Appendix: Tables

Table 1.1: Units of Length Commonly Used in Microbiology
Metric Unit	Meaning of Prefix	Metric Equivalent
meter (m)	—	1 m = 100 cm
decimeter (dm)	1/10	1 dm = 0.1 m = 10⁻¹ m
centimeter (cm)	1/100	1 cm = 0.01 m = 10⁻² m
millimeter (mm)	1/1000	1 mm = 0.001 m = 10⁻³ m
micrometer (μm)	1/1,000,000	1 μm = 0.000001 m = 10⁻⁶ m
nanometer (nm)	1/1,000,000,000	1 nm = 0.000000001 m = 10⁻⁹ m

Table 3.1: Types of Symbiotic Relationships
Type	Population A	Population B
Mutualism	Benefitted	Benefitted
Amensalism	Harmed	Unaffected
Commensalism	Benefitted	Unaffected
Neutralism	Unaffected	Unaffected
Parasitism	Benefitted	Harmed

Table 4.1: The Eukaryote Supergroups and Some Examples
Supergroup	Subgroups	Distinguishing Features	Examples	Clinical Notes
Excavata	Fornicata	Form cysts Pair of equal nuclei No mitochondria Often parasitic Four free flagella	Giardia lamblia	Giardiasis
	Parabasalids	No mitochondria Four free flagella One attached flagellum No cysts Parasitic or symbiotic Basal bodies Kinetoplastids	Trichomonas	Trichomoniasis
	Euglenozoans	Photosynthetic or heterotrophic Flagella	Euglena	N/a
			Trypansoma	African sleeping sickness, Chagas disease
			Leishmania	Leishmaniasis
Chromalveolata	Dinoflagellates	Cellulose theca Two dissimilar flagella	Gonyaulax	Red tides
			Alexandrium	Paralytic shellfish poisoning
			Pfiesteria	Harmful algal blooms
	Apicomplexans	Intracellular parasite Apical organelles	Plasmodium	Malaria
			Cryptosporidium	Cryptosporidiosis
			Theileria (Babesia)	Babesiosis
			Toxoplasma	Toxoplasmosis
	Ciliates	Cilia	Balantidium	Balantidiasis
			Paramecium	N/a
			Stentor	N/a
	Oomycetes/ peronosporomycetes	“Water molds” Generally diploid Cellulose cell walls	Phytophthora	Diseases in crops
Rhizaria	Foraminifera	Amoeboid Threadlike pseudopodia Calcium carbonate shells	Astrolonche	N/a
	Radiolaria	Amoeboid Threadlike pseudopodia Silica shells	Actinomma	N/a
	Cercozoa	Amoeboid Threadlike pseudopodia Complex shells Parasitic forms	Spongospora subterranea	Powdery scab (potato disease)
	Cercozoa		Plasmodiophora brassicae	Cabbage clubroot
Archaeplastida	Red algae	Chlorophyll a Phycoerythrin Phycocyanin Floridean starch Agar in cell walls	Gelidium	Source of agar
	Red algae		Gracilaria	Source of agar
	Chlorophytes	Chlorophyll a Chlorophyll b Cellulose cell walls Starch storage	Acetabularia	N/a
	Chlorophytes		Ulva	N/a
Amoebozoa	Slime molds	Plasmodial and cellular forms	Dictyostelium	N/a
	Entamoebas	Trophozoites Form cysts	Entamoeba	Amoebiasis
			Naegleria	Primary amoebic meningoencephalitis
			Acanthamoeba	Keratitis, granulomatous amoebic encephalitis
Opisthokonta	Fungi	Chitin cell walls Unicellular or multicellular Often hyphae	Zygomycetes	Zygomycosis
			Ascomycetes	Candidiasis
			Basidiomycetes	Cryptococcosis
			Microsporidia	Microsporidiosis
	Animals	Multicellular heterotrophs No cell walls	Nematoda	Trichinosis; hookworm and pinworm infections
			Trematoda	Schistosomiasis
			Cestoda	Tapeworm infections

Table 4.2: Select Groups of Fungi
Group	Characteristics	Examples	Medically Important Species	Organism
Ascomycota	Septate hyphae Ascus with ascospores in ascocarp Conidiospores	Cup fungi Edible mushrooms Morels Truffles Neurospora Penicillium	Aspergillus spp. Trichophyton spp. Microsporum spp. Epidermophyton spp. Blastomyces dermatitidis Histoplasma capsulatum	Aspergillus niger
Basidiomycota	Basidia produce basidiospores in a basidiocarp	Club fungi Rusts Stinkhorns Puffballs Mushrooms Cryptococcus neoformans Amanita phalloides	Crytococcus neoformans	Amanita phalloides
Microsporidia	Lack mitochondria, perioxisomes, centrioles Spores produce a polar tube	Enterocystozoan bieneusi	Enterocystozoan bieneusi	Microsporidia
Zygomycota	Mainly saprophytes Coenocytic hyphae Haploid nuclei Zygospores	Rhizopus stolonifera	Mucor spp.	Rhizopus sp.

Table 5.1: Characteristics of Viruses
Characteristics
Infectious, acellular pathogens
Obligate intracellular parasites with host and cell-type specificity
DNA or RNA genome (never both)
Genome is surrounded by a protein capsid and, in some cases, a phospholipid membrane studded with viral glycoproteins
Lack genes for many products needed for successful reproduction, requiring exploitation of host-cell genomes to reproduce

Table 8.1: Some Genetically Engineered Pharmaceutical Products and Applications
Recombinant DNA Product	Application
Atrial natriuretic peptide	Treatment of heart disease (e.g., congestive heart failure), kidney disease, high blood pressure
DNase	Treatment of viscous lung secretions in cystic fibrosis
Erythropoietin	Treatment of severe anemia with kidney damage
Factor VIII	Treatment of hemophilia
Hepatitis B vaccine	Prevention of hepatitis B infection
Human growth hormone	Treatment of growth hormone deficiency, Turner’s syndrome, burns
Human insulin	Treatment of diabetes
Interferons	Treatment of multiple sclerosis, various cancers (e.g., melanoma), viral infections (e.g., Hepatitis B and C)
Tetracenomycins	Used as antibiotics
Tissue plasminogen activator	Treatment of pulmonary embolism in ischemic stroke, myocardial infarction

Table 9.1: Biosafety Levels. The CDC classifies infectious agents into four biosafety levels based on potential risk to laboratory personnel and the community. Each level requires a progressively greater level of precaution.
Biological Safety Levels	Description	Examples	CDC Classification
BSL-4	Microbes are dangerous and exotic, posing a high risk of aerosol-transmitted infections, which are frequently fatal without treatment or vaccines. Few labs are at this level.	Ebola and Marburg viruses	Maximum
BSL-3	Microbes are indigenous or exotic and cause serious or potentially lethal diseases through respiratory transmission.	Mycobacterium tuberculosis	High
BSL-2	Microbes are typically indigenous and are associated with diseases of varying severity. They pose moderate risk to workers and the environment.	Staphylococcus aureus	Moderate
BSL-1	Microbes are not known to cause disease in healthy hosts and pose minimal risk to workers and the environment.	Nonpathogenic strains of Escherichia coli	Low

Table 9.2: Common Protocols for Control of Microbial Growth
Protocol	Definition	Common Application	Common Agents
For Use on Fomites
Disinfection	Reduces or destroys microbial load of an inanimate item through application of heat or antimicrobial chemicals	Cleaning surfaces like laboratory benches, clinical surfaces, and bathrooms	Chlorine bleach, phenols (e.g., Lysol), glutaraldehyde
Sanitization	Reduces microbial load of an inanimate item to safe public health levels through application of heat or antimicrobial chemicals	Commercial dishwashing of eating utensils, cleaning public restrooms	Detergents containing phosphates (e.g., Finish), industrial-strength cleaners containing quaternary ammonium compounds
Sterilization	Completely eliminates all vegetative cells, endospores, and viruses from an inanimate item	Preparation of surgical equipment and of needles used for injection	Pressurized steam (autoclave), chemicals, radiation
For Use on Living Tissue
Antisepsis	Reduces microbial load on skin or tissue through application of an antimicrobial chemical	Cleaning skin broken due to injury; cleaning skin before surgery	Boric acid, isopropyl alcohol, hydrogen peroxide, iodine (betadine)
Degerming	Reduces microbial load on skin or tissue through gentle to firm scrubbing and the use of mild chemicals	Handwashing	Soap, alcohol swab

Table 10.1: Common Antibacterial Drugs by Mode of Action
Mode of Action	Target	Drug Class
Inhibit cell wall biosynthesis	Penicillin-binding proteins	β-lactams: penicillins, cephalosporins, monobactams, carbapenems
	Peptidoglycan subunits	Glycopeptides
	Peptidoglycan subunit transport	Bacitracin
Inhibit biosynthesis of proteins	30S ribosomal subunit	Aminoglycosides, tetracyclines
Inhibit biosynthesis of proteins	50S ribosomal subunit	Macrolides, lincosamides, chloramphenicol, oxazolidinones
Disrupt membranes	Lipopolysaccharide, inner and outer membranes	Polymyxin B, colistin, daptomycin
Inhibit nucleic acid synthesis	RNA	Rifamycin
Inhibit nucleic acid synthesis	DNA	Fluoroquinolones
Antimetabolites	Folic acid synthesis enzyme	Sulfonamides, trimethoprim
Antimetabolites	Mycolic acid synthesis enzyme	Isonicotinic acid hydrazide
Mycobacterial adenosine triphosphate (ATP) synthase inhibitor	Mycobacterial ATP synthase	Diarylquinoline

Table 10.2: Drugs that Inhibit Bacterial Cell Wall Synthesis
Mechanism of Action	Drug Class	Specific Drugs	Natural or Semisynthetic	Spectrum of Activity
Interact directly with PBPs and inhibit transpeptidase activity	Penicillins	Penicillin G, penicillin V	Natural	Narrow-spectrum against gram-positive and a few gram-negative bacteria
		Ampicillin, amoxicillin	Semisynthetic	Narrow-spectrum against gram-positive bacteria but with increased gram-negative spectrum
		Methicillin	Semisynthetic	Narrow-spectrum against gram-positive bacteria only, including strains producing penicillinase
	Cephalosporins	Cephalosporin C	Natural	Narrow-spectrum similar to penicillin but with increased gram-negative spectrum
		First-generation cephalosporins	Semisynthetic	Narrow-spectrum similar to cephalosporin C
		Second-generation cephalosporins	Semisynthetic	Narrow-spectrum but with increased gram-negative spectrum compared with first generation
		Third- and fourth-generation cephalosporins	Semisynthetic	Broad-spectrum against gram-positive and gram-negative bacteria, including some β-lactamase producers
		Fifth-generation cephalosporins	Semisynthetic	Broad-spectrum against gram-positive and gram-negative bacteria, including MRSA
	Monobactams	Aztreonam	Semisynthetic	Narrow-spectrum against gram-negative bacteria, including some β-lactamase producers
	Carbapenems	Imipenem, meropenem, doripenem	Semisynthetic	Broadest spectrum of the β-lactams against gram-positive and gram-negative bacteria, including many β-lactamase producers
Large molecules that bind to the peptide chain of peptidoglycan subunits, blocking transglycosylation and transpeptidation	Glycopeptides	Vancomycin	Natural	Narrow spectrum against gram-positive bacteria only, including multidrug-resistant strains
Block transport of peptidoglycan subunits across cytoplasmic membrane	Bacitracin	Bacitracin	Natural	Broad-spectrum against gram-positive and gram-negative bacteria

Table 10.3: Drugs That Inhibit Bacterial Protein Synthesis
Molecular Target	Mechanism of Action	Drug Class	Specific Drugs	Bacteriostatic or Bactericidal	Spectrum of Activity
30S subunit	Causes mismatches between codons and anticodons, leading to faulty proteins that insert into and disrupt cytoplasmic membrane	Aminoglycosides	Streptomycin, gentamicin, neomycin, kanamycin	Bactericidal	Broad spectrum
30S subunit	Blocks association of tRNAs with ribosome	Tetracyclines	Tetracycline, doxycycline, tigecycline	Bacteriostatic	Broad spectrum
50S subunit	Blocks peptide bond formation between amino acids	Macrolides	Erythromycin, azithromycin, telithromycin	Bacteriostatic	Broad spectrum
		Lincosamides	Lincomycin, clindamycin	Bacteriostatic	Narrow spectrum
		Not applicable	Chloramphenicol	Bacteriostatic	Broad spectrum
	Interferes with the formation of the initiation complex between 50S and 30S subunits and other factors	Oxazolidinones	Linezolid	Bacteriostatic	Broad spectrum

Table 10.4: Drugs That Inhibit Bacterial Membrane Function
Mechanism of Action	Drug Class	Specific Drugs	Spectrum of Activity	Clinical Use
Interacts with lipopolysaccharide in the outer membrane of gram-negative bacteria, killing the cell through the eventual disruption of the outer membrane and cytoplasmic membrane	Polymyxins	Polymyxin B	Narrow spectrum against gram-negative bacteria, including multidrug-resistant strains	Topical preparations to prevent infections in wounds
		Polymyxin E (colistin)	Narrow spectrum against gram-negative bacteria, including multidrug-resistant strains	Oral dosing to decontaminate bowels to prevent infections in immunocompromised patients or patients undergoing invasive surgery/procedures. Intravenous dosing to treat serious systemic infections caused by multidrug-resistant pathogens
Inserts into the cytoplasmic membrane of gram-positive bacteria, disrupting the membrane and killing the cell	Lipopeptide	Daptomycin	Narrow spectrum against gram-positive bacteria, including	Complicated skin and skin-structure infections and bacteremia caused by gram-positive pathogens, including MRSA

Table 10.5: Drugs That Inhibit Bacterial Nucleic Acid Synthesis
Mechanisms of Action	Drug Class	Specific Drugs	Spectrum of Activity	Clinical Use
Inhibits bacterial RNA polymerase activity and blocks transcription, killing the cell	Rifamycin	Rifampin	Narrow spectrum with activity against gram-positive and limited numbers of gram-negative bacteria. Also active against Mycobacterium tuberculosis.	Combination therapy for treatment of tuberculosis
Inhibits the activity of DNA gyrase and blocks DNA replication, killing the cell	Fluoroquinolones	Ciprofloxacin, ofloxacin, moxifloxacin	Broad spectrum against gram-positive and gram-negative bacteria	Wide variety of skin and systemic infections

Table 10.6: Antimetabolite Drugs
Metabolic Pathway Target	Mechanism of Action	Drug Class	Specific Drugs	Spectrum of Activity
Folic acid synthesis	Inhibits the enzyme involved in production of dihydrofolic acid	Sulfonamides	Sulfamethoxazole	Broad spectrum against gram-positive and gram-negative bacteria
		Sulfones	Dapsone
	Inhibits the enzyme involved in the production of tetrahydrofolic acid	Not applicable	Trimethoprim	Broad spectrum against gram-positive and gram-negative bacteria

Table 10.7: Common Antifungal Drugs
Mechanism of Action	Drug Class	Specific Drugs	Clinical Uses
Inhibit ergosterol synthesis	Imidazoles	Miconazole, ketoconazole, clotrimazole	Fungal skin infections and vaginal yeast infections
	Triazoles	Fluconazole	Systemic yeast infections, oral thrush, and cryptococcal meningitis
	Allylamines	Terbinafine	Dermatophytic skin infections (athlete’s foot, ringworm, jock itch), and infections of fingernails and toenails
Bind ergosterol in the cell membrane and create pores that disrupt the membrane	Polyenes	Nystatin	Used topically for yeast infections of skin, mouth, and vagina; also used for fungal infections of the intestine
	Polyenes	Amphotericin B	Variety of systemic fungal infections
Inhibit cell wall synthesis	Echinocandins	Caspofungin	Aspergillosis and systemic yeast infections
Inhibit cell wall synthesis	Not applicable	Nikkomycin Z	Coccidioidomycosis (Valley fever) and yeast infections
Inhibit microtubules and cell division	Not applicable	Griseofulvin	Dermatophytic skin infections

Table 10.8: Common Antiprotozoan Drugs
Mechanism of Action	Drug Class	Specific Drugs	Clinical Uses
Inhibit electron transport in mitochondria	Naphthoquinone	Atovaquone	Malaria, babesiosis, and toxoplasmosis
Inhibit folic acid synthesis	Not applicable	Proguanil	Combination therapy with atovaquone for malaria treatment and prevention
	Sulfonamide	Sulfadiazine	Malaria and toxoplasmosis
	Not applicable	Pyrimethamine	Combination therapy with sulfadoxine (sulfa drug) for malaria
Produces damaging reactive oxygen species	Not applicable	Artemisinin	Combination therapy to treat malaria
Inhibit DNA synthesis	Nitroimidazoles	Metronidazole, tinidazole	Infections caused by Giardia lamblia, Entamoeba histolytica, and Trichomonas vaginalis
Inhibit DNA synthesis	Not applicable	Pentamidine	African sleeping sickness and leishmaniasis
Inhibit heme detoxification	Quinolines	Chloroquine	Malaria and infections with E. histolytica
Inhibit heme detoxification	Quinolines	Mepacrine, mefloquine	Malaria

Table 10.9: Common Antihelminthic Drugs
Mechanism of Action	Drug Class	Specific Drugs	Clinical Uses
Inhibit microtubule formation, reducing glucose uptake	Benzimidazoles	Mebendazole, albendazole	Variety of helminth infections
Block neuronal transmission, causing paralysis and starvation	Avermectins	Ivermectin	Roundworm diseases, including river blindness and strongyloidiasis, and treatment of parasitic insects
Inhibit ATP production	Not applicable	Niclosamide	Intestinal tapeworm infections
Induce calcium influx	Not applicable	Praziquantel	Schistosomiasis (blood flukes)
Inhibit RNA synthesis	Thioxanthenones	Lucanthone, hycanthone, oxamniquine	Schistosomiasis (blood flukes)

Table 10.10: Common Antiviral Drugs
Mechanism of Action	Drug	Clinical Uses
Nucleoside analog inhibition of nucleic acid synthesis	Acyclovir	Herpes virus infections
	Azidothymidine/zidovudine (AZT)	HIV infections
	Ribavirin	Hepatitis C virus and respiratory syncytial virus infections
	Vidarabine	Herpes virus infections
	Sofosbuvir	Hepatitis C virus infections
Non-nucleoside noncompetitive inhibition	Etravirine	HIV infections
Inhibit escape of virus from endosomes	Amantadine, rimantadine	Infections with influenza virus
Inhibit neuraminidase	Oseltamivir, zanamivir, peramivir	Infections with influenza virus
Inhibit viral uncoating	Pleconaril	Serious enterovirus infections
Inhibition of protease	Ritonavir	HIV infections
Inhibition of protease	Simeprevir	Hepatitis C virus infections
Inhibition of integrase	Raltegravir	HIV infections
Inhibition of membrane fusion	Enfuvirtide	HIV infections

Table 11.:1 Nomenclature of Symptoms
Affix	Meaning	Example
cyto-	cell	cytopenia: reduction in the number of blood cells
hepat-	of the liver	hepatitis: inflammation of the liver
-pathy	disease	neuropathy: a disease affecting nerves
-emia	of the blood	bacteremia: presence of bacteria in blood
-itis	inflammation	colitis: inflammation of the colon
-lysis	destruction	hemolysis: destruction of red blood cells
-oma	tumor	lymphoma: cancer of the lymphatic system
-osis	diseased or abnormal condition	leukocytosis: abnormally high number of white blood cells
-derma	of the skin	keratoderma: a thickening of the skin

Table 11.2: Comparison of Endotoxin and Exotoxins Produced by Bacteria
Characteristic	Endotoxin	Exotoxin
Source	Gram-negative bacteria	Gram-positive (primarily) and gram-negative bacteria
Composition	Lipid A component of lipopolysaccharide	Protein
Effect on host	General systemic symptoms of inflammation and fever	Specific damage to cells dependent upon receptor-mediated targeting of cells and specific mechanisms of action
Heat stability	Heat stable	Most are heat labile, but some are heat stable
LD₅₀	High	Low

Table 12.1: Incidence of Four Notifiable Diseases in the United States, Week Ending January 2, 2016
Disease	Current Week (Jan 2, 2016)	Median of Previous 52 Weeks	Maximum of Previous 52 Weeks	Cumulative Cases 2015
Campylobacteriosis	406	869	1,385	46,618
Chlamydia trachomatis infection	11,024	28,562	31,089	1,425,303
Giardiasis	115	230	335	11,870
Gonorrhea	3,207	7,155	8,283	369,926

Table 12.2: Some Emerging and Reemerging Infectious Diseases
Disease	Pathogen	Year Discovered	Affected Regions	Transmission
AIDS	HIV	1981	Worldwide	Contact with infected body fluids
Chikungunya fever	Chikungunya virus	1952	Africa, Asia, India; spreading to Europe and the Americas	Mosquito-borne
Ebola virus disease	Ebola virus	1976	Central and Western Africa	Contact with infected body fluids
H1N1 Influenza (swine flu)	H1N1 virus	2009	Worldwide	Droplet transmission
Lyme disease	Borrelia burgdorferi bacterium	1981	Northern hemisphere	From mammal reservoirs to humans by tick vectors
West Nile virus disease	West Nile virus	1937	Africa, Australia, Canada to Venezuela, Europe, Middle East, Western Asia	Mosquito-borne

Table 13.1: Defenses Overview
Types of Defenses
Physical defenses	Physical barriers
	Mechanical defenses
	Microbiome
Chemical defenses	Chemicals and enzymes in body fluids
	Antimicrobial peptides
	Plasma protein mediators
	Cytokines
	Inflammation-eliciting mediators
Cellular defenses	Granulocytes
Cellular defenses	Agranulocytes

Table 13.2: Physical Defenses of Nonspecific Innate Immunity
Defense	Examples	Function
Cellular barriers	Skin, mucous membranes, endothelial cells	Deny entry to pathogens
Mechanical defenses	Shedding of skin cells, mucociliary sweeping, peristalsis, flushing action of urine and tears	Remove pathogens from potential sites of infection
Microbiome	Resident bacteria of the skin, upper respiratory tract, gastrointestinal tract, and genitourinary tract	Compete with pathogens for cellular binding sites and nutrients

Table 13.3: Chemical Defenses of Nonspecific Innate Immunity
Defense	Examples	Function
Chemicals and enzymes in body fluids	Sebum from sebaceous glands	Provides oil barrier protecting hair follicle pores from pathogens
	Oleic acid from sebum and skin microbiota	Lowers pH to inhibit pathogens
	Lysozyme in secretions	Kills bacteria by attacking cell wall
	Acid in stomach, urine, and vagina	Inhibits or kills bacteria
	Digestive enzymes and bile	Kill bacteria
	Lactoferrin and transferrin	Bind and sequester iron, inhibiting bacterial growth
	Surfactant in lungs	Kills bacteria
Antimicrobial peptides	Defensins, bacteriocins, dermicidin, cathelicidin, histatins	Kill bacteria by attacking membranes or interfering with cell functions
Plasma protein mediators	Acute-phase proteins (C-reactive protein, serum amyloid A, ferritin, fibrinogen, transferrin, and mannose-binding lectin)	Inhibit the growth of bacteria and assist in the trapping and killing of bacteria
	Complements C3b and C4b	Opsonization of pathogens to aid phagocytosis
	Complement C5a	Chemoattractant for phagocytes
	Complements C3a and C5a	Proinflammatory anaphylatoxins
Cytokines	Interleukins	Stimulate and modulate most functions of immune system
	Chemokines	Recruit white blood cells to infected area
	Interferons	Alert cells to viral infection, induce apoptosis of virus-infected cells, induce antiviral defenses in infected and nearby uninfected cells, stimulate immune cells to attack virus-infected cells
Inflammation-eliciting mediators	Histamine	Promotes vasodilation, bronchoconstriction, smooth muscle contraction, increased secretion and mucus production
	Leukotrienes	Promote inflammation; stronger and longer lasting than histamine
	Prostaglandins	Promote inflammation and fever
	Bradykinin	Increases vasodilation and vascular permeability leading to edema

Table 14.1: The Five Immunoglobulin (Ig) Classes
Properties	IgG monomer	IgM pentamer	Secretory IgA dimer	IgD monomer	IgE monomer
Heavy chains	γ	μ	α	δ	ε
Number of antigen-binding sites	2	10	4	2	2
Molecular weight (Daltons)	150,000	900,000	385,000	180,000	200,000
Percentage of total antibody in serum	80%	6%	13% (monomer)	<1%	<1%
Crosses placenta	yes	no	no	no	no
Fixes complement	yes	yes	no	no	no
Fc binds to	phagocytes	–	–	–	mast cells and basophils
Function	Neutralization, agglutination, complement activation, opsonization, and antibody-dependent cell-mediated cytotoxicity.	Neutralization, agglutination, and complement activation. The monomer form serves as the B-cell receptor.	Neutralization and trapping of pathogens in mucus.	B-cell receptor.	Activation of basophils and mast cells against parasites and allergens.

Table 14.2: Classes of T Cells
Class	Surface CD Molecules	Activation	Functions
Helper T cells	CD4	APCs presenting antigens associated with MHC II	Orchestrate humoral and cellular immunity
Helper T cells	CD4	APCs presenting antigens associated with MHC II	Involved in the activation of macrophages and NK cells
Regulatory T cells	CD4	APCs presenting antigens associated with MHC II	Involved in peripheral tolerance and prevention of autoimmune responses
Cytotoxic T cells	CD8	APCs or infected nucleated cells presenting antigens associated with MHC I	Destroy cells infected with intracellular pathogens

Table 14.3: Subtypes of Helper T Cells
Subtype	Functions
T_H1 cells	Stimulate cytotoxic T cells and produce memory cytotoxic T cells
	Stimulate macrophages and neutrophils (PMNs) for more effective intracellular killing of pathogens
	Stimulate NK cells to kill more effectively
T_H2 cells	Stimulate B cell activation and differentiation into plasma cells and memory B cells
T_H2 cells	Direct antibody class switching in B cells
T_H17 cells	Stimulate immunity to specific infections such as chronic mucocutaneous infections
Memory helper T cells	“Remember” a specific pathogen and mount a strong, rapid secondary response upon re-exposure

Table 14.4: Mechanisms of Acquisition of Immunity
	Natural acquired	Artificial acquired
Passive	Immunity acquired from antibodies passed in breast milk or through placenta	Immunity gained through antibodies harvested from another person or an animal
Active	Immunity gained through illness and recovery	Immunity acquired through a vaccine

Table 14.5: Classes of Vaccines
Class	Description	Advantages	Disadvantages	Examples
Live attenuated	Weakened strain of whole pathogen	Cellular and humoral immunity	Difficult to store and transport	Chickenpox, German measles, measles, mumps, tuberculosis, typhoid fever, yellow fever
		Long-lasting immunity	Risk of infection in immunocompromised patients
		Transmission to contacts	Risk of reversion
Inactivated	Whole pathogen killed or inactivated with heat, chemicals, or radiation	Ease of storage and transport	Weaker immunity (humoral only)	Cholera, hepatitis A, influenza, plague, rabies
Inactivated		No risk of severe active infection	Higher doses and more boosters required	Cholera, hepatitis A, influenza, plague, rabies
Subunit	Immunogenic antigens	Lower risk of side effects	Limited longevity	Anthrax, hepatitis B, influenza, meningitis, papillomavirus, pneumococcal pneumonia, whooping cough
			Multiple doses required
			No protection against antigenic variation
Toxoid	Inactivated bacterial toxin	Humoral immunity to neutralize toxin	Does not prevent infection	Botulism, diphtheria, pertussis, tetanus
Conjugate	Capsule polysaccharide conjugated to protein	T-dependent response to capsule	Costly to produce	Meningitis (Haemophilus influenzae, Streptococcus pneumoniae, Neisseria meningitides)
		T-dependent response to capsule	No protection against antigenic variation
		Better response in young children	May interfere with other vaccines

Table 15.1: Selected Preformed Components of Mast Cell Granules
Granule Component	Activity
Heparin	Stimulates the generation of bradykinin, which causes increased vascular permeability, vasodilation, bronchiole constriction, and increased mucus secretion
Histamine	Causes smooth-muscle contraction, increases vascular permeability, increases mucus and tear formation
Serotonin	Increases vascular permeability, causes vasodilation and smooth-muscle contraction

Table 15.2: Selected Newly Formed Chemical Mediators of Inflammation and Allergic Response
Chemical Mediator	Activity
Leukotriene	Causes smooth-muscle contraction and mucus secretion, increases vascular permeability
Prostaglandin	Causes smooth-muscle contraction and vasodilation
TNF-α (cytokine)	Causes inflammation and stimulates cytokine production by other cell types

Table 15.3: Type I Hypersensitivities
Common Name	Cause	Signs and Symptoms
Allergy-induced asthma	Inhalation of allergens	Constriction of bronchi, labored breathing, coughing, chills, body aches
Anaphylaxis	Systemic reaction to allergens	Hives, itching, swelling of tongue and throat, nausea, vomiting, low blood pressure, shock
Hay fever	Inhalation of mold or pollen	Runny nose, watery eyes, sneezing
Hives (urticaria)	Food or drug allergens, insect stings	Raised, bumpy skin rash with itching; bumps may converge into large raised areas

Table 15.4a: Common Type II Hypersensitivities
Common Name	Cause	Signs and Symptoms
Hemolytic disease of the newborn (HDN)	IgG from mother crosses the placenta, targeting the fetus’ RBCs for destruction	Anemia, edema, enlarged liver or spleen, hydrops (fluid in body cavity), leading to death of newborn in severe cases
Hemolytic transfusion reactions (HTR)	IgG and IgM bind to antigens on transfused RBCs, targeting donor RBCs for destruction	Fever, jaundice, hypotension, disseminated intravascular coagulation, possibly leading to kidney failure and death

Table 15.4b: Blood Type
Red blood cell type	A	B	AB	O
Isohemagglutinins	Anti-B	Anti-A	Neither Anti-A nor Anti-B	Anti-A and Anti-B
Antigens on red blood cell	A antigen	B antigen	A and B antigens	Neither A nor B antigens

Table 15.5: Common Type IV Hypersensitivities
Subcategory	Antigen	Effector Mechanism	Examples
1	Soluble antigen	Activated macrophages damage tissue and promote inflammatory response	Contact dermatitis (e.g., exposure to latex) and delayed-type hypersensitivity (e.g., tuberculin reaction)
2	Soluble antigen	Eosinophil recruitment and activation release cytokines and pro-inflammatory chemicals	Chronic asthma and chronic allergic rhinitis
3	Cell-associated antigen	CTL-mediated cytotoxicity	Contact dermatitis (e.g., contact with poison ivy) and tissue-transplant rejection

Table 15.6: Hypersensitivity Types and Their Mechanisms. Notice that types I–III are B- cell/antibody-mediated hypersensitivities, whereas type IV hypersensitivity is exclusively a T-cell phenomenon.
	Type I	Type II	Type III	Type IV
Immune reactant	IgE	IgG or IgM	IgG and IgM	T cells
Antigen form	Soluble antigen	Cell-bound antigen	Soluble antigen	Soluble or cell-bound antigen
Mechanism of activation	Allergen-specific IgE antibodies bind to mast cells via their Fc receptor. When the specific allergen binds to the IgE, cross-linking of IgE induces degranulation of mast cells.	IgG or IgM antibody binds to cellular antigen, leading to complement activation and cell lysis. IgG can also mediate ADCC with cytotoxic T cells, natural killer cells, macrophages, and neutrophils.	Antigen-antibody complexes are deposited in tissues. Complement activation provides inflammatory mediators and recruits neutrophils. Enzymes released from neutrophils damage tissue.	T_H1 cells secrete cytokines, which activate macrophages and cytotoxic T cells.
Examples of hypersensitivity reactions	Local and systemic anaphylaxis, seasonal hay fever, food allergies, and drug allergies	Red blood cell destruction after transfusion with mismatched blood types or during hemolytic disease of the newborn.	Post-streptococcal glomerulonephritis, rheumatoid arthritis, and systemic lupus erythematosus	Contact dermatitis, type I diabetes mellitus, and multiple sclerosis

Table 15.7: Select Autoimmune Diseases
Disease	Cause	Signs and Symptoms
Addison disease	Destruction of adrenal gland cells by cytotoxic T cells	Weakness, nausea, hypotension, fatigue; adrenal crisis with severe pain in abdomen, lower back, and legs; circulatory system collapse, kidney failure
Celiac disease	Antibodies to gluten become autoantibodies that target cells of the small intestine	Severe diarrhea, abdominal pain, anemia, malnutrition
Diabetes mellitus (type I)	Cytotoxic T-cell destruction of the insulin-producing β cells of the pancreas	Hyperglycemia, extreme increase in thirst and urination, weight loss, extreme fatigue
Multiple sclerosis (MS)	Cytotoxic T-cell destruction of the myelin sheath surrounding nerve axons in the central nervous system	Visual disturbances, muscle weakness, impaired coordination and balance, numbness, prickling or “pins and needles” sensations, impaired cognitive function and memory
Myasthenia gravis	Autoantibodies directed against acetylcholine receptors within the neuromuscular junction	Extreme muscle weakness eventually leading to fatal respiratory arrest
Psoriasis	Cytokine activation of keratinocytes causes rapid and excessive epidermal cell turnover	Itchy or sore patches of thick, red skin with silvery scales; commonly affects elbows, knees, scalp, back, face, palms, feet
Rheumatoid arthritis	Autoantibodies, immune complexes, complement activation, phagocytes, and T cells damage membranes and bone in joints	Joint inflammation, pain and disfigurement, chronic systemic inflammation
Systemic lupus erythematosus (SLE)	Autoantibodies directed against nuclear and cytoplasmic molecules form immune complexes that deposit in tissues. Phagocytic cells and complement activation cause tissue damage and inflammation	Fatigue, fever, joint pain and swelling, hair loss, anemia, clotting, a sunlight-sensitive “butterfly” rash, skin lesions, photosensitivity, decreased kidney function, memory loss, confusion, depression

Table 16.1: Some Medical Terms Associated with Skin Lesions and Rashes
Term	Definition
abscess	localized collection of pus
bulla (pl., bullae)	fluid-filled blister no more than 5 mm in diameter
carbuncle	deep, pus-filled abscess generally formed from multiple furuncles
crust	dried fluids from a lesion on the surface of the skin
cyst	encapsulated sac filled with fluid, semi-solid matter, or gas, typically located just below the upper layers of skin
folliculitis	a localized rash due to inflammation of hair follicles
furuncle (boil)	pus-filled abscess due to infection of a hair follicle
macules	smooth spots of discoloration on the skin
papules	small raised bumps on the skin
pseudocyst	lesion that resembles a cyst but with a less defined boundary
purulent	pus-producing; suppurative
pustules	fluid- or pus-filled bumps on the skin
pyoderma	any suppurative (pus-producing) infection of the skin
suppurative	producing pus; purulent
ulcer	break in the skin; open sore
vesicle	small, fluid-filled lesion
wheal	swollen, inflamed skin that itches or burns, such as from an insect bite

Table 16.2: Bacterial Infections of the Skin
Disease	Pathogen	Signs and Symptoms	Transmission	Antimicrobial Drugs
Acne	Propionibacterium acnes	Comedones (whiteheads, blackheads); papules, pustules, nodules, or pseudocysts	Not transmissible; clogged pores become infected by normal skin microbiota (P. acnes)	Erythromycin, clindamycin
Anthrax (cutaneous)	Bacillus anthracis	Eschar at site of infection; may lead to septicemia and can be fatal	Entry of B. anthracis endospores through cut or abrasion	Penicillin, erythromycin, or tetracycline
Cellulitis	Streptococcus pyogenes	Localized inflammation of dermis and hypodermis; skin red, warm, and painful to the touch	Entry of S. pyogenes through cut or abrasion	Oral or intravenous antibiotics (e.g., penicillin)
Erysipelas	S. pyogenes	Inflamed, swollen patch of skin, often on face; may be suppurative	Entry of S. pyogenes through cut or abrasion	Oral or intravenous antibiotics (e.g., penicillin)
Erythema nodosum	S. pyogenes	Small red nodules, often on shins	Associated with other streptococcal infection	None or anti-inflammatory drugs for severe cases
Impetigo	Staphylococcus aureus, S. pyogenes	Vesicles, pustules, and sometimes bullae around nose and mouth	Highly contagious, especially via contact	Topical or oral antibiotics
Necrotizing fasciitis	S. pyogenes, Klebsiella, Clostridium, others	Infection of fascia and rapidly spreading tissue death; can lead to septic shock and death	Entry of bacteria through cut or abrasion	Intravenous broad-spectrum antibiotics
Staphylococcal scalded skin syndrome (SSSS)	S. aureus	Erythema and severe peeling of skin	Infection of skin and mucous membranes, especially in children	Intravenous antibiotics, fluid therapy

Table 16.3: Bacterial Infections of the Eyes
Disease	Pathogen	Signs and Symptoms	Transmission	Antimicrobial Drugs
Acute bacterial conjunctivitis	Haemophilus influenzae	Inflammation of conjunctiva with purulent discharge	Exposure to secretions from infected individuals	Broad-spectrum topical antibiotics

Table 16.4: Viral Infections of the Skin and Eyes
Disease	Pathogen	Signs and Symptoms	Transmission	Antimicrobial Drugs
Oral herpes	Herpes simplex virus 1 (HSV-1)	May cause initial systemic symptoms; cold sores	Highly contagious via direct contact with infected individuals	Acyclovir, penciclovir, famciclovir, valacyclovir
Papillomas	Human papillomavirus (HPV)	Common warts, plantar warts, flat warts, filiform warts, and others	Contact with infected individuals	Topical salicylic acid, cantharidin

Table 16.5: Some Common Tineas and Location on the Body
Type of Tinea	Location on the Body
Tinea corporis (ringworm)	Body
Tinea capitis (ringworm)	Scalp
Tinea pedis (athlete’s foot)	Feet
Tinea barbae (barber’s itch)	Beard
Tinea cruris (jock itch)	Groin
Tinea unguium (onychomycosis)	Toenails, fingernails

Table 16.6: Mycoses of the Skin
Disease	Pathogen	Signs and Symptoms	Transmission	Antimicrobial Drugs
Tineas	Trichophyton spp., Epidermophyton spp., Microsporum spp.	Itchy, ring-like lesions (ringworm) at sites of infection	Contact with dermatophytic fungi, especially in warm, moist environments conducive to fungal growth	Terbinafine, miconazole, clotrimazole, griseofulvin

Table 16.7: Parasitic Skin and Eye Infections
Disease	Pathogen	Signs and Symptoms	Transmission	Antimicrobial Drugs
Loiasis	Loa loa	Recurring fever and localized Calabar swelling, itching, and skin or eye pain during subcutaneous migration of worms	Larvae transmitted between humans by deerfly vector	Diethylcarbamazine, albendazole

Table 17.1: Respiratory Pathogens and Their Vaccines
Disease	Pathogen	Available Vaccine(s)^[1]
Chickenpox/shingles	Varicella-zoster virus	Varicella (chickenpox) vaccine, herpes zoster (shingles) vaccine
Common cold	Rhinovirus	None
Diphtheria	Corynebacterium diphtheriae	DtaP, Tdap, DT, Td, DTP
Epiglottitis, otitis media	Haemophilus influenzae	Hib
Influenza	Influenza viruses	Inactivated, FluMist
Measles	Measles virus	MMR
Pertussis	Bordetella pertussis	DTaP, Tdap
Pneumonia	Streptococcus pneumoniae	Pneumococcal conjugate vaccine (PCV13), pneumococcal polysaccharide vaccine (PPSV23)
Rubella (German measles)	Rubella virus	MMR
Severe acute respiratory syndrome (SARS)	SARS-associated coronavirus (SARS-CoV)	None
Tuberculosis	Mycobacterium tuberculosis	BCG

Table 17.2: Bacterial Infections of the Respiratory Tract
Disease	Pathogen	Signs and Symptoms	Transmission	Diagnostic Tests	Antimicrobial Drugs	Vaccine
Acute otitis media (AOM)	Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis, others	Earache, possible effusion; may cause fever, nausea, vomiting, diarrhea	Often a secondary infection; bacteria from respiratory tract become trapped in eustachian tube, cause infection	None	Cephalosporins, fluoroquinolones	None
Pertussis (whooping cough)	Bordetella pertussis	Severe coughing with “whoop” sound; chronic cough lasting several months; can be fatal in infants	Inhalation of respiratory droplets from infected person	Direct culture of throat swab, PCR, ELISA	Macrolides	DTaP, Tdap
Streptococcal pharyngitis, scarlet fever	Streptococcus pyogenes	Fever, sore throat, inflammation of pharynx and tonsils, petechiae, swollen lymph nodes; skin rash (scarlet fever), strawberry tongue	Direct contact, inhalation of respiratory droplets or aerosols from infected person	Direct culture of throat swab, rapid enzyme immunoassay	β-lactams	None
Tuberculosis	Mycobacterium tuberculosis	Formation of tubercles in lungs; rupture of tubercles, leading to chronic, bloody cough; healed tubercles (Ghon complexes) visible in radiographs; can be fatal	Inhalation of respiratory droplets or aerosols from infected person	Mantoux tuberculin skin test with chest radiograph to identify Ghon complexes	Isoniazid, rifampin, ethambutol, pyrazinamide	BCG

Table 17.3: Bacterial Causes of Pneumonia
Disease	Pathogen	Signs and Symptoms	Transmission	Diagnostic Tests	Antimicrobial Drugs	Vaccine
Haemophilus pneumonia	Haemophilus influenzae	Cough, fever or low body temperature, chills, chest pain, headache, fatigue	Inhalation of respiratory droplets or aerosols from infected person or asymptomatic carrier	Culture on chocolate agar, serotyping of blood or cerebrospinal fluid samples	Cephalosporins, fluoroquinolones	Hib
Mycoplasma pneumonia (walking pneumonia)	Mycoplasma pneumoniae	Low fever, persistent cough	Inhalation of respiratory droplets or aerosols from infected person	Culture with penicillin, thallium acetate	Macrolides	None
Pneumococcal pneumonia	Streptococcus pneumoniae	Productive cough, bloody sputum, fever, chills, chest pain, respiratory distress	Direct contact with respiratory secretions	Gram stain, blood agar culture with optichin and sodium deoxycholate, quellung reaction	β-lactams, macrolides, fluoroquinolones	Pneumococcal conjugate vaccine (PCV13), pneumococcal polysaccharide vaccine (PPSV23)

Table 17.4: Comparing the Common Cold and Influenza
Sign/Symptom	Common Cold	Influenza
Fever	Low (37.2 °C [99 °F])	High (39 °C [102.2 °F])
Headache	Common	Common
Aches and pains	Mild	Severe
Fatigue	Slight	Severe
Nasal congestion	Common	Rare
Sneezing	Common	Rare

Table 17.5: Different Types of Influenza
	Influenza A virus	Influenza B virus	Influenza C virus
Severity	Severe	Moderate	Mild
Animal reservoir	Yes	No	No
Genome segments	8	8	7
Population spread	Epidemic and pandemic	Epidemic	Sporadic
Antigenic variation	Shift/drift	Drift	Drift

Table 17.6: Viral Infections of the Respiratory Tract
Disease	Pathogen	Signs and Symptoms	Transmission	Vaccine
Chickenpox (varicella)	Varicella-zoster virus	In children, fever, chills, pustular rash of lesions that burst and form crusty scabs; in adults, more severe symptoms and complications (e.g., pneumonia)	Highly contagious via contact with aerosols, particles, or droplets from infected individual’s blisters or respiratory secretions	Varicella (chickenpox) vaccine
Common cold	Rhinoviruses, adenoviruses, coronaviruses, others	Runny nose, congestion, sore throat, sneezing, headaches and muscle aches; may lead to otitis media, pharyngitis, laryngitis	Highly contagious via contact with respiratory secretions or inhalation of droplets or aerosols	None
Influenza	Influenza viruses A, B, C	Fever, chills, headaches, body aches, fatigue; may lead to pneumonia or complications such as Reye syndrome. Highly virulent strains may cause lethal complications	Highly contagious between humans via contact with respiratory secretions or inhalation of droplets or aerosols. Influenza A virus can be transmitted from animal reservoirs.	Vaccines developed yearly against most prevalent strains
Measles	Measles virus (MeV)	High fever, conjunctivitis, sore throat, macular rash becoming confluent, Koplik’s spots on oral mucosa; in severe cases, can lead to fatal pneumonia or encephalitis, especially in children	Highly contagious via contact with respiratory secretions, skin rash, or eye secretions of infected individual	MMR
Shingles	Varicella-zoster virus	Painful lesions on face or trunk lasting several weeks; may cause postherpetic neuralgia (chronic pain) or spread to organs in severe cases	Nontransmissible; occurs when dormant virus is reactivated, generally many years after initial chicken-pox infection	Herpes zoster (shingles) vaccine

Table 18.1: Bacterial Infections of the Reproductive Tract
Disease	Pathogen	Signs and Symptoms	Transmission	Diagnostic Tests	Antimicrobial Drugs
Bacterial vaginosis (BV)	Gardnerella vaginalis, Bacteroides spp., Fusobacterium spp., others	Often asymptomatic; vaginal discharge, burning, odor, or itching	Opportunistic infection caused by imbalance of normal vaginal microbiota	Vaginal smear	Clindamycin, metronidazole, tinidazole
Chlamydia	Chlamydia trachomatis	Often asymptomatic; in men, urethritis, epididymitis, orchitis; in women, urethritis, vaginal discharge or bleeding, pelvic inflammatory disease, salpingitis, increased risk of cervical cancer	Sexual contact or from mother to neonate during birth	NAAT, urine sample, vaginal swab, culture	Azithromycin, doxycycline, erythromycin, ofloxacin, or levofloxacin
Gonorrhea	Neisseria gonorrhoeae	Urethritis, dysuria, penile or vaginal discharge, rectal pain and bleeding; in females, pelvic pain, intermenstrual bleeding, pelvic inflammatory disease, salpingitis, increased risk of infertility or ectopic pregnancy; in disseminated infections, arthritis, endocarditis, meningitis	Sexual contact	Urine sample or culture, NAAT, PCR, ELISA	Ceftriaxone, azithromycin

Table 18.2: Viral Infections of the Reproductive Tract
Disease	Pathogen	Signs and Symptoms	Transmission	Diagnostic Tests	Antimicrobial Drugs/Vaccines
Genital herpes	Herpes simplex virus (HSV-1 or HSV-2)	Recurring outbreaks of skin vesicles on genitalia and elsewhere; asymptomatic in many individuals	Sexual contact or contact with open lesions	Viral culture, PCR, ELISA	Acyclovir, famciclovir, valacyclovir
Human papillomas	Human papillomavirus (HPV) (various strains)	Genital warts or warts in other areas	Direct contact, including sexual	Pap smear	Imiquimod, podofilox, sinecatechins

Table 18.3: Fungal and Protozoan Infections of the Reproductive Tract
Disease	Pathogen	Signs and Symptoms	Transmission	Diagnostic Tests	Antimicrobial Drugs
Trichomoniasis	Trichomonas vaginalis	Urethritis, vaginal or penile discharge; redness or soreness of female genitalia	Sexual contact	Wet mounts, NAAT of urine or vaginal samples; OSOM Trichomonas Rapid Test, Affirm VPII Microbial Identification Test	Metronidazole, tinidazole
Vaginal candidiasis (yeast infection)	Candida spp., especially C. albicans	Dysuria; vaginal burning, itching, discharge	Transmissible by sexual contact, but typically only causes opportunistic infections after immunosuppression or disruption of vaginal microbiota	Culture, Affirm VPII Microbial Identification Test	Fluconazole, miconazole, clotrimazole, tioconazole, nystatin

Table 19.1: Oral Infections
Disease	Pathogen	Signs and Symptoms	Transmission	Diagnostic Tests	Antimicrobial Drugs
Dental caries	Streptococcus mutans	Discoloration, softening, cavities in teeth	Non-transmissible; caused by bacteria of the normal oral microbiota	Visual examinations, X-rays	Oral antiseptics (e.g., Listerine)

Table 19.2: Some Pathogenic Groups of *E. coli*
Group	Virulence Factors and Genes	Signs and Symptoms	Diagnostic Tests	Treatment
Enterotoxigenic E. coli (ETEC)	Heat stable enterotoxin similar to cholera toxin	Relatively mild, watery diarrhea	Culturing, PCR	Self-limiting; if needed, fluoroquinolones, doxycycline, rifaximin, TMP/SMZ; antibiotic resistance is a problem
Enteroinvasive E. coli (EIEC)	Inv (invasive plasmid) genes	Relatively mild, watery diarrhea; dysentery or inflammatory colitis may occur	Culturing, PCR; testing for inv gene; additional assays to distinguish from Shigella	Supportive therapy only; antibiotics not recommended
Enteropathogenic E. coli (EPEC)	Locus of enterocyte effacement (LEE) pathogenicity island	Severe fever, vomiting, nonbloody diarrhea, dehydration; potentially fatal	Culturing, PCR; detection of LEE lacking Shiga-like toxin genes	Self-limiting; if needed, fluoroquinolones, doxycycline, rifaximin, TMP/SMZ; antibiotic resistance is a problem
Enterohemorrhagic E. coli (EHEC)	Verotoxin	May be mild or very severe; bloody diarrhea; may result in HUS	Culturing; plate on MacConkey agar with sorbitol agar as it does not ferment sorbitol; PCR detection of LEE containing Shiga-like toxin genes	Antibiotics are not recommended due to the risk of HUS

Table 19.3: Bacterial Infections of the GI Tract
Disease	Pathogen	Signs and Symptoms	Transmission	Diagnostic Tests	Antimicrobial Drugs
Cholera	Vibrio cholerae	Severe diarrhea and fluid loss, potentially leading to shock, renal failure, and death	Ingestion of contaminated water or food	Culture on selective medium (TCBS agar); distinguished as oxidase positive with fermentative metabolisms	Generally none; tetracyclines, azithromycin, others if necessary
Clostridium difficile infection	Clostridium difficile	Pseudomembranous colitis, watery diarrhea, fever, abdominal pain, loss of appetite, dehydration; in severe cases, perforation of the colon, septicemia, shock, and death	Overgrowth of C. difficile in the normal microbiota due to antibiotic use; hospital-acquired infections in immunocompromised patients	Detection of toxin in stool, nucleic acid amplification tests (e.g., PCR)	Discontinuation of previous antibiotic treatment; metronidazole or vancomycin
E. coli infection	ETEC, EPEC, EIEC, EHEC	Watery diarrhea, dysentery, cramps, malaise, fever, chills, dehydration; in EHEC, possible severe complications such as hematolytic uremic syndrome	Ingestion of contaminated food or water	Tissue culture, immunochemical assays, PCR, gene probes	Not recommended for EIEC and EHEC; fluoroquinolones, doxycycline, rifaximin, and TMP/SMZ possible for ETEC and EPEC
Peptic ulcers	Helicobacter pylori	Nausea, bloating, burping, lack of appetite, weight loss, perforation of stomach, blood in stools	Normal flora, can also be acquired via saliva; fecal-oral route via contaminated food and water	Breath test, detection of antibodies in blood, detection of bacteria in stool sample or stomach biopsy	Amoxicillin, clarithromycin metronidazole, tetracycline, lansoprazole; antacids may also be given in combination with antibiotics
Staphylococcal food poisoning	Staphylococcus aureus	Rapid-onset nausea, diarrhea, vomiting lasting 24–48 hours; possible dehydration and change in blood pressure and heart rate	Ingestion of raw or undercooked meat or dairy products contaminated with staphylococcal enterotoxins	ELISA to detect enterotoxins in uneaten food, stool, or vomitus	None

Table 19.4: Viral Causes of Gastroenteritis
Disease	Pathogen	Signs and Symptoms	Transmission	Diagnostic Tests	Vaccine
Norovirus gastroenteritis	Noroviruses	Fever, diarrhea, projectile vomiting, dehydration; generally self-limiting within two days	Highly contagious via direct contact or contact with contaminated food or fomites	Rapid enzyme immunoassay confirmed with RT-qPCR	None
Rotavirus gastroenteritis	Rotaviruses	Fever, diarrhea, vomiting, severe dehydration; recurring infections can lead to malnutrition and death	Fecal-oral route; children and elderly most susceptible	Enzyme immunoassay of stool sample, latex agglutination assays, RT-PCR	Preventive vaccine recommended for infants

Table 19.5: Protozoan Infections of the GI Tract
Disease	Pathogen	Signs and Symptoms	Transmission	Diagnostic Tests	Antimicrobial Drugs
Giardiasis	Giardia lamblia	Diarrhea, nausea, stomach cramps, gas, greasy stool, dehydration if severe; sometimes malabsorption syndrome	Contact with infected individual or contaminated fomites; ingestion of contaminated food or water	Stool O&P exam; ELISA, direct fluorescence antibody assays	Metronidazole, tinidazole

Table 19.6: Helminthic Infections of the GI Tract
Disease	Pathogen	Signs and Symptoms	Transmission	Diagnostic Tests	Antimicrobial Drugs
Ascariasis	Ascaris lumbricoides	Eggs in fecally contaminated food or water	Microscopic examination of the stool, imaging	Shortness of breath, cough, nausea, diarrhea, blood in stool, abdominal pain, weight loss, fatigue	Self-limiting within 1 to 2 years; albendazole and mebendazole if needed
Enterobiasis (pinworm)	Enterobius vermicularis	Fecal–oral route	Observation of eggs or worms from anal area; examination of samples under fingernails	Itching around the anus, abdominal pain, insomnia, irritation of female genital tract	Mebendazole, albendazole, pyrantel pamoate
Strongyloidiasis	Strongyloides stercoralis	Often asymptomatic; cough (sometimes bloody), skin rash, abdominal pain, diarrhea; in immunosuppressed patients, may become disseminated, causing serious and potentially fatal complications	Soil-dwelling larvae penetrate the skin, usually bare feet	Microscopic observation of larvae in stool; serological testing for antigens	Ivermectin, albendazole
Tapeworms (taeniasis)	Taenia solium, T. saginata, T. asiatica, Diphyllobothrium latum	Asymptomatic or mild GI distress; cysts in muscle, eye, or brain (cysticercosis); brain cysts can cause headaches, seizures, or death	Ingestion of raw or undercooked pork or beef from infected animal	Observation of worm segments or microscopic eggs in stool; CT or MRI to detect cysts	Praziquantel, niclosamide
Trichinosis	Trichinella spiralis, other Trichinella spp.	Diarrhea, constipation, abdominal pain, headache, cough, chills, light sensitivity, muscle pain, fever, conjunctivitis; in severe cases may affect motor coordination, breathing, heart function	Ingestion of raw or undercooked pork or other meat of infected animal	Observation of cysts in muscle biopsy, enzyme immunoassay	Albendazole, mebendazole
Whipworm (trichuriasis)	Trichuris trichiura	Abdominal pain, anemia, diarrhea (possibly bloody), rectal prolapse	Ingestion of eggs in fecally contaminated food	Microscopic observation of eggs in stool	Albendazole, mebendazole, ivermectin

Table 20.1: Bacterial Infections of the Circulatory and Lymphatic Systems.
Disease	Pathogen	Signs and Symptoms	Transmission	Diagnostic Tests	Antimicrobial Drugs
Lyme disease	Borrelia burgdorferi	Early localized: bull’s eye rash, malaise, headache, fever, muscle stiffness; early disseminated: stiff neck, facial paralysis, arthritis, carditis; late-stage: arthritis, meningitis, possibly fatal	From deer, rodent, bird reservoirs via tick vector	IFA, serology, and ELISA	Amoxicillin, doxycycline, penicillin G, chloramphenicol, ceftriaxone
Plague	Yersinia pestis	Bubonic: buboes, fever, internal hemorrhaging; septicemic: fever, abdominal pain, shock, DIC, necrosis in extremities; pneumonic: acute pneumonia, respiratory failure, shock. All forms have high mortality rates.	Transmitted from mammal reservoirs via flea vectors or consumption of infected animal; transmission of pneumonic plague between humans via respiratory aerosols	Culture of bacteria from lymph, blood, or sputum samples; DFA, ELISA	Gentamycin, fluoroquinolones, others

Table 20.2: Viral Diseases of the Circulatory and Lymphatic Systems.
Disease	Pathogen	Signs and Symptoms	Transmission	Diagnostic Tests	Antimicrobial Drugs
AIDS/HIV infection	Human immunodeficiency virus (HIV)	Flu-like symptoms during acute stage, followed by long period of clinical latency; final stage (AIDS) includes fever, weight loss, wasting syndrome, dementia, and opportunistic secondary infections leading to death	Contact with body fluids (e.g., sexual contact, use of contaminated needles)	Serological tests for antibodies and/or HIV antigens; nucleic acid test (NAT) for presence of virus	Antiretroviral therapy (ART) using various combinations of drugs
Burkitt lymphoma	Epstein-barr virus (human herpesvirus-4 [HHV-4])	Rapid formation of malignant B-cell tumors, oral hairy leukoplakia; fatal if not promptly treated	Contact with body fluids (e.g., saliva, blood, semen); primarily affects patients immune-compromised by HIV or malaria	CT scans, tumor biopsy	Intensive alternating chemotherapy regimen
Ebola virus disease (EVD)	Ebola virus	Fever, headache, joint pain, diarrhea, vomiting, hemorrhaging in gastrointestinal tract, organ failure; often fatal	Contact with body fluids (e.g., blood, saliva, sweat, urine, feces, vomit); highly contagious	ELISA, IgM ELISA, PCR, virus isolation	None
Infectious mononucleosis	Epstein-Barr Virus (HHV-4), cytomegalovirus (HHV-5)	Pharyngitis, fever, extreme fatigue; swelling of lymph nodes, spleen, and liver	Contact with body fluids (e.g., saliva, blood, semen)	Tests for antibodies to various EBV-associated antigens	None

Table 20.3: Parasitic Diseases of the Circulatory and Lymphatic Systems.
Disease	Pathogen	Signs and Symptoms	Transmission	Diagnostic Tests	Antimicrobial Drugs
Protozoa
Malaria	Plasmodium vivax, P. malariae, P. falciparum, P. ovale, P. knowlesi	Extreme fever, chills, myalgia, nausea, and vomiting, possibly leading to organ failure and death	Between humans via Anopheles mosquito vectors	Blood smear, EIA	Chloroquine, atovaquone, artemether, and lumefantrine
Toxoplasmosis	Toxoplasma gondii	Tissue cysts; in pregnant women, birth defects or miscarriage	Contact with feces of infected cat; eating contaminated vegetables or undercooked meat of infected animal	Serological tests, direct detection of pathogen in tissue sections	Sulfadiazine, pyrimethamine, spiramycin

Table 21.1: Bacterial Infections of the Nervous System.
Disease	Pathogen	Signs and Symptoms	Transmission	Antimicrobial Drugs	Vaccine
Botulism	Clostridium botulinum	Blurred vision, drooping eyelids, difficulty swallowing and breathing, nausea, vomiting, often fatal	Ingestion of preformed toxin in food, ingestion of endospores in food by infants or immunocompromised adults, bacterium introduced via wound or injection	Antitoxin; penicillin (for wound botulism)	None
Haemophilus influenzae type b meningitis	Haemophilus influenzae	Nausea, vomiting, photophobia, stiff neck, confusion	Direct contact, inhalation of aerosols	Doxycycline, fluoroquinolones, second- and third-generation cephalosporins, and carbapenems	Hib vaccine
Listeriosis	Listeria monocytogenes	Initial flu-like symptoms, sepsis and potentially fatal meningitis in susceptible individuals, miscarriage in pregnant women	Bacterium ingested with contaminated food or water	Ampicillin, gentamicin	None
Meningococcal meningitis	Neisseria meningitidis	Nausea, vomiting, photophobia, stiff neck, confusion; often fatal	Direct contact	Cephalosporins or penicillins	Meningococcal conjugate
Neonatal meningitis	Streptococcus agalactiae	Temperature instability, apnea, bradycardia, hypotension, feeding difficulty, irritability, limpness, seizures, bulging fontanel, stiff neck, opisthotonos, hemiparesis, often fatal	Direct contact in birth canal	Ampicillin plus gentamicin, cefotaxime, or both	None
Pneumococcal meningitis	Streptococcus pneumoniae	Nausea, vomiting, photophobia, stiff neck, confusion, often fatal	Direct contact, aerosols	Cephalosporins, penicillin	Pneumococcal vaccines
Tetanus	Clostridium tetani	Progressive spasmatic paralysis starting with the jaw, often fatal	Bacterium introduced in puncture wound	Penicillin, antitoxin	DTaP, Tdap

Table 21.2: Acellular Infections of the Nervous System.
Disease	Pathogen	Signs and Symptoms	Transmission	Diagnostic Tests	Antimicrobial Drugs	Vaccine
Creutzfeldt-Jacob Disease and other TSEs	Prions	Memory loss, confusion, blurred vision, uncoordinated movement, insomnia, coma, death	Exposure to infected nerve tissue via consumption or transplant, inherited	Tissue biopsy	None	None
Poliomyelitis	Poliovirus	Asymptomatic or mild nausea, fever, headache in most cases; in neurological infections, flaccid paralysis and potentially fatal respiratory paralysis	Fecal-oral route or contact with droplets or aerosols	Culture of poliovirus, PCR	None	Attenuated vaccine (Sabin), killed vaccine (Salk)
Rabies	Rabies virus (RV)	Fever, headaches, hyperactivity, hydrophobia, excessive salivation, terrors, confusion, spreading paralysis, coma, always fatal if not promptly treated	From bite of infected mammal	Viral antigen in tissue, antibodies to virus	Attenuated vaccine, rabies immunoglobulin	Attenuated vaccine
Zika virus infection	Zika virus	Fever, rash, conjunctivitis; in pregnant women, can cause fetal brain damage and microcephaly	Between humans by Aedes spp. mosquito vectors, also may be transmitted sexually or via blood transfusion	Zika virus RNA assay, Trioplex RT-PCR, Zika MAC-ELISA test	None	None

Full names of vaccines listed in table: Haemophilus influenzae type B (Hib); Diphtheria, tetanus, and acellular pertussis (DtaP); tetanus, diphtheria, and acellular pertussis (Tdap); diphtheria and tetanus (DT); tetanus and diphtheria (Td); diphtheria, pertussis, and tetanus (DTP); Bacillus Calmette-Guérin; Measles, mumps, rubella (MMR) ↵

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