A1262163605JXUzR

1
Bacterial Diseases
of Man
2
Bacterial Diseases of the Skin

• Boils, pimples, abscess, acne (p. 582)
• Impetigo (p. 585)
• Pseudomonas Infections (p. 586)

3
Boils, pimples, abscesses

• Staphylococcus aureus and epidermidis
• Gram coccus,
• b-hemolytic, catalase coagulase positive
• Leukotoxin
• Can develop into bacteremia
• Toxic Shock Syndrome

4
Impetigo

• Streptococcus pyogenes
• Gram cocci, chains
• b-hemolytic, M protein Anti-phagocytic,
• streptokinase dissolves blood clots, heart
  attacks
• hyaluronidase- dissolves tissue cement

5
Pseudomonas Infections

• Pseudomonas aeruginosa
• Gram aerobic, rod
• Produces pyocyanin green toxin, kills cells.
• Co-infection with C. perfringins can lead to gas
  gangrene.
• Opportunistic pathogen for burn patients.
• Resistant to many antibiotics
• Rx fluoroquinolones

6
Acne

• Propionibacter acnes
• Diphtheroid, anaerobe
• Gram rod,
• 17 million cases
• Breaks down sebum to glycerol for energy
  metabolism.
• OTC- benzoyl peroxide
• Rx tetracycline, doxycycline, Retin A, accutane
  (reduces sebum)

7
Bacterial Diseases of the Nervous System

• Bacterial meningitis (p.603)
• Other meningitis (p.604)
• Listerosis (p.606)
• Tetanus (p. 607)
• Botulism (p.608)
• Leprosy (p.610)

8
Bacterial Meningitis

• Hemophilus influenzae
• Gram rod, aerobe
• Oral- air borne transmission
• Part of normal flora
• Esp. common in young children
• Starts as sore throat, to blood, and then to CNS.
• In blood bacteremia, sepsis
• Inflames meninges- fever, severe headache, coma,
  death in 24-48 hrs. endotoxic shock.
• Rx erythromycin, (penicillin cant cross BBB)
  cephalosporins.
• Vaccine- 2, 4 , 6 months. (Hib)

9
Bacterial Meningitis

• Neisseria meningitidis
• Gram diplococcus, aerobe
• Oral- air borne transmission
• 5-10 carriers
• Starts as sore throat, to blood, and then to CNS.
• In blood bacteremia, sepsis
• Inflames meninges- fever, severe headache, coma,
  death in 24-48 hrs. endotoxic shock.
• Rx erythromycin, (penicillin cant cross BBB)
  cephalosporins.
• Vaccine- military primarily.

10
Other Meningitis

• Streptococcal meningitis
• S. pyogenes
• Hospitalized older adults.
• Diagnosis
• Spinal tap, measure glucose
• 90 -120 mg/dl normal
• If lower, suspect bacteria
• If normal, suspect viral
• Gram stain sometimes useful
• Latex agglutination- 20 min

11
Listerosis

• Listeria monocytogenes
• Gram rod
• Grows in macrophages, CNS
• mostly affects pregnant women cancer patients.
• Can cross placenta and cause fetal death.
• Mainly food-borne infections
• Poultry, dairy products.
• Grows at 4C
• Rx penicillin

12
Tetanus

• Clostridium tetani
• Gram anaerobic, rod
• Usually wound infection.
• Produces potent neurotoxin, tetanospasmin.
• Toxin enters CNS and blocks relaxation pathway
  causing a spasmotic paralysis.
• Masseter greatly affected- lockjaw.
• Later stages uncontrollable spasms
  opisthotonos.

13
Tetanus

• Clostridium tetani
• Vaccine- part of DPT- tetanus toxoid. Booster
  every 10 years with no incidents, or every 5 if
  have injury.
• Can also administer anti-toxin antibodies (TIG)

14
Botulism

• Clostridium botulinum
• Gram anaerobic, rod
• Usually food-borne.
• Produces potent neurotoxin.
• Toxin enters CNS and blocks ACh to motor neurons
  causing a flaccid paralysis.
• 1 mg kills 60 million mice.. Death due to cardiac
  and respiratory failure (diaphram).
• Nausea, no fever, blurred vision, difficulty
  swallowing.

15
Botulism

• Clostridium botulinum
• Toxin types
• A, - USA, 60-70 mortality. 20-30 cases/ yr.
• B, - European, 25 mortality.
• E seafood, 40 mortality.
• Infant botulism- honey due to immature GI
  tract ID 2000 spores or organisms.
• Botox- used cosmetically.

16
Leprosy

• Mycobacterium leprae
• Acid fast rod 30C optimum growth
• Grows in pheripheral nerves.
• Cannot cultivate on lab media- can in armadillos,
  rat foot-pads.
• Tuberculoid - (neural form) loose feeling,
  sensation.

17
Leprosy

• Mycobacterium leprae
• Lepromatous - (progressive) infects skin cells
  deformation of hands.
• Not very contageous, requires long intimate
  contact.
• Incubation -years.
• Death from complications.
• Many Biblical descriptions probably fungal
  dematidis.
• 100-150 cases/ yr 500,000 worldwide.
• Rx dapsone, rifampin, clofamizine

18
Diseases of the Cardiovascular System

• Septicemia (p. 626)
• Tularemia (p.629)
• Brucellosis (p. 630)
• Anthrax (p. 631)
• Gangrene (p. 631)
• Plague (p. 633)
• Relapsing Fever (p. 634)
• Lymes Disease (p. 634)
• Typhus (p. 635)
• Rocky Mountain Spotted Fever (p.637)

19
Septicemia

• Pathogens usually dont grow in blood
  lymphocytes and low Fe3
• Lymphangitis- inflammation of lymph nodes.
• Sepsis- toxic condition from septicemia.
• Septic Shock - endotoxin, 1 millionth of a gm.

20
Puerperal Sepsis

• Disease of Childbirth
• Semmelweis 1840s
• Disinfection procedures.
• Streptococcus pyogenes.
• Rx penicillin.

21
Endocarditis

• Inflammation of the inner heart lining.
• Acute- S. aureus.
• Rapid destruction of heart valves leads to death.
• Rx penicillin.

22
Rheumatic Fever

• Repeated infections with S. pyogenes -strep
  throat.
• Ages 4 - 18.
• Joint pain.
• Streptococal antigens (M protein) cross react
  with heart antigens.
• Antibody response to kill organisms damages heart.

23
Tularemia

• Franciella tularensis
• Gram - pleomorphic rod.
• Oral, dermal, or ingestion transmission.
• Rabbits, squirrels
• Small ulcer at primary site of infection.
• 1 week - lymph nodes enlarge.
• Can progress to septicemia, pneumonia.
• ID50 -10 organisms.
• Survives inside phagocytes. Endotoxin.
• Rx streptomycin, gentamycin.

24
Brucellosis

• Brucella abortus
• Gram - rod
• Cattle, swine
• Direct contact, milk products.
• Infects uterus- mesoerythritol requirement.

25
Brucellosis

• Brucella abortus
• Chills, fever, malaise, heavy sweating.
• Undulating- fever rises in evening 104C.
• Animals secrete bacteria in milk.
• Pasteurization process tailored for this
  pathogen.
• Organism survives phagocytosis, grows
  intracellularly.
• Rx tetracycline streptomycin -long treatment.

26
Anthrax

• Bacillus anthracis
• Gram rod, aerobe, sporeformer.
• Grows in long chains - square ends.
• Direct contact, wool, aerosol -spores.
• Spores survive for decades.
• Pustule forms at primary site.

27
Anthrax

• Bacillus anthracis
• Pulmonary form most serious, enters lungs then to
  bloodstream, leads to septicemia.
• Pathogenic factors include anti-phagocytic
  capsule (poly-D-glutamic acid) potent exotoxin.
• Once septicemic, death in 48-72 hours.
• Rx penicillin.
• Vaccine - 6 inj. over 18 months.
• BT agent. Refined spores.

28
Gas Gangrene

• Clostridium perfringens
• Gram rod, anaerobe (not strict), sporeformer.
• Ischemia -lack of blood supply.
• Necrosis -tissue death.
• Gangrene -death of soft tissue.
• Diabetes, injury, cancer.

29
Gas Gangrene

• Many proteolytic enzymes, hyaluronidase,
  collagenase, lipases.
• P. aeruginosa can co-infect.
• Treatment - remove necrotic tissue, amputation,
  surgical maggots.
• Hyperbaric O2 - internal tissues
• Rx penicillin.

• Clostridium perfringens
• Produces toxins that travel down muscle bundles.

30
Vector Borne Diseases - Plague

• Ysernia pestis
• Gram - rod.
• Zoonoses, disease of rodents (squirrels, prairie
  dogs) spread by rat flea.
• 14 -15th Centuries killed 25 of entire European
  population.
• Organism enters blood via bite and can grow in
  phagocytes.

31
Bubonic Plague (Black death)

• Ysernia pestis
• Organism enters blood via bite and spreads to
  lymph nodes creating a bubos.
• Septicemia causes septic shock.
• Death occurs in a week.
• 50-75 Mortality if untreated.
• Can go pneumonic -death can occur in 15 -24
  hours.
• Rx streptomycin, tetracycline.

32
Plague

• Distribution in US.
• N. Mexico highest.
• Vaccine - live attenuated strain.
• Short-lived immunity.
• BT agent ?? Limited.

33
Relapsing Fever

• Borrelia recurrensis
• Spirochete - no Gram reaction.
• Spread by soft ticks.
• Fever, jaundice, rose-colored skin spots.
• Fever breaks after 3-4 days and patient appears
  to recover.
• Fever reappears due to surface antigens changing.
• Rx penicillin.

34
Lymes Disease

• Borrelia burgdorferi
• Spirochete - no Gram reaction.
• Spread by hard ticks.
• Organisms infects tick salivary glands.
• 10,000 cases annually -most prevalent ABD.
• Rodents reservoir. Deer in life cycle of tick.

35
Lymes Disease
36
Lymes Disease

• Borrelia burgdorferi
• Bulls -eye rash -erythema migrans around bite.
• Flu-like symptoms follow.
• Later stages similar to syphilis - heart and
  neurological involvement.
• Joint degeneration.
• Rx penicillin.

37
Endemic Typhus

• Rickettsia prowazekii
• Obligate intracellular parasite.
• Spread by body louse.
• Organism grows in louse gut and is excreted in
  feces.
• Introduced in body when host scratches site and
  rubs in feces.
• Produces high and prolonged fever, and severe
  headache.
• Subcutaneous red spots indicate hemorrhagic
  response.

38
Endemic Typhus

• Rickettsia prowazekii
• Disease peaks after 12-14 days.
• Rx chloramphenicol and tetracycline.
• Vaccine available for military.
• Typhus killed Anne Frank and about 30 of
  Napoleons army retreating from Moscow.

39
Rocky Mountain Spotted Fever

• Rickettsia rickettsii
• Obligate intracellular parasite.
• Spread by ticks.
• 800 cases / yr.
• 3 Mortality
• Fever, chills, headache, nausea.

40
Rocky Mountain Spotted Fever

• Rickettsia rickettsii
• 2-4 days rash starts on palms and soles.
• After 1 week, rash spreads over entire body.
• Mistaken frequently for measles but presence on
  palms of hands and soles of feet (uncommon).
• Kidney and heart failure leads to death.

41
Rocky Mountain Spotted Fever

• Rickettsia rickettsii
• Rx chloramphenicol and tetracycline.
• No vaccine.

42
Diseases of the Respiratory System

• Strep Throat (p. 659 )
• Scarlet Fever (p. 659 )
• Diphtheria (p. 660 )
• Otidis media (p. 661 )
• Pertussis (p. 663 )
• TB (p. 663 )
• Pneumonias (p. 667 )
• Legionaires Disease (p. 669 )

43
Steptococcal Pharyngitis

• Streptococcus pyogenes
• Gram cocci, chains
• b-hemolytic, M protein makes resistant to
  phagocytosis.
• Streptokinase, streptolysin.
• Culture from throat swab.
• Local infection, sore throat, fever.
• Can progress to otidis media.
• Rx penicillin.

44
Scarlet Fever

• Streptococcus pyogenes
• Invades upper respiratory tract.
• Erythrogenic toxin produces small goose bumps
  on skin - spreads over entire body except face,
  palms, and soles to make red rash.
• High fever, nausea, vomiting.
• Rx penicillin.

45
Diphtheria

• Corynebacterium diphtheriae
• Gram pleomorphic rods
• Club shaped, chinese characters.
• Colonizes throat.
• Produces pseudomembrane on back of throat.
• Can block breathing.

46
Diphtheria

• Corynebacterium diphtheriae
• Produces potent toxin that inhibits protein
  synthesis.
• Give anti-toxin.
• Rx penicillin, erythromycin.
• Vaccine DPT -2, 4, 6 months.

47
Otidis media

• Earache.
• S. pneumoniae 35
• H. influenzae 20-30
• M. catarrhalis 10-15
• S. pyogenes 8-10
• S. aureus 1-2
• 85 under age of 3
• Eustacian tube S-shaped.
• Rx amoxicillin, sulfa drugs.

48
Pertussis (Whooping cough)

• Bordetella pertusis
• Gram - obligate aerobe, capsulated,
  coccobacillus.
• Destroys cillary cells.
• Cytotoxin.
• Whoop comes from sound of patient gasping for air
  between coughs.
• Vaccination -DPT has reduced number from 250,000
  to 7000.
• Immunity lasts 12 yrs.
• Rx erythromycin.

49
Tuberculosis (consumption)

• Mycobacterium tuberculosis
• Acid -fast rod, in filaments (myco -fungus).
• Air-borne, sputum.
• Enters lung, reaches alveoli.
• Macrophages wall off into a tubercle in healthy
  people.
• When immune system weakens or fails they can
  reinfect lungs.

50
Tuberculosis
51
Tuberculosis
52
Tuberculosis

• Symptoms include coughing, rusty (blood) sputum,
  weight loss.
• Diagnosis
• X-ray, tuberculin test
• Tuberculin indicates exposure , not necessarily
  active disease.
• Culture, PCR faster.
• MAIS - AIDS patients.
• Rx isoniazid, rifampicin, streptomycin.

53
Tuberculosis

• 10 - 12 million Americans infected.
• 2000 deaths, in decline.
• 3 million die world-wide.

54
Bacterial pneumonias

• Streptococcus pneumoniae
• Gram diplococcus, capsulated.
• Infects bronchi and alveoli.
• High fever, difficulty breathing, chest pains.
• Lungs fill with fluid.
• Sometimes progresses to septicemia and
  meningitis.
• Rx penicillin.

55
Bacterial pneumonias

• Hemophilus influenzae
• Rx cephalosporins.
• Mycoplasma pneumoniae
• Atypical walking pneumoniae
• No cell wall
• Low grade fever, headache, cough
• Colonies fried eggappearance.
• Rx tetracycline.
• Chlamydia pneumoniae
• OIP, needs ATP.
• Associated w atherosclerosis
• Rx tetracycline.

56
Legionaires Disease

• Legionella pneumophila
• Gram - rod, aerobic, non-sporeformer.
• Occurs in nature, water. Resistant to chlorine.
• Enters lung via aerosol.
• High fever, other symptoms of pneumonia.
• Rx erythromycin.

57
Legionaires Disease

• NORMAL
• Legionella

58
Diseases of the Digestive System

• Caries (p. 686 )
• Peridontal Disease (p. 688 )
• Food poisoning (p. 690 )
• Dysentery (p. 691 )
• Typhoid Fever (p. 695 )
• Cholera (p. 695 )
• E. coli (p. 697)
• Peptic ulcers (p. 697)

59
Caries

• Streptococcus mutans
• Gram cocci
• Requires sucrose to make dextran cement.
• Binds to teeth, secretes acid to etch enamel.

60
Caries

• Best prevention minimize sucrose ingestion
  brush and floss use of fluorides.
• No Rx , no vaccine.

61
Peridontal Disease

• Treponema denticola (relative of pallidum)
• Over 300 organisms in oral cavity.
• Infects gingiva around teeth, causes gum
  inflammation - gingivitis. retardation and
  ulceration.

62
Peridontal Disease

• Continual gingivitis leads to peridontidis.
• Retardation, ulceration and disintrigation of
  gums.
• Porphyromonas
• Prevotella
• Remove infected tissue.
• Rx oxidizing agents, metroniazole.

63
GI Diseases

• Intoxication- ingest toxin.
• Infection -pathogenesis due to organism.

64
Staphylococcal Poisoning

• Staphylococcus aureus - enterotoxin.
• Custards, cream pies, potato salad, ham.
• 106 organisms.
• Toxin is heat stable
• 30 min boiling.
• Incubation 4-6 hrs.
• Causes nausea, vomiting, abdominal cramps,
  diarrhea.

65
Shigellosis (Bacillary Dysentery)

• Shigella dysentariae
• Gram - facultative anaerobe rod, enteric.
• ID50 lt100 organisms.
• 20,000 -30,000 cases/ yr.
• 5-15 deaths
• 20 mortality if untreated.

66
Shigellosis (Bacillary Dysentery)

• Shigella dysentariae
• Enters mucosa, infect cells, cytotoxic (Shiga
  toxin).
• Symptoms, fever, severe diarrhea with blood and
  mucus, abdominal cramps.
• Rarely invades bloodstream.
• Culture from stool.
• Treatment- rehydration.
• Rx fluoroquinolones.

67
Salmonellosis (Salmonella Gastroenteritis)

• Salmonella typhimurium
• Gram - fac. anaerobe rod, enteric.
• ID50 104 - 105 organisms.
• 40-50,000 reported may be as high as 2 million
• 500-2000 deaths.
• Incubation- 12-36 hrs.

• Common eggs, poultry products.

68
Salmonellosis (Salmonella Gastroenteritis)

• Spread from mucosa to lymph nodes.
• Symptoms include fever, nausea, cramps, diarrhea.
• Recovered from feces.
• Mortality 1 mainly in very young and old.
• No Rx . Rehydration.

69
Typhoid Fever

• Salmonella typhi
• Gram - fac. anaerobe rod, enteric.
• Only in humans
• Mary Mallon
• Incubation 2 weeks
• Symptoms- high fever, headache, diarrhea.

70
Typhoid Fever

• Mortality 1-2, was 10.
• 1-3 of recovered become carriers- colonizes gall
  bladder.
• Organisms divide in phagocytes and lymph nodes.
• Rx 3rd generation cephalosporin.
• Vaccine - killed organisms.

• 350 - 500 cases 70 foreign.

71
Cholera

• Vibrio cholerae
• Gram - curved rod, polar flagella.
• In water sources.
• Grows in intestines, not invasive but produces
  toxin.
• Causes a copious, painless, watery diarrhea that
  can quickly lead to severe dehydration -rice
  water stool.
• Usually no fever.

72
Cholera

• Cholera toxin disrupts cAMP intestines loose
  water and electrolytes.
• Loss of 15 - 20 L per day.
• Usually self -limiting with treatment.
• Treatment- rehydration with sugar water,
  electrolytes.
• Rx tetracycline.

73
Cholera

• Vaccine available, subunit B of toxin killed
  organisms
• Most cases along Gulf, associated with
  shell-fish.

74
E. coli gastroenteritis

• E. coli - O157H7
• Gram - fac. anaerobe rod, enteric.
• Enterotoxic not invasive- cause travelers
  diarrhea.
• 65-75 nonenvasive types.

75
E. coli gastroenteritis

• E. coli - O157H7
• Enterohemorrhagic is invasive, similar to
  Shigella- toxin.
• 73,000 cases occur annually
  in the United States.
• Most deaths young children.

76
Peptic Ulcers

• Helicobacter pylori
• Spiral shaped micro-aerophilic rod. Gram -
• Urease
• Survives in stomach urea ammonia neutralizes
  stomach acid.
• Immune system causes inflammation.

77
Diseases of the Urinary and Reproductive System

• Leptospirosis (p. 723 )
• Gonorrhoea (p. 725 )
• NG Urethritis (p. 727 )
• Syphilis (p. 728 )
• Chancroid (p. 731 )
• Vaginosis (p. 732 )

78
Leptospirosis

• Leptospira interogans
• Spirochete no Gram reaction, aerobe.
• Animal reservoirs.
• Animals shed in urine from infected kidneys.
• Many times spread expand in water- lakes, ponds.
• Enters through micro-breaks in intact skin.

79
Leptospirosis

• Enters blood stream.
• 1-2 weeks later headache, muscle aches, chills,
  fever appears abruptly.
• Infects kidneys and liver.
• Death sometimes due to kidney failure.
• 50 cases / yr.
• Rx penicillin, tetracycline.
• No vaccine.

80
STDs
STD Cases 2001
Chancroid 78
Chlamydia 783,242
Gonorrhoea 361,705
Herpes 1,000,000
HIV/ AIDS 41,755
Syphilis 6103
Trichomonas 5,000,000
81
Gonorrhoea

• Neisseria gonorrhoeae
• Gram - diplococcus
• 150 AD Galen semen flow.
• 350,000 cases/yr.
• 1/5 reported.
• Gonococcus adheres to columnar epithelium via
  fimbriae (pili).

82
Gonorrhoea

• Gonococcus adheres to columnar epithelium
  (urethra, cervix, throat) via fimbriae (pili)
  does not adhere to squamous epithelium (vagina).

83
Gonorrhoea

• Neisseria gonorrhoeae
• Gram - diplococcus
• Requires extra CO2 for growth, fastidious.
• Oxidase positive.
• Differentiate from N. meningitidis by maltose
  fermentation.

84
Gonorrhoea

• Causes inflamation leukocytes inflitrate.
• Purulent discharge.
• Female -infects cervix.
• 60-90 infection rate
• 60-80 asymptomatic
• Male - infects urethra.
• 80 infection rate
• No asymptomatic.
• Painful urination.

85
Gonorrhoea

• Incubation 1-2 days.
• Untreated -male can block urethra, can spread to
  testis- sterility.
• Female - cervix, Not vagina.
• Lead to PID, joints, heart, meninges.
• Neonatal - eye infection, used AgNO3,
  antibiotics.
• Recovery- no immunity.

86
Gonorrhoea
Gonococcal ophthalmia.
Can also produce throat infections.

• Rx penicillin, ceftriaxone.
• Combined with Chlamydia Rx.
• Resistance - PPNG, TRNG.
• Antibiotic pump.

87
Nongonoccal Urethritis

• Chlamydia trachomatis
• OIP - needs ATP
• Most prevalent bacterial STD.
• 1 million cases /yr.
• 5X females than males.
• Infects uterine tubes leads to PID.
• Males- infects epididymus.

88
Nongonoccal Urethritis

• Chlamydia trachomatis
• Cell culture or FAb test.
• Mycoplasma hominus
• Ureaplasma urelyticus
• Rx tetracycline, doxycycline, azithromycin

89
Nongonoccal Urethritis
Cervix
Cervicitis with discharge
90
Pelvic Inflammatory Disease
N. gonorrhoeae, C. trachomatis, M. hominus, U.
urelytica
91
Pelvic Inflammatory Disease

• Salpingitis- inflammation of the ovaries.
• Lead to sterility and ectopic pregnancy.
• Rx doxycycline cefoxitin.

92
Syphilis

• Treponema pallidum
• Spirochete, micro- aerophilic, obligate parasite.
  Motile. Fastidious culture in epithelial cells.
• Stealth pathogen. Transmitted direct contact
  any part of body.
• 6000 cases / yr.

93
Syphilis

• Site of infection produces a single painless
  ulcer, chancre.
• Peripheral nerves affected.
• Incubation 1-3 weeks.
• Chancre disappears after 2-3 weeks.
• In female, may go unnoticed, if internal.

94
Syphilis
95
Syphilis

• 2-6 months later Secondary stages may appear.
• Rash appears on trunk and spreads, Includes palms
  and soles (RMSF).

96
Syphilis

• Secondary stages - infection is systemic.
• Organisms invade organs.
• Rash disappears after 2-3 weeks.
• Rash if ulcerates, is contagious.

97
Syphilis

• 1-20 years later enters Tertiary Stage.
• Serious damage to internal organs.
• Heart, aorta, CNS,
• Gummas of soft tissue.
• Not infectious.

98
Syphilis

• Rx penicillin, tetracycline.
• Congenital syphilis - transmitted to fetus.
• Can result in stillborn or deformaties, esp
  hearing and sight.

99
Syphilis

• Diagnosis serological.
• RPR, DFA-TP, TP-PA

100
Chancroid

• Hemophilis ducreyi
• Gram - rod, requires hemin.
• ID50 - 1-2 organisms.
• Primary site can include multiple ulcers that
  resemble the syphilis chancre.

101
Chancroid

• Hemophilis ducreyi
• Multiple ulcers filled with organisms.
• But they are very painful.

102
Chancroid

• Growth on blood agar with added nutrients, and
  vancomycin.
• Pathogenic mechanisms not fully understood do
  resist phagocytosis.
• Rx azithromycin, ceftriaxone, ciprofloxacin.
• Strains becoming resistant to some antibiotics
  (ampicillin, tetracycline, streptomycin).

103
Bacterial Vaginosis

• Candida albicans, Trichomonas vaginalis,
  Gardnerella vaginalis.
• Occurs when normal flora (Lactobacillus)
  disrupted.
• Normal pH 4.0-4.5
• Above pH 4.5 abnormal.
• Lactobacillus produce H2O2, keeps other flora
  supressed.

104
Bacterial Vaginosis

• When Lactobacillus reduced others take over and
  cause vaginosis.
• Produces milky white fluid teeming with
  organisms foul odor.

105
Bacterial Vaginosis
NORMAL
Vaginosis
106
Bacterial Vaginosis

• Treatment
• Re-establish Lactobacillus
• Acid production will restore flora.
• Sometimes reintroduce Lactobacillus.
• Serious, Rx metraniazole.

Which parasite??