his

ABC

DTI Skin IE

HBD
AFB Easilyfragile
Toxin Endotoxin
Exotoxin
 Metronidazole
DNA integrity Nitrofurontoin

SMX PABA t

Tmp
p topoisomerase

0 inhibitor inhibitor
DIF
cell
a my
7fi ggg
Fluoroquinolone

membrane a

man I 141 RNApolymerase

inhibitor
Daptomycin rifampicin

as
cell wall t
chloramphenicol
peptidoglycansynthesise l carbapenem

vancomycin Anyway Erythromycin

Imipene .gg Tetracyclines
Meropene.m linegolid
intuiting pentitoc
penicillinbindingprotein lincomycin
Monobactum
Naturalpenicillin Agteomam
pent PENV
Aminopenicillin
AT E1h50
Anoxic Ampicillin
BLactamase
inhibitor
30
Anti
staphylococcal
Tazobactam
cloxacinin subactam
Fueloxaciain clavulanicia
Antipseudomonal

piperacinin

cephalosporin
ist cephalaxin
cofactor
2ndcefuroxime

3rd ceftriaxone
gotaxime
affagictime
4th cerpine
5th ceftaroline
5 Quinolone
 13lactamantibiotics MACROLIDES LINCOSAMIDE AMINOGLYCOSIDES

Hypersensitivity reaction cholestatic J CE'mycin nephrotoxicity

macrolide
Diarrhoea Long27 syndrome DuetoRos
ofotoxicity
cholestatic sc coamoxidar
ClindamycinCCDI
Acuteinterstitialnephritis
NMBlockage

FIDO
QUINOLONE VANCOMYCIN TEKOPLATIN

55
S i ch nephrotoxicity

Oto
toxicity
ciprofloxacin is associated é releaseof
Mrsa CDs Redman dueto
Prolong at
Archivestendonrupture
Effects histamine

Drugreactionwith
DRESSC
eosinophilia systemicsymptoms

DAPTOMYCIN POLY
MUCINS

CK T SJ
eosinophilic pneumonitis Encephalopathy
GPD deficiency
Megaloblastie macrocytic At

TETRACYCLINES M h
K Metallictaste

jiff
syndrome
doxycycline
Grey baby
Pancytopenia
with discoloration

opticneuropathy
Myelodysplastic
Jj
Effects
Synergisticeffect é Maol
seize
 GI Infection

exit

Watery diarrhea Bloody diarrhea

u ESC
Bacillus EHEC
Staph Salmonella
ETEC
Cholera shigella
Rotavirus Campylobacter
Norovirus Amoebiasis
Giardiasis
Clostridium difficile
Milrosporidiasis

Gyptosporidiasis

Cystiososporiasis
Cholera
• Gram-negative bacillus, Vibrio cholerae, Two biotypes- classical, El Tor
• Epidemiology - India, Bangladesh
• CF - typical ‘rice water' material is passed, consisting of clear uid with ecks of mucus
without abdominal pain, enormous loss of uid and electrolytes, leading to intense
dehydration with muscular cramps, acute circulatory shock, Cholera Sicca
• Diagnosis - Stool dark- eld microscopy shows the typical ‘shooting star' motility of V.
cholerae

• Treatment - rehydration, Three days' treatment with tetracycline 250 mg 4 times daily, a
single dose of doxycycline 300 mg or cipro oxacin 1 g in adults reduces the duration
of excretion of V. cholerae and the total volume of uid needed for replacement
 DYSENTERY

Typhoid fever
2 3Wh
• Salmonella enterica serotypes Typhi and Paratyphi A, B and C(Gram negative bacillus)
• Epidemiology - South Asia, sub-Saharan Africa and Latin America
• Pathogenesis - lymphoid tissue of the small intestine, resulting in typical lesions in the
Peyer's patches and follicles, spleen, chronic carrier stage in gallbladder

• Parathyroid - short IP, rose spot more prominent, GI complications less frequent
• A drop in temperature to normal or subnormal levels may be falsely reassuring in
patients with intestinal haemorrhage
• Investigation- Blood culture in rst week, Stool culture in second and third weeks,
leucopenia, Widal test - not use in nowadays
• Treatment - Cipro oxacin or Azithromycin for 2 weeks, 4 weeks for chronic carrier,
Pyrexia may persist for up to 5 days after the start of speci c therapy
• Prevention - live vaccine
[Link] infection
• Strain - ETEC, EAEC, EIEC, EPEC, EHEC
• Gram negative bacillus
• ETEC
Traveller’s diarrhea, self limiting, no role of antibiotics
• EIEC
CF similar to Shigella but ဝမ် း များ ေသွးနည်း
• EHEC

• No role of antibiotic in [Link]

Clostridioides di cile infection

• [Link] cile (Gram positive bacillus) ciprofloxacin
• Associated with antibiotics like penicillin, cephalosporin, clindamycin, cefuroxime
• CF - due to Toxin ( A and B), 80% cases are >65 yr age, 1- 6 weeks after antibiotics,
watery diarrhea to colitis associated with tenesmus, can lead to toxic mega colon,
septic shock
• Diagnosis - Toxin A and B, Glutamate dehydrogenase (GDH), Sigmoidoscopy- pseudo
membrane ( erythema, white plaques)
• Treatment -
Bacillary dysentery (shigellosis)
• Gram-negative rods, closely related to E. coli, that invade the colonic mucosa. There
are four main groups: Sh. dysenteriae, exneri, boydii and sonnei.
• In tropical regions bacillary dysentery is usually caused by Sh. exneri
• Epidemiology - Egypt
• person-to-person transmission is the most important factor
• Outbreaks - psychiatric hospitals, residential schools and other closed institutions
• CF - colicky abdominal pain, ေသွးများ ဝမ် းနည်း
• Treatment- Cipro oxacin or Azithromycin
 Respiratory Infection

Diphtheria
• Corynebacterium diphtheriae(Gram positive bacillus)
• CF - IP-within 7days

moppNOMA

Motor neuropathy

• Treatment - Anti-toxin plus penicillin, anaphylaxis, serum sickness is antibody mediated

adverse reaction
Anthrax
• [Link](Gram positive bacillus)
• Zoonosis disease

Cutaneous anthrax - painless oedematous haemorrhagic base(Escher)

GI anthrax - dysentery with tenesmus, toxaemia and death rapidly developed

Inhalational anthrax - bio weapon, high mortality 50-90%

Treatment - Cipro oxacin, penicillin

Prophylaxis - Cipro oxacin (500 mg twice daily for 2 months) is recommended for anyone
at high risk of inhalational exposure to anthrax spores and is combined with three doses
of anthrax vaccine adsorbed (AVA)
 Systemic bacterial infection

Leptospirosis
• Gram negative spirochete
• IP - 1-2 weeks
• Epidemiology - Spain
• Pathogenesis - Prolonged immersion in contaminated water facilitates invasion, as the
spirochaete survives in water for months. Organisms persist in rat urine, penetrate
intact skin or mucous membranes, facilitated by cut and abrasion
• CF Phases
Bacteraemic phase - high fever, muscle pain and tenderness (especially of the calf
and back), headache, photophobia, Conjunctival congestion
Aseptic meningitis - caused by L. canicola
Weil’s disease - by L. icterohaemorrhagiae, 10% of case, fever, haemorrhage,
thrombocytopenia in 50% of cases, ATN and AKI, hepatitis but hepatic failure is
rare, uveitis and iritis appear months after recovery
Pulmonary syndrome - hight mortality due to ARDS
• Investigation
Baseline - neutrophil leucocytosis, thrombocytopenia, modest elevation of LFT,
Raised CK
Meningitis - bacterial meningitis ndings except normal glucose
Con rmation - blood culture in rst week, urine culture in second week, MAT
(serology)
• treatment - penicillin or doxycycline, antibiotic therapy do not prevent renal failure,
dialysis for renal failure
Brucellosis
• B. melitensis(Gram negative bacillus)
• Zoonosis- goats, sheep, Cattle, camels
• Epidemiology - Middle East, Africa, South America
• IP 1-3 weeks
• Transmission - diary products, uncooked meat
• CF - Reticuloendothelial system infected intracellular bacteria

Investigation - blood culture, bone marrow culture

Treatment -
Borrelia
• Gram negative spirochete
• Transmission - bite by ixodid tick
• Epidemiology - Europe, Australia
• CF - 3 phases
Early localized disease - erythema migrans( bull eyes), regional lymphadenopathy
Early disseminated disease - via lymphatics and blood, neurological presentation
like lymphocytic meningitis, cranial nerve palsies (bilateral facial nerve palsy), CVS -
heart block(AV block as prolong PR in ECG)
Late disease - Acrodermatitis chronica atrophicans, arthritis, polyneuritis

• Diagnosis - early localized phase - clinical, Antibody detection is frequently negative

early in the course of the disease but detected in disseminated or late disease
• Treatment - Guideline - IV Ceftriaxone prefer, penicillin or doxycycline

Listeriosis
• Listeria monocytogenes(Gram-positive bacillus)
• Transmission - cold enriched soft cheese, raw vegetables, meat
• Risk person - pregnancy, >60 yr, immunocompromised person
• CF - meningitis, brain-stem encephalitis
• Investigation - CSF ( normal glucose)
• Treatment - amoxicillin or ampicillin plus aminoglycosides, ceftriaxone is not e ective

Melioidosis
• Burkholderia pseudomallei(Gram negative bacillus-bipolar)
• Epidemiology - Southeast Asia, Thailand
• Transmission - rice paddy elds, inhalation or inoculation
• Risk person - diabetes, renal stones, thalassaemia, severe burns
• CF - abscesses in lung, liver, spleen
• Investigation - Ashdown agar
• Treatment - Ceftazidime 100 mg/kg (2 g 3 times daily) or meropenem (0.5–1 g 3 times
daily) is given for 2–3 weeks, followed by maintenance therapy of co-trimoxazole
(sulfamethoxazole 1600 mg plus trimethoprim 320 mg twice daily) or doxycycline 200
mg daily for 3–6 months
 Skin infection

JE't

Bullons Nonballoons

v Y
Strep
Staph
aureus pyogenes

Cellulitis Deepderris
v

ill defined edge

Erysipelas superficial

well defined edge

Pain is less common
 • Deep
• Very painful on light touch
• Wd debridement+AB

Necrotizing fasciitis
Leprosy
 Clostridia species

d
c u v

C perfringent C tetani C difficile C botulinum

 Intracellular organisms
Scrub typhus fever
• Orientia tsutsugamushi
• Epidemiology - Myanmar, Pakistan, Bangladesh, India, Indonesia
• CF - Escher and mild symptoms are common, headache (often retro-orbital), fever,
malaise, weakness cough, maculopapular rash spreads to the trunk, face and limbs,
including the palms and soles, generalized painless lymphadenopathy,
• Renittent fever, delirium, MOF
• Investigation - abnormal LFT, thrombocytopenia 20%
• Treatment - doxycycline

Q fever
• Coxiella burnetii
•
zoonosis
Transmission - Cattle, sheep and goats , inhalation
• Investigation - Phase 1 very infectious, Phase 2 is not
• CF - aortic valve IE, culture negative IE
• Treatment - doxycycline

Bartonellosis
• intracellular Gram-negative bacilli
• Cat scratch disease - regional lymphadenopathy, rare - encephalitis
• Treatment - doxycycline or macrolides
 Rare organisms

Dog bite Pasteur ella multocida

Gram cocoobacillus

R Coamoxiclav

Human bite Eike nella corrodene

Gram bacillus
Commensal of mouth
R Coamoxiclav