Organism

Clinical Features

Epidemiologic Features

Aerobic and Facultatively Anaerobic Gram-Positive Cocci Elderly patients and patients who have been Urinary tract infections, peritonitis, hospitalized for bacteremia, endocarditis extended periods receiving broadspectrum antibiotics Suppurative infections: impetigo, Colonize human skin folliculitis, furuncles, carbuncles, and mucosal surfaces; wounds survive on Disseminated infections: environmental surfaces; bacteremia, endocarditis, able to grow at pneumonia, empyema, temperature extremes osteomyelitis, septic arthritis and in high salt Toxin-mediated infections: toxic concentrations shock syndrome, scalded skin syndrome, food poisoning Colonize human skin and mucosal surfaces; survive on environmental surfaces; able to grow at temperature extremes

Enterococcus faecalis and Enterococcus faecium

Staphylococcus aureus

Wound infections, urinary tract Staphylococcus , coagulase- infections, catheter and shunt negative infections, prosthetic device infections

Streptococcus pyogenes (group A)

Suppurative infections: pharyngitis, scarlet fever, sinusitis, skin and softtissue infection (impetigo, erysipelas, cellulitis, necrotizing Diverse populations fasciitis), toxic shocklike syndrome; bacteremia Nonsuppurative infections: rheumatic fever, glomerulonephritis

Streptococcus agalactiae (group B)

Neonatal disease (early onset, late onset): bacteremia, pneumonia, meningitis; postpartum endometritis, wound infection, skin and soft-tissue infection, urinary tract infections, pneumonia Abscess formation; septicemia in neutropenic patients; subacute endocarditis; odontogenic infections; dental caries Pneumonia, sinusitis, otitis media, meningitis, bacteremia, endocarditis, spontaneous bacterial peritonitis, septic arthritis

Neonates; pregnant women; patients with diabetes, cancer, or alcoholism

Viridans streptococci

Patients with abnormal heart valves; neutropenic patients Diverse: neonates, children, adults with chronic diseases, elderly persons

Streptococcus pneumoniae

Aerobic or Facultatively Anaerobic Gram-Positive Rods Anthrax: cutaneous, gastrointestinal, inhalation Animal workers; microbiologic accidents; bioterrorism

Bacillus anthracis

Bacillus cereus

Corynebacterium diphtheriae

Corynebacterium jeikeium

Contaminated food; Food poisoning; ocular infections; traumatic eye injury bacteremia; pneumonia with introduction of contaminated soil; Spread by respiratory droplets to Diphtheria: respiratory, cutaneous unimmunized individuals Immunocompromised Opportunistic infections; patients at increased bacteremia risk Risk factors include immunosuppression, underlying genitourinary disorders, antecedent urologic procedures, prior antibiotic therapy

Corynebacterium urealyticum

Urinary tract infections, including pyelonephritis with calculi; bacteremia

Erysipelothrix rhusiophathiae

Erysipeloid (localized skin lesion); generalized cutaneous infection; septicemia

Occupational disease of butchers, meat processors, farmers, poultry workers, fish handlers, and veterinarians

Listeria monocytogenes

Early onset neonatal disease: granulomatosis infantiseptica Late-onset neonatal disease: meningitis with septicemia; flulike illness in adults; bacteremia or disseminated disease in pregnant women or patients with cellmediated immune defect; meningitis

Immunocompromised hosts, elderly persons, neonates, pregnant women; ingestion of contaminated food

Acid-Fast Bacteria Localized disease in patients with chronic pulmonary disease; disseminated disease in AIDS and other immunocompromised patients Close contact with infected individual most likely responsible for spread All ages with HIVinfected patients at greatest risk for active disease

Mycobacterium avium complex

Localized pulmonary disease; disseminated disease with multiorgan involvement

Mycobacterium leprae

Leprosy: range from tuberculoid form to lepromatous form

Mycobacterium tuberculosis complex

Tuberculosis: pulmonary, extrapulmonary

Nocardia

Bronchopulmonary disease; brain abscess; primary or secondary cutaneous infections: mycetoma, lymphocutaneous infections, cellulitis, subcutaneous abscess

Rhodococcus equi

Bronchopulmonary disease; opportunistic infections in immunocompetent patients

Opportunistic pathogen in immunocompetent patients with chronic pulmonary disease or immunocompromised patients with T-cell deficiencies Pathogen most commonly found in immunocompromised patients (e.g., AIDS patients, transplant recipients) Sexual transmission, asymptomatic carriage Carrier state, aerosol transmission, most common in children and young adults

Aerobic Gram-Negative Cocci Gonorrhea, septic arthritis; pelvic Neisseria gonorrhoeae inflammatory disease; perihepatitis; septicemia Neisseria meningitidis Meningitis, septicemia (meninigococcemia); pneumonia; arthritis; urethritis

Aerobic and Facultatively Anaerobic Gram-Negative Rods Acinetobacter Opportunistic infections: pneumonia, septicemia, urinary tract infections, wound infections Nosocomial infections

Aeromonas

Wound infections; gastroenteritis Carrin disease (Oroya fever) + Peruvian wart Bacillary angiomatosis (BA); subacute endocarditis; cat-scratch disease (CSD) Trench fever (TF); BA; subacute endocarditis

Healthy and immunocompromised patients Bite of infected sandfly Healthy (endocarditis, CSD) and immunocompromised patients (BA) Healthy (TF, endocarditis) or immunocompromised patients (BA)

Bartonella bacilliformis

Bartonella henselae

Bartonella quintana

Bordetella pertussis, B. parapertussis

Pertussis (whooping cough)

Aerosol transmission; severe diseases in infants, milder in adults

Exposure to infected goats, sheep, cattle, or Brucella Brucellosis other animals; bioterrorism Compromised individuals especially Burkholderia cepacia Pulmonary infections; opportunistic cystic fibrosis and complex infections chronic granulomatous disease patients Meliodosis (asymptomatic to Burkholderia pseudomallei Opportunistic pathogen severe pulmonary disease) Zoonotic infection Campylobacter jejuni, C. following ingestion of Gastroenteritis coli, C. upsaliensis contaminated food, milk, or water Septicemia; meningitis; Infects elderly, Campylobacter fetus gastroenteritis; spontaneous immunocompromised abortion patients Opportunistic pathogen in patients with Cardiobacterium hominis Subacute endocarditis previously damaged heart valve Human bite wounds; opportunistic pathogen Subacute entocarditis; wound Eikenella corrodens in patients with infections previously damaged heart valve Escherichia coli : Infants in developing Watery diarrhea and vomiting enteropathogenic (EPEC) countries Foodborne, waterborne E. coli : enterohemorrhagic Watery diarrhea; hemorrhagic outbreaks in developed (EHEC) colitis; hemolytic uremic syndrome countries Childhood diarrhea in E. coli : enterotoxigenic Watery diarrhea developing countries; (ETEC) travelers diarrhea E. coli : enteroaggregative Diarrhea with mucus Childhood diarrhea (EAEC)

E. coli: enteroinvasive (EIEC) E. coli: uropathogenic E. coli: meningitis associated Francisella tularensis

Watery diarrhea; hemorrhagic colitis Cystitis; pyelonephritis Acute meningitis Tularemia: ulceroglandular, oculoglandular, pneumonic

Childhood diarrhea in developing countries Sexually active women Neonates Tick bites; exposure to infected rabbits; bioterrorism Aerosol transmission in young, unimmunized children; spread from upper respiratory tract in elderly patients with chronic respiratory disease

Haemophilus influenzae

Encapsulated type b strains: meningitis, septicemia, cellulitis, epidlottis

Unencapsulated strains: otitis media, sinusitis, bronchitis, pneumonia

Helicobacter pylori

Kingella kingae

Klebsiella pneumoniae

Infections particularly common in people in Gastritis, peptic, and duodenal low socioeconomic class ulcers; gastric adenocarcinoma or in developing countries Opportunistic pathogen in patients with Subacute endocarditis previously damaged heart valve Nosocomial infection; Pneumonia; urinary tract infections alcoholism Waterborne; elderly and Legionnaires disease (pneumonia); immunocompromised Pontiac fever (flulike illness) patients Bronchopneumonia; ear or eye infections Urinary tract infections, wound infections Children; patients with compromised pulmonary system Structural abnormality in urinary tract

Legionella pneumophila

Moraxella catarrhalis

Proteus mirabilis

Pseudomonas aeruginosa

Salmonella enterica

Serratia, Enterobacter Shigella Stenotrophomonas maltophilia

Pulmonary; primary skin and softtissue infection: burn wounds, folliculitis, osteochondritis; urinary Nosocomial infections tract infections; ear or eye infections; bacteremia; endocarditis Contaminated food; Diarrhea; enteric fever (serovar immunocompromised Typhi) patients at higher risk for bacteremia Pneumonia; urinary tract Nosocomial infections infections; wound infections Contaminated food or Bacillary dysentery water; person-to-person spread Wide variety of local and systemic infections Nosocomial infections Bite of rat or other small rodent; ingestion of contaminated food or water Children and adults in developing countries Seafood-borne outbreaks Compromised individuals with preexisting hepatic or chronic diseases

Streptobacillus moniliformis Rat-bite fever; Haverhill fever

Vibrio cholerae Vibrio parahaemolyticus

Severe watery diarrhea; septicemia Water diarrhea; wound infection Wound infections; primary septicemia

Vibrio vulnificus Anaerobes Actinomyces

Colonizes human Actinomycosis: cervicofacial, mucosal surface thoracic, abdominal, pelvic, central (oropharynx, intestine, nervous system vagina) Polymicrobial infections of abdomen, female genital tract, cutaneous and soft tissues Normal inhabitant of the gastrointestinal tract

Bacteroides fragilis

Clostridium botulinum

Clostridium difficile

Clostridium perfringens

Clostridium tetani

Proprionibacterium acnes

Found in environment (e.g., soil, water, Botulism: foodborne, infant, wound sewage) and gastrointestinal tract of animals and humans Colonized human gastrointestinal tract Antibiotic-associated diarrhea; and female genital tract; pseudomembranous colitis contaminates hospital environment; prior antibiotic use Found in environment Soft-tissue infections: cellulitis, (e.g., soil, water, myositis, myonecrosis; food sewage) and poisoning; enteritis necroticans; gastrointestinal tract of septicemia animals and humans Found in environment (e.g., soil, water, Tetanus: generalized, localized, sewage) and neonatal gastrointestinal tract of animals and humans Acne; opportunistic infections (e.g., Colonizes human skin of catheters, shunts, and other and mucosal surfaces prosthetic devices)

Anaplasma, Ehrlichia, Rickettsia, Coxiella, Mycoplasma, Chlamydia, and Chlamydophila Anaplasma phagocytophilum Anaplasmosis (granulocytic ehrlichiosis) Trachoma; neonatal conjunctivitis and pneumonia; urethritis; cervicitis; proctitis; salpingitis; lymphogranuloma venereum Transmission by tick bite (Ixodes) Trachoma in developing countries; exposure to infected secretions during birth or sexual contact

Chlamydia trachomatis

Chlamydophila pneumoniae Chlamydophila psittaci

Pneumonia; cardiovascular disease Children, young adults (?) Exposure to birds and Pneumonia their secretions

Coxiella burnetii

Persons exposed to Q fever: acute (fever, headache, infected livestock; chills, myalgias, granulomatous primarily acquired by hepatitis) or chronic (endocarditis, inhalation; relatively hepatic dysfunction) uncommon in United States Transmission by tick bite (Amblyomma) Symptomatic disease more common in children than adults; severe disease in patients with hypogammaglobulinemia Most prevalent in hikers and other individuals who spend a lot of time outdoors; transmission by tick bite ( Dermacentor in United States) Transmission by ticks (Ixodes)

Ehrlichia chaffeensis

Monocytic ehrlichiosis

Mycoplasma pneumoniae

Tracheobronchitis; pharyngitis; atypical pneumonia

Rickettsia rickettsii

Rocky Mountain spotted fever

Spirochetes Borrelia burgdorferi, B. garinii, B. afzelii Borrelia recurrentis Lyme disease: erythema migrans; cardiac, neurologic, or rheumatologic abnormalities

Borrelia species

Leptospira interrogans

Transmission by human Epidemic relapsing fever body louse; no animal host Transmission by tick bite (Ornithodoros); rodent Endemic relapsing fever and small mammal reservoir Transmission by Leptospirosis: mild, viral-like illness exposure to infected to severe multiorgan illness (Weil urine or tissues of disease) rodents, dogs, farm animals, wild animals

Treponema pallidum

Syphilis: primary, secondary, tertiary, congenital

Transmission congenitally or through sexual contact

Virulence Factors

Treatment

Relatively avirulent

Penicillin/ampicillin or vancomycin; combined with gentamicin for endocarditis or severe infections; linezolid, daptomycin, tigecycline, or quinupristin/dalfopristin Localized infections: trimethoprim/sulfamethoxazole, doxycycline, clindamycin or linezolid Systemic infections: oxacillin (if susceptible) or vancomycin; daptomycin, tigecycline, or linezolid

Possess thick peptidoglycan layer, capsule, protein A, various toxins (cytotoxins, exfoliative toxins, enterotoxins, toxic shock syndrome toxin, PantonValentine leukocidin) and hydrolytic enzymes

Possess thick peptidoglycan layer and loose polysaccharide slime layer; Staphylococcus As with S. aureus saprophyticus produces high concentrations of urease

Capsule, M protein, M-like protein, F protein, pyrogenic exotoxins, streptolysin S and O, streptokinase, deoxyribonuclease, C5a peptidase

Penicillin V, amoxicillin; macrolides, cephalosporins, clindamycin, vancomycin; surgical debridement for necrotizing fasciitis

Similar to group A but no capsule

Penicillin; cephalosporins or vancomycin

Relatively avirulent

Penicillin; penicillin plus aminoglycoside; broad spectrum cephalosporin, vancomyin

Polysaccharide capsule; Penicillin; levofloxacin, cephalosporins, teichoic acid; immunoglobulin clindamycin; broad-spectrum A protease; pneumolysin O cephalosporins, vancomycin

Capsule; edema toxin; lethal toxin; spore formation

Heat-stable and heat-labile toxins; necrotic toxin

Diphtheria toxin

Cutaneous anthrax: amoxicillin Inhalation anthrax: ciprofloxacin or doxycycline plus rifampin, vancomycin, penicillin, imipenem, clindamycin or clarithromycin Food poisoning: symptomatic treatment Other infections: fluoroquinolones or vancomycin, clindamycin, gentamicin Penicillin or erythromycin to eliminate organism and terminate toxin production; immunize with diphtheria toxoid Vancomycin

Unknown

Urease production

Vancomycin

Unknown

Localized infection: penicillin, ciprofloxacin, clindamycin

Disseminated infection: ceftriaxone, imipenem

Listeriolysin O; internalins; intracellular survival and growth; intracellular motility; growth at 4 C

Gentamicin plus penicillin or ampicillin

Intracellular replication

Clarithromycin or azithromycin combined with rifabutin or ethambutol

Dapsone and rifampicin for tuberculoid Ability to survive and replicate form; add clofazimine for lepromatous in macrophages form Multidrug therapy with isoniazid (INH), Ability to survive and replicate rifampin, ethambutol, and in macrophages pyrazinamide, followed by INH plus rifampin; multidrug-resistant strains

Intracellular survival and growth; catalase and superoxide dismutase

Trimethoprim/sulfamethoxazole for cutaneous infections in immunocompetent patients; add amikacin, imipenem, or broadspectrum cephalosporin for disseminated infection or infection in immunocompromised patient Combination therapy with vancomycin, carbapenems, aminoglycosides, ciprofloxacin, rifampin

Intracellular growth and survival

Pili, adhesins, IgA protease, transferring-binding proteins, antigenic variation Polysaccharide capsule, endotoxin, pili, adhesins, IgA protease, transferrin-binding proteins

Ceftriaxone plus azithromycin or doxycycline

Ceftriaxone or cefotaxime

Unknown

Unknown

Imipenem or ceftazidime combined with aminoglycosides for serious infections; multidrug resistance increasingly common Ciprofloxacin; trimethoprim/sulfamethoxazole, gentamicin, or amikacin as alternative therapy Chloramphenicol + penicillin Azithromycin; erythromycin or doxycycline

Unknown

Unknown

Unknown

Azithromycin; erythromycin or doxycycline

Pertussis toxin, adenylate cyclase toxin; adhesins; tracheal cytotoxin Ability to persist and replicated in macrophates

Supportive therapy, erythromycin (or other macrolide) to decrease infectivity; azithromycin for contact prophylaxis Doxycycline plus rifampin; trimethoprim/sulfamethazole Trimethoprim/sulfamethoxazole; piperacillin, ceftazidime, or ciprofloxacin as alternative therapy if trimethoprim/sulfamethoxazole resistant Trimethoprim/sulfamethoxazole + ceftazidime Self-limited; severe infections treated with azithromycin; tetracycline or fluoroquinolones used as alternative therapy Aminoglycosides, carbapenems, chloramphenicol

Unknown

Unknown Factors regulating adherence and invasion into intestinal mucosa Unknown

Unknown

Penicillin or ampicillin

Unknown

Penicillin, cephalosprins, tetracycline, or fluoroquinolones

Bundle-forming pili; attaching Unknown and effacing Shiga toxins; attaching and effacing Antibiotics contraindicated

Pili; heat-labile and heat-stable Ciprofloxacin shortens course (high enterotoxins level of resistance) Pili; cytotoxins Fluoroquinolones used in AIDS patients

Invasion and destruction of colonic epithelial cells Adhesins (P pili, AAF/I, AAF/III, Dr); hemolysin; pathogenicity islands K1 capsule; S fimbriae; cellular invasion Capsule

Antibiotics reduce duration of disease and infectivity Trimethoprim/sulfamethoxazole, fluoroquinolones Extended-spectrum cephalosporins Doxycycline or ciprofloxacin for mild infections; add gentamicin for serious infections

Polysaccharide capsule; pili; adhesins; IgA protease

Broad-spectrum cephalosporin, azithromycin, or fluoroquinolone; many strains resistant to ampicillin

Urease; heat-shock protein; acid-inhibitory protein adhesins; mucinase; phospholipases; vacuolating cytotoxin; other factors Unknown

Multidrug therapy: omeprozole + amoxicillin + clarithromycin

-Lactam with -lactamase inhibitor, cephalosporins, macrolides, tetracycline, fluoroquinolone Cephalosporins, fluoroquinolones Macrolides (erythromycin, azithromycin, clarithromycin); fluoroquinolones as alternative therapy Cephalosporins; amoxicillin/clavulanic acid Amoxicillin; trimethoprim/sulfamethoxazole; cephalosporins; fluoroquinolones

Capsule C3b adhesins; cytotoxins; evasion of phagolysosome fusion Unknown

Urease; swarming motility

Capsule; exotoxin A; ExoS; phospholipase C; elastase

Combination therapy generally required (e.g., aminoglycoside with extended-spectrum cephalosporins, piperacillin-tazobactam, or carbapenem)

Type III secretion system; May prolong carrier state in simple epithelial cell invasion; survival diarrhea treatment; fluoroquinolones in macrophages for enteric fever Unknown Carbapenems; piperacillin-tazobactam

Type III secretion system; Ampicillin; intracellular spread; induction trimethoprim/sulfamethoxazole; of macrophage apoptosis fluoroquinolones Trimethoprim/sulfamethoxazole; Unknown doxycycline or ceftazidime as alternative Unknown Cholera toxin; toxin coregulated pilus (TCP); other toxins; neuraminidase Hemolysin/enterotoxin Capsule; numerous degradative enzymes Penicillin; tetracycline

Rehydration; azithromycin; doxycycline or ciprofloxacin as alternative Rehydration for diarrhea; doxycycline + ceftriaxone for wound infection Minocycline or doxycycline + ceftriaxone or cefotaxime

Unknown

Surgical debridement; penicillin; carbapenems, macrolides, or clindamycin as alternative drugs

Polysaccharide capsule; shortchain fatty acids; catalase; Metronidazole; carbapenems; superoxide dismutase; piperacillin/tazobactam hydrolytic enzymes

Spores; botulinum toxin blocks Ventilatory support + metronidazole or release of neurotransmitter penicillin + trivalent botulinum acetylcholine antitoxin

Spores; enterotoxin; cytotoxin

Discontinue implicated antibiotics; metronidazole or vancomycin

Spores; production of many Surgical debridement + penicillin toxins and hemolytic enzymes

Spores; tetanospasmin blocks Wound debridement + penicillin or release of neurotransmitters metronidazole + vaccination with for inhibitory synapses tetanus toxoid + passive immunization Opportunistic pathogen of relatively low virulence Acne treated with benzoyl peroxide + clindamycin or erythromycin

mydophila Intracellular survival and Doxycycline; rifampin as alternative growth; oxidant-mediated cell therapy injury Doxycline, erythromycin, or azithromycin; fluoroquinolones

Unknown

Unknown Unknown

Macrolides; doxycyline, levofloxacin Doxycycline or macrolides

Intracellular survival and replication; formation of Acute disease: doxycycline endospore-like structures that enhance survival in environment; formation of Chronic disease: doxycycline + immune complexes in chronic hydroxychloroquine; fluoroquinolones disease used as alternative to doxycycline Intracellular survival and Doxycycline; rifampin used as replication; oxidant-mediated alternative therapy cell injury

P1 adhesin protein

Erythromycin, doxycycline, fluoroquinolones

Intracellular and rapid cell-toDoxycycline; fluoroquinolones uses as cell spread; oxidant-mediated alternative therapy cell injury

Surface-binding proteins Antigenic variation during infections causes relapses Antigenic variation during infections causes relapses Direct invasion through skin and replication in tissues; immune complex glomerulonephritis

Early: amoxicillin, doxycycline, cefuroxime; late: ceftriaxone, cefotaxime, or penicillin G Tetracyclines; penicillins

Tetracyclines; penicillins

Penicillin; doxycycline

Adherence to host cells; hyaluronidase, antiphagocytic Penicillins; doxycycline or azithromycin coat; tissue destruction as alternative therapy primarily mediated by host immune response