1. Ziad Elnasser, MD, Ph.D

2.  General properties.  Colorful water soluble pigments.  The most resistant to antimicrobials.  Minimal growth requirements.  Wide temperature range 20-42C.  High level of cytochrome oxidase.  Grows anaerobically if Nitrate is available.  Metallic sheen colonies, fruity odor.  Pyocyanin, Pyoverdin, and Florescene.

3.  LPS and porin proteins..  Pili and polar flagellum.  Alginate slime layer.  Mucoid colonies in CF patients.  Extracellular products:  Exotoxin A, ADP ribosylation of EF-2.  Exotoxin S, ADP ribosylation of Vimentin.  Elastase. IgG, IgA, and Complement.

4.  Debilitated and Immunecompromised pts.  Multisystem.  Environmental.  Normal flora.  CF, Leukemia, and extensive burns.  Humidifiers and respirators.  Attachment, exotoxin A, S and Elastin  Hemorragic destruction of blood vessels wall.  CF cells are less sialinated more receptors, biofilm formation (Glycocalyx), more alginate (gene regulation).  Both humoral and CMI are important.

5.  Opportunistic.  Burn, wound, UTI, skin, eye, ear, respiratory tract, and bacteremia.  Pneumonia is the leading cause of death.  Otitis externa and swimmer’s ear, in DM.  Eye infection.  Ecthyma gangrenosum.

6. Diagnosis

7.  The most resistant to antimicrobials.  Gentamycin, Tobramycin, and Amikacin.  Carbenicillin, and Ticarcillin.  3 rd generation Cephalosporins, Carbapenems, Monobactams.  Flouroquinolones in UTI.  Susceptibility is a must.  CF problems in treatment.  Prevention.

8.  Burkholderia pseudomallei and Melioidosis.  Acinetobacter.  Moraxella.  Aeromonas and Plesiomonas.  Stenotrophomonas.  CDC group II F.

10.  Long chain spore forming rods, nonmotile, nonhemolytic.  Medusa head colonies.  Polypeptide capsule.  Exotoxins.  Adenylate cyclase activity.

11.  Ulcers.  Pneumonia.  Robert Koch and Louis Pasteur.  Herbivores to humans.  Spores are inhaled, ingested or skin contact.  Biological warfare or Terrorism, 1979 accident.  Tripartite nature of the toxin.  Immunity against the toxin, capsule is antigenic but Ig against is not protective.

12.  Cutaneous anthrax:  papule to vesicle, ulcer, to black eschar (scab) surrounded by edema.  Malignant pustule.  Pulmonary anthrax:  Wool sorter’s disease.  Severe respiratory distress with cyanosis.  CNS dissamination.

18.  Penicillin.  Doxycycline.  Ciprofloxacin.  Eradicate animal anthrax.  Vaccination dilemma.