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๐ฆ Microbiology Module 14 - Complete Exam Notes
PART 1: ENTEROBACTERIACEAE
General Features (memorize ALL of these)
- Gram-negative rods
- Facultative anaerobes
- Oxidase NEGATIVE
- Ferment glucose
- Reduce nitrates โ nitrites
- Normal GI flora
- Have LPS endotoxin
- Antigens: O (somatic), H (flagellar), K (capsular)
E. COLI
Diseases: UTIs, neonatal meningitis, sepsis, gastroenteritis
Diarrhea Types - HIGH YIELD TABLE
| Strain | Disease | Mechanism |
|---|---|---|
| ETEC | Traveler's diarrhea | Heat-labile toxin (โcAMP), Heat-stable toxin (โcGMP) |
| EPEC | Infantile diarrhea | Attaches, effaces intestinal cells |
| EHEC | Hemorrhagic colitis + HUS | Shiga-like toxin - inhibits protein synthesis |
| EIEC | Dysentery-like illness | Invades colonic cells |
| EAEC | Persistent diarrhea | Aggregative adherence |
Memory trick: "ETEC Travels, EPEC in Infants, EHEC = Hemorrhage/HUS, EIEC = Invasion, EAEC = persists"
Pathogenesis:
- P pili (fimbriae) โ attach to urinary tract
- EHEC โ Shiga-like toxin โ HUS (anemia + thrombocytopenia + renal failure)
- K antigen (capsule) โ inhibits phagocytosis
Lab: Pink colonies on MacConkey (lactose fermenter), Indole positive
Treatment:
- UTIs: TMP-SMX, fluoroquinolones, beta-lactams
- EHEC diarrhea: supportive only - NO antibiotics (antibiotics increase HUS risk!)
- Meningitis/sepsis: IV antibiotics
SALMONELLA
Diseases: Gastroenteritis, Typhoid fever (S. typhi), Bacteremia
Key Pathogenesis:
- Invades intestinal epithelial cells
- Survives INSIDE macrophages
- Vi capsule (S. typhi) โ increased virulence
- Chronic carriers: colonize the gallbladder
Clinical Signs:
- Gastroenteritis: fever, diarrhea, abdominal pain
- Typhoid fever: sustained fever, headache, rose spots, hepatosplenomegaly, constipation or diarrhea
Lab: Non-lactose fermenter on MacConkey, produces HโS, blood culture positive early in typhoid
Treatment: Gastroenteritis - supportive; Typhoid - ceftriaxone or fluoroquinolones
Vaccines for typhoid: oral live attenuated OR injectable polysaccharide
SHIGELLA
Disease: Bacillary dysentery
Key Facts:
- Very low infectious dose (very contagious)
- Person-to-person spread common
- Invades colonic mucosal cells
- Produces Shiga toxin (inhibits protein synthesis)
Clinical Signs: Fever, abdominal cramps, bloody mucoid diarrhea, tenesmus
Lab: Non-lactose fermenter, does NOT produce HโS, leukocytes in stool
Treatment: Rehydration + ciprofloxacin or azithromycin
KLEBSIELLA
Diseases: Pneumonia, UTIs, sepsis, liver abscess
Key Feature: Large polysaccharide capsule - inhibits phagocytosis
Classic Clue: "Currant jelly sputum" in pneumonia (alcoholics/debilitated patients)
Lab: Lactose-fermenting mucoid colonies on MacConkey, non-motile, encapsulated
Important: ESBL-producing strains โ multidrug resistance
PROTEUS
Diseases: UTIs, kidney stones (struvite calculi)
Key Feature: Strong urease activity โ alkalinizes urine โ promotes stone formation
Lab: Non-lactose fermenter, swarming growth on blood agar, urease positive
ENTEROBACTERIACEAE QUICK COMPARISON
| Bug | Key Feature | Disease Clue |
|---|---|---|
| E. coli | Most common UTI | EHEC โ HUS |
| Salmonella | Invades, survives in macrophages | Rose spots, typhoid |
| Shigella | Low ID, Shiga toxin | Bloody diarrhea + tenesmus |
| Klebsiella | Big capsule, mucoid | Currant jelly sputum |
| Proteus | Urease positive, swarming | Kidney stones |
PART 2: GRAM-NEGATIVE RODS & CURVED BACTERIA
VIBRIO
Shape: Comma-shaped (curved) rods, Oxidase POSITIVE, grows in alkaline media
| Species | Disease |
|---|---|
| V. cholerae | Cholera |
| V. parahaemolyticus | Gastroenteritis (seafood) |
| V. vulnificus | Wound infections/septicemia |
Cholera Toxin Mechanism:
- AB toxin โ A subunit activates adenylate cyclase โ โcAMP โ massive Clโป and water secretion
- No mucosal invasion
- "Rice-water" diarrhea โ dehydration โ shock
Lab: TCBS agar, oxidase positive
Treatment: Aggressive fluid replacement + doxycycline/azithromycin (severe)
HELICOBACTER PYLORI
Characteristics: Curved/spiral rods, microaerophilic, strongly urease positive, multiple flagella
Diseases: Chronic gastritis, peptic ulcer disease, gastric adenocarcinoma, gastric MALT lymphoma
Pathogenesis:
- Urease โ ammonia โ neutralizes gastric acid
- Flagella penetrate mucus layer
- VacA + CagA toxins โ damage epithelial cells
Diagnosis:
- Urea breath test
- Stool antigen test
- Biopsy + rapid urease test
Treatment - Triple Therapy:
- Proton pump inhibitor + Clarithromycin + Amoxicillin (or metronidazole)
Memory: "PCA" = PPI + Clarithromycin + Amoxicillin
CAMPYLOBACTER JEJUNI
Characteristics: Curved rods, microaerophilic, oxidase positive, grows at 42ยฐC
Key Complication: Guillain-Barrรฉ syndrome (post-infectious, molecular mimicry)
Clinical Signs: Fever, abdominal pain, bloody diarrhea
Lab: "Gull-wing" shaped organisms, grows at 42ยฐC
Transmission: Undercooked poultry, unpasteurized milk
Treatment: Usually self-limited; azithromycin for severe cases
PART 3: GRAM-NEGATIVE RODS - SPECIAL FEATURES
PSEUDOMONAS AERUGINOSA
Characteristics: Oxidase positive, obligate aerobe, non-lactose fermenter, blue-green pigment (pyocyanin), fruity odor
Diseases: Ventilator-associated pneumonia, burn wound infections, UTIs, otitis externa (swimmer's ear), sepsis
Pathogenesis: Exotoxin A (inhibits protein synthesis), biofilm formation, MDR
Clue: Ecthyma gangrenosum (necrotic black skin lesions) in neutropenic patients + greenish pus + fruity odor
Treatment (antipseudomonal):
- Piperacillin-tazobactam
- Ceftazidime
- Carbapenems
- Combination therapy for severe infection
BURKHOLDERIA
| Species | Disease |
|---|---|
| B. cepacia | Pneumonia in cystic fibrosis patients |
| B. pseudomallei | Melioidosis |
Treatment: TMP-SMX; ceftazidime for severe melioidosis
BACTEROIDES FRAGILIS
Characteristics: Gram-negative anaerobic rods, normal colon flora, has capsule
Disease: Intra-abdominal abscesses, peritonitis, bacteremia (after bowel trauma/surgery)
Key Features:
- Capsule inhibits phagocytosis
- Produces beta-lactamase
- Synergistic infection with aerobes
Treatment: Metronidazole or carbapenems
PREVOTELLA
Characteristics: Gram-negative anaerobic rods, normal oral and genital flora
Diseases: Aspiration pneumonia, periodontal infections, pelvic infections
Clue: Foul-smelling discharge, pigmented colonies on culture
Treatment: Metronidazole, clindamycin
FUSOBACTERIUM NECROPHORUM
Disease: Oropharyngeal infections, Lemierre syndrome (septic thrombophlebitis of internal jugular vein)
Memory: "Lemierre = Lemur living in your jugular vein" - starts as sore throat โ septicemia
Treatment: Metronidazole; beta-lactam + beta-lactamase inhibitor
PART 4: RESPIRATORY GRAM-NEGATIVE RODS
HAEMOPHILUS INFLUENZAE
Characteristics: Gram-negative coccobacilli, requires Factor X (hemin) and Factor V (NAD) - grows on chocolate agar only
Key Species:
- Type b (encapsulated): meningitis, epiglottitis
- Non-typeable: otitis media, sinusitis, pneumonia
Lab: Satellitism around S. aureus (S. aureus provides Factor V)
Treatment: Ceftriaxone (meningitis); amoxicillin-clavulanate (non-typeable)
Prevention: Hib vaccine - very effective, dramatically reduced childhood meningitis
BORDETELLA PERTUSSIS
Disease: Whooping cough (Pertussis)
Pathogenesis:
- Pertussis toxin โ โcAMP (same as cholera but different mechanism)
- Tracheal cytotoxin โ destroys ciliated epithelium
- Filamentous hemagglutinin โ attachment
- Causes lymphocytosis
Stages of Whooping Cough:
| Stage | Features |
|---|---|
| Catarrhal | Mild cough, rhinorrhea (most contagious!) |
| Paroxysmal | Severe coughing fits + inspiratory "whoop" |
| Convalescent | Gradual recovery |
Key: Apnea in infants (no "whoop" in infants!)
Lab: Bordet-Gengou or Regan-Lowe medium; PCR
Treatment: Macrolides (azithromycin) - reduces transmission but does NOT reverse toxin effects
Prevention: DTaP/Tdap vaccine
LEGIONELLA PNEUMOPHILA
Characteristics: Obligate intracellular, poorly staining, aerobic
Disease: Legionnaires' disease (severe pneumonia), Pontiac fever (mild, flu-like)
Transmission: Inhalation of aerosolized water (AC units, cooling towers) - NO person-to-person
Pathogenesis: Survives inside macrophages, inhibits phagolysosome fusion
Classic Clues:
- Hyponatremia (low sodium)
- Diarrhea + pneumonia
- Confusion
- History of staying in hotel or near cooling towers
Lab: Urinary antigen test (gold standard); BCYE agar; silver stain
Treatment: Azithromycin or fluoroquinolones
ACINETOBACTER BAUMANNII
Characteristics: Gram-negative coccobacilli, aerobic, oxidase negative, non-motile
Disease: Ventilator-associated pneumonia, bacteremia, wound infections (hospital pathogen)
Key: Biofilm formation, MDR, survives on dry surfaces for long periods
Treatment: Carbapenems; colistin for MDR strains
PART 5: MYCOBACTERIA
GENERAL FEATURES
- Acid-fast bacilli (Ziehl-Neelsen stain)
- Aerobic, slow-growing
- Cell wall rich in mycolic acids (makes them acid-fast)
- NOT true gram-negative organisms
MYCOBACTERIUM TUBERCULOSIS
Transmission: Airborne droplet nuclei
Pathogenesis:
- Survives INSIDE macrophages
- Inhibits phagosome-lysosome fusion
- Cell-mediated immunity โ granuloma formation โ caseous necrosis
Classic Symptoms: Chronic cough, hemoptysis, fever, night sweats, weight loss
Lab:
- Acid-fast stain (Ziehl-Neelsen)
- Lowenstein-Jensen medium (slow grower)
- Tuberculin skin test (PPD)
- IGRA (Interferon-gamma release assay)
Treatment - RIPE Regimen:
- Rifampin
- Isoniazid
- Pyrazinamide
- Etambutol
Prevention: BCG vaccine; isolation of active cases
MYCOBACTERIUM LEPRAE
Disease: Leprosy (Hansen's disease)
Key Facts:
- Infects skin and peripheral nerves
- Cannot be cultured in vitro
- Cell-mediated immunity determines disease type (lepromatous vs tuberculoid)
Signs: Hypopigmented anesthetic skin lesions, peripheral neuropathy, deformities
Treatment: Dapsone + Rifampin + Clofazimine (multidrug therapy)
PART 6: ZOONOTIC GRAM-NEGATIVE RODS
BRUCELLA (Undulant Fever)
Animal Source: B. melitensis (goats), B. abortus (cattle), B. suis (pigs), B. canis (dogs)
Transmission: Unpasteurized milk/dairy, contact with infected animals, inhalation (lab risk)
Pathogenesis: Facultative intracellular, survives in macrophages, inhibits phagolysosome fusion
Classic Signs: Undulating (intermittent) fever, night sweats, fatigue, arthralgia, hepatosplenomegaly
Lab: Blood culture with prolonged incubation; HIGH lab hazard
Treatment: Doxycycline + Rifampin (prolonged course to prevent relapse)
No human vaccine available
FRANCISELLA TULARENSIS (Tularemia)
Transmission: Tick/deer fly bites, contact with rabbits, inhalation, contaminated water
Highly infectious - requires special lab notification
Clinical Forms:
| Form | Signs |
|---|---|
| Ulceroglandular | Skin ulcer + lymphadenopathy |
| Glandular | Lymphadenopathy only |
| Pneumonic | Cough, chest pain |
| Typhoidal | Systemic illness, no localized findings |
Treatment: Streptomycin or gentamicin; doxycycline for mild cases
YERSINIA PESTIS (Plague)
Transmission: Flea bite from rodents; pneumonic = respiratory droplets
Forms of Plague:
- Bubonic: Painful lymphadenopathy (buboes), fever
- Septicemic: DIC, gangrene
- Pneumonic: Severe pneumonia, hemoptysis (most dangerous, person-to-person!)
Lab: Bipolar "safety pin" staining appearance
Treatment: Streptomycin or gentamicin; doxycycline alternative
YERSINIA ENTEROCOLITICA
Disease: Gastroenteritis, mesenteric adenitis, pseudoappendicitis (mimics appendicitis!)
Transmission: Contaminated pork, unpasteurized milk
Key: Grows at low temperatures (refrigeration) = cold enrichment improves isolation
PASTEURELLA MULTOCIDA
Transmission: Animal bites/scratches (especially cats and dogs)
Disease: Cellulitis with rapid onset at bite site
Treatment: Penicillin; amoxicillin-clavulanate
BARTONELLA
| Species | Disease | Vector |
|---|---|---|
| B. henselae | Cat scratch disease, Bacillary angiomatosis | Cat scratch/flea |
| B. quintana | Trench fever | Body lice |
Pathogenesis: Infects endothelial cells, angiogenic (causes vascular lesions)
Lab: Warthin-Starry silver stain; serology; PCR
Treatment: Azithromycin (cat scratch); doxycycline or erythromycin (severe)
PART 7: MYCOPLASMA
MYCOPLASMA PNEUMONIAE
Key Features:
- Smallest free-living organism
- NO cell wall โ resistant to beta-lactams
- Does NOT stain with Gram stain
- Cell membrane has sterols (unusual for bacteria)
Disease: Atypical ("walking") pneumonia, tracheobronchitis, pharyngitis
Typical in: Adolescents, young adults, military recruits, college students
Classic Clue: "Worse on X-ray than they look clinically" (mild symptoms but interstitial infiltrates on CXR)
Lab: Cold agglutinin test positive; no growth on standard media; PCR used
Treatment: Macrolides (azithromycin), doxycycline, fluoroquinolones (NO beta-lactams!)
PART 8: SPIROCHETES
General: Thin, spiral, corkscrew motility - TOO THIN for Gram stain - dark-field microscopy
TREPONEMA PALLIDUM (Syphilis)
Transmission: Sexual contact, transplacental (congenital syphilis)
Stages of Syphilis:
| Stage | Key Features |
|---|---|
| Primary | Painless chancre + regional lymphadenopathy |
| Secondary | Maculopapular rash on palms and soles, condyloma lata, fever |
| Tertiary | Gummas, cardiovascular syphilis, neurosyphilis |
| Congenital | Hutchinson teeth, saddle nose, deafness |
Lab Tests:
- Dark-field microscopy of lesion
- Nontreponemal: VDRL, RPR (screening)
- Treponemal: FTA-ABS, TPPA (confirmatory)
Treatment: Penicillin G (gold standard); doxycycline if penicillin-allergic
Cannot be cultured in vitro
BORRELIA BURGDORFERI (Lyme Disease)
Transmission: Ixodes tick bite
Stages of Lyme Disease:
| Stage | Signs |
|---|---|
| Early (Localized) | Erythema migrans (bull's-eye rash), fever |
| Early (Disseminated) | Facial nerve palsy, heart block, multiple EM rashes |
| Late | Arthritis, neurologic disease |
Key: Antigenic variation โ immune evasion
Lab: ELISA then Western blot (two-step testing)
Treatment: Doxycycline (adults); amoxicillin (pregnant women, children)
Relapsing Fever (B. recurrentis): Louse or tick transmission; recurrent cycles of fever/chills; visible in blood smear during febrile episodes
LEPTOSPIRA INTERROGANS (Leptospirosis)
Transmission: Water contaminated with animal urine (enters through abraded skin)
Classic Signs: Fever, headache, severe calf muscle pain, conjunctival suffusion
Weil Disease (severe form): Jaundice + renal failure + hemorrhage
Treatment: Doxycycline; penicillin G for severe disease
Prevention: Doxycycline prophylaxis in high-risk exposure
PART 9: RICKETTSIA
Characteristics: Small gram-negative coccobacilli, obligate intracellular, arthropod vectors
Pathogenesis: Invade endothelial cells โ vasculitis โ vascular permeability โ edema, hemorrhage, ischemia
| Species | Disease | Vector |
|---|---|---|
| R. rickettsii | Rocky Mountain Spotted Fever | Tick |
| R. prowazekii | Epidemic typhus | Louse feces |
| R. typhi | Endemic (murine) typhus | Flea |
RMSF Classic Features:
- High fever + severe headache
- Rash starts on wrists/ankles โ spreads centrally (centripetal)
- Rash involves palms and soles
Treatment: Doxycycline for ALL rickettsial infections
Lab: Serologic tests; PCR; Weil-Felix test is OBSOLETE
PART 10: ACTINOMYCES ISRAELII
Characteristics: Gram-positive branching filamentous rods (looks like fungi but is bacteria), anaerobic, non-acid-fast, normal oral/GI/genital flora
Transmission: Endogenous - mucosal disruption (dental procedures, trauma)
Key Features:
- Chronic granulomatous inflammation
- Abscesses with sulfur granules in pus (pathognomonic)
- Draining sinus tracts
Classic Presentation: "Lumpy jaw" (cervicofacial actinomycosis) - firm jaw swelling + draining sinuses
Treatment: High-dose penicillin, prolonged therapy
PART 11: CHLAMYDIA
Key Features:
- Gram-negative like but obligate intracellular
- Cannot synthesize ATP (energy parasite)
- Does NOT grow on artificial media
- Unique two-stage life cycle:
- Elementary body (EB): Infectious, extracellular form
- Reticulate body (RB): Replicating intracellular form
CHLAMYDIA TRACHOMATIS
Most common bacterial STI
Diseases:
- Urethritis, cervicitis, PID
- Neonatal conjunctivitis
- Trachoma (leading infectious cause of blindness worldwide)
- Lymphogranuloma venereum (LGV)
Key: Often asymptomatic
Lab: NAAT (nucleic acid amplification test) from urine or swab
Treatment: Azithromycin (single dose) or doxycycline
CHLAMYDIA PNEUMONIAE
Disease: Atypical pneumonia, pharyngitis, bronchitis
Clue: Gradual onset cough + hoarseness + mild fever
Treatment: Macrolides or doxycycline
CHLAMYDIA PSITTACI
Disease: Psittacosis (atypical pneumonia)
Transmission: Inhalation of dried bird droppings (parrots, birds)
Clue: History of bird exposure + pneumonia
Treatment: Doxycycline
MASTER HIGH-YIELD TABLES
TOXIN MECHANISMS - MUST KNOW
| Organism | Toxin | Mechanism |
|---|---|---|
| ETEC | Heat-labile toxin | โ cAMP |
| ETEC | Heat-stable toxin | โ cGMP |
| V. cholerae | Cholera toxin (AB) | โ cAMP |
| B. pertussis | Pertussis toxin | โ cAMP |
| EHEC / Shigella | Shiga toxin | Inhibits protein synthesis |
| Pseudomonas | Exotoxin A | Inhibits protein synthesis |
| H. pylori | VacA, CagA | Epithelial cell damage |
INTRACELLULAR ORGANISMS (survive inside macrophages)
| Organism | Mechanism |
|---|---|
| Salmonella | Invades, survives inside macrophages |
| Brucella | Inhibits phagolysosome fusion |
| Francisella | Suppresses immune response |
| Legionella | Inhibits phagolysosome fusion |
| M. tuberculosis | Inhibits phagosome-lysosome fusion |
| Rickettsia | Obligate intracellular - endothelial cells |
| Chlamydia | Obligate intracellular - unique EB/RB cycle |
CULTURES & MEDIA - HIGH YIELD
| Organism | Media/Lab Finding |
|---|---|
| E. coli | Pink colonies on MacConkey (lactose +), Indole + |
| Salmonella | Non-lactose fermenter, HโS + |
| Shigella | Non-lactose fermenter, no HโS |
| Klebsiella | Mucoid lactose fermenter on MacConkey |
| Proteus | Swarming on blood agar, urease + |
| Vibrio | TCBS agar, oxidase + |
| Haemophilus | Chocolate agar (X + V factors), satellitism |
| Bordetella | Bordet-Gengou or Regan-Lowe agar |
| Legionella | BCYE agar; urinary antigen test |
| Mycobacteria | Lowenstein-Jensen medium; acid-fast stain |
| Campylobacter | Grows at 42ยฐC; "gull-wing" morphology |
| Actinomyces | Anaerobic culture; sulfur granules |
TREATMENT CHEAT SHEET
| Organism | Treatment |
|---|---|
| H. pylori | PPI + Clarithromycin + Amoxicillin |
| TB | RIPE (Rifampin, Isoniazid, Pyrazinamide, Ethambutol) |
| Leprosy | Dapsone + Rifampin + Clofazimine |
| Syphilis | Penicillin G |
| Lyme Disease | Doxycycline (adults) |
| Rickettsia | Doxycycline (ALL species) |
| Brucella | Doxycycline + Rifampin |
| Chlamydia | Azithromycin or Doxycycline |
| Mycoplasma | Macrolides or Doxycycline (NO beta-lactams!) |
| Pseudomonas | Piperacillin-TZB, Ceftazidime, Carbapenems |
| MDR Acinetobacter | Colistin |
| Actinomyces | High-dose Penicillin (prolonged) |
| Bacteroides fragilis | Metronidazole |
| Whooping cough | Azithromycin/Erythromycin (macrolides) |
| Plague (Yersinia pestis) | Streptomycin/Gentamicin |
| EHEC diarrhea | Supportive ONLY - NO antibiotics |
RASH ON PALMS AND SOLES (2 key organisms)
- Treponema pallidum (Secondary syphilis) - maculopapular
- Rickettsia rickettsii (RMSF) - starts wrists/ankles, spreads centrally
VECTOR-BORNE DISEASES
| Organism | Vector | Disease |
|---|---|---|
| R. rickettsii | Tick | RMSF |
| R. prowazekii | Louse feces | Epidemic typhus |
| R. typhi | Flea | Endemic typhus |
| B. burgdorferi | Ixodes tick | Lyme disease |
| Y. pestis | Flea from rodents | Plague |
| F. tularensis | Tick/deer fly | Tularemia |
| B. quintana | Body lice | Trench fever |
CANNOT BE CULTURED IN VITRO
- Treponema pallidum
- Mycobacterium leprae
- Chlamydia (won't grow on artificial media)
- Rickettsia (obligate intracellular)
UNIQUE/CLASSIC PRESENTATIONS
| Clue | Organism |
|---|---|
| Currant jelly sputum | Klebsiella |
| Rice-water diarrhea | V. cholerae |
| Gull-wing organisms | Campylobacter |
| Rose spots + hepatosplenomegaly | Salmonella typhi |
| Bull's-eye rash | Borrelia burgdorferi (Lyme) |
| Painless chancre | Treponema pallidum (syphilis) |
| Buboes | Yersinia pestis (plague) |
| Sulfur granules, lumpy jaw | Actinomyces israelii |
| Safety-pin bipolar staining | Yersinia pestis |
| Whoop + lymphocytosis | Bordetella pertussis |
| Hyponatremia + pneumonia | Legionella |
| Cat scratch + lymphadenopathy | Bartonella henselae |
| Pseudoappendicitis | Yersinia enterocolitica |
| Undulating fever | Brucella |
| Blue-green pus + fruity odor | Pseudomonas aeruginosa |
| Weil disease (jaundice + renal failure) | Leptospira |
| Lemierre syndrome | Fusobacterium necrophorum |
| Melioidosis | Burkholderia pseudomallei |
| Psittacosis | Chlamydia psittaci |
| HUS after bloody diarrhea | EHEC (E. coli O157:H7) |
| Atypical pneumonia in college student | Mycoplasma pneumoniae |
Good luck on your exam tomorrow! The most commonly tested points are: EHEC โ HUS (no antibiotics), H. pylori triple therapy, TB RIPE regimen, syphilis stages, Lyme stages, Rickettsia = doxycycline for all, Mycoplasma = no cell wall so no beta-lactams, and the intracellular organisms that survive in macrophages.
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