INFECTIOUS DISEASES
Ed Friedlander, M.D., Pathologist
scalpel_blade@yahoo.com

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Welcome to Ed's Pathology Notes, placed here originally for the convenience of medical students at my school. You need to check the accuracy of any information, from any source, against other credible sources. I cannot diagnose or treat over the web, I cannot comment on the health care you have already received, and these notes cannot substitute for your own doctor's care. I am good at helping people find resources and answers. If you need me, send me an E-mail at scalpel_blade@yahoo.com Your confidentiality is completely respected. No texting or chat messages, please. Ordinary e-mails are welcome.

I am active in HealthTap, which provides free medical guidance from your cell phone. There is also a fee site at www.afraidtoask.com.


If you have a Second Life account, please visit my teammates and me at the Medical Examiner's office.

Freely have you received, give freely With one of four large boxes of "Pathguy" replies.

I'm still doing my best to answer everybody. Sometimes I get backlogged, sometimes my E-mail crashes, and sometimes my literature search software crashes. If you've not heard from me in a week, post me again. I send my most challenging questions to the medical student pathology interest group, minus the name, but with your E-mail where you can receive a reply.

Numbers in {curly braces} are from the magnificent Slice of Life videodisk. No medical student should be without access to this wonderful resource.

I am presently adding clickable links to images in these notes. Let me know about good online sources in addition to these:

Freely have you received, freely give. -- Matthew 10:8. My site receives an enormous amount of traffic, and I'm still handling dozens of requests for information weekly, all as a public service.

Pathology's modern founder, Rudolf Virchow M.D., left a legacy of realism and social conscience for the discipline. I am a mainstream Christian, a man of science, and a proponent of common sense and common kindness. I am an outspoken enemy of all the make-believe and bunk that interfere with peoples' health, reasonable freedom, and happiness. I talk and write straight, and without apology.

Throughout these notes, I am speaking only for myself, and not for any employer, organization, or associate.

Special thanks to my friend and colleague, Charles Wheeler M.D., pathologist and former Kansas City mayor. Thanks also to the real Patch Adams M.D., who wrote me encouragement when we were both beginning our unusual medical careers.

If you're a private individual who's enjoyed this site, and want to say, "Thank you, Ed!", then what I'd like best is a contribution to the Episcopalian home for abandoned, neglected, and abused kids in Nevada:

I've spent time there and they are good. Write "Thanks Ed" on your check.

Help me help others

My home page
More of my notes
My medical students

Especially if you're looking for information on a disease with a name that you know, here are a couple of great places for you to go right now and use Medline, which will allow you to find every relevant current scientific publication. You owe it to yourself to learn to use this invaluable internet resource. Not only will you find some information immediately, but you'll have references to journal articles that you can obtain by interlibrary loan, plus the names of the world's foremost experts and their institutions.

Alternative (complementary) medicine has made real progress since my generally-unfavorable 1983 review. If you are interested in complementary medicine, then I would urge you to visit my new Alternative Medicine page. If you are looking for something on complementary medicine, please go first to the American Association of Naturopathic Physicians. And for your enjoyment... here are some of my old pathology exams for medical school undergraduates.

I cannot examine every claim that my correspondents share with me. Sometimes the independent thinkers prove to be correct, and paradigms shift as a result. You also know that extraordinary claims require extraordinary evidence. When a discovery proves to square with the observable world, scientists make reputations by confirming it, and corporations are soon making profits from it. When a decades-old claim by a "persecuted genius" finds no acceptance from mainstream science, it probably failed some basic experimental tests designed to eliminate self-deception. If you ask me about something like this, I will simply invite you to do some tests yourself, perhaps as a high-school science project. Who knows? Perhaps it'll be you who makes the next great discovery!

Our world is full of people who have found peace, fulfillment, and friendship by suspending their own reasoning and simply accepting a single authority that seems wise and good. I've learned that they leave the movements when, and only when, they discover they have been maliciously deceived. In the meantime, nothing that I can say or do will convince such people that I am a decent human being. I no longer answer my crank mail.

This site is my hobby, and I do not accept donations, though I appreciate those who have offered to help.

During the seventeen years my site has been online, it's proved to be one of the most popular of all internet sites for undergraduate physician and allied-health education. It is so well-known that I'm not worried about borrowers. I never refuse requests from colleagues for permission to adapt or duplicate it for their own courses... and many do. So, fellow-teachers, help yourselves. Don't sell it for a profit, don't use it for a bad purpose, and at some time in your course, mention me as author and KCUMB as my institution. Drop me a note about your successes. And special thanks to everyone who's helped and encouraged me, and especially the people at KCUMB for making it possible, and my teaching assistants over the years.

Whatever you're looking for on the web, I hope you find it, here or elsewhere. Health and friendship!

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More of Ed's Notes: Ed's Medical Terminology Page

Perspectives on Disease
Cell Injury and Death
Accumulations and Deposits
Inflammation
Fluids
Genes
What is Cancer?
Cancer: Causes and Effects
Immune Injury
Autoimmunity
Other Immune
HIV infections
The Anti-Immunization Activists
Infancy and Childhood
Aging
Infections
Nutrition
Environmental Lung Disease
Violence, Accidents, Poisoning
Heart
Vessels
Respiratory
Red Cells
White Cells
Coagulation
Oral Cavity
GI Tract
Liver
Pancreas (including Diabetes)
Kidney
Bladder
Men
Women
Breast
Pituitary
Thyroid
Adrenal and Thymus
Bones
Joints
Muscles
Skin
Nervous System
Eye
Ear
Autopsy
Lab Profiling
Blood Component Therapy
Serum Proteins
Renal Function Tests
Adrenal Testing
Arthritis Labs
Glucose Testing
Liver Testing
Porphyria
Urinalysis
Spinal Fluid
Lab Problem
Quackery
Alternative Medicine (current)
Preventing "F"'s: For Teachers!
Medical Dictionary

Courtesy of CancerWEB

The author of these notes had the privilege of being trained in microbiology by Northwestern's legendary pathologist-microbiologist, Herbert M. Sommers (1925-2001).

He was a leader of his profession, and a genuinely good human being.

Thanks, Bert.

In science, it is always a mistake not to doubt when facts do not compel you to affirm.

For the cost of Kyoto in just 2010, we could once and for all solve the single biggest problem on earth. We could give clean drinking water and sanitation to every single human being on the planet. This would save two million lives and avoid half a billion severe illnesses every year.

Kisses blown are kisses wasted,
Kisses aren't kisses until they are tasted,
Kissing spreads germs, and germs are hated,
So kiss me, darling, I'm vaccinated.

Infectious Disease
Taiwanese pathology site
Good place to go to practice

Infectious Disease
Photo Library of Pathology
U. of Tokushima

Infectious Disease
Iowa Virtual Microscopy
Have fun

Infection Images
University of Washington
Pictures and comments

Protozoa and Worms
CDC image library
Lots and lots of pictures

Pathology of Infectious Diseases
Great site
Yutaka Tsutsumi MD

Sexually Transmitted Diseases

Chaing Mi, Thailand

Infectious Disease
Photos, explanations, and quiz
Indiana U.

Infection
Sampurna Roy, MD
Lots of photos and good text

Pathology of Biologic Warfare
Plague, anthrax, exotic viruses
Interesting site

KCUMB Students
"Big Robbins" -- Infectious
Lectures follow Textbook

QUIZBANK -- Infectious disease (all)

Microbe Library -- American Society for Microbiology teaching resources

CDC'S RECOMMENDATIONS FOR ADULT IMMUNIZATION: JAMA 288: 2258, 2002. Health advice and immunization (hepatitis A, hepatitis B, typhoid, cholera, rabies, meningococcus, Japanese encephalitis, BCG, Lyme disease, tick encephalitis) for those planning to go overseas: NEJM 342: 1716, 2000.

Infectious diseases for the team doctor: JAMA 271: 862, 1994; Ann. Int. Med. 122: 283, 1995. The main ones to worry about are the viruses, but AIDS transmission in sports seems most unlikely.

Future physicians: Before you start practice in the community, be sure you know how to recognize, and have a fair index of suspicion for, each of the following infections, which might be introduced by bioterrorists:

Learning Objectives: Viruses

NOTE: This unit begins with a focus on the common, whole-body virus infections. We will study hepatitis viruses, skin viruses, brain viruses, and retroviruses in systemic pathology.

Define, and correctly use, the following terms:

Explain why it is simplistic to think of a particular microbe as the single, sufficient "cause" of a particular clinical problem. Give some examples, and some exceptions.

Mention the essential features, and give the names and sizes of the largest and smallest pathogenic human viruses. Mention the four phases of the virus cycle. Explain how viruses do us harm at the cellular level, and give examples.

Given the name of a virus, recall its family and nucleic acid type, and whether (and where) it produces inclusion bodies. (* This is a reasonable objective, Doctor; people will be asking you to do this for the rest of your life.)

Describe the essential features and important complications of the following viral illnesses:

Describe the essential pathology of the common cold, and mention the viruses that produce it. Mention the other viruses that produce respiratory infections, the distinctive features of each, and other clinical syndromes they can produce. Name the non-virus that is a very important cause of "chest colds".

List the three important agents of true viral gastroenteritis.

Describe the common features of arbovirus infections, the nature of "hemorrhagic fevers", and the distinctive features of yellow fever, dengue, and Lassa fever.

Recall the numbered strain of human papillomavirus that causes most simple warts, and the two strains most strongly linked to cancer of the cervix.

Explain current thinking about chronic fatigue syndrome, and tell when you might make this diagnosis.

Discuss the basic biology of chlamydia, rickettsia, and mycoplasma. Tell how they are like familiar bacteria, and how they differ from them and from one another.

Recognize those viral diseases that could theoretically be eradicated, and mention impediments to this.

Recognize and distinguish the various chlamydial diseases, mentioning their distinctive features. Explain why it is difficult to eradicate chlamydial infections.

Name the agents, vectors, and pathologic and clinical features of typhus, ehrlichiosis, Rocky Mountain spotted fever, scrub typhus, and Q-fever.

Mention the major mycoplasmal diseases, and the distinctive features of a mycoplasmal respiratory infection.

Give the classical synonyms for each disease in this unit.

Recognize the following under the microscope:

NOTE: In spite of what anybody else might tell you, prions (the agents of kuru, scrapie, Creutzfeldt-Jakob, and so forth) are not viruses ("slow" or otherwise). There's no longer any reasonable doubt. More about prions under "CNS".

Neonatal sepsis
Tom Demark's Site

Septic transfusion reaction
Pittsburgh Pathology Cases

INTRODUCING THE INFECTIOUS DISEASES

INTRODUCING THE VIRUSES

Pathology of viral infections
Great site
Yutaka Tsutsumi MD

Viral inclusions
Lung pathology series
Dr. Warnock's Collection

VIRUS RESPIRATORY DISORDERS

{24371} adenovirus lung infection; low power shot just shows thickening of the alveolar septa
{24374} adenovirus lung infection; hyaline membranes; no visible smudge cells but lots of lymphocytes
{01743} smudge cell, schematic diagram

Adenovirus pneumonia

Yutaka Tsutsumi MD

Adenovirus of the kidney
Advanced students
Yutaka Tsutsumi MD

Influenza

Yutaka Tsutsumi MD

Hand foot and mouth disease

Yutaka Tsutsumi MD

Viral myocarditis

Yutaka Tsutsumi MD

Acute Bronchitis
From Chile
In Spanish

GI TRACT VIRUSES

RASH VIRUSES

{12292} measles
{24924} Koplik's spots

Measles pneumonia

Yutaka Tsutsumi MD

Measles of the placenta

Yutaka Tsutsumi MD

{24925} measles giant cell

{53732} congenital rubella after-effects

Rubella of the placenta
Aadvanced students
Yutaka Tsutsumi MD

Molluscum contagiosum

Yutaka Tsutsumi MD

{08157} fifth disease (parvovirus 19; "slapped cheek disease")
{08158} fifth disease

Parvovirus B19
Aplastic crisis in hereditary spherocytosis
Yutaka Tsutsumi MD

Parvo B-19 hydrops fetalis

Yutaka Tsutsumi MD

HERPES VIRUSES

{21245} primary herpes infection (trust me)
{21247} primary herpes infection (trust me)

Herpetic folliculitis

Yutaka Tsutsumi MD

Herpes
Patient photos
Health Awareness Connection

Herpes simplex pneumonia

Yutaka Tsutsumi MD

Herpes simplex encephalitis

Yutaka Tsutsumi MD

{14122} herpes on the lip
{14124} herpes on the eyelids
{14128} herpes on the thumb
{12009} herpes on the lip
{12010} herpes on the wrist

{15473} herpes encephalitis, residual

{20038} herpes of a baby's liver, gross

{13338} herpes of skin, histology (swollen pale nuclei, no inclusions today)
{13341} herpes of skin, histology (swollen pale nuclei, no inclusions today)
{13342} herpes of skin, high magnification (swollen pale nuclei, no inclusions today)
{14136} positive Tzanck prep

Herpes blister

WebPath Photo

Herpes in epithelium

WebPath Photo

Herpes viruses

WebPath Photo

{14133} herpes on a man
{14134} herpes on a woman
{24936} herpes on a pap smear, good inclusions
{05272} herpes in a man with AIDS

Herpes simlex of the vulva

Yutaka Tsutsumi MD

{15609} baby died of herpes 2

Kaposi's sarcoma
Photomicrograph
KU Collection

{14146} zoster
{14149} zoster, trig-1
{14152} zoster, trig-2
{14154} zoster, trig-3
{14155} zoster, face ("facial nerve")
{12116} varicella
{14137} varicella

Varicella-Zoster encephalitis in AIDS

Yutaka Tsutsumi MD

Varicella, hemorrhagic

Yutaka Tsutsumi MD

Varicella-zoster pneumonia

Yutaka Tsutsumi MD

{15805} CMV "blueberry muffin rash"

CMV pancreatitis

Yutaka Tsutsumi MD

CMV retinitis in AIDS

Yutaka Tsutsumi MD

CMV of the placenta

Yutaka Tsutsumi MD

{16626} CMV in the kidney
{18807} CMV in the kidney
{20035} CMV in salivary gland
{20036} CMV in salivary gland
{22232} CMV in the retina (you need only recognize that there is lots wrong)
{01741} CMV schematic diagram

CMV pneumonia

Yutaka Tsutsumi MD

Cytomegalovirus

KU Collection

CMV
WebPath Photo

CMV
Adrenal necrosis
WebPath Photo

CMV
Kidney
WebPath Photo

CMV
Tom Demark's Site

{13706} circulating upset T-cell in infectious mononucleosis
{21243} posterior auricular lymph nodes
{23434} immunoblasts in infectious mono node (don't worry about how to tell this from CMV)
{46188} immunoblasts in infectious mono node

Epstein-Barr coronary aneurysm
Advanced students
Yutaka Tsutsumi MD

Infectious mononucleosis
Pittsburgh Pathology Cases

Leiomyomas in HIV
EBV effect
Pittsburgh Pathology Cases

Infectious mononucleosis
Blood picture
WebPath Photo

ARBOVIRUSES (arthropod-borne)

Hantavirus in the kidney
Korean hemorrhagic fever
Yutaka Tsutsumi MD

"CHRONIC FATIGUE SYNDROME" ("myalgic encephalomyelitis", philosophical review Ann. Int. Med. 134: 838, 2001; practical approach Am. Fam. Phys. 65: 1083, 2002)

CHLAMYDIAL DISEASES

Rickettsia and Chlamydia

Chaing Mi, Thailand

{23386} LGV, histopathology
{23425} LGV, histopathology

Chlamydia of the cervix

Yutaka Tsutsumi MD

RICKETTSIAL DISEASES

{05981} Rocky Mountain spotted fever, histology (necrosis and microthrombus in a small vessel)
{08145} Rocky Mountain spotted fever, face
{08146} Rocky Mountain spotted fever, wrist
{14281} Rocky Mountain spotted fever, bleeds from vasculitis
{14283} Rocky Mountain spotted fever, necrosis from vasculitis

Japanese rickettsial spotted fever
Advanced students
Yutaka Tsutsumi MD

Tsutsugamushi disease

Yutaka Tsutsumi MD

Bartonellosis
Cat scratch fever
Yutaka Tsutsumi MD

Bartonellosis
Bacillary angiomatosis in AIDS
Yutaka Tsutsumi MD

Ehrlichiosis

Yutaka Tsutsumi MD

MYCOPLASMAL DISEASES

Christina's world* PRESENT-DAY OPPOSITION TO IMMUNIZATION: "I don't care if my kid makes the others sick." It affects your patients.

The Anti-Immunization Activists
The lying is unbelievable.
Ed's data.

* INFECTIOUS DISEASE WORLDWIDE

Learning Objectives: The Bacteria

Rhodococcus
Pittsburgh Pathology Cases

INTRODUCTION TO THE BACTERIA

Pathology of bacterial infections
Great site
Yutaka Tsutsumi MD

Bacterial Infections
First Section
Chaing Mi, Thailand

Bacterial Infections
Second Section
Chaing Mi, Thailand

TERMS

Pneumococcal pneumonia
Sputum gram stain
KU Collection

Medical Word Roots

Symmetrical gangrene
Pneumococcal sepsis post splenectomy
Great photo from NEJM

PYOGENIC COCCI (round bacteria; "coccus" is Greek for "berry"; say "COX-eye", please, "cockeye" is ophthalmology)

STAPHYLOCOCCAL INFECTIONS

{24478} carbuncle
{10985} carbuncle (histology; it's all pus)
{12227} furuncle
{24871} furuncle, skin of wrist
{24661} furuncle (histology; the eosin is strong making the dermis red)
{08979} acute folliculitis, histology of a pimple

{12128} impetigo
{14190} impetigo
{43771} impetigo

{05946} toxic shock syndrome, skin starting to come off

MRSA conjunctivitis

Yutaka Tsutsumi MD

The many faces of staph
Rogues' gallery
Yutaka Tsutsumi MD

Staph impetigo

Yutaka Tsutsumi MD

Staph botyromycosis
Advanced students
Yutaka Tsutsumi MD

STREPTOCOCCAL INFECTIONS

Strep infections
Including "The Flesh Eater" and Fournier's
Yutaka Tsutsumi MD

NEISSERIAL INFECTIONS

{08386} neisseria

{39103} meningococcemia (note the purpura)
{39106} meningococcemia
{40212} meningococcemia
{40213} meningococcemia
{46212} meningococcemia
{07570} Waterhouse-Friderichsen syndrome, adrenal
{08953} Waterhouse-Friderichsen syndrome, histology of adrenal

Meningococcemia / DIC
Good teaching case
Pittsburgh Pathology Cases

{12443} gonorrhea in the male
{25537} chancre (syphilis) and gonorrhea

Gonorrhea

Yutaka Tsutsumi MD

Gonorrhea
Patient photos
Health Awareness Connection

GRAM NEGATIVE RODS

Klebsiella pneumonia

Yutaka Tsutsumi MD

Some necrotizing pneumonias
Lung pathology series
Dr. Warnock's Collection

Pseudomonas pneumonia

Yutaka Tsutsumi MD

{26972} legionella pneumonia, H&E (this is just neutrophils in the alveoli)
{26975} legionella, Dieterle silver stain (black speckles are the bugs)
{08179} legionella

Legionella
Lung pathology series
Dr. Warnock's Collection

Legionella pneumonia

Yutaka Tsutsumi MD

H. 'flu of the throat

Yutaka Tsutsumi MD

{19946} diphtheria, tonsils
{24489} diphtheria, membrane (trachea is opened from behind)

Diphtheria

Yutaka Tsutsumi MD

Diphtheria
Australian Pathology Museum
High-tech gross photos

ENTERIC PATHOGENS

{26369} typhoid ulcers, small intestine
{49172} typhoid ulcers, small intestine
{32078} typhoid microabscess, liver

Typhoid ulcers of the intestine
Classic drawing
Adami & McCrae, 1914

{49213} shigella in the gut

Vibrio vulnificus

Yutaka Tsutsumi MD

Aeromonas hydrophila
Advanced students
Yutaka Tsutsumi MD

CLOSTRIDIA: An ancient family of sporulating gram-positive strict anaerobes, common in the gut and in the outside world, but rarely troublesome.

THE BACTERIAL ZOONOSES

Pathology of Anthrax
Nice photoessay
Pathmax

Anthrax
Inoculation site
KU Collection

{12394} black plague!

{24488} tularemia ulcer (looks like pretty much any other acute infectious ulcer)

Tularemia

Yutaka Tsutsumi MD

Brucellosis

Yutaka Tsutsumi MD

Leptosirosis
Also relapsing fever
Yutaka Tsutsumi MD

Learning Objectives: The Other Bacteria

SYPHILIS ("lues", "the great pox", "VD", etc., etc.)

{25239} spirochetes, testis, stained blue
{27989} spirochetes, optic nerve
{46491} spirochetes
{12445} primary syphilis, man
{12447} secondary syphilis, woman

Syphilitic aneurysm
Classic patient photo
Adami & McCrae, 1914

Primary syphilis

Yutaka Tsutsumi MD

Syphilis in a lymph node

Yutaka Tsutsumi MD

Secondary syphilis

Yutaka Tsutsumi MD

"The Medical Inspection"
Toulouse-Lautrec
CSW's at the Moulin Rouge

Chancre histology
Classic drawing
Adami & McCrae, 1914

Syphilitic periostitis, skull
Classic photo
Adami & McCrae, 1914

{12352} primary syphilis
{14265} primary syphilis

Syphilis
Patient photos
Health Awareness Connection

{12282} secondary syphilis
{14268} secondary syphilis
{14271} secondary syphilis
{14275} secondary syphilis, condylomata lata
{25541} secondary syphilis
{25543} secondary syphilis

{26603} syphilis of the aorta

Gumma
WebPath Photo

Spirochetes
WebPath Photo

Tabes dorsalis, myelin stain
Dorsal columns at bottom
Classic drawing, Adami & McCrae, 1914

Syphilitic aortitis

Yutaka Tsutsumi MD

{25547} born with congenital syphilis
{53731} born with congenital syphilis, lacks nasal septum
{25548} born with congenital syphilis, gumma in palate

{08199} yaws
{08200} yaws

LYME DISEASE: The recently-discovered dread infection, acquired from ixodes ticks that have feasted on infected deer mice. Update Lancet 379: 461, 2012.

Lyme disease
Expanding rings
McGill Center for Tropical Disease

Lyme disease

Yutaka Tsutsumi MD

EXOTIC BACTERIAL INFECTIONS that you might actually see in the clinic someday....

Gastric spirochetes

Yutaka Tsutsumi MD

TUBERCULOSIS ("TB", "the white plague" -- covered twice in both "Big Robbins" and "R&F", and it deserves the attention). All about TB, especially for Clinicians: Lancet 362: 877, 2003.

Keats
I know the color of that blood; it is arterial blood; I cannot be deceived. That drop is my death-warrant. I must die. * Keats's era believed that red, fresh blood was arterial, and dark, altered blood was venous.

TB granuloma
Classic drawing
Adami & McCrae, 1914

Tuberculosis of the jejunum
Classic drawing
Adami & McCrae, 1914

Tuberculosis I
From Chile
In Spanish

Tuberculosis II
From Chile
In Spanish

Tuberculosis
Lung pathology series
Dr. Warnock's Collection

Pulmonary TB
Australian Pathology Museum
High-tech gross photos

Tuberculosis of the lung
Classic drawing
Adami & McCrae, 1914

Tuberculosis of skin

Yutaka Tsutsumi MD

Tuberculosis

Yutaka Tsutsumi MD

{13809} red snappers

Tuberculous meningitis

Yutaka Tsutsumi MD

M. bovis
Pittsburgh Pathology Cases

Red snappers

WebPath Photo

{11012} miliary TB in the lung
{11015} miliary TB in the lung
{21147} miliary TB
{21148} miliary TB
{32807} TB meningitis (worst around the circle of Willis)

BCG in the bladder
After therapy
Yutaka Tsutsumi MD

ATYPICAL MYCOBACTERIAL INFECTIONS

Atypical mycobacteria in the lung

Yutaka Tsutsumi MD

Atypical mycobacteria of the skin
Buruli ulcer
Yutaka Tsutsumi MD

Mycobacterium avium

WebPath Photo

Atypical mycobacteria
Skin
Pittsburgh Pathology Cases

Atypical mycobacteria
Lung pathology series
Dr. Warnock's Collection

LEPROSY ("Hansen's disease"; Lancet 345: 697, 1995; Lancet 353: 655, 1999; Lancet 363: 1209, 2004)

Leprosy in the nerves

Yutaka Tsutsumi MD

Leprosy
Leonine facies
KU Collection

www.leprosy.org
Some good photos

{05975} lepromatous leprosy, lepra foam cells
{05978} lepromatous leprosy, acid-fast stain showing bugs
{12393} leprosy, hands
{13343} leprosy, lepromatous (leonine facies)

Lepromatous leprosy

Yutaka Tsutsumi MD

NOCARDIOSIS

Nocardia
Lung pathology series
Dr. Warnock's Collection

Nocardia

Yutaka Tsutsumi MD

Nocardia of the brain

Yutaka Tsutsumi MD

ACTINOMYCOSIS

{06115} actinomyces colony
{10904} endometrial actinomycosis

Actinomycosis of skin

Yutaka Tsutsumi MD

Actinomycosis of the lung

Yutaka Tsutsumi MD

Pathology of fungal infections
Great site
Yutaka Tsutsumi MD

Fungi
First Section
Chaing Mi, Thailand

Fungi
Second Section
Chaing Mi, Thailand

Fungi
Third Section
Chaing Mi, Thailand

Fungi
Fourth Section
Chaing Mi, Thailand

Fungal Diseases
Brazil Pathology Cases
In Portuguese
/td>

CANDIDIASIS ("moniliasis", "yeast infection")

{00416} candida in urine
{05283} thrush
{27362} candida yeast and pseudohyphae

Candida in the lung

Yutaka Tsutsumi MD

Candida
WebPath Photo

Candida
WebPath Photo

Candida
Silver stain
WebPath Photo

Oral thrush
WebPath Photo

Oral thrush
PAS
WebPath Photo

Candida
Tom Demark's Site

Candida
Male patient photos
Health Awareness Connection

Candida
Many places
Yutaka Tsutsumi MD

MUCORMYCOSIS ("mucor", "zygomycosis", "phycomycosis")

{06091} mucormycosis (good ninety-degree angle branching)

Mucormycosis

Yutaka Tsutsumi MD

Mucor of the lung
Pittsburgh Pathology Cases

Mucormycosis
WebPath Photo

ASPERGILLOSIS

{00413} aspergillus, brain
{06077} aspergillus, brain
{06085} aspergillus, vessel; silver stain
{10670} aspergillosis, lung
{10673} aspergillosis, lung
{11018} aspergillosis, lung; silver stain
{37661} aspergillosis, brain

Aspergillosis of the lung

Yutaka Tsutsumi MD

Fungus ball
WebPath Photo

Aspergillus pneumonia
WebPath Photo

Aspergillus in bronchus
WebPath Photo

Aspergillus
Nice branching
WebPath Photo

Aspergillus
Nice branching
WebPath Photo

Aspergillus sepsis
Pittsburgh Pathology Cases

Aspergillus
Tom Demark's Site

Aspergillus
Urbana Atlas of Pathology

Aspergilloma
Lung pathology series; follow the arrows
Dr. Warnock's Collection

Hyphal fungi and candida
Lung pathology series
Dr. Warnock's Collection

CRYPTOCOCCOSIS ("crypto")

Cryptococal meningitis

Yutaka Tsutsumi MD

Cryptoccal prostatitis

Yutaka Tsutsumi MD

Cryptococcosis
Infection in Virchow-Robin spaces
KU Collection

Disseminated cryptococcosis
Pittsburgh Pathology Cases

Cryptococcus
Lung
WebPath Photo

Cryptococcus
Pittsburgh Pathology Cases

Cryptococcus
Pittsburgh Pathology Cases

Cryptococcus
Silver stain
WebPath Photo

Cryptococcus
India ink prep
WebPath Photo

Cryptococcus and coccidioides
Lung pathology series
Dr. Warnock's Collection

Cryptoccal granuloma of lung

Yutaka Tsutsumi MD

BLASTOMYCOSIS ("blasto", "North American blasto", "Chicago disease"): JAMA 261: 3159, 1989; Lancet 1: 25, 1989 (still good); South. Med. J. 92: 289, 1999.

{00443} blastomycosis in tissue
{10667} blastomycosis in the lung (my case)
{00460} blastomycosis in AIDS patient (fungus is black)

Blastomycosis of the lung

Yutaka Tsutsumi MD

Blastomycosis
Single broad-based bud
KU Collection

Histoplasmosis and blastomycosis
Lung pathology series
Dr. Warnock's Collection

PARACOCCIDIOMYCOSIS ("South American blastomycosis")

{24491} South American "blastomycosis" of the face

Paracoccidioidomycosis

Yutaka Tsutsumi MD

COCCIDIOIDOMYCOSIS ("San Joaquin Valley fever") NEJM 332: 1077, 1995

{24221} coccidioidomycosis
{24224} coccidioidomycosis

Coccidioides

WebPath Photo

Coccidioidomycosis of the lung

Yutaka Tsutsumi MD

Coccidioides granuloma

WebPath Photo

Coccidioides

WebPath Photo

Coccidioides

WebPath Photo

HISTOPLASMOSIS ("histo")

{10364} histoplasmosis in macrophages
{06065} histoplasmosis
{06068} histoplasmosis

Histoplasmosis of the lung

Yutaka Tsutsumi MD

Histoplasmosis

WebPath Photo

Histoplasmosis
PAS stain

WebPath Photo

Histoplasmosis
Tom Demark's Site

Ghon focus; histoplasmosis
Lung pathology series
Dr. Warnock's Collection

OTHER DEEP FUNGI

Madura foot

Yutaka Tsutsumi MD

Sporotrichosis

Yutaka Tsutsumi MD

Chromomycosis

Yutaka Tsutsumi MD

Penicilliosis marneffei
AIDS patient
Yutaka Tsutsumi MD

Trichophytosis
Tinea capitis
Yutaka Tsutsumi MD

Alternariosis
Advanced students
Yutaka Tsutsumi MD

Protothecosis
Advanced students
Yutaka Tsutsumi MD

Rhinosporidiosis
Exotic fungus for advanced students
Yutaka Tsutsumi MD

Myospherulosis -- the bug that wasn't
Advanced students
Yutaka Tsutsumi MD

THE SUPERFICIAL FUNGI: You'll study ringworm, tinea versicolor, etc., in "Micro". Don't worry about them just now! Occasionally one can "go deep" in the immunocompromised.

Trichosporonosis
White piedra organisms
Pittsburgh Pathology Cases

{08148} ringworm
{12118} tinea pedis
{12268} tinea pedis
{14208} tinea pedis
{12182} tinea versicolor
{12267} tinea corporis
{14220} tinea corporis
{12270} tinea cruris
{14229} tinea unguum
{14232} tinea capitis
{14233} tinea capitis, black dots

Learning Objectives: "Critters"

For each of the infections covered in this unit, explain:

Recognize in a photomicrograph the infectious agents of each of the following:

Recognize each of the parasitic worms, given a scale and some clinical clues.

NOTE: We are not concerned with your learning taxonomies or intricacies of life cycles for these organisms, or the nuances of parasite identification (e.g., how many spots on a bancrofti's tummy, etc., etc.). You'll learn as much of this as you need in "Med Micro". For Pathology, you do need to know how and where these infections are contracted, and what they do to their victims. Knowing the rough sizes of the organism will help you recognize them in pictures* 

* Fear of the public toilet. The parts that several people touch may be contaminated with worm eggs of various kinds (Brazil abstract 95241825), transmissible hepatitis A (Eur. J. Epidem. 14: 187, 1998), rotavirus (Eur. J. Epidem. 11: 587, 1995), no doubt many others. Do wash your hands after.

INTRODUCTION TO THE NON-FUNGAL EUKARYOTIC INFECTIOUS AGENTS ("critters")

Pathology of protozoan infections
Great site
Yutaka Tsutsumi MD

AMEBIASIS

{08289} entamoeba histolytica (smear, trust us)
{08405} entamoeba histolytica
{11130} ameba, colon; three of them ate red cells
{26396} amebiasis ulcers in the colon
{46272} amebas, they have eaten red cells
{46273} amebic liver abscesses, trust me

Amebiasis of the colon
Classic drawing
Adami & McCrae, 1914

Amebic liver abscess

Yutaka Tsutsumi MD

Entamoeba gingivalis endometritis
Advanced students
Yutaka Tsutsumi MD

BALANTIDIUM COLI

{08398} balantidium

AMEBIC MENINGOENCEPHALITIS

Acanthameba meningoencephalitis

Yutaka Tsutsumi MD

Acanthamebic keratitis

Yutaka Tsutsumi MD

giardiaGIARDIASIS: The world's most ubiquitous gut protozoan

{00440} giardia
{08395} giardia
{09756} giardia (gut lumen)

CRYPTOSPORIDIOSIS (Clin. Lab. Med. 11: 873, 1991; Lancet 345: 1128, 1995)

{15548} cryptosporidium
{27368} cryptosporidium, acid-fast stain

Cryptosporidiosis
Tom Demark's Site

Cryptosporidiosis

WebPath Photo

Cryptosporidiosis
Acid-fast stain
WebPath Photo

Microsporidiosis

Yutaka Tsutsumi MD

TRICHOMONIASIS (Trichomonas vaginalis)

{46498} trichomonas, smear

Trichomonas

Yutaka Tsutsumi MD

PNEUMOCYSTIS PNEUMONIA (Pneumocystis carinii; the official name is now P. jirovecii yee-row-vet-zee)

{00431} pneumocystis, silver stain
{00456} pneumocystis, silver stain with H&E counterstain

Pneumocystis
Lung pathology series
Dr. Warnock's Collection

Pneumocystis
WebPath Photo

Pneumocystis
WebPath Photo

Pneumocystis
WebPath Photo

Pneumocystis
WebPath Photo

Pneumocystis
Silver stain
WebPath Photo

MALARIA

{13700} malaria, peripheral blood
{46249} malaria, brain; note pigment

Plasmodium vivax
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

Cerebral malaria

Yutaka Tsutsumi MD

Falciparum malaria

Yutaka Tsutsumi MD

Malaria
Pittsburgh Pathology Cases

TOXOPLASMOSIS (Toxoplasma gondii)

{06202} toxoplasmosis in a smear
{08235} toxoplasmosis
{08277} toxoplasmosis
{15472} toxoplasmosis of brain
{23494} toxoplasmosis; world's puniest granulomas

Toxoplasmosis in the lung

Yutaka Tsutsumi MD

Toxoplasma encephalitis in AIDS

Yutaka Tsutsumi MD

Toxoplasma lymphadenitis

Yutaka Tsutsumi MD

Disseminated toxoplasmosis
Pittsburgh Pathology Cases

Toxoplasmosis

WebPath Photo

Toxoplasmosis, brain

WebPath Photo

Toxoplasmosis, brain

WebPath Photo

OTHER PROTOZOANS

{46497} babesia in a red cell

Babesiosis

Yutaka Tsutsumi MD

{08241} African trypanosomes in a blood smear

Trypanosomiasis

Yutaka Tsutsumi MD

{08299} reduvid bug
{26573} Chagas's disease smear; don't worry about telling it from its African counterpart here
{26576} Chagas's heart, tremendous dilatation
{26579} Chagas's disease, heart histology (lymphocytes)
{26582} Chagas's disease, heart histology (lymphocytes and parasites)

Chagas disease

Yutaka Tsutsumi MD

{08393} mucocutaneous leishmaniasis
{11466} leishmaniasis, "oriental sore"
{08230} Leishmania in macrophages
{06211} Kala-Azar, bone marrow smear; can you find the one cell that is infected?
{46243} Kala-Azar, histology
{08423} leishmaniasis, "oriental sore"

Leishmania in smear

Wikimedia Commons

Leishmania tropica
Cutaneous leishmaniasis
Yutaka Tsutsumi MD

Sarcosporidiosis
Advance students
Yutaka Tsutsumi MD

INTRODUCING THE WORMS

{31826} worms in apple

Pathology of helminthic infections
Great site
Yutaka Tsutsumi MD

INTESTINAL ROUNDWORMS

Worm in appendix
Or perhaps a Meckel's?
KU Collection

{08309} ascaris in child's intestine
{24673} ascaris

Ascaris

WebPath Photo

{39229} pinworm egg; this is the only egg worth knowing for a family physician

Enterobius vermicularis in vagina

Yutaka Tsutsumi MD

{08122} hookworm portal of entry
{08123} hookworm larva
{08124} hookworm jaws

{00398} strongyloides in the gut
{15737} strongyloides
{15738} strongyloides
{32024} strongyloides

TISSUE ROUNDWORMS

{15756} larva migrans

Larva migrans
Creeping eruption
Yutaka Tsutsumi MD

{08304} dracunculus
{08397} dracunculus

Dracunculosis

Yutaka Tsutsumi MD

{08214} trichinella
{08215} trichinella
{15750} trichinella

Trichinosis

Yutaka Tsutsumi MD

FILARIASIS

{08390} filaria

Filariasis (elephantiasis)

Yutaka Tsutsumi MD

Filaria

WebPath Photo

Filariasis
Source unknown
Not for young or sensitive visitors.

Filariasis
Source unknown
Not for young or sensitive visitors.

Onchercercosis
Advanced
Yutaka Tsutsumi MD

Dirofilariasis of skin

Yutaka Tsutsumi MD

Nematode larva in urine

Yutaka Tsutsumi MD

TAPEWORMS ("Cestodes")

{09793} cysticercosis from brain
{43801} cysticercosis from brain

Cysticercosis of the brain

Yutaka Tsutsumi MD

Cysticercosis of skin
Advanced students
Yutaka Tsutsumi MD

Cysticercosis
Pittsburgh Pathology Cases

{08256} echinococcus worm
{08275} echinococcus cyst in brain
{24665} echinococcus cyst in liver
{08255} echinococcus, babies from a cyst plus lots of hooklets that fell off
{08411} echinococcus babies

Echinococcus in the lung

Yutaka Tsutsumi MD

TREMATODES ("flukes")

{32034} paragonimus

Paragonimiasis

Yutaka Tsutsumi MD

Paragonimus miyazakii of brain
Advanced students
Yutaka Tsutsumi MD

{06215} mama and papa schistosome
{15739} mama and papa schistosome
{08236} mansoni eggs
{08298} mansoni egg
{08211} hematobium, egg in bowel
{09863} hematobium, bladder (granuloma with eggs in the center)
{08250} hematobium
{10676} japonicum eggs

Schistosomiasis of the bladder

Yutaka Tsutsumi MD

Bladder schistosomiasis
Eggs have calcified
KU Collection

Schistosomiasis
Pittsburgh Pathology Cases

Cercarial dermatitis
Advanced students
Yutaka Tsutsumi MD

Angiostronylosis
Advanced students
Yutaka Tsutsumi MD

Thelaziasis, the eye worm
Advanced students
Yutaka Tsutsumi MD

Sparganosis
Advanced
Yutaka Tsutsumi MD

Gnathostomiasis

Yutaka Tsutsumi MD

BIGGER CRITTERS

{08248} crab lice

Botfly video
Human myiasis from Panama
Educational, some profanity

Myiasis
Nasty
Yutaka Tsutsumi MD

Pubic lice

Yutaka Tsutsumi MD

Scabies

Yutaka Tsutsumi MD

Scabies
Generalized ("Norwegian")
Yutaka Tsutsumi MD

Demodex folliculorum
Advanced
Yutaka Tsutsumi MD

Tick bite

Yutaka Tsutsumi MD

Honey bee sting

Yutaka Tsutsumi MD

Sand flea bite / burrow

Yutaka Tsutsumi MD

Mosquito bite allergy

Yutaka Tsutsumi MD

Scabies mite

WebPath Photo

Nits

WebPath Photo

Lice

WebPath Photo

Innocent Bystanders
A gallery of bugs
Yutaka Tsutsumi MD

Final note: I think most scientists have agreed for decades that it would be good (for the long run) to reduce or eliminate antibiotic use to promote the growth of farm animals. This has been politically impossible in the US until recently, but it may be catching on (thank for once, Mickey D's). See Science 301: 1027, 2003.

* Fun to know: Here are some real zebras that produce episodes of fever of unknown origin that can baffle physicians for your whole life:

If you have the opportunity, read Rudyard Kipling's famous alternative-history science fiction story, "The Eye of Allah" -- medieval Arab scientists invent the microscope and discover the true nature of infectious disease. Roger Bacon and his friends wonder whether this knowledge is too dangerous for humankind.

Helicobacter in the stomach

Yutaka Tsutsumi MD

CMV infection of stomach

Yutaka Tsutsumi MD

Malakoplakia of colon
Advanced learners
Yutaka Tsutsumi MD

E. coli xanthogranulomatous colitis
Advanced learners
Yutaka Tsutsumi MD

E. coli O-157 infection

Yutaka Tsutsumi MD

Typhoid fever

Yutaka Tsutsumi MD

Clostridium difficile
Pseudomembranous colitis
Yutaka Tsutsumi MD

MRSA colitis
Advanced students
Yutaka Tsutsumi MD

Biofilm

Yutaka Tsutsumi MD

Gas gangrene of the gut

Yutaka Tsutsumi MD

Yersinia colitis
Advanced students
Yutaka Tsutsumi MD

Rotavirus colitis

Yutaka Tsutsumi MD

Adenovirus

Yutaka Tsutsumi MD

Varicella-Zoster GI infection
Advanced students
Yutaka Tsutsumi MD

Measles
Advanced students
Yutaka Tsutsumi MD

Whipple's disease

Yutaka Tsutsumi MD

Isospora belli
Advanced students
Yutaka Tsutsumi MD

Crytosporidiosis

Yutaka Tsutsumi MD

Giardiasis

Yutaka Tsutsumi MD

Amoeba infection in AIDS
Advanced students
Yutaka Tsutsumi MD

Blastocystis hominis
Advanced students
Yutaka Tsutsumi MD

Strongyloidiasis

Yutaka Tsutsumi MD

Philippine capillariasis
Advanced students
Yutaka Tsutsumi MD

Anisakiasis
Advanced students
Yutaka Tsutsumi MD

Enterobiasis in appendix

Yutaka Tsutsumi MD

Schostomoasis japonicum
In the appendix
Yutaka Tsutsumi MD

Schistosomoasis
In the colon
Yutaka Tsutsumi MD

Heterophyiasis

Yutaka Tsutsumi MD

Syphilis
Secondary, in the stomach (!)
Yutaka Tsutsumi MD

Intestinal sirochetosis
Advanced students
Yutaka Tsutsumi MD

Chlamydia
Advanced students
Yutaka Tsutsumi MD

Epstein-Barr Virus
Hairy leukoplakia
Yutaka Tsutsumi MD

"Chronic active" Epstein-Barr infection
Advanced students
Yutaka Tsutsumi MD

Chronic granulomatous disease
Advanced students; mimics Crohn's
Yutaka Tsutsumi MD

Seed seeded into the peritoneum
Advanced students
Yutaka Tsutsumi MD

Sperm bag of squid
in a gourmet's oral mucosa
Yutaka Tsutsumi MD

Hepatitis B
Carrier's liver, great ground-glass cells
Yutaka Tsutsumi MD

Hepatitis C

Yutaka Tsutsumi MD

Epstein-Barr virus
Infectious mononucleosis
Yutaka Tsutsumi MD

Congenital herpes simplex

Yutaka Tsutsumi MD

Ascaris lumbricoides
Causing a liver abscess
Yutaka Tsutsumi MD

Actinomycosis
This was in the liver
Yutaka Tsutsumi MD

Alkaligenes liver abscess
Advanced students
Yutaka Tsutsumi MD

Melioidosis
Advanced students
Yutaka Tsutsumi MD

Amebic liver abscess

Yutaka Tsutsumi MD

Leishmania donovani
Kala-Azar
Yutaka Tsutsumi MD

Fascioliasis
The liver fluke
Yutaka Tsutsumi MD

Gall bladder spirochetes
Advanced students
Yutaka Tsutsumi MD

E. coli granulomatous cholecystitis
Advanced students
Yutaka Tsutsumi MD

Klebsiella in the bile
Advanced students
Yutaka Tsutsumi MD

Ascending cholangitis
Enterococcus
Yutaka Tsutsumi MD

Echinococcus

Yutaka Tsutsumi MD

Clonorchiasis
Advanced students
Yutaka Tsutsumi MD

Opistorchiasis
Advanced students
Yutaka Tsutsumi MD

Schistosoma japonicum
In the liver
Yutaka Tsutsumi MD

Visceral larva migrans
In the liver
Yutaka Tsutsumi MD

Pneumococcal pneumonia

Yutaka Tsutsumi MD

MRSA pneumonia

Yutaka Tsutsumi MD

BIBLIOGRAPHY / FURTHER READING

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Teaching Pathology


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