As always, comments are welcome. I’m sorry to say that I did not do a good job reviewing the section on viruses as this is my weakest subject.
- P.137, Bugs with exotoxins
- Bordetella pertussis does not stimulate adenylate cyclase, it instead inhibits GTPase. This differentiates its action from that of cholera toxin and the LT toxin of E.coli, whose actions stimulate adenylate cyclase.
- P.140, Intracellular bugs
- For facultative intracellular, I offer the following:
i. My Liege, Your Niece Lists Frank, Bruce and Sam.
ii. Mycobacterium, Leigonella, Yersinia, Neisseria, Listeria, Francisella, Brucella, Salmonella.
- P.144, Lactose-fermenting enteric bacteria
- After including Serratia, change the mnemonic from “lactose is KEE” to:
i. “Test lactose with MacConKEE’S”.
ii. Citrobacter, Klebsiella, E.coli, Enterobacter, Serratia.
- P.145, Bugs causing diarrhea
- O157:H7 should refer to Enterohemorrhagic E.coli (EHEC), not Enteroinvasive E.coli.
- The heading “Microbiology-Mycology” is on the wrong page, and should be on P.151.
- P.152, Pneumocystis carinii
- This microbe is now referred to as Pneumocystis jeroveci.
- P.154, Medically important helminths
- There should be some mention that Schistosomiasis can cause granulomas in the bladder and has a role in Squamous cell carcinoma of the bladder.
- P.163, HIV diagnosis
- A test with high sensitivity has low false-positives, not high. A sensitive test with high false-positives indicates that there is low prevalence of the tested disease in the population. It is more appropriate to use NPV for this type of statement.
- A test with high specificity has low false-negatives, not high. A specific test with high false-negatives indicates that there is a low prevalence of the tested disease in the population. It is more appropriate to use PPV for this type of statement.
i. You may not think that these distinctions are important, but they are. Sensitivity and specificity are qualities of a test and do not change depending on the population tested, but a test conducted in Africa (where prevalence of HIV is high) versus the same test conducted in the US (where the prevalence is low) will have different PPVs and NPVs, i.e., different numbers of false-positive and false-negative results.
- P.164, Prions
- Fatal Familial Insomnia should be included in this list of Prion diseases.
- P.169, Bactericidal antibiotics
- I think that Rifampin, daptomycin, the combination treatment SMX/TMP and the polymyxins should be included in the list of cidal drugs
- P.169, Methicillin….
- “Don’t need MeNDing: Methicillin, Nafcillin, Dicloxacillin”
- P.170, Cephalosporins
- The MTT group responsible for the disulfiram-like reaction is only found in 2nd generation cephalosporins cefotetan and cefamandole. I think it’s worth changing to “(in 2nd generation cephalosporins with a methylthiotetrazole group, e.g. cefamandole and cefotetan)”.
- P.172, Macrolides
- I think it’s worth mentioning that Erythromycin is a potent inhibitor of P450, that Azithromycin is used in prophylaxis of MAC, and that their clinical use is for atypical pneumonias.
- P.172, Clindamycin
- Lincomycin is listed on P.171 as one of the 50S inhibitors, but it is not mentioned that this drug belongs to the same family as Clindamycin. I think this should be changed to “Clindamycin, Lincomycin”
- P.173, Trimethoprim
- I think that the following grouping is interesting:
i. Methotrexate – inhibits human Dihydrofolate reductase
ii. Trimethoprim – inhibits microbial Dihydrofolate reductase
iii. Pyrimethamine – inhibits parasitic Dihydrofolate reductase
- P.176, Antifungal therapy
- The antimicrobials were listed as being either cidal or static, but this is not done for the antifungal drugs. I think this should be included with each description.
i. Polyenes (Amp B and Nystatin) – cidal
ii. Azoles – static
iii. Flucytosine – cidal
iv. Caspofungin – cidal
v. Terbinafine – static
vi. Griseofulvin – static