[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"$fxLN3MUwXCdr5RPjwZYIDpOj8CHyjOmngWTgoKXPtZbg":3,"$fiP_dEnO5zCHd0jvQtH9lU4LV5BIHTCjyvpybrue-DQ0":36,"$f3Ft0rKFJHppdzE-vuveecxx1BUcg9iOlMLtyzf_MJDg":224,"$fucxFBm2ZjZfGSdmdRaSNGBI_F0jJme4f0GTvzUhQfL8":288},[4,8,12,16,20,24,28,32],{"title":5,"slug":6,"path":7},"About Microbeonline.com","about-microbeonline-com","\u002Fabout-microbeonline-com\u002F",{"title":9,"slug":10,"path":11},"About Me","about-me","\u002Fabout-microbeonline-com\u002Fabout-me\u002F",{"title":13,"slug":14,"path":15},"Advertise with Us","advertise-us","\u002Fadvertise-us\u002F",{"title":17,"slug":18,"path":19},"Privacy Policy","privacy-policy","\u002Fprivacy-policy\u002F",{"title":21,"slug":22,"path":23},"Abbreviations","abbreviations","\u002Fabbreviations\u002F",{"title":25,"slug":26,"path":27},"Microbes","microbes","\u002Fmicrobes\u002F",{"title":29,"slug":30,"path":31},"Books","recommended-books","\u002Frecommended-books\u002F",{"title":33,"slug":34,"path":35},"Utilization Tests for Bacterial Identification","utilization-tests","\u002Futilization-tests\u002F",{"type":37,"data":38},"blog",{"slug":39,"title":40,"description":41,"seoTitle":42,"seoDescription":42,"author":43,"createdDate":44,"lastUpdatedDate":45,"draft":46,"category":47,"image":42,"body":48,"faq":49,"commentsClosed":46,"tags":70,"related":72,"comments":220},"borrrelia-burgdorferi-lyme-disease","Lyme Disease (Borrelia burgdorferi): Stages, Diagnosis, and How to Treat It","\u003Cp>How Borrelia burgdorferi causes Lyme disease, the three stages from the erythema migrans rash to Lyme arthritis, why early Lyme is treated on the rash alone, and how two-tier serology is interpreted.\u003C\u002Fp>",null,"Acharya Tankeshwar","2021-05-21","2026-08-13",false,"bacteriology","A 45-year-old hiker returns from a camping trip in rural Connecticut. Three weeks later he develops a circular expanding rash on his thigh: red at the edge, clearing in the center, now 12 cm across. He has had mild fever, fatigue, and joint aches for the past week. He did not notice a tick bite.\n\nThis is Lyme disease until proven otherwise. The rash, called erythema migrans, is the clinical hallmark, present in roughly 70 to 80% of cases. The 20 to 30% who never develop it are the diagnostic challenge.\n\nThe most important thing to understand about Lyme disease is that its diagnosis is often clinical, not serological. In an endemic area, the erythema migrans rash is enough to diagnose and treat Lyme disease on the spot, without waiting for a blood test, because antibodies take weeks to appear and the test is often negative this early. Getting this right, treating early on the rash, and knowing when serology helps and when it misleads, is what this page is about.\n\nLyme disease (Lyme borreliosis) is caused by *Borrelia burgdorferi sensu lato*, a complex of at least three genomospecies: *B. burgdorferi sensu stricto* (predominant in North America), *B. afzelii* and *B. garinii* (predominant in Europe and Asia). It is the most common vector-borne disease in North America and Europe, with over 30,000 cases reported annually in the USA and an estimated 65,000 in Europe: though both figures are considered significant underestimates of true incidence.\n\n- High-risk regions (Northeastern & Midwestern USA, Central Europe).\n- Seasonal variation (peak in spring\u002Fsummer due to tick activity).\n\n![](\u002Fblogs\u002FBorrelia-Burgdorferi-Lyme-Disease-min.png)\\## **Characteristics of *Borrelia burgdorferi***\n\n*Borrelia burgdorferi* is a helical-shaped spirochete that is poorly gram-stained (other spirochetes do not take up Gram stain). It stains weakly Gram-negative (safranin, the counterstain, is the last dye applied), but in practice Borrelia is not classified as Gram-positive or Gram-negative and is not identified by Gram stain. It is better seen with Giemsa or Wright stain, dark-field microscopy, or silver staining.\n\n*Borrelia* can be stained with [Giemsa stain](\u002Fgiemsa-stain-principle-procedure-and-results\u002F) or other blood stains and can be seen in the standard light microscope. It is better viewed under a dark ground microscope or by silver impregnation staining. The ultrastructure of *Borrelia* is similar to *Treponema* and *Leptospira,* with minor differences.\n\n- **Size**: Larger, 10-30 μm in length (longer than a human red blood cell, which is 7 μm in diameter) and 0.2-0.5 μm in width.\n- **Spirals**: fewer in number (about 3 to 10 per organism), with wider, looser coils than *Treponema.*\n- **Endoflagella**: More in number (7-11), attached subterminally at the pole.\n\n**Why *Borrelia* is hard to detect:** Unlike most bacteria, *B. burgdorferi* is present in blood only transiently and at very low density: which is why blood culture is insensitive and direct microscopy of blood rarely useful in Lyme disease. The organism rapidly disseminates to joints, nervous system, and cardiac tissue, where it persists. This tissue tropism explains the clinical stages of disease and the diagnostic challenge, you are rarely chasing the organism in blood.\n\n## Transmission\n\n**Rodents and deer** are the **main reservoirs** of Lyme disease. It is widespread in the USA and reported in other parts of the world.\n\nLyme disease is transmitted by the bite of black-legged tick (*Ixodes scapularis* or *Ixodes pacificus*). All three stages of ticks (i.e. larval, nymphal, and adult stages) can transmit the infection, but it is thought that nymphs infect more humans than adult ticks because they are so hard to see (<2 mm).\n\n![4 distinct life stages of tick - Life stages of tick (Imagesource)](\u002Fblogs\u002Ftick-different-stages.jpg)Figure: Life stages of tick\n\n*Borrrelia burgdorferi* expresses outer-surface protein A (OspA) in the midgut of the tick which is required for its survival in tick. When the bacterium reaches the salivary gland of the tick, it expresses protein **OspC** that binds to a tick salivary gland protein (Salp15). This attachment is crucial for transmission.\n\n> There is no evidence of person-person transmission of Lyme disease. There is no credible evidence that Lyme disease can be transmitted through air, food, water, or from the bites of mosquitoes, flies, fleas, or lice.\n\nThe tick must attach at least 24 hours for transmission. Removing a tick quickly (within 24 hours) can greatly reduce the chance of getting Lyme disease.\n\n### The 24-Hour Rule and Its Nuances\n\nThe tick must be attached for at least **24–36 hours** to transmit *B. burgdorferi*, the organism must migrate from the tick's midgut (where it expresses OspA for survival) to the salivary glands (where it switches to OspC for transmission). This migration takes time, which is why prompt tick removal is protective.\n\n**Practical implications:**\n\n- A tick found engorged (fed for >36 hours) represents a meaningful transmission risk\n- A tick found unengorged (flat, clearly recently attached) represents low but non-zero risk\n- The decision to give prophylactic doxycycline after a tick bite depends on the tick species, the estimated attachment duration, and local endemicity, not on the presence or absence of symptoms. The dose and timing are a clinical decision.\n\n**Tick identification matters:** Only *Ixodes scapularis* (black-legged tick, \"deer tick\") and *Ixodes pacificus* (western black-legged tick) transmit Lyme disease in North America. *Dermacentor* species (dog ticks, wood ticks) and *Amblyomma americanum* (lone star tick) do NOT transmit *B. burgdorferi*, a common source of patient and clinician confusion.\n\n## Clinical Manifestations: Three Stages\n\nLyme disease progresses through three stages if untreated. Not every patient passes through all three, some present in Stage 2 or 3 without a recognized prior rash.\n\n### Stage 1: Early Localized Infection (Days 3–30 After Bite)\n\n**Erythema migrans (EM)** is the defining feature, an expanding annular (ring-shaped) skin lesion at the site of the tick bite. It:\n\n- Appears 3–30 days after the bite (median 7 days)\n- Expands gradually, must reach ≥5 cm in diameter for clinical case definition\n- Is present in approximately **70–80% of cases**, 20–30% of patients never develop it\n- Does NOT always show the classic \"bull's-eye\" (target) pattern, many cases are uniformly red without central clearing\n- Is not painful or itchy in most cases, thus patients may not notice it\n\n**Associated symptoms:** Flu-like illness: fever, chills, myalgia, arthralgia, headache, fatigue. These are non-specific and easily attributed to viral illness, especially without the rash.\n\n![Erythema migrans can present itself in many different forms. - Different types of rash are seen in Lyme disease. Not everyone will have a “bullseye”  rash.(Imagesource)](\u002Fblogs\u002Flyme-disease-bullseye-rash.jpg)Figure: Different types of rash are seen in Lyme disease. Not everyone will have a “bullseye”  rash.\n\n**Clinical pearl:** In an endemic area, erythema migrans alone is sufficient to diagnose and treat Lyme disease, **serological testing is not required and may be negative at this early stage** (antibodies take 2–6 weeks to develop). Treating before seroconversion gives the best outcomes and prevents progression.\n\n### Stage 2: Early Disseminated Infection (Weeks to Months After Bite)\n\nIf untreated, *B. burgdorferi* disseminates haematogenously. Manifestations include:\n\n**Neurological (Lyme neuroborreliosis) \\~15% of untreated cases:**\n\n- **Facial nerve palsy (Bell's palsy)**: bilateral facial palsy should always raise suspicion for Lyme disease in an endemic area\n- Meningitis: typically lymphocytic, with CSF pleocytosis\n- Radiculopathy: shooting pains, numbness, weakness\n- **Bannwarth syndrome** (Europe): the classic European presentation: painful radiculopathy + CSF pleocytosis + cranial nerve palsy, particularly facial palsy\n\n**Cardiac \\~8% of untreated cases:**\n\n- **Atrioventricular (AV) block**: ranging from first-degree to complete heart block\n- Lyme carditis is usually self-limiting but complete heart block requires temporary pacing\n- Young patient + new AV block in endemic area = Lyme carditis until proven otherwise\n\n**Secondary skin lesions:**\n\n- Multiple secondary erythema migrans lesions at sites distant from the original bite\n\n### Stage 3: Late Disseminated Infection (Months to Years After Bite)\n\n**Lyme arthritis, the dominant manifestation:**\n\n- Intermittent or persistent arthritis affecting one or a few large joints, most commonly the **knee**\n- Episodes of joint swelling lasting weeks to months\n- Synovial fluid shows inflammatory cells (typically 10,000–25,000 WBC\u002Fmm³)\n- Distinguished from septic arthritis by the much lower WBC count and clinical context\n\n**Late Lyme arthritis is partly immune-mediated:** in some patients the joint inflammation persists even after the organism is cleared by antibiotics (sometimes called antibiotic-refractory Lyme arthritis), because the immune response continues. This is why a minority of arthritis does not resolve immediately with treatment, and it connects to the post-treatment syndrome below.\n\n**Late neurological Lyme (uncommon):**\n\n- Encephalopathy: cognitive difficulties, memory problems\n- Peripheral neuropathy\n\n**Post-treatment Lyme disease syndrome (PTLDS):**\n\n- Some patients have persistent fatigue, musculoskeletal pain, and cognitive difficulties after completing antibiotic treatment\n- Cause is debated, not evidence of ongoing active infection; additional antibiotics do not help\n- Important to distinguish from active Lyme disease requiring further treatment\n\n| Stage | Timing | Key Manifestations | Diagnostic Approach |\n| --- | --- | --- | --- |\n| Early localized | Days 3–30 | Erythema migrans (70–80%), flu-like illness | Clinical diagnosis; serology often negative, do not wait for it |\n| Early disseminated | Weeks–months | Bell's palsy, meningitis, radiculopathy, AV block, multiple EM | Serology (ELISA + Western blot); CSF if neurological; ECG if cardiac |\n| Late disseminated | Months–years | Lyme arthritis (knee), encephalopathy, neuropathy | Serology; synovial fluid PCR; joint fluid analysis |\n\n## Laboratory Diagnosis\n\n![Borrelia in dark-field microscopy - Borreliain dark-field microscopy (Imagesource)](\u002Fblogs\u002FBorrelia-in-dark-field-microscopy.jpg)Figure: *Borrelia* in dark-field microscopy\n\n### Specimen Selection\n\nSpecimen depends on clinical stage and presentation:\n\n- **Early localized:** Clinical diagnosis is sufficient if EM is present — serology not needed\n- **Early disseminated (neurological):** Serum + CSF (cell count, protein, glucose, intrathecal antibody index)\n- **Early disseminated (cardiac):** Serum serology + ECG\n- **Late disseminated:** Serum serology + synovial fluid (PCR, cell count)\n\n### Serology: The Primary Diagnostic Tool\n\nThe CDC recommends a **two-tier testing algorithm:**\n\n**Tier 1: ELISA (enzyme immunoassay):**\n\n- Detects IgM and IgG antibodies against *B. burgdorferi*\n- High sensitivity but lower specificity: false positives occur with other spirochetal infections (syphilis, leptospirosis), EBV, autoimmune diseases\n- **If negative → stop. Lyme disease is unlikely** (unless testing in first 2 weeks of illness)\n- **If positive or equivocal → proceed to Tier 2**\n\n![Modified two tiered testing for lyme disease - Modified two tiered testing for Lyme disease (Imagesource)](\u002Fblogs\u002FModified-two-tiered-testing-for-Lyme-disease.png)Figure: Modified two tiered testing for Lyme disease\n\n**Tier 2: Western Blot (immunoblot):**\n\n- More specific: detects antibodies against specific *B. burgdorferi* proteins\n- **IgM Western blot** (interpret only in first 4 weeks of illness): positive if ≥2 of 3 bands (OspC\u002F24 kDa, 39 kDa, 41 kDa)\n- **IgG Western blot** (use after 4 weeks): positive if ≥5 of 10 bands\n\n**Critical point:** IgM Western blot should NOT be used after 4 weeks of illness, the false-positive rate is unacceptably high and leads to overdiagnosis. After 4 weeks, only IgG Western blot is interpretable.\n\n**Modified two-tier testing (MTTT):** A newer approach replacing the second-tier Western blot with a second ELISA using a different antigen preparation is now endorsed by CDC as an acceptable alternative to the classic two-tier algorithm.\n\n### Culture\n\n*B. burgdorferi* can be cultured in **Barbour-Stoenner-Kelly (BSK) medium**: a specialised liquid medium. Sensitivity is low (<50% in early disease, much lower in late disease). Culture is a research tool, not a clinical diagnostic tool. Incubation requires weeks.\n\n### PCR\n\n- **Synovial fluid PCR** is the most useful PCR application: sensitivity \\~70% in Lyme arthritis, much better than culture\n- **Blood PCR**: low sensitivity, not recommended for routine diagnosis\n- **CSF PCR**: low sensitivity for CNS Lyme; intrathecal antibody index is preferred\n\n### Microscopy\n\nDirect visualization of *B. burgdorferi* in clinical specimens:\n\n- **Dark-field microscopy**: can demonstrate spirochetes in blood during early disease but sensitivity is poor; not used routinely\n- **Giemsa or Wright stain**: spirochetes visible in blood smear; again low sensitivity\n- **Silver impregnation staining** (Warthin-Starry or Dieterle stain): used in tissue sections from skin biopsy of EM lesion\n\n## Treatment\n\nTreatment depends on clinical stage and manifestations:\n\n- Early localized disease: oral doxycycline (amoxicillin or cefuroxime as alternatives).\n- Neurological disease or severe carditis: IV ceftriaxone.\n- Lyme arthritis: oral doxycycline, longer course.\n- Children under 8 and pregnant women: doxycycline avoided; amoxicillin or cefuroxime used.\n- Post-exposure prophylaxis after a high-risk Ixodes bite exists but is a clinical decision.\n\n### Borrelia Species: Lyme Disease vs. Relapsing Fever\n\n| Feature | Lyme Disease | Relapsing Fever |\n| --- | --- | --- |\n| Main species | *B. burgdorferi*, *B. afzelii*, *B. garinii* | *B. recurrentis* (epidemic), *B. hermsii*, *B. duttoni* (endemic) |\n| Vector | *Ixodes* tick | Body louse (*B. recurrentis*); *Ornithodoros* tick (others) |\n| Reservoir | Rodents, deer | Rodents (endemic); humans (epidemic) |\n| Key mechanism | Multi-stage tissue dissemination | Antigenic variation → relapsing fever |\n| Clinical hallmark | Erythema migrans, arthritis, neurological | Recurrent febrile episodes |\n| Diagnosis | Two-tier serology (ELISA + Western blot) | Blood smear (Giemsa\u002FWright) during febrile episode |\n| Treatment | Doxycycline (oral); ceftriaxone (severe) | Doxycycline |\n\nSee also: [Relapsing fever](https:\u002F\u002Fmicrobeonline.com\u002Frelapsing-fever-etiology-diagnosis\u002F)\n\n## How to Remember Lyme Disease\n\n**The name story:** Named after **Old Lyme, Connecticut**, where a 1975 cluster of childhood arthritis cases triggered investigation. The organism is named after Willy Burgdorfer, who identified the spirochete in 1982.\n\n**Three stages: three systems:**\n\n- Stage 1 = **Skin** (erythema migrans)\n- Stage 2 = **Heart and Nerves** (AV block, Bell's palsy, meningitis)\n- Stage 3 = **Joints** (knee arthritis)\n\n**Memory aid:** SKiN, then Heart\u002FNerves, then JoiNts. *The disease moves inward from the skin.*\n\n**The proportions worth knowing:** 20 to 30% never develop EM, about 15% of untreated cases develop neurological disease, and about 8% develop cardiac disease.\n\n**Two-tier testing logic:** ELISA first (sensitive screen) → Western blot only if ELISA positive (specific confirmation). Never order Western blot as a first test. Never interpret IgM Western blot after 4 weeks.\n\n**Tick attachment time:** 24–36 hours minimum for transmission. A flat, unengorged tick just removed = very low risk. A swollen, engorged tick = consider prophylactic doxycycline (a clinical decision).\n\n## Key Exam Facts in One Table\n\n| Feature | Detail |\n| --- | --- |\n| Causative organism | *Borrelia burgdorferi sensu lato* (spirochete) |\n| Vector | *Ixodes scapularis* \u002F *I. pacificus* (North America); *I. ricinus* (Europe) |\n| Reservoir | White-footed mouse (*Peromyscus leucopus*); deer amplify tick population |\n| Minimum attachment for transmission | 24–36 hours |\n| Staining | Giemsa, Wright, silver impregnation; poorly Gram-stained |\n| Stage 1 manifestation | Erythema migrans (≥5 cm); present in 70–80% |\n| Stage 2 manifestations | Bell's palsy, meningitis, AV block, radiculopathy |\n| Stage 3 manifestation | Lyme arthritis (knee); encephalopathy |\n| Diagnostic algorithm | Two-tier: ELISA → Western blot (IgG after 4 weeks) |\n| Best specimen for arthritis | Synovial fluid PCR |\n| Culture medium | Barbour-Stoenner-Kelly (BSK) medium |\n| Key European syndrome | Bannwarth syndrome (radiculopathy + facial palsy + CSF pleocytosis) |\n\n### Where Students Get Confused\n\n**Erythema migrans does not always look like a bull's-eye.** Many EM rashes are uniformly red with no central clearing. Waiting for a \"classic target\" rash before diagnosing means missing cases. An expanding red rash ≥5 cm after a plausible tick exposure is enough.\n\n**Do not wait for serology in early Lyme.** Antibodies take weeks to develop, so serology is often negative when the EM rash is present. In an endemic area, the rash alone justifies treatment. A negative early test does not rule Lyme out.\n\n**IgM Western blot is only valid in the first 4 weeks.** After 4 weeks, a positive IgM blot is more likely a false positive than real, and using it leads to overdiagnosis. After 4 weeks, only the IgG blot counts.\n\n**Not every tick transmits Lyme.** Only *Ixodes* (black-legged\u002Fdeer) ticks transmit *B. burgdorferi*. Dog ticks (*Dermacentor*) and the lone star tick (*Amblyomma*) do not. A bite from the wrong tick is not a Lyme risk.\n\n**Lyme arthritis is not septic arthritis.** The synovial fluid WBC in Lyme arthritis (roughly 10,000-25,000) is far lower than in bacterial septic arthritis. The clinical context (endemic area, prior stages) and the lower count separate them.\n\n**Post-treatment symptoms are not ongoing infection.** Persistent fatigue and aches after treatment (PTLDS) are not evidence of live organisms, and more antibiotics do not help. This is distinct from genuinely inadequately treated disease.\n\n**References and further readings**\n\n1. Steere AC, Strle F, Wormser GP, et al. Lyme borreliosis. Nat Rev Dis Primers. 2016;2:16090. \u003Chttps:\u002F\u002Fdoi.org\u002F10.1038\u002Fnrdp.2016.90>\n2. Wormser GP, Dattwyler RJ, Shapiro ED, et al. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006;43(9):1089–1134. \u003Chttps:\u002F\u002Fdoi.org\u002F10.1086\u002F508667>\n3. Centers for Disease Control and Prevention. Lyme Disease: Two-step Laboratory Testing Process. \u003Chttps:\u002F\u002Fwww.cdc.gov\u002Flyme\u002Fdiagnosistesting\u002Flabtest\u002Ftwostepp\u002Findex.html>\n4. Murray PR, Rosenthal KS, Pfaller MA. Medical Microbiology. 9th ed. Elsevier; 2020.\n5. Shapiro ED. Lyme disease. N Engl J Med. 2014;370(18):1724–1731. \u003Chttps:\u002F\u002Fdoi.org\u002F10.1056\u002FNEJMcp1314325>",[50,53,56,59,62,65,68],{"question":51,"answer":52},"\u003Cp>What is the rash of Lyme disease?\u003C\u002Fp>","\u003Cp>Erythema migrans: an expanding red rash at the site of the tick bite, appearing 3 to 30 days later. It reaches at least 5 cm and may or may not have the classic bull's-eye appearance. It is present in about 70 to 80% of cases.\u003C\u002Fp>",{"question":54,"answer":55},"\u003Cp>Do you need a blood test to diagnose Lyme disease?\u003C\u002Fp>","\u003Cp>Not in early disease with a typical rash. In an endemic area, the erythema migrans rash alone is enough to diagnose and treat Lyme disease. Antibodies take weeks to appear, so blood tests are often negative early and should not delay treatment.\u003C\u002Fp>",{"question":57,"answer":58},"\u003Cp>How long must a tick be attached to transmit Lyme disease?\u003C\u002Fp>","\u003Cp>Usually 24 to 36 hours. The organism has to move from the tick's gut to its salivary glands before it can be transmitted, which takes time. Removing a tick promptly greatly reduces the risk.\u003C\u002Fp>",{"question":60,"answer":61},"\u003Cp>What is two-tier testing for Lyme disease?\u003C\u002Fp>","\u003Cp>A two-step blood test: first an ELISA (a sensitive screen), and only if that is positive or equivocal, a confirmatory Western blot (more specific). A newer version replaces the second step with a second ELISA. The IgM Western blot is only reliable in the first 4 weeks of illness.\u003C\u002Fp>",{"question":63,"answer":64},"\u003Cp>Which ticks transmit Lyme disease?\u003C\u002Fp>","\u003Cp>Only \u003Cem>Ixodes\u003C\u002Fem> ticks (the black-legged or deer tick, \u003Cem>Ixodes scapularis\u003C\u002Fem> and \u003Cem>I. pacificus\u003C\u002Fem> in North America, \u003Cem>I. ricinus\u003C\u002Fem> in Europe). Dog ticks and the lone star tick do not transmit \u003Cem>Borrelia burgdorferi\u003C\u002Fem>.\u003C\u002Fp>",{"question":66,"answer":67},"\u003Cp>What are the stages of Lyme disease?\u003C\u002Fp>","\u003Cp>Three: early localized (the erythema migrans rash and flu-like illness), early disseminated (facial palsy, meningitis, heart block, multiple rashes), and late (mainly Lyme arthritis of the knee). Not everyone passes through all three.\u003C\u002Fp>",{"question":69,"answer":69},"",[71],"spirochetes",[73,107,136,168,193],{"slug":74,"title":75,"description":76,"seoTitle":42,"seoDescription":42,"author":77,"createdDate":78,"lastUpdatedDate":79,"draft":46,"category":80,"image":42,"faq":81,"tags":106},"giemsa-stain-principle-procedure-and-results","Giemsa Stain: Principle, Procedure, Results","Complete Giemsa staining guide; stock and working solution preparation, pH 7.2 buffer chemistry, thick\u002Fthin smear procedure, organism-specific results, and a troubleshooting table for common staining problems.","Nisha Rijal","2019-07-13","2026-07-17","staining-techniques",[82,85,88,91,94,97,100,103],{"question":83,"answer":84},"Why is Giemsa preferred over Wright stain for malaria?","WHO-recommended: superior Schüffner's dot and Maurer's cleft demonstration for species ID. Better thick smear performance — 20x concentration for low-density parasitemia detection.",{"question":86,"answer":87},"What is the difference between thick and thin blood smears?","Thick: 20x concentration, high sensitivity, RBCs lysed, harder species ID. Thin: intact RBCs, clear morphology for species ID. Always prepare both — thick for detection, thin for identification.",{"question":89,"answer":90},"Why must thick smears never be fixed with methanol?","Methanol fixes RBC membranes, preventing essential lysis. Thick smears must lyse during staining to reveal parasites. Only thin smears require methanol fixation.",{"question":92,"answer":93},"What is the significance of Schüffner's dots vs Maurer's clefts?","Schüffner's dots (fine, even, pink, whole RBC) = P. vivax or P. ovale — NOT P. falciparum. Maurer's clefts (coarser, fewer, irregular) = P. falciparum. Key species differentiation.",{"question":95,"answer":96},"How do you differentiate Leishmania from Histoplasma on Giemsa?","Leishmania has a kinetoplast — small rod adjacent to nucleus. Histoplasma lacks kinetoplast; may show narrow-based budding and pseudocapsule. Clinical context essential.",{"question":98,"answer":99},"What is the safety pin appearance of Yersinia pestis?","Bipolar staining — dark blue poles, pale centre = closed safety pin. Due to polyphosphate granules at cell poles. Seen in bubonic plague — immediate public health notification required.",{"question":101,"answer":102},"Why does Giemsa stain nucleus purple and cytoplasm blue?","Nuclei (acidic DNA\u002FRNA) attract basic azure dyes = purple. Cytoplasm (basic proteins) attracts acidic eosin = pink\u002Fblue. Granule staining depends on own chemistry.",{"question":104,"answer":105},"How long is Giemsa stock stable?","~2 years in dark amber glass at room temperature. Enemies: water contamination (irreversible) and light. Never return unused stain to stock. Label with date, batch, preparer, expiry.",[],{"slug":108,"title":109,"description":110,"seoTitle":42,"seoDescription":42,"author":43,"createdDate":111,"lastUpdatedDate":112,"draft":46,"category":47,"image":42,"faq":113,"tags":135},"relapsing-fever-etiology-diagnosis","Relapsing Fever (Borrelia): Why the Fever Comes Back, and How It Is Diagnosed","\u003Cp>How Borrelia causes relapsing fever, why antigenic variation makes the fever return in waves, the difference between louse-borne and tick-borne types, and how a blood smear during fever makes the diagnosis.\u003C\u002Fp>","2022-04-10","2026-08-06",[114,117,120,123,126,129,132],{"question":115,"answer":116},"\u003Cp>Why does the fever keep coming back in relapsing fever?\u003C\u002Fp>","\u003Cp>Because the \u003Cem>Borrelia\u003C\u002Fem> changes its surface proteins (antigenic variation). Each time the immune system makes antibodies and clears the organism, a few survive by switching to a new surface coat the antibodies do not recognize, multiply, and cause another fever. This repeats until the immune system finally catches up.\u003C\u002Fp>",{"question":118,"answer":119},"\u003Cp>What is the difference between louse-borne and tick-borne relapsing fever?\u003C\u002Fp>","\u003Cp>Louse-borne (epidemic) relapsing fever is caused by \u003Cem>Borrelia recurrentis\u003C\u002Fem>, spread person to person by the body louse, and occurs in epidemics in crowded settings; it is the more severe form. Tick-borne (endemic) relapsing fever is caused by other \u003Cem>Borrelia\u003C\u002Fem> species, spread by soft ticks from a rodent reservoir, and occurs as sporadic milder cases.\u003C\u002Fp>",{"question":121,"answer":122},"\u003Cp>How is relapsing fever diagnosed?\u003C\u002Fp>","\u003Cp>By finding the \u003Cem>Borrelia\u003C\u002Fem> on a blood smear (Wright or Giemsa stain) taken during a fever episode. Unlike other spirochetes, relapsing-fever \u003Cem>Borrelia\u003C\u002Fem> stain well on a routine blood film and are seen between the red cells. The smear must be taken during fever, because the organism is cleared from the blood between episodes.\u003C\u002Fp>",{"question":124,"answer":125},"\u003Cp>Why must the blood smear be taken during the fever?\u003C\u002Fp>","\u003Cp>Because the organism is only present in the blood during the febrile episodes, when bacteremia is high. Between episodes the immune system has cleared it, so a smear taken in the fever-free interval will be falsely negative.\u003C\u002Fp>",{"question":127,"answer":128},"\u003Cp>How is louse-borne relapsing fever transmitted?\u003C\u002Fp>","\u003Cp>Not by a bite. The body louse carries the organism, which is released when the louse is crushed (for example by scratching). The organisms then enter through broken skin or mucous membranes.\u003C\u002Fp>",{"question":130,"answer":131},"\u003Cp>Why can the Jarisch-Herxheimer reaction be dangerous in relapsing fever?\u003C\u002Fp>","\u003Cp>Because the blood carries a very high number of organisms. When antibiotics kill them all at once, the release of their contents can cause a severe worsening of fever and a fall in blood pressure. This is why treatment is started with close monitoring.\u003C\u002Fp>",{"question":133,"answer":134},"\u003Cp>Is relapsing fever the same as Lyme disease?\u003C\u002Fp>","\u003Cp>No. Both are caused by \u003Cem>Borrelia\u003C\u002Fem>, but they are different diseases. Relapsing fever causes recurrent fever episodes through antigenic variation and is diagnosed on a blood smear. Lyme disease causes a rash, arthritis, and neurological features and is diagnosed by two-tier serology.\u003C\u002Fp>",[71],{"slug":137,"title":138,"description":139,"seoTitle":42,"seoDescription":42,"author":43,"createdDate":140,"lastUpdatedDate":141,"draft":46,"category":47,"image":42,"faq":142,"tags":167},"treponema-pallidum-properties-pathogenesis-and-disease","Treponema pallidum and Syphilis: Stages, Pathogenesis, and Diagnosis","\u003Cp>How \u003Cem>Treponema pallidum\u003C\u002Fem> causes syphilis, the four stages of the disease from the painless chancre to tertiary syphilis, congenital syphilis, and the screen-then-confirm approach to diagnosis.\u003C\u002Fp>","2022-02-22","2026-08-05",[143,146,149,152,155,158,161,164],{"question":144,"answer":145},"\u003Cp>Why can't Treponema pallidum be cultured?\u003C\u002Fp>","\u003Cp>It is so dependent on the host that it cannot grow on any artificial laboratory medium. It has historically been maintained only by inoculating animals such as rabbits. This is why syphilis is diagnosed by dark-field microscopy or antibody tests, not by culture.\u003C\u002Fp>",{"question":147,"answer":148},"\u003Cp>What is a chancre?\u003C\u002Fp>","\u003Cp>The chancre is the sore of primary syphilis: a single, painless, firm, indurated ulcer at the site of infection, usually the genitals. It is full of spirochetes and highly infectious, and it heals on its own in a few weeks, even though the infection has already spread.\u003C\u002Fp>",{"question":150,"answer":151},"\u003Cp>Why does the secondary syphilis rash involve the palms and soles?\u003C\u002Fp>","\u003Cp>Secondary syphilis is the stage of widespread dissemination, and its rash characteristically includes the palms and soles. Because few rashes involve the palms and soles, this pattern is an important clue to secondary syphilis.\u003C\u002Fp>",{"question":153,"answer":154},"\u003Cp>What is the difference between treponemal and non-treponemal tests?\u003C\u002Fp>","\u003Cp>Non-treponemal tests (VDRL, RPR) detect antibodies against a lipid released from damaged cells; they are used to screen and to follow treatment, because their titer falls with cure, but they can give false positives. Treponemal tests (TPHA, FTA-ABS) detect antibodies against the organism itself; they confirm the diagnosis but stay positive for life. Screening uses a non-treponemal test, confirmation uses a treponemal test.\u003C\u002Fp>",{"question":156,"answer":157},"\u003Cp>Why do treponemal tests stay positive after treatment?\u003C\u002Fp>","\u003Cp>Because they detect antibodies against \u003Cem>Treponema pallidum\u003C\u002Fem> that persist for life. A positive TPHA or FTA-ABS after cure does not mean active infection. Treatment success is judged by a fall in the non-treponemal (VDRL\u002FRPR) titer instead.\u003C\u002Fp>",{"question":159,"answer":160},"\u003Cp>What is neurosyphilis?\u003C\u002Fp>","\u003Cp>Neurosyphilis is involvement of the nervous system by syphilis. It can appear as meningitis, meningovascular disease, general paresis (a form of dementia), or tabes dorsalis (spinal cord degeneration). It is the most important form of late syphilis, partly because many antibiotics penetrate the nervous system poorly.\u003C\u002Fp>",{"question":162,"answer":163},"\u003Cp>How is syphilis treated?\u003C\u002Fp>","\u003Cp>With penicillin, at every stage. \u003Cem>Treponema pallidum\u003C\u002Fem> has never developed significant resistance to penicillin, so it remains the drug of choice. A brief fever and worsening of symptoms after the first dose (the Jarisch-Herxheimer reaction) can occur as the organisms are killed, and is not an allergy.\u003C\u002Fp>",{"question":165,"answer":166},"\u003Cp>What is congenital syphilis?\u003C\u002Fp>","\u003Cp>Syphilis passed from an infected mother to her baby across the placenta. It can cause miscarriage or stillbirth, or a liveborn baby with features such as \"snuffles\" and rash early on, and later stigmata including Hutchinson's teeth, interstitial keratitis, and deafness. It is preventable by screening and treating pregnant women.\u003C\u002Fp>",[71],{"slug":169,"title":170,"description":171,"seoTitle":42,"seoDescription":42,"author":43,"createdDate":172,"lastUpdatedDate":112,"draft":46,"category":47,"image":42,"faq":173,"tags":192},"spirochetes-morphology-classification-disease","Spirochetes: Morphology, Classification, Disease","\u003Cp>What spirochetes are: long, thin, coiled bacteria that move with internal flagella and cannot be seen on ordinary stains. The three human pathogens, Treponema, Borrelia, and Leptospira, and the diseases they cause.\u003C\u002Fp>","2021-06-08",[174,177,180,183,186,189],{"question":175,"answer":176},"\u003Cp>What are spirochetes?\u003C\u002Fp>","\u003Cp>Long, thin, spiral-shaped bacteria that move using flagella located inside the cell (endoflagella), giving them a characteristic corkscrew motility. They are too slender to see on ordinary stains and include the causes of syphilis, Lyme disease, relapsing fever, and leptospirosis.\u003C\u002Fp>",{"question":178,"answer":179},"\u003Cp>Which spirochetes cause human disease?\u003C\u002Fp>","\u003Cp>Only three genera: \u003Cem>Treponema\u003C\u002Fem> (syphilis, yaws, pinta), \u003Cem>Borrelia\u003C\u002Fem> (Lyme disease and relapsing fever), and \u003Cem>Leptospira\u003C\u002Fem> (leptospirosis). All other spirochetes are harmless environmental organisms.\u003C\u002Fp>",{"question":181,"answer":182},"\u003Cp>How are spirochetes different from other bacteria?\u003C\u002Fp>","\u003Cp>Their flagella run inside the cell, in the space between the outer membrane and the cell wall (endoflagella), rather than sticking out. This internal-flagella arrangement, wrapped in an outer sheath, gives spirochetes their spiral shape and burrowing motility and defines the group.\u003C\u002Fp>",{"question":184,"answer":185},"\u003Cp>Why can't most spirochetes be seen on a Gram stain?\u003C\u002Fp>","\u003Cp>They are too thin to take up ordinary stains or be resolved by routine light microscopy. They are visualized instead by dark-field microscopy, silver staining, or immunofluorescence, or diagnosed by serology. \u003Cem>Borrelia\u003C\u002Fem> is thick enough to be seen on a Giemsa-stained blood smear.\u003C\u002Fp>",{"question":187,"answer":188},"\u003Cp>What is the difference between a spirochete and a spirillum?\u003C\u002Fp>","\u003Cp>Both are spiral-shaped, but spirochetes have internal flagella and a flexible outer sheath, while spirilla (such as \u003Cem>Campylobacter\u003C\u002Fem> and \u003Cem>Helicobacter\u003C\u002Fem>) have ordinary external flagella and no outer sheath. The internal flagella are what make a spirochete.\u003C\u002Fp>",{"question":190,"answer":191},"\u003Cp>Is Weil's disease the same as the Weil-Felix test?\u003C\u002Fp>","\u003Cp>No. Weil's disease is the severe form of leptospirosis, caused by a spirochete. The Weil-Felix test is an unrelated test for rickettsial infection that uses \u003Cem>Proteus\u003C\u002Fem> antigens. They share only the name.\u003C\u002Fp>",[71],{"slug":194,"title":195,"description":196,"seoTitle":42,"seoDescription":42,"author":43,"createdDate":197,"lastUpdatedDate":141,"draft":46,"category":47,"image":42,"faq":198,"tags":219},"leptospira-interrogans-characteristics-pathogenesis-and-lab-diagnosis","Leptospira and Leptospirosis: How It Causes Weil's Disease and How It Is Diagnosed","\u003Cp>How \u003Cem>Leptospira interrogans \u003C\u002Fem>causes leptospirosis and Weil's disease, why the illness comes in two phases, and how it is diagnosed (dark-field microscopy, culture, and the MAT), with the reasons each test can mislead.\u003C\u002Fp>","2020-10-02",[199,202,205,207,210,213,216],{"question":200,"answer":201},"\u003Cp>What causes leptospirosis?\u003C\u002Fp>","\u003Cp>\u003Cem>Leptospira interrogans\u003C\u002Fem>, a thin, coiled spirochete bacterium. People catch it from water, soil, or food contaminated with the urine of infected animals such as rats, dogs, cattle, and pigs, usually through cuts in the skin or the mucous membranes.\u003C\u002Fp>",{"question":203,"answer":204},"\u003Cp>What is Weil's disease?\u003C\u002Fp>","\u003Cp>Weil's disease is the severe form of leptospirosis, occurring in about 10% of cases. It combines jaundice (liver damage), kidney failure, and bleeding, including dangerous bleeding into the lungs, and can be fatal.\u003C\u002Fp>",{"question":190,"answer":206},"\u003Cp>No, and this is a common confusion. Weil's disease is severe leptospirosis. The Weil-Felix test is an unrelated test that uses \u003Cem>Proteus\u003C\u002Fem> antigens to detect antibodies against \u003Cem>Rickettsia\u003C\u002Fem> (the cause of typhus). They share only the name \"Weil.\"\u003C\u002Fp>",{"question":208,"answer":209},"\u003Cp>Why can't Leptospira be seen on a Gram stain?\u003C\u002Fp>","\u003Cp>Because it is extremely thin and does not take up ordinary stains. It has to be seen using dark-field or phase-contrast microscopy, silver staining, or immunofluorescence, not a routine light microscope.\u003C\u002Fp>",{"question":211,"answer":212},"\u003Cp>What is the gold-standard test for leptospirosis?\u003C\u002Fp>","\u003Cp>The microscopic agglutination test (MAT), which detects antibodies against \u003Cem>Leptospira\u003C\u002Fem>. It usually needs paired samples (an early and a later one) showing a rising antibody level, and it is often negative in the first days of illness, so it is not reliable very early.\u003C\u002Fp>",{"question":214,"answer":215},"\u003Cp>Why does the choice of test depend on the stage of illness?\u003C\u002Fp>","\u003Cp>Because the organism moves. In the first week (septicemic phase) it is in the blood, so blood culture and PCR work best. Later (immune phase) it moves to the kidneys and is shed in urine, and antibodies have appeared, so urine culture and the MAT become useful.\u003C\u002Fp>",{"question":217,"answer":218},"\u003Cp>What are the three R's of leptospirosis?\u003C\u002Fp>","\u003Cp>Rats, Rainfall, and Rice fields, the three main epidemiological risk factors. Animal urine contaminates water, which is why rainfall and flooding, and outdoor work such as rice farming, increase the risk.\u003C\u002Fp>",[71],{"enabled":221,"threads":222,"total":223},true,[],0,[225,231,238,245,251,256,262,267,273,276,282],{"slug":226,"name":43,"description":227,"image":228,"body":229,"postCount":230},"acharya-tankeshwar","Editor-in-chief","https:\u002F\u002Fassets.microbeonline.com\u002Fauthors\u002Ftankeshwar-acharya-author-microbeonline.jpg","***Tankeshwar Acharya, MSc (Medical Microbiology)***\n\n*Tankeshwar Acharya is an Assistant Professor in the Department of Microbiology at Patan Academy of Health Sciences (PAHS), Nepal, where he has been teaching and practicing clinical microbiology for over 14 years. He is the founder of Microbe Online, one of the leading free microbiology education resources on the web, covering bacteriology, mycology, parasitology, immunology, and clinical laboratory diagnostics written from direct experience in both the classroom and the diagnostic laboratory.*",468,{"slug":232,"name":233,"description":234,"image":235,"body":236,"postCount":237},"ashma-shrestha","Ashma Shrestha","SEO Copywriter and Science Communicator\nKathmandu, Nepal","https:\u002F\u002Fassets.microbeonline.com\u002Fauthors\u002Fashma-shrestha.png","Ashma Shrestha holds a Master of Science in Medical Microbiology from the Institute of Science and Technology (IOST), Tribhuvan University, Nepal, where she developed a strong foundation in virology, molecular biology, and diagnostic microbiology.\n\nShe now works as an SEO Copywriter at Resolution Digital, where she combines her scientific training with research-driven content strategy. She is certified in Google Analytics and Google Business Profile (GBP), and brings a data-informed approach to science communication writing content that is not only accurate but structured to reach and serve the students who need it most.\n\nAt microbeonline, Ashma contributes articles primarily in virology and molecular biology, areas she finds most compelling for their mechanistic depth and their growing clinical relevance. Her writing reflects the same standard the site is built on: factual rigor, clear explanation of the *why* behind microbiology concepts, and content that helps students move from memorization to genuine understanding.\n\nShe is passionate about making complex microbiological concepts accessible without sacrificing accuracy; a skill that sits at the intersection of her scientific training and her professional work in content and SEO.",78,{"slug":239,"name":240,"description":241,"image":242,"body":243,"postCount":244},"sushmita-baniya","Sushmita Baniya","Author \u002F Contributor","https:\u002F\u002Fassets.microbeonline.com\u002Fauthors\u002Fsushmita-baniya-1.png","Sushmita Baniya holds an M.Sc. in Medical Microbiology from Tribhuvan University (National College), with a research focus in Genetics and Molecular Biology. She is actively involved in teaching and research in the field of microbiology.",26,{"slug":246,"name":247,"description":241,"image":248,"body":249,"postCount":250},"samikshya-acharya","Samikshya Acharya","https:\u002F\u002Fassets.microbeonline.com\u002Fauthors\u002Fsamikshya-acharya.jpeg","Samikshya Sharma completed her postgraduate studies in Medical Microbiology at the Central Department of Microbiology, Tribhuvan University, Nepal. She contributes to Microbeonline with the goal of making foundational and clinical microbiology concepts clear and useful for students in medical, laboratory science, and allied health programs.",20,{"slug":252,"name":253,"description":241,"image":42,"body":254,"postCount":255},"alisha-tripathi","Alisha Tripathi","Alisha Tripathi holds an M.Sc. in Medical Microbiology from National College, Tribhuvan University. With over a year of teaching experience, her academic interests span Molecular Biology, Immunology, and Genetics.",6,{"slug":257,"name":258,"description":259,"image":42,"body":260,"postCount":261},"aastha-shrestha","Aastha Shrestha"," Author \u002F Contributor","Aastha Shrestha is a Biotechnology graduate with an M.Sc. from National College, Tribhuvan University. Her academic interests center on Molecular Biology and Immunology; two fields that are increasingly converging in modern diagnostic and clinical microbiology. \n\nShe contributes to Microbeonline with the goal of making complex concepts in these areas approachable and exam-relevant for students across medical, biotechnology, and laboratory science programs.",9,{"slug":263,"name":264,"description":265,"image":42,"body":42,"postCount":266},"guest-author","Guest Author","Guest Author \u002F Contributor",1,{"slug":268,"name":269,"description":241,"image":270,"body":271,"postCount":272},"srijana-khanal","Srijana Khanal","https:\u002F\u002Fassets.microbeonline.com\u002Fauthors\u002Fsrijana-khanal-1.png","Srijana Khanal is a microbiology educator with nearly a decade of teaching experience, including her role as faculty in the Microbiology Department at National College, NIST. \n\nHer time in the classroom has given her a clear sense of where students struggle and what explanations actually work, a perspective that directly shapes how she writes.\n\nHer academic interests span Immunology, Genetics, Basic Sciences, and Research Methodology, and she brings the same rigor to her writing that she brought to teaching. Alongside academic writing, she has a passion for creative writing -- an instinct that shows in her ability to make dense scientific material readable without sacrificing accuracy.\n\nShe contributes to Microbeonline to extend her teaching reach beyond the classroom, helping medical and laboratory science students across the region build a stronger foundation in microbiology.",17,{"slug":274,"name":275,"description":265,"image":42,"body":42,"postCount":266},"dr-poonam-acharya","Dr. Poonam Acharya",{"slug":277,"name":77,"description":278,"image":279,"body":280,"postCount":281},"nisha-rijal","Microbiologist and AMR Specialist Kathmandu, Nepal","https:\u002F\u002Fassets.microbeonline.com\u002Fauthors\u002Fnisha-rijal-1.png","Nisha Rijal is a microbiologist with nearly 15 years of frontline diagnostic and surveillance experience at the National Public Health Laboratory (NPHL), national reference laboratory under the Department of Health Services, Nepal. She currently works as an AMR Support Officer at the World Health Organization (WHO), Nepal, where her work focuses on strengthening antimicrobial resistance surveillance systems and translating AMR data into actionable public health response.\n\nHer research, published in peer-reviewed journals and cited over 220 times, spans some of the most clinically significant infectious disease challenges in Nepal and South Asia: antimicrobial resistance trends in *Vibrio cholerae* across an 11-year national surveillance dataset, sero-epidemiology of scrub typhus in patients with acute febrile illness, lower respiratory tract infections in HIV-positive patients, and gonococcal resistance surveillance. She was a contributor to Nepal's National Antimicrobial Resistance Containment Action Plan, a foundational policy document for AMR governance in Nepal. You can find list of [Nisha Rijal's article here in Google Scholar.](https:\u002F\u002Fscholar.google.com\u002Fcitations?user=N-Ruq54AAAAJ&hl=en)\n\nThis depth of experience is visible in her writing at Microbeonline. Her 53 published articles cover bacteriology, parasitology, mycology, immunology, and laboratory techniques, and are consistently among the most detailed and clinically grounded content on the site. She brings to every article the same standard that national reference laboratory work demands: methodological precision, awareness of real diagnostic constraints, and an understanding of what results actually mean for patient care in resource-limited settings.\n\nHer areas of particular expertise include antimicrobial susceptibility testing and resistance mechanism detection, quality assurance in clinical microbiology, and laboratory-based infectious disease surveillance.\n\n---\n\n*Nisha Rijal contributes to Microbeonline in a personal capacity. Her views and writing do not represent the positions of the World Health Organization or any other institution.*",54,{"slug":283,"name":284,"description":285,"image":286,"body":287,"postCount":266},"padma-shrestha","Padma Shrestha","Author","https:\u002F\u002Fassets.microbeonline.com\u002Fauthors\u002Fpadma-shrestha.png","Padma Shrestha is from Kathmandu, Nepal. She has completed Masters degree in Medical microbiology from Tribhuvan University. She has great interest in Microbiology and Molecular Biology.",[289,296,302,307,312,317,321,325,329,333,337,342,346,351,356,360,364,368,373,378,382,386,390,395,399,403,407,411,416,421,425,429,433,437,441,445,449,453,457,461,465,469,473,477,481,485,489,493,498,502,506,510,514,518,522,526,530,534,538,542,546,550,554,558,562,566,570,574,577,581],{"slug":290,"name":291,"description":292,"image":293,"body":294,"postCount":295},"gram-negative-cocci","Gram-Negative Cocci and Coccobacilli","Neisseria, Moraxella, Haemophilus and related gram-negative coccal organisms","https:\u002F\u002Fassets.microbeonline.com\u002Ftags\u002Fgram-negative-cocci.png","# Gram Negative Cocci\n\nNeisseria gonorrhoeae, Neisseria meningitides, Moraxella catarrhalis, and other Neisseria spp. are clinically relevant gram-negative cocci.\n\nN. gonorrhoeae is the leading cause of sexually transmitted disease whereas N. meningitides is a leading cause of fatal bacterial meningitis.",14,{"slug":297,"name":298,"description":299,"image":42,"body":300,"postCount":301},"microscopy","Microscopy","Microscope types, components, and microscopy techniques","These are list of blog posts related to microscopy. ",12,{"slug":303,"name":304,"description":305,"image":42,"body":42,"postCount":306},"gram-positive-cocci","Gram-Positive Cocci","Staphylococcus, Streptococcus, Enterococcus, Micrococcus — organisms, diseases, and identification tests",11,{"slug":308,"name":309,"description":310,"image":42,"body":42,"postCount":311},"gram-negative-rods","Gram-Negative Rods (Other than Enterobacteriaceae)","\u003Cp>Gram negative rods other than members of Enterobacteriaceae family such as  Pseudomonas, Acinetobacter and related organisms\u003C\u002Fp>",5,{"slug":313,"name":314,"description":315,"image":42,"body":42,"postCount":316},"gram-positive-rods","Gram-Positive Rods","Bacillus, Clostridium, Listeria, Corynebacterium, Actinomyces and related organisms",8,{"slug":318,"name":319,"description":320,"image":42,"body":42,"postCount":306},"mycobacteria","Mycobacteria","Mycobacterium tuberculosis, leprosy, atypical mycobacteria, and acid-fast organism diagnosis",{"slug":322,"name":323,"description":324,"image":42,"body":42,"postCount":306},"anaerobic-bacteriology","Anaerobic Bacteriology","Anaerobic organisms, anaerobic culture methods, and anaerobic infection diagnosis",{"slug":326,"name":327,"description":328,"image":42,"body":42,"postCount":301},"enterobacteriaceae","Enterobacteriaceae","Identification, differentiation, and clinical significance of Enterobacteriaceae family members",{"slug":71,"name":330,"description":331,"image":42,"body":42,"postCount":332},"Spirochetes","Treponema, Leptospira, Borrelia and spirochetal infections",7,{"slug":334,"name":335,"description":336,"image":42,"body":42,"postCount":295},"food-microbiology","Food Microbiology","Food-borne pathogens, food safety, spoilage, and preservation",{"slug":338,"name":339,"description":340,"image":42,"body":42,"postCount":341},"antimicrobial-susceptibility-testing","Antimicrobial Susceptibility Testing","Methods for testing antibiotic susceptibility in clinical microbiology",21,{"slug":343,"name":344,"description":345,"image":42,"body":42,"postCount":316},"antimicrobials-moa-amr","Antimicrobials (MOA & AMR)","Mechanisms, detection, and clinical significance of antimicrobial resistance",{"slug":347,"name":348,"description":349,"image":42,"body":42,"postCount":350},"sterilization-disinfection","Sterilization and Disinfection","Methods of sterilization and disinfection in healthcare and laboratory settings",10,{"slug":352,"name":353,"description":354,"image":42,"body":42,"postCount":355},"specimen-collection-transport","Specimen Collection and Transport","Collection, handling, and transport of clinical specimens for microbiological testing",27,{"slug":357,"name":358,"description":359,"image":42,"body":42,"postCount":341},"bacterial-structure-physiology","Bacterial Structure and Physiology","Bacterial cell structure, growth, physiology, and environmental factors affecting growth",{"slug":361,"name":362,"description":42,"image":42,"body":363,"postCount":255},"horizontal-gene-transfer","Horizontal Gene Transfer","Articles related to **Horizontal Gene Transfer**",{"slug":365,"name":366,"description":42,"image":42,"body":367,"postCount":350},"chromatography","Chromatography","Information about chromatographic techniques.",{"slug":369,"name":370,"description":371,"image":42,"body":372,"postCount":332},"electrophoresis","Electrophoresis","Information about Electrophoresis Techniques ","Detailed information  about Electrophoresis Techniques ",{"slug":374,"name":375,"description":376,"image":42,"body":377,"postCount":255},"pcr-techniques","PCR Techniques","Information about various types of Polymerase Chain Reaction Techniques ","More detailed information about various types of Polymerase Chain Reaction Techniques ",{"slug":379,"name":380,"description":381,"image":42,"body":42,"postCount":255},"bacteriophage","Bacteriophage","Description about Bacteriophage.",{"slug":383,"name":384,"description":385,"image":42,"body":42,"postCount":255},"malaria","Malaria","It is the collections of articles regarding malarial disease. ",{"slug":387,"name":388,"description":389,"image":42,"body":42,"postCount":255},"anaerobic-culture-techniques","Anaerobic Culture Techniques","Posts related with Anaerobic Culture Techniques.",{"slug":391,"name":392,"description":393,"image":42,"body":42,"postCount":394},"immunoassays","Immunoassays","You will get information about all the diagnostic tests that rely on the specific binding between an antigen and an antibody to detect or quantify a substance.",19,{"slug":396,"name":397,"description":398,"image":42,"body":42,"postCount":332},"biosafety-levels","Biosafety levels ","Articles related to Biosafety Levels",{"slug":400,"name":401,"description":402,"image":42,"body":42,"postCount":311},"environmental-factors","Environmental Factors ","In this case we are talking about growth requirements of microorganisms with deep dive in environmental factors that affect the growth. ",{"slug":404,"name":405,"description":406,"image":42,"body":42,"postCount":255},"pipette","Pipette","Posts related with Pipette. ",{"slug":408,"name":409,"description":410,"image":42,"body":42,"postCount":316},"bacteriology-mcqs","Bacteriology MCQs","This sections lists MCQs in Bacteriology.",{"slug":412,"name":413,"description":414,"image":42,"body":42,"postCount":415},"parasitology-mcqs","Parasitology MCQs","This section lists MCQs in Parasitology.",2,{"slug":417,"name":418,"description":419,"image":42,"body":42,"postCount":420},"virology-mcqs","Virology MCQs","This is the collections of Multiple Choice Questions in Virology.",4,{"slug":422,"name":423,"description":424,"image":42,"body":42,"postCount":311},"mcqs-in-microbiology","MCQs in Microbiology","This section lists the collections of Multiple Choice Questions in General Microbiology Topics. ",{"slug":426,"name":427,"description":428,"image":42,"body":42,"postCount":316},"immunology-mcqs","Immunology MCQs","In this section; we are posting collections of Multiple Choice Questions about Immunology. ",{"slug":430,"name":431,"description":432,"image":42,"body":42,"postCount":261},"microbial-curiosities","Microbial Curiosities","In this clusters, we are posting interesting and unique information about Microorganisms. ",{"slug":434,"name":435,"description":436,"image":42,"body":42,"postCount":341},"bacterial-culture-media","Bacterial Culture Media","Posts related to Bacterial Culture Media. ",{"slug":438,"name":439,"description":440,"image":42,"body":42,"postCount":255},"fungal-culture-media","Fungal Culture Media","Posts related to Fungal Culture Media.",{"slug":442,"name":443,"description":444,"image":42,"body":42,"postCount":311},"motility-test","Motility Test","This lists the procedure regarding various tests methods for bacterial motility.",{"slug":446,"name":447,"description":448,"image":42,"body":42,"postCount":350},"bacterial-enumeration","Bacterial enumeration","These posts are related to isolation and enumeration of bacteria. ",{"slug":450,"name":451,"description":452,"image":42,"body":42,"postCount":415},"gram-positive-coccobacillus","Gram-positive coccobacillus","List of Gram Positive Coccobacilli",{"slug":454,"name":455,"description":456,"image":42,"body":42,"postCount":420},"dimorphic-fungi","Dimorphic Fungi","This is about various dimorphic fungi. ",{"slug":458,"name":459,"description":460,"image":42,"body":42,"postCount":332},"bacterial-classification","Bacterial Classification","These posts are related with various approaches used for the classification of Bacteria. ",{"slug":462,"name":463,"description":464,"image":42,"body":42,"postCount":311},"immunofluorescence","Immunofluorescence ","Various Tests related to Immunofluorescence ",{"slug":466,"name":467,"description":468,"image":42,"body":42,"postCount":261},"antibody-mediated-immunity","Antibody-mediated Immunity","This clusters links the articles that are sharing insights about Antibody-mediated immunity. ",{"slug":470,"name":471,"description":472,"image":42,"body":42,"postCount":332},"hypersensitivity","Hypersensitivity","Articles related to Hypersensitivity.",{"slug":474,"name":475,"description":42,"image":42,"body":42,"postCount":476},"haemophilus","Haemophilus",3,{"slug":478,"name":479,"description":480,"image":42,"body":42,"postCount":420},"sexually-transmitted-infections-stis","Sexually transmitted infections (STIs)","This is the clusters of infections that are transmitted sexually. ",{"slug":482,"name":483,"description":484,"image":42,"body":42,"postCount":301},"adaptive-immunity","Adaptive Immunity","Blog posts related to B Cell Immunity and T Cell Immunity.",{"slug":486,"name":487,"description":488,"image":42,"body":42,"postCount":295},"fungal-diagnostics","Fungal Diagnostics","Various methods used for the Diagnosis of Fungal Infections. ",{"slug":490,"name":491,"description":492,"image":42,"body":42,"postCount":311},"laboratory-storage-and-preservation","Laboratory Storage and Preservation","Articles about Laboratory Storage of Antimicrobial Disk, Test organisms and Equipment used for this process. ",{"slug":494,"name":495,"description":496,"image":42,"body":497,"postCount":255},"laboratory-heating-equipment","Laboratory Heating Equipment","A guide to laboratory heating equipment, including hot plates, water baths, Bunsen burners, incubators, and dry baths, and how to choose the right one for each task.","Laboratory heating equipment covers the instruments that warm, melt, incubate, or sterilize samples and media in a microbiology laboratory. Each one delivers heat differently. \n\nA hot plate gives high, direct, dry heat; a water bath gives gentle, even, wet heat up to about 100°C; a Bunsen burner gives an open flame for rapid, very high heat; an incubator holds cultures at a steady temperature over hours or days; and a dry bath heats small tubes without water. Choosing the right one depends on the temperature you need, how precise it must be, and whether the sample can tolerate direct or open-flame heat.\n\nThe articles below cover each piece of heating equipment in detail, including its parts, working principle, uses, and the mistakes that most often go wrong at the bench.",{"slug":499,"name":500,"description":501,"image":42,"body":42,"postCount":316},"laboratory-glassware","Laboratory Glassware","Posts about Laboratory Glassware. ",{"slug":503,"name":504,"description":505,"image":42,"body":42,"postCount":255},"helminths","Helminths","In this section, we are covering properties, life cycle, pathogenesis and laboratory diagnosis of Helminths\u002FHelminthic infestations. ",{"slug":507,"name":508,"description":509,"image":42,"body":42,"postCount":255},"protozoan-parasite","Protozoan Parasite","In this cluster, we are covering protozoan parasites. ",{"slug":511,"name":512,"description":513,"image":42,"body":42,"postCount":266},"tests-for-gram-positive-cocci","Biochemical Tests for Gram Positive Cocci","This is the lists of Biochemical Tests that are used for Gram Positive Cocci. ",{"slug":515,"name":516,"description":517,"image":42,"body":42,"postCount":350},"bacterial-staining-technique","Bacterial Staining Technique","Lists of various staining techniques that are used to stain bacteria. ",{"slug":519,"name":520,"description":521,"image":42,"body":42,"postCount":250},"enzyme-tests","Enzyme Tests","\u003Cp>Various Biochemical Test that are based on enzymatic activity of the microorganisms. \u003C\u002Fp>",{"slug":523,"name":524,"description":525,"image":42,"body":42,"postCount":306},"carbohydrate-utilization","Carbohydrate Utilization","\u003Cp>Various biochemical tests which are related to Carbohydrate fermentation or Utilization\u003C\u002Fp>",{"slug":527,"name":528,"description":529,"image":42,"body":42,"postCount":311},"susceptibility-based-id","Susceptibility-based ID","\u003Cp>These are susceptibility based identification test such as optochin sensitivity, bacitracin sensitivity etc. \u003C\u002Fp>",{"slug":531,"name":532,"description":533,"image":42,"body":42,"postCount":420},"microbial-metabolism","Microbial Metabolism","\u003Cp>Tests about Microbial Metabolism. \u003C\u002Fp>",{"slug":535,"name":536,"description":537,"image":42,"body":42,"postCount":316},"substrate-utilization","Substrate Utilization","\u003Cp>The test in which a non-sugar carbon\u002Fnitrogen source is used or degraded (citrate, malonate, decarboxylases, indole, PAD).\u003C\u002Fp>",{"slug":539,"name":540,"description":541,"image":42,"body":42,"postCount":476},"atypical-pneumonia","Atypical Pneumonia","\u003Cp>Organisms responsible for Atypical Pneumonia. \u003C\u002Fp>",{"slug":543,"name":544,"description":545,"image":42,"body":42,"postCount":311},"antigen","Antigen","\u003Cp>Various articles related to Antigens.\u003C\u002Fp>",{"slug":547,"name":548,"description":549,"image":42,"body":42,"postCount":332},"innate-immunity","Innate Immunity","\u003Cp>Articles related to Innate Immunity. \u003C\u002Fp>",{"slug":551,"name":552,"description":553,"image":42,"body":42,"postCount":420},"respiratory-tract-infection","Respiratory Tract Infection","\u003Cp>In this cluster, you can see various etiological agents that causes respiratory tract infection. \u003C\u002Fp>",{"slug":555,"name":556,"description":557,"image":42,"body":42,"postCount":311},"torch-infection","TORCH Infection","\u003Cp>In this section; you can find articles related with TOCH infection. \u003C\u002Fp>",{"slug":559,"name":560,"description":561,"image":42,"body":42,"postCount":332},"microbiology-for-beginners","Microbiology for Beginners","\u003Cp>These articles are very basic articles, which will share general concepts in Microbiology. \u003C\u002Fp>",{"slug":563,"name":564,"description":565,"image":42,"body":42,"postCount":255},"dna-replication","DNA Replication","\u003Cp>Articles related to DNA and Replication of DNA. \u003C\u002Fp>",{"slug":567,"name":568,"description":569,"image":42,"body":42,"postCount":332},"genetic-code","Genetic Code","\u003Cp>Articles related to Genetic Code.\u003C\u002Fp>",{"slug":571,"name":572,"description":573,"image":42,"body":42,"postCount":311},"molecular-technique","Molecular Technique","\u003Cp>Posts related to Molecular Techniques. \u003C\u002Fp>",{"slug":575,"name":576,"description":42,"image":42,"body":42,"postCount":266},"colorimetric-assay","Colorimetric Assay ",{"slug":578,"name":579,"description":580,"image":42,"body":42,"postCount":311},"pharmaceutical-microbiology","Pharmaceutical Microbiology","\u003Cp>Various articles related to Pharmaceutical Microbiology\u003C\u002Fp>",{"slug":582,"name":583,"description":42,"image":42,"body":42,"postCount":476},"blood-and-immune-cells","Blood and Immune Cells"]