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Pathogenic Microbiology

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PRINCIPLES OF DISEASE

I. TERMINOLOGY * Pathology- the study of disease * Infection- the invasion or colonization of the body by a pathogenic microorganism * Disease- abnormal state of health as the result of an infection * If Pseudo aeruginosa infects the eye it can cause a disease termed Pseudomonas keratitis. The etiologic agent (cause) of this disease is: Microbial pathogenesis- the characteristics/traits the microbe has that leads to the disease.

II. NORMAL MICROBIOTA * 1 x 10^13 human cells in our body * 1x10^14 bacterial cells on/in our body (permanent residence that under normal conditions do not cause disease)

* Areas with normal Microbiota: 1. GI tract 2. Upper respiratory 3. Skin 4. Urogenital Tract

* Areas that are relatively sterile: 1. The Nervous System * The blood brain barrier (blood vessel cerebrospinal fluid) 1) Endothelial cells 2) Astrocytes 3) Neurons
*A structural impediment with restricted permeability * The lower respiratory tract * Upper respiratory- nasal hairs, mucous membrane, ciliary escalator, alveolar macrophages * In healthy person, microbes shouldn’t be able to make it down that far (past the upper respiratory) * The cardiovascular system (blood) * Septicemia- “blood poisoning,” growth of a pathogenic microorganism in the blood (non-specific term) * Bacteremia- bacteria in the blood * Toxemia- presence of toxin in the blood * Viremia- in the blood

* Q: Do we all have the same resident flora? A: Bacteria from our skin remains on the things we touch and could be used for the same purpose as fingerprints. Own personal bacteria can stay on things we touch for days or even weeks at a room temperature if left untouched. Dislodged microbes could help identify an individual

* REVIEW * What is pathology the study of? Disease

* What is the difference between an infection and a disease? An infection is the invasion or colonization of the body by a pathogenic microorganism. A disease is the abnormal state of health as the result of an infection.

* What is an etiologic agent? The cause of the disease

* Define the terms microbial pathogenesis and normal microbiota: Microbial pathogenesis- the characteristics/traits the microbe has that leads to the disease. Normal Microbiota- bacterial cells in our body that under normal conditions do not cause disease.

* What areas of our body have normal microbiota? GI tract, upper respiratory, skin, urogenital tract.

* What areas of our body are considered to be relatively sterile? Nervous system, lower respiratory tract, cardiovascular system (blood)

* What impeded microbes from entering our nervous system and what three cell types make up this structural barrier? The blood brain barrier. Endothelial cells, astrocytes, neurons.

* What does CSF stand for and what type(s) of microbes would you find in the CSF of a healthy individual? Cerebrospinal fluid.

* Why should the lower respiratory tract be considered a relatively sterile environment in a healthy individual? The upper respiratory tract has nasal hairs, mucous membrane, ciliary escalator, and alveolar macrophages that should prohibit microbes from making it down into the lower respiratory tract.

* Define septicemia, bacteremia, toxemia and viremia. Septicemia- “blood poisoning,” growth of a pathogenic microorganism in the blood Bacteremia- bacteria in the blood Toxemia- presence of toxin in the blood Viremia- in the blood

III. MICROBIAL RELATIONSHIPS * Microorganisms most often must share habitats and interact with either similar microbe, dissimilar microbes and/or multicellular organisms (including us!)

* Interactions may/may not be required and may be good or bad

* Symbiotic microbial relationship- organisms live in a close nutritional relationship that is required by at least one member for survival. Relationship between organisms in which at least one organism is dependent on another. 1. Commensalism- one of the organism’s benefits, the other is unaffected. * S. epidermidis- feeds off secretions & sloughed-off cells on our skin (benefits) * Humans- we get to carry non-pathogenic bacteria on our hands (unaffected) 2. Mutualism- benefits both organisms * E. coli- feeds off of nutrients in the large intestine & provides vitamin K and B to our blood stream (benefits) * Humans- e. coli makes vitamin K used by our cells (benefits) * Normal microbiota in the intestines- feeds off of nutrients in the large intestine (benefits) * Humans- normal microbiota provide us with “regularity” and protect us from invading pathogens (benefits) 3. Parasitism- one organism benefits by deriving nutrients at the expense of the other * HIV- uses our cells to replicate (benefit) * Humans- we contract a terminal disease (suffers)

* Probiotics- live microbial cultures that are administered or ingested with the intent to exert a beneficial effect. (Feces= the ultimate probiotic)

* Opportunistic pathogen- a microorganism that can cause disease only when an individual’s immune response is weak OR when it moves to a new location within the body (ex: E coli). They ordinarily do not cause disease in their normal habitat in a healthy person but may do so in a different environment. For example, microbes that gain access through broken skin or mucous membranes can cause opportunistic infections.

* Endogenous infections- infections caused by our normal flora (Pneuomocystis jirovecii, a fungus that can be found in the respiratory tract of healthy individuals-can be deadly in patients with HIV)

* Non-symbiotic relationship- organisms co-habitat but no relationship is required for survival * Synergism- all microbes cooperate and share nutrients (ex: a mixed infection) * Antagonism- Microbes compete for nutrients and if possible will inhibit or destroy competition. Example: Antibiotics produced by one type of microbe in order to out compete the other microbes. One consequence of this competition is that the normal microbiota protect the host against colonization by potentially pathogenic microbes by competing for nutrients, producing substances harmful to the invading microbes, and affecting conditions such as pH and available oxygen. When this balance between normal microbiota and pathogenic microbes is upset, disease can result.

* REVIEW * With respect to microbiology, explain what symbiotic & non-symbiotic relationships are.

* What is commensalism? Is it a symbiotic or non-symbiotic relationship? Provide a microbiological example of commensalism.

* What is mutualism? Is it a symbiotic or non-symbiotic relationship? Provide a microbiological example of mutualism.

* What are probiotics and what might be considered the “ultimate” probiotic?

* What is parasitism? Is it a symbiotic or non-symbiotic relationship? Provide a microbiological example of parasitism.

* What is an opportunistic pathogen?

* What are endogenous infections?

* What is synergism? Is it a symbiotic or non-symbiotic relationship? Provide a microbiological example of synergism.

* What is antagonism? Is it a symbiotic or non-symbiotic relationship? Provide a microbiological example of antagonism.

IV. IDENTIFYING THE ETIOLOGIC AGENT * How do you identify the microbe that is the cause of an infectious disease? * Robert Koch * Noble prize winner in medicine 1905 for his work on tuberculosis * Other great contribute to microbiology were his postulates to establish that a microorganisms was the cause of a disease * Koch’s postulates: 1) The same organism must be found in all hosts with disease but not in health hosts 2) The organism must be isolated from a diseased host and grown in pure culture 3) The cultured organism should cause the same disease when introduced into a healthy host 4) The same organism must be isolated from the new diseased host and grown in pure culture

* Are theses postulates perfect? No * What about an organism that cannot be cultured? NO * What about an opportunistic pathogen or a host that is infected with the organism but has no signs of disease (asymptomatic)? NO * What about organism that can cause several difference disease conditions? NO * What if the organism only infects and causes disease in humans? NO * REVIEW * What is the purpose of Koch’s postulates? To establish that a microorganism was the cause of a disease. They help determine the etiology of disease, the first step in treatment and prevention. Microbiologists use these steps to identify causes of emerging diseases.

* List several reasons why these postulates are not perfect and cannot be applied to the identification of all infectious etiologic agents. Because some pathogens can cause several disease conditions. Mycobac-terium tuberculosis, for example, is implicated in diseases of the lungs, skin, bones, and internal organs. Streptococcus pyogenes can cause sore throat, scarlet fever, skin infections (such as erysipelas), and osteomyelitis (inflammation of bone), among other diseases. When clinical signs and symptoms are used together with laboratory methods, these infections can usually be distinguished from infections of the same organs by other pathogens. Ethical considerations may also impose an exception to Koch’s postulates. For example, some agents that cause disease in humans have no other known host. An example is human immunodeficiency virus (HIV), the cause of AIDS. This poses the ethical question of whether humans can be intentionally inoculated with infectious agents.

V. CLASSIFYING INFECTIOUS DISEASE

How do you know when you have an infectious disease? * Symptom of a disease- subjective evidence like a soar throat (something the patient feels) * Sign of a disease- objective evidence (e.g. swollen tonsils) something that someone else can see. * Asymptomatic- no signs or symptoms of a disease but the patient is infected

VI. OCCURRENCE OF A DISEASE

* HIV/AIDS EXAMPLE- In 2011: world population 6.9 billion # people living with HIV 34.2 million # of newly infected 2.5 million # of deaths 1.7 million

* Prevalence = % of cases with respect to the entire population (34.2 million 6.9 billion) x 100% = prevalence of ~0.5%

* Incidence = measure of # of NEW cases/total # of susceptible people over a specific period of time (2.5 million 6.9 billion) = 36/100,000 cases per yr

* Mortality rate = total # of deaths in the entire population (1.7 million 6.9 billion) = 25/100,000 cases per yr

* Sporadic disease- disease only occurs occasionally * Endemic disease- disease is constantly present in a population (steady frequency) * Epidemic disease- disease is increasing in a population (rising frequency) * Pandemic disease- epidemic disease that occurs across continents (worldwide)

VII. DURATION OF A DISEASE

* Acute disease- develops rapidly but lasts short time (cold) * Chronic disease- develops more slowly but will continue/persist over a long period of time (e.g. hepatitis) * Latent disease- remains inactive for a time then becomes active to produce the symptoms of the disease again (e.g. herpes)

VIII. EXTENT OF A DISEASE

How much of the host’s body is affected? * Local infection- remains limited to a relatively small area of the body * Systemic infection- microbes are spread to other parts of the body by the blood or lymph (Systemic infections are EXTREMELY serious) * Focal infection- microbes from a local infection enter the blood or lymph and spread to other specific parts of the body where they remain confined (dental infection infection of the heart remains controversial)

Host resistance can also affect the extent of infections: * Primary infection- an acute infection that causes the initial illness (e.g. common cold) * Secondary infection- caused by an opportunistic pathogen after the primary infection has weakened the immune system (e.g. bacterial bronchitis)

IX. DEVELOPMENT OF THE DISEASE

1. Incubation Period * time between initial infection and first signs or symptoms of disease * NO indication of disease * NOT contagious

2. Prodromal Period * Time of early mild symptoms of the disease * Generally NOT contagious

3. Period of illness * time when the disease is most severe and generally most contagious * generally immune defenses kick in to high gear during this period to fight off the pathogen * if disease not overcome death occurs

4. Period of decline * Signs and symptoms of disease subside * Vulnerable to secondary infections at this time * Still may be contagious

5. Period of convalescence * Body returns to pre-disease state, recovery occurs * May still be contagious

* REVIEW * Define the terms symptom and sign with respect to disease. Symptom- subjective evidence like a soar throat (something the patient feels) Sign- objective evidence (e.g. swollen tonsils) something that someone else can see.

* What does asymptomatic mean? Showing no symptoms

* Define the terms prevalence, incidence and mortality rate as they relate to infectious diseases. Prevalence = % of cases with respect to the entire population Incidence = measure of # of NEW cases/total # of susceptible people over a specific period of time Morality rate=total # of deaths in the entire population

* What is a sporadic disease, an endemic disease, an epidemic disease and a pandemic disease?

* Graphically illustrate the incidence of a sporadic, endemic and epidemic disease over time.

* What is an acute disease, a chronic disease and a latent disease? Provide an example of each.

* Graphically illustrate an acute, chronic and latent disease with respect to the number of microbes versus the time after infection.

* What is a local infection, a systemic infection and a focal infection?

* What is a primary infection and a secondary infection?

* Describe the five periods that occur during the development of an infectious disease. * What period(s) during the development of an infectious disease will signs or symptoms of the illness be apparent?

* What period(s) during the development of an infectious disease may a person be considered contagious?

X. RESERVOIRS OF INFECTION

Where can disease-causing organisms “hang out”? * Reservoirs of infection: 1. Human reservoirs * Passive carriers- are not sick but can pick up and transmit organisms between others (e.g., Health care workers) * Incubation carriers– carry and spread disease during its symptom-free stage (e.g., HIV positive people) * Convalescent carriers– carry and spread disease during the recovery period (e.g., influenza) * Chronic carriers– have a life-long disease that can be carried and spread (e.g. hepatitis) * Asymptomatic carriers– have and spread a disease but no symptoms (e.g. typhoid Mary carried typhoid fever. Salmonella causes the fever. She infected 53 people, 3 of whom died) 2. Animal reservoirs * Zoonosis- disease that occurs primarily in animals but can be transmitted to humans 3. Nonliving reservoirs * Two most common: soil & water (clostridium species, vibrio chloerae)

XI. TRANSMISSION OF DISEASE

How does microbe move from its reservoir of infection to susceptible host? 1. Direct contact transmission (person to person) * Touching, kissing, sex 2. Indirect contact transmission * Nonliving object to person * Nonliving object termed a fomite 3. Droplet transmission * Microbe carried short distances in droplets 4. Vehicle transmission * Microbes carried by water, food, or air (longer distances than by droplet) * Microbes originate in the water, food, or air 5. Vectors * Insects are most common disease carrying vectors * Mechanical vector transmission- transport the microbes on parts of their bodies without being infected themselves * Biological vector transmission- transport the microbes through the bite; however, the insect is also infected

* Horizontal transmission- person, animal, fomite, food, water, insect person * Vertical transmission- person offspring (e.g. sperm, placenta) * Nosocomial infections- infections you pick up during a hospital stay * The “holy trinity” required for nosocomial infections: 1) Microorganisms 2) A compromised host 3) A chain of transmission (e.g., hospital personnel, visitors, fomites etc…)

XII. HOSPITAL-ACQUIRED INFECTIONS

* Microbes like us because: * Nutrient rich * Moist * Stable pH * Stable temperature * Lots of places to hang out

* REVIEW: * What are the three reservoirs of infection? Human, animal, non-living

* Name the five types of human carriers and give an example of each: * Passive carriers- are not sick but can pick up and transmit organisms between others (e.g., Health care workers) * Incubation carriers– carry and spread disease during its symptom-free stage (e.g., HIV positive people) * Convalescent carriers– carry and spread disease during the recovery period (e.g., influenza) * Chronic carriers– have a life-long disease that can be carried and spread (e.g. hepatitis) * Asymptomatic carriers– have and spread a disease but no symptoms (e.g. typhoid Mary carried typhoid fever. Salmonella causes the fever. She infected 53 people, 3 of whom died)

* Define zoonosis: disease that occurs in animals but can be transmitted to humans

* Name the two most common nonliving reservoirs of infection: soil & water

* List the five ways a microbe can be transmitted from a reservoir of infection to a susceptible host. 1.) Direct contact transmission (person to person) 2.) Indirect contact transmission 3.) Droplet transmission 4.) Vehicle transmission 5.) Vectors

* What is a fomite? Non-living object

* Explain the difference between mechanical vector and biological vector transmission. Mechanical vector transmission- transport the microbes on parts of their bodies without being infected themselves Biological vector transmission- transport the microbes through the bite; however, the insect is also infected

* Explain the difference between horizontal & vertical transmission of a disease. Horizontal- person, animal, fomite, food, water, insect person Vertical transmission- person offspring (e.g. sperm, placenta)

* What are nosocomial infections? Infections you pick up during a hospital stay

* What three things are required for a nosocomial infection to occur? Microorganisms, a chain of tranmission, a compromised host.

* What is one of the major sources of nosocomial infections?

* What is a primary infection and a secondary infection?

* Describe the five periods that occur during the development of an infectious disease.

* What period(s) during the development of an infectious disease will signs or symptoms of the illness be apparent?

* What period(s) during the development of an infectious disease may a person be considered contagious?

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...Aeromonas Hydrophila: The Improbable Culprit Edwin Myrick Abstract This study examines the structure and influences of Aeromonas Hydrophila, as a stand-alone bacterium and as it contribute to Necrotizing Fasciitis. Aeromonas Hydrophila impacts both aquatic life and humans, although the infection is not commonly known. This study examines those influences and explores medical case studies where individuals experienced illness, amputation, and even death. Aeromonas Hydrophila: The Improbable Culprit As the summer months begin to elevate the mercury level, nature’s creeks and streams provide cooling entertainment from the elements. People have long used these waterways for recreation activities, such as fishing, walking, swimming, and canoeing; unsuspecting of the dangers. Most bacteria are harmless, but certain types can cause complications and disease. The flesh eating bacteria Aeromonas Hydrophila, can create unthinkable devastation through minor cuts and scratches; causing sickness, amputation, and even death. The world has thousands of micro-living organisms called bacteria, these unicellular microorganisms have cell walls, but no structured nucleus, some of these microorganisms can cause disease (Hogan, 2005). Thousands of bacteria inhibit our environment every day, many of them unidentified but not all of them are unhealthy. Bacterial cells consist of shapes; spherical, rodlike, spiral, helical, and comm-shaped (Lerner, 2005). The...

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Registered General Nursing Student

...Section A: Basic Microbiology 1 SCOPE AND HISTORICAL DEVELOPMENTS IN MICROBIOLOGY “Science contributes to our culture in many ways, as a creative intellectual activity in its own right, as a light which has served to illuminate man’s place in the uni-verse, and as the source of understanding of man’s own nature” —John F. Kennedy (1917–63) The President of America The bacterium Escherichia coli INTRODUCTION AND SCOPE MICROBIOLOGY is a specialized area of biology (Gr. bios-life+ logos-to study) that concerns with the study of microbes ordinarily too small to be seen without magnification. Microorganisms are microscopic (Gr. mikros-small+ scopein-to see) and independently living cells that, like humans, live in communities. Microorganisms include a large and diverse group of microscopic organisms that exist as single cell or cell clusters (e.g., bacteria, archaea, fungi, algae, protozoa and helminths) and the viruses, which are microscopic but not cellular. While bacteria and archaea are classed as prokaryotes (Gr. pro-before+ karyon-nucleus) the fungi, algae, protozoa and helminths are eukaryotes (Gr. eu-true or good+ karyon-nucleus). Microorganisms are present everywhere on earth, which includes humans, animals, plants and other living creatures, soil,water and atmosphere. Microorganisms are relevant to all of our lives in a multitude of ways. Sometimes, the influence of microorganisms on human life is beneficial, whereas at other times, it is detrimental. For example...

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