Medical Microbiology and Infection at a Glance STEPHEN H. GILLESPIE MD.FRCP (Edin), FRCPath Professor of Medical Microbiology Royal Free and University College Medical School (Royal Free C University ¢ London KATHLEEN B. BAMFORD MD,FRCPath, Senior Lecturer in Medical Microbiology Imper School of Medicine pital London Edited by JANET P.GILLESPIE MB, MRCGP General Practitioner©2000 Blackwell Science Lid Exltorial tices: (Osney Mead, Oxford OX20EL 25 on Sect, London WIN 2B. 23 Ainslie Place. Edinburgh EH3 6A) 330 Main Street Malden MA (21485018, USA, 54 University Steet, Carton ‘Vieworia 3083, Australia 10,rue Casiniar Delavigne "7S006 Pars France ther Editorial Offices Black ll Wisenschafs- Verlag GmbH Kurfurstendamm 37 10707 Berlin, Germany Blackwell Science KK MG Kodenmacho Building 7-10 Kodenmacho Nibombashi ‘Chuo-ku, Tokyo 108 Japan Towa State University Press AA Blackwell Science Company 2121'S, State Avenue ‘Ames, Jowa 800148300, USA First published 2000 Reprinted 2000, 200 Setby Excel Typesetters Ca, Hong Kone Printed and bound in Groat Britain at the Alden Press, Oxford and Northampton The Blackwell Science logoisa teade mark of Blackyvll Science Ld, registered atthe United Kingdom Trade Marks Registry The right ofthe Autorstobe bistarnvrors iMesh Ao hs Work eae has been asrted in acordance ea esd with the Copyright, Designs and Abingdon, Oxon OX144YN Pateats Ac (one Teens 50 an uiasasss) llrightsreserved. No part of {hs publicotion may be eprntuccd The Americas Stored ina ettval sssem, or lacksell Pulshine Iransmited,inany form ory any cio AIDC ‘means electronic mechanical PO Box 20 ‘Photocopvine recording or otherwise, 50 Winter Sport Lane Exceptanpermited by the UK Wiiaton 1 05498 020 Gopyright-Designs and Patents Act. (Onder Te: SOD 216 2522 Tons without the pao pe Fax: M2 864 7626) ofthe copyright one. nil ‘Blackwell Seienee Ply Lid catalogue record fo this tite StUnivenaity Street isavalabl from the Brish Library Carton, Vitoria 3083 (Onder Te 398570300 ISBN 0.632-050268 Fax: 39875001) Library of Congress Cataloging-in-publication Data Peete eee [Blackwell Sience visit our website: Gittespic, SH. ‘www lackwellsecnec.com ‘Medical microbiology and infection ataglance/ Stephen H. Gillespie, Kathleen B. Barntord Eeited by Janet PCillspi P Includes index ISBN 0.632.050268 1. Medical microbiology. 1 Bamford, Kathloen i, Tie [DNLME 1. Microbiology. 2, Communicable Diseases. 616-01—de2t DNLM/DLC for Library of Congress we.2684 cP.Contents 10 u 2 B 4 15 16 ” 18 19 20 2 2 B Py 25 26 ” Preface,7 Concepts, Structure and classification of bacteria, 8 Innate immunity and normal flora, 10 Pathogenicity and transmission of ‘microorganisms, 12 ‘The laboratory investigation of infection, 14 Antibacterial therapy, 16 Resistance to antibacterial agents. 18 Hospital-acquired infections, 20 Control of infection in hospital, 22 Control of infection in the community, 24 Bacteriology Staphylococcus, 26 Streptococcal infections, 28 Corynebacterium, Listeria and Bacillus,30 ‘Mycobacteria, 32 Clostridium species, 34 ‘Non-sporing anaerobic infections,36 Neisseria and Haemophilus,38 ‘Small Gram-negative cocco-bacilli: Bordetella, Brucella, Francisella and Yersinia, 40 Enteric Gram-negative bacteria, 42 Vibrio, Campylobacter and Helicobacter, 44 Environmental pathogens: Pseudomonas Burkholderia and Legionella, 46 Chlamydia, Mycoplasma and Rickettsia, 48 Spiral bacteria, 50 Virology Virus structure, classification and antiviral therapy,52 Herpesvirus 1,54 Herpesvirus 11,56 DNA viruses: adenovirus, parvovirus and, poxvirus,58 Measles, mumps and rubella, 60 28 29 30 31 32 3B 50 Influenza and parainfluenza viruses, 62 Enterovirus and viruses infecting the gastrointestinal tract, 64 Hepatitis viruses, 66 ‘Tropical, exotic or arbovirus infections, 68 Mycology Yeast infections, 70 Filamentous fungi, 72 Parasitology Intestinal protozoa,74 Malaria, leishmaniasis and trypanosomiasis, 76 Gut helminths, 78. Tissue helminths, 80 Systemic infection Congenital and perinatal infections, 82 HIV infection and AIDS,84 Pyrexia of unknown origin and septicaemia, 86 Endocarditis, myocarditis and pericarditis, 8 Infections of the central nervous system, 90 Respiratory tract infections, 92 Urinary and genital infections, 94 Infections of the bones and joints, 96 Bacterial diarrhoeal disease, 98. Zoonoses, 100 Infections in immunocompromised patients, 102 Ocular infections, 104 Infections of the skin and soft tissue, 106 Glossary, 109 Antibiotic table, 113 Index, 117 A colour plate section follows facing page 120Preface This book is written for medical students and doctors who are secking a brief summary of microbiology and infectious diseases. It should prove useful to those embarking on a course of study and assist those preparing for professional examinations. Chapters are divided into concepts, the main human pathogens and the infectious syndromes. This broadly reflects the pattern of teaching in many medical schools Microbiology is a rapidly growing and changing sub- ject: new organisms are constantly being identified and our understanding of the pathogenic potential of re- cognized pathogens is being expanded. In addition the taxonomists keep changing the names of familiar friends to add to the confusion, Despite this, there are clear fundamental facts and principles that form a firm founda- tion of knowledge on which to build throughout a professional career. It is these that this book strives to, ‘encapsulate, Each chapter contains a diagram which illustrates core knowledge. The associnted text offers further insights and details where necessary. Irrespective of a doctor's specialty, diligent study of microbiology provides the basis for sound professional judgement, giving the clinician confidence and benefiting Patients for years to come, ‘The authors gratefully acknowledge the editorial work of Dr Janet Gillespie who has reminded the authors of practice in a community setting. They are also grateful to Dr Deenan Pillay for his critical reading of the virology sections. ‘Stephen Gillespie & Kathleen Bamford Lonslon, 2000Structure and classification of bacteria waa ~., [ee a ae mit Sia ee re Teichoic acid en =F ol [ten Cram a Outer membrane —§ ee ee. +- layer Grampostve (FET an nagave Obligate aerobes ——» Require oxygen Microaerophiles ——» Require reduced oxygen Obligate anaerobes ——+ Require no oxygen Facultative anaerobes ——» Anaerobic or aerobic Capnophiies ——+ Require increased CO Bacterial organelles Bacteria possess a rigid cell wall that is responsible for ‘maintaining ther shape and protecting the cell from differ- ences in osmotic tension between the inside and outside environment. Gram-positive walls have a thick peptidogly- can layer and a cell membrane, whereas Gram-negative cells have three layers with an inner and outer membrane and a thinner peptidoglycan layer. Mycobacteria cell wal has a high proportion of lipid, including immunoreactive antigens. Bacterial shape depends on cell wall structure: cocci are spherical, bacilli are long and thin, with cocco- bacilli in between, and spiral shapes of different wav length. Shape is used in bacterial classification, Outside the ‘ell wall the bacterium may express important antigens and structures * Capsule: a loose polysaccharide structure protecting it from phagocytosis and desiccation. 8 aD Spores Present in Clostridium and Bacillus 9pp. Batteries of reactions «—— Biochemistry areneeded for species Wdentification ‘+ Lipopolysaccharide: found in Gram-negative bacteria protecting against complement-mediated lysis and a potent stimulator of eytokine release. + Fimbriae or pi: specialized thin projections that aid adhesion to host cells and colonization. Uropathogenic Escherichia coli have specialized fimbriae (P fimbriae) that bind to mannose receptors on ureteric epithelial cells. Fim- brial antigens are often immunogenic but vary between strains so that repeated infections may occur, e.g, Neisseria, gonorrhoeae. '* Flagetia: bacterial organs of locomotion enabling organ- isms to find sources of nutrition and penetrate host mucus. Flagella can be single or multiple, at one end of the cell (polar) or at many points (peritrichous). In some species, eg. Treponema, the flagella are firmly fixed within the bac- terial cell wall. + Slime: polysaccharide material secreted by some bacteria