Lesson 1

Definition of microbiology
Microbiology is the science that deals with microbes which causative agents of infectious diseases.
Microorganism (any tiny usually microscopic, entity and capable of carrying on living process) are
naturally present on and in the human body as well as in the environment.

 Micro means small size, scope mean look or sees.

 microbe mean small life, logy mean study of
 Many of microorganisms are harmless which known as non pathogenic.

HISTORY OF MICROBIOLOGY
ANTON VAN LEEUWENHOEK ( 1632 – 1723)
 Microorganisms were first seen by Anton Van Leeuwenhoek in about 1675 in Holland using
a microscope.\
 He recognized them in living creatures because they swam actively in materials like water,
saliva, mud and etc.
 Leeuwenhoek saw bacteria, protozoa, yeasts and described all the microbial forms we know
now except for viruses.
 His drawings of the forms of life are
recognized today . As cocci (spheres), bacilli.

LOUIS PASTEUR :
 A chemist from France
 Established that Fermentation was the result of microbial activity & develop microbiology.
 Remembered as Father of microbiology
 Introduced techniques of sterilization and developed steam sterilizer, hot air oven and
autoclave.
 Pasteur was also pioneer in the development of vaccines. Three
 vaccines were introduced by him for chicken cholera, anthrax and
rabies.
 Work on Anthrax, Chicken Cholera and Hydrophobia attracted lot of attention worldwide.
 Discovery of streptococci
 Known as earliest microbiologist to use the term virus to describe disease aetiology.

ROBERT KOCH : ( 1843 – 1910 )

 He develops basic bacteriological techniques.
 He known as father of bacteriology from Germany.
 Introduced the staining techniques and method of obtaining bacteria in pure culture using
solid media.
 He discovered the Mycobacterium Tuberculosis ( 1882 ) & Vibro cholera (1883)
 Koch isolated anthrax and formulated his postulates and popularly known as the Koch’s
Postulates.

HOLMES ( 1843 ) & SEMMLWEISS ( 1846)

 Suggested that puerperal sepsis was transmitted by contaminated hands of doctors and
medical students.

LORD LISTER ( 1867 )

 Introduced the use of carbolic acid spray on wound during operation.
 Remembered as the father of antiseptic surgery today.

FLEMING ( 1929 )
 The person who observed that penicilliam (a fungus) creates a substance which
destroys staphylococcus (a bacterium).
SOME OF THE IMPORTANT EVENTS IN MICROBIOLOGY ARE:
1875 – Ferdinand J Cohn contributed to the founding of the science of bacteriology. He
classified bacteria using name bacillus.
1876 – Robert Koch work with anthrax which pointing that bacterium as the cause of disease.
1884 – Robert Koch published the etiology of tuberculosis.
1929 – Alexander Fleming published the first paper describing penicillin and its effect on Gram
positive microorganism.
1953 – James Watson and Francis Crick, together with Maurice Wilkins described double helix
structure of DNA.
1979 - Smallpox was declared officially eliminated.

20th century:
 Development of viral culture techniques and attenuation.
 Development of electron microscope.
 Discovery of antibiotics.

TERMINOLOGY
 Aerobes – any organism that requires oxygen in order to obtain energy.
 Anaerobes – denoting and organism, especially a bacterium that does not require oxygen
in order to obtain energy.
 Antigen – any foreign substance, usually a protein, which stimulates the body’s immune
system to provide antibodies.
 Antiseptic – describing a substance or drug that kill germs and so prevents infection or
disease.
 Aseptic – free from harmful bacteria, sterile.
 Barrier – anything, circumstance, etc that separates things and people.
 Culture – microorganisms or living tissue cells in special media conductive to their growth.
 Carrier - a person or animal infected by a disease in such a way as to be able to pass it on
to others without actually suffering from it.
 Contact – a person who has been exposed to an infectious disease through being near a
person who has it.
 Contaminated – to pollute or infect.
 Communicable disease – denoting on infectious or contagious disease, such as the
common cold, that can be transmitted from one organism to another by direct physical
contact, infected air borne.
 Disinfectant – germ killing substance
 Infection – the process of infecting or state of being infected. The invasion of a human,
animal, or plant by pathogenic microorganism like viruses, fungi, or protozoa which can
multiply rapidly and cause disease. Host – a plant or animal on which a parasite lives and
feeds for all or part of its life.
 Epidemic - sudden outbreak of infectious disease (such as cholera and influenza) which
spreads rapidly and affects a large number of people.
 Mortality – the number of deaths.
 Pathogen – any microorganism, e.g. a bacterium or virus that causes disease in living
organism.
 Parasite – a plant or animal that for all or part of its life obtains food and physical protection
from living organisms of another species (the host), which is usually damaged by the
presence of parasite.
 Phagocytes – cell, especially white blood cells that engulf and absorbs microorganism such
as bacteria.
 Vaccination – the act or process of inoculating with a vaccine.
Lesson 2

INTRODUCTION:
 Microorganisms are a heretagenous group of several distinct classes or living beings.
Microorganism belongs to the kingdom called prosista. The kingdom prosista has been
divided into two groups known as prokaryotes and eurokaryotes. Pro – primitive; caryote –
nucleus; eu – true; caryote – nucleus.

 Bacteria and blue algae are prokaryotes, while fungi, other algae,slime moulds and protozoa
are eukaryotes.

BACTERIA:
 Listed under parkaryotic group
 Do not contain chlorophyll.
 They are unicellular and do not show true branching, except in the so-called ‘higher bacteria
‘( actinomycetals ).
 Some bacteria may have capsule ( or loose slime ) around the cell wall.

SHAPE AND SIZE OF BACTERIA:

 The bacteria can be spheroid (coccus), rod or cylindrical (bacillus) and spirillar (spirochaete).
 Very short bacilli are called as coccabacilli.
 Some bacilli may be curved or comma shaped
( vibro cholerae.)
 Bacteria, being much smaller can be visualized only under magnification. (Microscope).
 Bacteria sometimes show characteristic cellular arrangement or grouping. Thus cocci, may
be arranged in pairs ( diplococci), chains ( streptococci ) group of four ( tetrads) or eight
(Sacrina), or as grape like clusters (staphylococci).
 Some bacilli may be arranged in chains
( streptobacilli.)
 Other are arranged at angles to each other, presenting a cuneiform or Chinese letter pattern
( corynebacteria).
 (Arrangement of cocci
o spirilla
o staphylococci
o bacillus
o streptococci
o diplococcic
o vibrio
State 3 characteristic of bacteria?
CYTOPLASMIC STRUCTURES:

The plasma membrane:

 This delicate membrane separates rigid cell wall from cytoplasm.
 Various structures are attached to it and hence it accounts for 30% total cell weight.
 Chemically, it is 60% of protein and 20% - 30% lipids and remaining carbohydrates.
 This membrane acts as an effective osmotic barrier and helps in establishing the movement
of certain essential nutrients.

Cytoplasm:
 The bacterial cytoplasm is a colloidal system of a variety of organic and inorganic solutes in
a viscous watery solution.

Capsule:
  Capsule surrounded the bacterium.
 Capsule is usually carbohydrate (polysaccharides) and antigenic too.
Ribosomes:
 There are small cytoplasmic particles which are the sites of protein synthesis in the
organism.
 These are composed of RNA and proteins and constitute up to 40% of total protein and 90%
of total cellular RNA.

Bacterial Flagellum:
 Motile bacteria, posses one or more unbranched, long, sinus filaments called flagella, which
are the organs of locomotion.
 Each flagellum consists of three distinct parts, the hook and the basal body.
 The filament is external to the cell and connected to the hook at the cell surface.
 The hook basal body portion is embedded in the cell envelope.
 Provided mortality to the bacterium.

Pilus:
 These are also called as fimbriae.
 Pilus is hair like structures located on the surface of certain gram negative bacteria.

Nucleus :
 Bacterial nuclei have no nuclear membrane or nucleolus.
 Consists of single molecule of double stranded DNA arranged in the form of circle, to form a
long chain.
 These cytoplasmic carriers of genetic information are known as plasmids.
 They are not essential for the life of the cell they inhibit but may confer on it certain property
like toxigenicity and drug resistance which constitute a survival advantage.

REPRODUCTION OF BACTERIA:
 Bacteria divide by binary fission.
 When bacterial cell reaches certain size, it’s divides to two daughter cells.
 The cell divides by a constructive or pinching process or by the ingrowths of transverse
septum across the cell.
 The interval time between two cell divisions or the time required for a bacterium give rise to
two daughter cells under optimum condition, is known as doubling time.
 The doubling time for bacteria is about 20 minutes.
 Some bacteria are slow growing; the generation time in the tubercle bacilli is about 20 hours
and in lepra bacilli as long as 20 days.

INFLUENCING FACTORS ON BACTERIA

INFESTATION:
 For their optimal growth, bacteria require proper nutrients, oxygen, PH, temperature and
light.
 Bacteria also require a source of nitrogen and a number of salts to have a supply of
potassium, magnesium, iron, phosphate and sulphate.
Oxygen:
 The need of oxygen for particular bacterium reflects, it’s mechanism to meet the
requirement of energy.
 Bacteria are divided into aerobes and anaerobes.
Aerobic bacteria:
 Require oxygen for growth.
 They may be obligate aerobes like the vibrio cholera (which will grow only in the presence of
oxygen.)
 Most bacteria of medical presence are facultative anaerobic bacteria.
Anaerobic bacteria:
 Grow in the absence of oxygen and obligate anaerobes may even die on exposure to
oxygen.
 Such as clostridia.
 Microaerophilic – These microorganisms can grow under conditions with low oxygen
tension. Clostridium tetani is an important example.
Temperature :
 Bacteria vary in their requirement of temperature for growth.
 For each species, there is temperature range and growth does not occur above.
 The temperature at which growth occurs best is known as the ‘optimum temperature’ which
most pathogenic bacteria are 37 degree.
Carbon dioxide :
 All bacteria require small amounts of carbon dioxide for growth.
 This requirement is usually met by the carbon dioxide present in the atmosphere or
produced endogenously by cellular metabolism.
Light :
 Bacteria (except the phototrophic species) grow well in the dark.
 Sensitive to ultraviolet light and other radiations.
 Cultures die if exposed to sunlight.
 Exposure to light may influence pigment production.
pH :
 The pH of medium of growth bacteria has profound effect upon the multiplication of
organisms.
 Most pathogenic bacteria require a pH of 7.2 – 7.6 for their optimal growth.
 The pH of the growth medium keeps a changing depend to the reaction performed by the
bacterium with the nutrients.
MICROSCOPIC EXAMINATION:
 The morphology of bacteria is studied in unstained preparation first and then after staining.
 Live bacteria do not show much structural details under the microscope. Therefore, staining
techniques are used to give a color contrast.
SIMPLE STAINS:
 Simple stains such as methylene blue shows the presence of organisms and nature or
cellular content.
DIFFERENTIAL STAIN:
 Gram stain
 Acid fast strain
 Albert stain
GRAM STAIN :
 Most important staining procedure.
 Used in identification of bacteria and frequently the only method required to study
morphology.
 Certain bacteria when treated with one of the basic dyes such as methyl violet, crystal,
violet and then with iodine, the violet colour even after discoloration with alcohol/ acetone.
It’s called as gram positive bacteria.
 The bacteria that are discolourised are visualized with the help of a counter stain that
imparts it a red/ pink are called as gram negative bacteria.
 Gram positive organisms are stained violet
 Gram negative organisms, cells are stained pink.
 Gram positive and gram negative bacteria are different in:
o staining properties
o growth requirement,
o sensitivity to antibiotic
o pathogenicity.
STAPHYLOCOCCUS :
  The name of staphylococcus was derived from Greek noun staphyle mean ( a bunch of
grapes) and coccus ( a grain or berry ).
 Gram positive cocci.
 Currently 3 species of staphylococcus. There are staphylococcus aureus, staphylococcus
epidermidis and staphylococcus saprophyticus.
Staphylococcus aerus:
 Gram positive
 Grouped in irregular clusters that resemble cluster of grape.
 These are easy to grow organisms.
 They prefer aerobic environment and temperature of 37 degree.
 Primary isolation is best done in blood agar medium.
 Staph.aereus can survive, propagate and produce disease in the host because of large
number of antigens, toxins and enzymes liberated by this organism.
 The diagnosis of staphylococcal disease is suggested by the finding of gram positive
bacteria in clumps in the pathological material such as cerebrospinal fluid, but final
diagnosis can be achieved culture and appropriate biochemical test.
 The characteristic hemolytic and yellow pigmentation strongly point toward staph aerues.
 A positive coagulate test confirms the identity to be that of staph aureus.
 Penicillin was introduced all the strains of staph aureus were sensitive to this drug.
Please differentiates with gram positive and gram negative microorganism?
NEISSERIA :
 Gram negative producing cocci.
 The pathogenic species or neisseria meningitis and neisseria gonorrhoae.
 There are oval, gram negative diplococci, with flattened or concave opposing edges.
 All pathogens neisseria have an optimum growth temperature that range 36 to 39 degree
and pH range 6 – 8.
 The most common complication bacterium is meningitis.
 Penicillin remains drug of choice.
VIRUS:
Introduction:
 Virus is a Latin word which means poison.
 Any member of unique class of infectious agents, which were originally distinguished by
their smallness and ability to replicate outside a living host cell. A virus consists of genetic
material, which may be either DNA or RNA and surrounded by a protein coat, in some
viruses by a membranous envelope.
General properties of viruses:
 Consists either of RNA or DNA but never both.
 Obligate intracellular parasites.
 Smallest infectious agents.
 Not inactivated by antibiotics.
 Divide by replication.
STRUCTURE AND SHAPE :
 The viruses are composed of nucleic acids and proteins.
 The genome consists of single nucleic acid which stores all vital information required by the
virus for its multiplication.
 The genome is surrounded by a shell or coat made of protein and called as ‘capsid’.
 Most of viruses have an additional covering of lipid around their nucleocapsid which known
as viral envelope.
 The complete virus particle is also called as virion.
 Viruses vary in diameter from 300 to 20 nm.
 adenoviridae
 papovaviridae
 paramyxoviridae
 poxviridae
CHEMICAL PROPERTIES
Viral nucleic acid:
 Viruses contain only one type of nucleic acid, either single or double stranded DNA or RNA.
 Viral nucleic acid may be extracted by treatment with detergents or phenol and in the case
of some viruses. ( for example picarnavirus, papovavirus) the extracted nucleic acid capable
of initiating infection when introduced into host cells.
Viral proteins :
 Viruses also contain protein which makes up the capsid.
 Viral protein besides protecting the nucleic acid, also determines the antigenic specificity of
the virus.
VIRAL REPLICATION :
 Viruses are obligatory intracellular parasites.
 The genetic information necessary for viral replication is contained in the viral nucleic acid,
but lacking biosynthetic enzymes, the virus depends on the synthetic machinery of the host
cell for replication.
 Replication means the process by which DNA duplicate itself when the cell divides.
 replication cycle can be divided into six sequential phases;
o absorption or attachment
o penetration
o uncoating
o bio- synthesis
o assembly
o release
ABSORPTION OR ATTACHMENT :
 The first event in the infection of cell by the virus is attachment of the virus to cell surface.
 This specific process and requires the presence of receptors on the surface of the host cell.
PENETRATION :
 Nucleic acid is introduced intracellular by a complex mechanism.
 Engulfed by a mechanism resembling phagocytosis which known as ‘ viropexis’.
 For enveloped viruses, the viral envelope may fuse with plasma membrane of the host cell
and release the nucleocapsid into the cytoplasm.
UNCOATING:
 Stripping the virus of its outer layers and capsid so that nucleic acid is released into the cell.
 Gradually complete uncoating occurs because of the interaction of virion with host
components and enzymes.
BIO SYNTHESIS:
 This phase include synthesis of the viral nucleic acid and capsid protein but also of enzymes
necessary in the various stage of viral synthesis, assembly and release .
 Most DNA viruses synthesize their nucleic acid in the host cell nucleus.
 RNA viruses synthesize all the components in the cytoplasm.
ASSEMBLY:
 virion assembly may take place in the host cell in the cytoplasm or the cell nucleus.
RELEASE :
 3 mechanisms which matured virion can escape from the host cell to new host are known
as :
1. cell lyses
2. cell degeneration
3. budding
RUBELLA ( GERMAN MEASLES) :
 It known as German measles because of the clinical appearance which is similar to
measles.
 Its cause severe congenital malformations can cause in the child if the mother contracts this
infection during first trimester of pregnancy.
CLINICAL MANIFESTATION:
  Atypical, mainly rash and lymphadenopathy with fever.
 The feature of congenital rubella may be retinopathy, cataract, deafness, ventricular septal
defect and diabetic.
PREVENTION:
 Vaccine is available as a component vaccine where it is present along with vaccines of
measles and mumps.
 Vaccination is done prior to the attainment of reproductive age by the girl.
ROTAVIRUS
 Rotavirus is the single most important agent of infantile gastroenteritis.
 Rotavirus is derived from latin word which mean wheel, reflecting its shape under the
microscope.
CLINICAL MANIFESTATIONS:
 Diarrhea accompanied by vomiting.
 Fever after incubation period of 2-3 days and last for 4-5 days.
 dehydration
 Can spread to other people by poor hygiene.
TREATMENT:
 Symptomatic towards rehydration of patient.
 A rotavirus virus vaccine is available in the market.
What is the clinical manifestation for rotavirus infection?

PROTOZOA:
Basic Properties of Protozoa :
 Eukaryotic microorganisms having animal-like cells
 No cell walls
 Most have heterotrophic metabolisms
 A few protozoa (eg Euglena) are photosynthetic
 Many are free-living in soil or aquatic environments.
 Few are parasitic.
 Single-celled or simple colonial organization
 Classification based predominately on the mechanism of motility.
 The 4 main subgroups of protozoa are:
o Ciliates
o flagellates
o Sarcodina
o apicomplexans.
SIZE AND SHAPE:
 Protozoa range in size from 5 to 500 micrometer in diameter. They classified in 3 ground
based on their shape.
1. CILIATES :
 First group is the ciliates which are generally the largest protozoa.
 Hair like projections called projections called cilia
 Can eat the other two types of protozoa as well as bacteria.
2. AMOEBAE:
 shell like covering
 Have false feet to move.
 Have fluid and cell membranes or covering that they can stretch out.
3.FLAGELLATES:
 Smallest protozoa.
 Whip like projections called flagella poking out of their cell.
 ciliates
 amoebae
 flagellates
REPRODUCTION:
  asexual or sexually
 Mostly by cell division or binary fission.
 Binary fission involving nuclear division and replication or organelles, yields two organisms
similar in size.
Please classified 3 groups of protozoa?
Protozoan Diseases:
 Amebiasis
 Primary Amebic Meningoencephalitis
 Giardiasis
 Trichomoniasis
 Balantidiasis
 Toxoplasmosis
 Malaria
 Cryptosporidiosis
 Pneumocystosis
Amebiasis :
Cause: Entamoeba histolytica
• A parasitic ameba; class Sarcodina.
• Transmitted via contaminated food & water.
• Trophozoites grow & reproduce in the intestinal tract.
PREVENTION :
 It is important to protect food and water from contamination.
 Health education and personal hygiene also important.

MALARIA :
Cause: Plasmodium species
 In Class Sporozoa
 Complex life cycle requiring two hosts:a mammal (human) and the mosquito Anopheles.
Symptoms:
 Fever, chills, anemia, weakness, hemorrhage.
 Intense fever & chills about 48 - 72 hr after exposure, due to the simultaneous rupture of so
many erythrocytes.
 Treatment by quinine & other antimalarial drugs.

State 4 group subgroup of protozoa?

FUNGUS:
 Recognized as causative agents of human disease earlier than bacteria.
 Eukaryotic cells
 Known as mycology meaning (mushroom in Greek.)
 100,000 species of fungi and 100 species act as primary pathogens.
 can be classified in four classes;
o yeast
o yeast like fungi
o Mould fungi
o dimorphic fungi
1.YEAST :
 uni cellular
 occur as spherical cells or ellipsoidal cells
 Reproduce by simple budding e.g.: Cryptococcus neoformans.
2.YEAST LIKE FUNGI:
 Grow partly as yeast and partly as elongated cells resembling hyphae. E.g.: Candida
albicans.
3. MOULD FUNGI:
 form true mycelia
  Reproduce by the formation of different types of spores. E.g: dermotophytes.
4.DIMORPHIC FUNGI:
 Occur as filaments or as yeasts, depending the condition of growth.
 In host tissue or cultures at 37°c, they occur as yeast form.
 In soil and culture at 22°c they appear as moulds.
SIZE AND STRUCTURE :
 The main body of most fungi is made up of fine, branching, and usually colourless threads
called hyphae.
 Size varies from microscopic (unicellular) to basketball size (multicellular).
 Yeast
 Yeast like fungus
 Mould fungus
 Dimorphic fungus
REPRODUCTION:
Asexual reproduction in four groups occurs by:
 budding - parent cell divides and produces offspring by forming a small bud that separates
(yeasts)
 Regeneration - piece of a mycelium breaks off and grows on its own spore production -
reproductive cells remain dormant.
 spore production - reproductive cells that can remain dormant.
CANDIADIASIS :
 Due to the yeast fungus and called as candida.
 candiadiasis is very common in AIDS patient.
 Candida albicans and candiadiasis are most common.
 Also produce infection of the vulva and vagina. Affect the skin, the mucosa, the skin
appendages and the internal organs and cause septicemias.
 Diagnosis can be established by direct microscopic examination of the clinical specimen.
 Affected area should keep dry and treat with nystatin.
MYCETOMAS:
 Localized; swollen lesion. Usually on a feet.
 Involve skin, subcutaneous tissue and bone.
 Lesion contains granulomas and abscess which suppurate and drain through sinus tracts.
 mycetomas can caused by actinomyces.
 Biopsy examination will be helpful.
 Treat with penicillin.
SPIROCHAETES :
 Long thin treads in the form of coiled.
 Occurring in nature in soil, water and upon the body of plants, animals and man.
 Reproduce asexually.
Medical important spirochetes are:
 Treponema
 Borrelia
 Leptospira
MORPHOLOGY OF TREPONEMA:
 Known as pathogenic and non pathogenic.
 Spiral length about 0.01 – 0.015mm.
Diseases caused by this treponema is:
 yaws caused by t.pertenue
 pinta caused by t. carateum
 Endemic syphilis caused by t. palladium (variant).
MORPHOLOGY OF BORRELIA:
 Delicate spiral threads measure 8- 20 micrometer and 0.3mm thickness.
 Disease cause by this borrelia relapsing fever.
MORPHOLOGY OF LEPTOSPIRA:
  Thin refined spiral.
 0.1 micron or even less in thickness and 4 – 12 microns in length.
 Actively motile.
 Disease caused by this leptospira is Weil disease.
SYPHILIS SPIROCHAETES :
 treponema palidium is responsible for this disease.
 The first sign of appearance is a small hard papule red in colour on the penis in males and
the labia in females.
 Secondary stage, produce sore throat, rashes, fever and lymph node enlargement.
 The third stage, lesion on the skin, meningitis and disturb on central nervous system.
 Treat with penicillin.
 Avoidance of sexual intercourse with individual known to be or likely to be infected.
YAWS SPIROCHAETE :
 Cause by treponema spirochaete.
 An infection of skin.
 Acquired by personal contact and its transmission facilated by dirt, poverty.
 Demonstrated under dark ground microscopy.
 Treat with penicillin.
 Need attention to hygeine.

Lesson 3

Definition:
 Infection is a process by which an organism establishes a parasitic relationship with its
host. . Tissue invasion with pathogenic agent that produce injurious effect.
 Six links make up the chain of infection. The etiologic agent, or microorganism; the place
where the organisms naturally reside (reservoir); the portal of exit from the reservoir; a
method of transmission; portal of entry into a host; and the susceptibility of the host.

AGENTS OF INFECTION:
 Many varieties of microorganism are present in our environment. Harmful microorganism
known as pathogenic.
 Able to produce disease in human (host).
 However, if microorganisms released into other areas of body, they become pathogenic
microorganisms.

HOST :
 Any person who at the risk for infection are known as susceptible host.
 A compromised host is the person at increased risk.
 When the microorganisms first associate with the host is said to be contaminated.
 If the microbes establish themselves and grow and multiply for a period of time, the host is
said to be infected.
 If the infection causes damage, the host said to have an infectious disease.

Question: what are the factors may affect the ability of the agent to produce infectious
disease?
 Many factors may affect the ability of the causative agent to produce an infectious disease in
a particular host:
o Age
o nutritional status
o presence of other diseases
o The individual immune system.
RESERVOIR:

 The transmission of infection involves the transfer of the infectious agent from the place
where it lives and multiply (reservoir) to the host, which it may enter in various ways.
 The reservoir may be human, animal, or non living.
 Some common inanimate reservoirs are contaminated food or water, and objects like eating
utensils, clothing and so on.
 A carrier is a person or animal reservoir of specific infectious agent that does not show
active evidence of infectious disease.
 Human carriers that harbor infectious disease known as healthy carriers.
 Carriers recovering from infectious disease and have no symptoms, although they continue
to harbor the infectious agent are known as convalescent carriers.
 Incubation period, the time between contact with infectious agent and the appearance of the
first symptoms of the infectious disease known as incubatory carriers.

PORTAL OF EXIT :
 The route by which the infectious agent escapes from the reservoir.
 The infectious organism may leave the body through:
o Respiratory
- Pathogen can released through sneezing, coughing, talking even breathing.
o gastrointestinal or genitourinary tracts
- faeces, vomitus, bile.
- There is an infection of the genitourinary tract, microorganisms can exit via the
urine.
o skin and mucous membranes
- Any break in the skin or mucous membranes can lead to infection. A surgical
wound, for example, can be an entry point, a portal of exit and reservoir for a
pathogen.
o Blood
-When a client has a blood borne infections disease such as hepatitis B or C or
AIDS, it become reservoir for the causative pathogens. Any break in the skin that
allows blood to escape, and menstrual blood from the vagina, are portal of exit.
o Reproductive tract
- A male urethral meatus or a female’s vagina canal can provide the means of exit
for pathogens that are transferred from the body
-
PORTAL OF ENTRY:
 Infectious agent usually leaves and enter the host by the same routes- the various body
systems or breaks in the skin and mucous membranes.
 The route by which, the infectious agent must gain entrance in appropriate portal of entry.
 Agent allowed to only one or several portal of entry.Example:
o The staphylococcus can cause disease by entering through the respiratory tract
(pneumonia)
o The skin (boils),
o Blood (internal abscesses)
o The gastrointestinal tract (food poisoning.)

MODE OF TRANSMISSION:
 Infectious agents may be transmitted to the host by direct or indirect transmission.

Direct transmission:
 Involve immediate and direct transfer of microorganisms from person to person through
touching, kissing, or sexual intercourse.
  Droplet spread also a form of direct transmission, sneezing, coughing, spitting, or talking
can project droplet spray to the mucous membranes of the eyes, nose or mouth of other
person.
 Gonorrhea spread by direct contact.

Indirect transmission :
 Indirect transmission can be vehicle borne transmission or vector borne.

Vector borne :
 A vector borne is an animal or flying or crawling insect that serves as transporting the
infectious agent.
 Transmission may occur by injecting salivary fluid during biting or other materials on the skin
through the bite wound and traumatized skin area.
 Insect vectors such as mosquitoes, flies, and mite are responsible for transmitting many
infectious diseases.

Airborne transmission :
 May involve droplets or dust.
 The residue of evaporated droplet emitted by an infected host such as some with
tuberculosis can remain in the air for long periods.
 Dust particles containing the infectious agent can also become airborne. The material is
transmitted by air circulation to a suitable portal of entry, usually through respiratory tract.

Question: please state some of the examples of direct transmission and indirect
transmission?

Methods by which micro- organisms are transmitted from their sources to their portals of
entry :
 Organism present in the upper passages they are expelled into the air on speaking and they
can then be readily inhaled by others.
 Infection can thus easily spread through close proximity to the infected person.
 In some cases the infected droplets can contaminate dust, and inhalation of the dust can
cause infection.
 Infection may spread through handling articles which have become infected with the
organism, clothes, bed linen, toys, and pencils.
 failure in washing hands thoroughly can lead to this infection.
 Organisms may present in the feces and urine, food can become contaminated and
infection may spread to others.
 Certain organisms, especially gonococci and syphilis require actual direct contact from the
infected person to be infected.

Lesson 4

Introduction:
 Infectious disease are a major health problem in both community and hospital environment.
Four major categories of microorganism that cause infection in humans are:
o bacteria,
o viruses
o fungi
o parasites.
 Bacteria the most common microorganisms causing infection.
 Most of hundred species can cause disease in human and can live and be transported
through air, water, food, soil, body tissue and fluids and inanimate objects.
  Viruses consist of nucleic acid and therefore must enter living cells in order to reproduce.

What is infection?

Definition:

 Infection is a process by which an organism establishes a parasitic relationship with its

host. Tissue invasion with pathogenic agent that produce injurious effect.
 The severity or mildness of the resulting disease depends upon:
o Number and virulence of the organism
o Resistance of the patient to infection depends on:
- Skin and mucous membranes (first line defense) by producing protective cover.
- Antibodies if present in the blood stream and tissue fluids will prevent disease
from developing.
- Development of inflammation.
 Primary infection is in flail infection with a parasite in a host.
 Secondary infection is new microorganism set up an infection in a host whose resistance is
lowered by a preexisting infectious disease.
 Cross infection is when a patient already suffering from a disease, a new infection is set up
from another host or another external source.
 Nosocomial infection known as when cross infection occurred in the hospital.

1. Define infection?
2. What is primary infection?
3. What is nosocomial infection?
4. What are the differences are between cross infection and nosocomial infection?

Types of infection:
 Types of infection can be divided into:
o local
o Systemic infection.
Aetiology:
 Factors that enter into the development of an infection include:
o effectiveness of the body’s defense mechanism,
o the virulence of the pathogen,
o The individual general health.
Local infection :
 An infection that cannot spread.
Systemic infection:
 Any microorganisms spread and damage different parts of the body, it is called as systemic
infection.
Inflammation:
 This is physiological response of the body to tissue damage or to an irritant and
accompanied by a characteristic series of local changes.
 The irritant can be a burn, chemical, wound or microorganism. It is usually painful.
 Most commonly take place when microbes have overcome the non specific defence
mechanism.
 Inflammation purpose is protective: to isolate, inactivate, and remove both the causative
agent and damaged tissue so that healing can take place.
 The agents that cause inflammation may be classified as below:
1. Microbes, e.g. bacteria, viruses, fungi
2. Mechanical injury, ultraviolet and radiation.
3. Chemical agents – microbial toxins and organic poisons
4. Antigens that stimulate immunological responses.
  The signs of inflammation are:
1. Redness
2. Heat
3. Pain
4. Swelling
5. Loss of function
 The changes that take place in the tissues are active hyperemia, exudation and migration of
leukocytes.

Give 2 sign of inflammation?

Stages of inflammation process:

Active hyperemia:
 Following injury, there is dilatation of arterioles and increased blood flow in the capillaries.
 Increased blood flow to the area of tissue damage provides more oxygen and nutrients for
the increased cellular activity that accompanies inflammation process.
 Redness and heat cause by hyperemia.

Exudation:
 In the inflammation area, the amount on interstitial fluid is increased and its composition
changed.
 Interstitial fluid normally consists of molecules of water and other substances small enough
to pass through pores in the walls.
 The composition is changed because the permeability of small vessels walls is increased by
basophils.
 This enables large molecules, including antibodies and fibrinogen, to enter the tissue
spaces.
 Most of the inflammatory exudates, phagocytes and cell debris are removed in lymph
vessels are larger, and the pressure inside is lower, than in blood capillaries.

Migration of leukocytes:
 The migrating cells are the phagocytic granulocytes and monocytes.
 The number involved and duration of the migration depend on the severity of inflammation.
 Exudation of fluid increases blood viscosity and slows the rate of flow.
 The leukocytes stick to the wall of small blood vessels, and then pass between the
endothelial cells into the interstitial spaces by amoeboid movement.
 The extra fluid dilutes toxins and fibrin walls off the site, preventing the local spread of the
inflammation.

Tissue changes :
 Occur after the vascular changes.
 It’s due to the severe irritation, bacterial toxins, closing of blood supply by increased tissue
in boil or carbuncle.
1. Spread of infection in the tissues.
Special terms are used to describe the process.
o Cellulitis – it is the direct spread of infection in the tissues, or more strictly, in the
extracellular spaces.
o Lymphangitis – the lymphatic vessels between the site of infection and the regional
lymphatic glands may be inflamed. This called lymphangitis.
o Lymphadenitis – the lymphatic glands are invaded by organisms carried by lymph stream
in the lymphatic vessels. The lymphatic glands, which become swollen and tender, are
structurally well equipped to deal with infection by their complex network, which filters the
organism.
o Bacteraemia – is spread of organisms into the blood stream.
 o Septicemia – is the invasion and multiplication of the bacteria in the bloodstream.

2. Failure of inflammatory reaction:

o The failure is partial and it is important to recognize at once the factors which may be
preventing its full development. They are :
- Poor arterial blood supply
- Deficient venous drainage
- Deficiency of the quality of the blood
- Malnutrition and dehydration
- Excess of fluid in the tissues
- Metabolic
- Drugs

3. The symptoms and signs of inflammation:

o Local symptoms and signs
- Redness is caused by dilation of capillaries in the inflamed area.
- Heat is due to increased blood flow.
- Swelling occurs because plasma is poured into the surrounding tissues. The
degree of swelling is depend to some extent on the natural laxity of the tissues.
- Pain is due to the accumulation of toxin.
- Loss of function occurs as a result of pain.

Possible results of inflammation:

Resolution:

 Body overcome the cause of inflammation and it’s occur when:

o Infecting agent become virulence
o Patient become resistance
o Inflammatory process reverse, neutrophils and macrophages in the tissue spaces
cover by particles of biological and non biological origin.
o Biological material means damaged and dead cells.
o Non biological materials include chemical substances and material contaminating
wounds.
o Redness and heat subside.
Repair:
 Tissue damages if repaired by formation of fibrous scar.

Suppuration:
 Pus formation leads some death of tissue.
 Pus consists of dead white cells and dead tissue cells.
 Small amounts of pus form boils and larger amount from abscess.

Spread:

 Spread into tissue immediately surrounding original site of infection.

Fibrosis (scar formation):

 Fibrous tissue is formed during healing when there of tissue or the cells destroyed do not
regenerate.
 Fibrosis tissue may have long lasting damaging effects.

Treatment:

 Remove the foreign body if possible.

  Rest is necessary to allow overcome invader.
 Movement is allowed when acute phase is over.
 Drainage of pus done after proper assessment by the physician.
 Reduce the temperature by giving tepid sponge.
 Sufficient diet calories needed to ensure energy.

Nosocomial infection:

Introduction :
 Hospital has always been considered places which help people in getting cured of
illness. However, infectious diseases are a major health problem in both the community
and hospital environments.
 Infections are also acquired in the hospitals. This known as nosocomial infection.

Definition:
 Nosocomial infections are infections which occurred in hospital during patient
hospitalization or present at time of admission to the hospital.
 The microorganism most commonly responsible for nosocomial infections are
staphylococcus Aureus, Escherichia Coli, and Pseudomonas Aeruginosa.
 Nosocomial infection may affect the out patients, in patients, discharged, hospital staff
and subsequently it may spill over the community.
 The source of causative infecting organism may be exogenous.
 exogenous mean from another patient or hospital staff or from the inanimate
environment in the hospital.

Person on risk:
 Hospitalized patients are more prone to infections. High risk group include patient in
intensive unit, new born, patient on immunosuppressive therapy.

Mode of spread :
Airborne
- Talking
- Sneezing
- Coughing
 Infection by contact
o Patients are constantly exposed to pathogenic microorganism of the hospital
environment. Hospital staff are frequent and direct contact with many patient
throughout the day, thus providing excellent mode of transmission.
 contaminated food
 contaminated water
 hospital equipment
o Patient to patient used equipment like ventilators, wheelchairs, and shared
bathrooms may harbor infections.

Common types of infection:

 Wound infections
 Urinary tract infections
 Respiratory infections
 Skin infections
 Septicemia
 Gastrointestinal infection

Prevention and control of infection :

 General measure of hygiene
 o First importance for the patient and nurse. Cleanliness of the ward, the handling of
the food, crockery, and personal cleanliness are of the greatest importance.
 Control of special local condition:
o Injury or bruising of a wound increases the risk of infection. The patient instructed not
to touch dressings or his skin which may have been contaminated by pus. Hand
washing should be frequent with antibacterial liquid soap. Masks should not be
touched with fingers, changed frequently as soon as dressings have been finished.
 Special methods of protection:
o Immunization and antibiotics
 Recognition:
o Routine recording of the temperature and pulse rate are important and inspection of
the wound is undertaken.
o Infection control committee is important to each hospital.
 Prevention:
o Staff with minor open wound should not on duty or should take a proper precaution.
o Contaminated dressings and instruments are treated by appropriate disinfection.
o Bed linen should be handled gently to reduce the risk of infection.
o Screen cover and curtains around the bed require regular laundering.
 Control :
o Patient with infected wound should, if possible been isolated. If impossible barrier
nursing should take place.
o Proper hand washing should follow frequently when handling patient nursing care.
Role of nurse in prevention:

Infection committee:
 Infection committee should consist of physician, nurses and administrators and laboratory
personnel.
 The committee should meet frequently and update the hospital policy related to infection
control.
 The responsibilities of the infection control committee are surveillance, education of hospital
personnel, and investigation and follow up of outbreaks of nosocomial infection.

Surveillance:
 Surveillance will help to detect report and record the nosocomial infections.
 Detection done by bacteriologic cultures like air sample which done in OT only. Sample are
also taken from various place in hospital for study. E.g swab for C&S
 The frequency of sampling decided by infection control team.
 This test also helps to determine the effectiveness of housekeeping department.

Education:
 Infection control team should provide education on method of reducing nosocomial infection.
 Meeting is important to discuss the findings of recent surveillance and recommend new
solutions to resolve the problems.

Hospital guidelines:
 The infection control committee needs to reinforce on guidelines for the prevention of
infection.
 The criteria should concern on health examination on staff, disposable of garbage and
infectious materials, isolation techniques, and housekeeping cleaning techniques.

Investigation and follow up of outbreak of nosocomial infections:

 Infection control committee should identify the source of infection.
 The committee meeting be able to recommend additional policies when needed to prevent
outbreak in the future.
Good housekeeping techniques
 Proper cleaning of floors, bathrooms, walls, patient equipments like beds, chairs and
surrounding.
 Proper laundry techniques because small number of pathogens on the contaminated lines
will lead to infections.
 Proper handling and disposable of all patient used materials.

Hand washing:
 Important method of preventing the spread of infection.
 Number one way to prevent the spread of disease is by hand washing.
 The hands should be washed before and after care of each patient.

Personal grooming:
 Personal cleanliness and good grooming will reduce the microorganism present on the
body.
 The hospital staff should change their uniform daily and when soiled.
 Hair should keep short and tidy.
 Fingernail should keep short and clean.
 Patient clothing and linen must be clean at all times.

Isolation and precautions:

 Isolation technique must be used when need arise.
 Isolation guidelines must be followed strictly by all care givers and visitors.

Effective sterilization:
 All used equipments by patient must sterilized.

Lesson 5

Introduction:
 We live in a world abundantly supplied with microorganism, and we do not become
infected very often why is this so?
 An efficient immune system provides protection to body against wide range of agents.

Definition:
 Immunity refers to the resistance exhibited by the host toward injury caused by
microorganism and their product.
 When microorganism or microbial product enter the body immunological reaction may
occurs. Body’s ability to resist invades and the disease they cause is called immunity.

Defense mechanisms:
 Defense mechanism is the way the body defends itself against agents that cause disease.

 The body has many means of self protection against invaders and they are divided into two
categories:
o Non specific defense mechanism – against any invaders.

o Specific defense mechanisms – result in an immune response to specific

invaders. The body can destroy them conferring resistance to specific microbes.

1. Non specific external defenses

Physical barriers:
The skin –
o The skin is the single largest organ of the body.
o The epidermis has several layers of dead epithelial cells that function as an excellent barrier
against injury and infection of deeper layers of the body.
o The skin surface is inhibited by normal flora whose metabolic product inhibits the growth of
pathogens.
o Sebum is an oily secretion maintains an acid pH in the skin that discourages bacterial
growth.

Mucous membrane – a thick but watery secretion that form a protective layer over the epidermal
cells, preventing drying and cracking of the membrane. This mucous trap the pathogens.

Conjunctiva - a mucous membrane covering the inner surface of the eyelid and anterior region of
the eye keeps bacteria from penetrating the eye. Tears breaks down the bacterial cell walls.

The respiratory system - this entire system lined with moist epithelium. In upper respiratory tract
the epithelium contains mucus – secreting cells and is covered with cilia that sweep mucus up to be
coughed up.

The lymphatic system – this system consists of vessels, nodes, another lymphatic tissue, and
lymph.
Provides many of non – specific and specific mechanisms against infection. The lymph nodes filter
out foreign agents and materials in lymph that passes through them.

1. Non specific internal defenses:

Cellular defenses:

 When the skin is broken by any kind of trauma or injury, microorganisms from the
environment may enter the wound.

Blood defensive cells:

 Leukocytes are important to specific and non specific immune response.why?

Granulo leukocytes:
 Have granular cytoplasm and an irregular shaped lobed nucleus. They include basophils,
mast cell eosinophil, and neutrophils.
 Basophils – release histamine, a chemical that causes dilation of blood vessels. They have
purple dark granules.
 Eosinophils – they are present in large numbers during allergic reactions, fungal, and worm
infections.
 Neutrophils – they guard the skin and mucous membrane against the infection. Neutrophils
are the most common WBC and are phagocytes of the circulating blood.

Non granular leukocytes:

 Include monocytes and lymphocytes.
 Monocytes – they are large cells and their nucleuses have a horse shoe shape. Monocytes
are in the circulation only temporarily (1 ½ days). They migrate to the tissues where now
they are called macrophages.
 Lymphocytes – contribute to specific host immunity. They circulate in the blood and are
found in large numbers in the lymph nodes, spleen, thymus and tonsils.

Molecular defenses:
 Interferon - interferon are a collection of proteins or chemical mediators released naturally
by blood and tissue cells in the injured area during inflammation against viral infection.
  They also play a role as immune stimulants. Interferons are part of non- specific defense
mechanisms and are of several types, but the most common are alpha, beta and gamma
interferon.
 A protein substance that appears to possess antiviral activity it’s use in the treatment of viral
disorder. When a cell is invaded by a virus, it produces and releases interferon, which then
appears to be absorbed or used by uninfected cell. This absorption of interferon by healthy
cells appears to prevent the multiplication of a virus should it invade a healthy

Alpha - they are produced by t cells and macrophages. To kill the viruses.
Beta – released by fibroblasts and epithelial cells infected with viruses.
Gamma - it is produced by infected lymphocytes which sensitive to foreign materials like viruses
and bacteria.

Specific defense mechanism :

 When microbes are encountered for the first time, there is a primary response where low
level antibodies can be detected in the blood after about 2 weeks.

Immunity :
 Two general types of immunity – natural
- acquired
 Natural immunity – immunity with which we are born with it and permanent.
 Acquired immunity – is the reaction that occurs as a result of exposure to invaders. This is
the immunity developed during an individual’s life time. It may be active or passive.
 Acquired immunity divided into:
- passive acquired immunity
- active acquired immunity
- Immunity may be acquired naturally or artificially and both forms active or passive.
 Active acquired immunity:
- Last longer
- Two types – naturally acquired
- artificially acquired

Table on types of immunity (Adapted from Herlihy and Maebius, 2000:354)

Active naturally acquired immunity:
 Result of having or had recovered from disease.
 The body may stimulated to produce its own antibodies in two ways:
 A person who has recovered from an attack of measles develops natural active immunity.
 Usually this immunity long lasting but the duration varies with the type pathogen.
 Secondly having a sub clinical infection. In this case the microbial infection is not sufficiently
severe to cause clinical disease.

Artificially acquired immunity :

 Comes from being inoculated with a suitable vaccines, antigen, or toxoid.
 This type immunity develops in response to the administration of dead or live artificially
weakened microbes (vaccines) or toxin (toxoids).
 The vaccines and toxoids retain the antigenic properties that stimulate the development of
immunity but they can not cause the disease.
 Many microbial diseases can be prevented by artificial immunization.
o Live ( BCG vaccine for tuberculosis)
o Killed ( cholera vaccine)
o Viral vaccines (oral polio vaccine)
 Active immunizations against some infectious disorders confer lifelong immunity, like
whooping and mumps.
  In other infectious the immunity may last for number of years and revaccination is
necessary.

Passive naturally acquired immunity:

 This type of immunity is acquired before birth by the passage of maternal antibodies across
the placenta to the and to the baby in breast milk.
 The variety of different antibodies provided depends on the mother’s active immunity.

Passive artificially acquired immunity:

 It is established when already made antibodies or defensive cells are introduced into the
body.
 These antibodies persist in the body only for a few weeks or months.
 This immunity is only for temporary.

Lesson 6

Introduction:
 The first and most obvious stage in the development of parasitology was the discovery of
parasites themselves.
 The relationship between parasites and hosts are typically quite intimate.

Definition:
 Parasite – any animal or vegetable organism living upon or within another, from which it
derives its nourishment.
 Logy – study of.
 Parasitology is largely study of Symbiotic relationship can be characterized further by
specifying the nature interactions between the participants.
 Symbiotic relationship can be characterized further by specifying the nature interactions
between the participants.

Terminology:
 Parasite – a small animal or plant that lives on or inside another animal or plant and gets its
food from it.
 Host – an organism which harbours the parasite and is usually larger than the parasite.
 Endoparasite – a parasite which lives within the body of the host.
 Commensal – a parasite which does not damage the host while deriving its advantages. a
commensal is capable of independent life.
 Pathogen – a parasite which is able to produce disease.
 Intermediate host – a host in which the intermediate stage of the parasite develops.
 Definitive host - a host in which sexual reproduction takes place or the adult form of the
parasite resides.
 Paratenic host – a host which acts as a transporting agent for the parasite and in which
parasite does not undergo any development.
 Infestation – presence of arthropods on the skin of the host.

 Incubation period – the time interval between the entrance of the parasite into the host and
the beginning of disease.
 Zoonosis – diseases which are transmissible between man and animals.
 Virulence- this refers to the degree of pathogen city.

Introduction:
  The first and most obvious stage in the development of parasitology was the discovery of
parasites themselves.
 The relationship between parasites and hosts are typically quite intimate.

Definition:
 Parasite – any animal or vegetable organism living upon or within another, from which it
derives its nourishment.
 Logy – study of.
 Parasitology is largely study of Symbiotic relationship can be characterized further by
specifying the nature interactions between the participants.
 Symbiotic relationship can be characterized further by specifying the nature interactions
between the participants.

Terminology:

 Parasite – a small animal or plant that lives on or inside another animal or plant and gets its
food from it.
 Host – an organism which harbours the parasite and is usually larger than the parasite.
 Endoparasite – a parasite which lives within the body of the host.
 Commensal – a parasite which does not damage the host while deriving its advantages. a
commensal is capable of independent life.
 Pathogen – a parasite which is able to produce disease.
 Intermediate host – a host in which the intermediate stage of the parasite develops.
 Definitive host - a host in which sexual reproduction takes place or the adult form of the
parasite resides.
 Paratenic host – a host which acts as a transporting agent for the parasite and in which
parasite does not undergo any development.
 Infestation – presence of arthropods on the skin of the host.

 Incubation period – the time interval between the entrance of the parasite into the host and
the beginning of disease.
 Zoonosis – diseases which are transmissible between man and animals.
 Virulence- this refers to the degree of pathogen city.

Lesson 7

Classification of parasite:
Endo – parasites ( internal parasite ):

 Lives inside the body.

 E.g plasmodium
o In the blood
o Tissues
o Body cavities
o Digestive tract
o Other organs.

Ecto – parasite ( external parasite )

 Lives outside on the surface.
 E.g mosquito
 fly
Common occurring parasitic infections are :
 Amoebiasis
 Malaria
 Trichomoniasis
 Roundworm infection
 Threadworm infection
 Hookworm infection
 Filiariasis
 Hydatid disease
 Taeniasis
 Larva migrans

Most common worms are:

1. Thread worm
2. Round worm
3. Hook worm
4. tapeworm

Helminthes:

Enterobiasis (Threadworm):
 common in children
 tiny white worms seen in faeces or around anus.
 Causative agent – enterobius vermicularis

Modes of transmission :
 The most common pattern of transmission is fecal oral route.
 Source of infection
- Eggs on clothes
- Bed linen
- utensils
 Inhaling airborne eggs, ingesting eggs in contaminated food or water from perianal region.

Life cycle :
 Completed in one host.
 No intermediate host required.
 The worm forms in the caecum and vermiform appendix of man until the eggs are
developed.
 After sexual maturity, the male fertilizes the female and dies.
 The matured worm migrates down the intestine and deposits eggs and perianal skin.
 The whole life – cycle is completed in 2 – 4 weeks time.

Clinical manifestation:
 Intense irritation and pruritus of the perianal and perianial area.

Treatment :
 Piperazine salts
 Thiabendazole

Prevention :
 Anal region should properly clean.
 Hand washed after visiting toilet.
 Children nails must be short.
 Underclothes, night attire, bed linen must boiled if infected.
  Provision and use of safe and adequate water supply
 Improvement of environmental sanitation.
 Practicing good sanitation and hygiene habits.

ASCARIASIS ( ROUND WORM):

 Results from eating and drinking contaminated food particularly raw veggie salads and
contaminated water.
 Caused by Ascaris lumbricoides.
 The adult worm lives in the lumen of the small intestine mainly jejunum.
 Round worm is the largest parasite in intestine.
 Cylindrical shape with tapering ends.
 It’s creamy to brown in colour.
 Female worm measure 20 – 35 cm in length and 3 – 6 mm in width.
 Male worm measure 12 – 30 cm in length and
2 – 4 mm in width.

Characteristic of eggs :
 Bile stained
 Surrounded by thick coat
 Float in saturated salt solution

Mode of transmission:
 mainly through faecal-oral route
 Faecal-contaminated soil may be carried long distances on feet or footwear and by animals
into houses.
 Infection results from drinking or eating contaminated food. Particularly raw vegetables and
salads.

Life cycle :
 Infective larvae hatch out in small intestine and penetrated the intestinal wall to enter the
portal circulation.
 From the liver it will travel to the heart and pulmonary artery to the lungs.
 From the lung these larvae breakout of the capillaries into the alveoli and move to bronchi.
 These larvae either swallowed with saliva or enter the digestive tract through epiglottis.
 After reach intestine it’s become sexually mature worms.
 The life span of adult worm is about one year.

Clinical manifestation:
 First sign is presence of worm in motion.
 Pneumonia due to heavy infection by larvae.
 Intestinal obstruction
 Allergic
 Liver abscess
 Appendicitis
 Abdo pain
 Diarrhea or constipation

Treatment :
 mebendazole

Prevention :
 Building and using sanitary latrine for safe disposal of human excreta;
 Washing hands with soap before eating or feeding children or after defecation; and
 Washing all raw food vegetables thoroughly.
  Cooking thoroughly.

Please give two steps on how to prevent threadworm disease?

Hook worm disease:

 caused by Ancylostama duodenale
 lives in jejunum and duodenum
 this worm is look bent like hook.
 Female worm is about 1.25cm in length and male around 0.8cm.
 It is light brown in colour.

Characteristic of hook worm eggs :

 Oval shape
 Colourless
 Surrounded by transparent shell membrane
 Contain segmented ovum
 Floats in saturated ovum

Mode of transmission :
 Infective larvae penetrate:
o The skin
o Passes the blood circulation.
 Infect humans when ingested with contaminated and unwashed raw vegetables or eating
with dirty hands.

Life cycle :
 No intermediate host is required and human is the only host.
 The eggs contained segmented ova will pass out through feces of infected person.
 First stage the larvae hatches out from egg in 24 – 48 hours.
 The filariform larva gain entrance by penetrating the skin, specially those walking bare foot
on soil containing larvae.
 It’s enter the lymphatic and through the venous system and carry to right side of the heart
to the pulmonary capillaries and enter alveolar.
 From alveolar its move to the bronchus, trachea from where it is swallowed with saliva and
renter the digestive tract.
 Finally, it attaches itself to the mucous membrane of the small intestine to mature as adult
worm.
 The adult worm survives 1 – 14 years.

Clinical manifestations :
 Anaemia
 Dermatitis
 Bronchitis
 Bronchopneumonia

Treatment :
 Mebendazole
 Anaemia should be corrected by giving iron tablet.

Prevention :
1. Building and using sanitary latrine for safe disposal of human excreta;
2. Washing hands with soap before eating
3. Washing hands before feeding children.
4. Washing hand after defecation.
 5. Washing and cooking vegetables thoroughly.

Tape worm :
 2 common type :
o taenia saginata (from cuttle)
o taenia salium (from pig)
 Long tape like worm.

Mode of infection :
 Man infected through eating infected meat of cattle or pig which has been insufficiently
cooked.
Please state two clinical manifestations on tape worm disease?
 
Life cycle :
 The adult worm is located in small intestine of pig/ cattle and migrates out of the anus or
discharged in the feces.
 After ingestion, oncosphere hatches out and penetrate the intestine.
 It is carried out in the circulation and is transformed into cysticercus stage.
 Man becomes infected by eating uncooked or partially cooked beef containing cysticercus.
 From this stage, it moves to small intestine attaches itself to the mucous membrane and
then develops into adult worm.

Prevention :
 Adequate cooking of meat destroys the tapeworm larvae.
 Good hygiene and hand washing after using the toilet will prevent self-infection in a person
already infected with tapeworms.

Filariasis :
 Caused by wuchereria bancrofti.
 Found in lymphatic vessels and lymph nodes
 Adult worm are long, hair like, transparent and creamy white structures.
 The male is 25 to 40 mm long and 0.1 mm thick.
 The female is 80 to 100 mm long and 0.2 – 0.3 mm thick.
 Males and females remain coiled together in the abdominal and inguinal lymphatic.

Mode of transmission :

 Transmitted by the bite of infected mosquito responsible for considerable

sufferings/deformity and disability.
Life cycle:
 Man is the definitive host and female mosquito is the intermediate host.
 The filariasis passes its life cycle in through man and mosquito.
 microfilariae are discharged in the blood via mosquito and penetrate the anterior end of
stomach wall.
 They lose their sheath and pass through three stages and last stage will infective to man by
the bite of mosquito.
 The larvae get deposited on the skin near the puncture site.
 The larvae enter through the puncture wound or penetrate the skin.
 From there, the larvae enter the lymphatic vessels and carried usually to abdominal or
inguinal lymph nodes where they become matured.
 Normally the gravid female worm releases large numbers of microfilaria.

Clinical manifestation :
 None
  Acute filarial fever
 Chronic lymphadetinitis, elephantiasis of genitals/ legs/ arms.

Treatment :
 Ivermectin
 Albendazole
 Couramin compound

Prevention :
 Reduction of man of mosquito contact by using mosquito nets.
 Screening of houses.

Trichomoniasis :
 Is caused by a protozoan parasite.
 Occurs only one form – trophozoite.
 Pear shape
 Measure 10 – 30 mm long and 5 – 10mm broad.
 There is a costa and parabasal body.
 Commonly infects vagina in women and urethra in men.

Mode of transmission :
 Transmission is only from direct person to person contact. ( sexual contact)

Life cycle :
 Spread by sexual contact from one person to another person.
 Newborns may get infected during birth.

Clinical manifestations :
 Foul smelling vaginal discharge
o Frothy, green, yellowish with strong fishing odour.
 Itching in vagina
 Cervicitis
 Cystitis
o Men may be asymptomatic but when symptom may occur with dysuria, urethral
discomfort.

Treatment :
 Metronidazole

Prevention :
 Avoid sharing towels, or other inanimate objects.
 Most infections transmitted during menstruation.
 Patients should be advised to avoid sexual intercourse until they and their partner have
completed treatment and follow-up.
 Patients should be given a detailed explanation of their condition.

Amoebiasis :
 Known as amoebiasis
 Infestation is associated with poor hygiene, unsafe sexual practice or contaminated drinking
water.
 Occurs in three forms: trophozoite, precystic, and cystic stages.
 Trophozoite is the growing or feeding stage.
 The precystic stage is smaller in size and round in shape.
  The cystic is spherical and about 10 to 15 micron. It has a cyst wall is highly retractile. The
cyst contains single nucleus.

Sign and symptoms:

 Amoebiatic dysentery:
o Abdo discomfort, stool with blood and mucous
 Amoebiatic liver
o Enlarge liver, tender with abscess formation

Mode of infection:
 Fecal contamination of drinking water
 Vegetables and food are the primary cause.

Life cycle :
 The cysts are ingested by a man in contaminated food or drink.
 Pass through the stomach and enter the small intestine.
 From small intestine it’s migrate to large intestine where they grow and reproduce by binary
fission.
 After some time due to the development of resistance of the host, the parasite form cyst and
pass through feces and the cycle continue.
 If there is extensive prolonged erosion of intestinal mucosa, trophozoites may gain entrance
into portal circulation and reach different organs of the body.
 Liver is the most common organ to which metastasis occurs.

Prevention :
 Avoid fresh fruit and vegetables that you did not peel yourself
 Be careful eating or drinking anything sold by street vendors
 Practice good personal hygiene
 Wash your hands frequently with soap and water, especially before handling food

Malaria:
 Caused by parasite plasmodium.
 4 type of plasmodium
o p.vivax,
o p.falciparum
o p.malariae
o p.ovale.

Life cycle in man :

 Involve two hosts; a cycle in man and another mosquito.
 Infective mosquito species injects sporozoites into man through its bite.
 The sporozoites remain in circulation for a short period and enter parachymal cells of the
liver where they grow and multiply for a week.
 Subsequently these are infecting the RBCs.
 This process continues unless antimalarial treatment is given.

Cycle in mosquito:
 When the mosquito feeds on a infected blood from man with malaria the parasite completes
the cycle in the mosquito..
 The male and female gametocytes undergo certain changes, unite and form a zygote which
develops into an oocyst where the sporozoites are developed.
 Then enter the salivary gland of the mosquito after the oocyst is burst.
 This stage where the mosquito get infected to human.
Clinical manifestation :
 pyrexia
 rigor
 sweating
 prostrating headache
 vomiting

Treatment :
 Chloroquine tablet

Prevention :
1. Prevent breeding
o Drainage
o spraying
2. protection measures
o sleeping in net
o spray in house
3. Visitors to malarial areas to take preventive tablets before, during, and after visit.