LEARNING OUTCOMES: TEST #2

CHAPTER 9 – Microbial Growth Control (in the Environment):

 Sterilization: the removal or destruction of ALL microbes – does NOT apply to proteins
 Aseptic: an area free of contamination of pathogens
 Disinfection: use of chemical or physical agents such as alcohol or bleach
 Degerming: removal of all mibrobes from surface via scrubbing
 Sanitization: disinfecting plates and utensils using steam, hotwater, or chemicals
 Pasturization: use of heat to kill pathogens and decrease spoilage to food and beverages
 Cidal: will destroy all microbes
 Static: will inhibit further growth
Explain Microbial Death Rate and its clinical relevance: the rate can be calculated to see permanent loss
under ideal conditions- within the first minute of treatment, the weakest die first. Broth will be sterile when all
the cells are dead
Antiseptic: chemical used on skin or tissue
Disinfectant: Are more concentrated and can be left on the surface for longer
List several physical methods used to inhibit growth of microorganisms:
 Heat – high temps denature proteins
 Moist heat – boiling
 Dry heat – occurs in oven
 Freezing – decreases microbial growth
 Desiccation – drying out, inhibits liquid s/a syphilis
 Lysophilization – combining freezing and drying to preserve microbes – prevents the formation of
large, damaging ice crystals
 Filtration – HEPA filters
 Osmotic pressure – preserves honey, jerky, jams, jelly
 Radiation – particulate high speed particles, electromagnetic
List several chemical methods used to inhibit growth of microorganisms
 Phenolics – denature proteins s/a with vomit
 Alcohols – bacterialcidal, fungicidal, virucidal against enveloped viruses
 Halogens – iodine, chlorine, bromine, fluorine
 Oxidizing agents – peroxides, ozone, peracetic acid preventing metabolism
 Surfactants – decrease attractions amount molecules such as soaps and detergents
 Heavy metals – copper to control algae growth
 Aldehydes – crosslink functional groups, what’s used in hospital rooms
 Gaseous agents – ethylene
 Enzymes – lysozyme
 Antimicrobials – antibiotics
Identify several factors that can influence the effectiveness of disinfectants.
 The concentration of the disinfectant – higher concentration = more effective than dilute solution
 How long the disinfectant is exposed to the area

In a particular health care situation, determine the appropriate level of control (eg disinfection vs
sterilization; low, intermediate, high) required.
 Disinfection should be used between devices used on patients such as a blood pressure cuff, or oximeter
probe, endoscopy tubes (practically anything that is in contact with mucous membranes)
 Sterilization needs to be done on surgical equipment that will be entering the patient – high

For each of the following organisms, describe important features (as discussed in lecture) and impact on
human health: Listeria monocytogenes, Yersinia enterocolitica
 Listeria monocytogenes: Food poisoning. Caused by bacteria that can grow in cold temperatures.
o Signs and symptoms of illness include: GI symptoms diarrhea, nausea, fever
o Outbreak in hotdogs, cantaloupe, soft cheeses
o Watch out for: Raw vegetables, animal meats, unpasteurized milk, processed foods such as deli
meat

o Clean all kitchen surfaces, cutting boards, and utensils with hot, soapy water when you finish
cooking.

o Scrub raw vegetables with a brush under running water.

o Cook meat, poultry, and egg dishes until they reach 160 F in the center. Use a meat thermometer to
make sure. Keep uncooked meat and poultry away from other food.

o Use hot dogs within a week after you open the package, and deli and luncheon meats within 3 to 5
days after opening.

o Wash your hands with soap before handling a whole melon. Clean it with a brush under running
water. Eat slices promptly. Throw out anything that sits at room temperature more than 4 hours.
 o Keep the temperature below 4.4 C in the refrigerator, and below -17 C in the freezer.

Yersinia enterocolitica: is a bacterial species in the family Enterobacteriaceae that most often causes
enterocolitis, acute diarrhea, terminal ileitis, mesenteric lymphadenitis, and pseudoappendicitis but, if it spreads
systemically, can also result in fatal sepsis

 By eating raw or undercooked pork

Relate how proper hand hygiene relates to control of microbial growth in vitro and in what situations
soap and water is superior and/or inferior to alcohol based hand rubs.
Scrubbing action of washing hands is important to ensure that microbial growth is sloughed off. It has been
proven that soap does nothing for killing the microbes but rather helps to attach to the microbe to be washed off
and away from human skin. Soap and water is more superior than alcohol based hand rubs in relation to C. diff.
Alcohol rubs can kill pathogens however, pathogens can still be living on your hands and you are then
transmitting those microbes onto other people or surfaces. Whereas, proper hand washing ensures that microbes
are removed and washed down the drain.

CHAPTER 10 – Microbial Growth Control (Antimicrobial Drugs)

Distinguish among the following terms:

Antimicrobial drugs: Prevent the growth of microbes
Antibiotics: Kill bacterial growth.
Semi-synthetic: Chemically altered antimicrobials, they are more effective, longer lasting, easier to administer.
Synthetic antibiotics: Antimicrobials drugs that are completely synthesized in a laboratory.

Selective toxicity: An effective antimicrobial agent must be more toxic to a pathogen than to the pathogen’s
host. This is possible because of differences in metabolism and structure between the pathogen and host.
Therapeutic index: The amount of drug needed to cause a therapeutic effect. To have a high therapeutic index
is good because that means that a large amount of drug can be effective. Whereas low therapeutic index can
easily cause toxicity in the patient.

Explain, in general terms, how antibiotic chemotherapeutic drugs work. [Comprehension]

 Drugs that inhibit cell wall synthesis. These drugs are selectively toxic to certain fungal or bacterial
cells, which have cell walls, but not to animals, which lack cell walls.
 Drugs that inhibit protein synthesis (translation) by targeting the differences between prokaryotic and
eukaryotic ribosomes.
 Drugs that disrupt unique components of the cytoplasmic membrane.
 Drugs that inhibit general metabolic pathways not used by humans.
 Drugs that inhibit nucleic acid synthesis.
 Drugs that block a pathogen’s recognition of or attachment to its host.

Explain why antimicrobial chemotherapeutic drugs that work against bacteria are unlikely to
successfully treat infections caused by a virus, protozoan, or fungus (and vice versa). Bacterial walls are
made of peptidoglycan. Antimicrobials work to prevent cross-linkage of NAM subunits – only effective on
bacterial cells that are growing or reproducing; dormant cells may be unaffected.

List and describe the 6 most common mechanisms of action of antimicrobial agents, and give an example
of each.
1. Drugs that inhibit cell wall synthesis. These drugs are selectively toxic to certain fungal or bacterial
cells, which have cell walls, but not to animals, which lack cell walls. Ex. Penicillin; beta lactams
 2. Drugs that inhibit protein synthesis (translation) by targeting the differences between prokaryotic and
eukaryotic ribosomes. Ex. Aminoglycosides s/a gentamicin
3. Drugs that disrupt unique components of the cytoplasmic membrane. Ex. Nystatin
4. Drugs that inhibit general metabolic pathways not used by humans. Ex. Sulfonamides
5. Drugs that inhibit nucleic acid synthesis. Ex. Actinomycin, quinolones
6. Drugs that block a pathogen’s recognition of or attachment to its host. – When they block the site, the
virus can’t bind to the host cell. Ex. Arildone, and pleconaril

Differentiate between narrow spectrum and broad spectrum antimicrobial agents.

 Narrow Spectrum: Drugs that only work against few kinds of pathogens.
 Broad Spectrum: Drugs that are effective against a larger amount of pathogens. Ex. Tetracycline can
act against a wide variety of gram +/- drugs, chlamydia’s, rickettsia,

Describe how beta-lactam antibiotics work. Explain what beta-lactamase is. Beta-lactam works to bind and
deactivate the enzyme that cross links NAM subunits of peptidoglycan. Beta-lactamase is an enzyme which
breaks down the beta lactam rings of penicillin, that render them inactive.

Describe briefly how the following antibiotics work:

 Penicillins: Inhibits cell wall synthesis; Natural penicillins. Bind to and deactivate NAM, oral, gram -
 Methicillin: Inhibits cell wall synthesis Semisynthetic penicillin, IV/IM, broader spectrum of action
 Vancomycin: Inhibits cell wall synthesis; Directly interferes with the alanine-alanine bridges between
NAM subunits, IV, for Gram + drug use such as MRSA strands Staphylococcus aureus
 Bacitracin: Inhibits cell wall synthesis; Gram +, applied topically: Three modes of action
o Interferes with the movement of peptidoglycan precursors through be bacterial cell membrane to
the cell wall
o Inhibit of RNA transcription
o Damage to the bacterial cytoplasmic membrane
 Erythromycin: Inhibit protein synthesis; Bind to 50S subunit of the prokaryotic ribosomes and
prevent the elongation of the nascent protein, effective against Gram + and same Gram -, Oral route,
does not transverse the blood-brain barrier
 Polymixin: Alter cytoplasmic membranes; destroys cytoplasmic membranes of susceptible hosts,
effective against Gram - , particularly pseudomembranous
 Sulpha drugs: Are antimetabolites; analogs of PABA that bind irreversibly to enzyme that produces
dihydrofolic acid; synergistic with trimethoprim, Broad Gram + and Gram - , however is resistant
widespread
 Quinolones: Inhibit DNA synthesis; Inhibit metabolism of malaria parasites (antiprotozoan). Inhibit
DNA gyrase and penetrates cytoplasm of cells (Fluoroquinolones), Broad Gram + and Gram -
 Tetracycline: Inhibit protein synthesis; prevent tRNA molecules from binding to ribosomes at 30S
subunit docking sites, Gram + and Gram -, as well as Mycoplasma
 Isoniazid (INH): Inhibits cell wall synthesis; Blocks gene for the enzyme that forms mycolic acid,
Oral, M. tuberculoses, M. leprae

Explain why antibiotic therapy for TB is longer than for most bacterial infections. A long treatment is
required because antibiotics work only when the bacteria are actively dividing, and the bacteria that
cause TB can rest without growing for long periods. This treatment is necessary to keep the latent TB infection
from developing into active disease

Describe two targets of anti-fungal medications. Cell wall and cell membrane.

Describe the 6 characteristics of an ideal antimicrobial drug:

  Readily available
 Inexpensive
 Chemically stable (so that it can be transported easily and stored for long periods of time)
 Easily administered
 Nontoxic and non-allergenic
 Selectively toxic against a wide range of pathogens

List 5 factors that a physician would consider before prescribing antimicrobial treatment for a particular
patient. In choosing antimicrobials, physicians must consider effectiveness, how a drug is best administered—
orally, intramuscularly, or intravenously—and possible side effects, including toxicity and allergic responses.

Describe some of the potential side effects (undesirable effects) of antimicrobial medication.
1. Toxicity: Metronidazole can cause a black hairy tongue
2. Allergy: Can cause anaphylactic
shock
3. Disruption of normal microbiota:
Can result in secondary infections
such as Candida albicans

CHAPTER 7 – Bacterial Genetics and

Antibiotic Resistance
List and describe 4 sources of resistance in
bacteria.
1. Natural Resistance – to an antibiotic
2. Acquired resistance
a. Mutation – random,
spontaneous changes in genes
b. Horizontal gene transfer –
DNA come from other bacterial or from the environment. Transformation, transduction, and
conjugation
3. Evolution
4.

Describe the events that could lead to evolution of increased antibiotic/antibacterial drug resistance in a
population of bacteria.
Variation: all individual species have variation in heritable traits.
Selection: Not all survive, some are better suited and love on. If those that live in reproduce then the resistant
genes are passed on.

Explain the process of selection by an antibiotic on a large population of bacteria.

Drug a – resistant microbe
Drug b – resistant microbe
Explanation: There is a cell with resistant bacteria. Drug A is wiping out black microbes, but one stays back and
reproduces
1. With drug b, it will wipe out all of the red ones
2. Using both drugs, you are wiping out the ones that are resistant and the ones that are not resistant
because you are using two different antimicrobials that will kill,
3. Mostly unlikely to have bacteria that is resistant to both.
Explain sources of new resistance genes. Evolution, mutation, horizontal gene transfer.

Briefly describe how resistance genes can be transferred from one bacterium to another. Through
horizontal gene transfer. DNA come from other bacteria or from the environment: Transformation, transduction,
conjugation
 Where can we pick up other genes: From the exposure of viruses, from chemicals such as
cigarettes
 Transformation – DNA from the environment (bits of DNA from dead cells, etc)
 Transduction – pick up DNA, get bacterial DNA from viruses
 Conjugation – normal donating of genes from one bacteria to another – looks like fusion
(bacterial sex)
 Going friend to friend, no generational thing, in the same generation which makes it
horizontal

Explain the potential impact of horizontal gene transfer of antibiotic resistance genes in environments
with high antibiotic selection pressure. A donor cell contributes part of it’s genome to a recipient cell,
recipient inserts part of it’s DNA into the donor cell forming recombinant cell. The gene of resistance is being
passed on making more cells resistant.

Describe different mechanisms of resistance to antimicrobial drugs, and provide examples.

 Resistant cells may produce an enzyme that destroys or deactivates the drug. This common mode of
resistance is exemplified by beta (�)-lactamases (penicillinases), which are enzymes that break the beta-
lactam rings of penicillin and similar molecules, rendering them inactive. Many MRSA strains have
evolved resistance to penicillin-derived antimicrobials in this manner. Over 200 different lactamases
have been identified. Frequently their genes are located on R plasmids.
 Resistant microbes may slow or prevent the entry of the drug into the cell. This mechanism typically
involves changes in the structure or electrical charge of the cytoplasmic membrane proteins that
constitute channels or pores. Such proteins in the outer membranes of Gram-negative bacteria are called
porins. Altered pore proteins result from mutations in chromosomal genes. Resistance against
tetracycline and penicillin are known to occur via this mechanism.
 Resistant cells may alter the target of the drug so that the drug either cannot attach to it or binds it less
effectively. This form of resistance is often seen against antimetabolites (such as sulfonamides) and
against drugs that thwart protein translation (such as erythromycin).
 Resistant cells may alter their metabolic chemistry, or they may abandon the sensitive metabolic step
altogether. For example, a cell may become resistant to a drug by producing more enzyme molecules for
the affected metabolic pathway, effectively reducing the power of the drug. Alternatively, cells become
resistant to sulfonamides by abandoning the synthesis of folic acid, absorbing it from the environment
instead.
 Resistant cells may pump the antimicrobial out of the cell before the drug can act. So-called efflux
pumps, which are typically powered by ATP, are often able to pump more than one type of antimicrobial
from a cell. Some microbes become multi-drug resistant (perhaps to as many as 10 or
 more drugs) by utilizing resistance pumps.
 Bacteria within biofilms resist antimicrobials more effectively than free-living cells. Biofilms retard
diffusion of the drugs and often slow metabolic rates of species making up the biofilm. Lower metabolic
rates reduce the effectiveness of antimetabolic drugs.
 Some resistant strains of the bacterium Mycobacterium tuberculosis have a novel method of resistance
against fluoroquinolone drugs that bind to DNA gyrase. These strains synthesize an unusual protein that
forms a negatively charged, rodlike helix about the width of a DNA molecule. This protein, called MfpA
protein, binds to DNA gyrase in place of DNA, depriving fluoroquinolone of its target site. This is the
first method of antibiotic resistance that involves protecting the target of an antimicrobial drug rather
than, say, changing the target or deactivating the drug. MfpA protein probably slows down cellular
division of M. tuberculosis, but that is better for the bacterium than being killed.

Describe 5 actions that physicians, patients and/or nurses can take to help prevent drug resistance.
4. Use antimicrobials only when necessary
5. Use drugs in combination: Two or more, antibiotics with drug that counters resistance
6. Develop new variations of existing drugs: 2nd and 3rd gen
7. Search for new antibiotics
8. In healthcare settings, follow routine practices for prevention of infectious disease transmission

Explain what is meant by superinfection. May result from the use of antibiotics. Clostridium can grow
excessively.

Describe the controversy around completing an entire antibiotic regimen as prescribed, and support your
personal view on this issue.
If you are taking antibiotics, you should take them for the 5-7 day period based on the doctor’s orders. The
controversy is that the prescription is given too long and the bacteria can develop resistant. If you only take the
antibiotics for a shorter period, the bacteria is less exposed and does not have time to become resistant.
However, if you do not take the antibiotic for long enough, how are you truly sure that the pathogenic bacteria
is cleared from you body.

Explain the difference between cross resistance and multiple resistance.

 Multiple resistance refers to resistance to more than 3 types of antimicrobial agents. Staphylococcus,
streptococcus, pseudomonas are multiple strains. Must treat patients without antimicrobials.
 Cross resistance when one microbial agent may confer resistance to similar drugs, typically when drugs
are similar in structure. One aminoglycoside drug may be resistant to anther aminoglycoside drug.

CHAPTER 14: Infection, Infectious Disease and Transmission

Distinguish among the different types of symbiosis: Symbiosis to live together.

 Commensal: Benefits one member without significantly affecting the other
 Mutualistic: Both members benefit
 Amensalism: One member is destroyed and the other is unaffected (not benefit nor destroyed)
 Parasitism: Benefits from its host wile harming it, though some hosts sustain only slight damage.

Identify the type of symbiotic relationship occurring between organisms in a particular situation. E.Coli
and the intestinal tract. If e.coli overgrows, it can make it’s way into the urinary tract causing an infection. This
is typically d/t antibiotic use.

Describe the relationships among the terms parasite, host, and pathogen.
  Parasite: Something that lives off of another organism to thrive.
 Host: Non-pathogenic cell that can be taken advantage of.
 Pathogen: Any parasite that causes disease.

Describe the microbiome, including resident and transient members, some of its roles and characteristics,
and how it is acquired.
Human Microbiome: All of the microorganisms found on and in the normal human
o Other names: normal microbiota, normal flora, indigenous microbiota
o Everyone has a unique set of microbes that are living on them
o Two major groups
o Resident: Those that are a part of the normal microbiota, are with you for life. Can be
commensal, or mutualistic.
o Transient: Can be here for short periods (hours or months), found in the same regions as
resident, do not remain in the body
 Competition from other microorganisms
 Elimination by the body’s defense cells
 Chemical or physical changes in the body

Explain how the microbiome protects against pathogens.

a. Attachment opportunities minimized
b. Compete for nutrients, etc
c. Secrete antimicrobials
d. Stimulate our human cells to secrete antimicrobial substances
e. Stimulate our immune system

List the parts of the human body that are expected to be axenic/sterile in a healthy male, and those in a
healthy female. Urinary and reproductive systems

Describe the microbial environments, in general terms, of the major regions where the normal human
flora/microbiota is present in a healthy individual.
 In the upper respiratory tract, the alveoli have NO natural microbiota and are axenic
 Lower GI there are strictly anaerobes in the resident bacteria
 Microbiota changes in the female urinary tract depends on the acidity of the vagina, changes occur as the
female cycles through menstruation
 Microbiota live on the outer dead layers of the skin, the deeper layers (dermis and hypodermis) are
axenic
 Tears wash away microbiota of the eyes and sclera so there are few

Describe some of the normal flora/microbiota. C. diff, staph, strep, pneumonia.

Explain why microorganisms are necessary to human existence. They contribute to digestion, detoxification,
immune system development.

Describe microbial antagonism, and its importance relating to the normal flora/microbiota.
Microbial antagonism is the method of using established cultures of microorganisms to prevent the intrusion
of foreign strains. When introduced to an already-colonized environment, an invasive strain of bacteria tends
not to thrive and may go completely extinct.

Explain how bacteria can be non-pathogenic under some conditions, and pathogenic under other
conditions, conditions under which this is likely to happen, and illustrate using an example.
Virulence Factors: Enable pathogens to cause disease are traits a pathogen that enables it to infect its host and
cause disease
 Plague and rabbit fever are most virulent in nature
o Attachment: Genes on the outside that are coding for the disease
o Extracellular enzymes: Enzymes used to break down tissue or blood cell coagulation – helps
bacteria infect b/c the blood clot catches up in it signaling the immune response
o Toxins: Things that can harm tissue or trigger immune response which will do the harm.
 Exotoxins: Broad, do many things. Pathogens create them and secrete them out
 Endotoxins: lipid A – comes from gram negative bacteria – outer membrane, when the
bacteria die, and lipid A is released leading to huge immune response that can cause
shock. One gene can cause the difference between toxic and non-toxic
o Antiphagocytic Factors: Eat up and digest them and break them down. Example: Listeria

List the groups of people more susceptible to opportunistic infections. Those on multiple antibiotic
treatment, hospitalized patients, those who use catheters.

Distinguish between opportunistic, true/primary bacterial pathogens.

 Opportunistic: Will cause disease only when introduced into an unusual location of
immunocompromised host.
 True/Primary: Can cause disease in a healthy host.

Describe three opportunistic pathogens in humans.

o Opportunistic: normal microbiota that can cause disease under certain circumstances
 Conditions include: end up in the wrong spot – gut to blood, immune suppression, changes in the
normal microbiota/reduced microbial antagonism or competition, stressful conditions
 Who’s at risk: old age, genetic, surgery, organ transplant, cancers
 Examples: C. Diff, staph, strep
 Not E.Coli
o True: Also known as primary, can cause disease in any susceptible host, including a healthy person
 Ex: malaria, rabies, plaque, influenza

Define etiology: The study of the cause of disease.

Describe Koch’s postulates and how it relates to infectious disease.

1. The suspected agent (bacterium, virus, etc.) must be present in every case of the disease.
2. That agent must be isolated and grown in pure culture.
3. The cultured agent must cause the disease when it is inoculated into a healthy, susceptible experimental
host.
4. The same agent must be reisolated from the diseased experimental host.

Identify challenges to fulfilling Koch’s postulates and illustrate with (and be able to recognize) examples.
 Some pathogens cannot survive in a laboratory setting
 Some diseases are caused by multiple pathogens
 Ethical considerations: Prevent applying these postulates into human only pathogens. You must culture
the pathogen in a healthy host and it is unethical to culture in a human. An example is AIDS

Describe types of reservoirs of human infectious disease and provide an example of each.
 Animal Reservoirs – Zoonoses: Diseases that spread naturally from the animal hosts to human.
Humans can get this by eating animals that have acquired disease. Example: Tapeworm, rabies,
ringworm, salmonella
  Human carriers – People have this, may be inactive for years so they don’t know that they have it. Ex.
Tuberculosis
 Nonliving Reservoirs:
o Soil – C.difficile can be found causing botulism and tetanus
o Water – Feces and urine containing parasitic worms
o Food – Meats and vegetables can harbor pathogens

Describe the steps or components of an infection. List and describe the 5 typical stages of infectious
diseases.

1. Incubation: Time between getting the infection and displaying the first signs and symptoms.
2. Prodromal Period: Short time, mild symptoms such as malaise,
3. Illness: Most severe part of the infection. Signs and symptoms are most evident. The person’s immune
system has not fully responded to the infection.
4. Decline: The body gradually returns to normal as the immune response and/or medical treatment
vanquish the pathogens. Immune response and antibodies peak during this stage.
5. Convalescence: The patient recovers from illness. Tissues are repaired and return to normal. This period
length depends on how much damage was done.
a. A patient is likely to be infectious during every stage of the disease process
b. Infection can spread during the incubation and convalescence stages.
c. Good aseptic technique can prevent the spread of pathogens

Identify the portals of entry and exit in humans, and explain their clinical relevance.
1. Skin: Pathogens can enter through cuts or abrasions in skin. Also, natural openings such as the hair
follicles and sweat glands. Larvae can burrow through skin and gain access to deeper, moister areas in
the body.
2. Mucous Membranes: This lines the entire inside of the body cavities. Prions enter through the oral
cavity. Parasites such as protozoa and helminths are able to survive the pH acidity of the stomach.
3. Placenta: Pathogens can pass and lead to spontaneous abortions, birth defects, or premature birth.

Compare and contrast:

 Morbidity: Another term for disease – when the injury is significant enough to interfere with normal
functioning of the body.
 Mortality: Number of deaths
 Infection: Caused by infectious agent
 Pathogenicity: The ability for a micro-organism to cause disease.
 Virulence factors: traits that interact with a host and enable the pathogen to enter a host, adhere to host
cells, gain access to nutrients, and escape detection or removal by the immune system.
 Colonization: Bacteria establishing itself in one area.

Distinguish among signs and symptoms, illustrate with examples, and identify each given a scenario.
Symptom: Subjective characteristics of a disease felt only by the patient. Ex: pain, tired, headache, sore throat,
chills
Sign: Objective manifestations of disease that can be observed or measured by others. Ex: Fever, rash

Distinguish between exotoxin and endotoxins.

 Exotoxin: Central to their pathogenicity in that they destroy host cells or interfere with host metabolism.
They have 3 principal types.
o Cytotoxins; which kill host cells in general or affect their function
o Neurotoxins; which specifically interfere with nerve cell function
 o Enterotoxins; which affect cells
lining the gastrointestinal tract
 Endotoxin: Also called lipid A, is the lipid
portion of the membrane’s
lipopolysaccharide.

Explain how lipid A acts as a virulence factor,

and identify infections that are at risk of
generating this toxin. It releases chemicals that
cause fever, inflammation, and diarrhea,
hemorrhaging, shock, and blood coagulation.
Endotoxin from dead bacteria can produce
serious, systemic, effects in the host.

Pathogen: Disease causing agent

Non-pathogen: An agent that does not cause
disease.
Opportunistic pathogen: Lives on the body in a
commensal relationship however, if there is a
suppression in the immune system then these
pathogens cause disease.
Reservoir: Living and nonliving areas that are the source to infectious disease.
Carrier: A living or nonliving thing that doesn’t have to get the pathogen but can carry it to other things that
will get the pathogen.
Fomite: Inanimate object that can transfer pathogens to new hosts.
Zoonoses: Diseases that spread naturally from animals to humans
Parenteral: A means by which creates a portal of entry. Such as needle or thorn piercing through the skin.
Normal flora/microbiota: Agents that are found normally on a surface. S/a human microbiota.
Probiotic: Good bacteria.

Compare and contrast contact, vehicle and vector transmission of pathogens, illustrating each with an
example.
 Contact: Transmission from one host to another via direct, indirect, or respiratory droplets.
o Direct: Touching, kissing, sex. Ex. Gonorrhea, warts, herpes
o Indirect: Transmitted by fomites. Ex. Money, paper, tissues
o Respiratory droplets: Cold or flu s/a coughing or sneezing. Droplet is by the cold and flu
whereas airborne is small particles of respiratory droplets that suspend in the air. Air-
conditioning, sweeping, mopping, etc.
 Vehicle: Spread by air, water, food, and body fluids being handled outside of the body
 Vector: Animals that transmit diseases from one host to another
o Biological: Transmit and serve as hosts for the multiplication of pathogens. Ex. Mice, ticks,
mosquitos, bloodsucking flies
o Mechanical: Just passively carry pathogens to new hosts. Ex. Houseflies and cockroaches

CHAPTER 14 CONTINUED: Epidemiology and Public Health

Epidemiology: The study of the occurrence and spread of diseases with groups of humans, and the methods by
which we can limit the spread of pathogens within society.
Incidence: The number of new cases of a disease in a given area or population during a given period of time.
Prevalence: The total number of cases, both new and already existing, in a given area or population during a
given period of time.
Mortality: Rate/Death Rate: relative # of deaths in a population due to a specific cause, per unit of time.
Eg 5 in every 1000 people per year, or 0.5% per year
Morbidity Rate: rate of new cases (incidence) or total cases (prevalence) per unit population per unit of time.
Endemic: A disease that normally occurs continually at a relatively stable incidence within a given population
or geographical area.
Nonendemic: Not endemic
Epidemic: When a disease occurs at a greater frequency than is usual for an area or population.
Pandemic: If an epidemic occurs simultaneously on more than one continent.
Sporadic: When only a few scattered cases occur within an area or population.
Index case: The first case of the disease in a given area or population.

Describe the role/purpose of public health organizations, and the two major ways in which public health
initiatives fulfil this purpose.
 Enforce standards of cleanliness in water and food supplies
 Work to reduce the number of disease vectors and reservors
 Establish and enforce immunization schedules
 Locate and prophylactically treat individuals
exposed to contagious pathogens
 Establish isolation and quarantine measures to
control the spread of pathogens
 Work to control vectors by eliminating breeding
grounds such as stagnant pools of water and
garbage dumps
 Public health agencies require the pasteurization
of milk

Evaluate the data (numeric or shown in graph)

gathered in outbreak surveillance for a particular
infectious disease, in the context of making analyses of
epidemiology and potential public health implications.
List and briefly describe the steps carried out in an
outbreak investigation
1. Prepare for field work
2. Establish the existence of an outbreak
3. Verify the diagnosis
4. Define and identify cases
5. Describe and orient the data in terms of time,
place, and person
6. Develop hypotheses
7. Evaluate/Test hypotheses
8. Refine hypotheses and carry out
9. Implement control and prevention measures
10. Communicate findings

Describe what is meant by “reportable”

communicable diseases in Ontario, how this reporting
occurs, and the reasons for collection of this
information.
The most common reasons include:
 1. To detect outbreaks and epidemics,
2. To enable timely follow-up of communicable disease reports so that further transmission is prevented,
3. To facilitate the prompt implementation of appropriate public health interventions and educational
efforts,
4. To help target prevention programs, identify specific
sub-populations at highest risk, and to use resources efficiently,
5. To evaluate the success of disease control efforts,
6. To facilitate epidemiological research,
7. To contribute to provincial, national and international surveillance efforts.”

Describe cholera, its cause, symptoms, virulence factors, transmission and treatment.
Cholera: The cause is Vibrio cholerae
• Gram negative, curved rod
• Occurs in salt- and freshwater
• In salt forms biofilms (not infective)
• In fresh water planktonic and infective
• Environment within the human body activates some Vibrio genes
• Produces enterotoxin (cholera toxin) that causes watery diarrhoea that can quickly lead to severe
dehydration and death if treatment is not promptly given. Vomiting common

Distinguish among infectious, iatrogenic, idiopathic and nosocomial infections

 Iatrogenic: doctor induced. Due to direct result of modern medical procedures such as catheters,
invasive diagnostic procedures, and surgery.
 Infectious:
 Idiopathic:
 Nosocomial: Acquired in the health care setting

Healthcare-Associated Infections (HAI): infections acquired by patients or health care workers.

Explain how HAIs differ from other infections. HAI are infections acquired by patients or health care
workers while they are in health care facilities,
including hospitals, dental offices, nursing homes, and
doctor’s waiting room.

Describe the factors that influence the development

of HAIs.
 Exposure to numerous pathogens present in the
health care setting, including many that are
resistant to antimicrobial agents
 The weakened immune systems of patients who
are ill, making them more susceptible to
opportunistic pathogens
 Transmission of pathogens among patients and
health care workers – from staff and visitors, to
patients and even from one patient to another via activities of staff members

Describe three types of HAI and how they may be prevented:

1. Exogenous: Pathogens acquired from the health care environment.
 2. Endogenous: Found on human normal microbiota but become pathogenic b/c of factors within the
health care setting.
3. Iatrogenic: “Doctor induced” from medical equipment that is poorly sterilized.

Differentiate among nosocomial, community-acquired, and iatrogenic infections. Nosocomial is hospital

acquired, community is acquired in the community, iatrogenic is from the use of medical equipment d/t surgical
equipment that is introduced to the patient directly.