1

MICROBIOLOGY AND
PARASITOLOGY

FINALS TOPIC CONTENTS

WEEK 4 A:
✓ Pathogenesis and Host Defense
Mechanisms: Pathogenesis of
Infectious Diseases (Page 1-7)
WEEK 4 B:
✓ Nonspecific Host Defense
Mechanisms (Page 8-13)
WEEK 4 C:
✓ Specific Host Defense Mechanisms:
An Introduction to Immunology
(Page 14-22)
WEEK 5 A:
✓ Overview of Human Infectious
Diseases (Page 23-27)
WEEK 5 B:
✓ Major Infectious Diseases of
Humans: Viral Infections of Humans
(Page 28-31)
WEEK 5 C:
✓ Major Infectious Diseases of
Humans: Bacterial Infections of
Humans (Page 32-38)
WEEK 6 A:
✓ Major Infectious Diseases of
Humans: Fungal Infections of
Humans (Page 39-41)
PROFESSOR:
WEEK 6 B
Dennis Espineli Salcedo, PhD
✓ Major Infectious Diseases of
Humans: Parasitic Infections of
Humans (Page 42-48) Buri, Jade B
BSN 1-4
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PATHOGENESIS AND HOST DEFENSE outcome of the pathogen–host

MECHANISMS encounter.
• The person may be immune to that
PATHOGENESIS OF INFECTIOUS
particular pathogen.
DISEASES
• Phagocytes present in the blood may
• The prefix “path” refers to disease. destroy the pathogen.
• Pathogenicity means the ability to cause
FOUR PERIODS OR PHASES IN THE
disease.
COURSE OF AN INFECTIOUS DISEASE
• Pathogenesis refers to the steps or
mechanisms involved in the development
of a disease
INFECTION VS. INFECTIOUS DISEASE
• An infectious disease is a disease
caused by a microbe, and the microbes
that cause infectious diseases are
collectively referred to as pathogens.
• Infection is commonly used as a
synonym for infectious disease (e.g., an
ear infection is an infectious disease of
the ear).
• Microbiologists reserve the word
infection to mean colonization by a
pathogen; the pathogen may or may not 1. The incubation period
go on to cause disease. - is the time that elapses between
• A person can be infected with a arrival of the pathogen and the onset
pathogen, but not have an infectious of symptoms. The length of the
disease. incubation period is influenced by
many factors, including the overall
Why Infection Does Not Always Occur health and nutritional status of the
• The microbe may land at an anatomic host, the immune status of the host
site where it is unable to multiply. (i.e., whether the host is
• Many pathogens must attach to specific immunocompetent or
receptor sites before they are able to immunosuppressed), the virulence
multiply and cause damage. of the pathogen, and the number of
• Antibacterial factors may be present at pathogens that enter the body
the site where the pathogen lands. 2. The prodromal period
• Indigenous microbiota of that site may - is the time during which the patient
inhibit growth of the foreign microbe feels “out of sorts” but is not yet
(i.e., microbial antagonism). experiencing actual symptoms of the
• The indigenous microbiota may disease. Patients may feel like they
produce antibacterial factors (i.e., are “coming down with something”
bacteriocins) that destroy the pathogen. but are not yet sure what it is.
3. The period of illness
• The individual’s nutritional and overall
health status often influence the

- is the time during which the patient
experiences the typical symptoms
associated with that particular
disease (e.g., sore throat,
headache, sinus congestion).
Communicable diseases are most
easily transmitted during this third
period
4. The convalescent period
- is the time during which the patient
recovers. For certain infectious
diseases, especially viral respiratory
diseases, the convalescent period
can be quite long. Although the
patient may recover from the illness
itself, permanent damage may be
caused by destruction of tissues in
the affected area. For example,
brain damage may follow
encephalitis or meningitis, paralysis
may follow poliomyelitis, and
deafness may follow ear infections.
LOCALIZED VS. SYSTEMIC
INFECTIONS
Localized infections
• Once an infectious process is initiated,
the disease may remain localized or it
may spread;
- Examples are: pimples, boils, and
abscesses.
Systemic infections
• When the infection spreads throughout
the body, it is said to have become a
systemic or generalized infection;
- example is miliary tuberculosis,
caused by Mycobacterium
tuberculosis.
ACUTE, SUBACUTE AND CHRONIC
DISEASES
• An acute disease is one that has a
rapid onset, and is usually followed by a
relatively rapid recovery;
3
- examples are measles, mumps, and
influenza.
• A chronic disease has a slow onset
and lasts a long time;
- examples are tuberculosis, leprosy,
and syphilis.
• A subacute disease is one that comes
on more suddenly than a chronic
disease, but less suddenly than an
acute disease;
- example would be bacterial
endocarditis.
SYMPTOMS OF A DISEASE VERSUS
SIGNS OF A DISEASE
• A symptom of a disease is defined as
some evidence of a disease that is
experienced by the patient--something
that is subjective; examples are aches
or pains, ringing in the ears, blurred
vision, nausea, dizziness, etc.
- There are symptomatic and
asymptomatic diseases. In a
symptomatic disease, the patient is
experiencing symptoms. In an
asymptomatic disease, the patient is
not experiencing any symptoms.
• A sign of a disease is defined as some
type of objective evidence of a disease
(e.g., elevated blood pressure,
abnormal heart sounds, abnormal pulse
rate, abnormal laboratory results, etc.).
LATENT INFECTIONS
• are infectious diseases that go from
being symptomatic to asymptomatic,
and then, later, go back to being
symptomatic.
- Examples include syphilis and
herpes virus infections such as cold
sores, genital herpes, and shingles.
STAGES OF SYPHILIS

PRIMARY VS. SECONDARY
INFECTIONS
• One infectious disease may commonly
follow another; in such cases, the first
disease is referred to as a primary
infection and the second disease is
referred to as a secondary infection.
✓ Example: serious cases of bacterial
pneumonia frequently follow mild
viral respiratory infections.
• During the primary infection, the virus
causes damage to the ciliated epithelial
cells of the respiratory tract; these cells
are then unable to clear opportunistic
bacterial pathogens from the
respiratory tract, leading to the
secondary infection (pneumonia).
STEPS IN THE PATHOGENESIS OF
INFECTIOUS DESEASES
4
A common sequence of steps in the
pathogenesis of infectious diseases is
• Entry of the pathogen into the body
• Attachment of the pathogen to some
tissue(s) within the body
• Multiplication of the pathogen
• Invasion or spread of the pathogen
• Evasion of host defenses
• Damage to host tissue(s)
VIRULENCE
• The term virulent is sometimes used as
a synonym for pathogenic.
• There may be virulent (pathogenic)
strains and avirulent (nonpathogenic)
strains of a particular species.
• strains are capable of causing disease;
avirulent strains are not.
✓ example, toxigenic (toxin-producing)
strains of Corynebacterium
diphtheriae can cause diphtheria,
but nontoxigenic strains of C.
diphtheriae cannot. Thus, the
toxigenic strains are virulent, but the
nontoxigenic strains are not.
• Sometimes, the term virulence is used
to express the measure or degree of
pathogenicity.
Example:
✓ It takes only 10 Shigella cells to
cause shigellosis, but it takes
between 100 and 1,000 Salmonella
cells to cause salmonellosis. Thus,
Shigella is more virulent than
Salmonella.
✓ Some strains of Streptococcus
pyogenes (e.g., the “flesh- eating”
strains) are more virulent than other
strains of S. pyogenes.
✓ Some strains of Staphylococcus
aureus produce toxic shock
syndrome, but other strains of S.
aureus do not. Those that do are
considered more virulent
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• are capable of both an intracellular and extracellular existence.

Virulence Factors
• are attributes that enable pathogens to Intracellular survival mechanisms
attach, escape destruction, and/or
✓ Possession of a cell wall
cause disease.
composition that resists digestion
• are phenotypic characteristics that are
(e.g., M. tuberculosis)
dictated by the organism’s genotype.
✓ Prevention of fusion of lysosomes
Examples are as follows: with phagosomes
✓ Production of phospholipases that
✓ Adhesins (ligands), special
destroy the phagosome membrane,
molecules on the surface of
thereby preventing lysosome–
pathogens, are considered to be
phagosome fusion
virulence factors because they
✓ Other unknown mechanisms
enable pathogens to recognize and
bind to particular host cell receptors. Example of Virulence Factors
✓ Pili (bacterial fimbriae) are
considered to be virulence factors
because they enable bacteria to
attach to surfaces, such as tissues
within the human body.
Adhesins and Receptors
• The general terms receptor and integrin
are used to describe the molecule on
the surface of a host cell that a
particular pathogen is able to recognize
and attach to. CAPSULES AND FLAGELLA

Obligate Intracellular Pathogens • considered to be virulence factors.

• Pathogens that must live within host Examples of encapsulated bacteria:

cells in order to survive and multiply are
referred to as obligate intracellular
pathogens (e.g., Rickettsia and
Chlamydia spp.).
✓ Intraleukocytic pathogens (e.g.,
Ehrlichia spp. and Anaplasma
phagocytophilum) live within white
blood cells, causing diseases known
as ehrlichiosis and anaplasmosis.
✓ Plasmodium spp. (which cause
malaria) and Babesia spp. (which
cause babesiosis) are examples of
intraerythrocytic pathogens; they
live within red blood cells.
Facultative Intracellular Pathogens
✓ Streptococcus pneumoniae
✓ Klebsiella pneumoniae
✓ Haemophilus influenzae
✓ Neisseria meningitidis.
• Flagella are virulence factors because
they enable flagellated bacteria to
invade aqueous areas of the body; they
may also help the bacterium to escape
phagocytosis.
➢ Photomicrograph of stained S.
pneumoniae showing capsules (the
unstained halos that surround the
bacteria)
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Exoenzymes
• The major mechanisms by which
pathogens cause disease are the
Toxins
exoenzymes or toxins that they
produce. • Toxins are poisonous substances
• Exoenzymes released by bacteria released by various pathogens.
include: • There are two general types:
✓ Necrotizing enzymes 1. Endotoxins
✓ Kinases ✓ Part of the cell wall structure of
✓ Collagenase Gram-negative bacteria
✓ Lecithinase ✓ Can cause serious, adverse
✓ Coagulase physiologic effects such as fever
✓ Hyaluronidase and shock
✓ Hemolysins 2. Exotoxins
Necrotizing Fasciitis ✓ Poisonous proteins secreted by a
variety of pathogens
- Examples: neurotoxins,
enterotoxins, exfoliative
toxin, erythrogenic toxin,
and leukocidins
Tetanus Patient Displaying
Opisthotonos

Mechanisms by Which Pathogens

Escape Immune Responses
Antigenic variation
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• Some pathogens evade the immune

system by changing their surface
antigens--antigenic variation;
- examples, Neisseria gonorrhoeae
and Borrelia recurrentis.
Camouflage and molecular mimicry
• Some organisms conceal their foreign
nature by coating themselves with host
proteins--like camouflage (e.g., adult
schistosomes).
Destruction of antibodies
• Some pathogens produce IgA
protease, an enzyme that destroys
some of the host’s antibodies (e.g., H.
influenzae).
RECAP OF BACTERIAL BIRULENCE
FACTORS

NON-SPECIFIC HOST DEFENSE
MECHANISMS
Host defense mechanisms
• Ways in which the body protects itself
from pathogens— referred to as three
lines of defense.
• The first two lines of defense are
nonspecific.
• The third line of defense, the immune
response, is very specific.
➢ In the third line of defense, special
proteins called antibodies are
produced in response to foreign
substances called antigens.
LINES OF DEFENSE
8
CATEGORIES OF HOST DEFENSE
MECHANISM
Nonspecific host defense
• mechanisms are general and serve to
protect the body against many harmful
substances.
- Example: innate or inborn resistance
✓ Exact factors that produce innate
resistance are not well understood.
• Other nonspecific host defense
mechanisms include mechanical and
physical barriers to invasion, chemical
factors, microbial antagonism, fever,
the inflammatory response, and
phagocytic white blood cells.
FIRST LINE OF DEFENSE
Skin and mucous membranes as
physical barriers
• Cellular and chemical factors
✓ In addition to the skin as a physical
barrier, there are other factors (e.g.,
pH and temperature of skin,
perspiration, cilia, and various
enzymes in secretions such as
lysozyme) that are components of
the first line of defense.
• Microbial antagonism
✓ When indigenous microbiota
prevent colonization of “new
arrivals” as a result of competition for
sites and nutrients and production of
lethal substances.
SECOND LINE OF DEFENSE

• Transferrin
✓ Levels of this glycoprotein increase
in response to systemic bacterial
infections; it binds to iron depriving
pathogens of this vital nutrient.
• Fever
✓ Stimulated by pyrogenic (fever-
producing) substances (e.g.,
pathogens and interleukin 1 [IL-1])
✓ Augments host’s defenses by
stimulating leukocytes, reducing
available free plasma iron, and
inducing the production of IL-1
• Interferons
✓ These are small antiviral proteins
produced by virus-infected cells;
they prevent viruses from
multiplying.
✓ There are three types (alpha, beta,
and gamma), produced by three
different types of cells.
✓ These three types are induced by
different stimuli (e.g., viruses,
tumors, bacteria, and foreign cells).
✓ Interferons are not virus-specific, but
they are species-specific.
✓ Interferons can cause nonspecific flu
like symptoms.
• The complement system
✓ It is a group of about 30 different
proteins found in normal blood
plasma — “complementary” to the
immune system.
✓ Complement components interact
with each other in a stepwise
manner known as the complement
cascade.
✓ The complement system assists in
the destruction of many different
pathogens.
✓ Opsonization is a process by which
phagocytosis is facilitated by the
deposition of opsonins (e.g.,
antibodies or certain complement
9
fragments) onto objects (e.g.,
pathogens).
• Acute-phase proteins
✓ Plasma proteins that increase
rapidly in response to infection,
inflammation, or tissue injury; (e.g.,
is C-reactive protein).
• Cytokines
✓ These are chemical mediators
released from many different types
of cells in the body; they enable cells
to communicate with each other—
within the immune system and
between the immune system and
other systems of the body.
✓ Some cytokines (called
chemokines) are chemoattractants;
they recruit phagocytes to sites
where they are needed.
Inflammation
• The body responds to any local injury,
irritation, microbial invasion, or bacterial
toxin by a complex series of events
referred to as inflammation; the three
major events in acute inflammation are
✓ An increase in the diameter of
capillaries, (vasodilation) which
increases blood flow to the site
✓ Increased permeability of the
capillaries, allowing the escape of
plasma and plasma proteins
✓ Exit of leukocytes from the
capillaries and their accumulation at
the site of injury
• The primary purposes of the
inflammatory response are to
✓ Localize an infection
✓ Prevent the spread of microbial
invaders
✓ Neutralize any toxins being
produced at the site
✓ Aid in the repair of damaged tissue

• The four major signs and symptoms of
inflammation are redness, heat,
swelling (edema), and pain.
• Plasma that escapes from the
capillaries into the site causes the area
to become edematous (swollen).
PURPOSES OF INFLAMMATION
Sequence of Events in Inflammation
1. Tissue injury
2. Vasodilation
3. Increased permeability
4. Emigration of leukocytes
5. Chemotaxis
6. Phagocytosis
Events That Occur in Inflammation
• The accumulation of fluid, cells, and
cellular debris at the inflammation site is
known as an inflammatory exudate.
✓ If the exudate is thick and greenish-
yellow, containing many live and
dead leukocytes, it is known as a
purulent exudate or pus.
10
• In many inflammatory responses (e.g.,
arthritis or pancreatitis), there is no
exudate and no invading microbes.
• Pyogenic microbes (pus-producing
microbes) such as staphylococci and
streptococci result in additional pus
formation.
PHAGOCYTOSIS
• Phagocytic white blood cells are called
phagocytes, and the process by which
they surround and engulf (ingest)
foreign material is called phagocytosis.
• The three major categories of
leukocytes (white cells) found in blood
are monocytes, lymphocytes, and
granulocytes.
• The three types of granulocytes are
eosinophils, basophils, and neutrophils.
• The most important groups of
phagocytes in the human body are
macrophages and neutrophils.
Cellular Elements of Human Blood
Opsonization
The phagocyte shown here is unable to
attach to the encapsulated bacterium
because there are no molecules
(receptors) on the surface of the phagocyte
that can recognize or attach to the
polysaccharide capsule. (B) Complement
 11

fragments (represented by the symbol C’) Ingestion Pseudopodia

have been deposited onto the surface of surround the object,
the capsule. (In this example, the opsonins and it is taken into
are complement fragments.) Now the the cell
phagocyte can attach to the bacterium Digestion The object is broken
because there are receptors (represented down and dissolved
by) on the phagocyte’s surface that can by digestive
recognize and bind to complement enzymes and other
fragments. (C) Antibodies (the Y shaped mechanisms
molecules) have attached to the capsule.
(In this example, the opsonins are
antibodies.) Now the phagocyte can attach INGESTION PHASE OF
to the bacterium because there are PHAGOCYTOSIS
receptors (represented by ) on the
phagocyte’s surface that can recognize
and bind to the Fc region of antibody
molecules.

DIGESTION PHASE OF
PHAGOCYTOSIS

FOUR STEPS IN PHAGOCYTOSIS

STEP BRIEF
DESCRIPTION
Chemotaxis Phagocytes are
attached by Photomicrograph of Rat Leukocytes,
chemotactic Some of Which Contain Phagocytized
Attachment A phagocyte Giardia Trophozoites
attaches to an object
 12

• Inability of leukocytes to migrate in

response to chemotactic agents may be
related to a defect in the production of
actin, a structural protein associated
with motility.
- Disorders and conditions affecting
intracellular killing by phagocytes
(e.g., chronic granulomatous
disease, CGD)
- Additional factors
Scanning Electron Micrographs
ADDITIONAL FACTORS THAT CAN
Illustrating the Phagocytosis of Giardia
IMPAIR HOST DEFENSE MECHANISMS
Trophozoites
FACTOR COMMENTS
Nutritional Status Malnutrition is
accompanied by
decreases
resistance to
infections
MECHANISMS BY WHICH Increased Iron High
PATHOGENS ESCAPE DESTRUCTION levels concentrations of
BY PHAGOCYTES iron make in easier
for bacteria to
• Capsules initially serve to protect the satisfy their iron
organism from phagocytosis (i.e., they requirements; high
serve an antiphagocytic function). concentrations of
• Some bacteria produce an exoenzyme iron reduce the
called leukocidin, which kills chemotactic and
phagocytic
phagocytes.
activities of
• Some bacteria (e.g., Mycobacterium phagocytes;
tuberculosis) are not destroyed within increased iron
the phagolysosome. levels may result
• The mechanism by which each from a variety of
pathogen evades digestion by conditions or habits
lysosomal enzymes differs from Stress People living under
pathogen to pathogen, and is not yet stressful conditions
fully understood. are more
susceptible to
DISORDERS AND CONDITIONS THAT infections than
ADVERSELY AFFECT PHAGOCYTIC people living under
AND INFLAMMATORY PROCESSES less stressful
conditions
- Leukopenia—an abnormally low
Age Newborn infants
number of circulating leukocytes lack a fully
- Disorders and conditions affecting developed immune
leukocyte motility and chemotaxis system; the
efficiency of the
 13

immune system
and other host
defenses declines
after age 50
Cancer and cancer Cancer
chemotherapy chemotherapeutic
agents kills healthy
cells and malignant
cells
ATDS Destruction of the
AIDS patients
helper T cells
decreases the
patient’s ability to
produce antibodies
to certain
pathogens
Drugs Steroids and
alcohol for example
Various genetic B cells and T cells
defects deficiencies for
example
 14

SPECIFIC HOST DEFENSE 1. Acquired immunity

MECHANISMS: AN INTRODUCTION TO - immunity that results from the active
IMMUNOLOGY production or receipt of antibodies
during one’s lifetime
• Immunology is the scientific study of
2. Active acquired immunity
the immune system and immune
- Antibodies are produced within the
responses.
person
• The primary functions of the immune
- Usually provides long-lasting
system are to: protection
- Differentiate between “self” and
“nonself” Two types of active acquired immunity:
- Destroy that which is “nonself” - Natural active acquired
• Cells involved in immune responses immunity—occurs naturally
originate in bone marrow; three lines of - Artificial active acquired
lymphocytes are derived from lymphoid immunity—artificially induced
stem cells of bone marrow: B
lymphocytes (B cells), T lymphocytes Natural active Immunity that is
(T cells), and natural killer cells (NK acquired immunity acquired in
cells). response to the
• There are two categories of T cells: entry of a live
pathogen into the
- Helper T cells
body (i.e., in
- Cytotoxic T cells response to an
• There are two major arms of the actual infection)
immune system: Artificial active Immunity that is
- Humoral immunity where special immunity acquired in
glycoproteins called antibodies are response to
produced by B cells to destroy vaccines
specific microbes
- Cell-mediated immunity involves a
Artificial active acquired immunity results
variety of cell types, with antibodies
when a person receives a vaccine.
playing only a minor role, if any.
- A vaccine is defined as material that
THE TWO MAJOR ARMS OF THE
can artificially induce immunity to an
IMMUNE SYSTEM
infectious disease, usually following
injection or ingestion of the vaccine.
- Most vaccines are made from living
or dead pathogens or the toxins that
they produce.
How Vaccines Work
Vaccines stimulate the recipient’s immune
system to produce protective antibodies
(i.e., antibodies that will protect the person
from disease).
IMMUNITY Types of available vaccines:
 15

Attenuated vaccines - Small antibodies, IgG, present in

mother’s blood cross the placenta to
Inactivated vaccines
reach the fetus
Subunit vaccines
Artificial passive acquired immunity
Conjugate vaccines
- Antibodies from an immune person
Toxoid vaccines are transferred to a susceptible
person (e.g., hepatitis B
CHILD RECEIVING VACCINES
immunoglobulin).
Natural passive Immunity that is
acquired immunity acquired by a fetus
when it receives
maternal
antibodies in utero
or by an infant
when it receives
maternal
antibodies
contained in
colostrum
Artificial passive Immunity that is
acquired immunity acquired when a
person receives
antibodies
contained in
antisera or gamma
globulin

HUMORAL IMMUNITY
Antigens
3. Passive acquired immunity - Foreign organic substances that are
- Antibodies are received that were large enough to stimulate the
produced by another person(s) or by production of antibodies
an animal - Substances capable of stimulating
- Usually provides only temporary antibodies are said to be antigenic
protection (or immunogenic).
- Antibodies produced in one person - A bacterial cell has many molecules
are transferred to another person to (antigenic determinants) on its
protect the latter from infection – surface that are capable of
provides temporary protection. stimulating the production of
antibodies.
Two types:
Antibodies
Natural passive acquired immunity

- Proteins produced by lymphocytes
in response to the presence of an
antigen
- Belong to a class of proteins called
immunoglobulins— globular
glycoproteins in the blood that
participate in immune reactions
Body fluids and sites where antibodies are
found
BASIC STRUCTURE OF AN ANTIBODY
• The amount and type of antibodies
produced by a given antigenic
stimulation depend on the nature of the
antigen, the site of antigenic stimulus,
the amount of antigen, and the number
16
of times the person is exposed to the
antigen.
• The majority of antigens are referred to
as T-dependent antigens because T
cells are required in their processing;
the processing of T-independent
antigens requires only B cells.
PROCESSING OF T- INDEPENDENT
ANTIGENS
MECHANISM BY WHICH T-
DEPENDENT AND T-INDEPENDENT
ANTIGENS ARE PROCESSED BY THE
IMMUNE SYSTEM

• The processing of either T-dependent
or T-independent antigens results in B
cells developing into plasma cells,
which are capable of secreting
antibodies.
• The initial immune response to an
antigen is called the primary
response; it takes 10 to 14 days for
antibodies to be produced.
• The increased production of antibodies
following the second exposure to a
particular antigen is called the
secondary response
Where do immune responses occur?
Immune responses to antigens in the blood
are usually initiated in the spleen;
responses to microbes and other antigens
in tissues are generated in lymph nodes
located near the infected area.
Antibody structure and function
Antibodies are a class of glycoproteins
called immunoglobulins; five types—IgA,
IgD, IgE, IgG, and IgM.
All antibodies are immunoglobulins,
but not all immunoglobulins are
antibodies!
STRUCTIRE OF THE DIFFERENT
CLASSES OF ANTIBODIES
Monoclonal Antibodies
17
- Long-lived, antibody-producing cells
called hybridomas are produced by
combining a single plasma cell and
a rapidly dividing tumor cell.
- Hybridomas are capable of
producing large amounts of specific
antibodies called monoclonal
antibodies.
- Monoclonal antibodies are used in
immunodiagnostic procedures (i.e.,
immunologic procedures used in
laboratories to diagnose diseases).
- Monoclonal antibodies are being
evaluated for possible use in fighting
diseases, killing tumor cells,
boosting the immune system, and
preventing organ rejection.
Antigen–Antibody Complexes
- When an antibody combines with an
antigen, an antigen–antibody
complex (or immune complex) is
formed.
- Antigen–antibody complexes are
capable of activating the
complement cascade, which results
in some of the following effects:
✓ Activation of leukocytes
✓ Lysis of bacterial cells
✓ Increased phagocytosis as a
result of opsonization
ANTIGEN-ANTIBODY INTERACTIONS
AND THEIR EFFECTS
 18

CELL-MEDIATED IMMUNITY - Delayed-type: usually takes more

than 24 hours to manifest
- Antibodies are unable to enter cells.
themselves
Cell-mediated immunity (CMI) ✓ Also known as type IV
hypersensitivity reactions.
- A complex system of interactions
among many types of cells and TYPES OF HYPERSENSITIVITY
cellular secretions (cytokines) REACTIONS
- An arm of the immune system
Immediate-type hypersensitivity
capable of controlling chronic
reactions (occur from within a few
infections by intracellular pathogens
minutes to 24 hours after contact with a
(e.g., certain bacteria, protozoa,
particular antigen)
fungi, and viruses)
✓ Examples of cells that participate Type I Anaphylactic
in CMI: macrophages, TH cells, hypersensitivity reactions (allergic
TC cells, NK cells, and reactions)
granulocytes Type II Cytotoxic reactions
Hypersensitivity (involve damage to
NK (Natural Killer) Cells reactions or death of body
- NK cells are a subpopulation of cells)
Type III Immune complex
lymphocytes called large granular
Hypersensitivity reactions (damage
lymphocytes.
Reactions to tissues and
- They resemble lymphocytes, but organs is initiated
lack typical T or B cell surface by antigen-
markers. antibody
- Do not proliferate in response to complexes)
antigen and appear not to be
involved in antigen-specific
recognition. Delayed-type hypersensitivity (DTH)
- NK cells kill target cells, including reactions (usually take 24 to 48 hours or
longer to manifest themselves)
foreign cells, host cells infected with
viruses or bacteria, and tumor cells. Type IV Also known as cell-
Hypersensitivity mediated
HYPERSENSITIVITY AND
reactions reactions,
HYPERSENSITIVITY REACTIONS
antibodies play
- Hypersensitivity refers to an overly only a minor role, if
sensitive immune system. any; an example is
a positive TB skin
Different types of hypersensitivity test
reactions:
- Immediate-type: occurs from within Type I Hypersensitivity Reactions
a few minutes to 24 hours after
contact with a particular antigen; • Type I hypersensitivity reactions are
three types: types I, II, and III also known as anaphylactic reactions;
hypersensitivity reactions they include:
- Classic allergic responses such as
hay fever symptoms, asthma, hives,
 19

and gastrointestinal symptoms that leukotrienes, prostaglandins, and other

result from food allergies potent chemical mediators
- Allergic responses to insect stings
and drugs
- Anaphylactic shock
The Allergic Response
• Type I immediate hypersensitivity is
probably the most common type of
hypersensitivity. Transmission Electron Micrograph
• People prone to allergies (atopic Showing Degranulation of a Rat Mast
persons) produce IgE antibodies when Cell
exposed to allergens (antigens that
cause allergic reactions).
• The allergic reaction results from the
presence of IgE antibodies bound to
basophils in the blood or to mast cells in
connective tissues—IgE antibodies that
were produced in response to the
person’s first exposure to the allergen. Transmission Electron Micrograph
Showing Phagocytosis of Rat Mast Cell
FACTORS IN THE DEVELOPMENT OF Granules by a Rat Eosinophil
TYPE I HYPERSENSITIVITY

• Type I hypersensitivity reactions may

EVENTS THAT OCCUR IN TYPE 1
HYPERSENSITIVITY REACTIONS
1. Mast cell sensitization first exposure
to antigen causes plasma cell to
produce specific IgE antibodies, which
attach the surface to tissue mast cell
and blood basophils
2. Binding to allergen receptor-bound
IgE molecules are cross-linked by
antigen (allergen)
3. Mast cell degranulation the sensitized
mast cell are stimulated to release
granules containing histamine,
be localized or systemic.
- Localized reactions involve mast cell
degranulation; they result in allergic
reactions, such as hay fever
symptoms, asthma, and food
allergies.
- Systemic reactions involve basophil
degranulation; they occur
throughout the body, can lead to
anaphylactic shock, and can be life-
threatening.
Systemic anaphylaxis

- Results from the release of chemical
mediators from basophils in the
bloodstream
- Occurs throughout the body—much
more serious than localized
anaphylaxis
- Common allergens involved are
drugs and insect venom.
Latex allergy
- Latex can trigger any of three types
of reactions: irritant contact
dermatitis, allergic contact
dermatitis, or immediate type
hypersensitivity.
Allergy skin testing and allergy shots
- Anaphylactic reactions can be
prevented by avoiding known
allergens, which is often difficult to
do.
- Skin tests (scratch tests) are used to
identify offending allergens in
patients.
✓ A positive test is indicated if
cutaneous anaphylaxis occurs at
the site of the scratch.
- Immunotherapy (i.e., allergy shots -
IM doses of the allergen) may be
used to treat the patient.
- IgG blocking antibodies are
produced in response to allergy
shots.
Type II Hypersensitivity Reactions
• Type II hypersensitivity reactions are
cytotoxic reactions, meaning that body
cells are destroyed during these
reactions.
Sequence of events in a type II
hypersensitivity reaction:
1. A particular drug binds to the surface
of a cell.
2. Antidrug antibodies then bind to the
drug.
20
3. Complement activation on the cell
surface is initiated.
4. The complement cascade leads to
lysis of the cell.
Type III Hypersensitivity Reactions
• Type III hypersensitivity reactions are
immune complex reactions—such as
those that occur in serum sickness and
certain autoimmune diseases (e.g.,
systemic lupus erythematosus and
rheumatoid arthritis).
• Involve IgG or IgM antibodies,
complement, and neutrophils
• Some complications of untreated or
inadequately treated strep throat and
other Streptococcus pyogenes
infections are the result of type III
hypersensitivity reactions (e.g.,
rheumatic fever and
glomerulonephritis).
Type IV Hypersensitivity Reactions
• Type IV hypersensitivity reactions are
delayed-type hypersensitivity (DTH) or
cell-mediated immune reactions, and
are part of cell-mediated immunity.
- Reactions are usually observed 24
to 48 hours or longer after exposure
or contact.
• DTH is the prime mode of defense
against intracellular bacteria and fungi.
• DTH involves a variety of cell types,
including macrophages, cytotoxic T
cells, and NK cells—antibodies do not
play a major role.
• A classic example of DTH is a positive
TB skin test.
MANTOUX SKIN TEST
 21

Autoimmune Diseases results are usually available on the

same day!
• result when a person’s immune system
• Three possible reasons for the
no longer recognizes certain body
presence of antibodies to a particular
tissues as “self” and attempts to destroy
pathogen: present infection, past
those tissues as if they were “nonself”
infection, and vaccination.
or foreign.
• A variety of different laboratory tests
• May occur with certain tissues that are
have been designed to observe the
not exposed to the immune system
presence of an antibody–antigen
during fetal development and, thus, are
reaction.
not recognized as “self.”
- Examples of these tests include
• There are more than 80 recognized
agglutination, precipitin tests,
autoimmune diseases.
immunofluorescence, and enzyme-
• Can be classified as organ-specific or linked immunosorbent assays
non-organ-specific. (ELISAs)
- Examples: Hashimoto thyroiditis, ➢ Skin Testing
Graves disease, systemic lupus - Performed in vivo
erythematosus, etc. - Antigens are injected within or
Immunosuppression beneath the skin.
- Example: the TB skin test
• Persons whose immune systems are
not functioning properly are said to be Procedures Used in the Diagnosis of
immunosuppressed. Immunodeficiency Disorders
• Acquired immunodeficiencies may be • For assessment of patient’s immune
caused by drugs (e.g., cancer status and evaluation of
therapeutic agents), irradiation, or immunodeficiency disorders
certain infectious diseases (e.g., HIV • Include B-cell deficiency states, cell-
infection).
mediated immunodeficiencies,
• Inherited immunodeficiency diseases complement deficiencies, etc.
can be the result of deficiencies in
antibody production, complement DETECTION OF ANTIGEN AND
activity, phagocytic function, or NK cell ANTIBODIES
function (e.g., DiGeorge syndrome and
Wiskott–Aldrich syndrome).
• People born lacking the ability to
produce antibodies (i.e., gamma
globulins) have agammaglobulinemia;
persons not producing a sufficient
amount of antibodies are said to have
hypogammaglobulinemia.
Immunodiagnostic Procedures
• Immunodiagnostic procedures
(IDPs) help diagnose infectious
diseases by detecting either antigens or AGGLUTINATION PROCEDURE
antibodies in clinical specimens; test
 22

AGGULATION PROCEDURE FOR ABO

BLOOD TYPING

BLOOD TYPING
 23

MAJOR INFECTIOUS DISEASES OF TYPES OF SURFACE LESIONS

HUMANS
OVERVIEW OF HUMAN INFECTIOUS
DISEASES
Pathogens cause two general categories
of diseases:
1. Microbial intoxications
2. Infectious diseases
• Infectious diseases are diseases that
are caused by pathogens following INFECTIOUS DISEASES OF THE EARS
colonization of some body site by the
• There are three pathways for
pathogen.
pathogens to enter the ear:
• Some infectious diseases affect more
1. Via the eustachian (auditory) tube,
than one anatomical site, and some
from the throat and nasopharynx
pathogens move from one body site to
2. Via the external ear canal
another during the course of a disease.
3. Via the blood or lymph
INFECTIOUS DISEASES OF THE SKIN ✓ Otitis media—infection of the
middle ear
• Students should be familiar with the
✓ Otitis externa—infection of the
following terms relating to skin and
outer ear canal
infectious diseases of the skin:
✓ Epidermis and dermis ANATOMY OF THE EAR
✓ Dermatitis
✓ Sebaceous glands
✓ Folliculitis
✓ Sty (or stye)
✓ Furuncle
✓ Carbuncle
✓ Macule
✓ Papule
✓ Pustule
✓ Vesicle
INFECTIOUS DISEASES OF THE EYES
CROSS SECTION OF THE SKIN
 24

• Important terms relating to the eye and • Students should be familiar with the
infectious diseases of the eye: following terms relating to the
- Conjunctiva respiratory system:
- Conjunctivitis ✓ Bronchitis
- Keratitis ✓ Bronchopneumonia
- Keratoconjunctivitis ✓ Epiglottitis
✓ Laryngitis
INFECTIOUS DISEASES OF THE
✓ Pharyngitis
RESPIRATORY SYSTEM
✓ Pneumonia
• Respiratory system can be divided into ✓ Sinusitis
two parts:
INFECTIOUS DISEASES OF THE ORAL
- Upper respiratory tract (URT)
REGION
paranasal sinuses, nasopharynx,
oropharynx, epiglottis, and larynx • The oral cavity is a complex ecosystem,
- Lower respiratory tract (LRT) suitable for growth of many types of
trachea, bronchial tubes, and alveoli microbes.
of the lungs • The microbiota of the mouth varies from
• Indigenous microbiota of the URT may one person to the next; consists of
cause opportunistic infections of the about 300 identified species of bacteria,
respiratory system both aerobes and anaerobes.
• LRT infections are the most common
cause of death from infectious
diseases.
ANATOMY OF THE RESPIRATORY
SYSTEM

• Students should be familiar with the

following terms relating to the oral
cavity:
✓ Dental caries
✓ Periodontal diseases
✓ Gingivitis
✓ Periodontitis
✓ Trench mouth
INFECTIOUS DISEASES OF THE
GASTROINTESTINAL (GI) TRACT
 25

- Transient and resident microbes • Terms relating to infectious diseases of

continuously enter and leave the GI the urinary tract include cystitis,
tract. nebphritis, ureteritis, urethritis,
- Most microbes are destroyed in the prostatitis, pyelonephritis.
stomach and duodenum. • The most common cause of cystitis and
• Terms relating to infectious diseases of pyelonephritis is E. coli; the most
the GI tract: colitis, diarrhea, dysentery, common cause of urethritis is
enteritis, gastritis, gastroenteritis, and Chlamydia trachomatis.
hepatitis.
• Infections of the GI Tract Having
Multiple Causes ANATOMY OF THE URINARY TRACT
- Diarrhea can have many causes
(e.g., foods, drugs, viruses, bacteria,
protozoa, or helminths).
ANATOMY OF THE
GASTROINTESTINAL TRACT

Infections of the genital tract

• Terms relating to infectious diseases of
the genital tract: bartholinitis, cervicitis,
endometritis, epididymitis, pelvic
inflammatory disease (PID), vaginitis,
vulvovaginitis.
Sexually transmitted diseases of the
genital tract

INFECTIOUS DISEASES OF THE • Sexually transmitted diseases (STDs)

GENITOURINARY (GU) SYSTEM include any of the infections transmitted
by sexual activities.
Urinary Tract Infections (UTIs)
• Sometimes include diseases of not only
• UTIs can be divided into upper UTIs the genital and urinary tracts, but other
(infections of the kidneys and ureters) areas of the body as well (e.g., skin,
and lower UTIs (infections of the mucous membranes)
bladder, urethra, and prostate).
 26

ANATOMY OF THE MALE AND • The nervous system is composed of the

FEMALE REPRODUCTIVE SYSTEM CNS (brain and spinal cord and three
membranes) and the peripheral
nervous system (nerves that branch
from the brain and spinal cord).
• There is no indigenous microbiota of the
nervous system.
• Terms relating to infectious diseases of
the CNS include encephalitis,
encephalomyelitis, meningitis,
meningo-encephalitis, and myelitis
ANATOMY OF THE CNS
INFECTIOUS DISEASE OF THE
CIRCULATORY SYSTEM
• The circulatory system consists of the
cardiovascular system (the heart and
various vessels) and the lymphatic
system (lymphatic vessels, lymphoid
tissue, and lymph).
• Terms relating to infectious diseases of
the cardiovascular system include
endocarditis, myocarditis, pericarditis.
• Blood is normally sterile.
• Terms relating to the lymphatic system
include lymphadenitis,
THE MENINGES AND RELATED
lymphadenopathy, lymphangitis.
STRUCTURES
ANATOMY OF THE HEART

INFECTIOUS DISEASES OF THE

CENTRAL NERVOUS SYSTEM
 27

INFECTIONS OF THE CNS HAVING ✓ Legionellosis

MULTIPLE CAUSES ✓ Lyme disease
✓ Marburg hemorrhagic fever
• Meningitis—inflammation of the
✓ Severe acute respiratory syndrome
meninges
(SARS)
- Many causes, including the
ingestion of poisons, ingestion or
injection of drugs, reaction to a
Examples of Reemerging Infections
vaccine or a pathogen (e.g., a virus,
a bacterium, a fungus, or a ✓ Cholera
protozoan) ✓ Dengue fever
- Three major causes of bacterial ✓ Diphtheria
meningitis: ✓ Malaria
✓ Haemophilus influenzae ✓ Rift Valley fever
✓ Neisseria meningitidis ✓ Tuberculosis
✓ Streptococcus pneumoniae ✓ Yellow fever
✓ Infections caused by MRSA and
Opportunistic Infections
other “superbugs”
• Opportunistic pathogens (opportunists)
are microbes that usually do not cause
disease, but have the potential to cause
disease under certain conditions.
Common opportunistic infections:
✓ Aspergillosis and other mold
infections
✓ Candidiasis
✓ Cytomegalovirus (CMV) and herpes
simplex infections
✓ Tuberculosis, malaria, and
toxoplasmosis
✓ Mycobacterium avium and
Pneumocystis infections
Examples of emerging infections
✓ H1N1 (swine flu)
✓ Avian influenza (bird flu)
✓ Cryptosporidiosis
✓ Hemolytic uremic syndrome and
other E. coli O157 infections
✓ Ebola hemorrhagic fever
✓ Hantavirus pulmonary syndrome
(HPS)
✓ HIV infection and AIDS
✓ Human monkeypox
✓ Lassa fever
 28

MAJOR INFECTIOIS DISEASES OF • Measles (rubeola) virus, an RNA virus

HUMANS
Monkeypox
VIRAL INFECTIONS OF HUMAN
• Monkeypox virus, a DNA virus
How Do Viruses Cause Disease?
Smallpox
• Viruses multiply within host cells.
• Two strains of variola virus (variola
• It is during their escape from those
minor and variola major), a DNA virus
cells—either by cell lysis or budding—
that the host cells are destroyed. Warts
• This cell destruction leads to most of the
• At least 70 different types of human
symptoms of a viral infection, which
papillomaviruses (HPV), DNA viruses
vary depending on the location of the
infection. VIRAL INFECTIONS OF THE EYES
NATIONAL NOTIFIABLE VIRAL Adenoviral conjunctivitis and
DISEASES keratoconjunctivitis
• caused by various types of
adenoviruses
Herpes simplex and varicella
• zoster viruses can also cause
keratoconjunctivitis.
Hemorrhagic conjunctivitis
• caused by adenoviruses and
enteroviruses
✓ People with viral infections (e.g.,
cold sores) should wash their hands
thoroughly before inserting or
removing contact lenses or
otherwise touching their eyes.
VIRAL INFECTIONS OF THE UPPER
RESPIRATORY TRACT
VIRAL INFECTIONS OF THE SKIN
The common cold (acute viral rhinitis,
Chickenpox and shingles acute coryza)
• Varicella-zoster virus (a DNA virus • Many different viruses cause colds.
which is also known as human • Rhinoviruses (more than 100
herpesvirus 3) serotypes) are the major cause in
German measles (rubella) adults.
• Other cold-causing viruses include
• Rubella virus, an RNA virus coronaviruses, parainfluenza viruses,
Measles (hard measles, rubeola) respiratory syncytial virus (RSV),

influenza viruses, adenoviruses, and
enteroviruses.
• Transmission occurs via respiratory
secretions by way of hands and fomites
or direct contact with or inhalation of
airborne droplets.
VIRAL INFECTIONS OF THE LOWER
RESPIRATORY TRACT
Acute, febrile, viral respiratory disease
• Caused by parainfluenza viruses,
respiratory syncytial virus (RSV),
adenovirus, rhinoviruses, certain
coronaviruses, coxsackieviruses, and
echoviruses; transmission occurs via
direct oral contact or by droplets.
Avian influenza (bird flu)
• Avian influenza virus type A; three
prominent subtypes – H5, H7, and H9;
bird-to-human transmission occurs via
contact with infected poultry or
contaminated surfaces.
Hantavirus pulmonary syndrome (HPS)
• Caused by at least five different
hantaviruses (Sin Nombre, Bayou,
Black Creek Canal, New York-1,
Monongahela); transmission occurs via
inhalation of aerosolized rodent feces,
urine, and saliva.
VIRAL INFECTIONS OF THE LOWER
RESPIRATORY TRACT
Influenza, flu
• Influenza viruses, types A, B, and C;
RNA viruses; transmission is via
infected humans; pigs and birds also
serve as reservoirs
Severe acute respiratory syndrome
(SARS)
• SARS-associated coronavirus (SARS-
CoV) (shown here)
29
• Transmission occurs via infected
individuals by respiratory droplets, or by
touching the mouth, nose, or eye after
touching a contaminated surface or
object.
VIRAL INFECTIONS OF ORAL REGION
Cold sores (fever blisters, herpes
labialis)
• Usually caused by herpes simplex virus
type 1 (HSV-1), but can be caused by
herpes simplex type 2 (HSV-2)
• DNA viruses in the family Herpesviridae
• Either HSV-1 or HSV-2 can also infect
the genital tract, although genital
herpes infections are most often
caused by HSV-2.
Viral gastroenteritis (viral enteritis, viral
diarrhea)
• Viral gastroenteritis (viral enteritis, viral
diarrhea)
• The most common viruses infecting
children in their first years of life are
enteric adenoviruses, astroviruses,
caliciviruses, and rotaviruses.
• Viruses infecting children and adults
include norovirus-like viruses and
rotaviruses.
• Transmission occurs via infected
humans, most often by way of the
fecal–oral route; possibly from
contaminated water and shellfish.
MOST COMMON TYPE OF VIRAL
HEPATITS
Type A hepatitis (HAV infection,
infectious hepatitis, epidemic Hepatitis)
• Hepatitis A virus (HAV)—a linear
ssRNA virus
• Fecal–oral transmission
 30

Type B hepatitis (HBV infection, serum genital, oral-anal, or anal-genital

hepatitis) contact when lesions are present.
• Hepatitis B virus (HBV)—an enveloped, Genital warts (genital papillomatosis,
circular dsDNA virus condyloma acuminatum)
• Sexual transmission or household
• Human papillomaviruses (HPV); DNA
contact with an infected person;
viruses
injected drug use; tattooing;
• Transmission occurs via infected
needlesticks
humans by direct contact, usually
Type C hepatitis (HCV infection, non-A sexual.
non-B hepatitis) • Genital warts can become malignant.
• Hepatitis C virus (HCV)—an enveloped, VIRAL INFECTIONS OF THE
linear ssRNA virus CIRCULATORY SYSTEM
• Primarily parenterally transmitted;
Human immunodeficiency virus (HIV)
rarely sexually
infection, acquired immunodeficiency
Type D hepatitis (HDV infection, delta syndrome (AIDS)
hepatitis)
• HIV—two types: HIV-1 (most common)
• Hepatitis D virus (HDV, delta virus)—an and HIV-2; ssRNA viruses
enveloped, circular ssRNA viral • Transmission occurs via infected
satellite; coinfection with HBV is humans, by direct sexual contact;
necessary contaminated needles/syringes;
• Exposure to infected blood and body transfusion of contaminated blood;
fluids, etc. transplacental transfer from mother to
child; transplantation of HIV-infected
Type E hepatitis
tissues or organs; needlestick, scalpel,
• Hepatitis E virus (HEV)—a and broken glass injuries.
nonenveloped, ssRNA virus COMMON MODES OF TRANSMISSION
• Fecal–oral transmission; primarily OF HIV
fecally contaminated drinking water;
also person-to-person
Type G hepatitis
• Hepatitis G virus (HGV)—a linear
ssRNA virus
• Parenteral transmission
VIRAL STD’s
Anogenital herpes viral infections
(genital herpes)
• Usually caused by HSV-2; occasionally
by HSV-1
• Transmission occurs via infected Infectious mononucleosis ( “mono,”
humans by direct sexual contact; oral- “kissing disease”)
 31

• Caused by Epstein–Barr virus (EBV), • Transmission is person-to-person,

which is also known as human primarily via the fecal–oral route;
herpesvirus 4; a DNA virus in the family also throat secretions.
Herpesviridae
Rabies
• Transmission occurs via infected
humans, person-to-person, direct • Caused by rabies virus; a bullet-
contact with saliva. shaped, enveloped RNA virus
• Many reservoirs, including dogs, foxes,
Mumps (infectious parotitis)
coyotes, wolves, jackals, skunks,
• Caused by mumps virus—an RNA virus raccoons, mongooses, bats
• Transmission occurs via infected • Transmission occurs via the bite of a
humans by droplet spread and direct rabid animal which introduces virus-
contact with saliva. laden saliva; airborne transmission
from bats in caves also occurs.
VIRAL HEMORRHAGIC DISEASES
(VIRAL HEMORRHAGIC FEVERS) Viral meningitis (aseptic meningitis,
abacterial meningitis)
• Caused by many different viruses,
including dengue virus, yellow fever • Caused by many different viruses
virus, Crimean-Congo hemorrhagic
SELECTED ANTHROPODBORNE
fever virus, Lassa virus, Ebola virus,
VIRAL ENCEPHALITIDES OF THE
and Marburg virus
UNITED STATES
• Ebola and Marburg viruses are
extremely large filamentous viruses.
• Infected humans serve as reservoirs;
infected African green monkeys also
serve as reservoirs in Marburg
infection.
• Transmission is person-to-person via
direct contact with infected blood,
secretions, internal organs, or semen;
also needlestick. RECAP OF SOME MAJOR VIRAL
INFECTIONS OF HUMANS
VIRAL INFECTIONS OF THE CNS
Lymphocytic choriomeningitis
• Caused by lymphocytic
choriomeningitis virus (LCMV)
• Transmission occurs via exposure to
mouse urine, droppings, saliva, or
nesting materials.
Poliomyelitis (polio, infantile paralysis)
• Caused by polioviruses—RNA
viruses MAJOR INFECTIOUS DISEASES OF
HUMANS
 32

BACTERIAL INFECTIONS OF HUMAN • Streptococcus pyogenes, a Gram +

coccus
How Do Bacteria Cause Disease?
Wound infections
• Adherence and colonization factors
• Factors that prevent activation of • Result when protective skin barrier is
complement broken as a result of burns, punctures,
• Factors that enable escape from surgical procedures, or bites
phagocytosis by white blood cells • Opportunistic indigenous microbiota
• Factors that prevent destruction within and environmental bacteria can invade
phagocytes and cause local or deep tissue
• Factors that suppress the host immune infections.
system (i.e., factors that cause • Pathogens may spread through blood
immunosuppression) or lymph, causing serious systemic
• Endotoxin (a component of the cell infections
walls of Gram-negative bacteria) DISEASES CAUSED BY
• Production of exotoxins (e.g., STPHYLOCOCCUS AUREUS
cytotoxins, enterotoxins, neurotoxins)
• Production of necrotic and other types
of destructive enzymes
BACTERIAL INFECTIONS OF THE SKIN
Acne
• Propionibacterium acnes and other
Propionibacterium spp.; anaerobic
Gram + bacilli
Anthrax, Woolsorter Disease
• Bacillus anthracis; a spore- forming,
Gram + bacillus
DISEASES CAUSED BY
Gas gangrene (myonecrosis) STREPTOCOCCUS PYOGENES
• Anaerobic bacteria in the genus
Clostridium, especially C. perfringens
Leprosy (Hansen disease)
• Mycobacterium leprae; an acid-fast
bacillus
Staphylococcal skin infections
(folliculitis, furuncles, abscesses, etc.)
• Staphylococcus aureus, a Gram +
coccus
Streptococcal skin infections (scarlet VIRAL AND BACTERIAL EAR
fever, erysipelas, etc.) INFECTIONS
 33

Otitis externa (external otitis, ear canal

infection, swimmer’s ear)
• Escherichia coli, Pseudomonas
aeruginosa, Proteus vulgaris,
Staphylococcus aureus; less commonly
caused by a fungus such as Aspergillus
Otitis media (middle ear infection)
• Bacterial causes: S. pneumoniae, a
Gram + diplococcus; Haemophilus
influenzae, a Gram - bacillus; and
Moraxella catarrhalis, a Gram –
diplococcus
• Viral causes: measles, parainfluenza,
and respiratory syncytial (RSV) viruses
(RSV)
BACTERIAL INFECTIONS OF THE
Bacterial conjunctivitis (pinkeye) UPPER RESPIRATORY TRACT
• Haemophilus influenzae biogroup Diphtheria
aegyptius and S. pneumoniae are the
• Corynebacterium diphtheriae; a
most common causes
pleomorophic, Gram + bacillus
Chlamydial conjunctivitis (inclusion • Transmission occurs via airborne
conjunctivitis, paratrachoma) droplets, direct contact, contaminated
fomites, and raw milk.
• Certain serotypes (serovars) of
Chlamydia trachomatis Streptococcal pharyngitis (strep throat)
Trachoma (chlamydia • Streptococcus pyogenes; beta-
keratoconjunctivitis) hemolytic, catalase-negative, Gram +
cocci in chains
• Certain serotypes of Chlamydia
• Transmission is human-to-human by
trachomatis
direct contact, usually hands; also via
Gonococcal conjunctivitis (gonorrheal aerosol droplets
ophthalmia neonatorum)
INFECTIONS OF THE RESPIRATORY
• Neisseria gonorrhoeae; a Gram - TRACT HAVING MULTUPLE CAUSES
diplococcus; also called gonococcus or
Pneumonia
GC
• May be caused by Gram + or Gram -
INFECTIONS CAUSED BY
bacteria, mycoplasmas, chlamydias,
HAEMOPHILUS INFLUENZAE
viruses, fungi, or protozoa
• Community-acquired bacterial
pneumonia is most frequently caused
by S. pneumoniae.
• S. pneumoniae is the most common
cause of pneumonia in the world

• Transmission, in most cases, occurs via
infected humans.
Gram-Positive Streptococcus
pneumoniae in a Gram-Stained Smear
of a Purulent Sputum. Note the
diplococci
BACTERIAL INFECTIONSOF THE
LOWER RESPIRATORY TRACT
Legionellosis (Legionnaire disease,
pontiac fever)
• Legionella pneumophila, a poorly
staining, Gram - bacillus; transmission
is via environmental water sources,
ponds, air- conditioning systems, hot
tubs, etc.
Mycoplasmal pneumonia (primary
atypical pneumonia)
• Mycoplasma pneumoniae, tiny, Gram -
bacteria, lacking cell walls;
transmission occurs via droplet
inhalation, direct contact with an
infected person, or contaminated
articles.
Tuberculosis (TB)
• Primarily Mycobacterium tuberculosis
(a slow-growing, acid- fast, Gram-
positive to Gram-variable bacillus),
occasionally other Mycobacterium spp.;
transmission occurs primarily via
infected humans (airborne droplets).
34
Whooping cough (pertussis)
• Bordetella pertussis, a small,
encapsulated, nonmotile, Gram -
coccobacillus that produces endotoxin
and exotoxins; transmission occurs via
infected humans (i.e., droplets by
coughing).
BACTERIAL INFECTIONS OF THE
ORAL CAVITY
• Terms relating to infectious diseases of
the oral cavity: dental caries,
periodontal disease, gingivitis,
periodontitis
• Acute Necrotizing Ulcerative Gingivitis
(ANUG); also known as Vincent’s
Angina and Trench Mouth
• A synergistic infection involving two or
more species of anaerobic bacteria of
the indigenous oral microbiota; most
commonly, Fusobacterium nucleatum
and Treponema vincentii
BACTERIAL INFECTIONS OF THE GI
TRACT
Bacterial gastritis and ulcers
• Helicobacter pylori, a curved,
microaerophilic, capnophilic, Gram -
bacillus
• Transmission occurs via infected
humans; probably by ingestion;
presumed to be either oral-oral or fecal-
oral.
Campylobacter enteritis
• Campylobacter jejuni (less common, C.
coli), curved, S-shaped or spiral Gram -
bacillus
• Transmission occurs via animals,
including poultry, cattle, sheep, swine,
rodents, birds, kittens, puppies, and
other pets.
Cholera
 35

• Certain biotypes of Vibrio cholerae Enterotoxigenic E. coli (ETEC) diarrhea

serogroup 01, curved, Gram- bacillus (traveler’s diarrhea)
that secretes enterotoxin
• Many different serotypes of
• Transmission occurs via infected
enterotoxigenic E. coli
humans and aquatic reservoirs; fecal-
• Transmission is via infected humans,
oral route.
fecal–oral route
Salmonellosis
URINARY TRACT INFECTIONS (UTIs)
• Salmonella spp.; members of the family
• The most common causes of UTIs are
Enterobacteriaceae, Gram - bacilli that
E. coli and other members of the family
invade intestinal cells, release
Enterobacteriaceae (especially Proteus
endotoxin, and produce cytotoxins and
and Klebsiella).
enterotoxins
• Other common causes of UTIs are
• Transmission occurs via domestic and
Enterococcus spp., Staphylococcus
wild animals; contaminated food, fecal-
spp. (especially S. aureus, S.
oral, food handlers, contaminated water
epidermidis, and S. saprophyticus), and
Typhoid fever (enteric fever) Pseudomonas aeruginosa.
• UTIs may be acquired either within a
• Salmonella typhi, a Gram - bacillus that
healthcare setting (called healthcare-
releases endotoxin and produce
associated UTIs) or elsewhere (called
exotoxins
community- acquired UTIs).
• Transmission occurs via infected
• UTIs are the most common type of
humans for typhoid and paratyphoid;
healthcare-associated infection.
some people become carriers after
infection (e.g., “Typhoid Mary”). Genital chlamydial infections (genital
chlamydiasis)
Shigellosis (bacillary dysentery)
• Certain serotypes of Chlamydia
• Shigella dysenteriae, S. flexneri, S.
trachomatis; obligate intracellular Gram
boydii, and S. sonnei; nonmotile, Gram
- bacteria
- bacilli, members of the family
• Transmission via infected humans,
Enterobacteriaceae
direct sexual contact, or mother-to-
• Transmission occurs via infected
neonate during birth
humans.
Gonorrhea
ENTEROVIRULENT ESCHERICHIA
COLI • Neisseria gonorrhoeae; a Gram -
diplococcus
Enterohemorrhagic E. coli (EHEC)
Diarrhea • Transmission via infected humans,
usually sexual contact or direct mucous
• Escherichia coli O157:H7 is most membrane-to-mucous membrane
commonly involved; others include contact
O26:H11, O111:H8, and O104:H21;
Syphilis
Gram - bacillus that produces potent
cytotoxins. • Treponema pallidum; Gram-variable,
• Transmission occurs via cattle feces; tightly-coiled spirochete; too thin to be
also infected humans, fecal-oral route.

seen by brightfield microscopy; can be
seen by darkfield microscopy
• Transmission via infected humans, by
direct contact with lesions, body
secretions, mucous membranes, blood,
semen, etc.; usually sexual contact;
also blood transfusions and
transplacentally from mother to fetus
Many Gram-Negative Bacilli (arrows)
and Many Pink-Staining PMNs Can be
Seen in This Gram-Stained Urine
Sediment From a Patient With Cystitis
Gram-Stained Urethral Exudate from a
Male Patient with Gonorrhea
OTHER BACTERIAL STDS
• Bacterial STDs that occur more
frequently in parts of the world other
than the United States:
- Chancroid—caused by
Haemophilus ducreyi; a Gram -
bacterium
36
- Granuloma inguinale—caused by
Calymmatobacterium granulomatis;
a Gram - bacterium
- Lymphogranuloma venereum—
caused by certain serotypes of
Chlamydia trachomatis
• STDs may be transmitted
simultaneously; if a patient is diagnosed
with one particular type of STD, other
types should be sought.
RICKETTSIAL AND EHRLICHIAL
DISEASES OF THE
CARDIOVASCULAR SYSTEM
Spotted fever rickettsiosis (tickborne
typhus fever)
• Rickettsia rickettsii; a Gram - bacterium;
an obligate intracellular pathogen
• Transmission occurs via infected ticks
on dogs, rodents, and other animals
Endemic typhus fever (murine typus
fever, fleaborne typhus)
• Rickettsia typhi; a Gram - bacterium; an
obligate intracellular pathogen
• Transmission occurs via rats, mice,
possibly other mammals, infected rat
fleas.
Epidemic typhus fever (louseborne
typhus)
• Rickettsia prowazekii; a Gram -
bacterium; an obligate intracellular
pathogen
• Reservoirs are infected humans and
body lice.
Erlichiosis
• Gram-negative coccobacilli, closely
related to rickettsias; obligate
intraleukocytic pathogens
• Reservoir unknown; transmission is via
tick bite
 37

OTHER BACTERIAL INFECTIONS OF

THE CARDIOVASCULAR SYSTEM
Lyme disease (Lyme borreliosis)
• Borrelia burgdorferi; a Gram -, loosely
coiled spirochete
• Transmission is via tick bite.
Plague (“black death,” bubonic plague,
pneumonic plague, septicemic plague)
• Yersinia pestis; a nonmotile, bipolar- BACTERIAL INFECTION OF THE CNS
staining, Gram coccobacillus
Listeriosis
• Transmission is via wild rodents and
their fleas (flea bite). • Listeria monocytogenes; a Gram +
coccobacillus
Tularemia (Rabbit Fever)
• Transmission occurs via ingestion of
• Francisella tularensis; a pleomophic, raw or contaminated milk, soft cheeses,
Gram - coccobacillus and vegetables.
• Transmission is via tick bite; associated Tetanus (lockjaw)
with rabbits.
• Clostridium tetani; a motile, Gram +
Bull’s Eye Rash of Lyme Disease
anaerobic, spore-forming bacillus
• Transmission occurs via spores of C.
tetani entering a puncture wound, burn,
or needlestick by contamination with
soil, dust, or feces.
Tetanus Patient Displaying the Bodily
Posture Known as Opisthotonos

Yersinia pestis (arrows)

Lesion of Tularemia
 38

HUMAN DISEASES COMMONLY

CAUSED BY ANAEROBES

MAJOR GROUPS OF MEDICALLY

IMPORTANT BACTERIA
 39

FUNGAL INFECTIONS OF HUMANS b. Tinea corporis

c. Tinea capitis
How do Fungi Cause Disease?
d. Tinea cruris
• The tissue damage associated with e. Tinea unguium
fungal infections results primarily from
direct invasion of tissue, with
subsequent displacement and
destruction of vital structures, coupled
with toxic effects of the inflammatory
response.
• Masses of fungal cells can cause
obstruction of bronchi in the lungs and
tubules and ureters in kidneys, leading
to obstruction of the flow of bodily fluids.
• Some fungi can grow in the walls of
arteries and veins, leading to occlusion
and tissue necrosis resulting from a lack
of oxygen.
FUNGAL INFECTIONS OF THE SKIN
• Fungal infections (mycoses) can be
classified into the following four
categories:
- Superficial mycoses fungal
infections of the outermost areas of
the body (outer surfaces of hair
shafts, the epidermis)
- Cutaneous, hair, and nail mycoses
(tinea or “ringworm” infections)
- Subcutaneous mycoses
- Systemic mycoses the most
serious types of fungal infections
• Dermatophytosis (Tinea [“Ringworm”]
Infections, Dermatomycosis)
- Caused by various species of
filamentous fungi, including
Microsporum, Epidermophyton, and
Trichophyton spp.
- These fungi are collectively referred
to as dermatophytes.
- Note that ringworm infections have
nothing to do with worms.
TYPES OF TINEA INFECTIONS
a. Tinea pedis
 40

SUBCUTANEOUS MYCOSES

FUNGAL INFECTIONS OF THE LOWER

RESPIRATORY TRACT FUNGAL INFECTIONS OF THE ORAL
CAVITY
• Coccidioidomycosis (Valley Fever)
Coccidioides immitis, a dimorphic Thrush
fungus; transmission occurs via
• a yeast infection of the oral cavity
inhalation of arthrospores
• Common in infants, elderly patients,
• Cryptococcosis two subspecies of
and immunosuppressed individuals
Cryptococcus neoformans, an
• White, creamy patches occur on the
encapsulated yeast; transmission
tongue, mucous membranes, and the
occurs via inhalation of yeasts
corners of the mouth
• Histoplasmosis histoplasma
• Caused by Candida albicans and
capsulatum var. capsulatum, a
related species
dimorphic fungus;transmission occurs
via inhalation of conidia from soil Oral Candidiasis (Thrush)
• Pneumocystis Pneumonia (PCP;
Interstitial Plasma-Cell Pneumonia)
- Caused by Pneumocystis jiroveci,
which has both protozoal and fungal
properties
- Was once classified as a protozoan,
but is now classified as a fungus
- Mode of transmission is unknown;
perhaps direct contact, transfer of
pulmonary secretions from infected
to susceptible persons, or perhaps Yeast Vaginitis
airborne
- Most cases are caused by the yeast,
Tissue Invasion by an Aspergillus Candida albicans
Species, the Cause of Aspergillosis - Can be diagnosed by microscopic
examination of a saline wet mount of
vaginal discharge material, in which
numerous yeasts and hyphae may
be observed
- The mere presence of yeast is not
proof of yeast vaginitis, as the
vaginal flora of up to 25% of healthy
women can contain Candida spp.
 41

Various Forms of Candida Yeasts Seen

in Clinical Specimens and Cultures

Cryptococcal Meningitis
- Can be caused by three subspecies
of Cryptococcus neoformans, an
encapsulated yeast
- Cryptococcosis starts as a lung
infection, but spreads via the
bloodstream to the brain
- Cryptococcal meningitis can be
presumptively diagnosed by
observing encapsulated, budding
yeasts in CSF specimens examined
by an India ink preparation
Gram-Stained Appearance of
Cryptococcus

Recap of Some Major Fungal Infections

of Humans

PARASITIC INFECTIONS OF HUMAN
Nationally Notifiable Parasitic Diseases
Parasitic Disease No. of new U.S
Cases Reported
to the CDC in
2010
Cryptosporidiosis 8, 944
Cyclosporiasis 179
Giardiasis 19, 811
Malaria 1, 773
Trichinellosis 7
➢ These figures provide insight
regarding how common or rare
these diseases are in the United
States. For updated information, go
to the CDC Web site; click on
“Morbidity & Mortality Weekly
Report”; then click on “Notifiable
Diseases”; then click on the most
recent year that is listed.
• Parasitology is a branch of
microbiology; it is the scientific study of
parasites.
• Parasitism is a symbiotic relationship
that is of benefit to one party or
symbiont (the parasite) and usually
detrimental to the other party (the host).
• Parasites are organisms that live on or
in other living organisms (hosts), at
whose expense they gain some
advantage.
- Parasites that live on the outside of
the host’s body are called
ectoparasites.
- Parasites that live inside the host are
called endoparasites.
• The life cycle of a parasite may involve
one or more hosts.
- If more than one host is involved, the
definitive host is the host that
harbors the adult or sexual stage of
the parasite.
42
- The host that harbors the larval or
asexual stage is the intermediate
host.
• An accidental host is one that can
serve as a host, but is not the usual host
in the parasite’s life cycle.
• A dead-end host is one in which the
parasite cannot continue its life cycle.
• A facultative parasite is an organism
that can be parasitic, but does not have
to live as a parasite; it is capable of an
independent life.
✓ Example: the free-living amoeba
Naegleria fowleri, which causes
primary amebic
meningoencephalitis
• An obligate parasite has no choice; it
must inhabit a host(s).
- Most parasites that infect humans
are obligate parasites.
HOW PARASITES CAUSE DISEASE
• The manner in which parasites cause
damage to their host varies from one
species of parasite to another, and
often depends on the number of
parasites that are present.
• Some parasites produce toxins; some
produce harmful enzymes; some
invasive and migratory parasites cause
physical damage to tissues and organs;
some cause the destruction of
individual cells; and some cause
occlusion of blood vessels and other
tubular structures.
• Sometimes, the host immune response
to the parasites causes more injury than
do the parasites themselves.
Parasitic Protozoa
• Most protozoa are unicellular.
• They are sometimes classified
taxonomically by their mode of
locomotion; amebae move by means of
pseudopodia (false feet); flagellates
 43

move by means of flagella; ciliates Toxoplasmosis

move by means of cilia; sporozoans do
• Caused by Toxoplasma gondii, an
not move.
intracellular sporozoan
• Not all protozoa are parasitic (e.g.,
• Can involve the CNS, lungs, muscles,
Paramecium spp.).
or heart, as well as the eyes
• Protozoal infections are most often
• Acquired by ingesting cysts or oocysts
diagnosed by microscopic examination
of body fluids, tissue specimens, or Protozoal Infections of the
feces—specimens are examined for Gastrointestinal Tract
motile trophozoites and dormant cyst
Disease Etiologic Mode of
stages.
agent Transmis
Protozoal Infections of the Skin sion
Leishmaniasis Amebiasis Entamoeba Humans;
• Caused by various species of histolytica fecally
flagellated protozoa in the genus contaminat
Leishmania ed food or
water
• Usually transmitted via the bite of an
infected sand fly
Balantidiasis Balantidium Pigs; food
• There are three forms of the disease:
coli or water
cutaneous, mucocutaneous, visceral. contaminat
• Cutaneous and mucocutaneous ed with pig
leishmaniasis can cause severe tissue feces
damage and disfigurement.
• Visceral leishmaniasis can lead to Cryptosporid Cryptospori Infected
death. iosis dium humans,
parvum cattle, and
Patients with Cutaneous
other
Leishmaniasis domesticat
ed animals

Cyclosporias Cyclospora Fecally

is cayetanensi contaminat
s ed water
and
produce

Protozoal Infections of the Eyes Giardiasis Giardia Humans

lamblia and
Amebic conjunctivitis and infected
keratoconjunctivitis animals
• Caused by several species of amebae
in the genus Acanthamoeba (facultative
parasites) Three Protozoal Infections of the GI
• Can lead to loss of vision or enucleation Tract
 44

Entamoeba histolytica
• Infects colon with secondary infection of
liver.
• Infected patients pass noninfectious
trophozoites as well as infectious cysts
in stools.
• Diagnosis by presence of characteristic
cysts (containing one to four nuclei) in
stools. Protozoal Infections of the
• Therapy: lodoquinol, metronidazole. Genitourinary Tract
Cryptosporidium parvum Trichomoniasis
• Infects lower small intestine. • Caused by Trichomonas vaginalis, a
• Organisms are intracellular parasites in flagellate
epithelial cells of intestinal villi. • A sexually transmitted disease of men
• Diagnosis by modified acid-fast stain of and women
stool sample. • Usually symptomatic in women and
• Therapy: Paromomycin (often not asymptomatic in men
effective). • T. vaginalis causes about 1/3 of the
Giardia lamblia cases of vaginitis in the United States.
• T. vaginalis vaginitis is usually
• Infection usually results from drinking diagnosed by observation of motile
contaminated water. trophozoites in a saline wet mount of
• Infects duodenum, with incubation time vaginal discharge material.
of about ten days.
• Acute infection shows sudden onset Trichomonas vaginalis
with foul smelling, watery diarrhea.
• Diagnosis by presence of cysts or
trophozoites in stools.
• Therapy: Metronidazole.

• trophozoites (arrows) are 7 to 23 μm

long by 5 to 15 μm wide.
• Live T. vaginalis trophozoites are
constantly in motion, as a result of the
Giardia lamblia Trophozoite flagella and an undulating membrane.

The trophozoite (10–20 μm long by 5–15

μm wide) resembles a face; the two nuclei Protozoal Infections of the Circulatory
look like eyes; it has been described as System
resembling an owl face, a clown face, and
an old man with glasses.
 45

Disease Etiologic Mode of • A stained peripheral blood smear from

agent Transmiss a patient with American
ion trypanosomiasis (Chagas disease).

African 2 different Bite of

Trypanosomi subspecie infected
asis s of tsetse fly
Trypanoso
ma brucei

American T. cruzi Reduvid

trypanosomia bug (also
sis (Chagas known as a
Disease) triatome,
kissing, or life Cycle of Malarial Parasites
cone-nosed
bug)

Babesiosis Babesia Tick bite

microti and
other
Babesia
spp.
Malaria 4 different Bite of
species of infected
Plasmodiu female
m Anopheles
mosquito
Plasmodium falciparum Trophozoites
• Peripheral blood erythrocytes infected
Trypanosoma brucei Trypomastigotes with trophozoites of Plasmodium
falciparum (arrows)
• A stained peripheral blood smear from
• Young P. falciparum trophozoites have
a patient with African trypanosomiasis
a “signet ring” appearance.

Trypanosoma cruzi Trypomastigotes

Protozoal Infections of the CNS
 46

Primary amebic meningoencephalitis Eyes Onchocerc O.

iasis volvulus
• Caused by Naegleria fowleri, an Loiasis Loa loa
ameboflagellate
• Acanthamoeba and Balamuthia spp. Respiratory Paragonim Paragoni
can cause similar conditions. system iasis mus
• Persons often become infected by westerma
swimming and/or diving in ameba- ni
contaminated water (e.g., “the old
swimming hole”). Circulatory Filariasis Wuchereri
• After the amebae colonize nasal system Schistoso a
miasis bancrofti/
tissues, they invade the brain and
Brugia
meninges by traveling along the
malayi
olfactory nerves; the disease is often Schistoso
fatal. ma spp
Helminths Central Cysticerco Taenia
nervous sis solium
• The word helminth means parasitic system Hydatid (cysts)
worm cyst Echinococ
• Helminths are multicellular, eukaryotic disease cus
organisms; two major divisions: (1) granulosis
round worms or nematodes, and (2) or E.
flatworms or platyhelminthes. The multilocula
ris
flatworms are further divided into
tapeworms (cestodes) and flukes
(trematodes).
• The helminth life cycle has three Helminth Infections of the GI Tract
stages: egg, larva, and the adult worm. ▪ Ascariasis – Ascaris lumbricoides (N)
• Helminth infections are primarily ▪ Hookworm infection – Ancylostoma
acquired by ingesting the larval stage; duodenale or Necator americanus (N)
in some helminth diseases, larvae enter ▪ Pinworm – Enterobius vermicularis (N)
by penetration of the skin. ▪ Whipworm – Trichuris trichiura (N)
Helminth Infections of Humans ▪ Strongyloidiasis – Strongyloides
stercoralis (N)
Location Helminth Cause ▪ Beef tapeworm – Taenia saginata (C)
disease ▪ Dog tapeworm – Dipylidium caninum
Skin Onchocerc Onchocer
(C)
iasis ca
▪ Dwarf tapeworm – Hymenolepis nana
volvulus
(C)
Muscle/Subcut Trichinosis Trichinella ▪ Fish tapeworm – Diphyllobothrium
aneous tissue Dracunculi spiralis latum (C)
asis Dracuncul ▪ Pork tapeworm – Taenia solium (C)
us ▪ Rat tapeworm – Hymenolepis diminuta
medinensi (C)
s
 47

▪ Fasciolopsiasis – Fasciolopsis buski

(T)
▪ Fascioliasis – Fasciola hepatica (T)
▪ Clonorchiasis – Clonorchis sinensis
(T)
Fish Tapeworm Life Cycle—An
Example of a Three-Host Life Cycle

Boy with a Swollen Abdomen Due to

Schistosomiasis

Pinworm

Medically Important Arthropods

• There ae three classes of arthropods
studied in parasitology courses:
Adult Ascaris lumbricoides Worms ✓ Insects (e.g., lice, fleas, mosquitoes)
✓ Arachnids (e.g., mites and ticks)
✓ Crustaceans (e.g., crabs, crayfish,
and certain Cyclops species)
• Arthropods serve as mechanical or
biologic vectors in the transmission of
certain infectious diseases.
✓ Mechanical vectors pick up a
parasite at point A and drop it off at
point B.
Elephantiasis of the Legs, Resulting ✓ Biological vectors harbor the
from Filariasis parasite in their body, where the
parasite matures and/or multiplies.
• Dermacentor andersoni, wood tick, one
of the tick vectors of spotted fever
rickettsiosis
 48

Ways in Which Arthropods May Be

Involved in Human Diseases
• Xenopsylla cheopis, oriental rat flea, Type of Example(s)
vector of plague and endemic typhus Involvement
The arthropod may Scabies, a disease
actually be the in which
cause of the microscopic mites
disease live in
subcutaneous
tunnels and cause
intense itching

The arthropod may Flea in the life cycle

serve as the of the dog
intermediate host tapeworm; beetle
in the life cycle of a in the life cycle of
parasite. the rat tapeworm
• Pediculus humanus, human body louse
(a vector of epidemic typhus) The arthropod may Female Anopheles
serve as the mosquito in the life
definitive host in cycle of malarial
the life cycles of a parasites
parasite

The arthropod may Oriental rat flea in

serve as a vector in the transmission of
the transmission of plague; tick in the
an infectious transmission of
disease. Rocky Mountain
spotted fever and
Lyme disease

• Phthirus pubis, the pubic or crab louse


MICROPARA LEC FINALS REVIEWER
QUIZ 1 (CHAPTER 14 – 16)
1. Which of the following virulence factors
enable(s) bacteria to attach to tissue?
a. Capsule
b. Endotoxin
c. Flagella
d. Pili
2. Neurotoxins are produced by:
a. Clostridium botulinum and
Clostridium tetani.
b. Clostridium difficile and Clostridium
perfringens.
c. Pseudomonas aeruginosa
Mycobacterium tuberculosis.
d. Staphylococcus aureus
Streptococcus pyogenes.
3. Which of the following pathogens produce
enterotoxins?
a. Bacillus cereus and certain serotypes
of Escherichia coli
b. C. difficile and C. perfringens
c. Salmonella spp. and Shigella spp.
d. all of the above
4. A bloodstream infection with __________
could result in the release of endotoxin into
the bloodstream.
a. C. difficile or C. perfringens
b. Neisseria gonorrhoeae or E. coli
c. S. aureus or M. tuberculosis
d. S. aureus or S. pyogenes
5. Communicable diseases are most easily
transmitted during the:
a. incubation period.
b. period of convalescence.
c. period of illness.
d. prodromal period.
49
6. Enterotoxins affect cells in the:
a. central nervous system.
b. gastrointestinal tract.
c. genitourinary tract.
d. respiratory tract.
7. Which of the following bacteria is least
likely to be the cause of septic shock?
a. E. coli
b. Haemophilus influenza
c. Mycoplasma pneumoniae
d. Neisseria meningitides
8. Which of the following produces both a
and cytotoxin and an enterotoxin?
a. C. botulinum
and b. C. difficile
c. C. tetani
d. Corynebacterium diphtheria
9. Which of the following virulence factors
enable(s) bacteria to avoid phagocytosis
by white blood cells?
a. capsule
b. cell membrane
c. cell wall
d. pili
10. Which of the following can cause toxic
shock syndrome?
a. C. difficile and C. perfringens
b. M. pneumoniae and M. tuberculosis
c. N. gonorrhoeae and E. coli
d. S. aureus and S. pyogenes
10. Host defense mechanisms—ways in which
the body protects itself from pathogens—
can be thought of as an army consisting of
how many lines of defense?
a. two
b. three
 50

c. four c. macrophage
d. five d. monocyte
11. Which of the following is not part of the 16. All the following would be considered an
body’s first line of defense? aspect of microbial antagonism except:
a. fever a. competition for nutrients.
b. intact skin b. competition for space.
c. mucus c. production of bacteriocins.
d. pH of the stomach contents d. production of lysozyme.
12. Each of the following is considered a part 17. Which of the following function as
of the body’s second line of defense opsonins?
except: a. antibodies
a. fever b. antigens
b. inflammation c. complement fragments
c. interferons d. both a and c
d. lysozyme. 18. Which of the following statements about
13. Which of the following is not a interferons is false?
consequence of activation of the a. Interferons are virus-specific.
complement system? b. Interferons have been used to treat
a. attraction and activation of leukocytes hepatitis C and certain types of cancer.
b. increased phagocytosis by phagocytic c. Interferons produced by a virus-
cells (opsonization) infected cell will not save that cell from
c. lysis of bacteria and other foreign cells destruction.
d. repair of damaged tissue d. Interferons produced by virus-infected
14. Each of the following is a primary purpose rabbit cells cannot be used to treat viral
of the inflammatory response except: diseases in humans.
a. to localize the infection 19. Which of the following is not one of the four
b. to neutralize any toxins being produced cardinal signs or symptoms of
at the site. inflammation?
c. to prevent the spread of microbial a. edema
invaders. b. heat
d. to stimulate the production of c. loss of function
opsonins. d. redness
15. Which of the following cells is a 20. Of the following, which is the least likely to
granulocyte? be involved in CMI?
a. eosinophil a. antibodies
b. lymphocyte b. cytokines
 51

c. macrophages d. receiving a vaccine

d. T. cells 27. Which of the following statements about
21. Antibodies are secreted by: IgM is false?
a. basophils a. IgM contains a J chain
b. macrophages b. IgM has a total of 10 antigen-binding
c. plasma cells sites
d. T. cells c. IgM is a pentamer
22. Humoral immunity involves all the following d. IgM is a long-lived molecule
except: 28. Which of the following could be an effect of
a. antibodies type III hypersensitivity?
b. antigens a. glomerulonephritis
c. NK cells b. rheumatoid arthritis
d. plasma cells c. SLE
23. Immunity that develops as a result of an d. all of the above
actual infection is called: 29. Most likely, immunology got its start in
a. artificial active acquired immunity 1890 when these scientists discovered
b. artificial passive acquired immunity antibodies while developing a diphtheria
c. natural active acquired immunity antitoxin.
d. natural passive acquired immunity. a. Edward Jenner and Louis Pasteur
24. Artificial passive acquired immunity would b. Elie Metchnikoff and Robert Koch
result from: c. Emil Behring and Kitasato
a. having the measles Shibasaburo
b. ingesting colostrum d. Jonas Salk and Albert Sabin
c. receiving a gamma globulin injection
d. receiving a vaccine
25. The vaccines that are used to protect
people from diphtheria and tetanus are:
a. antitoxins
b. attenuated vaccines
c. inactivated vaccines
d. toxoids
26. Natural passive acquired immunity would
result from:
a. having the measles
b. ingesting colostrum
c. receiving a gamma globulin injection
 52

QUIZ 2 (CHAPTER 17 – 19) d. Staphylococcus saprophyticus

7. The most common cause of urethritis is:
1. Otitis media is an inflammation or infection
a. Chlamydia trachomatis
of the:
b. E. coli
a. ear
c. Mycoplasma pneumoniae
b. eye
d. S. aureus
c. brain
8. Which of the following terms means
d. urinary bladder
swollen lymph glands?
2. Keratitis is an inflammation or infection of
a. lymphadenitis
the:
b. lymphadenopathy
a. conjunctiva
c. lymphangitis
b. cornea
d. lymphitis
c. kidney
9. Inflammation or infection of the brain is
d. skin
called:
3. Which of the following is/are the most
a. encephalitis
common cause of pharyngitis?
b. meningitis
a. Escherichia coli
c. myelitis
b. Staphylococcus aureus
d. otitis externa
c. Streptococcus pyogenes
10. Which of the following is not one of the
d. Viruses
three most common causes of bacterial
4. Which of the following is the most common
meningitis?
cause of tooth decay?
a. E. coli
a. S. aureus
b. Haemophilus influenzae
b. Streptococcus agalactiae
c. Neisseria meningitidis
c. Streptococcus mutans
d. Streptococcus pneumoniae
d. S. pyogenes
11. Which of the following is the cause of
5. An infection of the urinary bladder is known
smallpox?
as:
a. Vaccinia virus
a. cystitis
b. Varicella virus
b. pyelonephritis
c. Variola virus
c. ureteritis
d. None of the preceding choices
d. urethritis
12. Which of the following are considered to be
6. The most common cause of cystitis is:
oncogenic?
a. Candida albicans
a. Epstein–Barr virus and HPVs
b. E. coli
b. HIV and Ebola virus
c. Staphylococcus epidermidis
c. Rubella and rubeola viruses
 53

d. Variola and varicella viruses b. Measles virus

13. Laboratory diagnosis of HIV infection is c. Mumps virus
usually made by which of the following? d. Rabies virus
a. Electron microscopy 19. Which of the following viral diseases has
b. Growth of HIV in cell culture been acquired in the United States by
c. Growth of HIV in embryonated chicken handling pet prairie dogs?
eggs a. Chickenpox
d. Immunodiagnostic procedures for b. Hantavirus
the detection of antigen and c. Monkeypox
antibodies d. Smallpox
14. Which of the following is also known as 20. The disease known as severe acute
infectious hepatitis? respiratory syndrome (SARS) is caused by
a. HAV (Hepatitis A Virus) a type of:
b. HBV a. Coronavirus
c. HCV b. Herpes virus
d. HDV c. Papillomavirus
15. Mosquitoes serve as vectors in all of the d. Picornavirus
following viral diseases, except: 21. The most common STD in the United
a. Dengue fever States is caused by:
b. Hepatitis a. Candida albicans.
c. West Nile virus disease b. Chlamydia trachomatis.
d. Yellow fever c. Neisseria gonorrhoeae.
16. Which of the following viruses is/are not d. Trichomonas vaginalis.
transmitted sexually? 22. is the most common cause of pneumonia
a. Hantavirus in the world.
b. HSVs a. Chlamydophila pneumoniae
c. HIV b. Legionella pneumophila
d. Papillomaviruses c. Mycoplasma pneumoniae
17. Which of the following is a DNA virus? d. Streptococcus pneumoniae
a. HAV 23. Gas gangrene is always caused by:
b. HBV (Hepatitis B Virus) a. Bacillus anthracis.
c. HCV b. Clostridium spp.
d. HDV c. Staphylococcus aureus.
18. Which of the following is a type of herpes d. Streptococcus pyogenes.
virus? 24. The bacterial species most frequently
a. Epstein–Barr virus associated with necrotizing fasciitis is:
 54

a. Francisella tularensis 30. Which of the following associations is

b. S. aureus incorrect?
c. S. pneumoniae a. Lyme disease … tick
d. S. pyogenes b. Plague … rat flea
25. Which of the following diseases may be c. Spotted fever rickettsiosis … tick
caused by C. trachomatis? d. Typhoid fever … mosquito
a. Inclusion conjunctivitis
b. Nongonococcal urethritis (NGU)
c. Trachoma
d. All of the above
26. Which of the following organisms is the
most common cause of urethritis?
a. C. albicans
b. C. trachomatis
c. N. gonorrhoeae
d. T. vaginalis
27. Which of the following organisms is the
most common cause of cystitis?
a. C. trachomatis
b. E. coli
c. N. gonorrhoeae
d. T. vaginalis
28. Which of the following is the most common
arthropod-borne disease in the United
States?
a. Lyme disease
b. Plague
c. Spotted fever rickettsiosis (formerly,
Rocky Mountain spotted fever)
d. Tularemia
29. Which of the following diseases is not
caused by a spirochete?
a. Lyme disease
b. Plague
c. Relapsing fever
d. Syphilis
 55

QUIZ 3 (CHAPTER 20 – 21) 6. Bread moulds are most commonly

associated with which of the following
1. Which of the following diseases is caused
diseases?
by an encapsulated yeast?
a. thrush
a. Coccidioidomycosis
b. tinea versicolor
b. Cryptococcosis
c. vaginitis
c. Histoplasmosis
d. zygomycosis
d. Pneumocystis pneumonia
7. Which of the following is the fungus most
2. Which of the following diseases is not
often isolated from human clinical
caused by a dimorphic fungus?
specimens?
a. Coccidioidomycosis
a. Candida albicans
b. Cryptococcosis
b. neoformans
c. Histoplasmosis
c. Histoplasma capsulatum
d. Sporotrichosis
d. Pneumocystis jiroveci
3. Which of the following diseases is a
8. Which of the following methods is the
synonym for ringworm infection of the
quickest and most common way to
nails?
diagnose yeast vaginitis?
a. tinea barbae
a. culture
b. tinea cruris
b. India ink preparation
c. tinea nigra
c. KOH preparation
d. tinea unguium
d. saline wet mount
4. Which of the following is the most common
9. In the United States, C. albicans causes
systemic fungal disease in the United
approximately __________ of the cases of
States?
vaginitis.
a. Cryptococcosis
a. 10%
b. Coccidioidomycosis
b. 25%
c. Histoplasmosis
c. 33%
d. Pneumocystis pneumonia
d. 50%
5. One should associate the India ink
10. Tinea cruris is a ringworm infection of
preparation with diagnosis of which of the
which of these body sites?
following?
a. feet
a. Cryptococcal meningitis
b. groin area
b. thrush
c. nails
c. tinea pedis
d. palms of the hands
d. yeast vaginitis
11. Humans develop malaria after the injection
of Plasmodium __________ into the
 56

bloodstream by an infected female 16. You are visiting a friend whose parents
Anopheles mosquito when she takes a raise pigs. Which of the following diseases
blood meal. are you most likely to acquire by drinking
a. male and female gametocytes well water at their farm?
b. schizonts a. amebiasis
c. sporozoites b. balantidiasis
d. trophozoites c. cryptosporidiosis
12. These Plasmodium life cycle stages must d. giardiasis
be ingested by a female Anopheles 17. You are working on a cattle ranch. Which
mosquito for the Plasmodium life cycle to of the following diseases are you most apt
continue in the mosquito. to acquire as you perform your duties at the
a. male and female gametocytes ranch?
b. schizonts a. amebiasis
c. sporozoites b. balantidiasis
d. trophozoites c. cryptosporidiosis
13. Which of the following protozoal diseases d. giardiasis
is not transmitted via an arthropod vector? 18. Which of the following protozoal diseases
a. African trypanosomiasis are you most likely to acquire by eating a
b. American trypanosomiasis rare hamburger?
c. babesiosis a. amebiasis
d. giardiasis b. balantidiasis
14. Which of the following protozoal diseases c. giardiasis
is least likely to be transmitted via blood d. toxoplasmosis
transfusion? 19. Which of the following associations is
a. American trypanosomiasis incorrect?
b. babesiosis a. African trypanosomiasis . . . tsetse fly
c. malaria b. amebiasis . . . fecally contaminated
d. trichomoniasis water
15. Which of the following protozoal diseases c. Chagas’ disease . . . mosquito
is least likely to be transmitted via an d. toxoplasmosis . . . cats
infected food handler who fails to wash his 20. Which of the following is an example of an
or her hands after using the bathroom? infectious disease that is caused by a
a. amebiasis facultative parasite?
b. cryptosporidiosis a. African trypanosomiasis
c. giardiasis b. giardiasis
d. toxoplasmosis c. malaria
 57

d. PAM
21- 30 (Matching type)

• Dermatomycoses – Microsporum,
Epidermophyton, and Trichophyton
• Interstitial Plasma- Cell Pneumonia –
Pneumocystis jiroveci
• Meningitis – Cryptococcus neoformans
• Tinea nigra – Hortaea werneckii
• Tinea versicolor – Malassezia furfur
• Vaginitis – Candida albicans
• Thrush - Candida albicans
• Valley Fever – Coccidioides immitis
• White piedra – Trichosporon beigelii
• Black piedra – Piedraia hortae
31 – 40 (Matching type)

• Amebiasis – Entamoeba histolytica

• Gastrointestinal infection caused by
coccidial protozoan – Cryptosporidium
parvum
• Amebic ye Infections – Acanthamoeba
sp.
• Systemic Sporozoan Infection –
Toxoplasma gondii
• African sleeping sickness –
Trypanosoma brucei
• Cyclosporiasis – Cyclospora
catetanensis
• Protozoal infection of the duodenum –
Giardia lamblia
• Lyme disease – Borrelia burgdorferi
• Malaria – Plasmodium vivax
Chagas’ disease – Trypanosoma cruzi
 58

This is the inflammation of the mouth of the c. ears

trachea or “windpipe” d. oral cavity
a. epiglottitis 15. The site of the upper respiratory tract is
b. pharyngitis commonly infected by Haemophilus
c. pneumonia influenza type b.
d. bronchitis a. bronchi
10. This is defined as the inflammation of inner b. larynx
layer of the uterine wall of female patients. c. alveolar sacs
a. vaginitis d. epiglottis
b. endometritis 16. Which of the following skin lesions is
c. cervicitis commonly observed in chicken pox?
d. epididymitis a. folliculitis
11. This site of the upper respiratory tract is b. furuncle
commonly infected by Streptococcus c. papule
Pyogenes. d. pustule
a. pharynx 17. What of the following infections is
b. larynx considered as the most common type of
c. trachea urinary tract infection?
d. bronchi a. ureteritis
12. Sty is an infection commonly found in b. prostitis
________ c. cystitis
a. central nervous system d. nephritis
b. gastrointestinal tract 18. Which of the following is not an infection of
c. skin the upper respiratory tract?
d. respiratory tract a. laryngitis
13. This infection is defined as the b. pneumonia
inflammation of the membranes that c. pharyngitis
surrounds the brain and spinal cord. d. sinusitis
a. encephalitis 19. Which of the following modes of
b. myelitis transmission is commonly associated with
c. meningitis poliomyelitis?
d. meningoencephalitis a. inhalation of aerosol droplets
14. Streptococcus mutans commonly infects b. ingestion of contaminated food
which of the following anatomic site: c. through an arthropod vector
a. eyes d. direct contact with infected site
b. genitourinary tract
 59

20. Presence of Koplik’s spots is an early b. eyes

indicator of which infection: c. respiratory tract
a. measles d. genital tract
b. chickenpox 27. This viral infection can be transmitted
c. cold sore through kissing or any direct contact with
d. mumps saliva
21. Cold sores are commonly caused by? a. Monkeypox
a. Adenovirus b. St. Louis encephalitis
b. Human immunodeficiency virus c. Type E hepatitis
c. Varicella zoster virus d. Infectious mononucleosis
d. Herpex simplex virus 28. Which of the following type of organisms
22. AIDS is viral infection of __________ causes aseptic meningitis?
a. central nervous system a. protozoan
b. circulatory system b. bacteria
c. urinary tract c. fungi
d. oral region d. virus
23. Mumps is a viral infection of: 21– 25 (Matching type)
a. central nervous system
• Lyme disease – Borrelia burgdorferi
b. oral region
• Typhoid fever – Salmonella spp.
c. skin
• Hansen’s disease – Mycobacterium
d. circulatory system
leprae
24. Which of the following hepatitis viruses is
• Pink eye – Haemophilus influenza
transmitted through fecal-oral-route?
biogroup aegyptius
a. Hepatitis E virus
• Scarlet fever – Streptococcus pyogenes
b. Hepatitis A virus
26 – 30 (Matching type)
c. Hepatitis D virus
d. Hepatitis C virus • Clostridium tetani – central nervous
25. Which of the following hepatitis viruses system
needs a co-infection with Hepatitis B virus? • Yersinia pestis – cardiovascular system
a. Hepatitis D virus • Helicobacter pylori – gastrointestinal tract
b. Hepatitis A virus
• Bordetella pertussis – respiratory tract
c. Hepatitis E virus
• Haemophilus ducreyi – genital tract
d. Hepatitis C virus
26. Which of the following is not commonly
infected by Rhinovirus?
a. urinary tract