MEDICALLY IMPORTANT BACTERIA II

(PART 1)
UMMP STAGE 1 (2016)

Dr. Nadia Atiya

MB BCh, BAO, BMedSci (Ireland), MPATH (UM)
Clinical Specialist (Medical Microbiology)
University Malaya Medical Centre
Lecturer
Department of Medical Microbiology, Faculty of Medicine, University of Malaya
 LEARNING OBJECTIVES
At the end of the Medically Important Bacteria II (Part 1 & Part 2) lectures,
students should be able to describe the following, regarding medically important
Gram negative bacteria and spirochaetes:

 Bacterial classification & identification including microbiological characteristics

and some basic methods used for laboratory identification (microscopic and
macroscopic morphology, etc)

 Epidemiology (transmission, risk factors)

 Pathogenesis (self-reading from textbooks and will also be covered in other

lectures)

 Clinical manifestations/infections

 Prevention and infection control (will not be extensively covered in this lecture,

but slides provided for self-reading; will be covered in detail in future lectures)
BACTERIAL CELL STRUCTURE
 BACTERIAL TAXONOMY Salmonella

Bacteria are usually

named according to Salmonella enterica Salmonella bongori
the binomial
Linnean system,
which uses genus
and species only.
However, some
bacteria may have
different subspecies
and different
serogroups/ Salmonella enterica Another 5 subspecies
serotypes/serovars subspecies enterica

Other serogroups/serovars/
serotypes

Salmonella enterica subspecies enterica

serovar enteritidis

Salmonella enterica subspecies enterica

serovar typhi

SEROGROUP, SEROTYPE, SEROVAR,

SUBTYPE ARE SYNONYMOUS!
 HOW ARE BACTERIA USUALLY IDENTIFIED & CLASSIFIED?
 Nature of the bacterial cell wall

 Morphologic characteristics:

 Microscopic morphology i.e. appearance of bacteria under microscope using stains e.g. Gram stain, acid-fast
stain, spore stain, etc - bacterial cell shape (cocci, rod, coccobacilli, pleomorphic), arrangement (in pairs e.g.
diplococci, clusters, chains)

 Macroscopic/colony morphology – appearance of bacteria on culture media/agar e.g. lactose- or nonlactose-

fermenting on MacConkey agar, haemolysis on blood agar, sucrose- or nonsucrose-fermenting colonies on
TCBS agar, etc

 Atmospheric conditions required for growth – ability to grow in the presence or absence of oxygen

 Biochemical characteristics/reactions e.g. production of specific enzymes (catalase, coagulase, oxidase, etc),
requirement for specific nutrients (e.g., ability to ferment specific carbohydrates or use different compounds as a
source of carbon for growth), etc

 Motility - Motile or nonmotile

 Sensitivity to certain antibiotics

 Antigenic distinction - using antibodies to detect characteristic antigens on the bacteria

 Genotypic distinction – analysis of bacterial genetic material to distinguish bacteria by detection of specific
characteristic DNA sequences

 Type/site of clinical infection – skin, cardiovascular, respiratory (cough), gastrointestinal (diarrhoea), urinary
(dysuria/urgency) genital (vaginal/urethral discharge), central nervous system (headache, confusion) etc
 BACTERIAL CLASSIFICATION BASED ON THE NATURE OF THE BACTERIAL CELL WALL

Bacteria with rigid, Bacteria with no

Bacteria with flexible, thick-walled cells cell wall
thin-walled cells
(spirochaetes):
Borrelia species
Leptospira species Mycoplasma
Treponema pallidum

Free-living bacteria Non-free-living bacteria

(obligate intracellular
parasites):
Chlamydia species
Rickettsia species

Gram positive GRAM NEGATIVE Acid-fast

BACTERIAL CLASSIFICATION BASED ON GRAM STAIN MICROSCOPIC
MORPHOLOGY

4. View the slide under

the microscope

 Blue/purple-stained bacteria cells: Gram

positive bacteria
 Pink-stained bacteria cells: Gram
negative bacteria
 DIFFERENT SHAPES & ARRANGEMENT OF GRAM POSITIVE COCCI
BACTERIA

Gram positive cocci in “grape-like” clusters

Gram positive cocci in chains

Gram positive cocci in pairs/ Gram positive

diplococci (lancet-shaped)
Gram positive cocci in pairs or short chains
 DIFFERENT SHAPES OF GRAM POSITIVE ROD/BACILLI BACTERIA

What is this structure?

Thick Gram positive rods/bacilli with rounded/square ends
arranged in pairs or short chains

Thin Gram positive rods/bacilli Beaded Gram positive rods/bacilli

DIFFERENT SHAPES OF GRAM NEGATIVE BACTERIA

NOTE: Rod and bacillus (plural:

rods/bacilli) are synonymous

Curved, comma-shaped, S-shaped, spiral-shaped, seagull-shaped Gram negative rods/bacilli

 GRAM NEGATIVE BACTERIA
ENTEROBACTERIACEAE NONENTEROBACTERIACEAE

 Enterobacteriaceae = family of Gram negative rod/bacilli  Straight Gram negative rods/bacilli

• Acinetobacter baumanii
bacteria whom most members are part of the normal flora of
• Bacteroides fragilis (obligate
the colon and rectum* AND are aerobes but can be facultative anaerobe)
anaerobes AND are oxidase-negative • Burkhoderia pseudomallei
• Pseudomonas aeruginosa
 Straight Gram negative rods/bacilli (obligate aerobe)
• Escherichia coli*  Curved Gram negative rods/bacilli
• Proteus spp.* • Vibrio spp.
• Enterobacter spp.* • Campylobacter spp.
• Salmonella spp.  Gram negative cocci
• Shigella spp. • Acinetobacter baumanii
• Klebsiella pneumoniae* • Neisseria meningitidis
• Yersinia spp. • Neisseria gonorrhoeae
• Serratia mercascens* • Moraxella catarrhalis
 Gram negative coccobacilli
• Acinetobacter baumanii
Mnemonic: Enterobacteriaceae are • Bordetella pertussis
PESSKY Strains of bacteria • Brucella spp.
(Escherichia, Proteus, Enterobacter, • Francisella tularensis
Salmonella, Shigella, Klebsiella, • Haemophilus influenzae
Yersinia, Serratia) • Pasteurella multocida
 BACTERIA THAT CAN’T BE SEEN ON GRAM STAIN OR STAIN POORLY
WITH GRAM STAIN

Spirochaetes (Borrelia, Leptospira, Treponema)

seen on darkfield microscopy
 BACTERIAL CLASSIFICATION BASED ON MICROSCOPIC MORPHOLOGY &
ATMOSPHERIC CONDITIONS REQUIRED FOR GROWTH

MICROSCOPIC MORPHOLOGY ATMOSPHERIC CONDITIONS

REQUIRED FOR GROWTH

o Gram-positive cocci (GPC) o Obligate/strict aerobes (only grows

o Gram-positive rods/bacilli (GPR) (straight or curved)
o Gram-negative cocci (GNC)
o Gram-negative rods/bacilli (GNR/GNB)
o Gram-negative coccobacilli (GNCB)
o Spirochaetes
o Bacteria that can’t be stained with Gram
stain or stain poorly with the Gram stain
method
in the presence of oxygen)
o Microaerophiles (only grows in low
oxygen concentration)
o Facultative anaerobes (grows in the
presence or absence of oxygen)
o Obligate/strict anaerobes (only
grows in the absence of oxygen)
COMMON CULTURE MEDIA/AGAR USED TO ISOLATE &
IDENTIFY BACTERIA

Nutrient agar

Blood agar

Chocolate agar

MacConkey agar
 COLONY MORPHOLOGY ON MACCONKEY AGAR
MacConkey agar is used for the isolation of Gram negative bacteria and to differentiate lactose
fermenting from nonlactose-fermenting Gram negative bacteria.

 IMPORTANT LACTOSE-FERMENTING (pink

colonies) GRAM NEGATIVE BACTERIA:

 Escherichia coli
 Klebsiella pneumoniae
 Enterobacter species
 Serratia & Vibrio species (*late/slow
lactose-fermenter)

In addition to nutrients + vitamins for Gram negative

bacteria to grow, MacConkey agar contains:
 IMPORTANT NON-LACTOSE-FERMENTING
 Crystal violet + bile salts, which inhibit most (pale/colourless colonies) GRAM NEGATIVE
species of Gram positive bacteria BACTERIA:
 Lactose monohydrate as the fermentable source
of carbohydrate
 Neutral red is a pH indicator that turns from red
 Salmonella species
to pink at a pH < 6.8 and is colorless at pH > 6.8.  Shigella species
 Proteus mirabilis
* Bacteria that can ferment lactose will cause the pH  Acinetobacter baumanii
of the medium to↓, changing the color of neutral  Pseudomonas aeruginosa
red to pink
COMMON LABORATORY TESTS USED TO IDENTIFY
BACTERIA
 OXIDASE TEST
The oxidase test is used to identify bacteria that produce the enzyme cytochrome c oxidase.
 If a bacteria produces cytochrome c
oxidase, the enzyme will oxidise the
reagent, tetramethyl-p-phenylenediamine,
to indophenols, which appears as a purple
color end product.
 When the enzyme is not present, the
reagent remains reduced and is colourless.
 IMPORTANT OXIDASE-POSITIVE GRAM
NEGATIVE BACTERIA:
 Pseudomonas species
 Vibrio species
 Neisseria species
 Campylobacter species
 Helicobacter pylori
 Burkholderia pseudomallei
 IMPORTANT OXIDASE-NEGATIVE GRAM
NEGATIVE BACTERIA:
 Bacteria belonging to the Enterobacteriaceae
family are typically oxidase-negative (including
E. coli, K. pneumoniae, P. mirabilis, Salmonella
species, Shigella species, etc)
 Acinetobacter baumanii
 INDOLE TEST
 The indole test is used to identify Gram negative bacteria that produce indole from the amino acid,
tryptophan.

 Bacterial colony is added into a test tube containing

tryptophan broth and incubated for 24 hours.
 Kovac’s reagent is added to the broth culture and
indole is detected by the formation of a red dye.

 IMPORTANT INDOLE-POSITIVE GRAM  IMPORTANT INDOLE-NEGATIVE

NEGATIVE BACTERIA GRAM NEGATIVE BACTERIA
 Escherichia coli  Klebsiella pneumoniae
 Proteus vulgaris  Proteus mirabilis
18
 UREASE TEST
The urease test is used to identify bacteria that produce the urease enzyme.

 A media containing urea + phenol red (as the pH indicator) is used.

 If the bacteria has the urease enzyme, it will split urea in the medium to
release ammonia + carbon dioxide + water.
 The ammonia combines with carbon dioxide and water to form
ammonium carbonate which turns the medium alkaline, turning the
indicator phenol red from its original orange yellow color to bright pink.

 IMPORTANT UREASE-POSITIVE ORGANISMS

 Proteus species P
 Ureaplasma U
 Nocardia species N
 Cryptococcus species C
 Helicobacter pylori H
 Yersinia species Y
 Brucella species (B)
 MOTILITY TEST
Motility tests are used to identify motile bacteria.

Hanging drop method to test bacteria

Agar stabbing method to test bacteria motility (motility test medium) motility

 IMPORTANT MOTILE GRAM NEGATIVE

BACTERIA:
 Most Escherichia coli strains  IMPORTANT NONMOTILE GRAM
 Proteus mirabilis NEGATIVE BACTERIA
 Proteus vulgaris
 Pseudomonas aeruginosa  Acinetobacter baumanii
 Salmonella typhi and most other  Klebsiella pneumoniae
Salmonella species
 Vibrio cholerae  Shigella species
 Vibrio parahaemolyticus
NORMAL FLORA/NORMAL MICROBIOTA vs.
COLONISATION vs. CARRIER STATE
 CONCEPT OF NORMAL FLORA/MICROBIOTA

 The term “normal flora/normal microbiota/normal human microbiome” refers to the

population of bacteria and fungi that inhabit the skin and mucous membranes of the

nose, mouth, throat, small intestine, large intestine (colon), vagina, groin, perineum,

outside of the urethra of healthy normal persons i.e. they are bacteria that live inside

and on humans.

 Blood and internal organs except for the gastrointestinal tract are usually sterile i.e.

areas such as the blood, central nervous system, lower bronchi and alveoli, liver, spleen,

kidneys, and bladder are free of all but the occasional transient organism.

 Normal flora are also often referred as commensals

 ROLES OF NORMAL FLORA
 They may serve a nutritional function:
• Bacterial that is part of the intestinal tract flora produce several B vitamins and
vitamin K.
 They constitute a protective host defense mechanism:
• The nonpathogenic resident bacteria occupy attachment sites on the skin and
mucosa that can interfere with colonization by pathogenic bacteria.
• The ability of members of the normal flora to limit the growth of pathogens is
called colonisation resistance.
• If the normal flora is suppressed, pathogens may grow and cause
disease/infection
 They can cause disease in certain clinical situations:
• Although these organisms are nonpathogens in their usual anatomic location,
they can be pathogens if they enter other parts of the body, especially sterile
sites OR if the host/person is immunocompromised.
MEMBERS OF THE NORMAL FLORA & THEIR ANATOMIC
LOCATIONS
MEDICALLY IMPORTANT MEMBERS OF THE
NORMAL FLORA
NORMAL FLORA
 COLONISATION vs. NORMAL FLORA

 Colonisation refers to a person acquiring a new organism

other than those that’s typically part of the normal flora.

 After the new organism colonises a person (i.e., attaches and

grows, usually on a mucosal membrane), it may be eliminated
by our host immune defenses OR it may cause infection.

 A person colonised by a new organism can transmit that

organism to others (i.e., act as a reservoir of infection)
 CARRIER STATE vs. NORMAL FLORA vs.
COLONISATION
 The term carrier refers to a person that carries/harbors an

organism that is a potential pathogen and therefore can be a

source of infection of others.

 Carrier is most frequently used in reference to a person with an

asymptomatic infection (i.e. infection with no symptoms) OR

someone who has recovered from an infection but continues to

carry the organism and may shed it for a long period.

GRAM-NEGATIVE RODS/BACILLI
(ENTEROBACTERIACEAE)
 Escherichia coli
 Part of the normal flora of the colon, rectum,
vagina and outer urethra.

 MICROBIOLOGICAL CHARACTERISTICS
 Straight, Gram negative rods.
Straight, Gram negative rods/bacilli
 Facultative anaerobe. on Gram stain
 Lactose-fermenting, oxidase-ve, indole +ve,
motile bacteria.
 CLINICAL MANIFESTATIONS/INFECTIONS
o Gastrointestinal tract infection (diarrhoeal illness)
o Urinary tract infection
o Neonatal meningitis
o Nosocomial pneumonia
o Bloodstream infections
Dry, pink (lactose-fermenting)
o Wound infections colonies on MacConkey agar
 Escherichia coli
• E. coli are among the most frequent bacterial causes of diarrhoea and are
classified by the clinical syndrome they produce.

STRAIN SYNDROME
Enterotoxigenic E. coli (ETEC)  Major cause of traveler’s diarrhoea (watery
diarrhoea)
Enteropathogenic E. coli (EPEC)  Infantile diarrhoea (watery diarrhoea in infants)

Enteroinvasive E. coli (EIEC)  Dysentry (bloody diarrhoea)

Enteroaggregative E. coli (EAEC)
Enterohemorrhagic E. coli (EHEC)
 Persistent diarrhoea in children and patients
infected with HIV
 May also be a cause of traveler’s diarrhoea
 Haemorrhagic colitis and haemolytic uremic
syndrome (HUS)
 EHEC strains esp. those belonging to serotype
O157:H7 have been responsible for large
outbreaks of bloody diarrhoea some associated
with HUS.
 Escherichia coli

 EPIDEMIOLOGY

o Transmission

 E. coli can spread via ingestion of contaminated food (food-borne),

via person-to-person contact, contact with animals, or contact with

environments or fomites contaminated with faecal material.

 Fomites: Any nonliving object capable of acting as a vehicle that can carry infectious organisms
and transfer them from one person to another.
 Escherichia coli
 PREVENTION & INFECTION CONTROL
 Enterotoxigenic E. coli (ETEC) - prudent selection of food and drink while
traveling e.g.eating only food that has been thoroughly cooked and served hot,
drink only bottled beverages, etc

 Enterohemorrhagic E. coli (EHEC) - eat only properly cooked food, hospitalised

patients who are infected should be place on infection control measures (standard
and *contact precautions) to prevent person-to-person transmission.

 Multidrug-resistant E. coli (i.e. E. coli strains that are resistant to multiple

antibiotics) - hospitalised patients who are colonised or infected should be place
on infection control measures (standard and *contact precautions) to prevent
person-to-person transmission

*Contact precautions: infection control measures that include placing the colonised/infected patient
in a private room, washing hands before and after touching the patient, etc
 Klebsiella pneumoniae
 Klebsiella species are part of the normal flora of the
colon, rectum, vagina and outer urethra.

 MICROBIOLOGICAL CHARACTERISTICS
Straight Gram negative rods/bacilli on
 Straight, Gram negative rods Gram stain

 Facultative anaerobe

 Lactose-fermenting, oxidase -ve, indole –ve,

nonmotile bacteria.

 CLINICAL MANIFESTATIONS/INFECTIONS

o Primarily a hospital-acquired/nosocomial pathogen.

o Most commonly causes pneumonia, urinary tract

Pink (lactose-fermenting),
infections, bacteraemia/bloodstream infections. wet/mucoid colonies on
MacConkey agar
 Klebsiella pneumoniae
 EPIDEMIOLOGY

o Transmission

 Person-person transmission, especially in the hospital setting.

o Risk factors

 Hospitalised patients

Patients with impaired host immune defenses (e.g. diabetes mellitus,

cancer, etc)
 PREVENTION & INFECTION CONTROL

 Hospitalised patients who are colonised or infected with multidrug-

resistant Klebsiella pneumoniae (i.e. strains that are resistant to
multiple antibiotics) should be place on infection control measures
(standard and contact precautions) to prevent person-to-person
transmission.
COLONY MORPHOLOGY OF ESCHERICHIA COLI vs KLEBSIELLA
PNEUMONIAE

Escherichia coli “dry” lactose-fermenting colonies Klebsiella pneumoniae “mucoid/wet” lactose-

on MacConkey agar fermenting colonies on MacConkey agar
Proteus species
 Proteus species are part of the normal flora of the
colon, rectum, vagina and outer urethra.
 Also widespread in the environment, including in
animals, soil, and polluted water.
Straight, Gram negative rods/bacilli on Gram stain
 MICROBIOLOGICAL CHARACTERISTICS
 Straight, Gram negative rods
 Facultative anaerobe
 Nonlactose-fermenting, oxidase -ve, urease +ve,
motile bacteria.
 Proteus mirabilis (indole –ve) causes majority
(90%) of Proteus infections.
 Proteus vulgaris (indole +ve)
Colourless (nonlactose-fermenting) colonies
 CLINICAL MANIFESTATIONS/INFECTIONS
on MacConkey agar
 Most commonly causes urinary tract infections.
 May also cause wound infections, bacteraemia,
and hospital-acquired/nosocomial pneumonia.

Proteus species produces swarming

Proteus spp. has many flagella per organism causing it to swarm motility on blood agar
 Proteus species
 MODES OF TRANSMISSION
 Proteus spp. are part of the normal flora of the large intestine/colon and
can cause infection upon leaving this location.
 May also be transmitted from person to person through direct contact or
indirect contact e.g. via fomites OR through contaminated catheters
(particularly urinary catheters).
 However, the exact mode of transmission has not been identified.
 PREVENTION & INFECTION CONTROL
 Hospitalised patients who are colonised or infected with multidrug-
resistant Proteus spp. (i.e. strains that are resistant to multiple antibiotics)
should be place on infection control measures (standard and contact
precautions) to prevent person-to-person transmission.
 Salmonella species
 MICROBIOLOGICAL CHARACTERISTICS
 Straight, Gram negative rods
 Facultative anaerobes
 Nonlactose fermenting, oxidase –ve, mainly motile
bacteria
 CLINICAL INFECTIONS/MANIFESTATIONS
o Gastroenteritis
Straight, Gram negative rods on Gram
• Nausea, vomiting, fever, diarrhoea, and cramping stain
• Clinically indistinguishable from gastroenteritis
caused by many other pathogens.

• May be clinically mild or even asymptomatic.

o Enteric fever (typhoid fever and paratyphoid fever) -
systemic illness with fever and abdominal symptoms.

o Bacteraemia and endovascular infection

o Focal metastatic infections (such as osteomyelitis or
abscess)
o An asymptomatic chronic carrier state Colourless (nonlactose-fermenting) colonies
on MacConkey agar
 Salmonella

Salmonella enterica
Salmonella bongori

Salmonella enterica Another 5 subspecies

subspecies enterica

Nontyphoidal
Salmonella
species Other
serogroups/serovars/
serotypes
Typhoidal Salmonella species
e.g. Salmonella enterica
subspecies enterica serovar
Enteritidis, Salmonella enterica
subspecies enterica serovar e.g. Salmonella enterica subspecies
Typhimurium, etc enterica serotype Typhi, Salmonella
enterica subspecies enterica serotype
Paratyphi A, etc
 Salmonella spp.
 NONTYPHOIDAL SALMONELLA SPECIES

 Salmonella enteritidis and Salmonella typhimurium are frequently isolated

serotypes.

 Common causes of foodborne gastroenteritis worldwide.

 CLINICAL MANIFESTATIONS/INFECTIONS

 Gastroenteritis (nausea, vomiting, fever, diarrhoea, and cramping).

 EPIDEMIOLOGY

o Mode of transmission

 Consumption of contaminated food sources (beef, poultry, and eggs).

o Risk factors

Most infections occur in otherwise healthy individuals.

However, a variety of host defense alterations result in ↑ susceptibility to
infection (e.g. impaired cellular immunity due to AIDS, etc)
 Salmonella spp.
 TYPHOIDAL SALMONELLA SPECIES
 Salmonella typhi causes typhoid fever.
Typhoid fever “rose spots” –
 S. paratyphi A,B, or C causes paratyphoid fever. salmon-coloured skin lesions

 The term "enteric fever" is a collective term that refers to both typhoid
and paratyphoid fever.

 CLINICAL MANIFESTATIONS/INFECTIONS
 Severe systemic illness with fever, abdominal pain, rose spots,
hepatosplenomegaly, etc
 Chronic Salmonella carriage (asymptomatic chronic carrier state)
 MODES OF TRANSMISSION
 Consumption of contaminated food and water.
 Contact with an acutely infected individual or a chronic carrier.
 Salmonella spp.
 PREVENTION
o Nontyphoidal salmonella
 Adherence to good hand hygiene i.e. washing hands after going to
the bathroom and before cooking and preparing and cooking food.
 Paying attention to food safety i.e. only consuming properly cooked food
and properly washed fruits and vegetables and avoiding consumption of
unpasteurised milk.

o Typhoidal salmonella
 For travelers to regions where sanitation and personal hygiene may be poor:
o Behavioural precautions (proper hand-washing prior to eating or handling
food, consuming completely cooked food that is still hot, drinking only
bottled/boiled water, etc)

 Vaccination
GRAM-NEGATIVE RODS/BACILLI
(NON-ENTEROBACTERIACEAE)
 Vibrio species
 Vibrio spp. exists as free-living bacteria in marine
environments (sea).
 Vibrio cholerae and Vibrio parahaemolyticus are
the most common causes of Vibrio infections.
 MICROBIOLOGICAL CHARACTERISTICS
 Curved, comma-shaped Gram negative
rods/bacilli Curved, comma-shaped Gram negative
 Facultative anaerobes rods/bacilli on Gram stain

 Generally considered nonlactose-fermenting

but can be late/slow lactose-fermenters.
 Oxidase +ve, motile bacteria
 Vibrio cholerae
 CLINICAL MANIFESTATIONS
 Aetiological/causative agent of cholera, Curved, Gram negative rods/bacilli
on Gram stain
which is a gastroenteritis (diarrhoeal illness)
that typically produces “rice water” stool.
 However, most infections are asymptomatic.
 For those who are symptomatic, disease
can be mild to severe.
 TRANSMISSION Yellow (sucrose-fermenting) colonies on
TCBS agar
 Consumption of contaminated food
and water (foodborne disease).

“Rice water” stools

 Vibrio parahaemolyticus
 CLINICAL MANIFESTATIONS
o Gastroenteritis (diarrhoea, abdominal
cramps, nausea, vomiting, and fever)

o Wound infections

 TRANSMISSION

o Gastroenteritis: Consumption of
contaminated food (especially seafood).
o Wound infections: Most often associated with
marine recreational activities (swimming, etc)
Green (nonsucrose-fermenting)
colonies on TCBS agar
 Vibrio species
 PREVENTION

 Avoiding consumption of raw or undercooked shellfish.

 Minimise mishandling of fish and shellfish and to avoid cross-

contamination of cooked foods by raw seafood.

TO BE CONTINUED IN MEDICALLY IMPORTANT
BACTERIA II (Part 2) LECTURE ON 28TH DEC
Any questions, email me at
nadia.atiya@ummc.edu.my

THANK YOU