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    مُساهمة من طرف Zahraa الخميس أكتوبر 16, 2008 12:27 am

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    LFS 221/ Module 1
    Basic Concepts of Medical Bacteriology



    ý Introduction

    Medical Bacteriology: The study of disease causing bacteria.

    1) The ways by which they cause disease

    2) The ways in which they are transmitted from man to man or animal to man

    3) Methods of control & prevention, &

    4) Laboratory diagnosis

    The first three are of prime importance to all public Health Inspectors

    However, prior to the detailed study of these organisms a general understanding of the concepts of medical bacteriology is required.
    I. General characteristics of Bacteria


    Living things may be divided into two categories, what are these categories??

    Unicellular (single cells) or multicellular (Many cells) organisms.

    Those organisms which are not seen by the naked eye (mostly unicellular) are referred to as …………? microorganisms “.

    Bacteria are one type of microorganismsà Unicellular

    Living organisms also divided into: ………………. &…………………...

    Eukaryotes (those having a true nucleus with a nuclear membrane) & prokaryotes (those with no definite nucleus or nuclear membrane) Bacteria are ……….?

    So, in short, bacteria are prokaryotic, unicellular microorganisms.

    ý Classification

    Plants & animals are mainly classified on the basis of their morphology ( their form & structure) Plants: E.g. the shape of the leaf,……Animals: E.g. whether the animal lays eggs or gives birth, or whether an animal has hair or feathers

    Bacteria, in contrast to animals & plants, being unicellular, have a limited number of external structures to aid in their classification.

    Some of the characteristics which are important in the classification of bacteria are:

    *The shape of single cells, the shape of Clumps (groups of bacteria), Gram reaction, Ability to form spores, Biochemical reactions, Methods of motility

    1. Shape OF Single Cells

    Bacteria have a variety of shapes, & are of various sizes. The basic shapes include:

    ü Cocci - round cells, Bacilli ( or rods ) - cylindrical in shape, Vibrio - Curved rods ( comma shaped ) ,Spirillum - spiral shaped ( like a spring ), Lancet shaped cocci - round with pointed ends, Coccobacilli - fat rods, Filamentous

    2. Shape OF Clumps

    Bacteria divide by Binary fission

    Following division, the two cells may not completely separate. This results in many cells being attached to each other. Depending on the planes of division, these clumps may show a variety of shapes.

    a. Division in one plane results in a string of bacteria ( strepto-). If these were bacilli, they would be referred to as streptobacilli, Division in two planes results in cells found in groups of 4 usually, Division in three planes results in cubes containing mostly 8 single cells, Division in two or three planes with no organization results in sheets or clumps with no particular shape.

    3. Gram Reaction

    Simple stains are used to enhance the visibility of these m.o.

    A simple stain consists of staining with any type of stain which makes the bacteria look colored.

    Depending on the color of the stain the bacteria could be red, green, purple etc.

    ü Gram Stain

    It allows us to separate bacteria into two main types ?? Gram- positive & Gram- negative

    The method was developed by a Danish scientist by the name of Christian Gram in 1884.

    The staining procedure consists of :

    ü Preparation of a smear on a glass slide, Staining with crystal violet ,Addition of Gram’s iodine, Wash with Acetone or alcohol, Counter stain with saffranin stain

    After step (c) all bacteria are stained dark purple or black. Step (d) consists of washing the stained smear with acetone. This is the most important step in the staining procedure. Some bacteria (depending on their type of cell wall) allow the acetone to enter inside the cell & wash out the crystal violet, so then become colorless after step (d), While others will not allow theacetone towash the stain & will stay dark. Step (e) consists of staining with another stain, saffranin - a red stain So at the end of the procedure some bacteria are stained dark purple

    ( G+) & others are stained red or pink ( G- ).

    4. Ability to Form Spores

    Some bacteria are able to develop resting structures under conditions which may be unfavorable to the growth of the vegetative cell ( such as extreme dryness, heat, lack of nutrients .... etc.). These structures are developed within the bacterial cells & are called endospores ( endo refers to inside ) They are referred to more simply asà Spores

    Depending on the size & location of the spore inside the cell àdifferentiation is possible

    Examples are: Central spores, Terminal spores, Sub terminal

    Spores are smaller than vegetative cell, if larger than vegetative cell result in the cell looking like a club ( the wooden stick that a policeman carries).Spores are highly resistant to heat, dryness, radiation & lack of nutrients.

    5. BIOCHEMICAL REACTIONS

    Biochemistry: is the study of the chemistry of living things.

    Study of chemical reactions which are performed by living cells & which are usually results of presence of organic catalysts called enzymes. Not all bacteria have the same enzymes, so the presence or absence of certain enzymes is used in classifying these bacteria. Example, bacteria are able to breakdown sugars (glucose, sucrose, lactose etc.).

    To do this they need a set of enzymes.

    Two possible ways to breakdown these sugars.??

    In one of these pathways oxygen is needed à Oxidation

    & In the other, oxygen is not needed à Fermentation

    To test if an unknown bacterium is oxidative or fermentative??

    The bacteria are inoculated into a medium which contains a sugar & the tube is incubated in the absence of oxygen. If the bacterium is fermentative it will breakdown the sugar & organic acids will be produced. The medium becomes acidic (low pH) & this can be detected by the addition of an indicator which changes color at different pH. So from this simple test, we can tell an important property of this unknown bacterium this will aid in bacterial identification & classification. Many other biochemical tests can be performed on bacteria with the same ease.

    6. METHODS OF MOTILITY

    Several methods of motility are exhibited by bacteria.

    a. Flagella: The most common mode of bacterial locomotion, Hairlike structures attached to the bacteria at a variety of locations.

    Polar flagella : the flagella are located at one or both of the poles of the cell.

    There are - 3 types of polar flagellation: Monotrichous, Lophotrichous, Amphitrichous

    Peritrichous where the flagella are all around the cell.

    b. Gliding: Some bacteria demonstrate a unique mode of locomotion, The ability to move by gliding over a surface, The way this is achieved is still not understood.

    C. Axial filaments: the spirochetes, which are spiral - shaped bacteria, have a flexible cell wall. They also possess an axial filament which extends from one pole to the other. This filament contracts, thus pressing the spiral into a tight spring, then relaxes which causes the cell to move in a screw-type motion. Are all bacteria have the ability to move??Some bacteria have no means of locomotion, & are thus immotile.
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    مُساهمة من طرف Zahraa الخميس أكتوبر 16, 2008 12:31 am

    Host – Parasite Relations In Bacterial Diseases

    Medical bacteriology is concerned with the cause (etiology ), & mode ( pathogenesis ) of infection, laboratory diagnosis, & with the treatment of infections in an individual. It is also concerned with the study of diseases which affect whole communities ( epidemiology).

    Host - Parasite relations in bacterial diseases: the study of the properties of the organisms causing disease & the reaction of the body to this invasion.

    A. BASIC CONCEPTS & TERMINOLOGY

    1. Infection /Disease

    Infection: the process in which our bodies are invaded by mic.org.

    Infants at birth are relatively sterile. Soon after birth the infant breathes “ Contaminated “ air (the air around us is full of a variety of mic.org, touched by people with “ Contaminated “ hands ... etc. In a few days ( even hours ) the skin, respiratory system, & digestive tract of this infant become colonized with a variety of bacteria which later become the natural flora of the of the body ,infant is infected with a variety of bacteria. Thus, infectionà the colonization of the body with different organisms.

    Do you think that all infections result in diseases?? This does not have to result in disease. Disease, is the result of infection with a pathogenic mic.org. It is a consequence of infection by an organism which affects the basic functions of the body. Not all diseases are caused by infections

    2. Symptomless (Healthy) Carrier

    Following the recovery from some diseases (e.g. typhoid), an individual may continue on harboring the disease-causing organism in their body without any ill symptoms. Such individuals are referred to as symptomless ( or healthy ) carriers.These cases are not very frequent, but are a serious threat they will spread infections to other individuals.

    3. Pathogenicity

    The ability of an organism to cause disease A pathogenic organism is a disease- causing organism. All mic.org can be viewed as potential pathogens, given the right circumstances. our bodies have a variety of mechanisms which tend to: prevent infection of deeper tissues & function in preventing disease following infection. Examples of these are: Our protective skin layer, Phagocytic cells, Antibodies.. Etc

    Pathogenic is more properly applied to organisms which have the ability to evade (escape from) or neutralize the natural defenses,& usually cause disease soon after infection.

    4. Immunity

    The resistance of a host to a certain mic.org. 2 parts: Natural immunity & Acquired immunity

    v Natural immunity

    The properties in the host which tend to minimize inner tissue infection

    E.G : Skin, phagocytic cells, enzymes, other factors naturally found in blood etc.

    v Acquired Immunity

    A state in which specific antibodies or immune lymphocytes are present in the body.

    This state could be subdivided into 2 categories.

    Active ( acquired ) Immunity

    Results from immunizing a host with the killed ( or attenuated ) organism or its products.

    E.g.: Immunization against tetanus Following immunization you develop antibodies, if you later exposed to Clostridium tetani these will protect you from the disease.

    Active immunity is also acquired after recovery from a disease ( such as diptheria )

    Passive ( acquired ) Immunity

    When a patient is given an injection of antibodies to help him recover from a disease.

    E.g. somebody admitted to the hospital with a case of tetanus This patient is very weak due to the disease & will not survive too long if the effects of the organism causing the disease (toxin) are not stopped. The patient will not survive long enough to develop an active immunity, so he is given an injection of antibodies which help him recover.



    5. Communicability

    The case by which an infection is spread from an infected person to one who is not Disease which is highly communicable is a disease which spreads rapidly from one person to another The term is not necessarily associated with disease Non pathogenic organisms are sometimes communicable This results in infection, but not disease

    6. Epidemic / Pandemic

    Epidemic à a pathogenic organism which is highly communicable spreads through a population causing a general state of disease in a country or area.

    E.g. Cholera, typhoid, smallpox...etc. were very common until sanitary conditions & immunizations improved

    Nowadays, epidemics are quickly contained à routine immunizations &
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    مُساهمة من طرف Zahraa الخميس أكتوبر 16, 2008 12:31 am

    improvement of sanitation, Epidemics are usually associated with defined geographical areas.

    When an epidemic spreads world-wide àPandemic

    7. Incubation Period

    The period between the infection with a pathogenic organism & the appearance of the symptoms ( signs) of disease During this period the organisms which initially infected the person multiply & produce many products which cause the disease

    B. Pathogenic Properties Of Bacteria

    Soon after birth, & for the rest of our lives, we are continuously colonized by a variety of m.o. These m.o become our natural flora. They are part of every person, healthy or diseased On our skin, respiratory system & digestive system These 3 systems in our bodies are always “contaminated”. The rest of the systems & organs in the body are normally sterile ( no living m.o.) These natural flora are prevented access to the inner tissues by the skin & the respiratory & intestinal mucosa ,Our skin & intestinal mucosa, are continuously broken ( e.g. small scratches & cuts in our skin, in our mouth when we brush our teeth, in out intestines through the passage of some foods... etc. ).These bacteria can gain entrance to our inner tissues As soon as they do they have to face the phagocytic cells & other natural humoral factors which destroy them. The difference between a pathogenic organism & one which is not: Pathogenic organisms have properties & products which facilitate their invasion of our tissues, &protect them from the natural defenses of the body & cause the variety of symptoms associated with disease.What are these properties??

    These properties include the following


    1. Capsules: An extracellular layer consisting of carbohydrates or proteins, Protect pathogenic organisms from phagocytosis. Not all pathogenic bacteria have capsules

    2. Extracellular Enzymes: A variety of enzymes are produced by pathogenic bacteria which contribute to their powers of invading deeper tissues

    Can you mention an examples of these enzymes ??

    Examples

    A. Hyaluronidase - an enzyme which destroys the connective tissues

    B. Collagenase - an enzyme which breaks down muscles

    3. TOXINS: Toxins are “poisons “produced by pathogenic bacteria & account for a variety of symptoms & harmful effects.

    These are divided into: Endotoxins& Exotoxins

    A. Exotoxins: Synthesized by the bacteria & diffuse out of these cells,
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    مُساهمة من طرف Zahraa الخميس أكتوبر 16, 2008 12:32 am

    Reach their target organs or tissues, Causing the destruction associated with the disease

    The most destructive of the exotoxins are:

    *Neurotoxins à act on the nervous system

    *Enterotoxins à act on the intestine

    B. Endotoxins: Produced only by G- bacteria, they do not diffuse out of the cell, but actually are part of the C.W; they are usually released upon the death of the cell, & are less potent in their action than most exotoxins

    C. Antibacterial Defenses Of The Host

    To protect itself against microbial disease the mammalian body possesses a variety of defenses Can be divided into 2 types: Nonspecific defenses & Specific defenses

    Nonspecific Defenses à Defend the body against all microbial invasions Are innate ( we are all born with them) Specific defenses àattack only specific organisms Develop following a prior contact with the organism or its products.

    1. Non - Specific Defenses: Mechanical factors, Chemical factors, Microbial flora, Phagocytic Cells, Inflammation, Fever

    2. Specific Defenses: Antibody mediated defenses, Cell- mediated Immunity

    1. Non - Specific Defenses

    a. Mechanical factors: The outside of our body, our respiratory system & our alimentary canal are continuously exposed to the environment It is full of microbial organisms ( Air, dust, water, food... etc ) The rest of our body is normally free of all organisms ( except in case of disease) To prevent organisms on the outside from gaining entrance to the deeper tissues, we possess a skin layer which most m.o. cannot penetrate Also, in the lining of our intestines & parts of the respiratory system, we have mucous membranes which act in the same way as our skin Also, in the lining of parts of our R. system à are small hair-like cilia, which sweep out m.o. Not all of these organisms are effectively removed by the cilia They mainly act in reducing the amount of m.o. reaching the lungs.

    b. Chemical factors: Bacteria are very sensitive to a variety of environmental factors

    E.g. pH of their surrounding medium ,The natural acidity of the stomach fluids contributes significantly to the reduction of the No. of live bacteria which reach the intestines Another product made by the body is the enzyme Lysozyme Functions in breaking down peptidoglycan which is the major component of the C.W of G+ bacteria & part of the C.W of G- bacteria Present mainly in: Tears which continuously wash the eye ( the eye is also continuously exposed to the air) thus minimizing infections of the eye

    C. Microbial flora : Various parts of the body are continuously colonized by“ nonpathogenic “ bacteria These are considered the natural flora of the body Their presence is usually not harmful to the body & is rather advantageous How ?? Their presence suppresses the growth of many potentially pathogenic bacteria.

    How?? by either: Competing with them for the limited nutrients available Or By the production of substances which suppress their growth When the growth of these natural flora is interfered à such as the case when wide spectrum antibiotics are administered, What may happened ?? Some of these pathogens actually have a better chance of growing & causing disease

    d. Phagocytic Cells : The body contains a variety of cells which have the capacity to clean the body from any form of foreign particulate matter These cells achieve their duties by phagocytizing (engulfing ) these particles à Phagocytic cells 2 types of cells are recognized: Mononuclear phagocytes & Polymorphonuclear phagocytes (PMN) The difference between the two being the shape of the nucleus & a variety of physiological differences Monocytes & Macrophages ( both mononuclear )Have a nucleus which is horseshoe or bean shaped, PMNs have a nucleus with several lobes ( mostly three, but could be more) Both monocytes & PMNs are part of the WBC of the body They are normally found in the blood & at sites of inflammation due to bacterial infection of deeper tissues

    Macrophagesà function outside the circulation

    It is believed that Monocytes differentiate to become Macrophages after which they migrate outside of the blood into various organs

    Macrophages are found in the: Lung, Spleen, Liver, Bone, Skin & Lymph nodes

    All phagocytic cells à protect the body by phagocytizing & destroying any m.o. which invades the body

    Exceptions à some bacteria are not destroyed once inside the phagocyte Are nonspecific cells in that they will clear any particle that enters the body which is recognized as foreign .This particle could be: Bacterium, Dust, Or Smoke particles

    Inflammation: Inflammation results following a harmful stimulus such as: cut, burn, bruise ... etc. to any part of the body Externally, reddening & swelling of the area of the stimulus is observed. Also associated with a localized rise in temperature

    Internally, the inflammatory response consists of: dilation of surrounding blood vessels followed by an increase in vascular permeability which results in edema à accumulation of fluids which is the main cause of the swelling Finally, WBCs escape from the blood & invade the injured area .

    The process of inflammation serves to recruit phagocytic cells to the site of injury to clear it from any form of foreign material à Prevent disease

    à The response is nonspecific in that any stimulus àany injures of the tissues of the body results in the inflammatory response
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    مُساهمة من طرف Zahraa الخميس أكتوبر 16, 2008 12:33 am

    f. Fever: Most systematic infections ( infections which result in bacteremia) especially those caused by G- organisms, result in fever The rise in temperature is a result of the release of substances by PMNs following the interaction with the pyrogen ( the fever causing agent ) These substances released by PMNs have their effect on the thermoregulatory mechanism of the body .What do you think, is rising body temp. By thermoregulatory mechanism have any advantage to the body?? Fever is advantageous to the body à it limits the growth of temperature sensitive organisms such as in the case of syphilis & gonorrhea

    The advantage of fever in other diseases is questionable à To answer this question PLZ refer to any available resources.

    2. Specific Defenses

    Differ from the nonspecific responses in that: The response is developed only following exposure to: Live, Killed or Attenuated organism or its products, The response is specific in that the body will be protected against a second exposure to the same organism & only that organism, The response is not everlasting Depending on the organism which provoked the original response, the body may be protected for only a few months, years or a life-time in some cases.

    The specific responses are divided into 2 types: Those which are mediated by antibodies àHumoral responses & Those which are mediated by immune lymphocytesà Cellular responses

    A. Antibody mediated defenses (Humoral)

    Blood is divided into 2 components: Cellular portion ,Red blood cells (REC),White blood cells ( WBC) & Platelets & fluid part à Plasma

    Made up of a variety of à Salts & Proteins dissolved in water

    The proteins include: Albumin à the major component & Globulins

    The globulins are classified into 3 groups, the alpha globulins, the Beta globulins & Gamma globulins They differ in their physical & chemical nature Antibodies, which are protein molecules, belong to the G- globulins .They are also referred to as immunoglobulins. Why?

    because their concentration in the plasma rises following immunization Blood Proteins are made up of amino acids (aa) which are linked to each other in chains They may contain from a few to several hundred aa

    Protein molecule.. aa- aa- aa- aa- aa- aa- aa- aa

    An antibody molecule is made up of 4 proteins chains each 2 are identical 2of these chains à short &à Light chains, ( L- chains ) & the other 2 are about twice as long & à heavy chains ( H - chains).

    Those 4 chains are joined together by chemical bonds in a special way .Ab are produced in the body in response to an antigen, & will specifically combine with this Ag

    An antigen ( Ag):Any substance which when introduced into the body will provoke (Ab) production

    Most antigens à Proteins or Polysaccharides (carbohydrates)

    It is important that an antigen be foreign to the body of the animal into which it is injected, otherwise antibodies will not be produced against it

    E.g.: If we took serum albumin from Ahmed & inject it into Abbas

    What will happen ??No antibodies will be produced in Abbas’s body against Ahmed’s albumin because the albumins of both are similar, so it is not “ foreign” to Abbas However, if we were to inject rabbit serum albumin into Abbas What will happen ??Antibodies will be produced against this antigen.

    Antibodies are produced in the blood by specialized cells called à Plasma cells

    Each antibody molecule has 2 sites ( places) which can combine with an antigen

    One antibody can attach itself to 2 separate antigen molecules at the same time. If we have several antibody molecules & several antigen molecules reacting, the result is the formation of a “Clump” consisting of Ag & Ab .Antibodies protect the body against disease by combining with antigens in the same manner

    Several different à Actions can result from this reaction

    I. Antitoxins

    When an antigen is present ( such as an exotoxin) the antibody react with the toxin & prevent it from causing harm to the body

    ii. Bacteriolytic action

    Ab against bacteria themselves Following the reaction of the antibody with a bacterial cell, a component of the serum called “ complement “ can destroy the bacteria Complement cannot affect the bacteria except after they react with antibodies.

    iii. Agglutination & Opsonization

    Some types of bacteria are not destroyed by complement, however, after they combine with antibodies & form “clumps”à agglutination It becomes possible for phagocytic cells to engulf them & destroy them .Some bacteria which have capsules à Not phagocytized by phagocytic cells can be phagocytized à After they combine with antibodies .What do we call this process ?? Answer:This process by which antibodies make it possible for phagocytic cells to recognize & phagocytized those bacterial cells is referred to as Opsonization

    b. Cell- mediated Immunity:

    The ability of the body to develop immune lymphocytes à which can defend the body against organisms which originally caused their formation Antibodies are not effective in defending the body against all diseases Some m.o are only destroyed by immune cells

    E.g. Tuberculosis & Listeriosis

    Organisms which cause these diseases are intracellular parasites à live inside cells Following infection with such organisms macrophages phagocytized them but cannot destroy them However, when lymphocytes found in the body come in contact with these organisms à they produce substances which affect macrophages & make it possible for them to destroy the organisms they phagocytized After recovery from infection, these lymphocytes become immune & when the same organisms enters thebody again the same thing happens again, but faster & the organisms are destroyed.
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    مُساهمة من طرف majhola الخميس أكتوبر 16, 2008 2:11 am

    يعطيش ربي ألف عااااااافيه زهور
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    مُساهمة من طرف A B D السبت ديسمبر 13, 2008 6:05 am

    رحم الله امش وابوش
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    مُساهمة من طرف Zahraa الإثنين ديسمبر 15, 2008 8:55 pm

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