MODULE MI.2014.Studentfile

MICROBIAL INFECTIONS
MODULE
MICROBIOLOGY
Contributors Modul :
Prof.Dr.dr. Noorhamdani AS, DMM., Sp.MK(K)
Prof.Dr.dr. Sanarto Santoso, DTM&H., Sp.MK(K)
dr.Roekistiningsih, MS, Sp.MK(K)
Dr.dra. Sri Winarsih, Apt., M.Si.
dr. Dewi Santosaningsih, M.Kes
Tutors :
Prof.Dr.dr. Noorhamdani AS, DMM., Sp.MK(K)
Prof.Dr.dr. Sanarto Santoso, DTM&H., Sp.MK(K)
dr.Roekistiningsih, MS, Sp.MK(K)
Dr.dra. Sri Winarsih, Apt., M.Si.
Dr.dr. Dwi Yuni Nur Hidayati, M.Kes
FOR STUDENT
LABORATORY OF MICROBIOLOGY
MEDICAL FACULTY
BRAWIJAYA UNIVERSITY
2014
MODULE 1
Sub-module :
Gram Positive & Negative Cocci Infections
FOR STUDENT
MEDICAL FACULTY
2014
Students Work Book : Microbial Infection (2014)
Page 2
Gram Positive & Gram Negative Cocci Infections

(Staphylococcus, Streptococcus, Neisseria)
Overview
Gram-positive cocci especially Staphylococcus are living and reproducing on
almost every square inch of our skin. They are members of every humans microbiota,
and usually unnoticed. However, they can be pathogen, causing minor to life-threatening
diseases.
Reseachers differentiate species of Streptococci using several different
overlapping schemes, including serological based on the reactions of antibodies to
specific bacterial antigens, type of hemolysis (,, or -hemolysis), cell arrangement,
and physiological properties as revealed by biochemical tests.
Neisseria is the only genus of Gram negative cocci that cause diseases in
humans. The cells of these bacteria are nonmotile and typically arranged as diplococci
(pairs) with their common sides flattened like coffee beans.
Staphylococcus:
S. aureus and S. epidermidis are found on the skin and in upper respiratory,
gastrointestinal, and urogenital tracts. S. aureus is the more virulent, partly
because of its production of various enzymes such as coagulase and
staphylokinase, and several toxins.
Food poisoning is a noninvasive disease caused by Staphylococcus. Skin
diseases caused by this bacteria include scalded skin syndrome, impetigo,
folliculitis, furuncles, and carbuncles.
Potentially fatal systemic infections caused by Staphylococcus include toxic
shock syndrome (TSS), bacteremia, endocarditis, pneumonia, empyema, and
osteomyelitis.
Streptococcus
Cells of group A streptococcus (S. pyogenes) produce protein M and
hyaluronic acid capsule, each of which contributes to the virulence of the
species. Enzymes and toxins produced by S. pyogenes dissolve blood clots,
stimulate fever, and lyse blood cells.
The diseases caused by S. pyogenes include streptococcal sore throat,
scarlet fever, pyoderma, erysipelas, streptococcal TSS, necrotizing fasciitis,
rheumatic fever, and glomerulonephritis.
Group B streptococci (S. agalactiae) are normal flora of lower gastrointestinal
and urogenital tracts. They are associated with neonatal infections and
usually are sensitive to penicillin.
The viridans group of -hemolytic streptococci include members that inhabit
mouth, pharynx, GI tract, UG tract; cause dental caries, and can enter the
blood and cause bacteremia, meningitis, and endocarditis.
Page 3
Virulent strains of S. pneumoniae are protected by polysaccharide capsules.

The bacteria secrete protein adhesion, secretory IgA protease and
pneumolysin which lyses cells of the lungs. Pneumonia is the most prevalent
disease caused by S. pneumoniae. Symptoms are fever, breathing difficulty,
chest pain and rusty-colored sputum. The bacteria can be identified by the
production of hemolysin, inhibition of growth by optochin, bile salt solubility,
and serological reaction (quelling). Other diseases include sinusitis, otitis
media, bacteremia, endocarditis, and meningitis.
Enterococci are normal flora of the intestines that can cause nosocomial
infections.
Neisseria
Neisseria is a pathogenic Gram negative coccus; its virulence results from
the presence of fimbriae, polysaccharide capsules, and lipooligosaccharide
containing lipid A in its cell wall.
Neisseria gonorrhoeae causes gonorrhea, a sexually transmitted disease
(STD) of humans. In men it results in acute inflammation of the urethra,
whereas in women it is generally asymptomatic. It can infect the uterus and
uterine tubes to cause pelvic inflammatory disease (PID).
Neisseria meningitidis causes a type of meningitis; it is transmitted on respiratory
droplets and is life-threatening when it enters the bloodstream or central nervous
system.
Learning Objective
Contrast the virulence of Staphylococcus aureus with S epidermidis in humans.

Discuss the structural and enzymatic features and toxins of Staphylococcus that
enable it to be pathogenic
Describe the symptoms and prevention of staphylococcal food poisoning
List and describe pyogenic lesions caused by S. aureus
Discuss systemic and potentially fatal diseases caused by Staphylococcus
Describe the classification of streptococcal strains
Describe diseases caused by Streptococcus pyogenes
Describe structures in S. pyogenes that enable this microbe to survive the bodys
defense
Identify enzymes and toxins that facilitate the spread of S. pyogenes in the body
Identify the conditions under which group A Streptococci cause disease
Contrast the structure of group A and group B Streptococcus
Describe how the structure of Streptotococcus pneumoniae affects its pathogenicity
List some structural features of Neisseria that contribute to its pathogenicity
Compare and contrast the symptoms of gonorrhea in men and women
Discuss the difficulties in developing an effective vaccine against N. gonorrhoeae
Page 4
Describe how meningococci survive in humans

Discuss the epidemiology of meningococcal infection
Task:
1. Describe the morphology and cultural characteristics of Staphylococcus spp.
2. Explain extracellular products and toxins produced by Staphylococcus aureus
and its contributions the mechanisms of pathogenicity!
food poisoning
3. Explain why Staphylococcus epidermidis is rarely pathogenic while S. aureus is
more commonly virulent!
4. Describe the clinical manifestation of staphylococcal infection.
5. Explain the laboratory diagnosis of staphylococcal infections.
6. Explain the classification of Streptocoocus.
7. Describe the antigenic structure, toxins and enzymes of Streptococcus that might
play big roles in the mechanisms of pathogenicity..
8. Explain the cultural characteristics of Streptococci.
9. Mention the streptococci of medical importance and diseases they cause.
,
10. Describe the possible cause of rheumatic fever. How is it prevented?
11. Describe the laboratory diagnosis of streptococcal infections.
test: ASO titer
12. Discuss reasons for the increased incidence of pneumonias during cold and rainy
weather.
13. What are the predisposing factors of pneumococcal pneumonia?
14. Mention the drug of choice for gram-positive cocci infection and the alternative
drugs if resistance occur.
15. Explain the morphology and cultural characteristics of Neisseria.
16. Modified Thayer Martin medium was developed to increase the recovery of
Neisseria gonorrhoeae from genital tract specimens. The ingredients that make
this medium selective are: .
Page 5
17. Explain the pathogenesis mechanisms of gonococcal infection and its

complications. In men and women, why is it different?
18. How do you differentiate between Neisseria meningitidis and N. gonorrhoeae in
bacterial identification?
: glucose+), maltose (-)
Reference:
1. Brooks GF, JS Butel, SA Morse: Jawetz, Melnick, & Adelbergs Medical
Microbiology, 23rd edition; chapter 14,15 & 21, 2004
2. Tortora GJ, BR Funke, CL Case: Microbiology An Introduction, 7th edition,
chapter 13. 2001
3. Mims C, HM Dockrell, RV Goering, I Roitt, D Wakelin, M Zuckerman: Medical
Microbiology, 3rd edition; chapter 24 & 28, 2004
Template presentation:
Classification
Morphology and cultural characteristics
Bacterial metabolites and antigenic structure
Pathogenesis
Clinical manifestations
Laboratory diagnosis
Treatment
Prevention
Page 6
MODULE 2
Sub-module :
Gram Positive Rods Infections
FOR STUDENT
MEDICAL FACULTY
2014
Page 7
Gram Positive Rods Infections

(Bacillus, Clostridium, Corynebacterium)
Overview
Scientists divide Gram-positive bacilli (rod-shaped cells) into sporeforming and
non-sporeforming genera. The sporeforming bacteria are Bacillus and Clostridium.
These bacteria are ubiquitous, and because they form spores they can survive in the
environment for many years. The Clostridia consist of many species; they can cause
several diseases, such as tetanus, gas gangrene, cellulitis, botulism, diarrhea and
others. The genus Bacillus includes many species of aerobic and facultative anaerobic
bacteria. Bacillus anthracis causes the zoonotic anthrax, a disease of animals that is
occasionally transmitted to humans, whereas Bacillus cereus can cause food poisoning.
Corynebacterium is pleiomorphic, non-sporeforming bacteria that are ubiquitous in
plants, animals, and humans. They possess storage granules called metachromatic
granules,and an unique side-by-side palisade arrangement. C. diphtheriae is the most
important member of the group, as it can produce powerful exotoxin that causes
diphtheria in humans.
Bacillus anthracis secrete anthrax toxin, which can cause three forms of anthrax:
gastrointestinal anthrax (rare but fatal, with intestinal hemorrhage), cutaneous
anthrax, and inhalation anthrax (often fatal)
Clostridium tetani is ubiquitous bacteria that enter the body by a break in the skin
and cause tetanus. Immunization is effective in preventing this disease.
Clostridium perfringens produce toxins that lyse blood cells and tissues, and cause
gas gangrene and food poisoning.
Clostridium difficile is an intestinal bacteria that can cause explosive diarrhea or
pseudomembranous colitis.
Clostridium botulinum can release a very poisonous toxin in improperly canned food.
Lysogenic Corynebacterium diphtheriae, transmitted via respiratory droplets,
contains bacteriophage that codes for diphtheria exotoxin, which cause the
symptoms of potentially fatal diphtheria. The bacteria can colonize the pharynx
(especially tonsilar regions), the larynx, nose, genital organ, and skin. Its exotoxin
inhibits protein synthesis; heart, kidney, and nerve damage may result. The toxin
destroys epithelial cells and PMNs, form an ulcer covered with necrotic exudates,
forming pseudomembrane. There is much local inflammation and swelling and the
cervical lymphnodes may enlarged to give bull-neck appearance. Diagnosis of this
toxigenic type based on isolation of the bacteria, the appearance of growth on
differential media, and immunoassay test called Elek test. Antitoxin (ADS) must be
administered to neutralize the toxin, and antimicrobial drugs can stop bacterial
growth. The infection is reduced due to widespread immunization with toxoid
vaccine. Compulsory vaccination includes diphtheria in DPT vaccine.
Listeria monocytogenes is rarely pathogenic but can cause severe disease in
pregnant women, newborns, the elderly, and immunocompromised patients. This
bacteria is a small Gram positive rod with some bacteriologic features that resemble
Page 8
those of Corynebacteria. In culture on blood agar, it grow as a smooth colonies

surrounded by a narrow zone of -hemolysis. The most common human infections
are meningitis, bacteremia, neonatal and puerperal infections associated with vaginal
colonization by Listeria. Intra uterine infection results in clinical syndrome of
granuloma infantiseptica.
Learning Objective
Identify the structural features of Bacillus that contribute to its pathogenicity

List methods of anthrax transmission
Characterize the major pathogenic species of Clostridium
Identify the mechanisms accounting the pathogenesis of Clostridium perfringens
infection
Discuss the role of antimicrobial drugs in the development if gastrointestinal diseases
caused by Clostridium difficile
Describe the manifestations of botulism
Describe the mechanisms of pathogenicity of tetanus
Characterize the arrangement of Corynebacterium cells and the special staining
used
Describe the media for culture Corynebacterium diphtheriae
Describe the transmission of Corynebacterium diphtheriae
Discuss the effect of diphtheria exotoxin
Discuss the diagnosis, treatment, and prevention of diphtheria
Describe the characteristics of Listeria monocytogenes
Describe the pathogenicity of Listeria monocytogenes
Describe the clinical manifestations, epidemiology, and prevention of listeriosis
Task
1.
2.
3.
4.
5.
6.
7.
8.
9.
List the characteristics of Clostridium tetani (morphology and culture).

Why is oxygen toxic for Clostridia?
Explain the hemolysis type of Clostridium perfringens, and stormy fermentation.
Explain the action of tetanus toxin.
What is the virulence factor of C. perfringens, C. botulinum, and C, difficile.
Mention the clinical manifestations of diseases caused by Clostridia.
What is the specific treatment for clostridial infections?
Explain the prevention of clostridial infections.
Mention and explain the procedure of metachromatic staining, and draw the
morphology of Corynebacterium diphtheriae.
10. What is Elek test, and explain its purpose.
Page 9
11. Explain the Schick test, the procedure, and purpose.

12. Explain the clinical manifestations of diphtheria, which of these is life-threatening
and why is it life-threatening?
13. Mention the treatment and prevention of diphtheria.
14. What are the specimens for the laboratory diagnosis of diphtheria, and explain
the laboratory diagnosis of diphtheria.
15. List the morphology and characteristics of Listeria monocytogenes culture.
16. Mention the clinical manifestations of listeriosis.
17. List antimicrobial drugs that used for listeriosis.
18. Describe the morphology and characteristics of Bacillus anthracis.
19. Explain the mechanisms of pathogenesis of anthrax.
Reference
Microbiology, 23rd edition; chapter 12 & 13, 2004
chapter 22, 24, & 25, 2001
3. Mims C, HM Dockrell, Rv Goering, I Roitt, D Wakelin, M Zuckerman: Medical
Microbiology, 3rd edition; chapter 23, 26, & 28, 2004
Template presentation
Classification
Pathogenesis
Treatment
Prevention
Page 10
MODULE 3
Sub-module :
Acid Fast Bacilli Infection
FOR STUDENT
MEDICAL FACULTY
2014
Page 11
Introduction
The mycobacteria are rod-shaped, aerobic bacteria that do not form spores.
Although they do not stain readily, once stained they resist decolorization by acid or
alcohol and are therefore called acid-fast bacilli. Mycobacterium tuberculosis causes
tuberculosis and is a very important pathogen of humans. Mycobacterium leprae causes
leprosy. Mycobacterium avium-intracellulare (M.avium complex, or MAC) and other
atypical mycobacteria frequently infect patients with AIDS, are opportunistic pathogens
in other immunocompromised persons, and occasionally cause disease in patients with
normal immune systems.
Learning objectives:
Upon completion of this module, the students will be able to :
1.
2.
3.
4.
5.
6.
Describe the microbiologic properties of Mycobacteria.

Explain the pathogenesis and clinical findings of lung tuberculosis.
Explain the diagnostic laboratory test for tuberculosis.
Know the first line drugs for tuberculosis.
Explain the pathogenesis and clinical findings of leprae.
Explain the diagnostic laboratory test for leprae.
Overview Lecture
Mycobacteria
Mycobacteria are considered "acid-fast", which means that they retain dyes
following an acid-alcohol decolorization step. These organisms are very slow growers; a
5 hour division time is not uncommon. Different species can be differentiated based on
growth rate, niacin secretion, reduction of nitrate, caratogenesis, etc. Mycobacteria
produce "cord factors", which are dimycolates of trehalose. This gives rise to a pattern of
growth in serpentine cords. The very lipid nature of the cell wall provides some
resistance to drying, acid or alkaline conditions. It is also a good adjuvant that enhances
humoral and cell-mediated immune responses. The responsible component may be Nacetyl-muramyl-L-alanyl-D-isoglutamine (MDP), which causes the inhibition of
macrophage migration. M. leprae has never been cultured in vitro but can be grown on
the footpads of armadillos.
Task 1.
1. Draw the cell wall structure of Mycobacteria.
2. Why is the Mycobacteria called as acid fast bacilli.
3. Explain about the Ziehl Neelsen staining technique.
Page 12
Mycobacterium tuberculosis
Mycobacterium tuberculosis is the agent responsible for the disease tuberculosis.
Tuberculosis is spread by airborne droplets that must penetrate deep into the respiratory
tree. Virulent strains of Mycobacteria have the capacity to disrupt phagosomal
membranes of alveolar macrophages while the cord factors inactivate mitochondrial
membranes of phagocytes. These properties enable the organisms to survive and
multiply in phagocytes. Tuberculosis is characterized by a prolonged and productive
cough. Performing an acid-fast stain on sputum can reveal the bacteria. Isoniazid,
rifampin and ethambutol are the drugs used to treat tuberculosis.
Task 2.
1. Explain the pathogenesis of lung tuberculosis.
2. List the signs and symptoms of lung tuberculosis.
3. What clinical specimens can be used for acid-fast stains and for culture to identify
Mycobacterium tuberculosis.
4. Mention 3 appropriate media for primary culture of Mycobacteria.
5. Mention the first line drugs other than isoniazid, rifampin, and ethambutol used to treat
tuberculosis.
Mycobacterium leprae
Although this organisms was described by Hansen in 1873 (9 years before
Kochs discovery of the tubercle bacillus), it has not been cultivated on nonliving
bacteriologic media. It causes leprosy. There are more than 10 million cases of leprosy,
mainly in Asia.
Page 13
Task 3.
1. Explain the pathogenesis of leprosy.
2. Fill in the following table.
Lepromatous leprosy
Borderline leprosy
Tuberculoid leprosy
3. Complete the following table.

Definition & purpose
Procedure
Interpretation
Tuberculin test
Lepromin test
4. What is the clinical specimen used for direct examination to identify M.leprae?
Page 14
MODULE 4
Sub-module :
Gram Negative Rods Infections (Enterobacteriaceae)
FOR STUDENT
MEDICAL FACULTY
2014
Page 15
Enteric Gram-negative Rods Infections

(Enterobacteriaceaea)
Overview
The family Enterobacteriaceae is composed a large number of closely related
species that are found in soil, water, decaying matter, and the large intestines of humans
, animals, and insects. Because their normal habitat in humans, these organisms are
referred to as the enteric bacilli or enterics. Included in this family are some of the
most important causes of gastrointestinal disease : the agents of typhoid fever and
bacillary dysentery. Most species are not intestinal pathogens, however, but
opportunistic organisms that can infect any body site when given an altered host. In fact,
the enterics are responsible for the majority of nosocomial (hospital-acquired) infections
seen today. The seriousness of the problem is further complicated by the fact that many
of the organisms isolated from nosocomial infections are resistant to multiple
antimicrobial agents
The Enterobacteriaceae are facultative anaerobes or aerobes, ferments a wide
range of carbohydrates, posses a complex antigenic structures, and produce a variety of
toxins and other virulence factors.
Historically the Enterobacteriaceae have been divided into the opportunistic
pathogens and the intestinal pathogens. The intestinal pathogens traditionally have
included the members of the genera Salmonella, Shigella and Yersinia, and the
opportunistic pathogens included all the other genera. All of the opportunistic enteric
bacilli are capable of causing similar diseases, but the epidemiology, frequency, severity,
and treatment of these diseases differ for the various species.
Learning Objectives
1.
2.
3.
Describe the general characteristics of Enterobacteriaceae including : taxonomy,

morphology and physiology, determinant of pathogenicity, clinical infections,
diagnostic laboratory, and treatment
Describe the characteristics of Opportunistic Enterobacteriaceae and its ability to
cause disease, especially Escherichia coli
Describe microbiology aspects of salmonellosis and typhoid fever, shigellosis, and
yersiniosis
Module Tasks
01. GENERAL CHARACTERISTICS OF ENTEROBACTERIACEAE
Describe briefly about :
Page 16
1.1
1.2
1.3
1.4
1.5
1.6
1.7
Taxonomy
Morphology and Physiology ( biochemical and cultural characteristics)
Determinants of pathogenicity
Antigenic structure
Clinical Infection
Treatment
02. OPPORTUNISTIC PATHOGENS

2.1 Mention the genera of opportunistic Enterobacteriaceae !
2.2 Describe briefly about antigenic structure and determinants of
pathogenicity of Escherichia coli
2.3 Describe the pathogenesis and clinical findings of E.coli infections :
- urinary tract infection
- E.coli associated diarrheal diseases
- sepsis
- meningitis
2.4 Describe the pathogenesis and clinical finding of Proteus infections
03. INTESTINAL PATHOGENS

What do you know about :
3.1 Salmonellosis and Typhoid Fever
3.2 Shigellosis
3.3 Yersiniosis
Describe briefly concerning to the etiologic agents, virulence factors, transmission and
pathogenesis, clinical finding, laboratory diagnosis, and treatment
References :
1. Brooks GF, Butel JS, Morse SA, 2004, Jawetz, Melnick, & Adelbergs Medical
Microbiology, 23rd ed, Mc Graw Hill Education
2. Joklik WK, Willet HP, Amos DB, Wilfert CM, 1992, Zinsser Microbiology, 20 th ed,
Appleton & Lange
3. Tortora GJ, Funke BR, Case CL, 2007, Microbiology An Introduction, 9 th ed, Pearson
Benjamin Cummin
Page 17
MODULE 5
Sub-module :
Gram Negative Rods Infections (non-Enterobacteriaceae)
FOR STUDENT
MEDICAL FACULTY
2014
Page 18
Gram Negative Bacterial Infections

(Non-Enterobacteriaceae)
Vibrio, Campylobacter & Helicobacter
Overview
Vibrio, Campylobacter and Helicobacter species are gram-negative rods that are
all widely distributed in nature. The vibrios are found in marine and surface waters.
Vibrio cholerae produce an enterotoxin that cause cholera, a profuse watery diarrhea
that rapidly lead to dehydration and death. Six pandemic (worldwide pandemic) occurred
between 1817 and 1923, caused most likely by V.cholerae O1 of the classic biotype and
largely originating in Asia, usually the Indian subcontinent. Some consider the cholera
caused by serotype O139 strain to be the eight pandemic that began in the Indian
subcontinent in 1992 1993, with spread to Asia,
The campylobacters are found in many species of animals, including many
domestic animals. Campylocabter jejuni and Campylobacter coli have emerged as
common human pathogens, causing mainly enteritis and occasionally systemic infection.
C.jejuni and C.coli cause infections that are clinically indistinguishable, and laboratories
generally do not differentiate between the two species. These bacteria are at least as
common as salmonellae and shigellae as acause of diarrhea; and estimated 2 million
cases occur in the United States each year.
Helicobacter pylori has been associated with gastritis and duodenal ulcer
disease. H.pylori is present on the gastric mucosa of less than 20 % of person under age
30 but increases in prevalence to 40 60 % of person age 60, including persons who
are asymptomatic. In developing countries, the prevalence of infection may be 80 % or
higher in adult. Person to person transmission of H.pylori is likely because intrafamilial
clustering of infection occurs.
Learning Objectives
1. Describe the microbiologic aspects of Vibrio
2. Describe the microbiologic aspects of Campylobacter
3. Describe the microbiologic aspects of Helicobacter
Module Tasks
Describe the characteristics, pathogenesis, and clinical findings of Vibrios, including the
diagnostic laboratory and treatment of:
Vibrio cholerae
Vibrio parahaemolyticus
Campylobacter jejuni
Helicobacter pylori
Page 19
Pseudomonads & Acinetobacter

Overview
The pseudomonads and acinetobacters are widely distributed in soil and water.
Pseudomonas aeruginosa sometimes colonizes humans and is the major human
pathogen of the group. P.aeruginosa is frequently present in small numbers in the
normal intestine flora and on skin of humans. P.aeruginosa is invasive and toxigenic,
produce infections in patients with abnormal host defenses, and is an important
nosocomial pathogen.
Acinetobacter species are aerobic gram-negative bacteria that are widely
distributed in soil and water and can occasionally be cultured from skin, mucous
membranes, secretions, and the hospital environment. Acinetobacter often are
commensals but occasionally cause nosocomial infection. Acinetobacter baumanii is the
species most commonly isolated
Learning Objectives
Describe the microbiologic aspects of Pseudomonads

Describe the microbiologic aspects of Acinetobacter
Module Tasks
1. Describe the characteristics, pathogenesis, and clinical findings
Pseudomonads, including the diagnostic laboratory and treatment of:
Pseudomonas aeruginosa
Pseudomonas (Burkholderia) cepacia
Pseudomonas (Burkholderia) pseudomallei
of
2. Describe the characteristics, pathogenesis, and clinical

Acinetobacters, including the diagnostic laboratory and treatment
of
findings
Haemophilus & Bordetella

Overview
The Haemophilus species is agroup of small, gram-negative, pleiomorphic
bacteria that require enriched media, usually containing blood or its derivatives for
isolation. Haemophilus influenzae type b is an important human pathogen, that may
cause meningitis especially in children. Haemophilus ducreyi, a sexually transmitted
Page 20
pathogen, causes chancroid; other Haemophilus species are among normal flora of
mucous membranes and only occasionally cause disease.
There are several species of Bordetella. Bordetella pertussis, a highly
communicable and important pathogen of humans, causes whooping cough (pertussis).
Bordetella parapertussis can cause a similar disease. Bordetella bronchiseptica causes
disease in animals such as kennelcough in dogs and snuffles in rabbit, and only
occasionally causes respiratory disease and bacteremia in humans, primarily in
immunocompromised hosts.
Learning Objectives
Describe the microbiologic aspects of Haemophilus

Describe the microbiologic aspects of Bordetella
Module Tasks
1. Describe the characteristics, pathogenesis, and clinical findings of Haemophilus,
including the diagnostic laboratory and treatment of:
1.1
Haemophilus influenzae
1.2
Haemophilus ducreyi
2. Describe the characteristics, pathogenesis, and clinical findings of Bordetella,
including the diagnostic laboratory and treatment of:
2.1 Bordetella pertussis
References
1. Brooks GF, Butel JS, Morse SA, 2004. Jawetz, Melnick & Adelbergs Medical
Microbiology, 24th ed. p 248 293
2. Joklik WK, Willet HP, Amos DB, Wilfert CM, 1992, Zinsser Microbiology, 20 th ed,
Appleton & Lange
3. Tortora GJ, Funke BR, Case CL, 2007, Microbiology An Introduction, 9 th ed,
Pearson Benjamin Cummings
Page 21
MODULE 6
Sub-module :
Spiral Bacteria Infection
FOR STUDENT
MEDICAL FACULTY
2014
Page 22
Introduction
The spirochetes are a large, heterogenous group of spiral, motile bacteria. One
family (Spirochaetaceae) of the order Spirochaetales includes three genera of free living,
large spiral organisms. The other family (Treponemataceae) has genera whose
members include human pathogens : (1) the Treponema; (2) the Borrelia; and (3) the
Leptospira.
All spirochetes are actively motile and achieve their motility by means of two or
more axial filaments. The axial filaments are enclosed in the space between an outer
sheath and the body of the cell.
The spirochetes include a number of important pathogenic bacteria. The best
known is the genus Treponema, which includes Treponema pallidum, the cause of
syphilis. Members of the genus Borrelia cause relapsing fever and Lyme disease,
serious diseases that are usually transmitted by ticks or lice. Leptospirosis is a disease
usually spread to humans by water contaminated by Leptospira species.
Learning objectives :
Upon completion of this module, the students will be able to :
1. Describe the microbiologic properties of genus Treponema, genus Leptospira,
and genus Borrelia.
2. List the antigenic structure of Treponema pallidum, Leptospira interrogans, and
Borrelia recurrentis.
3. Explain the virulence factors of Treponema pallidum, Leptospira interrogans, and
Borrelia recurrentis.
4. Explain the pathogenesis of syphilis, leptospirosis, and relapsing fever.
5. Know the clinical findings of syphilis, leptospirosis, and relapsing fever.
6. Know the diagnostic microbiology for syphilis, leptospirosis, and relapsing fever.
7. Know the antimicrobial agents administered to syphilis, leptospirosis, and
relapsing fever.
Overview Lecture
Genus Treponema
The Treponema are motile, helically coiled organisms having a corkscrew-like
shape. They stain very poorly because their thickness approaches the resolution of the
light microscope. Treponema are delicate organisms requiring pH in the range 7.2 to 7.4,
temperatures in the range 30C to 37C and a microaerophilic environment. The
structure of these organisms is somewhat different: the cells have a coating of
Task 1
Students
Work Book : Microbial Infection (2014)
Page 23
1. Draw the morphology of genus Treponema and explain about the important parts of
the bacteria.
2. Explain about the antigenic structure of Treponema pallidum?
glycosamino-glycans, which may be host-derived, and the outer membrane covers the
three flagella that provide motility. In addition, the cells have a high lipid content
(cardiolipin, cholesterol), which is unusual for most bacteria. Cardiolipin elicits
"Wassermann" antibodies that are diagnostic for syphilis. Treponema possess a complex
antigenic makeup that is difficult to determine because the organisms cannot be grown
in vitro.
Treponema pallidum is capable of infecting all body tissues. The disease caused
by T. pallidum is syphilis. This is a relatively painless, slowly evolving disease. The hostparasite relationship leads to short symptomatic periods when the organism multiplies,
followed by prolonged asymptomatic periods when host responses produce healing.
Syphilis is strictly a person-person disease. An incubation period of from 10 to 90 days
precedes the clinical presentation, despite the fact that the organisms disseminate
immediately. The prominent feature of the disease is vascular involvement, particularly
arterioles and capillaries. Treponemal antigen-host antibody complexes may cause
some immunosuppression of the host and production of the distinct clinical stages:
The primary stage occurs weeks to months following infection. The principal sign
of infection is the hard chancre, generally found on the genitals. This lesion is essentially
painless but filled with treponemes and is, therefore, highly contagious. The secondary
stage occurs following an asymptomatic period of 2-24 weeks. In the secondary stage, a
skin rash spreads from the palms and soles towards the trunk. This rash may last 2-6
weeks and is followed by recovery. On average, about 25% of patients experience
relapses of the secondary stage.
Following the secondary stage is a period of
latency which may last many years and during which there are essentially no clinical
symptoms. The tertiary stage may erupt following the period of latency and can affect all
areas of the body and be fatal. Cardiovascular and neurological involvement are the
most frequent causes of death. Typically, however, the appearance of lesions called
"gummas" mark the tertiary stage. These lesions are, in fact, large granulomas resulting
from hypersensitivity reactions and they can be extremely disfiguring. Syphilis that
occurs in utero is termed congenital syphilis. About 50% of such fetuses abort or are
stillborn. Of those surviving birth, two scenarios are observed: the "early" form shows
symptoms that are apparent at birth; in the "late" form, infants appear normal until they
are about 2 years old and only then display the traits known as "Hutchinson's triad",
which include interstitial keratitis, notched incisors and eighth nerve deafness.
Page 24
Task 2
multiply
locally
the site of entry, some spread to nearby lymph nodes and
1. Spirochetes
Complete the
following
flowatchart.
then reach the bloodstream
2- 10 weeks
Primary lesion :
...
2- 10 weeks
Secondary lesions :
1. .
2. .
There may also be syphilitic meningitis, chorioretinitis, hepatitis, nephritis & periostitis
Tertiary lesions :
1. ..
2. ..
3. Cardiovascular lesions (aortitis, aortic aneurysm, aortic valve insufficiency)
Darkfield examination of material from a chancre can show the presence of

2. Explain about latent syphilis.
spirochetes.
techniques
including fluorescent treponemal antibody
3. Explain theImmunological
pathogenesis of congenital
syphilis
(FTA) or T. pallidum immobilization (TPI) can be of great assistance in observing
the organisms. The Wassermann test looks for the presence of antibody against
cardiolipin. Many other tests are also available.
Task 3
What is the different between VDRL and TPHA test.
Benzathine penicillin (long acting) or penicillin G are the drugs of choice. One
must be aware of a possible Jarisch-Herxheimer reaction following treatment of
secondary or tertiary syphilis, however. The rapid release of treponemal antigens after
lysis by penicillin can cause hypersensitivity reactions in some persons.
Genus Leptospira
Page 25
Leptospira are thin, tightly coiled obligate aerobes that are highly motile. Their
structure is similar to other spirochetes; a multilayered outer membrane, helical shaped
peptidoglycan and flagella located in the periplasmic space. Their nutritional
requirements include long-chain fatty acids and vitamins B1 and B12. There are more
than 180 serotypes of Leptospira described.
Task 4
1. Draw the morphology of genus Leptopsira and explain about the important parts of
the bacteria.
2. Explain about the antigenic structure of Leptospira interrogans?
Mucosa and broken skin provide the entry for leptospires. The organisms
produce a generalized infection with bacteremia (leptospiremic phase). Antibody is
produced and the organisms then become localized primarily in the kidneys.
Multiplication in the kidneys leads to shedding in the urine (leptospiruric phase). This
may persist for weeks, months or years. Leptospira produce no known exo- or
endotoxins. Damage to the endothelial lining of capillaries and renal failure are the most
common reasons for death. Occasionally the central nervous system may become
involved. The host immune response is probably responsible for lesions associated with
late phase of disease. This is suggested because antibiotics are ineffective after
symptoms have persisted for more than 4 days.
Task 5
1. Explain the pathogenesis of Leptospirosis.
2. List the signs and symptoms of Weils disease.
3. What is the drug of choice for leptospirosis?
Genus Borrelia
Borreliae produce febrile diseases characterized by remittent fever. The
organisms are transmitted to humans by lice or ticks. B. recurrentis produces epidemic
relapsing fever (lice); B. hermsii causes endemic relapsing fever (ticks); B. burgdorferi is
the agent responsible for Lyme disease (ticks).
Borreliae produce a generalized infection following an incubation period of about
1 week. Symptoms include fever, headache and muscle pain that lasts 4-10 days and
subsides. An afebrile period lasting 5-6 days follows and then there is a recurrence of
acute symptoms. Epidemic relapsing fever (transmitted by lice) is generally more severe
than endemic relapsing fever (transmitted by ticks) and has an approximately 40%
mortality if untreated. Also, the epidemic form is generally characterized by having a
Page 26
single relapse, while the endemic form may have several relapses due to cyclic antigenic
variation of the Borrelia. Lyme disease (transmitted by ticks) involves the production of
ulcerative lesions on the skin and may lead to arthritis or neurologic involvement.
Task 6
Explain the important role of antigenic structure of Borrelia recurrentis in the pathogenesis
of relapsing fever.
The symptomology of the recurrent fevers is not specific enough for accurate
clinical diagnosis. With Lyme disease, however, the occurrence of a "bulls-eye" lesion on
the skin (erythema chronicum migrans, ECM) is almost always (85%) associated with
infection. This usually begins as a small red lesion that enlarges over several weeks to a
reddened area that may cover several inches in diameter. Among cases that show ECM,
about 20% progress to include arthralgia, about 50% involve intermittent episodes of
arthritis and 10% progress to chronic arthritis. Darkfield smears can be used to observe
the relapsing fever Borrelia but serologic tests (ELISA) are a better determinant for Lyme
disease.
Task 7
Explain the diagnostic laboratory for relapsing fever.
Page 27
MODULE 7
Sub-module :
DNA Virus Infections
FOR STUDENT
MEDICAL FACULTY
2014
Page 28
Introduction
The classification of viruses into major groups (families) is based on: the type of
nucleic acid in the genome; the number of nucleic acid strands and their polarity; the
mode of replication; the size, structure, and symmetry of the virus particle; and the
pathogen parade. The great classification is based on their nucleic acid, there are RNA
Viruses and DNA Viruses.
Five major families of DNA Viruses are:
No. Virus Family
1. Parvoviridae.
2. Papovaviridae
3.
4.
5.
Adenoviridae
Hepadnaviridae
Herpesviridae
6.
Poxviridae
Madically important viruses

Parvovirus B19
Papillomavirus
Polyomavirus (JC virus, BK virus)
Adenovirus
Hepatitis B virus
Herpes Simplex virus (HSV):
- HSV-type 1
- HSV type-2
Varicella-Zoster virus (VZV)
Cytomegalovirus (CMV)
Epstein-Barr virus (EBV)
Human Herpes virus (HHV)-6
HHV-7
HHV-8
Smallpox virus
Vaccinia virus
Nowadays the most frequent case of DNA viral diseases and still be Indonesian
human health problem are caused by: 1) Group of Herpesviridae, especially caused by
HSV, VZV, and CMV; 2) Group of Papillomaviridae, especially by Human Papillomavirus
(HPV); 3) and by the only one member of Hepadnaviridae is Hepadnavirus (Hepatitis B
virus).
Learning objective
1. Herpes Simplex Virus 1 & 2 infections
- Pathogenesis
- Pathology
- Clinical findings
- Immunity
- Laboratory diagnosis
- Epidemiology
- Treatment, prevention & control
Page 29
2. Varicella-Zoster Virus infection

- Pathogenesis
- Pathology
- Clinical findings
- Immunity
- Laboratory diagnosis the diseases caused by VZV
- Epidemiology
3. Cytomegalovirus infection
- Pathogenesis
- Pathology
- Clinical findings
- Immunity
- Laboratory diagnosis the diseases caused by HPV
- Epidemiology
4. Human Papillomavirus infection
- Pathogenesis
- Pathology
- Clinical findings
- Immunity
- Epidemiology
5. Hepadnavirus infection
- Pathogenesis
- Pathology
- Clinical findings
- Immunity
- Epidemiology
Outline
Herpesviruses able to establish lifelong persistent in their hosts and to undergo
periodic reactivation. The reactivated infection may be clinically quite different from the
disease caused by the primary infection.
The HSVs are extremely widespread in the human population, and exhibit broad
host range. The HSVs are responsible for spectrum of diseases, ranging from
Page 30
gingivostomatitis to keratoconjunctivitis, encephalitis, genital disease, and infection of

newborn.
Varicella is highly contagious disease, chiefly of children and may be severe in
adults and in immunocompromised children. Zoster is a disease in capacitating of adults
and immunocompromised individual. Both the diseases are caused by the same virus.
Varicella is an acute disease, but zoster is reactivation of latent form Varicella virus.
Cytomegalovirus is one agent of TORCH, which are known poses high
frequency of congenital infections, which may lead to severe congenital anomalies. CMV
is very species-specific and cell-type-specific.
Papillomavirus is highly tropic in epithelial cells of skin and mucous membranes.
Cause several different kinds of warts in human. HPV-associated sexually transmitted
genital lesion are common and now accepted as the cause of anogenital cancer.
Human Hepatitis Virus B (HBV) establish chronic infection in those infected as
infants, its a major factor in the eventual development of liver disease and
hepatocellular carcinoma in those individuals.
Task
1. Some virus causes latent infection and reactivation can be found. Explain why this
condition occurs?
2. List classification of human herpesviruses base on cytopathology and site of latent
infection!
3. Describe about oropharyngeal disease caused by HSV (e.g. the agent, signs and
symptoms, recurrence, transmission)!
4. Describe about genital herpes (e.g. the agent, signs and symptoms, recurrence,
transmission)!
5. Describe about neonatal hespes (e.g. the agent, sign and symptoms, transmission)!
6. Describe about congenital and perinatal infection caused by CMV!
7. Describe the relation between varicella and zoster, and about Rumsay Hunt
Syndrome
8. Describe about wart and anogenital wart (e.g. the agent, signs and symptoms,
recurrence, transmission)! What therapy can be gave to wart patients?
9. Which HBV antigens useful for hepatitis B diagnosis?
Reference:
1. Brooks GF., Butel JS., Morse SA. 2004. Jawetz, Melnick & Adelbergs Medical
Microbiology, 23rd edition.
2. Tortora GJ., Funke BR., Case CL. 2001. Microbiology An Introduction, 7th edition.
3. Mims C., Dockerell HM., Goering RV., Roitt I., Wakelin D., Zuckerman M. 2004.
Medical Microbiology, updated 3rd edition.
Page 31
MODULE 8
Sub-module :
RNA Virus Infections 1
FOR STUDENT
MEDICAL FACULTY
2014
Page 32
Overview
The most viruses which cause infection have RNA nucleus, so RNA viral infection
topics will be divided into 2 groups, Viral Infection 1 and Viral Infection 2. This submodule (Sub-modul: Viral Infection 1) contains viral infection caused by
orthomyxovirus, paramyxovirus, rubella virus which infect human respiratory tract,
hepatitis (hepatitis A,C,D,E) virus, and oncorna virus.
Orthomyxovirus (influenza viruses) are the major determinant of morbidity and
mortality caused by respiratory disease, and outbreaks of infection sometimes occur in
worldwide epidemics. Influenza has been responsible for millions of death wordwide.
The paramyxoviruses include the most important agents of respiratory infection
of infants and young children (rsv and parainfluenza virus) as well as the causative
agents of two of the most contagious diseases of childhood (mumps and measles). After
replication in the respiratory epithelia, mumps and measles become disseminated
throughout the body and produce generalized disease.
German measles (3-day measles) caused by rubella virus is the mildest of
common viral exanthems. However, infection during early pregnancy may result in
serious abnormality of the fetus, including congenital malformations and mental
retardation.
Viral hepatitis is a systemic disease primarily involving the liver. Most cases of
acute viral hepatitis in children and adults are caused by hepatitis A and E. Hepatitis
viruses produce acute inflammation of the liver, resulting in clinical illness characterized
fever, gastrointestinal symptoms such as nausea and vomiting, and jaundice.
Viruses are etiologic factors in development of several types of human tumors,
including two of great significance worldwide cervical cancer and liver cancer. Animal
viruses are studied to learn how a limited amount of genetic information (one or view
viral genes) can profoundly alter the growth behavior of cells, ultimately converting a
normal cells into a neoplastic one. Tumors viruses are agents that can produce tumors
when they infect appropriate animals. Many studies are done using cultured animal cells
rather than intact animals, because it is possible to analyze events at cellular and
subcellular levels. In such cultured cells, tumor viruses can cause transformation. Most
RNA tumor viruses belong to the retrovirus family. Retroviruses carry an RNA-directed
polymerase (reverse transcriptase) that constructs a DNA copy of the RNA genome of
the virus. The DNA copy (provirus) becomes integrated into the DNA of the infected host
cell.
Learning Objective
After learning using this sub-modul, the students will be able:
1. To understand the reason why influenza virus can cause epidemic or pandemic
compare to paramyxovirus
2. To know how the avian influenza can cause human disease
3. To know the role of paramyxovirus as causative agents of disease in children
Page 33
4. To understand the mechanism of congenital rubella

5. To know the pathophysiology of hepatitis A,C,D,E virus
6. To understand the mechanism of tumor viruses cause neoplasia
Module Task
1. Explain about characteristic of influenza virus compare to paramyxovirus.
2. What is antigenic shift and antigenic drift according to biological characteristic
of influenza virus? And what is the impact of those phenomena in epidemiology
area?
3. Explain how the avian influenza virus can infect human.
4. List the clinical symptom and sign of avian influenza disease.
5. Explain the pathomechanism of measles virus and mumps virus to become
apparent the sign of disease.
6. What do rubella virus cause congenital disease? And what the congenital rubella
syndrome?
7. What is the characteristic of RNA containing hepatitis virus (include transmission
and type of disease).
Characteristic
Hepatitis A virus
Hepatitis C virus
Hepatitis D virus
Hepatitis E virus
Family
Virion
Envelope
Stability
Transmission
Prevalence
Fulminant
disease
Chronic
disease
Oncogenic
8. Explain the mechanism of tumor viruses in causing neoplasia.
References
Microbiology, 23rd Edition, 2004.
2. Mims C, Dockrell HM, Goering RV, Roitt I, Wakelin D, Zuckerman M: Medical
Microbiology, 3rd Edition, 2004.
3. Ryan KJ et al: Sherris Medical Microbiology An Introduction to Infectious
Diseases, 3rd Edition, 1994.
Page 34
4. Tortora GJ, BR Funke, CL Case: Microbiology An Introduction, 6th Edition, 2001.
Page 35
MODULE 9
Sub-module :
RNA Virus Infections 2
FOR STUDENT
MEDICAL FACULTY
2014
Page 36
PICORNAVIRUS
Picornavirus, such as poliovirus, are single-stranded(ss)-RNA viruses. They are
the smallest viruses; and the prefic pico (small) plus RNA gives these virus their name.
The Picornaviridae family contains five genera: Enterovirus (enteroviruses), Rhinovirus
(rhinoviruses), Hepatovirus (hepatitis A virus), Aphthovirus (foot-mouth disease viruses),
and Cardiovirus (cardioviruses). The first three groups contain important human
pathogens. Enteroviruses are transient inhabitans of the human alimentary tract and
may be isolated from the throat or lower intestine. Rhinovirus are isolated chiefly from
the nose and throat. Many Picornaviruses cause diseases in humans ranging from
subclinical or mild to severe paralysis. The most serious disease caused by poliovirus is
poliomyelitis disease. However, subclinical infection is far more common than clinical
manifest disease. Etiology is difficult to establish, as different viruses may produce the
same syndrome.
Enterovirus of human origin include the following: (1) polioviruses, types 1-3; (2)
coxsackieviruses of group A, types 1-24 (there is no type 23); (3) coxsackieviruses of
group B, types 1-6; (4) echovirus types 1-33 (no type 10 or 28); (5) enterovirus, types
68-71. Rhinoviruses are the common cold viruses. They are the most commonly
recovered agents from people with mild upper respiratory illness. They are usually
isolated from nasal secretion, but may also be found in throat and oral secretions. These
viruses cause upper respiratory tract infection, including the common cold.
Learning Objectives:
Upon completion of this module, the students will be able to:
Describe the generall properties of Picornavirus
Describe the classification of Picornaviridae family
List the antigenic structure of Picornavirus: Poliovirus, Rhinovirus and Hepatitis A
virus
Explain the pathogenesis of the following Picornavirus infections: Poliomyelitis,
common cold and Hepatitis A virus infection.
Know the clinical manifestation of the following Picornavirus infections:
Poliomyelitis, Common cold and Hepatitis A virus infection.
What is the immunity of patient against poliomyelitis, Rhinovirus, HAV
infections?.
Know the laboratory diagnosis of the following Picornavirus infections:
Explain how to treat, prevent and control for the following Picornavirus infections:
Page 37
Modul Tasks :
Describe the structure and composition of picornavirus briefly. What is the

genome of picornavirus? What is the infectious structure of picornavirus?
Describe the classification of Picornaviridae family, and which are the
human pathogens virus?
Describe the characteristics of human Picornaviruses
Explain the pathogenesis of the following picornavirus infections:
poliomyelitis, common cold, and Hepatitis A virus infection
What is the clinical manifestation of the following picornavirus infections:
poliomyelitis, common cold, and Hepatitis A virus infection?
What is the immunity of patient against poliomyelitis, Rhinovirus, HAV
infections?
Explain the laboratory diagnosis for poliomyelitis.
Explain how to treat, prevent and control the following picornavirus
infections: poliomyelitis, common cold and Hepatitis A virus infection.
ARBOVIRUSES AND ROBOVIRUSES

The arthropod-borne viruses (Arbovirus) are a group of infectious agent that are
transmitted by bloodsucking arthropods from one vertebrate host to another. Replication
in the vertebrate host produces viremia of high enough titer that other blood-feeding
arthropods will be infected. The viruses multiply in the tissues of the arthropod without
evidence of disease or damage. The vector acquires a lifelong infection through the
ingestion of blood from a viremic vertebrate. Some arboviruses are maintained in nature
by transovarian and possibly sexual transmission in arthropods. Although arboviruses
are found in all tempareate and tropical zones, they are most prevalent in the tropical
rain forest with its abundance of animals and arthropods.
The roboviruses (rodent-borne virus), some virus maintained in nature by direct
intraspecies or interspecies transmission (or both) from rodent to rodent without
participation of arthropod vectors. Viral infection is usually persistent. Transmission
occurs through many routes by contact with body fluids or excretion. They are classified
according to their chemical and physical properties and their antigenic relationships.
Arboviruses and Roboviruses are placed among the Togavirus, Flavivirus, Bunyavirus,
Reovirus, Rhabdovirus, Arenavirus and Filovirus groups.
Disease produced by human Arboviruses may be divide into three clinical
syndromes : 1) fevers of an undifferentiated type with or without a maculopapular skin
rash, usually benign; 2) encephalitis, often with a high case-fatality rate; and 3)
hemorrhaghe fevers, also frequently severe and fatal. Some Arboviruses may be
associated with more than one syndrome, eg. dengue. They are very variable host
range: the insects : mosquito tick and the vertebrates : avian mammalian. They act
also as maintenance host, link host, amplifier host, or vector host.
Page 38
Describe the general properties of Arboviruses and Roboviruses
Describe the classification of Arboviruses and Roboviruses, according to their
chemical and physical properties and their antigenic relationships.
Explain the pathogenesis and clinical manifestation of the following Arbovirus
infections in human: dengue fever or dengue hemorrhagic fever and yellow
fever.
Know the laboratory diagnosis for the following Arboviruses infections: dengue
fever or dengue hemorrhagic fever and yellow fever.
Explain how to treat, prevent and control the following Arbovirus infections:
dengue fever or dengue hemorrhagic fever and yellow fever.
Explain the general profile of human chikungunya virus.
Modul Tasks :
What is the general properties of Arbovirus and Robovirus?

Mention the classification of Arboviruses and Roboviruses, according to their
chemical and physical properties and their antigenic relationships.
Explain the pathogenesis of the following Arbovirus infections: dengue fever or
dengue hemorrhagic fever and yellow fever.
Explain the laboratory diagnosis for dengue fever or dengue hemorrhagic fever
and yellow fever.
Explain how to treat, prevent and control the following Arbovirus infections:
dengue fever or dengue hemorrhagic fever and yellow fever.
Explain the general profile of human chikungunya virus
REOVIRUSES AND ROTAVIRUSES

Reovirus found in the respiratory and enteric (digestive) system of humans. They
were not associated with any diseases when the first discovered. The name comes from
the first letters of respiratory, enteric and orphan. The family includes human
Rotaviruses, the most important cause of infantile diarrhea around the world. Acute
gastroenteritis is a very common disease with significant public health impact. The virion
measure 60-80 nm in diameter and possess two concentric capsid shells, each of which
is icosahedral. But Rotaviruses have a triple-layered structure. Reoviruses are mediumsized viruses. They have not envelope. The capsid containing the double-stranded RNA
is digested upon entering a host cell. Viral mRNA of Reoviruses is produced in the
cytoplasm, where it is used to synthesized more viral proteins.
Page 39
The family of Reoviridae is divided into nine genera. Four of the genera able to
infect humans and animals: Orthoreovirus, Rotavirus, Coltivirus, and Orbivirus. Four
other genera infect only plants and insects, and one insect fish.
Rotaviruses are a major cause of diarrheal illness in human infants and young
animals. The morphology of Rotaviruses are as like as wheel (wheel= rota), they have
stable in pH 3 9, and in feces for 7 months. The replication of Rotavirus in cytoplasm,
and released by lytic mechanism. Rotaviruses are closely related to Reovirus in terms of
morphology and strategy of replication. Rotaviruses and reoviruses have no arthropod
vectors.
Describe the general properties of Reoviruses
Describe the general properties of rotavirus
Mention the classification of Reoviridae family
Explain the pathogenesis and clinical manifestation of Rotavirus infection in
humans
Know the laboratory diagnosis for Rotavirus infection
Explain how to treat, prevent and control the Rotavirus infection
Modul Tasks :
What is the general properties of Reoviruses?

What is the general properties of Rotavirus?
Mention the classification of Reoviridae family
Explain the pathogenesis and clinical manifestation of Rotavirus infection in
human
Explain the laboratory diagnosis for Rotavirus infection in human !
Explain how to treat, prevent and control the Rotavirus infection in human
RHABDOVIRUS and RABIES

Many different viruses invade the central nervous system and cause disease.
Rabies virus is rhabdovirus that containing a single-stranded RNA and has envelope The
viruses are rod or bullet-shaped particles measuring 75 X 180 nm. The viruses are
classified in the family Rhabdoviridae. Rabies viruses belong to the genus Lyssavirus.
Viral replication is in cytoplasm and released by budding formation.
Rabies is an acute infections of the central nervous system that is almost always
fatal. Humans usually acquire the rabies virus from the bite of an infected animal. Rabies
virus has a wide host range. All warm-blooded animals, including humans, can be
Page 40
infected. Rabies virus has not been isolated from the blood of infected persons. The
virus is widely distributed in infected animals, especially in the nervous system, saliva,
urine, lymph, milk, and blood. Rabies virus produces a specific eosinophilic cytoplasmic
inclusion, the Negri body, in infected nerve cells. Recovery from infection is rare except
in certain bats, where the virus has become peculiarly adapted to the salivary glands.
Vampire bats may transmit the virus for months without themself ever showing any sign
of the disease. Rabies is a major problem of public health, because it is wide spread
among animal reservoirs.
Describe the general properties of rhabdovirus according to the structure,
classification, reaction to physical and chemical agents, virus replication, animal
susceptibility and growth of virus, and antigenic properties.
Explain the pathogenesis of Rhabdovirus infection in human
Explain the clinical manifestation of rabies disease in human
Know the laboratory diagnosis for rabies
Explain how to treat, prevent and control rabies
Modul Tasks :
What is the general properties of rhabdovirus according to the structure,

classification, reaction to physical and chemical agents, virus replication, animal
susceptibility and growth of virus, and antigenic properties?
How does the rabies virus infect human and spread into the human body?
Explain the clinical manifestation of rabies in human
Explain the laboratory diagnosis for rabies in human
Explain how to treat, prevent and control rabies
HIV and AIDS

HIV (human immunodeficiency virus) is a nononcogenic retrovirus, and as the
primary etiologic agent of acquired immunodeficiency syndrome (AIDS). The virus is a
member of the Lentivirinae subfamily. The virus contains single-stranded RNA, has an
envelope and an enzyme reverse transcriptase. The illness was first described in 1981,
and the virus was isolated by the end of 1983. The pathogen causing the loss of immune
function had been identified as a virus that selectively infects helper T cells. Since then,
the disease has become a worldwide epidemic, and affected different populations and
geographic regions. Millions are now infected worldwide; once infected, individuals
remain infected for life.
Page 41
The transmission of HIV requires the transfer of, or direct contact with, infected
body fluids. The most important of these is blood, which contains 1000-100.000 infective
viruses per milliliter, and semen, which contains about 10-50/ml. HIV is transmitted
during sexual contact, through parenteral exposure to contaminated blood or blood
products, and from mother to child during perinatal period. The presence of other
sexually tranmitted disease or genital lesion, such as syphilis, gonorrhea, or chancroid,
increases the risk of sexual HIV transmission as much as a hundredfold.
Describe the general properties of lentiviruses
List the classication of lentiviruses and HIV
Describe the general properties of HIV and HIV infections?
Explain the pathogenesis of HIV infection in human
Explain the clinical manifestation and complication of HIV infection in human
Describe the high risk factors that may produce the HIV infection in human
Describe the route of transmission of the HIVs producing infection in human
Explain the laboratory diagnosis for HIV infection disease in human
Explain how to treat, prevent and control the HIV infection disease in human.
Modul Tasks :
What is the general properties of lentiviruses ?

List the classification of lentiviruses and HIV
What is the general properties of HIV and HIV infections?
How does the HIV infect the human and spread into the human body ?
Explain the clinical manifestation and complication of HIV infection in human
Describe the high risk factors that may produce the HIV infection in human
Describe the route of transmission of the HIVs producing infection in human
Explain the laboratory diagnosis for HIV infection in human
Explain how to treat, prevent and control the HIV infection disease in human
References :
1. Brook GF, Butel JS and Morse SA, 1998. Jawetz, Melnick, and Adelbergs
Medical Microbiology, 21th ed, Appleton & Lange, Stamford, Connecticut.
2. Tortora GJ, Funke BR and Case CL, 1998. Microbiology an Introduction, 6th ed,
The Benjamin/Cummings Publ., California.
Page 42
3. Fauci AS, Brunwald E, Isselbacher KJ,et al. l998. Harrisons Principles of

Internal Medicic
Page 43
MODULE 10
Sub-module :
Fungal Infections
FOR STUDENT
MEDICAL FACULTY
2014
Page 44
Fungal Infection
Overview
Medical Mycology is the study of the diagnosis, management, and prevention of
mycoses. Only a few fungi cause serious diseases in humans. The actual incidence of
mycoses is unknown because they are not reportable. Most fungi are not considered
infectious agents because they are almost never spread by human-to-human contact.
The few exceptions include the dermatophytes, species of Candida, and Pneumocystis.
True fungal pathogens are capable of actively invading the tissues of immunocompetent
people. Opportunists can infect only weakened patients. Clinically, mycoses include
infections, toxicoses, and hypersensitivity reactions. Infections can be superficial,
subcutaneous, and systemic. Diagnosis of mycoses usually correlates signs and
symptoms with microscopic examination of tissues or laboratory cultures for identifying
unique morphological features. Biochemical and immunological tests exist for some
fungi.
Fungal pathogen can be clasified on the basis of their growth forms, or the type
of infection they cause (mycoses).
Three types of infection are recognized:
Superficial mycoses, where the fungi grow at the body surface on skin or hair,
Cutaneous and subcutaneous mycoses where nails and deeper layers of the skin
are involved
Systemic or deep mycoses with involvement of internal organs. This category
includes the opportunistic fungi that cause disease in patients with compromised
immune system.
There are three genera of Dermatophytes that can infect human body such as
skin, hair, and nail. These genera consist of Trichophyton, Epidermophyton, and
Microsporum.
Fungi that cause subcutaneous mycoses are ubiquitous; human are infected by
spores and vegetative form through minor lesion in skin. This disease involve
subcutaneous and lymphatic tissues.
Learning Objectives
State the most significant mode of transmission for mycoses

Explain why the actual prevalence of fungal infection is unknown
Compare the true fungal pathogens with opportunistic fungi
Identify the factors that predispose people to opportunistic fungal infections
Discuss why the diagnosis of opportunistic fungal infection can be difficult
Discuss the advantages and disadvantages of fungicidal and fungistatic drugs
Page 45
Compare the clinical appearance of the diseases resulting from the pathogenic fungi
Identify the laboratory technique used to distinguish among the pathogenic fungi
Explain how candidiasis can develop from a localized infection to a systemic
infection
List the characteristics of Pneumocystis that distinguish it from other opportumistic
fungi
Describe the general manifestations of superficial, cutaneous, and subcutaneous
mycoses
Explain why subcutaneous mycoses is not as much as superficial mycoses
Identify the types of hypersensitivity reactions fungal allergens produce
Task:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Discuss the mode of transmission for mycoses.

What are cutaneous mycosis (dermatomycoses)?
Mention the etiologic agents of superficial mycoses.
Explain about subcutaneous mycosis.
Discuss the pathogenic feature of Cryptococcus neoformans.
List the etiologic agent of systemic mycoses and its characteristics.
List the etiologic agent of opportunistic mycoses.
Describe the predisposing factor of opportunistic mycoses.
Explain the allergicf form of aspergillosis.
References:
Microbiology, 23rd edition; chapter 45, 2004
chapter 12, 2001
3. Mims C, HM Dockrell, RV Goering, I Roitt, D Wakelin, M Zuckerman: Medical
Microbiology, 3rd edition, chapter 4, 2004
4. Ryan KJ et al: Sherris Medical Microbiology An Introduction to Infectious
Diseases, 3rd edition, chapter 44 49, 1994
Template presentation
Classification
Pathogenesis
Page 46
Treatment
Prevention
Page 47

MODULE MI.2014.Studentfile

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

MODULE MI.2014.Studentfile

Uploaded by

Copyright:

Available Formats

MICROBIAL INFECTIONS

Students Work Book : Microbial Infection (2014)

Gram Positive & Gram Negative Cocci Infections

Students Work Book : Microbial Infection (2014)

Virulent strains of S. pneumoniae are protected by polysaccharide capsules.

Contrast the virulence of Staphylococcus aureus with S epidermidis in humans.

Students Work Book : Microbial Infection (2014)

Describe how meningococci survive in humans

Students Work Book : Microbial Infection (2014)

17. Explain the pathogenesis mechanisms of gonococcal infection and its

Students Work Book : Microbial Infection (2014)

Students Work Book : Microbial Infection (2014)

Gram Positive Rods Infections

Students Work Book : Microbial Infection (2014)

those of Corynebacteria. In culture on blood agar, it grow as a smooth colonies

Identify the structural features of Bacillus that contribute to its pathogenicity

List the characteristics of Clostridium tetani (morphology and culture).

Students Work Book : Microbial Infection (2014)

11. Explain the Schick test, the procedure, and purpose.

Students Work Book : Microbial Infection (2014)

Students Work Book : Microbial Infection (2014)

Describe the microbiologic properties of Mycobacteria.

Students Work Book : Microbial Infection (2014)

Students Work Book : Microbial Infection (2014)

3. Complete the following table.

Students Work Book : Microbial Infection (2014)

Students Work Book : Microbial Infection (2014)

Enteric Gram-negative Rods Infections

Describe the general characteristics of Enterobacteriaceae including : taxonomy,

Students Work Book : Microbial Infection (2014)

02. OPPORTUNISTIC PATHOGENS

03. INTESTINAL PATHOGENS

Students Work Book : Microbial Infection (2014)

Students Work Book : Microbial Infection (2014)

Gram Negative Bacterial Infections

Students Work Book : Microbial Infection (2014)

Pseudomonads & Acinetobacter

Describe the microbiologic aspects of Pseudomonads

2. Describe the characteristics, pathogenesis, and clinical

Haemophilus & Bordetella

Students Work Book : Microbial Infection (2014)

Describe the microbiologic aspects of Haemophilus

Students Work Book : Microbial Infection (2014)

Students Work Book : Microbial Infection (2014)

Students Work Book : Microbial Infection (2014)

Darkfield examination of material from a chancre can show the presence of

Students Work Book : Microbial Infection (2014)

Students Work Book : Microbial Infection (2014)

Students Work Book : Microbial Infection (2014)

Madically important viruses

Students Work Book : Microbial Infection (2014)

2. Varicella-Zoster Virus infection

Students Work Book : Microbial Infection (2014)

gingivostomatitis to keratoconjunctivitis, encephalitis, genital disease, and infection of

Students Work Book : Microbial Infection (2014)

Students Work Book : Microbial Infection (2014)

Students Work Book : Microbial Infection (2014)

4. To understand the mechanism of congenital rubella

Students Work Book : Microbial Infection (2014)

4. Tortora GJ, BR Funke, CL Case: Microbiology An Introduction, 6th Edition, 2001.

Students Work Book : Microbial Infection (2014)

Students Work Book : Microbial Infection (2014)

Students Work Book : Microbial Infection (2014)

Describe the structure and composition of picornavirus briefly. What is the