Exam 2 Study Guide

discuss the general immunology principles underlying vaccinations

(1) ability to detect and fight off infection; (2) ability to recognize a host's own cells as "self," thereby protecting them from attack; (3) a memory from previous foreign infections; and (4) ability to limit the response after the pathogen has been removed. To produce an immune response, live attenuated vaccines must replicate (grow) in the vaccinated person. A relatively small dose of virus or bacteria is administered, which replicates in the body and creates enough of the organism to stimulate an immune response. Trigger an immune response. Results in the formation of memory cells and antibodies. When the vaccinated individual encounters the real microbe at a later time the memory cells can act quickly to prevent the infection.

describe the factors that limit infection of the respiratory system

Innate defenses of the respiratory tract include: -Normal Microbiota -Mucous membranes -Goblet cells and mucus -Ciliated epithelial cells: move particles up and out. -Mucociliary escalator: cilia moving mucus and any trapped molecules up and out. -Mucosa-associated lymphoid tissue (MALT), including the adenoids and tonsils: houses lymphocytes in a concentration, which can react quickly and drain and filter lymph in those places. -Alveolar macrophages

transduction

Introduction of new genetic material into a bacterial cell by a virus.

explain why it is important to promptly treat a case of pharyngitis caused by Streptococcus pyogenes

It is important to promptly treat a case of pharyngitis caused by Streptococcus pyogenes because infection of Streptococcus pyogenes (Group A streptococcus) can lead to many sequelae. Sequelae is a condition which is the consequence of a previous disease or injury. Possible sequelae of pharyngitis are Scarlet fever, Rheumatic fever, and Acute glomerulonephritis.

describe the considerations when choosing an antimicrobial therapy

-administration route: oral vs. parenteral (IV). -drug stability and elimination: half life (ex: penicillin V (roughly 30 mins. vs. azithromycin (roughly 68 hours)). -drug safety (toxicity, side effects). -activity/spectrum: broad spectrum drugs: broad range. narrow spectrum drugs: limited range of bacteria. Preferred because there is less disruption to the normal microbiota. Need specific identity of pathogen (full ID can take several days).

name and describe the four categories of adaptive immunity and state which confer long term protection and why

-natural/active: antibodies that your body naturally makes. -natural/passive: antibodies from mother's breastmilk to the baby. -artificial/active: vaccinations, not giving pre formed antibodies, but giving you something to stimulate the activation of your immune system. Introduce it to you in an amount small enough to not get sick, but enough to be able to mount an immune response. -artificial/passive: like an IV of antibiotics. artificially acquired active immunity involves vaccines that trigger an immune response that results in the formation of memory cells and antibodies, and confers long-term protection. natural active acquired immunity also produces antibodies which can prevent someone from contracting the same disease a second time, thus conferring long term protection.

name and describe the three categories of acquired antimicrobial resistance tools that microbes may use to thwart drug action

1. target alteration. 2. drug inactivation. 3. reducing drug concentrations inside the cell (blocking entry or by pumping the drug out of the cell).

thermal dimorphism

1. when fungal spores from the environment gain entrance to a warm-blooded animal, they germinate into yeasts and remain in this phase in the host. 2. the yeast cells leaving the animal host return to the environment and revert to the sporulating hyphen state. These conversions can be demonstrated on artificial media in the laboratory. natural habitat: saprobic (free living), mycelial phase, temperature at less than 30 degrees Celsius, reproduction through sporulation. > increased temperature, reduced O2, or suboptimal nutrients leads to animal habitat: parasitic, yeast phase, temperature from 35-50 degrees Celsius, reproduction through budding or endospores. > decreased temperature, optimal O2 content, or improved nutrients leads to back to natural habitat

exudate

A fluid discharge (can be pus-like or clear fluid) that is present in a given tissue; usually produced in response to inflammation; fluid that accumulates in the tissues as a result of vascular changes that accompany early inflammation. a mass of cells and fluid that has seeped out of blood vessels or an organ, especially in inflammation.

antigenic shift

A major genetic reassortment that dramatically changes the virus; often leads to viral strains with new features; leads to influenza pandemics.

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hypae

a collection of tubular structures which most fungi (besides yeasts) grow. A single threadlike filament of a mold.

sequelae

a condition which is the consequence of a previous disease or injury.

antibiotic stewardship

a coordinated program that promotes the appropriate use of antibiotics, improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.

non-communicable

a disease that is not transmitted from one host to another

acquired resistance

a form of antimicrobial drug resistance that develops due to genetic mutation or, in the case of bacteria, a form of antimicrobial drug resistance that develops when drug resistant genes are transferred or shared via horizontal gene transfer events such as conjugation and transformation.

yeast

a fungus that is characteristically single-celled most of its life, eukaryotic, reproduces asexually by budding or binary fission, produces spores, and is capable of fermenting carbohydrates.

empiric therapy

a standard, accepted, or typical treatment based on clinical presentation in the absence of definitive or complete clinical data; when considering antimicrobial therapies, empiric treatments are often intentionally broad spectrum and later narrowed if the causative agent is identified and found to respond to a narrow spectrum drug.

transformation

a type of horizontal gene transfer in which bacteria are genetically altered when they take up DNA from their environment

state what adjuvants are and describe their purpose

adjuvants are pharmacological additives that enhance the body's natural immune response to an antigen; often added to vaccines to encourage antigen uptake and processing by antigen-presenting cells.

atypical pneumonia

also known as walking pneumonia, is the type of pneumonia not caused by one of the pathogens most commonly associated with the disease. Its clinical presentation contrasts to that of "typical" pneumonia. A variety of microorganisms can cause it.

dimorphic

Able to exist in two distinct forms; Blastomyces dermatitidis is an example of a dimorphic fungus; it lives as a spore-producing saprophyte in natural environments, and once inside the lungs, the saprophyte spores can germinate into a unicellular, yeast-like form that causes disease. (depending on temperature, will switch between being a yeast and a mold).

superinfection

an infection caused by superbugs that is difficult to treat

community-acquired infection (CAI)

an infection obtained from a human, animal, or environmental source in a non-healthcare setting.

otitis externa

Swimmer's ear; Pseudomonas aeruginosa infection in which the outer ear canal is infected; in some cases the pinna (the flaplike tissue that most think of as the ear) can also become inflamed and exhibit pus-filled lesions.

induration

The hardening of a tissue often caused by inflammation; a hardened or fibrous mass in a normally elastic and soft tissue; a hardened area of the skin that develops following the injection site of a Mantoux test for tuberculosis; redness is also common around the induration, although only the size of the induration weighs into the test result.

describe the anatomical and physiological features of the respiratory system that limits the establishment of pathogenic organisms

The respiratory tract has innate defenses that limit the establishment of pathogenic organisms, which include: -Normal Microbiota. -Mucous membranes. -Goblet cells and mucus. -Ciliated epithelial cells: move particles up and out. -Mucociliary escalator: cilia moving mucus and any trapped molecules up and out. -Mucosa-associated lymphoid tissue (MALT), including the adenoids and tonsils that houses lymphocytes in a concentration, and can react quickly to drain and filter lymph in those places. -Alveolar macrophages.

superantigen

antigen which yields an exaggerated response/excessive activation of the immune system.

discuss antigenic drift versus antigenic shift and their roles in the emergence of new influenza viral strains

antigenic drift is random mutations that cause minor changes in the HA (HemAgglutinin) and NA (NeuroAminidase) spikes and allows evasion of the immune system. Responsible for seasonal epidemics of influenza viral strains. Antigenic shift is major genetic change that causes major alterations in viral antigens and can allow for pandemics. Responsible for pandemics of influenza viral strains.

define antimicrobial resistance and describe the four ways it can develop

antimicrobial resistance occurs when a microbe is not affected by a drug therapy that is intended to inhibit or eliminate the pathogen. Antimicrobial resistance can develop through mutations that occur in the DNA of the cell during replication, through horizontal gene transfer. Target alteration- bacterial protein changes so drug is no longer effective. Drug inactivation- beta-lactamases are enzymes that will cut the beta-lactam so they no longer work. Reducing drug concentrations inside the cell- through limiting drug entry or pumping drugs out via porins or efflux pumps. Genetic mutations or horizontal Gene transfer.

intrinsic resistance

built in qualities that help some bacteria naturally resist antimicrobial drugs; while intrinsic resistance rarely provides full protection from all antimicrobials, it does make certain pathogens harder to eliminate and it tends to limit what drugs can be used to combat those pathogens.

fungi

cell type: eukaryotic (nucleus); cell membrane: ergosterol; cell wall: chitin; spores: a wide variety of sexual and asexual reproductive spores; antimicrobials: antifungals.

how are natural, synthetic, and semisynthetic antibiotics different and how are drug modifications useful clinically

Natural antibiotics occur naturally in the environment. synthetic antibiotics are completely chemically composed. semisynthetic antibiotics started with something from nature, and chemically modified it for multiple "rounds"/generations in order to try to keep the pharmaceutical ahead of the pathogens occurring in nature. Drugs in later generations have expanded capabilities.

eustachian tube

connects the middle ear with the nasopharynx and allows passage of air. connects middle ear to nasopharynx.

given the staining results (gram and or acid fast) from a sputum sample, correctly identify the most likely etiological agent

contain S. pneumoniae, S. aureus, H. influenzas, M. catarrhalis, K. pneumoniae, P. aeruginosa. The most common pathogens detected with a sputum culture are bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus.

describe why children are prone to developing otitis media as a complication of ARI (colds)

Because the eustachian tube is smaller and more narrow, they are more susceptible to ARI (colds), and have an increased risk for otitis media.

nasopharynx

region of the pharynx at the back of the nose and above the soft palate

spore

reproductive unit of fungus. May be formed sexually or asexually. Critical to identifying fungal species.

define sequelae and how they relate to treatment of bacterial pharyngitis. Provide an example

sequelae are a condition which is the consequence of a previous disease or injury. It is important to treat bacterial pharyngitis because infections with Streptococcus pyogenes (Group A streptococcus) can lead to many sequelae, like Scarlet fever, Rheumatic fever, and Acute glomerulonephritis.

name and describe the causative agent of tuberculosis and the forms of the disease

the causative agent of tuberculosis is Mycobacterium tuberculosis. The forms of the disease are are initial infection, latent TB, and active TB. -initial infection: Bacteria are phagocytosed by alveolar macrophages and replicate intracellularly. -Latent TB: Immune cells wall off infection forming as granuloma or tubercle. Tubercle gradually collects calcium deposits to form what is known as a Ghon focus. Tubercles often heal, leaving permanent scars that appear as shadows in chest X rays. Disease does not progress, but bacteria may remain in the body for many years. -Active TB: If immune system is weakened, the tubercle opens, releasing the bacteria. More severe symptoms: violent coughing, bloody sputum, weight loss, fatigue, night sweats and chest pain. Untreated secondary TB has a nearly 60 % mortality rate. Highly communicable at this stage.

bacteriocidal

substance that kills bacteria; bactericidal drugs tend to target bacterial cell walls, cell membranes, or nucleic acids.

bacteriostatic

substances that prevent bacteria from growing; bacteriostatic drugs tend to target bacterial protein synthesis and metabolic pathways like folic acid production.

summarize how super antigens cause an inflammatory response

superantigens result in excessive activation of the immune system. It causes non-specific activation of T-cell resulting in polyclonal T cell activation (about 20% of T helper cells can be activated at once), and increases cytokine release/causes a massive cytokine release and inflammation.

encapsulated

surrounded by a membranous envelope, can be an encapsulated drug or bacteria. ex: Streptococcus pneumoniae, Haemophilus influenzae Pneumonia.

compare and contrast the symptoms of the common cold and influenza.

symptoms of the common cold are gradual symptom onset, sneezing, stuffy nose, and sore throat. symptoms of influenza are abrupt symptom onset, fever, aches, chills, and headache. symptoms of both diseases are aches, fatigue, weakness, sneezing, stuffy nose, sore throat, chest discomfort/cough. Cold symptoms are usually milder than flu symptoms.

anti fungal drugs

target fungal infections

beta-lactam

target the cell wall, contain a four-sided beta-lactam ring, prevent cross-linking of peptidoglycan. beta lactam antimicrobials: a superfamily of antibacterial drugs that work by blocking bacterial cell wall construction. Includes penicillin, cephalosporins, carbapenems, and monobactams. beta-lactam ring: four sided ring that is part of the active chemical structure of penicillins, cephalosporins, carbapenems, and mombactams.

antiviral drugs

target viral infections

mycelium

the mass of hyphae that form a colony of mold.

state where normal flora is found in the respiratory system and name examples of respiratory flora

the respiratory system contains an abundant and diverse microbiota. nasal passages and sinuses: similar to skin flora (mostly gram positive bacteria - Staphylococcus spp., Streptococcus spp., Corynebacterium spp.). Oropharynx: skin and mouth flora (mostly Streptococcus spp, also Haemophilus spp). pharynx: skin and mouth flora (Mostly Streptococcus spp, Haemophilus spp, Neisseria spp). Surfaces can include opportunistic pathogens in low number (Streptococcus pneumoniae, Haemophilus influenza, Neisseria meningitidis Candida albicans (yeast)). lower respiratory tract: transient microflora. lungs are effectively sterile (most of the time, there's nothing there). note: normal microbiota varies from person to person and is affected by many factors including immune status, antibiotic use, smoking etc.

antimicrobial drugs

therapeutic compounds that kill microbes or inhibit their growth; categorized based on the type of pathogen they target: antibacterial drugs treat bacterial infections, antiviral drugs target viral infections, antifungal drugs work against fungal infections, and anti parasitic drugs treat protozoan and helminthic (worm) infections.

pharynx

throat; passageway for food to the esophagus and air to the larynx.

describe the conditions that might cause a sputum sample to be rejected and why this has clinical significance

too much saliva in a sample will give misleading results. clinical significance is that the sputum sample would be rejected because it would have less than 10 squamous epithelial cells per LPF (low power field).

transpeptidase

transpeptidase enzymes build protein cross links in the peptidoglycan cell wall. penicillin blocks transpeptidase enzymes from building cross links in the peptidoglycan cell wall. this results in a weak cell wall that cannot protect the cell from lysing (bursting).

bacterial conjugation

transposon (a chromosomal segment that can undergo transposition, especially a segment of bacterial DNA that can be translocated as a whole between chromosomal, phage, and plasmid DNA in the absence of a complementary sequence in the host DNA) moved from a donor cell to a recipient cell.

antibacterial drugs

treat bacterial infections

antiparasitic drugs

treat protozoan and helminthic infections

acellular vaccine

vaccine that may contain cellular material but does not contain complete cells; consists of portions of rather than the whole bacteria.

define vaccine-hesitancy and describe factors that contribute to the re-emergence of vaccine-preventable diseases

vaccine-hesitancy refers to delay in acceptance or refusal of vaccination despite availability of vaccination services. CDC estimates from 1994-2013, in the U.S. alone, vaccines prevented 21 million hospitalizations and 732,000 deaths. Centuries of historical evidence and scientific research show benefits. However, the practice has been a frequent source of controversy. Fears about vaccination re-erupted in 1998. Paper published in The Lancet: -Study of just 12 patients. -Claimed a correlation between the measles, mumps, and rubella (MMR) vaccine and the development of autism. -Shortly after publication, many parents in the US and UK started to decline MMR and many other vaccinations for their children. In 2010: The Lancet fully retracted the MMR/autism study as bad science. -Study's authors were funded by lawyers of parents with autistic children who were filing lawsuits against vaccine companies, a major conflict of interest. The main author has since lost his medical license amid charges of fraud and malpractice.

describe the various types of vaccine formulations

vaccine: an injection of a microbial antigen as a prevention for a disease. 1. active agent: live attenuated vaccines. 2. Inactive agent: whole-agent vaccines, purified subunit vaccines, toxoid vaccines, and conjugate vaccines.

describe how strains are selected for the annual influenza vaccine

whole inactivated viral strains: injectable vaccines, contain at least three inactivated viruses. live attenuated viral strains: -nasal mist vaccine (FluMist), contained at least 4 different, active but weakened viruses. World Health Organization works to predict the strains most likely to be circulating in the next flu season.

broad-spectrum drugs

drugs that are effective against both gram negative and gram positive bacterial cells

narrow-spectrum drugs

drugs that target a limited range of bacteria. For example, bacitracin and vancomycin are mainly effective against gram positive bacterial species.

ubiquitous

grow in varied climates and under diverse conditions; some are even common members of the normal flora of the human body. Typically only cause disease in immunocompromised patients.

vaccination

injection of a weakened or mild form of a pathogen to produce immunity

describe the best practices for collecting a sputum sample

position the patient upright in a chair or in bed in the Fowler position; a sodium chloride nebulizer can help loosen secretions; ask the patient to take deep breaths, in through the nose and out through the mouth, to help loosen secretions; collect the specimen in the pot and seal it with a lid to prevent contamination and reduce the risk of cross infection. Best practices: -Obtaining the specimen prior to antibiotic treatment. -Early morning samples are best. -Rinsing the mouth prior to expectoration. -No food for one to two hours prior to expectoration. -Saline nebulizer treatment before collection. -Prompt transport to the microbiology lab. -Keeping the saliva content to a minimum provides the best chance of diagnosing the problem.

upper respiratory tract

mouth, nasal passages, nasal sinuses, pharynx, and epiglottis.

mold

multicellular, characterized by hyphae, requires special stains to visualize, colony morphology is "fluffy" colonies.

Human Rhinovirus (HRV) replication

naked virus attaches to a nasal epithelial cell, happens to be a RNA virus, so goes through that process to make more RNA, and then leaves the cell through lysis

antibiotic

naturally occurring antimicrobial compounds

antibiotic resistance

occurs naturally, but misuse of antibiotics in humans and animals is accelerating the process. A growing number of infections, such as pneumonia, tuberculosis, gonorrhea, and salmonellosis, are becoming harder to treat as the antibiotics used to treat them become less effective. Antibiotics resistance leads to longer hospital stays, higher medical costs and increased morality.

diplococcus

pair of cocci, ex: Streptococcus pneumoniae (Pneumococcus).

prophylaxis

process that prevents infection or disease in a person at risk

bacteremia

A situation in which bacteria spread to the bloodstream; usually confirmed by culturing bacteria from a blood sample.

paroxysm

A sudden and violent attack (as in a paroxysm of coughing). a sudden recurrence or attack of a disease, a sudden worsening of symptoms.

consolidation

A term that refers to the apparent merging of the lung air sacs (alveoli) when fluid accumulates in the lungs; evident as white opaque areas by X-ray imaging. apparent merging of alveoli when fluid accumulates in lungs; white opaque areas on chest x-ray. characterized by a productive cough, patients can easily produce a sputum sample.

toxoid vaccines

A type of subunit vaccine; vaccines made with naturally occurring bacterial toxins that have been purified and inactivated.

epidemic

A widespread disease outbreak in a particular region during a specific time frame.

conjugate vaccines

Also called polysaccharide vaccines; these vaccines are created by linking polysaccharides to a protein antigen to stimulate an immune response in a vaccinated patient.

healthcare-acquired infection (HAI)

Also known as nosocomial infections; an infection that a patient develops while receiving care in a healthcare setting.

tachypnea

An abnormally high number of breaths per minute.

state why an empiric therapy may be intentionally broad spectrum

An empiric therapy may be broad spectrum when the causative organism is unknown. Broad spectrum antibiotics can be used to treat infections when the causative agent has not yet been identified.

define antigenic drift and antigenic shift and explain the consequences of each.

Antigenic drift is random mutations in a virus that cause minor changes in hemagglutinin and neurominidase (glycoprotein spikes on the viral surface), allowing for the evasion of the immune system. These changes are responsible for seasonal epidemics. Antigenic shift is major genetic change, which causes major alterations in viral antigens, which can allow for pandemics.

identify the target of the following drugs classes and explain the effect they have on bacterial cells: beta-lactams, penicillins, cephalosporin, carbapenems, glycopeptides, daptomycin, poplypeptides, quinolones, sulfa drugs, macrocodes, lincosamides, phenicols, tetracyclines, and ahminoglycosides.

Beta-lactams: contain a four sided beta-lactam ring that prevents cross linking of peptidoglycan, so the bacterial cell bursts. Drugs must bind the bacterial protein transpeptidase to disrupt PG synthesis. penicillin: blocks transpeptidase enzymes from building cross links in the peptidoglycan cell wall, resulting in a weak cell wall that cannot protect the cell from lysing (bursting). Cephalosporin: are bactericidal (kill bacteria) and work in a similar way to penicillins. Gylcopeotides: target bacterial cell walls. daptomycin: targets the cytoplasmic membrane, is effective against gram positive bacteria as it cannot penetrate gram negative bacteria, and causes loss of ions and lysis. polypeptides: targets outer membrane, interacts with with lipopolysaccharide, only effective against gram negative bacteria, and has a narrow therapeutic index and usually only works topically. quinolone: target DNA replication enzymes, taken orally and have a long half life. sulfa drugs: are competitive inhibitors of folic acid production, chemically resemble para-aminobenzoic acid (PABA), humans do not synthesize folic acid and it is needed in the diet. macrocodes/macrolides: contain a macrocyclic lactone ring, inhibit bacterial RNA-dependent protein synthesis, and are effective especially against gram positive bacteria (ex: staphylococci and streptococci). lincosamides: prevent bacterial replication in a bacteriostatic mechanism by interfering with the synthesis of proteins. phenicols: bacteriostatic by inhibiting protein synthesis, diffuses through the bacterial cell wall. tetracyclines: are protein synthesis inhibitors, target ribosomes. ahminoglycosides: interfere with bacterial protein synthesis. Bind to ribosomes, target ribosomes.

describe the role of carbapenems, vancomycin and daptomycin in the treatment of MRSA and other MDR bacteria

Carbapenems are broad-spectrum beta-lactam drugs that target bacterial cell wall construction; usually well tolerated; drug names for group members tend to end the suffix "penem." vancomycin: has no beta-lactam ring, can fight beta-lactam resistant bacteria, can be used against MRSA (Methicillin-resistant staphylococcus aureus) which is resistant to all beta-lactam drugs, is the preferred treatment for C. difficile, and most gram negatives are not affected. daptomycin: targets the cytoplasmic membrane, is effective against gram positive bacteria as it cannot penetrate gram negative bacteria, and causes loss of ions and lysis. Uses are in gram positive bacteria including MDR strains and can be given by IV only.

adenovirus infections

Causative agent: DNA virus; more than 50 types of adenoviruses can infect humans. Epidemiology: cause up to 10% of respiratory illnesses in children. Transmission: respiratory droplets and fomites. prevention: Sanitation practices and hand washing. Signs and symptoms: attack the respiratory tract; sore throat and cold-like symptoms. Pathogenesis and virulence factors: most strains causes Bronchitis, pneumonia, and croup. Occasionally cause potentially deadly infections. Certain adenoviruses cause viral conjunctivitis, gastroenteritis, and cystitis. Diagnosis: Nasopharygeal swab or NAAT. treatment: may require only care to help relieve symptoms, such as over-the-counter pain medicines or fever reducers. Vaccine against adenovirus types 4 and 7 given to military in the U.S.

Influenza virus infections (influenza or flu)

Causative agent: RNA viruses with segmented genome; envelope. Three types: A,B,C. Epidemiology: 2nd most common viral respiratory illness. Seasonal: late fall to early spring. Transmission: respiratory droplets and fomites. Prevention: Sanitation practices and hand washing. Seasonal vaccine. Signs and symptoms: Fever, aches, chills, headache, cough; sometimes runny nose. Pathogenesis and virulence factors: Binds ciliated cells of URT; Hemagglutinin (HA) and neuraminidase (NA). Complications: pneumonia. Diagnosis: Nasopharyngeal swab or NAAT. Treatment: Oseltamivir (Tamiflu®) can lessen severity and duration.

pharyngitis

Causative agent: Streptococcus pyogenes. Transmission: Respiratory droplets. prevention: droplet precautions. Signs and symptoms: Inflammation of the throat, exudate in the throat or tonsils. Diagnosis: rapid strep test for bacterial antigens, culture that identifies S. pyogenes. treatment: Penicillins; macrolides if allergic to penicillin.

state why certain mycoses are called endemic and others are not

Certain mycoses are endemic because the are caused by endemic fungi that only grow in specific geographical locations, are characterized by thermal dimorphism (depending on temperature, will switch between being a yeast and a mold), and can cause disease in healthy people through transmission by inhalation of spores. certain mycoses are not endemic because they are caused by ubiquitous fungi, which grow in varied climates and under diverse conditions, some being part of the normal flora and only causing disease in immunocompromised patients.

Blastomyces dermatitidis

Characteristics: Endemic fungus. Dimorphic. (endemic and dimorphic go hand in hand). Found in Great Lakes region, Mississippi and Ohio river valley. Diseases: Blastomycosis (Chicago disease). Transmission: Inhalation of spores (conidia). Non-communicable. Virulence factors: Dimorphism. Adhesins. Lab Diagnosis: Fungal culture (1-4 weeks). Treatment: Antifungals. Prevention: Avoiding exposure. Caution with rich organic soils, rotting wood, demolition.

Aspergillus species

Characteristics: Ubiquitous mold. Many species. A. fumigatus most common. Diseases: Aspergillosis. Transmission: Inhalation of spores. Non-communicable. Virulence: Avoiding immune detection. Surviving phagocytosis. Lab Diagnosis: Fungal Culture (1-4 weeks). Treatment: Antifungals. Prevention: Avoid exposure.

Mycobacterium tuberculosis

Characteristics: Acid-fast bacillus, Obligate aerobe. Diseases: Tuberculosis. Transmission: Airborne. Precautions: Airborne. Virulence Factor: Ability to survive phagocytosis. Lab Diagnosis: Acid-fast stain, NAAT, Culture (2-8 weeks), Mantoux test, chest x-ray. Treatment: Combined antibiotics (up to 2 yrs). Vaccine: Bacillus Calmette-Guérin, (BCG) vaccine, Live-attenuated (Not in use in U.S.).

Legionella pneumophila

Characteristics: Gram negative bacillus. Fastidious (?). Difficult to culture in lab. Diseases: Legionnaires disease. Pontiac fever (mild form). Transmission: Aerosols or aspiration of contaminated water. Virulence factors: Survive phagocytosis. Biofilm formation. Lab Diagnosis: Urine antigen test. Confirmed with culture (takes up to 10 days). Treatment: Quinolone, Macrolides. Prevention: Sanitation of water esp. air conditioners, humidifiers ect.

Haemophilus influenzae Pneumonia

Characteristics: Gram negative coccobacillus. Diseases: Otitis media, Pneumonia, Meningitis, Bacteremia. Transmission: Respiratory droplets, Normal microbiota of URT. Precautions: Droplet (for epiglottitis cases), Droplet (for meningitis cases), Droplet ( for pneumonia cases, children). Virulence factors: Capsule (not always). 6 types; Type B (Hib) cause most invasive disease. Lab Diagnosis: Culture. Will not grow on blood agar; needs chocolate agar. Treatment: Ceftriaxone; Resistant to beta lactams common. Prevention: vaccine: conjugate vaccine protects against Hib only. (conjugate vaccine means that the subunit portion of the virus is the capsule, the Type B capsule used).

Streptococcus pneumoniae (Pneumococcus)

Characteristics: Gram positive coccus; diplococcus. Lancet-shaped. Diseases: Pneumonia, Otitis media, Meningitis, Bacteremia. Transmission: Respiratory droplets, Normal microbiota of URT. Virulence factors: Capsule, Pneumolysin. Lab Diagnosis: Culture. Treatment: penicillin; usually. Antibiotic resistant strains on CDC serious threat list. Prevention: vaccine: conjugate vaccines; PCV13 (Prevnar®); childhood Pneumovax®; >50 yrs.

Human Parainfluenza Virus (HPIV) infections

Characteristics: RNA virus; Four types HPIV 1, 2, 3, and 4. Diseases: acute respiratory infection. (30% of respiratory infections in children under age 5. High risk: children. Cause infections in fall, spring, and summer.). Transmission: respiratory droplets and contact (fomites). Precautions: contact precautions. Pathogenesis: enters URT, frequently spreads to the paranasal sinuses, larynx and bronchi. Lab Diagnosis: nasopharyngeal swab or NAAT. Treatment: supportive care. Prevention: sanitation practices and hand washing; vaccine in trials.

Respiratory Syncytial Virus (RSV)

Characteristics: RNA virus; two subtypes RSV A and RSV B. Diseases: Acute respiratory infection (ARI). (Leading cause of ARI in children <5 worldwide (66,000-199,000 deaths per year; High risk for infants (esp. premature) and elderly). Transmission: respiratory droplets and contact (fomites). Precautions: contact and droplet precautions. Pathogenesis: enters URT, spreads to LRT. Causes inflammation of airways and formation of syncytium (fusion of an infected cells with neighboring cells leading to the formation of multi-nucleate enlarged cells). Lab Diagnosis: nasopharyngeal swab, NAAT. Treatment: supportive care, extensive antibody treatment. Prevention: sanitation practices and hand washing; vaccine in development.

Mycoplasma Pneumoniae

Characteristics: Small bacterium. No cell wall. Obligate Intracellular bacterium. Diseases: Atypical pneumonia or walking pneumonia. Transmission: Respiratory droplets. Virulence factors: Adhesins. Intracellular lifestyle. Hydrogen peroxide production. Lab Diagnosis: NAAT. Serology. Treatment: Macrolides. Prevention: Hand washing. Sanitation.

describe the Lancefield classification system for Streptococcus spp.

Classification system developed by Rebecca Lancefield (1895-1981). Grouped based on reaction of bacterial cell wall with different antibodies. 14 different groups (A thru O). -React with group "A" antibody = Group A (Streptococcus pyogenes). -React with group "B" antibody = Group B (Streptococcus agalactiae). -Only one type of Streptococcus would not react with any of the antibodies, Streptococcus pneumoniae.

list the top three urgent drug resistant bacterial threats to health in the U.S.

Clostridium difficile (Clostridioides difficile), Carbapenem-resistant Enterobacteriaceae (CRE), and Drug-resistant Neisseria gonorrhoeae.

artificial active acquired immunity

Immunity that involves using vaccines or other man-made interventions to trigger an immune response in the patient; confers long-term protection against specific antigens.

endemic

Describes infections that are routinely detected in a population or region.

describe the pathological progression of diphtheria and how it is prevented

Diphtheria toxin inhibits protein synthesis of host cells; cells die. Pseudomembrane caused by death of mucosal epithelial cells. Diphtheria is prevented by vaccines. Diphtheria progression can be prevented/treatment is antibiotics and an antitoxin that neutralizes the diphtheria toxin.

describe the process for diagnosing a LRT infection

Direct Gram stain of sputum sample (takes a few minutes). Samples that are of low quality (contaminated with saliva) are rejected. Bacteria culture of sample (takes 2-3 days).

mycoses

Diseases caused by fungi.

review the early history of vaccines from variolation to Jenner's advancements

Edward Jenner (1796): -milkmaids weren't affect by smallpox epidemics, most had previously contracted cowpox. -Jenner suspected that prior cowpox infection was protective against smallpox. Edward jenner tested his hypothesis by purposefully inoculating a boy with cowpox pus. The boy contracted cowpox, but quickly recovered. Jenner then infected him with smallpox, but he showed no symptoms.

describe the mechanism for rise in macrolide resistant GAS

Efflux pumps. Contributing to the resistance by choosing the more expensive and "better" drugs because they work faster instead of choosing the penicillin Which is less expensive and still effective.

describe the features of the most common causes of atypical bacterial pneumonia: mycoplasma pneumoniae and legionella pneumophila

FEATURES OF MYCOPLASMA PNEUMONIAE Characteristics: Small bacterium. No cell wall. Obligate Intracellular bacterium. Diseases: Atypical pneumonia or walking pneumonia. Transmission: Respiratory droplets. Virulence factors: Adhesins. Intracellular lifestyle. Hydrogen peroxide production. Lab Diagnosis: NAAT. Serology. Treatment: Macrolides. Prevention: Hand washing.Sanitation. FEATURES OF LEGIONELLA PNEUMOPHILA Characteristics: Gram negative bacillus. Fastidious. Difficult to culture in lab. Diseases: Legionnaires disease. Pontiac fever (mild form). Transmission: Aerosols or aspiration of contaminated water. Virulence factors: Survive phagocytosis. Biofilm formation. Lab Diagnosis: Urine antigen test. Confirmed with culture (takes up to 10 days). Treatment: Quinolone, Macrolides. Prevention: Sanitation of water esp. air conditioners, humidifiers ect.

for bacterial pathogens describe: gram morphology, diseases, transmission, virulence factors, diagnosis, treatment, and vaccine type

FLASHCARDS TO FOLLOW

for each viral pathogen describe: genome (RNA or DNA), transmission, clinical manifestations, diagnosis, treatment, and vaccine

FLASHCARDS TO FOLLOW

for fungal pathogens describe: morphology, disease, transmission, diagnosis, and treatment

FLASHCARDS TO FOLLOW

natural passive acquired immunity

Immunity that occurs when someone receives antibodies to an antigen through nonmedical means. The most common examples are maternal antibodies passing across the placenta to a baby in utero, and maternal antibodies moving into an infant through colostrum (an antibody and mineral rich fluid that precedes milk) and breast milk.

what can healthcare workers do to reduce the emergence of antimicrobial resistance

Healthcare workers can reduce the emergence of antimicrobial resistance through antibiotic stewardship: a coordinated program that promotes the appropriate use of antibiotics, improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.

what is herd immunity, how is it generated, and how does it protect a non-immunized person

Herd immunity is the communal immunity that protects unvaccinated individuals IF the majority of the population is vaccinated. Roughly 85% of the population for most pathogens. Roughy 95% of the population for measles and whooping cough. Immunization programs aim to create herd immunity. It protects non-immunized people (immunocompromised people, pregnant women, newborns, people with HIV, people whose immune systems cannot handle the vaccine at all) because when the majority of the population is vaccinated, it prevents a pathogen from finding enough susceptible hosts in the community to persist and spread to those that are unable to be vaccinated for medical reasons.

artificial passive acquired immunity

Immunity in which the patient receives protective antibodies from a medical treatment (such as the administration of an antivenom); does not lead to long-term protection against specific antigens.

natural active acquired immunity

Immunity that involves contracting an infection that triggers the patient's immune system to make memory cells and antibodies that confer long-term protection thereafter.

described how inactivated vaccines may be safer for the public than live attenuated vaccines

Inactivated vaccines may be safer for the public than live attenuated vaccines because they do not contain live components of the pathogen, only the antigenic parts of the pathogen. They do not create a large immune response and need boosters and additional doses in order to evoke an immune response. They are also good for immune-compromised patients Live attenuated vaccines can cause disease in people who are immune-compromised which can be very dangerous for them. A live attenuated vaccine can also possibly be mutated which would then lead to it being in an infectious form, once again dangerous to the public. The inactivated vaccines provide less risk or no risk of these things which makes them safer in comparison to the public.

latent infection

Infection in which the host does not have signs or symptoms (they are asymptomatic); if conditions are right, the agent can cause an active illness; infections that may be distinguished by flare-ups with intermittent periods of dormancy (latency).

pharyngitis

Inflammation of the pharynx (throat); mainly caused by bacteria, viruses, or allergens.

discuss how influenza A strains are categorized and the special features of the 1918 pandemic

Influenza A is the most common cause of human flu epidemics, the emergence of a new and very different influenza A virus can cause an influenza pandemic. Influenza A strains are categorized by variations in hemagglutinin and neuromidase (glycoprotein spikes on the surface of the virus). special features of the 1918 pandemic included that the highest mortality rate was in 15 to 34 year olds and cytokine storms that cause aggressive and out of control immune responses.

describe the progression of infection in latent versus active tuberculosis along with diagnostic criteria and treatment options

Latent tuberculosis is when the immune cells wall off infection forming as granuloma or tubercle. Tubercle gradually collects calcium deposits to form what is known as a Ghon focus. Tubercles often heal, leaving permanent scars that appear as shadows in chest X rays. Disease does not progress, but bacteria may remain in the body for many years. Diagnostic criteria is that they have the TB pathogen, but have no symptoms. treatment options are antibiotics. active tuberculosis is when the immune system is weakened, and the tubercle opens, releasing the bacteria. It involves more severe symptoms including violent coughing, bloody sputum, weight loss, fatigue, night sweats and chest pain. Untreated secondary TB has a nearly 60 % mortality rate. Highly communicable at this stage. diagnostic criteria is that they have the TB pathogen and symptoms. treatment options are antibiotics. _________________________________________________ The progression of TB starts with the bacteria being inhaled into the lungs, it is met with macrophages. Some of the phagocytized bacteria begins to thrive inside macrophages. In the latent form of TB, the immune system detects that there are certain macrophages in the lungs that are infected with bacteria. So, the immune system walls them off in fibrous granulomas to limit the spread. In the latent stage, the person is essentially a host to the bacteria and are showing no symptoms. In the event that it reaches active TB, this would mean that the host is able to transfer the bacteria to others. Active TB happens when the center of the granulomas liquifies which causes the walls to break down. When the walls break down this allows for an active infection that can transmit the bacterium to others. A person will notice an increase in symptoms when actively infected. Diagnosis is a Mantoux or PPD screening test, an intradermal injection of tuberculin purified protein derivative (PPD) and then measuring the size of the induration. This test does not distinguish between latent and active TB. Diagnosis can also include a chest X ray, acid fast stain, NAAT, and/or a culture (which takes 2-8 weeks). treatment options are combined antibiotic therapy.

explain the significance of MRSA, VRSA, and CRE

MRSA: (Methicillin-resistant staphylococcus aureus), Methicillin-resistant Staphylococcus aureus strains that have altered their cell wall construction enzymes in such a way that they do not associate with methicillin, penicillin, or a variety of other penicillin based drugs; infections caused by these bacteria are now commonplace in healthcare settings and in the general community. VRSA: (Vancomycin-resistant S. aureus), Staphlococcus aureus strain that is emerging, making S. aureus even more challenging to treat. CRE: (carbapenem-resistance enterobacteriacaea), Certain genera of the Enterobacteriaceae, a large family of Gram-negative bacteria, that have developed resistance to carbapenems and have rendered even these last-resort drugs useless against some infections. Klebsiella pneumonia and Escherichia coli are among the more prevalent CRE. all types of antibiotic resistant bacterias.

otitis media

Middle ear infection, which may occur during a cold, when inflamed membranes can cause mucus to accumulate in the respiratory tract, providing an ideal environment for bacteria to grow. In children, otitis media is a frequent example of such an infection.

antigenic drift

Minor genetic changes in a virus. (what causes influenza epidemics).

describe what a mycosis is and why they are becoming more common

Mycosis is a fungal infection. They are becoming more common due to increased urban development and deforestation (bringing certain fungal pathogens to us at a higher rate than they were before), climate change, and the increased number of people with weakened immunity.

convalescent period

Not fully better, but recovering; stage of infection that usually involves elimination of the pathogen from the body, but sometimes the host harbors a pathogen indefinitely; this is especially true for certain viruses.

horizontal gene transfer

Occurs when genetic information is passed between cells by a process independent of cell division, and therefore separate from reproduction.

Bacterial Disease of Upper Respiratory Tract

Otitis media: -Streptococcus pneumoniae -Non-typeable Haemophilus influenzae Pharyngitis: -Streptococcus pyogenes (Group A Streptococcus) Diphtheria: -Corynebacterium diphtheriae Pertussis: -Bordetella pertussis

describe the pathological progression or pertussis and why it is a reemerging disease

Pertussis toxin triggers generalized inflammation in the respiratory tract. Additional exotoxins can inhibit killing by phagocytes and damage ciliated epithelium. Pertussis is a reemerging disease because Immunity wanes by 12yrs, so teens and adults should get boosters.

explain why strains of S. pneumoniae and M. tuberculosis are on the CDC's serious threat list

S. pneumoniae is on the CDCs serious threat list because it causes pneumococcal disease, which can range from ear and sinus infections to pneumonia and bloodstream infections, and has 1.2 million drug resistant infections per year. M. tuberculosis is on the CDCs serious threat list because it is among the most common infectious diseases and a frequent cause of death worldwide. Also known as multi drug-resistant TB (MDR TB), or extensively drug-resistant TB (XDR TB) - is very drug resistant.

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describe how antitoxin is produced and how it can treat diphtheria

Scientists learned to harness the immune systems of some animals to produce antitoxin serums to use as medicines. Diphtheria antitoxin was one of these medicines. Doctors used diphtheria antitoxin to treat and prevent diphtheria, an often deadly childhood disease. 1. scientists grow diphtheria-causing bacteria in the laboratory and harvest its toxin. 2. next, researchers inject horses with the diphtheria toxin. As an immune response, the animals' blood produces diphtheria antitoxin. 3. scientists collect blood from the horses and separate out the antitoxin rich serum. 4. then, researchers purify the antitoxin serum for use as medicine for people.

compare and contrast typical and atypical pneumonia (signs and symptoms, expected culture results, and prevalence)

Signs and symptoms of TYPICAL PNEUMONIA include a cough with sputum, no runny nose, no joint aches, no muscle aches, chest pain with inhaling, shortness of breath, high fever, and severe chills. Expected culture results reveal a gram negative or positive bacteria. The prevalence is 4 out 5 pneumonia cases. Signs and symptoms of ATYPICAL PNEUMONIA include runny nose, joint aches, muscle aches, cough with little or no sputum, no chest pain with inhaling, shortness of breath, low grade fever, and little or no chills. In expected culture results, often an agent is not successfully cultured from a sputum sample. The prevalence is 1 out of 5 pneumonia cases.

recognize antibiotic names by family and identify their cellular targets

TARGET BACTERIAL CELL WALL SYNTHESIS: Beta-lactams: -penicillins (end in "-cillin") penicillin, ampicillin ... -cephalosporins (start with "cef-" or "ceph-"). cefipme, cephotaxime ... -Carbapenems (end in "-penem"). meropenem, imipenem ... Gylcopeptides: -Vancomycin (really important in fighting resistant bacteria). TARGET CELL MEMBRANES Daptomycin (lipopeptide): targets the cytoplasmic membrane, is effective against gram positive bacteria as it cannot penetrate gram negative bacteria, and causes loss of ions and lysis. Uses are in gram positive bacteria including MDR strains and can be given by IV only. Polymyxin B and Colistin (polypeptides): targets outer membrane, interacts with lipopolysaccharide, only effective against gram negative bacteria, and has a narrow therapeutic index and usually only works topically. TARGET DNA/RNA SYNTHESIS Quinolones: have "Fl" in the name, target DNA replication enzymes, taken orally and have a long half life. Ex: Ciprofloxacin (effective against Mycobacterium and Pseudomonas species); Levofloxacin (used to treat "walking pneumonia" caused by Mycoplasma pneumonia. TARGET METABOLIC PATHWAYS Sulfa drugs (sulfonamides): originally discovered in the 1930s, are competitive inhibitors of folic acid production, chemically resemble para-aminobenzoic acid (PABA), humans do not synthesize folic acid and it is needed in the diet. ex: sulfamethoxazole- often administered with another antifolaxe drug, trimethoprim (not a sulfa drug), which targets different steps of the same biochemical pathway, together they exhibit synergism, and is a combination drug commonly known as Bactrim. TARGET RIBOSOMES/PROTEIN SYNTHESIS Macrolide drugs (end in "-mycin"). ex: erythromycin, clarithromycin, azithromycin ("Z-Pak"). Aminoglycosides (end in "-mycin"). Lincosamides (end in "-mycin"). Note: vancomycin and daptomycin do not belong to any of these families Tetracyclines (end in "-cycline"). Phenicols (end in "-phenicol"). ex: Chloramphenicol. Reserved for treating severe infections caused by certain multidrug-resistant bacteria.

compare and contrast typical and atypical pneumonia

TYPICAL PNEUMONIA general presentation: -High fever. -sudden onset of severe chills. -Shortness of breath. -Cough with sputum (productive cough). -Chest pain when inhaling. -usually absent: runny nose, muscle aches, joint aches. physical examination: -Noticeable respiratory distress. -Consolidation usually present (fluid accumulation in the lungs). chest x ray: -Consolidation. -Usually an opaque white area is visible in at least one lung lobe. sputum culture: reveals gram positive or negative bacteria. prevalence: 4 out of 5 pneumonia cases. ATYPICAL PNEUNOMIA general presentation: -Low grade fever. -Little to no chills. -Shortness of breath. -Cough with little or no sputum (nonproductive cough). -Usually no chest pain upon inhaling. -Commonly present: runny nose, muscle aches, joint aches.-Usually community acquired. -Onset is usually more subtle than for typical pneumonia. physical examination: -Limited respiratory distress. -Limited consolidation (minimal fluid in lungs). -Breathing sounds: crackling sound (or rales) as the patient breathes. Chest x ray:-X-ray often looks worse than the patient appears or feels. -May see white opaque areas in both lungs in a patchy or a diffuse pattern. -Usually only a small amount of fluid in the lung air sacs. Sputum culture: often an agent is not successfully cultured from sputum. prevalence: 1 out of 5 pneumonia cases.

discuss how the use of antibiotic drugs selects for resistant microbes and describe the 3 methods by which bacteria can exchange genetic information

The use of antibiotic drugs selects for resistant microbes because only microbes that can survive the the drugs are able to survive and reproduce, leading to future resistant microbes. The three methods by which bacteria can exchange genetic information are bacterial transformation, bacterial transduction, and bacterial conjugation. bacterial transformation is the release of DNA containing an antibiotic resistant gene from the recipient cell to the donor cell. bacterial transduction is the release of a phage from phage-infected donor cell to the recipient cell. bacterial conjugation is when a transposon is moved from a donor cell to a recipient cell.

discuss how the use of antimicrobials selects for resistant microbes and summarize how resistance many spread by clinical practices

The use of antimicrobials selects for resistant microbes because the more often antimicrobials are used, the more opportunities there are for microbes to adapt. Healthcare settings are incubators for antimicrobial resistance Healthcare workers and staff often pick up resistance strains on their hands, scrubs, and personal electronic devices. They transfer to themselves, their patients, their communities.

exotoxin

Toxic soluble proteins made by both Gram-positive and Gram-negative bacteria that affect a wide range of cells; these protein toxins are often named based on the organism that makes the toxin or the type of cells the toxin targets; usually classified into three main families based on their mode of action. a toxin released by a living cell into its surrounding environment.

herd immunity

Type of communal immunity that occurs when a pathogen won't find enough susceptible people in the community to persist, even if a small number of individuals there remain unvaccinated; herd immunity allows nonvaccinated individuals, such as premature babies and immune-compromised patients, to still reap the protective benefits of immunization provided a sufficient percentage of the rest of the population is vaccinated.

contrast endemic and ubiquitous fungal infection, and provide an example of each type

Ubiquitous fungal infections grow in varied climates, under diverse conditions, some are part of the normal flora, and they typically only cause disease in patients that are immunocompromised. Example would be Aspergillus. Endemic fungal infections only grow in specific geographical regions, cause endemic mycoses, characterized by thermal dimorphism, can cause disease in healthy people, and transmission is through the inhalation of spores. Example would be Balstomyces dermatidis.

describe the different vaccine types, and the advantages and disadvantages of each

Vaccine formulations are active agent (live attenuated vaccines) and Inactive agent (whole-agent vaccines, purified subunit vaccines, toxoid vaccines, and conjugate vaccines). Active agent (live attenuated vaccines): contain pathogens that can multiply but have lost important virulence factors. Whole organism that is alive and can replicate. benefit: best immune response, most closely mimics natural infection. drawbacks: must be refrigerated, can cause disease in immune-compromised hosts, possible mutation to an infectious form. inactive agent: whole agent vaccines: inactivated vaccines; consist of whole, inactivated pathogens. benefits: good immune response, safe for immune-compromised patients, and stable at room temperature. drawbacks: boosters required to achieve full immunity. subunit vaccines: do not include whole pathogens, consist of purified antigens (immunogenic portion of the pathogen). can be harvested from a natural pathogen or purified from a genetically engineered expression system (recombinant vaccines). portion of a pathogen is used to stimulate an immune response. Requires adjuvants (something we add to a vaccine to increase the immune response, like aluminum salts or monophosphoryl lipid A). purified subunit vaccines: purified antigenic components of pathogen. made by either purifying parts of the actual pathogen or, in recombinant vaccines, using genetic engineering to make parts of the pathogen. toxoid vaccines: purified and inactivated toxins (ex: tetanus and diphtheria of DTap and Tdap). conjugate vaccines: polysaccharide antigens conjugated to a more immunogenic protein antigen (ex: meningococcal vaccines, pneumococcal vaccines, and Hib vaccines). polysaccharides are conjugated or linked to a component that enhances immunogenicity.

define vaccine hesitancy. what factors have contributed to vaccine hesitancy and how has declining immunization rates affected public health

Vaccine hesitancy is waiting or not wanting to receive vaccinations for you, or in many cases, for your child. Factors that have contributed to vaccine hesitancy include: -objection to vaccines based on the use of human cell lines for vaccine production (Viruses cannot be grown in the lab without host cells. Host cells often can be chicken eggs or other animal cells in culture. For viruses that will only grow in human cells, human cell lines must be used). Moral objection if human cells were derived from embryonic or fetal tissue. -The Lancet paper that claimed a correlation between the measles, mumps, and rubella (MMR) vaccine and the development of autism, which was proven to be bad science and incorrect. Declining immunization rates have affected public health because it lessens herd immunity and leads to more cases of vaccine-preventable diseases. For example, the Measles Outbreak in 2019: the greatest number of cases reported in the U.S. since 1992. More than 75% of the cases this year are linked to outbreaks in New York. Measles is more likely to spread and cause outbreaks in U.S. communities where groups of people are unvaccinated. The majority of cases are among people who were not vaccinated against measles. Measles can cause serious complications. As of September 19, 2019, 131 of the people who got measles this year were hospitalized, and 65 reported having complications, including pneumonia and encephalitis.

live attenuated vaccines

Vaccines in which pathogens have been altered so that they do not cause disease (are not pathogenic), but are still infectious. These vaccines are the closest to the actual agent encountered in nature and therefore tend to simulate potent immunological responses that are accompanied by long-lived memory.

whole agent vaccines

Vaccines that contain the entire pathogen, which has been rendered inactive by heat, chemicals, or radiation; benefit of whole-agent vaccines is that the agent is essentially the same as what would be encountered in nature, but they can't cause disease in a weak host or mutate to cause disease.

subunit vaccines

Vaccines that do not include whole pathogens, instead consisting of purified antigens or parts of the infectious agent. Because subunit vaccines have fewer antigens than whole-agent or live attenuated vaccines, they require adjuvants to stimulate a strong immune response.

pandemic

Worldwide outbreak of disease.

vaccine hesitancy

beahavior, influenced by a number of factors including issues of confidence (not trusting vaccine or provider), complacency (do not perceive vaccines value, and convenience (access) -contextual influence -individual and group influence -specific vaccine issues

compare and contrast the symptoms of colds and influenza

cold: gradual symptom onset, sneezing, stuff nose, sore throat, chest discomfort/cough. flu: abrupt symptom onset, fever, aches, chills, chest discomfort/cough, headache.

acute respiratory infection (ARI)

common cold. Causative agent: 200 different viruses including rhinoviruses (25%), coronaviruses (10%), parainfluenza viruses, respiratory syncytial virus, and adenoviruses. Epidemiology: most prevalent of all URTI; leading cause of patient visits to the physician, as well as work and school absenteeism. Transmission: respiratory droplets and fomites. Prevention: sanitation practices and hand washing. Signs and symptoms: sore throat, runny nose, sneezing, fatigue, general body aches, loss of appetite, cough, low grade fever (rarely). pathogenesis and virulence factors: attachment to nasal epithelial cells, destruction of the epithelial layer. diagnosis: clinical diagnosis. treatment: usually self limiting; supportive care.

duspnea

difficult or labored breathing, commonly called shortness of breath.

lancet-shaped

elongated cocci with a slightly pointed outer curvature. Streptococcus pneumoniae cells are Gram positive, lancet-shaped cocci.

URT infections (URTI)

etiology: most URTI are caused by viruses. Pathogenesis: portal of entry are droplets and fomites. Epithelial destruction, redness, edema, and exudate. Clinical manifestations: signs and symptoms: runny nose, sneezing, fatigue, coughing, stridor, dyspnea, sometimes fever. Lab diagnosis: clinical symptoms are a common cold, otitis media. Nasal or nasopharyngeal swab for bacterial and viral testing. Viral testing is usually Nucleic Acid Amplification Testing (NAAT).

explain herd immunity and describe how it protects non-immunized people

herd immunity is the idea that communal immunity protects unvaccinated individuals IF the majority of the population is vaccinated. Roughly 85% of the population for most pathogens. Roughy 95% of the population for measles and whooping cough. Immunization programs aim to create herd immunity. Herd immunity prevents a pathogen from finding enough susceptible people in the community to persist, allowing a small number of individuals to remain unvaccinated. It only serves as protection for those unable to receive immunizations due to medical reasons.

Respiratory Syncytial Virus (RSV) Infections

if it invades or is infecting neighboring cells, these cells will merge all their membranes to become one giant, multi nucleated host cell = syncytial (causes giant, multi nucleated host cells).

rheumatogenic

strain that causes rheumatic fever, this usually follows pharyngeal infection.

describe the difficulties of developing drugs against viruses and eukaryotic pathogens

it is difficult to develop drugs that specifically target viruses and eukaroytic pathogens without damage to the host cell because they have similar structures, their physiology is similar to our own.

lower respiratory tract

larynx, trachea, bronchi, bronchioles, lungs, and alveoli. Directs air to the lungs (site of gas exchange).

Pertussis (Whooping Cough), Bordetella pertussis

signs and symptoms: 7-10 day incubation period. -Catarrhal stage: cold-like symptoms, 1-2 week. -Paroxysmal stage: severe cough (paroxysms), 2-6 weeks. Vomiting, fractured ribs, bleeding behind eyes and in brain. -Convalescent stage: less frequent coughing, ~ 4 weeks. pathogenesis and virulence: Pertussis toxin triggers generalized inflammation in the respiratory tract. Additional exotoxins can inhibit killing by phagocytes and damage ciliated epithelium. characteristics: gram negative bacillus, challenging to grow in lab. transmission: respiratory droplets, direct contact. precautions: droplet. virulence factors: Pertussis toxin, other endotoxins. lab diagnosis: NAAT. treatment: macrolide antibiotics. prevention: DtaP vaccine: subunit toxoid vaccine that includes inactivated pertussis toxin (toxoid). Boosters recommended for teens, pregnant women, health-care and child-care workers.

Corynebacterium diphtheriae, diphtheria

signs and symptoms: Cold-like symptoms; sore throat, low-grade fever, cough, "Bull neck". Pseudomembrane forms in the upper airway causing respiratory distress. Mortality: 10% of treated cases and ~50% of untreated cases. pathogenesis: Diphtheria toxin inhibits protein synthesis of host cells; cells die. Pseudomembrane (the formation of a dense, gray debris layer composed of a mixture of dead cells, fibrin, RBCs, WBCs, and organism) caused by death of mucosal epithelial cells. characteristics: gram positive bacillus. transmission: respiratory droplets. precautions: droplet. virulence factors: diphtheria toxin. lab diagnosis: culture. treatment: antitoxin. prevention: DtaP vaccine: a subunit toxoid vaccine that includes inactivated diphtheria toxin (toxoid).

Otitis media

signs and symptoms: ear ache, redness of eardrum, drainage, fever. pathogenesis: ARI (viral) cause inflammation of Eustachian tubes; inflammation causes mucus to accumulate; lack of drainage allows for bacterial infection of the middle ear, usually part of the normal microbiota. diagnosis: clinical diagnosis. treatment: treat with pain relievers, antibiotics are not recommended, temporary tubes to increase drainage. causative agents: Streptococcus pneumoniae (Gram positive coccus); vaccines, but some strains are not in the vaccines; Nontypable Haemophilus influenza (Gram negative bacillus); vaccines, but some strains are not in the vaccines; Also can be viral. prevention: For infants: breast-feeding until at least 6 months. Pneumococcal vaccine (PCV13 or PCV23): a conjugate vaccine that protects from some strains of Streptococcus pneumoniae. Haemophilus influenza type B (Hib) vaccine: a conjugate vaccine that protects from some strains Haemophilus influenza type B.