Microbiology Ch10- CH11-CH12- CH13-CH14-CH15-CH16-CH17

QU. Describe the Normal biota of the eye?

-16s rRNA analysis showed that the biota of the eye resembles that of the skin. -Corynebacterium is the dominant species of the eye.

H. What are the patterns of Transmission in Communicable diseases?

- Horizontal Transmission: From parent to offspring via ovumn, sperm, placenta, milk -Vertical Transmission: Spread through a population from one infected individual to another. -Indirect Transmission: Passes from an infected host to an intermediate conveyor and from there to another host -Direct Transmission- Close contact to people -Special Category of indirect transmission: Refers to a puncture, in which material from the environment is deposited directly in deeper tissue -Vector Transmission: Arthropods that harbor infectious agent and transmits it to a human (biological: If the microorganism lives and multiples inside the insect) (Mechanical: the insect is not necessary for the life cycle of the infectious agent and merely transport it without being infected)

QH. Describe the overview of laboratory Techniques?

-Analyzing patient signs of microbial infection comes first -then specimens are collected and analyzed with time required for types of tests. -Then results of specimen analysis are entered into a Summary Patient Chart for assessment and treatment regimens -As a health care provider, understanding and communication of lab results are critical in treatment of a patient.

Fda. describe step Five in infecting a host: Vacating the host- Portals of exit?

-Pathogens are defined as successful if it can leave the host to move to other susceptible hosts. - Portal of exit is how pathogens depart by a specific avenue. 1. Done by shed or release from the body through secretion, excretion, discharge, or sloughed tissue. 2. In many cases it is the same as the portal of entry but some use a different route for their portal of exit.

Ra. Describe Haemophilus Influenzae?

-Results in severe meningitis -Is now less common in US because of vaccinations -Cases in the US now are often caused by the non- serotyped B strain -Globally is a important cause of death for children under 5

QO. Describe Impetigo caused by Staphylococcus Aureus?

-Virulence factors: exotoxins, exfoliative toxins A and B that codes for a phage that infects some S. Aureus strains -The breakdown/ blistering of skin that facilitates the spread of the skin is caused by the toxin that attacks the epithelial cell to cell binding in the outermost later of the skin.

K. What cells are of permeant residence at the portal of entry or by filtration organs?

Differentiated macrophages, Dendrites, and specializes histiocytes cells (can be Kupffer cells of the liver, Alveolar macrophages of the lungs, and Langerhans cells of the skin)

B. How do drugs that treat protozoa work?

Modifies free heme so Pasmodium can't gain nutrition. Makes parasites less effective in eating hemoglobin (messes with blood availability)

QN. What is the Roseola disease?

- "Sixth disease" occurs in young children and babies -30% cases end up in a maculopapular rash -exhibit high fever that lasts three days and seizures may occur -fourth day fever disappears and a rash can appear on chest and trunk and is less prominent on face -When rash appears, disease is almost over -Causative agent is herpesvirus called HHV-6- remains latent after disease has cleared to reactivate later leading to mononucleosis like or hepatitis like symptoms -100% population is thought to be infected by adulthood- could be the cause of other diseases like multiple sclerosis, no treatment or vaccine exists

H. Describe the transmission of infectious agents?

- A disease is communicable when an infected host can transmit the infectious agent to another host and establish infection in that host. -Transmission can be direct or indirect. - A disease is contagious if an agent is highly communicable, especially through direct contact -A disease is noncommunicable if it does not arise through transmission of the infectious agent from host to host but the infection is acquired through special circumstances (like if one is invaded by their own microbiota or by accidental contact in a nonliving reservoir.

QR. Describe Vesicular or Pustular Rash diseases?

- Are generalized rashes over the body that have individual lesions that contain fluid called a pox. -Two diseases are: Chickenpox (common and mostly benign) and Smallpox (constitutes a public health emergency) Both are viral diseases

I. Describe the Epidemiological Statistics: frequency of Cases?

- Prevalence of a disease is the total number of cases within a population. (total number of cases in population/ total number of persons in a population times 100= %) -Disease incidence measures the number of new cases over a certain period of time indicating the rate and risk of infection. (number of new cases in a designated time period/ Total number of susceptible people= usually reported per 100,000 people)

G. What is a sign? What is a symptom? What is a syndrome?

-A sign is any objective evidence of disease as noted by an observer - A symptom is the subjective evidence of disease as sensed by the patient. Signs are more accurate than symptoms - A syndrome is when a disease can be identified or defined by a certain complex of signs and symptoms.

G. List the long term infections and long term affects of an infection? (Latency and Sequelae)

-Latency is a dormant state that an infectious agent retreats into which gives it the opportunity to periodically become active and produce a recurrent disease. (herpes complex, hepatitis B, AIDS, Malaria) If shed during latent stage, a person can become a chronic carrier that serves an a source of infection for the rest of the population. - A sequelae left by diseases is a long term or permanent damage to tissues or organs

G. What are signs of infection in the blood?

-Leukocytosis: Is an increase in the level of white blood cells - Leukopenia: Is a decrease in white blood cells -Occurrence of microbe or its products in the blood. -Septicemia: General state in which microorganisms are multiplying in the blood and are present in large numbers -Bacteremia or Viremia: When small numbers of bacteria or viruses are found in the blood meaning that they are present and not necessarily multiplying

QJ. Describe Normal Biota of the skin?

-Microbes must be capable of living in dry, salty conditions they my find on the skin but can grow on moist areas of skin folds & groin. Can also live in protected areas of hair follicles and glandular ducts -16s rRNA sequencing and the Human microbiome project help us to learn about our skin's biota. Different species flavor different parts of the body and different people have different species.

QW. Describe the Normal Biota of the Nervous system?

-No normal biota in either the CNS or the PNS and any organisms found here are representing a deviation from a healthy state. -Gut Microbiome influences the nervous system in many ways. In fact the brain development, the blood brain barrier, and proper construction of peripheral nerves are influenced by microbiome in the gut

RT. Describe Measles Virus: Subacute Sclerosing Panencephalitis?

1. (SSP) :Slow virus infection" bc symptoms appear years after initial measles episode & is different from immune mediated postinfectious encephalitis 2. Caused by direct viral invasion of neural tissue 3. No effective treatment and is always fatal

L. Describe Helicobacter pylori?

Gram negative, motile via flagella: takes up residence on epithelial cells in the stomach Stomach has low Ph, so this microorganism produces enzyme urease to convert some of the urea and water into carbon dioxide and ammonia which will help to neutralize the stomach to it can replicate and will eat epithelial cells and cause ulcers and even cancer.

B. What are the categories of antimicrobial drugs dependent on what metabolic target they affect? Name the targets.

Inhibition of well call synthesis, inhibition of nucleic acid structure and function (RNA and DNA), inhibition of protein synthesis, interference with cytoplasmic membrane structure or function, and inhibition of folic acid synthesis

Q. What are qualities of effective vaccines?

Inject or drink, body will take antigen and present it to B cells and make antibodies and overtime you make memory B cells that make an Anti body against the antigen presented in the vaccine. 1. Protect against natural and wild forms of exposure to pathogen 2. It should be a low level adverse side effect and not cause harm 3. Should stimulate a B cell response and cell mediated T cell response 4. Long term and lasting effects 5. Not require numerous doses or boosters be inexpensive, long shelf life, and easily administered Should involved either Whole cells: 1. live attenuated 2. Killed cells or inactive viruses OR involve Part- of organisms: Antigenic molecules 1. subunits from cultures/cells/viruses 2. Subunits chemically synthesized to mimic 3. subunits manufactured via genetic engineering 4. subunits conjugated with protein to make then more immunogenic. New Vaccines: DNA vaccines: DNA is inserted into plasmid vector and inoculated into recipient. Immunotherapy: T cells or dendritic cells are removed from the patient and are synthesized to known cancer antigens and are injected back into the patient in hopes that tumor antigens match the ones used for activation in labs and hope that patients immune system will attack the tumor. Administration of vaccines: Nasal spray/ oral does stimulate IgA- mucous protection on portal of entry Adjuvant: Compound that enhances immunogenicity and prolongs antigen retention at the injection site in tissues for gradual release contact with antigen presenting cells and lymphocytes. (trick immune system into thinking it is infected)

M. What are Antimicrobial products?

Interferons: Small proteins produced naturally by White blood and tissue cells for defense against viruses and microbes and in immune regulation and intercommunication. They bind to cell surfaces and induce changes in genetic expression, often to prevent multiplication of infectious agents (degrading RNA or preventing the translation of viral proteins). They can also induce the production of proteins to fight infection like an enzyme that produces reactive oxygen chemicals. They are not microbe specific so they are used for treatment in a number of viral infections. Complement: Compliments the immune system by producing blood proteins that work together to destroy bacteria, effect viruses, parasites or other nearby cells. Complement Cascade goes through 4 stages in its deployment: Initiation (many ways like antibodies), activation (by binding to antibodies that are bound to microbes) and cascade, polymerization, and membrane attack. Alternative Complement Pathway: Does not require antibody to get started, but is INITIATED by foreign cell antigens. A C3 protein either free or bound to a pathogen membrane is hydrolyzed into C3b and C3a ACTIVATION AND CASCADE: is further enzymatic action. C3b protein cleaves the protein C5 into C5a and C5b. POLYMERIZATION: The C5 is now free to form a complex with C6, C7, and C8 called a Membrane Attack Complex (MAC). MEMBRANE ATTACK: Mac causes pore formation in the membrane which lead to lyses of the cell. C3 left over acts non specifically to new pathogens and this accounts for complement activation gone awry which leads to autoimmune dysfunction. Activation of the complement provides a strong link from the second line of defense to the third and help regulate immunity by helping attract host antibodies to bind to pathogens so phagocytes can easily identify and eat them. Antimicrobial peptides: Have the capability of inserting themselves into bacterial membranes and have mechanisms for killing microbes (disrupts the cell membrane) like how defensin causes a cell to fold on itself and can cause a pore in the membrane which leads to cell lyses. Though to be used in therapeutic drugs Complement system: lyse cells Lactoferrin by the host vs Siderophores by the pathogen: iron- binding proteins; they fight each other for the iron Restrictive factors: Some hosts an immune cells have the capability to prevent the synthesis of new virus parts by making proteins and nucleic acids that bind to certain parts of the virus. An example is a restrictive factor that prevents replication of retroviruses by changing cytosine to uracil and utilizing miRNAs that selectively target the viral DNA

B. What is the goal of Antimicrobial drugs?

Is to disrupt the cell process or structures of bacteria, fungi, and protozoa or to inhibit virus replication (inhibit enzymes that synthesize or assemble macromolecules or destroy structures already formed in the cell) Selectively toxic: Should kill or inhibit microbial cells without damaging the host cell

B. What is a Epigenetic event and the gene silencing called in fungi?

It is the reverse mechanism of binding the a regulatory RNA to block the target of antibiotic targets rendering a temporary resistance to that drug called: Epigenetic event The gene silencing is called Epimutation

G. What is asymptomatic or subclinical?

It means that a host can be infected but does not manifest the disease.

B. What are the four main drug groups to treat fungal infections?

Macrolide Polyene Antibiotics(Bind to fungal membranes causing loss of selective permeability, used to treat skin and mucous membrane lesions, injectable forms treat histoplasmosis and Cryptococcus), the azoles (disrupt sterol synthesis), the echinocandins (inhibit cell wall synthesis), and the allylamines (inhibit enzyme critical for ergosterol synthesis

P. What kinds of different cells serve as Antigen- presenting Cells (APCs) which is how antigens are formally presenting to a lymphocyte.

Macrophages B Cells Dendritic Cells: They grab an ingest antigen carrying microbes, they pass the antigen on to its membrane complexed with either MHC-1 or MHC-2 markers. after processing is complete, the antigen is bound to the MHC receptor and moved to the surface of the APC so that it is accessible to T lymphocytes during presentation.

Fdhij. Describe the Virulence factors of epigenetic changes in the host of an infection?

Microbes can shut down or inactivate regions of DNA in a host cell by 1. Binding to host cell histones 2. Binding to small RNAs used for the silencing of genes 3. Binding to chromatin itself 4. Secrete proteins to interact with DNA that change its structure and disorganizes the cell and can pass to new cell hosts and causing persistent symptoms These changes can harm the host by changing its function.

B. Describe why the nonrecommended antibiotics for sinus, ear, and throat infections can cause increased antibiotic resistance?

Nonrecommended antibiotics are more broad spectrum than the recommended ones, and are therefor more likely to lead to microbial disruption and increased antibiotic resistance.

Qk. Describe Genotypic methods?

Nucleic base tests have become a mainstay for microbial identification. A. Polymerase Chain Reaction (PCR): The backbone of new diagnostics: AB. Results in numerous identical copies of DNA or RNA molecules within hours AC. Using primers to amplify specific DNA sequences Three types: a1. Real Time PCR: It uses fluorescence labeling during the amplification procedure and the level of fluorescence is measure in real time as the reaction is running. It also assesses the antimicrobial susceptibilities at the same time as they are identifying the organism. a2. Multiplex PCR: Contains primers for multiple different organisms in the differential diagnosis for the patients symptoms. It often is also the Real time PCR. a3. Panbacterial qPCR: Is important for assessing wound or infection that is polymicrobial because it uses a primer that is common to all bacteria, so all bacteria will be amplified, even after antibiotic treatment. a4. Hybridization: 1. Uses small fragments of single DNA or RNA strand (a probe) that is fluorescently labeled or attached to an enzyme that triggers a colorimetric change when hybridization occurs with its specific sequences of nucleic acid isolated form a microbe in which are complementary to probes. 2. Fluorescent in stu hybridization involves the use of fluorescently labeled probes to intact cells within a sample. Used to indicate glowing cells and conclude the identity of a specific microbe or microbial components within a biofilm. Use for Cancer diagnosis & when examining specific DNA or characteristics that make certain drug choices better than others. 3. Microarrays: The use of absorbent plates (chips) that contain gene sequences from potential infections of the one being investigated. Patient sample is isolated an incubated with labeled genes on the microarray. Matching sequences hybridize to the chip and is detected by a computer program which provides the identity of the isolate(s). a5. Whole Genome sequencing: A single genome can be scanned and analyzed multiple times in a process known as "deep sequencing" which minimizes error and provides for a rapid test in the common workplace. a6. Pulsed Field Gel Electrophoresis: Uses a technique of slowly applying alternative voltage levels to the gel from three different directions, allowing DNA fragments to fully separate. DNA is subjected to restrictive enzymes, and single changes in the DNA sequence will result in fragments of different sizes. Used of investigation of food born outbreaks.

B. What kinds of drugs are the most toxic to humans?

One's designed to interfere with the cell membrane (Amphotericin B- used to treat fungal infections)

C. What is Anti-biotic associated colitis?

Oral therapy with tetracyclines, clindamycin, and broad spectrum penicillin's and cephalosporins cause an overgrowth of endospore- forming bacterium called Clostridium difficile that invades the intestinal lining releasing toxins that induce diarrhea, fever, and abdominal pain.

B. Describe the development of penicillin?

Original penicillin was narrow spectrum and susceptible to microbial counter attacks. Later penicillin were developed to ever come those two limitations

B. What is a drugs with excellent selective toxicity and why?

Penicillin- They block the synthesis of the bacteria wall by interfering with peptidoglycan which humans do not have in their cell walls.

B. What category of microbial drug inhibitors are (50s subunit) Azithromycin, clindamycin, synercid, pleuromutilins, (30s subunit) aminoglycosides, glentamicin, streptomycin tetracyclines, glycylcyclines, and (30s and 50s subunit) linezolid involved in ?

Protein synthesis Inhibitors

B. What drug treats malaria?

Quinolones, mainly chloroquine and primaquine which are less toxic to humans. Many variations because no drug is universal to the many species, in many different places, and stage of life of plasmodium's. Like the drug Artemisinin has become a staple treatment in combination with quinine or other drugs in most parts of the world.

B. What microbial drug inhibitors are Quinolones and Rifampin involved in?

Quinolones- inhibit replication and transcription and inhibit gyrase( unwinding enzyme) Rifampin- Inhibit RNA polymerase

E. What is Virulence? What is Virulence factors?

Relative severity of a disease caused by a particular microorganism. It is determined by its ability to establish itself inside the host, and cause damage (can range from toxins ability. Any characteristic or structure of the microbe that contributes to proceeding activities that aid in these goals)

QG Describe severe combined Immunodeficiencies: dysfunction in B and T Cells?

SCIDs involve dysfunction in both lymphocyte systems, some are due to complete absence of lymphocytes stem cell in the marrow and others are from dysfunctional B and T cells later in development. Two common forms are Swiss-type agammaglobulinemia and thymic alymphoplasia which are genetic defects in the development in lymphocyte types and poorly developed humoral and cellular immunity. Adenosine Deaminase deficiency (ADA) is caused by autosomal recessive defect in the metabolism of adenosine which has a metabolic product build up abnormally and it destroys lymphocytes that develop. The only treatment is total replacement or correction of dysfunctional lymphoid cells via gene therapy insertion. Secondary Immunodeficiency Diseases in B cell and t Cells: Caused by: Infection, noninfectious metabolic disease, chemotherapy, or radiation. AIDS- Infection induced: Immune cells including T helper cells, monocytes, macrophages, and antigen presenting cells are infected by the immunodeficiency Virus. Its though the depletion of T helper cells and functional impairment of immune system responses account for cancers and opportunistic infections associated with this disease. Other infections that deplete Immunities are measles, leprosy, and malaria Cancer that target bone Marrow or lymphoid organs are responsible for extreme malfunction of both humoral and cellular immunity (leukemia) Plasma cell tumors produce large amounts of nonfunctional antibodies. thymus tumors cause severe T cell deficiencies

QI. Describe the phenotypic Method in detail?

The Immediate direct Examination of Specimen: 1. Direct microscopic observation is a rapid test for determining presumptive and sometimes confirmatory microbial characteristics 2. The gram stain and Acid fast stain: Used for bacterial identification, but they can only identify a few on their own Methods Requiring Growth Selective and Differential Growth -In cases where pathogen is present in small numbers or is easily overgrown by normal biota, specimen can be initially enriched with specialized media -Diversity of bacterial species are cultured on a selective media to encourage the growth of only the suspected pathogen. -Specimens inoculated on differential media are to identify definitive characteristics such as reactions in blood (blood agar) and fermentation patters (mannitol salt and MacConkey agar) -The starting point for "dichotomous key" is a flow chart leading to identification; staring with gram stain, growth on differential media, and simple enzymatic tests. Biochemical Testing -Physiological reactions bacteria have to nutrients and other substrates provide evidence of the types of enzyme systems present in a sample. -many are enzyme- mediated metabolic reactions facilitated by a special substrate in the media that cause particular end product, often a color change* *Fully automated by diagnostic companies and their machines in some places but for of it is preformed manually* *can be preformed without incubation for results in hours and not days* -MGIT system: Monitor oxygen levels in a tube with an inoculated specimen. Contains a medium that encourages growth and a silicon tip at the bottom of a tube that has fluorescent substance that is sensitive to oxygen levels (if the bacterium uses oxygen it will use what is remaining in the tube from inoculation until the silicon compound fluoresces and identifies culture. ) Antimicrobial Susceptibility Testing Adaptation of the tube dilution method: Automated phenotype systems incorporate a panel of commonly used antimicrobials for the particular infection site, and simultaneously test susceptibility while identifying the pathogen Miscellaneous Tests -Phage typing: Inoculating a lawn of bacterial cells onto agar, mapping it off blocks, and applying a different phage to each sectioned area of growth. Clear area will indicate lysed cells sensitive to the phage and bacterial identification may determined. -Susceptible animals cultivate bacteria, and Avian embryos and cell cultures are used to grow host cell dependent rickettsia's, chlamydia's, and viruses. Determining Clinical Significance of Cultures - first focus on the number of microbes ibn a specimen -Repeated isolation of relatively pure culture of any microorganism can mean its an agent of disease Drawbacks of phenotypic methods: 1. When it is cultured it often takes 18-24 hours and sometimes longer 2. Possibility that the organism we do have is a bystander because many infectious conditions may be caused by non-curable organisms.

D. What is Microbial antagonism?

The antagonistic effect good microbes have against intruder microorganisms. It is the result of a limited number of attachment sites in a host cell and by the chemically or physiological environment created by the resident biota which is hostile to other microbes. It also keeps members of biota that would cause disease, in check in terms of numbers.

Qj. Describe the skin (integument) and its defenses?

epidermis: 4/5 layers. 1. Top layer- Stratum Corneum: Packed with Keratin (ability to withstand damage abrasion & water penetration)& antimicrobial peptides (positively charged particles that disrupt negatively charged membranes of bacteria. 2. Below the Stratum Corneum are three/ 4 more layers of epithelial cell 3. Lowest layer- the Stratum Basale: Is attached to the dermis and is a source for all cell that make up the epidermis 4. Dermis: Rich matrix of fibroblasts, collagen, macrophages & mast cells, network of nerves, blood vessels, lymphatic vessels, hair follicles& Sebaceous Glands (Low ph making it a inhospitable environment to many microorganisms and also its oil made up of lipids is nutrients for normal microbiota, but breakdown of the fatty acids in lipids leads to toxic biproducts that inhibit the growth of microorganisms) &scent glands& Separate Sweat glands (Inhibit growth of pathogenic bacteria by having a low pH and a high salt concentration. Lysozyme is an enzyme in sweat and tears that breaks down peptidoglycan.)

A. What are antimicrobials?

all-inclusive term for any antimicrobial drug, regardless of its origin

A. What are Semisynthetic Drugs?

drugs that are chemically modified in the laboratory after being isolated from natural sources

E. What is pathogenicity?

An organisms potential to cause disease and is used to divide pathogenic microbes into two groups: 1. True Pathogens: capable of causing disease in healthy persons with normal immune defenses. (specific recognizable disease varying in mild, severe to fatal severity ranges 2. Opportunistic Pathogens: Cause disease when the host's defenses are compromised or when pathogens become established in a part of the body that is not normal to them. They are not considered pathogenic to normal health persons and do not generally posses well developed virulence properties.

QB. Describe Anaphylaxis: An overpowering IgE- Mediated Allergic reaction

Anaphylaxis: swift reaction to allergens; two types: 1. Cutaneous Anaphylaxis: Wheal and flare inflammation reaction to the local injection of the allergen 2. Systemic Anaphylaxis: Sudden respiratory and circulatory disruption that can be fatal within minutes. Events parallel those of atopy but concentration and strength of chemical mediators and response are greatly amplified. (death is known after 15 minutes from airway blockage. 3. Type and route of entry causing anaphylaxis can vary

QL. Describe measles?

-Measles is also called rubeola, there is a vaccine for this disease that killed 6 million people worldwide but many are opting against it because they think it is linked to autism Signs and Symptoms -Initial symptoms: sore throat, dry cough, headache, conjunctivitis, lymphadenitis, and fever -Oral lesions called kolpik's spots form -then exanthem (red maculopapular- flat to slightly raised bumps) starts at the head and progresses to the trunk and extremities to cover the whole body -the rash then turns into red patches and then turns brown -coma, permanent brain damage, and epilepsy can result (intellectual and neurological impairment) -Progressive neurological degeneration of the cerebral cortex, white matter, and brain stem can result- subacute sclerosing panencephalatis (results from a defective virus that has lost its ability to form a capsid and be release from an infected cell and destroys neurons, accessory cells, and breaks down myelin via cell fusion) Pathogenesis and Virulence factors -Starts in respiratory mucosa and spreads to the lymphatic system to multiply and enter the blood stream and then to skin and various organs (condition known as viremia) -Induces the cell membranes of adjacent cells to fuse into large syncytia- giant improper cells of function with many nuclei -Disables the immune response: cell mediated immunity and delayed hypersensitivity Transmission and Epidemiology -Very contagious via respiratory droplets -Only reservoir are humans and they are infected during the periods of incubation, prodrome phase, and the skin rash but usually not during coalescence Culture and Diagnosis -diagnosed on clinical presentation but if needed, the ELISA test that tests for IgM to measles antigen. PCR test is also available Prevention -MMR vaccine: has live attenuated measles virus for 20 years of protection -ProQuad vaccine protects against measles, mumps, rubella, and varicella. -Vaccine is recommended for kids 12-15 months and a booster before the beginning of school. Treatment -Reducing fever, suppressing cough, and replacing lost fluid -Additional remedies for complications such as neurological and respiratory symptoms, and to sustain nutrient, electrolyte, and fluid levels -Vitamin A is recommended to reduce symptoms and rate of complications

QY. Describe Neisseria Meningitis?

1. Gram negative Diplococci 2. Known as Meningococcus 3. Is most serious form of acute meningitis (15-20% of cases) 4. Most seen in kids Pathogenesis and Virulence factors: 1. Enters the body via upper respiratory tract and moves into blood and penetrates meninges 2. Most serious complications are from meningococcemia with can accompany meninges but can occur on its own 3. Release of endotoxin into circulation which is a stimulus for certain white blood cells: Cytokines released by white blood cells cause damage, leads to vascular collapse, hemorrhage, and crop of lesions called petechiae (purple spot) on the trunk and appendages. 4. Has sudden onset, fever high than 40 c or 104 degrees f, sore throat, chills, delirium, bleeding under the skin, shock, coma, intravascular clotting, cardiac failure, damage to the adrenal glands, and death 5. Has IgA protease and a capsule that encounter the body's defenses. Transmission and epidemiology: 1. Acquired through close contact of secretions/ droplets 2. Meningococcal has epidemic incidence in late winter/ early spring 3. Reservoir is in human, in the nasopharynx Culture/ Diagnosis 1. Differential diagnosis to rule out or confirm meningococcal meningitis 2. Cerebral spinal fluid, blood, or nasopharyngeal samples are stained and observed directly for typical gram negative diplococci. Cultivation is the preferred method to enable quick assessment of antimicrobial susceptibilities. 3. Specimens are streaked on modified Thayer-Martin medium, or chocolate agar and incubate din a high CO2 atmosphere 4. Identification Via gram stain and oxidase testing on isolates. Prevention and Treatment: -Natural immunization develops during early years if one is exposed to meningococcus via close relatives -Antibiotic therapy with multiple drugs, in high doses intravenously & treatments for shock and intravascular clotting -vaccination & preventive therapy with rifampin or tetracycline

QR. describe Chickenpox (and shingles virus) and Small pox?

Chickenpox: -Incubation period of 10-20 days -Symptoms first appear as fever & a abundant rash that begins on scalp, face, and trunk and progresses in sparse crops to extremities. Skin lesions progress from macules to papules to itchy vesicles filled with clear fluid that takes a couple days to encrust and drop off, resulting in a tiny pit/ scar. -Lesion distribution is centripetal (center of body a fewer on extremities) -Illness lasts 4-7 days, new lesions stop after 5 days, and patients are contagious until all lesions have encrusted -Some cases are fatal via encephalopathy (inflammation of the brain) but most cases recover. Shingles: After recovery of chickenpox, virus enters sensory nerve endings of cutaneous spinal nerve branching, becoming latent and reemerging into shingles -Characterized by asymmetrical distribution on the skin of the trunk or head. -Develops abruptly via stimuli of stress, x ray treatments, immunosuppressive and other drug therapy, surgery, or development of malignancy Causative Agent of Chickenpox/ shingles: -Human Herpesvirus 3 (HH-3/ Varicella)- enveloped DNA virus Pathogenesis/ Virulence factors of chickenpox/ Shingles -Attaches to respiratory mucosa and invades bloodstream-Viremia disseminates virus into skin where virus cause adjacent cells to fuse and then lyse- causing lesions -Virus then enters sensory nerves traveling to dorsal root ganglia and remains latent here and is protected from the immune system and provides a reservoir for reactivation of shingles Transmission and Epidemiology -Humans are natural host in respiratory tract via respiratory droplets and fluid of skin lesions -Most infectious a day or two prior to development of rash Prevention -Live attenuated vaccine & Zostavax vaccine for prevention of shingles Treatment -Uncomplicated varicella requires no therapy aside from alleviation of discomfort. -Bacterial infection treatment is topical & systemic antibiotics (oral acyclovir) -No asprin: may lead to Reye's syndrome Small Pox: Though it is a thing of the past, the terrorist attack & anthrax bioterrorism made vaccines available to certain populations Sign and Symptoms -Begins with fever, malaise, and a rash begins in the pharynx (macular and evolves into popular, vesicular, and pustular), spreads to face, and progresses to the extremities before crusting over leaving nonpigmented sites of scare tissue. -Two forms: Variola Minor (rash that is less dense and is les ill) and Variola Major (Highly virulent, causes toxemia, shock, and intravascular coagulation) -Symptoms of variola major progress as followed: Prodrome period is characterized by high fever, malaise, and a rash in the mouth along with sever abdominal & back pain. Spread through skin in 25 hours and occur more on the extremities. 3rd/4th day of rash: forms large bumps filled with opaque fluid with pustulates indented in the middle & feeling of lesions contain a bb pellet. few days, they scab over and in two weeks they are mostly all crusted over and patient remains contagious until all scabs fall off. Causative agent of Smallpox: -Orthopoxvirus enveloped DNA virus, other members are monkeypox virus, and vaccinia virus Transmission And Epidemiology of Smallpox: -Droplets or contaminated bedding and clothing can spread it. -Currently samples of stored smallpox exists in storage at the CDC in Atlanta Georgia, and a state research center in Koltsovo Russia. Prevention of Smallpox -Vaccination via Vaccinia Virus -US has a stockpile of smallpox vaccine in case of a smallpox attack. _vaccination can also prevent or lessen disease after contraction of it (postexposure prophylaxis) Treatment: Drugs: Tecovirimat & Cidofovir work in laboratory but no in humans, thought to be used in emergencies

A. What are Synthetic Drugs?

drugs produced entirely by chemical reactions

A. What are antibiotics?

substances produced by the natural metabolic processes of some microorganisms that can inhibit or destroy other microorganisms; The term used for drugs targeting bacteria and not other type of microbes

A. What is antimicrobial chemotherapy?

the use of chemotherapeutic drugs to control infection

Fb. Describe step two for infections: Becoming established by attaching to the host and interacting with the Microbiome?

"Adhesion (binding to specific molecules on both the host and pathogen- in turn limits them to those types of cells)" is termed for the process microbes use to get a stable foot hold on to a host's tissues. -Fimbriae, surface proteins, and adhesive slimes or capsules, Receptors: Main mechanisms used by bacterial, fungal, and protozoa pathogens to invade the body compartments. - Viruses: Attach by specialized receptors -Parasitic Worms: Use a mechanical fastens as a portal of entry b y suckers, hooks, and barbs. -Microbes also have to encounter the Microbiome: Often can prevent settling of newcomers from attachment or becoming established via microbial antagonism.

QT. Describe superficial Mycoses?

-Agents involve the outer epidermal surface and are ordinarily innocuous infections and cosmetic rather than outright disease causing. -Tinea Versicolor is caused by the yeast genus Malassezia (10 species live on human skin) and they feed on high oil content of skin glands -In some people its growth is mild, chronic scaling and interferes with the production of the pigment by melanocytes. Trunk, face, and limbs may take on a mottled appearance.

QA. Describe the nature of Allergens and their portals of entry?

-Allergens enter the epithelial portals in the respiratory tract, gastrointestinal tract, and the skin -Mucosal surfaces are thin and quite penetrable of gut and respiratory system -Keratin coating of the skin is less permeable but the portal of entry would be in tiny breaks, glands, and hair follicles. -Inhalants: Airborne environmental allergens -Ingestants: Cause food allergies -Injectants: Triggered by drugs/ vaccines/ hymenopteran venom (bee) -contactants: Allergies that enter through the skin

Qz. Describe Streptococcus pneumoniae? (pneumococcus)

-Causes majority of bacterial pneumonias -More likely to occur in patients with an underlying susceptibility -Common cause of ear infections and Pneumonia -Penetrate respiratory mucosa and go into the blood stream where in some cases it can infect the meninges. -Has a gram- positive, flattened coccus in end to end pairs Virulence factors: -Polysaccharide capsule to protect against phagocytoses, has a alpha- hemolysin and hydrogen peroxide that induces damage to the CNS, and is capable of inducing brain cell apoptosis Treatment: -Cerebral spinal fluid needs to be cultured -Many are resistant to first line antibiotic penicillin -Treatment with vancomycin + ceftriaxone -Two vaccinations: Prevnar and Pneumovax 23

QJ. Describe Immunologic Methods?

-Characteristic of antibodies that form in a immune reaction to combat infection are a powerful diagnostic tool. Characteristics such as quantity or specify reveal the history of a patients contact with microorganisms and other antigens. -Serology Testing: The ability to visualize the interaction of a certain antigen being exposed to a certain antibody and fitting like a glove, can help identify and detect either an antibody or antigen by using the other's presence. Can test urine, cerebrospinal fluid, whole tissues, or saliva. This test and other supplemented ones can determine the immunologic status of patients, confirm a suspected diagnosis, or screen for a certain disease. Different kinds of Antigen- Antibody Interactions: *Basis is the binding of an antibody (Ab) to a specific site (epitope) on an antigen (Ag). Can only be seen if the antigen and antibody is suspended in fluid under the right circumstances indicated by the clumps in a solution. Angulation (Antibody mediated clumping of whole cells) and Precipitated Reactions (Smaller complexes of antibody- antigen):::::: -When antigen and antibody concentrations are optimal, one antigen is interlinked by several antibodies to form soluble aggreges that settle out in the solution. -Agglutination is also used to determine blood compatibilities -How these reactions are modified to be seen with the naked eye: 1. Immunochromatography (pregnancy tests and strep throat tests): Has plastic cartilage with porous material/ polymer that directs fluid flow in a certain direction into antibodies along its route of flow. If the sample has the correct antigen it will bind the antibodies and continue on to the next step: a molecule on the paper stripe pattern that binds the complexes and causes the stripe to change color. Antibody Titers (a concentration of antibodies in a sample) -Determined by diluting patient serum into test tubes or wells of a microtiter plate that has equal amounts of bacterial cells (antigens) -The more a serum sample can be diluted and still react with an antigen, the great the concentration of antibodies in the titer. -Used to diagnose immune disorders and determine past exposure to diseases. Serotyping -A antigen-antibody technique for identifying, classifying, and subgrouping bacteria into categories called serotypes. -Employs antisera against cell antigens (capsules, flagellum, cell wall) -Used for identifying and differing among numerous pneumococcal and streptococcal serotypes. Western Blot procedure: -Separating of proteins by electrophoresis and then using antibodies to detect the proteins. -First they are lysed and separated via electrical charge within a gel and sampled. Proteins of gel are transferred/ immobilized to a special filter and incubated with labeled antibody solutions with radioactive, fluorescent, and luminescent molecules. -After incubation, the presence of microbial specific antigens or antibodies will appear as bands that can be compared as positive and negative controls -Is a second verification test for preliminary antibody positive HIV screening tests Immunofluorescence Testing: - A monoclonal antibody labeled by a fluorescent dye (fluorescent antibody) is used for diagnosis in 2 ways: 1. Direct testing: Fluorescent microscopy is visualized for a positive result via if an unknown test specimen/ antigen is fixed to a slide and exposed to FAb causing antigen antibody complexes formation (valuable for identifying and locating microbial antigens on cell surface or in tissues and identifying the causative agents) 2. Indirect Testing: FAbs are used in recognizing the Fc region of antibodies in patient sera. Known antigen is added to test serum by binding of fluorescent antibody, fluorescing aggregates or cells indicate that fabs have complexed with microbe- specific antibodies in the test serum, and it is visualized through fluorescent microscopy. Enzyme- Linked Immunosorbent Assay (ELISA) -enzyme linked indicator antibody to visualize antigen- antibody reactions and relies on a plastic microtiter that can absorb the reactants. Indirect ELISA: -A known antigen in patients sera is absorbed to the surface of a well and mixed with unknown antibodies, if a complex forms an added indicator antibody will bind and produce a color change for a positive result. *false positives are common so a verification test like Western Blot may be necessary* Directs ELISA (multiple ways to preform) 1. Sandwich test: A known antibody is absorbed to the bottom of a well& incubated with an unknown antigen, if a antibody- antigen complex forms, it will attract an indicator antibody and a color change will occur for a positive result. Computer chips sense minute changes in electrical current when the complexes are formed. In Vivo Testing: An antigen is introduced to elicit some sort of response of visible reaction -Tuberculin Reaction: I where s small amount of purified protein derivative of mycobacterium tuberculosis is injected into skin and red, raised, thickened lesions developed 48-72 hours later indicated previous exposure to tuberculosis General Features of Immune Testing -The two characteristics of effective serological testing is specificity (Property of test to react to specific antibody/ antigen and not react to unrelated or distantly related ones) and sensitivity (detection of even minute qualities of antibodies or antigens in a specimen; high sensitivity= low false positive rate)

QK. Describe Methicillin- Resistant Staphylococcus Aureus (MRSA)

-Characterized by Skin lesions & usually resistant to multiple antibiotics and disinfectants -Gram positive and grows in clusters. It is nonmotile, highly virulent, appears as normal biota. It is destructive due to its array of super-antigens -has a 10 to 7.5% to withstand salt, extremes in pH, and high temperatures (60 degrees for 60 minutes) and is also viable after months of air drying Signs and Symptoms: -Skin is Raised, red, tender, localized lesions, featuring pus and feeling hot to the touch, fever is common -causes are injury of shaving, or just abrasion Transmission and Epidemiology: -Common contaminants of all kinds of surfaces you touch daily are all sources indirect contact infection Pathogenesis and Virulence factors: -Coagulase as an enzyme that coagulates plasma -Hyaluronidase as an enzyme that digests the intracellular glue (hyaluronic acid) that binds connective tissue in host tissues -Staphylokinase which digests blood clots -Nuclease that digests DNA (DNase) -Lipases that help the bacteria colonize oily skin surfaces Culture/ Diagnosis: -Polymerase chain reactions is use to diagnose -Cultivation on blood agar is a useful diagnostic technique -In heavily contaminated specimens: Selective media such as mannitol salt agar are used -Production of catalase that breaks down hydrogen peroxides is used to differentiate between staphylococci which produce it, from streptococci which do not. -To separate S. aureus from other species of staphylococcus is a positive test from that of the coagulase test Prevention and Treatment: -Good hygiene is prevention -Antimicrobial treatments should include more than 1 antibiotic- Rn the recommendations are Vancomycin

QU. Describe Keratitis?

-Damage of deeper tissues occur and can lead to complete corneal destruction -After trauma to the eye, any microorganism can cause this infection. Major ones: Miscellaneous Bacteria and Herpes Simplex virus -Cause of Herpes Keratitis= misdirected reactivation (result of a sexual encounter or genital contact wit the eye) of oral herpes simplex virus type 1. Upon reactivation, travels into the ophthalmic rather than the mandibular branch of the trigeminal nerve. -Blindness via herpes is the leading infectious cause of blindness in the US. Bacterial and fungal causes of keratitis is more common in developing countries. -Treatment is with Trifluridine or acyclovir or both -Recent years, an Amoeba called Acanthamoeba is a serious cause of keratitis especially in those who wear contact lenses: Associated with less than ideal hygiene of lenses or previous trauma to the eye

QS. Describe Cutaneous and Superficial Mycoses: Ringworm?

-Dermatophytes: Are fungi that cause a variety of body surface conditions- mycoses are strictly confined to nonliving epidermal tissues (stratum corneum) and their derivatives (hair and nails) -Conditions are cause by one of three different dermatophytes (signs and symptoms are in table 16.1 on page 482) Causative Agents -There are 39 species in the genera Trichophyton, Microspore, and Epidermophyton. -Varies from one location to another and is not restricted to a particular genus and species. Diagnosis of Tinea of scalp: -Caused by some species is aided by use of a long wave ultra violet lamp that causes infected hairs to fluorescent. -Samples of hair, skin, nails treated and heated with potassium hydroxide show a thin branching fungal mycelium if the infection is present Pathogenesis and Virulence factors: -have the ability to invade and digest keratin that is abundant of the cells of the stratum corneum but fungi do not go deeper into the epidermal layers -Have the ability to suppress the immune system to respond to them Transmission and Epidemiology: -Direct or indirect contact with other humans or with infected animals. -Some can be acquired from soil (cultures who walk barefoot actually have low levels of transmission suggesting that the atmosphere of the shoe that encourages fungal growth. Therapy is tropical antifungal agent- ointments with tolnaftate, miconazole, itraconazole, terbinafine, thiabendazole applied for several weeks.

QP. Describe Staphylococcal Scalded Skin Syndrome?

-Dermolytic condition, affects mostly newborns and babies -transmission via caregivers (nursery adults, 30% are asymptomatic carriers) carrying the bacteria from one baby to another from nasopharynx, axilla, perineum, and vagina (5% are lysogenized by a phage that has toxins responsible for this disease) -Exotoxin Mediated disease -Phage encoded exfoliative toxins A and B are responsible for the damage. toxins enter the blood steam from some focus of the infection (throat, eye, or from impetigo infection) and travel to skin throughout the body -Toxins from the disease characterize bullous lesions (around umbilical cord or in the diaper or axilla area), a split occurs above the stratum basal, and a burned appearance follows from widespread desquamation of the skin. -Antibiotic therapy works after immediate diagnosis

I. What is an endemic, sporadic, epidemic, and pandemic?

-Endemic is an infectious disease that exhibits a relatively steady frequency over a long time period in a particular geographical location. - Sporadic diseases are characterized by occasional cases that are reported at irregular intervals in random locations. -Epidemic is a pattern that describes when statistics indicate the prevalence of the endemic or sporadic disease is increasing beyond what is expected for that population. -A pandemic is the spread of an epidemic across continents (AIDS or Influenza)

QN. Describe the fifth disease?

-Erythema infectiosum -Characterized by a fluent reddish rash that begins on the face- "slapped cheek" -Prominent spread of the body is arms legs, trunk -Brought on in a reoccurring fashion by any activity increasing heat -Causative agent is parvovirus B19 _diagnosed by clinical presentation, but can rule out rubella using IgM against rubella. -Very contagious and no vaccine and no treatment for the mild disease

A. Describe what Microbes need sensitivity testing and which do not?

-Essential to those that commonly show resistance: Staphylococcus, Neisseria gonorrhoeae, Streptococcus pneumoniae, and enterococcus. -Essential to Aerobic Gram negative bacteria. Not necessary of fungal or protozoal infections because antimicrobial agent generally target all representatives of this group and is difficult in general

QP. Describe Cellulitis?

-Fast spreading infection in the dermis an din subcutaneous tissues characterized by pain, tenderness, swelling, warmth, fever, swelling of lymph nodes, and red lines leading away from area of infection (called lymphangitis which is a symptom caused by microbes and inflammatory products being carried away from the lymphatic system) -Bacteremia could develop from disease but uncomplicated cellulitis is a good prognosis -Transmission: Either through trauma or by subtle means into the dermis of bacteria or fungi, with no obvious breaks into the skin -Most common causative agents are staphylococcus aureus (usually MRSA) and streptococcus pyogenes but almost any bacterium can be causative in an immunocompromised patient -In infant, group B streptococci are a frequent cause -Responds well to proper antibiotics' either oral in mild cases or intravenous in immunocompromised people. Sometimes if there is extensive tissue damage, surgical debridement is warranted

QH. Describe the first steps for identification methods: Specimen Collection. Describe where common sites are and common techniques?

-General antiseptic procedure are used like a sterile container and tools to prevent contamination from the environment 1. Nasopharynx/ Lungs/ Throat For Saliva and Sputum: Swabs, containers for saliva, and catheters are common to use 2. Bladder for Urine: Catheters and Clean scratch method (washing the external urethra and collecting the urine sample midstream. 3. Vaginal: Mucous lining, vagina, and urethra is sampled with the use a swab or stick 4. Skin: Swabbed/ scrapped with a scalpel to reveal deeper layers, Wounds are swabbed by using a punch biopsy tool, 5. Blood/ cerebrospinal fluid/ tissue fluids: Sterile needle aspiration. 6. Eye, ear canal, synovial fluid, nasal cavity are all using swabs 7. Diseased tissue: surgically removed and biopsied. *Samples that are correct in labeling then must be stored for a time (usually refrigerated because nonsterile samples are deteriorated at room temperature). Storage must be nonnutritive maintenance media (so it lives but doesn't grow), a buffering system, and anaerobic environment to prevent destruction of oxygen sensitive bacteria.

QO. Describe Impetigo caused by Streptococcus pyogenes?

-Gram positive, hemolytic on blood agar -Causes streptococcal pharyngitis (strep throat), scarlet fever, pneumonia, puerperal fever, necrotizing fasciitis, serious bloodstream infections, and poststreptococcal conditions such as rheumatic fever -If the precise etiologic agent must be identified, there are well established methods for identifying group A streptococci

QO. Describe Impetigo?

-Highly contagious superficial bacterial infection that is most prominent in children and causes the skin to flake or peel -Causative agents are thought to be either these alone or in a mixture: Staphylococcus aureus or streptococcus pyogenes. Tough that S. pyogenes begins all cases and in some cases, S. Aureus (has toxin that destroys S. pyogenes) later takes over and is responsible for lesions -Transmits via direct contact, or fomites, or mechanical vector transmission -Prevention is good hygiene Signs and Symptoms: -Lesions: Peeling skin, crusty and flakey scabs, or honey colored crusts around mouth, face and extremities or anywhere on skin really -Superficial and itches -Symptomatology does not indicate which causative agent caused the disease.

QS. Describe Cutaneous Anthrax?

-Infection from Bacillus Anthracis is most common an least dangerous -Transmission: Endospores entering the skin via small cuts or abrasions. Also can be transmitted via contact with hides of infection from animals. -Production of a papule that becomes increasingly necrotic and later ruptures to form a painless black eschar is a marking of Germination and Growth. -Bioterrorism in 2001 via mail workers and other contracting it through endospores in the mail. -Untreated, fatal 20% of the time, a vaccine exists but is recommended for high risk persons and the military.

G. What is inflammation and what are its key signs of it: Edema, granulomas, abscesses, and lymphadenitis?

-Inflammation is the earliest symptom of disease that is a body defense process that comes into activation. The inflammatory response includes cells an chemicals' that respond nonspecifically to disruptions in the tissue. -The sign Edema: accumulation of fluid in afflicted tissue -The sign granulomas and abscesses: Walled off collections of inflammatory cells and microbes in the tissue - The sign Lymphadenitis: Swollen Lymph nodes

M. Describe the Inflammatory Response?

-Is the combination of Rubor (redness caused by increased circulation), Calor (warmth from increased blood flow) Tumor (swelling cause by fluid escape) and pain (caused by stimulation of nerve endings. Factors that elicit this response are: trauma from infection, tissue injury or necrosis due to physical or chemical agents, and specific immune reactions. Main functions are: To mobilize and attract immune components to sites of injury by producing cytokines, set mechanisms in motion to repair tissue and clear away harmful substances, and to destroy microbes and block further invasion But, it can sometimes be the cause of injury, destruction, or disease.

QS. Describe Leishmaniasis?

-Is transmitted by zoonosis among various mammalian hosts by female flies -Cutaneous Leishmaniasis: localized infection of capillaries of skin cause by L. tropica -Mucocutaneous leishmaniasis called Espundia is caused by L. Brasilliensis and affects skin and mucous membranes. -Systemic Leishmaniasis is another form of this infection -Leishmania is transmitted to mammalian host via sand fly ingesting hosts blood. Disease is endemic to equatorial regions that have favorable conditions for the sand fly. -No vaccine, avoiding sand fly is the only prevention

QC. Describe hemolytic disease of newborns and Rh incompatibility?

-Placental sensitivity occurs when a mother is Rh- and her fetus is Rh+ because the mother's immune system detects foreign Rh factors on the babies RBCs and is sensitized to them, forming antibodies and memory B cells; doesn't affect the first but affects the second child -In second child, mother's antibodies cross the placenta and cause complemented mediated lysis of babies RBCs. Can result in: 1. Hemolytic disease of Newborn (HDN) or called Erythroblastosis fetalis: characterized by severe anemia and Jaundice. Reflects release of immature nucleated RBCs (erythroblasts) into the blood to compensate for destroyed RBCs. Preventing Hemolytic Disease of the Newborn: 1. Careful family history examination: If the father is Rh- then so will the child of the father and they will be free of risk. But if the father is Rh+ then there may be a chance the fetus is Rh+ via treatment: 2. Mother is immunized with antiserum RhoGAM (immunoglobin fraction of human anti- Rh serum) First is injected at 28-32 weeks and again immediately after delivery and it reacts with any fetal RBCs that have escaped into the maternal circulation, therfor preventing the sensitization of a mother immune system to Rh factor. Must be given at every pregnancy with a Rh+ fetus but is ineffective if the mother is already sensitized.

QC. What is the Rh factor and its clinical importance?

-Rh factor is an antigen on red blood cells. -Results from a combination of two possible alleles- a dominant one that codes for the factor and a recessive one that does not The - or + appears after a blood type reflects the Rh status of a person. -Rh factor can cause disease, especially in a natural circumstance like pregnancy. -ABO antigens are antibodies against foreign blood antigens -Antibodies against the Rh factor are developed through exposure to a fetus's antigen while pregnant or through blood transfusions -Rh factors should be matched in transfusions but a Rh- is acceptable if the Rh type is unknown

QO. What are the Pathogenesis and Virulence factors associated with Impetigo?

-S. Aureus has a arsenal of enzymes and toxins (exfoliative toxin A, coagulase, other enzymes) -Rarely impetigo caused by S. Pyogenes can be followed by acute poststreptococcal glomerulonephritis, strains never cause rheumatic fever -Both can cause infection in either age groups but, S pyrogens' happen in newborns and S. aureus happen in older children

Fghijk. Describe how you will know if a disease will occur?

-Some disease has a high and low likelihood of causing a disease and most fall somewhere in-between, meaning that they can cause disease under the right circumstances among many variables that can be: 1. permanent like genetics 2. temporary like pregnancy or a patient being immunocompromised (susceptible), An underlying condition, Medications taken because of other diseases (Opportunistic pathogens infect all of these) -Virulence factors on the Microbes side include: 1. Native virulence (ex, does it produce exotoxins?) 2. How Many organisms have encountered the host? (How close is it to its optimal infectious dose) 3. Whether it has made contact with the correct portal of entry? -Virulence factors on the host side include: 1. Natural genetic variability (how well defense components respond) 2. Whether the host has seen the microbe before (infection or injection?) 3. The host's general level of health

QT. What is the surface of the eye and it defenses composed of?

-The conjunctiva is a thin membrane that covers the eye lids except for the cornea. It secretes oil and mucous containing fluid for lubrication and protection of the eye surface. -The Cornea is a dome shaped central portion of the eye lying over the iris. It has 5-6 layers of epithelial cells that regenerate if they are damaged "the windshield eye" -Tears formed in lacrimal gland are best defense: has aqueous fluid, oil, and mucous (has proteins and sugars for a protective role), sugars, lysozyme, and lactoferrin. (last two have antimycobacterial properties). Flow of tear film prevents attachment of microorganisms. -Inflammation and lymphocytes and phagocytes interferes with vision so it does not occur in the eye which makes it relatively susceptible to infection. -Immune privilege: Evolution of the vertebrae eye has been toward reduced innate immunity and a corresponding reduction in inflammatory response.

H. What is a reservoir? What are living reservoirs? What is a nonliving reservoir?

1. - A primary habitat in the natural world where a pathogen makes its home. (Human, animal, plants soil, water) -Not an infection transmitter which is the individual or object that an infection is acquired from - They can be interrelated 2. -A living reservoir Is a carrier that is an individual who inconspicuously shelters a pathogen and spreads it to others without any notice (arthropods) 3.Nonlibing reservoirs live in the air, water and soil:. Some are saprobic and cause little harm. Some are opportunistic and few are regular pathogens

Q. WHat are the steps of B- Cell activation?

1. A b cell binds to a receptor that fits it called a epitope. 2. B cell encloses Antigen to degrade it into peptide determinants and the antigen is bound to the MHC-2 receptors on B cell surface 3. They interact with a T helper cell that has antigen receptors for that same microbe and has already been activated by an APC, they engage in recognition: MHC-2 receptor bearing antigen on B cell bind to the T cell antigen receptor, the CD3 molecule, and then the CD4 molecule on the T cell. 4. A signal is transmitted to the B cell nucleus and triggers B cell activation events 5. B cell differentiates into three types of B cells: plasma, memory, and regulatory cells 6. Undergoing mitotic divisions, they expand their population Plasma cells are short lived factories for antibodies Memory cells seed lymphatic circulation ready for more encounters with antigen Regulatory cells proliferate and secrete IL-10 to regulate T cell response

QT. Describe Botulism?

1. A intoxication (caused by exotoxin) of eating poorly preserved foods. Signs and Symptoms: 1. Botulinum Toxin: from circulatory system, site of action is the neuromuscular junction were it prevents release of Acetylcholine and results in flaccid paralysis 2. 12 to 72 hours until onset symptoms, affecting: muscles of the head including double vision, difficulty in swallowing, dizziness. Later symptoms are descending muscular paralysis and respiratory compromise. 3. Botox uses this endotoxin to inhibit muscle contractions and relieve facial wrinkles. and has other medical uses for headaches and others Causative Agent: 1.Clostridium Botulinum- endospore forming anaerobe that does damage via exotoxin. Lives in Soil & water, in mostly northern hemisphere. Prevention and Treatment: Treatment: antitoxin that prevents worst outcomes of disease Respiratory and cardiac support systems used in the weeks of recovery in the hospital 5% mortality rate

Rj. Describe Poliomyelitis?

1. Acute enteroviral infection of the spinal cord that causes neuromuscular paralysis and affects small children Signs and Symptoms: 1. Short term, mild viremia symptoms: fever, headache, nausea, sore throat, and myalgia 2. Neurotropic if it is carried to the central nervous system and spread in spinal cord and brain it: Attacks motor neurons of the anterior horn of spinal cord, spinal ganglia, cranial nerves, and motor nuclei causing degrees of paralysis 3. Bulbar Poliomyelitis: When brain stem, medulla, or cranial nerves are affected leading to atrophy/ slowed growth/ deformities via loss of control of cardiorespiratory regulatory centers, requiring mechanical respirators. Crippled limbs are very painful. 4. Post- Polio Syndrome: Survivors of childhood infection that causes muscle deterioration. 25-50% chance of developing after original polio attack Causative Agent 1. Poliovirus is from the family Picornaviridae, genus Enterovirus 2. Non enveloped, non segmented, naked capsid (for chemical stability and resistance to acid, bile, and deterrents 3. Survives in gastric environment/ other harsh conditions and transmitted easily Pathogenesis and Virulence Factors: 1. Ingested, absorb into the receptors of mucosal cells in the oropharynx/ intestine & multiple in the epithelia/ lymphoid tissue, results in high # of viruses shed into throat and feces and some into blood. 2. Symptoms are dependent on how many viruses are in the blood & their duration they stay there Transmission and Epidemiology: 1. Reservoir is humans and is passed via food, water, objects contaminated with feces, and mechanical vectors 2. Eliminated from the western hemisphere in the 20th century 3. Through vaccination, elimination of all viable transmission in hosts (only humans) is possible Prevention and Treatment: 1. Live attenuated Vaccine (OPV) or inactivated vaccine (IPV) 2. Treatment: largely alleviating pain and suffering via drugs, ventilation maintenance, physical therapy,

P. Describe the activation of T cell and their differentiation into Subsets? Describe different types of T cell helpers?

1. After a T cell is sensitized by antigen/ MHC complex coming into contact of its receptors, it differentiates into subsets of its effector cells, such as Memory Cells which mount an immediate response. 2. All T helper cells have CD4 markers and regulate immune reactions to antigens and in activating Macrophages by direct contact and indirectly by releasing cytokines (like interferon gamma). Some T helper cells secrete interleukin-2 which stimulate primary growth and activation of many types of T cell including cytotoxin T cells. Some T helper cells secrete interleukin-4, -5, -6 which stimulate activities of B cells.

QB. Describe the Type 1 Allergic reactions. Define allergy, allergens, and the two levels of severity? Who is affected?

1. Allergy is an exaggerated immune response 2. Allergens are antigens that have been found to be acutely sensitive through repeated contact in an individual 3. The levels of severity are: a. Atopy: A chronic local allergy such as hay fever or asthma b. Anaphylaxis: A systemic sometimes fatal reaction that involves airway obstruction and circulatory collapse Who is affected? -Half of the population is affected by airborne allergens. Some have them throughout lifetime and some outgrow them -Generalized susceptibility is the heredity component: The likelihood a child develops an allergy is 25% if one parent has symptoms and jumps to 50% if grandparent or siblings have a allergy. -Basis for atopy is if a genetic program favors allergic antibody production, increased reactivity to mast cells, and results in an increased susceptibility of target tissue to allergic mediators

Re. Describe neonatal meningitis?

1. Almost always a result of infection in utero or during passage through the birth canal. Condition is favored in patients with a immature immune system 2. Common causes of neonates: Streptococcus agalactiae & Escherichia Coli & Listeria Monocytogenes

I. What are Healthcare- associated infections?

1. Are infectious diseases that are acquired or develop during hospital or health care facility stay. they are also called nosocomial infections (average stays in hospital are a 4% of chance of infection)

Qc Describe the types of Immune Complex Diseases?

1. Arthus reaction (Associated with certain passive immunizations):localized dermal injury die to inflamed blood vessels in the vicinity of any injected antigen: After a second injection, destruction of tissues in and around the blood vessels and the release of histamine from mast cells and basophiles is the result of symptoms that are: a area is red hot to the touch and swollen and painful. Intravascular blood clotting can occasionally cause necrosis (loss of tissue) 2. Serum Sickness (Associated with certain passive immunizations): Systemic injury initiated by antigen-antibody complexes that circulate in the blood and settle into the membrane at various sites like the kidneys, heart, skin and joints. Can cause enlarged lymph nodes, rashes, painful joints, swelling, fever, and renal dysfunction Serum sickness and the Arthus reaction are similar to anaphylaxis in that they both require sensitivity leading to preformed antibodies. But that differ in that: 1. They depend on IgG and IgM or IgA (precipitating antibodies) rather than IgE 2. They require large doses instead of small ones 3. Symptoms are delayed (few hour to days)

H. What are Asymptomatic, Incubating, convalescent, chronic, and passive carriers?

1. Asymptomatic Carriers are infected but show no symptoms of the disease 2. Incubating Carriers spread the infectious agent during incubation period 3. Convalescent Carriers are recuperating patients without symptoms; they continue to shed viable microbes and convey the infections to others 4. Chronic Carriers are individuals who shelter the infectious agent for a long period after recovery because of the latency of the infectious agent. 5. Passive carriers are medical and dental personnel who must contently handle patient materials that are heavily contaminated with patient secretions and blood risk picking up pathogens mechanically and accidently transferring them to other patients.

M. Describe Inflammation?

1. Bacteria/ pathogens enter wound 2. Platelets release blood clotting proteins at wound site 3. Mast cells secrete factors that mediate vasodilation and vascular constriction. Delivery of blood, plasms, and cells to injured area increases. 4. Neutrophils secrete factors that kill and degrade pathogens 5. Neutrophil and macrophages remove pathogens by phagocytosis 6. Macrophages secrete hormones called cytokines that attract the response of the immune system cells to the site involved in tissue repair 7. Inflammatory response continues until the foreign material is eliminated and the wound is repaired.

B. What are the three major modes of action for antiviral drugs?

1. Barring penetration of the virus into the host cell(assembly and release) 2. Blocking the transcription and translation of viral molecules (prevents genome replication) 3. Preventing the maturation of viral particles The best way to mess with genomes is if you have an RNA virus. There are no Eukaryotic cells that make DNA using a RNA template. SO you can target its viral RNA polymerase. Treating Retroviruses (HIV): RNA uses a protein called reverse transcriptase to convert its RNA genome into DNA. Then because its a provirus, that DNA is integrated into the hosts DNA, hanging out in immune cells until you die. If you have a virus with an RNA genome it has to have a polymerase that makes an RNA out of an RNA genome (RNA dependent RNA polymerase) (reverse transcriptase is a RNA dependent DNA polymerase) Both of these are not made by your cells so you can use Nucleotide Analog's drugs to get into your cells enzymes using chain termination which stops polymerizing by posing like a nucleotide and stopping those enzymes that aid in viral replication.

RN. Describe Acute Encephalitis?

1. Can be acute or subacute: is inflammation of the brain 2. Caused by Viral encephalitis: virus born insects called Arboviruses (Including West Nile Virus) 3. Members of the Herpes Virus, JC virus are causative agents 4. bacteria from meningitis can also cause encephalitis Signs and symptoms: 1. Bc of inflammation: behavioral changes/ confusion, decreased consciousness & seizures, meningitis symptoms Treatments: 1. Few agents have specific treatments 2. Herpesvirus encephalitis: Acyclovir therapy

Rc Describe Cryptococcus neoformans?

1. Classified as meningoencephalitis, a fungus, is a more chronic form of Meningitis and has a more gradual onset of symptoms 2. Symptoms: headache, nausea, and neck stiffness 3. Structure: Spherical to ovoid shape, has small constricted buds and a large capsule for pathogenesis 4. Ecological niche: the bird population, it proliferates on high nitrogen environment of droppings. 5. Is a opportunist because humans have a high resistance to it. 6. Frequently occur in people with AIDS 7. Is not communicable among humans 8. Prevention and Treatment for systemic cryptococcosis: Amphotericin B and Fluconazole over a period of weeks or months, no prevention

QU. What are diseases caused by microorganisms of the eye?

1. Conjunctivitis: -Common, of microorganisms that have a predilecting for eye tissue and proliferates due to: inoculating eye in traumatic experience, presence of contact lens or eye injury. Signs and Symptoms: -Many different clinical presentations -Infection= milky discharge & Virus= clear watery exudate -typical to wake up with eyes glued shut from secretions -Some are from allergic response of clear fluid -Pinkeye is common of conjunctivitis Causative Agents and Their transmission -Neonatal eye infection with Neisseria gonorrhea and Chlamydia trachomatis (most common) is transmitted via -Herpes Virus cause neonatal conjunctivitis. -Other common agents are: Staph. epidermis, Streptococcus pyogenes, streptococcus pneumoniae -infections transmitted through autoinoculation from genital infection or from sexual activity. -Can be transferred through infection of contact lenses and cases. -Viral conjunctivitis agent commonly caused by Adenoviruses -Both viral and bacterial are transferred via direct or indirect contact and highly contagious Prevention and Treatment: -Newborns= antimicrobial administrates into they eye to prevent conjunctivitis. -Treatment if infections are suspected are accomplished by erythromycin both tropical and oral. -If N gonorrhoeae is confirmed: oral therapy via ceftriaxone. -If a viral cause is suspected: prophylactic antibiotics is prescribed

RK. Describe Meningoecephalitis?

1. Disease of both meningitis and the brain 2. Causative agents (amoeba's): Naegleria Fowleri & Acanthamoeba, parasites that invade in unusual circumstances

Ro. escribe Arthropod-Borne Viruses (arboviruses)

1. Feed on the blood of hosts, peak incidents of infection in late spring through early fall, Vertebrates maintain virus during cold and dry seasons. Humans are a dead end accidental host (as in equine encephalitis) or can be a maintenance reservoir (as in yellow fever) 2. Common outcomes are acute fever, accompanied by a rash 3. Symptoms and management of arboviruses that cause encephalitis are similar, the transmissions are different however Pathogenesis and Virulence Factors: 1. Begins after an arthropod bite, after the release and replication of virus into near by lymphoid tissues 2. Prolonged Viremia establishes the virus in the brain where inflammation causes damage to brain, nerves, and meninges. 3. Symptoms: Variable; Coma, convulsions, paralysis, tremor, loss of coordination, memory deficits, changes in speech and personality, heart disorders, and sometimes permanent brain damage. Children are most sensitive to symptoms. Adults will normally show no symptoms Culture and Diagnosis: 1. Patients history of travel to endemic areas, contact with vectors, serum analysis are supportive in Diagnosis. Serological and nucleic acid amplification tests are available for some viruses Treatment: 1. No satisfactory treatment exists for arboviral encephalitis. 2. Acyclovir treatment is for herpes complex or varicella zoster 3. Supportive measures are other treatments: Control fever, convulsions, dehydration, shock, edema Prevention: 1. Safeguards by eliminating mosquito breeding sites via insecticides 2. Birds are reservoirs but transmission between birds and humans does not occur

Rh. Describe Cronobacter Sakazakii?

1. Found in the environment implicated for outbreaks of neonatal and infant meningitis transmitted via contaminated powder infant formula 2. Mortality rates= 40% 3. Prevention: Hospitals use ready to feed concentrated liquid formulas, caregivers wash hands & use clean feeding equipment when preparing the formula, use fresh formulas for feeding, and discard leftover formulas

Rd. Describe the coccidioides Species:

1. Fungus called Valley fever 2. Morphology at 25degrees Celsius: Moist white to brown colony with abundant branching hyphae that fragment into arthroconidia (arthrospores) at maturity. On special media (37-40 degrees celsius) arthrospores germinate into the parasitic phase (spherical cell called a spherule) found in infected tissues as well. 3. Two species in different locations: C. immitis (california) & C. posadasii (Northern mexico, central/south america, Arizona) Pathogenesis & Virulence factors 1. Systematic fungal infection starting with a pulmonary infection & dissipating throughout the body 2. Spreads with arthrospores and develop into spherules in the lungs and release endospores resulting in mild symptoms that self resolve or a disseminated disease (meningitis, osteomyelitis, and skin granulomas 3. Outbreaks are related to farming activity, archeological digs, construction, and minning Viruses 1. 4/5 meningitis cases are caused by a variety of viruses 2. Aseptic meningitis: No bacteria or fungi found in CSF in viral meningitis, majority occurring in children, 90% are caused by enteroviruses (HSV-2). 3. Viral meningitis is generally milder and resolved in 2 weeks. 4. Diagnosed via viral culture or specific antigen tests 5. No treatment available, usually

B. What are the two main ways microbes acquire antimicrobial resistance?

1. Genetic versatility and adaptability of microbial populations. Some resistant is intrinsic as well (It is a fixed strait of a microbe) for example, all microbes are intrinsically resistant to antibiotics they themselves produce 2. The acquisition of resistance to a drug by a microbe that was previously sensitive to the drug (acquired resistance) Specifically: 1. Spontaneous mutations in critical chromosomal genes 2. Acquisition of entire new genes or sets of genes via horizontal transfer from another species 3. "Going to sleep" to slow or stop metabolism until the antibiotic concentration decreases 4. In fungi: A small regulatory RNA called interfering RNA or RNAi, bind to specific genetic sequences temporarily to silence the gene causing the target to antibiotic not manufactured by the fungus resulting in temporarily being resistant to a drug

Rb. Describe Listeria Monocytogenes?

1. Gram positive bacteria. In morphology ranges from coccobacilli to long filaments in palisade formation 2. Have from one to 4 flagella 3. It is not fastidious, is resistant to cold, heat, pH extremes, bile. 4. It grows inside host cells and can move directly from one infected host cells to an adjacent healthy host cell. 5. In elderly or immunocompromised patients, it usually affects the brain and meninges and results in septicemia (Multiplication of bacteria in the blood stream)- some strains target the heart 6.MIld Subclinical infections with symptoms such as: fever, diarrhea, and sore throat 7. In pregnant women who can transmit the infection prenatally through the microbe crossing the placenta or postnatally through the birth canna; the death rate is 20%. Intrauterine infections usually result in premature abortion and fetal death 8. Primary reservoir is soil, water Secondary sources of infection: animals, plants, and food 9. Most cases are associated with ingesting contaminated dairy products, poultry, and meat. 10. Because of difficulty in isolating it, Cold enrichment technique is used which can take 4 weeks Also, ELISA, immunofluorescence, and gene probe technology are available for direct testing on food. 11. Antibiotic therapy: Ampicillin & trimethoprim- sulfamethoxazole after first, followed by erythromycin 12. Prevention: adequate pasteurization temperatures, proper handwashing, refrigeration, and cooking of foods. Pregnant women are cautioned to avoid unpasteurized cheeses.

A. What are three factors important to know prior to antimicrobial therapy?

1. Identity of the Microorganism causing infection 2. Degree of microorganism's susceptibility (sensitivity) to various drugs 3. Medical condition of the patient

Q. Classes of immunoglobins are called isotypes (Ig), describe IgA?

2 forms of IgA: monomer that circulate through the blood and a dimer that is formed by two monomers by the support of a J chain: that is essential for specific local immunity to mucous secretions in the body. An example of this is: Colostrum which is a secretion of the breast for infants that are high in IgA for immunity of newborns.

QA. What is immunopathology? What is hyposensitivity disease and what are the 4 types?

1. Immunopathology is associated with over reactivity or under reactivity of the immune response 2. Hyposensitivity disease is when immune function is incompletely developed, is suppressed or has been destroyed. The 4 types are: a. Type 1- "common": allergy and anaphylaxis b. Type 2 :"IgG and IGM mediated cell damage c. Type 3: Immune complex d. Type 4: Delayed hypersensitivity *Type 1,2,3 involve a B- cell immunoglobulin Response, Type 4 involves a T cell response The Antigens that elicit these responses can be exogenous (originating outside the body) or they can be Endogenous (originating inside the body from self tissue- autoimmunity) They responses result in tissue damage and trigger the inflammatory response (So that's why allergies are mistaken as infections)

Rp. Describe the Herpes Simple Complex Virus (HSV)?

1. In HSV positive mothers: Type 1 and 2 can cause encephalitis in new borns 2. Other are susceptible to this but in these cases, HSV encephalitis usually represents a reactive of dormant HSV from the terminal ganglion 3. Varicella zoster virus can also reactivate from the dormant state and is responsible for rare cases of encephalitis

Qv. Describe the Nervous system and its defenses?

1. In the meninges: three layers, inside subarachnoid space is a clear serum like fluid called: cerebral spinal fluid which provides nutrients to the CNS and cushion for the brain and spinal cord. -Is a common site of infection for example meningitis Central nervous system is considered "immunologically privileged": can only amount a partial/ different immune response when exposed to immunological challenge (Vast majority of immune system does not penetrate into the Nervous system) So instead these things help: Structural defenses: 1. bony casing of the brain and spinal cord to protect from traumatic injury 2. Cerebral Spinal fluid 3. Blood brain barrier: Restricted permeability- does not allow microorganisms into the CNS 3. Specialized cells for defense functions: Microglia (has phagocytic capabilities) & Brain macrophages (also exit in the CNS)

G. Name the 4 distinct phases of infection? and the fifth that sometimes occurs?

1. Incubation period(2-30 days): Time of initial contact at the entry portal with infectious agent (multiplying here) to the appearance of the first symptoms (multiplication led to enough damage to elicit symptoms) It varies according to hosts resistance, degree of virulence, and distance between the target organ and the portal of entry. 2. Prodromal Stage (1-2 days): Notable symptoms appear as vague feeling of discomfort, such as head or muscles aches, fatigue, upset stomach. 3. Acute Phase (Time is extremely variable): Infectious agent multiplies at high levels, exhibits great virulence, and becomes well established in its target tissue. Marked by prominent and more specific symptoms (cough, rash, swelling ect) 4. The convalescence: Responding to symptoms which results in a decline of symptoms which is the recovery period. I response to the immune system, strength will return but that means you still have to finish antibiotics or infection left will grow a higher resistance and repopulate. 5. Continuation Phase: Organism lingers ( short time or indefinitely) after the patient is completely well or symptoms continue after the organism is gone. Transmissibility can occur at different stages for different organisms.

D. Describe the colonization of the fetus of a newborn?

1. Intestines were colonized in utero 2. If birthed through the canal, newborns acquire a variety of bacteria: Lactobacillus (digests milk) and other species that defend against skin conditions and disorders. 3. Babies born via cesarean section have different gut bacteria than those born vaginally. 4. Gets more bacteria from environment- notably diet/ breast milk (600 species of bacteria and sugar used by healthy gut bacteria to maintain health of gut bacteria 5. Pathogens transmitted from mother to child: ToRCH: Toxoplasma, Other (hepatitis B, HIV- chlamydia), Rubella (German Measles, virus), Cytomegalovirus (deafness, breathing problems), Herpes simplex virus (lesions, inflammation) : Toxoplasma (toxoplasmosis causing: water on the brain hydrocephaly- mild symptoms to cognitive delay and death- thought that those who have thrill seeking behavior could have toxoplasma), Protozoan, hypdroencephalitis

RQ. Describe Prions?

1. Prions are Proteinaceous infectious particles with no genetic materials 2. Cause Transmissible Spongiform Encephalopathies (TSEs): Neurodegenerative disease with a long incubation period but rapid when it begins 2. Human TSEs: Creutzfeldt- Jakob Disease (CJD), Gerstmann Strussler-Scheinker disease, and fatal familia Insomnia 3. In Animals: Scrapie in sheep & goats transmissible mink encephalopathy, and bovine spongiform encephalopathy (mad cow disease) Signs and Symptoms of CJD: Symptoms: Altered behavior, dementia, memory loss, impaired senses, delirium, and premature senility, uncontrollable muscle contractions until death (1 year of diagnosis) Causative Agent: 1. Prion 2. Transformation of normal host protein (PrP), a protein that is suppose to function for normal brain development, it becomes catalytic and converts other human Prp proteins to abnormal forms in a self propagating chain reaction that causes plaques and spongiform damage and severe loss of brain function 3. Some can be heritable traits through genetic mutation of PrP genes 4. Highly resistant to chemicals, radiation, and heat Transmission and Epidemiology: 1. Via ingestion of contaminated cattle meat with bovine spongiform encephalopathy, cases centered in Great Britain 1990s 2. Median age with vCJD is 28 years, median age of death is 68 years old 3. No none treatment of CJD, mortality rate is 100%

Ql. Describe additional diagnostic technologies?

1. Lab on chip: Microarrays are contained on chips. Facilitated by the use of microfluid is using minuscule amounts of reagents and fluid to preform reactions that were previously done in large test tube (DNA and RNA sequencing, PCR methods made available on chips). Has a big impact on developing countries that have lack of supplies. 2. Mass Spectrometry: Used to determine the structure and composition of various chemical compounds and biological molecules. Works by adding the patient sample to a metal plate and then striking it with a Lasor causing the sample to be ionized. Ions are guiding into the machine and are separates their identities based off of mass- to charge ratio. An advantage is that it can be used in the workplace as an infinitely customizable and expandable database by it constructing databases of local strains of microorganisms by running profiles of known microbes. 3. Imaging: Magnetic resonance imaging, computerized tomography scan, and position emission tomography scans can find areas of localized infection in deep tissue, which can later be biopsied to aspirate samples for culture. It can sometimes spare someone from an invasive procedure by offering a pair of eyes to inaccessible places. 4. Entirely New Diagnostic Strategies 1. Uses blood to check for the presence of seven genes that the host cells express in response to a bacterial infection- not a viral infection. If the seven genes are active, then a antibiotic prescription is appropriate, if the 7 genes are inactive then the symptoms are caused by a virus and will save someone from unnecessary being prescribed antibiotics. 2. Uses blood test to scan for antibodies to more than 1000 strains of viruses representing 206 species. It reveals a persons history with being exposed to viruses which can help either explain someone's symptoms or find viruses that correlate with different cancers.

N. Describe the immunologic development and interaction?

1. Lymphocyte development and clonal deletion: Originate from the same basic stem type, they diverge into two district types: B cell specialization occurs in the bone marrow while, T cells occur in the thymus. Both cell types migrate into separate areas in the lymphoid organs (like nodes and spleens). They constantly recirculate in the circulatory system and lymphatics, migrating in and out of lymphoid organs. 2. Entrance and presentation of antigens and clonal selection: When pathogens carrying antigens enter tissue, resident phagocytes migrate to the site and ingest the pathogen and induce an inflammatory response if appropriate. Tissue dendritic cells ingest the antigen and migrate to the nearest lymphoid organ to present antigen to T and B lymphocytes and the response of B cells often needs T helper cells that are activated by the PAMPs. Major markers and receptors of lymphocytes and macrophages play an important role to serve as an activator of different components of immunity: Major histocompatibility Complex (MHC): gives rise to glycoproteins which is known as human leukocyte antigen system (HLA) which plays a vital role in self recognition by the immune system. Three cases of these are: 1. Class 1 Genes: Markers for nucleated cells, for regulation of self molecules 2. Class 2 MHC Genes: Immune regulator markers found on Macrophages, dendrites, B cells. They present antigens to T cells in immune reactions 3. Class 3 MHC Genes: Encode proteins involved with the complement system. CD Molecules: Other Markers; (CD= cluster differentiation) It is a naming scheme for many of cell surface molecules. They are involved in the Immune response Lymphocyte Receptors: Major role is to accept or grasp antigens in some form. 3. The challenge of B and T lymphocytes: When challenged by an antigen they both proliferate and differentiate, creating clones of their genetic material, some will be memory cells for future reactiveness against the specific antigen. 4. T lymphocytes response: Cell mediated immunity When activated they give rise to a variety of different cell types: 1. Helper T cells: activate macrophages, assist in B cell processes, and help activate cytotoxic T cells. 2. Regulatory T cells: Control the T cell response by secreting anti- inflammatory cytokines or preventing proliferation 3. Cytotoxic Cells: Destroy infected host cells or other foreign cells. THEY DO NOT PRODUCE ANTIBODIES< OVERALL 5. B lymphocyte response: the production and activities of antibodies When B cell is activated by an antigen, it gives rise to plasma cells with reactive profiles that release antibodies into the tissue or blood to mark the antigen for destruction/ neutralization

I. What is mortality rate? Morbidity Rate? What is Reproductive rate?

1. Measures the total number of deaths in a population due to a certain disease. 2. The number of persons afflicted with infectious diseases 3. A factor calculated when keeping track of incident rates in epidemic and nonepidemic situations that is useful in predicting and managing the spread of an infectious disease.

RI. Describe the Zika Virus Disease?

1. Microcephaly: Babies born with small heads in 2015-2016 2.First discovered in Uganda, Africa and migrated to western Africa and southeast Asia 3. Still a threat, pregnant women are cautioned against travel to Zika-endemic areas Signs and Symptoms: 1. Adult symptoms: none at all to, skin rash, conjunctivitis, muscle and joint pain, triggering of Guillain Barre syndrome (neurological condition that can occur after infections with certain bacteria (most common is Campylobacter jejuni) or exposures to certain vaccines 2. GBS: Immune system attacking peripheral nerves, usually resolve by themselves but can be long lasting 3. Respiratory muscles can be infected and death can follow 4. Can cause Congenital Zika Virus syndrome: Small head, vision problems, involuntary movements, seizures, irritability, Brain stem dysfunction, swallowing problems Causative Agent: 1. RNA virus in the Flaviviridae family. 2. Related viruses: Dengue fever, West Nile fever, and yellow fever Transmission and Epidemiology: 1. Transmitted via: Bite of Aedes Misquotes, sexual intercourse of infected individuals, Vertically in utero 2. 2016- Spread throughout America, Genus Aedes spread throughout world Prevention and treatment: 1. No vaccine 2. Treatment: Supportive measures like physical therapy and mechanical ventilation 3. 2016: genetically modified male mosquitos causing offspring of mates to die.

Rf. Describe Streptococcus agalactiae?

1. Most frequent cause of neonatal meningitis, belongs to group B of streptococcus, and colonizes 10-30% in female genital tracts 2. Treatment: Penicillin and sometimes is supplemented by aminoglycoside 3. For high risk pregnancies, it is screen for presence of this bacteria by cervical and rectal swab at 35-37 weeks 4. To avoid passing the bacteria to the infant, a mother is given antibiotics (Penicillin or erythromycin or cefuroxime) at beginning and throughout labor

B. What are the two reasons for Biofilm resistance? What drug has been successful and why?

1. Problem of penetration for the ionically charged antimicrobial drug. Some experts found that adding DNase to antibiotics help with penetration through the extracellular debris 2. The different phenotype expressed by biofilm bacteria. When secured to surfaces, they express different genes and therefor have different antibiotic susceptibility profiles Daptomycin which is a lipoprotein has been successful in disrupting the quorum sensing pathways that mediate communication that may change phenotype expressions.

P. What are the categories that most Antigens fall under?

1. Proteins and polypeptides (enzymes, cell surface structures, exotoxins) 2. Lipoproteins (Cell membranes) 3. Glycoproteins (Blood cell markers) 4. Nucleoproteins (DNA complexed to proteins but not pure DNA) 5. Polysaccharides (Certain bacterial capsules) and lipopolysaccharides

B. Why is selective toxicity difficult to achieve to treat viruses?

A single metabolic system is responsible for the well being of both the virus and the host

QS. Describe Tetanus?

1. Neuromuscular disease, name refers to an early effect on the jaw muscle. 2. Agent: Clostridium Tetani- a gram positive, spore forming(endospores case vegetative cell to swell and are produced under anaerobic conditions) rod: Is a common resident of cultivated soil and gastrointestinal tract of animals Signs and Symptoms: 1. Releases endotoxin that is a neurotoxin, tetanospasmin, that binds to target sites on peripheral motor neurons, spinal cord and brain, and in the sympathetic nervous system. It block the inhibition of muscle contraction, causing them to contract uncontrollably resulting in spastic paralysis Symptoms: Clenching of the jaw, extreme arching of the back, flexion of the arms, and extension of the legs, locked jaw (ridus sardonicus-sardonic grin). Death occurs due to paralysis of respiratory muscles and respiratory arrest Pathogenesis and Virulence factors: 1. Is a strict anaerobe, establishes its endospores at wound site if it is necrotic/ poorly supplied with blood, conditions that favor germination 2. Tetanospasmin is released and spreads to bind to motor nerve endings, travels via axons to the ventral horns of the spinal cord and initiates symptoms Transmission and Epidemiology: 1.Endospores enter through punctures 2. Has a low incident rate in North America & most occur via geriatric patients and intravenous drug users. 3. Worldwide maternal and neonatal Tetanus is high, 60,000 death per year Prevention and Treatment: 1. Treatment: Antitoxin therapy with human tetanus immune globulin (TIG) and Penicillin G. 2. Vaccinations; DT protects against diphtheria and tetanus 3. Tetanus Toxoid immunization for injured persons who have never been immunized

What are the five mechanisms that microbials use to develop drug resistance?

1. New enzymes are synthesized that inactivate drugs through genes that are acquired (enzymes cut part of the drug- Destroy it and then can pass beta lactamase around via horizontal gene transfer) 2. Using mutations, permeability or uptake of the drug is decreased (They block it) 3. Through acquisition of new genes, Drug is immediately eliminated by specialized pumps for example (Pump it out using genes to make different type of pumps that are turned on using antibiotics) 4. Through mutation or acquisition of genes, binding sites for drugs are decreased in number of affinity (changes the target- common for ribosomes to mutate) 5. Through mutation of original enzymes, an affected metabolic pathway is shut down. (like usual pathways of folic acid synthesis) (Organism works around it)

D. What are the risk factors that cause someone to easily experience a disease caused by their normal biota?

1. Old age/ extreme youth 2. Acquired and genetic defects in immunity 3. Surgery/ organ transplants 4. Underlying disease 5. Chemotherapy/ immunosuppressive drugs 6. Physical/ mental stress 7. Pregnancy 8. Other infections

Q. What are the functions of Antibodies?

1. Opsonization: makes them readily recognized by phagocytes and provide them with handle on it for better grips 2. Neutralization: Antibodies fill receptor to prevent it from attaching normally 3. Agglutinate them by using cross linking cells or particles to put them into large clumps, immobilizing them 4. Complement interactions result in lysing of cells 5. Antitoxin neutralizes bacterial exotoxins

QH. broadly describe the methods used to identify bacteria to its level of genus and species?

1. Phenotypic Methods (Morphology): -Examines appearance and behavior. discovers what kind of enzymatic activities it can carry out, what kinds of physical conditions it thrives in, what antibiotic it is susceptible to, and chemical composition of its walls/ membranes 2. Immunologic Methods (serological analysis) -Nature of the antibody is exploited for diagnostic purposes when a patient sample is tested for the presence of specific antibodies to a suspected pathogen. -Laboratory kits are used for immediate identification by taking a patients tissues that have microbial antigens and testing it with antigens "off the shelf" 3. Genotyping Methods (genetic techniques): -Examining genetic material itself for identification and classification of bacteria. -Advantages compared to phenotyping are: Many organisms cannot be cultured for phenotyping and culturing organism is not always necessary for genotyping methods. Also, genotyping methods are increasingly automated, producing rapid results that are often more precise that phenotyping methods. 4. Other Techniques in diagnosis: A. Computerized Tomography(diagnose peritonsillar abscesses) B. Magnetic Resonance c. Position Emission Tomography(find areas of deep infection)

L. What are the three components of the first line of defense? What are 4 body systems that participate in the first line of defense? What are two examples of normal microbiota contributing to the first line of defense?

1. Physical, chemical, and genetic components. 2.Skin and mucous membranes (mucous impedes attachment and entry of bacteria) of respiratory and digestive tracts. Cutaneous barriers of skin that include the stratum coronium, and hair follicles and skin glands. 2. Tear production: Lysosome enzymes that rid irritants by breaking down peptidoglycan in cells 2.Saliva: Lysosome enzymes helps carry microbes into the stomach and break down cell walls. 2. Vomiting's and defecating is transport of substances of microbes out of the body 2. Nasal Hair traps and flushes particles in mucous. 2. Ciliated epithelium in respiratory tract moves foreign particles out 2. Sneezing is caused by irritants and results in high volume of air velocity. Coughing is caused by acute sensitivity to expel irritants 3. Microbiome of vaginal secretions for a structural barrier by altering pH and making an unfavorable environment. 3. Microbiome of gut protects from overgrowth of pathogens 2. Sweat: affects Ph of skin 2. Semen have antimicrobial chemicals

Rm. Describe Acanthamoeba?

1. Portal of entry: Broken skin, conjunctivital, and sometimes the lungs and urogenital epithelia 2. Causes ningoencephalitis, lengthier infection and 2-3% survival rate 3. Disease is called: Granulomatous Amoebic Meningoencephalitis (GAM) 4. Special risk of infection: Traumatic eye injuries, contact lens wearers, AIDS patients exposed to contaminated water

Rs. Describe the Toxoplasma Gondii?

1. Protozoal infection in the fetus and in immunodeficient people 2. May have effects on the brain and responses it controls resulting in thrill seeking behaviors, and slower reaction times Signs and Symptoms: 1. Either are asymptomatic or have mild symptoms: Sore Throat, Lymph node enlargement, and a low grade fever 2. Infection causes more chronic or subacute form of encephalitis often producing extensive brain lesions, fatal disruption of the heart and lungs. 3. Pregnant women have a 33% chance of transmitting it to her fetus; Congenital infection in first or second term results in stillbirth or severe abnormalities of the liver and spleen enlargement, liver failure, hydrocephalus, convulsions, and blindness via damage to the retina Pathogenesis And Virulence factors Is a Obligate intracellular parasite, making its ability to invade the host an important virulence factor Transmission and Epidemiology 1. Can attack at least 200 different types of birds and mammals 2. In cats, it undergoes a sexual phase in their intestine and is then released in feces where it becomes an infected oocyst(that can now survive in moist soil for several months) that eventually enter a asexual cyst state in tissues called pseudocyst. It is spread through oocyst to intermediate hosts. Scientists found it also crowds a part of the rat brain so they lose their fear of cats, get eaten, and this protozoan continues its life cycle 3. Humans are infected via uncooked contaminated meat, contact with mammals, or even dirt. Fetuses become infected after tachyzoites cross the placenta Prevention: hygiene, adequate cooking/ freezing (-20 Celsius destroys oocyst/ tissue cyst 4. In pregnant women, it can result in miscarriage, premature birth, and or babies born with brain and visual problems

C. What are the novel approaches researchers are taking to develop new drugs?

1. RNA Interference: They are being exploited in attempts to shut down the metabolism of pathogenic microbes 2. Defense Peptides: Artificially engineered dense peptides like SNAPP has promise in killing types of bacteria that has become resistant to drugs by preventing bacteria from inserting their membranes, or can inhibit fusion of virus into human cells 3. CRISPR: A system found in bacteria that cause specific cuts in genes is being genetically engineered to destroy bacteria genes that are causing resistance. 4. Drugs from Noncultivable Bacteria: New antimicrobial substances in soil somewhere in the environment that will never be identified with traditional methods for example the discovery of Teixobactin that inhibits wall synthesis 5. Bacteriophages: The use of a extremely specific phage that can kill a certain bacterium alone 6. Probiotics and Prebiotics: Probiotics are being investigated for their mucosal immunity and management of food allergies. Fecal transplants are also become accepted to establish healthy bacteria into the intestines. In prebiotics, certain nutrients are being investigated for their ability to prohibit growth of certain pathogens

B. What are three ways microbes use to resist antimicrobials?

1. RNAi in epigenetic event that uses epimutation, 2. Random spontaneous mutations of chromosomes 3. Gene transfers from plasmids that aid in horizontal transfer through conjugation, transformation, or transduction.

RG Describe Escherichia Coli?

1. Second most common cause of neonatal meningitis: K1 stain of E. coli. 2. Babies with this, even with antibiotic treatment die at about a 20 to 30% chance, those that survive have brain damage 3. Transmitted through mothers birth canal, no damage to the mother but infect tissues of neonate tissues iin the nervous system 4. Treatment: Ceftazidime or cefepime and or gentamicin intravenously

Rq. Describe JC virus?

1. Serological studies indicate that asymptomatic infection with this polyoma virus is a commonplace. 2. Can cause Progressive multifocal leukoencephalopathy in those with immune disfunction. Is uncommon, fatal, and a result of JC virus attack of accessory brain cells. It demyelinates parts of the cerebellum. 3. Treatment/ prevention: Seen with high doses of zidovudine

QR. Describe Rabies?

1. Slow and progressive zoonotic disease characterized by fatal encephalitis Signs and Symptoms: 1. Incubation period is 1-2 months or more depending on the severity and inoculation dose. 2. Prodromal Phase: Fever, Nausea, vomiting, headache, fatigue, and other nonspecific symptoms Pathogenesis and Virulence Factors: 1. Begins when infected saliva enters a punctured site (sometimes inhaled or inoculated via membrane of the eye. Remains at the site up to a week where it multiplies and enters never endings, advancing to ganglia, spinal cord, and brain. In the brain it migrates to sites such as the eye, heart, skin, and oral cavity and is completed when virus replicates in the salivary glands. The it has several stages until death, unless pre- exposed vaccination is preformed before symptoms 2. Virulence is associated with a enveloped glycoprotein that seems to give the virus its ability to spread in the CNS and invade neural cells. Transmission and Epidemiology: 1. Reservoirs: wild mammals that can pread infection to domestic animals and can spread it to humans via bites, inhalation of droplets. 2. Worldwide cases are 35000-50000 cases, 90% are acquired from dogs 3. Common animal reservoirs in US: raccoons, bats, skunks, regional differences in dominant reservoir occur (skunks California, foxes Texas) 4. Diagnosis requires these tests: Reverse transcriptase PCR w salivary samples, Antibody detection to virus in serum or spinal fluid, and skin biopsies Prevention and Treatment: 1. Wound care (Human rabies immune globulin is infused to stop spread and is injected intravenously to provide immediate systemic protection), and specific treatment regimen (vaccine of intramuscular or intradermal injections on days, 0, 3,7 & 14 with two additional booster shots) 2. High risk groups should receive three doses to protect against exposure. 2. Post-exposure Prophylaxis regimen

RR. Describe Subacute Encephalitis?

1. Subacute Encephalitis: When symptoms are less striking and take longer to show up Common cause: Protozoan Toxoplasma or the Persistent Measles Virus or Prions cause Spongiform Encephalopathy 2. Differential Diagnosis Should consider a variety of infections with primary symptoms elsewhere in the body

k. What is a healthily functioning immune system responsible for?

1. Surveillance of the body 2. recognition of foreign material- white blood cells search for potential pathogens by looking for foreign antigens which are called Markers. But it has to recognize itself and not attack (Rheumatoid arthritis: the body attacks its own joints and tissues causing pain) 3. destruction of entities deemed to be foreign via phagocytosis by foreign marker detection. Pathogen-associated molecular patterns (PAMPs)are: marker than many different pathogens have in common

A. Characteristics of Ideal Antimicrobial Drugs?

1. Toxic to Microbe but nontoxic to host cells 2. Microbicidal rather than Microbistatic 3. Relatively soluble; functions even when highly diluted in body fluids 4. Remains potent long enough to act and is not broken down or excreted prematurely 5. Does not lead to the development of antimicrobial resistance 6. Complements or assists the activities of the host's defense 7. Remains active in body tissues and fluids 8. Readily delivered to the site of infection 9. Reasonably priced 10. Does not disrupt the host's health by causing allergies or predisposing the host to other infections

Rl. Describe Naegleria Fowleri?

1. Transmission/ causes: When forced into human nasal passages via swimming, diving, or other aquatic activities 2. It burrows into nasal mucosa, multiplies, and uses the olfactory nerve to migrate into the brain and surrounding structures. 3. Result is Primary Amoeba Meningoencephalitis (PAM): destruction of brain and spinal tissue that causes hemorrhage and coma within a week, common in children Treatment: rapid progression makes treatment futile. Early therapy with amphotericin B, sulfadiazine, or tetracycline in some combination is effective Prevention: Public Swimming pools need to be chlorinated and checked for amoeba, limit warm freshwater or untreated tap water entering nasal cavity

B. What drugs have antiprotozoal activities?

Amebicide metronidazole (used for intestinal infections caused by Entamoeba histolytica), quinacrine, sulfonamides, and tetracyclines

H. What is a zoonosis?

An infection indigenous to animals but naturally transmissible to humans (Humans are a dead end host and does not contribute to the natural persistence of the microbe). Some zoonotic infections have a multi- host involvement and others have complex cycles in the wild. They make up 70% of new emerging diseases worldwide and they are impossible to eradicate without eradicating the animal reservoirs.

P. How is an Antigen formally presented to T cells?

APS's engulf a microbe via vesicles and degrade it down. The antigen pieces complexed with MHC- 2 receptors are transported to the APC membrane and surface location antigens are presented to T helper cell. MHC antigen on the APC binds to the T cell receptor. then a coreceptor on the T cell hooks itself to a position on the MHC 2 receptor so ensure simultaneous recognition of the antigen (non-self) and MHC receptor (self) Then when identification occurs, the APC activates this T helper cell. and the APT secretes interleukin-1. The cell in turn produces interleukin-2 which is a growth factor for the T helper cells and cytotoxin T cells. These T cells help activate B cells.

K. What are cytokines?

Active molecules released by monocytes, macrophages, lymphocytes, fibroblasts, mast cells, platelets, and endothelial cells of blood vessels. They are among the chemicals and proteins that influence defensive responses and that immune cells use to communicate to each other.

A. Describe the kirby- Bauer technique? What is the Minimum inhibitory concentration (MIC)? "from lecture"

Agar diffusion test that provides susceptibility by dispensing small premeasured amounts of antimicrobials onto small discs and setting them on bacterial lawn. Then after incubation, the zone of inhibition surrounding the discs is measured and compared with a standard for each drug. (It is not a determination of a specific dose but it determines what works) This is less effective on anaerobic, highly fastidious, or slow- growing. MIC helps determines a specific dose of a drug that works- it is the Minimum amount of antibiotic to completely inhibit the growth of a known amount of microbes. It is a dilution series of tubes from the highest amount of drug and dilute it down from tube to tube so you can see what amount of drug inhibits growth based on what you see between two test tubes (one with growth the other without) This helps to decrease the toxicity of a drug.

Qx. Describe Meningitis?

Anatomical syndrome: Is inflammation of the Meninges Causes: Many different microorganisms: 1. Bacteria causing acute meningitis: Entrance to CNS is often facilitated by coinfection or previous infection with respiratory viruses Noninfectious causes: Diagnosis via lumbar puncture to obtain CSP and then examined by Gram stain/ culture. Most physicians prescribe broad spectrum antibiotics and shift treatment if necessary after diagnosis Signs and Symptoms: Symptoms are flulike: Severe headache, painful/stiff neck, nausea, vomiting, sensitivity to light. Skin rashes may be present in specific kinds of meningitis -Increased white blood cells in CSF -Some meningitis can manifest into acute or chronic depending on the kind of microorganism Microorganism penetrated the NS because of specific virulence factors

D. Describe infection in the microbiome in broad terms? and disease? and infectious disease?

Are when transient microbes lead to infection in which microbes get past host defenses, enter the tissues , and multiple. When the cumulative effects damage or disrupt tissues and organs, the pathological state results is DISEASE which is a deviation from health. An infectious disease is a pathological state caused directly by microorganisms or their products.

A. What are Narrow Spectrum (limited spectrum)

Antimicrobials effective against a limited array of microbial types for example, a drug effective mainly against gram positive bacteria

What are broad spectrum (extended Spectrum)?

Antimicrobials effective against a wide variety of microbial types for example, a drug effective against both gram positive and gram negative bacteria

A. Describe Neosporin mechanisms?

Are a translation inhibitor, inhibits membrane stability, and is a cell wall inhibitor (first inhibits the ribosome, then there is membrane stability, then bacitracin inhibits peptidoglycan)

O. What are T Cell receptors?

Are formed by genetic modification, have variable and constant regions being inserted into the membrane and have an antigen bonding site at the end of two parallel polypeptide chains. But, the T cell receptor is relatively small and is never secreted.

QD. Describe the Inappropriate Response to Self: Autoimmunity?

Autoimmune disease: Antibodies, T cells, and in some cases both, mount an abnormal attack against self antigens. Can be classified as: Systemic- several major organs Organ specific-one organ or tissue Possible Causes of Autoimmune diseases: Genetics: 1. Particular genes in the class 1 and 2 major histocompatibility complex coincide with certain autoimmune diseases. (B-27 HLA Type: common in persons w/ rheumatoid arthritis & Ankylosing spondylitis) 2. Some autoimmune responses may be a side effect of the body's immune response to cancer in the body. 3. Genetic irregularity or inherent errors in physiological processes: largely microbes are behind these. Molecular Mimicry 1. Microbial Antigens bearing molecular determinants similar to human cells induce the formation of antibodies that can cross react with normal tissues Infection Some autoimmune disease are triggered by a viral infection via Viruses alter cell receptors causing immune cells to attack tissues bearing viral receptors The Gut Microbiome: 1. Many scientists connect the rise of autoimmune disorders to changes of the microbiome in the past 50 years: use of antibiotics, less exposure to the outdoors, and an altered artificial diet. They believe the Microbiome is important for training out immune system what to react against and what to tolerate and drastic changes could disrupt this process. 2. Specific members of the microbiome and autoimmunity connections are being made. (Rheumatoid arthritis has a higher percentage of the bacterium Prevotella in Mice) (Polysaccharide A protects mammals from sclerosis symptoms and is being developed as a therapeutic treatment- altering the microbiome or using chemicals from a healthy microbiome may be a treatment strategy)

I. Why are koch's postulates viewed with causation?

Because perhaps the majority of human infections are polymicrobial so in those infections, koch's postulates cannot be satisfied.

M. What are the benefits of fever? What are the downsides?

Benefits: 1. Inhibits multiplication of temperature sensitive microorganisms. 2. Fever reduces the availability of iron, so it impedes on nutrition for bacteria 3. Increases metabolism and stimulates immune reactions and protective physiological responses. It speeds up phagocytosis, hematopoiesis, and other that help lymphocytes hone in on the infection Downsides: 1. Tachycardia (rapid heart rate) 2. Tachypnea (rapid respiratory rate) 3. Risk of seizure at high temperatures

QB Describe Diagnosis of Allergy?

Blood Testing 1.Radioallergosorbent Test (RAST): Measures levels of IgE to specific allergens 2. Test that distinguishes if a patient has experienced an allergic attack: -Measures elevated blood cells of trypase, an enzyme released by mast cells that increases during an allergic response 3. In Vitro Tests can determine the allergic potential of a patients blood sample 4. Differential blood count reveals high levels of basophiles and eosinophils 5. Leukocytes histamine release test measure the amount of histamine release from a patients basophiles when exposed to a specific allergen. Skin Testing: In vivo method to detect atopic or anaphylactic sensitivity 1. Skin is injected, scratched, or pricked with a small amount of pure allergy extract. Site is appraised for wheal response indicative of a histamine release and the diameter is measured and rated on a scale of 0 (no reaction) to 4(greater than 15mm) 2. Food extracts are not reliable in this testing

M. Describe phagocytosis process in second line of defense? Remember it is an innate immune system that does not respond differently to pathogens. This includes inflammation, fever, antimicrobial proteins, and complement.

Bone Marrow and Thymus are primary lymphatic organs. They survey tissue compartments to discover microbes, particulate the matter, and injured or kill cells. They ingest and eliminate these materials and extract immunogenic information (antigens) from foreign matter. Neutrophils: General purpose phagocytes. Have limited ability due to rapid death when exposed to their own oxygen products to engulf bacteria, this is why we see pus at the site of an infection: its built up dead neutrophils. Monocytes are transformed into macrophages: They live longer and consume a lot of material and can live in tissues during their lifespan for defense (Kupffer cells, dendritic cells, macrophages of spleen, lymph nodes, bone, marrow, kidneys, bone and brain) The events of phagocytosis are: Chemotaxis (Attracted by gradient of stimulant products from parasite and host tissue, phagocytes migrate to site of infection), Adhesion on the pit of the membrane (Use PRRs to see PAMP's on foreign cells causing them to stick together) Ingestion (Extends pseudopods that enclose the cell in a pocket and internalizes them in a vacuole called a phagosome and excretes more chemokines), phagolysosome formation(lysosomes migrate to scene and fuse with it to form phagolysosome which produces more poisons to ingest material), destruction( Myeloperoxidase hydrogen peroxide, superoxide anion and hydroxyl free radicals combine to form killing ability. Liberation of Lactic Acid, lysosome, and nitric acid also kills bacteria) and inhibits replication. Cationic proteins injure cytoplasmic membranes and a number of enzymes complete the job like DNase and RNase.), and Excretion: Small undigestible debris are release by macrophage via exocytosis)

B. Describe the difference between broad spectrum and narrow spectrum?

Broad spectrum- effective against more than one group (tetracyclines) Narrow spectrum- Target a specific group (polymyxin and even penicillin)

QM. Describe Rubella?

Called: "German Measles" "3 day measles" -Causes a minor rash with few complications -Serious damage occurs when the fetus is exposed to the virus while in the mother's womb. Signs and Symptoms -"postnatal infection": in children and adults -"Congenital infection": In fetus, types of birth defects Postnatal Rubella -Rash of pink macules and papules appears on the face and progresses to the trunk and extremities -Characterized by joint inflammation and pain, resolves in three days usually Congenital Rubella -Teratogenic Virus -Transmits even if mother is asymptomatic. -First term results often in miscarriage or multiple permanent defects (deafness, cardiac abnormalities, ocular lesions, mental and physical retardation. Less drastic ones that resolve in time are: anemia, hepatitis, pneumonia, cardits, and bone infection. Causative agent: -Rubella virus in the family Togaviridae -Stops mitosis which is no important for a fetus -Induces apoptosis (cell death) of tissue/ organs -Induces Vascular Endothelium, leading to poor development of many organs Transmission and Epidemiology -Infection through contact with respiratory secretions and sometimes urine -Virus is shed during prodromal phase and up to a week after the rash appears -Congenital infected infants are infected longer _moderately communicable virus mean close living conditions to prevent spread. Culture and Diagnosis -not diagnosed on clinical grounds alone bc it mimics -IgM antibody test using ELISA technique or Latex agglutination card -Women of developing countries undergo antibody testing for checking immune status Prevention and treatment -MMR or MMRV vaccine for children at 12-15 months and a booster at 4-6 years of age -Postnatal rubella requires asymptomatic treatment -No treatment for congenital manifestations

B. What category of microbial drug inhibitors are polymyxins, and Daptomycin involved in?

Cause loss of selective permeability: These are cytoplasmic membrane inhibitors (most toxic to humans)

P. Describe good antigens

Characteristics Based on their: chemical composition, types of cytokines present and their size. Haptens: Are small foreign molecules that are too small to stimulate an immune response. But they will sometimes inappropriately develop antigenicity in the body by combining with larger carrier molecules Alloantigens are cell surface molecules that occur in some members of species but not other. They are the basis for an individuals blood group and major histocompatibility profile and are responsible for compatibilities in transfusions or organ grafting. Superantigens: Potent stimuli of bacterial toxin for T cells. The 100 times greater rate of ordinary antigens results in great release of cytokines and cell death. toxic shock syndrome is related with these antigens Allergens: Antigens that evoke an allergic reaction.

E. What are polymicrobial infections?

Contributions from more than one microbe (Influenza- from a virus and Pneumonia- caused by a bacterium) (One can lead to another OR both can aid in increasing their transcription of virulence factors or combinations can result in disease symptoms)

QD. Describe the classes of grafts and types of transplants?

Classes of grafts (relationship of donor & recipient) 1. Autograft: Tissues transplanted from one part of an individuals body to another 2. Isograft: Tissue from an identical twin is used 3. Allografts: A close genetic correlation is sought to exchange between two different individuals 4. Xenograft: Tissue exchange between two different species Types of Transplants: Transplants of every organ, common are: kidney liver, heart, skin, coronary artery, cornea, and bone marrow. Fetal tissues: treatment of diabetes and Parkinson's disease Parents donate organs to safe children's lives suffering from cystic fibrosis and liver disease. Stem cell technology to better isolate stem cells from blood donors &The use of the Umbilical cord blood cells to further this area of science In bone Marrow transplants to treat patients with immune deficiencies, aplastic anemia, leukemia, and other cancers: Patient is pretreated with chemotherapy and whole body radiation to destroy a person's own stem cells to help prevent rejection of new marrow cells. Then, donor marrow cells are dipped intravenously into the circulatory system and the new cells automatically set into the appropriate bone marrow regions. Then antirejection drugs prevent donor lymphoid cells from causing GVHD. (can change blood type of the recipients to the donor)

O. What is Clonal Selection and Deletion?

Clonal Selection: The mechanism of the correct B or T cell is activated by an incoming antigen. Lymphocyte specificity is preprogrammed into genetic makeup before an antigen has entered the tissues. Each genetically distinct lymphocyte expresses only a single specificity and can react to that chemical epitope. After activation, they multiply rapidly in a process called clonal expansion. Clonal Deletion: Is destruction of any lymphocytes that are able to react to self. Its creates memory Cells.

M. Describe fever and its role in the immune system?

Common in infection, and associated with certain allergies, cancers, and organic illnesses. FUO- Fevers of an unknown caused origin Pyrogens are described as exogenous (coming from outside the body- are products of infectious agents such as the production of endotoxin. Blood, blood products, vaccines, or injectable solutions can contain exogenous pyrogens) and endogenous (originating internally. Are released by monocytes, neutrophils, or macrophages during phagocytosis. they are a normal part of the immune response) When pyrogens which are circulating substances are roaming, it sets internal temperature higher by sending signals to the hypothalamus which results in: Musculature to increase heat production and peripheral arterioles to decrease heat loss through vasoconstriction.

B. What are the hazard levels categorized by the CDC? What is the biggest problem according to the CDC?

Concerning, Serious, and Urgent Biggest problem is drug resistance because every antibiotic ever made, has resulted in Microbes who became drug resistant.

M. What is diapedesis and Chemotaxis?

Diapedesis (oozing movement by squishing themselves out between epithelial cells and get closer to pathogens excreting chemokines) is the migration of WBC's out of blood vessels and into tissues may possible because: 1. Endothelial cells lining the venules that contain adhesive receptors that capture the WBCs and aid in their transportation from venules to extracellular spaces 2. Migratory habits of these WBCs is chemotaxis: they migrate in response to specific chemical stimuli given off at the site of injury/ infection. Smells are called chemokines.- essential for the intercommunication and deployment of cells required for most immune reactions

C. What are the three categories of serious adverse reactions to antimicrobial drugs?

Direct damage to tissues through toxicity: To the liver, kidneys, gastrointestinal tract, cardiovascular system, blood forming tissue, nervous system, respiratory tract, skin, bones, and teeth. Allergic reactions: Occurs because the drug acts as an antigen and stimulates an allergic response from no the drug itself but usually by its biproduct. People who are allergic usually become sensitized during the first contact, without suffering symptoms. In subsequent exposure, this leads to an allergic response by the body. (penicillin most common) Disruption in the balance of normal Microbial Biota: If a broad spectrum drug is used and kills all beneficially microbes, it leaves the ones that were once in small numbers, giving them an environment to overgrow in causing a superinfection. A disturbance in microbial biota leads to replacement biota and superinfection.(C Diff- Diarrhea. Spore forming so antibiotics will work over time but probiots or a fecal transplant work better)

fdg. Describe how enzymes and toxins contribute to virulence factors?

Enzymes and toxins are secretions that breakdown (for example, host defense barriers to inflict damage on deeper tissues) and inflict damage on tissues. Examples of enzymes are: -Mucinase: Digests protective coating on membranes - hyaluronidase: Digests hyaluronic acid that keeps animal cells together -Coagulase: Causes clotting of plasma/ blood -Bacterial Kinases: Dissolve fibrin clots and expediting the invasion of damaged tissues

I. How is it determined if the infections is a common- source or propagated epidemic? What is a point source epidemic? What is the index case?

Examine the epidemic curve- which is plotted over time- when there is an increase in disease in a particular geographical area. - A common source epidemic is one in which the infectious agent was present in a single source that had widespread distribution, infecting people in a wide geographical area. - A point source epidemic is a common source, it is a single batch of food or water that was contaminated and everyone was infected at once resulting in a shorter time span on the horizontal axis. - A propagated epidemic results from an infectious agent that was sustained over a time in a population because it is communicable from person to person. - Index case refers to the patient found in epidemiological investigation. It is useful because how cases unfurl from this case help explain the type of epidemic it is.

k. Describe the first, second, and third line of defenses of hosts?

First Line of Defense: Include barriers that block the invasion at any portal entry; limits access of internal tissues of the body; not an immune response (Examples: Lysosome in tears, mucous, sweat ph, enzymes, keratinized layer that is hard to puncture) Second Line of defense: Acts at the local and systematic levels once the first line of defense has been overtaken. A cellular and chemical system that comes immediately into play if infectious agents make it past the surface defenses: Determined by: Pattern- recognition Receptors: Used to recognize PAMPs. Defenses includes protective cells, fluids and processes such as inflammation and phagocytosis Third Line of defense: Includes specific host defenses that must be developed uniquely for each microbe through the action of specialized white blood cells- Lymphocytes that adapt to the invader. Provides log- term immunity by creating protective substance cells that are unique to that invader if it came again.

B. What category of microbial drug inhibitors are Sulfonamides and trimethoprim involved in?

Folic Acid Synthesis in cytoplasm

A. Describe the tube dilution tests? "in book"

For more sensitive and quantitative results. Antimicrobial is diluted serially into tubes of broth. Then each broth is inoculated of a small uniform pure culture, incubated, and examined for growth. The smallest concentration (Highest dilution) of a drug that visibility inhibits growth is called the: Minimum inhibitory concentration (MIC) which is useful for determining the smallest effective dosage of a drug and in providing a comparative index against other antimicrobials

B. What gene is being closely monitored by the CDC?

Gene mcr-1 because it makes a resistance to colistin known as polymyxin which is a last resort antibiotic for bacteria that are multi-resistant. The gene easily spreads to bacteria raising the possibility that the spread of infections can no longer be treated by a drug

QB. Describe the treatment and prevention of Allergy?

General treatment/ prevention of type 1 allergy: 1. Using drugs that block action of lymphocytes (corticosteroids), mast cells(cromolyn- block degranulation and reduce levels of inflammation), or chemical mediators: a. Block route between IgE production and the appearance in symptoms (antihistamines- block histamine activity by binding to histamine receptors on target organs) 2. Avoiding the allergen 3. Desentization: controlled by exposure to the antigen through ingestion, sublingual absorption, or injection to reset the allergic reaction a. Allergen shots: thought to: 1a: Allergens stimulate the formation of allergen- specific IgG blocking antibodies that can remove allergen from the system before it can bind to IgE. It combines with IgE itself and takes it from circulation. b. Eating small amounts of food allergens like milk in baked goods: b1: Heating proteins dentures them; so its possible the changed epitopes increases the IgG response- blocking antigen binding on the IgE on mast cells, thus blocking degranulation C. Oral Immunotherapy for peanut allergy: Patient is given increasing amounts of peanut protein daily, effectively curing them c1: altering the way the antigen is presented can correct the inappropriate response D. Probiotics have been shown helpful in some cases *Sudden development of allergies may be a result of a sudden disappearance of worm and protozoan pathogens in the world because the parts of immunity (IgE) in allergies naturally react to helminths and larger microbes. E. Experimental Approach: Causing infections that cause brief colonization without symptoms causes the immune system to respond and in some cases resets it inappropriate responses.

D. Describe the human Microbiome Project. (HMP)

Goals are to characterize the microbes living on human bodies when they are healthy, but also to determine how the microbiome differs in variations of diseases. 1. Human cells have 21,000 protein encoding genes and microbes contain 8 million, many being enzymes that help us digest and metabolize food 2. We have lots of microbes everywhere, including places thought to be sterile like our lungs 3. Viruses are present in healthy humans in vast quantities for ex, 100 million viruses are thought to be in human feces. Viruses affect how the entire ecosystem is developed 3. Regular Biota presence keep in check the dangerous pathogenic viruses in a healthy person 4. Intestinal biota influences one's overall health. Ex, gut health have been associated with Crohn's disease and obesity, heart health, asthma, autism, diabetes, moods, influences body's response of toxic side effects to cancer drugs, 5. Success of viruses in causing disease is influenced by the composition of the hosts microbiome because viruses have to interact with it to establish a place in the host 6. The profile of proteins that give off enzymatical capabilities is more important than the exact microbial profile of a specific body site.

C. What are sub inhibitory Concentrations of a drug?

Happens when people stop taking the drug when they feel better. It allows the Microbe to gain full resistance to the drug and then grow back the population that was lost

QB. Describe IgE and mast cell mediated Allergic conditions: Atopic diseases, food allergy, drug allergy?

Hay Fever (Allergic Rhinitis): 1. Reactions to inhaled plant pollen, mold, or chronic- year around reaction to a widespread spectrum of airborne allergens or inhalants 2. Targets respiratory membranes, symptoms include: nasal congestion, sneezing, coughing, perfuse mucous secretion, itchy, red, and teary eyes, mild bronchoconstriction Asthma: 1. Respiratory disease characterized by episodes of impaired breathing due to sever bronchoconstriction via small amounts of inhalants, ingestants, or infectious agents 2. Symptoms: Occasional difficult to sever suffocation, labored breathing, shortness of breath, wheezing, cough, ventilatory rales are present to one degree or another. 3.Respiratory tract is chronically inflamed and overreactive to leukotrienes and serotonin from pulmonary mast cells 4. In allergic response natural killer T cells are recruited and activated, adding to a brewing cytokine storm in the lungs Eczema 1. Atopic dermatitis intensely itchy inflammatory condition of the skin 2. Sensation occurs via: ingestion, inhalation, and skin contact with allergens 3. Begins with reddening, weeping, encrusted skin lesions in face, scalp, neck, and inner limbs and trunk. It progresses into dry, scaly, thickened skin condition in adulthood 4. People of this condition are predisposed to bacterial infections Food Allergy: 1. Mode of entry is the intestine but can affect the skin and respiratory tract 2. Gastrointestinal symptoms include: vomiting, diarrhea, and abdominal pain, hives, rhinitis, asthma, and occasionally anaphylaxis 3. Food sensitivity involves IgE and degranulation of mast cells, but not all do like food intolerances often involve missing enzymes Drug Allergy 1. Drugs are foreign compounds capable of stimulating allergic reactions (5-10% of hospitalized patients have these allergies) 2. Any tissue can be affected and reactions range from a rash to fatal anaphylaxis 3. The actual allergen is not the intact drug itself but a hapten produced when the liver processes the drug

B. Why are antiprotozoal and anthelminthic drugs likely to be more toxic that antibacterial drugs?

Helminthic are larger and have more human like physiology. Protozoal have enormous diversity resulting in no single drug being universally effective.

K. Describe blood cell development?

Hematopoiesis: Production of blood cells via the primary precursor of new blood cells is a pool of undifferentiated cells called: Pluripotential Stem Cells. These cells originate in the red bone marrow where exposure of growth factors and hormones cause differentiation of cells. Blood cells change their genetic expression which changes their markers and causes them to respond to new signals and mature. This is Blood cell development. Two Primary lines that arise from stem cells: 1. Those that differentiate from the Myeloid cell (erythroblasts) and platelet precursors (megakaryoblasts) 2. Those that differentiate from lymphoid precursor cells such as white blood cells (myoblasts) and precursors of lymphocytes (lymphoblast's) White Blood cells (Leukocytes) can be divided into two categories: Granulocytes: Have granules that can kill foreign material Agranulocytes: Do not have granules

A. How do you know if a drug has a potential for a greater toxic drug reaction?

If the therapeutic index (TI) (defined as ratio of the does of the drug that is toxic to humans as compared to its minimum effect) components are close, the closer they are, the greater potential for toxic drug reactions. TD: Toxic Dose is the amount of a drug, above which there is toxicity in humans. (TD50 50% experience toxicity & TD 90 90% experience toxicity) Hepatotoxic= liver, Nephrotoxic= kidneys Hemotoxic= GI, cardiovascular, Neurotoxic= Nervous system. TD= Toxic dose/ mic= therapeutic index (1 would kill patient, -1 is a very bad antibiotic because it will kill patient before it kills the microbe, more than 1 is a good because the toxic does is big and the MIC is small making it safe- low level to kill the microbe and high toxic does level to kill the patient.

O. What are specific B cell receptors?

Immunoglobin (A conglomerate of four protein chain; Two light, and two heavy (constants regions), and at the ends of the fork are pockets containing the antigen bonding site. They have variable regions where amino acid composition is highly varied from one clone B lymphocyte to another) and large glycoproteins serve antigen receptors of B cells, when secreted as antibodies.

QA. Describe the mechanisms of Type 1 Allergy: sensitization and provocation: The role of Mast cells and Basophiles?

Important Role of Mast cells and basophiles?: 1. Their ubiquitous location in tissues. Mast cell are especially of high population in the lungs, skin, gastrointestinal tract, and genitourinary tract. Basophiles circulate the blood but readily migrate into the tissues. 2. Their capacity to bind to IgE (30,000 to 100,000 receptors) during sensitization and degranulate the release of inflammatory cytokines from the cytoplasmic granules when stimulated by the allergen. Effects are physiological from mast cell derived allergic mediators on target organs.

I. How does an essential aim in the study of infection and disease determine the precise etiologic, or causative agent?

Koch's Postulates- Is a standard for determining causation that would stand the test of scientific scrutiny. General idea is to isolate the thought to be "causative agent" and then apply it to a naïve population and produce the same effect, holding all other variables constant. This is reliable for many infectious diseases but cannot completely fulfill in certain situations (like if some infectious agents are not readily isolated or grown in the laboratory, then you cannot elicit a similar infection to another animal to prove it is the same infection) (difficult for viral diseases because viruses have a narrow host range so T. M Rivers modified postulates for viral infections)

G. What is a localized infection and focal infection?

Localized infection: Infections in one location Focal Infections: Infections in a location that is different than the initial infection

K. Describe the lymphatic system vessels and fluids?

Lymphatic system- Compartmentalized network of vessels, cells and accessory organs. Starts at tiny capillaries that transport lymph through larger system of vessels and filters called lymph nodes and it goes to major vessels that drain back into circulatory system. Major functions are: 1. Return route transfers of extracellular fluid to circulatory system 2. A drain off system for inflammatory response 3. Are a surveillance, recognition, and protection from foreign materials via lymphocytes, phagocytes, and antibodies.

Fghi. Explain virulence factors induce a damaging host response?

Microbial disease are often the result of indirect damage caused by a host's excessive and inappropriate response to a microorganism. Meaning, that pathogenicity is not a trait inherited by the microorganism but it is a consequence of the interplay between the microbe and the host.

B. Describe agents used to treat Helminthic Infections?

Most effective drugs immobilize (Pyrantel paralyzes muscles of intestinal roundwarms allowing them to be excreted), disintegrate, or inhibit metabolism in all stages of life (Mebendazole and albendazole are broad spectrum antiparasitic drugs that work to inhibit intestinal function of Microtubules of worms, eggs, and larvae) Newer antihelminthic drugs are praziquantel (tapeworm and fluke infections), and ivermectin (For strongyloidiasis and oncocercosis (drugs are difficult to create because they are eukaryotic cells that are similar to humans- drugs tend to be ones that mess with microtubule functions in intestines- stops perastalsis that worms use to get food into them)

QE. Describe Neurotransmitter Autoimmunities?

Myasthenia Gravis Syndrome: Autoantibodies binding to receptor sites for acetylcholine- caused by this It results in complete skeletal muscle function loss and death. Treatment includesimmunosuppresive drugs and therapy to remove the autoantibodies from the circulation. Multiple Sclerosis: Paralyzing neurotransmitter disease associated with lesions in the insulating myelin sheath of neurons in the white matter of the central nervous system. T- cell and autoantibody damage reduces capacity in neurons resulting in muscular weakness and tremors, difficulty in speech and vision, and paralysis. There may be an association with herpesvirus 6 and the onset of the disease. Can be treated by monoclonal antibody therapy toward certain T cell agents and Immunosuppressants like cortisone and interferon beta help alleviate symptoms.

R. What is natural, artificial, active, and passive immunity?

Natural Immunity: Acquired during normal biological experiences, not through medical intervention. Artificial Immunity: Protection obtained through medical procedures like immunization. Active Immunity: Occurs when receiving an antigen that activates B and T cells causing production of antibodies, creates memory cells, takes several days to develop, and lasts for a long time Passive Immunity: When someone receives antibodies produced by another donor and is protected by a short time from its antigen. Does not produce memory cells, or new antibodies, has immediate protection for a short time, and can be natural or artificial by origin.

P. What are Natural Killers (NK), What are Hybrid kind of killer cell that is also part T cell(NKT)?

Natural Killers are a type of lymphocyte related to T cells that lack specificity for antigens. They are acutely sensitive to cytokines such as interleukin-12 and interferon. Hybrid kind of cell that is park of a killer cell and part T cell with T receptors for antigen and the ability to release large amounts of cytokines for quick cell death and are considered a bridge link between nonspecific and specific immunity.

Fc. Describe step three of infections: Becoming established- Surviving Host defenses?

Phagocytes: Are white blood cells that use enzymes and antimicrobial chemicals as a means of destroying pathogens. -Antiphagocytic factors: Helps microorganisms avoid phagocytes by circumventing some part of the Phagocytic process. (Some species produce Leukocidins that are toxic to white blood cells and kill them; Some species secrete a slime or capsule that makes it difficult to be engulfed and have shield (can be precursors to biofilms for persistence in favorable environment & a diffusion barrier against toxic substances& protects from phagocytosis) and surface antigens from antibodies; Some are adapted to survive one engulfed, some run away via motility)

A. What is Prep?

Pre-Exposure Prophylaxis- 2 nucleotide analogs and if you do come into contact with virion it is very likely that you will not be infected because your body is already at a high enough level of nucleotide analog that the transcriptase of (HIV) process will be inhibited preventing the replication of viral genome. Really expensive. HIV have been cured twice surprisingly!

K. What are primary lymphatic organs? Secondary?

Primary lymphatic organs are the birth place of immune cells. B- and T- lymphocyte precursors originate in red bone marrow. The thymus is the maturation site of T- Lymphocytes via thymic hormones Secondary Lymphatic organs are the places in the body where immune cells become active. Example Are: The lymph nodes (Outer rim is called the cortex, T- Lymphocytes are in the Paracortical Area, and B Lymphocytes and macrophages are in the medullary Sinus) are an example: they filter out materials in the lymph and provide appropriate cells for immune reactions The Spleen: Is a Filtering pathogens from the blood.It also acts as a storehouse of blood for the release of blood during hemorrhage

Q. Describe the relationship of the Primary and Secondary response to antigens?

Primary response is the first exposure to an antigen which is when an antigen is concentrated in lymphoid tissue and processed by correct B lymphocytes and plasma cells synthesize antibodies (most are the IgM type) and secrete them to kill the invader. The secondary response (anamnestic response) happens when exposure to an antigen repeats, resulting in an increased intensity of antibodies due to Memory B cells which is a potent response against infectious agents

K. What are Associated Lymphoid tissues?

Skin Associated Tissues (SALT): bundles of lymphocytes underneath the skin Mucosa Associated Lymphoid Tissues (MALT) Tonsils: In the pharynx are an active source of lymphocytes Gut- associated lymphoid Tissue (GALT): Intestine tract houses are a collected bunch of lymphatic tissue. (Appendix and Lacteals, Peyer's Patches: Lymphocytes in the ileum of the small intestine)

M. What are inflammasomes?

Special innate immune system cells containing Pattern Protein receptors (PPRs) inside their cytoplasm. They recognized microbials RAMPs (Pathogen- associated molecular Patterns) as well as markers from damaged host cells.

J. What is epidemiology?

Study of frequency and distribution of disease and other health related factors in defined populations. Involves many disciplines other than Microbiology: A&P, immunology, medicine, psychology, sociology, ecology, and statistics. Epidemiologist try to identify causative agents using adaptations of Koch's Postulates when disease is not infectious and nonexperimental types of analysis. They try to track behaviors. They collect clues on the causative agent, pathology, sources, modes of transmission, and tracks the number and distribution of cases of disease in the community to help develop prevention and treatment programs.

QE. What are Examples of Autoimmune diseases?

Systemic Autoimmunities: 1. Lupus Erythematosus: Thought to be caused by a viral infection or loss of normal immune response suppression- They produce antibodies against a variety of targets like organs, intracellular materials such as nucleoprotein of the nucleus and mitochondria. 2. Rheumatoid Arthritis: Autoantibodies form immune complexes that bind to the synovial membrane of the joints(which activates phagocytes to release cytokines. Chronic inflammation develops an leads to scare tissue/ joint destruction. Cytokines cause type 4 delayed hypersensitivity responses. An IgM antibody called rheumatoid factor is present in some. This causes overall progressive debilitating damage to the joints and at times to the lungs, eyes, skin, and nervous system. Autoimmunities of the Endocrine Glands: Grave's disease: Caused by the attachment of autoantibodies to receptors on the thyroxin secreting follicle cells of the thyroid gland. Abnormal stimulation of these cells leads to overproduction and the symptoms of hyperthyroidism affects every body system. Type 1 diabetes: Insulin secreted by beta cells in the pancreas regulates the utilization of glucose and molecular mimicry has been implicated in the sensitization of cytotoxic T cells which leads to lysis of beta cells.

QA. Describe Cytokines, Target organs, and Allergic symptoms?

The chemical mediators that are substances that mediate allergic reactions produced by Mast cells and Basophiles are: (inflammatory Cytokines) -Histamine: A fast acting stimulator of secretory glands and smooth muscle. 1. Constricts smooth muscle layers: causing labored breathing and increased intestinal motility 2.Relaxes Vascular smooth muscle and dilates arterioles and venules: Causing wheal and flare reactions in the skin and pruritus (itching) -Serotonin, 1. Role in human allergy is uncertain 2. Appears to complement the roles of histamine and bradykinin -leukotriene: slow reacting substance of anaphylaxis: 1. Gradual concentration of smooth muscle 2. Prolonged bronchospasm 3. Vascular permeability 4. Mucous secretion of asthmatic individual 5. Stimulation of immune system via activities of polymorphonuclear leukocytes or granulocytes -platelet- activating factor -Prostaglandins 1. Normally Regulate smooth muscle concentration (uterine contractions) 2. Vasodilation 3. Increased vascular permeability 4. increased sensitivity to pain 5. bronchoconstriction -Bradykinin: 1. Prolonged muscle contraction of bronchioles 2. Dilation of peripheral arterioles 3. Increased capillary permeability 4. increased mucous secretion

M. What are the benefits of Edema and Leaky Vessels?

The influx of fluid dilutes toxic substances and the fibrin clot can effectively trap microbes and prevent their further spread Neutrophils are at the inflamed site are phagocytosing and destroying bacteria, dead tissues, and particulate matter; contributing to pus which is liquified cellular debris. Some bacteria is especially powerful in attracting neutrophils so they are called pyogenic.

O. What are specific events in T cell development?

The maturation and development of specific receptors are directed by the thymus and its hormones. Some reach full maturity in the gastrointestinal tract. In addition to specific antigen receptors, they have coreceptors: C3 surround the T cell receptor and assists in binding. They will also has either a: CD4 coreceptor: Mostly found on T helper cells & helps them bind to MHC class 2 molecules or a CD5 coreceptor: Mostly found on cytotoxic T cells and helps bind MHC class 2 molecules. They migrate in the circulatory system to specific T cell areas of the lymph nodes and spleen.

A. How do Antibiotics work?

The most common target is the peptidoglycan of cell walls. (Synthesis- lots of places) Making the bacteria not able to stand the osmotic pressures of it environment. Beta lactam ring formed by "Cillins". The next common is translation: the production of proteins synthesize in the ribosomes (Erythromycin) Then there are those that affect the cell membrane (polymyxins) Then you can inhibit the production of DNA by messing with components of DNA replication You can inhibit RNA polymerase to make RNA transcription You can inhibit pathways to synthesize compounds for the cell (Folic Acid Synthesis because humans don't make folic acid)

D. What is the human Microbiome?

The sum total of all microbes found on and inside a normal human, is critically important to health and functioning of its host organism Our human microbiome colonize us for long term and do not cause disease

C. What is one way known to be responsible for causing the emergence of drug resistant bacteria that cause epidemics?

The unregulated use of antibiotic drugs being sold that leads to superinfections by the development of resistance in bystander microbes that helped spread resistance to pathogens that cause epidemics.

Q. Describe Antibody Structure and Function?

There are two distinct segments called fragments: They are the two arms that bind the antigen called: Antigen Binding fragments (Fabs). The rest of the molecule is called a crystallizable fragments (FC). It is 4 polypeptide chains: a pair of identical heavy chains and a pair of identical light chains. One light chain is bonded to a heavy chain and the pairs are both bonded together with another disulfide bond that creates a Y arrangement There are folds at the end that accommodate one epitope, and the special site of each attachment between Fab and Fc fragments allows a swiveling of Fab fragments to change their angels to accommodate antigen sites slightly. .

I. Why must certain reportable, or notifiable, diseases be reported to authorities?

These reports along with other collected trends by the authorities help track disease in a population. Reportable: Required (Anthrax ,HIV infections) Notifiable: Volunteer based : What is reported by physicians and hospitals

B. What category of microbial drug inhibitors are Penicillin, cephalosporins, carbapenems, vancomycin, bacitracin, fosfomycin, and isoniazid involved in?

They are cell wall inhibitors by blocking synthesis an repair

A. How do you select the right antimicrobial treatment?

Using in Vitro activity of various drugs to expose and observe effects of drugs on growth of microbe in a pure culture

QD. Describe type 4 hypersensetivities: cell mediated (delayed) reactions?

They are different from B- cell involvement and antibodies in that it primarily involves the T cell branch of the immune system. Results when T cells respond to antigens displayed on self tissues or transplanted foreign cells. Symptoms arise one to several days following the second contact with the antigen. 1. Infectious Allergy Example is when a person sensitized by tuberculosis infection is injected with an extract (tuberculin) from Mycobacterium tuberculosis. The reaction is a acute skin infection at sit eon injection appearing 24-48 hours later. It is a main diagnostic tool for TB infection. This kind of hypersensitivity involves a specific class of T cells and their release of cytokines that recruit various inflammatory cells The build up of cells and fluid gives rise to the red bump. 2. Contact Dermatitis (caused by exposure to resins in poison ivy or poison oak, to household and personal articles to certain drugs) Requires a sensitive dose followed by a provocative dose. Allergen first penetrates the outer layer and is processed by Langerhans cells and presented to T cells. Subsequent exposure attract lymphocytes and macrophages to the area and these cells release enzymes and inflammatory cytokines that damage the epidermis resulting in itchy papules and blisters. Healing is then progressed and the epidermis is replaced by a thick keratinized layer. 3. T cells and their role in Organ Transplant Similarity of genes and their markers (MCH and MLA) is seen in siblings and parents. When a donor tissue has different surface molecules of a different MHC class, the T cells of the recipient with recognize it as foreign and fight against it. T Cell Recognition of foreign MHC Receptors Host rejection of Graft If cytotoxic T cells of a host recognized a foreign class 1 MHC markers on a graft, they will release interleukin 2 to immobilize the immune system. Antigen specific helper and cytotoxic T cells bind to the graft and secrete lymphokines that help form antibodies against the transplanted tissue, contributing to damage , destruction of vascular supply and death of graft. Graft Rejection of the Host Graft Versus Host disease: When a graft contains a population of lymphocytes that make it quite possible for the graft tissue to reject the host via host tissue barring MHC markers foreign to the graft can be attacked. The effects are systemic and toxic: A papular peeling rash is common and it occurs 100 to 300 days after the graft

P. What are Gamma- Delta T cells?

They are specifically responsive against certain types of phospholipids, react against tumor cells, they create memory cells when activated, and they are considered a bridge between nonspecific and specific immune responses.

Q. Describe the function of Fc fragments?

They bind to receptor on the cell, function depends on the cell it binds to. For example in opsonization, Binding of fc fragment to phagocytes happens after the attachment of antibodies. Attachment of Fc to an allergy binds to basophiles and mast cells which releases allergic mediators such as histamines.

P. What are cytotoxic T cells?

They destroy other cells including: Virally infected cells (recognize telltale virus peptides on their surface), Cancer cells, Cells from other animals for humans (important in graft rejection). Cross presentation is a term describing that there are always T helper cells and T cytotoxin cells in a immune response.

0. What are specific Events in B Cell development?

They develop in the bone Marrow as a result of gene modification and selection. They circulate through the blood honing in to specific sites in the lymph nodes, spleen, and other lymphoid tissue to adhere to specific binding molecules (antigens)

N. Describe the third and final line of defense broadly. What is Immunocompetence? What are antigens? What are immunogens? what are epitope? What is specify and memory in terms of immunity?

Third and final line of defense response type is adaptive. It is the product of a duel system: B and T lymphocytes. Immunocompetence is the ability of the body to react with countless foreign substances. Antigens are molecules that can be seen and identified by the immune system, they are highly individual and stimulate specific immunity. If sensed and they do not provoke a response they are called: immunogens and they are protein or polysaccharides molecules on or inside all cells or viruses. An epitope is a fragment of an antigen molecule that lymphocytes respond to: it is the primary signal that a molecule is foreign. Specificity: Response is focused on a single antigen Memory: Is the rapid immobilization of lymphocytes preprogrammed to recall their first engagement with the antigen.

A. What is antiretroviral therapy?

Three drugs taken together: 2 are Nucleotide analogs And either a protease or an integrase(inhibits the sticking of DNA in your genome called integrase) or a transcriptase inhibitor) Decreases chances of get mutations of the virus of any one of the drugs.

Fa. Describe step one for Infections: Portal of entry? What is an infectious dose about?

To initiate an infection, a microbe must enter the tissues by a characteristic(can be many portals for some)/specific (for majority of pathogens have specific because it provides a favorable environment they may NEED to cause infection) route.(Skin via mucous membrane, abrasions, punctures, conjunctiva of the eye, Gastrointestinal tract via eating or drinking, respiratory tract via inhalation, Urogenital tract via skin/ mucosa w/ abrasions) Organisms can be coming from outside the body are called: exogenous Organisms coming from somewhere inside the same host are called: endogenous. Many Microbes have a factor crucial to the course of infection which is the quantity of microbes. For some, infection only proceeds if a minimum number called an infectious dose (ID). (ID 50)

Fdh. Explain how bacterial toxins: a potential source of cellular damage contributes to virulence factors?

Toxins are poisonous chemical products and is named according to its specific target of action (neurotoxins: act on nervous system; enterotoxins act on the intestine; hemotoxins lyse red blood cells; nephrotoxins damage the kidneys) Categories of toxins are: -Exotoxins: powerful and even deadly that specify to a target cell: typically damage cell membranes to cause lysis, or disrupt intracellular function (Hemolysins cause damage to red blood cells and causes them to hemolyze- burst and release red pigment. Colonies that use hemolysins can be identified by distinct zones/ patterns of hemolysis that grow on agar to help identify bacteria and degree of virulence) - Endotoxin: A chemical called lipopolysaccharide (LPS) which is part of the outer membrane of gram negative cell walls that allow it to be shed into these LPS molecules in gram negative bacteria causing fever, inflammation, hemorrhage, and diarrhea. (phospholipase: produced outside of the cell. It cuts the hydrophilic part off of membranes, destabilizing it and pop it. Can also be ingested via phagocytosis and it produces phospholipase which cuts off the hydrophilic part of the membrane and destabilizes the membrane and escape the phagocytotic membrane and now they can eat everything in the hosts cytoplasm= intracellular infection like listeria monocytogenes).

QC. Describe Type 2 hypersensitivities: Reactions that lyse foreign cells

Type 2 hypersensitivities: A complex group of syndromes that involve compliment- assisted destruction (lysis) of foreign cells by antibodies (IgG and IgM) dirrected against those cell's surface antigens: 1.Transfusion reactions: They introduce alloantigen's on donor cells that are recognized by the lymphocytes of the recipient which causes the immune system to not properly distinguish between desirable foreign cells and undesirable ones of the microbe 2. Types of autoimmunity's

QC. describe type 3 hypersenetivities: Immune complex Reactions

Type 3 hypersensetivity involves the reaction of soluble antigen with antibody(production of IgM and IgG antibodies) and the deposition of the resulting complexes (and activation of complement) in various tissues of the body. *Differs from type 2 because the interaction of these antigens with antibodies produces free floating complexes that can be deposited in the tissue causing an immune complex reaction, or disease.* Mechanisms of Immune Complex Disease Normal response: After initial exposure to a antigen, the immune system creates antibodies that circulate fluid compartments until the antigen enters the system a second time, reacting with the anti bodies to form antigen-antibody complexes that recruit inflammatory components such as complement and neutrophils that eliminate Ag-Ab complexes. Immune complex disease: Neutrophils release lysosomal granules that digest tissues and cause destructive inflammatory condition. This happens because of the multiply cross linking antigens with scarce anti bodies that form complexes that are deposited into the basement membranes, making them inaccessible. This all happens because there were excessive antigens and small amounts of antibodies.

A. What are Prophylaxis?

Use of drug to prevent infection of a person at risk

Fd. Describe Step four for infections: causing disease: How Virulence factors contribute to tissue damage?

Virulence factors are structures or adaptations of capabilities to allow a pathogen to cause an infection. The three ways that microorganisms cause damage to their host: 1. Action of enzymes (endotoxins and exotoxins that disrupt the hosts defenses such as: a. Mucinase- digest mucous membranes b. hyaluronidase- digests the connection between host cells c. Coagulase- creates fibrous clot to hide in d. Staphylokinase-Breaks down clots to facilitate invasion) 2. Induces host defenses to respond excessively or inappropriately 3. Epigenetic changes made to the host cell by the microbe

QF. Describe Immunodeficiency diseases: Hyposensitivity of the Immune system?

When a person is born (primary disease) with or develops weakened immune responses (secondary diseases) it is called immunodeficiencies. Results in recurring infections with opportunistic microbes. Primary Immunodeficiency Diseases: Due to inherited abnormality, though the exact nature of it is not known for some diseases. In some deficiencies, the lymphocyte in question is completely absent or low in numbers or some don't function properly. Because development of B and T cells diverges at some point, an individual can lack one or both cell lines. Some deficiencies affect other cell functions as well. Clinical Deficiencies in B cell Development or Expression: Deficiencies in B cell usually result in abnormal immunoglobulin expression, some are absent and in all others they are reduced. Hypogammaglobulinemia: The absence of gamma globulin that is part of the component of serum that contains immunoglobulins. Symptoms are recurrent; bacterial infections last up to 6 months after birth. Common infection sites are blood, lungs, sinuses, meninges and patients have recurrent infections with viruses and protozoa. Treatment is passive immunotherapy with immune serum globulin IgA deficiency is thought to be the cause of lack of protection of local microbial invasion of the mucous membranes and why they suffer from recurring repertory and gastrointestinal infections. Clinical Deficiencies in T cell Development or expression: *A genetic defect in T cell development cause a spectrum of diseases including severe opportunistic infections and Cancer. T cell defects are more severe than B cell because T helper cells are required to assist in Most specific immune reactions Abnormal development of the thymus: DiGeorge Syndrome/ thymic aplasia is the congenital absence or immaturity of the thymus resulting in being highly susceptible to persistent infections by fungi, protozoa, and viruses. Typically have reduced antibodies as well

B. Describe "natural selection and drug resistances?

When environmental factor (the drug) select pressure on the population, it allows the more fit microbe to survive and the population has evolved to a condition of drug resistance