Microbiology Pathology

virus
From the following list select the THREE items associated with Hepatitis C.
picornavirus
ss RNA
oral-anal
f lavivirus
ds DNA
hepadnavirus
blood borne
vaccination avai lable
copyright 0 201)..2014 Dental Decks
MICROBIOLOGY/PATHOLOGY
Saad Alqahtani, Twitter @saaddes
SAADDES
ss RNA
flavivirus
blood borne
Viru s Family Transmission
Hepatitis A Picornavirus ss RNA Oral-anal Hepatitis A
Hepatitis B He.padnavirus dsDNA Blood borne Hepatitis B
HepatitisC Flavivirus ssRNA Blood borne HepatitisC
Hepatitis D Delta virus ssRNA Blood borne Hepatitis D: Can only infect cells
pre.viously infected with hepatitis B
Hepatitis E CaJicivirus ss RNA OraJ. anal Hepatitis E
Infl uenza Orthomyxovirus ssRNA droplets Infl uenza
Respiratory syncytial Paramyxovirus ssRNA droplets Bronchiolitis and pneumonia in in
virus fants
Measles Paramyxovirus ssRNA Res piratory droplets Measles (rubeola)
Mumps Paramyxovirus ssRNA Res piratory droplets Mumps
Rubella Toga virus ssRNA Res piratory droplets Rubella (German measles)
Adenovirus Adenovirus dsDNA Res piratory droplets Pltaryngitis, Pneumonia,
Conjunctivitis
Rhinovirus Picornavirus ss RNA Res piratory droplets Common cold
HJV Retrovirus ssRNA Blood borne, Genital AIDS
Cytomegalovirus Herpesvirus dsDNA Re.;piratory droplets Mononucleosis syndrome
Epstein Barr Herpesvirus dsDNA Ro->piratory droplets Infectious mononucleosis
HSV.J Herpesvirus dsDNA Oral (saliva) Gingivostomatitis, Herpes labialis
HSV-2 Herpesvirus dsDNA Genital (sexually Genital herpes
transmitted disease)
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virus
Rotaviruses are the most common cause of gastroenteritis in children (2 and
under).
Reoviruses have an icosahedral capsid composed of an outer and inner prot-
ein shell containing a double-stranded segmented genome.
both statements are t rue
both statements are false
the first statement is t rue, the second is false
the first statement is fa lse, t he second is true
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both statements are true
Reoviruses are non-enveloped and have an icosahedral capsid composed of an
outer and inner protein shel l containing segmented, double-stranded RNA.
Important: The viri on contains an RNA-dependent RNA polymerase, which is
required because human cell s lack t hi s enzyme and t herefore cannot synthesize
mRNA from an RNA template. They repl icate in t he cytoplasm.
Important members of reovirus family that cause human disease:
Rotaviruses (also cal led gastroenteritis virus type B): the most common
cause of gastroenteritis in children (2 and under). It is spread via t he fecal
oral route. It can survive the acidic conditions in the stomach, after which it is
adsorbed in the smal l intestine. Adults may become infected with rotavirus but
symptoms are usual ly mild or absent.
Coltivirus (also cal led Colorado t ick fever virus): causes Colorado t ick fever.
Viral gastroenteritis is a self-l imiting disease, often referred to as the 24-hour or
intestinal flu. An influenza vi rus does not cause it. It is associated with RNA viruses
and is often diagnosed by ELISA on fecal samples. The il lness is characterized by
vomiting, low-grade fever, diarrhea, and t he metabolic consequences of water and
elect rolyte loss. Recovery usual ly occurs withi n 12-24 hours.
Important: Dehydration is a major concern, especially in infants where vi ral
gastroenteritis is somet imes fatal.
RNA non-enveloped virus families:
Picornavirus (Poliovirus, Coxsackie A & B vi ruses, Rhi novirus, Hep. A virus)
Reovi rus
Cali civi ruses (includes noroviruses and sapoviruses)
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virus
Which of the following is a paramyxovirus that causes many respiratory
infections in epidemics each winter. It is a common cause of bronchiolitis in
infants, which is complicated by pneumonia in approximately 10% of cases?
influenza
rubell a
coxsackievi rus
respiratory syncytial virus (RSV)
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respiratory syncytial virus (RSV)
RSV is the only member of the paramyxovirus fami ly (which also includes the measles, mumps,
and parainfluenza viruses) that lacks the envelope glycoproteins hemagglutinin and neuramini-
dase. Its surface spikes are fusion (F) proteins. RSV commonly causes respiratory tract infections
ranging from the common cold to pneumonia and bronchiolit is. The more severe manifestations
occur in infants and immunocompromised individuals.
Remember: The envelope of paramyxoviruses is covered with spikes, which contain either hemag-
glutinin, neuraminidase, or a fusion protein that causes cell fusion and, in some cases, hemolysis.
Its virion surface proteins cause infected cells to fuse, forming multinucleated giant cells (syncyt ial),
which give rise to the name of the virus. Treatment is generally supportive, but aerosolized ribavirin
(Virazole) can be given to severe cases, particularly those with underlying cardiac or respiratory
disease. No vaccine is currently available for RSV.
Note: RSV undergoes antigenic drift, and consequently, reinfection can occur throughout life.
Parainfluenza viruses cause croup (acute laryngotracheobronchitis) and pneumonia in children
and a disease resembling the common cold in adults. Infection is limited to the respiratory tract
(upper respiratory tract disease is most common). The surface spikes present on the viruses consist
of hemaggluti nin (H), neuraminidase (N), and fusion (F) proteins. These viruses are transmitted by
respiratory droplets and direct contact; there is neither antiviral therapy nor a vaccine available.
Note: Parainfluenza viruses rarely cause viremia (unlike measles and mumps viruses).
Important: Interstitial pulmonary inflammation is most characteristic of viral pneumonia.
Paramyxoviruses:
ss negative RNA
Enveloped
Contain an RNA-dependent RNA polymerase
Resemble orthomyxoviruses except they are usually larger in size, and have different surface
proteins as well as non segmented genomes
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virus
The cytopathic effect (CPE) is a single mechanism of infection.
All viruses cause CPE.
the first statement is true, the second is false
the first statement is fa lse, the second is true
MICROBIOLOGY /PATHOLOGY
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The hallmark of viral infection of the cell is the cytopathic effect (CPE). This change
starts with alterations of cell morphology accompanied by marked derangement of
cell function and culminates in the lysis and death of cell s.
Important: Not all viruses cause CPE; some can replicate while causing li ttle
morphologic or functional change in the cell. Such cytopathic changes include:
Necrosis Detachment from substrate
Hypertrophy Lysis
Giant cell formation Membrane fusion
Hypoplasia Altered membrane permeability
Metaplasia Inclusion bodies
Altered shape Apoptosis
These cytologic changes provide useful presumptive evidence for the diagnosis of
the viruses t hat induce the cytopathic effects.
Important: Viruses use specific cell surface receptors to bi nd to and subsequently
gain entry into their host cells. The identification of these receptors explains the
cellular tropism of viruses.
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virus
All of the following are included in the family of Herpesviruses EXCEPT one.
Which one is the EXCEPTION?
varicell a-Zoster virus (VZV)
epstein-Barr virus (EBV)
cytomegalovirus (CMV)
coxsackievi rus (A & B)
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coxsackievirus (A & B)
*** Both coxsackievirus group A & B are in the picornavirus family (ss RNA, icosahedral cap-
sid, wi th no envelope present)
Members of the Herpesvirus family include: herpes simplex types 1 and 2, varicella zoster
virus, epstein-barr virus, human herpesvirus types 6, 7, and 8, and cytomegalovirus. All
herpesviruses are morphologically identical.
Herpesviruses:
dsONA
Nuclear membrane
Enveloped
Icosahedral nucleocapsid
Important: Herpesviruses replicate in the nucleus of the host cell and are the only viruses t o
obtain their virion envelopes by budding from the host nuclear or Golgi membrane, not the
host plasma membrane.
The hallmark of all herpesvirus infections is the abi lity of the viruses to establish latent (or
silent) infections that then persist for the life of the individual. HSV-1 most commonly remains
latent in the trigeminal ganglion, HSV-2 most commonly remains latent in the sacral ganglia,
VZV most commonly remains latent in dorsal root and cranial nerve ganglia. CMV most
commonly remains latent in the nuclei of the cells in the endothelium of the arterial wall and
in T lymphocytes. EBV remains latent in resting memory B lymphocytes.
Three of the herpesviruses, herpes simplex 1, 2 and the varicella-zoster virus, cause a vesicular
rash.
Certain herpesviruses have oncogenic potential (causing cancer) in humans. The Epstein-
Barr virus is associated with Burkitt's lymphoma and nasopharyngeal carcinoma, Human
herpesvirus type 8 (Kaposi's sarcoma-associated herpesvirus) is strongly associated with the
etiology of classical and AIDS-related Kaposi's sarcoma.
DNA enveloped viruses: herpesvirus, poxvirus, and hepadnavirus
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virus
Prions are the most recently recognized and the simplest infectious
agents, consisting of a single protein molecule.
Prions contain no nucleic acid and therefore no genetic information.
the fi rst statement is true, the second is false
the fi rst statement is fa lse, the second is t rue
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Prions are infectious protein particles (atypical virus-like agents) that are composed solely of
protein. They cause certain "slow" diseases such as Creutzfeldt-Jakob disease, a severe
degenerative brain disease caused by t he ingestion of beef from a cow infected with mad cow
disease. Note: Their ability to propagate withi n a host relies on inducing the conversion of
endogenous prion protein PrP into a protease-resistant isoform PrPSc.
Important: Prions do not elicit inflammatory or antibody responses. Prions are generally quite
resistant to proteases, heat, radiation, and formalin treatments, although their infectivity can
be reduced by such treatments.
The viral particles, or virions, contain either single- or double-stranded DNA or RNA (never
both) that is encased in a protein coat called a capsid. The combination of the nucleic acid and
the protein capsid is call ed the nucleocapsid. They are either naked or enveloped,
depending on whether the capsid is surrounded by a lipoprotein envelope.
The capsid is composed of polypeptide units called capsomeres. Some viruses (e.g., orthomyx-
oviruses and paramyxoviruses) have envelopes that are covered with spikes, which contain
either hemagglutinin, neuraminidase, or a fusion protein that causes cell fusion and, in some
cases, hemolysis.
In contrast to bacteria, fungi, and parasites, viruses are not cells; i.e., they are not capable of
reproducing independently, do not have a nucleus, and do not have organelles such as
ribosomes, mitochondria, and lysosomes. Viruses are smaller than cells and cannot be seen in
the light microscope.
Note: Almost all viruses are haploid (contain a single copy of their genome; the exception is
the retrovirus family, whose members are diploid).
Viroids consist solely of a single molecule of circular RNA without a protein coat or envelope.
They cause several plant diseases but are not implicated in any human disease.
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virus
Herpes simplex virus type 2 is mainly spread through sexual contact.
It cannot be spread from mother to infant during childbirth.
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HSV-2 is mainly spread through sexual contact, although i t can be spread from mother to
infant during child birth. Most geni tal infections are HSV-2; HSV-1 predominantly causes labial
lesions. Remember: Of all of the herpesviruses, herpes simplex viruses 1 and 2 cause
manifestations of recurrent infection in otherwise healthy people.
Herpes simplex virus type 1 - Primary herpetic gingivostomatitis
Caused by initial exposure to HSV-1
Transmitted from person to person through oral secretions
Usually occurs in a child under ten years of age
Nearly all primary infections are of t he subclinical type, they may only have flu-like
symptoms and one or two mild sores in the mouth which go unnoticed by the parents
Acute herpetic gingivostomatitis:
In other children, the primary infection may be manifested by acute symptoms
Acute symptoms include fever; irritability; cervical lymph-adenopathy; fiery red gingival
t issues; and small, yellowish vesicles which rupture and resul t in painful ulcers on t he free
and attached mucosa
The most serious potential problem in a child with this infection is dehydration due to the
child not wanting to eat or drink because of t he pain
Adult recurrence - herpes labial is ("cold sore")
Following primary infection, the virus remains latent most commonly in the trigeminal
ganglia
Reactivation often produces localized paraesthesia in t he lip before the appearance of a
cold sore
The most common site of recurrence in adults is along the vermillion border of the lips
(known as herpes labi alis or cold sores). Herpetic conjunctivitis (infection of the eye is also
common).
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virus
Which of the following herpesvirus infections can be treated prophy-
lactically by a vaccine?
HSV-1
HSV-2
varicel la-zoster virus
epstein-barr vi rus
cytomegalovirus
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varicella-zoster virus
VZV produces two distinct diseases, varicel la (chickenpox) and herpes zoster
(shingles). The primary infection is chickenpox. Foll owing recovery from chickenpox
the virus remains latent in dorsal root and cranial nerve gangl ia. Reactivation of
infection then results in shingles.
An effective live attenuated varicella vaccine is a routine vaccination of chi ldhood
in the United States. Note: Recent evidence suggests that vaccination of all adults
over the age of 60, with a dose higher than that used for chickenpox prophylaxis in
childhood, reduces shingles-related morbidity and post-herpetic neuralgia.
Remember: Typicall y, HSV-1 infects ABOVE the waist: eye and mouth lesions. HSV-2
infects BELOW the waist: genital lesions. Note: Oral-genital sex can lead to HSV-1
below the waist and HSV-2 above the waist.
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1. Pri mary infection with HSV-1 can range from subclinical (asymptomatic)
to severe systemic infections.
2. Compli cations of HSV-1 infection include transfer to the eye (dendri tic
ulceration, keratitis) acute encephalitis, skin infections such as herpetic
whitlow and erythema multiform e.
3. Diagnosis can be made by Tzanck preparation of vesicular fluid, which
typically shows multinucleated giant cell s.
4. Systemic antiviral drugs (e.g., acyclovir, famciclovir, or valacycl ovir) can be
used as episodic or suppressive therapy.
Genital herpes (caused by HSV-2) may have seri ous consequences in pregnant
women because the virus can be t ransmitted to the infant duri ng vaginal deli very.
The virus can cause damage to the infant's central nervous system and/or eyes.
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virus
A bacteriophage with the ability to form a stable, nondisruptive relationship
within a bacterium is called a:
vi rulent phage
plasmid
temperate phage
phage T4
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temperate phage
It is a bacteriophage which is capable of replication by an alternate method in which
the phage genome is incorporated into the bacterial chromosome. It persists through
many cell divisions of the bacterium without destroying the host, in contrast to a
vi rulent phage that lyses and kil ls its host.
Remember the characteristics of a bacteriophage: a virus that can replicate only
within specific host bacterial cell s.
A lysogenic bacterium is one that contains a temperate bacteri ophage.
(Example: Corynebacterium diphtheriae, see below)
Lysogenic conversion: the alteration of a bacterium to a virulent strain by the
transfer of a DNA temperate bacteri ophage. The classic example of this conversion is
in the alteration of Corynebacterium diphtheriae to a virulent strain. The presence of
this temperate phage renders the bacterium pathogenic (without the phage it would
not be harmful).
Note: The integrated viral DNA is call ed a prophage.
1. Enterobacteria phage T4 is a phage that infects E. coli bacteria.
2. Plasmids are extrachromosomal, double-stranded, circular DNA
molecules that are capable of repli cating independently of the bacterial
chromosome.
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virus
For each numbered definition below, select the most closely linked term
from the list provided.
Definition
I. A bacterial virus
2. A cell within which a virus replicates
3. Jntcgration into the host genome without killing
the host
4. Viral multiplication within a host cell leading to
destruction
5. Transfer of DNA from a donor cell to a recipient
cell with the DNA packaged within a bacteriophage
Term
A. Lytic cycle.
B. Lysogenic cycle.
C. Transduction
D. Host cell
E. Transfom1ation
F. Conjugation
G. Bacteriophage
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1. Bacteriophage, 2. Host cell, 3. Lysogenic cycle, 4. Lytic cycl e, 5. Transduction
A bacteriophage is a very delicate bacterial virus which may attack and destroy bac-
t erial cells under certain conditions. It contains a nucleic acid core which can consist
either of DNA or RNA. This core can be either single-stranded or double-stranded. The
nucleic acid core is surrounded by a protein coat. Some bacteri ophages may contain
li pid. Some have a tail-like structure through which they inject their nucleic acid into
the bacteri al host cell. It is also call ed a phage.
A host cell is a cell within which a virus replicates. Once inside the host cell, the viral
genome achieves control of the cell's metabol ic activities. The virus then uses the
metaboli c capacity of the host cell to reproduce new viruses. Often the replication of
these new vi ruses causes death of the host cell.
Bacteriophage infection follows one of two courses: lysis or lysogeny. If the infecti ng
virus multipli es within the host cel l and destroys it, the virus is said to be lytic, or vir-
ulent. On the other hand, if the virus does not replicate but rather integrates into the
bacterial chromosome, the vi rus is said to be temperate, or lysogenic. The phage in
the lysogenic cycle can spontaneously become lytic. The presence of the integrated
virus, which is called a prophage, generall y renders the cell resistant to infection by
similar phages. Lysogeny does not result in the destruction of the host cell.
Remember: Transduction is the transfer of DNA from a donor cell to a recipient cell
with the DNA packaged within a bacteriophage. Transformation is gene transfer
resulting from the uptake by a recipient cell of naked DNA from a donor cell.
Conjugation is the exchange of genetic materi al from one bacterial cell (donor) to
another (recipient) by the close association of the two cells and the passage of the
bacterial chromosome or plasmid through the F pilus.
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virus
Retroviruses contain an RNA genome and reverse transcriptase.
A provirus i s formed as viral RNA is directly incorporated into the host
DNA.
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Retroviruses contain 2 identical, single-stranded, positive-sense RNA molecules. They
also contain an RNA-directed DNA polymerase (reverse transcri ptase). Once infected,
this reverse transcri ptase uses the viral RNA as a template to create viral DNA, which
is then incorporated into the host DNA to form a provirus. This provides the template
for viral RNA synthesis by host-deri ved mechanisms.
Important point to remember: Retroviruses are distinguished f rom other RNA
viruses by their ability to repli cate through a DNA intermediate using an enzyme,
reverse transcriptase.
Human lymphotrophic retroviruses:
Lentivirus - HIV-1 which causes AIDS
- HIV-2 which causes AIDS
Oncovirus - HTLV-1 which causes adult T cell leukemia
- HTLV-2 which causes myelopathy
Important points to remember:
For RNA viruses:
- Transcription occurs in the cytoplasm except for retroviruses and influenza
viruses.
-Transcription involves an RNA-dependent RNA polymerase except for retro-
viruses, whi ch as explained above possess the enzyme reverse transcriptase
(an RNA-dependent DNA polymerase).
For DNA viruses:
-Transcription occurs in the nucleus except for poxviruses.
-Transcription involves a host-cell DNA-dependent RNA polymerase.
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virus
For each numbered site of latency below, select the most closely linked virus
from the list provided.
Site of Latency
I. Sacral Ganglia
2. Resting memory B lymphocytes
3. Trigeminal ganglion
4. T lymphocytes
5. Dorsal root and cranial nerve ganglia
Virus
A. Cytomegalovirus
B. Epstein-Barr
C. HSV-2
D. Varicell a-Zoster
E. HSV- 1
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1.C,2.8,3.E, 4.A, S.D
Virus Usual Site of Lat ency Disease
HSV-1 Trigeminal ganglion Pri mary: Gingivostomatiti s
Secondary: Cold sore
Kerat itis
Encephal it i s
HSV-2 Sacral gang I i a Genital herpes
Epstein-Barr Resting memory B lymphocytes Pri mary: I nfectious mononucleosis
Secondary: Burki tt's lymphoma
B cell lymphoma
Hairy leukoplakia
Nasopharyngeal carcinoma*
Associated wit h
Cyt omegalovirus I n the nuclei of the cells i n the Congenital infection (if a mother becomes
endothelium of the arterial wall infected with CMV dur i ng pregnancy)
and in T lymphocytes Infection i n irnmunocompromised individuals
Varicella-Zoster Dorsal root and crani al nerve Pri mary: Chickenpox
ganglia Secondary: Shi ngles
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virus
All of the following are RNA enveloped viruses EXCEPT one. Which one is
the EXCEPTION?
rubel la virus
influenzae viruses A, B, and C
rotavirus
measles vi rus
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rotavirus
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virus
Human adenoviruses are unlikely to target the central nervous system
BECAUSE adenoviruses prefer epithelial cells for replication.
both the statement and the reason are correct and related
both the statement and the reason are correct but NOT related
the statement is correct, but the reason is NOT
the statement is NOT correct, but the reason is correct
NEITHER the statement NOR the reason is correct
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Adenoviruses are naked (non-enveloped) medium-sized viruses composed of anicosahedral
nucleocapsid and a double-stranded linear DNA genome. They have spikes
(glycoproteinaceous projections that in this case are hemagglut inin proteins) protruding from
their surfaces that are involved in the adsorption or attachment of the virus to epithelial
derivatives of the host. These viruses frequently cause subclinical infections. Infection is
usually transmitted in droplets of respiratory or ocular secretions. Diseases include respiratory
ill nesses (especially in children), conjunctivit is, gastrointestinal disease, uri nary tract infections,
and pharyngitis.
Virus Structure
Virion: infectious, complete virus particle: RNA or DNA and proteins
Note: Enveloped viruses have carbohydrates and lipids
Capsid: composed of repeating protein subunits (protomers}
- protect viral genome from extracellular nucleases
- impart structural symmetry to virion (icosahedral or helical)
- essential for the infectivity of virion
- in naked (non-enveloped) viruses, the capsid serves as t he attachment protein that bi nds
to t he host cell receptor
-antigenic and provoke host immune response
-most viruses have one capsid, an exception is Reoviridae that has two capsid layers
Nucleocapsid: composed of capsid and nucleic acid
Envelope: viral membrane, lipid bilayer carrying viral glycoproteins
Matrix protein: welds the capsid or nucleocapsid to the envelope
1. The ability of pathogenic microorganisms, including viruses, to attach to and
invade particul ar cells and t issues establi shes specific tissue affini ties for
pathogenic microorganisms.
2. Most viral antigens of diagnostic value are proteins.
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virus
From the following list select the FOUR items associated with poliovirus.
reoviri dae
salk vaccine
poliomyelitis
sabin vaccine
transverse myeli t is
picornaviridae
MMR vaccine
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salk vaccine, poliomyelitis, sabin vaccine, picornaviridae
Picornaviruses (Pico=small ) are a large family of smal l RNA viruses, which includes the
enteroviruses, rhinoviruses, and Hepatitis A virus which infect humans. The term
ente ro refers to the enteric means of spread of these viruses (i.e., via the fecal-oral
route). The enteroviruses include poli ovirus types 1-3, coxsackie A and B viruses,
echoviruses and enteroviruses 68-71.
Poliovirus, the causative agent of poliomyelitis, is a very small single-stranded positive
RNA virus with an icosahedral capsid. No envelope is present. The virus preferentially
repli cates in the motor neurons of the anterior horn of the spinal cord; thus, the death
of these cell s leads to muscle paralysis. It is t ransmitted by consumption of water with
fecal contaminants. It is uncommon in the Western worl d due to successful vaccina-
tion programs.
The initial symptoms of poliomyelitis include headache, vomiting, constipation, and
sore throat. Paralysis may follow and is asymmetric and flaccid.
1. Two vaccines are current ly used for active immunization against
poliomyelitis:
Salk vaccine containing formalin-treated inactivated viruses that is
given intravenously
Sabin vaccine containing live, attenuated viruses which is administered
orall y
***Both contain 3-types of poli o virus (trivalent).
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virus
Which of the following is the largest and most complex DNA virus?
poxvirus family
herpesvirus family
papovavirus famil y
parvovirus family
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poxvirus family
The poxvirus family includes three viruses of medical importance: smallpox virus (var-
iola virus), vaccinia virus, and molluscum contagious virus (MCV). Poxviruses are the
largest and most complex vi ruses known. They have complex, oval to brick-shaped
morphology with internal structure.
Poxviruses are very large (300 nm x 200 nm) and the viral genome consists of a large,
double-stranded, li near DNA that is fused at both ends. These viruses multiply in the
cytoplasm of host cells (as opposed to the nucleus) and are usually associated with
skin rashes. The most important human poxvirus is small pox (vari ola). Smallpox is an
acute, highly infectious, often fatal disease that is characterized by high fever, prostra-
tion, and a vesicular, pustular rash. This disease has been eradicated by global use of
the vaccine, which contains live, attenuated vaccinia virus.
1. The viri on of poxviruses contains a DNA-dependent RNA polymerase.
This enzyme is required because the virus repl icates in the cytoplasm and
does not have access to the cell ular RNA polymerase, which is located in the
nucleus.
2. Smallpox virus has a single, stable serotype, which is the key to the suc-
cess of the vaccine.lf the antigenicity varied as it does in the influenza virus,
eradication would not have succeeded.
3. Herpesviruses, adenoviruses, papovaviruses, and hepadnavirus are other
icosahedral DNA viruses and multiply in the nucleus of host cells.
Note: Poxviruses are the only DNA viruses that replicate in the cytoplasm.
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virus
All of the following are members of the Picornaviridae family EXCEPT
one. Which one is the EXCEPTION?
poliovirus
coxsackievirus
enterovirus
hepadnavi rus
hepatitis A vi rus
rhinovi rus
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hepadnavirus
Picornaviruses (Pico=small) are a large famil y of small (30 nm) RNA viruses, which
includes the enteroviruses, rhinoviruses, and Hepatit is A virus which infect humans.
The term entero refers to the enteric means of spread of these viruses (i.e., via the
fecal-oral route).
The enteroviruses include poliovi rus types 1-3, coxsackie A and B viruses, echovi rus-
es and enteroviruses 68-71.
The picornaviruses non-enveloped, and are composed of a single-stranded posi-
tive RNA genome with an icosahedral capsid. Note: The picornaviruses are inca-
pable of causing cell transformation, due to the RNA genome.
Coxsackieviruses:
Group A Virus: cause herpangina and hand-foot-and-mouth disease. Vesicular
lesions accompany fever, sore throat, and pain on swall owing.
Note: The location of oral lesions distinguishes these two diseases f rom one anoth-
er; t he oral lesions of herpangina appear on the t hroat, palate, or tongue; t he oral
lesions of hand-foot-and-mouth disease appear on t he buccal mucosa and ging-
iva.
Group B (for body) Virus: fever and chest pain with headache, fatigue, and ach-
ing muscles lasting 4-5 days.
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1. Diseases associated with echoviruses incl ude: aseptic meningitis,
encephalitis, paralysis, rash, fever, acute upper respiratory tract infections,
enterit is, pleurodynia, myocardit is and neonatal infections.
2. Rhinoviruses are the main cause of the common cold. There are more
t han 100 serologic types, which is t he main reason that a vaccine has not
been found.
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virus
Epstein-Barr virus is the causative agent for the all of the following EXCEPT
one. Which one is the EXCEPTION?
kaposi's sarcoma
infectious mononucleosis
nasopharyngeal carcinoma
burkitt's lymphoma
oral hai ry leukoplakia
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kaposi's sarcoma
The Epstein-Barr virus (EBV) is a member of the herpesvirus group. It causes infectious
mononucleosis and has been associated with the subsequent development of two forms of
cancer: Burkitt's lymphoma and nasopharyngeal carcinoma. EBV is also associated with
oral hairy leukoplakia, a whitish, nonmalignant lesion on the tongue seen especially in AIDS
patients. The virus specifically infects B lymphocytes, and following primary infection
remains latent in resting memory B lymphocytes.
Laboratory findings include lymphocytosis, the presence of atypical lymphocytes and lgM
heterophile antibodies identi fied by the heterophile test (also called the mononucleosis spot
test). Thi s antibody eventually appears in t he serum of more than 80% of the patients with
infectious mononucleosis; hence, it is highly diagnostic of the disease.
1. Rubella (German measles) is caused by a spherical, enveloped RNA virus which
is spread via droplets. German measles presents wi th a characteristic rash (flat, pink
spots on the face and then spreads to other body parts).
2. Paramyxoviruses are a heterogenous group of enveloped viruses with negative
single-stranded RNA genomes that are responsible for a variety of infections.
Measles (rubeola) is characterized by the formation of Koplik's spots in t he oral
cavity. These spots are small, bluish-white lesions surrounded by a red ring. They
cannot be wiped off and occur opposite t he molars. Mumps cause enlargement of
the parotid glands. Serious complications include deafness in children and orchitis
(inflammation of the testis) in males past puberty. Parainfluenza is caused by the
parainfluenza viruses types I-IV; t hese cause acute respiratory disease. Respiratory
syncytial virus (RSV) causes many respiratory infections each winter, it is a com-
mon cause of bronchiolitis in infants.
3. The MMR vaccine is a mixture of three live attenuated viruses, administered via
injection for immunization against measles, mumps and rubella. It is generally
administered to chi ldren around the age of one year, with a booster dose before
starting school (i.e., age 4/5).
SAADDES
virus
HIV-1 and the related virus, HIV-2 are further classified as lentiviruses
BECAUSE of their slowly progressive clinical effects.
19
SAADDES
Retroviruses are RNA viruses t hat have t heir genome surrounded by an inner protein envelope
and an outer envelope t hat contains lipid and glycoprotein spikes, which serve to attach t he
virus to t he host cells. The word "retro" refers to the possession of the enzyme reverse tran-
scriptase (an RNA-directed DNA polymerase), which transcribes RNA to DNA during t he
process of viral nucleic acid synthesis.
The nucleocapsid of HIV consists of two single strands of RNA along with t he enzymes reverse
transcriptase, protease, and integrase, all encased in an outer lipid envelope derived from a
host cell via budding. This envelope has 72 surface projections containing an antigen, gp120,
t hat aids in t he binding of t he virus to the target cells with CD4 receptors. A second glycopro-
tein, gp41, binds gp120 to the lipid envelope. The genome of HIV, similar to retroviruses in
general, contains three major genes:
env gene - codes for its two envelope glycoproteins
pol gene - codes for its three enzymes
gag gene - codes for core proteins
The transmission of HIV occurs primarily by sexual contact and by transfer of infected blood.
The virus infects and kills helper (CD4) T-cells, resulting in t he depression of both humoral
and cell-mediated immunity. It travels throughout the body, particularly in macrophages,
which are the first cells infected by HIV. It induces a distinctive CPE (cytopathic effect} called
giant-cell (syncytial} formation. In addit ion to the CD4 receptor, a core receptor known as a
chemokine is required for HIV to infect cells. Important: The rapid emergence of new strains
of HIV is primarily the resul t of frequent errors introduced by viral reverse transcriptase.
1. Acute HIV-1 primary infection can present as a mononucleosis-like syndrome
wi th fever, fatigue, sore throat, and skin rash.
2. HIV differs from the RNA tumor viruses in that it lyses the host cells. RNA tumor
viruses transform the cells that they invade but do not possess cytolytic activity.
3. HTLV-1 and 2 are also retroviruses that are further classified as oncoviruses.
SAADDES
virus
All of the following viruses have negative polarity or contain negative
sense RNA EXCEPT one. Which one is the EXCEPTION?
orthomyxovi ruses
paramyxovi ruses
rhabdovi ruses
retroviruses
20
SAADDES
retroviruses
Retroviruses have positive polarity, or in other words they possess positive sense
RNA molecules (RNA with t he same base sequence as t he mRNA).
RNA with negative polarity has a base sequence that is complimentary to t he
mRNA. For example, if t he mRNA sequence is G-U-C-A, an RNA with negative polarity
would be C-A-G-U, and an RNA with positive polarity would be G-U-C-A. Note: This
term, positive or negative polari ty, only refers to RNA viruses.
Important points to remember: The f irst step in viral gene expression is mRNA syn-
thesis. The positive polarity RNA viruses can use their RNA genome directly as
mRNA. The negative polarity RNA viruses must transcribe their own mRNA by using
the negative strand as a template. Because t he cell does not have an RNA polymerase
capable of using RNA as a template, t he virus carries its own RNA dependent RNA
polymerase. The polarity and genome structure govern how viral mRNA is generat-
ed and proteins are processed.
Note: RNA viruses have a genome which may be single-stranded or double-stranded,
segmented, or nonsegmented.
SAADDES
virus
A mother takes her child to their primary care physician. The child has a
recent history of malaise and fever, and now presents with a widespread
rash on his trunk and face. The mother states that the child has received the
vaccinia vaccine. This child has most likely been infected with:
variola
varicell a-zoster
cytomegalovirus
herpes simplex type 1
21
SAADDES
varicella-zoster
VZV produces two distinct diseases, varicella (chickenpox) and herpes zoster
(shingles). The primary infection is chickenpox. Following recovery from chi ckenpox
the virus remains latent in dorsal root and cranial nerve ganglia. Reactivation of
infection then results in shi ngles. 90% of all cases of chi ckenpox occur in children
under 9 years of age. Local lesions (vesicles) occur in the skin after dissemination of
the virus through the body. These lesions become encrusted and fall off in about one
week. Important: The administration of aspirin is contraindicated in this and in
other chil dhood viral infections. Aspirin given to infected chil dren increases the
incidence of Reye's syndrome, which can cause encephali tis and liver impairment.
Shingles (herpes zoster) is the result of reactivation of a latent varicella-zoster virus
that remained wit hin the body from a chi ldhood case of chickenpox. It is character-
ized by painful vesicles that occur on the skin or mucosal surfaces along the distribu-
tion of a sensory nerve. It is usually localized to a single dermatome, and is more com-
mon in individuals who are immunocompromised.
Note: Adenosine arabinoside (vidarabine):
Suppresses the synthesis of varicella-zoster and herpes simplex viruses
Tends to diminish new lesion formation and the duration of fever
Prevents the spread of the virus through the viscera
Remember: The vaccinia vaccine is a highly effective immunizing agent that enabled
the global eradication of smal lpox.
SAADDES
virus
Influenza viruses have all of the following features EXCEPT one. Which one is
the EXCEPTION?
single-stranded DNA
hemaggluti nin
neuraminidase
genetic reassortment
l ipoprotein coat
22
SAADDES
single-stranded DNA
Influenza viruses are the only members of the orthomyxovirus fami ly. The influenza virus
is composed of a unique segmented, negative, single-stranded, RNA genome. It is a spher-
ical or filamentous enveloped virus. Three types of influenza are recognized; A, Band C,
distinguishable by the nature of their internal proteins.
Influenza A is generally responsible for pandemics and epidemics
Influenza B often causes smaller or localized and milder outbreaks, such as in camps
or schools
Influenza C causes mild upper respiratory tract illness. Lower respiratory tract compli -
cations are rare.
The envelope is covered with two different types of spikes. Hemagglutinin (H), a surface
glycoprotein, aids attachment of the virus to the cell wall of susceptible host cells at spe-
cific receptor sites. The enzyme neuraminidase (N), facilitates cell penetration, probably
by pinocytosis, and release of replicated viruses from the cell surface effected by budding
through the cell membrane.
The ability of the influenza virus to cause epidemics is dependent on antigenic changes
in the hemagglutinin and neuraminidase. There are two types of changes: antigenic
shifts, which are major changes based on reassortment of genome pieces, and anti-
genic drifts, which are minor changes based on point mutations.
Important: Reye's syndrome includes vomiting, lethargy and may result in coma. It is rare,
but approximately 40% of cases are fatal. The origin of Reye's syndrome is unclear but
seems to follow certain viral infections such as influenza or chickenpox (varicella-zoster/
herpes zoster}, especially if they are in the young and especially if they have been treated
with aspirin. Aspirin is contraindicated for childhood or adolescent fevers because it is a
risk factor in the development Reye's syndrome. Acetaminophen and Ibuprofen are
apparently not associated with Reye's syndrome.
SAADDES
virus
For each numbered characteristic below, select the most closely linked disor-
der from the list provided.
Char acteristic.
I. Painful swell ing of the parotid glands
2. Skin rash with Koplik's spots
3. Flu-like symptoms and lymphadenopathy
followed by a rash on the entire body
4. Inflammation of the pharynx
5. Complications include Reye's Syndrome
Disorder
A. Measles
B. Mumps
C. Influenza
D. Rubella
E. l'hmyngitis
23
SAADDES
1. B, 2. A, 3. 0, 4. E, 5. C
1
1. Mumps is caused by an RNA para myxovirus and is transmitted via respirato-
Notcs ry droplets. The most noticeable symptom of mumps is the painful swelling of
the parotid glands, either unilateral or bilateral. Note: Two complications are of
significance: orchitis with painful swelling of the testicles in postpubertal males,
which can result in sterility, and deafness in children.
2. Influenza is caused by influenza viruses A, B, and C (orthomyxoviruses).
Complications incl ude Reye's syndrome in children. Amantadine and riman-
tadine act to prevent viral replication and are only effective against influenza A.
3. Measles (Rubeola) is caused by rubeola virus (RNA paramyxovirus). It charac-
terized by skin rash with Koplik's spots, and is transmitted via respiratory
droplets.
4. German measles (Rubel la) is caused by the rubella virus (RNA virus).
Transmitted via respiratory droplets. Flu-like symptoms and lymphadenopathy,
followed by a rash on t he entire body.
5. Pharyngitis is an inflammation of the pharynx. The main symptom is a sore
throat. It is caused by a variety of viruses (adenoviruses and coxsackieviruses).
6. The alphaviruses (member ofTogavirus family) and flaviviruses (i.e., Yellow
fever virus, Dengue virus, West Nile virus) are classified as arboviruses because
they are usually spread by arthropod vectors.
Remember: Rhinoviruses are the most important cause of the common cold and upper
respiratory tract infections. Such infections are self-limited, however, and do not cause
serious disease. More than 100 serotypes of rhinovirus have been identified. Rhinoviruses
are members of the picornavirus family, which have single-stranded positive sense RNA
genome, with an icosahedral capsid. No envelope is present. Note: Other agents likely to
cause the symptoms of the common cold are ent eroviruses, coronaviruses, adenoviruses,
and parainfluenza viruses.
SAADDES
virus
Order the steps in the replicative cycle of viruses. Match each letter with
its proper sequence number.
1. A. Release by budding through host plasma membrane or plasma membrane
rupture
2. B. Replication and viral protein production
3. C. Attachment through a receptor
4. D. Assembly of new virus particles
5. E. Entry via receptor-mediated endocytosis or membrane fusion
6. F. Uncoating t riggered by pH changes in endosomes
24
SAADDES
1. C, 2. E, 3. F, 4. B, 5. D, 6. A
Steps in the Replicative Cycle of Viruses
1. Attachment: Through a receptor.
Specifi c: CD4 on T cells for HIV
ICAM on upper respiratory epi thelial cells- Rhinoviruses (common cold)
Immunoglobulin-like receptors polio virus
2. Entry- receptor-mediated endocytosis (e.g., influenza and adenovirus)
- membrane fusion (e.g., herpesviruses and paramyxoviruses)
3. Uncoating- t riggered by pH changes in endosomes (e.g., Influenza A virus)
4. Replication and viral protein production transcription and translation
..,.*All DNA viruses (except poxviruses) replicate in the nucleus using host cell RNA polymerase.
***All RNA viruses (except retroviruses and orthomyxoviruses) replicate in the cytoplasm using
their own RNA polymerase.
5. Assembly: The new viral nucleic acid and capsid proteins are packaged.
6. Release: Either by budding through the host plasma membrane or by host plasma membrane
rupture.
A typical one-step growth analysis can be divided into several
phases:
1. Adsorption of virus (ini tial phase)
2. Eclipse phase: This lasts for 10-12 hours, and it corresponds
to the period during which the input virus becomes uncoated.
As a result, no infectious virus can detected during this t ime
3. Synthetic phase: This starts around 12 hours post-i nfection
and corresponds to the time during which new virus particles
are assembled.
4. Latent period: During this period, no extracellular virus can
be detected. After a certain ti me period, extracellular virus is
detected. Ultimately, product ion will reach a maximum plateau
level.
SAADDES
virus
Orthomyxoviruses and Paramyxoviruses share the following characteristics
EXCEPT one. Which one is the EXCEPTION?
spheri cal shape
single-stranded RNA
segmented RNA
hemagglutinin
negative-sense RNA
25
SAADDES
segmented RNA
Both paramyxovi ruses and orthomyxovi ruses are enveloped, negative, single-
stranded RNA viruses.
Orthomyxoviruses- influenza viruses A, Band C
***Are known to show changes in the antigenicity of their surface proteins.
Paramyxoviruses- measles, mumps, respiratory syncytial, and parainfluenza viruses
1-4
***The cytopathic effect for paramyxoviruses is syncytia formation (they induce
cell s to form multinucleated giant cell s) .
Anti viral Tx I Vacdne Virus I I Anti\'iral Tx I V acd nt
lnOucnm. l nllucnu. Amantadin<.' Yt> H .. "tpp.-s>impkll. Ao."}'d.;,vir(luvirax) No
kmlilnt!dine f)'pt 1 li t 1-pe.t l.3bi:dl3 Jencido, ir (f>cn:hu)
Zanamh ir C,;,njuntli \'lltt .. "}}d.;,vi rtValtrtxt
Croopinduldren No H .. tpo.'S>irupll:ll. H""f'd gcnitlllis Acyd.;,vir (l.o\'llllll.) No
l'nocutiKMii:l and fhb:hi ti n No
1)'1*2
S)'I\C)'WII brondu.UI1t1t ttl
V3la .. ryd.;,vir(VIIhtext
tnr:lnts lni'I.'Cti\lutnWn<>l'lud c.;,$iS Nun< No
ltub<'lla N,;,not \'1:9;
Va.tio. -tlbZo!il<."'' Chick<11 p<t.\! Ao."}'d.;,vir(l.o\u:lll.l v .. "j
lf'lt:l.'lli:$)
Shinglct f':amckl.;,vir(F:'Itl\Ytrt
Mt::SSltll; No .. y.,
.. "}}d.;,vi rtValtrtxt
MUII'lp$ Mumpt No .. Yt$
Ad.:Mvin1$ l)ntmn.:mi:. 'None 'I'd
C.;,njuntti \'lllt
l'thin.;,virull Nun< No
l)b:'lr)'I\:SiliS
C.;,rooa:vm.tt N.;,noe No
.... ,.
C.;,xsiacb.:\'ltU3 A: Herp:.ngin:., No .. No
A& B li 3:nd (I)()Cilnd
11\()\lth N.;,noe No
8: l'kurod)'ni:.,
m)'OC::Irditl.t.,ilnd

SAADDES
virus
Each of the following viruses cross the placenta EXCEPT one. Which one is the
EXCEPTION?
rubel la
herpes
HIV
measles
cytomegalovirus
26
SAADDES
measles
Viruses that cause respiratory disease in children:
Common viral causes of pharyngitis:
Respiratory syncytial virus (RSV)
Coxsackievirus A
Parainfluenza viruses 1-4
Adenoviruses
Rhinoviruses
Orthomyxoviruses (influenza viruses)
Adenoviruses
Epstein-Barr virus
ommon causes of viral gastroenteritis:
Viruses that cross the placenta:
Rotavirus (most common cause in children)
Rubella
Noroviruses (i.e., Norwalk virus) and sapoviruses
Herpes
Adenoviruses and astroviruses (more common
HIV
in adults)
Cytomegalovirus
Causes of the common cold: Most common pediatric viral diseases with a rash:
Rhinoviruses Coxsackievi ruses Measles (measles virus) Erythema infectiosum
Coronaviruses Rubella (rubella virus) (Erythrovirus B19)
Adenoviruses
Roseola (H HV 6) VZV
Reoviruses are the only RNA viruses that are double-stranded
Rotaviruses are the most common cause of infectious diarrhea
Most common causes of
in infants and young children
aseptic meningitis:
Most common human disease caused by an arbovirus is
Coxsackieviruses
Dengue fever
Echoviruses
Most common cause of epidemic encephalitis is Japanese
Mumps virus
encephalitis virus
CMV is the most common viral cause of mental retardat ion in
the U.S.
SAADDES
virus
Which family comprises two genera: the rubiviruses, which include rubella
virus, and the alphavirus, which include some of the arthropod-borne virus-
es?
picornavirus
reovi rus
flavivirus
calicivi rus
togavi rus
27
SAADDES
togavirus
Rubella virus has the same structural properties and mode of repli cation as the other
togaviruses. However, unlike the other togaviruses, rubella is a respiratory virus and does
not cause readily detectable cytopathologic effect s.
Rubella (German measles) is one of the fi ve classic childhood exanthems, along with
measles, roseola, fifth disease, and chickenpox.
The typical picture of rubella includes a maculopapular rash that appears fi rst on the face
and neck and quickly spreads to the trunk and upper extremities and then to the legs. It
often fades on the face while progressing downwards. The lesions tend to be discrete at
first, but rapidly coalesce to produce a fl ushed appearance. The onset of rash is often
accompanied by low-grade fever. Although the rash usually last s 3 to 5 days (hence the
term "3-day measles"), the associated fever rarely persists for more than 24 hours. The ear-
liest and perhaps the most prominent and characteristic symptom of rubell a infection
is lymphadenopathy of the postauricular, occipital, and posterior cervical lymph nodes;
this is usually most severe during the rash but may occur even in the absence of rash.
Rubella infection acquired during pregnancy can result in stillbirth, spontaneous abor-
tion, or several anomali es associated with the congenital rubella syndrome. The classic
triad of congenital rubella syndrome includes cataracts, heart defects, and deafness.
~ " ' ! . 1. Rubella is caused by a spherical, enveloped RNA virus with hemagglutinin-
containing surface projecti ons.
2. The rubella vaccine in current use is prepared from attenuated rubella virus
and is incorporated into the MMR vaccine.
SAADDES
bacteria
All of the following are characteristics of Staphylococcus au reus EXCEPT one.
Which one is the EXCEPTION?
coagulase-negative
gram-positive
causes infective endocarditis
possesses surface protein A
causes Toxic Shock Syndrome
28
SAADDES
coagulase-negative
Staphylococcus aureus is coagulase positive whereas other Staphylococci are coagulase negative.
Staphylococcus aureus cannot invade through intact skin or mucous membranes, and infection
usually begins with traumatic inoculation of the organism. Once inside the body, it secretes a
number of enzymes and toxins that harm most tissues.
Note: The cell wall of S. aureus contains ribitol phosphate teichoic acid.
S. au reus are pyogenic gram-positive cocci that form clusters like bunches of grapes. These bacteria
cause a myriad of skin lesions (boils, carbuncles, impetigo, and scalded-skin syndrome) as well as
abscesses, sepsis, osteomyelitis, pneumonia, endocarditis, food poisoning, and toxic shock
syndrome (TSS).
S. aureus produces many toxins, including five cytolytic or membrane-damaging toxins (alpha,
beta, delta, gamma, and Panton-Valenti ne [P-v) leukocidin), two exfoliative toxins (A and B), eight
enterotoxins (A toE, G and I) and toxic shock syndrome toxin-1 (TSST-1).
Important: Exfoliative toxin A, the enterotoxins, andTSST-1 belong to a class of polypeptides known
as superantigens. These toxins bind to class II major histocompatibi lity complex molecules on
macrophages, which in turn interact with specific T Cell Receptors. This results in a massive release
of cytokines by both macrophages and T cells.
S. aureus strains possess two forms of coagulase: bound and free. Coagulase bound to the staphy-
lococcal cell wall can directly convert fibrinogen to insoluble fibrin and cause staphylococci to
clump. The cell-free coagulase accomplishes the same result by reacting with a globulin plasma fac-
tor (coagulase-reacting factor) to form staphylothrombin, a thrombin-like factor. This factor cat-
alyzes the conversion of fibrinogen to insoluble fibrin.
Note: This process may protect the organisms from phagocytosis.
Staphylococci produce a variety of other enzymes that hydrolyze host tissue components and aid in
the spread of the bacteria. Hyaluronidase hydrolyzes hyaluronic acids, present in the acellular
matrix of connective tissue. Fibrinolysin, also called staphylokinase, can dissolve fibrin clots. All
strains ofS. au reus and more than 30% of the strains of coagulase-negative Staphylococcus produce
several different lipases, which hydrolyze lipids and ensure the survival of staphylococci in the
sebaceous areas of the body. S. au reus also produces a thermostable nuclease, which can hydrolyze
viscous DNA.
SAADDES
bacteria
From the following list select the THREE items associated with Staphylococc-
us au reus.
protein A
streptokinase
causes toxic shock syndrome
M protein
streptolysin 0
causes scalded skin syndrome
gas gangrene
29
SAADDES
protein A, causes toxic shock syndrome, causes scalded skin syndrome
Organism
Streptococcus
pyogenes
Staphylococcus
au reus
Clostridium
bon.linum
Clostridium
perfl"ingens
Major Virulence Factor (s)
M protein
DNasesA to D
4 Streptococcal pyrogenic exotoxins (Spe)
(SpeA, B, C and F)
S!reptolysin 0 and S
Sueptokinase A and B
Hyaluronidase
Exotoxin A (SpeA)
Exotoxin B (SpeB)
Protein A
Coagulase. nuclease, lipases
Staphylokinase (fibl'inolysin)
Hyaluronidase (spreading factor)
Bera-lactamase (penicillinase}
Toxins:
5 Cytolytic toxins (alpha, beta, delta,
gamma. and P-V leukocidin)
8 Enterotoxins (A toE, G and I)
2 Exfoliative toxins (A and B)
TSST 1 (toxic shock syndrome toxin)
Botulinum neurotoxin:
is the most potent roxin knm.vn w man.
J)otent exotoxin:
a.- toxin (a lecithinase)
Clostridium tetani Neurotoxin: recanus toxin.
(tetanospa..'im)
Corynebacterium Diphtheria toxin
diptheriae
Action (s)/Disease (s)
Resistance [0 phagocytosis
Cleaves DNA
Responsible for many of the clinical manifestations of
severe streptococcal diseases (i.e., scarlet fever)
lysis of red & whi te blood cells
Dissolves fibrin in blood clots
Breaks down hyaluronic acid
Streptococcal toxic shock syndrome
Rapidly destroys tissue
Inhibits complement fixation by binding to the Fe
po11ion of JgG
Clots blood; hydrolyze DNA; hydrolyze lipids
Dissolves blood clots
Breaks down hyaluronic acid
htac[ivate-$ penicillin.
Toxic ro many types of ce.l!$, including erythrocyres,
leukocyte$, hepatocyres. and platelets
Causes food poisoning
Causes .. scalded skin syndrome''
Causes toxic shock syndrome"'
Muscle and nerve paralysis
Botulism
Des-rroys integrity of cell membrane; breaks down
fibrous tissue
Ga.s gangrene
Interfere$ with motor neurons
Tetanu.< (lockjaw)
Blocks elongation factor-2 during translation,
inhibiting prorein synthesis
Diphtheria
SAADDES
bacteria
Which ofthe following is the predominant type of bacteria on the skin?
lactobaci ll i
lactic acid bacteri a
neisseria
staphylococci
30
SAADDES
staphylococci
Predominant Bacteria at Yarious Locations in Adults
Anatomical Location Predominant bacteria
Skin Staphylococci and corynebacteria
Conjunctiva Sparse: gram-J)()Sitive cocci and gram negative rods
Oral cavity:
Teeth Streptococci, lactobacilli
Mucous membranes Streptococci and lactic acid bacteria
Upper respiratory tract
Nares (nasal membranes) Staphylococci and corynebacteria
Pharynx (throat) Streptococci, neisseria, Gram-negative rods and cocci
Lower respiratory tract None
Gastrointestinal tract
Stomach Helicobacter pylori (up to 50%)
Small intestine Lactics, enterics, enterococci, bifi dobacteria
Colon Bacteroides, lactics, enterics, enterococci, clostridia
U rogcnital tract
Anterior urethra Sparse: Staphylococci, corynebacteria, enterics
Vagina Lactic acid bacteria during child-bearing years; otherwise mixed
SAADDES
bacteria
The Lancefield groupings are based on the antigenic characteristics of a cell
wall carbohydrate called the A substance.
The main pathogenic groups for humans are A, B, C, D, and G.
the fi rst statement is true, the second is false
31
SAADDES
the first statement is false, the second is true
The genus Streptococcus is a diverse col lection of gram-positive cocci typically arranged in pairs
or chains. Most species are facultative anaerobes. Their nutritional requirements are complex,
necessitat ing the use of blood- or serum-enriched media for isolation. Carbohydrates are
fermented, resulting in the production of lactic acid, and unli ke staphylococcal species, streptococci
are catalase-negative.
Different, overlapping schemes are used to classify streptococci: (1) Serologic properties: Lancefield
groupings (originally A toW); (2) Hemolytic patterns: complete [beta [b]) hemolysis, incomplete
(alpha [a]) hemolysis, and no (gamma [g]) hemolysis; and (3) Biochemical (physiologic) properties.
The Lancefield groupings are based on the antigenic characteristics of a cell wall carbohydrate
called the C substance. The main pathogenic groups for humans are A, B, C, D, and G, and each
group is given a species name.
Group A strains are pathogenic for humans. More than 90% of streptococcal disease in humans
is caused by group A beta-hemolytic strep - S. pyogenes. They are further subdivided by Arabic
numerals into specific antigenic types based on the cell wall M protein. This M protein seems to
be closely associated with the virulence of the bacteria. Other important components in the cell
wall of S. pyogenes include lipoteichoic acid and F protein.
Remember: Toxins produced by Group A beta-hemolytic streptococci include streptococcal
pyrogenic exotoxins (Spe) A,B,C and F, DNases A to D, streptolysins 0 and S, hyaluronidase, and
streptokinase A and B.
1. Streptococcal pyrogenic exotoxin A (SpeA) is a superantigen [as is SpeB) produced
by Streptococcus pyogenes and is associated with severe infections characterized by
rash, hypotension, multiorgan fail ure and a high mortality rate.
2. Oral Streptococci are usually alpha-hemolytic (i.e., S. viridans, S. mutans, S. sanguis
and S. salivari us). These bacteria are the most common organisms causing subacute
endocarditis.
SAADDES
bacteria
In this graph, a standard bacterial growth curve is depicted. Which of the
following is true of the stage indicated by 'C'?
l!
!l
0
.2
t 1
8
D
!
'--A
0 30 90 150 210
Time (minutes)
more logari thmic bacterial growth during C than during A
more logari thmic bacteri al growth during C than during D
less logarithmic bacterial growth during C than during A
32
less logarithmic bacterial growth during C than during B
SAADDES
less logarithmic bacterial growth during C than during B
The bacteri al growth curve reflects the dynamics in a population of bacteri a over a
period oftime.
When bacteria are placed in a fresh, nutrient-ri ch medium, they exhibit four charac-
teri stic phases of population growth:
1. A = Lag phase
2. B = Log (logarithmic or exponential) phase
3. C = Maximum stationary phase
4. D = Decl ine (death) phase
Lag phase: cells are metabolical ly active but are not dividing. This is a period when
the cel ls are resynthesizing enzymes, coenzymes, etc., necessary for growth and divi-
sion.
Log phase: bacteria are growing and dividing at an exponential, or logarithmic, rate.
This is the period of fastest growth; the generation time is maximal and constant.
Note: Most cidal antibiotics work best during this phase. This is the best phase to stain
bacteria culture to study them.
Maximum stationary phase: at this point, the medium is becoming depleted in
some nutri ents, and toxic quantities of waste materials may be accumulating. The
number of new cel ls produced is offset by the number of cells that are dying; thus, the
total number of viable cells remains constant.
Death phase: conditions are becoming less and less conducive to cell growth. Cells
are dying more rapidly than new ones are being formed, resulting in a logarithmic
decrease in the number of cell s.
SAADDES
bacteria
Endotoxins are part of the outer membrane of the cell wall of:
gram-positive bacteria only
gram-negative bacteria only
both gram-positive and gram-negative bacteria
neither gram-positive nor gram-negative bacteria; they are a component of viruses
33
SAADDES
gram-negative bacteria only
The biological activity of endotoxin is associated with the lipopolysaccharide
(LPS). Toxicity is associated with the lipid component (Li pid A) and immunogenicity
is associated with the polysaccharide components. The cell wall antigens (0 anti-
gens) of gram-negative bacteria are components of LPS. LPS elicits a variety of
inflammatory responses. It activates complement by the alternative (properdin)
pathway.
Charactcl'istics of Bacterial Endotosins and Esotosins
Property Endotoxin Exotoxin
Organisn1s G ratn negative Gratn pos itivc and gran1 ncgativc
Chen1ical n ~ . t t u r e Lipopolysaccharide Protein
Relationship to cell Part of outer 1nen1branc Extracel lu lar, ditlUs ible
Denatured b y boiling No Usually
Antigenic Yes Yes
Form toxoid No Yes
Pote ncy Very high Relatively high
Sp ecificity Low degree High degree
Enzymatic activity No Otlcn
Py rogenicity Yes Occasionally
Released b y organisms No Yes
SAADDES
bacteria
Which of the following is essential to the function of the outer membrane of
gram-negative bacteria?
protein
p antigen receptors
coagulase
LPS
34
SAADDES
LPS
The function of the outer membrane of gram-negative bacteria is to act as a protective permeability
barrier. The outer membrane is impermeable to large molecules and hydrophobic compounds from
t he environment. LPS is essential to t he function of the outer membrane.
Important:
1. Endotoxins are not secreted by bacterial cells. The bacterial cell must die and the outer mem
brane be broken down for the endotoxin to be released into t he bloodstream. The host's responses
to endotoxins include chills, fever, weakness, generalized aches, and, in severe cases, shock and
death.
2. Endotoxins are highly potent lipopolysaccharides released from t he cell walls of gram-negative
bacteria. Minute amounts in the oral mucosa cause inflammation and resorption of adjacent bone.
Endotoxin has a chemotactic effect on neutrophilic granulocytes and induces phagocytosis by
these cells.
1.1n addit ion to endotoxin, plaque bacteria al so produce enzymes (hyaluronidase, collage
Notes nase, chondroitin sulfatase, elastase, and proteases) that may initiate periodontal disease.
Free endotoxin is present in dental plaque and in infl amed gingiva. Remember: The most
likely source of bacteria found in diseased periodontal t issue is subgingival plaque.
2. Collagenase is the protease which degrades collagen, one of the body's primary connec
t ive t issues. In pat ients with periodontal disease, the collagen which forms the structural
basis of the periodont ium is broken down by collagenase. Thi s protease has been demon
strated to be a part of the component system in the following bacteria: Porphyromonas
species, Clostridium species, Bacteroides species, and Actinobacillus actinomycetemcomi
tans (Aa).
3. Although most bacterial exotoxins are proteinaceous in nat ure, endotoxin is a
lipopolysaccharide compl ex composed of a lipid A (portion most responsible for toxic
activity) core polysaccharide, and an "0" antigeni c side chain.
4. Endotoxin can activate t he complement system via the alternative pathway. C3 can be
activated by endotoxin in the absence of preceding activat ion of C1, 4, and 2. As a result, the
various complement components (C3, 59) are consumed and then their activity disappears
or is reduced from serum.
SAADDES
bacteria
Detection of protein A can be used as a specific identification test for:
streptococcus pyrogenes
neisseri a gonorrhoeae
salmonell a
staphylococcus au reus
35
SAADDES
staphylococcus aureus
S. aureus are pyogenic gram-positive cocci that form clusters like bunches of grapes. These bacteria
cause a myriad of skin lesions (boils, carbuncles, impetigo, and scalded-skin syndrome) as well as
abscesses, sepsis, osteomyelitis, pneumonia, endocarditis, food poisoning, and toxic shock
syndrome (TSS). S. aureus is a major cause of hospital acquired (nosocomial) infection of surgical
wounds and infections associated with indwell ing medical devices. S. aureus causes food
poisoni ng by releasing enterotoxins into food, and toxic shock syndrome by release of
superantigens into the blood stream.
The surface of most S. aureus strains (but not the coagulase-negative staphylococci) is coated with
protein A. This protein is bound to either the peptidoglycan layer or the cytoplasmic membrane
and has a unique affinity for binding to the Fe receptor of lgG and inhibiting complement fixation.
The genus Neisseria contains two important human pat hogens, N. gonorrhoeae and N. meningi-
tidis. N. gonorrhoeae causes gonorrhea, and N. meningitidis causes meningococcal meningitis. N.
gonorrhoeae infect ions have a high prevalence and low mortality, whereas N. meningitidis infec-
t ions have a low prevalence and high mortality.
Salmonella is a gram-negative facultative rod-shaped bacterium in the same proteobacterial fam-
ily as Escherichia coli, the family Enterobacteriaceae, t rivially known as "enteric" bacteria. In
humans, Salmonella is the cause of two diseases called salmonellosis: enteric fever (typhoid),
resulting from bacterial invasion of the bloodstream, and acute gastroenteritis, resulting from a
foodborne infection/intoxication.
1. Streptococci are aerobic to facultatively anaerobic gram-positive cocci that grow in
pairs or chains in culture. They are the most numerous group of microorganisms that
occur in the oral cavity, where they can grow and cause dental caries (mainly S.
mutans). Other more serious infections caused by Streptococcus include pneumonia
(S. pneumoniae), rheumatic fever (S. pyogenes), and heart valve infections (S. viridans).
2. Staphylokinase (produced by S. aureus), Streptokinase (produced by hemolytic
streptococci), and Urokinase are enzymes that cleave plasminogen, producing plas-
min, which causes the liquefact ion of fibrin. They are used clinically in the removal of
blood clots.
SAADDES
bacteria
Each of the following bacteria produce hyaluronidase EXCEPT one. Which
one is the EXCEPTION?
staphylococcus aureus
streptococcus pyogenes
bordetella pertussis
clostridium perfringens
36
SAADDES
bordetella pertussis
Extracellular Bacterial P roteins That .\rc Considcnd lm a sins
Jnvasin Bact eria Activity
Hyaluronidase Streptococci, staphylococci and clostridia Degrades hyaluronic acid of connective tissue
Collagenase Clostridium specie$ Dissolve$ collagen framework of muscles
Neuraminidase Vibrio cholerae and Shigella dyse-nteriae Degrades neuraminic acid of intestinal mucosa
Coagulase Staphylococcus aureus fibrinogen to fi brin which causes ctoning
Kinases Staphylococci and streptococci Conve11s plasminogen to which digests fibrin
Leukocidin Staphylococcus aureus Disrupts neutrophil membranes and causes discharge of
lysosomaJ granules
Streptolysin Streptococcus pyogenes Capable of lysing e.yrhmcyles, leukocyres, and plalelels
Hemolysins Streptococci, staphylococci. and closrridia Phospholipase$ or lecithinases that de$troy red blood
cells (and olher cells) by lysis
lecithinases Clostridium perfringens Destroy lecithin in cell membrane$
Phospholipases Clostridium pe.rfringens Destroy in cell membrane
/\nlhrax EF Bacillus anthrncis One component (EF) is an adenyl ate which
causes increa'\ed levels of intracellular cyclic AMP
Pertussis AC Bordete.lla pertussts One toxin component is an adenylate cyclase that acts
locally producing an in intracellular cyclic
AMP
SAADDES
bacteria
Mycobacterium species, along with members of a related genus Nocardia,
are classified as:
coagulase-positive bacteria
coll agenase-positive bacteria
acid-fast bacteria
phospholipase-positive bacteria
37
SAADDES
acid-fast bacteria
Mycobacterium t uberculosis is not classified as either gram-positive or gram-negative
because it does not have the chemical characteristics of either, although the bacteria do
contain peptidoglycan (murein) in their cell wall.
Important: Mycobacterium tuberculosis is a fairly large non-motile rod-shaped, acid-fast,
niacin-producing bacterium. It produces neither exotoxins or endotoxins. Many non-patho-
genic mycobacteria are part of t he normal flora of humans, found most often in dry and oily
locales. Mycobacterium tuberculosis is an obligate aerobe. For this reason, in the classic case
of tuberculosis, the M. TB complexes are always found in the well aerated upper lobes of t he
lungs. The bacterium is a facul tative intracellular parasite, usually of macrophages, and has a
slow generation time of 15-20 hours, a physiological characteristic that may contribute to its
virulence.
1. Acid-fast staining is one of t he methods used to diagnose active t uberculosis. It
is a method of staining used in bacteriology in which a smear on a slide is flooded
wit h carbol-fuchsin stain, decolorized with acid alcohol, and counterstained wit h
methylene blue. Acid-fast organisms resist decolorization and appear red against a
blue background when viewed under a microscope. This property of being acid-fast
is attributable to the presence of lipids and waxes (mycolic acids) in t he cell wall of
certain bacteria.
2. The classic skin test (PPD skin test) is another method of testing for tuberculosis.
It may indicate an infection, but not whether t he infection is active. A puri fi ed pro-
tein derivative (PPD} extract from mycobacterium tuberculosis is inj ected subcuta-
neously, and the area near t he inj ection is observed for evidence of a delayed
hypersensitivity reaction. A positive test indicates a hypersensitivi ty to tubercula-
proteins.
3. Common acid-fast bacteria of medical importance include t he Myco-
bacterium t uberculosis, Mycobacterium leprae, and Mycobacterium avium complex
(MAC) which consists of two species- M. avium and M. intracellulare.
SAADDES
bacteria
In addition to peptidoglycan, the acid-fast cell wall of Mycobacterium con-
tains a large amount of glycolipids, especially that make up approx-
imately 60% of the acid-fast cell wall.
beta-lactamases
lipopolysaccharides
teichoic acids
mycolic acids
38
SAADDES
mycolic acids
Mycobacteria have a peptidoglycan layer (sli ghtly different structure), which is inter-
twined with and covalently attached to an arabinogalactan polymer and surrounded
by a waxli ke lipid coat of mycolic acid (large a-branched b-hydroxy fatty acids), cord
factor (glycoli pid of trehalose and two mycolic acids), wax D (glycolipid of 15 to 20
mycolic acids and sugar), and sulfol ipids. The coat is responsible for virulence and is
antiphagocytic.
Functions of the Acid-Fast Cell Wall Components:
1. The peptidoglycan prevents osmotic lysis.
2. The mycolic acids and other glycol ipids also impede the entry of chemicals
causing the organisms to grow slowly and be more resistant to chemical agents
and lysosomal components of phagocytes than most bacteria.
3. The surface proteins in the acid-fast cell wall, depending on the strain and
species, carry out a variety of activities, including:
Functioning as enzymes
Serving as adhesins. Adhesins enable the bacteri um to adhere intimately to
host cells and other surfaces in order to colonize and resist flushing.
4. The periplasm contains enzymes for nutrient breakdown as wel l as periplasmic
binding proteins to facilitate the t ransfer of nutrients across the cytoplasmic mem-
brane.
1. Isoniazid inhibits mycoli c acid biosynthesis and is an efficient antimy-
cobacterial agent.
2. A tubercle or Ghon focus is a small, rounded nodule produced by infec-
t ion with M. tuberculosis. It is the primary lung lesion of pulmonaryTB.
Ranke complex is the result of ghon focus that has healed, fibrosed, and is
sometimes calcified.
SAADDES
bacteria
A major factor in the cariogenicity of S. mutans is the ability to adhere to the
tooth surface. This attachment is achieved largely in part due to the pres-
ence of an extracellular glycocalyx, or:
plasma membrane
capsule
pell icl e
reticulum
39
SAADDES
capsule
The capsule is a gelatinous coat which surrounds the cell wall of certain bacteria and is
especially important in protecting these cells against phagocytosis by eukaryoti c cells.
The presence of a capsule can be a maj or factor in determining the pathogenicity of a bac-
terium; that is, the ability of a bacterium to cause disease in the organism t hat it infects.
Other important functions include mediate adherence of cells to surfaces (i.e., caries on
the tooth surfaces) and for identification purposes. When the polysaccharide capsules
are treated with antiserum, they swell, allowing them to be identified.
These anti phagocytic polysaccharide capsules surrounding the cell s of strains of strep-
tococcus pneumoniae, for example, permit these bacteria to evade the normal defense
mechanisms of the host, allowing them to reproduce and cause the symptoms of pneu-
monia. The virulence of other bacteria, including Haemophilus influenzae, Klebsiella
pneumoniae, and Cryptococcus neoformans is also enhanced by capsul e production.
1 . The plasma membrane (cell membrane, cytoplasmic membrane) is made of
two layers of phospholipids. The membrane has many proteins (70% of the
mass of t he membrane) embedded in it. The maj or functi ons include: (1) selec-
t ive permeability and t ransport of solutes; (2) electron transport and oxidative
phosphorylation, in aerobic species; {3) excretion of hydrolytic exoenzymes; (4)
bearing the enzymes and carrier molecule t hat function in the biosynthesis of
DNA, cell wall polymers, and membrane lipids; and (5) bearing the receptors
and other proteins of the chemotactic and other sensory t ransducti on systems.
2. The cell wall is the membrane of the cell that forms external to the plasma
membrane whose main role is to give cells rigidity, strength and protection
against mechanical stress. In addition to giving osmoti c protection, the cell wall
plays an essential role in cell division, as well as serving as a primer for its own
biosynthesis.
SAADDES
bacteria
Which ofthe following are associated with a Gram-negative cell wall?
Select all that apply.
thick murein layer
li popolysaccharide layers
teichoic acids
mycolic acids
thin murein layer
40
SAADDES
lipopol ysaccharide layers
thin murein layer
Gram-posit ive cell wall:
Thick (15-80 nanometers)
Thick murein layer that makes up approximately 90% of the cell wall
Teichoic acids, polysaccharides that serve as attachment sites for
bacteriophages
Gram-negative cell wall:
Thin (10 nanometers)
More complex (multilayered) than gram-positive cell wall
Thin murein layer that accounts for only about 1 Oo/o of the cell wall
Lipoproteins are an integral part of the cell wall
Lipopolysaccharide layers (LPS or endotoxin)
Phospholipids
Proteins
***The proteins, lipopolysaccharide layers, and phospholi pids make up the cell envelope
of the gram-negative bacterial cell. This outer membrane protects the cell from antibi-
otics (e.g., penicillin) and enzymes (e.g., lysozyme).
1. Bacterial murein is a unique type of peptidoglycan. Peptidoglycan is a poly-
mer of sugars (a glycan) cross-linked by short chains of ami no acids (peptide).
All bacterial peptidoglycans contain N-acetylmuramic acid, which is the defini-
t ive component of murein.
2. The cell wall s of archaea may be composed of protein, polysaccharides, or
peptidoglycan-like molecul es, but never do they contain murein. This feature
distinguishes the archaebacteria f rom other bacteria.
SAADDES
bacteria
Most species of lactic acid bacteria ferment glucose into galactose.
Lactobacillus species are frequently found in association with dental caries.
the f irst statement is t rue, the second is false
the f irst statement is false, the second is t rue
41
SAADDES
Most species of lactic acid bacteria ferment glucose into lactate, hence the name
Lactobacil lus. The most common application of Lactobacill us is industrial, specifically
for dairy production. This genus also contains several bacteri a that make up part of
the natural flora of the human vagina. Because of their abil ity to derive lactic acid
from glucose, t hese bacteri a create an acidic environment which inhibits growth of
many bacterial species which can lead to urogenital infections.
Although Lactobacillus species are normally present in low numbers in t he oral cavi-
ty, they are frequently found in association with dental caries (especially
Lactobacill us casei), most probably as secondary microbial invaders.
Lactobacill us acidophilus is added to commercial mil k products to assist lactose
intolerant individuals in digesting lactose sugars. The enzymes produced by these
bacteria convert milk sugars to products that do not cause Gl problems.
Lactic acid bacteria incl ude Lactobacillus and Streptococcus. These bacteria use the
lactic acid fermentation pathway in which pyruvate is reduced to lactic acid. These
two bacteri a are also referred to as aciduric, meaning that t hey can tolerate an acid
environment, and acidogenic, meaning acid forming.
1. Lactobacillus is generally harmless to humans, rarely inciting harmful
infections or diseases. Treatment of this vancomycin-resistant microbe usu-
al ly consists of high doses of penicil li n in combination with gentamicin.
2. Streptococcus mutans is the main culprit in dental caries (especially
smooth surface caries).
3. Actinomyces has been found to be a causative agent of root surface
caries.
SAADDES
bacteria
The two organisms most commonly associated with the etiology of localized
aggressive periodontitis are Capnocytophaga ochraceus and:
actinobacill us actinomycetemcomitans (Aa)
wolinell a recta
porphyromonas gingivalis
actinomyces israelii
42
SAADDES
actinobacillus actinomycetemcomitans (Aa)
Important: The new classification system for periodont itis is more descriptive and
not as temporal as was the previous system. The terms adult, juvenile, early onset, and
prepubertal have been replaced wit h various forms of chronic and aggressive dis-
ease. The term refractory periodontitis has been removed as a distinct disease enti-
ty, as the current thinking is t hat any type of periodontitis may be refractory.
Aggressive periodontitis (formerl y called Juvenil e periodontitis) occurs in two
forms:
1. Generalized form (formerly known as rapidly progressive periodontitis):
Prevotella intermedia and Eikenell a corrodens predominate. It occurs between
the ages of 12-25 and is characterized by rapid, severe periodontal destruction
around most teeth. It is characterized by episodic, rapid, and severe attachment
loss.
2. Localized form: Gram-negative anaerobes Actinobacillus actinomycetem-
comitans (Aa) and Capnocytophaga species (ochraceus) predominate. Prevotell a
intermedia and Eikenell a corrodens may also be present to a lesser extent. It occurs
in an otherwise healthy adolescent (12-19). It is characterized by rapid and severe
attachment loss confined to the incisors and first molars. The one outstanding
negative feature is the relative absence of local factors (plaque) to explain the
severe peri odontal destruction which is present. Possible etiologic factors include
a genetic predisposition or a dysfunction of netrophil s (a chemotactic defect).
Note: Aa and Capnocytophaga species (specifically C. Ochraceus) are also associated
with periodont itis in juvenile diabetes.
SAADDES
bacteria
Streptococcus mutans grows optimally at a pH well below 7.0. From this
statement, it can be reasoned that Streptococcus mutans is:
acidophilic
acidogenic
aciduric
alkaliphil ic
neutrophilic
43
SAADDES
acidophilic
The range of pH over which an organism grows is defined by three cardinal points: the
minimum pH, below which the organism cannot grow, the maximum pH, above
which the organism cannot grow, and the optimum pH, at which the organism grows
best.
Those which grow best at neutral pH (7.0) are call ed neutrophils. Most bacteria are
considered to be neutrophi ls.
Examples include: Pseudomonas aeruginosa, Clostridium sporogenes, and
Proteus species.
Those which grow at an optimal pH well below neutrali ty (7.0) are called acidophiles.
Examples include: Thiobacil lus thiooxidans, Sulfolobus acidocaldarius, and
Bacil lus acidocaldari us.
Note: Obli gate acidophil es, such as some Thiobacillus species, actuall y require a
low pH for growth since thei r membranes dissolve and the cells lyse at neutrality.
Those that grow best under alkali ne conditions are call ed alkaliphiles.
Examples include: Nitrobacter species and Streptococcus pneumoniae.
Remember: Aciduric means that the bacteria is capable of or can tolerate living
under acid conditions. Acidogenic means that the bacteria can produce relatively
high concentrations of acid (Streptococcus and lactobacil lus produce lactic acid as
the pri mary fermentation product). Streptococci are the primary acidogenic microor-
ganisms in the oral cavity.
Important: l actic acid is the main cause of enamel decalcification.
SAADDES
bacteria
E. coli is in the bacterial family Enterobacteriaceae. All of the following are
characteristics of the family EXCEPT one. Which one is the EXCEPTION?
capnophil ic
facultative anaerobes
gram-negative
rod shaped
flagell ated
44
SAADDES
capnophilic
E. col i and its relatives are known to microbiologists as "enteric bacteria: because t hey live in t he
intest inal tract of humans and other animals. The best known other enteric bacteria are Salmonella, which
includes the agent of typhoid f ever. and Shigella. which is the bacterial cause of dysentery.
Important: Escherichia col i (E. Coli) is not usually considered a pathogen. However, it is responsible
pri marily for three types of i nfect ions in humans: uri nary t ract inf ections, neonatal meningit is, and
intestinal diseases. Note: Capnophilic bacteria require carbon dioxide for growth (i.e. Capnocytophaga
ochraceus).
Selected Groups of Bacteria
Gr oup Examples of Bacteria in Group
Enteric gram-negative rods; facultative anaerobes E. coli, Proteus. Salmonella, Shigella, Vib1io chole-rae, Ht -licobaclt -r
pylori, Bacteroides sp.
Gram-ne-gative cocci: anaerobic Veillonella
Gram-ne.gative rods and cocci; aerobic Pseudomonas. Borde[t-lla, Bruc.ella, Ne-isseria
Gram-negative o d s ~ microaerobic Cam,,ytobacter. Helicobac(er
Gram-negative rods; faculta[ive anaerobes Actinobacillus, Eikenella, E.coli. Haemophilus, Kle-bsiella. Proteus,
Salmonella, Shigella, Vibrio
Gram-ne.gative rods; anaerobic Bacteroides. Fu.,..obacteri um, Porph)romonas. Prevote.tla. Wolinella
Gram-positive coc.ci; facultatively anaerobes Smphylococcu..o; . Streptococcus, Etlterococcu..o;, Pe.ptosrreproc.occu..o;
Gram-positive rods and cocci: sporefonning Bacillus. Clostridium
Regular. non-sporefbrming gram-positive ods Lactobacillus, listeria
legular, non-spo1efonning gram-positive rods Actinomyces. Corynebacteriunl, Eubacterium.
Acid-fast r ... tycobacteria, Noca1dia
Spirochere.o; Treponema, Borre-lia. l eptospira
Chlamydias and Riclcen$ias Riclcett.o;ia, Chlamydia. Coxiella
Mycoplasmas (c-ell wall-le-ss) r ... tycopla.o;m.a, Spiroplasm.a, Ureapla.o;m.a
Acrinomyc-etes Nocardia, Stre-ptomyces, Rhodococcus
SAADDES
bacteria
Which of the following is NOT a characteristic of Streptococcus pyogenes?
group A streptococcus
gram-negative
nonmotil e
catalase-negative
45
SAADDES
gram-negative
The genus Streptococcus is a diverse collection of gram-positive cocci typically arranged in pairs or
chains. Most species are facultative anaerobes, and some grow only in an atmosphere enhanced
with carbon dioxide (capnophilic growth). Carbohydrates are fermented, resulting in the production
of lactic acid, and unlike staphylococcus species, streptococci are catalase-negative.
Streptococcus pyogenes (Group A streptococcus) is one of the most frequent pathogens of
humans. It causes a variety of suppurative and nonsuppurative diseases. It is the most common
cause of bacterial pharyngitis.
Spe-cies Hemolytic Clas.o;
Streptococcus
pyogenes
Streptococcus
pneumoniae
<x (alpt..)
Streptococcus <x (alpt..)
viridan..:;
Streptococcus
agalaetiae

Streptococcus
y (gamma): some
bovis
display a (alpha)
Enler01.oc.ci
y(gamma)
Strl'ptococcus Splrh.s
Virulent factors
rv1 protein
DNasesA to 0
4 Stn:ptococe-al pyrogenic
exotoxins (Spc) 4 A.B,C and F'
Strept<,Jysin 0 and S
Streptokinase A and B
J.Jyaluronidase
Exotoxin A (SpeA)
Exotoxin B (SpcB)
Polysac.charide
Pneumolysin
lg.A protease-
None
Polysac.charide
None
None
Oisea.ses
Pharyngitis (SLrep thr<,at)
Necrotizing fasciitis. Scarle-t feve.r
(rash), Toxic Shock Syndrome
Cellulitis
Toxic shock syndrome
Post-S(rtpt()Cottal St'Qudae:
Acute rheumatic feve.r
Acute glomerulonephritis
Pneumonia
Mcningilis
Oti tis mcxl ia
Endocarditis
Caries
Noonatal pneumonia
Noonatal meningitis
Noonatal sepsis
lnftive endocarditi..:;
Urinary tract infections
SAADDES
bacteria
Order the phases of phagocytosis. Match each letter with its proper
sequence number.
1. A. Fusion of the phagosome with a lysosome to form a phagolysosome
2. B. Formation of residual body containing indigestible material
3. C. Formation of a phagosome
4. D. Chemotaxis and adherence of microbe to phagocyte
5. E. Discharge of waste materials
6. F. Ingestion of microbe by phagocyte
7. G. Digestion of ingested microbe by enzymes
46
SAADDES

Phases of Phagocytosis
Microbe or
other particle Plasma
0 J.
Pseudopod 0\ Phagosome
(phagocytic
Cytoplasm,- "'d vesicle)
Lysooome
<e ...... PhagolysosOrnes

()
enzymes 0'\ Residual
-.. body
digested
mlctobe 0
ln<llgesii!H
Phagocyte
ma1erial
Phagocytes:
1. Chemotaxis and
adherence of microbe to
phagocyt e
2.1ngestion of microbe by
phagocyt e
3. Formation of a
phagosome
4. Fusion of the phagosome
with a lysosome to form a
phagolysosome
s. Digestion of ingested
microbe by enzymes
6. Formation of residual
body containing
indigestible material
7. Discharge of waste
materials
Fixed: do not circul ate, fixed macrophages and cell s of t he reti culoendothelial system
Free: circulate in the bl oodstream, incl ude the l eukocytes and the free macrophages
SAADDES
bacteria
Which of the following is the process in which DNA is transferred from a
bacterial donor cell to a recipient cell by cell-to-cell contact?
translation
transduction
transcri ption
conjugation
47
SAADDES
conjugation
Conjugation is a form of sexual reproduction in which DNA is transferred from one live
bacterium to anot her through direct contact. This physical contact is establi shed through
the presence of pili .
The ability to transfer DNA by conjugation is dependent on the presence of a
cytoplasmi c entity termed the fertility factor, or F
Cells carrying F are termed f+; cell s without F are F-. F is a small, circular DNA
element that acts li ke a minichromosome. It is an example of a class of element s
termed plasmids, which are self-replicating extrachromosomal DNA molecul es.
1. In conjugation, the greatest amount of genetic information is transferred
from one cell to another (compared to transduction and transformation).
2. Conjugation occurs more frequently than t ransformation; it takes place with-
in members of different genera (e.g. Escherichia-Shigella, Salmonella-Serrati a).
3. Can result in passage of genes for antibiotic resistance from one bacterium
to another; bacterium potential for pathogenicity can increase.
4. F factors are plasm ids transferred from a donor cell (an F+cell) to a recipient
cell (an F- cell) during conjugation.
5. An Hfr (high frequency of recombinati on) is a cell with an F plasmid incor-
porated into the chromosome.
6. During conjugation, portions of the Hfr chromosome are transferred from
the Hf r bact erium to the F- bacterium.
7. Transfer of DNA within bacterial cell occurs via t ransposons, which are por-
tions of DNA that move from one site on the chromosome to another (or to a
plasmid).
SAADDES
bacteria
Transcription occurs in the:
cytoplasm of prokaryotes, while it occurs in the nucleus of eukaryotes
cytoplasm of eukaryotes, whil e it occurs in the nucleus of prokaryotes
nucleus of both prokaryotes and eukaryotes
cytoplasm of both prokaryotes and eukaryotes
SAADDES
cytoplasm of prokaryotes, while it occurs in the nucleus of eukaryotes
Transcription is the t ransfer of the genetic information from the archival copy of DNA to t he
short-lived messenger RNA. The enzyme RNA polymerase binds to a particular region of the
DNA and starts to make a strand of mRNA wi th a base sequence complementary to the DNA
template that is "downstream" of the RNA polymerase binding site. When this transcription is
fini shed, the portion of the DNA that coded for a protein (i.e., a gene) is now represented by a
messenger RNA molecule that can be used as a template for translation.
The steps in transcription are:
1. DNA unzips (by DNA gyrase) and RNA polymerase enzyme binds to one strand of DNA.
2. RNA polymerase makes an elongating chain of RNA nucleotides; each new RNA nucleo-
t ide compl imentary to the DNA nucleotide has hydrogen bonded to it.
3. The completed mRNA molecule is released from RNA polymerase- DNA complex, and can
begin translation. In eukaryotic cells this means first moving from t he nucleus into the cyto-
plasm. In prokaryotic cells (bacteria), ribosomes can bi nd and begin translation before poly-
merase has completed the new mRNA strand.
1. Translation is the process wherein information in the form of ni trogenous bases
along an mRNA is t ranslated into t he amino acid sequence of a protein.
2. Transduction is the transfer of DNA via a phage particle. Does not require cell- to-
cell contact.
3. Reverse transcription is the formation of DNA from an RNA templat e. Retrovir-
uses (e.g., HIV, tumor viruses), which are enveloped and contain a linear, single-
stranded, posit ive-sense RNA genome, utilize this process. They use their RNA
genome as a template for an RNA-di rected DNA polymerase. These viruses have a
virion-associated reverse transcriptase, which makes DNA copies from RNA. This
DNA is then integrated into the host genome. Important: Thi s RNA-di rected synt he-
sis of DNA is the reversal of normal informational flow within the cell.
SAADDES
bacteria
The attachment of microbes and other foreign cells to phagocytes by anti -
body molecules such as lgG and complement proteins such as C3b is called:
conjugation
transformation
opsonization
adhesion
49
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opsonization
Opsonization, or enhanced attachment, refers to the antibody molecules lgG (or
lgM) and the complement proteins C3b and C4b attaching antigens to phagocytes.
This results in much more efficient phagocytosis.
The process starts with lgG (or lgM) being made against a surface antigen of the
organism or cell to be phagocytosed. The Fab portion of lgG reacts with epitopes of
the antigen. The Fe portion of lgG can then bind to neutrophils and macrophages
thus sticking the antigen to the phagocyte. Binding of lgG to the Fe receptor also acti-
vates the phagocyte.
Attachment then promotes destruction of the antigen. Microorganisms are placed in
phagosomes where they are ultimately digested by lysosomes. lfthe antigen is a cell
too large to be ingested, such as virus-infected host cells, transplant cell s, and cancer
cells, the phagocyte empties the contents of its lysosomes directly onto the cell for
extracellular kill ing.
Opsonization is especially important against microorganisms with antiphagocytic
structures such as capsules since opsonizing antibodies made against the capsule
are able to stick capsules to phagocytes. In vaccines against pneumococcal pneumo-
nia and Haemophilus influenzae type, it is the capsular polysaccharide that is given as
the antigen in order to stimulate the body to make opsonizing antibodies against the
encapsulated bacterium.
Important: The two major opsonins are lgG and C3b.
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bacteria
For each numbered virulence factor of Streptococcus pyogenes listed below,
select the most closely linked description from the list provided.
I. M protein
2. DNases A to D
3 Streptococcal pyrogenic exotoxins (Spe)
(SpcA, B, C and F)
4. Streptolysin 0 and S
5. Streptokinase A and B
6. Hyaluronidase
7. Exotoxin A (SpcA)
8. Exotoxin B (SpeB)
A. Rapidly destroys tissue
B. Streptococcal "Toxic Shock Syndrome"
C. Resistance to phagocytosis
D. Breaks down hyaluronic acid
E. Cleaves DNA
F. Lysis of red and white blood cells
G. Responsible for many of the clinical manifestations of
severe streptococcal diseases
H. Dissolves fibrin in blood clots
50
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1. C, 2. E, 3. G, 4. F, 5. H, 6. D, 7. B, 8. A
Characteristically, Streptococcus pyogenes is a gram-positive facultative anaerobic bacteri-
um. It is not motile, and does not produce spores. It occurs as long chains of cocci, and occa-
sionally in pairs. Streptococcus pyogenes is classified as Group A streptococcus. Group A
streptococci typically have a capsule composed of hyaluronic acid and are beta-hemolytic,
which is true for Streptococcus pyogenes. Beta-hemolytic streptococci produce a toxin that
forms a clear zone of hemolysis on blood agar, demonstrating its ability to destroy red blood
cells. This hemolysis is attributed to toxins formed by Group A streptococci called strep-
tolysins. Streptolysins can destroy not only red blood cells, but also the white blood cells
responsible for fight ing off bacteria and disease, as well as other body cells.
Several factors add to Streptococcus pyogene's ability to cause disease. These factors include
its production of exotoxins and streptokinase, the M proteins on its surface, and its
hyaluronic acid capsule. Streptococcus pyogenes produces three types of exotoxins. These
toxins are responsible for causing fever and scarlet fever rashes; they also increase the risk of
endotoxic shock and depress antibody synthesis. Streptococcus pyogenes also produces
streptokinase, a toxin t hat digests blood clots to assist in the invasion of wounds. The cell wall
of Streptococcus pyogenes contains M proteins, which are a major factor behind its virulence.
M protein is heat and acid resistant, it aids in the attachment to host t issues, and helps t he cell
to resist phagocytosis. Host immunity to Streptococcus pyogenes results from the develop-
ment of antibodies specific to M protein. The hyaluronic acid capsule of Streptococcus pyo-
genes is chemically similar to human connective t issue, which allows it to go unrecognized as
an antigen by the host's body, further helping t he bacteria to avoid phagocytosis.
Streptococcus pyogenes can be considered an opportunistic pathogen.lt is part of the normal
flora of t he respiratory tract in many people, but usually does not cause complications until the
person's natural defenses to disease compromised. Streptococcus pyogenes is somewhat
unique in that it does not cause j ust one disease, but is capable of causing many different dis-
eases. These diseases range from mild, like strep throat and impetigo, to severe, like necrotiz-
ing fasciit is, and streptococcal toxic shock syndrome.
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bacteria
Spirochetes are a principal etiologic factor in necrotizing ulcerative
gingivitis.
Prevotella intermedia is the most common spirochete found in patients with
this disease.
the first statement is t rue, the second is false
51
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the first statement is true, the second is fal se
ANUG is an acute recurring gingival infection of complex eti ology, characterized by
necrosis of papill ae, spontaneous bleeding and pain. The two principal bacteria associ-
ated with ANUG are Prevotella intermedia and Spirochetes (Treponema denticola is the
intermediate-sized spirochete associated with ANUG). Fusobacterium species as well as
Selenomonas species can also be seen.
Important: According to the American Association of Periodontics (AAP), ANUG is now
correctly referenced simply as "Necrotizing Ulcerative Gingivitis" without the "acute"
qualifier. Note: The National Boards may or may not reflect this change.
NUG (formerly called "Vincent's infection" or "trench mouth") is a condition which pres-
ents rather pathognomonic signs and symptoms.
Interproximal gingival necrosis ("punched-out" papillae)
Marginal gingival pseudomembrane formation
Pain
No attachment loss
Fetor oris
Gingiva bleeds easily
Metall ic taste
Low-grade fever,
lymphadenopathy
1. Predominant subgingival bacteria associated with gingival health:
Streptococcus mitis and sanguis
Actinomyces viscosus and naeslundii
Rothia dentocariosus
Staphylococcus epidermidis
Small spirochetes
2. lgG is the immunoglobuli n that is found in the highest concentration in
serum samples from patients with periodontal disease.
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bacteria
All of the following are eukaryotes EXCEPT one. Which one is the EXCEP-
TION?
fungi
plants
protozoa
bacteria
52
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bacteria
All living t hings can be classifi ed as ei t her prokaryotes or eukaryotes dependi ng on their
cellul ar and physi ol ogi cal charact eri sti cs.
( "ompanson of l'rokan otic and otic cdls
Prokaryotes Eukaryotes
Nucleus absen1 Nudeus present
Nuclear membrane ab.st.nt Nudear 1nembrane presen1
DNA in single-. dosed loop chromosome DNA in multiple c.hn)moson\t$
Important points to remember:
Eukaryotic cell s contain organ-
elles, such as mi tochondria and
lysosomes, and l arger (80s) ribo-
somes, where as prokaryotes
contain no organelles and small-
No protein in chromosome PI'Ottin in chromosomes er (70S) ribosomes.
1-N-o""'o'-rs-a_n_e_lle-,--------+o-rg_a_n_el_l<_-<_(e- .g- .-G-o- lg-i,-E- R-)--i Most proka ryotes (except
Smallerribosome.< urger ribosome.< Mycopl asmas) have a ri gi d extern-
__ _, a I cell wall that contains pepti do-
1-E-.-. -n- lp-le_s_o_f _ pr..:.o_k_ary _o_ re-s:----+E-. - -ll-pl-. - , .""' r'-,-u-ka-,-,.- . ,-,_-s:- --1 glycan. Euka ryotes do not contain
Bac<eria (including Rickeusia. Pro1ozoa pepti dogl ycan.
Chlamydia, and Mycoplasma) Fungi Eukaryotes replicate by mitosis,
whil e prokaryotes repli cat e by
l hunans binary fission.
The eukaryoti c cell membrane
contains sterols, whereas no pro-
karyote, except Mycopl asmas, has
sterol s in its membrane.
Remember: Viruses are not cell s (t hey are acell ul ar part icl es); t hey are obligate
intracellular parasites. They contain either RNA or DNA, do not contain organell es, and
have a protein capsid and lipoprotein envelope.
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bacteria
In terms of extracting chemical energy, aerobic respiration is more efficient
than fermentation BECAUSE aerobic respiration utilizes metabolically der-
ived organic acids as terminal electron receptors.
53
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Respiration refers to t he method of obtaining metabolic energy that involves an oxidative
phosphorylation. It involves the format ion of ATP during electron transfer. It can be aerobic
(wi th molecular oxygen as the terminal electron acceptor) or anaerobic (wi th nitrate or sulfate
as t he terminal electron acceptor). Respiration is much more efficient than fermentation, thus
respi ring organisms, including us, have come to dominate the earth. Fermenting organi sms
are restricted to niches where oxygen is lacking and suitable carbon sources exist.
Aerobic respiration involves a cell membrane respiratory (electron transport) chain. The
electron t ransport chain is present in the inner mitochondrial membrane and is t he final
common pathway by which electrons derived from different fuels of t he body flow to oxygen.
It has four stages:
1. Glycolysis 3. The citric acid cycle
2. Formation of acetyl coenzyme A 4. Electron transport chain and chemiosmosis
Fermentation is defined as an energy yielding process whereby organic molecules serve as
both electron donors and electron acceptors. The molecule being metabolized does not have
all its potential energy extracted from it. In other words, it is not completely oxidized.
Key points of fermentation:
NAD+ is almost always reduced to NADH Oxygen is not involved
Fermentation results in an excess of NADH Energy yields are low
Pyruvate is often an important intermediate
Energy is derived from Substrate-Level Phosphorylation
Fermentation can involve any molecule t hat can undergo oxidation. Typical substrates include
sugars (such as glucose) and amino acids. Typical products depend upon the substrate but can
include organic acids (lactic acid, acetic acid), alcohols (ethanol, methanol, butanol), ketones
(acetone) and gases (H2 and C02). NADH is recycled back to NAD+ through fermentation so
the process doesn't grind to a halt.
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bacteria
The bacteria most strongly linked with localized aggressive periodontitis
(formerly called localized juvenile periodontitis) is:
porphyromonas gingivalis
tannerella forsythia
actinobacill us actinomycetemcomitans
prevotella intermedia
54
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actinobacillus actinomycetemcomitans
In the healthy mouth, more t han 350 species of microorganisms have been found. Periodontal
infections are linked to fewer than 5% of these species.
Periodontal health is characterized by the presence of the following bacteria: Gram-pos-
itive bacteria such as Streptococcus sanguis, Streptococcus mitis, Actinomyces viscosus,
Actinomyces naeslundii and a few gram-negative species such as Veillonella parvula and
Capnocytophaga ochracea.
In periodontal disease, the bacterial balance shifts over to gram-negative, motile,
strictly anaerobic bacteria. Inflammatory disease and inj ury cannot develop without
t hese bacteria.
Among t he bacteria most implicated in periodontal disease and bone loss are the following:
Actinobacillus actinomycetemcomitans (Aa): associated with aggressive periodontal
disease (formerly called early onset periodonti tis) and localized aggressive periodontitis
(formerly called localized juvenile periodontitis).
Porphyromonas gingivalis: associated wi th chronic and aggressive periodontitis.
Tannerella forsythia (formerly Bacteroides forsyth us): strongly linked to periodontal dis-
ease.
Treponema denticola, sokranskii : associated with deep periodontal pockets chronic
periodontit is and ANUG.
Prevotella intermedia: associated with deep periodontal pockets, chronic periodontitis
and ANUG.
Note: All dental plaque-induced periodontal diseases are mixed infections. None of them is
caused by a single pathogen.
Note: Eikenella corrodens, Campylobacter rectus, Fusobacterium nucleatum, Peptostreptoco-
ccus, Prevotella nigrescens, Enteric rods/Pseudomonas species and Eubacterium species have
also been implicated as periodontal pathogens.
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bacteria
Anaerobic bacteria produce superoxide dismutase and catalase enzymes.
Most bacteria, grow in either the presence or the absence of oxygen.
the f irst statement is t rue, the second is false
the f irst statement is false, t he second is t rue
55
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Obligate aerobes require 0
2
for growth; they use 0
2
as a final electron acceptor in aerobic respira-
t ion. Aerobic bacteria produce superoxide dismutase and catalase enzymes which can detoxify
hydrogen peroxide and superoxide radicals that are the toxic byproducts of aerobic metabolism.
Most bacteria grow in the presence or the absence of oxygen. These bacteria are referred to as fac-
ultative anaerobes. These organisms can switch between aerobic and anaerobic types of metabo-
lism. Under anaerobic conditions (no 0
2
) they grow by fermentation or anaerobic respiration, but in
the presence of 0
2
they switch to aerobic respiration.
Obligate anaerobes (occasionally called aerophobes) do not need or use 0
2
as a nutrient. In fact,
0
2
is a toxic substance, which either kills or inhibits their growth.
Aerotolerant anaerobes are bacteria with an exclusively anaerobic (fermentative) type of metabo-
lism but they are insensitive to the presence of 0
2
. They live by fermentation alone whether or not
0
2
is present in their environment.
Bacteria that can rely entirely on inorganic chemicals for their energy and source of carbon (C0
2
) are
referred to as autotrophs (lithotrophs), whereas many bacteria and animal cells that require organ-
ic carbon sources are known as heterotrophs (organotrophs).
Group
Obhgatc aerobe
Obhgatc anaerobe
FacultatiVe anaerobe
Enviroomf nt
Anobic Ananobic
Growth No growth
No growth Growth
Growth Growth
Required
Toxic
Not required but
utilized wh-en
available Oblig:no:

not uuli2cd
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bacteria
Some gram-positive, but never gram-negative, bacteria, such as members of
the genera Bacillus and Clostridium, are spore formers.
The spore contains a complete copy of the chromosome, the bare minimum
concentration of essential proteins and ribosomes, and a high concentration
of calcium bound to dipicolinic acid.
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Spores (or endospores) are the most resistant biological form known to exist. Some
gram-positive, but never gram-negative, bacteria, such as members of the genera
Bacil lus (e.g., Baci ll us anthracis) and Clostridium (e.g., Clostridium tetani or botu-
li num), are spore formers. Under harsh environmental conditions, such as the loss of
a nutritional requirement, these bacteria can convert from a vegetative state to a dor-
mant state, or spore. When a spore-forming bacteri um (SFB) senses that tough times
are coming, a seri es of complex events are tri ggered that lead to the formation of a
spore.
The spore contains a complete copy of the chromosome, the bare minimum concen-
tration of essential proteins and ribosomes, and a high concentration of calcium
bound to dipicolinic acid.
Example: Bacterial endospore is a heat-resistant spore formed within the cel l. The
endospore is a complex, multilayered structure containing peptidoglycan within its
complex spore coat and calcium dipicoli nate within its core. This bacterial endospore
is very difficult to destroy (more so than HIV, HBV, and TB viruses) . To destroy the
bacteria it must be autoclaved at the proper temperature (121c for 20 minutes).
1. By means of a process called asexual reproduction, spores are able to
grow into new organisms without uniting with another reproductive cell.
2. Active spores have thin cell wall s; dormant spores have thick, strong
cell wall s.
3. Anthrax is caused by Baci ll us anthracis. Botuli sm, gas gangrene, and
tetanus are caused by Clostri dium botuli num, C. perfri ngens, and C. tetani,
respectively.
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bacteria
One of the most common forms of "traveler's diarrhea" is caused by an
enterotoxin produced by:
bacteroides
escherichia coli
neisseri a
eikenella
57
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escherichia coli
E. coli produces an enterotoxin whi ch causes t raveler's diarrhea, and is an important
etiologic agent in infantil e diarrhea in developing countries. This enterotoxin can be
detected using the ELI SA. The enzyme-linked immunosorbent assay, which is com-
monly abbreviated to ELISA, is a technique that promotes the binding of the target
antigen or antibody to a substrate, foll owed by the binding of an enzyme-linked mol-
ecule to the bound antigen or antibody. The presence of the antigen or antibody is
revealed by color development in a reaction that is catalyzed by the enzyme which is
bound to the antigen or antibody.
The ELI SA procedure has many applications. The procedure can provide qualitative
("yes or no") and quantitative ("how much") information on a myri ad of prokaryotic
and eukaryotic antibodies. Serum can be screened against a battery of antigens in
order to rapidly assess the range of antibodies that might be present. For example,
ELISA has proven very useful in the scrutiny of serum for the presence of antibodies
to the Human immunodeficiency virus.
1. S. aureus and Vibrio cholerae also produce enterotoxins that can be
detected using the ELISA assay.
2. Bacterial toxins are the most potent poisons known, and their potency is
paralleled by their efficiency as antigens.
SAADDES

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