Nursing Book PDF

Menoufia University
Faculty of Medicine
Microbiology Department
Medical Microbiology
For
Undergraduate Nursing Students
first Year
By
Staff Members
of
Faculty of Medicine
Menoufia University
2021-2022
‫رؤية الكلية‬
‫" أن تكون الكلية رائدة ومتميزة في مجال التعليم والممارسات التمريضية والبحث العلمي‬
‫وخدمة المجتمع لالرتقاء بالمنظومة الصحية وتحقيق اهداف التنمية المستدامة على المستوي‬
." ‫المحلي والقومي واالقليمي والدولي‬
Vision:
To be a pioneer and distinguished faculty in the field of nursing
education, practices, scientific research and community services to
contribute in the advancement of health system and achieving
sustainable development goals at the local, national, regional and
international level.
‫رسالة الكلية‬
‫" اعداد خريج مؤهل و كفء في مجال التعليم و الممارسات التمريضية والبحث العلمي‬
‫وخدمة المجتمع قادر على االبتكار ومنافسا محليا و قوميا واقليميا وفقا للقيم المهنية‬
".‫واالخالقية‬
Mission:
Preparing a qualified and competent graduate in the field of
nursing education, practices, scientific research and community
services capable to innovate and a competitor locally, nationally and
regionally taking into consideration professional and ethical values.
2
Preface
 The aim of this note is to present microbiology and infection control in a simplified and
illustrative manner. We wish that it will be a helpful guide for the Under-graduate Nursing
Students in the first term of first year.
Topics Pages
Chapter 1: Bacterial structure and physiology 4 -7
Chapter 2: Sterilization and disinfection 8-12
Chapter 3: Bacterial virulence and host immunity 13 -15
Chapter 4: Anti-Microbial agents and Sensitivity 16

Chapter 5: Systemic Bacteriology 17-35
Chapter 6: Virology
36-40
Chapter 7:Infection control
41-45
3
Microbiology for nursing students
CHAPTER 1
Bacterial structure and physiology
Microbiology is a subject which deals with living organisms that are too small to be
seen with the naked eye.
 Subdivision of Microbiology
 Bacteriology: is the study of bacteria.
 Mycology: is the study of fungi.
 Virology: is the study of viruses.
Table 1: Differences between Eukaryotic and Prokaryotic cells

Features Prokaryotic cell Eukaryotic cell
Size 1μm 10μm
Nuclear membrane Absent Present
Chromosome Single Multiple
Nucleolus Absent Present
Cytoplasmic ribosomes 70s 80s
Mitochondria Absent Present
Peptidoglycan Present Absent
Phospholipids &
Cell membrane composition Sterols
Proteins
Bacterial Cell
 Typical prokaryotic cell
 Contain both DNA and RNA
 Most grow on artificial media
 Replicate by binary fission
 Almost all contain rigid cell wall
 Sensitive to antimicrobial agent
4
Bacterial structure
Prokaryotic cells Eukaryotic cells
 Microscopic Identification of bacteria by Microscope after staining with:

1. Simple stain.
2. Gram stain.
Generally, All Bacteria classified according to Gram stain into Gram-positive or
Gram-negative bacteria and we always mention Gram reaction.
 If Gram positive bacteria → bacteria appear violet under microscope
 If Gram negative bacteria → bacteria appear pink under microscope
3. Ziehl Nilsen stain as in Mycobacteria.
Shape and arrangement of bacteria.
5
Bacterial cell structure from outside to inside
 Capsule -Flagella -Pili-Cell wall-Cell membrane.
 Single DNA-Ribosomes-Plasmids-Food granules.
Essential structure Non-essential structure

 Cell wall  Capsule-Glycocalyx
 Cytoplasmic membrane and cytoplasm  Flagella
 Nucleoid and DNA  Pili
 Ribosomes  Plasmid- food granules-spores
 Cell wall:
 Functions of cell wall

1. Provides shape to the bacterium 3. Gives rigidity to the organism
2. Protects from environment 4. Provides staining to the bacterium
 Function of cell membrane
1. Regulates the transport of nutrients and waste products into and out of the cell.
2. Synthesis of cell wall components
3. Assists DNA replication
4. Carries on electron transport system
 Function of capsule
1. Induce virulence 2. Protects from phagocytosis
 Flagellum: It is the organ of locomotion in bacterial cell.
 Spores: Resting cells which are capable of surviving under adverse environmental
conditions like heat, drying, freezing, action of toxic chemicals and radiation.
 Nuclear apparatus
Bacterial genome consists of single molecule of double stranded DNA arranged in a
circular form. Besides nucleoid, bacteria may have extra chromosomal genetic
material named as plasmids. Plasmids do not play any role in the normal function of
the bacterial cell but may confer certain additional properties (E.g. Virulence, drug
resistance) which may facilitate survival and propagation of the micro- organism.
6
Bacterial physiology
 The four most important elements of bacteria are: carbon, hydrogen, oxygen and
nitrogen.
I- Carbon: Nutritional requirements:
1. Autotrophs bacteria: utilizes simple inorganic nutrition (CO2 as source of
carbon - nitrogen) as in non-pathogenic bacteria.
2. Heterotrophs bacteria: these use complex organic substance sugars –proteins
as in pathogenic bacteria
II- Hydrogen and oxygen
• Obtained from water.
• Essential for the growth and maintenance of cell.
III- Nitrogen
• Constitutes 10% of dry weight of bacterial cell.
• Obtained from organic molecules like proteins and inorganic molecules like
ammonium salts and nitrates.
NB: The main source of nitrogen is ammonia, in the form of ammonium salt.
Bacterial Generation time:

It is the time taken for the size of a bacterial population to double. Bacteria grow by taking
nutrients and incorporate them into cellular components; then bacteria divide into two equal
daughter cells and double the number.
Bacterial reproduction Bacterial growth curve
7
Chapter 2
STERILIZATION AND DISINFECTION
 Sterilization: Destruction of all forms of microbial life including spores.
 Disinfection: Destruction of microbes that cause disease; may not be effective in
killing spores.
 Antisepsis: destruction or inhibition of microorganisms in living tissue thereby
limiting or preventing the harmful effect of infection.
I. Physical methods of sterilization and disinfection

 It includes: (HEAT- IRRADIATION- FILTERATION)
Heat
1. Dry heat: It is less efficient and requires higher temperature and longer period of
heating than moist heat. Dry heat can be used by the following methods:
a. Incineration: It is an efficient method of sterilization and disposal of
contaminated needles, syringes and cover slips at high temperature.
b. Red heat: Inoculating wires, loops and points of forceps are sterilized by
holding them in the flame of a Bunsen burner until they are red hot.
c. Flaming: Scalpels and neck of flasks, bottles and tubes are exposed for a few
seconds, but it is of uncertain efficacy.
d. Hot Air Sterilizer (Oven): it is essential that hot air should circulate between
the objects being sterilized and these must be loosely packed and adequate air
space to ensure optimum heat transfer. It is done by applying 160 0c for 1
hour.
 Use: Sterilizes glassware, oils, lubricants and powders.
2. Moist heat: It is preferred to dry heat due to more rapid killing. Moist heat can be
used by the following methods:
a. Boiling: It is not reliable method of sterilization. It is done by applying 100 0c
for 30 minutes. Used for sterilizing metal articles and glasswares.
b. Tyndallization: Intermittent steaming (Fractional sterilization) Steaming of the

material is done at 100 0c for 30 minutes on three consecutive days.
c. Pasteurization: It is the process of application of heat at temperature of 62 C0

for 30 minutes (Holder method) or 72 0c for 15 seconds (Flash method)
followed by rapid cooling to discourage bacterial growth.
Uses: Pasteurization of milk, Preparation of bacterial vaccines.
8
c. Autoclaving: Steam under pressure, it is based on the principle that when
water is boiled at increased pressure, hot saturated steam will be formed which
penetrates and gives up its latent heat when it condenses on cooler objects.
 Hot saturated steam in autoclaving acts as an excellent agent for sterilization

because of:
1. high temperature
2. High latent heat
3. ability to form water of condensation
4. contraction in volume that occurs during condensation
 Uses: Sterilize solid and fluid culture media, gowns, medical and surgical
equipments.
 Temperature-Time-Pressure level of autoclaving:
121° C for 15 minutes
126 ° C for 10 minutes
134 ° C for 3 minutes
Methods of controlling sterilization:
1. Recording of temperature and time of each sterilizing cycle.
2. Biological indicator: Use of paper strips impregnated with spores of Bacillus
stearothermophilus. Put the paper strip on the culture medium after autoclaving
and observe for germinating bacteria to check for growth. In complete sterilization
there should not be bacterial growth.
Filtration
Mechanical sieving through membrane filters.
  Uses:
- Sterilization of thermo-labile parental and ophthalmic solutions, sera and
plasma.
- Microbial evaluation of water purity.
- Viable counting procedures.
- Determination of viral particle size
Radiation
I) Ultra violet rays:
 Used for the sterilization of the air of the operating theatre.
 Disadvantages: has poor penetration power and can cause eye damage.
II) Ionizing radiation:

 Sterilize object that not withstand heat. Sterilize packed disposable items plastic
syringe-catheters- IV infusion sets -gloves -specimen containers and drug containers.
9
Packing
The aim of packing is to protect sterilized articles against recontamination until used.
Packing materials must be:
1. Permeable to air, steam and gases.
2. Resistant to penetration by microorganisms.
3. Resistant to tears.
4. Free from loose fibers and particles.
Some types of packs: Cotton pack -Kraft Paper-Aluminum Foil-Glass containers.
II. Chemical methods of sterilization and disinfection

1. Chemical agents that damage the cell membrane
 Surface active agents -Phenols-Organic solvents
2. Chemical agents that denature proteins
 Acids and alkalis.
3. Chemical agents that modify functional groups of proteins and nucleic acids
 Heavy Metals-Oxidizing agents -Dyes
1. Chemical agents that damage the cell membrane
Surface active agents
a. Cationic agents
• Quaternary ammonium compounds (Quats):
• More active in Gram-positive bacteria than in Gram negative bacteria.
• More active at alkaline PH-Inactivated by organic materials.
b. Anionic agents
• Soaps and fatty acids: More active in Gram-positive bacteria than in Gram-
negative bacteria. Active at acidic pH
Phenolic compounds
 Cresols e.g. Lysol, Creolin
 alogenated diphenyl compounds e.g. Hexachlorophene
 It is more active on Gram-positive bacteria.
Organic solvents
 Alcohol e.g. Ethyl alcohol, Isopropyl alcohol 70%.
 active against Gram-positive bacteria, Gram-negative bacteria
Uses:
1. Potent skin disinfectants
2. Disinfects clinical thermometer
2. Chemical agents that denature proteins

• E.g. Acids and alkalis, Quats, Alcohol
• Causes conformational alteration of proteins (unfolding of polypeptide chain)
resulting in irregular looping and coiling of polypeptide chain.
• Acids like benzoic acid, citric acid and acetic acid are helpful as food
preservatives: extending storage life of food products.
10
3. Chemical agents that modify functional groups of proteins

and nucleic acids
Heavy metals
1. Mercurial: mercuric chloride – limited use because of toxicity.
- Organic mercurial – less toxic than inorganic mercuric salts.
- Used as antiseptics. E.g. Methylate, Mercurochrome
2. Silver compounds
- E.g. Silver nitrate, Silver sulfasalazine
- Used as ophthalmic and wound (e.g. In burn patients) antiseptic.
Oxidizing agents
1. Halogens e.g. Chlorine, Iodine
a. Chlorine: inactivated by organic materials. 
b. Iodine: effective skin disinfectant
 Iodine Tincture: 2% iodine and 70% ethanol.
 Idiophones (e.g. Betadine): Less toxic and less active than
Aqueous iodine and iodine tincture.

2. Hydrogen peroxide (3%)
Used for cleansing of wound, disinfecting medical-surgical devices and plastic
contact lenses.
Antiseptic agents
 Antiseptic agents: Disinfectants that are applied on animate bodies.
 Characteristics: Never be toxic to cells. Never be corrosive. Should never change nature
of skin, E.g. Savlon, Alcohol (70%), Iodine tincture, Iodophor.
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Hot air oven
Simple autoclave
Packing
Ultra violet rays
12
CHAPTER 3
Bacterial virulence and host immunity
1. Adherence factors:
• Pilli: Hair-like appendages extending from the bacterial cell surface.
2. Invasiveness of micro-organism: A high degree of bacterial invasiveness is usually
associated with severe infection.
3. Bacterial toxins
These are of two types.
a. Exotoxins
b. Endotoxins
Table 4.1 Characteristics of bacterial toxins
Character Exotoxin Endotoxin
Composition Protein lipopolysaccharide
Action Specific non-specific
Antigenicity Strong Weak
Effect of heat Labile Stable
Produced by Gram +ve &Gram -ve . Gram-ve bacteria only.
Converted to toxoid Yes No
Mode of release from Excreted by bacteria released on bacterial

Bacteria death of living cell
(Integral part of cell wall)
4. Enzymes
•
Tissue degrading enzymes
•
Collagenase: Degrade collagen, which is major protein of fibrous connective tissue.
•
Hyaluronidase: (Early spreading factor) hydrolyzes hyaluronic acid, which is the
ground substance of connective tissue.
5. Anti-phagocytic factors
• Protein A of Staphylococcus aureus
• M protein of Streptococcus pyogenes
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Immune defense of the host

I) Non-specific defense mechanisms
1. Skin: impermeable barrier to invasion of the tissues by microorganisms from the
environment. Infection is frequent when this barrier is broken as in wounds, Burns
2. Mucus membrane: A single layer of epithelium and less protective than skin.
3. Lysozyme: An enzyme which lyses the Gram-positive bacteria.
4. Normal flora: Prevents establishment of pathogenic bacteria. Flushing of tears, urine
and respiratory secretion.
5. Tears: Keep the eye surface sterile due to lysozyme and flushing.
6. Respiratory secretion: Traps bacteria and constantly moves them upward propelled
by cilia on the cells of the epithelium.
7. Urine: Voiding helps to flush out bacteria that have gained entry to the bladder.
8. pH of body tract
- Low pH in stomach due to hydrochloric acid secretion kills ingested bacteria.
- Low pH in vagina due to lactic acid conferred by lactobacilli spp. prevents
entry of pathogenic bacteria.
9. Phagocytosis: The process by which microorganisms are ingested and destroyed by
phagocytic cells.
 There are two types of phagocytic cells.
1. Neutrophil polymorphonuclear leukocytes (The polymorphs)
• Produced and mature in bone marrow.
• Short lived cells; circulate in the blood stream for six hours.
• Act as an early defense against infection and are the “pus cells”
seen in the exudate from acute infection.
• Perform only one phagocytic event.
2. Macrophages
• Produced in the bone marrow and found in blood stream as
monocyte and in tissue as fixed macrophage.
• Long-lived cells
• Can perform many phagocytic events.
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Ⅱ) Specific defense mechanisms

 There are two main mechanisms by which the host mounts a specific immune response
against bacterial infection. These are:
1. The humoral (antibody) response
2. The cell mediated response
The humoral response: antibodies are proteins produced by B-lymphocytes in response to

antigens (foreign substance which induces and binds with antibody).
 Functions of antibodies:
1. Neutralization of toxin
2. Promotion of phagocytosis
3. Bacterial Lysis
The cell mediated response: It is important in killing of intracellular pathogenic bacteria. T-
lymphocytes are population of lymphocytes conferring cell mediated immunity due to release
of hormone-like mediators (lymphokines).
 Functions of lymphokines
1. Inhibition of macrophage migration: Localizes macrophage to the site of infection.
2. Chemotactic attraction of lymphocytes, macrophages and polymorphs to the site of
infection.
Normal microbial flora
 It denotes the population of micro-organisms that inhabit the skin and mucus membrane of
healthy normal person.
 There are two groups of normal flora. These are:
1. Resident normal flora
2. Transient normal flora
 Resident normal floras are relatively fixed microorganisms regularly inhabiting the
skin and mucus membrane of the normal host.
 Roles of (Resident) normal flora
Prevent colonization by pathogenic micro-organisms and possible disease through
“bacterial interference”.
 Transient normal floras are non-pathogenic or potentially pathogenic
microorganisms that inhabit the skin and mucus membrane for a short period of time
like hours, days and weeks.
15
CHAPTER 4
Anti-Microbial agents and Sensitivity
• Anti-microbial drugs show specific toxicity to microbial cells due to differences in cell
envelope, protein and enzymes to host cells.
Mechanism of action of anti-microbial drugs
1. Those inhibiting cell wall synthesis, leading to cell lyses.
- Penicillin –cephalosporin -vancomycin
2. Those damaging cell membrane leading to loss of cell contents and then cell death.
- Polymyxin -Amphotericin B
3. Those inhibiting protein synthesis and then arresting bacterial growth
- Aminoglycosides- tetracycline-erythromycin-chloramphenicol
4. Those inhibiting nucleic acid synthesis
4.1. Preventing DNA synthesis
- Nalidixic acid
- Quinolones
4.2. Preventing RNA synthesis
- Rifampicin
5. Those inhibiting nucleotide synthesis
- sulfonamide
- Trimethoprim
Dangers of indiscriminate use of anti-microbial drugs

1. Wide spread sensitization resulting in hypersensitivity and anaphylactic reaction,
and drug rashes.
2. Changing normal microbial flora leading to “super infection” due to over growth
of drug-resistant micro-organism.
3. Direct drug toxicity e.g. renal and auditory nerve damage due to aminoglycosides
toxicity.
4. Masking serious infection without eradicating it.
5. Development of drug resistance by micro-organisms.
Anti-microbial sensitivity testing
Anti-microbial activity is measured in vitro in order to determine:
• The potency of an anti-microbial agent.
• Concentration of anti-microbial agent in body tissues or fluids.
• The sensitivity of a given micro-organism to known concentrations of the drug.
16
CHAPTER 5
Systemic Bacteriology
Classification of bacteria
Bacteria
Cocci Bacilli
Gram negative Gram positive Gram negative Gram positive Organism not
Cocci Cocci Bacilli Bacilli stained by Gram
General diagnosis
1-Specimen→ according to disease site
2-Direct smear→ direct Gram stain to see organisms important in sterile specimen
3-Direct detection test → done on specimen directly before culture → very rapid to detect
Antigen in specimen → by ELISA-Immunofluorescence
If antigen is capsule → by agglutination or Quelling test
Nucleic acid in specimen→ by Probe or PCR
4-Culture→ says character
5-Identification of the organism colony that appear after culture (24 hr) by:
-Gram stain
-Biochemical reactions
- Serological → detect antigen by slide agglutination test (take colony on slide
and put its specific antibody on it)
- Nucleic acid by probe
Generally, when we study any bacteria, we start with its morphology→ Gram
reaction and arrangement.
Generally, all bacteria are classified according to Gram stain into Gram positive Or Gram
negative bacteria
 If Gram positive bacteria → bacteria appear violet under microscope
If Gram negative bacteria → bacteria appear pink under microscope
17
Gram positive cocci Clusters→ Staphylococci

chains→ Streptcocci
diplococci (oval lancet shape) →pneumococci
Gram negative cocci Pairs (kidney shape) →Neisseria
Gram positive bacilli Spore forming 1-C. diphtheriae → club shape with Chinese letter
appearance
2- diphtheroid→ parallel (palisade shape)
Non-Spore forming 3-B. anthrax and anthracoid→ spore forming rectangle

bacilli in chain
4-Clostridium→ spore forming Gram positive bacilli
Gram negative Enterobacteriaceae 1-E. coli- - klebsiella - salmonella -shigella -proteus →
bacilli family rod shaped
2- Pseudomonas
Respiratory pathogen 3- Hemophilus- Bordetella - legionella
4-Vibrios→ Comma shape

5-Yersinia→ Bipolar staining= safety pin appearance
6-Brucella→ rod shaped
7-Helicobacter and Campylobacter→ S shape
8-Spirochaetes→spiral shape with endoflagella
Organism not stained by Gram
1- Obligate Intracellular  Rickettsia / Chlamydia and Coxiella
2- Others  Mycoplasma-Mycobacteria – spirochetes
Cocci
Gram positive Cocci Gram negative cocci
Staphylococci→ Catalase positive Neisseria
S. aureus N. meningitid (meningococci)
S. epidermidis N. gonorrhoea (gonococci)
Streptococci → Catalase negative Moraxella

Str. Pyogenes
Str. agalactiae.
Viridans streptococci
Enterococci: E. faecalis
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Staphylococci
 Morphology
Gram positive cocci arranged in Grape-like cluster. Capsulated (spherical violet in
groups). Gram positive cocci → Catalase positive
 Classification
 There are normal flora in 40-50% of persons in nose
 Three are human pathogen S. aureus- S. epidermidis- S.saprophyticiis.
Diseases caused by S. aureus

 S. aureus lesions is localized due to coagulase protein which deposits fibrin around
the lesions forming a wall
I- Suppuration and abscess formation
1. Superficial infections e.g. folliculitis, carbuncles, boils and abscesses.
2. Deep seated lesions e.g. osteomyelitis in children, bronchopneumonia, empyema,
Bacteremia.
3. Outbreaks of hospital acquired wound infections due to antibiotic resistant.
4. Septicemia (sepsis) can originate from any localized lesion, especially wound
infection, or as a result of intravenous drug abuse.
II- Toxigenic staphylococcal diseases
1- Food poisoning:
 Cause: ingestion of preformed staphylococcal enterotoxin
 S. aureus multiply in food and release enterotoxin in it before ingestion.
 Incriminated Food: carbohydrate rich food e.g. cakes, pastry, koskosi,
koshari as well as milk and milk product that improperly cooked and kept
unrefrigerated
 Symptoms: short I.P (1-8hrs) - nausea- vomiting- diarrhea -no fever.
2- Toxic shock syndrome(TSS): Cause TSST-1.
 Symptoms in menstruating women - wound or localized infections. → fever,
vomiting, diarrhea, rash Hypotension, heart failure and renal failure.
3- Staphylococcal scalded skin syndrome= SSSS
 Symptoms occurs in babies and young children and characterized by large areas
of desquamation of the skin.
19
STREPTOCOCCI
 Morphology
Gram positive cocci arranged in chains or pairs -» catalase negative.
Streptococcus pyogenes
Diseases caused by Str. pyosenes:
1- Streptococcal sore throat or follicular tonsillitis: May be followed by rheumatic
fever or acute glomerulonephritis.
2- Pyoderma (impetigo): A local infection of the skin characterized by formation of

blisters which break leaving crusts. May be followed by acute glomerulonephritis.
3- Toxigenic diseases
1- Streptococcus toxic shock syndrome: Invasive infections with toxic shock.
Infection follows minor trauma. Associated with group A streptococci of the M
type 1,3 produce pyrogenic exotoxin A and B.
2- Scarlet fever: disease of children characterized by sore throat and erythematous
rash. Caused by strains that produce erythrogenic toxin.
4- Post-streptococcal immunologic diseases:

1- Acute glomerulonephritis (AGN):
 Develops 3 weeks after throat or skin infection with a nephrogenic strain of
streptococci (M types 2,4,12,49 and 59-61).
 The condition is due to antigen-antibody complex deposition on the
glomerular basement membrane (type III hypersensitivity reaction).
2- Acute rheumatic fever (ARF) = damage of the heart valves and muscle.
 Follows 1-4 weeks after throat infection with group A Streptococci M types 1,3,5,
6,18 and others.
20
Streptococcus agalactiae
 They inhabit about 25% of the normal adult vagina.

Disease
1- Neonatal septicemia, meningitis and pneumonia→ acquired by the infant from the
birth canal during labour after rupture of membranes. Women identified as carriers
should receive intravenous ampicillin at least 4 hours prior to delivery.
Diagnosis: A rapid test for detection of group B Streptococci DNA in vaginal sample.
Streptococcus pneumonia (Pneumococci)

Morphology
Grain positive-diplococci (lancet shape=oval with pointed end), Capsulated
Diseases produced:
 Transmitted by droplet from person to person
1- Pneumonia
2- Bacteremia and its complication (meningitis-otitis media-endocarditis)
 Predisposing factors: When general resistance is lowered by

1- Viral or other respiratory infections
2- Alcoholism or drug intoxication.
3- Abnormal circulatory dynamics e.g. heart failure and pulmonary congestion.
4- Certain chronic diseases e.g. sickle cell anemia, nephrosis, diabetes, malnutrition.
Enterococci- E. faecalis
Diseases
 Enterococci are normal inhabitants of the intestine
1- Nosocomial urinary tract infections, where indwelling urinary catheters are
important predisposing factors.
2- 10% of cases of subacute bacterial endocarditis in patients who have
undergone GIT or urinary tract surgery or instrumentation.
3- Pelvic and intra-abdominal infections, typically in combination with anaerobes
4- Meningitis and bacteremia in neonates.
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Family Neisseriaceae
Pathogenic Neisseriae
1- N. gonorrhea (gonococci)
2- N. meningitides (meningococci)
Neisseria, Gram-negative cocci arranged in pairs (diplococci)
Diseases caused by Gonococci

Gonococci attack mucous membranes of the genitourinary tract, eye, anorectal area.
A- Venereal disease (Gonorrhea):
 Definition of gonorrhea: Its Gonococcal urethritis= specific urethritis→ sexually
transmitted disease and affects both males and females and manifested by discharge
and dysuria.
1- Male gonorrhea: usually symptomatic
If acute → purulent discharge and dysuria.
If chronic → scanty discharge (morning drop).
If complicated → urethral stricture, prostatitis.
2- Female gonorrhea: Usually asymptomatic (adapted for discharge).
 Vagina not affected → due to its acidity. But →cervicitis and urethritis with
mucopurulent discharge- salpingitis and infertility
B-Non-venereal diseases
1- Gonococcal ophthalmia neonatorum: newborn infected from the birth canal.
3- Gonococcal vulvo-vaginitis: may affect young girls due to contaminated toilets
Treatment:
Penicillin was the drug of choice until resistant occurred.
1- In uncomplicated gonococcal infections Ceftriaxone is the drug of choice.
2- In complicated gonococcal infections tetracycline or erythromycin is added
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Disease caused by Meningococci
Meningococcemia and meningitis

● Three organisms cause more than 80% of cases of bacterial meningitis in persons over
2 months of age; HIb, S. pneumoniae, and N. meningitidis (cause epidemics).
Transmission; airborne droplets from cases or carriers.

Disease: three stages
1- Localized infection of nasopharynx: pharyngitis
2- Spread to blood: meningococcemia and spread to specific sites
• Arthritis- endocarditis -skin rash (small on chest and lower limb)
• Suprarenal gland causing the life threatening Waterhouse-Friderichsen syndrome
which is characterized by high fever, shock., purpura, DIG and adrenal insufficiency.
3- Cross Blood brain barrier: Meningitis.
 Severe headache, fever, vomiting and rigidity of the neck and back muscles, it may
progress to coma within few hours.
Diagnosis
1 Specimens include CSF, blood and joint fluids. CSF is withdrawn by lumbar puncture
under complete aseptic conditions (between L3, L4).
2 CSF examination.
1 Physical examination: the CSF is under tension and turbid
2 Chemical examination: proteins are elevated and glucose is reduced.
Prophylaxis:
1- Vaccination: Meningococcal polysaccharide vaccine:
a) Two vaccines are available:
 Meningococcal polysaccharide vaccine (MPSV).
 Meningococcal conjugate vaccine (MCV).
b) Both immunizes against types A, C, Y, W135
2- Chemoprophylaxis (used for contacts): Rifampicin: 600 mg orally twice daily for
2 days or Ciprofloxacin as a single dose.
23
Gram
positive
bacilli
Spore forming Non- Spore
forming
Aerobic genus Anaerobic Genus Genus

Bacillus genus Corynebact-
Listeria
Clostridium erium
Corynebacterium diphtheria (It causes diphtheria)
C. diphtheriae are pleomorphic Gram-positive bacilli that appear club shaped with Chinese
letters arrangement. The rods have a beaded appearance
 Virulence factor: Diphtheria toxin

 Disease caused by C. diphtheria: Diphtheria --Respiratory (tonsillar) diphtheria.
 Transmitted by airborne droplets. Organism multiplies in pharynx releasing the
toxin causing inflammation of the throat, and necrosis of its of mucosa resulting in
formation of pseudo-membrane = pus –fibers -necrotic tissue.
● Clinical findings: The patient presents with fever, sore throat
Toxin enter blood stream causing toxemia and it causes irreversible damage in:
 heart: circulatory failure
 Nerves: paralysis of muscles of the soft palate
Prophylaxis:
Active immunization: By injecting the diphtheria toxoid. Such toxoids are commonly
combined with tetanus toxoid and pertussis vaccines in the form of DPT (diphtheria,
pertussis, tetanus) vaccine and given IM to children at age of 2,4.6 and 15 months.
24
4.
GRAM POSITIVE SPORE FORMING RODS
1- Genus Bacillus 2- Genus Clostridium
Bacillus anthraces
Gram-positive bacilli arranged in chains, spore forming with central and
oval spores
Major agent of bioterrorism and biological warfare

 Clinical presentation: There are three forms of anthrax:
1- Cutaneous anthrax (Malignant pustule): 95 % of anthrax presentation
Characterized by a black necrotic lesion with a definite edematous margin on hands,
arms, face or neck with regional lymphadenitis
2- Pulmonary anthrax (Wool sorter’s disease): 5% of anthrax presentation.
Presents with substernal pain, cough with hemorrhagic mediastinitis and CXR-revealing
mediastinal widening; and fatal if not treated early
3- Intestinal anthrax: Presents with abdominal pain, vomiting, and bloody diarrhea
Steps in lab. diagnosis:
1- Specimen collection: According to the site of infection:
 Cutaneous anthrax → Fluid from vesicles or ulcer.
 Pulmonary anthrax → Sputum.
 Gastric anthrax → Faeces.
2- Microscopy: Large rectangular Gram-positive bacilli arranged in chains, spore
forming with central and oval spores.
3- Culture: Aerobic, grow at 37°C on nutrient and blood agar with production of
large, irregular colonies with waxy dry appearance often grey-green colour (medusa
head appearance). On blood agar, B. anthracis colonies are non-hemolytic while
anthracoids are hemolytic.
Prevention and control:
1- Protective clothing and gloves for handling potentially infected materials
2- Active immunization of domestic animals with live attenuated vaccine.
25
Genus: Clostridium
Four important species in this group and their diseases:
I) C. perfringens produces gas-gangrene and food poisoning.
 The wound is edematous, foul smelling, dark in colour with crepitations generalized
toxaemia, shock in, multiple organ failure and may be fatal.
II) C. tetani produces tetanus and infant (tetanus neonatorum).
 generalized muscle spasms and hyper-reflex → spastic paralysis
III) C. botulinum produces botulism.
 Food poison without GIT symptom due to ingestion of un sterilized canned food
meat, tuna fish. Canning provides anaerobic conditions
VI)) C. difficile is responsible for antibiotic associated diarrhoea.
 A complication of antibiotic therapy (Clindamycin -Ampicillin and- Cancer
therapy). The antibiotics suppress drug sensitive normal flora allowing the drug
resistant to multiply.
Steps in lab. diagnosis of infections caused by Clostridium species:
1- Specimen collection: According to the site of infection:
Gas gangrene → Wound exudate or tissue sample.
Food poisoning with C. perfringens → Faecal sample.
Tetanus (wound) → Wound exudate or tissue sample.
Pseudomembranous colitis→Faecal sample for culture or for toxin detection.
Botulism → Faecal or vomit sample.
2- Microscopy: All the 3 Clostridia other than Cl. perfringens, are motile non-
capsulated while Cl. Perfringens is capsulated and non-motile.
 Spore shape:
Cl. Botulinium Cl. Perfringens Cl. tetani
Oval, sub-terminal or Oval, sub-terminal Spherical terminal bulging (drum-
central stick appearance)
3- Culture for clostridia: Anaerobic media
a. Robertson cooked meat broth
b. Thioglycolate broth
c. Anaerobic jar → Clostridium species can grow on nutrient agar or blood agar.
They require anaerobic conditions for growth using anaerobic gas jar with gas
pack or anaerobic chamber.
Robertson cooked meat Anaerobic Jar
broth
26
Gram negative bacilli

Enterobacteriaceae
 Classification
Gram negative bacilli
A- respiratory pathogen Haemophilus -bordetella -legionella
B- primary animal pathogen Brucella –yersinia- pasteurella- Francisella
and cause zoonotic disease and Campylobacter
C- Enterobacteriaceae E.coli- klebsiella –enterobacter -citrobacter

Salmonella-shigella- proteus – yersinia
D- Other Gram negative bacilli Pseudomonas-Vibrios-helicobacter
E- Anaerobic Gram-negative bacilli Bacteroids
According to pathogenicity
1. Pathogenic→ Salmonella -Shigella -yersinia – some strain of E. coli
2. Opportunistic→ Klebsiella –Enterobacter- Citrobacter -Proteus –some E. coli
Escherichia coli (E. coli)

Gram negative bacilli A rose-pink colony of E. coli on
MacConkey’s medium
Diseases
1- Neonatal meningitis (40%)- followed by Group B Streptococci and Listeria
2- Urinary tract infection → 90% of community acquired UTI. It’s called uropathic
strain which contains pili= colonization antigen cause adherence to mucosa-
haemolysin
3- Hospital acquired infection→ Urinary tract infection especially with catheter
4- Pneumonia-sepsis-bacteremia in immunosuppresed
5- Intestinal disease = Diarrhoeagenic strains cause diarrhea by 5 mechanisms.
27
Klebsiella
K. pneumoniae It is an important nosocomial pathogen.
 It causes:
1- Pneumonia
2- Urinary tract infection
3- Septicemia and meningitis (especially in neonates)
Enterobacter
 Medical important species is Enterobacter aerogens is associated with urinary tract
infection, wound infection and septicemia in immunocompromised and hospital
acquired infection
Salmonella
The most important serotypes Their diseases

S. typhi, S. paratyphi A, S.  Enteric fever (typhoid fever)
paratyphi B and S. paratyphi C  Only human disease
S. typhimurium, S. enteritidis and  Salmonella food poisoning or enterocolitis.
 Zoonotic disease → transmitted from animal by
eating improperly cooked meat, eggs or infected
birds.
S. choleraesuis  Septicemia with metastatic abscesses.
Enteric fever
 Transmitted by fecal-oral route via contaminated food and drinks
 Incubation period: 10-14 days
 Predisposing factors:
- Reduced gastric acidity
- Disrupted intestinal microbial flora
- Compromised local intestinal immunity
 Both manifest with persistent fever, headache, malaise, chills,
enlargement of liver and spleen and skin rashes.
 Paratyphoid fever is milder than typhoid fever
 Complications:
- Intestinal perforation
- Lower gastrointestinal bleeding
- Mortality rate: Untreated cases: 10-15%
28
 Laboratory diagnosis:
 Lab. diagnosis of enteric fever depends on the stage of clinical illness.
1- Isolation of organism:
a) Isolation from blood: by Blood culture.
b) Isolation from stools: The organism is found in the stools during the second and third
week of illness.
c) Isolation from urine: The organism appears in urine from the second week onwards.
2- Serological diagnosis by the Widal test:
a) Detect antibodies in patient serum from the7th to the10th day of illness.
b) The highest dilution of the serum which gives agglutination is the titre. The significant
titre is ≥ 1/160
Prevention and control
- Vaccine is recommended for those who are travelling to endemic high-risk area.
- Sanity measures like hygienic food and drink handling, and avoid carriers from food
handling until properly treated
Shigella
 Species of medical importance are: S. dysenteriae
 Pathogenesis and Clinical features: Route of infection is fecal-oral route
 Pathogenicity determinant (Toxins):
a. Endotoxin: irritate the bowel wall
b. Exotoxin: Enterotoxin and neurotoxin.
Disease: Bacillary dysentery (shigellosis)
 S. dysenteriae type 1(shiga bacillus) produce heat labile exotoxin mediated diarrhea
 IP: 1-2 days
 Characterized by sudden onset of bloody mucoid diarrhea, abdominal cramp,
tenesmus, fever, generalized muscle ache and weakness.
Complication:
a. Dehydration
b. Electrolyte and acid-base disturbance
High prevalence:
 Poor sanitation
 Poor personal hygiene
 Polluted water supply
Prevention and control:
 Sanitary control of water, food and milk, sewage disposal and fly control.
 Antibiotic treatment of infected individuals
29
Primary animal bacterial pathogen that cause zoonotic disease
Yersinia
Y. pestis → Primary animal pathogen and cause zoonotic disease Plague and need vector for
transmission
Vector transmission:
 Y. pestis transmitted by infected Flea from infected rat to human
Disease passes in three stages
1. Bubonic plague →when flea bite human Y. pestis enter and multiply in lymph node (L.N)
2. Septicaemic plague → from L.N Y. pestis reach blood and organs cause disseminated
intravascular coagulopathy (DIC).
3. Pneumonic plague → occur by two ways
 Secondary Pneumonic plague →Y. pestis enter lung from blood
 Primary Pneumonic plague →when disease transmitted from person to person by
inhalation
Brucella
 All are transmitted from animal to human (zoonotic disease) cause Malta fever
(Brucellosis)
Disease: Malta fever (Brucellosis)
 Transmission: Animal pathogen found in animal products (milk product- meat).
 Affected persons are → farmers, butchers, veterinarians → who contact animal
1. Ingestion → of animal products
2. Inhalation → of secretion
3. Contacts by abrasion in skin or mucosa
- Clinically: Chronic disease (for years)
 facultative intracellular organism lives in phagocytes – and metabolically inactive
 long incubation period 2-6 week
 the organism lives in lymph node-liver-spleen-bone marrow and can persist in phagocyte
for years lead to chronicity and granuloma formation
Steps in laboratory diagnosis:

1. Specimens: Blood sample during febrile stage
2. Microscopy: Gram-negative cocco-bacilli.
3. Serological tests show high titre or four-fold rise in titre in two weeks.
30
Helicobacter (H.pylori)
Only human pathogen
 Cause: Gastritis- peptic ulcer (only human)
 Transmission by oral route in family and genetic predisposition is common
 Colonization of H. pylori in gastric mucosa by:
1. Motility.
2. Production of ammonia from urea by the urease
H. pylori.
Diagnosis: by gastric biopsy

Treatment: Triple therapy (metronidazole, amoxicillin or clarithromycin plus proton pump
inhibitor (e.g. omeprazole) for one-week
Vibrios
V. cholera→ only human pathogen
Film of V. cholera culture stained by Gram showing

characteristic Gram-negative curved rods
 The most common organism on surface water

 Disease: Cholera: only human disease
 Transmission: Oral route
Ingestion of food (under cooked FISH) or drink contaminated with human excreta
 Pathogenesis (Toxin mediated not by invasion) occurs in 3 stages:
1. Colonization→ Large number of organism is needed
2. Adherence →by Pili and mucinase enzyme attach to mucosa
3. Enterotoxin = Choleragen secretion → Disease start
31
Clinical picture:
1- Sever vomiting
2- Rice water stool =watery diarrhea 10 -20 L/day
3- No Invasion to mucosa (no pus or blood in stool no pain no fever)
4- Death occur from dehydration – collapse –shock – renal and cardiac failure
Diagnosis: During epidemic:
- Specimen: stool
1- Direct Smear for stool→ V. cholera - comma shaped bacilli –highly motile bacilli
2- Confirmation serologically → adding anti-O1 and anti-O139→ motility stop (death)
Prevention
1- Adequate personal hygiene to prevent faeco-oral transmission.
2- Proper sewage disposal.
3- Chemoprophylaxis for exposed persons by using tetracyclines.
4- Vaccination:
a) A heat-killed vaccine
b) A live-attenuated oral
Respiratory pathogen
Haemophilus influenza
 Gram-negative cocco-bacilli in shape. Very small in size.
 Facultative anaerobe, small cream-coloured spherical colonies on chocolate.
 Require X (haematin) and V (nicotinamide adenine dinucleotide) factors
small creamy-coloured mucoid colonies H. influenzae on chocolate agar
I-Capsulated strains Hib: invasive diseases affect children

1- Meningitis in infant and children 3month -6 years transmitted by droplet
2- Acute bacterial epiglottitis and stridor
3- Pneumonia in infants
II-Non –capsulated strains cause non-invasive diseases
1- Upper respiratory infection initiated by viral infection
2- Pneumonia in adult with risk factor as old age or malignancy
32
Bordetella
 Bordetella pertussis cause whooping cough
 Respiratory disease of children characterized by cough followed by inspiratory whoop
 Transmission: droplet infection from case.
 Prevention and control:
A) Vaccination:
 DPT vaccine: at 2, 4, 6 months with booster doses at 12 and 18 months. Adults should
not receive the pertussis vaccine since it may cause encephalopathy if given after 6 years
of age.
 Acellular vaccine: It is given to children with diphtheria and tetanus toxoids at 2, 4, 6
months and boosters at 18 months and at 4-6 years. & 10-18 yrs.
B) Chemoprophylaxis: Erythromycin for 10 days.
Mycobacterium tuberculosis
Definition: Acid- fast bacilli, which are difficult to stain by gram
Morphology: Acid and alcohol - fast bacilli
 They are difficult to stain by Gram due to the high lipid (mycolic acid) content of the cell
wall. They can be stained by:
1. Ziehl-Neelsen stain (Z.N.)
2. Fluorochrome stains (e.g. auramine, rhodamine)
Smear of Z.N stain showing pink bacilli against L-J medium showing irregular, dry and off-white
blue background colonies of M. tuberculosis.
Disease: TUBERCULOSIS
 Human tuberculosis is caused by M. tuberculosis and M. bovis.
 Infection with M. tuberculosis is airborne and causes pulmonary tuberculosis
 Infection with M. bovis occurs by ingestion of milk and causes intestinal tuberculosis
Diagnosis of TUBERCULOSIS
1. Specimen: Sputum or morning gastric aspirate, urine, CSF, stools
 Sputum → Three morning sputum samples
2. Direct smears stained with Z-N stain→ detection of acid alcohol-fast bacilli
3. Direct smears stained with auramine→ examined by fluorescent microscopy
33
 Decontamination and concentration:

1- Specimens are mixed with an equal volume of N-Acetyl-L-cystiene-2% NaOH
2- The technique leads to:
a- Liquefaction of the specimen
b- Destruction of all bacteria other than tubercle bacilli by NaOH.
4. Smears are made from the sediment and stained with Z.N. stain.
5. Sediments are cultured on L-J medium and incubated at 35-37°C.
 Tuberculin skin test (TST) (The Mantoux method)

 Intradermal injection of 0.1 ml of the purified protein derivative (PPD), in the forearm.
Result
 A positive test is read as an induration that appears after 48-72 hours. The induration is
due to accumulation of CD4 T cells that are activated and release cytokines that attract
macrophages and polymorphs to the site of injection.
Prevention and control:
Specific prophylaxis by BCG vaccine:
 It is given intradermal (0.1ml in the deltoid region).
 The immunity after the vaccine depends on creating a controlled focus which stimulates
CMI.
 It is given to:
1. Neonates during the first month.
2. Adults who are exposed to infection e.g. nurses, doctors, students.
3. Members of tuberculous families.
4. Tuberculin negatives.
 In Egypt, the vaccine is given to neonates during the first month. It should be given
to health care workers who are TST negative and are working in areas where TB cannot
be properly contained.
Mycobacterium leprae
M. leprae is the causative agent of leprosy in man.
M. leprae is an obligate intracellular, acid-fast bacillus affects mainly the mucous membranes of
the nose, the skin and nerve fibers (optimal temperature for their growth is 30°C).
Mode of transmission: acquired by prolonged contact (nasal secretions, skin lesions)
There are two major clinical forms of leprosy:
 Lepromatous leprosy (LL): is characterized by multiple, raised lesions,
often with the appearance of leonine facies (the face resembles a lion with a
prominent brow).
 Tuberculoid leprosy (TL): is characterized by a single, flat hypopigmented
lesion that has lost sensation.
34
Mycology
Classification of fungi:
1. Yeasts (budding) fungi: These are oval or round cells
2. Filamentous (moulds) fungi: These are branching filaments (hyphae)
3. Dimorphic fungi: these occur in two forms; a yeast form in tissues or at 37°C; and
a filamentous form (hyphae) when grown at 25°C
Fungal diseases may be due to either:

(1). Infection: The diseases they cause are called Mycoses.
 Superficial mycoses
 Cutaneous mycoses (Dermatomycoses)
 Subcutaneous mycoses
 Systemic (deep) mycoses
(2). Allergy: to fungal spores, particularly those of Aspergillus. They cause mainly type I
hypersensitivity reactions or atopy manifesting as bronchial asthma, hay fever, urticaria etc.
(3). Mycotoxicosis: Diseases due to the consumption of food containing fungal toxins
(Aflatoxins) (mycotoxins) with spoiled grains and nuts are metabolized in the liver and act as a
potent carcinogen → hepatic carcinoma in man
Candidiasis (Moniliasis)
 Candida albicans is the most important species of Candida.
Candida albicans in Gram Staining Candida on Sabaroud’s agar (offwhite creamy colonies).
(Oval budding yeast cells)
 Clinical infections include:

1. Oral candidiasis: produces white patches i.e. oral thrush or moniliasis.
2. Vulvo-vaginal candidiasis: (creamy or yellowish discharge).
3. Cutaneous (skin and nails) candidiasis.
4. Alimentary candidiasis: It commonly follows antibiotic administration.
5. Systemic candidiasis: Candida may disseminate to many organs causing:
 Pulmonary lesion in the form of pneumonia.
 Endocarditis in patients with intravascular prostheses.
 Urinary tract infections in catheterized patients.
35
Virology
Virus structure Viral nucleocapsid and the envelope
36
Papillomaviruses
Mode of transmission:
 Direct contact: (skin-to-skin contact and genital contact) or contaminated
surfaces.
Diseases caused by papillomavirus:
1. Warts.
 Cutaneous warts.
 Mucosal warts: Anogenital warts (condylomata acuminata).
2. Benign head and neck tumours: Single oral papillomas. Laryngeal papillomas.
3. Cervical dysplasia and neoplasia: HPV infection has been established as the
primary cause of cervical cancer especially HPV-16 and HPV-18.
Prevention
 A quadrivalent HPV vaccine (types 6, 11, 16, and 18) and a bivalent vaccine
(types 16 and 18). Both vaccines are non-infectious recombinant vaccines.
Herpes simplex viruses

• There are two distinct herpes simplex viruses (type 1 and type 2).
HSV-1 HSV-2
Mode of By contact with, or droplets of By contact with, or droplets of
transmission infected saliva, infected saliva,
Clinical Most HSV-I lesions are above the Most HSV-2 lesions are below
forms of waist the waist.
infection
Clinical 1- Gingivostomatitis: 1- Genital
syndromes of 2- Pharyngitis or tonsillitis herpes
primary in adults. 2- Neonatal
infections 3- Keratoconjunctivitis herpes including meningitis
which may lead to blindness. or encephalitis.
4- Encephalitis.
Varicella-Zoster virus (VZV)

 These are two distinct diseases caused by the same virus:
Varicella (chickenpox) Zoster (Shingles)
Primary disease characterized by Recurrent form and manifests by
generalized rash. localized eruptions.
Prevention Varivax live, attenuated VZV. Zostavax, live, attenuated VZV.
 Acyclovir is useful in preventing varicella and disseminated zoster
in immunocompromised people exposed to the virus.
 Varicella-zoster immunoglobulin (VZIG) is also used for
prophylaxis.
37
Polioviruses
The causative agent of poliomyelitis →that affect CNS and causes flaccid
paralysis mainly in children transmitted by oral route.
Prophylaxis
Active immunization by two vaccines contain 3 antigenic types
Character Sabine vaccine: Oral polio vaccine Salk vaccine: inactivate or injected polio
(OPV) vaccine (IPV)
Nature living attenuated killed vaccine

Route of intake Oral (Herd immunity) Injection
Influenza virus
 Family classification: Family contain 3 influenza virus A, B, C
 Clinical picture
A. Influenza
B. Complications:
1. Pneumonia
2. Reye’s syndrome
Prevention by vaccination: Two types of vaccines are available

 Inactivated influenza vaccines (IIV): is reformulated every year. It is given
by intramuscular injections.
Mumps, Measles and Rubella viruses

 Mumps virus: This virus causes mumps; non-suppurative enlargement of one
parotid glands
 Measles virus: This virus causes Measles; Measles is an acute, highly
infectious disease characterized by fever, respiratory symptoms, and a
maculopapular rash.
 Rubella viruses: This virus causes Rubella (German measles)
Prevention by vaccination: Living attenuated vaccine (MMR vaccine) given in

combination against Mumps, Measles and Rubella. S.C injection: 2 doses first at 15
months and second at school entry (4-6 years) as it gives immunity for 10 years
38
Human immunodeficiency virus (HIV)
Mode of transmission: Plasma viral load determine transmission

1. Sexual contact: or any intimate exposure from carriers as it need close contact
as virus found in semen and vaginal secretion
2. Parenteral: Blood or its products (so blood donor should be screened for P24
antigen which present early in window phase of AIDs before antibody formed)
3. Transmission by prick contaminated needles or scalpels in surgery- mainly
occurs in medical personnel - drug abusers, renal dialysis, with repeated
transfusions
4. Mother to fetus: pre-peri -postnatal as during birth canal or in breast milk
Microorganisms transmitted by blood transfusion

1-HIV, Hepatitis viruses except A and E 3-Herpes -EBV
4-Brucella 5-Treponema pallidum 6-Malaria
Donated blood should be tested for: HBsAg, HBcIgM, HCV, HIV I-II, VDRL of
syphilis
Disease transmitted from mother to fetus : Transplacental (in-utero)

TORCHS
T → toxoplasma
R→ Rubella → congenital rubella syndrome
C→CMV→ cytomegalic inclusion disease mental retardation
H→ HIV→ AIDS HSVII→ neonatal herpes
S→ syphilis
Sexually transmitted disease

Organism Disease
1-Bacteria
N. gonorrhea gonorrhea
Treponema pallidum syphilis
Genital mycoplasma Non-specific urethritis
2-Viruses HIV AIDS
HBV Hepatitis
Herpes simplex virus II (HSV II) Genital herpes
39
Hepatitis Viruses
Virus Transmission Virus Incubation Diagnosis Special criteria

presence Period(I.P)
HAV Faeco-oral Stool 2-6 weeks HAV IgM or rising Occurs in epidemic affect
2weeks titre of IgG for children 5-15 years Cause
before and recent infection by infectious hepatitis
after ELISA
jaundice
HBV Parental- sexual Blood 2-6 months ELISA –PCR Cause serum hepatitis
Chronicity and carrier
HCV Parental Blood 6-7 weeks ELISA and RIBA undergo mutation and
test specific for variation
HCV Chronicity and carrier
HEV Faeco-oral-water Stool 2-10 weeks ELISA High mortality in pregnant

born
HDV Parental Blood 2-12 weeks PCR always Co- infection with
HBV
HGV Parental Blood - PCR Its role not clear
 Prevention of HBV: Recombinant DNA- derived vaccine

(Recombivax) consists of HBsAg produced by a recombinant DNA. The
vaccine is given in three intramuscular injections in the deltoid region at
0, 1 and 6 months.
40
INFECTION CONTROL PROGRAM

 The Infection Control Program develops effective measures to: Prevent, Identify and
Control infections acquired in the Medical Center.
Hand hygiene in healthcare settings

Technique Indication Influence Agents Speed of
Residual
on hand Antimicrobial
effect
flora action
Routine Hand Cleansing after Partly Use of water and
wash patient contact removes non-antimicrobial
Slow Short
& transient soap (Plain non-
contamination flora antimicrobial soap)
Antiseptic Hand antisepsis Kills Use of water and
Can be sustained
Hand prior to transient antimicrobial
for agents such as
wash Invasive and reduces soap (e.g.,
Chlorhexidine;
procedures, or resident Chlorhexidine,
less so for alcohol
to flora Hexachlorophene
and
Remove Iodine; Iodophors
Iodophors
pathogens
(e.g.,
antimicrobial
resistant
strains).
Antiseptic hand Hand antisepsis Kills Use of alcohol-
Fastest
rub prior to Invasive transient based hand rub.
for Can be sustained
procedures, or and
alcohol for agents such as
to remove reduces
Chlorhexidine;
pathogens (e.g. resident
less so for alcohol
antimicrobial flora
and iodophors
resistant
strains).
Surgical Preoperative Kills Use of water and Varies by type
Can be sustained
Hand antisepsis transient antimicrobial soap of agent
for agents such as
antisepsis Recommended flora and (e.g., Chlorhexidine Fastest
Chlorhexidine;
duration is 2-6 reduces Hexachlorophene, for alcohol
less so for
minutes. resident Iodine; Iodophors;
alcohol and
flora Para-chlorometa-
iodophors
xylenol
(PCMX)
-Alcohol-based.
Water less
antiseptic.
-after washing hands
by soap and water.
41
When should I wash my hands?

1- Before and after patient contact
2-After contact with any infectious material
3-After removing gloves or before putting on a new pair
4-After using the restroom before and after eating
If you have possible HIV exposure
• Wash exposed site with soap and water (If eye, flush with water only).
• In this order of preference contact:
- Your immediate supervisor
- Employee Health
- Emergency Department
- Infection Control Physician on call
• Tests for HIV will most likely occur immediately and 3, 6, and 12 months
after exposure.
42
43
‫‪Microbiology for nursing students‬‬
‫مكافحة العدوى‬
‫يشير مصطلح مكافحة العدوى إلى الترتيب الخاص بالوقاية من عدوى المستشفيات أو العدوى‬
‫المصاحبة لتقديم خدمات الرعاية الصحية ومن ثم فقضية مكافحة العدوى تخاطب العوامل‬
‫آخر‪،‬‬
‫مريض ٍ‬
‫ٍ‬ ‫المرتبطة بانتشار العدوى داخل أماكن تقديم الرعاية الصحية (سوا ًء من مريض إلى‬
‫أو من المرضى لطاقم العمل بالمستشفيات‪ ،‬أو العكس من طاقم العمل إلى المرضى‪ ،‬أو فيما بين‬
‫أعضاء طاقم العمل نفسه)‪ ،‬ومنها الوقاية (سوا ًء من خالل التدابير الصحية لنظافة اليد‪/‬غسل‬
‫اليدين‪ ،‬التنظيف‪/‬تطهير العدوى‪ /‬التعقيم‪ ،‬التطعيم‪ ،‬والمراقبة)‪ ،‬باإلضافة إلى إجراءات‬
‫الرقابة‪/‬التحقيق في انتشار العدوى المشتبه بها داخل إحدى مناطق تقديم الرعاية الصحية (مراقبة‬
‫وتفشي العدوى)‪ ،‬وكذلك إدارة (مقاطعة حوادث تفشي العدوى)‪ .‬ومن هنا يصبح العنوان شائع‬
‫االستخدام ضمن مجال الرعاية الصحية هنا هو "مكافحة العدوى والوقاية منها"‬
‫‪-1‬نظافة اليد‬
‫‪-2‬التنظيف‪ ،‬التطهير والتعقيم‬
‫تهدف عملية التعقيم إلى قتل الكائنات الدقيقة‪ ،‬باإلضافة إلى أنه يمثل المستوى األعلى لعملية قتل‬
‫الميكروبات‪ .‬ومن ثم فقد تكون المعقمات الحرارة فقط‪ ،‬أو البخار‪ ،‬أو المواد الكيميائية السائلة‪.‬‬
‫أما التطهير فيشير إلى استخدام الماد الكيميائية السائلة على األسطح وفي درجات حرارة الغرفة‬
‫بهدف قتل الكائنات الحية الدقيقة مسببات األمراض‪ .‬وهنا نالحظ أن عملية التطهير أقل فعالي ٍة من‬
‫التعقيم بسبب أنها ال تقتل مسببات األمراض البكتيرية نتيجة أنها ال تقتل األبواغ البكتيرية‪.‬‬
‫‪-3‬تجهيزات الحماية الشخصية‬
‫معدات الوقاية الشخصية المستخدمة لمرة واحدة‬
‫‪44‬‬
‫‪Microbiology for nursing students‬‬
‫‪(Personal protective equipment‬‬ ‫تتضمن تجهيزات الحماية الشخصية (باإلنجليزية‪:‬‬

‫)‪(PPE‬المالبس الخاصة أو المعدات التي يرتديها العامل للحماية من أي مخاطر‪ .‬ويتمثل الخطر‬
‫في منشآت الرعاية الصحية في التعرض للدم‪ ،‬اللعاب‪ ،‬أو السوائل الجسدية األخرى أو العباء‬
‫الجوي والتي قد تكون محملة بمصادر العدوى ومنها التهاب الكبد الفيروسي ج‪ ،‬اإليدز أو مسببات‬
‫األمراض األخرى المنتقلة عن طريق الدم أو السوائل الجسدية‪ .‬وهنا تقي تجهيزات الحماية‬
‫الشخصية من االتصال مع المواد المعدية من خالل خلق مانع أو عازل فيما بين المادة المعدية‬
‫(المسببة للعدوى) وعامل الرعاية الصحية المعرض للعدوى‪.‬‬
‫وفي الواليات المتحدة األمريكية‪ ،‬تُطالب «إدارة السالمة والصحة المهنية» العمال باستخدام‬
‫تجهيزات الحماية الشخصية لحماية أنفسهم من التعرض لمسببات األمراض الناقلة لألمراض‬
‫المعدية عن طريق الدم أو السوائل الجسدية األخرى‪ ،‬وذلك في حالة توقع احتمالية تعرضهم لمثل‬
‫تلك المواد‪.‬‬
‫ومن أمثلة تجهيزات الحماية الشخصية القفازات الطبية‪ ،‬العباءة الطبية‪ ،‬القلنسوات‪ ،‬أغطية‬
‫الواقية‪ ،‬األقنعة‬ ‫االصطناعي‪ ،‬النظارات‬ ‫أقنعة التنفس‬ ‫(الكمامة)‪،‬‬ ‫الوجه‬ ‫الحذاء‪ ،‬أقنعة‬
‫الجراحية وكمامة قناع مانع لالستنشاق‪ .‬وغالبا ً ما تقرر التنظيمات والتشريعات أو بروتوكول‬
‫مكافحة العدوى عدد تلك التجهيزات المستخدمة باإلضافة إلى طريقة استخدامها داخل المنشأة‬
‫الطبية محط التساؤول أو الشك‪ .‬مع مالحظة أن العديد من تلك األدوات يتم التخلص منها بعد‬
‫آخر‬
‫مريض إلى ٍ‬
‫ٍ‬ ‫استخدامها لمر ٍة واحد ٍة فقط بهدف تجنب حملها لمسببات األمراض المعدية من‬
‫‪-4‬تطعيم العاملين في مجال الرعاية الصحية‬

‫‪-5‬الوقاية بعد التعرض للعدوى‬
‫في بعض الحاالت التي يتعذر فيها الحصول على اللقاح بعد التعرض للعدوى‪ ،‬تكون الوقاية هنا‬
‫هي خير سبيل لحماية عمال الرعاية الصحية المعرضين لتهديد اإلصابة باألمراض المعدية‪ .‬على‬
‫سبيل المثال‪ ،‬يمكن أن تترسب الجسيمات الفيروسية المسببة لعدوى نقص المناعة المكتسب‬
‫ت من التعرض المثبت الواضح‬
‫(اإليدز) إن تم الحقن باألجسام المضادة في غضون أربعة ساعا ٍ‬
‫للفيروس‪.‬‬
‫‪45‬‬

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Menoufia University

Chapter 2: Sterilization and disinfection 8-12

Chapter 3: Bacterial virulence and host immunity 13 -15

Chapter 4: Anti-Microbial agents and Sensitivity 16

Table 1: Differences between Eukaryotic and Prokaryotic cells

Size 1μm 10μm

Nuclear membrane Absent Present

Chromosome Single Multiple

Nucleolus Absent Present

Cytoplasmic ribosomes 70s 80s

Mitochondria Absent Present

Peptidoglycan Present Absent

Prokaryotic cells Eukaryotic cells

 Microscopic Identification of bacteria by Microscope after staining with:

Essential structure Non-essential structure

 Functions of cell wall

Bacterial Generation time:

Bacterial reproduction Bacterial growth curve

I. Physical methods of sterilization and disinfection

b. Tyndallization: Intermittent steaming (Fractional sterilization) Steaming of the

c. Pasteurization: It is the process of application of heat at temperature of 62 C0

 Hot saturated steam in autoclaving acts as an excellent agent for sterilization

II) Ionizing radiation:

II. Chemical methods of sterilization and disinfection

2. Chemical agents that denature proteins

3. Chemical agents that modify functional groups of proteins

Hot air oven

Ultra violet rays

Composition Protein lipopolysaccharide

Action Specific non-specific

Antigenicity Strong Weak

Effect of heat Labile Stable

Produced by Gram +ve &Gram -ve . Gram-ve bacteria only.

Converted to toxoid Yes No

Mode of release from Excreted by bacteria released on bacterial

Immune defense of the host

Ⅱ) Specific defense mechanisms

The humoral response: antibodies are proteins produced by B-lymphocytes in response to

Dangers of indiscriminate use of anti-microbial drugs

Gram positive cocci Clusters→ Staphylococci

Non-Spore forming 3-B. anthrax and anthracoid→ spore forming rectangle

4-Vibrios→ Comma shape

Organism not stained by Gram

1- Obligate Intracellular  Rickettsia / Chlamydia and Coxiella

2- Others  Mycoplasma-Mycobacteria – spirochetes

Streptococci → Catalase negative Moraxella

Diseases caused by S. aureus

2- Pyoderma (impetigo): A local infection of the skin characterized by formation of

4- Post-streptococcal immunologic diseases:

 They inhabit about 25% of the normal adult vagina.

Streptococcus pneumonia (Pneumococci)

 Predisposing factors: When general resistance is lowered by

Diseases caused by Gonococci

Disease caused by Meningococci

Meningococcemia and meningitis

Transmission; airborne droplets from cases or carriers.

Aerobic genus Anaerobic Genus Genus

Corynebacterium diphtheria (It causes diphtheria)

 Virulence factor: Diphtheria toxin