MICRO BIOLOGY

Microbiology; is the study of microscopic organisms that cannot be seen by the naked eyes

Microorganisms /microscopic organisms; are living organisms which can only be seen with
an aid of a microscope..

The microorganisms of medical importance are four that is to say;

- Bacteria
- Viruses
- Fungi
- Protozoa

HISTORY OF MICROBIOLOGY

Some of the outstanding persons who contributed to the modern of micro biology include

ANTON VAN LEEUWENHOEK (1632-1723)

He was a Dutch Scientifics commonly known as the farther of micro biology, was one of the first
microscopists in history i.e.

He committed himself to discovery and research related to the invisible world of biology, notable
among them is the discovery of protozoa (giardia lambilia) and the first to describe the red blood
cell

EDWARD JENNER (1749-1823)

As he was still a youth discovered that people who caught the relatively harmless cow pox
diseases could not contract small pox so in 1796 he inoculated younger boy with exudates taken
from fresh cowpox lesions of a dairy maid.

The boy caught cow pox and when subsequently inoculated with small pox, did not contract the
deadlier disease. The procedure spread and the death late from small pox fell (reduced)

LOUISE PASTEUR (1822-1895)

Discovered that microbes where responsible for souring alcohol and come up with the process of
pasteurization, where Bactria where destroyed by treating beverage and then allowing them to
cool

His work in germ theory also led him and his team to create vaccination for anthrax and rabies.
JOSEPH LISTER (1827-1912)

He observed that 45-50% of amputated patients died from sepsis in 1865, he learnt of Louise
pastures theory that micro-organisms causes infections, using phenol, he reduced the mortality
rate in his ward by 15% within 4 years. Today is regarded as the founder of antiseptic medicine

ROBERT KOCH (1843-1910)

Was a physician based known for isolating the T.B bacterium which was the cause of numerous death
in the mid 19th century and won the noble price in 1905 for his work

He is considered one of the founders of micro biology and developed criteria which he named
Koch’s postulate that was meant to establish a causal relationship between a microbe and disease

ALEXANDER FLAMING (1881-1955)

Was serving as a physician during World War 1,through research and experimentation,
discovered a bacteria destroying mold which he called “penicillin” in 1928 paving the way for
the use of antibiotics in modern health care

Important terminologies

• REPLICATION: Refers to multiplication/reproduction of microoganisms

• PATHOGEN: Refers to microorganisms capable of causing disease

• MORPHOLOGY: Refers to the structure or shape of microoganusms

• PATHOGENICITY: Refers to the ability of microoganisms to cause disease

• MICROBE: Refers to minute microoganism which can only be seen by the help of a
microscope under high power of magnification.

• HOST: It is any organism on which other living organism live as a parasite.

• PARASITE: It is any organism which live at the surface or in the tissues of other living
organism called a host.

BRANCHES OF MICROBIOLOGY

• Bacteriology – the study of bacteria and diseases they cause

• Parasitology- the study of parasites and the diseases they cause.

• Mycology- the study of fungi and the diseses they cause

• Virology – the study of viruses and the diseases they cause.

 • Entomology – study of vectors/insects which transmit diseases

Why study microbiology in Nursing

 To understand diseases caused by microorganisms

 To gain insight on how microorganisms cause diseases in the human body

 To understand the modalities of controlling infections

 Gain insight on how to treat infections

PATHOGENICITY OF MICROORGANISMS

Definition of key terms

1. Pathogenicity; ability of pathogenic microorganisms to cause disease

2. Virulence; a measure of microbe’s ability to cause disease

Microorganisms can be classified as

- Non pathogens. One which do not cause disease

- Pathogens are microorganisms capable of causing disease

Pathogens are further divided into two

1 Opportunistic pathogens

Are microorganisms capable of causing disease only when the hosts defenses are
compromised.

Majority of the opportunistic pathogens are part of the normal floras as below
 Pathogen Site Disease
Candida albicans Vagina and GIT oral and vagina candidiasis ,
intestinal candidiasis
Escherichia coli (E.coil) Colon Urinary tract infection
Clostridium difficle Gut Pseudomembranous calitis
following antibiotic therapy
Staphylococcus aureues Skin Skin and soft tissue infection
(s.aureus)
Pneumocystis jirovici Air way.(nose ,throat) Pneumonia.
(pneumocystis carini)

PRIMARY PATHOGENS

Are microorganisms capable of causing disease even when the hosts defense mechanisms are
interact( health person )

Primary pathogens have means of overcoming the defense mechanisms and some can affect
even animals as below

PATHOGEN DISEASE WHAT IS AFFECTED

Neisseria Gonorrhoeae Gonorrhea Humans

Bacillus anthracis Anthrax Humans and animals

Salmonella typhi Typhoid Humans

PROKARYOTES AND EUKARYOTES

PROKARYOTES

Are single celled organisms that luck membrane bound nucleus, mitochondria and any other
membrane bound organelles’.

They reproduce by binary fission e.g. bacteria.

Lll
EUKARYOTES

Are organisms whose cells contain a nucleus and other organelles enclosed with in membranes.

They reproduce by mitosis.Eg protozoa, gung helminthes etc.

Structure

I'm

DIFFERENCES BETWEEN PROKARYOTES AND EUKARYOTES

Prokaryotes Eukaryotes
Reproduction is always a Is asexual or sexual
sexual
Cell division is by binary Cell division is by mitosis or
fission mitosis
No membrane bound Have a nucleus and other
organelles like mitochondria membrane bound organelles
May have pili Do not have pili
Its ribosomes are small in Its ribosomes are large in size
size (70s) (80s)
Have single circular DNA Have multiple linear DNA
NORMAL FLORA OF THE HUMAN BODY

Normal floras are organisms that inhibit the body of health person without causing diseases
under normal circumstances.

Majority of them are bacteria or yeasts. Viruses, protozoa and worms are not considered to be
among the normal floras

TYPES OF NORMAL FLORAS

Resident flora: are microorganisms commonly found in a particular areva of the body at a given
age

Transient flora: are microorganisms that are present at a given time and disappear or die off
within hours, days, weeks or months

DISTRIBUTION OF NORMAL FLORA

Parts of body Normal flora

Nose Staphylococcus epidermidis, staphylococcus aureus
Eyes S, epidemidis, s. aureus , streptococcus pneumonia
Month and teeth Streptococcus mutans
Colon Bacteria fragilis, clostridium tetan, candida albicans
Vagina Lactob acillus, candida albicans
Skin s, aurous, s. epidermidis, propionibacterium acnies

IMPORTANCE OF NORMAL FLORA

Prevent colonization by pathogens as they occupy space which would have been occupied by
pathogens and also compete for nutrients

They stimulate antibody mediated immune response that may cross react with future pathogens
thus preventing diseases

Lactobacilli a normal flora in the vagina produce acid which maintains acidic ph thus preventing
growth of micro organisms like over growth of Candida albicans

Normal floras in gut secrets vit k and B12 enteric bacteria and other vit b by lactic acid bacteria
by e into food which help in food supplementation
 and others produce antimicrobial substances which kill or inhibit pathogen growth eg intestinal
bacterias produce avariety of substances ranging from relatively non specific fatty acids and
peroxides to highly specific bacteriocins which inhibit or kill other bacteria

www.textbookofbacteriology.net 2008 -2012 kenneth todar

DISADVANTAGES OF NORMAL FLORAS

In case of immune suppression can act as opportunistic pathogens

May be a source of infection to other persons

They may share nutrients with pathogens leaving the host with nothing hence leading to
infections

MECHANISMS THAT CAN DISRUPT NORMAL FLORAS

Suppression of the normal flora by antibiotics allowing overgrowth of resistant spacies

Changes in the general health of the person such as immunity suppression

Local trouma such as skin breakage due to accident or surgery

Introduction to anew site eg migration of E. coli from anus to vagina leads to urinary tract
infections

Hormonal changes especially during pregnancy and menstruation

SYMBIOTIC RELATIONSHIPS

Symbiosis: is aclose interaction between two organisms of different spiecies that is to say host
and symbiot living together.

Host is usually the larger organism and symbiot is the small one in the relationship

symbiotic relationships may be classified as below

Mutualism: an association in which both orgarnisms benefit from the relationship eg E.coli in the
colon produces vit k for the host while the host provides nutrients and shelter to it

Commensalism; association in which one organism benefits and the other is left an affected eg
most of the normal floras
Parasitism: an association in which one organism benefits and the other is harmed eg the worms
in our bodies

LABORATORY EQUIPMENTS

The main equipment used in the laboratory is the microscope

AMICROSCOPE

Is an optical instrument used to observe tiny objects that cannot be seen by the naked eye.

Is commonly used in medical laboratories for diagnostic purposes

TYPES OF MICROSCOPES

There are two types of microscopes commonly used which include

Simple microscope: amicroscope containing only one magnifying lens

Compound microscope: contains more than one magnifying lens. And is the most commonly
used microscope in Uganda

COMPONENTS OF AMICROSCOPE AND THEIR FUNCTIONS

Part Function
Ocular Contains lens that helps to increase the magnification, can be replaced with a high
lens( eye or low magnification lens
piece)
Condenser Contains alens that focuses light on to the specimen
Stage Aflat surface on which the specimen is placed
Stage clips Are used to hold the specimen slide firmly in place
Fine Helps to permit exact focusing by moving stage or body tube up or down slightly
adjustment
knob
Coarse Helps to move the body tube up and down wards to correct the distance from the
adjustment spacimen
knob
Mirror (light Reflects light upward through the diaphragm to stage
source
Base
Objectives Contain lenses of different magnification
Arm Supports the body tube and coarse adjustment knob
Revolving Permits interchange of low and higher power objectives
nosepiece
Diaphragm Regulates the amount of light passing through the specimen
Research on light and electronic microscopes

OF MICROORGANISMS IMPORTANCE

For decomposition of waste materials

Fermentation during brewing

Protect against diseases

Manufacture of drugs

Provision of body nutrients like vit kfrom E.coli

Help in fixing nitrogen into the soil

Study purposes

They cause infections

BACTERIOLOGY

Is the scientific study of a bacteria

Bacteria are single celled prokaryotic organisms and are the most common cause of infections in
the community

Structure

FUNCTIONS OF DIFFERENT PARTS OF A BACTERIAL CELL

Cell walls: is the strong protective outer covering of a bacterial cell and is composed of
peptidoglycan layer

 Gives the cell rigidity and support to maintain shape

 Protects the bacterial against external osmotic pressure
 Is in solved in cell divisions

Cell membrane (cytoplasmic membrane).Is a semi permeable and allows only certain
substances like water, to enter and leave the cell while inhibiting others

- It controls the movement of water, ions nutrients and excretory substances in and out of
the cell.
Cytoplasm. Is a viscous gel containing many solutes which forms inside of the cell

- Reduces friction between the cell organelles

Capsule. Is the outer most layer of some bacteria’s

- Provides protection resisting destruction by means like phagocytosis

- Are important virulence determinants as are able to a touch on hard and rough surfaces
and poor environments.

Ribosomes. Are small particles in the cytoplasm and in the nuclear region of the cell.

- Produce proteins required for reproduction and growth

Fimbriae(pili). Are thin hair like appendages that arise from the cytoplasmic membrane. Are
mostly found in gram negative and some gram positive bacteria.

Flagella. Are long thin spiral shaped filaments consisting of proteins

- Facilitates locomotion in motile bacteria

Spores. Are small metabolically dormant cells with thick walls, common with bacillus and
clostridium

- Spores are highly resistant to heat, other disinfectants and boiling

- Protect bacteria in hostile environment i.e. with radiation, delay duration etc.

Research on

 Spore formation and capsule formation.

BACTERIAL NOMENCLATURE (TAXONOMY)

Refers to a system of organizing, classifying and naming of bacteria for the purposes of easy
identification.

Levels of taxonomy in descending order

kingdom
Phylum
Class
Order
Family
Genus
Spices

Bacterial are named according to a binomial system which is a formal system of naming species
of living things by giving each a name composed of two parts

In binomial system, the genus name is started with a capital letter and species name with a small
letter.

Genus name Species name Common name Abbreviated name

Escherichia Coli Escherichia coil E. coil
Staphylococcus Aurous Staphylococcus aurous S. aurous
Neisseria Gonorrhea Neisseria gonorrhea N .gonorrhea
Mycobacteria Tuberculosis Mycobacteria M .tuberculosis
tuberculosis

Helicobacter Pylori Helicobacter pylori H .pylori

Bacillus Authracis Bacillus anthracis B .anthracis

CLASSIFICATION OF BACTERIA

Bacteria may be classified in many ways basing on

- Shape
- Staining
- Oxygen requirement
- Temperature requirement
- Toxin production
 - Spore formation

CLASSIFICATION ACCORDING TO SHAPE

Bacteria may be classified into various groups basing on their shapes i.e.

COCCI

These are a rounded or spherical in shape and is divided into three i.e.

a) Diplococci
These appear in pairs
 Neisseria gonorrhea
 Neisseria meningitides

b) Staphylococci:
These appear in clusters or groups
 Staphylococcus aurous
 Staphylococcus epidermis
 Staphylococcus saprophytic

c) Streptococcus:
These appear in chains e.g.
 Streptococcus pyogenes
 Streptococcus pneumoniae
 Streptococcus agalactiae

ii) Bacilli.

These are rod shaped bacteria e.g

 E .coli
 Clostridium tetani
 Bacillus anthracis
 Shilgella species.

(iii) Spirochetes.

These are bigger than bacillus and cocci in size and appear in spiral form e.g.

- Treponema palladium which causes syphilis

CLASSIFICATION ACCORDING TO OXYGEN REQUIREMENT

This classification depends on whether bacteria need oxygen or not to produce energy as below.

a) Obligatory aerobes. These bacteria strictly require free oxygen to service e.g.
pseudomonas aeruginosa.
b) Miro-aerophilic bacteria: these grow better in the presence of low oxygen to
concentration e.g. campylobacter jejuni.
c) Obligate anaerobes: these grow only in absence of oxygen e.g. clostridium tetani
d) Facultative anaerobes: these can grow in presence or absence of oxygen e.g.
- Staphylococcus aereus
- Streptococcus pyogenes
- Escherichia coli
e) Carboxyphilic bacteria: these require an environment with is carbondioxide e.g.
Neisseria meningitides

CLASSIFICATION ACCORDING TO STAINING

Bacteria are commonly classified basing on to the reaction to certain stains

The commonly used stains to classify bacteria include

 Gram stain
 Acid fat stain.

i) GRAM STAIN

Is divides bacterias into gram positive and grain negative bacteria depending on the way they
react to the gram staining techinique as below.

Gram positive bacteria

Cell walls are thick and contain large amount of peptidoglycan layer e.g.

COCCI

 Staphylococcus aereus
 Streptococcus saprophyticus
 Streptococcus agalactias
 Streptococcus pyogenes

BACILLI

 Clostridium tetani
  Clostridium difficle
 Bacillus anthracis
 Clostridium perfringens

Gram negative bacteria

These have thin cell wall and contains small amount of peptidoglycan layer e.g.

BACILLI

 Haemephillus influenza
 Escherichia coli
 Klebsiella pneumoniae
 Vibrio cholera
 Brucella species
 Haemophilus ducreyi
 Shigella species
 Salmonella species

COCCI

 Neisseria meningitidis
 Neisseria gonorrboeae

GRAM STAINING TECHNIQUE

Requirements

- Acetone / alcohol
- Safranin
- Sterile swab
- Microscope
- Iodine solution
- Specimen
- Crystal violet
- Water

Procedure
 Fix the dried smear on to the slide,

Cover the fixed smear with crystal violet solution and Allow it to act for one minute.

 Rinse off the stain with clean water and dry off excess water with swabs
 Cover the smear with iodine solution and allow it to act for 30-60 seconds
 Rinse off the excess iodine with clean water and dry off excess water with the swabs
 Decolorize rapidly with acetone / alcohol for at least 5 seconds
 Wash sleds immediately with clean water and dry off excess water with swabs
 Cover the smear with safranin for 2 minutes
 Wash off the strain with clean water and dry in air
 Gram positive bacteria will appear dark purple and Gram negative appear pale purple

ACID FAST STAIN

Is used to stain mycobacterium species whose cell wall contain mycolic acid which makes it
impermeable to the dye of gramstain

Species Example Reaction to acid fast colour

Mycobacterium M . tuberculosis Strong acid fast Bright red
M .leprae weakly acid fest Pale red

CLASSIFICATION ACCORDING TO TEMPERATURE REQUIREMENT

Different bacteria live /stay in different temperature

Psychrophiles; can grow at cold temperature of O-150C

Psychrotroph; can grow at temp ranges of (20-30)0c for optimal growth

Mesophiles. Can grow at moderate temperature of (25-40) oc. And its where we meet most of the
medically important bacteria since most of human pathogens ideal temperature is about 25 oc

Thermopiles,Can grow at temperature of above (55-65 to 80)0c

Hyperthermophiles,Can grow at temperature of (80-135)0c

CLASSIFICATION ACCORDING TO TOXIN PRODUCTION

Some bacteria produce toxins as their defense mechanism and they are either, endotoxic or
exotoxic

a) Exotoxic

These produce toxins outside their cell membrane. They cause diseases with acute rapid onself
because the toxins are produced directly into blood circulation e.g Cholera.

b) Endotoxic

These produce toxins inside their cell membrane

They cause diseases which have gradual on set as their toxins are not poured directly into the
blood circulation

CLASSIFICATION ACCORDING TO SPORE FORMATION

Bacteria like clostridium tetani, E coli, and klebsiella pneumoniae form spores for protection
against heat mostly in dry conditions and other materials like drugs

Some bacterias are unable to form spores eg Vibrio choleraea, Nisseria spp, Pseudomonas
aeroginosa

BACTERIA GROWTH AND DEVELOPMENT

They reproduce by binary fission, where a cell divides into two identical daughter cells which are
able to grow and divide at some rate as parent cell

Research on binary fission

NB; Generation time

Time required for the number of bacteria in a cultural media to double e.g.

staphylococcus aureus 20-30 minutes

E’coli30 minutes

- M tuberculosis 15-20 hours

- Clostridium tetani 40 minutes
CONDITIONS NECESSARY FOR BACTERIA GROWTH

AERATION

Different bacteria need different levels of aeration for growth e.g aerobic Bactria need oxygen,
facultative can grow both in presence of oxygen and carbon dioxide and anaerobic need CO 2.

TEMPERATURE

Each bacterium has its own temperature range within which optimum growth takes place i.e.
psychrophilic grow in range of 0-15, psychrotrophs 20-30.

Mesopliles 25-40oc, thermophiles 55-65 up to 80oc and hyperthermophiles 80-1300C.

MOISTURE

Three quarters ¾ of bacterial cell contain water, this moisture is necessary for growth . And the
need of water/moisture by different bacterial varies i.e. Treponema pallidium dies almost at once
in the absence of moisture while tubercle bacilli can survive for several months without moisture

PH (potentials of Hydrogen)

PH is the degree of alkalinity or acidity of an environment.

A number of bacteria grow best at various PH levels although most bacteria require neutral PH
of 7

Bacteria are divided as below basing on PH ranges acidophile require a PH of 0-5.5, neutrophile
5.5 -8, alkalophile 8.5-11.5, for their optimal growth

DARKNESS

Most bacteria grow well in dark areas because ultraviolet rays are bactericidal to them and only a
few of them can survive

NUTRIENTS

Carbon is needed for synthesis of protoplasm i.e microbes obtain their carbon from carbon
dioxide, carbohydrates, lipids and proteins. Nitrogen is from ammonium compounds and amino
acids for synthesis of proteins and nucleic acids of the cell

MINERAL SALT

Sulphur obtained from proteins, phosphates are needed for the production ATP which is used in
synthesis of nucleic acids (RNA AND DNA) magnesium, potassium and calcium stimulates
enzymes to become active
OSMOTIC PRESSURE

Is the pressure exerted on Bactria by their surrounding. variation in osmotic pressure affects the
bacterial growth.

THE PATTERN OF BACTERIA GROWTH

Under suitable conditions such as availability of nutrients optimal PH, right temp etc. bacterial
cell wall will increase in size and then divide into two identical bacterial cells.

The growth of a colony of bacteria in a laboratory under controlled conditions of can be

described in four major phases as illustrated below.

An illustration of a bacterial growth curve

Key
A – Lag phase
B – Log phase
C – Stationary phase
D – Decline phase
Lag phase

Is usually associated with adaption of bacteria to the new environment, increase in metabolic
rate and enlargement in size of the cell.
Log (exponential) phase

This is the growth phase where active binary fission occurs. During this phase, most bacteria are
metabolically active and cell production is at its peak. Its at this stage that bacteria are very
resistant to antibiotics and this rate of growth is maintained as long as conditions remain
favorable.

Betalactum antibiotics such as penicillin’s and cephalosporin’s act during this phase.

Stationary phase

The no of cells produced is almost equal to those that are dying. This may be due to
accumulation of toxic products, lack of nutrients and limited space; some bacteria may start
producing spores at this stage.

Decline (death) phase

This is the last phase of bacterial growth and it represents a decline in the number of dividing
cells, generally the number of bacteria dying exceeds the number of those being produced.

The decline may be due to buildup of waste toxic materials and exhaustion of nutrients.
BACTERIAL CULTURE MEDIUM

Culture media is a solid/liquid substance used for cultivation, isolation, identification or storage
of microorganisms.

The growth of bacteria in a culture media helps to identify pathogens and aid in the diagnosis of
infection. Culture media are also used to determine susceptibility of antimicrobials.

BASIC REQUIREMENTS OF A CULTURE

The successful growth of bacteria in a culture requires the presence of basic requirement such as
nutrients, ions, moisture, correct PH, osmotic pressure and accessory growth factors. A culture
media should mimic the natural environment required for bacterial growth.

TYPES OF MEDIA

SELECTIVE MEDIA

Is a solid media that contains ingredients which inhibit growth of one organism while preventing
the growth of another.

Selective medium is used to culture specimens from sites that have normal floral in order to
prevent unwanted contamination from growing.

In cultivation the organisms must be provided with conditions that irritate those that face them
when they invade the human body i.e if it is a pathogenic bacteria, should be kept in a temp
similar to that of a human body, provided with food nutrients like fats, proteins, PH and others
found in human tissues.

N.B These media is possible for bacterial and fungal cultivation.

Space for research work

PARASITOLOGY

Is the study that deals with medically important parasites.

Definitions of terms used

 1. Parasite is an organism that lives on or inside of another orgnaism to detrimente of the
hosts organism.
2. Host. Is an organism which support the parasite.
3. Parasitism. Is a form of symbiosis in which one organism benefits from the their
expenses of another organism usually of a different species.
4. Ecto parasite. Ara parasites that live on the surface of the host such as lice and mice.
5. Endo parasite. Are parasites that live inside the host such as Giardia-lamblia, Ascaris
lumbricoides.
6. Facultative parasite. Is an organism that exhibit both parasitic and non-parasitic mode
of living in that it does not absolutely depend on the parasite mode of life. E.g Naegleria
flowleria.
7. Trophezoite. Is the active feeding stage of a protozoa parasite
8. Cyst/Oocyst. Is the inactive feeding or infective form of a parasite.

Reservoir. a host that makes the parasite available for transmission to another host and
is usually not affected by the infections.

Obligate parasite. a parasite that must always live in contact with its host.

Definitive host. The host in which sexual reproduction takes place.

Intermediate host. Host where/that harbours the larval stages of the parasite or where a
sexual stage cycle of development occurs from.

CLASSIFICATION OF PARASITES

Parasites of medical importance are classified into two

o Protozoa
o Helminthes

PROTOZOA

Are single celled organisms’ occurrying both as free living organisms and as parasites.

They are eukaryotic organisms

Protozoa have a complex life cycle involving trophozoite and cysts. The cyst formed enables
protozoa to survive in harsh conditions even outside the host.

They replicate a sexually by binary fission and sexually with gamete formation.

They cause diseases as a consequence of their infestation but symptoms occur as a result of
immune response.
CLASSIFICATION OF PROTOZOA

Are classified into four major groups depending on their means or mode of reproduction and
mode of locomotion.

a) Amoeba (rhizopoda)

E.g Entamoeba, move by pushing out their ectoplasm to form a pseudopodia and reproduce a
sexually by binary fission.

Have two stages i.e.Trophozoites. Which is motile and able to feed and Cyst. The infective form
that is capable of surviving outside the body.

b) Ciliates

e.g Balantidium coli, they have multiple cili (hair like structures) attached to the outer surface
for locomotion.

Reproduce by binary fission and sexually by conjugation.

Ciliates form cyst which is the infective form.

c) Sporozoa (coccidia)

e.g plasmodia spp, toxoplasmodia and cryptosporidium, all sporotozoa are intercellular and non
motile.

Reproduction is both by a sexual (schizogony) and sexual (gametogony) they have multiple
stages in their life cycle i.e. oocyte, sporozoites, trophozoites and merozoites.

d) Flagellates (mastigophia)

e.g giardia spp, trichomonos spp, typanosoma spp and leishmania spp.

Usually have long hairy flagella for movement, they reproduce a sexually by binary fission. They
exist in two forms in their life cycle i.e cysts and trophozortes.

MODE OF TRANSMISSION OF PROTOZOA INFECTIONS

- Person to person contact

- Insect bites e.g. malaria
- Sexual contact with the infected person e.g. trichomoniasis.
- Fecal-oral route through ingestion of contaminated food or H 2O e.g Amoebiosis.
FACTORS THAT CONTRIBUTE TO THE SPREAD OF PROTOZOA INFECTIONS

- Poor sanitation that results into feacal contamination of the environment.

- Poor access to clean H 2O
- Lack of resources which results into failure to control vectors.
- Poverty
- HIV infections which increase susceptibility of parasitic infections.

PREVENTION OF PROTOZOA INFECTIONS

- Proper disposal of wastes

- Boiling of drinking water
- Regular hand washing before and after defecation and eating and whenever need be.
- Educating the community including food handlers and health workers
- Screening and treatment of all food handlers.
- Covering food and water to prevent contamination from house files.
- Proper cooking of meat
- Using of insect repellants and bed nets

COMMON PROTOZOA AND THEIR ASSOCIATED DISEASES

Location Protozoa Diseases…..

Intestinal tract Entamoeba hystolytica Amoebiasis
Giardia lamblia Giardiasis
Cryptosporidium species Cryptosporidiosis
Microsporidia Microsporidiosis
Blood and tissues Typanosoma species Sleeping sickness
Toxoplasma gondi Toxoplasmosis
Leishmania species Ceishmeniasis
Plasmodium species Malaria
Urine genital truct Trichomonas vaginalis Trichomoniasis
Research on the following

Plasmodium species
Trypanosome spp
Trichomonas vaginalis
Entamoeba histolytica under mode of transmission, disease caused, clinical presentation,
factors (predisponsing factors, prevention, treatment and lifecycle).
Read about;

Loxoplasm gondi
Giardia lamblia

HELMINTHS

Are eukaryotic parasitic worms that live mainly in the gastro intestinal tract of human host.
Unlike bacteria and virus, helminthes are often large organisms.

The infective larval forms are usually smaller than adult worms. The infections are usually
common in developing countries and affects more of children than adults.

NB. Helminthiosis. A disease condition resulting from infection with parasitic worms.

CLASSIFICATION OF HELMINTHS

Class Examples
Trematodes (flunkes) Schistosoma species
Fasciola species
Nematodes (round warms) Ascaris lumbriacoides
Strongyloides, stercorolis
Hook worms
Trichinella spirali
Enterobios vermioularis
Gestodes (tape worms) Teania species
Diphyllobothrim latrim

NB. Trematodes and nematodes feed on human tissue and the content of host intestines.

Tape worms lack digestive systems therefore have to feed by absorption of digested nutrients
from their hosts.

MODE OF TRANSMISSION

Fecal oral route

Inhalation of dust

Penetration of skin by larvae from contaminated soil e.g. hook worms.

PREVENTION

- Proper disposal of feaces

- Avoid eating uncooked food
- Daily washing of hands before and after eating food
- Finger nails should be regularly cut to avoid collection of eggs.
- Treat the entire family at some time to prevent infections.
- Encourage people to wear shoes and sandals
- Health education
- Destroying intermediate host like snails
- Avoiding contact with water known to contain cercarias like for shistosoma spp.

Research

Schistosome spp
Hook worms
Taenia spp under mode of transmission, disease, sign and symptoms, treatment,
prevention and lifecycle.

MYCOLOGY

Is the study of fungi;

fungi are non-motile eukaryotic organisms which exist as saprophyte (derives its nourishments
from decaying organic matter) or as parasite.

CLASSIFICATION OF FUNGI

Fungi may be classified into 4 groups as depending on their appearance and means of growth as
below.
 CLASS EXAMPLE REMARK
Moulds Aspergillusspp Are ones which form mycelia and can also be called
Trichophyton filamentous fungi
Rubrum
Yeasts Crytotoccus Are round, oval unicellular in nature and reproduce
Neoformans by budding.
Yeasts like Candida albicans Are similar to yeasts that produce pseudohyphate
fungi
Dimorphic Histoplasmacapsulation Can grow either as a mould or yeast depending on
fungi Blastomycesdermatidus the environmental factors

DIFFERENCES III MOULDS AND YEASTS

YEASTS MOULDS
Are unicellular Are multicellular
Are either oval or rounded Are filamentous
Reproduce by budding Reproduce by spore
Some yeasts are opportunistic pathogens Are not opportunistic pathogens

IMPORTANCE OF FUNGI TO HUMANS

 Help in decomposition of nutrients and in carbon cycling.

 Are sources of antibiotics such as penicillin
 Some like mushrooms can be used as food
 Fungi are used in the manufacture of beer, chocolates, cheese, bread etc.

MYCOSES

Are disease causes by fungi. Are classified into three;

 Superficial infections; are localized to teratinized tissues such as skin, nails and hairs. Are
caused by dermatophytes and candida albican.
 Subcutaneous infection; are limited to subcutaneous tissues though they may spread to
the surrounding skin and bones.
  Systemic infections; occurs when pathogenic fungi enter the body and infact internal
organs such as lungs, brains etc. are further divided into two mainly.

Primary which occur in healthy individuals and opportunistic which occur in immunocom
promised patients.

Examples of opportunistic pathogens

- Cryptococcusis Systematic candiasis

- Aspergillosis pneumocystis (pcp)

CLASSIFICATION OF DERMATOPHYTE INFECTIONS

They were previously called tineas/ ringworms

Their growth is enhanced by foot and humid conditions, poor personal hygiene.

Are classified as below;

- Tineacorpris e.g trichophytonrubrum and e.floccosum which affects their non hairly,
smooth part of the skin.
- Tineapedis which affect el webs and the sole e.g I.rubrum and
epidermophytonfloccossum.
- Tineacapitis of microsporuumcanis, trichophyton and mentagrophytes which affects
el scalp.
- Tineacruris. Affects the grain e.g t.trubrum. e.floccosum and
frichphytonmentagraphytes.
- Tineaungulium affects the board area e.g Trichophytonmentagraphytes.
- Tineamanuum. Affects the finger wbbs e.g tirubrum.

VIROLOGY

The study of viruses

DEFINITIONS OF COMMON TERMS USED

Casped.The protein shell surrounding the nuclei acid virion.The complete infective virus
particle.
Genom. Is either the RNA or DNA contained in the viral capsid.

Fusion. Is the process by which viruses attach themselves to cell membranes of the host cells for
the purpose of viral replication.

Envelop. Is a lipid membrane of the host cell.

Transcription. Mechanisms by which specific information encoded in nucleic acid chain is

transferred to the RNA and translate on ribosome through RNA into the structures of protein.

VIRUSES

Are very small microorganisms only seen by electronic microscope.

Are obligate intracellular pathogens which can only multiply in living cells of host.

Contain either DNA or RNA as their genome.

Are metabolically inert outside the host cell.

They survive by altering the function of the cells they impact so that these cells supply the
viruses with energy and means of replicating themselves.

STRUCTURE OF A VIRUS

They contain on external protein coating called capsizedcontaining nuclei acid in form of DNA
of RHA.

The nucleic acid controls infected cells and help in their division to for more nfected cell which
invade other neighboring cells.

Surface protein help in recognizing and binding the cell in host organisms.
MODE OF TRANSMISSION

Viruses may be transmitted through any of the following ways

- Inhalation of airbornes droplets e.g measles, influenza etc.

- Ingestion of food or H 2 O contaminated with viruses e.g hepatitis A.
- From infected mother to mother unborn baby (vertical transmission) e.g HIV and
Rubella viruses.
- Sexual intercourse with an infected person e.g HIV
- Through animal bites such as rabies viruses.
- Inoculation with the aid of injections, insect bites etc.
- Through body contact e.g ebola and Marburg.

VIRAL REPLICATION

Viruses only multiply in a living cell and below are he steps adoption/attachment.

Involves interaction of a variation with a specification receptor site, on the surface of the cell
viruses may use more than one host cell receptor forexample HIV.

Entry/penetration

Once the vinon has been attached to the receptor. It gains access to the interior of the cell by
either endocytosis or fusion of virus envelope with the cell membrane.

Uncoating

Occurs immediately after penetration and involves release of viral genome as the cell
enzymes (gysosomes) strip off the virus protein coat.

During this step, the infectivity of the parental virus is lost.

Synthesis of virus components

Involves synthesis of viral proteins and replication of viral genomic nucleic acid.

Assembly

Involves assembly of capsid, and association of the viral genomic with in the capsid.

Release
 Involves sudden rapture of cell and release of new various. Occurs by either lysis or budding
off from the parent or host cell.

Research

Illustrate using a diagram

HOW VIRUSES CAUSE DISEASES

NB. Viruses are capable of infecting all types of living organisms such bacteria, plants, insects
and human cells.

A major factor that controls which cell type a virus can infect (cell tropism) “cell tropism” is the
presence of appropriate receptor to which the virus must attach in order to gain entry into cell.

CLASSIFICATION OF VIRUSES

Are classified as below

DNA enveloped DNA Enveloped

RNA enveloped RNA Enveloped

CLASS
DNA Enveloped
- Herpes simplex virus
- Hepatitis B virus
- Pox virus
- Cytomegalo virus
- Varicella – zoster virus
DNA Non-enveloped – Adeno virus
RNA Enveloped
- Measles
- Rabies virus
- Mumps virus
- Rubella virus
 - Influenza virus
- Para – influenza virus
RNA non enveloped
- Polio virus
- Hepatitis A virus
- Rhino virus

Research on;
HIV (retro viruses)
Herpes viruses
Murburg viruses and ebola
Mumps viruses

INFECTION PREVENTION AND CONTROL

Infection is the successful invasion and multiplication of micro-organism in or on body tissues

with or without signs and symptoms.

Infection can be classified as below;

- Localized infection. Confined to a smaller part of the body

- Disseminated. Infections which are widely spread in that is affect the body beyond the
initial site of infection.
- Systematic. Infection that affects the whole body.it is spread through blood and lymphatic
system.

TYPES OF INFECTION

Can be classified basing on anatomical site as

- Urinary tract infections

- Respiratory infections
- Vaginal infections
- Skin infections etc.

RESERVOIRS OF INFECTIONS

Are places where pathogens grow and accumulate which include;

(1) Human reservoirs which include infected persons who are called carriers diseases such as
typhoid can be transmitted from carriers

Carriers can be grouped into

- Patient with infection

- Patient with acute infection
- Convalescent carriers
- Contact carriers

(2) Non-living Reservoirs, include H2O, food, soil, Air and dead vegetation. Diseases such as
cholera, tetanus, ebola.

(3) Animal reservoirs

Diseases can be transmitted from animal to humans

Animals reservoir include cattle, monkey, cats, dogs,ducks, rats etc.

Zoonoseszoonoses

Are infectious diseases that infect animals but can be transmitted to human. Can be transmitted
through the following means.

Direct contact with infected animal tissues

Consumption of contaminated food stuffs like milk and meat and others as below;

Zoonese Causative pathogen Means of transmission

Rabies rabies viruses transmitted through a bite of a rabid
Anthrax Bacillus anthracis Through contact with cats.
Inhalation of pathogens.
Brucellosis Brucella species Ingestion of contaminated milk.
Eating under cooked infected meat.
Marburg Marburg Direct contact with infected person or tissues
of infected monkey
Tuberculosis Mycobacterium Ingestion of unboiled or unpasteurised milk
Bovis
Tuberculosis

CHAIN OF INFECTION

Microorganisms live and multiply in a reservoir where they can transferred to a susceptible host.
An infection can occur if all the six components are present and removal of one link in the chain
prevents infection.

Below are the components

- Causative agent. Refers to any micro-organism that is capable of causing disease these
may be bacteria, viruses protozoa and fungi.
- Reservoir. Is a environment, object in or on which micro-organism can survive and
sometimes multiply. Common reservoirs include; animals, humans and non-living
objects.
- Portal of exit. The path by which an infectious organism leaves its reservoir. In relation to
human may include;

Respiratory tract - Skin - GIT

Genital - Urinary
- Mode of transmission. Is the means by which infectious organism pass from the portal of
exist to the susceptible host, common modes of transmission include contact, vector
borne and vehicle transmission.
- Portal of entry. Is the path which an infectious organism goes through to ivadea
susceptiblehost.

The portal entry is usually similar to the portal exist.

Susceptible host. The host which is vulnerable to infectious. Vulnerability may occur as
result of weakened immune system of the host due to age, health, status, chemotherapy.

MODE OF TRANSMISSION OF INFECTION

This is the means by which pathogens pass from the portal exit in the reservoir to the susceptible
host.

The three major modes include;

Contact transmission

A person is exposed to a pathogen by either touching or being close to an infected person or

object.

Can be further divided into three as below;

 (i) Direct contact transmission involves person 2 person transmission through touching,
kissing, sexual intercourse etc. common diseases in this route may include hepatitis A
and sexually transmitted diseases.
(ii) Indirect contact. Is a where pathogens are transferred via non-living objects such as
towels, eating utensils, thermometers; beddings which are contaminated disease
include Hepatitis B.

1. Droplet transmission; involves transfer of pathogens via infections droplets generated through
sneezing, coughing and laug….. diseases by this route include common cold, whooping cough,
measles etc.

2. Vector transmission. Refers 2 transmission of an infectious disease by the bite of an infected

(block flies and sand flies)

3. Vehicle transmission; involves transfer of pathogens via a medium like H2O, air, blood fluids
and invenous fluids administered to the patients. These diseases include cholera, typhoid.

Research

Describe the causes of infections

CLASSIFICATION OF INFECTIONS

Infections may be classified into 2 depending on the source of infections i.e. community acquired
and hospital acquired.

Community Acquired

Are infections acquired within the community, they also include infections incubating during
time of hospital admission.

Routes of transmission

Fecal oral route. This can occur via contaminated food or house materials which are
contaminated. Disease causing organisms include salmonella typhi, vibric cholera.

Airborne route. Are spread by inhalation of infectious droplets after infected person coughing,
sneezing, laughing, organisms include; measles virus, influenza virus etc.

Direct in oculation.These occur when pathogens are injected into the body either due to
accident, bite by infected animals / vectors air contaminated needles used on patients e.g
plasmodium falciparum, guinea worm, HIV virus etc.
Trans placental/mother to child.Where infections are transferred from mother to child during
pregnancy delivery and after delivery like T-reponema palladium, HIV etc.

Direct person to person contact.Most conditions on skin infections like ringworm, scabies etc.

Sexual contact.

NOSOCOMIAL INFECTIONS (HOSPITAL ACQUIRED INFECTIONS)

Are infections acquired from a hospital, or health care facility when the patient is admitted for
any other reason.

The most common nosocomial infections in Uganda include;

Pneumonia - septicemia
Sepsis - antibiotic associated diarrhea
CAUSES OF NOSOCOMIAL INFECTIONS

The common pathogens than can cause nosocomial infections are mainly bacteria and include;

S. aureus

Proteus spp ecoli

Websiellaspp - mycobacterium tuberculosis

SOURCES OF NOSOCOMIAL INFECTIONS

They can be endogenous or exogenous i.e.

Endogenous infection. Originates from the patients normal flora

Exogenous infections; originates from external sources which include;

- Acutely all patients

- Asymptomatic patients (people incubating on infection)
- Inadequate sterilized equipment’s
- Hospital staff during patient care
- Healthy carries

Main routes for transmission of nosocomial infections

They include;
 - Contact with infected persons
- Air borne
- Direct inoculation
- Facial oral routs

FACTORS CONTRIBUTING TO NOSOCOMIAL INFECTION

- Failure to health care workers to follow injection control guidelines.

- Increasing number of patients with compromise immunity
- Overcrowding of patients in the hospital
- Prolonged stay in the hospital
- Age in that a patient with adversed age and young ones like babies are more susceptible
to infections.
- Underlying diseases such as diabetes mellitus, renel failure tend to lead to increased
susceptibility.
- Drugs being administered like nati-cancers and steroids tend to lower body or hosts’
immunity.

PATIENTS AT RISK OF NOSOCOMIAL INFECTION

- Patients with compromised immunity due to diseases like HIV or immune suppressive
drugs.
- Patients with broken skin (wound)
- Patients undergoing surgery characterization ventilation.
- Women in labour and delivery
- Highly old and young patients

CONSEQUENCES OF NOSOCOMIAL INFECTION

- Prolonged stay in the hospital which may result into dark.

- Increases the cost of medical care i.e. drugs
- Infected person may become a source of infections to other patients.

PREVENTION OF NOSOCOMIAL INFECTION

 - Protecting patients with appropriate use of prophylactic anti-microbial, nutrition and
vaccination.
- Limiting the risk of endogenous infections by minimizing invasive procedures and
promoting optimal microbial use.
- Prevention of infections among the staff members.
- Enhancing staff patient care.
- Surveillance of infections i.e. identifying and controlling outbreaks.
- Health education of both patients and staff members.
- Use of appropriate a septic practices like hand washing, sterilization, disinfection.
- Isolation of infectious patients from other patients.

Qn. Describe the standard precautions of infection control in a hospital

Describe the causes of infections

 UNIVERSAL PRECAUTION / PRINCIPLES OF INFECTION
PREVENTION AND CONTROL
Are a set of guidelines developed by the center of disease control and prevention in order to
avoid contact with potentially infective body fluids and objects such as csf, pleural fluid, blood,
amniotic fluid etc. which may harber infections such as hepatitis B, Hix

They include;

- Hand washing
- Safe waste management
- Adequate protective gears
- Proper sharp disposal
- Proper sterilization disinfectant

1. WASTE MANAGEMENT AND DISPOSAL

Refer to how the different wastes in hospital and homes are segregated. The methods used for
disposal of wastes from hospital and homes are almost similar. The main difference is the type
and amount involved.

In medical field wastes and their disposals is of high standards due to the fear of infection spread
to the handlers and public.

GENERAL PRINCIPLES OF SEGREGATION, STORAGE AND TRANSPORTATION

- All health care workers should understand the risks and safety procedures for the wastes
they are handling.
- All the containers which are filled with wastes should labeled to help the person in charge
and to control the workers.
- Separate containers should be available in each a medical area for proper segregation of
wastes.
- Separate containers should be available in each a medical area for proper segregation of
wastes.
- Local storages inside or near to a medical area may be needed if wastes are not collected
frequently.
- Do not mix hazardous and non-hazardous wastes during collection, transport and storage.
- Collection wastes are often taken to central storage site before treatment and disposal.
HEALTH CARE WASTES

Is the total wastes generated in healthy facility during health care service delivery like during
diagnosis, prevention and treatment of diseases.

TYPES OF WASTES

Wastes may be classified into two;

- Hazardous health care wastes

Is a waste with potential to cause harm to both human and environment if improperly handled.
Almost 20% of all health care waste is estimated to be hazardous.

- Non-hazardous flow

Are wastes that are harmless to both humans and environment. They contribute almost 80% of
wastes generated in a health facility, although they are harmless, they become nuisance when not
appropriately disposed off. Examples include; papers, boxes, empty tins and discarded food.

Examples of hazardous waste include;

- Un used blood
- Human tissue
- Contaminated animal carcasses
- Disinfectants
- Drugs
- Needles
- Syringes
- Laboratory reagents
- Swabs and bandages

SEGREGATION OF MEDICAL WASTES

The responsibility of segregation of wastes lies one person who has generated the wastes. All
wastes should be segregated and disposed off in their appropriate container.

Cobour coding also provides a visual indication of the potential risk posed by the wastes in that
container i.e.

Red – highly infectious wastes

Yellow – infectious wastes

Brown – pharmaceutical and chemical wastes

Black – general/noninfectious wastes

Yellow/ white sharp container for sharp wastes only.

Segregated wastes become easy to be carried by the workers in that if bins become full, its liner
wrapped tightly and taken to incineration.

WASTE SEGREGATION CHART

Recommended Type of waste

Black bin with liner Leftover food – food feelings
Empty bottles – papers, boxes
Yellow bin with liner Used gloves – nasal gastric tubes
Catheter tubes – used infusion sets
Used gauge – used cotton, paid and cloth
Red bin with liner Used blood bags, used test tubes
Placenta and extracted teeth
Amputated limbs
Brown bin with liner Lab reagents – empty vials
Heavy metals like lead, mercury and silver
Expired drugs and damaged drugs like syrups, creams
capsules etc.
Yellow safety box Used syrings and needles

Research
Describe
1. Hand washing. This is effective measure for preventing the spread of pathogens. There
must readily accessible hand washing facilities in a hospital
2. For example soap most especially liquid soap for hand washing and running water and
towel for drying hands immediately after washing.
3. Sterilization, this is the process intendedto kill am microorganisms and is a highest level
of microbial kill that is possible, sterilizers may be heat only, steam or liquid
4. 3.Cleaning, infections can be prevented fromaccuring in hospital/home as well in order to
reduce their chances to contract on infections, patients , medical perfuse are
recommended to maintain
5. Disinfection. Disinfection uses liquid chemicals on suraces and at room temperature to
kill diseases causing microorganismultras let light has also been used to disinfect the
rooms of patients infected with clostridium difficult after discharges
6. Personal protective equipment e.g. gloves, bonnets, shoes, covers, face shield, surgical
mask and respirators. Many are most of those items are disposable to avid carrying
infections materials from the patients to another and to avoid difficult or costly to
disinfection.
7. Auti microbial surfaces, microorganisms are known to survive on non-antimicrobial in
animate “touch” surface e.g. bedrails, over-the-bed trays, call buttons, bathroom hard
wore etc. as a public hygienic measure in addition to regular cleaning
8. Vaccination of health care workers.
SHARP DISPOSAL

Asharp is anything that can pierce. it allows the hazard to contaminate the recipient with the

Infected body.

HOW TO HANDLE SHARPS

-Needles must not be bent or broken by hand or removed from the syringe.

-Needles should not be bent or broken by hand or removed from the syringe.

-All sharps should be disposed off in a safe manner ie with the sharp part of painting down.

-Needles and syringes should be disposed off as a single unit into a safety box which is puncture

Resistant.

-Sharp containers should be labeled.

-Sharp containers should be filled up to ¾ and sealed to avoid injuries.

-Avoid patients movements during the the time of administering drugs by injection.

-Avoid carrying and moving with sharps in hands in that dispose in a safety box immediately

After the procedure.

-The safety box should be disposed off after sealing.

-Final dispose of sharps should be burnt and residue buried.

HOW TO PREVENT ACCESSIBILITY TO USED SHARPS

-Seal sharp containers after use and dispose.

-Do not open the sealed container for re-use.

-Store full safety boxes,awaiting final disporsal in a secure area that is only accessible to

Health facility staff members and not the general public.

STRATEGIES

-Training health workers in injection safety issues and appropriate waste disporsal.

-Educate and encourage patients to seek treatment only from qualified providers.

-Support for supervision of health workers involved in administering of drugs and

those who dispose wastes.

-Organising records to health workers who dispose offsharps well.

3 HAND WASHING

Hands are notorious for spreading infections from one preson to another and should

be washed before and after contact with each patient, before and after meals,before

and after visiting the toilet,before and after breast feeding and whenever water is seen.

Hand washing has been described as the most effective way of preventing cross infection

That is regarded as the style most important in preventing and controlling infection transmission.

Hand washing is defined as the vigorous rubbing together of all the leathered hand surface

Including the skin up to the wrist (and up to the elbow surgical scrubbing) for a minimum of 10

Seconds,using running water, soap and friction to remove all,or inactivate any transient micro
organisnm,development and organic materials.

WHAT MUST BE DONE BEFORE THE PROCEDURE.

-Remove all the jewllery eg rings watches.

-In case of oresence of acut or injured tissue,cover, it with exclusive water proof plaster.

-Keep the nails clean without

-Soap and soap dispensers should be clean.

DURING THE PROCEDURE

-Wet hands, add some of the cleaning agent ie soap to form lurther.

-Pay attention to the area under finger nails.

-Avoid splashing water on your self and flour because micro-organisms and even the slippery
floor is dangerous.

-Avoid touching the skin of the other body parts.

TEACHING OF HAND WASHING

Palm to palm.

Right palm over the left palm and vice-versa.

Palm to palm with fingers inter locked.

Back of the fingers to opposing palm with fingers interlocked.

Rotational rubbing in the palm using the finger tips.

Right thumb is clusped in left in left and vice versa.

Continue washing the hand for 1 minute and teo minutes for pre operative use.

Rinse the hands and dry thoroughly.

Dry hands from elbow using a single towel or disposable paper.

Always keep the hands higher than t1z

e elbow.

Drop the towel to dispose the the bin.

ADEQUATE PROTECTIVE GEARS

These help to protect the body from infected body fluids of the patient.

Examples include ;

-Gloves protect the hands.

-Goggles to protect the eyes against solashes.

-Apron protects clothes from contamination.

-Face masks.

Face shields and gumboots.

DIFINITION OF TERMS

Disinfection; is the destruction of harmful micro organisms from anon living object except
bacterial spores

Aseptic; characterized by the absence of pathogenic microbes

Sanitization; the reduction of microorganisms to levels considered safe by the public health
standards

Decontamination; the process of making used instruments safer for handling before cleaning

Cleaning; the process that removes foreign materials and organic matter. this is done using water
and soap

Pasteurization; process used to eliminate pathogens from food using heat. such as milk

Aseptic techniques; are measures used to prevent contamination of surgical instruments, medical
personel and petients during procedures

Bacteriostatic agent; are agents that inhibit the growth of bacteria but do not kill them

Bactericidal;

IMMUNITY

This is the way a body protects itself against harmful foreign bodies which can invade it. These
protective measures are divided into 2 categories.

 Non specific defence mechanism  Specific defence mechanism

NON SPECIFIC DEFENCE MECHANISM

This is the first line protection and prevents entry or minimize further passage of micro
organisms into the body. It includes the following:  Defence at body surface  Phagocytosis 
Natural anti microbial substances  Inflammatory response  Immunological surveillance

1. .Defense at body surface

Skin: If intact and healthy it is an efficient physical barrier to prevent entry of micro
organisms.

Mucus This is secreted by mucus membranes and creates a sticky surface which can trap
foreign bodies.
 Sebum and sweat This is secreted on the skin surface and it contain an antibacterial
substance.

Hairs in the nose These act as a filter and the sweeping movement of the cilia moves inhaled
foreign bodies towards the throat then it is swallowed or coughed up.

Urine Since it is acidic it prevents multiplication of micro organisms. Its one way flow also
helps to wash out any micro 0rganisms.

2. Phagocytosis

This is known as cell eating. Macrophages and neutrophils migrate to the site of inflammation
and infection (chemostasis).Neutrophils release chemicals that attract the micro organisms,
phagocytes engulf the micro organisms using their body mass or extending long pseudopodia
towards them. These cells are non selective and engulf any foreign cells r particles. After
engulfing they act as antigens presenting cells to stimulate lymphocytes.

3. Natural anti microbial substances

Hydrochloric acid Mostly in gastric juices kill ingested microorganisms.

Lysozyme A protein with antibacterial properties found in tears, sweat, urine, cerebrospinal
fluid.

Antibodies Present in nasal secretions and saliva

Saliva Secreted in the mouth and washes away food debris that may attract microbes. It is
slightly acidic.

Interferon Produced by the T lymphocytes. It prevents replication of viruses within infected cells
and spread to new cells.

Complement A system of about 20 proteins found in blood and tissues. It is activated by immune
complex (antigen and antibody bound together) and foreign sugars on bacterial cell walls. It acts
in the following ways:  Binds and damages bacteria walls thus destroying the microbe  Binds
bacteria cell wall stimulating Phagocytosis  Attracts Phagocytosis cells into area of infection

4. Inflammatory response

This is the physiological response to tissue damage. It mostly occurs when microbes have
overcome other non specific defence mechanisms. It protects in the following ways:  It
isolates, activates, and removes both causative organism and damaged tissue to allow healing to
take place.

5. Immunological surveillance
Lymphocytes known as natural killer cells constantly patrol the body searching for abnormal
cells. These may be malignant, infected with virus, have abnormal markers on their cell
membranes. Any abnormal cell recognized is killed.

SPECIFIC DEFENCE MECHANISM

There are cells responsible for immunity known as lymphocytes which are manufactured in the
bone marrow. After release into the blood stream they are processed to form 2 types: a. T
lymphocytes b. B lymphocytes

T lymphocytes These are processed by the thymus gland. They are programmed to recognize
only one type of antigen. They provide cell mediated immunity.

B lymphocytes These are processed by the bone marrow. They are responsible for producing
antibodies (immunoglobulins) these are designed to bind and destroy antigens. Each B
lymphocyte has a specific antigen it reacts to. They provide humoral (antibody) mediates
immunity.

CELL MEDIATED IMMUNITY T lymphocytes are released into the blood after being activated
by the thymus. When they meet an antigen for the first time they become sensitized to it. Four
main types of lymphocytes are produced and each is directed towards the original antigen but
deals with it in different ways.

 Memory cells These are long lived cells which survive after the threat has been neutralized.
They provide cell mediated immunity by responding rapidly to another attack of the same
antigen.

 Cytotoxic cells These directly inactivate any cells carrying the antigen. They attach
themselves to the target cell and release powerful toxins. They destroy abnormal body cells e.g.
infected or cancer cells.

 Helper cells These correct function of both cell mediated and antibody mediated immunity.
They are c0mmonly destroyed in HIV infection and when their number is too low the immune
system is suppressed. Their major functions are a. Produce special; chemical called cytokines
e.g. interferons which support and promote Cytotoxic T lymphocytes and macrophages. b. Co
operating with B lymphocytes to provide antibodies.

 Suppressor cells These are known as brakes. They turn off activated T and B lymphocytes
thus limiting the damaging effects of the immune response.

ANTIBODY MEDIATED (HUMORAL) IMMUNITY

B Lymphocytes are fixed on lymphoid tissue e.g. spleen and lymph nodes, they do not circulate
freely. The B lymphocytes can recognize and bind antigens. Once the antigen is recognized it is
bound with the help of helper T lymphocytes. The B lymphocytes enlarge and divide. It produces
2 types of cells:  Plasma cells  Memory B cells

PLASMA CELLS These secrete antibodies (immunoglobulins) into blood. The antibodies are
carried in blood but the B lymphocytes remain fixed in the lymphoid tissue. Plasma cells produce
one type of antibody which targets a specific antigen. Antibodies have the following functions:
 Bind antigens; label them as targets for other cells to attack.  Bind to bacterial toxins
neutralizing them  Activate the complement

MEMORY B CELLS These remain in the body long after initial episode and respond rapidly in
case of another attack by the same antigen by stimulating production of antibody secreting
plasma cells. There is a balance in this system to prevent a body reacting to its own cells. If this
balance is changed auto immune diseases occur.

Types of antibodies

IgA Found in body secretions e.g. breast milk saliva. These antibodies prevent antigens crossing
epithelial membranes and invading deeper tissues.

IgD Made by B cells and displayed on their surfaces. Antigens bind here to activate B cells.

IgE Found on cell membranes e.g. basophils and mast cells. If it binds with an antigen it
activates the inflammatory response. In allergy it is excessive.

IgG This is the largest and most common antibody type. It attacks many different pathogens. It
crosses the placenta and protects the fetus.

IgM Produced in large quantities in primary response and is a potent activator of complement.

ACQUIRED IMMUNITY

When antigens e.g. microbes are encountered for the first time a primary response occurs. Low
levels of antibodies are formed after 2 weeks. The response may be enough to fight the antigen
but after sometime the antibody levels reduce unless there is a second encounter within 2 – 4
weeks. The second encounter (secondary response) results into rapid response by memory B
cells resulting in increase in antibody production. This increases until the maximum level is
achieved. Immunity can be acquired naturally or artificially. Active immunity means the person
responds to the antigen by producing his own antibodies. It commonly leads to long lasting
immunity. Passive immunity means an individual is given antibodies produced by some one else.
These antibodies gradually break down so passive immunity is usually short lived.
ACTIVE NATURAL ACQUIRED IMMUNITY This can be stimwulated by a person suffering
from the disease or getting a sub clinical infection not causing signs and symptoms but strong
enough to cause formation of antibodies e.g. suffering from measles results into life long
immunity.

PASSIVE ARTIFICIAL ACQUIRED IMMUNITY This is acquired by the baby while still in
utero. Maternal antibodies cross the placenta barrier into the baby. These give immunity for a
short time.

PASSIVE ARTFICIALLY ACQUIRED IMMUNITY Ready made antibodies are given e.g. Anti
tetanus serum, Antivenom, Antirabies. Since they are ready made they can be given to a person
exposed to prevent development of disease (prophylaxis) or after disease has developed to
prevent worsening (therapeutic)

ABNORMAL IMMUNE FUNCTION

HYPERSENSITIVITY (ALLERGY) This is a powerful immune response to an antigen which is

usually harmless to other people e.g. perfume. The body is harmed by the response but not the
allergen. When a hypersensitive person is exposed to the allergen he is sensitized and the body
forms a response which is beyond normal. Some symptoms are mild e.g. running nose and eyes
or may be fatal e.g. anaphylactic shock. There are 4 types of hypersensitivity classified according
to the part of immune system involved.

TYPE 1: ANAPHYLACTIC It occurs in a person who inherited very high levels of IgE. When
exposed the antibodies activate basophils and mast cells which release histamines. This
constricts the airway smooth muscles cause vasodilatatio0n and increase vascular permeability.
Fluids move into the tissues, there is broncho constriction and shock due to vaso dilation. It can
lead to death e.g. anaphylaxis due to drugs. Onset is immediate

TYPE 11: CYTOTOXIC The antibody reaction with an antigen on a cell surface marks it for
destruction by Phagocytosis or lytic enzymes. This is useful in elimination of bacteria but
antibodies may be directed to body tissues (auto immunity).This mechanism causes conditions
e.g. haemoltytic disease of newborn and blood transfusion reactions. Onset is immediate

TYPE 111: IMMUNE COMPLEX MEDIATED Antibody- antigen complexes are cleared by
Phagocytosis. If they are not cleared or are excessive they can be deposited in kidney, skin, joints
and the eye thus causing g inflammation e.g.glomerulonephritis. Sensitivity to some drugs is type
3 where the immune complexes are deposited in tissues causing rashes, joint pains and
haematuria. On set is 4 – 8 hours.

TYPE 1V: DELAYED TYPE This does not involve antibodies. It is over reaction of T
lymphocytes to an antigen. If an antigen is recognized by memory T lymphocytes large numbers
of Cytotoxic T lymphocytes are produced to eliminate the antigen. If the T lymphocyte system is
not controlled normal tissues are damaged e.g. graft rejection (it becomes necrotic and sloughs
off).Onset 24 – 48 hours.

AUTO IMMUNE DISEASES Normally immune response is towards foreign antigens but
sometimes the body fails to recognize its own tissues and attacks itself. This is an exaggerated
type 3 hypersensitivity. The following conditions occur due to auto immunity.

RHEUMATOID ARTHIRITIS Body produces antibodies against synovial membranes. The

antibody (Rheumatoid factor) can be detected in blood. It binds to synovial membrane and
causes chronic inflammation of joints which are stiff, painful and swollen.

HASHIMOTO’S DISEASE The body makes antibodies against thyroglobulin leading to

destruction of thyroid hormone and low secretion by the thyroid gland.

GRAVE’S DISEASE Body makes antibodies to thyroid cells. The antibodies stimulate the gland
to produce high level of hormones and thus hyperthyroidism.

AUTO IMMUNE HAEMOLYTIC ANAEMIA The individual makes antibodies towards their
own red blood cells and thus haemolysis

MYASTHENIA GRAVIS Origin is unknown but it’s more common in women between 20 and
40 years. Antibodies are produced and block acetylcholine receptors in neuromuscular junction.
Nerve impulses to muscles are blocked. This results into progressive and extensive muscle
weakness although the muscles are normal. Eyelid muscles are affected first (Ptosis or drooping
eyelids), diplopia (double vision).These are followed by muscles of the neck (Difficulty in
chewing, swallowing, speech) Later limbs are involved. There are periods of improvement;
relapses are precipitated by strenuous exercises, infections and pregnancy.

IMMUNITY

INNATE
(Born with)

NON SPECIFIC SPECIFIC

1. Defence at surface Cell mediated

Antibody mediated 2. Phagocytosis a. memory T cells
(Humoral) 3. Natural antimicrobial b.Cytotoxic T cells a.
Plasma cells Substances c. Helper T cells
b. memory B cells 4. Inflammatory process d. Suppressor T cells 5.
Immunological Surveillance
 ACQUIRED

1. ARTIFICIAL 2. NATURAL
Active Passive Active Passive