تلخيص ميكرو بيولوجي microbiology

موضوع: تلخيص ميكرو بيولوجي microbiology 23.12.07 17:50

Microbiology
Dr.Mohammed Battikhi
Department of Medical Lab.
Sciences
The history and Scope of Microbiology
Microbiology is studying
of small organism can not be seen by human naked eye
-I.e.< 1 mm in
diameter i.e. the study of microorganisms
-Viruses, some fungi, protozoa,
algae fit within this definition
-Roger Stainer, suggested definition not in
term of size, but in technique of isolation and culturing
The discovery of
Microorganisms
-Before microorganisms were seen, their existence and
responsibility for disease was suspected
*****-Francesco Stelluti was the
earliest microscopic observation
-Antony leeuwvenhock was first to observe
and describe microorganism by using simple magnifying lens 50-300 power,
describe bacteria and protozoa
The spontaneous generation
-Living from
non Living matter
-Francesco Radi Meat experiment, 3 petri dish first
uncovered, 2nd covered with paper (exclude flies, 3rd with gauze (flies laid
eggs on gauze-Other experiment-sterilized medium
-Allowed hot air to enter
tube to flask
-Until pasture: He filtered air on cotton (Find all object
caught on cotton

-Tyndell proved if dust kept away no growth
-All
proved of air contamination-
Recognition of Microbial Role in disease

*****-Pasture proved relation between Silk warm diseases due to protozoan
laid eggs
Josef Lister surgeon use sterile instrument and clean the wound,
wound healed faster
*****-However first direct correlation between
microorganisms and diseases was by Koch
-He injected healthy mice with
material from diseased animal; mice die due to Bacillus anthrax
Koch
postulates.
*****
Microorganism must present in every case of disease and
absent in Health
2-Suspected microorganism must be isolated and grown in
pure culture
3-Disease result if isolated microorganism injected in healthy
host
Same microorganism must be isolated again4- from diseased host

Therefore Koch studies lead to isolation which mean growing first.

-Media then required, the used potatoes, but not all microorganism
grown
-Gelatin was added as solidifying media, separated colonies
appear
-However microorganism hydrolyzed gelatin and gelatin liquefied at
370C
-Agar was used because agar not hydrolyzed by microorganism and
solidified at 45 0C
-Another assistant called petri, develop Petri dish
(Plate)

-Koch used this technique he isolated TB
-Charles Chamberland
Used porcelain filter,discovered Tobacco mosaic virus
-Animal Resistance was
then developed
-Pasture working on chicken cholera found old microorganism
(Attenuated)
-Attenuated microorganism injected in healthy animal no deseed
formed
-Animal developed resistance to microorganism lead to vaccination
(later rabies anthrax diphtheria
-Pasture institute found that immunity
developed from soluble substance in the body (antibodies humoral immunity) and
blood cells (cellular immunity.
-Discovery of microbial effect on organic
and inorganic matters
-Changes in sugar to alcohol knows as alcoholic
fermentation (was believed to chemical instability
-Pasture explained
fermentation and lactic acid fermentation

-The Birth of Modern
Chemotherapy (Dream of Magic Bullet), discovery of one drug
-Treatment of
disease by chemical susb. Called chemotherapy
Substance produce in lab.
Called synthetic drug
-Natural substance called antibiotic
-Paul Ehrlic
1910 chemotherapeutic agent Salvrsan arsenic sub. Against syphilis
--The
first antibiotic discovered by Alexander Fleming by contaminated plate by
Penicillium notatum lead to discovery of penicillin
Problems of antibiotic

-Side effect
-Kill normal flora
-Mutation
*****Modern development
in Microbiology
-Immunity
-Virology
-Recombinant DNA technologies

Naming and classification of Microorganism
-Binomial
nomenclature
-Two Names genus and species, first capitalized and both
underlined
Microbes and human welfare
-Food spoilage
-Recycles vital
elements
-Sewage treatment
-Clean toxic dumps
Insecticides

Ch 2
Structure and function, multiplication of Microorganism
-Human infection
caused by microorganism
-Bacteria include a-Mycoplasma, rekettsia and
chlamydiaa
-Virus (Small pieces of DNA called prion
-Fungi and protozoa

-Helminthes

*****
-Eukaryotes and prokaryote difference
(compartmental organization_
Bacteria:0. 3-14 um length
-Vary in substance
utilization therefore location different
-Some bacteria required animal or
insect to live on (Vector)
-Different kind of bacteria lead to medical,
industrial, soil, food
Classification according to
Morphology
1-cocci,
chain, single clumps, diplococci
2-Bacilli (rod) thread like
3-Spiral:
a-spirilla long, rigid S.minus cause rat bite fever in tropic b-spirochetes
longer, flexible Borrella, Treponema leptospira
II-Nutritional
requirement
Different substance: All req. food Vit aa, all req. Co2 all need
Po4
Q2 requirement
a-Strict aerobe surface of wound
-Facultative
anaerobe grows with or without O2 (Majority of Medical imp.
Microorganism
c-Strict anaerobe killed by O2 clostridium tetani
,C.perifrengens deep wound stab
Staining
*****a-Gram stain a-gram
positive gram negative
b-Cid fast stain for TB
c-Special stain for
flagella, spores and capsules
Structural difference between gram +ve and
–ve
-Gram positive: chain of carbohydrate (peptidoglycan) crossed liked by
amino acids and layer of teichoic acid sugar phosphate complex
-Gram
negative: thin layer of peptodoglycan +outer membrane structure lip
polysaccharides (LPS) (endotoxin cause shock in patients
Cell wall

Shape, defense action of antibiotics
Multiplication
Binary fission
every 20-30 min
Bacterial genetics
-DNA contains single chromosome
%
extracelluler chromosome (plasmid) can replicate with or independently of
host
Important of plasmid add genetic information: Drug resistance
Genetic
recombination
A-Transformation fragment of naked DNA
absorbed
B-Transduction mediated by virus
C-Conjugation mediated by
plasmid
-Virus
--So small electron microscope
-Either DNA Or
RNA
-Inside host

Structure
*****-Core of N.A, surround by protein
coat (capsid) composed of capsomer
-Some have envelop Influenza if no
envelope
-Some have spikes for
attachment
Capsid
-Protection
Attachment-
-Ag material (serotype)

Function and replication

*****-Recognition
-Attachment
-Penetration
-Replication
-New
virus protein by taking over machinery of host cells
-Release out of cells by
budding-
Effect of virus
-Cytopathic effect (CEP) infection kill cells
adenovirus
-Latency no obvious effect remain potentially infection
(Zoster)
-Transformation: Normal cells to cancer cells malignant: Epstein
Barr virus
Richetsiae:
-Like bacteria DNA and RNA, like virus:
parasites
Killed by antibiotics, > virus transmitted by flees and
tick
Chlamydia Pneumonia , trachoma
-Mycoplasma =larger virus Box virus ,
no cell wall
Eukaryote smallest single cell animal
-Have
compartment
-Move by pseudopodes
Protozoa :
-Fungi
-Eukaryote: 4
groups
1-Yeast: round (budding) [img]images/smilies/SugarwareZ-034.gif[/img]ptococcus neoformus
2-Yeast
like fungi: like yeast budding, some filament. Candida albicans
3-Dimorphic
fungi yeast in body, mycelial in environment Histoplasma
4-Filamentous grow
hyphae (Mycelium sexual spores Aspergillums
Fungal disease called
Mycosis
-Effecting skin ringe worm (superficial
-Whole system Histoplasma

Ch 3 The infection process
Route by which infecting organism enter and
leave body
Factors of infection
1-pathogenic organism
2-susceptiblr
host
3-means of transmission
Pathogenic Microorganism
-Cause disease
depends on their
a-virulence, which depends on structure
b-invasiveness
c-ability to produce toxin
-Therefore low no of organism with high virulence
needed to cause disease
--High no of less virulence organism
needed
-Virulence: how effective is organism at causing
dieses
-Invasiveness: the ability to enter and multiply in
host
-Colonization and invasiveness depends on structure of organism and
susceptible host

-To do so
1-some have capsule (resist phagocytes) S,
pneumoniea
2-Adhesivness (pili structure /and or plasmid
3-Toxin
production
a-Exotoxin potent enzymes) diphtheria, botulism, tetani, food
poisoning
b-Endotoxin (intracellular)Lip polysaccharide (LPS) cause fever
shock and death
A-Human B-Environment C-Animal and birds
A-Human

Covered with I Kg of normal flora which vary from one to another depends
on
a-age
b-health c-tem. And condition as acidity: change condition
change N.flora e.g. H.inluenza in upper respiratory tract goes to lower resp.
tract during viral infection cause disease. E.coli from gut to urinary tract
cause UTI
*****-Therefore N.flora can be pathogenic and Hospital patient more
susceptible to infection with less virulence organism
-Any individual is
source of infection
-Cross infection
a-Exogenouse Nurse contaminating
catheter with her hand
b-Endogenous contamination patients by [img]images/smilies/SugarwareZ-011.gif[/img]el flora

Carrier and infected individual
1-Incubating
infection short prodromal phase non-specific symptoms e.g hepatitis
2-Acute
or chronic infection Infecting micro. Present and transmissible in large amount
(urine and stool) influenza, measles spread rapidly before
diagnosed.
3-Convalescent carrier food handler, typhoid
fever
4-Asymtomatic carriage streptococcal and meningitis transfer to
susceptible host in hospital

B-The inanimate environment.

*****-Normal condition environment does not cause infection, unless break
barrier
e.g. break skin, by catheter
C -Other animal and birds
Animal
to man zoonoses, e.g., brucella.TB . Listeria Salmonella, Anthrax

II
Susceptible Host
-e.g. not immune nurse in pediatric ward, transfer chicken
pox during prodromal phase because incubation period 2-3 weeks
-Factors
affecting susceptibility
Extreme of age (neonate, elderly)1-
2-Druge
treatment, radiotherapy, suppress immunity
3-Underlying disease
(diabetes)
Hospital acquired (nosocomial) infection
--From patient,
staff, equipments
-Nurse has to take care
Community
infection
-Bacterial infection is less like to cause outbreak
-Viral
infection Mumps is easier
Therefore Hospital and community large population.
Health care worker must understand process of
infection

-Route of entry
1- respirotory-tract inhalation
common cold, TB, diphtheria, Mumps
2-alimentary tract: Ingestion HAV,
Amoeba
3-Skin and mucus membrane Inoculation of skin, clostridium.
S.aureus
4-Transpla-placentary, cytmgalovirus. Listeria
monocytogens

Routes/Means of transmission
1-Contact Most important in
nosocomial infection
a-direct staff hand, surgery, sexual
b-indirect
fomits
2-Airborne inhalation of
a-droplets by kissing sneezing
coughing
b-Droplet nuclei in air waiting to be held
3-common vehicle
contaminated food water (salmonella, cholera)
4-vectors-born (via arthropod
e.g., ticks mosquitoes, malaria
5-Blood borne inoculation injury sexual.
HBV, HIV
***** Note more than one route of entry may involve Nurse should
understand route of entry
Case study
Malaria patients no need to isolate
but care must be taken in blood transfusion
-Foolish nurse allow chicken pox
child to nursed in ward with immunosuppressed children
-Chicken pox spread by
air borne, by direct contact with lesion, indirect with limb and
tissue
-Patient should be nursed with immune nurse in isolated room.
Ch 4
Immunity
-Term immunity in relation to infection like exemption from
army
-Small Box. Exempt from further immune attack lead to Specific immune
response
Non-specific defense
I-prevention of invasion. Prevent
microorganism entry by

a-Skin. Impact, Impermeable. anti bacterial
secretion (sebaceous gland and hair follicle get infected
b-Mucus surface
trap bacteria, until removed by nose mouth vagina (smell)
c-Secretion Act in
two ways
1-Mechanial tears and secretion in alveoli by cilia
action
2-chemical action: acidic secretion, sweat, adult vaginal, gastric,
alkali bile/ or active antibacterial sub. (Lysozyme in
tears)

*****
d-Mechanical arrangement of structure
a-turbinate
bone in nose (air hit, bacteria stick) speed of air reduce
b-Mucus moved out
by cilia to pharynx to stomach, bacteria
c-auditory tube in ear arranges in
away to reduce air speed and killed by acid
II-General Influence: differ
from person to person
A-General health
B-State of nutrition

C-Metabolic activity
D-hormonal influence
E-genetic
factors

III-Non-specific defense mechanism following invasion

a-Inflammation caused by organism after entry
Sign of
inflammation
a-heat b-redness c-swelling d-pain e-phagocytosis

Phagocytosis, capillary dilate, out pour fluid (WBCs, RBCs) into tissue,
invade organism phagocyte and lyses by enzymes

Immunity
Immunity
-Term immunity in relation to infection like exemption
from army
-Small Box. Exempt from further immune attack lead to Specific
immune response
Non-specific defense
I-prevention of invasion. Prevent
microorganism entry by
a-Skin. Impact, Impermeable. anti bacterial secretion
(sebaceous gland and hair follicle get infected
b-Mucus surface trap
bacteria, until removed by nose mouth vagina (smell)

-Secretion Act in
two ways
1-Mechanial tears and secretion in alveoli by cilia
action
2-chemical action: acidic secretion, sweat, adult vaginal, gastric,
alkali bile/ or active antibacterial sub. (Lysozyme in tears)
d-Mechanical
arrangement of structure
a-turbinate bone in nose (air hit, bacteria stick)
speed of air reduce
b-Mucus moved out by cilia to pharynx to stomach,
bacteria
c-auditory tube in ear arranges in away to reduce air speed and
killed by acid

II-General Influence: differ from person to
person
A-General health B-State of nutrition C-Metabolic activity D-hormonal
influence E-genetic factors
*****
III-Non-specific defense mechanism
following invasion
a-Inflammation caused by organism after entry
Sign of
inflammation
a-heat b-redness c-swelling d-pain e-phagocytosis

*****
Phagocytosis, capillary dilate, out pour fluid (WBCs, RBCs) into
tissue, invade organism phagocyte and lyses by enzymes
Two types of
WBCs

1-Plymorphonuclear leucocytes (Neutrophiles) circulate in blood for
few hours, attract to site of infection by chemical release by organism lead to
inflammation
2-Mononuclear phagocytes
-Pass to blood as monocytes to
tissue as macrophage (wonder and free),
a-last longer than
neutrophiles
b-Poses Antigen
c-secrete interlukin 2 which activate T and
B-lymphocytes
f-Interferon

-E.g., virus infection
Three human
types of interferon
1-alpha from leukocyte (IFNa)
2-Beta from fibroblast (
IFNB)
3-gamma from antigenically stimulated lymph (IFN gamma)
-Interferon
used to treat chronic hepatitis, immune compromised
patients

IV-Complement System (C)
*****
-Consist of number of
enzymes and cofactors called enzyme cascade
-Worked in orderly way to
destruct organism
*****
Activation of compliments system
1-by
alternative pathway (by contact with surface or microorganism)
-Classical
pathway. Involve Abs. (later)
-Both lead via enzyme cascade to active the
most important complement (C3).

Ant microbial effects of complement
system Fig 4.2,4.3
-Complement leak out from blood due to inflammation and
infection
-Once this happened lead to
1-organism coated with derivative of
C, which adhere to phagocyte cell receptor for C3, which enhance
engulfing.
-Therefore absent of C3 (congenital) cause death
2-Other
component modified enzymetically due to chemotaxin which attract more phagocytic
cells to site of infection
3-Other groups of C can lyses cell membrane lytic
pathway) e.g. RBC lyses by wrong transfusion
Destruction of engulf
organism
(Engulfed organism by WBCs or macrophage trapped organism in vacuole
(Phagosomes) hysosome contain digestion enzyme (lytic path)
-If organism kill
phagocytes pus formed (bacteria, WBCs and debris)

The specific immune
response
-Lymphocyte mount in lymphoid system to help non-specific
mechanism
Induction of immune response
-Stage I :Organism foreign to body
lead to form Ag pass free/or in macrophage to lymph node
Stage 11:Organis
recognized and coat by receptor by lymph in node
-Lead to more proliferation
of WBCs, which will recognize Ag in question
-Lymph leaves lymph. Node via
lymphatic system to site of infects. Via blood stream
Humeral
immunity
-Mechanism of action of specific immune response by lymphocytes and
Abs production
Tow kinds of lymphocytes
-
1-T cells also from bone
marrow but thymus dependent require thymus gland for development
*****
2-B
cells from bone marrow. Basic of a-humeral immunity 2-precursor of Abs producing
cell (plasma cells), which give Abs present in serum in high
number

Abs
Several classes of with different proportion known as
immunoglobulin
Abs is protein produce in response to infection
-Y shape

-Two Fab fragments combine specific Ag (specificity)
-One Fc fragment has
complement attachment site
-Each Abs bind > Ag induces proliferation of
Lymphocyte from lymph node
-Other B cell develop into memory cells their
function to
-Respond quickly to any further invasion by same
Ag.
-Therefore they spread through lymphatic system to be (on
guard)
-Because their production take weeks but last for life
Types of
Abs

IgG:
1-Most abundant in serum with two binding site
2-cross
placenta, 3-appear 1-2 weeks after infection 4-last long time
IgM 1-> IgG
2-has 10 binding site 3-first appear one week 4-lase 4-6 weeks 5-secreat in gut,
saliva, bronchi and tears 6-bloock adherence of organism to mucus
surface
IgE: Hay fever and worm infection, attach to mast cells target to
release histamine
IgD Uncertain and no Abs function
IgA- secrets in
gut

How Abs protect the host fig 4,6
1-Nutrilizing Toxin
(diphtheria)
2-cover viruses stop bind virus to cell
3-agglutination since
Abs bind > Ag form clump
4-Activate compliment to bind Ag
5-Receptor
for C3 and FC receptor site
6-IgA secrets in gut specific barrier tears, IgG
milk

T lymphocytes
*****thymus dependent absent congenital low
resistance
-Defense against infection
Two ways T cells protect Host fig
4.7
1-Regognise Abs release lymphokinase IFN gamma that activate macrophage
in more than one-way
-The most import. Is to increase destroying ability of
organism
2-T cell and activated macrophage kill organism
Proliferation of
T cell into 2 types
1-Helper T cell
-Activate and encourage B cell
proliferation, which lead to Abs production (humeral)
-React to Abs on CD4
cell surface Ag
-65% of total cells
Proliferation of T cell into 2 types

1-Helper T cell
-Activate and encourage B cell proliferation, which lead
to Abs production (humeral)
-React to Abs on CD4 cell surface Ag
-65% of
total cells
2-Suppresser T cells
-Encounter helper cells to destroy
tissue 35% of total cells
-React to Abs to CD8 Ag
Imbalance in immune
system
Between Helper and suppressor T cells
Use as marker in Aids
patients
Skin test TB test

-Quantity of Ag too small to cause
non-specific inflammation
-Therefore introduce into skin
-Individual
develop cell-mediated immune response to Ag, T lymph. And Macrophage accumulate
at site of infection cause inflammation swilling 48-72 h called delayed
hypersensitivity
-Hypersensitivity test suggest previous infect. Or
immunization
Immunogenetic
-In graft rejection on chromos responsible know
as major histocomplatibility (MHC)
-Interleukin
-10 known important in
function of lymph.
1-Interlukin derived from macrophage increase T cell cause
fever
2-Interlukin 2 from T lymphocyte increase T cell lines in
tissue
3-Interlukin 3 from T cells help destruction of some
WBCs
Monoclonal Abs
-Fused Abs producing cell +tumor cell (hybridoma)
increase Abs
-Vaccine and immunization
-Mortality and congenital
abnormality stop
Passive immunity to give serum contain Abs against disease

1-given therapeutically patient have disease and con not produce
Abs
(Diphtheria antitoxin, anti-tetanus
II-Protectively to person at high
risk
a-human normal immunoglobuline (HNIG) pooled human plasma
b-specific
immunoglobulin. Pooled convalescent sera (HBV, zoster)
III-Transplacentaly
fetus from mother, few month measles 12-18 month
Active immunity induced
by
1-Suffering from disease
2-Inoculation of organism/or toxin
Vaccine
and antitoxin produce in
1-Killing organism e.g. typhoid
2-Attenuated
organism BCG poliomyelitis
3-Modified exotoxin Diphtheria
Length of
protection
*****
-Varies streptococcal Abs decrease quickly and further
attack possible
-Measles Abs decrease but immune response remain no more
attack
-Cold is different due to Ag variation influenza
Immunization
schedules
Pertusis, tetanus, influenza measles poliomyelitis differ and
urgent

Chemotherapy
Chemotherapy

-Infection and transmissible disease know
for 2000 years
-Treatment 1904 Ehrilich treated trypanosomiasis by trypan red
last for 25 y
-Modern era 1935 Domagk used prontosil against B.hemolytic
streptococci
-Other groups as sulphonamide (bacterostatic) were used
-1940
Wood and fields explain bacteriostatic and bactericidal
hypothesis
-Combination of two drugs (Synergistic)
-Natural produce
antibacterial called antibiotic

-1928 Alexander Fleming penicillin
notatum inhibit streptococci
-1940 Florey and Chain purified penicillin by II
world war
-Resistance to penicillin was noted, which required look for other
drug
-Streptomycin from soil streptomyces venezuelae
-1948 Tetracycline
followed, erythromycin, cephalosporine, quinolone
-Toxicity and resistance
appeared, more study was needed.

Mechanism of action
-4 main
mechanism
1-Inhibit cell-wall synthesis
2-Alternation of cell
membrane
3-inhibit N.acid synthesis
4-Inhibit protein synthes
Main
groups of antimicrobial agents
*****Penicillin for gram-positive cocci and
bacilli, spirochetes
Resistance for 3 reasons
1-B-lctamaze enzyme
inactivate penicillin
2-Alter binding site of penicillin
3-Impermeability
by outer membrane structure of gram negative bacteria
To avoid resistance

-Modification of b-lactum ring to other drug
1-Acid stable compound
tetracycline
2-Penicilline resistances to sensitive
3-New broad-spectrum
compound against gram-negative rods. Ampicilline amoxyciline.
Augmentin
4-copmpound active against pseudomonas aeruginosa (mezlocilline,
pipracilline, carbinicilline mainly intravenous injection

Cephalosporine

-Similar to penicillin in chemical structure and spectrum of
activity
-Part of molecule can be modified give diff comp. With diff
action
Cephalothin was the IST cephalosporin 1960
-2nd generation against
penicillinase-producig gonococcal R table 5.1
-3rd generation more active
against gram negative bacteria
-In leukemia ceftazidime used but resistance
blood isolates appear
-Imipenem wide spectrum appea

Cholramphinicole
-Originally from streptomyces-now is synthetically
prepared
-Toxicity rare 1/40000-fetal aplastic anemia
-Cheep and most
popular, lead to coliform and typhoid resistance
isolate
*****
Quinolones
-Synthetically from nalidexic acid,
ciprofloxacine, ofloxacine
-For UTI
*****
Broad-spectrum
antibiotics
-Chloramphinicole, tetracycline wide action inhibit Normal flora
in gut
-Over growth of candida. Oral, vulval [img]images/smilies/SugarwareZ-069.gif[/img]tation

Metronidazole
-Antiparasitic-trichomonas and anaerobic infection
Bacteriods spp., prophylatically, [img]images/smilies/SugarwareZ-011.gif[/img]l and vaginal
surgery
*****
Ant fungal agents
-Antibacterial produced by fungi
therefore antibiotic no good against fungi
-Table 5,1

Antiviral
agents

-Virus intracellular parasite, damage requires. Slow
replication
-Therefore drug should follow viral replication
-Interferon
family of natural protein
Idoxuridine against herpes virus
-Amantadine
against influenza virus A
-Acyclovir

Problems is to treat before
damage to cell occur

*****
Resistance to antibiotics
I-Natural
resistance irrespective to antibiotics
a-production of drug destroying
enzyme
b-resistant of c. membrane of gram negative)
c-Bacteria lack target
site for drug
II Acquired resistance misused if antibiotic
a-chromosomal
resistance mutation
b-Plasmid mediated resistance R cofactor

Example
of resistance

-Penicillin destroying penicillin b-lactum ring-Adaptation
of gonococcal to penicillin
-Bacterial develop new metabolic process-by pass
target site
*****
Significant of urgent bacterial
resistance
Mecithilline resistance S.aureus acquired RE in
hospital
*****
*****
*****
*****

Infection control nurse
(ICN) is a
-Registered general nurse with experience allow her to act as a
source of information and advise in all infections matter
-The duties of ICN
are those of the IC team (except those unique to IC). They are
1-Surveillance
aware of background infection
2-conducting with microbiologist and
epidemiologist survey with specific objective such as
a-evaluating prevention
and control activities
b-identifying groups of people who are at risk of
disease
c-providing information for service planning and resource
allocation
+ Analysis of data and results so appropriate action could be
taken

2-education: lecture control advises even to
visitors
3-Monitoring: corporation with all department to insure IC policies
are usable
4-Research acting as nursing research resources for all health
care workers on all aspects

Infection control and occupational health

*****-Relation ship between IC and occupational health (OH)
-Should be
mutually beneficial
-E.g. ICNs may become aware of staff sickness as they
visit wards and will alert the OH nurse (OHN) to any outbreak of
infection
_OHN play important rule in educating staff in safety and personal
hygiene as part of hospital IC program
-They should be aware of health of all
employees with regards to immunization
to
1-TB
2-poliomyelitis
3-diphtheria
4-tatanus
5-ribella
6-hepatitis
B

Epidemiology
Study of distribution of disease in human population

-Epidemiologist involved in local, national and international organization
share with (microbiologist, sociologist, genetics)
-To prevent transmission
of disease
-Should know when where how and to whom of any disease
World
health Organization
-Is a mass amount of information on incidence of
disease?
-Make regulation to minimize spread of disease
-Acts as
educators trainers and investigators

Public health laboratory services
(PHLS)
-52-network lab. In Uk and Wales
-Work with NHS lab
-Concern
with diagnosis, prevention, and control of human infections
-Provide
resources for out break as food poisoning
*****
The communicable disease
surveillance center (CDSC)
-Attached to PHLS head quarter in London WHO
report data about infections and organism to CDSC
-Staff offers guidelines
to local public health
-E.g. increasing incidence of AIDs

Center
for disease control
-IN USA at Atlanta
-Run by USA federal
government
-Same as CDSC
-Publish weekly information of mortality and
morbidity MMWR)
*****
Education
- Is important because if you have
everything Lab equipment technique) but don’t know how disease
spread????
-Therefore in order education to work it must be
1-aimed at the
right level for group being educated
2-clear, consistent and
concise
3-interesting
4-appropriate
*****

The strategy for
Nursing (1989) highlights a number of important educational targets for
practice
1-Target 25 that all staff delivering health care are appropriately
prepared for practice
2-Target 32 – Individual responsibility for keeping up
to-date
Target 7 –that clinical practice is founded on current information
and research.
ICN education
-To establish the up requirement center must
be establish for trainer to give qualified personnel certificate to
practice
*****
*****
*****
*****

The strategy for Nursing
(1989) highlights a number of important educational targets for
practice
1-Target 25 that all staff delivering health care are appropriately
prepared for practice
2-Target 32 – Individual responsibility for keeping up
to-date
Target 7 –that clinical practice is founded on current information
and research.
ICN education
-To establish the up requirement center must
be establish for trainer to give qualified personnel certificate to
practice
*****
*****
*****
*****

Cleaning disinfections, sterilization

Cleaning disinfections,
sterilization
-Why it is important: To remove organism
Cleaning: removal
of contamination such as dirt
Disinfections: Destruction /reduction in number
of harmful organism (not spores)
Antiseptic: Chemical disinfectant applies to
skin to remove harmful organism without damaging skin
Sterilization:
Removal/destruction of all microorganism including spores

Factors
influence action of Killing agent
1-Susceptibility or organism 2-number or
organism 3-time needed
4-Optimum temp. 5-Concentration of agent 6-Optium
acidity/alkalinity 7-Physical state of contaminated material (coat)
8-direct
contact between object and killing agent (bubble in tube)
9-Nutrilizing subs.
for killing agent 10-impurities in the agent
10-Inactivition of agent with
time
Risk categories
1-High risk (Break skin, mucus membrane, surgical
equipment, cystoscope
2-Intermediate (direct and indirect contact with
skin/endoscopes, respiratory equipment
3-Low risk (equipment material, no
contact) wall, sink, beds).

-Killing at constant rate depend
on
1-Number or organism
2-efficiency and reliability of sterilizing
method
3-Correct application
I-Cleaning Important before applying agent
why
1-reduce number of organism
2-remove organic matter, grease (protect
bacteria)
3-cleaning maintain appearance and efficiency of
structure
*****
Disinfections
-In situation where overall reduction of
microorganism is safe for staff
Method of disinfections

Method of
disinfections

1-Moist heat
-Reliable, inexpensive (bed pan,
anesthetic equipment
a-Hot water kill organism not spores (100 c)
b-Low
tem steam for heat sensitive item cont be autoclaved
c-Pasteurization Milk
removes pathogens two ways
1-63-66 c for 30 min cool quickly < 10 C holder
process
2-72 c for 15 min. rapid cooling < 10 c flesh method

II-
Chemical agent
-Prepared by qualified person
-Select effective agent
dilution and time
Nurse must remember and understand
1-never use chemical
if other method available
2-cleaning prior is important
3-recommended
strength must be known
4-equipment must be rinsed after chemical
use
5-Material inactivate chemical agent must know
6-Antiseptic and
ointment become contaminated.

Halogens
1-Cholrine releasing agent

a-Hypo-chlorides (bleach) bacteria, fungi. 1/10 gives 10.000ppm use for
blood spill (corrosive and bleach fabric)
b-Sodium dichlorosocyanurate
(NaDCC), more active and less corrosive than a
2-Iodine and
iodophores
-Similar to hypo-chlorite more to skin than
environment
3-phenplic Black fluid (Jeys fluid) white fluid (Izol)
-Less
[img]images/smilies/SugarwareZ-069.gif[/img]table
-Active against many microbes (not virus or spores)
-For
bed and fomits specially for methicilline staphylococcus resistant
(MRSA)
-Hexachlorophene chlorinated phenolic mix with soap for
skin
Alcohol
-Effective agent against most microbes (not spores or
virus)
-70% used after organic material
removed

-Diguanides
-chlorhexide active against gram positive,
fungi, gr –ve
-Less [img]images/smilies/SugarwareZ-069.gif[/img]tant and toxic
-Salvan mix
chlorhexidine and certimide for pseudomonas and dirty injuries as car
accident
Aldehyde
-Glutaraldehyde against all microbes but slow
activity
-Useful in heat sensitive high-risk equipment
(endoscopes)
-Sufficient time needed 2% 3h
-Toxic allergic highly [img]images/smilies/SugarwareZ-069.gif[/img]tant (eye skin mucus)
Used in ventilated area
-Fixative therefore
equipment should be cleaned afterward

Formaldehyde
-Too [img]images/smilies/SugarwareZ-069.gif[/img]tant as disinfectant carefully controlled
Responsibility to other
staff
-HBV, HIV should be contaminated and left notice as
well.
*****
III-Sterilization table 6.4
Autoclave 121 c for 15 min134
c for 3 min
Heat
-Organism vary to heat, heat resistant spore
former
-Time tem relation if tem high time is less 121 15 min 134 for 3
min
Moist heat
-Steam under pressure

Autoclave pressure cooker

--3 types
1-hugh pressure pre vacuum autoclave fully
automated
2-Downward displacement autoclave or unwrapped
instrument
3-pressure cookers laboratories
*****
Bench top
sterilizer
-Used in clinic for unwrapped instrument
*****
Dry
heat
-High temp long exposure
-Not good for fabric
-Glass syringes
ophthalmic instrument

Incineration
-Safest sterilization and
disposing
-Lab wire loops Bunsen burner

Hot air oven
-Standard time
ratio 60 min
-Most contain fan and automated door lock
-Low tem. Steam
and formaldehyde
-Kill vegetative organism and most spores on heat sensitive
equip. (Endoscopes)
-Autoclave modified administration steam of fromaline:
temp. Not> 80 c and exposure time 30 min to 2 h

-Disadvantageous

1-smell of gas
2-[img]images/smilies/SugarwareZ-069.gif[/img]tation to eyes and
mucus
-Poor penetration to tube and fabric therefore should be packed in away
to allow penetration
-Ethylene oxide sterilization
-Large hospital and
industry gas used 1t low temp. 37-55 c
-Used for material and
equipment
-Less toxic and explosive
-Need prolonged time and
microbiological control

-Glutaraldehyde sterilizing heat sensitive
item
Irradiation thermo labile (heat sensitive)
-Safe wise if
internationally and commercially organized
-In UK 2.5 M rad to sterilize
medical disposable (needed)
*****
Filtration
Pharmaceutical
flied
Cold

Freezing
-Not satisfactory because surviving rate of
organism differed
Drying
-Many organism killed by drying not spores
UV

-Reduce number of airborne bacteria used in hospital
-Intensity reduce by
time
re-use of disposable equipment
-Equipment should be sterilized before
used again but not all
-Before re-processed we should consider
1-can item
be re-processed
2-is it coast effective
3-risk to patient and
staff

Community disinfections and sterilization
protection
-Cleaning, disinfections, antiseptic and sterilization still not
understood
-More education is needed in this
concept
*****
*****
*****
*****
*****
*****

A guide to
pathogenic bacteria
Main division
1-Cocci gram positive
2-Acid fast
bacilli
3-spirochetes
4-chlamydia and mycoplasma
A-aerobic gram
positive cocci
Staphylococcus.spherical,clust ers grape like
S.aureus
pathogenic,coagulase positive clot rabbit blood plasma
-found on body
anterior narse,hair ..etc

Pathogenicity
-superficial cause
abscesses.wound infection-Deep –ostemylitis.endo carditis septicemia
-Toxin
=toxic shock syndromes (TSST!), diarrhea hypotension food
poisoning
Treatment
fLucloxacin.erythromycin,clind amycin
-Resistance
to penicillin methicilline resistant in hospital
S.epidermis
-Normal skin
flora infection on artificial joint, more resistant then
S.aureus
S.saprophyticus skin normal flora 10%
UTI
*****

Streptococcus (include interococcus and
Pneumococcus)
-Oval in hair (diplococci) S.pneumonia chain
S.pyogenes
-Inhibit mucus membrane.upper respiratory tract
Classification
Lancfield group according to outer membrane
1-beta 2- alpha 3- gamma

Streptococcus (include interococcus and Pneumococcus)
-Oval in hair
(diplococci) S.pneumonia chain S.pyogenes
-Inhibit mucus membrane.upper
respiratory tract
Classification lancfield according to outer
membrane
1-beta 2- alpha 3- gamma
Pathogenicity
B hemolytic most
pathogenic divided according to lancfield to
1-group A (S.pyogenes) out
break, tonsillitis.septicemia
2-group B (S,agalactica 30% in normal vagina
cause meningitis in infant
3-group C (S.pneumonia, alpha hemolytic,bacterima
opportunistic pathogens
*****
B Anaerobic gram
positive
Peptostreptococcus
-Wound and deep abscesses(brain
Aerobic
gram positive)
Bacillus
-Aerobic gram positive chain spore
former,saprophytic on dead mutter
-Pathogenesis and potential
pathogens
B.anthrax
-cause anthrax, spore highly resistant to heat-via
skin cautious anthrax
-inhaled
*****

Corynebacteria gram
positive skin membrane respiratory tract)
-C.diphtheria club shape swell at
one end no spores
-Presence nose skin throat
Pathogenicity
Diphtheria
biochemical test exotoxin marker of virulence
-Guiana pig
-Toxin affect
neurological disease and cardiovascular lesion
-Immunization reduce
mortality, treatment first by penicillin

Listeria monocytogens
Feces
of animal cattle pig rodent,soil,food contaminant
-Infection in man mild
unrecognized) but threat too
1-Neonate unrecognized vaginal infection in
mother still birth meningitis
2-pregnant women bacteremia placenta and
amnionitis
3-Adult immunocopmressor (lymphoma)
-treatment
ampicillin

Anaerobic gram positive bacilli
Clostridium spore
former.saprophytes,strict anaerobes
-Pathogenicity
grow in tissue with
poor blood supply.Therefore remove dead tissue.
-gas s g[img]images/smilies/36_2_10.gif[/img]ene dead tissue
external toxin .C.perfringens
2-food poisoning reheated meat, enterotoxins in
gut,diarrhea 6-8 h outbreak
-treatment surgical excision-C.tetati soil,horse
feces
Pathogenicity deep cut wound toxin to nerve anterior horn cell spinal
cord,muscle spasm lock jaw
-treatment surgical excision,antititanus
mioglobulin

C.botulism
-presence through environment contaminate
food(cold water
-pathogenicity rare food poisoning exotoxin acute
toxemia,paralysis of cranial motor nerve
*****
–Actinomysis
In
soil
-Pathogenic :A Israeli in small number in mouth granulomatous lesion.jaw
cecum opportunistic,after surgery

II-Areobic gram negative division cocci
and bacilli aerobe and anaerobes
- Aerobic gram negative cocci
Neisseria
:kidney shape oval diplococcic
-In mucus membrane upper respiratory
tract
two pathogens die quickly outside body

-Meningitis
.menengococcus
-3 serological groups A,B,C
-3-50% of healthy people
nasopharynx
-Infection organisms- mucus blood stream
meningitis
-Pathogenesis meningitis may occur without septicemia
-Most
cases show bacteremia rapidly meningitis
-10% mortality in acute
meningococcal infection
-Atypical hemorrhagic rash may occur with
septicemia,disease progress rapidly victim die

Treatment prompt
treatment with intravasculer ,intravenous penicillin/chloromph.
Transmission
direct close contact
N,gonorrhoea (gonococcus) not normal flora
-organism
to mucus membrane by sexual course,eye, oral sex
Pathogenicity
:men
1-urithritis dysuria,purulent discharge
2-rectal (homosexual)
pharyngeal gonorrheal.prostatitis,gonococ cal arthritis follow
bacteremia

Women: 1-a symptomatic endocervical infection
,urethral,rectal
2-dysurea, vaginal discharge,pelvic inflammation
,bacteremia,arthritis
-Neonate :ophthalmic 48h after delivery
Treatment
:penicillin single dose ,cefurixime..etc
Prevention :control
contact

Moraxella :commensally of respiratory tract infection chronic
bronchitis sinusitis
-Resistance to penicillin b,lactum therefore
tetracycline used
Anaerobic gram negative cocci
Veillonella commensal of
oropharynx ,colon,female genital cause local sepsis

Anaerobic gram
negative bacteria
Enterobacter
1-aerobic/facultative
anaerobe
2-lactose/non lactose fomenter
3-rod shape
4-some
motile
5-some capsulated
6-Nature and intestine
7-some pathogenic in
gut(Salmonella,Shigella)
*****

Lactose fomenter

Lactose fomenter

-E.coli
-In gut mostly motile some capsulated.
UTI, wound,septicemia gastroenteritis chest inf.
Klebseilla
,Enterobacter,Serratia
-Normal inhabitant of gut,pathogenic UTI wound
respirotory,septicemia
-K.pneumonia large mucoid
capsule
*****
Non-Lactose fermenters

-Normal flora of man
animal
-Proteus metabolism ,UTI, mixed growth, swarming
-Salmonella
intestine source of humans infection
-Pathogenicity S,typhi, paratyphi
enteric fever food poisoning
-isolates,feces,blood,urine,bio chemical
,identification,serological
-Non typhoid salmonella
S,typhimurium,bactericidal and septicemia
-some bone
joint,meningitis,osteomylitis

-Enteric fever S.typhi A.B,C
paratyphoid
-contaminated food,lymph,blood stream,bone marrow,reproduce in
lymphoid tissue of reticuloendothelia system to feaces,urine gall bladder
colonized
-Incubation 10-14 H headache,septicemia rash ,spot in abdomen
,diarrhea
-Paratyphoid infection is milder
II Gastroenteritis food
poisoning S.enteritidis .S.typhimurium,Campylobacter
-Poultry and
eggs
-Biochemical and agglutination test
-incubation period 6-72 H to 12to
36 h

-Shigella

Rod shape non motile,biochemical and
serology
-Intestine of human and animal
Pathogenicity bacillary
dysentery
-Sh.sonnies 90% in UK mild illness
-Sh.dysenteriae (shiga)
virulent enterotoxine
-Sh flexnerri (6 types) severs in tropic
-Sh. bodie
14 types

Anaerobic gram negative bacteria glucose non
fomenters
Pseudomonas .Aeromonas.Xanthomonas,
-Pseudomonas Motile,strict
aerobes,rod,characteristic smell,blue green color(pyomycien) color pus
-Found
water,soil,human animal gut Hospital
-P.aeruginisa Hospital
acquired.equipments
-Acinetibacter Strict aerobic,non motile gram negative
coccobacilli oxidase negative
-Nature,normal human skin,commensally,blood
culture contamination
-Opportunistic in burn

Vibrio and campylobacter

-V,cholera cause cholera.fecal contamination water and food-
-two biotype
classic and el-tour
treatment fluid replacement
-V.parahaemolyticus food
poisoning shellfish contamination
Campylobacter
-Faces in farm
animal,poultry,dogs raw milk
C,jejuni human path.enteritis
C coli:
enteritis
Helicobacter pylori gastroenteritis,peptic ulcer

Pasteurella
:small ovoid bacilli,bipolar stain some time capsulated
-respiratory.tract of
many animal dogs and cats
-Pathogenic.after scratch or bites
-Infected
wound slow to heal
-treatment :penicillin tetracycline
Yesrsinia :short
bipolar,facultative anaerobes
-intestine of animals infection in
thalasemia
-Y enterocolitis gastroenteritis septicemia
Y
pseudotuberculosis abdominal pain rarely diarrhea

Treatment :
streptomycin tetracycline
Francisella tularensis : in rodents to human by
ticks bites
Pathogenicity :N,American,Scandinavian extremely
infectious
Clinical symptoms :skin ulcer to lymphoadenopathy ,pyrexia,headack
and hepatospleenomegaly
Treatment streptomycin
gentamycine

Proionebacterium
:human skin normal flora
path.P.acne
Haemophilus spp:Normal flora upper respiratory tract, lower
infection
-capsulated strain b virulent in children < 5 y conjunctivitis,
pneumonia blood stream CNS meningitis
-treatment chloramphenicol
tetracycline
-require x,v factor on chocolate agar

-Bordetella
:fragile need specific medium
Pathogenic :one of 3 cause whooping cough
B.pertusis
-enter respiratory tract and spread by
droplets
-treatment-erythromycin cough last 3 month

Brucella

-Parasites of animal and man cattle goat swine
Pathogenicity acute. sub
acute,chronic pyrexia of unknown origin (PUO) acute soft tissue
joint
Osteomyelitis .B suis swine B.melitensis sheep goat to human infection
Mediterranean. B abortus cattle abortion
Treatment : long term tetracycline 4
month+ streptomycin
Legionella

-Non spore ,non acid
fast,short,aerobes,coccobacill i,slow grower
presence : in moist environment
air circulator
Pathogenicity one main human pathogen. L.pneumophila cause
atypical pneumonia
Clinical symptoms :influenza like symptoms x ray needed
it
Treatment :erythromycin ad rifampicin one weak
*****

Anaerobic
gram negative bacteria

Bacteriodes non spore,non motile anaerobe
feaces,mouth ,genital tract
Pathogen: B fragilis :post operative
abdominal/gynecological sepsis
-Wound infection
-Treated
:metronizadole
Fusobacteria :anaerobic gram –ve bacteria, commensally of
mouth and female genital tract

Acid fast bacilli
Mycobacterium
cylinder rods wax material acid fast stain
Pathogen.Mycobacterium
tuberculosis (bone joints kidney)
-Direct microscopy but culture is
needed
-Inhalation of air droplets
Treatments: rifampicin 6 month
pyrazinamid 2 month
-combination for quick healing

M.bovis
injection of milk
M.Lepri :leprosy skin scraping biopsy
-Not infectious
require long close contact for transmission
-disease occurs as tuberculoid
leprosy,anesthetic skin lesion lacking pigment
-Lepromatous (infectious)
leprosy Nasal discharge.secondary infection ulceration to nose
face
-treatment rifampicn +dapsone
Atypical mycobacterium M.kansasii
pulmonary infection in miner with damage lung
tissue

Spirochetes
-Motile spiral (helical) curl screw motion
poorly stained Most non path. Anaerobic in mouth gum and genital 3 main genera
include path,strains
1-Treponema helical regular coil 3 spp.
-T pallidium
syphilis
-several stages a-initial local lesion (chancre) b-secondary blood
stream invasion c-central nerve.system rash enlargement lymph,node d- after
latent period of year chronic lesion (gummas) brain bone.etc.
T pertenue
cause yaws chronic endemic relapsing disease of tropic spread by direct contact
of skin lesion

-T.caratenum :Pinta disease of central and S America
direct contact with infectious skin thickened and
dipigmented.
Leptospira
Lightly coiled crock screw shaped spiral with
hocked end
-2 spp L.biflexa in pools,streams wet natural
sites
-L.interrogans :Kidneys of rodent and domestic animals has 20
serotypes
-Treatment :penicillin
*****

Borrelia large irregular
warm like spiral
-B recurrentis, B duttoni carried by lice and ticks to human
cause relapsing fever in tropical countries
Mycoplasma:No cell wall smallest
independent organism size of largest virus small box
-aerobic M.pneumoniae
atypical pneumonia

Ricketsiae :obligate intracellular parasites
RNA,DNA
-two genera Reckettsiae and Coxiella
1-R.prowazekii cause typhus
body lice
2-R mooseri cause murine typhus (flees)
3-R tsutusgamushi
tsutsugamushi fever (mites)
4-R rickettsii cause rocky mountain spotted
fever
5-Coxiella burnetti Q fever
R. conorii tick born fever with
rash

Chlamydia
-Obligate intracellular parasites RNA and
DNA
-No peptidoglycan in cell wall
Pathogenicity
C.trachomitis Host
human different serogroup variety of diseases
1-Non-specific urethritis and
cervitis sex transmitted diseases
2-Eye infection neonate ophthalmic (birth)
trachoma
3-Pneumonia in neonate
4-Lymphogranulous venereum sex transmitted
disease

Treatment : tetracycline /erythromycin
C.psittaci Bird
reservoir transmitted to human by inhalation of contaminated dust
C
pneumoniae:mild pneumonia outbreak in
school.
*****
*****
*****
*****
*****

A guide to viruses

*****
Infection >Mild cold,silent CMV, Latent Herpes, Fetal
(Rabbis)
*****
-Enter :Inhalation Influenza ,measles Ingestion
:Poliomyelitis Inculcation HBV
-Some spread locally other via blood stream to
target organ
-After invasion take over metabolic process die release particle
if not latent no toxin change genetic material malignant
Defense mechanism
:interferon

Destruction of viruses Heat,boiling few min < - 70
C,sensitive to UV,aldehyde,chloroform,iodine alcohol
-virus contain lipids
inactivated by ether/chloroform way of identification
classification N.A
symmetry of capsid,structure,disease
Lab identification and investigation ch
7
Structure ch 2
Infectivity .sources transmission table 9
Respiratory
group :cough sneeze,droplet

Adenoviruses
-DNA,naked icosahedrons
–Diagnostic material throat swab,feces conjunctive,clotted
blood
-identification :tissue culture,florescent
Abs,RIA.ELISA
effect:1-pharyngitis,2-conjunctivitis,epidemic
keratoconjuctivitis(shipyard eye)4-pneumoniea5-immuocompromized
patient
Orthomyxovirus (influenza virus)

-RNA,helical
enveloped
-Diagnostic material throat swab clotted blood
-Investigation
isolation of virus tissue culture ,2-complement fixation,heamagglutination
inhibition
-Unique to influenza viruses Ag variation H&A antigen
shift
Influenza AV epidemic influenza
Influenza BV smaller epidemic Ag
drift residual protection immunity
Influenza CV rarely cause clinical
infection, spread by respiratory droplets
*****

Paramyxovirus
-RNA
helical enveloped
-diagnosis throat,clotted blood identification tissue
culture heamadsorbtion
effect : febrile colds bronchiolitis
Respiratory
syncytial virus RSV Nasopharymgial secretion
Identification direct
observation of nasopharyngial aspirates by Immunoflurescnt ,}.Compliment
fixation
Effect cold bronchioles(pneumonia < 1
y
*****

Mumps
CSF,throat swab clotted blood identification
:tissue culture, serology c,fixation
Effect fever inflammation of salivary
glands.swelling of peritoneal glands
-incubation 12-25 days infective 48 h
before onset of illness
*****

Measles (rubeola)
-Nasopharyngeal
aspirate ,clotted blood
identification direct demonstration I.flu resent
heamadsorbtin
effect fever facial rash bronchitis otitis media
pneumonia
-Incubation 10 days
*****
Rhinovirus RNA icosahedral
naked
Lab test no need effect upper respiratory tract
-respiratory spread
and contact
*****
Corona virus RNA envelop effect upper respiratory tract
mild
*****

Rubella virus (German measles RNA helical
-It is
togavirus but not arthropod borne ,diagnosis blood
-identification
ELIZA
-effect mild fibril illness, macular rash pharyngitis congenital defect
in fetus 4 month
-vaccine MMR measles ,mumps rubella
*****
Virus
involve gastrointestinal system
I-Picornavirus :RNA.icosahedral, naked
pico=small
-faeces throat swabs.CSF it includes

a-Enterovirus
Polio
-Ingest ,multiply in alimentary tract and pharynx to gut tissue organ
via blood then excreta by faeces
-spread fecal oral route,some by repertory
droplets
-prevention careful handling of faeces and droplets it
includes
-poliovirus paralytic poliomyelitis symptomless ,intestine
infection
-vaccine important
*****

b-Coxackie virus hand food
mouth disease
-Coxackie A
-Coxackie B myocardial,pericardial
-Coxackie
C common meningitis and skin rash
*****

II-Reovirus RNA double
strand icosahedral
a-rotavirus
-Wheel shape diagnostic material
faeces
-Identification :complement fixation Eliza ,incubation period 24-72
h
-Outbreak school
*****
III- HAV ,RNA Single strand material
blood
-spread fecal oral route
-nursery school wide
spread
-formaldehyde inactivation
-Infectivity 10 days before
symptoms
*****
HEV :RNA naked single strand spherical
Effect :epidemic
sporadic infection similar to HAV

Blood born viruses *****
HBV Very Happy

strand double shell (Dane particle) consist of nucleocapsid ,core contain
HbcAg,surround by outer lipoprotein coat contain surface Ag HbsAg
-other Ag
associate with the core is HbeAg presence in blood mean high
infectivity
HbeAg,HbcAg and their Abs for diagnostic purposes table
9.3
Diagnostic material blood identified Elisa fir Ag and
Abs
HVC

=RNA Single strand diagnostic material blood by Eliza and
RIA
-90 % transfusion associated with HCV
-Illness similar to acute HBV
milder
-Asymptotic chronic hepatitis followed acute infection
cirrhosis
*****

Retrovirus
-RNA enveloped helical
-Reverse transcraptase
enzyme
-cause sarcoma or leukemia

1-HTLV human T-cell lymphotropic
viruses cause leukemia and lymohoma.
HTLVI ,Japan,Caribbean cause tropical
spastic paralysis (TIP)
HIV 1 &2 human immunodeficiency virus
-Attach
to T cells (T4 helper lymphocytes) binding to CD4 therefore T4 cell deployed T8
(suppressers) slowly raised and opportunistic infection Pneumocystic carinii
pneumonia attack host.

*****
Herpes virus type 1&2
-effect
vesicular lesion
-Infection 1&2 primarily symptomless or hepatic whitlow,
gingivostomatitis or conjunctivitis HSV2 silent-
-Herpes genitalis (sexually
transmitted) contact nursing care or neonate high mortality acquired at
birth

-Reactivate later infection cold sore virus latent in
trigeminal nerve ganglion reactivate by non specific stimuli sun,
cold
Diagnostic material vesicle fluid scrape blood
-identified virus by
EM,or serology
-Spread by close contact.kissing
-Treatment
acyclovir
*****

-Varicella –zoster virus VZV
-Varicella
(chicken pox
-Diagnostic material exudates scrape,blood
-identification
tissue culture,serology
-effect mild fever,rash from maculopapuler to
vesicular
*****
Vericella pneumonias disseminated lesion in
immunosupressed
-spread contact and droplet
-Nurse care in isolated
patients
*****

ZOSTER(Shingles) reactivated varicilla from sensory
nerve ganglion while immunity down cause zoster
-Diagnostic vesicle fluid
scrape ,swab,blood
-spread to not immune nurse
treatment
–acyclovir

*****
CMV cytomegalo virus
Diagnostic material
urine.throat swabs,blood
Identified Elisa,immunoflurescent.
Effect
glandular fever like illness
-congenital effect,
symptomless
*****
-Epstein –Barr virus EBV
Diagnostic blood ,serology
wound pus
Effect a symptom less granduler fever sore throat
lymphoadenopathy
-spread close kissing

Arthropod-born
virus
-spread by bite of infective insect
1-flaviviridae mosquito yellow
fever Japanese B encephalitis
-2Togavirus -equine
encephalitis
-3Bunyaviridea –Rift valley
-Revriridea Colorado tick
fever
-Diagnostic blood identification heamagglutunation of Abs
-effect
encephalitis 2-febrile disease

Zoonoses
-Rabdoviruses RNA bullet
shape enveloped helical
-Diagnostic :Saliva CSF urine
1-Rabies doges cats
bat wild animals(carnivores)to CSF fetal
-Treatment prophylactic immunization
,human diploid cell vaccine (HDCV) acute
immunization
*****

Papovaruse
-DNA naked
icosahedrons
-P{papilloma.polyoma –1Human wart Human planter and genital
wart
-BK virus reactivate in immunodefecient
patient
*****
Parvovirusr
-DNA naked icosahedrons single
strand
-diagnosis blood identification serological IgM by DNA
hybridization
*****
*****
*****
*****
*****

A guide to
fungi protozoa, helminthes and ectoparasites

Systemic fungal infection
cause death to immunisuppress in hospital
-H patients with candida,[img]images/smilies/SugarwareZ-034.gif[/img]ptococcus,histoplas ma, tinea
-Fungi divided into 4 groups (ch2)
infection divided into superficial or deep.systemic e.g yeast candida Table
10.1

I-Yeast and yeast
-Found in soil (bird
dropping)
-Pathogenicity [img]images/smilies/SugarwareZ-034.gif[/img]ptococcus iseoformans only
path._inhalation lung colonization/meningitis
-Mainly in HIV and
transplantation
Treatment :amphotericin
-Nurse care req.skill care in
CSF
Candida C.albicans N.flora mouth,vagina
-Pathogenicity systemic
infection in immunosupressed,pregnancy (thrush)
-Treatment topical
nystasin
-Nurse care god hygiene practice

II filamentous fungi

A-Dermatophyte (ring worm or tinea fungi
-Presence in soil/animal source
of infection
-Pathogenicity skin,nail,hair by 3 genera
a-Microsporum (hair
skin) T capitis cause scalp ring worm
b-Trichophyton (skin,hair, nail)
T.pedis or athletes foot
c-Epidermophyton (skin nail) T cruris groin and
perineum
treatment :Topical imidazol for mild infection/griseofulvin long
severe infect.

-Aspergillus

-Ascus in soil dust
-Pathogenicity
:A.Fumigates ,A.ngier, A.fluvus
Cause
1-Pulmonary aspergillosis inhalation
of spors
a-aspergilloma fungal ball in exciting old
tuberculosis
b-Allergic form due to spores
c-Invasive asprgellosis Lung
inf.to other organ in immunisupresser

2-Superficial infection
ear,surgical wound
B-Zygomycetes imuunicomprommised and diabetes
patients
Presence in soil,air.dust
-Pathogenicity 2 species a-Mucor
b-Rhizobus
C-Dimorphic fungi
-Grow as yeast or filaments cause systemic
infection
-In soil, geographic regons

-Pathogenicity resistant to
treatment ,initial pulmonary disease follow generalized infect.or localized
granulomatous lesion such as
1-Histoplasma capsulatum inhalation of
spores
2-Blastomyces dermatitis generalized granuloma skin inf.by
inhalation
3-Coccidioides immitis inhalation flue like
4-Paracoccidiodies
brasiliensis inhalation lung lesion, lymph node
5-sporothix schenki cause
sporotrihasion implantation of fungi in skin
*****

Diagnostic
Microbiology
Diagnostic Microbiology

Lab test for
1-Kind of
infection 2-eliminate site of infection 3-Patients free of causative infection
4-Monitoring infection
All depends on results of test to clinicians
-ALL
depends on collection of specimens at 1-correct time 2-Technique 3 dispatch to
lab to procedure
Collection of specimens
1-Adequate amount of
uncontaminated material before Antibiotic
2-Specimen label with all
information Patients name age, source
3-Transfer to lab plastic bag no pin
with safe and minimal delay (org. kill,)

Lab requisition
form
1-Name of patients sex, time sample source, diagnosis, test
required.
Collection of swab
-Case study
Throat swab, nasal or HVS,
ear. Conjunctiva, wound, sputum
Blood: 20 ml two bottle right time, suspected
organism biphasic, uncontaminated, date of illness
Serum for
Abs

-Clotted blood detected for Abs
-Clinical History of patients
2-date of onset 3-History of immunization
-CSF
-Collected by medical
stuff
-3 sterile
bottle
-Culture
-Cells
-Chemistry
Urine
-MSU
-Genital area
should be washed and clean especially female
(contamination)

-Catheter specimen recommended if
possible
-Specimen to lab in 1 h at 4 c why ????
1-chemical change
2-bacteria count
Faces
-Virus, ova, parasites and culture
-Clean leak
proof container and spoon
-Prompt collection is vital
-Look for tap warm
segment easily seen +Head Tenia saginata
-Thread warm perennial skin
Entrobeus vermiculares
-Amoeba :Entamoeba histolytica
-Trophozoites
motile, cysts non-motile easily distinguished in fresh
specimen

Fungal investigation
-Wet mount preparation + KOH
preparation
Hair
-Broken hair removes by forceps to dry container
-Some
fungal fluoresce therefore use UV light
Nail
=Whole nail and
scaring
Skin lesion
-Clean with alcohol epidermal scale to lab in dry
container
Material for viral investigation
-Require viral transport media
(VTM) + prompt transport virus killed

outside body
1-Date on onset
2-History of blood transfusion 3- Patients immunization
4-serological test
often used for detection of virus Why ??
Lab isolation of organism from
specimen
1Macroscopic appearance
-Microscopic, size, stain 3-culture
4-Macroscopic of colonial growth
5-Biochemical test 6-Sensitivity test
7-Serological test 8-bacteriophage 9-Pathogenicity test in lab
animal

Reject sample
1-Not enough 2-wrong information 3-not
representative (sputum)
Microscopic
-For morphology rod cocci
spiral
Case study G.C
Microscope (All compound)
1-transmitted light
microscopes 2-Dark filed 3-Fluorescence 4-Phase contrast 5-Electron Microscope

-Gram stain, Nisseriae gonorrhoea,
-Zeil Nelson stain (Mycobacterium
tuberculosis)

Culture
-Material required different culture
media
-Aerobe, facultative anaerobe, strict anaerobe
-Fastidious organism
needs certain requirements aas, vitamin etc.
Cultural
characteristics
Media
-Selective 2-enrichment, differential
-O2
requirement
-Anaerobic jar
-Candle jar for co2

-Viral
culture
-Difficult need living cells
2-Cytopathic effect
(CEP)
2-Haemadsorption test RBCs added and stick to infected
cells
3-Immuniflorescence adding AG labeled with dye +Eliza
Macroscopic
appearance of colony
-Size 2-color 3-haemolysis Beta alpha and gamma
4-swarming ) Proteus)

Biochemical test
-Detect specific enzyme
reaction e.g.
1-triple iron sugar for carbohydrate
2-Soluble bile for
pneumonia
Sensitivity test Antibiotic diffusion disk
Serological
test
-Abs + Ag complex pot.
-Lancsfield antisera for streptococci

Precipitation
Ab +AG tube ppt

Viral serology very important in
diagnosis
1-Neutralization Of CEP by presence of specific Abs
2-Inhibition
of viral agglutination by RBCs by specific Abs (immunity to rubella lyses
RBCs
3Addition of complement +Abs-Ag complex (compliment fixation
4-Large
particle coated e.g polystyrene latex particle
5-Labeling antihuman globulin
Abs or virus specific Ag/Abs
a-readsorbtion RIA b-Color producing enzyme
(Enzyme linked immunosorbent AB (ELISA)

Viral abs reporting
IgG or
IgM + raise in titer
Bacterial typing
Stereotyping salmonella spp.
different strains by different antigenic structure
-Biotyping biochemical
test
-bacteriophage typing according to viruses
-Bacetricin typing inhibit
growth of certain species like antibiotic
Protein typing
Chromatography
outer membrane protein reveals specific pattern

DNA typing
-Plasmid
short small piece of DNA not require for growth but add new character as
resistant to antibiotics
-DNA probe for identification bind to complementary
strand
*****
Pathogen city test
-Certain organism con not culture on
artificial media but in animal
e.g. definitive test for corynebacterial
diphtheria inject guinea pig with bacteria the toxin cause adrenal
haemorrhage

The lab report
-Very important when get back to nurse
to understand and act promptly (MRSA) to isolate the patients for instances
Features described in the report
Microscopy, bloody stool or
urine
_Microscopy cells cast [img]images/smilies/SugarwareZ-034.gif[/img]stal mucus pus
cells
-Culture
1-organism-name streptococcus
2-growth of organism as
heavy +++, moderate ++ light +
3-screening tests for salmonella in
faces
*****

Antibiotic sensitivity
*****
S-FULLY SINSITIVE
LIKELY TO ACT IN VITRO
R-RESISTANCE UNLIKELY TO BE ACTIVE
M-MODERATELY
SENSITIVE NOT FIRST CHOISE OF TREATMENT
SERUM assay
To measure level of
certain antibiotic in blood
Tough the lowest concentration and peak the
highest dose concentration taken I h after dose

Infection
control-general
Infection control-general
-Disease as Plague, smallpox
and typhus are disappeared, due to modern technical knowledge.
-However,
community acquired infections still exist due to several factors
1-Increase
complexity of treatment for many disease and increase R
2-Averaged age of
population is increasing and elderly more susceptible to infection
3-Range of
organism causing infections expand and new species identified.
4-Human
mistake exist and simple procedure to prevent transmission difficult to
maintain

Hospital Acquired Infection (HAI) (mosocomial
)
-Acquired
in hospital by patients or staff
-It is important to distinguish between
prevalence and incidence
-Prevalence rate is the number of patients found
with infection at any one time
-Incidence rate the number found over a
specific time period of continuous recording
-Prevalence rate for hospital
inf. is twice incidence rate (length of stay)

-National Survey of
Infection in Hospital

*****
–Microbiology for Nurses Lectures
control, sterilization, planning
Development, antibiotic.

Infection
control nurse (ICN) is a
-Registered general nurse with experience allow her
to act as a source of information and advise in all infections matter
-The
duties of ICN are those of the IC team (except those unique to IC). They
are
1-Surveillance aware of background infection
2-conducting with
microbiologist and epidemiologist survey with specific objective such
as
a-evaluating prevention and control activities
b-identifying groups of
people who are at risk of disease
c-providing information for service
planning and resource allocation
+Analysis of data and results so appropriate
action could be taken

2-education: lecture control advises even to
visitors
3-Monitoring: corporation with all department to insure IC policies
are usable
4-Research acting as nursing research resources for all health
care workers on all aspects
*****

Infection control and occupational
health
-Relation ship between IC and occupational health (OH)
-Should be
mutually beneficial
-E.g. ICNs may become aware of staff sickness as they
visit wards and will alert the OH nurse( OHN) to any outbreak of
infection
_OHN play important rule in educating staff in safety and personal
hygiene as part of hospital IC program

-They should be aware of
health of all employees with regards to immunization
to
1-TB
2-poliomyelitis
3-diphtheria
4-tetanus
5-rubella
6-hepatitis
B

Epidemiologist
Study of distribution of disease in human population

-Epidemiologist involved in local, national and international organization
share with (microbiologists oncologist, genetics)
-To prevent transmission of
disease
-Should know when where how and to whom of any disease

World
health Organization
-Is a mass amount of information on incidence of
disease?
-Make regulation to minimize spread of disease
-Acts as
educators trainers and investigators
*****

Public health
laboratory services (PHLS)
-52-network lab. In UK and Wales
-Work with NHS
lab
-Concern with diagnosis, prevention, and control of human
infections
-Provide resources for out break as food poisoning
*****
The
communicable disease surveillance center (CDSC)
-Attached to PHLS head
quarter in London WHO report data about infections and organism to CDSC

-Staff offers guidelines to local public health
-E.g. increasing
incidence of Aids

Center for disease control
-IN USA at Atlanta

-Run by USA federal government
-Same as CDSC
-Publish weekly
information of mortality and morbidity MMWR)
*****
Education
- Is
important because if you have everything Lab equipment technique) but don’t know
how disease spread????
-Therefore in order education to work it must
be
1-aimed at the right level for group being educated
2-clear, consistent
and concise
3-interesting
4-appropriate

The strategy for Nursing
(1989) highlights a number of important educational targets for
practice

1-Target 25 that all staff delivering health care are
appropriately prepared for practice
2-Target 32 – Individual responsibility
for keeping up to-date
Target 7 –that clinical practice is founded on
current information and research.
ICN education
-To establish the up
requirement center must be establish for trainer to give qualified personnel
certificate to practice
*****