Basic Principles of Medical Microbiology and Immunology

General Aspects of Medical Microbiology

The History of Infectious Diseases 2

The Past 2

The Henle-Koch Postulates 3

The Present 3

Pathogens 4

Subcellular Infectious Entities 4

Prokaryotic and Eukaryotic Microorganisms 4

Bacteria 5

Fungi and Protozoa 6

Animals 7

Host-Pathogen Interactions 7

Basic Terminology of Infectiology 8

Determinants of Bacterial Pathogenicity and Virulence... 8

Adhesion 11

Invasion and Spread 12

Strategies against Nonspecific Immunity 12

Strategies against Specific Immunity 13

Clinical Disease 15

Regulation of Bacterial Virulence 18

The Genetics of Bacterial Pathogenicity 20

Defenses against Infection 21

Nonspecific Defense Mechanisms 21

Specific Defense Mechanisms 23

Defects in Immune Defenses 24

Normal Flora 24

Immune Defects 118

Immunoregulation 118

Immunostimulation 119

Immunosuppression 120

Adaptive Immunotherapy 120

Immunological Test Methods 121

Antigen and Antibody Assays 121

Immunoprecipitation in Liquids and Gels 121

Agglutination Reaction 123

Complement Fixation Test (CFT) 125

Direct and Indirect Immunofluorescence 125

Radioimmunological and Enzyme

Immunological Tests 128

In-Vitro Cellular Immunity Reactions 129

Isolation of Lymphocytes 129

Lymphocyte Function Tests 132

II Bacteriology

3 General Bacteriology 146

The Morphology and Fine Structure of Bacteria 146

Bacterial Forms 146

Fine Structures of Bacteria 148

Nucleoid (Nucleus Equivalent) and Plasmids 148

Cytoplasm 151

The Cytoplasmic Membrane 151

Cell Wall 152

Capsule 157

Flagella 157

Attachment Pili (Fimbriae), Conjugation Pili 158

Biofilm 158

Bacterial Spores 159

The Physiology of Metabolism and Growth in Bacteria 160

Bacterial Metabolism 160

Types of Metabolism 160

Catabolic Reactions 161

Anabolic Reactions 163

Metabolic Regulation 164

B-Cell Epitopes and B-Cell Proliferation 67

Monoclonal Antibodies 69

T-Independent B Cell Responses 69

T Cells 71

T-Cell Activation 71

T-Cell Activation by Superantigens 72

Interactions between Cells of the Immune System 72

T Helper Cells (CD4+ T Cells) and T-B Cell

Collaboration 72

Subpopulations of T Helper Cells 75

Cytotoxic T Cells (CD8+ T Cells) 75

Cytokines (Interleukins) and Adhesion 77

Antibody-Dependent Cellular Immunity and

Natural Killer Cells 85

Humoral, Antibody-Dependent Effector

Mechanisms 85

The Complement System 86

Immunological Cell Death 90

Immunological Tolerance 90

T-Cell Tolerance 90

B-Cell Tolerance 93

Immunological Memory 94

B-Cell Memory 96

T-Cell Memory 98

Immune Defenses against Infection and Tumor Immunity 99

General Rules Applying to Infection Defenses 100

Immune Protection and Immunopathology 103

Influence of Prophylactic Immunization on the

Immune Defenses 106

Tumor Immunity 107

The Pathological Immune Response 108

Type I: IgE-Triggered Anaphylaxis 108

Type II: Cytotoxic Humoral Immune Responses 109

Autoantibody Responses 110

Anti-blood Group Antibody Reactions 111

Type III: Diseases Caused by Immune Complexes 113

Type IV: Cell-mediated Immunopathology 114

Transplantation Immunity 115

Immune Defects and Immune Response Modulation 117

Immune Defects 118

Immunoregulation 118

Immunostimulation 119

Immunosuppression 120

Adaptive Immunotherapy 120

Immunological Test Methods 121

Antigen and Antibody Assays 121

Immunoprecipitation in Liquids and Gels 121

Agglutination Reactions 123

Complement Fixation Test (CFT) 125

Direct and Indirect Immunofluorescence 125

Radioimmunological and Enzyme

Immunological Tests 128

In-Vitro Cellular Immunity Reactions 129

Isolation of Lymphocytes 129

Lymphocyte Function Tests 132

II Bacteriology

3 General Bacteriology 146

The Morphology and Fine Structure of Bacteria 146

Bacterial Forms 146

Fine Structures of Bacteria 148

Nucleoid (Nucleus Equivalent) and Plasmids 148

Cytoplasm 151

The Cytoplasmic Membrane 151

Cell Wall 152

Capsule 157

Flagella 157

Attachment Pili (Fimbriae), Conjugation Pili 158

Biofilm 158

Bacterial Spores 159

The Physiology of Metabolism and Growth in Bacteria 160

Bacterial Metabolism 160

Types of Metabolism 160

Catabolic Reactions 161

Anabolic Reactions 163

Metabolic Regulation 164

Growth and Culturing of Bacteria 164

Nutrients 164

Growth and Cell Death 165

The Molecular Basis of Bacterial Genetics 166

The Structure of Bacterial DNA 167

DNA Replication 168

Transcription and Translation 168

Regulation of Gene Expression 169

The Genetic Variability of Bacteria 170

Molecular Mechanisms of Genetic Variability 171

Spontaneous Mutation 171

Recombination 171

Intercellular Mechanisms of Genetic Variability 174

Transformation 174

Transduction 174

Conjugation 175

Restriction, Modification, and Gene Cloning 177

Bacteriophages 182

Definition 182

Morphology 182

Composition 183

Reproduction 184

Lysogeny 186

The Principles of Antibiotic Therapy 187

Definitions 187

Spectrum of Action 196

Efficacy 196

Mechanisms of Action 197

Pharmacokinetics 200

Side Effects 200

The Problem of Resistance 201

Definitions 201

Incidence, Significance 201

Resistance Mechanisms 202

Evolution of Resistance to Anti-Infective Agents 203

Resistance Tests 204

Combination Therapy 205

Chemoprophylaxis 206

Immunomodulators 207

Laboratory Diagnosis 207

Preconditions, General Methods, Evaluation 208

Preconditions 208

General Methods and Evaluation 208

Sampling and Transport of Test Material 208

Microscopy 211

Culturing Methods 212

Identification of Bacteria 214

Molecular Methods 216

Direct Detection of Bacterial Antigens 217

Diagnostic Animal Tests 217

Bacteriological Laboratory Safety 217

Taxonomy and Overview of Human Pathogenic Bacteria 218

Classification 218

Nomenclature 228

4 Bacteria as Human Pathogens 229

Staphylococcus 229

Staphylococcus aureus 230

Coagulase-Negative Staphylococci (CNS) 234

Streptococcus and Enterococcus 234

Streptococcus pyogenes (A Streptococci) 237

Streptococcus pneumoniae (Pneumococci) 240

Streptococcus agalactiae (B Streptococci) 242

Oral Streptococci 242

Enterococcus (Enterococci) 243

Gram-Positive, Anaerobic Cocci 244

Bacillus 244

Bacillus anthracis (Anthrax) 245

Clostridium 246

The Pathogens That Cause Gas Gangrene

(Clostridial Myonecrosis) and Anaerobic Cellulitis... 246

Clostridium tetani (Tetanus) 248

Clostridium botulinum (Botulism) 250

Clostridium difficile (Pseudomembranous Colitis) . . . 251

Listeria, Erysipelothrix, and Gardnerella 251

Listeria monocytogenes 252

Erysipelothrix rhusiopathiae 253

Gardnerella vaginalis 254

Corynebacterium, Actinomyces, Other Gram-Positive Rod Bacteria 254

Corynebacterium diphtheriae (Diphtheria) 255

Actinomyces 258

Other Gram-Positive Rod Bacteria 260

Mycobacterium 262

Tuberculosis Bacteria (TB) 263

Leprosy Bacteria (LB) 269

Nontuberculous Mycobacteria (NTM) 271

Nocardia 272

Neisseria, Moraxella, and Acinetobacter 273

Neisseria gonorrheae (Gonorrhea) 274

Neisseria meningitidis (Meningitis, Sepsis) 276

Moraxella and Acinetobacter 278

Enterobacteriaceae, Overview 278

Salmonella (Gastroenteritis, Typhoid Fever, Paratyphoid Fever)... 282

Shigella (Bacterial Dysentery) 287

Yersinia (Plague, Enteritis) 289

Yersinia pestis 289

Yersinia enterocolitica and Yersinia pseudotuberculosis 290

Escherichia coli 292

Opportunistic Enterobacteriaceae 295

Vibrio, Aeromonas, and Plesiomonas 296

Vibrio cholerae (Cholera) 297

Other Vibrio Bacteria 300

Aeromonas and Plesiomonas 300

Haemophilus and Pasteurella 300

Haemophilus influenzae 301

Haemophilus ducreyi and Haemophilus aegyptius . . 303 Pasteurella 303

Gram-Negative Rod Bacteria with Low Pathogenic Potential 304

Campylobacter, Helicobacter, Spirillum 306

Campylobacter 306

Helicobacter pylori 307

Spirillum minus 308

Pseudomonas, Stenotrophomonas, Burkholderia 308

Pseudomonas aeruginosa 309

Other Pseudomonas species, Stenotrophomonas and Burkholderia 310

Legionella (Legionnaire's Disease) 311

Brucella, Bordetella, Francisella 313

Brucella (Brucellosis, Bang's Disease) 313

Bordetella (Whooping Cough, Pertussis) 315

Francisella tularensis (Tularemia) 316

Gram-Negative Anaerobes 317

Treponema (Syphilis, Yaws, Pinta) 320

Treponema pallidum, subsp. pallidum (Syphilis) 320

Treponema pallidum, subsp. endemicum

(Nonvenereal Syphilis) 323

Treponema pallidum, subsp. pertenue (Yaws) 323

Treponema carateum (Pinta) 323

Borrelia (Relapsing Fever, Lyme Disease) 324

Borrelia That Cause Relapsing Fevers 324

Borrelia burgdorferi (Lyme Disease) 326

Leptospira (Leptospirosis, Weil Disease) 328

Rickettsia, Coxiella, Orientia, and Ehrlichia

(Typhus, Spotted Fever, Q Fever, Ehrlichioses) 330

Bartonella and Afipia 334

Bartonella 334

Afipia felis 335

Chlamydia 335

Overview and General Characteristics of Chlamydiae 336

Chlamydia psittaci (Ornithosis, Psittacosis) 337

Chlamydia trachomatis

(Trachoma, Lymphogranuloma venereum) 338

Chlamydia pneumoniae 339

Mycoplasma 340

Nosocomial Infections 342

Definition 342

Pathogens, Infections, Frequency 342

Sources of Infection, Transmission Pathways 345

Control 345

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