Importance of Microbiology is the study of Microbes.

-Individual microbes can be observed only with the use of different types of microscope.

"micro" - too small to be seen with the naked eye

"bio/s" - life / refers to the living organisms

"logy" - study of

"biology"- is the study of living organisms.

MICROBES are "ubiquitous" meaning they are virtually everywhere

Truth about Microbiology

Indigenous microflora = are microbes that usually live on or in a human body

Benefits: Inhibit the growth of pathogens in areas of the body where they live by occupying space.

Deplete/burn/consume food supply

Secrete materials that may prevent or reduce the growth of pathogens, Microbes are essential for life.

= Some produce oxygen, a process known as photosynthesis.

= Microbes contribute more oxygen than do plants.

Ex: algae and cyanobacteria

Many microbes are involved in the decomposition of dead organisms and the waste products of living
organisms.

=They are collectively referred to as decomposers or saphrophytes.

Opportunistic pathogens = are microbes that colonize (inhabit) our bodies. = do not cause disease under
ordinary conditions, but have the potential to cause disease should the opportunity present itself.

Ex: Escherichia coli ([Link]) lives in our intestinal tracts They do not cause us any harm as long as it
remains in our intestinal tract but can cause disease if it gains access to our urinary bladder,
bloodstream, or a wound.

FIRST MICROORGANISM on EARTH

- Archaea and Cyanobacteria The first microbes on Earth

EARLIEST KNOWN INFECTIOUS DISEASE

Scientist have learned that the following diseases have been around for a very long time

Tuberculosis

Syphilis

Parasitic worm infection

1. schistosomiasis

2. dracunculiasis(guinea worm infection)

Tape worm infections

Robert Koch

Discovered the M. tuberculosis that causes tuberculosis and the Vibrio cholerae that causes cholera.

Works on tuberculin( a protein derived from M. Tuberculosis) that ultimately led to the development of
a skin test valuable in diagnosing tuberculosis.

A German Physician

• Made a significant contributions to the germ theory of disease.

•Developed methods of cultivating bacteria on solid media.

R.J. Petri, invented a flat glass dish (now known as petri dish) in which to culture bacteria on solid media.

1. Microbiologist = is a scientist who studies microbes

[Link] = is a scientist who specializes in the study of the structure, functions, and activities of
bacteria,

[Link] (algologist) = is a scientist who studies the various types of algae

[Link] = is a scientist who studies the protozoa and their activities.

5. Mycologist = is a scientist who specializes in the study of fungi.

6. Virologist = is a scientist who studies viruses and their effects on living cells of all types

MEDICAL AND CLINICAL MICROBIOLOGY

Medical Microbiology-is the study of pathogens, the diseases they cause, and the body's defenses
against the disease.

CLINICAL MICROBIOLOGY OR DIAGNOSTIC MICROBIOLOGY- is concerned with the laboratory diagnosis

of infectious diseases of humans.

A way to remember the sequence of Taxa from Kingdom to Species

•K- (Kingdom)- King

- P- (Phylum)- Philip

C-(Class) - Came

-O-(Order) - Over

•F (Family) - for

-G (Genus) – Good
•S-(Species)- Spaghetti

Acellular Microbes infectious particles/agents

VIRUSE are extremely small.

They are observed using electron microscope.

Viruses are not alive.

• To replicate, they must invade live host cells.

• No type of organism is safe from viral infections,

VIRUSES infect humans, animals, plants, fungi, protozoa, algae, and bacterial cells.

• ONCOGENIC VIRUSES OR ONCOVIRUSES= cause specific type of cancer including human cancers such
as: 1. lymphoma, 2. carcinomas, and 3. some types of leukemia.

Staining Procedure

• Bacteria are smeared onto a glass microscope slide resulting in what is known as "smear"

. Air dried

• Fixed

2 most common method of fixation:

1. Heat fixation= passing the smear in the "bunsen burner flame"

2. Methanol fixation=flooding the smear with absolute methanol for 30 seconds

• 3 Purposes of Fixation:

1. Kills the organisms

2. Preserves their morphology (shape)

3. Anchors the smear to the slide

Dr. Hans Christian Gram = developed a staining technique that bears his name - the Gram stain or Gram
staining procedure.

Acid-fast Stain Is used to identify if the causative agent is Mycobacterium species.

is of value in the diagnosis of tuberculosis.

• Acid-fast bacteria are red at the end of the acid-fast staining procedure.

Chemotherapy

Refers to the use of any chemical (drug) to treat any disease or condition Chemotherapeutic agent is any
drug used to treat any condition or disease.

Paul Ehrlich = the "Father of Chemotherapy"

Salvarsan(arsphenamine)- proved effective in treating syphilis; also known as "Compound 606".

Antibiotic = is a substance produced by a microorganism that is effective in killing or inhibiting the

growth of other microorganisms.

All antibiotics are antimicrobial agents, but not all antimicrobial agents are antibiotics.

• Are produced by certain moulds and bacteria, usually those that live in soil.

Penicillin and cephalosporins = are examples of antibiotics produced by moulds.

Bacitracin, Erythromycin, and Chloramphenicol are examples of antibiotics produced by bacteria.

Multidrug Therapy

The use of two or more drugs simultaneously to kill all the pathogens and to prevent resistant
mutant pathogens from emerging.

Ex: mutidrug-resistant strains of Mycobacterium tuberculosis Isoniazid, Rifampin, Pyrazinamide,

Ethambutol

• Antiviral Agents - Are the newest weapons in antimicrobial methodology. Antiviral agents work by
inhibiting viral replication within cells.

ex: zidovudine (also known as azidothymidine [AZT]) = the first antiviral effective against AIDS

Epidemiology and Public Health

• Is the study of factors that determine the frequency, distribution, and determinants of diseases in
human populations, and ways to prevent, control, or eradicate diseases in population.

• Pathology = the study of structural and functional manifestations of disease and is involved in
diagnosing diseases in individuals.

Interactions among Pathogens, Hosts, and Environments

Factors pertaining to the Pathogen:

•The Virulence of a pathogen = the measure or degree of pathogenicity

-A way for the pathogen to enter the body( portal of entry)

• The number of organisms that enter the body

Factors pertaining to the Hosts:

The person's health status

• The person's nutritional status

Factors pertaining to the susceptibility of the host

Age, lifestyle, socioeconomic level, occupation, travel, hygiene, substance abuse, immune status
Factors pertaining to the Environment:

• Physical factors such as geographic location, climate, heat, cold, humidity, and season of the year.

Availability of appropriate reservoirs.

Sanitary and housing conditions; adequate waste disposal; adequate healthcare

• Availability of potable (drinkable) water.

Chain of infection or the 6 components in the Infectious Disease process

1. There must first be a pathogen( ex. Cold virus)

2. There must be a source of the pathogen (Reservoir)

3. There must be a portal of exit( the way for the pathogen to escape from the reservoir) in cold virus.
when a person blow his nose, cold virus get onto his/her hands)

4. There must be a mode of transmission. (way of a pathogen to travel from the source to another
person) the cold virus is being transferred by direct contact between the source and the victim like
handshaking)

5. There must be a portal of entry way of the pathogen to gain entry into the victim)When the victim rub
his nose, the cold virus is transferred from his hand to the mucous membranes of his nose.

6. There must be a susceptible host.

ex. The victim would not be a susceptible host if he/she had previously been infected by that particular
cold virus and had developed immunity to it.

5 PRINCIPAL MODES IN THE TRANSMISSION OF PATHOGENS

1. Contact (Direct contact or Indirect contact)

2. Droplet

3. Airborne

4. Vehicular transmission

5. Vector transmission

Direct contact

• Involves skin-to-skin contact, mucous membrane-to- mucous membrane contact such as kissing, or
sexual intercourse.

•Ex: STDs such as syphilis, gonorrhea, and infections caused by chlamydia, herpes, and HIV.

Indirect contact

Droplet transmission = involves the transfer of pathogens via infectious droplets (particles 5 um in
diameter or larger).
May be generated by coughing, sneezing, and talking.

• Airborne transmission involves the dispersal of droplet nuclei, which are the residue of evaporated
droplets, and are smaller than 5 μm in diameter.

•Ex: colds, influenza, measles, mumps, chickenpox, smallpox, and pneumonia

Symptom of a Disease- Is defined as some evidence of a disease that is experienced or perceived by the
patient.

• Are subjective.

• Ex: pain, tinnitus, blurred vision, nausea, dizziness, itching, and chills

Symptomatic disease (clinical disease) = is a disease in which the patient is experiencing symptoms.

Asymptomatic disease (subclinical disease) is a disease that the patient is unaware of because he or
she is not experiencing any symptoms

FIRST LINE OF DEFENSE

1. Skin and Mucous Membranes as Physical Barriers

2. Cellular and Chemical Factors

1. Skin- the dryness, acidity, and temperature inhibits colonization by pathogens

= Oily sebum produced by the sebaceous glands in the skin contains fatty acids that are toxic to other
pathogens

= Perspiration flushed organisms from pores and the surface of the skin

= Sloughing off of dead skin cells removes potential pathogens from the skin

2. Sticky mucous membranes kill, inhibit, or trapped pathogens.

3. RESPIRATORY TRACT=The mucociliary covering on epithelial cells mave trapped dust and microbes
upward toward the throat, where they are swallowed and expelled.

4. GIT = The pathogens entering the GIT are often killed by digestive enzymes or the *acidity or
*alkalinity of different anatomical regions.

5. URINARY TRACT = Peristalsis and urination serve to = the acidity of the vaginal fluid pathogens

remove [Link] colonization of the vagina by

The 4 Cardinal S/S of inflammation:

1. Redness

2. Heat

3. Swelling(edema)

4. Pain
Pus = is a purulent inflammatory exucate

Inflammatory exudate = is the accumulation of fluid, cells, and cellular debris at the inflammation site

Purulent exudate = thick and greenish yellow exudate, containing many live and dead leukocytes

Pyogenic microbes = are pus-producing microbes

• Hepatitis A (infectious Hepatitis/ Catarrhal jaundice)

Inflammation of the liver caused by hepatitis A virus.

It is known as infectious hepatitis because it spreads relatively easy to individuals who have closer
contact w/ the infected person.

Incubation period:

15 to 60 days, or 3-5 weeks, with a mean incubation period of 30 days

Mode of transmission: Fecal oral pathway

Ingestion of contaminated drinking water or ice, uncooked fruits and vegetables, fruits and vegetables
grown in or washed with contaminated water.

Contaminated food/drinks by infected food handlers.

Groups at risk:

Children in day care center - diapers and toys

•Troops living in crowded conditions- military camps

Homosexual men - oral- anal sexual contact

• People who live in areas w/ a breakdown of sanitary conditions

- after flood r any natural calamity

Clinical manifestations:

• Flu-like symptoms w/ chills and high fever

• Diarrhea, fatigue and abdominal pain

• Loss of appetite - anorexia

• Nausea

• Jaundice and dark-colored urine

Complications:

Progressive encephalopathy characterized by drowsiness and cerebral edema

• GI bleeding progressing to stupor and later coma. Bleeding is not responsive to parenteral vit. K
administration
 Clonus and hyperreflexia are later replaced by loss of Deep Tendon Reflexes.

Edema and ascites

• Aplastic anemia

• Loss of corneal and papillary reflexes, respiratory failure, cerebrovascular collapse.

* clonus - muscular spasm

Treatment modalities:

• No specific treatment Bed rest is essential

• High carbohydrates, low in fat and low in protein diet.

Vitamin supplements (B complex groups)

• IVT

• Isoprinosine (Methisoprenol) may enhance the cell-mediated immunity of the T-lymphocytes

Alkalies, belladonna, and anti emetics

Nursing management:

• Enteric isolation must be employed.

• Rest during acute or symptomatic phase.

• Nutritional status must be improved

. Observe for melena

• Optimum skin and oral care

• Limit activity when fatigued

• Gradual resumption of activities and mild exercise during recovery.

Prevention and Control:

•Hand washing after using the toilet

•Travelers should avoid water and ice if unsure of their purity

• Screening of food handlers

• Safe preparation and serving of food must be practiced.

Hepatitis B

Serum Hepatitis

• Inflammation of the liver caused by hepatitis B virus.

• Considered to be more serious than hepatitis A due to the possibility of severe complications such as
massive damage and hepatocarcinoma.

• Etiologic agent:

Hepatitis B virus

HBsAg appears in the blood 30 to 60 days after exposure and persists for variable periods of time.

Incubation period:

50 to 189 days (2 to 5 months)

• Period of communicability:

The infected person is capable of transmitting the virus during the latter part of the incubation
period and during the acute phase.

• It may persist in the blood for many years.

Mode of transmission:

Direct transmission through infected body fluids.

• Contaminated needles and syringes.

• Infected blood or body fluids at birth

Sexual contact

It does not occur via:

Fecal-oral route

Foodborne ort waterborne transmission Arthropod (mosquito) transmission

Clinical manifestations:

• Prodromal period: Fever, malaise, and anorexia

• Nausea, vomiting, abdominal discomfort, fever, and chills

• Jaundice, dark urine and pale stools

• Recovery is indicated by a decline of fever and improved appetite.

• Fulminant hepatitis = may be fatal AMB severe symptoms like ascites and bleeding

Prevention:

Screening of blood donors

• Handwashing immediately after contact w/ body fluids

• Avoid injury w/ sharp objects or instruments,

• Use disposable needles and syringes only once and discard properly.

• Avoid sharing toothbrushes, razors, and other instruments that may be contaminated w/ blood.

- Practice safe sex

• Have adequate rest, sleep, and exercise, and eat nutritious foods

Hepatitis B vaccine for pre-exposure HBIg w/in 72 hours to those exposed directly to HBV, either by
ingestion, prick or inoculation

Nursing management for Hepatitis

Suggest that large meal is eaten in the morning because nauses tends to intensify as the day progresses.

•Provide diversional activities to relieve boredom

• Take juices with occasional ice chips to maintain hydration without inducing vomiting

• Monitor the patient's weight daily. Record I and O.

Observe stools for color, consistency and amount. Record the frequency of bowel movement.

Before the patient is discharged, discuss restrictions and how to prevent recurrence of hepatitis.

Infectious Diseases of the Skin

•Folliculitis. Inflammation of a hair follicle, the sac that contains a hair shaft.

• Sty (or stye). Inflammation of a sebaceous gland that opens into a follicle of an eyelash

•Furuncle. A localized pyogenic (pus-producing) infection of the skin, usually resulting from

folliculitis; also known as a boil

• Macule. A surface lesion that is neither raised nor depressed, such as the lesions of measles

• Papule. A surface lesion that is firm and raised, such as the lesions of chickenpox.

• Vesicle. A blister or small fluid-filled sac, such as is seen in chickenpox and shingles.

• Pustule. A pus-filled surface lesions.

There are three pathways for pathogens to enter the ear: (a) through the eustachian (auditory) tube,
from the throat and nasopharynx; (b) from the external ear; and (c) via the blood or lymph.

• Infection of the middle ear is known as otitis media, whereas infection of the outer ear canal is known
as otitis externa.

Conjunctiva. The thin, tough lining that covers the inner wall of the eyelid and the sclera (the white of
the eye).

• Conjunctivitis. An infection or inflammation of the conjunctiva.

• Keratitis. An infection or inflammation of the cornea-the domed covering over the iris and lens.
• Keratoconjunctivitis. An infection that involves both the cornea and conjunctiva.

Bronchitis. Inflammation of the mucous membrane lining of the bronchial tubes; most commonly caused
by respiratory viruses.

Bronchopneumonia. Combination of bronchitis and pneumonia.

Epiglottitis. Inflammation of the epiglottis (the mouth of the windpipe); may cause respiratory
obstruction, especially in children; frequently caused by Hemophilus influenzae type b (Hib

Laryngitis. Inflammation of the mucous membrane of the larynx (voice box).

• Pharyngitis. Inflammation of the mucous membrane and underlying tissue of the pharynx; commonly
referred to as sore throat. -Strep throat|| is pharyngitis caused by Streptococcus pyogenes. Even though
S. pyogenes is the most-publicized|| cause of pharyngitis, most cases of pharyngitis are caused by
viruses

Infectious Diseases of the Central Nervous System

• Encephalitis. Inflammation of the brain.

• Encephalomyelitis. Inflammation of the brain and spinal cord.

• Meningitis. Inflammation of the membranes (meninges) that surround the brain and spinal cord.

• Meningoencephalitis. Inflammation of the brain and meninges.

• Myelitis. Inflammation of the spinal cord

Chicken pox (varicella)

Is an acute and highly contagious disease of viral etiology

is characterized by vesicular eruptions on the skin and mucous membrane w/ mild constitutional
symptoms.

• Infectious Agent:

Herpes virus varicellae - a DNA containing virus.

Closely identical to herpes zoster virus.

Human beings are the only source of infection

Incubation period:

10-21 days after exposure

• Mode of transmission:

• Direct contact w/ patients who shed the virus from the vesicles.

Indirect contact, through linens or fomites

 Airborne, and droplet spread.

• Period of communicability:

• The patient is capable of transmitting the infection about a day before the eruption of the first lesion
up to about five days after the appearance of the last crop of vesicles.

Pre-eruptive manifestations are mild fever and malaise.

Eruptive stage:

Rash starts from the trunk (unexposed area), then spread to other parts of the body centrifugal
appearance of rashes

• Initial lesions are red papules where contents become milky and pus-like w/in 4 days.

• In adult and bigger children, the lesions are widespread and more severe

There is rapid progression so that transition is completed in 6-8 hours.

• Vesicular rashes are very pruritic.

All stages are present simultaneously before all are covered w/ scabs, known as "Celestial map."

Nursing responsibilities

Continuation

• Respiratory isolation is a must until all vesicles have crusted.

• Prevent secondary infection of the skin lesion through hygienic care of the patient.

• Attention to nasopharyngeal secretions and discharges because these are highly infectious.

Linen must be disinfected under the sunlight or through boiling.

Cut finger nails short to prevent skin breakdown.

• A child must wear mittens.

•Provide activities to keep child occupied to lessen pruritus.

Observe oral and nasal care.

Acne - Acne is a common condition in which pores become clogged with dried sebum, flaked skin, and
bacteria, which leads to the formation of blackheads and whiteheads (collectively known as acne
pimples) and inflamed, infected abscesses.

- Acne is most common among teenagers.

Pathogens: The etiologic agents of acne are Propionibacterium acnes and other Propionibacterium
spp., all of which are anaerobic, Gram-positive bacilli.
• Reservoirs and Mode of Transmission: Infected humans serve as reservoirs, although acne is probably
not transmissible.

Whooping cough is a highly contagious, acute bacterial childhood (usually) infection. - The first stage
(the prodromal or catarrhal stage) of the disease involves mild, cold like symptoms.

•- The second stage (the paroxysmal stage) produces severe, uncontrollable coughing fits.

• The coughing often ends in a prolonged, high-pitched, deeply indrawn breath (the-whoop, from which
whooping cough gets its name).

Leprosy is today more commonly known as Hansen disease. - There are two forms of leprosy: (a)
lepromatous leprosy, characterized by numerous nodules in skin and possible involvement of the nasal
mucosa and eyes and (b) tuberculoid leprosy, in which relatively few skin lesions occur. Peripheral nerve
involvement tends to be severe, with loss of sensation. Pathogen: The etiologic agent of leprosy is
Mycobacterium leprae, an acid-fast bacillus. Reservoirs and Mode of Transmission: Infected humans
serve as reservoirs; M. leprae is present in nasal discharges and is shed from cutaneous lesions. The
exact mode of transmission has not been clearly established. The organisms may gain entrance through
the respiratory system or broken skin. Leprosy does not appear to be easily transmitted from person to
person

Classification of Fungal Infections

Black piedra, caused by Piedraia hortae, is a fungal infection of scalp hair and, less commonly,
eyebrows and eyelashs.

• White piedra, usually caused by Trichosporon beigelii, is a fungal infection of moustache, beard, pubic,
and axilla hair.

- Tinea versicolor, caused by Malassezia furfur, is a ringworm infection that affects the skin of the
chest or backdand, less commonly, the arms, thighs, neck, and face.

- Tinea nigra, caused by Hortaea werneckii, is a ringworm infection of the palms of the hands and,
less commonly, the neck and feet.

Fungal Infections of the Lower Respiratory Tract

• Pneumocystis Carinii Pneumonia (PCP, Interstitial Plasma-Cell Pneumonia) - PCP is an acute-to-

subacute pulmonary disease found in malnourished, chronically ill children; premature intrants, and
immunosuppressed patients, such as those with AIDS. Patients have fever, difficulty in breathing, rapid
breathing, dry cough, cyanosis, and pulmonary infiltration of alveoli with frothy exudate. PCP is usually
fatal in untreated immunosuppressed patients. - It is a common contributory cause of death in AIDS
patients.

Protozoal Infections of the Eyes

• Toxoplasmosis - Toxoplasmosis is a systemic sporozoan infection that, in immunocompetent persons,

may be asymptomatic or resemble infectious mononucleosis • Parasite: Toxoplasmosis is caused by
Toxoplasma gondii, an intracellular Sporzan
• Reservoirs and Mode of Transmission: Definitive hosts include cats and other felines that usually
acquire infection by eating infected rodents or birds. Intermediate hosts include rodents, birds, sheep,
goats, swine, and cattle. Humans usually become infected by eating infected raw or undercooked meat
(usually pork or mutton) containing the cyst form of the parasite or by ingesting oocysts that have been
shed in the feces of infected cats.

• Patient Care: Use Standard Precautions for hospitalized patients. Patient Care: Use Standard
Precautions for hospitalized patients.

Giardiasis is a protozoal infection of the duodenum (the uppermost portion of the small intestine) and
may be asymptomatic, mild, or severe. - Patients experience diarrhea, steatorrhea (loose, pale,
malodorous, fatty stools), abdominal cramps, bloating, abdominal gas, fatigue, and possibly weight loss.

• Pathogen: Giardiasis is caused by Giardia lamblia (also called Giardia intestinalis), a flagellated
protozoan). Trophozoites attach by means of a ventral sucker to the mucosal lining of the duodenum.
Trophozoites and/or cysts are expelled in feces. Reservoirs and Mode of Transmission: Reservoirs
include infected humans, possibly beavers and other wild and domestic animals that have consumed
water containing Glardia cysts; and fecally contaminated drinking water and recreational water. The
disease commonly occurs in day care centers. Transmission occurs via the fecal-oral route, usually by
ingestion of cysts in fecally contaminated water or foods, or from person to person by soiled hands to
mouth (as occurs in day care centers).