Chapter 02: Host–Parasite Interaction
Mahon: Textbook of Diagnostic Microbiology, 6th Edition
MULTIPLE CHOICE
1. Organisms that participate in a biological relationship where both benefit from one another are
called
a. parasites.
b. symbionts.
c. hosts.
d. flora.
ANS: B
Symbiosis is a relationship where two organisms live together and their association benefits
both organisms. Organisms that live in symbiosis are said to be symbionts. Parasites are
organisms that live off a host and harm the host. The host is the organism that provides the
nutrients to the other organisms. Flora are described as microorganisms that inhabit the body
sites of healthy individuals.
OBJ: Level 1: Recall
2. Parasitism is
a. a biological relationship between two or more organisms in which both benefit
from one another.
b. a biological relationship between only two organisms in which there are no
beneficial or harmful effects to the host.
c. a biological relationship in which one species gains benefits at the expense of the
host.
d. a synonym for mutualism.
ANS: C
When both organisms live together and one organism benefits at the expense of the host, this
is parasitism. When both organisms live together and both benefit, this is symbiosis. When
both organisms live together and neither benefits, this is commensalism. Mutualism and
symbiosis are synonyms.
OBJ: Level 1: Recall
3. This bacterial state occurs when a host harbors a disease-causing organism, but does not show
signs of disease.
a. Carrier
b. Transient
c. Resident
d. Indigenous
ANS: A
Transient, resident, and indigenous refer to particular types of flora associated with the human
body, whereas carrier refers to the state in which pathogenic organisms establish themselves in
a host without causing disease, but the host can still transmit the infection.
OBJ: Level 1: Recall
4. Healthy people are colonized by many different bacteria in many different sites. These
bacteria are referred to as
a. transient flora.
b. carrier flora.
c. maintenance flora.
d. indigenous flora.
ANS: D
Indigenous flora are usual or normal flora, whereas transient flora are microbial flora that are
present at a site temporarily. Carrier and maintenance flora are not types of microbial flora
found on the human body.
OBJ: Level 1: Recall
5. Diabetics may sometimes be infected with their own resident flora. This type of infection is
called
a. an opportunistic infection.
b. a carrier state.
c. symbiosis.
d. a parasitic infection.
ANS: A
Opportunistic infections occur when the host has changes in body chemistry associated with
age, disease states, and drug or antibiotic effects. Carrier states are those in which a host does
not show symptoms of a disease, but it can infect other hosts with pathogenic organisms.
Symbiosis is a biological relationship that benefits the host and the organism. A parasitic
infection is one in which the parasite receives benefits, but at the expense of the host.
OBJ: Level 1: Recall
6. Mechanisms used by the skin to prevent infection and protect the underlying tissue from
invasion by potential pathogens include all the following, except
a. desquamation of the epithelium.
b. excretion of lysozyme by sweat glands.
c. antibiotics that inhibit many microorganisms.
d. mechanical separation of microorganisms from the tissues.
ANS: C
The skin produces fatty acids that inhibit microorganisms, not antibiotics. The remaining three
mechanisms are described in the text on page 25.
OBJ: Level 1: Recall
7. A laboratory professional is testing a new antimicrobial soap. The tech washes her forearm
then does a culture of the skin. Which organisms should she most likely expect to find
growing in the culture?
a. Diphtheroids and Bacillus spp.
b. Staphylococcus epidermidis and Propionibacterium
c. S. aureus and Propionibacterium
d. Diphtheroids and Propionibacterium
e. None of these organisms should be found.
ANS: B
Superficial antisepsis of the skin does not kill the Propionibacterium and S. epidermidis that
live in the hair follicles and sebaceous glands. Diphtheroids are found in moist areas such as
the axillae and toes. S. aureus is typically a pathogen but can be found on healthy skin.
Handwashing does not remove all bacteria from the skin.
OBJ: Level 1: Interpretation
8. What mechanism allows strict anaerobes to grow in the cervices and areas between the teeth
when plaque is present?
a. A low oxidation-reduction potential occurs at the tooth surface under the plaque.
b. The bacteria secrete sugar to nourish the strict anaerobes.
c. The normal flora secrete antibiotics to kill all the other bacteria and allow the strict
anaerobes to thrive.
d. The plaque-causing bacteria secrete an alkaline fluid and change the pH around the
tooth.
ANS: A
The growth of the plaque-causing bacteria on the tooth’s surface contain as many as 1011
streptococci per gram, and this amount of bacteria lowers the oxidation-reduction potential at
the tooth surface. Strict anaerobes cannot grow in the presence of oxygen, and lowering the
oxidation-reduction potential lowers the amount of oxygen at the tooth surface. Normal oral
flora organisms do not secrete sugar, antibiotics, or alkaline fluid.
OBJ: Level 1: Recall
9. The stomach can be considered a first line of defense against microbial infections because
a. most microorganisms are susceptible to the antibiotics and alkaline pH present in
the stomach.
b. most microorganisms are killed by the liver enzymes that are emptied into the
stomach during a meal.
c. the stomach produces proteases, which attack the lipopolysaccharide cell wall of
the organisms.
d. most microorganisms are susceptible to the acid pH of the stomach.
ANS: D
The stomach cells secrete enough acid to create an environment with a pH of approximately 1.
Bacteria that are enmeshed in food, spore-forming bacterial species in their spore phase, and
the cysts of parasites can survive the extreme pH present in the stomach. The stomach does
not produce antibiotics, and liver enzymes do not empty into the stomach during digestion.
OBJ: Level 1: Recall
10. This type of bacteria is able to live in the colon with little to no oxygen and is the predominant
organism.
a. Anaerobes
b. Facultative anaerobes
c. Facultative gram-negative rods
d. Gram-positive cocci
ANS: A
Anaerobes make up over 90% of the microbial flora of the large intestine. The facultative
anaerobes, facultative gram-negative rods, and gram-positive cocci are present in the colon in
much smaller numbers than the anaerobes.
OBJ: Level 1: Recall
11. After perforation of the colon, surgeons must guard against infection in the _____ because of
leakage of the contents of the colon.
a. peritoneal cavity
b. urinary bladder
c. vaginal flora
d. renal vein
ANS: A
The peritoneal cavity is the space between the internal organs and the abdominal wall—a
normally sterile space. The colon contains lots of bacteria that can cause an infection in this
normally sterile space because there are no normal flora or immune system cells here to fight
off an infection. The organisms would have no natural defenses to overcome before causing
an infection.
OBJ: Level 1: Recall
12. The human body is constantly challenged by pathogens in the environment. It is not infected
by every pathogen it encounters because the microbial flora
a. engulf the pathogenic bacteria.
b. produce conditions at the microenvironmental level that block colonization.
c. prime our immune system.
d. activate and support the action of antigen-presenting cells, cytokines, and cell-
mediated immunity.
ANS: B
Several mechanisms are used by microbial flora to ensure that colonization of pathogenic
organisms is blocked, such as lowering the reduction-oxidation potential, lowering the pH,
producing antimicrobials, and depleting the nutrients present in a particular environment.
OBJ: Level 2: Interpretation
13. The ability of an organism to produce disease in an individual is called
a. pathogenicity.
b. iatrogenic infection.
c. parasitic infection.
d. opportunistic infection.
ANS: A
An iatrogenic infection occurs as the result of medical treatment or procedure. A parasitic
infection occurs when an organism invades a host and only the organism benefits from the
biological relationship. An opportunistic infection occurs when the condition of the host
changes and the resident flora cause an infection.
OBJ: Level 1: Recall
14. A patient with an indwelling catheter develops a fever and lethargy. In addition, the urine in
the catheter bag has turned a brownish color and smells foul, which suggests an infection is
present. What type of infection does this describe?
a. Opportunistic
b. Iatrogenic
c. Pathogenic
d. Parasitic
ANS: B
An iatrogenic infection occurs as the result of medical treatment or procedures. In this case,
the use of an indwelling catheter to treat a medical condition has resulted in an infection. An
opportunistic infection occurs when a host’s condition changes and resident flora are able to
cause disease. Pathogenic describes the types of organisms that cause disease, but not a type
of infection. A parasitic infection occurs when an organism invades a host and only the
organism benefits from the biological relationship.
OBJ: Level 2: Recall
15. The smaller the number of microorganisms necessary to cause infection in a competent host,
the more _____ the microorganism.
a. opportunistic
b. parasitic
c. invasive
d. virulent
ANS: D
Virulence refers to the relative ability of a microorganism to cause disease; more virulent
organisms need fewer organisms to cause disease in a host. Opportunistic refers to a type of
resident flora that causes infection when the conditions in a host change. A parasitic infection
occurs when an organism invades a host and only the organism benefits from the biological
relationship. Invasive refers to entering tissue, not the degree of ease with which an organism
can cause disease.
OBJ: Level 1: Recall
16. Factors that determine the pathogenicity and increase the virulence of organisms include all
the following, except
a. an organism’s ability to avoid phagocytosis.
b. an organism’s ability to produce exotoxins and extracellular enzymes.
c. an organism’s ability to produce infection when host conditions change.
d. an organism’s ability to survive intracellularly when phagocytized.
ANS: C
An organism’s ability to produce infection when the host conditions change is referred to as
an opportunistic pathogen. The other three statements refer to ways that a microorganism can
survive the attack of a host’s immune system and produce disease.
OBJ: Level 2: Interpretation
17. The most common bacterial characteristic that allows for evasion of phagocytosis by the host
is called
a. exotoxin production.
b. extracellular enzyme production.
c. pili.
d. polysaccharide capsule.
ANS: D
Organisms possessing a polysaccharide capsule are considered highly virulent because they
can evade phagocytosis. Exotoxin and extracellular enzyme production and pili are factors
that can increase an organism’s virulence. The exotoxins and extracellular enzymes may be
used to survive phagocytosis, but these do not help an organism evade phagocytosis. Pili are
used to transfer plasmids that may contain the genes for antimicrobial resistance and,
therefore, help an organism survive in the host.
OBJ: Level 1: Recall
18. This is a leukocidin that is lethal to leukocytes and produced by staphylococci.
a. Panton-Valentine
b. Lancefield
c. Hemolysin
d. Adhesins
ANS: A
The Panton-Valentine leukocidin is lethal to leukocytes and contributes to the invasiveness of
staphylococci. Lancefield deals with classifying -hemolytic streptococci on the basis of
antigens found on their outer covering. Hemolysins are produced by streptococci, and these
lyse red blood cells. Adhesins are cell-surface structures that mediate attachment to other
cells.
OBJ: Level 1: Recall
19. Changes in these host structures can result in lower virulence of a microorganism.
a. Pili
b. Adhesin receptors
c. Surface polysaccharides
d. Phagocytes
ANS: B
Adhesin receptors are structures found on the host cell that are necessary for attachment of
bacterial adhesins and the beginnings of an infection. Pili and surface polysaccharides are the
main bacterial structures of attachments called adhesins. Phagocytes are white blood cells
(WBCs) that engulf invading microorganisms.
OBJ: Level 1: Recall
20. After attachment to host cells, a pathogen may use the following mechanisms to establish
itself and cause disease, except:
a. Uses lactoferrin for iron
b. Produces an IgA protease that degrades the IgA at mucosal surfaces
c. Produces lysozyme to kill the host cell
d. Circumvents host antibodies by shifting key cell-surface antigens
ANS: C
After engulfing bacteria, the host cell releases lysosomal contents that kill the organism. The
bacteria do not produce lysozyme.
OBJ: Level 1: Recall
21. Dissemination of a pathogen is
a. when a pathogen penetrates and grows in tissues.
b. when a pathogen multiplies intracellularly.
c. when a pathogen circumvents host antibodies by shifting key cell-surface antigens.
d. when infection with a pathogen spreads from the initial infection site to distant
sites such as organs and tissues.
ANS: D
Invasion of a pathogen allows the microbe to take advantage of the host’s transport system
(the blood) and seek out other areas that can be infected. This occurs only if the pathogen can
elude the host’s immune system during this journey. Invasion is when a pathogen penetrates
and grows in tissues. Intracellular multiplication of a pathogen occurs when an organism can
survive phagocytosis. When a pathogen shifts key cell-surface antigens, it is evading a host’s
immune system.
OBJ: Level 1: Recall
22. A physician notices that several patients are infected with Clostridium difficile, but only a few
of the patients are symptomatic for disease. The reason for this discrepancy is
a. only those strains of the organism carrying the extrachromosomal DNA coding for
the toxin gene will produce toxin and cause the individuals to be symptomatic.
b. only those strains of the organism carrying DNA coding for the toxin within its
main DNA molecule will produce toxin and cause the individuals to be
symptomatic.
c. the exotoxin produced contains only the nontoxic portion.
d. the exotoxin must be produced in conjunction with extracellular enzymes to cause
problems.
ANS: A
The exotoxin gene is commonly encoded for by phages, plasmids, or transposons and does not
normally reside within an organism’s main DNA molecule. Exotoxins are highly characterized
molecules that are composed of a nontoxic subunit that binds the toxin to the host cells,
allowing attachment of the toxin. Exotoxins exhibit their effects without the aid of
extracellular enzymes. Extracellular enzymes are another factor that contributes to the
virulence and invasiveness of organisms.
OBJ: Level 2: Interpretation
23. The effects of endotoxins consist of dramatic changes in all the following, except
a. blood pressure.
b. fluid imbalance.
c. clotting.
d. body temperature.
ANS: B
Unlike shock caused by fluid loss, such as that seen in severe bleeding, septic shock is
unaffected by fluid administration. An increase in body temperature occurs within an hour
after exposure. Severe hypotension occurs within 30 minutes after exposure. The endotoxin
also initiates coagulation, which can result in intravascular coagulation.
OBJ: Level 2: Interpretation
24. A patient is brought to the emergency room with the following symptoms: body temperature
of 102° F, low blood pressure, elevated WBC, and disseminated intravascular coagulation.
This person has gram-negative rods growing in the blood. What is responsible for these
symptoms?
a. Exotoxin
b. Extracellular enzymes
c. Endotoxin
d. Exfoliating toxin
ANS: C
Effects of the lipid A portion of the lipopolysaccharide present in the cell walls of gram-
negative bacteria include increased body temperature, hypotension, intravascular clotting,
neutropenia, metabolic changes, changes in humoral and cellular immunity, and changes
resistance to infection.
OBJ: Level 3: Synthesis
25. Healthy skin secretes these substances to help prevent colonization by transient and possibly
pathogenic organisms.
a. Long-chain fatty acids
b. Sebaceous glands
c. Carbohydrates
d. Antibodies
ANS: A
Long-chain fatty acids produced by the sebaceous glands allow the skin environment to be
acidic, leading to a low pH environment. Many pathogens prefer the near-neutral environment
in the body to produce disease. Bacteriocidal substances are produced by the microbial flora
that colonize the skin, and antibodies are produced by lymphocytes.
OBJ: Level 1: Recall
26. Lysozyme is
a. an antibody produced by the skin.
b. a low-molecular-weight enzyme that hydrolyzes the peptidoglycan layer of
bacterial cell walls.
c. an exotoxin that digests the lipopolysaccharide layer of the bacterial cell wall.
d. a radical similar to hydrogen peroxide.
ANS: B
Antibodies are produced only by the lymphocytes. Exotoxins are produced by bacteria and are
toxic to the host. Lysozyme is a low-molecular-weight enzyme that hydrolyzes the
peptidoglycan layer of bacterial cell walls.
OBJ: Level 1: Recall
27. Interferon is a substance produced by the body that inhibits viral replication. Interferon
accomplishes this task by
a. digesting the virus that is attempting to attach to the host cell.
b. destroying the host cell before the virus can attach and replicate.
c. binding to surface receptors that stimulate the cell to synthesize enzymes that
inhibit viral replication over several days.
d. stimulating platelets to produce -lysins.
ANS: C
Interferon is produced by eukaryotic cells in response to a viral infection, and it stimulates the
cell to synthesize enzymes that inhibit viral replication over several days. Interferons are not
enzymes and cannot digest viruses. Destroying the host cell before the virus can attach would
be counterproductive, because the purpose is to keep the host cells viable and free of
infection. The -lysin’s cationic proteins are produced by platelets during coagulation and are
active against gram-positive bacteria, not viruses.
OBJ: Level 2: Interpretation
28. All the following activities must occur for phagocytosis to take place and be effective in host
defense, except
a. attachment of the particle to the phagocyte.
b. ingestion.
c. killing.
d. migration of lymphocytes to the area of infection (chemotaxis).
ANS: D
Phagocytes are neutrophils or macrophages. Lymphocytes are not phagocytic and cannot
engulf bacteria.
OBJ: Level 1: Recall
29. This process results in enhanced phagocytosis by neutrophils.
a. Opsonization
b. Chemotaxis
c. Digestion
d. Glycolysis
ANS: A
Chemotaxis is the process of phagocytes migrating toward the site of the infection. Digestion
is when the contents of the lysozyme are mixed with the phagocytized bacteria. Glycolysis is a
metabolic process where glucose is broken down and energy is generated.
OBJ: Level 1: Recall
30. One of the most effective defenses bacteria have against phagocytosis is
a. enzymes.
b. the capsule.
c. plasmids.
d. lipopolysaccharide layer.
ANS: B
Enzymes facilitate host cell destruction but do not have any effect on phagocytosis. Plasmids
carry small pieces of DNA that can code for toxins, enzymes, and antibiotic resistance. The
lipopolysaccharide layer acts as an endotoxin that causes septic shock.
OBJ: Level 1: Recall
31. Innate immunity consists of which of the following components?
a. Physical and chemical barriers such as the skin and mucous membranes
b. Blood proteins that act as mediators of infection
c. Cells capable of phagocytosis
d. All of the above are part of the innate immune system
ANS: D
Innate immunity includes (1) physical and chemical barriers, such as the skin and mucous
membranes; (2) blood proteins that act as mediators of infection; and (3) a cellular mechanism
capable of phagocytosis, such as neutrophils and macrophages, and other leukocytes such as
natural killer cells.
OBJ: Level 2: Interpretation
32. The major constituents of the adaptive or specific immune response are
a. neutrophils.
b. macrophages.
c. monocytes.
d. lymphocytes.
ANS: D
Lymphocytes produce antibodies in response to specific antigens present in the blood.
Neutrophils, macrophages, and monocytes are all phagocytic cells that function in innate
immunity, not the specific immune response.
OBJ: Level 1: Recall
33. This class of antibodies is usually found as a pentamer.
a. IgM
b. IgG
c. IgA
d. IgE
ANS: A
IgM is made up of five basic immunoglobulin subunits and is considered a pentamer. IgG is a
monomer, IgA is a dimer, and IgE is a monomer.
OBJ: Level 1: Recall
34. A subsequent exposure to the same antigen elicits a(n) _____, characterized by a rapid
increase in IgG antibody associated with higher levels, a prolonged elevation, and a more
gradual decline in antibody levels.
a. primary immune response
b. anamnestic immune response
c. opsonin immune response
d. innate immune response
ANS: B
The primary immune response consists of production of IgM antibodies. The innate immune
response does not consist of antibody production but rather physical and chemical barriers to
infection and phagocytosis.
OBJ: Level 1: Recall
35. These are low-molecular-weight proteins secreted by T cells.
a. Antibodies
b. Opsonins
c. Lymphokines
d. Lysozyme
ANS: C
Antibodies are produced by B cells. Opsonins are antibodies or pieces of complement that
help make a pathogen ready to be phagocytized. Lysozyme is the enzyme present in host cell
vacuoles that assist in killing a phagocytized microorganism. Lymphokines are produced by T
cells as a result of antigen binding, activation, cell division, and differentiation.
OBJ: Level 1: Recall
36. Immunity to intracellular bacterial pathogens, such as Mycobacterium tuberculosis, is
primarily cell mediated, through the activities of
a. interferons and macrophages.
b. antibodies and lymphokines.
c. lysozyme, T lymphocytes, and antibodies.
d. T lymphocytes, lymphokines, and macrophages.
ANS: D
T lymphocytes, lymphokines, and macrophages are used by the immune system to battle
intracellular pathogens most effectively. Interferons are useful against viruses, not bacteria.
Macrophages are effective against intracellular pathogens because they are phagocytes.
Antibodies are not useful against intracellular pathogens because they cannot reach the
pathogen that lives inside the cell. Lysozyme is an enzyme that is used to kill bacteria once
they are phagocytized.
OBJ: Level 2: Interpretation
37. Pathogens can be transmitted through all the following routes, except
a. ingestion.
b. handwashing.
c. sexual contact.
d. air.
ANS: B
Handwashing is a major method to prevent spread of infections. Pathogens can be transmitted
by ingestion, sexual contact, and air.
OBJ: Level 1: Recall
38. Because infections can be encountered via the air, _____ can cause transmission of some
pathogens.
a. cuts
b. eyes
c. coughing
d. eating
ANS: C
Airborne infections are the most commonly encountered infections. They are transmitted by
droplets in the air that can be generated by coughing or sneezing. Cuts, eyes, and children are
not usual pathways for airborne transmission of a pathogen.
OBJ: Level 1: Recall
39. The resulting disease from this route of transmission is a disease of animals that is transmitted
to humans.
a. Sexual contact
b. Zoonotic
c. Airborne
d. Ingestion
ANS: B
Sexual contact, airborne, and ingestion are all routes of transmission for diseases of humans
that are passed from person to person. Zoonotic describes diseases of animals that infect
humans.
OBJ: Level 1: Recall