12.

Medical microbiology

 Definition of Terms
 Mechanisms of Pathogenicity
 Major microbial diseases and pathogens
 Diagnosis and control of microbial diseases
 Immunity to infection
 Chemotherapy: Antimicrobial drugs

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 Objectives
At the end of this unit students will be able:

• To distinguish between pathogenicity & virulence

• To explain how pathogens cause diseases

• To define normal flora, pathogens, opportunistic

pathogens

• To describe various bacterial and viral diseases

• To discuss immunity to infections

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 Definition of Terms
• Medical microbiology is the study of microbes that
cause diseases (infectious agents) in humans and
animals.

• Microbes that cause diseases are called pathogens.

• Microbial pathogens include bacteria, fungi, protozoa,

viruses and some algae can cause diseases. Helminthes
are also pathogens.

• An opportunistic pathogen is a microbe that causes

infection in patients with impaired immunity.

• Diseases caused by pathogens are called infectious

diseases.
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• Pathogenicity is the ability of a pathogen to
cause disease.

• Virulence is the degree of pathogenicity.

• Infectivity is the ability to breach the host’s

defenses.

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• Pathology is the scientific study of disease.

• It is concerned with
– the cause (etiology) of disease,
– pathogenesis, and
– structural and functional changes brought about by
disease and with their final effects on the body.

• Pathogenesis is the manner in which a disease

develops.

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• Infection refers to the invasion of the host by a
microorganism.

• Invasion is penetration of host cells and tissues.

• The establishment of a stable population of bacteria

in the host is called colonization.

• Disease refers to infections that result in clinical

signs and symptoms.

• The incubation period is the interval between the

initial infection and the first appearance of any signs
or symptoms. 6
• Epidemiology is the study of spread of infection,
including the source, transmission, distribution
and prevalence of infection in the community.

• Acquisition of pathogens may occur via many

routes, including direct contact, inhalation,
ingestion, injection or vertical transmission.

• Reservoirs are sources of infection.

– Examples: animals, humans, soil, water, food, etc.

• Incidence is the number of new disease cases in

a population in a given time period. 7
• The prevalence of a disease is the number of people
in a population who develop a disease at a specified
time, regardless of when it first appeared.

• If a particular disease occurs only occasionally, it is

called a sporadic disease.

• A disease constantly present in a population is called

an endemic disease.

• If many people in a given area acquire a certain

disease in a relatively short period, it is called an
epidemic disease.

• An epidemic disease that occurs worldwide is called

a pandemic disease. 8
• An acute disease is one that develops rapidly
but lasts only a short time. Eg. influenza.

• A chronic disease develops more slowly, and

the body’s reactions may be less severe, but
the disease is likely to continue or recur for
long periods.

• Zoonoses are diseases that affect wild and

domestic animals and can be transmitted to
humans.

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 12.1. Mechanisms of Pathogenicity
• Pathogenicity is the capacity to cause disease by
overcoming the defenses of a host.

• This will require transmissibility between hosts,

survival in the new host, infectivity and
virulence.

• To cause disease, most pathogens must

– gain access to the host,
– adhere to host tissues,
– penetrate or evade host defenses, and
– damage the host tissues.
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Gaining access to the host
• Pathogens can gain entrance to the human body
and other hosts through several avenues, which
are called portals of entry.

• The portals of entry for pathogens are

– mucous membranes (lining the respiratory tract,
gastrointestinal tract, genitourinary tract, and
conjunctiva),
– skin, and
– direct deposition beneath the skin or membranes
(the parenteral route) when these barriers are
penetrated or injured.
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Virulence
• Virulence is measured by the number of microbes
required to cause disease.

• Virulence depends on the ability of the pathogen to

invade body tissues (invasiveness) and to produce
toxins (toxigenicity).

• Pathogens have various factors that enhance their

ability to establish infection, survive host’s defense,
or ignore the infected host. These are called
virulence factors.

• Virulence factors include ability to adhere, to and

invade a specific body cells or tissues, to avoid host
defense and produce toxins. 12
Adherence

• Almost all pathogens have some means of

attaching themselves to host tissues at their portal
of entry.

• This attachment is called adherence (or adhesion).

• The attachment between pathogen and host is

accomplished by means of surface molecules on
the pathogen called adhesions or ligands that bind
specifically to complementary surface receptors on
the cells of certain host tissues.
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Overcoming host defense
• Mechanisms by which pathogens evade host
immunity:

• The capsule impairs phagocytosis.

• The M protein mediates attachment and helps the

bacterium resist phagocytosis by white blood cells.

• The waxy lipid (mycolic acid) of cell wall of M.

tuberculosis resists digestion by phagocytes.

• Some pathogens can alter their surface antigens (

antigenic variation). 14
Host tissue damage

• If the pathogen overcomes the host’s defense,

then the microorganism can damage host tissue
by:
– using the host’s nutrients;
– causing direct damage to tissue;
– producing toxins ; and
– inducing hypersensitivity reactions.

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 12.2.Major microbial diseases and pathogens
• Tuberculosis is a lung disease that is caused by
Mycobecterium tuberculosis.

• It also attacks other parts of the body such as the

kidneys, bones, lymph nodes, and brain.

• It is transmitted through breath.

• Leprosy is caused by the bacterium Mycobacterium

leprae.

• It primarily affects cooler, surface areas of the body,

such as the skin, nerves near the skin, and the
surface membranes of the nose and mouth.
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• Typhoid fever is an acute infectious disease caused by
Salmonella typhi.

• The bacterium is transmitted by milk, water, or solid food

contaminated by feces of typhoid victims or of carriers.

• Trachoma is a contagious infection of the eye caused by

Chlamydia trachomatis.

• Infection is spread by the bite of a house fly.

• Tetanus is a disease of the nervous system, in which a

bacterial toxin causes severe muscle contraction.

• Infection occurs when wounds are contaminated with

Clostridium tetani. 17
• Meningitis is an inflammation of the meninges.

• It may be caused by a physical injury, a reaction to

certain drugs, or more commonly, by viruses,
bacteria, fungi, or parasites.

• Gonorrhea is a sexually transmitted disease of

humans, which primarily involves the mucous
membranes of the urogenital tract.

• Characterized by a discharge of pus.

• It is caused by Neisseria gonorrhoeae.

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• Diphtheria is an acute and highly infectious disease,
affecting children particularly, characterized by the
formation of a false membrane in the throat.

• It is caused by Corynebacterium diphtheriae.

• Pneumonia is the inflammation of lung.

– Fever, chills, cough, breathing difficulty
• It is primarily caused by viruses, bacteria,
mycoplasmas and fungi.

• Whooping cough (pertussis) is an acute disease of

the respiratory tract, caused by Bordetella pertussis.
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• Rabies is an acute, contagious infection of the
central nervous system, caused by a rabies virus
that enters the body through the bite of an
animal.

• Rabies is virtually always fatal when vaccine is not

administered.

• Hepatitis is an inflammation of the liver caused

by viruses, bacterial infections, or continuous
exposure to alcohol, drugs, or toxic chemicals.

• Hepatitis can also result from an autoimmune

disorder.
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• Influenza is a contagious infection primarily of the
respiratory tract.
• It is characterized by cold-like symptoms plus chills,
fever, headaches, muscle aches, and fatigue.

• Polio is infectious viral disease that can result in

paralysis.

• The infection chiefly affects children and young

adults and is caused polio virus.

• Mumps is an acute infectious disease caused by a

mumps virus that mainly attacks glandular and
nervous tissues, frequently characterized by swelling
of the salivary glands.
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• Measles is an acute, highly contagious, fever-
producing disease caused by a measle virus.

• It is characterized by small red dots appearing on the

surface of the skin, irritation of the eyes, coughing,
and a runny nose.
• Yellow fever is a noncontagious, infectious disease,
caused by a yellow fever virus, and characterized in
severe cases by high fever and jaundice.
• It also affects monkeys and other animals.

• It is transmitted by mosquito.

• Pathogenic fungi cause mycoses (superficial,

cutaneous, subcutaneous, systemic or opportunistic).
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 12.3. Diagnosis and control of microbial diseases
• Laboratory diagnosis is done by culture, microscopy,
biochemical tests, serological tests (e.g. ELISA) and
molecular methods such as PCR.

Ways of controlling of microbial diseases:

• Blocking transmission ways. E.g. Vector control

• Hygiene and sanitation

• Isolation - a patient with a communicable disease is

prevented from having contact with the general
population.

• Immunization by vaccination
• Use of antimicrobial drugs
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 12.4. Immunity to infection
• Immunity is the ability of our body to resist
infection.

• Immunity to infections is provided by the immune

system.
• It consists of cells, molecules, and organs that act
together to defend the body against foreign
invaders.

– Cells: WBC (neutrophils, eosinophils, basophils,

macrophages, dendritic cells, natural killer cells, T cells, B
cells , etc)
– Molecules: antibodies, cytokines, complement proteins,
etc
– Organs: Bone marrow, thymus, spleen, lymph nodes,
tonsils, etc 24
• There are two types of immunity: innate
(nonspecific) and adaptive (specific).

• Innate (nonspecific) immunity is the body’s first,

generalized line of defense against all invaders.

• Innate immunity is provided by

– barriers such as skin, tears, mucus, and saliva
– phagocytosis
– inflammation of tissues
– Antimicrobial substances
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• Adaptive (specific) immunity provides specific
response to a specific microbe.

• It is of two types: humoral and cellular immunity.

• Humoral immunity is mediated by B cells though

production of antibodies.
– Fights extracellular pathogens
• Cellular immunity is mediated by T cells, which
can directly kill infected cell or release chemicals
that kill pathogens.
– Fights intracellular pathogens and tumor cells. 26
• We can acquire immunity in our life time in two
ways:
– active immunization and
– passive immunization.

• In active immunization body's immune system is

activated and generates immune responses.

• Active immunization can be triggered in two

ways:
– by natural immunization (exposure to antigens)
(natural active immunity)
– by vaccination (artificial active immunity)
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• Passive immunization does not engage the
person’s own immune system.

• The individual receives antibodies that were

created in another person or animal.
– Natural passive immunity
– Artificial passive immunity

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 12.5. Chemotherapy: Antimicrobial drugs
• An antimicrobial drug is a chemical substance that
destroys pathogenic microorganisms with minimal
damage to host tissues.

• Antimicrobial drugs are either microbicidal (they kill

microbes directly) or microbistatic (they prevent
microbes from growing).

• They have selective toxicity.

– They must not interfere with essential functions of the host.

• Antibacterial drugs affect many targets in a prokaryotic

cell.

• Antimicrobial agents should not cause excessive harm to

normal microbiota. 29
Mechanism of action of antimicrobial drugs

• Inhibitors of cell wall synthesis: penicillins,

cephalosporins, bacitracin, vancomycin

• Inhibitors of protein synthesis: chloramphenicol,

erythromycin, tetracyclines, streptomycin

• Inhibitors of nucleic acid replication and

transcription: quinolones, rifampin

• That cause Injury to plasma membrane: polymyxin

B and bacitracin

• Inhibitors of essential metabolite synthesis:

sulfanilamide, trimethoprim 30
Mechanisms of Resistance to antimicrobial drugs

• Many bacterial diseases, previously treatable with

antibiotics, have become resistant to antibiotics.

• Drug resistance factors are transferred horizontally

between bacteria.

• Resistance may be due to

– enzymatic destruction or inactivation of a drug,
– prevention of penetration of the drug to its target site,
– cellular or metabolic changes at target sites,
– altering the target site, or
– rapid efflux of the antibiotic.
• The discriminating use of drugs in appropriate
concentrations and dosages can minimize resistance.
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