SECTION 1 General Microbiology

1 Introduction to Microbiology, 3

Introduction, 3

Five-Kingdom Classifi cation of Living Organisms, 3

Types of Microbes, 3

History of Microbiology, 4

Microbiology and Nurses, 5

2 Morphology and Physiology of Bacteria, 6

Introduction, 6

Typical Features of a Prokaryotic Cell, 6

Microscopy, 6

Staining of Bacteria, 7

Shape and Arrangement of the Bacteria, 8

Bacterial Anatomy, 8

Bacterial Appendages, 12

Bacterial Spores, 13

Bacterial Growth, 13

Bacterial Nutrition, 13

Oxygen Requirement, 14

Temperature Requirements, 14

Bacterial Growth Curve, 14

Synchronous Growth, 14

3 Culture Media, 16

Introduction, 16

Defi nitions, 16

History, 16

Agar, 16

Types of Culture Media, 16

Some Important Bacteriological Culture Media, 17

Anaerobic Culture Media, 19

4 Culture Methods, 20

Introduction, 20

Types of Culture Methods, 20

Anaerobic Culture Methods, 22

5 Laboratory Methods in Identifi cation of

Microorganisms, 25

Introduction, 25

Collection and Transport of Specimen, 25

Transport Medium, 26

Storage of Specimen, 26

Identifi cation of Bacteria, 26

SECTION 2 Infection Control

6 Infection, 35

Introduction, 35

Pathogen, 35

Infection, 35

Mode of Transmission, 36

7 Sterilization and Disinfection, 40

Introduction, 40

Defi nitions, 40

Difference Between Sterilization and Disinfection, 40

Factors that Influence the Degree of Sterilization and

Disinfection, 40

Methods of Sterilization and Disinfection, 41

Physical Methods of Sterilization, 41

Chemical Methods of Sterilization, 45

8 Hospital-Acquired Infection and Its Control, 48

Introduction, 48

Sources of Hospital-Acquired Infections, 48

Factors Influencing Hospital-Acquired Infections, 48

Microorganisms Causing Hospital Infection, 48

Routes of Transmission, 49

Common Hospital-Acquired Infections, 49

Infection Control Committee, 49

Role of Nurses in Prevention and Control of Infections, 50

9 Chemotherapy and Antibiotics, 52

Introduction, 52

Antibiotic, 52

Mechanisms of Action of Antibiotics, 52

Drug Resistance, 54

Antibiotic Sensitivity Test, 54

10 Hospital Waste Disposal, 57

Introduction, 57

Universal Precautions, 57

Defi nition of Biomedical Waste (BMW), 57

Types of Biomedical Waste, 57

Categories of Biomedical Waste, 58

Waste Segregation, 58

Treatment and Disposal Technologies for Health Care

Wastes, 58

SECTION 3 Medical Bacteriology

11 Staphylococcus, 63

Introduction, 63

Classifi cation, 63

Staphylococcus aureus, 63

Other Staphylococci, 65

12 Streptococcus, 67

Introduction, 67

Classifi cation of Streptococci, 67

Haemolytic Activity, 67

Serological Properties, 67

Biochemical (Physiologic) Properties, 67

Streptococcus pyogenes, 68

Virulence Factors of S. pyogenes, 68

Laboratory Diagnosis, 70

Treatment, 71

Other Pathogenic Streptococci, 71

Group B Streptococci: Streptococcus agalactiae, 71

Diseases, 71

Laboratory Diagnosis, 71

Group D Streptococci, 72

Enterococcus, 72

Characteristics of Enterococci, 72

Identifi cation, 72

Diseases, 72

Vancomycin-Resistant Enterococci, 72

Treatment, 72

Viridans Streptococci, 72

Streptococcus pneumoniae, 72

13 Neisseria, 76

Introduction, 76

Neisseria meningitidis (Meningococcus), 76

Neisseria gonorrhoeae (Gonococcus), 77

14 Corynebacterium, 80

Introduction, 80

Corynebacterium diphtheriae, 80

15 Clostridium, 85

Introduction, 85

Clostridium perfringens, 85

Clostridium tetani, 87

Clostridium botulinum, 89

Clostridium diffi cile, 90

16 Nonsporing Anaerobic Bacteria, 92

Introduction, 92

Classifi cation of Nonsporing Anaerobic Bacteria, 92

17 Mycobacteria, 94

Introduction, 94

Mycobacterium tuberculosis Complex, 94

Mycobacterium Tuberculosis, 94

Mycobacterium Leprae, 96

18 Haemophilus, Bordetella and Brucella, 99

Haemophilus, 99

Haemophilus influenzae, 99

Bordetella, 101

Bordetella pertussis, 101

Brucella, 102

19 Enterobacteriaceae, 104

Introduction, 104

Escherichia coli, 104

Shigella, 105

Klebsiella pneumoniae, 106

Salmonella typhi, 107

Proteus, 108

20 Vibrios, 110

Introduction, 110

Vibrio cholerae, 110

21 Pseudomonas, 113

Introduction, 113

Pseudomonas aeruginosa, 113

22 Mycoplasma, Chlamydia and Rickettsia, 115

Mycoplasma, 115

Mycoplasma pneumoniae, 115

Chlamydia, 116

Chlamydia trachomatis, 116

Chlamydia pneumoniae, 116

Chlamydia psittaci, 116

Genus rickettsia, 116

Rickettsia rickettsii, 117

23 Spirochaetes, 119

Introduction, 119

Treponema, 119

Treponema pallidum, 119

Borrelia, 120

B. recurrentis – Relapsing Fever, 121

Borrelia vincentii (Treponema vincentii) – Vincent’s

Angina, 121

B. burgdorferi – Lyme Disease, 121

Leptospira, 121

Leptospira interrogans, 121

24 Actinomycetes, 124

Introduction, 124

Actinomyces, 124

Nocardia, 125

25 Miscellaneous Bacteria, 126

Introduction, 126

Bacillus, 126

Bacillus anthracis, 126

Anthracoid Bacilli, 127

Bacillus cereus, 128

Helicobacter, 128

SECTION 4 Medical Virology

26 General Properties of Viruses, 133

Introduction, 133

Important Properties of Viruses, 133

Structure of Viruses, 133

Symmetry of Virus, 134

Viral Replication, 134

Epidemiological Aspects of Virus, 134

Types of Viral Infection, 135

Viral Tropism, 135

Laboratory Diagnosis of Viral Infection, 135

The Baltimore Classifi cation of Viruses, 137

27 DNA-Enveloped Viruses, 138

Introduction, 138

Poxviridae, 138

Herpesviruses, 139

Herpes Simplex Virus (HSV), 139

Varicella-Zoster Virus (VZV), 140

Cytomegalovirus (CMV), 140

Epstein–Barr Virus (EBV), 141

Human Herpesvirus (HHV6), 141

Human Herpesvirus 8 (HHV8), 141

28 DNA-Nonenveloped Viruses, 143

Introduction, 143

Parvoviruses, 143

Adenoviruses, 143

29 RNA-Enveloped Viruses, 146

Introduction, 146

Orthomyxoviruses, 146

Paramyxoviruses, 147

Rhabdoviruses, 148

30 RNA-Nonenveloped Viruses, 152

Introduction, 152

Picornaviruses, 152

Poliovirus, 152

Rhinoviruses, 153

Caliciviruses, 154

Reovirus, 154

Rotavirus, 154

31 Hepatitis Viruses, 155

Introduction, 155

Hepatitis a Virus – Infectious Hepatitis, 155

Hepatitis B Virus – Serum Hepatitis, 156

Hepatitis C Virus, 158

Hepatitis D Virus, 159

Hepatitis E Virus, 159

Hepatitis G Virus, 159

32 Arboviruses, 161

Introduction, 161

Classifi cation, 161

Chikungunya Virus, 161

Dengue Virus, 161

Kyasanur Forest Disease Virus, 162

33 Tumour Viruses, 164

Introduction, 164

Viral Tumorigenesis, 164

Human Tumour Viruses, 164

34 Slow Viruses and Prions, 167

Introduction, 167

Slow Diseases Caused by Conventional Viruses, 167

Slow Diseases Caused by Atypical Agents, 167

35 Human Immunodefi ciency Virus, 169

Introduction, 169

Structure, 169

Routes of Transmission, 169

Pathogenesis, 169

Clinical Features, 169

Laboratory Diagnosis, 170

Treatment, 171

36 Miscellaneous Viruses, 173

Introduction, 173

Astroviruses, 173

BK Virus, 173

Ebola Virus, 173

Hantaviruses, 173

Lassa Fever Virus, 173

Marburg Virus, 174

SECTION 5 Medical Mycology

37 Basic Mycology, 177

Introduction, 177

Morphology, 177

Mycotic Diseases, 177

Mycotic Infections, 178

Laboratory Diagnosis of Fungal Infections, 178

Antifungal Agents, 178

38 Cutaneous and Subcutaneous Mycoses, 180

Introduction, 180

Types of Cutaneous Mycoses, 180

Other Cutaneous Mycoses, 180

Subcutaneous Mycoses, 182

39 Systemic Mycoses, 184

Introduction, 184

Histoplasmosis, 184

Coccidioidomycosis, 184

Blastomycosis, 184

Paracoccidioidomycosis, 185

40 Opportunistic Mycoses, 186

Introduction, 186

Important Risk Factors, 186

Candidiasis, 186

Cryptococcosis, 186

Aspergillosis, 186

Zygomycetes, 187

SECTION 6 Medical Parasitology

41 Intestinal Protozoa, 191

Introduction, 191

Entamoeba histolytica, 191

Giardia lamblia, 192

Cryptosporidium, 193

42 Blood and Tissue Protozoa, 195

Introduction, 195

Plasmodium, 195

Leishmaniasis, 197

Trypanosomias, 198

African Sleeping Sickness, 198

Chagas Disease, 199

43 Other Minor Protozoan Pathogens, 201

Introduction, 201

Balantidium, 201

Acanthamoeba and Naegleria, 201

Toxoplasma, 201

Trichomonas, 202

44 Helminths: Cestodes, 204

Introduction, 204

Cestodes, 204

Taenia, 204

Taenia solium, 204

Taenia saginata, 206

Diphyllobothrium, 207

Echinococcus, 207

Hymenolepis nana, 209

45 Helminths: Trematodes, 211

Introduction, 211

Schistosoma, 211

Clonorchis, 212

Paragonimus westermani, 213

46 Helminths: Nematodes, 217

Introduction, 217

Enterobius vermicularis – the Pinworm, 217

Trichuris trichiura – the Whipworm, 219

Ascaris lumbricoides, 221

Hookworm, 223

Strongyloides stercoralis – Thread Worm, 224

Trichinella spiralis, 224

Filarial Worms, 225

Wuchereria bancrofti and Brugia malayi, 225

47 Laboratory Methods in Identifi cation of Parasites, 229

Introduction, 229

Stool Examination, 229

Blood Examination, 230

Serum and Plasma, 230

Sputum Examination, 230

Vaginal Swabs, 230

Urine Specimens, 230

SECTION 7 Laboratory Diagnosis of Systemic Infections

48 Respiratory Tract Infections, 233

Introduction, 233

Laboratory Diagnosis of Upper Respiratory Tract

Infections, 233

Laboratory Diagnosis of Lower Respiratory Tract

Infections, 234

49 Urinary Tract Infections, 236

Introduction, 236

Aetiology of UTIs, 236

Laboratory Diagnosis, 236

50 Diarrhoeal Infections, 238

Introduction, 238

Aetiology, 238

Laboratory Diagnosis, 238

51 Central Nervous System Infections, 240

Introduction, 240

Encephalitis, 240

Meningitis, 240

52 Skin and Soft Tissue Infections, 242

Introduction, 242

Aetiology of SSTIs, 242

Laboratory Diagnosis, 242

53 Infective Endocarditis, 244

Introduction, 244

Predisposing Factors, 244

Aetiology of Infective Endocarditis, 244

Laboratory Diagnosis, 244

54 Pyrexia of Unknown Origin, 246

Introduction, 246

Microbial Aetiology of PUO, 246

Laboratory Diagnosis of PUO, 246

SECTION 8 Immunology

55 Immunity, 251

Introduction, 251

Types of Immunity, 251

56 Antigens and Antibodies, 254

Introduction, 254

Antigens, 254

Types of Antigen, 254

Antigens of Microorganisms, 254

Autoantigens, 254

Tumour Antigens, 255

Characteristics of Antigens, 255

Haptens or Incomplete Antigens, 255

Factors Infl uencing Immunogenicity, 255

Epitopes, 255

Superantigens, 255

Heterophilic Antigens, 255

Sequestered Antigens, 255

Antibody, 255

Structure of Immunoglobulin, 255

Enzymatic Digestion of Immunoglobulin, 256

Immunoglobulin Isotypes: Classes of Antibodies, 256

Functions of Antibodies, 256

57 Antigen–Antibody Reaction, 258

Introduction, 258

Types of Antigen–Antibody Reactions, 258

Precipitation Reactions, 258

Agglutination, 260

Labelled Immunoassay Techniques, 261

58 Serological Tests, 264

Introduction, 264

Important Serological Tests, 264

59 Hypersensitivity Reactions, 268

Introduction, 268

Type I: Immediate Hypersensitivity, 268

Type II: Cytotoxic Hypersensitivity, 269

Type III: Immune Complex Hypersensitivity, 270

Type IV: Hypersensitivity Reaction, 270

60 Vaccines, 272

Introduction, 272

Types of Vaccines, 272

Live Vaccines, 272

Toxoids, 273

Killed or Inactivated Whole Cell Vaccines, 273

Subunit Vaccines, 273

Conjugate Vaccines, 273

Recombinant DNA-Derived Antigen Vaccines, 273

Synthetic Peptide Vaccines, 273

Anti-Idiotypic Vaccines, 273

Immunization Schedule, 273

Herd Immunity, 273

Vaccine Storage or Cold Chain, 273

Glossary, 276

Index, 279