Microbiology Final Exam Material

Chapter 12: Healthcare Epidemiology
Microbiology Final Exam Material Review and additional Excercises CHAPTER 12

Review of Key Points
Healthcare epidemiology can be defined as the study of the occurrence, determinants, and distribution of health and disease within healthcare settings. Community-acquired infections are those that are present or incubating at the time of hospital admission. All other infections are considered healthcare-acquired infections (HAIs), including those that erupt within 14 days of hospital discharge. An iatrogenic infection is an infection that results from medical or surgical treatment an infection that is caused by a surgeon, another physician, or some other healthcare worker. HAIs occur all too frequently. In the United States, approximately 5% of hospitalized patients develop HAIs. Although some of the pathogens that cause HAIs originate in the external environment, many come from the patients themselvestheir own indigenous microflora that enter a surgical incision or otherwise gain entrance to areas of the body other than those where they normally reside. The seven most common causes of HAIs in the United States are Staphylococcus aureus, coagulase-negative staphylococci, Enterococcus spp., Escherichia coli, Pseudomonas aeruginosa, Enterobacter spp., and Klebsiella spp. Approximately 70% of HAIs involve drug-resistant bacteria. The three most common modes of transmission in healthcare settings are contact, droplet, and airborne transmission. The four most common types of HAIs are urinary tract infections (UTIs), surgical site infections (also referred to as postsurgical wound infections), lower respiratory tract infections (primarily pneumonia), and bloodstream infections (septicemia). Clostridium difficile is a common cause of healthcare-associated gastrointestinal infections. The patients most likely to develop HAIs are immunosuppressed patients, elderly patients, women in labor and delivery, premature and newborn infants, and surgical, burn, diabetic, cancer, paralyzed, and transplant patients. The three major causes of HAIs are drug-resistant bacteria, the failure of healthcare
personnel to follow infection control guidelines, and an increased number of immunocompromised patients. The primary way to reduce the number of HAIs is strict compliance with infection control guidelines. Handwashing is the single most important measure to reduce the risks of transmitting pathogens from one patient to another or from one anatomic site to another on the same patient. Infection control measures are designed to break various links in the chain of infection. Aseptic techniques are actions taken to prevent infection or break the chain of infection. Medical asepsis is a clean technique. Its goal is to exclude pathogens. Medical aseptic techniques include frequent and thorough handwashing; personal grooming; wearing of clean masks, gloves, and gowns whenever appropriate; proper cleaning of supplies and equipment; disinfection; and proper disposal of needles, contaminated materials, and infectious waste; and sterilization. Surgical asepsis is a sterile technique. Its goal is to exclude all microbes. Surgical aseptic techniques include surgical scrubbing of hands and fingernails before entering the operating room; wearing sterile masks, gloves, caps, gowns, and shoe covers; using sterile solutions and dressings; using sterile drapes and creating a sterile field; and using heat-sterilized surgical instruments. Standard Precautions are to be applied to the care of ALL patients in ALL healthcare settings, regardless of the suspected or confirmed presence of a pathogen. Implementation of Standard Precautions constitutes the primary strategy for the prevention of healthcare-associated transmission of infectious agents among patients and healthcare personnel. Personal protective equipment (PPE) includes gloves, gowns, masks, eye protection, and respiratory protection. Transmission-Based Precautions (Contact, Droplet, and Airborne Precautions) are used in addition to Standard Precautions to protect healthcare personnel and hospital patients from contact, droplet, and airborne modes of pathogen transmission. Contact transmission is the most important and frequent mode of transmission of HAIs. Droplet Precautions are used for particles that are larger than 5 m in diameter. Airborne Precautions are used when particles are 5 m or less in diameter. The preferred placement for patients who require Airborne Precautions is in an airborne infection isolation room (AIIR). AIIRs are under negative pressure, and air that is evacuated from these rooms passes through HEPA filters. Patients who are especially vulnerable to infection can be protected by placing them in Protective Environments. Protective Environments are rooms that are under positive pressure, and vented air that enters these rooms passes through HEPA filters. A hospitals infection control program is usually under the jurisdiction of the hospitals Infection Control Committee (ICC) or Epidemiology Service. Clinical Microbiology Laboratory personnel participate in infection control by monitoring the types and numbers of pathogens isolated from hospitalized patients,
performing antimicrobial susceptibility testing, notifying the appropriate infection control professional (ICP) when appropriate, and processing environmental samples that have been collected from within the affected ward(s) during an outbreak in the hospital. All healthcare workers must fully comprehend the problem of healthcare-associated infections, must be completely knowledgeable about infection control practices, and must personally do everything in their power to prevent HAIs from occurring.
Matching Questions _____ 1. A. B.

arthropodborne infections
community-acquired infections iatrogenic infections healthcare-associated infections healthcare-associated zoonoses _____ 2.
Infections that patients develop while hospitalized or within 14 days of hospital discharge are considered to be _______________.
C. D.
Infections that patients have on hospital admission are considered to be _______________.
E.
_____ 3.
_______________ may result if healthcare workers fail to wash their hands after handling laboratory animals or pets being used for pet therapy.
_____ 4.
Infections that are actually caused by healthcare workers are specifically known as _______________.
_____ 5.
Each year, in the United States, approximately 2 million hospitalized patients develop _______________.
A. B. C. D. E.
Airborne Precautions Contact Precautions Droplet Precautions Medical aseptic technique Surgical aseptic technique
_____ 6.
In addition to Standard Precautions, _______________ must be used when managing a patient with streptococcal pneumonia.
_____ 7.
The goal of _______________ is to render and keep objects and areas sterile.
_____ 8.
In addition to Standard Precautions, _______________ must be used when managing a tuberculosis patient.
_____ 9.
The goal of _______________ is to reduce the number and transmission of pathogens.
_____ 10.
In addition to Standard Precautions, _______________ must be used when managing a patient with a Clostridium difficileassociated disease.
Chapter 13: Diagnosing Infectious Diseases
True/False Questions
_____ 1.
Most of the pathogens involved in healthcare-associated infections come from the patients themselves.
_____ 2.
An infection that results from urinary catheterization would be considered an iatrogenic infection.
_____ 3.
Bacteria are the only pathogens that have become drug resistant.
_____ 4.
A patient with tuberculosis should be placed in a Protective Environment.
_____ 5.
A superinfection with Clostridium difficile could lead to diseases such as antibioticassociated diarrhea and pseudomembranous colitis.
_____ 6.
One of the major factors contributing to healthcare-associated infections is the failure of healthcare personnel to follow infection control guidelines.
_____ 7.
Joseph Lister is considered the Father of Handwashing.
_____ 8.
A leukopenic patient should be placed in a patient room having positive air pressure.
_____ 9.
Members of a hospitals Infection Control Committee would investigate outbreaks and epidemics that occur within that hospital.
_____ 10.
By practicing Standard Precautions, healthcare workers will be protected from becoming infected, regardless of the type of infectious disease that the patient has.
Answers to the Additional Chapter 12 Self-Assessment Exercises
Matching Questions
1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
D B E C D C E A D B
1. 2.
True True
3. 4.
False (certain viruses, fungi, and parasitic protozoa have also become drug resistant) False (a patient with tuberculosis should be placed in an airborne infection isolation room) True True False (Ignaz Semmelweis is considered the Father of Handwashing) True True False (for certain types of diseases, transmission-based precautions must also be practiced)
5. 6. 7. 8. 9. 10.
CHAPTER 13
When a clinician suspects that a patient has a particular infectious disease, appropriate clinical specimens must be obtained and certain diagnostic tests requested. Laboratory professionals then make laboratory observations and generate test results which are used by clinicians to diagnose infectious diseases and initiate appropriate therapy. The laboratory is responsible for publishing a book (often referred to as the Lab Policies & Procedures Manual) that contains instructions for the proper selection, collection, and transport of clinical specimens. To avoid becoming infected, extreme care must be taken by those involved in collecting, handling, and processing clinical specimens, particularly, blood, urine, cerebrospinal fluid, sputum, mucous membranes, and fecal specimens. Healthcare personnel who collect specimens must adhere to the safety precautions known as Standard Precautions. The clinical specimens that are used to diagnose infectious diseases must be of the highest possible quality. The quality of the laboratory work performed in a Clinical Microbiology Laboratory (CML) can be only as good as the quality of the specimens it receives. The person who collects the specimen is ultimately responsible for its quality. The three components of specimen quality are proper selection, proper collection, and proper transport of the specimen. Clinical specimens must be collected in a manner that eliminates, or at least reduces, contamination of the specimens with members of the indigenous microflora. All clinical specimens must be labeled properly, and laboratory request slips must contain all necessary information. Bacteremia the presence of bacteria in the bloodstream may or may not be a sign of disease. Septicemia, on the other hand, is a disease. When collecting blood specimens for culture, the venipuncture site must be thoroughly cleansed and disinfected to prevent contamination of the specimen with indigenous skin flora. The proper specimen to diagnose urinary tract infections (UTIs) is a clean-catch, midstream urine (CCMS urine). Urine specimens must be refrigerated until they can be transported to the laboratory. A complete urine culture consists of a colony count, isolation and identification of the pathogen, and antimicrobial susceptibility testing. Because meningitis is such a serious and often rapidly fatal disease, cerebrospinal fluid (CSF) specimens are processed immediately on their receipt in the CML. Important information that is learned about the specimen is immediately reported to the requesting clinician; this is known as a preliminary report. Such reports often save patients lives. Laboratory workup of a good quality sputum specimen can provide important information about a patients lower respiratory infection, whereas workup of a patients saliva can not.
Routine throat swabs are collected to determine whether a patient has strep throat. If any pathogen other than Streptococcus pyogenes (e.g., Neisseria gonorrhoeae or Corynebacterium diphtheriae) is suspected to be causing the patients pharyngitis, that information must be included on the laboratory test requition. Aspirates (i.e., pus that has been collected using a needle and syringe assembly) are the preferred types of wound specimens. Specimens collected by swab are frequently contaminated with indigenous microflora and often dry out before they can be processed in the CML. The laboratory test requisition that accompanies a wound specimen must indicate the type of wound and its anatomical location. Neisseria gonorrhoeae is a fastidious bacterium that is both microaerophilic and capnophilic. Therefore, when attempting to diagnose gonorrhea, swabs (vaginal, cervical, urethral, throat, and rectal swabs) should be inoculated immediately onto a highly enriched and highly selective medium (such as Thayer-Martin or Martin-Lewis medium) and incubated in a carbon dioxide (CO2) atmosphere. In gastrointestinal infections, the pathogens frequently overwhelm the indigenous intestinal microflora, so that they are the predominant organisms seen in smears and cultures. Within a hospital, the CML is an integral part of the Pathology Department, and is located within the Clinical Pathology division of that department. The primary mission of the CML is to assist clinicians in the diagnosis and treatment of infectious diseases. The 4 major responsibilities of those employed in the CML are (1) processing clinical specimens, (2) isolating pathogens from specimens, (3) identifying (speciating) pathogens, and (4) performing antimicrobial susceptibility testing. A less frequent responsibility of the CML is to process environmental samples whenever there is an outbreak or epidemic within the hospital. In general, the processing of clinical specimens in the CML includes (1) examining the specimen macroscopically, (2) examining the specimen microscopically, and (3) inoculating the specimen to appropriate culture media. To isolate bacteria and fungi from clinical specimens, specimens are inoculated into liquid culture media or onto solid culture media. CML professionals gather clues (phenotypic characteristics) about a pathogen until they are have sufficient clues to identify (speciate) it. The overall responsibility of the Bacteriology Section of the CML is to assist clinicians in the diagnosis of bacterial diseases. The overall responsibility of the Mycology Section of the CML is to assist clinicians in the diagnosis of fungal infections (mycoses). When isolated from clinical specimens, yeasts are identified using a variety of biochemical tests, primarily based on their ability to catabolize various carbohydrates. Moulds, however, are identified using a combination of rate of growth and macroscopic and microscopic observations. The overall responsibility of the Parasitology Section of the CML is to assist clinicians in the diagnosis of parasitic diseases. Parasites are identified primarily by their characteristic
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appearance. The overall responsibility of the Virology Section of the CML is to assist clinicians in the diagnosis of viral diseases. Viruses are identified primarily by the type(s) of cell lines that they are able to infect and the physical changes (called cytopathic effect or CPE) that they cause in the infected cells. The primary responsibility of the Mycobacteriology Section (TB Lab) of the CML is to assist clinicians in the diagnosis of tuberculosis.
(Note: Dont peek at the answers before you attempt to solve these self -assessment exercises.)
Matching Questions A. B. C. agar dilution method disk diffusion method macro broth dilution method D. micro broth dilution method
_____ 1.
Because the _____________ of antimicrobial susceptibility testing uses large numbers of test tubes, this method is impractical for use in the Clinical Microbiology Laboratory.
_____ 2.
The _______________ of antimicrobial susceptibility testing is also known as the Kirby Bauer method.
_____ 3.
The _______________ of antimicrobial susceptibility testing is considered to be the gold standard.
_____ 4.
In the United States, the _____________ is currently the most popular method for performing antimicrobial susceptibility testing.
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_____ 5.
Agar plates are used in both the agar dilution
method and the _____________ of antimicrobial susceptibility testing.
A. B. C.
Bacteriology Section Mycology Section Mycobacteriology Section
_____ 6.
Mycoses are diagnosed in the ________ of the Clinical Microbiology Laboratory.
_____ 7.
Tuberculosis is diagnosed in the ______ of the Clinical Microbiology Laboratory.
D. E.
Parasitology Section Virology Section _____ 8. Hair clippings, nail clippings, and skin scrapings are most often processed in the _______________ of the Clinical Microbiology Laboratory.
_____ 9.
Susceptibility testing is routinely performed only in the Bacteriology Section and the _______________ of the Clinical Microbiology Laboratory.
_____ 10.
Miniaturized biochemical test systems known as minisystemsare most often used in the _______ _ of the Clinical Microbiology Laboratory.
Chapter 14: Pathogenesis of Infectious Diseases
12
_____ 1.
Poor-quality clinical specimens are unlikely to produce clinically relevant results.
_____ 2.
The director of the Clinical Microbiology Laboratory (CML) is ultimately responsible for the quality of clinical specimens submitted to the CML.
_____ 3.
Special disinfection procedures are required to prevent indigenous microflora of the skin from contaminating blood cultures.
_____ 4.
Bacteriuria is a sure sign of urinary tract infection.
_____ 5.
CSF specimens are treated as stat specimens in the Clinical Microbiology Laboratory.
_____ 6.
CSF specimens should be refrigerated en route to the Clinical Microbiology Laboratory.
_____ 7.
There is no need to refrigerate urine specimens for culture if they are cleancatch midstream specimens.
_____ 8.
Many clinical specimens labeled sputum are actually saliva specimens.
13
_____ 9.
The Clinical Microbiology Laboratory is part of the Clinical Pathology Division of the Pathology Department.
_____ 10.
-Lactamase testing is always performed on isolates of Neisseria gonorrhoeae and Haemophilus influenzae.
Matching Questions
1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
C B A D B B C B C A
14
1. 2.
True False (the people who collect clinical specimens are responsible for the quality of those specimens) True False (very often, the bacteria causing bacteriuria are contaminants; thus, bacteriuria does not necessarily mean that the patient has a urinary tract infection) True False (CSF specimens should not be refrigerated; refrigeration might kill pathogens that are present in the specimens) False (even clean-catch, midstream urine specimens will contain contaminants, so they must be refrigerated if there will be a delay between collection and processing) True True True
3. 4.
5. 6.
7.
8. 9. 10.
15
CHAPTER 14
Words containing the prefix path- or patho- pertain to disease. Examples include pathogen, pathology, pathologist, pathogenicity, and pathogenesis. Although most people, including most healthcare professionals, use the terms infection and infectious disease synonymously, microbiologists define infection as colonization by a pathogen. Once colonized by a pathogen, the person is said to be infected with that pathogen, regardless of whether the pathogen is causing disease. Many factors influence whether or not exposure to a pathogen results in disease, including a persons immune, nutritional, and overall health status. The four periods or phases of an infectious disease are the (1) incubation period, (2) prodromal period, (3) period of illness, and (4) convalescent period. In some cases, the period of illness is followed by disability or death. An infection may remain localized or it may spread, becoming a systemic or generalized infection. A disease may be acute, subacute, or chronic, depending upon the length of its incubation period and its duration. Symptoms of a disease are various types of subjective evidence of disease that are experienced or perceived by patients (e.g., aches or pains, chills, anorexia, nausea, and itching). Signs of a disease are various types of objective evidence of a disease (e.g., increased or decreased blood pressure, elevated body temperature, abnormal pulse rate, abnormalities that are discovered by palpation, and abnormal test results). A latent disease is a disease that is lying dormant, not currently manifesting itself. If not successfully treated, syphilis can progress through several stages, including a latent stage. A primary infection caused by one pathogen can be followed by a secondary infection caused by a different pathogen. Pathogenicity is the ability of a microbe to cause disease, whereas pathogenesis refers to the actual steps that are involved in the development of a disease. Sometimes (but not always) pathogenesis follows this sequence: entry of the pathogen into the body attachment multiplication invasion or spread evasion of host defenses damage to host tissue(s). Viruent strains of a microbe are capable of causing disease, whereas avirulent strains are not. Virulence is a measure or degree of pathogenicity. Different species or even different strains of the same species vary in their ability to cause disease; thus, some are more virulent than others. Some strains of a particular species may be virulent, whereas other strains of the same species are avirulent. Virulence factors are the phenotypic characteristics of a microorganism that enable it to cause disease. Some virulence factors are structural features (e.g., capsules, flagella, pili)
16
that enable pathogens to avoid phagocytosis and reach and attach to various tissues within the host. Molecules on a host cells surface that pathogens are able to recognize and attach to are called receptors or integrins. Molecules on a pathogens surface that recognize and attach to receptors on a host cells surface are called adhesins or ligands. Bacterial fimbriae (pili) are virulence factors, in that they enable fimbriated (piliated) bacteria to adhere to cells and tissues within the human body. Rickettsias and chlamydias are obligate intracellular pathogens. Ehrlichia and Anaplasma spp. (which are bacteria) are intraleukocytic pathogens, whereas Plasmodium and Babesia spp. (which are protozoa) are intraerythrocytic pathogens. Pathogens that can live both within and outside of host cells are called facultative intracellular pathogens. Many bacteria, including Mycobacterium tuberculosis, are facultative intracellular pathogens. The two most important categories of phagocytes in the human body referred to as professional phagocytes are macrophages and neutrophils. Bacterial capsules serve an antiphagocytic function; i.e., they protect encapsulated bacteria from being phagocytized. Flagella are considered to be virulence factors because they enable flagellated bacteria to invade areas of the body that nonflagellated bacteria cannot reach. The two major virulence factors by which bacteria cause disease are exoenzymes and toxins. Exoenzymes that are virulence factors include necrotizing enzymes, coagulase, kinases, hyaluronidase, collagenase, hemolysins, and lecithinase. These exoenzymes enable pathogens to evade host defenses, invade, and cause damage to body tissues. Necrotizing enzymes are exoenzymes that cause destruction of cells and tissues. Coagulase is a virulence factor that causes clotting. Kinases are exoenzymes that dissolve clots. Hyaluronidase and collagenase are virulence factors that dissolve hyaluronic acid and collagen, respectively, enabling pathogens to invade deeper into tissues. Hemolysins are enzymes that damage red blood cells. Lecithinase is an exoenzyme that causes destruction of host cell membranes. Toxins include endotoxins (components of the cell walls of Gram-negative bacteria) and exotoxins (poisonous proteins that are released from the cells that produce them). Examples of exotoxins are neurotoxins (which affect the central nervous system), enterotoxins (which cause gastrointestinal disease), TSST-1 (which causes toxic shock syndrome), exfoliative or epidermolytic toxin (which causes scalded skin syndrome), erythrogenic toxin (which causes scarlet fever), leukocidins (which destroy leukocytes), and diphtheria toxin (which causes diphtheria). Some pathogens are able to escape immune responses. The mechanisms by which they are able to accomplish this include antigenic variation, camouflage, molecular mimicry, and destruction of antibodies.
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Matching Questions _____ 1. A. B. C. D. E. coagulases enterotoxins kinases necrotizing enzymes neurotoxins _____ 2. The _______________ produced by Clostridium perfringens and Streptococcus pyogenes are examples of virulence factors. The _______________ produced by Clostridium botulinum and Clostridium tetani are examples of virulence factors.
_____ 3.
_______________ are exoenzymes that cause clot formation.
_____ 4.
_______________ are exoenzymes that dissolve clots.
_____ 5.
_______________ are produced by Clostridium difficile, Salmonella spp., Shigella spp., Vibrio cholerae, and certain serotypes of E. coli.
A. B. C.
adhesins endotoxin hyaluronidase
D. E.
integrins leukocidins
18
_____ 6.
_______________ is a virulence factor that is found in (and released from) the cell walls of Gramnegative bacteria.
_____ 7.
The molecules on the surfaces of host cells that pathogens are able to recognize and attach to are known as receptors or _______________.
_____ 8.
Molecules on the surfaces of pathogens that are able to recognize and bind to molecules on the surfaces of host cells are known as ligands or _______________.
_____ 9.
_______________ is also known as spreading factor.
_____ 10.
_______________ are toxins that destroy white blood cells.
Chapter 15: Nonspecific Host Defense Mechanisms
19
_____ 1.
Bacterial capsules protect bacteria from being phagocytized by leukocytes.
_____ 2.
A headache is a classic example of a sign of a disease.
_____ 3.
To cause disease, all bacterial pathogens must first attach to some tissue in the body.
_____ 4.
Rickettsias and chlamydias are examples of obligate intracellular pathogens.
_____ 5.
Babesia spp., Ehrlichia spp., and Plasmodium spp. are examples of intraerythrocytic pathogens.
_____ 6.
The exoenzyme that causes toxic shock syndrome is called erythrogenic toxin.
_____ 7.
The neurotoxins produced by Clostridium botulinum and Clostridium tetani cause a spastic, rigid type of paralysis.
_____ 8.
Although most people use the terms infection and infectious disease synonymously, microbiologists define infection as colonization by a pathogen.
_____ 9.
Avirulent strains do not cause disease.
20
_____ 10.
It is thought that the waxes in the cell walls of Mycobacterium tuberculosis protect this pathogen from digestion within phagocytes.
Matching Questions
1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
E D A C B B A D C E
1. 2. 3.
True False (a headache is a symptom, not a sign) False (some pathogens can cause disease without attaching to tissue)
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4. 5.
True False (Babesia and Plasmodium spp. are intraerythrocytic pathogens, but Ehrlichia spp. are intraleukocytic pathogens) False (erythrogenic toxin causes scarlet fever) False (the neurotoxin produced by Clostridium botulinum causes a flaccid type of paralysis, whereas the neurotoxin produced by Clostridium tetani causes a spastic, rigid type of paralysis) True True True
6. 7.
8. 9. 10.
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CHAPTER 15
Host defense mechanisms are ways in which the body protects itself from pathogens and infectious diseases. Certain human host defense mechanisms are classified as nonspecific, whereas others are classified as specific. Nonspecific host defense mechanisms serve to protect the body from a variety of foreign substances or pathogens. Specific host defense mechanisms are directed against a particular foreign substance or pathogen that has entered the body. Another way to categorize host defense mechanisms is to divide them into first, second, and third lines of defense. The first and second lines of defense are nonspecific, whereas the third line of defense (the immune system) is specific. The first line of defense includes innate or inborn resistance; physical barriers such as intact skin and intact mucous membranes; chemical, physiologic, and temperature barriers; microbial antagonism by indigenous microflora; and overall nutritional status and state of health. The dryness, acidity, and temperature of the skin inhibit colonization and growth of pathogens, and perspiration flushes them away. Sticky mucous serves as a nonspecific host defense mechanism by trapping pathogens. It also contains toxic substances, such as lysozyme, lactoferrin, and lactoperoxidase. The mucociliary covering on epithelial cells in the respiratory tract move trapped dust and microbes upward toward the throat, where they are swallowed or expelled. Pathogens entering the gastrointestinal (GI) tract are often killed by digestive enzymes or the acidity or alkalinity of different anatomical regions. Peristalsis and urination serve to remove pathogens from the GI tract and urinary tract, respectively. The acidity of vaginal fluid usually inhibits colonization of the vagina by pathogens. When indigenous microflora prevent the establishment of arriving pathogens, it is known as microbial antagonism. Colicin and other bacteriocins are proteins produced by some bacteria to kill other bacteria. A decrease in the number of indigenous microflora at a particular anatomical site can lead to an overgrowth of pathogens or opportunistic pathogens present at the site; this is referred to as a superinfection. The second line of defense includes nonspecific cellular and chemical responses such as inflammation, fever, interferon production, activation of the complement system, iron balance, cellular secretions, activation of blood proteins, chemotaxis, phagocytosis, neutralization of toxins, and the cleanup and repair of damaged tissues. Lactoferrin and transferrin are host molecules that tie up iron, thereby preventing pathogens access to this essential mineral.
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Substances that stimulate the production of fever are called pyrogens or pyrogenic substances. Fever is a nonspecific host defense mechanism that augments host defenses by stimulating leukocytes to deploy and destroy invaders, reducing available free plasma iron, and inducing the production of IL-1, which causes the proliferation, maturation, and activation of lymphocytes in the immunologic response. Elevated body temperatures also slow down the rate of growth of certain pathogens and kill especially fastidious pathogens. Interferons are small, antiviral proteins produced by virus-infected cells. They interfere with viral multiplication and serve to limit viral infections. Interferons are not virus-specific, but they are host-specific. The 30 or so proteins of the complement system (collectively referred to as complement components) interact with each other in a stepwise manner, known as the complement cascade a nonspecific host defense mechanism that assists in the destruction of many different pathogens. Complement activation by immune complexes or other mechanisms aids in the initiation and amplification of inflammation, attraction and activation of leukocytes, lysis of bacteria and other foreign cells, and enhanced phagocytosis (opsonization). Opsonization is a process by which phagocytosis is facilitated by the deposition of opsonins (e.g., antibodies or certain complement fragments) onto the surface of particles or cells. Cytokines are chemical mediators that are released from many different types of cells in the human body. They act as chemical messengers, enabling cells to communicate with each other. The three major events in acute inflammation are vasodilation (an increase in the diameter of capillaries), increased permeability of the capillaries, and escape of leukocytes from the capillaries. Indications of inflammation include redness, heat, edema, and pain. Inflammation is often accompanied by pus formation, and sometimes there is a loss of function of the inflamed part of the body. The purposes of the inflammatory response are to localize an infection, prevent the spread of microbial invaders, neutralize toxins, and aid in the repair of damaged tissue. Pyogenic means pus-producing; thus, pyogenic microbes are pus-producing microbes. A purulent (pus-containing) inflammatory exudate is often referred to as pus. The primary functions of the lymphatic system include draining and circulating intercellular fluids from tissues, transporting digested fats from the digestive system to the blood, removing foreign matter and microbes from the lymph, and producing antibodies and other factors to aid in the destruction and detoxification of any invading microbes. The two most important groups of phagocytes in the human body - sometimes referred to as professional phagocytes - are macrophages and neutrophils. Wandering macrophages leave the bloodstream and migrate to sites of infection and other areas where they are needed. Fixed macrophages remain within tissues and oregans.
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Phagocytes rid the body of unwanted or harmful substances, such as dead cells, unused cellular secretions, dust, debris, and pathogens. After their recruitment to a particular site by chemotactic substances, they attach to, surround, ingest, and digest the unwanted or harmful substances. The four steps in phagocytosis are chemotaxis, attachment, ingestion, and digestion. The directed migration of phagocytes is called chemotaxis. It is caused by chemicals referred to as chemotactic agents. During the ingestion step in phagocytosis, the particle becomes surrounded by a membrane. The membrane-bound vesicle is called a phagosome. The fusion of a lysosome and a phagosome results in a phagolysosome, within which the ingested particle is digested. Some bacteria and protozoa are able to survive within phagocytes. For example, Ehrlichia and Anaplasma spp. are intraleukocytic bacteria, able to live and multiply within leukocytes. Leukopenia is a condition in which patients have an abnormally low number of circulating leukocytes. Neutropenia is a condition in which patients have an abnormally low number of circulating neutrophils.
Matching Questions
A. B. C. D. E.
bacteriocins chemotactic agents complement fragments cytokines interferons
_____ 1.
_______________ are chemical mediators that enable cells to communicate with each other.
_____ 2.
When attached to the surface of particles or cells, _______________ can facilitate phagocytosis.
_____ 3.
Proteins produced by one bacterial species that kill other bacterial species are known as _______________.
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_____ 4.
_______________ are small, antiviral proteins that are produced by virusinfected cells.
_____ 5.
_______________ attract leukocytes to sites where they are needed.
A. B. C. D. E.
chemotaxis opsonization phagolysosome phagosome vasodilation
_____ 6.
A _______________ is a membranebound vesicle containing only an ingested object.
_____ 7.
The directed migration of leukocytes is known as _______________.
_____ 8.
A _______________ is a membranebound vesicle containing an ingested object and digestive enzymes.
_____ 9.
_______________ is an increase in the diameter of blood vessels.
_____ 10.
_______________ is a process by which phagocytosis is facilitated by the deposition of antibodies or complement fragments onto the surface of particles or cells.
Chapter 16: Specific Host Defense Mechanisms: An Introduction to Immunology
26
_____ 1.
Lactoferrin and transferrin are proteins that bind iron, and therefore deprive pathogens of this essential nutrient.
_____ 2.
Pyrogenic substances cause the production of pus.
_____ 3.
Interferons are virus-specific, but are not species-specific.
_____ 4.
Complement is the name of a single plasma protein that complements the actions of the immune system.
_____ 5.
Eosinophils are much better phagocytes than neutrophils.
_____ 6.
Phagocytes can only ingest objects that they are able to attach to.
_____ 7.
The terms leukemia and leukopenia both refer to an abnormally low number of circulating leukocytes.
_____ 8.
Ehrlichia spp. are intraleukocytic pathogens.
27
_____ 9.
Chemokines are chemotactic agents that are produced by various cells of the human body.
_____ 10.
Perspiring, swallowing, and urinating are all considered to be part of the first line of defense.
Matching Questions
1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
D C A E B D A C E B
28
1. 2.
True False (pyrogenic substances cause the production of fever; pyogenic substances cause the production of pus) False (the reverse is true) False (complement is not a single plasma protein; the term refers to a group of approximately 30 different proteins found in the blood) False (the reverse is true) True False (leukemia is a type of cancer, in which there is a high number of abnormal leukocytes in the blood; the term leukopenia refers to an abnormally low number of circulating leukocytes) True True True
3. 4.
5. 6. 7.
8. 9. 10.
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CHAPTER 16
Immunology is the scientific study of the immune system and immune responses. Scientists who study various aspects of the immune system are called immunologists. The immune system is considered to be a specific host defense mechanism and the third line of defense. Immune responses involve complex interactions among many different types of body cells and cellular secretions. An understanding of immunology boils down to an understanding of two terms: antigens and antibodies. Antigens are molecules that stimulate the immune system to produce antibodies. Antibodies are proteins produced by the immune system in response to antigens. The primary functions of the immune system are to differentiate between self and non-self (something foreign), and destroy that which is non-self. The two major arms of the immune system are humoral immunity (also known as antibody-mediated immunity) and cell-mediated immunity. Antibodies play a major role in humoral immunity. Antibodies that protect us from infection or reinfection are called protective antibodies. Cell-mediated immunity involves a variety of cell types (including macrophages and various types of lymphocytes) with antibodies only playing a minor role, if any. Immunity to an infectious disease may be innate or acquired. If acquired, the immunity may have been acquired actively (in which case antibodies were actively produced by the person) or passively (in which case the person received antibodies that were produced by others). Acquired immunity may be the result of a natural or artificial event. The production of antibodies in response to a pathogen that has entered the body is an example of natural active acquired immunity. The production of antibodies in response to a vaccine is an example of artificial active acquired immunity. Vaccination deliberately exposes a person to a harmless version of a pathogen (or toxin), to stimulate that persons immune system to produce protective antibodies and memory cells. In passive acquired immunity, a person receives antibodies, rather than producing them. This can occur naturally or in an artificial manner. A fetus receiving maternal antibodies in utero and an infant receiving maternal antibodies in colostrum are examples of natural passive acquired immunity. A soldier receiving antibodies contained in a shot of gamma globulin is an example of artificial passive acquired immunity.
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The various categories of vaccines include attenuated vaccines (made from weakened pathogens), inactivated vaccines (made from killed pathogens), subunit or acellular vaccines (containing only that part of the pathogen that stimulates the production of protective antibodies), and toxoids (toxins that have been modified so that they no longer cause disease). The major categories of lymphocytes are T lymphocytes (T cells), B lymphocytes (B cells), and natural killer (NK) cells. The two major types of T cells are helper T cells and cytotoxic T cells. Helper T cells are so-named because they assist in the production of antibodies. The primary function of cytotoxic T cells and NK cells is to destroy virally infected host cells, foreign cells, and tumor cells. Immune responses occur at many body sites, including the spleen, lymph nodes, tonsils, and adenoids. Antigens can be defined as substances that stimulate the immune system to produce antibodies. Proteins make the best antigens, but large polysaccharides can also serve as antigens. Individual molecules that stimulate the production of antibodies are referred to as antigenic determinants or epitopes. Antigens can be classified as being either T-independent or T-dependent, depending on the manner in which they are processed by the immune system. Only B cells are involved in the processing of T-independent antigens. A T-dependent antigen requires the interaction of a macrophage, a helper T cell, and a B cell. The end result is the same, in that antibodies are secreted by plasma cells (which are derived from B cells). Immune responses occur at many body sites, including the spleen, lymph nodes, tonsils, and adenoids. The amount and type of antibodies produced by a given antigenic stimulation depend on the nature of the antigen, the site of antigenic stimulus, the amount of antigen, and the number of times the person is exposed to the antigen. The initial response to an antigen is called the primary response, whereas a subsequent response to the same antrigen is referred to as the secondary, anamnestic, or memory response. Antibodies are usually very specific, binding only with the antigenic determinant that stimulated their production. Antibodies are in a category of proteins called immunoglobulins. An antibody is an immunoglobulin having particular specificity for an antigen. The basic structure of an antibody, referred to as a monomer, consists of two light protein chains, two heavy protein chains, two antigen-binding sites, and the part of the molecule called the FC region. Light chains contain fewer amino acids than heavy chains. As a result, they are shorter and lighter in weight than heavy chains. There are five types of immunoglobulins, designated as IgA, IgD, IgE, IgG, and IgM. Three typesIgD, IgE, and IgGare monomers. Although IgA may be a monomer or a dimer, the dimer form is most important. IgM is a pentamer, having a total of 10 antigen-
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binding sites. Once produced, antibodies are capable of recognizing and binding to the antigenic determinant that stimulated their production. Because a monomer contains two antigenbinding sites, it can attach to two copies of that antigenic determinant. The combination of an antibody and an antigen is called an antigenantibody complex, Ag-Ab complex, or immune complex. Antibodies function in several ways, including neutralization of toxins, preventing the attachment of pathogens to host cell receptors, serving as opsonins, and initiating the complement cascade. Monoclonal antibodies are produced by long-lived cells called hybridomas. Monoclonal antibodies are commonly used in immunodiagnostic procedures immunologic procedures used in laboratories to diagnose diseases. Hypersensitivity can be thought of as an overly sensitive immune system. Hypersensitivity reactions may be immediate or delayed, depending on the nature of the immune reaction and the time required for an observable reaction. Immediate-type hypersensitivity reactions occur within 24 hours of exposure to an antigen, whereas delayed-type hypersensitivity reactions take longer than 24 hours to manifest themselves. Type I hypersensitivity reactions (anaphylactic reactions) include the classic allergic responses of hay fever, asthma, and hives, resulting from allergies to pollen, mold spores, animal dander, foods, insect venom, drugs, and other allergens. Type I hypersensitivity reactions range from relatively mild, localized reactions to very severe, systemic reactions (e.g., anaphylactic shock). People who are prone to allergies are described as being atopic. They produce IgE antibodies when they are exposed to allergens (antigens that cause allergic reactions). Following their production, IgE antibodies bind to the surface of basophils and mast cells. Degranulation of the basophils and mast cells occurs when allergen binds to these IgE antibodies. Allergy shots result in the production of IgG blocking antibodies, which prevent the allergen from attaching to basophil- or mast cellbound IgE. Type II hypersensitivity reactions are cytotoxic reactions. An example of a type II reaction is the massive destruction of red blood cells that occurs when a person receives a unit of incompatible blood (e.g., if a type A person receives a unit of type B blood). Type III reactions are immune complex reactions, resulting from the deposition of immune complexes beneath various membranes in the body; they can lead to rheumatic fever, rheumatoid arthritis, and glomerulonephritis. Type IV reactions are delayed-type hypersensitivity (cell-mediated) reactions, such as those that occur in positive TB and fungal skin tests, contact dermatitis, and transplant rejection. An autoimmune disease results when a persons immune system attacks that persons body tissues as if they were non-self or foreign. Autoimmune diseases may be the result of type II, type III, or type IV hypersensitivity reactions.
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If a persons immune system is not functioning properly, that person is said to be immunosuppressed, immunodepressed, or immunocompromised. Immunodeficiencies nay either be inherited or acquired. A person lacking the ability to produce antibodies is said to have agammaglobulinemia, whereas a person who produces too few antibodies is said to have hypogammaglobulinemia. Immunodiagnostic procedures (IDPs) are laboratory tests that are valuable in diagnosing infectious diseases by detecting either antigens or antibodies in clinical specimens. IDPs performed on serum specimens are called serologic procedures. Detecting antibodies to a particular pathogen in a clinical specimen may represent present infection, past infection, or prior vaccination against that pathogen. The value of antibody detection procedures can be improved by specific detection of IgM antibodies or via the use of paired sera (i.e., acute and convalescent sera). The reagent used to detect antigens contains antibodies and is called an antiserum. The reagent used to detect antibodies contains antigens. Tests used to determine that an antigen-antibody reaction occurred include agglutination, precipitin procedures, immunofluorescence procedures, and enzyme-linked immunosorbent assays.
Matching Questions
A.
artificial active acquired immunity artificial passive acquired immunity natural active acquired immunity natural passive acquired immunity
_____ 1.
B.
The immunity that a fetus acquires in utero, as a result of receiving protective antibodies from Moms blood is called _______________.
C.
_____ 2.
D.
The immunity that someone acquires as a result of an infection is called _______________.
_____ 3.
The immunity that someone acquires after receiving a shot of gamma globulin is called _______________.
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_____ 4.
The immunity that someone acquires as a result of receiving a vaccine is called _______________.
_____ 5.
The immunity that an infant acquires as a result of breast-feeding is called _______________.
A. B. C. D. E.
antibodies antigens epitopes haptens immune complexes
_____ 6.
_______________ are also known as immunogens.
_____ 7.
Molecules referred to as antigenic determinants are also known as _______________.
_____ 8.
_______________ are in a class of proteins called immunoglobulins.
_____ 9.
Small molecules called _______________ are antigenic only when they are coupled with large carrier molecules such as proteins.
_____ 10.
_______________ initiate type III hypersensitivity reactions.
34
35
_____ 1.
Technically speaking, all antibodies are immunoglobulins, but not all immunoglobulins are antibodies.
_____ 2.
IgG is the largest of the five classes of immunoglobulins.
_____ 3.
The primary function of NK and K cells is to kill foreign cells, virus-infected cells, and tumor cells.
_____ 4.
Common allergic reactions, such as those experienced in hay fever, are also known as anaphylactic reactions.
_____ 5.
IgM antibodies and basophils play major roles in anaphylactic reactions.
_____ 6.
The penicillin molecule is an example of a hapten.
_____ 7.
Autoimmune diseases are always the result of type II hypersensitivity reactions.
_____ 8.
With respect to a particular pathogen, detection of antibodies in a patients blood provides better proof of current infection than does detection of antigens.
_____ 9.
If a persons immune system is not functioning properly, that person is said t o be immunocompetent.
Chapter 16: Specific Host Defense Mechanisms: An Introduction to Immunology _____ 10.
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An IgM molecule can bind to ten antigenic determinants, but they would all have to be the antigenic determinant that stimulated the production of that IgM molecule.
Matching Questions
1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
D C B A D B C A D E
1. 2.
True False (IgM is the largest of the five classes of immunoglobulins)
Chapter 16: Specific Host Defense Mechanisms: An Introduction to Immunology 3. 4. 5. 6. 7. True True False (IgE antibodies and basophils play major roles in anaphylactic reactions) True False (autoimmune diseases may be the result of type II, type III, or type IV hypersensitivity reactions) False (the reverse is true)
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8. 9.
False (if a persons immune system is not functioning properly, that person is said to be immunosuppressed, immunodepressed, or immunocompromised) True
10.
Collected by : Mohammed Hamidi Wish u the best and luck in the Finals END OF SEMESTER =)

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Chapter 12: Healthcare Epidemiology