Introducing a new and completely different microbiology textbook
Microbiology a clinical approach
Anthony Strelkauskas Jennifer Strelkauskas • Danielle Moszyk-Strelkauskas
Here are ten reasons you should adopt Microbiology: A Clinical Approach… 1. CLINICAL FOCUS- It is focused on clinicallyrelevant microbiology. 2. AUDIENCE- Written specifically for health science students studying microbiology. 3. THEME- The book’s theme is the relationships between microbes and infectious disease, an area highly relevant to human health. 4. MOTIVATION- Introduces students to the clinical world they have their sights on. 5. AUTHORSHIP- Brings together authorial expertise from basic science, medicine, and veterinary medicine. 6. CONTENTS- Tailored to healthcare students, the book includes unique chapters on emerging infectious diseases, antibiotic resistance, and bioterrorism.
7. PEDAGOGY- Contains numerous pedagogical features, such as “Keep in Mind” section summaries and three types of end-of-chapter questions, to help students more easily learn the material and achieve success. 8. INSTRUCTOR SUPPLEMENTS- A complete set of support materials, including an Instructor’s Manual, digital images from the book, and lecture outlines, are available to facilitate incorporation of the text into the course. 9. STUDENT RESOURCES- An array of electronic student resources, including movies and an online tutor, are available for free. 10. Free Class Testing- contact science@garland.com for your free chapters now.
Contents site of replication
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clinical manifestation
examples
rhinitis (common cold)
rhinovirus coronavirus parainfluenza virus
nasal cavity oral cavity tongue
The underlined chapters below are available at www.garlandscience. com/microchapters. Permission is granted for you to use these chapters in the classroom and
tonsillar lymphoid tissues
pharyngitis
cervical lymph node esophagus
respiratory syncytial virus influenza virus adenovirus herpes simplex virus
laryngitis
Epstein-Barr Virus
tracheitis
parainfluenza virus respiratory syncytial virus
trachea alveolar macrophage alveolus
bronchus bronchial lymph node
bronchiole
bronchitis bronchiolitis bronchopneumonia
influenza virus adenovirus
microbiology: a clinical approach | chapter 13 | figure 6
PART I Foundations
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Chapter 1: What is Microbiology and Why Does It Matter? Chapter 2: Fundamental Chemistry for Microbiology Chapter 3: Essentials of Metabolism Chapter 4: An Introduction to Cell Structure and Host-Pathogen Relationships
PART II Disease Mechanisms Chapter 5: Requirements for Infection Chapter 6: Transmission of Infection, the Compromised Host, and Epidemiology Chapter 7: Principles of Disease Chapter 8: Emerging and Re-emerging Infectious Diseases
PART III Characteristics of Disease-Causing Microorganisms Chapter 9: The Clinical Significance of Bacterial Anatomy Chapter 10: Bacterial Growth Chapter 11: Microbial Genetics and Infectious Disease Chapter 12: The Structure and Infection Cycle of Viruses Chapter 13: Viral Pathogenesis Chapter 14: Parasitic and Fungal Infections
PART IV Host Defense Chapter 15: The Innate Immune Response Chapter 16: The Adaptive Immune Response Chapter 17: Failures of the Immune Response
PART V Control and Treatment Chapter 18: Control of Microbial Growth with Disinfectants and Antiseptics Chapter 19: Antibiotics Chapter 20: Antibiotic Resistance
PART VI Microbial Infections Chapter 21: Infections of the Respiratory System Chapter 22: Infections of the Digestive System Chapter 23: Infections of the Genitourinary System Chapter 24: Infections of the Central Nervous System Chapter 25: Infections of the Blood Chapter 26: Infections of the Skin and Eyes
PART VII The Best and the Worst; Important Issues in Microbiology Chapter 27: Biotechnology Chapter 28: Bioterrorism
Microbiology: A Clinical Approach is a new and unique microbiology textbook for health science students studying microbiology. It is clinically-relevant and uses the theme of infection as its foundation. The book includes innovative chapters on emerging infectious diseases, antibiotic resistance, and bioterrorism not seen in other textbooks. Microbiology is student-friendly: its text, figures and electronic resources have been carefully designed to help students understand difficult concepts and to keep them interested in the material. The textbook is supported with a robust ancillary package for instructors which will easily allow them to incorporate the book’s new approach into their lectures. Students working towards careers in the healthcare professions will achieve success with Microbiology: A Clinical Approach. January 2010 • 733 pages • 630 full-color illustrations • Paperback • ISBN: 978-0-8153-6514-3 • £45.00
Pedagogical Features Transmission of Infection, the Compromised Host, and Epidemiology Title
Chapter 6 X Why Is This Important?
OVERVIEW In the previous chapter we discussed the principles involved in the infectious disease process. In this chapter we focus on the transmission of diseases by looking at where the pathogens responsible for infection are found and at the mechanisms by which those pathogens are transmitted from the environment to a host, and from one host to another. We also consider the compromised host, which is a very important and integral part of the infection process. The more compromised the host, the greater is the risk of successful infection. Last, we review some of the basic principles of epidemiology, the discipline that helps us to understand how infectious diseases are spread and thus to develop methods for prohibiting their spread.
Our understanding of the ways etc in which infectious diseases are 100 Chapter 6 Transmission of Infection, the Compromised Host, and Epidemiology transmitted and the role of a compromised host in the process a classroom full of second-grade students, by the time one student shows are vital for developing to Fast methods Fact the symptoms — aches, fever, red spots — there is a good possibility that prevent the spread of disease. the rest of the class and the teacher have already been exposed. Next time you are cleaning the litter box for Fluffy the cat, remember that Human reservoirs are also found in infected people who are carriers. the waste material you are dealing with These people can carry such diseases as AIDS, diphtheria, and typhoid can indirectly transmit pathogens such fever but never show any signs of disease. However, they can readily as Toxoplasma gondii from Fluffy to infect others. you! By the way, for those of you who Our second type of reservoir of pathogens involves animals other than carry the “pooper scooper,” Fido’s fecal humans. Diseases that are transferred from animals to humans are called material can also transmit pathogens zoonotic diseases. Two well-known zoonotic diseases are rabies, in indirectly. which the virus is transferred from a rabid animal to a human, and Lyme disease. Others are shown in Table 6.1. Zoonotic diseases usually occur after direct contact with the animal, but there are also ways in which indirect contact can cause infection. For instance, the waste material of a litter box, fur, feathers, infected meats, or vectors can indirectly transmit pathogens from an animal to a person. Our third reservoir, nonliving, includes water, food, and soil. Of these three, water may be the most dangerous. In many underdeveloped countries there is poor sanitation, and in some cases little personal hygiene, which result in the fecal contamination of water. Because water is something that we cannot live without, it becomes the key component in the fecal–oral route of contamination. Many diseases are spread from this reservoir — typhoid fever and cholera, for instance — and these diseases are endemic in many parts of the world. In the case of food acting as a pathogen reservoir, contamination is part of the spoilage that occurs naturally. (Note that refrigeration only slows pathogen growth; it does not stop it.)
We will divide our discussions into the following topics: Transmission of Infection, the Compromised Host, and Epidemiology TRANSMISSION OF INFECTION
THE COMPROMISED HOST
EPIDEMIOLOGY
As far as soil is concerned, it is a normal habitat for many organisms that are potentially pathogenic, but these organisms must find a way to pass the physical barriers that protect the body if they are to cause disease. A case in point would be Clostridium tetani, a Gram-positive rod-shaped bacterium found in soil that can be transferred to humans through breaks in the skin, as, for example, in the “stepping on a rusty nail” scenario. In
TRANSMISSION OF INFECTION The transmission, or spread, of an infection is the final requirement necessary for a successful infection. We can best study this process by looking at two factors: reservoirs of infectious organisms (which are places where pathogens can grow and accumulate) and mechanisms of transmission (which are the various ways in which organisms move from place to place). We begin with reservoirs. Reservoirs of Pathogens There are three potential reservoirs where pathogens can accumulate: humans, other animals, and nonliving reservoirs. With human reservoirs, it is obvious that a sick person is a reservoir for the pathogens causing the infection and will continue to be a reservoir for as long as the infection continues. However, determining that a given individual is acting as a reservoir can be difficult because some infectious diseases are transmitted before the symptoms are manifested. Take measles as an example. In
Disease Anthrax What Do I Need to Know? Bubonic plague To get the mostLyme out of this chapter, disease please review the following terms Typhus from your previous courses in biology, anatomy, physiology, chemistry Rocky or Mountain spotted fever or in previous chapters of this book fever as indicated in Relapsing parentheses: fomite, neutropenia, zoonotic, Malaria morbidity, endemic, pandemic (1). African sleeping sickness
Causative Agent
Mode of Transmission
Bacillus anthracis
Direct contact with infected animals; inhalation
Yersinia pestis
Flea bite Tick bite Louse bite
Rickettsia rickettsii
Tick bite
Borrelia species
Tick bite
Plasmodium species
Anopheles mosquito bite
Trypanosoma brucei gambiense
Tsetse fly bite
American sleeping sickness (Chagas’ disease)
Trypanosoma cruzi
Triatoma species (kissing bug)
Rabies
Rabies virus
Bite of infected animal
Hantavirus pulmonary syndrome
Hantavirus
Inhalation of virus in dried feces and urine
Yellow fever
Flavivirus
Aedes mosquito bite
• The first chapter presents a series of case studies designed to grab the readers’ attention and demonstrate the vital importance of studying microbiology. This • Each chapter begins with “Why is this Important?” feature helps students understand why they need to learn the material in the chapter. • Chapters also start with a “What Do I Need to Know” section . This feature overviews what background information is needed to make it easier to understand the chapter. • Throughout each chapter there are section summaries called “Keep in Mind” .This feature allows the student to pause and review the material they have just read.
• Reservoirs are places where pathogens grow and accumulate. • There are three potential reservoirs of infection; humans, animals, and nonliving reservoirs. • Human reservoirs can be infected people who are carriers. • Animal-to-human infections are referred to as zoonotic disease. • Nonliving reservoirs are water, soil, and food. Mechanisms of Transmission There are three mechanisms that can be used to transfer infectious organisms: contact transmission, vehicle transmission, and vector transmission. Contact transmission In the mechanism known as contact transmission, a healthy person is exposed to pathogens by either touching or being close to an infected person or object. We can subdivide the contact transmission mechanism into three types: direct, indirect, and droplet. In direct contact transmission, there is no intermediary between the infected person and the uninfected person (Figure 6.1). This mechanism encompasses such things as touching, kissing, and sexual interactions. The diseases transmitted through direct contact include hepatitis A, smallpox, staphylococcal infections, mononucleosis, and of course sexually transmitted diseases. Figure 6.1 shows that the direct-contact mechanism can also involve zoonotic disease. In that case, the infected organism is not a person but an animal. Indirect contact transmission occurs through intermediates that are usually nonliving articles, such as tissues, handkerchiefs, towels, bedding, and contaminated needles, the latter easily transferring HIV and hepatitis B.
Fast Fact Contaminated needles have become a major factor in the spread of HIV among intravenous drug abusers, and many cities have instituted needle-exchange programs, where authorities swap clean needles for used ones to try to slow this type of transmission.
contact transmission
Table 6.1 Examples of Zoonotic Diseases
• The book opens with a “Learning Skills” section which introduces students to practical strategies for improving reading comprehension.
Keep in Mind • Transmission is the final requirement for a successful infection.
We refer to the nonliving intermediates that act as the agents of transmission by indirect contact as fomites.
Borrelia burgdorferi Rickettsia prowazekii
Microbiology: A Clinical Approach contains many features that make it an effective tool for teaching and learning.
TRANSMISSION OF INFECTION 101 fact, the rust has nothing to do with it. It is the contamination of the nail with C. tetani that causes the infection. Recall from our discussions in Chapter 5 that this organism produces a neurotoxin that can be lethal.
direct contact
indirect contact by fomites
rabies
common cold
droplets
influenza, common cold
Figure 6.1 Examples of contact transmission of pathogenic organisms.
- Multiple-choice “Self Evaluation and Chapter questions test basic comprehension. Confidence” questions require the - “Depth of Understanding” students to integrate important concepts in a more challenging way. questions ask students to apply what - “Clinical Corner” they have just learned to a specific clinical setting or problem. • The book figures are bold, bright, and user-friendly. The numerous photographs and micrographs were chosen to illustrate the organisms and infections discussed in the text. The tables present a great deal of information in an easily digestible form. • The “MicroMovies” provide dynamic views of the microscopic and molecular worlds, and they were developed to make some of the in the margin challenging topics more accessible to students. Icons of the book indicate when a movie is available that corresponds to a particular section or figure. • The authors wrote the text in everyday language to explain things as simply as possible.
sections are found throughout the book. They • “Fast Facts” highlight a particularly interesting microbiology topic or fact.
• The Pathogen List is a quick and easy reference to the pathogens mentioned in the book, their characteristics, and the diseases they cause.
• There are three types of questions at the end of chapters. The correct answers, and explanations of the answers, are available on the Student Resources Website through the E-Tutor.
terminology.
• The Glossary contains definitions of the scientific and clinical
Instructor Resources All instructors who adopt the book will be entitled to the full complement of resources described below. These resources will be supplied on the Instructor’s CD and the Classwire™ course management system. ww
ndscience.c om w.garla
Microbiology a clinical approach
Instructor’s Resources
Includes: • Figures and tables in PowerPoint® and JPEG formats
Anthony Strelkauskas Jennifer Strelkauskas
• Instructor’s Manual
• Instructor’s Lecture Outlines
Danielle MoszykStrelkauskas
• MicroMovies
• Instructor’s Media Guide
Instructor’s Media Guide This PDF overviews the multimedia package available for students and instructors. It also contains the text of the voice-over narration for all of the “MicroMovies.”
• Question Bank
Scientific direction by Anthony Strelkauskas Produced by Michael Morales Narrated by Julie Theriot and Summers Scholl
© 20 10 Garland Science
The Art of Microbiology: A Clinical Approach The images from the book are available in two convenient formats: PowerPoint® and JPEG. They are located on the Instructor’s CD or can be downloaded from Classwire. On Classwire, the individual JPEGs are searchable by figure number, figure name, or by keywords used in the figure legend from the book. Instructor’s Manual To facilitate the design of a course around this book, the authors provide: a sample syllabus, based on their course; detailed guidance on each chapter; presentation strategies; clinical connections; instructional goals; and discussion of potential problem areas for students. Instructor’s Lecture Outlines These PowerPoint presentations provide a complete set of lecture outlines for this course integrated with illustrations and tables from the book. There is one presentation for each chapter. The presentations can be used “as is,” or can be easily adapted to suit your course. MicroMovies Short movies have been developed to complement material in a select number of chapters, with a special emphasis on molecular genetics, virology, and immunology. The movies are identified in the text with a special icon . Each movie has a voice-over narration, and the text for this voice-over is located in the “Instructor’s Media Guide.” The movies can easily be imported into PowerPoint presentations, and are available in two handy formats: WMV and Quick Time. Students are provided with the movies and movie scripts on the Student Resource Website.
CD4 co-receptor
viral cDNA
provirus
cytoplasm
nucleus
chromosomal DNA
Question Bank Written by Sherry L. Fuller-Espie, Cabrini College, the “Question Bank” contains over 800 questions in a variety of formats: multiplechoice, true-false, fill-in-the-blank, matching, and depth-ofunderstanding questions organized by book chapter. Answers are also given. The questions are designed for quizzes and examinations, and the multiple-choice questions are suitable for use with personal response systems (clickers). Diploma® Computerized Question Bank The questions from the Microbiology: A Clinical Approach question bank have been loaded into the Diploma test generator software. The software is easy to use and can scramble questions to create multiple tests. Questions are organized by chapter and type, and can be additionally categorized by the instructor according to difficulty or subject. Existing questions can be edited and new ones added. It is fully compatible with several course management systems, including Blackboard®. Classwire™ The instructor’s supplements described above are available online via the Classwire course management system. The system also provides access to instructor’s resources for other Garland Science books. In addition to serving as an online archive of electronic teaching resources, Classwire allows instructors to build customized websites for their classes. For additional information, please visit www.classwire.com/garlandscience or email science@ garland.com. (Classwire™ is a trademark of Chalkfree, Inc.)
Student Resource Website (www.garlandscience.com/micro) The Website contains multimedia designed to help students master the concepts and terminology presented in the book. The Student Resource Website is easy to use and freely available to all students. E-Tutor The E-Tutor provides guidance for answering all of the questions found at the end of each chapter of the book. The E-Tutor not only provides the right answer, but also explains in detail exactly why a particular answer is correct. MicroMovies A number of short movies (animations and videos) were created that will help students understand the concepts presented in the book. The movies are referenced in the textbook with an icon that indicates when a corresponding movie is available on the Website. Bug Parade The Bug Parade is an enhanced version of the Pathogen List found at the end of the book. If you click on the name of the bug, you will hear the correct pronunciation. This can be very useful since many of the Latin names are difficult to pronounce. Interactive Flashcards and Searchable Glossary Interactive Flashcards and a Searchable Glossary are available on the student resource site, and will help students master unfamiliar terms. Student Lecture Notes These topical outlines are designed to help students follow a lecture on a particular chapter. Students may want to print these out, bring them to class, and annotate them during the lecture.
infection
Viruses Latin name
Nucleic Acid Type
Disease
Chapter
adenovirus
dsDNA
acute respiratory disease, diarrhea, gastrointestinal infections
12, 13, 22
alphaviruses
+ ssRNA
encephalitis
28
arboviruses
+ ssRNA
hemorrhagic fever, hepatic necrosis, West Nile fever (fever and encephalitis)
8, 24, 25
+ ssRNA – ssRNA arena virus
– ssRNA
zoonotic central nervous system infections
13
Arenaviridae
– ssRNA
Lassa fever
8
avian influenza virus
– ssRNA
avian influenza (bird flu)
8
Bunyaviridae
– ssRNA
hantavirus pulmonary syndrome
8
calicivirus
+ ssRNA
diarrhea, gastrointestinal infections
22
coronavirus
+ ssRNA
acute mild respiratory infections
13
cowpox virus
dsDNA
cowpox
13, 16
coxsackievirus A16
+ ssRNA
hand–foot–and–mouth disease
13
cytomegalovirus
dsDNA
acute polyneuritis, mononucleosis syndrome
13, 17, 19, 23, 24, 25
eastern equine encephalitis virus
+ ssRNA
encephalitis
24, 25
Ebola virus
– ssRNA
hemorrhagic fever
4, 8, 12, 25, 28
+ ssRNA
diarrhea, gastrointestinal infections, meningitis, persistent enterovirus infection of the immunodeficient
13, 22, 24
ABOUT THE AUTHORS enterovirus merozoite invasion merozoite
red blood cell (RBC)
sporozoites
liver
infected RBC
transmission to mosquito
asexual cycle
O
infected RBC
O
Anthony J. Strelkauskas, Ph.D. Epstein–Barr virus 12, 13, 16, 25 polyneuritis, Burkitt’s After earning adsDNA Ph.D. from the acute University Illinois Medical lymphoma, infectiousof mononucleosis, lymphoproliferative infections in Center, Chicago, Tony Strelkauskas completed postdoctoral immunocompromised patients, nasopharyngeal carcinoma research at the Sidney Farber Cancer Institute, Harvard Medical flavivirus + ssRNA hemorrhagic fever, yellow fever 6, 8 School, before becoming a professor at the Medical University of hanta fever, hantavirus pulmonary 8, 19, 21 hantavirus – ssRNA South Carolina, where he taught immunology and microbiology syndrome to medical students. He is now the lead instructor for the microbiology course at Trident Technical College, Charleston, South Carolina, where his students have repeatedly nominated him for Who’s Who Among American Teachers. Jennifer E. Strelkauskas, D.V.M. Jennifer Strelkauskas is pictured here with a 6 day old baby alpaca (called a cria) after giving the newborn its first examination. She earned her D.V.M. from Auburn University, Alabama, and is currently practicing veterinary medicine in Hood River, Oregon. Danielle Moszyk-Strelkauskas, M.D. Danielle Strelkauskas earned her M.D. from the Uniform Services University of the Health Sciences and then completed an internal medicine internship at the Naval Medical Center, San Diego, California. She is currently the Chief Academic Resident in Emergency Medicine at the Naval Medical Center, San Diego, California.
gametocytes adhesion to endothelium of blood vessels
endothelium
Morphology