C07 PHYSICAL METHODS OF • Fractional sterilization (Tyndallization)

STERILIZATION Also known as intermittent sterilization;

involves exposing the material to be
HEATING - Most common physical method sterilized to live steam at 100°C for 30-90
of sterilization. minutes for three consecutive days
> The rate of killing is expressed in thermal c. Temperature above 100 °C
death time, i.e., the minimum time required • Autoclave (Steam under pressure)
to kill a suspension of an organism at a Most efficient method of sterilization
predetermined temperature and because it can all destroy microbial forms.
environment.
2. DRY HEAT - the effectiveness of dry
Several factors can affect the process of heat depends on the penetration of heat
sterilization through heating. These through the material to be sterilized.
include: a. Red flame
Sterilize articles like bacteriological wire
1. Nature of the heat - moist heat has loops, straight wires, tips of forceps, and
greater killing action than dry heat. searing spatulas. The materials are held
2. Temperature and time - as temperature over the flame of a Bunsen burner until they
increases, the time taken to sterilize become red hot.
decreases. b. Open flame (Flaming)
3. Number of microorganisms - the more Use of the Bunsen burner or alcohol lamp.
microorganisms there are, the higher the The material to be sterilized is passed over
temperature and the longer the duration of the flame several times but is not heated to
the process required to destroy all of them. redness.
4. Nature of microorganisms - c. Incineration
spore-forming microorganisms are more This method is aimed at burning the
difficult to destroy than non-spore-forming organism into ashes.
ones. d. Hot air oven
5. Type of material - the temperature The use of the hot air oven was first
required to sterilize materials depends on introduced by Louis Pasteur, Articles to be
the sensitivity of the material to heat. sterilized are placed in the oven with a
6. Presence of organic material - the temperature of 160°C for a period of one
presence of organic materials such as fats, hour.
proteins, and sugars may necessitate higher e. Infrared rays
temperatures. Articles to be sterilized are placed in a
conveyor belt and passed through a tunnel
TYPES OF HEAT that is heated by infrared radiators.
1. MOIST HEAT - preferred over dry heat
because of its more rapid killing action. DESICCATION - Based on the principle of
These include: depriving the microorganism of moisture.
a. Temperature below 100 °C FREEZING - Not a reliable method of
• Pasteurization sterilization because most pathogenic
Destroys disease-producing organisms in organisms are resistant to low
milk and milk products as well as other temperatures.
beverages. FILTRATION - Form of mechanical sieving
• Vaccine bath that does not kill microorganisms but merely
Destroys contaminating bacteria in vaccine separates them from the fluid.
preparations.
• Serum bath RADIATION
Inactivates bacteria contaminating serum 1. Ultraviolet Light (UVL)/Non-Ionizing
preparations and is done by heating at 56°C Radiation - It is used to disinfect hospital
for several successive days. wards, operating rooms, laboratories, and
• Inspissation other rooms in the hospital that need to be
Solidifies and disinfects egg-containing and sterilized.
serum-containing media. 2. Ionizing Radiation - Ionizing rays have
b. Temperature of 100 °C greater penetrance than UV rays.
• Boiling a. Electron beams
Utilizing water at a boiling temperature of Electron beams are particulate in nature. A
100°C. linear accelerator from a heated cathode is
used to generate high speed electrons. It (3) mechanism of action
can be used to sterilize syringes, gloves, MECHANISM OF ACTION
dressing packs, food, and some 1. Surface active agents - Compounds
pharmaceuticals. have long chain hydrocarbons that are
b. Electromagnetic rays (Gamma rays) - fat-soluble and charged ions that are
Produced from nuclear disintegration of water-soluble.
selected radioactive isotopes. It is used a. Cationic agents
commercially to sterilize disposable Petri > Detergents where the fat-soluble portion is
dishes, plastic syringes, vitamins, positively charged due to combination with a
antibiotics, hormones, fabrics and quaternary nitrogen atom.
glassware. b. Anionic agents
> Negatively charged agents that contain
SONIC AND ULTRASONIC VIBRATIONS long chain hydrocarbons. Ex. soaps and bile
Some bacteria can be killed after exposure salts.
to a certain frequency of sound waves. 2. Phenolic compounds - Act by
Exposure to sound waves at a frequency of disrupting cell membranes as well as
approximately 20,000 cycles/second for one causing precipitation of proteins and
hour can kill some bacteria and viruses. inactivation of enzymes.
OSMOTIC PRESSURE a. Phenol
When the concentration of the fluid > No longer used as a disinfectant because
surrounding the organism is altered, this will it is toxic to human cells.
cause the bacterial cell to collapse. Used for > Used as a gold standard in the chemical
preservation of fruits in syrup and meats in evaluation of new chemical agents using the
brine. phenol coefficient test.
b. Cresols
Chemical Methods of Sterilization > Phenol derivatives are more potent and
1. Concentration and potency of the safer than phenol. Ex. Lysol.
chemical agent c. Chlorhexidine
2. Duration of exposure > Used as a skin disinfectant in isopropanol
3. Temperature solution.
4. Nature of the surrounding medium > Its main use is as antiseptic hand wash.
5. Nature of the organism d. Chloroxylenol
6. Number of organisms/size of inoculum. > Used for topical purposes.
Good Chemical Agent Possesses the Ff. > They are effective against gram-positive
Characteristics: bacteria.
1. It should be broad spectrum, able to e. Hexachlorophene
destroy a wide variety of microorganisms. > Chlorinated diphenyl which has greater
2. It should be fast-acting, able to destroy activity against gram-positive bacteria
microbes within a short period of time. similar to chloroxylenol.
3. It should be active in the presence of f. Triclosan
organic matter. > Organic phenyl ether, has good activity
4. It should be active in any pH. against gram-positive bacteria and a
5. It should be stable. number of gram-negative bacteria including
6. It should be non-toxic, non-allergenic, Pseudomonas.
non-irritative, and non-corrosive. 3. Alcohols - Disorganize the lipid structure
7. It should be soluble in water and easy to of the cell membrane, dehydrate cells, and
apply. cause denaturation and coagulation of
8. It should leave a residual antimicrobial cellular proteins.
film on the treated surface. a. Ethyl alcohol
9. It should have high penetrating power. > Skin antiseptic, it is bactericidal and
10. It should not be expensive and must be removes lipids from skin surfaces.
easily available. b. Isopropyl alcohol
11. It should be safe under storage and > Has greater bactericidal activity than ethyl
shipping for reasonable periods of time. alcohol and is less volatile.
12. It should not have a bad odor. > Can be used to disinfect surfaces.
Classification of Chemical Disinfectants Inhalation of its fumes can cause narcosis.
(1) consistency (liquid/gaseous) c. Benzyl alcohol
(2) spectrum of activity (high, > Used mainly as a preservative,
intermediate, low) d. Methyl alcohol
> Fungicidal and sporicidal used in Broad Spectrum Antibiotics
disinfecting inoculation hoods. > Wide coverage of activity against a wide
spectrum of microorganisms.
Denaturing Agents Narrow Spectrum Antibiotics
(1) acids and alkalis > Limited coverage of activity, effective only
(2) alcohol and acetone against a limited number of microorganisms.
(3) phenol and cresol.
Classification of Antibiotics According to
1. Heavy metals - cause damage to the Mechanism of Action
enzyme activity of bacteria.
a. Mercurials (e.g., mercurochrome and Agents that Interfere with the Synthesis
merthiolate) of Bacterial Cell
b. Silver compounds (e.g., silver nitrate) are > These agents act by inhibiting the different
bactericidal stages of peptidoglycan synthesis or by
2. Halogens - bactericidal oxidizing agents destroying an already formed peptidoglycan
that cause oxidation of essential sulfhydryl by activating autolytic enzymes.
groups of enzymes causing inactivation of Agents that Alter the Function or
the enzymes. Permeability of the Cell Membrane
a. Iodine (tincture of iodine, iodophores) > The microbial cell membrane is essential
> Best antiseptic because it is sporicidal, to the survival of the organism because not
bactericidal, fungicidal, viricidal, and only does it serve as a barrier by its
amoebicidal. selective permeability but more importantly
b. Chlorine it is the site of bacterial ATP production.
> used in the treatment of water (chlorine Agents that Inhibit Protein Synthesis
gas). > These agents bind with the ribosomes,
c. Hydrogen peroxide either the 30S or the 50S ribosomal
> Weak antiseptic and used only for subunits or both.
cleaning wounds and in the disinfection of Agents that Act on the Nucleic Acid
surgical devices. 1. Agents that inhibit DNA topoisomerases
3. Alkylating Agents > Topoisomerase enzymes (types I and
a. Aldehydes II) are essential to DNA synthesis and are
> Damage nucleic acids by alkylation of critical enzymes involved in protein
amino-, carboxyl-, or hydroxyl groups. translation and cell replication..
> Kills all microorganisms including spores. 2. Agents that inhibit RNA synthesis
• Formaldehyde (formalin) > Agents that act by interfering with the
> Used for surface disinfection. B-subunit of an
• Glutaraldehyde RNA polymerase that is needed for RNA
> Sporicidal and used as a cold sterilant in synthesis.
sterilizing medical equipment such as > Rifampicin is a first-line drug used for the
respiratory therapy treatment of tuberculosis that specifically
machines and other equipment that can be inhibits bacterial RNA synthesis.
damaged by heat. Agents that Inhibit Microbial Metabolic
b. Ethylene oxide Pathways
> Sporicidal and is used in the gaseous > These agents interfere with metabolic
sterilization of heat-sensitive materials or pathways crucial for the survival of the
equipment like heart-lung machine, microorganism.
respiratory and dental equipment, and
polyethylene tubes in anesthesia machines. Mechanisms of Drug Resistance
(1) Intrinsic Resistance
C08 ANTIMICROBIAL AGENTS > Stable genetic property that is encoded in
the chromosome of the organism and
Antibiotics or Antimicrobials shared by all strains of the species.
> Substances produced from (2) Acquired Resistance
microorganisms or synthetically that are > Resistance arising from the ability of an
capable of inhibiting or destroying organism to resist an antimicrobial drug to
microorganisms even at low concentrations. which the species, as a whole, is naturally
susceptible.
Resistance acquired through genetic > any substance capable of inducing an
exchange can occur through any of three immune response, whether humoral or
ways; cell-mediated or both.
(1) TRANSFORMATION ● Antigen
> Simplest and the earliest form of genetic > substance recognized by the immune
exchange studied. system, whether by the B cell or the T cell,
> In transformation, naked or free microbial that serves as the target of the immune
DNA inserts itself into the DNA of the same response but may not necessarily lead to an
species. immune response.
(2) TRANSDUCTION ● Epitope
> Transfer of genetic material by a > structure in the antigen that is recognized
bacteriophage. by the B cell or the T cell.
(3) CONJUGATION ● Hapten
> Transferred to another bacterium is an > substance that is of low molecular weight
extrachromosomal DNA called plasmid. that can only induce an immune response if
> The resistance gene is carried by the bound to another substance that is already
plasmid. immunogenic (carrier molecule).

Mechanisms of Drug Resistance PROPERTIES OF ANTIGENS

● Drug modification or Inactivation (1) foreignness and genetic composition
> Ex. Certain bacteria produce (2) chemical composition and
beta-lactamases which can hydrolyze the complexity,
beta-lactam bonds in the chemical structure (3) molecular size and stability
of the antimicrobial agent. (4) mode of entry of the antigen
● Prevention of Cellular Uptake
(EFFLUX) ANTIGEN
> Gram-negative bacteria have developed > Genetically foreign to the host or
the ability to change the lipid composition of recognized by the body as non-self.
their outer membrane thereby preventing > Molecular weights below 10,000 daltons
the antibiotic from reaching its cellular are weakly immunogenic or not
target. This prevents their accumulation in immunogenic at all.
the bacterial cell. > Those with molecular weights greater than
● Modification of Target Sites 10,000 daltons are very potent
> Antimicrobials have specific targets in the immunogens.
bacterial cell. Any change in the structure of
these target structures will lead to the THE IMMUNE SYSTEM
inability of the antibiotic to exert its action on > Composed of molecular and cellular
the target bacteria. components that are derived from the
● Overproduction or Bypass of central (primary) and peripheral (secondary)
Target Enzyme lymphoid organs.
> One of the mechanisms developed by a. Central Lymphoid Organs (Bone
bacteria is targeting specific enzymes that marrow & Thymus)
are essential to the metabolism of the > Primary sites for differentiation and
organism. maturation of the important cells that play
● Target Mimicry an important role in adaptive immunity
> Target mimicry is a new mechanism of which are the T lymphocytes (or T cells) and
antimicrobial resistance that has been the B lymphocytes (or B cells).
discovered. b. Peripheral Lymphoid Organs
> It involves bacteria producing proteins that > Consist of lymph nodes, spleen, and the
are similar in structure to the target sites of mucosa-associated lymphoid tissues
the antibiotics. (MALT), which include the tonsils, adenoids,
Peyer's patches in the ileum, and the
C09 HOST RESPONSE TO INFECTION appendix.

● Immunology CELLS OF IMMUNE SYSTEM

> study of the immune system and the
immune response. (1) granulocytes (e.g., neutrophil) which
are 50%-80% of white blood cells
● Immunogen
(2) lymphocytes, approximately 20%-45% > they were originally classified as cytotoxic
of total white blood cells T cells because they had the same manner
(3) monocytes and macrophages, 3%-8% of killing target antigens.
of white blood cells. ● T CELLS & B CELLS
> most important cells of the immune
system
● NEUTROPHILS > originates from bone marrow
> play a major role in acute inflammation as > involved in adaptive immunity
well as in bacterial infections. ● B CELLS (HUMORAL)
● LYMPHOCYTES & > cells mature in the fetal liver and in the
MACROPHAGES adult bone marrow, which is the equivalent
> mainly involved in chronic inflammation. of the bursa of Fabricius in birds.
> Lymphocytes are the predominant > located mostly in the germinal centers of
inflammatory cells in viral infections. the lymph nodes and in the spleen.
> Macrophages are also predominant in > differentiate into antibody-producing
chronic inflammation. plasma cells as well as memory B cells.
● ANTIGEN PRESENTING CELL > function as a professional antigen
> cells that are involved in the processing presenting cell
and presentation of antigens to the T cells. ● T CELLS (CELL-MEDIATED)
These includes: > located mainly in the paracortical and
(1) Macrophages, B cells, Dendritic interfollicular areas of the lymph nodes and
cells - professional antigen spleen.
presenting cells; dendritic cells being > further differentiate into CD4+ T cells and
the most important. CD8+ T cells (cytotoxic or cytolytic)
> Dendritic cells - considered as the true > CD4+ T cells consist of the helper T cells
link between innate and adaptive immunity. and the regulatory T cells (CD4+CD25+ T
(2) Langerhans cells (skin) - bring cells).
antigens to paracortical zone of > helper T cells do not have the direct
lymph nodes capacity to destroy an antigen.
(3) Kupffer cells (liver) > T cells, most especially the CD4+ T cells
(4) Glial cells (CNS) are the predominant lymphocytes in the
circulation and constitute part of the body's
● EOSINOPHILS immune surveillance.
> possess eosinophilic granules that play a
role in type 1 hypersensitivity reaction or
allergy. INNATE IMMUNITY (non-specific)
> secrete a substance that is called major > also known as natural immunity.
basic protein that is toxic to parasites, > already active from the time of birth, prior
especially helminths or worms. to exposure to an antigen.
● BASOPHILS
> also play a role in allergies. (1) FIRST LINE OF DEFENSE, includes
> granules of both eosinophils and host barriers that prevent entry of
basophils contain histamine which when microorganisms such as the skin
released is responsible for the changes and mucous membranes
seen during the initial phase of an allergic (2) SECOND LINE OF DEFENSE,
reaction. processes such as phagocytosis and
inflammation; prevents the
● PLATELETS multiplication of organisms that gain
> membrane-bound cell fragments that are entry to the body preventing them
derived from large cells called from multiplying before they have a
megakaryocytes. chance to produce disease.
> platelets are mainly involved in blood (3) FINAL DEFENSE (immune
coagulation, however, they secrete response)
substances that play a role in inflammation.
● NATURAL KILLER CELLS
> large granular lymphocytes that are also
called NK cells or null cells.
PATHOGEN-ASSOCIATED MOLECULAR > main immunoglobulin produced early in
PATTERNS (PAMP) the primary response; predominant antibody
> microorganisms are recognized by innate in acute infections.
immune cells and soluble mediators 3. IgA (secretory immunoglobulin)
because of their molecular patterns. > main immunoglobulin in secretions such
as colostrum, saliva, and tears, as well as
CLASS SWITCHING respiratory, gastrointestinal, and
> some of the IgG in the circulation can genitourinary tract secretions.
undergo modifications in their structure to > an important component of mucosal
become converted to another antibody (e.g., immunity.
IgA or IgE). 4. IgE (monomer; reaginic antibody)
> medically important for two reasons: (1) it
HUMORAL IMMUNITY mediates immediate or anaphylactic
(1) Innate Humoral Immunity, involves hypersensitivity rxn, and (2) provides
cytokines and the complement defense against parasites such as
system. helminths or worms.
(2) Adaptive Humoral Immunity, 5. IgD (monomer; no known antibody
involves the action of antibodies. function)
(3) Antibody-Mediated Immunity, > found on the surface of many B cells and
directed primarily against (1) serves as the surface marker for B cells but
extracellular pathogens, (2) may also function as an antigen receptor.
toxin-induced diseases, (3)
certain viral infections, and (4) CELL-MEDIATED IMMUNITY
infections caused by 4 Basic Functions, namely:
encapsulated pathogens (e.g., (1) provide resistance and aid in recovery
pneumococci and haemophilus from infections due to intracellular
influenzae). organisms (e.g., viruses)
(2) important defense against fungi,
ANTIBODIES parasites, and bacteria
> globulin proteins (immunoglobulins) that (3) involved in transplant and graft rejection
react specifically with the antigens that (4) main defense against tumor cells.
stimulate their production. Components of the Cell-Mediated
> fxn of antibodies are: Immune System
(1) to neutralize toxins and viruses (1) macrophages
(2) to opsonize microbes so that they will (2) natural killer cells
be readily recognized and more easily (3) helper T cells
phagocytosed (4) cytotoxic T cells
(3) to activate complement system (5) macrophages, together with B cells and
(4) to prevent the attachment of dendritic cells present antigens to T cells.
microbes to mucosal surfaces.
ANTIBODY STRUCTURE COMPLEMENT SYSTEM
> the region at which the arms of the > consists of a group of soluble proteins (C1
antibody molecule form a letter Y is a - C9) which are proteases that cleave and
flexible region called the hinge region. activate one another in a sequential
manner.
Classes of Immunoglobulins > 3 Pathways That Act Synergistically
1. IgG (monomer) With Each Other:
> predominant antibody in the secondary ● Alternative or Properdin Pathway,
immune response (anamnestic response) activated by bacterial products such
and is a major defense against bacteria and as endotoxin or complexes of
viruses. immunoglobulins.
> most abundant antibody in newborns ● Classical Pathway, activated by
> fxn as an opsonin, thus enhancing antigen-antibody complexes.
phagocytosis. ● Mannose Binding Lectin (MBL)
> main immunoglobulin in chronic infections. Pathway, activated by specific
2. IgM (pentamer) patterns of sugars found on the
> largest among the immunoglobulins. bacterial cell wall.
> has a J chain (joining chain) that holds (1) C3a and C5a - chemotactic for
the IgM pentamer together. neutrophils; chemical mediators in
 inflammation causing vascular natural killer cells which can destroy the
leakage or increased vascular target cells without phagocytosis.
permeability. > COMPLEMENT AND FC
(2) C3a, C4a, and C5a - function as RECEPTOR-MEDIATED INFLAMMATION -
anaphylatoxins, causing initiated when antibodies (IgG or IgM)
degranulation of mast cells and deposit in fixed tissues such as basement
release of histamine. membrane or extracellular matrix.
(3) Membrane Attack Complex (MAC) > There is no destruction or lysis of target
- causes lysis of the bacterial cell. cells.
> The autoantibodies produced may act as
HYPERSENSITIVITY REACTIONS competitive inhibitors or may mimic the
> exaggerated and inappropriate immune action of the normal ligand for the receptor.
responses that lead to tissue injury resulting > Ex. Myasthenia Gravis
in harm to the host.
● Type III: Immune
● Type I: Immediate (Anaphylactic) Complex-mediated
Hypersensitivity (IgE; allergic rxn) Hypersensitivity
> Involves accurate history taking. > Initiated by the formation of immune
> Type I hypersensitivity can be divided into complexes in the circulation.
two phases: immediate phase and late > LOCAL IMMUNE COMPLEX DISEASE -
phase. exemplified by Arthus rxn. Seen as a
> IMMEDIATE PHASE - represents the complication of immunization especially with
vascular events of inflammation which vaccines that are given with multiple doses
include vasodilation and increased vascular (e.g., DPT).
permeability. > SYSTEMIC IMMUNE COMPLEX
> LATE PHASE - represents the cellular DISEASE - exemplified by acute serum
events of inflammation; tissues will show sickness. Triggered by the administration of
infiltration by inflammatory cells which large amounts of foreign serum (e.g.,
include neutrophils and eosinophils. anti-tetanus serum) or after receiving
> LOCAL ANAPHYLAXIS (food allergy, antibodies from another person or species.
urticaria (hives), eczema, allergic rhinitis or
hay fever, and asthma) ● Type IV: T Cell-mediated
> SYSTEMIC ANAPHYLAXIS Hypersensitivity
(hypotension, severe bronchoconstriction, > Formerly known as delayed type of
and laryngeal edema) hypersensitivity.
> It involves T lymphocytes (either CD4+ or
DIAGNOSTIC TEST (size of ≥ 10 mm is CD8+ T lymphocytes), not antibodies.
considered positive) > INDURATION - detectable skin rxn.
● SKIN PRICK TEST, known allergens
are administered subcutaneously
like doing a skin test. VACCINES
● SCRATCH TEST, superficial
scratches spaced equally are HERD IMMUNITY (immunization of a
created on the ventral aspect of the population stops the spread of an infectious
forearm after which varying solutions agent by reducing the number of
of known food allergens are applied. susceptible hosts)

● Type Il: Antibody-mediated TYPES OF IMMUNIZATION

Hypersensitivity (cytotoxic; IgG or 1. PASSIVE IMMUNIZATION
IgM) > administration of purified antibodies in
> The first sub-type involves the processes preparations called immune globulins or
of opsonization and phagocytosis. antibody-containing serum.
> OPSONIZATION - process where an > Ex. treatment of rabies
antigen is coated by molecules that facilitate 2. ACTIVE IMMUNIZATION
recognition by phagocytic cells resulting in > injection of vaccines prepared from
enhanced phagocytosis. organisms or their products.
> ANTIBODY-DEPENDENT CELLULAR > Ex. TDaP, MMR, and BCG.
CYTOTOXICITY (ADCC) - activation of
TYPES OF VACCINES
 1. LIVE ATTENUATED VACCINES ● SYMBIOSIS - prolonged and close
> prepared using organisms with limited interaction between organisms of
ability to cause disease. different species.
> immunity acquired is usually long-lived ● MUTUALISM - form of symbiosis in
> Edward Jenner for smallpox. which both organisms benefit from
> Albert and Sabin developed the first live the relationship.
oral polio vaccine. ● COMMENSALISM - form of
> Ex. Bacille-Calmette-Guarin (BCG) symbiosis in which one organism
vaccine for tuberculosis and vaccines benefits from another organism
against measles, mumps, rubella (German without causing harm to it.
measles), chickenpox. ● PARASITISM - form of symbiosis
Cons: where one organism benefits from
(1) organisms may still revert to their another organism and at the same
original virulent form once they enter the time causes harm to the other.
body. ● PATHOGENICITY - ability of an
(2) may be dangerous to organism to produce disease. An
immunocompromised patients and organism that can produce disease
pregnant women. in humans is said to be pathogenic.
2. TOXOID VACCINES ● VIRULENCE - describes the degree
> developed based on the principle that of pathogenicity of an organism or
certain diseases are caused by exotoxins the degree to which an organism
produced by the causative agents. can produce disease.
> Ex. are tetanus, botulism, pertussis, ● CONTAMINATION - presence of
diphtheria, and cholera. unwanted materials (chemical,
Pros: biological, or radiologican amina
(1) they are safe without possibility of they should not be or at
reverting to a virulent form concentrations above the normal.
(2) the component antigens are ● POLLUTION - presence of
non-replicating; and contaminants that can cause
(3) they are more stable compared to live adverse biological effects to humans
vaccines. and communities.
3. KILLED VACCINES ● BACTEREMIA - presence of
> refer to vaccines derived from bacterial bacteria in the blood.
sources ● SEPTICEMIA - presence of actively
> first killed vaccine to be produced was the multiplying bacteria in the blood,
typhoid vaccine during the latter part of the usually from a source of
19th century ● infection. The condition is called
4. INACTIVATED VACCINES sepsis.
> are derived from viruses. ● PREMIA - presence of
> Ex. of inactivated vaccines that are pus-producing bacteria in the
popularly used are the polio vaccine and bloodstream.
hepatitis A vaccine. ● VIREMIA - presence of viruses in
5. SUBUNIT VACCINES the blood.
> produced the same way as the ● TOXEMIA - presence of toxins in the
killed/inactivated; but only a specific antigen blood.
or structure on the organism is used.
> Ex. hepatitis B, haemophilus influenzae,
streptococcus pneumoniae KOCH POSTULATES
Robert Koch
C10 BACTERIA AND DISEASE > was a German physician who made
● DISEASE - result of an undesirable significant contributions to the field of
relationship between the host and microbiology.
the pathogen, marked by interruption > one of his greatest and most well-known
in the normal functioning of a body contributions was proving that certain
part or parts. microorganisms caused specific diseases.
● INFECTION - invasion of the body These postulates are as follows:
by pathogenic microorganisms. 1. The suspected organism must be absent
in healthy individuals but present in those
with the disease.
2. The suspected organism must be isolated > usually the site where the infectious agent
from the infected host and grown in pure is commonly located or localized.
culture. (2) MODE OF TRANSMISSION
3. The organisms grown from pure culture a. DIRECT CONTACT
must produce the same disease as that of Person-to-person contact - involves
the infected source when inoculated to a transmission through skin-to-skin contact,
susceptible animal. kissing. or sexual transmission.
4. The same organism must be isolated Droplet spread - patients with respiratory
from pure culture from the tract infection such as the common colds or
experimentally-infected influenza can transmit the causative agents
host. during coughing and sneezing.
b. DIRECT CONTACT
Factors that Influence the Occurrence of Airborne transmission - infectious agents
Infection: The Chain of Infection may be transferred from an infected person
to a susceptible host through dust or
RESERVOIR aerosols.
> serve as the continual source of Vehicle transmission - transmission of
disease-producing microorganisms. organisms through media such as food,
> site where an infectious agent normally water, milk, or biologic substances such as
resides and multiplies. blood and body secretions.
ANIMAL RESERVOIRS Vector transmission - usually insects that
> can be transmitted from an animal to can transmit an infectious agent.
humans. - Mechanical transmission - passive
> these are called zoonotic infections. transport of the organism on the
HUMAN RESERVOIRS insect's feet or other body parts.
> may be directly transmitted from one - Biological transmission - active
individual to another. transport of the organism.
> Ex. respiratory pathogens, sexually (3) PORTAL OF ENTRY
transmitted infections. > how the infectious agent enters a
> CARRIERS susceptible host.
> those who developed the disease, got (4) HOST
well but still harbor the organism thereby > final link in the chain of infection.
transmitting them to others.
> individuals who are not aware that they How Organisms Produce Disease
are transmitting infectious agents which
makes them public health hazards. ● Mechanical: Invasiveness
● ASYMPTOMATIC/ HEALTHY > organisms can produce disease by
CARRIERS directly damaging tissues or body surfaces.
> infected but do not manifest symptoms. > this involves invasion of the epithelial
● INCUBATORY CARRIERS surface and penetration into deeper tissues.
> transmit the causative agent during the ● Chemical: Toxin Production
incubation period of the illness. > TOXINS - poisonous substances are often
● CHRONIC CARRIERS the primary factors that contribute to
> those who harbor the organism for months disease production.
or longer after the patient developed the ENDOTOXINS - integral components of the
initial infection. outer membrane of gram-negative bacteria.
● CONVALESCENT CARRIERS > Ex. Salmonella, Shigella, Escherichia coli.
> developed the disease, recovered but EXOTOXINS - intracellular products of
remained capable of transmitting the some bacteria as part of their growth and
causative agent metabolism and are released into the
surrounding medium.
ENVIRONMENTAL RESERVOIRS > Ex. diphtheria toxin, botulinum toxin,
> water, soil, and plants can harbor tetanus toxin
infectious organisms. ● Immunologic
> some organisms produce disease not as a
(1) PORTAL OF EXIT consequence of mechanical invasion or
> route by which an infectious agent exits its toxin production but as a consequence of
host. the immune response of the host to the
microorganism or its product.
 Based on the Extent of Host Involvement
Classification of Infectious Diseases ● LOCALIZED INFECTION
> which the invading organisms are limited
● COMMUNICABLE DISEASE to a relative, small area of the body.
> spread from one host to another, either ● FOCAL INFECTION
directly or indirectly. > causative agents of a localized infection
● CONTAGIOUS DISEASE may enter a blood or lymphatic vessel,
> easily and rapidly spread from one person spread to specific parts of the body and
to another. become confined to specific areas.
● FULMINANT INFECTION ● PRIMARY INFECTION
> if the infection results in the death of the > acute infection that causes the initial
patient over a short period of time. illness
● NON-COMMUNICABLE DISEASE ● SECONDARY INFECTION
> not spread from one person to another. > caused by opportunistic pathogens after
the primary infection has weakened the
Based on the Source of the body's defenses.
Microorganism ● SUBCLINICAL OR INAPPARENT
● EXOGENOUS (outside) INFECTION
> if the source of the infectious agent is from > does not cause noticeable illness.
outside the body.
> NOSOCOMIAL (HOSPITAL ACQUIRED) Stages of an Infectious Disease
● ENDOGENOUS (inside) 1. INCUBATION PERIOD
> infection is one where the source of the > the time interval between entry of the
causative organism is from inside the body. offending agent and the appearance of the
initial signs and symptoms of the disease.
Based on the Occurrence of a Disease 2. PRODROMAL PERIOD
● SPORADIC DISEASE > relatively short period, is characterized by
> occurs occasionally early, mild symptoms of disease which are
● ENDEMIC DISEASE generally non-specific.
> constantly present in a population at low 3. PERIOD OF ILLNESS
levels > corresponds to the period of maximal
● EPIDEMIC invasion.
> if a great number of people in a given > during this period the disease is most
locality develop an infectious disease in a acute.
relatively short period of time. > patient manifests signs and symptoms
● PANDEMIC distinctive of the disease.
> if a disease has a worldwide occurrence 4. PERIOD OF DECLINE
or involves at least three regions in the > corresponds to what is known as the
world. period of defervescence.
> the signs and symptoms of the patient
Based on the Severity or Duration of a start to subside.
Disease 5. PERIOD OF CONVALESCENCE
● ACUTE DISEASE > this period is marked by recovery of the
> develops rapidly but lasts for only a short patient from the disease.
period of time. > patient regains strength and the body
> Ex. common cold returns to its pre-diseased, normal
● CHRONIC DISEASE condition.
> develops more slowly and occurs for long
periods of time.
> Ex. tuberculosis
> Hepatitis B infection can be acute or
chronic.
● LATENT DISEASE
> causative organism remains inactive for a
time but can become active again and
produce symptoms of the disease
> Ex. shingles, reactivation of a latent
chickenpox infection
QUESTIONS 8. Which among the following chemical
CHAP 07 agents act by modifying functional groups of
1. What is the process where all microbial proteins and nucleic acids?
forms in non-living objects, including the a. Detergents
spores are destroyed: b. Chlorhexidine
a. Sterilization c. Formaldehyde
c. Tyndallization d. Isopropyl Alcohol
b. Disinfection 9. Which among the following statements is
d. Lyophilization true regarding physical methods
2. An agent capable of inhibiting the growth of sterilization?
of bacteria but does not kill them is called: a. Dry heat is more effective than moist
a. Bactericidal heat.
b. Bacteriostatic b. Heat-sensitive materials will require lower
c. Bacteremia temperatures than heat-resistant ones.
d. None of the above c. Spores are destroyed using boiling at 100
3. This method is used to effectively sterilize °C.
instruments, surgical bandages, culture d. In autoclave, when the temperature is
media, and other contaminated materials. It 100°C, the pressure is 15 psi.
can destroy all microbial forms including 10. Which among the following statements
spores: is true regarding chemical methods of
a. Autoclaving disinfection?
b. Boiling a. Chemical agents must not leave a
c. Pasteurization residual antimicrobial film on the treated
d. Tyndallization surface.
4. The method of pasteurization called b. A lower temperature is needed to speed
Ultra-High Temperature (UHT) involves up the rate of chemical reactions.
which of the following? c. Alcohol is bactericidal at 100%
a. Heating at 60°C-65°C followed by rapid concentration.
cooling d. A good chemical agent must be odorless
b. Heating at 72°C for 15 seconds followed and easy to prepare.
by quick cooling to 13 °C
c. Heating is done at 140°C for a period of CHAP 08
15 seconds and 149°C 1. Which of the following mechanisms
for 0.5 seconds describes the action of beta-lactamases?
d. Heating at 121 °C for 15-20 minutes at 15 a. Efflux pump
psi c. Drug inactivation
5. This form of radiation causes disruption b. Target mimicry
of H bonds in bacterial DNA, causing d. Target overproduction
formation of thymine dimers and frameshift 2. Which of the following resistance
mutations: mechanisms is commonly effective against
a. Ultraviolet light (UVL) a wide range of antimicrobials in multiple
c. Gamma rays classes?
d. X-ray a. Efflux pump
b. Ionizing radiation c. Target modification
6. Which of the following is correct b. Target mimicry
regarding ethylene oxide? d. Target overproduction
a. It is used in gaseous sterilization. 3. Which among the following methods of
b. It is more potent than glutaraldehyde. gene exchange involves the transfer of
c. It is sporicidal. naked or free DNA?
d. All of the above a.Transformation
7. This chemical agent is used as a gold b. Transduction
standard in the evaluation of new chemical c. Conjugation
agents. d. Binary fission
a. Phenol 4. Which among the following methods of
b. Alcohol gene exchange involves the transfer of
c. Cresols plasmid DNA from a donor bacterium to a
d. Acetone recipient bacterium?
a. Transposition
c. Transduction
b. Transformation b. Can revert to virulent form
d. Conjugation c. Can be safely given to pregnant women
5. Which among the following is not a d. Composed of organism that is rendered
characteristic of a good antimicrobial agent? virulent
a. Broad spectrum 8. Which hypersensitivity reaction has been
b. Stable when stored implicated in diabetes type IP
c. Does not remain for a long time in body a. TypeI
tissues c. Type III
d. Demonstrate selective toxicity b. Type II
6. Trimethoprim d. Type IV
7. Ampicillin 9. Which immunoglobulin is also an
8. Metronidazole opsonin?
9. Amphotericin B a. IgA
10. Rifampicin b. IgG
c. IgE
CHAP 09 d. IgM
1. The following are secondary lymphoid 10. Hepatitis A vaccine is an example of
organs, EXCEPT which type of vaccine?
a. Appendix a. Killed vaccine
c. Lymph node c. Live, attenuated vaccine
b. Bone marrow b. Inactivated vaccine
d. Spleen d. Subunit vaccine
2. Destruction of organisms by phagocytosis
is an example of which type of immune CHAP 10
reaction? 1. Which of the following is the proper order
a. Adaptive, cell-mediated on the stages of an infectious disease
c. Innate, cell-mediated process?
b. Adaptive, humoral a. Convalescence, Incubation, Illness,
d. Innate, humoral Prodromal, Decline
3. The following are characteristics of b. Prodromal, Convalescence, Incubation,
adaptive immunity, EXCEPT: Decline, Illness
a. Specific c. Incubation, Prodromal, Illness, Decline,
c. Possess immunologic memory Convalescence
b. Short-term protection d. Illness, Incubation, Prodromal,
d. Amplifiable response Convalescence, Decline
4. Which cell is involved in antibody 2. The site where pathogens grow is called:
production? a. Reservoir
5. B lymphocyte b. Portal of exit
c. CD8+ T lymphocyte c. Portal of Entry
b. CD4+ T lymphocyte d. Host
d. Natural killer cell 3. An individual who is more likely than
5. What is true regarding the secondary others to acquire an infection is a:
immune response? a. Vector
a. Antibody response is lower than the c. Fomite
primary immune response. b. Reservoir
b It is seen on first encounter with the d. Susceptible host
antigen. 4. A 6-year old child was brought to the
c. The predominant immunoglobulin present Emergency Room because of high-grade
is IgG. fever and petechial rashes. Dengue was
d. All of the above suspected. Dengue exemplifies which type
6.The following constitutes the body's first of transmission?
and second lines of defense, EXCEPT: a. Person-to-person contact
a. Tears b. Vehicle transmission
c. Phagocytosis c. Vector transmission
b. Saliva d. Airborne transmission
a Antibodies 5. Blood can be classified under which type
7. Which of the following is a characteristic of transmission?
of live, attenuated vaccines? a. Direct contact
a. Needs more doses c. Droplet transmission
b. Vehicle transmission
d. Vector transmission
6. Which among the following clinical
conditions can be considered as an
ourbreak
or epidemic?
a. Two or more people with diarrhea and
vomiting
b. Two people living together with diarrhea
and vomiting
c. Two or more people which exceeds the
expected number experiencing the same
illness in the same place and at the same
time
d. Two or more people with a respiratory
infection
7. Which of the following IS NOT considered
a portal of entry for bacteria?
c. Mouth
a. Eyes
b. Nose
d. Intact skin
8. A 75-year old male patient was admitted
for elective cataract extraction. While in the
hospital, he developed pneumonia. This is
classified as what type of infection?
a. Community-acquired infection
c. Epidemic
b. Nosocomial infection
d. Sporadic
9. A patient was brought to the hospital
because of symptoms of tetanus. The
disease is due to the bacterium Clostridium
tetani and the manifestations are the effects
of tetanospamin, a neutrotoxin produced by
the causative agent. Which mechanism of
disease production is involved?
a. Mechanical
b. Chemical
c. Immunological
d. A and B
10. A 5-year old child was exposed to a
neighbor who has measles. After 5 days,
she started to manifest cough, colds, and
conjunctivitis. The time from exposure until
the development of the signs and symptoms
presented by the child corresponds to which
stage of the disease process?
a. Incubation period
b. Prodromal period
c. Period of illness
d. Period of defervescence