MICROBIOLOGY

& IMMUNOLOGY

Y1SEMESTER1 SEPT
2021CLASS
PRESENTED BY

Jepkemboi

18hrs
 Module Competence

• This module is designed to enable the learner

promote health, prevent illness, diagnose,
manage and rehabilitate patients/clients
suffering from infections diseases

3
 Module outcomes
By the end of this module, the learner
should;
Apply concepts in microbiology for
diagnosis and management of patients
suffering from infectious diseases.
Apply principles of immunology in
management of patients

4
 UNITS
Microbiology – 8HRS
Immunology - 10HRS

5
 COURSE OUTLINE

a)Microbiology.
•definition of terms
•historical background of microbiology
•Classification of microorganisms,properties
of microorganisms and their clinical
importance

6
 CONT.
• sources of microorganisms, modes of
transmission of microorganisms
• Concept of infection : definition of terms
related to infection, stages in development
of an infection, common nosocomial
infections

7
 Cont.
a) Immunology
•Definition of terms and importance
•types of immunity (humoral, cell-mediated,
passive, active and herd immunity) antigen-
antibody reaction, types of antibodies,
modes of action of antibodies, complement
system of immunity

8
 Cont.
• Immune reaction type1,2 (anaphylaxis,
hypersensitivity) nonspecific defences,
specific immunity

9
 SPECIFIC OBJECTIVES
1. To define terminologies
2. To describe the historical development of
microbiology
3. To describe the structure and characteristics
of micro organisms
4. To describe the importance of microbiology in
nursing.
5. To describe the immunological process
6. To describe the body defense mechanisms

10
 Terminologies
• Microbiology is the study of living organisms of
microscopic size
• Immunology is the study of all aspects of immunity
• Commensal-organisms living on or within organism
without causing any harm
• Pathogen-any disease producing agent/organism
• Toxin- harmful substance causing poison
• Medium(in relation with microbiology)- a substance
providing a suitable environment for the growth of
organisms
• Vaccine-suspension of attenuated killed micro-
organisms for prevention of infectious diseases
11
 Conts…
• Vaccination-introduction of vaccines into the body to
produce immunity of specific diseases.
• Antigen –any substance capable of producing antibody
formation reacting specifically.
• Inflammation-localized protective response elicited by
an injury and destruction of tissues
• Innoculation-introduction of a disease into a health
individual
• Incubation period-time between the infection of the
body by the pathogenic organism and appearance of the
first symptoms of disease
12
 Conts…
• Immunization-process of rendering the subject highly
resistant to a disease
• Virulence-ability of the pathogen to invade the tissues of
the host
• Host –an animal or a plant that provides substances for
another organism
• Exotoxin-toxins formed and excreted by the host cells
• Endotoxin-heat stable toxins produced and retained
inside the bacteria

13
INTRODUCTION
• Microbiology is derived from a greed word
Micro= small, tiny, minute
Bio= life
Ology= study
• Micro-biology is the study of micro-organisms
which very small and cannot be seen by naked
eye.
• Microbiology is the branch of science that deals
with the study of micro organisms

14
BRANCHES OF
MICROBIOLOGY
Microbiology is divided into branches according
to the types of micro-organisms
1.Parasitology; the study of parasites
2.Mycology ; study of fungi/yeast
3.Bacteriology; bacteria
4.Virology; viruses
5.Protozoology; protozoa

15
 Historical background
• Microbiology had its beginning in the ancient
times
HISTORICAL ERAS OF MICROBIOLOGY
1. In ancient times, men associated illnesses with
sorts of will and hypothetical factors e.g. Gods
wrath, ancestral spirits, demons, witchcrafts,
bad weather e.t.c

16
 Theories
1. Theory of spontaneous generation
• It was believed by philosophers that living
things arose from dead and decomposed
organic matter. This was later disputed by Louis
Pasteur a French chemist when he proved that
when particles were filtered through cotton wool
and introduced to flasks with sterilized organic
materials they gave rise to growth of numerous
living organisms.

17
Microbial theory of fermentation
• Pasteur proved that lactic fermentation was due
to living organisms. Between 1855-1860 he
showed conclusively that lactic acid and butyric
acid fermentation was the work of bacteria and
the fermentation involved yeast.
• He also showed that there was a relationship
between the type of micro organisms involved
and the type of fermentation produced. He
rescued the silk worm industry from the scourge
of an infectious disease called Pebrine
18
 PRINCIPAL CONTRIBUTORS TO
MICROBIOLOGY
1. Anthony Van Leewenhoek (1632-1728)
He was a Dutch scientist and is known as the
father of microbiology
He discovered microorganisms by making
magnifying lenses as a profession and later
invented microscopes
2. Edward Jenner (1749- 1825)
He discovered that there was a relationship
between bacteria and diseases

19
 Cont’
He discovered and successfully tried the first
smallpox vaccines and the whole concept of
immunity
3. Louis Pasteur (1822-1895)
He is the father of bacteriology.
He was a French chemist who disapproved the
theory of spontaneous generation
He proved that lactic fermentation was due to
living organisms and based on experiments
prooved that fermentation of wine was caused
by bacteria

20
 Cont’
• He opened the field of sterilization by showing
that boiling renders the fluid sterile
• He introduced the idea of autoclaving in
laboratories
• He taught farmers about prevention of diseases
in animals- silk worms
• He introduced 3 vaccines: chicken pox, rabies
and anthrax vaccines
4. Semmelweis (1818-1865)
He showed that man can be a carrier of disease
He later died of an infection by bacteria
21
 Cont’
5. Joseph Lister (1827-1912)
He heard of Pasteur’s work and realized that
if bacteria can cause fermentation then
they would cause suppuration of wounds
He therefore realized that there were ways
to stop these “ little bodies” from
multiplying by cleaning wounds regularly,
Soaking instruments and dressings and
beginning to use antiseptic technique
22
 Cont’

6. Robert Koch
he was a German general practitioner
- In 1881 he described the method of preparing
cultures on solid media which made it possible
for the isolation of pure stains of bacteria from
single colonies
- In 1882 he discovered the Tubercle bacillus
and in 1883 the Vibrio cholera. He modified
Henre’s criteria of disease causation and came
up with Koch’s postulates.
23
 Cont’
• According to the postulates a micro organism
can be accepted as a causative agent of
infectious disease only if the following
conditions are met:
1. The microorganism should be found in plenty
in all organisms suffering from the disease but
should not be found in an health animals.
2. The microorganism must be isolated from a
diseased organism and grown in pure culture

24
 Cont’
3 The agent cultured microorganism should cause a
disease when introduced into a healthy organism
4. The microrganism must be reisolated from the
innoculated,diseased experiment host and
identified as being identical to the original specific
causative agent
NB Henre a scientist had earlier stated that before
any microscopic organism could be regarded a s
a cause of disease to man: It must be found
constantly in the diseased tissue, must be
isolated from the animal and it must reproduce
the same disease in a different animal

25
IMPORTANCE OF MICROBIOLOGY
IN NURSING
• Helps the nurse to know pathogens, their
sources and composition
• Helps to know how these micro organisms
are transmitted and how they spread
diseases
• It is a step in prevention and cure of many
diseases
• Helps the nurse to take universal precautions
when in the hospital environment
• It an important aspect in infection control
• Forms a rich source in health education,
immunization and surveillance

26
MAJOR DIVISIONS OF
ORGANISMS
• Micro-organisms can either be pathogenic or non
pathogenic
• Can be further classified into 2
1. prokaryotes (Unicellular)- single cell for example f
bacteria,
2. Eukaryotes (Multicellular) e.g Protozoa and Fungi
• Viruses are on their own because they
consist of a length of DNA or RNA
surrounded by a capsid and they have no
cells
27
 Differences
Differences between Prokaryotes and Eukaryotes
1. Prokaryotes belong to kingdom monera e.g.
bacteria while Eukaryotes belong to the
kingdoms protista, fungi, plantae and
animalia
2. A distinct nucleus is absent in prokaryotes
while eukaryotes have a distinct nucleus
3. In prokaryotes the DNA is in the form of a
singular chromosome and its additional DNA
are carried in plasmids while in eukaryotes,
DNA is carried on several chromosomes
within the nucleus
4. In addition it is only in the eukaryotes that the
cytoplasm is rich in membrane bound
organelles like mitochondria, golgi bodies and 28
 Differences between
Prokaryotes and eukaryotes
Prokaryotes: bacteria eukaryotes
• Less complex More complex
True nuclears with
• Circular chromosomes nuclear membrane
• Lack nuclear membrane Membrane bound
organelles
• Lack membrane bound Contain multiple
organelles chromosomes and mitotic
(mitochondrial, apparatus
lysosomes E.gs of eukaryotic cells:
plant; animal; protozoa,
• Divides through binary human; fungi; algae
fission Divides by mitosis
29
30
 Similarities between
Prokaryotes and Eukaryotes
• Prokaryotic and eukaryotic cells are similar
in several ways. Both types of cells are
enclosed by cell membranes (plasma
membranes), and both use DNA for their
genetic information.

• Prokaryotes include several kinds of

microorganisms, such as bacteria and
cyanobacteria. Eukaryotes include such
microorganisms as fungi, protozoa, and
simple algae. Viruses are considered neither
prokaryotes nor eukaryotes because they
lack the characteristics of living things,
except the ability to replicate (which they
31
accomplish only in living cells).
HOST- ORGANISM
RELATIONSHIP
• It is estimated that humans have very many
cells with bacteria largely associated with
them especially in the large bowel.
• The organisms occur in those parts of the body
that are exposed to or communicate with the
external environment like the skin, nose
mouth,Intestinal and urogenital tract.
• These organisms live in a symbiotic
relationship and are called normal flora.
• Normal flora is acquired rapidly during and
shortly after birth and change continuously
throughout life.
32
Advantages of Normal flora

They prevent colonization by pathogens by the

following ways:
1. By producing compounds which kill other
bacteria e.g. Gut bacteria release a number
of factors with antibacterial activity
(bacteriocins,)
2. Lowering the PH so that other pathogenic
bacteria can’t grow e.g. Vaginal lactobacilli
maintain an acid environment
Skin bacteria produce fatty acids which
discourage other species from invading
33
Advantages of N. Flora
cont’
3.By competing with invaders for space and
nutrients e.g. the presence of normal flora
in the intestine occupies all niches there is
competition when other organisms invade
Disadvantages
1.If normal flora escape from their location ,
they can cause disease for example
Escherichia coli, commonly found in the
intestine, can cause urinary tract infections
If introduced into bladder
It may also happen when the intestine is
perforated or the skin is broken, when there
is tooth extraction or an ascending infection
when the normal flora spreads to sterile 34
 Cont.

•2.Immunosuppression can allow

otherwise harmless bacteria to cause
diseases e.g. in HIV AIDs

35
 SYMBIOTIC
ASSOCIATIONS
• As normal flora demonstrates, pathogenesis
is not the inevitable consequence of host-
microbe associations, many factors must
come into play for a disease to occur.

• To understand the micro logic basis of

infectious diseases, host microbe
associations that can be pathogenic need to
be placed firmly in the context of other
symbiotic relationships like commensalism,
Mutualism and parasitism 36
 Symbiosis Cont’
1. Commensalism
This is an association in which one species
uses the body of a larger species as its
physical environment and may make use of
that environment to acquire nutrients.
Majority of theses microbes are bacteria
and their relationship with the host is highly
specialized with specific attachments and
precise environmental requirements.

It normally exist out of convenience and can

emerge into either mutualism or parasitism
37
Symbiotis Assciation Cont’
2. Mutualism
These relationships provide reciprocal
benefits for the two organisms involved
e.g the bacteria and protozoa living in the
stomachs of domestic ruminants which
play an essential role in digestion and
utilization of cellulose, receiving in return
both the environment and the nutritional
essential for survival
3. Parasitism
The relationship benefits only the parasite.
It is a one sided relationship.
38
 Cont.
CLASSIFICATION OF
MICRO –ORGANISMS
STRUCTURE AND
CHARACTERISTICS OF
MICRO ORGANISMS

39
 CLASSIFICATION OF
MICRO –ORGANISMS
• Micro- organism are classified as follows :
1)Bacteria
2)Virus
3)Fungi
4)Protozoan

40
 BACTERIA
Characteristics
Are single-celled organisms ,
 have neither a well defined nucleus nor a
nucleus membrane
It consists of a unique cell wall, cytoplasmic
membrane enclosing the cytoplasm, a nucleus
apparatus, ribosomes and cytoplasmic granules.
Some have flagella, pili and can produce spores
They have a large surface area to volume ratio
and can gain food rapidly from their environment
by diffusion and active transport

41
 Bacteria Cont’d
 They reproduce by binary fission (asexually)
and branching (budding)
 Bacteria are very small and the unit of
measurement in bacteriology is the micron or
micrometer

42
 Structure of Bacteria
 Bacterial cell component can be divided
into 2 components :-
 1. cell wall and cytoplasmic or plasma
membrane ( beneath the cell
 2. cell interior which is made up of
structures and substances that are bound
by the cytoplasmic membrane and include
cytoplasm,cytoplasmicinclusions:
mesosmes,ribosomes,inclusion
granules,vacuoles and single circular
chromosomes of deoxyribonucleic acid
43
Bacteria cell
 Microscopic structure of
bacteria cell
Capsule: Is the outermost, slimy coating
over the bacterial surface.
• It provides protection against phagocytosis
by host cells
• It confers increased virulence of bacteria
possessing them.
• It helps in reliable means of diagnosis in
bacterial infections
45
 Microscopic structure of
bacteria cell
Cell wall
• It contributes to the ultimate shape of the
organism
• Helps in bacterial identification
• Gives rigidity to the organism
• Chemically bacterial cell wall is
composed of mucopeptide called
peptidoglycan
46
 Microscopic structure of
bacteria cell
Flagella
• Are long helical filaments extending from
the cell surface
• Aids in bacterial motility
• Flagella are built of protein components
(flagellum) which are strong antigenic.
These antigens are important targets of
protective antibody responses.
47
 Microscopic structure of
bacteria cell
Pili
• Are very thin hair like external appendages
of a cell protruding from the capsule.
• Function: aids in bacterial attachment

48
 Classification of Bacteria
• Only pathogenic bacteria cause disease in
man or animals
• Comensals- live on the host but do not
cause harm to the host under normal
circumstances
• Bacteria of medical importance can be
divided/grouped/classified depending on
structure, shape, size, staining properties,
and ability to form spores etc .
49
Bacteria can be classified based on:

1.shape. Depending on their

shape ,bacteria can be further classified
into
a)Cocci- these are spherical bacterial
e.g. streptococci
They may be observed in various
arrangements e.g. pairs (or diplo cocci),
chains (or streptococci), clusters (or
staphylococci), packets of four or
tetrads, packets of 8 depending on the 50
particular species and how it divides
 Cont.
b)Bacilli-are straight , rod shaped
e.g. They may occur singly, in pairs
(diplobacilli), in chains (streptobacilli),
They are strictly aerobes or facultative
anaerobes e.g. Clostridium tetani and
Bacillus anthracis, lactobacilli
c)Vibrios – are curved or comma
shaped e.g. vibrio cholerae
D)Spirilla are rigid spiral non
flexous spiral filament or helical forms
51
Bacteria Cont’d
E.Spirochetes -are flexuons spiral forms e.g
Treponema pallidum a causative agent of
syphilis, Borellia spp. and Leptospira sp.
Vi .Mycoplasma – are cell wall deficient
bacteria
2.Gram staining
Bacteria are also classified according to their
cell wall characteristics as either gram positive
or gram negative.
In gram positive bacteria the cell wall called
peptidoglycan forms a thick layer to the cell
membrane and may contain her macromolecules.

52
Bacteria Cont’d
 In gram negative bacteria the
peptidoglycan is thin and is overlaid by an
outer membrane, anchored to lipoprotein
molecules.
 Many bacteria species are less demanding
nutritionally and may require a single
organic compound to meet all of their
biosynthetic needs
 The cell must encounter acceptable
conditions of temperature, oxygen, PH,
moisture and ionic strength

53
 Bacteria Cont’d
 The rate at which bacteria grow and divide
depends in large part on the nutritional status
of the environment e.g. In the division of E
coli in a rich media takes 20 minutes and 2
hours in a depleted environment.

 The gram stain and acid fast are the most

widely used procedures in the staining of
specimens and cultures for microscopic
examination

54
Gram Staining
Gram staining (or Gram's method) is a method
of differentiating bacterial species into two large
groups (Gram-positive and Gram-negative).
It is based on the chemical and physical
properties of their cell walls. Primarily, it detects
peptidoglycan, which is present in a thick layer in
Gram positive bacteria. A Gram +ve results in a
purple/blue color while a Gram -ve results in a
pink/red color.

• Gram stain is almost always the first step in the

identification of a bacterial organism, and is the
default stain performed by laboratories over 55
a
sample when no specific culture is referred.
Gram Staining cont’d

While Gram staining is a valuable

diagnostic tool in both clinical and
research settings, not all bacteria can be
definitively classified by this technique,
thus forming Gram-variable and Gram-
indeterminate groups as well.

The word Gram is always spelled with a

capital, referring to Hans Christian Gram
56
Gram Staining mechanism

Gram-positive bacteria have a thick

mesh-like cell wall made of
peptidoglycan (50-90% of cell envelope),
which are stained purple by crystal
violet.

Gram-negative bacteria, on the other

hand, have a thinner layer (10% of cell
envelope), which are stained pink by the
counter-stain. 57
Gram Staining mechanism
cont’d
There are four basic steps of the Gram stain:

(i)Applying a primary stain (crystal violet) to a

heat-fixed smear of a bacterial culture. Heat
fixing kills some bacteria but is mostly used to
affix the bacteria to the slide so that they don't
rinse out during the staining procedure.

(ii)The addition of a mordant, which binds to

crystal violet and traps it in the cell (Gram's
iodine).
58
Gram Staining mechanism
cont’d
(iii) Rapid decolorization with alcohol or
acetone, and

(iv) Counterstaining with safranin.

Carbol fuchsin is sometimes substituted
for safranin since it will more intensely
stain anaerobic bacteria but it is much
less commonly employed as a
counterstain.
59
60
61
62
63
64
A Gram stain of mixed Staphylococcus
aureus(Gm +ve cocci) and Escherichia coli
(Gm -ve bacilli), the most common Gram
stain reference bacteria.

65
66
Gram-positive B. anthracis bacteria (purple
rods) and white blood cells (round) in
cerebrospinal fluid. Gram-negative bacteria
would have appeared pink.

67
68
 Examples of gram positive
bacteria
1.Corynebacterium
Are pleomorphic, club-shaped Gram positive
bacilli arranged in V form or palisades (
Important genus
C Causes diphtheria (throat) esp in child
aged 3-6 months (disease of URT)

69
 2.Bacillus Anthracis
Morphology:Large, gram positive bacilli
•Causes anthrax (is a zoonoses)
i.Cutaneous anthrax
ii.Pulmonary anthrax
iii.Intestinal anthrax
Spread via inoculation (broken skin),
inhalation and ingestion of infected meat.
Also from infected soil
70
 cont
3.Clostridium Tetani
Morphology: A slender gram positive
bacillus
Non-capsulated, non-motile. Form terminal
spores
•produce very toxic toxins
•Causes tetanus.

71
 Cont.
4.Mycobacteria
a)Mycobacterium tuberculosis (tubercle
bacilli)
That causes pulmonary tuberculosis
b) Mycobacterium leprae
Pathogenesis-causes leprosy

72
 cont

STAPHYLOCOCCI
•Morphology
•Gram positive.
•Spherical,Arranged in grape-like clusters
•Common species include:
a)Staphylococcus aureus: that causes
skin infections eg Wound and burn
infections, furuncles and boils
 Cont.
Deep infections
Osteomyelitis, Peritonitis, Tonsilitis,
pharyngitis, sinusitis, bronchopneumonia, ,
septicemia, meningitis, endocarditis,. Food
poisoning

74
 4.STREPTOCOCCUS
• Are gram positive cocci which grow in
chains (strept) common sps are:
• i)Streptococcus pyogens (Group A)
• Causes diseases e.g tonsolitis and
pharyngitis, puerperal sepsis.
• Strept Pneumoniae (pneumococcus.
pneumonia causes broncho and lobar
pneumonia, bronchitis, sinusitis, otitis
media,
75
 Cont.
• meningitis,endocarditis
• Is a common cause of bacterial meningitis
esp in children and the elderly

76
 Examples of gram negative
Neisseria (genus)
This genus contain gram negative oxidase
producing cocci
Important species
1)Primary human pathogens are:
a)N. menengitidis
b)N. gonorrhoeae

77
 Cont,
Neisseria meningitidis (Meningococcus)
Morphology
Gram negative cocci, occurs in pairs
(diplococci)
Pathogenicity
Causes meningitis
Occassionally causes acute urethritis,
prostatis, epidydimitis, vulvovaginitis
78
 N. Gonorrhoeae
Pathogenicity
The primary infection is gonorrheae. (STD),
Babies born to infected mothers contact
serious gonococcal eye infection
(ophthalmia neonatorum)
Anorectal gonococcal infection among
homosexuals
Gonococcal pharyngitis via orogenital sex
79
 vibrio's
• Vibrio cholera
Morphology it is a gram negative ,Are short,
curved/comma shaped rods with rounded
or pointed ends
Pathogenesis
Is the most serious.
Causes Cholera-an acute diarrheal disease
in man
80
 Spirochetes
• Morphology : Are thin, helical, motile,
flexible bacteria, twisted spirally along the
long axis giving them the name
spirochaetes
Examples;
i)Treponema pallidum
Pathogenesis
Causes syphyllis.
81
 Helicobacter pylori
Morphology
S-shaped, short spirals gram negative rods.
Pathogenicity
Gastric and duodenal ulcers

82
83
 Cont.
Based on oxygen requirement
bacteria can be further separated
into aerobes and anaerobes
a)Aerobic bacteria
Require oxygen for survival and
growth and may be:
obligate aerobes they have an
absolute or obligate requirement for
oxygen like vibrio cholerae

84
 Cont.
Facultative anaerobes is one that
can survive in both aerobic and
anaerobic conditions though less
abundantly in absence of oxygen e.g.
staphylococcus spp, E.coli
B) Anaerobic bacteria-grow in
absence of oxygen
Obligate anaerobes: They may even
die on exposure to oxygen e.g
Clostridium tetani ,
85
VIRUSES
• General properties of viruses
Are the smallest known infective agents
Are obligate intracellular parasites
They infect most forms of life to include animals
and plants
The main properties distinguishing viruses
from other micro-organisms
1.Small size-they are smaller than other
organisms. Are of various sizes from 10-300
nanometers (nm).
86
 Cont.
They can pass through bacterial filters and
cannot be seen in light microscope. Need to
be visualized by an electron microscope
•2)Genome
•A virus carries its own genetic information
in form of either DNA/RNA but NOT both.
•The genome may be a single or double-
stranded; circular or linear
87
 3)Metabolically inert
The virus particles or virions are
metabolically inert and do not carry
out the respiratory or biosynthetic
functions
They don’t posses ribosomes or protein-
synthesizing apparatus, although some
viruses contain one or more enzymes within
their particles

88
Viruses Cont’d
• Virus are considered as agents of disease
or as agents of heredity
• They infect animals, plants, bacteria and
fungi
• They are obligatory intracellular parasites
and can only replicate in susceptible cells

89
 Cont.
• Structure of a virus
• Functional areas of a virus
RNA –Ribonucleic acid occur in the nucleus
and is genetic material that is involved in
protein synthesis
DNA –genetic material of nearly all viruses
and control heredity and located in cell
nucleus
90
 Cont.
• Viruses consist of nucleic acid core
surrounded by a protein coat called
capsid.
• The capsid with the enclosed nucleic acid
is known as nucelocapsid
• Tail –This is used for propulsion during its
movement to various part

91
 Cont.
• Membrane envelop – this encloses the
protein coat containing RNA and DNA
• Fibers – this helps the virus to stick onto
the host cell
personal Assignment
Draw a well labeled diagram of a virus

92
Viruses cont’d
Viruses grow and replicate within the living cells of
the host
•When infected by a virus, a host cell is forced to
produce many thousands of identical copies of the
original viruses
•The virus depends on the host cell for energy for
synthesis of viral components
The Viral replication cycle
1.Attatchment- The virus has attachment site and
cell receptors that enable it to attach to host cell
and the cycle begins

93
 Cont.
2.Penetration- After attachment the
nucleocapsid enters the cell by fusion with
the aid of a viral protein
3. Uncoating - Here there is disassembly of
the nucleocapsid into a capsid and nucleic
acid with the help of the host enzyme
4. Transcription and translation- here
there is the synthesis of virus specific
messenger RNA, synthesis of viral genes
and translation of mRNA into polypeptides
94
 Classification of
Viruses
• Is based on the type of nucleic acid,
its strandness (double/single) and
the size of the viruses
DNA viruses infecting humans
Orthopox virus (Genus)
Smallpox (species)
Morphology-Has a biconcave
dumbbell shaped DNA
Was globally eradicated in 1980
(WHO)
 Simplex virus (genus)
Herpes viruses
Morphology-Has double-stranded DNA
Important species
i.Herpes simplex virus type 1 (HSV-1)-that
causes oral and CNS and causes genital
herpes infections
ii.Herpes simplex virus type 2 (HSV-2)-
infects genital and anal regions e.g genital
herpes, meningitis, neonatal infections
 Cont.’
Cytomegalovirus
Important species
Human cytomegalovirus
Has DNA. Has huge cytoplasm.
Causes cytoplasmic disease of newborn

97
 (Genus)
Varicellovirus
Important species
Varicella zoster virus
Causes Varicella (chickenpox) in children
and zoster (shingles) in adults and
immunocompromised pts.
 cont.
Cytomegalovirus
Important species
Human cytomegalovirus
Has DNA. Has huge cytoplasm.
Causes cytoplasmic disease of newborn

99
 Cont.
• Papovirus
Important species
Human papillomavirus (wart viruses)
Causes warts at different sites on the human
body e.g plantar, common, flat, genital and
skin warts

100
 Cont.
• Adenoviridae (adenovirus)
Morphology:Double-stranded DNA genome
that cause respiratory diseases like
sore throat and pneumonia, eye
infections, gut infections and chronic
diarrhea in HIV patients
Epstein-barr Virus (EB) VIRUS
Causes glandular fever
101
 Cont.
Hepatitis
Morphology
Size 42 nm. Is a DNA virus. Is spherical
Is enveloped, transmitted parenterally,
sexually, intrauterine and perinatally
•B Virus (HBV)

102
 RNA VIRUSES
• ARBOVIRUSES
• Are arthropod borne viruses.
• Causes arthralgia, haemorrhagic fever and dengue
fever (painful bone disease
Rubella
Has RNA with an envelop.
Causes German measles affecting pregnant women
in first trimester. Congenital rubella may cause
microcephally, retinopathy, deafness and patent
ductus arteriosus.
103
 Picornaviridae family
• The viruses are very small (pico) with
RNA. Non-enveloped, icosahedral
Important genus are;
a)Enterovirus
Has 4 known species
i. Poliovirus-causes paralytic polio and
asceptic meningitis

104
 Cont.
i. Coxsackievirus A-causes aseptic
meningitis, myocarditis
ii. Echovirus-causes aseptic meningitis,
conjunctivitis
iii. Enterovirus-causes hepatitis
b) Rhinovirus-the commonest cause of
common cold

105
 cont.
Orthomyxoviridae family
•This is the family of influenza virus.
•Have RNA genome,
Has 3 genera;
i.Influenza A
ii.Influenza B} causes RTIs & esp
pneumonia by type B(immunizable)
iii.Influenza C
106
 Paramyxoviridae family
has single molecule of RNA.
•Has 3 genera pathogenic to man
i.Paramyxovirus (genus)
Species a) Parainfluenza virus
Causes URTI esp in children
b)Mumps virus
Causes mumps (bilateral inflammation of
salivary glands)
107
 Cont,
ii)Morbillivirus (genus)
Species-Measles virus-causes measles
Rhabdoviridae family
Important species
Rabies virus
Causes rabies which is a hydrophobia
terrifying, fatal communicable disease.
108
 Reoviridae family
• Has two genus.
i. Rotavirus
Morphology: double stranded RNA
genome.
Causes rota virus gastroenteritis (95% of
children worldwide are infected within 3-
5yrs) ,Rota virus vaccine was introduced
in Kenya in July 2014
109
 Cont.
• ii) Reovirus
• Causes gastroenteritis

110
Examples of viruses
• Adenoviruses that cause respiratory
diseases, eye infections, gut infections
and chronic diarrhea in HIV patients
• Herpes virus (herpes simplex) that cause
oral infection, skin infection, eye, genital
and CNS infections and herpes zoster.
There is also the human herpes virus that
causes a tumor called karposis sarcoma
• Poxviruses that causes smallpox
• Papovavirus that causes skin warts
• Picornavirus that causes viral meningitis

111
Laboratory diagnosis of specific
viral diseases
1. Morphological studies though
electron microscopic examination
or immunoflourescent tests.
2. Serology in which the principle of
antigen antibody reaction applies
3. Virus isolation in cultures or
laboratory animals for observation
of replication
4. Nucleic acid technology like in
the Polymerase chain reaction tests
112
Antivirals
• They act by intercepting the viral
cycle either at the attachment site
e.g. human serum immune globulin,
or they interfere with penetration and
uncoating or with the maturation
phase or release

113
FUNGI

114
FUNGI
The study of fungi is called mycology
derived from a Greek word mycos
meaning mushroom.

All fungi are eukaryotic organisms.

They are chemotropic thus obtain

nutrients from chemicals found in
nature.

Most survive by secreting enzymes

that degrade a wide variety of 115
Fungi cont’d
The natural habitats for most fungi are
water, soil and decaying organic debris.

They grow as moulds or yeasts.

In medicine they are an important source of

biologically active compounds like
immunosuppressive agents and potential
anti cancer drugs.

Yeasts are unicellular, some produce by

binary fission but most by budding. 116
Fungi cont’d
Moulds are multicellular, filamentous
colonies.

Some species of fungi are dimorphic

thus capable of growing in more than
one form under different
environmental conditions.

Fungi reproduce asexually, sexually or

Para sexually ( mitotic recombination).117
FUNGAL INFECTIONS
Fungi cause disease in human in 3 general
ways:
1. Allergic reactions to fungal allergens
(spores) e.g. causing bronchial asthma.

2. Toxic reactions e.g. aflatoxins.

3. Infections and active growth on animals

e.g. Mycoses which is an actual growth
of a fungus on the human body e.g.
118
ringworm, yeast infections etc.
Fungi cont’d

Fungi may enter the host through

penetration on the skin (Candida
albicans), inhalation, ingestion or
via lactrogenic inoculation
(indwelling catheters, surgery or
after chemotherapy

119
120
 Types of fungi

•Superficial mycosis which include

dermatophyte like ring worms, tenea capitis ,
tenae corporis
•Deep mycoses which affect lungs,
subcutaneous tissue eg Candida
albicans,Cryptoccus neofomans,
Pnemocytis carini
121
 Cont.
• Mucosal mycoses which affect oral,
oesophageal and vagina which include
candida albicans

122
Identification of fungi
(i) Microscopy through direct observation
with Potassium hydroxide added to the
specimen.

(ii)Culture in Sabourand agar which is

acidic, high sugar with an antibiotic added
to prevent bacterial growth.
Fungi take 2-4 weeks to grow in a culture
unlike bacteria which takes 24hrs

123
Importance of fungi
1. Decomposition of organic matter

2. Production of drugs

3. Are disease causing organisms

124
Protozoa
• These are unicellular single celled
organisms with a true membrane bound
nucleus and cytoplasm.
• They are eukaryotes that have a relatively
complex internal structure and carry out
complex metabolic activities
• Some protozoa have structure for propulsion
or other types of movement
• Most protozoans reproduce asexually by binary
fusion but a few like plasmodium reproduce
sexually and some both
• They are microscopic with most parasitic
protozoa to human being less than 50
micrometer
\\
 Cont.
Protozoa contain 4 important
parasites of humans:

(i) Amoeboids eg Entamoeba

histolytica:
( cells that move by extending
pseudopodia)
(i) Flagellates (Tryponosoma spp).
(Motile Cells equipped with whip
like organelles of locomotion
126
 Cont.
(iii)Ciliates eg Balantidium coli
(cells equipped with large numbers of
short hair like organs of locomotion)
(iv)Sporozoans ( e.g. Plasmodium
species)
Parasitic, spore producing cells, whose
adult form lacks organs of motility
NB .Some protozoans have two phase life
cycles, alternating between proliferative
stages( Trophozoites) and dormant cysts
127
 Cont.
• As cysts, protozoa can survive harsh
conditions, such as exposure to extreme
temperatures or long period without
access to nutrients ,water or oxygen for
long period of time
• Being a cyst enable parasitic species to
survive outside of a host and allow
transmission from one host to another

128
 Cont.
• The conversion of a trophozoite to cyst is
called encystation while the process of
transforming back into trophozoite is
known as excystation

129
Cont.

130
Cont.

131
Cont.

132
Cont.

133
 STERILIZATION, DISIFECTION
AND ANTISEPSIS
• Sterilization is destruction or elimination of all
microorganisms by physical means e.g heat,
radiation and filtration
• Disinfection is destruction of pathogenic or
potentially pathogenic microorganisms by
chemical means
• Antisepsis refers to destruction or prevention of
growth and multiplication by chemical means. It
is external application of a chemical to tissues
• Bacteriastatic agent refers to a chemical or
biological agent that prevents growth and
multiplication but does not kill pathogens
134
 Cont’
• A bactericidal agent destroys pathogenic
or potentially pathogenic microorganisms
• Sterilization is achieved by dry heat (hot
air oven, ), moist heat like boiling
autoclaving and pasteurization
• Freezing also kills bacteria together with
radiation and filtration

135
Factors that influence the activity of
disinfectants and antiseptics
1. Concentration
2. Exposure time
3. Temperature
4. PH
5. Condition of the surface
6. Type of microorganism

136
 THE IMMUNOLOGICAL
PROCESS
• The body has several ways of preventing
microorganisms from entering the body called
defense mechanisms
• There are three 3 defense mechanisms:

1. PRIMARY/ FIRST LINE DEFENSE

This is non specific and includes:
a. The skin
- forms a barrier to microbial invasion.
- The acidic secretions in the sebum maintains a
PH of 3-5 on the skin and inhibits some bacteria
137
 Cont’
- High salt concentration in sweat inhibits
microorganisms
- Normal skin flora contribute to skin
defenses as some of their metabolic
products inhibit the growth of other
microbes e.g. lactobacilli in the vagina
- The skin has a water proof keratin in the
outer epidermis and basement membrane
between the dermis and epidermis
138
 Cont’
b. Eyes
- Eye lashes and eyelids act mechanically to
prevent foreign objects from reaching the cornea
- Tears contain lysosomes which help destroy
bacteria by breaking down bacterial cell walls
- Tears also contain antibodies that coat micro
organisms and prevent their attachment to
tissues
c. Ears
- Cerumen and hairs in the auditory canal prevent
microorganisms from invading the ear
139
 Cont’
- The surfaces of the ear in the auditory canal are
lined with skin that contain normal flora that
prevent the growth of pathogens
d. Respiratory tract
- Mucus on the lining of the bronchial tree traps
foreign materials. The mucus contain lysozymes
which degrades the cell wall of bacteria
- Cillia beats the foreign particles up towards the
pharynx where they are spit out or swallowed
- Phagocytes in the bronchioles eliminates
microorganisms and other foreign material

140
 Cont’
5. Digestive system
Saliva which has some antibodies to kill bacteria
Stomach acids provide unfavorable environments
for bacteria
Enzymes which destroy some microorganisms in
the digestive system
Bile which is alkaline helps in destroying some
micro organisms
Normal flora of the large intestines competes with
pathogens and prevents growth under normal
conditions
141
 Cont’
6. Nervous system
- This a sterile system that has no normal
flora
- Its protected by the blood brain barrier and
the meninges that prevent microorganisms
and toxic substances from reaching the
brain
- Phagocytes found in the spinal cord and
brain also destroy any microorganisms
142
 Cont’
8. Urogenital system
- Urinary sphincters act as a mechanical
barrier to microbes
- Flow of urine through the urethra washes
away microbes
- The low PH of the urethra and vagina
prevents invasion of pathogens

143
 SECOND LINE/SECONDARY
DEFENSE
 This is also non specific and involves
chemical responses
 Blood consists of a fluid called plasma
which contain formed elements (cells
and cell fragments namely:
1. Erythrocytes (red blood cells which
transport oxygen and carbon dioxide

144
 Cont’
1. Leukocytes (white blood cells)
a) Granulocytes- neutrophils, basophils and
esonophils ( necessary for defense
mechanisms)
b) Monocytes for defense
c) Lymphocytes for antibody production and
immunity
Collectively the granulocytes, monocytes and
lymphocytes are called phagocytes
Platelets that are necessary for blood clotting
145
 Cont’
 During active stage of infection leukocyte
count increases
 Some of he chemical mediators
produced include: Interferons,
Fibronectin, B-lysin and interleukins (all
from white blood cells)
 The second line defense mechanisms
results in a series of mechanisms that
include:
146
 Cont’
1. Fever production
- When phagocytes ingest gram negative
bacteria for example, endotoxins are released
that causes interleukin 1 to be released and
this stimulates the hypothalamus to respond by
causing fever
- High body temperature intensifies the action of
Interferons and this inhibits the growth of
microorganisms by decreasing the amount of
iron available for them

147
 Cont’
2. Phagocytosis
- This is the ingestion of a microorganism by
phagocytes
- When an infection occurs, both granulocytes
especially neutrophils (dominate in the early
stages of disease) and monocytes migrate to the
infected area
- During this migration the monocytes enlarge and
become macrophages (dominate in the later
stages)
- Phagocytosis occurs in four main phases:

148
 Cont’
a. Chemotaxis
This is the chemical attraction of the phagocytes
to the microorganisms
b. Adherence
The phagocyte’s plasma membrane attaches to
the surface of the microorganism or foreign
material
c. Ingestion
During this time the plasma membrane of the
phagocyte extends projections called
psudopods that engulf the microorganism
149
 Cont’
d. digestion
This is done when the engulfed organism
enters the cell’s cytoplasm and contacts
lysosomes that contain digestive enzymes like
lysozyme and lipase.
3. Inflammation
Damage to the body’s tissues either by physical
agents or chemical agents triggers an
inflammatory response

150
 cont
The purpose of an inflammatory response is:
- To localize an infection by limiting its
effect on the body
- To neutralize toxins by destroying and
removing it from the body
- To aid in the repair of damaged tissue
It is characterized by four main symptoms
Redness, pain, heat and swelling
151
 The process of inflammation
 Immediately following tissue damage, blood
vessels dilate (vasodilation) and this causes an
increase in blood flow to the area resulting in
redness and heat
 Increased permeability permits defensive
substances that are normally retained in the
blood to pass through the walls of blood vessels
and enter the injured area (permeability) that
results in swelling
 The chemical mediators that are released in
response to injury include histamine, kinins,
prostaglandins and leukotrienes
152
 Inflammation cont’
 Vasodilation and increased permeability help
deliver clotting elements around the site and this
prevents toxins from spreading
 As a result there may be a localized collection of
pus( a mixture of dead cells and body fluids due
to breakdown of tissues)
 Pain is due nerve damage, irritation by toxins or
pressure of edema
 Hours after the inflammatory response is
initiated phagocytosis occurs
 The final stage of inflammation is tissue repair

153
 Cont’
4. The compliment system
- This is a defensive system consisting of serum
proteins that participates in destroying foreign
cells, inflammation and phagocytosis
- It is activated in 2 ways: by an immune reaction
of antibodies to antigen or by direct interaction of
certain proteins with polysaccharides
- It consists of at least 20 interacting proteins
found in normal serum ( accounting for 5% of all
proteins in vertebrates)

154
 Cont’
- The components are C1 to C9,
C1q,C1r,C1s, B factor, D and factor P
- The compliment system contribute to
destruction of microbes though cleavage
of C3 into two fragments C3a and C3b
which causes three processes:
- A. Cytolysis- destruction of foreign cells
by damaging the plasma membrane (this
causes the cellular contents to leak out)
155
 Cont’
- B. Inflammation- cleavage of C3a and
C5a causes acute inflammation by binding
to mast cells, basophils and platelets to
release histamine
- C. Opsonization – When bound to the
surface of a microorganism C3b interacts
with special receptors on phagocytes to
promote phagocytosis

156
 THIRD LINE/SPECIFIC IMMUNE
RESPONSE
1. TERMINOLOGIES
a. Antigen- A substance that the body senses as
foreign
b. Antibody- A protein produced in response to
an antigen
c. Immune- Free from getting diseases
d. Immunity- The ability of an organism to
recognize and defend itself from infections.
Mechanisms used by the body to fight
invasions of pathogens
e. Immunology- Study of the immune system
157
 Attributes of specific immunity
1. Recognition of self versus non self
2. Specificity- The ability of the immune system to
react in different and particular way to each
foreign substance
3. Heterogeneity- The ability of immune system
to respond in a specific was to a great variety
of different foreign substances
4. Memory- The ability of the immune system to
recognize and quickly respond to foreign
substances to which it previously responded

158
 ORGANS OF THE IMMUNE
SYSTEM
1. Bone marrow- Produces WBC- lymphocytes,
phagocytes, macrophages, T-cell, B- cells
2. Thymus gland: multi lobed lymphatic organ
located beneath the sternum. At birth it
produces lymphocytes and releases them into
the blood as B cells (medulla) and the inner
cortex produces T cells
3. Lymph nodes: produces lymphocytes and
macrophages. They also store WBC until
needed. They also help to transport and
dispose off wastes or toxins. They filter lymph
159
 Cont’
4. Spleen: It has phagocytes which engulf
and digest worn out RBC’S,
microorganisms and other foreign
particles
It contains B & T cells
storage of platelets
Other organs are the appendix, peyer’s
patches, tonsils and adenoids
160
TYPES OF SPECIFIC IMMUNITY
Innate immunity exists due to genetically
determined characteristics e.g. when humans
have immunity against some animal diseases
1. NATURALLY ACQUIRED ACTIVE IMMUNITY
This occurs in people who have had a specific
infection and developed resistance to re
infection by the same causative pathogen
because of the presence of antibodies and
stimulated lymphocytes e.g. in measles
The resistance may be permanent or
temporary like in pneumonia

161
2. ARTIFICIALLY ACQUIRED ACTIVE
IMMUNITY
• This occurs when a person receives vaccination
( administration of a vaccine that causes specific
antibodies to be produced). It may be permanent
or temporary

162
 3.NATURALLY ACQUIRED PASSIVE
IMMUNITY
• This occurs when antibodies formed in
one person (usually the mother) are
transferred to another to protect the latter
from infection
• It is temporal lasting about 3-6 weeks
• Small antibodies cross the placenta or are
passed through colostrum during
breastfeeding

163
 4. ARTIFICIALLY ACQUIRED
PASSIVE IMMUNITY
• Accomplished by transferring antibodies from an
immune person to a susceptible person
• After a person has been exposed to a disease,
the length of incubation period does not allow
sufficient time for vaccination because a span of
2 weeks is needed before sufficient antibodies
are formed to protect the exposed person
• To provide temporary protection in these
situations, the patient is given human gamma
globulin or immune serum globulin (antibodies)
from an immune person
164
 5. HERD IMMUNITY
• Occurs when a higher proportion of the
population (80%) or more have been
immunized or have had the disease thus
those without the diseases in such
populations get naturally active immunity

165
 IMMUNE RESPONSES TO
DISEASE
HUMORAL IMMUNE RESPONSE
 This also called antibody mediated immunity
 It involves the production of antibodies which act
against foreign organisms and substances
 The antibodies are found in extra cellular fluids
like blood and plasma, lymph and mucus
secretions
 They are produced mainly by the B
cells/lymphocytes
 The process that leads to the production of
antibodies starts when B
166
 Cont’
 cells are exposed to free or extra cellular
antigens. In response the B cells become
activated, divides and differentiates into a clone
of many effector cells called plasma cells
 These plasma cells produce antibodies that are
directed against the specific antigen that
activated the original B cell
 B cells develop from stem cells located in the
bone marrow in adults and in the liver of fetuses.
 The Humoral immune response defends against
bacteria and viruses circulating in body fluids

167
 Humoral response cont’
 Antibodies are protein in nature and are highly
specific
 They have two identical sites (antigen binding
sites) that bind to antigenic determinants
 Antibodies are members of a group of soluble
proteins collectively called immunoglobulins
 Each of the five classes of immunoglobulins
plays a different role in the immune response

168
 Cont’
a. Immunoglobulin G (IgG)
 This is the major immunoglobulin present in
serum accounting for 80% of the total
 It readily crosses the walls of blood vessels
and enter tissue fluids
 It protects against It neutralizes bacterial
toxins, triggers circulating bacteria and viruses

169
 Cont’
 the compliment system and when bound to
antigens enhance the effectiveness of
phagocytic cells
b. Immunoglobulin A (IgA)
 Accounts for 10-15% of the antibodies in serum
 Found in mucus membranes and body
secretions like mucus, tears, saliva and breast
milk

170
 Cont’

 Its function is to prevent attachment of

pathogens particularly virus and certain
bacteria (respiratory pathogens) to
mucosal surfaces
c. Immunoglobulin E, (IgE)
 Constitutes only o.002% in the serum
and is attached to mast cells or basophils
 Causes allergies, drug sensitivity, and
immediate hypersensitivity
171
 Cont’
 It attracts IgG, compliment and phagocytic
cells and this is especially useful against
parasitic worms
d. Immunoglobulin D, (IgD)
 Make up only 0.2% of total serum antibodies
 Their structure resembles that of IgG
molecules
 Found in blood and on lymph and on surfaces
of B cells
 Causes antigen stimulation of B-cells in
antibody formation
172
 Cont’
e. Immunoglobulin M, (IgM)
 Forms about 10 % of the total serum
immunoglobulins
 It is always the first to be released in an immune
response and protects against early infection
 It is predominant in the response to the ABO
blood group antigens on the surface of red blood
cells

173
 Antibody- antigen reaction
• The study of the antigen antibody
reaction is called serology
TYPES OF ANTIBODY- ANTIGEN
REACTIONS
1. Neutralization
IgG antibodies inactivate viruses by
blocking their attachment to host cells
and they neutralize bacterial toxins by
blocking their active sites
174
 Cont’
2. Agglutination
 antibodies cause antigens to clump together
that make it easier for ingestion by phagocytes
3. Opsonization
 The antibodies coat the antigen in such away
that ingestion and lysis by phagocytic cells is
enhanced
4. Antibody dependent cell mediated cytotoxicity
 Antibodies are attached to target cells and
destruction is by non specific immune system
cells
175
 Cont’
5. Activation of the compliment system
 Both IgG and IgM trigger the compliment
system to cause inflammation which
attracts phagocytic and other defensive
immune system cells and result in microbe
lysis

176
Basic steps in the antigen antibody
reaction
1. Recognition-
2. Defense activation- Inflammatory
response
3. Phagocytosis – attack of the antigen
through antibody production
4. Cessation when the reaction ends as the
response slows

177
 CELL MEDIATED IMMUNITY
 Antigens that stimulate cell mediated immunity
are mainly intracellular in nature
 It is based on the activity of specialized
lymphocytes called T cells
 T cells are the key cellular component of
immunity. They develop from stem cells in the
bone marrow
 The T cells are influenced by the thymus gland
where they differentiate into mature cells before
they migrate to the lymphoid organs

178
 Cont’
 Like the B cells the T cells use antigen
receptors to recognize and react to an antigen
TYPES OF T CELLS
1. T helper (TH) cells: These play a central role in
the immune response.
With the aid of Cytokines they induce the
formation of cytotoxic T cells and activate
macrophages.
They are also essential in the formation of
many antibodies by B cells

179
 Cont’
An example is CD 4 cells
2. Cytotoxic T (TC) cells: They destroy target cells
on contact
An example are the CD 8 cells
3. Delayed Hypersensitivity cells (TD): They are a
combination of TH and afew TC that are
associated with certain allergic reaction and
rejection of transplanted tissues
4. Suppressor T cells (TS): They regulate the
immune response by turning it off when an
antigen is no longer present

180
 Cont’
• They help to prevent destruction of our
own body cells and tissues
• Helps in maintaining transplanted tissue
and blood transfusion
• They carry the CD 8 receptors
4. Memory T cells
• Recognizes previous invading and
pathogens and destroy them before they
can cause any symptoms
181
 Non specific cellular components
• Apart from the T cells which are generally
directed towards specific antigens, there are
other important elements that include:
1. Activated macrophages: Phagocytic cells in a
resting state until when stimulated by the
presence of an antigen
They have an enhanced ability to eliminate
certain virus infected cells and pathogenic
intracellular bacteria like that of TB
2. Natural killer cells: capable of destroying other
cells especially virus infected cells and tumor
cells.
182
 HYPERSENSITIVITY
• This is an inappropriate reaction or excess
activation of the immune system to an antigen
it normally ignores in normal circumstance
COMMON ALLERGENS
1. Animal proteins especially from milk and eggs
2. Drugs like aspirin, antibiotics like penicillins
3. Insect/ animal venoms e.g. from bees, wasps,
spider or snakes
4. Hormone preparations
5. Pollen from grass, trees and weeds
6. Spores like fungal or bacteria
183
 Cont’
7. Insecticides
8. Dust
9. Insects like mites and their feces
TYPES OF HYPERSENTIVITY REACTIONS
1. Type 1. Immediate/ anaphylactic reaction
2. Type 2- Cytotoxic reaction
3. Type 3 – Immune complex
4. Type 4 –Delayed/ cell mediated reaction

184
1. Immediate/ anaphylactic reaction
• Occur a few minutes after a person sensitized to
an allergen is re exposed to that antigen
• IgE is immediately released and it binds to the
surfaces of mast cells or basophils and causes
degranulation that releases mediators like
histamine
• The release of histamine increases permeability
and dilation of blood capillaries resulting in an
inflammatory response

185
 Cont’
• Other mediators like leukotrienes and
prostaglandins are also sensitized and
collectively they attract neutrophils and
esonophils to the site
• The effect may be systemic reaction or localized
reaction
• In a localized reaction the symptoms depend
primarily on the route by which the antigen
enters the body. It is associated with ingested or
inhaled antigens

186
 Cont’
• In systemic reactions injected antigens
causes peripheral blood vessels
throughout the body to dilate, resulting in
a drop in the blood pressure (shock) and
this can be fatal in few minutes
• An example is insect stings that causes
anaphylactic reactions or the penicillin
reaction

187
 2. Type II hypersensitivity-
Cytotoxic reaction
• This involves the activation of the compliment by
the combination of the IgG and IgM antibodies
with an antigenic cell that causes lysis (of the
foreign cell or the host cell that carries the
foreign antigenic determinant
• An example is in transfusion reactions in which
RBC are destroyed as a result of reacting with
circulating antibodies in the ABO incompatibility
• Another reaction may be drug induced cytotoxic
reactions

188
 Type III (Immune complex)
reactions
• This involves antibodies against soluble
antigens circulating in the serum
• Immune complexes form when certain ratios of
antigen and antibody occur
• IgG is mainly involved and when the antigen-
antibody ratio exists usually with a slight excess
of antigen, the soluble complexes that form are
small and they escape phagocytosis.
• The complexes circulate in the blood, pass
between endothelial cells of blood vessels and
become trapped in basement membranes
beneath the cells that gradually cause damage
189
 Cont’
• An example occurs in Glomerulonephritis

4. Type IV delayed cell mediated reaction

This occurs when certain foreign antigens
particularly those that bind to tissue cells are
phagocytized by macrophages and then
presented to the surface of T cell
Contact with T cells triggers a delayed type
hypersensitivity reaction with the release of
cytokines causing an inflammatory reaction
An Example is allergic contact dermatitis
190
 TRANSPLANTS
• This is moving tissue from one site to another
site
TYPES
1. Autograft – Transferring parts of the same
body
2. Isograft - Graft from an identical twin
3. Allograft- Graft between two people who are
not genetically identical but are close relatives
4. Xenograft – Graft from different species e.g.
pig skin used as a dressing for multiple burns
191
 HISTOCOMPATIBILITY
 All human beings have a set of antigens called
histocompatibility antigens found on the cell
membranes and body organs
 Only identical twins have the same
histocompatibility antigens
 In organ transplants tissue antigens (human
leukocyte antigens-HLA’S) are identified and
matched with the donor antigens as closely as
possible to reduce risk of rejection
 HLA’s are determined by a set of genes
designated A,B, C and D

192
 Cont’
• Organ rejection occurs due to mismatched HLA
and also when the body’s immune system
senses it as foreign
• T cells and HLA DR are the main causes of
rejection
• Rejection can take 2-5 days to occur or can be
immediate
• Slow onset can be due to delayed sensitization
• To deal with this the candidates for transplant
may be on immunosuppression drugs for life

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 END

• THE END

• GOOD LUCK

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