MICROBIOLOGY

Mr. KIWA

BScN/KRCHN.
 MICROBIOLOGY
MODULE COMPETENCES
• To enable the learner to acquire knowledge of the normal structure
and function of the human body, microbiology, and apply relevant
skills and attitudes to promote health, prevent and manage
illnesses.
Module objectives
• To apply knowledge of microbiology,parasitology and immunology
in promoting health, preventing illnesses, diagnosing, managing
and rehabilitating patients/clients suffering from diseases caused
by microorganisms.
• To acquire knowledge of the normal structure and function of the
human body as a basis for identifying deviations from normal.
 CONTENT
Microbiology
• infection
• Sources of microorganisms
• Modes of transmission
• Classification of microorganisms and their
clinical importance.
Parasitology
• sources of parasites
• classification of parasites:-
ascariasis,hookworm,tapeworm,filariliasis,plasmodium
• modes of transmission
• life cycle and clinical importance.
Immunology
• Types of immunity: humoral,cellular,passive,active and
herd immunity.
• Immunological processes
• Immunizing agents and clinical importance.
 MICROBIOLOGY

Learning objectives
⮚ Define microbiology,pathogen,non-pathogen,and
opportunistic pathogen
⮚ List reasons why microorganisms are important
⮚Explain historical development of microbiology
⮚Describe the characteristics of microorganisms
⮚Explain the classification of microorganisms
⮚Discuss the significance of microbiology in nursing
⮚Identify microorganisms in a laboratory
 MICROBIOLOGY

What is microbiology?
• Micro means very small-anything so small that it must be
viewed with a microscope( A microscope is an optical
instrument used to observe small objects) . Bios refers to
living organisms and Logy means the study of
• Therefore, microbiology is the study of very small living
organisms- called microorganisms or microbes.
Microorganisms are said to be ubiquitous meaning they are
virtually everywhere.
• The various categories of microorganisms include:
Viruses,Bacteria,Archaeans,Certain Algae,Protozoa and
CertainFungi.
 What is microbiology? Cont’d
• Most scientists do not consider viruses to be living
organisms,they are often reffered to as infectious agents or
infectious particles rather than microorganisms.
• Disease causing microorganisms are called pathogens. Only
about 3% of known microbes are capable of causing disease.
Thus, the vast majority known microorganisms are
nonpathogens (_microorganisms that do not cause disease.)
 Why study microbiology?

• Although they are very small, microorganisms play very

important role in our lives.
1. organisms living on and in our bodies (e.g on our skin,
in our mouth, and interstinal tract) are known as
indigenous microflora . They are important to us
because inhibit the growth of pathogens in those areas
of the body where they live by occupying space,
depleting the food supply, and secreting
materials(wasteproducts,toxins,antibiotics etc)that may
prevent or reduce growth of pathogens.
 Why study microbiology cont’d?

2. Some organisms that colonize (inhabit) our body are

known as opportunistic pathogens (or opportunists.).
Although such organisms do not usually cause any
problems, they have the potential to cause infections if
they gain access to a part of our anatomy where they
do not belong. Other opportunistic pathogens strike
when a person becomes run down, stressed out or
debilitated by disease or condition.
❖ Opportunistic pathogens can be thought of as
microorganisms awaiting the opportunity to cause
disease.
 Why study microbiology cont’d?

3. Microorganisms are essential for life on this planet because

they produce oxygen by the process known as photosynthesis.
Actually microorganisms contribute more oxygen to our
atmosphere than do plants. Such organisms include algae and
cyanobacteria (a group of photosynthetic bacteria).
4. Many microorganisms are involved in the decomposition of
dead organisms and waste products of living organisms.
Collectively they are called decomposers or saprophytes. A
saprophyte is an organism that lives on dead and or decaying
organic matter.
 Why study microbiology cont’d?

5. Microorganisms are involved in breaking down dead organic

materials into inorganic nutrients (e.g. nitrates and phosphates).
This is important to farmers.
6. Microorganisms serve as important links in food chains. e.g
Algae and Bacteria serve as food for tiny animals, larger animals
eat small creatures and so on.
7. Some microorganisms which live in the intestinal tracts of
animals’ aid in the digestion of food and, in some cases, produce
substances that are of value to the host animal. E.g E.coli
produces vitamins K and B1 which are used and absorbed by
human body.
 Why study microbiology cont’d?

8. Certain bacteria and fungi produce antibiotics that are used

to treat patients with infectious diseases. An antibiotic is a
substance produced by a microorganism that is effective in
killing or inhibiting the growth of other microorganisms.

9. Microbes are essential in the field of genetic engineering.

Bacteria and yeast have been engineered to produce a variety of
substances, such as insulin, various types of growth hormone,
interferones, and materials for use as vaccines.
 Why study microbiology cont’d?

10. Microorganisms cause diseases. The diseases are of two

categories, infectious diseases and microbial intoxications .
⮚ An infectious disease results when a pathogen colonizes the
body and subsequently causes disease
⮚ A microbial intoxication results when a person ingests a toxin
(poisonous substance) that has been produced by a
microorganism.
 DEVELOPMENT OF MICROBIOLOGY

• Bacteria and protozoa were the first microorganisms to be

observed by humans. It then took about 200 years before a
connection was established between microorganisms and
infectious disease. Among the most significant events in the
history of microbiology were:
• -development of microscopes
• -bacterial staining procedures
• -culture techniques
• -isolation of microorganisms
 Pioneers in the science of microbiology
Anton van Leeuwenhoek (1632-1723).
▪ He was the first person to bacteria and protozoa thus he is
referred to as the father of microbiology. (Father of bacteriology,
protozoology).
▪ He was not a trained scientist. He was a fabric merchant, a
surveyor, a wine assayer, and a minor city official in Delft,
Holland.
▪ As a hobby, he ground tiny glass lenses, which he mounted in
small metal frames, thus creating what today is known as Single
lens microscopes or simple microscope.
Anton van Leeuwenhoek (1632-1723)
▪ During his lifetime he made more than 500 such
microscopes. His fine art of grinding lenses that would
magnify an object 200-300 times its size was lost at
his death because he did not teach anyone his skill.
▪ He had a curiosity of examining things as he used his
microscope and he could examine almost anything he
could get his hands. He examined scrapings from his
teeth, water from the ditches and ponds, water which
he had soaked peppercorns, blood, sperm, and his
own diarrhea stools. In many of these specimens he
observed a variety of tiny living creatures which he
called animalcules. He recorded his observations in
letters which finally convinced scientists of the late 17
th century of the existence of microorganisms.
 Louis Pasteur (1822-1895).
⮚ Louis Pasteur is a French chemist who made numerous
contributions to microbiology and those contributions are
considered by many people to be the foundation of the science
of microbiology and a cornerstone of modern medicine. Some of
these contributions are:
⮚ -while attempting to discover why wine becomes
contaminated with undesirable substances, Pasteur discovered
what occurs during alcohol fermentation. He discovered different
types of microorganisms that produce different fermentation
products .e.g yeast convert glucose in grapes into ethyl alcohol(
ethanol) by fermentation, acetobacter convert glucose to acetic
acid(vinegar) by fermentation.
• Pasteur discovered forms of life that could exist in the absence
of oxygen. He introduced the term aerobes(organisms that
require oxygen to live) and anaerobes(organisms that do not
require oxygen for life).
• -he developed the process of pasteurization (a process to kill
microorganisms). Microorganisms were subjected to higher
temperatures of 55 degree and the temperature for several
minutes.
• Pasteur made significant contribution to the germ theory of
disease, the theory that specific microorganisms cause specific
infectious disease.
• -Pasteur championed changes in hospital practices to minimize
spread of disease by pathogens. e.g aseptic technique and
sterilization.
• -Pasteur developed vaccines to prevent chicken pox, anthrax,
and swine erysipelas(a skin disease).
 Robert Koch (1843-1910).

• Robert Koch a German physician, made numerous

contributions to the science of microbiology.
• -he made significant contributions to the germ theory of
disease. e.g he proved that anthrax bacillus(bacillus
anthracis) was truly the cause of anthrax.
• -Koch discovered that bacillus anthracis produced spores
capable of resisting adverse conditions.
 Robert Koch (1843-1910) cont’d

• He developed method of fixing, staining, and photographing

bacteria as well as methods of cultivating bacteria on a solid
media (petri dish).
• Koch discovered the bacterium (mycobacterium tuberculosis)
that causes tuberculosis and the bacterium (vibrio cholerae) that
causes cholera.
• Koch’s work on tuberculin (a protein derived from
(M.tuberculosis) ultimately led to the development
 Micro-organisms and infection
⮚ Few of the micro-organisms are disease
producing in nature thus pathogenic to man.
⮚ Most of the micro-organisms live in soil,
water or in air and are unable to invade the
living body
⮚ Some obtain their energy from day light
while others live and feed on their host known
as parasites
 Micro-organisms and infection cont’d

⮚ Others constitute the normal flora/indigenous micro-

flora/commensals of the body.(they live and obtain
nourishment from the areas they live in). such areas
include:- the skin, mucous membranes of respiratory
tract, intestines, vagina.
⮚ However under special circumstances they may
cause opportunistic infections
 Micro-organisms and infection cont’d

⮚ True pathogens are micro-organisms which

overcome
body defenses and invade the tissue
⮚ Their growth or production of
toxins(harmful/poisonous substances) damages the
tissues and causes disease
⮚ This process of microbial invasion of the body is
infection
 INFECTION

⮚ Is the successful invasion of the body tissue by

micro-organisms
⮚ Characterized by their multiplication inside the host
⮚ Incubation period :- period between invasion of
organisms and manifestation of the disease
⮚ Host:- living organism in which a parasite grows
and multiplies at hosts (its) cost.
 Infection cont’d

Forms of infection
⮚ . Primary infection :- a fresh infection, primarily
caused by a micro organism
⮚ Secondary infection :- when a second infection is
superimposed on a primary infection
⮚ Mixed infection :- when more than one organism
simultaneously infect a host
⮚ Focal infection:- localized or circumscribed
infection in the body
 Infection cont’d

⮚ Endogenous infection :- infection caused by commensals

due to lowering of host immunity
⮚ Exogenous infection :- infection caused by pathogenic
organism from outside the host
⮚ Reservoir :- a host which harbors a parasite and acts as a
sources of infection
• Vector : - an anthropoid which acts as an important agent for
transmission of the parasite to human
 Sources of micro-organisms

❖ Animals:- especially zoo noses(have an animal reservoir)

❖ Insects/ arthropods :-like
• mosquitoes-malaria,
• fleas-plague,
• louse-epidemic typhus fever,
• ticks-relapsing fever
❖ Soil:-Ingestion
❖ Air :-expelled in spitting, blowing, sneezing or coughing
 Sources of micro-organisms cont’d

Food:- contaminated by food handlers, during

preparation, hands.
Water: - contaminated poor environmental hygiene e.g.
water washed -scabies, water borne-cholera, water
related-malaria
 Modes of transmission

1.Contact:-
• Direct skin-to-skin contact e.g common cold virus is frequently
transmitted from the hand of someone who has just blown his nose to
another person by hand shaking. Within the hospital this mode of
transmission is common and that why it is important to wash hands after
every patient contact.
• Direct mucous membrane –to mucous membrane contact by kissing or
sexual intercourse. Most STDs are transmitted that way i.e syphilis,
gonorrhea, and infections caused by Chlamydia, herpes and HIV.
• Indirectly via formites that become contaminated by respiratory
secretions, blood, feces, vomitus, or exudates from hospitalized patients.
 Modes of transmission cont’d

2.Inhalation ( breathing):-
• Indirectly via airborne droplets of respiratory secretions
usually produced as a result of sneezing or coughing e.g
improperly cleaned inhalation therapy equipment can easily
transfer these pathogens from one patient to another.
Diseases such as mumps, colds, influenza, measles,
chicken pox, and pneumonia spread this way.
3.Ingestion (swallowing) :-
• Indirectly via contamination of food and water by
fecal material
4.Mother to child:- before, During and after birth
 Modes of transmission cont’d

5.Self-infection:-
• from normal flora
6.Medical or surgical procedures :-
• Indirectly via transfusion of contaminated blood or blood
products from an ill person or by parenteral injection.
• Invasive procedures
CLASSIFICATION OF MICROORGANISMS

⮚ Micro-organism of medical importance

is divided into five classes
• Bacteria
• Rickettsiae and Chlamydia
• Viruses
• Fungi
• protozoa
 Classification of microorganisms cont’d

⮚ Bacteria:- are
• Unicellular
• Reproduce by binary fission
• Has a permeable cell wall which controls internal
osmotic pressure
• Divided into gram- positive and gram-negative
• Within the cell there is cytoplasm surrounded by
cytoplasmic membrane
 Classification of microorganisms cont’d
• Within the cytoplasm there is ribosome's( containing
cell`s ribonucleic acid (RNA) and chromosome or
nuclear body consisting of double-stranded deoxy-
ribonucleic acid (DNA)
• Some bacteria forms capsules outside their cell walls
• Some have whip-like or ganelle of locomotion (flagella)
protruding from their surfaces .
• Others have Pilli (hair-like protrusions) enabling them to
attach to surfaces
• A few forms spores helps in reducing metabolic
activities and increase resistance to adverse conditions
 Classification of microorganisms cont’d

Types of bacteria:-
• Bacteria varies greatly in size usually ranging from
spheres, long spiral-shaped bacteria, to even longer
filamentaous bacteria.
• There are three basic shapes of bacteria
• Round or spherical shaped- bacteria-the cocci
• Rectangular or rod shaped- bacteria-the bacilli
• Curved or spiral shaped-bacteria-the sprilla
 Classification of microorganisms cont’d

The cocci:-
• May be seen in singly or in pairs
• May be seen in chains(streptococci)
• May be seen in clusters(staphylococci)
• May be in packets of four(tetrads)
• May be in packets of eight(octads)
• Examples of cocci include:- enterococcus spp,
neisseria species, staphylococcus species,
streptococcus spp.
 Classification of microorganisms cont’d
❑ The bacilli:-
▪ May be tMay be short or longer(cocobacilli) e.g listeria
monocytogenes(common cause of neonatal meningitis)
▪ thick or thin
▪ May be pointed or with curve or blunt ends
▪ May be singly or pairs(diplobacilli)
▪ May be in chains(streptobacilli)
▪ May have long filaments or branched
▪ May be stuck up next to each other
▪ May be side by side in a palisade arrangement e.g
corynebacterium diphtheriae
 Classification of microorganisms cont’d

Examples of bacilli:-
-members of enterobacterial family-
enterobacter, escherichia, klebsiela, proteus,
salmonella, and shigella spp
-haemophilus influenzae
-Pseudomonas aeruginosa
-bacillus spp and
-clostridium spp
 Classification of microorganisms cont’d
❑ Curved and spiral shaped bacteria :- e.g vibrio
spp(vibrio choleriae-cholera), vibrio
parahaemolyticus-(common cause of diarrhea)
▪ Are curved(comma shaped) bacilli:-
-a pair of curved bacilli resmbles a bird and is
described as having a gull-wing morphology e.g
campylobacter spp(common cause of diarrhea)
▪ Spiral shaped bacteria(spirochetes)
• Are cork-crew like spirals.
• they may be singly or in form of pairs .
 Classification of microorganisms cont’d
Staining procedures
• Bacteria are colorless, transparent, and difficult to see
• Different staining methods have been devised in examining
bacteria-
• Bacteria are smeared onto a glass microscope slide
(smear), air-dried, and then fixed’
Two common methods are used:-
• Heat fixation :
-tends to distort morphology of cells
-Smear is passed through a bunsen burner flame
• Methanol fixation :
-is a more satisfactory fixation technique
-It is accomplished by flooding the smear with
absolute methanol for 30 seconds.
 Rickettsiae
• Are very short rods
• Have a cell wall(resembles that of gram-negative
rods)
• They are bacteria as they contain RNA and DNA
• They are obligate intracellular parasites
• However they are smaller than bacteria
• Divide by binary fission within the host cell
• Some Rickettsiae are Cocci or bacilli
 Chlamydia
• Chlamydiae are obligate intracellular bacteria i.e they can grow only
within cells.
• They have a rigid cell wall but lack a typical peptidoglycan layer.
• Their cell wall resemble those of gram-negative bacteria but lack
muramic acid.
• Chlamydia are spherical and have intracellular developmental cycle
where infective forms are phagocytosed by host cell and develop
inside the cell to reticulate bodies
• In 40hrs become elementary bodies and rupture within 48-72hrs to
infect other cells

*Trademark
 Virus
• Very small unclear whether they are living or not hence
referred to as active and inactive
• Virion – is a virus particle
• Viruses are particles composed of an internal core containing
either RNA or DNA(but not both) covered by a protective coat.
• Viruses do not have a nucleus, cytoplasm, mitochondria,or
ribosomes.
• The nucleic acid core is packed within protein coat (capsid)
which protects it during transmission between host cells.
Multiply by replication in host cell(are obligate intracellular
parasites)
• Classified according to nucleic acid, presence of envelop, size
and symmetry of the capsid
 Clssification of medically important viruses
RNA VIRUSES
DNA VIRUSES
• Parvovirus • Picornaviruses
• Polyomaviruses • Caliciviruses
• Papllomaviruses • Reoviruses
• Adenoviruses • Flaviviruses
• Hepadnaviruses • Togaviruses
• Herpesviruses • Retroviruses
• Poxviruses • Orthomyxoviruses
• Paramyxoviruses
• Rhabdoviruses
• Filoviruses
• Coronaviruses
• Arenaviruses
 Virus cont’d
PATHOGENESIS
• The ability of virus to cause disease can be viewed in two
levels:-
1.Changes that occur within individual cell
2.Process that takes place in infected patient
Effects of viral infection on the cell
• Death, fusion of cells to form multinucleated cells, malignant
transformation ,and no apparent morphologic or functional
change.
NB:- assignment
Make short notes on various types of viruses.
 Fungi
• The study of fungi is called mycology
• Fungi are a diverse group of eucaryotic organisms that include
yeasts,molds,and mushrooms
• Fungi have no chlorophyll
• Fungal spores are very resistant structures that are carried great
distances by wind-resist heat,cold,acids bases,and other chemicals.
Many people are allergic to fungal spores.
• Are found almost everywhere on earth
• Some are (saprophytic) living on organic matter in water and soil.
• Others are parasitic living on and within animals and plants
• Some are harmful and others beneficial
• Beneficial fungi are important in production of cheese,beer,wine,and
other foods as well as certain drugs.
 Fungi cont’d
• Have thick cell wall which contains cytoplasmic
membrane target for antifungal drugs
• Their cell wall do not contain cellulose
• Fungal cell wall contain chitin(polysaccharide)
• Although many fungi are unicellular(e.g yeast) others
grow filaments called hyphae
• Reproduce by budding,hyphal extension or formation
of asexual spores(conidia)
• Many fungi pathogenic for men are dimorphic ( affects
skin)
 Types of fungi /classes of fungi
• They are divided into five classes based in their mode of sexual
production
• Zygomycotina(zygomycetes)-include the common bread molds
and other fungi that cause food spoilage.
• Chytridiomycotina(chytrdiomycetes)-live in water(water molds)
and soil.
• Ascomycotina(ascomycetes)-include certain yeasts and some
fungi which cause plant disease. E.g dutch Elm disease
• Basidiomycotina(basidiomycetes)-include some yeasts and
some fungi which cause plant disease and the fleshy fungi that
live in the woods. e.g mushrooms, toadstools bracket fungi
• Deutromycotina( deutromycetes)-contains fungi having no mode
of sexual reproduction e.g aspergillus and penicillium
Classes of fungi cont’d
N.B

• Yeasts are microscopic ,eurcaryotic,single celled

organisms that lack mycelia, usually they reproduce
by budding
Fungal diseases
⮚ Yeast:- e.g candida albicans-causes thrush,
creptococcus neoformans-causes
creptococcosis(lung infection, meningitis etc)
⮚ Molds:- e.g aspergillus spp-causes
aspergillosis(lung infection,systemic infection,
tinea(ring worm) infections.
Protozoa
⮚ The study of protozoa is called protozoology
⮚ Are eucaryotic organisms
⮚ Are unicellular(single celled)
⮚ Larger than bacteria
⮚ Reproduction mechanism vary from simple
binary fission to complex life circles
⮚ They do not have cell walls
⮚ All protozoa cells posses cell membranes,
nuclei, mitochondria, centrioles, food vacuoles,
lysosomes, golgi bodies, and endoplasimic reticulum.
Protozoa
• Most of them are free living organisms- live in soil and
water
• They do not have chlorophyll hence can not make their
own food
• Some protozoa are parasites:-parasitic protozoa break
down and absorb nutrients from the body of the host in
which they live e.g plasmodium, giardiasis.
• A typical life cycle of protozoa consists of two stages:-
-The trophozoite stage:-is the motile, feeding
dividing stage in protozoan’s stage
-The cyst stage: -is the dormant, survival stage
Classification of Protozoa
❖ Sarcodina. e.g ameba-move by means of
cytoplasimic extensionscalled pseudopodia
❖ Mastigophora(flagellates).e.g move by whip
like flagella. e.g trypanosoma cruzi, trypanosoma
brucei, trichomonas vaginalis, giardia lambia
❖ Ciliates(ciliophora)-move about by means of a
large number of hair-like cilia on their surfaces e.g
balantidium coli(causes dysentry)
❖ Sporozoa e.g Plasmodium
PARASITOLOGY
❖ Parasitology is the study of parasites.
• Parasites occur in two distinct forms:-
❑ Single-celled protozoa
❑ Multicellular metozoa
helminths
PARASITOLOGY cont’d

Metozoa are divided into:-

⮚ Platyhelminthes(flatworms)
⮚ Nemathelminthes
Platyhelminthes contains two medically important
classes:-
▪ Cestoda(tapeworms)
▪ Trematoda(flukes)
 classification of parasites
Parasites
Protozoa Metozoa(helminths)

Sarcodina sporozoa mastigophora cilliata

(Amebas )(sporozoans)( flagellates)( cilliates)

Platyhelmenthes nemathelmenthes
( Flatworms ) (roundworms)

Trematoda Cestoda
( Flukes) (tapeworms)
parasitology cont’d

Plasmodium (Blood and tissue protozoa)

• Plasmodium is a malaria causing parasite.
⮚ There are four types of plasmodia that cause
malaria:-
• Plasmodium vivax
• Plasmodium ovale
• Plasmodium malariae
• Plasmodium falciparum
parasitology cont’d

• P. vivax and p. falciparum are more common

causes of malaria than are p.ovale and p.malriae.
• The vector and definitive host for plasmodia is the
female anopheles mosquito(only the female takes a
blood meal).
• There are two phases in the lifecycle of plasmodia
• A sexual circle - which occurs primarily in the
mosquitoes
• The asexual circle which occurs in humans(the
intermediate host)
parasitology cont’d
• The sexual cycle is called sporogony because sporozoites are
produced.
• The asexual cycle is called schizogony because schizoints are
made.
• Lifecycle in humans
• The lifecycle in humans begins with the introduction of sporozoites
into the blood from the saliva of the biting mosquito.
• The sporozoites are taken up by hepatocytes within 30 minutes.
• This "exoerythrocytes“ phase consists of cell multiplication and
differentiation into merozoites . p.vivax and p.ovale produce a
latent form(hypnozoite) in the liver; this form is the cause of
relapses seen with vivax or ovale malaria.
lifecycle cont’
• Merozoites are released from the liver cells and
infect red blood cells.
• During the erythrocytic phase , the organism
differentiates into ring-shaped trophozoite.
• After release, the merozoites infect other
erythrocytes. This cycle in the red blood cells
repeats at regular intervals typical for each species.
• The periodic release of merozoites causes a typical
recurrent symptoms of chills, fever, and sweats
seen in malaria patient.
 lifecycle cont’
• The asexual cycle begins in human red blood cells when some
merozoites develop into male and others into female
gametocytes.
• The gametocyte containing red blood cells are ingested by the
female anopheles mosquito and, within her gut, produce a
female macrogamete and eight sperm like male microgametes.
• After fertilization, the diploid zygote differentiates into a motile
ookinate that burrows into gut wall, where it grows into an
oocyst within which many haploid sporozoites are produced.
• The sporozoites are released and migrate to the salivary glands
ready to complete the cycle when the mosquito takes her next
meal.
METOZOA HELMINTHS (WORMS)

⮚ Helminths cause much disease and are the

largest of human parasites.
• Helminths of medical importance are divided into
three zoological classes ,namely
▪ Nematodes
▪ Cestodes
▪ Trematodes
 CESTODES (tapeworms)
• Tapeworm consist of two main parts
▪ A rounded head called a scolex
▪ Flat body of multiple segments called proglottids

• The scolex has specialized means of attaching to the intestinal wall-

suckers,hooks,or sucking grooves
• The worm grows by adding new proglottids from its germinal centre
next to the scolex.
• The oldest proglottids at the distal end are gravid and produce many
eggs ,which are excreted in the feces and transmitted to various
intermediate hosts such as cattle,fish,and pigs.
 Cestodes(tapeworm) cont’d
• Humans acquire the infection when undercooked flesh
containing the larvae is ingested.
• Two important diseases caused by cestodes(tapeworms)
✓ Hydatid disease
✓ Cystercosis
• There are four medically important cestodes
▪ Taenia solium -causes cystercosis(human)
▪ Taenia saginata -cause cystercosis(in other animals not
human)
▪ Diphyllobothrium latum (lives in fish)-causes
diphyllobothriasis
▪ Echinococcus granulosus (dogs definitive host,sheep
intermediate host)-causes echinococcosis(hydatid cyst).
 Trematodes(flukes) cont’d
• Trematoda(flukes) and cestoda(tapeworm) are the two large
classes of parasites in the phylum platyhelminthes.
▪ The most important trematodes are:-
⮚ Schistosoma species -blood flukes(schistosomiasis) e.g
schistosoma mansoni,schistosoma japonicum(gastrol
interstinal tract),schistosoma haematobium-urinary tract.
⮚ Clonorchis sinensis -liver fluke(cause clonorchiasis)
⮚ Paragonimus westerman -lung fluke(cause
paragonimiasis)
• Schistosomiasis have the greatest impact in terms of the
number of people infected,morbidity,and mortality.
 Trematodes(flukes) cont’d

• The lifecycle of the medically important trematodes

involves asesual cycle in humans(definitive host) and
a sexual reproduction in fresh water
snails(intermediate host).
• Transmission to humans takes place either through
penetration of the skin by the free-swimming
cercariae of the schistosomes or through ingestion of
undercooked (raw) fish or crabs in clonorchis and
paragonimus infection,respectively.
 NEMATODES (NEMATHELMINTHES)
⮚ Nematodes are round worms with acylindrical body and
complete digestive tract including the mouth and an anus.
⮚ The body is covered with a noncellular, hihly resistant
coating called a cuticle.
⮚ Nematodes have separate sexes;-female usually larger
than male. The male has typically has a coiled tail.
Medically important nematodes are divided into two categories
according to their primary location in the body.i.e
▪ Interstinal nematodes
▪ Tissue nematodes
 Interstinal nematodes
❖ Interstinal nematodes include

• Enterobius(pinworm)-causes enterobiasis(human)
• Trichuris(whipworm)-causes trichuriasis(human);may
cause diarrhea and rectal prolapse in children.
• Ascaris(giant round worm )-causes ascariasis(human )
• Necator
• Ancylostoma(the two hookworm)
• Strongyloides(small roundworm)- causes strongoloidiasis
• Trichinella.
 Tissue nematodes
▪ The important tissue nematodes include:-
• Wuchereria-causes filariasis(elephantiasis);-transmitted by female
a mosquito anopheles and culex.
• Onchocera-causes onchoceriasis;-transmitted by black fly
• Loa-causes loasis;-transmitted by deer fly(mango fly)
▪ The three are called filarial worms because they produce motile
embryos called microflariae in blood and tissue fluids.
▪ A fourth species is the guinea worm- dracunculus whoose larvae
inhabit tiny crustaceans(copepods) and are ingested in drinking
water.
▪ Nematodes cause disease as a result of presence of adult worms
within the body.
 IMMUNOLOGY
Introduction
▪ Humans and animals have survived on earth for hundreds of
thousands of years because they have many built-in or naturally
occurring mechanisms of defense against pathogens and infectious
disease they cause.
▪ The ability of any animal to resist these invaders and recover from
disease is due to many complex interacting functions within the
body.
 Immunology cont’d
Immunology
is the scientific study of the immune system
and immune responses, including the active and
passive acquired immunity to infectious
agents,antibody production, cell-mediated immune
responses, and allergic responses, other types of
hypersensitivity reactions, autoimmune disorders and
immunodiagnostic procedures.
• The immune system is the third line of defense
against pathogens; it is a specific host defense
mechanism.
 Immunological processes

⮚ The body protects against harmful pathogens

through two ways
• Nonspecific host defense mechanism
✓ First line of defense
✓ Second line of defense
• Specific immunity or specific host defense
mechanism. It is also called the third line defense.
 Definition of terms

• Host defense mechanisms :-are ways in which the

protects itself from pathogens.
• Non-specific defense mechanisms :-are ways in which
the attempts to destroy all types of substances that are
foreign to it including pathogens.
• Specific host defense mechanisms :-is the immune
response ,very specific –because antibodies(special
proteins) are usually produced in the body in response to
the presence of foreign substances(antigens).
• Antigens :- are foreign substances.
 NONSPECIFIC HOST DEFENSE MECHANISMS

• These are general and serve to protect the body against

many harmful substances.
FIRST LINE OF DEFENSE
a) Mechanical and physical factors
ii. Skin:-
• intact, unbroken skin that covers our bodies serves as a
physical or mechanical barrier to pathogens.
• very few pathogens are able to penetrate the skin.
• the dryness of most areas of skin inhibits colonization by
many pathogens .
 Mechanical and physical factors

ii. Mucous membranes :-

• they serve as physical and mechanical barriers to
pathogens.
• most pathogens can only pass when these membranes
have are cut or scratched.
• the sticky mucous produced by the goblet cells within the
mucus membranes serve to entrap
invaders(pathogens).They can be removed by normal
reflex like coughing or sneezing.
• Such areas include nose (respiratory tract), mouth, and
vagina
b).Cellular and Chemical factors:-

• Body temperature -<37ºc and acidity of the skin inhibit the growth
of pathogens.
• the oily sebum that is produced by sebaceous glands in the skin
contains fatty acids which are toxic to some pathogens.
• Perspiration (sweat) aids in flushing organisms from pores and
surface of skin.
• Sweat contains enzyme-lysozyme which degrades peptidoglycan in
bacteria cell walls.
• Sloughing off of dead skin cells removes potential pathogens from
the skin.
Cellular and Chemical factors cont’d

• Sticky mucus produced by the mucous membranes contains

lysozyme,lactoferin,and lactoperoxidase that kill bacteria or
inhibit growth.
• Lactoferrin binds with iron, a mineral that is required by all
pathogens;because they are unable to compete with
lactoferrin for free iron,the pathogens are deprived of these
essential nutrient.
• Lactoperoxidase is an enzyme that produces superoxide
radicals, highly reactive forms of oxygen which are toxic to
bacteria.
Cellular and Chemical factors cont’d

• Because mucosal cells are among the most rapidly dividing

cells in the body, they are constantly being produced and
released from the mucous membranes. Bacteria that is
adhering to the cells are often expelled along with the cells
they are attached.
• The hair, mucous membranes and irregular chambers of the
nose serve to trap much of the inhaled debris.
• The cilia present on the epithelial cells of the posterior nasal
membranes, nasal sinuses, bronchi and trachea sweep the
trapped dust and microbes upward toward the throat where
they are swallowed or expelled by sneezing and coughing.
Cellular and Chemical factors cont’d

• Swallowing of saliva can be thought of as a non-specific defense

mechanism ,because thousands of bacteria are removed from the
oral cavity every time we swallow. Humans swallow approximately 1
litre of saliva per day.
• Digestive enzymes, acidity of the stomach (approx.PH 1.5), alkalinity
of the intestines protects the digestive system from bacteria
colonization.
• Peristalsis and expulsion of feces serve to remove bacteria from the
intestine. Bacteria make up 50% of feces.
Cellular and Chemical factors cont’d

• Microorganisms are continually flushed from the

urethra by frequent urination and expulsion of mucus
secretions.
• The low PH of vaginal fluid usually inhibits
colonization of the vagina by pathogens.
c). Microbial antagonism:-
• The indigenous microflora prevent colonization by
new arrivals to a particular anatomical site through
competition for colonization sites, nutrients and
production of substances that kill other bacteria.
SECOND LINE OF DEFENSE

▪ Pathogens able to penetrate the first line of

defense are usually destroyed by non-specific
cellular and chemical responses(second line of
defense).
▪ A complex sequence of events develops
involving production of fever, interferons,
activation of the complement system,
inflammation, chemotaxis, and phagocytosis .
 Second line of defense cont’d

a) Transferrin:-
• a glycoprotein synthesized in the liver has a high affinity for iron.
• Its normal function is to store and deliver iron to the host cells.
• Transferrin serves as a nonspecific host defense mechanism by
sequestering iron and depriving pathogens of these essential
nutrient.
b) Fever:-
• normal body temperature fluctuates between 36.2c and 37.5c.
Average 37.2c.
• A body temperature greater than 37.8c is generally considered to
as be fever..
 Second line of defense cont’d

• substances that stimulate production of fever are called

pyrogens or pyrogenic substances
• Fever acts as a body nonspecific host defense mechanism
by:-
⮚ Stimulating white blood cells(leukocytes) to deploy and
destroy invaders
⮚ Reducing the available free plasma iron ,which limits
growth of pathogens that require iron for replication and
synthesis of toxins.
⮚ Inducing the production of interleukin-1(IL-1) which
causes the proliferation,maturation,and activation of
lymphocytes in the immunologic response.
 Second line of defense cont’d

c). interferons:- are small antiviral proteins produced by virus-

infected cells .
• They are called interferons because they “interfere” with viral
replication.
• There are three types of interferons – alpha, beta and gamma
induced by different stimuli, including viruses ,tumors, bacteria and
other foreign cells.
• Alpha-interferon - are produced by B lymphocytes(B
cells),monocytes, macrophages.
• Gamma-interferon - activated by T lymphocytes(T cells) and Natural
killer cells(NK cells).
• Beta-interferon - by fibroblasts and other virus-infected cells.
 Second line of defense cont’d

• Interferons produced by a virus-infected cell are

unable to save that cell from destruction, but once
they are released from that cell, they attach to the
membranes of surrounding cells and prevent viral
replication from occurring in those cells.
• Thus the spread of infection is inhibited ,allowing the
body to fight the disease more effectively.
 Second line of defense cont’d

d). The complement system:-

• is not a single entity, but rather a group of
approximately 30 different proteins(including nine
proteins designated as C1-C9) that are found in
normal blood plasma.
• Proteins of the complement system sometimes
collectively referred to as complement components,
interact with each other in a step-wise manner called
complement cascade.
 Second line of defense cont’d

• The complement system assists in the destruction of

many different pathogens by
⮚ Initiation and amplication of inflammation
⮚ Attraction of phagocytes to the sites where
they are needed(chemotaxis).
⮚ Activation of leukocytes
⮚ Lysis of bacteria and other foreign cells
⮚ Increased phagocytosis by phagocytic
cells(opsonization).
 Second line of defense cont’d

e). Inflammation :-the body normally responds to local

injury,irritation,microbial invasion or bacterial toxin by a
complex series of events collectively referred to as
inflammation or inflammatory response.
• The 3 major events in acute inflammation are:-
i). An increase in the diameter of capillaries , which increases
blood flow to the site.
ii). Increased permeability of the capillaries ,allowing the
escape of plasma and plasma proteins.
iii). Egress(exit) of leukocytes from the capillaries and their
accumulation at site of injury.
 Second line of defense cont’d

• The primary purpose of the inflammatory response

-Localize an infection
-Prevent the spread of microbial invaders
-Neutralize any toxins being produced at the site
-Aid in the repair of any damaged tissue
 Second line of defense cont’d

f). Phagocytosis:- is the process by which phagocytes surround

and engulf (ingest) foreign material.
• The phagocytic white blood cells are called phagocytes.
• The three major categories of leukocytes found in blood are-
-monocytes
-lymphocytes and
-granulocytes.
• The three types of granulocytes are:-
-eosinophils
-basophils and
- neutrophils.
 Second line of defense cont’d

• The two most important groups of phagocytes in the human

body are macrophages and neutrophils; sometimes called
‛professional phagocytes ’ because their major function is
phagocytosis.
• Phagocytes serve as a ‛clean-up crew’ to rid the body of
unwanted and often harmful substances such as dead cells,
unused cellular secretions, debris and microorganisms.
• Granulocytes –are named from the prominent cytoplasmic
granules that they posses. The phagocytic granulocytes
include neutrophils and eosinophils .
• Neutrophils are much more efficient in phagocytosis than
eosinophils .
 Second line of defense cont’d

• Macrophages-develop from monocytes during the

inflammatory response to infections.
• Those that leave the blood stream and migrate to infected
areas are called wandering macrophages. Fixed
macrophages remain in the tissues and organs and serve to
trap foreign debris.
• Macrophages are extremely efficient phagocytes. They are
found in tissues of the reticuloendothelial system(RES).
g). Chemotaxis:- phagocytosis begins when phagocytes
move to the site where they are needed. The directed
migration is called chemotaxis and is the result of chemical
attraction called chemotaxic agents.
 Second line of defense cont’d

• Chemotaxic agents produced that are produced by various cells of

the human body are called chemokines.
• Chemotaxic agents are produced during the complement cascade
and inflammation.
• The phagocytes move along the concentration gradient, meaning
they move from areas of low concentration of chemotaxic agents to
the area of the highest concentration.
• The area of highest concentration is the site where the chemotaxic
agents are being produced or released-often the site of
inflammation.
SPECIFIC IMMUNITY or THIRD LINE OF DEFENSE

• Micro-organisms that overcome non-specific are faced with specific

immunity
• The antigens of the invading micro-organisms comes into contact
with cells of immune system (macrophages and lymphocytes) and
initiate a response
• The response takes two ways:- humoral immunity and cell-
mediated immunity
Humoral immunity

⮚ Humoral(antibody-mediated) immunity is directed primarily

against
▪ Exotoxin-mediated diseases such as tetanus and diphtheria
▪ Infections in which virulence is related to polysaccharide capsules
(e.g meningococci,pneumococci,haemophilus influenzae).
▪ Certain viral infections.
Antibody synthesis is by
• The primary response
• Secondary response
The primary response

• When an antigen is first encountered, antibodies are detectable in

the serum after a long period.
• The lag period can is typically 7-10 days but can be longer
depending on the nature and dose of the antigen and the route of
administration(oral or parenteral).
• A small clone of B cells and plasma cells specific for the antigen is
formed.
• Serum antibody concentration continues to rise for several
weeks,then drops to low levels.
• The first antibodies formed are IgM,followed by IgG,IgA or both.IgM
levels decline earlier than IgG levels.
The secondary response

• When there is a second encounter with the same antigen or closely

related one, months or years after the primary response, there is a
rapid antibody response(in 3-5 days) to higher levels than primary
response.
• This is due to persistence of antigen-specific memory cells after the
first contact.
• In the secondary response the amount of IgM produced is
qualitatively similar to that produced during first contact with the
antigen;
• However, much more IgG is produced and the levels tend to persist
longer than in the primary response.
ANTIBODIES

• Antibodies(immunoglobulins) are formed by B

lymphocytes-each individual has a large pool of
different B lymphocytes that have a lifespan of days
or weeks and are found in the bone marrow, lymph
nodes, and gut associated lymphoid tissues
• B cells display immunoglobulin on their surface.
• They serve as receptors for specific antigen
• An antigen interacts with B lymphocyte that shows the
best fit” by of its immunoglobulin surface receptor
Antibodies or immunoglobulins
IgG:-
• It has two identical antigen binding sites
• Is the predominant antibody in secondary responses and
constitutes an important defense against bacteria and
viruses.
• It is the only antibody that can pass the placenta barrier
and is the most abundant immunoglobulin in newborns.
IgM:-
• Is the main immunoglobulin produced early in the primary
response
• It is present in the surface of virtually all uncommitted B
cells. It has ten binding sites
• It is the most efficient immunoglobulin in agglutination
complement fixation and other antigen body reactions
Antibodies cont’d
IgA:-
• is the main immunoglobulin in secretions such as milk,
saliva, and tears and secretions of the respiratory,
interstinal and genital tract.
• It protects the mucous membranes from bacteria and
viruses.
IgE:-
• It binds to the receptor on the surface of mast cells,
basophils, and eosinophil
IgD:-
• It acts as an antigen receptor when present on the surface
of certain B lymphocytes
• It is present in serum only in trace amounts
CELL-MEDIATED IMMUNITY

⮚ This depends on development of lymphoid cells which are

specifically sensitized to the inducing antigen and which react directly
with the antigen to bring about cytotoxic effects
⮚ Development of activated macrophages can also result from this
process
⮚ Antibody response is a physiological reaction to the introduction
into the body of foreign materials, irrespective of whether it is harmful
or not.
⮚ Immunity can be natural or acquired
⮚ Specific immunity may be acquired in two ways
• actively or passively
types of immunity

Immunity

Natural Artificial

Active Passive Active Passive

Sickness breast milk vaccination antiserum

or
via placenta
Active immunity:-
• is induced after contact with foreign antigens. This contact may
consist of clinical or sub-clinical infections, immunization with live or
killed infectious agents or antigen exposure to microbial products e.g
toxins, toxoids
• The host actively produces antibodies and lymphocytes acquire the
ability to respond to the antigens.
• Advantages:-
-long-term protection
• Disadvantages:-
-slow onset of protection.
-Need for prolonged or repeated contact with the
antigen.
Active immunity can be acquired naturally or artificially e.g
• The production of antibodies in response to a pathogen that has
entered the body is an example of natural active acquired immunity.
• The production of antibodies in response to a vaccine is an example
of artificial active acquired immunity.
• Passive immunity:- is transmitted by antibodies or lymphocytes
performed in another host.
• Advantage:-
-prompt availability of large amounts of antibodies.
• Disadvantages:-
-short lifespan of antibodies
-Possible hypersensitivity reactions if antibodies from
another species are administered.
• Passive immunity can be acquired naturally or artificially
• A fetus receiving antibodies that were produced by the mother is an
example of natural passive acquired immunity.
• A soldier receiving antibodies contained in a shot of gamma globulin
is an example of an artificial passive acquired immunity.
Herd immunity

▪ When a large proportion of people are immunized in a community,

even those few people who have not been vaccinated also get some
protection because the disease becomes so uncommon. This is
called herd immunity.
▪ It is mainly effective for those diseases that pass from man to man
e.g measles, polio and pertusis.
Immunizing agents and clinical importance
• Immunization:- is the process of protecting a person from a
particular disease.
• It happens when a vaccine against a disease has been given. This is
called active immunization.
• Some vaccines are made from live bacteria or viruses that have been
modified enough not to cause a severe infection, but they are still
similar to the original bacteria or viruses for the body not to be able to
make a difference. They are called live attenuated vaccine.
• Other vaccines are made out of dead bacteria(inactivated) or by
modifying the toxins that some bacteria produce. The modified toxins
are called toxoids.
• The vaccines are given either by mouth or injections. They act
as antigens.
references
The end
MICROBIOLOGY

C.M GARAMA
Dept. of Clinical Medicine
Introduction to Microbiology
 To understand:
a) Definition of common terms
b) Structure & Function of Prokaryotic /
Eukaryotic Cells
c) Staining Procedures
d) Preventive & Control Measures
e) A Quiz
COMMON TERMINOLOGIES
 Abscess:
 A localized collection of pus.

 Acid fast:
 Resistant to decolorization by acid after staining with hot
carbol fuchsin and hence retaining a red color when stained by
Ziehl-Neelsen method

 Adjuvant:
 Insoluble materials which act to keep antigens in tissues for
longer period, thus cause a longer stimulation of antibody
production.
 Cont….
 Aerobe:
 An organism which requires oxygen to live and reproduce.

 Agglutinate:
 To join together to form clump.

 Allele:
 One of a group of genes which can occupy a given place on a pair
of identical chromosomes.
 Allergy:
 An abnormal sensitive reaction.

 Anaerobe:
 A microorganism not requiring oxygen to live or reproduce

 reaction:
 level in response to irrelevant stimulus
 Anhydrous:
 Containing no water

 Antagonism:
 Impairment of the efficacy of drug in the presence of the other.

 Antibiotic:
 A substance used to kill microorganisms. It is a product of
microorganism

 Antibody:
 A globulin produced in the body in response to the antigen or
foreign bodies
 Antigen:
 Any substance which can cause the production of antibodies

 Asepsis:
 Without infection

 Attenuated:
 Reduced virulence but retaining antigenecity for host

 Atypical:
 Unusual. Auto- Infection of oneself. infection: Automatic: Doing
something by itself
B
 Bacilli:
 Stick-like or rod-like bacteria.

 Bacteria:
 Single celled organisms containing both RNA and DNA which
reproduce by binary fission.

 Bacteriology:
 The study of bacteria.

 Bacteremia:
 Presence of bacteria in bloodstream.
 Bacteriocide:
 A chemical used to kill bacteria

 coli:
 agent of balantidiasis, a type of dysentry

 Beaded:
 Staining at intervals along the length of bacillus.
 Binary fission :
 Simple cell division by which the nucleus and cytoplasm
divides into two.

 Biopsy:
 The removal of small piece of tissue during life for examination.

 Bio-type:
 A classification or a group of genetically similar organisms.
 Bi-polar:
 The staining of bacillus at both ends

 Blister:
 A small swelling in the skin filled with serum

 Budding:
 An asexual form of reproduction of unicellular organisms, e.g.
yeast cells.

 Buffer:
 A solution, the reaction of which is not easily altered by adding
an acid or alkali
C
 Capsid:
 The protein coat surrounding the genome of virus.

 Capsomere:
 One of the units of which virus capsid is composed.

 Capsule:
 A coating outside cell walls of some bacteria and fungi.
 Carrier:
 One who is harboring but not currently suffering any ill-effect
from pathogenic organism

 Cell:
 A microscopic mass of protoplasm containing nucleus

 Cellulitis:
 The result of a spreading infection of pyogenic bacteria in the
subcutaneous tissues
 Chemotherapeutic agent: -
 A synthetic chemical suitable for systemic administration and
effective in treatment of microbial infections

 Chitin:
 Polysaccharide containing glucosamine, characteristic of cell walls
of some fungi and also found in insects

 Chromatin:
 Darkly staining nuclear material.
 Chromosomes:
 Thread-like structure in the cell nucleus which contains genes
carrying inherited characteristics

 Coccus:
 A rounded or ovoid bacterium.

 Colony:
 A number of organisms living or multiplying together on
culture media and they result from multiplication of a single
organism
 Commensal:
 Deriving nourishment from a host without causing any harm or
benefit to host.

 Conjugation:
 Exchange of genetic material between bacteria.

 Culture:
 The growth and multiplication of microorganism
 Culture media:
 The material used in a culture to nourish the growth of
microorganism

 Cytopathic effect:
 Degenerative changes occurring in tissue culture cells as a result
of microorganism infection

 Cytoplasmic streaming:
 Continuous movement of cytoplasm within the cell which
results in constant distribution of intracellular contents. It
provides amoebic motility to some types of cell
D
 Decolorize:
 To remove color.

 Diplococci:
 Cocci which occur in pairs.

 Disinfectant:
 A substance of chemical nature used for destroying pathogenic
microorganisms.
E
 Embed:
 To penetrate into tissue.

 Encapsulate:
 To surround with a capsule

 Endemic:
 A disease constantly present in an area.
 Endogenous:
 Originated by organisms or factors already present in the
patient’s body before onset of disease

 Endotoxin:
 A toxic component of microorganism (Gram negative), largely
dependent on the death or disruption of the organism for its
release

 Enriched medium:
 A culture medium to which an extra nourishing substance is
added.
 Exogenous:
 Originated by organisms or factors from outside the patient’s
body.

 Exotoxin:
 A toxin released by living microorganisms into the surrounding
medium or tissues.

 Exudate:
 A fluid, often from formed elements of blood, discharged from
tissue to a surface or cavity.
 Facultative:
 Able to behave in a specified way, with the implication that is
not, however, the usual behavior

 Filament:
 A fine thread-like structure.

 Fimbria:
 Hair-like protrusion from bacterial cells

 Flagellum:
 Whip-like organ of motion.
 Fomites:
 Objects contaminated with pathogenic microorganisms.

 Fungus:
 A simple unicellular or multicellular structure which
reproduces by forming spores.

 Fusiform:
 Spindle shaped
G
 Gram- negative:
 Staining red by Gram’s method.

 Gram- positive:
 Staining violet by Gram’s method

 Growth factor:
 An ingredient of which at least small amount must be present in
a culture medium so that it supports the growth of given
organism

 Granules:
 Small grains or particles, e.g. metachromatic granules of
diphtheria bacilli.
H
 Hereditary:
 Transmitted from one generation to the other

 Heterologous:
 Related to different kind of organism.

 Homologous:
 Related to same kind of organism

 Host:
 The organism from which a parasite takes its nourishment
I
 Immune:
 Protected from disease by the presence of antibodies

 Immunoglobulin:
 Globulins which act as antibodies

 Infection:
 The entry and multiplication of pathogenic organisms within the
body

 Inoculate:
 To introduce a living organism into a culture medium.
M
 Macrophage: A large mononuclear phagocytic cell.
 Medium: A nutrient substance used to grow
microorganisms
 mutation: effect that a wrong amino acid has been put into
essential protein.
 Molecule:
 The smallest part of an element or compound which can exist
in normal way.

 Morphology:
 A study of the form of cells and organisms

 Motile:
 Capable of movement

 Mutation:
 An alteration in genetic material.
 Nodule:
 A small rounded swelling.

 Nucleus:
 An essential part of the living cell, containing the chromosomes
and controlling cell activity
 Nucleoid
 Genome.

 Nucleocap
 The genome and capsid
O
 Obligatory anaerobe:
 An organism which cannot live in oxygen.

 Occult:
 Hidden

 Oxidation:
 Combination with oxygen.
P
 Parasite:
 An organism which takes its food from another organism
without giving anything in return

 Passive immunity:
 Dependent upon injection of readymade antibodies and not
upon the subject’s own immunological mechanisms.

 Pathogen:
 An organism which can cause disease.
 Plasmid:
 An extrachromosomal portion of genetic material.

 Polymerase:
 General name of enzymes concerned with synthesis of nucleic
acid

 Protoplast:
 A bacterium deprived of its cell wall.
R
 Replication:
 Virus reproduction.

 Ribonucleo protein:
 Material in the cytoplasm and nucleus of cell.

 Reticuloendothelial:
 The system of phagocytic cells in the body.
S
 Saprophytic:
 Living on dead organic matter

 Serology:
 The study of serum especially antibody contents.

 Sterilization:
 The process of killing all living microorganisms including
spores.

 Symbiotic:
 Living in mutually with the host.
T
 Tissue:
 A group of similar cells.

 Toxoid:
 Toxin rendered harmless but retaining antigenicity

 Transduction:
 Transfer of genetic material from bacterial strain to another by
means of bacteriophage.
U
 Unicellular:
 Single celled.

 Undulating:
 Up and down, i.e. wavy.
V
 Vector:
 An insect which carries microorganism or parasite and is
capable of transmitting this

 Viremia:
 Presence of viruses in the bloodstream.

 Virion:
 A virus particle.

 Virulent:
 Harmful.
Y
 Yeast:
 A unicellular fungus.
Z
 Zygote:
 The cell formed by the fertilization of a female cell by a male
cell.
 END

REF: The Short book of Microbiology

By Satish Gupte
 STRUCTURE & FUNCTION OF
PROKARYOTIC & EUKARYOTIC CELL
C. M. Garama
Dept. of Clinical Medicine
OBJECTIVES
 Understand structure and functions of both prokaryotic &
Eukaryotic cells
 Structural differences
INTRODUCTION
 Prokaryotic cells and eukaryotic cells are the two types of

cells that exist on Earth.

 There are several differences between the two, but the

biggest distinction between them is that eukaryotic cells have

a distinct nucleus containing the cell's genetic
material, while prokaryotic cells don't have a nucleus
and have free-floating genetic material instead.
INTRODUCTION
 All living things can be divided into three basic domains:
1) Bacteria,
2) Archaea and
3) Eukarya.
 single-celled organisms found in the Bacteria and Archaea
domains are known as prokaryotes (made of prokaryotic
cells — the smallest, simplest and most ancient cells).
 Organisms in the Eukarya domain are made of the more
complex eukaryotic cells(can be unicellular or multicellular).
They include;
1. animals,
2. plants,
3. fungi and
4. protists
DIFFERENCES OF THE TWO CELLS
DIFFERENCES OF THE TWO CELLS
Prokaryotic Cell
GENERAL STRUCTURE OF P/CELL
 Cell Appendages
 Cellular Envelope
 Internal Structure
A. General Structure
1. Cell Appendages
A) Flagella
Functions in movement of the cell
3 components
a) Filament
I. Whip-like, helical structure
b) Hook
I. Holds the filament
II. Attached to the rod portion of the basal body
c) Basal body
I. A complex structure consisting of a rod, 4 rings and a motor
contained within the cell envelope
II. Activation of the motor causes the hook ( and therefore the
filament) to swivel
B) Periplasmic Flagella

A type of modified flagella

Found in a special bacteria known as spirochetes

Consist of a filament and a hook but the entire structure is

located between the cell wall and membrane (the periplasmic

space)
c) Fimbriae
 A small, hair-like fibers on the surface of the cell
 Tend to stick to each other as well as other surfaces
D) Pilus
 Elongated, tubular structure
 Only present on certain species of Gram-negative bacteria
 Primarily involved in attachment, movement, and
conjugation
 The transfer of DNA from one bacterium to another
 2. Cellular Envelope
A) Glycocalyx
 Refers to the gel-like outer covering of some bacteria
 Its usually sticky, ―sugar coating‖ (glue)
 Are of 2 types
a) Slime layer
 Diffuse & irregular structure

b) Capsule
 Distinct & gelatinous structure
 Functions
a) Protection against phagocytosis
 Encapsulated bacteria tend to have a greater pathogenicity because of this
Cont……..

b) Helps bacteria adhere to its environment or other bacteria

 All the bacteria to stick to a larger number of substances

including tooth enamel and hospital equipments

 Allows bacteria to grow as a biofilm ( i.e dental plague)

c) Help prevent the loss of water and nutrients

B) Cell Wall

 Lies immediately below the glycocalyx

 Provides the bacteria with structure and protection from lysis

• Certain drugs, including penicillin, destroy the cell wall

allowing cell lysis to occur

 Composed primarily of peptidoglycan

• Basic structure

• Composed of 2 repeating sub-units

• N-acetylmuramic acid (NAM)

• N-acetylglucosamine (NAG)

• Covalently bonded together to form a glycan chain

• Adjacent glycan chains are held together by tetrapeptide chains

attached to each NAM

 Bacteria are lumped into 2 groups based on the staining of
their cell walls
• Hans Christian Gram developed Gram staining in 1884
• The result is a group of bacteria that stain violet ( Gram-positive) and
a group that stain red ( Gram-negative)

1) Gram-positive bacteria
• Cell wall composed of a thick layer of peptidoglycan
• There is a narrow periplasmic space
• Gram-positive bacteria are more permeable but less susceptible to lysis
• 2 molecules (besides peptidoglycan) are commonly found
a) Teichoic acid – binds together layers of peptidoglycan
b) Lipoteichoic acid- link the peptidoglycan layers to the cell
membrane
2) Gram-negative bacteria
 Cell wall composed of a thin layer of peptidoglycan

 There is a wider periplasmic space

 Gram-negative bacteria are less permeable but more susceptible

to lysis
 Surrounded by an outer membrane

 Similar to cell membrane ( lipid bilayer)

 Inner layer of phospholipids bound to the cell wall by lipoproteins

 Outer layer is composed of lipopolysaccharides
Gram negative

 Responsible for the multiple shapes seen in bacteria

a) Coccus – Round

b) Bacillus – Rod- shaped

1) Coccobacillus – short, plump rods

2) Vibrio – slightly bent rods

c) Spirillum – spiral-shaped cylinder

SHAPES
 C) CELL MEMBRANE
 Composed primarily of phospholipids
 Membrane proteins provide the membrane with structure and
functionality
 Mesosomes are inward projections of the membrane
 Believed to increase surface area for membrane activities
 Functions primarily in controlling the movement of substances
into and out of the cell.
3.Internal Structure
A)CYTOPLASM
 Fluid within the cell

 Primarily water containing dissolved nutrients & wastes

 Serve as a site for numerous metabolic reactions

B) CHROMATIN BODY
 A single, circular loop of a single DNA
 Aggregated in a dense area of the cell known as nucleoid
C) PLASMIDS
 Extra, nonessential pieces of DNA

 Arranged in isolated loops or attached to the chromatin body

 They are reproduced and passed on to the offspring

 Often contain protective traits

 Exchanged during conjugation

D) RIBOSOMES ( 70s)
 The site of protein production within the cell

 Composed of rRNA and proteins

 Comprised of 2 subunits

 Small subunits (30S)

 Large subunits ( 50S)

E) INCLUSION BODIES
 Aggregation of nutrients and other substances often needed

by the cell

 May or may not be membrane-bound

 Allows the cell to go for long periods in the absence of

essential nutrients
EUKARYOTIC CELLS

PART II
Assigment
 The Function of ALL organelles found in the Eukaryotic cell
STAINING PROCEDURES

C.M.GARAMA
Dept. of Clinical Medicine
Objectives

• Define staining
• Describe the unique features of commonly
used stains
• Explain the procedures and name clinical
applications for Gram, endospore, acid-fast,
negative capsule, and flagella staining
What is Staining?

• Staining is a supplementary method that

gives divergence to the microscopic image
for better vision under the microscope.
• It is a technique that is widely used for the
examination of cells, tissues and cellular
components.
What is Stain?

• It’s a chemical reagent or dye that is

responsible for the discolouration of the
specimen.

• It adds contrast to the microscopic image

that gives a distinct view of the organism
Ways staining is done
Classification of stains

a) Based on chemical nature:

b)Based on the staining method
Objectives of Staining
1. Enables us to see the organism better

2. Helps to differentiate organisms

3. Identify a particular structure

Staining Techniques

• Staining generally involves three steps

1. Preparation of smear

2. Fixation of smear

3. Staining of the specimen

Types of Staining
1)SIMPLE STAINING
• It determines the cell shape, size and
arrangement of the microorganism.
• It is a very quick or simple method to
perform.
• To perform this staining, it requires the use
of a single stain only.
• These are of two types, namely ;
• direct and indirect staining
CHARACTERISTICS DIRECT STAINING INDIRECT STAINING
Stain used Basic stain Acidic stain
Charge of stain Positive Negative
Examples Methylene blue, crystal violet, Nigrosine, india ink, congo red
carbol fuschin

Outcome Stains the specimen Stains the background

General view after staining

Principle for discoloration Because of the positively Because of the negatively

charged stain, it gets charged stain, it gets repelled
attracted towards the by the negatively charged cell,
negatively charged cell, hence hence it does not fixed to the
it get fixed to the cell that cell, results in colorless cell
retain the color of stain with colored background.
results in colorless background
with colored cell.
2) DIFFERENTIAL STAINING
• It differentiates between the physical and
chemical properties of two different groups
of an organism based on cell-wall
characteristics.
• To perform this staining, it requires the use
of multiple or more than one stains.
• It is categorised into two types
a. Gram staining
b. Acid fast staining
a) Gram staining

• It identifies and classifies two major groups

of bacteria, i.e. Gram-positive and Gram-
negative.
• Dr Hans Christian Joachim Gram introduced
it in 1884.
• This process is Carried out by differential
stain known as Gram’s stain.
 Gram positive Gram negative
Gram staining Protocol
bacteria bacteria
Primary staining Heat fixed smear is
flooded by crystal violet
and allowed to stand for
1min.
Mordanting After washing, iodine is
then flooded and
allowed to stand for
1min.
Decolourization After washing, alcohol is
added that is washed
immediately
Counter staining At last, safranin is
flooded over the smear
and allowed to stand for
30sec, then washed by
water.
Observation After air drying, place
one drop of oil
immersion over the
smear and adjust the Appear purple in Appear pink in color due
microscope to identify colour because of to lack of teichoic acid,
the specimen, whether teichoic acid that alcohol creates pore in
it is gram negative or resist the primary the cell which
gram positive. stain. decolourizes the primary
stain
b) Acid fast staining

• It differentiates species of mycobacterium

from the other group of bacteria.

• Paul Ehrlich first developed it in 1882.

• And later, modified by Ziehl Neelson

ACID FAST ACID FAST NON ACID FAST
PROTOCOL
STAINING BACTERIA BACTERIA

Primary staining Heat fixed smear is flooded with carbol

fuschin and allowed to stand for 1 min.

Decolourization After washing, acid alcohol is added.

Counter staining At last, methylene blue is flooded over

the smear and allowed to stand for 30
sec, then wash it with water

Observation After air drying, place one drop of oil

immersion over the smear and adjust
the microscope to identify the
specimen, whether specimen is acid fast
or not. Appears red in Appears blue in colour,
colour due to as they lack mycolic
presence of acid, alcohol creates
mycolic acid that pore in the cell that
resist the color of decolourizes the
primary stain and primary stain.
does not
decolourize.
3) SPECIAL STAINING
• It identifies particular internal and external
structural components of the specimen.
• It is of three types, namely
a. Capsule,
b. Endospore
c. Flagella staining.
a) Capsule
• It differentiates the capsule from the rest of
the cell body.
• This is carried out by the use of both positive
and negative dyes.
• Capsule acts as an envelope around the cell
wall that consists of a polysaccharide
• Functions:
a. it protects the cell from desiccation
b. it protects the cell from phagocytic actions
c. helps in attachment of bacteria to the host cell
CAPSULE STAINING PROTOCOL DIAGRAM

Primary staining Drop of India ink is placed on a

clean slide.

Smearing Inoculum is then smeared in a

dye.
Dragging Use another slide to drag the
mixture into thin film, and then
air dried.

Secondary staining Crystal violet is flooded over the

thin film, and then air dried.

Observation Examine the cells whether they

are encapsulated or not.

Interpretation of result

Positive: Zone formation

occurs against dark
background

Negative: Zone formation does

not occur
b) Endospore Staining
• It differentiates the endospore from the
vegetative cell.
• This also makes the use of both acidic and
basic stains.
• Endospore (endo: means inside and spore:
means reproductive structure) Therefore,
these are the reproductive structures that
form within the cell.
Types of Endospore
procedure
ENDOSPORE STAINING PROTOCOL DIAGRAM
Primary staining Malachite green is flooded
over the smear

Heat fixing Then the mixture is heat

fixed
Decolourization Decolourized by water

Counter staining Safranin is then flooded over

the mixture and then air
dried

Observation Examine the slide under the

microscope, whether
endospore is present or not

Interpretation of result:

Positive: If Endospore
present, it will appear green
in color whereas vegetative
cell appears as pink

Negative: And if endospore is

absent then only vegetative
cells will appear pink in color
c) Flagella Staining
• It identifies the motility of bacteria by the
presence or absence of flagella.
• It makes the use of acidic and neutral stain.
• Its primary function is to provide motility or
locomotion.
Types of Flagella
Procedure
FLAGELLA STAINING PROTOCOL DIAGRAM

Primary staining One drop of leifson’s stain is

flooded over the smear

Secondary staining After that methylene blue is

added, and allowed to stand
for one minute

Observation Examine the appearance of

flagella to know whether the
bacteria is motile or not

Interpretation of result:

Positive: If flagella is present,

then it will appear red in
color while cell appears blue

Negative: And if not present,

only cell will appear blue in
color
Reference
• https://biologyreader.com/staining.html
• Short Book of Microbiology
MYOCARDITIS & PERICARDITIS

C. M. Garama
Dept. of Clinical Medicine
OBJECTIVES
1. Myocardial Disease
 Myocarditis
 Cardiomyopathy

2. Pericardial Disease
 Pericardial fluid accumulation
 Pericarditis
MYOCARDITIS
 Its Inflammation of the heart muscle

 It is a rather common form of heart disease that can occur at

any age.

 Its exact incidence is difficult to ascertain as the histological

examination has been largely confined to autopsy

material.

 Reports from different studies have estimated the incidence

of myocarditis in 1 to 4% of all autopsies

CLASSIFICATION OF MYOCARDITIS
1. General Classification
I. Interstitial and parenchymatous type
II. Specific and non-specific type
III. Acute, sub-acute and chronic type

2. Etiologic Classification
I. Infective myocarditis
II. Idiopathic (fiedler’s) myocarditis
III. Myocarditis in connective tissue diseases
IV. Miscellaneous types of myocarditis
General Classification
I. Interstitial and parenchymatous type
 depending upon whether the inflammation is confined to
interstitial tissue or the parenchyma

II. Specific and non-specific type

 depending upon whether the inflammation is granulomatous
or non-specific type

III. Acute, sub-acute and chronic type

 depending upon the duration of inflammatory response.
 ETIOLOGIC CLASSIFICATION

I). INFECTIVE MYOCARDITIS

1. Viral myocarditis
2. Suppurative myocarditis
3. Toxic myocarditis
4. Infective granulomatous myocarditis
5. Syphilitic myocarditis
6. Rickettsial myocarditis
7. Protozoal myocarditis
8. Helminthic myocarditis
9. Fungal myocarditis
1. VIRAL MYOCARDITIS
 Some of the common examples are influenza, poliomyelitis,
infectious mononucleosis, hepatitis, smallpox, chickenpox,
measles, mumps, rubella, viral pneumonias, coxsackievirus
and HIV infections.
 Grossly, the myocardium is pale and flabby with dilatation
of the chambers. There may be focal or patchy areas of
necrosis.
 Histologically, there are changes of acute myocarditis.
Initially, there is oedema and infiltration of the interstitial
tissue by neutrophils and lymphocytes. Later, there is
necrosis of individual myocardial fibres and the infiltrate
consists of lymphocytes and macrophages
2. SUPPURATIVE MYOCARDITIS
 Pyogenic bacteria, chiefly Staphylococcus aureus or
Streptococcus pyogenes, which cause septicaemia and
pyaemia

 Grossly, There are either abscesses in the myocardium or

there is diffuse myocardial involvement.

 Microscopically, the exudate chiefly consists of

neutrophils, admixed with lymphocytes, plasma cells and
macrophages. There may be foci of myocardial degeneration
and necrosis with areas of healing by fibrosis.
 3. TOXIC MYOCARDITIS.
 A number of acute bacterial infections produce myocarditis by
toxins e.g. in diphtheria, typhoid fever and pneumococcal
pneumonia
 It manifests clinically by cardiac arrhythmias or acute
cardiac failure due to involvement of the conduction system.
It may cause sudden death
 Grossly, the appearance is similar to that seen in viral
myocarditis.
 Histologically, there are small foci of coagulative necrosis in
the muscle which are surrounded by nonspecific acute and
chronic inflammatory infiltrate.
 4. INFECTIVE GRANULOMATOUS
MYOCARDITIS
 Tuberculosis, brucellosis and tularaemia are some examples
of bacterial infections characterized by granulomatous
inflammation in the myocardium.

 Sarcoidosis, though not a bacterial infection, has histological

resemblance to other granulomatous myocarditis

 Tuberculous myocarditis is rare and occurs either by

haematogenous spread or by extension from tuberculous
pericarditis.
5. SYPHILITIC MYOCARDITIS
 Syphilitic involvement of the myocardium may occur in 2
forms—a gummatous lesion consisting of granulomatous
inflammation which is more common, and a primary non-
specific myocarditis which is rare.
 The syphilitic gummas in the myocardium may be single or
multiple and may be grossly discernible.
 The gummas may affect the conduction system of the
heart
6. RICKETTSIAL MYOCARDITIS
 Myocarditis occurs quite frequently in scrub typhus (R.
tsutsugamushi) and Rocky Mountain typhus fever caused by
spotted rickettsii
 Microscopically, there is interstitial oedema and focal or
patchy infiltration by inflammatory cells which include
lymphocytes, plasma cells, macrophages, mast cells and
eosinophils but necrosis and degeneration are generally not
present.
7. PROTOZOAL MYOCARDITIS
 Chagas’ disease and toxoplasmosis are the two protozoal
diseases causing myocarditis. Chagas’ disease caused by
Trypanosoma cruzi frequently attacks myocardium besides
involving the skeletal muscle and the central nervous system.
 Microscopically, both these conditions show focal
degeneration and necrosis of the myocardium, oedema and
cellular infiltrate consisting of histiocytes, plasma cells,
lymphocytes and a few polymorphs.
 The organisms are found in the muscle fibres.
8. HELMINTHIC MYOCARDITIS
 Echinococcus granulosus and Trichinella spiralis are
the two intestinal helminths which may cause myocarditis.
9. FUNGAL MYOCARDITIS.
 Patients with immunodeficiency, cancer and other chronic
debilitating diseases are more prone to develop fungal
myocarditis.
 They include:
 candidiasis,
 aspergillosis,
 blastomycosis,
 actinomyosis,
 cryptococcosis,
 coccidioidomycosis
 histoplasmosis.
 II). IDIOPATHIC (FIEDLER’S)
MYOCARDITIS

 Idiopathic or Fiedler’s myocarditis is an isolated myocarditis

unaccompanied by inflammatory changes in the
endocardium or pericardium and occurs without the usual
apparent causes.

 The condition is rapidly progressive and causes sudden

severe cardiac failure or sudden death.
 Grossly, the heart is soft and flabby. The cardiac chambers are
generally dilated and sometimes show hypertrophy. There are
yellow-grey focal lesions throughout the myocardium. Mural
thrombi are commonly present.

 Histologically, two forms of idiopathic myocarditis are

described: diffuse type and giant cell (idiopathic
granulomatous) type.
i) Diffuse type
 Its more common of the two and characterised by diffuse
non-specific inflammatory infiltrate consisting of
lymphocytes, plasma cells, macrophages, eosinophils and a
few polymorphs in the interstitial tissue without formation of
granulomas.
 Late stage shows healing by fibrosis.
 ii) Giant cell type or idiopathic
granulomatous type

 characterised by formation of non-caseating granulomas

consisting of macrophages, lymphocytes, plasma cells and
multinucleate giant cells.

 The giant cells are of foreign body or Langhans’ type or of

myogenic origin.
III. MYOCARDITIS IN CONNECTIVE
TISSUE DISEASES
 Inflammatory involvement of the myocardium occurs in a
number of connective tissue diseases such as
 rheumatoid arthritis,
 lupus erythematosus,
 polyarteritis nodosa,
 dermatomyositis
 scleroderma.
 The pathologic changes in the heart muscle are similar to the
changes seen in other organs in these conditions
IV. MISCELLANEOUS TYPES OF
MYOCARDITIS

1. Physical agents

2. Chemical agents

3. Drugs

4. Immunologic agents

5. Metabolic derangements
1. Physical agents
 Physical agents initiate non-specific myocarditis, example of
agents are;
contusion of the myocardium
heat stroke
cardiac surgery
irradiation
 The features consist of an infiltrate of neutrophils,
eosinophils and mononuclear cells and shows contraction-
band necrosis of the myocardial fibres
 2. Chemical agents
 Toxic chemicals cause focal areas of degeneration and
necrosis of myocardial fibres and nonspecific inflammatory
reaction, chiefly consisting of lymphocytes and macrophages
 Examples are;
 arsenic,
 phosphorus
 carbon monoxide
3. Drugs
 Changes similar to those induced by chemical poisons are

produced by certain drugs such as;-

phenothiazine compounds,

sulfonamides,

catecholamines

cytotoxic compounds
4. Immunologic agents.

 Myasthenia gravis, Friedreich’s ataxia, and progressive

muscular dystrophies initiate a state of autoimmunisation

against the myocardium resulting in focal myocardial
degeneration and necrosis with secondary inflammatory
reaction. Later, myocardial fibrosis may occur
5. Metabolic derangements
 Uraemia, hypokalaemia and shock are associated with

degeneration and necrosis of the myocardial fibres, oedema

of the interstitial tissue and nonspecific inflammatory
reaction.
 PERICARDIAL DISEASES

I. Pericardial fluid accumulations

II. Pericarditis
PERICARDITIS
 Pericarditis is the inflammation of the pericardial

layers and is generally secondary to diseases in the heart or

caused by systemic diseases.

 Primary or idiopathic pericarditis is quite rare.

 Based on the morphologic appearance, pericarditis is

classified into acute and chronic types with their subtypes

based on the character of the exudate,
 Classification of Pericarditis
A. ACUTE PERICARDITIS
1. Serous pericarditis
2. Fibrinous or serofibrinous pericarditis
3. Purulent or fibrinopurulent pericarditis
4. Haemorrhagic pericarditis

B. CHRONIC PERICARDITIS
1. Tuberculous pericarditis
2. Chronic adhesive pericarditis
3. Chronic constrictive pericarditis
4. Pericardial plaques (milk spots, soldiers’ spots)
A. ACUTE PERICARDITIS

1. SEROUS PERICARDITIS.

 may be accompanied by accumulation of serous effusion

 caused by
i) Viral infection e.g. coxsackie A or B viruses, influenza virus,
mumps virus, adenovirus and infectious mononucleosis.
ii) Rheumatic fever.
iii) Rheumatoid arthritis.
iv) Systemic lupus erythematosus.
v) malignant tumour e.g. carcinoma lung, mesothelioma and
mediastinal tumours.
vi) Tuberculous pericarditis in the early stage
Cont..
 Microscopically, the epicardial and pericardial surfaces
show infiltration by some neutrophils, lymphocytes and
histiocytes.
 The fluid usually resorbs with the resolution of underlying
disease.
 2. FIBRINOUS AND
SEROFIBRINOUS PERICARDITIS.
 Quite often, there is admixture of fibrinous exudate with
serous fluid.
 The various causes of this type of pericarditis are as
follows:
i) Uraemia
ii) Myocardial infarction
iii) Rheumatic fever
iv) Trauma such as in cardiac surgery
v) Acute bacterial infections.
 The amount of fluid accumulation is variable. The cardiac
surface is characteristically covered by dry or moist, shaggy,
fibrinous exudate which gives ‘bread and butter’
appearance.
 Clinically, these cases manifest by friction rub
 pericarditis heals by organisation and develops fibrous
adhesions resulting in adhesive pericarditis.
3. PURULENT OR
FIBRINOPURULENT PERICARDITIS
 Mainly caused by pyogenic bacteria (e.g. staphylococci,
streptococci and pneumococci) and less frequently by fungi
and parasites
 The infection may spread to the pericardium by the following
routes:
 i) By direct extension from neighbouring inflammation e.g. in
empyema of the pleural cavity, lobar pneumonia, infective
endocarditis and mediastinal infections.
 ii) By haematogenous spread.
 iii) By lymphatic permeation.
 iv) Direct implantation during cardiac surgery
 The amount of exudate is variable and is generally thick,

creamy pus, coating the pericardial surfaces

 Microscopically, besides the purulent exudate on the

pericardial surfaces, the serosal layers show dense infiltration

by neutrophils. Purulent exudate generally does not resolve
completely but instead heals by organisation resulting in
adhesive or chronic constrictive pericarditis
4. HAEMORRHAGIC PERICARDITIS
 One in which the exudate consists of admixture of an
inflammatory effusion of one of the foregoing types along
with blood.
 The causes are as under:
 i) Neoplastic involvement of the pericardium
 ii) Haemorrhagic diathesis with effusion
 iii) Tuberculosis
 iv) Severe acute infections
B. CHRONIC PERICARDITIS
 Chronic pericarditis is the term used for tuberculous
pericarditis and the healed stage of one of the various forms
of acute pericarditis already described
1. TUBERCULOUS PERICARDITIS
 Tuberculous pericarditis is the most frequent form of
granulomatous inflammation of the pericardium.
 The lesions may occur by the following mechanisms:
 i) Direct extension from an adjacent focus of tuberculosis.
 ii) By lymphatic spread e.g. from tracheobronchial lymph nodes,
chronic pulmonary tuberculosis or infected pleura
 The exudate is slightly turbid, caseous or blood-stained with
sufficient fibrin.
 Tubercles are generally visible on the pericardial surfaces and
sometimes caseous areas are also visible to the naked eye
 Microscopically, typical tuberculous granulomas with

caseation necrosis are seen in the pericardial wall. The lesions

generally do not resolve but heal by fibrosis and calcification
resulting in chronic constrictive pericarditis
READ ON
2. CHRONIC ADHESIVE PERICARDITIS.
3. CHRONIC CONSTRICTIVE PERICARDITIS.
4. PERICARDIAL PLAQUES (MILK SPOTS, SOLDIERS’
SPOTS)