Microbiology Board Examination Review Notes

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I. INTRODUCTION
Microbiology is the study of microorganisms. Microbiology is named as such because it studies the plant and animal forms not visible to the naked eye. Sometimes called bacteriology, a curriculum in microbiology outlines the effect that microorganisms have on other living organisms (esp. man).

A. Divisions of Microbiology
Microbiology can encompass many species of organisms. The divisions of microbiology are... 1. Bacteriology is the science that studies bacteria. Numerous bacterial organisms are found in our environment that are capable of causing disease in man. a. Examples: (1). Staphlococcus aureus can produce skin abscesses and food poisoning. (2). Clostridium tetani may cause tetanus (also known as lock jaw). 2. Rickettsiology studies rickettsia. Rickettsia are sometimes smaller than bacteria and exist as either spherical in form or they are shaped as rods. Rickettsia are responsible transmitting typhus, Q-fever and rocky mountain spotted fever in man. 3. Virology is the scientific study of viruses.. Viruses are extremely small in size and are composed primarily of nucleic acid. Common viral infections include small pox, hepatitis and HIV 4. Protozoology scientifically studies protozoa. Protozoa are one-celled organisms that transmit such diseases as amoebic dysentery and malaria. 5. Mycology is a branch of microbiology that studies fungi. Fungi may be unicellular or multicellular and are often associated with such diseases as candidiasis and aspergillosis.

B. Scope of Study - This document surveys a number of organisms that are
considered pathological to man. Not only will you discover the disease associated with a given organism, but also you will gain insight into the mode of transmission and man's portal of entry and exit. Further, this document will assist the reader to understand bacterial anatomy & survival, methods of controlling the spread of microorganisms bacteria, and man's natural and acquired defense mechanisms to microbial infection. 1. Microorganisms of Health Importance Bacteria Viruses Mycoplasmas Protozoa Rickettsia Fungi Chlamydias Prion

II. ANATOMY OF BACTERIA

A. Morphology - The study of structure and form.
1. Size - Bacteria range in size from 0.2 micrometers to 2.0 micrometers. On an average, bacteria are one micrometer in size. These microorganisms are very small and can only be seen with the aid of a microscope 2. Shape - Bacteria vary in shape. Common shapes include: a. Spherical - A spherically-shaped cell is referred to as a coccus. True cocci appear as perfectly shaped balls. Not all cocci are truly spherical. Cocci may exist in bean and cone shapes. (1). Arrangement - Cocci may be further categorize according to the way they are bundled or grouped together. (a). Micrococcus - Bacteria cell is grouped with no others. (b). Diplococcus - A pair of bacterial cells; seen as two attached cocci. This familiar arrangement is found in a common type of pneumonia. (c). Streptococcus - Chains; cocci divided on one plane, resulting in its progeny dividing in a parallel plane. As a result, chains of cocci are formed. If the organisms divide in three planes, resulting in an eight cell cube shape, the resulting arrangement is termed a sarcina. (d). Staphylococcus - is an arrangement where the grouping resembles a bunch of grapes. The organisms have divided along a number of planes. b. Rod - Bacteria can also take on the shape of a small rod. This shape is often called a bacillus. The bacillus may also exist alone or in groups. (1). Diplobacilli - A pair of bacilli linked together. (2). Streptobacilli - A chain of linked bacilli. c. Spiral (1). Spirillum - A single helical cell. (2). Vibrio - The shape of a “comma.” One curve, only. (3). Spirochete - Spiral shape. This type differs from the spirillum. While a spirillum has a more rigid wall and will often move by flagella, spirochetes are more flexible and move by smaller axial filaments

B. Structure and Function of Bacteria
Bacterial cells are capable of independent life. Each cell carries out its life processes, growth, multiplication, and death without depending upon other cells which may be attached in groups or chains. 1. Cell Wall - The cell wall is made of layers, which is sometimes referred to as the cell envelope. The cell wall lies between the cytoplasmic membrane and the cell's capsule. Compounds found in this envelope vary, giving rise to what are known as gram-negative and gram positive bacteria. The cell wall has a high tensile strength that helps it maintain proper osmotic pressure.

2. Cytoplasm - The cytoplasm is thought of as the protoplasmic material located within the cell membrane. It consists of a water suspension of enzymes, proteins, RNA, ions, and nutrients. Except for the nucleus, the cytoplasm contains the mitochondria, endoplasmic reticulum, golgi apparatus, and other cell organelles.

3. Cell Membrane - The cell membrane is a type of semi-fluid found on the internal side of the cell wall, Sometimes referred to as the cytoplasmic membrane, this thin structure separates the cell wall and the cytoplasm. The cell membrane is semipermeable, allowing only the movement of certain types of particles through its structure. Further, it allows for electron transport and the excretion of hydrolytic exoenzymes. 4. Capsule - The capsule is the outermost layer of the cell wall. Not all bacteria have a capsule. This jacket (or armor) is a gummy/slimy coating on the surface that insulates the cell against phagocytes, antibodies, and other defense mechanisms of the host. Bacteria exhibiting a thick capsule are more virulent and tend to be more difficult to kill. 5. Endospore - The endospore is a dormant form of a bacterial cell that resists drying, heat, sunlight, and many disinfectants, sometimes for long periods of time. Think of the endospore as a small condensed dehydrated form of the cell that survives in unfavorable conditions and waits for the optimum time where it can grow, reproduce, and cause harm to the host. Not all bacteria produce endospores. a. Examples: (1). Clostridium (e.g., Clostridium Pefringens, Clostridium Welchii) - should be of concern to the embalmer, due to the fact that they resist the action of many disinfectants. Tissue gas is caused by a spore forming bacteria. Gas Forming organisms may be transferred from one decedent to another when an embalmer fails to properly sterilize embalming instruments. Since spores are resistant to many disinfectants, the embalmer should select embalming chemicals that will not only kill this type of bacteria, but also it's resistant spores. (2). Diseases caused by spore forming bacteria - lockjaw, anthrax, botulism, and gas gangrene. b. Sporulating versus Vegetative - Bacteria can be thought of as either sporulating or vegetative. (1). Sporulation is known as the creation of spores. When nutritional conditions become unfavorable, bacterial cultures begin to form spores within their cytoplasm. This complex process insures the survival of the bacteria until the nutritional environment becomes more favorable. For the embalmer, remember that the spores are difficult to kill. (2). Vegetative - the non-dormant, hydrated form of a living organism. It contains all essential cell organelles necessary for survival. (non-dormant, functioning cell.) 6. Flagella - Flagella are threadlike appendages, composed entirely of protein. They function as a device to move the bacterial cell throughout it's environment. A single unit resembles a tail that rotates like a propeller. Also, it functions like a rudder as it steers the bacteria along it's path. 7. Pili - (Pili - which is Latin for "hair") Short surface appendages. Like flagella but smaller in size. Made of protein, pili enables the adherence of symbiotic bacteria to host cells so they may exchange nutrients and conjugate during reproduction.

III. PHYSIOLOGY OF BACTERIA
Physiology is study of the functions and vital processes of living organisms. Areas of interest include: bacterial reproduction methods, bacterial colonies, conditions affecting bacterial growth, and bacterial associations.

A. Reproduction - Bacteria reproduce by way of transverse binary fission, sometimes
referred to as simple transverse division. 1. Transverse Binary Fission is defined as cell division where the mother cell splits into two daughter cells. This type of asexual reproduction results in two complete individual organisms. Under ideal conditions, cells divide once every nine minutes. Typically, cells divide one every thirty minutes. Bacterial cells reproduce exponentially. For example, the progeny of one cell may number in the millions after a period 10 - 12 hours. B. Bacterial Colony - Sometimes biologists refer to groups of bacterial cells as colonies. A bacterial colony is the population of bacteria, growing on a medium, that results from one cell. C. Conditions Affecting Bacterial Growth - Not all bacterial colonies grow at the same rate. Factors controlling the growth rate include: 1. Food - Organisms require food for building cell components and proteins. In addition, food supplies the necessary energy for cell survival. Microbial activity is limited when food supplies become exhausted. The amount and type of food available will have an impact on the type of organisms that survive and the rate at which they grow. a. Organism Classification According to Food Supply: (1). Autotrophic bacteria thrive in areas where organic matter is scarce. Autotrophic bacteria are "self-nourishing," meaning they are capable of surviving in the absence of organic compounds. Instead of relying on organic compound as a source of carbon, these organisms use carbon dioxide (inorganic compound). The carbon is used to build essential cell materials. Other inorganic compounds, such as ammonia, dihydrogen, hydrogen sulfide, and iron containing compounds, provide essential elements to autotrophic organisms, as well. Algae and some bacteria are autotrophic.

(2). Heterotrophic organisms use organic matter for energy and the synthesis of cell materials. Most bacteria are heterotrophic. Heterotrophic bacteria are categorized according to the type of organic material upon which they feed. (a). Strict (obligate) saprophytes are heterotrophic bacteria that obtain nutritional need from non-living sources. Examples include: (aa). Clostridium Tetani - (responsible for lock jaw) proliferates on dead tissue.

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(bb). The causative agent for the food poisoning known as botulism. (b). Strict (obligate) parasites are heterotophic bacteria that only grow on other living organisms. Most pathogenic bacteria tend to be of this type. Staph and strept infections are caused by this type of organism. (c). Facultative bacteria are those heterotrophs that live and adapt in food conditions that may vary. Sometimes they feed on dead tissue, at other times they feed on living tissue. 2. Moisture Requirements - Vegetative cell maintenance and growth requires water. Food and waste are transported through the cell wall in water solutions. In addition, water is a building material necessary in cell synthesis. Finally, the necessary element of dioxygen is derived from water. 3. Oxygen Requirements - Many forms of bacteria require the presence of oxygen. Bacteria are often categorize according to their oxygen need (some bacteria require it and some do not). a. Strict (obligate) aerobes are bacteria that only grow in the presence of oxygen. Micrococcus lutea is an example of such an organism. b. Strict (obligate) anaerobes are bacteria that require a total absence of oxygen. Clostridium sporogenes is an example of this organism. c. Facultative bacteria are those growing in the absence or presence of oxygen. Without the presence of oxygen these bacteria rely on dioxygen derived from fermentation or anaerobic glycolysis. In the presence of oxygen, the same bacteria may rely on the surrounding atmosphere as a source of dioxygen for respiration. Escherichia coli (E. Coli) is a facultative organism requiring only a small amount of dioxygen for growth but may die when in the presence of excess dioxygen. d. Microaerophillic organisms require very little free oxygen to maintain growth.

4. Temperature Requirements - As a rule, temperature is the most important factor affecting the growth of microorganisms. Bacteria can grow within a range of temperatures. a. Maximum temperature is the upper limit at which reproduction is possible. The rate of bacterial growth will decline when exposed to high temperature. Eventually, the bacteria will die if the temperature becomes too extreme. The maximum temperature will vary from one organism to another. Boiling at

one hundred degrees centigrade for ten to fifteen minutes will kill bacilli and cocci. Pasteurization, however, will not kill all organisms. As a method of making dairy products safe for human consumption, pasteurization incorporates the use of heat at seventy-two degrees centigrade for fifteen minutes. This results in killing pathogenic organisms, such as streptococci, salmonella, and rickettsia. However, some non-pathogens , such as lactobacilli, are not killed. b. Minimum temperature represents the lowest temperature at which growth occurs. At low temperatures, cell membranes lose their structural integrity, resulting in faulty transportation of nutrients through the cell wall. The growth rate of bacteria found in dead human remains becomes slow during refrigeration. c. Optimum temperature is that which enzyme reactions occur efficiently and reproduction proceeds at a maximal rate. The optimum temperature is near the normal human body temperature (37 degrees centigrade) for many, but not all, bacteria. For example, E coli and the gonococcus require thirty five degrees centigrade as an optimum. d. Classification Organisms may be classified according to their temperature requirements. This classification is based on an organism's temperature range. (1). Psychrophiles are those organisms that prefer cold temperatures. Temperatures range from zero to twenty-five degrees centigrade. An optimum temperature appears to be around fifteen degrees centigrade. These organisms take part in the spoilage of refrigerated foods (e.g., milk). (2). Mesophiles prefer a moderate temperature, usually on or about normal human body temperature. Temperatures range from twenty-five to forty degrees centigrade. Most pathogenic organisms are considered mesophiles. (3). Thermophiles are organisms that prefer high temperatures. Their range begins around forty-five degrees centigrade and may exceed fifty-five degrees. Some spore forming bacteria require this temperature range. 5. pH Requirements - Most microorganisms thrive in a pH range of six to nine. Exceptions do exist, however. As with temperature, bacteria function within a maximum, minimum, and optimum pH. Most animal pathogens work best near a pH of seven. “Pickling” or preserving food may be accomplished in an acidic medium (such as vinegar).

6. Light Requirements - Green and purple pigmented bacteria use light as a source of part or all of their energy. These organisms undergo a type of bacterial photosynthesis resulting in the creation of food for the cell. When compared to other bacterial forms, these species do appear in abundance. (In comparison, most pathogens are killed by direct sunlight. Both ultraviolet rays and warmth harm bacteria.)

7. Osmotic Pressure - Osmotic pressure is created by osmosis. Osmosis is the passage of solvent (e.g., water) from a dilute to a more concentrated area through a semipermeable membrane. When a cell is placed in a concentrated or hypertonic environment, such as a salt water solution, water is drawn from the cell. As a result, the cell may shrink and die. Bacterial cells vary in their resistance to unfavorable osmotic conditions. Many saprophytic microorganisms that cause food spoilage are dehydrated by immersion in strong brines or syrups. They may not always die, but at least they do not grow and spoil the food product. Shelf-life of such products as pickles, corned beef, salt fish, jams, and jellies is lengthened by this principle.

D. Bacterial Association (Bacterial Relationships)
In the course of evolution many species of living organisms, forced to co-exist, have established a variety of interrelationships. Below are examples of the types of bacterial associations. 1. Symbiosis is a type of relationship where two species live together in close association. Symbiosis may be divided into three types of relationships: mutualism, commensalism, and parasitism. a. Mutualism involves a relationship whereby two organisms live together . Each will benefit from the other. (e.g., a healthy relationship of husband and wife - both share responsibilities and duties for the mutual benefit of each other.) b. Commensalism involves two different species that live side by side in peace. Some would call this relationship an “armed truce.” Although each will live near the other without harm, there is no mutual benefit for either. (e.g., a married couple experiencing irreconcilable differences - instead of divorcing or killing each other, they choose to remain together at arm's length.) Commensalism occurs as opportunistic organisms live within the human body. Opportunists are allowed to live without danger. However, when conditions turn in favor of the organism (such as the host experiencing an illness), the opportunists may multiply in enough numbers to harm the host. Hence, the host's natural defenses begin to battle the opportunists. (Opportunistic organisms wait for the “opportunity” to cause harm to the host.) c. Parasitism is a relationship whereby one organism, known as a parasite, thrives at the host's expense. One is at risk, while the other receives a benefit. The host may not always experience harm but the possibility may exist. (e.g., assume that the husband has no job, nor has any ambition of finding work. Instead, his daily activities only include television, beer drinking, and scratching. He may feel comfortable living as a parasite sponging from his hard working wife.) 2. Synergism is an interaction between bacteria in which both species work together to achieve the desired result. These reactions may produce substances or results that neither organism can produce alone. (e.g., two business partners working together to achieve economic success of their business. One has talents that the other lacks. One without the other would result in failure.) Synergism can be found when one looks to the human oral cavity and finds an organism known as borrelia and also a rod-shaped fusobacteria. In the presence of the herpes virus infection, injury to the mucous membranes results when these two

bacteria cooperate to produce lesions. 3. Antagonism occurs when some microorganisms produce substances that inhibit or prevent growth of other microbes. This may be thought of as mutual opposition. (e.g., two enemies trying to kill each other.) Antagonism is found when one looks to the effect that penicillin has in stopping the growth of staph infections.

IV. CONTROL OF MICROORGANISMS
“Control of microorganisms” is synonymous with killing bacteria and/or inhibiting their growth (in an effort to prevent the onset/spread of illness). This information is of great value to the embalmer, since he or she encounters pathogenic microorganisms on a daily basis. The scientific principles of embalming plus the maintenance of a germ free working environment utilize many of the principles outlined here.

A. Levels of Control: Three terms are often used to describe the control of
microbial populations. 1. Disinfection may be described as any process that destroys, neutralizes, or inhibits pathogenic organisms. (“a process that destroys infectious agents found on inanimate objects.”) Often, vegetative organisms are destroyed, but not spores. A definition of disinfection may also suggest that not all microorganisms are destroyed. An example would be the pasteurization of milk whereby the harmful pathogens are killed, but harmless organisms are not. Disinfection is not always selective. Some harmless organisms may die in the process. 2. Sterilization is defined as any process that completely removes or destroys all living organisms in or on an object. Sterilization also destroys spores. Think of sterilization as a process that has a 100% “kill rate.” In contrast, disinfection results in a “kill rate” less than 100 %. 3. Antisepsis is a process that prevents and/or combats infection or growth of pathogenic bacteria on living tissue. Antisepsis occurs when an antiseptic product is applied on a skin surface.

B. Methods of Control - To control growth or spread of microorganisms, one may
employ physical and/or chemical methods. 1. Physical Methods - A physical method of control avoids the use of chemicals. (e.g., scrubbing or the use of heat) a. Scrubbing requires the use of an abrading device to remove large sized contaminants. Often this method does not sterilize or disinfect unless used with a suitable chemical. For example, the removal of blood by way of scrubbing (with a germicidal soap) may serve to partially disinfect the area.

b. Heat of sufficient temperature and duration will sterilize objects. Heat may be applied to an object in a number of ways. (1). Incineration - Sterilization occurs by way of direct flame. Equipment and materials that are not damaged by direct heat (e.g., inoculating needle) may be sterilized in this fashion. (2). Dry heat produced by an oven may sterilize glassware in laboratories. Flasks and pipettes are often sterilized in two hours (or more) time at 160 degrees centigrade. (3). Moist heat can be used to sterilize objects. Moist heat may be generated by: (a). Steam Under Pressure (Autoclave) - Similar to a pressure cooker, the autoclave releases steam at approximately fifteen lbs. per sq. inch. Instrument sterilization occurs in about twenty minutes. The pressure has no direct bearing on sterilization. However, at fifteen pounds of pressure, the temperature of the steam can reach 121 degrees centigrade, resulting in a more efficient destruction of organisms (when compared to the higher temperatures required by an open flame or dry heat). (b). Boiling Water - Boiling an object for a sufficient length of time may render an object sterile. (c). Free flowing steam. c. Cold temperatures (through refrigeration or freezing) may inhibit microbial growth. For example, dead human remains stored in a refrigeration unit at forty degrees Fahrenheit or less will exhibit much less bacterial growth than remains stored at seventy degrees Fahrenheit. Frozen remains would harbor even fewer numbers of microbes. Extreme cold may not kill all bacterial colonies. d. Ultraviolet Light - As previously mentioned, ultraviolet light will destroy many pathogens.

2. Chemical Methods - Chemical methods of disinfection incorporate the use of
agents that destroy pathogenic organisms. These chemicals are often called disinfectants and are usually applied inanimate objects (e.g., counter or table top). Iodine and phenol are compounds found in many disinfecting solutions. Disinfectants are capable of inhibiting or destroying pathogenic organisms, but may be ineffective in killing spores. a. Disinfectants - Disinfectants are often categorized according to their target organism. (1). Germicide - a general term that describes a disinfectant that will kill germs. (Germs are simply any type of microorganism.) (2). Bactericides kill bacteria. (3). Fungicides kill fungi. (4). Viricides kill viruses. (5). Insecticides kill insects (6). Larvacides kill insect larva b. Factors Influencing the Action of Disinfectants - No single disinfectant is capable of killing all microorganisms. Consider the following: (1). Nature of the disinfectant (The constituents found in the disinfecting

(2).

(3).

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solution) (a). Will the solution only inhibit bacterial growth? Will it kill bacteria? (b). Is the solution corrosive? Will it destroy the contaminated object? (e.g., does it contain a strong acid or base?) (c). Is the compound hazardous product user? Necessary concentration of the disinfectant Some solutions may be ineffective if the concentration is either too low or too high. Error in judgment may result in a lack of disinfecting action or a waste of the product. Nature of the material to be disinfected If the chemical is to come in contact with live skin, it is best to avoid toxic substances as well as strong acids and bases. If applied to inanimate objects, one must determine possible adverse reactions between the chemical and object. Also, determine if the solution is diffusive enough to disinfect porous objects. Finally, determine if the solution is able to penetrate any type of protective coating that may be present. When a large number of microorganisms are present in material, such as feces, sputum, and other discharges, more that minimal amounts of disinfectants and longer applications times are required. For example, the disinfectant must be able to penetrate clumps or masses to reach deeper contaminated areas. The number of microorganisms present With more microorganisms present, a larger amount of disinfectant may be required. Kind of microorganisms present Some microorganisms are more resistant to a given disinfectant than others. Non-spore forming bacteria are readily destroyed, as a rule. However, exceptions do exist. The tubercle bacillus is a non-spore forming bacteria that produces a waxy coating as part of the cell wall. This organism is more resistant to chemical application. Spore forming bacteria and their spores tend to be highly resistant. Some spores can survive boiling or baking for an hour or more. However, autoclaving will kill all organisms if sufficient heat is applied during a sufficient length of time.

(6). Time of exposure to disinfectant Bacteria must be in contact with the disinfectant for an adequate length of time. Cell wall penetration occurs over a period of time (it does not occur instantly). Not all disinfectants penetrate at the same rate. To insure optimum disinfecting results, the user should follow product manufacturer’s instructions on proper usage. (7). Temperature of disinfectant during exposure Temperature can also play a part in the killing efficiency of the solution. Warm solutions often increase the rate of reactivity of many compounds.

Again, it is prudent to consult the usage directions provided by the product manufacturer. (8). pH of disinfectant during exposure pH will also effect the disinfecting efficiency during exposure. Cationic bactericides work best under alkali conditions. Anionic bactericides work best under acidic conditions. c . Effective Disinfectants Suitable for Mortuary Purposes. (1). Halogens/halogenated compounds (a). hypochlorites (bleaches) (b). iodophores (2). Alcohols (a). ethyl alcohol & methyl alcohol (b). isopropyl alcohol (3). Aldehydes (a). formalin (formaldehyde solutions) (b). glutaraldehyde (4). Phenolic Compounds (a). phenol (carbolic acid) (b). cresols (lysol) (c). hexachlorophene (5). Quaternary Ammonium Compounds (a). benzalkonium chloride

V. MICROORGANISMS AND DISEASE
A. Terminology
1. Infection is a process whereby a parasite enters into a relationship with a host. First, the parasite enters the host by way of the mouth, nose, or open wound. Proliferation soon follows. Infection may lead to tissue destruction, injury, or death of the host. 2. Contamination is the act of introducing the parasite or organism into the host. 3. Pathogenic organisms are those having the potential to cause disease. For example, a parasite is said to be pathogenic if it causes disease. a. True pathogens tend to be pathogenic under any circumstance. Vibrio cholerae, the causative agent of cholera, is a known true pathogen. b. Opportunistic organisms are defined as those living as a commensal (but under suitable conditions), as they proliferate within the host to cause infection. Opportunist may be considered “normal flora” since they are naturally found in the host without causing harm. Opportunist have to potential to cause harm when the host becomes ill or the host’s natural defenses are compromised. For example, some patients who receive chemotherapy become susceptible to opportunistic infection, since the drugs tend to alter the bodies natural defenses. 4. Pathogenicity is the ability of microorganisms to cause disease or to spur the production of progressive lesions. 5. Virulence is the degree of pathogenicity a microorganism exhibits. Pathogens are

thought of as “highly virulent” when a small amount cause injury to the host. Alternately, other pathogens may require large numbers to produce harm or injury. These organisms are considered less virulent. Two types of virulent organisms exist. a. Those that produce toxins (biological poison). “Toxigenicity” measures this organism’s strength. b. Those that invade the host, multiply, and spread to cause harm. “Invasiveness” measures this organism’s strength. 6. Attenuation is the weakening of an organism. Attenuation results in reducing or abolishing the organism's pathogenicity. For example, attenuation occurs when an organism is grown in environments considered less than optimal. a. Example (benefit to man): Artificial immunity may be induced by vaccinating man with attenuated microorganisms.. The use of an attenuated viral vaccine serves as a vehicle of immunization against small pox. 7. Indigenous Flora - (see glossary) 8. Drug-fast (see glossary) - Resistant to a drug or drugs.

B. Types of Infection
1. Exogenous vs. Endogenous Infection a. Exogenous infection originates outside of the host.. For example, the common cold is passed from one person to another. The HIV virus is considered exogenous , as well. b. Endogenous infection originates within a cell or organism. Opportunistic organisms that normally live within the host may proliferate when conditions are favorable. For example, injury to the host may occur when indigenous flora, such as staph or strept, grow out of control. 2. Acute vs. Chronic Infection a. Acute infection will last for a short period of time (if properly treated). Sore throats, common colds, and flu infections are considered acute infections. b. Chronic infection will last for a long period of time. Some may result in death of the host. Hepatitis, tuberculosis, and HIV may be considered chronic infections.

3. Communicable vs. Non-communicable Infection a. Communicable disease (transmittable disease) is caused by an agent transmitted from an affected individual to one who is not affected. Numerous methods of transfer are possible including a handshake, the exchange of body fluids, or the sharing of contaminated hypodermic needles. HIV, measles, and hepatitis are common examples. Communicable diseases may be categorized according to the numbers of infected people. (1). Endemic - A disease that occurs continually in a particular region but has a low mortality rate. (2). Epidemic - A disease that affects many people at the same time in a given

geographical area. (3). Pandemic - A disease found in many parts of the world at the same time. (4). Sporadic - A disease occurring occasionally or is scattered in its existence. b. Non-communicable disease remains within the host and can not be transmitted from one infected individual to another. Peritonitis, an infection and inflammation of the host's peritoneum, can not be transmitted to another individual. 4. Primary vs Secondary Infection a. Primary infection is the original infection caused by a microorganism. b. Secondary infection often coexists with the primary infection and is caused by a microorganism that is different from the first A secondary infection sometime requires the presence of a primary infection before it can injure the host. (1). Example: HIV infection. Consider HIV as a primary infection. Infected patients ordinarily do not die from HIV, rather they succumb to a secondary infection. Pneumonia (spurred by bacterial infection) often takes the life of this patient due to the depression of the body's natural immune system. Consider pneumonia as a secondary infection to HIV. 5. Mixed Infections - The mix of two or more organisms causing infection at the same time. 6. Local, General, and Focal Infections a. Local infections affect only a limited area within the host. (e.g., sore throat) b. General infections affect the entire body. (e.g., HIV) c. Focal infections begin in one area and later spread throughout the body. Untreated syphilis can spread, eventually causing widespread damage to arteries (and ultimately death). 7. Blood Infection - Human blood often a target tissue for microbial infection. The following terms describe different types of blood infection. a. Bacteremia is a disease resulting from the presence of bacteria in the blood. A patient suffering bacteremia may not be considered gravely ill. With some infections, the causative organism circulates for time periods ranging from hours to days. Also, bacteria may invade intermittently. Phagocytosis helps control bacterial proliferation, thus protecting the host from further danger. b. Septicemia (blood poisoning) is a condition whereby bloodborne bacteria is allowed to multiply. The host’s natural defenses may not win the battle against said bacteria. Hence, septicemia patients may be considered very ill. Often, bacteria invade individual cells resulting in cell necrosis. c. Toxemia is a general term describing the poisoning of blood by bacteria. Consider it a common use term referencing both bacteremia and septicemia.

C. Factors Influencing Virulence
Consider each case of infection as an individual matter. A variety of factors determine the degree or severity of disease in man. Below is a list of factors influencing an organism’s virulence. 1. Toxin Production - a biological poison. Generally, two types of toxins exist. a. Exotoxins (true toxins) - formed by the organism and diffuse into the

surrounding environment. During toxin producton, the organism remains alive and intact. Clostridium botulinum and clostridium tetani examples of dangerous organisms that produce exotoxins. Exotoxins tend to be highly toxic. Exotoxin producing organisms are considered virulent b. Endotoxins are found within the organism and are released upon lysis of the organism. In other words, the cell must die and break apart before the endotoxin is released. Salmonella produces an endotoxin. Generally, endotoxins are toxic only in large doses. Bacteria that produce endotoxins tend to be less virulent 2. Production of Enzymes - In addition to toxin production, many pathogens produce enzymes that serve to lower the host’s defenses. Organisms aided by the benefits of enzyme production are thought of as more virulent. Three common enzymes produced by bacteria are as follows: a. Hyaluronidase catalyzes a breakdown of hyaluronic acid (hyaluronic acid is like a “cementing substance” that holds the cell together). When cells break down, infection easily spreads. Hyaluronidase is produced by staphylococci, clostridia, and streptococci. b. Coagulase catalyzes the coagulation of plasma. Many staphylococci produce coagulase that aid in the formation of protective fibrin on or about staphylococcal lesions. The lesion is allowed to persist due to the protection fibrin provides against phagocytosis. c. Fibrinolysin (produced by many hemolytic streptococci) has the ability to dissolve coagulated plasma. Once plasma is dissolved, strept may easily spread throughout tissues. 3. Capsules - A capsule protects the virulent bacteria against the host’s phagocytic activities. Although it is not a spore, pneumococci has an outer “protective armor” that enhances the organism's virulent characteristics. 4. Endospores - (see glossary)

D. Sources of Infection - The occurrence of a communicable disease suggests that a
source of infection exists. Logically, an active pathogenic agent must exist in or on some transmittable form of matter. Said matter may be an animate (e.g., animal) or inanimate (e.g., fomite) form. Man’s contact with contaminated matter occurs directly or through a vector. Common sources of infection include: 1. Animals or people ill with the infection. For example, a person ill with the flu can transmit the organism responsible for that illness to another. Likewise, an animal infected with rabies may infect man through a bite. 2. Chronic carriers - Some animals or humans are chronic carriers of pathogenic organisms. These carriers may or may not show signs of an illness. Tuberculosis is a disease that may be carried for years by a chronic human carrier. 3. The environment may serve as a source of infection as well, Common examples include infected water supplies and direct contact with contaminated soil.

E. Modes of Transmission
1. Direct transmissions occur when the susceptible individual receives the infectious agent by one of three modes: a. Physical contact with an infected person, animal or object. (e.g., kissing a person ill with a common cold; unprotected sex with HIV infected person) b. Droplet infection - Forceful exhalation (which accompanies a cough or sneeze) sprays airborne saliva contaminated with microorganisms originally present in the oral-nasal cavity or respiratory tract. These microorganisms remain airborne on minute flakes of protein for a period of time and are inhaled by susceptible individuals. Tuberculosis and the common cold are often transmitted to others by way of droplet infection. c. Congenital infection - The transmission of an organism from mother to fetus during birth gives rise to what is known as a congenital infection. Ophthalmia neonatorum (an eye disorder), is contracted by the newborn during birth when the mother is infected with gonorrhea. 2. Indirect transmissions occur where the susceptible individual receives the infectious agent during contact with non-human sources harboring pathogens. a. Food infection (food poisoning) - Gastroenteritis is caused by ingesting food contaminated with bacterial toxins. b. Milk - Milk of infected animals serves as a source of infection. Pasteurization mitigates this danger. c. Water - Common water-borne diseases, such as cholera, typhoid fever, amoebic dysentery, and bacillary dysentery result from drinking contaminated water. d. Fomites - Contaminated (with pathogens) inanimate objects. Common examples include contaminated bed sheets, eating utensils, and toys. e. Soil - Soil often contains pathogenic bacteria. Open skin lesions (resulting from a fall or accident) may come in contact with contaminated soil. Example: Clostridium bacteria (responsible for causing gas gangrene) can be found in soil. f. Insect vector - Many of man’s infectious diseases are transmitted from host to host by insects (e.g., fleas, lice, and ticks). The word “vector” often refers to these living animals as carriers of pathogens (however, inanimate objects may also be considered vectors, as well). Insect vectors may carry organisms in one of two ways. (1). An insect carrying the pathogenic organism inside its body is known as a biological vector. The susceptible human may become infected by way of an insect bite or through open skin wound contact with contaminated insect feces when the human squishes the insect on his/her skin. (2). Mechanical vectors are insects that carry the pathogenic organism on the outside of their body. Open skin wound contact with this vector may cause infection.

F. Portals of Entry
Portals of entry are pathways by which microorganisms normally enter the host’s body.

The particular route depends upon the microorganism and, to an extent, the type of vector involved. Sometimes pathogens cause infection only if they enter their obligate portal of entry. For instance, the dysentery bacillus would cause no harm of rubbed into a skin lesion. However, this same organism can produced fatal results of ingested. Examples of said portals include: 1. Skin wounds 2. Mucous membranes 3. Respiratory tract, 4. Digestive tract, 5. Genito-urinary tract, 6. Placenta. From the various portals of entry, organisms may pass into the circulatory system and initiate a secondary infection in some internal organs or in membranes.

G. Portals of Exit - Microorganisms leave the body via a “portal of exit” as they
continue their journey from one host to the next. In humans, microorganisms may enter one portal, but will leave through another. Example: The portal of entry for the hepatitis virus can be through a contaminated hypodermic needle, whereas the portal of exit would be the direct contact with contaminated blood. To control occupational exposure of pathogens, embalmers should be aware of the portals of exit. Examples include: 1. Skin wounds 2. Mucous membranes 3. Respiratory tract, 4. Digestive tract, 5. Genito-urinary tract, 6. Placenta.

H. Exit Vehicles of Pathogens
When exiting the host, pathogens require a method of transportation. The following are examples of vehicles used to transport pathogenic organisms through the aforementioned portals of exit. (The practice of universal precautions helps protect embalmers from risk exposures to pathogenic organisms.) 1. Feces 2. Urine 3. Semen 4. Vaginal Secretions 5. Sputum 6. Saliva 7. Blood 8. Pus and Lesion Exudates 9. Tears

I. Factors Influencing the Occurrence of an Infection
1. Portal of Entry - The entrance of pathogens into the body is theoretically preventable if the portal of entry is known. An embalmer can protect from respiratory contamination by wearing an oral-nasal mask. Scratches or open skin sores on the susceptible host could be covered with bandages. Careful selection and preparation of food may prevent the ingestion of harmful organisms. 2. Number of Organisms - As a general rule, large numbers of organisms are more likely to cause disease than small numbers. Exceptions to this rule may exist. 3. Invasiveness (organism’s ability to enter, multiply, and spread through the host’s tissues). Invasive organisms are more likely to cause disease. Exceptions to this rule exist. Some infectious agents, such as viruses, may be widely spread throughout the body without causing illness. Toxin production and the resistance of the host are additional factors that affect the end result. In sum, if an invasive organism, such as anthrax, is allowed to spread in large numbers in the host, injury to the host is likely to occur, especially in a host that has a low resistance to infection. 4. Virulence of the Organism - Relative power and degree of pathogenicity possessed by organisms to produce disease. 5. Resistance of the Host - If unable to resist the pathogen and its destructive action on tissues, the host may die. Such is the case in many HIV infections, whereby the host's immune response is depressed to a point where it con no longer fight other infections.

J. Defenses of the Body Against Infection
1. Mechanical Defenses a. Skin - Pathogenic organisms must enter the body tissues before they harm the host. Very few pass directly through healthy skin. Think of skin as a form of armor. b. Mucous Membranes - Mucous membranes are the soft inner linings of organs. These membranes serve as an internal barrier (similar to the external protection of skin). 2. Physiological or Cellular Responses a. Phagocytosis - Phagocytic cells migrate throughout the body in search for harmful microorganisms. Phagocytes engulf and kill pathogens entering the lymphatic system, lungs, bone marrow, and bloodstream. Types of phagocytic cells include, leukocytes, wandering macrophages, and fixed phagocytes found in the spleen, liver, bone marrow, and lymph nodes. (Think of phagocytes as scavenger cells that “search and destroy” pathogens.) b. Inflammatory Response - When organisms escape phagocytosis, an inflammatory response is initiated by the host. Elements of this response include the dilation of blood vessels, an increase in vascular permeability (allowing plasma to localize at the site of infection), and the passage of some leukocytes through capillary walls

into infected tissues. Both phagocytosis and the inflammatory response are non-specific. In other words, these responses work against any invading material. c. Fever - (a symptom of infectious disease). Fever is the most common systemic manifestation of the inflammatory response. Fever is the elevation of body temperature designed to create an unfavorable environment for pathogenic life. 3. Chemical Defenses a. Body Secretions - Lysozyme is found in skin secretions. It helps kill microorganisms found on the skin surface. Gastric Juice is an acidic substance found in the stomach. The acidic pH kills ingested microorganisms. Other helpful body secretions include tears and mucous. b. Antibodies - Produced by the host, gamma globulins are formed in response to antigenic stimulation. (See “Immunology” below) c. Interferon - a viral-induced protein that interferes with viral replication at the cellular level.

VI. IMMUNOLOGY
Immunology is the science that studies antigen-antibody reactions. Immunity is a relative term describing one's ability to resist or overcome a harmful antigen, such as an infecting bacterium or virus. The term may also refer to any state in which the individual has produced an immunoglobulin to a specific antigen. The goal of immunity is to provide resistance to harmful microorganisms.

A. Antigens are substances that stimulate the formation of antibodies within the host.
They react with the antibody in a demonstrable way. Most often, antibodies are large protein molecules. Exotoxins and extracellular enzymes (originating from microbes) antigen examples. Antigens may enter the body through infective routes, such as in food or by way of droplet infection. Substances normally native to the body do not ordinarily produce the immune response.

B. Antibodies - (a.k.a. gamma globulins) - When an antigen is introduced into the
body, certain cells develop the capacity to react with the antigen in a manner different from their previous behavior. This altered cell reactivity spurs the production of specific antibodies. Antibodies naturally occur in blood serum. Other sources include tears and the first milk of lactating animals. Antibody formation is not ordinarily detected for several days or weeks after the introduction of an antigen.

C. Types of Immunity
Many infectious diseases produce a specific immunity that does not protect against other infections. Some diseases confer no immunity at all. Others produce some immunity, while another group induces a possible life-long immunity.

Categorically, there are two major types of immunity. The difference depends upon the source of the antibody and the degree of protection and duration. 1. Natural (innate) Immunity - Natural immunity is based on genetics or heredity. It is not based on a theory of an individual’s prior contact with an infectious organism. A species, race, or individual may exhibit natural immunity. For example, man does not develop hog cholera or distemper, whereas an animal would. Additionally, some races within a species may be more susceptible than others to a disease. For instance, the wild mouse may resist pneumococcal infection, whereby the white mouse is susceptible 2. Acquired Immunity - the development of resistance by susceptible individuals. Acquired immunity may be categorized into two groups, natural acquired immunity and artificially acquired immunity. a. Natural acquired immunity may be further broken down into two groups; natural active immunity and natural passive immunity. (1). Natural active immunity (active immunity) develops as a result of the activity taking place in the cells of the individual who is becoming immune. This individual is, in a sense, active in his own response. Here, the individual achieves immunity by having an infection and recovering from it. This type of immunity can last a lifetime.

(2). Natural passive immunity (passive immunity) is obtained by the transfer of an immune substance which was developed by another. The individual receives pre-formed antibodies. For example, when one individual has achieved a natural active immunity and has transferred antibodies to another person. We can say that this second person has now achieved natural passive immunity. A newborn may receive gamma-globulins from placental transfer before birth. Or a newborn may receive gamma globulins from mothers milk during feeding (colostrum). This type of immunity provides immediate protection but for a short duration. b. Artificially acquired immunity - Acquired immunity may be achieved artificially, as well. Artificial immunity may be grouped into two categories, artificial active immunity, and artificial passive immunity. (1). Artificially acquired active immunity (active) occurs upon the injection of a vaccine or a detoxified product which stimulates antibody formation. A vaccine may be constructed from killed or attenuated organisms. Protection by this method may last for many years. As a rule, periodic boosters may be required to reinforce protection. (2). Artificially acquired passive immunity (passive) involves the receipt of

pre-formed antibodies in a serum obtained from an immune animal or human. These antibodies are commonly referred to as gamma-globulins. Often this type of immunity is provided when an individual has been exposed to an infectious disease of during an epidemic. For example, if an embalmer is exposed to viral hepatitis, he or she may seek an immunoglobulin shot to prevent illness. Often embalmers choose to seek immunization in advance of an exposure. Again, gamma-globulins are injected in a series of shots.

VII. SURVEY OF PATHOGENIC ORGANISMS
A. BACTERIA 1. Staphylococcus Aureus - a non-spore forming bacteria that does produce a toxin that may be harmful to red blood cells. In most cases, penicillin will kill it. a. Staphylococcus Aureus is responsible for the following diseases: (1). Skin abscesses - This facultative anaerobe is responsible for producing skin abscesses, boils, and carbuncles in man. (2). Food Poisoning - The enterotoxin produced by this organism is responsible for gastroenteritis, also known as food poisoning. (3). Nosocomial Infections - “in hospital” infections. (4). Toxic Shock Syndrome b. Portals of entry and exit - broken skin, oral ingestion, mucous membranes, and the respiratory tract. c. Modes of transmission - contaminated food, infections which accompany accidental or surgical wounds, contaminated bedding or linens, and other infected carriers, often experiencing oral/nasal infections. 2. Streptococcus Pyogenes - The streptococci comprise a large group of organisms. Some of these organisms are useful and/or harmless. Others are deadly pathogens. Streptococcus pyogenes is a facultative anaerobe that does not form spores. This organism may be found in dairy products, but is easily killed by pasteurization. Often it is found in sputum.

a. Streptococcus pyogenes is responsible for the following diseases: (1). Scarlet Fever (2). Septic sore throat (strept throat) (3). Puerperal Sepsis, (A disease of the uterus caused by contact with contaminated dressings or instruments) (4). Rheumatic Fever (a serious disease that can result in heart damage if strept throat goes untreated). b. Portals of entry and exit - the respiratory tract, oral ingestion, and open wound infection. c. Modes of transmission - eating and drinking unsanitary dairy products, contact with another person's contaminated saliva or mucous membranes through a handshake or a kiss, infection of an open skin wound. 3. Streptococcus Pneumoniae - (Sometimes referred to as “pneumococcus”). Streptococcus pneumoniae is a gram positive encapsulated coccus. a. Streptococcus pneumoniae is responsible for the following diseases: (1). Lobar Pneumonia - Lobar pneumonia affects one or more entire lobes of lung. Said lobe(s) may become wholly consolidated if left untreated. This common type of pneumonia is rarely fatal when treated with antibiotics. (2). Meningitis - Meningitis is the inflammation of the meninges. It may be caused by a number of organisms. Up to forty percent of untreated cases are fatal. (3). Ostitis Media - Infection of the middle ear of children. b. Portals of entry and exit - The respiratory tract, broken skin, and mucous membranes. c. Modes of transmission - Most common mode: direct contact via handshake or a kiss with an infected person. Other modes include: aerosol droplet contamination (infected person coughs or sneezes on another), contact with sputum, saliva and pus exudates. d. Factor influencing virulence - This organism forms a capsule making it more resistant to natural body defenses. 4. Neisseria Gonorrhea - a gram negative diplococcus that may be killed with penicillin therapy. Pili is present on the organism’s surface. Pili allows the organism to adhere to other surfaces. Hence, the organism readily receives nutrients from the surrounding environment. Pili serve to enhance the organism’s virulence. a. This organism is responsible for causing the following diseases: (1). Gonorrhea - Gonorrhea is a common venereal disease. (2). Ophthalmia Neonatorum - Ophthalmia neonatorum is characterized by an inflammation of the eye in newborn infants (contracted during childbirth by gonorrheal infection from the mother and may result in blindness if left untreated). b. Portal of entry and exit - Genito-urinary tract of the infected person. c. Mode of transmission - Gonorrhea is transmitted by direct contact through unprotected sexual intercourse. d. Factor influencing virulence - Presence of Pili.

5. Neisseria Meningitidis (a.k.a. meningococcus) a. Neisseria Meningitidis is responsible for the following diseases: (1). Epidemic Meningitis - Epidemic meningitis causes a very dangerous and often fatal inflammation of the meninges (coverings of the brain and spinal cord). Also known as meningococcus meningitis, this disease may attack many people at one time. Symptoms include; sudden fever, intense headache and nausea. Delirium and coma may follow. The patient could die within six hours after the initial onset. (2). Meningococcemia - Meningococcemia may spur thrombosis formation in many small blood vessels of organs. Meningitis could be a complication stemming from meningococcemia. One might observe petechial hemorrhages on the skin of the infected patient. b. Portals of entry and exit - The respiratory tract (nasopharynx), skin, and mucous membranes. c. Modes of transmission - The primary mode of transmission is by way of contact with aerosol droplets, specifically an infected person coughing or sneezing on another. Other modes include; physical contact with contaminated blood, spinal fluid, saliva, and sputum (“hocker,” “lugie”).

6. Clostridium Tetani - Clostridium organisms are often found in contaminated soil. These are spore forming anaerobic bacteria. a. Clostridium tetani is responsible for the following diseases: (1). Tetanus ( "lockjaw.") Tetanus is an acute disease with a high fatality rate if left untreated. Symptoms include; painful muscle contractions of the jaw, neck, and trunk. Active immunization with a tetanus toxoid will produce adequate short term protection (i.e., tetanus shot). b. Portal of entry - Through an open skin wound. c. Mode of transmission - Direct contact with contaminated soil (or a contaminated fomite found in the same soil) is the usual mode of transmission. For example, if a person falls off his bike and is cut by a tin can embedded in contaminated soil, the risk of infection is great. d. Factors influencing virulence - Formation of endospores and exotoxins. 7. Clostridium Perfringens - Clostridium perfringens is another anaerobic bacteria. This organism produces endospores, exotoxins, and enzymes. Additionally, clostridium perfringens is extremely virulent and tough to kill in a prep room environment. Special chemicals (e.g., Dryene, San Veino, etc) may be used to combat these organisms. a. Clostridium perfringens is responsible for the following diseases: (1). Gas Gangrene - Gas gangrene is characterized by a spreading destruction of muscular tissue together with the development of hydrogen gas in the affected tissue. Clostridium perfringens elicits an exotoxin containing an enzyme capable of breaking down cell membranes. The cell’s destruction will soon follow. Death of the host is imminent as the exotoxin spreads throughout tissue. The only treatment for this patient is the surgical removal of the

affected tissue. (2). Food Poisoning (food intoxication) - Some forms of food poisoning may be caused by clostridium perfringens. (3). Tissue Gas - Although this is not a disease, tissue gas is of concern to the embalmer since this is postmortem gas formation that can spread throughout the body. Unclean instruments (esp. trocar) may carry this organism from one body to another. Instruments used in the preparation of know tissue gas cases must be sterilized before they are used again. b. Portal of entry - Through open skin wounds. c. Mode of transmission - Direct contact with contaminated soil or fomites found in that soil. d. Factors influencing virulence - Formation/presence of endospores, exotoxins and enzymes.

8. Corynebacterium Diphtheriae - Corynebacterium diphtheriae is an aerobic, non-motile, non-spore forming bacteria that is primarily responsible for diphtheria. This organism produces a very powerful exotoxin capable of damaging epithelial cells lining mucous surfaces. Said damage leads to the development of an inflammatory exudate consisting of blood cells, fibrin, dead tissue cells and the bacteria. This exudate is sometimes referred to as a Pseudomembrane. Corynebacterium diphtheriae bacteria tends to localize in the pharynx during the illness. a. Corynebacterium Diphtheriae is responsible for the following disease: (1). Diphtheria - Usually considered a childhood disease, diphtheria is an acute infection characterized by the formation of patches of a grayish membrane in the throat or other localized mucous surfaces, such as tonsils. b. Portals of entry and exit - The respiratory tract. c. Mode of transmission - The primary mode of infection is by way of droplet infection. For example, this bacteria may be transferred through a couch or sneeze. d. Factors influencing virulence - Formation of exotoxins and the localization in the pharynx (pseudomembrane formation) 9. Salmonella Typhi a. Salmonella Typhi is responsible for the following disease: (1). Typhoid Fever - Typhoid fever is an acute infectious disease caused by salmonella typhi and is characterized by a gradual rise in fever and systematic invasion throughout the lymphatic system and bloodstream. The end result yields a condition known as bacteremia. b. Portals of entry and exit - The digestive tract. c. Mode of transmission - Typhoid fever is spread via fecal contamination of water and food. In sum, careless food handlers and contaminated water supplies serve as vehicles of transmission.

10. Francisella Tularensis - A gram-negative, non-motile bacillus responsible tularemia, or "rabbit fever." a. Francisella Tularensis is responsible for the following disease: (1). Tularemia - Tularemia is a disease marked by chills, fever, and swollen lymph nodes in the area of infection. Additionally, tularemia can be incapacitating for long periods of time. b. Portals of entry and exit - The gastro-intestinal tract and the respiratory tract. c. Modes of transmission - People working with small animals may encounter francisella tularensis by inhaling dust found in hay contaminated with infected feces. Cleaning a contaminated rabbit cage would be a likely activity that could result in infection. Ticks, fleas, deer flies, and other arthropods found on rodents, rabbits, and other mammals transmit tularemia from one animal to another and eventually to humans. Another mode of transmission involves contaminated water sources. Infected animals will occasionally die on a stream’s bank or near a water source used for human consumption. 11. Mycobacterium Tuberculosis - Mycobacterium tuberculosis is a long and slender bacillus, that does not form spores and is non-motile. The cell wall of the bacillus has a high lipid content. As a result, the waxy nature of the cell wall creates a relatively high resistance to dryness. The bacillus appears to be resistant to heat and chemicals. However, pasteurization will kill the bacillus. Caution: one information source indicates that formaldehyde is unreliable in killing the organism. The idea is that formaldehyde will coagulate the outer layer of the tubercle, but will not penetrate deep. Hence, no contact is made with the bacteria. a. Mycobacterium Tuberculosis is responsible for the following disease: (1). Tuberculosis - Tuberculosis is a chronic disabling disease which has been a long-time deadly killer. It is a respiratory disease transmitted by way of respiratory droplets either directly from infected people or through various secondary contaminated vehicles, such as dust. Lesions (tubercles) form in the lung. These lesions result from a proliferation and aggregation of certain body cells responding to stimulation caused by the presence of the bacillus. The products of this stimulation encapsulate the bacillus and infected material. Meanwhile, the bacillus continues to multiply within this nodule. In some cases, the tubercles break open and liberate this virulent organism, thus causing tissue destruction. In other cases, the infection may persist for years without further development. Symptoms of tuberculosis include pleurisy, chest pain, cough, fever, and weakness. b. Portal of entry and exit - The respiratory tract. c. Modes of transmission - The primary mode of transmission is by way of droplet infection. Inhaling contaminated aerosols or dust particles should be avoided. This bacillus is often found in sputum. d. Factor influencing virulence - High lipid content of cell wall. 12. Mycobacterium Avium - Another species of mycobacterium. It grows best at forty degrees centigrade. Mycobacterium Avium tends to infect birds but rarely causes disease in humans. However, poultry workers (and poultry eaters) may be at risk.

a. Mycobacterium Avium is responsible for the following disease: (1). A form of opportunistic tuberculosis: Sometimes found in patients who suffer from AIDS as their immune systems deteriorate. b. Portals of entry and exit - The respiratory tract (especially in the southeastern United States where this organism is found in soil and water.) c. Mode of transmission - The primary mode of transmission is through contaminated sputum and dust.

13. Treponema Pallidum - Treponema pallidum as a spirochete that causes syphilis. a. Treponema pallidum is responsible for the following disease: (1). Syphilis - A venereal disease transferred from one infected person to another by way of unprotected sexual intercourse. An infected person would first notice a chancre or ulcer developing on the genitals. This ulcer will discharge an exudate filled with spirochetes. The chancre will later disappear but the spirochetes continue to spread throughout the body. Lesions of the skin may develop in the form of a rash. Later, the heart and central nervous system become affected. In later stages of the disease, arteries may develop aneurysms. Penicillin or tetracycline will kill the organism in the early stages of the disease. b. Portals of entry and exit - The genito-urinary tract and broken skin. c. Modes of transmission - The primary mode of transmission includes direct physical contact during unprotected sexual intercourse. Congenital infection of an infant is possible if a mother is infected during pregnancy. The spirochete may pass into the placenta, then into fetal blood. (The spirochete is one of the very few organisms that can accomplish placental transfer) The infection of an infant in this manner is not considered a venereal disease since it is contracted inutero. 14. Borrelia Burgdorferi - Borrelia burgdorferi is a spirochete responsible for Lyme Disease. a. Borrelia Burgdorferi is responsible for the following disease: (1). Lyme Disease - Lyme Disease is named after the town of Lyme, Connecticut. Here, a number of people were infected a many years ago. Usually a summertime disease, Lyme Disease manifests skin lesions, headaches, fever, and lymphadenopathy. Weeks or months after initial infection, some patients develop neurologic symptoms and arthritis that may recur for several years. b. Portal of entry - Skin c. Mode of transmission - Lyme disease requires an insect vector to infect

humans. Small ticks carry the spirochete. The susceptible individual may come in direct contact with the tick or may encounter the tick found on animals. The tick will bite the human and infect the bloodstream. This spirochete may find its way into cerebrospinal fluid. Penicillin and tetracycline will kill the spirochete in the early stages of the disease.

15. Others Organism a. Vibrio Cholerae b. Yersinia Pestis c. Klebsiella Pneumoniae d. Clostridium Botulinum e. Bacillus Anthracis f. Hemophilus Influenzae g. Proteus sp. h. Shigella sp. i. Pseudomonas sp. j. Leptospira Interrogans k. Escherichia Coli l. Campylobacter jejuni Disease Asiatic Cholera Plague Pneumonia and urinary infection Botulism Anthrax Influenzal Meningitis Secondary infection of burns Bacillary Dysentery Secondary infection of burns Leptospirosis Enteritis Campylobacteriosis

B. MYCOPLASMAS Mycoplasmas are a genus of bacteria lacking cell wall material due to the cell's genetic inability for its synthesis. Some would argue that these are the smallest free living organisms presently known. They range in size between viruses and bacteria. 1. Mycoplasma Pneumoniae - Mycoplasma pneumoniae is a non-bacterial pneumonia that is sometimes referred to as "primary atypical pneumonia." This organism tends to grow in the cytoplasm of the infected cell. Due to the absence of a cell wall, the mycoplasma tends to be susceptible to drug therapy (esp. penicillin).

C. RICKETTSIA

Rickettsia are a genus of gram-negative, pathogenic intracellular parasitic bacteria shaped as either spheres or rods. They range in size between viruses and bacteria. Morphologically, they resemble the bacteria. Biologically (because of their obligate parasitism), they are related to viruses. Rickettsia are widespread in nature and are found in arthropods (a species of insects and ticks) and mammals. Except for the louse, rickettsia do not harm arthropods or mammals. Mammals become infected with rickettsia through the bites of infected ticks, mites, lice, or fleas. Man is an accidental host. Once transmitted to man, the rickettsia quickly spread by blood to other body areas and tend to localize in endothelial cells of small blood vessels. The symptoms of man’s disease include fever, rash, stupor, and terminal shock. Rickettsial diseases can be highly fatal. There are at least four diseases caused by rickettsial infection. 1. Rickettsia Prowazekii - Rickettsia prowazekii is responsible "epidemic or louse-borne typhus" a. Portal of entry and exit - Skin b. Mode of transmission - Direct contact with the feces of lice is the primary mode of infection. (1). Man becomes a natural reservoir by rubbing feces from infected lice into a skin wound created by the vector's bite. (2). Later, different uninfected lice become carriers after feeding on infected human blood (man as the reservoir). (3). Now, these recently infected lice (vector) make contact with other susceptible humans. (4). The spread of the organism continues. 2. Rickettsia typhi - Rickettsia typhi is responsible "endemic or flea-borne typhus." This is a milder form of typhus. Symptoms of illness often resemble those of louse-borne typhus. The difference is that the rat is the reservoir and the rat flea is the vector. a. Portal of entry - Skin b. Mode of transmission - Same as #1 above except: (1). The rat is the natural reservoir. A large number of fleas may become infected. (2). The rat flea is the vector. (3). Man becomes the accidental host as he make contact with the flea. (4). As the infected flea takes a blood meal, its feces will contaminate human skin. 3. Rickettsia Rickettsia - Rickettsia rickettsia is responsible for "Rocky Mountain Spotted Fever." This tick-borne disease occurs throughout the United States, especially during the spring and summer months. Rabbits, mice, and dogs are natural reservoirs. Also, ticks are a reservoir since they harbor the pathogen for life and pass it on to future generations of ticks. Man becomes infected via the tick (vector). Symptoms of Rocky Mountain Spotted Fever include: sudden fever, headache, and a generalized rash. If left untreated, the rate of fatality may reach twenty percent. a. Portal of entry - Skin b. Mode of transmission - By way of direct contact with an infected tick, man becomes contaminated when feces from the tick is pressed into the bite wound (as man crushes the tick).

4. Coxilla Burnetii (a.k.a. rickettsia burnetii) - the organism responsible for Q fever in man. Q fever resembles influenza or hepatitis rather than typhus. Q fever produces no rashes or lesions. a. Portals of entry - The primary portal of entry is by way of respiratory inhalation of dust contaminated from dried feces, urine, or milk. Skin contamination resulting from the bites of infected ticks is also a portal of entry. b. Mode of transmission - Droplet infection and direct skin contact via tick bites.

D. CHLAMYDIA
Chlamydia are a large group of non-motile, gram-negative intracellular parasites. Closely related to gram-negative bacteria, chlamydia were once thought to be large viruses. They contain cell walls with high lipid content. Chlamydias appear to parasitize their host cells to gain energy since they lack energy yielding enzyme systems. Chlamydias are responsible for eye infections that could result in blindness from corneal infection and conjunctivitis in newborns as a result of contact with an infected mother's birth canal during expulsion. Chlamydias are also responsible for urethritis in adults. 1. Chlamydia Psittaci - Chlamydia psittaci is responsible for a condition known as psittacosis or "parrot fever." Psittacosis is a disease of birds that may be transferred to humans. Clinical manifestations in humans include severe pneumonia and sepsis. Psittacosis can be fatal. (However, some infections are mild.) a. Portals of entry and exit - The respiratory tract. b. Modes of transmission - The primary mode of transmission is the direct handling of infected birds, including pigeons, chickens, ducks, geese, turkeys, parrots, and cockatoos. The infected birds excrete or shed large amounts of the infectious organism. In addition, the handler may inhale dust contaminated with dried bird feces. Also, poultry rendering workers may become infected via inhalation of contaminated aerosol droplets. Humans can spread the disease to other humans if the susceptible person ingests contaminated sputum (yuk!) or inhales contaminated droplets . 2. Chlamydia Trachomatis - Man is a natural host of chlamydia trachomatis. a. Chlamydia Trachomatis is responsible for the following diseases: (1). Trachoma - Trachoma is an eye disease that affects the conjunctiva and cornea by causing inflammatory changes leading to scarring and blindness. This disease also affects the genital tract. Trachoma can be treated with tetracycline or sulfonates. The effect on the urinary tract may result in urethritis, cervititis, salpingitis, and pelvis inflammatory disease. (2). Lymphogranuloma Venereum - Lymphogranuloma venereum is a sexually transmitted disease common in tropical climates. Several weeks after exposure, the patient may experience the development of small vesicles on the genitalia, anus, or rectum. Lymph nodes may enlarge. Manifestations

in late stages are characterized by fever, skin rashes, headache, and nausea. (3). Non-gonococcal Urethritis (NGU) is sometimes known as non-specific urethritis (NSU). This disease is characterized by an inflammation of the urethra. b. Portals of entry and exit - The portal of entry and exit for trachoma is the genito-urinary tract. For the infant, it is direct tissue contact during birth. c. Mode of transmission - Except for infants, the primary mode of transmission is direct contact during unprotected sexual intercourse.

E. VIRUSES
Viruses are small agents composed primarily of either DNA or RNA. Viruses multiply only inside the cells of cellular organisms which they penetrate. Viruses are not cells but are parts of cells that have the ability to live independently. Viruses are very small. They range in particle size from about 10 to 300 nanometers. Although the majority of viruses are much smaller than bacteria (usual size is 1000 nm), a few bacteria are as small as the largest viruses. Viruses have a pathogenic effect an man causing minor to severe illness or death. 1. Dermotropic (skin) Diseases a. Smallpox - Variola is the typical name for this severe infectious disease that creates pustular lesions on the face, forearms, wrists, and hands. b. Measles (a.k.a. rubeola) - This common childhood disease is transferred by way of droplet infection. c. German Measles - Also known as rubella, this form of measles produces a mild fever and a rash. It is sometimes known as "3 day measles." d. Chickenpox - The same chickenpox virus is responsible for "shingles" in adults and "varicella zoster" in children. Both disease types cause the formation of skin lesions on the host. e. Herpes Simplex I - Creates cold sores on the skin of the host. f. Herpes Simplex II is also known as genital herpes. 2. Pneumotropic (upper respiratory tract) Diseases a. Influenza b. Common Cold c. Hantavirus 3. Neurotropic (central nervous system) Diseases a. Rabies - Rabies is transferred to man from an animal bite. Rabies is characterized by severe acute encephalitis. b. Poliomyelitis - Polio damages motor nerve pathways resulting in paralysis of voluntary muscles. Sometimes respiratory muscle are affected. c. Viral Encephalitis - This disease is characterized by the inflammation of the brain. 4. Viscerotropic (visceral) Diseases a. Hepatitis A (infectious) - Hepatitis A is transferred to susceptible individuals by way of contaminated food or water. (e.g., when infected food handlers to do not

properly wash their hands) Hepatitis A has a short incubation period and can result in liver problems and jaundice if left untreated. b. Hepatitis B (serum) - Hepatitis B is transferred by way of infected blood serum. This disease can be chronic and may lead to cirrhosis of the liver. c. Hepatitis C (non A, non B) d. Infectious Mononucleosis - Infectious mononucleosis is caused by the Epstein-Barr virus and can cause fatigue, chills, and anorexia in the host. (a.k.a. "kissing disease") e. Cytomegalovirus - Cytomegalovirus affects salivary glands and may cause congenital infections in a newborn's lungs, liver, and brain. This type of herpes virus may cause mental retardation in the infant as well. f. Epidemic Parotitis - Epidemic parotitis is also known as the mumps and may result in the swelling of the parotid glands. The primary mode of transmission is via contaminated saliva. 5. Immunological a. HIV is responsible for acquired immune deficiency syndrome.

F. FUNGI
Fungi are more complex and higher in evolutionary development than bacteria. They are eucaryotic, meaning they are plants with a true nuclei. Molds, yeasts, mildews, rusts, smuts, and puffballs are common types of fungi. Fungi characteristically enter the body through the respiratory tract and invade the lungs or other internal parts of the body causing disease. These diseases are sometimes referred to as deep of systemic mycoses. Other fungal disease are considered "contact diseases" due to the fact that the susceptible individual will directly come in contact with fungi on the skin surface 1. Microsporum sp. - Microsporum is responsible for a condition known as dermatomycosis. This skin disorder, also known as ringworm, may also be caused by trychophyton sp.,epidermophyton sp., and dermatomycosis. (these also cause "athletes foot") 2. Coccidioides Immitis - Coccidioides immitis is responsible for a disease known as coccidioidomycosis. This non-contagious disease can be fatal. Mild cases result in skin lesions, but some may progress to the lungs creating a condition similar to tuberculosis. In fatal cases, the organism spreads throughout the bloodstream causing generalized infections of the organs. This condition may be more common among vineyard workers who inhale dried fungal spores. 3. Histoplasma Capsulatum - Histoplasma capsulatum causes histoplasmosis which is a disorder of the pulmonary system. Lesions of the lung are similar to those found in tuberculosis. Ulcerations of the oral cavity and throat are common. Those that become infected usually inhale spores originating in soil contaminated with the feces of chickens, birds and bats.

4. Candida Albicans - Candida albicans is responsible for a disorder known as candidiasis or moniliasis.

5. Cryptococcus Neoformans - Cryptococcus neoformans is responsible for a disease known as cryptococcosis. This disorder may involve only the lungs and skin, but it can be fatal if the organism spreads throughout the system by way of the bloodstream. Often, the brain and meninges can be affected in later stages. 6. Aspergillus sp. - Aspergillosis is a disorder caused by aspergillus sp. 7. Pneumocystis Carinii - is responsible for a disorder known as PCP

G. PROTOZOA
Protozoa are microscopic, single-celled animals. 1. Entamoeba Histolytica - Entamoeba histolytica is responsible for a disorder known as amoebiasis or amoebic dysentery. This is an intestinal disorder that results from ingesting contaminated food or drink. 2. Plasmodium Malariae - Plasmodium malariae is the causative agent of malaria. The anopheles mosquito becomes a vector as she ingests a blood meal from an infected human. The organism is later spread to other humans as the infected mosquito seeks a blood meal from another host. Chills followed by sweating are common symptoms of this disease. 3. Toxoplasma Gondii - Toxoplasma gondii is responsible for a disorder known as toxoplasmosis.

H. PRION
A small proteinaceous infectious particle that is resistant to most procedures that modify nucleic acids. 1. Creutzfeldt - Jakob - A rare disease, Creutzfeldt - Jakob causes dementia. Death may result with 8 to 10 months.

I. BE CERTAIN TO REVIEW OSHA’S BLOODBORNE PATHOGEN RULE!