Modulus Infection - 2019 - Description

Study Programme in Medicine
SUB MODULE
INFECTION
Third course
Sixth semester
Faculty of Medicine
Lithuanian University of Health Sciences
1. General information
Supervisor of the sub module: prof. Alvydas Pavilonis, Department of Microbiology

(alvydas.pavilonis@kmu.lt), 32 73 65
Coordinator of the sub module: Assoc. Prof. Rita Plančiūnienė, Department of Microbiology
(ritaplanc@mail.lt)
Divisions:
1. Department of Microbiology
2. Clinic of Pathological Anatomy
3. Department of Infectious Diseases
4. Clinic of Laboratory Medicine
5. Department of Theoretical and Clinical Pharmacology
6. Department of General Surgery
Subjects:
1. Microbiology
2. Infectious Diseases
3. Pathological Anatomy
4. Clinical Laboratory Diagnostic
5. Pharmacology
6. General Surgery
2. General thematic contents of the sub module
While preparing, analysing and solving presented problems in the Infection module, students obtain
new theoretical knowledge, practical skills and apply into the following domains:
 Normal microbial flora and its role in physiological and pathological processes; dysbacteriosis;
 Opportunistic microorganisms and their pathogenicity factors. Opportunistic infections.
 Specific and non-specific (immune) defences, skin and mucous protective defence and the
factors of their disturbance and suppression ;
 Hospital (acquired) infections and their clinical forms;
 Hospital resistant bacterial strains and multidrug resistance;
2
 Tests in clinical microbiology: microscopic, bacteriological, immunological. Specimen collec-
tion, transport and processing;
 Chemoterapeutic drugs for the treatment of infectious diseases, modern antiseptics and disin-
fectants, their mechanisms of action and pharmacological properties;
 The priniciples of rational chemotherapy, antibacterial and their mechanisms of action, side ef-
fects of antibioticotherapy;
 Antibiogramm and antibiotic susceptibility testing methods, MIC – Minimum Inhibitory Con-
centration;
 Specific and non-specific prophylaxis of hospital infections;
3. Aim and objectives of the module
The aim – to cover the theoretical and practical aspects of clinical microbiology. By the end of this
modulus students should be able to determine, analyse and connect the phenomenon discussed
during the modulus.
When reaching the target students have to obtain the knowledge in:
 the normal human microbial microflora and its role in in physiological and pathological pro-
cesses;
 opportunistic microorganisms: their ecology and the factors influencing spread and
pathogenicity of infection;
 hospital (acquired) infection and the factors impacting on the problem of antibiotic
resistance, the personal hygiene in patients;
and to be able:
 to choose the tests in clinical microbiology and successful usage of these tests in clinical
laboratory practice;
 to understand antimicrobial resistant microorganisms, the occurrence and mechanisms of

antimicrobial strains, antibiogram- its evaluation, the principles of rational chemotherapy, important
characteristics of an antibacterial -its pharmacokinetic properties and a mode of action;
 to understand etiology and pathogenesis of systemic infections and its clinical appearance,
the most common pathway of pathogenic spread;
 to understand specific and Non-specific (immune) defence mechanisms.
3
 to choose an appropriate groups of chemotherapeutical agents for the treatment of infectious
diseases caused by bacteria, fungi, viruses, protozoa and helminths, also to recognize the
representatives of these groups;
 to understand pharmacokinetic and pharmacodynamic processes of chemotherapeutical
agents and be able to relate the mechanism of action and pharmacological properties of drug
to the induced changes in pathogen and human organism and clinical use;
 to understand the origins of adverse effects of drugs, be able to classify it according the hu-
man organ systems, also to understand main contraindications.
4. Tutorials
4.1. First problem. Bacteria and fungi - respiratory tract infection agents.
The patient was a 31-year-old-male who presented with a 1 month history of a dry continuous
coughing, a tight feeling in his chest and a sharp chest pain, especially by breathing. Over a year
ago this patient has been released from prison and normally has a large intake of alcohol daily.
On physical examination, he was noted to be weak and fatigue. A chest X-ray film showed
interstitial pneumonia. The laboratory findings were significant for a white blood cells (WBC)
count of 12 x 109/l; Erythrocyte Sedimentation Rate (ESR) is 28mm/h; C - reactive protein (CRP) –
52 mg/l (2.9 mmol/L), lymphocytes – 3.5 x 109/l. Based on these findings, an appropriate
antimicrobial treatment was administered by his family doctor.
After 1 week of treatment, despite appropriate antimicrobial agents, the patient was admitted to
hospital’s intensive care unit (ICU) with progressive shortness of breath and rapidly progressive
respiratory failure. Artificial ventilation of the lungs and urinary catheterization was begun
immediately. Two days later he developed a productive cough, fever of 38,5 0C and chills. A chest
X-Ray test showed bilateral bronchopneumonia.
Questions:
 Is there enough data to make a valid conclusion about the primary disease?
 What additional tests are required to clarify the primary disease?
 What tests are required to determine the reason of chills in a patient?
 What are the microorganisms that could cause a Lower Respiratory Tract Infection in
this patient?
 What test samples should be taken in order to detect the nosocomial pathogen, and
how should the samples be taken?
4
 What microbiological test should be done to detect probable primary and secondary
nosocomial pathogens?
 Indicate the main groups of antibacterial agents and drugs that belong to these groups
and could be used for the treatment of bronchopneumonia and other respiratory tract
infections, including pulmonary tuberculosis.
 Explain pharmacokinetic and pharmacodynamic properties of drugs what could be
used in this clinical case, discuss the mechanism of action and adverse effects, indicate
the main contraindications and interpret the possible reasons and mechanism of
microbial resistance to chemotherapeutical agents.
Essence of the problem: Lower Respiratory Tract Infections;

Clinical signs and symptoms: coughing, chest pain, fatigue, etc.
The Aim:
Knowledge of the normal microbial flora in the respiratory tract, the pathogenic and opportun-
istic microorganisms involved into the Respiratory Tract Infections (LRTI) and their resistant
strains; bacterial respiratory infections, their etiology, pathogenesis, common features of mor-
phology, complications and causes of death; the pharmacological properties of chemotherapeut-
ical agents used in this clinical situation and understand the pathogen resistance to medications
Learning objectives and contents:

After solving this problem students must know:
 Predominant microorganisms in Respiratory Tract Infections (Streptococcus pneumo-
niae, Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydia pneumonia, Le-
gionella pneumophila, Corynebacterium, Bordetella, Pseudomonas, Mycobacterium
tuberculosis, and Fungi) and their pathogenicity factors.
Subject- Microbiology
Division-Department of Microbiology
Reading Assignment:
1. Mims C, Dockrell H, Roitt I, Goering R, Roitt I, Wakelin D, Zuckerman M. Medical
microbiology. Third edition. Mosby. 2004. p. 217-240.
2. Murray PR, Rosenthal KS, Pfaller MA. Medical Microbiology. Fifth edition. Mosby. 2005. p.
252-257; 297-310; 367-374; 391-396; 443-447; 533-541; 597-617.
 To learn the most common bacterial infections morphogenesis, morphological expressions and
characteristics, complications and causes of death.
Subject- Pathological anatomy
5
Division – Clinic of pathological anatomy
Reading Assignment :
 Predominant microorganisms in hospital-acquired Lower Respiratory Tract Infections (Pseudo-
monas spp., Acinetobacter spp., Klebsiella spp.) and the risk factors for hospital - acquired in-
fections
Reading Assignment:
1. Mims C, Dockrell H, Roitt I, Goering R, Roitt I, Wakelin D, Zuckerman M. Medical microbi-
ology. Third edition. Mosby. 2004. p. 546-566.
 Microbiological diagnosis methods of community aqcuired pneumoniae, caused by S. pneu-
moniae, H. influenzae, M. pneumoniae, C. pneumoniae, Legionella pneumophila, M.tuber-
culosis and requirements for sample procurement in laboratory diagnostics.
 Infections caused by Moraxella catarrhalis (Gram negative coccus). Requirements for sam-
ple procurement and evaluation of antimicrobial susceptibility testing.
 Nosocomial infections, caused by P. aeruginosa, K. pneumoniae, Acinetobacter spp. Re-
quirements for sample procurement and evaluation of antimicrobial susceptibility testing.
 To analyze clinical situations. To evaluate test cultures from lower respiratory tract samples
and antimicrobial susceptibility results of isolated pathogens. To understand the importance
of microbiological diagnosis in selection of rational antimicrobial therapy.
Subject - Clinical laboratory diagnosis
Division - Laboratory medicine clinic
Reading assignment:
1. Mandell, Gerald L, Bennett, John E., , Dolin, Raphael, Mandell, Douglas, and Bennett's
principles and practice of infectious diseases / Churchill Livingstone/Elsevier/ (pp. 818-828,
831-836) (pp. 2321-2348, 2362-2375).
Additional literature:
1. Vitkauskienė, Astra., Skrodenienė, Erika, , Pavilonis, Alvydas, Laboratorinė tuberkuliozės
diagnostika : mokymo priemonė / Kauno medicinos universiteto leidykla/.
 To be able to apply the appropriate chemotherapeutical agents, understand their phramaco-
dynamic and pharmacokinetic properties, relate them to the mechanism of action and ad-
verse effects and contraindications, explain the reasons and mechanisms of microbial resist-
ance to medication.
Subject – pharamacology
Division – Institute of physiology and pharmacology
6
Reading Assignment:
1. Katzung BG. Basic & Clinical Pharmacology. International edition. McGrawHill Lange, 2009.
2. Finkel R, Cubeddu LX, Clark MA, RD, Harvey RA, Champe PC. Pharmacology. 4 rd edition.
Lippincott‘s Illustrated Reviews. Lippincott Williams&Wilkins, 2009.
4.2. Second Problem. Soft tissue infection. Gram-positive and gram-negative

cocci.
85 year old woman with a second type of diabetes was hospitalized because of generalized atopic
dermatitis. Woman was treated with prednisolone for one week. When his health improved patient
released into the house. A week later, a woman felt weak, painful derivatives appeared in armpits.
After two days, she was brought to the emergency department with a fever 38- 38.5 ° C. A physical
examination axillary revealed multiple painful subcutaneous derivatives. The laboratory findings
were significant for WBC - 12 x 109/l and CRP- 110 mg/l. After opening of furuncles under aseptic
conditions the material was taken and sent to the laboratory for bacteriological examination.
Microscopic examination defined gram-positive cocci. The infection agent was isolated and
identified. Based on these findings, an appropriate antimicrobial treatment was administered. Two
days later the patient again developed a fever of 38,5 0C and chills. From the patient blood were
isolated gram-positive cocci as the first time and the treatment strategy was adjusted.
Questions:
 What is the most likely diagnosis of this patient?
 What is the surgical treatment strategy?
 What additional tests are required to clarify the diagnosis of nosocomial infection?
 What are the possible reasons for the re-fever and chills?
 What preliminary susceptibility testing should be done?
 List requirements for sample procurement; describe antimicrobial susceptibility
testing steps and evaluation of results.
and could be used for the treatment of soft tissue infections.
 Explain pharmacokinetic and pharmacodynamic properties of drugs what could be
used in this clinical case, discuss the mechanism of action and adverse effects, indicate
the main contraindications and interpret the possible reasons and mechanism of
microbial resistance to chemotherapeutical agents.
7
Essence of the problem: Skin and soft tissue infections;
Clinical signs and symptoms: fever, furuncles etc.
The Aim:
Knowledge of the microorganisms involved into the skin and soft tissue infections- their mi-
crobiological properties, pathogenicity factors, laboratory diagnosis, and surgical treatment strategy.
To know pharmacological properties of chemotherapeutical agents used to treat these infectious dis-
eases and understand a phenomenon of microbial resistance to medication.
 Gram-positive cocci that cause skin and soft tissue infections (S. aureus, Streptococcus
spp.,) – their pathogenicity factors, pathogenesis of the disease.
Reading Assignment:
1. Mims C, Dockrell H, Roitt I, Goering R, Roitt I, Wakelin D, Zuckerman M. Medical microbio -
logy. Third edition. Mosby. 2004. p. 350-357.
 Enterococci and coagulase-negative staphylococci, their pathogenicity factors, pathogenesis
of the disease.
Reading Assignment:
1. Murray PR, Rosenthal KS, Pfaller MA. Medical Microbiology. Fifth edition. Mosby. 2005.
p.202-240.
 Definition and classification of surgical infection. Classification of bacterial surgical infec-
tion. Surgical Site Infection (Superficial SSI, Deep SSI, Organ/space SSI). Development of
surgical infection. Local and general signs of surgical infection. Diagnostics methods (clin-
ical findings, laboratory, imaging studies, endoscopic and surgical methods). Principles of
conservative and surgical management of surgical infection. Principles of antibacterial ther-
apy.
Subject- General surgery
Division- Clinic of General Surgery
Reading Assignment:
1.Clinical Surgery. Second edition. Edited by Michael M. Henry, Jeremy N. Thompson. 2007, 115-
124p.
8
• Infections caused by Gram positive cocci (S. aureus, S. pyogenes, S. agalactiae, Enterococ-
cus spp.). Requirements for sample procurement, antimicrobial susceptibility testing and
evaluation of antimicrobial susceptibility testing.
Reading assignment:
2362-2375).
 To be able to apply the appropriate chemotherapeutical agents, understand their pharmaco-
verse effects and contraindications, explain the reasons and mechanism of microbial resist-
ance to medication.
Subject – pharmacology
Reading Assignment:
4.3. Third problem. Urinary Tract Infection
A 32-year-old woman visited a family practice clinic with 1- week history of continuous fever of
37.0 – 37.5 0C, lower abdominal pain and frequent urination. She claimed to use medication for the
“common cold”. She had noted that her urine became turbulent and turned red. The female
remembered that 1.5 weeks ago she was also suffering from cold. She had been sexually active and
admitted to unprotected sex with a new partner 2 month ago.
On examination, the female was pale and she felt the pain on palpation of the kidney; no edema
noted. A urinalysis (UA) showed pyuria, hematuria, and bacteriuria. Gram negative rods (>105
CFU/mL of urine) grew from the urine. Ultrasound scanning of kidney (renal echoscopy) detected
asymmetric lesions in the renal pelvis and calyx areas.
Questions:
9
 What additional tests are required to identify the Sexually Transmitted Diseases
(STD)?
 What are the microorganisms that might be involved into the Urinary Tract Infections
(UTI) in this case?
 What laboratory diagnosis methods can be used to detect the pathogen?
 What antimicrobials should be tested for Gram negative rods in UTI?
and could be used for the treatment of urinary and sexually transmitted diseases
according to differential diagnosis (lower urinary tract, upper urinary tract, and
genital tract diseases).
 Explain the mechanism of action, mode of antibacterial and antifungal action and
pharmacokinetic properties of the drugs that could be used in this clinical case,
discuss the adverse effects, indicate the main contraindications and interpret the
possible reasons and mechanism of microbial resistance to chemotherapeutic agents.
 Could “common cold“ medicines exhibit adverse effect on kidney function?
 Treatment of which STD may cause Jarisch-Herxheimer syndrome and what are the
symptoms of this syndrome? Which group of antibacterial drugs may cause this
syndrome? Why?
 Which group of antibacterial drugs should not be administered to pregnant women
with UTI? Why?
Essence of the problem: Pathogenic and opportunistic microooganisms associated with Urinary
Tract Infections (UTI) and Sexually Transmitted Diseases (STD)
Clinical signs and symptoms: frequent urination, lower abdominal pain, chills, changes in urine
color and consistency.
The Aim:
Knowledge of the normal microbial flora in the urinary tract, the microorganisms involved
into the UTI and STD and their pathogenicity factors, laboratory diagnosis and prophylaxis; to ap-
ply the appropriate chemotherapeutical agents, to know their pharmacological properties and a phe-
nomenon of microbial resistance to medication.

 Normal microbial flora, pathogenic microorganisms that cause UTI (E. coli, S. saprophyti-
cus, Proteus spp. Klebsiella spp., Enterobacter spp., P.aeruginosa, Candida spp.) - their
major factors of pathogenicity.
10
Reading Assignment:
221-236; 259-263; 335-338; 357-363; 779-787.
 Pathogenic microorganisms that cause STD (T. pallidum, N. gonorrhoeae, C. trachomatis,
T. vaginalis, HIV, HPV) – their major pathogenicity factors
Reading Assignment:
1. Mims C, Dockrell H, Roitt I, Goering R, Roitt I, Wakelin D, Zuckerman M. Medical microbio -
logy. Third edition. Mosby. 2004. p. 241-276.
311-316; 427-433; 463-472; 523-532; 541-550; 657-671.
 The microorganisms that might be involved into the Urinary Tract Infections. Requirements
for sample procurement, antimicrobial susceptibility testing and evaluation of antimicrobial
susceptibility testing.
 Laboratory diagnosis of microorganisms that cause Sexually Transmitted Diseases (STD).
Reading assignment:
principles and practice of infectious diseases / Churchill Livingstone/Elsevier/ (875-893 psl.)
 To be able to apply the appropriate chemotherapeutical agents, understand their pharmaco-
ance to medication.
Reading Assignment:
11
Additional reading:
1. Goodman and Gilman’s. The Pharmacological Basis of Therapeutics.12 th edition. Mc GrawHill,
2011.
4.4. Fourth problem. Gastrointestinal Tract Infection.
A 6-year-old boy with 1-day history of chills, fever, nausea, diarrhoea and pain in the right lower
quadrant of the abdomen sided was admitted to surgery unit with diagnosis of acute appendicitis.
Parents told that the younger sister was presented to infectious diseases clinic with diarrhoea and
vomiting two days ago. He had subicterus and was suspected for hepatitis.
On physical examination the boy had a temperature of 39°C; the tongue was with white coating,
hyperaemic eyes, bloated and painful abdomen, and palpable mesenteric lymph nodes.
After abdominal ultrasound examination was determined increases in mesenteric lymph nodes. The
complete blood analysis revealed 14x109 /l white blood cells, 60% neutrophils, CRP was 160 mg / l.
Stool culture allowed to identify the infection agent. Based on the lab data the treatment was given.
After treatment with sulfamethoxazole/trimethoprim CRP decreased to 70 mg/l.
Questions:
 What microorganisms are likely causing the disease in this patient?
 Describe the epidemiology and pathogenesis of these organisms?
 What laboratory tests can be performed to confirm the clinical diagnosis?
 Explain the mechanism of action, mode of antibacterial action and pharmacokinetic
properties of the sulphonamides and other drugs which could be used in this clinical case,
discuss the adverse effects, indicate the main contraindications and interpret the possible
reasons and mechanism of microbial resistance to chemotherapeutic agents.
 In which situations antimicrobial treatment should be administered to children with
gastrointestinal tract infection?
 Which groups of antibacterial drugs, recommended for use in this clinical case, could cause
toxic effect on haematopoiesis? Why?
Essence of the problem: etiopathogenesis of the gastrointestinal tract infections.
Clinical signs: fever, diarrhoea, vomiting, abdominal pain.
Aim: to explore etiopathogenesis of gastrointestinal tract infections(GITI), to learn possible infec-
tious agents and principles of laboratory diagnosis, to apply the appropriate chemotherapeutical
12
agents for the treatment of these infectious diseases, to know pharmacological properties of the
drugs and mechanisms of pathogen resistance to medication.
 Bacteria that cause gastrointestinal tract infections (Escherichia coli, Salmonella spp.,
Campylobacter spp., Vibrio cholerae, Shigella spp., Yersinia enetrocolitica, Clostridium
difficile), their virulence factors, epidemiology, pathogenesis, laboratory diagnosis,
prevention and control.
Subject – Microbiology
Division - Department of Microbiology
References:
1.Mims C, Dockrell H, Roitt I, Goering R, Roitt I, Wakelin D, Zuckerman M. Medical
2.Murray PR, Rosenthal KS, Pfaller MA. Medical Microbiology. Fifth edition. Mosby. 2005.p.
323-335; 339-351; 411-413.
 Viruses that cause gastrointestinal tract infections (enteroviruses, noraviruses, adenoviruses,
rotaviruses), their etiopathogenesis, principles of laboratory diagnosis.
References:
1. Mims C, Dockrell H, Roitt I, Goering R, Roitt I, Wakelin D, Zuckerman M. Medical micro-
biology. Third edition. Mosby. 2004, p.277 - 312.
2. Murray PR, Rosenthal KS, Pfaller MA. Medical Microbiology. Fifth edition. Mosby. 2005.
p.533-541; 579-596.
• microorganisms that cause systemic GITI (Salmonella typhi, Salmonella paratyphi, Listeria
monocytogenes, hepatitis viruses), principles of laboratory diagnosis.
Reading Assignment:
1. Murray PR., Rosenthal KS., Kobayashi GS., Pfeller MA.: Medical Microbiology (fourth
edition), 2002, p. 217-219, 232-239, 523-535.
2. Mims C, Dockrell H, Roitt I, Goering R, Roitt I, Wakelin D, Zuckerman M. Medical micro-
biology. Third edition. Mosby. 2004, p.277 - 312.
• food-borne infections (Staphylococcus aureus, Clostridium botulinum), principles of
laboratory diagnosis
13
Reading Assignment:
1. Mims C, Dockrell H, Roitt I, Goering R, Roitt I, Wakelin D, Zuckerman M. Medical mi-
crobiology. Third edition. Mosby. 2004, p.277 - 312.
ance to medication.
Reading Assignment:
Additional reading:
2011.
4.5. Fifth problem. Central Nervous System Infection.
A 4-year-old child J. K. was brought to the Emergency Department with abrupt headache, vomiting
and fever. His temperature was 39,5º C. The child attended playgroup. On February, two weeks
ago, for many children in playgroup were diagnosed with nasopharyngitis.
Physical examination of the child revealed that he was disoriented, had neck stiffness, low level of
tendon reflexes, and photophobia. The face of patient was hyperaemic, the lips and tongue dry. He
had small, petechial skin lesions in the buttock area. Blood examination revealed leucocytosis of
neutrophils, and an increase in ESR and CRP – 85 mg/l. A lumbar puncture was done. The opening
pressure was increased. The CSF specimen was cloudy. Analysis of CSF revealed WBC count 20
×109cells /l with 93% polymorphonuclear leukocytes, and a protein level 8 g/l. Microscopic
examination of CSF and rapid diagnostic test gave positive results. Bacteriological examination
allowed to identifying the infection agent. Based on the laboratory data the treatment was given.
Questions:
 What is the most likely diagnosis of this disease?
14
 Which tests can be performed to confirm the clinical diagnosis?
 What microorganisms can cause infection of the CNS?
 What is the course of this infection and way of prevention?
and could be used for the treatment of bacterial CNS infections, depending of their
ability to penetrate through hematoencephalic barrier (conditions that could improve
the penetration).
 Explain the mechanism of action, mode of antibacterial action and pharmacokinetic
properties, discuss the adverse effects, indicate the main contraindications and interpret
the possible reasons and mechanism of microbial resistance to chemotherapeutic agents.
 What kind of treatment strategy and tactics should be considered when treating child
with bacterial CNS infection?
Essence of the problem: etiopathogenesis of infections of the central nervous system (CNS).
Clinical signs: fever, headache, vomiting, and neck stiffness.
Aim: to investigate etiopathogenesis of CNS infections, to study possible infectious agents, prin-
ciples of the laboratory diagnosis and prophylaxis; to apply the appropriate chemotherapeutical
agents for the treatment of these infectious diseases, to know pharmacological properties of drugs
and phenomenon of microbial resistance to medication.
• Bacteria that cause CNS infections (Streptococcus pneumoniae, Staphylococcus aureus,
Haemophilus influenzae, Neisseria meningitidis, Listeria monocytogenes, Mycobacterium
tuberculosis, Cryptococcus spp.), their virulence factors and pathogenesis of CNS infections.
Reading Assignment:
edition), 2005, p. 221-236; 252-257; 273-278; 297-310; 316-320; 367-374.
• Laboratory diagnosis methods of bacterial meningitis and encephalitis. Requirements for
sample procurement and evaluation of test results.
15
Reading assignment:
1101-1102).
• Pathogenesis of Clostridium tetani ir Clostridium botulinum infections
Reading Assignment:
1. Murray PR., Rosenthal KS., Kobayashi GS., Pfeller MA.: Medical Microbiology (fifth
edition), 2002, p. 299-304.
ance to medication.
Reading Assignment:
Additional reading:
2011.
4.6. Sixth problem. Multisystem viral infection.
Four-year old boy with fever (temperature 40.3 ºC) has been admitted to the Emergency
Department. The child had a cough for nearly two weeks. One week ago a doctor of family
medicine had diagnosed chronic bronchitis and prescribed treatment. The boy has been treated with
amoxicillin for 5 days, but suddenly his temperature has risen, a boy had headaches and sore throat.
During check-up doctor noticed redness of the eye sclera, swollen eyelids, throat and dental arch
red, tonsils with purulent plaque, neck and mandibular lymph nodes swollen. No skin rash has been
detected, but liver edge was palpable Complete blood count: hemoglobin - 123 g/l, erythrocytes-
16
4,35x1012 /l, thrombocytes - 318x109/l, leukocytes - 12,9x109/l, neutrophils - 7,9x109/l, lymphocytes
- 2,6x109/l, monocytes - 2,3x109/l, CRP - 6,9 mg/l. Ultrasonography of abdominal organs showed
enlarged liver and spleen. Infectious mononucleosis was suspected, therefore cytological
examination of blood was performed. Slight leukocytosis and 19% monocytosis has been
determined and no atypical mononuclear cells found. No pathogens were found during bacteriologic
analysis of the tonsil litter. After prescribing antipyretics and two days of treatment with penicillin,
condition of the patient has improved: no fever or rash has been noticed but tonsils were still red
and swollen.
Questions:
 What might be the cases of viral infections when monocytosis and atypical mononuclear
cells in blood are detected?
 What additional tests should be performed to determine the final diagnosis of the patient?
 What microorganism is likely causing illness in this patient?
 What might be sources and ways of infection?
 What is prognosis? What kind of complications might be?
 What treatment strategy and tactic should be applied? Why?
 Why child’s condition did not improve while taking amoxicillin?
 Explain the mechanism and mode of action of β-lactam antibiotics, relate them with their
pharmacokinetic and pharmacodynamic properties, discuss the adverse effects and
contraindications and interpret the possible reasons and mechanism of microbial resistance
to chemotherapeutical agents.
 Explain the principle of action of immunoglobulin and interferon, and their importance for
the treatment of viral diseases.
Essence of the problem: multisystem viral infections.
Clinical sings: fever, swollen lymph nodes, tonsillitis, and conjunctivitis.
Aim: to know viruses those injury different organ systems of human organism during infection,
their epidemiology, diseases caused by them, complications, also to know chemotherapeutical
agents used to manage these clinical situation, their pharmacological properties and mechanism of
pathogen resistance to medication.
17
• The microorganisms that cause infections of many organs (Rubella virusas, Morbilivirus,
Paramyxovirus, Herpesviridae, Adenovirus ir Parvovirus), their pathogenesis and ways of in-
fection.
Reading Assignment:
1. Murray PR., Rosenthal KS., Kobayashi GS., Pfeller MA.: Medical Microbiology (fifth
edition), 2005. p 467-499, 405-590; 597 –608.
microbiology. Third edition. Mosby. 2004.
3. Mims C, Dimmork N, Nash A, Stephen J. Pathogenesis of Infectious Diseases. Fourth
Edition. Academic Press. 1995. p. 106-134.
• Viruses – infection agents of upper respiratory tract and other organs (Picornaviridae,
Herpesviridae ir Ortomyxoviridae), their pathogenesis and ways of infection.
Reading Assignment:
edition), 2005. p 541-565, 579-590, 597 –608.
microbiology. Third edition. Mosby. 2004. p. 202-210, 343-345.
Additional reading:
1.Strauss JH, Straus EG. Viruses and human disease. Academic Press. 2002. p. 58-71; 132-
144, 223-252.
 To know laboratory diagnosis methods of systemic viral infections (Herpes simplex, Cy-
tomegalovirus, Respiratory syncytial virus), requirements for sample procurement and eval-
uation of test results. To be able to explain the sequence of virological tests and expected re-
sults.
Reading assignment:
principles and practice of infectious diseases / Churchill Livingstone/Elsevier/ (pp. 1787-1789).
The regularities of morphogenesis, peculiarities of morphological background, complications and
causes of death of the mostly frequent viral infections.
18
Subject – pathological anatomy
Reading Assignment:
1. Pathologic Basis of Disease/Eds I.L. Robbins, R.S. Cotran. 7 th edition, 2005, p. 879-887,
890-901.
 To be able to apply the appropriate chemotherapeutical agents, understand their
phramacodynamic and pharmacokinetic properties, relate them to the mechanism of action
and adverse effects and contraindications, explain the reasons and mechanism of microbial
resistance to medication.
Reading Assignment:
Additional reading:
2011.
5. Lectures
5.1. Permanent (autochtonous) and transient (allochtonous) microflora of the
human body (1 h). Fungi: their microbiological characteristics and infections
caused by them (1 h.)
Division – Department of Microbiology

In Charge – assoc. prof. D. Janulaitytė-Gunther
Description
The Normal Microbial Flora (NMF): Permanent (autochthonous) and Transient (allochthonous) and
its role in physiological and pathological processes; The development of NMF during the age; The
establishment of NMF in the human body (colonization) and its role in the ethiopathogenesis of
infections; Natural mechanisms on mucosal surfaces and skin that safeguard natural microflora;
NMF of the skin, mouth, intestinal tract, genitourinary tract and respiratory tract; NMF - secondary
and opportunistic pathogens; Dysbiosis; Probiotics; Prebiotics.
Fungi: Yeasts Candida albicans, Candida (Torulopsis) glabrata, Saccharomyces cerevisiae,
Cryptococcus neoforman); Molds: Aspergillus fumigates, Aspergillus flavus, Aspergillus clavatus;
19
Dimorphic: Blastomyces dermatitidis, Blastomyces brasiliensis, Pneumocystis jirovecii.
Classification of fungi; Epidemiology of fungi; Pathogenicity factors of fungi; Immunity; Mycosis
and mycotoxicosis; Laboratory diagnosis of fungi.
5.2. Infection, Infectious process, Infectious disease and the peculiarities of Viral
Infections (2h)
In Charge – assoc. prof. D. Janulaitytė-Gunther
Description
Host-Microbial relationship Factors influencing development of infectious process. Susceptible and
non-susceptible macroorganism to the microorganisms. Peculiarities of the infectious diseases (ID).
The modes of transmission of the microorganisms. Development and the periods of infectious
process. The peculiarities of viral infections. Mechanisms of viral pathogenesis. Primary and
secondary infections, superinfections, reinfections, recurrent and persistent infections. Microbial
mechanisms of pathogenicity: adhesion, colonization, invasion, toxigenicity, intracellular
parasitism.
5.3. Gram-positive and Gram-negative cocci, the most important genera and
species, infections caused by them (2 h.)
In Charge – assoc. prof. R. Plančiunienė
Description
Staphylococcus genus. S.aureus, S.epidermidis, S.saprophyticus, their differential marks, ecology,
ways of spreading. Staphylococci – normal flora of human organism. S. aureus distribution in com-
munity and colonization rate of medical personnel. Suppurative - pyogenic infections, systemic and
toxin-mediated diseases of staphylococci. Virulence factors of staphylococci: adherence, coloniza-
tion and invasion factors, enzymes, toxins (exfoliative toxins, enterotoxins, toxic shock syndrome
toxin and cytotoxins). Antibiotic resistance of staphylococci. Methicillin-resistant S. aureus
( MRSA) strains, their spread in hospitals and community. Vancomycin resistant S. aureus (VRSA)
strains. Resistance mechanisms determinate by chromosomal genes and plasmid. Laboratory dia-
gnosis of staphylococcal infections and intoxications. Treatment, prevention, and control of staphyl-
ococcal infections.
Streptococcaceae family. Streptococcus genus classification, the most important groups and species,
their ecology, ways of spreading. A, B, D, C, G and F groups of streptococci. Beta-hemolytic and
20
alpha-hemolytic (“green”) streptococci. Suppurative -pyogenic streptococcal infections and nonsup-
purative diseases, associated with immunopathological mechanisms (rheumatic fever and acute
glomerulonephritis). The role of streptococci in etiology of scarlet fever. Virulence factors of strep-
tococci: adherence, colonization and invasion factors, enzymes, toxins, heterogenic and super anti-
gens of streptococci. Viridans streptococci associated endocarditis.
Streptococcus pneumoniae, serotypes, ecology, ways of spreading, virulence factors. S.pneumoniae
infections: pneumonia, sinusitis, otitis media, meningitis. Immunoprophylaxis by polyvalent con-
jugated vaccine.
Enterococcus genus: species, infections, ways of spreading and transmission. The role of entero-
cocci in etiology and pathogenesis of infections: septicemia, endocarditis, urinary tract and wound
infections. Virulence factors and antibiotic resistance of enterococci. Laboratory diagnosis of strep-
tococcal and enterococcal infections.
Neisseria spp.: species, their spreading, ways of transmission, diseases caused by them, the role in
infectious pathology, virulence factors. Antibiotic resistance. Laboratory diagnosis of infections.
5.4. Enterobacteriaceae family (2 h.)

Description
Gram-negative bacteria. The most important genera and species. Primary pathogens (some
serogroups of Escherichia genus, Salmonella, Shigella ir Yersinia genera) and secondary oportun-
istic pathogens (Escherichia, Klebsiella, Enterobacter, Citrobacter, Proteus, Serratia genera). Vir-
ulence factors of enterobacteria: adherence, colonization and invasion factors, enzymes, toxins. En-
dotoxin-mediated toxicity. Suppurative – pyogenic infections of enterobacteria: wound infections,
septicemia, urinary and respiratory tracts infections, neonatal meningitis. Gastrointestinal tract in-
fections of enterobacteria: salmonellosis, shigellosis, E. coli associated gastroenteritis. Serogroups
of E. coli, that causes gastroenteritis (EPEC, ETEC, EHEC, EIEC, EAEC), serogroups and sero-
types of salmonella, species and serotypes of shigella.
Yersinia genus: Y.pseudotuberculosis, Y.pestis, Y.enterocolitica, their spreding (zoonotic infec-
tions), ways of transmition, virulence factors and infections caused by them. Laboratory diagnosis
of enterobacterial infections. Treatment, prevention, and control of enterobacterial infections.
5.5. Bacterial genera: Yersinia, Listeria, Francisella, Brucella and Bacillus (2 h.)
21
Description
Yersinia genus: Y.pseudotuberculosis, Y.pestis, Y.enterocolitica, their spreading (zoonotic infec-
tions), ways of transmition, virulence factors and infections caused by them.
Zoonotic infections agents: Listeria monocytogenes , Brucella spp., Francisella spp. and Bacillus
anthracis: properties, virulence factors, epidemiology, pathogenesis and clinical diseases.
Laboratory diagnosis of zoonotic infections. Treatment, prevention, and control.
5.6. Bacterial genera: Vibrio, Aeromonas, Campylobacter, Helicobacter.

Spirochetes (2 h.)
Description
Vibrionaceae family: Vibrio parahaemolyticus, Vibrio cholerae – infections agent of cholera, its
ecology, biotypes, serotypes, virulence factors. Aeromonas spp. and Plesiomonas spp. Laboratory
diagnosis, treatment, prevention. Campylobacter genus species, zoonotic reservoirs, ways of trans-
mission, infections caused by them. Laboratory diagnosis, treatment, prevention .Helicobacter
pylori – infection agent of gastritis, peptic ulcer, risk factor of gastric carcinoma. Spreading and vir-
ulence factors of H. pylori. Laboratory diagnosis, treatment, prevention. Medical important genera
of spirochetes, infections caused by them. Laborastory diagnosis, treatment, prevention.
5.7 Rickettsia : Anaplasma, Ehrlichia and Coxiella genera. Chlamydiaceae and

Mycoplasmataceae families (2 h.)
Description
Anaplasmų, Ehrlichia, Coxiella species: the most important biological properties, epidemiology,
transmission of infections. Chlamydia and Chlamydophila speacies, their ecology, ways of trans-
mission, intracellular parasitism. Infections of C. trachomatis ir C. pneumoniae, laboratory dia-
gnosis of them. Mycoplasma – prokaryotic cells without cell wall. The most important species, vir-
ulence factors, clinical diseases. Mycoplasma and Ureaplasma species – normal flora of respiratory
and genitourinary tract. Peculiarities of laboratory diagnosis.
22
5.8. Bacteria of Pseudomonadaceae and Pasteurellaceae families . Pathogenic
Mycobacteria, Corynebacteria, Bordetella (1h.).
Description
Pseudomonadaceae family genera: Pseudomonas, Burkholderia,. P.aeruginosa – the most common
species associated with human diseases. Their virulence factors, epidemiology, ways of transmis-
sion, infections. Hospital acquired infections and hospital strains. Resistance to antimicrobial
agents. Laboratory diagnosis and prevention.
Pasteurellaceae genera: Haemophilus, Pasteurella, Actinobacillus, their species.
H. influenzae biotypes and serotypes. Their epidemiology, ways of transmission, infections. Vir-
ulence factors of Haemophilus species. Laboratory diagnosis and prevention.
Pasteurella and A. actinomicetemcomitans.
Peculiarities of structure and chemical composition of mycobacteria. Infection agents of tubercu-
losis, leprosy, and nontuberculous mycobacteriosis. M. tuberculosis virulence factors. Epidemi-
ology of mycobacteria. Way of infection and laboratory diagnosis of mycobacteria. Antibiotic res-
istance and methods of determination. Atypical mycobacteria – opportunistic infection agents.
Treatment, prevention and control of tuberculosis. Tuberculin skin test and BCG vaccine, mechan-
ism of action.
Structure, biological properties, spreading, ways of transmission, virulence factors, and infections of
corynebacteria and bordetella. Laboratory diagnosis, peculiarity of treatment and prophylaxis.
5.9. Viruses: classification, structure. Retroviruses, Oncogenic viruses, Slow

viral infections, Prions (1h.).
Description
Classification of viruses. The most important families and species. Peculiarities of structure and re-
production of viruses. Retroviruses: classification, structure, reproduction. HIV epidemiology,
pathogenesis and immunity. HIV infections laboratory diagnosis. Oncogenic viruses. Mechanisms
of viral transformation and immortalization of cells. Slow viral infections and unconventional slow
viruses: prions. Epidemiology and diseases caused by them.
23
5.10. Orthomyxoviruses, Paramyxoviruss, Reoviruses, Rubiviruses,
Rhinoviruses, Adenoviruses, Coronaviruses, Herpesviruses (2 h.)
In charge- Assoc. prof. Daiva Janulaityte-Gunther
Description
Respiratory viruses: Rhinovirus, Parainfluenza, Coronavirus, Adenovirus, RSV, Influenza virus, herpesvir-
uses, etc.; Classification, structure, replication of respiratory viruses. Epidemiology and diseases caused
by them. Laboratory diagnosis of respiratory viral infections; Immunoprophylaxis.
5.11. Enteroviruses, Rotviruses, Caliciviruses, Hepatitis viruses, Rabdoviruses

and Arboviruses (2 h.)
Description
Enteroviruses: classification, ecology and infectious diseases; Rotaviruses, Caliciviruses, Rabdoviruses, Ar-
boviruses: characteristics, ecology and infectious diseases; Hepatitis viruses (HAV, HBV, HCV, HDV,
HEV): characteristics, ecology and infectious diseases; Laboratory diagnosis of viral infections; Immunop -
rophylaxis.
5.12. Nosocomial (Hospital) Infections (2h.)

Description
Definition of Nosocomial (Hospital) Infections (NI); Prevalence of NI; The principal factors influ-
encing NI; The types of NI: Lower respiratory Tract Infections (LRTIs), Urinary Tract Infections
(UTIs), Post- surgical Wounds, Blood Infections, Etc.; The patients-associated risk factors predis-
posing NI; Reservoirs/sources and Routes of transmission of NI; The role of Normal Microbial
Flora (NMF) in the development of NI; The major bacteria associated with NI: S. aureus, S. epider-
midis, P. aeruginosa, Acinetobacter baumannii, Proteus spp., Klebsiella spp., Escherichia coli.,
Candida spp., C. difficile, etc. ; The major viruses associated with NI: Influenza virus, RSV, CMV,
Rotavirus, Enterovirus, HBV & HCV.; Hospital strains – specific markers and their identification;
Control of Nosocomial (Hospital) Infections.
5.13 Antimicrobial chemotherapy (2 h.)

Division – Clinic of Infectious Diseases
In Charge – assoc. prof. A. Mickienė
24
Description
Conception of rational antibiotic therapy. Application programs of antibiotics. Antimicrobial agents
use for prophylaxis and treatment of infectious diseases.
Reading Assignment:
1. Murray PR, Rosenthal KS, Pfaller MA. Medical Microbiology. Fifth edition. Mosby. 2005. P.
203-212.
2. Jawetz EJL, Melnick EA, Adelberg GB, Butel JS, Ornston LN. Medical Microbiology. Twenty-
third Edition. Appleton & Lange. 2004. P. 161-195.
5.14. Immunotherapy and immunoprophylaxis of infectious diseases (2 h.)

Division - Clinic of Infectious Diseases
In Charge – assoc. prof. D. Vėlyvytė
Description
History of vaccination. Types of vaccines: live vaccines (natural virulent strains, attenuated
mutants, hybrid viruses) and inactivated vaccines (whole-agent, subunit and recombinant vaccines,
toxoid, anti-idiotype antibodies and DNA vaccines). Conjugated and associated vaccines, adjuvants.
Type of immunity acquired after vaccination, its duration, importance for revaccinations. The
primary and the secondary antibody response, immunomemory, their importance for revaccination.
Immunization schedule according to the WHO recommendations. Safety and effectiveness of vac-
cines, methods of determination. Indications and contraindications of vaccination, possible complic-
ations.
Immunoglobulins preparations, their application for treatment and specific prophylaxis of infectious
diseases.
Reading Assignment:
159-167.
5.15. Surgical infection (2 h.)

Division – Clinic of General Surgery
In Charge – lecturer J. Juočas
Description
Definition and classification of surgical infection. Classification of bacterial surgical infection.
Surgical Site Infection (Superficial SSI, Deep SSI, Organ/space SSI). Development of surgical
infection. Local and general signs of surgical infection. Diagnostics methods (clinical findings,
laboratory, imaging studies, endoscopic and surgical methods). Principles of conservative and
25
surgical management of surgical infection. Principles of antibacterial therapy. Hospital infection in
surgery: causes, classification, forms of clinical manifestation. Prevention of hospital infection.
5.16. Pathological anatomy of the bacterial and viral infections (2 hours)

In charge – prof. R. Gailys, prof. V. Lesauskaitė
Description
The conception of infectious disease. Common regularities of the development of general (cyclic)
local (endo-) bacterial and viral infections, classification and morphological background. General
septic infection (sepsis). Pathogenesis of the tuberculosis in different phases of development:
morphology of primary tuberculosis, haematogenous tuberculosis and it’s forms, secondary (organ)
tuberculosis, it’s morphological peculiarities in different organs and systems, complications and
causes of death. Acute viral respiratory infections, it’s morphology, complications and causes of
death. Viral hepatitis, principles of classification; morphology, complications and causes of death.
The syndrome of liver cirrhosis.
5.17. Beta-lactam antibiotics (2 hours)

Division – Institute of Physiology and Pharmacology
Responsible persons – lect. G. Sakalauskienė, lect. A.Ūsas
Description
Antimicrobial and antiparasitic drugs, their antimicrobial effects. Classification of
chemotherapeutic agents. Activity of chemotherapeutic drugs. Antibiotics: definition, production,
activity, intensity, classification according to the spectrum of activity and mechanism of
antimicrobial action. Β-lactam antibiotics (penicillins, cephalosporins, monobactams, carbapenems,
inhibitors of β-lactamases), representatives, general and specific properties of β-lactam antibiotics
(chemical structure, mechanism of action, antbacterial spectrum, adverse effects). Classification of
penicillins by origin and pharmakokinetic properties, classification of cephalosporins by resistance
to β-lactamases and antibacterial spectrum.
Main reading:
Additional reading:
26
2011.
5.18. Narrow and wide spectrum antibiotics (2 hours)

Division – Institute of Physiology and Pharmacology
Description
Narrow and wide-spectrum antibiotics (old generation and new generation macrolides and
ketolides, lincozamides, oxazolidones, glycopeptides, lipopeptides, polymyxins, old generation and
new generation tetracyclines and glycyclines, amphenicols, aminociclitols, streptogramins, old
generation and new generation aminoglycosides, rifamycins, old generation and new generation
chinolones), representatives, mechanizm of action, mode of action, antibacterial spectrum,
pharmacokinetic and pharmacodynamic properties, adverse effects, potential clinical use and
contraindications.
Main reading
1. Katzung BG. Basic & Clinical Pharmacology. International edition. McGrawHill Lange, 2009. 2.
Finkel R, Cubeddu LX, Clark MA, RD, Harvey RA, Champe PC. Pharmacology. 4 rd edition.
Additional reading
2011.
5.19. Sulfonamides and antimycobacterial agents (2 hours)

Division-Institute of Physiology and Pharmacology
Description
Sulfonamides: classification by pharmacological properties, representatives, mechanism and mode
of action, antibacterial spectrum, pharmacodynamic and pharmacokinetic properties, adverse
reactions, potential clinical use and contraindications. Classification of antibiotics and synthetic
preparations used for the treatment of tuberculosis according to the effectiveness and toxicity of
drugs, main representatives and new antimycobacterials, mechanism and mode of action,
pharmacokinetic and pharmacodynamic properties, adverse effects, contraindications and safe
usage.
27
Main reading:
Additional reading:
2011.
5.20. Other chemotherapeutic drugs (nitrofuran derivatives, antiprotozoal

drugs, antihelmintic drugs, antiseptics and desinfectants (2 hours)
Description
Other chemotherapeutic agents (nitrofuran derivatives, antimalarial agents, antitrichomonal
preparations, antihelmintic drugs): representatives, mechanism and mode of action,
pharmacodynamic and pharmakokinetic properties, adverse reactions, clinical use and
contraindications. Antiseptics and desinfectants (halogens, oxidative substances, heavy metal salts,
alcohols, aldehydes, phenoles, detergents, acids and bases, biguanides, nitrofuran derivatives),
classification by chemical structure, representatives, mechanizm of action, antibacterial spectrum,
adverse effects, and potential clinical use. Requirements for the antiseptics and desinfectants,
factors that influence their effectiveness.
Main reading
Addditional reading
2011.
5.21 Antifungal and antiviral agents (2 hours)

Description
Antifungal drugs, classification according to chemical structure and clinical efficiency,
representatives, mechanism of action, mode of action, antifungal spectrum, pharmacodynamic and
pharmacokinetic properties, adverse reactions and contraindications. Antiviral drugs, classification
28
according to the mechanism of action and clinical targets, main representatives, general and
individual pharmacokinetic and pharmacodynamic properties of antiviral drugs, adverse effects.
Main reading
Additional reading
2011.
6. Practical Works
6.1. Infectious diseases caused by Staphylococcus, Streptococcus, Neisseriae,
Acinetobacter, Moraxella, Kingella and their Laboratory Diagnosis (3 h.)
Description
Microorganisms:
 Staphylococcus spp. (S. aureus, S. epidermidis, S. saprohyticus, Methicillin Resistant S.
aureus, MRSA, Vancomycin Resistant S. aureus (VRSA);
 Streptococcus spp. (S. pneumoniae, S. pyogenes, S. agalactiae);
 Enterococcus spp. (E. faecalis, E. faecium (Vancomycin Resistant Enterococci, VRE);
 Family Neisseriaceae (Neisseria spp. (N. meningitidis, N. gonnorhoeae), Kingella spp.
(K.kingae);
 Family Moraxellaceae (Moraxella spp. (M. catarrhalis), Acinetobacter spp. (A. baumanii);
Solving the tasks (sample cases) by Microbiological Method: Patient‘s samples selection,
collection, and transportation; Microscopic identification of microorganisms; Evaluation of
bacterial growth in different cultures; Biochemical identification and biochemical profiles
(biotyping); Immunological (Serological) identification; Evaluation of the antibiotic susceptibility
patterns (antibiograms) to determine a succesful treatment; susceptibility to bacteriophages (phage
typing), and nucleic acid analysis; Evaluation of the results and Discussion (on the basis of
presenting signs and symptoms and the laboratory data) with MD- Microbiologist.
1. Murray PR. Medical Microbiology. 5th ed. Philadelphia (Pa.): Elsevier Mosby; 2005;
213; 221-236; 237-258; 259-263; 311-322; 364-365 pages.
Books for additional reading:
29
1. Mims C, Dockrell H, Roitt I, Goering R, Roitt I, Wakelin D, Zuckerman M. Medical Microbio-
logy. 4th ed. Philadelphia (Pa.): Mosby; 2008
2. Levinson W. Review of Medical Microbiology and Immunology. 11th ed. New York [etc.]: Mc-
Graw-Hill Medical; 2010.
3. Engelkirk PG. Laboratory Diagnosis of Infectious Diseases: Essentials of Diagnostic Microbio-
logy. Baltimore (Md.): Wolters Kluwer/Lippincott Williams & Wilkins; 2008.
6.2. Infectious diseases caused by: Escherichia, Proteus, Klebsiella, Enterobacter,

Morganella, Serratia, Gardnerella, Legionella and their Laboratory Diagnosis
(3h.)
Objectives
Microorganisms:
 Escherichia spp. (E. coli);
 Proteus spp. (P. vulgaris, P. mirabilis, P. penneri);
 Klebsiella spp. (K. pneumonia, K. oxytoca);
 Enterobacter spp. (E. aerogenes, E. cloacae, E. sakazakii);
 Serratia spp. (S. marcescens, S. ficaria, S. fonticola);
 Morganella spp. (M. morganii);
 Gardnerella spp. (G. vaginalis);
 Legionella spp. (L. pneumophila).
bacterial growth in different cultures; Biochemical identification; Immunological (Serological)
identification; Evaluation of the antibiotic susceptibility patterns (antibiograms) to determine a
succesful treatment; Nucleic acid analysis; Evaluation of the results and Discussion (on the basis of
213; 326-330; 335-338; 391-396;
30
6.3. Infectious diseases caused by: Shigella, Salmonella, pathogenic Escherichia

coli and their Laboratory Diagnosis (3 h.)
Description
Microorganisms:
 Shigella spp. (S. sonnei, S. dysenteri, S. boydii, S. flexneri);
 Salmonella spp. (S. enterica: S. typhi, S. paratyphi A and B, S. typhimurium, S. enteritidis, S.
london, S. infantum, S. bongori), etc.
 Pathogenic E. coli. (EPEC, ETEC, EHEC, EIEC, EAEC),
Reading Assignment:
213; 323- 339; 733-817 pages.
6.4. Infectious diseases caused by: Vibrios, Campylobacter, Helicobacter and
pathogenic Spirochetes (Treponemma, Borrelia, Leptospira) and their Laboratory

Diagnosis (3 h.)
Description
Microorganisms:
31
 Vibrio spp. (V. cholera, V. eltor);
 Campylobacter spp. ( C. jejuni)
 Helicobacter spp. (H. pylori)
 Treponemma spp. (T. pallidum);
 Borrelia spp. (B. burgdorferi);
 Leptospira spp. (L. interrogans);
bacterial growth in different cultures; Biochemical identification and biochemical profiles
(biotyping); Immunological (Serological) identification; Evaluation of the antibiotic susceptibility
patterns (antibiograms) to determine a succesful treatment; Nucleic acid analysis; Evaluation of the
results and Discussion (on the basis of presenting signs and symptoms and the laboratory data)
with MD- Microbiologist
213; 339- 357; 427- 443 pages.
6.5. Infectious diseases caused by: Mycobacterium, Corynebacterium, Bordetella,

and their Laboratory Diagnosis (3 h.)
Description
Microorganisms:
 Mycobacterium spp. (M. tuberculosis complex, M. avium complex, MAC);
 Corynebacterium spp. (C. diphtheriae);
 Bordetella spp. (B. pertussis, B. parapertussis);
32
213; 273-287; 297-311; 377-383 pages;
6.6. Infectious diseases caused by: Pseudomonas, Haemophilus, Acinetobacter

Description
icroorganisms:
 Pseudomonas spp. (P. aeruginosa);
 Haemophilus spp. (H. influenza, H. ducreyi);
 Acinetobacter spp. (A. baumanii, Acinetobacter calcoaceticus-baumanii complex, A. iwoffii,
A. haemolyticus);
213; 357-363; 364-365; 367-374 pages.
33
6.7. Infectious diseases caused by: Yersinia, Brucella, Francisella, Bacillus and
their Laboratory Diagnosis (3 h.)
Description
Microorganisms:
 Yersinia spp. (Y. pestis CO92, Y. pestis, Y. enterocolitica, Y. pseudotuberculosis);
 Brucella spp. (B. abortus, B. melitensis, B. suis);
 Francisella spp. (F. tularensis);
 Bacillus spp. (B. anthracis);
213; 334-335; 383-390; 421-426 pages.
6.8. Infectious diseases caused by: Chlamydia, Mycoplasma, Rickettsia and Fungi
(Aspergillus, Candida, Cryptococcus, Coccidioides, Histoplasma, Blastomyces and
Pneumocystis) their Laboratory Diagnosis (3 h.)
Description
34
Microorganisms:
 Chlamydia spp. (C. pneumoniae, C. psittaci, C. trachomatis);
 Mycoplasma spp. (M. pneumoniae, M. genitalium, M. hominis);
 Rickettsia spp. (R. prowazekii, R. typhi, R. akari);
 Fungi: Mucor, Aspergillus spp., Candida spp. (C. albicans C. glabrata, C. rugosa),
Cryptococcus spp. (C. neoformans), Coccidioides spp. (C. immitis), Histoplasma spp.(H.
capsulatum), Blastomyces spp. ( B. dermatitidis), Pneumocystis (carinii) jiroveci .
collection, and transportation; Immunological (Serological) identification; Nucleic acid analysis;
Evaluation of the results and Discussion (on the basis of presenting signs and symptoms and the
laboratory data) with MD- Microbiologist.
213; 443- 457; 463- 473 pages.
6.9. Infectious diseases caused by Respiratory and Enteroviruses and their Labor-
atory Diagnosis (3 h.)
Description
Viruses:
 Orthomyxoviridae (Influenza viruses A, B, C, dsRNR);
 Paramyxoviridae (Parainfluenza viruses (PIV), ssDNR);
 Adenoviridae (Human adenoviruses: B (HadV-B) and C (HadV-C), dsDNR);
 Coronaviridae (SARS coronavirus (SARS-CoV), ssRNR);
 Reoviridae (Rotavirus A, dsRNR);
 Picornaviridae: Genus “Human Enterovirus” (Human enteroviruses A, B, C, D) and “Hu-
man rhinovirus” (Human rhinovirus A, B, C), ssRNR);
 Caliciviridae (Noroviruse, ssRNR);
35
Solving the tasks (sample cases) by Virological Method: Patient‘s samples selection, collection, and
transportation; Immunological (Serological) identification; Evaluation of the results and Discussion
(on the basis of presenting signs and symptoms and the laboratory data) with MD- Microbiologist.
513; 533- 541; 579- 619; 627-637;
6.10. Infectious diseases caused by: Herpesviruses, Retroviruses, Hepatitis viruses

Description
Viruses:
 Hepadnaviridae (Hepatitis B virus (HBV), dsDNR;
 Flaviviridae (Hepatitis C virus (HVV, ssRN);
 Herpesviridae (Herpes simplex viruses (HS-1 and HSV-2,dsDNA);
 Herpesviridae (Varicella zoster virus (VZV, dsDNA);
 Herpesviridae (Epstein-Barr virus (EBV, dsDNA);
 Herpesviridae (Cytomegalovirus (CMV, dsDNR);
 Retroviridae (Human immunodeficiency virus (HIV, ssRNR);
Solving the tasks (sample cases) by Virological Method: Patient‘s samples selection, collection, and
transportation; Immunological (Serological) identification; Evaluation of the results and Discussion
(on the basis of presenting signs and symptoms and the laboratory data) with MD- Microbiologist.
513; 541-565; 657-674; 675- 691 pages.
36
6.11. Beta-lactam antibiotics (2hours)

Division – Institute of physiology and pharmacology Pharmacology
Description
Beta-lactam antibiotics: discussion about this class of antibiotics (questioning of students). Students
independently complete multi-stage assignments (10 assignments). Prescription writing from the
mandatory list of drugs as well as of other drugs. Discussion about the prescriptions and the
assignments.
References:
1. Katzung BG. Basic & Clinical Pharmacology. Eighth edition. 2001: 754-768
2. Howland RD, Mycek MJ, Harvey RA, Champe PC. Pharmacology. 3 rd edition. Lippin-
cott‘s Illustrated Reviews. 2006: 353-364
3. Rang HP, Dale MM, Ritter JM, Moore PK. Pharmacology. Fifth Edition. 2003: 639-643
4. Mutschler E, Geisslinger G, Kroemer HK, Schafer-Korting M. Arzneimittelwirkungen.
Lehrbuch der Pharmakologie und Toxicology. 8 Auflage. Stuttgart, 2001: 781-799.
Supplementary readings:
1. Goodman and Gilman‘s The Pharmacological Basis of Therapeutics. Eleventh edition. 2006:
1127-1152.
2. Basevičius R, Budnikas V ir kt. Farmakologija. Mokslas, 1986: 364-379; 386-389.
6.12. Narrow and broad spectrum antibiotics (2hours)

Description
Narrow and broad spectrum antibiotics: discussion about this class of antibiotics (questioning of
students). Students independently complete multi-stage assignments (10 assignments). Prescription
writing from the mandatory list of drugs as well as of other drugs. Discussion about the
prescriptions and the assignments.
References:
1. Katzung BG. Basic & Clinical Pharmacology. Eighth edition. 2001: 774-792; 797-802.
cott‘s Illustrated Reviews. 2006: 364-365; 367-377; 381-386.
37
3. Rang HP, Dale MM, Ritter JM, Moore PK. Pharmacology. Fifth Edition. 2003: 643-649
Lehrbuch der Pharmakologie und Toxicology. 8 Auflage. Stuttgart, 2001: 799-816; 822-
823.
1119-1122; 1155-1200.
2. Basevičius R, Budnikas V ir kt. Farmakologija. Mokslas, 1986: 380-386; 389-403; 409
6.13. Sulfanilamides and drugs to treat tuberculosis (2 hours)

Description
Sulfanilamides and agents to treat tuberculosis: discussion about this class of antibiotics
(questioning of students). Students independently complete multi-stage assignments (10
assignments). Prescription writing from the mandatory list of agents as well as other agents.
Discussion about the prescriptions and the assignments.
References:
1. Katzung BG. Basic & Clinical Pharmacology. Eighth edition. 2001: 793-796; 803-811.
cott‘s Illustrated Reviews. 2006: 387-392; 395-400.
3. Rang HP, Dale MM, Ritter JM, Moore PK. Pharmacology. Fifth Edition. 2003: 637-639;
649-651.
829.
1111-1200; 1203-1216.
2. Basevičius R, Budnikas V ir kt. Farmakologija. Mokslas, 1986: 402-405; 409-422.
6.14. Other chemotherapeutic agents. Antispetics and disinfectants (2 hours)

Description
Discussion about antifungal agents, derivatives of nitrofurane, antimalarial agents, antitrichomonal
agents, antihelmintic agents (questioning of students). Students independently complete multi-stage
38
assignments (10 assignments). Prescription writing from the mandatory list of drugs as well as of
other drugs. Discussion about the prescriptions and the assignments.
Antiseptics and disinfectants: discussion about this class of antibiotics (questioning of students).
References:
1. Katzung BG. Basic & Clinical Pharmacology. Eighth edition. 2001: 814-822; 845-846, 847-
852; 882-893; 894-895; 903-920.
cott‘s Illustrated Reviews. 2006: 392-393; 403-421; 427-432; 649.
3. Rang HP, Dale MM, Ritter JM, Moore PK. Pharmacology. Fifth Edition. 2003: 637-639;
649-651.
822; 831-839; 857-865; 867-871.
1021-1045; 1057-1060;1073-1090; 1122-1124; 1225-1240.
2. Basevičius R, Budnikas V ir kt. Farmakologija. Mokslas, 1986: 348-363, 363-364; 405-408;
432-426; 430-437; 441-449.
6.16. Principles of diagnostics and management of surgical infection (3 hours)

Description
Classification of surgical infection (bacterial, toxic, viral). Classification of bacterial surgical
infection (purulent, putridic, anaerobic, bakteriotoxic, specific). Local and generalized infection.
Bacterial translocation. Local and general signs of infection. Diagnostics methods (clinical findings,
laboratory, imaging studies, endoscopic and surgical methods). Principles of conservative and
surgical management of surgical infection. The features of surgery in cases of putrid and anaerobic
infection.
References:
 Juočas J., Venskutonis D. et all. Asepsis and antisepsis. Kaunas, 2006, p.34-52.
 Clinical Surgery. Second edition. Edited by Michael M. Henry, Jeremy N. Thompson. 2007,
115-124p.
1. Principles of Surgery. Seymour I. Schwartz (Editor), Josef E. Fischer, John M. Daly
(Editor), Aubrey C. Galloway, G. Tom Shires (Editor), Frank C. Companion Handbook, 7th
39
edition.1998, Chapter 5, Surgical Infections.
6.17. Traumatic and surgical wound infection, prophylaxis and principles of

treatment (3 hours)
Description
Conception of contaminated, infected and purulent wound. Risk factors for developing a traumatic
wound infection. Signs of wound infection. Principles of local and general treatment in
contaminated, infected and purulent wound (first aid, primary surgical debridement, wound
irrigation, drainage, wound closure, antibacterial therapy, detoxication, nutritional support).
Classification of Surgical Site Infection (Superficial SSI, Deep SSI, Organ/space SSI). Causes of
incisional SSI: asepsis during surgical procedure and during postoperative care, poor surgical
technique, disturbances in tissue blood supply (suture), class of surgical wound cleanliness (clean,
clean – contaminated, contaminated, dirty - infected), length of operation, ASA classification,
implants and prosthetic appliances. Principles of prophylaxis and treatment of SSI. Surgical
antibiotic prophylaxis.
References:
1. Juočas J., Venskutonis D. et al. Asepsis and antisepsis. 2006, p.34-52, 252-330
2. Hartmann P. AG Compendium Wounds and Wound Management. 1st Edition, 1999, p.88-
112.
3. Heinzelmann M, Scott M, Lam T. Factors predisposing to bacterial invasion and infection.
Am J Surg 2002; 183(2): 179-90.
1. Leaper DJ, van Goor H, Reilly J, Petrosillo N, Geiss HK, Torres AJ, et al. Surgical site
infection - a European perspective of incidence and economical burden. Int Wound Journal
2004; 1(4): 247-273.
2. Drosou A, Falabella A, Kirsner RS. Antiseptics on wounds: an area of controversy. Wounds
2003; 15(5): 149-66.
3. Clinical Surgery. Second edition. Edited by Michael M. Henry, Jeremy N. Thompson. 2007,
p. 104-108,176-179.
6.18. Pathological anatomy of the bacterial infections (3 hours)

40
Description
Studying macro-, micropreparations and electron micrographs, the students must select preparation
illustrating morphological background, complications and causes of death of tuberculosis, syphilis,
diphtheria, scarlet fever measles, whooping cough, typhoid fever, Shigeliosis (dysentery). To tolve
morphological diagnostic tasks.
Epithelioid cell engulfing tuberculous bacillus. Electron micrograph (x7.000). Find and draw
tuberculous bacillus in epitelioid cells.
Langhans’ multinucleate giant cell. Electron micrograph (x8.000) Pay attention to the characteric
ultrastructure of macrophage and numerous nuclei with nucleoli.
Tubercula epithelioidea lymphonodi (pulmonis). Histological slide (H+E). Find immune
granulomas, i. e. tubercules, composed of epitelioid cells, Langhans type cells, lymphocytes. Some
of tubercules are with caseous necrosis (Fig.4).
Pneumonia caseosa tuberculosa. Histological slide (H+E). Spaces of alveoli are filed with sero-
fibrinous exudate and lymphocytes. Pay attention to the formation of caseous necrosis (cells
destroyed, undistinet staining, remains of nuclei), in its margins are seen separated epitelioid cells.
Macropreparations
Gummata hepatis, pulmonum, ossium etc.
Hepar, pulmo lobatum
Aortitis syphilitica et aneurysma aortae
Ulcera typhosa intestini tenuis
Reactio immunica lienis, lymphnodorum et folliculorum lymphatici aggregatum intestini tenuis
Pneumonia focalis (bronchopneumonia)
Emphysema interstitiale pulmonum
Glomerulonephritis haemorrhagica
Colitis fibrinosa-necroticans
Selflearning questions
What are the stages of development of tuberculosis?
What components does primary complex consist of?
What are the variants of the primary complex course?
How does the primary complex manifest itself?
What is an early hematogenous generalization?
What is haematogenous tuberculosis?
What is a late hematogenous generalization?
Enumerate and chracterize the forms of secondary pulmonary tuberculosis.
What are the causes of death in cases of secondary pulmonary tuberculosis?
41
What is the location of vertebral tuberculosis?
What are the complications of vertebral tuberculosis?
What are the manifestations and complications of renal tuberculosis?
How does adrenal tuberculosis manifest itself?
What is the pathomorphosis of tuberculosis?
What are the stages of typhoid fever?
What components form typhoid granuloma?
What are the complications of typhoid fever?
Which part of the digestive tract is damaged in cases of dysentery?
What are the stages of dysentery
What are the most frequent complicafions of dysentery?
What is the causative agent of scarlet fever?
What are the forms and frequent complications of scarlet fever?
What are the forms and frequent complications of whooping cough?
What organs are most frequently damaged in cases of diphatheria and what are its main
complications?
What inflammation is present in the larynx and what is in the trechea in cases of diphtheria?
What are the periods of syphilis and what morphological changes are typical for each period?
What damage occurs in the nervous system in cases of syphilis?
6.19. Pathological anatomy of the viral infections (3 hours)

Description
Wil studying macro-, micropreparations and electron micrographs, students must select
preparations, illustrating morphological backgrand, complications and causes of death of the viral
infections (grippe, paragrippe, measles, cytomegalyc inclusion, AIDs, viral hepatitis, liver cirrhosis
syndrome.
Viral damage of the cell (Cytopathic effect). Electron micrograph (x4500). Pay attention to the
vacuoles in the cytoplasm and distribution of nuclear chromatin.
Liver cell during viral hepatitis. Electron micrograph (x 12 000). Find swelled cisterns of
endoplasmic reticulum and large cytoplasmic vacuoles. Pay attention to the desintegration of
ribosomes and mitochondrias, karyopyknosis and collagen fibers between liver cells.
Infectio virosa respiratoria acuta complicata; bronchitis fibrinosa – necrocans. Histological
slide (H+E). Find the lumen of the bronchus filled by fibrinous purulent exudate, necrosis of
42
mucosa, regeneration of epithelium and infiltration of the wall by immune cells: macrophages,
lymphocytes and plasma cells.
Cytomegalia inclusiva. Histological slide (H+E). Pay attention to the enlarged epithelial cells
lining the ducts of salivary glands (renal tubules) with abundant cytoplasm and a big excentrically
located nucleus, pushed away by inclusions (colonies of virus).
Hepatis virosa acuta fulminans: necrosis massiva hepatocytorum. Histological slide (H+E).
Find the injured liver cells. Most of liver cells are without nucleus, have cosinophilic cytoplasm,
some of them containing lipids 9vacuoles) and bile pigments. Pay attention to the loss of regular
structure of lobes: betwwwn liver cells and in the periportal tissue there is infiltration by immune
cells (granulocytes, macrophages, lymphocytes, plasma cells).
Hepatitis virosa chonica progrediens cum cirrhosi. Histological slide (H+E). Pay attention to the
features of cirrhosis of the liver, i. E. to the changes of the liver normal architecture: abundant
connective tissue with proliferating bile ductuli (pseudotubuli) and noduli of regeneration composed
from irregular lobuli with one or some excentric located venae (pseudotubuli). Find some features
of progressing hepatitis: destruction of hepatocytes (cells without nuclei, vacuolized) and
infiltration by immune cells (lymphocytes, macrophages, plasma cells, granulocytes).
Macropreparations
Oedema laryngitis
Tracheobronchitis haemorrhagica
Pneumonia focalis (abscedens, confluens)
Haemorrhagiae punctatae cerebri
Panbronchitis, bronchiolitis, pnemonia morbillosa
Leptomeningitis purulenta
Necrosis massiva hepatis
Hepatitis chronica progrediens cum cirrosi
Splenomagalia (reactio immunica, hyperaemia venosa chronica)
Varices venarum eosophagi, recti
Cirhosis hepatis et hepatoma
Carcinoma hepatis
Selflearning questions
What are general features of morphology of viral infections?
How do you understand the cytopatthic viral effect?
What are the forms of grippe?
How do you distinguish morphological changes caused by viral infection from those of
endoinfection?
43
What is the morphological background of rash in measles?
What kinds of viral hepatitis do you know
What are the ways of transmission of hepatitis A and B viruses?
Point out clinico-morphological kinds of acute viral hepatitis.
What are the morphological types of cirrhosis of the liver?
What are morphological differences in cases of cirrhosis due to chronic hepatitis and alcoholism?
What are the most common complications of cirrhosis of the liver?
Enumerate the collateral systemic anastomotic venous channels in cases of cirrhosis of the liver.
7. Seminars
7.1. Laboratory diagnosis of Gastro-Intestinal infections (2 h.)
Description
1. Shigella sp and pathogenic Escherichia coli . Laboratory diagnosis and identification meth-
ods.
2. Laboratory diagnosis and identification methods of Salmonellosis and Typhoid fever.
3. Laboratory diagnosis of Cholera and Campylobacter gastroenteritis.
4. Helicobacter pylori infections laboratory diagnosis.
5. Hepatitis A and E laboratory diagnosis and prevention.
6. Hepatitis B, C and D laboratory diagnosis and prevention.
References:
microbiology. Third edition. Mosby. 2004. P. 277 - 312
7.2. Hospital infection in surgery and principles of antibacterial therapy (2 h.)

In Charge – lecturer J. Juočas
Description
Conception of hospital infection. Hospital - acquired (nosocomial), community - acquired and
health care - associated infection. Sources of hospital infection. The main causes of hospital
infection. The main forms of clinical manifestation. Prevention of hospital infection (medical
44
asepsis, removal the sources of infection, priciples of antibacterial therapy in surgery, isolation
precautions, etc.).
References:
1. Juočas J., Venskutonis D. et al. Asepsis and antisepsis. 2006, p.34-52, 293-330.
2. Clinical Surgery. Second edition. Edited by Michael M. Henry, Jeremy N. Thompson. 2007,
p.104-108.
Leaper DJ, van Goor H, Reilly J, Petrosillo N, Geiss HK, Torres AJ, et al. Surgical site infection - a
European perspective of incidence and economic burden. Int. Wound Journal 2004; 1(4): 247-273.
45

Modulus Infection - 2019 - Description

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Modulus Infection - 2019 - Description

Uploaded by

Copyright:

Available Formats

Study Programme in Medicine

Supervisor of the sub module: prof. Alvydas Pavilonis, Department of Microbiology

2. General thematic contents of the sub module

3. Aim and objectives of the module

 to understand antimicrobial resistant microorganisms, the occurrence and mechanisms of

 to understand specific and Non-specific (immune) defence mechanisms.

Essence of the problem: Lower Respiratory Tract Infections;

Learning objectives and contents:

4.2. Second Problem. Soft tissue infection. Gram-positive and gram-negative

4.3. Third problem. Urinary Tract Infection

Learning objectives and contents:

4.4. Fourth problem. Gastrointestinal Tract Infection.

4.5. Fifth problem. Central Nervous System Infection.

4.6. Sixth problem. Multisystem viral infection.

Division – Department of Microbiology

5.4. Enterobacteriaceae family (2 h.)

5.6. Bacterial genera: Vibrio, Aeromonas, Campylobacter, Helicobacter.

5.7 Rickettsia : Anaplasma, Ehrlichia and Coxiella genera. Chlamydiaceae and

5.9. Viruses: classification, structure. Retroviruses, Oncogenic viruses, Slow

5.11. Enteroviruses, Rotviruses, Caliciviruses, Hepatitis viruses, Rabdoviruses

5.12. Nosocomial (Hospital) Infections (2h.)

5.13 Antimicrobial chemotherapy (2 h.)

5.14. Immunotherapy and immunoprophylaxis of infectious diseases (2 h.)

5.15. Surgical infection (2 h.)

5.16. Pathological anatomy of the bacterial and viral infections (2 hours)

5.17. Beta-lactam antibiotics (2 hours)

5.18. Narrow and wide spectrum antibiotics (2 hours)

5.19. Sulfonamides and antimycobacterial agents (2 hours)

5.20. Other chemotherapeutic drugs (nitrofuran derivatives, antiprotozoal

5.21 Antifungal and antiviral agents (2 hours)

6.2. Infectious diseases caused by: Escherichia, Proteus, Klebsiella, Enterobacter,

6.3. Infectious diseases caused by: Shigella, Salmonella, pathogenic Escherichia

6.4. Infectious diseases caused by: Vibrios, Campylobacter, Helicobacter and

pathogenic Spirochetes (Treponemma, Borrelia, Leptospira) and their Laboratory

6.5. Infectious diseases caused by: Mycobacterium, Corynebacterium, Bordetella,

6.6. Infectious diseases caused by: Pseudomonas, Haemophilus, Acinetobacter

6.10. Infectious diseases caused by: Herpesviruses, Retroviruses, Hepatitis viruses

6.11. Beta-lactam antibiotics (2hours)

6.12. Narrow and broad spectrum antibiotics (2hours)

6.13. Sulfanilamides and drugs to treat tuberculosis (2 hours)

6.14. Other chemotherapeutic agents. Antispetics and disinfectants (2 hours)

6.16. Principles of diagnostics and management of surgical infection (3 hours)

6.17. Traumatic and surgical wound infection, prophylaxis and principles of

6.18. Pathological anatomy of the bacterial infections (3 hours)

6.19. Pathological anatomy of the viral infections (3 hours)

3. Laboratory diagnosis of Cholera and Campylobacter gastroenteritis.

4. Helicobacter pylori infections laboratory diagnosis.

5. Hepatitis A and E laboratory diagnosis and prevention.

6. Hepatitis B, C and D laboratory diagnosis and prevention.

7.2. Hospital infection in surgery and principles of antibacterial therapy (2 h.)

You might also like