INFECTION AND

IMMUNITY
• I. Compare innate and adaptive
immune responses

• II. Describe how the innate immune

response helps protect a person
from illness
• How does the body protect itself
from disease causing organisms?
• What happens to you when you get
sick?
• What do you think are the causes of
these diseases:
rhinoviruses
- common colds (____________);
- diarrhea (___________________);
Various bacterial toxins

- influenza (__________________).
Influenza virus
 What is an immune system?
• The body’s defense against disease causing
organisms, malfunctioning cells, and foreign
particles
• Collection of cells and proteins that function
to protect the skin, respiratory passages,
intestinal tract and other areas from foreign
antigens, such as microbes
*The health of the body is dependent on the
immune system’s ability to recognize and then
repel or destroy these invaders.
Most animals have systems that resist
disease. The disease resistance
provided by these systems is called
_ _ _ _ _ _ _ _.
• Two types:
-innate
-adaptive
 • Innate/nonspecific immunity
-the body’s first, generalized line of defense
against all invaders
-furnished by barriers such as ______,
skin _______,
tears
mucus and _______,
_______, saliva as well as by the rapid
inflammation of tissues that takes place shortly
after injury or infection (fast-acting)
• Internal defenses of the innate immune
response consist of phagocytic cells, natural
killer cells, antimicrobial proteins (interferons,
complement system) and the inflammatory
response (that involves histamines, mast
cells).
*These innate immune mechanisms hinder the
entrance and spread of disease but can rarely
prevent disease completely.
 The First Line of Defense
~Skin~
- The dead, outer
layer of skin, known
as the __________,
forms a shield
against invaders and
secretes chemicals
that kill potential
invaders
- You shed between
40 – 50 thousand
skin cells every day!
 Role of skin

• Dead skin cells constantly

slough off, making it hard
for invading bacteria to
colonize.
• Sweat and oils contain
anti-microbial chemicals,
including some
antibiotics.
 The First Line of Defense
~Mucus and Cilia~
- As you breathe in,
foreign particles and
bacteria bump into
mucus throughout
your respiratory
system and become
stuck
- Hair-like structures
called cilia sweep this
mucus into the throat
for coughing or
swallowing
 Role of mucus and cilia
lysozymes
• Mucus contains _______,
enzymes that destroy bacterial
cell walls.
• The normal flow of mucus
washes bacteria and viruses off
of mucus membranes.
• _______ in the respiratory tract
move mucus out of the lungs to
keep bacteria and viruses out.
 The First Line of Defense
~Saliva~
What’s the first thing you do when you cut
your finger?
- Saliva contains many
chemicals that break down
bacteria
- However, thousands of
different types of bacteria can
survive these chemicals.
 The First Line of Defense
~Stomach Acid~
- Swallowed bacteria are
broken down by incredibly
strong acids in the stomach
that break down your food
- The stomach must produce a
coating of special mucus or
this acid would eat through
the stomach!
 Role of phagocytes
• Phagocytes are several types of
white blood cells (including
macrophages and neutrophils)
that seek and destroy invaders.
Some also destroy damaged
body cells.
• Phagocytes are attracted by an
inflammatory response of
damaged cells.
 ~White Blood Cells~
- If invaders actually
get within the body,
then your white
blood cells (WBCs)
begin their attack
- WBCs normally
circulate throughout
the blood, but will
enter the body’s
tissues if invaders
are detected
 White Blood Cells
~Phagocytes~
• These white blood cells are
responsible for eating
foreign particles by
engulfing them
• Once engulfed, the
phagocyte breaks the
foreign particles apart in
organelles called ________
Lysosomes
 Viruses
Viruses enter body cells, hijack their organelles, and
turn the cell into a virus making-factory. The cell
will eventually burst, releasing thousands of viruses
to infect new cells.

Cell before infection… …and after.

 ~Interferon~
- Virus-infected body cells release
interferon when an invasion
occurs
Interferon – chemical that
interferes with the ability of
viruses to attack other body
cells
-a protein produced by cells in
response to virus infection that
inhibits viral replication
 ~T-Cells~
• T-Cells or T
lymphocytes recognize
infected human cells
and cancer cells.
• T-cells will attack these
infected cells, quickly
kill them, and then
continue to search for
more cells to kill
 • T Cells are natural killer cells of
the immune system.
-____________, directly attack
foreign substances in the body.
Diseases that damage the ability of T
cells to function threaten the body's
ability to defend itself against
infection.
 ~The Inflammatory Response~

- Injured body cells release

chemicals called
histamines, which begin
inflammatory response
- Capillaries dilate
- Pyrogens released, reach
hypothalamus, and
temperature rises
- Pain receptors activate
- WBCs flock to infected area
like sharks to blood
 Role of inflammation

• Inflammation is signaled by mast cells,

histamine
which release __________.
• Histamine causes fluids to collect around an
injury to dilute toxins. This causes swelling.
• The temperature of the tissues may rise,
which can kill temperature-sensitive
microbes.
 Role of fever
• Fever is a defense mechanism that can
destroy many types of microbes.
• Fever also helps fight viral infections by
increasing interferon production.
• While high fevers can be dangerous, some
doctors recommend letting low fevers run
their course without taking aspirin or
ibuprofen.
Non-Specific immunity
Ouch!
 Fever is caused by:
1. Toxins on the surface
of viruses.
2. Release of histamines
by damaged cells.
3. Your own body’s
accumulated toxins.
4. Your body’s pyrogens
signaling the
hypothalamus.
 Based on what you know about non-specific
defenses, what’s the best way to treat a cut in
your skin?

1. Leave it exposed to
open air.
2. Wash it, and cover it
with a clean bandage.
3. Rub it with dirt.
• If an invader gets past this first line of defense,
the cells, molecules, and organs of the
immune system develop specifically tailored
defenses against the invader. The immune
system can call upon these defenses
whenever this particular invader attacks again
in the future.
 Things to remember:
1. The innate immune response is always the first response to
an infection.

2. The innate immune response acts fast.

3. Inflammation is characterized by fever (CALOR), redness

(RUBOR), swelling (TUMOR), pain (DOLOR), and loss of
function (FUNCTIO LASAE) in the infected area.

4. Inflammation can help kill the pathogen (fever produces

heat that may kill the bacteria/ viruses or make them stop
replicating for example).
 2. Adaptive or specific immunity
• involves the recognition of traits specific to
particular pathogens using a vast array of
receptors
 Four distinguishing properties
• responds only after the invader is present
• it is specific, tailoring each response to act
only on a specific type of invader
• it displays memory, responding better after
the first exposure to an invader, even if the
second exposure is years later
• it does not usually attack normal body
components, only those substances it
recognizes as nonself
• Adaptive immune responses are actually
reactions of the immune system to structures
on the surface of the invading organism called
antigens.
 Two types of adaptive immune
responses
• The Humoral response- production and
secretion of antibodies or immunoglobulins
against specific antigens (any foreign
body/structure- pollen, bacteria, virus, dust).
Antibodies are produced by cells that secrete
them in the bloodstream or display them in
the surface of some cells, ready to face and
combat any antigen.
 antibodies
• proteins called ____________, which can stick
to and destroy antigens, appear in the blood
• Humoral immune responses resist invaders
that act outside of cells, such as bacteria and
toxins (poisonous substances produced by
living organisms).
• Humoral immune responses can also prevent
viruses from entering cells.
• The humoral immune response involves a
complex series of events after antigens enter the
body.
• First, macrophages take up some of the antigen
and attach it to class II MHC molecules, which
then present the antigen to T helper cells.
• The T helper cells bind the presented antigen,
which stimulates the T helper cells to divide and
secrete stimulatory molecules called interleukins.
• The interleukins in turn activate any B
lymphocytes that have also bound the antigen.
The activated B cells then divide and secrete
antibodies. Finally, the secreted antibodies bind
the antigen and help destroy it.
• Cell mediated response- occurs when
cytotoxic cells defend the body against
infection. The development of B and T cells,
memory cells and plasma cells are important
aspects of cell mediated immune mechanism.
• During cell-mediated immune responses, cells
that can destroy other cells become active.
Their destructive activity is limited to cells that
are either infected with, or producing, a
specific antigen. Cell-mediated immune
responses resist invaders that reproduce
within the body cells, such as viruses.
Cell-mediated responses may also destroy
cells making mutated (changed) forms of
normal molecules, as in some cancers.
• The cell-mediated immune response involves a
complex series of events after antigens enter the
body.
• Helper T cells are required, so some of the antigen
must be taken up by macrophages and presented to
helper T cells. The helper T cells bind the presented
antigen and thereby become activated to divide and
secrete interleukins. The interleukins in turn activate
any killer T cells that have already bound antigen
attached to class I MHC molecules on infected cells.
The activated killer T cells can then kill any cells
displaying antigen attached to class I MHC molecules,
effectively eliminating any cells infected with the
antigen.
 Helper T cells
• Helper T-cells have receptors for
recognizing antigens. If they are presented
with an antigen, they release cytokines to
stimulate B-cell division.
• The helper T-cell is the key cell to signal an
immune response. If helper T-cells are
disabled, as in people with AIDS, the
immune system will not respond.
 B cells
• B-cells in general produce antibodies. Those
antibodies that bind with the invader’s antigen
are stimulated to reproduce rapidly.
• B-cells differentiate into either plasma cells or
memory B-cells. Plasma cells rapidly produce
antibodies. Memory cells retain the “memory”
of the invader and remain ready to divide
rapidly if an invasion occurs again.
 Role of antibodies
• Antibodies released into the blood stream
will bind to the antigens that they are
specific for.
• Antibodies may disable some microbes, or
cause them to stick together (agglutinate).
They “tag” microbes so that the microbes are
quickly recognized by various white blood
cells.
 “Killer” T cells

• While B-cells divide and differentiate, so do

T-cells.
• Some T-cells become cytotoxic, or “killer”
T-cells. These T-cells seek out and destroy
any antigens in the system, and destroy
microbes “tagged” by antibodies.
• Some cytotoxic T-cells can recognize and
destroy cancer cells.
 Calling a halt

• When the invader is destroyed, the helper

T-cell calls a halt to the immune response.
• Memory T-cells are formed, which can
quickly divide and produce cytotoxic T-cells
to quickly fight off the invader if it is
encountered again in the future.
A foreign protein that enters the
body is an:

1. antibiotic.
2. antigen.
3. antibody.
4. anti-inflammatory.
 Things to remember:

• 1. Without the innate immune response, the

adaptive immune response cannot be
activated, because the innate immune
response gives the rest of the immune system
signals that say there is a real threat to the
body that must be eliminated.
• 2. Stopping inflammation is not always a good
thing. For example, you need to have a fever to
really mount a full-blown response against a
pathogen so taking paracetamol when you have
a mild fever (below 38.3ºC) for example, may
not always be a good thing since you may lose
the sterilizing effects of the fever and dampen
the danger signals that activate the adaptive
immune response. However, it is still best to get
medical advice on how to treat disease.
When can you say that the inflammation is good and
when it is bad?

• Acute inflammation can be good since it

activates the immune response, but chronic
inflammation (e.g., arthritis, psoriasis,
irritable bowel disease) is bad because it
ultimately leads to tissue damage.
What is the importance of inflammation in the
immune response?

• Inflammation is a signal produced by the

body in response to a real infection. It also
sends signals to the adaptive immune
response that there is a real danger present
and that it has to be eliminated.
What are the five hallmarks of
inflammation?
• Fever
• redness
• swelling
• pain
• loss of function
PART 2
• I. define the term “antibody”

• II. name the different kinds of antibodies

produced by humans and

• III. explain the function of each type of

antibody
 Why is innate immune response
necessary?
• It is necessary to activate the adaptive
immune response.
• How long would it take for a person to get
better from an illness?
-It should take about 3-4 days for a person to
“get better” from an illness, meaning fever and
other symptoms of inflammation should
disappear after 3-4 days.
• At day 3-4 of infection, the adaptive
immune response is fully activated
and is able to effectively control,
combat, and eliminate the pathogen.
• Antibody - a protein produced by
our immune system to specifically
bind a target. Usually, these targets
are parts of pathogens.
• Antigen is a substance / part of
pathogen that generate an immune
response. Usually this response leads
to the production of a specific
“antibody” for the given target.
 • REVIEW
• The adaptive immune response has two aspects: the
_________ and __________ response.

• The humoral response is due to the production of antibodies

by _______.

I. B cells are white blood cells that develop and mature in the
bone marrow.

II. B cells are activated when they encounter antigen in the lymph
nodes.

III. Activated B cells produce __________, proteins that recognize

and bind to specific parts of the pathogen, called _______. Each B
cell produces only one ___________ which recognizes only one
kind of antigen (specificity).
 Five major types of Antibody
• A. IgM is the first antibody produced. It
coats the pathogen and promotes
endocytosis by macrophages.

• B. IgG is a major antibody produced. It

activates the other parts of the immune
response and leads to neutralization and
destruction of pathogen.
Only antibody capable of crossing the
placental barrier
• C. IgA is the important antibody for the
mucosal immune response. It prevents
pathogens from crossing the epithelium and
entering the blood stream.

• D. IgE activates mast cells and leads to the

production of histamine, which is why it is also
associated with allergic reactions.

• E. IgD- Expressed on the surface of mature B

cells, works with IgM in B cell development;
appears to be involved in homeostasis
• What type of cell produces antibodies?
• Where are B cells produced?
• The antibody involved in allergy is ______.
• What will happen if a person cannot produce
antibodies?

• 1. B cells
• 2. In the bone marrow
• 3. IgE
• 4. This person becomes very susceptible to
diseases. They cannot effectively combat
pathogens and can eventually die from even
the mildest infections.
 Why is vaccination important?
• Most vaccines today contain an adjuvant
(substance that activates the innate immune
response) along with a protein antigen from the
pathogen, or an inactivated version of the
pathogen which stimulates B cells to produce
antibodies against the pathogen. After getting
the vaccine, you now have cells that remember
the pathogen and can act quickly when you
actually get infected with the disease-causing
organism. This memory of the B cells and quick
response prevents the person from feeling any
symptoms of the disease.
 Republic of the Philippines
Benguet State University
College of Natural Sciences
DEPARTMENT OF BIOLOGY
La Trinidad, Benguet 2601

Course Code: BIO 59

Course Title: Microbiology and Parasitology (LECTURE)

Modular Learning Guide # 5

Topic: PATHOGENIC MICROORGANISMS (PART 1)

A. Learning Outcomes
1. Describe the normal flora of microorganisms found in the different organ systems of the body
2. Identify microorganisms that cause diseases in the different organs systems of the human body
3. Describe the pathogenicity of the different microbial pathogens

B. Learning Content

INTRODUCTION

Pathology the scientific study of disease (pathos = suffering; logos = science)

*Pathology is first concerned with the cause, or etiology, of disease. Second, it deals with pathogenesis,
the manner in which a disease develops. Third, pathology is concerned with the structural and
functional changes brought about by disease and with their final effects on the body.

Infection the invasion or colonization of the body by pathogenic microorganisms

Disease occurs when an infection results in any change from a state of health
*Disease is an abnormal state in which part or all of the body is not properly adjusted or incapable of
performing its normal functions.

*An infection may exist in the absence of detectable disease. For example, the body may be infected
with the virus that causes AIDS, but there may be no symptoms of the disease.
*The presence of a particular type of microorganism in a part of the body where it is not normally found
is also called an infection --- and may lead to disease. For example, although large numbers of E. coli
are normally present in the healthy intestine, their infection of the urinary tract usually results in disease.

NORMAL MICROBIOTA

Read Me!

Animals, including humans, are generally free of microbes in utero. At birth, however, normal
and characteristic microbial populations begin to establish themselves. Just before a woman gives
birth, lactobacilli in her vagina multiply rapidly. The newborn's first contact with microorganisms is
usually with these lactobacilli, and they become the predominant organisms in the newborn's intestine.
More microorganisms are introduced to the newborn's body from the environment when breathing
begins and feeding starts. After birth, E. coli and other bacteria acquired from foods begin to inhabit
the large intestine. These microorganisms remain there throughout life and, in response to altered
environmental conditions, may increase or decrease in number and contribute to disease.

Many other usually harmless microorganisms establish themselves inside other parts of the
normal adult body and on its surface. A typical human body contains 1 x 1013 body cells, yet harbors
an estimated 1 x 1014 bacterial cells.

The microorganisms that establish more or less permanent residence (colonize) but that do not
produce disease under normal conditions are members of the body's normal microbiota, or normal
flora. Others, called transient microbiota, may be present for several days, weeks, or months and then

1|Page –JBE
disappear. Microorganisms are not found throughout the entire human body but are localized in
certain regions.

Representative Normal Microbiota by Body Region

2|Page –JBE
Relationships between the Normal Microbiota and the Host

Once established, the normal microbiota can benefit the host by preventing the overgrowth of
harmful microorganisms. This phenomenon is called microbial antagonism, or competitive exclusion.
Microbial antagonism involves competition among microbes. One consequence of this competition is
that the normal microbiota protect the host against colonization by potentially pathogenic microbes
by competing for nutrients, producing substances harmful to the invading microbes, and affecting
conditions such as pH and available oxygen. When this balance between normal microbiota and
pathogenic microbes is upset, disease can result.

For example, the normal bacterial microbiota of the adult human vagina maintains a local pH
of about 4. The presence of normal microbiota inhibits the overgrowth of the yeast Candida albicans,
which can grow when the balance between normal microbiota and pathogens is upset and when pH
is altered. If the bacterial population is eliminated by antibiotics, excessive douching, or deodorants,
the pH of the vagina reverts to nearly neutral, and C. albicans can flourish and become the dominant
microorganism there. This condition can lead to a form of vaginitis (vaginal infection).

Another example of microbial antagonism occurs in the large intestine. E. coli cells produce
bacteriocins, proteins that inhibit the growth of other bacteria of the same or closely related species,
such as pathogenic Salmonella and Shigella. A bacterium that makes a particular bacteriocin is not
killed by that bacteriocin, but may be killed by other ones. Bacteriocins are used in medical
microbiology to help identify different strains of bacteria.

Another bacterium, Clostridium difficile, is also in the large intestine. The normal microbiota of
the large intestine effectively inhibit C. difficile, possibly by making host receptors unavailable,
competing for available nutrients, or producing bacteriocins. However, if the normal microbiota are
eliminated (for example, by antibiotics), C. difficile can become a problem. This microbe is responsible
for nearly all gastrointestinal infections that follow antibiotic therapy, from mild diarrhea to severe or
even fatal colitis (inflammation of the colon).

The relationship between the normal microbiota and the host is called symbiosis, a relationship
between two organisms in which at least one organism is dependent on the other. In the symbiotic
relationship called commensalism, one of the organisms benefits, and the other is unaffected. Many
of the microorganisms that make up our normal microbiota arc commensals; these include the
corynebacteria that inhabit the surface of the eye and certain saprophytic mycobacteria that inhabit
the ear and external genitals. These bacteria live on secretions and sloughed-off cells, and they bring
no apparent benefit or harm to the host.

Mutualism is a type of symbiosis that benefits both organisms. For example, the large intestine
contains bacteria, such as E. coli, that synthesize vitamin K and some B vitamins. These vitamins are
absorbed into the bloodstream and distributed for use by body cells. In exchange, the large intestine
provides nutrients used by the bacteria, resulting in their survival.

In still another kind of symbiosis, one organism benefits by deriving nutrients at the expense of
the other; this relationship is called parasitism. Many disease-causing bacteria are parasites.

Opportunistic Microorganisms

Although categorizing symbiotic relationships by type is convenient, keep in mind that under
certain conditions the relationship can change. For example, given the proper circumstances, a
mutualistic organism, such as E. coli, can become harmful. E. coli is generally harmless as long as it
remains in the large intestine; but if it gains access to other body sites, such as the urinary bladder,
lungs, spinal cord, or wounds, it may cause urinary tract infections, pulmonary infections, meningitis, or
abscesses, respectively.

Microbes such as E. coli are called opportunistic pathogens. They ordinarily do not cause disease
in their normal habitat in a healthy person but may do so in a different environment. For example,
microbes that gain access through broken skin or mucous membranes can cause opportunistic
infections. Or, if the host is already weakened or compromised by infection, microbes that are usually
harmless can cause disease. AIDS is often accompanied by a common opportunistic infection,

3|Page –JBE
Pneumocystis pneumonia, caused by the opportunistic organism Pneumocystis carinii. This secondary
infection can develop in AIDS patients because their immune systems are suppressed.

Opportunistic pathogens possess other features that contribute to their ability to cause disease.
For example, they are present in or on the body or in the external environment in relatively large
numbers. Some opportunistic pathogens may be found in locations in or on the body that are
somewhat protected from the body's defenses, and some are resistant to antibiotics.

In addition to the usual symbionts, many people carry other microorganisms that are generally
regarded as pathogenic but that may not cause disease in those people.

C. Learning Activities
To be announced soon….

D. Assessment
To be announced soon….

E. Reference

(Copied from) TORTORA, G.J., FUNKE, B.R. and C. L. CASE. 2010. Microbiology: An Introduction. 10th
edition. Benjamin Cummings. USA.

4|Page –JBE
Objective: This PBL is intended to introduce you to the
diverse world of microbes by examining various cases of
infectious diseases presenting merely as cough. Apply
clinical nursing principles and research skills to determine
the nature of each disease.
 Chief Complaint: Cough and fever for 5 days

 History: Sean M., a 25-year old man, Filipino, developed a

transient productive cough three days prior to being seen by a
physician. It was reported that the patient had 2 days of colds
prior to the development of cough. There was associated mild
fever of 37.9˚ Celsius and no other related symptoms. Thinking
that he might have bacterial infection, patient decided to self-
medicate with Co-amoxiclav 625 mg tablet twice a day but did
not note any improvement in his symptoms.
 Physical Examination: The patient appears to be well with good
physical stature. His complexion is fair. He coughs occasionally. Vital
signs are as follows: blood pressure is 110/70, heart rate is 85
beats/minute with regular rhythm, respiratory rate of 21 cycles/minute
and temperature of 37.6˚ Celsius. Examination of the neck reveals no
lymph node enlargement. Auscultation reveals mild crackles diffused
all-over both lung fields. Percussion and auscultation of the heart
reveals no significant abnormality. Examination of the fingers was
unremarkable.

 Laboratory: WBC 16,000/mm3 (Increased); neutrophils 56%

(increased), lymphocytes 44% (increased)

 Course of Illness: Patient was then discharged with vitamin+zinc

supplementation. Patient then improved after 7 days.
 Yes, the disease is infectious based on the presence of:
a. Clinical symptoms of colds preceding cough, mild
fever, tachypnea and cough directing to a primary
diagnosis of pneumonia
b. The presence of elevated WBC and lymphocytosis
indicating a primary viral process
The most likely etiologic agent is:
Variable response: It might be rhinovirus, influenza,
adenovirus and to some degree RSV
 Viral agents  inhalation still the most common route 
PRIMARY INOCULATION AT THE NASAL CAVITY THUS
RESULTING TO COLDS  gradual descent to the
respiratory tree due to practices (i.e. swallowing of colds) or
simply release of viral particles/respiratory droplets via air
inhalation  failure to eliminate by immune response results
to inoculation  DIFFUSE DISTRIBUTION OF VIRAL
PARTICLES, HENCE, SHOWING AS DIFFUSE
INFILTRATES IN X-RAY  gradual elimination by immune
system
It is because antibiotics only work for bacteria.
Vitamin C: Immune booster and collagen repair
especially for points on inoculation/inflammation
Zinc: Immune booster only
Infant: RSV
Toddlers: RSV and Parainfluenza
School-age: RSV, Parainfluenza, Influenza
Young adults: Influenza, Adenovirus
Old age: Influenza
 Chief Complaint: Vomiting and Diarrhea

 History: M.D., a 20-year old male, college student presented to

the ER at 12:00 AM due to profuse vomiting and diarrhea. There is
no history of falls or trauma. The patient was allegedly fine when
he went to class this morning. At 10:00 AM, he ate fried rice topped
with shomai at a Chinese food cart for breakfast. At 12:30 PM, he
went back to the dorm for lunch. He re-heated a left-over potato
salad from his dinner last night. At 8 PM, he began to feel
nauseous and his stomach started rumbling. He had two episodes
of vomiting and 3 episodes of diarrhea during the night which
prompted his dorm master to take him to the hospital. During
physical assessment, the patient keeps asking you for water.
Physical Examination: The patient was conscious
and coherent but appeared weak. His vital signs are
as follows: BP is 100/60; HR is 105bpm; RR is
20cpm; T is 37˚C; SpO2 95%. His lips and oral
mucosa were dry but his skin turgor is fair. Pulses
are 1+, heart beat is tachycardic but with normal
rhythm. No S3 or S4 noted. Breath sounds are clear.
Abdominal examination reveals soft globular
abdomen, no tenderness, hyperactive bowel sounds.
Reflexes and muscle strength were normal.
Course of Illness: After stabilization, the patient
was admitted for observation. He was given an oral
rehydration solution. After 1 hospital day, he was
discharged without further complications.
 Patient’s Manifestations
Objective
Signs of dehydration:
-dry lips and oral mucosa
-Tachycardia (HR 105bpm) with 1+ pulse
-Hyperactive bowel sounds
Subjective
-History of vomiting and diarrhea
-Consumption of potato salad
-Keeps asking for water
Possible Condition- Classic Manifestations
Objective
-Vomiting and diarrhea (witnessed episodes)
-Hyperactive bowel sounds
-Signs of dehydration:
*dry lips and oral mucosa
*Poor skin turgor
*Sunken eyeballs
*Tachycardia (HR >100bpm) with weak pulse
*Hypotension (BP <90/60)
Subjective
-History of vomiting and diarrhea
-Abdominal pain
-Consumption of processed meat, custard
containing food, mayonnaise products, ice cream
Symptoms of dehydration;
*Thirst
 a. Morphology (give pictures)

S. aureus B. cereus C. perfringes

 b. Causative Toxin/Virulence factor

S. aureus B. cereus C. perfringes

Enterotoxin (Enterotoxin Enterotoxin Heat resistant spores

A) Epsilon toxin
 c. Food stuff usually contaminated

S. aureus B. cereus C. perfringes

Processed food, mayo, Fried rice, macaroni and High protein food
custard, ice cream cheese, improperly
stored meat and
vegetables
 d. Incubation period

S. aureus B. cereus C. perfringes

1-8 hours Emetic: 1-6 6-18

Diarrheal: 8-16
 e. Major signs and symptoms

S. aureus B. cereus C. perfringes

Vomiting and diarrhea Vomiting; diarrhea Diarrhea, nausea, mid-

epigastric pain
 f. Specific biochemical tests that differentiate them from other bacteria

S. aureus B. cereus C. perfringes

Catalase test Swarming motility, no Lecithinase test, nagler

Coagulase test lyses by gamma phage reaction with anti-alpha
toxin
 Most likely: S. aureus
 Pathophysiology:
Contamination of food by S. aureus  release of enterotoxin ingestion of
food with enterotoxin  enterotoxin induce non-specific activation of T
cell and inflammatory response  massive release of inflammatory
mediators by mast cells 
1.Stimulation of enteric nervous system  increase peristalsis  diarrhea
2. Stimulation of area postrema in the CNS  nausea and vomiting
Vomiting and diarrhea  increased fluid loss 
1. Increased heart rate
2. Dry oral mucosa
3. Increased thirst
 Nursing diagnoses: Fluid volume deficit related to
vomiting and diarrhea as evidenced by signs of
dehydration
 Basis:
Subjective: vomiting and diarrhea
Objective: signs of dehydration as stated previously
 Interventions:
-Regularly monitor vital signs and perform physical
examination for progression or relief of signs of dehydration
-Monitor intake and urine output
-Give ORS as ordered
-Allow patient to have adequate rest to conserve energy
-Educate about proper food handling and storage, reiterate
that toxin-contaminated food may not show any changes
 Proper ORS administration:
-Patient has some dehydration, give 75 ml/kg in first 4 hours.
Then reassess, and if patient still shows signs of dehydration,
repeat.
No. The condition is caused by the toxin and not
the organism. Once the toxin is flushed out of the
body, the patient will recover.