ISE Microbiology: A Systems Approach

6th Edition Marjorie Kelly Cowan

Professor
Visit to download the full and correct content document:
https://ebookmass.com/product/ise-microbiology-a-systems-approach-6th-edition-mar
jorie-kelly-cowan-professor/
 SIXTH EDITION

Marjorie Kelly Cowan

Heidi Smith
MICROBIOLOGY

Published by McGraw-Hill Education, 2 Penn Plaza, New York, NY 10121. Copyright ©2021 by McGraw-Hill
Education. All rights reserved. Printed in the United States of America. No part of this publication may be
reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the
prior written consent of McGraw-Hill Education, including, but not limited to, in any network or other electronic
storage or transmission, or broadcast for distance learning.

Some ancillaries, including electronic and print components, may not be available to customers outside the
United States.

This book is printed on acid-free paper.

1 2 3 4 5 6 7 8 9 LWI 24 23 22 21 20

ISBN 978-1-260-57151-6
MHID 1-260-57151-3

Cover Image: Science Photo Library/Alamy Stock Photo

All credits appearing on page or at the end of the book are considered to be an extension of the copyright page.

The Internet addresses listed in the text were accurate at the time of publication. The inclusion of a website does
not indicate an endorsement by the authors or McGraw-Hill Education, and McGraw-Hill Education does not
guarantee the accuracy of the information presented at these sites.

mheducation.com/highered
 Brief Contents

C H A P TE R 1 C H A P TE R 14
The Main Themes of Microbiology 1 Host Defenses I: Overview and
Nonspecific Defenses 385
C H A P TE R 2
The Chemistry of Biology 26 C H A P TE R 15
Host Defenses II: Specific Immunity
C H A P TE R 3 and Immunization 411
Tools of the Laboratory: Methods for the Culturing
and Microscopic Analysis of Microorganisms 53 C H A P TE R 16
Disorders in Immunity 445
C H A P TE R 4
Bacteria and Archaea 80 C H A P TE R 17
Diagnosing Infections 475
C H A P TE R 5
Eukaryotic Cells and Microorganisms 108 C H A P TE R 18
Infectious Diseases Affecting the Skin and Eyes 497
C H A P TE R 6
Viruses and Prions 140 C H A P TE R 19
Infectious Diseases Affecting the Nervous System 536
C H A P TE R 7
Microbial Nutrition and Growth 169 C H A P TE R 20
Infectious Diseases Affecting the Cardiovascular
C H A P TE R 8 and Lymphatic Systems 574
Microbial Metabolism: The Chemical
Crossroads of Life 197 C H A P TE R 21
Infectious Diseases Affecting the
C H A P TE R 9 Respiratory System 615
Microbial Genetics 229
C H A P TE R 22
C H A P TE R 10 Infectious Diseases Affecting the
Genetic Analysis and Genetic Engineering 264 Gastrointestinal Tract 652

C H A P TE R 11 C H A P TE R 23
Physical and Chemical Control of Microbes 288 Infectious Diseases Affecting the
Genitourinary System 700
C H A P TE R 12
Antimicrobial Treatment 316 C H A P TE R 24
Microbes and the Environment 735
C H A P TE R 13
Microbe–Human Interactions: C H A P TE R 25
Health and Disease 347 Applied Microbiology and Food and Water Safety 758

 iii
About the Authors

Kelly Cowan has taught microbiology to pre-nursing and allied health students
for over 20 years. She received her PhD from the University of Louisville and held
postdoctoral positions at the University of Maryland and the University of Groningen
in the Netherlands. Her campus, Miami University Middletown, is an open admissions
regional campus of Miami University in Ohio. She has also authored over 25 basic
research papers with her undergraduate and graduate students. For the past several
years, she has turned her focus to studying pedagogical techniques that narrow
the gap between underresourced students and well-resourced students. She is
past chair of the American Society for Microbiology’s Undergraduate Education
committee and past chair of ASM’s education division, Division W. ©Greg Zoeller

Having a proven educator as an integrated digital author

makes a proven learning system even better.
We are pleased to have Heidi Smith on the team. Heidi works hand-in-hand with the textbook author, creating
online tools that truly complement and enhance the book’s content. Because of Heidi, we offer you a robust digital
learning program, tied to Learning Outcomes, to enhance your lecture and lab, whether you run a traditional,
hybrid, or fully online course.

Heidi Smith leads the microbiology department at Front Range Community College in
Fort Collins, Colorado. Collaboration with other faculty across the nation, the development
and implementation of new digital learning tools, and her focus on student learning
outcomes have revolutionized Heidi’s face-to-face and online teaching approaches and
student performance in her classes. The use of digital technology has given Heidi the ability
to teach courses driven by real-time student data and with a focus on active learning and
critical thinking activities.
Heidi is an active member of the American Society for Microbiology and participated as
a task force member for the development of their Curriculum Guidelines for Undergraduate
Heidi Smith
Microbiology Education. At FRCC, Heidi directs a federal grant program designed to increase
student success in transfer and completion of STEM degrees at the local university as well as
facilitate undergraduate research opportunities for underrepresented students.
Off campus, Heidi spends as much time as she can enjoying the beautiful Colorado
outdoors with her husband and four children.

iv
 Preface

Students: d ! I th in k y o u will find it

microbial worl h us and with
Welcome to the rob es in te ra ct w it
a ti n g to u n d e rstand how mic th a t ea ch of you has
fascin th in g is u
e nvi ro n m e n t. The interesting ic ro b io lo g y . F or one thing, yo
ou r m
y h a d a lo t o f experience with h t n o w , a n d m uch of your
alread ri g
u g h ly p o p u la te d with microbes se s a n d other microbes
.
a re th o ro fr o m vi ru
e n et ic m a te ri a l actually came a d e x p e ri e n ce s with quite a
ow n g bably had some
b tly
n d w h il e y o u h a ve p ro
y o u h a ve ce rt ainly been grea
A s,
ic ro b es in th e form of disease
few m
n ef it ed b y th e m as well. st u d e n ts a n d doesn’ t require
b e so f
h is b o o k is su ited for all kind ch e m is try. If you are
T lo g y o r
y p re re q u is it e knowledge of bio p ro fe ss io n in some way, this
a n re
ri ng the health ca of
intere st ed in e n te
g ro u n d in the biology
o o k w il l g iv e y ou a stro n g b a ck
y o u w it h u n n ecessary details.
b in g
o rg a n is m s w it hout overwhelm fe ss io n s. A g rasp of this
micro hp ro
o rr y if y o u’ re not in the healt e a tt a in ed with this boo
k.
Don’ t w nd ca n b
for everyone — a
—Kelly Cowan
is im p o rt a n t
topic

 v
 ®

FOR INSTRUCTORS

You’re in the driver’s seat.

Want to build your own course? No problem. Prefer to use our turnkey,
prebuilt course? Easy. Want to make changes throughout the semester?
65%
Sure. And you’ll save time with Connect’s auto-grading too. Less Time
Grading

They’ll thank you for it.

Adaptive study resources like SmartBook® 2.0 help
your students be better prepared in less time. You
can transform your class time from dull definitions to
dynamic debates. Find out more about the powerful
personalized learning experience available in
SmartBook 2.0 at www.mheducation.com/highered
/connect/smartbook
Laptop: McGraw-Hill; Woman/dog: George Doyle/Getty Images

Make it simple, Solutions for your

make it affordable. challenges.
Connect makes it easy with seamless A product isn’t a solution. Real
integration using any of the major solutions are affordable and
Learning Management Systems— reliable, and come with training and
Blackboard®, Canvas, and D2L, among ongoing support when you need it
others—to let you organize your course and how you want it. Our Customer
in one convenient location. Give your Experience Group can also help
students access to digital materials at you troubleshoot tech problems—
a discount with our inclusive access although Connect’s 99% uptime
program. Ask your McGraw-Hill means you might not need to call
representative for more information. them. See for yourself at status
.mheducation.com
Padlock: Jobalou/Getty Images Checkmark: Jobalou/Getty Images
 FOR STUDENTS

Effective, efficient studying.

Connect helps you be more productive with your study time and get better grades using tools like
SmartBook 2.0, which highlights key concepts and creates a personalized study plan. Connect sets you
up for success, so you walk into class with confidence and walk out with better grades.

Study anytime, anywhere. “I really liked this

Download the free ReadAnywhere app and access your app—it made it easy
online eBook or SmartBook 2.0 assignments when it’s to study when you
convenient, even if you’re offline. And since the app don't have your text-
automatically syncs with your eBook and SmartBook 2.0
assignments in Connect, all of your work is available book in front of you.”
every time you open it. Find out more at
www.mheducation.com/readanywhere - Jordan Cunningham,
Eastern Washington University

No surprises.
The Connect Calendar and Reports tools keep you on track with the
work you need to get done and your assignment scores. Life gets busy;
Connect tools help you keep learning through it all.

Calendar: owattaphotos/Getty Images

Learning for everyone.

McGraw-Hill works directly with Accessibility Services
Departments and faculty to meet the learning needs
of all students. Please contact your Accessibility
Services office and ask them to e-mail
accessibility@mheducation.com, or visit
www.mheducation.com/about/accessibility
for more information.
Top: Jenner Images/Getty Images, Left: Hero Images/Getty Images, Right: Hero Images/Getty Images
Digital Tools for Your Success

Save time with auto-graded assessments.

Gather powerful performance data.
McGraw-Hill Connect for Cowan’s Microbiology provides online presentation,
assignment, and assessment solutions, connecting your students with the tools
and resources they’ll need to achieve success.

Homework and Assessment

With Connect for Cowan’s Microbiology, you can deliver
auto-graded assignments, quizzes, and tests online. Choose
from a robust set of interactive questions and activities
using high-quality art from the textbook and animations.
Assignable content is available for every Learning Outcome Detailed Reports
in the book and is categorized ­according to the ASM
Curriculum Guidelines. As an instructor, you can edit Track individual student performance—by question, by
assignment, or in relation to the class overall—with detailed
existing questions and author ­entirely new ones.
grade ­reports. Integrate grade reports easily with your
Significant faculty demand for Learning ­Management Systems (LMS).
content at higher Bloom’s
levels led us to examine
assessment quality and
consistency of our Connect
content, to develop a
scientific approach to
systemically increase critical-
thinking levels, and develop
balanced digital assessments
that promote student learning.
The increased challenge at
higher Bloom’s levels will help
the student grow intellectually
and be better prepared to
contribute to society.

Instructor Resources
Lecture Capture
Customize your lecture with tools such as PowerPoint®
McGraw-Hill Tegrity® Tegrity in Connect is a tool that makes
presentations, animations, and art from the textbook.
class time available 24/7 by automatically capturing every
An instructor’s manual for the text saves you time in
lecture. With a simple one-click, start-and-stop process, you
developing your course.
capture all computer screens and corresponding audio in a
format that is easy to search, frame by frame. Students can
replay any part of any class with easy-to-use, browser-based
viewing on a PC, Mac, or other mobile device.
viii
Unique Interactive Question Types in Connect® Tagged
to ASM’s Curriculum Guidelines for Undergraduate
Microbiology and to Bloom’s Taxonomy
•• Case Study: Case studies come to life in a learning activity that is interactive, self-grading, and assessable.
The integration of the cases with videos and animations adds depth to the content, and the use of integrated
questions forces students to stop, think, and evaluate their understanding.
•• Media Under The Microscope: The opening cases in the textbook help students read science articles in the
popular media with a critical eye. Questions in Connect are designed to extend these cases in a manner that
promotes active student learning, either at home or in the classroom.
•• Concept Maps: Concept maps allow students to manipulate terms in a hands-on manner in order to assess their
understanding of chapter-wide topics. Students become actively engaged and are given immediate feedback,
enhancing their understanding of important concepts within each chapter.
•• SmartGrid Questions: New to this edition, SmartGrid questions replace the traditional end-of-chapter questions,
and all of these questions are available for assignment in Connect. These questions were carefully constructed to
assess chapter material as it relates to all six concepts outlined in the American Society of Microbiology curriculum
guidelines plus the competency of “Scientific Thinking.” The questions are cross-referenced with Bloom’s taxonomy
of learning level. Seven concepts/competencies × three increasing Bloom’s levels = a robust assessment tool.
•• Study Smarter: Better Together: A new feature in every chapter, Study Smarter gives guidance for students’
group study, either in person or online. No instructor intervention required! Research shows that well-structured
group study benefits under-resourced learners and students with lower levels of reading ability.
•• What's the Diagnosis: Specifically designed for the disease chapters of the text, this is an integrated learning
experience designed to assess the student’s ability to utilize information learned in the preceding chapters to
successfully culture, identify, and treat a disease-causing microbe in a simulated patient scenario. This question
type is true experiential learning and allows the students to think critically through a real-life clinical situation.
•• Animations: Animation quizzes pair our high-quality animations with questions designed to probe student
understanding of the illustrated concepts.
•• Animation Learning Modules: Making use of McGraw-Hill Education’s collection of videos and animations,
this question type presents an interactive, self-grading, and assessable activity. These modules take a
stand-alone, static animation and turn it into an interactive learning experience for your students with real-time
remediation.
•• Labeling: Using the high-quality art from the textbook, check your students’ visual understanding as they
practice interpreting figures and learning structures and relationships. Easily edit or remove any label you wish!
•• Classification: Ask students to organize concepts or structures into categories by placing them in the correct “bucket.”
•• Sequencing: Challenge students to place the steps of a complex process in the correct order.
•• Composition: Fill in the blanks to practice vocabulary, and then reorder the sentences to form a logical
paragraph (these exercises may qualify as “writing across the curriculum” activities!).

All McGraw-Hill Connect content is tagged to Learning Outcomes for each chapter as well as topic, section, Bloom’s
Level, and ASM Curriculum Guidelines to assist you in customizing assignments and in reporting on your students’
performance against these points. This will enhance your ability to assess student learning in your courses by
allowing you to align your learning activities to peer-reviewed standards from an international organization.

 ix
Lab Resources

Need a lab manual for your microbiology course? Customize any of these manuals—
add your text material—and Create your perfect solution!
McGraw-Hill Education offers several lab manuals for the microbiology course. Contact your McGraw-Hill Education learning
technology representative for packaging options with any of our lab manuals.

Brown/Smith: Benson’s Microbiological Morello: Laboratory Manual and Workbook

Applications: Laboratory Manual in in Microbiology: Applications to Patient
General Microbiology, 14th edition Care, 12th edition (978-1-260-00218-8)
Concise Version (978-1-259-70523-6)
Complete Version (978-1-259-91979-4)

Chess: Laboratory Applications in

Microbiology: A Case Study Approach,
4th edition (978-1-259-70522-9)

Prep for Microbiology is an adaptive learning tool that

prepares students for college-level work in Microbiology.
Prep for Microbiology individually identifies concepts
the student does not fully understand and provides learning
resources to teach essential concepts so he or she enters the
classroom prepared. Data-driven reports highlight areas
where students are struggling, helping to accurately identify
weak areas.

x
 Note from the Authors
This Text’s Most Important Distinguishing Features:
These are the features we feel most strongly about. They
represent proven methods for enabling our students to learn
and we have seen them work in the classroom. The Cowan
books have always been built around logical and clear
organization, a factor that is critical when nonmajors are
attempting to learn a science full of new vocabulary and
concepts.
•• SYSTEMATIC ORGANIZATION of the disease chapters
that groups microbes by the conditions they cause.
•• EPIDEMIOLOGY in every disease table.
•• OPENING CASES that teach students how to read science
articles in the popular media with a critical eye.
•• MICROBIOME findings in all 25 chapters—in form of
Microbiome Insight boxes as well as in the text. This
reinforces how game-changing the microbiome
findings are.
•• STUDY SMARTER: BETTER TOGETHER in each chapter
that provides guidance for students’ group study, either in
person or online. No instructor intervention required!
Research shows that well-structured group study benefits
under-resourced learners and students with lower levels
of reading ability.
•• SMARTGRIDS in each chapter. The end-of-chapter
questions are dramatically reformatted into a 21-question
 xi
grid that cross-references questions by their Bloom’s level
and the six core concepts of microbiology (plus the
competency of scientific literacy) as identified by the
American Society for Microbiology.
•• VISUAL feature on the difference between the deadliness
and the contagiousness of various microbes that appears
in every disease chapter.
•• CLEAN, uncluttered, and predictable sequence of chapter
content.
•• CONNECT UPDATES
• C
 RITICAL THINKING applied through higher Bloom’s
level questions added to the Connect Question Bank.
• S
 MARTBOOK LEARNING RESOURCES added based on
heat map results from areas where students struggle
the most. Help when they need it, with a library of
resources available for refresher.
• S
 UB-SECTION LEARNSMART assignability to allow for
a more narrowed focus of chapters or further ability to
assign chapter content in smaller chunks for student
understanding.
—Kelly Cowan
—Heidi Smith
Capturing Students’ Attention and Learning

Chapter Opening Case Files That Teach Students How to Judge Popular Media
Articles About Science!
Each chapter opens with a revolutionary kind of case study. Titled “Media Under The Microscope,” these are summaries of
actual news items about microbiology topics. Students are walked through the steps of judging the relative accuracy of the
popular media stories. Chapter by chapter, they learn how to critically assess the journalistic accounts. They encounter the
principles of causation vs. correlation, biological plausibility, and the importance of not overstating experimental results. It is a
critical need among the public today, and this textbook addresses it.

Active learning activities are assignable in

Connect to extend these case files in or
outside of the classroom.

xii
Student-Focused Instructional Art
Effective science illustrations not only look pretty but
help students visualize complex concepts and
processes and paint a conceptual picture for them. The
art combines vivid colors, multidimensionality, and
self-contained narrative to help students study the
challenging concepts of microbiology from a visual
perspective. Drawings are often paired with
photographs or micrographs to enhance
comprehension.

Figures
Many difficult microbiological concepts are
best portrayed by breaking them down into
stages. These figures show each step clearly
marked with an orange, numbered circle and
correlated to accompanying narrative to benefit
all types of learners. The accompanying legend
provides additional explanation.

 xiii
Connecting Students to Their Future Careers
Many students taking this course will be entering the health care field in some way, and it is absolutely critical that they have a
good background in the biology of microorganisms. Authors Kelly Cowan and Heidi Smith have made it their goal to help all
students make the connections between microbiology and the world they see around them. Cowan textbooks have become
known for their engaging writing style, instructional art program, and focus on active learning. The “building blocks” approach
establishes the big picture first and then gradually layers concepts onto this foundation. This logical structure helps students
build knowledge and connect important concepts.

“Diagnosing Infections” Chapter

Chapter 17 brings together in one place the current methods
used to diagnose infectious diseases. The chapter starts
with collecting samples from the patient and details the
biochemical, serological, and molecular methods used to
identify causative microbes.

Systematic Presentation of
Disease-Causing Organisms
Microbiology: A Systems Approach takes a unique approach to
diseases by organizing microbial agents under the heading of the
disease condition they cause. After all of them are covered, the
agents are summarized in a comparative table. Every condition gets
a table, whether there is one possible cause or a dozen. Through
this approach, students study how diseases affect patients—the
way future health care professionals will encounter them in their
jobs. A summary table follows the textual discussion of each
disease and summarizes the characteristics of agents that can
cause that disease.

Every disease table contains national and/or

worldwide epidemiological information for each
causative agent.

This approach is logical, systematic, and intuitive, as it

encourages clinical and critical thinking in students—
the type of thinking they will be using if their eventual
careers are in health care. Students learn to examine
multiple possibilities for a given condition and grow
accustomed to looking for commonalities and
differences among the various organisms that cause
a given condition.

xiv
Student-Centered Pedagogy Created to Promote Active
Learning
Learning Outcomes and Assess Your Progress Questions
Every chapter in the book opens with an outline—which is a list of
Learning Outcomes. Assess Your Progress with the learning outcome
questions concludes each major section of the text. The Learning
Outcomes are tightly correlated to digital material. Instructors can
easily measure student learning in relation to the specific Learning
Outcomes used in their course.

Animated Learning Modules

Certain topics need help to come to life off the page. Animations, video,
audio, and text all combine to help students understand complex
processes. Key topics have an Animated Learning Module assignable
through Connect. An icon in the text indicates when these learning
modules are available.

Disease Connection
Sometimes it is difficult for students to see the relevance of
basic concepts to their chosen professions. So the basic
science chapters contain Disease Connections, very short
boxes that relate esoteric topics
such as pH and growth phase to
clinical situations (H. pylori and
M. tuberculosis, in these examples).

Insight Readings
Each chapter includes a
Microbiome Insight box and a
Clinical Insight box. The
Microbiome Insight boxes are a
way to emphasize the important
and revolutionary ways the recent
findings influence almost
everything we know about
human health.

 xv
System Summary Figures
“Glass body” figures at the end of each disease chapter
highlight the affected organs and list the diseases that were
presented in the chapter. In addition, the microbes are color
coded by type of microorganism.

Communicability vs. Deadliness Feature

Each microbe can be characterized using two
important descriptors: its relative communicability
and its relative deadliness. These are important
epidemiologically and clinically—and usually
receive only sporadic mention in textbooks—so
we have created a visual feature that appears
in each disease chapter, and in the
epidemiology chapter.

Taxonomic List of Organisms

A taxonomic list of organisms is presented at the
end of each disease chapter so students can see
the taxonomic position of microbes causing diseases
in that body system.

xvi
Developing Critical Thinkers
The end-of-chapter material is linked to Bloom’s Taxonomy. It has been carefully planned to promote active learning and
provide review for different learning styles and levels of difficulty.

SmartGrid
This innovative learning tool distributes
chapter material among the American Society
for Microbiology’s six main curricular concepts,
plus the competency of scientific thinking.
Each of the seven areas is probed at three
different Bloom’s levels. The resulting
21-question grid can be assigned by column
(all multiple-choice questions about each core
concept, for example) or by row (all questions
related to evolution, but at increasing Bloom’s
level). The highest Bloom’s level questions can
easily be assigned as a group project or
presentation topic.

High Impact Study Feature

Students benefit most from varied study and
assessment methods. We’ve created a short set
of “Terms” and “Concepts” that help students
identify the most important 10 to 15 items in a
chapter. If they understand these, they are well
on their way to mastery.

 xvii
Group Study Guide
The new feature “Study Smarter: Better Together”
gives students a format for their self-guided group study.
We know that group study can be immensely useful for
learning—but only if it is well-structured. This feature,
in every chapter, helps students make the best use of
their study time with their classmates, either in person
or virtually, with no effort on the part of the instructor!

Visual Connections
Visual Connections questions take images
and concepts learned in previous chapters
and ask students to apply that knowledge
to concepts newly learned in the current
chapter. This helps students evaluate
information in new contexts and enhances
learning.

xviii
 Changes to the Sixth Edition
New to Microbiology, A Systems Approach
GLOBAL CHANGES THROUGHOUT THE
SIXTH EDITION
•• Many art pieces have been turned into infographics, a form of
data visualization 21st-century learners are comfortable with.
•• Language is simplified throughout the book. Sentences
are shortened and general vocabulary is updated.
•• Disease Tables now indicate the taxonomy of each
microorganism.
•• The end-of-chapter materials now include the
SmartGrid—21 questions probing chapter content with
respect to the ASM curriculum concepts and Bloom’s
taxonomy. Also, each chapter contains a simple guide for
students to engage in face-to-face or virtual group study.
This is called Study Smarter: Better Together.
•• In all disease tables, each organism is denoted as “B, V, F,
P, or H”—indicating bacterium, virus, etc. When bacterial,
the table also indicates G+ or G-.
Major chapter updates or new material. Note: Each
chapter contains between 400 and 700 edits,
ranging from minor grammatical improvements to
major insertions of content. Listed here are just the
highlights.
Chapter 1: The Main Themes of Microbiology
•• New infographics for better understanding of cell types
•• More time on scientific methods
•• Updates on evolutionary history of cell line
•• Taxonomy and classification discussions clarified and
simplified
Chapter 2: The Chemistry of Biology
•• New elements named
•• Case study on why saline might not be ideal for hydration
(hint: it’s the chloride!)
Chapter 3: Tools of the Laboratory
•• In this chapter, there is typically a lot of terminology that
is used to describe phenomena, yet the terms themselves
are not defined (such as “what is growth?”); rewritten
with an eye to what the students do not yet know
•• New infographic to illustrate the “Five I’s”
Chapter 4: Bacteria and Archaea
•• New infographics that make different categories of
bacteria more visual
Chapter 5: Eukaryotic Cells and Microorganisms
•• Updated origins of eukaryotes narrative
•• Highlighted increase in fungal opportunistic diseases
•• Neglected parasitic infections (NPIs)
Chapter 6: Viruses and Prions
•• Discussion of viruses in the microbiome
•• New diseases caused by prions
Chapter 7: Microbial Nutrition, and Growth
•• Improved the presentation of serial dilution
•• Added origin of oxygen
Chapter 8: Microbial Metabolism
•• Expands on electricity-eating bacteria
Chapter 9: Microbial Genetics
•• Epigenetics and their connection with small RNAs
Chapter 10: Genetic Analysis and Genetic Engineering
•• Pangenomes introduced
•• CRISPR and gene drives updated
Chapter 11: Physical and Chemical Control of Microbes
•• Added the banning by the FDA of triclosan and other
chemicals in consumer products
Chapter 12: Antimicrobial Treatment
•• The influence of antibiotics on the microbiome,
throughout the lifespan
•• New approaches to antimicrobials
Chapter 13: Microbe-Human Interactions: Health and
Disease
•• Added the need to negotiate the host microbiome as one
of the steps required for microbes to cause disease
•• Several new figures
Chapter 14: Host Defenses I: Overview and Nonspecific
Defenses
•• Changed overall organization to more logical sequence
Chapter 15: Host Defenses II: Specific Immunity and
Immunization
•• New infographic about the properties of specific immunity
•• Information about vaccines for noninfectious conditions
and CAR-T treatments
 xix
Chapter 16: Disorders in Immunity
•• Updated discussion of causes of autoimmunity
•• Several new infographics
•• New information on asthma incidence
Chapter 17: Diagnosing Infections
•• Point-of-care diagnostics
•• More emphasis on genetic testing, qPCR, pan bacterial
qPCR
•• New infographics summarize the testing procedures for
phenotypic, genotypic, and immunological methods in a
visually consistent manner
Chapter 18: Infectious Diseases Affecting the Skin
and Eyes
•• Not new, but important: Retained and updated opening
case study about measles transmission in an airport
Chapter 19: Infectious Diseases Affecting the Nervous
System
•• Zika virus disease added
•• New prion described
Chapter 20: Infectious Diseases Affecting the
Cardiovascular and Lymphatic Systems
•• Updated the section on Rocky Mountain spotted fever
to include all spotted fever rickettsias and noted their
dramatic increase in the United States
xx
•• Discussion of CRISPR techniques for making mosquito
populations sterile
•• New figure detailing who gets AIDS in the United States
Chapter 21: Infectious Diseases Affecting the
Respiratory System
•• Updated differential diagnoses for pharyngitis and
pneumonia
Chapter 22: Infectious Diseases Affecting the
Gastrointestinal Tract
•• Updated the C. diff genus to Clostridioides
•• Updated foodborne disease trends
Chapter 23: Infectious Diseases Affecting the
Genitourinary System
•• More discussion of catheter-associated urinary tract
infections
•• Updated discussion on role of vaginal microbiome in
high infant mortality rates
•• Updated STI statistics
Chapter 24: Microbes and the Environment
•• Increased emphasis on climate change
Chapter 25: Applied Microbiology and Food and Water
Safety
•• Clearer illustration of water purification
 Acknowledgments

We are most grateful to our students who continually teach us how to more effectively communicate this
subject. All the professors who reviewed manuscript or sent e-mails with feedback were our close allies
as well, especially when they were liberal in their criticism. Jennifer Lusk contributed invaluable content to the
text. Our minders at McGraw-Hill Education are paragons of patience and professionalism: Darlene Schueller
is the best editor in the business, which makes it all the more surprising that she continues to work with us on
book after book. Other members of our McGraw-Hill Education team upon whom we lean heavily are Lauren
Vondra, Kristine Rellihan, Jim Connely, Jessica Portz, Beth Blech, Rachael Hillebrand, Lori Hancock, and Betsy
Blumenthal.
—Kelly Cowan
—Heidi Smith

Review Process, Including Heat Maps

In the preparation of each edition, we have been guided
by the collective wisdom of reviewers who are expert
microbiologists and excellent teachers. They represent
experience in community colleges, liberal arts colleges,
comprehensive institutions, and research universities. We
have followed their recommendations, while remaining
true to our overriding goal of writing a readable, student-
centered text. This edition has also been designed to be
amenable to a variety of teaching styles. Each feature
incorporated into this edition has been carefully
considered in how it may be used to support student
learning in both the traditional classroom and the flipped
learning environment.
Also we are very pleased to have been able to
incorporate real student data points and input, derived
from thousands of our LearnSmart users, to help guide
our revision. LearnSmart Heat Maps provided a quick
visual snapshot of usage of portions of the text and the
relative difficulty students experienced in mastering the
content. With these data, we were able to hone not only
our text content but also the LearnSmart questions.
•• If the data indicated that the subject covered was more
difficult than other parts of the book, as evidenced by a
high proportion of students responding incorrectly, we
substantively revised or reorganized the content to be
as clear and illustrative as possible.
•• I (Kelly) have spent some time researching student
literacy levels and have found that although most
students understand that there is a great deal of
technical language they must master for the first
time, they can have trouble with the way we
(professors, textbook authors) communicate in
writing. So the heat maps also point me to places
where I wrote a complex sentence when a simple
one would do.

 xxi
Table of Contents

Preface v Insight 2.2 CLINICAL: Acidic Blood in Diabetes 38

The Chemistry of Carbon and Organic

CHAPTER 1 Compounds 38
2.2 Macromolecules: Superstructures of Life 39
Carbohydrates: Sugars and Polysaccharides 40
The Main Themes of Microbiology 1 Lipids: Fats, Phospholipids, and Waxes 42
1.1 The Scope of Microbiology 2 Image Source
Proteins: Shapers of Life 44
1.2 The Impact of Microbes on Earth: Small The Nucleic Acids: A Cell Computer and
Organisms with a Giant Effect 4 Its Programs 46
Microbial Involvement in Shaping Our Planet 5 2.3 Cells: Where Chemicals Come to Life 48
1.3 Human Use of Microorganisms 6 Fundamental Characteristics of Cells 48
1.4 Infectious Diseases and the Human Condition 7 Media Under The Microscope Wrap-Up 49
Insight 1.1 CLINICAL: Infections of the Heroin Epidemic 9 Study Smarter: Better Together 49
Chapter Summary 50
1.5 The General Characteristics of Microorganisms 10
SmartGrid: From Knowledge to Critical Thinking 51
Cellular Organization 10
Visual Connections 52
1.6 The Historical Foundations of Microbiology 10
High Impact Study 52
The Development of the Microscope:
“Seeing Is Believing” 11
The Establishment of the Scientific Method 14
Deductive and Inductive Reasoning 14
Insight 1.2 MICROBIOME: What Is a Microbiome? 14
CHAPTER 3
The Development of Medical Microbiology 16 Tools of the Laboratory Methods for
1.7 Naming, Classifying, and Identifying Microorganisms 17 the Culturing and Microscopic Analysis Nikolay Denisov/123RF

Nomenclature: Assigning Specific Names 17 of Microorganisms 53

Classification: Constructing Taxonomy 18 3.1 Methods of Culturing Microorganisms:
The Origin and Evolution of Microorganisms 18 The Five I’s 54
A Universal Tree of Life 20 Inoculation: Producing a Culture 54
Media Under The Microscope Wrap-Up 21
Incubation 54
Study Smarter: Better Together 22
Media: Providing Nutrients in the Laboratory 55
Chapter Summary 23
Isolation: Separating One Species from Another 61
SmartGrid: From Knowledge to Critical Thinking 23
Rounding Out the Five I’s: Inspection
and Identification 62
Visual Connections 25
High Impact Study 25
3.2 The Microscope: Window on an Invisible
Realm 64
Microbial Dimensions: How Small Is Small? 64
Magnification and Microscope Design 65
CHAPTER 2 Principles of Light Microscopy 65
Insight 3.1 CLINICAL: A New Human Organ? 66
The Chemistry of Biology 26 Preparing Specimens for Optical
2.1 Atoms, Bonds, and Molecules: Microscopes 68
Paul Bradbury/Getty
Fundamental Building Blocks 27 Images Insight 3.2 MICROBIOME: Diabetic Wounds and
Different Types of Atoms: Elements Their Microbiome as Seen by Microscopy 74
and Their Properties 27 Media Under The Microscope Wrap-Up 75
The Major Elements of Life and Their Primary Study Smarter: Better Together 75
Characteristics 27 Chapter Summary 76
Bonds and Molecules 29 SmartGrid: From Knowledge to Critical Thinking 77
Insight 2.1 MICROBIOME: Thanks to the Sponge, and Its Visual Connections 79
Microbiome, for Letting Us Breathe 32 High Impact Study 79

xxii
 Contents xxiii

4
Chloroplasts: Photosynthesis Machines 118
CHAPTER Ribosomes: Protein Synthesizers 118
The Cytoskeleton: A Support Network 119
Bacteria and Archaea 80 Survey of Eukaryotic Microorganisms 120
©Rich Carey/
4.1 The Bacteria 81 5.4 The Fungi 121
Shutterstock
The Structure of a Generalized Bacterial Fungal Nutrition 121
Cell 82 Organization of Microscopic Fungi 123
Bacterial Arrangements and Sizes 82 Reproductive Strategies and Spore Formation 123
Insight 4.1 CLINICAL: Biofilms Complicate Infections 82 Fungal Identification and Cultivation 124
4.2 External Structures 86 The Effects of Fungi on Humans and the Environment 125
Appendages: Cell Extensions 86 Insight 5.1 MICROBIOME: Are Eukaryotic Microorganisms
Surface Coatings: The S Layer and the Glycocalyx 89 Part of Our Microbiome? 126
4.3 The Cell Envelope: The Boundary Layer of Bacteria 90 5.5 The Protists 127
Differences in Cell Envelope Structure 91 The Algae: Photosynthetic Protists 127
Structure of the Cell Wall 91 Biology of the Protozoa 127
Cytoplasmic Membrane Structure 93 Insight 5.2 CLINICAL: Eukaryotic Pathogens: Neglected Parasitic
The Gram-Negative Outer Membrane 93 Infections 128
The Gram Stain 94 Classification of Selected Important Protozoa 130
Practical Considerations of Differences in Cell Protozoan Identification and Cultivation 131
Envelope Structure 95 Important Protozoan Pathogens 131
4.4 Bacterial Internal Structure 95 5.6 The Helminths 132
Contents of the Cell Cytoplasm 95 General Worm Morphology 133
Bacterial Endospores: An Extremely Resistant Stage 97 Life Cycles and Reproduction 133
4.5 The Archaea 99 A Helminth Cycle: The Pinworm 133
4.6 Classification Systems for Bacteria and Archaea 100 Helminth Classification and Identification 134
Insight 4.2 MICROBIOME: Archaea in the Human Microbiome 101 Distribution and Importance of Parasitic Worms 134
Taxonomic Scheme 102 Media Under The Microscope Wrap-Up 135
Diagnostic Scheme 102 Study Smarter: Better Together 135
Species and Subspecies in Bacteria and Archaea 103 Chapter Summary 136
Media Under The Microscope Wrap-Up 103 SmartGrid: From Knowledge to Critical Thinking 137
Study Smarter: Better Together 103 Visual Connections 139
Chapter Summary 104 High Impact Study 139
SmartGrid: From Knowledge to Critical Thinking 105
Visual Connections 107
High Impact Study 107 CHAPTER 6
Viruses and Prions 140
5
Daryl Benson/Getty
6.1 The Search for the Elusive Viruses 141 Images
CHAPTER
6.2 The Position of Viruses in the Biological
Eukaryotic Cells and Spectrum 142
Microorganisms 108 Andrea Migliarini/123RF 6.3 The General Structure of Viruses 142
Size Range 142
5.1 Overview of the Eukaryotes 109
Viral Components: Capsids, Envelopes,
Becoming Eukaryotic 109
and Nucleic Acids 142
5.2 Form and Function of the Eukaryotic Cell: External
Structures and Boundary Structures 110 Insight 6.1 MICROBIOME: Are Viruses Part of the
Microbiome? 144
Appendages for Movement: Cilia and Flagella 111
The Glycocalyx 112 6.4 How Viruses Are Classified and Named 150
Boundary Structures 113 6.5 Modes of Viral Multiplication 150
5.3 Form and Function of the Eukaryotic Cell: Internal Multiplication Cycles in Animal Viruses 150
Structures 114 Viruses That Infect Bacteria 157
The Nucleus: The Control Center 114 Insight 6.2 CLINICAL: Phage Therapy in Cystic Fibrosis 159
Endoplasmic Reticulum: A Passageway in the Cell 114 6.6 Techniques in Cultivating and Identifying Animal
Golgi Apparatus: A Packaging Machine 116 Viruses 160
Nucleus, Endoplasmic Reticulum, and Golgi Apparatus: Using Live Animal Inoculation 160
Nature’s Assembly Line 116 Using Bird Embryos 161
Mitochondria: Energy Generators of the Cell 118 Using Cell (Tissue) Culture Techniques 161
xxiv Contents
6.7 Viruses and Human Health 162
6.8 Prions and Other Noncellular Infectious Agents
Media Under The Microscope Wrap-Up 163
Study Smarter: Better Together 163
Chapter Summary 164
SmartGrid: From Knowledge to Critical Thinking 165
Visual Connections 167
High Impact Study 168
CHAPTER 7 Phosphorylation 213
Microbial Nutrition and Growth 169
7.1 Microbial Nutrition 170 ChaNaWiT/Getty Images
Chemical Analysis of Microbial Cytoplasm 170
Sources of Essential Nutrients 171
How Microbes Feed: Nutritional Types 172
How Microbes Feed: Nutrient Absorption 175
The Movement of Molecules:
Diffusion and Transport 175
The Movement of Water: Osmosis 176
Active Transport: Bringing in Molecules Against a
Gradient 179
7.2 Environmental Factors That Influence Microbes 179
Temperature 179
Insight 7.1 CLINICAL: Inducing Fever to Treat
Infections 180
Gases 181
pH 183
Osmotic Pressure 183
Radiation and Hydrostatic Pressure and
Moisture 183
Insight 7.2 MICROBIOME: The Great Oxidation Event
and Earth’s Microbiome 184
Other Organisms 184
7.3 The Study of Microbial Growth 186
The Basis of Population Growth: Binary Fission 187
The Rate of Population Growth 187
The Population Growth Curve 188
Other Methods of Analyzing Population Growth 191
Media Under The Microscope Wrap-Up 192
Study Smarter: Better Together 193
Chapter Summary 194
SmartGrid: From Knowledge to Critical Thinking 194
Visual Connections 196
High Impact Study 196
8
CHAPTER
Microbial Metabolism The Chemical
Crossroads of Life 197 Image Source/Getty
Images
8.1 The Metabolism of Microbes 198
Enzymes: Catalyzing the Chemical Reactions of Life 199
Regulation of Enzymatic Activity and Metabolic
Pathways 203
8.2 The Pursuit and Utilization of Energy 206
162 Energy in Cells 206
A Closer Look at Oxidation and Reduction 206
Adenosine Triphosphate: Metabolic Money 207
8.3 Catabolism: Getting Materials and Energy 208
Overview of Catabolism 208
Aerobic Respiration 209
Pyruvic Acid: A Central Metabolite 211
The Krebs Cycle: A Carbon and Energy Wheel 211
The Respiratory Chain: Electron Transport and Oxidative
Summary of Aerobic Respiration 215
Insight 8.1 CLINICAL: NADH Treats a Variety of Diseases 216
Anaerobic Respiration 217
Fermentation 217
Catabolism of Noncarbohydrate Compounds 219
8.4 Biosynthesis and the Crossing Pathways of
Metabolism 219
The Efficiency of the Cell 220
Anabolism: Formation of Macromolecules 221
Assembly of the Cell 221
8.5 Photosynthesis: It All Starts with Light 221
Insight 8.2 MICROBIOME: Electricity Eaters 222
Light-­Dependent Reactions 223
Light-­Independent Reactions 223
Other Mechanisms of Photosynthesis 224
Media Under The Microscope Wrap-Up 224
Study Smarter: Better Together 225
Chapter Summary 226
SmartGrid: From Knowledge to Critical Thinking 227
Visual Connections 228
High Impact Study 228
CHAPTER 9
Microbial Genetics 229
9.1 Introduction to Genetics and Purestock/Superstock
Genes: Unlocking the Secrets of
Heredity 230
The Nature of the Genetic Material 231
The DNA Code: A Simple Yet Profound Message 232
The Significance of DNA Structure 232
DNA Replication: Preserving the Code
and Passing It On 233
9.2 Applications of the DNA Code: Transcription
and Translation 236
The Gene-­Protein Connection 237
The Major Participants in Transcription
and Translation 237
Insight 9.1 CLINICAL: Micro RNA: Tiny but Mighty 238
Transcription: The First Stage of Gene Expression 240
Translation: The Second Stage of Gene Expression 241
Eukaryotic Transcription and Translation: Similar Yet
Different 243
The Genetics of Animal Viruses 245
 Contents xxv

11
9.3 Genetic Regulation of Protein Synthesis 246
The Lactose Operon: A Model for Inducible Gene CHAPTER
Regulation in Bacteria 246
A Repressible Operon 248 Physical and Chemical Control
Phase Variation 249 of Microbes 288 Brian Hagiwara/
Stockbyte/Getty
Antibiotics That Affect Transcription and Translation 249 11.1 Controlling Microorganisms 289 Images
9.4 DNA Recombination Events 249 General Considerations in Microbial Control 289
Horizontal Gene Transfer in Bacteria 249 Relative Resistance of Microbial Forms 289
Pathogenicity Islands: Special “Gifts” Methods of Microbial Control 290
of Horizontal Gene Transfer? 254 What Is Microbial Death? 292
9.5 Mutations: Changes in the Genetic Code 255 How Antimicrobial Agents Work:
Causes of Mutations 255 Their Modes of Action 294
Categories of Mutations 256 11.2 Methods of Physical Control 295
Insight 9.2 MICROBIOME: Customizing the Microbiome 256 Heat as an Agent of Microbial Control 295
Repair of Mutations 257 The Effects of Cold and Desiccation 298
The Ames Test 257 Radiation as a Microbial Control Agent 299
Positive and Negative Effects of Mutations 257 Insight 11.1 CLINICAL: Hospitals Using New Tools Against
Media Under The Microscope Wrap-Up 259 Bacteria 302
Study Smarter: Better Together 259 Decontamination by Filtration: Techniques
Chapter Summary 260 for Removing Microbes 302
SmartGrid: From Knowledge to Critical Thinking 261 Osmotic Pressure 303
Visual Connections   262 11.3 Chemical Agents in Microbial Control 303
High Impact Study 263 Selecting a Microbicidal Chemical 304
Factors Affecting the Microbicidal Activity of Chemicals 304

10
Germicidal Categories According
to Chemical Group 304
CHAPTER
Insight 11.2 MICROBIOME: Hand Hygiene 308
Genetic Analysis and Genetic Media Under The Microscope Wrap-Up 311
Engineering 264 Digital Vision/Getty Study Smarter: Better Together 311
Images
10.1 Tools and Techniques of Genetic Chapter Summary 312
Engineering 265 SmartGrid: From Knowledge to Critical Thinking 313
DNA: The Raw Material 265 Visual Connections 315
Systems for Dicing, Splicing, and Reversing Nucleic High Impact Study 315
Acids 267

12
Analysis of DNA 268
Insight 10.1 MICROBIOME: Host Genetics and the CHAPTER
Microbiome 270
Methods in Recombinant DNA Technology: How to Imitate Antimicrobial Treatment 316
Nature 272 12.1 Principles of Antimicrobial Therapy 317 milos luzanin / Alamy;
10.2 Products of Recombinant DNA Technology 275 Gary He/McGraw-Hill
The Origins of Antimicrobial Drugs 318 Education
Genetically Modified Organisms 275 Starting Treatment 318
10.3 Genetic Treatments: Introducing DNA into the Body 276 Identifying the Agent 318
Gene Therapy 276 Testing for the Drug Susceptibility of
Small RNAs as Medicine 277 Microorganisms 318
CRISPR 277 The Art and Science of Choosing an Antimicrobial
Insight 10.2 CLINICAL: Gene Therapy Restoring Sight 278 Drug 321
10.4 DNA Analysis: Maps and Profiles 278 12.2 Interactions Between Drug and Microbe 322
Genome Sequencing 278 Mechanisms of Drug Action 322
Profiling 280 12.3 Survey of Major Antimicrobial Drug Groups 325
Measuring Gene Expression: Microarrays 282 Antibacterial Drugs Targeting the Cell Wall 325
Media Under The Microscope Wrap-Up 283 Antibacterial Drugs Targeting Protein Synthesis 327
Study Smarter: Better Together 284 Antibacterial Drugs Targeting Folic Acid Synthesis 329
Chapter Summary 285 Antibacterial Drugs Targeting DNA or RNA 329
SmartGrid: From Knowledge to Critical Thinking 286 Antibacterial Drugs Targeting Cell Membranes 329
Visual Connections 287 Antibiotics and Biofilms 329
High Impact Study 287 Agents to Treat Fungal Infections 330
xxvi Contents

Antiprotozoal and Antihelminthic Treatment 330 SmartGrid: From Knowledge to Critical Thinking 382
Antiviral Agents 331 Visual Connections 384
12.4 Antimicrobial Resistance 333 High Impact Study 384
Interactions Between Microbes and Drugs:

14
The Acquisition of Drug Resistance 333
The Human Role in Antimicrobial Resistance 335
CHAPTER
An Urgent Problem 336
Insight 12.1 CLINICAL: Using Viruses as Antibiotics 337 Host Defenses I Overview and
New Approaches to Antimicrobial Therapy 337 Nonspecific Defenses 385 Steven Schleuning
12.5 Interactions Between Drug and Host 338 14.1 Defense Mechanisms of the Host: An Overview 386
Toxicity to Organs 339 Tissues, Organs, and Cells Participating in Immunity 388
Allergic Responses to Drugs 339 14.2 The First Line of Defense 394
Suppression and Alteration of the Microbiota by Physical or Anatomical Barriers at the Body’s Surface 394
Antimicrobials 339 Nonspecific Chemical Defenses 395
Insight 12.2 MICROBIOME: Do Antibiotics Make Us Fat? 340 14.3 The Second Line of Defense 396
Media Under The Microscope Wrap-Up 342 Phagocytosis: Cornerstone of Inflammation and Specific
Study Smarter: Better Together 342 Immunity 396
Chapter Summary 343 Inflammation: A Complex Concert of Reactions to
SmartGrid: From Knowledge to Critical Thinking 344 Injury 398
Visual Connections 346 Insight 14.1 MICROBIOME: Are We Treating Autoimmune Diseases
High Impact Study 346 Correctly? 399
The Stages of Inflammation 399

13
Fever: An Adjunct to Inflammation 401
CHAPTER Insight 14.2 CLINICAL: Fever: To Treat or Not to Treat? 402
Antimicrobial Products 403
Microbe–Human Interactions Health Media Under The Microscope Wrap-Up 406
and Disease 347 michaeljung/Shutterstock Study Smarter: Better Together 406
13.1 The Human Host and Its Microbiome 348 Chapter Summary 407
Colonization, Infection, Disease—A Continuum 348 SmartGrid: From Knowledge to Critical Thinking 408
The Human Microbiome Project 348 Visual Connections 409
High Impact Study 410
Insight 13.1 MICROBIOME: Breast Cancer and the Breast
Microbiome 350
13.2 When Colonization Leads to Disease 353
Becoming Established: Step One—Portals of Entry 356
Becoming Established: Step Two—Attaching to the Host and
CHAPTER 15
Interacting with the Microbiome 357 Host Defenses II Specific Immunity
Becoming Established: Step Three—Surviving Host and Immunization 411 Gabriela Medina/Getty
Images
Defenses 358 15.1 Specific Immunity: The Third Line of
Step Four—Causing Disease 359 Defense 412
Step Five—Vacating the Host: Portals of Exit 363 A Brief Overview of the Major Immune System
Long-Term Infections and Long-Term Effects 364 Components 415
The Course of an Infection 364 Entrance and Presentation of Antigens 415
13.3 Epidemiology: The Study of Disease in Populations 365 Antigen Challenge and Clonal Selection 416
Reservoirs: Where Pathogens Persist 365 15.2 Step I: The Development of Lymphocyte Diversity 417
The Acquisition and Transmission of Infectious Agents 369 Specific Events in T-­Cell Development 417
Healthcare-Associated Infections: The Hospital as a Source Specific Events in B-­Cell Development 417
of Disease 372 Building Immunologic Diversity 417
Which Agent Is the Cause? Using Koch’s Postulates to Clonal Deletion and Selection 418
Determine Etiology 372 15.3 Step II: Presentation of Antigens 419
Insight 13.2 CLINICAL: Cell Phones in Hospitals 373 Characteristics of Antigens 420
Tracking Disease in a Population 373 Encounters with Antigens 421
Global Issues in Epidemiology 378 The Role of Antigen Processing and Presentation 421
Media Under The Microscope Wrap-Up 379 15.4 Step III: Antigenic Challenge of T Cells and B Cells 423
Study Smarter: Better Together 380 The Activation of T Cells and Their Differentiation into
Chapter Summary 381 Subsets 423

The Activation of B Cells: Clonal Expansion and Antibody
Production 423
15.5 Step IV (1): The T-­Cell Response 426
T Helper (TH) Cells 426
Regulatory T (TR) Cells: Cells That Maintain the Happy
Medium 426
Cytotoxic T (TC) Cells: Cells That Kill Other Cells 426
Insight 15.1 MICROBIOME: Cancer and the Microbiome 427
Gamma-Delta T Cells 427
Additional Cells with Orders to Kill 427
15.6 Step IV (2): The B-­Cell Response 428
The Structure of Immunoglobulins 428
Antibody-­Antigen Interactions
and the Function of the Fab 428
Functions of the Fc Fragment 430
Accessory Molecules on Immunoglobulins 430
The Classes of Immunoglobulins 431
Monitoring Antibody Production over Time: Primary and
Secondary Responses to Antigens 431
15.7 Specific Immunity and Vaccination 432
Artificial Passive Immunization: Immunotherapy 433
Artificial Active Immunity: Vaccination 434
Development of New Vaccines 436
Route of Administration and Side Effects of Vaccines 437
Vaccinating: Who and When? 437
Insight 15.2 CLINICAL: The Coalition for Epidemic Preparedness
Innovations 439
Media Under The Microscope Wrap-Up 439
Study Smarter: Better Together 440
Chapter Summary 441
SmartGrid: From Knowledge to Critical Thinking 442
Visual Connections 443
High Impact Study 444
CHAPTER 16
Disorders in Immunity 445
16.1 The Immune Response: A Two-­Sided Realistic Reflections
Coin 446
Hypersensitivity: Four Types 446
16.2 Type I Allergic Reactions: Atopy and Anaphylaxis 447
Insight 16.1 MICROBIOME: Asthma and the Airway—and
Gut—Microbiome 448
Who Is Affected, and How? 448
The Nature of Allergens and Their Portals of Entry 449
Mechanisms of Type I Allergy: Sensitization and
Provocation 450
Cytokines, Target Organs, and Allergic Symptoms 450
IgE-­and Mast-­Cell-­Mediated Allergic Conditions 452
Anaphylaxis: An Overpowering Systemic Reaction 454
Diagnosis of Allergy 454
Treatment of Allergy 455
Insight 16.2 CLINICAL: Take Two Hookworms and Call Me in the
Morning 456
Contents xxvii
16.3 Type II Hypersensitivities: Reactions That Lyse Foreign
Cells 456
The Basis of Human ABO Antigens and Blood Types 457
Antibodies Against A and B Antigens 458
The Rh Factor and Its Clinical Importance 459
Other RBC Antigens 459
16.4 Type III Hypersensitivities: Immune Complex
Reactions 461
Mechanisms of Immune Complex Disease 461
Types of Immune Complex Disease 461
16.5 Type IV Hypersensitivities: Cell-­Mediated (Delayed)
Reactions 462
Delayed Hypersensitivity to Microbes 462
Contact Dermatitis 462
T Cells and Their Role in Organ Transplantation 463
16.6 An Inappropriate Response Against Self:
Autoimmunity 465
Possible Causes of Autoimmune Disease 465
The Origins of Autoimmune Disease 465
Examples of Autoimmune Disease 466
16.7 Immunodeficiency Diseases: Hyposensitivity of the
Immune System 467
Primary Immunodeficiency Diseases 467
Secondary Immunodeficiency Diseases 469
Media Under The Microscope Wrap-Up 469
Study Smarter: Better Together 470
Chapter Summary 471
SmartGrid: From Knowledge to Critical Thinking 472
Visual Connections 474
High Impact Study 474
17
CHAPTER
Diagnosing Infections 475
17.1 Preparation for the Survey of Microbial
Diseases 476
kwanchai.c/Shutterstock
Phenotypic Methods 476
Immunologic Methods 476
Genotypic Methods 477
17.2 First Steps: Specimen Collection 477
Insight 17.1 MICROBIOME: The Human Microbiome Project and
Diagnosis of Infection 478
Overview of Laboratory Techniques 478
17.3 Phenotypic Methods 480
Immediate Direct Examination of Specimen 480
Methods Requiring Growth 480
Determining Clinical Significance of Cultures 482
17.4 Immunologic Methods 483
Different Kinds of Antigen-Antibody Interactions 483
In Vivo Testing 486
General Features of Immune Testing 486
17.5 Genotypic Methods 488
Polymerase Chain Reaction (PCR): The Backbone of New
Diagnostics 488
xxviii Contents

Hybridization: Probing for Identity 488 SmartGrid: From Knowledge to Critical Thinking 571
Whole-Genome Sequencing 489 Visual Connections 572
Pulsed-Field Gel Electrophoresis: Microbial High Impact Study 573
Fingerprints 490
17.6 Additional Diagnostic Technologies 490
Lab on a Chip 490
Mass Spectrometry 490
CHAPTER 20
Insight 17.2 CLINICAL: Quick Test for Zika 491 Infectious Diseases Affecting
Imaging 491 the Cardiovascular and Lymphatic Lipik Stock Media/
Shutterstock
Entirely New Diagnostic Strategies 492 Systems 574
Media Under The Microscope Wrap-Up 492
20.1 The Cardiovascular and Lymphatic Systems and Their
Study Smarter: Better Together 493 Defenses 575
Chapter Summary 494 The Cardiovascular System 575
SmartGrid: From Knowledge to Critical Thinking 494 The Lymphatic System 576
Visual Connections 496 Defenses of the Cardiovascular and Lymphatic
High Impact Study 496 Systems 576
20.2 Normal Biota of the Cardiovascular and Lymphatic

18
Systems 577
CHAPTER 20.3 Cardiovascular and Lymphatic System Diseases Caused by
Microorganisms 577
Infectious Diseases Affecting the Skin Insight 20.1 CLINICAL: Ebola 589
and Eyes 497 C. Zachariasen/ Insight 20.2 MICROBIOME: Gut Microbiome and High Blood
PhotoAlto
18.1 The Skin and Its Defenses 498 Pressure 605
18.2 Normal Biota of the Skin 500 Media Under The Microscope Wrap-Up 606
Insight 18.1 MICROBIOME: C-Section Babies vs. Vaginally Study Smarter: Better Together 607
Delivered Babies 500 Summing Up 608
18.3 Skin Diseases Caused by Microorganisms 501 Chapter Summary 609
SmartGrid: From Knowledge to Critical Thinking 612
Insight 18.2 CLINICAL: Skin, Staph, and Strep 504
Visual Connections 613
18.4 The Surface of the Eye and Its Defenses 522
High Impact Study 614
18.5 Normal Biota of the Eye 523
18.6 Eye Diseases Caused by Microorganisms 523
Media Under The Microscope Wrap-Up 527
Study Smarter: Better Together 528 CHAPTER 21
Summing Up 529
Infectious Diseases Affecting the
Chapter Summary 530
SmartGrid: From Knowledge to Critical Thinking 533
Respiratory System 615 Image Source

Visual Connections 534 21.1 The Respiratory Tract and Its Defenses 616
High Impact Study 535 21.2 Normal Biota of the Respiratory Tract 617
Insight 21.1 MICROBIOME: The Lungs Are Not Sterile 618

19
21.3 Upper Respiratory Tract Diseases Caused by
Microorganisms 618
CHAPTER
21.4 Diseases Caused by Microorganisms
Infectious Diseases Affecting the Affecting Both the Upper and Lower
Nervous System 536 Arshad Butt/AP Photo
Respiratory Tracts 627

19.1 The Nervous System and Its Defenses 537 Insight 21.2 CLINICAL: Influenza: A Time Line 632
19.2 Normal Biota of the Nervous System 538 21.5 Lower Respiratory Tract Diseases Caused by
Microorganisms 634
19.3 Nervous System Diseases Caused by
Media Under The Microscope Wrap-Up 645
Microorganisms 539
Study Smarter: Better Together 645
Insight 19.1 CLINICAL: Mysterious Polio-Like Disease 547
Summing Up 646
Insight 19.2 MICROBIOME: This Is Your Brain on Toxo 551 Chapter Summary 647
Media Under The Microscope Wrap-Up 565 SmartGrid: From Knowledge to Critical Thinking 649
Study Smarter: Better Together 566 Visual Connections 650
Summing Up 567 High Impact Study 651
Chapter Summary 568
Another random document with
no related content on Scribd:
Gutenberg™’s goals and ensuring that the Project Gutenberg™
collection will remain freely available for generations to come. In
2001, the Project Gutenberg Literary Archive Foundation was
created to provide a secure and permanent future for Project
Gutenberg™ and future generations. To learn more about the
Project Gutenberg Literary Archive Foundation and how your
efforts and donations can help, see Sections 3 and 4 and the
Foundation information page at www.gutenberg.org.

Section 3. Information about the Project

Gutenberg Literary Archive Foundation
The Project Gutenberg Literary Archive Foundation is a non-
profit 501(c)(3) educational corporation organized under the
laws of the state of Mississippi and granted tax exempt status by
the Internal Revenue Service. The Foundation’s EIN or federal
tax identification number is 64-6221541. Contributions to the
Project Gutenberg Literary Archive Foundation are tax
deductible to the full extent permitted by U.S. federal laws and
your state’s laws.

The Foundation’s business office is located at 809 North 1500

West, Salt Lake City, UT 84116, (801) 596-1887. Email contact
links and up to date contact information can be found at the
Foundation’s website and official page at
www.gutenberg.org/contact

Section 4. Information about Donations to

the Project Gutenberg Literary Archive
Foundation
Project Gutenberg™ depends upon and cannot survive without
widespread public support and donations to carry out its mission
of increasing the number of public domain and licensed works
that can be freely distributed in machine-readable form
accessible by the widest array of equipment including outdated
equipment. Many small donations ($1 to $5,000) are particularly
important to maintaining tax exempt status with the IRS.

The Foundation is committed to complying with the laws

regulating charities and charitable donations in all 50 states of
the United States. Compliance requirements are not uniform
and it takes a considerable effort, much paperwork and many
fees to meet and keep up with these requirements. We do not
solicit donations in locations where we have not received written
confirmation of compliance. To SEND DONATIONS or
determine the status of compliance for any particular state visit
www.gutenberg.org/donate.

While we cannot and do not solicit contributions from states

where we have not met the solicitation requirements, we know
of no prohibition against accepting unsolicited donations from
donors in such states who approach us with offers to donate.

International donations are gratefully accepted, but we cannot

make any statements concerning tax treatment of donations
received from outside the United States. U.S. laws alone swamp
our small staff.

Please check the Project Gutenberg web pages for current

donation methods and addresses. Donations are accepted in a
number of other ways including checks, online payments and
credit card donations. To donate, please visit:
www.gutenberg.org/donate.

Section 5. General Information About Project

Gutenberg™ electronic works
Professor Michael S. Hart was the originator of the Project
Gutenberg™ concept of a library of electronic works that could
be freely shared with anyone. For forty years, he produced and
distributed Project Gutenberg™ eBooks with only a loose
network of volunteer support.

Project Gutenberg™ eBooks are often created from several

printed editions, all of which are confirmed as not protected by
copyright in the U.S. unless a copyright notice is included. Thus,
we do not necessarily keep eBooks in compliance with any
particular paper edition.

Most people start at our website which has the main PG search
facility: www.gutenberg.org.

This website includes information about Project Gutenberg™,

including how to make donations to the Project Gutenberg
Literary Archive Foundation, how to help produce our new
eBooks, and how to subscribe to our email newsletter to hear
about new eBooks.