A Simple Guide to

Germs and Disease

June 2005
Microbiology (1)

Microbiology is the study of organisms not visible to the naked

eye, thus requiring the use of a microscope to see them
(i.e. microscopic organisms or sometimes called microbes)

Smallest

Prions
Viruses
Bacteria
Fungi
Protozoa

Largest
Microbiology (2)

What are Germs?

• Germs are microorganisms that are likely to cause disease

• Microorganisms are found throughout the environment. Only
a very small number are pathogenic, i.e. capable of causing
disease, and not all diseases are caused by microorganisms
• Some bacteria live in our gut and help to digest food.
Some yeasts and bacteria are used in baking, brewing
or cheese making
• Bacteria are just one type of micro-organism, alongside viruses,
fungi and protozoa
Germs* - Family Tree
Germs

Bacteria Viruses Fungi Protozoa

Gram Gram Non- Giardia

Enveloped
Positive Negative Enveloped Cryptosporidium

Rotavirus
Spore Non-Spore Influenza
Poliovirus Moulds Yeasts
Formers Formers HIv
SRSV

Salmonella
E.coli
Campylobacter

Bacillus subtilis
Cladosporium
Bacillus cereus Staphylococcus
Aspergillus Candida
Clostridium Listeria
Penicillium
perfringens

*Germs = all potentially harmful micro-organisms

Bacteria (1)

Bacteria are prokaryotes and have a characteristic cellular

organisation. They are simple, small, unicellular organisms, varying
in size between 1-20 um long

Bacteria can be classified by shape:

Spherical (coccus) Spiral/helical Rod (bacilli)

e.g. Staphylococcus aureus e.g. Treponema e.g Escherichia coli
Bacteria (2)

• Not all bacteria cause disease. Most bacterial species cannot

cause disease. Many even play beneficial roles e.g. producing
antibiotics. Our bodies are covered with commensal bacteria (the
normal flora)
• Even among bacteria that can cause disease, only a few species
are always pathogenic. Many free-living bacteria or members of
the normal flora are potentially pathogenic in certain types of
individual (particularly the immuno-compromised), but are most
of the time harmless
• Consumers tend to be very aware of pathogenic bacteria such as
Salmonella, Listeria and E.coli that have made headlines in
recent years in connection with outbreaks of food poisoning.
They often regard bacteria as modern problems that are more
hazardous than traditional “germs”
Bacterial Classification

The nature of the cell wall determines the classification of bacteria

as either Gram-positive or Gram-negative, as determined by the
Gram stain
• Gram-positive bacteria: cell wall is a thick multi-layer of
peptidoglycan (a mixture of sugars and amino acids)
• Gram-negative bacteria: cell wall is thin and surrounded by
an outer membrane (made up of lipopolysaccharides and lipoprotein)

Lipoteichoic
acids Outer
membrane

Cell wall lipoprotein

(peptidoglycan)
Cell membrane
(lipid bilayer)

Gram-positive Gram-negative
Bacterial Growth (1)

Given good growing conditions, a bacterium grows slightly in

size or length, new cell wall grows through the centre, and
the mother cell splits into two daughter cells.
If the environment is optimum, the two daughter cells may
split into four in 15-30 minutes.
This will continue for some time until the nutrients start to
run out or conditions become unstable.
Conditions are rarely optimum all of the time.
Bacterial Growth (2)

Typical Growth Curve for a Bacteria Population

• Lag Phase
growth is slow whilst they become used to their new environment and
nutrients
• Log Phase
once the metabolic machinery is running, they start multiplying
exponentially, doubling in number every few minutes
• Stationary Phase
as more and more bacteria are competing for nutrients which are
decreasing, growth stops and the number of bacteria stabilizes
• Death Phase
toxic waste products build up, nutrients have run out and the bacteria
begin to die
Bacterial Growth (3)

Typical bacterial growth rate Bacteria divide

in optimum conditions by binary fission
Time N° of bacteria
0 1
20 mins 2
2 hours 64
6 hours 262,144
8 hours 16,777,216
Typical growth curve
for a bacteria population
Log10 viable organisms/ml

8.0

6.0

4.0
and so on ...
2.0
Lag Log Stationary Death
0

Time
Bacteria and Temperature

HIGH 100
Campylobacter Cl botulinum A&B
Bacteria die if heated
Minimum for a sufficient time.
Growth Staph aureus
Cl perfringens The longer the time, the
Temp. E. coli greater the destruction
Salmonella
Cl botulinum E 63
Listeria
LOW Bacillus cereus 40

38
LOW HIGH
Heat resistance Bacteria
Bacteria
Bacteria Grow
grow grow at slower
• Pathogenic bacteria grow best at human body quickly rate
temperature 37ºC. However the majority will grow
between 15-45ºC 36
• Non-sporing cells of bacteria are killed at 15
temperatures above 60ºC. The length of time
ranges depending on the organism 7

• Boiling kills living cells, but will not kill all

bacterial spores Bacteria stop growing,
4 but do not die
• Fridges should be set below 5ºC. Some bacteria
such as Listeria monocytogenes can grow
at refrigeration temperatures 0
Bacterial Food Poisoning (1)

Because harmful microorganisms are present everywhere in

the environment, any food can become contaminated if not
properly handled before consumption. There are several
causes of food poisoning (bacteria, viruses, parasites,
chemicals)
• Infective bacterial food poisoning
infections occur when pathogens are ingested via contaminated food and
the bacteria is established in the body, usually growing inside the intestinal
tract and irritating intestines e.g. Salmonella spp. and Campylobacter jejuni.
The infection may involve subsequent growth in other tissues

• Toxic bacterial food poisoning

some bacteria grow in food and produce a toxin within the food
which is then consumed e.g. Bacillus cereus and Staphylococcus
aureus. When the food is consumed viable cells of the bacteria
do not need to be present. Other microorganisms in food may
produce harmful or deadly toxins while growing in the intestinal
tract e.g. Clostridium perfringens, enterotoxigenic Escherichia
coli and enterohaemorrhagic E. coli
Bacterial Food Poisoning (2)

The main causes of food poisoning are:

• preparing foods too far in advance

• not cooking foods properly
• storing foods wrongly; so bacteria grow rapidly
• cross contamination of foods after cooking
• infection from people handling foods due to poor hygiene
Bacterial Food Poisoning (3)

• Campylobacter jejuni
most common cause of diarrhoea
Sources: raw and undercooked poultry and meat, raw milk and untreated water

• Listeria monocytogenes
causes listeriosis, a serious disease for pregnant women,
babies, elderly and immunocompromised individuals
Sources: dairy products, soft cheeses, raw and undercooked meat, poultry and
meat patés

• Salmonella spp.
second most common cause of foodborne illness
Sources: raw and undercooked eggs,undercooked poultry and meat, dairy
products, fruits and vegetables
Bacterial Food Poisoning (4)

• Staphylococcus aureus
produces a toxin that causes vomiting shortly after ingesting
Sources: cooked foods high in protein e.g. cooked meats, custard, cream cakes

• E. coli O157
a bacterium that can produce a deadly toxin
Sources: undercooked hamburger/ minced beef, contaminated cooked meat
and raw milk

• Shigella spp.
poor hygiene causes this bacterium to be easily passed from
person to person
Sources: salads, milk and dairy products, and unclean water
Fungi (1)

• Fungi are eukaryotic and exist in different growth forms in

different environments. They range from small single cells such
as yeasts (~5um) to large complex structures
such as mushrooms (~5cm)

• The high humidity and temperatures often found in bathrooms

and kitchens are conducive to fungal growth. Mould, or mildew
as it is sometimes referred, likes warmth and moderate
to high humidity
Fungi (2)

Fungi responsible for human disease can be divided

into two distinct morphological forms
• Yeasts
which grow as oval or spherical single cells like bacteria and multiply by
budding and division

• Filamentous fungi
more commonly known as moulds, consist of long, branching hyphae
forming a mycelium. Asexual reproduction results in formation of spores
Fungal Growth

Bud formation Mother Daughter

Yeasts - unicellular
oval or spherical cells which divide by budding and division

Spore Hyphal Branched Mycelium

development hyphae

Filamentous fungi - branched hyphal structure

often pigmented with age. Reproduce by forming large amounts
of spores
Why are fungi a problem?

• They can be responsible for infections

• They can cause an allergic response
• Fungi cause discolouration and deterioration of household surfaces
giving the characteristic blackening of walls, tile grouting, plaster and
around window frames
• Can cause unpleasant odours which are difficult to disguise. Fungi such
as Aspergillus, Penicillium, and Alternata have been found to produce
volatile organic compounds
• Numerous fungi have been found to produce volatile organic compounds
(VOC) and it has been suggested that these affect the health of persons
living in mouldy houses. Symptoms include headache, eye, nose and
throat irritation and fatigue
• VOC’s have been implicated in health issues relating to sick building
syndrome
• Spores of toxigenic fungi contain mycotoxins (toxic secondary
metabolites). Many fungal spores are small enough to reach the alveoli
in the lungs. The mycotoxins may be transported via the blood from the
lung to other body sites, possibly causing other effects e.g. skin lesions
What infections do fungi cause?

Fungi cause 2 types of infection:

• Superficial mycoses
– fungus grows at the body surface in skin, hair and nails
– spread by direct contact, highly contagious and easily spread
to others
• e.g. Candida albicans (thrush and nappy rash)
• e.g. dermatophyte fungi: Epidermophyton, Microsporum and
Trichophyton (athlete’s foot)

• Deep mycoses
– involve internal organs, usually life-threatening
– rare except in immunocompromised people
– caused by opportunistic fungi (e.g. Aspergillus)
– acquired by inhalation of spores or by entry through wounds
– some part of the normal body flora and are harmless unless the
body’s defences are compromised in some way (e.g. Candida)
Fungi are also a source of allergens

• Allergic rhinitis (hayfever)

• Bronchitis
• Asthma
• Extrinsic allergic alveolitis

Almost all microbial allergens are fungal in origin, with the major
ones being Penicillium, Aspergillus, Cladosporium and Alternaria
Asthma can be initiated and provoked by allergens commonly
encountered in the general environment, for example pollens
(trees, grass), house dust mites and moulds, e.g. Alternaria
alternata, Cladosporium herbatum and Aspergillus fumigatus
Fungi in the Home

What evidence is there for occurrence of fungal

contamination in the home?
There have been a number of studies investigating fungi in the
home. Fungi isolated include:
• Penicillium spp.
• Cladosporium spp.
• Aspergillus spp.
• Mycelia sterilia
• Rhodotorula (pink yeasts)
• Sporobolomyces (yeasts)
Fungi isolated from the air was similar in homes surveyed in
Scotland, Germany, Finland, North America, Taiwan, Canada and
Australia
Viruses

What is a virus?
• It is not a bacterium
• It is very small, typically 0.1um
• It is not a true cell
• It is not an independently living organism. It must be inside
a living cell to replicate
• They have genetic material but lack cell membranes, cytoplasm and
machinery
• The virus uses the infected cell's machinery and enzymes to generate
virus parts which are later assembled into new virus particles which
leave the cell to infect other cells
• It can infect bacteria, fungi, plants, animals and man
• It may remain viable for long time, even in dry conditions
• It can survive but does not grow in food
Structure of Viruses

Classification based on characteristics such as genetic material present (RNA

or DNA), symmetry of virus particle and presence or absence of an envelope
Structurally there are 2 distinct types of virus:
Enveloped and Non-Enveloped
Non-enveloped Enveloped
Protein/lipid coat
Envelope
Protein Nucleic
coat acid

Polymerase

e.g. poliovirus e.g. hepatitis B e.g. herpes simplex

adenovirus HIV
rotavirus Flu
What infections do viruses cause? (1)

Nearly 1000 different types of viruses are known to infect

humans and it has been estimated that they account for
approx. 60% of human infections. The young, elderly and
immuno-compromised are particularly at risk from virus
infections

Many viral diseases are well known and easily

identified:
• from colds and flu to chicken pox and measles
• from mumps and herpes to polio, hepatitis and HIV
What infections do viruses cause? (2)

From the ‘Home Hygiene’ point of view, we are mainly concerned

with virus infections relating to poor personal or surface hygiene,
and are thus preventable

• Gastrointestinal infections
– Gastroenteritis
– Diarrhoea
– Infectious intestinal disease

• Respiratory infections
– Flu
– Common cold
– Bronchitis
Viruses causing Gastrointestinal Infections

• Rotavirus
– Most important viral cause of diarrhoea in children worldwide
– Infects virtually all children 3-5 years old in developed and developing
countries
– Can be asymptomatic excreter
• Small Round Structured Virus (SRSV)
– Play a predominant part in epidemic viral gastroenteritis
– Main symptom is projectile vomiting generating aerosols and virus can be
transmitted via aerosols, can contaminate work surfaces with potential for
subsequent transfer to food
• Astroviruses and Adenoviruses
– Have been associated with gastroenteritis outbreaks in schools, nursing
homes, day-care centres, children’s hospital wards
• Hepatitis A
– Viral hepatitis is most common of the food associated virus diseases,
most common vehicle is shellfish
– Easily spread in areas where good personal hygiene is not observed.
– Outbreaks occur in day-care centres, hospitals, nurseries and schools
– Outbreaks may lead to secondary cases in the general community
Viruses causing Respiratory Infections

Viral respiratory infections are common in winter when people are

crowded together indoors for longer periods of time, air in ill-
ventilated rooms is more humid, favouring survival of suspended
enveloped viruses
• Rhinoviruses and coronaviruses
together cause more than 50% of common colds can also cause acute
bronchitis
• Influenza viruses
main cause of flu, can cause acute bronchitis
• Parainfluenza viruses
cause of pneumonia in children
• Respiratory Syncytial Virus (RSV)
most important cause of bronchiolitis and pneumonia in infants major cause
of hospital-acquired illness on neonatal wards
• Adenovirus
common cause of sore throats and acute bronchitis
Virus Transmission (1)

Presence or absence of an envelope is the major

structural determinant for mode of transmission

• Non-enveloped viruses
most can withstand the acidic environment of the stomach
or detergent-like bile of the intestines. Transmitted by respiratory and
faecal-oral routes e.g. rotaviruses, SRSV

• Enveloped viruses
more fragile, require an intact envelope for infectivity, sensitive
to acids and detergents, so not spread via faecal-oral route; spread in
respiratory droplets, blood, saliva. e.g. influenza
Virus Transmission (2)

Activities of the infected host may increase

the efficiency of transmission

• Coughing and sneezing

viruses that are better at increasing fluid secretions or irritating
respiratory lining will induce more coughing and sneezing increasing
efficiency of shedding and transmission

• Diarrhoea
eliminates infection more rapidly but is great for contamination of the
environment and therefore will spread the microbes

• Projectile vomiting
generates aerosols, virus can be transmitted via aerosols, can
contaminate work surfaces with potential for subsequent transfer to
food
Protozoa (1)

• Protozoa are single-celled eukaryotes

• Live in water or moist places or other
organisms as parasites
• Have a resistant transmissable cyst
stage
• Transmission to humans via insect bite
or accidental ingestion of infective
stages
Protozoa (2)

• Cryptosporidium spp.
infects the intestines causing Cryptosporidiosis. Large outbreaks are
associated with contaminated water or treatment deficiency of water
supplies

• Giardia lamblia
causes giardiasis, an infection of the small intestine, spread via
contaminated food and water and by direct person-to-person contact.
Ingestion of one or more cysts may cause disease

• Entamoeba histolytica
an amoeba infecting the large intestine, causes diarrhoea/dysentery,
spread via contaminated water or food

• Toxoplasma gondii
causes toxoplasmosis, a very severe disease that can produce central
nervous system disorders
Hygiene Hazards In The Home

• Micro-organisms are introduced continually into the home via: people,

food, pets, water, insects, air. Wet sites such as sinks, toilets, dishcloths
and facecloths can also support microbial growth and themselves
become reservoirs of potentially hazardous microorganisms
• Many organisms occurring in the home are of little consequence.
Some organisms have the potential to cause infectious disease
• Some people carry highly pathogenic organisms without themselves
being affected - other family members unaware of hazard
• Hands, and a whole range of food and hand contact surfaces,
combine to provide transfer routes that can move pathogens around the
home and ultimately into the body producing infection

Ingestion of: Inhalation of:

• microorganisms - bacteria, • toxins
viruses, protozoa • allergens/spores
• toxins - bacterial, fungal • microorganisms
 Risk of health hazard from
Skin Direct Food
Primary sources Infection Ingestion Positioning
Inhalation

Moulds, viruses,
Air Moulds Mycotoxins Legionella,
G+bacteria
G-bacteria, G-bacteria,
Water Parasites Legionella
Protozoa, viruses viruses
Walls/Ceiling Moulds
Environment Dermatophytes,
Shower/bath/sink G-bacteria
G-bacteria
Toilet ? G-bacteria, viruses G-/G+bacteria
Kitchen G-/G+bacteria, G-/G+bacteria,
Surface/sink Listeria Listeria
Derm atophytes, Dustmites,
Furnishing/fabrics
viruses Moulds
G-/G+bacteria,
Cleaning aids G-/G+bacteria
Listeria
Utensils and G-/G+bacteria,
G-bacteria
equipment Listeria
Dermatophytes, G-bacteria, G-bacteria, G+bacteria,
People
viruses viruses? Staphylococcus viruses
Dermatophytes,
Pets Parasites, G-bacteria Hairfur, viruses?
viruses
Parasites,
Insect viruses, G-bacteria
G-bacteria