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CENTRAL LUZON DOCTORS' HOSPITAL EDUCATIONAL INSTITUTION, INC.

Romulo Highway, San Pablo, Tarlac City, Tarlac

Microbiology Parasitology Lecture

2nd Semester – Final Term
Self-Assessment Exercises

Name: Nazh Asher C. Tagaza

Section: BSN – 1E

Chapters 11-12 & 14 Self-Assessment Exercises

1. Differentiate between infectious, communicable, and contagious diseases.

 Infectious diseases are caused by pathogenic microorganisms, such as bacteria, viruses,
parasites or fungi; the diseases can be spread, directly or indirectly, from one person to
another.
 If you caught that disease from another person or animal, it is called a communicable
disease. These illnesses are usually caused by viruses or bacteria and are passed through
the air, through contact with contaminated surfaces, or through contact with bodily fluids.
 Contagious disease is a communicable disease that can spread rapidly from person to
person through direct contact (touching a person who has the infection), indirect contact
(touching a contaminated object), or droplet contact (inhaling droplets made when a
person who has the infection coughs, sneezes, or talks).

2. List the six components of the chain of infection.

i. Source Of Infection (the pathogen) - There must first be a pathogen. As an example, let
us assume that the pathogen is a cold virus
ii. Reservoir - There must be a source of the pathogen. The infected person (“Andy”) is the
reservoir.
iii. Portal Of Exit - There must be a portal of exit. When Andy blows his nose, cold viruses
get onto his hands.
iv. Mode Of Transmission - There must be a mode of transmission. The cold virus is being
transferred by direct contact between Andy and his friend (“Bob”) by shaking hands.
v. Portal Of Entry - There must be a portal of entry. When Bob rubs his nose, the cold virus
is transferred from his hand to the mucous membranes of his nose.
vi. Susceptible Host - There must be a susceptible host. For example, Bob would not be a
susceptible host if he had previously been infected by that particular cold virus and had
developed immunity to it.

3. List six reasons why an infection may not occur even though a pathogen is present.
i. The microbe may land at an anatomic site where it is unable to multiply. For example,
when a respiratory pathogen lands on the skin, it may be unable to grow there because
the skin lacks the necessary warmth, moisture, and nutrients required for growth of that
particular microbe. Additionally, the low pH and presence of fatty acids make the skin a
hostile environment for certain organisms.
ii. Many pathogens must attach to specific receptor sites (described later) before they are
able to multiply and cause damage. If they land at a site where such receptors are absent,
they are unable to cause disease.
iii. Antibacterial factors that destroy or inhibit the growth of bacteria (e.g., the lysozyme that
is present in tears, saliva, and perspiration) may be present at the site where a pathogen
lands.
iv. The indigenous microflora of that site (e.g., mouth, vagina, intestine) may inhibit growth
of the foreign microbe by occupying space and using up available nutrients. This is a
type of microbial antagonism, in which one microbe or group of microbes wards off
another.
v. • The indigenous microflora at the site may produce antibacterial factors (proteins called
bacteriocins) that destroy the newly arrived pathogen. This is also a type of microbial
antagonism.
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vi. The individual’s nutritional and overall health status often influences the outcome of the
pathogen–host encounter. A person who is in good health, with no underlying medical
problems, would be less likely to become infected than a person who is malnourished or
in poor health.

4. Discuss the disease process.

i. The incubation period is the time that elapses between arrival of the pathogen and the
onset of symptoms. The length of the incubation period is influenced by many factors,
including the overall health and nutritional status of the host, the immune status of the
host (i.e., whether the host is immunocompetent or immunosuppressed), the virulence of
the pathogen, and the number of pathogens that enter the body.
ii. The prodromal period is the time during which the patient feels “out of sorts” but is not
yet experiencing actual symptoms of the disease. Patients may feel like they are “coming
down with something” but are not yet sure what it is.
iii. The period of illness is the time during which the patient experiences the typical
symptoms associated with that particular disease (e.g., sore throat, headache, sinus
congestion). Communicable diseases are most easily transmitted during this third period.
iv. The convalescent period is the time during which the patient recovers. For certain
infectious diseases, especially viral respiratory diseases, the convalescent period can be
quite long. Although the patient may recover from the illness itself, permanent damage
may be caused by destruction of tissues in the affected area. For example, brain damage
may follow encephalitis or meningitis, paralysis may follow poliomyelitis, and deafness
may follow ear infections.

5. Define acute and chronic diseases.

 An acute disease has a rapid onset, usually followed by a relatively rapid recovery;
measles, mumps, and influenza are examples.
 A chronic disease has an insidious (slow) onset and lasts a long time; examples are
tuberculosis, leprosy (Hansen disease), and syphilis.
 Acute conditions are severe and sudden in onset. This could describe anything from a
broken bone to an asthma attack. A chronic condition, by contrast is a long-developing
syndrome, such as osteoporosis or asthma.

6. State the difference between primary and secondary diseases.

 One infectious disease may commonly follow another, in which case the first disease is
referred to as a primary infection and the second disease is referred to as a secondary
infection.
 Primary disease is a disease that is due to a root cause of illness, as opposed to secondary
disease, which is a sequela, or complication that is caused by the primary disease. For
example, a common cold is a primary disease, where rhinitis is a possible secondary
disease, or sequela.

7. State the difference between local and generalized infections.

 Once an infectious process is initiated, the disease may remain localized to one site or it
may spread. Pimples, boils, and abscesses are examples of localized infections.
 If the pathogens are not contained at the original site of infection, they may be carried to
other parts of the body by way of lymph, blood, or, in some cases, phagocytes. When the
infection has spread throughout the body, it is referred to as either a systemic infection or
a generalized infection.
 Systemic means affecting the entire body, rather than a single organ or body part. ... An
infection that is in the bloodstream is called a systemic infection. An infection that affects
only one body part or organ is called a localized infection.

8. List three factors associated with the virulence of a pathogen.

i. Bacterial fimbriae (pili) are long, thin, hairlike, flexible projections composed primarily
of an array of proteins called pilin.
ii. Bacterial capsules are considered to be virulence factors because they serve an
antiphagocytic function (i.e., they protect encapsulated bacteria from being
phagocytized by phagocytic white blood cells).
iii. Bacterial flagella are considered virulence factors because flagella enable flagellated
(motile) bacteria to invade aqueous areas of the body that nonflagellated (nonmotile)
bacteria are unable to reach.
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9. List and discuss eight factors that affect the Pathogenicity of bacteria.
i. An important identifying feature of S. aureus in the laboratory is its ability to produce a
protein called coagulase.
ii. Kinases (also known as fibrinolysins) have the opposite effect of coagulase. Sometimes
the host will cause a fibrin clot to form around pathogens in an attempt to wall them off
and prevent them from invading deeper into body tissues.
iii. The “spreading factor,” as hyaluronidase is sometimes called, enables pathogens to
spread through connective tissue by breaking down hyaluronic acid, the polysaccharide
“cement” that holds tissue cells together.
iv. The enzyme collagenase, produced by certain pathogens, breaks down collagen (the
supportive protein found in tendons, cartilage, and bones). This enables the pathogens
to invade tissues.
v. Hemolysins are enzymes that cause damage to the host’s red blood cells (erythrocytes).
Not only does the lysis (bursting or destruction) of red blood cells harm the host, but it
also provides the pathogens with a source of iron.
vi. C. perfringens, the major cause of gas gangrene, is able to rapidly destroy extensive
areas of tissue, especially muscle tissue. One of the enzymes produced by C.
perfringens, called lecithinase, breaks down phospholipids that are collectively referred
to as lecithin.
vii. Septicemia (often referred to as sepsis) is a very serious disease consisting of chills,
fever, prostration (extreme exhaustion), and the presence of bacteria or their toxins in
the bloodstream.
viii. Exotoxins are poisonous proteins that are secreted by a variety of pathogens; they are
often named for the target organs that they affect. Examples include neurotoxins,
enterotoxins, cytotoxins, exfoliative toxin, erythrogenic toxin, and diphtheria toxin.

10. Define epidemiology and the following types of diseases epidemic, endemic, pandemic,
sporadic, and non-endemic diseases.
 Epidemiology is the study of factors that determine the frequency, distribution, and
determinants of diseases in human populations, and ways to prevent, control, or eradicate
diseases in populations.
 Endemic diseases are diseases that are always present within the population of a
particular geographic area. The number of cases of the disease may fluctuate over time,
but the disease never dies out completely.
 Non endemic disease is the opposite of endemic
 An epidemic (or outbreak) is defined as a greater than usual number of cases of a disease
in a particular region, usually occurring within a relatively short period of time. An
epidemic does not necessarily involve a large number of people, although it might. If a
dozen people develop staphylococcal food poisoning shortly after their return from a
church picnic, then that constitutes an epidemic—a small one, to be sure, but an epidemic
nonetheless.
 A pandemic disease is a disease that is occurring in epidemic proportions in many
countries simultaneously— sometimes worldwide.
 A sporadic disease is a disease that occurs only occasionally (sporadically) within the
population of a particular geographic area, whereas an endemic disease is a disease that is
always present within that population.

11. List three factors that contribute to an epidemic.

i. 1992–1993. An epidemic involving Escherichia coli O157:H7-contaminated hamburger
meat occurred in the Pacific northwest. It resulted in approximately 500 diarrheal cases,
45 cases of kidney failure as a result of hemolytic uremic syndrome (HUS), and the
death of several young children. E. coli O157:H7 is a particularly virulent serotype of E.
coli; it is also known as enterohemorrhagic E. coli. In this epidemic, the source of the E.
coli was cattle feces. The ground beef used to make the hamburgers had been
contaminated with cattle feces during the slaughtering process. The hamburgers had not
been cooked long enough, or at a high enough temperature, to kill the bacteria.
ii. 1993. An epidemic of hantavirus pulmonary syndrome (HPS) occurred on Native
American reservations in the Four Corners region (where the borders of Colorado, New
Mexico, Arizona, and Utah all meet). It resulted in approximately 50 to 60 cases,
including 28 deaths. The particular hantavirus strain (now called Sin Nombre virus) was
present in the urine and feces of deer mice, some of which had gained entrance to the
homes of villagers. Aerosols of the virus were produced when residents swept up house
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dust containing the rodent droppings. The pathogen was then inhaled by individuals in
those homes.
iii. 1993. An epidemic of cryptosporidiosis (a diarrheal disease) occurred in Milwaukee,
Wisconsin. It resulted from drinking water that was contaminated with the oocysts of
Cryptosporidium parvum (a protozoan parasite). This epidemic is described more fully
later in this chapter.

12. List six reservoirs of infection.

i. The most important reservoirs of human infectious diseases are other humans—people
with infectious diseases as well as carriers.
ii. Passive carriers carry the pathogen without ever having had the disease.
iii. An incubatory carrier is a person who is capable of transmitting a pathogen during the
incubation period of a particular infectious disease.
iv. Nonliving or inanimate reservoirs of infection include air, soil, dust, food, milk, water,
and fomites.
v. Technically, arthropods are animals, but they are being discussed here separately from
other animals because, as a group, they are so commonly associated with human
infections.
vi. As previously stated, infectious diseases that humans acquire from animal sources are
called zoonotic diseases or zoonoses. Many pets and other animals are important
reservoirs of zoonoses.

13. List five modes of disease transmission.

i. Direct skin-to-skin contact. For example, the common cold virus is frequently
transmitted from the hand of someone who just blew his or her nose to another person
by hand shaking. Within hospitals, this mode of transfer is particularly prevalent, which
is why it is so important for healthcare professionals to wash their hands before and
after every patient contact. Frequent handwashing will prevent the transfer of pathogens
from one patient to another.
ii. Direct mucous membrane-to-mucous membrane contact by kissing or sexual
intercourse. Most STDs are transmitted in this manner. STDs include syphilis,
gonorrhea, and infections caused by chlamydia, herpes, and HIV. Chlamydial genital
infections are especially common in the United States; in fact, they are the most
common nationally notifiable infectious diseases in the United States. (Nationally
notifiable infectious diseases are discussed later in this chapter.)
iii. • Indirect contact via airborne droplets of respiratory secretions, usually produced as a
result of sneezing or coughing. Most contagious airborne diseases are caused by
respiratory pathogens carried to susceptible people in droplets of respiratory secretions.
Some respiratory pathogens may settle on dust particles and be carried long distances
through the air and into a building’s ventilation or air-conditioning system. Improperly
cleaned inhalation therapy equipment can easily transfer these pathogens from one
patient to another. Diseases that may be transmitted in this manner include colds,
influenza, measles, mumps, chickenpox, smallpox, and pneumonia.
iv. • Indirect contact via food and water contaminated with fecal material. Many infectious
diseases are transmitted by restaurant food handlers who fail to wash their hands after
using the restroom.
v. • Indirect contact via arthropod vectors. Arthropods such as mosquitoes, flies, fleas,
lice, ticks, and mites can transfer various pathogens from person to person.

14. Discuss the procedure for stopping an epidemic.

 Disease outbreaks affect the social fabric of communities. A community is a social
network, and infectious diseases outbreaks are deeply linked to the social life, the
structure of society and people’s interactions. They spread through personal and social
contacts and links at home or during professional and recreational activities.
 Communities are the main actors in preventing, identifying, responding and recovering
from the physical, psychological, social and economic impacts of epidemics.
Communities are not passive subjects of interventions.
 Community understanding of diseases and their spread is complex, context-dependent
and culturally mediated. Thus, a one-sizefits-all approach is neither desirable nor
effective.
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 . Community engagement helps to strengthen and ensure resilience to future outbreaks:

when people have already learned how to implement their own solutions, they will be
better able to deal with the next outbreak.
 The approach and messaging directed towards each community has to evolve with the
epidemic and incorporate new messages and communication methods as it unfolds.
These messages must also proactively detect misinformation and rumours. Effective
community engagement limits the opportunities for misunderstandings and the
proliferation of rumours, and it mitigates the spread of fear and anxiety.
 Identify people that the community trusts and build relationships with them. Involve
them in decision-making to ensure interventions are collaborative, contextually
appropriate and that communication is community-owned.

Chapter 13 Self-Assessment Exercises

1. List six factors that have contributed to an increase in hospital-acquired infections.

i. Infections that are acquired within hospitals or other healthcare facilities (called
healthcare-associated infections or HAIs).
ii. Infections that are acquired outside of healthcare facilities (called community-acquired
infections).
iii. An iatrogenic infection is an infection that results from medical or surgical treatment—
an infection that is caused by a surgeon, another physician, or some other healthcare
worker.
iv. Catheter-associated urinary tract infection (CAUTI) - is one of the most common
infections a person can contract in the hospital, according to the American Association
of Critical-Care Nurses.
v. Central line-associated bloodstream infection (CLABSI) - is defined as a laboratory-
confirmed bloodstream infection not related to an infection at another site that develops
within 48 hours of a central line placement.
vi. Surgical site infection (SSI) - is an infection that occurs after surgery in the part of the
body where the surgery took place. Surgical site infections can sometimes be superficial
infections involving the skin only.

2. List areas in the hospital where nosocomial infections are most probable.
 The hospital environment harbors many pathogens and potential pathogens. Some live on
and in healthcare professionals, other hospital employees, visitors to the hospital, and
patients themselves. Others live in dust or wet or moist areas.
 Sink Drains
 Showerheads
 Whirlpool Baths
 Mop Buckets
 Flower Pots
 Even food from the kitchen

3. List several types of patients who are extremely vulnerable to infectious diseases.
 Elderly patients
 Women in labor and delivery
 Premature infants and newborns
 Surgical and burn patients
 Patients with diabetes or cancer
 Patients with cystic fibrosis
 Patients having an organ transplant
 Patients receiving treatment with steroids, anticancer drugs, antilymphocyte serum, or
radiation
 Immunosuppressed patients (i.e., patients whose immune systems are not functioning
properly
 Patients who are paralyzed or are undergoing renal dialysis or urinary catheterization
 Patients with indwelling devices such as endotracheal tubes, central venous and arterial
cathers, and synthetic implants
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4. Write a brief description of reverse isolation and source isolation.

 Reverse isolation is used to protect you from germs when your immune system is not
working properly. Germs can be carried on droplets in the air, medical equipment, or
another person's body or clothing.
 Source Isolation aims to confine the infectious agent and prevent its spread from one
patient to another.

5. Briefly describe important procedures to follow in standard precautions.

 Standard Precautions provide infection prevention guidelines regarding hand hygiene;
wearing of gloves, gowns, masks, eye protection; respiratory hygiene/cough etiquette;
safe injection practices; lumbar puncture; cleaning of patient-care equipment;
environmental control (including cleaning and disinfection); handling of soiled linens;
handling and disposal of used needles and other sharps; resuscitation devices; and patient
placement

6. Discuss the role of healthcare professional in the collection of clinical specimens.

 Healthcare professionals who collect and transport clinical specimens should exercise
extreme caution during the collection and transport of clinical specimens to avoid
sticking themselves with needles, cutting themselves with other types of sharps, or
coming in contact with any type of specimen.
 Healthcare personnel who collect clinical specimens must strictly adhere to the safety
policies known as Standard Precautions.

7. List types of specimens that usually must be collected from patients

 Blood consists of a mixture of cells and fluid (Fig. 13-2). Within the human body, the
liquid portion of blood is called plasma; it makes up about 55% of the volume of blood.
 Urine is ordinarily sterile while it is in the urinary bladder.
 Sputum is pus that accumulates deep within the lungs of a patient with pneumonia,
tuberculosis, or other lower respiratory infection.
 Wound specimen should be an aspirate (i.e., pus that has been collected using a small
needle and syringe assembly), rather than a swab specimen.
 fecal specimens (stool specimens) should be collected at the laboratory and processed
immediately to prevent a decrease in temperature, which allows the pH to drop, causing
the death of many Shigella and Salmonella species.

8. Discuss general precautions that must be observed during collection and handling of
specimens.
 The specimen must be properly selected. That is, it must be the appropriate type of
specimen for diagnosis of the suspected infectious disease.
 The specimen must be properly and carefully collected. Whenever possible, specimens
must be collected in a manner that will eliminate or minimize contamination of the
specimen with indigenous microflora.
 The material should be collected from a site where the suspected pathogen is most likely
to be found and where the least contamination is likely to occur.
 Whenever possible, specimens should be obtained before antimicrobial therapy has
begun. If this is not possible, the laboratory should be informed as to which antimicrobial
agent(s) the patient is receiving.
 The acute stage of the disease—when the patient is experiencing the symptoms of the
disease—is the appropriate time to collect most specimens. Some viruses, however, are
more easily isolated during the prodromal or onset stage of disease.

9. Describe proper procedures for obtaining specimens.

 Specimen collection should be performed with care and tact to avoid harming the patient,
causing discomfort, or causing undue embarrassment. If the patient is to collect the
specimen, such as sputum or urine, the patient must be given clear and detailed collection
instructions.
 A sufficient quantity of the specimen must be obtained to provide enough material for all
required diagnostic tests. The amount of specimen to collect should be specified in the
Lab P&P Manual.
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10. Describe the organization of the Pathology Department and the Clinical Microbiology
Laboratory.
 The Pathology Department is under the direction of a pathologist (a physician who has
had extensive, specialized training in pathology—the study of the structural and
functional manifestations of disease). Pathology Department consists of two major
divisions: Anatomical Pathology and Clinical Pathology.
 Most pathologists work in Anatomical Pathology, where they perform autopsies in the
morgue and examine diseased organs, stained tissue sections, and cytology specimens.
Other healthcare professionals employed in Anatomical Pathology include cytogenetic
technologists, cytotechnologists, histologic technicians, histotechnologists, and
pathologist’s assistants.
 Clinical Pathology consists of several other laboratories: the Clinical Chemistry
Laboratory (or Clinical Chemistry/ Urinalysis Laboratory), the Hematology Laboratory
(or Hematology/Coagulation Laboratory), the Blood Bank (or Immunohematology
Laboratory), and the Immunology Laboratory.

11. List ten phenotypic characteristics of value when attempting to identify bacterial pathogens
i. Gram reaction (i.e., Gram-positive or Gram-negative)
ii. Cell shape (e.g., cocci, bacilli, curved, spiral-shaped, filamentous, branching)
iii. Morphologic arrangement of cells (e.g., pairs, tetrads, chains, clusters)
iv. Growth or no growth on various types of plated media
v. Colony morphology (e.g., color, general shape, elevation, margin)
vi. Presence or absence of a capsule
vii. Motility
viii. Number and location of flagella
ix. Ability to sporulate
x. Location of spores (terminal or subterminal)

12. Discuss the importance of quality control in a microbiology laboratory

 The CML is sometimes called on to assume an additional responsibility, namely the
processing of environmental samples (i.e., samples collected from within the hospital
environment). Such samples are processed by the CML whenever there is an outbreak or
epidemic within the hospital, in an attempt to locate the source of the pathogen involved.
Environmental samples include those collected from appropriate hospital sites (e.g.,
floors, sink drains, showerheads, whirlpool baths, respiratory therapy equipment) and
employees (e.g., nasal swabs, material from open wounds).

13. List sources of water contamination

 Wastewater and Sewage. The wastewater and sewage that is produced by every home is
treated with chemicals and then released into the sea.
 Industrial Waste
 Fossil Fuels
 Sewer Line Leaks
 Fertilizers and Pesticides

14. Describe how water and sewage are usually treated

 Removing contaminants from municipal wastewater, containing mainly household
sewage plus some industrial wastewater. Physical, chemical, and biological processes are
used to remove contaminants and produce treated wastewater (or treated effluent) that is
safe enough for release into the environment. A by-product of sewage treatment is a
semi-solid waste or slurry, called sewage sludge. The sludge has to undergo further
treatment before being suitable for disposal or application to land.

15. Discuss how epidemics are controlled and prevented

 Stay at home if you have signs and symptoms of an infection.
 Wash your hands often.
 Don't share personal items
 Be smart about food preparation.
 Use antibiotics sensibly. Take antibiotics only when prescribed. Unless otherwise
directed, or unless you are allergic to them, take all prescribed doses of your antibiotic,
even if you begin to feel better before you have completed the medication.