Medical Microbiology

Microorganisms can be found in every ecosystem and in close association with every type of
multicellular organism.
 They populate the healthy human body by the billions as benign passengers (normal flora) and
even as participants in bodily functions. For example, Bacteria play a role in the degradation of
intestinal contents.
 In this course, we primarily consider the role of bacteria in the initiation and spread of human
diseases
 Those relatively few species of microorganisms that are harmful to humans, either by production
of toxic compounds or by direct infection, are characterized as pathogens.
 Most infectious disease is initiated by colonization (the establishment of proliferating
microorganisms on the skin or mucous membranes) as shown in Figure 1.
 The major exceptions are diseases caused by introduction of organisms directly into the
bloodstream or internal organs.
 Microbial colonization may result in:
1) elimination of the microorganism without
affecting the host.
2) infection in which the organisms multiply
and cause the host to react by making an
immune or other type of response.
3) a transient or prolonged carrier state.
Infectious disease occurs when the organism
causes tissue damage and impairment of
body function
PROKARYOTIC PATHOGENS
 All prokaryotic organisms are classified as bacteria,
whereas eukaryotic organisms include fungi,
protozoa, and helminths as well as humans.
 Cells of prokaryotic and eukaryotic organisms
differ in several significant structural features .

characteristic Prokaryotic cells Eukaryotic cells

Chromosome Usually single,circular Multiple
Nucleus No nuclear envelope or Membrane bound,nucleoli
nucleoi present
Membrane-bound organelles Not present Present(examples include
mitochondria,endoplasmic
reticulum)
Cell wall Usually present,may contain Present in plant cells,no
peptidoglycan peptidoglycan
Plasma membrane No carbohydrates,most lack Sterols and carbohydrates
sterols present
Ribosome 70s 80s (70s in organelles)
Average size 0.2-2 mm in diameter 10-100 mm in diameter
Notes
Some bacteria have more than one circular molecule as their genome.
Vibrios, for example, have two circular chromosomes.
Borrellia have linear chromosomes and a wide array of different sized plasmids.
A.Typical bacteria
 Most bacteria have shapes that can be described as a rod, sphere, or corkscrew.
 Nearly all bacteria, with the exception of the mycoplasma, have a rigid cell wall surrounding the
cell membrane that determines the shape of the organism.
 The cell wall also determines whether the bacterium is classified as gram positive or gram
negative .
 External to the cell wall may be flagella, pili, and/or a capsule.
 Bacterial cells divide by binary fission.
 However, many bacteria exchange genetic information carried on plasmids (small, specialized
genetic elements capable of self-replication) including the information necessary for
establishment of antibiotic resistance
B.Atypical bacteria
 Atypical bacteria include groups of organisms such as Mycoplasma, Chlamydia, and Rickettsia
that, although prokaryotic, lack significant characteristic structural components or metabolic
capabilities that separate them from the larger group of typical bacteria.
 Normal Flora
 The human body is continuously inhabited by many different micro organisms (mostly bacteria,
but also fungi and other microorganisms),which, under normal circumstances in a healthy
individual, are harmless and may even be beneficial.
 These microorganisms are termed “normal flora.” The normal flora are also termed commensals,
which literally means “organisms that dine together.”
 Except for occasional transient invaders, the internal organs and systems are sterile, including the
spleen, pancreas, liver, bladder, central nervous system, and blood.
 A healthy newborn enters the world in essentially sterile condition, but, after birth, it rapidly
acquires normal flora from food and the environment, including from other humans.
Distribution Of Normal Flora In The Body
 The most common sites of the body inhabited by normal flora are, as might be expected, those
in contact or communication with the outside world, namely, the skin, eye, and mouth as well as
the upper respiratory, gastrointestinal, and urogenital tracts.
A. Skin
 Skin can acquire any bacteria that happen to be in the immediate environment, but this transient
flora either dies or is removable by washing. Nevertheless, the skin supports a permanent
bacterial population (resident flora), residing in multiple layers of the skin (Figure 2). The resident
flora regenerate even after vigorous scrubbing.
 Estimate of the skin microbiome using classical culture techniques:
1. Staphylococcus epidermidis and other coagulase-negative staphylococci () that reside in the
outer layers of the skin appear to account for some 90 percent of the skin aerobes.
 2. Anaerobic organisms, such as Propionibacterium acnes, reside in deeper skin layers, hair
follicles, and sweat and sebaceous glands.
Skin inhabitants are generally harmless, although S. epidermidis can attach to and colonize
plastic catheters and medical devices that penetrate the skin, sometimes resulting in serious
bloodstream infections.
 Examples of bacteria that inhibit the skin
A. Gram +ve cocci
1. Staphylococcus aureus
2. Staphylococcus epidermidis
3. Staphylococcus species
B. Gram +ve bacilli
1. Corynebaterium species
2. Propionibacterium acnes
Note
Skin propping injection of drugs below the skin rather than directly into a vein breaks the skin
barrier and may result in soft tissue infections caused by introduction of normal skin flora into
subcutaneous tissue
 Estimate of the skin microbiome using molecular sequencing techniques:
1. The estimate of the number of species present on skin bacteria has been radically changed by
the use of the 16S ribosomal RNA gene sequence to identify bacterial species present on skin
samples directly from their genetic material.
2. Previously, such identification had depended upon micro biological culture, upon which many
varieties of bacteria did not grow and so were not detected. Staphylococcus epidermidis and
Staphylococcus aureus were thought from culture-based research to be dominant.
3. However DNA analysis research finds that, while common, these species make up only 5 percent
of skin bacteria. The skin apparently provides a rich and diverse habitat for bacteria.
 The Human Microbiome
 The human microbiome is the total number and diversity of microbes found in and on the human
body. In the past, the ability to cultivate organisms from tissues and clinical samples was the gold
standard for identification of normal flora and bacterial pathogens.
 However, the recent application of culture independent molecular detection methods based on
DNA sequencing () indicates that the human body contains a far greater bacterial diversity than
previously recognized.
 Even using advanced molecular techniques, it is difficult to define the human microbiome
because microbial species present vary from individual to individual as a result of physiologic
differences, diet, age, and geographic habitat.
 Despite these limitations, it is useful to be aware of the dominant types and distribution of
resident flora, because such knowledge provides an understanding of the possible infections that
result from injury to a particular body site.
B. Eye
 The conjunctiva of the eye is colonized primarily by S. epidermidis, followed by S. aureus, aerobic
corynebacteria (diphtheroids), and Streptococcus pneumoniae.
  Other organisms that normally inhabit the skin are also present but at a lower frequency
(Figure).
 Tears, which contain the antimicrobial enzyme lysozyme, help limit the bacterial population of
the conjunctiva.
 Examples of bacteria that inhibit the The conjunctival sac of the eye
1.Gram +ve cocci
 Staphylococcus aureus
 Staphylococcus epidermidis
 Staphylococcus species
2.Gram +ve bacilli
 Corynebaterium species
 Propionibacterium acnes
3.Gram –ve cocci
 Moraxella
 Neisseria species
 Note:
 Tears,which contain the antimicrobial enzyme lysozyme,help limit the bacterial population of
the conjunctiva