A 4-year-old boy developed severe watery diarrhea and vomiting. The stool collected has a rice water type of appearance. It was sent for bacteriological analysis.
a. What is the probable etiological diagnosis of this condition?
b. Describe in detail the pathogenesis of this condition.
c. Add a note on its laboratory diagnosis.
Which of the following media can be used as transport medium for vibrio?
a. Selenite F broth
b. Nutrient broth
c. Tetrathionate broth
d. Venkatraman–Ramakrishnan medium
All of the following tests can differentiate between classical and El Tor biotypes of V. cholerae, except:
a. β-hemolysis on sheep blood agar
b. Chick erythrocyte agglutination
c. Growth on TCBS agar
d. Polymyxin B (50 IU)
Pathogenesis of V. cholerae involves one of the following second messenger systems:
a. cGMP
b. cAMP
c. Ca2+
d. IP3
Selective media for Vibrio cholerae:
a. TCBS
b. Mannitol salt agar
c. Robertson cooked meat medium
d. Modified Thayer Martin medium
All of the following Vibrio species are halophilic, except:
a. V. cholerae
b. V. parahaemolyticus
c. V. alginolyticus
d. V. vulnificus
O139 (Bengal strain)—all are true, except:
a. Capsulated
b. Toxigenic
c. Clinically similar to El Tor
d. More common than El Tor
All are selective media for V. cholerae, except:
Alkaline peptone water
Alkaline bile salt agar
TCBS agar
Monsur’s agar (GTTTA) medium
Which of the following confirms the isolate of V. cholerae as Hikojima serotype?
a. If agglutinated with Ogawa antisera
b. If agglutinated with Inaba antisera
c. If agglutinated with Hikojima antisera
d. If agglutinated with both Ogawa and Inaba antisera
Gram negative
Rigid, curved rods
“Vibrio” – vibratory motility
Non - sporing
Non - capsulated
Present in marine environments & surface waters worldwide
1854 – observed by Pacini
1883 – first isolated by Koch
Vibrio cholerae Top
V. cholerae was first described as the cause of cholera by Pacini in 1854. Pathogenic V. cholerae
produces a heat-sensitive enterotoxin that causes the characteristic cholera symptoms, including
"rice water stool." The species comprises several somatic (O) antigen groups, including O-group1, which is associated with classical and El Tor biotypes. V. cholerae Ol may have several
serotypes, including Inaba, Ogawa, and Hikojima. V. cholerae non-O1 (referred to in older
literature as nonagglutinable or NAG vibrios) also can cause gastrointestinal disease, though
typically less severe than that caused by V. cholerae O1 (Yamamoto et al., 1983). Serotype O139
is an exception, and produces classic cholera symptoms. This serotype was first identified in
1992 (CWG, 1933) as the cause of a new epidemic of cholera in India and Bangladesh. Non-O1
V. cholerae is found more readily in estuarin! e waters and seafood in the United States than is
the Ol serogroup; however, the 0139 serogroup has not yet been found here. Because this species
can grow in media lacking sodium chloride, it is not considered a halophilic Vibr
Cholera is a serious bacterial disease that usually
causes severe diarrhea and dehydration. The disease is typically spread through contaminated water.
Modern sewage and water treatment have effectively eliminated cholera in most countries. It’s still a problem in countries like Asia, America and Africa. Mostly in India.
Countries affected by war, poverty, and natural disasters have the greatest risk for a cholera outbreak.
Taxonomy:
class : Gamma Proteobacteria
Order: Vibrionales
Family: Vibrionaceae
Genus: Vibrio
Species: v.cholerae, v.parahaemolyticus,
v. vulnificus, v. alginolyticus
MORPHOLOGY:
Gram negative, actively motile, short, rigid curved bacilli
Resembling letter “V”
about 34 genus
most common in water
1.5µ X 0.2 -0.4 µ in size
polar flagellum , strongly aerobic
Smear – fish in stream appearance
PATHOGENESIS:
Source: Ingestion of contaminated water, food,
fruits and vegetables etc.,
Incubation periods: 1-5 days
Symptoms: Watery diarrhoea, vomiting, thirst, dehydration, muscle cramps
Complications: muscular pain, renal failure, pulmonary edema, cardiac arrhythrnias
DIAGNOSIS:
Specimen: stool sample, water sample(envt)
Microscopy: a) Hanging drop : +ve
b) Gram stain :-ve
Culture: Mac conkey Agar :colourless to light pink
TCBS : yellow colonies
Serology: serological tests are no diagnostic value
TREATMENT:
Adequate replacement of fluids and electrolytes.
Oral tetracycline reduces the period of vibrio excreation.
PREVENTION:
Drink and use bottled water
Frequent washing
Sanitary environment
Defecate in water
Cook food thoroughly
Cholera is a serious bacterial disease that usually
causes severe diarrhea and dehydration. The disease is typically spread through contaminated water.
Modern sewage and water treatment have effectively eliminated cholera in most countries. It’s still a problem in countries like Asia, America and Africa. Mostly in India.
Countries affected by war, poverty, and natural disasters have the greatest risk for a cholera outbreak.
Taxonomy:
class : Gamma Proteobacteria
Order: Vibrionales
Family: Vibrionaceae
Genus: Vibrio
Species: v.cholerae, v.parahaemolyticus,
v. vulnificus, v. alginolyticus
MORPHOLOGY:
Gram negative, actively motile, short, rigid curved bacilli
Resembling letter “V”
about 34 genus
most common in water
1.5µ X 0.2 -0.4 µ in size
polar flagellum , strongly aerobic
Smear – fish in stream appearance
PATHOGENESIS:
Source: Ingestion of contaminated water, food,
fruits and vegetables etc.,
Incubation periods: 1-5 days
Symptoms: Watery diarrhoea, vomiting, thirst, dehydration, muscle cramps
Complications: muscular pain, renal failure, pulmonary edema, cardiac arrhythrnias
DIAGNOSIS:
Specimen: stool sample, water sample(envt)
Microscopy: a) Hanging drop : +ve
b) Gram stain :-ve
Culture: Mac conkey Agar :colourless to light pink
TCBS : yellow colonies
Serology: serological tests are no diagnostic value
TREATMENT:
Adequate replacement of fluids and electrolytes.
Oral tetracycline reduces the period of vibrio excreation.
PREVENTION:
Drink and use bottled water
Frequent washing
Sanitary environment
Defecate in water
Cook food thoroughly
It discusses laboratory tests involved in diagnosing meningitis with more emphasis on details of each test and findings, esp useful for microbiologists and medical students.
The genus Shigella exclusively infects human intestine.
Shigella dysenteriae is the causative agent of bacillary dysentery or shigellosis in humans.
It is a diarrheal illness which is characterized by frequent passage of blood stained mucopurulent stools.
The four important species of the genus Shigella are:
Shigella dysenteriae
Shigella flexneri
Shigella sonnei
Shigella boydii.
It discusses laboratory tests involved in diagnosing meningitis with more emphasis on details of each test and findings, esp useful for microbiologists and medical students.
The genus Shigella exclusively infects human intestine.
Shigella dysenteriae is the causative agent of bacillary dysentery or shigellosis in humans.
It is a diarrheal illness which is characterized by frequent passage of blood stained mucopurulent stools.
The four important species of the genus Shigella are:
Shigella dysenteriae
Shigella flexneri
Shigella sonnei
Shigella boydii.
Cholera is devastating diarrheal disease caused by V. Cholerae that has been responsible for seven global pandemics.
Epidemic cholera remains a significant public health concern in the developing world today.
A bunch of topic were selected for our subject Communicable Diseases, surprisingly I picked up "Cholera El tor"...
I have done enough research regarding this topic from Brunner and Suddarths MedSurg books and other resources. I collated the ideas and came up to this presentation...
Hope it will be able to help my colleagues, students and those people who needs to know the what, why's, and how of Cholera!
xoxo ^___^
Cholera is a acute diarrhoeal disease caused by Vibrio cholerae.
Majority of infection are mild or asymptomatic.
IV B.PHARM, 8-SEMESTER ,SOCIAL AND PREVENTIVE PHARMACY.
CHOLERA DISESASE
DEFINITION, SYMPTOMS, CAUSES, TREATMENT, PREVENTION.
Acute infectious diarrhoea is the leading cause of morbidity leading to dehydration, hospital admission and death in children.
Viral causes (rotavirus) predominate as the pathogen.
Initial management rely on assessment of severity of dehydration and fluid replacement.
Early refeeding
Antibiotic are needed only in some bacterial and parasitic infections.
Probiotics, prebiotics and zinc reduce the duration and severity of symptoms.
Honey, amazingly contain all these substances and extremely useful in diarrhoea
Similar to Vibrio cholera and Halophilic vibrio.ppt (20)
ANTIGEN- SECTION IMMUNOLOGY DEPARTMENT OF MICROBIOLOGYDrmayuribhise
Defined as any substance that satisfies two distinct immunologic properties-
Immunogenicity
Antigenicity.
Immunogenicity:Ability of an antigen to combine specifically with the final products antibodies and/or T cell-surface receptors.
All molecules having immunogenicity property, also show antigenicity, but the reverse is not true
E.g. Haptens- which are antigenic but not immunogenic.
Ability of an antigen to induce immune response in the body (both humoral and/or cell mediated).
B cells + antigen → effector B cells (plasma cell) + memory B cells
T cells + antigen → effector T cells (helper T cell or cytotoxic T cell) + memory T cells
Substance that satisfies immunogenicity - more appropriately called as ‘immunogen’ rather than ‘antigen’. Smallest unit of antigenicity.
Definition - Small area present on the antigen comprising of few (four to five) amino acids or monosaccharide residues, that is capable of sensitizing T and B cells and reacting with specific site of T cell receptor or an antibody.
Specific site of an antibody that reacts with the corresponding epitope of an antigen is called as paratope.
Types of epitope:
Sequential or linear epitope- Present as a single linear sequence of few amino acid residues.
Sequential or linear epitope- Present as a single linear sequence of few amino acid residues.
Conformational or non sequential epitopes:
Found on the flexible region of complex antigens having tertiary structures.
Formed by bringing together the surface residues from different sites of the peptide chain during its folding into tertiary structure.
Low molecular weight molecules that lack immunogenicity (cannot induce immune response) but retain antigenicity or immunological reactivity (i.e. can bind to their specific antibody or T cell receptor).
Haptens can become immunogenic when combined with a larger protein molecule called carrier.
Classification:
Complex haptens - contain two or more epitopes.
Simple haptens - contain only one epitope
Based on the antigen-host relationship, antigens can be grouped into two groups:
Self or auto antigens
Non-self or foreign antigens
Belong to the host itself - not immunogenic.
Hosts do not react to their own antigens by exhibiting a mechanism called immunological tolerance.
Sometimes, the self-antigens are biologically altered (e.g. as in cancer cells) and can become immunogenic.
Immunogenic and are of three types based on their phylogenetic distance to the host.
Alloantigens
Isoantigens ---Blood group — Human erythrocyte antigen
Histocompatibility antigen — Transplantation
Heteroantigens
Type of Heteroantigens that are present in two different species; but they share epitopes with each other.
Antibody produced against antigen of one species can react with the other and vice versa.
Heterophile antigens can be used in various serological tests.
Antibody against one antigen can be detected in patient’s serum by employing a different antigen which is heterophile (cross reactive) to th
8 august FUNGAL INFECTIONS OF RESPIRATORY TRACT.pptxDrmayuribhise
Opportunistic fungal agents: Major fungal agents cause respiratory infections
Pneumocystis jirovecii pneumonia
Zygomycoses
Aspergillosis
Penicillosis.
Fungi causing systemic mycoses:
Blastomyces dermatitidis
Histoplasma capsulatum
Paracoccidioides brasiliensis
Coccidioides immitis.
Yeast: Cryptococcus neoformans
Recently, the taxonomy of Pneumocystis has been changed (2002).
Once thought to be a protozoan, now under fungus based on nucleic acid sequence studies.
Taxonomists renamed the human species of Pneumocystis as Pneumocystis jirovecii.
Two known species: P. carinii & P. jirovecii
Pneumocystis pneumonia is one of the common opportunistic infections in AIDS
Pneumocystis exists in cyst and trophozoite forms. The
Cysts - found in the environment; in human tissues, both cysts and trophozoites (containing 4–8 sporozoites) are found.
Once inhaled, the cysts are carried to – the lungs - transform into trophozoite
Trophozoites induce - inflammatory response – recruitment of plasma cells -frothy exudate - also called plasma cell pneumonia
Infection is transmitted by respiratory droplets
In immunocompetent individuals: Asymptomatic
In immunocompromised patients: Fatal pneumonia
Specimens: Induced sputum, BAL or lung biopsy
Microscopy
Trophozoites can be demonstrated by Giemsa, toluidine blue, Grocott’s methenamine silver stain
The cyst wall stains black with methenamine silver stain
The organism cannot be cultured
Serology
Complement fixation test & Latex agglutination test
Histopathological examination of lung tissue - reveals cysts.
Gomori’s methenamine silver (GMS) staining method-demonstrate the cysts of P. jirovecii.
Cysts – black-colored crushed ping-pong balls against the green background
Histopathological examination of lung tissue - reveals cysts.
Gomori’s methenamine silver (GMS) staining method-demonstrate the cysts of P. jirovecii.
Cysts – black-colored crushed ping-pong balls against the green background
Histopathological examination of lung tissue - reveals cysts.
Gomori’s methenamine silver (GMS) staining method-demonstrate the cysts of P. jirovecii.
Cysts – black-colored crushed ping-pong balls against the green background
Radiology: Chest X-ray - classical finding of bilateral diffuse infiltrates.
CT of the lung - ground-glass opacities at the early stage.
Atypical manifestations - nodular densities, cavitary lesions
PCR - developed for detection of P. jirovecii specific genes
Detection of 1, 3 β-D-glucan in serum
Cotrimoxazole (trimethoprim/sulfamethoxazole) - drug of choice for Pneumocystis pneumonia.
Given for 14 days in non-HIV patients and 21 days in patients with HIV.
Also the recommended drug for primary and secondary prophylaxis in patients with HIV
Life-threatening infections caused by aseptate fungi belonging to the phylum Zygomycota
1. Order Mucorales (causes mucormycosis)
Rhizopus (R. arrhizus and R. microsporus)
Mucor racemosus, Rhizomucor pucillus
Lichtheimia corymbifera , Apophysomyces elegans
2. Order ento
Polioviruses cause a highly infectious childhood disease - polio (or poliomyelitis) causing acute flaccid paralysis - involvement of nervous system.
Polio is in the verge of eradication globally.
Group: Group IV (ssRNA)
Family: Picornaviridae
Genus: Enterovirus
Species: Poliovirus
Simple in structure, very small (28–30 nm size) , non-enveloped
Spherical shaped and have icosahedral symmetry
Capsid is composed of 60 subunits, each consisting of four viral proteins (VP1-VP4), except parechoviruses (have three proteins).
Possess single stranded positive sense linear RNA
3 types
Type 1 (Brunhilde/Mahoney): mostly causes outbreaks
Type 2 (Lansing/MEF1): easiest to eradicate
Type 3 (Leon/Sankett): often last to be eradicated
Highly contagious (usually infects 100% of all susceptibles)
Occurs worldwide and is seasonal
Inapparent to apparent infection ratio = 200-1000:1
Polioviruses - classified into wild polioviruses - cause natural disease
Vaccine derived poliovirus (VDPV) - vaccine strains that have regained neurovirulence and are capable of producing disease in man
There are three wild poliovirus strains: Wild poliovirus type 1 (WPV1), wild poliovirus type 2 (WPV2) and wild poliovirus type 3 (WPV3).
All three strains are identical, produce similar manifestations and severity of illness.
They are genetically and immunologically distinct; differ from each other in VP1 region.
Antibody response is type-specific and not cross-protective.
Currently all the natural cases - caused by WPV1.
Both WPV2 and WPV3 - globally eradicated, in the years 1999 and 2019 respectively
Age – most vulnerable 6 months to 3 years
Sex – 3 males:1 female
Risk Factors – Fatigue, trauma, IM injections, tonsillectomy, alum containing DPT
Active
through immunization / natural infection
immunity believed to be lifelong
immunity to one type not protective against infection with other types
two types of immunity: intestinal and humoral
Passive
infants born to mothers with high antibody protected for first several weeks
Virus intermittently excreted for 6-8 weeks after infection
Most heavy excretion
just prior to paralysis onset
up to first two weeks
dramatically tapers off after 4 weeksShort incubation period
usually 7-14 days,
but may be a short as 4 days
(range 3-35 days)
Virus enters oral cavity
Local replication in tissues expressing receptor (tonsils, intestinal M cells, Peyer patches of ileum, and lymph nodes)
Viremia with hematologic spread to CNS
Retrograde spread along neurons to spinal cord
Motor neurons destroyed by viral replication
Paralysis extent depends on proportion of motor neurons lost
Transmission: Feco-oral route (most common), or rarely by respiratory droplets via inhalation or conjunctival contact.
Multiply locally- Intestinal epithelial cells, sub mucosal lymphoid tissues, of tonsils and Peyer's patches.
Receptor- Viral entry into the host cells - mediated by binding to CD155 receptors present on the host cell Hematogenous spread (most commo
Pharyngitis (or sore throat) - most common upper respiratory tract infections (URTI).
Viral pharyngitis - vast majority of cases – self-limited.
Bacteria - important etiologic agents of pharyngitis, require specific antibiotic treatment - can lead to serious complications and sequelae
Streptococcus pyogenes
Corynebacterium diphtheriae
Rare causes
Other β-hemolytic streptococci (group C and G)
Arcanobacterium hemolyticum
Fusobacterium necrophorum
Mycoplasma pneumoniae
Neisseria gonorrhoeae
Size – 0.5-1 m.
Shape – oval /elliptical.
Arrangement – in chains esp. in liquid culture media. (upto 50 cocci in a chain).
Divide in one plane.
Daughter cells do not seperate.
Gram positive
Cultures older than log phase may lose gram reaction.
Capsule –
Hyaluronic acid (group A, C). Nonimmunogenic.
Polysaccharide (group B, D ).
Nonmotile.
Nonsporing.
L-forms – cell-wall deficient, require thiol & pyridoxal for growth. Found in blood (due to antibiotics).
Aerobes & facultative anaerobes.
22-42°C; opt.37.
pH for growth –opt. 7.4.
Capnophilic – 10% CO2.
Fastidious; need blood / serum / sugar.
Liquid medium (e.g. Todd-Hewitt broth) – granular turbidity + powdery deposits.
Blood agar –
0.5-1mm, circular, low convex, -hemolytic.
Matt colonies – pathogenic
Glossy colonies – nonpathogenic.
Selective medium –
Crystal violet (1:500,000) in B.A.
Catalase – ve
Sugar fermentation –
Glucose, lactose, maltose, trehalose - . (constitutive enzymes).
Other sugars & alcohols - ,(inducible enz.).
*Ribose sugars – not fermented.
*Pyrolidonyl naphthalamide hydrolysis (PYR) - +ve (differentiates gr. A from other groups).
Delicate organism
Survives in dust in dark for many weeks.
Susceptible to heat , 54°C x 30 min.
Susceptible to common antiseptics.
Resistant to –
Crystal violet (1mg/litre) – for isolation of gr A.
Nalidixic acid (15mg/litre) for isolation of & Colistin (10mg/litre) gr. B
Bacitracin sensitive – differentiates gr. A from other hemolytic
Hyaluronic acid capsule-nonantigenic, antiphagocytic, thrombolytic.
Innermost cell wall layer peptidoglycan (NAG-NAM)
Cell-wall CHO – Group sp. Ag. Todd-Hewit growth →
Extraction by –
HCl (Lancefield)
Formamide (Fuller)
Enzyme of Streptomyces albus (Maxted)
Autoclave (Rantz & Randall).
Capillary pptn /ring pptn
M protein –
Acid extraction & Serotyping.
100 M-types.
T protein –
Typing by slide agglutination with trypsinised RBCs.
R protein –
Present in gr. B, C, G & some serotypes of gr. A (23, 28, 48).
. Antigenic cross-reactions
Capsular hyaluronic acid synovial fluid.
Cellwall CHO cardiac valves.
Cellwall peptidoglycan skin.
Cyto. membrane vascular intima & cardiac muscle.
M protein* - reqd. for invasive infection.
Receptor for fibrinogen, factor H, IgG.
Capsule - antiphagocytic
Group CHO Ag’-invasive properties.
Protein F- binds fibronectin on epi. Surface
Lipoteichoic acid loosely binds strepto’ to epi surface. F prtn, M prtn secur
lab diagnosis of viral infections - mayuri.pptxDrmayuribhise
T.M. River, 1937
Modified from Koch’s Postulates (proof of bacterial diseases)
Isolate virus from diseased hosts.
Cultivation of virus in host cells.
Proof of filterability.
Production of a comparable disease when the cultivated virus is used to infect experimental animals.
Reisolation of the same virus from the infected experimental animal.
Detection of a specific immune response to the virus.
Much more expensive and difficult to study animal viruses than bacteriophages
Cultivation in host cells
Living animal
Embryonated chicken eggs
Cell or tissue culture (= in vitro)
Over 60% of all infectious disease cases seen by a physician are due to viral infections.
Quality of patient specimens and their transport to the laboratory is importantViral Diagnostics in the Clinical Laboratory
Types of specimens:-
Respiratory tract infections: Nasal and bronchial washings, throat and nasal swabs, sputum
Eye infections: throat and Conjunctival swab/scraping
Gastrointestinal tract infections: stool and rectal swabs
Vesicular rash: vesicle fluid, skin scrapings
Maculopapular rash: throat, stool, and rectal swabs
CNS (encephalitis and meningitis cases): stool, tissue, saliva, brain biopsy, cerebrospinal fluid
Genital infections: vesicle fluid or swab
Urinary tract infections: urine
Blood borne infections: blood
Sterile, leak proof container
Minimal interval
Transport media
Viral infusion broth (VIB)
Sucrose-phosphate-glutamate (SPG)
Storage temperature:
4 deg C for up to 96 hours
Minus 70 deg C beyond 96 hours
Repeated cycles of freezing and thawing to be avoided
106 virus particles per ml required for visualization,
50,000 - 60,000 magnification normally used.Specimens are negatively stained by Potassium phosphotungstate and scanned under EM
Viruses may be detected in the following specimens.
Virus particles are detected and identified on the basis of morphology.
A) Shape
Rabiesvirus –bullet shaped
Rotavirus –Cart wheel
Coronavirus –petal shaped peplomers
Adenovirus –space vehicle shaped
Astrovirus ---Star shaped
B) Direct detection from specimens
For viruses that are difficult to cultivate ,EM can be used as primary tool for diagnosis
Faeces Rotavirus, Adenovirus
Norwalk like viruses
Astrovirus, Calicivirus
Vesicle Fluid HSV
VZV
Skin scrapings papillomavirus, orf
molluscum contagiosum
As an alternative to tissue culture
As tissues culture is time consuming and technically demanding ,EM is used as an alternative :-
1) Vesicular rashes –HSV and VZV detection from vesicular fluid
2) Meningitis—Detection of enterovirus and mumps from CSF.
Virus detection from tissue cultures EM can be used for detection of viral growth in tissue culture
The sensitivity and specificity of EM can be improved by adding specific antiviral antibody to the specimen to aggregate the virus particles which can be centrifuged
The sediment is negatively stained and viewed under EM
Direct immumofluroscence
For decades microbes, in particular bacteria, have become increasingly resistant to various antimicrobials.
The World Health Assembly’s endorsement of the Global Action Plan on Antimicrobial Resistance (AMR) in May 2015, and the Political Declaration of the High-Level Meeting of the General Assembly on AMR in September 2017, both recognize AMR as a global threat to public health.
These policy initiatives acknowledge overuse and misuse of antimicrobials as a main driver for development of resistance, as well as a need to optimize the use of antimicrobials.
The Global Action Plan on AMR sets out five strategic objectives as a blueprint for countries in developing national action plans (NAPs) on AMR:
Objective 1: Improve awareness and understanding of AMR through effective communication, education and training.
Objective 2: Strengthen the knowledge and evidence base through surveillance and research.
Objective 3: Reduce the incidence of infection through effective sanitation, hygiene and infection prevention measures.
Objective 4: Optimize the use of antimicrobial medicines in human and animal health.
Objective 5: Develop the economic case for sustainable investment that takes account of the needs of all countries, and increase investment in new medicines, diagnostic tools, vaccines and other interventions.
Antimicrobial stewardship programmes optimize the use of antimicrobials, improve patient outcomes, reduce AMR and health-care-associated infections, and save health-care costs amongst others.
Today, AMS is one of three “pillars” of an integrated approach to health systems strengthening. The other two are infection prevention and control (IPC) and medicine and patient safety.
Linking all three pillars to other key components of infection management and health systems strengthening, such as AMR surveillance and adequate supply of quality assured medicines, promotes equitable and quality health care towards the goal of achieving universal health coverage
CDC has defined “Antimicrobial stewardship” as-
The right antibiotic
for the right patient,
at the right time,
with the right dose, and
the right route, causing
the least harm to the patient and future patients
Why AMSP is needed?
Antimicrobial Resistance (AMR)
Misuse and Over-use of Antimicrobials
Widespread Use of Antimicrobials in Other Sectors
Poor Antimicrobial Research
IMPLEMENTATION OF ANTIMICROBIAL STEWARDSHIP PROGRAM
Administrative Support (Leadership)
Formulating AMS Team
Infrastructure Support
Framing Antimicrobial Policy
Implementing AMS strategies
Education and Training
Should be publicly committed to the program.
Provide necessary funding and infrastructure support.
Multidisciplinary committee - responsible for framing, implementing and monitoring the compliance to antimicrobial policy of the hospital.
Led by the antimicrobial steward - infectious disease physician or infection control officer or clinical microbiologist.
Other members of AMS team - stewardship nurses
Dr Mayuri -Water surveillance (Practical).pptxDrmayuribhise
Coliforms ( other than
E.coli)
Fecal (thermo tolerant)
E.coli
Fecal streptococci
Sulphite reducing
clostridia
Pseudomonas aeruginosa
Bacteriophages specific for E.coli
Container- Screw capped borosilicate glass or plastic bottles (500 ml)
Avoid contamination
Volume- At least 150-200 ml of water
For testing dialysis water
For testing clean water
For testing large volume of water
When bacterial count in water is expected to be low
F o r t h e e s t i m a t i o n o f presumptive coliform count
Extensively used for drinking water analysis
For highly turbid samples
F o r t h e e s t i m a t i o n o f presumptive coliform count
Extensively used for drinking water analysis
For highly turbid samples
To confirm that the coliform bacilli detected in presumptive test are faecal E.coli
Inoculate the positive tubes into brilliant green bile broth and tryptone water. Incubate at 44°C for 24 hours
Positive for indole, acid, and gas production confirms thermotolerant E. coli
Filtration of known volume of water sample on cellulose filter paper and incubate it on suitable culture media.
Pore size = 0.2-0.45 μm
Media : Membrane lauryl sulphate broth
Drinking-water supply surveillance is “the continuous and vigilant public health assessment and review of the safety and acceptability of drinking-water supplies” (WHO, 1976). This surveillance contributes to the protection of public health by promoting improvement of the quality, quantity, accessibility, coverage, affordability and continuity of water supplies (known as service indicators) and is complementary to the quality control function of the drinking-water supplier. Drinking-water supply surveillance does not remove or replace the responsibility of the drinking-water supplier to ensure that a drinking-water supply is of acceptable quality and meets predetermined health-based targets
All members of the population receive drinking-water by some means—including the use of piped supplies with or without treatment and with or without pumping (supplied via domestic connection or public standpipe), delivery by tanker truck or carriage by beasts of burden or collection from groundwater sources (springs or wells) or surface sources (lakes, rivers and streams). It is important for the surveillance agency to build up a picture of the frequency of use of the different types of supply, especially as a preliminary step in the planning of a surveillance programme. There is little to be gained from surveillance of piped water supplies alone if these are available to only a small proportion of the population or if they represent a minority of supplies.
Information alone does not lead to improvement. Instead, the effective management and use of the information generated by surveillance make possible the rational improvement of water supplies—where “rational” implies that available resources are used for maximum public health benefit.
Surveillance is an important element in the development of strategies for in
Smallest known DNA viruses.
Structure
Non-enveloped
18-26 nm diameter
Single-stranded DNA, 5.6 kb
Icosahedral
Parvovirinae (vertebrates)
Parvovirus
Erythrovirus
Dependovirus (requires helper virus, such as an adenovirus)
Bocavirus
Amdovirus
Densovirinae (invertebrates)`
B19 virus most common.
Diseases
Erythema infectiosum (cutaneous rash)
Polyarthropathy syndrome (acute or chronic)
Transient aplastic crisis (severe acute anemia)
Pure red cell aplasia (chronic anemia)
Hydrops fetalis (fetal anemia)
Simplest animal viruses infecting humans, responsible for - childhood exanthema - erythema infectiosum (fifth disease).
Smallest viruses (18–26 nm size)
Non-enveloped with icosahedral symmetry
Only DNA viruses - possess single-stranded DNA
Depend upon the host cell enzymes for replication
Transmission - Respiratory route, followed by blood transfusion and transplacental route.
Infects precursors of RBCs: Parvovirus B19 has a special tropism for erythroid progenitor cells present in adult bone marrow and foetal liver as it binds to blood group P antigen as receptors; which are present on the RBC surface.
This results in red cell destruction and inhibition of erythropoiesis
Erythema infectiosum (or fifth disease)
Transient aplastic crisis
Pure red cell aplasia
Non-immune hydrops fetalis
Papular-purpuric gloves and socks syndrome
Known to cause foetal loss through hydrops fetalis; severe anaemia, congestive heart failure, generalized oedema and foetal death
No evidence of teratogenicity.
Risk of foetal death highest when infection occurs during the second trimester of pregnancy (12%).
Molecular methods:
PCR - detects viral DNA (e.g. genes coding for VP1 and VP2) from serum, tissue or respiratory secretions.
Real time PCR - used for quantification of viral load in blood, during acute infections
Antibody detection: ELISA – detecting antibodies against VP1 and VP2 antigens. IgM appears early - recent infection and remains elevated for 2–3 months
Antigen detection: Immunohistochemistry - detect viral antigens in fetal tissues and bone marrow.
No antiviral drug is available
Symptomatic treatment is given
Immunoglobulins containing neutralizing antibodies to human parvovirus are available commercially
No antiviral drug is available
Symptomatic treatment is given
Immunoglobulins containing neutralizing antibodies to human parvovirus are available commercially
Measles is an acute, highly contagious childhood disease characterized by fever & respiratory symptoms, followed by typical maculopapular rash.
Transmission
Droplets inhalation over short distances and, less commonly,
Small-particle aerosols - remain suspended especially in schools, hospitals, and enclosed public places in the air for longer period.
Spread-The virus multiplies locally in the respiratory tract; then spreads to the regional lymph nodes → enter into the bloodstream in infected monocytes (primary viremia)→further multiply in reticuloendothelial system → spills over into blo
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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2. Case Scenario
A 4-year-old boy developed severe watery
diarrhea and vomiting. The stool collected
has a rice water type of appearance. It
was sent for bacteriological analysis.
a. What is the probable etiological
diagnosis of this condition?
b. Describe in detail the pathogenesis of
this condition.
c. Add a note on its laboratory diagnosis.
3. INTRODUCTION
• Gram negative
• Rigid, curved rods
• “Vibrio” – vibratory motility
• Non - sporing
• Non - capsulated
• Present in marine environments & surface
waters worldwide
• 1854 – observed by Pacini
• 1883 – first isolated by Koch
9. PATHOGENESIS OF CHOLERA
Pathogenesis of cholera - toxin-mediated.
Both V. cholera O1 and O139 - capable of producing cholera
toxin - resulting in cholera.
Mode of transmission - Ingestion of contaminated water or
food
Infective dose - Acid-labile - high infective dose of 108
bacilli - required to bypass the gastric barrier
10. Cont…
Factors promoting transmission - Conditions where gastric
acidity is reduced - hypochlorhydria, use of antacids, etc.
Crossing of the protective layer of mucus:
Its highly active motility
Secreting mucinase and other proteolytic enzymes
Secreting hemagglutinin protease (cholera lectin) -
Cleaves the mucus and fibronectin.
11. Mechanism of action
Cholera toxin (CT) - Resembles heat-labile toxin (LT) of
E. coli in its structure and function - more potent than the
latter
The toxin molecule consists of two peptide fragments—A
and B.
Fragment B is the binding fragment.
Fragment A is the active fragment, causes ADP
ribosylation of G protein - accumulation of cyclic
adenosine monophosphate (cAMP).
12. Increase in cyclic AMP -
accumulation of sodium chloride
in intestinal lumen
Water moves passively into the
bowel lumen accumulation of
isotonic fluid (watery diarrhea)
Loss of fluid and electrolytes
shock (due to profound
dehydration) and acidosis (due to
loss of bicarbonate)
14. Clinical features
1. Asymptomatic infection (75% of cases)
2. Mild diarrhoea or cholera (20% of cases)
3. Sudden onset of explosive and life-threatening diarrhoea
(cholera gravis – 5%)
IP - 24 to 48 hours
Watery diarrhoea - sudden onset of painless watery
diarrhoea
Rice water stool - watery with mucus flakes &
inoffensive odor
Vomiting may be present but fever is usually absent
16. COMPLICATIONS
• Muscular cramps
• Renal failure
• Cardiac arrhythmias
• Paralytic ileus
The clinical severity of
cholera varies from
rapidly fatal disease to
a transient
asymptomatic
colonization of the
intestine by the vibrios
The incidence of mild & asymptomatic infection is more
with El Tor Vibrio than Classical Cholera Vibrio
17. DEFFERENCE BETWEEN
CLASSICAL
VIBRIO
EL Tor VIBRIO
Hemolysis - + *
Voges-Proskauer - + *
Chick embryo
agglutination
- +
Polymyxin B
sensitivity
+ -
Group Iv phage
susceptibility
+ -
El Tor phage V
susceptibility
- +
18. Epidemiology
History of Pandemics:
Cholera can occur—sporadic, limited
outbreaks, endemic, epidemic or
pandemic
Till 19th century – confined to its home
land (West Bengal & Bangladesh)
1817 -1923 – 6 pandemics originating
from Bengal – Classical Vibrio
1923 – 1961 – Restricted to homeland
19. History of Pandemics (Cont..):
Seventh pandemic - Started in 1961 and it
differed from the first six pandemics in many
ways
Was the only pandemic that originated outside
India, i.e. from Indonesia (Sulawesi, formerly
Celebes Island) in 1961.
India was affected in 1964 and the whole world
was encircled by 1991
Only pandemic to be caused by El Tor
20. Current Situation - World
Cholera is a notifiable disease, often under
reported
Annual cases >1.3-4 million
Annual deaths - 21 000 to 1.4 Lakh
Majority of cases are due to O1 El Tor
21. Indian Scenario
Situation has greatly changed
West Bengal is no longer the home land,
All states affected
Both morbidity and mortality have greatly
reduced.
National Institute of Cholera and Enteric
Diseases (NICED), Kolkata - National
reference Center for cholera in India
22. O139 (Bengal Strain)
Isolated first from Chennai in 1992
O139 – Not agglutinated by any of the antisera
available at that time (O1 to O138)
Bengal strain - spread rapidly along the coastal
region of Bay of Bengal
Derivative of O1 El Tor – differs in having a
distinct LPS & capsulated
Invasive bacteremia and extraintestinal
manifestations
No cross protection between O1 and O139
By 1994 - O1 El Tor replaced O139
23. LABORATORY DIAGNOSIS
• Stool before administration of antibiotics
• Lubricated catheter
• Rectal swab (moistened with transport medium)
24. TRANSPORT
• Sent immediately to the laboratory
• Preservation at 4°C
• Transport medium
• VR medium
• Cary Blair medium
• Enrichment medium
• Alkaline peptone water
• Monsurs medium
Others:
Strips of blotting
paper packed in
plastic envelopes
25. MICROSCOPY
• Direct microscopic examination
• Inhibition of characteristic motility – with
antiserum
• Direct immunofluorescence
26. CULTURE
• Direct plating before enrichment
• Enrichment medium – incubation for 6-8 hours
• Non-selective media
• Blood agar
• Mac Conkeys agar
• Bile Salt Agar
30. SLIDE AGGLUTINATION
Cholera O subgroup 1 serum
If positive
Agglutination using specific Ogawa & Inaba sera
If not agglutinated by O1 antisera – considered
Non – O1 cholera vibrio (O139)
33. Treatment
Fluid replacement - Most important measure for
management of the cholera patient.
In mild to moderate fluid loss: oral rehydration solution
(ORS) should be given
In severe cases: Intravenous fluid replacement with
Ringer’s lactate (or normal saline) should be carried out
till the consciousness arrives, thereafter replaced by
ORS.
WHO recommends the use of antibiotics - only severely
dehydrated patients
Drug of choice: Macrolides such as azithromycin or
erythromycin are the drugs of choice for adults, children
and also in pregnancy.
34. PREVENTION
• Provision of protected water supply
• Improvement in environmental sanitation
• Vaccination
36. Non O1/O139 V. cholerae
Biochemically resemble V. cholerae O1/O139,
but do not agglutinate with O1 or O139 antisera.
Gastroenteritis: Sea food consumption (raw
oysters)
Stool – watery/partly formed & bloody/ mucoid
Abdominal cramps, nausea, vomiting and fever
Treatment is same as that of cholera
37. Cont…
Extraintestinal manifestations: Otitis
media, wound infection & bacteremia
Acquired by - occupational or recreational
exposure to seawater
Sensitive to - Tetracycline, ciprofloxacin
and third generation cephalosporins
38. Halophilic vibrio
Can withstand higher salt concentration (>6%) in
contrast to V. cholerae, which can tolerate up to
6%
Widespread in marine environments
Cases tend to occur during late summer and
early rain fall, when the bacterial counts are
highest in the water
39. Vibrio parahaemolyticus
infections
Was first reported from Japan (1953), the
incidence of infection has greatly
increased in several countries including
Japan since 1993.
In India, it has been reported from Kolkata.
40. Clinical Manifestations
Food-borne gastroenteritis - most common
presentation, occurs following raw or uncooked
sea food (e.g. oyster) intake.
Commonly presents as watery diarrhea or rarely
as dysentery with abdominal cramps
Extraintestinal manifestations - wound infection,
otitis and sepsis are rare.
41. Cont…
Morphology - Capsulated - bipolar staining in
fresh isolates and pleomorphism in older
cultures
Motile - peritrichous flagella (but it does not
show darting motility)
On TCBS agar - produces green colonies
(sucrose nonfermenter)
42. Cont…
Kanagawa phenomenon: It causes β-hemolysis on
Wagatsuma agar (a special type of high salt blood agar)
Swarming: Swarms on blood agar
Urease test - positive in few strains
Salt tolerance test: Can resist maximum of 8% NaCl
Identification - MALDI-TOF and VITEK.
43. Treatment of V.
parahaemolyticus infections
Most of the gastroenteritis - self-limiting and treatment is
same as that of cholera
Indications for antibiotic use:
Severe gastroenteritis or
Extraintestinal manifestations associated with underlying
diseases - diabetes, pre-existing liver disease, iron
overload states, or immunosuppression
46. Clinical Infections
1. Primary sepsis: Occurs in patients with underlying
liver disease and iron overload or rarely in renal
insufficiency and immunosuppression
2. Primary wound infection: Characterized by painful
erythematous swelling or cellulitis or even vesicular,
bullous or necrotic lesions - affects people without
underlying disease (Vulnificus is Latin word for “wound
maker”).
47. Cont…
V. vulnificus - cultured from blood or cutaneous
lesions. It
Ferments lactose - differentiates it from all other
vibrios.
Identification can also be made by automated
methods such as MALDI-TOF and VITEK
48. Treatment of Vibrio vulnificus
infections
Early antibiotic institution, wound debridement,
and general supportive care - keys to recovery.
V. vulnificus - sensitive in vitro to a number of
antibiotics, including tetracycline,
fluoroquinolones, and third-generation
cephalosporins.
49. Vibrio alginolyticus infections
V. alginolyticus - occasionally cause eye, ear and wound
infections.
Few cases of otitis externa, otitis media and
conjunctivitis have been reported
Rarely causes bacteremia in immunocompromised hosts
Most salt-tolerant Vibrio - grow at salt concentrations of
more than 10%
Self-limiting - severe infections respond well to
antibiotics (tetracycline) and drainage.
50. MCQ Q 1
Which of the following media can be used
as transport medium for vibrio?
a. Selenite F broth
b. Nutrient broth
c. Tetrathionate broth
d. Venkatraman–Ramakrishnan medium
51. Q. 2
All of the following tests can differentiate
between classical and El Tor biotypes of V.
cholerae, except:
a. β-hemolysis on sheep blood agar
b. Chick erythrocyte agglutination
c. Growth on TCBS agar
d. Polymyxin B (50 IU)
52. Q 3
Pathogenesis of V. cholerae involves one
of the following second messenger
systems:
a. cGMP
b. cAMP
c. Ca2+
d. IP3
53. Q 4
Selective media for Vibrio cholerae:
a. TCBS
b. Mannitol salt agar
c. Robertson cooked meat medium
d. Modified Thayer Martin medium
54. Q 5
All of the following Vibrio species are
halophilic, except:
a. V. cholerae
b. V. parahaemolyticus
c. V. alginolyticus
d. V. vulnificus
55. Q 5
O139 (Bengal strain)—all are true, except:
a. Capsulated
b. Toxigenic
c. Clinically similar to El Tor
d. More common than El Tor
56. Q 6
All are selective media for V. cholerae,
except:
a. Alkaline peptone water
b. Alkaline bile salt agar
c. TCBS agar
d. Monsur’s agar (GTTTA) medium
57. Q 7
Which of the following confirms the isolate
of V. cholerae as Hikojima serotype?
a. If agglutinated with Ogawa antisera
b. If agglutinated with Inaba antisera
c. If agglutinated with Hikojima antisera
d. If agglutinated with both Ogawa and
Inaba antisera
