Unit 9 Overview

key concepts
0 skin diseases
0 STDs
0 Respiratory
illnesses
0 Cardiovascular and
lymphatic diseases

keywords
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scaled skin syndrome

rubella
measles
chickenpox
smallpox
genital warts
candidiasis
urinary tract infections
toxic shock syndrome
gonorrhea
syphilis
chlamydia
herpes
strep
common cold
pertussis
pneumonia
tuberculosis
influenza
bacterial endocarditis
anthrax
bubonic plague
lymes disdease
Epstein-Barr virus
malaria

F. Yalls I.
0 only diseases presented in class will show up on the

assessments

Skin Diseases
0 Skin has a high diversity of microbiota, unevenly

spread across the body

0 dry spots have less than wet (stomach vs. arm pits)

S. aureus
0 Staphylococcus aureus is responsible for many

common bacterial skin infections, including pimples

0 certain strains can produce 2 different exfoliantins

exotoxins, the gene for one of which is carried on a

plasmid

0 these exotoxins cause the skin to peel off in leaf-like sheets

0 common in infants
0 if it reaches the blood stream, septicemia and death can

occur within 36 hours

0 Scalded Skin Syndrome

Scalded Skin Syndrome

Rubella (German Measles)

0 caused by a virus
0 symptoms are flat, pink skin rash that first appears on the

trunk 16-21 days post-infection

0 transmission occurs via nasal secretions and is highly
contagious via direct contact (especially in children)
0 Due to MMR vaccine, the incidence of Rubella has
decreased to nearly zero, with only 8 cases occurring in
2006
0 The vaccine does not create the same antibody levels as
acquiring the disease and thus immunity is not as longlasting with the vaccine

Rubella

Measles (Rubeola)
0 virus that causes a skin rash which spreads from the forehead

down the body

0 rash is red and raised
0 rash is caused by T-cells reacting with the virus infected cells in
small blood vessels
0 Two serious complications:
0 measles encephalitis, which occurs in 1 in 1000 with a 30%

mortality rate
0 subacute sclerosing panencephalitis which occurs in 1 in 200,000
measles cases and is almost always fatal.
0 Measles are highly contagious with a respiratory entry
0 susceptible people have a 99% chance of acquiring the virus

when exposed
0 In U.S. incidence rate is low due to MMR vaccine
0 developing countries without access to the vaccine continue to
have outbreaks with a greater than 15% mortality rate in
children

measles

Varicella-Zoster Virus (VZV)

0 Herpes virus that is responsible for two different diseases:

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chickenpox and shingles

Chickenpox is a highly contagious disease causing skin
lesions
VZV has a respiratory entry and travels through the blood
to various tissues
around 2 weeks after exposure, small, irregular, rosecolored skin lesions appear that start on the scalp and
trunk then spread to the face and limbs
these lesions can be portals of entry for secondary
infections
After the disease runs its course, the virus becomes latent
in the central nervous ganglia

Varicella-Zoster Virus (VZV)

continued
0 The latent virus is activated when cell-mediated immunity

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drops below a critical level

the virus moves down the nerves, often damaging them,
causing pain/burning and then the appearance of lesions
confined to one area of the body
chickenpox is an endemic disease primarily in children (it
can be epidemic, depending on the range of those
infected!)
shingles generally occurs in people over 45
infection is spread via direct contact and respiratory
secretions
there is a vaccine available for both chickenpox and
shingles

Shingles & Chicken Pox

Smallpox
0 First disease treated with vaccine
0 Officially declared eradicated in 1980 and there hasnt

been a case in the U.S. since 1949

0 Virus enters body via throat and respiratory tract and
infects blood cells then spreads to skin cells causing
pus-filled vesicles to form, appearing first in the
mouth and throat.
0 Death can occur 10-16 days after first symptoms
0 [Check news for recent info regarding Smallpox cases
due to refusal to vaccinate]

Smallpox

Candidiasis
0 caused by oval, budding yeast Candida albicans

0 Present in normal microbiota

0 can occur as thrush, milky patches on oral membranes

OR vaginitis, milky discharge from vagina

0 Finding budding cells with pseudohyphae in
microscopic examination of the sample is the normal
diagnostic tool
0 Can invade lungs, kidneys, heart, bloodstream and
cause a severe toxic reaction

Thrush

HPV
0 warts are called by human papillomavirus

0 there are many strains, some cause cancers

0 Transmitted via direct contact
0 dermal and genital warts are caused by strains of HPV

Urinary Tract Infections

0 causative agent: bacteria (E. coli is most common)
0 portal of entry/transmission: urethra/bladder
0 disease mechanism: bacteria sticks to bladder wall and

form a biofilm that resists the bodys immune response

0 Symptoms: burning feeling when you pee, frequent or
intense urge to void bladder, pain in back or side below
ribs, cloudy, dark, bloody or foul-smelling urine, fever,
chills and confusion (in old people)
0 treatment/prognosis: antibiotics
0 interesting tidbit: 80-90% of UTIs are caused by a single
type of bacteria; women get it more than men due to short
urethra, once a man gets one hes likely to get another
because the bacteria can hide deep in prostate tissue.

Toxic Shock Syndrome (TSS)

0 causative agent: Staph. aureus
0 portal of entry/transmission: mucus membrane of
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urogenitals
disease mechanism: produces exotoxins
Symptoms: high fever, low BP, vomiting, diarrhea, rash
resembling sunburn on palms of hands and soles of feet,
confusion, muscle aches, headaches, and seizures
treatment/prognosis: hospitalization, antibiotics, stabilize
symptoms, IV immunoglobin
interesting tidbit: its rare and preventable, you can select
low-absorbency tampons, use sanitary napkins at night

Gonorrhea
0 causative agent: bacteria
0 portal of entry/transmission: sexual: oral, anal, vaginal
0 disease mechanism: interaction with urethral epithelial

cells triggers cytokine release, which promotes neutrophil

influx and inflammatory response
0 Symptoms: impacts vision in newborns, itchy, burning,
greenish-yellow discharge (m and f), increase in vaginal
discharge, burning sensation when you pee, lower
abdominal pain which resembles signs of UTI
0 treatment/prognosis: antibiotic
0 interesting tidbit: second most common disease and is
becoming harder to treat because of drug-resistance

Syphilis
0 causative agent: bacteria Treponema pallidum
0 portal of entry/transmission: sexual activity, including oral, anal,
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vaginal and prolonged kissing (dun dun dun)

disease mechanism: infection of endothelial cells leads to
periarteritis with plasmacytic infiltration
Symptoms: skin rash, mucous patches in mouth, vagina and
penis, moist warty patches in genitals or skinfolds, fever, loss of
appetite, muscle aches, joint pain, swollen lymph nodes, vision
changes, hair loss, and general ill-feeling.
treatment/prognosis: If less than a year, a single dose of
penicillin can destroy infection. In later stages, more doses
needed. Prognosis is good if caught early.
interesting tidbit: higher risk of neurosyphilis, if it goes
untreated, it can cause dementia

Chlamydia
0 causative agent: bacteria
0 portal of entry/transmission: vaginal, anal or oral sex
0 disease mechanism: cytotoxin
0 Symptoms: in women: abdominal and cervical pain,

bleeding between cycles, fever. men: unilateral abdominal

pain, enlarged scrotum, anal or urethral discharge, fever.
0 treatment/prognosis: antibiotics; if left untreated can lead
to P.I.D.
0 interesting tidbit: highest percentage of people infected are
women between the ages of 15 and 24.

Herpes
0 causative agent: virus
0 portal of entry/transmission: vaginal, penile, oral, rectal
0 disease mechanism: viral takeover of hosts cell; virus

replicates in the genital, perigenital skin sites and/or anal

skin sites with seeding of the sacral ganglia.
0 Symptoms: redness, raw and cracked lesions, pain, blisters,
and flu-like symptoms
0 treatment/prognosis: no cure, there are some treatments
available (pritelivir) to minimize outbreaks. Gift that
keeps on giving.
0 interesting tidbit: Most common STD in U.S. and 1 in 6
people have it.

Genital Warts (HPV)

0 causative agent: virus
0 portal of entry/transmission: anal, vaginal, oral sexual contact
0 disease mechanism: causes changes in the cells of a womans

cervix by taking over host cells (may lead to cancer)

0 Symptoms: unusual vaginal discharge and bleeding after
intercourse, pain in lower back region, painful urination, painful
intercourse
0 treatment/prognosis: no treatment
0 interesting tidbit: there is some controversy regarding the HPV
vaccine with some alleging that the vaccine may result in higher
mortality than the risk of dying of cervical cancer as a result of
HPV (ALLEGEDLY: no data presented in class to corroborate
this!)

Respiratory Diseases
0 Upper respiratory system has a large amount of

normal microbiota, but the lower (below trachea) is

sterile under normal conditions

Strep Throat
0 caused by group A, beta-hemolytic Streptococcus

pyogenes
0 transmitted by inhalation droplets
0 typically the throat, adenoids and lymph nodes in the
neck become inflamed while white pus-filled lesions
appear on the tonsils. This is accompanied by chills,
headache, soreness, high fever, and occasionally
nausea and vomiting.

Common Cold
0 one of the most common infectious diseases, but is not life

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threatening
signs and symptoms include sneezing, inflammation of mucous
membranes, excessive mucus secretion and airway obstruction.
Sore throat, malaise, headache and cough may also occur.
Many causative agents for the common cold, in fall and spring
rhinovirus is the majority while parainfluenza virus peaks in
summer.
There are around 200 viruses that can cause the cold. Rhinoviruses
are the most common, in which there are at least 113 serotypes.
0 Spread by formite transmission: touching used tissues, etc.

0 Paraninfluenza virus can cause the common cold, as well as, croup,

an acute obstruction of the larynx that causes a high-pitched,

barking cough.

Pertussis/Whooping Cough
0 Highly contagious disease caused by a gram-negative bacteria, Bordatella

pertussis
0 Transmission occurs by inhaling respiratory droplets.
0 Bacteria colonizes cilia lining the respiratory tract and produces toxins that
destroy the ciliated cells, which allows mucus to accumulate in the airway.
0 Progresses through three stages: catarrhal, paroxysmal, and convalescent.

0 Catarrhal is characterized by fever, sneezing, vomiting and airway and a mild, dry,

persistent cough
0 Paroxysmal is characterized by mucus and bacteria masses that fill the airway and
immobilize the cilia, leading to a lack of oxygen in the blood. Straining to breathe
leads to the whooping sound. After 1-6 weeks, the convalescent stage begins.
0 Convalescent stage is where milder coughing can continue for several months.
0 vaccine is highly effective but safety concerns due to deaths associated with the

vaccine led to a decrease in immunizations in the 1980s. Due to this, the incidence of
Pertussis more than doubled.
0 Now recombinant DNA has allowed for a safer vaccine.
0 Immunity seems to wane five to ten years after the vaccine.

Pneumonia
0 leading cause of infectious disease death in the U.S.
0 Several bacteria are known to cause this inflammation of the lung
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tissue
Transmission includes respiratory droplets by carriers
Symptoms include violent chills, high fever, chest pain, cough and
eventually sputum containing blood, mucus, and pus
Streptococcus pneumoniae is the 4th leading cause of death in the
U.S. With immediate treatment, mortality is still 5%, without
treatment its 30%.
Klebsiella pneumoniae has a 50% mortality rate, even with
treatment
diagnosis is based on clinical observation, X-rays and sputum
culture

Tuberculosis (TB)
0 massive global health problem, up to 1/3 of the population has

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TB
the causative agent of TB is Mycobacterium, mostly M.
tuberculosis which have waxy cell walls and therefore require
acid-fast staining.
They are highly resistant to drying and can remain in dried
sputum for 6-8 months.
Inhalation of droplets and dried particles are the common
transmission methods.
The bacteria grows very slowly, eventually forming tubercles,
accumulation of enlarged macrophages, lymphocytes and
bacteria.
Diagnosis involves sputum culture, chest x-rays and skin tests.

Influenza Structure

Influenza
0 viral disease caused by orthomyxoviruses which are enveloped RNA viruses
0 On the surface there are two antigens: hermagglutinin and neuraminidase
0 Hemagglutinin spikes is responsible for infectivity while neuraminidase

spikes helps the virus penetrate cells

0 Influenza mutates frequently causing antigenic variations to these antigens
0 Composition of these antigens allow for identification (H1N1 for example)
0 Antigenic shift results for gene reassortment, trading and mixing genomes
between viruses
0 This has allowed influenza to jump between species

0 Transmission occurs via droplet inhalation or indirect contact with infected

respiratory secretions
0 signs and symptoms include fever, malaise, muscle soreness
0 cough, nasal discharge, sore throat, gastroenteritis can also occur
0 diagnosis is made by throat swabs

Flu Vaccines
0 clicky

0 What risks do you think this vaccine poses?

0 Is it 100% effective?

Cardiovascular Diseases
0 The cardiovascular system has no normal microbiota

Bacterial Endocarditis
0 inflammation and infection of the lining and valves of the
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heart
life threatening
many microbes, including fungi, can cause this, but most
are due to Streptococcus or Staphylococcus
Microbes from another area of the body are transported to
the heart where they attach and damage the heart valves
This can occur from a dental procedure, where infection
from a tooth extraction enters the bloodstream

Anthrax

0 caused by endospore-forming gram-positive bacteria, Bacillus

anthracis
0 Endospores are formed when exposed to oxygen, but are not found
in tissues or blood
0 most human anthrax results from contact with endospores in work
with farm animals
0 there are three different clinical forms: cutaneous, respiratory and
intestinal
0 cutaneous anthrax develops lesions on the skin and has a mortality rate

of 10-20% without treatment. With treatment, drops to 1%

0 respiratory anthrax occurs from inhaling endospores which germinate in
the lung and kill macrophages and is almost always fatal, regardless of
treatment. Early symptoms are similar to the common cold and thus
treatment is not often sought until its too late.
0 Intestinal anthrax is when endospores are consumed and mimics food
poisoning and has a mortality rate of 25-50%. Diagnosis is done by
culturing blood or examining smears from cutaneous lesions

Bubonic Plague
0 caused by the gram-negative, rod-shaped Yersinia pestis
0 When approached by a phagocyte, they release a protein which
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kill the phagocyte

they reduce inflammatory response of the immune system and
can destroy complement factors, thus keeping the immune
system unable to respond.
One of the most devastating diseases in history and is
transmitted via flea vectors
Swollen lymph nodes called buboes are characteristic of the
plague
Diagnosis occurs with fluorescent antibody tests or culture
identification.
Recovery produces life long immunity, but mortality rate is high
Incidence is low in U.S.

Bubonic Plague

Lymes Disease
0 caused by a spirochete Borrelia burgdorferi

0 Carried by a tick vector

0 Symptoms vary but most develop flulike symptoms

and rash
0 Weeks to months later, arthritis and loss of insulation
form myelin sheaths can cause Alzheimer-like
symptoms

Lymes Disease

After being infected by a tick, a bullseye type of rash occurs.

Epstein-Barr Virus (EBV)

0 Human herpesvirus number 4 is a DNA virus that has been shown to cause a wide
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variety of diseases and is suspected to play a role in many others

EBV infects B lymphocytes
EBV causes infectious mononucleosis, Burkitts lymphoma and nasopharyngeal
carcinoma
Infectious mononucleosis causes lymphatic tissue to become inflamed, liver cells
necrotic and monocytes accumulate in the liver
The disease causes great discomfort but is rarely fatal
most fatalities stem from an immunological defect
Diagnosis is tricky
Incidence in the U.S. is highest in teens and young adults and is spread by large saliva
transfers.
Burkitts lymphoma is a tumor on the jaw and is seen mainly in children
the tumor frequently arises from a single cell
nasopharyngeal carcinoma is found most often in China and is a common tumor
compromising 20% of all cancers
Chronic fatigue syndrome is suspected to be due to EBV thought other viruses have
been reported as well

Malaria
0 Malaria is caused by several species of protozoa in the genus Plasmodium
0 The disease is transmitted via a mosquito vector and is the worlds greatest
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public health problem

while it is endemic to South and Central America, Africa and Asia, global
travel has allowed the disease to spread
Sporozoites enter the blood from the bite of an infected mosquito and invade
cells of the liver and other organs
They release merozoites which invade and reproduce in red blood cells
Average malaria destroys 25-75% of the hemoglobin in the red blood cell
Of the 4 species, P. falciparum causes the most severe disease as the red
blood cells clump and obstruct blood vessels
Mortality depends on the infecting species
Diagnosis requires identification of the protozoan species in the cells