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MICROBIOLOGY - Last moment revision

The first person to observe bacteria Anton von leuwen hock The earliest discovery of pathogenic micro organism was probably made by Augustino Bassi The development of bacteriology as a scientific discipline date from Louis Pasteur The kingdom Protista has been divided into two groups prokaryotes and Eukaryotes Bacteria and blue green algae are Prokaryotes while fungi, algae, slime moulds and protozoa are Eukaryotes. The types of staining that may be toxic and that which kills bacteria is called supravital staining. Bacteria have an affinity to basic dyes due to acidic nature of protoplasm. Acid fast staining discovered by Ehrlich and modified by Zeil and Neelssen. According to shape bacteria are classified into 1. Cocci - spherical shaped bacteria 2. Bacilli - rod shaped cells 3. Vibrio - comma shaped cells 4. Spirilla- rigid spiral forms 5. Spirochetes- flexuous spiral forms 6. Actinimycetes - branching filamentous form. 7. Mycoplasma lacks cell wall. Hence do not possess stable morphology. Cultural media may be a complex medic if ingredients are added for special purpose of growth. IMMUNITY Refers to resistance exhibited by host towards injury caused by microorganisms and their products. Innate immunity is inborn. Acquired immunity may passive and active immunity. Active immunity developed by an individual due to antigenic stimulus . once developed it is long lasting. In PASSIVE immunity no antigenic stimulus; preformed ontibodies are administered. An antigen has been defined as any substance when introduced parenterally into the body stimulates the production of antibodies. The smallest unit of antigenicity is called an epitope Antibodies are immunoglobulins IgG :- this is major serum immunoglobulin. Its level is raised in chronic malaria, kala azar, or myeloma. IgG is only maternal immunoglobulin that is normally transported across the placenta and provides natural passive immunity in newborn. IgA:-it is the second most abundant class of immunoglobulin seen in body fluids such as colostrums, saliva and tears. IgM:- is called millionaire molecule. It is not transported across the placenta hence presence of IgM in the foetus or newborn indicates diagnosis of congenital infection such as syphilis, rubella, HIV and toxoplasmosis.

IgM antibodies are short lived, hence their presence in serum indicates recent infection. IgE:- greatly elevated in atopic (Type I allergy) conditions such as asthma, hay fever, eczema, and also in children having high load of intestinal parasites. In general IgM protects body fluids IgA protects body surfaces IgM protects blood stream IgE - mediates reagenic hypersensitivity Bence jones proteins are abnormal light chain immunoglobulins seen in multiple myeloma. Coombs test antiglobulin test- dirct commbs test is positive in haemolytic disease of newborn due to Rh incompatibility Indirect commbs test is positive in Brucellosis Wasserman reaction (Serodiagnosis of syphilis) is a complement fixation test The term hypersensitivity means injurious consequence in sensitized host following contact with specific antigens. Mainly classified into Immediate B-cell or antibody mediated and Delayed t cell mediated Immediate hypersensitivity 1. Appears rapidly and recedes rapidly 2. Induced by antigens or happens by any route 3. Circulating antibodies are present and responsible for reaction 4. So antibody mediated reaction Delayed hypersensitivity 1. Appears slowly and lasts longer 2. Induced by infection, ingestion antigen or happen intradermally 3. Antibodies absent 4. Cell mediated reaction

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In anaphylactoid reactions there is no immunological basis. Shwartzan reaction is not an immune reaction but reaction resembles immune inflammation. Auto immunity is a condition in which structural or functional damage is produced by action of immunologically competent cells or antibodies against normal components of body. Rose water test is used for the detection of rheumatic fever.

STAPHYLOCOCCUS Gram positive Occurs in grape like clusters Enzyme coagulase present It causes LOCALISED SUPPURATIVE LESIONS Common culture media is nutrient ogar and organization shows oil paint appearance in medica. Main exotoxins of S.aureus are cytolytic toxin, enterotoxin and exfoliative toxins. Entero toxin causes staphylococcal food poisoning (milk and milk products are responsible for common food items) Exfoliative toxins causes TSS (toxic shock syndrome) And SSSS - Staphylococcal scalded skin syndrome- seen in infants Ritters disease PATHOGENESIS

Localized skin lesions including furuncles, styes, boils, abscesses, carbuncles, impetigo. Sepsis in burns and wounds Acute osteomyelitis Tonsillitis, pharyngitis, pneumonia, especially bronchopneumonia secondary to some respiratory infections Breast abscess in lactating mothers Tropical myositis- in young adults of tropics multiple abscess in voluntary muscles. In staphylococcal food poisoning diarrhea and vomiting starts with in 6 hours of taking contaminated food Exfoliative diseases such as impetigo, pemphigus neonatorum, Ritters disease, toxic epidermal necrolysis. Non pathogenetic staphylococci- staphylococcus epidermitidis

STREPTOCOCCI Gram positive It causes SPREADING PYOGENIC INFECTIONS and non suppurative lesions sucj as rheumatic fever and glomerulonephritis 3 types Alpha haemolytic s.cocci Beta haemolytic s.cocci Gamma haemolytic s.cocci (non haemolytic) Streptococci form several exotoins and ensumes. The two haemolysins are haemolysin O and S. Streptolysin O is oxygen labile. Streptolysin regularly appear in sera following streptococcal infection - ASO tite Strepto lysine S is not antigenic Erythrogenic toxin is also called Dick , scarlatinal or pyrogenic toxin. DICK TEST:- this test is used to identify children susceptible to scarlet fever (scarlet fever is a type of acute pharyngitis with extensive rash caused by str.pyogens SCHULRZ CHARTON reaction:- blanching of rash on localinfection convalescent serum. This is used as a diagnostic test in scarlet fever. The enzyme sternodornase present in the str.cocci helps to liquefy pus and hence responsible for serous character of pus. PATHOGENESIS Respiratory infection including sore throat, tonsillitis, pharyngitis Extension of infection from throat to surrounding tissues causes ASOM, mastoiditis , quinsy, Ludwigs angina, suppurative adenitis Skin and subcutaneous infection - Variety of suppurative infection including infection of wounds or burns. 2 typical streptococcus infections are Erysipelas and impetigo (impetigo are vesicular pin head like infection with exfoliation.) Streptococcal subcutaneous infection range from cellulites to necrotizing fascitis. Genital infection including puerperial sepsis and abscess in internal organs such as brain, kidneys etc. Non suppurative leisions such as rheumatic fever and acute glomerualonephritis.

In rheumatic fever, a connective tissue degeneration of heart valve and inflammatory myocardial leisions causes Aschoff nodules Str. Viridans normally residing in mouth and upper respiratory tract

PNEUMOCOCCI It is gram positive Single most prevalent bacterial genera in pneumonia, otitis media, acute sinusitis, meningitis, and other infectious processes Cultural characters :- on blood agar draughtsman or carom coin appearance. It exhibits capsule swelling reaction called quelling reaction. The toxins are oxygen labile haemolysin and a leucosidin PATHOGENESIS -Lobar pneumonia - Bronchopneumonia following viral infections - Acute exacerbation of chronic bronchitis (haemophilus influenza also causes this) - Empyema, pericarditis, ASOM, otitis media, sinusitis, conjunctivitis, suppurative arthritis NEISSERIA Gram negative cocci N.meningitidis Causes meningococcal meningitis or cerebrospinal fever Oval or spherical in shape Grows only on enriched media such as blood agar, chocolate agar Modified Thayer-Martin media is a useful selective media PATHOGENESIS Cerebrospinal meningitis Meningococcal septicemia In meningococcal septicemia there occurs adrenal haemorrhage and shock. This is Water house Frederickson syndrome N. gonorrhoea Causes veneral disease gonorrhoea. Here also Thayer Martin media is used. PATHOGENESIS Gonorrhoea is acquired by sexual contact. c/c urethritis lead to stricture formation. The may spread to periurethral tissue causing abscess and multiple discharging sinuses. (Water can perineum) In women causes Bartholinitis and salpingitis Proctitis, conjunctivitis, arthritis, ulcerative endocarditis and meningitis Non veneral infection is gonococcal ophthalmia in newborn NON GONOCOCCAL URETHRITIS (NGU) Causative organisms are a. Chlamydia trachomatis b. Ureaplasma urealyticum c. Mycoplasma hominis CORYNE BACTERIA Gram positive Non acid fast, non motile rods

C.diphtheria :- syn. (Lofflers bacillus) Having Chinese letter of cuneiform arrangement Usual media - Loefflers serum slope and tellurate blood agar 3 types Gravis most fatal infections Intermediate Mitis Universally used strain is Park williams strain PATHOGENESIS Site of infection 1. Faucial 2. Laryngeal 3. Nasal 4. Otitic 5. Conjunctival 6. Genital 7. Cutaneous -Faucial diphtheria is the commonest type. Classified into malignant or hyper toxic diphtheria in which there is sever toxaemia with marked adenitis bull neck. Death occurs due to circulatory failure. -Septic- which leads to ulceration, cellulitis, gangrene - Haemorrhagic characterized by bleeding from edge of membranes Common complication asphyxia, acute circulatory failure, post diphtheritic paralysis SHICK TEST- susceptibility test for diphtheria BACILLUS Rod shaped bacteria 2 types Aerobic bacilli and anaerobic bacillus Gram positive B.anthracis :- first pathogenic bacteria observed under microscope and it is the first bacillus to be isolated in pure culture and first bacterium used for preparation of attenuated vaccine. M-Faydens reaction:- used for presumptive diagnosis of anthrax in animals Culture media:- on agar media frosted glass appearance with locks of matted hair called medusa head appearance, on gelatin slab having inverted fir tree appearance when grown on solid media strings of pearl reaction. ANTRAX is a zoonosis 3 types 1. Cutaneous 2. Pulmonary 3. Intestinal All types leads to fatal septicemia. Cutaneous anthrax Follows infection through skin. Leisions are called malignant pustule or black eschar Disease is common in dock workers carrying loads of hides and skins on bare back. Hence called hide porters disease.-

PULMONARY ANTHRAX:Wool sorters disease due to inhalation of dust from infected wool. There is haemorrhagic pneumonia. Haemorrhagic meningitis is a complication. Intestinal anthrax is rare. Occurs mainly in primitive communities which uses undercooked meat. Lab diagnosis is by immunofluoroscence Bacillus cereus causes food borne disease characterized by diarrhea and abdominal pain associated with consumption of cooked rice, usually fried rice from Chinese restaurant. CLOSTRIDIUM Gram positive Anaerobic sphere forming bacilli Genus responsible for 3 major diseases 1. Gas gangrene. 2. Food poisoning 3. Tetanus Spores may be central or equatorial. Eg. Cl. Bifermingens Oval or terminal Tennis racket eg. Cl. Tertian Spherical and terminal drum stick appearance eg. Cl. Tetani Useful media Robertsons cooked meat broth cl. perfingens - Gas gangrene (malignant oedema) Wound contamination Septic abortion Anaerobic myositis Food poisoning and Necrotizing enteritis In litmus reaction fermentation of lactose causes stormy fermentation cl. perfingens show Nagler reaction due to specific lecithinase effect Food poisoning starts between 8-24 hours self limiting illness cl.noviji (cl.oedematiens) Also causes gangrene characterized by high mortality and large amount of oedema fluid with little or no observable gas. Clostridium tetani Drumstick appearance Media: robertsons cooked meat broth 2 toxins: tetanolysin which is haemolysin and tetanospasmin which is a powerful neurotoxin Tetanus toxins block synaptic inhibitors in spinal cord. While strychnine acts post synaptically. Abolition of spinal inhibition causes uncontrolled spread of impulses initiated any where in CNS. This results in muscle rigidity and spasm. Sometimes tetanus may be due to local suppuration called otogenic tetanus. Clostridium botulinum

Causes food poisoning exotoxin is responsible for pathogenicity. It acts by blocking acetylcholine at synapse and neuromuscular junction. Hence onset marked by diplopia, dysphagia and dysarthria Botulinum 3 type 1. Food borne botulism 2. Wound botulism 3. Infantile botulism Food borne botulism- 12- 36 hours after ingestion Vomiting, thirst, constipation, ocular paresis, difficulty in swallowing, speaking, breathing, coma or delirium Death is due to respiratory failure. Wound botulism Rare. Symptoms similar to food borne botulism except GIT symptoms Infant botulism - Infants less than 6 months are affected. Manifestations are constipation, poor feeding, lethargy, weakness, pooled oral secretion, weak or altered cry, loss of head control.

NON SPORING ANAEROBS Enterobacteria proteus Mc conkeneys medium E coli- pathogenesis Neonatal meningitis Septicemia Clinical features: 1. UTI 2. Pylonephritis and hypertension in pregnant women For diagnosis - Mid stream urinalysis 3. 4. 5. Diarrhea travellers diarrhea Enterohaemorrhagic colitis frank dysentery Pyogenic infection and septicemia

KLEBSIELLA (fried landlers bacillus) -Pneumonia, UTI, septicemia and rarely diarrhea ENTEROBACTERIA Shigella causes bbacillary dysentery Short incubation period 1-7 days; usually 48 hours Enterobacteria - Salmonella Salmonella typhi:- causes typhoid fever. Enteric fever :- typhoid and paratyphoid fever- salmonella paratyphi A,B,C Widal reacton Leucopenia Diazo test of urine Slamonella gastroenteritis Poultry, meat, milk, cream and eggs

Short incubation period less than 24 hours VIBRIO Gram negative; comma shaped Described by Koch as fish in stream vibrio colonies are identified by string test Biochemical reaction- cholera rod reaction In cholera watery diarrhea, vomiting with hypovolumic shock and death in less than 2 hours Stool has fishy odour and it is described as rice watery stool. PSEUDOMONAS Bacillus pyocyanius Gram negative Pyocyanis forms blue pus ; self limiting illness - shanghai fever YERSINIA, PASTEURELLA, FRANCISCILLA Yersinia safety pin appearance On nutrient agar - stalactile growth Yersinia causes plague Pandemic plague causes black haemorrhage and gangrene. 3 forms Bubonic, pneumonic and septicemic Vector is rat flea xenophilla cheopis

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HAEMOPHILUS INFLUENZAE Gram negative bacillus Cultural media is blood agar and shows Satelletism in media Pathogenesis Meningitis Otitis media Pneumonia Arthritis Endocarditis, pericarditis Bronchitis Haemophilus ducreyi Cause chancroid or soft sore. Veneral disease. Bacilli are arranged in groups called school of fish or rail road track appearance BORDETELLA PERTUSIS ( bordet- gengou glycerine potatoe blood agar Bisected pearls or mercury drops with aluminium paint appearance Pathogenesis: Pertusis or whooping cough. BRUCELLA Acute brucellosis ; undulant fever Malta fever Relapsing fever Caused by B. melitensis Brucellosis is primarily a disease of reticuloendothelial system

Lab investigation:- castinada method of blood culture. MYCOBACTERIUM TUBERCULOSIS Gram positive Acid fast bacillus In children it causes primary complex. Ghons focus :- subpleural focus of tuberculous pneumonia in lung parenchyma Adult type TB is due to reactivation of primary infection. In mantoux test 0.1 ml. purified protein derivative is injected intracutaneously on flexor aspect of forearm. Site is examined after 48-72 hours If induration of diameter 10mm or more positive mantoux test If induration is 5 mm. or less than 5mm. negative If induration is between 6-9 mm it is doubtful case. LEPROSY Caused by gram positive mycobacterium leprae. Organism is arranged in parallel rows are having cigar bundle appearance. Masses of bacilli are called globi. The globi appear in virchows lepra cell or foamy cell Leprosy is a chronic granulomatous disease. 4 types 1. Lepromatous 2. Tuberuloid 3. Dimorphous 4. Indeterminate Lepromatous variety is most infectious type. Lepromin test is negative in lepromatous leprosy due to deficient cell mediated immunity. In Tuberculoid leprosy patient is having high resistance. Good prognosis. Lepromin test is positive. Few skin lesions but neurological symptoms are more and deformity occurs early. The term borderline or dimorphous refers to lesions possessing characteristic of both tuberculoid and lepromatous type. The indeterminate type is early unstable tissue response to the microorganism. Lesions undergo spontaneous healing. Classification according to Reiding & jopteng scale of classification Lepromin test is described by metsuda Biphasic events First phase - early reaction - Fernandes reaction. Ie. Erythema and induration developing in 24-48 hours. Late phase - Mitsuda reaction - starting 1 or 2 weeks later. It consists of indurated skin nodule which may ulcerate. Lepromin test is positive in Tuberculoid leprosy Lepromin test is negative in lepromatous leprosy Lepromin test is variable in dimorphous and indeterminate varieties

SPIROCHAETES Treponema pallidum causing syphilis

Treponema pertenue causes yaws Treponema carateum causes pinta Staining reaction is silver impregnation method Syphilis is a veneral disease Primary lesion is chancre Lymph nodes are characteristically rubbery in consistency Secondary syphilis starts after 2-6 weeks, characterized by roseolar skin rashes After secondary syphilis there is a stage of latent syphilis. During this period diagnosis is possible by serological test. There occurs cardiovascular lesions including aneurysm. Tertiary syphilis delayed hypersensitivity reaction mainly tabes dorsalis and general paralysis of insane. Serological test for diagnosing syphilis A. Reagin test B. Kahn test (floaculation test) C. VDRL test (veneral disease research laboratory test) D. Rapid plasma regain test is the first modified VDRL First reagen test is Wasserman reaction BORELLIA Causes relapsing fever 2 types Louse borne relapsing fever Tick borne relapsing fever Louse borne relapsing fever is caused by Borellia recurrentis Borellia vincenti causes ulcerative gingivostomatitis or oropharyngitis called vincents angina or cancre oris Borellia burgdorferi causes lyme disease Rat bite fever caused by spirillum minus or streptobacillus moniliformis LEPTOSPIRA Leptospira icterohaemorrhagica causes Weils disease which causes hepatorenal damage. Antibodies appear in serum towards the end of first week of disease and increase till 4th week. Caonicola fever is caused by leptospira canicola. MYCOPLASMA Smallest free living microorganism. Organism in colony have fried egg appearance. Mycoplasma causes pneumonia and genital infection especially of children and adolescents. ACTINOMYCETES Gram positive. Between bacteria and fungi It causes lumpy jaw in cattle. Actinomycosis is a chrnic granulomatous infection characterized by development of indurated swelling mainly in connective tissue with suppuration and discharge of sulphur granules. Actinomycosis in human being is an endogenous infection. Actinomycetes Israeli is the causative organism. 3 forms 1. Cervico fascial 2. Thoracic

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3. Abdominal Pelvic actinomycosis is associated with the use of IUCD (intra uterine contraceptive device) Actinomycetes mycetoma( Madura mycosis) It is a localized chronic granulomatous involvement of subcuteneous and deeper tissue affecting foot and less commonly hands and presenting as a tumour with multiple discharging sinuses. Helicobacter pylori associated with antral gastritis and peptic ulcer disease. Legionella pneumonia is caused by Legionella pneumophilia. Human infection is typically caused by inhalation of aerosols produced by airconditioners and shower heads. RICKETTSIAE Gram negative organism Weil Felix raction used for diagnosis of rickettsial infection. Scrub typhus Rickettsiae tsu tsu gambusti Epidemic typhus Rickettsiae prowazekii (vector is louse or pediculus humanis) Recrudescent typhus is activated latent infection called Brill- Zeinsser disease Rocky mountain spotted fever - Rickettsia rickettsi Endemic typhus is caused by rickettsiae typhi ( r. mooseri) Transmitted by xenopsyla cheopis or rat flea Trench fever is caused by Rickettsiae Quintana Transmitted by body louse Q fever is caused by coxellia burnetti CHLAMYDIAE Main pathogenitic varieties are Chlamydiae psittaci Chlamydiae pneumoniae trachomatis causes 1.Trachoma which is a chronic keratoconjunctivitis (lab diagnosis by Hp bodies) 2. Inclusion benorrhoea (neonatal form of inclusion conjunctivitis) 3. Pool conjunctivitis 4. Lymphogranuloma venerum Chlamydia psittaci Causes psittacosis consumption of infected poultry products leads to this disease VIROLOGY Interferon antiviral substances, it is a family of host coded proteins produced by cells on induction by viral or non viral substances Pox virus:- small pox- last detected case of small pox sarban devi , a bengladeshi woman on 24th may 1975.

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HERPES VIRUS Herpes simplex virus type I causes oral and cutaneous lesions spreading by direct contact Herpes simplex type II causes genital tract infection transmitted venerally. Occupational variety of cuteneous lesion is herpetic whitlow seen in doctors, nurses and dentists. Eczema herpeticum Generalized eruption occurs in children suffering from eczema Crops of vesicles appear around the ulcer;clinically indistinguishable from vaccinia virus infections . both designated as Kaposis varicella form eruptions. In chicken pox eruptions are centrifugal in distribution. (small pox rashes are centripetal in distribution) In chicken pox patients , secondary bacterial infection due to streptococci or staphylococci occurs. This is called Reyes syndrome. Clinically characterized by acute hepatic failure, encephalopathy and hypoglycemia. Herpes zoster (syn; shingles, zona) Occurs in patients affected with chicken pox years later. Ramsay hunt syndrome:- rare form of zoster affecting facial nerve with eruption on areas of tympanic membrane and external auditory canal with facial palsy. Epstein Barr virus Causes IMN (infectious mono nucleosis) Associated with Burkitts lymphoma Immunodeficiencies Naso pharyngeal carcinoma IMN (glandular fever) acute self limited illness seen in non immune adults following primary infection with EB virus. Incubation period is 4- 8 weeks . standard diagnostic test is Paul - Bunnel test Adenovirus causes respiratory infection , usually picorno virus includes enterovirus - coxachie virus and polio virus poliomyelitis is mainly 3 types 1. Minor illness :- called abortive polio with head ache, sore throat, and malaise 2. Non paralytic illness:- it does not progress beyond asceptic meningitis 3. 5-10% causes paralytic polio Vaccine:- 2 types a. Salks killed polio vaccine b. Live polio vaccine is oral polio vaccine Orthomyxovirus causes influenza. Paramyxovirus Eg. Mumps virus Measles (Rubiola) genus morbiliform virus Multinucleated giant cells called Warthin Finkelclay cells are found in lymphoid tissue of patients. Kopliks spots developon buccal mucosa two or three days before the appearance of rash.

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FLAVI VIRUS Causes 1. Japanese encephalitis (vector- culex tritaneorynchus) 2. Yello fever Vector Aedes aegypti 3. Dengue fever - Vector - Aedes aegypti Tick borne encephalitis eg. KFD (Kyansur forest disease) RHABDO VIRUS Eg. Rabies virus causes hydrophobia Diagnosis is confirmed by negri bodies (inclusion bodies) in brain in post mortem examination mostly in hippocampus and cerebellum PAPOVA virus include papilloma virus group and polyoma virus group. The common human disease produced by papova virus is papilloma or wart. (verruca vulgaris) A special type of wart is condylom accuminatum or genital wart found on external genitalia. This may be transmitted venerally and may occasionally turn malignant. Parvo virus cause erythema infectiosum the fifth disease a contagious disease of children characterized by erythematous rash first appearing on cheeks. slapped cheek appearance. RUBELLA OR GERMAN MEASLES Caused by genus rubivirus of family toga viridae Kopliks spot absent Rash is discrete and coalesce and disappear on 3rd day Non tender enlargement of post cervical glands is characteristic If Rubella occurs in early pregnancy, the foetus may die Congenital malformations are common during first trimester. Infected babies constitute an important source of infection for about 6 months (virus may persist for years in tissues such as cataractous lenses) Diagnosis of Rubella in early pregnancy is an indication for therapeutic abortion. Cruzfelt Jacob disease is sub acute encephalopathy with progressive incoordination and dementia caused by group b prion virus. Haemorrhagic fever with renal syndrome(HFRS)- also known as epidemic haemorrhagic nephrosonephritis is caused by Huntaan virus of family Bunya viridae. HIV human immunodeficiency virus retro virus now called Human T cell lymphotrophic virus - RNA virus attacks CD4 cells. A. Envelops antigens 1. spicks antigen, 2. transmembrane B. Shell antigen C. Core antigen D. Polymerase antigen Incubation period varies from 2-6 weeks to 15 years. Features characaterising AIDS 1. Lymphopenia 2. Selective T cell deficiency reduction in numbers of T4 (CD4) cells, inversion of T4: T8 ratio

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Decreased delayed hypersensitivityon skin testing Hypergammaglobulinaemia predominantly IgG and Ig A; also IgM in children. 5. Polyclonal activation of B cells an dincreased spontaneous spontaneous secretion Ig. Common malignancies associated with HIV infection is Kaposis sarcoma and lymphoma- hodgkins and Non hodgkins types. HIV- Elisa for detection Western blot for confirmation Ergotoxicosis (ergotism) is due to claviceps purpura growing on fruiting heads of rye. HEPATITIS Hepatitis A incubation period - 2- 6 weeks Hepatitis B - I P 4 8 weeks Hepatitis C IP 2 22 weeks Hepatitis D Ip 4 8 weeks Hepatitis E IP 2 9 weeks Hepatitis B DNA virus ; all others are RNA virus Spreads by faeco oral route - hepatitis A and E Spreads by percutaneous route - Hepatitis B,C and D Hepatitis B also spread by vertical and sexual route Oncogenicity present in Hepatitis B especially after neonatal infection. Carrier state present in Hepatitis B only Hepatitis B virus may present in blood and other body fluids and excretions such as saliva, breast milk,semen, vaginal secretions, urine , bile etc. Feces not known to be infectious HBs Ag is the first viral marker to appear in blood after infection; it remains in circulation throughout icteric course of disease. In a typical case it disappear within roughly 2 months but may last for 6 months. HBsAg is not demonstrable in circulation but antibody, antiHBe appear in serum a week or two after appearance of HbSAg So anti-HbeAg is the antibody marker to be seen in blood. HBeAg (HB envelop antigen) appears in blood concurrently with HBsAg. HbeAg is an indicator of intrahepatic viral replication and its presence in blood indicates high infectivity. For diagnosis of HBV infection, simultaneous presence of IgM, HBC indicates recent infection and presence of IgG ;anti H-Be indicates remote infection.

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Type E hepatitis : enterically transmitted. Non A non B hepatitis caused by Hep. C virus Inclusion body inviruses a. Intracytoplasmic Guarnieri body - Varicella, Vaccinia Negri body Rabies Henderson Paterson body - Molluscum contagium b. Intranuclear a. Lipschutz bodies - herpes fibrilis, herpes zoster, varicella

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b. c.

Councilmanns bodies - yellow fever, virus B encephalitis Nicolaus bodies herpes fibrilis, herpes zoster , polio, Rift valley fever

Association of virus with human cancer Virus family Herpes virus Virus genus E-b Virus Human cancer Nasopharyngeal carcinoma African Burkitts lymphoma B- cell lymphoma

Herpes 2 virus Papova viridae Papilloma virus

Cervical carcinoma Urogenital tumour Squamous cell carcinoma Primary Hepatocellular carcinoma Adult T Cell Leukaemia

Hepadne virus Retrovirus

Hep B virus HTL virus

Viral infections associated with associated with maculopapular rash 1. Adenovirus infection 2. Arbovirus infection 3. Measles 4. Cytomegalovirus infections 5. Enterovirus 6. Hep-B virus 7. IMN (kissing disease) 8. Rubella

Haemolytic uraemic syndrome caused by virotoxin producing e-coli Brazilian purpuric fever caused by Haemphilus aegypticus Cryptospridum causes diarrhea Cat scratch disease is caused by cat scratch bacillus

FUNGAL INFECTIONS Superficial mycosis(cutaneous ) or dematophytis 1. Microsporum - attacks skin and hair ; not nail 2. Tricophyton attacks skin , hair and nails. Most important human parasites are T. rubrum and T. tonsuran 3. Epidermophyton - e.floccosum attacks skin and nails but not hair. Dermatophytes: Tinea capitis ring worm of scalp Tinea circinata ringworm of glabrous skin Tinea barbae - ringworm of beard

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Tinea pedis Athletes foot Tinea cruris Dhobi itch or Jock itch Tinea unguum - ring worm of nails

Systemic mycosis Candid albicans yeast like fungi Histoplasma capsulatum - Darlings disease Cryptococcus neoformans yeast Aspergillus - fungus ball Cocciodes immitis desert rheumatism

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