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American physician Charles Drew invented the technique for plasma separation that allowed blood to be stored arteria lusoria order avalide cheap online, or "banked. Combinations of at least two drugs are recommended to minimize development of resistance. Hepatitis c In the 1960s, a previously unsuspected form of transfusiontransmitted hepatitis, now called hepatitis C, appeared. It is often clinically inapparent-few people have recognizable symptoms until about 20 years have elapsed. Often, hepatitis C is detected only during some routine testing, such as for insurance or blood donation. About 25% of chronically infected patients develop liver cirrhosis or liver cancer. In one exceptional case, the disease was transmitted by means of a straw shared for inhaling cocaine. About 90% of cases of acute viral gastroenteritis are caused by either the Rotavirus or the human caliciviruses, better known as the Norwalk family of viruses now in the Norovirus. More than 90% of children in the United States have been infected by the age of 3. This negatively stained electron micrograph Q shows the morphology of the rotavirus (rota 5 wheel), which gives the virus its name. Clinical Case the health department makes a visit to the petting zoo to investigate the animals with which anna had contact. In most cases, following an incubation period of 2 to 3 days, the patient suffers from low-grade fever, diarrhea, and vomiting, which persists for about a week. An infectious dose is estimated to be fewer than 100 viruses, and patients shed billions in every gram of stool. The first vaccine to prevent rotavirus, introduced in 1998, was withdrawn after serious problems developed. Rotavirus infections are routinely diagnosed by several types of commercially available tests, such as enzyme immunoassays. Norovirus Noroviruses were first identified following an outbreak of gastroenteritis in Norwalk, Ohio, in 1968. Several similar viruses were later identified, and this group was termed Norwalk-like viruses. All were determined to be members of the caliciviruses (named for the Latin calyx, meaning cup- cup-shaped depressions are visible on the viruses) and are now termed noroviruses. It is not practical to culture them, and they do not infect the usual laboratory animals.

Syndromes

• Genital warts or HPV
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• Inflammation of the lymph vessels (lymphangitis)
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The bacteria are spread in the lymph system and cause enlargement of the lymph nodes hypertension kidney failure 162.5 mg avalide purchase fast delivery, obstruction of lymph vessels, and swelling of the external genitals. Chancroid, a swollen, painful ulcer on the mucous membranes of the genitals or mouth, is caused by Haemophilus ducreyi. Bacterial vaginosis is an infection without inflammation caused by Gardnerella vaginalis. Symptoms of the infection are painful urination, genital irritation, and fluid-filled vesicles. Vulvovaginal candidiasis is characterized by lesions that produce itching and irritation. Predisposing factors are pregnancy, diabetes, and broad-spectrum antibacterial chemotherapy. Diagnosis is based on observation of the protozoa in purulent discharges from the site of infection. Chapter 26 Microbial Diseases of the Urinary and Reproductive Systems 769 Study Questions For answers to the Knowledge and Comprehension questions, turn to the Answers tab at the back of the textbook. Microscopic examination of vaginal smear shows epithelial cells covered with bacteria. Frothy, fishy discharge Use the following choices to answer questions 9 and 10: a. Syphilis epidemics in Europe coincided with the return of Columbus from the New World. Why can frequent douching be a predisposing factor to bacterial vaginosis, vulvovaginal candidiasis, or trichomoniasis The list below is a key to selected microorganisms that cause genitourinary infections. Complete this key by listing genera discussed in this chapter in the blanks that correspond to their respective characteristics. Philadelphia hospital had pain in the right knee, left ankle, and left wrist for 3 days. Pathogens cultured from synovial fluid or urethral culture were gram-negative diplococci that required proline to grow. A previously healthy 19-year-old woman was admitted to a hospital after 2 days of nausea, vomiting, headache, and neck stiffness. Cerebrospinal fluid and cervical cultures showed gramnegative diplococci in leukocytes; a blood culture was negative. A 28-year-old woman was admitted to a Wisconsin hospital with a 1-week history of arthritis of the left knee. Four days later, a 32-year-old man was examined for a 2-week history of urethritis and a swollen, painful left wrist. A 20-year-old woman seen in a In the Clinic As an environmental health nurse, you are investigating ways to reduce nitrous oxide (N2O) levels in the atmosphere. Global warming is a public health concern, and N2O is a greenhouse gas that can absorb 300 times more radiant energy than carbon dioxide.

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This rate of infection is 10 per 1000 patients-nearly 300% higher than the average of 2 arrhythmia journal purchase avalide 162.5 mg visa. You request that housekeeping clean rooms and equipment with a hypochlorite-based disinfectant rather than the standard hospital (quat) disinfectant normally used. In the mid-1800s, the Hungarian physician Ignaz Semmelweis and English physician Joseph Lister used this thinking to develop some of the first microbial control practices for medical procedures. Until that time, hospital-acquired infections, or nosocomial infections, were the cause of death in at least 10% of surgical cases, and as high as 25% in delivering mothers. Ignorance of microbes was such that during the American Civil War, a surgeon might have cleaned his scalpel on his boot sole between incisions. We now know that handwashing is the best way to prevent transmission of pathogens such as the norovirus in the photo. Controlling noroviruses on environmental surfaces is the topic of the Clinical Case. Over the last century, scientists have continued to develop a variety of physical methods and chemical agents to control microbial growth. In Chapter 20 we will discuss methods for controlling microbes once infection has occurred, mainly antibiotic chemotherapy. A word frequently used, and misused, in discussing the control of microbial growth is sterilization. In reality, the heat treatment required to ensure absolute sterility would unnecessarily degrade the quality of the food. The endospores of a number of thermophilic bacteria, capable of causing food spoilage but not human disease, are considerably more resistant to heat than C. If present, they will survive, but their survival is usually of no practical consequence; they will not grow at normal food storage temperatures. A drinking glass or a fork in a restaurant requires only enough microbial control to prevent the transmission of possibly pathogenic microbes from one person to another. Disinfection might make use of chemicals, ultraviolet radiation, boiling water, or steam. In practice, the term is most commonly applied to the use of a chemical (a disinfectant) to treat an inert surface or substance.

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Trypanosoma is introduced into the bloodstream by a tsetse fly blood pressure drops after eating buy avalide 162.5 mg amex, it produces and displays a specific antigen. Because the microbe can make up to 1000 different antigens, such an infection can last for decades. Helminths the presence of helminths also often produces disease symptoms in a host (see Table 12. Some of these organisms actually use host tissues for their own growth or produce large parasitic masses; the resulting cellular damage evokes the symptoms. This parasite blocks lymphatic circulation, leading to an accumulation of lymph and eventually causing grotesque swelling of the legs and other body parts. Waste products of the metabolism of these parasites can also contribute to the symptoms of a disease. For example, some genera of dinoflagellates, such as Alexandrium, are important medically because they produce a neurotoxin called saxitoxin. Although mollusks that feed on the dinoflagellates that produce saxitoxin show no symptoms of disease, people who eat the mollusks develop paralytic shellfish poisoning, with symptoms similar to botulism. The parasite prevents normal acidification and digestion; thus, it can grow in the phagocytic vacuole. Some protozoa can evade host defenses and cause disease for very long periods of time. The immune system is alerted to recognize foreign substances called antigens; the presence of antigens causes the immune system to produce antibodies designed to destroy them (see Chapter 17). When Identify one virulence factor that contributes to the pathogenicity of each of the following: fungi, protozoa, helminths, and algae. Just as microbes enter the body through a preferred route, they also leave the body via specific routes called portals of exit in secretions, excretions, discharges, or tissue that has been shed. In general, portals of exit relate to the infected part of the body, with microbes tending to use the same portal for entry and exit. Portals of exit let pathogens spread through a population by moving from one susceptible host to another. This type of information about the dissemination of a disease is very important to epidemiologists (see Chapter 14). After entering the host, most pathogens adhere to host tissue, penetrate or evade host defenses, and damage host tissues. Pathogens usually leave the body via specific portals of exit, which are generally the same sites where they entered initially. Many pathogens living in the respiratory tract exit in discharges from the mouth and nose, expelled during coughing or sneezing. Pathogens that cause tuberculosis, whooping cough, pneumonia, scarlet fever, meningococcal meningitis, chickenpox, measles, mumps, smallpox, and influenza are discharged through the respiratory route. Feces may be contaminated with pathogens associated with salmonellosis, cholera, typhoid fever, shigellosis, amebic dysentery, and poliomyelitis.

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The base pairing of codon and anticodon at the ribosome results in specific amino acids being brought to the site of protein synthesis hypertension harmony of darkness discount avalide 162.5 mg buy. Genetics is the study of what genes are, how they carry information, how their information is expressed, and how they are replicated and passed to subsequent generations or other organisms. Phenotype is the expression of the genes: the proteins of the cell and the properties they confer on the organism. At the replication fork, the leading strand is synthesized continuously and the lagging strand discontinuously. Regulating protein synthesis at the gene level is energy-efficient because proteins are synthesized only as they are needed. When cells are exposed to a particular end-product, the synthesis of enzymes related to that product is repressed. In bacteria, a group of coordinately regulated structural genes with related metabolic functions, plus the promoter and operator sites that control their transcription, is called an operon. In the operon model for an inducible system, a regulatory gene codes for the repressor protein. In repressible systems, the repressor requires a corepressor in order to bind to the operator site; thus, the corepressor controls enzyme synthesis. Transcription of structural genes for catabolic enzymes (such as -galactosidase) is induced by the absence of glucose. Replica plating is used for negative selection-to detect, for example, auxotrophs that have nutritional requirements not possessed by the parent (nonmutated) cell. The Ames test is a relatively inexpensive and rapid test for identifying possible chemical carcinogens. The test assumes that a mutant cell can revert to a normal cell in the presence of a mutagen and that many mutagens are carcinogens. In crossing over, genes from two chromosomes are recombined into one chromosome containing some genes from each original chromosome. Vertical gene transfer occurs during reproduction when genes are passed from an organism to its offspring. F cells contain plasmids called F factors; these are transferred to the F2 cells during conjugation. There are several types of plasmids, including conjugative plasmids, dissimilation plasmids, plasmids carrying genes for toxins or bacteriocins, and resistance factors. Complex transposons can carry any type of gene, including antibiotic-resistance genes, and are thus a natural mechanism for moving genes from one chromosome to another. Chemical mutagens include base-pair mutagens, nucleoside analogs, and frameshift mutagens. Mutation rate is the probability that a gene will mutate when a cell divides; the rate is expressed as 10 to a negative power.

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While still in the sterile environment arteria supraorbitalis buy avalide on line, the material is formed into packages, which are then filled with liquid foods that have been conventionally sterilized by heat. A specialized use of irradiation has been to sterilize meats eaten by American astronauts, and a few health facilities have selectively used irradiation to sterilize foods ingested by immunocompromised patients. Irradiated food is marked in the United States with a radura symbol and a printed notice. Unfortunately, this symbol has often been interpreted as a warning rather than the description of an approved processing treatment or preservative. Chang initiates a case-control study with representatives of the state health departments that had reported S. Fifteen items, suspected as possible vehicles of infection on the basis of the individual case investigations, are listed. State officials determine whether each suspect item was used or consumed by the infected person within the 3 days before onset of illness. Controls were asked the same questions as patients, except that they were questioned about the use or consumption of the 15 suspect items during the previous month. Foil-Wrapped Chocolate Balls ate Did not eat Cases 38 7 Controls 12 79 radiation and Industrial Food Preservation It has long been recognized that irradiation is lethal to microorganisms; in fact, a patent was issued in Great Britain in 1905 for the use of ionizing radiation to improve the condition of foodstuffs. X rays were specifically suggested in 1921 as a way to inactivate the larvae in pork that are the cause of trichinellosis. The ionizing irradiation is usually X rays or the gamma rays produced by radioactive cobalt-60. Up to certain energy levels, high-energy electrons produced by electron accelerators are also used. These sources inactivate the target organisms and do not induce radioactivity in the food or packaging material. This development quickly led to an improved understanding of the relationships between specific microbes and their products and activities. For example, once it was understood that a certain yeast grown under certain conditions produced beer and that certain bacteria could spoil the beer, brewers were better able to control the quality of their products. Specific industries became active in microbiological research and selected certain microbes for their special qualities. The brewing industry extensively investigated the isolation and identification of yeasts and selected those that could produce more alcohol. In this section, we will discuss the role of microorganisms in the production of several common foods. Cheese the United States leads the world in the making of cheese, producing millions of tons every year.

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Larvae injected by the mosquito migrate to various organs blood pressure chart morning order online avalide, where they mature into adults. Wolbachia bacteria appear to be essential to development of the worm embryos (see the box in Chapter 11 on page 297). Four genera of roundworms called anisakines, or wriggly worms, can be transmitted to humans from infected fish and squid. Arthropods are animals characterized by segmented bodies, hard external skeletons, and jointed legs. Although arthropods are not microbes themselves, we will briefly describe them here because a few suck the blood of humans and other animals and can transmit microbial diseases while doing so. Representative classes of arthropods include the following: Arachnida (eight legs): spiders, mites, ticks Crustacea (four antennae): crabs, crayfish Insecta (six legs): bees, flies, lice table 12. An exception to this is the louse, which spends its entire life on its host and cannot survive for long away from a host. Mosquitoes Q are the vector for several pathogens to humans, including yellow fever, malaria, and West Nile virus. While doing so, a housefly can pick up a pathogen on its feet or body and transport the pathogen to our food. Large numbers of parasites can then be deposited on or in the host while the vector is feeding there. The spirochete that causes Lyme disease is transmitted by ticks in this manner (see Chapter 23, page 625), and the West Nile virus is transmitted in the same way by mosquitoes (see Chapter 22, page 625). As discussed earlier, Plasmodium is an example of a parasite that requires that its vector also be the definitive host. To eliminate vectorborne diseases, health workers focus on eradicating the vectors. To reproduce, fission yeasts divide symmetrically, whereas budding yeasts divide asymmetrically. Sexual spores are usually produced in response to special circumstances, often changes in the environment. A fungal thallus consists of filaments of cells called hyphae; a mass of hyphae is called a mycelium. The Ascomycota have septate hyphae and produce ascospores and frequently conidiospores.

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Commercial systems have been designed to separate cellular fatty acids to compare them to fatty acid profiles of known organisms arteria frontalis- purchase 162.5 mg avalide free shipping. Genetic sequences of hundreds of organisms are compiled in databases that can be used online through the BioProject. However, the use of restriction enzymes enables researchers to compare the base sequences of different organisms. Plaques, or areas of lysis, were produced by bacteriophages, indicating that the strain was sensitive to infection by these phages. Antibodies against Listeria can be labeled with a fluorescent dye and added to the milk to be tested. The milk is passed through the flow cytometer, which records the fluorescence of the antibody-labeled cells. This base composition is usually expressed as the percentage of guanine plus cytosine (G 1 C). The base composition of a single species is theoretically a fixed property; thus, a comparison of the G 1 C content in different species can reveal the degree of species relatedness. An electrical current was then applied to the gel to separate the fragments by size and electrical charge. This has led to interest in finding a few genes that are present in all species and that provide a large variation between species. This was first proposed in 2003 for eukaryotic species, but the necessary six to nine genes for bacterial identification have not been found yet. Clinical Case Salmonella serovars are identified by serotyping with antisera against previously isolated serovars. By now, the department of health has been inundated with calls; 27 additional cases of Salmonella tennessee infection have been identified and reported from all over the state of Nevada. This information was used to determine the relationships between the ancient bacteria and modern bacteria. If the single strands are then cooled slowly, they will reunite to form a double-stranded molecule identical to the original double strand. The procedure assumes that if two species are similar or related, a major portion of their nucleic acid sequences will also be similar. Nucleic acid hybridization reactions are the basis of several techniques (described below) that are used to detect the presence of microorganisms and to identify unknown organisms. Ribotyping and Ribosomal Rna Sequencing Ribotyping is currently being used to determine the phylogenetic relationships among organisms. The amplified fragments are subsequently cut with one or more restriction enzymes and separated by electrophoresis.

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Animals infected with the spirochete shed the bacteria in their urine for extended periods blood pressure medication with c avalide 162.5 mg free shipping. In rats, the bacteria inhabit renal tubules, an immunologically privileged site, where they continue to reproduce and are shed, copiously, in urine for cystitis Cystitis is a common inflammation of the urinary bladder in females. The female urethra is less than 2 inches long, and microorganisms traverse it readily. These considerations are reflected in the fact that the rate of urinary tract infections in women is eight times that of men. Lactose-fermenting, gram-negative rods are cultured from her urine (see the photo). Designed to selectively grow gram-negative bacteria and differentiate them by their ability to ferment lactose. Disease cystitis (urinary bladder infection) Pyelonephritis (kidney infection) Leptospirosis (kidney infection) Pathogen Escherichia coli, Staphylococcus saprophyticus primarily E. Humans become infected by contact with urine-contaminated water from freshwater lakes or streams, soil, or sometimes with animal tissue. People whose occupations expose them to animals or animal products are most at risk. Usually the pathogen enters through minor abrasions in the skin or mucous membranes. Domestic dogs have a sizable rate of infection; even when immunized, they may continue to shed leptospira. After an incubation period of 1 to 2 weeks, headaches, muscular aches, chills, and fever abruptly appear. Several days later, the acute symptoms disappear, and the temperature returns to normal. Because of this, the immune response is delayed long enough (1 or 2 weeks) for the population in the blood and tissues to reach enormous numbers. An emerging form of leptospirosis, pulmonary hemorrhagic syndrome, has appeared globally. Affecting the lungs with massive bleeding, it has a fatality rate of more than 50%. Recovery results in a solid immunity, but only to the particular serovar involved. Chapter 26 Microbial Diseases of the Urinary and Reproductive Systems 751 Most cases of leptospirosis are diagnosed by a serological test that is complicated and usually done by central laboratories. However, a number of rapid serological tests are available for a preliminary diagnosis.

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This is a broadspectrum arrhythmia laying down 162.5 mg avalide order free shipping, bacteriostatic antibiotic that binds to the 30S ribosomal subunit, blocking protein synthesis. An important advantage is that it inhibits the effects of rapid efflux, an important mechanism for bacterial antibiotic resistance (see page 571). Among its disadvantages is that it must be administered by slow intravenous infusion. Macrolides Macrolides are a group of antibiotics named for the presence of a macrocyclic lactone ring. However, erythromycin is not able to penetrate the cell walls of most gram-negative bacilli. Its spectrum of activity is therefore similar to that of penicillin G, and it is a frequent alternative drug to penicillin. Because it can be administered orally, an orange-flavored preparation of erythromycin is a frequent substitute for penicillin in treating streptococcal and staphylococcal infections in children. Erythromycin is also the drug of choice for the treatment of legionellosis, mycoplasmal pneumonia, and several other infections. It has a rather narrow spectrum of activity and is mainly used to treat Clostridium difficile and clostridia infections. Compared to erythromycin, they have a broader antimicrobial spectrum and penetrate tissues better. This is especially important in the treatment of conditions caused by intracellular bacteria such as Chlamydia, a frequent cause of sexually transmitted infection. A new generation of semisynthetic macrolides, the ketolides, is being developed to cope with increasing resistance to other macrolides. The first of these drugs to be released, Synercid, is a combination of two cyclic peptides, quinupristin and dalfopristin, which are distantly related to the macrolides. They block protein synthesis by attaching to the 50S portion of the ribosome, as do other antibiotics such as chloramphenicol. Dalfopristin blocks an early step in protein synthesis, and quinupristin blocks a later step. Synercid is effective against a broad range of gram-positive bacteria that are resistant to other antibiotics. Oxazolidinones the oxazolidinones are another new class of antibiotics developed in response to vancomycin resistance. However, they are unique in their target, binding to the 50S ribosomal subunit close to the point where it interfaces with the 30S subunit. Pleuromutilins Pleuromutilin derivatives and the oxazolidinones represent two of the new classes of antibiotics developed since 2000 (also see the following discussion of lipopeptides). Originally a product of the Pleurotis mutilus mushroom, most are now semisynthetic derivatives.

Avogadro, 61 years: In malarial areas, a sleeping room often will contain hundreds of mosquitoes, 1­5% of which are infectious.

Grobock, 36 years: For example, with age, there is a progressive decline in the efficiency of phagocytosis.

Lares, 64 years: Inserting the needle into sterile cotton to expel air bubbles can prevent aerosols from forming.

Navaras, 28 years: The apex of the bladder is directed toward the top of the pubic symphysis; a structure known as the median umbilical ligament (a remnant of the embryologic urachus) directs itself from it up in the anterior abdominal wall to the navel.

Oelk, 22 years: Chapter 14 described several relationships between normal microbiota and host cells.

Kippler, 41 years: The sources of these materials may include landfills, illegal industrial dumps, or pesticides applied to agricultural crops.

Cobryn, 32 years: Aflatoxin poisoning Cryptosporidiosis Pinworms Whipworms Causative Agent Aspergillus flavus Cryptosporidium hominis Enterobius vermicularis Trichuris trichiura Suspect Foods Oysters, shrimp Water Water, vegetables, ground beef Chicken Meat, milk Meat Method of Transmission Ingestion of toxin Ingestion Ingestion Ingestion Prevention Cooking Cooking 4.

Cole, 45 years: In this procedure, the fungus is removed from the growth medium, filtered to remove extraneous material, and dried in a desiccator.

Vandorn, 26 years: Epiglottitis is a rapidly developing disease that can result in death within a few hours.

Bernado, 48 years: Q Why are M cells especially important for immune defenses against diseases affecting the digestive system

Emet, 34 years: Microsporidiosis is an emerging opportunistic infection in immunocompromised patients and the elderly.

Cruz, 42 years: Understanding of these principles is vital to prevent disease transmission to patients in health care settings.

Myxir, 30 years: Bacteria in the large intestine assist in degrading food and synthesizing vitamins.

Thorek, 52 years: Extensive damage to the fascia (sheet of connective tissue binding the muscles) may require reconstructive surgery or even amputation of limbs.

Jaffar, 24 years: Also, tests of antimicrobials intended for special purposes, such as dairy utensil disinfection, can substitute for other test bacteria.

Sinikar, 50 years: Beer is fermented slowly with yeast strains that remain on the bottom (bottom yeasts).

Ningal, 58 years: When associated with the Trendelenburg position, the pneumoperitoneum, which makes laparoscopic procedures possible, can lead to cardiorespiratory parameter changes.

Saturas, 53 years: During mitosis, each daughter cell retains one-half of the cell wall from the parent (yellow) and must synthesize the remaining half (pink).