PST05103 Pharmaceutical Microbiology

NTA Level 5 • Semester 1 • PST05103 Mycobacterial Infections Pharmaceutical Microbiology • Source Session/Topic 17 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 17: Mycobacterial Infections Total Session Time: 120 minutes Pre-requisites • Human anatomy and physiology Students Learning Tasks By the end of this session students are expected to be able to: • Describe mycobacterium infection(causative agents, transmission, signs and symptoms) • Describe treatment, prevention and control of mycobacterial infection Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers SESSION OVERVIEW |Step |Time |Activity/ |Content | | | |Method | | |1 |5 minutes |Presentation |Introduction, Learning Tasks | |2 | |Buzzing/ |Cause and Transmission of | | |25 minutes |Presentation |Tuberculosis | |3 |10 minutes |Presentation |Signs and Symptoms of Tuberculosis| |4 |25 minutes |Brainstorming/|Treatment, Prevention and Control | | | |Presentation |of Tuberculosis | |5 |15 minutes |Presentation |Cause and Transmission of Leprosy | |6 | 10 minutes|Presentation |Signs and Symptoms of Leprosy | |7 |20 minutes |Presentation |Treatment, Prevention and Control | | | | |of Leprosy | |9 |5 minutes |Presentation |Key Points | | |5 minutes |Presentation |Evaluation | |10 | | | | SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks (5 minutes) READ or ASK students to read the learning tasks and clarify ASK students if they have any questions before continuing STEP 2: Cause and Transmission of Tuberculosis (25 minutes) |Activity: Buzzing (5 minutes) | | | |ASK students to pair up and buzz on the following question for 2 | |minutes | | | |What is the cause and transmission of Tuberculosis?? | | | |ALLOW few pairs to respond and let other pairs to add on points | |not mentioned | | | |WRITE their response on the flip chart/board | | | |CLARIFY and SUMMARIZE by using the content below | • • Tuberculosis (TB) is a chronic, progressive airborne mycobacterial infection, often with a period of latency following initial infection. TB most commonly affects the lungs • Tuberculosis is caused by Mycobacterium tuberculosis (for which humans are the main reservoir) o Similar disease occasionally results from the closely related mycobacteria, M. bovis, M. africanum, and M. microti—which together with M. tuberculosis are known as the Mycobacterium tuberculosis complex • Tuberculosis is transmitted through inhalation of airborne particles (droplet nuclei) containing M. tuberculosis. o Mycobacteria disperse primarily through coughing, singing, and other forced respiratory maneuvers by people who have active pulmonary or laryngeal TB • Mycobacteria are slender, curved, acid-fast bacilli that belong to the family Mycobacteriaceae • Types of Tuberculosis o Pulmonary TB ▪ It is the most common and infectious affecting the lungs o Extra pulmonary TB ▪ This type of TB occurs when bacteria spread outside the lung to cause damage in any organ such as meninges, lymphnodes, kidneys, spine, intestinal and ostearticular ▪ It common among people with HIV/AIDS • Tuberculosis occurs in three forms, primary infection (usually asymptomatic), latent infection (dormant stage) and active infection. STEP 3: Signs and Symptoms of Tuberculosis (10 minutes) • Cough of more than two weeks • Fever • Excessive Night sweats • Haemoptysis (sputum mixed with blood stains) • Loss of weight • Fatigue • Chest pain • Anorexia STEP 4: Treatment, Prevention and Control of Tuberculosis (25 minutes) • Combination of antituberculosis drugs is used to avoid emergence of drug resistance • Compliance must be ensured before initiation of therapy • Antituberculosis (Anti-TB) drugs are; o First line drugs ▪ Isoniazid ▪ Rifampicin ▪ Pyrazinamide ▪ Ethambutol ▪ Streptomycin o Second line drugs include; ▪ Kanamycin ▪ Capreomycin ▪ Ethionamide ▪ Cycloserin ▪ Ofloxacin • According to National TB and Leprosy programme (NTLP) patients are grouped into three categories namely category I, II and III o Combination of anti-Tb drugs into regimens is based on these categories • Considerations in provision of anti-Tb drugs o HIV/AIDS and other chronic diseases e.g. liver failure o Oral contraceptive use o Pregnancy o Breastfeeding o Drug resistance ▪ Multidrug resistance tuberculosis • Prevention and control o Treatment of patients with active tuberculosis o Treating causes of immune suppression o Immunization with BCG vaccine o Pasteurization of milk o Isolation of patients |Activity: Take home Assignment (10 minutes) | | | |DIVIDE students in groups or individual. | | | |ASK the students to work on the following assignment | | | |What are the regimens (drug, dose and schedule) used for treatment of | |tuberculosis in different patients? | | | |ALLOCATE time for students to do the assignment and submit | | | |REFER students to recommended references | STEP 5: Cause and Transmission of Leprosy (15 minutes) • Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae • The disease mainly affects the skin, the peripheral nerves and the mucous memberanes, usually affecting the cooler parts of the body such as skin, nose and upper respiratory tract • Leprosy is a disease mainly of human beings, which affects people of all races, all ages and both sexes • Leprosy is the commonest cause of peripheral neuritis in the world • Leprosy is transmitted through prolonged contact with patients with lepromatous leprosy who discharge large numbers of M. leprae in nasal secretions and from skin lesions • There three forms of leprosy namely tuberculoid leprosy, lepromatous leprosy and a mixture of the two o Tuberculoid leprosy the disease is non-progressive and benign o Lepromatous leprosy the disease is progressive and malignant STEP 6: Signs and Symptoms of Leprosy (10 minutes) • The major clinical features therefore include hypopigmented anaesthetic macula or nodular and erythematous skin lesions and nerve thickening • Patients is suspected of having leprosy when they show one or more of the following signs of symptoms: o Burning sensations in the skin o Pale patches on the skin with loss of feeling o

NTA Level 5 • Semester 1 • PST05103 Cholera and Plague Pharmaceutical Microbiology • Source Session/Topic 18 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 18: Cholera and Plague Total Session Time: 120 minutes Pre-requisites • Human anatomy and physiology Students Learning Tasks By the end of this session students are expected to be able to: • Describe Cholera and Plague (causative agents, transmission, signs and symptoms) • Describe treatment, prevention and control of Cholera and Plague e Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers SESSION OVERVIEW |Step |Time |Activity/ |Content | | | |Method | | |1 |5 minutes |Presentation |Introduction, Learning Tasks | |2 | 25 minutes|Presentation |Cause and Transmission of Cholera | |3 |5 minutes |Presentation |Signs and Symptoms of Cholera | |4 |25 minutes |Presentation |Treatment, Prevention and Cholera | |5 | |Presentation |Cause and Transmission of Plague | | |25 minutes | | | |6 |15 minutes |Presentation |Signs and Symptoms of Plague | |7 |10 minutes |Presentation |Treatment, Prevention and Control | | | | |of Plague | |8 |5 minutes |Presentation |Key Points | | 9|5 minutes |Presentation |Evaluation | SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks (5 minutes) READ or ASK students to read the learning tasks and clarify ASK students if they have any questions before continuing STEP 2: Cause and Transmission of Cholera (10 minutes) • Cholera is an acute gastrointestinal infection caused by Vibrio cholerae. • Cholera is transmitted by faecal-oral route through ingestion of contaminated water or food by human faeces leading to severe diarrhoea and emesis associated with body fluid and electrolyte depletion • Vibrio cholerae is a Gram negative bacterium that is oxidase positive and motile via a polar flagellum STEP 3: Signs and Symptoms of Cholera (10 minutes) • Cholera is characterized by o Profuse watery diarrhoea, vomiting, severe dehydration and muscular cramps, leading to hypovolemic shock and death o The stool has a characteristic “rice water” appearance ▪ non-bilious, grey, slightly cloudy fluid with flecks of mucus, no blood and inoffensive odour • Cholera may result in the following complications o severe dehydration o shock o renal failure STEP 4: Treatment, Prevention and Control of Cholera (15 minutes) • Treatment options o Replacement of fluids and electrolytes ▪ Lactated Ringer solution or, Normal saline ▪ Oral rehydration salts (ORS) if patient can drink o Antibiotics ▪ Macrolides e.g. erythromycin ▪ Sulphonamides –co-trimoxazole ▪ Fluoroquinolones e.g. ciprofloxacin ▪ Tetracyclines –doxycycline o Vitamins and minerals ▪ Zinc ▪ Folic acid • Prevention and control measures include; o Drinking water from safe sources (taps, decontaminated deep wells, bottles) o Boiling or treating of water to kill bacteria and make it safe for drinking and other domestic uses o Washing hands with liquid soap and running water after visiting the toilet, before preparing foods, and before eating o Avoiding consumption of uncooked street food or cooked food that is no longer hot. o Avoiding consumption of street prepared fresh fruits STEP 5: Cause and Transmission of Plague (30 minutes) • Plague is an infectious disease of wild rodents transmitted from one rodent to another and occasionally from rodents to humans by the bites of an infected flea. It can also be transmitted to humans through direct contact with infected materials or by inhalation • Plague is caused by the bacteria Yersinia pestis which is short, pleomorphic Gram-negative rod that can exhibit bipolar staining with special staining such as Giemsa. • The genus Yersinia where Y. pestis belongs, is in the family Enterobacteriaceae • The bacteria are catalase positive, oxidase negative, and microaerophilic or facultatively anaerobic. • The ability of this organism to be transmitted by aerosol and the severity and high mortality associated with pneumonic plague make Y. pestis a potential biological weapon. • There are 3 forms of plague infection, depending on the route of infection: o Bubonic plague ▪ This is the most common, caused by the bite of an infected flea ▪ Y. pestis, enters at the bite and travels through the lymphatic system to the nearest lymph node, replicates itself and causes the lymph node to be inflamed, tense and painful, turning into open sores with pus o Septicaemic plague ▪ This occurs when infection spreads through the bloodstream, following untreated bubonic plague causing bleeding, tissue necrosis and shock o Pneumonic plague ▪ This is the most virulent form and is rare ▪ It is typically caused by spread to the lungs from advanced bubonic plague ▪ However, any person with pneumonic plague may transmit the disease via droplets to other humans ▪ Untreated pneumonic plague can be fatal A bubo in bubonic plague [pic] • Life cycle o When a flea feeds on a rodent infected with Y pestis, the ingested organisms multiply in the gut of the flea and, helped by the coagulase, block its proventriculus so that no food can pass through. o Subsequently, the “blocked” and hungry flea bites ferociously, and the aspirated blood, contaminated with Y pestis from the flea, is regurgitated into the bite wound. o The inoculated organisms may be phagocytosed by polymorphonuclear cells and macrophages. o The organisms are killed by the polymorphonuclear cells but multiply in the macrophages; because the bacteria are multiplying at 37°C, they produce the antiphagocytic protein and subsequently are able to resist phagocytosis o The pathogens rapidly reach the lymphatics, and an intense hemorrhagic inflammation develops in the enlarged lymph nodes, which may undergo necrosis and become fluctuant o Although the invasion may stop there, Y pestis often reach the bloodstream and become widely disseminated. o Hemorrhagic and necrotic lesions may develop in all organs; meningitis, pneumonia, and serosanguineous pleuropericarditis are prominent features o Primary pneumonic plague results from inhalation of infective droplets (usually from a coughing patient), and it is characterized by hemorrhagic consolidation, sepsis, and

NTA Level 5 • Semester 1 • PST05103 Haemophilus type b, Pertussis and Brucellosis Pharmaceutical Microbiology • Source Session/Topic 19 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 19: Haemophilus type b, Pertussis and Brucellosis Total Session Time: 120 minutes Pre-requisites • Human anatomy and physiology Students Learning Tasks By the end of this session students are expected to be able to: • Describe Haemophilus type b, pertussis and brucellosis (causative agents, transmission, signs and symptoms) • Describe treatment, prevention and control of Haemophilus type b, pertussis and brucellosis Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers SESSION OVERVIEW |Step |Time |Activity/ |Content | | | |Method | | |1 |5 minutes |Presentation |Introduction, Learning Tasks | |2 | 35 minutes|Presentation |Haemophilus type b (Hib) Disease | |3 |30 minutes |Presentation |Pertussis (Whooping Cough) | |4 |40 minutes |Presentation |Brucellosis | |6 |5 minutes |Presentation |Key Points | | 7|5 minutes |Presentation |Evaluation | SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks (5 minutes) READ or ASK students to read the learning tasks and clarify ASK students if they have any questions before continuing STEP 2: Haemophilus type b (Hib) Disease (35 minutes) • Cause and Transmission o Haemophilus influenza type b (Hib) is a bacterium that causes severe pneumonia, meningitis and other invasive diseases almost exclusively in children aged less than 5 years. o Hib disease can occur at any age, but is most common in unvaccinated kids younger than 5 years old and those who have not completed the full series of Hib vaccines during infancy. o Hib also causes potentially severe inflammatory infections of the face, mouth, blood, epiglottis, joints, heart, bones, peritoneum, and trachea o Hib disease also can be a concern for the elderly and people with weakened immune systems. o Although this problem occurs worldwide the burden of Hib disease was considerably higher in resource-poor countries, prior to the introduction of the vaccine into their national immunization programmes o The bacteria are short, Gram negative coccoid bacilli, sometimes occurring in pairs or short chains o Hib is transmitted through the respiratory tract from infected to susceptible individuals • Signs and Symptoms o Children with Hib disease present with fever but other symptoms depend on the type of illness that results from the Hib disease: ▪ Meningitis symptoms include severe headache, stiff neck, and vomiting and may progress to coma and death if untreated ▪ Pneumonia symptoms include coughing and breathing difficulty ▪ Epiglottitis symptoms include sore throat and breathing difficulty due to swollen and inflamed epiglottitis ▪ Cellulitis symptoms include red, tender skin ▪ Arthritis symptoms include severe pain, swelling, and redness in a joint ▪ Ear infections cause ear pain o Each illness caused by Hib also has its own specific complications o Meningitis can cause permanent brain damage and death o Epiglottitis can quickly lead to life-threatening breathing difficulties o The other infections, like pneumonia, cellulitis, and arthritis, can cause organ failure if not promptly treated • Treatment, Prevention and Control o Treatment of Haemophilus infections depends on nature, severity and location of the infection, but beta-lactam/beta-lactamase inhibitors, fluoroquinolones, 2nd and 3rd generation cephalosporins, and carbapenems are used for invasive disease o The disease is prevented by immunization with Hib conjugate vaccine in childhood. STEP 3: Pertussis (Whooping Cough) (30 minutes) • Cause and Transmission o Pertussis or Whooping cough is a highly infectious bacterial disease of childhood caused by Bordetella pertussis o The disease is most severe in young infants who have not yet been immunized o Whooping cough is transmitted through respiratory droplets (the bacilli spread in the air through cough or sneezes) o The bordetellae are small, Gram-negative, aerobic coccobacilli o Bordetella pertussis produces a number of virulence factors, including pertussis toxin • Signs and Symptoms o After an incubation period of 7 to 10 days, whooping cough begins with the catarrhal phase usually characterized by low-grade fever, rhinorrhea (nasal discharge), and progressive cough; the patient is highly infectious o Paroxysmal phase, lasting 2 to 4 weeks, is characterized by severe and spasmodic (paroxysmal) cough episodes o The episodes of coughing can continue for 3 months or longer o The main clinical feature is paroxysmal cough associated with a ‘whoop’ during breathing in • Treatment and Prevention o Antibiotics ▪ Erythromycin ▪ Chloramphenicol • This does not shorten the illness but reduces the period of infectiousness o Supportive therapy ▪ Oxygen is given to children with apnoea or cyanosis, or severe paroxysms of coughing o Pertussis is preventable by immunization by pertussis toxoid vaccine STEP 4: Brucellosis (40 minutes) • Cause and Transmission o Brucellosis is a severe acute febrile disease caused by bacteria of the genus Brucella ▪ Brucella melitensis –affects sheep and goats ▪ Brucella suis –occurs in area where pigs are kept ▪ Brucella abortus –occurs where cattle are kept ▪ Brucella canis –occurs in dogs o Brucellae are facultative intracellular parasites, multiplying mainly in monocyte-macrophage cells o In animals, Brucellae typically affect the reproductive organs, and abortion is often the only sign of the disorder. o Human brucellosis is either an acute febrile disease or a persistent disease with a wide variety of symptoms o It is a true zoonosis in that virtually all human infections are acquired from animals o Brucellosis is transmitted to humans through skin lesions, mucous membranes, inhalation and by consumption of contaminated meat or other animal-derived foods o There are six species in the genus but B abortus, B melitensis and B suis are serious pathogens in humans B canis causes mild disease and the other two species have not affected humans o Brucella melitensis in sheep and goats is the most important source of brucellosis in humans o The bacteria can survive inside human cells and spread to many different organs • Signs and symptoms o Early

NTA Level 5 • Semester 1 • PST05103 Urinary Tract Infection and E-coli associated Diarrheal Pharmaceutical Microbiology • Source Session/Topic 20 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 20: Urinary Tract Infection and E-coli associated Diarrheal Diseases Total Session Time: 120 minutes Pre-requisites • Human anatomy and physiology Students Learning Tasks By the end of this session students are expected to be able to: • Describe Urinary Tract Infection and E-coli associated Diarrheal Diseases (causative agents, transmission, signs and symptoms) • Describe treatment, prevention and control of Urinary Tract Infection and E-coli associated Diarrheal Diseases Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers SESSION OVERVIEW |Step |Time |Activity/ |Content | | | |Method | | |1 |5 minutes |Presentation |Introduction, Learning Tasks | |2 | 30 minutes|Presentation |Cause of Urinary Tract Infection | |3 | |Small group |Signs and Symptoms of Urinary | | |20 minutes |discussion/ |Tract Infection | | | |Presentation | | |4 |20 minutes |Presentation |Treatment, Prevention and Control | | | | |of Urinary Tract Infection | |5 |30 minutes |Presentation |E.coli associated Diarrheal | | | | |Diseases | |6 |10 minutes |Presentation |Key Points | | 7|5 minutes |Presentation |Evaluation | SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks (5 minutes) READ or ASK students to read the learning tasks and clarify ASK students if they have any questions before continuing STEP 2: Cause of Urinary Tract Infection (30 minutes) • Urinary tract infection (UTI) is the presence of an infection in the urinary tract. • Urinary tract infections (UTIs) can be divided into upper tract infections, which involve the kidneys (pyelonephritis) and lower tract infections, which involve the bladder (cystitis), urethra (urethritis) and prostate (prostatitis) • Urinary tract infection may be caused by fungi, viruses, and parasites • E. coli is the most common cause of urinary tract infection and accounts for approximately 90% of first urinary tract infections in young women • There are two types of UTI, complicated UTI and uncomplicated UTI • Uncomplicated UTI o Is usually considered to be cystitis or pyelonephritis that occurs in premenopausal adult women with no structural or functional abnormality of the urinary tract and who are not pregnant and have no significant comorbidity that could lead to more serious outcomes o In men, most UTIs occur in children or elderly patients, are due to anatomic abnormalities or instrumentation, and are considered complicated. • Complicated UTI o Occurs both in male and female following underlying cause such as structural or functional abnormality in the urinary tract, comorbidity, recent instrumentation or surgery of the urinary tract • Some risk factors for UTI include sexual intercourse, diaphragm and spermicide use, broad spectrum antibiotic use and new sex partner within the past year. STEP 3: Signs and Symptoms of Urinary Tract Infection (20 minutes) |Activity: Small Group Discussion (10 minutes) | | | |DIVIDE students into small manageable groups | | | |ASK students to discuss on the following; | |Write down the signs and symptoms of urinary tract infection (UTI) | | | |ALLOW students to discuss for 10 minutes | | | |ALLOW few groups to present and the rest to add points not | |mentioned | | | |CLARIFY and SUMMARIZE by using the contents below | • The symptoms and signs include o Urinary frequency o Dysuria o Hematuria o Pyuria o Flank pain/tenderness (associated with upper tract infection) o Fever of 38°C or higher o Tachypnoea, Tachycardia, Confusion and Hypotension o Vomiting STEP 4: Treatment, Prevention and Control of Urinary Tract Infection (20 minutes) • Non pharmacological management o Adequate hydration • Pharmacological management o Antibiotics ▪ Fluoroquinolones e.g. ciprofloxacin ▪ Penicillin e.g. amoxicillin/clavulanic acid ▪ Cephalosporins e.g. ceftriaxone ▪ Aminoglycosides e.g. gentamycin • Prevention and control of UTI involves; o Increasing fluid intake o Avoiding spermicides and diaphragm use o Not delaying urination o Wiping front to back after defecation o Avoiding douching o Urinating immediately after sexual intercourse STEP 5: E. coli associated Diarrhoeal Diseases (30 minutes) • E. coli that causes diarrhea are extremely common worldwide. • The E. coli are classified by the characteristics of their virulence properties and each group causes disease by a different mechanism • Enteropathogenic E coli (EPEC) o Enteropathogenic E. coli are an important cause of diarrhea in infants, especially in developing countries o EPEC adhere to the mucosal cells of the small bowel and cause lesions which result in diarrhoea o The result of EPEC infection in infants is characterized by severe, watery diarrhea, vomiting, and fever, which are usually self-limited but can be prolonged or chronic o The duration of the EPEC diarrhea can be shortened and the chronic diarrhea cured by antibiotic treatment • Enterotoxigenic E coli (ETEC) o Enterotoxigenic E coli (ETEC) are a common cause of “traveler’s diarrhea” and a very important cause of diarrhea in children less than 5 years of age in developing countries o ETEC produce enterotoxins and Shiga-like toxins that are identical to the Shiga toxin of Shigella dysenteriae • Enteroinvasive E coli (EIEC) o Enteroinvasive E. coli (EIEC) produce a disease very similar to shigellosis. o The disease occurs most commonly in children in developing countries and in travelers to these countries. o Similar to Shigella, EIEC strains are nonlactose or late lactose fermenters and are nonmotile o EIEC produce disease by invading intestinal mucosal epithelial cells • Enteroaggregative E coli (EAEC) o Enteroaggregative E. coli (EAEC) causes acute and chronic diarrhea (>14 days in duration) in persons in developing countries o These organisms also are the cause of foodborne illnesses in industrialized countries and have been associated with traveler’s diarrhea and persistent diarrhea in patients with HIV o They are characterized by their specific patterns of adherence to human cells • These diarrheal diseases are treated by fluids and

NTA Level 5 • Semester 1 • PST05103 Shigellosis, Enteric Fever and Peptic Ulcer Disease Pharmaceutical Microbiology • Source Session/Topic 21 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 21: Shigellosis, Enteric Fever and Peptic Ulcer Disease Total Session Time: 120 minutes Pre-requisites • Human anatomy and physiology Students Learning Tasks By the end of this session students are expected to be able to: Describe Shigellosis, Enteric Fever and Peptic Ulcer Disease • (causative agents, transmission, signs and symptoms) Describe treatment, prevention and control of Shigellosis, Enteric Fever and Peptic Ulcer Disease Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers SESSION OVERVIEW |Step |Time |Activity/ |Content | | | |Method | | |1 |5 minutes |Presentation |Introduction, Learning Tasks | |2 | 35 minutes|Presentation |Shigellosis | |3 |35 minutes |Brainstorming/|Typhoid Fever | | | |Presentation | | |4 |35 minutes |Brainstorming/|Peptic Ulcer Disease | | | |Presentation | | |6 |5 minutes |Presentation |Key Points | | 7|5 minutes |Presentation |Evaluation | SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks (5 minutes) READ or ASK students to read the learning tasks and clarify ASK students if they have any questions before continuing STEP 2: Shigellosis (35 minutes) • Cause and Transmission o Shigellosis is an infectious disease caused by shigella (Shigella dysenteriae) o Most who are infected with shigella develop diarrhea, fever, and stomach cramps starting a day or two after they are exposed to the bacteria • Signs and Symptoms o Sudden onset of severe abdominal cramping, high-grade fever, emesis, anorexia, and large-volume watery diarrhea o Abdominal pain, tenesmus, urgency, fecal incontinence, and small volume of bloody, mucoid diarrhoea. o Extra intestinal manifestations associated with S. dysenteriae may include the following: ▪ Severe headache, lethargy, meningismus, delirium, and convulsions ▪ Hemolytic uremic syndrome (HUS), microangiopathic hemolytic anemia, thrombocytopenia, and renal failure, profound dehydration and hypoglycemia • Treatment o Replacement of fluids and electrolytes o Antibiotics ▪ Ciprofloxacin ▪ Nalidixic acid ▪ Erythromycin • Prevention and Control o Hygienic disposal of refuse o Hygienic food handling o Personal hygiene e.g. washing hands after using toilets and before eating o Washing of fruits and vegetables STEP 3: Typhoid Fever (35 minutes) • Cause and Transmission o Typhoid fever is also known as Enteric fever o Typhoid fever is an acute systemic disease caused by the gram- negative bacteria Salmonella typhi. o Salmonella paratyphi causes paratyphoid fever which has the same features as typhoid fever. o Typhoid infection is transmitted through ingestion of contaminated food and water • Signs and Symptoms |Activity: Brainstorming (5 minutes) | | | |Ask students to brainstorm on the following question: | | | |What are signs and symptoms observed in a patient with | |enteric fever? | | | |ALLOW few students to respond? | | | |WRITE their responses on the flip chart/ board | | | |CLARIFY and SUMMARIZE by using the content below | o The clinical manifestation and duration of illness vary markedly from one patient to another o The course of paratyphoid fever is shorter and less severe compared to that of typhoid fever o The major clinical features are: ▪ Fever, cramps, diarrhoea, severe headache, drowsiness and muscle pains (myalgia) ▪ Untreated, typhoid fever may progress to delirium, obtundation, intestinal hemorrhage, bowel perforation, and death ▪ Survivors may be left with long-term or permanent neuropsychiatric complications • Treatment Prevention and Control o Treatment ▪ Antibiotics • Fluoroquinolones e.g. Ciprofloxacin • Chloramphenicol o Prevention and control ▪ Washing hands after using toilets and before eating ▪ Food cleanliness ▪ Safe and hygienic food production STEP 4: Peptic Ulcer Disease (35 minutes) o Cause o Peptic ulcer disease is a circumscribed ulceration of the gastrointestinal mucosa occurring in areas exposed to acid and pepsin (lower oesophagus, stomach and duodenum) and most often caused by Helicobacter pylori infection o Gastro Esophageal Reflux Disease (GERD), a disorder resulting from gastric acid and other gastric contents into the esophagus due to incompetent barriers at the gastro esophageal junction may result in ulceration of the lower oesophagus • Signs and Symptoms o Peptic ulcer presents in many different ways o The commonest is chronic, episodic pain present in many different ways, and may persist for months or years. o However, the ulcer may come to attention as an acute episode with bleeding or perforation, with little or no previous history o Epigastric pain is the commonest symptom of peptic and gastric ulcer • Treatment Prevention and Control |Activity: Brainstorming (5 minutes) | | | |Ask students to brainstorm on the following question: | | | |What are the treatment options for Peptic Ulcer Disease? | | | |ALLOW few students to respond? | | | |WRITE their responses on the flip chart/ board | | | |CLARIFY and SUMMARIZE by using the content below | o Treatment goal for PUD ▪ To provide symptom relief and heal erosive esophagitis and prevent complication ▪ Anti secretory drugs and life style changes may be adequate if H. pylori is not present • H2 blockers e.g. Ranitidine • Proton Pump Inhibitors E.g. Omeprazole and Esomeprazole ▪ H. pylori is present in majority of PUD patients, therefore a triple therapy is used to eradicate the bacteria and provide relief and healing ▪ Generally, a combination of Proton Pump Inhibitor (PPI) + Amoxycillin or Azithromycin + Nitroimidazole is used. ▪ Recommended triple therapy for PUD are; • Omeprazole + Amoxicillin + Metronidazole • Lansoprazole + Azithromycin + Tinidazole • Prevention and Control o Discontinue NSAIDs and use paracetamol for pain control if possible o By using acid suppression e.g. Antacids o Smoking cessation o No dietary restrictions unless certain foods o Alcohol in moderation o Stress reduction STEP 5: Key Points (5 minutes) o Shigellosis is an infectious disease caused by Shigella dysenteriae o Most who are infected with

NTA Level 5 • Semester 1 • PST05103 Chlamydial Infections Pharmaceutical Microbiology • Source Session/Topic 22 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 22: Chlamydial Infections Total Session Time: 120 minutes Pre-requisites • Human anatomy and physiology Students Learning Tasks By the end of this session students are expected to be able to: • Describe chlamydial infection (causative agents, transmission, signs and symptoms) • Describe treatment, prevention and control chlamydial infection Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers SESSION OVERVIEW |Step |Time |Activity/ |Content | | | |Method | | |1 |5 minutes |Presentation |Introduction, Learning Tasks | |2 | 15 minutes|Presentation |Characteristics of Chlamydia | |3 |10 minutes |Presentation |Cause and Transmission of Trachoma| |4 |30 minutes |Presentation |Signs and Symptoms of trachoma | |5 |20 minutes |Presentation |Treatment, Prevention and Control | | | | |of trachoma | |6 | |Presentation |Non gonococcal urethritis and | | |30 minutes | |Lymphogranuloma Venereum | |7 |5 minutes |Presentation |Key Points | | 8|5 minutes |Presentation |Evaluation | SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks (5 minutes) READ or ASK students to read the learning tasks and clarify ASK students if they have any questions before continuing STEP 2: Characteristics of Chlamydia (15 minutes) • The genus chlamydia consists of obligate intracellular bacteria • The bacteria have cell wall resembling Gram negative bacteria but do not have peptidoglycan. They have DNA, RNA and ribosomes. • All chlamydiae exhibit similar morphologic features, share a common group antigen, and multiply in the cytoplasm of their host cells by a distinctive developmental cycle • The chlamydiae lack mechanisms for the production of metabolic energy and cannot synthesize adenosine triphosphate (ATP) • This restricts them to an intracellular existence, where the host cell furnishes energy-rich intermediates • Three species of Chlamydiae infect humans namely Chlamydia trachomatis, Chlamydia pneumoniae, and Chlamydia psittaci • C. trachomatis causes Trachoma, urogenital infections, lymphogranuloma venerium and pneumonia • C. pneumoniae causes bronchitis, sinusitis and pneumonia • C. psittaci causes psittacosis STEP 3: Cause and Transmission of Trachoma (10 minutes) • Trachoma is a chronic conjunctivitis caused by infection with Chlamydia trachomatis • It is one of the commonest causes of blindness worldwide. • It is a chronic keratoconjunctivitis that begins with acute inflammatory changes in the conjunctiva and cornea and progresses to scarring and blindness • The disease is associated with poverty and crowded living conditions • It is endemic in Africa, middle east, India and South East Asia, mostly affecting children • Trachoma is transmitted through inoculation of eye by contaminated hands, flies, clothing and droplets. STEP 4: Signs and Symptoms of Trachoma (30 minutes) • The incubation period for chlamydial conjunctival infection is 3–10 days • In endemic areas, initial infection occurs in early childhood, and the onset of the long-term consequence, trachoma, is insidious • Chlamydial infection is often mixed with bacterial conjunctivitis in endemic areas, and the two together produce the clinical picture • The earliest features of trachoma are lacrimation, mucopurulent discharge, conjunctival hyperemia, and follicular hypertrophy • Microscopic examination of the cornea reveals epithelial keratitis, subepithelial infiltrates, and extension of limbal vessels into the cornea (pannus) • As the pannus extends downward across the cornea, there are scarring of the conjunctiva, eyelid deformities (entropion, trichiasis), and an added insult caused by eyelashes sweeping across the cornea (trichiasis) • With secondary bacterial infection, loss of vision progresses over a period of years. • Generally, the signs and symptoms include; o Photophobia in early stages or re- infection o Follicles in the upper tarsal plate seen as round and white nodules in active diagnostic o In late stages, in-turned eyelashes rub on the cornea leading to corneal ulcers o Loss of vision due to corneal Scarring • Clinical Stages according to World Health Organization o Trachomatous Inflammation Follicular (TF) – Presence of at least 5 follicles on the upper tarsal plate o Trachomatous Inflammation Intense (TI) – There is intense inflammation, the conjunctival blood vessels cannot be seen o Trachomatous Scarring (TS) – Presence of white scars in the upper tarsal plate o Trachomatous Trichiasis (TT) – Presence of some eye lashes rubbing against the cornea o Corneal Opacity (CO) – Presence of corneal opacity (scar) affecting the central cornea STEP 5: Treatment, Prevention and Control of Trachoma (20 minutes) Treatment • Non pharmacological management o Face washing and total body hygiene to prevent transmission of disease from one person to the other o Environmental improvement/hygiene • Pharmacological management o Use of antibiotics ▪ Tetracyclines e.g. oxytetracycline ointment 3% ▪ Macrolides e.g. azithromycin • Surgery o To correct entropion in Trachomatous Trichiasis (TT) patients o This procedure can be done at a Dispensary or Health Centre and community level by a trained health worker Prevention and Control • The World Health Organization has initiated the S-A-F-E program to eliminate blinding trachoma and at least markedly reduce clinically active disease o Surgery for deformed eyelids o Antibiotic use involving periodic azithromycin therapy o Face washing and hygiene o Environmental improvement such as building latrines and decreasing the number of flies that feed on conjunctival exudates. STEP 6: Nongonococcal Urethritis and Lymphogranuloma Venereum (30 minutes) Urogenital infections • C. trachomatis also causes urogenital infections in both male and female • In female the infection is almost asymptomatic o May cause cervicitis, urethritis, salpingitis and postpartum fever • In male the infection is symptomatic o It causes nongonococcal urethritis (which must be ruled out in treatment of gonorrhea or co-treated) o Urethritis, dysuria and pyuria o It is a common cause of post-gonococcal urethritis • Treatment options include use of Tetracycline e.g. doxycycline, macrolides e.g. erythromycin and sulphonamides • Preventive measures include sanitation, safe sex practices, treatment of patients and their sexual partners. Lymphogranuloma venereum (LGV) • Is a sexually transmitted infection caused

NTA Level 5 • Semester 1 • PST05103 Spirochetes Infection Pharmaceutical Microbiology • Source Session/Topic 23 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 23: Spirochetes Infection Total Session Time: 60 minutes Pre-requisites • Human anatomy and physiology Students Learning Tasks By the end of this session students are expected to be able to: • Describe common bacterial diseases (causative agents, transmission, signs and symptoms) • Describe treatment, prevention and control of common bacterial diseases Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers SESSION OVERVIEW |Step |Time |Activity/ |Content | | | |Method | | |1 |5 minutes |Presentation |Introduction, Learning Tasks | |2 | 10 minutes|Presentation |Characteristics of Spirochetes | |3 |5 minutes |Presentation |Cause and Transmission of Syphilis| |4 | |Small group |Signs and Symptoms of Syphilis | | |20 minutes |discussion/ | | | | |Presentation | | |5 |10 minutes |Presentation |Treatment, Prevention and Control | | | | |of Syphilis | |6 |5 minutes |Presentation |Key Points | | 7|5 minutes |Presentation |Evaluation | SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks (5 minutes) READ or ASK students to read the learning tasks and clarify ASK students if they have any questions before continuing STEP 2: Characteristics of Spirochetes (10 minutes) • Spirochetes are a large, heterogeneous group of spiral, motile bacteria • One family (Spirochaetaceae) of the order Spirochaetales consists of two genera whose members are human pathogens, Borrelia and Treponema • Spirochetes are long, slender, helically coiled, spiral, or corkscrew- shaped bacilli that are motile by endofagella or internal flagella • Spirochaetes are distinguished from other bacterial phyla by the location of their flagella (sometimes called axial filaments or endofagella or internal flagella) which run lengthwise between the bacterial inner membrane and outer membrane in periplasmic space • Spirochetes are susceptible to drying and chemicals o They are readily killed in dry conditions and various chemical agents including penicillins. • The spirochetes are so thin that they are not readily seen unless immunofluorescent stain or dark-field illumination is used • Treponema pallidum is a spirochete bacterium with subspecies that cause treponemal diseases such as syphilis, bejel, pinta, and yaws. STEP 3: Cause and Transmission of Syphilis (5 minutes) • Syphilis is a sexually transmitted spirachetal infection characterized by one or more skin lesions (chancres) at the site where the spirochete penetrated • Syphilis is caused by the bacterium Treponema pallidum subspecies pallidum • Syphilis is transmitted through sexual intercourse with an infected person, close contact with active lesions, blood transfusion and passage to placenta in pregnancy (congenital syphilis) STEP 4: Signs and Symptoms of Bacillus Food Poisoning (20 minutes) |Activity: Small Group Discussion (10 minutes) | | | |DIVIDE students into small manageable groups | | | |ASK students to discuss on the following question | |What are the clinical manifestations of syphilis? | | | |ALLOW students to discuss for 15 minutes | | | |ALLOW few groups to present and the rest to add points not | |mentioned | | | |CLARIFY and SUMMARIZE by using the contents below | • Incubation period is 3 to 90 days • Early or primary syphilis o General lymphadenopathy ▪ Lymph node enlarges and become rubbery, painless, discrete and mobile o One or more skin lesion ▪ A papule develops at site of entry and breaks down to form an ulcer with clean base “a chancre” o This primary lesion heals spontaneously and later reappear • Secondary syphilis o Signs of disseminated disease appear, with prominent skin lesions dispersed over the entire body surface. ▪ Rash on trunc and promal extremeties spreading to involve palms and soles ▪ Fever, malaise, headache o Spontaneous remission may occur after the primary or secondary stages or the disease may progress to the late phase (tertiary syphilis) • Tertiary syphilis o Manifest years after chancres have healed o Virtually all tissues may be involved ▪ Cardiovascular syphilis, neurosyphilis • Latent syphilis shows no symptoms • Congenital syphilis o In utero infections can lead to serious fetal disease, resulting in latent infections, multiorgan malformations, or death of the fetus o Most infected infants are born without clinical evidence of the disease, but rhinitis then develops and is followed by a widespread desquamating maculopapular rash o Teeth and bone malformation, blindness, deafness, and cardiovascular syphilis are common in untreated infants who survive the initial phase of disease STEP 5: Treatment, Prevention and Control of Syphilis (10 minutes) • Treatment options o Antibiotics ▪ Penicillins • Benzathine Penicilli • Benzyl penicillin ▪ Macrolides • Azithromycin ▪ Tetracyclines • Doxycycline • Preventive and control measures o Early diagnosis and treatment o Safe sex practices e.g. use of condoms o Detection and treatment of pregnant STEP 6: Key Points (5 minutes) • Spirochetes are a large, heterogeneous group of spiral, bacteria that move by endogeonous flagella • Treponema pallidum is a spirochete bacterium with subspecies that cause treponemal diseases such as syphilis, bejel, pinta, and yaws. • Treponema pallidum subspecies pallidum causes syphilis in humans. • Syphilis is a sexually transmitted infection which is characterized by painless chancre and progression to chronic disease • Syphilis is treated by antibiotics such as penicillins and prevented by safe sex practices and early diagnosis and treatment of patient to prevent progression of the disease. STEP 7: Evaluation (5 minutes) • What is a chancre? • How is syphilis transmitted? • What are the medicines used for treatment of syphilis? References Hugo and Russell (2011), Pharmaceutical Microbiology 8th Edition, Willey- Blackwel publications Karen C. Carroll et al (2013); Jawetz, Melnick and Adelberg’s Medical Microbiology 26th Ed. McGraw Hill Co. Inc. Greenwood et al (2012); Medical Microbiology, 18th edition Churchill Livingstone ← Previous TopicNext Topic →View all Pharmaceutical Microbiology topicsOpen Complete Full Notes PDF / OFFLINE NOTES Unataka kutumiwa notes hizi kupitia WhatsApp?Kwa notes zilizopangiliwa vizuri

NTA Level 5 • Semester 1 • PST05103 Introduction Virus Pharmaceutical Microbiology • Source Session/Topic 24 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 24: Introduction Virus Total Session Time: 120 minutes Pre-requisites • Human anatomy and physiology Students Learning Tasks By the end of this session students are expected to be able to: • Define common terms used in virology • Describe general structure and properties of viruses • Classify viruses according to their genetic and morphological properties • Describe viral-host-cell interaction and replication • List various drug targets in virus Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers SESSION OVERVIEW |Step |Time |Activity/ |Content | | | |Method | | |1 |5 minutes |Presentation |Introduction, Learning Tasks | |2 | |Presentation |Common terms used in Virology | | |10 minutes | | | |3 |10 minutes |Buzzing/ |Characteristics of viruses | | | |Presentation | | |4 |25 minutes |Presentation |Viral structure | |5 |30 minutes |Presentation |Classification of viruses | |6 |15 minutes |Presentation |Viral-host cell interaction and | | | | |replication | |7 |15 minutes |Presentation |Drug targets in viruses | |8 |5 minutes |Presentation |Key Points | | 9|5 minutes |Presentation |Evaluation | SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks (5 minutes) READ or ASK students to read the learning tasks and clarify ASK students if they have any questions before continuing STEP 2: Common Terms Used in Virology (10 minutes) • Virology o Virology is the study of viruses. Their structures and activities including infections caused by viruses. • Virus o This is a very small acellular particle that can only replicate inside cells of another organism. A virus is capable of infecting cells and potentially cause disease • Virion o Is complete virus particle. • Capsid o Is the protein shell or coat that encloses the nucleic acid of a virus • Capsomeres o Morphological units seen in electron microscopes that make up the capsid • Envelope o A lipid-containing membrane that surrounds some viruses. It is acquired during maturation by a budding process through the cell membrane. • Peplomers o Are virus-encoded glycoproteins that are exposed on the surface f the envelope • Nucleocapsid o This is the protein-nucleic acid complex representing the packed form of the viral genome. STEP 3: Characteristics of Viruses (10 minutes) |Activity: Buzzing (5 minutes) | | | |ASK students to pair up and buzz on the following question for 2 | |minutes | | | |What are the characteristics of viruses? | | | |ALLOW few pairs to respond and let other pairs to add on points not | |mentioned | | | |WRITE their response on the flip chart/board | | | |CLARIFY and SUMMARIZE by using the content below | • Characteristics of viruses include; o They infect prokaryotic and eukaryotic cells o They are acellular o They contain either DNA or RNA surrounded by a protein coat o Viruses are obligate intracellular entities o They cannot reproduce outside a host cell ▪ Viruses are cultivated in living cells e.g. bacteria ▪ Viruses that infect bacteria are called bacteriophage ▪ Some viruses multiply in cytoplasm of host cell while others multiply in the nucleus of host cells o They are very small (the largest virus is the size of a small bacteria) o Some viruses have envelope outside the capsid while other are naked STEP 4: Viral Structure (25 minutes) • A complete viral particle (virion) consists of; o Nucleic acid ▪ A virus contains only one type of nucleic acid (DNA or RNA) that can be linear or circular, segmented or one molecule. • The viral DNA o single-stranded DNA (ssDNA) o double-stranded DNA (dsDNA) o single-stranded RNA (ssRNA) ▪ The RNA can be of positive sense (+) which is the same as Mrna or a negative sense (-) which is complementary to mRNA • double-stranded RNA (dsRNA) o Protein coat (capsid): ▪ The nucleic acid is surrounded by a protein coat (the capsid) ▪ The capsid is formed from protomers which collectively form capsomeres. The capsomere is the basic unit of the capsid ▪ The capsid protects the virion in the external environment ▪ It also helps in transfer of nucleic acid between host cells ▪ The capsid and the nucleic acid are collectively called Nucleocapsid ▪ Viral Symmetry • Capsid is constructed in a highly symmetrical manner o Icosahedral ▪ The capsid is composed of triangular faces made from capsomeres (hexons) ▪ The virus appears spherical e.g. poliovirus o Helical ▪ Virus is hollow, cylindrical in shape ▪ The virus can be rigid or flexible e.g. tobacco mosaic virus (TMV) o Complex ▪ Contains several types of symmetry in one virus o Viral envelope ▪ Some viruses have a lipid layer (the envelope) surrounding the nucleocapsid ▪ Viruses with the envelope are called enveloped viruses while those not containing the envelope are called non enveloped (or naked) virues ▪ Contains proteins projecting from the envelope. These proteins help with attachment of the virus to the host cells STEP 5: Classification of Viruses (30 minutes) • Viruses are not included in the five kingdom classification • Universal classification of viruses group viruses into orders, families, sub families, genera and species. • More than 24 families cause disease in human) • The nomenclature and classification of viruses do not use the conventional taxonomic groups o Suffix endings ▪ Genus –ends in ‘virus’ e.g. coronavirus ▪ Sub-family –ends in ‘virinae’ ▪ Family –ends in ‘viridae’ ▪ Order –ends in ‘virales’ ▪ Species –contains name of host, the word virus etc. • Viruses are classified based on the following criteria; o Nucleic acid type: DNA viruses and RNA viruses o Nature of the nucleic acid: linear, circular, segmented, non- segmented genome or polarity i.e. positive sense or negative sense of the