BACTERIAL TOXINS
Bacterial toxins are
exotoxins and endotoxins. Characteristics and differences of exotoxins and
endotoxin are listed in down the page.
EXOTOXINS
Exotoxin producing bacteria
1. Corynebacterium diphtheriae. Strains that carry a temperate
bacteriophage are toxigenic causes diphtheria. Exotoxin inhibits protein
synthesis and causes cell death. Causes diphtheria.
2. Clostridium tetani. Exotoxin blocks action of inhibitory
neurones of spinal cord. Causes tetanus.
3. Clostridium perfringens. (a) Causes gas gangrene. Exotoxin
(alpha toxin) has lacithinase activity and thereby causes cell death, (b)
Enterotoxin causes hyper secretion of water and electrolytes in diarrhoea.
4. Clostridium botulinum. Exotoxin causes paralysis of
deglutination and respiratory muscles. It blocks release of acetylcholine of
synapses and neuromuscular junctions. Causes botulism.
5. Vibrio cholerae 01 and 0139. Enterotoxin (Exotoxin) causes hyper
secretion of water and electrolytes within gut in diarrhoea.
6. Enterotoxigenic E. coll. Produce enterotoxin (LT- heat labile
exotoxin) causes hypersecretion of water and electrolytes within gut.
7. Shigella dysenteriae type 1 (Shiga bacillus). Exotoxin causes
acute inflammation.
8. Staphylococcus aureus- some strains : (a) Toxic shock syndrome
toxin-1. Causes toxic shock syndrome. (b) Staphylococcal enterotoxin causes
toxin type food poisoning and stimulates vomiting centre of brain.
9. Streptococcus pyogenes. Pyrogenic (Erythrogenic) exotoxin causes
scarlet fever and toxic shock syndrome.
NOTE : Enterotoxins are exotoxins that are associated with
diarrhoea) diseases and food poisoning. Bacteria producing enterotoxins are V.
cholerae, enterotoxigenic E. coli (ETEC), some strains of S. aureus, V.
parahaemolyticus, Y. enterocolitica, Aeromonas species, and C. perfringens.
Toxoid. Toxoid is modified exotoxin. An exotoxin has two main
properties :
(1) toxicity, and
(2) antigenicity. In
toxoid, the toxicity of the toxin is destroyed but its antigenicity is
preserved. As such toxoids e.g. diphtheria toxoid, tetanus toxoid can be safely
used for vaccines. Toxins can be converted to toxoid by different methods e.g.
formalin treatment.
ENDOTOXINS
Endotoxins are the integral part of the cell walls of
Gram-negative bacteria, and are liberated when bacteria are disintegrated
(lysed). Cell wall of Gram negative bacteria contain lipopolysaccharides (LPS,
endotoxin) which consists of : (1) Lipid A. This is the endotoxin and is the
core, and (2) Polysaccharide form coat. This is the 0 antigen which can induce
specific immunity. Physiological, pathological and clinical effects of
endotoxins of different Gram negative bacteria are similar. These are :
1. Fever. The endotoxin acts on mononuclear phagocytes
(monocytes/macrophages), with liberation of interleukin-1 (endogenous pyrogen).
Interleukin-1 acts on thermoregulatory centre. Chill is due to widespread
arteriolar and venular constriction.
2. Leucopenia occurs early with onset of fever. It may be followed
by leucocytosis.
3. Hypoglycaemia. LPS enhances glycolysis in many cell types and
can lead to hypoglycaemia.
4. Hypotension occurs early in Gram-negative bacteraemia.
5. Shock. 'Endotoxic' or 'septic' shock may develop in severe
Gram-negative bacteraemia (See chapter 4).
6. Activation of complement. Endotoxin
activates complement system by alternative pathway.
7. Disseminated Intravascular Coagulation (DIC). DIC may
occur in Gram negative bacteraemia. It is initiated on activation of factor XII
(Hageman factor) of coagulation cascade by endotoxin which finally leads to
conversion of fibrinogen to fibrin. Endotoxin leads platelets to adhere on
vascular endothelium. Endotoxin can activate plasminogen to plasmin which acts
on fibrin producing fibrin-split products. Shwartzman phenomenon is taken as a
specialized form of DIC.
8. Death may occur due to shock and/or DIC.
NOTE: Peptidoglycan of Gram-positive Bacteria: Peptidoglycan of
Gram-positive bacteria released during infection may produce similar activities
as LPS of Gram-negative bacteria. However, peptidoglycan is much less potent
than LPS.
Characteristics and Differences of Exotoxins and Endotoxins
Endotoxin:
1. Integral part of the cell wall of Gram-negative bacteria. Released
on bacterial death and in part during growth. Release is not required for
biologic activity.
2. Formed only by Gram-negative bacteria
3. Lipopolysaccharides. Lipid A portion is responsible for
toxicity.
4. No specific receptor.
5. Moderately toxic. Fatal to animals in large doses.
6. Relatively heat stable. Toxicity is not destroyed above 60°C for
hours.
7. Weakly antigenic. Antibodies are protective.
8. Not converted to toxoid.
9. Synthesis directed by chromosomal genes.
10. Usually produce fever in the host by release of interleukin-1 and
other mediators..]
Exotoxins:
1.Excreted by living cells
2. Produced by Gram-positive and Gram-negative bacteria
3. Polypeptides
4. Usually bind to specific receptors on cells
5. Highly toxic. Fatal to animals in very small doses
6. Relatively heat labile. Toxicity destroyed over 60°C
7. Highly antigenic. Stimulate formation of antitoxin. Antitoxin
neutralizes the toxin
8. Converted to toxoid by formalin. Toxoid is nontoxic but antigenic.
Toxoids are used to immunize, e.g. tetanus toxoid
9. Usually controlled by extra-chromosomal genes, e.g. plasmids,
phage gene
10. Usually do not produce fever in the host.
GENETIC ELEMENTS
Nucleoid- Bacterial Chromosome
Bacterial nucleoid consists of a single circular molecule. It is a single,
haploid chromosome of about 1 mm long in unfolded state. Bacterial chromosome
(DNA) is attached to a septa) mesosome. Nucleoids consist of DNA, smaller
amounts of RNA, RNA polymerase and probably other proteins. The nucleoid
replicates by fission. It has no nucleolus, nuclear membrane, spindle or
non-identical chromosomes. Genes of the nucleus determines the amino acid
sequences and hence the structure of a protein and thereby all the properties
of the organism. These account for heredity. Recently it has been found that
some prokaryotes have a linear chromosome. Staining of Nucleus. Nuclei are
stained with Feulgan stain which is specific for DNA.
Plasmid
Certain bacteria contain plasmid. These are extra-chromosomal genetic material
(DNA), ie. genetic determinant, and are mostly circular. Certain properties are
determined by plasmid:
1.Virulence factors, eg. In enteropathogenic E. coli strains, both enterotoxins
and colonization antigens (pill). Other exotoxin productions are frequently
controlled by plasmids.
2.Drug resistance by R
factors (Resistance plasmids).
3.Metabolic activities
may be determined. Examples: Sucrose uptake and metabolism, and citrate uptake
by Escherichia coli.
4.Production of colicins
(Bacteriocins) by many Gram-negative bacteria is controlled by plasmids.
5.Transfer of genetic
material by sex factors (See Chap. 40).
Transposon
Transposons are genetic elements with DNA sequences
CYTOPLASMIC STRUCTURES
Mitochondria are absent in prokaryotic cells.
1. Ribosomes. They are present as minute granules in large number.
RNA is the principal component of ribosomes.
2. Nutrient granules. These are not essential or permanent
structures: These may be:
(a)Metachromatic, Volutin or Babes-Ernst granules. These may be present in
Corynebacterium diphtheriae and may be used for identification. These act as
reserve of energy. These have affinity for basic dyes. Albert staining is done
to demonstrate metachromatic granules.
(b)Lipid granules. These are P- hyd roxybu rate.
(c)Polysaccharide granules, eg. glycogen, starch.
(d)Other granules, eg. sulphur.
3. Carotenoids- Photosynthetic pigments are present in
photosynthetic bacteria.
FLAGELLA
A large number of
bacteria possess flagella. Flagellum is the organ of locomotion. Flagellated
bacteria are motile. Nonflagellated bacteria are non-motile.
Examples:
Motile Bacteria: Escherichia, Salmonella, Proteus, Pseudomonas,
Vibrio, Aeromonas, Plesiomonas, Campylobacter, Helicobacter, Clostridium
tetani.
Nonmotile Bacteria: All Cocci, Shigella, Klebsiella,
Corynebacterium diphtheriae, Clostridium perfringens, Bacillus anthraces,
Haemophilus, Bordetella, Brucella, Yersinia, Pasteurella, Francisella.
Structure . Flagella are long, slender thread-like (12-30 nm in
diameter) organs of locomotion. A flagellum is attached to the bacterial cell
body by a complex structure consisting of filament, hook and basal body. The
basal body has one pair of rings in Gram-positive bacteria and two pairs in
Gram-negative bacteria. A bacterial flagellum is composed entirely of protein.
A flagellum is made up of several thousand molecules of a protein subunit
called flagellin. The flagellum is formed by the aggregation of subunits to
form a helical structure.
A flagellated bacterium may become non-flagellated but not the reverse. The
arrangement of flagella for a particular bacterium is constant and is one of
the four types.
1. Peritrichous. Flagella are distributed over the
entire cell, e.g. Escherichia coli, Salmonella genus.
2. Amphitrichous. There is a single flagellum at each
pole.
3. Lophotrichous. There is a bunch of flagella at one
or both poles, e.g. Spirillum minus.
4. Monotrichous. There is a single polar flagellum at
one pole, e.g. Vibrio cholerae.
They have no function in the virulence of the bacteria. Antigenic structure of
the flagella (H antigens) may be used for identification and classification of
bacteria.
Sensory transduction is the behavior of the flagellated bacteria in response to
the environment. This may be: (1) Chemo taxis is the movement of the bacterium
towards a chemical attractant, e.g. sugar, amino-acid, (2) Aerotaxismovement
towards the optimal oxygen concentration, (3) Electron acceptor taxis- movement
towards alternative electron receptors, (4) Photo taxis- movement towards light
of photosynthetic bacteria.
Motility Test. Hanging-drop preparation is done by placing a drop of bacterial
suspension between a slide and cover slip separated by a circular layer of Vaseline
on the surface of the slide.
Flagella Staining. They are demonstrated by special staining. Flagella are not
visible under light microscope. Bacteria are first treated with tannic acid
salt which precipitates on flagella and cell walls and increases the diameter
of the flagella. They are then visible under light microscope.
PILI (FIMBRIAE)
Pill or fimbriae are
very thin, hair-like short rigid surface appendages. Many Gram-negative
bacteria possess pili or fimbriae. There may be 100-500 pili in one cell. They
are shorter and finer than flagella and composed of protein subunits termed
pilins. Minor proteins, located at the tips of pili, are responsible for the
attachment properties. They are seen by electron microscope. Pellicle formation
in the fluid media by bacteria is due to fimbriae. Pill of different bacteria
are antigenic ally distinct. Some bacteria, e.g. N. gonorrhea are able to make
pili of different antigenic types (antigenic variation) and this can still
adhere to cells by a type in presence of antibodies to other types. Fimbriae of
group a streptococci are the site of the surface antigen, M protein.
Lipoteichoic acid, associated with these fimbriae is responsible for adherence
of these streptococci to epithelial cells of the hosts. There are two types of
pili on function:
1. Ordinary pill. These play roles in adherence of bacteria to host
cell surfaces. 'Colonization antigens' are ordinary pili that provide the cells
with adherent properties, genetically determined by plasmids.
2. Sex pill. These give the 'maleness'. They are few in
number and very long, e.g. in enter bacteria. During bacterial conjugation the
male (donor) cell adhere with its sex pili and transfer DNA to non-male
(recipient) cell. The pili act as conjugation tubes. In this way the genetic
material which determines antibiotic resistance may pass from one bacterium to
another. Sex pili possess receptors to which bacteriophage can become attached.
BACTERIAL SPORES (ENDOSPORES)
Bacterial endospores are
formed when conditions for vegetative growth are not favorable.
Spore-Forming Bacteria
1.Bacillus and Clostridium genera form spores.
2. Sporosarcina (Gram-positive coccus) and possibly Coxiella
burnetii can produce spores.
Demonstration of Spore:
1.In Gram stain, the spore appears as unstained colorless areas in cells.
2. Spores are stained with malachite green, or carbol fuchsin (by modified
Ziehl-Neelsen stain).
Nature. The spore is a resting cell. Spores are in a subdued
metabolic state and non-reproducing. Each cell forms a single internal spore
that is liberated when the mother cell undergoes autolysis. The spore is highly
resistant to heat, chemical agents and desiccation. In sporulation, each
vegetative cell forms only one spore, and in subsequent germination each spore gives
rise to a single vegetative cell.
BACTERIAL GROWTH
Growth of Bacteria is the orderly increase of all the
chemical constituents of the bacteria. Multiplication is the consequence of
growth. Death of bacteria is the irreversible loss of ability to reproduce.
Bacteria are composed of proteins, carbohydrates, lipids, water and trace
elements.
Factors Required for
Bacterial Growth
The requirements for bacterial growth are:
(A)) Environmental
factors affecting growth, and
(B) Sources of metabolic
energy.
A. Environmental Factors affecting Growth
1. Nutrients. Nutrients in growth media must contain all the
elements necessary for the synthesis of new organisms. In general the following
must be provided : (a) Hydrogen donors and acceptors, (b) Carbon source, (c)
Nitrogen source, (d) Minerals : sulphur and phosphorus, (e) Growth factors:
amino acids, purines, pyrimidines; vitamins, (f) Trace elements: Mg, Fe, Mn.
Growth Factors: A growth factor is an organic compound which a cell
must contain in order to grow but which it is unable to synthesize. These
substances are essential for the organism and are to be supplied as nutrients.
Thiamine, nicotinic acid, folic acid and para-aminobenzoic acid are examples of
growth factors.
Essential Metabolites: These metabolites are essential for growth
of bacterium. These must be synthesized by the bacterium, or be provided in the
medium. Mg, Fe and Mn are essential trace elements.
Autotrophs live only on inorganic substances, i.e. do not require
organic nutrients for growth. They are not of medical importance.
Heterotrophs require organic materials for growth, e.g. proteins,
carbohydrates, lipids as source of energy. All bacteria of medical importance
belong to heterotrophs. Parasites may depend on the host for certain foods.
Saprophytes grow, on dead organic matter.
2. pH of the medium. Most pathogenic bacteria grow best
in pH 7.2-7.4. Vibno cholerae can grow in pH 8.2-9.0
3. Gaseous Requirement
(a) Role of Oxygen. Bacteria may be classified into four groups on oxygen
requirement :
(i) Aerobes. They cannot grow without oxygen, e.g.
Mycobacterium tuberculosis.
(ii) Facultative anaerobes. These grow under both aerobic and
anaerobic conditions. Most bacteria are facultative anaerobes, e.g.
Enterobacteriaceae.
(iii)Anaerobes. They only grow in absence of free oxygen, e.g. Clostridium,
Bacteroides.
(iv) Microaerophils grow best in oxygen less than that present in
the air, e.g. Campylobacter.
Aerobes and facultative anaerobes have the metabolic systems: (1) cytochrome
systems for the metabolism of oxygen, (2) Superoxide dismutase, (3) catalase.
Anaerobic bacteria do not grow in the presence of oxygen. They do not use
oxygen for growth and metabolism but obtain their energy from fermentation
reactions. Anaerobic bacteria are killed by oxygen or toxic oxygen radicals.
Multiple mechanisms play role for oxygen toxicity : (1) They do not have
cytochrome systems for oxygen metabolism, (2) They may have low levels of
superoxide dismutase, and (3) They may or may not have catalase.
(b) Carbon dioxide. All
bacteria require CO2 for their growth. Most bacteria produce CO2. N.
gonorrhoeae and N. meningitides and Br abortus grow better in presence of 5 per
cent CO2.
4. Temperature. Most
bacteria are mesophilic. Mesophilic bacteria grow best at 30-37°C. Optimum
temperature for growth of common pathogenic bacteria is 37°C. Bacteria of a
species will not grow but may remain alive at a maximum and a minimum
temperature.
5. Ionic strength and osmotic pressure.
6. Light. Optimum
condition for growth is darkness.
B.Sources of Metabolic Energy
Mainly three mechanisms generate metabolic energy. These are fermentation,
respiration and photosynthesis. An organism to grow, at least one of these
mechanisms must be used.
REPRODUCTION
Bacteria reproduce by binary fission. Multiplication takes place in geometric
progression. The nucleus (chromosome) undergoes duplication prior to cell
division. When the cell grows about twice its size, the nuclear material
divides, and a transverse septum originates from plasma membrane and cell wall
and divides the cell into two parts. The two daughter cells receive an
identical set of chromosomes. The daughter cells separate and may be arranged
singly, in pairs, clumps, or chains.
GROWTH CURVE
The growth curve indicates multiplication and death of bacteria. When a
bacterium is inoculated in a medium, it passes through four growth phases which
will be evident in a growth curve drawn by plotting the logarithm of the number
of bacteria against time. Number of bacteria in the culture at different
periods may be : (1) Total count. It includes both living and dead bacteria, or
(2) Viable count. It includes only the living bacteria. Microbial concentration
can be measured in terms of cell concentration, i.e. the number of viable cells
per unit volume of culture, or of biomass concentration, i.e. dry weight of
cells per unit volume of culture.
Bacterial count is of Growth Phases
1. Lag Phase. In this phase there is increase in cell
size but not multiplication. Time is required for adaptation (synthesis of new
enzymes) to new environment. During this phase vigorous metabolic activity
occurs but cells do not divide. Enzymes and intermediates are formed and
accumulate until they are present in concentration that permits growth to
start. Antibiotics have little effect at this stage.
2. Exponential Phase or Logarithmic (Log) Phase. The cells multiply
at the maximum rate in this exponential phase, i.e. there is linear
relationship between time and logarithm of the number of cells. Mass increases
in an exponential manner. This continues until one of two things happens:
either one or more nutrients in the medium become exhausted, or toxic metabolic
products, accumulate and inhibit growth. Nutrient oxygen becomes limited for
aerobic organisms. In exponential phase, the biomass increases exponentially
with respect to time, i.e. the biomass doubles with each doubling time. The
average time required for the population, or the biomass, to double is known as
the generation time or doubling time. Linear plots of exponential growth can be
produced by plotting the logarithm of biomass concentration as a function of
time. Importance : Antibiotics act better at this phase.
3. Maximal Stationary Phase. Due to exhaustion of nutrients or
accumulation of toxic products death of bacteria starts and the growth cease
completely. The count remains stationary due to balance between multiplication
and death rate. Importance: Production of exotoxins, antibiotics, metachromatic
granules, and spore formation takes place in this phase.
4. Decline phase or death phase. In this phase there is progressive
death of cells. However, some living bacteria use the breakdown products of
dead bacteria as nutrient and remain as persister.
Recently, some authors are dividing the growth curve into six
phases by the letters A to F as follows
(a) Lag phase- Growth rate is zero.
(b) Acceleration phase- Increasing growth rate. C Exponential phase — Constant
growth rate.
(c) Retardation phase- Growth rate is decreasing.
(e) Maximum stationary phase- Growth rate is zero. F Decline phase- Growth rate
is negative (death).
use in the examination of water and milk
Genetic.
Genetic is the science
that deals with heredity. Thus, it is the study of the mechanisms by which
different characteristics are passed on from parents to offsprings (progeny).
Gene. Genes are genetic determinants and thus control heredity and determine properties
of the organism. The genes are functional units of the chromosomes. Synthesis
of protein components and enzymes of a cell is regulated by genes. DNA is
responsible for both gene function and replication. By replication heredity or
stability of a type is maintained. An organism containing a normal gene is
known as 'wild type'. Genes may rarely mutate (change) resulting in heritable
variations called mutations (See chapter 8). The changed organism is called a
mutant.
Genotype. It is the genetic determinant of a cell.
Phenotype. This is the structural and physiological manifestations of the
organism due to a particular genotype.
Genome. Genome is the entire set of genes and thus is the totality of genetic
information in an organism.
BACTERIAL GENOME (PROKARYOTIC GENOME)
Genes are carried on :
1. Bacterial chromosome. Chromosomes carry most prokaryotic genes.
Genes essential for bacterial growth are carried on chromosome. It is present
in all bacteria. Only one chromo-some is present in a bacterial nucleoid.
Bacterial chromosome is a single circle containing about 4000 kbp (kilobase
pairs) of DNA. DNA is a double stranded helical structure. A molecule of DNA
consists of many mononucleotides. A mononucleotide consists of a molecule of
sugar, a molecule of phosphate and a molecule of base. In each strand of DNA,
molecules of phosphate and sugar alternate, and one of the four bases present
in DNA is attached with the sugar. The four bases are adenine, thymine, guanine
and cytosine. A base of a strand joins with its complementary base of the other
strand. Adenine is always complementary to thymine, and guanine to cytosine.
During cell division, duplication of chromosome occurs so that each daughter
cell receives an identical set.
2.Plasmid. Certain bacteria contain plasmids. Plasmids carry genes
associated with specialized function. These are extra-chromosomal genetic
elements. Plasmid is a circular double stranded DNA having several to 100 kbp.
Plasmids replicate autonomously and they code for functions which are normally
not indispensable. In some cases, plasmids may be transferred from one cell to
another and thus may carry sets of specialized genetic information through a
population, e.g. Drug resistance plasmids (R factors) may render diverse
bacteria resistant to antimicrobial drugs.
3.Transposon. Transposons are genetic elements with DNA sequences
of several kbp. They can migrate from one genetic
locus to another. Transfer of transposons can occur between one plasmid to
another, or between plasmid and chromosome within a bacterial cell. The process
is called transposition. Transposons carry genes for specialized functions,
e.g. antibiotic resistance. Transposons do not contain genetic information for
their replication.
NOTE: Bacteria infected with bacterial viruses (bacteriophages)
contain the genes of the phage. Lysogenic bacteria are the bacteria which
contain nonlytic prophage state of temperate phages.
Phenotypic changes that can occur in bacteria due to Mutation:
1. Loss of
capsule formation by capsulated bacteria.
2. Change in colony characters.
3. Change in fermentation activity.
4. Loss of sensitivity to antibiotics.
5. Loss of sensitivity to bacteriophage (Bacterial virus).
TRANSFER OF GENE
Transfer of DNA is widespread among bacterial cells. In intercellular transfer,
the genetic material passes from the donor cell to the recipient cell. It leads
to genetic diversity of bacteria. Intercellular transfer of DNA between
bacterial strains can occur by conjugation, transduction and transformation.
1. Conjugation
In conjugation, a suitable donor cell (male) comes near a recipient cell
(female), establishes direct cell-to-cell contact and transfers genetic
material. Plasmids are most frequently transferred by conjugation. Plasmids can
also mobilize portions of chromosome for transfer. This is mediated by a
fertility or F factor which is carried on a plasmid. Sex pilus is responsible
for the attachment of donor (F*) cell and recipient cell (F) in bacterial
conjugation (mating) process. Cell with sex pilus is the male and without sex
pilus is the female bacteria.
Example: Transfer of antibiotic resistance can occur by
conjugation. Transfer of drug resistant plasmid is called R-factor (Resistance
plasmid). This occurs via sex pilus from the male (donor) cell to the female
(recipient) cell.
2.Transduction
Transduction is phage-mediated. In transduction, genetic material of donor
bacterial cell is enclosed in a bacterial virus (phage) and transferred to the
recipient cell.
3.Transformation
In transformation, the recipient cell directly takes up naked DNA released from
the donor cell altering its genotype. It can occur in the medium. Natural
transformation also can occur.
Sterilization
Sterilization is the
killing or removal of all microorganisms, including bacterial spores which are
highly resistant. Sterilization is an absolute term, i.e. the article must be
sterile meaning the absence of all microorganisms.
Disinfection is the killing of many, but not all microorganisms. It
is a process of reduction of number of contaminating organisms to a level that
cannot cause infection, i.e. pathogens must be killed. Some organisms and
bacterial spores may survive.
Disinfectants are chemicals that are used for disinfection.
Disinfectants should be used only on inanimate objects.
Antiseptics are mild forms of disinfectants that are used
externally on living tissues to kill microorganisms, e.g. on the surface of
skin and mucous membranes.
Uses of Sterilization
1. Sterilization for Surgical Procedures: Gloves, aprons, surgical
instruments, syringes etc. are to be sterilized.
2. Sterilization in Microbiological works like preparation of
culture media, reagents and equipments where a sterile condition is to be
maintained.
CLASSIFICATION OF
METHODS
Sterilization and
disinfection are done by :
(A). Physical Agents
1. Heat
2. Radiation
3. Filtration
(B). Chemical Agents
In practice, certain methods are placed under sterilization which in fact do
not fulfill the definition of sterilization such as boiling for 1/2 hr and
pasteurization which will not kill spores.
STERILIZATION BY HEAT
Heat is most effective and a rapid method of sterilization and disinfection.
Excessive heat acts by coagulation of cell proteins. Less heat interferes
metabolic reactions. Sterilization occurs by heating above 100°C which ensure
lolling of bacterial spores. Sterilization by hot air in hot air oven and
sterilization by autoclaving are the two most common method used in the
laboratory.
Types of Heat :
A. Sterilization by moist heat
B. Sterilization by dry heat
A. Sterilization by
Moist Heat
Moist heat acts by denaturation and coagulation of protein, breakage of DNA
strands, and loss of functional integrity of cell membrane.
(I). Sterilization at 100°C
1. Boiling. Boiling at 100°C for 30 minutes is done in
a water bath. Syringes, rubber goods and surgical instruments may be sterilized
by this method. All bacteria and certain spores are killed. It leads to
disinfection.
2. Steaming. Steam (100°C) is more effective than dry
heat at the same temperature as: (a) Bacteria are more susceptible to moist
heat, (b) Steam has more penetrating power, and (c) Steam has more sterilizing
power as more heat is given up during condensation.
Steam Sterilizer. It works at 100°C under normal atmospheric
pressure i.e. without extra pressure. It is ideally suitable for sterilizing
media which may be damaged at a temperature higher than 100°C.
It is a metallic vessel
having 2 perforated diaphragms (Shelves), one above boiling water, and the
other about 4" above the floor. Water is boiled by electricity, gas or
stove. Steam passes up. There is a small opening on the roof of the instrument
for the escape of steam. Sterilization is done by two methods :
(a) Single Exposure for 11/2 hours. It leads to disinfection.
(b) Tyndallization (Fractional Sterilization). Heat labile
media like those containing sugar, milk, gelatin can be sterilized by this
method. Steaming at 100°C is done in steam sterilizer for 20 minutes followed
by incubation at 37°C overnight. This procedure is repeated for another 2
successive days. That is 'steaming' is done for 3 successive days. Spores, if
any, germinate to vegetative bacteria during incubation and are destroyed
during steaming on second and third day. It leads to sterilization.
II. Sterilization above 100°C: Autoclaving
Autoclaving is one of the most common methods of sterilization.
Principle: In this method sterilization is done by steam under pressure.
Steaming at temperature higher than 100°C is used in autoclaving. The
temperature of boiling depends on the surrounding atmospheric pressure. A
higher temperature of steaming is obtained by employing a higher pressure. When
the autoclave is closed and made air-tight, and water starts boiling, the
inside pressures increases and now the water boils above 100°C. At 15 ib per sq.
inch pressure, 121°C temperatures is obtained. This is kept for 15 minutes for
sterilization to kill spores. It works like a pressure cooker.
'Sterilization holding time' is the time for which the
entire load in the autoclave requires to be exposed.
Autoclave is a
metallic cylindrical vessel. On the lid, there are : (1) A gauge for indicating
the pressure, (2) A safety valve, which can be set to blow off at any desired
pressure, and (3) A stopcock to release the pressure. It is provided with a
perforated diaphragm. Water is placed below the diaphragm and heated from below
by electricity, gas or stove. Working of Autoclave. (a) Place materials inside,
(b) Close the lid. Leave stopcock open, (c) Set the safety valve at the desired
pressure, (d) Heat the autoclave. Air is forced out and eventually steam
ensures out through the tap, (e) close the tap. The inside pressure now rises
until it reaches the set level (i.e. 15 Win), when the safety valve opens and
the excess steam escapes, (f) Keep it for 15 minutes (holding time), (g) Stop
heating, (h) Cool the autoclave below 100°C, (i) Open the stopcock slowly to
allow air to enter the autoclave.
Checking of Autoclave for Efficiency. Methods :
(i) Spores of Bacillus stearothermophilus are used. Spores
withstand 121°C heat for up to 12 min. Strips containing this bacteria are
included with the material being autoclaved. Strips are cultured between 50°C
and 60°C for surviving spores. If the spores are killed the autoclave is
functioning properly.
(ii)Automatic Monitoring System.
III. Sterilization below 100°C
1. Pasteurization. Pasteurization
is heating of milk to such temperature and for such a period of time so as to
kill pathogenic bacteria that may be present in milk without changing colour,
flavour and nutritive value of the milk. Mycobacterium bovis, Salmonella
species, Escherichia coli and Brucella species may be
present in milk. It does not sterilize the milk as many living organisms
including spores are not destroyed..
Methods of Pasteurization
(i) Flash Method. It is "high temperature- short time
method". Heating is done at 72°C for 15 seconds.
(ii) Holding Method. Heating is done between 63°C and 66°C for 30
minutes.
2. Inspissation. Inspissation
is done between 75°C to 80°C. Inspissation means stiffening of protein without
coagulation as the temperature is below coagulation temperature. Media
containing serum or egg is sterilized by heating for 3 successive days. It is
done in 'Serum Inspissator'.
B. Sterilization by Dry Heat
Mechanisms. (1)
Protein denaturation, (2) Oxidative damage, (3) Toxic effect of elevated
electrolyte (in absence of water).
Dry heat at 160°C (holding temperature for one hour is required to
kill the most resistant spores). The articles remain dry. It is unsuitable for
clothing which may be spoiled.
1. Red Heat. Wire
loops used in microbiology laboratory are sterilized by heating to 'red' in
bunsen burner or spirit lamp flame. Temperature is above 100°C. It leads to
sterilization.
2. Flaming. The
article is passed through flame without allowing it to become red hot, e.g.
scalpel. Temperature is not high to cause sterilization.
3. Sterilization by Hot Air
Hot Air Oven (Sterilizer). It Is one of the most
common method used for sterilization. Glass wares, swab sticks, all-glass
syringes, powder and oily substances are sterilized in hot air oven. For
sterilization, a temperature of 160°C is maintained (holding) for one hour.
Spores are killed at this temperature. It leads to sterilization.
Hot Air Oven is an
apparatus with double metallic walls and a door. There is an air space between
these walls. The apparatus is heated by electricity or gas at the bottom. On
heating, the air at the bottom becomes hot and passes between the two walls
from below upwards, and then passes in the inner chamber through the holes on
Me top of the apparatus. A thermostat is fitted to maintain a constant
temperature of 160°C.
TYPES OF CULTURE MEDIA
Media are of different
types on consistency and chemical composition.
A. On Consistency:
1. Solid Media. Advantages of solid media: (a) Bacteria may be
identified by studying the colony character, (b) Mixed bacteria can be
separated. Solid media is used for the isolation of bacteria as
pure culture. 'Agar' is most commonly used to prepare solid
media. Agar is polysaccharide extract obtained from
seaweed. Agar is an ideal solidifying agent as it is :
(a) Bacteriologically inert, i.e. no influence on bacterial growth, (b) It
remains solid at 37°C, and (c) It is transparent.
2. Liquid Media. It is used for profuse
growth, e.g. blood culture in liquid media. Mixed organisms cannot be
separated.
B. On Chemical Composition :
1. Routine Laboratory Media
2. Synthetic Media. These are chemically defined media
prepared from pure chemical substances. It is used in research work.
ROUTINE LABORATORY MEDIA
These are classified into six types: (1) Basal media, (2) Enriched media, (3)
Selective media, (4) Indicator media, (5) Transport media, and (6) Storage
media.
1. BASAL MEDIA. Basal media are those that may be used
for growth (culture) of bacteria that do not need enrichment of the media.
Examples: Nutrient broth, nutrient agar and peptone water.
Staphylococcus and Enterobacteriaceae grow in these media.
2. ENRICHED MEDIA. The media are enriched
usually by adding blood, serum or egg. Examples: Enriched media are
blood agar and Lowenstein-Jensen media. Streptococci grow in
blood agar media.
3. SELECTIVE MEDIA. These media favour the growth of a
particular bacterium by inhibiting the growth of undesired bacteria and
allowing growth of desirable bacteria. Examples: MacConkey agar,
Lowenstein-Jensen media, tellurite media (Tellurite inhibits the growth of most
of the throat organisms except diphtheria bacilli). Antibiotic may be added to
a medium for inhibition.
4. INDICATOR (DIFFERENTIAL) MEDIA. An
indicator is included in the medium. A particular organism causes
change in the indicator, e.g. blood, neutral red, tellurite. Examples:
Blood agar and MacConkey agar are indicator media.
5. TRANSPORT MEDIA. These media are used when
specie-men cannot be cultured soon after collection. Examples: Cary-Blair
medium, Amies medium, Stuart medium.
6. STORAGE MEDIA. Media used for storing the bacteria
for a long period of time. Examples: Egg saline medium, chalk cooked meat
broth.
COMMON MEDIA IN ROUTINE USE
Nutrient Broth. 500 g meat, e.g. ox heart is minced and mixed
with 1 litre water. 10 g peptone and 5 g sodium chloride are added, pH is
adjusted to 7.3. Uses: (1) As a basal media for the preparation of other media,
(2) To study soluble products of bacteria.
Nutrient Agar. It is solid at 37°C. 2.5% agar is added in nutrient
broth. It is heated at 100°C to melt the agar and then cooled.
Peptone Water. Peptone 1% and sodium chloride 0.5%. It is used as
base for sugar media and to test indole formation.
Blood Agar. Most commonly used medium. 5-10% defibrinated sheep or
horse blood is added to melted agar at 45-50°C. Blood acts as an enrichment
material and also as an indicator. Certain bacteria when grown in blood agar
produce haemolysis around their colonies. Certain bacteria produce no
haemolysis. Types of changes : (a) beta (p) haemolysis. The colony is
surrounded by a clear zone of complete haemolysis, e.g. Streptococcus pyogenes
is a beta haemolytic streptococci, (b) Alpha (a) haemolysis. The colony is
surrounded by a zone of greenish discolouration due to formation of biliverdin,
e.g. Viridans streptococci, (c) Gamma (y) haemolysis, or, No haemolysis. There
is no change in the medium surrounding the colony,
Chocolate Agar or Heated Blood agar. Prepared by heating blood
agar. It is used for culture of pneumococcus, gonococcus, meningococcus and
Haemophilus. Heating the blood inactivates inhibitor of growths.
MacConkey Agar. Most commonly used for enterobacteriaceae. It
contains agar, peptone, sodium chloride, bile salt, lactose and neutral red. It
is a selective and indicator medium :
(1) Selective as bile salt does not inhibit the growth
of enterobactericeae but inhibits growth of many other bacteria.
(2) Indicator medium as the colonies of bacteria that
ferment lactose take a pink colour due to production of acid. Acid turns the
indicator neutral red to pink. These bacteria are called 'lactose fermenter',
e.g. Escherichia coll. Colourless colony indicates that lactose is not
fermented, i.e. the bacterium is non-lactose fermenter, e.g. Salmonella.
Shigella, Vibrio.
Mueller Hinton Agar. Disc diffusion sensitivity tests for
antimicrobial drugs should be carried out on this media as per WHO
recommendation to promote reproducibility and comparability of results.
Hiss's Serum Water Medium. This medium is used to study the
fermentation reactions of bacteria which can not grow in peptone water sugar
media, e.g. pneumococcus, Neisseria, Corynebacterium.
Lowenstein-Jensen Medium. It is used to culture tubercle bacilli.
It contains egg, malachite green and glycerol. (1) Egg is an enrichment
material which stimulates the growth of tubercle bacilli, (2) Malachite green
inhibits growth of organisms other than mycobacteria, (3) Glycerol promotes the
growth of Mycobacterium tuberculosis but not Mycobacterium bovis.
Dubos Medium. This liquid medium is used
for tubercle bacilli. In this medium
drug sensitivity of tubercle bacilli can be carried out. It contains 'tween
80', bovine serum albumin, casein hydrolysate, asparagin and salts. Tween 80
causes dispersed growth and bovine albumin causes rapid growth.
Loeffler Serum. Serum is used
for enrichment. Diphtheria bacilli grow in this medium in 6 hours when the secondary
bacteria do not grow. It is used for rapid diagnosis of diphtheria and to demonstrate
volutin granules. It contains sheep, ox or horse serum.
Tellurite Blood Agar. It is used
as a selective medium for isolation
of Cotynebacterium diphtheriae. Tellurite inhibits the growth of most secondary
bacteria without an inhibitory effect on diphtheria bacilli. It is also
an indicator medium as the diphtheria bacilli produce black colonies. Tellurite
metabolized to tellbrism, which has black colour.
EMB (Eosin-methylene blue) Agar. A selective and
differential medium for enteric Gram-negative rods. Lactose-fermenting colonies
are coloured and nonlactose-fermenting colonies are nonpigmented. Selects
against gram positive bacteria.
XLD (Xylose Lysine Deoxychoiate). It is used
to isolate Salmonella and
Shigella species from stool specimens. This is a selective media.
SS (Salmonella-Shigella) Agar. It is a
selective medium used to isolate
Salmonella and Shigella species. SS Agar with additional bile salt is used
if Yersinia enterocolitica is suspected.
DCA (Desoxycholate Citrate Agar). It is used
for isolation of Salmonella and
Shigella. The other enteric bacteria are mostly inhibited (a selective medium).
It is also a differential (indicator) medium
due to presence of lactose and neutral red.
Tetrathionate Broth. This medium is used
for isolating Salmonella from
stool. It acts as a selective medium. It inhibits normal intestinal bacteria
and permits multiplication of Salmonella.
Selenite F Broth. Uses
and functions are same as that of tetrathionate broth.
Thiosulphate-Citrate-Bile-Sucrose
(TCBS) Agar. TCBS agar is a selective
medium used to isolate Vibrio cholerae and other Vibrio species from stool.
Charcoal-yeast agar. Used for Legionella pneumophila. Increased
concentration of iron and cysteine allows growth.
Tellurite-Gelatin Agar
Medium (TGAM). It may be used as
transport, selective and indicator medium.
Alkaline peptone water. See under Vibrio. (Chapter 51).
Campylobacter Medium. This selective medium is used to isolate
Campylobacter jejuni and Campylobacter coli from stool.
Cary-Blair Medium. It is used as a transport medium for
faeces that may contain Salmonella, Shigella, Vibrio or Campylobacter species.
Amies medium is used for gonococci and other pathogens.
Peptone Water Sugar
Media. These indicator
media are used to study 'Sugar fermentation'. 1 % solution of a sugar (lactose,
glucose, mannitol etc) is added to peptone water containing Andrade's indicator
in a test tube. A small inverted Durham tube is placed in the medium. The media
are colourless. After culture, change of a medium to red colour indicates acid
production. Gas, if produced collects in Durham tube.
Motility Indole Urea
(MIU) Medium. This is used to
differentiate enterobacteria species by their motility, urease, and indole
reactions.
TSI (Triple sugar iron)
Agar- See chapter 53.
KIA (Kligler Iron Agar). This is a differential slope medium used
in the identification of enteric bacteria. The reactions are based on the
fermentation of lactose and glucose and the production of hydrogen sulphide
(chapter 53).
Christensen's Urea
Medium. This is used to
identify urea splitting organisms, e.g. Proteus. A purple pink colour indicates
urea splitting (See chapter 53).
Bordet-Gengou Medium. This medium is used for culture of
Bordetella pertussis. Increased concentration of blood allows growth. It
contains agar, potato, sodium chloride, glycerol, peptone and 50% horse blood.
Penicillin may be added to it.
Host-parasite Interactions
Infectious Diseases. These are caused by infectious agents
which are bacteria, viruses, fungi, protozoa and helminths.
Parasite is a living organism (bacteria, viruses, fungi, protozoa,
helminths) that lives in another organism, and receives shelter and
nourishment. However, in medical science parasitology traditionally deals with
animal parasites- protozoa and helminths.
Strict or obligate parasite is an organism that cannot live without
a host. That is they have no free-living existence. Examples: Treponema
pallidum, viruses, malarial parasite.
Facultative parasite is an organism that has both a free-living and
a parasitic existence, e.g. Clostridium species, Pseudomonas species.
Pathogen. Pathogen is an organism which can cause disease.
Nonpathogen. An organism that does not cause disease. It may be a
member of normal flora.
Opportunistic pathogen is an organism (nonpathogen, commensal or
saprophyte) that can cause disease only in immunocompromised individuals that
is having impaired
resistance. Example : Cytomegalovirus, Pneumocystis carinii, Atypical
mycobacteria, opportunist fungi.
Saprophyte is an organism that lives on dead organic matter.
NORMAL FLORA (Commensals)
Microorganisms that is present on the skin and mucous membrane of normal
(healthy) persons. One particular microorganism of the normal flora may be a
nonpathogen, or opportunistic pathogen. Normal flora is of two types: (1)
Resident flora. These are microorganisms regularly present in the region at a
given age, e.g. Viridans streptococci in mouth and throat, Escherichia coli in
intestine, (2) Transient flora. The microorganism is present only for hours to
weeks, e.g. Streptococcus pyogenes in throat. Microorganisms of transient flora
play no role when the normal resident flora remains intact. But if the resident
flora is disturbed than the microorganisms of transient flora may colonize and
produce disease. See chapter 62.
Beneficial Functions of Normal Flora. Examples: (1) In mouth and lower b jvel
an invading pathogen may fail to compete for nutrients and receptor sites with
normal flora, (2) Some bacteria of the bowel produce antimicrobial substances,
(3) In new born, bacteria acts as a powerful stimulus for the development of
immune system, (4) Bacteria of the gut can produce
vitamin K.
Harmful Effects of Normal Flora. Clinical diseases by opportunist pathogen of
normal flora arise under : (1) when the organism leaves the normal site and
localizes to another site, e.g. Escherichia coli in the urinary tract from gut,
(2) competitive advantage due to antibiotic therapy, e.g. colitis by
Clostridium difficile, (3) In immunocompromised individuals.
HOST
Host is the harbouring
organism of a parasite. They fall into three groups or classes:
1. Definitive host. In this host the adult stage of
animal parasites lives and sexual reproduction takes place. Man is the
definitive host for all animal parasites except malarial parasites and hydatid
tapeworm.
2. Intermediate host. In this host the asexual reproduction takes
place, or the larval stages of animal parasites develops. When development of
larval stage takes place in two different hosts they are called 'first' and
'second' intermediate hosts. Man is the intermediate host for malarial
parasites and hydatid tapeworm. Man is both definitive and intermediate host
for Taenia solium and Trichinella spiralis.
3. Paratenic host. A carrier or transport host.
Note : The term infestation is used when the parasite lives on the
outer surface. They are arthropodes- mites, ticks and insects.
INFECTION
Infection is the multiplication of an infectious agent within the body.
Multiplication of pathogenic bacteria (e.g. Salmonella typhi) even if the
person is asymptomatic is taken as an infection. Multiplication of bacteria of
normal flora at its normal site is not an infection. However, if they multiply
and cause disease it is an infection, e.g. Escherichia coli when causes
diarrhoea.
An infection involves the following : (1) Source or reservoir of
infectious agent, (2) Transmission of the infectious agent from the source to
the host (3) Susceptible host- Portal or route of entry of the agent in the
host, its localization, multiplication and finally host-parasite interactions
which result in either (a) Destruction of the agent or, (b) Infectious disease.
Source (Reservoir) :
1. Human Source.
(a) Exogenous source :
Patient or carrier,
(b) Endogenous source : The individual himself.
Carrier. A person with asymptomatic infection which can be
transmitted to another susceptible person. An individual may be a carrier : (a)
in the incubation period (Incubatory carrier), e.g. in measles, (b) during
convalescence (convalescent carrier), e.g. typhoid fever, or (c) for a
prolonged period, e.g. typhoid fever.
2. Foods and Drinks
(a) Food :Any contaminated food, (b) Water contaminated with bacteria of
typhoid fever, cholera, diarrhoea and dysentery,
(c) Milk contaminated with salmonella, M. bovis.
3. Animals : Zoonoses are diseases which are transmitted from
infected animals to humans.
(a) Cow : Bovine tuberculosis, brucellosis by Brucella abortus, Salmonella food
poisoning, anthrax, Taenia saginata, (b) Fowl. Salmonella food poisoning by
eggs and meat, (c) Dog. Rabies, hydatid disease, Weil's disease, (d) Horse.
Tetanus and glanders, (e) Goat. Anthrax and brucellosis (by B. melitensis ),
(f) Sheep. Anthrax and tetanus, (g) Cat. Cat scratch disease, (h) Rat. Plaque,
Weil's disease, (i) Parrot and pigeons. Psittacosis.
4. Soil. Tetanus, gas gangrene.
Modes of Transmission
1.
Water-borne, e.g. cholera and
other diarrhoea) diseases, enteric fever from contaminated water.
2. Food-borne (contaminated food) e.g. enteric fever,
salmonella food poisoning (e.g. eggs of duck, foul). Milk and milk products-
enteric fever, bovine tuberculosis.
3. Air-borne e.g. Droplets. During
coughing, sneezing and talking: Diphtheria, tuberculosis, measles, chickenpox,
mumps, influenza,
4. Dust-borne. e.g. tuberculosis,
5. Soil- Tetanus, gas gangrene.
6. Contaminated fomites like beddings, clothings,
utensils: Diphtheria, enteric fever, food poisoning.
7. Direct contact- STD like gonorrhoea, syphilis, AIDS.
8. Transplacental: Rubella, toxoplasma, congenital
syphilis.
9. Insect borne. (a) Actively, e.g. malaria, filaria,
kala azar, dengue, plague, yellow fever, (b) Passively, e.g. diarrhoea)
diseases, enteric fever, salmonella food poisoning.
Portal or Route of Entry
(1) Alimentary system by ingestion, (2) Respiratory system by inhalation, (3)
Genitourinary system, (4) Skin due to trauma, bite of insects, (5) Placenta.
Self-infection and cross-infection
Self-infection is the infection that occurs from the patient's own flora.
Examples : (i) infection of an wound of a patient by staphylococci carried by
the individual in his nose, (2) coliforms and anaerobes released from his bowel
during surgery.
Cross infection is the infection derived from other patients or
healthy carriers by direct spread as droplets during talking, coughing,
sneezing, by air-born dust, food, fluids etc. Cross-infection is common in
hospitals.
BACTERIAL TOXINS
Bacterial toxins are
exotoxins and endotoxins. Characteristics and differences of exotoxins and
endotoxin are listed in down the page.
EXOTOXINS
Exotoxin producing bacteria
1. Corynebacterium diphtheriae. Strains that carry a temperate
bacteriophage are toxigenic causes diphtheria. Exotoxin inhibits protein
synthesis and causes cell death. Causes diphtheria.
2. Clostridium tetani. Exotoxin blocks action of inhibitory
neurones of spinal cord. Causes tetanus.
3. Clostridium perfringens. (a) Causes gas gangrene. Exotoxin
(alpha toxin) has lacithinase activity and thereby causes cell death, (b)
Enterotoxin causes hyper secretion of water and electrolytes in diarrhoea.
4. Clostridium botulinum. Exotoxin causes paralysis of
deglutination and respiratory muscles. It blocks release of acetylcholine of
synapses and neuromuscular junctions. Causes botulism.
5. Vibrio cholerae 01 and 0139. Enterotoxin (Exotoxin) causes hyper
secretion of water and electrolytes within gut in diarrhoea.
6. Enterotoxigenic E. coll. Produce enterotoxin (LT- heat labile
exotoxin) causes hypersecretion of water and electrolytes within gut.
7. Shigella dysenteriae type 1 (Shiga bacillus). Exotoxin causes
acute inflammation.
8. Staphylococcus aureus- some strains : (a) Toxic shock syndrome
toxin-1. Causes toxic shock syndrome. (b) Staphylococcal enterotoxin causes
toxin type food poisoning and stimulates vomiting centre of brain.
9. Streptococcus pyogenes. Pyrogenic (Erythrogenic) exotoxin causes
scarlet fever and toxic shock syndrome.
NOTE : Enterotoxins are exotoxins that are associated with
diarrhoea) diseases and food poisoning. Bacteria producing enterotoxins are V.
cholerae, enterotoxigenic E. coli (ETEC), some strains of S. aureus, V.
parahaemolyticus, Y. enterocolitica, Aeromonas species, and C. perfringens.
Toxoid. Toxoid is modified exotoxin. An exotoxin has two main
properties :
(1) toxicity, and
(2) antigenicity. In
toxoid, the toxicity of the toxin is destroyed but its antigenicity is
preserved. As such toxoids e.g. diphtheria toxoid, tetanus toxoid can be safely
used for vaccines. Toxins can be converted to toxoid by different methods e.g.
formalin treatment.
ENDOTOXINS
Endotoxins are the integral part of the cell walls of
Gram-negative bacteria, and are liberated when bacteria are disintegrated
(lysed). Cell wall of Gram negative bacteria contain lipopolysaccharides (LPS,
endotoxin) which consists of : (1) Lipid A. This is the endotoxin and is the
core, and (2) Polysaccharide form coat. This is the 0 antigen which can induce
specific immunity. Physiological, pathological and clinical effects of
endotoxins of different Gram negative bacteria are similar. These are :
1. Fever. The endotoxin acts on mononuclear phagocytes
(monocytes/macrophages), with liberation of interleukin-1 (endogenous pyrogen).
Interleukin-1 acts on thermoregulatory centre. Chill is due to widespread
arteriolar and venular constriction.
2. Leucopenia occurs early with onset of fever. It may be followed
by leucocytosis.
3. Hypoglycaemia. LPS enhances glycolysis in many cell types and
can lead to hypoglycaemia.
4. Hypotension occurs early in Gram-negative bacteraemia.
5. Shock. 'Endotoxic' or 'septic' shock may develop in severe
Gram-negative bacteraemia (See chapter 4).
6. Activation of complement. Endotoxin
activates complement system by alternative pathway.
7. Disseminated Intravascular Coagulation (DIC). DIC may
occur in Gram negative bacteraemia. It is initiated on activation of factor XII
(Hageman factor) of coagulation cascade by endotoxin which finally leads to
conversion of fibrinogen to fibrin. Endotoxin leads platelets to adhere on
vascular endothelium. Endotoxin can activate plasminogen to plasmin which acts
on fibrin producing fibrin-split products. Shwartzman phenomenon is taken as a
specialized form of DIC.
8. Death may occur due to shock and/or DIC.
NOTE: Peptidoglycan of Gram-positive Bacteria: Peptidoglycan of
Gram-positive bacteria released during infection may produce similar activities
as LPS of Gram-negative bacteria. However, peptidoglycan is much less potent
than LPS.
Characteristics and Differences of Exotoxins and Endotoxins
Endotoxin:
1. Integral part of the cell wall of Gram-negative bacteria.
Released on bacterial death and in part during growth. Release is not required
for biologic activity.
2. Formed only by Gram-negative bacteria
3. Lipopolysaccharides. Lipid A portion is responsible for
toxicity.
4. No specific receptor.
5. Moderately toxic. Fatal to animals in large doses.
6. Relatively heat stable. Toxicity is not destroyed above 60°C for
hours.
7. Weakly antigenic. Antibodies are protective.
8. Not converted to toxoid.
9. Synthesis directed by chromosomal genes.
10. Usually produce fever in the host by release of interleukin-1 and
other mediators..]
Exotoxins:
1.Excreted by living cells
2. Produced by Gram-positive and Gram-negative bacteria
3. Polypeptides
4. Usually bind to specific receptors on cells
5. Highly toxic. Fatal to animals in very small doses
6. Relatively heat labile. Toxicity destroyed over 60°C
7. Highly antigenic. Stimulate formation of antitoxin. Antitoxin
neutralizes the toxin
8. Converted to toxoid by formalin. Toxoid is nontoxic but
antigenic. Toxoids are used to immunize, e.g. tetanus toxoid
9. Usually controlled by extra-chromosomal genes, e.g. plasmids,
phage gene
10. Usually do not produce fever in the host.
MECHANISMS OF ACTION OF ANTIMICROBIAL DRUGS
Selective Toxicity.
Selective toxicity is the property of an ideal antimicrobial agent. Selective
toxicity means that the drug is harmful to a parasite but not to the host.
Usually the effect is relative rather absolute, i.e. a drug in a concentration
tolerated by the host may damage an infecting microorganism. Selective toxicity
may be a function of a specific receptor required for drug attachment, or it
may depend on inhibition of biochemical events essential to the organism but
not to the host. The mechanisms are discussed under four headings: (1)
Inhibition of cell wall synthesis, (2) Inhibition of cell membrane function,
(3) Inhibition of protein synthesis, and (4) Inhibition of nucleic acid
synthesis.
Classification on mode of Action:
1. Inhibition of cell wall synthesis. Penicillins, cephalosporin,
vancomycin, bacitracin, cycloserin are examples.
All (3-Iactarn drugs like penicillins, cephalosporins are selective inhibitors
of bacterial cell wall synthesis and therefore active against growing bacteria.
Mechanism of action: Initial step is the binding of the drug to specific drug
receptor PBPs (Penicillin- binding proteins) on bacteria. There are 3 to 6 PBPs
having different effects. At least some of which are enzymes involved in
transpeptidation (cross-linking) reactions. After attachment, peptidoglycan
synthesis is inhibited as final transpeptidation is blocked. Then there occurs
inactivation of an inhibitor of autolytic enzyme in the cell wall. This
activates the autolytic enzymes in the cell wall that results in lysis
resulting in bacterial death. Organisms with defective autolysin function are
inhibited but not killed by l3dactam drugs, and they are said to be
"tolerant".
The Gram-positive and Gram-negative bacteria differ in susceptibility to
penicillins or cephalosporins on structural differences in their cell walls
that decide binding, penetration, and activity of the drugs. The differences in
cell wall are in the amount of peptidoglycan, presence of receptors and lipids,
nature of cross-linking and activity of autolytic enzymes. Peptidoglycan layer
of the cell wall is much thicker in Gram-positive than in Gram-negative
bacteria.
Lack of toxicity of p-lactam drugs to animal cells is attributed to the absence
of bacterial type cell wall with its peptidoglycan in animal cells.
Extended-spectrum P lactum (ESBLs) are enzymes that mediate resistance to
extended-spectrum (third generation) cephalosporins (e.g., ceftazidime,
cefotaxime, and ceftriaxone) and monobactams (e.g., aztreonam) but do not
affect cephamycins (e.g., cefoxitin and cefotetan) or carbapenems (e.g.,
meropenem or imipenem). Production of ESBLs can be screened by broth
microdilution and disk diffusion screening tests using selected antimicrobial
agents.
2. Alteration of cell
membrane function. Polymyxin,
amphotericin B, imidazole are examples.
These drugs act by
disruption of the functional integrity of the cytoplasmic membrane.
Macromolecules and ions escape from the cell causing cell damage or death.
Selective chemotherapy is possible as the cytoplasmic membrane of bacteria and
fungi has a structure different from that of animal cells, and can be more
readily disrupted by certain chernothe rape utics.
3. Inhibition of protein synthesis. These drugs inhibit protein
synthesis in bacteria. Bacteria have 70S ribosomes, whereas mammalian cells
have 80S ribosomes. Subunits of each type of ribosome, their chemical
composition, and functional specifities differ. Thus a drug can inhibit protein
synthesis in bacterial ribosomes but not in mammalian ribosomes.
(a) Action on 50S ribosomal subunit. Chloramphenicol, erythromycin
and chindamycin are examples.
(b) Action on 30S ribosomal subunit. Tetracycline and aminoglycosides are
examples.
4. Inhibition of nucleic acid synthesis. These drugs inhibit
nucleic acid synthesis by different mechanisms. (a) Inhibition of nucleotide
synthesis. Sulphonamides, trimethoprin Sulphonamides compete for the enzyme
required for essential metabolite PABA involved in the synthesis of folic acid
needed for synthesis of nucleic acid. (b) Inhibition of DNA synthesis. Quinolones
block DNA gyrase. (c) Inhibition of mRNA synthesis- Rifampin.
RESISTANCE TO ANTIMICROBIAL DRUGS
A. Mechanisms of Drug
Resistance. Microoganisms
exhibit resistance to antimicrobial drugs by different mechanisms.
1. Microorganisms produce enzymes that destroy the active
drug. Examples: P-lactamases (Penicillinases) produced by certain
bacteria destroy penicillin. Staphylococci resistant to penicillin G produce a
P-lactamase that destroys the drug. Other P-lactamases are produced by
Gram-negative rods.
2. Microorganisms change their permeability to the drug, e.g.
tetracycline accumulate in susceptible bacteria but not in resistant bacteria.
3. Microorganisms develop an altered metabolic pathway that
bypasses the reaction inhibited by the drug. Sulphonamide resistant bacteria do
not require extracellular PABA, but can utilize preformed folic acid.
4. Microorganisms develop an altered structural target for the
drug: Erythromycin resistant organisms have on altered receptor on the
50S subunit of the ribosome. Aminoglycosidesresistant is due to alteration or
loss of a specific protein in the 30S subunit of the bacterial ribosome that
serve as a binding site in susceptible organisms. Resistance to some
penicillins and cephalosporins occurs due to alteration or loss of PBPs.
5. Microorganisms develop an altered enzyme that can
perform its metabolic function but is much less affected by the drug.
B. Origin of Drug
Resistance. The origin of drug
resistance may be genetic or nongenetic.
1. Genetic Origin of
Drug Resistance. Most
drug-resistant microorganisms emerge as a result of genetic change and
subsequent selection processes by antimicrobial drugs. Genetic mechanism may be
chromosomal or extra-chromosomal.
(i)
Chromosomal Resistance. Chromosome-mediated
resistance occurs by spontaneous mutation in a locus that controls
susceptibility to the drug. The antimicrobial drug serves as a selecting
mechanism to suppress susceptible organisms and favor the growth of
drug-resistant mutants. Spontaneous mutation is not a frequent cause of the
clinical drug resistance in a given patient. But it occurs with high frequency
to rifampicin. Mutation can result in the loss of PBPs, making such mutants
resistant to a-Iactam drugs. ExamplesRifampicin, streptomycin, erythromycin.
Resistance of M. tuberculosis to rifampicin is caused by mutation in RNA
polymerase and that to isoniazid by mutation in catalase.
(ii)Extrachromosomal
Resistance
(a)
Plasmid Resistance. This occurs by the extrachromosomal genetic elements called
plasmid. Plasmidmediated drug resistance is more common than that of
chromosome. R factors (drug resistance plasmids) are a class of plasmids that
carry genes for resistance to antimicrobial drugs. A single plasmid can carry
genes that code for resistance to several drugs (multi-drug resistance -MDR)
such as streptomycin, chloramphenicol, tetracycline and sulphonamides. Plasmid
genes control the formation of enzymes capable of destroying the antimicrobial
drugs, e.g. Plactamases destroy P-lactam ring of penicillins and
cephalosporins.
(b) Transposon
Resistance.
Genetic material
responsible for antimicrobial resistance of a donor cell may be transferred to
a sensitive recipient cell, and the recipient cell thus becomes resistant to
the drug(s). The intercellular transfer of genetic material may occur by : (a)
Conjugation, Conjugation is the most important of these mechanisms for the
transfer of antimicrobial resistance. In most cases of conjugation the
transferable DNA is plasmid, but chromosomal DNA may also be transferred, (b)
Transduction. Transduction is the transfer of cell DNA by means of a bacterial
virus (bacteriophage, phage). Transfer of gene for Beta lactamase production is
mediated by bacteriophage, and (c) Transformation. It is a natural occurrence,
and is a direct uptake of donor DNA by recipient cells.
2. Nongenetic Origin of
Drug Resistance. This may be due to:
(i) Metabolic inactivity. Most antibacterial
drugs act when the microorganisms multiply actively. As such they become
resistant to the drug when metabolically inactive, i.e. not multiplying.
However, their offsprings are fully susceptible. Example: "Persisting"
organisms like mycobacteria survive in tissues for many years after infection
and do not multiply. They can not be eradicated by drugs. But if they start to
multiply then they become fully susceptible to the same drugs.
(ii) Loss of
specific target structure. Microorganisms
become resistant due to loss of a specific target structure. Example: During
penicillin administration, penicillin-susceptible organisms may change to cell
wall deficient L forms, and become resistant to cell wall-inhibitor drugs
(penicillins, cephalosporins).
(iii)Infection at sites where antimicrobials are excluded or are not active.
NOTE: Examples:
A. Resistance to
penicillins can be due to:
1. Production of P-lactamases by staphylococci, gonococci,
Gram-negative rods, and others. About 50 fl-lactamases are known and under the
control of plasmids.
2. Altered or lack of PBPs. Mostly under the control of
chromosomes.
3. Failure of activation of autolytic enzymes in cell wall.
4. Failure to synthesize peptidoglycans, e.g. in L forms,
mycoplasma.
B. Resistance to
cephalosporins can be due to
1. Poor permeation of bacteria by the drug
2. Lack of PBP
3. Degradation of drug by β-lactamases.