UNIVERSITY OF TECHNOLOGY, JAMAICA

SYLLABUS OUTLINE DRAFT

COOLAGE OF HEALTH SCIENCES SCHOOL OF DENTAL SCIENCES

COURSE OF STUDY: Doctor of Medical Dentistry YEAR /LEVEL 1

MODULE TITLE: Microbiology and Immunology

MODULE CODE: DMD 1007

DURATION (Hours): Lecture 45 Hours Laboratory 45 Hours

CREDIT VALUE: 4

PREREQUISITES: None

1.0 MODULE DESCRIPTION

Focus will be on the most common pathologic pathogens encountered in the clinical setting, the clinical signs and symptoms, and medical management of their related diseases. Presented also will be the concepts of sterilization, disinfection, and universal precaution, in preventing the spread of these diseases. Concepts related to basic immunology will also be presented

2.0 MODULE OBJECTIVES/LEARNING OUTCOMES

Dental Health Care Workers (DHCW) should have a working knowledge of the most common pathologic bacteria, viruses and fungi common to man. This is most important as DHCW function in an environment which brings them in close contact with pathologic microorganisms.

Upon completion of this module, the student should be able to:

1. when presented with clinical signs and symptoms of bacterial infections, identify their etiologic agent, and as indicate treatment and preventive methods

2. when presented with clinical signs and symptoms of viral infections, identify their etiologic agent, and indicate treatment and preventive methods

3. when presented with clinical signs and symptoms of fungal infections, identify their etiologic agent, and indicate treatment and preventive methods

4. when presented with clinical signs and symptoms of parasitic infections, identify their etiologic agent, as well indicate treatment and preventive methods

5. demonstrate a working knowledge of the human immune response, and when presented with the clinical signs and symptoms of autoimmune diseases articulate the correct diagnosis

6. apply the concepts of sterilization, disinfection, and universal precaution utilized in the prevention of the spread of microbial disease in the clinical setting..

3.0 MODULE CONTENT AND CONTEXT

3.1. BACTERTIOLOGY 5 weeks 15 Hour

A. INTRODUCTIONNormal Microbial Flora

Properties Location

SkinOral cavityNasopharynxStomachSmall intestineColonVagina

Microbial Virulence FactorsEnzyme productionToxinsSurface components

B. BACTERIOLOGY OVERVIEWClassification & Identification of Bacteria

General propertiesClassification Biomedical characteristicsSerologic reactivityBacteriopharge typingAnimal pathgogenicityAntibiotic sensitivity

Bacterial StructureCell envelopeCapsule production

Slime layerBacterial cell wall

Gram positive, gram negativePeriplasma

Plasma (cell) membrane

Cytoplasmic structuresNucleoid regionRibosomesPolyaminesCytoplasmic granulesSpores

Bacterial GrowthIn a closed systemLag phaseExponential (lo) phase

Stationary phasePhase of decline

Survival in Oxygen

Energy ProductionSiderophoresMechanism of Energy productionFermentationOxidative respiration

SporulationSporeGermination and Outgrowth

Genetic TransferTransformationTransduction

Generalized transductionSpecialized transduction

Conjugation (direct transfer)Plasmid mediatedNarrow-host-range plasmidBroad-host-range plasmidConjucation plasmidNonconjucated plasmid

Insertion sequencesTransposon

Dental Clinical MicrobiologySterilization versus DisinfectionSterilization methodsPreparation ofinstrumentsFailure of sterilizationDisinfection / Antiseptic / Sterilization ActionsDisinfection GuidelinesSterilization Monitors

Process indicatorsBiologic monitorsSpore forming BacteriaBenchmark organisms

Universal PrecautionsBarrier methodsCritical instrumentsSemicritical instrumentsHand piecesHandwashingBrief history of Universal precautionsClinically related hepatitis B virus (HBV) / HIV

C. GRAM POSITIVE COCCISTAPHYLOCOCCUS

Genus characteristics and classificationClustersResistant to heat and dryingFacultative and posses superoxide dismutase & catalaseCoagulase test positive

Staphylococcus aureus

Virulence factorsCommon conditions caused by S aureusTreatment, Vancomycin-resistant S. aureus (VRSA)

Staphylococcus epidermidisVirulence factorCommon conditionsTreatment

Staphylococcus saprophyticusCommon conditionsTreatment

D. STREPTOCOCCUS (KNOW VERY WELL)Genus characteristics

Chains Aerotolerant Anaerobes (facultative anaerobes)Energy by FermentationLack CatalaseAuxotrophic (require Vitamins, Amino acids, Nucleic acid)

Classificationα-Hemolysis: Intact RBC, green(viridians) pigmentβ-Hemolysis: RBC lysedγ-Hemolysis: No hemolysis, no color change

α-Hemolytic streptococcusInhibition or growth in Optochin or BileTransmissionClinical ManifestationRisk Factors

Steptococcci Most Commonly Found in Oral CavityNon-beta-hemolytic streptococc

S. mutans S. mitis S. sanguis S. salivarius

Other Aciduric BacteriaLactobacillus species

Effects of Fluoride on S. mutans and Caries formation

Viridians Streptococcus and Subacute Bacterial Endocarditis (SBE)

β-Hemolytic StreptococcusGroup A Streptococcus (GAS)

S. pyogens

Transmission EpidemiologyVirulence Factor:

Group B Steptococcus (Strep. agalactiae)Virulence Factor = antiphagocytic polysaccharide capsuleClinical ManifestationsTreatment

Clinical Correlation:

Enterococcus (formally group D Streptococcus)Enterococcus faecalisEnterococcus faecium

E. GRAM POSITIVE BACILLILISTERIA MONOCYTOGENS

Characteristics:TransmissionRisk factors:

CORNEYBACTERIUM DIPHTHERIA

CharacteristicsDiphtheria ToxinClinical Manifestations:TreatmentPrevention:

BACILLUS ANTHRACISCharacteristicsTransmission Clinical Manifestations: Cutaneous Anthrax (95%)

Systemic Anthrax:Treatment: PenicillinPrevention

BACILLUS CEREUSClinical ManifectationsTreatmentPrevention

CLOSTRIDIUMCharacteristics:

C. PERFRINGENSCharacteristicsTransmissionClinical ManifestationsTreatment:

CLOSTRIDIUM DIFFICILECharacteristics Clinical Manifectation Treatment of Pseudomembranous colitis

CLOSTRIDIUM TETANICharacteristics:Four (4) Clinical Manifestations

Local InfectionCephalic Infection: Generalized Form:

TreatmentPrevention

CLOSTRIDIUM BOTULINUMCharacteristics TransmissionClinical ManifestationsTreatment

F GRAM NEGATIVE COCCINEISSERIA MININGOCOCCUS

Virulence TransmissionClinical Manifestations:TreatmentPrevention

NEISSERIA GONORRHOEAE (Gonococcus)CharacteristicsTransmission:Clinical ManifestationsDiagnosisTreatment

G GRAM NEGATIVE BACILLIENTEROBACTERIACEAE

CharacteristicsPhysiology

SHIGELLACharacteristicsObligate Human Pathogen

S. dysenteriae

S. flexneriS. sonneiS. boydi

TransmissionPathogenesisClinical Manifestations: (Shigellosis)Bacillary DysenteryTreatment

ESCHERICHIA COLICharacteristics

Enterotoxigenic E. coli (ETEC)TransmissionClinical Manifestations

SALMONELLA (Motile)Nontyphoidal SalmonellaTyphoidal Salmonella (Typhoid Enteric Fever)Transmissi

COMMON OPPORTUNISTIC ENTEROBACTERIACEAEGenus KlebsiellaKlebsiella pneumoni:Genus Proteus

OTHER ENTERIC BACTERIAVibrio cholera

TransmissionClinical Manfestation: (Cholera)Treatment:

Camplyobacter C. jejuniC. fetusHelicobacter pylori

Conditions associated withTreatment

Pseudomonas P. aeruginosa

Patients at High Risk:Clinical Manifestations:Treatment

H. RESPIRATORY PATHOGENSHAEMOPHILUS INFLUENZE

CharacteristicsClinical Manifestations

H. ducreyl Chancroid (Venereal disease)

BORDETELLA PERTUSSIS

CharacteristicsVirulent FactorsClinical ManifestationsTreatment

LEGIOELLA PNEUMOPHILIACharacteristicsTransmissionRisk FactorsClinical ManifestationsTreatment: Erythromycin

I OBLIGATE ANAEROBESCharacteristics PathologyTreatment

J ANAEROBIC GRAM NEGATIVE BACILLIBACTEROIDESB. fragilis

CharacteristicsFour (4) Virulence FactorsClinical Manifestations

Prevotella melaninogenicusCharacteristicsVirulence Factor

FusobacteriaFusobacterium nucleatumFusobacterium necrophorum found in Liver AbscessTreatment

K ANAEROBIC GRAM POSITIVE BACILLIClostridium species: Spore—formingPropionibacteriaActinomyces

L. ANAEROBIC COCCIPeptostreptococci

CharacteristicsClinical ManifestationsTreatment

Veillonella species:Periodontal Pathogens:

Bacteroides melaninogenicusPorphyromonas gingivalisSpirochetes (Borrelia – associated with ANUG)Fusobacteria –associated with ANUGCampylobacter rectusEichenella corrodensActinobacillus actinomycetemcomitans (Juuvenile periodontitis)Veillonella

M. MYCOBACTERIA Mycobacteria tuberculosis

CharacteristicaAntigenicity PathogenicityEpidemiologTransmissionPathogenesisClinical ManifestationsDiagnosis:TreatmentPrevention:

Mycobacterium bovisNon-tuberculoid mycobacteria (“atypical”) – non-TBClinical Manifestations

M. lepraeCharacteristicsLeprosyTransmissionDisease formsImmunityTreatment

O. ACTINOMYCETESA. Israeli & A. naeslundii

CharacteristicsClinical manifestations (Actinomycosis)Treatment

Nocardia asteroidsCharacteristicsClinical manifestations Treatment

P. RICKETTSIAE & CHLAMYDIA RICKETTSIAE

CharacteristicsPhysiologyRickettsial diseasesTransmissionClinical Manifestations

CHLAMYDIACharacteristicsLife cycleC. trachomatisC. psittaci

C. pneumonia

Q. SPIROCHETESTREPONEMA PALLIDUM

CharacteristicsTransmission EpidemiologyClinical Manifestations

Primary syphilisSecondary syphilisLatent syphilisTertiary syphilis Congenital syphilis

Serologic diagnosisTreatmentPrevention

BORRELLACharacteristicsLyme disease

TransmissionEpidemiologyClinical manifestationDiagnosis

Relapsing fever

R MYCOPLASMA & UREAPLASMAMYCOPLASMATACAE

CharacteristicsPhysiology

Mycoplasma pneumoniaeEpidemiologyTransmissionClinical manifestations

Mycoplasma hominisMycoplasma urealyticum

3.2. VIROLOGY Weeks 5, 6 6 HoursA. CLASSIFICATION & IDENTIFICATION

MorphologyTerminologyNucleocapsidsEnvelopesVirus classificationViral proteinsReplication

B. DNA VIRUSESAdenoviruses

Characteristics

TransmissionClinical manifestations

PapovavirusCharacteristics Human papilloma virus

Transmission

HerpesvirusesCharacteristicsHerpes simplex (Type 1 & 2)

Clinical manifestationsDiagnosis teeatment

Vaicella-zoster Clinical manifestationsTreatmentPrevention

Epstein-Barr virus Clinical manifestationsNonspecific serologic responses

Cytomegalovirus Immunocompromized hostImmunosupressed hostCongenital diseaseTreatment

Human herpesvirus 6 (HHV-6)Clinical manifestation

PoxvirusesCharacteristics Variola virus (small pox)Mulluscum cantagiosum virusCowpox

C. RNA VIRUSES Picornaviruses

CharacteristicsPoliovirus

Characteristics TransmissionPathogenesisPrevention

EchovirusesCharacteristics TransmissionEpidemiology

Clinical manifestations

Coxsackieviruses (A & B)Characteristics TransmissionEpidemiologyClinical manifestations

Enterovirus 72 (Hepatitis A)

RhinovirusesCharacteristics TransmissionEpidemiologyClinical manifestations

Orthomyxoviruses Influenza viruses A, B, C

CharacteristicsTransmissionClinical manifestationsTreatmentPrevention

ParamyxovirusesCharacteristics Parainfluenza viruses (croup)

TransmissionClinical manifestation

Rubeola virus (measles virus)TransmissionClinical manifestations (Koplik spots)ComplicationsTreatmentPrevention

Mumps virus (parotitis)Prevention (MMR vaccine)

Respiratory syncytial virus (RSV)Transmission

Togovirus CharacteristicsAlphaviruses

TransmissionEastern equine encephalitis (EEE) virusWestern equine encephalitis virus

Rubella (Rubivirus)

TransmissionClinical manifestationsCongenital rubellaPrevention

Flaviviruses Yellow fever

TransmissionClinical manifestationPrevention

Dendue feverTransmissionClinical manifeastations

Rhabdovirus (Rabies virus)CharacteristicsTransmissionPathogenesisClinical manifestationsTreatmentPrevention

Retrovirus CharacteristicsHuman T-cell leukemia viruses (HTLV 1&11)Human immunodeficiency virus (HIV)Oncoviruses

Human T-lyphotropic virus (HTLV 1)Acute T-cell lymphocytic leukemia (ATLL)HTLV 11 (Hairy cell leukemia)

D. HEPATITIS VIRUSES (A, B, C, D, E & G)

3.3 MYCOLOGY Week 7 3 hoursA. INTRODUCTION

MorphologyYeastsMoldsDimorphic fungiImmunity

B. OPPORTUNISTIC MYCOSESCandida albicans

CharacteristicsClinical manifestationDiagnosisTreatment

Crytococcus neoformans

CharacteristicsClinical manifestations

Aspergillus fumigatesCharacteristicsClinical manifestations

C. Rhizopus and MucorCharacteeisticsPeople at riskClinical manifestation (Zygomycosis)

Rhinocerebral diseasePulmonary disease

Treatment

D. Pneumocystosis cariniiCharacteristicsClinical manifestationsTreatment

E DERMATOPHYTOSIS Cutaneous Mucosis – Tinia)

Subcutaneous MycosisSporothrix schenckii (rose gardener’s disease)

Systemic MycosisHistoplasma capsulatum (Histoplasmosis)Coccidioides immitis (Coccioidomycocsis)Blastomyces dermatidis (Dermatomycosis)

3.4. PARASITES Week 8 3HoursProtozoa

Giardia lamlia (giardiasis)Entamoeba histolytica (amebiais)Trichomonas vaginalis (vaginitis)

Blood and Tissue ProtozoaPlasmodium (malaria – Anopheles mosquito)Leishmania ( Leishmanaisis – sand fly)Trypanosoma brucei (sleeping sickness – Tsetse fly)Trypanosomia cruzi [Chaga’s disease – Reduviid bug (kissing bug)]Toxoplasma gondii (Toxoplasmosis)

3.5. IMMUNOLOGY. Week 9 - 13 15 hours A. CELLS OF THE IMMUNE SYSTEM

Monocyte & MacrophageFunctionsMorphology

ActivationAntigen presenting cell

Dendritic cells (Langerhan cell)

Granulocytes or Polymorphonuclear leucocytesNeutrophilsEosinophilsBasophils

Lymphocytes B lymphocyteT lymphocytesT helper cells (CD4 positive)Cytotoxic T cells (CD8 positive)

Natural killer cells

B. LYMPHORETICULAR SYSTEMBone marrow

StructureHematopoietic cell differentiation

ThymusStructure FunctionDevelopmentOrganizationThymectomyThymosin

LymphaticsLymph nodes

StromaCortex

Lymphatic sinusesGerminal centers

MedullaFunction

SpleenStromaParenchyma

White pulpRed pulp

Gut-associated lymphoid tissue (GALT)StructureFunction

Bronchus-associated lymphoid tissue (BALT)Tonsils

Organization

Types of tonsilsLingual tonsilsPharyngeal tonsils

C. THE IMMUNE SYSTEM

Natural immunityAcquired immunitySelf-toleranceAntigens and Antibodies

Epitope (antigenic determinant)Antibodies

Macromolecules as antigensProteinsPolysaccharidesNucleic acidLipidsHaptens

Major Histocompatabiltiy ComplexHLA class 1 antigensHLA-A, HLA-B, HLA-CHLA class 11 antigenHLA class 111 antigen

AntibodiesStructure

Light chains (kappa, lamda)Heavy chains (IgG, IgA, IgM, IgE, IgD)

Antigen-antibody sitesIdiotypes, allotypes, isotypesImmune serumMonoclonal antibodiesProperties of Immunoglobulin SubclassesT-cell receptors (TCR)Types of Immune Response

InflammationHumoral immune response

PrimarySecondary

Cellular immune responseT-helper cell activation

RegulationImmunologic tolerance

Factors:Form of antigenRoute of exposureAge of recipientDose of antigen

Immune suppressionSuppression by CD8+ cellsPhysical immune suppression

X-ray & ultraviolet radiationSurgical interventionChemical agents

D. CELLULAR INTERACTIONS IN IMMUNE RESPONSESAntigen processing

Exogenous route (MHC class 11)Endogenous route (MHC class 1)

T-cell receptor and its interaction with antigenRequirement for activation of cytotoxic T cellsRequirement for activation of B cellsCytokines

Lymphokines (Interleukin -2, Interleukin-6, Interleukin-8)Monokines (Interleukin-1, Tumor Necrosis Factor α)Autocrine & para crine effects)

E. COMPLEMENT AND INFLAMMATIONComplement

ActivationClassic pathwayAlternate Pathways

Membrane attack complex (MAC)

Inflammation Signs: pain, redness, heat, and swelling)Vasoactive and smooth muscle constrictors

HistamineArachidonic acid products

Cyclooxygenase pathway (prostaglandin, thromboxane)Lipoxygenas pathway (leukoyrienes)

Platelete activating factor PAF)

Chemotactic factors Eosinophil chemotactic factors (histamine)Neutrophil chemotactic factors (IL-1, IL-8)

Enzymes mediatorsNeutral proteases (Mast cells)Acid proteases (Lysosomes)

Proteogylcans HeparinTrytaseChondrotin sulateToxic oxygen molecules (O3-, H2O2, OH-)Kinins (bradykinin)

F. CLINICAL IMMUNOLOGYImmunodeficiencies

Primary immunodeficiency diseasesAcquired immunodeficiency (HIVD)

Causative agentRisk groupsMechanism of transmissionCellular implications (T cells, B cells, macrophages)Natural history of HIV disease

Group 1Group 11 Group 111 [AIDS-related complex (ARC)]

Clinical correlationDiagnosisHIV testingNew treatmentsPost exposure treatmentBody fluids and spreadPediatric AIDS

G. HYPERSENSITIVITIES (Type 1, 11, 111, 1V)

H. AUTOIMMUNE DISEASETheoriesGenetic predispositionFrequencyGeneral signsDiagnostic testsTherapySystemic lupus erythematosisSclerodermaSjogren’ssyndrome

I. AMYLOIDOSIS

J. TRANSPLANTATION AND TUMOR IMMUNOLOGY

LABORATORY: 45 Hours Demonstrations of selected microorganisms discussed will be presented, and then the

students will be able to:1. appreciate the appearance,2. identify the characteristics,3. know basic tests used to identify and4. correlate clinical manifestations present and the causative agent.

4.0. LEARNING AND TEACHING APPROACHESLectures (Power Point Presentations)Lecture Notes35 mm Clinical & Histologic SlidesReading Assignments

5.0 ASSESSMENT PROCEDURES

Two Class tests (30%)Laboratory (20%)

Final Examination (50%)

NOTE: Pass score = 70%. Pass on Final Examination is compulsory.

6.0 BREAKDOWN OF HOURS

Lectures: 45 hoursLaboratory: 45 hours

7.0 TEXTBOOKS AND REFERENCES

Clinical Microbiology. Murray, Pfaller, Rosenthal. 6th Edition. 2009. REQUIRED

8.0 NAME OF SYLLABUS WRITTER/DEVELOPER

Dr. Doryck L. Boyd

9.0 DATE OF PRESENTATIONS OR REVISION

2010– 8 – 30

10 DATE OF ACCEPTANCE

....................................................Program Director

…………………………………OCDE