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If microorganisms actually reach the lungs depression and erectile dysfunction causes order aurogra toronto, phagocytic cells called alveolar macrophages usually locate erectile dysfunction treatment washington dc order aurogra 100 mg on-line, ingest, and destroy most of them. IgA antibodies in such secretions as respiratory mucus, saliva, and tears also help protect mucosal surfaces of the respiratory system from many pathogens. Thus, the body has several mechanisms for removing the pathogens that cause airborne infections. By contrast, the lower respiratory tract is nearly sterile- although the trachea may contain a few bacteria-because of the normally efficient functioning of the ciliary escalator in the bronchial tubes. However, they usually do not cause illness because the predominant microorganisms of the normal microbiota suppress their growth Normally, the lower respiratory tract is nearly sterile. As most of us know from personal experience, the respiratory system is the site of many common infections. We will soon discuss pharyngitis, inflammation of the mucous membranes of the throat, or sore throat. When the larynx is the site of infection, we suffer from laryngitis, which affects our ability to speak. The microbes that cause pharyngitis also can cause inflamed tonsils, or tonsillitis. The nasal sinuses are cavities in certain cranial bones that open into the nasal cavity. They have a mucous membrane lining that is continuous with that of the nasal cavity. Infection of a sinus involving heavy nasal discharge of mucus is called sinusitis. If the opening by which the mucus leaves the sinus becomes blocked, internal pressure can cause pain or a sinus headache. These diseases are almost always self-limiting, meaning that recovery will usually occur even without medical intervention. Probably the most threatening infectious disease of the upper respiratory system is epiglottitis, inflammation of the epiglottis. Epiglottitis is a rapidly developing disease that can result in death within a few hours. The Hib vaccine, although directed primarily at meningitis (page 610), 678 Part Four Microorganisms and Human Disease has significantly reduced the incidence of epiglottitis in the vaccinated population. This gram-positive bacterial group consists solely of Streptococcus pyogenes, the same bacterium responsible for many skin and soft tissue infections, such as impetigo, erysipelas, and acute bacterial endocarditis. Frequently, tonsillitis occurs, and the lymph nodes in the neck become enlarged and tender. They are also able to produce special enzymes, called streptokinases, which lyse fibrin clots, and streptolysins, which are cytotoxic to tissue cells, red blood cells, and protective leukocytes. At one time, the diagnosis of pharyngitis was based on culturing bacteria from a throat swab. Currently, there is a wide range of rapid tests commercially available to evaluate cases of pharyngitis, which reflects the fact that millions of patients seek care for it every year. Actually, the majority of patients seen for sore throats do not have a streptococcal infection. Some cases are caused by other bacteria, but many are caused by viruses-for which antibiotic therapy is ineffective. In areas where acute rheumatic fever occurs the recommendation is to use both bacterial culture and rapid tests. Pharyngitis is now most commonly transmitted by respiratory secretions, but epidemics of streptococcal pharyngitis spread by unpasteurized milk were once frequent. Scarlet Fever When the Streptococcus pyogenes strain causing streptococcal pharyngitis produces an erythrogenic (reddening) toxin, the resulting infection is called scarlet fever. Recall that this means the genetic information of a bacteriophage (bacterial virus) has been incorporated into the chromosome of the bacterium, so the characteristics of the bacterium have been altered.

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Unexpectedly erectile dysfunction pump prescription purchase 100 mg aurogra overnight delivery, once the contamination was corrected it was found that the purified vaccine was often less effective how to get erectile dysfunction pills buy discount aurogra on-line. This led to experiments designed to determine whether chemical additives could improve effectiveness. An imaginative assortment of substances (some as bizarre as tapioca) were tried for this purpose. This led to the chance discovery that certain aluminum salts improved vaccine effectiveness. Generally grouped under the term alum, these aluminum salts, called adjuvants, are combined with many vaccines. At this time, alum is the only adjuvant approved for use in humans in the United States. The exact mechanism by which adjuvants work is not known in all detail, but they are known to improve the innate immune response, especially activation of Toll-like receptors. Further investigation identifies seven other pertussis cases in health care workers (a respiratory therapist, a radiologic technician, and five student nurses), all of whom work in the emergency department but not in pediatrics. Nevertheless, vaccines still remain the safest and most effective means of preventing infectious disease in children. In 1999, a vaccine to prevent infant diarrhea caused by rotaviruses was withdrawn from the market because several recipients developed a life-threatening intestinal obstruction. However, public reaction to such risks has changed; most parents have never seen a case of polio or measles and therefore tend to view the risk of a vaccine side effect as more worrisome than the risk of the disease itself. Moreover, reports or rumors of harmful effects often lead people to avoid certain vaccines for themselves or their children. The journal that first published the study that ignited this controversy later retracted it, and the chief scientist who conducted the research later lost his medical license under accusations of fraud. But because autism is a poorly understood developmental condition that is usually diagnosed at the age of 18 to 30 months, about the time immunization schedules are nearing completion, some people have attempted to make a cause-and-effect connection. Medically, however, most experts agree that autism is a condition with a major genetic component and begins before birth. Extensive scientific surveys have provided no evidence to support a connection between the usual childhood vaccines and autism or any other disease condition. Some experts even recommend again introducing the rotavirus vaccine that was withdrawn in the United States, maintaining that it would be well justified on a risk-versus-benefit calculation in much of the underdeveloped world. The writings of ancient and medieval physicians left descriptions of many diseases that are recognizable even today. Sensitivity is the probability that the test is reactive if the specimen is a true positive. Specificity is the probability that a positive test will not be reactive if a specimen is a true negative. Immunologic-based diagnostic tests Knowledge of the high specificity of the immune system soon suggested that this might be used in diagnosing diseases. In fact, it was an accidental observation that led to one of the first diagnostic tests for an infectious disease. More than 100 years ago, Robert Koch was trying to develop a vaccine against tuberculosis. He observed that when guinea pigs with the disease were injected with a suspension of Mycobacterium tuberculosis, the site of the injection became red and slightly swollen a day or two later. Koch, of course, had no idea of the mechanism Chapter 18 Practical Applications of Immunology 501 of cell-mediated immunity that caused this phenomenon, nor did he know of the existence of antibodies. Immunology has given us many other invaluable diagnostic tools, most of which are based on interactions of humoral antibodies with antigens. A known antibody can be used to identify an unknown pathogen (antigen) by its reaction with it. One problem that must be overcome in antibody-based diagnostic tests is that antibodies cannot be seen directly. Other problems that had to be overcome were that antibodies produced in an animal were mixed with numerous other antibodies produced in that animal and the quantities of any particular antibody were severely limited. Unfortunately, a B cell reproduces only a few times under the usual cell culture conditions.

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These media contain ingredients erectile dysfunction treatment yoga cheap aurogra 100 mg mastercard, such as sodium thioglycolate erectile dysfunction sample pills aurogra 100 mg on-line, that chemically combine with dissolved oxygen and deplete the oxygen in the culture medium. To routinely grow and maintain pure cultures of obligate anaerobes, microbiologists use reducing media stored in ordinary, tightly capped test tubes. When water is mixed with the chemical packet containing sodium bicarbonate and sodium borohydride, hydrogen and carbon dioxide are generated. Reacting on the surface of a palladium catalyst in a screened reaction chamber, which may also be incorporated into the chemical packet, the hydrogen and atmospheric oxygen in the jar combine to form water. Also in the jar is an anaerobic indicator containing methylene blue, which is blue when oxidized and turns colorless when the oxygen is removed (as shown here). Materials are introduced through the small doors in the air-lock chamber at the left. Q In what way would an anaerobic chamber resemble the Space Laboratory orbiting in the vacuum of space Mycobacterium leprae, the leprosy bacillus, is now usually grown in armadillos, which have a relatively low body temperature that matches the requirements of the microbe. Another example is the syphilis spirochete, although certain nonpathogenic strains of this microbe have been grown on laboratory media. With few exceptions, the obligate intracellular bacteria, such as the rickettsias and the chlamydias, do not grow on artificial media. Cultures are placed in a large sealed jar containing a lighted candle, which consumes oxygen. The candle stops burning when the air in the jar has a lowered concentration of oxygen (at about 17% O2, still adequate for the growth of aerobic bacteria). Candle jars are still used occasionally, but more often commercially available chemical packets are used to generate carbon dioxide atmospheres in containers. When only one or two Petri plates of cultures are to be incubated, clinical laboratory investigators often use small plastic bags with self-contained chemical gas generators that are activated by crushing the packet or moistening it with a few milliliters of water. These packets are sometimes specially designed to provide precise concentrations of carbon dioxide (usually higher than can be obtained in candle jars) and oxygen for culturing organisms such as the microaerophilic Campylobacter bacteria (page 302). The lab is a sealed environment within a larger building and has an atmosphere under negative pressure, so that aerosols containing pathogens will not escape. The laboratory itself should be negatively pressurized and equipped with air filters to prevent release of the pathogen from the laboratory. Selective media are designed to suppress the growth of unwanted bacteria and encourage the growth of the desired microbes. For example, bismuth sulfite agar is one medium used to isolate the typhoid bacterium, the gram-negative Salmonella typhi (T-f), from feces. Bismuth sulfite inhibits gram-positive bacteria and most gram-negative intestinal bacteria (other than S. Differential media make it easier to distinguish colonies of the desired organism from other colonies growing on the same plate. Similarly, pure cultures of microorganisms have Chapter 6 Microbial Growth 161 Enrichment Culture Because bacteria present in small numbers can be missed, especially if other bacteria are present in much larger numbers, it is sometimes necessary to use an enrichment culture. The medium (enrichment medium) for an enrichment culture is usually liquid and provides nutrients and environmental conditions that favor the growth of a particular microbe but not others. In this sense, it is also a selective medium, but it is designed to increase very small numbers of the desired type of organism to detectable levels. Suppose we want to isolate from a soil sample a microbe that can grow on phenol and is present in much smaller numbers than other species. If the soil sample is placed in a liquid enrichment medium in which phenol is the only source of carbon and energy, microbes unable to metabolize phenol will not grow. The culture medium is allowed to incubate for a few days, and then a small amount of it is transferred into another flask of the same medium. After a series of such transfers, the surviving population will consist of bacteria capable of metabolizing phenol. The bacteria are given time to grow in the medium between transfers; this is the enrichment stage. When the last dilution is streaked onto a solid medium of the same composition, only those colonies of organisms capable of using phenol should grow. A remarkable aspect of this particular technique is that phenol is normally lethal to most bacteria. Air pressure in the suit is higher than the atmosphere, preventing microbes from entering the suit.

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The characteristics of the various forms of viral hepatitis are summarized in Diseases in Focus 25 erectile dysfunction and diabetes ppt generic 100 mg aurogra free shipping. Viremia eventually occurs medicare approved erectile dysfunction pump buy aurogra 100 mg overnight delivery, and the virus spreads to the liver, kidneys, and spleen. The amount of virus excreted is greatest before symptoms appear and then declines rapidly. Therefore, a food handler responsible for spreading the virus might not appear to be ill at the time. The virus can probably survive for several days on such surfaces as cutting boards. Mollusks, such as oysters, that live in contaminated waters are also a source of infection. In clinical cases, the initial symptoms are anorexia (loss of appetite), malaise, nausea, diarrhea, abdominal discomfort, fever, and chills. These symptoms are more likely to appear in adults; they last 2 to 21 days, and the mortality rate is low. In some cases, there is also jaundice (signs are yellowing of the skin and the whites of the eyes) and the dark urine typical of liver infections. There is no chronic form of hepatitis A, and the virus is usually shed only during the acute stage of disease. The incubation time averages 4 weeks and ranges from 2 to 6 weeks, making epidemiological studies for the source of infections difficult. The 30,000 or more cases reported in the United States each year represent only a fraction of the actual number. Two weeks before the first patient became ill, the family had purchased a small (<10 cm) red-eared slider turtle at a flea market. Disease Staphylococcal Food Poisoning Shigellosis (bacillary dysentery) Salmonellosis Pathogen Staphylococcus aureus Shigella spp. No specific treatment for the disease exists, but people at risk of exposure or who have been exposed to hepatitis A can be given immune globulin, which provides protection for several months. There are also smaller spherical particles, about half the size of a complete virion, and filamentous particles, which are tubular particles similar in diameter to the spherical particles but about ten times as long. The spherical and filamentous particles are unassembled components of the virion without nucleic acids; assembly is evidently not very efficient, and large numbers of these unassembled components accumulate. Health care workers and others who are in daily contact with blood have a considerably higher incidence of hepatitis B than members of the general population. Federal regulations require that employees exposed to blood be offered free vaccinations by their employers. There have also been instances of transmission to patients by surgeons and dentists. Intravenous drug users often share syringes and needles and fail to sterilize them properly; as a consequence, they also have a high incidence of hepatitis B. Transmission by semen donated for artificial insemination has been documented, and semen has been implicated in transmission between heterosexuals with multiple partners and in male homosexuals. Chronic hepatitis may be asymptomatic, or there may be evidence of liver disease (including cirrhosis or liver cancer). Hepatitis can be caused by a variety of viruses, alcohol, or drugs; however, it is most often caused by one of the following viruses. Use the table below to determine which virus is the most likely cause of this infection: After eating at one restaurant, 355 people are diagnosed with the same hepatitis virus. Most of these carriers are Asians and Africans, with a considerable proportion from Mediterranean countries. Many chronic carriers eventually die of liver cancer or cirrhosis (hardening and degeneration; see photo at the top of this page) of the liver.