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Morphology Similarly to the viruses that infect animals order ketoconazole cream 15 gm without a prescription, bacteriophages vary widely in ap- pearance order 15gm ketoconazole cream amex. Right: phage shell Tail (contractile) after injection of the 3 Tail fibers genome with phage head empty and tail sheath con- a Base plate with tail pins tracted. The proteins form the head, tail, and other morphological elements, the function of which is to protect the phage genome. This element bears the genetic information, the structural genes for the structural proteins as well as for other proteins (enzymes) re- quired to produce new phage particles. Attachment to cell surface involving specific interactions be- tween a phage protein at the end of the tail and a bacterial receptor. Lysis occurs by a phage-encoded murein hydrolase, which gains access to the murein through membrane channels 3 formed by the phage-en- coded protein holin. Enzymatic penetration of the wall by the tail tube tip and injection of the nucleic acid through the tail tube. Beginning with synthesis of early proteins (zero to two minutes after injection), e. Then follows transcription of the late genes that code for the structural proteins of the head and tail. The new phage particles are assembled in a maturation process toward the end of the reproduction cycle. This step usually follows the lysis of the host cell with the help of murein hydrolase coded bya phage gene that destroys the cell wall (Fig. Depending on the phage species and milieu conditions, a phage reproduction cycle takes from 20 to 60 minutes. This is called the latency period, and can be considered as analogous to the generation time of bacteria. Depending on the phage species, an infected cell releases from 20 to several hundred new phages, which number defines the burst size. In view of this fact, one might wonder how any bacteria have survived in nature at all. It is important not to forget that cell population density is a major factor determining the probability of finding a host cell in the first place and that such densities are relatively small in nature. Another aspect is that only a small proportion of phages reproduce solely by means of these lytic or vegetative processes. Following injection of the phage genome, it is integrated into the chromosome by means of region-spe- cific recombination employing an integrase. Cells carrying a prophage are called lysogenic because they contain the genetic information for lysis. It prevents immediate host cell lysis, but also ensures that the phage genome replicates concurrently with host cell reproduction. Lysogenic conversion is when the phage genome lysogenizing a cell bears a gene (or several genes) that codes for bacterial rather than viral processes. Genes localized on phage genomes include the gene for diphtheria toxin, the gene for the pyrogenic toxins of group A streptococci and the cholera toxin gene. Ad- ministration of suitable phage mixtures in therapy and prevention of gastrointestinal infections. Recognition of the bacterial strain responsible for an epidemic, making it possible to follow up the chain of infection and identify the infection sources. The Principles of Antibiotic Therapy 187 The Principles of Antibiotic Therapy & Specific antibacterial therapy refers to treatment of infections with anti- infective agents directed against the infecting pathogen. The most important group of anti-infective agents are the antibiotics, which are products of fungi and bacteria (Streptomycetes). Anti-infective agents are categorized as having a broad, narrow, or medium spectrum of action. The efficacy, or effectiveness, of a substance refers to its bactericidal or bacteriostatic effect. Under the influence of sulfonamides and trimethoprim, bacteria do not synthesize sufficient amounts of tetrahydrofolic acid. Due to their genetic variability, bacteria may devel- op resistance to specific anti-infective agents. The most important resistance mechanisms are: inactivating enzymes, resistant target molecules, reduced influx, increased efflux. Resistant strains (problematic bacteria) occur fre- quently among hospital flora, mainly Enterobacteriaceae, pseudomonads, staphylococci, and enterococci. The disk test is a semiquantitative test used to classify the test bacteria as resistant or susceptible. In combination therapies it must be remembered that the interactions of two or more antibiotics can give rise to an antagonistic effect.

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Lecithinase and catalase Microbiology/Select methods/Reagents/Media/Bacteria/ Identification/2 β Hemolysis Motility Oxidase Catalase Lecithinase Glucose B 15 gm ketoconazole cream amex. Which is the specimen of choice for proof of food Answers to Questions 3–6 poisoning by Bacillus cereus? Penicillin (10-unit) susceptibility test performed in a biological safety hood 15gm ketoconazole cream fast delivery, and personnel B. Which of the following tests should be performed appears on the Gram stain smear as gram-positive for initial differentiation of Listeria monocytogenes short, thin, diphtheroidal shapes, whereas from group B streptococci? Culture of a finger wound specimen from a meat streptococci packer produced short gram-positive bacilli on a blood agar plate with no hemolysis. Colonies Motility (wet prep) = Neg growing on blood agar are small and transparent, Motility (media) = Neg (bottle-brush growth in stab may be either smooth or rough, and are often culture) surrounded by a green tinge. Bacillus subtilis Microbiology/Evaluate laboratory data to make identifications/Bacteria/3 7. A non–spore-forming, slender gram-positive rod Answers to Questions 7–11 forming palisades and chains was recovered from a vaginal culture and grew well on tomato juice agar. D Corynebacterium species recovered from a throat Microbiology/Evaluate laboratory data to make culture are usually considered part of the normal identifications/Bacteria/2 throat flora. In this event, direct inoculation on Loeffler culture is considered a pathogen when it produces: serum medium or tellurite medium and the following A. A pseudomembrane of the oropharynx biochemical tests should be performed to confirm B. Gray-black colonies with a brown halo on Tinsdale’s agar Gelatin hydrolysis = Neg Catalase = + D. D A Gram stain smear from a vaginal secretion showing can be made using which of the following many squamous epithelial cells loaded with findings? A gram-positive branching filamentous organism Kinyoun stain and 1% sulfuric acid as the decolorizing recovered from a sputum specimen was found to agent. The other organisms listed are negative for be positive with a modified acid-fast stain method. Darkfield microscopy for direct identifications/Bacteria/2 visualization or indirect immunofluorescence using 11. Routine laboratory testing for Treponema fluorescein-conjugated antihuman globulin (the pallidum involves: fluorescent treponemal antibody-absorption test, A. Gram staining including chemiluminescence and point-of-care Microbiology/Select methods/Reagents/Media/ immunochromatography. Spirochetes often detected in the hematology Answers to Questions 12–17 laboratory, even before the physician suspects the infection, are: 12. D Lyme disease may result in acute arthritis and Microbiology/Apply knowledge of fundamental meningitis and is caused by B. This biological characteristics/Spirochetes/1 spirochete is carried by the deer tick belonging to the Ixodes genus (I. Which of the following organisms is the cause of North-central United States and I. A Serological analysis using immunofluorescence or Microbiology/Apply knowledge of fundamental an enzyme immunoassay is the method of choice biological characteristics/Spirochetes/1 for diagnosis of Lyme disease. Te diagnostic method most commonly used for be cultured directly from lesions, and darkfield the identification of Lyme disease is: microscopy can be used for detection of spirochetes A. Primary atypical pneumonia is caused by: from the upper and lower respiratory tracts onto A. Which organism typically produces “fried-egg” is grown on “M” agar containing arginine and colonies on agar within 1–5 days of culture from a phenol red. Treponema pallidum Colonies of Ureaplasma are small and golden brown on A7/A8 agar. Te manganous chloride–urea test is used for the utilizes manganous chloride (MnCl2) in the presence identification of which organism? Borrelia burgdorferi is observed under a dissecting microscope and is a Microbiology/Select methods/Reagents/Media/ rapid test for the identification of U. A gram-positive (gram-variable), beaded organism Answers to Questions 18–22 with delicate branching was recovered from the sputum of a 20-year-old patient with leukemia. D All of the listed organisms produce mycelium (aerial Te specimen produced orange, glabrous, waxy or substrate), causing them to appear branched colonies on Middlebrook’s agar that showed when Gram stained, but only the Nocardia spp. What is the most likely opportunistic pathogen, and cultures typically have a identification? A The “whiff” test is used for a presumptive diagnosis stained with Loeffler methylene blue stain showed of an infection with G. Culture using McCoy and Hela cells produce antibodies especially in extra respiratory D. Which test is the most reliable for the detection of to produce an IgM response especially in recurrent Mycoplasma pneumonia in serum and for the infections, so the best confirmatory approach is a confirmation of diagnosis? Complement fixation Microbiology/Select test/Identification/Mycoplasma/2 432 Chapter 7 | Microbiology 23. Identify the following bacterium and specimen Answers to Questions 23–25 pairing that is mismatched (specimen not appropriate for isolation).

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This usually occurs in a metaphyseal region of the bone and has the appearance of a minimally angulated fracture with a buckling of one cortex ketoconazole cream 15 gm with mastercard. In high-energy injuries buy ketoconazole cream 15gm fast delivery, the bone may compress at one side and fail in tension on the other cortex, leading to a greenstick fracture, in which the bone appears bent, as would occur when trying to break a live branch from a tree. Another important aspect of pediatric fractures is the involvement of the growth plate. The Salter-Harris classification describes the injury through the growth plate of long bones (Fig. In a Salter- Harris type I fracture, the injury occurs through the growth plate without radiographic evidence of damage to the metaphyseal or epi- physeal bone. They involve compression of the growth plate with no obvious fractures in the metaphyseal or epiphyseal region. Type V injuries also carry an increased risk of growth disturbance, although it is diffi- cult to change the clinical outcome. Musculoskeletal Injuries 601 Common Musculoskeletal Injuries by Body Region Shoulder The skeletal anatomy of the shoulder consists of the humerus, the scapula, and the clavicle. The lone skeletal connection of the upper extremity to the axial skeleton consists of the articulation between the proximal clavicle and the sternum. The scapula articulates with the distal end of the clavicle at the acromioclavicular joint, but the body of the scapula has no true skeletal articulation with the rib cage. The humerus articulates with the scapula at the glenoid, forming the gleno- humeral joint. Although the body of the scapula does not form a true joint with the axial skeleton, it is fastened securely to the chest wall by surrounding musculature. The glenohumeral joint does not have tremendous osseous stability, since the articular surface area of the humeral head is much greater than that of the glenoid, yet, the radius of curvatures of both articular surfaces is identical. The external musculature of the shoulder certainly is prone to muscle strain injury. Since the external muscles, such as the deltoid, pectoralis major, trapezius, and latissimus dorsi, are used to position the arm in space, injuries from lifting heavy objects and protecting oneself from a fall are quite common. A tendon injury that commonly occurs around the shoulder is a rupture of the proximal biceps tendon. The biceps muscle actually has two origins, one from the superior aspect of the glenoid and one from the coracoid process. Rupture of the long head, the tendon that attaches to the superior glenoid tuber- cle, is common in the older population. This usually occurs with routine daily activities and generally is the result of attritional tearing of the biceps tendon. There is essen- tially no effect on elbow supination strength, and elbow flexion strength also is maintained by the brachialis muscle. Rupture of the biceps proximally usually is indicative of preexisting rotator cuff pathology. The rotator cuff is formed by four muscles: the supraspinatus, the infraspinatus, the subscapularis, and the teres minor. These four muscles form a conjoined tendinous cuff that attaches to the proximal humerus. Rotator cuff muscles take their origin from the scapula and essentially pull the humeral head into the glenoid. Rotator cuff strains can occur as a result of lifting relatively light as well as heavy objects. Repetitive use of the upper extremity also can lead to inflammation of the rotator cuff. In these cases, patients will note pain with forward elevation or abduction of the upper arm. Most strains and tendinopa- thy resolve with antiinflammatories and rehabilitative exercises. In some cases, the rotator cuff can tear away from the attachment on the proximal humerus. In these cases, patients notice pain and weak- ness with forward elevation and abduction of the shoulder. Small tears of the rotator cuff can be managed conservatively, using nonsteroidal antiinflammatory drugs and rehabilitative exercises. The usual treatment involves removal of the anterior portion of the acromion, release of the coracoacromial ligament, and repair of the torn rotator cuff to its humeral attachment. As stated earlier, the glenohumeral joint does not have tremendous osseous stability.

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