4/8/2019 Chapter 23 Homework

Chapter 23 Homework
Due: 1:59pm on Wednesday, April 17, 2019
You will receive no credit for items you complete after the assignment is due. Grading Policy

A Perfect Storm: Overcrowding, Poor Sanitation, and Vibrio cholerae

In January 2010, a devastating earthquake struck Haiti about 15 miles west of the capital city of Port-au-Prince. The earthquake killed over 200,000 people and displaced over 1 million
from their homes. Many of these people had nowhere to go other than displacement camps and shantytowns, where the sanitary conditions were less than ideal. It was not only private
homes that were destroyed; hospitals, communication networks, land and air transport, and other important infrastructure were damaged.In October 2010, a cholera epidemic was
reported in the Artibonite Department (Haitian departments are analogous to states). This was the first cholera epidemic in Haiti in over a century. Within 10 weeks, cholera had spread
to all Haitian departments. By the end of the epidemic, more than 470,000 cases had been reported, and more than 6500 people were dead.Both during and after the epidemic,
epidemiologists, doctors, and scientists were working to determine the source of the outbreak and its transmission patterns, identify the causative strains, and care for the infected.

Part A
The ability of Vibrio cholerae to cause disease depends on a number of factors. Which of the following are general requirements for any organism to cause disease within a host?

Select all that apply.

Hint 1. Establishing and infection and disease

For the pathogen to infect and cause disease in the host, several key interactions must occur. These include entry and exit, avoiding the host immune response, and
causing damage to host cells.

ANSWER:

evasion of host defenses

production of exotoxins

direct damage of host tissues

depleting the host of nutrients at the site of infection

gaining access to the host via a portal of entry

adherence to host tissues

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Correct

For an organism to establish an infection, it needs to gain entry to the host. Once inside a host, the organism will need to adhere to host tissues in order to invade cells
and/or cause infection. Remember that from the moment that the bacteria enter the body, the immune system will be fighting them; therefore, bacteria need some
mechanisms to help them evade this response so they are not eliminated. Disease also requires that the pathogen damage the host tissues, either directly (e.g., by lysing
the cell) or indirectly (e.g., by producing toxins that circulate throughout the body).

Gaining entry to the host is just part of the story. The number of organisms that enter the host is significant; enough bacteria must survive in order to establish the infection and cause
disease. One measure of virulence is the ID50 value. It is important to note that this value is determined experimentally and can vary for each pathogen under different conditions.

Part B

Some studies have indicated that the ID50 for Vibrio cholerae can be as high as 108 organisms. Which of the following most likely explains the requirement for this relatively high
ID50?

Hint 1. High versus low ID50

The ID50 (the dose required to cause infection in 50% of the sample population) can vary significantly among organisms. For most organisms, the ID50 is directly related to
its virulence. For example, a highly virulent organism typically has a low ID50; few organisms are required to cause infection. What are some possible reasons why an
organism would have a high ID50?

ANSWER:

To establish infection, V. cholerae must survive the host immune response and the acidic environment of the stomach.

V. cholerae does not produce enough virulence factors to overcome the host response and cause disease.

Because the major virulence factor of V. cholerae is cholera toxin, large numbers of bacteria are required to produce enough toxin to cause disease.

Because V. cholerae cells are relatively small compared to host cells, thousands of bacteria must infect each cell to cause disease.

Correct
The acidic environment of the stomach is extremely harsh on V. cholerae, and the microbe doesn’t possess particular virulence factors to help it combat this environment.
Therefore, the high infective dose is needed to ensure that enough bacteria make it through the acidic environment and into the intestine, where the pH is much higher
than that of the stomach. Once in the intestine, V. cholerae is able to begin to establish infection.

One of the virulence factors responsible for disease caused by V. cholerae is cholera toxin. This is an exotoxin produced by V. cholerae under specific environmental conditions found in
the intestine.

Part C
Which of the following are properties of exotoxins?

Select all that apply.

Hint 1. Exotoxins versus endotoxins

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Although both endotoxins and exotoxins can have significant impact on eukaryotic cells during infection, they differ significantly in their chemical composition, targets,
stability, and toxicity.

ANSWER:

Exotoxins are produced primarily by gram-negative bacteria.

Exotoxins are extremely heat stable.

Exotoxins are released from the cell during death or replication.

Exotoxins target specific cellular structures or molecules.

Exotoxins are protein molecules.

Very small amounts of exotoxin can be lethal.

Correct
Cholera toxin attaches to G proteins within host cells. This results in a disruption of signaling pathways in the host cell and, ultimately, in an electrolyte imbalance within
the intestine. Water rushes out of cells and into the lumen of the intestine, causing the profuse, watery diarrhea that is associated with cholera.

Part D
Cholera toxin is an A-B toxin; A-B toxins exert their effects after entering host cells. Label the following figure to indicate the sequence of events leading to the activity of A-B toxins
such as cholera toxin.

Drag the following statements onto the figure to label the events in the correct order of events leading to the activity of cholera toxin.

Hint 1. Cholera toxin mechanism of action

After interacting with a receptor on a host cell, cholera toxin enters the cell. Once inside, the A subunit activates adenylate cyclase, which elevates cAMP levels. This

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ultimately leads to a loss of electrolytes from the cell. Water follows the electrolytes, contributing to the profuse, watery diarrhea associated with cholera.

ANSWER:

Reset Help

Cholera toxin A subunit

Cholera toxin B subunit

B subunit mediates
binding to host cell via
interaction with specific
cell receptor

A-B toxin enters host

cell via endocytosis

A and B subunits
separate

B subunit leaves the

cell
A subunit alters host
cell function

Correct

Part E
The physical symptoms of cholera present only after a specific series of events has taken place. What is the most likely sequence of events in the pathogenesis of V. cholerae?
Place the following statements in the order that best reflects the chronology of events during V. cholerae infection.

Hint 1. Events in pathogenesis

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Disease pathology results from a multifactorial, multistep process involving interplay between an invading pathogen and the eukaryotic host.

ANSWER:

Reset Help

V. cholerae survives The host intestinal cells

V. cholerae is ingested passage through the V. cholerae attaches via V. cholerae produces are destroyed, resulting V. cholerae exits the
via contaminated water. stomach and enters the pili. cholera toxin. in a profuse, watery host via the feces.
intestine. diarrhea.

Correct
You might reasonably think that elimination from the body in feces would not confer an advantage for the bacteria. However, this is quite advantageous for V. cholerae
because it enables the pathogen to go on to infect another host. V. cholerae can also survive as an environmental organism, so it will be able to survive even if it is not
immediately introduced into another host.

Part F
Although cholera can be treated with antibiotics, data suggest that antibiotic treatment alone is NOT the most effective therapy. Which of the following statements describes the
most likely reason for supplementing antibiotic therapy?

Hint 1. The function of antibiotics

Antibiotics are designed to target specific bacterial structures or functions. In doing so, antibiotic therapy can significantly inhibit growth of the bacterial invader, allowing the
immune system to eliminate the pathogen.

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ANSWER:

The production of cholera toxin helps V. cholerae resist antibiotic treatment.

Antibiotic therapy addresses only the growth of V. cholerae; it doesn’t address the extreme dehydration suffered by a person infected with V. cholerae.

Because V. cholerae is a gram-negative organism, it is not very effectively treated with antibiotics.

As with V. cholerae, the acidic environment of the stomach can have a negative impact on antibiotic activity.

Correct
Antibiotics (particularly doxycycline) are commonly included in the treatment of cholera. However, rehydration therapy is considered more essential in the effective
treatment of the disease. Rehydration therapy will replace the lost fluids and electrolytes that were lost with the watery diarrhea. This diarrhea is so profuse that patients
can lose up to 20 liters of fluid a day! This extreme loss of fluid and electrolytes often has severe consequences, such as shock and death. However, with prompt
rehydration treatment, patients can fully recover, even in areas of the world where the disease is endemic.

Part G
Disease research and epidemiology bring together many different facets to help us better understand disease pathology and spread. Which of the following statements are true?
Select all that apply.

Hint 1. Important concepts in host/microbe interactions

Understanding the complex interactions between microbe and host requires an understanding of basic concepts, including the following:

Infection: the successful invasion of the body by a pathogenic organism

Pathogenicity: the ability of an organism to cause disease
Virulence factors: molecules produced by the pathogen that impact its ability to cause disease

ANSWER:

Bacterial exotoxins can be altered to create toxoids, which can be used to produce protective immunity in a host.

The terms pathogenicity and virulence can be used interchangeably to describe the severity of an infection.

Intoxications result from a bacterial infection in which a large amount of bacterial toxin is produced.

Some pathogens are able to cause disease within a host without penetrating the body.

The ID50 value refers to the number of microbes needed to cause half of an infected population to die.

The interactions that occur between a microbe and host influence the evolution of both.

Correct

The Case of the Hidden Souvenir

Michael was excited when his boss sent him to work on a 6-month project with the Vice President of International Affairs at their corporation in Beijing, China. Before leaving the United
States, he visited his family doctor for a complete physical and to receive his immunizations. The physician reviewed Michael’s medical history and current lab results and declared that
he was a healthy 32-year-old. Michael adjusted well to the move and made many new friends. They would often get together on the weekends to go swimming at a nearby lake, to play
volleyball at the local park, or to watch movies and cook dinner. He quickly found that his favorite meal was a stir-fry containing a mixture of pork, fresh raw vegetables, and noodles. He
would eat this combination of foods three to four times a week.

To his surprise, within 3 months of moving to China, Michael started losing weight. He was not trying to lose weight and when asked about his diet, Michael would say that he ate all the
time. At first, he thought the weight loss was just a result of his metabolism adjusting to his new Asian diet and was not a cause for concern. However, after 2 months of continuous
weight loss, the non-stop eating was replaced by nausea and slight abdominal pain. At this time, Michael began to think something might be wrong.

Michael scheduled an appointment with Dr. Clark at the local medical center. During his appointment, the two of them discussed where Michael had traveled since he had been in
China, the types of foods he had eaten, the specifics of his exercise regimen, and his extracurricular activities. They also discussed the lack of symptoms other than the weight loss and
recent bouts of nausea. After talking with Michael, Dr. Clark requested that multiple stool specimen be sent to the laboratory for examination. He also ordered serological testing of
Michael’s blood to determine his antibody titer levels. He was concerned that Michael may have an intestinal parasite infection, even though many are asymptomatic.

Part A
Why does Dr. Clark request stool samples for examination?

Select all that apply.

Hint 1. The human host’s involvement in the life cycle of an intestinal parasite
Humans are the definitive host for tapeworm infections. Adult worms live and reproduce in the gastrointestinal tract of the human host. Eggs are produced and released from
the human and can contaminate food that is eaten by the intermediate host (i.e. cattle, pigs, deer, etc…). Inside the intermediate host larvae hatch from the eggs and
migrate from the intestinal tract to other host tissues where they are encysted as cysticerci. Humans are then infected when they ingest items contaminated with the cysts,
which then become adults in the intestinal tract and complete the cycle.

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ANSWER:

He will have the laboratory prepare the samples for an ova and parasite (O&P) exam. Fresh or preserved stool samples can be observed microscopically for the
presence of parasites or their eggs/cysts.

Dr. Clark is hoping to find whole adult parasitic worms in Michael’s fecal matter.

Tapeworms are pathogens of the gastrointestinal tract; as a natural progression of digestion some of the tapeworm pieces will be expelled along with fecal matter.

The stool sample will tell Dr. Clark more information about the vegetables in Michael’s diet.

Correct
Investigation of stool samples is an important diagnostic tool for physicians and other medical personnel. The stool is prepared in such a way that any parasite eggs or
proglottids remain in the sample. After processing, the sample is placed on a microscope slide for observation. Staining can be performed, but is not always necessary.
Morphological examination of any specimen found in the stool will help with identification.

Preliminary laboratory results rule out bacterial, viral, and protozoan infections and indicate that Michael is most likely infected with a helminthic parasite.

Part B
Which of the following represents the MOST LIKELY route of transmission for Michael’s infection?

Hint 1. Types of transmission

Pathogens can be transmitted through the following means:

1. Contact – direct, indirect, or droplet

2. Vehicle – airborne, waterborne, fecal-oral, foodborne, or body fluids
3. Vector – biological or mechanical

ANSWER:

Airborne - Inhalation of parasitic eggs in the air

Foodborne - Eating undercooked, unwashed, or otherwise contaminated food that contained parasitic propagules

Waterborne - Swimming in a freshwater lake with his friends while he was in China

Vectorborne – Bitten by a mosquito carrying parasitic larvae

Correct
Correct! The most likely mode of transmission in Michael’s case was through the undercooked pork that he ate in his stir-fry. Humans are a definitive host for the pork
tapeworm and are infected when they ingest larval cysts embedded in the muscle tissue of the pig. This transmission cycle is common in Africa, Asia, and Latin America.
Interestingly, pigs in the United States are virtually parasite-free, and pork tapeworm infections are transmitted person-to-person via the fecal-oral route. Eggs from
infected people with poor hygiene can be ingested by others, which allows the life cycle to continue without the pigs as an intermediate host.

Part C
Which of the following organisms is most likely the causative agent of Michael’s tapeworm infection?

Hint 1. Differentiating between roundworms and tapeworms

Roundworms such as Ascaris and Enterobius are transmitted person-to-person. Tapeworms in the genus Taenia are transmitted via contaminated beef and pork.

ANSWER:

Ascaris lumbricoides

Taenia saginata

Taenia solium

Enterobius vermicularis

Correct
Correct! T. solium is the tapeworm associated with eating undercooked pork. Eggs and proglottids from the adult tapeworm are released in the intestines and can be
observed in fecal samples with a light microscope. Diagnosis is based on these findings.

Microscopic analysis of Michael’s stool sample confirmed the presence of tapeworm eggs and proglottids in the genus, Taenia. Image A is the microscopic view of tapeworm eggs from
a fecal sample. Image B is the microscopic view of a proglottid from a fecal sample. Dr. Clark informed Michael that given his diet history, he is most likely infected with the pork

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tapeworm, T. solium. A related species, T. saginata, is associated with eating raw beef and its scolex differs from that of T. solium. Image C is T. solium, the pork tapeworm. Notice how
T. solium has a row of hooks. These structures are not found in T. saginata. Image D is Enterobius vermicularis, a roundworm.

Part D
Compare the anatomy of the tapeworm (Image C) to the anatomy of the roundworm (Image D). Given that both are parasitic worms, which of the following reasons best explains
why the tapeworm is flat?

Hint 1. Surface-area-to-volume ratio

The surface-area-to-volume ratio is a measure of the amount of surface area per unit volume of an object. In a biological context, an organism with a larger ratio (i.e. a thin,
flat surface) has more area in contact with the environment, and a relatively small volume. Diffusion works best over small distances, thus thin and flat organisms can utilize
diffusion more efficiently than organisms with a smaller surface-area-to-volume ratio. Tapeworms have a large surface-area-to-volume ratio in part because they live in a
nutritionally rich environment (in this case, a human’s intestine) where they can absorb all the food they need!

ANSWER:

Tapeworms utilize diffusion to absorb nutrients from the host’s digestive system.

The shape of the tapeworm is constrained to fit in small spaces, such as the intestinal tract.

Tapeworms have a complex and differentiated digestive system.

Tapeworms are hermaphroditic, and need to accommodate both male and female gonads.

Correct
Correct! The tapeworm’s high surface-area-to-volume ratio is an adaptation to utilize diffusion in the nutrient-rich environment of the host’s intestine. These worms lack
digestive structures and must rely on the host to completely digest food before it is absorbed by the worm via its outer layer called a cuticle. Roundworms have a more
complex digestive system and are capable of digesting food that has only been partially digested by the host. This decreases the need for a high surface-area-to-volume
ratio because diffusion of nutrients is no longer an issue.

Part E
What is the correct sequence of events for the life cycle of the pork tapeworm, T. solium?

Arrange the following statements in chronological order

Hint 1. Moving between intermediate and definitive hosts for the life cycle
The tapeworm life cycle is complex and involves multiple hosts.

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Adult tapeworms produce eggs that will eventually cause an infection.
Eggs are ingested by the pigs.
Eggs mature into larvae that migrate to other host tissues.
Humans must ingest the larvae to become infected.
The larvae mature into adults in the intestine of the human.

ANSWER:

Reset Help

Inside the
Eggs are produced by Pigs eat grass
Eggs are released to intermediate host, the The definitive host
adult tapeworms contaminated, or
the environment in eggs mature into ingests the larvae and
living in the definitive fertilized, with human
the feces. larvae and encyst in becomes infected.
host. feces.
the hosts muscles.

Correct
Correct! The adult worm produces thousands of eggs in the human host. These eggs leave the digestive tract via the feces. When pigs eat grass contaminated with, or
fertilized by, human feces they become infected with T. solium. The tapeworm eggs mature into larvae that encyst themselves in the muscle tissue of the pig. When
humans eat pork that has not been cooked to high enough temperatures, they become infected with the tapeworm.

Michael’s blood work reveals an increase in eosinophils, which are granular white blood cells, and his IgE antibodies. Along with the microscopic analysis of the stool specimen, these
lab results confirm the diagnosis of a tapeworm infection.

Part F
Why do we see an increase in the levels of IgE antibody in Michael’s serum?

Hint 1. Classes of antibodies

The body produces five classes of antibodies in response to foreign antigens: IgG, IgA, IgM, IgE, and IgD. Each class serves its own function for the immune system. IgG
composes 80% of blood serum; IgA composes 10 to 15%; IgM composes 5 to 10%; IgE composes 0.2%, and IgE composes 0.002 %.

ANSWER:

IgE is the class of antibodies involved in hypersensitivities such as allergies and parasitic infections.

IgE is the class of antibodies found in secretions.

IgE is the most abundant class of antibodies in serum

IgE is the first class of antibodies to appear after exposure to an antigen.

Correct
Correct! IgE is typically found in very low amounts in the blood serum. It increases in response to allergic reactions and parasitic infections. There is also a correlation with
an increase in IgE amounts and the increase of eosinophils in a blood smear. Eosinophils are white blood cells that release peroxide ions to destroy the parasite from the
outside.

Part G
What is the treatment that Dr. Clark will most likely recommend?

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Hint 1. Anti-parasitic drug treatments

Tapeworm infections can be treated in many cases using anti-parasitic drugs that target the worm and cause minimal damage in the host.

ANSWER:

Oral rehydration to replace fluids because tapeworms cause excessive diarrhea which results in dehydration in the host.

Praziquantel or albendazole, drugs that target eukaryotic parasites with minimal side effects in the host.

Surgical removal of the tapeworms in Michael’s intestinal tract.

Dr. Clark will recommend doing nothing because the tapeworm infection is self-limiting and will eventually go away on its own.

Correct
Correct! Praziquantel and albendazole are both anti-helminthic drugs. Praziquantel is effective against tapeworms because it changes the permeability of the cuticle and
blocks nutrient uptake. During this process the drug also uncovers surface antigens that stimulate an immune response. Albendazole is a broad-spectrum anti-helminthic
drug that also blocks nutrient uptake by inhibiting microtubule formation in the cytoplasm. It is used commonly to treat livestock as well.

After treatment, Dr. Clark wanted to monitor Michael’s progress to make sure the tapeworm infection was completely cleared. He also ordered Michael to get a computed tomography
(CT) scan and a magnetic resonance imaging (MRI) scan. These scans confirmed that Michael’s infection was localized to the digestive tract and the tapeworms had not spread beyond
that point.

Part H
Why was Dr. Clark worried about tapeworm infection in other body sites?

Select all that apply.

Hint 1. What happens when humans are the intermediate host?

Tapeworm larvae are integral to the intermediate host. Once they leave the stomach, they migrate to other areas in the body and form cysts.

ANSWER:

When tapeworm larvae escape the stomach, they can travel to other parts of the body such as muscles, the liver, the eye, and even the brain to form cysticerci.

Once ingested, the eggs of T. solium migrate to multiple body sites where they develop into structures called hydatid cysts.

When the eggs are ingested, the larvae hatch and enter the intestinal glands. As the worm grows, it makes its way to the intestinal lumen where it survives for years by
feeding on blood from the host.

The presence of T. solium in the brain can result in neurocysticercosis, a serious condition which has symptoms resembling those of brain tumors or epilepsy.

Correct
Tapeworms in the intestinal tract are usually asymptomatic. Humans are the definitive host and support the growth of adult tapeworms. Pigs are intermediate hosts that
continue the life cycle of T. solium. Occasionally, the human host can become an intermediate host. Larvae escape the stomach and migrate to other tissues in the body.
Once in other tissues, the larvae form cysts called cysticerci. These cysts can cause problems, especially in the eye and in the brain.

Score Summary:
Your score on this assignment is 100%.
You received 2 out of a possible total of 2 points.

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