VIROLOGY/BACTERIOLOGY

REVISION
Dr Jenny Moore
Virology SpR
August 2014
jennifer.moore@nnuh.nhs.uk

Overview
Virology
Bacteriology
Infection Control
Public Health/Epidemiology
Context

Virology
What is a virus?
The smallest of all self replicating organisms 20

300nm
Small segment of nucleic acid encased in a protein

shell, may be enveloped.

No metabolism invade cells
Baltimore classification system
DNA/RNA

Replication cycle
1.

Attachment: The virus attaches to a host cell.

2.

Entry: The virus forms a hole in the membrane or cell wall of the host.
The nucleic acid of the virus enters the host cell.

3.

Synthesis: The virus nucleic acid is used to make new viral nucleic
acid and proteins for the new viruses being produced.

4.

Assembly: New viruses are made inside the host cell.

5.

Release: The host cell bursts to release the new viruses. The bursting
is called lysis.

Transmission
Inhalation
Influenza

Ingestion
Norovirus, Hepatitis A

Inoculation/insect bites
West Nile Virus/Rabies

Transplacentally
Parvovirus, Rubella, CMV

Sexual contact
HIV, Hepatitis B,

Diagnosis of viral infections

Tests

Samples

Skin swab

Clinical assessment
Antigen detection
Serological methods
Immunofluorescence
Molecular methods

Nose/throat swab
BAL
Induced sputum
CSF
Serology samples
EDTA whole blood

Treatment of viral infections

Oseltamivir
Zanamivir
Aciclovir
Tenofovir
NSI/PEP (28 days)
Truvada (Tenofovir + Emtracitabine)
Raltegravir

Viral or Bacterial?
A 19 year old male presented to his GP with his new partner complaining
of a sore throat, tiredness, myalgia and lethargy. On examination the GP
found cervical lymph nodes were enlarged, no diarrhoea or vomiting, low
grade temperature, no other symptoms. The patient was born in the UK,
had not travelled abroad but recently arrived in the area to start university.
The GP prescribed Amoxicillin, 4 days later he returned with a rash.
Wbc 12.1 (4.0 - 10.0)
Rbc 5.09 (4.50 - 5.50)
Hb 141
(130 170)
Neutrophils 3.33 (2.00 - 7.00)
Eosinophils 1.01 (0.02 0.50)
Lymphocytes 8.07 (1.00 - 3.00)

Bacteriology
What is bacteria?
Bacteria: Single-celled microorganisms that can
exist either as independent (free-living)
organisms or as parasites (dependent on another
organism for life)
0.5-5m For comparison to viruses (300nm = 0.3m)
Multiply through binary fission
E coli are capable of dividing every 20 minutes in
favourable conditionsexponential growth

Bacterial structure
No nucleus or membrane bound organelles.
Single loop of DNA.
Some bacteria have an extra circle of genetic material

called a plasmid.
Classified into 5 groups according shapes:
spherical (cocci),
rod (bacilli),
spiral (spirilla),
comma (vibrios)
corkscrew (spirochaetes).
They can exist as single cells, in pairs, chains or clusters.

Cell membranes

Gram stain

Diagnosing bacterial infections

Tests

Gram stain
Blood cultures
Urine culture
Sputum culture
Molecular methods
Microscopy
Maldi-TOF
Sensitivity testing

Samples

CSF
Blood
Sputum
Urine
Faeces
Various/wound swabs
Tissues
Aspirate
Devices

How do antibiotics work?

Differences between the structure of

the bacterial cell and the hosts cell

Bacterial cells from multiplying so that the bacterial

population remains the same

Or
By stopping the mechanism responsible for building
their cell walls

Classes of antibiotics

Spectrum of antibiotics (an unhelpful description)

Broad (examples)

Beta-lactams/lactamase

Narrow (examples)

inhibitors
Amoxicillin
Benzyl penicillin
Pip/Tazocin

Gentamicin
Chloramphenicol
Carbapenems
Meropenem

Azithromycin
Clarithromycin
Clindamycin
Erythromycin
Vancomycin

http://www.slideshare.net/ManishGoyal30/biological-treatment-i-activated-sludge-process

Causes of resistance
Selective pressure
Mutation
Gene transfer
Structural changes to cell wall
Changes in molecular binding site
Efflux pumps
Inappropriate use

Bacterial or Viral, Neither?

A 13-year-old teenager developed fever, sore throat, and headache. The
following day, the patient developed chills, nausea, photophobia, and neck pain,
which prompted a visit to the local hospital. Examination revealed an oral
temperature of 38.2C, pulse of 90, respiration of 20, blood pressure of 120/80,
and nuchal rigidity. The neurologic examination was otherwise normal. CT scan
of the brain was normal. 2 hours later a rash was noted to be developing on the
childs legs.
CSF Examination
App : Heavily bloodstained
WBC 300.0 x10^6/l
Lymph 10%
Poly 90 %
RBC 58725.0 x10^6/l

Infection, Prevention & Control

Appropriate & timely testing
Droplet & contact precautions
Isolation and cohorting
Privacy curtains
Appropriate sign use
Limit patient movement
Cough etiquette
Hand washing, aprons, doors, regular cleaning

Epidemiology/Public Health

Why is this this important?

To plan resources appropriately
To allow for data collection and mapping of

infections
To develop or improve clinical/medical

research
To develop preventative healthcare

Questions?

jennifer.moore@nnuh.nhs.uk