Medical microbiology & immunology: examination & board review

656 Pages·2004·16.083 MB·English

by  Levinson, Warren

a LANGE medical book
Medical
Microbiology
& Immunology
Examination &
Board Review
eighth edition
Warren Levinson,MD,PhD
Professor of Microbiology
Department of Microbiology and Immunology
University of California,San Francisco
San Francisco,California
Lange Medical Books/McGraw-Hill
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DOI: 10.1036/0071431993
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Contents
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
How to Use This Book . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x
I. BASIC BACTERIOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1. Bacteria Compared With Other Microorganisms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2. Structure of Bacterial Cells. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
3. Growth. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
4. Genetics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
5. Classification of Medically Important Bacteria. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
6. Normal Flora . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
7. Pathogenesis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
8. Host Defenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
9. Laboratory Diagnosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
10. Antimicrobial Drugs: Mechanism of Action. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
11. Antimicrobial Drugs: Resistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
12. Bacterial Vaccines. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
13. Sterilization & Disinfection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
II. CLINICAL BACERIOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
14. Overview of the Major Pathogens & Introduction to Anaerobic Bacteria. . . . . . . . . . . . . . . . 99
15. Gram-Positive Cocci. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
16. Gram-Negative Cocci. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
17. Gram-Positive Rods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
iii
iv / CONTENTS
18. Gram-Negative Rods Related to the Enteric Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
19. Gram-Negative Rods Related to the Respiratory Tract. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
20. Gram-Negative Rods Related to Animal Sources (Zoonotic Organisms) . . . . . . . . . . . . . . . . 152
21. Mycobacteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
22. Actinomycetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
23. Mycoplasmas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
24. Spirochetes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
25. Chlamydiae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
26. Rickettsiae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
27. Minor Bacterial Pathogens. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
III. BASIC VIROLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
28. Structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186
29. Replication. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192
30. Genetics & Gene Therapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
31. Classification of Medically Important Viruses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
32. Pathogenesis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
33. Host Defenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
34. Laboratory Diagnosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226
35. Antiviral Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
36. Viral Vaccines. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
IV. CLINICAL VIROLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
37. DNA Enveloped Viruses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244
38. DNA Nonenveloped Viruses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
39. RNA Enveloped Viruses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
40. RNA Nonenveloped Viruses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275
41. Hepatitis Viruses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
CONTENTS / v
42. Arboviruses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
43. Tumor Viruses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 298
44. Slow Viruses & Prions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 308
45. Human Immunodeficiency Virus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
46. Minor Viral Pathogens. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 322
V. MYCOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 326
47. Basic Mycology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 326
48. Cutaneous & Subcutaneous Mycoses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331
49. Systemic Mycoses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333
50. Opportunistic Mycoses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 338
VI. PARASITOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 342
51. Intestinal & Urogenital Protozoa. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343
52. Blood & Tissue Protozoa. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349
53. Minor Protozoan Pathogens. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359
54. Cestodes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361
55. Trematodes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 367
56. Nematodes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 372
VII. IMMUNOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383
57. Immunity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383
58. Cellular Basis of the Immune Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393
59. Antibodies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413
60. Humoral Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 422
61. Cell-Mediated Immunity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 424
62. Major Histocompatibility Complex & Transplantation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 426
63. Complement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431
64. Antigen-Antibody Reactions in the Laboratory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 435
vi / CONTENTS
65. Hypersensitivity (Allergy). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 445
66. Tolerance & Autoimmune Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 453
67. Tumor Immunity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 461
68. Immunodeficiency. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 463
VIII. BRIEF SUMMARIES OF MEDICALLY IMPORTANT ORGANISMS . . . . . . . . . . . . . . . 469
Summaries of Medically Important Bacteria. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 469
Summaries of Medically Important Viruses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 485
Summaries of Medically Important Fungi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 495
Summaries of Medically Important Parasites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 498
IX. CLINICAL CASES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 507
X. USMLE (NATIONAL BOARD) PRACTICE QUESTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . 517
Basic Bacteriology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 517
Clinical Bacteriology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 522
Basic Virology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 530
Clinical Virology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 534
Mycology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 541
Parasitology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 544
Immunology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 547
Extended Matching Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 557
Clinical Case Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 559
XI. USMLE (NATIONAL BOARD) PRACTICE EXAMINATION . . . . . . . . . . . . . . . . . . . . . . . 568
INDEX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 581
Preface
This book is a concise review of the medically important aspects of microbiology. It covers both the basic and clini-
cal aspects of bacteriology, virology, mycology, parasitology, and immunology. Its two major aims are (1) to assist
those who are preparing for the USMLE (National Boards) and (2) to provide students who are currently taking
medical microbiology courses with a brief and flexible source of information.
This new edition presents current, medically important information in the rapidly changing fields of microbiol-
ogy and immunology. It includes updated information on such topics as human immunodeficiency virus, hepatitis
viruses, and immunology. My goal is to provide the reader with an accurate source of clinically relevant information
at a level appropriate for those beginning their medical education.
These aims are achieved by utilizing several different formats, which should make the book useful to students
with varying study objectives and learning styles:
1. A narrative text for complete information.
2. Summaries of important microorganisms for rapid review of essentials.
3. Sample questions in the USMLE (National Board) style, with answers provided after each group of questions.
4. A USMLE (National Board) practice examination consisting of 80 microbiology and immunology questions.
The questions are incorporated into a clinical case format and simulate the computer-based examination. An-
swers are provided at the end of each block of 40 questions.
5. Clinical case vignettes to provide both clinical information and practice for the USMLE.
The following features are included to promote a successful learning experience for students using this book:
1. The information is presented succinctly, with stress on making it clear, interesting, and up to date.
2. There is strong emphasis in the text on the clinical application of microbiology and immunology to infectious
diseases.
3. In the clinical bacteriology and virology sections, the organisms are separated into major and minor
pathogens. This allows the student to focus on the clinically most important microorganisms.
4. Key information is summarized in useful review tables. Important concepts are illustrated by figures in color.
5. The 654 USMLE (National Board) practice questions cover the important aspects of each of the subdisci-
plines on the USMLE: Bacteriology, Virology, Mycology, Parasitology, and Immunology. A separate section
containingextendedmatching questions is included. In view of the emphasis placed on clinical relevance in the
USMLE, another section provides questions set in a clinical case context.
6. Brief summaries of medically important microorganisms are presented together in a separate section to facili-
tate access to the information and to encourage comparison of one organism with another.
7. Fifty clinical cases are presented as unknowns for the reader to analyze in a brief, problem-solving format.
These cases illustrate the importance of basic science information in clinical diagnosis.
After teaching both medical microbiology and clinical infectious disease for many years, I believe that students ap-
preciate a book that presents the essential information in a readable, interesting, and varied format. I hope you find
this book meets those criteria.
Warren Levinson, MD, PhD
San Francisco, CA
June 2004
vii
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