Mims' Medical Microbiology E-Book

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Learn all the microbiology and basic immunology concepts you need to know for your courses and exams. Now fully revised and updated, Mims’ clinically relevant, systems-based approach and abundant colour illustrations make this complex subject easy to understand and remember.

Learn about infections in the context of major body systems and understand why these are environments in which microbes can establish themselves, flourish, and give rise to pathologic changes. This systems-based approach to microbiology employs integrated and case-based teaching that places the ‘bug parade’ into a clinical context.

Effectively review for problem-based courses with the help of chapter introductions and ‘Lessons in Microbiology’ text boxes that highlight the clinical relevance of the material, offer easy access to key concepts, and provide valuable review tools.

Approach microbiology by body system or by pathogen through the accompanying electronic ‘Pathogen Parade’ – a quickly searchable, cross-referenced glossary of viruses, bacteria and fungi

A new electronic ‘Vaccine Parade’ offers quick-reference coverage of the most commonly used vaccines in current clinical practice

Deepen your understanding of epidemiology and the important role it plays in providing evidence-based identification of key risk factors for disease and targets for preventative medicine.

Grasp and retain vital concepts easily, with a user-friendly colour coded format, succinct text, key concept boxes, and dynamic illustrations.

New and enhanced information reflects the growing importance of the human microbiota and latest molecular approaches

Access the complete contents on the go via the accompanying interactive eBook, with a range of bonus materials to enhance learning and retention – includes self-assessment materials and clinical cases to check your understanding and aid exam preparation.

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Front Cover 2
Inside Front Cover 3
Mims' Medical Microbiology and Immunology 4
Copyright Page 7
Table Of Contents 8
Foreword by Cedric Mims 12
Preface to the sixth edition 13
Acknowledgements 14
A contemporary approach to microbiology 15
- Introduction 15
  - The Context for Contemporary Medical Microbiology 15
    - Emerging or re-emerging diseases continue to pose new microbiological problems 15
  - Microbes and parasites 15
    - The conventional distinction between ‘microbes’ and ‘parasites’ is essentially arbitrary 15

Front Cover 2
Inside Front Cover 3
Mims' Medical Microbiology and Immunology 4
Copyright Page 7
Table Of Contents 8
Foreword by Cedric Mims 12
Preface to the sixth edition 13
Acknowledgements 14
A contemporary approach to microbiology 15
- Introduction 15
  - The Context for Contemporary Medical Microbiology 15
    - Emerging or re-emerging diseases continue to pose new microbiological problems 15
  - Microbes and parasites 15
    - The conventional distinction between ‘microbes’ and ‘parasites’ is essentially arbitrary 15
  - Microbiology Past, Present and Future 16
    - Infectious diseases are killers in both resource-rich and resource-poor countries 16
    - Infections continue to emerge or re-emerge 16
    - Modern lifestyles and technical developments facilitate transmission of disease 17
    - What of the future? 18
  - The Approach Adopted in This Book 18
- 1 The Adversaries – Pathogens 20
  - 1 Pathogens as parasites 21
    - The Varieties of Pathogens 21
      - Prokaryotes and eukaryotes 21
        
        All organisms other than viruses and prions are made up of cells 21
        
        Bacteria are prokaryotes; all other organisms are eukaryotes 21
        
        Gram-negative bacteria have an outer lipopolysaccharide-rich layer 23
      - Microparasites and macroparasites 23
        
        Microparasites replicate within the host 23
        
        Organisms that are small enough can live inside cells 23
      - Living Inside or Outside Cells 23
        
        Living outside cells provides opportunities for growth, reproduction and dissemination 23
        
        Pathogens within cells are protected from many of the host’s defence mechanisms 23
      - Systems of Classification 24
        
        Classification of bacteria and viruses 24
        
        Correct identification of bacteria below the species level is often vital to differentiate pathogenic and non-pathogenic forms 24
        
        Classification of viruses departs even further from the binomial system 25
        
        Classification assists diagnosis and the understanding of pathogenicity 25
        
        2 The bacteria 26
        
        Introduction 26
        
        Structure 26
        
        Bacteria are ‘prokaryotes’ and have a characteristic cellular organization 26
        
        Pili are another form of bacterial surface projection 28
        
        Bacteria are classified according to their cell wall as Gram-positive or Gram-negative 28
        
        Many bacteria possess flagella 28
        
        Keywords 27
        
        Introduction 27
        
        Nutrition 29
        
        Bacteria obtain nutrients mainly by taking up small molecules across the cell wall 29
        
        All pathogenic bacteria are heterotrophic 29
        
        Growth and Division 30
        
        A bacterial cell must duplicate its genomic DNA before it can divide 31
        
        Replication must be accurate 31
        
        Cell division is preceded by genome segregation and septum formation 31
        
        Bacterial growth and division are important targets for antimicrobial agents 32
        
        Gene Expression 32
        
        Most genes are transcribed into messenger RNA (mRNA) 32
        
        Transcription 32
        
        Transcription usually terminates at specific termination sites 32
        
        mRNA transcripts often encode more than one protein in bacteria 32
        
        Transcription is initiated at promoters 32
        
        Translation 32
        
        Translation begins with formation of an initiation complex and terminates at a STOP codon 33
        
        Transcription and translation are important targets for antimicrobial agents 33
        
        Regulation of gene expression 33
        
        The most common way of altering gene expression is to change the amount of mRNA transcription 33
        
        Bacteria adapt to their environment by controlling gene expression 33
        
        The principles of gene regulation in bacteria can be illustrated by the regulation of genes involved in sugar metabolism 33
        
        Expression of many virulence determinants by pathogenic bacteria is highly regulated 33
        
        Many bacterial virulence genes are subject to positive regulation by ‘two-component regulators’ 35
        
        In some instances the pathogenic activity of bacteria specifically begins when cell numbers reach a certain threshold 35
        
        Expression of bacterial virulence genes is often controlled by regulatory proteins 35
        
        Survival Under Adverse Conditions 35
        
        Some bacteria form endospores 35
        
        Mobile Genetic Elements 36
        
        Many bacteria possess small, independently replicating (extrachromosomal) nucleic acid molecules termed plasmids and bacteriopha 36
        
        Widespread use of antimicrobials has applied a strong selection pressure in favour of bacteria able to resist them 36
        
        Plasmids are valuable tools for cloning and manipulating genes 37
        
        Bacteriophages are bacterial viruses that can survive outside as well as inside the bacterial cell 37
        
        Plasmids can carry virulence genes 37
        
        Transposition 38
        
        Insertion sequences are the smallest and simplest ‘jumping genes’ 38
        
        Mobile genetic elements promote a variety of DNA rearrangements which may have important clinical consequences 40
        
        Other mobile elements also behave as portable cassettes of genetic information 40
        
        Transposons are larger, more complex elements, which encode multiple genes 40
        
        Mutation and Gene Transfer 41
        
        Mutation 41
        
        Bacterial cells are not defenceless against genetic damage 41
        
        Bacterial DNA repair has provided a model for understanding similar, more complex processes in humans 41
        
        Changes in the nucleotide sequence of DNA can occur spontaneously or under the influence of external agents 41
        
        Gene transfer and recombination 41
        
        Transformation 42
        
        Some bacteria can be transformed by DNA present in their environment 42
        
        Transduction 42
        
        Transduction involves the transfer of genetic material by infection with a bacteriophage 42
        
        Conjugation 43
        
        Conjugation is a type of bacterial ‘mating’ in which DNA is transferred from one bacterium to another 43
        
        The Genomics of Medically Important Bacteria 44
        
        Microarrays provide a more global targeted genomic analysis 44
        
        DNA microarrays have been especially useful in the identification of mutations and studies on bacterial gene expression 44
        
        Various targeted approaches to the detection and utilization of genomic sequence information exist 44
        
        Sequence of the entire bacterial chromosome (whole genome sequencing; WGS) represents the most global approach to genomic analys 45
        
        Major groups of bacteria 46
        
        WGS methods continue to evolve in what has been described as generational increments 46
        
        Current WGS methods have some common challenges 46
        
        3 The viruses 48
        
        Major Groups of Viruses 48
        
        Viruses share some common structural features 48
        
        The outer surface of the virus particle is the part that first makes contact with the membrane of the host cell 48
        
        Introduction 48
        
        Keywords 49
        
        Introduction 49
        
        Infection of Host Cells 50
        
        Virus particles enter the body of the host in many ways 50
        
        Viruses show host specificity and usually infect only one or a restricted range of host species. The initial basis of specificit 50
        
        Once in the host’s cytoplasm the virus is no longer infective 51
        
        Replication 51
        
        Viruses must first synthesize messenger RNA (mRNA) 51
        
        Viruses must also replicate their nucleic acid 51
        
        RNA viruses produce mRNA by several different routes 51
        
        Viral mRNA is then translated in the host cytoplasm to produce viral proteins 51
        
        Replication of viral DNA occurs in the host nucleus – except for poxviruses, where it takes place in the cytoplasm 52
        
        The final stage of replication is assembly and release of new virus particles 53
        
        Outcome of Viral Infection 53
        
        Some viruses can ‘transform’ the host cell into a tumour or cancer cell 53
        
        Viral infections may cause cell lysis or be persistent or latent 53
        
        Tumour formation as a result of viral infection: direct and indirect mechanisms 54
        
        Viral oncogenes have probably arisen from incorporation of host oncogenes into the viral genome during viral replication 54
        
        4 The fungi 57
        
        Major Groups of Disease-Causing Fungi 57
        
        Importance of fungi in causing disease 57
        
        Fungal pathogens can be classified on the basis of their growth forms or the type of infection they cause 57
        
        Control of fungal infection 59
        
        Introduction 57
        
        Keywords 58
        
        Introduction 58
        
        The study of fungi is known as mycology and fungal infections are known as mycoses 58
        
        5 The protozoa 61
        
        Protozoa can infect all the major tissues and organs of the body 61
        
        Introduction 61
        
        Keywords 62
        
        Introduction 62
        
        Protozoa have evolved many sophisticated strategies to avoid host responses 63
        
        Protozoa use a variety of routes to infect humans 63
        
        6 The helminths 65
        
        Introduction 65
        
        Transmission of helminths occurs in four distinct ways 65
        
        Introduction 66
        
        Keywords 66
        
        The outer surfaces of helminths provide the primary host–parasite interface 67
        
        Life Cycles 67
        
        The larvae of flukes and tapeworms must pass through one or more intermediate hosts, but those of nematodes can develop to matur 67
        
        Many helminths have complex life cycles 67
        
        Helminths and Disease 67
        
        Adult tapeworms are acquired by eating undercooked or raw meat containing larval stages 67
        
        The most important flukes are those causing schistosomiasis 68
        
        Certain nematodes are highly specific to humans; others are zoonoses 68
        
        Survival of helminths in their hosts 69
        
        7 The arthropods 70
        
        Arthropod infestation carries the additional hazard of disease transmission 70
        
        Introduction 70
        
        Many arthropods feed on human blood and tissue fluids 70
        
        Keywords 71
        
        Introduction 71
        
        8 Prions 73
        
        ‘Rogue Protein’ Pathogenesis 73
        
        Prions are unique infectious agents 73
        
        Prions are host-derived molecules 73
        
        Introduction 73
        
        Introduction 74
        
        Keywords 74
        
        Development, Transmission and Diagnosis of Prion Diseases 75
        
        Prions can cross species boundaries 76
        
        Prion diseases are difficult to diagnose 77
        
        Lessons from kuru 77
        
        Prevention and Treatment of Prion Diseases 77
        
        Prion diseases are incurable 77
        
        9 The host–parasite relationship 79
        
        The Microbiota and Microbiome 79
        
        The skin is an example of a complex microbiome due to multiple microenvironments 79
        
        Identifying and understanding the microbiota and microbiome 79
        
        The microbiome is acquired rapidly during and shortly after birth and changes continuously throughout life 79
        
        The pharynx and trachea carry their own microbiota 81
        
        Both the nose and mouth can be heavily colonized by bacteria 81
        
        In the gut the density of microorganisms increases from the stomach to the large intestine 81
        
        Dental caries is one of the most common infectious diseases in developed countries 81
        
        The urethra is lightly colonized in both sexes, but the vagina supports an extensive presence of bacteria and fungi 82
        
        Advantages and disadvantages of the microbiota 82
        
        Studies of germ-free animals underscore the importance of the microbiota 82
        
        Studies of the microbiome have confirmed the benefit of various species to the host 82
        
        Problems arise if members of the microbiota spread into previously sterile parts of the body 83
        
        Symbiotic Associations 83
        
        Commensalism, mutualism and parasitism are categories of symbiotic association 83
        
        Parasitism 84
        
        In parasitism, the symbiotic relationship benefits only the parasite 84
        
        Mutualism 84
        
        Mutualistic relationships provide reciprocal benefits for the two organisms involved 84
        
        Commensalism 84
        
        In commensalism, one species of organism lives harmlessly in or on the body of a larger species 84
        
        The Characteristics of Parasitism 84
        
        Many different groups of organisms are parasitic and all animals are parasitized 84
        
        Viruses are completely dependent upon the host for all their metabolic needs 85
        
        Parasite development can be controlled by the host 85
        
        Parasitism has metabolic, nutritional and reproductive advantages 85
        
        Disadvantages of parasitism 85
        
        The Evolution of Parasitism 85
        
        The pathway of virus evolution is uncertain 86
        
        Bacterial parasites evolved through accidental contact 86
        
        Many bacterial parasites have evolved to live inside host cells 86
        
        Parasite adaptations to overcome host inflammatory and immune responses 87
        
        Pressure of infection has been a major influence in host evolution 87
        
        Changes in parasites create new problems for hosts 88
        
        Eukaryote parasites have evolved through accidental contact 87
        
        Host adaptations to overcome changes in parasites 88
        
        Social and behavioural changes can be as important as genetic changes in altering host–parasite relations 88
        
        2 The Adversaries – Host Defences 91
        
        10 The innate defences of the body 92
        
        Defences Against Entry Into the Body 92
        
        A variety of biochemical and physical barriers operate at the body surfaces 92
        
        Introduction 92
        
        The body has both ‘innate’ and ‘adaptive’ immune defences 92
        
        Keywords 93
        
        Introduction 93
        
        Defences Once the Microorganism Penetrates the Body 94
        
        Phagocytosis 94
        
        Macrophages are widespread throughout the tissues 95
        
        Polymorphs possess a variety of enzyme-containing granules 97
        
        Phagocytosis and killing 97
        
        How do phagocytes sense infection? 97
        
        The phagocyte is activated through PAMP recognition 98
        
        The internalized pathogen is the target for a fearsome array of killing mechanisms 98
        
        Phagocytes are mobilized and targeted onto the microorganism by chemotaxis 98
        
        Activation of the complement system 98
        
        C9 molecules form the ‘membrane attack complex’, which is involved in cell lysis 101
        
        Complement synergizes with phagocytic cells to produce an acute inflammatory response 101
        
        Inflammasomes 102
        
        Acute phase proteins 102
        
        Other extracellular antimicrobial factors 103
        
        Interferons are a family of broad-spectrum antiviral molecules 103
        
        Innate lymphoid cells (ILCs) 106
        
        Natural killer cells attach to virally infected cells, allowing them to be differentiated from normal cells 106
        
        Eosinophils act against large parasites 107
        
        11 Adaptive immune responses bring specificity 109
        
        Introduction 109
        
        Lymphoid Tissues Primary and Secondary 109
        
        The thymus is a highly specialized organ producing mature T cells 109
        
        Keywords 110
        
        Introduction 110
        
        How to recognize an extensive repertoire of foreign antigens in an efficient way 110
        
        Subsets of T Cells 113
        
        Why do we need so many types of T cell? 113
        
        Secondary Lymphoid Organs 113
        
        Antibody Structure and Function 115
        
        Antibodies come in different classes and subclasses, with different structures and functions 117
        
        Subsets of B cells 118
        
        Recirculation of T and B Cells 118
        
        12 Cooperation leads to effective immune responses 120
        
        Opsonization by Antibody Enhances Phagocytosis and Leads to Complement Activation 120
        
        Introduction 120
        
        Beneficial Inflammatory Reactions Can Also Be Enhanced by Antibodies 120
        
        Cooperation Means Greater Efficiency 120
        
        Keywords 121
        
        Introduction 121
        
        Activation of T Cells Involves Antigen-Presenting Cells and Additional Co-Stimulatory Signals 122
        
        T cells need additional signals for activation 123
        
        T cells with a γδ TCR and other invariant T cells 125
        
        Superantigens stimulate too many T cells 125
        
        Complex intracellular signalling cascades follow the phosphorylation of ITAMs 125
        
        Clonal Expansion 125
        
        Antibody Production Involves a Series of Steps Within the Germinal Centre 126
        
        Monoclonal antibody technology exploits clonal expansion and transformation to produce large quantities of monoclonal antibodies 126
        
        T-cell help for antibody production 126
        
        Sometimes B cells can make antibodies without T-cell help 126
        
        Cytokines Play an Important Part in These Cell–Cell Interactions 127
        
        Immunological Memory Enables a Second Infection With the Same Microbe to Be Dealt With More Effectively 128
        
        Armies Must Be Kept Under Control 130
        
        3 The Conflicts 134
        
        13 Background to the infectious diseases 135
        
        Host–Parasite Relationships 135
        
        The speed with which host adaptive responses can be mobilized is crucial 135
        
        Adaptation by both host and parasite leads to a more stable balanced relationship 139
        
        Introduction 135
        
        Microbes rapidly evolve characteristics that enable them to overcome the host’s defences 135
        
        Introduction 136
        
        Keywords 136
        
        Causes of Infectious Diseases 140
        
        More than 100 microbes commonly cause infection 140
        
        Conclusions about causation are now reached using enlightened common sense 141
        
        Koch’s postulates to identify the microbial causes of specific diseases 141
        
        The Biological Response Gradient 142
        
        It is uncommon for a pathogen to cause exactly the same disease in all infected individuals 142
        
        14 Entry, exit and transmission 143
        
        Sites of Entry 143
        
        Skin 143
        
        Microorganisms gaining entry via the skin may cause a skin infection or infection elsewhere 143
        
        Receptor molecules 143
        
        Exit from the body 143
        
        Introduction 143
        
        Introduction 79
        
        Keywords 80
        
        Introduction 80
    - Introduction 21
    - Introduction 22
    - Keywords 22

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Afiljacja autora

Richard Goering: Professor and Chair, Department of Medical Mi
Hazel Dockrell: Professor of Immunology, Department of Immuno
Mark Zuckerman: Consultant Virologist and Honorary Senior Lec
Peter L. Chiodini: Honorary Professor, Infectious & Tropical Dis

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