Vydehi Institute of Medical Sciences
Microbiology

Microbiology Curriculum

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Curriculum

MICROBIOLOGY

GOAL :

The broad goal of the teaching of undergraduate students tin Microbiology is it provide an understanding of the natural history of infectious disease in order to deal with the etiology, pathogenesis, laboratory diagnosis, treatment and control of infections in the community.

OBJECTIVES :

KNOWLEDGE:

At the end of the course, the student shall be able to :

State the infective micro-organisms of the human body and describe the host parasite relationship;

List pathogenic micro-organisms (bacteria, viruses, parasites, fungi) and describe the pathogenesis of the diseases produced by them;

State or indicate the modes of transmission of pathogenic and opportunistic organisms and their sources, including insect vectors responsible for transmission of infection;

Describe the mechanisms of immunity to infections;

Acquire knowledge on suitable antimicrobial agents for treatment of infections and scope of immunotherapy and different vaccines available for prevention of communicable diseases;

Apply methods of disinfection and sterilization to control and prevent hospital and community acquired infections;

Recommend laboratory investigations regarding bacteriological examination of food, water and air

SKILLS :

At the end of the course, the student shall be able to:

oPlan and interpret laboratory investigations for the diagnosis of infections diseases and to correlate the clinical manifestations with the etiological agent;

Identify the common infection agents with the help of laboratory procedures and use antimicrobial sensitivity test to select suitable antimicrobial agents.

Perform commonly employed bed-side tests for detection of infections agents such as blood film for malaria, filaria, gram staining and Acid Fast Bacilli (AFB) staining and stool sample for ova cyst etc.

INTEGRATION:

The student shall understand infection diseases of national importance in relation to the clinical, therapeutic and preventive aspects.

COURSE CONTENTS

THEORY

I. INTRODUCTION

Must know

1. Morbidity and mortality data of infectious diseases prevalent in the country with reference to the National Health Programs and in the local geographic area.

Desirable to know

1. Significant milestones in the history of Microbiology

II. GENERAL MICROBIOLOGY

Must know

1. Definitions: infections, parasite, host, vector, fomite, contagious disease infectious disease, epidemic, endemic, pandemic, Zoonosis, Epizootic, Attack rate.

2. Normal flora of the human body.

3. Routes of infection and spread; endogenous and exogenous infections; source at reservoir of infections.

4. Bacterial cell. Morphology limited to recognizing bacteria in clinical samples Shape, motility and arrangement. Structures, which are virulence, associated. Physiology: Essentials of bacterial growth requirements.

5. Sterilization, disinfection and universal precautions in relation to patient care disease prevention. Definition of asepsis, sterilization, disinfection.

6. Antimicrobials: Mode of action, interpretation of susceptibility tests, resistance spectrum of activity.

7. Bacterial genetics.

III. IMMUNOLOGY

Must know

1. Basic principles of immunity immunobiology: lymphoid organs and tissues. Antigen, antibody reactions with relevance to pathogenesis and serological diagnosis.

2. Humoral immunity and its role in immunity

3. Cell mediated immunity and its role in immunity.

4. Immunology of hypersensitivity,

5. Measuring immune functions.

6. Immunological basis of the autoimmune phenomena.

7. Immunodeficiency with relevance to opportunistic infections.

8. Basic principles of transplantation immunity

9. Basic principles of tumour immunity.

SYSTEMATIC MICROBIOLOGY

IV. BACTERIOLOGY

To be considered under the following headings

Morphology, classification according to pathogenicity, mode of transmission, methods of prevention, collection and transport of samples for laboratory diagnosis, Interpretation of laboratory reports, Rapid bedside diagnosis where feasible, list of antimicrobial agents and control measures with special relevance to the National Control and Eradication programs

Must know

1. Staphylococci,

2. Streptococci and pneumococci,

3. Neisseriae,

4. Corynebacterium diphtheria,

5. Mycobacteria: Tuberculosis, M.leprae, atypical mycobacteria,

6. Enterobacteriaceae,

7. Parvobacteria: Haemophilus, Bordetella, Brucella, Pasteurella, Gardnerella,

8. Vibrois: V. cholerae and other medically important vibrios,

9. Campylobacters and Helicobacters,

10. Pseudomonas,

11. Bacillus anthracis,

12. Sporing and non-sporing anaerobes: Clostridia, Bacteroides and Fusobacteria,

13. Chlamydiae: Mycoplasma

14. Actionmycetales: Actinomycetes and Nocardia,

15. Spirochetes,

16. Rickettsiae

Desirable to know

Listeria monocytogenes

V. GENERAL VIROLOGY

Must know

General properties: Basic structure and broad classification of viruses, Pathogenesis and pathology of viral infections, Immunity and prophylaxis of viral diseases, Principles of laboratory diagnosis of viral disease, List of commonly used antiviral agents, Bacteriophage with relation to virulence mechanism and epidemiology,

Desirable to know: Replication and genetics.

VI. SYSTEMATIC VIROLOGY

Must know

1. Herpes viruses: List of viruses included, lesions produced, pathogenesis and latency principles and Laboratory diagnosis.

2. Arbo viruses: List of arboviruses prevalent in India, general properties, mode of transmission, disease syndromes produced, common diagnostic tests, prevention of spread.

3. Picoma viruses: Common infections produced classification and general properties, pathogenesis of poliomyelitis, immunoprophylaxis of poliomyelitis.

4. Myxoviruses: General properties, classification according to diseases produced, antigenic variations in influenza virus with relevance to vaccine efficacy; measles, mumps and rubella; important features and prophylaxis.

5. Rabies virus: General properties; antirabies vaccine, antemortem diagnosis in rabies.

6. Hepatitis virus: List of viruses, pathogenesis, mode of infection, list of diagnostic tests and their interpretation, methods of prevention and control.

7. Human immunodeficiency virus: Structure with relevance to laboratory diagnosis and type of infection, laboratory tests and their interpretation, universal precautions, specific precautions, recent trends in diagnosis and prophylaxis.

8. Rota virus: laboratory diagnosis.

9. Adenovirus - Infections caused and Laboratory diagnosis.

Desirable to know

1. Slow virus infection.

2. Poxviruses.

3. Oncogenic viruses.

VII. MYCOLOGY

Must know

General properties of fungi.

Classification based on disease: superficial, subcutaneous, deep mycoses,

Opportunistic infections including Mycotoxins and systemic mycoses.

General principles of fungal diagnosis,

Rapid diagnosis.

Method of collection of samples.

Antifungal agents.

VIII. PARASITOLOGY

1. Protozoans :

i) Intestinal,

ii) Genital,

iii) Protozoans in blood

iv) Opportunistic protozoans.

2. Helminths :

Cestodes: Taenia, Echinococcus, Hymenolepis

3. Nematodes :

Intestinal, Tissue

4. Medical entomology with reference to vectors.

Desirable to know

Trematodes of medical importance.

IX. CLINICAL / APPLIED MICROBIOLOGY

Must know

1) Streptococcal infections: Rheumatic fever and Rheumatic heart disease,

2) Meningitis,

3) Tuberculosis,

4) Enteric fever,

5) Dysentery,

6) Diarrheal diseases,

7) Pyrexia of unknown origin,

8) Eye-infections,

9) leprosy,

10) Sexually transmitted diseases,

11) Poliomyelitis,

12) Hepatitis,

13) Acute-respiratory infections,

14) Central nervous System infections,

15) Urinary tract infections,

16) Pelvic inflammatory disease,

17) Wound infection,

18) Opportunistic infections,

19) HIV infection,

20) Malaria,

21) Filariasis,

22) Zoonotic diseases.

78 (Integrated teaching suggested for the above topics)

Desirable to know

1) Bone and joint infections,

2) Food poisoning,

3) Exanthematous conditions.

4) Organisms used in bioterrorism.

X. BIO-MEDICAL WASTE :

Types, potential risks and their safe management.

XI. SKILLS

Must know

1. Do stool exam for ova and cysts; and hanging drop for vibrio for vibrio cholera.

2. Do and examine a wet film of vaginal smear for Trichomonas and fungus.

3. Perform and interpret Gram's stain and Ziehl-Neelsen or modified Ziehl Neelsen's stain.

4. Perform skin scrapings and do a KOH preparation for fungal infection.

5. Do cell counts and gram stain of CSF and other body fluids.

6. Interpret blood smear for parasites like malaria and filaria.

7. Interpret antimicrobial sensitivity reports.

8. Interpret serological tests such as VDRL, ASLO, WIDAL, HIV, Rheumatoid factor, hepatitis and TORCH infections, Treponema pallidum Haemagglutination, Haemagglutination in Virology, Haemagglutination inhibition.

9. Be able to collect and transports following clinical samples for microbiological tests: Blood, pus, urine, CSF, body fluids, stool, sputum, throat swabs and serum.

10. Adopt universal precautions for self-precaution against HIV and hepatitis.

TEACHING HOURS

THEORY

No. of hours of teaching: 120 hrs.

1. Introduction To Microbiology and General Bacteriology: 10 hrs.

2. Immunology: 20 hrs.

3. Systematic Bacteriology: 35 hrs.

4. Virology: 20 hrs.

5. Mycology: 05 hrs.

6. Parasitology: 25 hrs.

7. Applied Microbiology: 05 hrs.

PRACTICAL

PRACTICAL EXERCISES IN MICROBIOLOGY

The students would perform the following procedures:

i) Gram stain,

ii) Ziehl Neelsen stain,

iii) Modified Ziehl Neelsen stain,

iv) Albert stain,

v) Hanging drop

vi) Wet mount for stool examination,

vii) Iodine mount for stool examination,

viii) Lactophenol cotton blue mount for fungus examination,

ix) Simple stain

I. MICROSCOPE

Principles and use of compound Microscope in detail

Dark ground Microscope

Fluorescent Microscope

Phase Contrast Microscope

Electron Microscope

II. STERILIZATION

Principle, Uses and Demonstration of common sterilization equipment namely, Autoclave, Hot Air Oven, Serum Inspissator, Arnold Steriliser, Filters.

III. CULTURE MEDIA :

Classification of culture media, Principles, main ingredients and uses of common culture media.

Namely-Peptone water, Nutrient Broth, Nutrient Agar, Blood Agar, Chocolate agar, Mac Conkey, Wilson Blair, TCBS, LJ, Potassium telluride, Dorset egg, Loeffler's serum slope, RCM, milk agar, Selenite F-broth, Blood culture broth.

Media for Biochemical reaction - Sugar Fermentation, Urease, Citrate, Indole

Media with growth of common organisms for demonstration namely Staphylococci, C. diphtheria, Mycobacterium tuberculosis, Salmonella on W.B., Vibrio on TCBS, Mac-Conkey with LF & NLF, Milk Agar with Staphylococci, Proteus on Nutrient Agar.

Antibiotic sensitivity - methods & principles.

IV. STAINING AND HANGING DROP :

1) Demonstration of motility by hanging drops method.

2) Gram Stain

3) ZN Stain

V. PARASITOLOGY :

Examination of faeces for helminthic Eggs, (Round worm, hook Worm, Whip Worm, H. nana)

VI. APPLIED BACTERIOLOGY :

Demonstration of specimen collection.

Growth on appropriate media Biochemical reactions.

Appropriate special tests for the lab-diagnosis of common infectious diseases. Namely:

1. Pyogenic Infection

2. Enteric Fever

3. Bacillary Dysentery

4. Cholera

5. U.T.I.

6. Infantile Diarrhea

7. Tuberculosis

VII. DEMONSTRATION OF SEROLOGICAL TEST :

Widal Test, VDRL, ELISA.

VIII DEMONSTRATION OF FUNGUS:

Growth, Slide mounts of common fungi, Candida, Aspergillus, Mucor, Rhizopus, Penicillium, Dermatophytes (one or two)

VIII. USES OF LABORATORY ANIMALS:

Rabbit, Guinea Pig & Mouse

IX. DEMONSTRATION OF SLIDES & INSTRUMENTS

X. MEDIA & SPECIMENS

(DEMONSTRATION) The following procedures are only for demonstration. Students will interpret results, but need not perform the procedure of tests.

Serological demonstration of - WIDAL, VDRL. Haemagglutination, Haemagglutination inhibition, Complement fixation test, Viral Haemagglutination, ELISA.

XI. INTEGRATED TEACHING:

1. Enteric fever

2. Cholera

3. HIV & AIDS

4. Tuberculosis

5. Hospital infection & Control Measures

6. Malarias

The following materials are to be procured for the conduct of practical classes.

i. SLIDES

1. Staphylococci

2. Streptococci

3. Gonococci

4. M. tuberculosis

5. M. Leprae

6. C. diphtheriae

7. T. pallidum

8. C. tetani

9. Negative Staining (Pneumococci)

10. Malarial Parasite

11. Microfilaria

12. Cyclops 1

3. Hydatid cyst wall

14. Negri Bodies

15. Molluscum contagiosum

16. Rhinosporidiosis

17. Candida

18. Cryptococcus

19. Aspergillus

20. Penicillium

21. Mucor/Rhizopus

22. Pneumococci - Gram stain

23. Y. pestis

24. Mycetoma - H & E Stain

25. Cestode – Segment

ii. MEDIA

1. Without Growth :

1. Peptone Water

2. Nutrient broth

3. Nutrient agar

4. Blood agar

5. Chocolate agar

6. Mac-Conkey agar

7. Wilson & Blair medium

8. T.C.B.S.

9. L.J. Medium

10. Robertson Cooked meat medium

11. Milk agar

12. Selenite F Broth

13. Blood culture Broth

14. Dorset egg medium

15. Loeffler's Serum Slope.

2. With Growth:

1. Staphylococcus - albus, aureus on Nutrient agar

2. Staphylococcus - albus, aureus on milk agar

3. Potassium tellurite medium with C. diphtheria

4. L.J. with M. tuberculosis

5. Mac Conkey with LF & NLF

6. Wilson & Blair with growth

7. TCBS with growth

8. Proteus - on Nutrient agar or on Blood agar

9. Sugar fermentation - Indole - Negative & Positive

10. Urease - Negative & Positive

11. Citrate - Negative & Positive

12. Sabouraud's glucose agar with Candida / Aspergillius

13. Sabouraud's glucose agar with any Dermatophyte.

iii. LIST OF INSTRUMENTS

1. Seitz filter 6. Sterile swab

2. Candle filter 7. Tuberculin syringe

3. Macntosh filde's jar 8. Microtitre plate

4. VDRL slide 9. Inoculation loop

5. Widal rack with tubes 10. Pasteur pipette

iv. LIST OF SPECIMENS

1. Roundworm 5. Hydatid cyst

2. Hookworm 6. Embryonated egg

3. Whip worm 7. Suckling mouse

4. Tapeworm 8. Guinea worm

v. EXPERIMENTAL ANIMALS :

1. Rabbit

2. Guinea pig.

3. Mouse

TERM WISE DISTRIBUTION OF THEORY PORTIONS

3rd TERM: GENERAL BACTERIOLOGY, IMMUNOLOGY & SYSTEMATIC BACTERIOLOGY (COCCI)

4th TERM: REMAINING SYSTEMATIC BACTERIOLOGY & PROTOZOOLOGY

5th TERM: HELMINTHOLOGY, VIROLOGY, MYCOLOGY & APPLIED MICROBIOLOGY.

RECOMMENDED BOOKS (Recent Editions)

1. Ananthanarayan: (Ananthanarayan and Jayaram Paniker's) Textbook of Microbiology, Et. & Orient Longman Ltd., Chennai.

2. Jawetz (Melnick) et al, Medical Microbiology, ed. Z Appleton and Lange, USA. 3. Zinsser (Joklik and Willett) et. Al, Microbiology, Appleton and Lange, USA.

4. Chatterjee (KDC), Parasitology, Chatterjee Medical Publishers, Calcutta.

5. Paniker (C.K. Jayaram), Text book of Medical Parasitology, Jaypee, New Delhi.

6. Bhatia and Ichhpujani, Essential of Medical Microbiology, Jaypee, New Delhi.

7. A text book of Microbiology by Chakraborthy, New Delhi. REFERENCE BOOKS:

LEVEL - I

1. Green wood, Medical Microbiology, Ed-15, Churchill Livingstone.

2. Roitt (Ivan.M), Essential Immunology, Ed.6, ELBS, Hong Kong.

3. MIMS (Cedric, Playfair) et al, Pathogenesis of Infectious diseases, Academic Press, London.

4. RIPPON, Medical Mycology, Ed.2, W.B. Saunder's and Co.

5. KONEMAN (Allen and Janda et al), Diagnostic Microbiology, J.B. Lippincott Co.

6. BELLANTI, Immunology, Ed.3, W.B. Saunder's and Company.

LEVEL - II

1. BALOWS, Manual of clinical Microbiology, ASM, Washington DC.

2. STITES (Terr and Parslow), Medical Immunology, Appleton and Lange USA.

3. ROITT (Brostoff and Male), Immunology, Mosby, London.

4. EMMONS (Binford) et al, Medical Mycology, K.M. Varghese Co., Bombay.

5. MANSON-BARR (BELL), Monson's Tropical diseases, ELBS. 6. BEAVER, (Jung and Corpp), Clinical Parasitology.

LEVEL III

1. TOPELY AND WILSON - Principles of Bacteriology, Virology, Immunity, Edward Arnold.

2. BERGEY'S manual, (Holt and Kreig) et al, Determinative bacteriology, Williams and Wilkins, Maryland, USA.

3. Roitt, Encyclopedia of Immunology, Academic Press Ltd., London

4. HOEPRICH, Infectious diseases, Harper and Row Publishers, Philadelphia.

5. MENDELL (Donerglas Aan Benett), Principles and Practice of Infections diseases, Churchill Livingstone.

DIAGNOSIS MICROBIOLOGY

1. BAILEY AND SCOTT, Diagnostic Microbiology, Mosby Publishers

2. MACKIE & MACCARTNEY - Vol II (Collee & Duguid) et al, Churchill Livingstone.

3. Clinical Microbiology procedures Handbook, Henry D. et al, ASM.

4. COWAN & STEEL (Barrow & Feltham), Manual for the identification of medical bacteria, Cambridge University Press.

5. STOKES (Ridgeway & Wren), Clinical Microbiology, Edward Arnold, London.

6. Basic Laboratory Procedures in Clinical Bacteriology, WHO, Vandepitte et al, Jaypee.

7. Basic Laboratory Procedures in Medical Parasitology, WHO, Vandepitte et al, Jaypee. 8. COLLINS & Lyne, Microbiological Methods, Butterworth - Heinemann Ltd.