Micro 2 - Dr. Botta

is your life you must be whatever is possible in control of it so please check okay and tell your grandmother and grandfather please is more important than the exam so we reach at the prevention stage here this was the last slide as you remember and this is PRX what is the number the number is the number of capsular polysaccharides which are included in the vaccine in the Kingdom you have the 17 which is excellent okay the the same approach I mean capsular polysaccharide are present in the hemophilus influenza type B but here we are lucky

there is only one serotype that is dangerous for humans in regard to manes type B is the most and then we have also the beningo ca a C Y and W which as you remember is to be used in developing countries where these agents are more common but as you remember we have also type B regarding neria meni and I address this uh vaccination because he has been part from has been done by a very good friend of mine Professor RI at the Glo Center in in Sienna but has been a unique approach in vaccine

preparation so these are the different the different cot types but let's focus on B this has been approved now I think is more than 10 years uh to the by the European agency and has been approved later on by Food and Drug Administration what they did they sequenced the genome they identify the genes which according to the structure according to the triplet you identify the amino acid according to the amino acid you identify a sequence in the in the protein and they identified the proteins which were more likely to be antigenic then what they did

among those were more antigenic they selected according to the structure of the protein which one was more likely to be relevant as a let's call it toxin okay from a pathogenetic point of view they synthesize these proteins okay and use this protein as component of the vacine this we call reverse engineering the traditional approach was to purify the tetanos Toxin inactivate and inject here they start from the Genome of the neria and they came up to say artificially synthesized protein in eoli or in a East okay is a beautiful application of modern technology for purposes

and so this is the you see the different protein that they identified and um this is very this is very interesting see is and so this is an important vence factor because is an inhibitor of the alternative complement pathway if you don't remember go to see again again P this is a adhesion protein and this is very important because is a um is an inhibitor again say of kiding so we have Inhibitors of different immune function and this has been identified and synthesized by reverse engineering so the vaccination against type B meningo cus which was

was lacking for 5050 years follow a completely different strategy for numo we have polysaccharide for hemophilus influenza we have polysaccharide for a c w y we have polysaccharide of the capsule here we have a completely different approach with three antigens which are important virulence factor identify by sequencing and interpreting the Genome of n fantastic approach okay completely Innovative okay here there is something not working proper ah this is my garden I miss it a lot but we didn't have snow for the last five six years very sad okay now we go to The Chronic infection

so we move to a completely different setting we move we see that is not exactly completely different but anyway let's say it's completely different and as you see the names is completely new I am very happy that some of you was mentioning ten Sol because we see here Sy ciros some chronic venes okay involve the meninges as a or and some are causing focal localized leion this is very important because when you will perform city scan you will perform right you can orent yourself in the possible ethological agent according to the type of vision that

you are observing in the Imaging investigation right as mention you this difference is important if is a virus involved or you have analitis more than many GES let's go through some of them these are very very interesting the list OB unfortunately is always long we will concentrate on some of them it's not working properly I should open as I mentioned you tuberculosis from usually is not Primary in the brain tuberculosis usually is a respiratory disease here we see in in near three don't forget that tuberculosis can be a genital infection tuberculosis can be a gastrointestinal

infection you will see ovary tu osis from the lung the direct pathway is to the brain so is a secondary manifestation and in this case is a chronic you know TB usually is a chronic disease and you have to look for a source what we discussed already uh is the location and the location of TP is usually on the base typically is the points you see this is the typical the typical and obviously you the first case is like a normal tuberculosis but this case is clearly a tubercula so be careful tuberculosis can take different

manifestation the classical one is the granulometer Legion with the tubercul formation always always secondary Trona you will learn syphilis in sexually transmitted disease and three again and the syphilis as you know from P can go through different stages so there is an initial leion but then this goes away and the bacteria they go inside the body everywhere after 15 20 30 years if untreated if not properly treated and diagnosed you can have different lesions especially in the cardiovascular and in the nervous system this is a feature you will discover little by little is a feature

of all the Spyro kids Lyme disease is affecting the nervous system boria is affecting the nervous system remember all the organism they have a tropism for the skin they have a tropis for the CNS because skin and nervous system they come from the same embryonic lifet if you close your eyes you see yourself at 15 days of life and you see the neural crest forming up can you see it when you were 15 days old okay and we have can be disseminated can be grand Legion can be different localization tertiary syphilis so again chronic infection

Krypto Krypto has a unique feature because it can be acute and chronic crypto usually is in imuno compromise and we saw crypto as as we saw G in HIV patient now becomes much much more rare but Krypto is EAS and as unique feature look look at the capsule is bigger than the organ you see the organ inside look at the capsu is a huge capsu unfortunately we don't have a vaccine when you see capses oh maybe there is a vaccine no in this case there is no vaccine for cryptococcus is a what is the peculiarity

of [Music] Krypto it grows on leaves of eucalyptus so there are trees which are reservoir for the East and if you go in the for how nice how beautiful well there is a risk of crypto coca infection okay is a respiratory and then the clay birds birds dropping of the birds bird disc are a source of infection the organism can survive as you can imagine very well in the environment and we get to the infection through inhalation of the let's call spores as you understand are not exactly spores because this is Easter what are making

Spore are the moldes are the organism which are resistant to the harsh environment Krypto can be acute and can be chronic so you see we have bacteria we have fungi we have e among the fungi this is just for you to read it doesn't add nothing to what we discuss and we can have also for instance protos here we enter in a completely different route of transmission compared to the other that we had the chance already to examine and this root of transmission is the placenta so Toxoplasma is an infection which might be acquired during

pregnancy and the protozoa is a protosol can be transmitted to the fetus during pregnancy through the placenta but from where is the mother getting toxin from the cheese no from unpasturized milk no from the C cat cat Okay so cat fces cat is the reservoir is the definitive host for tox so women should never when you are pregnant if you have a cat you ask your husband to move the lit of the cat and you don't have to touch anything you don't have to work in the garden also because the cat can go in the

garden to defecate and if you like flowers then you have to wear your gloves okay is high risk before I'm talking about it and from which we have sound data 70% of pregnant ladies were positive for Toxoplasma which is protective now I suspect that 70% of you especially in this area where pets are not very popular now are becoming more popular but before they were not um I think 70% of you are negative for tox so 70% of you are at risk of getting the infection okay so majority of you is not not protected you

know your tox antibod no you don't know you don't know the major things for life you know a lot of things about the genetic anti psychiatric drugs but you don't know your CMV you don't know your toxo you don't know if you're vaccinated for meningo cab this will be in the exam joking but this okay so this is what is this hydros the infection damage the brain blocks can block the um flow of the CSF and then this is what happen Okay the brain is compressed and this child has a lot of problem what you

do in this child you treat you make ultrasound during pregnancy so you have a lot of strategy but in this child you have to put an omaya valve so you are changing the risk of having an infection this child will be susceptible to a health care Associated infection acquired to the foreign body of the omaya reservoir and this is the cycle of the protoo this is directly this is the omaya valve that we discuss and here you have to imagine here is a tunel sometimes can be outside or you can put under the skin so

in this case here there is a tube going into the ventricle and here you see there is a tube going probably here is going to the subcl so they put under the skin can be also outside the skin and go into the periton and there are different option that those of you will be neurosurgeons will apply and this is can be for chemotherapy so this is the see coagul negative stai the organ is now are completely different we have to think from from pod you have to think about the Slime you have to think about

addition you have to think other properties which are not inia in influenza you will never find morous influenza in this set okay the bacteria are completely different what is interesting 24% is a good percentage is C bacterium acess that you will find in the block of the skin this is the cause of acne a very common infection of the skin all right and these are data for I cannot read exactly but 16 18 years so this was a very good stud and I presented the I included the data for for you malaria malaria is a

systemic disease and you remember you remember you can't remember you remember because you didn't because malaria will be in the he block which would be in September but probably yeah you remember something from pod is a systemic infection it affects the article endenial system splain omally also because of destruction of the red blood cells goes everywhere and can go to the brain look these are the capillaries they are full of plasmodium and this um it's not only the the amount of protozoa is that the protozoa they stick to the endo they damage the endium so

you can have occlusion because of the amount of parasites but also because of coagulation okay activation of the endium with all the Cascade that you know that you know about so and this is 99% is fatal be very careful last weekend we went to the Lakes Park down of RI beautiful fresh water what I saw I saw neia for I didn't see cryptosporidum I didn't see J because this is not the right place but I saw amiba warm water warm environment okay and then amiba can be high risk rain eating amiba you swim it goes

inside it goes through the atmo which is a very tiny lifl and goes to the gra we have this is is a am is an AM and this is the type of Legion that sorry the organis with the nucleus and this is the tropos white and is called brain eating amiba look this is a leion occupying space now is a space occupying leion you see is amoma we can call amoma like tuberculoma like granuloma we will see now some of these examples and this open a completely different diagnostic profile so what we have here we

have the abses from where come the absess the absess one important source of space occupying lesions in the brain which is mainly well we can have tuberculoma we can have cila but mainly is represented by absess comes from two major sources the mouth and The sinoses Chronic citis we just discuss this in the mouth you can have chronic parodontitis Google Google some image of chronic parodontitis there is destruction of the Ginga there is a hyper proliferation of anerobic bacteria and this can gain absess to the brain so poor oral hene sometimes even hene is useless

because there is a genetic familial basis on parodontitis and is a possible source of anerobic bacteria usually as you know from anerobic bacteria this is a mixed infection and it goes to the brain okay so we have different organism certainly anoses are playing a major role in space occupying leion when this space occupying lesions can be defined as absess in other cases the space occupying leion the first thing you have a 53 year old man and you see a picture like this you think about G okay this is the first but even you have to

put in the differential absess and the granet so you have to investigate for tuberculosis the chest R will be more than enough a vdrl for syphilis will be more than enough but you cannot exclude this type of leion okay so what we have mobian tuberculosis we discuss uh forget about histoplasma for you is too complicated now and one important is asperin we discuss already amiba and we discuss already Toxoplasma you see the this is terrifying and this patient probably he had seizure he had a ag so these are the initial symptom very specific okay luckily

that you are having M and C look okay why does it look blue H why is it blue in the this is [Music] computer the different colors depend on the density of the tissue this is the normal tissue okay this is pass fluid so has a different density and the computer give a different a different C so you understand if he a tumor will not be like this because here the tissue is destroyed by the protasis so you have like a fluid inside just the computer computer generated okay neurological SE in survivors is up to

80% so is a very severe infection and is very difficult to manage with systemic antibiotic okay because the penetration is very is very so Sur and are necessary okay I this is important young people 40 50 this is the or nothing specific it depends some of the symptoms and again as I told you oros are the most important so you have to think about mogen prella fteri NE completely different organ in this case more rarely the source is from abdominal most is from oral C and these are some of the bacteria you see thees they

are typical because of the branch they form what we call Chinese letter they have a way to divide if you remember basos is make like a ro after the other here no here they divide changing angles and they make this type of appearance under the microscope and this one is fuzo bacteria negative fuzo means um I don't know how to say in English is the instrument that you use for the pool when you take the O from the sheep and you have to make spinning wheel spin spinning with bra spinning whe okay thank you very

much this is fusobacteria very long very elegant and these are the names are terrible fusobacterium mortifer means producing death fusobacterium necro bringing the dead so the names are terrible all of them are can be involved in the brain absess because of their presence as normal microbiota in the oral cavity becoming predominant during periodontitis and these are the type of leion okay the type of Legion is a Gran similar to to it's just a space occupying Legion can have many different theologies okay space occupy what can we have look at the biopsy what you recognize bra

fungus but you are a phasa student which type of fungus is this one start with a Asus okay you see that as is the one that we were using As a Christian I mean for the holy water to asge asur from Latin so as perus there is holy water inside and we do like this to our our friends okay I know a tradition in om man when a guest come to your home you have Rose smelling water and you do like this to your guest as a sign of Welcome aspergilus flowers figat there are 760

species of aspergilus space occupy leion chronic infection is an absess is not exactly an AB abs are bacteria this is a granatus legion asper many different organism many many different species what are the major risk factor immun supression mostly leukemia mostly chemotherapy for L and this can be in the lung can be you will see as is a a disaster all right done any question any comment I know it's difficult it's difficult because you have to scan so many organism and to understand the different property so I try to give you some suggestion to make

the process easy and I'm sure the images will help will help a lot any queries before we move to the other important Group which are the viruses so we will go through some of the major viral organism some are included with the decision by in agreement with Dr ative because they were requested by student taking usle we are covering in average 60% of what required for USM so if you have if you want if you are planning to sit for USMLE examination you have to do some independent work we in this case in every block

we added something requested by the say the best student and I will point out to you what I'm talking about so this is the list and the star is indicating just a guide for you what what we will be discussing in more detail and what you will um approach in different in different blocks be very careful this is a PPL based um program and is a spiral program so don't expect to know all the microbiology in one block you are expected to complete the full program by the end of year three so so you will

be presented in different blocks to different organisms some will be like a review some will be new but don't worry okay some of these organism will be readdressed more in detail in other blogs where they are more pertinent but the list is already there for the time being you have to focus on some of them which one the one that we are discussing in the so for there will be no question on Ms although Ms is an important agent of many this and this is the other other groups we will discuss mostly ENT we will

review some heres nothing nothing special be very careful there are two points here one is the arthropod born viruses one example that we will not discuss is zika very famous transmitted by mosquito other that we will discuss very important USM related are the St Louis and sephtis the West n fever these are extremely important arthropod B transmitted by in I will briefly address rabbish a zootic disease we live near Mecca Road and we live near the and when I was going for my walking I was scared in the evening seeing six 10 dogs big this

size wild dogs and surely affected by rabies I told the student if you become minister of Health please take care of this probably some of them is a minister because I don't see the dogs anymore so they have taken action removing this possible source of infection I'm very I'm very happy I'm very proud of my student someone is a minister of he but before I'm talking 10 years ago it was impossible to walk near the W you saw this group of dogs terrifying so a big Improvement in the in the Kingdom what is fascinating about

the virus is the root how they reach the brain I we told about the vascular okay we told about penetration through bones here they travel along the nerves in a retrograde way so one gets an infection or how can I put it okay one I get an infection of herpes Sy then it disappear what happen of this herpes virus it goes back back back back through the trinal G and stay there quiet for days months years when it gets reactivated they travel again along the N is unique so imagine this is one traveling under the

myin sheet is a fantastic route of coing to reach to travel back and forth the gang we will discuss also some epidemiology I think is important enterovirus when I say enterovirus I say mostly Co the other enteroviral agents are more limited enterovirus is the majority bacteria you see is much less is much less involvement Aus virus has an important presence in the in the infection funi limit but this 2% are very delicate patient patient with high risk of dying of the infection because they have cancer they have leukemia they are under chemotherapy they are heavily

immuno suppressed what I want to point out to you that we have laboratory we have Imaging we have everything 20% remain unknown so please go back to the Tate Gallery picture okay and expect not to understand or not to make a diagnosis in a high number of cases although you are sending the proper sample to the lab although you are getting the most sophisticated uh Imaging still 20% of a theologies goes on know prab if you go to Paris and you you must go to two place if you go to Paris you can go everywhere

but two places you must go one is the saletri which is the famous Hospital especially for this block was the beginning of modern neurology with Professor sh and you have to go to The Institute p this is a statue of the child who was saved by Pastor with vaccination against rabis he was 14 years old I don't remember his name and he had been beaten by a dog and the pastor saved his life so we are talking about Rish and this is the virus the shape is unique and we call ballet ballet shape as you

see is a RNA obviously is a zootic zootic infection and is transmitted through the biting but not the biting is not necessary the virus is in the saliva so if you get in touch with the saliva the skin damage even the dog can lick you there is no need for biting okay the saliva is and you see the number of that is ific we have a very good vaccine for rabis but is not used prophylactically in human so I'm not recommending you to be vaccinated nobody's vaccinated against R why because Ravis is a classical therapeutical

vaccine we vaccinate only after a patient has been beaten and the animal has been proven to be rabid so it's used for therapy okay it's very strange it's very very unique and this is so it goes to through the brain traveling in the nerves okay is not going what you say the preferred way to reach the brain is through the nerves not through vascular root and these are the famous everybody knows the famous nry bodies what are the ne bodies are million of virus which viruses which are replicating in the cells and then they are

aggregating inside the cell and they didn't know they call nry nry bodies is a typical feature pathological feature of r one of the feature of rabis is there are many feature one that is most attractive to the common people is the inability to swallow we call hobia a dog which is rabid in the common Lang language is called hydrophobic what is the problem with Hydrophobia it's not that they don't wash okay they cannot drink water why they are not afraid of drinking the water they cannot because one of the feature is the paralysis of the

muscles so you give some water and they spit because they cannot drink this we call Hydrophobia if you if you read hypocrates 2,000 years ago this is already described is classical historical of okay and this is the vaccine already we discuss is not as other is therapeutical is given after not as a profis Now we move to the real issue and the real issue are the anro virus and you see there are many of them uh and we will concentrate on polio and we concentrate on Cox hepatitis will be addressed in another setting as you

understand in common what they have they are very small they are naked they are absolutely resistant in the environment one thing that I will leave Saudi without knowing where is where the sewage goes but if you go to check the sewage there will be billions of billions of billions of entov virus one of our PhD student G the one who is taking care of the lab she will do a study on the phases in the uh sewage just to look for potential antibiotics is a fascinating research project for her THD uh extremely resistant as you

see and they are single stranded positive R this is all common to the family all the entov viruses have this property very very small PO is 24 Nom uh forget about that this is just to show you that we will concentrate on this there is a beautiful book I suggest you to read read is called ignorance and so I put some time this slide so that you know how ignorant you are I am I don't know anything about after virus I think is animal animal is not affecting humans so I don't know anything about Veterinary

microbiology but ignorance is a big is the biggest problem all right so we will concentrate on this one they C many diseases the typical diseases that you will if you speak with any clinician any GP they will know for instance is hepatitis obviously myocarditis menitis which is the topic of our block and very typical disease which is called borol disease borol is a group of island in the Northern sea Denmark between Denmark and Norway and is called ploa is a form of acute citis so they cause many infection we will concentrate on some of them

for poo virus I'm going very superficially because now there is unfortunately only one country in which we have PO is very sad and is Pakistan and in Pakistan there is still an epidemic going on always they cannot get rid especially at the border with Afghanistan and this is the only country we were supposing to get rid of Po by the year 2000 we are in 2025 and still polio is with us unfortunately we have three stereotypes and this is important because in the vaccine the vaccine that are used everywhere you must include the three cot

types because there is very poor cross reactivity so it's possible to get polio three times so a vaccine is effective only if there are the three types so is important to know that PO is three C types and you see there is minimum heterotypic immunity among cypes FAL oral so finger food we know very well about this and this is only human not even the primates the chimpanzee which are very close to us 3% gen genetic diversity they don't get is only hum is we are the only one if we get R po will disappear

like box they enter through the intestine they cause a mild gastritis and they go systemically and they reach the brain especially polio reaches the Moto neurons of the anterior horns in the spinal cord these neurons are destroyed and polio is causing a flacy paralysis can be just a finger can be the arm can be arms and legs but one terrible terrifying location of the destruction are the neurons involving the muscle of the chest look this is the IR look this is New York 1958 look all this children they will spend their life if they don't

die earlier under this bash compressing and relieving compressing and relieving the chest which was the only way for them to breathe to be aive look a tragedy but then two people came I was so honored I know very well Professor seie who came to my university to give a seminar and they made the vaccine the first one was Suk who made a killer vacine needed for injection then the vaccine by Professor saing came uh there is a sebin vaccine center now in his memory and I think the University's partner scientific partner with this Center and

he made what a live uated what is the advantage of S which now at least in Europe is a disadvantage the advant is that you give following the natural route of infection so you give the drop right the classical Dr all of you are vaccinated so it goes to the intestine it stimulates the immune response a but it has no virence so does not penetrate contrary to the wild type it's stay in the intestine there is a little diarrhea little gastroenteritis one two days and then what happen of this live virus it is secreted in

the environment other children can be vaccinated you see the point is alive is spreading but is activated stimulates IG immunity okay but it doesn't invade the organism what happen in your Europe what we realize in Europe that in one out of 5 million [Music] vaccin there was a reverse to V so we had cases of polio Indus by the vaccine virus which through this passage from me to you okay it became again vage for this reason 10 15 years ago we stopped sing vaccination and we came back to Suk I am vaccinated with Suk 1950

okay 51 but no I was vaccinated later because in 15 I was vaccinated 1956 s was available s was not available now we went back to so because the risk of s is too high is higher than having volum all right in the Kingdom you have both because you are in a middle situation in Pakistan they have still seven clear so you have to adjust the use of the vaccine according to the epidemiology one is alive activated and the other is killed so when you inject you produce IG but when you eat you produce IG

that's completely different strategy and and then everything everything change everything change let's hope the Pakistan day but reach there is very difficult wow talking too much today to reach there is very difficult if you see the picture in Google Mountain tribe far away it's very difficult okay next time we start from C this is the Village from where they are coming and this is the Mississippi River oh no sorry this is the h have a great day doctor