1. 인간의 세균성 질병들 (Bacterial Diseases of Humans) Slate-Wipers and Current Concerns 19

2. 호흡기매개 세균 질병 (Airborne Bacterial Diseases) The impact of bacterial disease on history –Captain Cook(1778) and the South Pacific Syphilis( 매독 ) Tuberculosis( 결핵 ) Pertussis( 백일해 ) –Black death( 흑사병 ) spread to Europe from Asia –Cholera spread to Europe from India –Conquest of the New World by Columbus, Cortez, and Pizarro Infectious diseases that devastated naïve native populations Greater impact than all the military might that was brought from Europe

3. 호흡기매개 세균질병 (Airborne Bacterial Diseases) Streptococcal disease ( 연쇄상구균성 질병 ) –Streptococcus pyogenes Strep throat( 급성인후염 ) Childbed fever( 산욕열 ) Necrotizing fasciitis( 근막염 ) (flesh-eating disease) Scarlet fever( 성홍열 ) –Streptococcus mutans Tooth decay( 충치 ) Rheumatic heart disease ( 류마티즘 심장질환 ) –Enterococcal illnesses GI tract infection –Treatment Antibiotics Fig. 19.1 Streptococci Reprinted with permission from the American Society for Microbiology (Tao, L., Tanzer, J.M and MacAlister, T.J.; J. Bacteroil, 1987 June; 169(6): 2543-2547.) Reprinted with permission from the American Society for Microbiology (Fluckiju, U. and Fischetti, V.A.; Infect. and Immun, 1998 March; 66(3): 974-979.) Photo courtesy of Doctor Vincent A. Fischetti. Courtesy of Vincent A. Fischetti, Ph.D., Head of the Laboratory of Bacterial Pathogenesis at Rockefeller University

4. Airborne Bacterial Diseases 디프테리아 (Diphtheria) –Caused by Corynebacterium diphtheriae –Prevented by toxoid vaccination – 디프테리아 - 파상풍 - 백일해 백신 내에 포함되는 디프테리아 유독소 백일해 (Pertussis) : 파괴된 세포들과 점액이 기도에 침착되어 호흡곤란을 일으킨다. –Also known as whooping cough( 백일기침 ) –Caused by Bordetella pertussis –Disintegrating cells and mucus accumulate in airways( 기도 ) –Debris causes labored breathing –Prevented by toxoid vaccination –Re-emerging as problem in Eastern Europe

5. Airborne Bacterial Diseases 세균성 수막염 (Bacterial meningitis) –Disease of meninges( 뇌막, 수막 ), membranes that cover brain –Most severe is meningococcal meningitis Caused by Neisseria meningitidis Accompanied by –Pounding headache( 두통 ) –Stiff neck( 목의 마비 ) –Numbness in extremities Starts as upper respiratory infection( 상 기도 감염 ) Toxins can spread from bloodstream and cause rapid death Transmissible as aerosol or through shared utensils or cups –Childhood meningitis : 생후 6 개월부터 2 년사이의 어린이들에 발생 Typically caused by Haemophilus influenzae or Streptococcus pneumoniae Vaccine available for both causes : Hib 백신, 치료약으로는 rifampin

6. Airborne Bacterial Diseases: Bacterial Meningitis( 세균성 수막염 ) Fig. 19.2 Neisseria meningitidis ( 그람음성 쌍구균 ) Reprinted with permission from the American Society for Microbiology (ASM News. July 1998, Vol. 64, Cover.)

7. Airborne Bacterial Diseases 결핵 (Tuberculosis) –Caused by Mycobacterium tuberculosis Extremely resistant to desiccation –Tubercle( 결절 ) –Granuloma( 육아종 ) –Sometimes called consumption( 폐결핵 ) –Purified protein derivative test (PPD) –Treatment Antibiotics –Rifampin –Ethambutol –Isoniazid –Pyrazinamide Vaccine –BCG –Appearance of multi-drug-resistant TB (MDR-TB)

8. Airborne Bacterial Diseases: Tuberculosis Fig. 19.3 The progress of tuberculosis

9. Airborne Bacterial Diseases 레지오넬라증 (Legionairre’s disease 재향군인병 ) –Caused by Legionella pneumophila Grow in standing water ( 냉각탑, 산업용 에어컨, 가습기, 수영장 및 물 웅덩이 등이 세균의 서식지로 밝혀졌다.) –Cooling towers –Industrial air-conditioning unit –Humidifiers Hard to grow in laboratory –Signs( 증산은 열, 약간의 가래를 동반하는 마른기침 및 폐의 감염. Fever Dry cough with little sputum Potentially fatal lung infection

10. Airborne Bacterial Diseases 세균성 폐렴 (Bacterial pneumonia) –Microbial disease of the bronchial tubes( 기관지 ) and lungs –Infection usually results in significant fluid infiltration into lungs –Can be caused by many agents, including Streptococcus pneumoniae( 폐렴쌍구균 ) –Signs ( 고열, 격심한 흉부 통증, 호흡곤란 및 폐의 기낭으로 혈액이 침투하여 생기는 적갈색 가래 등을 동반한다.) High fever Sharp chest pains Difficulty breathing Rust-colored sputum (from blood in lungs) –Treatment of both with antibiotics

11. Airborne Bacterial Diseases 기타 호흡기성 질병 (Other respiratory diseases) –Q fever( 큐열 ) Caused by Coxiella burnetii Signs ( 심한 두통, 고열, 마른기침 및 폐 표면에 병변을 동반한다.) –Severe headache –High fever –Dry cough –Occasionally, lesions on lung surface –Psittacosis( 앵무병 ) : 삼 뿐만 아니라 앵무새, 카나리아, 비둘기 및 닭과 같은 새들에게도 발병한다. Caused by Chlamydia psittaci Transmitted by inhaling infected bird droppings –Chlamydial pneumonia ( 클라미디아성 폐렴 ) Caused by Chlamydia pneumoniae Similar to primary atypical pneumonia

12. 식품매개 및 수인성 세균 질병 (Foodborne and Waterborne Bacterial Diseases) Botulism( 보틀리누스 중독증 ) –Caused by Clostridium botulinum Spore-forming obligate anaerobes –Botulism toxin as bioterrorism agent 1 pint(0.568 L) of pure material could eliminate world population 1 ounce(28.35 g) would kill all the people in the United States –Toxin produced by spores that germinate Canned foods –Signs ( 섭취한지 몇 시간내에 시야가 흐릿해지고, 발음이 분명하지 않으며, 음식을 삼키고 씹지 못하고, 호흡곤란 및 진행성 마비를 동반하며 1-2 일 이내에 사망한다.) Slurred speech Labored breathing Flaccid paralysis –Botox as cosmetic agent –Once toxin enters bloodstream, only treatment is antitoxin( 항독소 )

13. Foodborne and Waterborne Bacterial Diseases Staphylococcal food poisoning –Caused by Staphylococcus aureus –Signs similar to most food poisoning cases( 복부경련, 구역질, 구토, 설사 등을 동반한다.) Diarrhea Vomiting Other signs of gastrointestinal distress Salmonellosis( 살모넬라증 ) –Caused by various Salmonella species –Sources may be poultry, contaminated animals, eggs –Signs similar to most food poisoning cases ( 발열, 구토, 설사 및 격심한 복부경련 ) Fig. 19.6 Salmonella © Scimat/Photo Researchers, Inc. Courtesy of Dr. W.L. Dentler

14. Foodborne and Waterborne Bacterial Diseases 장티푸스 (Typhoid fever) –Caused by Salmonella typhi –Spread by not washing hands during food preparation –Signs ( 심한 궤양과 혈변을 유발한다. 혈액에 침투한 다음, 몇일이 지나면 환자는 고열, 혼수상태 및 광란상태 등을 동반한다.) Deep intestinal ulcers Bloody stools In a few days, mounting fever Lethargy Delirium If left untreated, frequently fatal –Antibiotic treatment

15. Foodborne and Waterborne Bacterial Diseases: Typhoid Fever Fig. 19.7 Reported cases of Typhoid Fever in the United States by year, 1967 to 1999

16. Foodborne and Waterborne Bacterial Diseases 세균성 이질 (Shigellosis) –Sometimes called bacterial dysentery –Caused by four different species of Shigella –Signs ( 격렬한 경련과 소량의 잦은 점액성 혈변 ) Intense abdominal cramps Small-volume, bloody, mucoid stools –Shiga toxins Cholera –Caused by Vibrio cholerae –Severe watery diarrhea may lead to death due to dehydration Fig. 19.8 Vibrio cholerae Courtesy of Louisa Howard, Dartmouth College, Electron Microsocpe Facility Courtesy of Janice Carr/CDC

17. Foodborne and Waterborne Bacterial Diseases 대장균성 설사 (E. coli diarrheas) –Sometimes called “Hamburger disease” Traveler’s diarrhea –Caused by subset of Escherichia coli Enterohemorrhagic E. coli (EHEC) 출혈성 대장염 –O157:H7 Enteropathogenic E. coli (EPEC) Enterotoxigenic E. coli (ETEC) Enteroinvasive E. coli (EIEC) Enteroaggregative E. coli (EAggEC) –Spread from contaminated animal feces Water supplies Raw ground meat

18. Foodborne and Waterborne Bacterial Diseases 소화성 궤양 (Peptic ulcer disease) –Many cases caused by Helicobacter pylori –Survival in very low pH of stomach acid ( 세균은 위장의 점액 피복을 통과하여 위장 벽에 부착한다. 거기서 이 세균은 주변의 요소를 분해하여 최종산물로 암모니아를 생산하는 우레아제 (urease) 라는 효소를 분비하여 암모니아를 생성하여 위산을 중화하고 위 조직을 파괴한다. –Treatment with antibiotics

19. 그림 19.9 소화성 궤양의 진행. ( 소화성 궤양의 대부분이 Helcobacter pylori 균에 의해 발생 )

20. Campylobacteriosis ( 가벼운 설사, 위장 통증, 복부통증, 혈변 등을 동반한다.) –Caused by Campylobacter jejuni –Characterized with typical gastrointestinal distress signs Listeriosis ( 두통, 목 경직, 의식혼탁 및 혼수상태 등을 동반한다.) –Caused by Listeria monocytogenes –Transmission from contaminated food –Treated with antibiotics Brucellosis( 동물에 있어 몇몇 장기에 나타나고, 합병증으로 생식불능이 된다. 사람에도 감염되며 독감과유사한증상과 관절통 및 고열을 동반한다. –Caused by different species of Brucella –Affecting elk and bison in Yellowstone National Park Sterility Spontaneous abortion

21. Foodborne and Waterborne Bacterial Diseases Other intestinal disease –Vibrio parahaemolyticus Causes intestinal distress associated with contaminated seafood –Vibrio vulnificus Associated with bad oysters and clams –Bacillus cereus Spore-forming bacteria that cause food poisoning May contaminate rice stores –Yersinia enterocolitica Fever, diarrhea, abdominal pain

22. 토양매개 세균 질병 (Soilborne Bacterial Diseases) 탄저병 (Anthrax) –Sometimes called wool sorter’s disease –Caused by Bacillus anthracis Spore-forming Gram-positive bacteria –Spread by Aerosol inhalation of spores Ingestion of spores Entrance of spores into open wounds –Spores germinate and vegetative cells make fatal toxin –Signs ( 피부에는 검은 외피로 덮여 있는 부스럼과 유사한 병변이 나타난다. 장에서는 혈변을 동반한 심한 설사가 발생한다.) Organs fill with black, bloody fluid Black, crusty, boil-like lesions Violent dysentery with bloody stool Frequently fatal –Potential as bioterrorism weapon –Antibiotic therapy Fig. 19.10 Bacillus anthracis Courtesy of CDC/James H. Steele © Phototake/Alamy Images

23. Soilborne Bacterial Diseases 파상풍 (Tetanus) –Also called lockjaw –Caused by Clostridium tetani Spore-forming obligate anaerobes –Acquired from environment Soil-contaminated nail Piece of glass Dirty needle –Spores germinate under skin –Vegetative cells produce tetanus toxin Rigid paralysis( 마비 ) Can lead to death –Tetanus toxoid vaccine

24. Soilborne Bacterial Diseases 가스괴저 (Gas gangrene) –Caused by Clostridium perfringens Spore-forming obligate anaerobe –Spores germinate in tissues Vegetative cells ferment muscle carbohydrates Putrefy muscle proteins Producing copious amounts of gas that tear tissue apart –Signs Intense pain at wound Swelling at wound Extremely foul odor Site turns dull red, then green, and finally blue-black If not treated, rapidly leads to death –Treatment Antibiotics Debridement Amputation Hyperbaric oxygen

25. 절지동물매개 세균 질병 (Arthropodeborne Bacterial Diseases) 페스트 (Plague) –Also called The Black Death –Caused by Yersinia pestis –Transmitted by infected fleas( 벼룩 ) Infected rats bitten by fleas Fleas regurgitate bacteria when taking next blood meal from people –Two forms Bubonic plague: flea bite Pneumonic plague: bacteria inhaled from cough of infected person –Signs Grossly swollen, blue-black bubos (lymph nodes 림프선종 ) Nearly 100% mortality –Exists endemically in US in prairie dogs Fig. 19.11 A direct fluorescent antibody stain (DFA) of Yersinia pestis (x200) Courtesy of Larry Stauffer, Oregon State Public Health Laboratory/CDC

26. Arthropodeborne Bacterial Diseases 야토병 (Tularemia) –Also called rabbit fever –Caused by Francisella tularensis –Transmitted from blood of infected animals through cuts in skin –Potential bioterrorism agent

27. Arthropodeborne Bacterial Diseases 라임병 (Lyme disease) –Transmitted by bite of infected deer tick( 사슴진드기 ) –Caused by Borellia burgdorferi –Characteristic bullseye rash Never appears in up to 1/3 of cases –If left untreated, result is severe, potentially chronic joint pain –Treatment with antibiotics Fig. 19.12 Borrelia burgdorferi and the Lyme disease rash (erythema chronicum migrans) © Science VU/Visuals Unlimited Reprinted with permission from the American Society for Microbiology (Brusca, J.S., McDowall, A.W., Norgard, M.V. and Radolf, J.D.; J. Bacteriol, 1991 December; 173(24): 8004-808) Photo courtesy of Doctor Justin D. Radolf. Courtesy of A. Garon, Rocky Mountain Laboratory/NIAID

28. Arthropodeborne Bacterial Diseases 재발성 열 (Relapsing fever) –Caused by Borrelia recurrentis –Transmitted by lice or tick bite –Signs, which may reappear up to ten times over the course of weeks Substantial fever Shaking chills Headache Prostration( 피로 ) Drenching sweats

29. Arthropodeborne Bacterial Diseases 록키산 발진열 (Rocky Mountain spotted fever) –Transmitted by tick( 진드기 ) bite –Caused by Rickettsia rickettsii –Signs High fever of many days Pink spotted skin rash that develops into maculopapular rash Rash starts on palms and soles and spreads to trunk –Treatment with antibiotics 발진티프스 (Typhus fever) –Transmitted by head and body lice –Caused by Rickettsia prowazekii –Fever, rash, and potentially death Fig. 19.13a The tick (Ixodes) Fig. 19.13b The body louse (Pediculus) Courtesy of Jim Gathany/CDC © Oliver Meckes/Photo Researchers, Inc.

30. 성적으로 전파되는 질병 (Sexually Transmitted Diseases) 매독 (Syphilis) –Caused by spirochete Treponema pallidum –Spirochetes penetrate skin and cause disease –Three stages Primary syphilis –Chancre( 경성하감 ) –Disappears after 2-6 weeks Secondary syphilis –Systemic lesions –Fever –Rash( 발진 ) –Patchy loss of hair on head Tertiary syphilis –Gumma( 고무종 ) –Paralysis( 마비 ) –Insanity( 정신이상 )

31. Sexually Transmitted Diseases 매독 (Syphilis) –Treatment with antibiotics Penicillin effective against primary and secondary syphilis Usually too late to intervene during tertiary syphilis Fig. 19.14 Treponema pallidum, the agent of syphillus Courtesy of the CDC Courtesy of Susan Lindsley/CDC

32. Sexually Transmitted Diseases 임질 (Gonorrhea) –Also called “the clap” –Caused by Neisseria gonnorhoeae –Can cause pelvic inflammatory disease and sterility –Treatment with antibiotics 클라미디아 증 (Chlamydia) –Caused by Chlamydia trachomatis –Frequently no signs of infection in males –Female signs and symptoms Slight vaginal discharge Inflammation of cervix Burning pain upon urination –Can result in scarring of Fallopian tubes and sterility

33. Sexually Transmitted Diseases Other sexually transmitted diseases –Chancroid Caused by Haemophilus ducreyi Painful, shallow, saucer-shaped ulcer that bleeds easily –Lymphogranuloma venereum (LGV) Caused by Chlamydia trachomatis Fever, malaise, and swelling and tenderness of inguinal lymph nodes –Granuloma inguinale Caused by Calymmatobacterium granulomatis Granular ulcer that bleeds easily –Vaginitis Many causes, including Gardnerella vaginalis Foul-smelling discharge

34. Sexually Transmitted Diseases Other sexually transmitted diseases –Ureaplasmal urethritis Caused by a mycoplasma, Ureaplasma urealyticum Signs and symptoms similar to those of gonorrhea and chlamydia –Mycoplasmal urethritis Caused by Mycoplasma hominis or Mycoplasma genitalium

35. Contact and Miscellaneous Bacterial Diseases 나병 (Leprosy) –Also called Hansen’s disease –Caused by Mycobacterium leprae Acid-fast bacillus that resists desiccation –Spread by multiple skin contacts or aerosol droplets –Signs Disfigured skin and bones Twisted limbs Curled fingers Loss of sensation in extremities Loss of extremities –Leper colonies

36. Contact and Miscellaneous Bacterial Diseases Staphylococcal skin disease –Caused by Staphylococcus aureus Normal flora –Appears as Boils Carbuncles Abscesses –Spread by skin contact –Methicillin-resistant S. aureus –Toxic shock syndrome

37. Contact and Miscellaneous Bacterial Diseases: Staphylococcal Skin Infection Fig. 19.16 A) Staphylococci at the base of a hair follicle; B) A severe abscess on the head of a young boy Courtesy of CDC

38. Contact and Miscellaneous Bacterial Diseases Conjunctivitis and trachoma –Conjunctivitis Also called pinkeye Caused by many different bacteria, including Haemophilus aegyptius Spread by aerosol droplets from close contact Effective antibiotic therapy –Trachoma Caused by Chlamydia trachomatis Also eye infection, like pinkeye Spread by contaminated fingers, towels, etc. Needs figure of pinkeye

39. Contact and Miscellaneous Bacterial Diseases Animal contact diseases –Pasteurelossis Caused by Pasteurella multocida –Common inhabitant of pharynx of cats and dogs –Rat-bite fever Caused by Streptobacillus moniliformis or Spirillum minor –Cat-scratch disease Also called cat scratch fever Most likely caused by Bartonella henselae –Leptispirosis Caused by Leptospira interrogans

40. Contact and Miscellaneous Bacterial Diseases Dental diseases –Dental caries –Caused by many bacteria that are normal flora Streptococcus mutans Streptococcus viridans Streptococcus mitis Streptococcus salivarius Lactococci –Fermentation of sugars results in acid production –Acid destroys hard enamel coating –Effective prophylaxis is best treatment Good oral hygiene Regular trips to dentist

41. Contact and Miscellaneous Bacterial Diseases Urinary tract disease –Typically associated with normal gastrointestinal residents infecting urogenital tract –Bacteria enter through urethra and migrate to bladder, ureters, kidneys –Typical signs Abdominal discomfort Burning pain on urination Frequent urges to urinate –Causes Proteus mirabilis Proteus vulgaris Morganella morganii Escherichia coli Enterococcus faecalis –Treatment Cranberry juice Antibiotics