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Parasitology Lab

Here are the key steps in practicing aseptic technique in the microbiology laboratory: 1. Wash hands thoroughly before and after procedures using antimicrobial soap. 2. Wipe down all surfaces and equipment with 70% ethanol or isopropanol before and after use. 3. Flame sterilize loops, needles, and other equipment before and after each use. 4. Work in a biological safety cabinet to prevent airborne contamination. 5. Avoid unnecessary touching or movement within the cabinet. 6. Properly dispose of all waste, used loops/needles, and contaminated materials. Maintaining strict aseptic technique is essential for obtaining accurate results and preventing laboratory acquired infections. Cont
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0% found this document useful (0 votes)
69 views78 pages

Parasitology Lab

Here are the key steps in practicing aseptic technique in the microbiology laboratory: 1. Wash hands thoroughly before and after procedures using antimicrobial soap. 2. Wipe down all surfaces and equipment with 70% ethanol or isopropanol before and after use. 3. Flame sterilize loops, needles, and other equipment before and after each use. 4. Work in a biological safety cabinet to prevent airborne contamination. 5. Avoid unnecessary touching or movement within the cabinet. 6. Properly dispose of all waste, used loops/needles, and contaminated materials. Maintaining strict aseptic technique is essential for obtaining accurate results and preventing laboratory acquired infections. Cont
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Pharmaceutical Microbiology and

Parasitology

PBS 3

Laboratory Manual

PREPARED BY: JEBB PATRICK M. DELOS SANTOS, RPh

1 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS
TABLE OF CONTENT
Worksheet Topic
No.
1 The Microscope
2 Aseptic Techniques
3 Different Culture Media
4 Different Staining Techniques
5 Case Discussion: Gastrointestinal Infections and
Cardiovascular Infections
6 Case Discussion: Infections of the Skin and Eye and
Zoonoses Infection
7 Case Discussion: Respiratory and Genitourinary
Infection
8 Case Discussion: Fungal Infections
9 Case Discussion: Protozoal and Helminth Infection
10 Case Discussion: DNA and RNA Viral Infection
11 Grand Case Presentation

2 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS
WORKSHEET 1: The Microscope

Group No:
Name: Date:
Section:
I. Objective of the Activity
1. Differentiate the types of microscopes in terms of features,
advantages/disadvantages, and their principal uses
2. Identify the parts of a microscope
3. Demonstrate the proper use of microscopes

II. Instruction: Answer the following questions regarding Microscope. Make your
answers concise and use reliable references. Please write all your references at
the last page of the activity.

1. What is Microbiology?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

2. What is a Microscope?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

3. Provide practices in the proper use of Microscope:


___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

4. Provide an illustration of a Compound Microscope and label its parts accordingly.

3 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS

This material is downloaded for Janelle Bianca G. Jimenez (20210014001)


at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
4 Pharmaceutical Microbiology and Parasitology (PBS 3)
SY 2022 – 2023 – VER 1 - JPMDS

This material is downloaded for Janelle Bianca G. Jimenez (20210014001)


at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
5. Differentiate the following types of microscopes:
Type Unique Features Principal Use
LIGHT MICROSCOPE
Brightfield

Darkfield

Phase Contrast

Differential
Interference
Contrast

Fluorescence

ELECTRON MICROSCOPE
Transmission
Electron
Microscopes

5 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS

This material is downloaded for Janelle Bianca G. Jimenez (20210014001)


at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
Scanning
Electron
Microscope

OTHERS
Confocal

Two Photon

Scanning
Acoustic

Scanning
Tunneling

Atomic Force

III. Additional Readings


1. Wasfi, O., Power, M., & Slavcev, R. A. (2010). Clinical Microbiology in
Pharmacy Education: A Practice-based Approach. Journal of microbiology
& biology education, 11(2), 135–139.
https://doi.org/10.1128/jmbe.v11i2.220

6 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS

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at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
IV. Activity
A. Quiz (Game)
o Parts of Microscope
o Different Type of Microscope
o Proper Use of Microscope

V. Reference

7 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS

This material is downloaded for Janelle Bianca G. Jimenez (20210014001)


at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
WORKSHEET 2: Aseptic Techniques

Group No: Date:


Name:
Section:
I. Objective of the Activity
1. Understand the proper way of working in a Microbiology Laboratory
through practicing Aseptic Techniques

II. Instruction: Answer the following questions regarding Aseptic Techniques.


Make your answers concise and use reliable references. Please write all your
references at the last page of the activity.

1. Define Aseptic Technique


___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

2. Differentiate the following terms:


TERMS DEFINITION
Sterilization

Disinfection

8 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS

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at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
Antisepsis

3. Provide at least 5 possible causes of contamination in the laboratory


___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

4. What is the difference between contamination and cross-contamination?


___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

5. Why are ethyl and isopropyl alcohol believed to be more potent at 70% than at
higher concentrations?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

6. Differentiate the following terms:


Term Description/Definition
Sterile Broth

9 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS

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at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
Bacterial Broth

Sterile Slant

Bacterial Slant

7. For the following aseptic technique, provide the step-by-step procedure:


Inoculation Techniques
Bacterial Broth
to Sterile Broth

Bacterial Slant
to Sterile Slant

10 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS

This material is downloaded for Janelle Bianca G. Jimenez (20210014001)


at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
Bacterial Broth
to Sterile Slant

Bacterial Slant
to Sterile Broth

Preparation of Smear
From Broth with
Fixing

From Slant
without Fixing

11 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS

This material is downloaded for Janelle Bianca G. Jimenez (20210014001)


at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
Pouring of Media
From a Flask

From a Pipette

III. Additional Readings

1. Aseptic Technique:
Link: https://www.healthline.com/health/aseptic-technique

IV. Activity
o Audio Visual Presentation:
i. How to Properly Inoculate from Broth to Broth, Broth to Slant, and
Broth to Plate
https://www.youtube.com/watch?v=Y1QaQY8NxH0
https://www.youtube.com/watch?v=I9XBRyl7nPo
ii. How to properly inoculate from Bacterial Slant to Sterile Slant
https://www.youtube.com/watch?v=IiGGmHXLm1o
iii. Preparation of Smear
https://www.youtube.com/watch?v=4evK8HV-0ZY
https://www.youtube.com/watch?v=c2BPE7wIK20
iv. Pouring of Media
https://www.youtube.com/watch?v=cneascR3OEc

12 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS

This material is downloaded for Janelle Bianca G. Jimenez (20210014001)


at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
V. Reference

13 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS

This material is downloaded for Janelle Bianca G. Jimenez (20210014001)


at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
WORKSHEET 3: Different Culture Media

Group No: Date:


Name:
Section:
I. Objective of the Activity
1. To identify the requirements for good culture media
2. To enumerate the different types of culture media
3. Differentiate Streak Plate and Pour Plate Culture Media Technique

II. Instruction: Answer the following questions regarding different culture media.
Make your answers concise and use reliable references. Please write all your
references at the last page of the activity.

1. Enumerate the requirements of a good culture medium:


___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
__________________________________________________________________________

2. Differentiate the following types of culture media:


Type Description Use/Examples
BASED ON CONSISTENCY
Solid

14 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS

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Liquid

Semi-solid

Biphasic

BASED ON NUTRITIONAL COMPONETS


Chemically
Defined Media
(Synthetic)

15 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS

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at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
Complex
Media (Non-
synthetic)

BASED ON FUNCTIONAL
Basal (Simple)
Media

Enriched
Media

Selective
Media

16 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS

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at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
Enrichment
Media

Differential
Media

Reducing
Media

SPECIFIC EXAMPLES OF CULTURE MEDIA


Blood Agar

17 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS

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at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
Chocolate
Agar

Lowenstein-
Jensen (L-J)
Media

Mueller Hinton
Agar

Thayer-Martin
Agar

18 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS

This material is downloaded for Janelle Bianca G. Jimenez (20210014001)


at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
Sabouraud
Dextrose Agar

MacConkey
Agar

Mannitol Salt
Agar

3. Differentiate Streak Plate and Pour Plate Method in terms of:

Streak Plate Pour Plate


Appearance

19 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS

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at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
Advantage

Disadvantage

Principle
Involved

Steps

20 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS

This material is downloaded for Janelle Bianca G. Jimenez (20210014001)


at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
III. Activity
o Quiz Game
i. Different types of Culture Media
o Audio Visual Presentation:
https://www.youtube.com/watch?v=SQC8_65auw8

IV. Reference

21 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS

This material is downloaded for Janelle Bianca G. Jimenez (20210014001)


at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
WORKSHEET 4: Different Staining Techniques

Group No: Date:


Name:
Section:

I. Objective of the Activity


1. To enumerate and differentiate the staining techniques based on their
reagents, procedures, and applications.

II. Instruction: Answer the following questions regarding different staining


techniques. Make your answers concise and use reliable references. Please
write all your references at the last page of the activity.

1. What is the reason behind the different staining techniques?


___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

2. Differentiate the following Staining Techniques based on the following:

Staining Reagents Used of Reagents Used of Staining


Gram

22 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS

This material is downloaded for Janelle Bianca G. Jimenez (20210014001)


at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
Negative

Acid-Fast

Spore

Capsule

23 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS

This material is downloaded for Janelle Bianca G. Jimenez (20210014001)


at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
3. Differentiate gram (+) from gram (-) bacteria by filling out the table below.
Visible Result
GRAM (+) GRAM (-)
After addition of
primary stain
solution

After addition of
Gram’s Iodine

After
decolorization with
alcohol

After addition of
counterstain

4. What are the advantages of negative stain over other staining methods?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

5. What are the precautions to be considered in performing the negative stain?


___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

6. What accounts for the acid-fast property of Mycobacterium sp.?


___________________________________________________________________________
___________________________________________________________________________

24 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS

This material is downloaded for Janelle Bianca G. Jimenez (20210014001)


at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

7. Explain why acid-fast stain a very useful diagnostic technique is


___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

8. Why is a spore more difficult to stain than the vegetative cell?


___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

9. Is the location (position) of a spore in a bacterial cell the same for all spore-
forming bacteria?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

10. What kind of chemical substance(s) constitutes the capsules of bacteria?


___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

11. What are some of the physiological roles ascribed to capsular substances?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

25 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS

This material is downloaded for Janelle Bianca G. Jimenez (20210014001)


at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
12. Provide Pictures of the results of the following staining:

Staining Reagents
Gram

Negative

Acid-Fast

Spore

26 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS

This material is downloaded for Janelle Bianca G. Jimenez (20210014001)


at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
Capsule

III. Activity
1. Audiovisual Presentation
i. Gram Staining: https://www.youtube.com/watch?v=sxa46xKfIOY
ii. Negative Staining: https://www.youtube.com/watch?v=HlP0Wha6f_E
iii. Acid-Fast Staining:
https://www.youtube.com/watch?v=yMxUHAsjo8k
iv. Spore Staining: https://www.youtube.com/watch?v=-sSE-hEYrVY
v. Capsule Staining: https://www.youtube.com/watch?v=0_cEdk1gx2A

IV. Reference

27 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS

This material is downloaded for Janelle Bianca G. Jimenez (20210014001)


at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
WORKSHEET 5: Case Discussion: Gastrointestinal Infections
and Cardiovascular Infections

Group No: Date:


Name:
Section

I. Objective of the Activity


1. To familiarize the different causative agent that leads to Gastrointestinal
Infections and Cardiovascular Infections
2. To describe the common signs and symptoms and determine the proper
action that should be taken both pharmacologic and non-pharmacologic.

II. Instruction: Answer the following questions regarding Gastrointestinal and


Cardiovascular Infections. Make your answers concise and use reliable
references. Please write all your references at the last page of the activity.

1. Differentiate the term INFECTION and INTOXICATION based on GI Infection.


___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

2. Differentiate the following terms:


TERMS DEFINITION
Diarrhea

Dysentery

Gastroenteritis

28 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS

This material is downloaded for Janelle Bianca G. Jimenez (20210014001)


at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
3. Complete the following table:

Disease Causative Transmission Signs and Treatment


Agent Symptoms
Staphylococcal
Enterotoxicosis

Peptic Ulcer
Disease

Shigellosis

Salmonellosis

29 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS

This material is downloaded for Janelle Bianca G. Jimenez (20210014001)


at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
Typhoid Fever

Cholera

E. Coli
Gastroenteritis

Campylobacter
Gastroenteritis

30 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS

This material is downloaded for Janelle Bianca G. Jimenez (20210014001)


at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
4. Define the following terms:
Terms Definition
Infective
Endocarditis

Acute
Endocarditis

Sub-acute
Endocarditis

Rheumatic
Fever

III. Activity: Case Discussion


Case 1: Patient JPMD is 27 years old. During the bacterial culture, the causative
agents was described as Slightly curved, Gram-negative rod with a
single polar flagellum. Upon history taking, the physician confirmed this because of
the record of eating contaminated food and water or by drinking water after
watermelon, uncooked food, and fruits.

After a 24–48 h, some symptoms begin with the sudden onset of painless watery
diarrhea that quickly become voluminous and is often followed by vomiting. Its main
symptoms are vomiting and diarrhea and because of this disease, the patient suffers
severe dehydration.

He vomits if he eats or drinks anything. After a day, his color become pale yellow, and
he became weak due to dehydration (severe loss in water) by loose motions and
vomiting. In the first day of infection, he drank some rehydration solutions, but it was
not very effective. He also felt severe pain in stomach.
He experienced accompanying abdominal cramps and no fever was recorded.

31 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS

This material is downloaded for Janelle Bianca G. Jimenez (20210014001)


at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
The result of the laboratory results are as follows:

Guide questions:
1. What is the causative agent of the infection?
2. What are the general characteristics of the bacterium present?
3. What is the common mode of transmission of the infection?
4. Described the signs and symptoms of the infection
5. What is the other diagnostic test that can be used to diagnose the infection?
6. Provide prevention strategies for this infection
7. Provide the primary treatment for this infection
Case 2: Patient CDR, a normally fit Tahitian boy aged 10 years, presented to his
community clinic with a 1-week history of fever, worsening breathlessness and nausea
leading to loss of appetite in August 2016. On clinical examination, he was sweating,
tachycardic and a murmur of grade 3/6 was noted. He also stated he had a sore
throat 3 months previously, which was dismissed as trivial due to its intermittent
nature. His mother highlighted a rash on the upper aspects of both thighs. He had
intermittent hip and knee pain for the 12 months, resulting in limping and reduced
mobility—emphasised by the fact he was visiting his neighbour much less than usual.
He commented on a 3-month history of a change in handwriting at school, and a
greater tendency to drop objects, suggestive of a subtle chorea. There was no
significant medical history. The birth history includes a 2-week stay in hospital after
birth due to ongoing fevers. The social history includes residing with three other
family members in a two-bedroom apartment; however, there are occasions when
family members stay for periods of time and the household can exceed nine persons.

32 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS

This material is downloaded for Janelle Bianca G. Jimenez (20210014001)


at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
Upon doing a bacterial cultured in a blood agar plate, a gram-positive coccus,
nonmotile, and nonsporulating bacteria was seen. Also, a formation of beta hemolysis
was observed. (Please picture below)

Guide Questions:
1. What is the causative agent of the infection?
2. What are the general characteristics of the bacterium present?
3. What is the common mode of transmission/pathophysiology of the infection?
4. Described the signs and symptoms of the infection
5. What is the other diagnostic test that can be used to diagnose the infection?
6. Provide prevention strategies for this infection
7. Provide the primary treatment for this infection

IV. Reference

33 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS

This material is downloaded for Janelle Bianca G. Jimenez (20210014001)


at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
WORKSHEET 6: Case Discussion: Infections of the Skin and
Eye and Zoonoses Infection

Group No: Date:


Name:
Section

I. Objective of the Activity


1. To familiarize the different causative agent that leads to skin, eye and
zoonoses infection.
2. To describe the common signs and symptoms and determine the proper
action that should be taken both pharmacologic and non-pharmacologic.

II. Instruction: Answer the following questions regarding Gastrointestinal and


Cardiovascular Infections. Make your answers concise and use reliable
references. Please write all your references at the last page of the activity.

1. Provide the common causative agents for the infection that targets the skin and
eyes.
Region Common Causative Agent
Skin

Eyes

34 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS

This material is downloaded for Janelle Bianca G. Jimenez (20210014001)


at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
2. Differentiate the following types of acne based on the following:
Type Description Treatment
Comedonal

Inflammatory

Nodular
Cystic

3. Differentiate the different types of Skin infections:


Disease Causative Agent Description (S/Sx) Treatment
Scalded
Skin
Syndrome

35 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS

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at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
Impetigo

Erysipelas

Necrotizing
Fasciitis

4. Differentiate the following Eye Infections:


Disease Causative Agent Description (S/Sx) Treatment
Conjunctivitis

Ophthalmia
neonatorum

36 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS

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at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
Trachoma

5. Differentiate the following Zoonoses Infection based on the following:


Disease Causative Common Signs and Treatment
Agent/Animal Transmission Symptoms
Source
Brucellosis

Anthrax

Plague

Tularemia

37 Pharmaceutical Microbiology and Parasitology (PBS 3)


SY 2022 – 2023 – VER 1 - JPMDS

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at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
Lyme
Diseases

Rickettsia
Infection

III. Activity: Case Discussion


Case 1: ACF, a 4-year-old Caucasian boy with is observed to have blistering skin
syndrome. He had no relevant medical history and no use of medication prior to this
event. No allergies were known, and he had been vaccinated, according the Dutch
vaccination program.
He presented to an emergency room with a history of loss of appetite, constipation,
and agitation of 1-week duration. Furthermore, he experienced pain at his buttocks,
lower back, thorax, and face. In addition, skin lesions started in the peri buccal area
and appeared after rubbing of the skin (Nikolsky’s sign). At physical examination,
erythema and exfoliation were present. He was apyretic. Mucous membranes were
not affected. Exfoliation affected 10% of his total body surface area (TBSA).
Laboratory tests revealed no signs of infections: leukocyte count (L) of 7.4 × 109 and
C-reactive protein (CRP) was 3 mg/l. Further investigation was performed, including
skin cultures and biopsies. After gram staining, it was observed as clusters resembling
bunch of grapes.
Images:

Figure 1 Superficial exfoliation of the lower Figure 2 Superficial exfoliation of


back and gluteal region the face

38 Pharmaceutical Microbiology and Parasitology (PBS 3)


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Guide Questions:
1. What is the causative agent of the infection?
2. What are the general characteristics of the bacterium present?
3. What is the common mode of transmission/pathophysiology of the infection?
4. Described the signs and symptoms of the infection
5. What is the other diagnostic test that can be used to diagnose the infection?
6. Provide prevention strategies for this infection
7. Provide the primary treatment for this infection

Case 2: Patient CKS was a 65-year-old blind man, living in countryside of Birjand, the
center of South Khorasan province located in southeast of Iran. The case-patient
mainly lived alone in the past 3 months due to his wife’s death. He had a history of
keeping animals including some sheep and goats at home, but his animals were not
infected. He had a long history of COPD. But his symptoms had started a week ago.
The symptoms had not improved despite antibiotic treatment and therefore, the
patient was referred to us at the medical center of the province. He characterized with
mild fever, dyspnea, non-bloody sputum, anorexia, and myalgia. In primary
examination, he had a blood pressure of 120/80 mmHg, respiratory rate of 24 per
minute, pulse rate of 90 beats per minute, and a temperature of 37.6 °C. In physical
examination, he had no skin rash, ulcer, and necrosis in his face and extremities, and
also no symptoms of icterus were observed. Lung auscultation revealed a slightly
hoarse voice. The patient had no signs of meningeal irritation and chest x-ray was
normal.
Initial tests of the patient were as follows: White blood cell = 7.3 × 103/µL,
Neutrophils = 85 %, Hemoglobin = 13.2 g/dl, Hematocrit = 42.2 %, Platelet = 137 ×
103/µL, ESR = 19, CRP = 2+, Urine analysis = normal.
By physical examination, patient was diagnosed as exacerbation of COPD or
pneumonia and received intravenous ceftriaxone and azithromycin. Despite 3 days of
treatment, his symptoms did not change and the patient became slightly disoriented.
Because of the intermittent sleepiness, lack of signs of meningeal irritation and lack of
his next of kin consent, the patient did not undergo lumbar puncture, but blood
samples were sent to the laboratory for examination.
The first blood sampling was taken on the 1st day of admission but the results were
reported to the ward on the 3rd day. According to laboratory reports, microscopic
blood samples revealed presence of gram-positive streptobacilli. Blood culture on
blood agar showed growth of creamy coarse grayish texture with irregular borders
colonies without hemolysis looking like a jellyfish. In the next stage, by conducting a
number of microbial enzymatic and metabolic tests, including motility, gelatin

39 Pharmaceutical Microbiology and Parasitology (PBS 3)


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hydrolysis, bacterial sensitivity to penicillin, string of pearls test and sugars
fermentation
On the 3rd day of hospitalization, the chest x-ray of the patient was repeated, which
showed closed right side angles, wide mediastinum, and opacities in lower region of
the lung.
With regard to blood culture results and x-rays of the patient, the antibiotic was
changed to ciprofloxacin, clindamycin, and penicillin. Moreover, the patient’s blood
and lung secretion samples were sent to the National Reference Laboratory to repeat
the culture and subsequently to do PCR.
On the 2nd day of treatment, the patient was complicated with jaundice, elevation of
liver enzymes, and a significant drop in hemoglobin, hematocrit, and platelet despite
lack of obvious bleeding and this was complicated with respiratory distress and
sepsis. The patient was finally died a week after treatment. Autopsy was not
performed because of discontentment of patient’s family.
The doctor requested bacterial culture and seen the following observations:
1. Endospore forming, aerobic and g(+) rod
2. gram-positive rod-shaped bacilli with square ends.

Guide Questions:
1. What is the causative agent of the infection?
2. What are the general characteristics of the bacterium present?
3. What is the common mode of transmission/pathophysiology of the infection?
4. Described the signs and symptoms of the infection
5. What is the other diagnostic test that can be used to diagnose the infection?
6. Provide prevention strategies for this infection
7. Provide the primary treatment for this infection

40 Pharmaceutical Microbiology and Parasitology (PBS 3)


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IV. Reference

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WORKSHEET 7: Respiratory and Genitourinary Infection

Group No: Date:


Name:
Section:

I. Objective of the Activity


1. To familiarize the different causative agents that leads to respiratory and
genitourinary infection.
2. To describe the common signs and symptoms and determine the proper
action that should be taken both pharmacologic and non-pharmacologic.

II. Instruction: Answer the following questions regarding Respiratory and


Genitourinary Infections. Make your answers concise and use reliable
references. Please write all your references at the last page of the activity.

1. Differentiate the following Upper and Lower Infection based on the following
criteria:

Disease Causative Agent Signs and Symptoms Treatment


Pharyngitis

Diphtheria

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Pertussis

Tuberculosis

Legionnaire’s
Disease

2. Differentiate the following cause of pneumonia

Cause Transmission Symptoms Prevention Treatment


Pneumococcal

Mycoplasma

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Respiratory
Syncytial Virus
Disease

Pneumocystis
pneumonia

*CA: Causative Agent


3. Enumerate the normal biota seen in the following organ of reproductive system:
Organ Normal Biota
Urethra

Female
Genitalia

Male
Genitalia

44 Pharmaceutical Microbiology and Parasitology (PBS 3)


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4. Differentiate the following infections of Urinary and Reproductive System:
Disease S/Sx CA Transmission Prevention Treatment
UTI

Leptospirosis

Gonorrhea

Vaginosis

Syphilis

*S/Sx – Signs and Symptoms, CA – Causative Agent

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III. Activity: Case Discussion
Case 1: A 10-year-old male child with unknown immunization history, living away
from his parents, was apparently healthy when he presented to a local primary care
practitioner with 2 days of high-grade fever, cough with expectoration, and mild
swelling of the neck. After initial management for another 5 days, the patient was
taken to a secondary care center in view of worsening cough and neck edema. There,
the patient was clinically suspected to have an infection characterized as Gram-
positive nonmotile, club-shaped bacillus and crystalline penicillin was administered,
following which antitoxin was arranged. However, toxigenic symptoms continued,
and patient was shifted to a tertiary care center. The child was admitted to the
pediatric ICU and was started on 60% oxygen via venturi, IV fluids, inotropic support,
and antibiotics.
Examination revealed anemia (Hb = 8.8 g/dL), leukocytosis (26.4 103/μL), and mild
edema of lower limbs. Tonsils were congested, partially covered with a grayish-white
membrane, and severely tender. Upper motor neuron facial nerve palsy and
palatopharyngeal incompetence (9th and 10th cranial nerves) were also noted on
examination. Mild hepatomegaly and deranged liver functions was also noted
(aspartate aminotransferase = 4266 IU/L; alanine aminotransferase = 4398IU/L).
Chest radiograph revealed cardiomegaly with pulmonary plethora. In view of
significant nephrotic proteinuria (24 h urine protein = 224 mg/m2/h) and acute
kidney injury (serum creatinine = 4.82 mg/dL), renal functions were maintained with
diuresis and fluid resuscitation.
Guide Questions:
1. What is the causative agent of the infection?
2. What are the general characteristics of the bacterium present?
3. What is the common mode of transmission/pathophysiology of the infection?
4. Described the signs and symptoms of the infection
5. What is the other diagnostic test that can be used to diagnose the infection?
6. Provide prevention strategies for this infection
7. Provide the primary treatment for this infection

Case 2: Patient ZND, 21-year-old Swiss female clerk, residing since her birth in a
countryside village in the canton of Zurich, presented with painless red patches and
scaling, ulcerated, weeping nodules of up to 2 cm in diameter. The skin lesions were
symmetrically located in the face, neck and upper parts of the trunk and arms.
Mucous membranes, palms and soles were not affected, and regional
lymphadenopathy was absent. Aside skin lesions, the patient suffered from

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headache, but without systemic symptoms such as fever, malaise, or weight loss. Two
months before the visit to our clinic and soon after the onset of symptoms, a private
dermatologist diagnosed a pyoderma on grounds of the inflammatory aspect of skin
lesions and the detection of Staphylococci by the cultivation of skin swabs taken from
the facial nodules and the nasal vestibule. Because the treatment with topical and
systemic fusidic acid did not improve skin lesions, a histological examination of two
lesioned punch biopsies was performed. Histopathology showed inflammatory
infiltrate at the dermo epidermal junction (interface dermatitis) and non-caseating (ie,
non-necrotizing) granulomas in the whole dermis with multinucleated giant cells,
eosinophil leucocytes and plasma cells. Standard and specific staining (PAS, Brown-
Brenn-Gram, Ziehl-Neelsen) did not reveal fungal, bacterial or mycobacterial
infection. Based on histopathology with granulomas, a cutaneous sarcoidosis was
proposed and treatment with oral corticosteroids initiated. With that, skin lesions
slightly improved, but steroids had to be aborted owing to adrenal insufficiency
(fasting cortisol 100 nmol/l). Because skin lesions persisted, the patient was
presented to our clinic.
The patient reported to be in a stable heterosexual relationship, and having had
sexual contact with two clinically healthy men within the last 2 years before the onset
of symptoms. She could not recall genital, anal, or oropharyngeal ulceration prior to
current symptoms.

Figure 3 Clinical images of the 21-year-old patient. (A) Erythematous patches, papules and plaque-like skin lesions
in the face. (B) Excoriated plaques on the neck

Guide Questions:
1. What is the causative agent of the infection?
2. What are the general characteristics of the bacterium present?
3. What is the common mode of transmission/pathophysiology of the infection?
4. Described the signs and symptoms of the infection
5. What is the other diagnostic test that can be used to diagnose the infection?
6. Provide prevention strategies for this infection
7. Provide the primary treatment for this infection

47 Pharmaceutical Microbiology and Parasitology (PBS 3)


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IV. Reference

48 Pharmaceutical Microbiology and Parasitology (PBS 3)


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WORKSHEET 8: Case Discussion: Fungal Infections

Group No: Date:


Name:
Section:
I. Objective of the Activity
1. To familiarize the different causative agents that causes different types of
fungal infection
2. To describe the common signs and symptoms and determine the proper
action that should be taken both pharmacologic and non-pharmacologic.

II. Instruction: Answer the following questions regarding fungal infections. Make
your answers concise and use reliable references. Please write all your
references at the last page of the activity.

1. Differentiate the different types of Fungal Infections:


Type Description Examples
Superficial

Cutaneous

Subcutaneous

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Systemic

Opportunistic

2. Complete the table below regarding the drugs for Fungal Infection:
Class MOA Example Side Effects
Polyene

Azoles

Allylamine

Echinocandins

Antimetabolites

50 Pharmaceutical Microbiology and Parasitology (PBS 3)


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3. Differentiate the following Fungal Diseases of Skin and Nails

Disease CA Signs and Symptoms MOT and Treatment


Tinea
Versicolor

Ringworm*

Candidiasis

Sporotrichosis

*For Ringworm infection, please indicate all types


* MOT – Mode of Transmission

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4. Differentiate the following Fungal Diseases of Nervous System and Respiratory
Tract

Disease CA Signs and Symptoms MOT and


Treatment
Cryptococcosis

Coccidioidomycosis

Histoplasmosis

Pneumocystis
Pneumonia

III. Activity: Case Discussion


Case 1: JKE, a 12-month-old male infant, Caucasian, Italian, in good general health,
with no history of recent fever or any other symptoms. The patient was evaluated for
erythematous scalp lesions and annular patches combined with hair loss (Fig.

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(Fig.1).1). The infant had not been in contact with animals; her mother and other
family members were asymptomatic. No other systemic symptoms were elicited. The
Wood’s light examination revealed a brilliant green fluorescence on the scalp lesions.
Other laboratory test was performed such as mycological analysis, fungal culture to
check the causative agent.

Guide Questions:
1. What is the causative agent of the infection?
2. What are the general characteristics of the bacterium present?
3. What is the common mode of transmission/pathophysiology of the infection?
4. Described the signs and symptoms of the infection
5. What is the other diagnostic test that can be used to diagnose the infection?
6. Provide prevention strategies for this infection
7. Provide the primary treatment for this infection
Case 2: A 37-year-old Japanese man presented to our hospital with a nonproductive
cough of two weeks in duration. He did not have fever or dyspnea. He had a history of
right hemiparesis, intellectual disability with pica, and symptomatic epilepsy caused
by intracerebral hemorrhage, which occurred at two years of age. He had never
smoked or consumed alcoholic beverages.
His initial vital signs were as follows: blood pressure, 105/55 mm Hg; pulse rate, 70
beats/minute; respiratory rate, 18 breaths/min; SpO2, 93% in room air; body
temperature, 36.5°C. There was no lymphadenopathy. Auscultation revealed no
chest rales. A cardiovascular examination was normal, and no murmurs, rubs, or
gallops were detected. Abdominal and neurological examinations were
unremarkable, and the patient had no rash or petechiae. A chest radiograph revealed
bilateral diffuse infiltration.
The patient’s laboratory test values were as follows: hemoglobin, 14.9 g/dl; white
blood cell count, 8,850/mm3 with a left shift; platelets, 329,000/mm3; serum
aspartate aminotransferase 29 U/L (normal, 0-35 U/l); serum alanine

53 Pharmaceutical Microbiology and Parasitology (PBS 3)


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aminotransferase, 31 U/L (normal, 0-35 U/l); serum lactate dehydrogenase, 425 U/L
(normal, 119-229 U/l); serum total protein, 5.3 g/dl (normal, 6.5-8 g/dl); serum
albumin, 2.1 g/dl (normal, 4-5 g/dl); serum C-reactive protein, 9.18 mg/dl (normal, <
0.2 mg/dl); serum KL-6, 2940 U/ml (normal, < 500 U/ml); serum surfactant protein D,
173.0 ng/ml (normal, < 109.9 ng/mL); and serum surfactant protein A, 115.0 ng/ml
(normal, < 43.8 ng/mL). The patient’s serum was negative for rheumatoid factor and
antinuclear antibodies. The serum levels of immunoglobulin M, G, and A were within
the normal ranges. An electrocardiogram revealed normal findings. An examination
of the patient’s sputum showed no predominant pathogen, and no acid-fast
organisms were observed on staining. Two sets of blood cultures were prepared at
the time of admission; however, they did not yield any organisms.
The patient underwent a fiberoptic bronchoscopic examination that revealed a
normal endobronchial system, and combined bronchoalveolar lavage
(BAL)/transbronchial biopsy (TBLB) was performed. BAL fluid (BALF) was obtained
from the right middle lobe. The results of the BALF analysis were as follows:
histiocytes, 87%; neutrophils, 6%; lymphocytes, 4%; and eosinophils, 3%. Routine
cultures of bronchial the washings were negative. The TBLB sample from the right
upper lobe revealed alveolar septal thickening due to chronic inflammation, as well
as collagen-type fibrosis.
After these examinations, the patient was diagnosed with acute interstitial
pneumonia, and intravenous levofloxacin (500 mg) was administered once daily with
corticosteroid pulse therapy (methylprednisolone [1000 mg] for three days) followed
by prednisolone (1 mg/kg/day). On the 5th day after the initiation of therapy, his
respiratory condition worsened and noninvasive positive pressure ventilation was
started. His interstitial pneumonia was thought to be getting worse, and
cyclophosphamide (500 mg/body) was administered intravenously. On the same day,
an additional examination revealed the elevation of the serum (1-3) β-D glucan (BG)
level (104.3 pg/ml; normal, <6.0 pg/ml). He was therefore suspected to have fungal
infection or PCP, and voriconazole (200 mg, every 12 hours) and sulfamethoxazole
trimethoprim (1600 mg and 320 mg, respectively, every 8 hours) were started. An
additional HIV antibody test was negative and the serum protein electrophoresis
revealed normal findings. Despite the additional antifungal therapy, his respiratory
status gradually worsened, and intravenous corticosteroid pulse therapy
(methylprednisolone [1000 mg] for three days) and cyclophosphamide therapy (500
mg/body) were each administered a second time, on the 8th and 11th days,
respectively, without improvement. The patient died due to respiratory failure on the
12th day.
Guide Questions:
1. What is the causative agent of the infection?

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2. What are the general characteristics of the bacterium present?
3. What is the common mode of transmission/pathophysiology of the infection?
4. Described the signs and symptoms of the infection
5. What is the other diagnostic test that can be used to diagnose the infection?
6. Provide prevention strategies for this infection
7. Provide the primary treatment for this infection

IV. Reference

55 Pharmaceutical Microbiology and Parasitology (PBS 3)


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WORKSHEET 9: Case Discussion: Protozoal and Helminth
Infection
Group No: Date:
Name:
Section:
I. Objective of the Activity
1. To familiarize the different causative agents of protozoal and helminthic
infection.
2. To describe the common signs and symptoms and determine the proper
action that should be taken both pharmacologic and non-pharmacologic.

II. Instruction: Answer the following questions regarding Protozoal and


Helminthic Infection. Make your answers concise and use reliable references.
Please write all your references at the last page of the activity.

1. Differentiate the following terms:


Endoparasites Ectoparasites

Infection Infestation

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2. Differentiate the following Protozoal Infections:
Disease CA MOT S/Sx Tx
Amoebiasis

Giardiasis

Trichomoniasis

Malaria

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African
Sleeping
Sickness

American
Sleeping
Sickness

3. Differentiate the following:


Description Examples
Trematodes

Cestodes

Nematodes

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4. Differentiate the following Helminthic Infections:
Disease CA MOT S/Sx Tx
Paragonimiasis

Schistosomiasis

Taeniasis

Filariasis

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River Blindness
Disease

Ascariasis

III. Activity: Case Discussion


PROTOZOAL INFECTION CASE
Case 1: Patient CFR, a four-month-old male infant from a rural district in
Khorramabad, southwest Iran was brought to the emergency room of the Lorestan
University of Medical Sciences Hospital with history of refusal of feeds, hyperactive
bowel sound, vomiting, and change in stool texture. The patient also had episodes of
retching and mild abdominal distension. The mother suffered abdominal pain and
had history of diarrhea.

The complete blood count showed a leukocyte count of 7800 μL with eosinophilia of
7%. The results of biochemistry tests were as follows: Na (130.0 mEq/L), Ca
(10.4 mg/dL), and total protein (4.6 g/dL). The urine analysis and culture were normal
and negative, respectively. Direct examination of fresh fecal samples using Lugol's
iodine solution and the concentration technique showed like a colorless (transparent)
jelly moving across the field very slowly as they change shape.

Laboratory Results:

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Guide Questions:
1. What is the causative agent of the infection?
2. What are the general characteristics of the bacterium present?
3. What is the common mode of transmission/pathophysiology of the infection?
4. Described the signs and symptoms of the infection
5. What is the other diagnostic test that can be used to diagnose the infection?
6. Provide prevention strategies for this infection
7. Provide the primary treatment for this infection

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HELMINTHIC INFECTION
Case 2: A 32-year old female homemaker presented to the orthopedic out-patient
department with complaints of a painless swelling over the lateral aspect of her left
upper arm for five months. There was no antecedent history of injury or trauma. There
was no history of similar swelling elsewhere in the body or of constitutional symptoms
associated. On examination, there was a 2x2.5cm non-tender, immobile swelling
which was firm in consistency and adherent to the skin . It was not warm to touch.
There were 2-3 lymph nodes, non-tender, in the left axilla. The systemic examination
was normal. Hematological investigations were completely normal.

Fine needle aspiration cytology (FNAC) was done, with aspiration of about 0.3ml of
clear fluid. The smear showed presence of thin, slender colorless thread like larvae
with blunt head and tail tip free of nuclei were identified. The patient was started on
oral Diethylcarbamazine 100mg thrice a day for 21 days. There was a tremendous
decrease in the swelling at the end of four weeks. There was disappearance of the
axillary lymphadenopathy at the end of three months. The patient was closely
followed-up for two years and showed no signs of recurrence.

Guide Questions:
1. What is the causative agent of the infection?
2. What are the general characteristics of the bacterium present?
3. What is the common mode of transmission/pathophysiology of the infection?
4. Described the signs and symptoms of the infection
5. What is the other diagnostic test that can be used to diagnose the infection?
6. Provide prevention strategies for this infection
7. Provide the primary treatment for this infection

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IV. Reference

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WORKSHEET 10: Case Discussion: DNA and RNA Viral
Infection

Group No: Date:


Name:
Section:
I. Objective of the Activity
1. To familiarize the different causative agents of viral infection.
2. To describe the common signs and symptoms and determine the proper
action that should be taken both pharmacologic and non-pharmacologic.

II. Instruction: Answer the following questions regarding Viral Infection. Make
your answers concise and use reliable references. Please write all your
references at the last page of the activity.

1. Differentiate the following Herpes Virus:


Disease CA/ MOT Signs and Symptoms Treatment and
Prevention
HSV 1

HSV 2

64 Pharmaceutical Microbiology and Parasitology (PBS 3)


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Chicken Pox and
Shingles

Infectious
Mononucleosis

Cytomegalovirus
Disease

Roseola

Kaposi Sarcoma

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2. Differentiate the following Hepatitis Infection:
Diseases CA MOT & S/Sx Treatment Prevention
Hepatitis A
Infection

Hepatitis B
Infection

Hepatitis C
Infection

Hepatitis D
Infection

Hepatitis E
Infection

3. Differentiate the following RNA Viral Infection


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Diseases CA MOT & S/Sx Treatment Prevention
Poliomyelitis

Dengue
Fever

Covid-19

Rabies

HIV

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Ebola

4. Differentiate QUARANTINE and ISOLATION

QUARANTINE ISOLATION

III. Activity – Case Discussion


Case 1: A 28-year-old female presents to the clinic with a 10-day history of flu-like
symptoms, including anorexia and malaise. She does not report any pertinent prior
medical history or surgeries. She takes no medications. Her family history is
noncontributory, and she reports no sick contacts. She is sexually active with multiple
partners and has used oral contraceptives regularly for the past 12 years. She has not
traveled outside the United States in the past 5 years.
On physical examination, she is alert and oriented, in no acute distress. Her vital signs
are temperature of 99.9°F, pulse 78/minute, respirations of 18/minute, and blood
pressure of 121/78 mm Hg. Her extraocular muscles are intact; however, mild scleral
icterus is noted. Heart sounds are regular rate and rhythm without murmurs, and
lungs are clear to auscultation bilaterally. The abdomen is soft and nontender, except
the liver is tender when palpated and extends 8 cm below the costal margin, with a
smooth edge.
Laboratory Result:

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Guide Questions:
1. What is the causative agent of the infection?
2. What are the general characteristics of the bacterium present?
3. What is the common mode of transmission/pathophysiology of the infection?
4. Described the signs and symptoms of the infection
5. What is the other diagnostic test that can be used to diagnose the infection?
6. Provide prevention strategies for this infection
7. Provide the primary treatment for this infection

Case 2: A 38-year-old male with no significant past medical or surgical history


presented to the emergency department (ED) with complaints of fever, headache,
retro-orbital pain, and myalgia of one-week duration. The patient reported high-
grade intermittent fever for the past seven days that was associated with rigors and
chills. His other complaints included reddish-colored urine with clots for two days
along with two episodes of gum bleed. The pertinent denials included sore throat,
chest pain, shortness of breath, vomiting, abdominal pain, diarrhea, burning
micturition, dysuria, urinary frequency, and contact with animals. On physical
examination, the patient was vitally stable, oriented to person, place and time, and
had mild conjunctival pallor. On skin examination, there were multiple purpuras and
petechiae on the left shoulder, trunk, and both legs, and two large ecchymotic lesions
on the patient's back. The rest of the systemic examination was unremarkable.
The baseline workup done in the ED was normal except for a low platelet count of
20,000 x 109/L and a low white blood cell (WBC) count of 2.4 x 109/L. The patient
was admitted in the isolation ward. The tourniquet test was performed, which turned
out to be positive. The patient was treated conservatively with acetaminophen one
gram three times a day and one liter infusion of normal saline twice daily. The patient
continued to have reddish-colored urine and had one more episode of gums bleed
on his third day of admission with a platelet count of 6,000 x 109/L. Infectious
diseases department was consulted who recommended transfusion six units of

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platelets. Platelet count continued to deteriorate further with a count of 2,000 x 109/L
on his sixth day of admission but with clinical improvement in his fever and bleeding
manifestations. The patient was monitored daily with blood counts and bleeding
manifestations. The patient improved clinically on the 11th day of his admission with
no hemorrhagic manifestations and normalization of blood counts (platelet count 112
x 109/L and WBC count 6.3 x 109/L). The patient was discharged home with a follow-
up appointment one month later.

Guide Questions:
1. What is the causative agent of the infection?
2. What are the general characteristics of the bacterium present?
3. What is the common mode of transmission/pathophysiology of the infection?
4. Described the signs and symptoms of the infection
5. What is the other diagnostic test that can be used to diagnose the infection?
6. Provide prevention strategies for this infection
7. Provide the primary treatment for this infection

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WORKSHEET 11: Grand Case Discussion

Brief Description of the Community


The municipality of Celebes is the only upland municipality with a coastal area in the
province of Tubigan. It is bounded on the east by Habagat Bay, on the north by the
municipality of Sta. Clarita, on the west by the municipality of Gising-gising, and on
the south by the municipality of Sta. Cruz. It is about 90 km from the nearest city and
capital of the province and 480 km from Manila. Celebes has a total land area of 81.5
sq. km. It is a fourth-class municipality composed of 12 barangays. There are only two
(2) distinct seasons – wet and dry. The dry season begins in March and ends in August
while the wet season lasts from September to February.
Population
Total Population for the baseline year
Celebes has an estimated population of 23,921 in 2018 (5,754 households)
distributed in 12 barangays.
Population Density
The municipality of Celebes has a total land area of 81.5 sq. km. and a population
density of 294 persons per sq. km. Thirty-nine percent of the population is below 15
years old. The average age is around 17 years old. Around 51 babies are born every
year, and there are more than 20 elderly persons per barangay.
Population by Age and Sex
When it comes to sex distribution, males are less dominant in numbers compared to
females. There were 98 males for every 100 females in the population in the year
2019.
Economic Reference
Celebes is a predominantly agricultural municipality. The principal agricultural
products include rice, mangoes, abaca, apples, vegetables, and root crops. Mango is
the town's most valuable agricultural product. A great majority of the municipality’s
land area is covered by forest. The forest supports a developing industry of various
forest products that include wood and bamboo. Because of the frequent hunting and
deforestation practices, some wildlife such as wild pigs and chickens have become
nearly extinct.

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Another industry of the municipality that is gaining popularity is fishing. Half of the
barangays in the municipality are known for their rich fishing grounds. In order to
help boost the fishing industry of the entire province, two (2) fishing port-wharf were
constructed in Barangay Alon and Agos.
The average family size has risen steadily and is now at 4.0. A family earns an average
of Php 7,500 a month. The heads of families work as farmers, fishermen, sidewalk
vendors, or pedicab drivers. The women on the other hand sell fruits, vegetables, or
fishes in the public market situated in the heart of Barangay Amihan. There are also
men employed as temporary laborers in construction firms in nearby municipalities.
During payday, they would usually go out together for a drinking spree, karaoke
singing, and smoking. Most of the occupations available in the municipality are
sporadic in nature.
Unemployment
Celebes is a 4th income class municipality, with an unemployment rate of 29% (2019),
which is higher compared to the previous rate of 19.8% (2018). Within the
municipality, approximately 81% of total land is devoted to agricultural use.
Electrification
An electric company, Sinag Electric, located in the province capital, Sanaya, supplies
electricity to Celebes. Most households in Celebes have electric appliances such as
television sets and electric fans. Only a few households have refrigerators, cooking
stoves, and computers. Almost all households across all barangays have access to
mobile phones. According to municipal data, only 68.27% of households are
energized. Some residents use kerosene as an alternative energy source for lighting
purposes.
Table 1. Households in Celebes with Electrical Services, 2019

Number of
Total Percentage
Households

Households with Electrical


3,928 5,754 68.27%
Connection

Households without
1,826 5,754 31.73%
Electrical Connection

The road network of the municipality represents only 2% of its total land area.
Because of this road condition, most barangays remain not easily accessible. There is
no regular transportation across all barangays and the utilization of pedicabs is quite

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costly, especially for most residents, thus they prefer to walk to and from their
location.
Most residents live in low-lying places. When it rains heavily even for a short span of
time only, most areas get flooded. Maintaining good roads is a difficult endeavor
because of this problem. There is also poor drainage. Flooding is very common.
Usually, floods last for weeks during the rainy season. As per an interview with one
barangay captain, wading in flood water is a norm in their municipality. Because of
these problems, it is difficult to maintain satisfactory sanitation in the community.
Environmental Indices
Safe Water Supply
According to municipal data, 59% of the total households in Celebes have access to
safe drinking water. The Celebes Water District (CWD) is a level III water system
serving seven of the 12 barangays in the municipality; the remaining five barangays
are not being served due to problems with installation of pipelines. Some of the
residents obtain their drinking water from deep wells located in different areas in the
community. The residents make use of water containers for storage. On regular days,
people, both children and adults, are usually seen taking a bath near deep wells.
Waste Disposal
Garbage collection poses a problem in the municipality. There is no regular method
of garbage collection because of budget constraints in the Local Government Unit
(LGU) for the said service. There is also no Materials Recovery Facility (MRF) in the
municipality. Most residents resort to dumping their garbage into different bodies of
water. There is also a lack of sanitary toilet facilities. Residents, especially children,
defecate in bodies of water. Insects and other vermin such as rats also pose a threat
and these populations have increased in the recent years.
Forty-six percent (46%) of the total household in Celebes have sanitary toilet facilities.
Those without comprise 54%. The latter population disposes of their human wastes
using the “balot system” in which they mix waste with other domestic wastes, deposit
them in open latrines, or just dispose them in bodies of water. Several problems
faced by the municipality in relation to solid waste management include: zero to low
collection coverage, irregular collection services, open dumping, burning without air
and water pollution control, breeding of flies, and handling and control of scavenging
activities.
Table 2. Waste Disposal in Celebes, 2019

Type of Disposal No. of Households Percentage

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With Sanitary Toilets 2651 46%

With Unsanitary Toilets 3004 52%

No Toilets 99 2%

Commercial Establishments
There is only one (1) public market in the community and most remote barangays
have difficulty accessing it. Some residents visit adjacent municipalities for their food
and grocery needs. In total, there are 83 commercial establishments, and 41 are sari-
sari stores. There are also fruit and vegetable stalls, fish and meat shops, and farm
suppliers. Currently, there are 29 existing food establishments (e.g.
bakeries, carinderias, etc.), but only 59% have sanitary permits. Only 49% of the 86
food handlers in the municipality have been issued health certificates.
Table 3. Number of Sanitary Permit and Health Certificate Granted in Celebes,
2019

No. Percentage

Food Establishment 29

Food Establishments with


17 59%
Sanitary Permit

Food Handlers 86

Food Handlers with Health


42 49%
Certificate

Around schools, food vendors sell their products. Not only school children buy from
these vendors but also majority of the residents since most are not used to cooking
meals at home. They prefer to buy food from vendors since it is more convenient—it
saves time so they can have more time watching their favorite soap operas. When
vendors were asked what food products are usually bought from them, they
answered that residents usually buy fish balls, kikiam, fried orange quail eggs, gizzard
barbecue, one-day old, and sweet beverages. There are also vendors of burgers,
fries, and chips in food stalls around the schools. At home, especially for the fisher
folks, water products like fish, small crabs, and snails are the usual meals. Since not all
have cooking appliances, they usually it these seafood “kinilaw” or “paksiw” style.
During special occasions such as birthdays, backyard-raised pigs are slaughtered,
and fresh meat is simply soaked in salt, vinegar, and certain spices.

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Socio-Cultural Reference
Education
In total, there are 11 elementary schools, 1 secondary school, and 1 vocational school
located in different barangays. The literacy rate in Celebes was 69% in 2019, a
decrease of 3 percentage points from the 2018 rate of 72%.
Health Facilities and Manpower
Since Celebes is a fourth-class municipality, there are no public or government
hospitals. There is only one rural health unit located in the largest barangay, Barangay
Bagyon. The RHU has one (1) medical doctor who is from the Doctors to the Barrios
(DTTB) program of the Department of Health. He serves as the Municipal Health
Officer (MHO). There is also one (1) Public Health Nurse, one (1) Public Health
Associate, two (2) Public Health Midwives, one (1) Municipal Nutrition Action Officer,
one (1) Sanitary Inspector, one part-time Medical Technologist (who also serves the
neighboring municipalities), and one (1) Administrative Aide. The RHU staff are
assisted by 28 Barangay Health Workers. Out of the 12 barangays, only 7 have
Barangay Health Stations. Pre-natal care services are offered in selected Barangay
Health Stations (every Wednesday) and at the RHU (daily) from 8:00AM to 3:00PM.
Immunization services for newborns are available in the RHU only (services available
daily). In order to get a medical consultation with the MHO, residents need to secure
a referral note from the Barangay Health Station that they are under. For patients that
shall require special treatment/ hospitalization, there is a need to go to the nearest
city (found in the neighboring municipality, the Municipality of Sta. Clarita). Others
opt to go to a government hospital which is 90 km away. The table shows the health
facility to population ratio.
Table 4. Health Facility to Population Ratio, 2019

Health Facility Number Ratio to Population

Rural Health Unit 1 1:23,921

Barangay Health Station 7 1:3,417

Health Status of the Population


The crude birth rate (CBR) remains to be relatively unchanged within the 5-year
period but there was a significant increase in the year 2019. There was also an
increase in crude death rate from 6/1,000 in 2016 to 12/1,000 in 2019.
Maternal Health

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There were five (5) cases of maternal deaths in 2015, three (3) in 2016, four (4) in
2017, and three (3) in 2018. In 2019, there were six (6) cases of maternal mortality
reported. Based on the interviews with pregnant women, most of them complain of
easy fatiguability.
Other Health Status Indicators
The Expanded Program on Immunization (EPI) is being implemented on the
municipality. The fully immunized child (FIC) rate was 70% in 2019.
Nutritional Status
The municipality has its very own Municipal Nutrition Action Officer (MNAO) who
directly monitors the nutritional status of preschool children from 0 to 71 months.
These children are weighed on an annual basis. The nutritional status of these
children is classified as very low, low, normal, or above normal as determined by their
weight-for-age. On the other hand, the nutritional status of school children was
determined by their weight-for-height. The current nutritional status of preschool and
school children in Celebes are shown in the following tables:
Table 5. Nutritional Status of Preschool Children in Celebes, 2019

Nutritional Status Preschool Number

Very Low 109

Low 976

Normal 2877

Above Normal 102

Table 6. Nutritional Status of School Children in Celebes, 2019

Nutritional Status Preschool Number

Below Normal 1076

Normal 2409

Above Normal 188

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The MNAO, in coordination with the MHO, ensures that nutritional programs are
being successfully implemented in the municipality. Malnutrition is one of the priority
problems in the municipality and several programs are being implemented to
address it, with the focus on the undernourished. There is supplemental feeding of
the undernourished with one meal a day for the duration of 3 months in selected
barangays, Mother’s classes are being conducted to provide education on proper
child feeding, and the Food Always in the Home (FAITH) program is being
implemented with the aim of ensuring food security in the home by means of
gardening and animal and livestock raising. There is also iron and vitamin
supplementation and the Operation Timbang which is done yearly.
Child Feeding
Infants are breastfed for four (4) months, thereafter mixed with solid foods and milk
substitutes. It was found that those mothers attended by traditional hilots only start
breastfeeding 3 days after birth because the hilots advised mothers to throw away the
first milk secretions since it is considered ‘spoiled’. Upon introduction of milk
substitutes, mothers usually give filled milk or condensed milk. Rice gruel and
mashed potatoes are the first solid food given to children at 4 months. At around 1
year, children share the same food shared on the table in the household. The usual
meal pattern of children is comprised of rice and sauce from meat dishes/ food
products bought from nearby vendors.

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CASE ANALYSIS
Based on the latest available health records, the causes of illnesses in the municipality
were described as follows (your group number is your case no.):
Case 1: Chronic productive cough (with occasional sputum and blood) in 15 adult
individuals of both sexes, who also reported chest and/or back pain, fever, night
sweats, weakness, loss of weight, and easy fatiguability. TUBERCULOSIS
Case 2: Ten cases of fever with chills, muscle aches, and fatigue, five (5) of the
patients developed anemia and yellowing of the skin and eyes. One (1) patient
developed seizures and was later reported dead. All patients live close to bodies of
water where insect vectors are present in increased numbers.
Case 3: Cases of high-grade fever, headache, muscle pain, abdominal pain, diarrhea,
vomiting, and slight yellowing of the eyes in 10 males and two (2) females, all adults
working in a construction site who were stranded there for one (1) whole day due to
the great flood last September.
For your written report and oral presentation, based on the brief description of the
signs/symptoms presented, determine the most probable disease condition, and
prepare a presentation that will highlight the following:
1. Provide a brief background of the municipality
2. Probable diagnosis of the condition described
3. Probable etiologic agent/s responsible
4. Host factor/s
5. Environmental factor/s
6. Laboratory test/s which will help confirm the diagnosis (Note: the test/s need not
be available in the setting presented)
7. Brief description of the current DOH control program in the Philippines
8. Objectives and strategies of the DOH control program
9. Your group’s proposed approaches and activities to meet program targets in
Celebes
10. Two identified gaps, issues, or challenges to the control program in Celebes
11. Proposed approaches to deal with these gaps, issues, or challenges
12. Means of verification/ parameters for success

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