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Since these lesions are not sites of initial infection, they are signs of a systemic infection.
Sometimes a **primary infection**, the initial infection caused by one pathogen, can lead to a **secondary infection** by another pathogen. For example, the immune system of a patient with a primary infection by HIV become... | {
"Header 1": "**15.2 How Pathogens Cause Disease**",
"Header 2": "**Molecular Koch's Postulates**",
"token_count": 942,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
#### **Learning Objectives**
- Explain how virulence factors contribute to signs and symptoms of infectious disease
- Differentiate between endotoxins and exotoxins
- Describe and differentiate between various types of exotoxins
- Describe the mechanisms viruses use for adhesion and antigenic variation
In the previ... | {
"Header 1": "**15.3 Virulence Factors of Bacterial and Viral Pathogens**",
"token_count": 392,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
| Pathogen | Disease | Adhesin | Attachment Site |
|-----------------------------------|------------------------|-------------------------------|---------------------------------|
| Streptococcus pyogenes | Strep throat |... | {
"Header 1": "**15.3 Virulence Factors of Bacterial and Viral Pathogens**",
"Header 2": "**Some Bacterial Adhesins and Their Host Attachment Sites**",
"token_count": 2029,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
anthracis* is ingested by phagocytic cells of the immune system, phospholipase C degrades the membrane of the phagosome before it can fuse with the lysosome, allowing the pathogen to escape into the cytoplasm and multiply. Phospholipases can also target the membrane that encloses the phagosome within phagocytic cells. ... | {
"Header 1": "**15.3 Virulence Factors of Bacterial and Viral Pathogens**",
"Header 2": "**Some Bacterial Adhesins and Their Host Attachment Sites**",
"token_count": 1742,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
| Category | Example | Pathogen | Mechanism and Disease |
|-... | {
"Header 1": "**15.3 Virulence Factors of Bacterial and Viral Pathogens**",
"Header 2": "**Some Bacterial Adhesins and Their Host Attachment Sites**",
"token_count": 2037,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
The two types of streptolysins, O and S, are categorized by their ability to cause hemolysis in erythrocytes in the absence or presence of oxygen. Streptolysin O is not active in the presence of oxygen, whereas streptolysin S is active in the presence of oxygen. Other important pore-forming membrane-disrupting toxins i... | {
"Header 1": "**15.3 Virulence Factors of Bacterial and Viral Pathogens**",
"Header 2": "**Some Bacterial Adhesins and Their Host Attachment Sites**",
"token_count": 2026,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
- Name at least two ways that a capsule provides protection from the immune system.
- Besides capsules, name two other virulence factors used by bacteria to evade the immune system.
#### **Clinical Focus**
#### **Resolution**
Based on Michael's reported symptoms of stiff neck and... | {
"Header 1": "**15.3 Virulence Factors of Bacterial and Viral Pathogens**",
"Header 2": "**Some Bacterial Adhesins and Their Host Attachment Sites**",
"token_count": 1449,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
#### **Learning Objectives**
- Describe virulence factors unique to fungi and parasites
- Compare virulence factors of fungi and bacteria
- Explain the difference between protozoan parasites and helminths
- Describe how helminths evade the host immune system
Although fungi and parasites are important pathogens caus... | {
"Header 1": "**15.4 Virulence Factors of Eukaryotic Pathogens**",
"token_count": 1082,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
Protozoan pathogens are unicellular eukaryotic parasites that have virulence factors and pathogenic mechanisms analogous to prokaryotic and viral pathogens, including adhesins, toxins, antigenic variation, and the ability to survive inside phagocytic vesicles.
Protozoans often have unique features for attaching to ho... | {
"Header 1": "**15.4 Virulence Factors of Eukaryotic Pathogens**",
"Header 2": "**Protozoan Virulence**",
"token_count": 525,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
Helminths, or parasitic worms, are multicellular eukaryotic parasites that depend heavily on virulence factors that allow them to gain entry to host tissues. For example, the aquatic larval form of *Schistosoma mansoni*, which causes schistosomiasis, penetrates intact skin with the aid of proteases that degrade skin pr... | {
"Header 1": "**15.4 Virulence Factors of Eukaryotic Pathogens**",
"Header 2": "**Helminth Virulence**",
"token_count": 1510,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
In the United States and other developed nations, public health is a key function of government. A healthy citizenry is more productive, content, and prosperous; high rates of death and disease, on the other hand, can severely hamper economic productivity and foster social and political instability. The burden of disea... | {
"Header 1": "**Introduction**",
"token_count": 233,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
#### **Learning Objectives**
- Explain the difference between prevalence and incidence of disease
- Distinguish the characteristics of sporadic, endemic, epidemic, and pandemic diseases
- Explain the use of Koch's postulates and their modifications to determine the etiology of disease
- Explain the relationship betwe... | {
"Header 1": "**16.1 The Language of Epidemiologists**",
"token_count": 2025,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
Suspecting a link between the cases based on the localized nature of the outbreak, hospitals handed over their medical records to the regional public health office for study.
Laboratory testing of stool samples had indicated that the infections were caused by *Salmonella* bacteria. Patients ranged from children as yo... | {
"Header 1": "**16.1 The Language of Epidemiologists**",
"token_count": 1324,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
#### **Learning Objectives**
- Explain the research approaches used by the pioneers of epidemiology
- Explain how descriptive, analytical, and experimental epidemiological studies go about determining the cause of morbidity and mortality
Epidemiology has its roots in the work of physicians who looked for patterns i... | {
"Header 1": "**16.2 Tracking Infectious Diseases**",
"token_count": 2029,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
Today, epidemiologists make use of study designs, the manner in which data are gathered to test a hypothesis, similar to those of researchers studying other phenomena that occur in populations. These approaches can be divided into observational studies (in which subjects are not manipulated) and experimental studies (i... | {
"Header 1": "**16.2 Tracking Infectious Diseases**",
"Header 2": "**Types of Epidemiological Studies**",
"token_count": 1790,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
#### **Learning Objectives**
- Describe the different types of disease reservoirs
- Compare contact, vector, and vehicle modes of transmission
- Identify important disease vectors
- Explain the prevalence of nosocomial infections
Understanding how infectious pathogens spread is critical to preventing infectious dis... | {
"Header 1": "**16.2 Tracking Infectious Diseases**",
"Header 2": "**16.3 Modes of Disease Transmission**",
"token_count": 2031,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
(credit left: modification of work by Lisa Doehnert)
**Figure 16.10** Fomites are nonliving objects that facilitate the indirect transmission of pathogens. Contaminated doorknobs, towels, and syringes are all common examples of fomites. (credit left: modification of work by Kate Ter Ha... | {
"Header 1": "**16.2 Tracking Infectious Diseases**",
"Header 2": "**16.3 Modes of Disease Transmission**",
"token_count": 605,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
#### **Resolution**
After identifying the source of the contaminated turduckens, the Florida public health office notified the CDC, which requested an expedited inspection of the facility by state inspectors. Inspectors found that a machine used to process the chicken was contaminated with *Salmonella* as a result of... | {
"Header 1": "**16.2 Tracking Infectious Diseases**",
"Header 2": "**Clinical Focus**",
"token_count": 2031,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
aegypti* mosquito extinct—a noble goal according to some, given the damage they do to human populations.[13] But opponents of the idea are concerned that the gene could escape the species boundary of *A. aegypti* and cause problems in other species, leading to unforeseen ecological consequences. Opponents are also wary... | {
"Header 1": "**16.2 Tracking Infectious Diseases**",
"Header 2": "**Clinical Focus**",
"token_count": 542,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
Individuals suspected or known to have been exposed to certain contagious pathogens may be **quarantined**, or
11. Blandine Massonnet-Bruneel, Nicole Corre-Catelin, Renaud Lacroix, Rosemary S. Lees, Kim Phuc Hoang, Derric Nimmo, Luke Alphey, and Paul Reiter. "Fitness of Transgenic Mosquito *Aedes aegypti* Males Carry... | {
"Header 1": "**16.2 Tracking Infectious Diseases**",
"Header 2": "**Quarantining**",
"token_count": 817,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
Hospitals, retirement homes, and prisons attract the attention of epidemiologists because these settings are associated with increased incidence of certain diseases. Higher rates of transmission may be caused by characteristics of the environment itself, characteristics of the population, or both. Consequently, special... | {
"Header 1": "**16.2 Tracking Infectious Diseases**",
"Header 2": "**Healthcare-Associated (Nosocomial) Infections**",
"token_count": 395,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
#### **Learning Objectives**
- Describe the entities involved in international public health and their activities
- Identify and differentiate between emerging and reemerging infectious diseases
A large number of international programs and agencies are involved in efforts to promote global public health. Among thei... | {
"Header 1": "**16.2 Tracking Infectious Diseases**",
"Header 2": "**16.4 Global Public Health**",
"token_count": 501,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
Both WHO and some national public health agencies such as the CDC monitor and prepare for **emerging infectious diseases**. An emerging infectious disease is either new to the human population or has shown an increase in prevalence in the previous twenty years. Whether the disease is new or conditions have changed to c... | {
"Header 1": "**16.2 Tracking Infectious Diseases**",
"Header 2": "**Emerging and Reemerging Infectious Diseases**",
"token_count": 1713,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
#### **[16.1 The Language of Epidemiologists](#page-709-0)**
- **Epidemiology** is the science underlying public health.
- **Morbidity** means being in a state of illness, whereas **mortality** refers to death; both **morbidity rates** and **mortality rates** are of interest to epidemiologists.
- **Incidence** is the... | {
"Header 1": "**16.2 Tracking Infectious Diseases**",
"Header 2": "**Summary**",
"token_count": 816,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
Despite relatively constant exposure to pathogenic microbes in the environment, humans do not generally suffer from constant infection or disease. Under most circumstances, the body is able to defend itself from the threat of infection thanks to a complex immune system designed to repel, kill, and expel disease-causing... | {
"Header 1": "**Introduction**",
"token_count": 273,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
#### **Learning Objectives**
- Describe the various physical barriers and mechanical defenses that protect the human body against infection and disease
- Describe the role of microbiota as a first-line defense against infection and disease
Nonspecific innate immunity can be characterized as a multifaceted system of... | {
"Header 1": "**17.1 Physical Defenses**",
"token_count": 2022,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
**Figure 17.5** This scanning electron micrograph shows ciliated and nonciliated epithelial cells from the human trachea. The mucociliary escalator pushes mucus away from the lungs, along with any debris or microorganisms that may be trapped in the sticky mucus, and the mucus moves up ... | {
"Header 1": "**17.1 Physical Defenses**",
"token_count": 664,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
In addition to physical barriers that keep microbes out, the body has a number of mechanical defenses that physically remove pathogens from the body, preventing them from taking up residence. We have already discussed several examples of mechanical defenses, including the shedding of skin cells, the expulsion of mucus ... | {
"Header 1": "**17.1 Physical Defenses**",
"Header 2": "**Mechanical Defenses**",
"token_count": 845,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
#### **Learning Objectives**
- Describe how enzymes in body fluids provide protection against infection or disease
- List and describe the function of antimicrobial peptides, complement components, cytokines, and acute-phase proteins
- Describe similarities and differences among classic, alternate, and lectin complem... | {
"Header 1": "**17.2 Chemical Defenses**",
"token_count": 206,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
Fluids produced by the skin include examples of both endogenous and exogenous mediators. Sebaceous glands in the dermis secrete an oil called sebum that is released onto the skin surface through hair follicles. This sebum is an endogenous mediator, providing an additional layer of defense by helping seal off the pore o... | {
"Header 1": "**17.2 Chemical Defenses**",
"Header 2": "**Chemical and Enzymatic Mediators Found in Body Fluids**",
"token_count": 968,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
The **antimicrobial peptides (AMPs)** are a special class of nonspecific cell-derived mediators with broad-spectrum antimicrobial properties. Some AMPs are produced routinely by the body, whereas others are primarily produced (or produced in greater quantities) in response to the presence of an invading pathogen. Resea... | {
"Header 1": "**17.2 Chemical Defenses**",
"Header 2": "**Antimicrobial Peptides**",
"token_count": 2010,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
The term **opsonization** refers to the coating of a pathogen by a chemical substance (called an **opsonin**) that allows phagocytic cells to recognize, engulf, and destroy it more easily. Opsonins from the complement cascade include C1q, C3b, and C4b. Additional important opsonins include mannose-binding proteins and ... | {
"Header 1": "**17.2 Chemical Defenses**",
"Header 2": "**Antimicrobial Peptides**",
"token_count": 1935,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
| Defense | Examples | Function |
|---------------------------|------------------------------------------------------------------|------------------------------------------------... | {
"Header 1": "**17.2 Chemical Defenses**",
"Header 2": "**Antimicrobial Peptides**",
"token_count": 675,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
#### **Learning Objectives**
- Identify and describe the components of blood
- Explain the process by which the formed elements of blood are formed (hematopoiesis)
- Describe the characteristics of formed elements found in peripheral blood, as well as their respective functions within the innate immune system
In th... | {
"Header 1": "**17.3 Cellular Defenses**",
"token_count": 2041,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
**Figure 17.14** Granulocytes can be distinguished by the number of lobes in their nuclei and the staining properties of their granules. (credit "neutrophil" micrograph: modification of work by Ed Uthman)
#### **Neutrophils (PMNs)**
Neutrophils (PMNs) are frequently involved in the... | {
"Header 1": "**17.3 Cellular Defenses**",
"token_count": 1491,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
As their name suggests, **agranulocytes** lack visible granules in the cytoplasm. Agranulocytes can be categorized as lymphocytes or monocytes (**[Figure 17.13](#page-759-0)**). Among the lymphocytes are natural killer cells, which play an important role in nonspecific innate immune defenses. Lymphocytes also include t... | {
"Header 1": "**17.3 Cellular Defenses**",
"Header 2": "**Agranulocytes**",
"token_count": 1465,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
#### **Learning Objectives**
- Explain how leukocytes migrate from peripheral blood into infected tissues
- Explain the mechanisms by which leukocytes recognize pathogens
- Explain the process of phagocytosis and the mechanisms by which phagocytes destroy and degrade pathogens
Several of the cell types discussed in... | {
"Header 1": "**17.4 Pathogen Recognition and Phagocytosis**",
"token_count": 979,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
As described in the previous section, opsonization of pathogens by antibody; complement factors C1q, C3b, and C4b; and lectins can assist phagocytic cells in recognition of pathogens and attachment to initiate phagocytosis. However, not all pathogen recognition is opsonin dependent. Phagocytes can also recognize molecu... | {
"Header 1": "**17.4 Pathogen Recognition and Phagocytosis**",
"Header 2": "**Pathogen Recognition**",
"token_count": 2022,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
#### **Learning Objectives**
- Identify the signs of inflammation and fever and explain why they occur
- Explain the advantages and risks posed by inflammatory responses
The inflammatory response, or **inflammation**, is triggered by a cascade of chemical mediators and cellular responses that may occur when cells a... | {
"Header 1": "**17.5 Inflammation and Fever**",
"token_count": 2001,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
In addition, some studies suggest that fever may also stimulate release of iron-sequestering compounds from the liver, thereby starving out microbes that rely on iron for growth.[3]
During fever, the skin may appear pale due to vasoconstriction of the blood vessels in the skin, which is mediated by the hypothalamus t... | {
"Header 1": "**17.5 Inflammation and Fever**",
"token_count": 2036,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
People living in developed nations and born in the 1960s or later may have difficulty understanding the once heavy burden of devastating infectious diseases. For example, smallpox, a deadly viral disease, once destroyed entire civilizations but has since been eradicated. Thanks to the vaccination efforts by multiple gr... | {
"Header 1": "**Introduction**",
"token_count": 302,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
#### **Learning Objectives**
- Define memory, primary response, secondary response, and specificity
- Distinguish between humoral and cellular immunity
- Differentiate between antigens, epitopes, and haptens
- Describe the structure and function of antibodies and distinguish between the different classes of antibodie... | {
"Header 1": "**18.1 Overview of Specific Adaptive Immunity**",
"token_count": 2031,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
The two 'arms' of the Y-shaped antibody molecule are known as the **Fab region**, for "fragment of antigen binding." The far end of the Fab region is the variable region, which serves as the site of antigen binding. The amino acid sequence in the variable region dictates the three-dimensional structure, and thus the ... | {
"Header 1": "**18.1 Overview of Specific Adaptive Immunity**",
"token_count": 2028,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
The pentameric structure of IgM provides ten Fab binding sites per molecule, making it the most efficient antibody for agglutination.
**Figure 18.7** Neutralization involves the binding of specific antibodies to antigens found on bacteria, viruses, and toxins, preventing them from atta... | {
"Header 1": "**18.1 Overview of Specific Adaptive Immunity**",
"token_count": 704,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
#### **Learning Objectives**
- Identify cells that express MHC I and/or MHC II molecules and describe the structures and cellular location of MHC I and MHC II molecules
- Identify the cells that are antigen-presenting cells
- Describe the process of antigen processing and presentation with MHC I and MHC II
As discu... | {
"Header 1": "**18.2 Major Histocompatibility Complexes and Antigen-Presenting Cells**",
"token_count": 838,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
All nucleated cells in the body have mechanisms for processing and presenting antigens in association with MHC molecules. This signals the immune system, indicating whether the cell is normal and healthy or infected with an intracellular pathogen. However, only macrophages, dendritic cells, and B cells have the ability... | {
"Header 1": "**18.2 Major Histocompatibility Complexes and Antigen-Presenting Cells**",
"Header 2": "**Antigen-Presenting Cells (APCs)**",
"token_count": 1217,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
#### **Learning Objectives**
- Describe the process of T-cell maturation and thymic selection
- Explain the genetic events that lead to diversity of T-cell receptors
- Compare and contrast the various classes and subtypes of T cells in terms of activation and function
- Explain the mechanism by which superantigens ef... | {
"Header 1": "**18.3 T Lymphocytes and Cellular Immunity**",
"token_count": 2040,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
The **T-cell receptor (TCR)** is involved in the first step of pathogen epitope recognition during the activation process.
The TCR comes from the same receptor family as the antibodies IgD and IgM, the antigen receptors on the B cell membrane surface, and thus shares common structural elements. Similar to antibodies,... | {
"Header 1": "**18.3 T Lymphocytes and Cellular Immunity**",
"token_count": 1761,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
Cytotoxic T cells (also referred to as cytotoxic T lymphocytes, or CTLs) are activated by APCs in a three-step process similar to that of helper T cells. The key difference is that the activation of cytotoxic T cells involves recognition of an antigen presented with MHC I (as opposed to MHC II) and interaction of CD8 (... | {
"Header 1": "**18.3 T Lymphocytes and Cellular Immunity**",
"Header 2": "**Activation and Differentiation of Cytotoxic T Cells**",
"token_count": 1846,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
Like T cells, B cells are formed from multipotent hematopoietic stem cells (HSCs) in the bone marrow and follow a pathway through lymphoid stem cell and lymphoblast (see **[Figure 17.12](#page-758-0)**). Unlike T cells, however, lymphoblasts destined to become B cells do not leave the bone marrow and travel to the thym... | {
"Header 1": "**18.4 B Lymphocytes and Humoral Immunity**",
"Header 2": "**B Cell Production and Maturation**",
"token_count": 2011,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
T cell-dependent activation of B cells plays an important role in both the primary and secondary responses associated with adaptive immunity. With the first exposure to a protein antigen, a T cell-dependent primary antibody response occurs. The initial stage of the primary response is a **lag period**, or latent period... | {
"Header 1": "**18.4 B Lymphocytes and Humoral Immunity**",
"Header 2": "**Primary and Secondary Responses**",
"token_count": 472,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
#### **Learning Objectives**
- Compare the various kinds of artificial immunity
- Differentiate between variolation and vaccination
- Describe different types of vaccines and explain their respective advantages and disadvantages
For many diseases, prevention is the best form of treatment, and few strategies for dis... | {
"Header 1": "**18.5 Vaccines**",
"token_count": 2038,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
More serious and sometimes fatal infections did occur, and because smallpox was contagious,
<sup>3.</sup> Elizabeth Yale. "Why Anti-Vaccination Movements Can Never Be Tamed." *Religion & Politics*, July 22, 2014.
http://religionandpolitics.org/2014/07/22/why-anti-vaccination-movements-can-never-be-tamed.
infectio... | {
"Header 1": "**18.5 Vaccines**",
"token_count": 1924,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
- · What is the risk associated with a live attenuated vaccine?
- · Why is a conjugated vaccine necessary in some cases?
#### **Micro Connections**
#### **DNA Vaccines**
DNA vaccines represent a relatively new and promising approach to vaccination. A DNA vaccine is produced by incorporating genes for antigens int... | {
"Header 1": "Check Your Understanding",
"token_count": 2000,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
An allergic reaction is an immune response to a type of antigen called an allergen. Allergens can be found in many different items, from peanuts and insect stings to latex and some drugs. Unlike other kinds of antigens, allergens are not necessarily associated with pathogenic microbes, and many allergens provoke no imm... | {
"Header 1": "**Introduction**",
"token_count": 207,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
#### **Learning Objectives**
• Identify and compare the distinguishing characteristics, mechanisms, and major examples of type I, II, III, and IV hypersensitivities
In **[Adaptive Specific Host Defenses](#page-782-1)**, we discussed the mechanisms by which adaptive immune defenses, both humoral and cellular, protec... | {
"Header 1": "**19.1 Hypersensitivities**",
"token_count": 2014,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
Late-phase reactions in type I hypersensitivities may develop 4–12 hours after the early phase and are mediated by eosinophils, neutrophils, and lymphocytes that have been recruited by chemotactic factors released from mast cells. Activation of these recruited cells leads to the release of more chemical mediators tha... | {
"Header 1": "**19.1 Hypersensitivities**",
"token_count": 963,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
Immune reactions categorized as **type II hypersensitivities**, or cytotoxic hypersensitivities, are mediated by IgG and IgM antibodies binding to cell-surface antigens or matrix-associated antigens on basement membranes. These antibodies can either activate complement, resulting in an inflammatory response and lysis o... | {
"Header 1": "**19.1 Hypersensitivities**",
"Header 2": "**Type II (Cytotoxic) Hypersensitivities**",
"token_count": 2033,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
In the most serious reactions, dangerously low blood pressure can lead to shock, multi-organ failure, and death of the patient.
Hospitals, medical centers, and associated clinical laboratories typically use hemovigilance systems to minimize the risk of HTRs due to clerical error. Hemovigilance systems are procedures ... | {
"Header 1": "**19.1 Hypersensitivities**",
"Header 2": "**Type II (Cytotoxic) Hypersensitivities**",
"token_count": 2005,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
Why might Kerry's physician refer her to this particular type of specialist even though she is exhibiting none of these symptoms?
*Jump to the [next](#page-836-0) Clinical Focus box. Go back to the [previous](#page-825-1) Clinical Focus box.*
#### **Type III Hypersensitivities**
Type III hypersensitivities are im... | {
"Header 1": "**19.1 Hypersensitivities**",
"Header 2": "**Type II (Cytotoxic) Hypersensitivities**",
"token_count": 1970,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
However, sensitization stimulates helper T cells, leading to production of memory helper T cells that can become reactivated on future exposures. (b) Upon secondary exposure, the memory helper T cells become reactivated, producing inflammatory cytokines that stimulate macrophages and cytotoxic T cells to induce an infl... | {
"Header 1": "**19.1 Hypersensitivities**",
"Header 2": "**Type II (Cytotoxic) Hypersensitivities**",
"token_count": 1993,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
Diagnosis of type I hypersensitivities is a complex process requiring several diagnostic tests in addition to a welldocumented patient history. Serum IgE levels can be measured, but elevated IgE alone does not confirm allergic disease. As part of the process to identify the antigens responsible for a type I reaction al... | {
"Header 1": "**19.1 Hypersensitivities**",
"Header 2": "**Diagnosis of Hypersensitivities**",
"token_count": 515,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
Allergic reactions can be treated in various ways. Prevention of allergic reactions can be achieved by **desensitization** (hyposensitization) therapy, which can be used to reduce the hypersensitivity reaction through repeated injections of allergens. Extremely dilute concentrations of known allergens (determined from ... | {
"Header 1": "**19.1 Hypersensitivities**",
"Header 2": "**Diagnosis of Hypersensitivities**",
"Header 3": "**Treatments of Hypersensitivities**",
"token_count": 919,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
#### **Learning Objectives**
- Explain why autoimmune disorders develop
- Provide a few examples of organ-specific and systemic autoimmune diseases
In 1970, artist Walt Kelly developed a poster promoting Earth Day, featuring a character from *Pogo*, his daily newspaper comic strip. In the poster, Pogo looks out acr... | {
"Header 1": "**19.2 Autoimmune Disorders**",
"token_count": 2037,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
Symptoms of AAD include weakness, nausea, decreased appetite, weight loss, hyperpigmentation (**[Figure 19.15](#page-846-0)**), hyperkalemia (elevated blood potassium levels), hyponatremia (decreased blood sodium levels), hypoglycemia (decreased levels of blood sugar), hypotension (decreased blood pressure), anemia, ... | {
"Header 1": "**19.2 Autoimmune Disorders**",
"token_count": 1897,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
(credit a: modification of work by Mikael Häggström; credit b: modification of work by Shrestha D, Dhakal AK, Shiva RK, Shakya A, Shah SC, Shakya H)
- List the ways antibodies contribute to the pathogenesis of myasthenia gravis.
- Explain why rheumatoid arthritis is considered a type III hypersensitivity.
- Describe ... | {
"Header 1": "**19.2 Autoimmune Disorders**",
"token_count": 661,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
#### **Learning Objectives**
- Explain why human leukocyte antigens (HLAs) are important in tissue transplantation
- Explain the types of grafts possible and their potential for interaction with the immune system
- Describe what occurs during graft-versus-host disease (GVHD)
A graft is the transplantation of an org... | {
"Header 1": "**19.3 Organ Transplantation and Rejection**",
"token_count": 1894,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
#### **Learning Objectives**
- Compare the causes of primary and secondary immunodeficiencies
- Describe treatments for primary and secondary immunodeficiencies
Immunodeficiencies are inherited (primary) or acquired (secondary) disorders in which elements of host immune defenses are either absent or functionally de... | {
"Header 1": "**19.3 Organ Transplantation and Rejection**",
"Header 2": "**19.4 Immunodeficiency**",
"token_count": 1401,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
A **secondary immunodeficiency** occurs as a result an acquired impairment of function of B cells, T cells, or both. Secondary immunodeficiencies can be caused by:
- Systemic disorders such as diabetes mellitus, malnutrition, hepatitis, or HIV infection
- Immunosuppressive treatments such as cytotoxic chemotherapy, b... | {
"Header 1": "**19.3 Organ Transplantation and Rejection**",
"Header 2": "**Secondary Immunodeficiency**",
"token_count": 1339,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
#### **Learning Objectives**
- Explain how the adaptive specific immune response responds to tumors
- Discuss the risks and benefits of tumor vaccines
Cancer involves a loss of the ability of cells to control their cell cycle, the stages each eukaryotic cell goes through as it grows and then divides. When this cont... | {
"Header 1": "**19.5 Cancer Immunobiology and Immunotherapy**",
"token_count": 2033,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
Many laboratory tests are designed to confirm a presumptive diagnosis by detecting antibodies specific to a suspected pathogen. Unfortunately, many such tests are time-consuming and expensive. That is now changing, however, with the development of new, miniaturized technologies that are fast and inexpensive. For exampl... | {
"Header 1": "**Introduction**",
"token_count": 245,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
#### **Learning Objectives**
- Compare the method of development, use, and characteristics of monoclonal and polyclonal antibodies
- Explain the nature of antibody cross-reactivity and why this is less of a problem with monoclonal antibodies
In addition to being crucial for our normal immune response, antibodies pr... | {
"Header 1": "**20.1 Polyclonal and Monoclonal Antibody Production**",
"token_count": 1992,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
Some types of assays require better antibody specificity and affinity than can be obtained using a polyclonal antiserum. To attain this high specificity, all of the antibodies must bind with high affinity to a single epitope. This high specificity can be provided by **monoclonal antibodies (mAbs)**. **[Table 20.1](#pag... | {
"Header 1": "**20.1 Polyclonal and Monoclonal Antibody Production**",
"Header 2": "**Producing Monoclonal Antibodies**",
"token_count": 1449,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
#### **Learning Objectives**
- Describe various types of assays used to find antigen-antibody complexes
- Describe the circumstances under which antigen-antibody complexes precipitate out of solution
- Explain how antibodies in patient serum can be used to diagnose disease
Laboratory tests to detect antibodies and ... | {
"Header 1": "**20.2 Detecting Antigen-Antibody Complexes**",
"token_count": 2034,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
In this assay, the antiserum is added to tempered agar (liquid agar at slightly above 45 °C), which is poured into a small petri dish or onto a glass slide and allowed to cool. Wells are cut in the cooled agar, and antigen is then added to the wells and allowed to diffuse. As the antigen and antibody interact, they for... | {
"Header 1": "**20.2 Detecting Antigen-Antibody Complexes**",
"token_count": 2022,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
**Figure 20.11** (a) This graph shows normal measurements of serum proteins. (b) This photograph shows an immunoelectrophoresis of urine. After electrophoresis, antisera were added to the troughs and the precipitin arcs formed, illustrating the distribution of specific proteins. The ske... | {
"Header 1": "**20.2 Detecting Antigen-Antibody Complexes**",
"token_count": 1965,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
#### **Learning Objectives**
- Compare direct and indirect agglutination
- Identify various uses of hemagglutination in the diagnosis of disease
- Explain how blood types are determined
- Explain the steps used to cross-match blood to be used in a transfusion
In addition to causing precipitation of soluble molecule... | {
"Header 1": "**20.3 Agglutination Assays**",
"token_count": 2033,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
The Coombs' reagent links the IgG attached to neighboring red blood cells and thus promotes agglutination.
There is also an **indirect Coombs' test** known as the **indirect antiglobulin test (IAT)**. This screens an individual for antibodies against red blood cell antigens (other than the A and B antigens) that are ... | {
"Header 1": "**20.3 Agglutination Assays**",
"token_count": 1930,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
In addition to antibodies against bacteria and viruses to which they have previously been exposed, most individuals also carry antibodies against blood types other than their own. There are presently 33 immunologically important blood-type systems, many of which are restricted within various ethnic groups or rarely res... | {
"Header 1": "**20.3 Agglutination Assays**",
"Header 2": "**Blood Typing and Cross-Matching**",
"token_count": 1243,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
#### **Learning Objectives**
- Explain the differences and similarities between EIA, FEIA, and ELISA
- Describe the difference and similarities between immunohistochemistry and immunocytochemistry
- Describe the different purposes of direct and indirect ELISA
Similar to the western blot, **enzyme immunoassays (EIAs... | {
"Header 1": "**20.4 EIAs and ELISAs**",
"token_count": 1983,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
We must confirm any suspected positive test, which is most often done using either an immunoblot that actually identifies the presence of specific peptides from the pathogen or a test to identify the nucleic acids associated with the pathogen, such as reverse transcriptase PCR (RT-PCR) or a nucleic acid antigen test. ... | {
"Header 1": "**20.4 EIAs and ELISAs**",
"token_count": 1622,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
#### **Learning Objectives**
- Describe the benefits of immunofluorescent antibody assays in comparison to nonfluorescent assays
- Compare direct and indirect fluorescent antibody assays
- Explain how a flow cytometer can be used to quantify specific subsets of cells present in a complex mixture of cell types
- Expla... | {
"Header 1": "**20.5 Fluorescent Antibody Techniques**",
"token_count": 661,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
**Indirect fluorescent antibody (IFA) tests** (**[Figure 20.29](#page-906-0)**) are used to look for antibodies in patient serum. For example, an IFA test for the diagnosis of syphilis uses *T. pallidum* cells isolated from a lab animal (the bacteria cannot be grown on lab media) and a smear prepared on a glass slide. ... | {
"Header 1": "**20.5 Fluorescent Antibody Techniques**",
"Header 2": "**Indirect Fluorescent Antibody Techniques**",
"token_count": 989,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
Fluorescently labeled antibodies can be used to quantify cells of a specific type in a complex mixture using **flow cytometry** (**[Figure 20.31](#page-908-0)**), an automated, cell-counting system that detects fluorescing cells as they pass through a narrow tube one cell at a time. For example, in HIV infections, it i... | {
"Header 1": "**20.5 Fluorescent Antibody Techniques**",
"Header 2": "**Flow Cytometry**",
"token_count": 1238,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
The flow cytometer and immunofluorescence can also be modified to sort cells from a single sample into purified subpopulations of cells for research purposes. This modification of the flow cytometer is called a **fluorescenceactivated cell sorter (FACS)**. In a FACS, fluorescence by a cell induces the device to put a c... | {
"Header 1": "**20.5 Fluorescent Antibody Techniques**",
"Header 2": "**Cell Sorting Using Immunofluorescence**",
"token_count": 1832,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
Production of end product from the chromogenic substrate is directly proportional to the amount of captured antigen.
- **Indirect ELISA** is used to detect antibodies in patient serum by attaching antigen to the well of a microtiter plate, allowing the patient (primary) antibody to bind the antigen and an enzyme-conjug... | {
"Header 1": "**20.5 Fluorescent Antibody Techniques**",
"Header 2": "**Cell Sorting Using Immunofluorescence**",
"token_count": 332,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
**31.** What is meant by the term "neutralizing antibodies," and how can we quantify this effect using the viral neutralization assay?
**32.** Explain why the titer of a direct hemagglutination assay is the highest dilution that still causes hemagglutination, whereas in the viral hemagglutination inhibition assay, ... | {
"Header 1": "**20.5 Fluorescent Antibody Techniques**",
"Header 2": "**Review Questions**",
"token_count": 579,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
The human body is covered in skin, and like most coverings, skin is designed to protect what is underneath. One of its primary purposes is to prevent microbes in the surrounding environment from invading underlying tissues and organs. But in spite of its role as a protective covering, skin is not itself immune from inf... | {
"Header 1": "**Introduction**",
"token_count": 252,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
#### **Learning Objectives**
- Describe the major anatomical features of the skin and eyes
- Compare and contrast the microbiomes of various body sites, such as the hands, back, feet, and eyes
- Explain how microorganisms overcome defenses of skin and eyes in order to cause infection
- Describe general signs and symp... | {
"Header 1": "**Eyes**",
"token_count": 1529,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
While the microbiota of the skin can play a protective role, it can also cause harm in certain cases. Often, an opportunistic pathogen residing in the skin microbiota of one individual may be transmitted to another individual more susceptible to an infection. For example, methicillin-resistant *Staphylococcus aureus* (... | {
"Header 1": "**Eyes**",
"Header 2": "**Infections of the Skin**",
"token_count": 2020,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
Inflammation of the conjunctiva is called **conjunctivitis**, although it is commonly known as pinkeye because of the pink appearance in the eye. Infections of deeper structures, beneath the cornea, are less common (**[Figure 21.8](#page-925-1)**). Conjunctivitis occurs in multiple forms. It may be acute or chronic. Ac... | {
"Header 1": "**Eyes**",
"Header 2": "**Infections of the Skin**",
"token_count": 987,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
#### **Learning Objectives**
- Identify the most common bacterial pathogens that cause infections of the skin and eyes
- Compare the major characteristics of specific bacterial diseases affecting the skin and eyes
Despite the skin's protective functions, infections are common. Gram-positive *Staphylococcus* spp. an... | {
"Header 1": "**21.2 Bacterial Infections of the Skin and Eyes**",
"token_count": 1468,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
Even if identification and decolonization procedures are perfected, ethical questions will remain. Should patients have the right to decline testing? Should a patient who tests positive for MRSA have the right to decline the decolonization procedure, and if so, should hospitals have the right to refuse treatment to the... | {
"Header 1": "**21.2 Bacterial Infections of the Skin and Eyes**",
"Header 2": "**Screening Patients for MRSA** According to the CDC, 86% of invasive MRSA infections are associated in some way with healthcare, as opposed to being community-acquired. In hospitals and clinics, asymptomatic patients who harbor MRSA m... |
*Streptococcus* are gram-positive cocci with a microscopic morphology that resembles chains of bacteria. Colonies are typically small (1–2 mm in diameter), translucent, entire edge, with a slightly raised elevation that can be either nonhemolytic, alpha-hemolytic, or beta-hemolytic when grown on blood agar (**[Figure 2... | {
"Header 1": "**21.2 Bacterial Infections of the Skin and Eyes**",
"Header 2": "**Screening Patients for MRSA** According to the CDC, 86% of invasive MRSA infections are associated in some way with healthcare, as opposed to being community-acquired. In hospitals and clinics, asymptomatic patients who harbor MRSA m... |
"Blunt Trauma as a Risk Factor for Group A Streptococcal Necrotizing Fasciitis." *Annals of Epidemiology* (2007) 17:878–881.
**Figure 21.16** (a) Hot tub folliculitis presents as an itchy red rash. It is typically caused by *P. aeruginosa*, a bacterium that thrives in wet, warm environ... | {
"Header 1": "**21.2 Bacterial Infections of the Skin and Eyes**",
"Header 2": "**Screening Patients for MRSA** According to the CDC, 86% of invasive MRSA infections are associated in some way with healthcare, as opposed to being community-acquired. In hospitals and clinics, asymptomatic patients who harbor MRSA m... |
The second consists of protective antigen (PA) and an edema factor (EF), forming edema toxin (EdTX).
<sup>8.</sup> Shadomy, S.V., Traxler, R.M., and Marston, C.K. "Infectious Diseases Related to Travel: Anthrax" 2015. Centers for Disease Control and Prevention*.* http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious... | {
"Header 1": "**21.2 Bacterial Infections of the Skin and Eyes**",
"Header 2": "**Screening Patients for MRSA** According to the CDC, 86% of invasive MRSA infections are associated in some way with healthcare, as opposed to being community-acquired. In hospitals and clinics, asymptomatic patients who harbor MRSA m... |
pyogenes,<br>Klebsiella,<br>Clostridium,<br>others | Infection of fascia and<br>rapidly spreading tissue<br>death; can lead to septic<br>shock and death | Entry of bacteria<br>through cut or abrasion | Intravenous<br>broad-spectrum<br>antibiotics ... | {
"Header 1": "**21.2 Bacterial Infections of the Skin and Eyes**",
"Header 2": "**Screening Patients for MRSA** According to the CDC, 86% of invasive MRSA infections are associated in some way with healthcare, as opposed to being community-acquired. In hospitals and clinics, asymptomatic patients who harbor MRSA m... |
#### **Learning Objectives**
- Identify the most common viruses associated with infections of the skin and eyes
- Compare the major characteristics of specific viral diseases affecting the skin and eyes
Until recently, it was thought that the normal microbiota of the body consisted primarily of bacteria and some fu... | {
"Header 1": "**21.3 Viral Infections of the Skin and Eyes**",
"token_count": 668,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
Another common skin virus is herpes simplex virus (HSV). HSV has historically been divided into two types, HSV-1 and HSV-2. HSV-1 is typically transmitted by direct oral contact between individuals, and is usually associated with **oral herpes**. HSV-2 is usually transmitted sexually and is typically associated with ge... | {
"Header 1": "**21.3 Viral Infections of the Skin and Eyes**",
"Header 2": "**Oral Herpes**",
"token_count": 1455,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
Like bacterial conjunctivitis viral infections of the eye can cause inflammation of the conjunctiva and discharge from the eye. However, **viral conjunctivitis** tends to produce a discharge that is more watery than the thick discharge associated with bacterial conjunctivitis. The infection is contagious and can easily... | {
"Header 1": "**21.3 Viral Infections of the Skin and Eyes**",
"Header 2": "**Viral Conjunctivitis**",
"token_count": 331,
"source_pdf": "datasets/websources/Med_v1/med_textbook/Microbiology-LR.pdf"
} |
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