Essentials of Medical Microbiology Apurba Sankar Sastry, Sandhya Bhat K, Anand Janagond
Chapter Notes

Save Clear

Apurba Sankar Sastry MD DNB MNAMS PDCR Hospital Infection Control Officer Assistant Professor Department of Microbiology Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Puducherry, India Sandhya Bhat K MD DNB MNAMS PDCR Associate Professor Department of Microbiology Pondicherry Institute of Medical Sciences (PIMS) (A Unit of Madras Medical Mission) Puducherry, India Co-Editor Anand Janagond Associate Professor Department of Microbiology Velammal Medical College Madurai, Tamil Nadu, India
Jaypee Brothers Medical Publishers (P) Ltd
Jaypee Brothers Medical Publishers (P) Ltd
4838/24, Ansari Road, Daryaganj
New Delhi 110 002, India
Phone: +91-11-43574357
Fax: +91-11-43574314
Overseas Offices
J.P. Medical Ltd
83 Victoria Street, London
Phone: +44-2031708910
Fax: +02-03-0086180
Jaypee-Highlights Medical Publishers Inc.
City of Knowledge, Bld. 237, Clayton
Panama City, Panama
Phone: +1 507-301-0496
Fax: +1 507-301-0499
Jaypee Medical Inc.
The Bourse
111 South Independence Mall East
Suite 835, Philadelphia, PA 19106, USA
Phone: +1 267-519-9789
Jaypee Brothers Medical Publishers (P) Ltd
17/1-B Babar Road, Block-B, Shaymali
Mohammadpur, Dhaka-1207
Mobile: +08801912003485
Jaypee Brothers Medical Publishers (P) Ltd
Bhotahity, Kathmandu, Nepal
Phone: +977-9741283608
© 2016, Jaypee Brothers Medical Publishers
The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent those of editor(s) of the book.
All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers.
All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book.
Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book.
This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought.
Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity.
Inquiries for bulk sales may be solicited at:
Essentials of Medical Microbiology
First Edition: 2016
Printed at
5Dedicated to
Our Beloved Parents, Family Members
And, above all, the Almighty
When one door of happiness closes, another opens; but often we look so long at the closed door that we do not see the one which has been opened for us.
Helen Keller6
Few decades back, there were hardly any books on Medical Microbiology written by Indian authors. With expansion of medical education in the country over the years, the undergraduate students’ population has grown significantly and there is an intensely felt need for books to suite the students’ choices with regards to style, presentation, language and content. It is in this backdrop that we have to visualize the birth of a good number of Indian books in the recent past.
Most of these books are authored by teachers who have spent considerable time in teaching microbiology in medical colleges. However, here we have a couple of young enthusiastic passionate teachers of microbiology, who have taken pains to put their thoughts in the shape of a wonderful book. Though this book looks like another book in the field, but certain features, like the updated matter, lucid presentation style, useful pictures and clinical case-based discussions are unique to this book.
I am sure that many students would relish to go through this book and get benefited. The information provided might become handy for postgraduate students as well, even though they cannot fully depend on this.
I really appreciate the efforts made by my colleague Dr Apurba Sankar Sastry and his wife Dr Sandhya Bhat K for this commendable work.
Dr BN Harish MD
Professor and Head
Department of Microbiology
Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)
Puducherry, India
Essentials of Medical Microbiology by Dr Apurba Sankar Sastry and Dr Sandhya Bhat K comes at a time when several Microbiology books are being written and published in the country. We have come a long way from the time the students had to depend on one or two textbooks in microbiology which were published in India to the current time where the choice is varied, to pursue the course.
This book has many advantages over other textbooks in microbiology in being a concise, easy-to-read book, which can be used both as a textbook for an undergraduate MBBS course as well as a handbook for easy reference for microbiology examinations. Chapters range from General Microbiology, which addresses the basic concepts in microbiology, to schematically represented easily comprehensible immunology. New concepts in immunology and details of cells and cellular products have been lucidly explained with the help of diagrams. Bacteriology has been written with a clinical approach to make it relevant to a student in the clinical years. Several infections have been supported with clinical pictures and images. Virology also follows a similar trend with updated information on recent outbreaks, epidemics and emerging infections.
The book will be useful for students preparing for examinations, both formative assessments and the final summative examination. An additional attraction is the orientation for postgraduate entrance examination. The students will find the book very handy. The authors must be congratulated on their continuous efforts to bring forth textbooks for students of microbiology.
Reba Kanungo MD PhD
Dean–Research and Professor and Head
Department of Clinical Microbiology
Pondicherry Institute of Medical Sciences (PIMS)
Puducherry, India
Past President, Indian Association of Medical Microbiologists
Former Editor-in-Chief, Indian Journal of Medical Microbiology
The association of man and microorganisms, and their fight to survive each other is never-ending. With the increasing complexity of interaction between man and microbes, the relevance of studying medical microbiology has increased manifold. Our book titled, Essentials of Medical Microbiology attempts to provide smart ways to master the world of microbes relevant to the mankind.
The idea of yet another book on the subject, but with a quite different approach was born after several discouraging and unsatisfying experiences with several existing books regarding many needs of the enthusiastic students of the subject and a strong desire to make medical microbiology more interesting, up-to-date, clinically relevant and yet palatable to mainly undergraduate students of medicine and also the postgraduate aspirants and students. This book was conceptualized and brought to reality to meet the strongly felt diverse needs of the Indian students, such as gaining essential concepts, acquiring contemporary knowledge, approaching university exams with ease and confidence, scoring high in postgraduate entrance examinations, etc.
The book focuses on providing good foundation in clinically important concepts and principles of microbiology. Enough (over 300) tables and flow charts have been included along with the text. Over 200 schematic diagrams have been drawn to simplify difficult concepts, and they are easy to reproduce where necessary as in examinations. Plenty of clinical photographs (over 400) included in the book will create a real life-like picture in the minds of the reader and also are meant to help solving image-based MCQs in postgraduate entrance examinations. It has more content in fewer pages, making the book handy. The concise bulleted format and to-the-point text used in this book will be helpful in rapid revision before the examinations. Best attempts have been made to keep the language simple yet lucid to help easy comprehension. Summary of laboratory diagnosis and treatment in separate boxes makes quick review possible. Highlighted boxes are incorporated to cover the important concepts. In a nutshell, this book is carefully written targeting to meet the varied needs of undergraduate students with an approach that will orient them to build concepts and to clear undergraduate examinations as well as to equip them for postgraduate entrance examinations in future.
General Microbiology section deals with principles of microscopy, morphology, physiology, culture identification of bacteria, concepts of bacterial genetics, etc. Principles of sterilization, antimicrobial chemotherapy and susceptibility testing are also explained in detail.
It is our humble hope that this book would change the general feeling of the students regarding immunology as being a difficult section into immunology as an interesting and enjoyable topic. In this section, topics such as immunity, antigen, antibody, complement and structure of immune system are explained in a simple and logical manner. Chapters like immune response and antigen-antibody reaction have been fully updated according to the current need. Appropriate diagrams and flow charts are incorporated to make critically tough content easy to grasp. Topics such as autoimmunity, immunodeficiency and immunization provide complete and latest information compiled in tabular form at one place.
Systematic Bacteriology section deals with individual bacterial pathogens in detail. Flow of information follows a very logical and clinically relevant course. More stress is given to the knowledge that helps in clinical setting and a careful attempt has been made to reduce the obsolete and not-so-useful core microbiology content. Sections like laboratory diagnosis, treatment and prophylaxis are most updated and referenced from internationally accepted literature and guidelines.
Virology is another section where the readers will find a different approach from the existing books. The updated and succinct information provided in this section with emphasis on pathogenesis and laboratory diagnosis will be useful to the students.
This book also addresses to the long-time complaint of the undergraduate students about unavailability of a concise and pictorialized Mycology section. Written in a clear and concise manner with appropriate and beautiful schematic pictures, images and illustrations, this section will surely make the students enjoy reading.
12Applied Microbiology covers important aspects of various clinical infective syndromes with special reference to the approach towards the diagnosis. Useful information regarding hospital-acquired infections and biomedical waste management have been incorporated. The annexure incorporated at the end covers the recent topics, such as emerging pathogens, bioterrorism and laboratory-acquired infections.
Clinical case-based essay questions and MCQs are given at the end of each chapter to orient and prepare students for the examinations. Advanced and newer postgraduate entrance-oriented topics like H1N1, ebola, polio eradication, bacterial drug resistance mechanisms (such as ESBL, VRSA, VRE), automations and molecular methods in microbiology, etc. are incorporated.
We hope that the undergraduates, postgraduate aspirants, and postgraduate students will relish reading this book and find it useful. We also hope that we have made a good start in addressing the varied needs of students and faculty teaching medical microbiology with a single comprehensive book. We will feel glad to receive your valuable feedback, which will enable us to improve further.
Apurba Sankar Sastry
Sandhya Bhat K
Acknowledgment for contributing towards the figures
We are extremely thankful to the people/institutes/companies who have agreed to provide valuable photographs.
Sincere acknowledgments for helping in manuscript preparation
  • Dr Anand Janagond, Associate Professor, Department of Microbiology, Velammal Medical College, Madurai, Tamil Nadu, India, co-editor of the book, for helping in the correction of the manuscript.
  • Dr S Sujatha, Professor, Department of Microbiology, JIPMER for her valuable suggestions during the manuscript preparation.
  • Dr Noyal M Joseph, Assistant Professor, Department of Microbiology, JIPMER for his useful inputs during the manuscript preparation.
Special acknowledgments to my publishers
Jaypee Brothers Medical Publishers (P) Ltd.
  • Shri Jitendar P Vij (Group Chairman)
  • Mr Ankit Vij (Group President)
  • Mr Tarun Duneja (Director–Publishing)
  • Ms Seema Dogra (Senior Designer)
  • Dr Sakshi Arora (Director–Development and Content Strategy), Ms Nitasha Arora (Project Manager) and her team
    • Mr Phool Kumar, Mr Bunty Kashyap, Mr Vikas Kumar, Mr Puneet Kumar, Mr Parbhat Ranjan, Mr Iqbal, Mr Sandeep Kumar, Mr Sanjeev Kumar, Mr Neeraj Choudhary, Ms Neelam, Ms Sonal Jain, Ms Ankita Singh and Mr Prashant Soni (Development Team).
    • It was a lifetime memorable week for me working with this team. These guys are simply the best. They are extremely workaholic and have a very good team spirit. I salute them for their professionalism.
  • Staff from other branch office: Mr Venugopal (Bengaluru Branch), Mr Suresh and Mr Sharma (Hyderabad Branch), Mr Senthil Kumar (Chennai Branch), Mr Muralidharan (Puducherry Branch), Mr CS Gawde (Mumbai Branch), Mr Sandip Gupta and Mr Sanjoy Chakraborty (Kolkata Branch) and Mr Vasudev H (Mangalore Branch).
Hearty acknowledgments to the departmental staff and relatives for their blessings and support
  • We would like to sincerely thank Dr BN Harish, Senior Professor and Head, Department of Microbiology, JIPMER, for giving the foreword.
  • We are extremely thankful to Dr Reba Kanungo, Dean Research, Professor and Head, Department of Microbiology, Pondicherry Institute of Medical Sciences (PIMS) for giving the foreword.
  • Dr Subhash Chandra Parija, Director, JIPMER and Former Head, Department of Microbiology, JIPMER.
  • Dr John Abraham, Director-Principal, Pondicherry Institute of Medical Sciences (PIMS).
  • Other faculty of JIPMER, Microbiology—Dr Jharna Mandal (Associate Professor), Dr Rakesh Singh (Associate Professor), Dr Rahul Dhodapkar (Associate Professor) and Dr Nonika Rajkumari (Assistant Professor).
  • Pondicherry Institute of Medical Sciences (PIMS), Microbiology Faculty—Dr Shashikala (Professor), Dr Sheela Devi (Professor) and other faculty members.
  • JIPMER, Department of Microbiology–Residents, MSc, PhD scholars and others.
  • PIMS, Department of Microbiology–PG students and others.
  • 14Meenakshi Medical College, Chennai, Tamil Nadu, India, Department of Microbiology staff—Dr Amshavathani (Professor and HOD), Dr Senthamarai (Professor), Dr Sivasankari (Associate Professor), Dr Kumudavathi (Tutor) and Dr Anitha (Assistant Professor).
  • ESIC Medical College and PGIMSR, Chennai, Tamil Nadu, India, Department of Microbiology staff—Dr Manisha S Mane (Associate Professor) and others.
  • Sri Siddhartha Medical College, Tumkur, Karnataka, India (All faculty members, Department of Microbiology).
  • Our friends—Dr Godfred, Dr Sadia, Dr Ramakrishna, Dr Neelesh, Dr Srinivas, Dr Chhaya, Dr Manisha, Dr Ira and others.
  • All maternal and paternal relatives and cousins.
  • Last but not the least, we want to thank our parents—Mr Ganesh Bhat and Mrs Shakunthala Bhat for their continuous support throughout the journey of the manuscript preparation and bestowing all their blessings.151617
18Further Reading
  • Harrison's Principles of Internal Medicine, 18th Edition
  • Gillespie's Medical Microbiology and Infection at a Glance, 4th Edition
  • Bailey & Scott's Diagnostic Microbiology, 13th Edition
  • Koneman's Color Atlas and Textbook of Diagnostic Microbiology, 6th Edition
  • Mackie and McCartney's Practical Medical Microbiology, 14th Edition
  • Prescott's Microbiology, 9th Edition
  • Jawetz Melnick and Adelbergs’ Medical Microbiology, 26th Edition
  • Kuby's Immunology, 7th Edition
  • Abbas’ Cellular and Molecular Immunology, 8th Edition
  • Stites’ Medical Immunology, 10th Edition
  • Robbins & Cotran Pathologic Basis of Disease, 9th Edition
  • Topley and Wilson's Microbiology and Microbial Infections, 10th Edition
  • Patrick R Murray's Medical Microbiology, 7th Edition
  • Centers for Disease Control and Prevention, Atlanta, USA
  • World Health Organization (WHO)
  • National AIDS Control Organisation (NACO), India
  • Revised National Tuberculosis Control Programme (RNTCP), India
  • National Vector Borne Disease Control Programme (NVBDCP), India
  • Various national and international journals and other internet sources