Advances in Antimicrobial Strategies

Introduction

Module Information
Module Coordinators: A/Prof Vincent Chow and A/Prof Kevin Tan
Email:
Tel:

micctk@nus.edu.sg; mictank@nus.edu.sg
6516-3691; 6516-6780

LECTURES:
WEDNESDAYS
PRACTICALS: FRIDAYS
Lecturers:

A/Prof. Vincent Chow (VC)

A/Prof. Kevin Tan (KT)
A/Prof .Sylvie Alonso (SA)
A/Prof. Gamini K. (GK)
A/Prof. Tan Yee Joo (TYJ)
A/Prof. Thomas Dick (TD)

TIME:1400 1600 hrs

TIME:1000 1400 hrs

VENUE:LT 20
VENUE:LS Lab 9 @MD4

Lectures:
Team Presentations:
Practicals / Tutorials:

16 hrs
8 hrs
28 hrs

Total

50 hrs

W
K

MONTH

LECTURES/ TEAM PRESENTATIONS

WEDNESDAYS

PRACTICALS / TUTORIALS
FRIDAYS

Introduction (VC)
Lab Methods (GK)

P1 (Diagnostic Microbiology) (SA/GK)

Lab Methods (GK)

Antibiotic Resistance (GK)

P2 (Diagnostic Microbiology) (SA/GK)

Microbial Pathogenesis (TYJ)

P3 (Diagnostic Microbiology)
(SA/GK)

Immunology & Infection (SA)

Mid-Semester Break

Immunization (SA)

P4 (Immunological Methods) (KT/VC)

Opportunistic Infections

P5 (Molecular Techniques) (VC/TYJ)

10

New and New Infections (VC)

P6 (Molecular Techniques) (VC/TYJ)

11

Team Presentations

12

Team Presentations

P7 (Molecular Techniques) (VC)

13

Team Presentations

14

Team Presentations

Objectives
LSM 4223 is an advanced course in the study of human infectious
diseases with emphasis on new and emerging infections as well as
those of major clinical/economic importance
Students are expected to have basic knowledge of infectious diseases

Understanding the principles and practice of Medical Microbiology

Microbial pathogenesis
Host immune response and vaccines
Nature and emergence of antimicrobial resistance
Changing epidemiology of infections
Classical diagnostic techniques and current molecular approaches

Seminars will be conducted as team presentations to explore current

topics on infectious diseases & recent advances in antimicrobial

strategies in depth

Reference Texts
Fundamentals of Microbiology (Alcamo)
Jones & Bartlett

Medical Microbiology (Jawetz, Melnick & Adelberg)

McGraw Hill, Appleton and Lange

Medical Microbiology (Baron S)

http://gsbs.utmb.edu/microbook/

Microbial Biotechnology (Lee)

World Scientific

Reference Textbooks for Immunology

Background Reading

Caution about Websites

Good websites:
From authoritative sources
WHO www.who.int
CDC www.cdc.gov
From good Universities

Bad websites:
Those not from academic or authoritative sources

Your Lecturers

A/Prof Vincent Chow MD, PhD, FRCPath

Associate Professor
Molecular Virologist
Department of Microbiology
Tel: 65 6516 6200
Email: micctk@nus.edu.sg
Research area
- Emerging Viral Diseases
- Molecular genetics and infectomics

Your Lecturers
Dr. Kevin SW Tan BSc (Hons) PhD
Associate Professor
Molecular Parasitologist
Laboratory of Molecular and Cellular Parasitology
Department of Microbiology
Level 5, Block MD4
Tel: 6516 6780
Email: mictank@nus.edu.sg
Research area

Cell and molecular biology of the malaria parasite Plasmodium falciparum

Clinical aspects of the protozoan parasite Blastocystis hominis

Your Lecturers
A/Prof. Gamini Kumarasinghe MBBS, DPath, FRCPath, FRCPA
Senior Consultant
Division of Microbiology, National University Hospital
Clinical Microbiologist
Department of Laboratory Medicine
Main Building, Level 3
National University Hospital
Email: GaminiK@nuh.com.sg
Main responsibilities
Supervision of the clinical microbiology laboratory, clinical
liaison and consultation
Infection control policy formulation

Your Lecturers
A/Prof. Sylvie Alonso PhD
Associate Professor
Bacteriologist / Immunologist
Department of Microbiology
Tel: 65 6516 3541
Email: micas@nus.edu.sg
Research area
Host-pathogen Interactions
Development of live bacterial vaccines

Your Lecturers
A/Prof. Tan Yee Joo
Associate Professor, Microbiology, NUS
Virologist
Email: mictyj@nus.edu.sg
Research areas
Understanding how RNA viruses make use of host cell
machineries for their own benefits
SARS coronavirus, avian influenza virus, hepatitis C virus

Your Lecturers
A/Prof. Thomas Dick
Associate Professor, Microbiology, NUS
Molecular Bacteriologist
Email: micdickt@nus.edu.sg
Research areas

Resistance and persistence of bacterial

infections
Antibacterial drug discovery

Assessment

Assessment
Team presentation
Written report (CA)
Lab reports
Final exam
Total

10%
20%
20%
50%
100%

Team Presentations
Broad Topics

Critical Discussion on Diagnostic Lab Methods

Microbial Pathogenesis and Host Defence
Evolution of Microbial Pathogens / Emerging

Diseases
Infections of Immunocompromised/ Vaccines

Typically:

8 group presentations
Team reports = CA

~ 7-8 students per group

Full details on IVLE

Relevance and Impact of Infectious Diseases

Lectures
Lab methods of Diagnosis
Antibiotic/ Drug Resistance
Microbial Pathogenesis
Immunology and Infection
Vaccines
Opportunistic Infections
Emerging Infections

http://www.cia.gov/nic/special_globalinfectious.html

http://www.cia.gov/nic/special_globalinfectious.html

http://www.cia.gov/nic/special_globalinfectious.html

http://www.cia.gov/nic/special_globalinfectious.html

Swine Flu
Genes in this new virus very similar to influenza

viruses in pigs in North America.

Genes from swine flu viruses in Europe and Asia.
Genes from avian and human flu viruses.
Quadruple reassortant" virus.
Reinforces the importance of pigs as mixing
vessels for reassortment events.

Novel H1N1-2009 virus

Highly contagious among humans.
Transmission similar to seasonal influenza

coughing, sneezing, via infected surfaces and

objects.
Symptoms fever, cough, sore throat, runny or
blocked nose, headache, body aches, lethargy.
Also diarrhea and vomiting.

Clinical severity
Mild to severe. Most infected individuals recover

without treatment.
However, hospitalizations and deaths may occur
especially in high-risk groups (70%), i.e. asthma,
heart disease, renal disease, diabetes,
immunosuppressed, pregnancy.
Unlike seasonal influenza, adults over 65 years are
not at increased risk of flu complications. One
third have cross-reactive neutralizing antibodies.

WHO activities in avian influenza and pandemic

influenza preparedness
I. Reduce human exposure to the H5N1 virus
II. Strengthen the early warning systems
III. Intensify rapid containment operations
IV. Build capacity to cope with a pandemic
V. Coordinate global scientific research and
development

H5N1 Airborne Spread?

Two separate groups, led by Y. Kawaoka

(Wisconsin-Madison), and Ron Fouchier

(Rotterdam).
Passaged the virus from one ferret to another
several times, to mimic natural evolution. After
several generations, the virus had acquired the
ability of airborne transmission.

H5N1 Controversy in 2011

Transmissible strain had 5 mutations in 2 genes.

Each mutation already exists in nature: but only

in separate strains, and so far not together in a
single strain.
Potential for this H5N1 strain to be abused as a
bioterrorist agent or for biological warfare.
Current H5N1 fatality rate of ~60%.

http://www.cia.gov/nic/special_globalinfectious.html

http://www.cia.gov/nic/special_globalinfectious.html

Impact of Infectious Diseases on Trade

Cholera in Peru. The outbreak of cholera in 1991 cost the Peruvian fishing industry an
estimated $775 million in lost tourism and trade because of a temporary ban on seafood
exports.
Avian flu in Hong Kong. The avian influenza outbreak in 1997 cost the former colony
hundreds of millions of dollars in lost poultry production, commerce, and tourism, with
airport arrivals in November of that year alone down by 22 percent from the preceding
year.
BSE and nvCJD in Britain. The outbreak of BSE and new variant Creutzfeldt-Jakob
disease in the United Kingdom in 1995 prompted a mass slaughter of cattle, drastically
cut beef consumption, and led to the imposition of a three-year EU embargo against
British beef. The losses to the British economy were estimated by the WHO at $5.75
billion, including $2 billion in lost beef exports.
Foot and mouth disease in Taiwan. In 1997 an outbreak of foot and mouth disease
(FMD) devastated Taiwan's pork industry--one of the largest in the world--shutting
down exports for a full year.
Nipah in Malaysia. In 1999, the Nipah virus caused the shutdown of over half of the
country's pig farms and an embargo against pork exports.
Cyclospora in Guatemalan raspberries. The outbreak of cyclospora-related illness
in the United States and Canada associated with raspberries from Guatemala led to
curbs in imports that cost Guatemala several million dollars in lost revenue.

http://www.cia.gov/nic/special_globalinfectious.html

Projected Outcomes (2020) by

National Intelligence Council, CIA, USA
Steady Progress
Aging of global populations and declining fertility

rates, socioeconomic advances, and improvements in

health care and medical breakthroughs
Non-infectious diseases as heart disease and cancer
would replace infectious diseases as the overarching
global health challenge
Unlikely because it gives inadequate emphasis to
persistent demographic and socioeconomic challenges
in the developing countries, to increasing microbial
resistance to existing antibiotics

Projected Outcomes (2020)

Progress Stymied

Little or no progress in countering infectious diseases over the

duration of this estimate

HIV/AIDS reaches catastrophic proportions as the virus spreads
throughout the vast populations of India, China, the former
Soviet Union, and Latin America
Multidrug treatments encounter microbial resistance and remain
prohibitively expensive for developing countries
Multidrug resistant strains of TB, malaria, and other infectious
diseases appear at a faster pace than new drugs and vaccines,
wreaking havoc on world health
Although more likely than the "steady progress" scenario, this
scenario also is unlikely to prevail because it underestimates the
prospects for socioeconomic development, international
collaboration, and medical and health care advances

Projected Outcomes (2020)

Deterioration, Then Limited Improvement

Worsens during the first half of time frame

Decreases after that, owing to better prevention and control efforts, new drugs and
vaccines, and socioeconomic improvements
In the previous decade, under this scenario, negative demographic and social
conditions in developing countries, such as continued urbanization, poor health care
capacity, and natural disasters remain conducive to the spread of infectious diseases
During this decade, more positive demographic changes such as reduced fertility and
aging populations; gradual socioeconomic improvement in most countries; medical
advances against childhood and vaccine-preventable killers such as diarrheal diseases,
neonatal tetanus, and measles; expanded international surveillance and response
systems; and improvements in national health care capacities take hold in all but the
least developed countries
Barring the appearance of a deadly and highly infectious new disease, a catastrophic
upward lurch by HIV/AIDS, or the release of a highly contagious biological agent
capable of rapid and wide-scale secondary spread, these developments produce at
least limited gains against the overall infectious disease threat
Most likely scenario

Salient Points

Globally, infectious diseases are a leading cause of

death
Infectious diseases influence social, economic and
political aspects of countries
Human behavior and mutations in pathogens lead
to spread of infectious diseases
New and reemerging infectious diseases will pose a
rising global health threat
Need novel strategies to detect, treat and prevent
emerging and existing infectious threats