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Immunology > Microbiology DSA > Flashcards

Microbiology DSA Flashcards

1
Q

Gram Staining

A
  • Separates organisms into Gram Pos (Blue, absorb Crystal Violet) or Gran Negative (Red, absorb Safranin). Also allows for the shape of the organism to be observed

Steps:
1) Smear the substance to be stained, onto a slide and then heat to fix the bacteria on the slide

2) Pour CRYSTAL VIOLET stain (Blue dye) and wait 60 Secs
3) WASH OFF with water and flood with IODINE Solution. Wait 60 Secs
4) WASH OFF with water and then “DECOLORIZE” with 95% ALCOHOL
5) COUNTER-STAIN with SAFRANIN (Red dye). Wait 30 Secs and WASH OFF with water

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2
Q

Gram Positive Cell Wall

A

2 Layers:

1) Inner Cytoplasmic membrane (Phospholipid Bilayer)
2) Outer THICK PEPTIDOGLYCAN Layer (60-100% Peptidoglycan)

  • LOW Lipid Content (No Cholesterol or other Sterols)
  • NO ENDOTOXIN
  • NO Periplasmic space
  • NO Porin Channel
  • VULNERABLE to LYSOZYME and PENICILLIN attacks
  • Outer Layer also contains TEICHOIC ACID!!!!
  • TRANSPEPTIDASE (Penicillin Binding Protein) catalyzes the formation of the Cross-Linked Peptidoglycan!!!
    - PENICILLIN binds to and INHIBITS this enzyme!!!!!
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3
Q

Gram Negative Cell Wall

A

3 Layers:

1) Inner Cytoplasmic Membrane (Phospholipid Bilayer)
2) THIN PEPTIDOGLYCAN Layer (5 - 10%)
- Contains MUREIN Proteins (Binds 2nd and 3rd layer together)
3) Outer Membrane with LIPOPOLYSACCHARIDE (LPS)
- Outer Part: O Specific Side Chain
- Middel Part: Core Polysaccharide (Water Soluble)
- Inner Part: LIPID A (Endotoxin)
- Can cause Fever, Diarrhea, and possible Fatal Endotoxic Shock

  • HIGH Lipid Content
  • Has ENDOTOXIN LPS- (LIPID A)
  • Has Periplasmic Space
  • Has Porin Channel
  • RESISTANT to LYSOZYME and PENICILLIN attacks
  • NO TEICHOIC ACID!!!!!!
  • The Outer Lipid containing cell membrane is partially dissolved by the alcohol during Gram Staining which allows for the Gram Negative Bacteria to pick up the Safranin
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4
Q

Bacterial Morphology

A

1) COCCI: Spherical
2) BACILLI: Rods
3) SPIRAL FORMS: Comma- shaped, S Shaped, or Spiral-shaped
4) PLEOMORPHIC: lacking a distinct shape like Jello

  • PAIRS: Diplo
  • CLUSTERS
  • STRIPS
  • With FLAGELLA
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5
Q

Gram Positive Bacteria Coccus Shaped

A

1) Streptococcus (Strips)
2) Enterococcus (Strips)
3) Staphylococcus (Clusters)

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6
Q

Gram Positive Bacteria Bacillus Shaped that FORM SPORES

A

1) Bacillus

2) Clostridium

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7
Q

Gram Positive Bacteria Bacillus Shaped NO SPORES

A

1) Corynebacterium

2) Listeria

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8
Q

Gram Negative Bacteria Coccus

A

1) Neisseria (Diplococci)

2) Moraxella (Diplococci)

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9
Q

Gram Negative Bacteria SPIRAL- Shaped

A

1) SPIROCHETES
- Treponema pallidum (SYPHILIS)
- Borellia
- Leptospira

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10
Q

Gram Negative Bacteria Bacillus

A
  • Almost all Gram Negative Bacteria are Bacilli shaped or Pleomorphic

Pleomorphic:

1) Chlamydia
2) RIckettsiae

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11
Q

Bacteria Exceptions for Shape

A

1) Mycobacteria
- Weakly Gram Positive
- Stain better with ACID- FAST STAINING!!!!!!!!
- Cause TUBERCULOSIS and LEPROSY!!!!!!

2) Spirochetes
- Have Gram Negative cell wall but are too SMALL to be seen with light microscope
- Visualized with a DARKFIELD MICROSCOPE
- Have THIN Peptidoglycan and LPS membrane
- Surrounded by ADDITIONAL PHOSPHOLIPID-RICH Outer MEMBRANE with few exposed proteins
- This causes Spirochetes to high from Immune Recognition (STEALTH)
- PERIPLASMIC FLAGELLA (Run sideways under outer membrane sheath)

3) Mycoplasma
- Do NOT have CELL WALL
- Only have a simple cell membrane, so neither Gram Pos or Gram Neg

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12
Q

Exotoxin

A
  • PROTEINS that are SECRETED by both Gram Positive and Gram Negative bacteria
    - Released by most of the Gram positive

Gram Negative Bacteria:

1) Vibrio cholera
2) Escherichia coli

Diseases caused by Exotoxin:

1) Anthrax
2) Botulism
3) Tetanus
4) Cholera

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13
Q

Exotoxin (NEUROTOXIN)

A
  • Act on the nerves or motor endplates to cause Paralysis

Examples:

1) Tetanis toxin
2) Botulinum toxin

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14
Q

Exotoxin (Enterotoxins)

A
  • Act on the Gastrointestinal tract to cause Diarrhea
  • Inhibit NaCl resorption
  • Activate NaCl secretion
  • Kill Intestinal Epithelial Cells
  • CAUSE DIARRHEA

Disease Manifestations:

1) INFECTIOUS DIARRHEA:
- Bacteria colonize and bind to the GI tract, continuously releasing Exotoxin. Diarrhea continues until bacteria destroyed
- Examples:
1) Escherichia coli
2) Campylobacter jejuni
3) Shigella dysenteriae

2) FOOD POISONING:
- Bacteria grow in food and release Enterotoxin in the food. Results in Diarrhea and vomiting
- Examples:
1) Bacillus cereus
2) Staphylococcus aureus

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15
Q

Exotoxin (Pyrogenic Exotoxins)

A
  • Stimulate the release of Cytokines and cause RASH, FEVER, and TOXIC SHOCK Syndrome
  • Examples:
    1) Staphylococcus aureus
    2) Streptococcus pyogenes
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16
Q

Exotoxin (Tissue Invasive Exotoxins)

A
  • Allow bacteria to destroy and tunnel through tissues. Include enzymes that Destroy DNA, Collagen, Fibrin, NAD, RBC, and WBC
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17
Q

Endotoxin

A
  • LIPID A is the best Example of an Endotoxin
    • It is a piece of the Outer Membrane Lipopolysaccharide (LPS) of Gram Negative bacteria
    • Lipid A is very toxic and is released when the bacterial cell undergoes LYSIS (Destruction)

** Sometimes treating the patient who has GRAM NEGATIVE infection with Antibiotics can WORSEN the patient’s condition because all the bacteria are Lysed, RELEASING LARGE AMOUNT OF ENDOTOXIN!!!!!!!!

  • ** Endotoxin is a NORMAL PART of the OUTER MEMBRANE that is shed during LYSIS of the bacteria!!!!!!!
    - It is NOT a PROTEIN SECRETED
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18
Q

Virulence Factors

A

Virulence: the DEGREE of PATHOGENICITY!!!

  • Virulence depends on the presence of certain structures and on bacterial Exotoxins and Endotoxins
  • Flagella
  • Pili
  • Capsules
  • Endospores
  • Biofilms
  • Facultative Intracellular Organisms
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19
Q

Flagella

A
  • Protein filaments that extend like long tails from the cell membrane of certain bacteria
  • Move the bacteria around
  • Flagellum is AFFIXED to the bacteria by a BASAL BODY
    • Basal Body spans through the entire cell wall
    • Basal body is what SPINS the FLAGELLA
  • Single polar Flagellum:
    • Vibrio Cholera
  • Peritrichous flagella (Many flagella around cell)
    • Excherichia coli
    • Proteus mirabilis
  • PERIPLASMIC FLAGELLA:
    • Spirochetes have AXIAL FLAGELLA which run along their unique outer membrane sheath
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20
Q

Pili

A
  • Straight filaments arising from the bacterial cell wall, making bacteria look like a porcupine
  • Pili are much shorter than flagella and DO NOT MOVE!!!
  • Pili serve as ADHERENCE FACTORS (Adhesins) which are vital for a bacterias ability to cause disease
    • Neisseria gonorrhea has pili that allow it to bind to cervical cells and buccal cells to cause gonorrhea
    • Escherichia coli and Campylobacter jejune cannot cause diarrhea without their Adhesions to bid to the Interstinal epithelium
    • Bordetella pertussis uses its Adhesions to bind to ciliated respiratory cells and cause WHOOPING COUGH!!!
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21
Q

Capsules

A
  • Protective walls that surround the cell membranes of bacteria
  • Composed of SIMPLE SUGAR residues
  • Bacteria secrete these sugar moieties, which coat their outer wall
  • Bacillus anthracis has a Capsule made up of AMINO ACIDS
  • Capsules enable bacteria to be MORE VIRULENT because Macrophages and Neutrophils are UNABLE to PHAGOCYTIZE the encapsulated bacteria
  • Encapsulated bacteria appear SMOOTH
  • Non encapsulated bacteria appear ROUGH
  • The process of Ab binding to the capsule is called OPSONIZATION
    • Once these Ab have bound to the capsule, Macrophages and Neutrophils can bind to the Fc portion of the Ab and kill the bacteria
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22
Q

Important tests for Capsules

A

1) India Ink Stain:
- Capsule appears transparent halo around the cell (because stain is not taken up by capsule)
- Identify fungus Cryptococcus

2) Quellung Reaction:
- The bacteria are mixed with Antibodies that bin to the Capsule
- When these Ab bind, the capsule SWELLS WITH WATER, and this can be visualized microscopically!!!

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23
Q

Endospores

A
  • Formed by only 2 Gram Positive bacteria:
    1) Bacillus (aerobic)
    2) Clostridium (anaerobic)
  • Endospores are metabolically dormant forms of bacteria that are resistant to heat (boiling), cold, dying, and chemical agents
    a) Cell Membrane
    b) Thick Peptidoglycan mesh
    c) Another Cell Membrane
    d) Wall of Keratin-like Protein
    e) Outer layer called EXOSPORIUM
  • Spores form when there is a shortage of needed nutrients and can lie dormant for years!!!!!!!!!
    • Autoclave is used to kill the bacteria that form spores
      • 121 degrees Celsius for 15 mins, with steam under pressure
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24
Q

Biofilms

A
  • Extracellular polysaccharide network, similar to the capsule polysaccharides that form a MECHANICAL SCAFFOLD AROUND THE BACTERIA
  • Protects the bacteria from attacks by antibiotics and the Immune system
    • Staphylococcus epidermis forms biofilms on catheters
  • Most effective way to cure and infection involving a prosthetic device is to remove the device
25
Q

Facultative Intracellular Organisms

A
  • Bacteria that are phagocytosed but still SURVIVE WITHIN THESE WHB UNHARMED!!!1
  • They INHIBIT PHAGOLYSOSOME FORMATION!!!!!!
  • Inside these cells, the bacteria are safe from antibodies and other immune defenses
  • Listeria monocytogenes
  • Salmonella typhi
  • Yersinia
  • Francisella tularensis
  • Brucella
  • Legionella
  • Mycobacterium
  • Nocardia

“Listen Sally Yer Friend Bruce Must Leave Now”

26
Q

Oxygen

A
  • for bacteria to live in Oxygen rich environments they must have 3 enzymes present

1) Catalse:
- Breaks down Hydrogen Peroxide

2) Peroxidase:
- Breaks down Hydrogen Peroxide

3) Superoxide Dismutase:
- Breaks down Superoxide radicals

27
Q

Obligate Aerobes

A
  • GLycolysis, Kreb Cycle, Electron Transport chain
  • These bacteria have all of the Oxygen Necessary enzymes

Gram Pos:

  • Nocardia
  • Bacillus cereus

Gram Neg:

  • Neisseria
  • Pseudomonas
  • Bordetella
  • Legionella
  • Brucella

Acid Fast:

  • Mycobacterium
  • Nocardia
28
Q

Facultative Anaerobes

A
  • These bacteria are AEROBIC
  • Contain Catalase and Superoxide Dismutase
  • They CAN GROW in the ABSENCE of OXYGEN by using FERMENTATION for Energy!!!!

Gram Pos:

  • Staphylococcus
  • Bacillus anthracis
  • Corynebacterium
  • Listeria
  • Actinomyces

Gram Neg:
- Mothe other gram negative rods

29
Q

Microaerophilic (Aerotolerant anaerobes)

A
  • These bacteria use Fermentation and have no electron transport system
  • Can tolerate LOW AMOUNT of OXYGEN because have Superoxide Dismutase (but have no Catalse)

Gram Pos:

  • Enterococcus
  • Streptococcus
  • Some species of Streptococci are Facultative Anaerobes

Gram Neg:

  • Spirochetes
    • Treponema
    • Borrelia
    • Leptospira
  • Campylobacter
30
Q

Obligate Anaerobes

A
  • HATE OXYGEN
  • Have no enzymes to defend against it

Gram Pos:
- Clostridium

Gram Neg:
- Bacteroides

31
Q

Carbon and Energy Source

A

1) Phototrophs:
- Use light as Energy Source

2) Chemotrophs:
- Use Chemical Compounds as Energy Source
A) Autotrophs:
- Use Inorganic sources as Energy Sources
- Ex: Ammonium and Sulfide
B) Heterotrophs:
- Use Organic Carbon sources as Energy Source

  • All MEDICALLY Important bacteria are Chemoheterotrophs
    • Use Glucose as Energy Source
32
Q

Fermentation

A

Glycolysis

  • Used by many bacteria for Oxygen Metabolism
  • Glucose is broken down to Pyretic acid, yielding ATP directly
  • EMBDEN-MEYERHOF PATHWAY!!!!! (Normal Glycolysis)
  • The pyruvate can be broken down into different products such as:
    • Lactic Acid
    • Ethanol
    • Propionic Acid
    • Butyric Acid
    • Acetone
33
Q

Respiration

A
  • Used with Aerobic and Facultative Anaerobic organisms
  • Includes Glycolysis, Krebs TCA Cycle, Electron transport chain Coupled with OXIDATIVE PHOSPHORYLATION
  • Produce ATP!!!
34
Q

Obligate Intracellular Organisms

A
  • Not capable of metabolic pathways for ATP synthesis and must STEAL ATP FROM THEIR HOST
    • CANNOT SURVIVE without Host
  • Examples:
    • Chlamydia
    • Rickettsia
35
Q

Septic Shock Statistics

A

(ENDOTOXIC SHOCK)

  • Common and deadly response to GRAM- NEGATIVE and Gram positive infection
  • NUMBER ONE CAUSE of DEATH in Intensive Care Units and 13th MOST COMMON cause of DEATH in the U.S.
36
Q

Bacteremia

A
  • Bacteria in the blood stream

- Triggers Immune System, resulting in Sepsis and possible Death

37
Q

Sepsis

A
  • Bacteremia that causes a SYSTEMIC IMMUNE RESPONSE to the Infection
  • Response can include HIGH or LOW Temperature, Elevation of the WBC count, and Fast Heart Rate or Breathing Rate
38
Q

Septic Shock

A
  • Results in a Dangerous DROP in Blood Pressure and Organ Dysfunction
  • ENDOTOXIC SHOCK
  • Endotoxin (Gram Neg bacteria) often triggers the Immune response that results in Sepsis and Shock
  • Can be caused by Gram Negative bacteria or Fungi
  • Organisms release structural components in the bloodstream and Stimulate Immune Cells such as Macrophages and Neutrophils
    • These Cells release proteins called ENDOGENOUS MEDIATORS of SEPSIS
  • Most famous endogenous mediator of sepsis is TUMOR NECROSIS FACTOR also called CACHECTIN
  • In Sepsis, TNF triggers the release of IL-1!!!!!! which triggers Macrophages and Endothelial cells, which in turn triggers the RELEASE of other Cytokines and Prostaglandins!!!!!
  • These mediators ultimately turn against the body and cause:
    • Vasodialtion
    • Hypotension
    • Organ System Dysfunction
  • ** Mortality Rate of Shock is high (40%) even with Intensive care and Antibiotics**
    • Usually two organ failures are involved w/ Septic Shock:
      1) Vascular System: Hypotension
      2) Lungs: Hypoxia

** For EACH ADDITIONAL Organ failure, add a 15-20% Mortality Rate**!!!!!!!!

39
Q

Treatment

A

FIND THE SITE OF INFECTION!!!!!!!!!

  • Start broad coverage Antibiotics (Empiric Therapy)
  • Blood Pressure must be supported with Fluids and Drugs (Dopamine and Norepinephrine)
  • Must be Oxygen Maintained and Mechanical Ventilation is often used
40
Q

4 Bacteria that Produce Exotoxins that Increase Levels of cAMP

A 
c = Cholera (Vibrio cholera)
A= Anthrax (Bacillus anthracis)
M = Montezuma's Revenge (E. coli "popular name")
P= Pertussis (Bordetella pertussis)
41
Q

Clostridium tetani

A

Toxin: Tetanospasmin

Mechanism: H (binds nerual Gangliosides) and L Subunit which blocks release of Neurotransmitters

Results: Uncontrolled Muscle Contractions (Lockjaw, tetanic paralysis of respiratory muscles)

Notes: DTaP VACCINE!!!!!

42
Q

Clostridium bolulinum

A

Toxin: Botulinum toxin

Mechanism: Inhibits Acetylcholine release from motor neuron endplates

Results: Botulism- Flaccid paralysis and respiratory muscle paralysis

Notes: MOST POTENT EXOTOXIN!!!!!!!!!

43
Q

Vibrio Cholerae

A

Toxin: Choleragen

Mechanism: Five B and Two A subunits, ELEVATED LEVELS of cAMP and SECRETION OF NACL!!!!!!

Results: Cholera, due to Increase cAMP levels in increased Intraluminal NaCl. Dehydration and Diarrhea

Notes: DEATH BY DEHYDRATION!!!!!

44
Q

E. coli
Campolybacter Jejuni
Bacillus cereus

A

Toxin: Labile Toxin

Mechanism: Five B and Two A subunits, ELEVATED LEVELS of cAMP and SECRETION OF NACL!!!!!!

Results: Increase cAMP levels in increased Intraluminal NaCl. Dehydration and Diarrhea

Notes: DEATH BY DEHYDRATION!!!!!

45
Q

E.coli

Y. enterocolitica

A

Toxin: Stabile Toxin

Mechanism: No effect on [cAMP], but activates production of GMP, and INHIBITION of NaCl reabsorption

Results: Increasing cGMP and inhibits NaCl resoption!!!!! OSMOTIC PULL OF ELECTROLYTES INTO Intestinal Tract ——> DIARRHEA

46
Q

Shigella dysteneriae
Enterohemorrhagic E.coli
Enteroinvasice E.coli

A

Toxin: SHIGA TOXIN!!!!!!

Mechanism: Five B and Two A subunits, INHIBITS PROTEIN SYNTHESIS by INACTIVATING 60S Ribosomal Unit!!!!!!! Kills Intestinal Epithelial cells!!!

Results: Shiga toxin kills absoptive intestinal epithelial cells, dead cells and poor absorption of fluid and electrolyte

Notes: BLOODY DIARRHEA, Hemolytic Uremic Syndrome, INHIBITS PROTEIN SYNTHESIS!!!!!!!!!

47
Q

Staphylococcus aureus

A

Toxin: Staphylococcal Heat Stabile Toxin

Mechanism: None

Results: Diarrhea and Vomiting LASTING LESS THAT 24 HOURS!!!!!

Notes: Toxins are deposited on food

48
Q

Bacillus cereus

A

Toxin: Heat Stabile Toxin

Mechanism: None

Results: Vomiting LESS THAN 24 HOURS, Limited DIARRHEA!!!!!!!

Notes: ENDOSPORES SURVIVE LOW TEMP COOKING!!!!!
Can produce food poising by HEAT STABILE ENTEROTOXIN!!!!!!!!

49
Q

Streptococcus pyrogenes (Group A streptococci)

A

Toxin: Pyrogenic Toxin

Mechanism: Activates endogenous mediators of SEPSIS, IL-1!!!!!!!!

Results: SCARLET FEVER!!!!!!!!!!!

Notes: Obtain Exotoxin from a temperature bacteriophage by Lysogenic Conversion

50
Q

Staphylococcus aureus

A

Toxin: Toxic Shock Syndrome Toxin

Mechanism: Activates Endogenous Mediators of SEPSIS, IL1!!!!!

Results: TOXIC SHOCK SYNDROME

1) Fever
2) Rash
3) Desquamination
4) Diarrhea
5) Hypotension (shock

Notes: TOXIC SHOCK SYNDROME

51
Q

Streptococcus pyrogenes (Tissue Invasive)

A

Toxin:

1) Hemolysis/ Streptolusin O and S
2) Streptokinase
3) DNAases
4) Hyalurinidase
5) NADase

Mechanism:

1) Lyses RBC
2) Activates plasminogen to lyse FIBRIN
3) Hydrolyzes DNA
4) Break down Proteoglycans
5) Hydrolyzes NAD

Results: TISSUE DESTRUCTION

1) Abscesses
2) Skin Infection
3) Systemic Infection

52
Q

Staphylococcus aureus (Tissue Invasive)

A

Toxin:

1) Lipases
2) Penicillinase
3) Staphylokinase
4) Leukocidin
5) Exfoliatin
6) Factors that bind Complement

Mechanisms:

1) Hydrolyzes lipid
2) Destroys Penicillin
3) Activates Plasminogen to Lye FIBRIN
4) Lyse WBC
5) Epithelial cell LYSES
6) Cripples host Complement Defense

Result: TISSUE DESTRUCTION, SCALDING SKIN SYNDOME IN INFANTS!!!!!!!!!!!!!!

1) Abscesses
2) Skin Infections
3) Systemic Infection

53
Q

Clostridium perfringens

A

Toxin: 12 lethal but ALPHA TOXIN is most Lethal!!!!!!

Mechanism: Hydrloyzes LECITHIN in Cell Membranes, resulting in cell death

Results: TISSUE DESTRUCTION and Gas GANGRENE!!!!!!

54
Q

Bacillus Anthracis (Miscellaneous Exotoxins)

A

Toxin: Anthrax TOXIN (EF,LF,PA)

Mechanism:

1) PA = Binding
2) EF = Calmodulin dependent adenylate cyclase (Incr cAMP)
3) LF = Inactivates Protein Kinase (Zine metalloprotease) and causes Macro to release TNF and IL-1beta!!!!!!!!

Results: ANTHRAX!!!!!!!!!!!!
- Edema Factor: Increase cAMP levels in Neutrophils and Macrophages

Notes: ALL THREE COMPONENTS ARE REQUIRED FOR ACTIVITY!!!!!!!!!!!!!!

55
Q

Corynebacterium diptheriae

A

Toxin: Diptheria Toxin

Mechanism:

1) B Subunit: HEART and NEURAL TISSUE
2) A Subunit: ADP RIBOSYLATES, INHIBITING Translation of mRNA into PROTEINS!!!!

Results: DIPTHERIA

1) MYOCARDITIS (Heart)!!!!!!!!
2) Peripherla Nerve Palsies
3) Central Nervous System Effects

Notes: This toxin is considered a HUMAN ANTIBIOTIC and INHIBITS PROTEIN SYNTHESIS!!!!!

  • DTaP VACCINE!!!!!!!!!!!!!
56
Q

Bordetella pertusis

A

Toxin:

1) Pertussis Toxin
2) Extracutoplasmic Adenylate Cyclase
3) Filamentous Hemagglutin
4) Tracheal Cytotoxin

Mechanism:

1) Incr cAMP
2) Impairs Chemotaxis and Phagocytosis
3) Bindin to ciliated Epithelial cells
4) Respiratory epithelial cell damages

Results: WHOOPING COUGH!!!!!!!!!!!!!!!!!

Nots: DTaP!!!!!!!!!!!!

57
Q

Clostrisium difficile

A

Toxin: Toxin A and B

Mechanism:

1) A= fluid secretion and mucosal inflammation (Diarrhea)
2) B= Cytotoxic to Colonic Epithelial cells

Results: PSEUDOMEMBRANEOUS ENTEROCOLITIS

  • Colonic inflammation
  • Diarrhea (bloody), fever, abdominal pain

Notes:

1) Antibiotic associated DIARRHEA
2) HYPERVIRULENT STRAIN NAP1/BI/027 produces “BINARY TOXIN”!!!!!!!!!!!!!!!!!!!!!

58
Q

Pseudomonas auruginosa

A

Toxin: Pseudomonas Exotoxin A

Mechanism: Inhibits PROTEIN SYNTHESIS by inhibiting Elongation Factor 2

Results: None

Notes: Diptheria toxin has the same action as Pseudomonas Exotoxin A, but different targets

- Exotoxin A: LIVER!!!!!!!!!!!!!!!!!
- Diptheria: HEART

Immunology (6 decks)

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