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Rajesh Bhatia
MD (Medical Microbiology)
Formerly Director National Institute of Biologicals, New Delhi
and
Department of Microbiology
Maulana Azad Medical College, New Delhi
India

Rattan Lal Ichhpujani
MD (Medical Microbiology)
Additional Director and
Chief of Division of HIV/AIDS and Related Diseases
National Institute of Communicable Diseases, Delhi
Formerly Department of Microbiology
Medical College, Rohtak
Haryana
India

First Edition: 1994
Second Edition: 1999
Third Edition: 2004
Fourth Edition: 2008

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Book Details
 Price
 3.00
 Pages
 517 p
 File Size 
 12,244 KB
 File Type
 PDF format
 ISBN
 81-8448-154-3  
 Copyright©   
 2008,
 Jaypee Brothers Medical Publishers 

Preface to the Fourth Edition
Teaching of Medical Microbiology to the MBBS students is changing rapidly. This is primarily due to emergence of newer pathogens, newer diagnostic tools, emerging and re-emerging infections and above all shrinking time available to accommodate all this. Microbiology continues to be the backbone of understanding diagnosing and controlling the communicable diseases. Our primary focus of this Fourth Edition is to update various chapters, delete the contents that have become relatively unimportant and enhanced focus on the topics of current interest. For easy assimilation and reproducibility of the subject by the students, a lot of tables, figures and flow charts have been included. The book is for the first time being printed in colour which will definitely enhance its acceptability by our valued readers.
We are deeply indebted to Shri Jitendar P Vij, Chairman and Managing Director, Jaypee Brothers Medical Publishers and his dedicated team for their magnificent support in bringing this book to its current shape. We continue to be thankful to our family members, friends, well-wishers and above all our dear students for their continuous support. We are optimistic that this revised edition will be liked by our readers. We look forward to their patronage.
Rajesh Bhatia
RL Ichhpujani

Table of Contents
PART I: History and Scope of Medical Microbiology
1. History of Medical Microbiology 1
Contributions of Louis Pasteur 1; Contributions of Robert Koch 2; 
Antimicrobial Agents 3; Discovery of Viruses 4; Nobel Laureates 5
2. Scope of Medical Microbiology 6
Microorganism 6; Microbiology and Patient 6; Microbiology and Healthy Individual 7; Microbiology and Community 7; Branches of Microbiology 7; Role of Medical Microbiology 7

PART II: Cellular and Molecular Microbiology
3. Bacterial Morphology 8
The Bacterial Cell 9; Bacterial Spores 15; 
Classification of Bacteria 17; Techniques to Study Morphology of Bacteria 17
4. Nutrition and Growth of Bacteria 22
Nutrients 22; Oxygen and Carbon Dioxide 22; 
Temperature 23; Moisture and Desiccation 24;
Bacterial Metabolism 24; Bacterial Growth 24
5. Bacterial Genetics 27
Mutations 29; Gene Transfer 29; 
Newer Approaches to Bacterial Genetics 32; Genetic Engineering 32
6. Bacteriophage 38
7. In Vitro Cultivation of Bacteria 41
Bacteriological Media 41; Cultivation of Bacteria 43; Anaerobic Cultures 45
8. Identification of Bacteria 46

PART III: Microbial Control and Mechanism of Pathogenicity
9. Disinfection and Sterilization 49
Definitions 49; Physical Agents 49; 
Chemical Agents 53; Ideal Disinfectant 56; Combined Treatments 59
10. Antimicrobial Chemotherapy 60
Antiviral Drugs 62; Antifungal Drugs 62;
 Drug Resistance 63; Biochemical Mechanisms of
Drug Resistance 63
11. Infection and Disease 65
Dynamics of Infectious Diseases 66
12. Microbial Pathogenicity 69
Pathogenic Microorganisms 69; 
Virulence Factors of Microorganisms 69

PART IV: Immunology
13. Nonspecific Defenses of Host 74
Host-parasite Relationship 74; Resistance of Host to Microorganisms 74
14. Overview of Acquired Immunity 78
15. Functional Anatomy and Development of Immune System 82
16. Biology of Immune Response 85
Dynamics of Antigen Elimination 85; 
Immune Response 85; 
Uses of Primary and Secondary Immune Responses 86; 
Factors Influencing Antibody Production 87
17. Antigen 88
18. Antibody 91
Monoclonal Antibody (Hybridomas) 94
19. Cells of Immune System 95
Major Cells of Immune System 95
20. The Complement System 100
21. Antigen-Antibody Reactions 105
Precipitation 106; Agglutination 110; 
Complement Fixation Test 112; Neutralisation Tests 113;
Immunofluorescence 114; Enzyme Immunoassays 115; 
Radioimmunoassay 115; Miscellaneous Tests 116; Opsonisation 117
22. Hypersensitivity 118
Type I Hypersensitivity 118; Type II Hypersensitivity 120; 
Type III Hypersensitivity 121; Type IV
Hypersensitivity 122; Type V Stimulatory Hypersensitivity 123
23. Immunodeficiency 125
24. Autoimmunity 128
Major Histocompatibility Complex (MHC) 128; Autoimmunity 128
25. Transplantation and Malignancy 131
Tumour Immunology 132
26. Blood Group Antigens 135
PART V: Gram-positive Bacteria
27. Staphylococcus 139
Species of Staphylococcus 139; Staphylococcus aureus 139; 
Coagulase Negative Staphylococci 146; 
Staphylococcus epidermidis 146; 
Staphylococcus saprophyticus 146; Micrococcus 147; Planococcus 147
28. Streptococcus 148
Streptococcus pyogenes 149; Other Pathogenic Streptococci 154;
 Group C and G Streptococci 155;
Group D Streptococci 155; Viridans Streptococci 156
29. Pneumococcus 158
30. Corynebacterium 162
Corynebacterium Diphtheriae 162; Other Corynebacteria 167
31. Mycobacterium 169
Mycobacterium tuberculosis 169; 
Tests for Confirmation of Identity 175 
Mycobacterium leprae 178; Atypical Mycobacteria 181; 
Mycobacteria Producing Skin Ulcers 182; Saprophytic mycobacteria 183
32. Bacillus 184
Bacillus anthracis 184; Anthracoid bacilli 187;
 Bacillus cereus 187; Bacillus stearothermophilus 188; Other Bacillus Species 188
33. Clostridium 189
Clostridium botulinum 190; Clostridium difficile 192; 
Clostridium perfringens 193;
Clostridium novyi 196; Clostridium septicum 196; 
Other Histotoxic Clostridia 197; Clostridium tetani 197
34. Actinomycetes 200
Actinomycosis 200; Nocardiosis 201; Actinomycotic Mycetoma 202

PART VI: Gram-negative Bacteria
35. Neisseria 203
Neisseria meningitidis 203; Neisseria gonorrhoeae 206; 
Other Neisseriae 208
36. Haemophilus 209
Haemophilus influenzae 209; Other Haemophilus Species 212; 
Gardnerella vaginalis 213
37. Bordetella 214
Bordetella parapertussis 217;
 Bordetella bronchiseptica 217; Bordetella avium 217
38. Brucella 218
39. Enterobacteriaceae 222
Escherichia coli 224; Klebsiella 228; Proteeae 228; 
Other Members of Enterobacteriaceae 230
40. Salmonella 232
Enteric Fever 235; Salmonella Gastroenteritis 240; 
Salmonella bacteraemia with Focal Lesions 240
41. Shigella 241
42. Yersinia 245
Yersinia pestis 245; Yersinia pseudotuberculosis 248; 
Yersinia enterocolitica 249
43. Vibrio 251
Vibrio cholerae 251; V. parahaemolyticus 256; 
Aeromonas 256; Plesiomonas 257
44. Pseudomonas 258
Pseudomonas aeruginosa 258; 
Other Species of Pseudomonas 260; Burkholderia mallei 260; Burkholderia
pseudomallei 260; Burkholderia cepacia 260

PART VII: Spirochaetes and Other Bacteria
45. Treponemes 261
Treponema 262; Treponema Pallidum 262; 
Pinta 269; Endemic Syphilis 270
46. Leptospira 271
47. Borrelia 274
Borrelia vincenti 275; Lyme Disease 275
48. Mycoplasma 276
49. Chlamydia 278
Psittacosis 280; Trachoma 280; 
Lymphogranuloma venereum 280
50. Rickettsia 282
Epidemic Typhus 284; Brill-Zinsser Disease 284; 
Endemic or Murine Typhus 284; Scrub Typhus 284; 
Trench Fever (Quintana Fever) 285; 
Rocky Mountain Spotted Fever 285 Q-fever 285; 
Laboratory Diagnosis of Rickettsial Diseases 286; 
Ehrlichia 287; Rochalimaea 287
51. Non-sporing Anaerobes 288
Anaerobic Gram-negative Bacilli 288; Bacteroides, 
Prevotella and Porphyromonas 288; 
Fusobacteria and Leptotrichia 290; 
Anaerobic Gram-positive Bacilli 290; Anaerobic Cocci 290; 
Peptostreptococcus and Peptococcus 290; 
Veillonella and Acidaminococcus 291; 
Spiral Shaped Motile Anaerobes 291
52. Legionella 292
Legionella pneumophila 292
53. Campylobacter and Helicobacter 294
Helicobacter pylori 295; Gastrospirillum hominis 296
54. Miscellaneous Bacteria 297
Pasteurella multocida 297; Actinobacillus 297; 
Francisella tularensis 297; Streptobacillus moniliformis 298; 
Spirillum minus 298; Listeria monocytogenes 298; 
Erysipelothrix rhusiopathiae 299; Calymmatobacterium 
granulomatis 299; Eikenella 299; Cardiobacterium 300; 
Chromobacterium 300; Achromobacter 300; 
Capnocytophaga 300; DF-2 Bacteria 300; 
Flavobacterium meningosepticum 300; Kingella 300;
acinetobacter 301; Alcaligenes 301; Bartonella 301
55. Normal Microbial Flora of the Human Body 302
Sites with Normal Flora 303

PART VIII: General Virology
56. Nature and Classification of Viruses 306
Viroids 308; Prions 308
57. Morphology of Viruses 209
58. Replication of Viruses 313
Release 314; Defective Viruses 315
59. Cultivation and Assay of Viruses 316
60. Genetics of Viruses 320
Mutations 320; Genetic Recombination Between Viruses 320; 
Interaction Between Viral Gene Products 320;
Genetic Variation in Nature 321; Viral Vectors 321
61. Viral Pathogenesis and Host Response 322
Pathogenicity of Viruses 322; Host Response to Viral Infections 323
62. Oncogenic and Teratogenic Viruses 328
Oncogenic Viruses 328; Teratogenic Viruses 329

PART IX: DNA Viruses
63. Adenoviruses 330
Adenoviruses Associated Defective Viruses 332
64. Herpesviruses 333
Herpes Simplex Virus 334; Varicella-zoster Virus 336; 
Cytomegalovirus 337; Human Herpesvirus 6 339;
Human Herpesvirus 7 340
65. Poxviruses 341
Smallpox 341; Human Monkeypox 342; 
Cowpox 342; Buffalopox 342; Tanapox 343; Milker’s Nodules 343;
ORF 343; Molluscum contagiosum 343
66. Papovaviruses 344
Human Papillomaviruses 344; Human Polyomaviruses 345
67. Parvoviruses 346

PART X: RNA Viruses
68. Picornaviruses 348
Poliovirus 348; Coxsackieviruses 351; 
Echoviruses 352; Enteroviruses Types 68-72 353; Enterovirus 71 353;
Rhinoviruses 353
69. Paramyxoviruses 355
Measles 355; Mumps 357; Infections Caused 
by Parainfluenza Viruses 359; Infections Caused by
Respiratory Syncytial Virus 359
70. Orthomyxoviruses 361
Avian Influenza (Bird Flu) 364
71. Retroviruses 367
Human T Cell Leukaemia Viruses 367; 
Human Immunodeficiency Virus 368
72. Rhabdoviruses 382

PART XI: Multiple Viral Complexes
73. Viral Hepatitis 389
Hepatitis A Virus 389; Hepatitis B Virus 391; 
Hepatitis C 396; Hepatitis E 397; Hepatitis D 398;
Hepatitis G 399; Hepatitis F 400; Overview of Viral Hepatitis 400
74. Arboviruses 401
Definition 401; Virology of Common Arboviruses 401;
 Togaviridae 402; Bunyaviridae 402; General Clinical
Features 403; Laboratory Diagnosis of Arboviruses 404; 
Arboviral Diseases in India 404; Dengue Fever
and Dengue Haemorrhagic Fever 405; 
Kyasanur Forest Disease 406; Chikungunya Virus 407
75. Miscellaneous Viruses 408
Rubella 408; Rotavirus 410; Coronaviridae 411; 
Arenaviridae 412; Lymphocytic Choriomeningitis 413;
Argentinian Haemorrhagic Fever 413; 
Bolivian Haemorrhagic Fever 413; 
Lassa Fever 413; Filoviruses (Ebola and Marburg Virus) 413

PART XII: Mycotic Infections
76. Medical Mycology 415
Spore Formation in Fungi 416; Economic Importance of Fungi 419; Mycoses 419; Tinea Versicolor 419; White Piedra (Piedra Alba) 420; Black Piedra (Piedra Nigra) 420; Dermatophytes 421; Dermatophytids (ID Reaction) 424; Paracoccidioidomycosis 424; Blastomycosis 425; Histoplasmosis (Darling’s Disease) 426; Candidiasis 427; Mycetoma 429; Cryptococcosis 430; Rhinosporidiosis 431; Sporotrichosis 432; Coccidioidomycosis 433; Opportunistic Fungi 434; Otomycosis 435; Fungal Contaminants 435; Absidia Species 436; Mucor Species 436; Rhizopus Species 436; Septate Contaminants 437; Dematiaceous Contaminants 437; Alternaria Species 437; Cladosporium (Hormodendrum Species) 437; Curvularia Species 438; Penicillium Species 438; Mycotoxicosis 438; Immunodiagnosis of Fungal Infections 438

PART XIII: Applied Microbiology
77. Microbiology of Water, Milk and Air 440
Examination of Milk 444; Bacteriological Examination of Milk 445; Examination of Milk for Specific Pathogens 446; Examination of Air 446
78. Nosocomial Infections 448
Role of Microbiology Laboratory in Prevention and Control of Nosocomial Infections 450
79. Blood Transfusion Associated Infections 452
Blood Culture 453
80. Quality Assurance in Microbiology 455
81. Immunoprophylaxis Against Infectious Diseases 458
Vaccine 458; Immunoglobulins and Antisera 460
Essentials of Medical Microbiology

PART XIV: Clinical Microbiology
82. Laboratory Diagnosis of Important Clinical Syndromes 462
Laboratory Diagnosis of Meningitis 462; Laboratory Diagnosis of Tetanus 465; Laboratory Diagnosis of Gas Gangrene 466; Laboratory Diagnosis of Urinary Tract Infections 467; Laboratory Diagnosis of Pertussis 468; Laboratory Diagnosis of Pyrexia of Unknown Origin 470; Laboratory Diagnosis of AIDS 472; Molecular Level Detection 474; Laboratory Diagnosis of Syphilis 474; Laboratory Diagnosis of Sore Throat 476; Laboratory Diagnosis of Cholera 478; Laboratory Diagnosis of Diarrhoeal Diseases (Gastroenteritis) 480; Laboratory
Diagnosis of Acute Respiratory Infections (ARI) 484
Index 489

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Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
B-3 EMCA House, 23/23B Ansari Road, Daryaganj
New Delhi 110 002, India
Phones: +91-11-23272143, +91-11-23272703, +91-11-23282021, +91-11-23245672
Rel: +91-11-32558559, Fax: +91-11-23276490, +91-11-23245683

Apurba Sankar Sastry MD (JIPMER),DNB, MNAMS, PDCR
Assistant Professor
Department of Microbiology
Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER)
Pondicherry, India

Sandhya Bhat K MD, DNB, MNAMS, PDCR
Assistant Professor
Department of Microbiology
Pondicherry Institute of Medical Sciences (PIMS)
(A Unit of Madras Medical Mission)
Pondicherry, India

Foreword
Reba Kanungo

JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD


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Book Details
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 Pages
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 File Size 
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 ISBN
 978-93-5152-329-1
 Copyright©   
 2014, Jaypee Brothers Medical Publishers 

Foreword
Our understanding of human diseases has been greatly benefited from the
rapid strides made in Medical Science. It is necessary to compile and document
these advances in textbooks for students who are pursuing medical and allied
courses. To add the existing resources of information on parasitic diseases,
Dr Apurba Sankar Sastry and Dr Sandhya Bhat k have conceptualized and
compiled this book entitled “Essentials of Medical Parasitology.” They have
addressed details of information required by a medical graduate to help him to
understand the subject and also keep abreast with latest developments in the
field of Medical Parasitology.
The book is divided into four sections that deal with Protozoa, Helminths,
etc that are of importance to human health and disease. Each section deals
with general concepts including commonly used terminologies and their
definitions which will help the reader to understand their implications when used later in the text. Every
chapter is designed in a thematic manner with a brief classification including classification based on the
habitat and site of infection. This is followed by description of the parasite’s morphology, epidemiology of the disease and pathogenesis. Clinical spectrum of the disease is described with emphasis on pathology, clinical features and stages of the parasite that are encountered in the human host. Life cycle outside the human host and natural habitat in the environment or animals have been explained in detail in the respective chapter.
Thee chapters are interspersed with relevant illustrations. Photomicrographs are clear emphasizing
the natural appearance in clinical material. Diagrams and flow charts of life cycles are clear and well
represented. The authors have collected original images from several sources to highlight the actual
microscopic images seen in the laboratory and in situ appearance in tissue sections.
Laboratory methods to detect the agents in relevant clinical material have been described in detail
in easy procedural steps. Several additional and supportive tests to diagnose the infections have been
mentioned in each chapter. Recent techniques and current tests including specific antigen and antibody
detection methods used in the laboratories have been described. This will help a fresh graduate in
clinical practice to use the information in day to day practice.
An interesting feature in each chapter is the preventive aspect of commonly encountered parasitic
diseases, with a note on vaccination. An additional feature of the book is an up-to-date information on
the parasitic diseases of public health importance in India including national programs for prevention
and control. Opportunistic parasitic infections in the immunocompromised patients including HIV
infected individuals have been described along with the specific indicators for detection.
Each chapter ends with a set of self assessment questions which will help a student to prepare for the
examination. This is a well planned and executed parasitology book which both MBBS undergraduate
students and postgraduates pursuing a course in Medical Microbiology will find useful. I congratulate
the authors for bringing out this comprehensive textbook on parasitology.
Reba Kanungo MD PhD
Dean Research and Professor and Head
Department of Clinical Microbiology
Pondicherry Institute of Medical Sciences
Puducherry
Past President, Indian Association of Medical Microbiologists
Former Editor-in-Chief, Indian Journal of Medical Microbiology

Preface
Medical parasitology is an interdisciplinary science that deals with the study of animal parasites which
infect and produce diseases in human beings. This book is designed specifically for undergraduate
medical and paramedical students as well as for postgraduate students.
Medical students always complain that there is no standard Indian textbook on parasitology at present
which can fulfil the need of the examination and for the management of the parasitic diseases.
Currently available Indian medical parasitology books are neither updated with recent advances nor
presented in a student‐friendly manner. Day-to-day developments in the field of parasitology and the
unavailability of a standard textbook fulfilling the needs and expectation of the students, motivated us
to write a book in an updated format with recent epidemiological data, laboratory techniques, treatment
strategies, etc in such a way that student can grasp it easily.
The whole content of the book has been arranged in a bulleted format and use of sub heads has
increased the readability. Entire book is divided into four sections—General introduction, Protozoology,
Helminthology and Miscellaneous. At the end, six appendices have been incorporated which will be of
immense use and initiate interest among the students. Expected questions including MCQs have been
added at the end of each chapter which will help to reinforce and understand the related topic in a
better way. Life cycles are drawn in lucid and easy-to-grasp manner, exactly according to the text. Real
microscopic images of parasites and specimens from various sources are being incorporated to correlate
their impressions with the related parasitic diseases. Laboratory diagnosis and treatment boxes are
introduced as a different entity for a quick review for students as well as for physicians.
Our endeavor will be successful, if the book is found to be useful for student as well as for the faculty.
Apurba Sankar Sastry
Sandhya Bhat K


Table of Contents
Section 1: Introducion
Chapter 1: General Introduction To Parasitology 3–15
• Taxonomy of parasites 3
• Parasite 3
• Host 4
• Host-parasite relationship 4
• Transmission of parasites 5
• Life cycle of the parasites 6
• Pathogenesis of parasitic diseases 6
• Immunology of parasitic diseases 8
• Laboratory diagnosis of parasitic diseases 9
• Treatment of parasitic diseases 10
Section 2: Protozoology
Chapter 2: Introduction to Protozoa 19–23
Chapter 3: Amoeba 24–48
• General features of protozoa 19 • Classification of protozoa 19
• Classification of amoeba 24
• Intestinal amoeba 24
hh Pathogenic intestinal amoeba 24
−− Entamoeba histolytica 24
hh Nonpathogenic intestinal amoeba 35
−− Entamoeba dispar 35
−− Entamoeba moshkovskii 36
−− Entamoeba coli 36
−− Entamoeba hartmanni 38
−− Entamoeba gingivalis 38
−− Entamoeba polecki 39
−− Endolimax nana 39
−− Iodamoeba butschlii 39
• Free-living (opportunistic) amoeba 40
hh Naegleria fowleri 40
hh Acanthamoeba species 43
hh Balamuthia mandrillaris 46
hh Sappinia diploidea 47
Chapter 4: Flagellates—I (Intestinal and Genital) 49–62
• Classification of flagellates 49
• Giardia lamblia 50
• Trichomonas vaginalis 55
• Pentatrichomonas hominis 58
• Trichomonas tenax 58
• Chilomastix mesnili 58
• Enteromonas hominis 59
• Retortamonas intestinalis 60
• Dientamoeba fragilis 60
Chapter 10: Cestodes 156–189
Chapter 5: Flagellates—II (Hemoflagellates) 63–89
Chapter 6: Sporozoa—I (Malaria and Babesiosis) 90–117
Chapter 7: Sporozoa—II (Opportunistic Coccidian Parasites) 118–139
Chapter 8: Miscellaneus Protozoa 140–150
• Introduction 63
• Morphology of hemofl agellates 63
• Leishmania 64
hh Old World Leishmaniasis 64
−− Leishmania donovani 64
−− Leishmania tropica complex 74
hh New World Leishmaniasis 76
−− Leishmania mexicana complex 77
−− Leishmania viannia braziliensis complex 77
−− Leishmania leishmania chagasi 78
• Trypanosoma 79
• Trypanosoma cruzi 79
• Trypanosoma brucei complex 85
• Classification 90
• Malaria parasite 90
• Babesia 114
• Introduction 118
• Toxoplasma gondii 118
• Cryptosporidium parvum 126
• Cyclospora cayetanensis 131
• Isospora belli 133
• Sarcocystis species 135
• Microsporidium species 140
• Balantidium coli 146
• Blastocystis hominis 149
• General characteristics of cestodes 156
hh Classification of cestodes 156
hh Morphology of cestodes 157
• Pseudophyllidean cestodes 160
hh Diphyllobothrium species 160
hh Spirometra species 163
• Cyclophyllidean cestodes 165
hh Taenia species 165, 175
hh Echinococcus species 176
hh Hymenolepis nana 184, 186
hh Dipylidium caninum 187
Section 3: Helminthology
Chapter 9: Introduction to Helminths 153–155
• General charactristics 153
• Morphology 154
• Life cycle 155
Chapter 14: Nematodes—III (Somatic Nematodes) 262–289
Chapter 13: Nematodes—II Nematodes of Lower Animals 248–261
that Rarely infect Man
Chapter 12: Nematodes—I (Intestinal Nematodes) 220–247
Chapter 11: Trematodes or Flukes 190–219
• Classification of trematodes 190
• General characteristics of trematodes 191
• Blood flukes 193
hh Schistosoma species 194, 201, 202
• Liver fluke 202
hh Fasciola species 202, 206
hh Clonorchis species 206
hh Opisthorchis species 208, 210
• Intestinal fluke 210
hh Fasciolopsis species 210
hh Gastrodiscoides species 213
hh Watsonius species 213
hh Heterophyes species 214
hh Metagonimus species 214
hh Echinostoma species 214
hh Lung fluke 215
hh Paragonimus species 215
• General properties of nematodes 220
• Classification 220
• General description 221
• Large intestinal nematodes 224
hh Trichuris trichiura 224
hh Enterobius vermicularis 227
• Small intestinal nematodes 230
hh Hookworm 230
hh Strongyloides species 237, 242
hh Ascaris species 242, 246
• Classification 262
• Filarial nematode 262
• Lymphatic filarial nematodes 265
hh Wuchereria bancrofti 265
hh Brugia speices 274, 275
• Other filarial nematodes 276
hh Loa loa 276
hh Onchocerca volvulus 277
hh Mansonella species 280, 281
hh Dirofilaria species 282
• Other Somatic nematodes 282
hh Dracunculus medinensis 282
hh Trichinella spiralis 285
• Classification 248
• Larva migrans 248
• Toxocariasis 250
• Angiostrongylus species 252
• Baylisascaris procyonis 253
• Lagochilascaris minor 253
• Anisakiasis 253
• Gnathostoma species 254
• Capillaria species 255, 256, 257
• Trichostrongylus species 257
• Dioctophyme renale 258
• Oesophagostomum species 259
• Ternidens deminutus 259
• Mammomonogamus laryngeus 260
• Thelazia species 260
Section 4: Miscellaneous
Chapter 15: Laboratory Diagnosis of Parasitic Diseases 293–313
• Introduction 293
• Morphological identification techniques 293
• Culture techniques in parasitology 303
• Immunodiagnostic methods 307
• Molecular methods 309
• Intradermal skin tests 310
• Xenodiagnostic techniques 311
• Animal inoculation methods 311
• Imaging techniques 311
Chapter 16: Medical Entomology 314–321
Appendices 325–333
• Medical entomology 314
• Vector 314
• Class insecta 314
• Class arachnida 319
• Class crustacea 320
• Control of Arthropods 320
• Appendix I Clinical syndromes in parasitology 325
• Appendix II Common tropical parasitic diseases 327
• Appendix III Romanowsky stains, composition and staining procedures 327
• Appendix IV Laboratory-acquired parasitic infections 329
• Appendix V Biomedical waste management in parasitology 330
• Appendix VI Morphological forms of parasites seen in the fecal sample 331
Index 335–341


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First Edition: 2014

Headquarters
Jaypee Brothers Medical Publishers (P) Ltd
Overseas Offices
J.P. Medical Ltd
Jaypee Medical Inc
The Bourse
Jaypee Brothers Medical Publishers (P) Ltd
Jaypee-Highlights Medical Publishers Inc

K Sembulingam PhDPrema Sembulingam PhD

Madha Medical College & Research Institute

Kundrathur Main Road, Kovur, Thandalam (Near Porur)

Chennai, Tamil Nadu, India

Formerly
MR Medical College
Gulbarga, Karnataka, India
Sri Ramachandra Medical College and Research Institute
Chennai, Tamil Nadu, India
School of Health Sciences, Universiti Sains Malaysia
Kelantan, Malaysia
Sri Lakshmi Narayana Institute of Medical Sciences
Puducherry, India
Sri Manakula Vinayagar Medical College and Hospital
Puducherry, India
and
Shri Sathya Sai Medical College and Research Institute
Kanchipuram, Tamil Nadu, India

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 ISBN
 978-93-5025-936-8  
 Copyright©   
 2012,
 Jaypee Brothers Medical Publishers 

Preface to the Sixth Edition
With this Sixth edition, Sembulingam’s Essentials of Medical Physiology enters into its second decade and the core subject matter with updated physiological information remain as green as ever. We live in an era where the thirst for knowledge and urge for learning is so much increased that even a layman knows the fundamentals of common disorders like diabetes mellitus, hypertension, jaundice, etc. So, it becomes doubly important to fulfill the expectations of the educated mass, especially in medical field.
We are humbly thankful and heavenly happy for the popularity of this book among the undergraduate and postgraduate students of medical, dental and paramedical courses, doctors and other health professionals in and out of our country.
Like many other successful textbooks, this book also has sailed through the years smoothly, fruitfully and successfully. May be because, it meets the needs of every group of the readers. Students are happy because it is student-friendly while reading, and exam-friendly while revising. Knowledge seekers are happy because they get the updated and recent developments in the field of physiology. Doctors are happy because applied aspects are covered adequately.
Our thirst for improving this textbook is growing every year by seeing outright acceptance of this book by the students, and the appreciation and overwhelming support given by our fellow teachers. The most comments and the suggestions, we receive from our readers, are responsible for better shaping of this book in every edition. This edition is enriched with addition of many more flow charts, tables and descriptive diagrams to make the subject matter easier and approachable for all class of students. Many chapters are upgraded as per the suggestions from our colleagues and fellow teachers from various institutes and universities in and out of India.
Our thirst for improving this book is still alive. The improvement is possible only by the comments and suggestions expressed by the readers. So, we welcome the opinions, comments and valuable suggestions from one and all who happen to come across this book.
K Sembulingam
Prema Sembulingam

Introduction
Physiology is the most fascinating and ancient branch of science. It is fascinating because, it unfolds the mystery of complicated functional aspects of individual organs in the body. It is ancient because, it exists ever since the origin of life. Even before knowing the language, culture and society, man knew about the hunger, thirst, pain and fear which are the basics of physiology.
Physiology is defined as the study of functions of various systems and different organs of the body. Physiology is of different types namely, Human Physiology, Animal Physiology and Plant Physiology. Human Physiology and Animal Physiology are very much inter-related. Knowledge of Human Physiology is essential to understand the other allied subjects like Biochemistry, Pharmacology, Pathology, Medicine, etc. However, it is worthwhile to have a brief
know ledge of anatomy of different systems and various organs to understand the principles of Human Physiology. The basic physiological functions include, provision of oxygen and nutrients, removal of metabolites and other waste products, maintenance of blood pressure and body temperature, hunger and thirst, locomotor functions, special sensory functions, reproduction and the higher intellectual functions like learning and memory.
In the unicellular organisms, all the physiological functions are carried out by simple diffusion through the cell membrane. Because of the evolutionary and ecological changes over the years, individual system is developed for each function such as digestive system, cardiovascular system, respiratory system, excretory system, etc. Every system in the body is independent structurally and functionally yet, all the systems are interdependent.
Human Physiology is usually studied under the following headings:
1. General Physiology
2. Blood and Body Fluids
3. Muscle Physiology
4. Digestive System
5. Renal Physiology and Excretion
6. Endocrinology
7. Reproductive System
8. Cardiovascular System
9. Respiratory System and Environmental Physiology
10. Nervous System
11. Special Senses

Table of Contents
SECTIoN 1
GENERAL PHySIoLoGy
1. Cell .....................................................................................................................................3
2. Cell Junctions .................................................................................................................22
3. Transport through Cell Membrane ................................................................................27
4. Homeostasis ...................................................................................................................38
5. Acid-Base Balance .........................................................................................................42
SECTIoN 2
BLooD AND BoDy FLUIDS
6. Body Fluids .....................................................................................................................51
7. Blood ...............................................................................................................................58
8. Plasma Proteins..............................................................................................................61
9. Red Blood Cells ..............................................................................................................66
10. Erythropoiesis ................................................................................................................71
11. Hemoglobin and Iron Metabolism .................................................................................77
12. Erythrocyte Sedimentation Rate ...................................................................................83
13. Packed Cell Volume and Blood Indices ........................................................................86
14. Anemia.............................................................................................................................89
15. Hemolysis and Fragility of Red Blood Cells ................................................................95
16. White Blood Cells ...........................................................................................................97
17. Immunity ........................................................................................................................107
18. Platelets .........................................................................................................................122
19. Hemostasis ...................................................................................................................127
20. Coagulation of Blood ...................................................................................................129
21. Blood Groups ................................................................................................................139
22. Blood Transfusion ........................................................................................................146
23. Blood Volume ................................................................................................................148
24. Reticuloendothelial System and Tissue Macrophage ...............................................151
25. Spleen ............................................................................................................................153
26. Lymphatic System and Lymph ....................................................................................155
27. Tissue Fluid and Edema ..............................................................................................159
SECTIoN 3
MUSCLE PHySIoLoGy
28. Classification of Muscles.............................................................................................167
29. Structure of Skeletal Muscle .......................................................................................169
30. Properties of Skeletal Muscle......................................................................................176
31. Changes during Muscular Contraction ......................................................................188
32. Neuromuscular Junction .............................................................................................200
33. Smooth Muscle .............................................................................................................204
34. Electromyogram and Disorders of Skeletal Muscle ..................................................210
35. Endurance of Muscle ...................................................................................................214
SECTIoN 4
DIGESTIVE SySTEM
36. Introduction to Digestive System ...............................................................................219
37. Mouth and Salivary Glands .........................................................................................223
38. Stomach ........................................................................................................................230
39. Pancreas........................................................................................................................241
40. Liver and Gallbladder ...................................................................................................249
41. Small Intestine ..............................................................................................................261
42. Large Intestine ..............................................................................................................266
43. Movements of Gastrointestinal Tract .........................................................................270
44. Gastrointestinal Hormones .........................................................................................281
45. Digestion, Absorption and Metabolism of Carbohydrates .......................................287
46. Digestion, Absorption and Metabolism of Proteins ..................................................290
47. Digestion, Absorption and Metabolism of Lipids ......................................................292
SECTIoN 5
RENAL PHySIoLoGy AND SKIN
48. Kidney ............................................................................................................................301
49. Nephron .........................................................................................................................304
50. Juxtaglomerular Apparatus .........................................................................................309
51. Renal Circulation ..........................................................................................................312
52. Urine Formation ............................................................................................................315
53. Concentration of Urine .................................................................................................325
54. Acidification of Urine and Role of Kidney in Acid-Base Balance ............................330
55. Renal Function Tests ...................................................................................................333
56. Renal Failure .................................................................................................................337
57. Micturition .....................................................................................................................339
58. Dialysis and Artificial Kidney ......................................................................................346
59. Diuretics ........................................................................................................................348
60. Structure of Skin ...........................................................................................................351
61. Functions of Skin .........................................................................................................354
62. Glands of Skin ..............................................................................................................356
63. Body Temperature ........................................................................................................359
SECTIoN 6
ENDoCRINoLoGy
64. Introduction to Endocrinology ....................................................................................367
65. Hormones ......................................................................................................................371
66. Pituitary Gland ..............................................................................................................375
67. Thyroid Gland ...............................................................................................................388
68. Parathyroid Glands and Physiology of Bone ............................................................399
69. Endocrine Functions of Pancreas ..............................................................................415
70. Adrenal Cortex ..............................................................................................................425
71. Adrenal Medulla ............................................................................................................439
72. Endocrine Functions of other organs .......................................................................444
73. Local Hormones ...........................................................................................................447
SECTIoN 7
REPRoDUCTIVE SySTEM
74. Male Reproductive System ..........................................................................................455
75. Seminal Vesicles...........................................................................................................467
76. Prostate Gland ..............................................................................................................468
77. Semen ............................................................................................................................470
78. Female Reproductive System .....................................................................................473
79. ovary .............................................................................................................................476
80. Menstrual Cycle ............................................................................................................482
81. ovulation .......................................................................................................................492
82. Menopause ....................................................................................................................494
83. Infertility .......................................................................................................................496
84. Pregnancy and Parturition ...........................................................................................498
85. Placenta .........................................................................................................................505
86. Pregnancy Tests ...........................................................................................................508
87. Mammary Glands and Lactation .................................................................................510
88. Fertility Control .............................................................................................................513
SECTIoN 8
CARDIoVASCULAR SySTEM
89. Introduction to Cardiovascular System .....................................................................519
90. Properties of Cardiac Muscle ......................................................................................525
91. Cardiac Cycle ................................................................................................................533
92. Heart Sounds ................................................................................................................544
93. Cardiac Murmur ............................................................................................................549
94. Electrocardiogram (ECG).............................................................................................551
95. Vector.............................................................................................................................558
96. Arrhythmia ....................................................................................................................562
97. Effect of Changes in Electrolyte Concentration on Heart ........................................570
98. Cardiac output ..............................................................................................................572
99. Heart-Lung Preparation ...............................................................................................582
100. Cardiac Function Curves .............................................................................................584
101. Heart Rate......................................................................................................................587
102. Hemodynamics .............................................................................................................595
103. Arterial Blood Pressure ...............................................................................................602
104. Venous Pressure ..........................................................................................................617
105. Capillary Pressure ........................................................................................................620
106. Arterial Pulse ................................................................................................................622
107. Venous Pulse ................................................................................................................627
108. Coronary Circulation ....................................................................................................629
109. Cerebral Circulation .....................................................................................................634
110. Splanchnic Circulation .................................................................................................638
111. Capillary Circulation.....................................................................................................640
112. Circulation through Skeletal Muscle ..........................................................................644
113. Cutaneous Circulation .................................................................................................646
114. Fetal Circulation and Respiration ...............................................................................648
115. Hemorrhage ..................................................................................................................651
116. Circulatory Shock and Heart Failure ..........................................................................654
117. Cardiovascular Adjustments during Exercise ...........................................................664
SECTIoN 9
RESPIRAToRy SySTEM AND ENVIRoNMENTAL PHySIoLoGy
118. Physiological Anatomy of Respiratory Tract .............................................................673
119. Pulmonary Circulation .................................................................................................678
120. Mechanics of Respiration ............................................................................................682
121. Pulmonary Function Tests ...........................................................................................690
122. Ventilation .....................................................................................................................700
123. Inspired Air, Alveolar Air and Expired Air ..................................................................703
124. Exchange of Respiratory Gases .................................................................................705
125. Transport of Respiratory Gases .................................................................................711
126. Regulation of Respiration ............................................................................................716
127. Disturbances of Respiration ........................................................................................723
128. High Altitude and Space Physiology ..........................................................................737
129. Deep Sea Physiology ...................................................................................................743
130. Effects of Exposure to Cold and Heat ........................................................................746
131. Artificial Respiration ....................................................................................................749
132. Effects of Exercise on Respiration .............................................................................751
SECTIoN 10
NERVoUS SySTEM
133. Introduction to Nervous System .................................................................................757
134. Neuron ...........................................................................................................................759
135. Classification of Nerve Fibers .....................................................................................764
136. Properties of Nerve Fibers...........................................................................................766
137. Degeneration and Regeneration of Nerve Fibers ......................................................770
138. Neuroglia .......................................................................................................................773
139. Receptors ......................................................................................................................775
140. Synapse .........................................................................................................................780
141. Neurotransmitters ........................................................................................................787
142. Reflex Activity ...............................................................................................................795
143. Spinal Cord ...................................................................................................................803
144. Somatosensory System and Somatomotor System .................................................828
145. Physiology of Pain .......................................................................................................838
146. Brainstem ......................................................................................................................844
147. Thalamus .......................................................................................................................847
148. Internal Capsule............................................................................................................853
149. Hypothalamus ...............................................................................................................855
150. Cerebellum ....................................................................................................................863
151. Basal Ganglia ................................................................................................................878
152. Cerebral Cortex.............................................................................................................884
153. Limbic System ..............................................................................................................898
154. Reticular Formation ......................................................................................................901
155. Preparations of Animals for Experimental Studies ...................................................906
156. Proprioceptors ..............................................................................................................908
157. Posture and Equilibrium ..............................................................................................913
158. Vestibular Apparatus ....................................................................................................919
159. Electroencephalogram (EEG) ......................................................................................929
160. Physiology of Sleep .....................................................................................................931
161. Epilepsy .........................................................................................................................935
162. Higher Intellectual Functions ......................................................................................937
163. Cerebrospinal Fluid (CSF) ...........................................................................................949
164. Autonomic Nervous System (ANS) .............................................................................954
SECTIoN 11
SPECIAL SENSES
165. Structure of the Eye .....................................................................................................965
166. Visual Process ..............................................................................................................978
167. Field of Vision ...............................................................................................................987
168. Visual Pathway .............................................................................................................989
169. Pupillary Reflexes.........................................................................................................994
170. Color Vision ..................................................................................................................999
171. Errors of Refraction ....................................................................................................1004
172. Structure of Ear ..........................................................................................................1007
173. Auditory Pathway .......................................................................................................1013
174. Mechanism of Hearing ...............................................................................................1016
175. Auditory Defects .........................................................................................................1022
176. Sensation of Taste ......................................................................................................1024
177. Sensation of Smell .....................................................................................................1028
• Index ..................................................................................................................................1033


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Essentials of Medical Physiology
First Edition: 1999
Second Edition: 2000
Third Edition: 2004
Fourth Edition: 2006
Fifth Edition: 2010
Sixth Edition: 2012
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