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  <head>
    <title>035-02 Microbial strategy, ecological niches, and evolution under selection</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Microbial strategy, niches, and evolution under selection">
      <outline text="Architecture shapes clinical reasoning">
        <outline text="Architecture constrains ability and drug targets"/>
        <outline text="Fungi share eukaryotic machinery with humans">
          <outline text="Narrower selective toxicity"/>
        </outline>
        <outline text="Viruses expose step-specific targets"/>
        <outline text="Diagnose state, niche, burden, host relationship"/>
      </outline>
      <outline text="Bacterial envelope and drug access">
        <outline text="Wall-active drugs weaken the expanding structure">
          <outline text="Active growth important for killing"/>
        </outline>
        <outline text="Gram-positive: thick exposed wall, no outer membrane"/>
        <outline text="Gram-negative: thin wall behind outer membrane">
          <outline text="Porins restrict entry, pumps and enzymes reduce exposure"/>
          <outline text="Porin loss plus beta-lactamase: strong resistance"/>
        </outline>
        <outline text="Mycolic acids slow permeability, prolong treatment"/>
        <outline text="Mycoplasmas: no wall, beta-lactams fail"/>
        <outline text="Capsules inhibit complement and phagocytosis">
          <outline text="Opsonising antibody restores clearance"/>
          <outline text="Absent spleen: encapsulated bacteraemia dangerous"/>
        </outline>
      </outline>
      <outline text="Physiological state, biofilms, source control">
        <outline text="Abscess, phagolysosome, bone, biofilm slow growth">
          <outline text="Oxygen, iron, pH alter expression and susceptibility"/>
        </outline>
        <outline text="Persisters: transient phenotypic survivors">
          <outline text="Relapse from protected sites"/>
        </outline>
        <outline text="Biofilm: attachment, matrix, maturation">
          <outline text="Matrix limits immune access and diffusion"/>
          <outline text="Antibiotics fail to sterilise adherent reservoir"/>
        </outline>
        <outline text="Source control: drainage, debridement, device removal"/>
        <outline text="Persistent fever: reassess source before switching"/>
        <outline text="Suppressive therapy is distinct from eradication"/>
      </outline>
      <outline text="Viral tasks, tropism, and stability">
        <outline text="Positive-sense RNA acts directly as messenger"/>
        <outline text="Negative-sense viruses carry an RNA polymerase"/>
        <outline text="Retroviruses integrate, creating reservoirs"/>
        <outline text="Tropism needs more than a receptor">
          <outline text="Intracellular factors, temperature, access route"/>
        </outline>
        <outline text="Injury: cytopathic, immune, vascular, systemic"/>
        <outline text="Enveloped viruses fragile outside the body"/>
        <outline text="Non-enveloped capsids spread by surfaces, faecal-oral"/>
        <outline text="Tendencies, not sufficient infection-control rules"/>
      </outline>
      <outline text="Viral variation and selection">
        <outline text="Mutation, recombination, reassortment"/>
        <outline text="Most mutations neutral or harmful"/>
        <outline text="Selection enriches reproducing, transmitting variants"/>
        <outline text="Bottleneck passes a small subset"/>
        <outline text="Immune escape may compromise another property"/>
        <outline text="No intention, no guaranteed attenuation"/>
      </outline>
      <outline text="Fungal structure and dimorphism">
        <outline text="Chitin and glucan wall, ergosterol membrane"/>
        <outline text="Azoles, polyenes, echinocandins">
          <outline text="Activity varies by species and site"/>
        </outline>
        <outline text="Yeast in non-sterile sample may be colonisation">
          <outline text="Recovery from blood usually significant"/>
        </outline>
        <outline text="Invading hyphae prove disease more strongly"/>
        <outline text="Neutropenia: angioinvasion with little inflammation"/>
        <outline text="Dimorphic: mould outside, yeast after inhalation">
          <outline text="Geography and exposure are part of microbiology"/>
          <outline text="Impaired cellular immunity permits late dissemination"/>
        </outline>
      </outline>
      <outline text="Parasite life cycles">
        <outline text="Malaria: liver first, blood stage causes fever">
          <outline text="Dormant liver forms cause relapse"/>
          <outline text="Blood-stage treatment alone incomplete"/>
        </outline>
        <outline text="Thick films detect, thin films assess species"/>
        <outline text="Helminths: obstruction, migration, blood loss"/>
        <outline text="Eosinophilia tracks tissue migration"/>
        <outline text="Strongyloides autoinfection persists for decades">
          <outline text="Steroids trigger dissemination and sepsis"/>
          <outline text="Take exposure history before immune therapy"/>
        </outline>
        <outline text="Schistosome eggs drive granuloma and fibrosis"/>
      </outline>
      <outline text="Resistance and antimicrobial treatment">
        <outline text="Heritable variation meets selection and spread"/>
        <outline text="Target mutation, enzymes, pumps, permeability"/>
        <outline text="Horizontal transfer moves mechanisms together"/>
        <outline text="Genotype and phenotype are not identical"/>
        <outline text="Inhibitory concentration does not measure eradication"/>
        <outline text="Empirical choice: site, severity, host, history"/>
        <outline text="Narrow to the most limited effective option"/>
        <outline text="Duration matched to source control and response"/>
      </outline>
      <outline text="Specimens, microbiome, and causation">
        <outline text="Specimen quality limits what results show">
          <outline text="Squamous-rich sputum misses lower airway"/>
        </outline>
        <outline text="Blood cultures before antibiotics without delay"/>
        <outline text="Microbiome provides colonisation resistance"/>
        <outline text="Dysbiosis is descriptive, not causal"/>
        <outline text="Distinguish presence from pathogenic action">
          <outline text="Site, burden, invasion, timing strengthen cause"/>
        </outline>
        <outline text="Report method, site, burden, susceptibility"/>
        <outline text="Non-improvement: re-examine, do not escalate"/>
      </outline>
    </outline>
  </body>
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