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Humans can be infected by ingesting ascarid worms native to dogs, cats, or raccoons. Animals are the definitive hosts for these worms, which are unable to Nematode Infections Acquired by Ingestion: Enterobius (Pinworm) Pinworm an infection is frequent in each temperate and tropical regions, affecting at least 200 million individuals worldwide. It is most prevalent amongst small children, who sometimes infect their siblings and oldsters, and amongst institutionalized individuals. The eggs additionally resist drying and may be transmitted from an infected individual to other members of a family from D. Life cycle of Ascaris lumbricoides (human roundworm) and canine or cat roundworm (visceral larva migrans). Humans purchase these infections by ingesting embryonated roundworm eggs from the surroundings (1). After ingestion, the parasites hatch within the upper gut (2), cross the bowel wall (3), and enter the bloodstream. The human Ascaris (innermost set of arrows within the prime half of the diagram) enters the lung by crossing into the alveolus (4). It then travels up the trachea, is swallowed, and reenters the gastrointestinal tract to develop to a mature grownup (6). The open arrow and solid line on the diagram point out that neither dog nor cat Ascaris worms are in a position to enter the lung from the bloodstream. Stool examinations are therefore negative in sufferers with visceral larva migrans and optimistic in sufferers with human Ascaris infection (7). In the setting, fertilized Ascaris eggs (8) germinate and divide (9) and produce embryonated eggs (10) that are infectious on oral ingestion. In visceral larva migrans the infectious eggs are shed by infected dogs or cats quite than people. After ingestion, the eggs hatch within the small intestine (2), mature to adults within the large intestine (3, 4), and produce eggs (5). Because the gravid female lays her eggs within the perianal space, the eggs may be shed into the environment (lower half of diagram) or inadvertently ingested by sufferers or their shut contacts when fingers used to scratch the perianal area are licked or used to put together meals. Occasionally, the parasite is discovered within the lumen of the appendix, although it not often produces appendicitis. The buttocks are gently separated, and a microscope slide covered with Scotch tape (adhesive side out) or its commercially prepared paddle version is placed between them earlier than the patient arises in the morning. Pinworm eggs are captured on the adhesive surface and are massive enough to be recognized by direct microscopic examination utilizing low-power (�100) magnification. Several anthelmintics, together with albendazole, mebendazole, and pyrantel pamoate, are effective in the treatment of pinworm infection. Because one untreated person can easily infect others, the entire household must be treated (including relatives who reside with or visit the infected child, baby sitters, and other children on the day care center). The most common symptom of pinworm infection is perianal itching, which can be brought on by dermal sensitivity to parasite egg antigens. Scratching facilitates the spread of the an infection because infective eggs may be unfold to the same person (autoinfection) or to others by placing contaminated fingers into the mouth. The physical examination revealed pallor of the conjunctivae, and the examining physician ordered a blood rely, which showed a hematocrit of 28%. The astute doctor also ordered a stool examination for ova and parasites, which was optimistic for eggs of Ancylostoma duodenale, a hookworm. Treatment of the hookworm infection with mebendazole and the iron supplementation resulted in a return of the hematocrit to 45% at a 3-month follow-up visit. Intestinal Nematodes That Penetrate the Skin: Hookworms and Strongyloides Hookworms Hookworm illness is caused by two species of roundworms: Necator americanus and Ancylostoma duodenale. As larvae penetrate the skin on the time of initial an infection, they could cause local manifestations of itching and irritation ("ground itch"). In human hookworm infections, dermal manifestations are temporary and resolve when the larvae enter the bloodstream and lymphatics. However, individuals can also turn into contaminated with cat and dog hookworm larvae, a condition known as "creeping eruption" (or cutaneous larva migrans). This course of can produce an intensely itchy, red, serpentine observe across the web site of penetration that can persist for weeks. Human hookworm larvae enter the circulation by way of the bloodstream or lymphatics, traverse the best side of the center, and become trapped within the lungs.

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This evaluation identified 237 differentially regulated genes: forty four that had been expressed extra extremely within the micro organism recovered from the stool samples and 193 that had been expressed more extremely within the in vitro�grown micro organism. Some of the in vivo�induced genes had been the identical as those recognized using other approaches, together with these concerned in the ability of V. While microarrays remain a powerful and well-used device to analyze gene expression at a global level, newer transcriptomics strategies have taken benefit of the exceptional advances in nucleotide sequencing know-how, generally termed "massively parallel sequencing" or "deep sequencing. Direct comparison of the numbers of each transcript within the cell could be made very rapidly, enabling researchers to decide patterns of gene expression under circumstances of interest, including throughout infection. Host gene transcription responses to completely different pathogens in varied tissues and cell forms of hosts-both human and from experimental animal models-have been analyzed extensively. Sometimes researchers uncover very similar gene expression responses to killed bacteria and to widespread bacterial components, such as lipopolysaccharide. Of curiosity to questions of an infection and immunity, however, is that qualitative and quantitative variations in responses to numerous reside bacterial pathogens were observed. One potential consequence envisioned for this work is to establish particular infections based mostly on the distinct "signature" responses of the host. If true, bacterial infections could presumably be diagnosed sooner or later by analyzing the gene expression profile in cells obtained from a peripheral blood specimen quite than culturing the organism from the first site of an infection. Such data is crucial to the event of new diagnostic exams, vaccine strategies, and therapeutic agents. Proteome Analysis All the approaches described in this chapter so far have focused on identifying and characterizing genes concerned in pathogenesis. Therefore, major objectives toward understanding mechanisms of pathogenesis have been to identify and characterize directly the complete protein profile (or proteome) expressed by pathogenic bacteria. A comparability of the proteome expressed by bacteria grown in vitro with that of those recovered from an infected host, analogous to the transcriptome comparison described earlier, must be especially informative. Significant advances in two-dimensional polyacrylamide gel electrophoresis applied sciences, coupled with increased ability to recover proteins and determine their amino acid sequences utilizing extremely subtle mass spectrometry and mass peptide fingerprinting technologies, have made such analysis possible, and mixing both genetic and proteomic strategies has a major advance in this field. Identification of invasin: a protein that enables enteric bacteria to penetrate cultured mammalian cells. Selection of bacterial virulence genes which would possibly be particularly induced in host tissues [comments]. Characterization of the Vibrio cholerae ToxR regulon: identification of novel genes concerned in intestinal colonization. Among the substances that may kill microorganisms are heat, radiation, and robust acids. Targeting particular microbes whereas sparing host cells and tissues is rather more tough. According to Paul Ehrlich, a pioneer of contemporary chemotherapy, what we want is a "specific chemotherapy" to kill the microbes and not ourselves. Paradoxically, we depend on the microbial world to present us with most of the chemotherapeutic agents that we have to kill micro organism. One means organisms in the environment-soil, water, or areas of the human body-attempt to gain a bonus over different organisms is by secreting particular chemical compounds. Chapter three described how microorganisms secrete iron-chelating compounds and are able to reabsorbing their own iron-bearing products. Thus, in complicated environments, competitors for nutrients combines with the motion of antibiotic substances to produce a balanced microbial ecology. Ask older family members how they feared the loss of a liked one from pneumonia or postoperative infection, or discuss to older physicians about how powerless they were when treating youngsters with meningococcal meningitis or subacute bacterial endocarditis. The selective pressure exerted by antibiotics on micro organism is so great that inside one human era, many micro organism have responded by turning into resistant, often to a number of antibiotics. In 1934, Domagk discovered that one of those compounds, prontosil, cured a fatal streptococcal an infection in mice. It was then proven that prontosil was inactive in pure cultures of micro organism in vitro however was hydrolyzed in vivo to the lively drug sulfanilamide. These findings gave impetus to the efforts to purify penicillin, a true antibiotic produced by the mildew Penicillium and first detected by Alexander Fleming in 1928. A new era had arrived; the search for new antimetabolites and antibiotics has continued ever since. Between 1830 and 1940, the influence of sanitation, public well being, and immunization prolonged life expectancy.

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Because leprosy is primarily a rural and not an city disease, transmission by soil also has been advised. Even there, it grows very slowly (doubling as quickly as every 14 days), and yields of the organisms are low. This discovering revolutionized leprosy research because it offered adequate quantities of the organism for basic research. Accordingly, they multiply most rapidly within the skin, nose, and different superficial tissues. The prognosis of leprosy has dramatically improved with the introduction of effective drugs like dapsone, rifampin, and clofazimine. Tuberculoid Leprosy Tuberculoid leprosy is usually characterised by pink blotchy lesions with localized anesthesia (loss of sensation) on the face, trunk, and extremities. Such patients often show delayedtype hypersensitivity to lepromin (the M. Patients with tuberculoid leprosy have a vigorous cell-mediated immune response to M. The prognosis with tuberculoid leprosy is better than that with lepromatous leprosy and, in some circumstances, tuberculoid leprosy is a self-limited disease. The number of bacilli harbored by a lepromatous affected person (1015) is much larger than in another human disease. With time, the loss of native sensation leads to inadvertent, traumatic lesions of the face and extremities. The infecting organisms might play a role on this immunosuppression, and host genetic factors additionally may be involved. Tissue damage happens primarily due to exuberant hypersensitivity to the organism. The tubercle bacillus has a waxy coat, grows very slowly, and is a extremely successful intracellular pathogen. Clinical manifestations differ between the preliminary and subsequent encounters with the organism. Novel and improved applied sciences for tuberculosis analysis: progress and challenges. Leprosy is rare in the United States however nonetheless a big problem in lots of international locations. Tuberculoid leprosy is characterised by a vigorous cell-mediated immune response with few organisms present. In contrast, lepromatous leprosy is related to diminished delayed-type hypersensitivity to M. An outbreak of multidrugresistant tuberculosis among hospitalized patients with the acquired immunodeficiency syndrome. Encounter: Most commonly acquired by sexual contact Entry: the bacterium often enters by way of genital mucosa or pores and skin. Spread and Multiplication: Disease is characterized by three levels: primary syphilis, in which the organism is localized to a chancre, or pores and skin lesion; secondary syphilis, by which the organism disseminates to distant sites; and tertiary syphilis, during which the immune response to the organisms leads to the destruction of tissue. Diagnosis: Syphilis is initially recognized by checks such as Venereal Disease Reference Laboratory check; optimistic outcomes ought to be confirmed with more particular exams. A recent resurgence of syphilis in choose populations inside the United States has once again focused consideration on this historic infectious illness. Syphilis is a multistage disease, and each stage has a dramatically completely different scientific presentation. The first two stages (primary and secondary) manifest as acute and subacute illness, respectively, whereas tertiary syphilis is a chronic disease that lasts a few years. Nevertheless, scientific observations are beginning to elucidate why the organism is ready to escape the immune system and the way it induces disease. He had just lately noted a penny-sized, gray, translucent lesion on the inner side of his lower lip.

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Several weeks later, the sera from the immunized rabbits had been ready and used because the antibody supply (antisera). Known quantities of antigen (in a continuing volume) have been blended with an equal, fixed quantity of antiserum and incubated. Precipitate formed in several tubes and was separated (by centrifugation) from the supernatant, and the quantity of total nitrogen in the precipitate was determined. This experiment demonstrated that an antibody is a protein and that antigens and antibodies react in a predictable manner. The diploma of antigen�antibody cross-linking ends in lattice formation and can be utilized to describe the three distinct zones of the quantitative precipitin curve: � Zone of antigen excess: the antigen�antibody complexes are too small to precipitate. The ideas of the quantitative precipitin curve apply to all antigen�antibody reactions and form the idea for many fashionable scientific diagnostic checks. Antibody�Antigen Reactions Antigen�antibody (Ag�Ab) interactions are a few of the most particular noncovalent biochemical reactions identified and may be represented by the next easy method: Ag + Ab AgAb Agglutination Antibodies can also bind to and cross-link cells or particles, causing an aggregate formation in a reaction known as agglutination. Agglutination has the impact of throwing a molecular net over microbial invaders, significantly hindering their mobility and unfold all through the body before they encounter the tissue, cells, and fluids of the physique. Antibodies of the IgM and IgA isotypes are particularly adept at this as a outcome of they contain 10 and 4 binding sites, respectively; however enough concentrations Although the response is driven to the right, discover that antigen�antibody interactions are reversible. Antigen composed of a number of epitopes (green spheres) is diluted in a mild salt resolution (diluent) in a test tube and expressed as a ratio (1:2, 1:four, 1:eight, etc. Optimal precipitation (equivalence zone) happens when antigen and antibody react to kind giant latticelike complexes. It is the presence of neutralizing antibodies generated through the preliminary infection that provides the greatest safety in opposition to subsequent reinfection by the identical organism. Neutralization Neutralization describes the method of antibodies binding to microbial epitopes or soluble molecules. Many microbes and all viruses inflict injury once they bind to host cell surfaces to facilitate entry. Likewise, most toxin molecules bind to host cell surface buildings before entry and exertion of their poisonous results. The binding constructions on the microbe or toxin are shaped to match along with specific host cell surface buildings. For example, rhinoviruses (the common cold viruses) bind to the intracellular adhesion molecule 1 found on the surfaces of respiratory epithelium. Antibodies generated against the microbes (or toxins) typically embrace some that may bind and block the microbial buildings that interact with the host cell floor, effectively preventing the microbe (or toxin) from entering the cell. This form of immunoglobulin-mediated safety known as neutralization as a end result of it neutralizes the infective capability of the invader. Neutralizing antibodies are often of the IgG Opsonization Sometimes, the binding of an antibody (usually IgG) to a microbial surface is sufficient to "whet the appetite" of a phagocyte, making the microbe a gorgeous "meal. Phagocytic cells similar to macrophages, dendritic cells, and neutrophils bear surface receptors (FcRs) for the Fc portion of immunoglobulin. By binding an epitope, an antibody molecule makes a number of conformational adjustments that include adjustments in the Fc region. The binding of a microbe-associated epitope�antibody advanced by the FcRs tethers the certain invader to the phagocytic cell and stimulates it to engulf and destroy the microbe. In truth, initial microbe binding and engulfment stimulates the phagocytic cell to improve its search for different such "tagged" microbes. The immunoglobulin serves as an opsonin (an agent that stimulates phagocytosis), and the elevated phagocytic exercise that ensues is termed opsonization. Agglutination: Recognition of microbial floor epitopes by antibodies causes a cross-linked lattice formation analogous to the equivalence zone of the quantitative precipitin curve. Neutralization: In some situations, antibodies are specific for epitopes on the microbe, epitopes that would usually work together with molecules on the surface of the host cell. Antibodies that forestall molecule-to-molecule interaction between microbe and host cells are termed neutralizing antibodies. Opsonization: Antibody binding to microbial epitopes causes a conformational alteration within the Fc portion of the antibody molecule. Specialized Fc receptors (FcR) on phagocytes recognize and bind to the altered Fc portion of the antibody molecule, initiating phagocytosis of the FcR�antibody�microbe advanced for enzymatic degradation by the phagolysosome.

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Rickettsiae Like the chlamydiae, the rickettsiae are small, intracellular micro organism which may be also obligate parasites. Among the diseases these bacteria trigger are epidemic typhus and Rocky Mountain noticed fever. Included on this group is the genus Ehrlichia, micro organism that infect white blood cells in people and animals. Each species is transmitted by the chew of various arthropod species (lice, fleas, ticks, and so on. Rickettsiae are small, rod-shaped micro organism that lack distinctive progress cycle levels. The genes of those agents have been launched into surrogate organisms, corresponding to E. Bacteria, viruses, fungi, protozoa, and worms that had been previously unknown or identified to be current only in animals or the surroundings have now joined the list of potential or known human pathogens. The mixture of latest applied sciences and the changes in the human immune situation will undoubtedly lead to the invention of many extra agents of infectious diseases. At the same time, with progress in sanitation and vaccination, the importance of most of the basic infectious pathogens is waning. Virtually all of the pathogenic bacteria have turn out to be considerably extra resistant to each new antibiotic that has been launched within the final 5 a long time. For instance, pathogenic staphylococci are now almost universally proof against penicillin, though in the 1950s, when the drug came into general use, their ancestors had been sensitive to it. Furthermore, we at the moment are in an era during which the specter of organic weapons primarily based on human pathogens is very real, and our understanding of how some of those microbes trigger disease and tips on how to shield populations from them is scant. Thus, the research of microbial pathogens and microbial biology in general stays a rich target area for research and innovations that will have a significant influence on human health. The staphylococci or streptococci of today fit their authentic descriptions from the top of the 19th century. They embrace Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus saprophyticus (which almost solely causes urinary tract infections), and numerous others. Encounter: Organisms grow on the floor of humans and survive on inanimate surface. During a lifetime, roughly 90% of humans are colonized with sooner or later with S. Entry: Carriage of staphylococci normally occurs after direct, skin-to-skin contact with another provider. Infection may also occur after penetration of a contaminated object via the pores and skin. Staphylococci cause skin and gentle tissue infections (such as furuncles, abscesses, and necrotizing fasciitis), pneumonia, meals poisoning, and toxin-induced illnesses (toxic shock and scalded skin syndromes). If the organisms enter the bloodstream, they may trigger osteomyelitis, kidney abscesses, or endocarditis. They additionally secrete virulence factors corresponding to hemolysins, leukocidins, superantigens, and different exotoxins. Treatment: Most strains produce -lactamase (an enzyme that breaks down penicillin). However, some strains express penicillin-binding protein 2a, which additionally makes the organism proof against the abovementioned brokers (methicillinresistant S. Drainage of abscesses and supportive remedy for hypotension and shock are also important, nonantimicrobial components of care. They colonize the anterior nares of 30 to 40% of people and may be present on other mucous membranes and the pores and skin. The organism also causes more-frequent and various forms of diseases than maybe any other human pathogen (see field, Diseases Caused by Staphylococci). The bacteria can produce focal abscesses at virtually any site within the physique, from the skin (furuncles or "boils") to the lungs (pneumonia), bones (osteomyelitis), kidneys, and coronary heart (endocarditis). In addition, many strains of the bacterium secrete potent exotoxins that may trigger signs of sickness at sites distant from the bacterial an infection. The secreted and cell surface virulence factors produced by staphylococci act regionally primarily to help them face up to phagocytosis by neutrophils. For example, clumping issue (also generally recognized as sure coagulase) binds fibrin and helps the organism form walled-off abscesses protected against phagocytes.

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However, primaquine is more toxic than chloroquine and causes nausea, vomiting, and diarrhea. In endemic areas, individuals should protect themselves with mosquito netting, home screening, and bug repellents. The best hope for controlling malaria is the event of improved antimalarials and/or an effective vaccine. Babesia Species Like the plasmodia of malaria, Babesia species are protozoal parasites that trigger illness by infecting purple blood cells and generating fever on launch. Babesia microti is the most recognized cause of human babesiosis within the United States. Infected persons expertise a flulike illness, with fever, chills, sweats, muscle aches, and fatigue. Because the illness normally occurs in the summertime months, when ticks are feeding, babesiosis has been likened to a "summer time flu. In a person with an intact spleen, the proportion of infected purple blood cells is normally 0. In fact, the disease was first detected in postmortem research of splenectomized patients. As in malaria, the spleen is assumed to remove the less deformable Babesia-infected pink blood cells from the circulation. The epidemiology of the disease is restricted by the presence of a suitable tick vector and wildlife reservoir, in addition to by human contact with them. That is the one form of the parasite present in peripheral blood and may be easily missed when parasitemia is low. The distinction between the 2 parasites is important because Babesia infections are treated with different chemotherapeutic agents than malaria: clindamycin plus quinine for babesiosis versus a variety of medication for malaria (as discussed earlier). However, they typically seem too late (3 to four weeks after the onset of infection) to be useful within the prognosis and therapy of acute babesiosis. In the few persons with indicators and symptoms of energetic an infection, the clinical presentation of the disease varies. The first method seems to be the commonest, however that is troublesome to decide with certainty. Infectious merozoites are injected underneath the skin by the hard-bodied tick (Ixodes) vector (1) and they invade red blood cells immediately (2). Once inside the pink blood cells, parasites replicate asexually by binary fission (3). Babesia species characteristically type tetrads (4), lyse their host pink blood cells as they mature (5), and full the cycle when parasitized red blood cells are ingested by the tick vector (6). On a number of occasions he took his temperature orally and found that it ranged from 37�C to 38�C. On bodily examination, his doctor detected no stiff neck or pharyngitis; nonetheless, Mr. Routine laboratory checks have been similarly unremarkable and included a traditional white cell rely and regular liver operate tests. He was of Middle Eastern descent and lived together with his first-generation immigrant dad and mom. The household sometimes dined on kibbeh, a Middle Eastern dish made with lamb (sometimes raw), bulgur wheat, and spices. In these animals, and in all other nonfeline mammals that acquire toxoplasmosis, parasites that reach the small intestine penetrate the intestine wall, invade the bloodstream, and disseminate throughout the physique, to the mind, heart, muscular tissues, and different organs. In the first four to 6 weeks after the parasites enter the body, Humans Humans contaminated dealing with kitty litter or soil Humans contaminated by eating undercooked meat a standard host mount an immune response that controls the an infection. Cats become contaminated by ingesting animals that have these tissue cysts in their muscular tissues and organs. Thereafter, the infection stays inactive as a deadend an infection within the tissues until the person turns into immunosuppressed at a while in the future. After the preliminary acute infection, most people mount a successful immune response that eliminates the active infectious (tachyzoite) type of the parasite and leaves only tissue cysts with dormant organisms (4). A comparable progression is observed within the cat (l�4), the place the parasite additionally invades intestinal epithelial cells (6).

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In small quantities, endotoxin elicits fever and mobilizes sure protection mechanisms. This complicated phenomenon results in the activation and mobilization of macrophages, the powerful phagocytic cells that take part in the later levels of inflammation to clean up particles and remaining microorganisms. These damaging activities are characteristic of chronic infections, often brought on by intracellular microorganisms and viruses. The immune response is elicited by the tubercle bacilli, that are able to persist in cells for a long time. It is worth repeating that though the immune responses may cause tissue injury, in most cases, the price is well price it. This point is illustrated in people who have genetic or acquired defects of their immune methods. Immunocompromised patients are ravaged and later killed by microorganisms that trigger little or no disease in wholesome individuals. In the immunocompetent individual, for instance, energetic tuberculosis causes a lot damage, however demise solely occurs after a few years. In the immunocompromised affected person, the illness can become rampant in a much shorter period. The fascination of the topic could not suffice to overcome its inherent downside of super detail. The conceptual framework used on this chapter, which is predicated on the truth that all host�parasite interactions have steps in common, could additionally be useful in mastering lots of the particulars of microbiology. As indicated firstly of this chapter, parasite and host must encounter one another, and the parasite must enter the host, unfold, multiply, and eventually cause injury. To intervene and to change the pure end result of infection, one must accomplish a mixture of the three objectives: diagnosis, treatment, and/or prevention of the an infection. For most of the infections described on this book, the pure outcome of an infection is typically altered by our understanding of the relevant occasions and our ability to intervene efficiently. Various properties of the invading agent and the host result in an intricate and ever-changing interaction. Most coexist with people with out causing harm and in some instances provide great benefit. The members of the conventional microbiota change with time, however their quantity at any prompt continues to be formidable. Members of the normal microbiota are outlined as microorganisms incessantly discovered on or within the body of wholesome persons. Some of these organisms are found only in the bodies of humans or animals; others can also live freely in the setting. A exact roll name of the organisms that constitute the normal microbiota is usually not possible, as discussed in Chapter 1. In truth, it appears that we collectively share a "core microbiota," and a few of us harbor others which might be perhaps more transient. Consider, for example, the meningococcus or the pneumococcus, both true pathogens able to causing meningitis, pneumonia, or septicemia. Thus, colonization is necessary, but insufficient, for meningococcal or pneumococcal illness. The same problems that come up in exactly identifying the normal microbiota pertain to terms such as pathogenicity and virulence. In addition, disease seldom results from the activities of the agent alone but often reflects the responses of the host as properly. A good analogy: firefighters often add to the property destruction resulting from a hearth by producing water damage as they try to comprise the flames. In the human physique, essentially the most successful microbe is the one that may rapidly and effectively turn out to be two microbes. In reality, probably the most virulent pathogens, those who kill their hosts, could also be poorly tailored for survival and represent current organic associations. If the average bacterium were about 1 m3 in volume, the densest possible packing would result in a mass of 1 � 1012 per mL. To colonize the human physique, invading microorganisms must be succesful of resist host mechanisms that could dislodge or kill them, in addition to compete successfully with other microbial species.

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Rasarus, 61 years: Zoster in a toddler who introduced with 6 days of eye ache and a rash within the distribution of the ophthalmic branch of the trigeminal nerve.

Silvio, 60 years: First, nongrowing bacteria are still immunogenic and may elicit immune responses with each helpful and detrimental outcomes.

Tukash, 34 years: Typical leukocidin producers are highly invasive micro organism, corresponding to pseudomonads, staphylococci, group A streptococci, and the clostridia that cause gasoline gangrene.