Chapter 14:  For example, Staphylococcus

epidermidis growing on the

Infection, Infectious Diseases, and skin typically causes no
Epidemiology measurable harm to a
person.
Symbiotic Relationships Between
 Parasitism
Microbes and Their Hosts
 A concern to health care
Symbiosis professionals
 A parasite derives benefit
 means “to live together.”
from its host while harming
 Each of us has symbiotic
it, though some hosts sustain
relationships with countless
only slight damage.
microorganisms.
 In the most severe cases, a
 The 10 trillion or so cells in your parasite kills its host, in the
body provide homes for more than
process destroying its own
100 trillion bacteria and fungi and
home, which is not beneficial
even more viruses.
for the parasite.
Types of Symbiosis  parasites that allow their
hosts to survive are more
 Mutualism likely to spread.
 both members benefit from
 hosts that tolerate a parasite
their interaction.
are more likely to reproduce.
 For example, bacteria in your
 Any parasite that causes
colon receive a warm, moist,
disease is called a pathogen.
nutrient-rich environment in
which to thrive, while you
o A variety of protozoa, fungi,
absorb vitamin precursors
and bacteria are microscopic
and other nutrients released
parasites of humans.
from the bacteria.
o Larger parasites of humans
 mutualistic relationships
include parasitic worms.
provide such important
benefits that one or both of
the parties cannot live
without the other.
 Commensalism
 a second type of symbiosis
 one member of the
relationship benefits without
significantly affecting the
other.
Normal Microbiota in Hosts
Describe the normal microbiota, including
resident and transient members.
Axenic environments
 sites that are free of any microbes.
 other parts of your body shelter
millions of mutualistic and
commensal symbionts.
 The microbes that colonize the
surfaces of the body without
normally causing disease constitute
the body’s normal microbiota also
sometimes called the normal flora
or the indigenous microbiota.
 The normal microbiota is of two
main types: resident microbiota and
transient microbiota.
Resident Microbiota
 remains a part of the normal
microbiota of a person throughout
life.
 These organisms are found on the
skin and on the mucous membranes
of the digestive tract, upper
respiratory tract, distal portion of
the urethra, and vagina.
Transient Microbiota
 remains in the body for only a few
hours, days, or months before
disappearing.
 They are found in the same locations
as the resident members of the
normal microbiota but cannot
persist because of competition from
other microorganisms.
o elimination by the body’s
defense cells, or chemical
and physical changes in the
body that dislodge them.
Acquisition of Normal Microbiota
 You developed in your mother’s
womb without normal microbiota
because you had surrounded
yourself with an amniotic
membrane and fluid.
o which generally kept
microorganisms at bay.
Your normal microbiota began to
develop when your surrounding
amniotic membrane ruptured
and microorganisms came in
contact with you during birth.
most of the resident microbiota
was initially established during
your first months of life.
How Normal Microbiota Become
Opportunistic Pathogens
normal microbiota become opportunistic
pathogens, or opportunists. Conditions that
create opportunities for pathogens include
the following:
1. Introduction of a member of the
normal microbiota into an unusual
site in the body
a. Every site has a specific
normal microbiota; if a
normal microbiota of one
site is introduced to a site
that is unfamiliar- it will
become opportunistic.
 2. Immune response (wild) animals can also affect
a. Any disease, malnutrition, humans.
emotional or physical stress, b. Diseases that spread
extremes of age, use of naturally from their usual
radiation or chemotherapy, animal hosts to humans are
use of immunosuppressive called zoonoses. Over 150
drugs can enable zoonoses have been
opportunistic pathogens. identified throughout the
b. AIDS patients often die from world.
opportunistic infections. i. examples include
yellow fever, anthrax,
3. Changes in the normal microbiota bubonic plague, and
rabies.
a. Microbial c. Routes
antagonism/Microbial i. direct contact – waste
competition exposure, eating
i. Normal microbiota animals, blood
use nutrients, take up sucking arthropods.
space, and release  Human carriers
toxic waste products, a. Experience tells you that
all of which make it humans with active diseases
less likely that are important reservoirs of
arriving pathogens infection for other humans.
can compete well b. carriers incubate the
enough to become pathogen in their body and
established and eventually develop the
produce disease. disease.
c. others remain a continued
source of infection without
Reservoirs of Infectious Diseases of ever becoming sick.
Humans  Nonliving Reservoirs Soil,
Sites where pathogens are maintained as a a. water, and food can be
source of infection are called reservoirs of nonliving reservoirs of
infection infection.
i. Soil - especially if
3 types of reservoirs: fecally contaminated,
 Animal reservoirs can harbor
a. Many pathogens that Clostridium bacteria,
normally infect either which cause botulism,
domesticated or sylvatic tetanus, and other
diseases.
 Portals of Entry
ii. Water can be
contaminated with Pathogens thus enter the body at several
feces and urine sites, called portals of entry.
containing parasitic three major types: the skin, the mucous
worm eggs, membranes, and the placenta.
pathogenic protozoa,
bacteria, and viruses. A fourth entry point, the so-called
iii. Meats and parenteral route, is not a portal but a way
vegetables can also of circumventing the usual portals.
harbor pathogens. Skin
The Invasion and Establishment of  the outer layer of skin is composed
Microbes in Hosts: Infection of relatively thick layers of tightly
packed, dead, dry cells.
events that occur when hosts are exposed
 a formidable barrier to most
to microbes from a reservoir, the sites at
pathogens as long as it remains
which microbes can gain entry into hosts,
intact.
and the ways entering microbes become
established in new hosts.  some pathogens can enter the body
through natural openings in the skin,
Exposure to Microbes: such as hair follicles and sweat
Contamination and Infection glands. Abrasions, cuts, bites,
scrapes, stab wounds, and surgeries
Contamination
open the skin to infection by
 mere presence of microbes in or on contaminants.
the body.
Mucous Membranes
 Some microbial contaminants reach
the body in food, drink, or the air,  line all the body cavities that are
whereas others are introduced via open to the outside world.
wounds, biting arthropods, or sexual o They include the linings of
intercourse. the respiratory,
gastrointestinal, urinary, and
Infection
reproductive tracts as well as
 a successful invasion of the body by the conjunctiva.
a pathogen is called an infection.  unlike the skin, mucous membranes
 An infection may or may not result are relatively thin, moist, and warm,
in disease; that is, it may not and their cells are living.
adversely affect the body.  The respiratory tract is the most
frequently used portal of entry.
 o Pathogens enter the mouth
and nose in the air, on dust
particles, and in droplets of
moisture.
Placenta
 The placenta is in such intimate
contact with the wall of the
mother’s uterus that nutrients and
wastes diffuse between the blood
vessels of the developing child and
of the mother.
The Parenteral Route
 not a portal of entry but instead a
means by which the portals of entry
can be circumvented.
 To enter the body by the parenteral
route, pathogens must be deposited
directly into tissues beneath the skin
or mucous membranes, such as
occurs in punctures by a nail, thorn,
or hypodermic needle.
 Example: intravenous medications
and blood transfusion.
The Role of Adhesion in Infection
After entering the body, symbionts must
adhere to cells if they are to be successful in
establishing colonies.
 The process by which
microorganisms attach themselves
to cells is called adhesion or
attachment.
o To accomplish adhesion,
pathogens use adhesion
factors, which are either
specialized structures or
attachment proteins.
 Ligands are also called adhesins on
bacteria and attachment proteins
on viruses.
 Adhesions are found on fimbriae,
flagella, and glycocalyces of many
pathogenic bacteria.
o If ligands or their receptors
can be changed or blocked,
infection can often be
prevented.
 the result of some genetic change
(mutation) or exposure to certain
physical or chemical agents (as
occurs in the production of some
vaccines)—become harmless, or
avirulent.
 Some bacterial pathogens do not
attach to host cells directly. but
instead interact with each other to
form a sticky web of bacteria and
polysaccharides called a biofilm,
which adheres to a surface within a
host.
The Nature of Infectious Disease
 Most infections succumb to the
body’s defenses
 some infectious agents affect body
function.
 By definition, all parasites injure
their hosts. When the injury is
significant enough to interfere with
the normal functioning of the body,
the result is termed disease.
 Disease, also known as morbidity, is
any change from a state of health.
Infection and disease are not the
same thing.
 a. Infection is the invasion of a
pathogen; disease results
only if the pathogen
multiplies sufficiently to
adversely affect the body.
Manifestations of Disease:
Symptoms, Signs, and Syndromes
 Diseases may become manifest in
different ways.
 Symptoms are subjective
characteristics.
 Signs are objective manifestations of
disease that can be observed or
measured by others.
 Symptoms include pain, headache,
dizziness, and fatigue; signs include
swelling, rash, redness, and fever.
Sometimes pairs of symptoms and
signs reflect the same underlying
cause.
 Symptoms and signs are used in
conjunction with laboratory tests to
make diagnoses.
 A syndrome is a group of symptoms
and signs that collectively
characterizes a particular disease or
abnormal condition.
 Some infections go unnoticed
because they have no symptoms.
Such cases are asymptomatic, or
subclinical, infections.
Causation of Disease: Etiology
Hereditary diseases, are genetically
transmitted from parents to offspring.
Congenital diseases, are diseases that are
present at birth.
Other diseases are classified as
degenerative, nutritional, endocrine,
mental, immunological, or neoplastic.
1. Degenerative - Result from aging
2. Nutritional Result - lack of some
essential nutrients in diet
3. Endocrine (hormonal) - excesses or
deficiencies of hormones
4. Mental - Emotional or
psychosomatic
5. Immunological - Hyperactive or
hypoactive immunity
6. Neoplastic (tumor) - Abnormal cell
growth benign tumors,
7. Iatrogenicb - Caused by medical
treatment or procedures;
8. Idiopathicc – Unknown cause
9. Nosocomiald - Disease acquired in
health care setting
The study of the cause of a disease is called
etiology.
USING KOCH’S POSTULATES
Louis Pasteur, Robert Koch, and other
microbiologists proposed the germ theory
of disease, which states that disease is
caused by infections of pathogenic
microorganisms.
Koch developed a series of essential
conditions, or postulates, that scientists
must demonstrate or satisfy to prove that a
particular microbe is pathogenic and causes
a particular disease.
1. The suspected agent (bacterium,
virus, etc.) must be present in every
case of the disease.
2. That agent must be isolated and
grown in pure culture.
 3. The cultured agent must cause the
disease when it is inoculated into a
healthy, susceptible experimental
host.
4. The same agent must be reisolated
from the diseased experimental
host.
EXCEPTIONS
1. Some pathogens cannot be cultured in
the laboratory.
2. Some diseases are caused by a
combination of pathogens or by a
combination of a pathogen and
physical, environmental, or genetic
cofactors.
3. Ethical considerations prevent
applying Koch’s postulates to diseases
and pathogens that occur in humans
only.
Virulence Factors of Infectious Agents
Explain how microbial extracellular
enzymes, toxins, adhesion factors, and
antiphagocytic factors affect virulence.
 The ability of a
 microorganism to cause disease is
termed pathogenicity and the
degree of pathogenicity is termed
virulence.
o Virulence is the relative
ability of a pathogen to infect
a host and cause disease.
Pathogens have a variety of traits that
interact with a host and enable the
pathogen to enter a host, adhere to host
cells, gain access to nutrients, and escape
detection or removal by the immune
system. These traits are collectively called
virulence factors.
Extracellular Enzymes
Many pathogens secrete enzymes that
enable them to dissolve structural
chemicals in the body and thereby maintain
an infection, invade further, and avoid body
defenses.
 Hyaluronidase and collagenase
degrade specific molecules to enable
bacteria to invade deeper tissues.
Hyaluronidase digests hyaluronic acid,
the “glue” that holds animal cells
together, and collagenase breaks
down collagen, the body’s chief
structural protein.
 Coagulase causes blood proteins to
clot, providing a “hiding place” for
bacteria within a clot.
 Kinases, such as staphylokinase and
streptokinase, digest blood clots,
allowing subsequent invasion of
damaged tissues.
Toxins
are chemicals that either harm tissues or
trigger host immune responses that cause
damage.
 Difference between extracellular
enzymes and toxins
not always clear because:
 many enzymes are toxic
 and many toxins have enzymatic
action.
 Toxemia – a condition wherein the
toxins enter the bloodstream and
are carried to other parts of the
body, including sites that may be far
removed from the site of infection.
two types of toxin: exotoxins and
endotoxins
Exotoxins
microorganisms secrete exotoxins that
are central to their pathogenicity in that
they destroy host cells or interfere with
host metabolism.
Three principal types:
■ Cytotoxins - kill host cells in general
or affect their function.
■ Neurotoxins - specifically interfere
with nerve cell function.
■ Enterotoxins - which affect cells lining
the gastrointestinal tract.
Endotoxin
Gram-negative bacteria have an outer
(wall) membrane composed of:
 Lipopolysaccharide
 Phospholipids
 proteins
Also called lipid a.
 lipid portion of the membrane’s
lipopolysaccharide.
 Endotoxin can be released when
Gram-negative bacteria divide, die
naturally, or are digested by
phagocytic cells such as
macrophages.
 Many types of lipid A stimulate the
body to release chemicals that cause
fever, inflammation, diarrhea,
hemorrhaging, shock, and blood
coagulation.
Antiphagocytic Factors
 Longer pathogen in host = greater
damage & severe the disease
 Limits the extent & duration of
infections, body’s phagocytic cells
like macrophages
 Macrophages – WBC that engulfs &
removes invading pathogens
 Virulence factors r/t evasion of
phagocytis:
■ Capsules
 Effective because they’re
composed of
polysaccharides
 Result: don’t stimulate
host’s immune system
 Slippery which makes
phagocytes difficult to
surround & phagocytize;
their pseudopods can’t grip
the capsule
 ■ Antiphagocytic Chemicals
 Bacterias that causes
gonorrhea, produce
chemicals that prevent
fusion of lysosomes with
phagocytic vesicles for their
survival
 Streptococcus pyogenes –
produces protein in cell wall
and fimbrae called M
protein
 M protein – inhibits
phagocytosis which
increases virulence
 Leuokocidins – destroys
phagocytic WBCs
Stages of Infectious Diseases
5 DISEASE PROCESS:
1) Incubation Period
 Infection, symptoms
& signs of disease
 Length: depends on
infective agents’
virulence, infect dose
( initial # of
pathogens), immune
system, nature &
reproduction of
pathogen and site of
infection
2) Prodromal Period
 Short time of
generalized, mild
symptoms that
precedes illness
3) Illness
 Severe stage
 Evident signs &
symptoms
 Unresponsive
immune system to
harming pathogen
4) Decline
 Body returns to
normal
 Immune response
and/or medical
treatment vanquish
pathogens
 Immune response &
products (antibodies
in blood) peaks
5) Convalescence
 Recovery
 Repaired & normal
tissues
 Length: depends on
amount of damage,
nature of pathogen,
site of infection &
overall health
Movement of Pathogens Out of
Hosts: Portals of Exit
 Identical to portals of entry
 Pathogens often leave the body via
bodily secretions and excretions
Examples:
o Ear: earwax
o Broken Skin: blood
 o Skin: flakes  pathogens from
o Eyes: tears portal of exit directly
o Nose: secretions to portal of entry
o Mouth: saliva, septum
o Mammary glands: milk, - Indirect contact transmission
secretions  pathogens spread
o Vagina: secretions, blood from one host to
o Seminal vesicles: semen & another by fomites
lubricating secretions  Fomites –
o Urethra: urine contaminated
inanimate objects
Modes of Infectious Disease
 Contaminated
Transmission needles are major
 Infectious disease agent must be source of hepa-B and
transmitted from either a reservoir AIDS
or portal of exit to another host’s
portal of entry
- Droplet transmission
3 MODES:  Pathogens are
transmitted within
droplet nuclei less
 Contact Transmission
than 1 meter
(droplets of mucus)
- Direct contact transmission
that exit body during
 Person-to-person
exhaling, coughing, &
spread
sneezing
 Involves body contact
 Cold and flu
between hosts
 Touching, kissing and
 Vehicle Transmission
sex could transmit
warts, herpes, and
gonorrhea - Airborne transmission
 Touching, biting or  Spread of pathogens
scratching could farther than 1 meter
transmit zoonoses to respiratory mucous
like rabies, ringworm, membranes of a new
and tularemia from host via an aerosol
animals  Aerosol – cloud of
 Transfer of infected small droplets and
mother to developing solid particles
baby in placenta suspended in air
  Aerosols are from
sneezing, coughing
and generated by
aircon, sweeping,
mopping, changing
clothes and bed
linens, flaming
inoculating loops
 Dust can carry
Staphylococcus,
Streptococcus, and
Hantavirus
 Measles and TB bacilli
can be transmitted in
dried airborne
droplets
 Fungal spores of
Histoplasma and
Coccidioides are
typically inhaled
- Waterborne transmission
 GI diseases such as
giardiasis, amebic - Body Fluid transmission
dysentery, and
cholera
 Water can act as
reservoir and vehicle
of infection
 Fecal-oral infection –
major source of  Vector Transmission
disease in the world
 Schistosoma worms - Biological Vectors
and entreroviruses
are shed in feces,
enter through GI
mucous or skin and
cause disease in body
- Foodborne transmission
 Inadequately
processed,
undercooked, poorly
pasteurized milk or
poorly refrigerated
foods
 Foods can be
contaminated with
normal microbiota (E.
Coli and S. Aureus),
zoonotic pathogens
(Mycobacterium bovis
and Taxoplasma) and
parasitic worms that
alternate between
humans and animals
 Hepatitis A –
contamination of
food with feces is an
example of fecal-oral
transmission
 Pathogens in blood,
urine, saliva, and
other fluids
 AIDS, hepatitis,
herpes
 Transmits pathogens
and serves as hosts
for multiplying
pathogens
 Biting arthropods
(mosquito, ticks, lies,
fleas, bloodsucking
 flies and bugs & Classification of Infectious Diseases
mites)
Infection/Disease Definition
 After pathogens Acute Disease  Symptoms develop
replicate often in its rapidly and lasts short
gut/salivary glands, it time
enters new host  Ex. Common cold
through bite Chronic Disease  Develop slowly,
 Bite site becomes continual or recurrent
contaminated with and with mild
symptoms
vector’s feces or bites
 Ex. Infectious
directly introducing mononucleosis,
pathogens in new hepatitis C, TB &
host leprosy
Subacute disease  Disease with time
course and symptoms
- Mechanical Vectors between acute and
 Passively carry chronic
 Ex. Subacute bacterial
pathogens to new
endocarditis
hosts on their feet/ Latent Disease  Appears long time after
other body parts infection
 Houseflies and  Ex. Herpes
Communicable  Transmitted one host
cockroaches has
Disease from another
Salmonella and  Ex. Influenza, herpes &
Shigella into drinking TB
water and food onto Contagious Disease  Communicable disease
easily spread
skin
 Ex. Chicken pox and
measles
Non-communicable  Arise from outside
Disease hosts/normal
microbiota/opportunist
ic pathogen
 Ex. Tooth decay, acne,
and tetanus
Asymptomatic  No symptoms
Disease
Local Infection  Infection confined to
small region of body
Systematic Infection  Widespread infection in
many body systems
 Often in lymph or blood
Focal Infection  Source of pathogens of
infections at other sites
in body
Primary Infection  Intial infection within a
given patient
Secondary Infection  Follows a primary
infection
 Often by opportunistic
pathogen
Epidemiology of Infectious Diseases
Frequency of Disease
 Epidemiologists tracks occurrence of
diseases using 2 measures:
 Incidence – number of new
cases of disease in a given
population, area and time
 Prevalence – total or
cumulative number of cases
both new and existing
 Endemic – disease that normally
occurs continually at a stable
incidence within given population or
geographical area
 Sporadic – few scattered cases
 Epidemic – greater frequency than
usual
 Pandemic – an epidemic that occurs
simultaneously on more than 1
continent
Epidemiological Studies
3 APPROACHES:
 Descriptive Epidemiology
 Tabulation of data
concerning a disease
 Includes location and time of
cases, info about patients
 Strives to identify index case
(1st case) of disease
 1st descriptive epidemiology
study was:
 By John Snow
 1813-1858
 Cholera Outbreak in
London (1854)
 Analytical Epidemiology
 Detailed investigation of a
disease
 Includes analysis of data,
probable cause, mode of
transmission & possible
preventions
 Retrospective – attempts to
identify cause and mode of
transmission after outbreak
has occurred
 Experimental Epidemiology
 Hypothesis testing of a
disease
 Application of Koch’s
postulates
 Includes testing analytical
study results, efficacy
preventive measures or
treatment
 Example: Chlamydophila
pneumonia may contribute
to arteriosclerosis, resulting
to heart attacks
 Hospital Epidemiology:
Healthcare Associated
(Nosocomial) Infections
 Healthcare associated
infections (HAIs) or
nosocomial infections –
infections acquired by
patients or health workers
while they are in health care
facilities
TYPES OF HEALTHCARE
ASSOCIATED INFECTIONS:
 Exogenous HAIs – caused by
pathogens acquired from health
care environment
 Endogenous HAIs – arise from
normal microbiota within health
care setting
 Iatrogenic infections – doctor-
induced” infections; direct result of
modern medical prcoedures
 Superinfections – result from the use
of antimicrobial drugs by inhibiting
resident microbiota to allow others
to thrive in the abscene of
competition
 Transmission of pathogens
among patients and health
workers
CONTROL OF HEALTHCARE
ASSOCIATED INFECTIONS:
 Health care workers can help
protect their patients and
themselves from exposure to
pathogens by hand washing
and other aseptic and
disinfecting techniques
 World Health Organization
(WHO), use epidemiological
data to promulgate rules and
standards for clean, potable
water and safe food, to
prevent disease by
controlling vectors and
animal reservoirs, and to
educate people to make
healthy choices concerning
the prevention of disease

FACTORS INFLUENCING
HEALTHCARE ASSOCIATED
INFECTIONS:

 Exposure to numerous
pathogens in healthcare
setting
 Weakened immune system
of patients