MICROBIAL

ASSOCIATIONS/INTERACTIO
NS
Nanette Ramilo-Cruz, MD, DPAFP
 Case
After typhoon Ondoy, several Metro Manila
residents were temporarily sheltered in
evacuation centers for safety. However, after
2 weeks in the shelter, many of the evacuees
exhibited diarrhea, many of the children also
had fever, maculopapular rash and cough.

Diagnosis of Disease?
What factors contributed to the development of these diseases?
 Objectives
• Define the different types of host-parasite
relationships
• Define the terms used to describe the
attributes of infectious agents
• Describe the different types of hosts.
• Describe the different types of parasites
• Enumerate some attributes of
microorganisms which help them in
producing damage/disease to the host
 Objectives
• Define immunity and describe the two types
of immunity
• Discuss the non-specific defenses of the
human host.
 Global Burden of Infectious Diseases
• Communicable or infectious disease continue
to remain a leading cause of morbidity,
disability and mortality worldwide.
• Rich countries: 1/10 deaths Poorer countries:
6/10 deaths
• 2 M deaths annually from diarrhea
• 4 M die annually of LRTI
• 700,000 die from measles annually
• 2 M die from TB, 90% from developing
countries
Epidemiology of Infectious Diseases
Host
 The Human Host
• Constant exposure to microbes
• Normal Flora
• Microbes living in and on body
Transient—temporary
Resident—always present
• Come into world sterile
Exposed areas acquire flora
closed areas remain sterile
 Human Host
• Skin
GPB, GPC, Staph. Corynebacterium,
Propionibacterium
• Alimentary tract
Mouth—everything—Streptococcus
Large intestine—anaerobic GNB
Bacteriodes, coliforms
Stomach and small intestine—almost no bacteria
 Human Host
• Respiratory Tract
Upper—normal throat flora
Lower—considered sterile
• Genitourinary Tract
Vagina—changes with age
Menstruating—Lactobacillus
Non-menstruating—Skin flora
Urethra—normal skin flora and
sometimes coliforms
 Human Host
• Sterile areas
Body cavities with serous membranes—
thoracic, abdominal, joint, pericardium
Closed organs in those body cavities
Blood, CSF, Urine
 Infectious Disease Process

Etiologic Agent

Reservoir

Portal of exit Mode of transmission Portal of Exit

Susceptible Host
 Types of Host
• Reservoir
• Carrier
• Vector
• Sources
 Reservoir
• A living organism or inanimate matter in which an
infectious agent normally lives and multiplies.
• The infectious agent depends on the reservoir
primarily for survival and reproduces itself in such a
manner that it can be transmitted to a susceptible
host
• May be:
– Physical environment: contaminated water supply
– Animals (insect vectors)
– Other humans (AIDS, HepB)
• Zoonoses: infectious diseases that have
vertebrate animal reservoirs; they are
potentially transmissible to humans under
natural conditions

• Carrier: any person or animal that harbors a

particular infectious agent without discernible
clinical disease and serves as a potential
source of infection
 Humans As Carriers

• Type of Carrier Example

• Inapparent throughout Polio, meningitis, hepatitis

• Incubatory Chickenpox, measles, hepatitis

• Convalescent Diphtheria, Hep B, Salmonella,

Cholera
• Chronic Typhoid fever, Hep B
Transmission
Infection
The entry, development or multiplication of an infectious
agent in the body tissues of man

Infectious disease
a clinically manifest disease of man resulting from an infection

Communicable Disease
an illness due to a specific infectious agent or its toxic
products that arises through transmission from a reservoir to
a susceptible host either directly or indirectly
Incubation Period
the time interval between initial contact with an
infectious agent and the first appearance of
symptoms associated with the infection

Communicable Period
the time during which an infectious agent may be
transferred from an infected host/reservoir to
another susceptible host
 Portal of Entry
• Breaks in skin and mucous membranes
• Natural openings
GI, respiratory, GU tracts
• Cross placenta—STORCH
Syphilis
Toxoplasma
Others (HepB, HIV)
Rubella
 Portals of Exit
• Secretions,
• excretions,
• discharges,
• sloughed tissue
 Gradient of Infection
• Ranges from subclinical infection to severe clinical
disease or even death
• Inapparent Infection
– Infection in a host without recognizable clinical signs or
symptoms
– Identifiable only by laboratory means
• Severe Disease
– High rate of severe clinical manifestations
– High case fatality rate (CFR)
– High proportion of surviving patients with sequelae
– Serious problem from a public health standpoint where
the disease causes excess mortality
• The host after exposure to the agent may progress from
subclinical (inapparent) infection to a clinical case of the
disease
• The end result may be complete recovery, permanent
disability, disfigurement or death
• Degree of infection and disease severity depends on the
defense mechanisms (immunity) of the host
• Immunity refers to the resistance of the host to a disease
agent
 Patterns of Infection
• Local infection: Confined to specific site or
tissue
• Systemic infection: Spreads to several sites or
tissues
• Focal infection: Local infection that could
spread
Head infections—blood supply
Toxemia
 Patterns of Infection
• Mixed infection—polymicrobial, More than
one organism involved. Ex: Dental caries
Organisms may show synergism
• Primary infection: Initial infection
• Secondary infection: Complicates primary
infection: Opportunist
 Patterns of Infection
• Acute infection
Rapid, severe, short-lived
• Chronic infection
Persistent, slow progress
• Subacute infection
Onset less rapid than acute
Less persistent than chronic
 Acquisition of Disease
• Direct Transmission: skin or mucous membrane
contact
• between hosts: crossing placenta
• Indirect Transmission
Vectors—living animal
Fomites—inanimate objects
Vehicle—inanimate material
Droplet nuclei
Aerosols (fine dust, moisture)
 Nosocomial Infection
• Result of stay in hospital or longterm
care medical facility
• AKA—hospital acquired infections
• Average—5% of patients
AGENT
 The Infectious Agent
The Types of Infectious Agents
A. Bacteria: TB, Shigellosis
B. Viruses and Rickettsia: AIDS, Hepatitis
C. Fungi: candidiasis, athlete’s foot
D. Protozoans: amoebiasis, giardiasis
E. Helminths: schistosomiasis, ascariasis
 Infectious Agent
Intrinsic Properties
- properties of infectious agents that do not need
any interaction with host
- understanding a particular intrinsic property may
be essential to understanding an agent’s
epidemiology, including its mode of transmission
- strains or isolates of a particular agent from
different outbreaks, different geographic areas at
different times may vary significantly in these
intrinsic properties.
 Properties related to host-agent
interactions

a) Infectivity
b) Immunogenicity
c) Pathogenicity
d) Virulence
e) Toxigenicity
f) Resistance
 Infectivity

• The ability of an agent to enter and multiply in a

susceptible host and produce infection
• Can only be inferred by: the ease of spread in a
population
• High infectivity: Polio
 Infectivity
• Infectious Dose (ID)
Minimum number of organisms required to
cause disease
• Varies from organism to organism
10 for M. tuberculosis
1000 for N. gonorrhoeae
• Less than ID—no disease
• More than ID—may get more rapid onset
 Infectivity
Binding to Host (Adhesion)
• Bacteria: fimbriae, flagella
• Viruses: receptors
• Protozoa: organelles for locomotion
• Helminths: hooks and suckers
 Immunogenicity

• Infection’s ability to produce specific

immunity in the host e.g. measles
• Measured by serologic surveys
• Depends on:
– Amount of antigen formed in the host
– Agent’s ability to induce lifelong immunity
 Pathogenicity

• Ability to produce clinically apparent illness in

an infected population
• High Pathogenicity: measles
• Pathogenicity = # of infected persons w/ disease
Total number of infected persons
 Virulence

• The extent to which severe disease is

produced in a population with clinically
manifest disease
• Highly Virulent: rabies
• Measures:
– (CFR) Case Fatality Rate
– Proportion of Severe Cases
 Toxigenicity

• Capacity of an agent to produce a toxin or

poison
• Disease results from the toxin produced by
the agent rather than from the agent itself
 Diseases According to Agent-related
properties
Degree Infectivity Pathogenicity Virulence

Measles, Rabies, Measles,

Chickenpox, Polio, Chickenpox, Rabies, TB,
High Smallpox Smallpox, Common Leprosy, Smallpox
colds

Mumps, Rubella,
Intermediate Rubella, Mumps Poliomyelitis
Common colds

Polio
Low TB Measles
TB

Chicken pox,
Very Low Leprosy Leprosy Rubella, Common
colds
 Host-parasite Relationship
• Neutralism: 2 populations of Microbes found
in a microecosystem w/o affecting one
another; do not compete for nutrients
• Mutualism/Symbiosis: Each organism
benefits from the association
Syntrophism: Lactobacillus arabinosus and
Streptococcus faecalis
 Host-parasite Relationship
• Commensalism: 1 microbe benefits from the
association but the other is not affected
ex: Staphylococcus aureus and Haemophilus
influenzae
• Antagonism: A microbe adversely affects the
environment of another microbe
ex: 1. Penicillum notatum vs. gram + cocci and
bacilli
2. Lactobacillus casie (lactosin) vs. V.
cholerae, Salmonella and Shigella
 Host-parasite Relationship
• Parasitism: 1 microbe lives in or on another
microbe(host) w/c is commonly harmed
ex: vibriophage vs. Vibrio
Bedellovibrio bacteriovulus vs. E.coli

• Predation: 1 microbe ingests another microbe

ex: Zooplankton feed on smaller algae and
fungi
Immunity
 Types of Immunity
• Non-specific Immunity
• Specific Immunity
Humoral
Cell-mediated
 Immunity to Microbes
Criterion Description of
Immunity
Presence in the Host Innate Acquired

Targets of Action Non Specific

specific
Location and Nature of Defense Factors

Criterion Non specific Innate Specific Acquired

Immunity Immunity

Location of Local Systemic Local Systemic

Defense
Factors
Nature of Structural Humoral Humoral Humoral
Defense barriers, or or or
Factors Physiologic Molecular Molecular Molecular
Factors, factors, factors, factors,
Chemical, cellular cellular cellular
Cellular factors factors factors
Disease-Specific Defense Mechanisms (Humoral
Immunity)
• Natural, active immunity
– An infection induces an immune response
• Artificial, active
– Vaccination stimulates antibody production
• Natural, passive
– Maternal antibodies
• Artificial, passive
– Preformed antibodies administered to an
individual as a means of prophylaxis
Questions?
 Case
After typhoon Ondoy, several Metro Manila
residents were temporarily sheltered in
evacuation centers for safety. However, after
2 weeks in the shelter, many of the evacuees
exhibited diarrhea, many of the children also
had fever, maculopapular rash and cough.

Diagnosis of Disease?
What factors contributed to the development of these diseases
(Agent, Transmission, Host)?