Principle of

infectious disease
Definitions
• Disease – a pathological condition of body parts or
tissues characterized by an identifiable group of signs
and symptoms.
• Infectious disease – disease caused by an
infectious agent such as a bacterium, virus,
protozoan, or fungus that can be passed on to others.
• Infection – occurs when an infectious agent enters
the body and begins to reproduce; may or may not
lead to disease.
• Pathogen – an infectious agent that causes disease.
• Host – an organism infected by another organism.
Koch’s Postulates
Koch developed four criteria to demon-
strate that a specific disease is caused by
a particular agent.
1. The specific agent must be associated
with every case of the disease.
2. The agent must be isolated from a diseased
host and grown in culture.
3. When the culture-grown agent is introduced
into a healthy susceptible host, the agent must
cause the same disease.
4. The same agent must again be isolated from
the infected experimental host.
 Infection chain

transmission
Etiologic
Host
agent • direct contact
• Age
• Infectivity • indirect contact
• Sex
• Pathogenicity • vector
• Genotype
• Virulence
• Behaviour
• Immunogenicity
• Nutritional status
• Antigenic stability
• immunity status
• Survival
Infectious Disease
Agents
• Most infectious agents that cause disease are
microscopic in size  microbes or microorganisms.
• Different groups of agents that cause disease are:
– Bacteria
– Viruses
– Protozoa (Protists)
– Fungi
– Helminths (Animals)
Agent
Pathogenicity and Virulence
– Pathogenicity
• The ability of a microbe to cause
disease
• This term is often used to describe or
compare species
– Virulence
• The degree of pathogenicity in a
microorganism
• This term is often used to describe or
compare strains within a species
Agent
Normal human microbiota (flora)
Location Microflora Abundance
Dry skin Gram positive anaerobes 102
Moist skin Staphylococcus, corynebacteria 10 6-7
(axilla, groin)
Oropharynx Anaerobes, streptococcus, 109
neisseria, candida
Small intestine Anaerobes, lactobacillus, 105-9
peptostreptococcus
Large intestine Anaerobes, clostridium, 106-11
bacteriodes, enterobacteria,
enterococcus, protozoa
Vagina Anaerobes, lactobacillus, 108-9
candida
Transmission
Factors Influencing Disease
Agent Environment
• Weather
• Infectivity
• Housing
• Pathogenicity
• Geography
• Virulence
• Occupational
• Immunogenicity
• Air quality
• Antigenic stability
• Food
• Survival Host
• Age
• Sex
• Genotype
• Behaviour
• Nutritional status
• Health status
Transmission
Transmission
• Reservoirs
– A host that carries a pathogen without injury to itself
and serves as a source of infection for other host
organism
– (asymptomatic infective carriers)
– Humans {hepatitis}, Other Vertebrates {zoonoses},
Birds & Bats {histoplasmosis}
• Vectors
– A host that carries a pathogen without injury to itself
and spreads the pathogen to susceptible organisms
– (asymptomatic carriers of pathogens)
– Mosquitoes: (Arbovirus, malaria), Dog (rabies)
Pathogenesis:
How Infectious Agents Cause Disease

• Production of poisons
– such as toxins and enzymes, that
destroy cells and tissues.
• Direct invasion and destruction of host
cells.
• Triggering responses from the host’s
immune system leading to disease signs
and symptoms.
Inflammation
• Calor
• Rubor
• Dolor
• tumor
• Functiolaesa

Robin Cochran-Dirksen (Many

slides from BioEdOnline Baylor
Phases of Infectious Disease
• Incubation period – time between infection and
the appearance of signs and symptoms.
• Prodromal phase – mild, nonspecific symptoms
that signal onset of some diseases.
• Clinical phase – a person experiences typical
signs and symptoms of disease.
• Decline phase - subsidence of symptoms.
• Recovery phase – symptoms have
disappeared, tissues heal, and the body regains
strength.
Timeline for Infection

Dynamics of Latent Infectious Non-infectious

infectiousness period period

Susceptible
Time

Dynamics of Incubation Symptomatic Non-diseased

disease period period

Susceptible
Time
Classification of Infectious Disease
• By duration
– Acute – develops and runs its course quickly.
– Chronic – develops more slowly and is usually less severe, but
may persist for a long, indefinite period of time.
– Latent – characterized by periods of no symptoms between
outbreaks of illness.
• By location
– Local – confined to a specific area of the body.
– Systemic – a generalized illness that infects most of the body
with pathogens distributed widely in tissues.
• By timing
– Primary – initial infection in a previously healthy person.
– Secondary – infection that occurs in a person weakened by a
primary infection.
Classification of Infectious Disease
• By symptoms
– Clinical Infection : infection with obvious observable or
detectable symptoms
– Subclinical Infection: infection with few or no obvious symptoms
• Opportunistic infection
– An infection caused by microorganisms that are commonly found
in the host’s environment This term is often used to refer to
infections caused by organisms in the normal flora
 Sepsis:
the continuum

Increasing Inflammation
High Risk Infection SEPSIS Septic Shock MOF
Of Infection

Wheeler AP, NEJM 340:207-14

Working definitions associated with
sepsis and related disorders
• Bacteremia: bacteria present in the blood, as
confirmed by culture, may be transient or associated with
sepsis and organ failure
• SIRS (systemic inflammatory response syndrome)
Manifested by 2 or more of the following:
– Temperature : > 38 0C or < 360C
– HR : > 90 BPM
– RR : > 20 breaths/min or arterial C0 2 tension < 32 mmHg
– WBC : > 12.000 cell/ml or < 4.000 cell/ml or > 10 %
immature forms
• Sepsis
– SIRS plus a documented infection
Working definitions associated with
sepsis and related disorders
• Severe sepsis: Sepsis with associated organ disfunction
with one or more of the following:
– Hypotension
– Confussion
– Oliguria
– Hipoxia
– metabolic acidosis
– DIC
– Hepatic dysfunction
• Septic shock: severe sepsis plus hypotension despite
adequate fluid resuscitation
• MODS: multiple Organ Dysfunction syndrome
– More than one mayor system failure
DIAGNOSIS
• Clinical
– Complete patient history (subjective)
– Physical examination (objective)
• Case definition and surveilans syndromic
• Clinical diagnosis: lab tests
– Detect causative organism in clinical specimens
– Immune response
• Detect and assay antibodies
• Detect and assay other specific immune responses
– Detect other specific factors associated with infection
• Radiologic
– Detect location of infection
Laboratory Investigation of Microbial
infections
Examining specimens to detect isolate and identify
pathogens:
1- Microscopy
2- Culture techniques
3- Biochemical reactions
4- Serological identification:
5- Molecular biology techniques
6- Bacteriophage typing
General Management Principles
• Focus on life-threatening conditions.
• Use general precautions.
• Anti-infective drugs
• Supportive treatment
• Prevention
Treatment principle of sepsis
Prevention
strategies that prevent development of diseases or interrupt
progression of disease

Primary Prevention
• Preventing disease before it occurs.
• reduce exposure or susceptibility
• Intended to REDUCE DISEASE INCIDENCE.
• Addresses HEALTH through health promotion
and specific disease protection among
COMMUNITIES and RISK GROUPS.
• Primary responsibility of PUBLIC HEALTH.
Secondary Prevention
• Identifying and treating disease before it
becomes symptomatic and causes
dysfunction.
• early detection and treatment, reduce risk
• Intended to REDUCE DISEASE PREVALENCE.
• Addresses ILLNESS through early case finding
and treatment among INDIVIDUALS.
• Responsibility of PUBLIC HEALTH and
MEDICAL CARE PROVIDERS.
Tertiary Prevention
• Preventing disease progression and
suffering after a diagnosis is established;
treatment and rehabilitation
• Intended to REDUCE DISEASE
COMPLICATIONS and DISABILITY.
• Addresses ILLNESS through rehabilitation and
limiting disability for INDIVIDUALS.
• Responsibility of MEDICAL and LONG TERM
CARE PROVIDERS.
Emerging Infectious Diseases

• Emerging diseases are those that have recently

appeared within a population, or whose incidence or
geographic range is increasing rapidly.
• Diseases can emerge or re-emerge due to:
– appearance of a previously unknown agent.
– evolution of a new infectious agent.
– spread of an infectious agent to a new host.
– spread of an infectious agent to new locations.
– acquisition of resistance to anti-microbial drugs.
– deliberate introduction into a population.
History: newly emerging infectious
disease
1976 Ebola virus (haemorrhagic fever)
1980 HTLV-1 (T-cell lymphoma or leukemia)
1983 HIV (AIDS)
Helicobacter pylori
1988 HHV-6 (Roseola subitum)
Hepatitis E Virus
1989 Hepatitis C virus
1995 KSHV (HHV-8) (kaposi sarcoma)
2002 West nile virus (encephalitis)
2003 SARS Coronavirus
2005 Avian influenza
2009 Influenza H1N1 2009 (Swine Flu)
2012 MERS CoV
Basic concepts in infectious disease
emergence

• Emergence of infectious diseases is complex.

• Infectious diseases are dynamic.
• Most new infections are not caused by genuinely new pathogens.
• Agents involved in new and reemergent infections cross taxonomic
lines to include viruses, bacteria, fungi, protozoa, and helminths.
• The concept of the microbe as the cause of disease is inadequate
and incomplete.
• Human activities are the most potent factors driving disease
emergence.
• Social, economic, political, climatic, technologic, and environmental
factors shape disease patterns and influence emergence.
• Understanding and responding to disease emergence require a
global perspective, conceptually and geographically.
• The current global situation favors disease emergence.
Robin Cochran-Dirksen (Many
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What is carried by humans into new
regions?

• Pathogens in or on body
• Microbiologic flora
• Vectors on body
• Immunologic sequelae of past infections
• Vulnerability to infections
• Genetic makeup
• Cultural preferences, customs, behavioral
• patterns, technology
• Luggage and whatever it contain
Robin Cochran-Dirksen (Many
slides from BioEdOnline Baylor
Terimakasih

Robin Cochran-Dirksen (Many

slides from BioEdOnline Baylor