INFECTION

Definition, Classification, Source, Click to edit Master subtitle style Mode of transmission and types of Infectious disease

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PARASITISM

all organisms living in or on the bodies of other organisms and drawing their sustenance from them are considered to be parasites.

In medical terminology, parasites include intestinal worms and organisms causing malaria, kala azar or amoebic dysentery whereas bacteria and viruses do not find mention as parasites.
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Predators are organisms that hunt, catch and kill other organisms before eating them, Parasites do not hunt, catch and kill their prey before eating it, rather they eat it while it continues to live. Saprophytes, on the other hand, neither feed on the still living nor kill before eating.
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Symbiosis : Any relationship in which two organisms live together in an intimate association is considered to be symbiosis.

mutualistic if both members of the pair benefit, commensal if one benefits and the host is not harmed, or

parasitic if the organism benefits and the host is harmed to a greater or lesser 5/23/12 44

Contamination

The presence of an infectious agent on a body surface; also on or in clothes, beddings, toys, surgical instruments or dressings, or other inanimate articles or substances including water, milk and food. Pollution is distinct from contamination and implies the presence of offensive, but not necessarily infectious matter in the 5/23/12 55 environment.

Infestation

For persons or animals the lodgment, development and reproduction of arthropods on the surface of the body or in the clothing, e.g., lice, itch mite. It also describe invasion of the gut by parasitic worms, e.g., ascariasis. Infested articles or premises are those which harbour or give shelter 5/23/12 66 to animal forms, especially

Host

A person or other animal, including birds and arthropods, that affords subsistence or lodgment to an infectious agent under natural (as opposed to experimental) conditions.

An obligate host means the only host, e.g., man in measles and typhoid fever. Hosts in which the parasite attains maturity or passes its sexual stage are primary or definitive hosts; in which the parasite is77 a larval in

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Infection

The entry and development or multiplication of an infectious agent in the body of man or animals. It also implies that the body responds in some way to defend itself against the invader, either in the form of an immune response (evidence of this may not be readily available) or disease.
88 An infection does not always cause

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Levels of infection:

colonization (e.g., S.aureus in skin and normal nasopharynx); subclinical or inapparent infection (e.g., polio); latent infection (e.g., herpes simplex); and virus of

manifest or clinical infection.

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Infectious disease: A clinically manifest disease of man or animals resulting from an infection . Contagious disease : A disease that is transmitted through contact. Examples include scabies, trachoma, STD and leprosy. Communicable disease : An illness due to a specific infectious agent or its toxic products capable of being directly or indirectly transmitted from man to man, animal to animal, or 5/23/12 1010

Epidemic

(Epi = upon; demos = people). The "unusual" occurrence in a community or region of disease, specific health-related behavior (e.g., smoking) or other health-related events (e.g., traffic accidents) clearly in excess of "expected occurrence". the term "outbreak" use for a small, usually localized epidemic in the 5/23/12 1111 interest of minimizing public alarm,

Endemic

(En = in; demos = people). It refers to the constant presence of a disease or infectious agent within a given geographic area or population group, without importation from outside; may also refer to the "usual" or expected frequency of the disease within such area or population group.
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Hyperendemic: the disease is constantly present at a high incidence and/or prevalence rate and affects all age groups equally; and Holoendemic: a high level of infection beginning early in life and affecting most of the child population, leading to a state of equilibrium such that the adult population shows evidence of the disease much less commonly than do the children, e.g. malaria
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Sporadic

The word sporadic means scattered about. The cases occur irregularly, haphazardly from time to time, and generally infrequently. A sporadic disease may be the starting point of an epidemic when conditions are favourable for its spread. Many zoonotic diseases are characterised by sporadic 5/23/12 1414 transmission to man

Pandemic

An epidemic usually affecting a large proportion of the population , occurring over a wide geographic area such as a section of a nation, the entire nation, a continent or the world .

e.g., influenza pandemics of 1918 and 1957, cholera el tor in 1962

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Exotic

Diseases which are imported into a country in which they do not otherwise occur, as for example, rabies in UK.

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Zoonosis

An infection or infectious disease transmissible under natural conditions from vertebrate animals to man. May be enzootic (endemic in animals) or epizootic (epidemics in animals)

e.g., rabies, plague, bovine tuberculosis, anthrax, brucellosis, salmonellosis, endemic typhus.
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(a) anthropozoonoses : that is, infections transmitted to man from vertebrate animals,

e.g., rabies, plague, hydatid disease, anthrax and echinosis;

(b) zooanthroponoses: that is, infections transmitted from man to vertebrate animals,

e.g., human tuberculosis in cattle; and

(c) amphixenoses : that is infections maintained in both man and lower vertebrate animals that may be 5/23/12 1818 transmitted in either direction,

Nosocomial infection

Nosocomial (hospital acquired) infection is an infection originating in a patient while in a hospital or other health care facility. It denotes a new disorder (unrelated to the patient's primary condition) associated with being in a hospital . It includes infections acquired in the hospital but appearing after discharge, and also such infections 5/23/12 1919

Opportunistic infection

This is infection by an organism(s) that takes the opportunity provided by a defect in host defense to infect the host and hence cause disease. Infection by an organism that is not normally pathogenic, but can cause disease if resistance is lowered.
e.g., Herpes simplex, Cytomegalovirus, Toxoplasma, M. tuberculosis, M. avium intracellulare, pneumocystis, etc. 5/23/12 2020

Iatrogenic (physicianinduced) disease

Any untoward or adverse consequence of a preventive, diagnostic or therapeutic regimen or procedure, that causes impairment, handicap, disability or death resulting from a physicians professional activity or from the professional activity of other health professionals .
e.g., reactions to penicillin and 5/23/12 2121 immunizing agents, aplastic anaemia

Surveillance

The continuous scrutiny of the factors that determine the occurrence and distribution of disease and other conditions of ill health. Surveillance also connotes exercise of continuous scrutiny of health indices, nutritional status, environmental hazards, health practices and other factors 2222 may that 5/23/12

Eradication

Eradication is an absolute process, an "all or none" phenomenon, restricted to termination of an infection from the whole world. The term elimination is sometimes used to describe "eradication of disease (e.g., measles) from a large geographic region or political jurisdiction .
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Infection and Disease

Infection is the invasion or colonization of the body by pathogenic microorganisms. Disease occurs when an infection results in any change from a state of health. microbes capable of causing infections that result in disease are called pathogens.
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Degree of pathogenicity of a

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When microorganisms first associate with a host, the host is said to be contaminated. If the microbes establish themselves and grow and multiply for a period of time the host is said to be infected and if the infection causes the damage, the host is said to have an infectious disease.
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Type of pathogens

Obligate pathogens: The organism cause disease in human beings in order to continue to survive and propagate. eg. Viruses, M. tuberculosis. Accidental or incidental pathogens: Did not require for survival;
Natural habitat in man but cause disease in only a small minority; bacterial pharyngitis ( S. pyogens), 5/23/12 2626

Capabilities of a pathogen

Maintain a reservoir Transmission from reservoir to host Adhere to the surface of host Invade the body of the host Evade the body defense Multiply within the body Transmission from host to reservoir or another host. 5/23/12 2727

STEPS FOR INFECTIOUS MICROORGANISM

Steps
Attachment/entry into body Local or general spread in body Multiplication Evasion of host defenses Exit from body Cause damage in host
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Phenomenon
Infection Spread Multiplication Microbial answer to host defenses Transmission Pathology, disease
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DYNAMICS OF DISEASE TRANSMISSION

Communicable diseases are transmitted from the reservoir/source of infection to susceptible host.
reservoi r/ source
MODES OF TRANSMISSION SUSCEPTI BLE HOST

Chain of Infection
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The source of infection is defined as the person, animal, object or substance from which an infectious agent passes or is disseminated to the host. A reservoir is defined as any person, animal, arthropod, plant, soil or substance (or combination of these) in which an infectious agent lives and multiplies, on which it depends 5/23/12 primarily for survival, and 3030 where it

Source, Reservoir & Carrier

A carrier is defined as an infected person or animal that harbours a specific infectious agent in the absence of overt clinical signs and serves as a potential source of infection for others. The term "source" refers to the immediate source of infection and may or may not be a part of reservoir.
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Homologous reservoir is applied when another member of the same species is the victim, as for example man is the principal reservoir for some enteric pathogens, e.g., vibrio cholerae. Heterologous reservoir is applied when the infection is derived from a reservoir other than man, as for example animals and birds infected with salmonella.
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The reservoir may be of three types:

Animal reservoir, Human reservoir, and Reservoir in non-living things or Environmental reservoirs

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Animal reservoir

There are over 100 zoonotic diseases which may be conveyed to man from animals and birds. e.g., rabies, yellow fever and influenza.

There is evidence that genetic recombination between animal and human viruses might produce "new" strains of viruses (e.g., 5/23/12 3434

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Human reservoir

the most important source or reservoir of infection for humans is man himself. He may be a case or carrier.

Cases: a person in the population or study group identified as having the particular disease, health disorder or condition under investigation.

Carriers: an infected person or animal that harbours a specific infectious agent 5/23/12 the absence of discernible clinical 3636 in

Cases

The clinical illness (may be mild or moderate, typical or atypical, severe or fatal) mild cases may be more important sources of infection than severe cases. The subclinical cases ( inapparent, covert, missed or abortive cases): the disease agent may multiply in the host but does not manifest itself by signs and symptoms. The disease 5/23/12 3737 agent is, eliminated and

Primary case :the first case of a communicable disease introduced into the population unit being studied. Index case: the first case to come to the attention of the investigator; it is not always the primary case. Secondary cases : the case those developing from contact with primary 5/23/12 3838 case.

Carriers

The elements in a carrier state are:

(a) the presence in the body of the disease agent (b) the absence of recognizable symptoms and signs of disease, and

(c) the shedding of the disease agent in the discharges or 5/23/12 excretions, thus acting as 3939 a source

classes of carriers A. By Type

(a) INCUBATORY CARRIERS: Incubatory carriers are those who shed the infectious agent during the incubation period of disease. e.g., measles, mumps, polio, pertussis, influenza, diphtheria and hepatitis B. (b) CONVALESCENT CARRIERS: That is those who continue to shed the disease agent during the period of convalescence, e.g., typhoid fever, 5/23/12 4040

(c) HEALTHY CARRIERS: Healthy carriers emerge from subclinical cases. They are victims of subclinical infection who have developed carrier state without suffering from overt disease, but are nevertheless shedding the disease agent, e.g., poliomyelitis, cholera, meningococcal meningitis, salmonellosis, and diphtheria.
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Contact carrier: A person can become a contact carrier when he acquires the microorganism due to his contact with the patient. Paradoxical carrier: A person is a paradoxical carrier when he acquires the microorganism from another carrier.

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genetic carrier: One whose chromosomes contain a pathological gene that may be transmitted to offspring. In some cases (e.g., TaySachs disease) this condition can be detected prenatally by a laboratory test done on amniotic fluid. active carrier : One who harbors a pathogenic organism for a clinically significant time and is able to pass 5/23/12 4343

B. By Duration

(a) TEMPORARY CARRIERS : Temporary carriers are those who shed the infectious agent for short periods of time. In this category may be included the incubatory, convalescent and healthy carriers. (b) CHRONIC CARRIERS: A chronic carrier is one who excretes the infectious agent for indefinite periods. Chronic carrier state occurs in a number of diseases, e.g., typhoid 5/23/12 4444

(c) PSEUDO-CARRIERS: carriers of avirulent organisms are called pseudo-carriers. pseudo-carriers are not important epidemiologically. Intermittent carrier: One who harbors an infectious organism (e.g., methicillin-resistant Staphylococcus aureus in the nasal passages) from time to time, but not continuously.
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C. By Portal of Exit

Carriers may also be classified according to the portal of exit of the infectious agent. Thus we have urinary carriers, intestinal carriers, respiratory carriers, nasal carriers, etc. Skin eruptions, open wounds and blood are also portals of exit. the portal of exit and the 5/23/12 4646 occupational status of the carrier are

MODES OF TRANSMISSION

Communicable diseases may be transmitted from the reservoir or source of infection to a susceptible individual in many different ways, depending upon the infectious agent, portal of entry and the local ecological conditions.

transmission one route, e.g., typhoid fever by vehicle transmission and common cold by direct contact. multiple transmission route, e.g., 4747

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classification

DIRECT TRANSMISSION

1. Direct contact 2. Droplet infection 3. Contact with soil 4. Inoculation into skin or mucosa 5. Transplacental (vertical)

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INDIRECT TRANSMISSION

1. Vehicle-borne 2. Vector-borne

a. Mechanical b. Biological

3. Air-borne

a. Droplet nuclei b. Dust

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Fomite-borne

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Direct transmission

Direct contact implies direct and essentially immediate transfer of infectious agents from the reservoir or source to a susceptible individual, without an intermediate agency, e.g., skin-to-skin contact as by touching, kissing or sexual intercourse or continued close contact.
Direct contact not only reduces the period for which the organism will have to survive outside the human host but 5/23/12 5050 also ensures a larger dose of infection.

Droplet infection : This is direct projection of a spray of droplets of saliva and nasopharyngeal secretions during coughing, sneezing, or speaking and spitting, talking in to the surrounding atmosphere. Particles 5 m or less can penetrate deeply and reach the alveoli. The droplet spread is usually, limited to a distance of 30-60 cm between source and host.
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e.g.,

many

respiratory

5151 infections,

Contact with soil : The disease agent may be acquired by direct exposure of susceptible tissue to the disease agent in soil, compost or decaying vegetable matter in which it normally leads a saprophytic existence . e.g., hookworm mycosis etc.
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larvae,

tetanus,

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Inoculation into skin or mucosa: The disease agent may be inoculated directly in to the skin or mucosa. e.g., rabies virus by dog bite, hepatitis B virus through contaminated needles and syringes etc.

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Transplacental (or vertical) transmission : Disease agents can be transmitted transplacentally. This is another form of direct transmission.

e.g., TORCH agents (Toxoplasma gondii, rubella virus, cytomegalovirus and herpes virus), varicella virus, syphilis, hepatitis B, Coxsackie B and AIDS. Some of the non-living agents (e.g., thalidomide, diethylstilbestrol). disease agent
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Contact transmission

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(a) prenatal- placenta (rubella, syphilis)

(b) perinatal - infected birth canal (gonococcal, HBV)

(c) postnatal - milk/ direct contact (HIV, Cytomegalovirus) (d) germ line - viral DNA in Hu. Genome ( Retroviruses)
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Indirect transmission

This embraces a variety of mechanisms including the traditional 5 F's - "flies, fingers, fomites, food and fluid". An essential requirement for indirect transmission is that the infectious agent must be capable of surviving outside the human host in the external environment and retain its basic properties of pathogenesis and 5/23/12 5757

Vehicle-borne

Vehicle-borne transmission implies transmission of the infectious agent through the agency of water, food (including raw vegetables, fruits, milk and milk products), ice, blood, serum, plasma or other biological products such as tissues and organs.
e.g., S. aureus in food, transmitted by blood include hepatitis B, malaria, syphilis, brucellosis, trypanasomes 5/23/12 (Chaga's disease), infectious 5858

Vector-borne

In infectious disease epidemiology, vector is defined as an arthropod or any living carrier (e.g., snail) that transports an infectious agent to a susceptible individual.

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I. By vector:

Epidemiological classification of vectorborne diseases

a) Invertebrate type : Arthropod vectors fall into seven orders largely

(1) Diptera - flies and mosquitoes (2) Siphonaptera - fleas (3) Orthoptera - cockroaches (4) Anoplura - sucking lice (5) Hemiptera - Bugs, including kissing bugs (6) Acarina -ticks and mites (7) Copepoda - cyclops
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II. By transmission chain : Vector-borne diseases are classified under heterogeneous infection chain and involve three principal patterns:

a) Man and a non-vertebrate host

1) Man-arthropod-man (malaria) 2) Man-snail-man (schistosomiasis)

b) Man, another vertebrate host, and a non-vertebrate host

1) Mammal-arthropod-man (plague) 2) Bird-arthropod-man (encephalitis)

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6161 c) Man and 2 intermediate hosts

III. By methods in which vectors transmit agent:

a) Biting: West Nile, St. Louis, Japanese encephalitis b) Regurgitation: the expulsion of material from the mouth, pharynx, or esophagus, usually characterized by the presence of undigested food or blood: Leishmania.

c) Scratching-in of infective faeces: 5/23/12 6262 T.cruzi

IV. By methods in which vectors are involved in the transmission and propagation of parasites: (a) Mechanical transmission :

The infectious agent is mechanically transported by a crawling or flying arthropod through soiling of its feet or proboscis; or by passage of organisms through its gastro-intestinal tract and passively excreted.

There is no development or multiplication of the infectious agent on 5/23/12 6363 or within the vector.

(b) Biological transmission: The infectious agent undergoing replication or development or both in vector and requires an incubation period before vector can transmit. Biological transmission is of three types ;

(i) Propagative : The agent merely multiplies in vector, but no change in form, e.g., plague bacilli in rat fleas

(ii) Cyclo-propagative: The agent 5/23/12 6464 changes in form and number, e.g.,

Transovarial transmission : When the infectious agent is transmitted vertically from the infected female to her progeny in the vector it is known as transovarial transmission. Trans-stadial transmission: Transmission of the disease agent from one stage of the life cycle to another as for example nymph to adult is known as trans-stadial 5/23/12 6565

Airborne transmission

(1) Droplet nuclei : "Droplet nuclei" are a type of particles Implicated in the spread of airborne infection. They are tiny particles (1-10 microns range) that represent the 'dried residue of droplets.

Diseases spread by droplet nuclei include tuberculosis, influenza, chickenpox, measles, Q fever and many respiratory infections. Particles in the 1-5 micron range are
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(2) Dust: Some of the larger droplets which are expelled during talking, coughing or sneezing, settle down by their sheer weight on the floor, carpets, furniture, clothes, bedding, linen and other objects in the immediate environment and become part of the dust.
Diseases carried by infected dust include streptococcal and staphylococcal infection pneumonia, tuberculosis, Q-fever, 5/23/12 6767 Coccidioidomycosis and psittacosis.

Fomite-borne

Fomites (singular; fomes) are inanimate articles or substances other than water or food contaminated by the infectious discharges from a patient and capable of harbouring and transferring the infectious agent to a healthy person.
Diseases transmitted by fomites indude diphtheria, typhoid fever, bacillary 5/23/12 6868 dysentery, hepatitis A, eye and skin

Unclean hands and fingers

Hands are the most common medium by which pathogenic agents are transferred to food from the skin, nose, bowel, etc as well as from other foods.

The transmission takes place both direct.; (hand-to-mouth) and indirectly.

Examples include staphylococcal and streptococcal infections, typhoid fever, dysentery, hepatitis A and intestinal 5/23/12 6969 parasites.

Types of bacterial infections

Types of infection

Description No detectable clinical symptoms of infection Carrier state Zoonosis and environmental exposures

Example Asymptomatic gonorrhoea in women and men Typhoid carrier Anthrax, cryptococcal infection

Subclinical Latent Accidental

Opportunistic

Serratia or Candida Infection caused by infection of the normal flora or transient bacteria when normal host genitourinary defences are compromised tract

Primary
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Shigella dysenteriae Clinical apparent invasion and multiplication 7070 of microbes in body

Types of infection Secondary

Description

Example

Microbial invasion Bacterial pneumonia subsequent to primary following viral lung infection infection Two or more microbes Anaerobic abscess infecting same tissue (Esch. coli and Bacteroides fragalis Rapid onset (hrs or days); brief duration (days/weeks) Prolonged duration (months, years) Diphtheria

Mixed

Acute

Chronic

Mycobacterial diseases (tuberculosis and leprosy) Staphylococcal boil

Localized Generalized

Confined to a small area or to an organ

Disseminated to many Gram negative body regions bacteremia (gonococcemia) Pus forming Staphylococcal 7171 and streptococcal

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Types of infection Retrograde

Description

Example

Microbes ascending Esch. coli urinary tract in a duct or tube infection against the flow of secretions or excretions Infections that occur Airbome Yersinia pestis suddenly and intensely Pneumonic plague

Fulminant

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