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 o elimination by the body’s
defense cells, or chemical
Describe the normal microbiota, including and physical changes in the
resident and transient members. body that dislodge them.
Axenic environments Acquisition of Normal Microbiota
 sites that are free of any microbes.  You developed in your mother’s
 other parts of your body shelter womb without normal microbiota
millions of mutualistic and because you had surrounded
commensal symbionts. yourself with an amniotic
 The microbes that colonize the membrane and fluid.
surfaces of the body without o which generally kept
normally causing disease constitute microorganisms at bay.
the body’s normal microbiota also
sometimes called the normal flora Your normal microbiota began to
or the indigenous microbiota. develop when your surrounding
 The normal microbiota is of two amniotic membrane ruptured
main types: resident microbiota and and microorganisms came in
transient microbiota. contact with you during birth.
most of the resident microbiota
Resident Microbiota was initially established during
your first months of life.
 remains a part of the normal
microbiota of a person throughout How Normal Microbiota Become
life. Opportunistic Pathogens
 These organisms are found on the
skin and on the mucous membranes normal microbiota become opportunistic
of the digestive tract, upper pathogens, or opportunists. Conditions that
respiratory tract, distal portion of create opportunities for pathogens include
the urethra, and vagina. the following:

Transient Microbiota 1. Introduction of a member of the

normal microbiota into an unusual
 remains in the body for only a few site in the body
hours, days, or months before a. Every site has a specific
disappearing. normal microbiota; if a
 They are found in the same locations normal microbiota of one
as the resident members of the site is introduced to a site
normal microbiota but cannot that is unfamiliar- it will
persist because of competition from become opportunistic.
other microorganisms.
 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  Ligands are also called adhesins on
and nose in the air, on dust bacteria and attachment proteins
particles, and in droplets of on viruses.
moisture.  Adhesions are found on fimbriae,
flagella, and glycocalyces of many
Placenta pathogenic bacteria.
 The placenta is in such intimate o If ligands or their receptors
contact with the wall of the can be changed or blocked,
mother’s uterus that nutrients and infection can often be
wastes diffuse between the blood prevented.
vessels of the developing child and  the result of some genetic change
of the mother. (mutation) or exposure to certain
physical or chemical agents (as
The Parenteral Route occurs in the production of some
 not a portal of entry but instead a vaccines)—become harmless, or
means by which the portals of entry avirulent.
can be circumvented.  Some bacterial pathogens do not
 To enter the body by the parenteral attach to host cells directly. but
route, pathogens must be deposited instead interact with each other to
directly into tissues beneath the skin form a sticky web of bacteria and
or mucous membranes, such as polysaccharides called a biofilm,
occurs in punctures by a nail, thorn, which adheres to a surface within a
or hypodermic needle. host.
 Example: intravenous medications The Nature of Infectious Disease
and blood transfusion.
 Most infections succumb to the
The Role of Adhesion in Infection body’s defenses
After entering the body, symbionts must  some infectious agents affect body
adhere to cells if they are to be successful in function.
establishing colonies.  By definition, all parasites injure
their hosts. When the injury is
 The process by which significant enough to interfere with
microorganisms attach themselves the normal functioning of the body,
to cells is called adhesion or the result is termed disease.
attachment.  Disease, also known as morbidity, is
o To accomplish adhesion, any change from a state of health.
pathogens use adhesion Infection and disease are not the
factors, which are either same thing.
specialized structures or
attachment proteins.
 a. Infection is the invasion of a Other diseases are classified as
pathogen; disease results degenerative, nutritional, endocrine,
only if the pathogen mental, immunological, or neoplastic.
multiplies sufficiently to
1. Degenerative - Result from aging
adversely affect the body.
2. Nutritional Result - lack of some
Manifestations of Disease: essential nutrients in diet
Symptoms, Signs, and Syndromes 3. Endocrine (hormonal) - excesses or
deficiencies of hormones
 Diseases may become manifest in 4. Mental - Emotional or
different ways. psychosomatic
 Symptoms are subjective 5. Immunological - Hyperactive or
characteristics. hypoactive immunity
 Signs are objective manifestations of 6. Neoplastic (tumor) - Abnormal cell
disease that can be observed or growth benign tumors,
measured by others. 7. Iatrogenicb - Caused by medical
 Symptoms include pain, headache, treatment or procedures;
dizziness, and fatigue; signs include 8. Idiopathicc – Unknown cause
swelling, rash, redness, and fever. 9. Nosocomiald - Disease acquired in
Sometimes pairs of symptoms and health care setting
signs reflect the same underlying
The study of the cause of a disease is called
cause.
etiology.
 Symptoms and signs are used in
conjunction with laboratory tests to USING KOCH’S POSTULATES
make diagnoses.
Louis Pasteur, Robert Koch, and other
 A syndrome is a group of symptoms
microbiologists proposed the germ theory
and signs that collectively
of disease, which states that disease is
characterizes a particular disease or
caused by infections of pathogenic
abnormal condition.
microorganisms.
 Some infections go unnoticed
because they have no symptoms. Koch developed a series of essential
Such cases are asymptomatic, or conditions, or postulates, that scientists
subclinical, infections. must demonstrate or satisfy to prove that a
particular microbe is pathogenic and causes
Causation of Disease: Etiology a particular disease.
Hereditary diseases, are genetically 1. The suspected agent (bacterium,
transmitted from parents to offspring. virus, etc.) must be present in every
Congenital diseases, are diseases that are case of the disease.
present at birth. 2. That agent must be isolated and
grown in pure culture.
 3. The cultured agent must cause the system. These traits are collectively called
disease when it is inoculated into a virulence factors.
healthy, susceptible experimental
host. Extracellular Enzymes
4. The same agent must be reisolated Many pathogens secrete enzymes that
from the diseased experimental enable them to dissolve structural
host. chemicals in the body and thereby maintain
EXCEPTIONS an infection, invade further, and avoid body
defenses.
1. Some pathogens cannot be cultured in
the laboratory.  Hyaluronidase and collagenase
2. Some diseases are caused by a degrade specific molecules to enable
combination of pathogens or by a bacteria to invade deeper tissues.
combination of a pathogen and Hyaluronidase digests hyaluronic acid,
physical, environmental, or genetic the “glue” that holds animal cells
cofactors. together, and collagenase breaks
3. Ethical considerations prevent down collagen, the body’s chief
applying Koch’s postulates to diseases structural protein.
and pathogens that occur in humans  Coagulase causes blood proteins to
only. clot, providing a “hiding place” for
bacteria within a clot.
Virulence Factors of Infectious Agents  Kinases, such as staphylokinase and
Explain how microbial extracellular streptokinase, digest blood clots,
enzymes, toxins, adhesion factors, and allowing subsequent invasion of
antiphagocytic factors affect virulence. damaged tissues.

 The ability of a Toxins

 microorganism to cause disease is are chemicals that either harm tissues or
termed pathogenicity and the trigger host immune responses that cause
degree of pathogenicity is termed damage.
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
 Difference between extracellular  lipid portion of the membrane’s
enzymes and toxins lipopolysaccharide.
 Endotoxin can be released when
not always clear because: Gram-negative bacteria divide, die
 many enzymes are toxic naturally, or are digested by
 and many toxins have enzymatic phagocytic cells such as
action. macrophages.
 Toxemia – a condition wherein the  Many types of lipid A stimulate the
toxins enter the bloodstream and body to release chemicals that cause
are carried to other parts of the fever, inflammation, diarrhea,
body, including sites that may be far hemorrhaging, shock, and blood
removed from the site of infection. coagulation.

two types of toxin: exotoxins and

endotoxins Antiphagocytic Factors

Exotoxins  Longer pathogen in host = greater

damage & severe the disease
microorganisms secrete exotoxins that  Limits the extent & duration of
are central to their pathogenicity in that
infections, body’s phagocytic cells
they destroy host cells or interfere with
like macrophages
host metabolism.
 Macrophages – WBC that engulfs &
Three principal types: removes invading pathogens
■ Cytotoxins - kill host cells in general  Virulence factors r/t evasion of
or affect their function. phagocytis:

■ Neurotoxins - specifically interfere

with nerve cell function.
■ Capsules

■ Enterotoxins - which affect cells lining  Effective because they’re

the gastrointestinal tract. composed of
Endotoxin polysaccharides
 Result: don’t stimulate
Gram-negative bacteria have an outer host’s immune system
(wall) membrane composed of:
 Slippery which makes
 Lipopolysaccharide phagocytes difficult to
 Phospholipids surround & phagocytize;
 proteins their pseudopods can’t grip
the capsule
Also called lipid a.
 ■ Antiphagocytic Chemicals symptoms that
precedes illness
 Bacterias that causes 3) Illness
gonorrhea, produce  Severe stage
chemicals that prevent  Evident signs &
fusion of lysosomes with symptoms
phagocytic vesicles for their  Unresponsive
survival immune system to
 Streptococcus pyogenes – harming pathogen
produces protein in cell wall 4) Decline
and fimbrae called M  Body returns to
protein normal
 M protein – inhibits  Immune response
phagocytosis which and/or medical
increases virulence treatment vanquish
 Leuokocidins – destroys pathogens
phagocytic WBCs  Immune response &
products (antibodies
in blood) peaks
Stages of Infectious Diseases
5) Convalescence
5 DISEASE PROCESS:  Recovery
1) Incubation Period  Repaired & normal
tissues
 Infection, symptoms
& signs of disease  Length: depends on
amount of damage,
 Length: depends on
nature of pathogen,
infective agents’
site of infection &
virulence, infect dose
overall health
( initial # of
pathogens), immune Movement of Pathogens Out of
system, nature &
Hosts: Portals of Exit
reproduction of
pathogen and site of  Identical to portals of entry
infection  Pathogens often leave the body via
2) Prodromal Period bodily secretions and excretions
 Short time of
generalized, mild 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 - Foodborne transmission
sneezing, coughing  Inadequately
and generated by processed,
aircon, sweeping, undercooked, poorly
mopping, changing pasteurized milk or
clothes and bed poorly refrigerated
linens, flaming foods
inoculating loops  Foods can be
 Dust can carry contaminated with
Staphylococcus, normal microbiota (E.
Streptococcus, and Coli and S. Aureus),
Hantavirus zoonotic pathogens
 Measles and TB bacilli (Mycobacterium bovis
can be transmitted in and Taxoplasma) and
dried airborne parasitic worms that
droplets alternate between
 Fungal spores of humans and animals
Histoplasma and  Hepatitis A –
Coccidioides are contamination of
typically inhaled food with feces is an
example of fecal-oral
- Waterborne transmission transmission
 GI diseases such as
giardiasis, amebic - Body Fluid transmission
dysentery, and  Pathogens in blood,
cholera urine, saliva, and
 Water can act as other fluids
reservoir and vehicle  AIDS, hepatitis,
of infection herpes
 Fecal-oral infection –
major source of  Vector Transmission
disease in the world
 Schistosoma worms - Biological Vectors
and entreroviruses  Transmits pathogens
are shed in feces, and serves as hosts
enter through GI for multiplying
mucous or skin and pathogens
cause disease in body  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  By John Snow
infection  1813-1858
 Often by opportunistic
pathogen  Cholera Outbreak in
London (1854)

Epidemiology of Infectious Diseases  Analytical Epidemiology

 Detailed investigation of a
Frequency of Disease disease
 Epidemiologists tracks occurrence of  Includes analysis of data,
diseases using 2 measures: probable cause, mode of
transmission & possible
 Incidence – number of new
preventions
cases of disease in a given
population, area and time  Retrospective – attempts to
identify cause and mode of
 Prevalence – total or
transmission after outbreak
cumulative number of cases
has occurred
both new and existing
 Endemic – disease that normally  Experimental Epidemiology
occurs continually at a stable
 Hypothesis testing of a
incidence within given population or
disease
geographical area
 Application of Koch’s
 Sporadic – few scattered cases postulates
 Epidemic – greater frequency than  Includes testing analytical
usual study results, efficacy
 Pandemic – an epidemic that occurs preventive measures or
simultaneously on more than 1 treatment
continent  Example: Chlamydophila
pneumonia may contribute
Epidemiological Studies to arteriosclerosis, resulting
3 APPROACHES: to heart attacks

 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:
 Hospital Epidemiology:  Transmission of pathogens
Healthcare Associated among patients and health
workers
(Nosocomial) Infections
CONTROL OF HEALTHCARE
 Healthcare associated ASSOCIATED INFECTIONS:
infections (HAIs) or
nosocomial infections –
 Health care workers can help
infections acquired by
protect their patients and
patients or health workers
themselves from exposure to
while they are in health care
pathogens by hand washing
facilities
and other aseptic and
disinfecting techniques
TYPES OF HEALTHCARE  World Health Organization
ASSOCIATED INFECTIONS: (WHO), use epidemiological
data to promulgate rules and
 Exogenous HAIs – caused by standards for clean, potable
pathogens acquired from health water and safe food, to
care environment prevent disease by
 Endogenous HAIs – arise from controlling vectors and
normal microbiota within health animal reservoirs, and to
care setting educate people to make
 Iatrogenic infections – doctor- healthy choices concerning
induced” infections; direct result of the prevention of disease
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

FACTORS INFLUENCING
HEALTHCARE ASSOCIATED
INFECTIONS:

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