Definition of Terms

Disease The result of an undesirable relationship between the host and the pathogen, marked by interruption in the normal functioning of a body part or parts.
Infection Refers to the invasion of the body by pathogenic microorganisms. The term is not synonymous with disease.

Cont. Definition of Terms

Symbiosis Refers to the relationship between the indigenous flora and the host literally.
Commensalism A form of symbiosis in which one organism benefits from another without causing harm to it.

Mutualism It is a form of symbiosis in which both organisms benefit from the relationship.

Cont. Definition of Terms

Parasitism It is a form of relationship in which one organism benefits from another and at the same time causes harm to the other. Pathogen It is an organism that invades and causes damage or injury to the host.

Cont. Definition of Terms

Pathogenicity Refers to the ability of an organism to cause a disease. An organism that can produce disease in humans is said to be pathogenic. Contamination This refers to the presence of organisms outside the body, as well as on water, food and other biological substances.

Cont. Definition of Terms

Pollution Refers to the presence of undesirable substances in water, air or soil.

Kochs Postulates
This is an experimental procedure developed by Robert Koch and his colleagues that proves that certain microorganisms cause specific disease. These postulates are as follows:
1. The same organism must be found in all cases of a given disease and must not be present in healthy animals or humans.

Kochs Postulates
2. The organism must be isolated and grown in pure culture from the infected animal.
3. The organisms form the pure culture must reproduce the disease when inoculated into a susceptible animal.

Kochs Postulates
4. The organism must be isolated in pure culture from the experimentally infected animal.
Once all of the above conditions are fulfilled, we can now conclude that the organism is indeed the cause of the particular disease.

Kochs Postulates
Exceptions of Kochs Postulates: To fulfill Kochs Postulates, it is necessary to grow (culture) the pathogen in the laboratory (in vitro) in or on artificial culture media. However, certain pathogens will not grow on artificial media. (Ex. Viruses, rickettsias, chlamydias, leprosy & syphilis)

Cont...Exception
To fulfill Kochs Postulates, it is necessary to infect

laboratory animals with the pathogen being studied. However, many pathogens are species-specific, meaning that they infect only one species of animal. Certain diseases, called synergistic infections, are caused not by one particular microorganisms but by the combined effects of two or more different microorganisms. It is very difficult to reproduce such infection in the laboratory.

Cont...Exception
Certain pathogens become altered when grown in

vitro. Some become less pathogenic, while others become non-pathogenic. Thus, they will no longer infect animals after being cultured on artificial media.

FACTORS THAT INFLUENCE THE OCCURENCE OF INFECTION

Portal of Entry
Mucous membranes Many organisms gain entry into

the host by penetrating mucous membranes lining the respiratory tract, gastrointestinal tract, genitourinary tract, and the conjunctiva of the eyes.
Skin The skin, if intact, is relatively impenetrable by

most organisms.

Portal of Entry
Skin Any break in the skin can allow entry of

pathogens into the body. Some, such as hookworms, can gain entry by penetrating intact skin.
Parenteral route Some microorganisms gain entry to

the body when they are deposited directly into the tissues beneath the skin or into mucous membranes when these are penetrated or injured.

Virulence of the organism

Microorganisms are equipped with certain

characteristics that can enhance their virulence. For instance, there are some organisms that are equipped with a capsule that enables the organism to evade phagocytosis. Other organisms produce specific enzymes and toxins that enable them to produce disease.

Number of microbes
In general, if only a small number of microorganisms

enter the body, they will most likely be overcome by the hosts defenses and therefore do not produce disease. This is not so if a large number of organisms gain entry. The likelihood of disease increases as the number of pathogens increases.

Defensive powers of the host

The most important factor that affects development of

disease is the defensive powers of the host. All of us are provided with defense mechanisms that can either prevent entry of organisms or limit the growth of organisms. Once there is a breakdown of all of the natural defense mechanisms of the body, there is no stopping microorganisms from entering the body, multiplying within the body and producing disease to the host.

Routes of Transmission
Contact transmission

- direct - indirect Vehicle transmission Vectors

HOW ORGANISMS PRODUCE DISEASE

Mechanical
Organisms can produce disease by directly damaging

tissues or surfaces. This involves colonization of the epithelial surface and penetration of epithelial cells and deeper tissues. This can be enhanced by the presence of surface molecules, such as those on the pili or fimbriae of some bacteria, which promote adherence of the organism to susceptible cells.

Chemical
A great number of bacteria produce disease as a

consequence of the chemicals and toxins that they produce. (some produce leukocidins which destroy WBC, some produce coagulase, which coagulates fibrinogen in blood, forming a blood clot) Most important chemical produced by organisms that can lead to disease are the toxins.

Cont...Chemical
Toxins are poisonous substances and are often primary

factors that contribute to disease production. 2 Major types of toxins: 1. Endotoxins are part of the outer membrane of Gramnegative bacteria; exert their effects when Gramnegative baceria die and their cell walls undergo lysis, releasing endotoxins.

Cont...Chemical
2 Major types of toxins contd. 2. Exotoxins are produced inside some bacteria of their growth and metabolism & are released into the surrounding medium; mainly proteins & many of them are enzymes (most are produced by Grampositive bacteria). Exotoxins are soluble in body fluids & are thus easily diffused into the blood and rapidly transported throughout the body.

Cont...Chemical
3 principal types of Exotoxins: 1. Cytotoxins which kill host cells or affect their functions 2. Neurotoxins which interfere with normal nerve impulse transmission 3. Enterotoxins which affect the cells lining the gastrointestinal tract.

Cont...Chemical
Exotoxins... Diseases produced by exotoxin-producing bacteria are often due to the effects of the exotoxin and not by the bacteria themselves. It is the exotoxin that produces the specific signs and symptoms. Exotoxins are, therefore, disease-specific.

Major differences between endotoxins & exotoxins

Property Bacterial source Relation to microorganism Exotoxin Mostly from Gram (+) Metabolic product of growing cell Endotoxin Gram (-) bacteria Present in LPS of outer membrane of cell wall & released only w/ destruction of cell Lipid portion (lipid A) of LPS of outer membrane General, such as fever, weaknesses, aches, and shock; all produce the same effects Stable; can withstand autoclaving (121C for one hour)

Chemistry Pharmacology (effect on body)

Protein or short peptide Specific for a particular cell structure or function in the host Unstable; can usually be destroyed at 60-80C (except staphylococcal enterotoxin)

Heat stability

Major differences between endotoxins & exotoxins

Property Toxicity (ability to cause disease)
Fever Immunology (relation to antibodies)

Exotoxin High
No Can be converted to toxoids to immunize against toxin; neutralized by antitoxins Small Gas gangrene, botulism, diptheria, tetanus, scarlet fever

Endotoxin Low
Yes Not easily neturalized by antitoxin; not converted into toxoids Considerably larger Typhoid fever, urinary tract infections, and meningococcal meningitis

Lethal dose Representative diseases

Immunologic
Some organisms produce disease not as a consequence

of mechanical invasion or toxin production, but as a consequence of the immune response of the host to the microorganisms or its products. (Ex. The damage to the liver seen in hepatitis infection is not a direct effect of the hepatitis virus, but the response of the immune system to the virus; the rashes seen in measles are due to the specific immune response of the body to the measles virus.

Classification of Infectious Diseases

Communicable disease a disease that spreads from

one host to another, either directly or indirectly. Contagious disease disease that is easily and rapidly spread from one person to another. Non-communicable disease is one that is not spread from one person to another. These are usually caused by organisms that normally inhabit the body and produce disease only occasionally, or by organisms that produce disease only when introduced into the body.

Classification of Infectious Diseases

Fulminating infection is an infection that results in

the death of the patient over a short period of time. (ex. Meningococcemia) Specific infection is one that is caused by a microorganism that is known. Non-specific infection infection that can be caused by several organisms.

Classification of Infectious Diseases

Nosocomial infections hospital-acquired infections.
Community acquired infections is an infection that

is acquired in the community during the course of our lives.

Occurrence of a Disease
Incidence of a disease refers to the number of people

in a population who develop a disease during a particular period of time. It serves as an indicator of the spread of the disease. Prevalence of a disease refers to the number of people in a population who develop a disease at a specified time, regardless of when it first appeared.

Occurrence of a Disease
Sporadic disease a disease that occurs only

occasionally Endemic disease a disease that is constantly present in the population. Epidemic if many people in a given locality develop a certain disease in a relatively short period of time. Pandemic if the disease has a worldwide occurrence.

Occurrence of a Disease
Zoonosis a disease primarily infecting lower animals.
Epizoonosis a disease that occurs as epidemic in

lower animals. Bacteremia the presence of bacteria in the blood. Septicemia the presence of actively multiplying bacteria in the blood. Toxemia involves the presence of toxins in the blood.

Occurrence of a Disease
Viremia refers to the presence of virus in the blood.
Pyemia refers to the presence of pus-producing

bacteria in the bloodstream.

Severity or Duration of a Disease

Acute disease is one that develops rapidly but lasts

for only a short period of time (6 months or less). Chronic disease is one that develops more slowly and occurs for long periods of time (more than 6 months). Latent disease is one in which the causative organism remains inactive for a time but can become active and produce symptoms of disease.

Extent of Host Involvement

Local infection is one in which the invading

microorganisms are limited to a relatively small are of the body (ex. Boils and abscesses) Systemic or generalized infection is one where the invading microorganisms or their products are spread throughout the body by the blood or lymph. Focal infection a local infection enters a blood or lymphatic vessel & spreads to specific parts of the body, where they are confined to specific areas of the body.

Extent of Host Involvement

Primary infection is an acute infection that causes

the initial illness. Secondary infection is one which is casued by opportunistic pathogens after a primary infection has weakened the bodys defenses. (common to patients with AIDS)

Predisposing factors
A predisposing factor is one that makes the body more

susceptible to the development of a particular disease. Example: gender, genetics, geographical location, nutritional status, age, lifestyle, habits, occupation, presence of a pre-existing illness, intake of certain drugs that can affect the immune system, emotional disturbances

Stages of an Infectious Disease

Incubation period refers to the time interval between the entry of the microorganism and the first appearance of the signs & symptoms. 2. Prodromal period is relatively short. It is characterized by early, mild symptoms of disease which are generally non-specific. (ex. In measles, prodromal period is fever, cough or colds)
1.

Stages illness corresponds to the period of of an Infectious Disease 3. Period of

maximal invasion; the disease is most acute. Patient manifests signs and symptoms that characterize the disease. Fulminant infection when the disease is not successfully overcome and patient may die of the infection in a short period of time. Carrier state patient does not show signs and symptoms any longer, but still continues to shed the infecting microorganisms.

Stages of an Infectious Disease

4. Period of decline corresponds to what is known as the period of defervescence. During this period, the signs and symptoms of the patient start to subside. It is during this period that the patient becomes more vulnerable to secondary infection. 5. Period of convalescence it is during this period when the patient regains strength and the body returns to its pre-diseased, normal condition. Recovery occurred during this period.

Reservoirs of Infection
Reservoirs serve as a continual source of diseaseproducing microorganisms. These can either be living or non-living organisms. They provide the organisms with conditions that enable the organisms to survive and multiply and provide opportunity for transmission.

Reservoirs of Infection
Human body principal living reservoir of human

disease Carriers specially serve as important living reservoirs, do not exhibit signs or symptoms of disease unknowingly transmit the organisms to other individuals.

Reservoirs of Infection
Transmission of zoonotic infections to humans

through: 1. Direct contact with infected animal 2. Direct contact with animal wastes 3. Contamination of food and water by animal wastes 4. Bite of the infected animal 5. Air from contaminated hides, furs or feathers 6. Ingestion of infected animal products 7. Insect vectors

Reservoirs of Infection
Non-living reservoirs can be varied.
Two major non-living reservoirs: water & soil.

Routes of transmission
Contact transmission - refers to the spread of a

pathogenic organism through direct contact (person to person), indirect contact (causative agent from reservoir to a susceptible host through non-living object-fomite), or droplet transmission (through droplet nuclei that travel only short distances usually less than a meter).

Routes of transmission
Vehicle transmission refers to transmission of

organisms through media such as food, water, air, milk or biological substances such as blood & body secretions. Vectors are animals that carry organisms from one host to another.

HOST RESPONSE TO INFECTION

Host defense mechanisms

Nonspecific host defense mechanisms

Specific host defenses mechanisms

First line of defense

Second line of defense

Third line of defense

Non-specific Host Defense Mechanisms serve to protect the body against They are general and
many harmful substances. One of the nonspecific host defenses is the innate, or inborn, resistance observed among some species of animals, some races of humans, and some persons who have a natural resistance to certain diseases. Innate or inherited characteristics make these people & animal more resistant to some diseases than to others.

First line of defense

Skin and mucous membranes as physical barriers
Cellular and Chemical Factors Microbial Antagonism

Second line of defense

Transferrin a glycoprotein synthesized in the liver,

has a high affinity for iron. Its normal function is to store and deliver iron to host cells. It serves as a nonspecific host defense mechanism by sequestering iron and depriving pathogens of this essential nutrient.

Second line of defense

Fever The resulting increased body temperature is

considered to be a nonspecific host defense mechanism. Substances that stimulate the production of fever are called pyrogens or pyrogenic substances.

Second line of defense

Interferons are small, antiviral proteins produces by

virus-infected cells. They are not virus-specific, meaning that they effective against variety of viruses, not just the particular type of virus that stimulated their production. They are species-specific, meaning that they are effective only in the species of animal that produced them.

Second line of defense

The Complement System The primary importance is

that activation of the complement system is considered a nonspecific host defense mechanism; it assists in the destruction of many different pathogen.

Second line of defense

Major consequences of complement activation: Initiation & amplification of inflammation Attraction of phagocytes to the sites where they are needed (chemotaxis) Activation of leukocytes Lysis of bacteria and other foreign cells Increased phagocytosis by phagocytic cells (opsonization)

Second line of defense

Acute-Phase Proteins they are plasma levels of

molecules that increase rapidly in response to infection, inflammation, and tissue injury. They serve as host defense mechanisms by enchancing resistance to infection and promoting the repair of damaged tissue.

Second line of defense

Cytokines they are chemical mediators that are

released from many different types of cells in the human body. They enable cells to communicate with each other. They act as chemical messengers both within the immune system and between the immune system and other systems of the body.

Second line of defense

Inflammation body normal response to any local

injury, irritation, microbial invasion, or bacterial toxin. 3 major events in acute inflammation: 1. Increase in the diameter of capillaries 2. Increased permeability of the capillaries 3. Exit of leukocytes from the capillaries and their accumulation at the site of injury

Second line of defense

Phagocytosis the process by which phagocytes

surround and engulf (ingest) foreign material. The two most important groups of phagocytes in the human body are macrophages and neutrophils; they are sometimes called professional phagocytes because phagocytosis is their major function.