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Symbiosis – to live together; each of us has symbiotic Normal Microbiota in Hosts

relationships with countless microorganisms
- colonize the surfaces of the body without normally causing
Types of Symbiosis disease; normal flora or indigenous microbiota

1. Mutualism – both members benefit from their interaction 1. Resident Microbiota – remain a part of the normal
microbiota of a person throughout life; most are commensal
2. Commensalism – one member of the relationship benefits
without significantly affecting the other 2. Transient Microbiota – remain in the body for only a few
hours, day, or months before disappearing; found in the same
3. Parasitism – parasite derives benefit from its host while locations as the resident members; cannot persist because of
harming it competition from other microorganism, elimination by the
body’s defense cells, or chemical and physical changes in the
body

Acquisition of Normal Microbiota

You developed in your mother’s womb without normal

Microbiota because you had surrounded yourself with amniotic
membrane and fluid

Mother’s uterus – axenic environment

Your normal Microbiota began to develop when your

surrounding amniotic membrane ruptured and microorganisms
came in contact during birth.

Most of the resident microbiota was initially established during

your first months of life.
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How Normal Microbiota Become Opportunistic Pathogens 2. Human Carriers

Opportunistic pathogens – opportunists Some of these carriers incubate the pathogen in their body
and eventually develop the disease
1. Introduction of a member of the normal microbiota into an
unusual site in the body Others remain a continued source of infection without ever
becoming sick. Many such healthy carriers have defensive
2. Immune suppression systems that protect them from illness.
3. Changes in the normal microbiota – changes in the relative 3. Nonliving Reservoirs
abundance of normal microbiota, for whatever reason, may
allow a member of the normal microbiota to become an Soil, water and food can be nonliving reservoirs.
opportunistic pathogen and thrive
Soil and water can be contaminated with feces and urine.
Reservoirs of Infectious Diseases of Humans
Meat and vegetables can harbor pathogens.
Most pathogens of humans cannot survive for long in the
relatively harsh conditions they encounter outside their hosts. Exposure to Microbes: Contamination and Infection

Reservoirs of infection – sites where pathogens are Contamination – mere presence of microbes in or on the body
maintained as a source of infection
Infection – other contaminants overcome the body’s external
1. Animal Reservoirs defenses, multiply and become established in the body;
successful invasion of the body by a pathogen
Zoonoses – diseases that spread naturally from their usual
animal host to humans Portals of Entry – sites through which most pathogens enter
the body
Humans may acquire zoonoses from animal reservoirs via
direct contact with animals and their wastes, by eating animal, 1. Skin
or via blood-sucking arthropods. - outer layer of skin is composed of relatively thick layers of
Humans are usually dead-end hosts for zoonotic pathogens. tightly packed, dead, dry cells; formidable barrier to most
They don’t act as significant reservoirs for the reinfection of pathogens
animal hosts - some pathogens can enter the body through natural
openings (hair follicles and sweat glands)
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- larvae of some parasitic worms are capable of burrowing - pathogens must be deposited directly into tissues beneath
through the skin to reach underlying tissues; some fungi can the skin or mucous membranes
digest the dead outer layers of skin
- puncture by a nail, thorn or hypodermic needle, cuts, bites,
2. Mucous Membranes stab wounds, deep abrasions, or surgery

- line all the body cavities that are open to the outside world; The Role of Adhesion in Infection
relatively thin, moist, and warm, and their cells are living
Symbionts must adhere to cells if they are to be successful in
- respiratory tract is the most frequently used portal of entry; establishing colonies
pathogens enter the mouth and nose in the air, on dust
particles, and in droplets of moisture Adhesion – process by which microorganisms attach
themselves to cells
- many viruses enter the respiratory tract via the eyes
Adhesion factors – specialized structures or attachment
- some parasitic protozoa, helminths, bacteria, and viruses proteins used by pathogens to accomplish adhesion
infect through the gastrointestinal mucous membranes; they
are able to survive the acidic pH of the stomach and digestive Adhesion disks – some protozoa and suckers
juices of the intestinal tract Hooks – some helminths
- Prions (noncellular pathogens) enter through oral mucous Ligands – surface lipoproteins and glycoprotein molecules of
membranes viruses and many bacteria; enable them to bind to
3. Placenta complementary receptors on host cells

- typically forms an effective barrier to most pathogens - Adhesins - on bacteria; found on fimbriae, flagella, and
glycocalyces; Attachment proteins on viruses
- in 2% pregnancies, pathogens cross the placenta and infect
the embryo, sometimes causing spontaneous abortion, birth Receptor molecules on host cells – typically glycoproteins
defects, or premature birth. containing sugar molecules such as mannose and galactose

4. Parenteral Route If ligands or their receptors can be changed or blocked,

infection can often be prevented.
- not a portal of entry; a means by which the portals of entry
can be circumvented
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The specific interaction of adhesins and receptors with Signs – objective manifestations of disease that can be
chemicals on host cells often determines the specificity of observed or measured by others
pathogens for particular hosts
Syndrome – group of symptoms and signs that collectively
Avirulent – harmless; bacterial cells and viruses that have lost characterizes a particular disease or abnormal conditions
the ability to make ligands whether as a result of some genetic
change (mutation) or exposure to certain physical or chemical Asymptomatic or Subclinical infections – some infections go
agents (as occurs in the production of some vaccines) unnoticed because they have no symptoms; in some cases,
certain signs may still be detected if the proper tests are
Biofilm - a sticky web of bacteria and polysaccharides formed performed
by the interaction of some bacterial pathogens with each other;
adheres to a surface within a host Causation of Disease: Etiology

- dental plaque – contains bacteria that cause dental caries Hereditary – genetically transmitted from parents to offspring
(tooth decay) Congenital – disease that are present at birth, regardless of
The Nature of Infectious Disease the cause (hereditary, environmental, or infectious)

Disease – injury is significant enough to interfere with the

normal functioning of the body;

- aka Morbidity – any change from a state of health

Infection – invasion of a pathogen

Disease - results only if the pathogen multiplies sufficiently to

adversely affect the body

Manifestations of Disease: Symptoms, Signs, and

Syndromes

Symptoms – subjective characteristics of a disease that can

be felt by the patient alone
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Etiology – study of the cause of a disease 4. The same agent must be reisolated from the diseased
experimental host.
Using Koch’s Postulates – Robert Koch’s Germ Theory of
Disease (disease is caused by infections of pathogenic Exception 4.1: Another pathogen (opportunistic pathogen)
microorganisms) other than the one causing the disease might be the one that
is reisolated, thus, further severing the disease.
- To prove that a microbe is pathogenic and causes a
particular disease Virulence Factors of Infectious Agents

1. The suspected agent (bacterium, virus, etc) must be present Pathogenicity – ability of a microorganism to cause disease
in every cause of the disease.
Virulence – degree of pathogenicity; relative ability of a
Exception 1.1: It is not possible to establish a single cause for pathogen to infect a host and cause disease
such infectious diseases (pneumonia, meningitis, hepatitis)
because the names of these diseases refer to conditions that Virulence factors – traits that interact with a host and enable
can be caused by more than one pathogen. the pathogen to enter a host, adhere to host cells, gain access
to nutrients, and escape detection or removal by the immune
Exception 1.2: Some pathogens have been ignored. system

2. The agent must be isolated and grown in pure culture. 1. Adhesion factors
2. Biofilm formation
Exception 2.1: Some pathogens cannot be cultured in the 3. Extracellular enzymes
laboratory. 4. Toxins
Exception 2.2: Some diseases are caused by a combination of 5. Antiphagocytic factors
pathogens or by a combination of a pathogen and physical, Extracelluar enzymes
environmental, or genetic cofactors.
- exoenzyme; most pathogens secrete enzymes that enable
3. The cultured agent must cause the disease when it is them to dissolve structural chemicals in the body, thereby
inoculated into a healthy, susceptible experimental host. maintaining an infection, invade further, and avoid body
Exception 3.1: Ethical considerations prevent applying Koch’s defenses
postulates to diseases and pathogens that occur in humans a. Hyaluronidase – digest hyaluronic acid (glue that holds
only. animal cells together) and Collagenase – breaks down
collagen (body’s chief structural protein)
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b. Coagulase – causes blood proteins to clot, providing a Antiphagocytic factors

hiding place for bacteria within a clot
- prevent phagocytosis by the hosts
c. Kinases – digest blood clots, allowing subsequent invasion
of damaged tissues - to limit the extent and duration of infections, the body’s
phagocytic cells (macrophages) engulf and remove invading
Toxins pathogens

- chemicals that either harm tissues or trigger host immune a. Capsules – composed of chemicals normally found in the
responses that cause damage body; don’t stimulate a host’s immune response; often slippery,
making it difficult for phagocytes to surround and phagocytize
Toxemia – condition wherein toxins enter the bloodstream and them
are carried to other parts of the body
b. Antiphacytic chemicals – prevent the fusion of lysosomes
a. Exotoxins – destroy host cells of interfere with host with phagocytic vesicles
metabolism; generally more serious
b.1 M protein – produced by streptococcus pyogenes on its
a.1 Cytotoxins – kill host cells in general or affect their function cell wall and fimbriae; inhibits phagocytosis and thus increase
a.2 Neurotoxins – interfere with nerve cell function virulence

a.3 Enterotoxins – affect cells lining the gastrointestinal tract b.2 leukocidins – capable of destroying phagocytic white blood
cells outright; allow pathogens to remain in a host for a longer
b. Endotoxins – lipid A; lipid portion of the membrane’s time
polysaccharide
The Stages of Infectious Diseases

Disease process – following exposure and infection

1. Incubation Period - time between infection and occurrence

of the first symptoms or signs of disease

- length depends on:

a. virulence of the infective agent
b. infective dose (initial number of pathogens)
c. state and health of the patient’s immune system
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d. nature and reproduction time of pathogen d. milk produced by mammary glands

e. site of infection e. excreted bodily wastes – feces and urine

2. Prodromal Period - pathogen continues to multiply; short Modes of Infectious Disease Transmission
time of generalized, mild symptoms (malaise and muscle
aches) that precedes illness; not all infectious diseases have 1. Contact Transmission – spread by direct, indirect contact, or
this stage respiratory droplets

3. Illness – most severe stage; signs and symptoms are most a. Direct – person-to-person spread; body contacts; touching,
evident; physician first sees the patient kissing, sexual intercourse (warts, herpes, and gonorrhea);
touching, biting, scratching (zoonoses like rabies, ringworm,
4. Decline – hosts are more susceptible to secondary infection; and tularemia)
signs and symptoms subside; body gradually returns to normal
- from infected mother to a developing baby across placenta
5. Convalescence – tissues are repaired and returned to
normal; patient recovers from illness - from a portal of exit directly to a portal of entry (fingers
contaminated with fecal pathogens into mouth)
- length depends on:
a. amount of damage b. Indirect – pathogens are spread from one host to another by
b. nature of pathogen fomites (needles, toothbrushes, paper tissues, toys, money,
c. site of infection diapers, drinking glass, bedsheets, medical equipment)
d. overall health of patient c. Droplet – pathogens can be transmitted within droplet nuclei
The Movement of Pathogens Out of Hosts: Portals of Exit (droplets of mucus) that exit the body during exhaling,
coughing, and sneezing
Pathogens must leave infected patients through portals of exit
in order to infect others. Pathogens often exit hosts in 2. Vehicle transmission – spread of pathogens via air, drinking
materials that the body secretes or excrete. water, and food

a. secretions – earwax, tears, nasal secretions, saliva, sputum, a. Airborne – spread of pathogens farther than 1 meter to the
resp. droplets respiratory mucous membranes of a new host via an aerosol
b. blood – arthropod bites, hypodermic needles, wounds Aerosol – cloud of small droplets and solid particles
c. vaginal secretions or semen suspended in the air; can come from sneezing, coughing, or
can be generated by such means as air-conditioning systems,
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sweeping, mopping, changing clothes, or bed linens, or even

from flaming inoculating loops in labs

b. Waterborne – important in the spread of many gastro-

intestinal diseases (giardiasis, amebic dysentery, and cholera)

Fecal-oral infection – major source of disease in the world

c. Foodborne transmission

d. Bodily fluid – blood, urine, saliva must be handled with

precautions to prevent AIDS, hepatitis, and herpes

3. Vector Transmission

Vectors – animals that transmit diseases from one host to

another

a. Biological vectors – transmit pathogens but also serve as

host for the multiplication of a pathogen; biting arthropods Classification of Infectious Diseases
(mosquitoes, ticks, lice, bloodsucking flies, bloodsucking bugs,
mites) 1. Taxonomic groups

b. Mechanical vectors – not required as hosts by the 2. Diseases according to body systems affected
pathogens they transmit; only passively carry pathogens to
3. Disease according to its longevity and severity
new hosts on their feet or other body parts; houseflies,
cockroaches Acute disease – disease develops rapidly but lasts a relatively
short time; common cold
Chronic disease – develops slowly with less severe symptoms
and are continual or recurrent; infectious mononucleosis,
hepatitis C, tuberculosis, leprosy

Subacute disease – have durations and severities that lie

somewhere between acute and chronic
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Latent disease – in which a pathogen remains inactive for a Epidemiology of Infectious Diseases
long period of time before becoming active; herpes
Epidemiology – study of where and when disease occur and
4. The way of diseases’ transmission how they are transmitted within populations

Communicable – infectious disease comes from another Frequency of Disease

infected host, either directly or indirectly; influenza, herpes,
tuberculosis Incidence – number of new cases of a disease in a given area
or population during a given period of time
Contagious – communicable disease is easily transmitted bet
hosts (chicken pox or measles) Prevalence – total number of cases, both new and already
existing, in a given area or population during a given period of
Non-communicable disease – arises outside hosts or from time
normal microbiota; not spread from one host to another;
diseased patients are not a source of contamination for others; The occurrence of a disease can also be considered in terms
tooth decay, acne, tetanus of a combination of frequency and geographic distribution

5. Effects the diseases have on populations Endemic – disease that normally occurs continually (at
moderately regular intervals) at a relatively stable incidence
within a given population or geographical area

Sporadic – disease when only a few scattered cases occur

within an area or population

Epidemic – disease occurs at a greater frequency than is

usual for an area or population

Pandemic – if an epidemic occurs simultaneously on more

than one continent; swine flu in 2009

Health depts. At the local and state levels require doctors and
hospitals to report certain infectious diseases

Centers for Disease Control and Prevention (CDC) – each

week, they report the number of cases of most of the
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nationally notifiable diseases in the Morbidity and Mortality Hospital Epidemiology: Healthcare Associated
Weekly Report (Nosocomial) Infections

Epidemiological Studies HAI – infections acquired by patients or health care workers

while they are in healthcare facilities
1. Descriptive Epidemiology – careful tabulation of date
concerning a disease Types of HAIs

- relevant info includes the location and time of cases of the 1. Exogenous– caused by pathogens acquired from the health
disease, info about the patients (age, gender, occupations, care environment
health histories, socioeconomic groups)
2. Endogenous – arise from the normal microbiota within the
Index case – first case, time course and chains of transmission patient that become pathogenic because of fectors within
are important in this approach; sometimes difficult or health care setting
impossible to identify because the patient has recovered,
moved or died. 3. Iatrogenic – doctor-induced infections; ironically are the
direct result of modern medical procedures
2. Analytical Epidemiology – investigates a disease in detail,
inc. the analysis of data acquired in descriptive approach, to 4. Superinfections – may result from the use of antimicrobial
determine the probable cause, mode of transmission, and drugs that, by inhibiting some resident microbiota, allow others
possible means of prevention of the disease to thrive in the absence of competition; not limited to health
care setting; clostridium difficile (transient microbe in the colon,
- may be used in situations where it’s unethical to apply Koch’s can grow excessively and cause pseodomembranous colitis)
postulates
Factors influencing HAIs
- retrospective (attempt to identify causation and mode of
transmission after an outbreak has occurred) 1. Exposure to numerous pathogens

3. Experimental Epidemiology – testing a hypothesis 2. The weakened immune systems

concerning the cause of a disease; application of Koch’s 3. Transmission of pathogens among patients and health care
postulate is an example workers
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The Role of Public Health Agencies in Interrupting

Disease Transmission

As we have seen, pathogens can be transmitted in air, food,

and water as well as by vectors and via fomites. Public health
agencies work to limit disease transmission by a number of
methods:

1. Enforce standards of cleanliness in water and food supplies.

2. Work to reduce the number of disease vectors and

reservoirs.

3. Establish and enforce immunization schedules

4. Locate and prophylactically treat individuals exposed to

contagious pathogens.

5. Establish isolation and quarantine measures to control the

spread of pathogens.