Introduction in Infectious Diseases

Maia
Zhamutashvili
MD- PhD
 What is infection and Infectious disease
Definition

Infection:  
is the invasion of an organism's body  tissues by disease-
causing agents, their multiplication, and the reaction
of host tissues to the infectious agents and the toxins they
produce.

Infectious disease:
also known as transmissible disease or communicable
disease, is illness resulting from an infection.
 Infectious Diseases as a Cause of Death
• Infectious diseases are responsible for a quarter to a third of all
deaths worldwide.

• Infectious diseases account for more than half of all deaths in

children under the age of 5.

• by the World Health Organization, of the top ten causes of death,

five are due to infectious diseases.

• The top single agent killers are: HIV/AIDS, malaria and

tuberculosis. The other top killers are lower respiratory infections
and diarrheal diseases.
 Infectious Diseases

Definition of infection
 Complex process of interaction between pathogen
and human body
 Three factors are involved in the infection:
pathogen, host and environment
Factors Influencing Disease Transmission

Agent Environment
 Infectivity  Weather
 Pathogenicity  Housing
 Virulence  Geography
 Immunogenicity  Occupational setting
 Antigenic stability  Air quality
 Survival  Food

 Age
 Sex
Host Behaviour
 Nutritional status
Health status
 Classification of Infectious Diseases

–Communicable Diseases:
Spread from one host to another, directly or indirectly.
Example: Tuberculosis, herpes, flu, AIDS, chickenpox,
mumps, polio, hepatitis and others.

–Contagious Diseases:
Spread easily from one person to another.
Example: Chickenpox, measles, Varicella and etc .
 Classifying Infectious Diseases

• Subclinical Infection :
without significant sign and symptoms

•Opportunistic Infections :
caused by non-pathogenic low virulence microorganisms in
immunocompromised individuals (in people with weakened
immune systems, including people with HIV).
 Opportunistic Pathogens

Opportunistic Pathogens: Organisms that normally do

not cause disease in their natural hosts in a healthy person.
They may cause disease if the host is weakened or if they
enter a different part of the body.

– Pneumocystis carinii pneumonia in AIDS patients.

– Neisseria meningitidis is usually harmless in respiratory tract,
but can cause meningitis.
– E. coli can cause urinary tract infections, meningitis,
pneumonia, and abscesses.
 Classification of infectious diseases

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 − A latent infection is hidden, inactive,
or dormant. characterized by periods of no symptoms
between outbreaks of illness.
 Classification of infectious diseases

By location
 Local − limited 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.
 Emerging and re-emerging Infectious Diseases

• Emerging infections
are those that have recently appeared within a
population, increasing rapidly. (ex: HIV, SARS, Ebola,
COVID 19 and etc.).

• Re-emerging Infectious
Diseases whose incidence had significantly declined
in the past, but have again reappeared. (ex: tuberculosis
and etc.).
Relationships Between the Microbiota and the Host

SYMBIOSIS: “Living together”.

1. Commensalism: biological interaction in which one

species gain benefits while those other species are not
harmed

2. Mutualism: Both organisms benefit from living together

• E. coli synthesizes vitamin K and some B vitamins.
3. Parasitism: One organism benefits, the other is harmed
• Most disease causing bacteria.
 Other Definitions
Bacteremia
Presence of small number of low virulence bacteria in the
bloodstream which do not multiply significantly e.g S. typhi,

E.coli

Septicemia
Presence of rapidly multiplying highly pathogenic
bacteria in the bloodstream. Septicemia can lead to;
• Sepsis
• Pyaemia
• Toxemia
 Other Definitions

Sepsis;
A whole-body inflammatory state leading to multiple organ
failure and death resulting from sepsis-induced hypotension and
diffuse intravascular coagulation (DIC)
Pyaemia;
A diseased state in which pyogenic bacteria are circulating in the
blood, by development of abscesses in various organs.

Toxemia;
Blood poisoning by toxins from a local bacterial infection
 Other Definitions
Viremia
Circulating viruses in the blood stream
Latent virus infection
Reactivation of infection from virus in latent phase
e.g. Herpes zoster: reactivation of Varicella Zoster Virus after
recovery from varicella

Oncogenic virus infection

virus which cause tumor e.g. HPV, HBV, HCV, EBV and
ect,
 Infectious diseases are characterized by epidemics
and pandemics

An epidemic 
(from Greek ἐπί epi "upon or above" and δῆμος demos "people") is
the rapid spread of infectious disease to a large number of people in
a given population within a short period of time. An attack rate in
excess of 15 cases per 100,000 people for two consecutive weeks is
considered an epidemic.

A pandemic 
(from Greek πᾶν pan "all" and δῆμος demos "people") is an epidemic
of disease that has spread across a large region; for instance multiple
continents, or even worldwide
The Ways of Transmission
Infectious Diseases
 Ways of Transmission of Infectious Diseases

• Droplet contact: also known as the respiratory

route:
airborne disease.example: If an infected person coughs or sneezes
the microorganisms, suspended in droplets, may enter to body
through the nose, mouth or eye surfaces: ex: COVID 19
and etc ).
• Fecal-oral transmission: when foods or water become
contaminated (by people not washing hands). Common fecal-oral
transmitted pathogens include, hepatitis A, Vibrio cholerae,
rotaviruses, Entameba histolytica, Escherichia coli, and etc.
• Sexual transmission: sexually transmitted disease. Ex:
AIDS, Hepatitis B, hepatitis C and etc,
 Ways of Transmission of Infectious Diseases
• Oral transmission:
Diseases that are transmitted primarily by direct oral contact such
as kissing, or by indirect contact such as by sharing a drinking
glass or a cigarette. Ex: Infectious mononucleosis (kissing
disease)

• By Blood transmission: blood-borne disease:

ex: Hepatitis C, Hepatitis B, HIV/ AIDS and etc.

• Vertical transmission:
from mother to embryo, fetus or baby during
pregnancy or labour. Ex: HIV/AIDS, Hepatitis B, Herpes
simplex and etc
 Ways of Transmission of Infectious Diseases

• Iatrogenic transmission:
due to medical procedures: injection or
transplantation infected material.

• Vector-borne transmission:
transmitted by a vectors (which include mosquitoes,
ticks, and fleas). Vector is an organism that
does not cause disease itself but transmits infection from

one host to another. (Dengue fever, West

Nile Virus, Lyme disease, malaria).
 Classification of Infectious Agents

•Bacteria (cocci &bacilli)

Gram-negative or Gram- positive •Prion protein aggregates, lack
•Viruses: DNA or RNA nucleic acid)
•Viroid composed of single-
•Fungi stranded
-Disseminated or Localized •Plasmid is a extra chromosomal
double stranded small DNA
•Parasites molecule
-Protozoa
-Helminths
 Bacterial Diseases

 Tuberculosis
 Scarlet Fever
 Tetanus
 Gonorrhea
 Diptheria
 Streptococcal Infections
 Pneumonia (can also be viral or fungal)
 Pertussis
 Bubonic Plague
 Viral Diseases
*Common Cold
*Influenza
*HIV/AIDS
*Herpes (Simplex and Zoster)
*Hepatitis A,B,C, D, E, F and G.
*Measles, Mumps and Rubella.
*Poliomyelitis.
*Infectious mononucleosis.
Taxonomy Size Site of Propagation Examples

Disease
Prions 30–50 kD Intracellular Prion protein Creutzfeld-Jacob
disease
Viruses 20–300 nm Obligate intracellular Poliovirus Poliomyelitis

Obligate intracellular Chlamydia Trachoma, urethritis

trachomatis
Bacteria 0.2–15 μm Extracellular Streptococcus Pneumonia
pneumoniae
Facultative Mycobacterium Tuberculosis
intracellular tuberculosis
Extracellular Candida albicans Thrush
Fungi 2–200 μm Facultative Histoplasma Histoplasmosis
intracellular capsulatum
Extracellular Trypanosoma Sleeping sickness
gambiense
Protozoa 1–50 μm Facultative Trypanosoma cruzi Chagas disease
intracellular
Obligate intracellular Leishmania donovani Kala-azar
Extracellular Wuchereria bancrofti Filariasis
Helminths 3 mm–10 m
Intracellular Trichinella spiralis Trichinosis
 Reservoirs of Infection agents

– Human Reservoirs: Infected individuals who may

or may not present disease. Carriers are infected
individuals without any signs or symptoms of disease
(AIDS, polio, HBV, HHV and etc).
– Animal Reservoirs: Zoonoses are diseases that
occur primarily in wild and domestic animals. About 150
different zoonoses are known (rabies, anthrax, and Lyme
disease).
– Nonliving Reservoirs: Two major sources are soil
and water.
• Soil: Clostridium tetani and botulinum.
• Water: Vibrio cholerae and Salmonella typhi.
 Infections can be classified:
By anatomic location:
• Urinary tract infection
• Skin infection
• Respiratory tract infection
• GI system infections
• CNS infections: (encephalitis, meningitis, encephalomyelitis and
etc).
• Odontogenic infection (an infection that originates within
a tooth or in the closely surrounding tissues)
• Vaginal infections
• Intra-amniotic infection
• others
 Periods (phases)
of Infectious Disease
 Periods ( phases) of Infectious Disease

• Incubation period (Phase)

• Prodromal period (Phase)
• Period of  illness (Phase)
• period of decline (Phase)
• Reconvalencence period (Phase)
The Stages of a Disease
Periods (stages or phases) of Infectious Disease
 Periods (phases) of Infectious Disease

The incubation period: after the entry of the pathogen into the

host (patient). After entering the pathogen begins replication in the
host. However, there are insufficient numbers of pathogen to cause
signs and symptoms of disease.

Incubation periods can vary from a day or two in acute disease

to months or years in chronic disease. Factors involved about the
length of the incubation period are varous, and can include strength
of the pathogen, strength of the host immune defenses, site of
infection, type of infection, pathogen dose and etc.

During this incubation period, the patient is unaware that a disease is

beginning to develop.(the patient is asymptomatic)
 Periods ( phases) of Infectious Disease

The prodromal period 

The prodromal period occurs after incubation period.

During this phase, the pathogen continues to multiply and
the host begins to experience general signs and symptoms
of illness(not specific), which typically result from
activation of immune system, such as fever, pain, sore
throat, swelling, or inflammation.

Usually, such signs and symptoms are too general (not

specific) to indicate a particular disease.
Periods (phases) of Infectious Disease

Period of  illness (Phase)

All specific clinical symptoms characteristic of this

particular disease will be revealed at this time.
This period is characterized by great diversity

During these period the signs and symptoms of disease are

most obvious and severe.
 Periods (phases) of Infectious Disease

Period of decline

The period of illness is followed by the period of decline, during

which the number of pathogen particles begins to decrease, and the
signs and symptoms of illness begin to decline.

However, during the decline period, patients may become susceptible

to developing secondary infections because their immune systems
have been weakened by the primary infection. 
Periods (phases) of Infectious Disease

Reconvalencence period (Phase)

The final period is known as the period of convalescence.

During this stage, the patient generally returns to normal

functions, although some diseases may cause permanent
damage and the body cannot fully repair.
Laboratory Diagnosis
of Infectious Diseases
 MICROSCOPY

The simplest method for microscopic evaluation is

the wet mount, which is used, for example, to
examine cerebrospinal fluid (CSF) for the presence
of pathogens.
Ex: wet mount with Indian ink as a background, to
detect cryptococcus neoformans (visualize large-
capsuled yeast cells).

Wet mounts with dark-field illumination also are

used to detect spirochetes, Borrelia or Leptospira
in blood.
 Laboratory Diagnosis of Infectious Diseases
STAINING

Gram’s stain differentiates between organisms with

thick peptidoglycan cell walls (gram-positive) and
those with thin peptidoglycan cell walls and outer
membranes that can be dissolved with alcohol or
acetone (gram-negative).

The examination of CSF and joint, pleural, or

peritoneal fluid with Gram’s stain is useful for
determining whether bacteria are present.
 ELISA
The enzyme-linked immunosorbent assay (ELISA) is a test
that uses antibodies or antigen to identify a substance.

Antigens from the sample are attached to

a surface. Then, a further specific
antibody is applied over the surface so it
can bind to the antigen. This antibody is
linked to an enzyme, and, in the final step,
a substance containing the
enzyme's substrate is added. The
subsequent reaction produces a detectable
signal, most commonly a color change in
 Laboratory Diagnosis of Infectious Diseases

Immunofluorescent stains

The direct immunofluorescent antibody technique uses

antibody bound to a fluorescent compound (e.g.,
fluorescein) and directed at a specific antigenic target to
visualize organisms

Evaluation under microscope

 DETECTION OF PATHOGENIC AGENTS BY CULTURE

To culture bacterial, fungal, or viral pathogens.

An appropriate sample must be placed into the proper

medium for growth (amplification).
 ISOLATION OF VIRAL AGENTS

Virus may be detected by direct observation of the cultured cells for

cytopathic effects or by immunofluorescent detection of viral
antigens after incubation

Conventional viral culture is useful for detection of rapidly

propagated agents, such as herpes simplex virus.

Viruses that grow more slowly (e.g., cytomegalovirus and varicella-

zoster virus) can be detected quickly by shell-vial culture, in which
the specimen is centrifuged on a monolayer of cells that is then
incubated for 1–2 days and finally is stained for viral antigens with
fluorochrome-conjugated antibodies.
 NUCLEIC ACID TESTS (NAT test)

Using PCR technology (polymerase chain reaction)

For detection of genetic materials (DNA or RNA) of pathogen

( Gold standard)

Nucleic acid tests (NAT) are used for four purposes.

 First: to detect, and sometimes to quantify, pathogens;
 Second: for identification of organisms, that are difficult to
identify by conventional methods;
 Third: to determine whether two or more isolates of the same
pathogen are closely related (belonging to the same “clone” or
“strain”);
 Fourth: to predict the sensitivity of organisms (typically viruses)
to chemotherapeutic agents.
 Prevention of
Infectious diseases
 Prevention of Infectious diseases

Immunization Principles and Vaccine Use

• Immunization is very important for economic savings, and

Patients quality of life.

• Since childhood vaccines have become widely available in

the United States, major declines in rates of vaccine-
preventable diseases among both children and adults have
become evident
Prevention of Infectious diseases
Immunization

Active - using Vaccine

Passive - Immunoglobulin
 Active Immunity

• Protection produced by the person's own

immune system
• Usually permanent
 Principles of Vaccination

General Rule

The more similar a vaccine is to the

disease-causing pathogen of the organism,
the better the immune response to the
vaccine.
 Classification of Vaccines
Vaccine types
Commercially available vaccines classified into four types:

• Live-attenuated vaccines
• Inactivated vaccines (killed)
• Subunit, recombinant, polysaccharide, and
conjugate vaccines
• Toxoid vaccines
 Live-attenuated vaccines
Live vaccines use a weakened (or attenuated) form of the pathogen
(germ).

Live vaccines create a strong and long-lasting immune

response.

Just 1 or 2 doses of most live vaccines can give lifetime protection

Examples of Live vaccines:

• Measles, Mumps, Rubella (MMR combined vaccine)

• Rotavirus
• Smallpox
• Chickenpox
• Yellow Fever
•
 Inactivated (killed) vaccines
Inactivated vaccines use the killed version of the Pathogen(germ)

Inactivated vaccines usually don’t provide immunity (protection)

that’s as strong as live vaccines.

So we need several doses over time (booster shots) in order to

get ongoing immunity against diseases.

Inactivated vaccines:

• Hepatitis A
• Flu
• Polio
• Rabies
Subunit, recombinant, polysaccharide, conjugate vaccines
Subunit, recombinant, polysaccharide, and conjugate vaccines use
specific pieces of the germ — like its protein(antigen) or capsid.

They can also be used on almost everyone who needs them,

including people with weakened immune systems.

One limitation of these vaccines is that you may need booster shots
These vaccines are used to protect against:

• Hib (Haemophilus influenza type b) disease

• Hepatiti B
• HPV (Human papilloma virus)
• Whooping cough (part of the DTaP combined vaccine)
• Pneumococcal disease
• Meningococcal disease
• Shingles
 Toxoid vaccines
Toxoid vaccines use a toxin (inactivated) made by the germ
that causes a disease.

They create immunity to the parts of the germ that cause a

disease instead of the germ itself.

Like some other types of vaccines, toxoid vaccine need

booster shots to get ongoing protection against diseases.
Toxoid vaccines are used to protect against:

• Diphtheria
• Tetanus
 Passive immunity
• Passive immunity is the transfer of active humoral
immunity of ready-made antibodies.

• Passive  immunity can occur naturally, when

maternal antibodies are transferred to the fetus through
the placenta.

• and it can also be induced artificially, when high

levels of antibodies specific to pathogen or toxin
(obtained from animals, humans, horses) are
transferred to non-immune persons through blood
products that contain antibodies, such as in
immunoglobulin therapy or antiserum therapy.
 Passive Immunity

• Temporary protection that diminishes with time

(weeks, months)

• Passive immunization is used when there is a high risk

of infection and insufficient time to develop its own
immune response.
• Passive immunization can be provided when people
cannot synthesize antibodies, and when they have been
exposed to a disease that they do not have immunity.
 Examples:

Hepatitis B (HBV)

Hepatitis C (HCV)
 Examples:
Prevention

Hepatitis B (HBV)
HBV vaccine and HBIG

Hepatitis C (HCV)
No prophylaxis exists
Treatment of Infectious
diseases

Antimicrobial therapy
Treatment of Infectious
diseases

Antibacterial therapy
Antiviral therapy
Antiprotozoal therapy
Antifungal therapy
 Treatment of Bacterial Infections
• Antibacterial agents (antibiotics), like all antimicrobial
drugs, are directed against unique targets of the bacteria
cell
• Bactericidal antibiotics kill the bacteria that are within
their spectrum of activity;
• Bacteriostatic drugs only inhibit bacterial growth.

• While bacteriostatic activity is adequate for the treatment of

most infections, bactericidal activity may be necessary for cure
in patients with altered immune systems (e.g., neutropenia),
protected infectious foci (e.g., endocarditis or meningitis), or
specific infections (e.g., complicated Staphylococcus aureus
bacteremia).
 Antiviral therapy

• Interferons
• DAA
• Other
 Antiviral therapy

• Interferons
 Conventional
 Pegylated
 Antiviral therapy

(DAA)

Direct-acting antivirals (DAAs), are drugs

targeted at specific steps within the viral life
cycle and results in disruption of viral
replication and infection
 Antiviral therapy
DAA and target proteins
• Tenofovir (reverse transcriptase)
• Entecavir (reverse transcriptase)
• Sofosbuvir (NS5B)
• Ledipasvir  (NS5A)
• Velpatasvir (NS5A)
• Dolutegravir (integrase)
• Raltegravir (integrase)
• Lopinavir (protease)
• Lamivudin (reverse transcriptase)
• etc
Elimination, and Eradication of infection
•

• Elimination: requiring the reduction to zero of new

cases in a defined geographic area.
sometimes defined as reduction in the local sustained
transmission of an infection in a geographic area.

• Eradication: Absence of a disease is achieved and its

absence can be sustained without ongoing
interventions. The only vaccine reventable disease that
has been globally eradicated thus far is smallpox.
 Thanks for
your attention