Disease

Infectious Diseases
a.k.a. Communicable Diseases Chapter 13 Immunity and Infection

! Acute vs. Chronic ! Infectious vs. Non-Infectious ! Communicable vs. Non-Communicable ! Changing Face of Disease
Lifestyle: activity, diets, daycare, etc. Travel: West Nile Virus Medical Progress: smallpox, iatrogenic,

Communicable Diseases
! Vaccines and/or cures for many ! Leading ones in Canada are:
infuenza, STD's, and food-borne illnesses

Infectious Agent (Pathogen) needs:

! Exit from origin ! Transmission medium/method
direct contact (blood) indirect (via H2O, food) airborne (dried sneezes, coughs, dust) vector (bite of insects or parasites through feet)

! Entrance portal to new host

Degree of illness experienced will depend upon:

! number of invading cells ! previous exposure (immunity) ! resistance/defenses of host
stress, fatigue, malnutrition, smoking, environment immutables: aging, genetics, gender

Pathogens
! Pathogens set up and multiply in host
damaging cells, tissues (e.g. malaria) block vessels toxins interfere with cell reproduction

Types of Pathogens (infectious

agents, microbes, micro-organisms)

! Bacteria
100 of the 1500 known are pathogens eg strep throat, TB, tetanus, gonorrhea, syphilis, (see text for more)

! Viruses
invade cells to replicate (vs bacteria which have own life cycle). Antibiotics are useless. e.g. smallpox (eradicated in 1980), polio, flu, measles, rabies, AIDS, hepatitis, common cold.

Types of Pathogens contd

! Fungi
yeast and moulds = plant-like parasites e.g. athletes foot, ringworm

Pathogens contd
! Parasitic Worms
Worms that feed off the host Amoebic Dysentery, Malaria

! Protozoa
single celled animals e.g. trichomoniasis, malaria

! Prions
infectious proteins cause of bovine spongiform encephalitis and Creutzfelt Jacob disease.

Stages of Infectious Disease

1. Incubation: between initial infection and
signs/symptoms. Can be infectious. 2. Prodromal: non-specific complaints (infectious) 3. Acme: symptoms characteristic of disease, most contagious 4. Convalescence: regaining normal function, possibly still contagious

Bodys Defenses Against Infectious Diseases

! External mechanical barriers
skin, depends on being unbroken and healthy nutrition maintains turnover mucous membranes, nasal and pubic hairs, cilia, eyelashes blinking, sneezing, coughing, vomiting

chemical defenses
secretions: sebum of skin, saliva, tears, acid in gut, genital enzymes, acid

Can still be a carrier if pathogen remains in asymptomatic host (e.g. hepatitis)

Bodys Defenses Against Infectious Diseases

! Fever: Fever can be caused by toxins. Can
be harmful to body, but paradoxically it can be protective, Increased body temp (by one or two degrees) kills many agents and increases white blood cell activity. ! Pain: Often not referred to as a defense mechanism. However, pain is important as a diagnostic tool (direct and referred pain). Also it is a warning device bringing the problem to the attention of our perception.

Bodys Defenses Against Infectious Diseases

! Internal general systemic responses:
inflammatory response: histamine release from mast cells cause swelling (to contain infection or injury) cytokines: e.g. interleukin and interferon: message from infected cells to others to protect selves, stimulate antibody , T and B cell production, inhibits viral reproduction. fever - cytokine pyrogens

Bodys Defenses Against Infectious Diseases

! Internal
Immune Response
" specific to pathogen

Immune Response
1) Recognition:
macrophages consume some of invading organisms, display antigen on their surface = to provide info to rest of immune system about pathogen. Helper T-cells respond

Immune Response
2) Amplification
helper T cells multiply, stimulate production of killer T and B cells cytokines help regulate and coordinate response

Immune Response
3) Killer T cells destroy pathogens and invaded cell
stimulate amplification of inflammation and recruit more macrophages to clean-up cellular response

B-cells produce antibodies to the pathogen's antigens

these bind to Ag and mark pathogen for destruction by macrophages. only works outside cells (humoral response or antibody-mediated)

Immune Response
4) Slowdown by suppressor T cells
clean-up: circulation of blood and lympocytes removes dead cells, killed pathogens etc.

Immunization
! Immunization with vaccines
live-weakened (attenuated) pathogens killed pathogen toxoid (harmless, but similar to toxin produced by pathogen e.g. tetanus)

Rate of antibody production following initial contact with an antigen and subsequent contact with the same antigen.

Types of Immunity
! Natural acquired
active: exposure to antigen passive: contains antibodies e.g. placental, breast feeding (colostrum)

Immune system problems

! Allergy:
immune response to 'non-self' but 'normal' substances such as dust, food, pollen

! Artificial acquired
active: vaccine of live or tamed virus passive: " antibody injection " time limited e.g. gamma globulin.

! Autoimmune diseases:
immune response to self e.g. rheumatoid arthritis, lupus erythmatosis, diabetes type 1

Read in your text about:

! Colds, influenza:
virus constantly changing characteristics so no immunity; treatments not cure

Read in your text about STDs:

! AIDS, gonorrhea, chlamydia, herpes, syphilis, PID, herpes ! Know especially:
can have more than one at a time, little immunity imparted / can get often often less symptomatic in women than men (silent until quite advanced) having had an STD can lead to other diseases, e.g. genital warts (HPV) can lead to cervical cancer.

! Immunity and stress highlight ! Hepatitis

-infectious A: fecal-oral route (food, water) -B form in serum: requires direct contact, can lead to cirrhosis, cancer. -C form in blood: requires direct contact, can lead to cirrhosis, cancer.

HIV/AIDS
! HIV infection:
retrovirus that attacks the immune system CD4 lymphocyte (T4 cell) these are responsible for sending the signals to the Killer T- cells that infection is occurring.

AIDS kills a fraction of the numbers cars, tobacco, heart disease, etc. kill.
! Why are we so concerned?
! infectious disease with no vaccine and no cure ! attacks young

high PYLL
! 40,000 people in Canada with HIV

! AIDS:
when number of CD4 cells falls below 200/mm3

newly infected are younger than the first generation of PWA: median 24 years, vs 30 years in 80's
! while the # of deaths is declining in Canada, the # of people infected is rising (5,000 new cases/year compared with 2500 in early 90s)

Who are the newly infected?

! In late 80s, largely gay men
who quickly took heed of the safe sex message was only 10% women

New HIV cases 1996

! ! ! ! 30% women 37% young gay men 26% aboriginals 38% IDU

! In late 90s, women were 30% of new HIV cases, 10% of AIDS death:
via heterosexual transmission and IV drug use

Treating Newly Infected in Canada

! Most cannot / do not take advantage of new drug therapies
little contact with the health care system often too late by the time they find out they are infected

IDU in Vancouver
! At least 8,000 injection drug users in Vancouver,
IV cocaine is popular " 20-30 hits/day (far more than heroin) 2 new cases of HIV /day among this group. Has overwhelmed the attempts at intervention

! Therapies too cumbersome

30 pills/day, some with food, others without, some need refrigeration (less mobility). Not likely when shooting cocaine 20 times/day, going a week without sleep

Treating Newly Infected

! Drugs cost about $1500/month ! Many with PWHIV or PWA quit their jobs and go on public assistance to qualify for provincial drug plans ! Some refuse the drugs by choice ! These people are shaping the epidemic in Canada and spreading it to the heterosexual population

Vulnerability
! Heterosexual population don't think they are vulnerable to HIV. ! Young gay men believe that it is no longer a killer.

Mortality
! 15,101 AIDS cases in Canada have been reported to authorities since early 80's;
73% have died. annual death toll is 1/5th what it was at its peak in 1993

Most Common AIDS-Related Causes of Death

! Pneumocystis carnii pneumonia (PCP) ! Kaposi's sarcoma
skin cancer / purple lumps or patches

! Brain infection
direct damage to brain cells: confusion, disorientation, etc.

! 61% death rate within 5 years of diagnosis. ! Die from AIDS-related diseases

Stages of HIV/AIDS
1. Window period
when virus replicating and immune system creating antibodies may take 3 months to be detectable on HIV test. this is when the virus is most readily transmitted.

Stages of HIV/AIDS
3. Symptomatic
immune system weakening, minor infections hang on, can last 6 months to 10+ years if treated Don't know who/why some progress to AIDS. Need to look after themselves to delay. Poverty speeds the progression of HIV to AIDS

2. Asymptomatic period
no symptoms but infectious. Can last 8+ years.

4. AIDS: the final stage and most severe form of HIV infection

Transmission
! Transmitted through body fluids:
vaginal, semen, blood, breast milk.

World AIDS
! Read highlight on AIDS infection around the world ! 53.1 million people in world have contracted HIV-AIDS to date; 18.8 million have died ! New cases
in 1989: 1/2 million In 1999: 5.4 million

! Blood to blood; semen to blood ! Easily destroyed outside body by hot soapy water or dilute bleach ! Create antibodies to HIV but they are useless against the virus.
can spread disease before seropositive takes 2-3 weeks to be identified

World AIDS
! ! ! ! ! Most infected: South Africa (4.2 million) Highest infection rate: Botswana: 36% of adults 1/100 sexually active adults infected world-wide 13 million AIDS orphans 95% of global HIV-AIDS infection is in developing world; 70% in sub-Saharan Africa

AIDS in the developing world

! generic pharmaceutical companies can produce treatment for $280/year vs. $10,000 (U.S.) cost of protected multinational products. ! Problem:
Ignorance (esp. lack of education and rights of women) Fear Poverty