I.

Categories of Human Behavior

A. preventive health behavior - patient is infected but doesnt showsigns and symptoms yet
and is making ways to prevent the progression of the disease
B. Illness behavior - individual is perceiving himself to be ill.
C. Sick role - he cant perfor his activities of daily living and assume himself as sick. He is
dependent to others in terms of support and healing. He begins to consult experts of
the disease (physicians) and considers the possibility of hospitalization and to be
recepient of health care services.

II.

The Six stages of infection

The process through which microorganisms cause disease involves several or all of the following
stages:
1.
2.
3.
4.
5.
6.

Encounter
Colonisation
Penetration
Spread
Damage
Resolution

Encounter with microorganisms

Initial contact with a given microbial species is critically important. The indigenous
microbial flora is already present on the body surface. Infections acquired from this pool of
organisms are said to be endogenous (example: Urinary Tract Infection). Organisms acquired as
a result of transmission from an external source are said to be exogenous. The major routes of
transmission are:

Direct contact (including intimate sexual contact) Soft tissue infections, gonorrhoea,
genital herpes
Inhalation/ Droplet infection- Common cold, pneumonia
Ingestion/ fecal-oral route- Gastroenteritis
Inoculation or trauma- Tetanus, Malaria
Transplacentally- Congenital toxoplasmosis

Colonisation
The initial encounter with a new microbial species may result in nothing more than
short-lived contact with an external body surface. The microorganism needs to survive and multiply
under local conditions to establish itself in its new habitat. It must successfully compete against an
established indigenous microbial flora and resist local defence mechanisms, some produce
mucolytic enzymes and specific adhesins. Once established on a body surface, an organism is said to
have colonised that site. However, not all organisms that colonize will go on to invade and damage
underlying host tissues.
Penetration of anatomical barriers
In order to invade living human tissues, a microorganism must breach surface barriers.
In the case of the skin, bacteria probably do not penetrate intact surfaces. Infection thus requires a

break in the epithelial cover due to trauma, surgical wounds, chronic disease or insect bites. Some
parasites can penetrate intact skin. The respiratory tract is continuously exposed to air-borne
organisms. However, the upper respiratory tract functions as a filter system and protects lungs from
exposure to inhaled particles. The cough reflex and the mucociliary escalator provide back-up,
expelling any particles inhaled into the airways. Infective particles (droplet nuclei, less than 5m in
dm.) may reach the alveoli and establish infection. In the gastrointestinal tract, some disease
causing organisms damage the mucosal surfaces by releasing cytotoxins. Only a small group of
organisms cause infection in the mother during pregnancy and can also traverse the placenta to
cause intrauterine infections such as toxoplasmosis, rubella, syphilis and cytomegalovirus infection.
Spread
An invading microorganism may spread by one or more routes: direct extension through
surrounding tissues, along tissue planes or via the veins and lymphatic vessels. The vascular route of
spread is a particularly effective means of delivering organisms from an initial focus to distant sites
around the body. As the organisms spread, evasion of host defences becomes increasingly
important.
Mechanisms of damage
Microorganisms damage tissues by a variety of mechanisms:

bulk effect- bulk of organisms may obstruct a hollow organ, e.g. some helminth infections of
the intestine.
toxin mediated- tetanospasmin: tetanus; botulinum toxin: botulism; cholera toxin: cholera;
diphtheria toxin: diphtheria.
altered function of host systems- Microbial invasion can change the function of organs,
tissues or cells. These changes can be the result of physiological mechanisms acting to
remove the infective agent, e.g. increased bowel motility leading to diarrhoea, or coughing
and sneezing.
host response to infection- damage due to swelling, increased fragility of tissues, formation
of pus, scarring or necrosis

III.

What factors makes an organism capable of producing an infection?

1. Infectivity- ability to gain access and adapt to the human host to the extent of finding
lodgment and multiplication. This is dependent on such factors as viability, portal of
entry, body defences and susceptibility of the host.
2. Pathogenicity- ability of an agent when lodged in the body to set up specific reaction,
local or general, clinical or subclinical. Inoculum size or dose is important; there is a
dose-response relationship. For example, it takes the ingestion of 100,000 salmonella
organisms to cause disease as compared to 100 shigella organisms, which represents a
1,000-fold difference.
3. Virulence- refers to the severity of reaction produced usually measured in terms of
fatality. As an infectious organism passes from one susceptible host to another, its
virulence usually increases, especially if it has a low antigenicity. Conversely, if it passes
from an immune host to another immune host, its virulence becomes attenuated.

IV.

How can a disease transmission be stopped and portal of exit be blocked?

Knowledge of the portals of exit and entry and modes of transmission provides a basis
for determining appropriate control measures. In general, control measures are usually
directed against the segment in the infection chain that is most susceptible to intervention,
unless practical issues dictate otherwise.
Some interventions are directed at the mode of transmission. Interruption of direct
transmission may be accomplished by isolation of someone with infection, or counseling
persons to avoid the specific type of contact associated with transmission. Vehicleborne
transmission may be interrupted by elimination or decontamination of the vehicle. To
prevent fecal-oral transmission, efforts often focus on rearranging the environment to
reduce the risk of contamination in the future and on changing behaviors, such as
promoting handwashing. For airborne diseases, strategies may be directed at modifying
ventilation or air pressure, and filtering or treating the air. To interrupt vectorborne
transmission, measures may be directed toward controlling the vector population, such as
spraying to reduce the mosquito population.
Some strategies that protect portals of entry are simple and effective. For example, bed
nets are used to protect sleeping persons from being bitten by mosquitoes that may
transmit malaria. A dentists mask and gloves are intended to protect the dentist from a
patients blood, secretions, and droplets, as well to protect the patient from the dentist.
Some interventions aim to increase a hosts defenses. Vaccinations promote development
of specific antibodies that protect against infection. On the other hand, prophylactic use of
antimalarial drugs, recommended for visitors to malaria-endemic areas, does not prevent
exposure through mosquito bites, but does prevent infection from taking root.
Finally, some interventions attempt to prevent a pathogen from encountering a
susceptible host. The concept of herd immunity suggests that if a high enough proportion of
individuals in a population are resistant to an agent, then those few who are susceptible will
be protected by the resistant majority, since the pathogen will be unlikely to find those
few susceptible individuals. The degree of herd immunity necessary to prevent or interrupt
an outbreak varies by disease. In theory, herd immunity means that not everyone in a
community needs to be resistant (immune) to prevent disease spread and occurrence of an
outbreak. In practice, herd immunity has not prevented outbreaks of measles and rubella in
populations with immunization levels as high as 85% to 90%. One problem is that, in highly
immunized populations, the relatively few susceptible persons are often clustered in

subgroups defined by socioeconomic or cultural factors. If the pathogen is introduced into

one of these subgroups, an outbreak may occur.
V.

What is the most significant and most commonly observed infection-causing agent in
health care institutions? Explain.
Nosocomial Infections acquired within a care unit, may be related to various agents
(Bacteria, virus, fungi, parasites...). Bacteria, mainly Enterobacteria, Staphylococcus and
Pseudomonas. Multiresistant Bacteria could be sometimes associated to nosocomial
infections and severe infections. Among Nosocomial Virus: VRS, Rotavirus, Hepatitis B and C
Viruses, HIV, Influenza Virus are cited. Fungal Agents (Aspergillus, Candida), Plasmodium,
Non Conventional Agents (Prions) are also causative agents of Nosocomial Infection.

VI.

Discuss the cycle of infection.

The following are required to produce an infectious disease:

1. Etiologic Agent- an agent that can produce an infectious disease.
2. Reservoir- must exist where the biologic agent can propagate, live, multiply, and die in a
natural state.
3 kinds of reservoirs:
A. Humans
-symptomatic
-asymptomatic/ carriers
4 types of carriers:
>Subclinical cases- patients who never develop clinical symptoms of disease.
>Incubatory carriers- patients incubating a communicable disease may transmit
infection shortly before they become symptomatic (example: chickenpox)
>Convalescent carriers- patients who recovered from an acute illness may shed
the organism, particularly in cases of enteric infections caused by salmonella and shigella.

>Chronic carriers- may transmit the infection for a long period of time, usualy
over 1 year. Salmonella typhi, Hepatitis B virus can cause lifelong infections.
B. Animals (zoonoses)- rabies, leptospirosis
C. Environment certain biologic agents such as Cryptococcus neoformans live in the
environment
3. Portal of exit- by which the biologic agent exits to cause disease
A. Respiratory tract- spread by coughing, sneezing
B. Genito-urinary tract- via urine and secretions from the genital tract (example:
leptospirosis from urine of infected animals, STDs in secretions)
C. Alimentary tract- via the saliva or the lower gastrointestinal route.
D. Skin- superficial lesions, such as lesions of impetigo, syphilis, and chickenpox, can be
dislodged easily; or via percutaneous route through breaks in the skin, insect bites, and needles.
E. In utero transmission- transmitted from the mother across the placenta to the
developing fetus.
4. Mode of transmission- mechanism by which an infectious agent is transferred from reservoir
to a susceptible host. An organism can be transmitted directly or indirectly. Here is one classification:

Direct
Direct contact
Droplet spread
Indirect
Airborne
Vehicleborne
Vectorborne (mechanical or biologic)

In direct transmission, an infectious agent is transferred from a reservoir to a susceptible host by direct
contact or droplet spread. Direct contact occurs through skin-to-skin contact, kissing, and sexual
intercourse.
>Direct contact also refers to contact with soil or vegetation harboring infectious organisms.
>Droplet spread refers to spray with relatively large, short-range aerosols produced by sneezing,
coughing, or even talking. Droplet spread is classified as direct because transmission is by direct spray
over a few feet, before the droplets fall to the ground. Pertussis and meningococcal infection are
examples of diseases transmitted from an infectious patient to a susceptible host by droplet spread.
Indirect transmission refers to the transfer of an infectious agent from a reservoir to a host by
suspended air particles, inanimate objects (vehicles), or animate intermediaries (vectors).

>Airborne transmission occurs when infectious agents are carried by dust or droplet nuclei suspended in
air. Airborne dust includes material that has settled on surfaces and become resuspended by air
currents as well as infectious particles blown from the soil by the wind. Droplet nuclei are dried residue
of less than 5 microns in size. In contrast to droplets that fall to the ground within a few feet, droplet
nuclei may remain suspended in the air for long periods of time and may be blown over great distances.
Measles, for example, has occurred in children who came into a physicians office after a child with
measles had left, because the measles virus remained suspended in the air.
>Vehicles that may indirectly transmit an infectious agent include food, water, biologic products (blood),
and fomites (inanimate objects such as handkerchiefs, bedding, or surgical scalpels). A vehicle may
passively carry a pathogen as food or water may carry hepatitis A virus. Alternatively, the vehicle may
provide an environment in which the agent grows, multiplies, or produces toxin as improperly canned
foods provide an environment that supports production of botulinum toxin by Clostridium botulinum.
>Vectors such as mosquitoes, fleas, and ticks may carry an infectious agent through purely mechanical
means or may support growth or changes in the agent.

5. Portal of entry- the route by which the agent enters the host to cause a disease
6. Susceptible host- a host is an individual exposed to the disease agent, and if proper conditions
for the agent of disease to infect the host are fulfilled, he affords subsistence to the agent and becomes
infected.

An infection will only develop if this chain is intact. As Health Practitioners, we should follow control
practices to break the chain so that infection wont ensue.

Group
Kiti kiti
Members:
Alvin Lorenzana
Sheila Joy Binlingan
Janelle Marquez
Marife Caranguian
Michelle Kimberly Tavas