PRINCIPLES OF EPIDEMIOLOGY

PATHOGEN – disease causing microorganisms

PATHOLOGY – scientific study of disease (pathos = suffering and logos = science)

ETIOLOGY – cause

PATHOGENESIS – manner of development

INFECTION – invasion or colonization of the body by pathogenic microorganisms

DISEASE – occurs when an infection results in any change from a state of health

NORMAL MICROBIOTA5

- Normal flora
- Permanent resident of the body that do not produce disease under normal conditions
- Escherichia coli in colon
- Staphylococcus aureus on skin

1. MICROBIAL ANTAGONISM
- competitive exclusion
- Normal microbiota preventing the overgrowth of harmful microorganisms
- Disruption of this balance can result to disease
- Control of Candida Albicans by normal flora
- Production of bacteriocin by E. coli to prevent the growth of other microbes
- Growth of Clostridium Difficile in the colon during antibiotic use
2. COMMENSALISM
- One benefit from the other but does not harm it that lives on secretions and slough off cells but has no
benefit nor harm for the host
3. MUTUALISM
- Both organisms benefit from each other
- E. coli in colon that synthesize Vitamin K. and some B Vitamins and the colon in return provides
nourishment with the E.coli
4. PARASITISM
- One organism is benefited by deriving nutrients at the expense of another

OPPORTUNISTIC MICROORGANISMS

- Usually do not cause disease in their normal habitat in a healthy person but may not do so in different
environment
- E. coli that gained access to urinary system
- Pneumocystis jiroveci (Carinii) in person with AIDS
- Neisseria Meningitidis – a normal flora of the respiratory tract can cause meningitis
- Streptococcus pneumonia – common in nose and throat but can cause pneumonia

CLASSIFYING INFECTIOUS DISEASE

SYMPTOMS

- “subjective” changes not apparent to an observer

- Overt

SIGNS

- “objective” changes an observer can see and measure

- Overt
SYNDROME

- Group of signs and symptoms

1. COMMUNICABLE DISEASE
- Disease that spreads from one host to another directly or indirectly
- Dengue, pneumonia, genital herpes, etc.
2. CONTAGIOUS DISEASE
- Diseases that are easily transmitted from one person to another
- Measles, SARS, MERS-Cov

ACCORDING TO OCCURRENCE

A. INCIDENCE
- Number of people in a population who develop a disease in a given time
B. PREVALENCE
- Number of people in a population who develop a disease at a specified time, regardless when it first
appears

FREQUENCY

A. SPORADIC DISEASE
- Occurs occasionally
- Rabies, tetanus, typhoid
B. ENDEMIC DISEASE
- Disease constantly present in a population
- Malaria in Palawan
C. EPIDEMIC DISEASE
- Occur in a greater number than what is expected in a given area over a specific time
- Dengue, influenza
D. PANDEMIC DISEASE
- Occurs worldwide, affects continents and countries
- SARS, AIDS, Zika virus

ACCORDING TO SEVERITY AND DURATION

A. ACUTE DISEASE
- Develops rapidly but lasts only a short time
- Influenza
B. CHRONIC DISEASE
- Develops slowly, body reaction may be less severe but is likely to be continual or recurrent for long
periods
- Tuberculosis, hepatitis
C. SUB-ACUTE DISEASE
- Intermediate between acute and chronic
- Sub-acute sclerosing panencephalitis
D. LATENT DISEASE
- Causative agent remains inactive for a time but then become active to produce symptoms of a disease
- Shingles (varicella zoster)
- HERD IMMUNITY – many immune people are present in a community

ACCORDING TO EXTENT OF HOST INVOLVEMENT

A. LOCAL INFECTION
- Invading microorganisms are limited to a small area of the body
- Boils and abscesses
B. SYSTEMIC (GENERALIZED) INFECTION
- Microorganisms or their products are spread throughout the body by the blood or lymph
- Measles
 C. FOCAL INFECTION
- From local infection, then spread to other specific parts of the body
- Tonsils, teeth, sinuses
D. SEPSIS
- Toxic inflammatory condition arising from the spread of microbes from a focus of infection
E. SEPTICEMIA
- Blood poisoning
- Systemic infection arising from multiplication of pathogen in the blood
 BACTEREMIA – bacteria in the blood
 TOXEMIA – toxins in the blood
 VIREMIA – viruses in the blood
F. PRIMARY INFECTION
- Acute infection that causes initial illness
G. SECONDARY INFECTION
- Caused by an opportunistic pathogen after the primary infection weakened the body’s defenses
H. SUBCLINICAL (INAPPARENT) INFECTION
- Does not cause any noticeable illness

STAGES OF ILLNESS

1. INCUBATION PERIOD
- Time interval between initial infection and the first appearance of signs and symptoms
2. PRODROMAL PERIOD
- Characterized by early, mild symptoms of disease
3. PERIOD OF ILLNESS
- Person exhibits overt signs and symptoms of the disease
- Disease is most severe
4. PERIOD OF DECLINE
- Signs and symptoms subside
5. CONVALESCENT PERIOD
- Person regains strength and body returns to pre-diseased state

PHASES OF ILLNESS

CHAIN OF INFECTION

CAUSITIVE AGENT – any microbe capable of producing disease (bacteria, virus, fungi, protozoa, etc.)

RESERVOIR OF INFECTION – where organisms survive and multiply

PORTAL OF EXIT – path through which the organism leaves the reservoir (Respiratory tract, GUT, GIT, skin mucus
membrane)
MODE OF TRANSMISSSION

- Means by which the infectious agent passes through from portal of exit to the susceptible host (easiest link to
break)
1. CONTACT TRANSMISSION
A. DIRECT (person to person)
B. INDIRECT (contaminated object/ fomites)
C. DROPLET SPREAD (respiratory secretions that settles on surface)
2. AIR-BORNE TRANSMISSION
- Microbes remain suspended in the air for prolonged period
3. VEHICLE TRANSMISSION
- Spread through articles or substances that harbor the microorganism
4. VECTOR-BORNE TRANSMISIION
- Occurs when intermediate carriers transfer the microbes to another living organism
a. Biological
b. Mechanical

CLASSIFICATION OF MICROORGANISMS

TAXONOMY

- Gr. Word – orderly arrangement

- Science of classification of living forms

SCIENTIFIC NOMENCLATURE

- Every organism is assigned two names (Binomial Nomenclature)

A. GENUS
- Always capitalized
- Always a noun
B. SCIENTIFIC EPITHET (species)
- Lowercase
- Adjective
1. HOMO SAPIENS
a. Genus – Homo (male)
b. Species – sapiens (wise)
2. KLEBSIELLA PNEUMONIA
a. Genus – Klebsiella (honors bacteriologist Edwin Kleb)
b. Species – pneumonia (the disease it causes)
3. STREPTOCOCCUS PYOGENES
a. Genus – Streptococcus (cells in chain)
b. Species – pyogenes (from pus – pyo)

TAXONOMIC HEIRARCHY

1. Domain (related kingdom)

2. Kingdom (related phyla or divisions)
3. Phylum (related classes)
4. Class (similar order)
5. Order (similar families)
6. Family (related genera)
7. Genus

CLASSIFICATIONS OF PROKARYOTES

1. Bacteria
2. Archea
CLASSIFICATION OF EUKARYOTES

1. Kingdom Fungi
a. Unicellular
b. Yeasts
c. Molds
d. Mushrooms
2. Kingdom Plantae
a. Algae
b. Mosses
c. Ferns
d. Conifers
e. Flowering
f. Plants
3. Kingdom Animalia
a. Sponges
b. Worms
c. Insects
d. Animals (vertebrates)

CLASSIFICATION OF VIRUSES

- Family banes end in -viridae followed by virus