JORS

Infection Extent of infection

§ Growth & multiplication of microorgansim -> damages their host § Primary infection
§ Bodily invasion -> pathogenic mircoorgansim -> reproduce, multiply - Initial infection
-> diseases through local cellular injury, toxin secretion, antigen-antibody § Secondary infection
reaction -> host - Caused by opportunistic pathogens
§ Entry of organism -> can lead to disease but not always § Latent infection
- Silently inside the body
Types of infection according to cause - No noticeable illness -> severe & acute infection
§ Autogenous infection § Mixed infection
- Microorganism -> microbiota (normal flora) of host - Caused by two or more organisms
§ Iatrogenic infection § Acute infection
- Result of medical treatment or procedure - Develops & progresses slowly
§ Oppotunistic infection § Chronic infection
- Immunocompromised host - Develops slowly with milder but long-lasting symptoms
- Overuse of antibiotics, immunosuppressive drugs, chemotherapy
Ø May cause this infection Route of infection
§ Nosocomial infection § Direct transmission
- Hospital-acquired infection • Congenital contact
- Acquired in healthcare facility Ø S. agalactiae, N. gonorrhoeae, T. pallidum subp. pallidum
- Handwashing -> cornerstone -> modern infection control program • Sexual contact
• Common types Ø N. gonorrhoeae, T. palladium subp. palladium, C. trachomatis
a. Urinary Tract Infection (UTI) • Infectious respiratory droplets or secretions
b. Lung infection (Pneumonia) Ø S. pyogenes, N. meningitidis
c. Surgical site infection • Hand-to-hand transmission
d. Blood stream infection Ø Rhinovirus
• Predispoing factors § Indirect transmission
a. Hospital environment • Fomites
b. Weakened or immunocompromised patients • Water
c. Chain of transmission Ø Shigella, Salmonella, Vibrio
o Health workers -> patient • Anthropod vectors
o Patient -> patients Ø Borrelia, Francisella, Yersinia
o Use of fomites
- Fomites: objects or materials that are likely to carry infection, Disease
such as clothes, utensils, and furniture. § Specific illness/disorder that is characterized by a recognizable set of
Ø Catheters, needles, dressings, beds, wheelchair signs & symptoms -> heredity, infection, diet or environment
o Airborne transmission § Product of infection
- Tuberculosis = inhalation of droplets ≤ 5𝜇m
- Pertussis = inhalation of droplets > 5𝜇m Classifications of infectious disease
o Vector-borne transmission § Communicable/contagious disease
- From one host to another -> directly or indirectly
Types of infection according to host distribution § Non-communicable disease
§ Local infection - Does not spread from one host to another
- One area - External microbes or opportunistic pathogens
- Specific organ
§ Focal infection Classifications of disease according to occurence
- Local infection -> other parts of body § Sporadic disease
§ Systemic infection/generalized infection - Occurs occasionally
- Multiple organs § Endemic disease
- Throughout the body - Constantly present in a particular location
- Blood -> lymph - Always present
• Types of systemic infection § Epidemic disease
a. Bacteremia - Affects a large number of people in a given population within a
- Bacteria in blood short span of time
- Without active multiplication (inactive) - Rapidly spreading
- Highest concentration -> fever spike § Pandemic disease
b. Septicemia - Affects populations across large regions around the world
- Bacteria in blood -> harms the host - Spread worldwide (global)
- Active multiplication
c. Pyemia Effects of infectious disease
- Pus in blood § Signs – measured
- Repeatedly invaded § Symptoms – subjective
d. Toxemia § Syndrome – group of signs & symptoms -> associated with disease
- Toxins in blood
- Localized in one area -> toxins -> spread -> absorbed by cells

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Phases of infectious disease Host resistance factors
§ Incubation period – time between exposure and onset § Physical barriers
§ Prodromal period – apperance of signs & symptoms - Skin
§ Clinical or illness period – peak of signs & symptoms • Physical & chemical barrier
§ Decline period – signs & symptoms begins to subside -> improving • First line of protection
§ Convalescence/period of recovery – recurpirating -> full recovery o Acellular - outermost layer of skin
o Tightly packed cellular layer underneath
Predisposing factors Ø Impenetrable physical barrier
§ Gender § Cleansing mechanism
§ Environment
§ Genetic factors - Nasal hairs -> keeps out airborne particles -> contains
§ Lifestyle
§ Climate & weather microorganism
§ Age
§ Nutrition - Cough-sneeze reflex -> removal of potentially infective agents
§ Occupation
§ Fatigue/stress - Cilia -> lining of trachea -> traps mucus & microorganism ->
upward & away from delicate cells of lungs
General classes of pathogenic microorganisms § Antimicrobial substances
§ True pathogens - Lysozymes -> destroy cell wall
- Invade the tissue of healthy individuals -> inherent ability causing various - Bile salt -> disrupt membranes
disease § Indigenous/Normal microbial flora/microbiota
- Outside the host - Found in or on the body sites of healthy host
§ Opportunistic pathogens - Accurate to prefer -> microbiota to the population of
- Does not cause disease -> natural habitat -> healthy host microorganism than microbial flora
- Immunocompromised • Types of microbiota
- N. meningitidis o Resident microbiota
• Harmless in respiratory tract - Temporarily inhabits, multiplies, colonizes for
• Meningitis months/years
- E. coli o Transient microbiota
• Urinary Tract Infection (100,000CFU/mL) - Inhabits, does not multiplies, colonizes an area -> until
eliminated -> host’s inherent immune defense or
Host-microbe relationship competition with resident microbiota
§ Symbiosis - two different organisms living in close proximity • Body sites & respective microbiota
§ Mutualism - benefits from each other o Skin – Staphylococci, Propionobacteria, C. diptheria
§ Commensalism - one organism benefits while the other is not harmed (diptheroids)
§ Parasitism - one organism is parasite & benefits at the expense of the host o Mouth & oral cavities – Viridans streptococci
o Upper respiratory tract – Viridans streptococci, diptheroids,
Ø Biofilm production S. epidermidis
- Complex interactions: o Nasopharynx – S. aureus, S. epidermidis, N. meningitidis,
Host + indwelling device + bacteria = bacterial pathogenesis H. influenzae, S. pneumoniae
Ø Pathogenicity o Colon – E. coli, bacteroids, lactobacilli
- Ability of the pathogenic agent to produce disease in a susceptible host o Urethra – diptheroids, S. epidermidis, Alpha- & non-
hemolytic streptococci
Virulence v Microorganisms usually does not reproduce -> eosophagus &
§ Ability of the microorganism to cause disease stomach -> present as transient microbiota -> contaminated
§ Degree of pathogenicity food
§ Very pathogenic microorganism/rapidly progressive condition v Kidneys, fallopian tubes, bladder -> normally sterile/free of
- High virulence factor microorganisms
§ Organism -> establish infection -> relatively low infective dose -> § Phagocytosis
considered more virulent than those who requires high doses - Phagocytes -> engulf & dispose -> microorganisms & cell debris
- Endocytosis = phagocytes (Polymorphonuclear leukocytes &
Factors influencing microbial virulence macrophages) -> ingests & destroys -> bacteria & foreign
§ Toxic factors materials
- Substances -> produced -> tissue & cellular damage § Inflammation
§ Enzymatic factors - Reinforcement mechanism -> microbial survival & proliferation
• Produced - aid in spread of infection & disease in tissue & organs
• Hyaluronidase - spreading factor (Duran Reynal factor) - Swelling, redness, burning sensation, pain = affected area
• Coagulase - clot formation - Components of inflammation = phagocytes, complement
• Leukocidin - kills WBC (Panton Valentine) system, coagulation system, cytokines
• Collagenase - breaks the peptide bond in collagen
• Streptokinase/staphlyokinase - dissolves clot
• Hemolysin - lyze RBC
• Lecithinase - causes myonecrosis & hemolysis
• Dnase - destroys DNA
• Lipase - fat splitting ezyme
§ Cellular structure
- Capsule resists phagocytosis

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§ Immune response § Production of toxins
- Ability to create specific protective response against microorganism • Exotoxin
- Immune system -> memorizes -> encountered microorganism -> - One of the most lethal
immune-mediated defensive response -> immediately available - Gram positive
- Normal immune system -> removes bacteria -> blood -> 30-45mins - Do not require bacterial death
- Host’s immune response -> reduced or altered -> immunosuppressive - Do not produce fever
drugs, chemotherapy, radiation - Secreted or excreted -> living microorganisms
• Types of specific immunity - Cytotoxin, neurotoxin, enterotoxins
o Humoral (antibody-mediated) immunity - C. botulinum, C. diptheriae, S. aureus, S. pyogenes
- Action of soluble proteins (antibodies) occurs in the body fluids & • Endotoxin
plasma membrane of B-lymphocytes - Composed of lipopolysaccharide
o Cellular (cell-mediated) immunity - Gram negative
- Action of specific kinds of T-lymphocytes -> directly attack -> - Bacteria needs to die to release the toxins via lysis
infected cells -> viruses, parasites, cancer cells, transplanted cells - Produces fever center in the hypothalamus
- Toxicity -> lipid A of lipopolysaccharide
Ø Active immunization - Elicits
- Protection of susceptible humans & domestic animals from communicable a. Fever
diseases -> administration of vaccines b. Chills
- Vaccines -> prepared from living weakened (attenuated), killed c. Hypotension
microorganisms, inactivated bacterial toxins (toxoids), purified d. Granulacytosis
macromolecules, recombinant vectors, DNA vaccines e. Thrombocytopenia
Ø Acquired active immunity f. Disseminated intravascular coagulation
- Specific response of the host to an invading organisn - Endotoxic shock -> gram negative septicemia
Ø Anamnestic response - Changes in:
- Ability of b-lymphocytes to recall pathogens during the primary encounter a. Blood pressure
leading to higher antibody response b. Clotting
Ø Antigenic shift c. Body temperature
- Major genetically determined change in the antigenic property of organism d. Blood cell circulation
-> becomes unrecognizable -> host’s immune system e. Metabolism
Ø Antigenic drift f. Humoral & cellular immunity
- Minor antigenic change -> result of mutation in the strain g. Infection resistance
Ø Complement-fixing antibodies
- Attached to the surface of pathogen -> kill via lysis Development of fever
Ø Natural (innate) immunity • Endotoxin
- Non-specific response -> activates chemotaxis • Peptidoglycan
- Phagocytes -> site of replecation -> engulf -> invading organisms • Cytokines
Ø Neutralizing antibodies • Interlukin-1 & tissue necrosis factor
- Attached to the surface of pathogen -> block surface receptors • Acute phase reactants
Ø Passive immunization
- Transient type immunization § Invasion
- Without fully activating the host’s immune system -> create -> - Process of penetrating & growing in tissues
corresponding antibodies to diseases - Some organisms -> only few layers of cells; other -> deep-tissue
- Does not require the participation of the recipient penetration
- Lasts until the transferred antibodies remain -> recipient’s body § Dissemination
Ø Opsonizing antibodies - Spread of microorganism to distant body sites
- Attached to the surface of pathogen -> renders -> phagocytosis - Certain organism -> survive phagocytosis -> rapidly disseminated
to body sites
Infectious agents factors
§ Adherence Routes of transmission
- Microorganism -> penetrates -> mucous layer -> attach to epithelium § Airborne transmission
- Host cell -> produce necessary receptors -> adhesion - Respiratory spread of infectious disease -> common
- Main adhesins: common pili (fimbriae), surface polysaccharides - Secretions -> aerolized -> coughing, sneezing, talking
§ Proliferation - Tuberculosis, brucellosis, tularemia, legionellosis, plague
- Establish & cause the disease -> pathogen -> must multiply - Less common & more serious -> lower respiratory tract
- Inhibits proliferation: secretory antibody, lactoferin, lysozyme - More common & less serious -> upper respiratory tract
- Evasion of phagocytosis -> essential for most pathogens -> survive & - Droplet nuclei
reproduce o Small residues from larger droplets
§ Tissue damage o Light enough to remain airborne for long period
- Preformed toxin (C. botulinum, B. cereus, S. aureus) - Some transmitted by dust particles
- Disruption of the normal function of intestinal cells ( E. coli, V. cholerae, - Streptococcal sore throat, sinusitis, acute epiglottis, diptheria
Shigella & Salmonella) § Transmission by food & water
- Disease or infection -> noticeable if tissue damage occurs - Fecal-oral route
- Gastric enzymes & juices -> prevents survival of most organisms
§ Close contact
- Passage of organism through salivary glans, skin, genital contact

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§ Cuts & bites
- Causes infections through normal oral microbiota
§ Anthropods
- Multiply within the anthropod -> transmitted to host
§ Zoonoses
- Depend on the contact with animals or animal by-products
- Passed through anthropod vectors, contact with secretions, contact with
animal carcasses & by-product

Epidemiology
§ Study of occurrence, distribution, causes of disease & injury

Factors contributing to epidemielogy
§ Carrier
- Person or animal that harbors & spread the microorganism -> causes the
disease but does not become ill
• Types of carrier
a. Casual/acute/transient – temporarily for few days/weeks
b. Chronic – relatively long time sometimes throughout the entire life
c. Convalescent – recovered but continious to harbor large number of
pathogen
d. Active – overt clinical case of the disease
§ Likelihood of becoming endemic
- Indigenous to and/or constantly present in a geographic
area/population
- Constantly present in a population
§ Likelihood of becoming epidemic
- Significantly large number in a short period of time in a geographic area
- Influeanza -> classic cause of epidemic
§ Likelihood of becoming pandemic
- Affects huge population across large regions like several countries or
continent
§ Incidence rate
- Number of times a new event occurs in a given period
§ Incubation period
- Time between the exposure to the onset of symptoms
- Host may be infectious at this period
§ Morbidity rate
- Number of cases of disease in a specified population during a defined
time interval
§ Mortality rate
- Number of death due to disease in a population
§ Reservoir
- Source of infection -> person, animal, any objects from the environment

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