INFECTIOUS DISEASES

AETIOLOGY PATHOGENESIS &

CONSEQUENCES

Dr.T.V.Rao MD

infection
dictionary means

Invasion by and multiplication of

pathogenic microorganisms in a
bodily part or tissue, which may
produce subsequent tissue injury and
progress to overt disease through a
variety of cellular or toxic
mechanisms.
b. The pathological state resulting
from having been infected.
a.

Dr.T.V.Rao MD

Definitions

Disease and Infectious Disease

Disease

Any deviation from a condition of

good health and well-being
Infectious Disease

A disease condition caused by the

presence or growth of infectious
microorganisms or parasites
Dr.T.V.Rao MD

Definitions
Pathogenicity and Virulence
Pathogenicity

The ability of a microbe to cause disease

This term is often used to describe or
compare species
Virulence

The degree of pathogenicity in a

microorganism
This term is often used to describe or
compare strains within a species
Dr.T.V.Rao MD

Principles of Infection
Understanding the basic
principles of infection is
essential for any health
care worker in any field
of health care.
1.Disease transmission
2.Prevention of disease
transmission

Nature of Microorganisms
Microorganisms (microbes)
are small, living organisms
that are not visible to the
naked eye.

Pathogens (germs) are

microorganisms that cause
disease.
Non-pathogens are

Infection is the
invasion of a host
organism's bodily
tissues by
disease-causing
organisms, their
multiplication,
and the reaction
of host tissues to
these organisms
and the toxins
they produce.
Infections are
caused by
microorganisms
such as viruses,
prions, bacteria,
and Viroids, and
larger
organisms
Dr.T.V.Rao
MD

Infection means

What is an Infection?
A harmful invasion and spread of foreign
species, or pathogen, in a host.
VIRUS
Small pox, measles, influenza, Ebola

PRIONS
Cows disease

BACTERIA
Tuberculosis, pneumonia, salmonella,
anthrax
FUNGUS
Athletes foot, ring worm
PROTISTS
Malaria, toxoplasmosis, Algae

COURSE OF INFECTIOUS
DISEASEs
Exposure/Invasion
of Host
Incubation -- period
of time between
exposure and onset
of symptoms -e.g., interval
between HIV
infection and
development of
AIDS can be as
long as 10-15Dr.T.V.Rao MD

Nature of Microorganisms

Saprophy
tes
Parasites
Pathogen
s

Causative Agents effecting

humans
Bacteri

a
Viruses
Fungi
Protoz

oa
Helmin

ths
Dr.T.V.Rao MD

Prions

11

Types of Bacteria
Streptococci (chains)
Staphylococci (clusters)
Diplococci (pairs)
Micrococci (tiny)
Flagellated forms (tails)
Bacilli (rod-shaped)
Vibrios
Spirilla (spiral)
Spirochetes (comma)

Types of Microorganisms
Fungi

A plantlike organism that

lives on dead organic
matter.
Yeasts and molds can be
pathogenic.
Cause conditions such as
ringworm, athletes foot,
yeast infections, and
thrush.
Antibiotics do not kill
fungi. Antifungal
medications are available,

Types of Microorganisms

Protozoa
One-celled animal like organisms
often found in decayed materials
and contaminated water.
Many contain flagella which
allow them to move freely.
Cause diseases such as malaria,
trichomonas, and amebic
dysentery.

Types of
Microorganisms
Viruses

Smallest of all microorganisms visible

only using an electron microscope.
Cannot reproduce unless they are
inside another living cell.
Spread by contact with blood and other
body fluids.
Difficult to destroy. Not affected by
antibiotics.
Associated with diseases such as the
common cold, chicken pox, herpes,
hepatitis B, measles, warts, polio,

Classification of Infections
Primary Infection
Reinfection
Secondary Infection,
Focal infection,
Cross infection,
Nosocomial infections
Iatrogenic infection

Source of Infections
Endogenous
infection

Exogenous
infections

Clinical Presentations

In apparent infection
subclinical Infection
In apparent infection,
Atypical infections
Latent infections

Source of Infection

Humans from patient or carrier

A healthy carrier
Convalescent carrier
Temporary carrier
Contact carrier
Paradoxical carrier

Source of Infections
Animals
Insects vectors
Mechanical
vector
Biological vector
Soil and water
Food

MODES OF COMMUNICABLE
DISEASE TRANSMISSION

Direct
Transmissi
on
Indirect
Transmissi
on
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Modes of Transmission
Direct contact
Indirect
contact
Droplet
transmission
Hands
Vector-borne
Nosocomial

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22

Transmission of Pathogens
Direct contact
Indirect contacts
Air
Objects

Vectors

Modes of Transmission
Direct
transmission

Indirect transmission

Direct contact

Airborne

Droplet spread

Vehicle borne
Vector borne

DIRECT TRANSMISSION
Immediate transfer of the disease agent by
direct contact between the infected and the
susceptible individuals
Occurs through such acts as touching, biting,
kissing, sexual intercourse, or by direct
projection (droplet spread) by coughing or
sneezing within a distance of one meter
Examples of diseases for which transmission
is usually direct are AIDS, syphilis,
gonorrhea, and the common cold
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25

INDIRECT TRANSMISSION
May be one of three types: air-borne, vehicleborne, or vector-borne
Air-borne transmission -- transmission of
microbial aerosols to a suitable port of entry,
usually the respiratory tract
Microbial aerosols are suspensions of dust
or droplet nuclei made up wholly or in part
by microorganisms -- may be suspended
and infective for long periods of time
Examples of air-borne diseases include
tuberculosis,Dr.T.V.Rao
influenza,
Histoplasmosis,
and
MD
26

INDIRECT TRANSMISSION
(contd.)

Vehicle-borne transmission -contaminated materials or objects (fomites)

serve as vehicles, nonliving objects by which
communicable agents are transferred to a
susceptible host
The agent may or may not have multiplied
or developed on the vehicle
Examples of vehicles include toys,
handkerchiefs, soiled clothes, bedding, food
service utensils, and surgical instruments
Dr.T.V.Rao MD

27

INDIRECT TRANSMISSION
(contd.)
Also considered vehicles are water,
milk, food (e.g., common vehicles),
or biological products such as blood,
serum, plasma, organs and tissues
Almost any disease can be
transmitted by vehicles, including
those for which the primary mode of
transmission is direct, such as
dysentery and hepatitis

Causing an Infection
Endogenous disease originates

within the body. Ex: metabolic

disorders, congenital abnormalities,
tumors.
Exogenous disease originates outside
the body. Ex: chemical agents,
electrical shock, trauma.
Nosocomial acquired by an individual
in a health care facility (workers to
patient).
Many are antibiotic resistant, lifethreatening.

Signs & Symptoms of Infection

Redness
Swelling
Tenderness
Warmth
Drainage
Red streaks leading away
wound
Dr.T.V.Rao MD

from

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Development of Infection:
Clinical Signs and Symptoms

Local signs
Inflammation
Purulent exudate if bacterial infection;
serous exudate if viral
Tissue necrosis
Lymphadenopathy
Respiratory effects

Systemic signs
Fever, fatigue, headache, nausea
Dr.T.V.Rao MD

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Generalized Stages of Infection

1. Entry of Pathogen
Portal of Entry

2. Colonization
Usually at the site of entry

3. Incubation Period
Asymptomatic period
Between the initial contact with the
microbe and the appearance of the
first symptoms
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32

Generalized Stages of
Infection
4. Prodromal Symptoms
Initial Symptoms

5. Invasive period
Increasing Severity of Symptoms
Fever
Inflammation and Swelling
Tissue Damage
Infection May Spread to Other Sites
Acme (Fastigium)
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Factors predisposing
pathogenicity
Pathogenicity
means ability of
the microbe to
produce disease
or tissue injury
Virulence
May undergo
variation

Virulence and
Pathogenicity
Pathogenicity: capacity of
microbes to cause disease
Virulence: degree of pathogenicity
of specific microbe
Based on:

Invasive qualities
Toxic qualities
Presence of pili or fimbriae for adhesion
Ability to avoid host defenses (mutate)
Dr.T.V.Rao MD

35

Virulence Factors and

Toxins
State of the Host
Immune System
Number of
Pathogenic Cells
encountered by
the Host

Infectious Dose

Dr.T.V.Rao MD

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Virulence Factors
and Toxins
Enzymatic Virulence Factors
Examples:
Coagulase (Staphylococcus aureus)
Streptokinase (Streptococcus
pyogenes)
Hyaluronidase (Many pathogens)
Collagenase (Many pathogens)
Leukocidin (Many pathogens)
Hemolysin (Many pathogens)
Dr.T.V.Rao MD

37

Virulence Factors and

Toxins
Adhesion Factors
Examples:

Protein A
(Staphylococc
us aureus)
Protein M
(Streptococcus
pyogenes)

Dr.T.V.Rao MD

38

Virulence Factors
Virulence factors help bacteria to (1)
invade the host, (2) cause disease,
and (3) evade host defences. The
following are types of virulence
factors:
Adherence Factors: Many pathogenic
bacteria colonize mucosal sites by
using pili (fimbriae) to adhere to cells.

Virulence Factors
Invasion Factors: Surface
components that allow the bacterium
to invade host cells can be encoded
on plasmids, but more often are on
the chromosome.
Capsules: Many bacteria are
surrounded by capsules that protect
them from opsonisation and
phagocytosis

Virulence Factors
and Toxins
Exotoxins
A type of bacterial toxin with the
following properties:
May be produced by either gram-positive or
gram-negative bacteria
Is secreted by the bacteria
The action of the exotoxin does not
necessarily require the presence of the
bacteria in the host
Most exotoxins are peptide or protein
Most exotoxins are heat sensitive (exception:
enterotoxin of Staphylococcus aureus)
Dr.T.V.Rao MD

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Virulence Factors
and Toxins
Exotoxins (cont.)
Classes of exotoxins: Neurotoxic,
cytotoxic, or enterotoxic exotoxins
Neurotoxins: Interfere with proper
synaptic transmissions in neurons
Cytotoxins: Inhibit specific cellular
activities, such as protein synthesis
Enterotoxins: Interfere with water
reabsorption in the large intestine; irritate
the lining of the gastrointestinal tract
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Virulence Factors and

Toxins
Endotoxins
A type of bacterial toxin having the
following properties:
Produced only by gram-negative bacteria
Endotoxins are a component of the gramnegative cell wall
The action of endotoxin requires the
presence of the bacteria in the host. The
endotoxin may be released from the cell
wall as the cells die and disintegrate
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Virulence Factors and

Toxins
Endotoxins (cont.)
Endotoxin is
composed of Lipid A:
Part of the
lipopolysaccharide
layer
Mode of action:
Irritation/inflammatio
n of epithelium, GI
irritation,
capillary/blood vessel
inflammation,
hemorrhaging
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Endotoxins
Endotoxins: The
lipopolysaccharide
endotoxins on Gram-negative
bacteria cause fever,
changes in blood pressure,
inflammation, lethal shock,
and many other toxic events.

Mechanism of Endotoxin
activity

Exotoxins
Exotoxins: Exotoxins include
several types of protein toxins
and enzymes produced and/or
secreted from pathogenic
bacteria. Major categories
include cytotoxins,
neurotoxins, and enterotoxins.

Exotoxins
Exotoxins, unlike the lipopolysaccharide
endotoxin, are protein toxins released from viable
bacteria. They form a class of poisons that is
among the most potent, per unit weight, of all
toxic substances. Most of the higher molecularsized exotoxin proteins are heat labile; however,
numerous low molecular-sized exotoxins are
heat-stable peptides. Unlike endotoxin, which is a
structural component of all Gram-negative cells,
exotoxins are produced by some members of
both Gram-positive and Gram-negative genera.

Exotoxins
The functions of these exotoxins for the
bacteria are usually unknown, and the
genes for most can be deleted with no
noticeable effect on bacterial growth. In
contrast to the extensive systemic and
immune-system effects of endotoxin on
the host, the site of action of most
exotoxins is more localized and is
confined to particular cell types or cell
receptors.

Exotoxins
Tetanus toxin, for example, affects
only intern uncial neurons. In
general, exotoxins are excellent
antigens that elicit specific
antibodies called antitoxins. Not all
antibodies to exotoxins are
protective, but some react with
important binding sites or enzymatic
sites on the exotoxin, resulting in
complete inhibition of the toxic

Exotoxins
Endotoxin is comprised of toxic
lipopolysaccharide components of the
outer membrane of Gram-negative
bacteria (see Ch. 2). Endotoxin exerts
profound biologic effects on the host and
may be lethal. Because it is omnipresent
in the environment, endotoxin must be
removed from all medical supplies
destined for injection or use during
surgical procedures.

Exotoxins
The term endotoxin was coined in 1893 by
Pfeiffer to distinguish the class of toxic
substances released after lysis of bacteria
from the toxic substances (exotoxins) secreted
by bacteria. Few, if any, other microbial
products have been as extensively studied as
bacterial endotoxins. Perhaps it is appropriate
that a molecule with such important biologic
effects on the host, and one produced by so
many bacterial pathogens, should be the
subject of intense investigation.

Other Factors
Plasmids
Bacteriopha
ges
Compatibilit
y

Other Bacterial factors

Coagulase
Fibrinolysin
Hyaluronida
se

Bacterial Appendages
Biofilms
Free floating bacteria come in
contact with medical devices
and attach to them with pili

Infecting Dose

Minimum
infective dose
Minimal lethal
dose

Types of Infectious diseases

Bacteraemia
Septicaemia
Pyemia

Other types
Endemic disease
Epidemic disease
Pandemic disease

Hospital acquired infections

Infection which was
neither present nor
incubating at the time of
admission
Includes infection which
only becomes apparent
after discharge from
hospital but which was
acquired during
hospitalisation (Rcn, 1995)
Also called nosocomial
infection
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Basic steps in Prevention of

Infection
There are possible
treatment and
prevention to stop
the infection cycle.
This is through
adequate hygiene,
sanitary
environment
maintenance and
health education.
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Antimicrobial agents In
Infection
Anti-infective drugs such as antibiotics,
antiviral, antifungal and ant tubercular drugs
suppress infection. It can be administered by
mouth, topically or intravenously depending
on the infection extent and severity.
Sometimes, if drug resistance is known,
multiple drugs are used to stop drug
resistance and increase drug effectiveness.
Antibiotics only work for bacterial infection
and have no effect on viral ones.
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INSPITE OF MANY ADVANCES THERE IS NO

STEP GREATER THAN HAND WASHING IN
CONTROL OF INFECTIOUS DISEASES

 Program Created by Dr.T.V.Rao

MD for Medical and Paramedical
Professional for Global education
on Infectious Diseases
Email

doctortvrao@gmail.com