Introduction to infectious disease

By
Wipawan Sirigulpanit (Ph.D)

Definitions and Terms

Disease a pathological condition of body
parts or tissues characterized by an identifiable
group of signs and symptoms.
Infectious disease disease caused by an
infectious agent such as a bacterium, virus,
protozoan, or fungus that can be passed on to
others.

 Infection occurs when an infectious agent

enters the body and begins to reproduce; may
or may not lead to disease.
Infectivity- the ability of an organisms to enter,
survive and multiply in the host.
Infectiousness of disease- indicates the
comparative ease with which the disease is
transmitted to other hosts.

 Pathogen an infectious agent that causes

disease.
Host an organism infected by another
organism.
Virulence the relative ability of an agent to
cause rapid and severe disease in a host.

Transmission of Infectious Diseases

Agents that cause infectious diseases can be
transmitted in many ways.
Through the air
Through contaminated food or water
Through body fluids
By direct contact with contaminated objects
By animal vectors such as insects, birds, bats,
etc.

Phases of infectious diseases

Incubation period time between infection and
the appearance of signs and symptoms.
Prodromal phase mild, nonspecific symptoms
that signal onset of some diseases.
Clinical phase a person experiences typical signs
and symptoms of disease
Decline phase - subsidence of symptoms.
Recovery phase symptoms have disappeared,
tissues heal, and the body regains strength.

Classification of infectious diseases

By duration
- Acute develops and runs its course quickly.
- Chronic develops more slowly and is usually less
severe, but may persist for a long, indefinite period of
time.
- Latent characterized by periods of no symptoms
between outbreaks of illness.
By location
- Local confined to a specific area of the body.
- Systemic a generalized illness that infects most of the
body with pathogens distributed widely in tissues.

By timing
- Primary initial infection in a previously healthy
person.
- Secondary infection that occurs in a person
weakened by a primary infection.
By symptom/evidence/appearence
- Symptomatic- patient experiencing symptoms
(clinical)
- Asymptomatic- patient is not experiencing any
symptoms (subclinical)

Infectious Agents
MOST infectious agents that cause disease are
microscopic in size an thus are called Microbes
(or) Microorganisms:
Different groups of agents that cause disease are:
- Bacteria
- Viruses
- Protozoa (Protists)
- Fungi
- Helminthes
- Prions

DIAGNOSING INFECTIOUS AGENTS

Some infectious agents or their products can be
directly observed in hematoxylin and eosinstained
sections .
Many infectious agents are best visualized by special
stains that identify organisms on the basis of particular
characteristics of their cell wall or coat Gram, acid-fast,
silver, mucicarmine, and Giemsa stainsor after labeling
with specific antibody probes.
Regardless of the staining technique, organisms are
usually best visualized at the advancing edge of a lesion
rather than at its center, particularly if there is necrosis.

Techniques

Infectious Agents

Gram stain

Most bacteria

Acid-fast stain

Mycobacteria

Silver stains

Fungi, legionellae, pneumocystis

Periodic acid-Schiff

Fungi, amebae

Mucicarmine

Cryptococci

Giemsa

Campylobacteria, leishmaniae, malaria

parasites

Antibody probe

All cases

Culture

All cases

DNA probes

All cases

Serological and nucleic acid detection

tests
Acute infections can be diagnosed serologically by
detecting pathogen-specific antibodies in the
serum.
Nucleic acidbased tests.
Nucleic acid amplification tests, such as
polymerase chain reaction (PCR) and transcriptionmediated amplification, have become routine for
diagnosis of gonorrhea, chlamydial infection,
tuberculosis, and herpes encephalitis.

TRANSMISSION AND DISSEMINATION

OF MICROBES
Microbes can enter the host by inhalation,
ingestion, sexual transmission, insect or animal
bites, or injection.
The first defenses against infection are intact
skin and mucosal surfaces, which provide
physical barriers and produce antimicrobial
substances.

 In general, respiratory, gastrointestinal, or

genitourinary tract infections that occur in
healthy persons are caused by relatively virulent
microorganisms that are capable of damaging or
penetrating intact epithelial barriers.
In contrast, most skin infections in healthy
persons are caused by less virulent organisms
entering the skin through damaged sites (cuts
and burns).

HOW MICROORGANISMS CAUSE

DISEASE
They can contact or enter host cells and
directly cause cell death.
They may release toxins that kill cells at a
distance, release enzymes that degrade tissue
components, or damage blood vessels and
cause ischemic necrosis.

 They can induce host immune responses that,

though directed against the invader, cause
additional tissue damage.
They are necessary to overcome the infection
but at the same time may directly contribute to
tissue damage.

Mechanisms of Viral Injury

Viruses can directly damage host cells by
entering them and replicating at the host's
expense.
The predilection for viruses to infect certain
cells and not others is called tropism and is
determined by several factors, including

1)expression of host cell receptors for the virus,

(2)presence of cellular transcription factors that
recognize viral enhancer and promoter sequences,
(3)anatomic barriers,
(4)local temperature, pH, and host defences.

Mechanisms of Bacterial Injury

Bacterial Virulence.
Bacterial Adherence to Host Cells.
Virulence of Intracellular Bacteria.
Bacterial Toxins.
Injurious Effects of Host Immunity

IMMUNE EVASION BY MICROBES

Microorganisms have developed many means to resist and
evade the immune system.
(1)growth in niches that are inaccessible to the host immune
system,
(2)antigenic variation,
(3)resistance to innate immune defenses, and
(4)impairment of effective T-cell antimicrobial responses by
specific or nonspecific immunosuppression.

SPECTRUM OF INFLAMMATORY
RESPONSES TO INFECTION
Suppurative or purulent inflammation.
Mononuclear and granulomatous
inflammation
Cytopathic or cytoproliferative reaction.
Tissue necrosis
Chronic inflammation and scarring.

Suppurative or purulent inflammation

This pattern is the reaction to acute tissue
damage is characterized by increased vascular
permeability and leukocytic infiltration,
predominantly of neutrophils.
The neutrophils are attracted to the site of
infection by release of chemoattractants from the
pyogenic (pus-forming) bacteria that evoke this
response, mostly extracellular gram-positive cocci
and gram-negative rods.
Massing of neutrophils and liquefactive necrosis
of the tissue form pus.

 Liquefaction necrosis occurs when some of

the cells die but their catalytic enzymes are
not destroyed
- softening of the center of an abscess with
discharge of its content

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 The sizes of exudative lesions range from tiny

microabscesses formed in multiple organs
during bacterial sepsis secondary to a
colonized heart valve to diffuse involvement
of entire lobes of the lung in pneumonia.
How destructive the lesions are depends on
their location and the organism involved.

 Pneumococci usually spare alveolar walls and

cause lobar pneumonia that resolves
completely, whereas staphylococci and
Klebsiella species destroy alveolar walls and
form abscesses that heal with scar formation.
Bacterial pharyngitis resolves without
sequelae, whereas untreated acute bacterial
inflammation of a joint can destroy it in a few
days.

Mononuclear and Granulomatous

Inflammation
Diffuse, predominantly mononuclear, interstitial
infiltrates are a common feature of all chronic
inflammatory processes.
They often are a response to viruses, intracellular
bacteria, or intracellular parasites. In addition,
spirochetes and helminths provoke chronic
inflammatory responses.
Which mononuclear cell predominates within the
inflammatory lesion depends on the host immune
response to the organism.

Granulomatous inflammation is a distinctive form

of mononuclear inflammation usually evoked by
infectious agents that resist eradication and are
capable of stimulating strong T cellmediated
immunity
Granulomatous inflammation is characterized by
accumulation of activated macrophages called
epithelioid cells, which may fuse to form giant
cells. In some cases there is a central area of
caseous necrosis

 Caseous necrosis (soft and cheeselike center)

is most commonly associated with tubercular
lesions and is thought to result from immune
mechanism

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Cytopathic-Cytoproliferative Reaction
The lesions are characterized by cell necrosis
or cellular proliferation, usually with sparse
inflammatory cells.
Some viruses replicate within cells and make
viral aggregates that are visible as inclusion
bodies (e.g., herpesviruses or adenovirus) or
induce cells to fuse and form multinucleated
cells called polykaryons (e.g., measles virus or
herpesviruses).

 Focal cell damage in the skin may cause

epithelial cells to become detached, forming
blisters
Some viruses can cause epithelial cells to
proliferate (e.g., venereal warts caused by HPV
or the umbilicated papules of molluscum
contagiosum caused by poxviruses).
Finally, viruses can contribute to the
development of malignant neoplasms.

Tissue Necrosis
Clostridium perfringens and other organisms that
secrete powerful toxins can cause such rapid and severe
necrosis (gangrenous necrosis) that tissue damage is the
dominant feature.
Because few inflammatory cells are present, these
lesions resemble infarcts with disruption or loss of
basophilic nuclear staining and preservation of cellular
outlines.
Clostridia are often opportunistic pathogens that are
introduced into muscle tissue by penetrating trauma or
infection of the bowel in a neutropenic host.

 Gangrene is applied when a considerable mass

of tissue undergoes necrosis
Can classified as dry or moist
In dry gangrene, the part become dry and
shrinks, the skin wrinkles, and its colour
changes to dark brown or black

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Dry gangrene

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 In moist or wet gangrene, the area is cold,

swollen and pulseless. The skin is moist, black,
and under tension. Blebs form on the surface,
liquefraction occurs and a foulodor is caused
by bacterial action.
Can occur in the internal organ

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Moist gangrene

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 Similarly, the parasite Entamoeba histolytica (

) causes colonic ulcers and liver abscesses
characterized by extensive tissue destruction with
liquefactive necrosis and without a prominent
inflammatory infiltrate.
By entirely different mechanisms, viruses can
cause widespread and severe necrosis of host cells
associated with inflammation, as exemplified by
total destruction of the temporal lobes of the brain
by herpesvirus or the liver by HBV.

Chronic Inflammation and Scarring

Chronic HBV infection may cause cirrhosis of
the liver, in which dense fibrous septae surround
nodules of regenerating hepatocytes.
Sometimes the exuberant scarring response is
the major cause of dysfunction.
pipe-stem fibrosis of the liver or fibrosis of
the bladder wall caused by schistosomal (blood
fluke)eggs or the constrictive fibrous pericarditis
in tuberculosis

Constrictive fibrous pericarditis