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PRINCIPLES OF DISEASE

AND EPIDEMIOLOGY
Pathology, Infection and Disease

 Disease-causing microorganisms are called pathogen.


 Pathogenic microorganisms have special properties that
allow them to invade the human body or produce toxins.
 When a microorganisms overcomes the body’s defense, a
state of disease results.
Pathology, Infection and Disease
 Pathology is the scientific study of disease.
 It is concerned with:
 Etiology - __________________________________________.
 Pathogenesis - _______________________________________.
 Effect of disease.

 Infection: invasion/colonization and growth of pathogens in


the body.
 A host is an organism that shelters and support the growth
of pathogens.
 Disease: an abnormal state in which the body is not
functioning normally or is incapable of performing normal
functions.
Normal Microbiota and the Host

 Animals and humans are usually germfree in utero.


 Microorganisms begin colonization in and on the surface of
the body soon after birth.
 Contact with lactobacilli from mother’s vagina.
 Predominant in newborn’s intestine.
 Breathing and feeding.
 E. coli inhabit large intestine.
 Normal microbiota/normal flora:
 Microorganisms that establishes permanent colonies inside or on
the body without producing diseases.
 Transient microbiota:
 Microbes that may be present for various periods(days, weeks,
or months) and then disappear.
Representative normal microbiota for different regions of the body.

Bacteria (orange Bacteria (brown) Bacteria (orange)


spheres) on the surface of on the lining of the stomach in the small intestine
the nasal epithelium
Normal Microbiota and the Host

 Microorganisms are not found throughout the entire human


body but are localized in certain regions.
 Colonize body sites that can supply appropriate nutrients.
 Factors that determine distribution and composition of
normal microbiota:
 Nutrients.
 Physical and chemical factors.
 Temperature, pH, availability of oxygen and carbon dioxide.
 Host defense.
 Mechanical factors.
 Chewing action of teeth and tongue can dislodge microbes attached to
tooth.
 Flushing action of urines will remove unattached microbes.
Normal Microbiota and the Host

 Age.
 Nutritional status.
 Diet.
 Health status.
 Disability.
 Hospitalization.
 Emotional status.
 Stress.
 Climate.
 Personal hygiene.
 Lifestyle.
 Living condition.
Relationship between Normal Microbiota and the Host

 The normal microbiota can prevent pathogens from


causing an infection. This phenomenon is known as
microbial antagonism/competitive exclusion.
 Involves competition between microbes.
 Normal microbiota protect the host by:
 ____________________________________________.

 ____________________________________________.

 ____________________________________________.

 Probiotics: ________________________________
_________________________________________.
Relationship between Normal Microbiota and the Host

 Examples of microbial antagonism:


 In large intestine, E. coli produces bacteriocins (protein that
inhibit growth of other closely related bacteria such as
Salmonella and Shigella).
 The presence of normal microbiota in large intestines
effectively inhibit C. difficile by making host receptors
unavailable, compete for available nutrients or produce
bacteriocins. If the normal microbiota is eliminated
(antibiotics), C. difficle can become a problem and cause
gastrointestinal infection.
Relationship between Normal Microbiota and the Host

 Symbiosis is the relationship between normal microbiota


and the host.
 Normal microbiota and the host exist in symbiosis (living together).
 Three types of symbiosis:
 ______________________________________.
 One organism benefits and the other is unaffected.
 S. epidemidis – inhabit surface of skin and bring no harm/benefit to host.
 ______________________________________.
 Both organisms benefit.
 E. coli in large intestine synthesize vit K and B which are used by body
cells. In exchange, large intestine provides nutrients used by bacteria for
survival.
 ______________________________________.
 One organism benefits at the expense of the other.
SYMBIOSIS
One organism One organism benefits
Both organisms benefit
benefits, and the other is unaffected at the expense of the other

Staphylococcus E. coli bacteria H1N1 virus particles


epidermidis on the skin (lavender) in the (orange) on a host
large cell (green)
intestine
Relationship between Normal Microbiota and the Host

 Some normal microbiota are opportunistic pathogens.


 Opportunistic pathogens do not cause disease under
normal conditions but cause disease under special conditions.
 Example:
 E. coli is harmless as long as it remains in large intestines. When it
gains access to other body sites such as urinary bladder, lungs,
spinal cord or wound, it can cause UTI, pulmonary infections,
meningitis or abscesses, respectively.
 In some situations, cooperation among microbes can also be
a factor in causing disease.
 Pathogens that cause periodontal disease and gingivitis have
been found to have receptors for oral streptococci to colonize
teeth.
The Etiology of Infectious Diseases

 Some diseases have a well-known etiology.


 Polio, tuberculosis.
 Some diseases have an etiology that is not completely
understood.
 Relationship between viruses and cancer.
 Some diseases have unknown etiology.
 Alzheimer disease.
 Diseases which are caused by microorganisms are
known as infectious diseases.
Koch’s Postulates

 Koch’s postulates are criteria for establishing that specific


microbes cause specific disease.
 Koch’s postulates have the following requirements:
1. The same pathogen must be present in every case of the
disease.
2. The pathogen must be isolated from the diseased host and
grown in pure culture.
3. The pathogen from the pure culture must cause the disease
when it is inoculated into a healthy, susceptible laboratory
animal.
4. The pathogen must be isolated from the inoculated animal and
must be shown to be the original organism.
Koch’s Postulates: Understanding Disease.

1 Microorganisms are isolated 2a The microorganisms are 3 The microorganisms


from a diseased or dead grown in pure culture. are injected into a healthy
animal. laboratory animal.
Colony

2b The microorganisms 4 Disease is reproduced


are identified. in a laboratory animal.

5a The microorganisms are isolated


from this animal and grown in
pure culture.

5b Microorganisms
are identified.

The microorganism from the


diseased host caused the same
disease in a laboratory host.
Koch’s Postulates

 Koch’s postulates are used to prove the cause of an


infectious disease.
 There are some exceptions to Koch’s postulates where the
postulates are modified to:
 Establish etiologies of diseases caused by viruses and some
bacteria which cannot be grown on artificial media.
 Some disease, such as tetanus have unequivocal signs and
symptoms.
 Some diseases such as pneumonia and nephritis may be caused
by a variety of microbes.
 Some pathogens, S. pyogenes, can cause several disease
conditions.
 Some pathogens, HIV, cause disease only in humans.
Classifying Infectious Diseases

 A patient may exhibit symptoms and signs in which a


physician uses to make a diagnosis.
 ______________: a change in body function that is felt by a
patient as a result of disease. Ex: pain, malaise.
 ______________: a change in a body that can be measured
or observed as a result of disease. Ex: lesion, swelling.
 ______________: a specific group of signs and symptoms
that accompany a disease.
 The diagnosis of a disease is made by evaluation of the signs
and symptoms, together with the results of lab tests.
Classifying Infectious Diseases

 Diseases are often classified in terms of how they


behave within a host and within a given population.
 Communicable disease.
A disease that is spread directly or indirectly from one host
to another.
 Chicken pox, measles, tuberculosis.

 Contagious disease.
A disease that is easily spread from one host to another.
 Noncommunicable disease.
A disease that is not transmitted from one host to another.
ANIMATION Epidemiology: Overview
Occurrence of a Disease

 Disease occurrence is reported by incidence and


prevalence.
 Incidence: number of people in a population who
develop a disease during a particular period time.
 Prevalence: number of people in a population who
develop a disease at a specified time, regardless of
when it first appeared. Takes into account both old and
new cases.
 Ex: incidence of AIDS in US in 2007 was 56,300
whereas the prevalence in the same year was
estimated to be about 1,185,000.
ANIMATION Epidemiology: Occurrence of Diseases
Occurrence of a Disease

 Diseases are classified by frequency of occurance:


 Sporadic disease:
 Disease that occurs occasionally in a population.
 Typhoid fever in US.
 Endemic disease:
 Disease constantly present in a population.
 Common cold.
 Epidemic disease:
 Disease acquired by many hosts/people in a given area in a
short time.
 Influenza disease.
 Pandemic disease:
 Worldwide epidemic.
Severity or Duration of a Disease

 The scope of disease can be defined as acute, chronic, subacute or


latent.
 Acute disease:
 Develop rapidly but lasts only a short time.
 Influenza.
 Chronic disease:
 Develops slowly, body’s reaction may be less severe.
 The disease is likely to continue or recur for long periods.
 Tuberculosis, hepatitis B.
 Subacute disease:
 Intermediate between acute and chronic.
 Subacute sclerosing panencephalitis (a rare brain disease).
 Latent disease:
 Disease with a period of no symptoms when the causative agent is inactive.
 When many people are present in a community, herd immunity exists.
 Presence of immunity to a disease in most of the population.
Extent of Host Involvement

 Infections can be classified according to the extent to


which host’s body is affected.
 __________________: pathogens are limited to a
small area of the body. Ex: boils and abscesses.
 __________________: an infection throughout the
body via circulatory system (blood/lymph). Ex: measles.
 __________________: systemic infection that began as
a local infection. Can arise from infections in areas such
as teeth, tonsils or sinuses.
Extent of Host Involvement

 ________________: toxic inflammatory condition


arising from the spread of microbes, especially
bacteria or their toxins, from a focus of infection.
 ________________: growth of pathogen in the blood.
 ________________: the presence of bacteria in the
blood.
 ________________: presence of toxins in the blood.
 ________________: presence of viruses in the blood.
Extent of Host Involvement

 Primary infection: acute infection that causes the initial


illness.
 Secondary infection: caused by opportunistic pathogen
after a primary infection has weakened the body’s
defense.
 Subclinical disease: no noticeable signs or symptoms in
the host (inapparent infection).
Patterns of Disease

 A definite sequence of events usually occurs during


infection and disease.
 For an infectious disease to occur:
 Source of pathogens.
 Pathogens must be transmitted to a susceptible host by
direct, indirect contact or vectors.
 Invasion occur where microorganisms enter host and
multiply.
 Microorganisms injures host through pathogenesis
 Extend of injury depends on degree to which host cells are
damaged.
Predisposing Factors

 Make the body more susceptible to disease or alter the


course of a disease:
 Gender.
 Femalehave higher incidence of UTI. Males have higher rate of
pneumonia and meningitis.
 Inherited traits, such as the sickle cell gene.
 Climate and weather.

 Fatigue.

 Age.

 Lifestyle.

 Chemotherapy.
Development of Disease

 Once a microorganism overcomes the defenses of the


host, development of disease follows a certain
sequence that tend to be similar whether the disease is
acute or chronic.
Incubation Period.
 Interval
between the initial infection and the first
appearance of signs and symptoms.
 Depends on:
 Specific microorganism involved.
 Its virulence.
 The number of infecting microorganisms.
 Resistance of the host.
Development of Disease

Prodromal Period.
 Shortperiod that follows period of incubation.
 Characterized by the appearance of the first mild signs
and symptoms.
Period of Illness.
 The disease is most severe and all disease signs and
symptoms are apparent.
 Number of WBC may increase/decrease.

 Period of illness will end if patient’s immune response


overcome the pathogen.
 If disease is not successfully treated, patient will die.
Development of Disease

Period of Decline.
 The signs and symptoms subside
Period of Convalescence.
 The body returns to its prediseased state, and health is
restored.
 Recovery has occurred.
Number of microbes

Incubation period (no signs or symptoms)

Time
Prodromal period (mild signs or symptoms)
The stages of a disease.

illness
Period of

and symptoms
Most severe signs
decline
Period of

symptoms
Signs and

Period of convalescence
The Spread of Infection

ANIMATION Epidemiology: Transmission of Disease


Reservoirs of Infection

 Continual sources of infection:


 Human: AIDS, gonorrhea.
 Carriers may have inapparent infections or latent diseases.
 Animal: rabies, Lyme disease.
 Wild and domestic animals are living reservoirs of
microorganisms that can cause human diseases.
 Some zoonoses (disease that affect wild and domestic animals)
may be transmitted to humans.
 Nonliving: botulism, tetanus.
 Soil harbours pathogens such as fungi (mycoses), C. botulinum
(botulism).
 Water contaminated with feces of humans/animals responsible
for gastrointestinal diseases.
Transmission of Disease

 The causative agents of disease can be transmitted from


reservoir of infection to a susceptible host by 3 routes:
 Contact.
 _________________: requires close association between
infected and susceptible host. Person to person transmission.
 Touching, kissing, sexual intercourse.
 Viral respiratory tract disease (cold/influenza), hepatitis A, measles,
sexually transmitted disease, AIDS.
 _________________: spread by fomites (inanimate object).
 Tissues, handkerchief, towels, eating utensils, contaminated syringes.
 AIDS, hepatitis B, tetanus.
 _________________: transmission via airborne droplets.
 Coughing, sneezing, laughing, talking.
 Influenza, pneumonia, pertussis (whooping cough).
Direct contact Preventing direct contact transmission Indirect contact
transmission through the use of gloves, masks, and face transmission
shields

Droplet transmission
Transmission of Disease

 Vehicle – transmission of disease agents by a medium such as:


 ____________: pathogens are usually spread by contaminated
water due to untreated or poorly treated sewage.
 Cholera, waterborne shigellosis, leptospirosis.
 ____________: pathogens are transmitted in food that are
incompletely cooked, poorly refrigerated or prepared undr
unsanitary conditions.
 Food poisoning, tapeworm manifestation.
 ____________: transmission via airborne droplets in dust that
travel more than 1 meter from reservoir to the host.
 Coughing, sneezing, laughing, talking.
Vehicle transmission.

Water Food Air


Transmission of Disease

 Vectors – arthropods, especially fleas, ticks and mosquitoes.


Transmit disease by two general methods:
 ________________________: arthropod carries pathogen on feet
or other body part.
 Houseflies – transfer pathogens of typhoid fever from feces of infected
people to food.
 ________________________: active process and more complex.
Pathogen reproduces in vector.
Mechanical transmission.
Mosquito.
Nosocomial (Hospital-Acquired) Infections

 Nosocomial infection is any infection that is acquired during the


course of stay in a hospital.
 Results from interaction of several factors:

 Microorganisms in hospital environment.


 The compromised status of a host

 The chain of transmission in hospital.

 About 5-15% of all hospitalized patients acquire nosocomial


infections.
 Health care-associated infections include those acquired in a setting
other than a hospital (ex: surgical centre, outpatient health care
clinics, nursing home).
Nosocomial infections.

Microorganisms in Compromised host


hospital environment
Nosocomial
infection

Chain of transmission

ANIMATION Nosocomial Infections: Overview


Nosocomial (Hospital-Acquired) Infections

Microorganisms in Hospital Environment.


 Certain normal microbiota are often responsible for nosocomial infections
when they are introduced into the body such as medical procedures as surgery
or catheterization.
 Opportunistic, drug-resistant gram-negative bacteria are the most frequent
causes of nosocomial infections.
Compromised Host.
 Patients with burns, surgical wounds and suppressed immune systems are the
most susceptible to nosocomial infections.
Chain of Transmission.
 Nosocomial infections are transmitted by direct contact between staff members
and patients and between patients.
 Fomites such as catheters, syringes and respiratory devices can transmit
nosocomial infections.
Common Causes of Nosocomial Infections

Percentage
Percentage of
Resistant to
Total Infections
Antibiotics
Coagulase-negative 15% 89%
staphylococci
S. aureus 15% 80%
Enterococcus 10% 4–71%
Gram-negative rods 15–25% 3–32%
C. difficile 13% Not reported
Nosocomial (Hospital-Acquired) Infections

 Control of nosocomial infections:


 Aseptic technique can prevent nosocomial infections.
 Insisting on frequent and thorough hand washing.

 Disinfect tubs used to bathe patients between uses so that


bacteria from previous patient will not contaminate the next one.
 Hospital infection control staff members are responsible for
overseeing the proper cleaning, storage and handling of
equipment and supplies.

ANIMATION Nosocomial Infections: Prevention


Emerging Infectious Diseases

 Diseases that are new, increasing in incidence, or


showing a potential to increase in the near future.
 Factors that contribute to the emergence of new
infectious disease:
 Genetic recombinant.
 New strains – E. coli O157:H7 and avian influenza (H5N1).
 Evolution of new strains.
 Vibrio cholera O139.
 Inappropriate use of antibiotics and pesticides.
 Antibiotic-resistant strain.
Emerging Infectious Diseases

 Changes in weather pattern.


 Introduction and dissemination of diseases such as malaria.
 Modern transportation.
 West Nile virus.
 Ecological disaster, war, and expanding human settlement.
 Coccidioidomycosisincreased 10-fold due to Northridge
earthquake in 1994.
 Animal control measures.
 Increasing of Lyme disease due to rising deer population.
 Public health failure.
 Failure to get diphtheria booster.
Emerging Infectious Diseases

 The CDC (Centre for Disease and Prevention), NIH and WHO
are responsible for surveillance and responses to emerging
infectious disease.
 Their priorities include:
 To detect, promptly investigate and monitor emerging infectious
pathogens, the diseases they cause and factors that influence their
emergence.
 To expand basic and applied research on ecological and
environmental factors, microbial changes and adaptations, and host
interactions that influence EIDs.
 To enhance the communication of public health information and the
prompt implementation of prevention strategies regarding EIDs.
 To establish plans to monitor and control EIDs worldwide.
Epidemiology

 The science of epidemiology is the study of the


transmission, incidence and frequency of disease.
 The study of where and when diseases occur and how they
are transmitted in a population.

 Modern epidemiology began in the mid-1800s with the


work of Snow, Semmelweis and Nightingale.
Epidemiology

John Snow 1848–1849 Mapped the occurrence of


cholera in London
Ignaz Semmelweis 1846–1848 Showed that handwashing
decreased the incidence of
puerperal fever

Florence 1858 Showed that improved


Nightingale sanitation decreased the
incidence of epidemic
typhus
Epidemiology

 Epidemiologists use three basic types of investigation when


analyzing the occurrence of disease:
 Descriptive: collection and analysis of data about infected
people.
 Snow’s search for the cause of the cholera outbreak in London.
 Analytical: comparison of a diseased group and a healthy
group.
 Nightingale’s work where she compared diseases in soldiers and civilians.
 Experimental: controlled experiments designed to test
hypothesis are performed.
Epidemiology

 Case reporting provides data on incidence and


prevalence specified disease to local, state and
national offices (usually reported by health-care
workers).
Epidemiology

 Epidemiology is a major concern of state and federal


public health departments.
 Centers for Disease Control and Prevention (CDC) is
the main source of epidemiological information in US.
 Collects and analyzes epidemiological information in the
United States.
 Publishes Morbidity and Mortality Weekly Report (MMWR) to
provide information on morbidity (incidence) and mortality
(death).
 www.cdc.gov
The CDC

 The MMWR contains data on:


 _____________: incidence of a specific notifiable disease.
 _____________: deaths from notifiable diseases.

 _____________: number of people affected in relation to


the total population in a given time period.
 _____________: number of deaths from a disease in
relation to the population in a given time.
 ______________________: diseases which physicians
are required by law to report cases to US Public Health
Service.
End Of Lecture