PowerPoint® Lecture

Presentations prepared by
Mindy Miller-Kittrell,
North Carolina State
University

CHAPTER 14
Infection,
Infectious
Diseases, and
Epidemiology

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 • Symbiosis means “to live
Symbiotic together”
• We have symbiotic relationships
Relationships with countless microorganisms
Between • Types of symbiosis
Microbes and • Mutualism
• Commensalism
Their Hosts • Amensalism
• Parasitism

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 Table 14.1 Types of Symbiotic Relationships

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 Figure 14.1 Mutualism.

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 • Microbiome of Humans
• Organisms that colonize the
Symbiotic body’s surfaces without
Relationships normally causing disease
• Also termed normal
Between microbiota, normal flora, and
Microbes and indigenous microbiota
Their Hosts • Two types
• Resident microbiota
• Transient microbiota

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 Figure 14.2 An example of normal microbiota.

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 PowerPoint® Lecture
Presentations prepared by
Mindy Miller-Kittrell,
North Carolina State
University

Symbiotic Relationships
Between Microbes & C H A P T E R
Hosts

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 Symbiotic
Relationships • Normal Microbiota in Hosts
• Resident microbiota
Between • Are a part of the normal microbiota throughout life
Microbes and • Are mostly commensal

Their Hosts

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 Table 14.2 Some Resident Microbiotaa (1 of 4)

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 Table 14.2 Some Resident Microbiotaa (2 of 4)

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 Table 14.2 Some Resident Microbiotaa (3 of 4)

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 Table 14.2 Some Resident Microbiotaa (4 of 4)

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 • Normal Microbiota in Hosts
• Transient microbiota
• Remain in the body for
Symbiotic short period
• Found in the same regions
Relationships as resident microbiota
Between • Cannot persist in the
body
Microbes and • Competition from
Their Hosts other microorganisms
• Elimination by the
body’s defense cells
• Chemical or physical
changes in the body

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 • Normal Microbiota in Hosts
• Acquisition of the
microbiome
Symbiotic
• Development in womb
Relationships free of microorganisms
Between • Microbiome begins to
develop during birthing
Microbes and process
Their Hosts • Much of one’s resident
microbiota established
during first months of
life

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 Symbiotic
Relationships
Symbiotic
Relationships
Between Transient
Microbes and Microbes
Their Hosts

Remain for
short time
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 • How Normal Microbiota Become
Opportunistic Pathogens
• Opportunistic pathogens
• Normal microbiota that
Symbiotic cause disease under certain
Relationships circumstances
• Conditions that provide
Between opportunities for pathogens
Microbes and • Introduction of normal
microbiota into unusual site
Their Hosts in body
• Immune suppression
• Changes in the normal
microbiota
• Stressful conditions

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 Symbiotic
Relationships • Tell Me Why
Between • Why is an absolute
commensalism difficult to
Microbes and prove?
Their Hosts

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 Reservoirs of
Infectious
Disease

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 • Most pathogens cannot survive
for long outside their host
Reservoirs of • Reservoirs of infection
Infectious • Sites where pathogens are
maintained as a source of
Diseases of infection
Humans • Three types of reservoirs
• Animal reservoir
• Human carriers
• Nonliving reservoir

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 • Animal Reservoirs
• Zoonoses
• Diseases that naturally
spread from animal host
Reservoirs of to humans
Infectious • Acquire zoonoses through
various routes
Diseases of
• Direct contact with
Humans animal or its waste
• Eating animals
• Bloodsucking arthropods
• Humans are usually dead-end
host to zoonotic pathogens
• Difficult to eradicate

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 Table 14.3 Some Common Zoonoses

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 • Human Carriers
Reservoirs of • Asymptomatic infected
individuals can be infective
Infectious to others
Diseases of • Some individuals eventually
develop illness, while others
Humans never get sick
• Healthy carriers may have
defensive systems that
protect them

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 Reservoirs of • Nonliving Reservoirs
Infectious • Soil, water, and food can
be reservoirs of infection
Diseases of • Presence of
Humans microorganisms often
due to contamination
by feces or urine

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 Reservoirs of
Infectious • Tell Me Why
Diseases of • Why might animal reservoirs
be involved in more diseases
Humans than are human reservoirs?

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 • Exposure to Microbes:
Contamination and Infection
The Invasion • Contamination
and • The mere presence of
Establishment microbes in or on the
body
of Microbes • Infection
in Hosts: • When organism evades
Infection body’s external defenses,
multiplies, and becomes
established in the body

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 • Portals of Entry
The Invasion • Sites through which
and pathogens enter the body
• Three major pathways
Establishment • Skin
of Microbes • Mucous membranes
in Hosts: • Placenta
Infection • Entry via the parenteral route
circumvents the usual portals

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 Figure 14.3 Routes of entry for invading
pathogens.

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 • Portals of Entry
• Skin
The Invasion • Outer layer of dead skin
cells acts as a barrier to
and pathogens
Establishment • Some pathogens can
of Microbes enter through openings
or cuts
in Hosts:
• Others enter by
Infection burrowing into or
digesting outer layers
of skin

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 Figure 14.4 A cross section of skin.

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 • Portals of Entry
• Mucous membranes
• Line the body cavities that
are open to the
The Invasion environment
and • Provide a moist, warm
environment hospitable to
Establishment pathogens
of Microbes • Respiratory tract is the
most common site of entry
in Hosts: • Entry is through the
Infection nose, mouth, or eyes
• Gastrointestinal tract may
be route of entry
• Must survive the acidic
pH of the stomach

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 • Portals of Entry
• Placenta
The Invasion • Typically forms effective
barrier to pathogens
and
• Pathogens may cross
Establishment the placenta and infect
of Microbes the fetus
in Hosts: • Can cause
spontaneous
Infection abortion, birth
defects, premature
birth

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 Table 14.4 Some Pathogens That Cross the
Placenta

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 • Portals of Entry
The Invasion • Parenteral route
• Not a true portal of entry
and
• Means by which portals
Establishment of entry can be
of Microbes circumvented
in Hosts: • Pathogens deposited
directly into tissues
Infection beneath the skin or
mucous membranes

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 • The Role of Adhesion in
Infection
• Adhesion
• Process by which
The Invasion microorganisms attach
and themselves
to cells
Establishment • Required to establish
of Microbes colonies successfully
in Hosts: within the host
• Uses adhesion factors
Infection • Specialized
structures
• Attachment
molecules

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 Figure 14.5 The adhesion of pathogens to host
cells.

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 • The Role of Adhesion in Infection
• Attachment proteins help in
adhesion
• Found on viruses and many
The Invasion bacteria
• Viral or bacterial ligands bind
and host cell receptors
Establishment • Interaction can
determine host cell
of Microbes specificity
in Hosts: • Changing/blocking a ligand or its
receptor can prevent infection
Infection • Inability to make attachment
proteins or adhesins renders
microorganisms avirulent
• Some bacterial pathogens attach
to each other to form a biofilm

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 Figure 14.6 Dental plaque.

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 The Invasion
and • Tell Me Why
Establishment • Why does every infection
start with contamination but
of Microbes not every contamination
in Hosts: results in an infection?
Infection

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 The Nature of • Infection is the invasion of the
host by a pathogen
Infectious
• Disease results if the invading
Disease pathogen alters normal body
functions
• Disease is also referred to as
morbidity

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 • Manifestations of Disease:
Symptoms, Signs, and Syndromes
• Symptoms
• Subjective characteristics of
The Nature of disease felt only by the
patient
Infectious • Signs
• Objective manifestations of
Disease disease observed or
measured by others
• Syndrome
• Symptoms and signs that
characterize a disease or an
abnormal condition
• Asymptomatic, or subclinical,
infections lack symptoms but
may still have signs of infection

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 Table 14.5
Typical
Manifestations
of Disease

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 Table 14.6 Terminology of Disease

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 The Nature of • Causation of Disease:
Etiology
Infectious • Etiology
Disease • Study of the cause of
disease
• Diseases have various
causes

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 Table 14.7 Categories of Diseasesa

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 • Causation of Disease:
Etiology
• Using Koch’s postulates
The Nature of • Germ theory of disease
Infectious • Infections by
pathogenic
Disease microorganisms
cause disease
• Robert Koch developed
a set of postulates one
must satisfy to prove that
a particular pathogen
causes a particular disease

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 Figure 14.7 Koch’s postulates.

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 The Nature of Infectious Disease

• Causation of Disease: Etiology

• Exceptions to Koch’s postulates
• Some pathogens can't be cultured in the laboratory
• Diseases caused by a combination of pathogens and other
cofactors
• Ethical considerations prevent applying Koch’s postulates to
pathogens that require a human host
• Difficulties in satisfying Koch’s postulates
• Diseases can be caused by more than one pathogen
• Pathogens that are ignored as potential causes of disease

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 The Nature of Infectious Disease

• Virulence Factors of Infectious Agents

• Pathogenicity
• Ability of a microorganism to cause disease
• Virulence
• Degree of pathogenicity
• Virulence factors contribute to virulence
• Adhesion factors
• Biofilms
• Extracellular enzymes
• Toxins
• Antiphagocytic factors

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 Figure 14.8 Relative virulence of some microbial pathogens.

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 The Nature of Infectious Disease

• Dr. Bauman’s Microbiology Video Tutor

• For more information, listen to Dr. Bauman explain how
virulence factors contribute to the pathogenicity of some
bacteria.

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 Virulence Factors: Inactivating Host Defenses

PLAY Virulence Factors: Inactivating Host Defenses

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 The Nature of Infectious Disease

• Virulence Factors of Infectious Agents

• Extracellular enzymes
• Secreted by the pathogen
• Dissolve structural chemicals in the body
• Help pathogen maintain infection, invade, and avoid body defenses
• Important to virulence of the pathogen
• Mutant species that do not secrete the enzymes are often
avirulent

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 Figure 14.9a Some virulence factors.

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 Virulence Factors: Penetrating Host Tissues

PLAY Virulence Factors: Penetrating Host Tissues

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 The Nature of Infectious Disease

• Virulence Factors of Infectious Agents

• Toxins
• Chemicals that harm tissues or trigger host immune responses that
cause damage
• Toxemia refers to the presence of toxins in the bloodstream
• The toxins are carried beyond the site of infection
• Two types
• Exotoxins
• Endotoxins

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 Figure 14.9b Some virulence factors.

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 Virulence Factors: Exotoxins

PLAY Virulence Factors: Exotoxins

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 Virulence Factors: Endotoxins

PLAY Virulence Factors: Endotoxins

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 Table 14.8 A Comparison of Bacterial Exotoxins and Endotoxins

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 The Nature of Infectious Disease

• Virulence Factors of Infectious Agents

• Antiphagocytic factors
• Factors prevent phagocytosis by the host’s
phagocytic cells
• Allow pathogens to remain in a host for longer time
• Bacterial capsule
• Composed of chemicals not recognized as foreign
• Slippery and difficult for phagocytes to engulf
• Antiphagocytic chemicals
• Prevent fusion of lysosome and phagocytic vesicles
• Leukocidins directly destroy phagocytic white blood cells

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 Figure 14.9c Some virulence factors.

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 Phagocytosis: Microbes That Evade It

PLAY Phagocytosis: Microbes That Evade It

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 Virulence Factors: Hiding from Host Defenses

PLAY Virulence Factors: Hiding from Host Defenses

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 The Nature of Infectious Disease

• The Stages of Infectious Disease

• The disease process occurs following infection
• Many infectious diseases have five stages following infection
• Incubation period
• Prodromal period
• Illness
• Decline
• Convalescence

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 Figure 14.10 The stages of infectious diseases.

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 Table 14.9 Incubation Periods of Selected Infectious Diseases

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 The Nature of Infectious Disease

• Tell Me Why
• Why is mutated Streptococcus pneumoniae, which cannot make a
capsule, unable to cause pneumonia?

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 The Movement of Pathogens Out of Hosts: Portals of
Exit

• Pathogens leave host through portals of exit

• Many portals of exit are the same as portals
of entry
• Pathogens often leave hosts in materials the body
secretes or excretes

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 Figure 14.11 Portals of exit.

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 The Movement of Pathogens Out of Hosts: Portals of
Exit

• Tell Me Why
• Why is the tube emptying the bladder (the urethra) more
likely to be a portal of exit than a portal of entry?

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 Modes of Infectious Disease Transmission

• Transmission is from a reservoir or a portal of exit to

another host’s portal of entry
• Three groups of transmission
• Contact transmission
• Vehicle transmission
• Vector transmission

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 Epidemiology: Transmission of Disease

PLAY Epidemiology: Transmission of Disease

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 Modes of Infectious Disease Transmission

• Contact Transmission
• Direct contact transmission
• Usually involves body contact between hosts
• Transmission within a single individual can also occur
• Indirect contact transmission
• Pathogens are spread from host to host by fomites
• Droplet transmission
• Spread of pathogens in droplets of mucus by exhaling,
coughing, and sneezing

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 Figure 14.12 Droplet transmission.

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 Modes of Infectious Disease Transmission

• Vehicle Transmission
• Airborne transmission
• When pathogens travel more than 1 m via an aerosol
• Aerosols can occur from various activities
• Sneezing, coughing, air-conditioning systems, sweeping
• Waterborne transmission
• Important in the spread of many gastrointestinal diseases
• Fecal-oral infection

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 Modes of Infectious Disease Transmission

• Vehicle Transmission
• Foodborne transmission
• Spread of pathogens in and on foods
• Inadequately processed, cooked, or refrigerated foods
• Foods may become contaminated with feces
• Bodily fluid transmission
• Bodily fluids such as blood, urine, and saliva can carry
pathogens
• Prevent contact with conjunctiva or breaks in the skin or
mucous membranes

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 Figure 14.13 Poorly stored foods can harbor pathogens and transmit diseases.

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 Modes of Infectious Disease Transmission

• Vector Transmission
• Biological vectors
• Transmit pathogens and serve as host for some stage of the
pathogen’s life cycle
• Biting arthropods transmit many diseases to humans
• Mechanical vectors
• Passively transmit pathogens present on their body to new
hosts

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 Table 14.10 Selected Arthropod Vectors (1 of 2)

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 Table 14.10 Selected Arthropod Vectors (2 of 2)

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 Table 14.11 Modes of Disease Transmission

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 Modes of Infectious Disease Transmission

• Tell Me Why
• Why can’t we correctly say that all arthropod vectors are
reservoirs?

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 Classification of Infectious Diseases

• Diseases can be classified in a number of ways

• Taxonomic categories
• The body system they affect
• Their longevity and severity
• How they are spread to their host
• The effects they have on populations

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 Table 14.12 Terms Used to Classify Infectious Diseases

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 Classification of Infectious Diseases

• Tell Me Why
• Why is an acute disease with a high rate of mortality unlikely
to be associated with a pandemic?

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 Epidemiology: Overview

PLAY Epidemiology: Overview

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 Epidemiology of Infectious Diseases

• Frequency of Disease
• Disease occurrence tracked using two measures
• Incidence
• Number of new cases of a disease in a given area during a
given period of time
• Prevalence
• Number of total cases of a disease in a given area during a
given period of time
• Occurrence also evaluated in terms of frequency and
geographic distribution

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 Figure 14.14 Curves representing the incidence and the estimated prevalence of AIDS
among U.S. adults.

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 Figure 14.15 Epidemiologists report data in a variety of ways.

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 Figure 14.16 Illustrations of the different terms for the occurrence of disease.

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 Epidemiology: Occurrence of Diseases

PLAY Epidemiology: Occurrence of Diseases

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 Figure 14.17 Epidemics may have fewer cases than nonepidemics.

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 Table 14.13 Nationally Notifiable Infectious Diseasesa

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 Figure 14.18 A page from the MMWR.

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 Epidemiology of Infectious Diseases

• Epidemiological Studies
• Descriptive epidemiology
• Careful tabulation of data concerning a disease
• Record location and time of the cases of disease
• Collect patient information
• Try to identify the index case of the disease

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 Figure 14.19 A map showing cholera deaths in a section of London, 1854.

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 Epidemiology of Infectious Diseases

• Epidemiological Studies
• Analytical epidemiology
• Seeks to determine the probable cause, mode of transmission,
and methods of prevention
• Useful in situations when Koch’s postulates can’t be applied
• Often retrospective
• Investigation occurs after an outbreak has occurred

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 Epidemiology of Infectious Diseases

• Epidemiological Studies
• Experimental epidemiology
• Tests a hypothesis concerning the cause of a disease
• Application of Koch’s postulates

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 Nosocomial Infections: Overview

PLAY Nosocomial Infections: Overview

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 Epidemiology of Infectious Diseases

• Hospital Epidemiology: Healthcare-Associated

(Nosocomial) Infections
• Types of healthcare-associated infections
• Exogenous
• Pathogen acquired from the health care environment
• Endogenous
• Pathogen arises from normal microbiota within patient
• Iatrogenic
• Results from modern medical procedures
• Superinfections
• Use of antimicrobial drugs inhibits some resident microbiota,
allowing other microbes to thrive

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 Figure 14.20 The interplay of factors that result in healthcare-associated infections
(HAIs).

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 Epidemiology of Infectious Diseases

• Hospital Epidemiology: Healthcare-Associated

(Nosocomial) Infections
• Control of healthcare-associated infections
• Requires aggressive control measures
• Handwashing is the most effective way to reduce healthcare-
associated infections

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 Nosocomial Infections: Prevention

PLAY Nosocomial Infections: Prevention

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 Epidemiology of Infectious Diseases

• Epidemiology and Public Health

• Sharing of data among public health organizations
• Agencies at the local, state, national, and global level
• The U.S. Public Health Service
• National public health agency
• CDC is one branch
• World Health Organization (WHO)
• Coordinates public health efforts worldwide

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 Epidemiology of Infectious Diseases

• Epidemiology and Public Health

• Role of public health agencies in interrupting disease
transmission
• Public health agencies work to limit disease transmission
• Enforce cleanliness of water and food supplies
• Work to reduce disease vectors and reservoirs
• Establish and enforce immunization schedules
• Locate and treat individuals exposed to contagious pathogens
• Establish isolation and quarantine measures

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 Epidemiology of Infectious Diseases

• Epidemiology and Public Health

• Public health education
• Diseases transmitted sexually and through the air are difficult to
control
• Public health agencies campaign to educate the public on healthful
choices to limit disease

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 Epidemiology of Infectious Diseases

• Tell Me Why
• Why are all iatrogenic infections healthcare associated, but not all
healthcare-associated infections are iatrogenic?

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