Sun 27/3/2011

Microbiology Lec # 13
Slides: (Lec 13, Epidemiology and Public Health) & (Lec 14 + 15,
Microbial Pathogenesis and Virulence)
Done By: Laith Jamal & Moh'd Rafay3a

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Today, for the first part of this lecture we will talk quickly about
epidemiology & public health, and in the second part of this lecture we
will talk about microbial pathogenesis and virulence which is the first
part of the next time lecture enshallah.

** Lec 13, Epidemiology and Public Health **

Ok, so today we will have many definitions, so I’ll read some of them
and describe the other in my words. So epidemiology can be loosely
defined as the study of disease, and the people who perform
epidemiological studies are called epidemiologists.
So these people study the factors that determine the frequency,
distribution, and determinants of diseases in human populations, and
also these are the people who develop ways to prevent, control or
eradicate diseases in populations. So if you have, for example,
salmonella in the person, who investigates where it’s coming from and
how to control it, is epidemiologist.

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Ok, here are a few epidemiologic terminologies
A Communicable disease is an infectious disease that can be
transmitted from one person to another, whereas a Contagious
disease is a communicable disease that is easily transmitted from
person to another. So for example common cold or influenza are
considered contagious diseases where as for example diarrhea (not
sure) is not considered as a contagious disease, it is considered to be a
communicable disease.

Ok, diseases can be acquired from many sources , if the disease

source is an animal then the net disease is called a Zoonotic disease,
and we also referred to zoonotic disease as zoonoses, and we will talk
about this later in this lecture.

Let’s talk about a few other terms. So whenever we say Incidence of

disease that means the number of new cases that occurred in a
particular population in a particular year or a particular time period. So
we can say there were 100 new cases for example of tuberculosis in
Jordanian population in 2009.

Whereas when we mentioned The Morbidity Rate, it is basically the

same as incidence but we refer to it as a percentage. So we can say we

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have 100 people out of 1000 people in Jordan are infected and so on.
(number of cases per population number)

In contrast to incidence and morbidity rate we have Prevalence. It

divides to 2 divisions:
- The period prevalence: it's the number of cases in total,
whether this cases occurred in this year or in a previous time.
So we can say that in 2009 for example, Jordan had 300
cases of HIV. But that does not tell you that this infection
occurred in 2009 or in a previous year.
- The point prevalence: it mentions the rate of infection
that's currently in population in a specific period of time.
So we can say that every year we have 20 people get infected
in Jordan with HIV.

Mortality/death rate: it's refers to percentage of how many people

died due to get infected with a particular disease. So out of 100 people
who get the disease let's say maybe 90% of them died, so the mortality
rate will be 90%.

Sporadic disease: it's the disease that happens pretty much randomly
in the population without any particular pattern, such as the tetanus.

Endemic disease: is one that is always present within the population of

a particular geographic area. For example in Egypt we have Pelharsya,
so Pelharsya is an Endemic disease in Egypt but its endemic in Jordan.

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An Epidemic disease is defined as a greater than the usual number of
cases of a disease in a particular region, usually within a short period of
time. For example, the Legionnaire’s disease epidemic of 1976 (a
severity infection of the lower respiratory tract). So usually some of the
diseases happen very infrequent but suddenly the number of the cases
in a particular area increases so it's considered as an epidemic disease.
Legionnaire is a severe infection of the lower respiratory tract.

Pandemic is a disease that is occurring in epidemic proportions in

many countries at the same time. The most recent example is the
H1N1 (swine flu), you still see many people in the world getting
infected with this flu in many locations in the world in the same time.
And the very famous example was the Spanish flu pandemic in 1918,
which killed more than 20 million people around the world, and
basically infected all the countries around the world.
HIV, Tuberculosis and Malaria are also examples about pandemic
diseases.
Now, if you get exposed to a particular microbe or a particular
pathogen, there are many factors which determine whether you are
actually going to develop a disease or not due to expose to this
microbe or pathogen.

* Factors related to the pathogen itself:

- The very important factor is the virulence of the
pathogen (we are going to talk about this next lecture)

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 - Mood of entry: for example a specific virus which causes
a GI disease by entering through the GI tract, so if it gets to
your skin it will not cause the disease.
- Number of organisms: you have to have a particular
number to enter your body in order to cause a disease. And the
number can be very high or can be very low. For example if you
get only one Bacillus of Tuberculosis you can be infected with
TB. Whereas you have to be injected with maybe a
million of cholera Bacillus in order to be infected with cholera.
So there is a huge variation in the infection dose in causing disease.

* Factors related to the host itself: (e.g., health status, nutritional

status, hygiene, age, travel, Lifestyle, etc.). So it depends
particularly on the immune system status, if you have a good
immune system then the probability of getting the
disease is low, on the other hand if you have a suppressed
immunity then your chance of getting the disease is high.

* Factors related to the environment surrounding the pathogen and the

host (e.g., physical factors such as climate, season,
geographic location, availability of appropriate reservoirs;
sanitary and housing conditions and availability of clean water).
* The Chain of Infection
There are 6 components in the infectious disease process:
_ A pathogen
_ A source of the pathogen (which we called a reservoir)

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 _ A portal of exit from the host
_ A mode of transmission
_ A portal of entry to a new host
_ A susceptible host
To get this point clear let's take an example, assume that we have a
host (reservoir ) with a virus of the common cold ( pathogen ), so he's
shedding the virus from nasal secretion ( portal of exit ) then he may
touch his nose with his hand an then he shakes the hand (mode of
transmission " skin to skin contact" ) with another person (susceptible
host), so now he may eventually touch his eyes or nose ( portal of entry
to a new host ) . (Look at The next picture)

* Reservoirs of Infection
The sources of microorganisms that cause infectious diseases are
many and varied, they are known as reservoirs of infection or simply
reservoirs.
Living reservoirs: humans, pets, farm animals, insects, arachnids
(spiders).
– Human carriers:

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 - Passive carriers: the person who transmits the virus without
getting infected with that virus. For example if I shake the hands
with a host then I shake with another person, I will transmit the virus
without getting infected.
- Incubatory carriers: a person who is developing a disease but
now he is in the incubation phase, so at this time the virus is
replicating and shedding in a small number from his body, but
regardless to the small number he still able to transmit the infection
to the other people.
- Convalescent carriers: A person, who is recovering from the
disease or in the final stages, so although there will not be any
symptoms of the disease, they may shed the virus in small numbers
and infects other people.
- Active carriers: a person completely recovered from disease
but still carry the pathogen for a long time, so he still able to
transmit the infection to other people. Their immune system was not
able to completely clear from the pathogen.

- Animals:
So we refer to the infections or diseases obtained from animals
as zoonoses (Plural, its singular is zoonosis).
And we can obtain animal diseases either with direct contact or
indirect contact.
Indirect contact: for example food materials or through the bite
of infected insect.
Examples: Rabies, Lyme disease.

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 - Arthropods:
They can be either reservoirs of infection, which means that
some of the infections maybe reserved in arthropods in the
environment. Alternatively they can be vectors of the infections, so
they can transmit the infection from the animals to humans. And
they can be reservoirs and vectors at the same time. So they
are considered as the best carriers for the infections.
Examples of arthropod-borne diseases: Lyme disease, Malaria
(reservoirs and vectors at the same time).

- Nonliving reservoirs: Air, soil, dust, contaminated water and foods,

and fomites.
- Fomites: inanimate objects capable of transmitting pathogens
(e.g., bedding, towels, eating and drinking utensils, hospital equipment,
telephones, computer keyboards, etc.) [Slide 8]

Now, we have many methods to transmit the diseases, they can be

direct or indirect methods.
- Direct skin-to-skin contact
- Direct mucous membrane-to-mucous membrane contact by
kissing or sexual intercourse
- Indirect contact via airborne droplets of respiratory secretions,
usually produced by sneezing or coughing.
- Indirect contact via food and water contaminated by fecal
matter
- Indirect contact via arthropod vectors

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 - Indirect contact via fomites
-Indirect contact via transfusion of contaminated blood or blood
products or by parenteral injection or Using non-sterile syringes or
needles.

[Slide 9]
Public Health Agencies
You have to read this slide, so maybe I would ask about this in the
exam.

So how can a public health agencies such as a WHO prevent and

control the spread of epidemics?
- Increase host resistance through the development and
administration of vaccines that induce active immunity and maintain
it in susceptible persons.
– Ensure that persons exposed to a pathogen are protected
against the disease e.g. passive immunization (Premade antibodies
against the pathogen).
– Segregate, isolate and treat those who have contracted a
contagious infection to prevent the spread of the pathogen to others.
– Identify and control potential reservoirs and vectors of
infectious diseases.

* Bioterrorism and Biological (Warfare Agents): self reading

required.
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Now we finished from part 1, so we are going to go through some
terms in microbial Pathogenesis.

** Lec 14 15 Microbial Pathogenesis and Virulence **

Pathogenicity means the ability to cause disease (Pathogenic

Microbe).
It refers to the steps or mechanisms involved in the development of a
disease.
So, any organism that causes human disease is called a pathogen and
the disease caused by this pathogen is called an infectious disease.
In contrast, the word infection itself does not necessarily mean
development of a disease. For example you maybe get infected with a
certain microbe but it may not develop any disease or symptoms.
However, this distinction is usually not very common in the field, only
microbiologists use it.
(I usually do not use this distinction)

Now, you might get exposed to a pathogen or a microbe, but do not

develop a disease, why?
- The microbe may land at an anatomic site where it is unable to
multiply (for example a respiratory disease microbe lands on your skin)
- Many pathogens must attach to specific receptor sites before they
are able to multiply and cause damage.
- Antibacterial factors may be present at the site where the pathogen
lands.

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- Indigenous microflora of that site may inhibit growth of the foreign
microbe (i.e., microbial antagonism).
- The indigenous microflora may produce antibacterial factors (i.e.,
bacteriocins) that destroy the pathogen.
- The individual’s nutritional and overall health status often influences
the outcome of the pathogen-host encounter.
- The person may be immune to that particular pathogen.
- Phagocytes present in the blood may destroy the pathogen.

Now, if you exposed to a particular microbe, it will get through 4

phases:
1 - The incubation period: the Microbes are multiplying in very high
numbers, without any symptoms of the disease. (Incubatory carrier)
2- The prodromal period: the microbe now reaches a high enough
number to cause some damage to the host, and we start experiencing
some vital symptoms of the infection.
3- The period of illness: when you have the characteristic signs and the
symptoms of any disease. Such as fever, vomiting, muscle aches and
so on.
4- The convalescent period: after that, you end up with 3 options, if the
disease is very severe and you survive you might end up with some
tissue damage or organ damage, or if it's for example a common cold
virus (very minor) you will completely recover. and also if it's very
sever and the host couldn't survive, he would die.

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Localized Versus Systemic Infections
Localized: Once an infectious process is initiated, the disease may
remain localized; examples of localized infections are pimples, boils
and abscesses.
System: When the infection spreads throughout the body it is said to
have become a systemic or generalized infection; an example is miliary
tuberculosis caused by Mycobacterium tuberculosis (it spreads from
the lungs to the tissues of the body).

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Regarding to the duration of the disease, we have acute, chronic and
subacute infections.
Acute disease: is the disease that begins quickly and disappeared
quickly by a rapid recover stage (2 – 3 weeks).
Examples: measles, mumps, and influenza.
Chronic disease: is a disease that has long time to show symptoms,
so it has a slow onset, and it lasts for a very long time (months or
years). Examples are tuberculosis, leprosy, and syphilis.
Subacute disease: is one that comes on more suddenly than a
chronic disease, but less suddenly than an acute disease; an example
would be bacterial endocarditis.

Also we have a 4th type of disease; it's the latent infection or latent
diseases. In latent disease you first get exposed to the pathogen, some
symptoms of the disease appear, then the symptoms eventually go
away and you will think that you treat the infection and you no longer
have the pathogen in your system, but actually the pathogen enters
the latent stage and now it's hiding somewhere in your tissues. at a
later time in your life, this latent infection will be activate, and now we
will start shedding the virus or the microbe again, and the new
symptoms of the disease start appear.
An example is syphilis; it's a chronic and a latent infection. So when
you exposed to syphilis, then you start suffering symptoms of primary
syphilis, then secondary syphilis, after that the symptoms disappear
and you go through a latent stage for months or years or even a life
time. Then at some point in your life, you might get a reactivation of

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syphilis, and the symptoms of the tertiary stage start appearing (And
do not want you to memorize the contents of these boxes, just now if
you see syphilis, it's an example of the latent infection, and I don't
want you to memorize the stages and so on).

And you also need to differentiate between terms, the symptoms of

disease versus the signs of disease.
so, symptom of disease is the subjective evidence of disease,
something that is not quantified ,it can not be described with numbers,
such as the degree of pain, ringing in the ears, blurred vision, nausea,
dizziness, and so on.
In contrast, the sign of disease is an objective evidence of disease,
something that can be measured in the lab, or in the clinic. Such as
increase in blood pressure, abnormal heart sounds, abnormal pulse
rate, abnormal laboratory results, and so on.
And there's something that I mentioned before, that we have a disease
with symptoms which is called symptomatic disease, and
alternatively we have disease without any symptoms which is called
asymptomatic disease.

I think this is the last slide (finally).

I mentioned this example before, so sometimes; one infection can
commonly follow another infection. When you have this particular
scenario, the first infection is a primary infection, and the second
infection is a secondary disease. An example, you might have an upper
respiratory tract infection which is caused by a virus, then the virus will

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damage the ciliated epithelial cells of the respiratory tract, so now you
can get opportunistic bacterial pathogens from the respiratory tract,
leading to the secondary infection (e.g. pneumonia), so the primary
infection will be the viral, the second infection will be the bacterial one.

The end
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shokor 5a9 la kol mn saham fe injaz hatha el3amal :

- Steam Café

- Semsema Super market

- Mr.Moh'd Sharayri

- Mr.Jehad Tamimi

- Our laptops + 3bood's headphones

- Miss Sara Ibdiwi ( elle jad et7amalt mna kol hata25eer  )

W a7la salam lakol shbab edof3a,,5a99a ( Mawkli, Pagera, Asteeka, Anteeka, Barameel &
toto )

w ma bnenker fa9'el "elflafel" 3alaina,,,sbb wjoodna 

w ma bnensa a9di8a2na fe (Jam3yt etwa7od) allah yshfeehom 

w salamna to our parents in Amman & Aqaba

Laith : mashkoor a5oy w 9adee8e M7mad elRafay3a,,w ya jabal ma yhezzak ree7 ;)

Mohammad: la $okor 3la wajeb 9ade8e laith.....w teslam 3al da3m

Done by :

Laith Jamal

Mo7ammad Rafay3a

 Good Luck 

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