Infectious Disease

Process

Topics
Definition

of Terms

Sporadic
Endemic
Hyperendemic
Epidemic
Pandemic
Infection
Infestation

Disease
Disorder
Sign
Symptom
Syndrome
Pathogenicity
Virulence

Chain of Infection

Etiologic Agent

Classification of Etiologic Agents

Examples of Diseases and their Etiologic Agents

Reservoir

Incubatory Carriers

Inapparent Infections

Convalescent Carriers

Chronic Carriers

Portal of Exit

Mode of Transmission

Direct Transmission

Indirect Transmission

Contact Precautions

Droplet Precautions

Airborne Precautions

Portal of Entry

Enteral Route

Parenteral Route

Susceptible Host

Stages of Infectious Disease

Incubation Stage

Prodromal Stage

Acute Stage

Declining Stage

Convalescent Stage

Objectives
Describe

how infections are spread

Familiarize
Explain
Know

the terms used in categorizing spread of infections

the infectious disease process and the chain of infection

the different classification of etiologic agents and some

of the diseases they may cause

Patterns of Disease Occurrence

Sporadic

Endemic

Disease occurs infrequently and irregularly

Constant presence or usual prevalence of a disease or infectious agent in a
population within a geographic area

Hyperendemic

Persistent, high levels of disease occurrence

Epidemic

A sudden increase in the number of cases of a disease above what is normally

expected in that population in that area

Pandemic

An epidemic that has spread over several countries or continents and has
affected a large number of people

What is the difference between

infection and infestation?

Infection
Invasion

of a body by an etiologic agent

Infestation
Presence

of etiologic agents in the skin, hair, or nails, of a host

What is the difference between

disease and disorder?
Disease
Appearance

of signs or symptoms brought about

by the presence of an etiologic agent or by
abnormal function

Disorder
Appearance

of signs or symptoms brought about

by abnormal function

 Sign
Objective
Blood

finding perceived by an examiner

in stool, rashes

Symptom
Subjective

indication of disease perceived by

the patient

Stomachache,

headache, fatigue

Syndrome
Group

of signs and symptoms

Chain of Infection
Elements

linked together which affect

transmission of infection

I. Etiologic agents
A.

Metazoan

B.

Protozoan

C.

Fungi

D.

Bacteria

E.

Rickettsia

F.

Viruses

G.

Prions

A. Metazoans

Multicellular animals, mostly parasitic

Kingdom Animalia

Examples of diseases:
1.

Trichinellosis

2.

Schistosomiasis

3.

Hookworm infection

4.

Filariasis

Metazoan
parasites

Annelids

Leeches

Helminths

Arthropods

Nematodes

Flatworms

Cestodes

Trematodes

1. Trichinellosis
Also

called trichinosis

Caused

by Trichinella
spiralis, an intestinal
roundworm
transmitted through
eating undercooked
meat, usually pork

2. Schistosomiasis

Schistosoma japonicum, Schistosoma haematobium, Schistosoma

mansoni

A blood fluke transmitted through contaminated water

Symptoms are related to number and location of eggs in the human body

3. Hookworm infection

Ancylostoma duodenale

Necator americanus

Transmitted through fecescontaminated water and soil

Can cause chronic anemia that

often results in retarded mental
and physical development of
children

4. Filariasis

Wuchereria bancrofti

Brugia malayi

Chronic infection may

cause elephantiasis

Unholy Three of Parasitic Infection

Roundworm

Ascaris lumbricoides

Hookworm

Ancylostoma duodenale

Necator americanus

Whipworm

Trichuris trichiura

B. Protozoans

Single-celled organisms with well-defined nucleus

Kingdom Protista

1.

Amoebiasis

2.

Giardiasis

3.

Malaria

4.

Toxoplasmosis

5.

Pneumocystis carinii pneumonia

1. Amoebiasis

Diarrheal illness

Entamoeba histolytica

Entamoeba coli (not pathologic)

2. Malaria

A mosquito-borne
disease and one of the
top three infectious
diseases in the world

Plasmodium falciparum

Plasmodium vivax

Plasmodium malariae

Plasmodium ovale

Considered as the top three infectious

diseases in the world:
Malaria
Tuberculosis
HIV

3. Giardiasis

Infection of the upper

small intestine which
causes diarrheal
illness

Giardia lamblia

3. Toxoplasmosis

Toxoplasma gondii

Transmitted to humans by
cats and undercooked meat

May cause fetal death if it

infects a pregnant woman

4. Pneumocystis carinii
pneumonia (PCP)

Often fatal

Usually seen in patients with

compromised immune system

Infected with HIV

C. Fungi

Non-motile, filamentous organisms

Cause diseases which are hard to treat

Kingdom Fungi

Kingdom Protista- slime molds

1.

Histoplasmosis

2.

Candidiasis

1. Histoplasmosis

Histoplasma
capsulatum

Transmitted by
inhaling dust
from soil that
contains bird
droppings

Severity varies
widely, but
commonly
affects the lungs

2. Candidiasis

Candida albicans

Transmitted by contact
with infected patients and
carriers

Causes lesions on the skin

or mucus membranes,
including thrush and
vulvovaginitis

Symptoms can be severe in

immunocompromised
patients

D. Bacteria

Single-celled organisms without nucleus

Kingdom Monera

Tuberculosis

Chlamydia

Gonorrhea

Other vaccine-preventable diseases

1. Tuberculosis

A chronic lung
disease

A major cause
of disability in
many parts of
the world

Mycobacterium
tuberculosis

2. Chlamydia and
Gonorrhea

Chlamydia
trachomatis

Neisseria
gonorrhea

Considered as
the most
widespread
sexually
transmitted
disease

E. Rickettsia

Usually found in the cells of lice, ticks, fleas, and mites

Smaller than most bacteria and share some characteristics

of viruses

Genus of bacteria

1.

Rocky Mountain Spotted Fever

2.

Typhus

1. Rocky Mountain
Spotted Fever

Tick-borne
systemic
disease

Rickettsia
rickettsii

2. Types of typhus
and carriers:
a. Epidemic typhus

Louse-borne typhus

Caused by Rickettsia prowazekii

b. Murine typhus

Carried by the rat or cat flea

Caused by Rickettsia typhi

c. Scrub typhus

Carried by mites

Caused by Orientia tsutsugamushi

F. Viruses

Small organisms consisting of an outer protein coat and an

RNA or DNA core

Can only grow inside living cells

Influenza

SARS

AIDS

Hepatitis

G. Prions

Infectious agents
without genes

Seem to be comprised
of protein which
replicates in animal or
human tissues

Cause severe damage

to the brain

Prion diseases
in animals:

TME (Transmissible
Mink Encephalopathy)affects minks

CWD (Chronic Wasting

Disease)- affects
mules, deer, elks

BSE (Bovine
Spongiform
Encephalopathy)affects cows

Prion diseases in humans:

CJD (Creutzfeld-Jacob Disease)

GSS (Gerstmann-Straussler-Scheinker Syndrome)

FFI (Familial Fatal Insomnia)

Kuru

Ability of an etiologic agent to cause

harm is measured by two factors

Pathogenicity

Ability of an etiologic agent to cause disease in a

susceptible host

Virulence

Degree of harm caused by an etiologic agent in a

susceptible host

II. Reservoirs

Usual habitat where etiologic agent lives and multiplies

1.

Humans

2.

Animals

3.

Environment

1. Human Reservoirs

Acute clinical cases

Carriers

What is the difference between acute

clinical cases and carriers?

Acute Clinical Cases

People

who are infected with the disease agent and

become ill

Their

contacts and activities may be limited

Carriers
People

who harbor infectious agents but are not ill

Activities

are not restricted by illness

Which present more risk for disease

transmission?

Acute clinical cases are more likely to be diagnosed and

treated than carriers

Carriers present more risk for disease transmission than

acute clinical cases because their contacts are unaware of
their infection

Types of carriers
A.

Incubatory carriers

B.

Inapparent infections

C.

Subclinical cases

D.

Convalescent carriers

E.

Chronic carriers

A. Incubatory Carriers

People infected with an etiologic agent has not yet

developed the disease, but begin transmitting the
etiologic agent to others

A person infected with measles begins to shed the virus in

nasal and throat secretions a day or two before any cold
symptoms or rash are noticeable

HIV infection may be present for years before the person

develops any sign or symptom

B. Inapparent Infections

People infected with an etiologic agent will not develop

the disease, but begin transmitting the etiologic agent to
others

Of every 100 individuals infected with the poliomyelitis

virus, only one becomes paralyzed. Four others will have a
mild illness with fever, malaise, headache, nausea and
vomiting, but 95 out of the 100 will have no symptoms at
all, although they pass the virus in their feces

C. Subclinical Cases

A type of inapparent infection wherein a huge number of

people gets infected before anyone develops the disease

In meningococcal meningitis, the number of subclinical

cases may be quite high before a single clinical case
appears

D. Convalescent Carriers

People infected with an etiologic agent who developed the

disease and has recovered continue to transmit the
etiologic agent for weeks or months

Salmonella patients may excrete the bacteria in feces for

several weeks, and rarely even for a year or more

This is most common in infants and young children

Treatment with inappropriate antibiotics may prolong the

convalescent carrier phase

E. Chronic carriers

People infected with an etiologic agent who developed the disease

and has recovered continue to transmit the etiologic agent for years
or longer

The chronic carrier state is common following hepatitis B infection,

whether or not the person becomes ill, and may be lifelong

Risk of developing chronic hepatitis B depends on the persons age at

infection

About 90% of infants infected at birth become chronic carriers of the

virus, compared with only 1-10% infected after age 5

Important to give hepatitis B vaccine to newborns

2. Animal Reservoirs

Can be described in the same way as human reservoirs:

Acute clinical cases

Carriers

3. Environmental Reservoirs

Plants, soil, and water

Most fungal agents live and multiply in the soil

Organism that causes histoplasmosis lives in soil with high

organic content and undisturbed bird droppings

Agents that cause tetanus, anthrax, and botulism are

widely distributed in soil

Agent of Legionnaires Disease lives in water, including hot

water heaters

III. Portal of Exit

Route by which etiologic agents escape from the reservoir

Secretions, excretions

IV. Mode of Transmission

Path of transfer of etiologic agent

from a reservoir to a susceptible
host

Vertical transmission

Horizontal transmission

Direct transmission

Indirect transmission

Direct Transmission

Due to direct contact with the reservoir

Direct Transmission

Requires physical contact between an infected person and a

susceptible person, and the physical transfer of microorganisms

Touching an infected individual, kissing, sexual contact, contact with

oral secretions, or contact with body lesions

Requires close contact with an infected individual

Usually occurs between members of the same household or close

friends and family

Diseases that spread exclusively by direct contact are unable to

survive for significant periods of time away from a host

Sexually transmitted diseases are almost always spread through direct

contact, as their etiologic agents are extremely sensitive to drying

Indirect Transmission
1. Inanimate mechanisms
Involves

transmission through nonliving vehicles

2. Animate mechanisms
Involves

transmission through living vectors

1. Inanimate Mechanisms
A. Fomites
B. Droplet nuclei

A. Fomites

Contaminated touch surfaces

Transmit etiologic agents to

susceptible host especially if
etiologic agents are capable of
surviving on surfaces for an
extended period of time

B. Droplet Nuclei

Residue from evaporated droplets

Aerosol transmission- inhalation of

infectious particles

Particles up to 100 m in size are

considered inhalable (inspirable)

Airborne transmission

Droplet transmission

What is the difference between airborne

transmission and droplet transmission?

Both involve transmission of droplet nuclei

The difference lies in the size of droplet nuclei being

transmitted

Airborne Transmission

Small droplets (< 10 m)

Travel a long distance

Droplet nuclei or dust particles containing microorganisms remain

suspended in air for long periods of time

Organisms are capable of surviving for long periods of time outside the
body and resistant to drying

Organisms enter the upper and lower respiratory tracts

A limited number of diseases are capable of airborne transmission

Droplet Transmission

Large droplets (>10 m)

Short distance

Coughing, sneezing, or talking, certain medical procedures

(bronchoscopy)

Too large to be airborne for long periods of time

Quickly settle out of air

Reduced with the use of personal protective barriers

2. Animate Mechanisms
Biological vectors vs. Mechanical Vectors

Can

biological vectors also become

hosts?

 Vector
Is

a living organism that transmits an infectious agent

from an infected animal to a human or another animal

Biological

vector

Mosquitos,

ticks

carry pathogens that can multiply within their bodies and

be delivered to new hosts usually by biting

May

Mechanical

vector

Flies
Can

pick up infectious agents on the outside of their bodies

and transmit them through physical contact

V. Portal of Entry

Route by which etiologic agents enter a host

Enteral route
Involves

the alimentary canal

Parenteral route
Does

not involve the alimentary canal

VI. Susceptible Host

Susceptibility
Likelihood

of being infected by an etiologic agent

Affected by:
Genetic

factors

General

resistance

Immunity

The Stages of Infectious Disease

1.

Incubation stage

2.

Prodromal stage

3.

Acute stage

4.

Declining stage

5.

Convalescent stage

1. Incubation Stage

Silent stage

Length of the incubation stage depends on the etiologic

agent

Some have very short incubation stage while others

require a longer time

Incubation stage ends when the first signs and symptoms

of the infectious disease appear

2. Prodromal Stage

First signs and/or symptoms occur

Lasts about one or two days

Signs and symptoms show that a disease process is taking

place

3. Acute Stage

Disease reaches its highest point of development

Signs and symptoms may become more severe

Signs and symptoms during this stage can help determine

one disease from another

4. Declining Stage

Signs and symptoms start to subside

Etiologic agent is still present

Health of the host starts to return to normal

5. Convalescent Stage

Signs and symptoms have nearly vanished

Etiologic agent has been mostly eliminated

Host begins to regain strength and returns to original state

of health

The Infectious Disease Spectrum

Impact of disease agents on human host populations is complex

If a large number of individuals are equally exposed to an infectious

agent, they do not all respond in the same manner

Broad range of host responses:

Some do not become infected at all

Some become infected but develop no signs nor symptoms

Some become infected and develop mild or moderate signs or symptoms

Some become infected and develop severe signs or symptoms

Some die as a result of their infection

Many diseases share the same signs and symptoms

Treatment and control measures are very different for

these diseases

Laboratory identification of specific disease agent is

important in any epidemiological investigation

This variation is due to:

Capacity of the agent to produce disease

Differing levels of resistance of the hosts

In summary:

In order for infection and disease to occur in an individual,

a process involving six related components must occur
Chain

of Infection

To stop the spread of disease, one or more of these links

must be broken