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Infectious Disease
Process
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Topics
Definition of Terms
Sporadic
Endemic
Hyperendemic
Epidemic
Pandemic
Infection
Infestation
Disease
Disorder
Sign
Symptom
Syndrome
Pathogenicity
Virulence
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Chain of Infection
Etiologic Agent
Classification of Etiologic Agents
Examples of Diseases and their Etiologic Agents
Reseroir
Incu!atory Carriers
Inapparent Infections
Conalescent Carriers
Chronic Carriers
Portal of Exit
"ode of Transmission
Direct Transmission
Indirect Transmission
Contact Precautions
Droplet Precautions
Air!orne Precautions
Portal of Entry
Enteral Route
Parenteral Route
Suscepti!le Host
Stages of Infectious Disease
Incu!ation Stage
Prodromal Stage
Acute Stage
Declining Stage Conalescent Stage
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#!$ecties
Descri!e ho% infections are spread
&amiliari'e the terms used in categori'ing spread of infections
Explain the infectious disease process and the chain of infectio
(no% the different classification of etiologic agents and some
of the diseases they may cause
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Patterns of Disease #ccurrence
Sporadic
Disease occurs infre)uently and irregularly
Endemic
Constant presence or usual prealence of a disease or infectious agent i
population within a geographic area
Hyperendemic
Persistent* high leels of disease occurrenceEpidemic
A sudden increase in the num!er of cases of a disease a!oe %hat is nor
expected in that population in that area
Pandemic
An epidemic that has spread oer seeral countries or continents and ha
affected a large num!er of people
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,hat is the difference !et%een
infection and infestation-
Infection
Inasion of a !ody !y an etiologic agent
Infestation
Presence of etiologic agents in the s.in* hair* or nails* of a h
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,hat is the difference !et%een
disease and disorder-
Disease
Appearance of signs or symptoms !rought a!out
!y the presence of an etiologic agent or !y
a!normal function
Disorder
Appearance of signs or symptoms !rought a!out
!y a!normal function
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Sign
#!$ectie finding perceied !y an examiner
/lood in stool* rashes Symptom
Su!$ectie indication of disease perceied !y
the patient
Stomachache* headache* fatigue
Syndrome
0roup of signs and symptoms
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Chain of Infection
Elements lin.ed together %hich affect
transmission of infection
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I1 Etiologic agents
A1 "eta'oan
/1 Proto'oan
C1 &ungi
D1 /acteria
E1 Ric.ettsia
&1 Viruses
01 Prions
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A1 "eta'oans
"ulticellular animals* mostly parasitic
(ingdom Animalia
Examples of diseases2
31 Trichinellosis
41 Schistosomiasis
51 Hoo.%orm infection
61 &ilariasis
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"eta'oanparasites
Helminths
Annelids
7eeches
8ematodes &lat%orms
Cestodes Trematode
Arthropods
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31 Trichinellosis
Also called trichinosis
Caused !y Trichinella
spiralis* an intestinal
round%orm
transmitted througheating undercoo.ed
meat* usually por.
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41 Schistosomiasis
Schistosoma japonicum, Schistosoma haematobium, Schisto
mansoni
A !lood flu.e transmitted through contaminated %ater
Symptoms are related to num!er and location of eggs in the
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51 Hoo.%orm infection
Ancylostoma duodenale
Necator americanus
Transmitted through feces9
contaminated %ater and soil Can cause chronic anemia that
often results in retarded mental
and physical deelopment of
children
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61 &ilariasis
Wuchereria bancrofti
Brugia malayi
Chronic infection may
cause elephantiasis
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:nholy Three of Parasitic Infection
Round%orm
Ascaris lumbricoides
Hoo.%orm
Ancylostoma duodenale
Necator americanus
,hip%orm
Trichuris trichiura
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/1 Proto'oans
Single9celled organisms %ith %ell9defined nucleus
(ingdom Protista
31 Amoe!iasis
41 0iardiasis51 "alaria
61 Toxoplasmosis
5. Pneumocystis carinii pneumonia
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31 Amoe!iasis
Diarrheal illness
ntamoeba histolytica ntamoeba coli !not pathologic"
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41 "alaria
A mos)uito9!orne
disease and one of the
top three infectious
diseases in the %orld
Plasmodium falciparum
Plasmodium #i#a$
Plasmodium malariae
Plasmodium o#ale
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Considered as the top three infectious
diseases in the %orld2
"alaria
Tu!erculosis
HIV
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51 0iardiasis
Infection of the upper
small intestine %hich
causes diarrheal
illness
%iardia lamblia
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51 Toxoplasmosis
To$oplasma gondii
Transmitted to humans !y
cats and undercoo.ed meat
"ay cause fetal death if it
infects a pregnant %oman
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61 Pneumocystis carinii
pneumonia ;PCP<
#ften fatal :sually seen in patients %ith
compromised immune system
Infected %ith HIV
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C1 &ungi
8on9motile* filamentous organisms
Cause diseases %hich are hard to treat
(ingdom &ungi
(ingdom Protista9 slime molds
31 Histoplasmosis
41 Candidiasis
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31 Histoplasmosis
&istoplasmacapsulatum
Transmitted !y
inhaling dust
from soil that
contains birddroppings
Seerity aries
%idely* !ut
commonly
affects the lungs
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41 Candidiasis
'andida albicans
Transmitted !y contact
%ith infected patients and
carriers
Causes lesions on the s.in
or mucus mem!ranes*
including thrush anduloaginitis
Symptoms can !e seere in
immunocompromised
patients
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D1 /acteria
Single9celled organisms %ithout nucleus
(ingdom "onera
Tu!erculosis
Chlamydia
0onorrhea
#ther accine9preenta!le diseases
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31 Tu!erculosis
A chronic lungdisease
A ma$or cause
of disa!ility in
many parts of
the %orld (ycobacterium
tuberculosis
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41 Chlamydia and
0onorrhea
'hlamydiatrachomatis
Neisseria
gonorrhea
Considered as
the most
%idespread
sexually
transmitted
disease
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E1 Ric.ettsia
:sually found in the cells of lice* tic.s* fleas* and mites
Smaller than most !acteria and share some characteristics
of iruses
0enus of !acteria
31 Roc.y "ountain Spotted &eer
41 Typhus
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31 Roc.y "ountain
Spotted &eer
Tic.9!ornesystemic
disease
)ic*ettsia
ric*ettsii
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41 Types of typhus
and carriers2
a1 Epidemic typhus
7ouse9!orne typhus
Caused !y )ic*ettsia pro+ae*ii
!1 "urine typhus
Carried !y the rat or cat flea
Caused !y )ic*ettsia typhi
c1 Scru! typhus
Carried !y mites
Caused !y -rientia tsutsugamushi
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&1 Viruses
Small organisms consisting of an outer protein coat and anR8A or D8A core
Can only gro% inside liing cells
Influen'a
SARS
AIDS
Hepatitis
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01 Prions
Infectious agents%ithout genes
Seem to !e comprised
of protein %hich
replicates in animal or
human tissues Cause seere damage
to the !rain
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Prion diseases in humans2
C=D ;Creut'feld9=aco! Disease<
0SS ;0erstmann9Straussler9Schein.er Syndrome<
&&I ;&amilial &atal Insomnia<
(uru
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A!ility of an etiologic agent to cause
harm is measured !y t%o factors
Pathogenicity A!ility of an etiologic agent to cause disease in a
suscepti!le host
Virulence
Degree of harm caused !y an etiologic agent in a
suscepti!le host
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II1 Reseroirs
:sual ha!itat %here etiologic agent lies and multiplies
31 Humans
41 Animals
51 Enironment
R i
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31 Human Reseroirs
Acute clinical cases Carriers
,h i h diff !
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,hat is the difference !et%een acute
clinical cases and carriers-
Acute Clinical Cases People %ho are infected %ith the disease agent and
!ecome ill
Their contacts and actiities may !e limited
Carriers
People %ho har!or infectious agents !ut are not ill
Actiities are not restricted !y illness
,hi h t i . f di
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,hich present more ris. for disease
transmission-
Acute clinical cases are more li.ely to !e diagnosed andtreated than carriers
Carriers present more ris. for disease transmission than
acute clinical cases !ecause their contacts are una%are of
their infection
T f i
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Types of carriers
A1 Incu!atory carriers
/1 Inapparent infections
C1 Su!clinical cases
D1 Conalescent carriers
E1 Chronic carriers
A I ! t C i
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A1 Incu!atory Carriers
People infected %ith an etiologic agent has not yetdeeloped the disease* !ut !egin transmitting the
etiologic agent to others
A person infected %ith measles !egins to shed the irus in
nasal and throat secretions a day or t%o !efore any coldsymptoms or rash are noticea!le
HIV infection may !e present for years !efore the person
deelops any sign or symptom
/ Inapparent Infections
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/1 Inapparent Infections
People infected %ith an etiologic agent %ill not deelopthe disease* !ut !egin transmitting the etiologic agent to
others
#f eery 3>> indiiduals infected %ith the poliomyelitis
irus* only one !ecomes paraly'ed1 &our others %ill hae amild illness %ith feer* malaise* headache* nausea and
omiting* !ut ?@ out of the 3>> %ill hae no symptoms at
all* although they pass the irus in their feces
C Su!clinical Cases
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C1 Su!clinical Cases
A type of inapparent infection %herein a huge num!er ofpeople gets infected !efore anyone deelops the disease
In meningococcal meningitis* the num!er of su!clinical
cases may !e )uite high !efore a single clinical case
appears
D Conalescent Carriers
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D1 Conalescent Carriers
People infected %ith an etiologic agent %ho deeloped thedisease and has recoered continue to transmit the
etiologic agent for %ee.s or months
Salmonella patients may excrete the !acteria in feces for
seeral %ee.s* and rarely een for a year or more This is most common in infants and young children
Treatment %ith inappropriate anti!iotics may prolong the
conalescent carrier phase
E Chronic carriers
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E1 Chronic carriers
People infected %ith an etiologic agent %ho deeloped the d
and has recoered continue to transmit the etiologic agent for longer
The chronic carrier state is common follo%ing hepatitis / in
%hether or not the person !ecomes ill* and may !e lifelong
Ris. of deeloping chronic hepatitis / depends on the personinfection
A!out ?>B of infants infected at !irth !ecome chronic carrie
irus* compared %ith only 393>B infected after age @
Important to gie hepatitis / accine to ne%!orns
4 Animal Reseroirs
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41 Animal Reseroirs
Can !e descri!ed in the same %ay as human reseroirs2
Acute clinical cases
Carriers
5 Enironmental Reseroirs
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51 Enironmental Reseroirs
Plants* soil* and %ater
"ost fungal agents lie and multiply in the soil
#rganism that causes histoplasmosis lies in soil %ith high
organic content and undistur!ed !ird droppings
Agents that cause tetanus* anthrax* and !otulism are
%idely distri!uted in soil
Agent of 7egionnaires Disease lies in %ater* including hot
%ater heaters
III Portal of Exit
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III1 Portal of Exit
Route !y %hich etiologic agents escape from the reseroir Secretions* excretions
IV "ode of Transmission
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IV1 "ode of Transmission
Path of transfer of etiologic agentfrom a reseroir to a suscepti!le
host
Vertical transmission
Hori'ontal transmission
Direct transmission
Indirect transmission
Direct Transmission
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Direct Transmission
Due to direct contact %ith the reseroir
Direct Transmission
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Direct Transmission
Re)uires physical contact !et%een an infected person and asuscepti!le person* and the physical transfer of microorganisms
Touching an infected indiidual* .issing* sexual contact* contact %ith
oral secretions* or contact %ith !ody lesions
Re)uires close contact %ith an infected indiidual
:sually occurs !et%een mem!ers of the same household or close
friends and family Diseases that spread exclusiely !y direct contact are una!le to
surie for significant periods of time a%ay from a host
Sexually transmitted diseases are almost al%ays spread through direct
contact* as their etiologic agents are extremely sensitie to drying
Indirect Transmission
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Indirect Transmission
31 Inanimate mechanisms Inoles transmission through nonliing ehicles
41 Animate mechanisms
Inoles transmission through liing ectors
31 Inanimate "echanisms
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31 Inanimate "echanisms
A1 &omites/1 Droplet nuclei
A1 &omites
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A1 &omites
Contaminated touch surfaces
Transmit etiologic agents to
suscepti!le host especially if
etiologic agents are capa!le of
suriing on surfaces for anextended period of time
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/1 Droplet 8uclei
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p
Residue from eaporated droplets
Aerosol transmission9 inhalation of
infectious particles
Particles up to 3>> m in si'e are
considered inhala!le ;inspira!le<
Air!orne transmission
Droplet transmission
,hat is the difference !et%een air!orne
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transmission and droplet transmission-
/oth inole transmission of droplet nuclei
The difference lies in the si'e of droplet nuclei !eing
transmitted
Air!orne Transmission
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Small droplets ; 3> m<
Trael a long distance
Droplet nuclei or dust particles containing microorganisms re
suspended in air for long periods of time
#rganisms are capa!le of suriing for long periods of time o
!ody and resistant to drying
#rganisms enter the upper and lo%er respiratory tracts
A limited num!er of diseases are capa!le of air!orne transmi
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Droplet Transmission
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7arge droplets ;3> m<
Short distance
Coughing* snee'ing* or tal.ing* certain medical procedures
;!ronchoscopy<
Too large to !e air!orne for long periods of time
Fuic.ly settle out of air
Reduced %ith the use of personal protectie !arriers
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41 Animate "echanisms
/iological ectors s1 "echanical Vectors
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/iological ectors s1 "echanical Vectors
Can !iological ectors also !ecome
hosts-
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Vector
Is a liing organism that transmits an infectious agent
from an infected animal to a human or another animal
/iological ector
"os)uitos* tic.s
"ay carry pathogens that can multiply %ithin their !odies and!e deliered to ne% hosts usually !y !iting
"echanical ector &lies
Can pic. up infectious agents on the outside of their !odies
and transmit them through physical contact
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VI1 Suscepti!le Host
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Suscepti!ility 7i.elihood of !eing infected !y an etiologic agent
Affected !y2
0enetic factors
0eneral resistance
Immunity
The Stages of Infectious Disease
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31 Incu!ation stage41 Prodromal stage
51 Acute stage
61 Declining stage
@1 Conalescent stage
31 Incu!ation Stage
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Silent stage 7ength of the incu!ation stage depends on the etiologic
agent
Some hae ery short incu!ation stage %hile others
re)uire a longer time
Incu!ation stage ends %hen the first signs and symptomsof the infectious disease appear
41 Prodromal Stage
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&irst signs andGor symptoms occur
7asts a!out one or t%o days
Signs and symptoms sho% that a disease process is ta.ing
place
51 Acute Stage
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Disease reaches its highest point of deelopment
Signs and symptoms may !ecome more seere
Signs and symptoms during this stage can help determine
one disease from another
61 Declining Stage
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Signs and symptoms start to su!side
Etiologic agent is still present
Health of the host starts to return to normal
@1 Conalescent Stage
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Signs and symptoms hae nearly anished
Etiologic agent has !een mostly eliminated
Host !egins to regain strength and returns to original state
of health
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The Infectious Disease Spectrum
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Impact of disease agents on human host populations is comp
If a large num!er of indiiduals are e)ually exposed to an inagent* they do not all respond in the same manner
/road range of host responses2
Some do not !ecome infected at all
Some !ecome infected !ut deelop no signs nor symptoms
Some !ecome infected and deelop mild or moderate signs
Some !ecome infected and deelop seere signs or symptom
Some die as a result of their infection
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"any diseases share the same signs and symptoms
Treatment and control measures are ery different for
these diseases
7a!oratory identification of specific disease agent isimportant in any epidemiological inestigation
This ariation is due to2
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Capacity of the agent to produce disease
Differing leels of resistance of the hosts
In summary2
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In order for infection and disease to occur in an indiidual*
a process inoling six related components must occur
Chain of Infection
To stop the spread of disease* one or more of these lin.s
must !e !ro.en