1. Copyright © 2011 Pearson Education Inc. Lecture prepared by Mindy Miller-Kittrell, University of Tennessee, Knoxville M I C R O B I O L O G Y WITH DISEASES BY TAXONOMY, THIRD EDITION Chapter 14 Infection, Infectious Diseases, and Epidemiology

2. Copyright © 2011 Pearson Education Inc. Symbiotic Relationships Between Microbes and Their Hosts Symbiosis means “to live together” We have symbiotic relationships with countless microorganisms Types of symbiosis – Mutualism – Commensalism – Parasitism

3. Copyright © 2011 Pearson Education Inc. Symbiotic Relationships Between Microbes and Their Hosts Table 14.1

4. Copyright © 2011 Pearson Education Inc. Mutualism Figure 14.1

5. Copyright © 2011 Pearson Education Inc. Symbiotic Relationships Between Microbes and Their Hosts Normal Microbiota in Hosts – Also termed normal flora and indigenous microbiota – Organisms that colonize the body’s surfaces without normally causing disease – Two types – Resident microbiota – Transient microbiota

6. Copyright © 2011 Pearson Education Inc. An example of normal microbiota Figure 14.2

7. Copyright © 2011 Pearson Education Inc. Symbiotic Relationships Between Microbes and Their Hosts Normal Microbiota in Hosts – Resident microbiota – Are a part of the normal microbiota throughout life – Are mostly commensal

8. Copyright © 2011 Pearson Education Inc. Symbiotic Relationships Between Microbes and Their Hosts Table 14.2

9. Copyright © 2011 Pearson Education Inc. Symbiotic Relationships Between Microbes and Their Hosts Normal Microbiota in Hosts – Transient microbiota – Remain in the body for short period – Found in the same regions as resident microbiota – Cannot persist in the body – Competition from other microorganisms – Elimination by the body’s defense cells – Chemical or physical changes in the body

10. Copyright © 2011 Pearson Education Inc. Symbiotic Relationships Between Microbes and Their Hosts Normal Microbiota in Hosts – Acquisition of normal microbiota – Development in womb free of microorganisms (axenic) – Microbiota begin to develop during birthing process – Much of one’s resident microbiota established during first months of life

11. Copyright © 2011 Pearson Education Inc. Symbiotic Relationships Between Microbes and Their Hosts How Normal Microbiota Become Opportunistic Pathogens – Opportunistic pathogens – Normal microbiota that cause disease under certain circumstances – Conditions that provide opportunities for pathogens – Introduction of normal microbiota into unusual site in body – Immune suppression – Changes in the normal microbiota – Changes in relative abundance may allow opportunity for a member to thrive and cause disease

12. Copyright © 2011 Pearson Education Inc. Reservoirs of Infectious Diseases of Humans Most pathogens cannot survive for long outside of their host Reservoirs of infection – Sites where pathogens are maintained as a source of infection Three types of reservoirs – Animal reservoir – Human carriers – Nonliving reservoir

13. Copyright © 2011 Pearson Education Inc. Reservoirs of Infectious Diseases of Humans Animal Reservoirs – Zoonoses – Diseases naturally spread from animal host to humans – Acquire zoonoses through various routes – Direct contact with animal or its waste – Eating animals – Bloodsucking arthropods – Humans are usually dead-end host to zoonotic pathogens

14. Copyright © 2011 Pearson Education Inc. Reservoirs of Infectious Diseases of Humans Human Carriers – Infected individuals who are asymptomatic but infective to others – Some individuals eventually develop illness while others never get sick – Healthy carriers may have defensive systems that protect them

15. Copyright © 2011 Pearson Education Inc. Reservoirs of Infectious Diseases of Humans Nonliving Reservoirs – Soil, water, and food can be reservoirs of infection – Presence of microorganisms often due to contamination by feces or urine

16. Copyright © 2011 Pearson Education Inc. The Movement of Microbes into Hosts: Infection Exposure to Microbes: Contamination and Infection – Contamination – The mere presence of microbes in or on the body – Infection – When organism evades body’s external defenses, multiplies, and becomes established in the body

17. Copyright © 2011 Pearson Education Inc. The Movement of Microbes into Hosts: Infection Portals of Entry – Sites through which pathogens enter the body – Four major pathways – Skin – Mucous membranes – Placenta – Parenteral route

18. Copyright © 2011 Pearson Education Inc. Routes of entry for invading pathogens Figure 14.3

19. Copyright © 2011 Pearson Education Inc. The Movement of Microbes into Hosts: Infection Portals of Entry – Skin – Outer layer of dead skin cells acts as a barrier to pathogens – Some pathogens can enter through openings or cuts – Others enter by burrowing into or digesting outer layers of skin

20. Copyright © 2011 Pearson Education Inc. A cross section of skin Figure 14.4

21. Copyright © 2011 Pearson Education Inc. The Movement of Microbes into Hosts: Infection Portals of Entry – Mucous membranes – Line the body cavities that are open to the environment – Provide a moist, warm environment hospitable to pathogens – Respiratory tract is the most common site of entry – Entry is through the nose, mouth, or eyes – Gastrointestinal tract may be route of entry – Must survive the acidic pH of the stomach

22. Copyright © 2011 Pearson Education Inc. The Movement of Microbes into Hosts: Infection Portals of Entry – Placenta – Typically forms effective barrier to pathogens – Pathogens may cross the placenta and infect the fetus – Can cause spontaneous abortion, birth defects, premature birth

23. Copyright © 2011 Pearson Education Inc. The Movement of Microbes into Hosts: Infection Portals of Entry – Parenteral route – Not a true portal of entry – Means by which the portal of entry can be circumvented – Pathogens deposited directly into tissues beneath the skin or mucous membranes

24. Copyright © 2011 Pearson Education Inc. The Movement of Microbes into Hosts: Infection The Role of Adhesion in Infection – Process by which microorganisms attach themselves to cells – Required to successfully establish colonies within the host – Uses adhesion factors – Specialized structures – Attachment proteins

25. Copyright © 2011 Pearson Education Inc. The adhesion of pathogens to host cells Figure 14.5

26. Copyright © 2011 Pearson Education Inc. The Movement of Microbes into Hosts: Infection The Role of Adhesion in Infection – Attachment proteins help in adhesion – Found on viruses and many bacteria – Viral or bacterial ligands bind host cell receptors – Interaction can determine host cell specificity – Changing/blocking a ligand or its receptor can prevent infection – Inability to make attachment proteins or adhesins renders microorganisms avirulent – Some bacterial pathogens attach to each other to form a biofilm

27. Copyright © 2011 Pearson Education Inc. Dental Plaque Figure 14.6

28. Copyright © 2011 Pearson Education Inc. The Nature of Infectious Disease Infection is the invasion of the host by a pathogen Disease results if the invading pathogen alters normal body functions Disease is also referred to as morbidity

29. Copyright © 2011 Pearson Education Inc. The Nature of Infectious Disease Manifestations of Disease: Symptoms, Signs, and Syndromes – Symptoms – Subjective characteristics of disease felt only by the patient – Signs – Objective manifestations of disease observed or measured by others – Syndrome – Symptoms and signs that characterize a disease or abnormal condition – Asymptomatic, or subclinical, infections lack symptoms but may still have signs of infection

30. Copyright © 2011 Pearson Education Inc. The Nature of Infectious Disease Causation of Disease: Etiology – Study of the cause of disease – Germ theory of disease – Disease caused by infections of pathogenic microorganisms – Robert Koch developed a set of postulates one must satisfy to prove a particular pathogen causes a particular disease

31. Copyright © 2011 Pearson Education Inc. Koch’s Postulates Figure 14.7

32. Copyright © 2011 Pearson Education Inc. 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

33. Copyright © 2011 Pearson Education Inc. 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

34. Copyright © 2011 Pearson Education Inc. Relative virulence of some microbial pathogens Figure 14.8

35. Copyright © 2011 Pearson Education Inc. 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

36. Copyright © 2011 Pearson Education Inc. Virulence factors Figure 14.9a

37. Copyright © 2011 Pearson Education Inc. 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 toxins in the bloodstream that are carried beyond the site of infection – Two types – Exotoxins – Endotoxins

38. Copyright © 2011 Pearson Education Inc. Virulence factors Figure 14.9b

39. Copyright © 2011 Pearson Education Inc. The Nature of Infectious Disease Animation: Virulence Factors: Exotoxins

40. Copyright © 2011 Pearson Education Inc. The Nature of Infectious Disease Animation: Virulence Factors: Endotoxins

41. Copyright © 2011 Pearson Education Inc. The Nature of Infectious Disease Virulence Factors of Infectious Agents – Antiphagocytic factors – Factors prevent phagocytosis by the host’s phagocytic cells – Bacterial capsule – Composed of chemicals not recognized as foreign – Slippery; difficult for phagocytes to engulf bacteria – Antiphagocytic chemicals – Prevent fusion of lysosome and phagocytic vesicles – Leukocidins directly destroy phagocytic white blood cells

42. Copyright © 2011 Pearson Education Inc. Virulence factors Figure 14.9c

43. Copyright © 2011 Pearson Education Inc. The Nature of Infectious Disease Animation: Virulence Factors: Hiding from Host Defenses

44. Copyright © 2011 Pearson Education Inc. 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

45. Copyright © 2011 Pearson Education Inc. The stages of infectious disease Figure 14.10

46. Copyright © 2011 Pearson Education Inc. 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

47. Copyright © 2011 Pearson Education Inc. Portals of exit Figure 14.11

48. Copyright © 2011 Pearson Education Inc. 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 – Direct, indirect, or droplet – Vehicle transmission – Airborne, waterborne, or foodborne – Vector transmission – Biological or mechanical

49. Copyright © 2011 Pearson Education Inc. Modes of Infectious Disease Transmission Animation: Epidemiology: Transmission of Disease

50. Copyright © 2011 Pearson Education Inc. Droplet transmission Figure 14.12

51. Copyright © 2011 Pearson Education Inc. Poorly refrigerated foods can harbor pathogens Figure 14.13

52. Copyright © 2011 Pearson Education Inc. Classification of Infectious Diseases Diseases can be classified in number of ways – The body system they affect – Taxonomic categories – Their longevity and severity – How they are spread to their host – The effects they have on populations (rather than on individuals)

53. Copyright © 2011 Pearson Education Inc. Classification of Infectious Diseases Terms used to classify infectious disease – Acute disease – Chronic disease – Subacute disease – Latent disease – Communicable – Contagious

54. Copyright © 2011 Pearson Education Inc. Epidemiology of Infectious Diseases Animation: Epidemiology: Overview

55. Copyright © 2011 Pearson Education Inc. Epidemiology of Infectious Diseases Frequency of Disease – Track occurrence of diseases 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

56. Copyright © 2011 Pearson Education Inc. The incidence and estimated prevalence of AIDS Figure 14.14

57. Copyright © 2011 Pearson Education Inc. Epidemiologists report data in a number of ways Figure 14.15

58. Copyright © 2011 Pearson Education Inc. Different terms for the occurrence of disease Figure 14.16

59. Copyright © 2011 Pearson Education Inc. Epidemiology of Infectious Diseases Animation: Epidemiology: Occurrence of Disease

60. Copyright © 2011 Pearson Education Inc. Epidemics may have fewer cases than nonepidemics Figure 14.17

61. Copyright © 2011 Pearson Education Inc. A page from the MMWR Figure 14.18

62. Copyright © 2011 Pearson Education Inc. 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 (or first case) of the disease

63. Copyright © 2011 Pearson Education Inc. A map showing cholera deaths in a section of London Figure 14.19

64. Copyright © 2011 Pearson Education Inc. 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

65. Copyright © 2011 Pearson Education Inc. Epidemiology of Infectious Diseases Epidemiological Studies – Experimental epidemiology – Involves testing a hypothesis concerning the cause of a disease – Application of Koch’s postulates is experimental epidemiology

66. Copyright © 2011 Pearson Education Inc. Epidemiology of Infectious Diseases Animation: Nosocomial Infections: Overview

67. Copyright © 2011 Pearson Education Inc. Epidemiology of Infectious Diseases Hospital Epidemiology: Nosocomial Infections – Types of nosocomial infections – Exogenous – Pathogen acquired from the health care environment – Endogenous – Pathogen arises from normal microbiota due to factors within the health care setting – Iatrogenic – Results from modern medical procedures

68. Copyright © 2011 Pearson Education Inc. The interplay of factors that result in nosocomial infections Figure 14.20

69. Copyright © 2011 Pearson Education Inc. Epidemiology of Infectious Diseases Hospital Epidemiology: Nosocomial Infections – Control of nosocomial infections – Precautions designed to reduce factors that result in disease – Hand washing is the most effective way to reduce nosocomial infections

70. Copyright © 2011 Pearson Education Inc. Epidemiology of Infectious Diseases Animation: Nosocomial Infections: Prevention

71. Copyright © 2011 Pearson Education Inc. Epidemiology of Infectious Diseases Epidemiology and Public Health – Agencies at the local, state, national, and global level share information concerning disease – The United States Public Health Service – World Health Organization (WHO) – Public health agencies work to limit disease transmission – Monitor water and food safety – Public health agencies campaign to educate the public on healthful choices to limit disease