1. Immunity and Infection
Chapter 13

2. © 2008 McGraw-Hill Companies. All Rights Reserved.
The Chain of Infection
Links in the Chain
Transmitted through a chain (six links)
Pathogen - disease causing microorganism
Reservoir - natural environment of the pathogen: Person, animal or environmental component
Portal of Exit
Transmission
Direct transmission
Indirect transmission
Portal of entry
Penetration of the skin
Inhalation
Ingestion
New host
Breaking the Chain
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

3. © 2008 McGraw-Hill Companies. All Rights Reserved.
Body’s Defense System
Physical and Chemical barriers
Skin, mucous membranes, respiratory tract
The Immune System
Immunological Defenders
Neutrophils
Macrophages
Natural killer cells
Dendritic cells
Lymphocytes
T-cells
Helper, Killer, and Suppressor
B-cells
Antibodies
Memory T and B cells
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

4. The Inflammatory Response
Histamine.
Dilation of blood vessels, heat, redness, and swelling.
The immune response
Phase 1 – Dendritic cells are drawn to the site
Phase 2 – Helper T cells multiply
Production of Killer T and B cells
Cytokines – chemical messengers
Phase 3 – Killer T cells strike
Cell-mediated immune
Anti-body mediated immune response
Phase 4 – Last Phase –
Suppressor T-cells
Slow down activity
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

5. © 2008 McGraw-Hill Companies. All Rights Reserved.
The Immune Response
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

6. © 2008 McGraw-Hill Companies. All Rights Reserved.
Immunity
An infected person will never get the same illness again.
Lymphocytes create amplification of the immune response are reserved by memory T and B cells
Symptoms and contagion
Incubation – viruses are multiplying in the body or when bacteria are actively multiplying
Will not feel symptoms until the second or third phase of the immune response cycle
Prodromal period – the infected host has acquired immunity
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

7. © 2008 McGraw-Hill Companies. All Rights Reserved.
Immunization
The process of ‘priming’ the body to remember an encounter with a specific antigen.
Types of vaccines
VACCINE- Introduction of a killed or weakened pathogen to stimulate the body to produce antibodies. (active immunity).
PASSIVE IMMUNITY- Injection of antibodies produced by other human beings or animals.
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

8. Allergy: The Body’s Defense System Gone Haywire
Allergies
Allergens
Pollen, Dander, Dust mites, Molds, Food, Insects
The Allergic response
Immunoglobulin (IgE)
Anaphylaxis
Dealing with Allergies
Avoidance
Medication
Immunotherapy
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

9. © 2008 McGraw-Hill Companies. All Rights Reserved.
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

10. The Troublemakers: Pathogens and Disease
Bacteria – Microscopic single celled organism
Pneumonia
Meningitis
Strep Throat and other streptococcal infections
Toxic shock and other staphylococcal
Tuberculosis
Lyme Disease and other tickborne infections
Ulcers
Other Bacterial infections
Tetanus
Pertussis
Urinary tract infections
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

11. © 2008 McGraw-Hill Companies. All Rights Reserved.
Antibiotic Treatment
Actions of Antibiotics
Antibiotic resistance
Proper antibiotics usage
Don’t take an antibiotic every time you are sick
Use antibiotics as directed
Never take an antibiotic without an prescription
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

12. © 2008 McGraw-Hill Companies. All Rights Reserved.
Pathogens
Viruses – (parasites – take what they need)
Common Cold
Influenza
Measles, Mumps and Rubella
Chickenpox, Cold Sores, and other herpes-virus infections
Herpes simplex virus (HSV) types 1 and 2
Epstein-Barr virus (EBV)
Viral Hepatitis
Human Papillomavirus (HPV)
Treatment
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

13. © 2008 McGraw-Hill Companies. All Rights Reserved.
Pathogens
Fungi –
Primitive plant – Yeast infections, athletes foot, and ringworm
Candida albicans
Protozoa –
Microscopic single-celled animal – Malaria, African sleeping sickness, Giardiasis, Tricomonias, Trypanosomiasis, and Amoebic dysentary.
Parasitic worm –
Largest organism that can enter the body – Tapeworm, Hookworm, and Pinworm.
Prions -
Fetal degeneration disorders of the CNS, linked to “proteinaceous infectious particles.
Lack DNA and RNA
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

14. Emerging Infectious Diseases
Selected Infections of concern
West Nile virus
Severe acute respiratory syndrome (SARS)
Rotavirus
Escherichia coli
Hantavirus
Ebola
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

15. Factors Contributing to Emerging Infections
Drug Resistance
Poverty
Breakdown of public health measures
Environmental changes
Travel and Commerce
Mass food production and distribution
Human behaviors
Bioterrorism
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

16. How to Support Your Immune System
Public Health
Taking care of yourself
Nutrition
Exercise
Rest
Moderation of Lifestyle
Controlling Stress
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

17. Sexual Transmitted Diseases
The United States has the highest rate of Sexual Transmitted Diseases of any developed nation
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

18. © 2008 McGraw-Hill Companies. All Rights Reserved.
The Major STDS (STD’s)
Seven different STDs pose major health threats
HIV/AIDS
Hepatitis
Syphilis
Chlamydia
Gonorrhea
Herpes
HPV
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

19. Acquired Immunodeficiency Syndrome (AIDS)
Leading cause of death in many parts of the world.
Worldwide, AIDS is the leading cause of death for people age 15-59
Approximately 65 Million people around the world are infected with Human Immunodeficiency Virus (HIV).
More than 25 million have died worldwide
Human immunodeficiency virus (HIV) is the virus which causes AIDS.
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

20. Approximate number of people living with HIV/AIDS in 2006
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

21. © 2008 McGraw-Hill Companies. All Rights Reserved.
HIV Infection and AIDS
By 2004, an estimated 1,000,000 Americans were believed to be living with HIV, with an estimated annual incidence of 40,000 cases
Estimated 1.5 million Americans have died
2006, researchers discovered a group of chimpanzees in Cameroon that carry SIVspc
1930s Genetic evidence shows that SIV first spread to humans
What is HIV Infections?
HIV attacks and invades CD4 T-cells, monocytes and macrophages.
AIDS opens the possibility for a opportunistic infections.
Once initial symptoms resolve, the asymptomatic period may last from 2 to 20 years.
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

22. Transmitting the Virus
HIV lives only within cells and body fluids.
3 primary means of transmission are: (1)Specific kinds of sexual contact, (2) direct exposure to infected blood, and (3) HIV-infected women to her fetus.
Sexual contact
Direct contact with infected blood.
Mother-to-Child transmission.
Not through casual contact.
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

23. Populations of Special Concern for HIV infection
Most common exposure has been sexual activity between men; injection drug use, and heterosexual contact.
African American men and women are vastly overrepresented among people newly diagnosed with AIDS.
See “HIV/AIDS Among African Americans and Latinos”
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

24. © 2008 McGraw-Hill Companies. All Rights Reserved.
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

25. Symptoms of HIV Infection
Few days or weeks, half the people will develop (Flu like symptoms)
Fever, fatigue, rashes, headache, swollen lymph nodes, body aches, night sweats, sore throat, nausea and diarrhea.
Specialized test HIV RNA assay.
Pneumocystis Carinii pneumonia (protozoal infection).
Kaposis sarcoma.
Difficult to treat yeast infections in women
Tuberculosis
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

26. Diagnosing HIV Infection and AIDS
Most common is tests for the presence of antibodies to the virus.
HIV antibody test
ELISA (first test) if positive then the.
Western blot (second test)
IF HIV-positive then check the status of the CD4-t cells.
New diagnostic test – HIV Replication Capacity.
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

27. Diagnosing HIV Infection and AIDS
Treatment (NO CURE).
Antiviral drugs.
Reverse transcriptase inhibitors.
Zidovudine (AZT).
Protease inhibitors.
Highly active antiretroviral therapy (HAART).
Structured intermittent therapy.
Fusion inhibitors
Enfuvirtide (Fuzeon)
Inhibit the fusion of viral and cell membranes
Post-Exposure prophylaxis.
Treatment for opportunistic infections.
HIV and Pregnancy
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

28. © 2008 McGraw-Hill Companies. All Rights Reserved.
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

29. © 2008 McGraw-Hill Companies. All Rights Reserved.
Prevention
Make careful choices about sexual activity.
Do Not share drug needles.
Participate in an HIV educational program.
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

30. Chlamydia Trachomatis
Most prevalent bacterial STD in the U.S.
Bacterial infection -
Can cause sterility in men and women
WOMEN infects the cervix and to urethra, fallopian tubes & ovaries, PID, bladder infections.
MEN- Epididymitis, urethra to testes, urethritis, bladder infections, watery discharge.
Symptoms –ASYMPTOMATIC : Discharge, pain and burning while urinating, vaginal bleeding, painful intercourse, abdominal pain, nausea, fever, inflammation of rectum or cervix, swelling and pain in the testes.
Symptoms appear in 7-21 days
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

31. Chlamydia Trachomatis
Spread - vaginal and anal intercourse, from the birth canal to the fetus
Diagnosis - Examination of tissue samples or urine
Treatment - Both partners treated fully with antibiotics
Protection
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

32. © 2008 McGraw-Hill Companies. All Rights Reserved.
Gonorrhea
700,000 new cases every year in the U.S.
Bacterial infection - Can cause sterility, arthritis and heart problems
PID, can cause ectopic pregnancy, premature labor and still birth, arthritis, rashes
Symptoms –
Women - Asymptomatic - Frequent burning urination, menstrual irregularities, pelvic pain, discharge.
Males – thick yellow-white discharge, painful urination.
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

33. © 2008 McGraw-Hill Companies. All Rights Reserved.
Gonorrhea
Spread - Vaginal, anal and oral sex.
Diagnosis - Microscopic exam of discharge.
Treatment - Oral antibiotics - People often have chlamydia at same time.
Protection
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

34. Pelvic Inflammatory Disease PID
Progressive infection that harms a women’s reproductive system. Can lead to sterility, ectopic pregnancy and chronic pain - treated or not.
Caused by chlamydia and gonorrhea.
Symptoms - long and painful periods, discharge, spotting, low abdominal pain, fever, chills, nausea, vomiting, pain during intercourse.
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

35. Pelvic Inflammatory Disease PID
Treatment - Antibiotics, bed rest, sexual abstinence and maybe surgery to remove scarring
Diagnosis - Pelvic Exam, cultures, laparoscopy
Protection
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

36. Human Papillomavirus Infection
More than 80% of sexually active individuals will have been infected with HPV by the age of 50.
Symptoms
Small bump on the skin or a large, warty growth
Cauliflower-like mass
May cause irritation and bleeding
How is it spread
Diagnosis
Appearance of the lesions
Women who are positive should have a Pap test very 12 months
Treatment
Removed by cryosurgery, electrocautery or laser surgery
Protection
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

37. © 2008 McGraw-Hill Companies. All Rights Reserved.
Genital Herpes
45 million have been diagnosed
Two forms - Herpes simples virus-1 and -2.
Type 1 is associated with cold sores and fever blisters.
50-80% of U.S. adults have anitibodies to HSV-1
Both are sexually transmitted.
Remains in the body for life.
Symptoms – 90% have no symptoms
Recurring rash, pain ulceration's.
Primary outbreak - pain and discomfort around infected area, itching, burning during urination.
2-20 days after infection - may years before outbreak.
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

38. © 2008 McGraw-Hill Companies. All Rights Reserved.
Genital Herpes
Spread - Touching, sexual intimacy - including kissing, vaginal, oral and anal sex
Diagnosis - Examination of sores and culturing of fluid taken from sores
Treatment - No cure - symptoms are relieved by drugs
Protection - Refrain for sex during out break
HSV-1 and 2 can cause miscarriages or still births along with serious health issues of newborns
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

39. Hepatitis B Virus (HBV)
Can cause liver disease and death
Preventable with vaccination.
750,000 total acquired sexually
Transmission - Semen, saliva, blood and urine
Symptoms - Extreme fatigue, headache, fever, hives, lack of appetite, nausea, vomiting, tenderness in lower abdomen
Diagnosis and Treatment
Blood Test
No cure
Prevention
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

40. © 2008 McGraw-Hill Companies. All Rights Reserved.
Syphilis
Syphilis organism remains in the body for life and leads to disfigurement, neurological disorders, or death.
Effective antibiotics and condom use.
Symptoms –
Primary phase- 3 weeks - 90 days - painless sores and wet ulcers (chancre) and swollen glands.
Secondary Phase weeks - up to 2 years body rash, mild fever, fatigue, sore throat (Flu like symptoms), and hair loss.
Late phase (tertiary)- Damage to organs and nervous system.
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

41. © 2008 McGraw-Hill Companies. All Rights Reserved.
Other STD’s
Trichomoniasis
Bacterial vaginosis (BV)
Pubic Lice
Scabies
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

42. © 2008 McGraw-Hill Companies. All Rights Reserved.
What You Can Do
Education.
Diagnosis and Treatment
Get vaccinated
Be alert for symptoms
Get tested
Inform your partners
Get Treated
Prevention
Use a barrier defense.
Know your potential partner.
Ask. Are you ready to have sex?
Chapter 13
© 2008 McGraw-Hill Companies. All Rights Reserved.

43. Immunity and Infection
Chapter 13