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1 Infectious Diseases Image References Carr, J. Spores of the bacterium that causes anthrax. CDC. Retrieved from Ewing Jr, E. Electron microscope image of an HIV particle. CDC. Retrieved from Foster, S. (1975). Child with smallpox (ID #7055). CDC. Retrieved from Gathany, J. Researcher working with an infectious agent. CDC. Retrieved from Stauffer, L. Bacteria growing in a laboratory culture dish. CDC. Retrieved from Robin Cochran-Dirksen (Many slides from BioEdOnline Baylor Christine Herrmann PhD)

2 Disease Genetic Biological Physical Chemical
There are different kinds of disease. Robin Cochran-Dirksen (Many slides from BioEdOnline Baylor Christine Herrmann PhD)

3 Infectious Diseases - Definitions
Disease – a pathological condition of body parts or tissues characterized by an identifiable group of signs and symptoms. Infectious disease – disease caused by an infectious agent such as a bacterium, virus, protozoan, or fungus that can be passed on to others. Infection – occurs when an infectious agent enters the body and begins to reproduce; may or may not lead to disease. Pathogen – an infectious agent that causes disease. Host – an organism infected by another organism. Virulence – the relative ability of an agent to cause rapid and severe disease in a host. Infectious Diseases - Definitions Human disease can be caused by infectious agents, genetic defects, environmental factors, or a combination of these factors. Here we will discuss only diseases brought about by infectious agents or pathogens. The infectious disease process begins at the time of infection, when a pathogen enters a host and starts to reproduce. Many infectious agents, though, are killed by the body’s numerous defenses before they can begin to reproduce. Further more, an infection may not necessarily produce disease; the infectious agent could be defeated quickly or it could hide somewhere in the body where it cannot be detected. The rapidity of onset and severity of the disease caused by an infectious agent depends on the virulence of the pathogen. References Black, J. G. (2005). Microbiology (6th ed.). John Wiley & Sons, Inc. National Institute of Allergy and Infectious Disease, National Institutes of Health. (2002). Microbes in sickness and in health. Retrieved from Robin Cochran-Dirksen (Many slides from BioEdOnline Baylor Christine Herrmann PhD)

4 Koch’s Postulates Koch developed four criteria to demon strate that a specific disease is caused by a particular agent. The specific agent must be associated with every case of the disease. The agent must be isolated from a diseased host and grown in culture. When the culture-grown agent is introduced into a healthy susceptible host, the agent must cause the same disease. The same agent must again be isolated from the infected experimental host. Koch’s Postulates Bacteria were discovered in 1675 by Antony van Leeuwenhoek, but it wasn’t until 1876 that a German physician named Robert Koch first demonstrated that specific diseases are associated with particular microorganisms. Koch developed a set of criteria to show that anthrax, a disease of cattle, was caused by a specific bacterium, named Bacillus anthracis, and that tuberculosis was caused by a separate distinct bacterium. Koch presented his discovery of Mycobacteium tuberculosis in a lecture in March of He brought his entire laboratory setup to the lecture hall and demonstrated his procedures for his audience, inviting them to check his findings themselves. His methods were so innovative that his criteria still are useful today in identifying disease-causing agents. Difficulties in applying these criteria can arise, however, for agents that are difficult to grow in culture or where a suitable, susceptible experimental host cannot be found. This is an especially difficult situation, and raises ethical concerns, where humans are the only known host. Robert Koch was awarded the Nobel Prize in Physiology and Medicine in 1905 for his work in tuberculosis. References Black, J. G. (2005). Microbiology (6th ed.). John Wiley & Sons, Inc. Flint, S. J., Enquist, L. W., Krug, R. M., Racaniello, V. R., & Skalka, A. M. (2000). Principles of virology: Molecular biology, pathogenesis, and control. ASM Press. Nobel Prize Organization. (2006). Robert Koch and tuberculosis. Retrieved from National Institute for Allergy and Infectious Diseases. (2006). Microbes in sickness and in health. Retrieved from Robin Cochran-Dirksen (Many slides from BioEdOnline Baylor Christine Herrmann PhD)

5 Infectious Disease Agents
Most infectious agents that cause disease are microscopic in size and thus, are called microbes or microorganisms. Different groups of agents that cause disease are: Bacteria Viruses Protozoa (Protists) Fungi Helminths (Animals) Infectious Disease Agents Most disease-causing organisms, or pathogens, are too small to be seen without a microscope. Some (e.g., most viruses) are even too small to be visible under a light microscope and must be viewed with the more powerful electron microscope. Because of their microscopic size, these minute organisms often are referred to as microbes or microorganisms. The study of these organisms is called microbiology, and scientists who study these organisms are microbiologists. Not all microbes cause disease; many are beneficial and even essential. Bacteria, in the digestive system, for example are important partners in digestion. Microbes that cause disease are sometimes informally referred to as “germs” or “bugs”. The five main groups of pathogens are bacteria, viruses, protozoa, fungi, and helminths. Bacteria are simple, single-celled organisms that lack an organized nucleus or membrane enclosed organelles. They often have a cell wall (prokaryotes), and their cells usually are rod-shaped or spherical. Commonly known diseases caused by bacteria are diarrheal diseases, pneumonia, strep throat, tuberculosis, and anthrax. Viruses are particles of nucleic acid (DNA or RNA) surrounded by a protective coat that replicate within specific host cells and can spread from cell to cell. Infectious diseases caused by viruses include the flu, the common cold, AIDS, chickenpox, and hepatitis. Protozoa are single-celled, motile, eukaryotic organisms, found in the Kingdom Protista, that can be human parasites. A protozoan known as Plasmodium (over 170 species), causes malaria, an infectious disease that is one of the world’s top killers. Fungi are made of eukaryotic cells (organized nucleus and membrane enclosed organelles). All fungi, with the exception of the yeast group, are multi-cellular organisms that absorb nutrients from the environment. Fungi can cause athlete’s foot, sinusitis, skin diseases, and vaginal infections. Helminths (worms and flukes) are invertebrate animals, some of which are parasitic. Wuchereia bancrofti is transmitted to humans by way of the mosquito. The mature adults pass into lymphatic glands, obstructing lymphatic drainage and resulting in a disfiguring condition, known as elephantiasis. References Alberts, B., Johnson, A., Lewis, J., Raff, M., Roberts, K., & Walter, P. (2002). Molecular Bbology of the cell, (4th ed.). New York: Garland Publishing, Inc. Black, J. G. (2005). Microbiology (6th ed.). John Wiley & Sons, Inc. National Institute for Allergy and Infectious Diseases. (2006). Microbes in sickness and in health. Retrieved from Image References Ajello, L. Yeast-type fungus that causes a skin disease (ID # 4314). CDC. Retrieved from CDC. Rod-shaped bacteria. Retrieved from Glenn, S. Malaria parasite inside a red blood cell. CDC. Retrieved from Melvin, M. (1979). Scolex of Taenia solium (ID #1515). CDC. Retrieved from Murphy, F. (1975). SARS-related virus (ID # 4814). CDC. Retrieved from Robin Cochran-Dirksen (Many slides from BioEdOnline Baylor Christine Herrmann PhD)

6 Infectious Diseases Throughout History
Infectious agents have probably always caused disease in humans. Smallpox has been described in ancient Egyptian and Chinese writings and may have been responsible for more deaths than all other infectious diseases combined. There is evidence that malaria and poliomyelitis have existed since ancient times. In the 14th Century, the bubonic plague, or Black Death, killed about 20 million people in Europe alone. In the 20th Century, the 1918 influenza may have killed up to 50 million people worldwide Close to 20 million people have died of AIDS to date. Courtesy of CDC Recreated 1918 Influenza virions. The 1918 Spanish flu killed more than 500,000 people in the United States and up to 50 million worldwide. Infectious Diseases Throughout History Infectious diseases probably have always afflicted humans. Numerous ancient writings describe recognizable infectious diseases that are still with us today. Through the centuries, these diseases have resulted in significant losses of human life. The scope of human death has at times influenced history; it is thought that the 1918 flu epidemic played a contributing role in ending World War I. In modern times, improved sanitation and the development of vaccines and antibiotics have saved many lives. However, despite advances in technology, success in eradicating smallpox, and virtually eliminating many other diseases in developed countries, new and old infectious diseases continue to plaque humans. This is clearly evidenced by the HIV epidemic and the looming potential threat of another influenza pandemic. Sadly, even though we have the technology and vaccines to prevent disease, especially childhood illnesses, these advances are not accessible to many of the children in the developing world. Nearly 1.5 million children continue to die of measles each year for lack of a vaccine that costs less than 12 cents per dose. References Black, J. G. (2005). Microbiology (6th ed.). John Wiley & Sons, Inc. National Institute for Allergy and Infectious Diseases. (2006). Microbes in sickness and in health. Retrieved from Baylor College of Medicine. (2006). Infectious diseases. Department of Molecular Virology and Microbiology. Retrieved from Image References Tumpey, T. (2005) influenza virions (ID # 8160). CDC. Retrieved from Robin Cochran-Dirksen (Many slides from BioEdOnline Baylor Christine Herrmann PhD)

7 Smallpox The only infectious disease to be considered eradicated. Humans are the only rewervoir for the virs. Smallpox is an infectious disease unique to humans, caused by either of two virus variants, Variola major and Variola minor. The disease is also known by the Latin names Variola or Variola vera, which is a derivative of the Latin varius, meaning spotted, or varus, meaning "pimple". The term "smallpox" was first used in Europe in the 15th century to distinguish variola from the great pox (syphilis). Smallpox localizes in small blood vessels of the skin and in the mouth and throat. In the skin, this results in a characteristic maculopapular rash, and laer, raised fluid-filled blisters. V. major produces a more serious disease and has an overall mortality rate of 30–35%. V. minor causes a milder form of disease (also known as alastrim, cottonpox, milkpox, whitepox, and Cuban itch) which kills ~1% of its victims. Long-term complications of V. major infection include characteristic scars, commonly on the face, which occur in 65–85% of survivors. Blindness resulting from corneal ulceration and scarring, and limb deformities due to arthritis and osteomyelitis are less common complications, seen in about 2–5% of cases. Smallpox is believed to have emerged in human populations about 10,000 BC. The disease killed an estimated 400,000 Europeans each year during the 18th century (including five reigning monarchs), and was responsible for a third of all blindness. Of all those infected, 20–60%—and over 80% of infected children—died from the disease. During the 20th century, it is estimated that smallpox was responsible for 300–500 million deaths. In the early 1950s an estimated 50 million cases of smallpox occurred in the world each year. As recently as 1967, the World Health Organization estimated that 15 million people contracted the disease and that two million died in that year. After successful vaccination campaigns throughout the 19th and 20th centuries, the WHO certified the eradication of smallpox in December To this day, smallpox is the only human infectious disease to have been completely eradicated. The last cases of smallpox in the world occurred in an outbreak of two cases (one of which was fatal) in Birmingham, England in A medical photographer, Janet Parker, contracted the disease at the University of Birmingham Medical School and died on 11 September 1978, after which the scientist responsible for smallpox research at the university, Professor Henry Bedson, committed suicide. In light of this accident, all known stocks of smallpox were destroyed or transferred to one of two WHO reference laboratories; the Centers for Disease Control and Prevention (CDC) in the United States and the State Research Center of Virology and Biotechnology VECTOR in Koltsovo, Russia where a regiment of troops guard it. In 1986, the World Health Organization recommended destruction of the virus, and later set the date of destruction to be 30 December This was postponed to 30 June In 2002 the policy of the WHO changed to be against its final destruction. Destroying existing stocks would reduce the risk involved with ongoing smallpox research; the stocks are not needed to respond to a smallpox outbreak. However, the stocks may be useful in developing new vaccines, antiviral drugs, and diagnostic tests. Robin Cochran-Dirksen (Many slides from BioEdOnline Baylor Christine Herrmann PhD)

8 How Infectious Agents Cause Disease
Production of poisons, such as toxins and enzymes, that destroy cells and tissues. Direct invasion and destruction of host cells. Triggering responses from the host’s immune system leading to disease signs and symptoms. Courtesy of CDC Human Immunodeficiency Virus. HIV-1 virions can be seen on surface of lymphocytes. How Infectious Agents Cause Disease Many microbes produce toxins or enzymes that damage host tissue. Bacteria produce two groups of toxins: endotoxins and exotoxins. Endotoxins are part of the cell wall of some types of bacteria and are released into host tissues when the bacteria divide or die. Exotoxins are secreted by bacteria into host tissues; they are sufficient to make a person ill even in the absence of the bacterial organisms. There are seven different types of the exotoxin produced by the organism that causes botulism (Clostridium botulinum). Types A, B, E, and F cause a severe type of food poisoning, producing one of the most poisonous substances known to mankind. Types C, D, and E cause illness in mammals, birds, and fish. Botox, a pharmaceutical, is a purified and diluted A neurotoxin used for clinical and cosmetic purposes (e.g., to remove wrinkles by paralyzing forehead muscles for several months). Viruses must invade a cell directly in order to reproduce and in the process disrupt normal host cell functions. In many cases, the assembly and release of new virus particles causes the cell to lyse or rupture, releasing the new virus particles which can go on to infect more cells. Fungi and protozoa also can release toxins and enzymes that destroy host tissues. Some protozoa, such as the parasite that causes malaria, directly invade host cells. Many signs and symptoms of disease are brought on by the host’s immune system in response to pathogen invasion. Fever, for example, is an attempt by your body to kill invading microbes that are sensitive to changes in temperature. Sneezing, coughing, vomiting, and diarrhea all are efforts by the body to rid itself of pathogens. Reference Black, J. G. (2005). Microbiology (6th ed.). John Wiley & Sons, Inc. Image Reference Goldsmith, C., Feoriino, P., Palmer, E. L., & McManus, W. R. (1989). HIV particles on the surface of a blood cell (ID # 8244). CDC. Retrieved from Robin Cochran-Dirksen (Many slides from BioEdOnline Baylor Christine Herrmann PhD)

9 Phases of Infectious Disease
Incubation period – time between infection and the appearance of signs and symptoms. Prodromal phase – mild, nonspecific symptoms that signal onset of some diseases. Clinical phase – a person experiences typical signs and symptoms of disease. Decline phase - subsidence of symptoms. Recovery phase – symptoms have disappeared, tissues heal, and the body regains strength. Phases of Infectious Disease Diseases caused by infectious agents usually run a standard course that is associated with different signs and symptoms. Before we describe these different phases of infectious diseases, we must first define the terms, “signs” and “symptoms.” Signs of an infectious disease are characteristics of a disease that can be observed by examining a patient. They include things such as fever, coughing, rash, vomiting, and diarrhea. Symptoms, on the other hand, can be felt only by the patient. They include pain, headache, and nausea. The time period from when a person first becomes infected until signs and symptoms become apparent is called the incubation period. During this phase, the person is not aware that he or she is infected, but he or she may already be contagious (capable of passing the agent on to others). The length of the incubation period is typical for a specific agent but can vary, depending on how virulent the agent is, the dose of infectious agent entering the body, and the route of infection (i.e., where the agent enters the body relative to the tissue it infects). In the prodromal phase, a person experiences mild, nonspecific symptoms. During this time, the agent is continuing to multiply and the person is contagious. This phase is absent in some diseases, which cause a person to feel ill suddenly, without any warning. The clinical phase (also called the invasive phase or acute phase) is the period in which typical disease signs and symptoms are evident. During this phase, there comes a time when symptoms reach their greatest intensity. Called the “acme,” this is the height of the battle between the pathogen that is invading and destroying tissue and the efforts of the body’s immune system to contain and obliterate the invader. Fever is usually a component of this phase, during which the patient is most contagious. Once the acme is reached, the number of infectious agents begins to drop and the signs and symptoms start to decrease. This is the decline phase, during which the body’s activities gradually return to normal, the tissues heal, and the individual no longer experiences any symptoms. The recovery phase also is known as the convalescent phase. With some diseases, such as chickenpox, a person can still be contagious during recovery until the lesions are healed. From the pathogen’s perspective, it is advantageous to induce the signs and symptoms of disease, such as coughing, sneezing, vomiting, and diarrhea, because these are ways that the infectious agent can be released from one host and spread to another. And although we do not enjoy feeling ill, these signs and symptoms are beneficial to us, in that they make us more likely to stay in bed and conserve energy to fight the pathogen and minimize the chance of spreading the disease to others. Reference Black, J. G. (2005). Microbiology (6th ed.). John Wiley & Sons, Inc. Robin Cochran-Dirksen (Many slides from BioEdOnline Baylor Christine Herrmann PhD)

10 Classification of Infectious Disease
By duration Acute – develops and runs its course quickly. Chronic – develops more slowly and is usually less severe, but may persist for a long, indefinite period of time. Latent – characterized by periods of no symptoms between outbreaks of illness. By location Local – confined to a specific area of the body. Systemic – a generalized illness that infects most of the body with pathogens distributed widely in tissues. By timing Primary – initial infection in a previously healthy person. Secondary – infection that occurs in a person weakened by a primary infection. Types of Infectious Disease Infectious diseases are classified by their duration and their location within the body, among other characteristics. “Acute,” “chronic,” and “latent” are terms used to describe the duration of a disease, how quickly the symptoms develop, and how long they last. The common cold is an acute disease; tuberculosis is a chronic disease; and herpes infections can produce latent infections with recurring attacks interspersed by periods with no symptoms (e.g. cold sores). “Local” and “systemic” refer to the location of a disease within the body. Pathogens that spread from a more localized site, enter the bloodstream and are carried to other tissues can produce a systemic infection. “Primary” and “secondary” characterize the order of infection. A primary infection, usually an acute infection, occurs first in a previously healthy person. Sometimes, when a person is suffering from a primary infection and his or her immune system has been weakened by battling the primary infection, the person can succumb to a secondary infection caused by another agent. Thus, a person who has caught a cold due to a virus may then become ill with an ear infection caused by a bacterium because his/her immune system is incapable of fighting off another agent in its weakened state. Reference Black, J. G. (2005). Microbiology (6th ed.). John Wiley & Sons, Inc. Robin Cochran-Dirksen (Many slides from BioEdOnline Baylor Christine Herrmann PhD)

11 Influenza Epidemic of 1918 killed million people worldwide. Image of rhinovirus Robin Cochran-Dirksen (Many slides from BioEdOnline Baylor Christine Herrmann PhD)

12 Example of an Infectious Disease - Flu
Acute contagious disease caused by the influenza virus. Respiratory tract infection, but symptoms felt throughout entire body. Epidemics occur seasonally with low fatality; more deadly pandemics occur several times each century. Highly changeable virus that can infect multiple species, including humans, pigs, and birds. Concern exists that current avian flu will lead to a new pandemic. Example of an Infectious Disease - Flu Influenza virus is spread through the air and causes an acute infection of cells within the respiratory tract. Following a brief incubation and prodromal phase, an infected individual will experience chills, fever, body aches, headache, weakness, and sometimes a sore throat and gastrointestinal symptoms. Except for the elderly, young children, and people with certain health conditions, seasonal flu epidemics are not life-threatening. A person usually recovers within a week, but fatigue can last up to several weeks. The flu often can be prevented with a vaccine. However, the “flu shot” must be given yearly because the flu virus mutates rapidly and thus, flu strains vary from year to year. There are two types of vaccines: live, attenuated (weakened) viruses; and inactivated. The vaccine stimulates the body’s immune system to identify and remember the invading virus. Subsequently, if the virus is detected, the defense is mounted and the virus is neutralized before it can spread. Anti-viral drugs are available, but these must be administered early in the course of infection to reduce the symptoms and duration of the disease. Of greater concern are variants of the flu that have never existed in human populations before. These variants can cause much more deadly pandemics because our immune systems have not experienced them previously and cannot mount an effective immune response against them. During the Spanish flu pandemic of 1918–1919, more than 500,000 people died in the United States alone. Currently, there is an outbreak of a strain of avian flu, called influenza A/H5N1. H5N1 has killed large number of birds in Asia, and now has spread to parts of Europe, Africa, and the Middle East. So far, there have been only a limited number of human infections. These resulted almost exclusively from direct contact with infected birds, but there is concern that the virus will mutate in a way that will make it easily transmissible from person to person. It is unclear whether effective vaccines and antiviral drugs could be produced in sufficient quantities in a short enough time period to protect the population should this virus acquire the capability of spreading easily from one person to another. Unfortunately, scientists can not predict if or when this virus—or other bird flu strains—might mutate and become transmissible among humans. References Baylor College of Medicine. (2006). Infectious diseases. Department of Molecular Virology and Microbiology. Retrieved from Hahn, D. B., Payne, W. A., & Mauer, E. B. (2005). Focus on health (7th ed.). New York: McGraw Hill. Robin Cochran-Dirksen (Many slides from BioEdOnline Baylor Christine Herrmann PhD)

13 Transmission of Infectious Diseases
Agents that cause infectious diseases can be transmitted in many ways. Through the air Through contaminated food or water Through body fluids By direct contact with contaminated objects By animal vectors such as insects, birds, bats, etc. Courtesy of VOA Chinese students wearing masks during a SARS outbreak Transmission of Infectious Diseases There are many ways that infectious diseases can spread. Pathogens usually have specific routes by which they are transmitted, and these routes may depend on the type of cells and tissue that a particular agent targets. For example, because cold viruses infect the respiratory tract, they are dispersed into the air via coughing and sneezing. Once in the air, the viruses can infect another person who is unlucky enough to inhale air containing the virus particles. Agents vary greatly in their stability in the environment. Some viruses may survive for only a few minutes outside of a host, while some spore-forming bacteria are extremely durable and may survive in a dormant state for a decade or more. As noted, some diseases, such as colds, the flu and tuberculosis, spread through the air when an infected person coughs or sneezes. Another route or transmission is through ingestion of contaminated food or water. Water- and food-borne illnesses can be caused by bacteria, viruses, or protozoa. This risk of contracting these illnesses is greatest with impure and untreated water and undercooked or improperly stored foods. Infectious diseases can also be transmitted through body fluids, such as blood, semen, and saliva. For example, HIV easily can be passed through contact with blood and semen, however, even though the virus has been found in saliva, there are no documented cases where HIV has been transmitted by contact with saliva. Similarly, there are no known cases of transmission of HIV by mosquitoes. Additionally, infectious agents can be passed through blood and blood products during medical procedures, such as blood transfusions. Many hemophiliacs receiving blood products were unwittingly infected with HIV before the responsible agent was identified and blood donations were screened. Other people can be infected as a result of sharing contaminated needles. Touching contaminated objects commonly leads to infection, especially among pre-school children. Fecal to oral transmission is a major path for diarrheal diseases, such as rotavirus and Norwalk virus, that are widespread in daycare centers. It is also possible to become infected with some agents by touching surfaces such as doorknobs and telephones, especially those located in public places. Pigs and birds, in particular, are known to harbor viruses that can mutate and spread to humans upon contact. Finally, pathogens can be transmitted through insect vectors, such as mosquitoes. Mosquitoes are responsible for the spread of malaria, yellow fever, and West Nile virus, among other diseases. Ticks, which spread Lyme’s disease, are another common vector. References Black, J. G. (2005). Microbiology (6th ed.). John Wiley & Sons, Inc. National Institute for Allergy and Infectious Diseases. (2006). Microbes in sickness and in health. Retrieved from Image References Chinese students wearing masks during the SARS epidemic. Courtesy: VOA Gathany, J. (2006). Feeding female mosquito (ID# 9182). CDC. Retrieved from Courtesy of CDC Aedes aegypti mosquito Known to transmit Dengue fever Robin Cochran-Dirksen (Many slides from BioEdOnline Baylor Christine Herrmann PhD)

14 Related Terms Endemic/Enzootic: The constant presence of a disease or infectious agent within a given geographic area. Epidemic/Epizootic: The occurrence in an area of a disease or illness in excess of what may be expected on the basis of past experience for a given population (in the case of a new disease, such as AIDS, any occurrence may be considered "epidemic"). Pandemic/Panzootic: A worldwide epidemic affecting an exceptionally high proportion of the global population. Robin Cochran-Dirksen (Many slides from BioEdOnline Baylor Christine Herrmann PhD)

15 Example of an Infectious Disease - AIDS
AIDS (Acquired Immune Deficiency Syndrome) is the disease caused by the virus called HIV (human immunodeficiency virus). HIV attacks cells of the immune system and destroys their ability to fight infection by other agents. HIV is spread through the direct exchange of body fluids. There is a long period of time from HIV infection to the onset of AIDS. Anti-HIV drugs prolong the length and quality of life, but there is no vaccine or cure for AIDS. Courtesy of CDC This highly magnified transmission electron micrographic (TEM) image revealed the presence of mature forms of the human virus immunodeficiency (HIV) in a tissue sample under investigation. Example of an Infectious Disease - AIDS AIDS, caused by the virus, HIV, has become the most devastating infectious diseases of our lifetime. Since 1983, when HIV was first identified, approximately one million Americans have been infected. In 2006, approximately 40 million people were living with HIV infection worldwide, over four million became newly infected, and about three million died of AIDS. The epidemic is growing most rapidly among minority populations and women. HIV infects white blood cells, primarily those called T cells, which are part of our immune systems. HIV destroys the ability of these cells to fight infection by other agents. Therefore, HIV-infected patients sometimes die from infection by other viruses, bacteria, or other agents that are not normally harmful to healthy individuals. Some AIDS patients also develop unusual cancers because of defects in their immune systems. HIV is not easily spread from person to person because it requires direct contact with the body fluids (blood and semen) of an HIV-infected person and it does not survive for very long in the environment. Transmission can occur through sexual contact, sharing of contaminated needles, transfusion of infected blood or blood products, and from mother to infant. There has not been documentation of HIV transmission in saliva or by blood carried by biting insects such as mosquitoes. There usually is a long lag period from the time someone is infected with HIV until the person begins to experience the symptoms of AIDS. (HIV infection does not follow the typical disease progression pattern described earlier, and the length of time to progression to AIDS can be highly variable.) Soon after infection, an individual may experience flu-like symptoms, but then remain asymptomatic (without symptoms) for up to a decade. However, during this phase, the virus continues to replicate and the infected person is contagious. The steady increase in the number of HIV particles during the period while the virus is reproducing leads to a gradual decline in the level of immune system cells, known as CD4-positive (CD4+) T cells. A normal person has about 1,000 CD4+ T cells in a milliliter of blood. Once CD4+ T cell numbers fall to 200 cells per milliliter, the patient enters the phase of HIV infection known as AIDS. From this point on, it becomes increasingly difficult for patients to fight off infections. Signs and symptoms of HIV/AIDS include tiredness, fever, loss of weight, diarrhea, and swollen glands. As of yet, there is no effective vaccine to prevent AIDS, and there is no cure. There are drugs that will reduce the number of HIV virus particles in the patient’s body (the viral load), which improves the length and quality of life. However, these drugs do not rid a person of HIV. Moreover, the drugs may become ineffective over time as the virus mutates and becomes resistant to the drugs. Once treatment is ceased, virus levels go back to earlier levels. Currently, there are four classes of anti-HIV drugs that block three essential steps in the virus reproductive cycle: the entry phase (where the virus particle fuses with the host cell); the reverse transcription step (where the virus makes a DNA copy of its RNA genome); and the protease step (where a virus protein chops long strands of virus proteins into smaller, functional units). These usually are given in combination, as a “cocktail” called “highly active antiviral therapy,” or HAART for short. HAART is very effective for many people, at least for a period of time, but the treatment can produce unpleasant side effects and is too expensive for most people in the developing world. Most of all, it is important to remember that HAART is not a cure for AIDS. References Baylor College of Medicine. (2006). Infectious diseases. Department of Molecular Virology and Microbiology. Retrieved from Hahn, D. B., Payne, W. A., & Mauer, E. B. (2005). Focus on health (7th ed.). New York: McGraw Hill. Image Reference CDC. (1983). Human Immunodeficiency Virus (ID # 8254). Retrieved from Robin Cochran-Dirksen (Many slides from BioEdOnline Baylor Christine Herrmann PhD)

16 Reducing the Spread of Infectious Diseases
Vaccines Antimicrobial drugs Good personal hygiene and sanitation Protection against mosquitoes Quarantine Reducing the Spread of Infectious Diseases Human activities drive emergence of disease and a variety of social, economic, political, climatic, technological, and environmental factors can shape the pattern of the disease and influence its emergence into populations. The most effective method of stemming the spread of infectious disease is through vaccination. Vaccines consist of weakened or killed microbes, or just components of a pathogen, and stimulate the body’s natural defenses—the immune system—to combat infections. Vaccination has eliminated smallpox, nearly eradicated poliovirus from much of the world, and drastically reduced the incidence of childhood infections, such as measles, mumps, and whooping cough, at least in the developed world. Influenza vaccines are available to reduce the occurrence of seasonal flu, although the shot must be given yearly due to the extreme variance of the influenza virus from season to season. Vaccines for other infectious diseases, especially HIV, still are being sought. Antibiotics are effective for many types of bacterial infections (although they are entirely useless against viruses). But increasingly, bacteria are becoming resistant to the arsenal of antibiotics at our disposal. Very few drugs work well against viruses (anti-viral drugs for influenza and HIV were discussed in the previous two slides). Anti-fungal drugs exist, but their use is limited. There are no vaccines against protozoan parasites, and other medications against them are becoming ineffective. Therefore, protection from insect vectors such as mosquitoes and control of mosquito populations are crucial strategies in containing the spread of insect-borne diseases, such as malaria. Good sanitation, water purification, hand washing, and proper cooking and storage of foods all help to reduce the prevalence of infectious disease. In cases of highly contagious, often fatal diseases, quarantine is employed as a means of preventing the spread of disease through a community. However, regardless of the disease, it is wise to limit contact with other individuals when ill. Reference Hahn, D. B., Payne, W. A., & Mauer, E. B. (2005). Focus on health (7th ed.). New York: McGraw Hill. National Institute for Allergy and Infectious Diseases. (2006). Microbes in sickness and in health. Retrieved from Image Reference Gathany, J. (2003). Influenza virus vaccine, (ID# 5404). CDC. Retrieved from Robin Cochran-Dirksen (Many slides from BioEdOnline Baylor Christine Herrmann PhD)

17 Infectious Diseases as a Cause of Death
Infectious diseases are responsible for a quarter to a third of all deaths worldwide. Infectious diseases account for more than half of all deaths in children under the age of 5. Of the top ten causes of death compiled by the World Health Organization, five are due to infectious diseases. The top single agent killers are HIV/AIDS, malaria and tuberculosis. The other top killers are lower respiratory infections and diarrheal diseases, which are caused by a variety of agents. Infectious Diseases as a Cause of Death Infectious diseases are a leading cause of death worldwide. They are an especially large problem in the developing world and in children. In addition to the human toll, infectious diseases present a large financial burden. In the United States alone, it has been estimated that the annual cost of medical care for treating infectious diseases is about $120 billion. References Baylor College of Medicine. (2006). Infectious diseases. Department of Molecular Virology and Microbiology. Retrieved from Black, J. G. (2005). Microbiology (6th ed.). John Wiley & Sons, Inc. World Health Organization. (2006). Infectious diseases. Retrieved from Robin Cochran-Dirksen (Many slides from BioEdOnline Baylor Christine Herrmann PhD)

18 Emerging Infectious Diseases
Emerging diseases are those that have recently appeared within a population, or whose incidence or geographic range is increasing rapidly. Diseases can emerge or re-emerge due to: appearance of a previously unknown agent. evolution of a new infectious agent. spread of an infectious agent to a new host. spread of an infectious agent to new locations. acquisition of resistance to anti-microbial drugs. deliberate introduction into a population. Emerging Infectious Diseases Although we have developed the technology to control many infectious diseases, new diseases continue to arise and spread. Emerging infectious diseases can be caused by both “new” and “old” pathogens. Diseases that recently appeared in a population, or whose range of hosts or geographic locations are rapidly expanding or threatening to expand in the near future are referred to as “emerging diseases.” Diseases whose incidence had significantly declined in the past, but have again reappeared are known as “re-emerging diseases.” Examples of emerging diseases are HIV, influenza, SARS, and Ebola. Tuberculosis is a disease that is re-emerging. “Old” pathogens are considered emerging if they are spreading to new species or new geographic locations. Diseases sometimes emerge due to natural processes, such as the evolution of the infectious agent over time, but many emerging diseases result from human activities. These include population growth, migration from rural areas to cities, international air travel, blood transfusions, poverty, wars, and destructive ecological changes caused by economic development and land use. Many emerging diseases arise when infectious agents in animals are passed to humans (referred to as zoonoses). This is occurring more and more as the human population grows and spreads into new geographical regions, resulting in increased contact with wild animal. It is not difficult to imagine a scenario in which a hunter in a remote area of Africa becomes infected with a “new” infectious agent and then travels to a village, where he infects other locals, one of whom boards a plane and infects his fellow passengers, who then travel to other parts of the world before any infection is detected. In this way, a disease could emerge quite rapidly. For an emerging disease to become established, at least two events must occur: (1) the infectious agent must be introduced into a vulnerable population; and (2) the agent must have the ability to spread readily from person to person, cause disease, and sustain itself within the population. Both of these events have occurred with HIV. To date, only the first has happened with avian flu. Even diseases previously thought to have been under control can sometimes make a comeback. This can occur when an agent becomes resistant to the drugs, such as antibiotics, used to treat the disease. An infectious agent can mutate so that these drugs are no longer useful in combating the disease. Drug resistance is on the rise, in large part due to overuse and misuse of antibiotics and other drugs. Tuberculosis, for example, is becoming highly antibiotic-resistant. Malaria, too is becoming increasingly drug-resistant. A frightening possibility is the emergence of an infectious disease due to its deliberate introduction into human or agricultural populations for terrorist purposes. Since the terrorist attacks of September 11, 2001, and the subsequent mailing of anthrax-laced letters, this threat is being taken very seriously. Agents considered most dangerous include those which cause anthrax, botulism, plague, and smallpox. Other potential agents classified as risks, albeit lower level ones, include West Nile virus, Salmonella, SARS, influenza, yellow fever, and drug-resistant tuberculosis. References National Institute of Allergy and Infectious Diseases. (1999). Understanding emerging and re-emerging infectious diseases. NIH Curriculum Supplements Series. Retrieved from Baylor College of Medicine. (2006). Infectious diseases. Department of Molecular Virology and Microbiology. Retrieved from Baylor College of Medicine. (2006). Infectious diseases. Department of Molecular Virology and Microbiology. Retrieved from Robin Cochran-Dirksen (Many slides from BioEdOnline Baylor Christine Herrmann PhD)

19 Re-emerging and Emerging Infectious Disease
So, what are the underlying causes? Some of the underlying causes are obvious and are related to poverty; lack of plumbing, lack of housing. Robin Cochran-Dirksen (Many slides from BioEdOnline Baylor Christine Herrmann PhD)

20 Climate Change A New Factor in Infectious Disease
Robin Cochran-Dirksen (Many slides from BioEdOnline Baylor Christine Herrmann PhD)

21 Barriers to Treatment Political leadership Socio-cultural factors
Biological research Robin Cochran-Dirksen (Many slides from BioEdOnline Baylor Christine Herrmann PhD)

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