Report: The infectious process, levels of infectious process. Features of infectious diseases, their characterization.

Sajid Mehmood Accident & Emergency Department. Royal Infirmary Liverpool. United Kingdom Adnan Akram Department of Infectious Diseases. University Hospital Riga. Latvia Aftab Ahmed Department of Infectious Diseases. Kaunas Medical University Hospital. Kaunas. Lithuania

The infectious process is a unity of physiological defensive reactions and pathological reactions that develop in definite conditions of outer world (environment) as a response to the impact of the initiator. In other words -: Infectious process is the interaction between micro and macro – organisms in the conditions of the outer world. Infectious disease – terminal stage of infectious process who’s manifestations are different. +/physiological, clinical, etc. Infectology – science of infectious process. Infectious disease are that which are initiated by pathogenic or conditioned pathogenic microorganisms. Characteristics: 1. contagiousness 2. incubation 3. cycle of clinical symptoms development 4. development of specific immunity Classification of infectious diseases: In the international classification infectious and parasitic diseases are included in the 1 st class. The 1st class can be subdivided into: - Intestinal infections - Tuberculosis - Other viral infections- Bacterial zoonosis - Syphilis and other venereal - Other bacterial infections diseases - Poliomyelitis and other enteroviral diseases of the CNS - Other diseases caused by - Viral infections with rash spirochetes - Viral infections carried by arthropods - Mycoses - Helminthiases - Other infectious and parasitic diseases -Rickettsiosis and other diseases carried by arthropods Classification according to carrying mechanism of causative agent - Intestinal infections : the intestines are the main localization of the disease,

e.g. shigellosis, cholera, poliomyelitis - Respiratory infections : causative agent is localized in the respiratory tract, in the mucous membrane of the oral cavity, trachea, bronchi, and teeth ridge (gums and jaw) e.g. influenza, diphtheria, meningococcal, TB - Transmissive infections (blood borne) : the causative agent is localized mainly in the blood and lymph, e.g. typhus, hemorrhagic fever, rabbit fever - Integument infections : the causative agent uses to localize in the integuments, e.g. erysipelas, rabies, tetanus, listeriosis General Clinical Characteristics A cyclic course interchanging in periodically defined succession. 1. Incubation – from entrance/ingression of disease initiator into the organism till occurrence of symptoms prior to disease. It lasts from some minutes till many months. 2. Prodromal or precursory period – occurrence of the first, usually general symptoms. Commonly it lasts for several days. 3. Meridian of peak period of disease – non-specific symptoms manifest to the utmost, specific symptoms appear. 4. Period of convalescence or recovery period – clinical symptoms gradually disappear, function and structure of injured organs are restored. Type of disease course 1. Typical course – the disease has the main symptoms and syndromes that are characteristic to it. 2. Atypical course – the disease has the main symptoms and syndromes characteristic to it but they are effaced (unmanifested), unapparent (subclinical form). 3. Carrying of infection – in spite of the presence of initiator in organism clinical symptoms of the disease are not present, completely missing. Obligatory steps for infection of microorganism 1. Attachment +/- entry into body 2. Local or general spread in the body – evade immediate local defense 3. Multiplication – typical clinical signs 4. Evasion of host defenses (microbial answer to host defense) 5. Shedding from body – leave body at a site and on a scale that ensures spread in new organisms (transmission) Causes damage to host (pathology, disease) Types of transmission – horizontal, vertical Vertical can be pre-natal, peri-natal, post-natal, and germ line

Host defense 1st line  skin and mucous membrane, few bacteria are found below larynx due to cough reflex Non-specific immune response factors  phagocytic cells Specific immune response factors  antibodies Tissue reactions 1. Multiplication of microorganisms, production of toxins, decreased host defense, host dies or, 2. Equilibrium between microorganism and host – latent period 3. Host > Microorganism Pathogenesis of infections 1. Toxin – can interact with adjacent or far situated cells (distant cells) 2. Virulence factors 3. Microbial adherence – microorganisms bind to surface of host, that adhere by fibrilla, specific adherence organ cells – fimbria (can attach to all cells) Viral infections – neurotropic virus grow in blood and then cross blood brain barrier. After viremia invades cerebral capsule etc. Manifestation of infection Fever > 37.8C orally 38.2C rectally Pyrogens cause fever. They may be exogens – microorganisms, microbial products, LPS of Gram negative bacteria on endogens cause fever by affecting metabolism in hypothalamic thermoregulation center. Systemic response Hematological manifestations – a) Leucocytosis -  Neu :  immature circulatory neu b) Anemia – acute bleeding, chronic c) DIC d) Thrombocytopenia Cardiopulmonary Manifestation – a) Tachycardia / bradycardia (dengue, plague) b) Hypotension c) Hyperventilation with marked respiratory alkalosis d) Adult respiratory distress syndrome Renal Manifestations – proteinuria, oliguria, azotemia Hepatic Manifestations – liver dysfunction GIT Manifestations – upper GIT bleeding caused by sepsis CNS Manifestations – confusion, coma, stupor

Endocrine and Metabolic Manifestations – Hypoglycemia, not common in sepsis Major pathogens can be: 1. Viruses, DNA or RNA 4. Protozoa 2. Bacteria 5. Worms 3. Fungi 6. Rickettsia Most common diseases 1. Diarrhea, 2. TB, 3. Helminthiasis, 4. Malaria, etc… Newly identified infectious agent – 1999, Napah virus Guidelines for health provision Education – what is infectious diseases, how to avoid them Control – epidemiological surveillance, vaccination