INFECTIOUS DISEASE (PART 1)
 Most common of human illness
TRANSMISSION OF INFECTIOUS AGENTS
1. contact (direct and indirect)
2. respiratory route
3. fecal oral route
4. Sexual transmission
5. vertical transmission
6. insect/arthropod vectors
VIRAL DISEASES
 typically evoke inflammatory infiltrates composed of
lymphocytes and macrophages
 Only when severe disease & tissue damage do neutrophils
respond
VIRAL RESPIRATORY DISORDERS
1. Most frequent & least preventable of all human infectious
disease, ranging in severity from discomforting but self-limiting
to life threatening pneumonia.
2. Viral species:
a) Rhinoviruses: upper resp tract
(rhinitis, sinusitis, pharyngitis, tonsillitis)
b) Influenza virus: upper & lower resp tract
(laryngotracheobronchitis, interstitial pneumonia, pleuritis,
bronchiolitis)
Human metapneumovirus
 a paramyxovirus discovered in 2001; is found worldwide
 associated with URTI and LRTI
 Infections can occur in any age group but are most common in
young children, elderly adults, and immunocompromised
patients.
 (bronchiolitis and pneumonia)
 are clinically indistinguishable from those caused by human RSV
and are often mistaken for influenza.
 Diagnostic: PCR tests for viral RNA
 Treatment: supportive measures
Human Coronaviruses
 enveloped, positive sense RNA viruses that infect humans and
several other vertebrate species.
 Weakly pathogenic coronaviruses cause mild cold like URTI
 highly pathogenic ones may cause severe, often fatal pneumonia
 SARS-CoV-2, a strain that emerged in late 2019 in China that is
producing a still evolving pandemic as of early 2020
  bind the ACE2 protein on the surface of pulmonary alveolar  German measles (Rubella):
epithelial cells, explaining the tropism of these viruses for the  “3-day measles”
lung.  Highly contagious but mild systemic febrile reaction
 the host immune response and locally released cytokines often  Morbiliform rash & swelling of posterior
produce acute lung injury and ARDS cervical lymph nodes
 Togavirus
VIRAL DISORDERS DIGESTIVE TRACT  Transmissible via placenta... severe
 MUMPS: congenital anomalies & malformations…cardiac …
 Acute, contagious childhood disease  Smallpox (Variola):
characterized by inflammation &  Etologic agent confined in cold storage in high security
swelling of parotid glands & less often research centers …outbreaks in some parts of the world
other minor salivary glands (India, South Africa
 Paramyxoviruses
 Viral Enteritis and Diarrhea:
 Etiologic agent:
o rotaviruses &
o Norwalk agents
 Guarneri bodies: characteristic of skin
o 10% adenoviruses
lesions composed of altered epidermal
cells containing eosinophilic
VIRAL DISORDERS – Exanthems (skin rashes)
intracytoplasmic inclusion bodies.
 MEASLES (Rubeola):
 HERPES VIRUS DISEASES:
 Duration: 1-2 weeks
1. Herpes Simplex I [HSVI]
 Acute febrile illness that begins with
 transmission: physical contact e.g.
coryza & conjunctivitis followed by
kissing
spotty lesions inside the mouth &
 lesions a.k.a: cold sores, gingivostomatitis
generalized erythematous rash
2. Herpes Simplex II [HSVII]
(morbiliform rash)
 transmission: sexual contact or during
 Etiologic agent: RNA paramyxovirus
birth
 Transmission: droplet aspiration;
 lesions: Genital Herpes…contributes to
placental transmission … no congenital anomalies
cervical cancer
 MEASLES (Rubeola):
 Tzanck prep: smears of blister fluids
1. Koplik’s spots: enanthem that ulcerates in
containing inclusion bearing
the mucosa of the cheek near molars
polykaryons or giant cells
2. Rashes: ears, neck, chest, trunk,
upper/lower extremities
3. Complications: bacterial superinfections like ….
bronchopneumonia, encephalomyelitis, giant cell pneumonia,
3. Chicken pox [Varicella]
reactivation of old “primary complex “
  etiologic agent: Varicella-Zoster virus  Etiologic agent: Epstein Barr virus
 contagious mild systemic infection w/
generalized vesicular eruption, rupture…
scabs/scales
 most common infectious rash of
 Characterized by fever, generalized lymphadenopathy, sore
childhood
throat, atypical lymphocytes in the blood
 Rarely cause congenital
 Diagnosis: serology: ID of EBVirus
malformation  Peripheral blood: elevated WBC count 95% lymphocytes
 Rash: several crops succeed each
other beginning from the trunk centrifugally to
the face and extremities.
4. Herpes Zoster [Shingles]
 Etiologic agent: Varicella-
Zoster virus
 Represents reactivation of
latent Varicella zoster
infection…. the virus travelling
from nerve ganglia …skin…causing localized
vesicular eruptions associated with itching
burning & sharp pain. ARBOVIRUS DISEASES
 Transmission of arthropod borne viruses
CYTOMEGALIC INCLUSION DSE  E.g. Dengue fever mosquito borne A. aegypti or
 Etiologic agent: CMV cytomegalovirus Aedes albopictus
 Transmission: prenatal, perinatal, respiratory
droplets, blood transfusion, transplantation, Mycoplasma Pneumonia
venereal [STDs], mother’s milk  Interstitial /Atypical pneumonia in
 Asymptomatic unless host is immunocompromised adolescents & young adults
 Diagnosis: demonstration of CMV inclusion bodies  Diagnosis: 40% immunoglobulins that
agglutinate Gp O cells at 4C (cold
CMV infected cells agglutinins)
 cytomegalic cells, typically two to fourfold  May cause false [+] serologic test for syphylis
larger than normal, containing basophilic
intranuclear inclusion bodies (Cowdry STAPHYLOCOCCAL INFECTIONS
bodies) surrounded by a clear halo, giving the 1. Skin abscess – Staphylococcus aureus
appearance of an owl's eye.  Furuncle [boil] = focal suppurative
 Cells show a thickened nuclear membrane and smaller granular inflammation of skin & subcutaneous
intracytoplasmic inclusions tissue
INFECTIOUS MONONUCLEOSIS  Carbuncle = shows deeper
 Benign self-limited lymphoproliferative disease suppuration that spreads beneath the
 deep subcutaneous fascia, that burrows superficially &  Spreading suppurative infections
erupts in adjacent skin sinuses.  Post streptococcal hypersensitivity disease
o e.g. hidradenitis suppurativa paronychia  Laboratory:
(nailbed)  Increased ASO titers (anti streptolysin O)
o  Disease conditions:
Hidradenitis suppurativa  Scarlet fever
 a skin condition that causes small, painful lumps to form under o Acute pharyngitisor tonsillitis associated with
the skin. rash due to production of erythrogenictoxin
 The lumps can break open, or tunnels can form under the skin.
 The condition mostly affects areas where the skin rubs together,
such as the armpits, groin, buttocks and breasts

 Streptococcal impetigo, folliculitis, pyoderma

o Wound infections induce
lymphangitic “red streaks
“along the course of draining
2. Staphylococcal food poisoning lymphatics & less frequently
 Ingestion of preformed enterotoxin in cause focal tissue necrosis or
contaminated food diarrhea, abdominal abscess.
cramps o Erysipelas: B-hemolytic group A
3. Toxic Shock Syndrome strep infection characterized by
 Febrile sometimes fatal illness, characterized by “volume rapidly spreading erythematous
resistant” shock, rashes, sore throat, GIT upset cutaneous swelling.
 Associated with use of vaginal tampons
PNEUMOCOCCAL INFECTIONS
 Reclassified as Streptococcus (S. pneumoniae)
 Disease conditions:
1. Lobar pneumonia
o diffuse consolidation of lungs in lobar distribution in
adults
o Red & gray hepatization of lungs -solidification with
“liver like consistency of the lungs (gross)
2. Bronchopneumonia
o patchy consolidation of lung parenchyma in children
& elderly
o Fibrinosuppurative exudate
STREPTOCOCCAL INFECTIONS
 Two Patterns of Disease  Stages of lobar pneumonia
 1. Congestion  This is the predominant manifestations in 2/3 of
o affected lobe is heavy, red, and boggy; histologically, meningococcal infections
vascular congestion is seen, with proteinaceous fluid,
scattered neutrophils, and many bacteria in the alveoli. GONOCOCCAL INFECTIONS
o catarrhal /serous exudation  Neisseria gonorrhoeae
2. Red heparinization o Gonorrheal urethritis ––“the clap”
o the lung lobe has a liver like consistency; the o Transmission:
alveolar spaces are packed with neutrophils, a) Sexually transmitted
red cells, and fibrin  Tissue involvement depends on sexual
3. Gray heparinization practice [ oral gonococcal pharyngitis]
o lung is dry, gray, and firm, because the red b) Vertical transmission
cells are lysed, while the fibrinosuppurative  Conjunctivitis in neonates
exudate persists within the alveoli c) Autoinoculation
4. Resolution  Conjunctivitis in neonates
o exudates within alveoli are d) Direct contact
enzymatically digested to produce  E.g. young girls cared for by infected
granular, semifluid debris that is adults/shared linens & towels ……
resorbed, ingested by macrophages, gonococcal vaginitis
coughed up, or organized by  LESIONS
fibroblasts growing into it o Chronic purulent inflammation of pelvic organs
o ** rales, & coughing of yellowish o PID [ pelvic inflammatory disease], is a more
phlegm common GC lesion
o BACTEREMIA = septicemia with skin rash &
PNEUMOCOCCAL INFECTIONS arthritis, endocarditis, meningitis
 EMPYEMA  SMEARS of EXUDATES
 URTI’s o [+] N. gonorrhoeae inside host phagocytes
 MENINGITIS o Gonococcal organisms have pili which attach to
 BRAIN ABSCESS columnar & transitional epithelial cells, but not
 Most deaths due to pneumococcal/streptococcal infections are to squamous epithelial cells
seen among the aged, debilitated & immune suppressed  Re infection is common produce low grade asymptomatic
infections which are:
MENINGOCOCCAL INFECTIONS a.) Resistant to drugs
 Neisseria meningitides b.) Other strains developed
 Disease conditions: c.) Antibodies produced not protective
o Waterhouse Fridericksen syndrome  Culture using Sensitive Media [Thayer Martin Agar]
 It is a fulminant form of meningococcemia with o more superior to smears of exudate
secondary adrenal gland involvement o ID of gonorrhea does not preclude syphilis &
o Meningococcal meningitis other STD’s
 b.) Gram [-] vasculitis associated with thrombosis &
GRAM NEGATIVE RODS hemorrhage ….. is highly suggestive of
1. E. coli infections Pseudomonas
 Normal flora of human & animal GIT lumen c.) LUNG: distribution of pneumonia through the
 DISEASES: terminal airways … ”fleur-de-lis ” pattern
o Urinary tract infection catheterization, d.) SKIN: in bacteremia, causes well demarcated
instrumentation necrotic & hemorrhagic lesions which are oval
o Abdominal suppurative infection shaped…called “Ecthyma gangrenosum“
 Acute appendicitis 4. Proteus & Serratia infections
 Acute cholangitis  P. mirabilis – chronic UTI
o Gram [-] bacteremia most frequent complication  Serratia marcescens - “innocuous germ“, nosocomial
2. Klebsiella & Enterobacter infections pathogen, where infections are limited to debilitated
 K. pneumoniae, Enterobacter aerogenes immune suppressed individuals
 Diseases:
a.) Lobar pneumonia inhalation or aspiration INFECTIOUS DISEASES (PART 2)
b.) Urinary tract infection urinary tract obstruction
 More resistant to antibiotics than E. coli INFECTIONS OF CHILDHOOD
3. Pseudomonas infections 1. Hemophilus influenza
 P. aeroginosa – low virulence owing to its poor resistance  Type B strain = 90% of infections
to natural host barriers [ e.g. phagocytosis]  Diseases: meningitis, URTI,
 Commonly causes nosocomial & opportunistic gram- pneumonia, endocarditis
negative infections in the predisposed  Most common single cause of
 Ranks first as source of skin infections & generalized suppurative meningitis in children up to 5
sepsis in burn units years of age
 High risk patients: 2. Bordetella pertussis
a.) Premature infants  Aka whooping cough, Pertussis
b.) Patients with neutropenia  Acute highly communicable, self-limiting childhood
c.) Immune suppressed disease characterized by violent coughing paroxysms
 Exotoxin A – one of several toxins from Pseudomonas followed by inspiration
 Diseases:  DPT vaccine has decreased its prevalence
o Chronic UTI
o Infection of surface of body
o Bacteremia lung involvement

 LESIONS:
a.) Necrotizing inflammation
3.
Corynebacterium diphtheriae
  Diphtheriae  Associated with O-group of E. coli; these are the toxigenic E.
 Acute communicable disease [2-15 yrs. of age] coli … enterotoxin
 Produces inflammatory membrane  Causes diarrhea & dysentery in infants, children & adults
[pseudomembrane] usually in the 2. Salmonella infections [no enterotoxin]
nasopharynx as a consequence of  Foremost cause of food-water borne enteric infections
localization of organism in the posterior  S. typhi – Typhoid fever
pharyngeal wall and respiratory tract
 Phage mediated exotoxin damages various
organs [myocardium, liver, kidney, adrenals]
 Diagnosis: culture
 DPT-vaccine; has reduced prevalence
TYPHOID FEVER [S. Typhi]
a. Organisms causes enlargement of Peyer’s patches of ileum as
well as reticulo-endothelial system organs and lymphoid tissue
in the other parts of the body
b. 2nd week: the intestinal mucosa over the affected lymphoid tissue
sheds …leaving ovoid ulcers with the long axis in the direction of
bowel flow. The ulcers & lymphatic lesions regenerate without
Enteropathogenic Bacteria [diarrheal syndromes]
permanent scarring.
 3 mechanisms of diarrhea:
o Direct invasion of gut wall
o Release of enterotoxins
o Hypersecretory state elicited by bacteria due to adhesion
to mucosal epithelial cells
 Organisms
o Enteric E. coli c. LABORATORY: neutropenia [leukopenia]
d. Clinical Sx: rose spots, fever, splenomegaly, bradycardia
o Salmonella
e. Diagnosis: isolation of organisms from blood
o Shigella, Campylobacter, Cholera, Yersinia
o 1st week = 90 of cases
 DISEASES:
o 2nd week = [+] widal test with increased
o E. coli infections
titers in subsequent next 2 weeks
o Salmonella infections
o 3rd - 5th week = organism isolated in
o Shigella species
stool
o Vibrio cholerae
o 3rd & 4th week = [+] urine culture in 25%
cases

Enteropathogenic Bacteria [diarrheal syndromes]

1. E. coli infection with enterotoxin
  Pathogenicity of organism due to enterotoxin which
activates adenylate cyclase of plasma membranes of crypt
epithelium of small intestine
 Complete recovery = with fluid replacement & supportive
treatment
 Lesion: V. cholerae does not invade or damage GUT mucosa
 Death: hypovolemic shock, dehydration, metabolic acidosis
3. Shigella sp. [Bacillary dysentery]
CLOSTRIDIA
 Diarrhea, abdominal cramps & tenesmus
 Toxin released requires germination of spores and proliferation
 Gram neg coliforms that are infectious only to man with
without interference by competing flora ….. leading to rarity &
outbreaks when hygiene is poor
severity of disease
 Endotoxin leads to manifestations of lesions in GIT
 TETANUS
 Culture essential is diagnosis
o C. tetani
o Severe acute disease characterized by
convulsive contractions of voluntary
muscles induced by powerful neurotoxin
tetanospasmin … elaborated by C. tetani
4. Vibrio cholerae [cholera] o Results from spore contamination of wounds
 Responsible for pandemics of diarrhea o Tetanospasmin – peripheral
 V. cholera – “El Tor” [less pathogenic] endings … nerves … CNS .. without
affecting their function
o Only when tetanospasmin passes
into pre synaptic terminals of
inhibitory spinal interneurons do
symptoms occur.
 V. parahemolyticus – [raw poorly cooked sea foods] o Manifestations of Trismus or lockjaw
[difficulty in opening of jaw]
o Sardonic smile [risus sardonicus]
o Respiratory difficulty, dysphagia
 BOTULISM
 V. alsinolyticus, V. vulnificus – sea water adapted … skin o C. botulinum
infections and septicemia o Severe paralyzing illness usually in the
form of food poisoning secondary to
ingestion of preformed neurotoxin
[rarely causes wound infection]
o Spores are resistant to drying &
boiling
 oSeen in spoiled canned
foods/processed foods
o Neurotoxin …synaptic vesicles of
cholinergic nerves where it blocks
release of acetylcholine…causes descending form of
paralysis from the cranial nerves down to the
extremities.
 GAS GANGRENE
o C. perfringens 3 STAGES OF ACQUIRED SYPHILIS
o Infection seen in large traumatic wounds with severe 1. Primary Stage
pyogenic infection  IP – 10 to 90 days
o C. myonecrosis – most severe form of anaerobic infection  Development of “chancre” at site invasion
 Location of lesion = glans penis, vulva or cervix
 Chancre = button-like mass directly
involving the eroded skin or mucosa
 Lab tests: STS and FTA usually negative

TREPONEMES
 SYPHILIS
o T. pallidum
o Venereal disease of insidious course
o Transmission:
a.) STD
b.) Vertical – transplacental “congenital syphilis”
o VDRL – very sensitive test because it can show false [+]
reaction due to non-specific antibodies
o FTA - [Fluorescent Treponemal antibody test]; for
detection of specific antibodies for T. pallidum
2. Secondary Stage
 IP – 2 weeks to 6 months
 Lesion: generalized/local skin eruptions
usually appearing spontaneously in 4-12
weeks
 “condyloma lata” – lesion of secondary
syphilis which appear flat or brown
elevations; distinctive of second stage
 Lab test: STS and FTS almost always
positive
3. Tertiary Stage
 IP – preceded by years or decade of apparent well-being
 Lesions:
o Gummas: localized destructive lesion of any tissue
 o Cardiovascular lesions involving aorta [macrophages] vaguely resembling
o CNS involvement epithelial cells [epithelioid cells] … hard
 Meningovascular syphilis [8th nerve deafness; tubercle
optic nerve]  soft tubercle
 Tapes dorsalis Central lesion of tubercle undergoes
 General pareses caseation necrosis … hallmark of
tuberculosis
CONGENITAL SYPHYLIS
 Pneumonia alba = diffuse interstitial fibrosis PRIMARY TUBERCULOSIS
 Liver = diffuse fibrosis  Infection of individual lacking previous contact
 Generalized syphilis of bone [nose, lower extremities] saber with TB bacilli
shins, Hutchinson’s teeth a) LUNG:
 Skin = interstitial keratitis b) Ghon focus – 1 to 1.5cm area of gray white
inflammatory consolidation
Characteristic Lesions of Congenital Syphilis c) Subpleural in location usually in: lower part
 TRIAD OF: of upper lobe / upper part of lower lobe
o Interstitial keratitis  GHON’S COMPLEX
o Hutchinson’s teeth o Ghon focus
o 8th nerve deafness o Lymphadenopathy
 CLINICAL COURSE
o Self-limiting
o Progressive primary tb … miliary tb [meningitis]

CHANCROID, soft chancre SECONDARY TUBERCULOSIS

 Hemophylus ducreyi  Phase of TB infection that arises in previously
 Acute venereal disease involving penis, labia sensitized persons
majora and minora  Usually represents reactivation of
asymptomatic primary disease
MYCOBACTERIA  Location: apex of lung
 Acid fastness: due to the waxy cell component of the bacilli  miliary tb
 Tuberculosis [koch’s dse]  Varied clinical course
o M. tuberculosis; M. bovis
o Transmission: inhalation of infective droplets & acquired LEPROSY
 M. leprae [ Hansen’s disease]
through sustained exposure
 Slowly progressing mycobacterial infection
o Prototype granulomatous dse in man
affecting skin & peripheral nerves [ coolest
 Tubercle
parts of body]
Organized microscopic aggregation of
plump rounded histiocytes
  Transmission: low communicability direct – from active case Tropic changes … trauma, pseudoamputation, contractures
[LL]
 Two / Three TYPES:
1. Lepromatous leprosy
2. Tuberculoid leprosy
3. Borderline leprosy

LEPROMATOUS LEPROSY
 Lacks T cell mediated immunity …. poor host
resistance with increased number of M. leprae
within macrophages ….. lepra cells filled with
masses of acid-fast bacilli … “GLOBI”
 Lepromin test negative
 More extensive & progressive difficult clinical
course

SKIN
 Maculopapular lesions…nodular…coal esces …
”Leonine facies ” anesthetic skin lesions

PERIPHERAL NERVES
 Loss of sensation & minimal nerve changes involving ulnar &
peroneal nerves

TUBERCULOID LEPROSY
 Intact T cell mediated immunity …. mount vigorous response …
decrease or absent number of M. leprae within macrophages……
local aggregation of macrophages …. ”tuberculoid granuloma”
 Lepromin test positive
 Nerve involvement dominates [ ulnar/peroneal]
= anesthesia’s