WEEK 6
INFECTION AND BACTERIAL INVASION
Learning Objectives
At the end of this chapter, the student should be able to:
1. Define common terms involved in the production
of disease by bacteria;
2. Explain the components of Koch’s postulates
3. Discuss thoroughly the various factors that play a
role in the chain of infection;
4. Compare the various mechanisms by which
bacteria produce disease, citing examples for
each mechanism;
5. Describe the various ways by which infectious
diseases are classified ;
6. Compare the events involved in the various
stages of infectious disease
I. Definition of Terms
 Disease : result of an undesirable relationship
between the host and the pathogen, marked by
interruption in the normal functioning of a body
part or parts.
 Infection : invasion of the body by pathogenic
microorganisms. The term is not synonymous
with disease.
 Symbiosis : prolonged and close interaction
between organisms of different species
 Mutualism : a form of symbiosis in which both
organisms benefit from the relationship
 Commensalism : a form of symbiosis in which
one organism benefits from another organism
without causing harm to it.
 Parasitism : a form of symbiosis where one
organism benefits from another organism and at
the same time causes harm to the other.
 Pathogenicity : ability of an organism to produce
disease. An organism that can produce disease in
humans is said to be pathogenic.
 Virulence : describes the degree of pathogenicity
of an organism or the degree to which an
organism can produce disease.
 Contamination : presence of unwanted materials
(chemical, biological, or radiological) where they
should not be or at concentrations above the
normal. The presence of these substances may
not necessarily lead to harm.
 Pollution : presence of contaminants that can
cause adverse biological effects to human and
communities. All pollutants are contaminants
but not all contaminants are pollutants.
 Bacteremia : presence of bacteria in the blood.
 Septicemia : Presence of actively multiplying
bacteria in the blood, usually from a source of
infection. The condition is called sepsis.
 Pyemia : presence of pus-producing bacteria in
the bloodstream
 Viremia : presence of viruses in the blood.
 Toxemia : presence of toxins in the blood
II. Koch’s Postulates
 Robert Koch and his colleagues developed a
scientific experimental procedure to prove
certain microorganisms caused specific disease.
 Published in 1884 and came to be known as
Koch’s postulates. These postulates are as
follows :
1. The suspected organism must be absent in
healthy individuals but present in those with
the disease.
2. The suspected organism must be isolated from
the infected host and grown in a pure culture.
3. The organisms grown from pure culture must
produce the same disease as that of the
infected source when inoculated to a
susceptible animal.
4. The same organism must be isolated from pure
culture from the experimentally-infected host.
  Once all the above conditions are fulfilled , it can
now be concluded that the organism isolated is
indeed the cause of the disease under study.
 The validity of Koch’s postulates lies in the
ability of the pathogen to grow in the
laboratory using artificial culture media.
Limitation of Koch’s postulate :
a. Certain microorganisms cannot be grown in artificial
culture media. Ex. Viruses are obligate intracellular
parasites (i.e. grown in living cells)
b. Not all people who acquire an infection develop overt
disease. Most of the time, infections are sub-clinical.
c. Reaction of humans to specific pathogens may differ
given a specific microorganisms.
(i.e. Humans have different genetic
compositions that may modulate their
responses to the same organism)
d. An issue involving Koch’s postulates : cultured organism
must be inoculated into a susceptible animal – however
certain organisms that are species-specific.
There are organisms that produce disease only in animals ;
infectious agents that produce disease only in humans.
 Therefore, organisms that produce disease only
in humans cannot be tested using laboratory
animals and vice versa.
e. Finally, there are certain pathogens that become altered
when grown in artificial media. Some become less
pathogenic while others may lose their pathogenicity, in
which case Koch’s postulates cannot be applied.
III. Factors that influence the occurrence of
Infection : The chain of Infections
 The development of an infectious disease is a
consequence of the interaction among three
components – the etiologic agent, the host, and
the environment.
 Transmission starts when the pathogenic
organism leaves its host or a reservoir through a
portal of exit.
 A susceptible organism acquires the infection
through a given mode of transmission, entering
the body of the susceptible host through a portal
of entry.
 Once inside the body, the organism starts to
multiply and produce disease. This is called the
chain of infection.
Reservoir
It is the site where an infectious agent normally
resides and multiplies.
 It provides organisms with conditions that
enable them to survive and multiply and provide
opportunity for transmission to a susceptible
host.
 Reservoirs include animals and humans as well
as the environment.
 ANIMAL RESERVOIRS
- Certain infectious disease can be transmitted from an
animal to humans. These are called zoonotic infections.
 Examples of zoonotic infections include anthrax,
plague, rabies.
 HUMAN RESERVOIRS
- These organisms may be directly transmitted
from one individual to another.
Examples : Respiratory pathogens and sexually
transmitted infections.
- The human reservoir may not necessarily
manifest with the disease. There are certain
infected humans who may harbor the organism
but only develop sub-clinical disease ; there are
those who developed the disease, got well but
still harbor that organism thereby transmitting
them to others.
- These are what are known as carriers and comes
in several forms :
a. Asymptomatic or healthy carriers : infected
but do not manifest symptoms
b. Incubatory carriers : carriers who transmit the
 causative agent during the incubation period of
illness
c. Chronic carriers : are those who harbour the
organism for months or longer after the patient
developed the initial infection.
d. Convalescent carriers : Individuals who
developed the disease, recovered but remain
capable of transmitting the causative agent.
Environmental Reservoirs
- Water, soil, and plants can harbor infectious organisms.
For instance, the fungus Histoplasma capsulatum is
associated with soil.
Direct Contact
Most infectious agents are transmitted through direct
contact.
 Contact with environmental sources harboring
infectious agents are also considered direct
contact.
 Ex. The blood fluke Schistosoma spp. can be
transmitted when one wades in fresh water
containing snails that harbor the larvae of the
parasite. ***
 The larvae in turn enter the human host through
skin penetration.

 The most important methods though of direct

- Water serves as a reservoir for Entamoeba histolytica, a
contact are the person-to-person contact and
protozoan parasite that cause amoebiasis.
droplet spread.

- Aquatic vegetation such as watercress and “kangkong”

harbor Fasciola hepatica larvae which causes damage to
the liver.
Portal of Exit
The portal of exit is the route by which an infectious agent
exits its host. It is usually the site where the infectious
agent is commonly located or localized.
 Ex. The blood fluke Schistosoma haematobium
which preferentially infects the urinary bladder
exits the host via urine. (see illustration)
 Infectious agents causing respiratory tract
infection will leave the host via droplets or
aerosols from the respiratory tract.
1. PERSON-TO-PERSON CONTACT
Involves transmission through skin-to-skin contact,
kissing, or sexual transmission.
 Warts can be transmitted through direct contact
with the lesion on the skin of infected persons.
 Infectious mononucleusis is caused by Epstein
Barr virus is transmitted through saliva, hence
the name “Kissing Disease”.
 Syphilis, gonorrhea, and other sexually
transmitted infections are spread through
vaginal and urethral secretions of infected
persons.
2. DROPLET SPREAD

 Sexually transmitted infectious agents exit via

Patients with respiratory tract infection such as the
vaginal or urethral secretions.
common colds or influenza can transmit the causative
agents during coughing and sneezing.
 There are also organisms that exit the host
through blood-sucking arthropods such as
 It is considered as direct contact because the
Plasmodium spp., the causative agent of malaria.
droplets are sprayed over a few feet before they
fall to the ground.
Mode of Transmission
 Close proximity with the source is necessary for
Infectious agents may be transmitted from the source to a
droplets to be transmitted.
susceptible host in several ways.

 These can be broadly categorized as direct or

indirect contact.
Indirect Contact
1. AIRBORNE TRANSMISSION – infectious agents may be
transferred from an infected person to a susceptible host
through dust or aerosols.
 Aerosols are droplets with nuclei less than 5
microns in size. Due to their small size, they may
remain suspended in air for a longer time and
may cover farther distance than droplets.
Ex :Measles, a common childhood illness, can be
transmitted through aerosols.
 There are also organisms that can be carried
with dust.
Ex. The fungus Cryptococcus neoformans can be
transmitted through aerosolized pigeon or fowl
droppings and inhaled by a susceptible host.
2. VEHICLE TRANSMISSION
 Refers to transmission of organisms through
media such as food, water, milk, or biologic
substances such as blood and body secretions.
 Fomites or inanimate objects such as beddings
and clothing may also serve as vehicles.
 Vehicles carry an infectious agent passively or
may provide an environment that promotes
growth and multiplication of an infectious agent.
 The most common vehicles are food and water.
 Gastrointestinal infections such as cholera and
typhoid are transmitted through contaminated
water.
 In food-borne transmission, the causative agent
is transmitted through ingestion of raw or
improperly cooked, poorly refrigerated food that
is contaminated by feces of the infected patient
(fecal-oral transmission).
 Ex. Food poisoning and gastroenteritis
3. VECTOR TRANSMISSION
 Vectors are usually insects that can transmit an
infectious agent.
 These spread the infectious agent by two general
methods: Mechanical and Biological.
1. Mechanical Transmission refers to the passive transport
of the organism on the insect’s feet or other body parts.
Ex. Cockroaches and flies can transfer the organisms from
the faeces of infected persons to food, which is later
swallowed by the host.
2. Biological Transmission is the active transport of the
organism. Here, the organism enters the insect vector
after the insect vector bites an infected person.
 The organism then multiplies within the insect
vector and is transmitted by the insect vector to
another person through bites.
 Ex. Malaria is transmitted to a susceptible host
through the bite of the female Anopheles
mosquito. Dengue virus, Chikungunya virus, and
Zika virus are also transmitted through bites of
mosquito vectors.
 Bite of the rat flea is the mode of transmission of
Yersinia pestis, the causative agent of the plague.
Portal of Entry
How the infectious agent enters a susceptible host. It
provides access to tissues where the infectious agent can
multiply.
 More commonly, the portal of exit of an
infectious agent is also the portal of entry into
another host.
 Ex. Organisms that leave the respiratory tract
will also enter another host through the
respiratory tract via inhalation.
 Organisms that are transmitted through food
and water enter the host through the mouth but
exit through the feces.
 In infection with the blood fluke Schistosoma
haematobium, the organism leaves the body of
the host through urine but enters through the
skin penetration by the infective larva.
 Hepatitis B virus and HIV enter the susceptible
host through blood and blood products.
 Host
The FINAL LINK in the chain of infection is the
susceptible host.
 The host’s susceptibility is affected by several
factors such as constitutional or genetic factors
and immune status of the host.
 Susceptibility to infection may be increased or
decreased in certain individuals with specific
genetic make-up.
 Ex. Patients born with the gene that codes for
the sickle cell trait, an abnormality in
morphology of red blood cells, are less prone to
develop Malaria than those who were not born
with the trait.
 The immune status of the host is probably the
most important factor that can affect
development of a disease process. Humans have
natural barriers that prevent entry of potential
pathogenic organisms.
 Besides these, they are also equipped with a
highly functional immune system that can mount
adequate defences to fight and destroy any
invading pathogen.
 Once there is breakdown in all these defences,
microorganisms can easily gain entrance into the
body, multiply, and produce disease.
 Factors that may impact the human immune
system include poor nutritional status, chronic
intake of alcoholic beverages, or any condition
that dampens the immune response.
How Organisms Produce Disease
(1) Mechanical : Invasiveness
- Organisms can produce disease by directly
damaging tissues or body surfaces. This involves
invasion of the epithelial surface and penetration
into deeper tissues.
- Invasiveness encompasses three important steps
:
1. Colonization
2. Ability to evade host immune defenses
3. Production of extracellular substances
that can promote invasion.
- Involves the ability of the invading organism to enter the
susceptible host and establish itself in the portal of entry.
- This can be facilitated by substances produced by the
organism that facilitate adhesion of the organism to
specific target cells.
- These substances are collectively called adhesins.
- Gram-negative bacteria possess pili or fimbriae that
promote adherence of the organism to susceptible host.
- By promoting adhesion, the organism can easily
evade the surfaces and enter the body of the
host.
- Once the organism enters the body, the immune
system of the host immediately mounts an
immune response that will lead to the
destruction of the invading pathogen.
- However, there are certain factors that allow the
organism to evade these immune defenses.
- - For instance :
* Bacteria possess a capsule, enables the
organism to evade phagocytosis.
* Staphylococcus aureus secretes the enzyme
coagulase that promotes formation of a
coagulum within which the organism may hide
to escape detection by the immune surveillance
cells.
* Mycobacterium tuberculosis can survive and
multiply inside macrophages by inhibiting
phagosome-lysosome fusion.
- Finally, some microorganisms produce
substances or have developed mechanisms that
can promote invasion.
- Neisseria gonorrheae can enter and multiply
within host cells and after multiplication is
extruded from the host cell allowing it to infect
other host cells. The process of extrusion from
the host cells causes direct destruction of the
host cells.
 - Some bacteria produce enzymes that aids them
in invading target cells. Example : Collagenase is
an enzyme produced by Clostridium perfrigens
that causes breakdown of collagen, a major
component of connective tissue of muscles
thereby contributing to the development of the
disease called gas gangrene.
transmission ; and
(3) Enterotoxins which affect the cell lining of the
gastrointestinal tract.
 Diseases produced by exotoxin-producing
bacteria are often due to the effects of exotoxin
and not of the bacteria themselves.

(2) CHEMICAL : TOXIN PRODUCTION  Exotoxins are therefore disease-specific.

Important examples are the diphtheria toxin,
- Toxins are poisonous substances are often the botulinum toxin, and the tetanus toxin.
primary factors that contribute to disease
production. There are two major types of toxins
– exotoxins and endotoxins.

- Endotoxins are integral components of the outer

membrane of gram-negative bacteria such as
Salmonella, Shigella, and Escherichia coli.

- The specific component responsible for the

endotoxin activity of these bacteria is the
lipopolysaccharide (LPS), which is further
composed of a lipid A moiety and a
polysaccharide moiety.

- The lipid A component is associated with its toxic

activity while the polysaccharide component is
antigenic.

- Endotoxins exert their effects when the gram-

negative bacteria die and their cell walls undergo
lysis, thereby releasing the endotoxin. All
endotoxins produce similar sings and symptoms,
although not to the same degree.

- EXOTOXINS are intracellular products of some

bacteria as part of their growth and metabolism
and are released into the surrounding medium.
These are mainly proteins and many of them are
enzymes.
(3) Immunologic
- Most of them are produced by gram-positive
bacteria but may also be produced by some
- Some organisms produce disease not as a
gram-negative bacteria.
consequence of mechanical invasion or toxin
production but as a consequence of the immune
- Exotoxins are soluble in body fluids and are thus
response of the host to the microorganism or its
easily diffused into the blood and rapidly
product.
transported throughout the body.
- In hepatitis caused by the hepatitis viruses, the
- Three principal types of exotoxins :
damage to the liver is not a direct effect of the
(1) Cytotoxins which kill host cells or affect their function ; virus but the response of the immune system to
(2) Neurotoxins which interfere with normal nerve impulse the virus.
 - Antibodies are produced against the virus and
cytotoxic T cells are activated leading to the
destruction of hepatocytes.
- In childhood measles and German measles, the
rashes seen are due to the specific immune
response of the body to the measles virus.
CLASSIFICATION OF INFECTIOUS DISEASES
Based on how they behave within a host and within a
given population
Communicable disease – a disease that is spread from one
host to another, either directly or indirectly.
Examples : Measles, tuberculosis, typhoid fever
Contagious Disease – disease easily and rapidly spread
from one person to another.
Examples : Measles and chicken pox
Fulminant Infection – if the infection results in the death of
the patient over a short period of time.
Example : Meningococcemia where a patient may die
hours after confinement in the hospital
Non-communicable disease – is one that is not spread
from one person to another.
- It is usually caused by organisms that normally inhabit
the body and produce disease only occasionally or by
organisms that produce disease only when introduced into
the body.
- Example : Clostridium tetani, agent that cause tetanus.
(Breaks in the skin)
BASED On the Source of the Microorganism
Exogenous – an infection in which the source of the
infectious agent is from outside the body.
Example : Cholera is an exogenous infection because the
causative agent enters the body through ingestion of
contaminated water.
Hospital-acquired infections / Nosocomial Infections – can
be considered as exogenous infections where the
offending organism was obtained from the hospital
environment during the period of confinement of the
patient in the hospital.
Endogenous infection – is one where the source of the
causative organism is from inside the body.
> Escherichia coli is part of the normal flora of the colon
that can enter the urinary tract via the urethra, especially
in women, due to its close proximity to the anal orifice.
- can cause UTI which can ascend to involve the kidney and
can lead to sepsis in immunocompromised patients.
BASED on the Occurrence of a disease
 Sporadic disease : a disease that occurs
occasionally.
 Endemic disease : if the disease is constantly
present in a population at low levels
ex. Malaria, endemic in Palawan
 Epidemic : if a great number of people in a given
locality develop an infection disease in a
relatively short period of time.
Ex. Influenza
 Pandemic : If a disease has a worldwide
occurrence or involves at least three regions in
the world.
Ex. Influenza, especially influenza A, SARS, AIDS
are examples
BASED On the Severity or duration of a disease
Acute Disease : is one that develops rapidly but lasts for
only a short period of time.
Ex : common cold
Chronic Disease : if the disease develops more slowly and
occurs for a long periods of time
Ex: Tuberculosis
*Hepatitis B infection is an example of a disease that can
have either an acute form or a chronic form.
Latent Disease : is one in which the causative organism
remains inactive for a time but can become active again
and produce symptoms of the disease.
Ex: Viruses that belong to Herpesviridae are characterized
by latency.
Shingles, a reactivation of a latent chickenpox infection
which occurs years after the initial infection
BASED On the extent of host involvement
Localized infection – is one in which the invading
organisms are limited to a relatively small area of the
body.
Ex. Boils and abscesses
Systematic or generalized infection – is one where the
causative organisms or their products are spread
throughout the body through blood or lymph.
In some cases, the causative agents of a localized infection
may enter a blood or lymphatic vessel, spread to a specific
parts of the body and become confined to specific areas.
This is called Focal Infection. Ex : arise from infections in
areas such as the teeth, tonsils, or sinuses.
A primary infection – is an acute infection that causes the
initial illness.
 Secondary infection – is one which caused by
opportunistic pathogens after the primary
infection has weakened the body’s defenses.
Ex. Common in patients whose immune system
have been compromised by another disease (e.g
AIDS) and can proved to be more devastating
than the primary infection.
Subclinical or inapparent infection – is one that
does not cause noticeable illness.
Ex : Hepatitis due to hepatitis A virus, (no signs
and symptoms)
Stage of an Infectious Disease
Once a microorganism invades a susceptible host, disease
follows. Sequence of events are:
 1. Incubation Period
 2. Prodromal Period
 3. Period of Illness
 4. Period of decline
 5. Period of convalescence
Incubation Period – the time interval between entry of the
offending agent and the appearance of the initial signs and
symptoms of the disease.
- The length is variable and is usually stated in the form of
a range (e.g 6-12 days).
- The length of this period can be affected by the virulence
of the organisms as well as the number of infecting
organisms.
- It also depends on the resistance of the host.
- An organism that is considered virulent can produce
disease within a short incubation period.
- In general, the greater the number of microorganisms
that invade the body, the shorter the incubation period.
- However, if the organism is highly virulent, it may take
only a small number of organisms to produce disease,
hence a shorter incubation period.
2. Prodromal Period – a relatively short period, is
characterized by early, mild symptoms of disease which
are generally non-specific.
- In measles infection, the prodromal period is
characterized by non-specific constitutional symptoms
such as fever, cough, colds, general aches, and malaise –
symptoms which can be seen in other disease processes
and are thus not specific to measles.
3. Period of Illness – corresponds to period of
maximal invasion. It is during this period that the disease is
most acute.
- During this period, the patient manifests signs and
symptoms distinctive of the disease.
For example, the period of illness in measles is marked by
the appearance of the typical rashes seen in measles.
- Examination of Complete Blood Count (CBC)
will generally show elevation of the white blood cells
although in some infections there may be a reduction in
the total WBC count.
As a rule, most bacterial infections will usually show
increased in neutrophil count while most viral infections
will have a high lymphocyte count.
 Several outcomes can arise during this period.
- Infection may remain acute where the
body’s defense mechanisms successfully
destroy the invading organisms leading
to resolution of the infection and recovery
of the patient.
- When the patient does not successfully
overcome the disease-producing agents,
he or she may develop severe disease that
can lead to a fulminant infection.
 - The infection may also progress from an
acute form into a chronic form (e.g. hepatitis
B infection).

Finally the infection can progress to a carrier

state where the patient is asymptomatic but
continues to transmit the infecting
microorganisms.

4. Period of Decline – corresponds to what is known as the

period of defervescence. During this period, the signs and
symptoms of the patient start to subside.

- Body temperature may return to normal and the

feeling of weakness may diminish.

- However, it is also during this period that the

patient becomes vulnerable to secondary
infections.

5. Period of Convalescence – this period is marked by

recovery of the patient from the disease.

- The patient regains strength and the body

returns to its pre-diseased, normal condition.