 Pollution : presence of contaminants that can
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.
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.
- Water serves as a reservoir for Entamoeba histolytica,
a protozoan parasite that cause amoebiasis.
- 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.
  Sexually transmitted infectious agents exit via
vaginal or urethral secretions.
 There are also organisms that exit the host
through blood-sucking arthropods such as
Plasmodium spp., the causative agent of
malaria.
Mode of Transmission
Infectious agents may be transmitted from the source to
a susceptible host in several ways.
 These can be broadly categorized as direct or
indirect contact.
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
contact are the person-to-person contact and
droplet spread.
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
Patients with respiratory tract infection such as the
common colds or influenza can transmit the
causative agents during coughing and sneezing.
 It is considered as direct contact because the
droplets are sprayed over a few feet before
they fall to the ground.
 Close proximity with the source is necessary
for droplets to be transmitted.
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 - Most of them are produced by gram-positive
coagulase that promotes formation of a bacteria but may also be produced by some
coagulum within which the organism may hide gram-negative bacteria.
to escape detection by the immune
surveillance cells. - Exotoxins are soluble in body fluids and are
thus easily diffused into the blood and rapidly
* Mycobacterium tuberculosis can survive and transported throughout the body.
multiply inside macrophages by inhibiting
- Three principal types of exotoxins :
phagosome-lysosome fusion.
(1) Cytotoxins which kill host cells or affect their function
- Finally, some microorganisms produce
;
substances or have developed mechanisms
(2) Neurotoxins which interfere with normal nerve
that can promote invasion.
impulse transmission ; and
- Neisseria gonorrheae can enter and multiply (3) Enterotoxins which affect the cell lining of the
within host cells and after multiplication is gastrointestinal tract.
extruded from the host cell allowing it to
 Diseases produced by exotoxin-producing
infect other host cells. The process of
bacteria are often due to the effects of
extrusion from the host cells causes direct
exotoxin and not of the bacteria themselves.
destruction of the host cells.
 Exotoxins are therefore disease-specific.
- Some bacteria produce enzymes that aids
Important examples are the diphtheria toxin,
them in invading target cells. Example :
botulinum toxin, and the tetanus toxin.
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.

(2) CHEMICAL : TOXIN PRODUCTION

- Toxins are poisonous substances are often the

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
- Some organisms produce disease not as a
consequence of mechanical invasion or toxin
production but as a consequence of the
immune response of the host to the
microorganism or its product.
- In hepatitis caused by the hepatitis viruses, the
damage to the liver is not a direct effect of the
 virus but the response of the immune system
to 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.
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.

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
 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).

 4. Period of decline Finally the infection can progress to a carrier

 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.
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.

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.