EPIDEMIOLOGIC TRIAD

Basic Concepts of
Communicable
Diseases
TERMS:

• “path” – disease 1. AGENT

• Pathogen – microbe that can cause
a disease
• Pathology – study of structural and
functional manifestations of the
disease
• Pathogenicity – the ability of the
pathogen to cause a disease
• Pathogenesis – mechanisms
involved in the development of a
disease
• Infection – colonization by a
pathogen
- the virulence of the pathogen
- how the pathogen that enters the body
- number of organisms that enter the host
2. HOST
- person’s health and nutritional status
3. ENVIRONMENTAL FACTORS
- Physical factors such as heat, location, etc.
- Availability of appropriate reservoirs,
hosts, vectors
- Sanitary and housing and water supply

CHAIN OF INFECTION
Reasons why an Infection may not
lead to a Disease:

• Microbe lands at site where it is

unable to multiply. Pathogens may
land on a site without a specific
receptor.
• Presence of antibacterial factors at
the site
• Presence of indigenous microbiota
(microbial antagonism) wherein
these indigenous substances occupy
spaces and ward off the newly
arrived pathogen and they may also
produce antibacterial factors. 1. pathogen
• Individual’s nutritional and overall 2. source of the pathogen / reservoir
health status 3. portal of exit (i.e., a way for the
• Development of immunity from prior pathogen to escape from the reservoir
infection and vaccination 4. mode of transmission (how the pathogen
• Line of defenses is transmitted from one person to another)
5.portal of entry
6.susceptible host

MC3 (Lecture) CDU – CN A.Y ’20-’21 BASIC CONCEPTS OF COMMUNICABLE DISEASE

 4 PHASES IN THE COURSE OF AN Classification of Infectious Diseases
INFECTIOUS DISEASE based on onset / incubation period:

(1) ACUTE INFECTION

– known to have a rapid onset and
recovery; i.e. measles, mumps, influenza

(2) CHRONIC INFECTION

– infection with a slow onset and prolonged
duration; i.e. leprosy

(3) SUBACUTE INFECTION

– in between; i.e. bacterial endocarditis

(1) INCUBATION PERIOD

– time between the arrival of the pathogen Terms:

and the onset of symptoms
• SYMPTOMS
(2) PRODROMAL PERIOD - experience perceived by the
patient only
– person feels out sorts but doesn’t
- subjective manifestation meaning
experience actual symptoms; person feels
only the patient can tell and express
like coming down with something but is
the presence and degree of severity
unsure about it
of a manifestation
(3) PERIOD OF ILLNESS - example: pain, nausea, dizziness
o Symptomatic Disease
– person experiences typical symptoms – disease wherein the patient
associated with that particular disease; This is experiencing and is aware
is where communicable diseases are easily of the symptoms
transmitted. o Asymptomatic Disease
(4) CONVALESCENT PERIOD – patient is unaware of; ex
gonorrhea, trichomoniasis;
– patient recovers and may have permanent partner should be tested and
damage from the destruction of tissues managed

• SIGN
Classification of Infectious Diseases - objective evidence of a disease
based on the degree of spread: - example: a lump felt during
palpation, skin rash, diagnostic
(1) LOCALIZED INFECTION
laboratory results, vital signs; results
- infections located in one organ or organ
of imaging studies
system

(2) GENERALIZED / SYSTEMIC • LATENT INFECTIONS

INFECTION - infectious disease that may go
from symptomatic to asymptomatic,
- infection that involves 2 or more organ
system

MC3 (Lecture) CDU – CN A.Y ’20-’21 BASIC CONCEPTS OF COMMUNICABLE DISEASE

 then sometime later go back to
symptomatic
- refers to the moment the infectious
disease kept lie low right before
going symptomatic again
- not currently manifesting
- Ex: Shingles starts as chickenpox.
After resolution of infectious disease,
the virus remains dormant on the
dorsal root ganglia of the nerves for
so many years. Once triggered again
by the same virus (Varicella Zoster
virus), Shingles develops.
• PRIMARY INFECTION
– infectious disease caused by one
pathogen
• SECONDARY INFECTION
– an infection that superimposes the
primary infection but caused by a
different pathogen
- Ex: viral respiratory infection
(primary infection) → damage to
ciliated epithelial cells in the airway
→ poor functioning of cilia and
protective mechanisms→ bacteria
come in → able to thrive and
multiply causing disease
STEPS IN THE PATHOGENESIS OF
INFECTIOUS DISEASE
(1) Entry of pathogen
(2) Attachment of pathogen to some tissues
(3) Multiplication of pathogen resulting in
localized infection
(4) Spread of pathogen to neighboring
tissues or to the bloodstream
(5) Evasion of host defenses
(6) Damage to host tissues
MC3 (Lecture) CDU – CN A.Y ’20-’21 BASIC CONCEPTS OF COMMUNICABLE DISEASE
VIRULENCE
- synonym for pathogenic
- not all microbes are virulent meaning
those virulent strains are capable of causing
disease
Ex: Streptococcus pneumoniae has
both encapsulated and some are non-
encapsulated. The presence of capsule or
the capsulated strains can definitely cause
disease.
Another example is Staphylococcus
aureus which has some strains that release
the toxin TSST-1. This is a very strong toxin
that causes shock or systemic infection;
however, some strains of S. aureus don’t
produce this so those strains are less
pathogenic.
- Virulence can also be used as a way to
express how pathogenic or how strong a
microorganism is causing a disease
Ex: Shigella spp VS Salmonella spp.
Both cause infectious diarrhea but shigella
is more virulent because it only takes 10
cells of shigella to cause diarrhea compared
to salmonella that takes 1000 cells to do so.
VIRULENCE FACTORS
- the physical characteristics that enable the
microbes to be virulent
- these are the attributes of the pathogen
that makes them escape various host
defense mechanisms
I. ATTACHMENT
- some pathogens must anchor or attach
themselves to its target cell right after they
have gained access to the body
(A) RECEPTORS AND INTEGRIN
- molecule on the surface of a host cell that
a particular pathogen is able to recognize
and attach to
-pathogens are specific so they only attach
to cells that carry the receptor that matches
with it
- Ex: viruses that cause respiratory infection
only attach to receptors of cells that are
present in the respiratory tract, and not in
GI, GU or in any other system
(B) ADHESIN AND LIGAND
- molecules found on the surface of the
pathogen that has the capability to
recognize and bind to a particular receptor
- it enables the pathogen to attach to host
cells
(C) PILI
– short, thin, hair-like, flexible projections
composed of an array of proteins called
PILIN
- they enable bacteria to attach to surfaces
-ex Neisseria gonorrhoeae have strains with
pili which allows them to anchor themselves
to the inner walls of urethra = “urethritis”
II OBLIIGATE INTRACELLULAR
PATHOGENS
– some bacteria must live within host cells
to survive and multiply. These pathogens
can quickly adapt to an intracellular
environment.
- ex: Rickettsia spp. are bacteria that are
capable of producing their own nutrients
but they need to stay in the cell because of
their unusual transport system → meaning
these bacteria have very leaky membranes,
that’s why it needs itself to immerse in this
environment to thrive. They can quickly
adapt to any environment.
MC3 (Lecture) CDU – CN A.Y ’20-’21 BASIC CONCEPTS OF COMMUNICABLE DISEASE
III. FACULTATIVE INTRACELLULAR
PATHOGENS
- Pathogens that can live both within and
outside host cells. It is considered a
virulence factor because these pathogens
can reside practically anywhere.
III. CAPSULES
- They are considered as virulence factors
because they serve an antiphagocytic
function by protecting encapsulated bacteria
from being phagocytized by phagocytic
white blood cells.
- Phagocytes are unable to attach to
encapsulated bacteria because the capsule
lack surface material for the phagocyte to
adhere to of which the capsule. If the
phagocyte cannot adhere, then it would not
be able to ingest the pathogen.
IV. FLAGELLA
- enables the flagellated (motile) bacteria to
invade aqueous areas of the body, thus it
also enables the bacteria to avoid
phagocytosis since it’s more difficult for
phagocytes to catch a moving target
V. EXOENZYMES
- enzymes produced by pathogens that
enable them to evade host defense
mechanisms, invade, or cause damage to
body tissues
(A) Necrotizing Enzymes (proteases and
lipases)
- exoenzymes that destroy tissues
(B) Coagulase
- causes clotting by conversion of fibrinogen
to fibrin
- enable the pathogen to clot plasma and
thereby to form a sticky coat of fibrin
around themselves for protection from
phagocytes
(C) Kinases / Fibrinolysins
- have the opposite effect of coagulase
- pathogens that produce kinases are able
to escape from clots. It is necessary for
them because normally, the host will cause
a fibrin clot to form around pathogens in an
attempt to wall them off and prevent them
from invading deeper. If they are able to
escape the clot, they will not be trapped
and can certainly move away from the
pathogen.
OTHER MECHANISMS USED BY SOME
PATHOGENS TO ESCAPE IMMUNE
RESPONSES
(1) ANTIGENIC VARIATION
- Pathogens are able to periodically change
their surface antigens
(2) CAMOUFLAGE
- Pathogens conceal their foreign nature by
coating themselves with host proteins.

(D) Hyaluronidase (3) MOLECULAR MIMICRY

- also called as “spreading factor” because - Pathogen’s surface antigens closely
they dissolve hyaluronic acid and collagen resemble host antigens and are therefore
enabling pathogens to invade deeper into not recognized as being foreign.
tissues
_ Hyaluronic acid and collagen are (4) DESTRUCTION OF ANTIBODIES
important structures in the tissues and - Pathogens are capable of destroying some
blood vessels. of the antibodies that the host’s immune
system has produced.
(E) Hemolysins
- Enzymes that cause damage to the host’s
red blood cells and also provides the
pathogens with a source of iron.

(F) Lecithinase
- breaks down phospholipids that are
collectively referred to as lecithin. They are
destructive to cell membranes because the
membranes are made up if phospholipid
bilayer.

VI. TOXINS
(A) Endotoxins
- parts of the cell walls of Gram-negative
bacteria
- can cause serious, adverse, physiologic
effects such as fever and shock. Shock is a
life-threatening condition resulting from
very low blood pressure and an inadequate
blood supply to body tissues and organs.

(B) Exotoxins
- toxins that are produced within cells and
then released from the cells;
- examples: neurotoxins, enterotoxins,
exfoliative toxin

MC3 (Lecture) CDU – CN A.Y ’20-’21 BASIC CONCEPTS OF COMMUNICABLE DISEASE