1.

Skin
The skin is the largest organ of your body. Image of inflammatory response
It acts as a barrier between invaders (pathogens) and
MODULE 5.1
your body. Skin forms a waterproof mechanical
REVIEW OF IMMUNOLOGY barrier. Microorganisms that live all over your skin
can’t get through your skin unless it’s broken.

IMMUNITY 2. Tears, mucus and saliva

Immunity is the balanced state of
multicellular organisms having adequate biological
defenses to fight infection, disease, or other
unwanted biological invasion, while having adequate
tolerance to avoid allergy, and autoimmune diseases.
The immune response is how your body
recognizes and defends itself against bacteria,
viruses, and substances that appear foreign and
harmful.
INNATE, OR NONSPECIFIC, IMMUNITY
is the defense system with which you were
born. It protects you against all antigens. Innate
immunity involves barriers that keep harmful
materials from entering your body. These barriers
form the first line of defense in the immune response.
Examples of innate immunity include:
• Cough reflex
• Enzymes in tears and skin oils
• Mucus, which traps bacteria and small particles
• Skin
• Stomach acid
First line of defense
The body's most important nonspecific
defense is the skin, which acts as a physical barrier to
keep pathogens out. Even openings in the skin (such as
the mouth and eyes) are protected by saliva, mucus,
and tears, which contain an enzyme that breaks down
bacterial cell walls.
Nose, mouth and eyes are obvious entry
points for pathogens. However, tears, mucus and saliva
contain an enzyme that breaks down the cell wall of
many bacteria. Those that are not killed immediately
are trapped in mucus and swallowed. Special cells line
and protect the nose, throat and other passages
within your body. The inner lining of your gut and lungs
also produces mucus to trap invading pathogens.
3. Cilia
Very fine hairs (cilia) lining your windpipe
move mucus and trapped particles away from your
lungs. Particles can be bacteria or material such as
dust or smoke.
4. Stomach acid
Stomach acid kills bacteria and parasites that have
been swallowed.
5. Urine flow
Urine flow flushes out pathogens from the bladder
area.
6. Normal Flora ‘Friendly’ (beneficial) bacteria
1.
Normal flora are growing on the skin, in the
bowel and other places in the body (such as the mouth
and the gut) that stop other harmful bacteria from
taking over.
Second line of defense
If a pathogen does make it into the body,
there are secondary nonspecific defenses that take
place.
An inflammatory response begins when a pathogen
stimulates an increase in blood flow to the infected
area. Blood vessels in that area expand, and white
blood cells leak from the vessels to invade the
infected tissue. These white blood cells, called
phagocytes engulf and destroy bacteria. The area
often becomes red, swollen, and painful during an
inflammatory response.
When a pathogen has invaded, the immune system may
also release chemicals that increase body
temperature, producing a fever. Increased body
temperature may slow or stop pathogens from growing
and helps speed up the immune response.
ANATOMY OF THE IMMUNE SYSTEM
IMMUNE ORGANS
Thymus
• Only clearly individualized 1⁰ lymphoid organ
• Primary function:- production of thymic lymphocytes
• A major organ for proliferation of lymphocytes in
body.
• Plays key role in determining the differentiation of T
cell
2. Bone marrow
• Hematopoiesis
• B cell maturation
• B cell selection
• Puts out mature, naive B cells
3. Lymph nodes
• 1st line of response to antigens
• Secondary follicle (Germinal center) is site of B cell
proliferation, mutation, differentiation
• Specificity is high
• >90% of B cells die through apoptosis
• After Ag stimulation lymphocyte numbers up by 50X
in efferent lymphatic vessel
4. Tonsils
• Filters out older RBCs
• Responds to Ag in circulatory system
• Produces activated B cells
5. Appendix
• Responds to Ag
• Role in GI immune response
6. Mucosa-Associated Lymphoid Tissue (MALT)
• Lymphoid tissues below epithelium
• Presence of B cells Specific immune responses are triggered by antigens.
• Ag presented through unique cell (M cell) Antigens are usually found on the surface of
The humoral response (or antibody‐mediated
• Preferentially responds with IgA antibody pathogens and are unique to that particular pathogen. response) involves B cells that recognize antigens or
B. SPECIFIC DEFENSE: THE ADAPTIVE IMMUNE The immune system responds to antigens by producing pathogens that are circulating in the lymph or blood
SYSTEM cells that directly attack the pathogen, or by (“humor” is a medieval term for body fluid).
producing special proteins called antibodies.
When pathogens are able to bypass innate immune Antibodies attach to an antigen and attract cells that
defenses, the adaptive immune system is activated. will engulf and destroy the pathogen. The response follows this chain of events:
Cells that belong in the body carry specific markers
that identify them as "self" and tell the immune The main cells of the immune system are lymphocytes 1. Antigens bind to B cells.
system not to attack them. known as B cells and T cells. B cells are produced and 2. Interleukins or helper T cells co-stimulate B cells. In
mature in bone marrow. T cells are also produced in most cases, both an antigen and a co-stimulator are
Once the immune system recognizes a pathogen as bone marrow, but they mature in the thymus. required to activate a B cell and initiate B cell
"non-self," it uses cellular and chemical defenses to proliferation.
attack it. After an encounter with a new pathogen, B.1. Humoral immunity
3. B cells proliferate and produce plasma cells. The
the adaptive immune system often "remembers" the
Humoral immunity relies on the actions of antibodies plasma cells bear antibodies with the identical antigen
pathogen, allowing for a faster response if the
circulating through the body. specificity as the antigen receptors of the activated
pathogen ever attacks again.
B cells. The antibodies are released and circulate
through the body, binding to antigens.
4. B cells produce memory cells. Memory cells provide
future immunity.

B.2. Cell-mediated immunity

 Antibodies alone are often not enough to protect the
body against pathogens. In these instances, the
immune system uses cell-mediated immunity to
destroy infected body cells.
The cell‐mediated response involves mostly T-cells
and responds to any cell that displays aberrant MHC
markers, including cells invaded by pathogens, tumor
cells, or transplanted cells. The following chain of
events describes this immune response:
1. Self cells displaying foreign antigens bind to T cells.
2. Interleukins (secreted by helper T cells) co-stimulate
activation of T cells.
3. If MHC‐I and endogenous antigens are displayed on
the plasma membrane, T cells proliferate, producing
cytotoxic T cells. Cytotoxic T cells destroy cells
displaying the antigens.
4. If MHC‐II and exogenous antigens are displayed on
the plasma membrane, T cells proliferate, producing
helper T cells. Helper T cells release interleukins
(and other cytokines), which stimulate B cells to
produce antibodies that bind to the antigens and
stimulate nonspecific agents (NK and macrophages) to
destroy the antigens.
NATURAL IMMUNITY
 occurs through contact with a disease-causing agent,
when the contact was not deliberate.
 immediately activate the rest of your immune system
to prevent you from getting sick.
A. Natural Passive immunity
 Passive immunity develops after you receive
antibodies from someone or somewhere else. This
type of immunity is short-lived, because it doesn’t
cause your immune system to recognize the pathogen
in the future.
 Example:
 Maternal antibodies are antibodies that transfer from
a mother to child. This usually happens across the
placenta or through breast milk, especially in the first
few days after birth.
 Ig can be transferred by breastfeeding as it is the
most abundant Ig found in human milk
 placental transfer of IgG or milk transfer of IgA
molecules specific for microbial antigens and have
demonstrated their role in infectious disease
prevention
B. Natural Active Immunity
 occurs when the person is exposed to a live pathogen,
develops the disease, and becomes immune as a result
of the primary immune response. Once a microbe
penetrates the body’s skin, mucous membranes, or
other primary defenses, it interacts with the immune
system. B-cells in the body produce antibodies that
help to fight against the invading microbes. The
adaptive immune response generated against the
pathogen takes days or weeks to develop but may be
long-lasting, or even lifelong. Wild infection, for
example with hepatitis A virus (HAV) and subsequent
recovery, gives rise to a natural active immune
response usually leading to lifelong protection.
ARTIFICIAL IMMUNITY
 Artificial immunity is a mean by which the body is
given immunity to a disease by intentional exposure to
small quantities of it.
A. Artificial Passive Immunity
 is short lived, and usually lasts only a few months
Artificially-acquired passive immunity is an immediate,
but short-term immunization provided by the injection
of antibodies, such as gamma globulin, that are not
produced by the recipient’s cells. These antibodies are
developed in another individual or animal and then
injected into another individual. Antiserum is the
general term used for preparations that contains
antibodies.
Artificial passive immunization is normally
administered by injection and is used if there has
been a recent outbreak of a particular disease or as
an emergency treatment for toxicity, as in for
tetanus. The antibodies can be produced in animals,
called ” serum therapy,” although there is a high
chance of anaphylactic shock because of immunity
against animal serum itself. Thus, humanized
Artificial Active Immunity
 lasts much longer and is sometimes life-long lasting.
 Artificial active immunization is where the microbe, or
parts of it, are injected into the person before they
are able to take it in naturally. If whole microbes are
used, they are pre-treated, attenuated vaccines. This
vaccine stimulates a primary response against the
antigen in the recipient without causing symptoms of
the disease.
 Example:
 Tetanus Toxoid, DPT, BCG
INFLAMMATORY RESPONSES
 The inflammatory response (inflammation) occurs
when tissues are injured by bacteria, trauma, toxins,
heat, or any other cause.
 The damaged cells release chemicals including
histamine, bradykinin, and prostaglandins. These
chemicals cause blood vessels to leak fluid into the
tissues, causing swelling. This helps isolate the foreign
substance from further contact with body tissues.
The chemicals also attract white blood cells called
phagocytes that "eat" germs and dead or damaged
cells. This process is called phagocytosis. Phagocytes
eventually die. Pus is formed from a collection of dead
tissue, dead bacteria, and live and dead phagocytes.
The simplest definition of inflammation is best stated
in Latin:
 RUBOR
 CALOR
 DOLOR
 TUMOR
 FUNCTIO LAESA

MODULE 5.2
OVERVIEW OF INFECTION
PROCESS
INFECTIOUS DISEASES
are caused by pathogenic microorganisms,
such as bacteria, viruses, parasites or fungi; the
diseases can be spread, directly or indirectly, from
one person to another. Zoonotic diseases are
infectious diseases of animals that can cause disease
when transmitted to humans.-WHO
CHAIN OF INFECTION (SHARE ME)
• Susceptible Host
• Infectious Agent
• Reservoir
• Portal of Entry
• Mode of Transmission
• Portal of Exit
1. Infectious Agent
is a term that is generally used to describe and
encompass any material that can cause an infection
that can lead to a disease.
Viruses
They can’t replicate independently in the host’s cells
and stimulate it to participate in the formation of
additional similar microorganism. They the smallest
microorgansm. - example Influenza A, shingles and
Hepatitis
Bacteria
They are simple, one celled microbe with double cell
membrane that protect them from harm. They
reproduce rapidly and considered as the
Fungi
They are found almost everywhere on earth. They live
in soil, water or animals and plants. They also live
inside or outside human body. example Candidiasis and
Aspergillosis
Parasitic protozoan diseases –
They are much larger than bacteria. The simplest
single-celled organism of animal kingdom. They absorb
nutrients from the body of the host such as Malaria,
Giardia and Toxoplasmosis
How well any pathogen is able to thrive depends on
three factors:
 Its pathogenicity - its ability to produce disease
 Its degree of virulence - its severity or harmfulness
 Its invasiveness - its tendency to spread
2. Reservoir
The reservoir of an infectious agent is the habitat in
which the agent normally lives, grows, and multiplies.
Reservoirs include humans, animals, and the
environment. The reservoir may or may not be the
source from which an agent is transferred to a host.
For example, the reservoir of Clostridium botulinum is
soil, but the source of most botulism infections is
improperly canned food containing C. botulinum spores.
B.1. Human reservoirs.
Many common infectious diseases have human
reservoirs. Diseases that are transmitted from person
to person without intermediaries include the sexually
transmitted diseases, measles, mumps, streptococcal
infection, and many respiratory pathogens. Because
humans were the only reservoir for the smallpox virus,
naturally occurring smallpox was eradicated after the
last human case was identified and isolated.
Types of carrier
 Asymptomatic or passive or healthy carriers are those
who neverexperience symptoms despite being
infected.
 Incubatory carriers are those who can transmit the
agent during the incubation period before clinical
illness begins. Convalescent carriers are those who
have recovered from their illness but remain capable
of transmitting to others.
 Chronic carriers are those who continue to harbor a
pathogen such as hepatitis B virus or Salmonella
Typhi, the causative agent of typhoid fever, for
months or even years after their initial infection.
 Frank or Symptomatic persons who have signs and
symptoms
B.2. Animal reservoirs.
Humans are also subject to diseases that have animal
reservoirs. Many of these diseases are transmitted
from animal to animal, with humans as incidental hosts.
The term zoonosis refers to an infectious disease
that is transmissible under natural conditions from
vertebrate animals to humans. Long recognized
zoonotic diseases include brucellosis (cows and pigs),
anthrax (sheep), plague (rodents), trichinellosis/
trichinosis (swine), tularemia (rabbits), and rabies
(bats, raccoons, dogs, and other mammals).
Zoonoses newly emergent in North America include
West Nile encephalitis (birds), and monkeypox (prairie
dogs). Many newly recognized infectious diseases in
humans, including HIV/AIDS, Ebola infection and
SARS, are thought to have emerged from animal
hosts, although those hosts have not yet been
identified.
B.3. Environmental reservoirs.
Plants, soil, and water in the environment are also
reservoirs for some infectious agents. Many fungal
agents, such as those that cause histoplasmosis, live
and multiply in the soil. Outbreaks of Legionnaires
disease are often traced to water supplies in cooling
towers and evaporative condensers, reservoirs for the
causative organism Legionella pneumophila.
B.4. Nonliving reservoirs
can include soil and water in the
environment. These may naturally harbor the organism
because it may grow in that environment.
c. Portal of exit
Portal of exit is the path by which a
pathogen leaves its host. The portal of exit usually
corresponds to the site where the pathogen is
localized.
For example, influenza viruses and
Mycobacterium tuberculosis exit the respiratory
tract, schistosomes through urine, cholera vibrios in
feces, Sarcoptes scabiei in scabies skin lesions, and
enterovirus 70, a cause of hemorrhagic conjunctivitis,
in conjunctival secretions. Some bloodborne agents
can exit by crossing the placenta from mother to
fetus (rubella, syphilis, toxoplasmosis), while others
exit through cuts or needles in the skin (hepatitis B)
or blood-sucking arthropods (malaria).
d. Modes of transmission
An infectious agent may be transmitted
from its natural reservoir to a susceptible host in
different ways. There are different classifications
for modes of transmission. Here is one classification:
D.1. Direct
In direct transmission, an infectious agent is
transferred from a reservoir to a susceptible host by
direct contact or droplet spread.
Direct contact occurs through skin-to-skin
contact, kissing, and sexual intercourse. Direct
contact also refers to contact with soil or vegetation
harboring infectious organisms. Thus, infectious
mononucleosis (“kissing disease”) and gonorrhea are
spread from person to person by direct contact.
Hookworm is spread by direct contact with
contaminated soil.
D.2. Droplet spread
refers to spray with relatively large, short-
range aerosols produced by sneezing, coughing, or
even talking. Droplet spread is classified as direct
because transmission is by direct spray over a few
feet, before the droplets fall to the ground. Pertussis
and meningococcal infection are examples of diseases
transmitted from an infectious patient to a
susceptible host by droplet spread.
d.3. Indirect transmission
refers to the transfer of an infectious
agent from a reservoir to a host by suspended air
particles, inanimate objects (vehicles), or animate
intermediaries (vectors).
d.4. Airborne transmission
occurs when infectious agents are carried by
dust or droplet nuclei suspended in air. Airborne dust
includes material that has settled on surfaces and
become resuspended by air currents as well as
infectious particles blown from the soil by the wind.
Droplet nuclei are dried residue of less than 5 microns
in size. In contrast to droplets that fall to the ground
within a few feet, droplet nuclei may remain
suspended in the air for long periods of time and may
be blown over great distances. Measles, for example,
has occurred in children who came into a physician’s
office after a child with measles had left, because
the measles virus remained suspended in the air.
d.5. Vehicles
that may indirectly transmit an infectious
agent include food, water, biologic products (blood),
and fomites (inanimate objects such as handkerchiefs,
bedding, or surgical scalpels). A vehicle may passively
carry a pathogen — as food or water may carry
hepatitis A virus.
Alternatively, the vehicle may provide an environment
in which the agent grows, multiplies, or produces toxin
— as improperly canned foods provide an environment
that supports production of botulinum toxin by
Clostridium botulinum.
d.6. Vectors
such as mosquitoes, fleas, and ticks may
carry an infectious agent through purely mechanical
means or may support growth or changes in the agent.
Examples of mechanical transmission are flies
carrying Shigella on their appendages and fleas
carrying Yersinia pestis, the causative agent of
plague, in their gut. In contrast, in biologic
transmission, the causative agent of malaria or guinea
worm disease undergoes maturation in an intermediate
host before it can be transmitted to humans (Figure
1.20).
e. Portal of Entry
The portal of entry refers to the manner in
which a pathogen enters a susceptible host. The portal
of entry must provide access to tissues in which the
pathogen can multiply or a toxin can act. Often,
infectious agents use the same portal to enter a new
host that they used to exit the source host. For
example, influenza virus exits the respiratory tract of
the source host and enters the respiratory tract of
the new host. In contrast, many pathogens that cause
gastroenteritis follow a so-called “fecal-oral” route
because they exit the source host in feces, are
carried on inadequately washed hands to a vehicle
such as food, water, or utensil, and enter a new host
through the mouth. Other portals of entry include the
skin (hookworm), mucous membranes (syphilis), and
blood (hepatitis B, human immunodeficiency virus).
f. Susceptible Host
The final link in the chain of infection is a
susceptible host. Susceptibility of a host depends on
genetic or constitutional factors, specific immunity,
and nonspecific factors that affect an individual’s
ability to resist infection or to limit pathogenicity. An
individual’s genetic makeup may either increase or
decrease susceptibility. For example, persons with
sickle cell trait seem to be at least partially protected
from a particular type of malaria.
Specific immunity refers to protective
antibodies that are directed against a specific agent.
Such antibodies may develop in response to infection,
vaccine, or toxoid (toxin that has been deactivated
but retains its capacity to stimulate production of
toxin antibodies) or may be acquired by
transplacental transfer from mother to fetus or by
injection of antitoxin or immune globulin. Nonspecific
factors that defend against infection include the
skin, mucous membranes, gastric acidity, cilia in the
respiratory tract, the cough reflex, and nonspecific
immune response. Factors that may increase
susceptibility to infection by disrupting host
defenses include malnutrition, alcoholism, and disease
or therapy that impairs the nonspecific immune
response.
BREAKING THE CHAIN OF INFECTION
There are many opportunities to stop the
spread of infection. We can interfere in every link in
the chain of infection. See figure below.

MODULE 5.3
EPIDEMIOLOGICAL MODELS IN AND PHILIPPINE
HEALTH SITUATION

Infectious Disease Causation Models

MODE OF EXIT
1. Epidemiologic triad or triangle

the traditional model for infectious

disease. The triad consists of an external agent,
a susceptible host, and an environment that
brings the host and agent together. In this
model, disease results from the interaction
between the agent and the susceptible host in an
environment that supports transmission of the
agent from a source to that host.

Agent, host, and environmental

factors interrelate in a variety of complex ways
to produce disease. Different diseases require
different balances and interactions of these
three components. Development of appropriate,
practical, and effective public health measures
to control or prevent disease usually requires
assessment of all three components and their
interactions.

MODE OF ENTRY
MODE OF TRANSMISSION
 to the previous model, the wheel model distinguishes the host
from the environmental factors, thus more useful for
epidemiologic analysis.
Factors that triggers epidemic
1. A recent increase in amount or virulence of the agent,
2. The recent introduction of the agent into a setting
where it has not been before,
3. An enhanced mode of transmission so that more
susceptible persons are exposed,
4. A change in the susceptibility of the host response to
the agent, and/or
5. Factors that increase host exposure or involve
introduction through new portals of entry

 Cluster
o refers to an aggregation of cases grouped in
place and time that are suspected to be
greater than the number expected, even
though the expected number may not be
known.

 Pandemic
3. The web or network of causation model
o refers to an epidemic that has spread
over several countries or continents,
This web of causation explores multiple causative usually affecting a large number of people.
factors, giving each an equal prominence in identifying
determinants and relevant interventions. The model implies
that disease is developed as a result of "chains" of causation.
This model implies that cutting the chains at different points
would interrupt the disease development, even without
complete understanding of causal mechanisms

Epidemiological Level of disease

The amount of a particular disease that is usually present in a
community is referred to as the baseline or endemic level of
the disease.
 Sporadic
o refers to a disease that occurs infrequently
and irregularly.
 Endemic
o refers to the constant presence and/or
usual prevalence of a disease or infectious
agent in a population within a geographic
area.
 Hyperendemic
o refers to persistent, high levels of disease
occurrence.
2. The wheel model  Epidemic
o refers to an increase, often sudden, in the
number of cases of a disease above what is
This model represents the host (man) as the focus, normally expected in that population in that
who has genetic make-up as its core, and is surrounded by the area. Outbreak carries the same definition
of epidemic but is often used for a more
four environmental elements. The relative sizes of the wheel limited geographic area.
components vary from one disease to the other. In contrast
 • Pneumonia can also be classified according to where 1.4.4. Pulse oximetry. This measures the oxygen level
or how it was acquired. in your blood. Pneumonia can prevent your lungs from
PNEUMONIA moving enough oxygen into your bloodstream.
1.2.4. Hospital-acquired pneumonia (HAP)
• This type of bacterial pneumonia is acquired during a 1.5. Signs and Symptoms
hospital stay. • Pathognomonic Sign-Rusty sputum
1.1. DEFINITION
• It can be more serious than other types, as the • coughing that may produce phlegm (mucus)
Other names: Lung-fever, pneumonitis, disease, lobar-
bacteria involved may be more resistant to antibiotics. • fever
pneumonia and croupous pneumonia.
1.2.5. Community-acquired pneumonia (CAP) • sweating or chills
• shortness of breath that happens while doing normal
 Pneumonia is an infection in one or both
• Community-acquired pneumonia (CAP) refers to activities or even while resting
lungs. The infection causes inflammation in
pneumonia that’s acquired outside of a medical or • chest pain that’s worse when you breathe or cough
the air sacs in your lungs, which are called
institutional setting. • feelings of tiredness or fatigue
alveoli. The alveoli fill with fluid or pus,
• loss of appetite
making it difficult to breathe
1.2.6. Ventilator-associated pneumonia (VAP) • nausea or vomiting
• When people who are using a ventilator get • headaches
1.2. CAUSATIVE AGENT pneumonia, it’s called VAP. 1.2.7. Aspiration pneumonia YOUUUUUU uwuuuuuu\
There are several types of infectious agents that can
• Aspiration pneumonia happens when you inhale
cause pneumonia.
bacteria into your lungs from food, drink, or saliva.
• This type is more likely to occur if you have a
1.2.1. Bacterial pneumonia
swallowing problem or if you’re too sedate from the
 The most common cause of bacterial
use of medications, alcohol, or other drugs.
pneumonia is Streptococcus pneumoniae.
1.3. Mode of Transmission Both viral and bacterial
1.2.2. Other causes include:
pneumonia can spread to others through inhalation of
 Mycoplasma pneumoniae
airborne droplets from a
 Haemophilus influenzae
sneeze or cough. You can also get these types of
 Legionella pneumophila
pneumonia by coming into contact with surfaces or
objects that are contaminated with pneumonia-causing
1.2.3. Viral pneumonia
bacteria or viruses. You can contract fungal pneumonia
Respiratory viruses are often the cause of
from the environment. However, it doesn’t spread
pneumonia. Some examples include:
from person to person.
 influenza (flu)
 respiratory syncytial virus (RSV)
1.4. Diagnostic Test
 rhinoviruses (common cold)
 Viral pneumonia is usually milder and can
improve in one to three weeks without 1.4.1. Chest x ray to look for inflammation in your
treatment. lungs. A chest x ray is the best test for diagnosing
pneumonia. However, this test won't tell your doctor
what kind of germ is causing the pneumonia.
1.2.3. Fungal pneumonia
o Fungi from soil or bird droppings can cause
1.4.2. Blood tests such as a complete blood count
pneumonia. They most often cause pneumonia in people
(CBC) to see if your immune system is actively fighting
with weakened immune systems. Examples of fungi
an infection
that can cause pneumonia include:
• Pneumocystis jirovecii
1.4.3. Sputum exam Confirm the type of
• Cryptococcus species
microorganism that causes the pneumonia
• Histoplasmosis species
• Types of pneumonia