2.
The suspected organism must be isolated from the
Chapter 10
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 humans 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.
•Koch's Postulates
Robert Koch was a German physician who made significant
contributions to the field of microbiology. One of his
greatest and most well-known contribution was proving
that certain microorganisms caused specific diseases.
Together with some of his colleagues, he developed a
scientific experimental procedure to prove this
relationship. This experimental procedure was 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
infected host and grown in 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
However, there are certain organisms that cannot be
grown in artificial culture media. Viruses are obligate
intracellular parasites that need to be grown in living cells.
Likewise, Mycobacterium leprae, the causative agent of
leprosy needs to be grown on foot pads of mice and
armadillo.
Another limitation of Koch's postulates is that not all
people who acquire an infection develop overt disease.
Most of the time, infections are sub-clinical. Also, the
reaction of humans to specific pathogens may differ given
a specific microorganism. This is because human beings
have different genetic compositions that may modulate
their responses to the same organism. One individual
might develop minor illness from a particular pathogen but
the same pathogen may produce fatal infection in another
host.
An issue involving Koch's postulates is the requirement
that the cultured organism must be inoculated into a
susceptible animal. However, there are certain organisms
that are species specific. There are organisms that produce
disease only in animals in the same manner that there are
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.
One also needs to consider the ethical issues involved in
such testing procedures. 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.
Factors that Influence the Occurrence of Infection: The
Chain of Infection
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
Reservoirs serve as the continual source of disease-
producing microorganisms. It is the site where an
infectious agent normally resides and multiplies. It
provides the 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 diseases can be transmitted from an
animal to humans. These are called zoonotic infections. In
most instances, humans serve only as an incidental host
and dead-end host and thus the disease will not be
transmitted to another human. Examples of zoonotic
infections include anthrax, plague, and rabies.
-Human Reservoirs
A number of pathogenic organisms have humans as their
reservoir. These organisms may be directly transmitted
from one individual to another. Examples are 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
the organism thereby transmitting them to others. These
are what are known as carriers and comes in several
forms. Those who are infected but do not manifest
symptoms are known as asymptomatic or healthy carriers.
Carriers who transmit the causative agent during the
incubation period of the illness are called incubatory
carriers. Chronic carriers are those who harbor the
organism for months or longer after the patient developed
the initial infection. Individuals who developed the
disease, recovered but remain capable of transmitting the
causative agent are known as convalescent carriers.
Carriers are individuals who are not aware that they are
transmitting the infectious agent which makes them public
health hazards.
Next Sick Person (Susceptible Host)
• Babies
• Children
• People with a weakened immune system
• Unimmunized people
• Anyone
Germs (Agent)
• Bacteria
• Viruses
• Parasites
How Germs Get In (Portal of Entry)
• Mouth
• Cuts in the skin
• Eyes
Where Germs Live (Reservoir)
• People
• Animal/Pets (dogs, cats,reptiles) Wild animals
• Food
• Soil
• Water
Germs Get Around (Mode of Transmission)
• Contact (hands, toys, sand)
• Droplets (when you speak, sneeze, or cough)
How Germs Get Out (Portal of Exit)
• Mouth (vomit, saliva)
• Cuts in the skin (blood)
• Stool
-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. For example, the
blood fluke Schistosoma haematobium which
preferentially infects the urinary bladder exits the host via
urine. 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. For
example, 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 mononucleosis 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. Droplets are
differentiated from aerosols by its larger size (> 5 microns
in size). 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. There are also organisms that can be carried with
dust. For example, the fungus Cryptococcus neoformans
can be transmitted through aerosolized pigeon or fowl
droppings and inhaled by a susceptible host. Measles, a
common childhood illness, can be transmitted through
aerosols.
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
the causative agent. The food ingested may be
contaminated by feces of the infected patient (fecal-oral
transmission). Examples are 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. Mechanical
transmission refers to the passive transport of the
organism on the insect's feet or other body parts. For
example, cockroaches and flies can transfer the organisms
from the feces of infected persons to food, which is later
swallowed by the host. 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
en person through bites. For example, 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 is
referred to as the portal of entry. 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. For example,
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 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. For example, 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 defenses to fight and destroy any
invading pathogen. Once there is a breakdown in all these
defenses, 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
•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-
colonization, ability to evade host immune defenses, and
production of extracellular substances that can promote
invasion. Colonization 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 cells. By promoting adhesion, the
organism can easily invade 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
that 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 cell causes direct destruction of
the host cells. Some bacteria produce enzymes that aids
them in invading target cells. Collagenase is an enzyme
produced by Clostridium perfringens that causes
breakdown of collagen, a major component of connective
tissue of muscles thereby contributing to the development
of the disease called gas gangrene.
Chemical: Toxin Production
Toxins are poisonous substances and 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 ind 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 signs 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. Most of them are produced by
gram-positive bacteria but may also be produced by some
gram-negative bacteria. Exotoxins are soluble in body
fluids and are thus easily diffused into the blood and •Chemistry
rapidly transported throughout the body. There are three Lipid A of LPS of outer membrane
principal types of exotoxins:
(1) cytotoxins which kill host cells or affect their function; •Pharmacology(effect on the body)
General such as fever, malaise, and shock; all produce the
(2) neurotoxins which interfere with normal nerve impulse same effects
transmission; and
•Antigenicity
(3) enterotoxins which affect the cells lining the Less antigenic
gastrointestinal tract. Diseases produced by exotoxin-
producing bacteria are often due to the effects of the •Enzymatic activity
exotoxin and not of the bacteria themselves. Exotoxins are No
therefore disease-specific. Important examples are the
diphtheria toxin,botulinum toxin, and the tetanus toxin. •Heat stability
Heat-Stable
EXOTOXIN
•Bacterial source •Fever production
Mostly gram-positive bacteria; some gram-negative Yes
bacteria
•Specificity
•Relation to microorganism low Degree
Metabolic product of growing cell; secreted outside cell
•Relation to antibodies
•Toxicity Cannot be converted to toxoids; not neutralized by anti-
Extremely toxic; sometimes fatal toxins paying

•Chemistry •Denaturation on boiling

Protein or short peptides No

•Pharmacology(effect on the body) •Location of genes

Specific for a particular cell structure or function in the Bacterial Chromosome
host (mainly affects cell functions, nerves, and GIT)
•Representative diseases
•Antigenicity Typhoid fever, urinary tract infections, meningococcal
Extremely antigenic meningitis, and meningococcemia

•Enzymatic activity -Immunologic

Yes Some organisms produce disease not as a consequence of
mechanical invasion or toxin production but as a
•Heat stability consequence of the immune response of the host to the
Heat-labile (except staphylococcal enterotoxin) microorganism or its product. In hepatitis caused by the
hepatitis viruses, the damage to the liver is not a direct
•Fever production effect of the virus but of the response of the immune
No system to the virus. Antibodies are produced against the
virus and cytotoxic T cells are activated leading to the
•Specificity destruction of hepatocytes. In childhood measles and
High Degree German measles, the rashes seen are due to the specifie
immune response of the body to the measles virus.
•Relation to antibodies
Can be converted to toxoids; neutralized by anti-toxins Classification of Infectious Diseases

•Denaturation on boiling • Based on how they behave within a host and

Yes within a given population
A disease that is spread from one host to another,
•Location of genes either directly or indirectly, is called a
Present on plasmids or bacteriophagesa communicable disease. Examples are measles,
tuberculosis, and typhoid fever. If the disease is
•Representative diseases easily and rapidly spread from one person to
Gas gangrene, botulism, dos diphtheria, tetanus, scarlet another, then it is classified as a contagious
fever disease (e.g., measles and chickenpox). If the
infection results in the death of the patient over a
ENDOTOXIN short period of time, it is called a fulminant
•Bacterial source infection. An example is meningococcemia where
Gram-negative bacteria only a patient may die hours after confinement in the
hospital.
•Relation to microorganism
Present in LPS of outer membrane of cell wall; released A non-communicable disease is one that is not
after lysis of cell wall spread from one person to another. It is usually
caused by organisms that normally inhabit the
•Toxicity body and produce disease only occasionally or by
Weakly toxic organisms that produce disease only when
introduced into the body such as Clostridium
 tetani, the agent that causes tetanus. It produces
disease only when it enters the body through
breaks in the skin.
• -Based on the source of the microorganism
An infection is said to be exogenous if the source
of the infectious agent is from outside the body.
For example, cholera is an exogenous infection
because the causative agent enters the body
through ingestion of contaminated water.
Hospital-acquired infections or nosocomial
infections can also 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. On the other hand, an 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. This can lead to the development of
urinary tract infection which can ascend to involve
the kidney and can lead to sepsis in
immunocompromised patients.
• Based on the occurrence of a disease
A disease that occurs occasionally is called a
sporadic disease. If the disease is constantly
present in a population at low levels, then it is
called an endemic disease. Malaria is said to be
endemic in Palawan while schistosomiasis is
considered endemic in Leyte. If a great number of
people in a given locality develop an infectious
disease in a relatively short period of time, it is
called an epidemic. Influenza is an example of a
disease that can cause epidemics. If a disease has
a worldwide occurrence or involves at least three
regions in the world, it is said to be a pandemic.
Influenza, especially due to influenza A, SARS, and
AIDS are examples of diseases that can cause
pandemics.
• Based on the severity or duration of a disease
An acute disease is one that develops rapidly but
lasts for only a short period of time. An example is
the common cold. If the disease develops more
slowly and occurs for long periods of time, it is
called a chronic disease. A good example of this is
tuberculosis. Hepatitis B infection is an example of
a disease that can have either an acute form or a
chronic form. A 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. Viruses that belong to the family
Herpesviridae are characterized by latency. An
example is shingles, a reactivation of a latent
chickenpox infection which occurs years after the
initial infection.
• Based on the extent of host involvement
Infections can be classified according to the extent
to which the body of the host is affected A
localized infection is one in which the invading
organisms are limited to a small area of the body.
Boils and abscesses are examples of localized
infections. A systemic 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 specific parts of the
body and become confined to specific areas. This
is called a focal infection. Focal infections can arise
from infections in areas such as the teeth, tonsils,
or sinuses. Relatively A primary infection is an
acute infection that causes the initial illness, while
a secondary infection is one which is caused by
opportunistic pathogens after the primary
infection has weakened the body's defenses.
Secondary infections are common in patients
whose immune system have been compromised
by another disease process (e.g., AIDS) and can
prove to be more devastating than the primary
infection. A subclinical or inapparent infection is
one that does not cause noticeable illness.
Hepatitis due to hepatitis A virus can, for instance,
occur in certain individuals who do not necessarily
develop the typical signs and symptoms
associated with the disease.
Stages of an Infectious Disease
Once a microorganism invades a susceptible host, disease
follows. The development of the disease follows a
sequence of events that tends to follow a similar pattern
whether the disease is chronic or acute. These periods are
the following:
1. Incubation period - the time interval between entry of
the offending agent and the appearance of the initial signs
and symptoms of the disease. In most cases, this period 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 microorganisms. It also depends on the
resistance of the host. An organism that is considered
virulent can produce disease within a short incubation
period. As for the number of infecting microorganisms, 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 also be
seen in other disease processes and are thus not specific
to measles.
3. Period of illness - corresponds to the 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 the
patient's 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 neutrophil count while most viral infections will
have a high lymphocyte count.
Several outcomes can arise during this period. The
infection may remain acute where the body's defense
mechanisms successfully destroy the invading
microorganism 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 x 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 microorganism.
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.
Incubation-Prodromal-illness-Decline-Convalesce
CHAPTER SUMMARY
•Robert Koch was the first to scientifically prove that a
specific infectious disease is caused by a specific infectious
agent. Together with some colleagues, they
experimentally provided evidence for this in what is now
known as Koch's postulates.
•The chain of infection involves the following elements-
reservoir, portal of exit,mode of transmission, and host.
» The reservoir is the site where the organism resides and
multiplies. It provides an environment conducive to the
growth and replication of the organism. Reservoirs
provide continual source of the infectious agent and may
be humans, animals, or the-environment.
» Portal of exit refers to where the organism exits from its
reservoir. For example, organisms that have the
gastrointestinal tract as their reservoir will exit through the
feces.
» Mode of transmission refers to how the organism is
spread. It is generally classified into direct contact
transmission and indirect contact transmission.
> The major routes of direct contact transmission are
through person-to-person contact and through droplet
transmission.
> Indirect transmission includes airborne transmission,
vector transmission, and vehicle transmission.
» The final link in the chain of infection is a susceptible
host. Development of infection in the host is affected by
several factors such as genetic constitution of the host, the
nature of the organism, and the immune status of the
host. The most important among these factors is the
defensive powers of the host.
» Bacteria produce disease in three ways-mechanical
1. (invasion),
2. chemical (toxin production),
3. and immunological.
» Invasion involves adhesion to mucosal surfaces and
penetration into deeper tissues. It is facilitated by
structures found on the external surface of certain
bacteria (e.g., pili in gram-negative bacteria), as well as
extracellular substances secreted by the bacteria to
promote adhesion (adhesins).
» Bacteria produce toxins that may cause damage to the
cells or affect the normal physiologic function of the
susceptible host. These are generally classified into
exotoxins and endotoxins.
› Endotoxins are components of the outer membrane of
gram-negative bacteria. These are mainly
lipopolysaccharides composed of a lipid A component and
polysaccharides. The endotoxin activity is attributed to the
lipid A component.
› Exotoxins are substances which are secreted by bacteria.
These are mainly produced by gram-positive bacteria but
may also be produced by some gram-negative bacteria.
» In some infections caused by microorganisms, the
damage to the host tissues is not a direct effect of the
infecting agent but is a consequence of the body's immune
response to the organism. An example is damage to the
liver seen in patients with hepatitis due to infection with
the hepatitis viruses.
• Infectious diseases are classified based on the following:
(1) how they behave within a host and within a given
population; (2) the source of the microorganism; (3) the
occurrence of a disease; (4) the severity or duration of a
disease; and (5) the extent of host involvement.
• An infectious disease may be divided into five stages: (1)
incubation period, (2) prodromal period, (3) period of
illness, (4) period of decline, and (5) period of
convalescence.
» Incubation period corresponds to the time from initial
entry of the infectious agent until the time the patient first
manifests signs and symptoms.
» Prodromal period corresponds to the initial
manifestations of the patient. These manifestations are
usually non-specific constitutional symptoms such as fever,
body malaise, cough, and colds.
>> The period where there is maximal invasion by the
infecting agent is the period of illness. It is during this
period where signs and symptoms characteristic of the
disease are seen.
>> The decline phase is the period when the
manifestations of the patient begin to diminish. It is also
known as the period of defervescence. The period of
convalescence is also known as the recovery period where
the patient already becomes asymptomatic and the body
returns to its normal, pre-diseased state.
CHAPTR 10 BACTERIA AND DISEASE
1. Proper order on the stages of an
infectious disease process
Answer.
Incubation, Prodromal, Illness,
Decline, Convalescence
2. The sit where pathogens grow is
called:
a. Reservoir
b. Portal of exit
c. Portal of entry
d. Host
3. An individual who I more likely than
others o acquire an infection is an:
a. Vector
 b. Reservoir by the child corresponds to which
c. Fomite stage of disease process?
d. Susceptible host A. Incubation period
4. A 6-year old child was brought to the B. Prodromal period
ER because of high-grade fever and C. Period of illness
petechial rashes. Dengue was D. Period of defervescence
suspected. Dengue exemplifies which
type of transmission?
A. Person-to-person
B. Vehicle transmission
C. Vector transmission
D. Airborne transmission
5. Blood can be classified under which
type of transmission
a. Direct contact
b. Vehicle transmission
c. Droplet transmission
d. Vector transmission
6. Which among the following clinical
conditions can be considered as an
outbreak or epidemic?
a. 2 or more people with diarrhea
and vomiting
b. 2 people living together with
diarrhea and vomiting
c. 2 or more people which exceeds
the expected number of
experiencing the same illness in
the same place and at the same
time,
d. 2 or more people with a
respiratory infection
7. Which of the following Is NOT
considered a portal of entry for
bacteria?
a. Eyes
b. Nose
c. Mouth
d. Intact skin
8. A 75-year old patient was admitted
for elective cataract extraction. While
in the hospital, he developed
pneumonia. This is classified s what
type of infection?
A. Community-acquired infection
B. Nosocomial infection
C. Epidemic
D. Sporadic
9. A patient was brought to the hospital
because of symptoms of tetanus. The
disease is due to clostridium tetani
and manifestation are the effects of
tetanospamin, a neutrotoxin
produced by the causative agent.
Which mechanism of disease
production is involved?
A. Mechanical
B. Chemical
C. Immunological
D. A and B
10. A 5 year-old child was exposed to a
neighbor who has a measles. After 5
days, she started to manifest cough,
colds, and conjunctivitis. The time
from exposure until the development
of the signs and symptoms presented