EPIDEMIOLOGY

- The study that deals/studies when and where diseases occur and how they are transmitted
in population

3 Basic types of investigation

1. Descriptive Epidemiology- entails collecting all data that describe the occurrence of the
disease under study
2. Analytical Epidemiology- analyzes a particular disease to determine its probable cause
3. Experimental Epidemiology- begins with a hypothesis about a particular disease;
experiments to test the hypothesis are conducted with a group of people

Case Reporting

- An effective way to establish the chain of transmission

- A procedure that requires health care workers to report specified diseases to local, state
and national health officials

Centers for Disease Control and Prevent (CDC)

- A branch of the US public Health service located in Atlanta Georgia

- Is a central source of epidemiological information in the US

EPIDEMIOLOGY: THE BASICS

Morbidity- the incidence of specific notifiable disease

Morbidity Rate- the number of people affected by a disease in a given period of time in relation to the
total population

Mortality- the number of deaths from these diseases

Mortality Rate- is the number of deaths resulting from a disease in a population in a given period of time
in relation to the total population

Notifiable Diseases- are those for which physicians are required by law to report cases to the US Public
Health Services

MICROBIAL MECHANISMS OF PATHOGENICITY

PORTALS OF ENTRY

a. Mucous membrane
b. Skin
c. Parenteral route

NUMBER OF INVADING MICROBES

a. LD 50 (lethal dose for 50% of hosts) – express the virulence of a microbe or the potency of its
toxin
 b. ID50 (infectious dose for 50% of hosts)- the dose required to produce a demonstrable infection
in 50% of the test animals

ADHERENS

- Attachment of pathogen to a host accomplished by means of surface molecules on the

pathogen called adhesions or ligands (bind specifically to complementary surface receptors
on the cells of certain host tissues)
- Adhesions may be located on a microbes glycocalyx or on other microbial surface structures
“Fimbrae”
- Majority are glycoproteins or lipoproteins receptors on host are typically sugars (mannose)

PENETRATION

- Capsules
- Cell wall
- M protein ( a heat and acid resistant protein produces by Streptococcus pyogenes) mediates
attachement of the bacterium to epithelial cells of the host and helps the bacterium resist
phagocytosis by white blood cells

ENZYMES

- Exoenzymes are extracellular enzymes that aids the virulence of some bacteria. They break
cells open, dissolve materials between cells and form or dissolve blood clots.
- Leukocidins can destroy neutrophils, leukocytes that are very active in phagocytosis.
- Coagulases are bacterial enzymes that coagulate the fibrinogen in the blood
- Kinases are bacterial enzymes that break down the fibrin and thus dissolve clots formed by
the body to isolate the infection.
- Hemolysins are bacterial enzymes that can cause the lysis of erythrocytes
- Hyaluronidase, another enzyme secreted by certain bacteria such as streptococci, it
hydrolyzes hyaluronic acid, a type of polysaccharide that holds together certain cells of the
body, particularly cells in connective tissue.
- Collagenase breaks down the protein collagen which forms the connective tissue of muscles
and other body organs and tissues.
- Necrotizing factors cause the death of body cells
- Hypothermic factors decrease the body temperature
- Lecithinase destroys the plasma membrane, especially around the erythrocytes.\
- Protease breaks down proteins, especially in the muscle tissue
- Siderophores which scavenge iron from the host’s body fluids.
- Shigella and Listeria uses actin to propel themselves through the host’s cell cytoplasm and
from one host to another.
- Cadherin, a glycoprotein which bridge junctions used by bacteria to move from cell to cell.

BACTERIAL PATHOGEN”S MECHANISM OF DAMAGE

-Direct damage in the immediate vicinity of the invasion through reverse phagocytosis.
Production of toxins- toxins are poisonous that are produced by certain microorganisms

Toxigenicity is the capacity of microorganisms to produce toxins.

2 TYPES OF TOXINS

1. EXOTOXIN
2. ENDOTOXIN

EXOTOXIN are proteins and many are enzymes that catalyze only certain biochemical reactions

Several Types:

a. Cytotoxin kills host cells or affects their function

b. Neurotoxin interferes with normal nerve impulse transmission.
c. Enterotoxin affects cells lining the gastrointestinal tract

ENDOTOXINS present in the LPS exert their effects when the gram negative bacteria and their cell wall
undergo lysis

- Activates blood clotting proteins causing the formation of small blood clots (DIC)
- Shock- threatening loss of blood; profound hemodynamic and metabolic disturbance
characterized by failure of the circulatory system to maintain adequate perfusion of vital
organs.
- Septic Shock (Endotoxin shock)- shock caused by gram negative bacteria

Tumor Necrosis Factor (TNF) “cachetin” is a polypeptide secreted by phagocyte upon phagocytosis of
gram negative bacteria.

2 WAYS of DAMAGE:

1. Increases blood capillary permeability, loss large amounts of blood

2. Weakening of blood-brain barrier to let phagocytosis in but at the same time letting bacteria in
from the bloodstream

Diagnostic TESTS

1. Limulus Amoebocyte Lysate (LAL) assay- detects even minute amounts of endotoxin
2. Plasmids resistance factor is responsible for the resistance of some microorganisms to
antibiotics; helps in determining a microbes pathogenicity
3. Lysogeny- prophage that remain latent and not cause lysis of cell and may exhibit new
properties coded for bacteriophage (lysogenic conversion) which results in immunity of bacteria
to the same type of phage.

Pathogenic properties of Nonbacterial Microorganisms

Viruses
Fungi
Protozoa
Helminthes
Algae

Viruses
- Have Cytopathic effects (CPE) which results to cell death called cytocidal effect and cell
damage called noncytocida effects.
Fungi
- Ergot contained in a sclerotia (highly resistant portion of the mycelia of the fungus that
can detach) and is an alkaloid that can cause hallucinations resembling those produced
by LSD.
- Aflatoxin, a carcinogenic property found in peanuts (large amounts).
- Mycotoxins produces by mushrooms like Phalloidin and Amanitin (death angels).
Protozoa
- Invades host cells, reproduce with in them causing them to rupture/
Helminthes
- causes cellular damage and waste products of metabolism.
Algae
- Produces saxitoxin, a neurotoxin produced by the dinoflagellates (Alexandrium).

Nationally Notifiable Infectious Diseases

Acquired Immunodeficiency Syndrome Listeriosis

(AIDS)
Lyme disease
Anthrax
Malaria
Botulism
Measles
Brucellosis
Chancroid Meningococcal disease
Chlamydia trachomatis, genital infections Mumps
Cholera Pertussis
Coccidioidomycosis Plague
Cryptosporidiosis Poliomyelitis, paralytic
Diphtheria Psittacosis
Ehrlichiosis Q fever
Encephalitis, meningitis arboviral Rabies, animal
Enterohemorrhagic Rabie, human
Escherichia coli Rocky mountain spotted fever
Giardiasis Rubella
Gonorrhea Rubella, congenital syndrome
Haemophilus influenzae, invasive disease Salmonellosis
Hansen disease (leprosy) Shigellosis
Hantavirus pulmonary syndrome Streptococcal diseases,
Hemolytic uremic syndrome, postdiarrheal invasive, Group A
Hepatitis A Streptococcal toxic shock syndrome
Hepatitis B Streptococcus pneumoniae, drug resistant
Hepatitis C Streptococcal toxic-shock syndrome
HIV infection Syphilis
Legionellosis syphilis , congenital
Tetanus
Toxic-shock syndrome
Trichinosis
Tuberculosis
Tularemia
Typhoid fever
Varicella
 West Nile encephalitis/meningitis
Yellow fever

IMMUNOLOGY

Immune System- specific host defense mechanism; 3rd line of defense

OVERVIEW OF HUMAN INFECTIOUS DISEASES

SKIN

1. Dermatitis- inflammation of the skin

2. Folliculitis- inflammation of a hair follicle
3. Stye – inflammation of a sebaceous gland that opens into a follicle of an eyelash
4. Furuncle- a localized pyogenic infection of the skin, usually resulting from folliculitis (aka boil)
5. Carbuncle- a deep seated pyogenic infection of the skin usually rising from a coalescence of
furuncles
6. Macule- a surface lesion that is neither raised nor depressed, such as the lesions of measles
7. Papule- surface lesion that is firm and raised (chickenpox)
8. Vesicle- a blister or small fluid-filled sac such as chickenpox or shingles
9. Pustule- a pus-filled lesion

EARS

1. Otitis media
2. Otitis externa

EYES

1. Conjunctivitis- infection of conjunctiva

2. Keratiitis- an infection of inflammation of the cornea- the domed covering over the iris and lens
3. Keratoconjunctivitis- infection of both the cornea and conjunctiva
4. Retinitis- infection of retina. Often caused by viral infection.

RESPIRATORY SYSTEM

URT (paranasal sinuses, nasopharynx, oropharynx, epiglottis, larynx)

LRT ( trachea, bronchial tubes, alveoli)

1. Bronchitis- inflammation of the mucous membrane lining of the bronchial tubes; most
commonly caused by respiratory viruses
2. Bronchopneumonia- combination of bronchitis and pneumonia
 3. Epiglottitis- inflammation of the epiglottis; may cause respiratory obstruction in the absence of
vax, frequently caused by Hemophilus influenzae type B.
4. Laryngitis- inflammation of the larynx
5. Pharyngitis- infection of the pharynx; strep throat; caused by streptococcus pyogens; most cases
caused by viruses
6. Pneumonia- inflammation of one of both lungs.
7. Sinusitis- Sinusitis inflammation of the paranasal sinuses
- Most common causes: bacteria streptococcus pneumoniae, H. influenzae
- Less common causes: bacteria, S. pyogenes, Moraxella catarrhalis, Staphylococcus aureus

ORAL REGION

1. Dental carries- tooth decay or cavities; commonly caused by S. mutans which produces lactic
acid
2. Gingivitis- inflammation of the gingiva (gums)
3. Periodontitis- inflammation of the periodontium (tissues that surround and support the teeth)
4. Thrush- infection of the oral tissues with candida albicans

GI TRACT

1. Colitis – inflammation of the colon

2. Diarrhea- abnormally frequent discharge; stool specimens that conform the shape of the
container; a symptom in a wide variety of conditions and diseases.
3. Dysentery- frequent watery stools accompanied by abdominal pain; stool may contain blood or
mucus
4. Enteritis- inflammation of the intestines
5. Gastritis- inflammation of the stomach
6. Gastroenteritis – inflammation of the stomach and intestines
7. Hepatitis- inflammation of the liver

URINARY INFECTIONS

1. Cystitis- inflammation of the urinary bladder; most common UTI commonly caused by
Escherichia coli.
2. Nephritis- inflammation of the kidneys (e. coli)
3. Pyelonephritis- inflammation of the renal parenchyma (e.coli)
4. Ureteritis- inflammation of the ureter
5. Urethritis- inflammation of the urethra. (chlamydia trachomatis)
6. Prostatitis- inflammation of the prostate gland

GENITAL INFECTIONS

1. Bartholinitis- inflammation of the Bartholin ducts in women

2. Cervicitis- inflammation of the cervix
3. Endometritis- inflammation of the endometrium (inner lining of uterine wall)
4. Epididymitis- inflammation of the epididymis
5. Pelvic Inflammatory Disease- inflammation of the fallopian tubes (salpingitis)
 6. Vaginitis – inflammation of the vagina (candida albicans-yeast; trichomonas vaginalis-
protozoan; bacteria); saline wet mount or grain stain used to diagnose
7. Vulvovaginitis- inflammation of the vulva (external f genitalia) and vagina

STD (sexually transmitted diseases- previously venereal disease)

CIRCULATORY SYSTEM

1. Endocarditis- inflammation of the endocardium

2. Myocarditis- inflammation of the myocardium
3. Pericarditis- inflammation of the pericardium
4. Bacteremia- presence of bacteria in blood
5. Transient Bacteremia- temporary presence of bacteria in blood
6. Septicemia- patient experiences chills, fever, and prostration and has bacteria or their toxins in
their bloodstream
7. Syphilis – caused by Treponema pallidum
8. Lymphadenitis- inflamed and swollen lymph nodes
9. Lymphadenopathy- diseased lymph nodes
10. Lymphangitis- inflamed lymphatic vessels

CENTRAL NERVOUS SYSTEM

1. Encephalitis- inflammation of the brain

2. Encephalomyelitis- inflammation of the brain and spinal cord
3. Meningitis- inflammation of the meninges (can be caused by ingestion of poisons, injection or
ingestion of drugs, a reaction to a vaccine or pathogen.
4. Meningoencephalitis- inflammation of the brain and meninges
5. Myelitis- inflammation of the spinal cord
6. Viral Meningitis- aseptic meningitis bec 50% of the cases pathogen is not identified.
a. H. influenzae - children
b. Neisseria meningitis- adolescence
c. S. Pneumonia- elderly
7. Botulism- caused by botulin toxin
8. Tetanospasmin- tetanus

Parasites that can cause CNS diseases include free-living amoebas and species of toxoplasma and
trypanosoma

OPPORTUNISTIC INFECTIONS

1. Aspergillosis and other mould infections

2. Candidiasis- yeast infection of the mouth (thrush), throat, vagina,
3. Cytomegalovirus infection- can cause eye disease that lead to blindness
4. Herpes Simplex Virus Infection- the cause of oral herpes (cold sores) and genital herpes
5. Malaria- parasitic infection
6. Mycobacterium avium complex- bacterial infection that cause recurring fevers, problems with
digestion, serious weight loss
7. Pneumocystis pneumonia- fungal infection that can cause a fatal pneumonia; major killer of aids
8. Toxoplasmosis – toxo; protozoal infection of the eyes and brain
9. TB- bacterial LRTI; can cause meningitis