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Infections and Diseases

Pathology

the scientific study of disease

pathos = suffering and logos = science

Pathology is first concerned with the cause of a disease — etiology

Second, it deals with pathogenesis — the manner in which a disease

develops

Third, it is concerned with the structural and functional changes brought

about
by disease and their effects on the body — pathophysiology

Infection

the invasion or colonization of the body by pathogenic microorganisms

Disease

occurs when an infection results in any change from a state of health

an abnormal state in which part or all of the body is incapable of performing its
normal functions

Epidemiology

the science that studies when and where diseases occur and how they are
transmitted in populations

Symbiotic Relationships
symbiosis

happens when different organisms live and interact together forming an

interdependent relationship

Infections and Diseases 1

 long-term interaction

may long and short term

helpful or harmful

Major Types of Symbiosis

based on the degree or type of interaction

Mutualism

both species benefit from the interaction

e.g. gut bacteria in humans (intestines) and animals that play a role in digestion.

gut bacteria

aids in digestion

production of nutrients — vitamins

protect the gut from more pathogenic MO as they create a more

competitive environment

humans

give nutrients

provide the habitat to provide optimum pH and temperature

requirement

the surface area of the body

ruminant animals

goat, cow

MO in their gut produce cellulase which can metabolize cellulose

Infections and Diseases 2

 Commensalism

one organism benefits while the other organism is neither harmed nor
benefitted.

e.g. bacteria that consume dead skin cells

normal flora

MO in our body that does not cause harm

can only act as pathogens if they become opportunistic pathogens

if low immune system or pag napunta sila sa location na hindi sila

dapat nandoon

S. aureus and S. epidermidis = dapat nasa skin lang, if pumasok

sa body, they will cause infection or sepsis

Infections and Diseases 3

 yeasts in the Candida genera, Malassezia, and Trichosporon are the best
known of those commensals (Rippon 1988).

Candida albicans

yeast infection

vaginal candidiasis

oral thrush or candidiasis

cottage cheese appearance on the mouth

normally doesn't cause disease

if the human is under immunosuppressants like corticosteroids

(e.g. when px has asthma and takes metered dose inhalers) =
magcacause na sila ng disease

advice px to gargle with mouthwash after mag metered dose

inhaler para di mag accumulate yung Candida albicans on the
mouth

Malassezia

fungi

dandruff

Parasitism

one species benefits while the other suffers or is harmed

detrimental to the host

pathogenic organisms

destructive or balanced

some MO cause the lysis of cells — destructive

cause infection → kill cell

some parasites want the host alive para makakuha ng nutrients = not
cause lysis of the cell

balanced

Infections and Diseases 4

 Examples

Vibrio cholerae — cholera infection

Cholera is an acute diarrheal illness caused by infection of the

intestine with Vibrio cholerae bacteria

A person can get cholera by drinking water or eating food

contaminated with cholera bacteria. In an epidemic, the source of the
contamination is usually the feces of an infected person that
contaminates water or food. The disease can spread rapidly in areas
with inadequate treatment of sewage and drinking water.

Giardia lamblia — giardiasis infection

Giardiasis is a diarrheal disease caused by the microscopic

parasite Giardia duodenalis (or “Giardia” for short). Once a person or
animal has been infected with Giardia, the parasite lives in the
intestines and is passed in the stool (poop). Once outside the body,
Giardia can sometimes survive for weeks or even months.

worms

helminths

nematodes

trematode

tapeworm

fishworm

all parasitic microbe

Humans as Favorable Host

Microorganisms are ubiquitous in nature

present, appearing, or found everywhere

The current estimate of microbes in the human body is 10 trillion human cells and
about 100 trillion bacterial cells.

Infections and Diseases 5

 microbes outnumbered the human cells by tenfold

1 human cell is to 10 bacteria

mas maraming bacteria sa katawan compared to the number of cells

Microbiota

a complex ecosystem consisting of bacteria, protozoa, viruses, and fungi

that varies in number even in body parts of the same individual (Chauhan,
2019).

localized MOs

E. coli

usually found in the gut

if nasa urinary tract, magiging UTI

Humans are a favorable host for microbes because of the constant source of
nourishment and moisture, the relatively stable pH and temperature for
microbial growth, and the extensive surface area available.

human is a favorable host because we give the optimum temp, SA, moisture,
pH, and water requirement for the MO

The Normal Microbiota

aka indigenous microbiota and normal flora

refers to the microorganisms that reside on various parts of the body — the
layers of the skin, oral mucosa, saliva, conjunctiva, and in the GIT of the human
being.

Normal flora usually develops in an orderly sequence from birth to old age cuz
nagbabago pH of the environment (body)

Factors that determine the composition of normal flora:

nature of the local environment (pH, temperature, redox potential, and

oxygen, water, and nutrient levels)

pH in the genitourinary area

Infections and Diseases 6

 alkaline from when we are young to acidic during childbearing and
menopausal stages

nagiiba ng MO na nagcocolonize

oxygen

large intestine = anaerobic

upper respiratory = aerobic

peristalsis, saliva, lysozyme secretion, and secretion of immunoglobulins.

cause a decrease in the growth of the normal flora

peristaltic action and saliva = excrete waste materials along with MO

lysozyme is an enzyme that can kill MO

immunoglobulin = antibodies

An infant begins to contact organisms as it moves through the birth canal —

normal birth

if may STD mother, di pede normal birth sa baby

A Gram-positive population (bifidobacteria and lactobacilli —good bacteria)

predominates in the GI tract early in life if the infant is breastfed

The bacterial population is reduced and displaced somewhat by a Gram-

negative flora (Enterobacteriaceae) when the infant is bottle-fed
(Davis,1996).

Differences in the microbiota of a child delivered vaginally or by C-section

Lactobacillus and Bacteroides are prevalent in the microbiota of infants

delivered vaginally

infants delivered by C-section more closely resemble of human skin, with

abundant Staphylococcus aureus

Types of Microbiota
Resident Microbiota

Infections and Diseases 7

 lifelong members of the body's normal microbial community, but are not
found everywhere.

part of our system from birth to death

typically colonizes the surface of the skin, mucous membranes, digestive

tract, upper
respiratory system, and the distal portion of the urogenital system

take over one location and create a competitive environment (sila lang
nandun)

they can die if u took a very strong antibiotic na pati sila mamamatay

absent in axenic regions of the body

sterile areas of the body that have no resident normal flora

CSF

present in meninges

if nakapasok MO sa meninges = it will cause meningitis

Brain

Lungs or lower respiratory tract

Infections and Diseases 8

 Transient Microbiota

microorganisms that are just passing through

may attempt to colonize the same areas of the body as resident microbiota but
transients are unable to remain in the body for extended periods of time
due to difficulty competing with established resident microbes.

pede maging resident ang transient if ineradicate all MO in the body by taking
strong antibiotics

ppl doing this experience diarrhea cuz pinapatay good and bad bacteria

dapat palitan agad good bacteria = Erceflora, Yakult para sila mauna sa gut

if nauna pathogenic MO = diarrhea

Skin Flora
skin is the largest organ of the body

Infections and Diseases 9

 colonized by diverse colonies of MO but most are harmless and sometimes are
beneficial

Here are some of the common resident microorganisms predominating the skin:

Staphylococcus epidermidis

Staphylococcus aureus

Micrococcus species

α-Hemolytic and nonhemolytic streptococci

Corynebacterium species

Propionibacterium species

Peptostreptococcus species

Acinetobacter species

Small numbers of other organisms (Candida species, Pseudomonas

aeruginosa)

Pseudomonas aeruginosa

pathogenic if it enters the body

one of the most common causes of nosocomial infection

hospital-acquired

bigla magkaka fever, pneumonia, UTI cuz mababa immune system

and exposed masyado sa iba’t ibang MO ang px

Oral and Upper Respiratory Tract Flora

dapat sterile ung lower respiratory — axenic

Streptococcal anaerobes inhabit the gingival crevice

Infections and Diseases 10

 gingiva

aka gums

gingivitis is inflammation of the gums

cause usually maraming naiiwan na remnant ng food sa mga crevice ng

gums

The nose consists of prominent corynebacteria, staphylococci, and

streptococci.

Predominant organisms

Upper respiratory tract

non-hemolytic and α-hemolytic streptococci and Neisseriae.

Staphylococci, diphtheroids, hemophili, pneumococci, mycoplasmas, and

prevotellae are also encountered.

don't really cause illness

Gastrointestinal Tract Flora

In the stomach, organisms are usually transient and their population is kept low
by the acidic environment.

the pH of stomach = 1.5 — 3.5

pH is low sa stomach cuz of peptic acid or pepsin so onti lang MO sa stomach

Helicobacter pylori

Infections and Diseases 11

 a potential pathogen that plays a role in the formation of certain ulcer
types

meron sa stomach

can neutralize the environment

spiral and can dig a hole in the stomach

marami sa small and large intestine

In normal hosts the duodenal flora is sparse (low in number)

The ileum contains a moderately mixed flora.

The large bowel is dense and is composed predominantly of anaerobes.

Organisms participate in bile acid conversion and in Vit. K and ammonia

production in the large bowel.

Six major phyla predominate a normal adult colon, and 96–99% of the resident
bacterial flora consists of anaerobes

Bacteroidetes, Firmicutes, Actinobacteria, Verrucomicrobiota, Fusobacteria, and

Proteobacteria

Infections and Diseases 12

 Urogenital Flora
In the anterior urethra

S. epidermidis, enterococci, and diphtheroids

E.coli, Proteus, and Neisseria

When pH becomes neutral (childhood until puberty), a mixed flora of cocci

and bacilli is present.

At puberty, aerobic and anaerobic lactobacilli reappear in large numbers.

lactobacilli lodge mostly in acidic environments

B streptococci — 25% in childbearing years

25% of your normal flora in the urogenital are made of B streptococci

Infections and Diseases 13

 After birth, aerobic lactobacilli appear

After menopause, lactobacilli diminish

α-hemolytic streptococci, anaerobic streptococci, Prevotella species, clostridia,

Gardnerella vaginalis, Ureaplasma urealyticum, and Listeria or Mobiluncus.

cuz of the changes in the pH kaya nagiiba ung flora

Conjunctival Flora
few or no microorganisms because it is normally held in check by the flow of
tears which contain antibacterial lysozyme.

most detected genera are Haemophilus and Staphylococcus

predominating organisms diphtheroids, S. epidermidis, and non-hemolytic

streptococci.

Neisseriae and gram-negative bacilli resembling haemophili — Moraxella

species — are also frequently present

can cause conjunctivitis —inflammation of the membrane of eyelids

accounts for many pathologies of humans including otitis media, sinusitis,

pneumonia, and conjunctivitis

Opportunistic Microorganisms
those that take advantage of a situation that arises

depletion of the body's natural immune response or component of it —

immunodeficiency.

non-pathogenic microorganisms that act as pathogen

dormant for long periods of time and seize the opportunity to attack

Example

people infected with Human Immunodeficiency Virus (HIV)

HIV can progress into Acquired Immunodeficiency Syndrome (AIDS)

Infections and Diseases 14

 When the CD4+ T cell numbers fall below a critical level, cell-mediated
immunity is lost.

When immunity is lost, opportunistic pathogens can easily infect AIDS

patients without being destroyed by the immune system.

Latent Tuberculosis (TB)

the patient has Mycobacterium tuberculosis but doesn't have the

disease — carrier of TB

no symptoms and cannot transmit infection

it means malakas ang immune system

if the px experiences immunodeficiency

magiging active TB na sya

may symptoms na and nakakahawa na sya

10—15% of the population gumagaling sa TB cuz malakas ung immune

system

Pathogens that Crosses the Placenta

Infections and Diseases 15

 can cause malformation in the baby

TORCHES

pathogens that can harm the baby

Toxoplasma gondii

toxoplasma

galing sa dumi ng pusa → napunta sa air and nalanghap

microcephaly

small and underdeveloped brain

Rubivirus rubella

Rubella virus

German measles

pag nagkatigdas (measles) ung mother sa first trimester, pede

maapektuhan ung baby = severe birth defect

Rubeola = Measles lang (not included sa TORCHES)

Cytomegalovirus

HE

Hepatitis B

bloodborne

thru blood transfusion

hepatitis A and E are food and water-borne

Herpes Simplex Virus

herpes

HIV

Syphilis

may erythema infectiosum sa adult and baby

Infections and Diseases 16

 Seven Capabilities of Pathogens
Maintain a Reservoir

reservoir = storage = place of replication

dapat marami sila to cause a disease

Humans

people who are sick

people who are apparently healthy but are

incubatory carriers

incubation period

from the moment you acquire the causative agent until the point
you have the first symptoms

the period between the infection of an individual by a

pathogen and the manifestation of the disease it causes

pede na makahawa kahit incubatory carrier palang

chronic carriers

Animals

aka zoonoses/zoonotic diseases

zoonotic pathogens

pathogens that maintain an animal reservoir

Rabies virus

dogs, skunks, bats, cats (in theory, possible sila magcarry ng disease)

caused by Lyssavirus

Ebola

not established na zoonotic cuz pede human to human

caused by the genus Ebolavirus

Leptospirosis

Infections and Diseases 17

 rat urine

bacterial infection of the spirochete Leptospira interrogans

Plague

bubonic/ black plague caused by the bacterium, Yersinia pestis

Humans usually get the plague after being bitten by a rodent flea
that is carrying the plague bacterium or by handling an animal
infected with the plague.

Zoonotic influenza

influenza A

subtype = H1N1

bird flu

Mosquito

Lyme Disease

West Nile Virus

Dengue

Aedes aegypti mosquito

Chikungunya Virus

Malaria

Anopheles mosquito

Salmonella

poultry products

egg

minsan may fecal matter or soil sa egg so don nangagaling

Environment

soil, water, food

bacteria Clostridium tetani → Tetanus

Infections and Diseases 18

 Leave its Reservoir and Enter a Host

Portals of entry

The most common ports of entry are the same anatomical surfaces
colonized by microbiota

lahat ng butas and sugat sa katawan (puncture on the skin)

Modes of Transmission

direct

kissing

touching

sexual intercourse

indirect

airborne

fomites

inanimate objects that could harbor microorganisms

Infections and Diseases 19

 Adhere to the Surface of the Host (Attachment)

Attachment to Tissue

Tropism

many bacterial and viral diseases are tissue-specific

the ability of a given pathogen to infect a specific location

may specific tissue and receptor kung saan sila kakapit

Receptor-mediated endocytosis (RME)

endocytosis that makes use of receptors on the cell surface to engulf

molecules

Also referred to as clathrin-dependent endocytosis

Infections and Diseases 20

 since clathrin is crucial for the proper execution of this cellular
process.

Clathrin is a self-assembling protein that is recruited to

membranes from the cytoplasm of eukaryotic cells to form a
protein coat. The function of this coat is to sort proteins in the
membrane and to contribute to membrane deformation.

In this technique, specific molecules that get bound to the receptors can only be
engulfed by the cell

Pilli

surface proteins that attach microbes to host tissues and cell

Invade the Body of the Host

Invasive pathogens that enter host cells to live are called intracellular
pathogens

intracellular = inside the cell

The cell provides a nutrient-rich environment safe from bodily defenses

Infections and Diseases 21

 Evade the Body’s Defenses

defenses of the body

cell-mediated immune system

fast acting

kill all pathogens

Some pathogens have capsules that keep a phagocyte from establishing direct
contact.

Most virulent pathogens are those with the thickest capsules.

Surface proteins on pathogens also keep phagocytes from establishing

contact.

Streptococcus pyogenes

produces M protein

M protein is a molecule that gives streptococcus the ability to resist

phagocytosis by polymorphonuclear leukocytes in the absence of
type-specific antibodies (Fischetti, 2016).

Mycobacterium tuberculosis survives inside the phagocytes

Some pathogens obtain iron by producing iron-binding compounds called

siderophores

Multiply within the Body

Toxin

Exotoxins

highly destructive soluble proteins produced by both Gram-positive

and Gram-negative bacteria.

Most exotoxins are composed of two units, the A (active) unit — which
mediates toxic activity — and the B (binding) unit — which binds to the
host cell and is highly specific.

A = cause illness

B = attachment

Infections and Diseases 22

 Endotoxin

lipopolysaccharide (LPS) component of the outer membrane of Gram-

negative bacteria.

It enters host tissue during division or after cell death.

It acts by stimulating human cells to secrete particular messenger

proteins.

Extracellular enzymes

Three types

cytolysins attack the cell membrane

hemolysins (erythrolysins) lyse red blood cells

leukocidins that lyse leukocytes

Leave the Body and Return to its Reservoir or Enter a New Host

aalis na sya if

wala nang benefit na nakukuha (patay na host)

hostile environment na yung body (tumaas na immune system)

transmission to another susceptible host

port of exit is the same as the port of entry

The portal of exit for most respiratory pathogens is the same as the portal
entry

the nose

Most gastrointestinal pathogens' portal of exit is the anus.

Most sexually transmissible disease exits the same way they entered,
through the genital mucous membranes.

Pathogens transmitted parenterally by arthropod vectors exit the same

way, in a small amount of blood

Arthropod vectors include mosquitoes, flies, biting midges, ticks,

mites, fleas, bugs, lice, and other arthropods that carry and transmit
disease-causing organisms, or pathogens, from one host to another.

Infections and Diseases 23

 Immunity
ability to ward off damage or disease through our defenses

2 General Types

Innate Immunity

defenses that are present at birth

This type of immunity is fast, non-specific, and has no memory.

they attack anything foreign in the body

Includes barriers, pH extremes, Phagocytes & NK cells, fever, inflammation,

complement, interferon

Adaptive Immunity

slower, specific & has a memory (remember the pathogen to which the
body was previously exposed)

adapts or adjusts to handle a specific microbe

Two important characteristics are specificity and memory

Infections and Diseases 24

 Includes lymphocytes (T-cells & B-cells)

Types of Adaptive Immunity

Cell-mediated Immunity

Cytotoxic T cells directly attack invading antigens

aka Killer T-cells

cell attacking cell

effective against intracellular pathogens

effective to some cancer cells

Antibody-Mediated/Humoral Immunity

B cells become plasma cells

Produce specific proteins called antibodies (Abs) or immunoglobulins

(Igs)

effective against extracellular pathogens

Helper T cells aid both cell- and antibody-mediated responses

Infections and Diseases 25

 IgG

aka classic antibody

most abundant

80% of Igs

can cross the placenta

IgA

aka immunosurface protein antibody

serum, saliva, breastmilk, intestinal fluid

bodily fluids

IgM

aka macroglobulin

largest

first responder then itutuloy ni IgG

Infections and Diseases 26

 can’t cross the placenta kaya yung IgG yung nagcocontinue ng activity ni IgM

IgD

B cell maintenance, silencing, and activation

IgE

aka regain/homocytotropic antibody

allergic or hypersensitivity reactions and parasitic infections

Infections and Diseases

Unit III Infections and Diseases

Infections and Diseases 27