TORTORA FUNKE

CASE

Microbiology
AN INTRODUCTION
EIGHTH EDITION

Chapter 14

B.E Pruitt & Jane J. Stein

Principles of Disease and

Epidemiology

Principles of Disease
and Epidemiology
Pathology Study of disease
Disease in a state of not being healthy,
change from health
Pathogensdisease causing organisms
Etiology
Study of the cause of a disease
Pathogenesis Development of disease
Infection
Colonization or invasion of
pathogens, may be microbes in the
wrong place (E. coli in the urinary
tract)

Normal Microbiota (Flora) and the

Host
Normal Flora - the normal bacteria in you and on you
You have 1013 eucaryotic cells and 1014 prokaryotic cells
Within 8 - 12 hours of life you are colonized by normal flora
(microbiota).
Breast feeding versus bottle - different organisms

Transient microbiota may be present for days, weeks,

or months
Microbial antagonism
Normal microbiota overwhelm pathogens - no place for them
to colonize
Intestines and vagina - excessive antibiotics disrupts balance
Vagina normally pH ~ 4 with Lactobacillus spp without can lead to
Candida infections

Symbiosis is the relationship between normal

microbiota and the host

Normal Microbiota and the Host:

In commensalism, one organism is benefited and the other
is unaffected.
In mutualism, both organisms benefit.
Be able to give a few examples of mutualistic bacteria

In parasitism, one organism is benefited at the expense of

the other.
Some normal microbiota are opportunistic pathogens.
E. coli and urinary tract
Pneumocystis carinii and respiratory system
Streptococcus pneumoniae and pneumonia

Normal Microbiota and the

Host:
Locations of
normal
microbiota on
and in the
human body

Figure 14.2

Normal Microbiota and the Host:

Microbial antagonism is competition
between microbes.
Normal microbiota protect the host by:
occupying niches that pathogens might occupy
producing acids
producing bacteriocins

Probiotics are live microbes applied to or

ingested into the body, intended to exert a
beneficial effect.
Lactobacillus spp

Kochs Postulates

Koch's
Postulates
are used to
prove the
cause of an
infectious
disease.
Figure 14.3.1

Kochs Postulates
Koch's Postulates are used to
prove the cause of an infectious
disease.
Problems with Kochs Postulates:
Not all diseases have bacterial
etiologies
Genetic
Degenerative
Congenital

Exceptions
Not culturable
Treponema / Rickettsia / Chlamydia /
viruses

Some pathogens cause many

different diseases
Figure 14.3.2

Classifying Infectious Diseases

Symptom A change in body function
that is
felt by a patient as a result of
disease
Sign A change in a body that can be
measured or observed as a result
of disease.
Syndrome A specific group of signs and
symptoms that accompany a
disease.

Classifying Infectious Diseases

Diseases may be grouped by how spread
Communicable disease A disease that is
spread
from one host to another.
Contagious disease A disease that is
easily
spread from one host to
another.
Noncommunicable disease A disease that is
not
transmitted from one host
to another. Example:
Clostridium tetani

By occurrence of Disease
Incidence
Fraction of a population that
contracts a disease during a
specific time.
Prevalence
Fraction of a population having
a specific disease at a given time.
Sporadic disease Disease that occurs
occasionally in a population.
Endemic disease Disease constantly present
in a
population.
Epidemic disease Disease acquired by many
hosts in a given area in a short
time.
Pandemic disease Worldwide epidemic.

By Severity or Duration of a
Disease
Acute disease
Symptoms develop rapidly
Chronic disease
Disease develops slowly
Subacute disease Symptoms between
acute and
chronic
Latent disease Disease with a period of no
symptoms when the patient is
inactive Shingles

By Extent of Host Involvement

Local infection Pathogens limited to a small

area
of the body
Systemic infection An infection throughout
the body
Focal infection Systemic infection that
began as
a local infection
Bacteremia
Bacteria in the blood
Septicemia
Growth of bacteria in the blood

Extent of Host Involvement

Toxemia
Toxins in the blood
Viremia
Viruses in the blood
Primary infection
Acute infection that causes
the
initial illness
Secondary infection Opportunistic infection after a
primary (predisposing) infection
Pneumocystis pneumonia and AIDS
Subclinical disease No noticeable signs or
symptoms
(inapparent infection)
Hepatitis /
Typhoid mary / Polio

Predisposing Factors
Make the body more susceptible to disease
Short urethra in females
Inherited traits such as the sickle-cell gene
Climate and weather
Fatigue and Stress
Age
Lifestyle
Chemotherapy
Gender

Development of Disease
Stages of Disease
infection up to first symptoms may or
be variable
short period of early mild symptoms --

Incubation
may not
Prodromal
malaise
Period of Illness overt signs -- fever and chills,
swollen lymph
nodes, GI disturbance
increase in WBCs
Period of Decline
signs and symptoms subside susceptible to
2 infections

TheStagesofaDisease

Figure 14.5

Reservoirs of Infection
Reservoirs of infection are continual sources of
infection.
Human AIDS, gonorrhea
Carriers may have inapparent infections or latent diseases.
Carriers may be in pre-symptom stage or recovery of a disease no symptoms

Animal Rabies, Lyme disease

Some zoonoses may be transmitted to humans
Plague / psittacosis / swine flu / bird flu

Nonliving Botulism, tetanus

Soil
Water - rivers, lakes, snow, oceans and laundry water

Transmission of Disease
Three main routes
Contact - Direct or indirect
Vehicles - inanimate objects - e.g. food or drugs
Vectors - arthropods

Contact
Direct

Requires close association between

infected and susceptible host
Indirect Spread by fomites (inanimate objects)
glass, toothbrush or clothing
Droplet Transmission via airborne droplets

Transmission of Disease

Figure 14.6a & 8

Transmission of Disease
Vehicle

Transmission by an inanimate
reservoir
(food, water) Shigella, cholera,
airborne on
dust aerosol >3, tapeworm
Staphylococci,
Streptococci, tuberculosis,
fungal spores -histoplasmosis,
coccidiodomycosis

Vectors
ticks, and

Arthropods, especially fleas,

mosquitoes

Mechanical

Arthropod carries pathogen on feet

Biological Pathogen reproduces in vector and

Transmission of Disease

Figure 14.6b, c

Nosocomial
(HospitalAre acquired as a result of a hospital stay
Acquired)
Infections
5-15% of
all hospital patients
acquire
nosocomial infections

Figure 14.7, 9

Nosocomial
Hospital acquired
5 - 15% acquire >20,000 per year die

why?

a) microbes in environment -- (lots of sick

people)

b) already sick or wounded -- compromised host

c) close to people - chain of transmission

Also resistant strains - E. coli, Pseudomonas,
enterics like Serratia
Control by aseptic techniques

Relative frequency of
nosocomial infections

Figure 14.10

Common Causes of
Nosocomial
Infections
Percentage of nosocomial
Percentage resistant to
infections

antibiotics

Gram + cocci
Streptoccous and
Staphylococcus

34%

28%-87%

Gram rods
Enterics and Pseduomonas

32%

3-34%

Clostridium difficile

17%

Fungi

10%

Emerging Infectious Diseases

Diseases that are new, increasing in
incidence, or showing a potential to increase
in the near future.
Contributing factors:
Evolution of new strains
V. cholerae O139

Inappropriate use of antibiotics and pesticides

Antibiotic resistant strains

Changes in weather patterns

Hantavirus

Spread of human populations and travel

Emerging Infectious Diseases

Contributing factors:
Modern transportation
West Nile virus

Ecological disaster, war, expanding human

settlement
Coccidioidomycosis

Animal control measures

Lyme disease

Public Health failure

Diphtheria

Epidemiology
The study of
where and when
diseases occur

Figure 14.11

Epidemiology

John Snow

1848-1849

Mapped the occurrence of cholera

in London

Ignaz Semmelweis

1846-1848

Showed the hand washing

decreased the incidence of
puerperal fever

Florence Nightingale

1858

Showed that improved sanitation

decreased the incidence of
epidemic typhus

 Descriptive

Collection and analysis of data

regarding occurrence of disease

Snow

Analytical

Comparison of a diseased group and a

healthy group

Nightingale

Experimental

Study of a disease using controlled

experiments

Semmelweis

Case reporting

Health care workers report specified

disease to local, state, and national
offices

Nationally Notifiable
Diseases

Physicians are required to report

occurrence

Table 14.7

Centers for Disease Control and

Prevention (CDC)
Collects and analyzes epidemiological
information in the U.S.
Publishes Morbidity and Mortality Weekly
Report (MMWR) www.cdc.gov
Morbidity: incidence of a specific notifiable
disease
Mortality: deaths from notifiable diseases
Morbidity rate = number of people affected/total
population in a given time period