MICROBIAL ASSOCIATIONS/INTERACTIONS

Nanette Ramilo-Cruz, MD, DPAFP

Case
After typhoon Ondoy, several Metro Manila residents were temporarily sheltered in evacuation centers for safety. However, after 2 weeks in the shelter, many of the evacuees exhibited diarrhea, many of the children also had fever, maculopapular rash and cough.
Diagnosis of Disease? What factors contributed to the development of these diseases?

Objectives
‡ Define the different types of host-parasite relationships ‡ Define the terms used to describe the attributes of infectious agents ‡ Describe the different types of hosts. ‡ Describe the different types of parasites ‡ Enumerate some attributes of microorganisms which help them in producing damage/disease to the host

Objectives
‡ Define immunity and describe the two types of immunity ‡ Discuss the non-specific defenses of the human host.

Global Burden of Infectious Diseases
‡ Communicable or infectious disease continue to remain a leading cause of morbidity, disability and mortality worldwide. ‡ Rich countries: 1/10 deaths Poorer countries: 6/10 deaths ‡ 2 M deaths annually from diarrhea ‡ 4 M die annually of LRTI ‡ 700,000 die from measles annually ‡ 2 M die from TB, 90% from developing countries

Epidemiology of Infectious Diseases

Host

The Human Host
‡ Constant exposure to microbes ‡ Normal Flora ‡ Microbes living in and on body Transient temporary Resident always present ‡ Come into world sterile Exposed areas acquire flora closed areas remain sterile

Human Host
‡ Skin GPB, GPC, Staph. Corynebacterium, Propionibacterium ‡ Alimentary tract Mouth everything Streptococcus Large intestine anaerobic GNB Bacteriodes, coliforms Stomach and small intestine almost no bacteria

Human Host
‡ Respiratory Tract Upper normal throat flora Lower considered sterile ‡ Genitourinary Tract Vagina changes with age Menstruating Lactobacillus Non-menstruating Skin flora Urethra normal skin flora and sometimes coliforms

Human Host
‡ Sterile areas Body cavities with serous membranes thoracic, abdominal, joint, pericardium Closed organs in those body cavities Blood, CSF, Urine

Infectious Disease Process
Etiologic Agent
Reservoir

Portal of exit

Mode of transmission

Portal of Exit

Susceptible Host

Types of Host
‡ ‡ ‡ ‡ Reservoir Carrier Vector Sources

Reservoir
‡ A living organism or inanimate matter in which an infectious agent normally lives and multiplies. ‡ The infectious agent depends on the reservoir primarily for survival and reproduces itself in such a manner that it can be transmitted to a susceptible host ‡ May be:
± Physical environment: contaminated water supply ± Animals (insect vectors) ± Other humans (AIDS, HepB)

‡ Zoonoses: infectious diseases that have vertebrate animal reservoirs; they are potentially transmissible to humans under natural conditions ‡ Carrier: any person or animal that harbors a particular infectious agent without discernible clinical disease and serves as a potential source of infection

Humans As Carriers
‡ Type of Carrier
‡ Inapparent throughout ‡ Incubatory ‡ Convalescent ‡ Chronic

Example
Polio, meningitis, hepatitis Chickenpox, measles, hepatitis Diphtheria, Hep B, Salmonella, Cholera Typhoid fever, Hep B

Transmission

Infection The entry, development or multiplication of an infectious agent in the body tissues of man Infectious disease a clinically manifest disease of man resulting from an infection Communicable Disease an illness due to a specific infectious agent or its toxic products that arises through transmission from a reservoir to a susceptible host either directly or indirectly

Incubation Period the time interval between initial contact with an infectious agent and the first appearance of symptoms associated with the infection Communicable Period the time during which an infectious agent may be transferred from an infected host/reservoir to another susceptible host

Portal of Entry
‡ Breaks in skin and mucous membranes ‡ Natural openings GI, respiratory, GU tracts ‡ Cross placenta STORCH Syphilis Toxoplasma Others (HepB, HIV) Rubella

Portals of Exit
‡ ‡ ‡ ‡ Secretions, excretions, discharges, sloughed tissue

Gradient of Infection
‡ Ranges from subclinical infection to severe clinical disease or even death ‡ Inapparent Infection
± Infection in a host without recognizable clinical signs or symptoms ± Identifiable only by laboratory means

‡ Severe Disease
± ± ± ± High rate of severe clinical manifestations High case fatality rate (CFR) High proportion of surviving patients with sequelae Serious problem from a public health standpoint where the disease causes excess mortality

‡ The host after exposure to the agent may progress from subclinical (inapparent) infection to a clinical case of the disease ‡ The end result may be complete recovery, permanent disability, disfigurement or death ‡ Degree of infection and disease severity depends on the defense mechanisms (immunity) of the host ‡ Immunity refers to the resistance of the host to a disease agent

Patterns of Infection
‡ Local infection: Confined to specific site or tissue ‡ Systemic infection: Spreads to several sites or tissues ‡ Focal infection: Local infection that could spread Head infections blood supply Toxemia

Patterns of Infection
‡ Mixed infection polymicrobial, More than one organism involved. Ex: Dental caries Organisms may show synergism ‡ Primary infection: Initial infection ‡ Secondary infection: Complicates primary infection: Opportunist

Patterns of Infection
‡ Acute infection Rapid, severe, short-lived ‡ Chronic infection Persistent, slow progress ‡ Subacute infection Onset less rapid than acute Less persistent than chronic

Acquisition of Disease
‡ Direct Transmission: skin or mucous membrane contact ‡ between hosts: crossing placenta ‡ Indirect Transmission Vectors living animal Fomites inanimate objects Vehicle inanimate material Droplet nuclei Aerosols (fine dust, moisture)

Nosocomial Infection
‡ Result of stay in hospital or longterm care medical facility ‡ AKA hospital acquired infections ‡ Average 5% of patients

AGENT

The Infectious Agent
The Types of Infectious Agents
A. B. C. D. E. Bacteria: TB, Shigellosis Viruses and Rickettsia: AIDS, Hepatitis Fungi: candidiasis, athlete s foot Protozoans: amoebiasis, giardiasis Helminths: schistosomiasis, ascariasis

Infectious Agent
Intrinsic Properties - properties of infectious agents that do not need any interaction with host - understanding a particular intrinsic property may be essential to understanding an agent s epidemiology, including its mode of transmission - strains or isolates of a particular agent from different outbreaks, different geographic areas at different times may vary significantly in these intrinsic properties.

Properties related to host-agent interactions
a) b) c) d) e) f) Infectivity Immunogenicity Pathogenicity Virulence Toxigenicity Resistance

Infectivity
‡ The ability of an agent to enter and multiply in a susceptible host and produce infection ‡ Can only be inferred by: the ease of spread in a population ‡ High infectivity: Polio

Infectivity
‡ Infectious Dose (ID) Minimum number of organisms required to cause disease ‡ Varies from organism to organism 10 for M. tuberculosis 1000 for N. gonorrhoeae ‡ Less than ID no disease ‡ More than ID may get more rapid onset

Infectivity
Binding to Host (Adhesion) ‡ Bacteria: fimbriae, flagella ‡ Viruses: receptors ‡ Protozoa: organelles for locomotion ‡ Helminths: hooks and suckers

Immunogenicity
‡ Infection s ability to produce specific immunity in the host e.g. measles ‡ Measured by serologic surveys ‡ Depends on:
± Amount of antigen formed in the host ± Agent s ability to induce lifelong immunity

Pathogenicity
‡ Ability to produce clinically apparent illness in an infected population ‡ High Pathogenicity: measles
‡ Pathogenicity = # of infected persons w/ disease Total number of infected persons

Virulence
‡ The extent to which severe disease is produced in a population with clinically manifest disease ‡ Highly Virulent: rabies ‡ Measures:
± (CFR) Case Fatality Rate ± Proportion of Severe Cases

Toxigenicity
‡ Capacity of an agent to produce a toxin or poison ‡ Disease results from the toxin produced by the agent rather than from the agent itself

Diseases According to Agent-related properties
Degree Infectivity Measles, Chickenpox, Polio, Smallpox Pathogenicity Rabies, Measles, Chickenpox, Smallpox, Common colds Rubella, Mumps Virulence

High

Rabies, TB, Leprosy, Smallpox

Intermediate

Mumps, Rubella, Common colds

Poliomyelitis

Low

TB

Polio TB

Measles Chicken pox, Rubella, Common colds

Very Low

Leprosy

Leprosy

Host-parasite Relationship
‡ Neutralism: 2 populations of Microbes found in a microecosystem w/o affecting one another; do not compete for nutrients ‡ Mutualism/Symbiosis: Each organism benefits from the association Syntrophism: Lactobacillus arabinosus and Streptococcus faecalis

Host-parasite Relationship
‡ Commensalism: 1 microbe benefits from the association but the other is not affected ex: Staphylococcus aureus and Haemophilus influenzae ‡ Antagonism: A microbe adversely affects the environment of another microbe ex: 1. Penicillum notatum vs. gram + cocci and bacilli 2. Lactobacillus casie (lactosin) vs. V. cholerae, Salmonella and Shigella

Host-parasite Relationship
‡ Parasitism: 1 microbe lives in or on another microbe(host) w/c is commonly harmed ex: vibriophage vs. Vibrio Bedellovibrio bacteriovulus vs. E.coli ‡ Predation: 1 microbe ingests another microbe ex: Zooplankton feed on smaller algae and fungi

Immunity

Types of Immunity
‡ Non-specific Immunity ‡ Specific Immunity Humoral Cell-mediated

Immunity to Microbes Criterion Description of Immunity Presence in the Host Innate Acquired Targets of Action Non specific Specific

Location and Nature of Defense Factors Criterion Non specific Innate Immunity Local Systemic Specific Acquired Immunity Local Systemic

Location of Defense Factors Nature of Defense Factors

Structural barriers, Physiologic Factors, Chemical, Cellular factors

Humoral or Molecular factors, cellular factors

Humoral or Molecular factors, cellular factors

Humoral or Molecular factors, cellular factors

Disease-Specific Defense Mechanisms (Humoral Immunity) ‡ Natural, active immunity
± An infection induces an immune response

‡ Artificial, active
± Vaccination stimulates antibody production

‡ Natural, passive
± Maternal antibodies

‡ Artificial, passive
± Preformed antibodies administered to an individual as a means of prophylaxis

Questions?

Case
After typhoon Ondoy, several Metro Manila residents were temporarily sheltered in evacuation centers for safety. However, after 2 weeks in the shelter, many of the evacuees exhibited diarrhea, many of the children also had fever, maculopapular rash and cough.
Diagnosis of Disease? What factors contributed to the development of these diseases (Agent, Transmission, Host)?

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