GENERAL CONCEPT

OF INFECTIOUS DISEASES

Wu di
The third People's Hospital of zheng jiang
 SINGNIFICANCE AND
IMPORTANCE OF STUDY
 History review
• In 14th century, Plague in European ,20 million people
death；

• In 17~18th century, smallpox in European ，150 million

people death；

In 1918, flu in the worldwide，40 million people death。

In 1905,Nobel gainer of
physiology and medicine award
Robert Koch (Germany)

In 1882，
Koch discovered
tuberculosis bacilli
In 1945,Nobel gainer of
physiology and medicine award
Alexander Fleming(Scotland)

In 1928年，
Fleming
Discovered Penicillin
Into antibiotics era
WHO reports：
★ Among 52 million of death in the worldwide annually, 17
million(32%) of death from infectious diseases and parasite
★ In developing country，a half of death by infectious
diseases；
★ About 15 million of death by infectious diseases per hour
in the worldwide，most occurred in developing country。
 Pattern of Infection in Developed
Countries
• In 20th century, fall in the incidence of communicable
diseases in developed countries
• due to factors such as :
• Immunization
• antimicrobial chemotherapy
• improved nutrition
• and better sanitation and housing.
Re-emergence of old infectious disease

• ◆(Tuberculosis)

• ◆(Viral hepatitis)

• ◆(Sexually transmitted diseases)

• ◆others: cholera
 1961-2000 years of global report
of the number of cholera cases
700000

600000 病例数

500000

400000

300000

200000

100000

0
60 65 70 75 80 85 90 95 00
 Re-emergence of old infectious
disease

• 2 million death of TB in the worldwide annually

• 7～8 million infected by TB in the worldwide annually

• March 24,for World TB Day

 Emerging infectious diseases
• WHO information
• near 30 years,

• about 30 kinds of infectious diseases discovered in the

worldwide

• “Emerging infectious diseases”

 Emerging infectious diseases

★ 40 million of HIV/AIDS cases worldwide

★ HIV infection rates:16000persons/per day，6 million
persons/annually，11 cases/minute。
★ 95% in developing country
★ Maximal nation :Africa,infection rate about 10%
★ Dec.1 for World AIDS Day
 Emerging infectious diseases
• In 1985,First case of AIDS in china, it is American tourer
to china 。
• To 2003,about 840 thousands HIV in china，80
thousands of AIDS cases
• HIV increase 30% annually in china
 Emerging infectious diseases
• SARS （SARS—CoV）
• From 2002.11.16 to 2003.7，SARS spreaded 6
continent, 32 countries，cases of 8437，death of 916
• In china, cases of 5327，death of 349
• SARS: most serious emerging infectious diseases in 21
century
Emerging infectious diseases

Avian influenza
H5N1 virus
H7N9 virus
Antibiotics
• Antibiotics, within the last 60 years,

• Resulted in the cure of many previously lethal infections,

“wonder drugs.”

• Only several years , drug-p emerged.

pathogenic staphylococci were found to have the ability to

produce enzymes (penicillinases) that destroyed penicillin,
thus rendering the drug useless against these strains

• Overuse and misuse of these, “wonder drugs” will

eventually render them useless.
COMMUNICABLE CONCEPT
DISEASES INFECTION AND
IMMUNITY

PATHOGENESIS

EPIDEMIOLOGY

DIAGLOSIS

TREATMENT

PROVENTION
 CONCEPT OF COMMUNICABLE DISEASES
•Caused by pathogens: virus、chlamydia、richettsia、
prion、bacteria、spirochete、fungus and parasite
（helminth、protozoa）or medical insect
•Infectious disease: involve any organ or system of the
body and thus embraces all medical disciplines.
•Communicability is another factor which differentiates
infections from non-infectious diseases. Transmission of
pathogenic organisms to other people, directly or
indirectly, may lead to an epidemic.
The goal of studying infectious disease:

learning the principle of disease happening

and developing in body, transmission, clinical
manifestations, diagnosis, different diagnosis,
therapy and prevention ways.
Infection and immunity
1. Concept of infection
The course of struggle between pathogens and human
(host).
•Absolutely necessary condition

infection
pathogens environment

human
 Kinds of infections
•Commensals

•opportunistic infection

•Primary infection

•Repeated infection

•Mixed infection

•Superinfection

•Secondary infection
•Commensalism
Pathogens live in the host
but don’t induce pathologic
changes.
Escherichia coli in the colon
•Opportunistic infection:
Pathogens within the host can
induce pathologic changes if host
immunity is suppressed by some
factors.
Cryptococcus neoformans
Cytomegalovirus
Candida albicans
•Primary infection: measles, chickenpox

•Repeated infection:

malaria, schistosomiasis, ancylostomiasis

•Mixed infection: rare

•Superinfection: HBV overlap HEV

•Secondary infection: HBV following bacilli

•Eliminate pathogen
•Inapparent/sub-clinical
infection
•Apparent/clinical infection
•Carrier status
•Latent infection
 1. Elimination:
pathogens were excluded out by host
nonspecific or specific immunity.
Such as: Candida albicans
Hepatitis A virus
 2 inapparent/sub-clinical infection:
most frequently occurs in health
individuals.
The outcomes will be:
A. Immunity acquired. HAV
B. Carrier state:
health carriers：HBV
3 apparent/clinical infection infection:
The outcomes will be:

A. Recovery. Shigella

B. Chronic carrier.

Salmonella typhi
4 Carrier state:
Definition of different types of carriers:
A.Clinical classification:
a Incubation period carriers
b Convalescent carriers
c Healthy carriers

B Laboratory classification:
a Acute carriers
b Chronic carriers
5 Latent infection:
After infection, pathogens remain latent
inside the body.
Develop clinical manifestations when the
host immunity has been impaired.
Pathogens usually will not
be excreted by the host during period of
latency. Herpes simplex
•The infection status may change each other in some

conditions.

Latent infection

Apparent

Carrier status

Inapparent

Eliminate
frequency/ratio
Role of Pathogens in Infection Process:
⑴ Invasiveness: adhesion, penetration ability.
Shigella
⑵ Virulence: toxins, enzymes, and histolytic ability.

E. histolytica
⑶ Infection dose: minimal dose that can cause an infection.

S.typhi
⑷ Variability: change in structure of the pathogen to evade
from host immunity.

Influenza virus
 The Role of Immune Response in Infection
Process:
Differentiation between protective
immunity and allergy.
. Protective immunity: beneficial
. Allergy(anaphylactic reaction): harmful
⑴ Nonspecific immunity:
A. Natural barriers: external (skin, mucous membrane, cilia),

internal (blood-brain barrier).

B. Phagocytosis: monocytes, macrophages, and granulocytes.
C. Humoral factors:
complements, lysozyme, interferons (α β γ), cytokines
⑵ Specific immunity:
Immune respond to specific
recognizable antigens.
A. Cell-mediated immunity:
Important in intracellular infections by viruses, fungi,
protozoa and certain bacteria.
B. Humoral immunity:
Different kinds of antibodies
(immune globulins, A D E G M) and their functions.
Pathogenic Mechanisms of Infectious
Diseases

Establishment and development of infection process can be

divided into three stages
1. Portal of entry:
Each pathogen has its specific portal of
entry.
Mycobacterium tuberculosis,
Meningococcus
----via breath tract.

Shigella
--- via digestive tract.
2. localization and Dissemination
in the host:
Specific for each pathogen.
. Mumps virus in parotid gland.
. Hepatitis C virus in the liver.
. Shigella in the intestine.
3. Channels of excretion:
Important factor for host infectivity. As
the source of infection.
.Hepatitis A in the stool.
. Hepatitis B in the blood.
. Measles virus in expirator air.
 Mechanism of Tissue Damages
1. Direct invasion: Cytolysis, tissue necrosis,
inflammation.
2.The actions of toxins and cytokines: Resulting
in septic shock, Disseminated intravascular
coagulation, DIC etc.
3. Immunopathogenesis:
Immunosuppression, T-cell destruction, immune
complexes induce cytotoxicities.
Shock is a special problem in severe infections.
•Endotoxin from Gram-negative bacteria caused by other cell
wall components and by lipoteichoic acid
•Several mediators including kinins, components, histamines,
cytokines, and endogeneous opiate
•Results from reduced systemic vascular resistance brought
about by dilated small vessels and leaky capillaries
•The cycle of shock, tissue anoxia, and organ failure is
difficult to break and may kill the patient within hours.
Bacteremia and Septicaemia
• Bacteraemia, the presence of living organisms in the blood,
can occur in healthy people without causing symptoms

• Unless there is a focus on which they can settle and multiply.

•Other organisms invading the blood stream, such as

staphylococcus aureus and Escherichia coli , are less likely to
be dealt with by the immune system and more likely to cause
disease;
Septicaemia
•Caused by Gram-positive, Gram-negative, or fungal
organisms.
•Complicated by septic lesions in organs or tissues.
•Such as: pneumococcal pneumonia and
meningococcal meningitis.
•Cirulatory failure, the septic shock syndrome, is the
most dangerous complication
•Blood cultures are the most important initial
investigation
Important Patho-physiologic
Changes in infection
1. Fever (pyrexia):

Exogenous and endogenous pyrogens.

. Exogenous pyrogens: virus etc.

. Endogenous pyrogens: IL-1, IL-6, TNF, interferon etc.

2. Metabolism changes:
(1) Protein metabolism:
higher proteins catabolism.
(2) Carbohydrate metabolism:
acceleration of glucolysis.
(3) Water and electrolytes metabolism:
dehydration, hypokalemia.
(4) Endocrine disturbances:
higher anabolism,
hyper-corticosteroidemia
Epidemiological Process of
Infectious
Diseases and Influencing Factors Epidemiological
Process(course)
include: Sources of infection
Routes of transmission
Susceptibility
1. Sources of infection:
Definition. Human, animal.
⑴ Patients: acute, chronic;
typical, atypical(mild, severe).
⑵ Subclinical infection:
no symptoms. poliomyelitis.
⑶ Carriers:
chronic:typhoid, shigellosis.
⑷ Infected animals:(natural source)
rabies, plague, schistosomiasis.
2. Routes of transmission
⑴ Air, droplets, dusts:
e.g. measles, diphtheria.
⑵ Water, food, flies(fecal-oral infection):
e.g. typhoid, cholera.
⑶ Fingers, utensils (contact infection):
e.g. shigellosis, influenza.
2. Routes of transmission

⑷ Arthropods:
A. Biologic: intermediate hosts,
e.g. mosquitoes in malaria,
chiggers in scrub typhus.
B. Mechanical: passive transfer.
e.g. flies in amebiasis
 2. Routes of transmission

⑸Blood,body liquid transmission

Such as HBV, HIV

Vertical transmission: mother to baby

Horizontal transmission: others

 3.susceptibility
• Susceptible person
• The susceptibility of population depend on the proportion
of susceptible individual who is lack of specific immune
in the population. When the proportion reach some
scale and there are proper source of infection, the routes
of transmission then the disease will spread.
 Factors Influencing the
Epidemiological Process
1. Natural factors:
. Climatic: season, rain, humidity.

. Geographic: endemicity,

schistosomiasis

clonorchiasis sinensis: fresh fish

2. Social factors:

Social system,

social-economic condition,

cultural background
 Characteristics of Infectious
Diseases
1. Basic characteristics:
(1) Presence of pathogens.
(2) Infectivity: duration of infection, chronic carrier.
(3) Epidemiological features:
age, sex, season; imported or
endemic; sporadic or
epidemic and; epidemic outbreaks
pandemic.
(4) Post-infection immunity.
 2. Clinical Characteristics:
(1) Stages of development:

A. Incubation period.

B. Prodromal period.

C. Symptomatic period.

D. Convalescent period.

E. Recrudescence, relapse.

F. Sequelae.
⒈ Incubation period
Incubation period is the period between the
invasion of the tissues by pathogens and the

appearance of clinical features of infection.

⒉ Prodromal period
From onset of diseases to apparent clinical features.
⒊ Symptomatic period.
Apparent of clinical manifestations.
⒋ Convalescent period

lighten and disappear clinical manifestations,Lab. normal

relapse Initial symptoms and signs re-occur during

the convalescent stage due to pathogen remained in tissue

re-multiplying, only in certain diseases (fever reappears
when body temperature fall to nomal).

recrudescence Fever reappears when body

temperature fall but is not normal

eg. typhoid fever

⒍ Sequela
body function abnormal after recovering of

diseases
 Characteristic of infectious disease

Characteristic
of infectious
disease
 Common symptoms and signs.
⑴ Fever(pyrexia) :
A. Effervescence: early stage.
B. Fastigium: full-blown stage.
C. Defervescence:
improvement stage
1.Fever forms
A. Sustained fever:
Difference of body
temperature less than
1 degree centigrade
within 24 hours, over 39℃.
e.g. Second week of typhoid
sustained fever
B. Remittent fever:
Change of body temperature
more than 1 degree
centigrade within 24 hours,
the base line higher than
normal.
e.g. Septicemia.
remittent fever
C. Intermittent fever:
Fluctuation between
normal temperature and high fever
within 24 hours.
e.g. Malaria.
intermittent fever
D. Relapsing fever:
Fever lasting 5~7 days
with relapse after several
days.
e.g. Relapsing fever,
brucellosis.
relapsing fever
E. Irregular fever:
Curve of body temperature
is irregular.
e.g. Brucellosis, septicemia
⒉ Skin rash or eruption:
Note appearance type and
day of the disease.
Eruption time:
first day: chickenpox
second day: scarlatina
third day: smallpox.
forth day: measles
Fifth day: ship fever
sixth day: typhoid fever
A. Enanthem:
Rash on mucous membrane (mucosa).
e.g. Koplik spots in measles.
B. Exanthem:
Rash on skin surface,
e.g. chickenpox, smallpox.
C. Maculopapular rash:
e.g. Macula and papule
(Maculopapule) in measles
Rose spots in typhoid fever.
macula
papule
herpes
pustule
D. Urticaria:
Seen in serum sickness,
tetanus antitoxin (TAT)
parasitic diseases,
schistosomiasis
drug hypersensitivity,
piperacillin, etc.
Urticaria
3. Toxemic symptoms:
A. General presentations:
malaise; headache; anorexia;
pain in muscles, joints and
bones; disturbance in
consciousness; meningeal
irritation; septic shock; liver
and kidney failure, etc.
B. Mononuclear-phagocyte
system(Reticulo-endothelial system)
reactions:
hepatomegaly,
splenomegaly,
lymphadenopathy.
4. Clinical forms:
(1) development: Acute, subacute

and chronic forms.

(2) forms of clinical manifestation:

mild, moderate (typical) or

severe forms of the disease.

ambulatory form in typhoid(without symptom

and signs).
Acute
•Fever; anoxia, protein catabolism, negative
nitrogen balance, acute-phase protein response,
albuminaemia, low serum iron, anemia,
neutrophilia
•Inflammation: pain, dysfunction, tissue damage
•Convulsion; especially in children
•Shock
•Hemorrhage: hemolytic anemia, intravascular
coagulation
•Organ failure: kidneys, liver, lung, heart, brain,
necrosis of skin
Chronic
•Weight loss and muscle-wasting
•Malnutrition: especially associated with diarrhea
•Retardation of growth and intellect in children
•Anemia: iron sequestration
•Tissue destruction: e. g. lung in pneumonia or
tuberculosis, liver in hepatitis B
•Post-infective syndromes: e.g:post-viral fatigue
syndrome
Diagnosis of Infectious Diseases
1. Clinical manifestations
(1) Mode of onset
(2) Type of fever
(3) Accompanying symptoms:
headache, myalgia, arthralgia etc.
(4) Signs:
Consciousness, jaundice, skin rash,
Koplik spot, eschar, subcutaneous hemorrhage,
liver, spleen, lymph nodes.
 Pathognomonic signs
• Measles: Koplik spots
• Mumps: swelling of parotid gland
• Scrub typhus: eschar
• Leptospirosis: myalgia, calf muscle
• Typhoid: rose spots
• Cysticercosis: subcutaneous nodules
• Hepatoencephalopathy: flapping tremor
• Schistosomiasis: urticaria
• Shigellosis: mucus-pus-bloody stool
• Amebic dysentery: strawberry jam-like stool
• Rabies: hydrophobia
2. Epidemiological Data:

(1) History of contact with similar cases.

(2) Occupation, living environment and life style.

(3) History of vaccination.

(4) History of transfusion of blood or blood products.

 Laboratory Examinations:
(1) Routine examinations: blood,
urine, stool.
Leukocytosis, leukopenia,
eosinopenia, eosinophilia.
Biochemical analysis of the
blood for liver functions and
kidney functions, etc.
 Leukocytosis:
• Infection with virus:

epidemic hemorrhagic fever

Japanese B encephalitis

infectious mononucleosis

rabies

• Infection with bacteria, etc.

(2) Detection and isolation of
pathogens:
A. Adequate collection and
transportation of specimens.
B. Direct examination:
Recognition of causative agent
• malaria in blood slides, Vibrio cholerae in stool, diphtheria in

throat swab, bacilli in urine

• Entamoeba in rectal scrape, schistosome ova in rectal snip,

rickettsia in rash aspirate, fungi in skin scrapings, pneumococci in

purulent sputum, leprosy bacilli and leishmania in slit skin smear

• By electron microscopy: viruses in stool; herpes viruses from skin

• By histology of biopsy specimen; acid fast bacilli in leprosy and

tuberculosis, hepatitis B in liver, rabies virus in brain

C. Culture by artificial
Culture of causative organism
• From blood: typhoid, brucellosis, Gram-negative
septicaemia, pneumococcal pneumonia, HIV
• From bone marrow: tuberculosis, brucellosis, leishmaniasis,
histoplasmosis
• From other body fluids, feces or tissues: urinary tract
infection, bacillary dysentery, sputum in pneumonia, liver in
tuberculosis
D. Animal inoculation

•Intraperitoneal inoculation:
Rickettsia tsutsugamushi.

•Intracerebral inoculation:
encephalitis virus.
E. Specific Immunological detection:
•Detection of microbial antigen
Meingococcal and pneumococcal disease (blood,
cerebrospinal fluid, sputum, urine)
•Detection of antibody of IgM class
Toxoplasmosis, hepatitis A
•Demonstration of antibody
Rising titre: typhoid, brucellosis, HIV infection
Closely linked to clinical syndrome: amoebic
abscess, visceral leishmaniasis
Screening for latent disease: schistosomiasis,
•Skin testing: Tuberculosis, histoplasmosis,
leishmaniasis Nonspecific
F. Molecular biologic assay:
Using isotope or non-isotope probes;
Polymerase chain reaction
(PCR).
Mycobacterium tuberculosis,
hepatitis C virus, etc.
Other examination
•X ray:lobar pneumonia, renal tuberculosis, muscular
cysticercosis
•Isotope: detection of abscess
•Ultrasound: abscess hydatid cyst
•Computed tomography (CT) or magnetic resonance
imaging (MRI): intracranial infection, visceral abscesses,
mediastinal lymph node enlargement
Treatment of Infectious Diseases
Principles of therapy
1. Aim of treatment:
. for alleviation of symptoms and signs
. for isolation of patients
. Comprehensive treatment
includes drug therapy, nursing care and isolation.
. Pay attention to both specific and symptomatic
treatments.
2. Therapeutic methods:
⑴ General and supportive treatment.
⑵ Etiologic (specific) treatment.
⑶ Symptomatic treatment.
⑷ Rehabilitation therapy for sequelae.
⑸ Traditional Chinese medicine and acupuncture.
Prevention of Infectious Diseases
1. Measures against the
source of infection
⑴ Report of cases:
According to the Law for
Controlling Infectious
Diseases issued by the
central government.
⑵ Isolation of patients:
until the patient becomes
non-infectious.
3. Quarantine of contacts:
until the incubation
period of the infectious
disease is over.
⑷ Identification and
treatment of carriers.

⑸ Control of infected animals:

Eradication or therapy
2. Interrupt the routes of

transmission
⑴ General hygienic measures:
Clean drinking water supply,
Food hygiene,
Correct sewage disposal.
⑵ Disinfection and eradication of
insect vectors.
⑶ Intervention of parasite life cycles.
e.g. eradication of snails
in endemic area of schistosomiasis.
3. Protection of the susceptible
persons:
⑴ Immunological prophylaxis:
. Active (vaccination):
intracutaneous inoculation with smallpox
vaccine.
subcutaneous inoculation with hepatitis B
vaccine.
. passive (immunoglobulins):
intramuscular injection with antibodies
against tetanus bacillus.
⑵ Protection from environmental factors:
e.g. mosquitoes bites,
skin penetration by Leptospira and
hookworm larvae.
HBV overlap HEV is__________
A. Primary infection
B.Repeated infection:

C.Mixed infection

D.Superinfection

E.Secondary infection
Which one is not the sourse of infection?
A.Patients
B.Subclinical infection
C. Carriers
D.Infected animals
E.Susceptible persons
3.Which one is the right fever form

A.Sustained fever B.Remittent fever

C.Intermittent fever D.relapsing fever
E.Irregular fever
Thank you very much.