INFECTIOUS AGENTS

Reservoirs of infection
Means of transmission
Chain of infection
• Reservoirs of infection
– Sites where pathogens are maintained as a source
of infection
• Three types of reservoirs
– Animal reservoirs
– Human carriers
– Nonliving reservoirs
Reservoirs of Infectious Diseases of Humans

• Animal Reservoirs
– Zoonoses
• Diseases naturally spread from animal host to
humans
– Acquire zoonoses through various routes
• Direct contact with animal or its waste
• Eating animals
• Bloodsucking arthropods
– Humans are usually dead-end host to zoonotic
pathogens
 Reservoirs of Infectious Diseases of Humans

• Human Carriers
– Infected individuals who are asymptomatic
but infective to others
– Some individuals eventually develop illness
while others never get sick
– Healthy carriers may have defensive systems
that protect them
 Reservoirs of Infectious Diseases of Humans

• Nonliving Reservoirs
– Soil, water, and food can be reservoirs of
infection
• Presence of microorganisms often due to
contamination by feces or urine
The Movement of Microbes into Hosts: Infection

• Exposure to Microbes: Contamination and

Infection
– Contamination
• The mere presence of microbes in or on the body
– Infection
• When organism evades body’s external defenses,
multiplies, and becomes established in the body
What are the modes of transmission?

 Exposure occurs through either direct

or indirect contact.  
 
Direct transmission 
 occurs when a pathogen is transmitted
directly from an infected individual to you.  

 For example, you could become infected

with HBV if you had an open wound that
came into contact with a patient’s HBV
infected blood.  
Indirect transmission 
 occurs when an inanimate object serves as a
temporary reservoir for the infectious agent.  

 For example, you could become infected with

HBV if you come into contact with equipment
that has dried infectious blood on it.
The Movement of Microbes into Hosts: Infection

• Portals of Entry
– Sites through which pathogens enter the
body
– Four major pathways
• Skin
• Mucous membranes
• Placenta
• Parenteral route
 Figure 14.3 Routes of entry for invading pathogens

Ear

Broken
skin

Insect Conjunctiva
bite of eye

Nose

Mouth

Placenta

Vagina
Anus In males:
Penis

Urethra
The Movement of Microbes into Hosts: Infection

• Portals of Entry
– Skin
• Outer layer of dead skin cells acts as a barrier
to pathogens
• Some pathogens can enter through openings
or cuts
• Others burrow into or digest outer layers of
skin
The Movement of Microbes into Hosts: Infection

• Portals of Entry
– Mucous membranes
• Line the body cavities that are open to the
environment
• Provide a moist, warm environment hospitable to
pathogens
• Respiratory tract is the most common site of entry
– Entry is through the nose, mouth, or eyes
• Gastrointestinal tract may be route of entry
– Must survive the acidic pH of the stomach
The Movement of Microbes into Hosts: Infection

• Portals of Entry
– Placenta
• Typically forms effective barrier to pathogens
• Pathogens may cross the placenta and infect the
fetus
– Can cause spontaneous abortion, birth defects,
premature birth
The Movement of Microbes into Hosts: Infection

• Portals of Entry
– Parenteral route
• Not a true portal of entry
• Means by which the portal of entry can be
circumvented
• Pathogens deposited directly into tissues beneath
the skin or mucous membranes
The Movement of Microbes into Hosts: Infection

• The Role of Adhesion in Infection

– Process by which microorganisms attach
themselves to cells
– Required to successfully establish colonies
within the host
– Uses adhesion factors
• Specialized structures
• Attachment proteins
• Respiratory pathogens such as
– influenza viruses
– rhinoviruses and Ebola
– S. pneumoniae
– H. influenzae
– L. pneumophila
– Y. pestis 
– B. anthracis

– all can enter through the mucus membranes of the

respiratory tract. All of these can be transmitted by
aerosol droplets released during coughing and sneezing. 
Many of these can enter the respiratory tract via the
nasolacrimal ducts when a person rubs their eyes.
• Organisms such as
– C. jejuni
– S. typhimurium
– E. coli
– H. pylori
– V. cholerae
– Shigella 

– use the gastrointestinal route, carried by vehicles

such as food and water. 
– Transmission is generally via fecal-contamination.
Examples of pathogens that enter through the mucus membranes of
the genitourinary tract are:

• Treponema pallidum
• Neisseria gonorrhoeae
• Chlamydia trachomatis
• papilloma viruses
• Herpes simplex II
• HIV
– Though most are sexually transmitted, some can be transmitted
nosocomially such as urinary tract infections caused by 
• Proteus mirabilis
• P. vulgaris 
• E. coli
• S. epidermidis.
The Nature of Infectious Disease

• Infection is the invasion of the host by a

pathogen
• Disease results if the invading pathogen
alters normal body functions
• Disease is also referred to as morbidity
 The Nature of Infectious Disease
• Manifestations of Disease: Symptoms, Signs, and
Syndromes
– Symptoms
• Subjective characteristics of disease felt only by the patient
– Signs
• Objective manifestations of disease observed or measured by
others
– Syndrome
• Symptoms and signs that characterize a disease or abnormal
condition
– Asymptomatic, or subclinical, infections lack symptoms but
may still have signs of infection
 The Nature of Infectious Disease

• Causation of Disease: Etiology

– Study of the cause of disease
– Germ theory of disease
• Disease caused by infections of pathogenic
microorganisms
– Robert Koch developed a set of postulates to
prove a particular pathogen causes a particular
disease
 The Nature of Infectious Disease

• Causation of Disease: Etiology

– Exceptions to Koch’s postulates
• Some pathogens can’t be cultured in the laboratory
• Diseases caused by a combination of pathogens and
other cofactors
• Pathogens that require a human host
– Difficulties in satisfying Koch’s postulates
• Diseases can be caused by more than one pathogen
• Pathogens that are ignored as potential causes of
disease
 The Nature of Infectious Disease

• Virulence Factors of Infectious Agents

– Pathogenicity
• Ability of a microorganism to cause disease
– Virulence
• Degree of pathogenicity
• Virulence factors contribute to virulence
– Adhesion factors
– Biofilms
– Extracellular enzymes
– Toxins
– Antiphagocytic factors
Figure 14.8 Relative virulence of some microbial pathogens

More virulent

Francisella tularensis
(rabbit fever)

Yersinia pestis
(plague)

Bordetella pertussis
(whooping cough)

Pseudomonas aeruginosa
(infections of burns)

Clostridium difficile
(antibiotic-induced colitis)

Candida albicans
(vaginitis, thrush)

Lactobacilli, diphtheroids

Less virulent
 The Nature of Infectious Disease

• The Stages of Infectious Disease

– The disease process occurs following infection
– Many infectious diseases have five stages
following infection
• Incubation period
• Prodromal period
• Illness
• Decline
• Convalescence
 Figure 14.10 The stages of infectious diseases

Incubation Prodromal Illness Decline Convalescence

period period (most severe signs (declining signs (no signs or
(no signs or (vague, and symptoms) and symptoms) symptoms)
intensity of signs or symptoms
Number of microorganisms or

symptoms) general
symptoms)

Time
The Movement of Pathogens Out of Hosts: Portals of Exit

• Pathogens leave host through portals of exit

• Many portals of exit are the same as portals
of entry
• Pathogens often leave hosts in materials the
body secretes or excretes
 Figure 14.11 Portals of exit
Eyes
(tears)
Ear
(earwax) Nose
(secretions)
Broken skin
(blood) Mouth
(saliva, sputum)

Skin
(flakes)
In females:
Mammary glands
(milk, secretions)

Vagina
(secretions, blood)

Anus Seminal vesicles Urethra

(feces) (semen and lubricating secretions) (urine)
Modes of Infectious Disease Transmission

• Transmission is from a reservoir or a portal of

exit to another host’s portal of entry
• Three groups of transmission
– Contact transmission
• Direct, indirect, or droplet
– Vehicle transmission
• Airborne, waterborne, or foodborne
– Vector transmission
• Biological or mechanical
 Classification of Infectious Diseases

• Terms used to classify infectious disease

– Acute disease
– Chronic disease
– Subacute disease
– Latent disease
– Communicable
– Contagious
The Chain of Infection
it is important to
understand two
things about
infection:
1. the various ways infection can
be transmitted

2. the ways the infection chain can

be broken
There are six links
in the chain of
infection :
 1st - The Infectious Agent

-any disease-causing
microorganism
(pathogen)
2nd - The Reservoir Host

-the organism in which the

infectious microbes reside
 What are “Carrier Hosts”
Hosts that do not show any outward signs or
symptoms of a disease but are still capable
of transmitting the disease are known as
carriers.
 3rd - The Portal of Exit
-route of escape of the pathogen
from the reservoir.

Examples: respiratory
secretions, blood
exposure, breaks in
skin
4th - The Route of Transmission

-method by which the

pathogen gets from the
reservoir to the new host
Transmission may occur through:

direct
contact
air
insects
 5th - The Portal of Entry

-route through which the

pathogen enters its new host
 Respiratory System

o n
t i
a la
h
in
 Gastrointestinal System

on
sti
ge
in
 Urinary & Reproductive Tracts
n t al
co x u
t
ac
Se
Breaks in Protective Skin Barrier
 6th - The Susceptible Host

-the organism that accepts the

pathogen

The support of pathogen life & its

reproduction depend on the degree
of the host’s resistance.
 Organisms with strong immune
systems are better able to fend off
pathogens.
 Organisms with weakened immune
systems are more vulnerable to the
support & reproduction of pathogens.
 How to interrupt the chain of
infection:
-The essential part of patient care
& self-protection.
 1. Pathogen Identification

-identification of infectious
agent & appropriate treatment
 2. Asepsis & Hygiene
-potential hosts
& carriers must
practice asepsis
& maintain
proper personal
hygiene
 3. Control Portals of Exit

-healthcare personnel must

practice standard precautions:
(Control body secretions & wash
hands according to protocol.)
 4. Prevent a Route of Transmission
-prevent direct or indirect contact by:

1. Proper hand washing

2. Disinfection & sterilization techniques

3. Isolation of infected patients

4. Not working when contagious

 5. Protect Portal of Entry
-Health professionals must make
sure that ports of entry are not
subjected to pathogens.

(nose, mouth, eyes, urinary tract,

open wounds, etc.)
6. Recognition of Susceptible Host

-health professionals must

recognize & protect high-risk
patients
•Cancer Patients
•AIDS Patients
•Transplant Patients
•Infant & Elderly
Patients