The Spread of Infection

Reservoirs of Infection
For a disease to perpetuate itself there must be a continual
source of the disease organisms. This source can be either a
living organism or an inanimate object that provides a
pathogen with adequate conditions for survival and
multiplication and an opportunity for transmission. Such a
source is called a reservoir of infection. These reservoirs
may be human, animal, or nonliving.
Human Reservoirs
The principal living reservoir of human disease is the human body itself. Many people harbor
pathogens and transmit them directly or indirectly to others. People with signs and symptoms of
a disease may transmit the disease; in addition, some people can harbor pathogens and transmit
them to others without exhibiting any signs of illness. These people, called carriers, are
important living reservoirs of infection. Some carriers have unapparent infections for which no
signs or symptoms are ever exhibited. Other people, such as those with latent diseases, carry a
disease during its symptom-free stages—during the incubation period (before symptoms appear)
or during the convalescent period (recovery). Typhoid Mary is an example of a carrier. Human
carriers play an important role in the spread of such diseases as AIDS, diphtheria,
typhoid fever, hepatitis, gonorrhea, amebic dysentery, and streptococcal infections.
Animal Reservoirs
Both wild and domestic animals are living reservoirs of microorganisms that can
cause human diseases. Diseases that occur primarily in wild and domestic animals
and can be transmitted to humans are called zoonoses (singular: zoonosis). Rabies
(found in bats, skunks, foxes, dogs, and coyotes), and Lyme disease (found in field
mice) are examples of zoonoses. Other representative zoonoses are presented in
Table 14.2.
About 150 zoonoses are known. The transmission of zoonoses to humans can occur

via one of many routes: by direct contact with infected animals; by direct contact

with domestic pet waste (such as cleaning a litter box or bird cage); by

contamination of food and water; by air from contaminated hides, fur, or feathers;

by consuming infected animal products; or by insect vectors (insects that transmit

pathogens).
Nonliving Reservoirs
The two major nonliving reservoirs of infectious disease are soil and water. Soil harbors such
pathogens as fungi, which cause mycoses such as ringworm and systemic infections;
Clostridium botulinum, the bacterium that causes botulism; and C. tetani, the bacterium that
causes tetanus. Because both species of clostridia are part of the normal intestinal microbiota
of horses and cattle, the bacteria are found especially in soil where animal feces are used as
fertilizer. Water that’s been contaminated by the feces of humans and other animals is

a reservoir for several pathogens, notably those responsible for gastrointestinal

diseases. These include Vibrio cholerae, which causes cholera; Cryptosporidium, one
cause of diarrhea; and Salmonella typhi, which causes typhoid fever. Other nonliving
reservoirs include foods that are improperly prepared or stored. They may be sources
of diseases such as trichinellosis and salmonellosis.
 Transmission of Disease
The causative agents of disease can be transmitted
from the reservoir of infection to a susceptible host
by three principal routes: contact, vehicles, and
vectors.
Contact Transmission
Contact transmission is the spread of a disease agent by direct contact, indirect contact, or
droplet transmission. Direct contact transmission, also known as person-to-person
transmission, is the direct transmission of an agent by physical contact between its source and
a susceptible host; no intermediate object is involved ( Figure 14.6a). The most common forms of
direct contact transmission are touching, kissing, and sexual intercourse. Among the diseases
that can be transmitted by direct contact are viral respiratory tract diseases (the common cold
and influenza), staphylococcal infections, hepatitis A, measles, scarlet fever, and sexually
transmitted infections (syphilis, gonorrhea, and genital herpes). Direct contact is also one way
to spread AIDS and infectious mononucleosis. To guard against person to-person
transmission, health care workers use gloves and other protective measures (Figure 14.6b).
Potential pathogens can also be transmitted by direct contact from animals (or animal
products) to humans. Examples are the pathogens causing rabies (direct contact via bites) and
anthrax.
Indirect contact transmission occurs when the agent of disease is transmitted

from its reservoir to a susceptible host by means of a nonliving object. The general

term for any nonliving object involved in the spread of an infection is a fomite.

Examples of fomites are tissues, handkerchiefs, towels, bedding, diapers, drinking

cups, eating utensils, toys, money, and thermometers (Figure 14.6c).

Contaminated syringes serve as fomites in transmitting AIDS and hepatitis B.

Other fomites may transmit diseases such as tetanus.

Droplet transmission is a third type of contact transmission in which microbes are spread in
droplet nuclei (mucus droplets) that travel only short distances (Figure 14.6d). These droplets are
discharged into the air by coughing, sneezing, laughing, or talking and travel less than 1 meter
from the reservoir to the host. One sneeze may produce 20,000 droplets. Disease agents that travel
such short distances are not considered airborne (airborne transmission is discussed shortly).
Examples of diseases spread by droplet transmission are influenza, pneumonia, and pertussis
(whooping cough).
Vehicle Transmission
Vehicle transmission is the transmission of disease agents by a medium, such as
water, food, or air (Figure 14.7). Other media include blood and other body fluids, drugs,
and intravenous fluids.
In waterborne transmission, pathogens are usually spread by water contaminated with

untreated or poorly treated sewage. Diseases transmitted via this route include cholera,

waterborne shigellosis, and leptospirosis.

In foodborne transmission, pathogens are generally transmitted in foods that are

incompletely cooked, poorly refrigerated, or prepared under unsanitary conditions.

Foodborne pathogens cause diseases such as food poisoning and tapeworm infestation.
Airborne transmission refers to the spread of agents of infection by droplet nuclei in

dust that travel more than 1 meter from the reservoir to the host. For example, microbes

are spread by droplets, which may be discharged in a fine spray from the mouth and nose

during coughing and sneezing (see Figure 14.6d). These droplets are small enough to

remain airborne for prolonged periods. The virus that causes measles and the bacterium

that causes tuberculosis can be transmitted via airborne droplets. Dust particles can

harbor various pathogens. Staphylococci and streptococci can survive on dust and be

transmitted by the airborne route. Spores produced by certain fungi are also transmitted

by the airborne route and can cause such diseases as histoplasmosis, coccidioidomycosis,

and blastomycosis.
Vectors
Arthropods are the most important group of disease vectors— animals that carry

pathogens from one host to another. Arthropod vectors transmit disease by two general

methods.

Mechanical transmission is the passive transport of the pathogens on the insect’s feet

or other body parts (Figure 14.8). If the insect makes contact with a host’s food,

pathogens can be transferred to the food and later swallowed by the host. Houseflies,

for instance, can transfer the pathogens of typhoid fever and bacillary dysentery

(shigellosis) from the feces of infected people to food.

Biological transmission is an active process and is more complex. The arthropod bites

an infected person or animal and ingests some of the infected blood. The pathogens

then reproduce in the vector, and the increase in the number of pathogens increases

the possibility that they will be transmitted to another host. Some parasites reproduce

in the gut of the arthropod; these can be passed with feces. If the arthropod defecates

or vomits while biting a potential host, the parasite can enter the wound. Other

parasites reproduce in the vector’s gut and migrate to the salivary gland; these are

directly injected into a bite. Some protozoan and helminthic parasites use the vector as

a host for a developmental stage in their life cycle.