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SARS: Severe Acute Respiratory Syndrome Microbiology With Diseases by Taxonomy PowerPoint® Lecture Slides Second Edition 14 Infection, Infectious Diseases, and Epidemiology Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings 2003 Chapter opener 14 Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Chapter Objectives Symbiotic Relationships Relationships between microbes and hosts Attachment and penetration Infectious diseases Mechanism of leaving host Sources of infections How they are spread Epidemiology Symbiosis means “to live together” Describes the relationship between microorganisms and their host Three types Mutualism Commenalism Parasitism skin colon Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings The Three Types of Symbiotic Relationships Normal Microbiota Also termed normal flora and indigenous microbiota Refers to the organisms that colonize the body’s surfaces without normally causing disease Most are commensals Two types Resident microbiota Transient microbiota Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Table 14.1 Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings 1 Resident Microbiota Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Resident Microbiota Table 14.2.1 Transient Microbiota Remain in the body for only hours to months before disappearing Found in the same regions as resident microbiota Cannot persist in the body Competition from other microorganisms Elimination by the body’s defenses cells Chemical or physical changes in the body Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Opportunistic (secondary) Pathogens Definition: Normal microbiota or other normally harmless microbes can cause disease under certain circumstances Conditions Immune suppression Changes in the normal microbiota Microbial antagonism from normal microbiota is inhibited Introduction of normal microbiota into unusual site in the body (E. coli from colon to urethra) Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Table 14.2.2 Acquisition of Normal Microbiota Development in the womb is generally free of microorganisms (axenic) Microbiota begins to develop during the birthing process Much of ones resident microbiota established during the first months of life Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Contamination vs. Infection Contamination – the mere presence of microbes in or on the body Infection – results when the organism has evaded the body’s external defenses, multiplied, and become established in the body Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings 2 Portals of Entry Sites through which pathogens enter the body Four major types Skin Mucous membranes Placenta Parenteral route Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Mucous Membranes Skin Outer layer of packed, dead, skin cells usually acts as a barrier to pathogens Some pathogens can enter through openings or cuts Others enter by burrowing into or digesting the outer layers of skin Example? Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Some Pathogens that Cross the Placenta Line the body cavities that are open to the environment Provides a moist, warm environment that is hospitable to pathogens Respiratory tract is the most commonly used site of entry – entry is through the nose, mouth or eyes…examples? Pathogens able to survive the acidic pH of the stomach may use the gastrointestinal tract as a route of entry…examples? Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Parenteral Route Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Table 14.3 Role of adhesion in infection Not a true portal of entry but a means by which they can be circumvented Pathogens deposited directly into tissues beneath the skin or mucous membranes Punctures, cuts, bites, stab wounds, surgery Process by which microorganisms attach themselves to cells Required to successfully establish colonies within the host Uses adhesion factors Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Specialized structures Attachment proteins 3 Attachment Proteins Infection vs. Disease Found on viruses (attachment proteins) and many bacteria (adhesins) LIGANDS: Surface lipoproteins or glycoproteins that bind host cell receptors Interaction of ligand with host receptor can determine specificity for host cells Ability to change or block the ligand or its receptor can prevent infection Inability to make attachment proteins or adhesins renders the microorganisms avirulent Infection is the invasion of the host by a pathogen Disease results only if the invading pathogen alters the normal functions of the body Disease is also referred to as morbidity Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Manifestations of Disease SYMPTOMS – subjective characteristics of disease felt only by the patient SIGNS – objective manifestations of disease that can be observed or measured by others SYNDROME – group of symptoms and signs that characterize a disease or abnormal condition..example? ASYMPTOMATIC, or subclinical, infections lack symptoms but may still have signs of infection Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Etiology Know table 14.5: disease terminology Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Table 14.5 Know the disease categories Definition: Study of the cause of disease Germ theory of disease – disease caused by infections of pathogenic microorganisms Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Table 14.6 4 Koch’s postulates one must satisfy to prove a particular pathogen causes a particular disease Exceptions to Koch’s Postulates Using Koch’s postulates is not feasible in all cases Some pathogens can’t be cultured in the laboratory Some diseases are caused by a combination of pathogens and other cofactors Ethical considerations prevent applying Koch’s postulates to pathogens that require a human host Difficulties in satisfying Koch’s postulates Diseases that can be caused by more than one pathogen Pathogens that are ignored as potential causes of disease Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Figure 14.7 Virulence factors learning objectives Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Virulence Factors of Infectious Disease Explain how the following affect virulence microbial extracellular enzymes toxins adhesion factors antiphagocytic factors Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Pathogenicity – ability of a microorganism to cause disease Virulence – degree of pathogenicity Virulence factors contribute to an organisms virulence Adhesion factors Biofilms Extracellular enzymes Toxins Antiphagocytic factors Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Degrees of virulence Extracellular Enzymes Enzymes secreted by the pathogen Dissolve structural chemicals in the body Help pathogen maintain infection invade further avoid body defenses Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Figure 14.8 Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings 5 Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Figure 14.9a (1 of 2) Toxins Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Figure 14.9a (2 of 2) Exotoxins and endotoxins Chemicals that harm tissues or trigger host immune responses that cause damage Toxemia refers to toxins in the bloodstream that are carried beyond the site of infection Two types Exotoxins Endotoxins Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Figure 14.9b (1 of 2) Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Figure 14.9b (2 of 2) 6 A Comparison of Bacterial Exotoxins and Endotoxins Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Exotoxin diseases Table 14.7 Antiphagocytic Factors Certain factors prevent phagocytosis by the host’s phagocytic cells Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Bacterial capsule Often composed of chemicals found in the body and not recognized as foreign Can be slippery making it difficult for phagocytes to engulf the bacteria Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Figure 14.9c (1 of 2) The Stages of Infectious Disease Antiphagocytic chemicals Some prevent fusion of lysosome and phagocytic vesicles Leukocidins directly destroy phagocytic white blood cells Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Figure 14.9c (2 of 2) Following infection, sequence of events called the disease process occurs Many infectious diseases have five stages following infection Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings 7 Movement of Pathogen Out of Host Pathogens leave host through portals of exit Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Table 14.8 Reservoirs of Infection Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Animal Reservoirs Most pathogens cannot survive long outside of their host reservoirs of infection: sites where pathogens are maintained as a source of infection Three types of reservoirs Animal reservoir Human carriers Nonliving reservoir Zoonoses – diseases that are naturally spread from their usual 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 Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Zoonoses: know this table Human Carriers Infected individuals who are asymptomatic but infective to others Some individuals will eventually develop illness while others never get sick Healthy carriers may have defensive systems that protect them from illness Haydon DT, Cleaveland S, Taylor LH, Laurenson MK. Identifying reservoirs of infection: a conceptual and practical challenge. Emerg Infect Dis [serial online] 2002 Dec [date cited];8. Available from: URL: http://www.cdc.gov/ncidod/EID/vol8no12/010317.htm Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Table 14.9 Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings 8 Nonliving Reservoirs Soil, water, and food can be reservoirs of infection Presence of microorganisms is often due to contamination by feces or urine E. coli in Spinach Update; 183 Cases Reported Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Modes of Infectious Disease Transmission Transmission from either a reservoir or portal of exit Three groups: Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Transmission Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Figure 14.12 Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Table 14.11 Fly mechanical Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings 9 Classification of Infectious Diseases KNOW Terms Used to Classify Infectious Diseases Many different methods of classification The body system they affect The taxonomic groups of the causative agent Their longevity and severity How they are spread to their host Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Epidemiology Table 14.12 Incidence vs. prevalence p. 425 DEFINITION: Study of where and when diseases occur and how they are transmitted within populations Track occurrence of diseases using two measures Incidence – number of new cases of a disease in a given area during a given period of time Prevalence – number of total cases of a disease in a given area during a given period of time Incidence = no. of new cases no. of people at risk Prevalence = no of old and new cases no. of people at risk Occurrence also evaluated in terms of frequency and geographic distribution PLAY Animation: Epidemiology Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Shigellosis in U.S. in 2000 Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Figure 14.13 Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Figure 14.14 - Overview 10 Occurrence of Disease Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Figure 14.15a-d Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Figure 14.16 Figure 14.17 Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Table 14.13 (1 of 2) http://www.cdc.gov/mmwr/ Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Epidemiologists Study Disease Dynamics Using Three Approaches Descriptive Analytical Experimental Legionnaires’ Disease Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Table 14.13 (2 of 2) Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings 11 Descriptive Epidemiology Descriptive study in 1854 cholera outbreak in London (p431) Careful tabulation of data concerning a disease Record information about the location and time of the cases of disease Collect patient information Try to identify the index case (or first case) of the disease Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Figure 14.18 Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings UN 14.2 Analytical Epidemiology Seeks to determine the probable cause, mode of transmission, and methods of prevention Useful in situations in which Koch’s postulates can’t be applied Often retrospective – investigation occurs after an outbreak has occurred Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Experimental Epidemiology Nosocomial Infections Involves testing a hypothesis concerning the cause of a disease Application of Koch’s postulates is experimental epidemiology Infections acquired while in a health care facility Types of nosocomial infections Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Exogenous – pathogen acquired from the health care environment Endogenous – pathogen arise from normal microbiota due to factors within the health care setting Iatrogenic – results from modern medical procedures 12 Nosocomial Infections Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Frequency Figure 14.19 Microbes Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Control of Nosocomial Infections Involves precautions designed to reduce the factors that result in disease Hand washing is the most effective way to reduce nosocomial infections Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Infection sites Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Epidemiology and Public Health Agencies at the local, state, national, and global level share information concerning disease The United States Public Health Service is the national public health agency World Health Organization (WHO) coordinates public health services internationally Public health agencies work to limit disease transmission Monitor water and food safety Public health agencies campaign to educate the public on healthful choices to limit disease Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings 13 Katrina 2005 p. 433 Copyright © 2007 Pearson Education, Inc. publishing as Benjamin Cummings UN 14.4 14
