CSLO8. Explain transmission and virulence mechanisms of cellular and acellular infectious agents.

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1 PowerPoint Lecture Presentations prepared by Mindy Miller-Kittrell, North Carolina State University CSLO8. Explain transmission and virulence mechanisms of cellular and acellular infectious agents. C H A P T E R 14 Infection, Infectious Diseases, and Epidemiology

2 Symbiotic Relationships Between Microbes and Their Hosts CONCEPT 14.1 Symbiosis means "to live together We have symbiotic relationships with countless microorganisms 3 Types of symbiosis Mutualism Commensalism Parasitism

3 CONCEPT 14.1 Any parasite that cause disease is called a pathogen

4 Symbiotic Relationships Between Microbes and Their Hosts CONCEPT 14.2 Normal Microbiota in Hosts Organisms that colonize the body's surfaces without normally causing disease is called normal microbiota Also termed normal flora and indigenous microbiota Two types 1) Resident microbiota 2) Transient microbiota

5 Normal Microbiota in Hosts 1) Resident microbiota CONCEPT 14.3 Are a part of the normal microbiota throughout life Are mostly commensal (one benefits other - no benefit no harm)

6 Normal Microbiota in Hosts 2) Transient microbiota CONCEPT 14.4 Found in the same regions as resident microbiota but remain for short time Cannot persist in the body because of following reasons 1) Competition from other microorganisms 2) Elimination by the body's defense cells 3) Chemical or physical changes in the body

7 Acquisition of Normal Microbiota in Hosts While fetus is developing in womb which is free of microorganisms called axenic) CONCEPT 14.5 (free of microorganisms = axenic) Microbiota begin to develop during birthing process Much of one's resident microbiota established during first months of life

8 What are Opportunistic Pathogens? CONCEPT 14.6 Opportunistic pathogens are normal microbiota that cause disease under certain circumstances CONCEPT 14.7 There are 3 ways by which Normal Microbiota become Opportunistic Pathogens 1) Introduction of normal microbiota into unusual site in body e.g. E.coli 2) Immune suppression e.g. AIDs 3) Changes in relative abundance of the normal microbiota may decrease microbial antagonism/competition and allow opportunity for a member to thrive and cause disease

9 Reservoirs of Infectious Diseases of Humans Reservoirs of infection are sites CONCEPT 14.8 where pathogens are maintained as a source of infection Most pathogens cannot survive for long outside of their host Three types of reservoirs CONCEPT ) Animal reservoir 2) Human carriers 3) Nonliving reservoir

10 1) Animal Reservoirs are called Zoonoses CONCEPT Zoonoses are Diseases naturally spread from animal host to humans CONCEPT Humans can acquire zoonoses through various routes A) Direct contact with animal or its waste B) Eating animals fruit bats Ebola connection C) Bloodsucking arthropods

11 e.g. Rabies virus (bats/foxes/skunks) spread to domesticated pets then to humans

12 Reservoirs of Infectious Diseases of Humans 2) Human Carriers CONCEPT Asymptomatic infected individuals can be infective to others Healthy carriers may have defensive systems that protect them Some individuals eventually develop illness while others never get sick 3) Nonliving Reservoirs CONCEPT Soil, water, and food can be reservoirs of infection Presence of microorganisms often due to contamination by feces or urine

13 CONCEPT Exposure to Microbes: Contamination/Infection/Disease Contamination = the mere presence of microbes in or on the body Infection is the invasion of the host by a pathogen Infection = when organism evades body's external defenses, multiplies, and becomes established in the body Infection may or may not result in disease Disease results if the invading pathogen alters normal body functions Disease is also referred to as morbidity

14 The Invasion and Establishment of Microbes in Hosts: Infection CONCEPT Portals of Entry are sites through which pathogens enter the body 4 major portals of entry 1. Skin 2. Mucous membranes 3. Placenta 4. Entry via the parenteral route circumvents the usual portals - punctures by nail, needle

15 The Invasion and Establishment of Microbes in Hosts: Infection 1) Portals of Entry : Skin CONCEPT Outer layer of dead skin cells acts as a barrier to pathogens Some pathogens can enter through openings or cuts Others enter by burrowing into or digesting outer layers of skin

16 The Invasion and Establishment of Microbes in Hosts: Infection 2) Portals of Entry : Mucous Membrane CONCEPT 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 (viruses) cold/influenza virus Gastrointestinal tract may be route of entry Must survive the acidic ph of the stomach

17 The Invasion and Establishment of Microbes in Hosts: Infection 3) Portals of Entry : Placenta CONCEPT Typically placenta forms effective barrier to pathogens Pathogens may cross the placenta and infect the fetus Can cause spontaneous abortion, birth defects, premature birth

18 The Invasion and Establishment of Microbes in Hosts: Infection 4) Portals of Entry : Parenteral route CONCEPT Not a true portal of entry Means by which portals of entry can be circumvented Pathogens deposited directly into tissues beneath the skin or mucous membranes nail/thorn/needles/cuts/bites/surgery

19 The Invasion and Establishment of Microbes in Hosts: Infection The Role of Adhesion in Infection CONCEPT Adhesion is process by which microorganisms attach themselves to cells and is required to successfully establish colonies within the host Uses adhesion factors 1) Specialized structures fimbriae/glycocalyx 1) Attachment proteins

20 Attachment proteins help in adhesion Found on viruses and many bacteria Viral or bacterial ligands bind host cell receptors - Interaction can determine host cell specificity Clinical Importance = Changing/blocking a ligand or its receptor can prevent infection

21 The Nature of Infectious Disease Manifestations of Disease: Symptoms, Signs, and Syndromes What are Symptoms? Subjective characteristics of disease felt only by the patient What are Signs? Objective manifestations of disease observed or measured by others What is a Syndrome? Symptoms and signs that characterize a disease or abnormal condition Asymptomatic, or subclinical, infections lack symptoms but may still have signs of infection CONCEPT 14.21

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23 The Nature of Infectious Disease CONCEPT Etiology = Study of the cause of disease Diseases have various causes

24 Find Causes of Disease Using Koch's postulates CONCEPT Robert Koch developed a set of postulates one must satisfy to prove a particular pathogen causes a particular disease Exceptions to Koch's postulates Some pathogens can't be cultured in the laboratory Diseases caused by a combination of pathogens and other cofactors Ethical considerations prevent applying Koch's postulates to pathogens that require a human host

25 What is Pathogenicity and Virulence? CONCEPT What is the Difference between them? Virulence Factors of Infectious Agents Pathogenicity Ability of a microorganism to cause disease Virulence How easily the organism can cause disease Not about severity of the disease it causes but how easily it causes disease An organism (species or strain) is defined as being pathogenic (or not), and depending upon conditions, may exhibit different levels of virulence.

26 Figure 14.8 Relative virulence of some microbial pathogens. CONCEPT All are pathogenic but less or more virulent Opportunistic pathogens

27 Virulence Factors of Infectious Agents CONCEPT ) Extracellular enzymes Secreted by the pathogen Dissolve structural chemicals in the body Help pathogen maintain infection, invade, and avoid body defenses

28 Virulence Factors of Infectious Agents CONCEPT ) Toxins are chemicals that harm tissues or trigger host immune responses that cause damage Two types of toxin are seen 1) Exotoxins 2) Endotoxins Toxemia is a condition that refers to the presence of toxins in the bloodstream and means the toxins are carried beyond the site of infection.

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30 The Nature of Infectious Disease CONCEPT Virulence Factors of Infectious Agents 3) Antiphagocytic factors Factors prevent phagocytosis by the host's phagocytic cells Allow pathogens to remain in a host for longer time 3a) Bacterial capsule Composed of chemicals not recognized as foreign Slippery and difficult for phagocytes to engulf 3b) Antiphagocytic chemicals Prevent fusion of lysosome and phagocytic vesicles Leukocidins directly destroy phagocytic white blood cells

31 Figure 14.9c Some virulence factors. CONCEPT main reasons why capsules block phagocytosis 1) They are Slippery 2) Hyaluronic acid or other normal body components seen in capsules Phagocytosis blocked by capsule Incomplete phagocytosis Capsule around bacterium Capsule around bacterium Bacteria reproduce Phagocyte Phagocytic vesicle Lysosome Antiphagocytic factors

32 The Nature of Infectious Disease The Stages of Infectious Disease CONCEPT The disease process occurs following infection Many infectious diseases have five stages following infection Incubation period Prodromal period ipidc Illness Decline Convalescence

33 The Movement of Pathogens Out of Hosts: Portals of Exit CONCEPT 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

34 Modes of Infectious Disease Transmission CONCEPT Transmission is from a reservoir or a portal of exit to another host's portal of entry Three groups of transmission 1) Contact transmission 2) Vehicle transmission 3) Vector transmission

35 Modes of Infectious Disease Transmission CONCEPT ) Contact Transmission 1a) Direct contact transmission Usually involves body contact between hosts Transmission within a single individual can also occur 1b) Indirect contact transmission Pathogens are spread from host to host by fomites (inanimate objects needles AIDS/hepatitis B) 1c) Droplet transmission Spread of pathogens in droplets of mucus by exhaling, coughing, and sneezing

36 Modes of Infectious Disease Transmission CONCEPT ) Vehicle Transmission 2a) Airborne transmission When pathogens travel more than 1 meter via an aerosol Aerosols can occur from various activities Sneezing, coughing, air-conditioning systems, sweeping 2b) Waterborne transmission Important in the spread of many gastrointestinal diseases Fecal-oral infection

37 Modes of Infectious Disease Transmission CONCEPT ) Vehicle Transmission 2c) Foodborne transmission Spread of pathogens in and on foods Inadequately processed, cooked, or refrigerated foods Foods may become contaminated with feces 2d) Bodily fluid transmission Bodily fluids such as blood, urine, saliva can carry pathogens Prevent contact with conjunctiva or breaks in the skin or mucous membranes

38 Modes of Infectious Disease Transmission CONCEPT ) Vector Transmission (animals which transmit) 3a) Biological vectors Transmit pathogens and serve as host for some stage of the pathogen's life cycle Biting arthropods transmit many diseases to humans 3b) Mechanical vectors Passively transmit pathogens present on their body to new hosts

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41 CONCEPT Classification of Infectious Diseases Diseases can be classified in a number of ways The body system they affect Taxonomic categories Their longevity and severity How they are spread to their host The effects they have on populations

42 CONCEPT 14.35

43 CONCEPT So far we looked at Effect of pathogens on individuals If studying effect of pathogens on populations - Epidemiology Study of where and when disease occur and how they are transmitted in populations e.g. Study Frequency of Disease

44 Epidemiology of Infectious Diseases CONCEPT Study Frequency of Disease - Track occurrence of diseases using two measures 1) Incidence Number of new cases of a disease in a given area during a given period of time 2) Prevalence (always larger than incidence) Number of total cases (old and new) of a disease in a given area during a given period of time

45 Figure Curves representing the incidence and the estimated prevalence of AIDS among U.S. adults. CONCEPT 14.37

46 CONCEPT Figure Epidemiologists report data in a variety of ways. - to find patterns which may give clues as to cause or cure

47 Figure Epidemics may have fewer cases than nonepidemics. Not about numbers but frequency CONCEPT Epidemic 1 Epidemic 2 Expected number of cases Actual number of cases Disease A Actual number of cases Disease B

48 Figure Illustrations of the different terms for the occurrence of disease. CONCEPT Ebola?

49 CDC s weekly Morbidity and Mortality Weekly Report (MMWR) reports on the number of cases of most of the nationally notifiable diseases Figure A page from the MMWR.

50 Epidemiology of Infectious Diseases CONCEPT How do they conduct Epidemiological Studies? 3 methods - Descriptive/Analytical/Experimental 1) Descriptive epidemiology Careful tabulation of data concerning a disease Record location and time of the cases of disease Collect patient information Try to identify the index case of the disease

51 Epidemiology of Infectious Diseases CONCEPT How do they conduct Epidemiological Studies? 2) Analytical epidemiology Seeks to determine the probable cause, mode of transmission, and methods of prevention 3) Experimental epidemiology Test a hypothesis concerning the cause of a disease Application of Koch's postulates

52 Figure A map showing cholera deaths in a section of London, CONCEPT methods - Descriptive/Analytical Record location and time of the cases of disease Collect patient information Seeks to determine the probable cause, mode of transmission, and methods of prevention

53 Figure The interplay of factors that result in nosocomial infections. CONCEPT 14.41

54 Epidemiology of Infectious Diseases CONCEPT Hospital Epidemiology: Nosocomial Infections Types of nosocomial infections 1) Exogenous Pathogen acquired from the health care environment 2) Endogenous Pathogen arises from normal microbiota due to factors within the health care setting 3) Latrogenic (procedure/technique induced) Results from modern medical procedures 4) Superinfections Use of antimicrobial drugs reduces competition from some resident microbiota other microbes may thrive

55 Epidemiology of Infectious Diseases CONCEPT Hospital Epidemiology: Nosocomial Infections Control of nosocomial infections Requires aggressive control measures Handwashing is the most effective way to reduce nosocomial infections

56 Epidemiology of Infectious Diseases CONCEPT Epidemiology and Public Health 1) Sharing of data among public health organizations Agencies at the local, state, national, and global level share information concerning disease National - The United States Public Health Service National public health agency CDC is one branch Global - World Health Organization (WHO) Coordinates public health efforts worldwide

57 Epidemiology and Public Health CONCEPT ) Role of public health agencies in interrupting disease transmission Monitor water and food safety Work to reduce disease vectors and reservoirs Establish and enforce immunization schedules Locate and treat individuals exposed to contagious pathogens Establish isolation and quarantine measures 3) Public health education Public health agencies campaign to educate the public on healthful choices to limit disease

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