Principles of Disease and Epidemiology Symbiosis living together An association between two or more species and one species is typically dependent on the other Mutualism - Commensalism - Parasitism - Infection = multiplication of any parasitic organism within or on the host s body. If the infection disrupts the normal functioning of the host then disease occurs I. Disease The production of a change in the normal physiology of the body, the disruption of normal body functions Microbial diseases are caused by infection (i.e., growth or replication of the pathogen within the body) or toxins produced by the pathogen. Note: Infections do not always cause disease Changes in host may be mild, severe but reversible or irreversible Pathology is the study of disease and is concerned with the following. Etiology - the cause of disease Pathogenesis (Pathos = disease, genesis = development) = mechanism by which a pathogen causes disease (i.e., factors involved in the development of disease). In other words, the manner in which a disease develops Structural and functional changes brought about by disease and the final effects on the body Pathogen = disease causing (etiologic) agent, a parasite pathogenicity is the capacity to produce disease and depends on a number of factors o ability of pathogen to invade host o ability of pathogen to multiply in host o ability of pathogen to avoid host defenses o the number of infectious organisms that enter the body (Shigella needs only 10 cells to cause dysentery) virulence is the degree or intensity of the disease caused by the pathogen; it is the quantitative measure of disease. May be expressed as the number of pathogen cells that elicit a pathogenic response in a host within a given time period Pathogenesis is the mechanism by which a pathogen causes disease (i.e., factors involved in the development of disease).
II. Normal (indigenous) microbiota An adult human is made of 10 13 cells and hosts 10 times that many microorganisms on the skin and mucous membranes and in the passageways of the respiratory, digestive and reproductive systems. Normal microbiota - Organisms that live in or on the host but do not cause disease under normal conditions. These organisms colonize (establish more or less permanent residence) the host and are able to multiply. Bacteria, archaea, fungi and protozoa are common inhabitants of the human body. Transient microbiota persist on the host for short periods of time as long as necessary conditions are met. Most are not capable of multiplying on the host Many factors affect the distribution and composition of the normal microbiota including: o Nutrients o chemical and physical factors (e.g., temperature, ph, available O 2 and CO 2, salinity and sunlight) o defenses of the host o mechanical factors (e.g., chewing action of the teeth, flow of saliva, peristalsis in the intestine, ) o Germfree animals (devoid of microbiota) may be reared in the laboratory. Animals colonized by specific strains of microorganisms (gnotobiotic animals) are also created in the laboratory. Normal microbiota can benefit the host in a number of ways o Microbial antagonism (competitive exclusion) prevent overgrowth of harmful microorganisms through competition for resources including nutrients, producing harmful substances and affecting conditions (e.g., ph and available O 2 ) o Probiotic a live microbial culture that is consumed or applied for the purpose of exerting a beneficial effect on the host o Prebiotic a chemical (usually a dietary constituent) that selectively promotes growth of beneficial microorganisms Opportunistic pathogens do not usually but may cause disease but under certain circumstances: o Failure of host s normal defenses immunocompromised individuals because of malnutrition, the presence of another disease, advanced or very young age, treatment with radiation or immunosuppressive drugs and physical or mental stress o Introduction of the organisms into unusual body sites o Disturbances of the normal microflora normal microflora interfere with the growth of pathogens by competing for and depleting resources 2
III. Etiology of Disease How does one go about determining the causative agent (etiologic agent) of a disease? Koch s postulates What are the limitations of Koch s postulates? IV. Classifying Disease Diseases tend to alter body structures and functions in particular ways and these changes are indicated by the manifestation of Symptoms - changes in body function such as pain and malaise (i.e., vague feeling of body discomfort) that are subjective and not apparent to an observer. Signs objective changes that can be observed and measured by a health care professional (e.g., lesions, swelling, fever, paralysis) Diagnosis of a disease is made by evaluating signs, symptoms and laboratory tests A. Kinds of disease Infectious caused by infectious agents such as bacteria, viruses, fungi, protozoa and helminthes o Communicable disease is one that is caused by a pathogen that can be spread from one host to another (contagious diseases are caused by pathogens that are easily spread from one host to the next) o Noncommunicable pathogens are not spread from one host to another Infections caused by an individuals normal microflora Poisoning following ingestion of preformed toxins (botulism) Infection cause by certain organisms found in the environment such as tetanus or legionellosis o Emerging infectious diseases infectious diseases that are new or changing, showing an increase in the incidence in the recent past or a potential to increase in the near future. A number of factors contribute to the emergence of a disease, including new strains or serovars of a pathogen, widespread use of antimicrobial agents or pesticides, global warming and weather change, modern transportation, animal 3
control measures, failure of public health measures, and exposure to pathogens in regions undergoing ecological changes brought about by natural disaster, construction, wars or expanding human settlement. Noninfectious caused by any factor other than infectious organisms B. Occurrence of disease To understand a disease we need to know something about its occurrence Incidence of a disease the number of people in a population who develop the disease during a particular time period Prevalence - the number of people in a population who have the disease at a specified time regardless of when the disease started. Frequency of occurrence is also an important consideration in the understanding of disease Sporadic diseases occur only occasionally (e.g., typhoid fever, cholera) Endemic diseases are always present in a population (e.g., common cold) Epidemic diseases are acquired by many people in a population in a relatively short period of time (e.g., influenza). A pandemic is an epidemic that is worldwide C. Severity or Duration of disease Acute disease develops rapidly but lasts only a short period of time Chronic disease develops more slowly and continue or recur over long periods of time Subacute disease intermediate between acute and chronic diseases Latent disease pathogen remains inactive for a time but becomes active to produce symptoms of disease D. Extent of Host involvment Infections are classified by the extent to which the host s body is affected Local infection infectious microbes are limited to a relatively small area of the body Systemic infections are general infections in which the pathogen or their products are spread throughout the body Focal infection pathogens from a local infection enter the blood or lymphatic vessel and spread to other parts of the body where they are confined Sepsis toxic inflammatory condition arising from the spread of microbes from a local infection Septicemia often called blood poisoning systemic infection arising from multiplication of the pathogen in the blood. The presence of bacteria in the blood is known as a bacteremia. Toxemia refers to the presence of toxins in the blood 4
The state of host resistance also determines the extent of infections Primary infections are acute infections caused by the initial illness. Secondary infection is one caused by opportunistic pathogens due to the weakened state of the host after the primary infection Subclinical infections do not cause noticeable illness E. Factors affecting the occurrence of disease i. Predisposing factors make the body more susceptible to disease e.g., gender, genetic background, climate & weather, indequate nutrition, age, environment, habits, lifestyle, occupation, preexisting illness, chemotherapy, emotional disturbances, stress ii. Reservoirs of infection source of the pathogen can be biotic or abiotic Carrier harbour the pathogen without signs of infection and serve as important living reservoirs of infection Animals may serve as reservoirs for pathogens that infect humans. Infectious diseases that are caused by pathogens that can be transmitted from wild or domestic animals to humans are known as zoonoses iii. Transmission of disease The pathogen is transmitted from the reservoir of infection to the susceptible host by three principal routes Contact o Direct contact (also known as person to person transmission) o Indirect contact pathogen spread from reservoir to host by an inanimate object o Droplet transmission pathogen spread across short distances (up to 1 m) in airborne droplets discharged from an infected individual Vehicle transmission pathogens are spread by a medium such as water, food or air Vectors animals that carry pathogens from host to host. Arthropods are the most important vectors of disease. The spread may through mechanical transmission (passive transport) or biological transmission (an active process often involving the biology of the vector, i.e., vector biting and blood feeding on host) Nosocomial infections hospital acquired infections result from a combination of factors including the weakened state of the host, the microorganisms found in the hospital environment and the chain of transmission in the hospital 5
F. Development of disease There is a definite sequence of events that occurs during infection and disease, once the microorganism overcomes the host defenses. Incubation period interval between initial infection and the first appearance of signs and symptoms. This period depends on a number of factors including the pathogen involved, its virulence, the number of infecting microorganisms and the resistance of the host Prodromal period follows the incubation period in some diseases. It is a relatively short period that is characterized by mild symptoms of the disease including general aches and malaise Period of illness The period when the disease is most severe with the host exhibiting overt signs and symptoms. Generally the hosts immune response and other defense mechanisms overcome the pathogen and the period of illness ends Period of decline the signs and symptoms subside. Host is susceptible to secondary infections at this time Period of convalescence Host regains strength and body returns to its prediseased state V. Epidemiology Epidemiology is the study of when and where diseases occur and how pathogens are transmitted in populations. Epidemiology examines not only the etiology of a disease but also other factors and patterns concerning the hosts infecting, including age, sex, occupation, personal habits, socioeconomic status, history of immunization, common histories of infected individuals, site where individual can in contact with the pathogen, and period of the year that the disease occurs. Epidemiologists are also concerned with various methods for controlling disease, such as chemotherapy, immunization, hygiene, control of reservoirs, water and waste water treatment, food preservation, changes in personal habits, food preparation and cooking, host nutrition and screening of blood products and transplanted organs Morbidity rate the number of people affected by a disease in a given period of time in relation to the total population Mortality rate the number of deaths resulting from a disease in a population in a given period of time in relation to the total population 6