>Bacterial Control< Asepsis:

the absence of pathogenic microorganisms from a

* It is a control of microbial growth, it means to given object or area
inhibit or prevent growth of microorganisms.
Control of growth usually involves the use of Surgical Asepsis - aseptic techniques employed
physical or chemical agents which either kill or to exclude all microbes during surgical operations.
prevent the growth of microorganisms. Medical Asepsis - aseptic techniques designed
to exclude all microbes associated with
>Terminology of Microbial Control communicable diseases.

Sterilization: Bacteriostasis:
The removal or destruction of all microbes, -The condition in which bacterial growth and
including viruses and bacterial endospores, in or multiplication are inhibited but the bacteria are
on an object or habitat. not necessarily killed
It is the complete destruction of all living
organisms on an object or material Bacteriostatic agents:
-agents that only inhibit the growth and
Autoclave: multiplication of bacteria. Antiseptics and
rely on moist – heat sterilization. They are used to chemical bacteriostatic agents are synonymous
raise temperatures above the boiling point of
water to sterilize items such as surgical Germicidal agents, Biocidal agents, and
equipments from vegetative cells, viruses and microbicidal gents
especially endospores, which are known to survive -Are disinfectants or antiseptics that kill microbes
boiling temperatures, without damaging the items.
The autoclave or autoclaving is still considered the Bactericidal agents (bactericides)
most effective method of sterilization.In the specifically kill bacteria, but not necessarily
hospital setting, this machine sterilizes by killing bacterial endospores.
all organisms and their spores. Viricidal agents (Virucidal agent)
-inactivates/destroys viruses
Disinfection: Fungicidal agents (Fungicide)
the process of destroying disease-producing -kill fungi includingfungal spores
organisms and destruction of their products, but Sporocidal agents – are required to kill bacterial
not necessarily the endospores or viruses endospores.
from non-living objects by physical or chemical Algicidal agents (algicides) – are used to kill
methods. -algae in swimming pools and hot tubs.
Pseudomonicidal agents - kills Pseudomonas
Disinfectant: species Tuberculocidal agents – kill Mtuberculosis
-the chemical agent used to destroy microbes
associated with inanimate objects. Degerming :
-The removal of microbes from a surface by
Aseptic: scrubbing (handwashing)
-An environment or procedure that is free of
contamination by pathogens. Preservatives:
- Chemical agents used to prevent deterioration
Pseudomonas aeruginosa: of foods, vaccines, serum, and other biological
products.In the early civilizations they practice salting,
-most common pathogen found in people who smoking, pickling, drying and exposure of food and
have been hospitalized for over a week; cause clothing to sunlight to control microbial growth.Some
respiratory related infections spices prevent spoilage.
Pasteurization:
Antisepsis: -The use of heat to kill pathogens and reduce the
-the chemical disinfection of skin, mucus number of spoilage microorganisms in food and
membrane beverages.
or other living tissues to prevent the multiplication
of the microorganisms but not necessarily kill Sanitization – The process of disinfecting places
them. and utensils used by the public to reduce the
number of pathogenic microbes to meet accepted
Antiseptic - the chemical agent applied to the public health standards.
skin and other living tissue to kill microorganisms

 >Factors Affecting the Efficacy of

Antimicrobial Methods< Moisture:
|All living organisms require water to carry out
Site to betreated: their normal metabolic processes.There are
• Harsh chemicals and extreme heat cannot be certain microbial stages (e.g., bacterial
used on human, animals and fragile objects. endospores, protozoan cysts), however, that can
• To sterilized the utensils to be used on the body survive the complete drying process (desiccation)
to prevent infections.
Temperature:
Relative Susceptibility of Microorganisms: Every microorganism has an optimal, a minimum,
-Often to select a method to kill the hardiest and a maximum growth temperature.
microorganisms present, assuming that method -Microorganisms that grow best at high
will kill more fragile microbes as well. temperatures are called thermophiles (meaning
-Germicides can be classified as high, intermediate organisms that love heat).
or low depending on their effectiveness on -Microbes that grow best at moderate
inactivating or destroying microorganisms temperatures are called mesophiles.
-Psychrophiles prefer cold temperatures. They
a. High Level kills all pathogens, including thrive in cold ocean water
endospores.
b. Intermediate Level kills fungal spores, pH:
protozoan cysts, -Most microorganisms prefer a neutral or slightly
viruses and pathogenic bacteria. alkaline growth medium (pH 7.0–7.4)
c. Low Level kills vegetative bacteria, fungi, - Acidophiles such as those that can live in the
protozoa and some viruses stomach and in pickled foods, prefer a pH of 2 to
5.
Environmental Conditions Alkaliphiles prefer an alkaline environment (pH
- Temperature: warm disinfectants work better 8.5), such as is found inside the intestine (pH 9),
than cool ones. Vibrio cholerae—the bacterium that causes
- pH: some disinfectants more effective at low cholera is the only human pathogen that grows
pH. - To clean objects before sterilization. well above pH 8.

Phenol Coefficient: Osmotic Pressure and Salinity

-The first method used. Osmotic pressure is the pressure that is exerted on
- If >1.0 ; the agent is more effective than phenol. a cell membrane by solutions both inside and
- The larger the ratio, the greater the outside the cell.
effectiveness Osmosis is defined as the movement of a solvent
(e.g., water), through a permeable membrane,
Use-dilution Test or Disk-diffusion Method from a solution having a lower concentration of
-The current standard test solute to a solution having a higher concentration
-The most effective agent is the one that entirely of solute.
prevents microbial growth at the highest dilution “salinity" refers to the concentrations of salts in
water or soils.
In-use test
-A more realistic method. Those microbes that actually prefer salty
-Swabs are taken from actual objects before and environments are called halophilic.
after application of disinfectant. halo referring to “salt” and philic meaning “to love.”
-More accurate determination of a given Organisms that do not prefer to live in salty
disinfection agent for each specific situation. environments but are capable of surviving there are
referred to as haloduric organisms.
>Factors that affect the microbial
Growth< Barometric Pressure
Most bacteria are not affected by minor changes in
Availability of Nutrients: barometric pressure. Some thrive at normal
-all living organisms require nutrients, the various atmospheric pressure (about 14.7 pounds per
chemical compounds that organisms square inch [psi]).
-use to sustain life. Therefore, to survive in a Others, known as piezophiles, thrive deep
particular environment, appropriate nutrients in the ocean and in oil wells, where the
must be available atmospheric pressure is very high

 -Chemotherapy used in conjunction with cancer Host:

(i.e., cancer chemotherapy), Living organism that harbors another organism
-chemotherapy actually refers to the use of any
(humans)
chemical (drug) to treat any disease or condition.
- The chemicals (drugs) used to treat diseases are
- referred to as chemotherapeutic agents. By Symbiosis:
definition, a chemotherapeutic agent is any drug A condition where two dissimilar organisms live
used to treat any condition or disease. together in an intimate associate that sees both
organisms benefit.
Antibiotics:
is a substance produced by
-a microorganism that is effective in killing or Microbial Symbiosis:
inhibiting the Defined as the co-existence of two microorganism
growth of other microorganisms.
-Antibiotics, semi synthetics and synthetics. Symbionts:
-Typically used for treatment of disease. The organisms that live together in such a
-Semisynthetic: antibiotic undergo modification
relationship
Bacteriostatic drugs:
- inhibit growth of bacteria, whereas bactericidal Mutualistic/ mutualism:
agents kill bacteria. Both organisms benefit – “mutually beneficial”
Narrow spectrum antibiotics kill either Gram-positive Commensalistic/ commensalism:
or Gram-negative bacteria, whereas broad spectrum One organism benefits, the other is neither helped
antibiotics kill both Gram-positives and Gram-
nor harmed
negatives
Parasitism: One organism (the parasite) gains,
>Antibacterial Agent< characteristics while the other (the host) suffers
Neutralism:
Solubility in body fluids to be transported in the A symbiotic relationship in which neither
body and reach the infectious organisms. symbiont is affected by the relationship.
Opportunistic:
Selective Toxicity: they must be more toxic to Under normal conditions, microbe does not cause
microorganisms than to host cells. disease, but if conditions become conducive , it
can cause disease. (Immuno-compromised or
• Toxicity is not easily altered: should have a immuno- suppressed conditions)
standard toxicity and not be made more or less
toxic by interactions with foods or other drugs. Escherichia coli: mutualistic
A ype of bacteria that normally lives in your
Nonallergenic: should not cause an allergic intestines. It's also found in the gut of some
reaction. animals. Most types
of E. coli are harmless and even help keep your
Stability: maintenance of a constant, therapeutic digestive tract healthy. But some strains can cause
concentration in blood and tissue fluids – should diarrhea if you eat contaminated food or drink
have the same therapeutic activity over many fouled water
hours.
Commensalistic:
Resistance by microorganisms not easily We have no Commensalistic relationships with Bacteria
• If Bacteria are in or on our body, they are either helping us
acquired. (Microbial Antagonism) or
harming us.
• Ex.: Indigenous Microbiota or Normal Flora – skin,
> Microbial Symbiosis< mammary glands, saliva etc.
• Many of the organisms in the indigenous microflora of
humans are considered to be commensals.
Ecology: • The relationship is of obvious benefit to the
Is the systematic study of the interrelationships microorganisms (they are provided nutrients
that exist between organisms and their • and “housing”), but the microorganisms have no effect on
the host. A host is defined as a living organism that
environment
• harbors another living organism. One example of a
commensal, is the tiny mite called
Microbial Ecology: • Demodex, which lives within hair follicles and sebaceous
Is the study of numerous interrelationships of glands, especially those of the eyelashes and eyebrows.
microbes and the world around them
Microbes- Humans Microbes- Microbes
Microbes -Inanimate Objects

 Demodex folliculorum:
-A microscopic mite that can only survive on the
skin of humans. Most people have D. folliculorum
on their skin.Usually, the mites do not cause any
harm, and are therefore considered an example of
commensalism rather than parasitism

Parasitism:
-a relationship in that is beneficial only to one
microorganism and is harmful to another
Ex.: T. gambiense or Trypanosoma gambiense Normal flora of Skin:
Important bacteria:
Human African Trypanosomiasis is also known 1. Staphylococcus epidermidis 2. Micrococcus sp.
as sleeping sickness. 3. Corynebacterium sp.
4. Mycobacterium smegmatis
Although the skin is constantly exposed to air, many of the
Opportunistic: bacteria that live on the skin are anaerobes; in fact,
• Escherichia coli - normally in our digestive tract anaerobes actually outnumber aerobes.
where it causes no problems, but if it gets into the Anaerobes live in the deeper layers of skin, hair follicles, and
urinary tract it can become pathogenic. sweat and sebaceous glands. The most common bacteria on
the skin are species of Staphylococcus (especially S.
• Staphylococcus aureus – commonly found in epidermidis and other coagulase-negative staphylococcia),
the upper respiratory tract, but if it gets into a Corynebacterium, and Propionibacterium.
wound or a burn it can become pathogenic Micrococcus species are the predominant
microorganisms found in raw milk drawn
>normal Flora < aseptically from the udder
These are mixture of micro-organisms regularly
found at any anatomical site on or within the body Normal Flora of the Conjunctiva:
of a healthy person.Includes all of the microbes 1. Staphylococcus epidermidis
(bacteria, fungi, protozoa, and viruses) that reside 2. Corynebacterium spp.
on and within that person 3. Propoinibacterium acnes 4. Staphylococcus
aureus 5. Viridans streptococci
6. Neisseria spp.
7. Haemophilus influenzae
The external surface of the eye is lubricated, cleansed, and
protected by tears, mucus, and sebum.
Thus, continual production of tears and the presence of the
enzyme lysozyme and other antimicrobial substances
found in tears greatly reduce the numbers of indigenous
microflora organisms found on the eye surfaces.

Normal Flora of the Respiratory:

A). The nares (nostrils) :
1. Staphylococcus epidermidis
2. Corynebacteria spp.
3. Staphylococcus aureus
4. Neisseria spp.
5. Haemophilus spp.
Resident Flora: 6. Streptococcus pneumoniae
-Microbes that are always The nasal passages and throat have an abundant and varied
population of microorganisms, because these areas provide
present on or within body moist, warm mucous membranes that furnish excellent
conditions for microbial growth.
Transient Flora: Many microorganisms found in the healthy nose and throat
-Microbes that live in or on the are harmless. Others are opportunistic pathogens, which
have the potential to cause disease under certain
body for a period of time (hours, days, weeks, circumstances.
months) then move on or die off
The upper respiratory tract (nasopharynx):
1. Non-hemolytic streptococci 2. Alpha-hemolytic
streptococci 3. Neisseria spp.
4. Streptococcus pneumoniae
5. Streptococcus pyogenes
6. Haemophilus influenzae
7. Neisseria meningitidis

The respiratory tract can be divided into the upper

respiratory tract and the lower respiratory tract. The upper
respiratory tract consists of the nasal passages and the throat
(pharynx). The lower respiratory tract consists of the larynx
(voice box), trachea, bronchi, bronchioles, and lungs

C) The lower respiratory tract:(trachea, bronchi, and

pulmonary tissues):Usually sterile.The individual may
become susceptible to infection by
pathogens descending from the nasopharynx: e.g. H.
influenzae,S. pneumoniae

Normal Flora of the Human Oral Cavity: In breast-fed infants :

Oral bacteria include: 1. Bifido bacteria account for more than 90% of the
1. Viridans streptococci total intestinal bacteria.
2. Lactobacilli Enterobacteriaceae
3. Staphylococci (S. aureus and S. epidermidis) 4. Enterococci,Bacteroides
Corynebacterium sp. Staphylococci
5. Bacteroides sp. Lactobacilli
6. Streptococcus sanguis (dental plaque) Clostridia
7. Streptococcus mutans (dental plaque)
8. Actinomyces sp. In bottle-fed infants:
Bifidobacteria are not predominant. When breast-fed
The Normal Flora of The Ears (i.e. external infants are switched to a diet of cow's milk or solid
ear) food, bifidobacteria are progressively joined by:
The external ears contains a variety of micro- 1. Enterics
organisms. These include: 2. Bacteroides
1. Staphylococcus epidermidis 2. Staphylococcus 3. Enterococci
aureus 4. Lactobacilli
3. Corynebacterium sp 5. Clostridia
The middle ear and inner ear are sterile, whereas the
outer ear and the auditory canal contain the same types In the upper GIT of adult humans mainly acid- tolerant
of microorganisms as are found on the skin lactobacilli present:
e.g. Helicobacter pylori
Normal flora of the Urogenital Tract: a)
The anterior urethra: The proximal small intestine:
1.Staphylococcus epidermidis 1. Lactobacilli
2 Enterococcus faecalis 2. Enterococcus faecalis 3. Coliforms
3.Alpha-hemolytic streptococci. 4. Bacteroides
. Some enteric bacteria (e.g. E. coli, Proteus sp.)
5.Corynebacteria sp. 6. Acinetobacter sp. The flora of the large intestine (colon):
7. Mycoplasma sp. 1. Enterococci
8. Candida sp. 2. Clostridia
9. Mycobacterium smegmatis 3. Lactobacilli
4. Bacteroides
5. Bifidobacterium (Bifidobacterium bifidum)
6. Escherichia coli
7. Methanogenic bacteria
8. Viridans streptococci
9. Staphylococcus sp.
10. Proteus sp.
11. Candida albicans (Yeast) 12. Mycoplama sp.

-The normal flora prevent colonization by

pathogens by competing for attachment sites or
for essential nutrients.
b) The vagina: This important beneficial effect, which has been
1. Corynebacterium sp. demonstrated in the oral cavity, the intestine, the
2. Staphylococci skin, and the vaginal epithelium.
3. Non-pyogenic streptococci 4. Escherichia coli
5. Lactobacillus acidophilus* 6. Flavobacterium sp. -The normal flora synthesize and excrete vitamins
7. Clostridium sp.
in excess of their own needs, which can be
8. Viridans streptococci
9. Other Enterobacteria absorbed as nutrients by the host.

 -The normal flora may antagonize other bacteria

through the production of substances which
inhibit or kill non-indigenous species.
Intestinal bacteria produce a variety of substances
like non-specific fatty acids, peroxides and highly
specific bacteriocins, which inhibit or kill other
bacteria.

-The normal flora stimulates the development of

certain tissues, i.e., the caecum (in animals) and
certain lymphatic tissues (Peyer's patches) in the
GI tract..The caecum of germ-free animals is >MICROBIAL PATHOGENECITY AND
enlarged, thin-walled, and fluid-filled CAPABILITIES OF PATHOGEN<
comparedtothatorganin conventionalanimals.
PATHOGENICITY:
-The normal flora stimulates the production of -the capacity to initiate disease. It requires the
“cross-reactive antibodies’’. Since the normal flora attributes of transmissibility or
behave as antigens in an animal, they induce an communicability from one host or reservoir to a
Ab mediated immune response.Low levels of fresh host, survival in the new host, infectivity or
antibodies produced against components of the the ability to breach the new host’s defenses, and
normal flora are known to cross react with certain virulence, a variable that is multifactorial and
related pathogens, and thereby prevent infection denotes the capacity of a pathogen to harm the
or invasion. host.

Sterile tissues: Primary pathogens

In a healthy human, the internal tissues such as: ➢are capable of establishing infection and causing
• blood disease in previously healthy individuals with
• brain intact immunological defenses.
• muscle
• Cerebrospinal fluid (CSF) Opportunistic pathogens
are normally free of microorganisms. ➢rarely cause disease in individuals’ with intact
immunological and anatomical defenses. Only
Role of Microbiologist: when such defenses are impaired or
Accurate diagnosis: by Rapid/ quick, meaningful compromised, as a result of congenital or
reporting acquired disease or by the use of
Role of Physician: immunosuppressive therapy or surgical
Proper treatment with antimicrobial regimen/ techniques, are these bacteria able to cause
standard guidelines by avoiding overuse*/ misuse disease.
of antimicrobials
* by treating pathogen, NOT the normal flora!! KOCH’S POSTULATES (MODIFIED)
1. The organism must always be found in humans
Probiotics/ Prebiotics: with the infectious disease but not found in
• Probiotic: healthy ones.
•Oral administration of living organisms to 2. The organism must be isolated from humans
promote health with the infectious disease and grown in pure
•Species specific: adherence and growth (tropism) culture.
• Prebiotic: Non-digestible food that stimulates 3. The organism isolated in pure culture must
growth or activity of GI microbiota, especially initiate disease when reinoculated into susceptible
bifidobacteria and lactobacillus bacteria animals.
•Typically a carbohydrate: soluble fiber 4. The organism should be re-isolated from the
experimentally infected animals.

Colonization
The establishment of a stable population of
bacteria on the host’s skin or mucous membranes
Colonization normally requires adhesion to the
mucosal cell surface.

 Pathogenesis: TISSUE INJURY

-The process of pathogenesis involves various -Bacteria cause tissue injury primarily by several
steps beginning with the transmission of the distinct mechanisms involving:
infectious agent (bacterial) to the host, followed by • Exotoxins
colonization of the site. After the colonization of • Endotoxins and non-specific immunity
host, the bacteria remain adherent at the site of • Specific humoral and cell mediated immunity
colonization then invades the host system. After
surviving the host immune system it is ready to Exotoxins
cause the disease. -Many bacteria produce proteins (exotoxins) that
modify, by enzymatic action, or otherwise destroy
Transmission: certain cellular structures. Effects of exotoxins are
-Potential pathogens may enter the body by usually seen acutely, since they are sufficiently
various routes, including the respiratory, potent that serious effects (e.g. death) often result.
gastrointestinal, urinary or genital tracts. Examples of this are botulism, anthrax, cholera
Alternatively, they may directly enter tissues and diphtheria. If the host survives the acute
through insect bites or by accidental or surgical infection, neutralizing antibodies (anti-toxins) are
trauma to the skin. often elicited that neutralize the affect of the
exotoxin.
Adhesion:
-necessary to avoid innate host defense Classes of exotoxins include:
mechanisms such as peristalsis in the gut and the • Toxins that act on the extracellular matrix of
flushing action of mucus, saliva and urine, which connective tissue e.g. Clostridium
remove non-adherent bacteria. perfringens collagenase, Staphylococcus aureus
hyaluronidase.
Invasion • Toxins that have a cell binding “B” component
-Invasion is penetration of host cells and tissues and an active “A” enzymatic
(beyond the skin and mucous surfaces), and is component (A-B type toxins)
mediated by a complex array of molecules, often These include:
described as ‘invasins’. a) Those with ADP-ribosylating activity e.g.
cholera toxin, E. coli heat labile
Virulence determinants toxin, Pseudomonas aeruginosa and diphtheria
-Both primary and opportunistic pathogens toxins.
possess virulence determinants or aggressins that b) Those with a lytic activity on 28S rRNA e.g.
facilitate pathogenesis. shiga and shiga-like (vero) toxins. c) Those with a
Possession of a single virulence determinant is partially characterized site of action e.g. botulinum
rarely sufficient to allow the initiation of infection toxin, tetanus
and production toxin and anthrax lethal toxin.
of pathology.
Membrane Damaging Toxins
SURVIVAL IN THE HOST e.g. Staphylococcus aureus delta toxin
Bacteria have evolved numerous structural and Toxins which act extracellularly. These include
metabolic virulence factors that enhance their proteases, collagenases and hyaluronidases.
survival rate in the host. Capsule formation has For example, Clostridium perfringens produces a
long been recognized as a protective mechanism potent collagenase, whilst Staphylococcus aureus
for bacteria. produces a hyaluronidase.
Encapsulated strains of many bacteria (e.g., A - B Toxins. Such toxins consist of two
pneumococci) are more virulent and more components. One binds to cell surfaces and the
resistant to phagocytosis and intracellular killing other passes into the cell membrane or cytoplasm
than are nonencapsulated strains. where it acts. The classical toxins demonstrated to
Organisms that cause bacteremia (e.g., act in this fashion are those of cholera and
Pseudomonas) are less sensitive than many other diphtheria.
bacteria to killing by fresh human serum
containing complement components, and
consequently are called serum resistant.

 > INFECTIOUS DISEASE<

Endotoxins
• Endotoxins are toxic components of the bacterial INFECTION VERSUS INFECTIOUS DISEASE
cell envelope. The classical and most potent The word infection tends to be confusing because
endotoxin is lipopolysaccharide. the term is used in different ways. Most
• Endotoxins are “non-specific” inciters of commonly, infection is used as a synonym for
inflammation. infectious disease.For example, saying that “the
Endotoxins are also potent B cell mitogens, patient has an ear infection”is the same thing as
polyclonal B cell activators and adjuvants (for both saying that “the patient has an infectious disease
antibodies and cell mediated immunity); this plays of the ear.”
a role in the development of a suitable chronic Infection is the invasion of a host organisms bodily
immune response in handling the microbes if they tissues by disease-causing organisms, their
are not eliminated acutely. multiplication, and the reaction of host tissues to
In a “primary” infection during the acute phase ” these organisms and the toxins they produce.
non-antigen specific” immunity will be of utmost Infections are caused by microorganisms such as
importance in eradicating the infection. viruses, bacteria, and larger organisms like
parasites and fungi.
IMMUNOPATHOLOGY
The infected tissue often serves as an innocent WHY INFECTION DOES NOT ALWAYS
bystander and immunopathology results. This can OCCUR ?
occur in acute and chronic infections. Over • Many factors influence whether or not exposure to a
stimulation of cytokine production and pathogen
complement activation by endotoxins can cause results in disease, including a person’s immune,
tissue injury in the absence of an immune nutritional, and overall health status.
• Listed here are some possible explanations:
response. - The microbe may land at an anatomic site where it is
unable to
The immune system in resistance to infection - examples multiply.
1. Extracellular parasites. Antibodies cause lysis of the - Many pathogens must attach to specific receptor sites
organism and/or their opsonization by phagocytes at which
point they are rapidly killed.
(described later) before they are able to multiply and
2. Intracellular parasites are primarily killed by cell cause damage.
mediated immunity. - Antibacterial factors that destroy or inhibit the
3. Exotoxins can be neutralized by antitoxins. These can be growth of bacteria - The indigenous microflora of that
elicited using toxoid vaccines (toxoids are antigenic but not site (e.g., mouth, vagina,
toxic). This occurs, for example, in vaccination against intestine) may inhibit growth of the foreign microbe by
diphtheria. occupying space and using up available nutrients.
4. Certain organisms produce IgA proteases (including H.
influenzae, S. pneumoniae, N. gonorrhoeae and N. - The indigenous microflora at the site may produce
meningitidis) this helps survival on external surfaces. antibacterial factors (proteins called bacteriocins) that
destroy the newly arrived
pathogen.
- The individual’s nutritional and overall health status
often influences the outcome of the pathogen–host
encounter.
- The person may be immune to that particular
pathogen
- Phagocytic white blood cells (phagocytes) present in
the blood and other tissues may engulf and destroy the
pathogen before it has an opportunity to multiply,
invade, and cause disease.

Obligate intracellular pathogens cannot

reproduce outside their host cell, meaning that
the parasite's reproduction is entirely reliant
on intracellular resources.
Facultative intracellular pathogens
are capable of living and reproducing either
inside or outside cells.

 Intracellular Survival Mechanisms Localized infections

Phagocytes play an important role in our -Once an infectious process is initiated, the
defenses against pathogens. disease may remain localized to one site.
The two most important categories of phagocytes Example : Pimples, boils, and abscesses
in the human body
(referred to as “professional phagocytes”) are Systemic infection – When the infection has
macrophages and neutrophils. spread throughout the body.
Example : Mycobacterium tuberculosis—may
INCUBATION PERIOD spread to many internal organs, a condition
the period between exposure to an infection and known as miliary (disseminated) tuberculosis.
the appearance of the first symptoms.
Pathogen is actively replicating without producing Acute disease – has a rapid onset, usually
symptoms. This stage may be as short as a few followed by a relatively rapid recovery
hours(salmonella), up to many years(HIV). Example : measles, mumps, and influenza

PRODROMAL PERIOD Chronic disease – has an insidious (slow) onset

Flu like symptoms. and lasts a long time
This is a short stage of disease development where Example : tuberculosis, leprosy (Hansen disease),
a person begins to feel that they are getting sick. and syphilis.
The symptoms may not be very specific or severe.
The affected person can still Subacute disease – a disease having a sudden
perform usual functions although distress or onset can develop into a long-lasting disease. This
discomfort may be felt. come on more suddenly than a chronic disease,
but less suddenly than an acute disease.
PERIOD of illness Example : subacute bacterial endocarditis, often
The maximum impact of the infectious process; referred to merely as SBE
there is rapid proliferation and spread of the
pathogen. The symptoms are more pronounced A disease may be acute, subacute, or chronic, depending on
and specific. the length of its incubation period and duration.
The signs and symptoms of disease are most
Symptom of a disease
obvious and severe
is defined as some evidence of a disease that is
experienced or perceived by the patient;
PERIOD of decline
something that is subjective
Infection is contained and being progressively
eliminated; The damaged tissue is repaired.
Symptomatic disease (or clinical disease) is
Symptoms are decreasing.
a disease in which the patient is experiencing
The number of pathogen particles begins to
symptoms.
decrease, and the signs and symptoms of illness
begin to decline. However, during the decline
Asymptomatic disease (or subclinical
period, patients may become susceptible to
disease)
developing secondary infections because their
is a disease that the patient is unaware of because
immune systems have been weakened by the
he or she is not experiencing any symptoms.
primary infection.
Sign of a disease
Convalescent PERIOD
is defined as some type of objective evidence of a
Total elimination of the pathogen; no residual
disease.
signs and symptoms.
The gradual recovery of health and strength after
LATENT INFECTIONS
illness or injury. It refers to the later stage of an
An infectious disease may go from being
infectious disease or illness when the patient
symptomatic to
recovers and returns to previous health, but may
asymptomatic and then, some time later, go back
continue to be a source of infection to others even
to being symptomatic.
if feeling better.
From the Greek word “latens,” meaning to lie
During this stage, the patient generally returns to
hidden.
normal functions, although some diseases may
inflict permanent damage that the body cannot
fully repair.

 5. There must be a portal of entry (i.e., a way for

Example : Herpes virus infections, such as cold the pathogen to gain entry into Bob). When Bob
sores (fever blisters), genital herpes infections, rubs his nose, the cold virus is transferred from his
and shingles hand to the
mucous membranes of his nose.
Primary Infection 6. There must be a susceptible host.
- the first disease caused by one pathogen For example, Bob would not be a susceptible host
Secondary Infection (and would, therefore, not develop a cold) if he
– the second disease caused by a different had previously been infected
pathogen by that particular cold virus and had developed
Example : Serious cases of bacterial pneumonia immunity to it.
frequently follow relatively mild viral respiratory
infections Strategies for breaking the chain of infection Some
of the broad goals are to:
1. Eliminate or contain the reservoirs of pathogens
or curtail the persistence of a pathogen at the
source
2. Prevent contact with infectious substances from
exit pathways
3. Eliminate means of transmission
4. Block exposure to entry pathways
5. Reduce or eliminate the susceptibility of
potential hosts

Some of the specific methods of breaking the

chain of infection are:
1. Practice effective hand hygiene procedures
2. Maintain good nutrition and adequate rest and
reduce stress
3. Obtain immunizations against common
The six components in the chain of infection are:
pathogens
1. pathogen- (agent) (germs”
4. Practice insect and rodent control measures
2. reservoir of infection - where germs live
5. Practice proper patient isolation procedures
3. portal of exit -how germs get out
6. Ensure proper decontamination of surfaces and
4. mode of transmission -Germs get around
medical instruments
5. portal of entry | How germs get in
7. Dispose of sharps and infectious waste properly
6. susceptible host -next sick person
8. Use gloves, gowns, masks, respirators, and
other personal
There are six components in the infectious disease
protective equipment, whenever appropriate to do
process (also known as the chain of infection).
so
1. There must first be a pathogen.
As an example, let us assume that the pathogen is 9. Use needle safety devices during blood
collection
a cold virus.
2. There must be a source of the pathogen (i.e., a
RESERVOIRS OF INFECTION
reservoir). the infected person is the reservoir.
A reservoir is any site where the pathogen can
Example has a cold.
multiply or merely survive until it is transferred to
3. There must be a portal of exit (i.e., a way for the
a host.
pathogen to escape from the reservoir). W hen
Reservoirs may be living hosts or inanimate
Andy blows his nose, cold viruses get onto his
objects or materials.
hands.
4. There must be a mode of transmission (i.e., a
Living reservoirs include humans, household pets,
way for the pathogen to travel from Andy to
farm animals, wild animals, certain insects, and
another person).
certain arachnids (ticks and mites).
the cold virus is being transferred by direct contact
between Andy and his friend — by speak, sneeze or
cough.

 A carrier Direct skin-to-skin contact.

is a person who is colonized with a particular For example, the common cold virus is frequently
pathogen, but the pathogen is not currently transmitted from the hand of someone who just
causing disease in that person. blew his or her nose to another person by hand
shaking. Within hospitals, this mode of transfer is
Passive carriers particularly prevalent, which is why it is so
carry the pathogen without ever having had the important for healthcare professionals to wash
disease. their hands before and after every patient contact.
Frequent handwashing will prevent the transfer of
Incubatory carrier pathogens from one patient to another.
is a person who is capable of transmitting a
pathogen during the incubation period of a Indirect contact via airborne droplets of
particular infectious disease. respiratory secretions, usually produced as
a result of sneezing or coughing.
Convalescent carriers Most contagious airborne diseases are caused by
harbor and can transmit a particular pathogen respiratory pathogens carried to susceptible
while recovering from an infectious disease people in droplets of respiratory secretions. Some
(i.e., during the convalescence period). respiratory pathogens may settle on dust particles
and be carried long distances through the air and
Active carriers - have completely recovered into a building’s ventilation or air-conditioning
from the disease, but continue to harbor the system.
pathogen indefinitely (see the following
“Historical Note” for an example). Respiratory 4. Indirect contact via food and water
secretions or feces are usually the vehicles by contaminated with fecal material.
which the pathogen is transferred, either directly Many infectious diseases are transmitted by
from the carrier to a susceptible individual or restaurant food handlers who fail to wash their
indirectly through food or water. hands after using the restroom.

Nonliving Reservoirs 5. Indirect contact via arthropod vectors.

Nonliving or inanimate reservoirs of infection Arthropods such as mosquitoes, flies, fleas, lice,
include air, soil, dust, food, milk, water, and ticks, and mites can transfer various pathogens
fomites. from person to person.
Air can become contaminated by dust or
respiratory secretions of humans expelled into the 6. Indirect contact via fomites that become
air by breathing, talking, sneezing, and coughing. contaminated by respiratory secretions,
blood, urine, feces, vomitus, or exudates
The five principal modes by which from hospitalized patients.
transmission of pathogens occur are : Fomites such as stethoscopes and latex gloves are
1. contact (either direct or indirect contact) 2. sometimes the vehicles by which pathogens are
droplet transferred from one patient to another.
3. airborne
4. vehicular 7. Indirect contact via transfusion of
5. vector transmission contaminated blood or blood products
from an ill person or by parenteral
injection (injection directly into the
Communicable diseases—infectious diseases bloodstream) using nonsterile syringes and
that are transmitted from person to person are needles.
most commonly transmitted in the following One reason why disposable sterile tubes, syringes, and
various other types of single-use hospital equipment have
ways: become very popular is that they are effective in preventing
bloodborne infections (e.g., hepatitis, syphilis, malaria,
Direct mucous membrane- AIDS, systemic staphylococcal infections) that result from
to-mucous membrane contact by kissing or sexual reuse of equipment. Individuals using illegal intravenous
drugs commonly transmit these diseases to each other by
intercourse. sharing needles and syringes, which easily become
Most STDs are transmitted in this manner. STDs contaminated with the blood of an infected person.
include syphilis, gonorrhea, and infections caused
by chlamydia, herpes, and HIV.