Unit 6

6. Infectious diseases and immunity

Infectious diseases:
 Are diseases caused by living organisms called infectious agents
like:
1. Bacteria,
2. Viruses,
3. Fungi,
4. Protozoa,
5. Helminthes
6. Prions
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 It occurs as the result of interactions between pathogenic (disease-
producing) microorganisms and the host.
 All infectious diseases begin at some surface of the host (Internal,
external).
 In order to cause infectious disease a pathogen must accomplish the
following steps:-
1. It must enter the host,
2. It must metabolize and multiply on or in the host
tissue.
3. It must resist host defenses
4. It must damage the host
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6.1. Principles of infectious diseases
Infection and disease
 The terms "infection" and "disease" are not synonymous.
 An infection – May or may not cause diseases.
 Results when a infectious agent (pathogen) enters
 Microbes enter your body and begin to multiply
 Begins to growing and multiply within a host
 Often the first step in getting a disease
 Occurs when microbes that cause disease enter the
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 Disease -
 Occurs when the cells in host body are damaged,
 Tissue function is impaired as a result of the infection
 Signs and symptoms of an illness appear.
 happens when the infection damages cells in the body.
 Then symptoms of an illness appear.
 occurs when the cells in your body are damaged as a
result of infection, and signs and symptoms of an illness
appear.

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 Sign, symptom and syndrome
 Symptom: A change in body function that is felt by a
patient as a result of disease. is a manifestation of disease
apparent to the patient himself,

 Sign: A change in a body that can be measured or

observed as a result of disease. A sign is a manifestation
of disease that the physician perceives.

 The sign is objective evidence of disease; a symptom,

subjective.

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Classifying infectious diseases
 Communicable disease: A disease that is spread from one host to
another
 Contagious disease: A disease that is easily spread from one host to
another (Influenza, Meningitis, COVID-19.
 Non-communicable disease: A disease that is not transmitted from one
host to another
 cardiovascular disease (coronary heart disease, stroke), cancer,
chronic lung disease, diabetes, chronic neurologic disorders
(alzheimer’s, dementias), arthritis/musculoskeletal diseases

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 Levels of transmission of infectious diseases

1. Incidence: fraction of a population that contracts a disease during a

specific time (is the number of new cases (morbidity or mortality),
during a specified time period)
2. Prevalence: fraction of a population having a specific disease at a given
time (describes the number of diseased individuals within the
population as a whole).
 Is the total number affected in the population, again usually expressed as a
proportion.
3. Sporadic disease: disease that occurs occasionally in a population (tetanus,
rabies, and plague.). They are rare, accidental
4. Endemic disease: disease constantly present in a population (Malaria, chicken
pox).
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 • Levels of transmission of infectious diseases
5. Endemic: pre-existing disease; there is always equilibrium

 This Diseases occur at a constant (and often low) level within a population.
Characterized by

•Stable prevalence

• Equilibrium

• Herd immunity of local population

• perennial infection

Levels of endemicity based on locality described with the following spectrum

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 Levels of transmission of infectious diseases
5. Epidemic-disease acquired by many hosts in a given area in a short

time (Yellow fever, smallpox, measles, and polio, cholera)

Epidemic is characterized by –

 sudden outbreak of ‘new’ disease

 introduced /new/ disease

 all ages of sexes equally affected

6. Pandemic disease - worldwide epidemic (Covid-19, Spanish flu,

Asian flu).

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 A typical disease infection process follow a
common set of stages:
1. The initial growth in the host is termed infection,

2. The time between the infection and when the first symptoms occur is
termed the incubation period,

3. When the disease is most active it is referred to as being acute.

4. Following the acute period is the period of decline when the fever and
other symptoms subside and the infected individual begins to return to
normal.

5. The time between the decline period and the complete regaining of health
is termed the convalescent phase.

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 Common set of stages of infection
 Acute period –the diseases is most active
 Decline period –
 Signs and Symptoms are subside OR
 Infected individuals return to the normal health
 recovery from diseases
 Convalescent period or phase
 The period between decline period and complete
recovery from diseases

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Severity or duration of infectious disease
Scope of infectious disease can be defined as:-
 Acute: disease develops rapidly
 Chronic: disease develops slowly
 Subacute: symptoms appear between acute and
chronic
 Latent: disease with a period of no symptoms when
the causative agent is Inactive.

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 Acute Infection (illnesses)
 Acute illnesses usually develop suddenly and don't last
long, a few days or weeks.

 An acute infection is a type of infection that typically

develops quickly.

 Lasts for a relatively short period of time (are short-

lived)

 .It is usually defined as lasting less than months.

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 Chronic infection
 Chronic conditions develop over time and may worsen over

time, which takes months to years

 Chronic infection is characterized by the continued presence of

infectious

 Following the primary infection and may include chronic or

recurrent disease.

 It is Slow infection characterized by a prolonged incubation

period followed by progressive disease.

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 6.1.6 Extent of host involvement:
 An Infection of Infectious diseases can be
 Local infection: Pathogens are limited to a small area of the body
 abscesses
 Systemic infection: an infection throughout the body by blood
and/or lymph
 Focal infection: systemic infection that began as a local infection.
 Primary: acute infection causing initial illness
 Secondary: occurs after host is weakened from primary
infection.
 Subclinical (in apparent): no noticeable signs and symptoms.

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 Bacteremia: bacteria in the blood
 Sepsis: toxic inflammatory condition arising from the
spread of microbes,
 Especially bacteria or their toxins, from a focus of
infection.
 Septicemia: growth of bacteria in the blood
 Toxemia: toxins in the blood
 Viremia: viruses in the blood

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6.1 Types of infectious disease and their causative agent
o The common pathogens known as causative agents for different types of
infectious diseases are:-

6.1.1 Bacteria
 are unicellular prokaryotic organisms; they have circular genomes, double-
stranded DNA that is associated with much less protein than eukaryotic
genomes.
 Most bacteria reproduce by growing and dividing into two cells in a process
known as binary fission.
 The energy sources for bacteria also vary.
 Some bacteria are photosynthetic and obtain their energy directly from the sun.
 Others oxidize inorganic compounds to supply their energy needs. Still other
bacteria generate energy by breaking down organic compounds.
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 Some bacteria require oxygen (aerobes), while Anaerobes
 Some bacteria can grow either with or without oxygen
(facultative anaerobes).
 Bacteria are frequently divided into two broad classes based on
their cell wall structures
1. Gram-negative bacteria e.g: Salmonella typhi, which causes
typhoid fever, and Yersinia pestis, which causes plague
2. Gram-positive bacteria e.g: Staphylococcus aureus, which
causes skin, respiratory, and wound infections, and
Clostridium tetani, which produces a toxin that can be lethal
for humans).
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 There are trillions of strains of bacteria (few of these
cause diseases and others with out causing harm in
humans.
 Some bacteria attack other bacteria and prevent them
from causing sickness).
 However, some bacterial diseases are deadly which
include: Example, cholera, diphtheria, dysentery,
bubonic plague, pneumonia, tuberculosis, typhoid,
typhus and etc.

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  Examples of bacterial infections are:
 Bacterial meningitis, otitis media,
 Pneumonia, tuberculosis, upper respiratory tract infection, gastritis,
urinary tract infections,
 Food poisoning, eye infections, sinusitis, skin infections.
 Tuberculosis (Tb) is a bacterial disease usually affecting the lungs
due to mycobacterium tuberculosis
Sexually transmitted diseases.
Example (syphilis, Gonorrhea, chlamydia and trichomoniasis).
 Bacterial infections can be treated with antibiotics, but some
strains become resistant and can survive the treatment.

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 6.2.2 Viruses
 Virology is the branches of microbiology that deals with viruses and
viral diseases - A single virus particle is referred as virion.
 General Characteristics of Viruses
 Infectious agents of both prokaryotes and eukaryotes
 Acellular organization
 Contains either DNA or RNA surrounded by a protein coat
 Requires host cell to reproduce
 Viruses are small, obligatory intracellular parasites

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  Virus Structure and Composition
 A virus (Composed of nucleic acid, Capsid and Envelope)
1. Virus genomes (nucleic acid)
 Virus genomes is composed of either RNA or DNA—but never
both.
 Each nucleic acid molecule is single-stranded (ss) or double-
stranded (ds), giving four categories of virus genome:
1. dsDNA (pox viruses, papilloma viruses, adeno virusesetc.),
2. ssDNA(Circo viruses, parvo viruses, erythro viruses),
3. dsRNA (reo viruses, rota viruses etc.)
4. ssRNA(Tobaco mosaic viruses, HIV etc.)

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2. Capsid – a protein shell that covers the viral genome.

Capsids are built from large numbers of protein subunits called

CAPSOMERES

 Function

 Protect nucleic acid

 Attach to receptors on cells

 Penetrate cell membrane

 Modify host cell (some viruses)

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3. Envelope, is a lipoprotein membrane that surrounds some viral
particles. Enveloped viruses _________NA + capsid + envelope
 Some viruses have membranous envelopes around nucleocapsid
 Function: protects the virion
 usually composed of
 A) lipid bilayer from host
 B) carbohydrates from the host
 C) proteins encoded by the virus proteins

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• Viruses can also be classified by the type of
organism they infect:
1. Animal-infecting viruses
2. Plant-infecting viruses
3. Bacteria-infecting viruses – these are called
bacteriophages
4. Viruses can be classified into DNA viruses, RNA
viruses and retroviruses based on nucleic acid

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 General phases in animal virus multiplication cycle:
1. Attachment (Adsorption)

 Virus bind to animal host cell.

 By a virus-attachment protein (or ‘anti receptor’) to a cellular receptor

molecule (e.g. Glycoproteins or glycolipids)

 Determines virus tissue and host TROPISM

2. Penetration (genome enters host cell)

 Translocation, Endocytosis, and fusion are

 viruses must cross the plasma membrane to gain entry to the host cell

3. Un-coating – the viral nucleic acid is released from the capsid

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4. Synthesis – genomic replication ( viral components are produced)

 Synthesis of basic viral components

o Viral DNA replication in (transcription), Viral RNA (in

translation). Capsomers, Spikes and glycoproteins

5. Assembly – formation of new viral, viral proteins and viral genome (virion

formation)

6. Maturation -virus became infection

 Structural changes in the virus particles are constructed and

7. Release - Assembled viruses are released by

 Budding (exocytosis)

 Cell lysis
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4. Genome Replication and Gene Expression
 The replication strategy of any virus depends on
 the nature of its genetic material (a DNA or RNA virus)
1. DNA viruses
 generally are replicated and assembled in the nucleus from
 DNA to Messenger RNA (mRNA) = Transcription process

2. RNA viruses
 generally are replicated and assembled in the cytoplasm.

 Positive-sense RNA contain the message for translation.

 mRNA to viral proteins is called translation process

• Negative-sense RNA must be converted into positive-sense message.

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• Transcription refers to the writing across of genetic information from a
sequence of bases in a nucleic acid to the complementary sequence in
messenger RNA (mRNA),
• Translation converts the genetic information from the language of bases in
nucleic acids to the language of amino acids in proteins.

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 Reverse transcription
• Synthesis of (−) DNA from a (+) RNA template followed
by synthesis of a second DNA strand. RNA To DNA
• Both steps are catalyzed by a reverse transcriptase that is
encoded by the virus.
• Reverse transcription takes place in retro within a viral
structure in the cytoplasm of the infected cell.

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• In the case of some RNA viruses, the genetic material
can be used directly as messenger RNA to produce
viral proteins, including a special viral RNA
polymerase that copies the RNA template to
produce the genetic material for new viral particles.
• Other RNA viruses, called retroviruses, use a
unique enzyme called reverse transcriptase to copy the
RNA genome into DNA.
• viral infections: hepatitis B, herpes simplex virus
(HSV), HIV and human papillomavirus (HPV).
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 Bacterial tarnscrption and translation differs from eukaryotic
in a number of features
• Translation may start before transcription is complete.
• The lack of a nucleus
• This allows transcription and translation to be coupled.
• No viruses of prokaryotes are known to carry out reverse
transcription.
• The ribosomes are smaller (the ribosomal subunits).
• They have sedimentation coefficients of 30S and 50S.

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 Virus multiplication

 In bacteriophage  In animal virus

• Attachment to special tail fibers to cell • Attachment of nucleo -capsid to cell
well surface receptor cells

• Penetration (injection of nucleic acid • Penetration (the whole virus is

through cell well) engulfed, fuse ( the envelope or virus

surface fuse with cell membrane)
• No un - coating of nucleic acid
• Un – coating - (nucleic acid release)
• Both DNA and RNA Replication - in
• Viral DNA in nucleus and RNA
cytoplasm
cytoplasm
• Viral persistent – Lysogenic infection
• Acute , chronic , latency (low)
infection and cancers.
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There are three different life cycles in viruses

1. lytic life cycle (infection causes the host cell to burst

and release new viruses)

2. lysogenic life cycle (infection causes the virus to

enter a latent state, where its DNA is reproduced with
the host DNA, but no new viruses are formed

3. chronic release life cycle (infection causes viruses to

be released without killing the host cell

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Reproduction occurs using lytic or lysogenic cycles

1. The Lytic Cycle 2. Lysogenic cycle

 Viral genome replicated without
 Culminates or result in the host
destroying the host cell.
cell death
 Viral genome Integrated with the host
 Virulent viruses reproduce
cell and Virus enters to latent stage
 are resistant to a particular  No new virus is formed and
phage  Non infective prophage

 have restriction enzymes to  E.g. Lambda virus: resembles T4 but

only has a single short tail fiber
destroy the phages.

 Replication of the a temperate virus may reproduce by either cycle

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• Outcome of Viral Infection
• Acute Infection
– Recovery with no residual effects
– Recovery with residual effects e.g. acute viral encephalitis
leading to neurological sequelae.
– Death
– Proceed to chronic infection
• Chronic Infection
– Silent subclinical infection for life
– A long silent period before disease
– Reactivation to cause acute disease
– Chronic disease with relapses and exacerbations
– Cancers

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6.2.3 fungi
 Fungi are eukaryotic, heterotrophic organisms
 That have rigid cellulose- or chitin-based cell walls
 Reproduce primarily by forming spores.
 They consist of yeasts and moulds
 Most fungi are multicellular, although some, such as yeasts,
are unicellular.
 Are decomposers as parasites or saprobionts in the
environment.
 Systemic diseases affect the whole body.

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 Many fungal infections will appear in the upper layers of the
skin, and some progress to the deeper layers.
 Inhaled fungal spores can lead to systemic fungal infections,
such as thrush, or candidiasis
 Those with a higher risk of developing a fungal infection include
people who:
 use strong antibiotics for a long time
 have a weakened immune system, due, for
example, to HIV or AIDS, diabetes, chemotherapy
treatment, and those who have undergone a
transplant, as they take medications to prevent their
body fromSetrejecting the new organ.
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 Many fungi infect plants and animals.

 Examples of diseases caused by fungi are

 Ringworm - Athlete’s foot

 Histoplasmosis (lung infection transmitted by bat or bird

droppings).

 Yeasts of the Candida genus are opportunistic pathogens that

may cause diseases such as thrush (a throat infection) among
people who are immunocompromised or undergoing antibiotic

therapy.

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6.2.3 Protozoa
 Protozoa are unicellular, heterotrophic eukaryotes that include the
familiar
 Diarrheal disease (Amoeba and Gardia Lmbilia, Balntidium coli,
Trichomonas vaginalis, paramecium, Toxoplasma gondi
Cryptosporidium parvum)
 Trypanosoma – by vector Tse fly and Rudivid bug,
 Lishamania - female sand fly vector
 Malaria – female anopheles mosquitos vector
 Because protozoa do not have cell walls, they are capable of a variety of
rapid and flexible movements.
 Protozoa can be acquired through contaminated food or water or by the
bite of an infected arthropod such as a mosquito and other vector
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 6.2.4 Helminths (Worms)
 Helminths are simple, invertebrate animals, some of which are
infectious parasites.
 They are multicellular and have differentiated tissues.
 Helminths are macroscopic, multicellular, eukaryotic worms
 Because they are animals, their physiology is similar in some
ways to ours.
 Their infections difficult to treat because drugs that kill helminths
are frequently very toxic to human cells.
 Many helminths have complex reproductive cycles that include
multiple stages, many or all of which require a intermediate and
definitive, reservoir hosts.

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 Three groups of helminthes
1. Trematodes (flukeworm)

 E.g. Schistosoma species, Fasciola buski/Fasiola hepatica

2. Cestodes (tapeworm) (E.g. Taenia saginata/Taenia solium),

Hymenolsis,D. latum E. granulosus)

3. Nematodes (roundworm) hookworms, whipworm, Strongyloides

stercholaris & Enterobius (pinworm or threadworm) and Ascaris
(roundworm)…..

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6.2.6. Prions
 A prion is a type of protein that can trigger normal proteins in the brain to
fold abnormally).
A prion is a protein that contains no genetic material.
It is normally harmless, but if it folds into an abnormal shape, it can become
a rogue agent and affect the structure of the brain or other parts of the nervous
system.
Prions do not replicate or feed on the host but trigger abnormal behavior in the
body's cells and proteins.
The known prion diseases include Creutzfeldt-Jakob disease (in humans),
scrapie (in sheep), and bovine spongiform encephalopathy ("mad cow
disease" in cattle); all known prion diseases frequently result in brain tissue
that is riddled with holes.

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 Mode transmission of prions

 unknown mode of transmission,

 While some prion diseases are inherited,

 Others are apparently due to infection by eating infected

tissue or consumption of infected material

 Inadvertently through medical procedures such as tissue

transplants.

 Are not contagious in the strict sense, i.e., by direct contact,

they are transmissible perorally and parenterally.

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 6.3. Modes of transmission of Infectious diseases
I. Direct mode of transmission:-
 The parasite or microbes dose not requires biological vectors and/or intermediate hosts
and require only a single host to complete its life cycle. It may use mechanical vectors
for transmission.
A. Horizontal direct mode of transmission: transmission is mainly effected through:
 feco-oral route: most intestinal parasites transmitted in this way.
 Sexual intercourse, blood transfusion, direct skin penetration (soil
transmitted helminthes)
B. Vertical direct mode of transmission:
– Transmission of the parasite is from the mother to child through:
 Congenital / trans placental
 Trans mammary (breast milk)
II. Indirect mode of transmission - The parasite has complex life cycle and requires
biological vectors and/or one or more intermediate hosts for transmission.
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 Infectious agents may be transmitted through either direct or
indirect contact.
 Direct contact occurs when an individual is infected by contact with
the reservoir, for example, by
 Touching an infected person
 Ingesting infected meat or
 Being bitten by an infected animal or insect.
 Inhaling the infectious agent in droplets emitted by
sneezing or coughing and contracting the infectious
agent through intimate sexual contact.

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 Ingesting food and beverages contaminated by contact
with a disease reservoir is another example of disease
transmission by indirect contact.
 The fecal-oral route of transmission, in which sewage-
contaminated water is used for drinking, washing, or
preparing foods, is a significant form of indirect
transmission, especially for gastrointestinal diseases
such as cholera, rotavirus infection, cryptosporidiosis,
and giardiasis.

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These modes of transmission are all examples of
horizontal transmission because the infectious agent is
passed from person to person in a group.
 Some diseases also are transmitted vertically; that is,
they are transmitted from parent to child during the
processes of reproduction (through sperm or egg
cells), fetal development, or birth. Diseases in which
vertical transmission occurs include AIDS and herpes
encephalitis (which occurs when an infant contracts the
herpes simplex typeSetIIBy Girma
virus during birth).
T.(Msc in Biomedical science) 50
 Host defenses against infectious diseases

Overview of the immune system

The immune system is the body‘s biological defense

mechanism that protects against foreign invaders.

 It is able to generate an enormous variety of cells and

molecules capable of specifically recognizing and
eliminating an apparently limitless variety of foreign
invaders.

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 The immune system

 is composed of a number of different cell types, tissues and

organs

 the immune system has a mobile force of cells in the bloodstream

that are ready to attack the invading microbe wherever it enters
the body

 the cells of the immune system are separate from each other, they
maintain communication through cell contact and molecules
secreted by them.

 For this reason the immune system has been likened to the
nervous system Set By Girma T.(Msc in Biomedical science) 52
The immune system

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Nonspecific mechanisms (Innate Immune system)
– Nonspecific mechanisms are the body's primary defense
against disease
– The Innate immune system is the first line of defense which
is present at birth and changes little throughout the life of
an individual
– These mechanisms include
– Anatomical barriers
– Physiological barriers
– Cellular defense (phagocytosis and extracellular
killing)
– Inflammation
– The complement system and
– Normal flora. Example E.coli in clone)

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 Specific mechanisms of host resistance
(Adaptive defense)
 When the first line defense fail(non-specific), the body initiates a
second, specific line of defense

 Adaptive immune system initiate the innate immune system unable

to remove the invading microbe.

 The difference between the two systems is that the adaptive system
shows far more specificity and remembers that a particular microbe
has previously invaded the body.

 This leads to a more rapid expulsion of the microbe on its second and
third time of entry
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 The branches of acquired
immunity:-
 Humoral or Antibody-  Cellular or Cell-mediated
mediated immunity immunity
– Mediated by lymphocytes
• Consists of (T-cells) themselves
antibodies circulating – Targets – virus or parasite-
in the fluids of the infected cells, cancer cells,
body foreign graft cells
• Targets are mainly – Can act directly by lysing
foreign cells
extracellular
– indirectly by releasing
microbes and
chemicals that enhance the
parasites inflammatory response
• Produced by B- – activate other lymphocytes
lymphocytes Set By Girma T.(Msc in Biomedicalorscience)
macrophages
56
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Fig 6.3 Patterns and layers of responses against pathogens
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 Immune Deficiencies primary or secondary
1. Primary immune deficiencies
 It is congenital because of genetic disorder, which caused by mutations affecting

any of a large number of genes that control the expression and activities of immune

responses.

 Defects in lymphoid lineage:- may involve B-cell, T-cell or both.

 The severity depends on the number and type of immune components involved.

 B- cell immunodeficiency: associated with recurrent bacterial infections but

may be normal immunity to viruses and fungi.

 T-cell deficiencies: can affect both cell and humoral immunity. Do not

response to various types of pathogens.

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2. Secondary immunodeficiency

o This type is acquired secondary to some agents after birth, more

common in malnutrition, infection, cancer, etc.

o Patients treated by immunosupressive drugs.

o The good example is HIV that causes AIDS.

o It occurs as the result of interactions between pathogenic (disease-

producing) microorganisms and the host.

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 Acquired immunity
1. Naturally acquired active immunity: Occurs in

response to the exposure of antigens during the course

of daily life.

2. Naturally acquired passive immunity: The natural

transfer of antibodies from mother to her unborn baby

(fetus) via the placenta or infant when mother

breastfeeds her baby.

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3. Artificially acquired active immunity: the immunity you need can be

triggered artificially by the process known as vaccination (immunization) –

 Is used to give immunity to a number of dangerous diseases.

They include polio, tetanus, tuberculosis, and measles.

 Is the use of dead or weakened strains of pathogens to

produce immunity to dangerous diseases. Your WBC develop

the antibodies to the disease.

4. Artificially acquired passive immunity: it is the introduction of

antibodies into the body. These antibodies come from an animal or person

who is already immune to the disease.

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