INFECTION AND INFECTIOUS PROCESS

Infection is the lodgement and multiplication of organism in the tissue of host
Biofilms of the different
types of bacteria
Microcolonies

Classification of infections
Primary infection: Initial infection with organism in host.
Reinfection: Subsequent infection by same organism in a host (after recovery).
Superinfection: Infection by same organism in a host before recovery.
Secondary infection: When in a host whose resistance is lowered by preexisting infectious disease, a new organism may set up in infection.

Classification of infections
5. Focal infection: It is a condition where due to infection at localized sites like appendix and tonsil, general effects are produced.
6. Cross infection: When a patient suffering from a disease and new infection it set up from another host or external source.
7. Nosocomial infection: Cross infection occurring in hospital.
8. Subclinical infection: It is one where clinical affects are not apparent.

Causative agents of infections
Saprophytes: They are free living organisms which fail to multiply on living tissue and so are not important in infectious disease.
Parasites: They are organisms that can establish themselves and multiply in hosts. They may be pathogens or commensal. Pathogens are those which are capable of producing disease in a host. On the contrary commensal microbes can live in a host without causing any disease.

Sources of infection in Man
Man: Man is himself a common source of infection from a patient or carrier. Healthy carrier is a person harboring pathogenic organism without causing any disease to him. A convalescent carrier is one who has recovered from disease but continues to harbor the pathogen in his body.
Anthroponosis

Sources of infection in Man
Animals: Infectious diseases transmitted from animals to man are called zoonosis. Zoonosis may be bacterial, (e.g. Plague from rat), rickettsial, (e.g. Murine typhus from rodent), viral, (e.g. Rabies from dog), protozoal, (e.g. Leishmaniasis from dogs), helminthic, (e.g. Hydatid cyst from dogs) and fungal (zoophilic dermatophytes from cats and dogs).

Sources of infection in Man
Insects: The diseases caused by insects are called arthropod borne disease. Insects like mosquitoes, fleas, lice that transmit infection are called vector. Transmission may be mechanical (transmission of Dysentery or typhoid bacilli by housefly) and these are called mechanical vector. They are called biological vector if pathogen multiplies in the body of vector, e.g. Anopheles mosquito in Malaria.

Sources of infection in Man
Some vectors may acts as reservoir host, (e.g. ticks in Relapsing fever and Spotted fever).
Soil: Spores of tetanus bacilli, Gas-gangrene infection remain viable in soil for a long time.
Clostridium tetani

Sources of infection in Man
Water: Vibrio cholerae, infective hepatitis virus (Hepatitis A and Hepatitis E) may be found water.
Food: Contaminated food may be source of infection. Presence of pathogens in food may be due to external contamination, (e.g. food poisoning by Staphylococcus).

Methods of transmission of infection
Contact (sexual intercourse): syphilis, gonorrhea.
Inhalation: influenza, tuberculosis, smallpox, measles, mumps, etc.

Methods of transmission of infection
Ingestion: cholera (water), food poisoning (food) and dysentery (hand borne).
Inoculation: tetanus (infection), rabies (dog), arbovirus (insect) and serum hepatitis, i.e. Hepatitis B (infection).
Human hand contaminated with colonies of bacteria (blue/pink patches)

Methods of transmission of infection
Congenital: syphilis,
rubella, toxoplasmosis, cytomegaloviruses
Eight week old fetus attached to its placenta by the umbilical cord

Methods of transmission of infection
Insects: they act as mechanical vector (dysentery and typhoid by housefly) or biological vector (malaria) of infectious disease
Jatrogenic and laboratory infections: infection may be transmitted during procedures

Characters of pathogens
Bacteria should be able to enter the body.
Organism should be able to multiply in the tissue.
They should be able to damage the tissue.
They must be capable to resist the host defense.

Pathogenecity is referred to the ability of microbial species to produce disease.
Virulence is referred to the ability of microbial strains to produce disease.

Factors of Virulence
Adhesion: The initial event in the pathogenesis of many infections is the attachment of the bacteria to body surfaces. This attachment is specific reaction between surface receptors and adhesive structures on the surface of bacteria (adhesins).

Adherence of bacteria

Factors of Virulence
Invasiveness is the ability of organism to spread in a host tissue after establishing infection. Less invasive organisms cause localized lesion. Highly invasive organisms cause generalized infection (septicemia).
Toxigenicity. Bacteria produce two types of toxins – exotoxins & endotoxins

Factors of Virulence - Exotoxins
Heat labile protein.
Diffuse readily into the surrounding medium.
Highly potent, e.g. 3 kg botulinum can kill all the inhabitants of world.
They are generally formed by Gr+ bacteria and also by Gr- organisms like Shigella, V.cholerae, E.coli.
Exotoxin is specifically neutralized antitoxin.
Can be separated from culture by filtration.
Action is enzymatic and it has specific tissue affinity.
Specific pharmacological effects for each exotoxin.
Cannot cause pyrexia in a host.
Can be toxoided.

Modification of Toxin to Toxoid
Toxin

Factors of Virulence - Endotoxins
Endotoxin (lipid a portion of lypopoly-saccharide) has biological activities causing fever, muscle proteolysis, uncontrolled intravascular coagulation and shock.
These may be mediated by production from mononuclear cells of IL-1, probably IL-6.

Characters of Endotoxins
Proteins polysaccharide lipid complex heat stable.
Forms part of cell wall (don’t diffuse into the medium).
Obtained only by cell lysis.
They have no enzymatic action.
Effect is non-specific action.
No specific tissue affinity.
Active only in large doses 5 to 25 mg.
Weakly antigenic.
Neutralization by antibody ineffective.
Cannot be toxoided.
Produce in Gram negative bacteria.

Factors of Virulence
Communicability is the ability of parasite to spread from one host to another. It determines the survival and distribution of organism in a community.
Coagulase (S.aureus) which prevents phagocytosis by forming fibrin barrier around bacteria.
Fibrinolysin promotes the spread of infection by breaking down the fibrin barrier in tissues.

Factors of Virulence
Hyaluronidase split hyaluronic acid (component of connective tissue).
Leucocidins damage polymorphonuclear leucocytes.
Ig A1 proteases: split IgA and inactivates its antibody activity.
Hemolysin is produced by some organisms capable of destroying erythrocytes.

Factors of Virulence. Bacterial appendages
Capsulated bacteria like Pneumococcus, K.pneumoniae and H.influenzae stand phagocytosis
Surface antigen, e.g. Vi-antigen of S. typhi and K- antigen of E.coli resisted phagocytosis and lytic activity of complement.

Infecting dose
The minimum infection dose (MID) or minimum lethal dose (MLD) is the minimum number of organism required to produce clinical evidence of infection or dearth of susceptible animal.
Route of infection
Vibrio cholerae is effective orally. No effect when it is introduced subcutaneously.
Streptococci can initiate infection whatever be the mode of entry.

Types of infectious diseases
Infectious diseases may be localized or generalized. Localized infections may be superficial or deep-seated.
Circulation of bacteria in the blood is known as bacteremia (viruses – virusemia).

Types of infectious diseases
Septicemia is the condition where bacteria circulate and multiply in the blood, form toxic products and cause swinging type of fever.
Pyemia is a condition where pyogenic bacteria produce septicemia with multiple abscesses in the internal organs such as the spleen, liver and kidney.

Types of infectious diseases
Depending on the spread of infectious disease in the community they may be classified into different types.
Endemic diseases are ones that are constantly present in a particular area. Typhoid fever is endemic in most parts of India. An epidemic disease is one that spreads rapidly, involving many persons in an area at the same time. Influenza causes annual winter epidemics in the cold countries.

Types of infectious diseases
A pandemic is an epidemic that spreads through many areas of the world involving very large numbers of persons within a short period (Influenza, cholera, plaque).
Epidemics vary in the rapidity of spread. Waterborne disease such as cholera and hepatitis may cause explosive outbreaks, while disease, which spreads by person-to-person contact evolve more slowly.

Stages of infectious disease
Incubation period – no symptoms.
Prodromal period – mild and generalized symptoms (fever, weakness, headache).
Invasive stage – symptoms specific to the disease.
Decline stage – symptoms subside.
Convalescence – no symptoms, health returns to normal.

Biofilms
Biofilms form when bacteria adhere to surfaces in aqueous environments and begin to excrete a slimy, glue-like substance that can anchor them to all kinds of material (metals, plastics, medical implant materials and, human or animal tissue).
Hundreds of microbial biofilm colonize the human mouth, causing tooth decay and gum disease.

Quorum Sensing
Many groups of bacteria can communicate - by releasing and detecting chemical pheromones to gauge their population density - the molecular structure of a key protein in this interbacterial communication has been solved.

Quorum sensing provides an explanation for why some disease-causing virulence factors are not expressed during the early stages of encounter with the human host

Characteristics of biofilm
A biofilm can contain a single species of bacteria or several species.
Genetic studies confirm that bacteria switch on different genes, depending on whether they're living as free-floating microbes or clustering as biofilms.
Biofilm bacteria can be up to 1000 times more resistant to antimicrobial stress (e.g. antibiotics and disinfectants) than free-swimming bacteria of the same species.

Plaque is a biofilm on the surfaces of the teeth which secretes acids that destroy teeth and gums
Dental plaque as seen under a scanning electron microcroscope

5 stages of P.aeruginosa biofilm development
1, initial attachment; 2, irreversible attachment;
3, 4 - maturation ; 5, dispersion.