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Chapter 13 We Are Not Alone

Microbe-Human Interactions
Infection, Disease, and Epidemiology The human body exists in a state of dynamic
equilibrium

Many interactions between human body and

microorganisms involve the development of biofilms

Colonization of the body involves a constant give

and take

1 2

Contact, Colonization, Infection, Disease

Contact, Colonization, Infection, Disease
Normal (resident) flora, indigenous flora, microbiota
_________________________________________
_________________________________________
Infection
_________________________________________
_________________________________________
Pathogen
________________________________________
Infectious disease
________________________________________
________________________________________

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Resident Flora Initial Colonization of the Newborn

Most areas of the body in contact with the outside
environment harbor resident microbes Uterus and contents are Copyright McGraw-Hill Education. Permission required for reproduction or display.

normally sterile
Internal organs, tissues, and fluids are microbe-free
During and shortly after
Transients microbes that occupy the body for only short birth microbes begin to
periods colonize
Residents microbes that become established xBecome members of

the normal flora, but

Microbial antagonism do not cause disease
____________________________________________ xBreaking of fetal

____________________________________________ membrane exposes the

Endogenous infections
x
infant; all subsequent
handling and feeding

occur when normal flora is introduced to a site that was continue to introduce
previously sterile what will be normal flora

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6

Flora of the Human Skin Flora of the Gastrointestinal Tract

Copyright McGraw-Hill Education. Permission required for reproduction or display.
Copyright McGraw-Hill Education. Permission required for reproduction or display.

Skin is the largest and Hair shaft

GI tract is a long hollow
most accessible organ Epidermis tube, bounded by mucous Oral cavity
Sweat pores Pharynx
membranes
Two cutaneous Sebaceous Tube is exposed to the
populations Dermis
(oil) gland

Hair follicle
environment Esophagus

Transients: influenced Hair root

Variations in flora
by hygiene distribution due to
Stomach
shifting conditions (pH,
Subcutaneous Duct of
Residents: stable, tissue sudoriferous

predictable, less (a)

(sweat) gland
oxygen tension, Duodenum

influenced by hygiene anatomy)

Oral cavity, large intestine, Large
intestine
and rectum Small
intestine
harbor appreciable flora
Rectum
(b)
Janice Carr/CDC 7
Anal canal 8

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Flora of the Mouth Flora of the Respiratory Tract

Most diverse and unique flora of the body Copyright McGraw-Hill Education. Permission required for reproduction or display.

Numerous adaptive niches Oral streptococci, first

Sinuses
organisms to colonize
x

Nasal
Bacterial count of saliva (5 x 109 cells per milliliter)
x
vestibule Nasal cavity
Nasal entrance, nasal

Internal naris
vestibule, anterior Nasal

Flora of the Large Intestine nasopharynx S. aureus

entrance

Larynx
Soft palate
Nasopharynx
Has complex and profound interactions with host
x
Mucous membranes of
x

Epiglottis
nasopharynx Neisseria
108-1011 microbes per gram of feces Bronchus Trachea
Tonsils and lower pharynx
x
Bronchiole
Intestinal environment favors anaerobic bacteria
x
Haemophilus
Intestinal bacteria contribute to intestinal odor
x

Right lung Left lung

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Flora of the Genitourinary Tract Maintenance of the

Uterine tube
Sites that harbor microflora Normal Resident Flora
Ovary
Females Vagina and Uterus

outer opening of urethra Urinary

Rectum
Normal flora is essential to the health of humans
bladder Vagina
Males Anterior urethra
Urethra
Anus
Flora create an environment that may prevent
Changes in female physiology External
reproductive infections and can enhance host defenses
influence the composition of
organs

the normal flora Antibiotics, dietary changes, and disease may alter
Vagina (estrogen, flora
glycogen, pH) Urinary
bladder Probiotics
Rectum
________________________________________
Penis

Urethra Anus
Testis 11

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Major Factors in the Development of an Major Factors in the Development of an Infection

Infection True (primary) pathogens
________________________________________________
________________________________________________
Influenza virus, plague bacillus, malarial protozoan
Opportunistic (secondary) pathogens
________________________________________________
________________________________________________
Pseudomonas sp & Candida albicans
Virulence
_______________________________________________
Severity of disease depends of virulence of the pathogen
Virulence factors
_______________________________________________
_______________________________________________
Determines degree of tissue damage/severity of disease
Surface components, enzymes, toxins, abscess formation, etc.

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Becoming Established Portals of Entry

Portals of entry ___________________________________
___________________________ Skin
nicks, abrasions,
Exogenous agents Conjunctiva punctures, incisions
originate from source Respiratory tract Gastrointestinal tract
outside the body Gastrointestinal food, drink, and other
tract

ingested materials
Endogenous agents Skin
Respiratory tract
already exist on or in oral and nasal cavities
the body (normal flora) Urogenital tract
sexual, displaced
organisms
Pregnancy
and birth
Transplacental
Urogenital tract
infection of placenta or
birth canal during
15 pregnancy 16

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Pathogens That Infect during Pregnancy Requirement for an Infectious Dose (ID)
STORCH Infectious dose (ID50)
____________________________________________________
____________________________________________________
_____________________________________
Syphilis, Toxoplasmosis, Other diseases (hepatitis B, AIDS and
_____________________________________
chlamydia), Rubella, Cytomegalovirus and Herpes simplex virus Microbes with small IDs have greater virulence
Bacterial
cells
Placenta
Lack of ID will not result in infection
Maternal blood pools
within intervillous space

Umbilical cord

Umbilical
vein
Placenta
Umbilical
arteries (fetal blood)
Maternal
blood vessel
Umbilical
cord
(a) (b)

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Attaching to the Host Adhesion Properties of Microbes

Adhesion microbes gain a stable foothold at the portal of entry
________________________________________________
___________________

Fimbrae
Flagella
Glycocalyx
Cilia
Suckers
Hooks
Barbs

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Surviving Host Defenses: Phagocytosis Entering Host Tissues

_______________________________________________
________________________________________
Antiphagocytic factors used to avoid phagocytosis
________________________________________
Leukocidins, produced by species of Staphylococcus and Streptococcus,
toxic to white blood cells
Slime layer or capsule makes phagocytosis difficult
Ability to survive intracellular phagocytosis

Copyright McGraw-Hill Education. Permission required for reproduction or display.

Capsule Bacteria cannot

be engulfed

Blocked

Continued growth
Phagocyte
of microbes damages
host tissue
(c) Blocked phagocytic response 21
22

Bacterial Toxins: A Potent Source of Cellular Damage

Causing Disease
2 Types of Bacterial Toxins:
Exoenzymes _______________________________________ Endotoxin ________________________________________
______________________
Dissolve extracellular barriers and penetrate through or between cells
__________________________________________________
Systemic, generalized physiologic effect: fever, malaise, aches, shock, DIC
Examples
Toxic in large doses; not stimulate antitoxins; stable; do not form toxoids
Coagulase cause fibrin to clot, wall off bacteria from the host defenses Induce macrophage to secrete cytokines damaging systemic immune responses
Kinase breaks down fibrin clot and aids spread of bacteria in host tissue
Exotoxin _________________________________________
Hyaluronidase breaks down hyaluronic acid of CT to aid spread of bacteria
_________________________________________________
Collagenase breaks down collagen in muscle and aids spread of bacteria Strong specificity for a target cell: heart, blood, nerve, liver (usu. no fever)
Mucinase breaks down (digests) mucus coating on mms, e.g. E. histolytica Toxic in tiny amounts; stimulate antitoxins; unstable; converted to toxoids
IgA protease cleaves and destroys IgA Abs, which normally prevent bacteria from 3 Categories of Exotoxins
adhering to hosts mms, e.g. Neisseria gonorrhea A-B toxins (most common): Two polypeptide parts designated A and B:
B (binding part) binds host cell; A (active enzyme part) inhibits protein
Toxigenicity _________ synthesis, destroying host cells E.g. diphtheria, tetanus, cholera toxins
_____________________ Membrane disrupting toxins: Disrupts host CM and lyse (destroy) host cells
E.g. Hemolysins, leukocidins
_____________________ Superantigens: Toxins that non-specifically bind TH cells, causing them to
_____________________ clone and release large amounts of cytokines in tissue fluid, which provoke
systemic immune responses such as fever, vomiting, diarrhea, shock, rash
E.g. Staphylococcal enterotoxin or TSST-1 cytotoxin
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Bacterial Toxins: Exotoxins and Endotoxins

Copyright McGraw-Hill Education. Permission required for reproduction or display. Process of Infection and Disease (4-5 stages)
Exotoxins Endotoxins
1) Incubation period
_________________________________________________
_________________________________________________
Several hours to several years; average is 2-30 days
Agent is multiplying but damage is insufficient to cause symptoms
2) Prodromal stage
________________________________________________
________________________________________________
Malaise (vague feelings of discomfort); nonspecific complaints, aches,
Koplik spots (measles)
3) Period of illness (invasion)
________________________________________________
________________________________________________
(a) Target organs are damaged;
Organism multiplies at high levels and becomes well-established
heart, muscles, blood Fever, chills, myalgia, pharyngitis, lymphadenitis, GI disturbances, paralysis
cells, intestinal tract show (b) General physiological effects 25
dysfunctions. fever , malaise, aches, shock

Process of Infection and Disease cont. Process of Infection and Disease cont.

4) Period of Decline
______________________________________________
Lasts one to several days; host is vulnerable to secondary infection

5) Period of Convalescence
______________________________________________
Person regains his strength and body returns to a healthy state

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Patterns of Infection Patterns of Infection

Localized infection microbes enter body and remains Mixed infection (Synergism or Polymicrobial) several
confined to a specific tissue (target tissue) microbes work together to digest host tissue at the infection site
Systemic infection microbes or toxins spread to several sites Primary infection acute initial infection
and tissue fluids usually in the bloodstream Secondary infection another infection (usually opportunistic)
Focal infection when infectious agent breaks loose from a that occurs during or
local infection and is following treatment of
carried to other tissues a primary infection
Sometimes more
dangerous than primary
infection

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Patterns of Infection Signs and Symptoms of Disease

Acute infection comes on rapidly, with severe but short-lived effects
Chronic infections progress and persist over a long period of time (months

or years) Chronic carrier: Person w/a latent infection who sheds the infectious agent
Subacute infection intermediate between acute and chronic infection

Subclinical (Inapparent or Asymptomatic) infection although infected, the

host doesnt show any noticeable symptoms, doesnt seek medical attention

and acts as carrier (harbors pathogen)

Latent infection after initial acute infection, the microbe can periodically
become active and produce a recurrent disease; person may or may not shed

it during the latent stage

Sequelae (Residua) long-term or permanent damage to tissues or organs

(pathologic effect) as a consequence of an infection
Nosocomial infections diseases acquired or developed during a
hospital or other health-care facility stay
From surgical procedures, equipment, personnel, and exposure to drug-
resistant microorganisms
2 to 4 million cases/year in U.S. with approximately 90,000 deaths
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Signs and Symptoms of Inflammation Portals of Exit

________________________________________________________
_______________________________________________________
Fever, pain, soreness, swelling
________________________________________________
________________________________________________
Copyright McGraw-Hill Education. Permission required for reproduction or display.

Signs of inflammation: Respiratory

Edema accumulation of fluid mucus, sputum, Coughing,
Granulomas and abscesses walled-off collections of inflammatory cells nasal drainage, saliva sneezing

and microbes Insect bite

Lymphadenitis swollen lymph nodes Skin scales Skin cells

Signs of Infection in the Blood

(open lesion)
Fecal exit
Changes in the number of circulating white blood cells Urogenital tract
Leukocytosis increase in white blood cells Removal of blood
Leukopenia decrease in white blood cells Removal
of blood
Septicemia microorganisms are multiplying in the blood and present
in large numbers Urine
Feces
Bacteremia small numbers of bacteria present in blood not necessarily
multiplying
Viremia small number of viruses present not necessarily multiplying 34

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Reservoirs of Infectious Disease Human Reservoirs

Reservoir
___________________________________________
___________________________________________
___________________________________________
Human or animal carrier, soil, water, plants
Carrier
___________________________________________________
___________________________________________________
Active carriers:
Asymptomatic carrier shows no symptoms
Incubation carriers spread infectious agent during incubation period
Convalescent carriers recuperating w/o symptoms
Chronic carriers individual who harbors agent for a long period

Source
Individual or object from which an infection is actually
acquired
Reservoir and source are not always the same
HAV reservoir is human, but source is food
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Human Reservoirs Animal Reservoirs

Vector
______________________________________________
Passive carriers ______________________________________________
Healthcare worker transfers pathogens to other Majority are arthropods fleas, mosquitoes, flies, and ticks
Some are larger animals mammals, birds
patients through contact with contaminated
material, e.g. bedpan Two Types of Vectors
Biological vectors actively participate in a pathogens life cycle
Mechanical vector not necessary to pathogens life cycle;
transports pathogen on feet or other body part w/o being
infected
Zoonosis
______________________________________________
______________________________________________
Animal may or may not exhibit symptoms of disease, e.g. bats
Impossible to eradicate disease w/o eradicating the animal reservoir

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Acquisition and Transmission of Patterns of Transmission

Infectious Agents
Communicable disease
___________________________________________________
___________________________________________________
Contagious disease a highly communicable disease
Non-communicable infectious disease
Direct contact ____________________________________
Indirect contact __________________________________
_________________________________________________
Vehicle inanimate material, food, water, biological
products, fomites
Airborne droplet nuclei, aerosols
Copyright McGraw-Hill Education. Permission required for reproduction or display.

___________________________________________________
Occurs primarily when a compromised person is invaded by his or her
own normal microflora
Contact with organism in natural, non-living reservoir

40
Marshall W. Jennison, Massachusetts Institute of Technology, 1940
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How Communicable Infectious Diseases are Acquired

Epidemiology
______________________________________________
______________________________________________

xSurveillance collecting, analyzing, and reporting data on

rates of occurrence, mortality, morbidity and transmission of
infections

Reportable, notifiable diseases

____________________________________________
Centers for Disease Control and Prevention (CDC) in Atlanta, GA
principal government agency responsible for keeping track of
infectious diseases nationwide

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Patterns of Infectious Disease Occurrence

Frequency of Cases
Prevalence ______________________________________
_________________________________________________ Endemic disease
Usually represented by a percentage of the population that exhibits a relatively
steady frequency over a
Incidence _______________________________________ long period of time in a
particular geographic
_________________________________________________ locale
Mortality rate the total number of deaths in a population due Sporadic when
to a certain disease occasional cases are
reported at irregular
Morbidity rate number of people afflicted with a certain intervals
disease

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Patterns of Infectious Disease Occurrence Kochs Postulates: Determining the causative agent of a disease

1. Find evidence of a particular

microbe in every case of a disease
Epidemic when 2. Isolate that microbe from an
infected subject and cultivate it
prevalence of a
artificially in the laboratory
disease is increasing
3. Inoculate a susceptible healthy
beyond what is
subject with the laboratory isolate
expected and observe the resultant disease
4. Reisolate the agent from this
Pandemic epidemic subject
across continents

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