Infection 27

2
33333333333333333333333 3
INFECTION 333
28 Microbiology for GNM

The lodgement and multiplication of a parasite in or on the tissue of a

host is known as infection.
Infection can be occur by various ways such as
Primary infection – intial infection with a parasite is called primary
infection.
Reinfection – subsequent infection with the same parasite in same
host is known as reinfection.
Secondary infection – when the primary infection lowers the
resistance of the host and the latter get infection with another
organisms is known as secondary infection.
Cross infection – when a patient already suffering from a disease
acquires a new infection is known as cross infection.
Nosocomial or Hospital infection – when cross infection is acquired
during his stay in the hospital is known as nosocomial or hospital
infection.
Physician induced infection – when the infection is acquired during
therapeutic or investigative procedures is known as iatrogenic or
physician induced infection.
Subclinical infection – when the clinical symptoms of an infection
are not apparent is known as subclinical infection.
Latent infection – after infection, parasite remain in a latent or hidden
form for some time and it proliferates and produced clinical disease
when the host resistance is lowered is known as latent infection.

SOURCES AND RESERVOIR OF INFECTION

Pathogens are either endogenous or exogenous. Endogenous are
arising from the host’s own flora and exogenous arising from the an
external source. Reservoir of infection is the pathogen existence in
human or animal population or environment and from which pathogen
can be transmitted.

Endogenous infections
It is also known as autoinfection. For example, normal flora present
inside the body, usually non pathogenic but occasionally they may
led to infection.
 Infection 29

Exogenous infections
Infections arise from outside the body, so it is referred to as exogenous.
Few source of exogenous infection are
1. Human
2. Animal
3. Insects
4. Environment

Human as carrier
Source of human infection comes from patient or carrier.
Patients – patients are ill persons from them infections may acquired.
Carrier – a carrier is a person who harbours the pathogens without
suffering from it. Types of carrier are
1. Healthy carrier – people harbours the pathogen but never suffered
from the disease.
2. Convalescent carrier – people recovered from the disease but
continues to harbour the pathogen on his body.
3. Temporary carrier – when carrier state lasts for less than six months
in the individual.
4. Chronic carrier – when carrier state lasts for years or may be for
the life of the patient.
5. Paradoxical carrier – person acquires the organisms from another
carrier.
6. Contact carrier – person acquires the organisms from the patient.

Animal
Animals are source of infections. Infections in animals may be
asymptomatic and serve as reservoir for human infections are known
as reservoir hosts.
Infectious diseases transmitted from animals to man are known as
zoonoses.
30 Microbiology for GNM

Diseases caused from animals

Diseases Pathogen Reservoir hosts Transmission
Viral Disease
Rabies Rhabdoviridae Animal species Bite of diseased animals
Tickborne encephalitis Flaviviridae Wild animals Ticks
Bacterial Disease
Animals milk and diary
Brucellosis Brucella Cattle, pig, goat.
products
Lyme Disease Borrelia Wild rodents Ticks
Plague Yersinia pestis Rodents Contact with diseased
animals
Q fever Coxiella burnetii Sheep,goat,cattle Dust, milk or diary
products.
Enteric salmonellosis Salmonella Pig, cattle, poultry Meat, milk, eggs
enterica
Protozoan disease
Toxoplasmosis Toxoplasma gondii Cat, sheep, pigs Oral, prenatal
Cryptosporidiosis Cryptosporidium Cattle Ingestion of oocysts
Helminthic Disease
Echinococcosis Echinococcus Dog, fox Ingestion of eggs
Taeniasis Taenia Cattle, buffalo, pigs Ingestion of
metacestodes with meat

Anthropod Disease
Contact with diseased
Pseudo scabies Sarcoptes spp. Dog, cat, pig
animals

Insects
Insects transmitting pathogens are known as vectors. Thus insects
act as a source of a number of human and animal infections. Few
examples for insects are mosquitoes, ticks, mites, flies and lice.
Vectors are of two types. They are mechanical vectors and biological
vectors.
Mechanical vectors – vectors which carry the organisms on their legs,
wings and body and transmit them to the food which act as a source
of infections.e.g salmonellosis and shigellosis (Domestic fly).
Biological vectors – vectors carry pathogens undergo multiplication or
developmental changes with or without multiplication inside their body.
Biological vectors are classified into three types
 Infection 31

1. Propagative vector
2. Cyclo-Propagative vector
3. Cyclo-Developmental vector

Anthropod transmitting disease

Insects Disease
Flies Typhoid and paratyphoid fever, diarrhea, dysentery,
cholera, gastroenteritis,amoebiasis.
Ticks Spotted fever, Q fever, relapsing fever.
Mosquitoes Malaria, filariasis, yellow fever, dengue, chikungunya
fever, rift valley fever.
Louse Epidemic typhus, relapsing fever, trench fever.
Rat flea Bubonic plague, endemic typhus.
Mites Scrub typhus, rickettsial pox, scabies.
Cockroaches Typhoid, diarrhea, dysentery.

Environment
Environment is the major source of infection. Environment includes
soil, water and food. Soil contain organisms such as Clostridium,
Bacillus, roundworms, hookworms and few fungal species. These
pathogens causes disease to the pathogens. Water also found with
different pathogens such as Salmonella, Shigella, Vibrio, Polio,
Hepatitis and larvae of worms. Food contain organisms causing food
poisoning, gastroentritis, diarrhea and dysentry.

SPREAD OR TRANSMISSION OF INFECTION

Pathogenic organisms can spread from one host to another by various
ways.

Inhalation
Most infections are transmitted by the respiratory route by
aerosolization of respiratory secretions when inhaled by others. Spread
of infection depends on the size of aerosol droplets. Droplets are vary
in size, in still air, a particle of 100µm in diameter requires seconds to
falls down but a 10µm particle remain airborne for about 20 minutes,
small particle even longer. When droplet particles with a diameter of
6µm or greater are usually trapped by the mucosa of the nasal
32 Microbiology for GNM

turbinates, where as particle of 0.6 to 5.0 µm attach to mucous sites

at various levels along the upper and lower respiratory tract and may
initiate infection. Respiratory secretions are often transferred on hands
or inanimate objects (fomites) and may reach the respiratory tract.
Clothing, handkerchiefs, bedding, floors, furniture and household
articles become contaminated with secretions and act as reservoir of
infection.

Ingestion (fecal-oral spread)

Fecal-oral spread involves direct or finger-to-mouth spread, the use of
human feces as a fertilizer or fecal contamination of food or water.
Food handlers who are infected with an organism transmissible by
this route, when their personal hygienic practices are very poor.

Contact
Infection may be acquired by direct or indirect contact with the
parasites. Sexually transmitted diseases are acquired by direct
contact, usually termed as contagious disease. E.g. syphilis,
gonorrhoea, and AIDS.

Blood borne transmission

Insect vectors are responsible for bloodborn transmission. E.g.
mosquito and the malarial parasite. Presently, direct transmission
from human to human through blood are increased by the use of blood
transfusions and blood products and the increased self-administration
of illicit drugs by intravenous or subcutaneous routes, using shared
nonsterile equipment. E.g. Hepatitis B and C viruses as well as HIV
are frequently transmitted in this method.

Vertical transmission
Organisms such as rubella virus can spread from the mother to the
fetus through the placental barrier is known as vertical transmission.
Other form of transmission from mother to infant occurs by contact
during birth with organisms such as group B Streptococci,
C.trachomatis and N.gonorrhoeae which colonize the vagina. The
third way of transmission is transmitted by breast milk. E.g. CMV.
 Infection 33

NOSOCOMIAL INFECTIONS OR HOSPITAL INFECTIONS

The hospital is ideal environment for the transmission of pathogens,
because patients with similar diseases and susceptibilities are present
in an enclosed community. Patients share contact with many health
care workers each day. In this setting, the ward, health care workers
become colonized by organisms adapted to the special environment.
New susceptible patients are frequently added to the population and
are at risk of colonization and infection.
Respiratory tract,urinary and wound infections are common in all
hospital patients.

Conditions promote hospital infection

1. Chronic chest disease, obstructed urinary outflow or previous
immune suppression.
2. Need for invasive devices ( intravenous cannulae, urinary catheters
etc)
3. Effect of surgery
4. Effect of antibiotic treatment
5. Effect of immunosuppressive treatment
6. Exposure to healthcare workers and other patients who may carry
or transmit pathogens.
7. Exposure to pathogens in the environment,especially bedding and
food.

Examples for hospital infection

1. Intravenous infection
2. Urinary catheter – related infection
3. Surgery related infection

Control of infection in hospitals

Appropriate organization and effective management protocols are
essential to the control of hospital infection.

Few control measures are

1. Sterilization and Disinfection
34 Microbiology for GNM

2. Proper hospital waste disposal

3. Public awareness
4. Education and training to hospital staff.

COLLECTION OF SPECIEMENS
Laboratory procedure is to identify causative agent for patient illness.
Laboratory identification start from specimen collection, handling,
transportation and examination like microscopy, staining, biochemical
tests etc.
Body fluids, secretions and biopsy material can all be examined to
detect pathogens, antigen or products or the immune response to
them. Samples from the environment, e.g. water, food or soil, may
also be examined. Some sample must be examined at a particular
time; for example malaria parasites are best sought at the peak of
fever and a short time afterwards, whereas blood for bacterial culture
should be taken as the fever begins to rise. Special precautions must
be taken to ensure survival of the pathogen and exclude contaminants,
e.g. cleaning the perineum before collection of a midstream specimen
of urine. Anaerobic species may die if exposed to atmospheric oxygen
and survive better in samples of pus, rather than in swab specimens.
Every sample or specimen collection has to be done with proper care
because if the quality of specimen collected is poor, the result obtained
will be unreliable.

Universal Precautions And Laboratory Safety

1. Specimen may contain hazardous pathogens and must be handled
with care.
2. General precaution is employed to reduce the risk of transmitting
blood-borne pathogens.
3. Personal protective measures has to be taken in collecting and
examining specimens.

General rule for specimen collection

1. The quantity of specimen must be adequate.
2. The sample should be collected from the appropriate region of the
body.
 Infection 35

3. Contamination of the specimen must be avoided by using only

sterile equipment and aseptic conditions.
4. Always collect specimens prior to administration of antimicrobial
drugs.
5. Specimens may be infectious, so proper precaution like wear gloves,
gowns, masks and goggles, whenever necessary.
6. Specimen containers labeled with information about patient name,
code number etc. and the specimen source, date and time of
collection.

Collection
Specimens are collected by several methods using aseptic techniques.
Aseptic techniques refer to specific procedures used to prevent
unwanted microorganisms from contaminating the clinical specimens.
Skin, Nails and Hair
Skin, nails and hair should be collected into folded squares of black
paper. The use of paper permits the specimen to dry out, which helps
to reduce bacterial contamination. Wood’s light will be used to select
infected scalp hairs for laboratory investigation. Hairs give the green
flourescence which is a feature of some forms of dermatophyte scalp
infection. Hairs should be plucked from the scalp with forceps. Nail
specimens should be taken from any discoloured, dystrophic or brittle
parts of nail.

Mucous Membrane
Although scrapings from oral lesions are better than swabs for diagnosis
of oral infections. Swabs are more frequently used, mainly because
they are more convenient for transporting material to the laboratory.
Swabs should be either be moistened with sterile water or saline prior
to taking the sample or sent to the laboratory in transport medium.

Anterior nares or Throat

The most common method used to collect specimens from the anterior
nares or throat is the sterile swab. Commercially manufactured swab
contain a transport medium designed to preserve a variety of
microorganisms and to prevent multiplication of rapidly growing
members of the population.
36 Microbiology for GNM

Ear
Scrapings of material from the ear canal are mostly preferred, although
swabs can also be used.

Sputum
Sputum is the most common specimen collected in suspected cases
of lower respiratory tract infections. Sputum is the mucous secretion
expectorated from the lungs, bronchi and trachea through the mouth.
Sputum is collected in specially designed sputum cups.

Urine
Proper collection of the specimen is the single most important step in
a urine culture.

Faeces
Stool specimens are collected in clean sterile leak-proof containers

Blood
The following rules are applied to collect blood specimens.
1. Use strict aseptic techniques. Wear gloves.
2. Apply a tourniquet and locate a fixed vein by touch. Release the
tourniquet while the skin is being prepared.
3. Prepare the skin for venipuncture by cleansing it vigorously with
70 – 95% isopropyl alcohol. Using 2% tincture of iodine or 2%
chlorhexidine, start at the venipuncture site and cleanse the skin
in concentric circles of increasing diameter. Allow the aseptic
preparation to dry for at least 30 seconds. Do not touch the skin
after it has been prepared.
4. Reapply the tourniquet, perform venipuncture, and (adults) withdraw
approximately 20 ml of blood.
5. Add the blood to labelled aerobic and anaerobic blood culture
bottles.
6. Take specimens to the laboratory promptly, or place them in an
incubator at 370C.

Cerebrospinal Fluid
As soon as infection of the central nervous system is suspected,
 Infection 37

cerebrospinal fluid is obtained for analysis. To obtain cerebrospinal

fluid, perform lumbar puncture with strict aseptic techniques, taking
care not to risk compression of the medulla by too rapid withdrawal of
fluid when the intracranial pressure is markedly elevated. Cerebrospinal
fluid is usually collected in three or four portions or 2-5ml each, in
sterile tubes.

Pus and Wound secretions

For surface wounds collect sample material with smear swabs and
transport in preservative transport mediums. Such material are
analysed for aerobic bacteria. For deep and closed wounds, liquid
material (e.g. pus) should be sampled if possible, with a syringe. Use
special transport medium for anaerobes.

Eye swabs
The swab is gently rubbed over the conjunctiva in the lower conjunctival
sac. Conjuctival swabs should be inoculated onto an agar plate at the
patient’s bedside and then sent to the laboratory.