Infection

s
 Infection
• Is the invasion
and
multiplication of
microbes in or
on body tissues,
resulting in
signs and
symptoms as
well as an
immunologic
response
• Microbial reproduction injures the
patient either by:
 competing with host metabolism
 causing cellular damage from toxins
produced by the microbes or
intracellular multiplications
 Communicable and
Contagious Diseases
Communicable Disease
• Transmitted from one person to
another
• Include childhood diseases:
 chickenpox
 measles
 mumps
Contagious Disease
• A communicable disease that is easily
transmitted from one person to another
Ex:
 influenza
 scabies
 Reasons Why Microbes
That Cause Diseases Are
Difficult to Treat
1. Some bacteria develop a resistance to
antibiotics
2. Some microbes such as influenza
virus have so many different strains
that a single vaccine can't protect
against them all.
3. Most viruses resist antiviral drugs
4. New infectious agents, such as HIV
and Legionella, occasionally arise.
5. Some microbes localize in areas of the
body that make treatment difficult,
including bone and CNS.
6. Opportunistic microbes can cause
infection in immunocompromised
patients.
7. Much of the world's ever-increasing
population has not received
immunization.
8. Increased air travel by the world's
population can speed a virulent
microbe to a heavily populated urban
area within house.
9. The use of biological warfare and
bioterrorism with organisms such as
anthrax, plague, and smallpox is an
increasing threat to public health and
safety throughout the world.
10. The expanded use of
immunosuppressant drugs and
invasive procedures increase the risk
of infection.
 Epidemiology
Epidemiology:
• The study of the factors that influence
the occurrence and distribution of
disease
Sporadic Diseases
• If investigators find cases occuring
occasionally and irregularly with no
specific pattern
Example:
 tetanus
 gas gangrene
Epidemic Diseases
• If a greater-than-expected number of
cases of a given disease arises
suddenly in a specific area over a
specific period
Pandemic
• An epidemic that affects several
several countries or continents
Ex:
 HIV
Endemic Diseases
• Are those that are present in a
population or community at all times
• They usually involve relatively few
people during a specified time.
Ex:
 Schistosomiasis is endemic in Palo
(during early years)
Herd Immunity
• When a high proportion of a population
has developed immunity to a specific
infectious agent
Ex:
 Most Filipinos now are resistant to
measles
Endogenous and Exogenous
Endogenous Microbes
• Found on microbes and in such body
substances as saliva, feces, and
sputum
• They can cause disease in a
susceptible individual
Exogenous Microbes
• Originate from sources outside the
body
• Usually, humans and exogenous
microbes live together in harmony
• However, if something disrupts this
harmonious relationship, the microbes
may cause infection
 The Fragile Chain of
Infection
• An infection can occur only if the six (6)
components described below are
present
• Removing any one link prevents
infection
1. Causative
Agents
• A causative agent
for infection is
any microbe
capable of
producing
disease
2. Reservoir
• Is the environment or object in or on
which a microbe can survive and, in
some cases, multiply.
• Inanimate objects, human beings, and
other animals can all serve as
reservoirs, providing the essential
requirements for a microbe to survive
at specific stages in its life cycle
• Human reservoir can be a case or
carrier
 Case and Carriers
Case
• A patient with an acute clinical
infection such as chickenpox
Carrier
• A person colonized by a specific
microbe but showing no signs or
symptoms of infection
• Or may have a subclinical or
asymptomatic infection (hepatitis)
Typhoid Mary
Types of Carriers
1. Incubatory Carrier
• One who is incubating the illness
 Has acquired the illness but does not
yet show symptoms
• Incubation periods vary from one
infectious organism to the next
2. Convalescent Carrier
• Is in the recovery of an illness but
continues to shed the pathogenic
organism
 A person who has Salmonella infection
commonly sheds the organism in feces
even after symptoms disappear
3. Intermittent Carrier
• Occasionally sheds the pathogenic
organism
• Some people are intermittent carriers of
S. aureus
4. Chronic or Sustained Carrier
• Always has the infectious organism in
his system
• Some people are chronic carrier o f
hepatitis B, their blood harbors the
hepatitis B surface antigen for years
3. Portal of
Exit
• Is the path by
which an
infectious
agent leaves
its reservoir
• Usually, this
portal is the
site where
the organism
grows
• Common portal of exit associated with
human reservoirs include:
 respiratory
 genitourinary
 GIT
 skin and mucous membrane
 placenta
 blood
 emesis
 stool
 urine
 wound drainage
 genital secretions
• The portal of exit varies from one
infectious agent to the next
4. Mode of Transmission
• The means by which the infectious
agent passes from the portal of exit in
the reservoir to the susceptible host
• Infections can be transmitted through 1
of 4 modes:
a. Contact
b. Airborne
c. Vehicle
d. Vector-borne
• Some organisms use more than one
transmission mode to get from the
reservoir to the new host
• As with portals of exit, the transmission
mode varies with specific microbe
A. Contact Transmission
Direct Contact
• Refers to person-to-person spread of
organisms through actual physical
contact
Indirect Contract
• Occurs when a susceptible person
comes in contact with a contaminated
object
Droplet
Transmission
• Results from
contact with
contaminated
respiratory
secretions
• It differs from
airborne
transmission in
that the droplets
don't remain
suspended in
the air but settle
to surface
B. Airborne Transmission
• Occurs when fine microbial particles
containing pathogens remain
suspended in the air for a prolonged
period, and then are spread widely by air
currents and inhaled
C. Vehicle
• A substance that maintains the life of
the microbe until it is ingested or
inoculated into the susceptible host
• The vehicle is not harmful in itself but
may harbor pathogenic microbes and
thus serve as an agent of transmission
Ex:
 water
 blood
 serum
 plasma
 medication
 food
 feces
D. Vector-borne
Transmission
• When an
intermediate
carrier, or vector
such as flea or a
mosquito, transfer
a microbe to
another living
organism
• It is of most
concern in tropical
areas, where
insects commonly
transmit disease
5. Portal of
Entry
• Refers to the
path by which
an infectious
agent invades a
susceptible
host
• Usually, this
path is the
same as the
portal of exit
6. Susceptible Host
• Required for the transmission of
infection
• The human body has many defense
mechanism for resisting the entry and
multiplication of pathogens
• However, in a weakened host, an
infectious agent is more likely to invade
the body and launch an infectious
disease
 Pathogenicity
• Refers to a microbe's ability to cause
pathogenic changes, or disease
 Factors Affecting
Pathogenicity
Mode of Action
• The means by which a microbe
produces disease
• Virus cause infection by invading with
cell and interfering with cell
metabolism
Other modes of microbial action include:
• Evasion or destruction of host
defenses by preventing host
phagocytes (phagocytic cells) from
engulfing and digesting them
 used by Klebsiella pneumoniae
• Secretion of enzymes or toxins, which
allows the microbe to penetrate and
spread through host tissues
 used by measle virus
• Production of toxins that interferes with
intercellular responses
 used by tetanus bacilli
• Stimulation of a pathologic immune
response
 used by group A beta-hemolytic
streptococci
• Destruction of T-helper lymphocytes
 used by HIV
Virulence
• Refers to the degree of a microbe's
pathogenicity
• It can vary with the condition of the
body's defense
• Virulence can be enhanced by several
factors:
Toxin produced by the bacteria such as
Streptococci and Clostridium
The ability of microorganisms to elude
host defenses (Pneumococcus with its
polysaccharide capsule)
Persistence in the environment (spores
and cysts)
Genetic variation (influenza)
Dose
• A microbe must be present in a
sufficient dose to cause human disease
• It varies from:
 one microbe to the next
 person to person
 mode of transmission
• Patient's immune system also plays an
important role in the pathogenic dose
requirement
Invasiveness (Infectivity)
• Refers to the ability of a microbe to
invade tissues
• Some tissue can enter the human body
through intact skin, other can penetrate
through a break in the skin or mucous
membrane
Ex:
 Leptospira interrogans usually enters
through a minor skin abrasion
 Clostridium tetani, through a deep
puncture wound
• The invasiveness of some microbes is
increased by the enzymes they produce
Toxigenicity
• Refers to a microbe's potential to
damage host tissue by producing and
releasing toxins
• Some bacteria release exotoxins that
are quickly disseminated in the blood,
causing systemic and neurologic
manifestations
 diptheria and tetanus
• Some bacteria release endotoxins
Specificity
• Refers to the attraction of a microbe to
a specific host or range of hosts
Ex:
 flavavirus that causes St. Louis
encephalitis has a number of hosts
including birds and humans
 rubeola, the virus that causes measles,
is only carried by humans
Viability
• Refers to the ability of a microbe to
survive outside the body
• Microbes can live and multiply in a
reservoir, which provides what the
microbes need to survive
• The microbes can then be transmitted
from the reservoir to another person
Antigenicity
• The degree to which a microbe can
induce a specific immune response,
varies among microorganisms
• Those that invade and localize in tissue
initially stimulate a cellular response
• While, those that dessiminate more
quickly generate an antibody response
 Nosocomial Infections
• Infections acquired during
hospitalization (hospital-acquired)
• Have been a problem since hospital
began
• Nosocomial infections pose a
significant and costly health problems
in hospitals around the world
• They ranges from very mild to fatal
• During the
Crimean War,
Florence
Nightingale
addressed the
cases of
nosocomial
infections of
the wound of
the soldiers in
the hospital
• Because of the seriousness of
nosocomial infections Centers for
Disease Control (CDC) and Department
of Health (DOH) recommend that each
hospital develop an infection-control
plan
• One of the important activities of a
control program is surveillance
• the systematic observation and
recording of cases of transmissible
disease
Factors Necessary for an
Infection to Occur
1. A source of microorganisms that can
cause infection
2. A route of transmission of the
microorganisms
3. A host susceptible to infection by the
microorganisms
 Bacteria Most Commonly
Implicated in Nosocomial
Infections
Enterococcus
• A part of the normal intestinal flora
• Common cause of urinary tract
infections as well as wound and blood
infection
• Some strain are resistant to all
conventional antimicrobial drugs
Escherichia coli and other members of
Enterobateriaccae
• E. coli is a part of normal intestinal
flora
• Common cause of nosocomial urinary
tract infections
Pseudomonas species
• They grow readily in many moist,
nutrient-poor environments such as the
water humidifier of a mechanical
ventilator
• They are resistant to many
disinfectants and antimicrobial drugs
• Common cause of hospital-acquired:
 pneumonia
 UTI
 burn wound infections
Staphylococcus aureus
• Many people including health care
personnel are carriers of this organism
• Because it survives for prolonged
periods in the environment, it is readily
transmissible on fomites
• A common cause of nosocomial
pneumonia and surgical site infection
• Hospital strains are resistant to variety
antimicrobial drugs
Other Staphylococcus species
• These normal skin flora can colonize
the tips of IV catheters
• The resulting biofilms continuously
seed organisms into the bloodstream
and increase the likelihood of a
systemic infection
 Reservoirs of Infectious
Agents in Hospitals
• Other Patients
• Hospital Environment
 Some microbes can thrive in certain
hospital environment such as sink,
respirators, and toilets
 Many nosocomial infections have been
traced to soaps, disinfectants, and other
aqueous solutions that have become
contaminated with the organism
Health Care Workers
• Personnel who report to work with even
a mild case of influenza can expose
patient to an infectious agent that has
serious or fatal consequences to those
with impaired health
• Carriers who are members of a surgical
team pose a particular threat to
patients, because innoculation of a
pathogen directly into a surgical site
can result in a systemic infection
• Patient's Own Normal Flora
 Isolation Techniques
• The segregation of patients with a
communicable disease
• There are 5 types of isolation technique
identified by the CDC:
1. Strict Isolation
• Recommended for patient with
diseases that are highly contagious or
• That can be transmitted by both direct
contact and airborne routes
• This requires:
 private room
 gowns
 masks
 proper handwashing
• Diseases requiring strict isolation
include:
 Staphylococcal and streptococcal
pneumonia
 extensive burns infected with
Staphylococcus aureus or Group A
streptococcus
 rubella
 smallpox
 diphtheria
• Personnel caring for these patients
should have up-to-date immunization
against the diseases for which
vaccines are available
2. Respiratory Isolation
• Requires:
 private room
 handwashing upon entering and
leaving the room
 masks for all susceptible persons who
must enter the room
• If possible, those who are susceptible
should be excluded from the patient
area
Example of diseases requiring
respiratory isolation:
 chickenpox
 German measles
 pertussis (whooping cough)
 meningococcal meningitis
 sputum-positive tuberculosis
3. Enteric Precautions
• Require a private room for children
only
• Mask are not necessary but gown and
gloves are worn by all persons having
contact with the patient or articles
contaminated with fecal material
• All such contaminated articles must be
discarded or disinfected
Examples of diseases requiring enteric
isolation:
 cholera
 viral hepatitis
 salmonellosis (including typhoid fever)
4. Wound and Skin Precautions
• Recommended for infected wounds
and for impetigo
• A private room is desirable and all
persons having direct contact with the
patient should wear gowns
• Gloves are worn when direct contact
with the infected area is necessary
• Masks are worn during dressing
changes
• Special precautions are necessary for
the handling and disinfection of
instruments, dressings, and bed linens
5. Protective (Reverse) Isolations
• Required in the care of all patients who
have seriously impaired resistance to
infectious diseases
• It requires private room that is under
slightly positive pressure to prevent
contaminated air from flowing into the
room
• Gowns, masks, and gloves must be
worn by all persons entering the room
and having direct contact with the
patient
• Under some circumstances, caps and
shoe booties are worn