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Title Principles of Disease: Why Is This Important? Why Is This Important?
Title Principles of Disease: Why Is This Important? Why Is This Important?
OVERVIEW
This is an important chapter because here is where we begin to look at the prin-
ciples of infectious disease. Armed with the things we learned in the previous
chapters, we are well prepared for these discussions, and the things we learn
here will become part of the foundation for all of the other topics we examine.
Our discussions will be broken down into three major parts. The first will ex-
amine how infectious disease can get started, which is referred to as etiology.
Part two will examine how disease can develop, including communicability and
contagiousness. The final discussion will be about infections that move into the
systemic circulation.
We will divide our discussions into the following topics:
Principles of Disease
s 4HAT THE DECLINE IN HEALTH IN OTHER WORDS THE DISEASE IS CAUSED
by microorganisms invading a host’s body What Do I Need to Know?
s 4HAT THESE MICROORGANISMS ARE THE ETIOLOGICAL AGENTS OF THE
To get the most out of this chapter,
disease
please review the following terms
One of the things we need to re-examine is the presence of normal micro- from your previous courses in biology,
bial flora, which we mentioned in Chapter 6. There is no denying that we anatomy, physiology, or chemistry or
exist in an environment of microorganisms and that our bodies contain in previous chapters of this book as
a variety of them that have a useful relationship with us. There are many indicated in parentheses: endocytosis
microorganisms located in many places in the body that make up the (4), exocytosis (4), electrolyte,
normal microbial flora (Table 7.2). For example, the large intestine has lipoprotein (2), phospholipid (2),
the largest population of bacteria (in fact, fecal material is mostly bac- lipopolysaccharide (2), lysis, lamina
teria). These organisms are supposed to be there because they provide propria, Peyer’s patches, cytokine.
118 Chapter 7 Priciples of Disease
Table 7.1 Some Common Terms Used necessary functions that are helpful to us. To use another example, the
When Describing Infections skin is covered with bacteria of many kinds, including normal resident
bacteria, transient organisms, and even pathogens. As we saw in Chapter
6, however, unless these organisms can find a way through the skin (and
some do), they are essentially harmless because the intact skin is such an
impenetrable barrier. The mouth, nose, and throat are also places where
large numbers of microorganisms are found, and once again many of
these are harmless. Some are pathogenic, though, so it is important to
remember that this area of the body is the most common portal of entry
for bacteria. The respiratory system is readily accessible to potential
pathogens from the nasopharynx and oropharynx.
There are three types of relationship between a host and bacteria living
in that host (Table 7.3). The first is commensalism, in which one partner
is benefited but the other is unaffected. The relationship between humans
and the microbial flora named in Table 7.2 is one form of commensal-
ism. The second type of host–bacteria relationship, mutualism, is one in
which the host offers benefits to the bacteria and the bacteria offer ben-
Table 7.2 Representative Normal efits to the host. Some bacteria provide us with vitamins such as K and
Microflora B, for instance, and we provide them with nutrients and a place to stay.
Commensalism Benefits Neither benefits Saprophytic bacteria that live off sloughed-off cells in
nor is harmed the ear and external genitalia
The third type of relationship is called parasitism, and here one of the Table 7.3 Host–Microorganism
partners benefits at the expense of the other. This is the relationship we Relationships
see with pathogens, which benefit at the expense of our health.
There are two points that are important to remember about host–bac-
teria relationships. First, microbial flora can protect us from disease.
This is accomplished by microbial antagonism. Like a dog that marks
its territory, bacteria that reside in certain areas of the body will fight
to prevent “outsiders” (such as pathogens) from taking up residence.
This prevention is easy for the resident bacteria to accomplish because
they are well established in the host. For instance, our microbial flora
competitively inhibits the growth of pathogenic interlopers by more effi-
ciently using all the available nutrients and all the available oxygen,
leaving none for the pathogens. In addition, the flora can acidify the
region and make it less hospitable to any infringing pathogen. In fact,
many bacteria, such as Streptococcus species and Escherichia coli, can
produce bacteriocins, which are essentially localized bacterial antibiot-
ics. These bacteriocins can kill invading organisms but do not affect the
bacteria that produce them. Bacteriocins are specific for the bacteria
that produce them, and for that reason they are useful as diagnostic
tools for identifying bacteria.
s 4HE SAME PATHOGEN MUST BE PRESENT IN EVERY CASE OF THE DISEASE
s 4HE PATHOGEN MUST BE ISOLATED FROM THE SICK HOST AND PURIlED
s 4HE PURE PATHOGEN MUST CAUSE THE SAME DISEASE WHEN GIVEN TO
uninfected hosts.
s 4HE PATHOGEN MUST BE RE
ISOLATED FROM THESE NEWLY INFECTED HOSTS
120 Chapter 7 Priciples of Disease
The procedure for testing the four postulates is illustrated in Figure 7.1.
s 4HE CAUSE OF A DISEASE IS REFERRED TO AS THE ETIOLOGY
s 4HE BODY CONTAINS NORMAL MICROBIAL mORA MADE UP OF BACTERIA THAT ARE
beneficial to the host.
2 microorganisms microorganisms s 4HERE ARE THREE TYPES OF RELATIONSHIP BETWEEN BACTERIA AND THEIR HOSTS
are grown in are identified commensalism, mutualism, and parasitism.
pure culture
s +OCHS POSTULATES ARE AN IMPORTANT WAY OF EVALUATING THE ETIOLOGY OF A
disease.
DEVELOPMENT OF DISEASE
The course of a disease can be broken down into five specific periods
(Figure 7.2). The first is called the incubation period and covers the
3 microorganisms are injected time between the initial infection and the first symptoms of the dis-
into a healthy mouse
ease. The length of the incubation period depends on the virulence of
the pathogen: the lower the virulence, the longer this period will last
(Figure 7.3). The second period is the prodromal period, during which
the first mild symptoms appear. Once major symptoms are noted the
disease has moved into the period of illness. It is here that the immune
response is highest, and depending on the severity of the illness the
patient may die during this period. The fourth period is called the period
of decline, during which the symptoms subside. Although this period is
4 disease is reproduced in an indicator of the end of the illness, it is also a time when the patient
the second mouse; can acquire a secondary infection. This is particularly true of opportun-
microorganisms are isolated
istic infections and of nosocomial infections. In many cases, because of
the debilitated condition of the patient, these secondary infections can
be more dangerous than the initial problem. The final period is called
the period of convalescence, during which the patient regains strength
and proceeds to a full recovery.
time
There are three methods available for full or partial control of communi-
cable and contagious diseases: isolation, quarantine, and vector control.
whooping cough
tetanus
plague
herpes
disease
gonorrhea
E. coli diarrhea
diphtheria
gas gangrene
influenza
cholera
Keep in Mind
s 4HE DEVELOPMENT OF A DISEASE CAN BE BROKEN DOWN INTO lVE PERIODS
incubation, prodromal, illness, decline, and convalescence.
s #OMMUNICABLE DISEASES CAN BE SPREAD FROM ONE PERSON TO ANOTHER
s #ONTAGIOUS DISEASES ARE COMMUNICABLE ON CONTACT WITH AN INFECTED
individual.
s -ETHODS FOR THE CONTROL OF COMMUNICABLE AND CONTAGIOUS DISEASES INCLUDE
isolation, quarantine, and vector control.
Duration of Disease
The duration of a disease can vary depending on several factors, in par-
ticular the overall health of the host. When we look at duration, there
are four basic categories we can use. Acute diseases such as chicken-
pox and measles develop quickly but last for only a short time, whereas
chronic diseases, such as hepatitis, mononucleosis, and tuberculosis,
develop slowly but remain for long periods. Diseases such as sclerosing
panencephalitis fall in the category of subacute. This disease has an
insidious onset that can take 6–12 months to develop and can be fatal.
Latent diseases are those that remain in the host after the initial signs
and symptoms disappear and can be become reactivated after long peri-
ods. Latency is seen in several viral diseases, the most common example
being chickenpox. The patient initially shows the classical signs of this
pox infection (reviewed in Chapter 13), and after a while these disappear.
However, the virus has taken up residence in the patient’s neurons. At
some point it can be reactivated and the patient will present with the rash
identified as shingles. The reasons for reactivation of the virus are not yet
understood, but they may involve stress or emotional anxiety.
Helicobacter pylori Gastritis, ulcers, and gastric cancer Extracellular and possibly
intracellular in the stomach
the organisms are never completely cleared. Persistently infected hosts Table 7.4 Selected Persistent
can harbor the pathogens for life, and in some cases the tuberculosis is Infections in Humans
reactivated later in life. This reactivation usually occurs in patients who
have become immunocompromised through the aging process. It is for
this reason that tuberculosis is seen in so many nursing homes.
bacteria
ingestion M cell epithelial cell shedding
Peyer’s
patch
neutrophil
B cell
T cell
dendritic
cell
mesenteric movement of
lymph node pathogen via bile
mesenteric
lymph node
gall
bladder spleen
liver
gall
bone liver bladder
marrow
Herd Immunity
One of the most important aspects of infection and the spread of infec-
tion is herd immunity, illustrated in Figure 7.6. This immunity can be
conferred through vaccination or developed after infection. Let’s look at
smallpox as a way of understanding this concept. In years past, smallpox
was a dangerous killer and had a hand in wiping out thousands. When
a vaccination against the disease was developed and given widely, the
population became immune to this infection. (Many older people carry
the vaccination mark on an arm.) When the population had become
immune, the disease essentially disappeared because there were no more
potential hosts in the “herd”. When smallpox was no longer a problem,
vaccinations stopped. As a result, there are now lots of potential (non-
vaccinated) targets in the herd and the infection can spread once again.
10% of the population is immune 50% of the population is immune 90% of the population is immune
126 Chapter 7 Priciples of Disease
organs. Bacteria in the blood are called a bacteremia, and if organisms are
growing in the blood, the condition is referred to as a septicemia. When
bacterial toxins move through the blood, the condition is referred to as
toxemia, whereas viruses moving through the blood are called viremia.
The dynamic changes in the host just described result in a state of shock for
the host. This type of shock is not the same as that seen in infections with
Gram-negative endotoxins, however. Although a similar rapid decrease in
blood pressure is seen with some Gram-negative endotoxins, the cause of
the decrease does not seem to be related to activated neutrophils.
Keep in Mind
SUMMARY
s .ORMAL MICROBIAL mORA HELPS TO PROTECT AGAINST OPPORTUNISTIC PATHOGENS
s %TIOLOGY IS DElNED AS THE CAUSE OF A DISEASE
s +OCHS POSTULATES CAN BE USED TO EVALUATE AND IDENTIFY THE ETIOLOGY OF A DIS-
ease.
s $ISEASE CAN BE ACUTE CHRONIC SUB
ACUTE OR LATENT
s )NFECTION CAN BE LOCAL OR SYSTEMIC
s 2ELATIONSHIPS BETWEEN BACTERIA AND HOSTS CAN BE DESCRIBED AS COMMENSAL
mutual, or parasitic.
s 4HERE ARE lVE PERIODS IN THE DEVELOPMENT OF AN INFECTION INCUBATION PERIOD
prodromal period, period of disease, period of illness, and period of convales-
cence.
s #OMMUNICABLE DISEASES CAN BE SPREAD FROM ONE PERSON TO ANOTHER
s #ONTAGIOUS DISEASES ARE SPREAD ON CONTACT WITH AN INFECTED PERSON
s (ERD IMMUNITY CAN LIMIT THE SPREAD OF INFECTION
s )NFECTION CAN CAUSE SEPTIC SHOCK OR SEPSIS
This chapter has taught us about how different infections get started, how
diseases can develop and be characterized, and how infections can spread
throughout the body. In addition, we learned about the importance of herd im-
munity and also about communicable and contagious diseases. Coupled with
Chapter 5 on the requirements for infection and Chapter 6 on the transmission
of infection, the material presented here completes our discussion of the infec-
tion process.
128 Chapter 7 Priciples of Disease
Multiple Choice
Answers are given in the back of the book and help can be found in the student resources at:
www.garlandscience.com/micro
1. Etiology refers to 6. The first mild symptoms of diseases are seen in the
A. Viral infection A. Illness period
B. The results seen after a disease occurs B. Decline period
C. The cause of the disease C. Prodromal period
D. The portal of exit D. Incubation period
E. None of the above E. None of the above
2. Microbial antagonism refers to 7. The period when major disease occurs is called the
8. Chronic diseases
3. The relationship in which one partner benefits at the
expense of the other is called A. Develop quickly and subside quickly
B. Develop quickly but subside slowly
A. Mutualism
C. Develop slowly and subside quickly
B. Parasitism
D. Develop slowly and remain for a long time
C. Commensalism
E. Develop quickly and remain for a long time
D. Discordance
E. None of the above 9. Latent diseases
4. Koch’s postulates were the first to show the A. Develop quickly and subside quickly
B. Develop quickly and subside slowly
A. Portals of entry for pathogens into the body
C. Remain in the host only when symptoms are
B. Portals of exit for pathogens leaving the body present
C. Existence of exotoxins D. Remain in the host after symptoms have gone but
D. Etiology of viral infections are able to be reactivated
E. Etiology of bacterial infections E. Remain in the host after symptoms have gone but
5. The time between the initial infection and the onset of are never reactivated
symptoms is called the 10. Septicemia refers to pathogens growing in the
A. Disease period A. Focus of infection
B. Illness period B. Tissues
C. Incubation period C. Urinary tract
D. Prodromal period D. Blood
E. Decline period E. None of the above
CLINICAL CORNER 129
DEPTH OF UNDERSTANDING
Questions listed here require you to bring together the concepts you
have learned in this chapter into a discussion format. This helps you to
increase your depth of understanding of the material you have learned.
Help can be found in the student resources at:
www.garlandscience.com/micro
CLINICAL CORNER
2. Your neighbor has had frequent bouts of severe gastritis. She has been
to the doctor and was diagnosed with a salmonella infection each time.
After she was given antibiotics, the infection subsided but always seemed
to reoccur. Finally the doctor explained that she needed to have her
gall bladder removed. She is confused by all this and frightened by the
possibility of surgery.
A. How would you explain her condition to her?
B. Why does the doctor want to remove her gall bladder?
C. Why did the infection keep recurring even after antibiotic therapy?
3. Montrose elementary school is located in southern Florida, a region
that sees a seasonal influx of migrant workers who help during the fruit
picking season. Two weeks into the orange-picking season, there was an
outbreak of measles in the second grade. Of the 26 students, only 4 came
down with the infection and one of those was the daughter of a migrant
worker.
A. Explain why only four students got the measles.
B. Why did the daughter of the migrant workers get infected?
C. Why did the three other children who were not from migrant worker
families get sick?