INFECTION

Definition

1. The state produced by the establishment of one or more pathogenic agents (such as a bacteria, protozoans, viruses, or
other microorganisms) in or on the body of a suitable host. (Merriam-Webster Dictionary)

2. The invasion and growth of germs in the body.

3. Infections can begin anywhere in the body and may spread all through it. An infection can cause fever and other health
problems, depending on where it occurs in the body. When the body’s immune system is strong, it can often fight the
germs and cure an infection.

How an infection spreads and its effects on the human body depend on the type of pathogen.

The immune system is an effective barrier against infectious agents. However, pathogens may sometimes overwhelm
the immune system’s ability to fight them off. At this stage, an infection becomes harmful.

Bacteria, viruses, fungi, and parasites are different types of pathogens. They vary in several ways, including:

 size
 shape
 function
 genetic content
 how they act on the body

Types of Infection

1. Bacterial Infections - Bacteria are single-celled microorganisms, also known as prokaryotes.

- Bacteria take three main shapes:
a. Spherical: These are known as cocci.
b. Rod-shaped: These have the name bacilli.
c. Spiral: Coiled bacteria are known as spirilla. If the coil of a spirillum is particularly tight, scientists
call it a spirochete.
- Bacteria can live in almost any type of environment, from extreme heat to intense cold, and some can even
survive in radioactive waste.
- Some of them live inside the human body, such as in the gut or airways, without causing harm.
- A bacterial infection can be treated with antibiotics. However, some strains become resistant and can survive
the treatment.

2. Viral Infections - Viral infections occur due to infection with a virus.

- Viruses contain a small piece of genetic code, and a coat of protein and lipid (fat) molecules protects them.
Viruses invade a host and attach themselves to a cell. As they enter the cell, they release their genetic
material. This material forces the cell to replicate the virus, and the virus multiplies. When the cell dies, it
releases new viruses, which infect new cells.
- Not all viruses destroy their host cell, however. Some of them change the function of the cell. Some viruses,
such as human papillomavirus (HPV) and Epstein-Barr virus (EBV), can lead to cancer by forcing cells to
replicate in an uncontrolled way.
- Viruses may remain dormant for a period before multiplying again. The person with the virus can appear to
have fully recovered, but they may get sick again when the virus reactivates.
- Viral infections include:
a. Common cold, which mainly occurs due to rhinovirus, coronavirus, and adenovirus;
b. encephalitis and meningitis, resulting from enteroviruses and the herpes simplex virus (HSV), as
well as West Nile Virus
c. warts and skin infections, for which HPV and HSV are responsible
d. gastroenteritis, which norovirus causes
e. COVID-19, a respiratory disease that develops after a novel coronavirus infection that is currently
causing a global pandemic

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 - Most treatment aims to relieve symptoms while the immune system combats the virus without assistance
from medication.
- Self-limiting – disease resolve without treatment.
- Antiviral medications can help relieve the symptoms of some viruses while the disease passes. They can
either prevent the virus from reproducing or boost the host’s immune system to counter the effects of the
virus.
- Caveat: Antibiotics are not effective against viruses. These drugs will not stop the virus, and their use
increases the risk of antibiotic (drug) resistance.

3. Fungal Infection - A fungus is often a multicellular parasite that can decompose and absorb organic matter using an
enzyme. However, some types, such as yeasts, are single celled.
- Fungi almost always reproduce by spreading single celled spores. The structure of a fungus is usually long
and cylindrical, with small filaments branching from the main body.
- Many fungal infections develop in the upper layers of the skin, and some progress to the deeper layers.
Inhaled yeast or mold spores can sometimes lead to fungal infections, such as pneumonia, or infections
throughout the body. These are also known as systemic infections.
- The body usually has a population of good bacteria that help maintain the balance of microorganisms. These
line the intestines, mouth, vagina, and other parts of the body.
- Those with a higher risk of developing a fungal infection include people who:
a. Use antibiotics for a long time
b. Have a weakened immune system, due, for example, to living with HIV or diabetes or
receiving chemotherapy treatment
c. Have undergone a transplant, as they take medications to prevent their body from rejecting the new
organ
- Examples of fungal infections are:
a. histoplasmosis
b. candidiasis
c. athlete’s foot
d. ringworm
e. some eye infections
f. A rash may indicate a fungal infection of the skin.
-
4. Prion (pree·aan) disease - A prion is a protein that contains no genetic material and is usually harmless. Scientists do
not class prions as living microorganisms. However, if a prion folds into an abnormal shape, it can become a rogue
agent and cause infection.
- Prions can affect the structure of the brain or other parts of the nervous system. They do not replicate or feed
on the host. Instead, they trigger abnormal behavior in the body’s cells and proteins.

5. Other infections
a. Protozoan infection –
- A single celled organism with a nucleus.
- Protozoa commonly show features similar to those of animals, such as mobility, and they can
survive outside the human body.
- They most commonly transfer to other humans through feces.
- Amebic dysentery (severe form of amebiasis associated with stomach pain, bloody stools, and
fever) is an example of a protozoan infection.

b. Helminths –
- larger, multicellular organisms that tend to be visible to the naked eye when fully grown. 
- This type of parasite includes flatworms and roundworms.

c. Ectoparasites
- can cause infection by attaching or burrowing into the skin.
- mites, ticks, lice, and fleas
- blood-sucking arthropods, such as mosquitoes, which transmit infection by consuming human
blood.

The effects of an infection, such as swelling or a runny nose, occur due to the immune system’s attempt to get rid of the
invading organism. A wound fills with pus, for example, when white blood cells rush to the site of an injury to combat foreign
bacteria.

Source: (https://www.medicalnewstoday.com/articles/196271#prevention)

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THE CHAIN OF INFECTION

Source: Texas Health and Human Services

(https://apps.hhs.texas.gov/providers/NF/credentialing/cna/infection-control/module2/Module_2_Chain_of_Infection5.html)

Chain of Infection
- Infectious diseases result from the interaction of agent, host, and environment. More specifically, transmission occurs when
the agent leaves its reservoir or host through a portal of exit, is conveyed by some mode of transmission, and enters
through an appropriate portal of entry to infect a susceptible host. This sequence is called the chain of infection. (CDC)
- The chain of infection is a set of 6 intertwined links that allow for communicable diseases to spread
- Each step of the chain is required to effectively transmit infectious illness.
- Breaking any one of the 6 links can slow the spread of infectious disease.

I. Pathogens
a. Pathogens are microorganisms that cause disease. Without pathogens, we would not have transmissible, infectious disease.
Examples of pathogens include Bacteria, Viruses, Fungi, Parasites, etc.
b.  How well a pathogen infects its host has to do with its:
a. Pathogenicity - The ability to produce the disease.
b. Degree of Virulence – Severity or harmfulness

c. Transmissibility – The ability to spread

II. Reservoir
- A reservoir serves as a place in the environment where a pathogen lives, replicates and thrives.
- Areas where a pathogen may live include People; Animals or insects; Soil/Environment; Food; Water.

A. Human Reservoir 
- In humans, there are two forms of reservoirs: Symptomatic infection and asymptomatic carriers.
1. Symptomatic infections - more likely to be recognized. This means that the patient's contacts and normal
activities will normally be restricted.
2. Asymptomatic infections - Carriers do not display any signs or symptoms of illness. They are asymptomatic
but can still spread disease.
B. Animal and Insect Reservoirs
- Any infectious disease that is naturally transmitted from animal to human is considered a zoonotic disease.
- Examples of disease spreading from animals or insects to humans include:
1. Lyme disease (ticks)
2. Rabies (animals)
3. Salmonella (raw meats, eggs, and dairy)

C. Environmental Reservoirs
- Environmental reservoirs harbor many infectious diseases.
- Some examples include:
1. Soil (which acts as a reservoir for Clostridium tetani, the causative agent of tetanus); and
2. Water (which is a reservoir for Legionella pneumophila, the causative agent of Legionnaire's
disease.)

III. Portal of Exit

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 - Refers to any route that the pathogen can leave the reservoir. This depends entirely on the characteristics of
the reservoir.
- In humans, the main portals of exit include:
1. Alimentary (digestive tract/system): vomiting, diarrhea, saliva
2. Genitourinary: sexual contact
3. Respiratory: secretions from coughing, sneezing, or talking
4. Integumentary System (skin): open wounds

IV. Modes of Transmission (CDC)

-  Infectious agent may be transmitted from its natural reservoir to a susceptible host in different ways. There are different
classifications for modes of transmission. Here is one classification (Centers for Disease Control and Preventions
[CDC]):

A. Direct Transmission –is usually considered person-to-person contact. Without physical contact, pathogens that
rely on direct contact spread cannot be passed on.
a. Direct Contact
- occurs through skin-to-skin contact, kissing, and sexual intercourse. Direct contact also refers to
contact with soil or vegetation harboring infectious organisms. (CDC)

- Examples of direct contact include:

a. Skin-to-Skin contact (like touching);
b. Contact with oral secretions; and
c. Contact with body lesions

- Pathogens that are spread by direct contact include:

a. Gonorrhea
b. Mononucleosis (“kissing disease”)
c. Bacterial Conjunctivitis (sore eyes)
d. Hookworm - is spread by direct contact with contaminated soil.
e. COVID-19

b. Droplet Spread
- refers to spray with relatively large, short-range aerosols produced by sneezing, coughing, or
even talking. (CDC)

- Droplet spread is classified as direct because transmission is by direct spray over a few feet,
before the droplets fall to the ground. (CDC)
- Droplet transmission occurs when a droplet from coughing, sneezing or talking carry the
pathogen to the host’s body. The transmission is completed by:
1. Inhaling droplets
2. Droplets entering the mucous membranes of the face
3. A host touching droplets that have settled on surfaces and then touching their face (mouth,
eyes, nose).

- Examples of illnesses caused by droplet transmission are:

1. Strep Throat
2. Influenza
3. The common cold
4. Pertussis and Meningococcal infection are examples of diseases transmitted from an
infectious patient to a susceptible host by droplet spread
5. COVID-19

B. Indirect Transmission - refers to the transfer of an infectious agent from a reservoir to a host by suspended air
particles, inanimate objects (vehicles), or animate intermediaries (vectors).

a. Airborne Transmission - occurs when infectious agents are carried by dust or droplet nuclei suspended in air.
(CDC)
- Airborne dust includes material that has settled on surfaces and become resuspended by air currents as well
as infectious particles blown from the soil by the wind. (CDC)
- Droplet nuclei are dried residue of less than 5 microns in size. In contrast to droplets that fall to the ground
within a few feet, droplet nuclei may remain suspended in the air for long periods of time and may be blown
over great distances. (CDC)

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 - A host then enters the space where the pathogen is suspended and has the potential to become infected.
- Examples of illnesses caused by airborne transmission are:
1. Measles - can remain suspended in the air for up to 18 hours after the infected individual coughs,
sneezes, or talks.
2. Tuberculosis - can remain suspended for up to six hours.
3. COVID-19 – according to the WHO, current evidence suggests that the virus also spreads via
airborne transmission. This is because aerosols can remain suspended in the air or travel farther than
conversational distance (this is often called long-range aerosol or long-range airborne transmission).

b. Vehicleborne Transmission - Vehicles that may indirectly transmit an infectious agent include food, water,
biologic products (blood), and fomites (inanimate objects such as handkerchiefs, bedding, or surgical
scalpels).
- A vehicle may passively carry a pathogen — as food or water may carry hepatitis A virus. Alternatively, the
vehicle may provide an environment in which the agent grows, multiplies, or produces toxin — as improperly
canned foods provide an environment that supports production of botulinum toxin by Clostridium botulinum.
1. Blood-Borne Transmission
- Pathogens are transmitted directly through blood. These pathogens require that infected
blood from the reservoir be directly exposed to the blood of the susceptible host.
- This can be accomplished by blood from a needlestick and blood entering mucous
membranes or other open wounds.
- Examples of blood-borne pathogens include:
a. Human Immunodeficiency Virus (HIV)
b. Hepatitis-B Virus
c. Hepatitis-C Virus

2. Fomites
- Respiratory secretions or droplets expelled by infected individuals can contaminate surfaces
and objects, creating fomites (contaminated surfaces).
- Examples of infections through fomites include:
a. Adenovirus – a group of viruses causing upper respiratory tract and eye infections
b. Hand foot and mouth disease – a common infection leading to fever and blisters on
the hands, feet, and inside the mouth
c. Influenza- an acute viral infection of the upper or lower respiratory tract
d. Norovirus – the most common cause of gastroenteritis
e. Rhinovirus – the most common viral infectious agent in humans
f. Rotavirus – the most common cause of diarrheal disease in infants and children
g. Coronavirus – a common virus that causes upper respiratory infections in both
animals and humans.

3. Vectorborne Transmission (mechanical or biologic)- Vector transmission utilizes insects to

transport the pathogen.
- Insects such as fleas, ticks, and mosquitos are unharmed by the pathogens they potentially carry
but can transmit the bacteria or virus when they bite a host.
- Examples of mechanical transmission include:
a. Flies: carrying Shigella on their appendages
b. Fleas: Bubonic Plague (Yersinia pestis in their gut)
- Examples of biologic transmission (undergoes maturation in an intermediate host before it can
be transmitted to humans) include:
a. Malaria - single-celled parasite of the genus plasmodium transmitted to humans by
female mosquitoes
.

V. Portal of Entry
- Opposite the Portal of Exit is the Portal of Entry.
- Refers to the manner in which a pathogen enters a susceptible host. (CDC)
- The portal of entry must provide access to tissues in which the pathogen can multiply or a toxin can act. (CDC)
- Often, infectious agents use the same portal to enter a new host that they used to exit the source host. For example,
influenza virus exits the respiratory tract of the source host and enters the respiratory tract of the new host. (CDC)
- In contrast, many pathogens that cause gastroenteritis follow a so-called “fecal-oral” route because they exit the source
host in feces, are carried on inadequately washed hands to a vehicle such as food, water, or utensil, and enter a new host
through the mouth.
- Other portals of entry include the skin (hookworm), mucous membranes (syphilis)
- Other examples include:

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 1. Skin (Hookworm)
2. Inhalation (via the respiratory tract)
3. Absorption (via mucous membranes such as syphilis)
4. Ingestion (via the gastrointestinal tract)
5. Inoculation (as the result of an inoculation injury - An inoculation injury involves a having a percutaneous
exposure or a mucocutaneous exposure to blood or bodily fluids. A percutaneous exposure is where a
needle/sharp object that has already been used on a patient, a human scratch or bite has broken the skin.)
(blood in Hepatitis B and Human Immunodeficiency Virus or HIV)
6. Introduction (via the insertion of medical devices)

VI. Susceptible Host

- The final link in the chain of infection is a susceptible host.
- Susceptibility of a host depends on genetic or constitutional factors, specific immunity, and nonspecific factors that
affect an individual’s ability to resist infection or to limit pathogenicity. It may depend on:
1. Age – The very young or very old are usually more susceptible.
2. Health status - Malnourished, dehydrated, immunocompromised or otherwise unhealthy persons are more at
risk
3. Medication usage – Immune suppressing drugs allow pathogens to take hold more freely
4. General resistance factors – Intact mucous membranes and skin, and robust cough and sneeze reflexes help
defend against invading pathogens.

- An individual’s genetic makeup may either increase or decrease susceptibility. For example, persons with sickle cell
trait seem to be at least partially protected from a particular type of malaria.

 Specific immunity - refers to protective antibodies that are directed against a specific agent.
- Such antibodies may develop in response to infection, vaccine, or toxoid (toxin that has been deactivated but
retains its capacity to stimulate production of toxin antibodies) or may be acquired by transplacental transfer
from mother to fetus or by injection of antitoxin or immune globulin.

- Factors that may increase susceptibility to infection by disrupting host defenses include malnutrition, alcoholism, and
disease or therapy that impairs the nonspecific immune response.

BREAKING THE CHAIN OF INFECTION

To break the chain of infection, and stop infectious disease spread, interventions can be directed at:

1. Controlling or eliminating agent at source of transmission;

- A patient sick with a communicable disease may be treated with antibiotics to eliminate the infection.
- An asymptomatic but infected person may be treated both to clear the infection and to reduce the risk of
transmission to others.
- Cooking food to safe temperatures ensures that all bacteria and/or spores have been killed before
consumption.
- Some interventions are directed at the mode of transmission. Interruption of direct transmission may be
accomplished by:
a. Isolation – isolation of someone with infection;
b. Counseling (the provision of assistance and guidance in resolving personal, social, or
psychological problems and difficulties, especially by a professional.) – counseling persons to
avoid the specific type of contact associated with transmission.
- Elimination or Decontamination - Vehicleborne transmission may be interrupted by
elimination or decontamination of the vehicle.
- To prevent fecal-oral transmission, efforts often focus on rearranging the environment to
reduce the risk of contamination in the future and on changing behaviors, such as promoting
handwashing.

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 c. Ventilation, air pressure, or air filter or treatment - For airborne diseases, strategies may be directed
at modifying ventilation or air pressure, and filtering or treating the air.
d. Spraying - To interrupt vectorborne transmission, measures may be directed toward controlling the
vector population, such as spraying to reduce the mosquito population.

2. Protecting portals of entry;

- Wearing proper PPE when you are knowingly exposed to a pathogen (Masks, gloves, face shields, etc.).
- Practicing hand hygiene consistently (Handwashing and using alcohol-based hand rubs).
- Isolating those who are infectious and minimizing contact
- Filtering or changing the flow of air (Negative pressure rooms).
- bed nets and wearing of long pants and sleeves and use of insect repellent are used to protect sleeping persons
from being bitten by mosquitoes that may transmit malaria and reduce the risk of Lyme disease and West
Nile virus infection, which are transmitted by the bite of ticks and mosquitoes, respectively.

3. Increasing host's defenses; and

- Increasing the host's defense allows for the body's immune system to fend off attacking pathogens before the
person ever knows they have been exposed.
a. Eating healthy.
b. Vaccinations promote development of specific antibodies that protect against infection.
c. Prophylactic drugs such as the prophylactic use of antimalarial drugs, recommended for visitors to
malaria-endemic areas, does not prevent exposure through mosquito bites, but does prevent
infection from taking root.

4. Prevent a pathogen from encountering a susceptible host.

- The concept of herd immunity suggests that if a high enough proportion of individuals in a population are
resistant to an agent, then those few who are susceptible will be protected by the resistant majority, since the
pathogen will be unlikely to “find” those few susceptible individuals.
- The degree of herd immunity necessary to prevent or interrupt an outbreak varies by disease.

“The degree of herd immunity necessary to prevent or interrupt an outbreak varies by disease. In theory, herd
immunity means that not everyone in a community needs to be resistant (immune) to prevent disease spread and
occurrence of an outbreak. In practice, herd immunity has not prevented outbreaks of measles and rubella in
populations with immunization levels as high as 85% to 90%. One problem is that, in highly immunized populations,
the relatively few susceptible persons are often clustered in subgroups defined by socioeconomic or cultural factors. If
the pathogen is introduced into one of these subgroups, an outbreak may occur.” - CDC

Targeting one or more of these areas can help to slow or stop the spread of infectious disease.

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 TEST

1. What factors determine the EXTENT to which an INFECTIOUS AGENT can cause an infection? Check all that apply.
a. Pathogenicity
b. Virulence
c. Transmissibility
d. None of the above
e. All of the above

2. What is the order of the Chain of Infection links?

_____ Mode of Transmission 4
_____ Reservoir 2
_____ Portal of Entry 5
_____ Infectious Agent (pathogen) 1
_____ Susceptible Host 6
_____ Portal of Exit 3

3. Which best describes how athlete's foot is spread to other individuals?

a. Inhaling fungal spores in the air
b. Having contact with fungus on a shower floor
c. Eating food contaminated with fungus
d. Swimming in a lake that has large amounts of algae
e. All of the above

4. Marites has an infection in her sinuses and lungs but has no sick time. She decides to go to work anyway. She is coughing
and sneezing the whole shift and only remembers to cover her nose and mouth about half the time. Which link represents the
link in the chain of infection in this scenario, placing you at risk of contracting the infection?

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 a. Host
b. Reservoir
c. Portal of Exit
d. Portal of Entry
e. All of the above

4. Identify the link of the chain of infection that has been broken by the following action: Early recognition of signs of
infection and subsequent treatment
a. Infectious agent
b. Mode of transmission
c. Portal of entry
d. Portal of exit
e. All of the above

5. Which of the following is NOT a way for a pathogen to enter a new host?
a. Penetration
b. Inhalation
c. Secretion
d. Ingestion

6. What are the following structures examples of?

• Respiratory Tract
• Gastrointestinal Tract
• Mucous Membranes
• Skin Lesions/Cuts/Abrasions

a. Portals of entry/exit
b. Vectors
c. Infectious agents
d. Modes of transmission

7. A nurse is working with a patient who has a contagious illness. In recalling the chain of infection, the nurse knows that an
environment favorable for the growth and reproduction of a pathogen is referred to as-
a. A susceptible host
b. A reservoir
c. A vector
d. A portal of entry

8. The Chain of Infection is a model of

a. How bacteria multiply
b. How microorganisms mutate into pathogens
c. How an infection affects the immune system
d. How pathogens are transmitted to cause infection

9. Identify the link of the chain of infection that has been broken by the following action: Handwashing
a. Infectious agent
b. Mode of transmission
c. Portal of Entry
d. Portal o Exit

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INSERT VIDEO

How to break the chains of COVID-19 transmission (by WHO)

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