INFECTION AND IMMUNITY (HOST-MICROORGANISM INTERACTIONS)

Terminologies:
Infection – entrance and multiplication of a microorganism in or on a host.
Acute infection – infectious process that develop quickly.
Chronic infection – infection that develop and progress slowly, sometimes over
a period of years.
Latent infection – infection that is clinically silent inside the body without any
noticeable effect on the host before suddenly causing a severe and acute
infection.
Disease – results when the infection produces notable changes in human physiology
that are often associated with damages to one or more of the body’s organ systems.
Infectious disease – infection with functional and structural harm to the host that
usually is accomplished by signs and symptoms.
Pathogen – microorganism capable of causing infections and/or disease (bacteria,
viruses, fungi, and parasites).
Virulence factors – characteristics of the pathogen that enable them to cause disease.
Normal flora – microorganisms that normally reside in a particular body site; they do
not generally cause infection.
Opportunistic pathogen – organism that only cause infection when one or more of
the host’s defense mechanisms are disrupted or malfunction.
Epidemiology – the science that characterizes the aspects of infectious diseases
(source of pathogen, method of transmission, susceptible host).

Epidemiologic Terms:
Carrier – a person who carries the etiologic agent but shows no apparent signs or
symptoms of infection or disease.
Common source – the etiologic agent responsible for an epidemic or outbreak
originates from a single source or reservoir.
Disease incidence – the number of diseased or infected persons in a population.
Disease prevalence – percentage of diseased persons in a given population at a
particular time.
Endemic – a disease constantly present at some rate of occurrence in a particular
location.
Epidemic – a larger than normal number of diseased or infected individuals in a
particular location.
Etiologic agent – a microorganism responsible for causing infection or infectious
disease.
Mode of transmission – means by which etiologic agents are brought in contact with
the human host.
Morbidity – the state of disease and its associated effects on the host.
Morbidity rate – the incidence of a particular disease state.
Mortality – death resulting from disease.
Mortality rate – the incidence in which a disease results in death.
Nosocomial infection – infection in which etiologic agent was acquired in a hospital.
Outbreak – a larger than normal number of diseased or infected individuals that occurs
over a relatively short period.
Pandemic – an epidemic that spans the world.
 Reservoir – origin of the etiologic agent or location from which they disseminate (e.g.,
water, food, insects, animals, other humans).
Strain typing – laboratory-based characterization of etiologic agents designed to
establish their relatedness to one another during a particular outbreak or epidemic.
Surveillance – any type of epidemiologic investigation that involves data collection for
characterizing circumstances surrounding the incidence or prevalence of a particular
disease or infection.
Vector – a living entity that transmits the etiologic agent.
Vehicle – a nonliving entity that is contaminated with the etiologic agent and as such is
the mode of transmission for that agent.

NORMAL FLORA
Organ Normal Flora
Skin Propionibacterium acnes
Staphylococcus epidermidis
Viridans streptococcus
Enterococcus
Mouth and Oral Cavity Viridans streptococcus (major normal flora)
Staphylococcus epidermidis
Nonpathogenic Neisseria spp.
Moraxella catarrhalis
Lactobacillus spp.
Diphtheroids
Anaerobic normal flora (Actinomyces,
Veilonella, Bacteroides)
Nasopharynx (site for asymptomatic Staphylococcus aureus
carriage of several microorganisms) Neisseria meningitidis
Colon Bacteroides
Lactobacillus
Clostridium
Eubacterium
Coliforms (e.g., Escherichia coli)
Aerobic and anaerobic streptococci
Yeast
Distal Urethra (both males and females) Diphtheroids
Alpha and non-hemolytic streptococci
Peptococcus
Staphylococcus epidermidis
Bacteroides

STERILE SITES IN THE BODY

1. Stomach
2. Upper small intestine
3. Blood
4. CSF
5. Urinary bladder
Opportunistic Pathogens

Opportunistic infections – infections in immunocompromised hosts that do not cause

disease in immunocompetent individuals.

Factors:
a. Widespread use of broad-spectrum antibiotics that can alter the normal flora.
b. Increased use of immunosuppressive drugs to prevent organ transplant
rejection.
c. Use of chemotherapeutic agents to treat cancer.
d. Increased and prolonged use of urethral catheters.

Opportunistic pathogens – organisms that attack an already debilitated host but

usually present no danger to an individual with an intact immune system.

In immunosuppressive conditions the host immune system is unable to efficiently battle

those microorganisms considered to be normal flora for the general population.

Other individuals at risk for opportunistic pathogens:

a. Dialysis patients.
b. Individuals on heart pumps.
c. Burn victims.
d. Diabetics.
e. Individuals with chronic medical problems.
f. Individuals undergoing invasive medical techniques.
g. Individuals with foreign body implants (heart valves, prosthetic devices,
indwelling intravenous catheters).
h. Alcoholics.
i. IV drug users.

True pathogen – organism that is able to infect those individuals with a healthy
immune system as well as those with an immunosuppressed state.

Routes of Infection
Infectious disease can be transmitted by several routes, which can be categorized as
direct or indirect transmission.

DIRECT TRANSMISSION
Congenital contact – may occur across the placenta or as the child passes through
the vaginal canal during delivery.
Sexual contact – may be the route for infection of several sexually transmittable
diseases.
Hand-to-hand transmission – mode of direct contact seen with the spread of the
common cold; also involved in the transmission of various GI infections when the hands
are not properly washed and are fecally contaminated.
 Infectious respiratory secretion (Droplet infection) – serves as a route for several
respiratory viruses, as well as bacterial pathogens (Streptococcus pyogenes and
Neisseria meningitidis).
(Coughing, sneezing, kissing, nasal drainage).
(Respiratory secretions can become dried on clothing, bedding, or floors and
converted to dust, which may serve as a route of indirect transmission).
INDIRECT ROUTES OF INFECTION

1. Fomites – inanimate objects.

2. Ingestion of contaminated food and water.
3. Animals or arthropod vectors.
4. Inhalation of infectious particles/aerosols that may be suspended in the air.

Host Defense Mechanisms

Immunity – host properties that confer resistance of the host to foreign substances;
sum of all mechanisms used by the body as protection against environmental agents
that are not normally present in the body.
Host defense mechanisms include:
a. Innate or natural immunity
b. Acquired immunity
c. Phagocytosis

INNATE OR NATURAL IMMUNITY

This immunity is inborn mainly genetically determined, and nonspecific. It is not

acquired through previous contact with an infectious agent.
Unbroken skin, secretions, normal flora, mechanisms

INFLAMMATORY RESPONSE AND PHAGOCYTOSIS

Inflammation – total of the changes occurring in tissue factors upon trauma or tissue
injury.
a. Hemodynamic changes [increased vascular permeability, dilation of arterioles
and capillaries, and increased blood flow to the injured area] occur.
b. Plasma proteins [complement, interferon, antibodies] are also released.
c. Edema may occur as a result of vasodilation, while there is also an influx of
red blood cells to the area.

Phagocytic cells (neutrophils and macrophages) have four functions:

a. Migration. The cells may adhere to the vascular endothelium or migrate
from the blood to the affected tissues in a process called diapedesis.
b. Chemotaxis. It is the attraction of the phagocytes to the affected area by
the microorganisms or its products from the blood to the injured site.
c. Ingestion. It involves the formation of a phagosome, which undergoes a
respiratory burst that results in the release of superoxide anion and peroxide,
both of which are toxic to microorganisms. (Lysosomes within the cell
 combine with phagosomes to form phagolysosomes, which eventually release
hydrolytic enzymes).
d. Killing.

Inflammation caused by microorganisms may be initiated through activation of the

complement system or the blood coagulation cascade.

ACQUIRED IMMUNITY

Involves contact with a foreign agent or antigen.

Known as immunization.
Initiates a series of reactions that leads to the activation of lymphocytes and the
synthesis of antibodies.

Types of Acquired Immunity:

a. Passively acquired immunity – temporary resistance to infectious agents
by administration of antibodies preformed in another host.

b. Actively acquired immunity – resistance built in an individual following

contact with foreign antigens.

Humoral immunity – mediated by serum antibodies (immunoglobulins) secreted by B

cells.
Major classes of immunoglobulins:
IgG – able to cross placenta; most active at 37°C; major immunoglobulin
in normal serum; primarily involved in the secondary (anamnestic)
immune response.
IgM – involved mainly in the primary immune response; appears in the
serum following initial exposure to antigen; greatest activity as 20-25°C.
IgA – only immunoglobulin found in secretions.
IgD – little is known, may serve as a B cell receptor or play a role in
autoallergic diseases.
IgE – major role in allergic response.

Complement system – involves more than 20 different serum proteins and enzymes
that can be activated by immune (antigen-antibody) complexes or nonimmune routes,
such as lipopolysaccharide. (If the complement cascade is activated, the target cell may
be lysed or phagocytic cells may be stimulated).

Cell-mediated immunity – involves T lymphocytes

Populations of T cells:
a. T helper (inducer cells)
b. Cytotoxic T cells
c. T suppressor cells
d. Null cells (natural killer [NK] cells and killer [K] cells)
Exotoxins and Endotoxins
Bacteria produce systemic effects of infection through the production of toxins.
A. Exotoxins – associated with gram-positive bacteria. Secreted by the living
bacterial cell. Usually found in high concentration in fluid media. Not
associated with the production of fever. Examples: Leukocidin, toxic shock
syndrome toxin, diphtheria toxin, theta toxin, and extracellular enzymes
(DNAse, coagulase, hemolysins, proteases, fibrinolysin)
B. Endotoxins – associated with gram-negative bacteria. Consist of
lipopolysaccharide (LPS). Released at cell lysis or death. Capable of inducing
fever in the host.

Signs of Infection

Some common general or systemic signs of acute infection include:

a. High-grade, spiking fever
b. Chills
c. Vasodilation with flushing
d. Increased pulse rate

Chronic or subacute infections may be accompanied by the following systemic signs:

 Intermittent, low-grade fever
 Weight loss
 Fatigue

Local signs of infection include:

a. Pain
b. Heat
c. Redness
d. Swelling

Gastrointestinal signs of infection include:

a. Nausea
b. Vomiting
c. Diarrhea

Laboratory diagnosis of infection:

Elevated WBC count
 Increased percentage of neutrophils (bacterial infections).
 Increased percentage of lymphocytes (most viral infections).
Increased erythrocyte sedimentation rate
ESR is a nonspecific indicator of inflammation.
Presence of C-reactive protein.
Presence of type-specific antibodies in a patient’s serum.

Radiographic signs of infectious disease:

 Pulmonary infiltrates
 Gas and swelling in the tissues
 Accumulation of fluid in a body cavity
Nosocomial Infections

Nosocomial infection – infection acquired in the hospital or other health care setting.
The organism is not present and not incubating in the patient on entry or
admission into the health care facility.
Community-acquired infection – infection that is present or incubating at the time of
admission into the health care facility.

Nosocomial and community-acquired infections can be categorized as endogenous or

exogenous:
Endogenous infections result from organisms that are a part of the patient’s
normal flora.
Exogenous infections result from organisms from external sources:
 Contaminated medical instruments or equipment.
 Inanimate objects in the health care setting.
 Contact with health care personnel.

Colonization – the presence and multiplication of a microorganism in a host, with no

clinical signs of infection.
(Such individuals may serve as a reservoir of infection and transmit the organism
to susceptible individuals).

Most Common Types of Nosocomial Infections:

 Urinary tract infections (35-40%)
 Surgical wound infections (20%)
 Lower respiratory tract infections (15%)
 Bacteremia (5%)

Bacteria most often associated with nosocomial infections:

 Staphylococcus aureus
 Escherichia coli
 Enterococcus
 Pseudomonas aeruginosa

Host factors that lead to increased susceptibility of nosocomial infections

include:
 Compromised immunity system
 Underlying medical disease or diseases
 Age
 Trauma
 Burns
 Poor nutritional status
 Anatomical abnormalities
 Use of medical instrumentation
 Diagnostic procedures