INFECTIOUS DISEASE:

Basic Concept of Infection

 Ancient Times

Microorganism existed long before humans

evolved. Infectious diseases we see today have
long history. Names of disease may have
changed but the disease stayed the same.
Before pathogens of disease were known, the
diasease was perceived as curse from God for
their sins Page 2
 Ancient Times

• Best known infectious disease from

ancient time  BLACK DEATH
• ~ Bubonic Plaque
• ~ NOW known as Pests or Sampar
• The plaque caused major impact since
its biggest epidemic killed 1/3 human
population
• Small pox indeed contributed to
dissappearance of Aztec civilization
Page 3
 Black/ Bubonic Plaque

• Characterized by fever, multiple swollen black

buboes (limfadenopathy), and coughing up
blood.
• Combination of bubonic, septicemia, and
pneumonic plaque Page 4
 Black/ Bubonic Plaque

Medical explanation was so poor that role of

priests became dominant

Page 5
 Victim of Black Death

Dobson M. Disease. 2007 Page 6

Invention of First Microscope

Page 7
 Evolution

• Medical explanation was identified 

microorganisms are etiology of disease
• Clear pathogenesis Page 8
Male Xenopsylla cheopis

This flea is the primary vector of plague in

most large plague epidemics in Asia, Africa,
and South America.
Page 9
 Thypoid Mary

Mary Mallon
• Asymptomatic thypoid
carrier
• Over of her carreer,
she infected 54
people and 3 of whom
died

http://en.wikipedia.org/wiki/Infectious_disease Page 10
 Small pox

• Young Bangladesh
girl was infected by
small pox in 1973
• The disease was
eradicated in 1979 
due to vaccination

http://en.wikipedia.org/wiki/Infectious_disease Page 11
 Definition of infection

• The invasion of the body of a human by a

pathogen such as a bacterium, fungus, or
virus. Infections can be localized, as in
pharyngitis, or widespread as in sepsis,
and are often accompanied by fever and
an increased number of white blood cells.
Individuals with immunodeficiency
syndromes are predisposed to certain
infections
Page 12
 Chain of Infection

• Chain of
infection
contains six
elements. If
broken,
infection will
not occur.

Page 13
 Chain of Infection

• Infectious Agent – pathogen such as a

bacteria or virus.
• Reservoir – a place the pathogen can
live.
– Examples: human body, animals, the
environment, fomites.
– Fomites are objects contaminated with
infectious material that contains
pathogens.
• Ex: doorknobs, bedpans, linens, instruments.

Page 14
 Chain of Infection

• Portal of Exit – way to escape from the

reservoir in which it has been growing.
– Urine
– Feces
– Saliva
– Respiratory tract
– Skin
– Blood
– Gastrointestinal tract
– Mucous discharge
– Tears
Page 15
 Armstrong D, Cohen J. Infectious Diseases. 2nd edition. 2004.

Osterhol MT. Hedberg CW. Epidemiology of infectious diseases. In:Mandell GL, Bennett JE, Dolin R. eds. Mandell, Douglass,
and Bennett’s principles and practice of infectious diseases. Sixth edition. Philadelphia: Elsevier Inc, 2005. 166-169. Page 16
Chain of Infection

• Mode of Transmission – way in which it

can be transmitted to another reservoir
or host where it can live.
– Can be through direct contact or
airborne droplet.
– Contaminated hands are one of the most
common sources of direct
transmissions.
• Hand washing is one of the most effective
means of preventing the spread of
pathogens.
Page 17
 Chain of Infection

• Portal of Entry – way to enter the new

reservoir or host.
– Respiratory tract, mucous membranes,
and gastrointestinal tract are common.
– Damaged skin.

Page 18
 Route of Transmission

Direct Indirect

•Touching •Vehicle borne

•Kissing •Vector borne
•Sexual •Airborne
intercourse
•Droplet
•Bite of animal
•In contact with
soil or decaying
matter
•Transplacental
Osterhol MT. Hedberg CW. Epidemiology of infectious diseases. In:Mandell GL, Bennett JE, Dolin R. eds. Mandell, Douglass, Page 19
and Bennett’s principles and practice of infectious diseases. Sixth edition. Philadelphia: Elsevier Inc, 2005. 166-169.
 Chain of Infection

• Susceptible Host – one that is capable

of being infected.
– Microorganisms must be present in large
enough quantity to be virulent.
– The host must be susceptible.
– Individuals with an immunity to certain
pathogens will not be susceptible.

Page 20
Pathogenesis of Infection

Page 21
 Body Defenses
• If defense mechanisms are intact and the
immune system is functioning, a human can
frequently fight off the causative agent and
not contract the disease.
– Mucous membranes (traps pathogens)
– Cilia (propel pathogens out of respiratory tract)
– Coughing and sneezing
– Hydrochloric acid (stomach)
– Tears in the eyes (contain bacteriocidal chemicals)
– Fever
– Inflammation (wbc’s destroy pathogens)
– Immune response (produce antibodies)
Page 22
Stages in Host-Pathogens Interactions
Stage Mechanism Utility to Pathogen

Colonization Ligand-specific adherence to Provides initial niche for the

host receptors, commonly by pathogen to establish and
way of specific sugar-protein initiate adverse effects on the
interactions host
Invasion Penetration of skin, mucosa or Provides entry of pathogen to
other epithelial membranes to the host; may also enter
reach the circulation or specific immunologic sanctuary, where it
target organ or cell type is sequestered & protected from
host immune response
Multiplication Depends on preferred niche of Organism increase in number &
the organism & its growth rate may be better able to survive
 slow / rapid, intra- / extra- host defenses
cellular
Dissemination Depends on biologic attributes Organism infects multiple sites
 spread locally / widely  cause added symptoms &
survive indefinitely

Osterhol MT. Hedberg CW. Epidemiology of infectious diseases. In:Mandell GL, Bennett JE, Dolin R. eds. Mandell, Douglass, and Bennett’s
principles and practice of infectious diseases. Sixth edition. Philadelphia: Elsevier Inc, 2005. 166-169.
Page 23
Cohen J. Eds. Infectious diseases. Second edition. London: Mosby, 2004. 12-28
 Signs & Symptoms of
Infection
• Redness
• Swelling
• Tenderness
• Warmth
• Drainage
• Red streaks leading away
from wound
Page 24
Host-agent-environment relationship

A. Host

B. Agent C. Environment

Osterhol MT. Hedberg CW. Epidemiology of infectious diseases. In:Mandell GL, Bennett JE, Dolin R. eds. Mandell, Douglass,
and Bennett’s principles and practice of infectious diseases. Sixth edition. Philadelphia: Elsevier Inc, 2005. 166-169.
Cohen J. Eds. Infectious diseases. Second edition. London: Mosby, 2004. 12-28
 A. Host

Influence exposure: Influence infection and

- Behavioral factor (drug usage, the occurrence and
alcohol consumption)
severity of disease:
- Closed living quarter
- Age at the time of infection
- Food and water consumption
- Anatomic defect
- Familial
- Antibiotic use
- Gender
- Coexisting infection and non
- Hygiene practice infectious disease
- Occupation - gender
- Socioeconomic status - Immune state
- Sexual activity - Nutritional status
Osterhol MT. Hedberg CW. Epidemiology of infectious diseases. In:Mandell GL, Bennett JE, Dolin R. eds. Mandell, Douglass,
and Bennett’s principles and practice of infectious diseases. Sixth edition. Philadelphia: Elsevier Inc, 2005. 166-169.
Agent(1)
• Three characteristics of agents that are
important for infection:
– characteristics that are involved in their
spread or transport through the
environment
– characteristics that are involved in
production of infection
– characteristics that are involved in the
production of disease

Osterhol MT. Hedberg CW. Epidemiology of infectious diseases. In:Mandell GL, Bennett JE, Dolin R. eds. Mandell, Douglass,
and Bennett’s principles and practice of infectious diseases. Sixth edition. Philadelphia: Elsevier Inc, 2005. 166-169.
Agent(2)
• Infectiousness: a characteristic that is
concerned with the relative easiness of
an agent to be transmitted to other
hosts, e.g. a droplet-spread infection
tends to be more infectious than an
infection transmitted by direct contact.
• Infectivity: a characteristic that
represents an infectious agent’s
capability to enter, survive and multiply
in the host.
Osterhol MT. Hedberg CW. Epidemiology of infectious diseases. In:Mandell GL, Bennett JE, Dolin R. eds. Mandell, Douglass,
and Bennett’s principles and practice of infectious diseases. Sixth edition. Philadelphia: Elsevier Inc, 2005. 166-169.
Strickland GT & Ruebush II TK. General principles of infectious disease transmission. In: Strickland GT. Hunter’s Tropical
Agent(3)
• Pathogenicity: a property of an agent
that determines the extent to which
overt disease is produced in an infected
population.
• Virulence: a characteristic that describe
the severity of disease produced by an
infectious agent.
• Infective dose: the number of
organisms necessary to cause infection.
Osterhol MT. Hedberg CW. Epidemiology of infectious diseases. In:Mandell GL, Bennett JE, Dolin R. eds. Mandell, Douglass,
and Bennett’s principles and practice of infectious diseases. Sixth edition. Philadelphia: Elsevier Inc, 2005. 166-169.
Strickland GT & Ruebush II TK. General principles of infectious disease transmission. In: Strickland GT. Hunter’s Tropical
 TYPE OF INFECTION

• Acute infection and chronic infection

– Acute Infection
• An infection characterized by sudden
onset, rapid progression, and often with
severe symptoms
– Chronic Infection
• An infection characterized by delayed
onset and slow progression
 TYPE OF INFECTION
• Primary infection and secondary
infection
– Primary Infection
• An infection that develops in an
otherwise healthy individual
– Secondary Infection
• An infection that develops in an
individual who is already infected with a
different pathogen
 TYPE OF INFECTION

• Localized infection and systemic

infection
– Localized Infection
• An infection that is restricted to a
specific location or region within the
body of the host
– Systemic Infection
• An infection that has spread to several
regions or areas in the body of the host
 TYPE OF INFECTION

• Clinical infection and subclinical

infection
– Clinical Infection
• An infection with obvious observable or
detectable symptoms
– Subclinical Infection
• An infection with few or no obvious
symptoms
 TYPE OF INFECTION

• Opportunistic infection
– An infection caused by
microorganisms that are commonly
found in the host’s environment This
term is often used to refer to
infections caused by organisms in the
normal flora
THANK YOU

Terima kasih
jwitjaksono@yahoo.com