Pathogenesis of Infectious Disease

Nonspecific Host Defense

Mechanisms Specific Host Defense
Mechanisms
disease
Terms r/t “path”
 Terms r/t “path”

PATHOGEN

disease-causing microbes
 Terms r/t “path”

PATHOLOGY

study of the structural and functional

manifestation of disease
 Terms r/t “path”

PATHOLOGIST

someone specialized in pathology

 Terms r/t “path”

PATHOGENICITY

ability to cause disease

 Terms r/t “path”

PATHOGENESIS

step or mechanisms involved in the

development of a disease
Why infection does not always occur?

anatomic and
receptor
sites
Why infection does not always occur?

antibacterial factors
at the site where
pathogens land
Why infection does not always occur?

microbial antagonism by
indigenous microflora
Why infection does not always occur?

production of
bacteriocins by
indigenous
microflora
Why infection does not always occur?

individual’s
nutritional and
overall health
Why infection does not always occur?

person may have

developed immunity
against particular
microorganism
Why infection does not always occur?

phagocytic WBCs
engulf and destroy
pathogens
 Stages in the course of a disease
Intensity of S/Sx

Time
 Stages in the course of a disease
Intensity of S/Sx

Time
Stages in the course of a disease

[incubation period]
initial contact – first symptom
 Stages in the course of a disease
Intensity of S/Sx

Time
Stages in the course of a disease

[prodromal period]
Earliest symptoms are
notable
“out of sorts” /
“coming down with
something”
 Stages in the course of a disease
Intensity of S/Sx

Time
Stages in the course of a disease

[period of illness]
a.k.a. period of invasion
period of most communicability
Stages in the course of a disease

[period of illness]
infectious agent multiplies at its
highest level, exhibits its
greatest toxicity, and becomes
well established in its target
tissue
 Stages in the course of a disease
Intensity of S/Sx

Time
Stages in the course of a disease

[convalescent period]
recovery period
patient‘s strength and
health
gradually return

If not,
 Stages in the course of a disease
Intensity of S/Sx

[terminal infection]

Time
 objective subjective
evidence of a evidence of a
disease disease
 Examples

 vital signs
 laboratory results

objective
evidence of a
disease
 Examples

 pain
 tinnitus
 blurred vision
 itching
 chills subjective
evidence of a
disease
Asymptomatic or
Subclinical
disease a patient is
unaware of
because he or she
is not experiencing subjective
symptoms evidence of a
disease
Asymptomatic or
Subclinical
Gonorrhea
(+) male | (-) female

subjective
Trichomoniasis evidence of a
(-) male | (+) female disease
 SYNDROME

a certain complex of signs and

symptoms

Acquired Immunodeficiency Syndrome

Severe Acute Respiratory Syndrome
Asperger’s Syndrome
 Classifications of infection

According to site affected

Localized
Systemic
 Classifications of infection

According to onset and duration

Chronic
Acute Subacute [Koch’s
[measles] [bacterial disease]
[mumps] endocarditis] [Hansen’
s
disease]
 Classifications of infection

According to sequence of infection

Primary Secondary Latent

infection infectio
infectio n
n
The three lines of elaborate and
highly complex defense
First and second line
Nonspecific
Third line
Specific
 Host defense

mechanisms

Nonspecific Specific host

host defense defense

First line of Second line Third line of

defense of defense defense
 Host defense

mechanisms
Natural, built-
Nonspecific in body
Specific host
host defense defense
components
that destroy all
types of
First line of Second line Third line of
foreign
defense of defense defense
substances
 Host defense

mechanisms
The 1st line:
Nonspecific surface
Specific host
host defense defense
protection
composed of
anatomical and
First line of Second line Third line of
physiological
defense of defense defense
barrier
 Host defense

mechanisms
The 2nd line:
Nonspecific nonspecific
Specific host
host defense cellular and
defense
chemical
responses
First line of Second line [phagocytes,
Third line of
defense of defense fever,defense
inflammation]
 Host defense

mechanisms
The 3rd line:
Specific host defenses that
Nonspecific Specific host
host defense
must be developed defense
uniquely for each microbe
through the action of
First lineWBC;
specialized of Second Third line of
line defense of defense defense
Not innate
impede entry not only of microbes
but any foreign object, whether
living or not
 SKIN
composition:
epithelial cells that
have become
compacted,
cemented together,
and impregnated
with an insoluble
protein, keratin
 SKIN

any disruption in the integrity of the

skin may provide a portal of entry
 SKIN

the sloughing off of dead skin cells

also removes potential pathogens
 SKIN

dryness, acidity and temperature

below 37 degrees centigrade
inhibit growth of microorganisms
 SKIN

oily sebum released by the

sebaceous glands also contain fatty
acids
 SKIN

perspiration has two purposes

flushing of microorganisms from

pores and the surface of the skin
 SKIN

perspiration has two purposes

contains lysozyme which hydrolyzes

peptidoglycan in bacterial cell wall
 MUCOUS MEMBRANE
physical or mechanical
barrier to pathogen as long
as it is intact

mucus produced by the

membranes serves to
entrap invaders
 MUCOUS MEMBRANE
substances contained in mucus

lactoferrin, a protein that binds with

iron
 MUCOUS MEMBRANE
substances contained in mucus

lysozyme, that degrades

peptidoglycan of bacterial cell wall

present in nasal secretions, saliva

and tears
 MUCOUS MEMBRANE
substances contained in mucus

lactoperoxidase that produces

superoxide radicals which are toxic
to bacteria
cilia present on
epithelial cells
swallowing of
saliva
GASTROINTESTINAL SYSTEM

digestive enzymes

acidity of the stomach

alkalinity of the intestines

GASTROINTESTINAL SYSTEM
stomach acid
+
bile salts
+
rapid flow of GI contents
small intestine is
relatively free of
bacteria
 GENITOURINARY SYSTEM
urinary tract is usually sterile

urination continually flush

microorganisms
 GENITOURINARY SYSTEM
conditions that may lead to UTI

infrequent urination
failure to urinate after intercourse
obstructions of urine
flow
 GENITOURINARY SYSTEM
low pH of vagina inhibits
colonization

oral contraceptives increase vaginal

pH
 blinking and
lacrimation flush the
eye’s surface with
tears and rid it of its
irritant
 MICROBIAL ANTAGONISM

competition for colonization

competition for nutrients
production of substances that kill
other microorganisms [bacteriocins]
 MICROBIAL ANTAGONISM

effectiveness decreases after

prolonged administration of broad-
spectrum antibiotics
 Second line of defense

Description Works by:

Transferrin
glycoprotein  deprives
synthesized in the bacteria of vital
liver having high nutrient
affinity for iron
 Second line of defense

Description Works by:

Fever
stimulate  Stimulating WBCs
d by  Reducing available
pyrogenic free plasma iron
(fever-  Inducing
producing) production of IL-1
substances
 Second line of defense

Description Works by:

Interferons
antiviral  Interfering with
proteins viral multiplication
produced by virus-  Activating certain
infected cells NK cells
 Second line of defense

Description Works by:

Inflammation
a complex  Localizing an
series of events infection
following a local  Preventing the
injury, irritation, spread of
microbial invasion microbial invaders
or bacterial toxin
 Second line of defense

Description Works by:

Inflammation
a complex  Neutralizing any
series of events toxin being
following a local produced
injury, irritation,  Aiding in the
microbial invasion repair of damaged
or bacterial toxin tissue
Second line of defense
Tissue injury

Vasodilation

Increased permeability

Emigration of leukocytes

Chemotaxis

Phagocytosis
 Second line of defense

English Latin
Redness
Heat
Edema
Pain
Loss of function
 Second line of defense

English Latin
Redness Rubor
Heat Calor
Edema Tumor
Pain Dolor
Loss of function Functio laesa
 Second line of defense

Cellular
Elements of
Human Blood
Second line of defense
 Functions of the immune system

recognize destroy those

between self which are
and non- non-self
self
Functions of the immune system

Lymphocytes

B cells
T cells
o Helper T
o Cytotoxic T
NK cells
 Immune System

B cells T cell

Helper T Cytotoxic T
 Immune System
Antibody-
Cell-mediated
mediated
involves involves different
antibodies cell types

antibodies play a antibodies have

major role no major role
 Immune System
Antibody-
Cell-mediated
mediated
involves involves different
antibodies cell types

antibodies play a antibodies have

major role no major role
 Antibody-mediated

IgM
IgA
IgD
IgG
IgE
Acquired Immunity

Natura Artificial
l active
active [vaccine
[exposur ]
e]

Artificial
Natural passive
passive [globuli
[maternal n]
 Vaccine
s
Types of Vaccines
Attenuated
weakened pathogens
Examples:
Viral: MMR, Varicella, OPV (Sabin)
Bacterial: BCG, cholera, typhoid fever
 Vaccine
s
Types of Vaccines
Inactivated
made from killed pathogens
Examples:
Viral: Hep A, encephalitis, IPV (Salk), rabies
Bacterial: Anthrax, typhoid
(subcutaneous)
 Vaccine
s
Types of Vaccines
Subunit
antigenic portions
Examples:
Hep B, whooping cough
 Vaccine
s
Types of Vaccines
Conjugate
conjugating bacterial capsular antigen
Examples:
Hib, meningococcal meningitis
 Vaccine
s
Types of Vaccines
Toxoid
made from exotoxin that has been
inactivated
Examples:
Diphtheria, tetanus
 Expanded
Program on
Immunizati
BCG

DPT

OPV
 Bacille-Calmette-Guerin (BCG)
Minimum age at 1st dose: At birth
Dosage: 0.05 mL
Number of doses: 1
Interval between doses: -
Route of administration: Intrade
Site: rmal
Vaccine Type: Right
deltoid
Diphtheria Pertussis Tetanus (DPT)
Minimum age at 1st dose: 6 weeks
Dosage: 0.5
mL Number of doses: 3
Interval between doses: 4 weeks Route
of administration: Intramuscular
Site:
 Oral Polio Vaccine (OPV)
Minimum age at 1st dose: 6 weeks
Dosage: 2 drops
Number of doses: 3
Interval between doses: 4 weeks
Route of administration: Oral
Site: Mouth
Vaccine type: Attenuate
d
 Hepatitis B vaccine
Minimum age at 1st dose: At birth
Dosage: 0.5
mL Number of doses: 3
Interval between doses: 6/8 weeks
Route of administration: Intramuscular
Site:
 Measles vaccine
Minimum age at 1st dose: 9 months
Dosage: 0.5
mL Number of doses: 1
Interval between
doses: -
Route of
administration:
Subcutaneous
 Tetanus toxoid
Minimum age at 1st dose: AEAPDP
Dosage: 0.5 mL
Number of doses: 5
Interval between doses: 1/6/12/12 mos.
Route of administration: Intramuscular
Site: Deltoid
 Storage

Most sensitive to -Oral Polio Vaccine -15 to -25 degrees

heat -Measles Celsius (freezer)

-DPT
-Hepa B 2 to 8 degrees
Least sensitive to Celsius (body
heat -BCG
-Tetatus Toxoid of refrigerator)