Principles of Disease and

Epidemiology
 Terminologies
1. pathogens- organisms that cause diseases
2. Pathology- the scientific study of diseases, the manner in which the disease
develops and the structural and functional changes that are brought about
by the disease.
3. Etiology- the cause of a disease
4. Pathogenesis- the manner in which the disease develops
5. Infection- the invasion or colonization of the body by pathogenic
organisms.
6. Disease- the result of the infection that result in any change from a state of
health.
7. Probiotics- live microbial cultures applied to or ingested to exert a beneficial
effect- aid in digestion
8. Prebiotics- chemicals that selectively promote growth of beneficial bacteria
9. Symptoms- can’t be seen, refers to changes in body function such as pain ,
fatigue or discomfort.
10. signs- changes that can be observed and measured.
11. Syndrome- a specific group of symptoms or signs accompanying a
particular disease.
12. Communicable disease- disease that can be spread from one host to
another either directly or indirectly
13. Contagious disease- disease that is easily spread from one person to
another.
14. Non-communicable disease- disease that is not spread from one host to
another
15. Incidence of a disease- is the number of people in a population who
develop an disease during a particular time period.
16. Prevalence of a disease- is the number of people in a population who
develop a disease a specified time, regardless of when it first appeared.
17. Sporadic disease- refers to when a particular disease occurs only
occasionally.
18. Epidemic- refers to when a disease is constantly present in a
population.ie. Common cold
19. epidemic- refers to when many people in a given area acquire a certain
disease in a relatively short period. Ie. Influenza
20. Pandemic- an epidemic disease that occurs world wide. Ie. Influenza/ AIDS
21. Acute disease- a disease that develops rapidly but last only a short time. Ie,
influenza
22. Chronic disease- develops more slowly, the body’s reaction is less severe, but
the disease is likely to continue or recurrent for long periods.
23. Subacute- a disease that is intermediate between acute and chronic. Ie
sclerosing panencephalitis ( a brain disease characterized by diminished
intellectual function and loss of nervous function)
24. Latent disease- a disease in which the causative agent remains inactive for a
time but then becomes active to produce symptoms of the disease. Ie.
Shingles
25. Local infection- one in which the invading microorganism are limited to a
relatively small area of the body. Ie boils or abscesses
26. Systemic (generalized) infection- microorganisms or their products are
spread throughout the body by the blood or lymph. Ie Measles
27. Focal infection- when the agents of a local infection enter a blood or
lymphatic vessel and spread to other specific parts of the body, where they
are confined to specific areas of the body.
28. sepsis- toxic inflammatory condition arising from the spread of microbes,
especially bacteria or their toxins, from a focus of infection.
29. Septicemia- also called blood poisoning, is a systemic infection arising from the
multiplication of pathogens in the blood.
30. Bacteremia- the presence of bacteria in the blood
31. Toxemia- refers to the presence of toxins in the blood.
32. Primary infection- an acute infection that cause initial illness.
33. Secondary infection- an infection caused by opportunistic pathogens after the
primary infection has weakened the body’s defenses.
34. Subclinical infection- one that does not cause any noticeable illness. Ie. Polio
virus and hepatitis A
35. Incubation period- the time interval between the initial infection and the first
appearance of any signs or symptoms
36. Prodromal period- a relatively short period that follows the period that follows
the period of incubation of a disease. It is characterized by mild symptoms.
37. Period of illness- the period when the disease is most severe.
38. Period of decline- the period when the signs and symptoms of a disease
subside.
39. Period of convalescence- the person retains strength and the body
returns to its prediseased state.
40. Carriers- people who can harbor pathogens and transmit them to others
without exhibiting any signs of illness.
41. Zooneses- disease that occur primarily in wild and domestic animals and
can be transmitted to humans.
42. Contact transmission- the spread of an agent of disease by direct
contact, indirect contact, or droplet transmission.
43. Direct contact transmission- also known as person to person contact, is
the direct transmission of an agent by physical contact between its
source and a susceptible host. No intermediate agent is involved.
44. Indirect contact transmission- occurs when the agent of a disease is
transmitted from its reservoir to a susceptible host by means of a non
living object.
45. Fomite- the general term for any non living object involved in the spread
of an infection. Ie. Bedding, Towels, utensils
46. Droplet transmission- transmission in which microbes are spread in
droplet nuclei that travel only short distances. (AMP)
47. Vehicle transmission- the transmission of disease agents by a medium,
such as water, food, or air.
48. Vectors- animals that carry pathogens from one host to another.
49. Mechanical transmission- the passive transport of the pathogens on the
insect’s feet or other body parts.
50. Nosocomial infection- is one that does not show any evidence of being
present or incubating at the time of admission to a hospital; it is acquired
as a result of hospital stay.
51. Compromised host- one whose resistance to infection is impaired by
disease, therapy or burns.
52. Emerging infectious disease- are ones that are new or changing, showing
an increase in incidence in the recent past, or a potential to increase in
the future.
53. Epidemiology- the science that studies when and where disease occur
and how they are transmitted in populations.
54. Morbidity- the incidence of specific notifiable disease
55. Mortality- number of death from these disease (morbidity)
56. Morbidity rate- the number of people affected by a disease in a given
period of time in relation to the total population.
57. Mortality rate- the number of deaths resulting from a disease in a
population in a given period of time in relation to the total population.
58. Herd immunity- the presence of immunity to a disease in most of the
population.
 Normal Microbiota
- Refers to the microorganisms that normally reside in the human body. But
do not produce disease under normal conditions.
- Organisms are free of microbes in utero.
- At birth microbial populations begin to establish themselves.
- Lactobacilli in the vagina replicates rapidly just before birth. At birth these
bacilli are the first microbes the baby contact, and thus it becomes the
predominant organism in its intestine. More organisms are then introduced
during the process of breathing and feeding. Ie. E.coli
- The increase or decrease of these microbes may contribute to disease.
- A typical human contain 1 x 10 14 bacterial cells (10x more than human cells)
- Transient microbiota- refers to those microbes that may be present in the
body for several days, weeks or months and then dissapear.
- Microbes are localized in certain areas of the body such as the skin, the
conjunctiva of the eyes, the upper respiratory tract-nose and throat, mouth,
large intestine and urinary and reproductive systems.
 Representative members of the normal microbiota
region Microbe present comments
skin Propionibacterium, -most not resistent
Staphylococcus, Micrococcus, -Sweat and oil have
Candida, Pityrosporum antimicrobial agents
-Keratin is a resistant barrier
and the low pH of the skin
inhibits many microbes.
-Skin has low moisture
content
Eyes Staphylococcus epidermidis, -tears and blinking eliminates
(conjunctiva) Corynebacterium, Streptococci, some microbes or inhibit
Micrococcus others from colonizing.
Nose and Staphylococcus aureus, S. -Nasal secretions kill or inhibit
throat epidermidis, diphtheroids (nose) many microbes.
+ S. Pneumoniae and Neisseria -Mucus and ciliary action
(throat) remove many microbes
 Representative members of the normal microbiota
Region Microbe Present Comments
Mouth Streptococcus, lactobacillus, Actinomyces, -moisture, warmth, food provide
treponema, Staphylococcus, Candida ideal environment for growth of
microbes.
-Saliva contain antimicrobial
agents
Large intestine E. Coli, Bacteriodes, Fusobacterium, -largest # of resident bacteria
Lactobacillus, Enterococcus, Enterobacter, cause of its moisture and
Proteus and Candida available nutrients
-Mucus and periodic shedding of
the lining prevents microbes
from attacking the
gastrointestinal tract
-Diarrhoea also flushes out some
of the microbes.
Urinary tract Staphyloccocus, Micrococcus, Enterococcus, -vagina has its acid tolerant
and Lactobacillus, Pseudomonas, Streptococus, microbes
reproductive Clostridium, Trichonomas vaginialis, Candida -muscus and periodic shedding
system prevent microbes from attacking
the lining.
-urine flow removes microbes
-cilia and mucus expel microbes
from the cervix
-Acidity of the vagina kills
microbes
 Factors that determines the distribution and
composition of the normal microbiota.
1. Nutrients:
vary with the type of nutrient they obtain their energy from. Ie. Body
fluids, dead cells , food in the gastro intestinal tract
2. Physical factors and chemical factors:
temperature, pH, available oxygen and carbon dioxide, salinity and
sunlight.
3. Defense of the host - includes a variety of molecules and activated cells
that kill microbes, inhibit their growth, prevent their adhesion to host cell
surfaces, neutralizes toxins that microbes produces
4. Mechanical factors- mastication, the flow of saliva and other digestive
secretions in the gastrointestinal tract, peristalsis, the flushing action of
urine, mucus trapping microbes in the respiratory tract, cilia propelling
microbes towards the throat
Others: age, nutritional status, health status, hospitalization, stress, climate,
personal hygiene, occupation and life style.
 Relationship between the normal Microbiota and the host
- The normal microbiota can benefit the host by preventing the overgrowth
of harmful microorganisms.(MICROBIAL ANTAGONISM or COMPETITIVE
EXCLUSION)
Microbial antagonism
- involves competition among microbes
- Normal microbiota protect the host against colonization by potentially
pathogenic microbes by competing for nutrients, producing substances
harmful to the invading microbes and affecting conditions such as pH and
available oxygen.
eg. 1. When the balance between the normal microbiota and pathogenic
bacteria is upset disease results . Ie. Normal microbiota inhibit yeast;
Present of Candida albicans –yeast infection when the pH changes from 4
to 7.
2. E.Coli produces bacteriocins (protein that inhibits the growth of other
bacteria such as Salmonella and Shingles)
3. The normal biota of the large intestine inhibits Clostridium difficile by
making host receptors unavailable, competition for available nutrients or
producing bacteriocins.
note: this microbes is responsible for nearly all gastrointestinal infections
- The relationship between the normal microbiota and the host is called
symbiosis . (may be commensalism, mutualism, parasitism)
- Ie.
Commensalistic: cornybacteria that inhabits the surface of the eye
mycobacterium that inhibits the surface of the ear
and external genitals

Mutualistic- E. Coli (synthesize K and B vitamins), gets food in intestine

Probiotics along with prebiotics

Parasitism- disease causing bacteria. Vibro chlorea

 Opportunistic Pathogens
- When a pathogen that is normally not parasitic and becomes
parasitic given certain circumstances. Ie .E. Coli
(generally harmless in the large intestine, but if it gains access to
body sites such as the urinary bladder, lungs, spinal cord or
wounds its may cause urinary tract infection, pulmonary
infection, meningitis, or abscesses.

- When the body’s immune system is already weak as in the case

of AIDS. Pneumocytis pneumonia can develop.

- Opportunistic pathogens are normally present in the body in

large amounts.

- They may be found in location in our body that are not somewhat
protected from the body defenses and are resistant to antibiotics.
 Classifying infectious disease
1. Communicable vs. non- communicable

2. Frequency of occurrence (incidence, prevalence,

sporadic , endemic, epidemic, pandemic)

3. Severity of disease (acute, chronic, subacute, latent)

4. Extent of host infection ( local infection, systemic

infection, focal infection, sepsis, primary infection,
secondary infection, subclinical infection)
 Patterns of Disease
- A definite sequence of events that usually occurs during infection and disease.
- There must be a reservoir of infection as a source of pathogens for an infectious
disease to occur.
- The pathogen must be transmitted directly or indirectly.
- The microorganism then invade the host
- Microorganism injure the host-pathogeneisis
Note:
- Certain predisposing factors affect the occurrence of a disease.
1. Gender ie. Female have higher chance of UTI
male have higher chance of pneumonia and meningitis
2. genetics- people who have sickle cell trait are relatively resistant to the most
serious form of malaria.
3. Climate/weather- temperate regions, the incidence of respiratory disease increase
4. Inadequate nutrition
5. Lifestyle
6. Emotional disturbances
7. Pre existing illness
 Development of a disease
1. Incubation period
- Depends on the specific microorganism involved, its virulence, the number
of infecting microorganisms and the resistance of the host.

2. Prodromal period

3. Period of illness
- Period when person exhibits signs and symptoms
- # of WBS’s may increase or decrease

4. Period of decline
- Patient maybe vulnerable to secondary infection during this phase

5. Period of convalescence
- Disease may still be contagious ie. Cholera , typhoid fever
 The spread of infection
Reservoir of infection
1. human/carrier
2. Animal- zoonoses (pg. 432)
3. Non living reserviors

Transmission of disease
4. Contact transmission (direct or indirect)
5. Droplet transmission
6. Vehicle transmission
7. Vectors /mechanical
8. Biological transmission- complex.
 BIOLOGICAL TRANSMISSION
• The arthropod bites an infected person or animal and ingest some of the
infected blood

• The pathogen then reproduce in the vector, and the increase in the
number of pathogens increases the possibility that they will be
transmitted to another host.

• Some parasites reproduce in the gut of the arthropod, these are passed
out in the feces/vomit

• When the vector bites the host the parasite enters through the wound or
if the parasite is transmitted to the salivary glands then it will be
transmitted directly in the bite. Ie. Bacteria
 NOSOCOMIAL (hospital-aquired) INFECTIONS
- Occurs from the interaction of several factors: (1) microorganisms in the hospital
environment; (2) the compromised (or weakened) status of the host and (3) the
chain of transmission in the hospital.
1. Microorganisms in the hospital
(a) they are opportunistic (ie. Staphylococcus aureus, Pseudomonas aeruginosa,
Enterococcus sp., E. Coli etc. (see table 14.4 pg. 436)
(b) They are resistant to antimicrobial drugs. Ie. P. aeruginosa (gram – bacteria) is
difficult to control because of their R factors, which carries genes that determines
resistance to antibiotics. –mutation

2. Compromised host
-ones whose resistance to infection is impaired by disease, therapy or burns.
- Host can be compromised by broken skin or mucous membrane and suppressed
immune system
- Invasive procedures such as administering anesthesia and tracheotomy
- Alteration of T (T. lymphocytes)and B cells (B. Lymphocytes) by drugs, radiation,
stress, diseases, malnutrition and AIDS.
3. Chain of Transmission
- Direct transmission from hospital staff to patient and patient to patient
- Indirect contact transmission through fomites and hospital ventilation
systems.

CONTROL OF NOSCOMIAL INFECTIONS

1. Aseptic techniques
2. Proper cleaning, storage and handling of hospital equipment and
supplies
Emerging Infectious Disease
Causes:
1. New strains that results from genetic recombination between organisms
2. Use of antibiotics and pesticides
3. Climatic changes (global warming
4. Travel
5. Failures in public health
6. Lack of vaccinations
Facts:
7. Vaccinations can provide long lasting and sometimes life long protection
of an individual against a disease.
8. Immune individuals acts as barriers to the spread of infectious agents.
9. The CDC, NIH and WHO are responsible for surveillance and response to
emerging infectious disease.