Disease - University of Lethbridge
Principles of Disease and EpidemiologySymbiosis – “living together”An association between two or more species and one species is typically dependent on the otherMutualism - Commensalism - Parasitism -Infection = multiplication of any parasitic organism within or on the host’s body. If the infection disrupts the normal functioning of the host then disease occursI.DiseaseThe production of a change in the normal physiology of the body, the disruption of normal body functionsMicrobial diseases are caused by infection (i.e., growth or replication of the pathogen within the body) or toxins produced by the pathogen. Note: Infections do not always cause diseaseChanges in host may be mild, severe but reversible or irreversiblePathology is the study of disease and is concerned with the following.Etiology - the cause of diseasePathogenesis (Pathos = disease, genesis = development) = mechanism by which a pathogen causes disease (i.e., factors involved in the development of disease). In other words, the manner in which a disease developsStructural and functional changes brought about by disease and the final effects on the bodyPathogen = disease causing (etiologic) agent, a parasitepathogenicity is the capacity to produce disease and depends on a number of factorsability of pathogen to invade hostability of pathogen to multiply in hostability of pathogen to avoid host defensesthe number of infectious organisms that enter the body (Shigella needs only 10 cells to cause dysentery)virulence is the degree or intensity of the disease caused by the pathogen; it is the quantitative measure of disease. May be expressed as the number of pathogen cells that elicit a pathogenic response in a host within a given time periodPathogenesis is the mechanism by which a pathogen causes disease (i.e., factors involved in the development of disease).II.Normal (indigenous) microbiotaAn adult human is made of 1013 cells and hosts 10 times that many microorganisms on the skin and mucous membranes and in the passageways of the respiratory, digestive and reproductive systems.Normal microbiota - Organisms that live in or on the host but do not cause disease under normal conditions. These organisms colonize (establish more or less permanent residence) the host and are able to multiply. Bacteria, archaea, fungi and protozoa are common inhabitants of the human body.Transient microbiota – persist on the host for short periods of time as long as necessary conditions are met. Most are not capable of multiplying on the hostMany factors affect the distribution and composition of the normal microbiota including:Nutrientschemical and physical factors (e.g., temperature, pH, available O2 and CO2, salinity and sunlight)defenses of the host mechanical factors (e.g., chewing action of the teeth, flow of saliva, peristalsis in the intestine,…)“Germfree” animals (devoid of microbiota) may be reared in the laboratory. Animals colonized by specific strains of microorganisms (gnotobiotic animals) are also created in the laboratory.Normal microbiota can benefit the host in a number of waysMicrobial antagonism (competitive exclusion) – prevent overgrowth of harmful microorganisms through competition for resources including nutrients, producing harmful substances and affecting conditions (e.g., pH and available O2)Probiotic – a live microbial culture that is consumed or applied for the purpose of exerting a beneficial effect on the host Prebiotic – a chemical (usually a dietary constituent) that selectively promotes growth of beneficial microorganismsOpportunistic pathogens – do not usually but may cause disease but under certain circumstances:Failure of host’s normal defenses – immunocompromised individuals because of malnutrition, the presence of another disease, advanced or very young age, treatment with radiation or immunosuppressive drugs and physical or mental stressIntroduction of the organisms into unusual body sitesDisturbances of the normal microflora – normal microflora interfere with the growth of pathogens by competing for and depleting resourcesIII.Etiology of DiseaseHow does one go about determining the causative agent (etiologic agent) of a disease?Koch’s postulatesWhat are the limitations of Koch’s postulates?IV.Classifying DiseaseDiseases tend to alter body structures and functions in particular ways and these changes are indicated by the manifestation of Symptoms - changes in body function such as pain and malaise (i.e., vague feeling of body discomfort) that are subjective and not apparent to an observer.Signs – objective changes that can be observed and measured by a health care professional (e.g., lesions, swelling, fever, paralysis)Diagnosis of a disease is made by evaluating signs, symptoms and laboratory testsA. Kinds of diseaseInfectious – caused by infectious agents such as bacteria, viruses, fungi, protozoa and helminthesCommunicable disease is one that is caused by a pathogen that can be spread from one host to another (contagious diseases are caused by pathogens that are easily spread from one host to the next)Noncommunicable – pathogens are not spread from one host to anotherInfections caused by an individuals normal microfloraPoisoning following ingestion of preformed toxins (botulism)Infection cause by certain organisms found in the environment such as tetanus or legionellosisEmerging infectious diseases – infectious diseases that are new or changing, showing an increase in the incidence in the recent past or a potential to increase in the near future. A number of factors contribute to the emergence of a disease, including new strains or serovars of a pathogen, widespread use of antimicrobial agents or pesticides, global warming and weather change, modern transportation, animal control measures, failure of public health measures, and exposure to pathogens in regions undergoing ecological changes brought about by natural disaster, construction, wars or expanding human settlement.Noninfectious – caused by any factor other than infectious organismsB. Occurrence of diseaseTo understand a disease we need to know something about its occurrenceIncidence of a disease – the number of people in a population who develop the disease during a particular time periodPrevalence - the number of people in a population who have the disease at a specified time regardless of when the disease started.Frequency of occurrence is also an important consideration in the understanding of diseaseSporadic diseases occur only occasionally (e.g., typhoid fever, cholera)Endemic diseases are always present in a population (e.g., common cold)Epidemic diseases are acquired by many people in a population in a relatively short period of time (e.g., influenza). A pandemic is an epidemic that is worldwideC. Severity or Duration of diseaseAcute disease – develops rapidly but lasts only a short period of timeChronic disease – develops more slowly and continue or recur over long periods of timeSubacute disease – intermediate between acute and chronic diseasesLatent disease – pathogen remains inactive for a time but becomes active to produce symptoms of diseaseD. Extent of Host involvmentInfections are classified by the extent to which the host’s body is affectedLocal infection – infectious microbes are limited to a relatively small area of the bodySystemic infections are general infections in which the pathogen or their products are spread throughout the bodyFocal infection – pathogens from a local infection enter the blood or lymphatic vessel and spread to other parts of the body where they are confinedSepsis – toxic inflammatory condition arising from the spread of microbes from a local infectionSepticemia – often called blood poisoning – systemic infection arising from multiplication of the pathogen in the blood. The presence of bacteria in the blood is known as a bacteremia. Toxemia refers to the presence of toxins in the bloodThe state of host resistance also determines the extent of infectionsPrimary infections are acute infections caused by the initial illness.Secondary infection is one caused by opportunistic pathogens due to the weakened state of the host after the primary infectionSubclinical infections do not cause noticeable illnessE. Factors affecting the occurrence of diseasei. Predisposing factors – make the body more susceptible to diseasee.g., gender, genetic background, climate & weather, indequate nutrition, age, environment, habits, lifestyle, occupation, preexisting illness, chemotherapy, emotional disturbances, stressii. Reservoirs of infection – source of the pathogen – can be biotic or abioticCarrier – harbour the pathogen without signs of infection and serve as important living reservoirs of infectionAnimals may serve as reservoirs for pathogens that infect humans. Infectious diseases that are caused by pathogens that can be transmitted from wild or domestic animals to humans are known as zoonosesiii. Transmission of diseaseThe pathogen is transmitted from the reservoir of infection to the susceptible host by three principal routesContactDirect contact (also known as person to person transmission)Indirect contact – pathogen spread from reservoir to host by an inanimate objectDroplet transmission – pathogen spread across short distances (up to 1 m) in airborne droplets discharged from an infected individualVehicle transmission – pathogens are spread by a medium such as water, food or airVectors – animals that carry pathogens from host to host. Arthropods are the most important vectors of disease. The spread may through mechanical transmission (passive transport) or biological transmission (an active process often involving the biology of the vector, i.e., vector biting and blood feeding on host)Nosocomial infections – hospital acquired infections result from a combination of factors including the weakened state of the host, the microorganisms found in the hospital environment and the chain of transmission in the hospitalF. Development of diseaseThere is a definite sequence of events that occurs during infection and disease, once the microorganism overcomes the host defenses.Incubation period – interval between initial infection and the first appearance of signs and symptoms. This period depends on a number of factors including the pathogen involved, its virulence, the number of infecting microorganisms and the resistance of the hostProdromal period – follows the incubation period in some diseases. It is a relatively short period that is characterized by mild symptoms of the disease including general aches and malaisePeriod of illness – The period when the disease is most severe with the host exhibiting overt signs and symptoms. Generally the hosts immune response and other defense mechanisms overcome the pathogen and the period of illness endsPeriod of decline – the signs and symptoms subside. Host is susceptible to secondary infections at this timePeriod of convalescence – Host regains strength and body returns to its prediseased stateV.EpidemiologyEpidemiology is the study of when and where diseases occur and how pathogens are transmitted in populations. Epidemiology examines not only the etiology of a disease but also other factors and patterns concerning the hosts infecting, including age, sex, occupation, personal habits, socioeconomic status, history of immunization, common histories of infected individuals, site where individual can in contact with the pathogen, and period of the year that the disease occurs.Epidemiologists are also concerned with various methods for controlling disease, such as chemotherapy, immunization, hygiene, control of reservoirs, water and waste water treatment, food preservation, changes in personal habits, food preparation and cooking, host nutrition and screening of blood products and transplanted organsMorbidity rate – the number of people affected by a disease in a given period of time in relation to the total populationMortality rate – the number of deaths resulting from a disease in a population in a given period of time in relation to the total population ................
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