PRINCIPLES OF DISEASE AND EPIDEMIOLOGY

Host-Microbe Relationship
- The infection may lead to disease
● Host and Pathogen
○ Host - handles/houses the microorganisms; harbors other organisms
○ Pathogen - parasite capable of causing harm to the host; agent; parasite
○ Non Pathogenic - not causing disease to the host
● Infection vs Disease
○ Infection - exists in the absence of the detectable disease; colonization of
pathogenic microorganisms
○ Disease - occurs when an infection results in any change in the state of
health or normal state of the body
● Pathology: is the scientific study of disease; what is the cause of the disease; what
pathogen did cause the disease
● Pathogenesis: how is the mode of transmission and the development in the body;
structural and functional changes

Transient Microbiota​ - microorganisms usually resides in the body surface and can be
easily loss; may be present for a certain time period then eventually disappear
Normal Microbiota (Normal Flora) ​- microbe that is implanted as colonies in the body
surfaces but they will not cause a disease; naturally present; colonists
● Factors that affect the distribution and composition of the normal microbiota:
○ Nutrients - microbes that could colonize to body sites that would give them
the appropriate nutrients they need. Derived from secretory and excretory, or
can be food from GIT
○ Physical and chemical factors - affect the growth and composition of normal
microbiota. Will usually migrate to other parts of the body. Temperature, pH,
oxygen, CO2, availability of sunlight
○ Host defense - usually the body of humans that has a certain defense
mechanism against the microbes; neutralize toxins that the microbes are
producing. Dependent on the ability of the pathogen to cause a disease.
○ Mechanical factors - certain regions in the body subject to mechanical forces;
fluch the microorganisms through the urine; can be trapped in other parts of
the body

Relationship between Normal Microbiota and the Host

● Pathogenicity: a broad concept that describes an organism’s potential to cause
infection or disease, and is used to divide pathogenic microbes into one of two
groups; capability of the pathogen to cause infections
● Virulence: How deadly; capability to cause severity of the microorganisms; degree of
pathogenicity; can be determined by the pathogen’s ability to establish itself in the
host and how they survive the host’s defenses. Can produce toxins that can result
sickness to the host
○ Virulence factor - structure of the microorganisms that contributes to the
preceding activities.

Pathogenicity vs Virulence
 ● True Pathogens: capable of causing disease in healthy persons with normal immune
defenses; primary pathogen; associated with specific or recognizable disease and
may vary in severity (mild-severe-fatal)
● Opportunistic Pathogens: Organisms that normally do not cause disease in their
natural habitat in a healthy person; already present in the body but do not cause
disease; when the immune system or defense mechanism is compromised

Factors that can affect the defense mechanism:

Age
Genetic Defects
Existing Diseases
Disturbances in the Normal Flora

Representative Microbiota by Body Region

 - Koch Postulate: Specific pathogen cause specific disease; the bacteria must be
present in every case of the disease; microorganisms must be present in the host
- Pre culture: directly from the animal
- Exceptions: ​a particular bacteria cannot be grown in pure culture​ in the
laboratory (Mycobacterium leprae - leprosy and Treponema pallidum). A ​single
pathogen can cause several conditions​ (Streptococcus pyogenes and
Mycobacterium tuberculosis). ​In one disease, it may involve several different
pathogens

Classification of Diseases
● Symptoms - subjective changes; only the patient can tell
● Signs - objective changes; healthcare professional can observe and measure
● Syndrome - specific group of signs and symptoms that may always accompany a
particular disease
● Infectious and Non-infectious Diseases
○ Infectious Disease: diseases caused by infectious agents such as bacteria,
viruses, fungi, protozoa, and helminths.
○ Non-infectious Disease: caused by any factor other than infectious organisms
● Inherited diseases - non
● Congenital diseases - non or infectious;
● Degenerative diseases - non
● Nutritional deficiency diseases - non
● Endocrine diseases - non
● Mental diseases - non or infectious
● Immunological diseases - infectious
● Neoplastic - non or infectious
● Iatrogenic diseases - infectious
● Idiopathic - unknown cause; infectious
● Communicable and Noncommunicable Diseases
○ Communicable Disease: infectious diseases can be spread from one host to
another; airborne; vector-borne
○ Noncommunicable Disease: not spread from one host to another and may
result from:
■ infections caused by an individual’s normal microflora,
■ poisoning following the ingestion of preformed toxins
■ infections caused by certain organisms found in the environment

Severity of Disease
● Acute and Chronic Disease
○ Acute Disease: Develops rapidly, but lasts a short time.
○ Chronic Disease: develops more slowly, and the body’s reactions may be less
severe, but the disease is likely to continue or recur for long periods; started
mild; did not cause disease right away; not cured right away
● Latent Disease: Causative agent remains inactive (no symptoms) for a time, but then
becomes active and produces disease symptoms. Usually caused by pathogens that
are inactive for a long time that became active.
Host Involvement

3 types of Infections based on what part of the body is being infected: Local,
Systemic, Focal
● Local Infection - the invading microorganisms are limited to small area of the body;
will remained confined to a specific tissue
● Systemic - substances they produce are spread throughout the body by blood or
lymph
● Focal - starts as local infection and will eventually spread to other parts of the body
ending up as systemic infection, can be carried out into other tissues
● Mixed - several agents that will establish themselves simultaneously at the infection
site; because of different types of microorganisms that are causing the infection;
synergistic infections because of microorganisms that cooperate to break down a
specific tissue; gangrene, wound infections, dental caries, bite infections; sometimes
called polymicrobial diseases
● Primary Infection - acute infection that will cause an initial disease or illness
● Secondary Infection - usually cause by opportunistic pathogen, after primary
infection, the immune response weaken which will lead to secondary infection
● Subclinical infection -does not cause any noticeable symptoms in the host
Stages of Disease

● Incubation Period - time between infection and appearance of the signs and
symptoms; ​Factors that can affect the incubation period​: nature of the
microorganism, virulence of microorganism, how many microorganisms, where -
what type of tissue is affected
● Prodromal - short period where nonspecific and mild symptoms show (headaches);
Prodrome - symptom indicating the onset of disease; many diseases lack prodromal
phase and may begin sudden onset of symptoms (fever and chills); during
prodromal phase - infected individuals are highly contagious, the host can spread the
disease
● Invasive - period during which typical signs and symptoms; the patient’s immune
response and defense mechanism will overcome the pathogen; height of infection
phase or aka ACME; signs and symptoms will reach their greatest intensity
● Decline phase - secondary infection may occur
● Convalescence - the tissues are repaired; healing will take place and body will regain
strength and recover; no more signs and symptoms; sequelae - the disease has
already ended but has an infection; chickenpox

What is Epidemiology
● Epidemiology: the study of factors and mechanisms involved in the frequency and
spread of diseases and other health-related problems within populations of humans,
other animals, or plants.
● Epidemiologist - scientist who studies epidemiology
● Related to public health
● Epidemiologic Studies: Collecting frequency data and drawing conclusions
○ Descriptive Studies - narrative/describing; physical aspects of an existing
disease; number of cases; who are the segments of population; locations and
time periods
○ Analytical Studies - focuses on establishing cause and effects in the
occurrence of disease in a population
■ Retrospective - factors that preceded an epidemic; control group -
individuals included in the same population that are not infected with
the disease
 ■ Prospective - factors that occur as epidemic spreads; factors used to
determine susceptibility and resistance
○ Experimental Studies - test a hypothesis; about the value of a particular
treatment; limited to lab animals or humans (clinical trials); subjects are not
subjected to harm

Occurrence of Disease
● Incidence and Prevalence Rates
○ Incidence Rate: Percentage of population that contracts a disease in a given
time period. Usually an indicator of a spread of disease. New cases.
○ Prevalence Rate: Percentage of population that has the disease during a
given time period. Number of people in a population who developed a disease
regardless of when it first appeared. Both old and new diseases. Indicator of
how serious or long… :<
● Morbidity and Mortality Rates
○ Morbidity Rate: the number of individuals affected by a disease during a set
period in relation to the total number in the population. Comorbid factors - an
individual already has an existing disease. Expressed as the number of cases
over 100,000 people per year.
○ Mortality Rate: the number of deaths due to a disease in a population during a
specific period in relation to the total population. Expressed as number of
deaths over 100,000 people per year

Diseases in Populations
● Endemic Disease: A disease constantly present in a population. Hepatitis - may case
palagi in a population, hindi nawawala
● Epidemic Disease: If many people in a given area acquire a certain disease in a
relatively short period.
○ Propagated epidemic: The pathogen moves from infected people to
uninfected but susceptible individuals.
● Pandemic Disease: epidemic disease that occurs worldwide
● Sporadic Disease: disease occurs only occasionally at a certain season of time.
● Common-source Outbreak: an epidemic that arises from contact with contaminated
substances. Cholera - one source of the disease; certain area only is infected

Spread of Infection
● Reservoirs (Carrier) of Infection - other people can have no signs and symptoms of
latent disease or no signs and symptoms during incubation period or
recovery/convalescence period
○ Human Reservoir: Infected individuals who may or may not present disease.
○ Animal Reservoir: Zoonoses are diseases that occur primarily in wild and
domestic animals.
○ Nonliving Reservoir: Two major sources are soil and water.
Portals of Entry for Human Pathogens

● Sites at which microorganisms can enter the body

● Skin, mucus membranes, digestive (food, water, contaminated fingers, fluid
discharge), respiratory (inhaled air, airborne droplets), urogenital (for women, sexual
intercourse)
● Open wounds, damaged tissues (P. aeruginosa), bites (insect, parasitic and
helminthic), burns, injection sites, accidental or surgical wounds
● Placenta - transmitted from the mother to the child. Syphilis, aids, robela
● Milk ducts of mammary glands
● Single portal

*Bubonic plague - flea bite; 50% mortality rate

*Pneumonic plague - close to 100% mortality rate

Portals of Exit for Human Pathogens

● Sites where organisms leave the body, through body fluids

● Respiratory pathogens - nose, mouth or body fluids; can be transferred to other
individuals; saliva of cats, dogs - rabies; GIT - anus, fecal matter
 ● Semen - may carry pathogens that may exit the body through WBC or sperm
● Hepatitis B and C
● Milk - portal of exit, aids; undergo pasteurization to stop the spread of tuberculosis
usually from cow to humans

Modes of Disease Transmission

● Direct Contact Transmission - require body contact between individuals to the

infected individual
○ Horizontal Transmission - can pass pathogens by shaking hands, kissing,
sexual contact
○ Vertical Transmission - pathogen is passed from pathogen to offspring;
across placenta or breast milk, present in birth canal
● Indirect Transmission - fomites (non living objects that can carry and transmit an
infectious agent; dirty clothes, utensils, doorknobs, toys, bar soap, money, metals)
● Droplet Transmission - third kind of contact transmission; when a person cougars or
sneezes or speaking; droplet nuclei - consists of dried mucus (protects
microorganisms) can be inhaled directly; can travel for less than 1 meter, more than
1 meter = airborne
● Vehicles - nonliving carrier of an infectious agent. Water, food (unsanitary cooking,
uncooked), air (do not grow in air, aerosole - fine solid particles suspended in air),
blood, body fluids.
● Vector - living organisms that transmit diseases to humans. Not necessarily human to
human but Insects, fleas, lice
○ Mechanical - when an insect may transmit pathogens passively using their
feet and other body parts
○ Biological - insects that transmit pathogens actively. Pathogens make the
insect their host that may cause infection, the insect is the carrier. Zoonosis
Disease cycle - Herd Immunity

● Life cycle of the disease

● Herd Immunity - also called group immunity

○ Proportion of individuals in the community who are immune to a particular
disease
○ When the percentage is very low, like 10% = immune. 90% = susceptible.
Faster mode of transmission
○ % Immune person increases = less likely to be susceptible. Lower chance for
transmission

Controlling Disease Transmission

● Isolation: a patient with a communicable disease is prevented from having contact
with the general population. Accomplished in a hospital in order to separate the
patient from the general population.
○ Strict - makes use of all available procedures
○ Contact
○ Respiratory
○ Tuberculosis
○ Enteric
○ Drainage
○ Blood and Body fluid
● Quarantine: the separation of ‘‘healthy’’ human or animal carriers from the general
population when they have been exposed to a communicable disease. Controlling
serious diseases
● Quarantine vs Isolation
○ Quarantine is applied to healthy individuals who are exposed during
incubation period. Pertains to limiting the movement of healthy people as a
precaution especially during treatment. Immunization program - proven to be
effective mean to control a communicable disease. Can greatly increase herd
immunity.
Nosocomial Infections
● Nosocomial Infection: an infection acquired in a hospital or other medical facility
● Source of Infection
○ Exogenous: caused by organisms that enter the patient from the environment
○ Endogenous: caused by opportunists among the patient’s own normal
microflora.
● Sites
○ Urinary Tract
○ Surgical Wounds
○ Respiratory Tract - hospital acquired pneumonia
○ Skin - burned patients
○ Blood
○ GIT - intubated
● Susceptibility and Transmission
○ Compromised Hosts: patients in hospitals are much more susceptible to
infection due to weakened immune system

Common Nosocomial Infections

● Catheterization - urinary, bed-ridden or undergone procedure

● Surgical - subcutaneous, cutaneous
● Low respiratory tract infections - pneumonia
Modes of Transmission of Nosocomial Infections

Prevention and Control of Nosocomial Infections

● Some Important Universal Precautions and Recommendations from CDC
○ Wear gloves and gowns if soiling of hands, exposed skin, or clothing with
blood or body fluids is likely.
○ Wear masks and protective eyewear or chin-length plastic face shields
whenever splashing or splattering of blood or body fluids is likely.
○ Wash hands before and after patient contact, and after removal of gloves.
Change gloves between each patient.
○ Use disposable mouthpiece/airway for cardiopulmonary resuscitation.
● Some Important Universal Precautions and Recommendations from CDC
○ Discard contaminated needles and other sharp items immediately into a
nearby, special puncture-proof container. Needles must not be bent, clipped,
or recapped.
○ Clean spills of blood or contaminated fluids by
■ Putting on gloves and any other barriers needed,
■ Wiping up with disposable towels,
■ Washing with soap and water, and
■ Disinfecting with a 1:10 solution of household bleach and water. Allow
it to stand on surface for at least 10 minutes. Bleach solution should
not have been prepared more than 24 hours beforehand.

Notifiable DIseases
● infectious diseases that are potentially harmful to the public’s health and must be
reported by physicians.
● Should be reported to DOH or government
● Objective:
○ to ensure that public health officials learn of diseases that jeopardize the
health of populations, and
○ to provide consistency and uniformity in the reporting of those diseases.
● Check list notifiable diseases in the Philippines, RA 11332