PATHOGENIC

MICROBIOLOGY

(STM 414)

THE CONCEPT OF INFECTION, PATHOGENECITY AND VIRULENCE

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Infection is the invasion of an organism's body tissues by disease-causing agents, their
multiplication and the reaction of host tissues to these organisms and the toxins they produce.
Infection is the multiplication of an infectious agent within the body. Multiplication of
pathogenic bacteria e.g. Salmonella typhi, even if the person is asymptomatic is taken as an
infection. Multiplication of bacteria of normal flora at their normal site is not an infection.
However, if they multiply and cause diseases, it becomes an infection e.g. Escherichia coli,
when it causes diarrhoea.
Infections are caused by infectious agents
including viruses, viroids, prions, bacteria, nematodes such as parasitic round worms and pin
worms, arthropods such as ticks, mites, fleas and lice, fungi such as ringworm fungus and
other macro-parasites such as tapeworms and other helminths.
The symptoms of an infection depend on the type of disease. Some symptoms of infection affect
the whole body generally, such as fatigue, loss of appetite, weight loss, fevers, night sweats,
chills, aches and pains. Others are specific to individual body parts, such as skin
rashes, coughing or a runny nose.
An infection is not synonymous with an infectious disease, as some infections do not cause
illness in a host. One way of proving that a given disease is infectious is to satisfy Koch's
postulates (first proposed by Robert Koch), which demands that the infectious agent be identified
only in patients and not in healthy controls and that patients who contract the agent also develop
the disease. Hosts can fight infections using their immune system. Mammalian hosts react to
infections with an innate response, often involving inflammation, followed by
an adaptive response. Specific medications or effective agents used to treat infections
include antibiotics, antivirals, antifungals, antiprotozoals and antihelminthics (chemotherapy).
Immuno-compromised patients are the main target of opportunistic infections. Immuno-
compromised patients are patients with weak or suppressed immunity. They include children
(mostly below 5 years) or neonates, the aged, pregnant or menstruating women, malnourished
patients and patients with pre-dispossessing factors e.g. an already existing disease (HIV,
diabetes, anaemia etc.), patients under chemotherapy or patients under steroids treatment.
Asymptomatic patients are patients or individuals that show no clinical symptoms i.e. perceptible
changes in their bodies as a result of invading infectious agents, pathogens, molecules or
particles.
Classification
Symptomatic infections are apparent and clinical, whereas an infection that is active but does not
produce noticeable symptoms may be called inapparent, silent or subclinical. An infection that is
inactive or dormant is called a latent infection. An example of a latent bacterial infection is latent
tuberculosis. Some viral infections can also be latent, examples of latent viral infections are any
of those from the Herpesviridae family.
A short-term infection is an acute infection. A long-term infection is a chronic infection.
Infections can be further classified by causative agent: bacterial, viral, fungal, parasitic and by
the presence or absence of systemic symptoms (sepsis).
A primary infection is an infection that is, or can practically be viewed as, the root cause of a
current health problem. In contrast, a secondary infection is a sequel or complication from a root

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cause. For example, pulmonary tuberculosis is often a primary infection but an infection that
happened only because a burn or penetrating trauma (the root cause) allowed unusual access to
deep tissues is a secondary infection. Primary pathogens often cause primary infection and also
often cause secondary infection. Usually opportunistic infections are viewed as secondary
infections because immunodeficiency or injury is the predisposing factor.
Types of pathogens
Primary pathogens
Primary pathogens cause disease as a result of their presence or activity within the normal,
healthy host. Many of the most common primary pathogens of humans only infect humans,
however, many serious diseases are caused by organisms acquired from the environment or that
infect non-human hosts.
Opportunistic pathogens
Opportunistic pathogens can cause an infectious disease in a host with depressed resistance
(immunodeficiency) or if they have unusual access to the inside of the body for example,
via trauma. An opportunistic disease requires impairment of host defenses, which may occur as a
result of genetic defects such as chronic granulomatous disease, exposure to antimicrobial drugs
or immunosuppressive chemicals as might occur following poisoning or cancer chemotherapy,
exposure to ionizing radiation or as a result of an infectious disease with immunosuppressive
activity such as with measles, malaria or HIV disease.

Prevention
Techniques like hand washing, wearing gowns and wearing face masks can help prevent
infections from being passed from one person to another. Aseptic technique was introduced in
medicine and surgery in the late 19th century and greatly reduced the incidence of infections
caused by surgery. Frequent hand washing remains the most important defense against the spread
of unwanted organisms. There are other forms of prevention such as avoiding the use of illicit
drugs, using a condom and having a healthy lifestyle with a balanced diet and regular exercise.
Cooking foods well and avoiding foods that have been left open for a long time is also important.
Antimicrobial substances used to prevent transmission of infections include;

 antiseptics, which are applied to living tissue/skin

 disinfectants, which destroy microorganisms found on non-living objects.
 prophylactic antibiotics, when given as prevention rather as treatment of infection.

However, long-term use of antibiotics leads to resistance and chances of

developing opportunistic infections such as Clostridium difficile (colitis). Thus, avoiding the use
of antibiotics longer than necessary helps to prevent such infectious diseases and so also
switching to alternative antibiotics in the case of resistance.
Tools for diagnosis of infectious diseases
Epidemiology
Epidemiology (study of spread of diseases) is an important tool used to study disease in a
population. For infectious diseases, it helps to determine if a disease outbreak is sporadic

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(occasional occurrence), endemic (regular cases often occurring in a region), epidemic (an
unusually high number of cases in a region) or pandemic (a global epidemic).
Microbial culture
In a microbial culture, a growth medium is provided for a specific agent. A sample taken from
potentially diseased tissue or fluid is then tested for the presence of an infectious agent and its
ability to grow on that medium. Most pathogenic bacteria are easily grown on nutrient agar.
Microbial culture may also be used in the identification of viruses: the medium in this case being
cells grown in culture that the virus can infect and then alter or kill. In the case of viral
identification, there would be a region of dead cells results from viral growth and it is called a
plaque. Eukaryotic parasites may also be grown in culture as a means of identifying a particular
agent.
Microscopy
Microscopic examination is for definitive identification of infectious agents. Microscopy may be
carried out with simple instruments such as the compound light microscope or with instruments
as complex as an electron microscope. Samples obtained from patients may be viewed directly
under the light microscope and can often rapidly lead to identification. Microscopy is often also
used in conjunction with biochemical staining techniques as almost all cells readily stain with a
number of basic dyes due to the electrostatic attraction between negatively charged cellular
molecules and the positive charge on the dye. A cell is normally transparent under a microscope,
and using a stain increases the contrast of a cell with its background. Microscopy can also be
made exquisitely specific when used in combination with antibody based techniques. For
example, the use of antibodies made artificially fluorescent (fluorescently labeled antibodies) can
be directed to bind to and identify a specific antigen present on a pathogen. A fluorescence
microscope is then used to detect fluorescently labeled antibodies bound to internalized antigens
within clinical samples or cultured cells. This technique is especially useful in the diagnosis of
viral diseases, where the light microscope is incapable of identifying a virus directly.
Biochemical tests
Biochemical tests used in the identification of infectious agents include the detection
of metabolic or enzymatic products characteristic of a particular infectious agent. Since bacteria
ferment carbohydrates in patterns characteristic of their genus and species, the detection
of fermentation products is commonly used in bacterial identification. Acids,
alcohols and gases are usually detected in these tests when bacteria are grown in selective liquid
or solid media.
The isolation of enzymes from infected tissue can also provide the basis of a biochemical
diagnosis of an infectious disease. For example, humans can make neither RNA
replicases nor reverse transcriptase and the presence of these enzymes are characteristic of
specific types of viral infections.
Molecular diagnostics
An infectious agent must grow within the human body to cause disease; essentially it must
amplify its own nucleic acids in order to cause a disease. This amplification of nucleic acid in
infected tissue offers an opportunity to detect the infectious agent by using PCR (polymerase
chain reaction). Polymerase chain reaction is a technique used in molecular biology to amplify a
single copy or a few copies of a piece of DNA across several orders of magnitude, generating
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thousands to millions of copies of a particular DNA sequence. It is an easy and cheap tool
to amplify a focused segment of DNA, useful for such purposes as
the diagnosis and monitoring of genetic diseases, identification of criminals (in the field of
forensics), and studying the function of a targeted segment of DNA. The only blockades to the
use of PCR as a standard tool of diagnosis are in its cost and application, neither of which is
insurmountable.

Pathogenicity
Pathogenicity is the potential disease-causing capacity of pathogens. Pathogenicity is related
to virulence in meaning but some authorities have come to distinguish it as a qualitative term,
whereas the latter is quantitative. Pathogenesis refers both to the mechanism of infection and to
the mechanism by which disease develops. A pathogen may be described in terms of its ability to
produce toxins, enter tissues, colonize, hijack nutrients and also show the ability to immuno-
suppress the host.

Virulence
Virulence is the measure of the pathogenicity of an organism. The degree of virulence is related
directly to the ability of the organism to cause disease despite host resistance mechanisms; it is
affected by numerous variables such as the number of infecting pathogens, route of entry into the
body, specific and nonspecific host defense mechanisms and virulence factors of the pathogen.
Virulence can be measured experimentally by determining the number of bacteria required to
cause animal death, illness or lesions in a defined period after the bacteria are administered by a
designated route.
Virulence factors
Virulence factors refer to the properties i.e. gene products that enable a microorganism to
establish itself on or within a host of a particular species and enhance its potential to cause
disease. Virulence factors include bacterial toxins, cell surface proteins that mediate bacterial
attachment, cell surface carbohydrates and proteins (proteases) that protect a bacterium and
hydrolytic enzymes (haemolysins) that may contribute to the pathogenicity of a bacterium.
Therefore, virulence factors help bacteria to invade the host, cause disease and evade host
defenses.
Virulence factors are molecules produced by pathogens (bacteria, viruses, fungi and protozoans)
that contribute to the pathogenicity of the organisms and enable them to achieve the following;

 colonization of a niche in the host (this includes attachment to cells)

 immune-evasion by evasion of the host's immune response
 immuno-suppression by inhibition of the host's immune response
 entry into and exit out of cells (if the pathogen is an intracellular one)
 obtaining nutrition from the host

The aforementioned factors are used to assist and promote colonization of the host and they are
referred to as adhesins, invasins and antiphagocytic factors.

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The following are types of virulence factors;
Adherence factors: Many pathogenic bacteria colonize mucosal sites by using pili (fimbriae) to
adhere to cells.
Invasion factors: Surface components that allow the pathogens to invade host cells can be
encoded on plasmids, but more often are on the chromosome.
Capsules: Many bacteria are surrounded by capsules that protect them from opsonization and
phagocytosis.
Endotoxins: Endotoxin is a component (lipopolysaccharide) of the cell wall of Gram-negative
bacteria and it is toxic. Endotoxins trigger intense inflammation, cause fever, changes in blood
pressure, lethal shock and many other toxic events. Endotoxins are non-immunogenic and
therefore do not have an acquired immune response.
Exotoxins: Exotoxins are actively secreted by many bacteria and have a wide range of effects
including inhibition of certain biochemical pathways in the host. The two most potent known
exotoxins are the tetanus toxin (tetanospasmin) secreted by Clostridium tetani and the botulinum
toxin secreted by Clostridium botulinum. Major categories include cytotoxins, neurotoxins and
enterotoxins. Exotoxins are extremely immunogenic meaning that they trigger the humoral
response (antibodies can target the toxins).
Exotoxins are also produced by some fungi as a competitive resource. The toxins,
named mycotoxins, deter other organisms from consuming the food colonised by the fungi. As
with bacterial toxins, there is a wide array of fungal toxins. Arguably one of the more dangerous
mycotoxins is aflatoxin produced by certain species of the genus Aspergillus, notably, A. flavus.
If ingested repeatedly, this toxin can cause serious liver damage.
Siderophores: Siderophores are iron-binding factors that allow some bacteria to compete with the
host for iron, which is bound to hemoglobin, transferrin and lactoferrin.

Virulence factors in viruses

Generally, the virulence of pathogenic bacteria is directly related to the ability of the organism to
produce one or more toxins. However, the virulence of viruses is not well defined. A number of
factors contribute to the virulence (pathogenicity) of a particular strain of virus. They include;
 Ability to enter the host’s cell
 Ability to grow within the cell
 Ability to combat host’s defense mechanisms
 Ability to produce temporary or permanent damage in the host via: Cell lysis, production
of toxic substances, cell transformation, induction of formation of substances which are
not specified by the viral genome but are apparently cellular products normally not
produced by the cell, induction of structural alterations in the host’s cell which may be
nuclear (including chromosomal) or cytoplasmic.

Some viruses enter host’s tissues directly by trauma or insect bite but most infections start on the
mucous membranes of the respiratory and alimentary tracts. To initiate infection, virus particles
must first survive on these mucous-covered membranes in the presence of viral and non-viral

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commensals. Subsequently, to replicate, the virus must enter host’s cells either in the mucous
membrane itself or in tissues after penetration through the surface membrane.

Comparison between bacterial and viral virulence

Bacterial virulence Viral virulence

Adhesion Adhesion (viral spikes)

Extracellular enzymes: Host evasion
Hyaluronidase
Coagulase
Toxins: Latency
Exotoxins
Endotoxins
Anti-phagocytic factors High mutability

General concepts

Host susceptibility
Susceptibility to some infections is higher in the very young and the very old and in immune-
suppressed patients.

Bacterial infectivity
Bacterial infectivity results from a disturbance in the balance between bacterial virulence and
host resistance. The “objective” of bacteria is to multiply rather than to cause disease; it is in the
best interest of the bacteria not to kill the host.

Host resistance
Resistance to bacterial infections is enhanced by phagocytic cells and an intact immune system.
Initial resistance is due to non-specific mechanisms. Specific immunity develops over time.
Bacteria invading tissues encounter phagocytic cells that recognize them as foreign, and through
a complex signaling mechanism involving interleukins, eicosanoids and complement, mediate an
inflammatory response in which many lymphoid cells participate.

Host-mediated pathogenesis
In certain infections e.g. tuberculosis, tissue damage results from the toxic mediators released by
lymphoid cells rather than from bacterial toxins.

Intracellular growth

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Some bacteria e.g. Rickettsia sp. can grow only within eukaryotic cells, whereas others
e.g. Salmonella sp. invade cells but do not require them for growth. Most pathogenic bacteria
multiply in tissue fluids and not in host cells.

Methods for test for virulence

Polymerase chain reaction

PCR allows for rapid and highly specific diagnosis of infectious diseases, including those caused
by bacteria or viruses. PCR also permits identification of non-cultivatable or slow-growing
microorganisms such as mycobacteria, anaerobic bacteria or viruses from tissue culture assays
and animal models. The basis for PCR diagnostic applications in microbiology is the detection of
infectious agents and the discrimination of non-pathogenic from pathogenic strains by virtue of
specific genes.
Characterization and detection of infectious disease organisms have been revolutionized by PCR
in the follow ways;

 The human immunodeficiency virus (or HIV), is a difficult target to find and eradicate. The
earliest tests for infection relied on the presence of antibodies to the virus circulating in the
bloodstream; however, antibodies don't appear until many weeks after infection.
PCR tests have been developed that can detect as little as one viral genome among the DNA
of over 50,000 host cells. The high sensitivity of PCR permits virus detection soon after
infection and even before the onset of disease.
 Some disease organisms, such as that for tuberculosis, are difficult to sample from patients
and slow to be grown in the laboratory. PCR-based tests have allowed detection of small
numbers of disease organisms (either live or dead), in convenient samples.

Immuno-diffusion assay

This is a technique to study antigen-antibodies reactions by observing precipitates formed by

antigen-antibody complexes, which are combinations of specific antigens and antibodies
separately placed in a gel and diffused. It is a technique involving diffusion of antigen or
antibody through a semi-solid medium, usually an agar or agarose gel, resulting in a precipitin
reaction. This technique is important for the identification and quantification of any of the
immunoglobulins. Its principle is based on the presence of a visible precipitate that results from
an antigen-antibody combination under certain circumstances. In electroimmuno-diffusion, an
electric field is applied to accelerate the reaction.

Parasitic infections
A parasite is a living organism (bacteria, viruses, fungi, protozoans, helminths) that lives in
another organism, and receives shelter and nourishment. However, in medical science,
parasitology traditionally deals with animal parasites which are typically protozoa and helminths.
In the field of medical parasitology, the term parasite has come to mean a eukaryotic, pathogenic
organism. Thus, protozoan and metazoan/macro infectious agents (round and flat worms) are
usually classified as parasites (endoparasites), while bacteria and viruses are not. Some of the
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parasitic protozoa are powerful agents of human diseases, such as members of the
genera Plasmodium and Trypanosoma. A parasite has to break through the different layers of
defense mechanisms of the host in order to localize and thrive on the host, therefore, a parasite
must be equipped with specialized mechanisms. In parasitism, there is always exploitation and
harm. However, such an association has been continuing, and there are no known cases of
species extinction traced to parasitism. Ectoparasites include arachnids such as mites (scabies)
and ticks. Ivemectin is a typical antiparasitic agent against endoparasites and ectoparasites.
Classes of parasites
Ectoparasites: They are parasites that occur on the body surface of a host, they have elaborate
mechanisms and strategies for finding hosts e.g. leeches, ticks, lice and mites. Some aquatic
leeches, for example, locate hosts by sensing movement and then confirm their identity through
skin temperature and chemical cues before attaching.

Endoparasites: They are parasites that live inside the body of a host, many of them invade hosts
through entrance of tissues as well as through consumption of raw food, such as hookworms and
Ascaris lumbricoides found in human intestines.
Epiparasites: These are parasites that feed on other parasites. A parasite that is being parasitized
by another organism is called a secondary parasite, especially in the insect world.
Macroparasites: These are multicellular parasites that are visible to a naked human eye, such as
helminth parasites.
Microparasites: These are minute and generally unicellular parasites that are invisible to a naked
human eye, such as protozoan parasites.
Mesoparasites: These are parasites that usually penetrate external openings such as buccal cavity,
cloaca, external ear etc.
Necrotrophs: These are parasites that use another organism’s tissues for their own nutritional
benefit until the host dies from loss of needed tissues or nutrients. Necrotrophs are also called
parasitoids e.g. Bacillus anthracis.
Biotrophs: These are parasites that can not survive in dead hosts and therefore keep their hosts
alive. Many viruses are biotrophic because they use the host’s genetic and cellular processes to
multiply.
Facultative parasites: These are parasites that can survive without the parasitic mode of life but
can adapt to it if placed in such a situation, they are opportunistic e.g. the parasitic nematode
Strongyloides stercoralis can also be free living.
Obligate parasites: The majorities of parasites are obligatory and are totally dependent on their
hosts for food, shelter and or protection i.e. they cannot survive without their hosts.
Monogenic parasites: These are parasites that complete their whole life cycles in one host e.g.
Entamoeba histolytica on a human host.

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Digenic parasites: These are parasites that require both a primary and secondary hosts (two
hosts) to complete their entire life cycles e.g. Plasmodium vivax completes its asexual part of its
life cycle in people and the sexual part in a female Anopheles mosquito.

Classes of hosts
A host is the harbouring or recipient organism of a parasite. They fall into three groups or
classes;

Definitive host: A definitive host is usually the main host. In this host, the adult stage of animal
parasites live and sexual reproduction takes place to complete their life cycles. Man is the
definitive host for all animal parasites except malarial parasites and tapeworms.
Intermediate host: This is usually a secondary host and it is needed for transmission to a
definitive host. In this host, asexual reproduction takes place or the larval stages of animal
parasites develop. When development of larval stage takes place in two different hosts, they are
called first and second intermediate hosts. Man is the intermediate host for malarial parasites and
tapeworm. Man is both definitive and intermediate host for Taenia solium and Trichinella
spiralis. A vector is usually an intermediate host by playing an active role in the transmission of
parasites.
Paratenic host: This is a carrier or transport host that receives a parasite in the position of an
intermediate host so that the parasite is helped to get to the definitive host.
Normal flora (Commensals)
These are microorganisms that are present on the skin and mucous membrane of normal
(healthy) persons. One particular microorganism of the normal flora may be a non-pathogen or
an opportunistic pathogen. Normal flora is of two types;
 Resident flora: These are microorganisms regularly present in the region at a given age
e.g. Viridans streptococcus in mouth and throat, Escherichia coli in intestine
 Transient flora: The microorganism is present only for hours to weeks e.g. Streptococcus
pyogenes in throat. Microorganisms of transient flora play no role when the normal
resident flora remains intact but if the resident flora is disturbed, then the microorganisms
of transient flora may colonize and produce diseases.
Beneficial functions of normal flora:
 In the mouth, an invading pathogen may fail to compete for nutrients and receptor sites
with normal flora
 Some bacteria of the bowel produce antimicrobial substances
 In new born, bacteria acts as a powerful stimulus for the development of immune system
 Bacteria of the gut can produce vitamin K.
Harmful effects of normal flora:
Clinical diseases by opportunist pathogens of normal flora arise under;

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  When the organism leaves the normal site and localizes to another site e.g. Escherichia
coli in the urinary tract from gut
 Competitive advantage due to antibiotic therapy e.g. colitis by Clostridium difficile
 In immune-compromised individuals.
Mechanism of infection
An infection involves the following: Source or reservoir of infectious agent, transmission of the
infectious agent from the source to a susceptible host and portal or route of entry of the agent
into the host, its localization, multiplication and finally host-parasite interactions which result in
either destruction of the agent or the manifestation of an infectious disease.

Sources or reservoirs of infections

Human reservoir
Many common infectious diseases have human reservoirs. Diseases that are transmitted from
person to person without intermediaries include the sexually transmitted diseases, measles,
mumps, streptococcal infection and many respiratory pathogens. Because humans were the only
reservoir for the smallpox virus, naturally occurring smallpox was eradicated after the last human
case was identified and isolated.

Foods and Drinks reservoirs

These include any contaminated food, water contaminated with bacteria of typhoid fever,
cholera, diarrhoea and dysentery, milk contaminated with Salmonella or M. bovis.

Animal reservoir
Zoonoses are diseases which are transmitted from infected animals to humans. These include:
Cow (Bovine tuberculosis, brucellosis by Brucella abortus, Salmonella food poisoning, anthrax,
Taenia saginata), Fowl (Salmonella food poisoning by eggs and meat), Dog (Rabies, Weil's
disease), Horse (Tetanus), Goat (Anthrax and brucellosis by B. melitensis), Sheep (Anthrax and
tetanus), Cat (Cat scratch disease), Rat (Plaque, Weil's disease).

Environmental reservoir
Plants, soil and water in the environment are also reservoirs for some infectious agents. Many
fungal agents, such as those that cause histoplasmosis, live and multiply in the soil, so also
bacteria that cause tetanus and gas gangrene.
Transmission
An infectious agent may be transmitted from its natural reservoir to a susceptible host in
different ways;
 Direct:
o Direct contact
o Droplet spread
 Indirect:

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 o Air-borne
o Vehicle-borne (mechanical as in fomite-borne or biological as in vector-borne)
In direct transmission, an infectious agent is transferred from a reservoir to a susceptible host
by direct contact or droplet spread.
Direct contact occurs through skin-to-skin contact, kissing and sexual intercourse. Direct
contact also refers to contact with soil or vegetation harboring infectious organisms. Thus,
infectious mononucleosis (“kissing disease”) and gonorrhea are spread from person to person by
direct contact. Hookworm is spread by direct contact with contaminated soil.
Droplet spread refers to spray with relatively large, short-range aerosols produced by sneezing,
coughing, or even talking. Droplet spread is classified as direct because transmission is by direct
spray over a few feet, before the droplets fall to the ground. Pertussis and meningococcal
infection are examples of diseases transmitted from an infectious patient to a susceptible host by
droplet spread.
Indirect transmission refers to the transfer of an infectious agent from a reservoir to a host by
suspended air particles, inanimate objects (vehicles/fomites) or animate intermediaries (vectors).
Airborne transmission occurs when infectious agents are carried by dust or droplet nuclei
suspended in air. Airborne dust includes material that has settled on surfaces and become re-
suspended by air currents as well as infectious particles blown from the soil by the wind. Droplet
nuclei are dried residue of less than 5 microns in size. In contrast to droplets that fall to the
ground within a few feet, droplet nuclei may remain suspended in the air for long periods of time
and may be blown over great distances. Measles, for example, has occurred in children who
came into a physician's office after a child with measles had left, because the measles virus
remained suspended in the air.
Vehicles that may indirectly transmit an infectious agent include food, water, biologic products
(blood) and fomites (inanimate objects such as handkerchiefs, bedding or surgical scalpels). A
vehicle may passively carry a pathogen — as food or water may carry hepatitis A virus.
Alternatively, a vehicle may actively provide an environment in which an agent grows,
multiplies or produces toxin — as improperly canned foods provide an environment that
supports production of botulinum toxin by Clostridium botulinum.
Portal of entry/exit
The portal of entry/exit refers to the manner in which a pathogen enters or leaves a susceptible
host. The portal of entry must provide access to tissues in which pathogens can multiply or
toxins can act. Often, infectious agents use the same portal to enter a new host that they used to
exit the source host. For example, influenza virus exits the respiratory tract of the source host and
enters the respiratory tract of a new host. In contrast, many pathogens that cause gastroenteritis
follow a so-called “feacal-oral” route because they exit the source host in feaces, are carried on
inadequately washed hands to a vehicle such as food, water or utensil and enter a new host
through the mouth. Other portals of entry include the skin (hookworm), mouth, mucous
membranes (syphilis) and blood (hepatitis B, human immunodeficiency virus by blood
transfusion). Portals of exist of pathogens are respiratory tract of the source host (sneezing),
mouth (coughing), anus, urinary organ and blood (haemorrhage).

PATHOGENIC ORGANISMS
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A pathogenic organism is a bacterium, fungus, protozoan, prion or virus that survives by feeding
off on a host, and typically causes disease in the host organism. The host may be an animal,
a plant, a fungus or even another micro-organism, as in a bacteriophage.

Not all pathogens are necessarily undesirable to humans. In entomology, pathogens are one of
the "three P's" (predators, pathogens and parasitoids) that serves as natural or
introduced biological controls to suppress arthropod pest populations.

Types of pathogens

A) Sub-cellular infectious objects

Prions

According to the prion theory, prions are infectious pathogens that do not contain nucleic acids.
These abnormally folded proteins are found characteristically in some diseases such
as scrapie, bovine spongiform encephalopathy (mad cow disease) and Creutzfeldt–Jakob
disease. Although, prions fail to meet the requirements laid out by Koch's postulates,
nevertheless, they are still significantly pathogenic.

Viruses

Pathogenic viruses are diseases mainly those of the families of;

Adenoviridae, Picornaviridae, Herpesviridae, Hepadnaviridae,Flaviviridae, Retroviridae, Orthom
yxoviridae, Paramyxoviridae, Papovaviridae, Polyomavirus, Rhabdoviridae, Togaviridae etc.
Viruses typically range between 20 and 300 nanometers in length. They are sub-cellular
infectious molecules.

B) Prokaryotes

Bacteria

Although, the vast majority of bacteria are harmless or beneficial, a few pathogenic bacteria can
cause infectious diseases. Bacteria can often be killed by antibiotics because the cell walls on the
outside are destroyed, expelling the DNA out of the bodies of the pathogens, therefore making
the pathogens incapable of producing proteins and they die. They typically range between 1 and
5 micrometers in length.

C) Eukaryotes

Fungi

Fungi comprise a eukaryotic kingdom of microbes that are usually saprophytes (consume dead
organisms) but can cause diseases in humans, animals and plants. Fungi are the most common
cause of diseases in crops and other plants. The typical fungal spore size is 1-40 micrometers in
length.

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Other parasites

Some eukaryotic organisms, such as protists and helminths, also cause diseases such as
giardiasis, amoebic dysentery, filariasis and other various worm infections.

Treatment and health care

Bacteria are usually treated with antibiotics while viruses are treated with antiviral compounds.
Eukaryotic pathogens are typically not susceptible to antibiotics and thus need specific drugs.
Infections from many pathogens can be prevented by immunization. A small amount of viral
pathogens are used in viral vaccines to make immunity stay alert and strengthen defense on the
insides of mammals to prepare them for a larger quantity of the viruses ever getting
inside. Hygiene is critical for the prevention of infection by pathogens.

Although, most bacteria do not cause disease in humans, people with suppressed immune
systems like pregnant women, old/aged people and children below five years of age are more
susceptible to opportunistic pathogens that often thrive in the warm, moist environments of the
human body. Opportunistic pathogens are disease-causing organisms that may be part of a host’s
normal micro-biota or occasionally from the environment, which cause diseases when the host is
immuno-compromised or when they have gained access to other tissue sites where they do not
normally occupy e.g. E. coli, Klebsiella pneumoniae, Pseudomonas aeruginosa etc. The body's
natural responses to invading pathogenic organisms include a rise in body temperature. Many of
the natural responses inhibit the ability of these organisms to live and reproduce. To survive
when confronted by antibiotics, some strains of bacteria have evolved and developed the ability
to resist the most commonly prescribed forms of medication used to rid the body of these
pathogens.

Transmission

Transmission of pathogens occurs through many different routes, including airborne, direct or
indirect contact, sexual contact, through blood, breast milk or other body fluids, and also,
through the fecal-oral route. They are classified as either direct or indirect transmission. They
could also be categorized as air-borne transmission, sexual contact transmission, body fluids
transmission, insect-vector transmission, fomites transmission or faecal-oral transmission
(food/water).

Zoonoses
A zoonosis or zoonose is any infectious disease that can be transmitted (in some instances, by a
vector) from non-human animals, both wild and domestic, to humans or from humans to non-
human animals (the latter is sometimes called reverse zoonosis). Many serious diseases fall
under this category.

The simplest definition of a zoonosis is a disease that can be transmitted from other vertebrate
animals to humans. A slightly more technical definition is a disease that normally infects other

14
animals but can also infect humans. The reverse situation (transmission from human to animal) is
known as anthroponosis.

Common zoonotic diseases and some corresponding activities about them

Mode of
Disease Pathogen Animals involved
transmission
chimpanzees, gorillas, fruit
Haemorrhagic fever- through body
Ebola virus bats, monkeys, forest antelope
Ebola virus disease fluids, organs
and porcupines
commonly - dogs, bats, through saliva by
monkeys, raccoons, foxes, biting, or through
Rabies Rabies virus
skunks, cattle, wolves, coyotes, scratches from an
mongooses and cats infected animal
commonly - grazing herbivores by ingestion,
Anthrax Bacillus anthracis such as cattle, sheep, goats, inhalation or skin
camels, horses, and pigs contact of spores
horses, pigs, domestic and wild
droplets
birds, wild aquatic mammals
Influenza Influenza virus transmitted
such as seals and whales,
through air
minks and farmed carnivores.
direct or indirect
Bacteria - Leptospir
Leptospirosis rats, mice, dogs, contact with urine
a interrogans
of infected animals
Prionic diseases- through eating
Bovine spongiform meat or bone meal
Prions cattle
encephalopathy made from
(BSE) infected animals
infected milk or
Brucellosis Brucella sp. cattle, goats
meat
Bacteria
(Campylobacter,
Food-borne illnesses,
Escheria coli, animals domesticated for food food made from
commonly diarrheal
Salmonella, Shigella production (cattle, poultry) infected animals
diseases
species
and Trichinella)
Haemorrhagic fevers-
Marburg viral
varies (sometimes unknown), infection usually
haemorrhagic
Varies, - commonly, commonly- camels, hares, occurs through
fever, Lassa
viruses hedgehogs, cattle, sheep, goats, direct contact with
fever, Crimean-Congo
horses and swine infected animals
haemorrhagic fever
(CCHF)
Bovine tuberculosis Mycobacterium infected cattle, deer, llamas, milk, exhaled air,

15
 pigs, domestic cats, wild sputum, urine,
carnivores (foxes, coyotes) and faeces and pus
bovis
omnivores (possums, mustelids from infected
and rodents) animals
eating water or
food contaminated
with the tapeworm
eggs
(cysticercosis) or
Cysticercosis & Taeni Tapeworms - Taenia raw or
commonly – pigs
asis solium undercooked pork
meat contaminated
with cysticerci
(taeniasis), the
larval form of the
tapeworm
eating organs
Tapeworms -
commonly - dogs, foxes, contaminated with
Echinococcosis Echinococcus
wolves, sheep and rodents the cysts of the
(genus)
worm
African sleeping Protozoa - Trypanos
range of wild animals and transmitted by the
sickness oma brucei
domestic livestock bite of tsetse fly
(rhodesian/zoonotic) rhodesiense

Prevention of zoonotic diseases

Anyone who has contact with animals can get a zoonotic disease, but people may be more at risk
than others. These include people with a weakened immune system, children age 5, the elderly,
and pregnant women. Prevention includes;

 Be aware of zoonotic diseases and your potential for infection

 Wash hands thoroughly and frequently
 Avoid direct contact with certain animals and their environment
 Closely supervise children to ensure they wash their hands properly and avoid hand–to–
mouth activities (thumb–sucking, eating, and use of pacifiers) after animal contact
 Use EPA–registered insect repellents that contain 20% or more DEET (N, N–diethyl–m–
toluamide) on the exposed skin for protection that lasts up to several hours
 Use products that contain repellents (such as permethrin) on clothing. Treat clothing and
gear, such as boots, pants, socks and tents
 Look for and remove ticks from your body. Parents should check their children for ticks
 Limit the number of places around your home for mosquitoes to breed by getting rid of
items that hold water.

Plant pathology

16
 Plant pathology (a.k.a. phytopathology) is the scientific study of diseases in plants caused
by pathogens (infectious organisms) and environmental conditions (physiological factors). Plant
pathology also involves the study of pathogen identification, disease etiology, disease cycles,
economic impact, plant disease epidemiology, plant disease resistance, how plant diseases affect
humans and animals and management of plant diseases.

Signs and symptoms of plant disease

Most plant diseases (around 85 percent) are caused by fungi or fungi-like organisms. However,
other serious diseases of food and feed crops are caused by viral and bacterial organisms. Certain
nematodes also cause plant disease. Some plant diseases are classified as “abiotic,” or diseases
that are non-infectious and include damage from air pollution, nutritional deficiencies or
toxicities, and growth under less than optimal conditions.
A sign of a plant disease is a physical evidence of the pathogen. For example, fungal fruiting
bodies are a sign of a disease while powdery mildew on a lilac leaf is actually the parasitic fungal
disease organism itself (Microsphaera alni). Bacterial canker of stone fruits causes gummosis, a
bacterial exudate emerging from the cankers. The thick, liquid exudate is primarily composed of
bacteria and is a sign of the disease, although the canker itself is composed of plant tissue and is
a symptom.
A symptom of plant disease is a visible effect of disease on the plant. Symptoms may include a
detectable change in color, shape or function of the plant as it responds to the pathogen. Leaf
wilting is a typical symptom of verticilium wilt, caused by the fungal plant
pathogens Verticillium albo-atrum and V. dahliae. Common bacterial blight symptoms include
brown, necrotic lesions surrounded by a bright yellow halo at the leaf margin or interior of the
leaf on bean plants.
Here are a few examples of common signs and symptoms of fungal, bacterial and viral plant
diseases.

Fungal disease signs;

 Leaf rust (common leaf rust in corn)
 Stem rust (wheat stem rust)
 Sclerotinia (white mold)
 Powdery mildew

Fungal disease symptoms;

 Birds-eye spot on berries (anthracnose)
 Damping off of seedlings (phytophthora)
 Leaf spot (septoria brown spot)
 Chlorosis (yellowing of leaves)

Bacterial disease signs: difficult to observe but can include;

 Bacterial ooze
 Water-soaked lesions
 Bacterial streaming in water from a cut stem

Bacterial disease symptoms;

17
 Leaf spot with yellow halo
 Fruit spot
 Canker
 Crown gall
 Sheperd’s crook stem ends on woody plants

Viral disease signs;

 None – the viruses themselves can’t be readily seen

Viral disease symptoms;

 Mosaic leaf pattern
 Crinkled leaves
 Yellowed leaves
 Plant stunting

Animal pathology
Animal pathogens are disease-causing agents of wild and domestic animal species, at times, they
also affect humans. They include:

Animal Viruses

These include;

Foot-and-mouth disease virus

This picornavirus is the etiological agent of an acute systemic vesicular disease that affects cattle
worldwide. FMDV is a highly variable and transmissible virus.

Paramyxo virus

Paramyxo viruses are a diverse family of non-segmented negative strand RNA viruses that
include many highly pathogenic viruses affecting humans, animals, and birds. Some paramy-
xoviruses such as the henipa viruses are zoonotic pathogens, occurring naturally in an animal
host but also able to infect humans.

Avian influenza

Wild aquatic birds are the natural hosts for a large variety of influenza A (avian) viruses.
Occasionally viruses are transmitted from this reservoir to other species and may then cause
devastating outbreaks in domestic poultry or give rise to human influenza pandemics, by directly
affecting humans.

18
Blue tongue virus

Blue tongue virus (BTV), a member of Orbivirus genus within the Reoviridae family causes
serious disease in livestock (sheep, goat, cattle).

Herpes virus

Herpes viruses are highly successful pathogens infecting animals and man. Although, there are a
wide variety of different herpes viruses with different biological characteristics, they have in
common basic properties such as morphology of the virion, highly regulated transcription and
establishment of latency.

African swine fever virus

The virus causes a haemorrhagic fever with high mortality rates in pigs, but persistently infects
its natural hosts, warthogs, bush pigs and soft ticks of the Ornithodoros species with no disease
signs.

Animal fungi

These include;

Dermatophytes

These fungi are ascomycetes which cause infection on or just under the skin. The most important
are the Trichophyton fungi which cause such infections as ringworm and athlete’s foot. These
fungi are biotrophic in the sense that they tend not to kill their hosts.

Aspergillosis

Most Aspergillus species are harmless; however, three species, A. niger, A. flavus and A.
fumigatus produce large numbers of conidia which can cause infection (Aspergillosis).

Cryptococcosis

The agent responsible for this disease, Cryptococcus neoformans or Filobasidiella neoformans,
is a haploid-dimorphic yeast in the phylum Basidiomycota and causes a flu-like illness in healthy
adults.

Candidiasis

Dimorphic yeasts in the family Candida, particularly Candida albicans, are organisms which
live on our skin, our mucous membranes, and our lower digestive tract, rarely bothering us.
However, if Candida proliferates, it can cause irritation, and in extreme cases death.

Coccoidomycosis

19
The agent of this disease is a dimorphic yeast; Coccoides immitis. People unfortunate enough to
develop the severe form of the disease usually develop pneumonia, which may spread to other
tissues, and cause damage to bones, connective tissue and major organs.

Animal bacteria
They include Bacillus anthracis (Anthrax), Leptospira sp. (Leptospirosis), Anaplasma marginale
(Anaplasmosis), Francisella tularensis (Tularemia), Borrelia recurrentis (Relapsing fever) and
Mycobacterium bovis (Bovine tuberculosis).
Human pathology

A human pathogen is a pathogen; microbe or microorganism such as a virus, bacterium, prion,

or fungus, that causes diseases in humans.

Viral

Pathogenic viruses are mainly those of the families

of: Adenoviridae, Picornaviridae, Herpesviridae, Hepadnaviridae,Flaviviridae, Retroviridae, Orth
omyxoviridae, Paramyxoviridae, Papovaviridae, Polyomavirus, Rhabdoviridae and Togaviridae.
Some notable pathogenic viruses cause smallpox, influenza, mumps, measles, chickenpox, ebola,
and rubella.

Bacterial

Although the vast majority of bacteria are harmless or beneficial to one’s body, a few pathogenic
bacteria can cause infectious diseases. The most common bacterial disease is tuberculosis,
caused by the bacterium Mycobacterium tuberculosis, which affects just about 2 million people
mostly in sub-Saharan Africa. Pathogenic bacteria contribute to other globally important
diseases, such as pneumonia, which can be caused by bacteria such
as Streptococcus and Pseudomonas and food-borne illnesses, which can be caused by bacteria
such as Shigella, Campylobacter and Salmonella. Pathogenic bacteria also cause infections such
as staphylococcal infections, tetanus, typhoid fever, diphtheria, syphilis and gonorrhoea.

Fungal

Fungi comprise a eukaryotic kingdom of microbes that are usually saprophytes but can cause
diseases in humans. Life-threatening fungal infections in humans most often occur in immuno-
compromised patients or vulnerable people with a weakened immune system, although fungi are
common problems in the immuno-competent population as the causative agents of skin, nail or
yeast infections. Most antibiotics that function on bacterial pathogens cannot be used to treat
fungal infections because fungi and their hosts both have eukaryotic cells. Some common fungal
pathogens include Candida, Aspergillus, Cryptococcus, Histoplasma and Pneumocystis.

Other parasites

20
Some eukaryotic organisms, such as protozoans and helminths, cause disease. One of the best
known diseases caused by a protozoan in the genus Plasmodium is malaria.

Prionic

Prions are infectious pathogens that do not contain nucleic acids. Prions are abnormal proteins
whose presence causes some diseases such as scrapie, bovine spongiform encephalopathy (mad
cow disease) and Creutzfeldt–Jakob disease.

COMMON PATHOGENIC INFECTIONS

Bacterial infections

1. Gastroenteritis

21
Gastroenteritis or infectious diarrhea is a medical condition from the inflammation of
the gastrointestinal tract that involves both the stomach (gastro) and the small intestine (entero).
It causes some combination of diarrhoea, vomiting, abdominal pain and cramping. Dehydration
may occur as a result. Although, unrelated to influenza, it has also been called stomach
flu or gastric flu.

The key treatment is enough fluids. For mild or moderate cases, this can typically be achieved
via oral rehydration solution (a combination of water, salts, and sugar). In those who are breast
fed, continued breast feeding is recommended. For more severe cases, intravenous fluids from a
healthcare centre may be needed. Antibiotics are generally not recommended. Gastroenteritis
primarily affects children and those in the developing world.

Cause

Viruses (particularly rotavirus), the bacteria Escherichia coli and Campylobacter species are the
primary causes of gastroenteritis. There are, however, many other infectious agents that can
cause this syndrome. Risk of infection is higher in children due to their lack of immunity and
relatively poor hygiene.

A number of protozoans can cause gastroenteritis – most commonly Giardia

lamblia, but Entamoeba histolytica and Cryptosporidium species have also been implicated.

Transmission

Transmission may occur via consumption of contaminated water or when people share personal
objects. In places with wet and dry seasons, water quality typically worsens during the wet
season and this correlates with the time of outbreaks.

Diagnosis

Gastroenteritis is typically diagnosed clinically, based on a person's signs and symptoms.

However, stool cultures should be performed in those with blood in the stool, those who might
have been exposed to food poisoning and those who have recently traveled to the developing
world.

Prevention

A supply of easily accessible uncontaminated water and good sanitation practices are important
for reducing rates of infection and clinically significant gastroenteritis. Personal measures, such
as hand washing with soap, have been found to decrease incidence and prevalence rates of
gastroenteritis in both the developing and developed world by as much as 30%. Alcohol-based
gels may also be effective. Breastfeeding is important, especially in places with poor hygiene, as
is improvement of hygiene generally. Breast milk reduces both the frequency of infections and
their duration. Avoiding contaminated food or drink should also be highly practised.

Treatment

22
Gastroenteritis is usually an acute and self-limiting disease that does not require medication. The
preferred treatment in those with mild to moderate dehydration is oral rehydration therapy (ORT)

2. Urinary tract infection

A urinary tract infection (UTI) (also known as acute cystitis or bladder infection) is
an infection that affects part of the urinary tract. When it affects the lower urinary tract it is
known as a simple cystitis (a bladder infection) and when it affects the upper urinary tract it is
known as pyelonephritis (a kidney infection). Symptoms from a lower urinary tract include
painful urination and either frequent urination or urge to urinate or both, while the symptoms of
pyelonephritis include fever and flank pain in addition to the symptoms of a lower UTI. In some
cases, a painful burning sensation in the urethra may be present even when not urinating. In the
elderly and the very young, symptoms may be vague or non-specific. The main causal agent of
both types is Escherichia coli, though other bacteria, viruses or fungi may rarely be the cause.

Urinary tract infections occur more commonly in women than men, with half of women having
at least one infection at some point in their lives. Recurrences are common. Risk factors include
female anatomy, poor personal hygiene, sexual intercourse and family history.

Signs and symptoms

Lower urinary tract infection is also referred to as a bladder infection. The most common
symptoms are burning with urination and having to urinate frequently (or an urge to urinate) in
the absence of vaginal discharge and significant pain. These symptoms may vary from mild to
severe and in healthy women last an average of six days. Some pain above the pubic bone or in
the lower back may be present.

Cause

E. coli is the cause of 80–85% of community-acquired urinary tract infections,

with Staphylococcus saprophyticus being the cause in 5–10%. Rarely, they may be due
to viral or fungal infections.

Women are more prone to UTIs than men because, in females, the urethra is much shorter and
closer to the anus. As a woman's estrogen levels decrease with menopause, her risk of urinary
tract infections increases due to the loss of protective vaginal flora.

The bacteria that cause urinary tract infections typically enter the bladder via the urethra.
However, infection may also occur via the blood or lymph. It is believed that the bacteria are
usually transmitted to the urethra from the bowel, with females at greater risk due to their
anatomy. After gaining entry to the bladder, E. coli is able to attach to the bladder wall and form
a biofilm that resists the body's immune response.

Treatment

Treatment could be by the use of antibiotics that target Gram negative bacteria.

23
Prevention

Using urinary catheters as little and as short of time as possible and the appropriate care of the
catheters when used prevent infections. They should be inserted using sterile technique in
hospitals, however, non-sterile technique may be inappropriate in those who self catheterize.

3. Bacterial skin infection

A skin infection is an infection of the skin. Infection of the skin is distinguished

from dermatitis, which is inflammation of the skin, but a skin infection can result in skin
inflammation. Skin inflammation due to skin infection is called infective dermatitis.

Cause

 Impetigo is a highly contagious bacterial skin infection most common among pre-school
children. It is primarily caused by Staphylococcus aureus and sometimes
by Streptococcus pyogenes.
 Erysipelas is an acute streptococcus bacterial infection of the deep epidermis
with lymphatic spread.
 Cellulitis is a diffuse inflammation of connective tissue with severe inflammation
of dermal and subcutaneous layers of the skin. Cellulitis can be caused by normal skin
flora or by exogenous bacteria, and often occurs where the skin has previously been
broken; cracks in the skin, cuts, blisters, burns, insect bites, surgical wounds,
intravenous drug injection or sites of intravenous catheter insertion. Skin on the face or
lower legs is most commonly affected by this infection, though cellulitis can occur on
any part of the body.

Fungal infections

1. Mycosis

Mycosis (plural: mycoses) is a skin fungal infection of animals, including humans. Mycoses are
common and a variety of environmental and physiological conditions can contribute to the
development of fungal diseases. Inhalation of fungal spores or localized colonization of
the skin may initiate persistent infections; therefore, mycoses often start in the lungs or on the
skin.

Causes

People are at risk of fungal infections when they are taking strong antibiotics for a long period of
time because antibiotics kill not only damaging bacteria but healthy bacteria as well. This alters
the balance of microorganisms in the mouth, vagina, intestines and other places in the body, and
results in an overgrowth of fungi.

24
Individuals with weakened immune systems are also at risk of developing fungal infections. This
is the case of people with HIV/AIDS, people under steroid treatments, and people
taking chemotherapy. People with diabetes also tend to develop fungal infections. Very young
and very old people, also, are groups at risk.

Classification

Mycoses are classified according to the tissue levels initially colonized.

Superficial mycoses

Superficial mycoses are limited to the outermost layers of the skin and hair. An example of such
a fungal infection is Tinea versicolor, a fungus infection that commonly affects the skin of young
people, especially the chest, back, and upper arms and legs. Tinea versicolor is caused by a
fungus that lives in the skin of some adults.

Cutaneous mycoses

Cutaneous mycoses extend deeper into the epidermis and also include invasive hair and nail
diseases. These diseases are restricted to the keratinized layers of the skin, hair and nails. Unlike
the superficial mycoses, host immune responses may be evoked resulting in pathologic changes
expressed in the deeper layers of the skin. The organisms that cause these diseases are
called dermatophytes. The resulting diseases are often called ringworm (even though there is no
worm involved) or tinea. Cutaneous mycoses are caused by Microsporum, Trichophyton,
and Epidermophyton fungi, which together comprise 41 species.

One common disease is the athlete's foot which most commonly affects children before puberty.
It is divided in three categories: chronic interdigital athlete's foot, chronic scaly athlete's foot, and
acute vesicular athlete's foot.

Subcutaneous mycoses

Subcutaneous mycoses involve the dermis, subcutaneous tissues, muscle and fascia. These
infections are chronic and can be initiated by piercing trauma to the skin which allows the fungi
to enter. These infections are difficult to treat and may require surgical interventions.

Systemic mycoses due to primary pathogens

Systemic mycoses due to primary pathogens originate primarily in the lungs and may spread to
many organ systems. Systemic mycoses due to opportunistic pathogens are infections of patients
with immune deficiencies who would otherwise not be infected. Examples of opportunistic
mycoses include candidiasis, cryptococcosis and aspergillosis.

25
Prevention

Keeping the skin clean and dry, as well as maintaining good hygiene will help larger topical
mycoses. Because fungal infections are contagious, it is important to wash after touching other
people or animals. Sports clothing should also be washed after use.

Treatment

Antifungal drugs are used to treat mycoses. Depending on the nature of the infection, a topical or
systemic agent may be used.

Example of antifungals include; fluconazole which is the basis of many over-the-

counter antifungal treatments. Another example is amphotericin B which is more potent and used
in the treatment of the most severe fungal infections that show resistance to other forms of
treatment and it is administered intravenously.

Drugs to treat skin infections are ketoconazole, itraconazole or terbinafine.

2. Dermatophytosis

Dermatophytosis is a clinical condition caused by fungal infection of the skin in humans, pets
such as cats, and domesticated animals such as sheep and cattle. The term "ringworm",
commonly used to refer to such infections, is a misnomer, since the condition is caused
by fungi of several different species and not by parasitic worms. The fungi that cause parasitic
infection (dermatophytes) feed on keratin, the material found in the outer layer of skin, hair, and
nails. These fungi thrive on warm and moist skin, but may also survive directly on the outsides
of hair shafts or in their interiors. In pets, the fungus responsible for the disease survives in skin
and on the outer surface of hairs.

Classification

A number of different species of fungi are involved. Dermatophytes of the

genera Trichophyton and Microsporum are the most common causative agents. These fungi
attack various parts of the body and lead to the conditions listed below. The disease patterns
below identify the type of fungus that causes them only in the cases listed;

 Dermatophytosis
o Tinea pedis (athlete's foot) affects the feet
o Tinea unguium affects the fingernails and toenails
o Tinea corporis affects the arms, legs, and trunk
o Tinea cruris (jock itch) affects the groin area
o Tinea manuum affects the hands and palm area
o Tinea capitis affects the scalp
o Tinea barbae affects facial hair
o Tinea faciei (face fungus) affects the face

26
Causes

Fungi thrive in moist, warm areas, such as locker rooms, tanning beds, swimming pools, and skin
folds; accordingly, those that cause dermatophytosis may be spread by sharing sporting
equipment, towels, or clothing.

Prevention

 Avoid sharing clothing, sports equipment, towels, or sheets.

 Wash clothes in hot water with fungicidal soap after suspected exposure to ringworm.
 Avoid walking barefoot; instead wear appropriate protective shoes in locker rooms and
sandals at the beach.
 After being exposed to places where the potential of being infected is great, wash with
an antibacterial and antifungal soap or one that contains tea tree oil, which
contains terpinen-4-ol.
 Avoid touching pets with bald spots, as they are often carriers of the fungus.

Treatment

Antifungal treatments include topical agents such

as miconazole, terbinafine, clotrimazole, ketoconazole, griseofulvin or tolnaftate, applied twice
daily until symptoms resolve, usually within one or two weeks.

Viral infections

1. Measles

Measles is caused by a virus in the paramyxovirus family and it is normally passed through
direct contact and through the air. The virus infects the mucous membranes, and then spreads
throughout the body. Measles is a human disease and is not known to occur in animals.

Signs and symptoms

The first sign of measles is usually a high fever, which begins about 10 to 12 days after exposure
to the virus, and lasts 4 to 7 days. A runny nose, a cough, red and watery eyes, and small white
spots inside the cheeks can develop in the initial stage.

Unvaccinated young children are at highest risk of measles and its complications, including
death. Unvaccinated pregnant women are also at risk. Any non-immune person (who has not
been vaccinated or was vaccinated but did not develop immunity) can become infected.

Transmission

27
 The highly contagious virus is spread by coughing and sneezing, close personal contact or direct
contact with infected nasal or throat secretions.

Prevention

Routine measles vaccination for children combined with mass immunization campaigns in
countries with high case and death rates are key public health strategies to reduce global measles
deaths. The measles vaccine has been in use for 50 years. It is safe, effective and inexpensive.

Treatment

No specific antiviral treatment exists for measles virus.

2. Polio

Polio (also known as poliomyelitis) is a highly contagious disease caused by a virus that attacks
the nervous system. Children younger than 5 years old are more likely to contract the virus than
any other group.

Types

There are three types of polio infections:

 Sub-clinical: Approximately 95 percent of polio cases are sub-clinical, and patients may not
experience any symptoms. This form of polio does not affect the central nervous system (the
brain and spinal cord).
 Non-paralytic: This form, which does affect the central nervous system, produces only mild
symptoms and does not result in paralysis.
 Paralytic: This is the rarest and most serious form of polio, which produces full or partial
paralysis in the patient. There are three types of paralytic polio: spinal polio (affects the spine),
bulbar polio (affects the brainstem), and bulbospinal polio (affects the spine and brainstem).
Post-polio syndrome is a complication that can occur after a person has caught and recovered
from poliovirus. Symptoms of the syndrome can appear up to 35 years after the polio infection.

Poliovirus is often transmitted from person-to-person through faecal matter. People living in
areas with limited access to running water or flush toilets often get the virus from drinking water
contaminated by human waste that contains the virus.

In addition, the virus can be spread by contaminated food or water or direct contact with an
infected person.

Diagnosis
Doctors will use the patient’s reported symptoms to help determine whether he or she has polio.
During a physical examination, a doctor may notice that the patient has impaired reflexes, back
and neck stiffness, or difficulty lifting his or her head while lying flat.

28
Prevention
The best ways to prevent polio is to have good personal hygiene and get vaccinated. Rarely, the
shots can cause mild or severe allergic reactions, including;
 breathing problems
 high fever
 dizziness
 hives
 swelling of throat
 rapid heart rate

Treatment: The treatment is the same as for measles.

Parasitic infections

1. Amoebiasis

This infection is caused by the protozoan parasite Entamoeba histolytica.

Transmission

Transmission occurs via the faecal–oral route, either directly by person-to-person contact or
indirectly by eating or drinking faecally contaminated food or water.

Sypmtoms

The clinical spectrum ranges from asymptomatic infection, diarrhoea and dysentery to fulminant
colitis and peritonitis as well as extra intestinal amoebiasis.

Acute amoebiasis can present as diarrhoea or dysentery with frequent, small and often bloody
stools. Chronic amoebiasis can present itself with gastrointestinal symptoms plus fatigue, weight
loss and occasional fever. Extra intestinal amoebiasis can occur if the parasite spreads to other
organs, most commonly the liver where it causes amoebic liver abscess. Amoebic liver abscess
presents with fever and right upper quadrant abdominal pain.

Precautions/Prevention

This is by food and water hygiene. No vaccine is available.

Treatment: This is by employing the appropriate anti-protozoal agent plus ORT.

2. Giardiasis

This infection is caused by Giardia lamblia.

Symptoms

29
The most common manifestations of giardiasis are diarrhoea and abdominal pain, particularly
cramping; however, diarrhea is not invariable and occurs in 60% to 90% of patients. Other
common manifestations include;

 bloating
 nausea with or without vomiting
 malaise and
 fatigue

Fever is unusual. The severity of the symptoms may vary greatly from mild or no symptoms to
severe symptoms. Stools may be foul smelling when the Giardia interferes with the absorption of
fat from the intestine (mal-absorption). The illness or the mal-absorption may cause loss of
weight. Symptoms and signs of giardiasis do not begin for at least seven days following
infection, but can occur as long as three or more weeks later.

Transmission

Giardia lamblia exists in two forms, an active form called a trophozoite, and an inactive form.
Cysts of Giardia are present in the feces of infected persons. Thus, the infection is spread from
person to person by contamination of food with feaces, or by direct fecal-oral contamination.
Cysts also survive in water, for example in fresh water lakes and streams. As a result, giardiasis
is the most common cause of water-borne, parasitic illness. Domestic mammals (for example,
dogs, cats, calves) and wild mammals (for example, beavers) can become infected with Giardia;
however, it is not clear how often domestic or wild mammals transmit giardiasis to humans.
Giardiasis also has occurred as outbreaks from recreational water sources such as swimming
pools, water parks, and hot tubs, most likely because of an infected user rather than a source of
water that was contaminated.

Prevention

The prevention of giardiasis is quite similar to that of gastro-enteritis.

Treatment

In most patients, the illness is self-limiting and lasts 2-4 weeks or patients may be treated with
anti-protozoal agents. In many patients who are not treated, however, infection can last for
several months to years with continuing symptoms.

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