Ch 14 Principles of Disease and Epidemiology: Structured Study Notes

Principles of Disease and Epidemiology

Pathology, Etiology, Infection, and Disease

Pathology is the scientific study of disease, focusing on its causes, development, and effects on the body. Etiology refers to the cause of a disease, while pathogenesis describes the process by which disease develops. Infection is the invasion or colonization of the body by pathogenic microorganisms, and disease is the abnormal state resulting from infection, impairing normal body functions.

• Pathology: Study of disease, including etiology, pathogenesis, physiological changes, and final effects.

• Etiology: The cause of a disease.

• Infection: Invasion or colonization by pathogens.

• Disease: Abnormal health state due to infection.

Normal Flora and Host Relationships

The human body hosts a variety of microorganisms known as normal flora, which reside in specific regions and play essential roles in health. These microbes can prevent the overgrowth of harmful organisms through microbial antagonism. The relationship between normal flora and the host can change, especially after antimicrobial therapy.

• Normal flora: Microorganisms regularly found at anatomical sites.

• Microbial antagonism: Competition between microbes that inhibits pathogens.

• Examples: Candida albicans (yeast infection after antibiotics), Escherichia coli (produces bacteriocins), Clostridium difficile (post-antibiotic colitis).

Region	Principal Components	Comments
Skin	Propionibacterium acnes, Staphylococcus epidermidis, Staphylococcus aureus, Corynebacterium xerosis, Pityrosporum spp. (fungi), Candida spp. (fungi)	Most microbes in direct contact with skin do not become resident; skin is hostile environment.
Eyes (conjunctiva)	S. epidermidis, S. aureus, diphtheroids	Conjunctiva is colonized by skin microbes; tears and lysozyme inhibit colonization.
Nose and throat	S. aureus, S. epidermidis, aerobic diphtheroids, Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae	Microbes colonize mucous membranes; some are opportunistic pathogens.
Mouth	Streptococcus, Lactobacillus, Bacteroides, Actinomyces, Neisseria, Corynebacterium, Candida (fungi)	Abundant microbes; saliva and chewing dislodge microbes.
Large intestine	Bacteroides, Fusobacterium, Lactobacillus, Bifidobacterium, Enterococcus, Enterobacter, Escherichia, Candida (fungi)	Largest microbial population; anaerobic environment.
Urogenital system	Staphylococcus, Micrococcus, Enterococcus, Lactobacillus, Candida (fungi), Trichomonas (protozoa)	Lower urethra and vagina colonized; urine flushes microbes.

Symbiotic Relationships

Microbes and hosts interact in various symbiotic relationships, including commensalism, mutualism, and parasitism. These relationships can shift depending on environmental or health changes.

• Commensalism: One organism benefits, the other is unaffected.

• Mutualism: Both organisms benefit.

• Parasitism: One organism benefits at the expense of the other.

Koch’s Postulates and Etiology of Infectious Disease

Koch’s postulates are a set of criteria used to establish the causative relationship between a microbe and a disease. They are foundational in medical microbiology but have limitations, especially for pathogens that cannot be cultured.

• 1. The same pathogen must be present in every case of the disease.

• 2. The pathogen must be isolated and grown in pure culture.

• 3. The cultured pathogen must cause the disease when inoculated into a healthy host.

• 4. The pathogen must be re-isolated from the experimentally infected host and shown to be the same as the original.

• Limitations: Some pathogens (e.g., Treponema pallidum, Mycobacterium leprae) cannot be cultured.

Definitions: Symptoms, Signs, Syndrome

Understanding disease requires distinguishing between symptoms, signs, and syndromes.

• Symptoms: Subjective changes felt by the patient (e.g., pain, malaise).

• Signs: Objective changes observable or measurable (e.g., fever, lesions).

• Syndrome: Group of symptoms or signs that accompany a disease.

Classification of Infectious Diseases

Diseases are classified based on their onset, duration, and mode of transmission.

• Acute: Rapid onset, short duration.

• Chronic: Slow onset, long duration.

• Latent: Pathogen inactive for a period.

• Communicable: Spread from host to host.

• Contagious: Easily spread between individuals.

• Non-communicable: Not spread between hosts.

Occurrence of Disease: Incidence and Prevalence

Incidence and prevalence are epidemiological measures used to describe disease frequency and impact.

• Incidence: Number of new cases in a specific time period.

• Prevalence: Total number of cases (old and new) at a given time.

• Applications: Incidence measures spread; prevalence measures severity and duration.

Frequency of Disease Occurrence

Diseases can be described by their frequency and distribution in populations.

• Sporadic: Occurs occasionally (e.g., West Nile Virus).

• Endemic: Constantly present (e.g., common cold).

• Epidemic: Many cases in a short time in a specific area (e.g., influenza).

• Pandemic: Worldwide epidemic (e.g., HIV).

• Herd immunity: Large proportion of population immune, reducing disease spread.

Types of Infections and Host Involvement

Infections are categorized by their location and progression within the host.

• Local: Confined to a small area (e.g., boils).

• Systemic: Spread throughout the body (e.g., measles).

• Focal: Local infection spreads via blood or lymph.

• Primary: Initial infection.

• Secondary: Subsequent infection by opportunistic pathogen.

• Subclinical: Inapparent infection.

• Bacteremia: Presence of bacteria in blood.

• Septicemia: Rapid multiplication of bacteria in blood.

• Toxemia: Presence of toxins in blood.

• Viremia: Presence of viruses in blood.

Spread of Infection: Reservoirs

Reservoirs are continual sources of infection, including humans, animals, and non-living environments.

• Human: Symptomatic or asymptomatic carriers (e.g., Typhoid Mary).

• Animal: Zoonotic reservoirs; zoonoses are diseases transmitted from animals to humans.

• Non-living: Soil, water (e.g., ringworm, botulism).

Disease	Causative Agent	Reservoir	Method of Transmission
Anthrax	Bacillus anthracis	Domestic livestock	Direct contact with infected animals or animal products
Brucellosis	Brucella spp.	Domestic livestock	Direct contact with contaminated milk, meat, or animal products
Bubonic plague	Yersinia pestis	Rodents	Flea bites
Cat-scratch disease	Bartonella henselae	Domestic cats	Direct contact
Lyme disease	Borrelia burgdorferi	Field mice, deer	Tick bites
Salmonellosis	Salmonella spp.	Poultry, reptiles	Ingestion of contaminated food or water

Disease Transmission

Transmission of infectious diseases occurs via contact, vehicles, and vectors.

• Contact transmission: Direct (person-to-person), indirect (fomites), droplet (short-range).

• Vehicle transmission: Via food, water, blood, or air (airborne).

• Vector transmission: Arthropods (mechanical or biological).

Development and Patterns of Disease

The progression of disease follows distinct stages, influenced by predisposing factors such as age, gender, genetics, climate, nutrition, and fatigue.

• Incubation period: No signs or symptoms.

• Prodromal period: Mild signs or symptoms.

• Period of illness: Most severe signs and symptoms.

• Period of decline: Signs and symptoms subside.

• Period of convalescence: Recovery.

Nosocomial Infections

Nosocomial infections are acquired in healthcare settings and are a major cause of morbidity and mortality. They result from a combination of microorganisms in the environment, compromised hosts, and chains of transmission.

• Common sites: Urinary tract, surgical sites, respiratory tract, skin, bloodstream.

• Risk factors: Broken skin, suppressed immunity, impaired defense cells.

• Prevention: Handwashing, aseptic technique, staff education, isolation rooms.

Type of Infection	Comment
Urinary tract infections	Most common, about 40% of nosocomial infections; often related to catheterization.
Surgical site infections	Second most common; 5-12% of surgical patients develop postoperative infections.
Lower respiratory infections	Account for about 15%; high mortality rates.
Cutaneous infections	About 8%; newborns especially susceptible.
Bacteremia (IV catheters)	About 6%; caused by bacteria and fungi.
Other	About 11% of nosocomial infections.

Procedure	MRSA-Infected Patients	Total Number of Patients Receiving Procedure
Hemodialysis	813	1807
IV catheter	1057	16516
Surgery	945	5659
Urinary bladder catheter	1750	7919
Ventilator (invasive airway)	722	7367

Epidemiology

Epidemiology is the science of disease incidence, distribution, and control in populations. It uses descriptive, analytical, and experimental studies to investigate disease patterns and causes.

• Descriptive: Data collection and analysis (often retrospective).

• Analytical: Case-control and cohort studies to determine causes.

• Experimental: Controlled experiments to test hypotheses.

• Case reporting: Chain of infection established through reporting.

• Notifiable diseases: Must be reported to health authorities.

Centers for Disease Control and Prevention (CDC)

The CDC is the central source of epidemiological information in the United States, publishing the Morbidity and Mortality Weekly Report (MMWR).

• Morbidity: Number of people affected by a disease relative to the population.

• Mortality: Number of deaths from a disease relative to the population.

Emerging Infectious Diseases

Emerging infectious diseases are those whose incidence has increased in recent years or threatens to increase in the near future. They may result from genetic changes, environmental factors, or human behavior.

Recap

• Defined key terms: pathology, etiology, infection, disease, sign, symptom, syndrome, bacteremia, septicemia.

• Explained normal flora and host relationships.

• Described Koch’s postulates and their limitations.

• Classified infectious diseases and described their occurrence.

• Outlined types of infections, spread, and development of disease.

• Defined epidemiology, morbidity, and mortality.