CHAPTER 5 : DISEASE PROCESS

Prepared by :
Queenie Valencia,RMT,MLS(ASCPi)CM
 DISEASE PROCESS
• FIVE(5) KINGDOM CLASSIFICATION
(ROBERT WHITTAKER)

A. ANIMALIA
B. PLANTAE
C.PROTISTA: single celled eukaryotes
algae, amoeba, euglena,
paramecium slime moulds,
plasmodium. Protozoans
D. FUNGI: fungus-like and related
eukaryotic organisms, yeast,
molds, mushrooms
E.MONERA(Prokaryotes)
 PATHOGENESIS OF INFECTIOUS DISEASE
KEY TERMS :
Pathology - scientific study of disease
Pathogenesis - the steps or mechanisms involved in the development
of a disease.
Infection - Infection is the invasion or colonization of the body by
pathogenic microorganism.
Disease - occurs when an infection results in any change from a state
of health ; an abnormal state in which part or all of the body is not
properly adjusted or incapable of performing its normal functions.
Normal microbiota – microorganisms that establish more or less
permanent residence (colonize) but that do not produce disease under
normal conditions.
Transient microbiota - may be present for several days, weeks, or
months and then disappear.
➢An infection may exist in the absence of
detectable disease.
➢The presence of a particular type of
microorganism in a part of the body where
it is not normally found is also called an
infection and may lead to disease.
• They are found in the soil, in the water, and on
plants and animals. In fact, billions are found in
humans on the skin and in both the nasal and
intestinal tracts.
• Although most microorganisms live in harmony
with the human body, some—called pathogens—
can infect the body and cause disease. Infectious
diseases range from mild illnesses, such as a cold,
to fatal illnesses, such as AIDS.
• We occasionally encounter people or animals that
are infected and thus expose ourselves to the
pathogens of their diseases. In fact, our environment
is such that everyday we live with some risk of
exposure to diseases.
 Infection Disease
Process
• The infectious disease
process is defined as the
interaction between the
pathogenic
microorganism, the
environment, and the
host. The process may be
thought of as a circular
chain with six links.
SIX (6) LINKS OF INFECTION PROCESS
 PATHOGEN / MICROORGANISM
The first link in the chain of infection is the infectious agent or pathogen
which can take the form of:
• Viruses – such as Influenza A, shingles and Hepatitis
• Bacteria – including Lyme disease and Leptospirosis
• Fungi – for example Candidiasis and Aspergillosis
• Parasitic protozoan diseases – such as Malaria, Giardia and
Toxoplasmosis
• Prions – which are the cause of rare progressive neurodegenerative
disorders such as Creutzfeldt-Jakob disease (CJD)
How well any pathogen can thrive depends on three factors:
• Pathogenicity – its ability to produce disease
• Degree of virulence – its severity or harmfulness
• Invasiveness – its tendency to spread
 RESERVOIR

• A reservoir is the principal habitat in which a pathogen

lives, flourishes and can multiply.
• Common reservoirs for infectious agents include humans,
animals or insects and the environment.
Human reservoirs
• In humans, there are two forms of reservoir: acute clinical ;
and carriers.
• Acute clinical cases are more likely to be diagnosed and
treated which means that the patient’s contacts and normal
activities will normally be restricted. Carriers, however, can
present more of a risk to those around them because they
do not display any signs or symptoms of illness.
Carriers can be further subdivided into four main types:
• Incubatory carriers – people who are infectious even before
their own symptoms start
• Inapparent carriers – in which an individual is able to
transmit an infection to others, without ever developing the
infection themselves
• Convalescent carriers – people who are in the recovery phase
of their illness but who continue to be infectious
• Chronic carriers – anyone who has recovered but who
continues to be a carrier for infection.
Animal & insect reservoirs
• Examples of animal or insect reservoirs include Lyme
disease (which is transmitted via ticks); Rabies (which is
transmitted by dogs, cats, foxes and bats); and Salmonella
(which is transmitted by poultry, cattle, sheep and pigs).
• Any infectious disease that is transmitted under natural
conditions from animal to human is referred to as zoonosis.
Environmental reservoirs
• The environment contains a large number of reservoirs of
infection, including soil (which acts as a reservoir for
Clostridium tetani, the causative agent of tetanus) and
water (which is a reservoir for Legionella pneumophila, the
causative agent of Legionnaire’s disease).
 PORTAL OF EXIT

The portal of exit is any route which enables a

pathogen to leave the reservoir or host. In humans
the key portals of exit are:
• Alimentary – via vomiting, diarrhea or biting
• Genitourinary – via sexual transmission
• Respiratory – through coughing, sneezing and
talking
• Skin – via skin lesions
• Trans-placental – where transmission is from
mother to fetus
 MODE OF TRANSMISSION
The two main ways that an infection can be transmitted from its
reservoir to a susceptible host are via direct transmission or
indirect transmission.
• Direct transmission - occurs when there is direct contact
with the infectious agent. Examples include tetanus,
glandular fever, respiratory diseases and sexually transmitted
diseases.
• Indirect transmission - can occur through animate
mechanisms such as fleas, ticks, flies or mosquitoes or via
inanimate mechanisms such as food, water, biological
products or surgical instruments, can also be airborne, in
which tiny particles of an infectious agent are carried by dust
or droplets in the air and inhaled into the lungs.
 PORTAL OF ENTRY
The portal of entry is the means by which an infection
is able to enter a susceptible host.
• Portals of entry into the human body include:
• Inhalation (via the respiratory tract)
• Absorption (via mucous membranes such as the
eyes)
• Ingestion (via the gastrointestinal tract)
• Inoculation (as the result of an inoculation injury)
• Introduction (via the insertion of medical devices)
 SUSCEPTIBLE HOST
• The last link in the chain of infection is the susceptible
host.
Susceptible host depends on a variety of factors:
• Their age
• Whether there is any presence of malnutrition or
dehydration
• Whether there is any underlying chronic disease
• If the host suffers from immobility
• If they are taking any medication which could disrupt or
suppress their immune response
• General resistance factors (such as mucous membranes,
skin, cough reflex etc) that can help defend against
infection
 How to break the chain of infection ?
• The healthcare environment can expose patients to infection
risks that they may not encounter elsewhere.
• Understanding how infections become established, and how they
are transmitted, is essential for effective infection prevention and
control.
• There are opportunities to break or disrupt the chain at any link:
though the rapid and accurate diagnosis of an infectious disease;
the prompt treatment of infected patients; the safe disposal of
waste; the sterilization and disinfection of medical equipment or
the implementation of an environmental decontamination
strategy.
Break the chain by:
• cleaning your hands frequently,
• staying up to date on your vaccines (including
the flu shot),
• covering coughs and sneezes and
• staying home when sick, following the rules for
standard and contact isolation,
• using personal protective equipment, the right
way,
• cleaning and disinfecting the environment,
 VIRULENCE FACTOR OF
PATHOGENIC
MICROORGANISM
• PATHOGENECITY
The capability of a microorganism to
cause a disease in a host; an innate
property. Disease warning signs are
often the result of toxic of allergic
reactions.

• VIRULENCE
The quantity of pathogenicity of a
microbe or a measure of the ability of
the microbe to cause disease; physical
attributes or properties of pathogens
that enable them to escape various host
defense mechanisms and cause disease.
Virulence is determined by the factors
of invasiveness and toxigenicity.
To cause disease, pathogens must penetrate the host tissues
and multiply. Usually, they become localized and form a
small focus of infection. In some cases, secretion is
produced and is called PYOGENIC infection.

Within the body, localization usually occurs within the lymph

nodes
liver, spleen or kidney. From this area of infection
microbes may pass into the bloodstream and set up the
conditions of BACTEREMIA (non multiplying bacteria in
the blood stream.) and SEPTICEMIA (reproducing
bacteria)
SPECIFIC VIRULENCE FACTOR

➢ ADHESION FACTOR
Adhesins- are specific virulence factors that enhance
the ability of a microorganism to attach to the surface
of mammalian.
proteins or polysaccharides on the surface of the
microorganism that bind to the specific receptor sites
on the surface of other cells
➢ INVASIVENESS
Is the ability of microorganism to invade human
tissues and to reproduce or multiply within the cells
and tissues of the human body.
microorganisms that possess invasive properties are
able to establish and to spread infections within host
cells and tissues.
➢ GROWTH AND SURVIVAL ENHANCING
FACTORS
Refers to the ability of the bacteria to grow within the
blood of the host utilizing the available iron.
Iron is needed by the bacteria for their growth. The
binding of iron to specific chemicals produced by the
body, namely transferrin and lactoferrin, are the host
defense mechanism that prevents most
microorganisms from establishing an infection in the
blood.
➢ INFECTIVE DOSE
Refers to the amount or quantity of
microorganisms required to produce disease
symptoms in a host; the more virulent the
microbe, the fewer the number needed.
➢ TOXIGENICITY
Refers to the ability of a microorganism to
produce toxins
 TOXINS
• Are biological poisons; they disrupt the normal
functions of cells and are generally destructive to
human cells and tissues.
❑ENDOTOXIN equated with the lipopolysaccharide
component of gram-negative bacterial cell wall. When
gram-negative bacteria die, their cell walls disintegrate
and LPS endotoxin is released. It can cause fever and
shock.
❑EXOTOXINS these are protein toxins produced from
various gram-negative and gram-positive pathogenic
bacteria; released by growing cells.
 EXOTOXINS EXAMPLES

❑NEUROTOXIN- most potent protein exotoxins

that interfere the functioning of the nervous
system; usually work by blocking nerve cell
transmissions.
❑ENTEROTOXINS stimulate the cells of the
gastrointestinal tract in an abnormal way, which
then causes inflammation of the tissues.
❑CYTOTOXIN are protein exotoxins that kill cells
by enzymatic attack or by blocking essential
cellular metabolism; interfere with cellular
functions .
CHAPTER 6 : INFECTION
AND DISEASES
• The common saying “ when you are tired and run-down
you are more prone to infection. ,” this is because an
infectious disease is as much the result of the failure of
the human defense as it is the result of the special
properties of pathogenic microorganisms.
• A sufficient number of microorganisms are necessary
to initiate an infective process that result in disease
(Infectious dose).
• INFECTIOUS DOSE – number of pathogens needed to
establish a disease. Factors that influence the infectious
dose that is required to initiate a disease, including the
route of entry of the pathogen and the state of the host
defenses.
A.Compromised Host – an individual whose defenses are
weakened by:
• Malnutrition
• Disease
• Chemotherapy
• Or burns
• Broken skin or mucous membrane
• Suppressed immune system
• And/or impaired cell activity.
B. Predisposing Factors-factors that affect the
occurrence of disease, making an individual or
population more susceptible to a certain disease;
these factors sometimes alter the course of the
disease.
• Gender
• Genetic
• Environment: Climate, weather, nutrition,
lifestyle, age, fatigue , occupation, pre-existing
illnesses or conditions and medications.
C. Disease Condition- is a state in which the body
does not function normally.
• Many microorganisms live on the surfaces of body
tissues without causing disease. Such
microorganisms constitute the so-called normal
microbiota.
• Many of the surfaces of the body, particularly of the
GIT , are covered by dense populations of these
microorganisms.
• The normal microbiota-contribute to the body’s
defenses by competing with and wading off
potentially invasive pathogens.
 THE PROGRESSION OF THE EFFECTS OF MICROORGANISMS
ON THEIR HOSTS FOLLOWS A DISTINCT PATTERN

1. Contamination: simply indicates the presence of

microorganisms not usually present in body.
2. Colonization: if the microorganisms present in the body
survive, they may begin to grow at the site of
contamination.
3. Infection: the continued growth of microorganisms, that is, the
multiplication of within the host organism whether or not
disease results from the growth.
4. Disease: a condition occurs only when the potential of the
microorganism to disrupt normal functions is fully expressed.
 EXTENT OF HOST INVOLVEMENT
Infections can also be classified according to the extent to which
the host’s body is affected.
LOCAL INFECTION - invading microorganisms are limited to a
relatively small area of the body.
SYSTEMIC GENERALIZED INFECTION - microorganisms
or their products are spread throughout the body by the blood or
lymph.
PRIMARY INFECTION - n acute infection that causes the initial
illness.
SECONDARY INFECTION - caused by an opportunistic
pathogen after the primary infection has weakened the body’s
defenses. Secondary infections of the skin and respiratory tract
are common and are sometimes more dangerous than the primary
infections.
SUBCLINICAL
INFECTIONS
• are infections that do not produce symptoms in the host. In such
cases, too few organisms are present, or the host’s defense
mechanisms effectively control the invading pathogens.
• AKA. preinfection or inapparent infection - is an infection by
a pathogen that causes few or no signs or symptoms of infection
in the host.
• Depending on the pathogen, which can be a virus or intestinal
parasite, the host may be infectious and able to transmit the
pathogen without ever developing symptoms; such a host is
called an asymptomatic carrier. Many pathogens,
including HIV, typhoid fever, and coronaviruses such
as COVID-19 spread in their host populations through
subclinical infection.
 NOSOCOMIAL INFECTIONS
• Does not show any evidence of being present or
incubating at the time of admission. to a
hospital; it is acquired as a result of a hospital
stay.
• Nosocomial infections result from the interaction
of several factors:
(1) microorganisms in the hospital environment,
(2) the compromised (or weakened) status of the
host,
(3) the chain of transmission in the hospital
 PATTERN OF DISEASE
SIGNS AND SYMPOTMS
Sign: is a characteristic of a disease that can be
observed by examining the patient.
• Examples: swelling, redness, coughing, runny
nose, fever, vomiting, and diarrhea

Symptom: is a disease characteristic that can be

observed or felt only by the patient.
• Examples: pain, shortness of breath, nausea,
and malaise
 5 STAGES OF INFECTION
1. Incubation Stage
• Occurs after the pathogen enters the body , before any
signs or symptoms appear
• Microorganism has invaded the host and is typically
migrating to various tissues
• The time of incubation depends on the specific
microorganism involved, its virulence, the number of
infecting microorganisms, and the resistance of the host.
• The disease generally is NOT communicable until after
the incubation period.
2. Prodromal Stage
• Onset of symptoms marks the start of prodromal stage
• Sufficient numbers of the pathogen may be present to make the patient
contagious to others.
• The immune defenses have detected the infection and have become
operative.
• characterized by early, mild symptoms of disease, such as general aches and
malaise.
3. Period of Illness(Clinical Stage)
• Various signs and symptoms that characterize the particular disease occur in
this period.
• This is when the diseases is most severe
• This phase of the disease progresses toward DEATH to
CONVALESCENCE.
• Recovery depends on whether the body’s defense systems or medical
treatment are adequate.
• Communicable diseases are most easily transmitted during this third
period.
4. Period of Decline
• the signs and symptoms subside. The fever decreases, and the
feeling of malaise diminishes.
• During this phase, which may take from less than 24 hours to
several days, the patient is vulnerable to secondary infection.

5. Convalescent Period
• the person regains strength and the body returns to its
prediseased state. Recovery has occurred.
• people can serve as reservoirs of disease and can easily
spread infections to other people.
• Progresses to a carrier stage or to freedom from the
pathogen.
6. Recovery
• Marks the end of the disease syndrome
• The patient is completely free of the
microorganism and all systems are functioning
normally
 SEVERITY / DURATION OF DISEASE
1. Acute Diseases: develops and complete their courses rapidly.
Ex: measles and influenza

2. Chronic Diseases: develop slowly, are less severe and last longer in
determinate period.
Ex: tuberculosis and Hansen Disease (leprosy) , Infectious mononucleosis ,
Hepatitis B

3. Subacute Diseases: an intermediate condition between an acute and a

chronic disease.
Ex: gum disease , sclerosing panencephalitis.

4. Latent Diseases: characterized by periods that are sign and symptom free,
e is one in which the causative agent remains inactive for a time but then
becomes active to produce symptoms of the disease;
Ex: syphilis , shingles
Herpes
REFERENCES
Engelkirk, P. G., & Duben-Engelkirk, J. L. (2015).
Burton’s Microbiology for the Health Sciences. LWW
Tortora, G. J., Funke, B. R., & Case, C. L.
(2013). Microbiology: An Introduction. Benjamin-
Cummings Publishing Company.