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Malaria

This false-colored electron micrograph shows a malaria sporozoite migrating through the midgut epithelia.

Infectious disorders alsoinfectious disease is a clinically evident condition resulting from the presence of pathogenic microbial agents, including viruses, bacteria, fungi, protozoa, multicellular parasites, and aberrant proteins known as prions. These pathogens are able to cause disease in animals and/or plants.

They are of interest to psychologists as they can result in short term effects such as depressed mood and fatigue or more longer term effects such as neurological disorders. We also have an interest in deveopment and delivery of public health programmed designed to reduce levels of infection as with HIV

Infectious pathologies are usually qualified as contagious diseases (also called communicable diseases) due to their potentiality of transmission from one person or species to another.[1] Transmission of an infectious disease may occur through one or more of diverse pathways including physical contact with infected individuals. These infecting agents may also be transmitted through liquids, food, body fluids, contaminated objects, airborne inhalation, or through vector-borne spread.[2]

The term infectivity describes the ability of an organism to enter, survive and multiply in the host, while the infectiousness of a disease indicates the comparative ease with which the disease is transmitted to other hosts.[3] An infection however, is not synonymous with an infectious disease, as an infection may not cause important clinical symptoms or impair host function.[2]

Infectious disorders are interest to psychologists in a number of ways. Do psychological factors help cause infection? see psychoneuroimmunology. Do infections cause conditions of interest to psychologists eg neuroinfections have cognitive repercussions. We are also interested in the ways in which people's behavior affects their likelihood of getting infections (eg condom use preventing sexually transmitted diseases) as well as how do psychological factors affect peoples response to these disorders (eg the social psychological factors such as denial affecting a communities response to AIDS

Infectious disorders of interest to psychologistsEdit

ClassificationEdit

Among the almost infinite varieties of microorganisms, relatively few cause disease in otherwise healthy individuals.[4] Infectious disease results from the interplay between those few pathogens and the defenses of the hosts they infect. The appearance and severity of disease resulting from any pathogen depends upon the ability of that pathogen to damage the host as well as the ability of the host to resist the pathogen. Infectious microorganisms, or microbes, are therefore classified as either primary pathogens or as opportunistic pathogens according to the status of host defenses.

Primary pathogens cause disease as a result of their presence or activity within the normal, healthy host, and their intrinsic virulence (the severity of the disease they cause) is, in part, a necessary consequence of their need to reproduce and spread. 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 which infect non-human hosts.

Organisms which cause an infectious disease in a host with depressed resistance are classified as opportunistic pathogens. Opportunistic disease may be caused by microbes that are ordinarily in contact with the host, such as bacteria or fungi in the gastrointestinal or the upper respiratory tract, and they may also result from (otherwise innocuous) microbes acquired from other hosts (as in Clostridium difficile colitis) or from the environment as a result of traumatic introduction (as in surgical wound infections or compound fractures). 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). Primary pathogens may also cause more severe disease in a host with depressed resistance than would normally occur in an immunosufficient 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. These postulates were first used in the discovery that Mycobacteria species cause tuberculosis. Koch's postulates cannot be met ethically for many human diseases because they require experimental infection of a healthy individual with a pathogen produced as a pure culture. Often, even diseases that are quite clearly infectious do not meet the infectious criteria. For example, Treponema pallidum, the causative spirochete of syphilis, cannot be cultured in vitro - however the organism can be cultured in rabbit testes. It is less clear that a pure culture comes from an animal source serving as host than it is when derived from microbes derived from plate culture. Epidemiology is another important tool used to study disease in a population. For infectious diseases it helps to determine if a disease outbreak is sporadic (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).

TransmissionEdit

An infectious disease is transmitted from some source. Defining the means of transmission plays an important part in understanding the biology of an infectious agent, and in addressing the disease it causes. Transmission may occur through several different mechanisms. Respiratory diseases and meningitis are commonly acquired by contact with aerosolized droplets, spread by sneezing, coughing, talking, kissing or even singing. Gastrointestinal diseases are often acquired by ingesting contaminated food and water. Sexually transmitted diseases are acquired through contact with bodily fluids, generally as a result of sexual activity. Some infectious agents may be spread as a result of contact with a contaminated, inanimate object (known as a fomite), such as a coin passed from one person to another, while other diseases penetrate the skin directly.[5]

Transmission of infectious diseases may also involve a "vector". Vectors may be mechanical or biological. A mechanical vector picks up an infectious agent on the outside of its body and transmits it in a passive manner. An example of a mechanical vector is a housefly, which lands on cow dung, contaminating its appendages with bacteria from the feces, and then lands on food prior to consumption. The pathogen never enters the body of the fly.
CulexNil

Culex mosquitos (Culex quinquefasciatus shown) are biological vectors that transmit West Nile Virus.

In contrast, biological vectors harbor pathogens within their bodies and deliver pathogens to new hosts in an active manner, usually a bite. Biological vectors are often responsible for serious blood-borne diseases, such as malaria, viral encephalitis, Chagas disease, Lyme disease and African sleeping sickness. Biological vectors are usually, though not exclusively, arthropods, such as mosquitoes, ticks, fleas and lice. Vectors are often required in the life cycle of a pathogen. A common strategy, used to control vector borne infectious diseases, is to interrupt the life cycle of a pathogen, by killing the vector.

The relationship between virulence and transmission is complex, and has important consequences for the long term evolution of a pathogen. Since it takes many generations for a microbe and a new host species to co-evolve, an emerging pathogen may hit its earliest victims especially hard. It is usually in the first wave of a new disease that death rates are highest. If a disease is rapidly fatal, the host may die before the microbe can get passed along to another host. However, this cost may be overwhelmed by the short term benefit of higher infectiousness if transmission is linked to virulence, as it is for instance in the case of cholera (the explosive diarrhea aids the bacterium in finding new hosts) or many respiratory infections (sneezing and coughing create infectious aerosols).

Diagnosis and therapyEdit

Diagnosis of infectious disease sometimes involves identifying an infectious agent either directly or indirectly. In practice most minor infectious diseases such as warts, cutaneous abscesses, respiratory system infections and diarrheal diseases are diagnosed by their clinical presentation. Conclusions about the cause of the disease are based upon the likelihood that a patient came in contact with a particular agent, the presence of a microbe in a community, and other epidemiological considerations. Given sufficient effort, all known infectious agents can be specifically identified. The benefits of identification, however, are often greatly outweighed by the cost, as often there is no specific treatment, the cause is obvious, or the outcome of an infection is benign.

Specific identification of an infectious agent is usually only determined when such identification can aid in the treatment or prevention of the disease, or to advance knowledge of the course of an illness prior to the development of effective therapeutic or preventative measures. For example, in the early 1980s, prior to the appearance of AZT for the treatment of AIDS, the course of the disease was closely followed by monitoring the composition of patient blood samples, even though the outcome would not offer the patient any further treatment options. In part, these studies on the appearance of HIV in specific communities permitted the advancement of hypotheses as to the route of transmission of the virus. By understanding how the disease was transmitted, resources could be targeted to the communities at greatest risk in campaigns aimed at reducing the number of new infections. The specific serological diagnostic identification, and later genotypic or molecular identification, of HIV also enabled the development of hypotheses as to the temporal and geographical origins of the virus, as well as a myriad of other hypothesis. The development of molecular diagnostic tools have enabled physicians and researchers to monitor the efficacy of treatment with anti-retroviral drugs. Molecular diagnostics are now commonly used to identify HIV in healthy people long before the onset of illness and have been used to demonstrate the existence of people who are genetically resistant to HIV infection. Thus, while there still is no cure for AIDS, there is great therapeutic and predictive benefit to identifying the virus and monitoring the virus levels within the blood of infected individuals, both for the patient and for the community at large.


Mortality from infectious diseasesEdit

The World Health Organization collects information on global deaths by International Classification of Disease (ICD) code categories. The following table lists the top infectious disease killers which caused more than 100,000 deaths in 2002 (estimated). 1993 data is included for comparison.

Worldwide mortality due to infectious diseases[6]
Rank Cause of death Deaths 2002 Percentage of
all deaths
Deaths 1993 1993 Rank
N/A All infectious diseases 14.7 million 25.9% 16.4 million 32.2%
1 Lower respiratory infections[7] 3.9 million 6.9%4.1 million1
2 HIV/AIDS 2.8 million 4.9% 0.7 million7
3 Diarrheal diseases[8]1.8 million 3.2% 3.0 million2
4 Tuberculosis (TB) 1.6 million 2.7% 2.7 million 3
5 Malaria 1.3 million 2.2% 2.0 million 4
6 Measles 0.6 million 1.1% 1.1 million 5
7 Pertussis 0.29 million0.5% 0.36 million 7
8 Tetanus 0.21 million 0.4% 0.15 million 12
9 Meningitis0.17 million 0.3% 0.25 million 8
10 Syphilis0.16 million 0.3% 0.19 million 11
11 Hepatitis B 0.10 million 0.2% 0.93 million 6
12-17 Tropical diseases (6)[9] 0.13 million 0.2% 0.53 million 9, 10, 16-18
Note: Other causes of death include maternal and perinatal conditions (5.2%), nutritional deficiencies (0.9%),
noncommunicable conditions (58.8%), and injuries (9.1%).

The top three single agent/disease killers are HIV/AIDS, TB and malaria. While the number of deaths due to nearly every disease have decreased, deaths due to HIV/AIDS have increased fourfold. Childhood diseases include pertussis, poliomyelitis, diphtheria, measles and tetanus. Children also make up a large percentage of lower respiratory and diarrheal deaths.

Historic pandemicsEdit

Smallpox PHIL 3265 lores

A young Bangladeshi girl infected with smallpox (1973). Thanks to the development of the smallpox vaccine, the disease was officially eradicated in 1979.

A pandemic (or global epidemic) is a disease that affects people over an extensive geographical area.

  • Plague of Justinian, from 541 to 750, killed between 50 and 60 percent of Europe's population.[10]
  • The Black Death of 1347 to 1352 killed 25 million in Europe over 5 years (estimated to be between 25 and 50% of the populations of Europe, Asia, and Africa - the world population at the time was 500 million).
  • The introduction of smallpox, measles and typhus to the areas of Central and South America by European explorers during the 15th and 16th centuries caused pandemics among the native inhabitants. Between 1518 and 1568 disease pandemics are said to have caused the population of Mexico to fall from 20 million to 3 million.[11]
  • The first European influenza epidemic occurred between 1556 and 1560, with an estimated mortality rate of 20%.[11]
  • Smallpox killed an estimated 60 million Europeans in the 18th century alone. Up to 30% percent of those infected, including 80% of the children under 5 years of age, died from the disease, and one third of the survivors went blind. [12]
  • The Influenza Pandemic of 1918 (or the Spanish Flu) killed 25-50 million people (about 2% of world population of 1.7 billion).[13] Today Influenza kills about 250,000 to 500,000 worldwide each year.

Emerging diseases and pandemicsEdit

In most cases, microorganisms live in harmony with their hosts. Such is the case for many tropical viruses and the insects, monkeys, or other animals in which they have lived and reproduced. Because the microbes and their hosts have co-evolved, the hosts gradually become resistant to the microorganisms. When a microbe jumps from a long-time animal host to a human being, it may cease to be a harmless parasite and become pathogenic.[14]

With most new infectious diseases, some human action is involved, changing the environment so that an existing microbe can take up residence in a new niche. When that happens, a pathogen that had been confined to a remote habitat appears in a new or wider region, or a microbe that had infected only animals suddenly begins to cause human disease.

Several human activities have led to the emergence and spread of new diseases,[14] see also Globalization and Disease:

  • Encroachment on wildlife habitats. The construction of new villages and housing developments in rural areas brings people into contact with animals--and the microbes they harbor.
  • Changes in agriculture. The introduction of new crops attracts new crop pests and the microbes they carry to farming communities, exposing people to unfamiliar diseases.
  • The destruction of rain forests. As countries make use of their rain forests, by building roads through forests and clearing areas for settlement or commercial ventures, people encounter insects and other animals harboring previously unknown microorganisms.
  • Uncontrolled urbanization. The rapid growth of cities in many developing countries tends to concentrate large numbers of people into crowded areas with poor sanitation. These conditions foster transmission of contagious diseases.
  • Modern transport. Ships and other cargo carriers often harbor unintended "passengers", that can spread diseases to faraway destinations. While with international jet-airplane travel, people infected with a disease can carry it to distant lands, or home to their families, before their first symptoms appear.

See alsoEdit

Notes and referencesEdit

  1. Dorland's Illustrated Medical Dictionary 2004 WB Saunders.
  2. 2.0 2.1 "Infectious disease." McGraw-Hill Encyclopedia of Science and Technology. The McGraw-Hill Companies, Inc., 2005.
  3. Glossary of Notifiable Conditions Washington State Department of Health
  4. This section incorporates public domain materials included in the text: Medical Microbiology Fourth Edition: Chapter 8 (1996) . Baron, Samuel MD. The University of Texas Medical Branch at Galveston.
  5. Kenneth J. Ryan and C. George Ray, Sherris Medical Microbiology Fourth Edition McGraw Hill 2004.
  6. The World Health Report - 2004 Annex Table 2 (pdf) and 1995 Table 5 (pdf-large!)
  7. Lower respiratory infections include various pneumonias, influenzas and acute bronchitis.
  8. Diarrheal diseases are caused by many different organisms, including cholera, botulism, and E. coli to name a few. See also: Intestinal infectious diseases
  9. Tropical diseases include Chagas disease, dengue fever, lymphatic filariasis, leishmaniasis, onchocerciasis, schistosomiasis and trypanosomiasis.
  10. Infectious and Epidemic Disease in History
  11. 11.0 11.1 Dobson, Andrew P. and E. Robin Carter (1996) Infectious Diseases and Human Population History (full-text pdf) Bioscience;46 2.
  12. Smallpox: The Triumph over the Most Terrible of the Ministers of Death
  13. Influenza of 1918 (Spanish Flu) and the US Navy
  14. 14.0 14.1 H. Krauss, A. Weber, M. Appel, B. Enders, A. v. Graevenitz, H. D. Isenberg, H. G. Schiefer, W. Slenczka, H. Zahner: Zoonoses. Infectious Diseases Transmissible from Animals to Humans. 3rd Edition, 456 pages. ASM Press. American Society for Microbiology, Washington DC., USA. 2003. ISBN 1-55581-236-8

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