INTRODUCTION TO

THE INFECTIOUS DISEASES COURSE

Nowadays there are about 2,500 well-known microorganisms that cause infectious
diseases. Many infectious diseases have been known since ancient times, such as plague,
smallpox, measles, polio, tetanus. In the last 30-40 years, there have been new, previously
unknown diseases, including particularly dangerous infections such as hemorrhagic fever
Ebola, Marburg, Lassa. Scientists identified the human immunodeficiency virus, described
the disease that causes acquired immunodeficiency syndrome. The flu virus has been
changing regularly. You have probably heard of swine and bird flu.
The common feature of the infectious diseases is the possibility of transmission
from the affected organism to a healthy one.
Every infectious disease is characterized by a definite etiology and has its own
specific causative agent. For example, the causative typhoid fever agent is Salmonella
typhi, diphtheria is toxigenic Corynobacterium diphtheria, etc. Many pathogenic
microorganisms produce toxins which cause a number of disorders in the organism.
Pathogenicity is the ability of a microorganism to cause a pathologic process in the
organism.
Virulence means the pathogenicity degree.
Toxigenicity denotes the ability of a microorganism to produce a toxin.
Toxinaemia is the circulation of microbial toxins in the blood.
Bacteraemia and viraemia signify the microorganisms circulation in the blood.
Infection (from Latin “infection” is to make something harmful, infect) represents the
interaction of the pathogen with the host.
Infectious disease is a painful condition that is not only caused, but also supported
by the presence of a living pathogen in the body. Under its influence the body responds
with a protective reaction and the specific immunity production (antibodies).
The infectious process is the process of interaction of the pathogenic
microorganism and the human body.
Infection in persons occurs necessarily in a particular environment. It manifests
itself at the molecular, subcellular, cellular, tissue, organ and organism levels and
naturally ends with either death of a person or his complete release from the pathogen.

Infectious Diseases Classification

Infectious diseases may be classified depending on the infection source and their
transmission mechanisms (anthroponoses, zoonoses, anthropozoonoses,
zooanthroponoses, sapronoses) or depending on their etiology (bacterial, viral,
protozooal, helminth infections).
The infectious disease may be classified according to the primary localization of the
causative agents, the main pathological process in the body, clinical picture of the
diseases and their epidemiologic signs (intestinal, respiratory, blood infections, skin
infections and mucous membranes).
Intestinal infections (typhoid fever, paratyphoids A and B, salmonellosis,
dysentery, amebiasis, cholera, botulism, etc.) are characterized by invasion of the
causative agents into the gastrointestinal tract through the mouth. The causative agents
may localize only in gastrointestinal tract (V. cholera, Sh. Flexneri; E. coli and others).
Also pathogenic microorganisms are able to enter the bloodstream with resultant
bacteraemia or viraemia (S. typhy, different serotypes of genus Salmonella, Poliovirus
hominis and others). Clinical picture is characterized by different symptoms of
gastrointestinal tract damage.
In the majority of cases respiratory infections (influenza, parainfluenza, measles,
chickenpox, meningococcal infection and others) are due to many viral and bacterial
agents. But viruses are far more common.
 Blood infections are characterized by the penetration of the causative agent into
the bloodstream of a person. It may occur through bloodsucking insects bites (tick-borne
encephalitis, malaria), by sexual contacts (viral hepatitis B, HIV-infection) or transfusion of
infected blood (viral hepatitis B, C and D, HIV-infection).
Skin infections and mucous membranes include anthrax, tetanus, erysipelas,
veneral and a number of other diseases. Causative agents are transmitted from patient or
infected animals and enter the organism of a healthy person mainly through damaged skin
or mucous membranes.
Protozoal and helminthic infections constitute special infectious groups.
Protozoal infections are caused by different unicellular pathogenic organisms (Entamoeba
histolytica, Balantidium coli, Giardia lamblia, etc.). The diseases caused by pathogenic
protozoa may spread by the faecal-oral route (Entamoeba histolytica, Balantidium coli),
blood-sucking insects (Plasmodium species, Trypanosoma, Leishmania), sexual contacts
(Trichomonas vaginalis) and through ingestion of undercooked meat, containing tissue
cysts (Toxoplasma gondii).
The major groups of parasitic worms are the following: intestinal nematodes,
tissue nematodes, trematodes, cestodes. Helminths may parasitize in different cavities,
tissues and organs of the body with development of corresponding clinical disease
symptoms.
According to the speed of clinical picture development and the general course of
infectious diseases it may be divided into the following forms: acute, subacute,
fulminant, protracted and chronic. Besides, the infectious disease course may be
typical or atypical.
The stages in the infectious disease
The incubation period occurs in every infectious disease and it lasts from the
invasion moment of the pathogenic microorganisms through the portal entry to the
appearance of the first disease clinical symptoms. The incubation period duration may be
from several hours to several months. During this period the microorganisms can spread
throughout the organism and multiply in different organs and tissues.
The prodromal period follows the incubation period. During this period the first
symptoms of the disease appear. For example the prodromal period in hepatitis В may last
to 2 or 3 weeks. But sometimes the prodromal period may be absent.
The prodromal period is followed by the active manifestations period with
subsequent development of the complete clinical disease picture. For example, in measles
on the 2nd or 3rd day of the prodromal period Belsky-Filatov-Koplik's sign in the mucous
membranes of the
Three stages of the active manifestation period of the infectious disease are
distinguished: the initial stage, the disease peak and the stage of all pathologic
manifestations abatement.
The infectious diseases severity varies considerably and depends on organism
susceptibility to the invasion of the particular microorganisms. Concurrent diseases,
intoxications, avitaminosis, insufficient immune reaction prior to the infectious disease
onset can foster the development of a severe course or a chronic form.
Complications may sometimes develop during the disease course or
convalescence. Besides, in some diseases (typhoid fever, malaria and others) the clinical
manifestation of the disease may recur (relapses).
Persons, who have survived infectious diseases, usually acquire mild, unstable
(dysentery) or lasting (typhoid fever) immunity. In some diseases immunity lasts for the
whole life (VHA, measles).
In cases of early diagnosis and adequate treatment infectious diseases frequently
end in complete recovery. Sometimes pathogenic microorganisms ([Link], Rickettsia
prowazekii, malarial plasmodia and others) may persist in the organism for a long time
without clinical symptoms. In such cases the excretion of pathogenic microorganisms into
the external environment may occur (S. typhi, S. typhimurium).
 The temperature rise is one of the earliest symptoms which gives ground to think of
an infection when there are still no other clinical manifestations of the illness.
The temperature curve nature
It is accepted to determine several types of a temperature curve, which are a
diagnostic value.
The remittent fever (f. remittens) is distinguished by daily fluctuations of the body
temperature from more than 1°C but not more than 2 °C (ornithosis).
The intermittent fever (f. intermittens) is manifested by the correct change of the
high or very high and normal temperature with daily fluctuations of 3-4 °C (malaria).
The relapsing fever (f. recurrens) is characterized by the correct change of the high-
fever and fever-free periods that last several days (typhoid fever, etc.).
The undulating or undulant fever (f. undulans) is distinguished by a gradual increase
of the temperature up to the high points and then its gradual decrease to the subfebrile or
normal temperature; in 2-3 weeks the cycle is repeated (visceral leishmaniasis,
brucellosis).
The hectic (exhausting) fever (f. hectica) is a prolonged fever with considerable
daily fluctuations (3-5°C) with the decrease to the normal or subnormal temperature
(sepsis, generalized virus infection, etc.).
The irregular (atypical) fever (f. irregularis) is characterized by large daily amplitude,
a various degree of a temperature increase, an indeterminate duration. It stands closer to
the hectic fever, but does not have a regular rhythm (sepsis, etc.).
The distorted (inverted) fever (f. inversa) is distinguished by a higher morning
temperature than the evening one.
The fever duration haves an important value for the differential diagnosis. A large
number of diseases are characterized by a short-term fever (herpangina, acute
shigellosis).
The long-term fever (more than a month) is observed seldom and only in infectious
diseases which have the lingering or chronic flow (brucellosis, toxoplasmosis, visceral
leishmaniasis). Thus the grade and characteristic of a temperature curve and the fever
duration allow to differentiate certain groups of infectious diseases.
Еxanthema
The second component which is very important for the diagnosis is a rash on the
skin – exanthema. There are exanthemas, characteristic of this or that infectious disease.
The following classificatia is generally accepted in infectious diseases.
Roseola – is a small spot (diameter 2-5 mm) of pink, red or purple-red color, often
of a spherical form. It is formed as a result of a local vasodilatation of a skin papillary layer.
The roseola disappears when the eruption area is pressed or the skin is stretched and
then it comes up again.
Рunctate rash consists of a set of shallow (about 1 mm) red elements. When the
skin is stretched these elements disappear. Each element rises a little above the skin
level.
Maculae (macula) represents an element, similar to the roseola, but larger (5-20
mm). It does not rise above the skin level. Its color is the same as roseola’s one. The
maculae form can be oval or spherical. There is small-spot eruption, when the elements
vary in diameter from 5 up to 10 mm (rubella) and large-spot eruption with the elements’
diameter of 11-20 mm (measles).
Papulae (papula) – a superficial formation without a cavity, rising above the skin
level. It has a mild or dense consistence, the reverse development ends without the scar
formation. Papulas have the same color as roseola. There are papulas of a different size
(1-20 mm).
Erythema is vast fields of the bloodshot skin which are red or purple-red. The
erythema is formed as a result of large maculae joining. Therefore the erythema has
festoon blurred edges.
 Tubercle (tuberculum, hillocks) is a formation without cavities which arise as a
result of an inflammatory infiltrate in derma. It lies deep in the derma and have distinct
borders. The hillock can necrotize, forming ulcers and leaving a scar. The hillocks develop
in dermal and visceral leishmaniasis.
Node (nodus) is a limited dense formation with a diameter from 1 up to 5 cm and
more that has a spherical or oval form. It is situated in the deep layers of derma and
hypodermic fat. In some cases they disappear without any traces (nodal erythema), in
chronic illnesses they ulcerate and heal leaving a scar.
Wheal (urtica) is an element of an acute inflammatory nature that has no cavity. It
has the cyanotic white coloring in the center and the pink-red one on the peripherals. An
itch and a burning skin sensation appear with the rash development. The urtica develops
in a serum disease, medicinal allergy and sometimes in infectious diseases (leptospirosis,
virus hepatitis).
Vesicle (vesicula) is a small cavity formation containing serous, less often serous-
hemorrhagic fluid with a diameter from 1 up to 5 mm. Then a blister can dry out, forming a
yellowish or brown crust. If a blister is damaged, soaking superficial erosion develops on
its place.
Pustule (pustula) is also a blister but its content is cloudy (purulent) because of a
large amount of leucocytes.
Blister (bulla) is a cavity formation with a dimension of more than 5 mm (up to 10
cm and more). The vesical borders are legible, the outline is round or oval. It is usually
unicameral and rolls off after a puncture. The contents is serous or serous-hemorrhagic.
The vesicles can be situated on the background of the inflamed skin (bullous form of
erysipelas, anthrax).
Hemorrhages (hemorrhage) is an extravasation into the skin of different kinds and
dimensions. They develop as a result of the erythrocytes yield from veins to the ambient
connecting tissue of derma or hypodermic fatty tissue. It can be a result of the vessel
damage or high permeability of a vascular wall.
According to the value and form hemorrhages are divided into the following
elements: petechias (petechiae) is dotted hemorrhages on the background of the normal
skin (primary petechias) or on the background of roseolas (secondary petechias); in
purpura the elements dimension oscillates from 2 up to 5 mm; ecchymomas
(ecchymosis) is the irregular-shaped form hemorrhages with a diameter of more than 5
mm.
All the reviewed exanthemas belong to the primary morphological elements of the
eruption. However, the secondary morphological elements of the eruption also have a
diagnostic value.
Erosion (erosio) is a epidermis defect which develops after opening of the cavity
primary elements (vesicles, pustules). After healing the erosion do not leave any skin
changes.
Ulcer (ulcus) is a deep skin defect which affects the epidermis, derma, and
sometimes underlying tissues. The ulcer develops as a result of the primary elements
disintegration in the deep parts of the derma (bullae, pustules). The ulcer always heals
leaving a cicatrix. The ulcers develop both in the infectious diseases (dermal
leishmaniasis, anthrax, tularemia) and in the noninfectious one (lues, tuberculosis,
neoplasm).
Skin dischromia (dyschromia cutis) is a pigmentation disorder which develops on
the place of the resolved elements of the dermal eruption. As a rule, pigmentary spots are
brown (measles, typoid fever).
Scale (squama) is a loosened tearing away cell of the corneous layer, which lost its
connection with the underlying epidermis. Depending on the flakes size there is micro-
and macrolaminar pityriasis. Small-laminar is observed in measles.
Macrolaminar pityriasis is characterized with a larger dimension of the flakes, and
they can get detached from the skin by the whole layers. The similar pityriasis is
characteristic of scarlet fever, pseudo-tuberculosis. The pityriasis develops in the period of
convalescence from the infectious diseases.
Crust (crusta) is a thickening product and desiccation of different kinds of exudates
elements (pustules, vesicles, ulcers). There are serous crusts (semidiaphanous or
grayish), purulent (yellow or green-yellow) and hemorrhagic (brown or dark red).
Cicatrix (cicatrix) is coarse-fibroid growth of the connecting tissue, which
substitutes skin deep defects.
The differential diagnostics of the infectious diseases is based on kind of
exanthema. The elements localization and the concentration place have a diagnostic
value. The duration of the elements existence, the sequence of the rash development,
repeated rashes are also important.
In addition to the clinical picture, in order to diagnose an infectious disease, the
doctor needs to find out an epidemiological anamnesis (use of stale food, departure to
other regions, contacts with infectious patients or animals, sexual contacts, or percutaneus
inoculation of their blood, the injections given to the patient, etc.)

To confirm the infectious diseases diagnosis are used a lot of specific laboratory
tests (investigation of the microscopy blood and cerebral fluid in malaria, meningococcal
infection and others).
The bacteriological method is used for confirmation of many bacterial diseases
diagnosis (typhoid fever, salmonellosis, cholera, diphtheria and others).
Immunological methods of examination (serological tests) are based on the
discovery of antibodies or antigens in many infectious diseases. Different serological tests
(RIHA, SAT, ELISA and others) are used for this purpose. For rapid diagnosis of different
infectious diseases PCR can be performed. Using this method virus or bacterium DNA or
RNA may be detected in the blood or other biological fluids (HIV, influenza, plague, VHB,
VHC, toxoplasmosis and many others).
In the infectious diseases diagnosis important role is played by such instrumental
methods as X-ray examination, colonoscopy, CT, MRT. Diagnosis is founded on a
complex of clinical, epidemiologic data and results of laboratory and instrumental
investigations.