1

Immunity[edit]

Mary Mallon (a.k.a. Typhoid Mary) was an asymptomatic carrier of typhoid fever. Over the course of
her career as a cook, she infected 53 people, three of whom died.
Infection with most pathogens does not result in death of the host and the offending
organism is ultimately cleared after the symptoms of the disease have waned. [44] This process
requires immune mechanisms to kill or inactivate the inoculum of the pathogen. Specific
acquired immunity against infectious diseases may be mediated by antibodies and/or T
lymphocytes. Immunity mediated by these two factors may be manifested by:

 a direct effect upon a pathogen, such as antibody-initiated complement-dependent

bacteriolysis, opsonoization, phagocytosis and killing, as occurs for some bacteria,
 neutralization of viruses so that these organisms cannot enter cells,
 or by T lymphocytes, which will kill a cell parasitized by a microorganism.
The immune system response to a microorganism often causes symptoms such as a
high fever and inflammation, and has the potential to be more devastating than direct damage
caused by a microbe.[11]
Resistance to infection (immunity) may be acquired following a disease, by asymptomatic
carriage of the pathogen, by harboring an organism with a similar structure (crossreacting), or
by vaccination. Knowledge of the protective antigens and specific acquired host immune factors is
more complete for primary pathogens than for opportunistic pathogens. There is also the
phenomenon of herd immunity which offers a measure of protection to those otherwise vulnerable
people when a large enough proportion of the population has acquired immunity from certain
infections.
Immune resistance to an infectious disease requires a critical level of either antigen-specific
antibodies and/or T cells when the host encounters the pathogen. Some individuals develop
natural serum antibodies to the surface polysaccharides of some agents although they have had
little or no contact with the agent, these natural antibodies confer specific protection to adults and
are passively transmitted to newborns.
Host genetic factors[edit]

The organism that is the target of an infecting action of a specific infectious agent is called
the host. The host harbouring an agent that is in a mature or sexually active stage phase is called
the definitive host. The intermediate host comes in contact during the larvae stage. A host can be
anything living and can attain to asexual and sexual reproduction. [56] The clearance of the pathogens,
either treatment-induced or spontaneous, it can be influenced by the genetic variants carried by the
individual patients. For instance, for genotype 1 hepatitis C treated with Pegylated interferon-alpha-
 2

2a or Pegylated interferon-alpha-2b (brand names Pegasys or PEG-Intron) combined with ribavirin,

it has been shown that genetic polymorphisms near the human IL28B gene, encoding interferon
lambda 3, are associated with significant differences in the treatment-induced clearance of the virus.
This finding, originally reported in Nature,[57] showed that genotype 1 hepatitis C patients carrying
certain genetic variant alleles near the IL28B gene are more possibly to achieve sustained virological
response after the treatment than others. Later report from Nature [58] demonstrated that the same
genetic variants are also associated with the natural clearance of the genotype 1 hepatitis C virus.

Treatments[edit]
When infection attacks the body, anti-infective drugs can suppress the infection. Several
broad types of anti-infective drugs exist, depending on the type of organism targeted; they include
antibacterial (antibiotic;
including antitubercular), antiviral, antifungal and antiparasitic (including antiprotozoal and antihelmin
thic) agents. Depending on the severity and the type of infection, the antibiotic may be given by
mouth or by injection, or may be applied topically. Severe infections of the brain are usually treated
with intravenous antibiotics. Sometimes, multiple antibiotics are used in case there is resistance to
one antibiotic. Antibiotics only work for bacteria and do not affect viruses. Antibiotics work by slowing
down the multiplication of bacteria or killing the bacteria. The most common classes of antibiotics
used in medicine
include penicillin, cephalosporins, aminoglycosides, macrolides, quinolones and tetracyclines.[59][60]
Not all infections require treatment, and for many self-limiting infections the treatment may
cause more side-effects than benefits. Antimicrobial stewardship is the concept that healthcare
providers should treat an infection with an antimicrobial that specifically works well for the target
pathogen for the shortest amount of time and to only treat when there is a known or highly
suspected pathogen that will respond to the medication. [61]

Epidemiology[edit]

Deaths due to infectious and parasitic diseases per million persons in 2012
  28–81
  82–114
  115–171
  172–212
  213–283
  284–516
  517–1,193
  1,194–2,476
  2,477–3,954
 3

  3,955–6,812
See also: Epidemic and Pandemic

Disability-adjusted life year for infectious and parasitic diseases per 100,000 inhabitants in 2004. [62]
  no data
  ≤250
  250–500
  500–1000
  1000–2000
  2000–3000
  3000–4000
  4000–5000
  5000–6250
  6250–12,500
  12,500–25,000
  25,000–50,000
  ≥50,000

In 2010, about 10 million people died of infectious diseases.[63]

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
by number of deaths in 2002. 1993 data is included for comparison.
 4

Worldwide mortality due to infectious diseases[64][65]

De De
Perce 1
R Cause aths 2002 aths 1993
ntage of 993
ank of death (in (in
all deaths Rank
millions) millions)

All 32.
N/A 14.7 25.9% 16.4
infectious diseases 2%

Lower

1 respiratory 3.9 6.9% 4.1 1

infections[66]

2 HIV/AIDS 2.8 4.9% 0.7 7

Diarrheal
3 1.8 3.2% 3.0 2
diseases[67]

Tuberculosi
4 1.6 2.7% 2.7 3
s (TB)

5 Malaria 1.3 2.2% 2.0 4

 5

Worldwide mortality due to infectious diseases[64][65]

De De
Perce 1
R Cause aths 2002 aths 1993
ntage of 993
ank of death (in (in
all deaths Rank
millions) millions)

6 Measles 0.6 1.1% 1.1 5

7 Pertussis 0.29 0.5% 0.36 7

8 Tetanus 0.21 0.4% 0.15 12

9 Meningitis 0.17 0.3% 0.25 8

10 Syphilis 0.16 0.3% 0.19 11

11 Hepatitis B 0.10 0.2% 0.93 6

12– Tropical 9,
0.13 0.2% 0.53
17 diseases (6)[68] 10, 16–18

Note: Other causes of death include maternal and perinatal conditions (5.2%), nutritional deficiencies

(0.9%),
 6

Worldwide mortality due to infectious diseases[64][65]

De De
Perce 1
R Cause aths 2002 aths 1993
ntage of 993
ank of death (in (in
all deaths Rank
millions) millions)

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. In 2012,
approximately 3.1 million people have died due to lower respiratory infections, making it the number
4 leading cause of death in the world.[69]

Historic pandemics[edit]

Great Plague of Marseille in 1720 killed 100,000 people in the city and the surrounding provinces
With their potential for unpredictable and explosive impacts, infectious diseases have been
major actors in human history.[70] A pandemic (or global epidemic) is a disease that affects people
over an extensive geographical area. For example:

 Plague of Justinian, from 541 to 542, killed between 50% and 60% of Europe's population. [71]
 The Black Death of 1347 to 1352 killed 25 million in Europe over 5 years. The plague reduced
the old world population from an estimated 450 million to between 350 and 375 million in the
14th century.
 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.[72]
 7

 The first European influenza epidemic occurred between 1556 and 1560, with an estimated
mortality rate of 20%.[72]
 Smallpox killed an estimated 60 million Europeans during the 18th century [73] (approximately
400,000 per year).[74] Up to 30% 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. [75]
 In the 19th century, tuberculosis killed an estimated one-quarter of the adult population of
Europe;[76] by 1918 one in six deaths in France were still caused by TB.
 The Influenza Pandemic of 1918 (or the Spanish flu) killed 25–50 million people (about 2% of
world population of 1.7 billion).[77] Today Influenza kills about 250,000 to 500,000 worldwide each
year.
Emerging diseases[edit]
In most cases, microorganisms live in harmony with their hosts
via mutual or commensal interactions. Diseases can emerge when existing parasites become
pathogenic or when new pathogenic parasites enter a new host.

1. Coevolution between parasite and host can lead to hosts becoming resistant to the parasites

or the parasites may evolve greater virulence, leading to immunopathological disease.
2. Human activity is involved with many emerging infectious diseases, such as environmental
change enabling a parasite to occupy new niches. When that happens, a pathogen that had
been confined to a remote habitat has a wider distribution and possibly a new host
organism. Parasites jumping from nonhuman to human hosts are known as zoonoses.
Under disease invasion, when a parasite invades a new host species, it may become
pathogenic in the new host.[78]
Several human activities have led to the emergence of zoonotic human pathogens, including
viruses, bacteria, protozoa, and rickettsia,[79] and spread of vector-borne diseases,[78] see
also globalization and disease and wildlife disease:

 Encroachment on wildlife habitats. The construction of new villages and housing developments

in rural areas force animals to live in dense populations, creating opportunities for microbes to
mutate and emerge.[80]
 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.

Germ theory of disease[edit]

Main article: Germ theory of disease
 8

East German postage stamps depicting four antique microscopes. Advancements in microscopy were

essential to the early study of infectious diseases.
In Antiquity, the Greek historian Thucydides (c. 460 – c. 400 BCE) was the first person to
write, in his account of the plague of Athens, that diseases could spread from an infected person to
others.[81][82] In his On the Different Types of Fever (c. 175 AD), the Greco-Roman
physician Galen speculated that plagues were spread by "certain seeds of plague", which were
present in the air.[83] In the Sushruta Samhita, the ancient Indian physician Sushruta theorized:
"Leprosy, fever, consumption, diseases of the eye, and other infectious diseases spread from one
person to another by sexual union, physical contact, eating together, sleeping together, sitting
together, and the use of same clothes, garlands and pastes." [84][85] This book has been dated to about
the sixth century BC.[86]
A basic form of contagion theory was proposed by Persian physician Ibn Sina (known as
Avicenna in Europe) in The Canon of Medicine (1025), which later became the most authoritative
medical textbook in Europe up until the 16th century. In Book IV of the Canon, Ibn Sina
discussed epidemics, outlining the classical miasma theory and attempting to blend it with his own
early contagion theory. He mentioned that people can transmit disease to others by breath, noted
contagion with tuberculosis, and discussed the transmission of disease through water and dirt. [87] The
concept of invisible contagion was later discussed by several Islamic scholars in the Ayyubid
Sultanate who referred to them as najasat ("impure substances"). The fiqh scholar Ibn al-Haj al-
Abdari (c. 1250–1336), while discussing Islamic diet and hygiene, gave warnings about how
contagion can contaminate water, food, and garments, and could spread through the water supply,
and may have implied contagion to be unseen particles. [88]
When the Black Death bubonic plague reached Al-Andalus in the 14th century, the Arab
physicians Ibn Khatima (c. 1369) and Ibn al-Khatib (1313–1374) hypothesised that infectious
diseases were caused by "minute bodies" and described how they can be transmitted through
garments, vessels and earrings.[89] Ideas of contagion became more popular in Europe during
the Renaissance, particularly through the writing of the Italian physician Girolamo Fracastoro.
 9

 Anton van Leeuwenhoek (1632–1723) advanced the science of microscopy by being the first to
[90]

observe microorganisms, allowing for easy visualization of bacteria.

In the mid-19th century John Snow and William Budd did important work demonstrating the
contagiousness of typhoid and cholera through contaminated water. Both are credited with
decreasing epidemics of cholera in their towns by implementing measures to prevent contamination
of water.[91] Louis Pasteur proved beyond doubt that certain diseases are caused by infectious
agents, and developed a vaccine for rabies. Robert Koch, provided the study of infectious diseases
with a scientific basis known as Koch's postulates. Edward Jenner, Jonas Salk and Albert
Sabin developed effective vaccines for smallpox and polio, which would later result in
the eradication and near-eradication of these diseases, respectively. Alexander Fleming discovered
the world's first antibiotic, Penicillin, which Florey and Chain then developed. Gerhard
Domagk developed sulphonamides, the first broad spectrum synthetic antibacterial drugs.

Medical specialists[edit]
The medical treatment of infectious diseases falls into the medical field of Infectious
Disease and in some cases the study of propagation pertains to the field of Epidemiology. Generally,
infections are initially diagnosed by primary care physicians or internal medicine specialists. For
example, an "uncomplicated" pneumonia will generally be treated by the internist or
the pulmonologist (lung physician). The work of the infectious diseases specialist therefore entails
working with both patients and general practitioners, as well as laboratory
scientists, immunologists, bacteriologists and other specialists.
An infectious disease team may be alerted when:

 The disease has not been definitively diagnosed after an initial workup
 The patient is immunocompromised (for example, in AIDS or after chemotherapy);
 The infectious agent is of an uncommon nature (e.g. tropical diseases);
 The disease has not responded to first line antibiotics;
 The disease might be dangerous to other patients, and the patient might have to be isolated

Society and culture[edit]

Several studies have reported associations between pathogen load in an area and human
behavior. Higher pathogen load is associated with decreased size of ethnic and religious groups in
an area. This may be due high pathogen load favoring avoidance of other groups, which may reduce
pathogen transmission, or a high pathogen load preventing the creation of large settlements and
armies that enforce a common culture. Higher pathogen load is also associated with more restricted
sexual behavior, which may reduce pathogen transmission. It also associated with higher
preferences for health and attractiveness in mates. Higher fertility rates and shorter or less parental
care per child is another association that may be a compensation for the higher mortality rate. There
is also an association with polygyny which may be due to higher pathogen load, making selecting
males with a high genetic resistance increasingly important. Higher pathogen load is also associated
with more collectivism and less individualism, which may limit contacts with outside groups and
infections. There are alternative explanations for at least some of the associations although some of
these explanations may in turn ultimately be due to pathogen load. Thus, polygyny may also be due
to a lower male: female ratio in these areas but this may ultimately be due to male infants having
increased mortality from infectious diseases. Another example is that poor socioeconomic factors
may ultimately in part be due to high pathogen load preventing economic development. [92]

Fossil record[edit]
Main article: Paleopathology
 10

Herrerasaurus skull.
Evidence of infection in fossil remains is a subject of interest for paleopathologists, scientists
who study occurrences of injuries and illness in extinct life forms. Signs of infection have been
discovered in the bones of carnivorous dinosaurs. When present, however, these infections seem to
tend to be confined to only small regions of the body. A skull attributed to the early carnivorous
dinosaur Herrerasaurus ischigualastensis exhibits pit-like wounds surrounded by swollen and porous
bone. The unusual texture of the bone around the wounds suggests they were affected by a short-
lived, non-lethal infection. Scientists who studied the skull speculated that the bite marks were
received in a fight with another Herrerasaurus. Other carnivorous dinosaurs with documented
evidence of infection include Acrocanthosaurus, Allosaurus, Tyrannosaurus and a tyrannosaur from
the Kirtland Formation. The infections from both tyrannosaurs were received by being bitten during a
fight, like the Herrerasaurus specimen.[93]

Outer space[edit]
Main articles: Effect of spaceflight on the human body, Medical treatment during spaceflight,

and Space medicine

A 2006 Space Shuttle experiment found that Salmonella typhimurium, a bacterium that can

cause food poisoning, became more virulent when cultivated in space.[94] On April 29, 2013,
scientists in Rensselaer Polytechnic Institute, funded by NASA, reported that, during spaceflight on
the International Space Station, microbes seem to adapt to the space environment in ways "not
observed on Earth" and in ways that "can lead to increases in growth and virulence". [95] More
recently, in 2017, bacteria were found to be more resistant to antibiotics and to thrive in the near-
weightlessness of space.[96] Microorganisms have been observed to survive the vacuum of outer
space.[97][98]