Biology of Disease

cells and grows intracellularly. The major symptoms are fevers of up to 40oC

and the development of abscesses in the intestine that may cause perforations

and a fatal peritonitis. Even when the patient recovers, a relapse may occur.

Salmonella typhi infects about 60 million patients annually, mainly in the

developing world. If untreated, it can be fatal. Some recovered patients retain

the pathogen in the gall bladder and excrete bacteria in their feces, becoming

carriers, although remaining healthy themselves.

The zoonosis, brucellosis, caused by various species of Brucella (Figure 3.24), is

also a primary systemic infection. This is a common infection of cattle (Brucella

abortus), sheep and goats (Brucella melitensis) and can infect humans if they

drink contaminated milk, if they inhale the bacteria into the lungs or if there

is direct contact through skin lesions. People who work in direct contact with

animals, such as farmers, veterinarians, shepherds, goatherds and abattoir

workers, are most at risk. The pathogen colonizes and grows in the main

abdominal organs and bone marrow producing periodic attacks of relapsing

fever over an extended period.

3.8 Investigating Infectious Diseases

To diagnose an infectious disease, two criteria must be satisfied. First, signs

and symptoms compatible with the suspected infectious agent must be

apparent. Secondly, the pathogen must be recovered from the infected site of

the patient or there must be evidence of the pathogen being present at that

site.

Infectious diseases can affect any organ or system and can cause a wide variety

of symptoms and signs (Chapter 1). The clinical history and examination

should aim to identify the sites of infection and the causative organism. The

clinical history focuses on aspects relevant to infectious disease, such as

recent travel history, food and water intake, occupational exposure, sexual

activity and any use of intravenous drugs. The clinical examination involves

identifying fever, skin rashes, swollen lymph nodes (lymphadenopathy) and

investigations of the eyes, ears, mouth and throat. Fever is a typical symptom

of infection but not all patients with fever have an infection and not all

infectious diseases present with fever. Investigations of the vagina, rectum

and penis are necessary in sexually transmitted diseases.

The history and clinical examination is often supported by tests to assess health

and identify the organs affected. These tests include imaging techniques such

as X-rays, ultrasound, computerized tomography (CT), magnetic resonance

imaging and blood tests (Chapters 18and 13 ). The blood tests involve a full

blood count where eosinophilia is an important finding in parasitic infections

and lymphocytosis is usually found in viral infections. The erythrocyte

sedimentation rate and C-reactive protein (Chapter 4) levels are nonspecific

tests of value in monitoring the course of infectious diseases. Other tests

involve assessing liver and renal functions (Chapters 11 and 8 ), which may be

disrupted by an infection.

Microbiological tests to identify the infectious agents are especially helpful.

Specimens for microbiological investigations include blood, cerebrospinal

fluid (CSF), feces, pus, sputum and urine (Chapter 1). Microbiological

investigations use a variety of techniques, including culture, serological,

biochemical and molecular biological tests.

Culture

The suspected microorganism from the patient is grown outside the body

usually on or in growth media, such as nutrient agar or broth, or in selective

media which support the growth of particular microorganisms, until growth

X]VeiZg(/ INFECTIOUS DISEASES AND TREATMENTS

*) W^dad\nd[Y^hZVhZ

Figure 3.23 Electron micrograph of Salmonella

typhimurium.Courtesy of Dr A. Curry, Manchester

Royal Infirmary, UK.

Figure 3.24 Light micrograph of Brucella species.

Courtesy of L. Stauffer, Public Health Image Library,

Centers for Disease Control and Prevention, USA.

Salmonella typhimurium (Figure

3.23), as its name suggests, causes

a lethal, systemic infection that

resembles typhoid fever in mice.

However, in humans it does not cause

as severe a disease as Salmonella

typhi although it is a major cause of

food poisoning. This rarely leads to

fatalities, other than in the elderly

or very young or in patients with

depressed immune systems who

are not treated with antibiotics. The

disease is characterized by symptoms

of nausea and vomiting, abdominal

cramps and diarrhea that generally

last up to seven days.

Margin Note 3.2 Salmonella

typhimurium i