Infectious diseasemedicine, infectious disease is disease caused by a biological agent, as opposed to physical (e.g. burns) or chemical (e.g. intoxication) causes.
|Table of contents|
2 The science of infectious disease
3 Diagnosis and therapy
4 The work of an infectiologist
6 See also
Agents and vectors
Infectious disease requires an agent and a mode of transmission (or vector). A good example is malaria, which is mainly caused by the parasite Plasmodium falciparum but does not affect humans unless the vector, the Anopheles mosquito, is around to introduce the Plasmodium into the human bloodstream.
The science of infectious disease
To prove whether a disease is of infectious nature, it has to answer Koch's postulates (Robert Koch), namely that the infectious agent is identified in patients and not in controls, and that patients who contract the agent also develop the disease. These postulates were tried and tested in the discovery of Mycobacteria as the cause for tuberculosis. Often, it has proven to be very hard to meet some of the criteria. For example, Treponema pallidum, the causative spirochete of syphilis, cannot be cultured.
Diagnosis is initially by medical history and physical examination, and imaging (such as X-rays), but the principal tool in infectious disease is the microbiological culture, i.e. providing a growth medium for a particular agent and determining whether there is growth on the media. This works for a number of bacteria, for example Staphylococcus or Streptococcus.
Certain agents cannot be cultured, for example the above-mentioned Treponema pallidum and most viruses. The first serological markers were developed to diagnose syphilis (the Wassermann test, later replaced by the VDRL and TPHA tests). Serology generally means detecting the antibodies against an infectious agent in the (suspected) patient's blood. In immunocompromised patients (e.g. AIDS), serology can be troublesome, because the antibody reaction is blunted.
A more recent is direct detection of viral proteins and/or DNA in blood or secretions. The latter can be done by PCR (polymerase chain reaction), i.e. the amplification of viral DNA and the subsequent detection with anti-DNA probes.
When a culture has proven to be positive, the sensitivity (or, conversely, the antibiotic resistance) of an agent can be determined by exposing it to test doses of antibiotic. This way, the microbiologist determines how sensitive the target bacterium is to a certain antibiotic - this is usually reported as being: Sensitive, Intermediate or Resistant. The antibiogram can then be used to determine optimal therapy for the patient. This can reduce the use of broad-spectrum antibiotics and lead to a decrease in antibiotic resistance.
The work of an infectiologist
Doctors who specialise in the medical treatment of infectious disease are called infectiologist or infectious disease specialist. Generally, infections are diagnosed by primary care physicians or internal medicine specialists. For example, an "uncomplicated" pneumonia will generally be treated by the internist or the pulmologist (lung physician).
The services of the infectious disease team are generally only called when:
- The patient is immunocompromised (for example, in AIDS or after chemotherapy);
- The infectious agent is of uncommon nature (e.g. tropical diseases);
- The disease has not responded to "normal" antibiotics;
- The disease might be dangerous to other patients, and the patient might have be isolated.
Louis Pasteur proved beyond doubt that certain diseases can be caused by infectious agents.
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