infection

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n.

1. 1. Invasion by and multiplication of pathogenic microorganisms in a bodily part or tissue, which may produce subsequent tissue injury and progress to overt disease through a variety of cellular or toxic mechanisms.
   2. An instance of being infected.
   3. An agent or a contaminated substance responsible for one's becoming infected.
   4. The pathological state resulting from having been infected.
2. An infectious disease.
3. 1. Moral contamination or corruption.
   2. Ready communication of an emotion or attitude by contact or example.

Concept

Humans may hold dominance over most other life-forms on Earth, but a few varieties of organism have long held mastery over us. Ironically, these life-forms, including bacteria and viruses, are so small that they cannot be seen, and this, in fact, has contributed to their disproportionate influence in human history. For thousands of years, people attributed infection to spiritual causes or, at the very least, to imbalances of "humors," or fluids, in the human body. Today germ theory and antisepsis—the ideas that microbes cause infection and that a clean body and environment can prevent infections—are ingrained so deeply that we almost take them for granted. Yet these concepts are very recent in origin, and for a much longer span of human history people quite literally wallowed in filth—with predictable consequences.

How It Works

What Is Infection?

The term infection refers to a state in which parasitic organisms attach themselves to the body, or to the inside of the body, of another organism, causing contamination and disease in the host organism. Parasite refers generally to any organism that lives at the expense of another organism, on which it depends for support. Numerous parasites and the diseases they cause are discussed in the essay Parasites and Parasitology; in the present context, we are concerned primarily with infections that relate to bacteria and viruses.

Almost all infections contracted by humans are passed along by other humans or animals.

Infections fall into two general categories: exogenous, or those that originate outside the body, and endogenous, which occur when the body's resistance is lowered. Examples of exogenous infection include catching a cold by drinking after someone else from the same glass; coming down with salmonella after ingesting under-cooked eggs, meat, or poultry; getting rabies from a dog bite; or contracting syphilis, AIDS (acquired immunodeficiency syndrome), or some other sexually transmitted disease from an infected partner.

Any number of factors—lack of sleep, prolonged exposure to extreme cold or moisture, and so on—can lower the body's resistance, opening the way for an endogenous infection. Malnutrition, illness, and trauma also can be factors in endogenous infection. Substance abuse, whether it be the use of tobacco in its many forms, excessive drinking, or drug use, lowers the body's resistance. Furthermore, all of these behaviors tend to be coupled with poor eating habits, which invite infection by denying the body the nutrients it needs.

Some Terms

A whole array of terminology attends the study of infection and infectious diseases, a subject that is touched upon in the present context but explored at length in its own essay as well. Among these terms are the names for the different branches of study relating to infection, its agents, and the resulting diseases. Although germ theory is a term (defined later) that is used widely in the context of infection, germ itself—a common word in everyday life—is not used as much as microorganism or pathogen. The latter word refers to disease-carrying parasites, which are usually microorganisms. Two of the principal types of pathogen, bacteria and viruses, are discussed later in this essay.

Words relating to the effects of infectious agents include epidemic, an adjective meaning "affecting or potentially affecting a large proportion of a population"; as a noun, the word refers to an epidemic disease. Pandemic also doubles as an adjective, meaning "affecting an extremely high proportion of a population over a wide geographic area," and a noun, referring to a disease of pandemic proportions. Areas of study relating to pathogens, their effects, and the prevention of those effects include the following.

• Bacteriology: An area of the biological sciences concerned with bacteria, including their importance in medicine, industry, and agriculture)
• Epidemiology: An area of the medical sciences devoted to the study of disease, including its incidence, distribution, and control within a population)
• Etiology: A branch of medical study concerned with the causes and origins of disease. Also, a general term referring to all the causes of a particular disease or condition)
• Immunology: The study of the immune system, immunity, and immune responses)
• Pathology: The study of the essential nature of diseases)
• Virology: The study of viruses

In addition, there are several terms relating to the prevention of infection.

• Antibiotic: A substance produced by, or derived from, a microorganism, which in diluted form is capable of killing or at least inhibiting the action of another microorganism. Antibiotics typically are not effective against viruses.
• Antisepsis: The practice of inhibiting the growth and multiplication of microorganisms)
• Germ theory: A theory in medicine, widely accepted today, that infections, contagious diseases, and other conditions are caused by the actions of microorganisms)
• Immunity: A condition of being able to resist a particular disease, particularly through means that prevent the growth and development of pathogens or counteract their effects
• Inoculation: The prevention of a disease by the introduction to the body, in small quantities, of the virus or other microorganism that causes the disease
• Vaccine: A preparation containing microorganisms, usually either weakened or dead, which are administered as a means of increasing immunity to the disease caused by those microorganisms

Some of these words appear in this essay and others in related essays on infectious diseases and immunity.

Bacteria

Five major groups of microorganisms are responsible for the majority of infections. They include protozoa and helminths, or worms—both of which are considered in Parasites and Parasitology—as well as bacteria and viruses. Bacteria and viruses often are discussed, along with fungi (the fifth major group), in the context of infection and infectious diseases. In the present context, however, we limit our inquiry to viruses and bacteria.

Bacteria are very small organisms, typically consisting of one cell. They are prokaryotes, a term referring to a type of cell that has no nucleus. In eukaryotic cells, such as those of plants and animals, the nucleus controls the cell's functions and contains its genes. Genes carry deoxyribonucleic acid (DNA), which determines the characteristics that are passed on from one generation to the next. The genetic material of bacteria is contained instead within a single, circular chain of DNA.

Members of kingdom Monera, which also includes blue-green algae (see Taxonomy), bacteria generally are classified into three groups based on their shape: spherical (coccus), rodlike (bacillus), or spiralor corkscrew-shaped (spirochete). Some bacteria also have a shape like that of a comma and are known as vibrio. Spirochetes, which are linked to such diseases as syphilis, sometimes are considered a separate type of creature; hence, Monera occasionally is defined as consisting of blue-green algae, bacteria, and spirochetes.

The cytoplasm (material in the cell interior) of all bacteria is enclosed within a cell membrane that itself is surrounded by a rigid cell wall. Bacteria produce a thick, jellylike material on the surface of the cell wall, and when that material forms a distinct outer layer, it is known as a capsule. Many rod, spiral, and comma-shaped bacteria have whiplike limbs, known as flagella, attached to the outside of their cells. They use these flagella for movement by waving them back and forth. Other bacteria move simply by wiggling the whole cell back and forth, whereas still others are unable to move at all.

Bacteria most commonly reproduce by fission, the process by which a single cell divides to produce two new cells. The process of fission may take anywhere from 15 minutes to 16 hours, depending on the type of bacterium. Several factors influence the rate at which bacterial growth occurs, the most important being moisture, temperature, and pH, or the relative acidity or alkalinity of the substance in which they are placed.

Bacterial preferences in all of these areas vary: for example, there are bacteria that live in hydrothermal vents, or cracks in the ocean floor, where the temperature is about 660°F (350°C), and some species survive at a pH more severe than that of battery acid. Most bacteria, however, favor temperatures close to that of the human body—98.6°F (37°C)—and pH levels only slightly more or less acidic than water. Since they are composed primarily of water, they thrive in a moist environment.

Viruses

One of the interesting things about bacteria is their simplicity, coupled with the extraordinary complexity of their interactions with other organisms. As simple as bacteria are, however, viruses are vastly more simple. Furthermore, the diseases they can cause in other organisms are at least as complex as those of bacteria, and usually much more difficult to defeat. Whereas there are "good" bacteria, as we shall see, scientists have yet to discover a virus whose impact on the world of living things is beneficial. There is something downright creepy about viruses, which are not exactly classifiable as living things; in fact, a virus is really nothing more than a core of either DNA or RNA (ribonucleic acid), surrounded by a shell of protein.

Two facts separate viruses from the world of the truly living. First, unlike all living things (even bacteria), viruses are not composed of even a single cell, and, second, a virus has no life if it cannot infect a host cell. When we say "no life" in this context, we truly mean no life. Although parasites, including bacteria and those species discussed in Parasites and Parasitology, depend on other organisms to serve as hosts, they can live when they are between hosts. They are rather like a person between jobs: without other means of support, the person eventually will go broke or starve, but typically such a person can hang on for a few months until he or she finds a new job. A virus without a host, on the other hand, is simply not alive—not dead, like a formerly living thing, but more like a machine that has been switched off.

Once a virus enters the body of a host, it switches on, and the result is truly terrifying. In order to produce new copies of itself, a virus must use the host cell's reproductive "machinery"—that is, the DNA. The newly made viruses then leave the host cell, sometimes killing it in the process, and proceed to infect other cells within the organism. As for the organisms that viruses target, their potential victims include the whole world of living things: plants, animals, and bacteria. Viruses that affect bacteria are called bacteriophages, or simply phages. Phages are of special importance, because they have been studied much more thoroughly than most viruses; in fact, much of what virologists now know about viruses is based on the study of phages.

Real-Life Applications

Bacteria and Humans

Not all bacteria are harmful; in fact, some even are involved in the production of foods consumed by humans. For example, bacteria that cause milk to become sour are used in making cottage cheese, buttermilk, and yogurt. Vinegar and sauerkraut also are produced by the action of bacteria on ethyl alcohol and cabbage, respectively. Other bacteria, most notably Escherichia coli (E. coli) in the human intestines, make it possible for animals to digest foods and even form vitamins in the course of their work. (See Digestion for more on these subjects.) Others function as decomposers (see Food Webs), aiding in the chemical breakdown of organic materials, while still others help keep the world a cleaner place by consuming waste materials, such as feces.

Despite its helpful role in the body, certain strains of E. coli are dangerous pathogens that can cause diarrhea, bloody stools, and severe abdominal cramping and pain. The affliction is rarely fatal, though in late 1992 and 1993 four people died during the course of an E. coli outbreak in Washington, Idaho, California, and Nevada. More often the outcome is severe illness that may bring on other conditions; for example, two teenagers among a group of 11 who became sick while attending a Texas cheerleading camp had to receive emergency appendectomies. The pathogen is usually transmitted through under-cooked foods, and sometimes through other means; for example, a small outbreak in the Atlanta area in the late 1990s occurred in a recreational water park.

Bacterial Infections

Many bacteria attack the skin, eyes, ears, and various systems in the body, including the nervous, cardiovascular, respiratory, digestive, and genitourinary (i.e., reproductive and urinary) systems. The skin is the body's first line of defense against infection by bacteria and other microorganisms, although it supports enormous numbers of bacteria itself. Bacteria play a major role in a skin condition that is the bane of many a young man's (and, less frequently, a young woman's) existence: acne. Pimples or "zits," known scientifically as Acne vulgaris, constitute one of about 50 varieties of acne, or skin inflammation, which are caused by a combination of heredity, hormones, and bacteria—particularly a species known as Propionibacterium acnes. When a hair follicle becomes plugged by sebum, a fatty substance secreted by the sebaceous, or oil, glands, this forms what we know as a blackhead; a pimple, on the other hand, results when a bacterial infection, brought about by P. acnes, inflames the blackhead and turns it red. For this reason, antibiotics may sometimes cure acne or at least alleviate the worst symptoms.

Acne may seem like a life-and-death issue to a teenager, but it goes away eventually. On the other hand, toxic shock syndrome (TSS), caused by other bacteria at the surface of the skin—species of Staphylococcus and Streptococcus—can be extremely dangerous. The early stages of TSS are characterized by flulike symptoms, such as sudden fever, fatigue, diarrhea, and dizziness, but in a matter of a few hours or days the blood pressure drops dangerously, and a sunburn-like rash forms on the body. Circulatory problems arise as a result of low blood pressure, and some extremities, such as the fingers and toes, are deprived of blood as the body tries to shunt blood to vital organs. If the syndrome is severe enough, gangrene may develop in the fingers and toes.

In 1980, several women in the United States died from TSS, and several others were diagnosed with the condition. As researchers discovered, all of them had been menstruating and using high-absorbency tampons. It appears that such tampons provide an environment in which TSS-causing bacteria can grow, and this led to recommendations that women use lower-absorbency tampons if possible, and change them every two to four hours. Since these guidelines were instituted, the incidence of toxic shock has dropped significantly, to between 1 and 17 cases per 100,000 menstruating women.

Many bacteria produce toxins, poisonous substances that have effects in specific areas of the body. An example is Clostridium tetani, responsible for the disease known as tetanus, in which one's muscles become paralyzed. A related bacterium, C. botulinum, releases a toxin that causes the most severe form of food poisoning, botulism. Salmonella poisoning comes from another genus, Salmonella, which includes S. typhi, the cause of typhoid fever.

Viral Infections

With viruses, as we have noted, there is no need even to discuss "good" kinds, because there is no such thing—all viruses are harmful, and most are killers. The particular strains of virus that attack animals have introduced the world to a variety of ailments, ranging from the common cold to AIDS and some types of cancer. Other diseases related to viral infections are hepatitis, chicken pox, smallpox, polio, measles, and rabies.

One reason why physicians and scientists have never found a cure for the common cold is that it can be caused by any one of about 200 viruses, including rhinoviruses, adenoviruses, influenza viruses, parainfluenza viruses, syncytial viruses, echoviruses, and coxsackie viruses. Each has its own characteristics, its favored method of transmission, and its own developmental period. These viruses can be transmitted from one person to another by sneezing on the person, shaking hands, or handling an object previously touched by the infected person. Surprisingly, some more direct forms of contact with an infected person, as in kissing, seldom spread viruses.

A group of viruses called the orthomyxoviruses transmit influenza, an illness usually characterized by fever, muscle aches, fatigue, and upper respiratory obstruction and inflammation. The most common complication of influenza is pneumonia, a disease of the lungs that may be viral or bacterial. The viral form of pneumonia that goes hand in hand with influenza can be very severe, with a high mortality (death) rate; by contrast, bacterial pneumonia, which typically appears five to ten days after the onset of flu, can be treated with antibiotics.

The Ever Elusive Virus

Viruses are tricky. Because their generations are very short and their structures extremely simple, they are constantly mutating (altering their DNA and hence their heritable traits) and thus becoming less susceptible to vaccines. This is the reason why flu vaccine has to be prepared a new each year to target the current strains, and even then the vaccine is far less than universally effective. On the other hand, vaccination has a high rate of success for strains of virus that undergo little mutation—for example, the smallpox virus.

One particularly elusive type of virus is known as a retrovirus, which reverses the normal process by which living organisms produce proteins. Ordinarily, DNA in the cell's nucleus carries directions for the production of new protein. Coded messages in the DNA molecules are copied into RNA molecules, which direct the manufacture of new protein. In retroviruses, that process is reversed, with viral RNA used to make new viral DNA, which then is incorporated into host cell DNA, where it is used to direct the manufacture of new viral protein. Among the diseases caused by retroviruses is AIDS, discussed in Infectious Diseases and The Immune System.

Fighting the Invisible War

Every day of our lives, we are at war with microorganisms, both individually and as a species. It is a war that has lasted for several million years, with billions of lives in the balance, yet it is an invisible war. Up until a few centuries ago, in fact, we had no idea what we were fighting. Before the advent of germ theory, the most scientific theories of disease blamed them either on an imbalance of "humors" (blood, phlegm, yellow bile, and green bile), or on inhaling bad air. These were the most advanced ideas, the ones held by men of learning; most of the populace, by contrast, believed that disease was caused by evil spirits, cast upon individuals or populations by an angry God as punishment for disobedience.

Personal hygiene and public health were completely foreign concepts: not only did people bathe infrequently, but they also thought nothing of throwing trash—including rotting food and even human excrement—into the city streets. This image of trash in the streets may call to mind a city of medieval Western Europe, a place and time widely known for its filth, squalor, and ignorance. Yet such an image also describes Athens during the fifth century B.C., when human imagination, wisdom, and appreciation for beauty reached perhaps their highest points in all of history. In the Athens of Socrates, Herodotus, Hippocrates, and Sophocles, the streets were piled with trash and crawling with vermin. In fact, this lack of concern for cleanliness contributed directly to the end of the Greek golden age, sometimes known as the Age of Pericles, after Athens's great leader (495-425 B.C.)—who died in a great plague that swept the germ-ridden city.

Bacteriology and Anti-Sepsis

The first inkling of any etiology other than that of imbalanced humors and demons was the work of the Italian physician Girolamo Fracastoro (ca. 1483-1553), who put forth the theory that disease is caused by particles so small they are almost imperceptible. The invention of the microscope in 1590 made it possible to glimpse those particles, which Holland's Anton van Leeuwenhoek (1632-1723)—the first human being to observe bacteria and other microorganisms—dubbed animalcules, or "tiny animals." The German scholar Athanasius Kircher (1601-1680) also observed "tiny worms" in the blood and pus of plague victims and theorized that they were the source of the infection. This was the first theory that dealt with microbial agents as infectious organisms.

In 1848 Ignaz P. Semmelweis (1818-1865), a Hungarian physician working in German hospitals, came up with a novel idea: after examining the bodies of women who had died of puerperal (childbed) fever, he suggested that doctors should wash their hands in a solution of chlorinated lime water before touching a pregnant patient. Semmelweis's idea resulted in a drastic reduction of puerperal fever cases, but his colleagues denounced his outlandish notion as a useless and foolish waste of time. Six years later, in 1854, modern epidemiology was born when the English physician John Snow (1813-1858) determined that the source of a cholera epidemic in London could be traced to the contaminated water of the Broad Street pump. After he ordered the pump closed, the epidemic ebbed—and still many physicians refused to believe that invisible organisms could spread disease.

Germ Theory

A major turning point came just three years later, in 1857, when the great French chemist and microbiologist Louis Pasteur (1822-1895) discovered that heating beer and wine to a certain temperature killed bacteria that caused these liquids to spoil or turn into vinegar. Thus was born the process of pasteurization, still used today to purify such foods as milk, because, as Pasteur observed, "There are similarities between the diseases of animals or man and the diseases of beer and wine." Pasteur also dealt the final blow to spontaneous generation, a centuries-old belief that living organisms could originate from nonliving matter. As he showed in 1861, microorganisms present in the air can contaminate solutions that seem sterile.

Then, in 1876, the German physician Robert Koch (1843-1910) proved what Kircher had postulated two centuries earlier: that bacteria can cause diseases. Koch showed that the bacterium Bacillus anthracis was the source of anthrax in cattle and sheep and generalized the methodology he had used in that situation to form a specific set of guidelines for determining the cause of infectious diseases. Known as Koch's postulates, these guidelines define a truly infectious agent as one that can be isolated from an infected animal, cultured in a laboratory setting, introduced into a healthy animal to produce the same infection as in the first animal, and isolated again from the second animal. These ideas formed the basis of research into bacterial diseases and are still dominant in the sciences devoted to the study of disease.

Koch's postulates helped usher in what has been called the golden era of medical bacteriology. Between 1879 and 1889 German microbiologists isolated the organisms that cause cholera, typhoid fever, diphtheria, pneumonia, tetanus, meningitis, and gonorrhea as well the Staphylococcus and Streptococcus organisms. Even as Koch's work was influencing the development of the germ theory, the influence of the English physician Joseph Lister (1827-1912) was being felt in operating rooms. Building on the work of both Semmelweis and Pasteur, Lister—for whom the well-known antiseptic mouthwash Listerine was named—began soaking surgical dressings in carbolic acid, or phenol, to prevent postoperative infection.

Antibiotics

Whereas antisepsis was the great battleground of the invisible war during the nineteenth century, in the twentieth century the most important struggle concerned the development of antibiotics. The first effective medications to fight bacterial infection in humans were sulfa drugs, developed in the 1930s. They work by blocking the growth and multiplication of bacteria and were initially effective against a broad range of bacteria, but many strains of bacteria have evolved resistance to them. Today, sulfa drugs are used most commonly in the treatment of urinary tract infections and for preventing infection of burn wounds.

The importance of sulfa drugs was eclipsed by that of penicillin, first discovered in 1928 by the British bacteriologist Alexander Fleming (1881-1955). Working in his laboratory, Fleming noticed that a mold that had fallen accidentally into a bacterial culture killed the bacteria. Having identified the mold as the fungus Penicillium notatum, Fleming made a juice with it that he called penicillin. He administered it to laboratory mice and discovered that it killed bacteria in the mice without harming healthy body cells.

It would be more than a decade before the development of a form of penicillin that could be synthesized easily. This drug arrived on the scene in 1941—just in time for the years of heaviest fighting in World War II—and after the war pharmaceutical companies began to manufacture numerous varieties of antibiotic. By the last decade of the twentieth century, however, a new problem emerged: bacteria were becoming resistant to antibiotics. This has been the case with medications used to treat conditions ranging from children's ear infections to tuberculosis.

An example is amoxicillin, a penicillin derivative developed in the late twentieth century. Many pediatricians found it a better treatment than penicillin for ear infections, because it did not tend to cause allergic reactions sometimes associated with the other antibiotic. However, by the late 1990s evidence surfaced indicating that certain types of bacteria had developed a protein that rendered amoxicillin ineffective against ear infections. Critics of amoxicillin (or of antibiotic treatments in general) maintained that widespread prescription of the antibiotic actually helped create that situation, because the bacteria developed the protein mutation defensively. Because of these and similar concerns associated with antibiotics, doctors have begun taking measures toward controlling the spread of antibiotic-resistant diseases, for instance by prescribing antibiotics only when absolutely necessary. Research into newer types and combinations of drugs is ongoing, as is research regarding the development of vaccines to prevent bacterial infections.

Where to Learn More

Biddle, Wayne. A Field Guide to Germs. New York: Henry Holt, 1995.

The Big Picture Book of Viruses. Tulane University (Web site). <http://www.tulane.edu/~dmsander/Big_Virology/BVHomePage.html>.

Cells Alive! (Web site). <http://www.cellsalive.com/>.

Centers for Disease Control and Prevention (Web site). <http://www.cdc.gov/>.

Infection Index. Spencer S. Eccles Health Sciences Library, University of Utah (Web site). <http://medlib.med.utah.edu/WebPath/INFEHTML/INFECIDX.html>.

"Oral Health Topic: Infection Control." American Dental Association (Web site). <http://www.ada.org/public/topics/infection.html>.

The Race Against Lethal Microbes: Learning to Outwit the Shifty Bacteria, Viruses, and Parasites That Cause Infectious Diseases. Chevy Chase, MD: Howard Hughes Medical Institute, 1996.

Virtual Museum of Bacteria. Bacteria Information from the Foundation for Bacteriology (Web site). <http://www.bacteriamuseum.org/>.

Weinberg, Winkler G. No Germs Allowed!: How to Avoid Infectious Diseases at Home and on the Road. New Brunswick, NJ: Rutgers University Press, 1996.

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A term considered by some to mean the entrance, growth, and multiplication of a microorganism (pathogen) in the body of a host, resulting in the establishment of a disease process.Others define infection as the presence of a microorganism in host tissues whether or not it evolves into detectable pathologic effects. The host may be a bacterium, plant, animal, or human being, and the infecting agent may be viral, rickettsial, bacterial, fungal, or protozoan.

A differentiation is made between infection and infestation. Infestation is the invasion of a host by higher organisms such as parasitic worms. See also Epidemiology; Hospital infections; Medical bacteriology; Medical mycology; Medical parasitology; Opportunistic infections; Pathogen; Virus.

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The normal human body is covered with billions of harmless microorganisms: indeed, we each carry more bacteria than the total human population of the world! These, together with the skin and the immune system, serve to protect the body from invasion by harmful, or ‘pathogenic’ microorganisms.

If there is a breach in one of these lines of defence, these pathogens can gain access to the body. Entry may be, for example, via a skin wound, inhalation, ingestion, or sexual intercourse, and may be facilitated by immune deficiency or loss of the normal organisms living on the body, for instance after a course of antibiotics.

As soon as the immune system detects the presence of a pathogen it mounts a response to kill it, which is highly successful in most cases in healthy people. On the rare occasions where it fails, or in people with poorly functioning immune systems, the organism may succeed in establishing itself and cause disease: an infection occurs. The term ‘infection’ therefore encompasses not only the classical ‘infectious diseases’, but also such diseases as boils, thrush, urinary tract infection, and surgical wound infections.

The immune response produces a syndrome of inflammation at the site of the infection. This is characterized by redness, warmth, pain, and swelling, caused by extra blood supply to the area bringing white blood cells to fight the infection. Pus may be formed (a mixture of white cells, dead tissue, and organisms). Usually this stops the infection from spreading. However, if the organisms gain entry to the bloodstream, sepsis or ‘blood poisoning’ may ensue. In sepsis the body's white cells respond by producing vast amounts of chemicals which, as well as helping to kill the marauders, result in fever, flushing, shivering, low blood pressure, rapid heart rate, and, in severe cases, delirium. Sometimes this immune response is more harmful than the infection itself. Conversely, sepsis may be difficult to recognize in patients with suppressed immune systems who cannot mount such a florid response. Finally, some microorganisms are not easily recognized by the immune system at all, so that infection may have few if any symptoms until later in the course of the disease when damage to the body by the organism is well advanced. Examples are the human immunodeficiency virus which causes AIDS, and the prion causing Creutzfeld-Jacob disease.

Hospital infection and antisepsis

For many hundreds of years, fevers and infections were believed to be caused by ‘miasmas’, or noxious air exuding from rotten materials. In the nineteenth century the most notorious, and perhaps the most tragic, manifestation of sepsis was puerperal sepsis, or childbed fever, in which the dangerous bacterium Streptococcus pyogenes (now known as the Group A streptococcus) gained entry to the bloodstream via the birth canal. It had a very high fatality rate and was responsible for the deaths of countless young mothers every year. Although well-recognized as a complication of childbirth, the cause was not understood. The Hungarian obstetrician Ignaz Semmelweis, working in Vienna in the 1850s, was particularly concerned by the high rate of childbed fever on one of his wards which was attended by medical students. On this ward nearly a fifth of his patients died of sepsis. On his other ward, attended only by midwives, the rate was only about 3%. He realized that the medical students came directly from the autopsy room to the obstetric ward and proceeded to examine the patients without even washing their hands in between. He insisted that each student should wash his hands with soap and water and then an antiseptic before entering the ward, and saw the mortality rate drop immediately to less than 2%. Thus he proved not only transmission by hand of an infectious agent, but also that it could be prevented by use of antisepsis.

This was a dramatic result, but despite this Semmelweis was ignored and even ridiculed. It was Joseph Lister, working in Glasgow in the late 1860s, who brought about the general acceptance of surgical antisepsis. He used carbolic acid to transform surgery from a highly dangerous last resort to the treatment of choice in many conditions. Florence Nightingale did the same for hospitals after the Crimean War, during which she had shown that cleanliness and hygiene were paramount in preventing injured soldiers from dying of infections — although, ironically, she never believed in the germ theory of disease, rather she believed that filth and dirt bred disease directly.

Since then the refinement of antisepsis before and during operations has been one of the most important developments in allowing the practice of surgery as we now know it. Even now, maintaining a low infection rate is one of the priorities of every surgeon. Low levels are attained by the use of ‘asepsis’ — that is, sterilizing the instruments so that no microorganisms are present on them — and ‘antisepsis’ — the use of chemical solutions to decrease the number of the patient's and the surgeon's own microorganisms as far as possible. Nowadays, one of the greatest challenges facing hospital infection control is the prevention of spread of bacteria that are resistant to many antibiotics, such as methicillin-resistant Straphylococcus aureus (MRSA).

— Angharad Puw Davies

See also infectious diseases; microorganisms.

n

Definition: contamination
Antonyms: sanitation, sterility

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Definition

An infection is a condition in which viruses, bacteria, fungi, or parasites enter the body and cause a state of disease. Such invaders are called pathogens. They damage cells of the body by adhering to and damaging the cell walls, releasing toxic substances or causing allergic reactions. The body has a set series of responses to infection, which mostly involve body chemicals, body tissues, and the immune system. It was recently reported that infection is the fourth leading cause of death in the United States and kills more people than cancer and heart disease combined.

Description

Pathogens are everywhere in a person's daily environment: They may enter the body through breathing, ingested food or water, sexual contact, open wounds, or contact with contaminated objects. Having entered the body, pathogens begin to reproduce. Most pathogens are kept in check before they have a chance to multiply. If, however, the body is unable to keep the pathogens in balance, serious disease and even death may occur. Chronic infections may develop if the body has only limited control over a given pathogen. In that case, the infection will have a tendency to flare up in response to stress and weakness. Sepsis is a serious condition in which pathogens spread and circulate throughout the body via the bloodstream. This type of infection affects the entire body.

The body has many natural barriers to infection. For example, the harmless bacteria normally found on the skin, known as commensals, inhibit the growth of many pathogens. Sweat and oil gland secretions also protect the skin; and the skin itself offers a significant physical barrier that no bacteria are able to penetrate. Damage to the skin from burns, insect bites, surgery, or injuries may leave the skin open to infection. In addition to the physical barrier of the skin, many of the body's secretions such as tears, sweat, urine, and saliva contain chemicals that destroy pathogens.

The mucous membranes that line the passageways of the body secrete mucus, which contains enzymes and chemicals that kill or disable pathogens. The pathogens are then trapped in the mucus and filtered out or swallowed. Commensal bacteria also live on the mucous membranes; there they inhibit the spread and multiplication of pathogens just as they do on the skin. The digestive tract contains stomach acid, pancreatic enzymes, and other secretions that protect against infection. Peristalsis and the shedding of the lining of the intestinal tract also help to remove pathogens. The acid pH of the stomach and vagina is protective, as well as the length of the urethra in males. The flushing action of urine and feces as they are excreted also protect against infection.

A fever is defined as the elevation of the body temperature to at least 100°F (37.8°C). Fevers are a helpful part of the body's response to an infection, since most pathogens do not thrive at higher temperatures while the immune system's white blood cells (WBCs) work best in a warm environment. If the fever reaches levels of 102°F (38.9°C) or higher, it may have to be brought down to avoid seizures, dehydration, and tissue damage.

The second level of the body's defenses is the immune system. The white blood cells are a major part of this system. In response to the invasion of pathogens, WBCs are released from the bone marrow into the bloodstream. The main function of these WBCs, depending on their type, is to engulf pathogens and render them harmless, detoxify poisons, produce and release antibodies and chemicals, and clean up wastes left by other WBCs. The spleen, thymus, lymph system, and liver all have roles in the immune response. Successful removal of pathogens from the body often gives immunity against infection by that pathogen in the future.

Pathogens can be persistent. They may secrete enzymes, destroying tissues in the body to spread the infection more quickly and effectively. They may secrete chemicals that counteract the actions of the WBCs. Some pathogens release toxins that kill the surrounding cells. Many also have methods to evade being engulfed and destroyed. In addition, the body's own commensal bacteria may become pathogenic if something upsets their balanced state in the body. This loss of balance may often result from chronic illness, low stomach acid, recurrent use of antibiotics, cross-contamination through medical or sexual exploration, or a compromised immune system.

Causes & Symptoms

Infections are caused by pathogens invading the tissues of the body and beginning to multiply. Headaches, muscle aches, fever, chills, and fatigue are common symptoms of infections. Many of these symptoms are due to inflammation and the response of the immune system to the pathogens. For example, during an infection, the blood supply is increased to the affected areas; as the blood rushes to the site of infection, it causes the skin to redden. The blood vessels also become more readily able to release WBCs into the tissues; when the WBCs die and decay they form a thick fluid known as pus. Enzymes released by the WBCs may also be responsible for pain and swelling.

More specific symptoms of infection vary according to the site and type of the infection. Some of these symptoms include:

• Gastrointestinal system: Diarrhea, vomiting, nausea, stomachaches, cramps, gas pains, and dehydration.
• Respiratory system: Coughing, sneezing, sore throat, congestion, fever, bronchitis, and runny nose.
• Urinary system: Increased frequency and urgency of urination; pain on urination; blood, pus, or other discharge in the urine; bad-smelling urine or discharge; and vaginal itching.
• Skin: Rashes, sores, itching, and blisters; redness, swelling, tenderness, and pain.
• Joints: Local pain, stiffness, redness, and swelling.

Risk factors for infections include chronic disease; severe emotional stress; broken skin; changes in the pH of various body fluids; malnutrition; surgery; rupture of amniotic membranes; invasive medical or dental procedures; tissue injuries or destruction; decreased flow of body fluids; changes in peristalsis; decreased output of stomach acid; recurrent use of antibiotics; and suppressed immune function. Many infections have a high probability of being passed from person to person. This is especially true of respiratory diseases, which can be transmitted through contact with the sputum and droplets produced by coughing or sneezing. Contact with infected waste products, open sores, skin eruptions, infected clothing and bedclothes, and sexual contact are circumstances which often lead to the further spread of infections.

New concerns about infections continue to baffle researchers and clinicians into the twenty-first century. First, the world faces the threat of infection from bioterrorism, and Americans faced a scare from deliberate distribution of anthrax spores through the United States postal system following the September 11, 2001, terrorist attack. The year 1999 saw the first reports of the West Nile virus in the United States, and reported cases of the disease began spreading after that date. Further, clinicians worry about widespread antibiotic resistance, as individuals and the public at large become exposed to more antibiotics for longer periods of time.

Diagnosis

Many infections are minor and self-limiting. Some infections, however, are serious; some can even lead to permanent impairment or death. If an infection does not clear up within a few days, or if it gets worse, a healthcare provider should be consulted. Infections are initially diagnosed by the patient's presentation and by a history of the illness or injury and the symptoms.

A complete blood count (CBC) is a simple clinical test that can be used to diagnose an infection. Increases in the total WBC count usually indicate a bacterial infection; decreases tend to indicate a viral infection or a very severe infection, both of which may cause the destruction of WBCs faster than they can be produced. Increases in specific types of white blood cells known as neutrophils, lymphocytes, and monocytes also point to an infection. An increase in eosinophils may be due to a parasitic infection. A blood chemistry panel may be taken to determine whether there are chemical changes that may have been brought on by an infection.

A serious illness may require further evaluation and diagnostic tests. Additional laboratory tests can be performed using blood, feces, or samples of the infected tissue. Ultrasound, computed tomography (CT) scans, and magnetic resonance imaging (MRI) may also be used. In some cases, a tissue sample (biopsy) is taken from the affected site for microbial culture tests and microscopic examination.

Treatment

Herbal Therapy

Echinacea spp. enhances the action of the immune system. It can be taken for up to six weeks to prevent or heal infections. Goldenseal (Hydrastis canadensis) has strong antibiotic qualities. Garlic (Allium sativum) is also antibiotic. Licorice (Glycyrrhiza glabra) has significant antiviral activity. It reduces the bad effects of stress on the health, and has been used to treat herpes, staphylococcal and streptococcal infections, typhus, cholera, pneumonia, and infections caused by Candida albicans. Astragalus membranaceus is a Chinese herb that may be used to enhance the immune system as well as to prevent the recurrence of chronic infections. Pau d'arco (Tabebuia impetiginosa) is recommended for internal fungal infections, while the topical use of tea tree oil (Melaleuca alternfolia) is recommended for some external infections.

Dietary Modifications

A healthful balanced diet and lifestyle are important supports of the immune function. Reishi (Ganoderma lucidum), shiitake (Lentinus edodes), and maitake (Grifola frondosa) mushrooms are renowned for their ability to strengthen the immune system and their antimicrobial properties. Regular supplementation with vitamin C, vitamin A or beta-carotene, zinc, and bioflavonoids is also recommended to boost the immune response.

Sugary foods, including honey, may depress the immune system. Very high levels of fat in the diet may also interfere. Alcohol decreases the functioning of the immune system. All of these substances should be avoided during the course of an infection. Food allergies should be considered, especially in the case of chronic colds, throat infections, and ear infections. Once allergens have been identified, they should be avoided. Patients should increase their intake of fluids, including soups, teas, diluted fruit and vegetable juices, and pure water.

Aromatherapy

Aromatherapy may be a useful supportive measure in infectious conditions. An essential oil of cedarwood (Cedrus atlantica) is recommended in fungal infections; essential oils of tea tree (Melaleuca alternifolia) and patchouli are also recommended. It should be remembered, however, that essential oils are very concentrated, toxic to the liver and kidneys, and should be used only in very small doses (drops).

Acupuncture

Acupuncture is helpful in stimulating the immune system. It reduces the effects of stress, improves circulation, and increases the production of RBCs and WBCs. It has been used for thousands of years to treat infectious diseases.

Hydrotherapy

Constitutional hydrotherapy is the use of applications of hot water alternated with cold. It is effective in respiratory infections and in stimulating the immune system. For proper administration of hydrotherapy, a naturopath or other healthcare provider familiar with its techniques should be consulted.

Allopathic Treatment

Minor infections are often relieved by over-the-counter medications. A high fever or joint pain may be a sign of an infection spreading throughout the body. A physician should be contacted. Infections from bites and puncture wounds should also receive medical attention and possibly a tetanus injection.

Serious infections may be treated with antibiotics. Antibiotics are effective against many parasitic and fungal infections as well as bacteria. Antibiotics may also be given during a viral infection even though they have no effect on viruses. This measure is taken to prevent bacterial infections, which may occur due to the weakened state brought on by the virus. In the case of viral infections, antiviral drugs are used to reduce symptoms. Their usefulness, however, is limited because viruses quickly mutate and develop resistance to them.

Antifungal drugs are often applied directly to fungal infections. They may be taken orally, applied topically, or injected. Fungal infections often require several weeks of treatment and repeated courses of the drug. Both antifungal and antiviral drugs tend to be somewhat toxic to people as well as to the pathogens.

Expected Results

Most minor infections resolve within a week. Chronic infections may last for years. Serious infections need to be attended by a physician, as tissue damage and death may be an imminent outcome. Anemia may result from severe infections, since RBCs or their production may be affected.

Prevention

Various vaccines are available to prevent major infections. These vaccines are made from deactivated parts of viruses or bacteria that confer future immunity to infection by those pathogens. Vaccinations for mumps, measles, chicken pox, tetanus, hepatitis, diphtheria, whooping cough, and pneumonia are widely available in the United States. They are routinely given to infants and children to provide lifetime immunity from these diseases. An anthrax vaccine is available but as of early 2002, reports say that a new, improved vaccine is needed in the United States, since the vaccine requires six doses over 18 months for full protection, with a booster every 12 months.

Good hygienic practices should be maintained. They include keeping the body clean as well as keeping food, utensils, and areas of preparation clean and free of contamination. Meat, seafood, and dairy products should be properly refrigerated. Breaks in the skin should be cleaned and disinfected to avoid further infection. Direct contact with people known or suspected to have infections should be limited, depending on the nature of the disease.

The health of the immune system should be maintained. A positive mental outlook is important, together with appropriate amounts of sleep, relaxation, and stress reduction. A healthful diet should be followed, with decreased sugar, salt, saturated fats, and chemical additives. Good lifestyle habits, such as giving up smoking and taking regular physical exercise, should be cultivated.

Resources

Books

Burton Goldberg Group. Alternative Medicine: The Definitive Guide. Fife, WA: Future Medicine Publishing, 1995.

Editors of Time-Life Books. The Medical Advisor: The Complete Guide to Alternative and Conventional Treatments. Alexandria, VA: Time-Life, Inc., 1997.

Lininger, Skye, et al. The Natural Pharmacy. Rocklin, CA: Prima Health, 1998.

Murray, Michael, and Joseph Pizzorno. Encyclopedia of Natural Medicine. Rocklin, CA: Prima Publishing, 1991.

Periodicals

Ford-Jones, E. Lee. "Human Surveillance for West Nile Virus Infection in Ontario in 2000." JAMA, The Journal of the American Medical Association 287, no. 12 (March 27, 2002): 1508.

Marwick, Charles. "Improved Anthrax Vaccine is Needed, Claims Report." British Medical Journal (March 16, 2002): 630.

Torpy, Janet M. "New Threats and Old Enemies: Challenges for Critical Care Medicine." JAMA, The Journal of the American Medical Association (March 27, 2002): 1513.

[Article by: Patience Paradox; Teresa G. Odle]

For more information on infection, visit Britannica.com.

Anxiety about Aids has generated a spate of rumours, gruesome jokes, and a contemporary legend based on the notion that those infected deliberately infect others, in revenge or despair. The story has often appeared in press reports in the USA, Britain, and Europe. One version, which was ‘all over the city’ of Sheffield in February 1987, told how a young man picked up an unknown girl at a nightclub and took her home for sex; when he woke she had left, after writing in lipstick on the bathroom mirror, ‘Welcome to the world of Aids!’ (Bennett and Smith, 1990: 113). In other variants the victim is a girl who, returning from a holiday abroad, unwraps a ‘parting gift’ from a casual partner, and finds a miniature coffin with the same message. Currently (1998), there is a third version:

Worthing nightclubbers are being asked to be on their guard against sick pranksters who fool them into thinking they have contracted the deadly HIV virus. Rumours have been spreading throughout Worthing that groups of people have been stabbing late-night revellers with needles containing blood contaminated with the virus. Small notes are then left in the revellers’ coats or handbags with the sick message, ‘Welcome to the Aids club.’ … [Police commented]: ‘There is no evidence whatsoever to suggest this is really happening … if people do find one of these notes it is likely to be no more than a very sick joke.’ (Worthing Herald (5 Feb. 1998), 25)

Despite the rational police warning, six months later another local paper reported as factual a ‘cruel and vicious attack’ on a girl in a nightclub, who allegedly felt a sharp jab in the back, and found a card in her pocket with the usual message. Neither the girl's name nor that of the ‘family friend’ who told the press is given (Worthing Guardian (17 Sept. 1998), 1).

In an article on this story-type, Paul Smith pointed to a precedent in Daniel Defoe's Journal of the Plague Year (1722):

A poor, unhappy gentlewoman, a substantial citizen's wife, was (if the story be true) murdered by one of these creatures [plague victims] in Aldergate Street, or that way. He was going along the street, raving mad to be sure, and singing … and meeting this gentlewoman, he would kiss her …. [He] mastered her, and kissed her; and, which was worst of all, when he had done, told her he had the plague, and why should not she have it as well as he? (Defoe, 1722; Penguin edn., 1986: 173)

Similarly, Pepys's Diary for 12 February 1666 records that his son's lutemaster had just told him how ‘in spite to well people [those already sick] would breathe (out of their windows) into the faces of well people going by’.

There was an old principle that one could cure oneself of a disease by deliberately transferring it to another, which survives in wart cures and the casual expression about ‘giving’ someone one's cold. To rid a child of whooping cough or fever, according to various 19th-century sources, one should wrap a few of his hairs in bread and butter and throw it to a dog, which would eat it and die, and the child recover (Opie and Tatem, 1989: 63). The most cruel application concerned venereal diseases; it is discreetly mentioned by Mabel Peacock (Folk-Lore 7 (1896), 272), when she says it is widely thought by ‘the ignorant and debased’ that ‘certain cures are only to be effected by doing violence to a girl yet in her childhood’.

Paul Smith, in Bennett and Smith, 1990: 113-41.

1. The process by which a disease is communicated from one person to another.

2. A disease that can be transmitted from one person to another. Such diseases always involve a micro-organism, such as a virus, bacterium, or fungus, which has a high capacity for reproduction (compare infestation). Sport offers many opportunities for the epidemic spread of infections due to the proximity of spectators and performers. Contact and collision sports are notorious for spreading highly contagious infections, such as scrumpox. Athletes with contagious infections should be precluded from participation in these sports and all athletes should avoid very strenuous physical activity during the febrile stage of an infection. Although moderate exercise may stimulate the body's immune system and offer some protection from infection, overtraining is associated with an increased incidence of infections such as colds, sore throats, and influenza-like illnesses. See also open window hypothesis.

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Invasion of the body or a body part by a pathogenic organism, which multiplies and produces harmful effects on the body's tissues.

1. invasion and multiplication of microorganisms in body tissues, especially that causing local cellular injury due to competitive metabolism, toxins, intracellular replication or antigen–antibody response.
2. an infectious disease.

• acute i. — short duration, of the order of several days.
• airborne i. — infection by inhalation of organisms suspended in air on water droplets or dust particles.
• arrested i. — restrained in its development by a capsule or adhesion but still containing infective material.
• chronic i. — long duration, of the order of weeks or months.
• i. control — the utilization of procedures and techniques in the surveillance, investigation and compilation of statistical data in order to reduce the spread of infection, particularly nosocomial infections.
• cross i. — infection transmitted between patients infected with different pathogenic microorganisms.
• droplet i. — infection due to inhalation of respiratory pathogens suspended on liquid particles exhaled by an animal that is already infected.
• dustborne i. — infection by inhalation of pathogens that have become affixed to particles of dust.
• endogenous i. — that due to reactivation of organisms present in a dormant focus, as occurs in tuberculosis, etc.
• exogenous i. — that caused by organisms not normally present in the body but which have gained entrance from the environment.
• general i. — see systemic infection (below).
• latent i. — the animal is infected but there are no clinical signs nor infectious agent detectable in discharges.
• local i. — has a common syndrome of varying degree, depending on the site and acuteness of the lesion and the type of microorganisms present, including fever, toxemia and leukocytosis with a left shift. The specific individual signs relate to the location of the lesion and the pressure it exerts on nearby organs. See also abscess, cellulitis, phlegmon, osteomyelitis, omphalophlebitis, empyema, adenitis, metritis, mastitis, periphlebitis.
• masked i. — an infection is known to occur but the infectious agent cannot be demonstrated, e.g. the sheep-associated malignant catarrhal fever virus.
• mixed i. — infection with more than one kind of organism at the same time.
• nosocomial i. — pertaining to or acquired in hospital.
• opportunistic i. — infection with organisms which are normally harmless but become pathogenic when the body's defense mechanisms are compromised.
• patent i. — one in which the infectious agent can be demonstrated in discharges of the patient.
• persistent i. — a characteristic of some viruses, particularly herpesviruses and lentiviruses, in which there may be long-lasting or life-long latent infections, with asymptomatic periods and recurring acute episodes of clinical disease (herpesviruses) or onset of severe clinical disease (lentiviruses).
• pyogenic i. — infection by pus-producing organisms.
• secondary i. — infection by a pathogen following an infection by a pathogen of another kind.
• i. stones — see struvite urolith.
• subclinical i. — infection associated with no detectable signs but caused by microorganisms capable of producing easily recognizable diseases, such as mastitis or brucellosis; often detected by the production of antibody, or by delayed hypersensitivity exhibited in a skin test reaction to such antigens as tuberculoprotein.
• super i. — a second infection occurs in an animal which is already experiencing an infection with another agent.
• systemic i. — the infection is widespread throughout the body and must be assumed to be in all organs.
• terminal i. — an acute infection occurring near the end of a disease and often causing death.
• transmissible i. — an infection capable of being transmitted from one animal to another. Called also contagious.
• waterborne i. — infection by microorganisms transmitted in water.

IN BRIEF: A disease caused by germs entering the body.

Antibiotics are important in fighting infections.

A dream about being infected might represent anything from absorbing (being "infected by") the negative attitudes of others to concerns about one's health. Possibly, the dream infection represents negative thoughts or feelings. (See also Illness).

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Dansk (Danish)
n. - infektion, smitte

Nederlands (Dutch)
infectie, infectiestof, negatieve beïnvloeding

Français (French)
n. - (gén, Méd) infection, contagion, (fig) contamination (péj)

Deutsch (German)
n. - Ansteckung, Infektion

Ελληνική (Greek)
n. - (παθολ., μτφ.) μόλυνση, λοίμωξη (κν. κακοφόρμισμα), επίδραση

Italiano (Italian)
infezione, contagio

Português (Portuguese)
n. - infecção (f)

Русский (Russian)
инфекция

Español (Spanish)
n. - infección, contagio

Svenska (Swedish)
n. - infektion, smittämne, smittosam sjukdom, fördärv (bildl.)

中文（简体）(Chinese (Simplified))
传染, 传染病, 影响

中文（繁體）(Chinese (Traditional))
n. - 傳染, 傳染病, 影響

한국어 (Korean)
n. - 전염, 전염병, 나쁜 영향

日本語 (Japanese)
n. - 伝染, 感染, 感染症, 伝染病, 感化, 影響

العربيه (Arabic)
‏(الاسم) تلوث, عدوى‏

עברית (Hebrew)
n. - ‮זיהום‬

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Yeast Infection Symptom