Chapter I : Infectious Disease

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Disease

Weakness
Alters/Loss of function
Loss good quality of life
Death

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Infectious Disease

Involves pathogen
Transmissible
Involves suitable environment
Dormant/Inactive

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Outbreak
Occurrence in excess than what is
expected in a community
Can be restricted to a geographical area
or extend across countries/continents
May last a few days, weeks or even years
Emergence from a long absent from a
population
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What leads to an outbreak?

Endemic - Present in a community at all times but in
relatively low frequency. Something that is endemic is
typically restricted or peculiar to a locality or region. Has
high risk of becoming an epidemic. E.g. Dengue fever in
Puerto Rico.
Epidemic - The occurrence of more cases of a disease
than would be expected in a community or region during
a given time period. A sudden severe outbreak of a
disease such as SARS. E.g. SARS in Hong Kong-China.
Pandemic An epidemic (a sudden outbreak) that
becomes very widespread and affects a whole region, a
continent, or the world. E.g. H1N1 swine flu
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Name of
disease

Type of
causative
organism

Name of
causative
organism

Method of
transmission

Symptoms

Drug/
Treatment

Eradication/
Control

Cholera

bacteria

Vibrio
cholerae

Contaminated water /
food
Contact through
densed population

Acute
diarrhea

ORS to treat
symptoms

Effective
sanitation

Malaria

protoctist

Plasmodium
falciparum /
vivax

Vector borne,
Anopheles mosquitoe

Severe
anemia

Antimalarial drug,
NOT antibiotic
Artemisinin-based
combination
therapy (more than
one drug) why?
Chloroquine (more
resistance)

Monitor water
reservoir

bacterium

Mycobacterium

Aerosol through
coughing/sneezing
Contact through
densed population

Cough with
sputum and
blood

Combination of
antibiotics
DOTS (directly
observed
treatment, short
course)

Take great
care of
immune
system

Unprotected sex
Sharing needle
Breastfeeding

Weak against
most
infections

ART antiretroviral
therapy

Practise safe
sex

Tuberculosis
Tuberculosis

tuberculosis /
bovis
AIDS
AIDS

virus

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HIV

Cholera
Vibrio cholerae
Bacterium
Breed in the small intestine
Secrete a toxin that reduces the ability of the
epithelial cells of the intestine to absorb salts
and water into the blood
Toxin activates an efflux pump through a
cascade of reactions that pumps out ions and
water into lumen of intestines
Prepared
Leads
to severe loss of fluid through diarrhea.
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Cholera
Transmission
Contaminated water / food supply
Eating raw/uncooked food, esp. seafood,
accumulates the bacterium from seawater.

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Cholera
Eradication / Control
Use clean and safe water
Ensure the process of preparing and cooking the
food is clean and thorough
Improve sewage system/treatment
Education/Awareness
Strict rules/penalty on food provider
Oral vaccines
Clinics and treatment centre must be ready and
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available

Cholera
Problems with Eradication / Control

(seeta social,

economic, environmental and technological implications and applications of biology)

Costs issues
Communities who are poor are still getting
water from polluted source
Antigenic concealment
Antigenic variation
Hard to control pollution dumping waste
into open sea
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Cholera
Treatment
ORS Oral Rehydration Salt
Antibiotics

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Cholera
Problems with Treatment
ORS only treats symptoms
Antibiotic resistance
Too late to receive treatment.

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Malaria
Plasmodium falciparum / vivax
Protoctist
Unicellular eukaryote and parasite
Several life cycle

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Malaria
Transmission
Vector - An organism responsible for the transmission or
spread of a pathogen. In the case of malaria, the female
mosquito is the vector as it transmits the Plasmodium
parasite from human to human. Sexual reproduction
occurs here
Host: An organism inside which the reproduction of
another organism occurs. Humans act as a host for the
malarial parasite. Asexual reproduction occurs here

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Malaria
Transmission
Mosquito bites usually occur during feeding. As the
infected mosquito feeds, it injects saliva containing an
anticoagulant to prevent the blood from clotting.
Malarial parasites known as sporozoites are injected
along with the saliva and enter the human bloodstream
where they migrate to the liver. The mosquito is therefore
said to act as a vector of the malarial parasite.
In the liver cells the sporozoites multiply asexually, very
rapidly increasing in number.
The liver cells burst open releasing many merozoites,
which then invade the red blood cells.
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Malaria
Transmission
These merozoites reproduce asexually again inside the red blood
cells, causing the red blood cells to burst, releasing more merozoites
which cause the characteristic fever and other symptoms of the
disease.
Some of these merozoites develop into gametocytes (the male and
female forms of the parasite) which are ingested by the female
mosquito during feeding, and so complete the cycle of transmission
between human and mosquito.
Once inside the female mosquitos gut, the male and female
gametocytes fuse to form sporozoites which migrate to the salivary
glands ready to be injected into a new human host at the next blood
meal.
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Prepared by Peter Ting

Malaria
Eradication / Control
Eliminate water drainage
Spreading oil over water surfaces
Biological control Rear fish to eat larvae,
Use mosquito nets
Sleeping with animals
Vaccination
Herd Immunity
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Malaria
Problem with Control

(seeta social, economic, environmental and

technological implications and applications of biology)

Mosquito will breed in the tinniest bodies of water

Insecticides may harm human health and cause
resistance
Civil war and unrest
Densed population
Tropical area/climate
Antigenic concealment
Antigenic variation
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Malaria
Treatment
Use antimalarial drugs
Must be in combination with artemisinin
(most effective)
Why combination?

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Malaria
Problems with Treatment

(seeta social, economic, environmental and

technological implications and applications of biology)

Antibiotic resistance
Drug cost
Not likely to make available to all
communities

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Tuberculosis
Mycobacterium tuberculosis / bovis

rod shaped bacterium

Infects the lungs / respiratory tract
Phagocytes take in by phagocytosis
Phagocytes line together and forms a small
tissue, granuloma.
This is seen as initial infection, usually in
children (primary infection) and most of the time,
the granuloma resolves and no spread of
infection
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Tuberculosis
Mycobacterium tuberculosis / bovis
Secondary tuberculosis: seen mostly in
adults as a reactivation of previous
infection (or reinfection), particularly when
health status declines. The granulomatous
inflammation is much more active and
widespread. Typically, the upper lung
lobes are most affected, and cavitation
can occur.
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Tuberculosis
Transmission
When infected person coughs or sneezes
aerosol / droplets and inhaled by uninfected
Can also infected by drinking unpasteurized milk
Infects the lung tissue first (rich in O2)
Usually stay dormant for years
If immune system weakens, the bacteria awakes
when lung tissue releases the content of the
granuloma
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Tuberculosis
Eradication / Control

Do not go to over-populated places

Take good care of the immune system
Quarantine
Skin testing (before leaving country and before
returning back to country)
Use of respiratory protective equipment
Herd immunity
Vaccination
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Tuberculosis
Problems with Eradication / Control
Difficult to control as people are free to move
and choose
Infection
Difficult to trace infected people in remote places
People will not obey and do skin testing
Negligence to carry protective equipment
Antigenic concealment
Antigenic variation
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Tuberculosis
Treatment
Combination of four antibiotics - ISONIAZID,
RIFAMPICIN, PYRAZINAMIDE and
ETHAMBUTOL
Taken in a long period of time

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Tuberculosis
Problems with Treatment
Antibiotic resistance
Antigenic variation

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AIDS
Human Immunodeficiency Virus (HIV)
Retrovirus
Binds to CD4 receptors on t-helper cells
Lead to weakened immune system and
many other opportunistic infections

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AIDS
Human Immunodeficiency Virus (HIV)
1. The glycoprotein on the outer surface of the virus attaches to receptors on the host cell
2. The lipid bilayer of the virus then fuses with the host cells membrane and the virus
enters the host cell
3. The viral enzyme reverse transcriptase stimulates the cell to make viral DNA from the
viral RNA template
4. This viral DNA is then inserted into the host cell's chromosomes
5. The viral DNA then codes for the production of thousands of new viruses
6. Eventually, these burst out of the cell, killing it
7. These viruses then infect other cells
8. These include helper T cells. These are part of the immune system. The immune
system is weakened and opportunistic infections result
9. Thus, AIDS is not a single disease, but a descriptive term for the opportunistic infections
10. People who develop AIDS often die from Karposis sarcoma, a rare cancer itself caused
by a virus.
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AIDS
Transmission
Through sexual contact -- including oral, vaginal,
and anal sex
Through blood -- through blood transfusions,
accidental needlesticks, or needle sharing
From mother to child -- a pregnant woman can
transmit the virus to her fetus through their
shared blood circulation, or a nursing mother
can pass it to her baby in her breast milk
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AIDS
Eradication / Control

Avoid drugs
Avoid unprotected sexual activities
Avoid donating blood (+ve person)
Trace contact
Strict communities/families
Education/Awareness
Usage of sterile needles
Avoid promiscuous relationships

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AIDS
Problems with Eradication / Control
Tracking can be expensive and difficult
Asymptomatic for the first 10 years long
incubation time
Community practices open culture
Family disruption lead to rebellious behavior
People are just too ignorant about safe sex and
good education
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AIDS
Treatment
Antiretroviral therapy
Check CD4 cell count

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AIDS
Problems with Treatment
Antigenic variation
Drug resistance

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Antibiotics
Chemicals produced by microorganism
which are capable of destroying or
inhibiting the growth of other
microorganisms.

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 Antibiotics are selective

toxins, killing or disabling
the pathogen without
harming the host.

They can be synthetic

(isoniazid) or derived
from living organisms.
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 Antibiotics interfere
with some aspects
of growth or
metabolism of the
target
microorganism:

Enzyme
function

Synthesis of
bacterial walls

Antibiotics
action
mechanism

Protein
synthesis
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Plasma
membrane
function

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The sites of action of

antibiotics in bacteria

 Different diseases are treated with

different antibiotics.
Some kinds of bacteria are completely
resistant to particular antibiotics
E.g. Mycobacterium tuberculosis is
resistant to penicillins
Other bacteria have certain strains that are
resistant.

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Broad spectrum antibiotics

Antibiotics that are effective against a wide
range of bacteria.
Narrow spectrum antibiotics
Antibiotics that are active only against a
few.

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Penicillin

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In 1928, bacteriologist
Alexander Fleming made a
chance discovery from an
already discarded,
contaminated Petri dish.
The mold that had
contaminated the experiment
turned out to contain a
powerful antibiotic, penicillin.
Though Fleming was credited
with the discovery, it was over
a decade before someone else
turned penicillin into the
miracle drug for the 20th
century.

Penicillin
Penicillin is a group
of antibiotics derived
from Penicillium fungi.

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 Bacteria that attempt

to divide in the
presence of penicillin
fail to do so and end
up shedding their cell
walls in the process.

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 Penicillin and other

-lactam antibiotics
act by inhibiting
penicillin-binding
proteins, which
normally catalyze
cross-linking of
bacterial cell walls.
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Penicillins Mode of Action

Penicillins functions by preventing the
synthesis of the cross links between the
peptidoglycan polymers in the cell walls of
bacteria.
They are only active against bacteria and
only when they are growing.
Many types of bacteria have enzymes for
destroying penicillins (penicillinase) and
are therefore resistant to these antibiotics.
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 Result of an
antibiotic
sensitivity test
carried out on a
pathogenic strain
of the human gut
bacterium
Escherichia coli.
Various antibiotics
are absorbed onto
discs of filter
paper and placed
on the agar plate.
The most effective
antibiotics are
chosen based on
the diameter of
the inhibition
zones.

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 Antibiotics should be chosen carefully

Screening antibiotics against the strain of
the bacterium or fungus isolated from
sufferers ensures that most of the effective
antibiotics can be used in treatment.

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 An example of this is MRSA, (Methicillin

Resistant Staphylococcus aureus) which is
a bacteria that is resistant to four of the
most popular antibiotics due to their
inappropriate use and people not finishing
their course of antibiotics leaving
antibiotic resistant bacteria to grow and
spread.

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 It is advisable to keep some antibiotics for

use as the last resort when everything else
has failed to lessen chances of more such
resistant organisms.
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