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Cholera Malaria AIDS Tuberculosis

Pathogen Vibrio cholera Plasmodium falciparum Human Immunodeficiency Virus Mycobacterium tuberculosis
 Bacteria P. vivax  Virus M. bovis
P. ovale  Not a disease  Bacteria
P. malariae  Collection of rare  Opportunistic infection to
P. knowles opportunistic disease strike HIV-positive
 Protoctist / protozoan associated with
 ‘acquired’
immunodeficiency as HIV is
the infective agent

Definition An acute intestinal An infectious disease caused by Acquired Immune Deficiency Ccommon and often deadly
infection caused by protozoan parasites from the Syndromes occurs when the HIV infectious disease caused by
ingestion of the bacterium plasmodium family that can be infection has badly damaged the mycobacterium that lived in
Vibrio cholera transmitted by the sting of the immune system human cells, particularly in the
Anopheles mosquito or by a lungs
contaminated needle or
Strain / 60 different strains Resistance to antimalarial Long latent stage Drug-resistance M.
resistance i. ‘classical strain’ 01 drugs  Can transmitted my people Tuberculosis
caused cholera  P. Falciparum who are HIV positive but  Use of antibiotic
ii. El Tor 01 (displaced i by  P. vivax show no symptoms  Killing drug-sensitive
2 years) Virus change its surface protein, strains, leaving drug-
iii. V. Cholera 0139 hard for body’s immune system resistance strains
(displaced ii by 2 months to recognise it Mutation in the bacterial DNA
– virulent) Development of vaccine is very 1 drugs used - chance of
difficult mutation occur is
1 in a thousand bact.
3 drugs used = 1 in a thousand
million bact.
4 drugs used = 1 in a billion
 people don’t complete the
drug course treatment as
they think they are cured,
 spread throughout the
 mutation will arise as
bacteria survive for a long
time + multiply
 develop resistance to all
drugs used
 May spread the drug-
resistance bacteria to
others if it become active
 1 person can easily infected
15 person
Multiple drug resistance TB
 M. Tuberculosis resistance
to 5 major drugs used to
treat the disease
 Including isoniazid, the
most successful drugs.
Extensively drug resistance TB
Transmission Food-borne Insect vector : female Intimate human contact, direct Airborne droplets
methods  Cooking utensils w/out Anopheles mosquito exchange of body fluid  Cough or sneeze
washing hands Blood transfusion – unsterilized  Virus unable to survive  Bactria are carried in the air
 Contaminated food needles reused outside human body in tiny droplet of liquid
Water borne Across the placenta  Semen + vaginal fluid during  People who are uninfected
 Contaminated water sexual intercourse inhale the droplets
supply  Infected blood / blood Unpasteurised milk
 No proper sanitation products  In meat + milk
 Contaminated hypodermic  Cattle
Mother to foetus
 Across placenta
 Breast milk
Causes of No sewage treatment or People from non-malarial Male homosexuals Living in overcrowded
spread of clean water countries visiting part of the  Anal intercourse + had many conditions
diseases  Increase quantities of tropics sex partners Sleep closed together in large
untreated faeces Dr in developed countries sees  Mucous lining at rectum not numbers
 Raw human sewage very few cases of malaria – as thick in vagina Homelessness
used to irrigate misdiagnose as influenza  Less natural lubricant Live in poor, substandard
vegetables Settled immigrants whose visit  Easily damaged during housing
 Inadequate cooking Africa or India did not take intercourse Low immunity because of
 Washing in prophylactic drugs bcuz not  Virus passes from semen to malnutrition + HIV-positive
contaminated water realised they lost their the blood.
Discharge of ship sewage immunity  Multiple partners allow virus
into the sea Environmental condition s for to spread more widely
 Straight onto shellfish transmission change (increase Haemophiliacs
bed rainfall + temperature  treated with clotting
 Seafood, filters feeders substances (factor VIII)
e.g. oysters + mussels –  isolated from blood
eaten raw  from many donors
Rapid urbanization  now largely synthetic
Overcrowded living
Unstable politics
Environmental condition
Global Asia Throughout tropics + Worldwide; Worldwide
distribution Africa subtropics (endemic in 91 Sub-Saharan country
Latin America countries) South-East Asia
 Immune if reinfected Africa – equal numbers of male
+ female are HIV positive

Annual 5.5 mil 300 mil (90% in Africa) 2002 1998

incidence Infected - 42 mil 8 mil; more 6 000 cases in UK
New cases – 5 mil
Annual 120 000 1.5 – 2.7 mil 3.1 mil; 1/3 due to TB 2 mil
mortality Topical Africa = kill 1 mil
children under 5

Site of action of Wall of small intestines Exoerythrocytic phase - Liver T-helper lymphocytes Primary
pathogen Erythrocytic phase - Red blood  Body are unable to defend  Lungs
cells from infection Secondary
 Plasmodium multiplies  Allowing range of pathogens  Lymph nodes
inside red blood cell to cause variety of  Bones
 Red blood cell packed opportunistic infections  Gut
tightly with malarial Macrophages
parasites Brain cells
 Cell will burst
 Parasites released
 Infect other red blood cells
Modus operandi Symptomless carrier female Anopheles mosquito Slow virus Active TB
Bacteria have to pass  Mosquito feed on human No symptoms until years later  develop TB quickly
through stomach blood that infected with Affect sexually active people in  causing symptom
 Acidic (<pH 4.5) kills plasmodium – obtain their 20’s and 30’s.  able to spread the diseases
Toxin - Choleragen protein needed to develop Some have no initial symptoms Latent TB
 disrupts the functions eggs (flu-like symptoms for several  remain inactive for many
of epithelium  Take some pathogen’s weeks) years
 salts + water leaves gametes with the blood Infections that can  Inactive TB x spread
blood meal opportunistically develop to  Positive skin test
severe diarrhoea  Gametes fused + develop in create AIDS – characteristics of  Positive TB blood test
the mosquito’s guts the condition  Normal x-ray test + sputum
 Form infective stages 2 caused by fungi test
 Move to mosquito’s  Oral thrush caused by  Can later become active
salivary gland Candida albicans  Weakened by other disease
 Mosquito feed again –  Rare form of pneumonia  Suffer from malnutrition
prevent blood meal from caused by Pneumocystis
 Infected by HIV
clotting - injects carinii
anticoagulant + infective  In early years people in
stages pass into the blood develop countries died
 Blood flow out of host into within 12 hours of
the mosquito + parasites contracting with this
(sporozoites) enter blood diseases,
stream Now manage better, drugs
 Migrate to the liver prescribed to prevent the
 Hepatocytes (liver cells) diseases developing
infected Become less effective in finding
 Multiply for a period of 6- + destroying cancers
15 days  Kaposi’s sarcoma caused by
 Merozoites rupture liver herpes-like virus
cells, migrate back to the Make people more vulnerable
RBC to existing diseases such as
 Sometimes produce malnutrition, TB + malaria
hypnozoites that remain
dormant for several
months or year
Clinical features Severe diarrhoea (rice Fever HIV infection – flu-like Racking cough
/ symptoms water) Anaemia symptoms, the symptomless Coughing blood
Loss of water + salts Nausea AIDS – opportunistic infection Chest pain
Dehydration Headaches  Pneumonia Shortness of breath
Weakness Muscle pain  TB Fever
Shivering  Cancers Sweating
Sweating  Weight loss Weight loss + look emaciated
Enlarged spleen  Diarrhoea Part of defence, cell released
Convulsions  Fever hormone-like compound cause
Retinal damage  Sweating fever + suppress appetite
Vomiting  Dementia
Methods of Microscopical analysis of Microscopical examination of Blood test for antibodies to HIV Microscopical examination of
diagnosis faeces blood sputum for bacteria
 Distinguish each species  Sample of sputum (mucus +
characteristics pus) from the lungs
 Thick films – screen larger collected
volume of blood, easier to Chest X-ray
identify low levels of
 Thin films – allow species
Field test
Molecular method
Laboratory test
Medication Oral rehydration therapy Anti-malarial drugs No cure for AIDS 1940s - Antibiotic streptomycin
 Solutions of salts + Chloroquine + quinine No vaccine for HIV Infected by drug-resistance TB
glucose  As prophylactic Drug therapy can slow down  Sufferer isolated while in
 Rehydrate the body (preventive) drugs onset of AIDS quite dramatically most infectious stage (2 – 4
 Glucose – absorbed  Stopping an infection if the  expensive weeks)
into the blood + takes person bitten by mosquito  side effects  Using several drugs to
salts (Na + K)  Taken before, during or  mild + temporary (rashes, ensure all bacteria are
 Fluids intake = fluids after visiting endemic area headaches, diarrhoea) killed
loss in urine + faeces Chloroquine  severe + permanent (nerve  9 months – 1 year = takes a
 Maintain osmotic  inhibit protein synthesis + damage, abnormal fat long time to kill the
balance of the blood +  prevents parasites distribution) bacteria as bacteria slow
tissue fluids spreading the body Combination of drugs growing + not very
 ..RESISTANCE  2 or more can prolongs life sensitive to drugs
Proguanil  But don’t offer cure DOTS ( Direct Observation
 inhibiting sexual production  Similar to DNA nucleotide Treatment, Short Course)
of Plasmodium inside biting  Zidovudine =similar to  scheme promoted by WHO
mosquito nucleotide that contain base to ensure patients
Mefloquine thymine complete their course of
 newer drugs  Binds to viral enzyme drugs
 expensive reverse transcriptase +  involves health worker or
 unpleasant effect blocks its action responsible family
(restlessness, dizziness,  Stops the replication of the members
vomiting, disturbed sleep) viral genetic material  making sure patients take
Several drugs used in  Leads to increase in some of their medicine regularly for
combination to reduce the the body’s lymphocyte 6 – 8 months
chances of drug resistance  Complicated to follow  complete their course of
arising. drugs
 Isoniazid + rifampicin +
combination with other

Immunity Continually reinfected Tiny minority of HIV positive

 Become immune people appear to have immunity
 If survive the first 5 years of
life when mortality from
malaria is very high.
 As long as in contact with
the diseases
More dangerous in
 Area during or after rainy
 Epidemics where area is
not endemic
Reason for  Plasmodium became  No vaccines for HIV  Strain are resistant to drugs
unsuccessful resistant to the drugs used developed  AIDS pandemic
eradication  Mosquito become  Antigenic concealment –  Poor housing in inner cities
resistance to DDT and other immune system cannot in developed world
insecticides e.g. dieldrin reach the T-lymphocyte  Rising homelessness
 Expensive  Breakdown of TB control
 People living in area of programme – partial
temporary eradication lost treatment of TB increase
immunity n suffered the chance of drug
 Dieldrin killed a parasitic resistance Mycobacterium
wasp that control the  Migration from Eastern
numbers of thatching Europe + developing
caterpillars – villagers lost countries to large cities
their house’s roof such as London + NY
 1970s, war + civil unrest  Antigenic concealment –
destroyed infrastructure at immune system cannot
Africa + South-East Asia reach the lungs
 Increase in drug-resistant
form of plasmodium
 Increase in proportion of
cases caused by
P.falciparum, fatal malaria
 Difficulties in developing
 Increase number of
epidemics caused by
climatic + environmental
changes favour the spread
of mosquito
 Migration of people as civil
unrest n war
Prevention Break transmission cycle Break transmission cycle Public Health Measure Cattle are routinely tested for
 Sewage treatment  Reduce number of  People educated about TB
 Clean piped water mosquitoes spread of infection Cattle with TB are destroyed
(chlorinated)  Spread oil at the surface of  Change their behaviour Milk is pasteurised
water – kill larvae unable to  Condoms, femidoms + Contact tracing
breath dental dams form barrier  Person diagnosed
 Drain marshes between two liquid  Identify people they have
 Vegetation cleared Contact tracing put at risk of infection
 Stocking pond, irrigation +  Person diagnosed  Contacts screen for
drainage ditches  Identify people they have symptoms of TB
 Fish feed on mosquito put at risk of infection  Up to 2 weeks
larvae  Offered HIV test Vaccination
 Spray preparation of  Identifies the presence of  BCG vaccination
bacillus thuringiensis – kill antibodies to HIV  Prevent spread to children
mosquito larvae, but Needle exchange scheme  In UK, teenagers routinely
harmless to others  Exchange used needles for vaccinated at 13 – 14.
Avoid bitten by mosquitoes sterile ones Protects up to 70 – 80%
 Sleep beneath mosquito  Injecting drug users advised teenagers
net to give up their habit  Derived from M. Bovis
 Insect repellent  Effectiveness decrease with
 Soaking mosquito net in  Stop sharing needles age
insecticide every 6 months  Take drugs in other way  Unless there’s exposure to
 X exposed skin at dusk  Reduce the chance of TB
 Sleeping with a dog or pig infection of HIV + other  May effective in some parts
Use drugs to prevent parasite blood-borne diseases of the world, but not others
infecting people Developed countries (India)
 Blood collected from blood
donors screened for HIV +
heat-treated to kill virus
 People that think they are
exposed to the virus are
strongly discourage from
donating blood
 Expensive
Developing countries
 People are going to have
operation recommended to
donate their own blood to
reduce risk of infection
Improvement Sterilization of infected Improve diagnosis Developed country Improvement in housing
material Improve supply of effective  HIV positive women advised condition
Treatment of general drugs not to breastfeed their child Improve in diet
sewage Promote appropriate methods  Risk of transmitting the
Water purification (boiling to prevent transmission diseases to the children
+ chlorination) ‘Dipstick’-type test for  Viral particles + infected
Warnings on contaminated diagnosing malaria – no lab lymphocyte found in breast
water resource The whole genome of milk
Improved sanitation plasmodium has been Widespread testing of a
facilities sequenced – development of population to find HIV positive
Better monitoring effective vaccines  Not expensive, but
surveillance system + Advice to international government reluctant to
prompt reporting traveller  Infringement of personal
Basic hygiene education Consultation with clinicians freedom
Sanitation programmes Advice to blood collection  HIV testing promoted
Spread awareness on value centre strongly to people in high
+ limitation of resource Investigation of new drugs to risk group
prevent + treat malaria  Male homosexual,
prostitute, injecting drug
users, their sexual partner
Developing countries
Not restricted to such easily
identifiable group
 Widespread testing is not
 Expenses of reaching the
majority of the population
 Difficulty of organising it
 People in this area find out
they have HIV when they
develop the symptoms
 Benefits of breast feeding
outweighs the risk of
transmitting HIV
 Protection of breast feeding
gives against other diseases
 Lack of clean water to make
up supplements