Infectious diseases

Infectious diseases are transmissible, or communicable, diseases (as they can pass from one person to another. These diseases are caused by pathogens that can spread from infected people to uninfected people. Some diseases can only spread from one person to another by direct contact, as the pathogen cannot survive outside the human body. Non-infectious diseases - these are not caused by pathogens and cannot be transmitted. (Strictly, diseases can be transmitted, but only by inheritance and these are not infectious. There are four main types of cause of non-infectious diseases: inherited (genetic) diseases, degenerative diseases, self-inflicted diseases and deficiency diseases. A disease is endemic in an area, if it is present all the time roughly the same level. It may be infectious disease such as malaria. It may be a deficiency disease. In an epidemic there is a sudden increase in the occurrence of an infectious disease, which spreads across a fairly large area. Childhood diseases, such as chicken pox, commonly show epidemics every few years when many younger children have not met the disease and have no immunity to it. Epidemiology - type of study in which the patterns of distribution of diseases are studied. Carriers - people which may spread a pathogen even though they do not have the disease themselves. Transmission cycle - the way in which a pathogen passes from one host to another.

Cholera y it is caused by the bacterium Vibrio cholerae. y Disease is water-borne, it occurs where people do not have access to proper sanitation,
a clean water supply or uncontaminated food.

y Three quarters of whom may be symptomless carriers, pass out large numbers of
bacteria in their faeces. If these contaminate the water supply, or if infected people handle food or cooking utensils without washing their hands, then bacteria are transmitted to uninfected people. To reach the site of action: y Small intestine bacteria have to pass through the stomach. If the contents are sufficiently acidic (<pH4.5) the bacteria are unlikely to survive.

If bacteria do reach the small intestine they multiply and secrete a toxin, choleragen, which disrupts the functions of the epithelium so that salts and water leave the blood causing severe diarrhoea. This loss of fluid can be fatal if not treated within 24 hours. To prevent: y By giving a solution of salts and glucose intravenously to rehydrate the body. y If people can drink, they are given oral rehydration therapy. y Glucose is effective because it is absorbed into the blood and takes salts (e.g. Na and K ) with it. y It is important to make sure that a sufferer's fluid intake equals fluid losses in urine and faeces and to maintain the osmotic balance of the blood and tissue fluids. y It is possible to vaccinate against cholera using a vaccine made from killed vibrios. It is only about 50% effective and only lasts for few months. y Antibiotics can be used if condition is particularly serious. Problems in developing countries (Causes): y no sewage treatment or clean water y increasing quantities of untreated faeces from a growing population favour cholera's survival. y Many countries, saddled with huge debts, do not have the financial resources to tackle large municipal projects such as providing drainage and a clean water supply to large areas of substandard housing. y In some countries raw human sewage is used to irrigate vegetables. y inadequate cooking or washing in contaminated water Vaccine: only provides short-term protection. Cholera is now almost unknown in the developed world as result of sewage treatment and the provision of clean piped water, which is chlorinated to kill bacteria. The transmission cycle has been broken. y Pathogen Methods of transmission Global distribution Incubation period Site of action of pathogen Clinical features Method of diagnosis Annual incidence worldwide Annual mortality worldwide Vibrio cholerae Food-borne, water-borne Asia, Africa, Latin America 1-5 days Wall of small intestine Severe diarhoea ('rice water'), loss of water and salts, dehydration, weakness Microscopical analysis of faeces 5.5 million 120 000

Malaria
Causes and effects y is caused by one of four species of the protoctist Plasmodium. y Plasmodium is also a parasite of mosquitoes. If the female Anopheles mosquito 'bites' and takes in blood from an infected person, the Plasmodium parasites enter her body. The parasites undergo various stages of their life history inside the mosquito. The parasites may then be introduced into another person as the mosquito pours her saliva into a wound during a further action. In this way, the mosquito acts as a vector, transmitting the parasite from one person to another y Malaria can also be transmitted during blood transfusion y when unsterile needles are reused y Plasmodium can also pass across placenta from mother to fetus. y Plasmodium multiplies in both hosts (mosquito's and human's) at each stage there is a huge increase in the number of parasites and this improves the chances of infecting another mosquito or human host y If people are continually reinfected they become immune to malaria. This only happens if they survive the first five years of life when mortality from malaria is very high. The immunity only lasts as long as they are in contact with the disease Economical role: epidemics in places where malaria is not endemic can be very serious, especially it is more dangerous in those areas where it only occurs during and after the rainy season. this often coincides with the time of maximum agricultural activity so the disease has a disastrous effect on the economy: people cannot cultivate the land when they are sick. Symptoms:  Headache, tiredness, aching and sometimes vomiting  Shivering, feeling of cold which lasts around 2 hours  sudden rise in body temperature to 40C or above, leading to faster heart rate and breathing rate, nausea and fever, lasting about 4 hours.  profuse sweating for between 2 and 4 hours as the body temperature is returned to normal. Prevention and control: y Providing drugs which protect against malaria, e.g. proguanil and pyrimethamine y use of vaccines - difficult and still being developed y use of insecticides to kill mosquitoes, especially in homes y use of mosquito nets to prevent biting by mosquitoes during sleep and soaking mosquito nets in insecticides every 6 months. y drainage of marshes and swamps where mosquitoes breed. y use of insecticides or oil on water where mosquitoes breed, to destroy the larvae before they develop into adults y use of carnivorous fish to eat mosquito larvae.

The reasons for the world wide concern over the spread of malaria are: y An increase in drug-resistant forms of Plasmodium; y an increase in the proportion of cases caused by P.falciparum, the form that causes severe, often fatal malaria; y difficulties in developing a vaccine; y an increase in the number of epidemics because of climatic and environmental changes that favour the spread of mosquitoes. y the migration of people as a result of civil unrest and war Pathogen Method of transmissions Global distribution Incubation period Site of action of pathogen Clinical features Plasmodium falciparum P.vivax, P.ovale, P.malariae Insect vector: female Anopheles mosquito Throughtout the tropics and subtropics (endemic in 91 countries) Form a week to a year Liver, red blood cells, brain Fever, anaemia, nausea, headaches, muscle pain, shivering, sweating, enlarged spleen Microscopical examination of blood 300 million (90% of cases are in Africa) 1.5-2.7 million; in tropical Africa malaria kills 1 million children under the age of 5

Method of diagnosis Annual incidence world wide Annual mortality worldwide

Acquired Immune Deficiency Syndrome (AIDS)

Causes and effects: y is caused by the human immunodeficiency virus HIV y the virus infects and destroys the cells of body's immune system so that their numbers gradually increase. These cells known as T helper lymphocytes control the immune system's response to infection. When the numbers are low, the body is unable to defend itself against the infection so allowing a range of pathogens to cause a variety of opportunistic infections.

AIDS is a collection of these rare opportunistic diseases associated with immunodeficiency caused by HIV infection. (HIV is an infective agent) Transmission: y viruses do not survive in an air and are quickly killed by hot water and detergent y during unprotected (without using condoms) homosexual or heterosexual intercourse. y by using a needle for intravenous injection which has been used by an infected person y by receiving contaminated blood products, for example in the treatment for hemophilia or during a blood transfusion y a fetus may be infected by its mother, as the viruses can pass across the placenta. A baby can also be infected during the process of birth or by its mother's milk. Symptoms: y the development of other diseases to which healthy people would quickly immunity y these diseases include tuberculosis, Kaposis's sarcoma ( a form of cancer rare in young people, which is caused by herpes-like virus, a rare form of pneumonia caused by Pneumocytosis carinii. economic development: - HIV infection makes people more vulnerable to existing diseases such as malnutrition, TB and malaria. AIDS is having and adverse effect on the economic development of countries in the region as it affects sexually active people in their 20s and 30s who are potentially the most economically productive and the purchase of expensive drugs drains government funds. Prevention and control: y no cure for AIDS and no vaccine for HIV y avoiding unprotected and promiscuous sexual intercourse. The use of condoms, femidoms, or dental dams is vital y avoiding the sharing of needles in drug abuse y the screening or treatment of blood products y testing pregnant women for HIV. Infected mothers should be treated with drugs, the babies should be delivered by Caesarean section and breastfeeding should be avoided. y drug therapy can slow down the onset of AIDS quite dramatically, so much so that some HIV positive people in developed countries are adjusting to a suddenly increased life expectancy. However, drugs are expensive and have a variety of side effects ranging y

y y

from the mild and temporary (rashes, headaches, diarrhea) to the severe and permanent (nerve damage, abnormal fat distribution). If used in combination , two or more drugs which prevent the replication of the virus inside host cells can prolong life, but they do not offer cure. Contact tracing is an important part of HIV control in the UK. If a person who is diagnosed as HIV positive is willing and able to identify people who they have put at risk of infection by sexual intercourse or needle sharing, then these people will be offeref an HIV test. This test identifies present of antibodies of HIV, though these will only appear several weeks after the initial infection.  The virus changes its surface proteins, which makes it hard for the body's immune system to recognize it. This makes the development of a vaccine very difficult.

E.g. of a drug used. The drugs are similar to DNA nucleotides. Zidovudine is similar to the nucleotide that contains the base thymine). Zidovudine binds to the viral enzyme reverse transcriptase and blocks its action. This stops the replication of the viral genetic material and leads to an increase in some of the body's lymphocytes. A course of combination therapy can be very complicated. Pathogen Methods of transmission Human Immunodeficiency virus In semen and vaginal fluids during sexual intercourse, infected blood or blood products, contaminated hypodermic syringes, mother to fetus across placenta, mother to infant in breast milk. Worldwide, especially in sub-Saharan Africa and South-East Asia Initial incubation a few weeks, but up to ten years or more before symptoms of AIDS may develop T helper lymphocytes, macrophages, brain cells HIV infection - flu-like symptoms and then symptomless; AIDS - opportunistic infections including pneumonia, TB, and cancers; weight loss, diarhoea, fever, sweating, dementia Blood test for antibodies to HIV

Global ditribution Incubation period

Site of action of pathogens Clinical features

Method of diagnosis

Tuberculosis (TB)
Causes and effects:

y y y

caused by two bacteria Mycobacterium tuberculosis and M. bovis. these are pathogens that live inside human cells, particularly in the lungs bacteria can spread throughout the whole body and even infect the bone tissue people with this inactive infection do not spread the disease to others. The bacteria can later become active and this is most likely to happen when people are weakened by other diseases, suffer from malnutrition or become infected with HIV.

TB is often first opportunistic infection to strike HIV-positive people. TB is now the main cause of death of HIV-positive people. The HIV pandemic has been followed very closely by a TB pandemic. Symptoms: y persistent cough y as part of their defense cells release hormone-like compounds which cause fever and suppress the appetite. y as a result sufferers lose weight and often look emaciated. Transmission: y when bacteria are carried in the air, in droplets of water breathed out by an infected person, even one not showing any symptoms of illness. other people can become infected by breathing in these droplets. The spread is favored by damp, dimply lit and overcrowded conditions y Bacteria can withstand many disinfectants but are destroyed quickly on exposure of sunlight. y drinking unpasteurized milk from cattle infected with M.bovis can also cause disease. The resurgence is due in part o the following factors: y some strains of TB bacteria which are resistant to drug y the AIDS is pandemic y poor housing in inner cities in the developed world and rising homelessness y the breakdown of TB control programmes, particularly in USA; partial treatment for TB increases the chance of drug resistance on Mycobacterium y migration from Eastern Europe and developing countries to large cities such as London and New York Prevention and control: y if TB is confirmed, then sufferers should be isolated while they are in the most infectious stage (which is at two to four weeks). This is particularly the case if they are infected with a drug-resistant strain of the bacterium. The treatment involves using several drugs

y y

to ensure that all the bacteria are killed. If not, drug-resistant forms remain to continue the infection. antibiotics act as selective agents klling drug-sensitive strains and leaving resistant ones behind. Drug resistance occurs as a result of mutation in the bacterial DNA. Mutation is a random event and occurs with a frequency of about one in every thousand bacteria. if TB is not treated or the person stops the treatment before the bacteria are completely eliminated, they spread throughout the body, increasing the likelihood that mutations will arise as the bacteria survive for a long time and multiply. people who do not complete a course are highly likely to infect others with drugresistant forms of TB. DOTS (Direct Observation Treatment, Short Course), involves health workers, or responsible family members, making sure that patients take their medicine regularly for six to eight months. The drugs widely used are ioniazid and rifampicin, often in combination with others. contact tracing and their subsequent testing for the bacterium is an essential part of controlling TB. Contacts are screened for symptoms of TB infection, but the diagnosis can take up to two weeks. The spread of the disease among children is prevented, to a large extent, by vaccination. Vaccine is effective in some parts of the world (e.g.UK) but less effective in others (e.g. India). Pasteurization of milk, which involves heating milk to 72 degrees Celsius for at least 15 minutes. is enough to kill the micro-bacteria in milk and prevent the spread of disease from infected cattle to humans. pathogen Mycobacterium tuberculosis; M.bovis Methods of transmission Airborne droplets; via unpasteurized milk Global distribution worldwide Incubation period Few weeks or months Site of action of pathogen Primary infection in lungs; secondary infections in lymph nodes, bones and gut Clinical features Racking cough, coughing blood, chest pain, shortness of breath, fever, sweating, weight loss. Method of diagnosis Microscopical examination of sputum for bacteria, chest X-ray

Antibiotics
Antibiotics are drugs that are used to treat or cure infections. Effective antibiotics show selective toxicity, killing or disabling the pathogen but having no effect on host cells. Antibiotics interfere with some aspect growth or metabolism of the target organism such as:

y synthesis of bacterial walls y protein synthesis (transcription and translation) y enzyme action Broad spectrum antibiotics are effective against a wide range of bacteria. Narrow spectrum antibiotics are active only against a few. Penicillins - function by preventing the synthesis of the cross-links between the peptidoglycan polymers in the cell walls of bacteria. This means that they are only active against bacteria and only while they are growing. Many types of bacteria have enzymes for destroying penicillins (penicillinase) and are therefore resistant to these antibiotics. y Screening antibiotics against the strain of bacterium or fungus isolated from sufferers ensures that the most effective antibiotic can be used in treatment. y Bacteria are collected from faeces, food or water, and grown on an agar medium. Various antibiotics are absorbed onto discs of filter paper and placed on the agar plate. The plate is incubated and the diameters of the inhibition zones where no bacteria are growing are measured. The diameters are measured and the most effective antibiotics are chosen to treat infected people. y some british hospitals harbour Methicillin Resistant Staphylococcus aureus (MRSA) which is resistant to at least four antibiotics due to their previous inappropriate and widespread use. It is advisable to keep some antibiotics for use as a 'last resort' when everything else has failed, so as to lessen the chances of more such resistant organisms.