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
immunodeficiency
 ‘acquired’
immunodeficiency as HIV is
the infective agent

Definition An acute intestinal
infection caused by
ingestion of the bacterium
Vibrio cholera
Strain / 60 different strains
resistance i. ‘classical strain’ 01
caused cholera
ii. El Tor 01 (displaced i by
2 years)
iii. V. Cholera 0139
(displaced ii by 2 months
– virulent)
An infectious disease caused by
protozoan parasites from the
plasmodium family that can be
transmitted by the sting of the
Anopheles mosquito or by a
contaminated needle or
transfusion
Resistance to antimalarial
drugs
 P. Falciparum
 P. vivax
Acquired Immune Deficiency
Syndromes occurs when the HIV
infection has badly damaged the
immune system
Long latent stage
 Can transmitted my people
who are HIV positive but
show no symptoms
Virus change its surface protein,
hard for body’s immune system
to recognise it
Development of vaccine is very
difficult
Ccommon and often deadly
infectious disease caused by
mycobacterium that lived in
human cells, particularly in the
lungs
Drug-resistance M.
Tuberculosis
 Use of antibiotic
 Killing drug-sensitive
strains, leaving drug-
resistance strains
Mutation in the bacterial DNA
1 drugs used - chance of
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
body
 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
(MDR-TB)
 M. Tuberculosis resistance
to 5 major drugs used to
treat the disease
 Including isoniazid, the
most successful drugs.
Extensively drug resistance TB
(XDR-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
syringes
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
condition
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
pathogen Erythrocytic phase - Red blood
cells
 Plasmodium multiplies
inside red blood cell
 Red blood cell packed
tightly with malarial
parasites
 Cell will burst
 Parasites released
 Infect other red blood cells
Brain
Modus operandi Symptomless carrier female Anopheles mosquito
Bacteria have to pass  Mosquito feed on human
through stomach blood that infected with
 Acidic (<pH 4.5) kills plasmodium – obtain
Toxin - Choleragen protein needed to develop
 disrupts the functions eggs
of epithelium  Take some pathogen’s
 salts + water leaves gametes with the blood
blood meal
severe diarrhoea  Gametes fused + develop in
the mosquito’s guts
 Form infective stages
 Move to mosquito’s
salivary gland
 Mosquito feed again –
prevent blood meal from
clotting - injects
anticoagulant + infective
stages pass into the blood
 Blood flow out of host into
T-helper lymphocytes Primary
 Body are unable to defend  Lungs
from infection Secondary
 Allowing range of pathogens  Lymph nodes
to cause variety of  Bones
opportunistic infections  Gut
Macrophages
Brain cells
Slow virus Active TB
No symptoms until years later  develop TB quickly
Affect sexually active people in  causing symptom
their 20’s and 30’s.  able to spread the diseases
Some have no initial symptoms Latent TB
(flu-like symptoms for several  remain inactive for many
weeks) years
Infections that can  Inactive TB x spread
opportunistically develop to  Positive skin test
create AIDS – characteristics of  Positive TB blood test
the condition  Normal x-ray test + sputum
2 caused by fungi test
 Oral thrush caused by  Can later become active
Candida albicans  Weakened by other disease
 Rare form of pneumonia  Suffer from malnutrition
caused by Pneumocystis
 Infected by HIV
carinii
 In early years people in
develop countries died
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
 infection
 Thin films – allow species
identification
Field test
Molecular method
Laboratory test
Medication Oral rehydration therapy Anti-malarial drugs
 Solutions of salts + Chloroquine + quinine
glucose  As prophylactic
 Rehydrate the body (preventive) drugs
 Glucose – absorbed  Stopping an infection if the
into the blood + takes person bitten by mosquito
salts (Na + K)  Taken before, during or
 Fluids intake = fluids after visiting endemic area
loss in urine + faeces Chloroquine
 Maintain osmotic  inhibit protein synthesis +
balance of the blood +  prevents parasites
tissue fluids spreading the body
 ..RESISTANCE
Proguanil
 inhibiting sexual production
of Plasmodium inside biting
mosquito
Mefloquine
 newer drugs
 expensive
 unpleasant effect
(restlessness, dizziness,
vomiting, disturbed sleep)
Several drugs used in
combination to reduce the
chances of drug resistance
arising.
No cure for AIDS
No vaccine for HIV
Drug therapy can slow down
onset of AIDS quite dramatically
 expensive
 side effects
 mild + temporary (rashes,
headaches, diarrhoea)
 severe + permanent (nerve
damage, abnormal fat
distribution)
Combination of drugs
 2 or more can prolongs life
 But don’t offer cure
 Similar to DNA nucleotide
 Zidovudine =similar to
nucleotide that contain base
thymine
 Binds to viral enzyme
reverse transcriptase +
blocks its action
 Stops the replication of the
viral genetic material
 Leads to increase in some of
the body’s lymphocyte
 Complicated to follow
1940s - Antibiotic streptomycin
Infected by drug-resistance TB
 Sufferer isolated while in
most infectious stage (2 – 4
weeks)
 Using several drugs to
ensure all bacteria are
killed
 9 months – 1 year = takes a
long time to kill the
bacteria as bacteria slow
growing + not very
sensitive to drugs
DOTS ( Direct Observation
Treatment, Short Course)
 scheme promoted by WHO
to ensure patients
complete their course of
drugs
 involves health worker or
responsible family
members
 making sure patients take
their medicine regularly for
6 – 8 months
 complete their course of
drugs
 Isoniazid + rifampicin +

Immunity Continually reinfected
 Become immune
 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
seasons
 Epidemics where area is
not endemic
Reason for  Plasmodium became
unsuccessful resistant to the drugs used
eradication  Mosquito become
resistance to DDT and other
insecticides e.g. dieldrin
 Expensive
 People living in area of
temporary eradication lost
immunity n suffered
 Dieldrin killed a parasitic
wasp that control the
numbers of thatching
caterpillars – villagers lost
their house’s roof
 1970s, war + civil unrest
destroyed infrastructure at
Africa + South-East Asia
Tiny minority of HIV positive
people appear to have immunity
 No vaccines for HIV
developed
 Antigenic concealment –
immune system cannot
reach the T-lymphocyte
combination with other
drugs
 Strain are resistant to drugs
 AIDS pandemic
 Poor housing in inner cities
in developed world
 Rising homelessness
 Breakdown of TB control
programme – partial
treatment of TB increase
the chance of drug
resistance Mycobacterium
 Migration from Eastern
Europe + developing
countries to large cities
such as London + NY
 Antigenic concealment –
immune system cannot
reach the lungs
  Increase in drug-resistant
form of plasmodium
 Increase in proportion of
cases caused by
P.falciparum, fatal malaria
 Difficulties in developing
vaccines
 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

Improvement Sterilization of infected
material
Treatment of general
sewage
Water purification (boiling
+ chlorination)
Warnings on contaminated
water resource
Improved sanitation
facilities
Better monitoring
surveillance system +
prompt reporting
Basic hygiene education
Sanitation programmes
 Soaking mosquito net in
insecticide every 6 months
 X exposed skin at dusk
 Sleeping with a dog or pig
Use drugs to prevent parasite
infecting people
Improve diagnosis
Improve supply of effective
drugs
Promote appropriate methods
to prevent transmission
‘Dipstick’-type test for
diagnosing malaria – no lab
The whole genome of
plasmodium has been
sequenced – development of
effective vaccines
Advice to international
traveller
Consultation with clinicians
Advice to blood collection
 Stop sharing needles age
 Take drugs in other way  Unless there’s exposure to
 Reduce the chance of TB
infection of HIV + other  May effective in some parts
blood-borne diseases of the world, but not others
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
Developed country Improvement in housing
 HIV positive women advised condition
not to breastfeed their child Improve in diet
 Risk of transmitting the
diseases to the children
 Viral particles + infected
lymphocyte found in breast
milk
Widespread testing of a
population to find HIV positive
 Not expensive, but
government reluctant to
 Infringement of personal
freedom
 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
feasible
 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