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 Type of Name of Method of Symptoms Drug/ Eradication/
disease causative causative transmission Treatment Control
organism organism

Cholera bacteria Vibrio Contaminated water / Acute ORS – to treat Effective

food symptoms
cholerae Contact through diarrhea sanitation
densed population

Malaria protoctist Plasmodium Vector borne, Severe Antimalarial drug, Monitor water
Anopheles mosquitoe NOT antibiotic
falciparum / anemia Artemisinin-based reservoir
vivax combination
therapy (more than
one drug) – why?
Chloroquine (more
Tuberculosis resistance)

Tuberculosis bacterium Mycobacterium Aerosol through Cough with Combination of Take great
coughing/sneezing antibiotics
tuberculosis / Contact through sputum and DOTS (directly care of
bovis densed population blood observed immune
treatment, short
system
AIDS course)

AIDS virus HIV Unprotected sex Weak against ART – antiretroviral Practise safe
Sharing needle therapy
Breastfeeding most sex
infections
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 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
available
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 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 mosquito’s 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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 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 cell’s 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 Karposi’s 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 Synthesis of
metabolism of the bacterial walls
target
microorganism:

Antibiotic’s Plasma
Enzyme action membrane
function
mechanism function

Protein
synthesis
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 The sites of action of
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•  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

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

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Penicillin’s 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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