NILAMANI MAHAVIDYALAYA

RUPSA, BALASORE

A
PROJECT ON
“BACTERIAL DISEASE”
SUBMITTED TO
FAKIR MOHAN UNIVERSITY
IN FULFILMENT OF THE REQUIREMENTS FOR DEGREE OF
BACHELOR OF SCIENCE
GUIDED BY: SUBMITTED BY
Mrs. KALPANA MANJARI PATRA Rajesh Kumar Sahu

(H.O.D. OF DEPT. OF ZOOLOGY) (Roll NO-5908B18029,Regd.No-05738/18)

Umakanta Roul
Mr. SATYENDRA KUMAR PAL
(Roll NO-5908B18025,Regd.No-05740/18)
(LECT IN ZOOLOGY)
Souratapa Rout
(Roll NO-5908B18026,Regd.No-05770/18)
Rudra Madhaba Satpathy
(Roll No-5908B18027,Regd.No-05764/18)
Rasmita Sahu
( Roll NO-5908B18028,Regd.No-05774/18),
Jogeswar Senapati
(Roll NO-5908B18030,Regd.No-05741/18)

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 F.M UNIVERSITY, BALASORE
DECLERATION

WeRajesh Kumar Sahu (Roll NO-5908B18029,Regd.No-05738/18)UmakantaRoul (Roll

NO-5908B18025,Regd.No-05740/18) Souratapa Rout (Roll NO-5908B18026,Regd.No-
05770/18),RudraMadhabaSatpathy(Roll NO-5908B18027,Regd.No-05764/18),RasmitaSahu
( Roll NO-5908B18028,Regd.No-05774/18), and jogeswarSenapati (Roll NO-
5908B18030,Regd.No-05741/18) do hearby certify that the project report entitled “A Survey
on Bacterial Disease” being submitted to NILAMANI MAHAVIDIYALAYA
,RUPSA,Balasore Odisha for the award of Bachelor of science is an original price of work
done by us and the same has not been submitted elsewhere for any other academic degree of
diploma to this college or any other colleges/University.

(Name Of the Students)

Rajesh Kumar Sahu
Umakanta Roul
Souratapa Rout
RudramadhabaSatpathy
Rasmita Sahu
Jogeswar Senapati

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 F.M UNIVERSITY, BALASORE
CERTIFICATE
This is to certify that the project entitled “Bacterial Disease” Submitted
by Umakanta Roul, Souratapa Rout, RudraMadhabaSatpathy, Rasmita
Sahu, Rajesh Kumar Sahu andJogeshwarSenapati, for the award of the
degree of bachelor of science from NILAMANI
MAHAVIDIYALA,RUPSA, Balasore,Odisha,India is a bonafide
record of work carried out by them under my guidance. Neither this
project nor any part of it has been submitted for any degree or academic
award elsewhere.

Signature Of Guide

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 F.M UNIVERSITY, BALASORE
ACKNOWLEDGEMENT
We Sincerely express our heartfelt gratitude and indebtedness to our supervisorMR. SATYENDRA
KUMAR PAL (Lect. In Zoology) And MRS. KALPANA MANJARI PATRA (Head Of The
Department of Zoology), NILAMANI MAHAVIDIYALA RUPSA,Balasore, Odisha,for their valuable
guidance, enlightened suggestions, constant encouragement, critical comments, creative support, deep
involvement and immense cooperation throughout the research work.
We acknowledge with thanks the head of the department of zoology NILAMANI MAHAVIDIYALA
RUPSA, BALASORE for providing us the facilities to carry out our research work. We express our heartfelt
gratitude and sincerer thanks to all our teachers of the U.G. Department of Zoology, NILAMANI
MAHAVIDIYALA RUPSA, Balasore for their helping views, scientific and constructive comments in
course of completion of our research work. We are thankful to all the non-teaching staff members of the
U.G. Department of Zoology for their immense help and cooperation in smooth conduct of the research
work.
We are indebted to our parents who have been a constant source of inspiration in our academic and research
pursuit. We have the pleasure in placing on record our deep sense of love and greatfullness to our family for
their persistant moral support and cooperation. Their care and affection encouraged us to carry out this work
successful.
We are indebted to the almighty God for everything he had done for us until now and also all those that he
will do for us in future. We have the pleasure in placing on record our deep sence of love and gratitude to
our beloved God.
Last but not the least, we thankful to our friends,near and dear for their help at different stages of the world.

Rajesh Kumar Sahu

Umakanta Roul

Souratapa Rout

RudraMadhabaSatpathy

Rasmita Sahu

Jogeshwar Senapati

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 ABSTRACT
Background & Objective: The bacterial disease is a infectious disease that can reasult
serious or life threatening complications. The vast majority of bacteria do not cause
disease, many bacteria are actually help full and many bacteria are cause disease. The
bacterial disease occurs in any age group or population. Commonly the bacterial disease
transmitted through communication. From the research we know about the bacterial
infections and their transmission, cause, treatment, prevention etc. In this project report
we research about some common and deadliest bacterial disease.
Materials & Methods: This is a descriptive based on the past and present history of some
bacterial disease. To create this research report we use some government educational
websites and some books. In this research paper we describe about bacterial disease and
some common bacterial infections.
Reasult & Conclusion: The bacterial infections caused many large pandamics, that impact
on the entire world. Bacterial disease can be transmitted any medium any time.

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 BRIEF CONTENT
SERIAL NUMBER TOPIC PAGE NUMBER
PART I
CHAPTER-1 INTRODUCTION 11
1.1 Bacterial Disease 11
1.2 Bacterial Structure 12
1.2.1 Cell Wall 12
1.2.2 Outer Membrane 12
1.2.3 Cytoplasm 12
1.2.4 Ribosome 12
1.2.5 Mesosome 13
1.2.6 Nucleus 13
1.2.7 Capsule 13
1.2.8 Flagella 13
1.2.9 Pili 14
1.2.10 Spore 14
1.3 Growth And Multiplication Of Bacteria 14
1.4 Bacrterial Growth Curve 15
1.4.1 Lag Phase 15
1.4.2 Log Phase Or Exponential Phase 15
1.4.3 Phase Of Decline 15
1.5 Factors Affecting Bacterial Growth 16
1.5.1 Nutrition 16
1.5.2 Oxygen 16
1.5.3 Carbon Dioxide 16
1.5.4 Temperature 16
1.5.5 Moisture And Drying 16
1.5.6 Light 16
1.5.7 Osmotic Effect 16
1.6 Bacterial Variation 16
1.7 Mutation 17
1.8 Genetic Recombination 17
1.9 Metabolism 17
1.1 Risk Factors 18
1.11 Reducing Risk Factor 19
1.12 Types Of Bacterial Infection 20
1.13 Symptoms Of Bacterial Disease 20
PART II
Chapter 2 Common Deadliest Bacterial Disease 23
2.1 Plague 23
2.2 Plague History 24
2.3 Transmission Of Plague 25
2.4 Incubation Period 27
2.5 Mortality Rate 27
2.6 Occurrence 27
2.7 Risk Factor 27

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2.8 Forms Of Plague 27
2.9 Bubonic Plague 27
2.9.1 Cause 28
2.9.2 Sign And Symptoms 28
2.9.3 Treatment 29
2.10. Pneumonic Plague 29
2.10.1 Cause 30
2.10.2 Sign And Symptoms 30
2.10.3 Treatment 31
2.11 Septicemic Plague 31
2.11.1 Cause 32
2.11.2 Sign And Symptoms 32
Prevention And Control
32
Chapter 3 Cholera 34
3.1 History 35
3.2 Transmission Of Cholera 35
3.3 Incubation Period 36
3.4 Cause 36
3.5 Sign And Symptoms 37
3.6 Treatment 37
3.7 Prevention And Control 38
Chapter-4 Tuberculosis 38
4.1 Transmission Of Tb 39
4.2 Forms Of Tb 42
4.3 Latent/Inactive Tb 42
4.4 Active Tb 42
4.5 Cause 42
4.6 Sign And Symptoms 43
4.7 Treatment 43
Chapter-5 Prevention And Control 44
5.1 Typhoid 44
5.2 History 45
5.3 Cause Of Typhoid 45
5.4 Symptoms Of Typhoid 46
5.5 Risk Factor Of Typhoid 47
5.6 Treatment Of Typhoid 47
Chapter-6 Prevention Of Typhoid 47
6.1 Tetanus 48
6.2 Cause Of Tetanus 49
6.3 Risk Factor Of Tetanus 50
6.4 Symptoms Of Tetanus 50
6.5 Treatment Of Tetanus 51
Prevention Of Tetanus 53
Part III 53
Chapter 7 Modes Of Transmission 56
7.1 Communicable Transmission 56

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7.2 Airborn Transmission 57
7.3 Common Vectors 58
Chapter 8 Resourses For Eradication Of Bacterial Disease 59
8.1 Vaccination 59
8.2 Probiotics 59
8.3 Bacteriophages 60
Chapter 9 Preventive Measure For Bacterial Infection 61
Chapter 10 Conclusion 62

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Part-1

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 Chapter-1: Introduction
The simplest organisms living on earth today are bacteria, and biologists think they
closely resemble the first organisms to evolve on earth too small to see with the unaided eye,
bacteria are the most abundant of all organisms and are the only ones characterized by
Prokaryotic cellular organization. Life on earth could not exist without bacteria because
bacteria make possible many Of the essential functions of ecosystems, including the capture
of nitrogen from the atmosphere, decomposition of organic matter, and, in many aquatic
communities, photosynthesis. Indeed, bacterial photosynthesis is thought to have been the
source for much of the oxygen in the earth’s atmosphere. Bacterial research continues to
provide extraordinary insights into genetics, ecology, and disease. An understanding of
bacteria is thus essential.
Bacteria are the oldest, structurally Simplest, and the most abundantForms of life on
earth. They are also the only organisms with prokaryotic cellular organization. Represented
in the oldest rocks from which fossils have been obtained, 3.5 to 3.8 billion years old,
bacteria were abundant for over 2 billion years before eukaryotes appeared in the world early
photosynthetic bacteria(cyanobacteria) altered the earth’s atmosphere with the production of
oxygen which lead to extreme bacterial and eukaryotic diversity. Bacteria play a vital role
both in productivity and in cycling the substances essential to all other life-forms. Bacteria
are the only organisms capable of fixing atmosphericnitrogen.
About 5000 different kinds of bacteria are currently recognized, but there are
doubtless many thousands more awaiting proper identification every place microbiologists
look, new species arebeing discovered, in some cases altering the way we thinkabout
bacteria. In the 1970s and 80s a new type of bacterium was analyzed that eventually lead to
the classification of a new prokaryotic cell type, the archeabacteria (Archaea). Even when
viewed with an electron microscope,the structural differences between different bacteria
areminor compared to other groups of organisms. Because thestructural differences are so
slight, bacteria are classifiedbased primarily upon their metabolic and genetic characteristics.
Bacteria can be characterized properly only whenthey are grown on a defined medium
because the characteristics of these organisms often change, depending ontheir growth
conditions. Bacteria are ubiquitous on Earth, and live everywhereeukaryotes do. Many of the
other more extreme environments in which bacteria are found would be lethal to anyother
form of life. Bacteria live in hot springs that wouldcook other organisms, hypersaline
environments thatwould dehydrate other cells, and in atmospheres rich intoxic gases like
methane or hydrogen sulfide that would killmost other organisms. These harsh environments
may besimilar to the conditions present on the early Earth, when life first began. It is likely
that bacteria evolved to dwell inthese harsh conditions early on and have retained the ability
to exploit these areas as the rest of the atmosphere has changed.
1.1 Bacterial Disease:
Bacterial diseases include any type of illness caused by bacteria. Bacteria are a type of
microorganism, which are tiny forms of life that can only be seen with a microscope. Other
types of microorganisms include viruses, some fungi, and some parasites. Millions of
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bacteria normally live on the skin, in the intestines, and on the genitalia. The vast majority of
bacteria do not cause disease, and many bacteria are actually helpful and even necessary for
good health. These bacteria are sometimes referred to as “good bacteria” or “healthy
bacteria. Harmful bacteria that cause bacterial infections and disease are called pathogenic
bacteria.
Bacterial diseases occur when pathogenic bacteria get into the body and begin
to reproduce and crowd out healthy bacteria, or to grow in tissues that are normally sterile.
Harmful bacteria may also emit toxins that damage the body. The global problem infectious
and deadly disease caused by bacteria are presently major scientific and medical issues. The
bacterial infections have a large impact on public death. Bacterial infections are easier to
treat then viral infections.
An infection is a proliferation of a harmful strain of bacteria on or inside the body.
Bacteria can infect any area of the body. Pneumonia, meningitis, and food poisoning are just
a few illnesses that may be caused by harmful bacteria. Bacteria come in three basic shapes:
rod-shaped (bacilli), spherical (cocci), or helical (spirilla). Bacteria may also be classified as
gram-positive or gram-negative. Gram-positive bacteria have a thick cell wall while gram-
negative bacteria do not. Gram staining, bacterial culture with antibiotic sensitivity
determination, and other tests like genetic analysis are used to identify bacterial strains and
help determine the appropriate course of treatment. Bacterial diseases are contagious and can
result in many serious or life-threatening complications, such as blood poisoning
(bacteremia), kidney failure, and toxic shock syndrome.
1.2 Bacterial Structure:The outer layer or cell envelope consists of two components,
a rigid cell walland beneath it a cytoplasmic or plasma membrane. The cell envelope
enclosestheprotoplasm, comprising the cytoplasm, cytoplasmic inclusions such asribosomes
and mesosomes, granules, vacuoles and the nuclear body.
 Cell wall: Beneath the external structures is the cell wall. It is very rigid & gives shape
to the cell. Its main function is to prevent the cell from expanding & eventually
bursting due to water uptake. Cell Wall constitutes a significant portion of the dry
weight of the cell and it is essential for bacterial growth & division.
The cell wall cannot be seen by direct light microscopy and does not stain withsimple
stains. It may be demonstrated by microdissection, reaction with specific antibodies,
mechanical rupture of the cell, differential staining procedures or by electron
microscopy. Chemically the cell wall is composed of peptidoglycan. Mucopeptide
(peptidoglycan or murine) formed by N acetyl glucosamine & N acetyl-muramic acid
alternating in chains, cross linked by peptide chains. Embedded in it are polyalcohol
called Teichoic acids. Some are linked to Lipids & called lipoteichoic acid.
Lipotechoic acid link peptidoglycan to cytoplasmic membrane and the peptidoglycan
gives rigidity.
 Outer Membrane:Cytoplasmic membrane is present immediately beneath the cell
wall, found inboth Gram positive & negative bacteria and it is a thin layer lining the
innersurface of cell wall and separating it from cytoplasm. It acts as a
semipermeablemembrane controlling the flow of metabolites to and from
theprotoplasm.
 Cytoplasm:Thecytoplasm is a Colloidal system containing a variety of organic
andinorganic solutes containing 80% Water and 20% Salts, Proteins. They are rich in
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 ribosomes, DNA & fluid. DNA is circular and haploid. They are highly coiledwith
intermixed polyamines & support proteins. Plasmids are extra circular D.N.A.
 Ribosomes:They are the centers of protein synthesis. They are slightly smaller thanthe
ribosomes of eukaryotic cells .
 Mesosomes: They are vesicular, convoluted tubules formed by invagination of plasma
membrane into the cytoplasm. They are principal sites of respiratory enzymes and help
with cell reproduction .
 Nucleus: The Nucleus is not distinct and has no nuclear membrane or nucleolus and
the genetic material consist of DNA. The cytoplasmic carriers of genetic information
are termed plasmids or epitomes.
 Capsule:Capsule is the outer most layer of the bacteria (extra cellular). It is a
condensed well defined layer closely surrounding the cell. They are usually
polysaccharide and if polysaccharide envelops the whole bacterium it is capsule and
their production depends on growth conditions. They are secreted by the cell into the
external environment and are highly impermeable. When it forms a loose mesh work
of fibrils extending outward from the cell they are described as glycocalyx and when
masses of polymer that formed appear to be totally detached from the cell and if the
cells are seen entrapped in it are described as slime layer. The Capsule protects against
complement and is antiphagocytic. The Slime layer& glycocalyx helps in adherence of
bacteria either to themselves forming colonial masses or to surfaces in their
environment and they resists phagocytosis and desiccation of bacteria.
 Flagella: Flagella are long hair like helical filaments extending from cytoplasmic
membrane to exterior of the cell. Flagellin is highly antigenic and functions in Cell
motility. The location of the flagella depends on bacterial species as polar situated at
one or both ends which swims in back and forth fashion and lateral at along the sides.
The parts of flagella are the filament, hook and the basal body. Filament is external to
cell wall and is connected to the hook at cell surface, the hook & basal body are
embedded in the cell envelope. Hook & filament is composed of protein subunits
called as flagellin. Flagellin is synthesized within the cell and passes through the
hollow center of flagella. The arrangement of flagella may be described as:

1.Monotrichous – single flagella on one side

2.Lophotrichous – tuft of flagella on one side
3.Amphitrichous – single or tuft on both sides
4.Peritrichous – surrounded by lateral flagella

Various types of mobility is observed because of the presence of the flagella as serpentine
motility is seen with Salmonella, Darting motility with Vibrio and tumbling motility with
Listeria monocytogenes

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.
 Pili / Fimbriae:Hair-like proteinaceous structures that extend from the cell membrane
toexternal environment are pili which are otherwise known as fimbriae. They
arethinner, shorter and more numerous than flagella and they do not function
inmotility. The fimbriae is composed of a subunit called pilin. There are two types pili
namely Non-sex pili (Common pili). fimbriae or typeIV and the sex pili. The fimbriae
are antigenic and mediate their adhesion whichinhibits phagocytosis. The sex pili help
in conjugation.
 Spore: Some bacteria have the ability to form highly resistant resting stage called
spores, which helps them to overcome adverse environmental conditions that are
unfavorable for vegetative growth of cell. They are not a reproductive form and not a
storage granule. These spores are resistant to bactericidal agents and adverse physical
conditions. Each spore can give rise to only one endospore which play a role in heat
resistance. Spores consists of three layers namely core,cortex and spore coat .

1.3 Growth and Multiplication of Bacteria

Bacteria divide by binary fission and cell divides to form two daughter cells. Nuclear
division precedes cell division and therefore, in a growing population, many cells having two
nuclear bodies can be seen. Bacterial growth may beconsidered as two levels, increase in the
size of individual cells and increase innumber of cells. Growth in numbers can be studied by
bacterial counts that oftotal and viable counts. The total count gives the number of cells
either livingor not and the viable count measures the number of living cells that are
capableof multiplication.

1.4 Bacterial Growth Curve: When bacteria is grown in a suitable liquid

medium and incubated its growth follows a definite process. If bacterial counts are carried

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out at intervals after innoculation and plotted in relation to time, a growth curve is obtained.
The curve shows the following phase :
(i) Lag phase:Immediately following innoculation there is no appreciable increase
in number,though there may be an increase in the size of the cells. This initial
period is the time required for adaptation to the new environment and this lag
phase varies With species, nature of culture medium and temperature.
(ii) Log or exponential phase:The lag phase, the cell starts dividing and their
numbers increaseexponentially with time.
(iii) Stationary phase: After a period of exponential growth, cell division stops due
to depletion of nutrient and accumulation of toxic products. The viable count
remains stationary as an equilibrium exists between the dying cells and the
newly formed cells.
(iv) Phase of decline:The various stages of bacterial growth curve are associated
with morphological and physiological alterations of the cells. The maximum
cell size is obtained towards the end of the lag phase.In the log phase, cells are
smaller and stained uniformly.
In the thestationary phase, cells are frequently gram variable and show irregular
staining due to the presence of intracellular storage granules. Sporulation occurs
at this stage. Also, many bacteria produce secondary metabolic products such as
exotoxins and antibiotics. Involution forms are common in the phase of
decline .

1.5 Factors That Affect The Growth Of Bacteria

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Many factors affect the generation time of the organism like temperature, oxygen, carbon
dioxide, light, pH, moisture, salt concentration.
 Nutrition:The principal constituents of the cells are water, proteins,
polysaccharides,lipids, nucleic acid and mucopeptides. For growth and multiplication
of bacteria,the minimum nutritional requirement is water, a source of carbon, nitrogen
andsome inorganic salts. Bacteria can be classifiednutritionally, based on their energy
requirement and on their ability to synthesise essential metabolites. Bacteria which
derive their from sunlight are called phototrophs, those who obtain energy from
chemical reactions are called chemotrophs. Bacteria which can synthesise alltheir
organic compounds are called autotrophs and those that are unable tosynthesise their
own metabolites are heterotrophs.Some bacteria require certain organic compounds in
minute quantities. Theseare know as growth factors or bacterial vitamins. Growth
factors are calledessential when growth does not occur in their absence, or they are
necessary for it.
 Oxygen: Depending on the influence of oxygen on growth and viability, bacteria
aredivided into aerobes and anaerobes.Aerobic bacteria require oxygen for growth.
They may be obligate aerobes like cholera, vibrio, which will grow only in the
presence of oxygen or facultativeanaerobes which are ordinarily aerobic but can grow
in the absence of oxygen. Most bacterial of medical importance are facultative
anaerobes. Anaerobicbacteria, such as clostridia, grow in the absence of oxygen and
the obligate anaerobes may even die on exposure to oxygen. Microaerophilic bacteria
arethose that grow best in the presence of low oxygen tension.
 Carbon Dioxide:All bacteria require small amounts of carbon dioxide for growth.
This requirement is usually met by the carbon dioxide present in the atmosphere.Some
bacteria like brucella abortus require much higher levels of carbon dioxide.
 Temperature:Bacteria vary in their requirement of temperature for growth. The
temperatureat which growth occurs best is known as the optimum temperature.
Bacteriawhich grow best at temperatures of 25-40°C are called mesophilic.
Psychrophilicbacteria are those that grow best at temperatures below 20°C. Another
group ofnon pathogenic bacteria, thermophiles, grow best at high temperatures, 55-
80°C.The lowest temperature that kills a bacterium under standard conditions in
agiven time is known as thermal death point.
 Moisture and Drying:Water is an essential ingredient of bacterial protoplasm and
hence drying is lethal to cells. The effect of drying varies in different species.
 Light :Bacteria except phototrophic species grow well in the dark. They are
sensitiveto ultraviolet light and other radiations. Cultures die if exposed to light.
 Osmotic Effect:Bacteria are more tolerant to osmotic variation than most other cells
due to the mechanical strength of their cell wall. Sudden exposure to hypertonic
solutions may cause osmotic withdrawal of water and shrinkage of protoplasm called
plasmolysis.

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1.6 Bacterial Variation:
Bacteria reproduce rapidly, allowing genetic variations to spread quickly through a
population. Two processes create variation among bacteria: mutations and genetic
recombination.

1.7 Mutation:Mutations can arise spontaneouslyin bacteria as errors in DNA

replications occur. Certain factors tend to increase the likelihood of errors occurring such as
radiation, ultraviolentlight, and various chemicals. In a typical bacterium such as
Escherichiacoli there are about 5000 genes. It ishighly probably that one mutationwill occur
by chance in one out ofevery million copies of a gene. With5000 genes in a bacterium, the
laws of probability predict that 1 out ofevery 200 bacteria will have a mutation .
A spoonful of soiltypically contains over a billion bacteria and therefore should contain
something on the order of 5 millionmutantindividuals . With adequate food and nutrients, a
population of E. coli can double in under 20 minutes. Becausebacteria multiply so rapidly,
mutations can spread rapidly in a population and can change the characteristics of
thatpopulation.
The ability of bacteria to change rapidly in response tonew challenges often has adverse
effects on humans. Recently a number of strains of Staphylococcus aureus associatedwith
serious infections in hospitalized patients have appeared, some of them with alarming
frequency. Unfortunately, these strains have acquired resistance to penicillin anda wide
variety of other antibiotics, so that infections causedby them are very difficult to treat.
Staphylococcus infectionsprovide an excellent example of the way in which mutationand
intensive selection can bring about rapid change in bacterial populations. Such changes have
serious medical implications when, as in the case of Staphylococcus, strains of bacteria
emerge that are resistant to a variety of antibiotics.Recently, concern has arisen over the
prevalence of antibacterial soaps in the marketplace.They are marketed as ameans of
protecting your family from harmful bacteria;however, it is likely that their routine use will
favor bacteriathat have mutations making them immune to the antibiotics contained in them.
Ultimately, extensive use of antibacterial soaps could have an adverse effect on our abilityto
treat common bacterial infections.

1.8 Genetic Recombination

Another source of genetic variation in populations of bacteria is recombination,Bacterial
recombination occurs by the transfer of genes from one cell to another by viruses, or through
conjugation. The rapid transfer of newly produced, antibiotic resistant genes by plasmids has
been an important factor in the appearance of the resistant strains of staphylococcus aureus
discussed earlier. An even more important example in terms of human health involves the
Enterobacteriaceae, the family of bacteria to which the common intestinal bacterium,
Escherichia coli, belongs. In this family, there are many important pathogenic bacteria,
including the organisms that cause dysentery, typhoid, and other major diseases. At times,
some of the genetic material from these pathogenic species is exchanged with or transferred

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to E.coli by plasmids. Because of its abundance in the human digestive tract, E. coli poses a
special threat if it acquires harmful traits.

1.9Bacterial Metabolism
Bacteria have evolved many mechanisms to acquire the energy and nutrients they need for
growth and reproduction.Many are autotrophs, organisms that obtain their carbonfrom
inorganic CO2. Autotrophs that obtain their energyfrom sunlight are called photoautotrophs,
while those thatharvest energy from inorganic chemicals are calledchemoautotrophs. Other
bacteria are heterotrophs, organisms that obtain at least some of their carbon from
organicmolecules like glucose. Heterotrophs that obtain their energy from sunlight are called
photoheterotrophs, while thosethat harvest energy from organic molecules are
calledchemoheterotrophs.
 Photoautotrophs: Many bacteria carry out photosynthesis, using the energy of
sunlight to build organic molecules from carbon dioxide. The cyanobacteria
useChlorophyll a as the key light-capturing pigment and useH2O as an electron donor,
releasing oxygen gas as a byproduct. Other bacteria use bacteriochlorophyll as
theirPigment and H2S as an electron donor, leaving elemental sulfur as the by-
product.
 Chemoautotrophs: Some bacteria obtain their energyBy oxidizing inorganic
substances. Nitrifiers, for example, oxidize ammonia or nitrite to obtain energy,
producing the nitrate that is taken up by plants. ThisProcess is called nitrogen fixation
and is essential in terrestrials ecosystems as plants can only absorb nitrogen in the
form of nitrate. Other bacteria oxidize sulfur, hydrogen gas, and other inorganic
molecules. On the darkOcean floor at depths of 2500 meters, entire ecosystem Subsist
on bacteria that oxidize hydrogen sulfide as it escapes from thermal vents.
 Photoheterotrophs: The so-called purple nonsulfur bacteria use light as their source
of energy but obtain carbon from organic molecules such as carbohydrates or alcohols
that have been produced by other organisms.Most bacteria obtain both carbon atoms
and energy from organic molecules. TheseInclude decomposers and most pathogens.

1.10 Risk Factors for Bacterial Disease

Bacterial diseases can occur in any age group or population, but a number of factors increase the
risk of developing bacterial diseases. Not all people with risk factors will get bacterial diseases.
Risk factors for bacterial diseases include:

 Being an infant, child or older adult

 Eating eggs or meats that are raw or undercooked
 Eating expired foods, or eating leftovers that have been stored for more than two
to three days
 Having a genetic predisposition to bacterial infection
 Having a compromised immune system due to an immunodeficiency disorder,
HIV/AIDS, diabetes, cancer or cancer treatment, kidney disease, or from taking
steroid medications   
 Having a chronic disease
 Malnutrition
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  Not washing your hands frequently, especially after using the bathroom, touching
pet feces, handling reptiles, or touching raw foods or foods contaminated with
bacteria
 Significant exposure to a person with a bacterial disease

1.11Reducing Risk Of Bacterial Disease

You can lower your risk of developing or transmitting bacterial diseases by :

 Avoiding contact with a person who has a bacterial disease or its symptoms, such
as fever, vomiting or diarrhea

 Covering your mouth and nose with a tissue when sneezing or coughing, then
washing your hands

 Defrosting foods in the refrigerator or microwave, not on the counter

 Refrigerating leftovers right away and eating them within two to three days
unless they have been frozen.

 Eating a healthy diet that is high in whole grains, fruits and vegetables and
contains adequate low-fat protein and low-fat dairy products or other calcium
sources.

 Getting enough rest and minimizing stress.

 Getting recommended vaccines for bacterial diseases, such as meningitis,
pneumonia, tetanus and rabies.

 Seeking regular medical care and following your treatment plan for a chronic
disease.

 Throwing out expired food or perishable food that has been sitting at room
temperature for two hours or longer.

 Using antibacterial products to clean surfaces, such as computer keyboards,

telephones and sinks.

 Washing your hands after using the bathroom and after contact with pet feces,
reptiles, dirty diapers, raw foods, and people who are ill.

 Washing plates, utensils, and cutting boards that have been exposed to raw meats
or poultry in hot soapy water.

 Wearing long pants and sleeves, and using insect repellant when in tall grass or
wooded areas.

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1.12 Types of Bacterial Infections
The severity of bacterial infections depends largely on the type of bacteria involved. Bacterial infections can
range from minor illnesses such as strep throat and ear infections to more life-threatening conditions
like meningitis and encephalitis.

Some of the most common bacterial infections include:

1. Salmonella: It is a type of infection often described as food poisoning. It causes severe stomach
upset, diarrhea, and vomiting. Salmonella is caused by a non-typhoidal salmonellae bacteria found in
the intestinal tracts of humans and other animals, and the most recognized method of infection is
through undercooked poultry.

2. Escherichia coli (E. coli):It causes gastrointestinal (GI) distress. The infection usually resolves on
its own, but it can be severe or even fatal. E. Coli bacteria is commonly spread through contaminated
food, including uncooked vegetables.

3. Tuberculosis: Tuberculosis is a highly contagious disease caused by the Mycobacterium

tuberculosis bacteria. It most commonly causes a lung infection, and it rarely affects the brain.

4. Methicillin-resistant Staphylococcus aureus (MRSA): It is an antibiotic-resistant bacteria that can

be deadly, particularly in people who have compromised immune systems.

5. Clostridium difficile (C. diff): This is a bacteria normally found in the intestine. It can cause GI
illness when it overgrows due to antibiotic use or an impaired immune system.

6. Bacterialpneumonia: This is a lung infection that can be caused by an array of different bacteria,
including Streptococcus pneumoniae, Klebsiella pneumoniae, Pseudomonas aeruginosa, and others.
These infections are typically spread through air particles from coughing or sneezing.

7. vaginosis: It is an infection of the vagina which can cause itchiness, discharge, and painful urination.
It is caused by an imbalance in the normal bacterial flora of the vagina.

8. Heliobacter pylori (H. pylori): It is a type of bacteria associated with stomach ulcers and chronic
gastritis. The environment of the GI system can change due to reflux, acidity, and smoking, which
predisposes to this bacterial infection.

9. Gonorrhea: It is a sexually transmitted infection caused by the bacteria Neisseria gonorrhoeae.

10. vulnificus:It is a rare, “flesh-eating” bacteria that can be found in warm seawater.

1.13 Symptoms Of Bacterial Disease

Symptoms of bacterial diseases vary depending on the type of bacterial infection, the area of the
body that is infected, and other factors, such as the patient’s age and health history. The
symptoms of bacterial diseases can also resemble symptoms of other diseases, such
as colitis, influenza, and viral infections. The classic symptom of a bacterial infection is a fever,
although not all people with a bacterial infection will have a fever.Bacterial disease symptoms
can include:

 Bloody urine and painful, frequent urination

 Diarrhea
 Flu-like symptoms (fatigue, fever, sore throat, headache, cough, aches and pains)
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  Irritability
 Nausea and vomiting
 Pain such as joint, ear or abdominal pain
 Rashes, lesions and abscesses
 Stiff neck
 Weakness
In infants, signs of a bacterial disease can also include:

 Bulging of the soft spot on the top of the head 

 Difficulty with feeding
 Excessive crying or fussiness
 Excessive sleepiness
Serious symptoms that might indicate a life-threatening condition
In some cases, bacterial diseases can result in serious or life-threatening complications, such as
sepsis or kidney failure.Have any of the following symptoms:

 Confusion or delirium
 Deep, wet chest cough that produces yellow, green or brownish phlegm
 Difficulty breathing, wheezing or shortness of breath
 High fever (higher than 101 degrees)
 Inappropriate change in alertness or level of consciousness
 Infants: sunken fontanel (soft spot) on the top of the head, lethargy, no tears with
crying, and few or no wet diapers
 Lethargy or unresponsiveness
 Not urinating or urinating small amounts of tea-colored urine
 Seizure

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 Part-2

Chapter-2: Common Deadliest Bacterial Disease

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Infectious disease spread from person to person by bacteria. There are records about
infectious disease as for back 3000 B.C.E number of significant pandamic caused by
bacteria have been documented over several hundred years. Some of the memorable
pandemics led to the decline of cities and nations.Some of the most deadliest bacterial
disease are described below :

2.1 A.Plague:
Plague is a deadly infectious disease that is caused by the enterobacteria Yersiniapestis.
Primarily carried by rodents (most notably rats) and spread to humans via fleas, the disease
is notorious throughout history, due to the unrivaled scale of death and devastation it
brought. Until June 2007, plague was one of the three epidemic diseases specifically
reportable to the World Health Organization (the other two being cholera and yellow fever).
Plague is a bacterial disease, caused by Yersiniapestis, which primarily affects wild rodents.
It is spread from one rodent to another by fleas. Humans bitten by an infected flea usually
develop a bubonic form of plague, which is characterized by a bubo, i.e. a swelling of the
lymph node draining the flea bite site.If the bacteria reach the lungs, the patient develops
pneumonia (pneumonic plague), which is then transmissible from person to person through
infected droplets spread by coughing. Initial symptoms of bubonic plague appear 7–10 days
after infection.If diagnosed early, bubonic plague can be successfully treated with
antibiotics. Pneumonic plague, on the other hand, is one of the most deadly infectious
diseases; patients can die 24 hours after infection. The mortality rate depends on how soon
treatment is started, but is always very high.

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2.2 Plague History:Three major plague pandemics have been recorded in human
history: in the 6th century, in the 14th century (known as the ‘Black Death,’ which killed up
to one-third of the European
population or an estimated 17 to 28 million people, and at the end of 19th century following
thespread of infection from China. The plague bacillus was isolated during the third
pandemic by Alexandre Yersin in 1894.
 The Justinian Plague: The first recorded pandemic, the Justinian Plague, was named
after the 6th centuryByzantine emperor Justinian. The Justinian Plague began in 541
AD and was followed by frequent outbreaks over the next two hundred years that
eventually killed over 100 million peopleand affected much of the mediterranean
basin--virtually all of the known world at that time.
 Black Death or the Great Plague: The second pandemic, widely known as the
"Black Death" or the Great Plague. The Black Death was one of the most devastating
pandemics in human history, peaking in Europe between 1348 and 1350. The balck
death was originated China in 1334 and spread along the great trade routes to
Constantinople and then to Europe, where it claimed an estimated 60% of the
European population. Entire towns were wiped out. Some contemporary historians
report that on occasion, there were not enough survivors remaining to bury the dead.
Despite the vast devastation caused by this pandemic, however, massive labor
shortages due to high mortality rates sped up the development of many economic,
social, and technical modernizations. It has Even been considered a factor in the
emergence of the Renaissance in the late 14th century.
 Modern Plague: The third pandemic, the Modern Plague, began in China in the 1860s
and appeared in HongKong by 1894. Over the next 20 years, it spread to port cities
around the world by rats on steamships. The pandemic caused approximately 10
million deaths (Khan, 2004). During this last pandemic, scientists identified the
causative agent as a bacterium and determined that plague Is spread by infectious flea
bites. Rat-associated plague was soon brought under control in most urban areas, but
the infection easily spread to local populations of ground squirrels and other small
mammals in the Americas, Africa, and Asia. These new species of carriers have
allowed plague to become endemic in many rural areas, including the western
U.S.However, as a bacterial disease, plague can be treated with antibiotics, and can be
prevented from spreading by prompt identification, treatment and management of
human cases. Applications of effective insecticides to control the flea vectors also
provide assistance in controlling plague.Recent Outbreaks the most recent plague
epidemics have been reported in India during the first half of the 20 thCentury, and in
Vietnam during wartime in the 1960s and 1970s. Plague is now commonly found In
sub-Saharan Africa and Madagascar, areas which now account for over 95% of
reported cases.

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2.3 Transmission of Plague:
Transmission of Y. pestis to an uninfected individual is possible by any of the following
means.
 Droplet contact – coughing or sneezing on another person.
 Direct physical contact – touching an infected person, including sexual contact.
 Indirect contact – usually by touching soil contamination or a contaminated surface.
 Airborne transmission – if the microorganism can remain in the air for long periods.
 Fecal-oral transmission – usually from contaminated food or water sources.
 Vector borne transmission – carried by insects or other animals.

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(Transmission Pathway For The Plague Agent Y. Pestis)

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2.4 Incubation period:A person usually becomes ill with bubonic plague 2 to 6 days
after being infected. When bubonic plague is left untreated, plague bacteria invade the
bloodstream. When plague bacteria multiply in the bloodstream, they spread rapidly
throughout the body and cause a severe and often fatal condition. Infection of the lungs with
the plague bacterium causes the pneumonic form of plague, a severe respiratory illness. The
infected person may experience high fever, chills, cough, and breathing difficulty, and expel
bloody sputum. If plague patients are not given specific antibiotic therapy, the disease can
progress rapidly to death.

2.5 Mortality Rate:Without treatment, fatality rates: up to 90% for bubonic plague,
100% for septicemic or Pneumonic plague. Treatment, fatality rate= (5-20%). About 14% (1
in 7) of all plague cases in the united States are fatal.

2.6 Occurrence:
 Plague can be acquired at anytime during the year.
 Generally, plague is most common in the southwestern states, particularly New
Mexico and Arizona.
 Outbreaks in people occur in areas where housing and sanitation conditions are poor.
These outbreaks can occur in rural communities or in cities. They are usually
associated with infected rats and rat fleas that live in the home.

2.7 Risk Factors:

 Location: Plague outbreaks are most common in rural areas and in urban areas
characterized by overcrowding, poor sanitation and a high rat population. The
greatest number of human plague Infections occurs in Africa.
 Occupation:Veterinarians and their assistants have a higher risk of coming into
contact with domestic cats that may have become infected with plague. Also at
higher risk are people who work outdoors in areas where plague-infested
animals are common.

2.8 Forms Of Plague:

The most common form of plague results in swollen and tender lymph nodes called buboes
in the groin, armpits or neck. The rarest and deadliest form of plague affects the lungs, and it
can be spread from person to person. There are three forms of plague :

2.9: 1.BubonicPlague:When a flea bites a human and contaminates the wound with
regurgitated blood, the plague carrying bacteria are passed into the tissue. Y. pestis can
reproduce inside cells, so even if phagocytosed, they can still survive. Once in the body, the
bacteria can enter the lymphatic system, which drains interstitial fluid. Plague bacteria
secrete several toxins, one of which is known to cause dangerous beta-adrenergic blockade.

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Y. pestis spreads through the lymphatics of the infected human until it reaches a lymph node,
where it stimulates severe haemorrhagicinflammation that causes the lymph nodes to
expand. The expansion of lymph nodes is the cause of the characteristic "bubo" associated
with the disease.

2.10 Causes:Medical knowledge had stagnated during the Middle Ages and the most
authoritative account at the time came fromthe Medical Faculty in Paris in a report to the
King of France, which blamed the heavensa conjunction of threeplanets in 1345, which
caused a "great pestilence in the air".This report became the first and most widelycirculated
of a series of "plague tracts" which sought to give advice to sufferers. That the plague was
caused by badair became the most widely accepted theory. It's important to realise that the
word plague had no special significanceat this time. But the recurrence of outbreaks during
the middle ages gave it a unique reputation and the name hasbecome the medical term.The
importance of hygiene was only recognised in the nineteenth century and until then it was
common that thestreets were filthy, with live animals of all sorts around and human fleas and
ticks abounding. Any transmissibledisease will spread easily in such conditions. One benefit
of the black death was the establishment of the idea ofquarantine in Dubrovnik in 1377 after
continuing outbreaks.

2.11 Sign and Symptoms:Bubonic plague is the most common variety of the disease. It's
named after the buboes swollen lymph nodes which typically develop within a week after an
infected flea bites you. Buboes may be:
 Situated in the groin, armpit or neck.
 About the size of a chicken egg.
 Tender and warm to the touch.
Other signs and symptoms may include:
 Sudden onset of fever and chills
 Headache
 Fatigue or malaise
 Muscle aches

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(Fig: Hand showing acral gangrene of the digits due to plague)

2.12 Treatment: The bubonic plague can be treated and cured with antibiotics. If you are
diagnosed with bubonic plague, you’ll be hospitalized and given antibiotics. In some
cases, you may be put into an isolation unit.Antibiotics that treat bubonic plague
include:

 Ciprofloxacin
 levofloxacin and moxifloxacin
 Gentamicin
 Doxycycline

2.13: 2.Pneumonic Plague:The pneumonic plague infects the lungs, and

with that infection comes the possibility of person to person transmission through respiratory
droplets. The incubation period for pneumonic plague is usually between two and four days,
but can be as little as a few hours. The initial symptoms are headache, weakness, and
coughing with blood (hemoptysis), or vomiting blood(hematemesis), are indistinguishable
from several other respiratory illnesses. Without diagnosis and treatment, the infection can
be fatal in one to six days; mortality in untreated cases is approximately 100%.

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2.14 Causes:Pneumonic plague occurs when Y. pestis infects the lungs. This type of
plague can spread from person to person through the air. Transmission can take place if
someone breathes in aerosolized bacteria, which could happen in a bioterrorist attack.
Pneumonic plague is also spread by breathing in Y. pestis suspended in respiratory droplets
from a person (or animal) with pneumonic plague. Becoming infected in this way usually
requires direct and close contact with the ill person or animal. Pneumonic plague may also
occur if a person with bubonic or septicemic plague is untreated and the bacteria spread to
the lungs.

2.15 Sign and Symptoms: Pneumonic plague affects the lungs. It's the least
common variety of plague but the most dangerous, because it can be spread from
person to person via cough droplets. Signs and symptoms can begin within a few
hours after infection, and may include:
 Cough, with bloody sputum
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  Difficulty breathing
 High fever
 Nausea and vomiting
 Weakness
Pneumonic plague progresses rapidly and may cause respiratory failure
and shock within two days of infection. If antibiotic treatment isn't
initiated within a day after signs and symptoms first appear, theinfection
is likely to be fatal.

(Fig: Showing Primary stage of Pneumonic Plague)

 Treatment: The bubonic plague can be treated and cured with antibiotics.
Some medicine and antibiotics are:
 Streptomycin
 Gentamicin

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2.16: 3.SepticemicPlague:Lymphatics ultimately drain into the bloodstream, so
the plague bacteria may enter the blood and travel to almost any part of the body. In
septicemic plague, bacterial endotoxins cause disseminated intravascular coagulation (DIC),
causing tiny clots throughout the body and possibly ischemic necrosis (tissue death due to
lack of circulation/perfusion to that tissue) from the clots. DIC results in depletion of the
body's clotting resources, so that it can no longer control bleeding. Consequently, there is
bleeding into the skin and other organs, which can cause red and/or black patchy rash and
hemoptysis/hematemesis (coughing up/ vomiting of blood).
There are bumps on the skin that look somewhat like insect bites; these are usually red, and
sometimes white in the center. Untreated, septicemic plague is usually fatal. Early treatment
with antibiotics reduces the mortality rate to between 4 and 15 percent. People who die from
this form of plague often die on the same day symptoms first appear.

2.17 Causes:Septicemic plague occurs when plague bacteria multiply in the blood. It

can be a complication of pneumonic or bubonic plague or it can occur by itself. When it
occurs alone, it is caused in the same ways as bubonic plague; however, buboes do not
develop. Patients have fever, chills, prostration, abdominal pain, shock, and bleeding into
skin and other organs. Septicemic plague does not spread from person to person.

2.18Sign and Symptoms:Septicemic plague occurs when plague bacteria

multiply in your bloodstream. Signs and symptoms include:
 Fever and chills
 Abdominal pain, diarrhea and vomiting.
 Bleeding from your mouth, nose or rectum, or under your skin shock.
 Blackening and death of tissue (gangrene) in your extremities, most commonly
your fingers, toes and nose.
2.19 Treatment: People with pneumonic plague must be kept away from caregivers and
other patients. There are some antibiotics are :
 Streptomycin
 Gentamicin
 Doxycycline
 Ciprofloxacin

2.20 PREVENTION AND CONTROL :

 Habitat around home, work place, and recreational areas should free from rodent.
 Removal of brush, rock piles, junk, cluttered firewood, and possible rodent food
Supplies, such as pet and wild animal food. One should make sure that his/her home
and Outbuildings are rodent-proof.
 One should wear gloves during handling or skinning of potentially infected animals
to prevent contact between your skin and the plague bacteria.
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  Use of repellent to prevent rodent fleas during activities such as camping, hiking, or
working outdoors. Products containing DEET can be applied to the skin as well as
Clothing and products containing permethrin can be applied to clothing.
 Keeping fleas off of pets by applying flea control products. Animals that roam
freely are More likely to come in contact with plague infected animals or fleas and
could bringthem into homes. If one’s pet becomes sick, seeking care from a
veterinarian as soon as possible.
 One should not allow dogs or cats that roam free in endemic areas to sleep on
his/her bed.
 Yersinia pestis poses a serious infectious hazard for nursing and laboratory
personnel.
 Protective clothing and a full face respirator should always be worn when working
with this organism.
 Cultivation and virulence testing of this organism should be attempted only in P-3
containment facilities by staff who have been immunized recently with live
attenuated vaccine.
One of the oldest identifiable diseases known to man, plague remains endemic in many
natural foci around the world. It is still widely distributed in the tropics and subtropics and in
warmer areas of temperate countries. Essentially a disease of wild rodents, plague is spread
from one rodent to another by flea ectoparasites and to humans either by the bite of infected
fleas or when handling infected hosts. Recent outbreaks have shown that plague may reoccur
in areas that have Long remained silent. Untreated, mortality particularly from pneumonic
plague may reach high levels. When rapidly diagnosed and promptly treated, plague may be
successfully managed with antibiotics such as streptomycin and tetracycline, reducing
mortality from 60% to less than 15%.

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 Chapter-3: Cholera
Cholera is an acute secretory diarrheal illness caused by toxin-producing strains of the gram-
negative bacterium Vibrio cholerae.Cholera is an infectious disease that causes severe
watery diarrhea, which can lead to dehydration and even death if untreated. Severe cholera is
characterized by profound fluid and electrolyte losses in the stool and the rapid development
of hypovolemic shock, often within 24 hours from the initial onset of vomiting and diarrhea.
Administration of appropriate rehydration therapy reduces the mortality of severe cholera
from over 10 percent to less than 0.5 percent. The term cholera has a long history and has
been assigned to several other diseases. For example, fowl or chicken cholera is a disease
that can rapidly kill chickens and other avian species rapidly with a major symptom of
diarrhea. However, the disease-causing agent in fowl is Pasteurella multocida, a gram-
negative bacterium. Similarly, pig cholera can cause rapid death (in about 15 days) in pigs
with symptoms of fever, skin lesions, and seizures. This disease is caused by a pestivirus
termed CSFV (classical swine fever virus). Neither one of these animal diseases are related
to human cholera, but the terminology can be confusing.

(Vibrio cholerae)
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3.1 History:Cholera has likely been affecting humans for many centuries. Reports of
cholera-like disease have been found in India as early as 1000 AD. Cholera is a term derived
from Greek Khloe (illness from bile) and later in the 14th century to cohere (French)
and choler . In the 17th century, cholera was a term used to describe a severe gastrointestinal
disorder involving diarrhea and vomiting. There were many outbreaks of cholera, and by the
16th century, some were being noted in historical writings. England had several in the 19th
century, the most notable being in 1854, when Dr. John Snow did a classic study in London
that showed a main source of the disease (resulting in about 500 deaths in 10 days) came
from at least one of the major water sources for London residents termed the "Broad Street
pump." The pump handle was removed, and the cholera deaths slowed and stopped. The
pump is still present as a landmark in London. Although Dr. Snow did not discover the cause
of cholera, he did show how the disease could be spread and how to stop a local outbreak.
This was the beginning of modern epidemiologic studies. The last reference shows the map
Dr. Snow used to identify the pump site.
V. cholerae was first isolated as the cause of cholera by Filippo Pacini in 1854, but
his discovery was not widely known until Robert Koch working independently 30 years
later, publicized the knowledge and the means of fighting the disease. The history of cholera
repeats itself. The U.S. National Library of Medicine houses original documents about
multiple cholera outbreaks in the U.S. from the 1820s to the 1900s, with the last large
outbreak in 1910-1911. Since the 1800s, there have been seven cholera pandemics. The
seventh pandemic of cholera started in 1961 and lasted until 1975; some researchers think
the occasional outbreaks represent remnants of the seventh pandemic.
Cholera riots occurred in Russia and England (1831) and in Germany (1893) when the
people rebelled against strict government isolation (quarantines) and burial rules. In 2008,
cholera riots broke out in Zimbabwe as police tried to disperse people who tried to withdraw
funds from banks and were protesting because of the collapse of the health system that began
with a cholera outbreak. Similar but less violent public protests have occurred when yellow
fever, typhoid fever, and tuberculosis quarantines have been enforced by health
authorities.Multiple outbreaks continue into the 21 st century, with outbreaks in India, Iran,
Vietnam, and several African countries over the last 10 years. Some recent outbreaks
occurred in Haiti and Nigeria in 2010-2011, and South Sudan, Tanzania, Iraq, Kenya, and
Cuba in 2015-2016, and Yemen in 2017-18. Since 2017-2018, the WHO has listed 1,084,191
suspected cases of cholera with 2,267 associated deaths in war-torn Yemen.

3.2 Transmission Of Cholera:

Vibrio cholerae is the causative agent responsible for cholera. It is a bean-shaped bacterium
with a long tail that it uses for self-propulsion. The bacteria are transmitted between humans
through the fecal-oral route; a bite of contaminated food or a sip of contaminated water can
cause infection. More specifically, a toxin secreted by the bacteria, which targets receptors in
the human intestine, is responsible for the pathology characteristic of the disease. Symptoms
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include excessive, watery diarrhea; vomiting; dehydration; and, without proper treatment,
rapid deterioration and death.

Before infecting a human host, a key component of the vibrios’s survival strategy in its
aquatic environment is the close interaction between the bacteria and a type of shrimp-like
crustacean called a copepod. The cholera bacteria acquire strength in numbers through the
formation of biofilms on the copepod surface. These biofilms act as a protective barracks for
the bacteria—within the biofilm structure, the bacteria can survive unfavorable conditions
during inter-epidemic periods.

The aggregation of the vibrios on the copepod also produces a very effective vehicle for
transmission to human hosts. Studies suggest that anywhere from 103 to 105 vibrios are
required to produce clinical cholera. However, as a result of biofilm formation, a mere 1-10
copepods can harbor enough V. cholera to lead to disease. In areas with poor sanitation and a
lack of water infrastructure, copepods are commonly found in drinking water – dramatically
increasing the risk of cholera infection.

3.3 Incubation Period:

The incubation period may vary from a few hours (about six to 12 hours) to five days, with
the average incubation period being about two to three days. About six to 12 hours is
considered a very rapid incubation period and may suggest that rapid/immediate intervention
is required for recovery.

3.4 Causes:
 Cholera is caused by the bacterium Vibrio cholerae. This bacterium is Gram stain-
negative, comma-shaped, and has a flagellum for motility and piliused to attach to
tissue.

 Although there are many V. cholerae serotypes that can produce cholera symptoms,
the O groups O1 and O139, which also produce a toxin, cause the most severe
symptoms of cholera. O groups consist of different lipopolysaccharides-protein
structures on the surface of bacteria that are distinguished by immunological
techniques.

 The toxin produced by these V. cholerae serotypes is an enterotoxin composed of two

subunits, A and B; the genetic information for the synthesis of these subunits is
encoded on plasmids.Another plasmid type encodes for a pilus.

 The enterotoxin causes human cells to extract water and electrolytes from the body
and pump it into the intestinal lumen where the fluid and electrolytes are excreted as
diarrheal fluid.

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  The enterotoxin is similar to toxin formed by bacteria that cause diphtheria in that both
bacterial types secret the toxins into their surrounding environment where the toxin
then enters the human cells. The bacteria are usually transmitted by drinking
contaminated water, but the bacteria can also be ingested in contaminated food,
especially seafood such as raw oysters.

3.3 Sign and Symptoms:The symptoms and signs of cholera-related disease are a
watery diarrhea that often contains flecks of whitish material that are about the size of pieces of rice.
The diarrhea is termed "rice-water stool"and smells "fishy." Although many bacterial infections may
cause diarrhea, the volume of diarrhea with cholera can be enormous; high levels of diarrheal fluid,
such as 250 cc per kg or about 10 to 18 liters over 24 hours for a 154-pound adult, can occur. People
may go on to develop one or more of the following symptoms and signs:

 Watery diarrhea
 Rice-water stools
 Fishy odor to stools
 Vomiting
 Rapid heart rate
 Loss of skin elasticity
 Dry mucous membranes (dry mouth)
 Low blood pressure
 Thirst
 Muscle cramps (leg cramps, for example)
 Restlessness or irritability (especially in children)
 Unusual sleepiness or tiredness
 Rectal pain
 Fever
 Severe vomiting
 Dehydration
 Low or no urine output
 Weight loss
 Seizures

3.4 Treatment:Cholera can be effectively treated provided early intervention with

Oral Rehydration Solution (ORS) or IV fluids is undertaken. Mortality rates can be brought
down to less than 1% by early and effective rehydration therapy.The patient should receive
rehydration therapy. Packets of WHO-ORS are generally available at all PHCs, Sub-canters
and hospitals. The ORS solution should be made fresh daily with boileddrinking water after
it has been cooled to room temperature. This reconstituted ORS solution should be used
within 24 hrs. After reconstitutionof ORS solution, it should not be boiled again
forsterilization purposes.

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Intravenous Rehydration: It is required for the rapid correction of fluid and electrolyte
imbalance in severely dehydrated patients who are in shock or are unable to retain fluid due
to excessive vomiting.Such patients require immediate attention and transfer to a nearby
hospital or treatment centre. The solutionsRecommended by WHO for intravenous
rehydration are:
a) Ringer’s Lactate Solution
b) Diarrhoea Treatment Solution
c) Normal Saline
Antibiotic Therapy: Antibiotic should be used with reservation depending upon
requirements of the case, its severity, age of the patients and local susceptibility pattern of
Vibrios. It diminishes the duration of diarrhoea, reduces the volume of rehydration fluids and
shortens the duration of vibrio excretion. The antibiotic can be started by the treating
clinician keeping in mind the age, drug, and route of administration. Resume feeding with a
normal diet when vomiting is under control. Breast feeding of infants and young children
should beContinued.

3.5 Prevention And Control:

(A) Control of cholera:
The following strategies are useful for the control ofCholera in an outbreak situation.
o Epidemiological investigations
o Establishment of cholera treatment centers
o Improve sanitation
o Provision of safe drinking water and food supply
o Proper disposal of night soil/sewage
o Health education

(B): Prevention:
o Drink water only from a safe source or water that has been disinfected
(boiled or chlorinated).
o Cook food or reheat it thoroughly and eat it whileIt is still hot. Boil milk
before drinking.
o Avoid ice creams from unreliable sources avoid uncooked food unless it can
be peeled or shelled.
o Wash your hands after any contact with excreta and before preparing or
eating food.
o Dispose off human excreta promptly and safely
o Avoid ice from unreliable sources.

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 Chapter-4: T.B(Tuberculosis)
Tuberculosis (TB) is a serious infection which most often occurs in the lungs and respiratory
system, which is the organ system that allows us to breathe. TB is caused by a bacterium
called Mycobacterium tuberculosis. It spreads from person to person when an infected
person coughs, sneezes, laughs, or spits. Tiny droplets of fluid from the lungs are carried in
the air and can be breathed in by someone nearby. Although it can affect many parts of the
body, TB most often occurs in the lungs, but TB bacteria can attack any part of the body
such as the kidney, spine, and brain. TB disease in the lungs or throat can be infectious. Not
everyone infected with TB bacteria becomes sick. One third of the world's people are living
with TB, and along with HIV, TB is one of the world's leading causes of death.
TB has always been associated with a high mortality rate over the centuries, and also
nowadays, it is estimated to be responsible for 1.4 million TB deaths, among infectious
diseases after human immunodeficiency virus (HIV) .Due to its infectious nature, complex
immunological response, chronic progression and the need for long-term treatment, TB has
always been a major health burden; in more recent years, the appearance of multi-drug
resistant forms and the current TB-HIV epidemic, associated with its severe social
implications, treating and preventing TB have represented a permanent challenge over the
course of human history.

4.1 Characteristics of TB Bacteria:

TB bacteria are:

 Rod-shaped
 1-5 microns Rod-shape
 Aerobic
 Slow-growing (divide once every 15 to 20 hours)
The cell walls of TB bacteria also have a high lipid content. This means that specific
laboratory methods are required to identify TB bacteria in smear examinations and in
culture.

4.2 Transmission Of Tuberculosis (T.B):

 M. tuberculosis is transmitted from human-to-human and is mainly spread by airborne
route. The source of infection is a patient with pulmonary or laryngeal tuberculosis
(TB) who expectorates bacilli.
 During coughing, speaking, or sneezing, the patient produces tiny infectious droplets.
These particles, called droplet nuclei, are about 1 to 5 microns in diameterabout 1-

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 5/1000 of millimeter. Droplet nuclei can remain suspended in the air for several hours,
depending on the environment.
 Transmission may occur when these infectious droplets are inhaled. Sunlight, UV light
and ventilation are effective in decreasing the ability of the droplets reaching the lung.
 The other modes of transmission are far less common. Cutaneous or mucous
inoculation rarely occurs, although such cases have been observed in laboratory
personnel. A rare cause of digestive transmission of TB can occur with M. bovis, most
commonly through cow’s milk.
 The infectiousness of a patient is linked to the quantity of bacilli contained in his
sputa. Patients with sputum smear-positive microscopy are by far the most contagious.
Those with smear-negative/culture-positive results are less contagious. Patients whose
sputum smear microscopy and culture are both negative are usually not contagious.
 Patients who are infected with M. tuberculosis, but do not have active disease, cannot
transmit TB. Extrapulmonary (EP) forms of TB are only contagious in exceptional
circumstances. Children are generally much less contagious than adults. This may be
due to weaker cough mechanics, less sputum production and lower bacillary load.
 Not everyone who is exposed to an infectious TB patient becomes infected with M.
tuberculosis. The probability that TB will be transmitted depends on three factors:

o Contagiousness of the source:

– Bacteriological status: smear-positive being the most infectious.
– Virulence of the tubercle bacilli: certain strains are very
transmissible .
o Environment where the exposure occurred:
– Open air and sunlight are conditions less likely to lead to
transmission, whereas small rooms/settings with no ventilation
are the conditions most likely to lead to transmission.
– The proximity of the person to the patient is also important.
o Duration of exposure:
–Contacts of TB patients are at highest risk of becoming infected
with M. tuberculosis. They may be family members, roommates,
friends, co-workers or others who spend multiple hours per day
with the TB patient while the person is infectious.
 The best way to stop transmission is to start giving patients effective TB treatment as
soon as possible. The length of time required for a TB patient to become non-
infectious after starting TB therapy is not exactly known. However, once an effective
TB therapy is started, as long as the patient follows the prescribed treatment regimen,
there is considerable evidence showing the infectiousness can rapidly decline, even
after a few days.

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(TB is spread from person to person through the air. The dots in the air represent droplet nuclei containing tubercle bacilli)

(TB Pathogenesis)
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4.3 Forms of TB: Having TB does not mean a person is contagious or able to
spread TB. Not everyone who is infected with TB bacteria shows signs of TB infection or
develops "active" disease.
 Latent/Inactive TB -Most people with healthy immune systems can fight off TB
bacteria, even after they breathe them in and are infected. This is called latent TB,
which means it is inactive. People with latent or inactive TB are infected with TB but
have no symptoms. They do not feel sick and cannot spread the disease to other
people. In some people, TB stays latent or inactive for their entire lives. But in other
people, latent TB turns into active disease if their immune system is damaged or
weakened, through things like HIV, cancer, or transplant surgery, which requires
taking drugs to suppress the immune system.
 Active TB - Some people who have TB develop active disease. Active TB usually
causes symptoms such as coughing, night sweats, and weight loss. People with active
TB can spread it to others. Active TB may develop either soon after infection or years
later when a person's immune system becomes weaker

4.4 Causes:
–Tuberculosis (TB) is caused by a type of bacterium called Mycobacterium tuberculosis.
–It’s spread when a person with active TB disease in their lungs coughs or sneezes and
someone else inhales the expelled droplets, which contain TB bacteria.
–Although TB is spread in a similar way to a cold or flu, it is not as contagious.You would
have to spend prolonged periods in close contact with an infected person to catch the
infection yourself.
–For example, TB infections usually spread between family members who live in the same
house. It would be highlyunlikely for you to become infected by sitting next to an infected
person on, for instance, a bus or train.
–Not everyone with TB is infectious. Children with TB or people with a TB infection that
occurs outside the lungs do not spread the infection.

4.5 TB Symptoms:After TB bacteria are inhaled, they settle in the lungs. People
with healthy immune systems can usually fight the bacteria and keep them from multiplying.
The immune system may build structures inside the lungs that contain the bacteria. These
structures can burst, leaving scars in the lungs. If a person's immune system is too weak and
the structures burst, the bacteria can get out and enter the bloodstream. Once in the
bloodstream, they travel to other parts of the body, including the brain, kidneys, bones, liver
and reproductive organs, where they can cause infertility. This is called "extrapulmonary
TB" because it has spread outside the lungs. Extrapulmonary TB is more likely in people
with advanced HIV disease.
People with active TB disease may develop symptoms including:
 Cough lasting more than two to three weeks

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  Coughing up sputum (phlegm) or blood
 Unexplained weight loss
 Fever or chills
 Night sweats
 Fatigue (unusual tiredness)
 Loss of appetite
 Chest pain

4.6 Treatment:
–Treatment for tuberculosis (TB) usually involves taking antibiotics for several months.
–While TB is a serious condition that can be fatal if left untreated, deaths are rare if
treatment is completed.Most people do not need to be admitted to hospital during treatment.

4.7 Prevention:
To prevent Tuberculosis (TB) follow the following prevention tips:
 Take all of your medicines as they’re prescribed, until your doctor takes you off them.
 Keep all your doctor appointments.
 Always cover your mouth with a tissue when you cough or sneeze. Seal the tissue in a
plastic bag, then throw it away.
 Wash your hands after coughing or sneezing.
 Don’t visit other people and don’t invite them to visit you.
 Stay home from work, school, or other public places.
 Use a fan or open windows to move around fresh air.
 Don’t use public transportation.

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 Chapter-5: Typhoid
Typhoid is a bacterial infection that can lead to a high fever, diarrhea, and vomiting. It can be fatal. It is
caused by the bacteria Salmonella typhi.The bacterium lives in the intestines and bloodstream of humans. It
spreadsbetween individuals by direct contact with the feces of an infected person.No animals carry this
disease, so transmission is always human to human.If untreated, around 1 in 5 cases of typhoid can be fatal.
With treatment, fewer than 4 in 100 cases are fatal.S. typhi enters through the mouth and spends 1 to 3
weeks in the intestine. After this, it makes its way through the intestinal wall and into the bloodstream.

From the bloodstream, it spreads into other tissues and organs. The immune system of the host can do little
to fight back because S. typhi can live within the host’s cells, safe from the immune trusted Source.Typhoid
is diagnosed by detecting the presence of S. typhi via blood, stool, urine, or bone marrow sample.

The infection is often passed on through contaminated food and drinking water, and it is more prevalent in
places where handwashing is less frequent. It can also be passed on by carriers who do not know they carry
the bacteria.

(Salmonella Typhi)

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5.1 History:According to the World Health Organization (WHO), typhoid fever
continues to affect between 11 and 20 million people each year and is responsible for
between 128,000 and 161,000 deaths each year.The pathogen that is responsible for causing
typhoid fever was not established until the late 19th century, which subsequently led to the
introduction of the first effective vaccination against this organism one year later. The
development of a vaccine against typhoid fever had a notable effect on its incidence,
particularly for highly susceptible populations, such as those serving in the military.
Some historians believe that typhoid fever was responsible for a widespread plague in
Athens in 430 BC, which proved fatal for one-third of the population, including the leader at
the time, Pericles. His successor, Thucydides, also contracted the same disease, although it
did not prove fatal.Jamestown, which was an English colony in Virginia, is also thought by
some historians to have died out as a result of typhoid fever.
The fever proved fatal for more than 6,000 settlers between 1607 and 1624, and may have
been responsible for eliminating the entire colony.Military and war environments have often
been subjected to the presence of typhoid fever throughout histhistor.
In excess of 80,000 soldiers died as a result of typhoid fever or dysentery in the American
Civil War. Likewise, the Spanish-American War led to infections with typhoid, both on the
field and in training camps.

5.2 Causes of Typhoid:Typhoid is caused by Salmonella typhi, a bacterium

from the same genus that causes salmonella food poisoning.Typhoid is spread through
contact with infected people’s feces and urine. This makes it very common in countries with
poor sanitation, where human waste can find its way into sources of drinking water and the
food chain.If caught early, typhoid symptoms will usually be mild and clear up within two
weeks. However without treatment, roughly one in five cases of typhoid is fatal, while those
surviving may have permanent physical or mental disabilities. This is why a typhoid fever
should be treated as quickly as possible with a course of antibiotics. Serious cases of typhoid
will require hospital treatment and a course of antibiotic injections.

5.3 Symptoms:Signs and symptoms are likely to develop gradually often appearing
one to three weeks after exposure to the disease.
 Fever that starts low and increases daily, possibly reaching as high as 104.9 F
(40.5 C).
 Headache
 Weakness and fatigue
 Muscle aches
 Sweating
 Dry cough
 Loss of appetite and weight loss
 Stomach pain
 Diarrhea or constipation
 Rash
 Extremely swollen stomach

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  Cough
 Small, red spots on your abdomen or chest
 Body aches
 Bloody stools
 Chills
 Difficulty paying attention
 Agitation, confusion, and hallucinations

(Picture showing Symptoms of Typhoid )

5.4 Risk factors:
Typhoid fever is a serious worldwide threat and affects about 27 million or more people each
year. The disease is established in India, Southeast Asia, Africa, South America and many
other areas.Worldwide, children are at greatest risk of getting the disease, although they
generally have milder symptoms than adults do.
If you live in a country where typhoid fever is rare, you’re at increased risk if you:
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  Work in or travel to areas where typhoid fever is established.
 Work as a clinical microbiologist handling Salmonella typhi bacteria.
 Have close contact with someone who is infected or has recently been infected. with
typhoid fever.
 Drink water polluted by sewage that contains Salmonella typhi.

5.5 Treatment:Antibiotics are used to treat typhoid fever. These medications kill
the bacteria that cause the infection. Several different types of antibiotics are used to treat
typhoid fever. In many cases, typhoid fever is treated with ampicillin, chloramphenicol, or
cotrimoxazole.However, doctors also use fluoroquinolones cephalosporins and azithromycin.
Your doctor will choose based on the most up-to-date recommendations. Antibiotics are
widely available in the United States and in most other countries in the world. Do not
attempt to self-treat with leftover antibiotics.Some people need supportive therapies, such as
fluid or electrolyte replacement, depending on the severity of the infection.
5.6 Prevention: Safe drinking water, improved sanitation and adequate medical care
can help prevent and control typhoid fever. Unfortunately, in many developing nations, these
may be difficult to achieve. For this reason, some experts believe that vaccines are the best
way to control typhoid fever.
A vaccine is recommended if you live in or are traveling to areas where the risk of getting
typhoid fever is high.
Vaccines
Two vaccines are available.

 One is given as a single shot at least one week before travel.

 One is given orally in four capsules, with one capsule to be taken every other day.
Neither vaccine is 100% effective. Both require repeat immunizations because their
effectiveness wears off over time.
Because the vaccine won't provide complete protection, follow these guidelines when
traveling to high-risk areas:

 Wash your hands. Frequent hand-washing in hot, soapy water is the best way to
control infection. Wash before eating or preparing food and after using the toilet.
Carry an alcohol-based hand sanitizer for times when water isn't available.
 Avoid drinking untreated water. Contaminated drinking water is a particular
problem in areas where typhoid fever is endemic. For that reason, drink only
bottled water or canned or bottled carbonated beverages, wine and beer.
Carbonated bottled water is safer than non-carbonated bottled water.
Ask for drinks without ice. Use bottled water to brush your teeth, and try not to
swallow water in the shower.

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 Avoid raw fruits and vegetables. Because raw produce may have been washed
in contaminated water, avoid fruits and vegetables that you can't peel, especially
lettuce. To be absolutely safe, you may want to avoid raw foods entirely.
 Choose hot foods. Avoid food that's stored or served at room temperature.
Steaming hot foods are best. And although there's no guarantee that meals served
at the finest restaurants are safe, it's best to avoid food from street vendors — it's
more likely to be infected.
 Know where the doctors are. Find out in advance about medical care in the
areas you'll visit, and carry a list of the names, addresses and phone numbers of
recommended doctors.

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 Chapter-6: Tetanus
Tetanus, also called lockjaw, is a serious infection caused by Clostridium tetani. This
bacterium produces a toxin that affects the brain and nervous system, leading to stiffness in
the muscles. If Clostridium tetani spores are deposited in a wound, the neurotoxin interferes
with nerves that control muscle movement.
The infection can cause severe muscle spasms, serious breathing difficulties, and can
ultimately be fatal. Although tetanus treatment exists, it is not uniformly effective. The best
way to protect against tetanus is to take the vaccinTetanus, also called lockjaw, is a serious
infection caused by Clostridium tetani. This bacterium produces a toxin that affects the brain
and nervous system, leading to stiffness in the muscles.

(Clostridium tetani)

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If clostridium tetani spores are deposited in a wound, the neurotoxin interferes with nerves
that control muscle movement. The infection can cause severe muscle spasms, serious
breathing difficulties, and can ultimately be fatal. Although tetanus treatment exists, it is not
uniformly effective.
The best way to protect against tetanus is to take the vaccine. Tetanus is a serious bacterial
infection. The bacteria exist in soil, manure, and other environmental agents. A person who
experiences a puncture wound with a contaminated object can develop the infection, which
can affect the whole body. It can be fatal.

6.1 Causes: Tetanus is caused by the Clostridium tetani bacterium. Clostridium

tetani spores are able to survive for a long time outside of the body. They are most
commonly found in animal manure and contaminated soil, but may exist virtually anywhere.
–When Clostridium tetani enter the body, they multiply rapidly and release tetanospasmin, a
neurotoxin. When tetanospasmin enters the bloodstream, it rapidly spreads around the body,
causing tetanus symptoms.
–Tetanospasmin interferes with the signals traveling from the brain to the nerves in the
spinal cord, and then on to the muscles, causing muscle spasms and stiffness.
–Clostridium tetani enters the body mainly through skin cut or puncture wounds. Thoroughly
cleaning any cut helps prevent an infection from devsymptoms. common ways of contracting
tetanus include:
 Wounds that have been contaminated with saliva or feces
 Burns
 Crush injuries
 Wounds that include dead tissue
 Puncture wounds
Rare ways of contracting tetanus include:
 Surgical procedures
 Superficial wounds
 Insect bites
 Compound fractures
 Intravenous drug use
 Injections into the muscle
 Dental infections

6.2 Risk factors:The greatest risk factor for tetanus infection is not being vaccinated
or not keeping up with the 10-year booster shots.
Other factors that increase the risk of tetanus infection are:

 Cuts or wounds exposed to soil or manure

 A foreign body in a wound, such as a nail or splinter

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  A history of immune-suppressing medical conditions
 Infected skin lesions in people living with diabetes
 An infected umbilical cord when a mother isn't fully vaccinated
 Shared and unsanitary needles for illegal drug use

6.3 Symptoms:
 Tetanus symptoms usually emerge about 7 to 10 days after initial infection. However,
this can vary from 4 days to about 3 weeks, and may, in some cases, may take months.

 In general, the further the injury site is from the central nervous system, the longer the
incubation period. Patients with shorter incubation times tend to have more severe
symptoms.

 Muscle symptoms include spasms and stiffness. Stiffness usually starts with the
chewing muscles, hence the name lockjaw.

 Muscle spasms then spread to the neck and throat, causing difficulties with
swallowing. Patients often have spasms in their facial muscles.

 Breathing difficulties may result from neck and chest muscle stiffness. In some
people, abdominal and limb muscles are also affected.

 In severe cases, the spine will arch backward as the back muscles become affected.
This is more common when children experience a tetanus infection.

 Most individuals with tetanus will also have the following symptoms:

 bloody stools
 diarrhea
 fever
 headache
 sensitivity to touch
 sore throat
 Sweating

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(This patient is showing a bodily posture known as “opisthotonos” due to Clostridium tetani exotoxin)

(Tetanus: Debilitating Infection)

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6.4 Treatment:Any cut or wound must be thoroughly cleaned to prevent infection.
A tetanus-prone wound should be treated by a medical professional immediately.A wound
likely to develop tetanus is defined as:
 A wound or burn that requires surgical intervention that is delayed for over 6
hours.
 A wound or burn that has a considerable amount of removed tissue.
 Any puncture-type injury that has been in contact with manure or soil.
 Serious fractures where the bone is exposed to infection, such as compound
fractures.
 Wounds or burns in patients with systemic sepsis.
–Any patient with a wound listed above should receive tetanus immunoglobulin (TIG) as
soon as possible, even if they have been vaccinated. Tetanus immunoglobulin contains
antibodies that kill Clostridium tetani. It is injected into a vein and provides immediate short-
term protection against tetanus.
–TIG is just short-term and does not replace the long-term effects of vaccination. Experts say
that TIG injectionsTrusted Source can be safely administered to pregnant and breastfeeding
mothers.
–Doctors may prescribe penicillin or metronidazole for tetanus treatment. These antibiotics
prevent the bacterium from multiplying and producing the neurotoxin that causes muscle
spasms and stiffness.Patients who are allergic to penicillin or metronidazole may be given
tetracycline instead.In treating muscle spasms and stiffness, patients may be prescribed:
–Anticonvulsants, such as diazepam (Valium), relax the muscles to prevent spasms, reduce
anxiety, and work as a sedative.
–Muscle relaxants, such as baclofen, suppress nerve signals from the brain to the spinal cord,
resulting in less muscle tension.
–Neuromuscular blocking agents block the signals from nerves to muscle fibers and are
useful in controlling muscle spasms. They include pancuronium and vecuronium.

6.5 Prevention:
Most cases of tetanus occur in people who have never had the vaccine or who did not have a
booster shot within the previous decade.
Vaccination
The tetanus vaccineTrusted Source is routinely given to children as part of the diphtheria and
tetanus toxoids and acellular pertussis (DTaP) shot.
The DTaP vaccine consists of five shots, usually given in the arm or thigh of children when
they are aged:

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  2 months
 4 months
 6 months15 to 18 months
 4 to 6 years
A booster is normally given between the ages of 11 and 18 years, and then another booster
every 10 years. If an individual is traveling to an area where tetanus is common, they should
check with a doctor regarding vaccinations.

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Part-3

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 Chapter-7: Modes of Transmission:
Breaking the chain at the ‘mode of transmission’ is one of the most important ways to
interrupt the spread of infection. This is where infection prevention and control strategies can
be most successful. Microorganisms are transmitted in health care settings by four main
routes:
• Contact
• Droplet
• Airborne
• Common vehicle
Routine Practices are designed to reduce the risk of transmission Microorganisms vary by
size, the length of time that they survive on surfaces or In the air and the method of getting
around. These factors plus the variability in virulence, the complications of treatment and the
complex symptoms may require special treatment of some patients. These ‘Additional
Precautions' are grouped, based on the mode of transmission of the infectious agent.

7.1 Contact:

(Picture Showing Transmission Through Contact)

 Contact is the most frequent mode of transmission of health care associated infections
and can be divided into: direct and indirect. An example of contact transmitted
microorganisms is Noroviruses which are responsible for many gastrointestinal
infections.

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  Direct: involves direct body surface to body surface contact and physical transfer of
microorganism between an infected or colonized person to another person by touch.
 Indirect: involves contact between a person and a contaminated object. This is often a
result of unclean hands contaminating an object or environment. The microorganism
remains on this surface to be picked up by the next person who touches it.

7.2 Droplet:

(Picture Showing Transmission ThroughDroplet)

 Transmission occurs when droplets containing microorganisms generated during
coughing, sneezing and talking are propelled through the air.
 These microorganisms land on another person, entering that new person’s system
through contact with his/her conjunctivae, nasal mucosa or mouth.
 These microorganisms are relatively large and travel only short distances (up to 6
feet/2 metres).
 These infected droplets may linger on surfaces for longperiods of time, so these
surfaces (within the range of the coughing/sneezing person) will need additional
cleaning.
 For this reason there may be both droplet and Contact Precautions required at the same
time.

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  Examples of microorganisms that are spread by droplet transmission are:influenza,
colds, respiratory syncytial virus (RSV) and some organisms causing pneumoni.

7.3 Airborne:
Airborne transmission of infectious agents occurs either by:
• Airborne droplet nuclei (small particles of 5 mm or smaller in size)
• Dust particles containing infectious agents.

(Picture Showing Transmission Through Airborne)

Microorganisms carried in this manner remain suspended in the air for long periods of time
and can be dispersed widely by air currents. Because of this, there is risk that all the air in a
room may be contaminated. Some examples of microorganisms that are transmitted by the
airborne route are: M. tuberculosis, rubeola, varicella and hantaviruses.

7.4 Common Vehicle:Applies to microorganisms that are transmitted by

contaminated items such as food, water, medications, medical devices and equipment. To
inhibit the transmission of microorganisms by this mode:
 Clean patient equipment between uses with different patients.

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  Handle, store and prepare food properly.
 Careful store and draw up doses of medication from multidose
medication vials.

Chapter-8: Our Resources For Fight Against Bacterial

Disease
Antibiotics are vital to treat serious diseases, but antibiotic resistance is a major and growing
concern threatening the health of humans and animals globally. It is estimated that if
antimicrobial resistance (AMR) continues to rise at the current rate it could lead to 10
million deaths by 2050.
To preserve their effectiveness in treating microbial diseases for future generations it’s
critical we use antibiotics responsibly, only when we need them most. And the animal health
sector is responding. By preventing disease from striking in the first place, we reduce the
need for antibiotics.we take a glimpse at a few of the ways industry is looking to help fend
off infections. Three tools which may help us fight bacterial infections :

8.1 Vaccinations (The foundation of prevention): Veterinarians use them

day-in-day-out to protect animals from disease, but they have potential to play an even
bigger part of the pathway to reducing antibiotics.
–Vaccines are like a boot camp for the body’s immune system, preparing it to create the right
defenses when it comes under attack.Often made of a ‘dead’ or weakened version of a
disease, vaccines are used to give the body a practice run at producing the right antibodies to
fight a particular microbe (or infection). They may also be made of antigens, the proteins on
the outside of microbes.
–While the weakened disease won’t cause an infection, the body will still identify it as an
enemy it needs to attack. Once the battle is over, the immune system will retain this
knowledge in ‘memory’ cells.
– means that if the microbe attacks in the future, the body’s immune system will ‘remember’
how to produce the right antibodies to fight off the infection. And crucially, it will be able to
produce these fast enough to avoid a serious health threat.
–Today, a variety of vaccines are available and are used on commercial farms and in
companion animal care, as part of the veterinarian’s health toolkit to help prevent and reduce
the spread of infectious diseases. But the labor costs attached to them and the-potential
impact on the animal’s immune system are sometimes barriers to use. Scientists are looking
at developing new vaccines using innovations that could help to overcome these issues in
future.

8.2 Probiotics(supporting the natural defenses): Probiotics, often

referred to as ‘good bacteria’, are increasingly being recognized as an effective feed
additive, which could help to ease the use of antibiotics.

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–This is due to the benefit they may have on gut health and the animal’s overall
wellbeing. The gut is made up of a complex mixture of bacteria, so when the balance
of gut bacteria is disrupted, it can result in the animal falling sick and lead to lower
productivity.Probiotics are a live form of bacteria.
–They work by taking up room in the animal’s gut and using up food, leaving fewer
available resources for the unfriendly bacteria so they cannot cause disease. And by
helping to maintain the balance of good and bad bacteria, probiotics are believed to
improve the animal’s health and performance, although scientists are still seeking
clarity into their effectiveness.But farmers are taking note.
–According to the USDA’s National Animal Health Monitoring System (NAHMS),
probiotics are used on nearly 30 percent of US feedlots with a capacity of 1,000
cattle or more.

8.3 Bacteriophages(Targeted, viral tools): Vaccines, probiotics and

other tools are effective at preventing disease, but, they are not foolproof. Bacterial
illness will still happen and antibiotics are the only available treatment.  

–Discovering another treatment would be groundbreaking, which is why many

researchers are exploring bacteriophages. Sometimes known simply as phages, these
are a type of virus that infects and kills bacteria. In fact, the name ‘bacteriophage’
literally means ‘bacteria eater’. 

–Because phages are a virus, they can’t live and reproduce alone, they need to eat
first. They work by recognizing and attaching to a bacterial cell, then injecting it
with their own DNA.

–Once the DNA is inside, the nutrients and components of the bacteria are used to
form new copies of the phage. These hungry offspring then break out by releasing
chemicals to destroy the host bacteria and go on to look for other bacteria to infect
and feed on.

– The phage therapy has shown promising results to treat bacterial infection in
animals. For example, when used in chickens infected with E.coli, bacteriophages
protected the animals from respiratory disease .

–But phages have limitations and their efficacy is uncertain in many situations. For
now, when a bacterial infection strikes antibiotics are essential for treatment.

–Although these alternative measures above give animals an extra lifeline,

antibiotics still ensure we can always treat the most serious antimicrobial infections
and keep our animals healthy. 

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 Chapter-9: Prevention For Bacterial Infections
Daily habits provide some of the strongest defenses against infectious diseases. Among the
sensible actions you can take:
 Keep immunizations up to date.
 Wash your hands often. Washing with regular soap and rinsing with running water,
followed by thorough drying, is considered the most important way to prevent disease
transmission. Routine consumer use of residue-producing antibacterial products, such
as those containing the chemical triclosan, have not been proven to confer health
benefits and may actually contribute to antibiotic resistance.
 Prepare and handle food carefully.
 Use antibiotics only for infections caused by bacteria. Viral infections cannot be
treated with antibiotics. Your doctor may prescribe an antiviral medication if your
condition warrants it.
 Report to your doctor any rapidly worsening infection or any infection that does not
get better after taking a course of antibiotics, if prescribed.
 Be careful around all wild animals and unfamiliar domestic animals. After any animal
bite, cleanse the wound with soap and water and consult a clinician for further
evaluation. Enjoy wild animals with your eyes, not by touching them.
 Avoid insect bites whenever possible by using insect repellent and wearing long-
sleeved shirts, long pants, and a hat outdoors.
 Protect yourself by using safe sex practices. You and your partner should be tested for
sexually transmitted diseases, including HIV, if there has been any risk of exposure.
Consistently and correctly use condoms when having sex with a partner of unknown
status. Avoid sex with an injecting drug user.
 Stay alert to disease threats when traveling or visiting underdeveloped countries. Seek
advice from a reliable source, such as the WHO or the CDC, if you are going to areas
of moderate-to-high disease risk.
 Acquire healthy habits such as eating well, getting enough sleep, exercising, and
avoiding tobacco and illegal drug use.
 Infectious diseases can easily be picked up while traveling, particularly when traveling
to underdeveloped countries. If your travel destination is one where water is
questionable, make sure to use a safe water source such as bottled water for drinking
and brushing your teeth. Eat foods that have been cooked, and avoid raw vegetables
and fruits.
 Toothbrushes, towels, razors, handkerchiefs, and nail clippers can all be sources of
infectious agents (bacteria, viruses, and fungi). In kindergarten, you were taught to
share your toys, but keep your hands to yourself. Now try to remember to keep

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 personal items to yourself as well! Remind children often about the types of items they
should not share with others.

Chapter-10: Conclusion
Bacterial disease, any of a variety of illnesses caused by bacteria. Until the mid-
20th century, bacterial pneumonia was probably the leading cause of death
among the elderly. Improved sanitation, vaccines, and antibiotics have all
decreased the mortality rates from bacterial infections, though antibiotic-
resistant strains have caused a resurgence in some illnesses. In the early 21st
century, tuberculosis, which is caused by Mycobacterium tuberculosis—several
strains of which had developed resistance to one or more drugs widely used to
treat the infection—was among the deadliest infectious diseases worldwide.
Bacteria cause disease by secreting or excreting toxins (as in botulism), by
producing toxins internally, which are released when the bacteria disintegrate
(as in typhoid), or by inducing sensitivity to their antigenic properties (as in
tuberculosis). Other serious bacterial diseases include cholera, diphtheria,
bacterial meningitis, tetanus, Lyme disease, gonorrhea, and syphilis. Harmful
bacteria that cause bacterial infections and disease are called pathogenic
bacteria. Bacterial diseases occur when pathogenic bacteria get into the body
and begin to reproduce and crowd out healthy bacteria, or to grow in tissues
that are normally sterile. Harmful bacteria may also emit toxins that damage the
body. Common pathogenic bacteria and the types of bacterial diseases they
cause include. Millions of bacteria normally live on the skin, in the intestines,
and on the genitalia. The vast majority of bacteria do not cause disease, and
many bacteria are actually helpful and even necessary for good health. These
bacteria are sometimes referred to as “good bacteria” or “healthy bacteria.”

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